The pox begins with fever for three days before erupting. At this stage, the lesions are sparse, clear, and bright, with pointed, round, and full shapes. They follow the expected timeline to produce pus (Jiang) and scab over (Ye). The patient’s spirit is refreshed and calm, they can eat, and there are no other symptoms.
This is a natural process of generation and transformation, indicating a favorable and auspicious course (Shun Ji). It is not achieved through human regulation nor cured by medicine; it is solely the miraculous work of Heaven. If three or five red lesions appear under the ears and beside the nose, with bright and moist roots, it is an auspicious sign.

If the pox is complicated by heat and fails to erupt fully, the patient’s spirit appears turbid and coarse. The lesions are dense like miliaria (prickly heat), lacking distinct lesion bases (Ke Li), with dark colors where boundaries between pores are indistinct. They resemble spots from mosquito or flea bites, silkworm pupal skins, or shed snake skins. The skin itches, muscles swell like melons, or lesions merge continuously resembling eggs. The color is dry red, grayish-purple, sunken, and lacks pus. Coupled with other malignant signs, even immortal elixirs would be of no benefit.

The term "dangerous pox" (Xian Dou) refers to cases where fortune and misfortune, life and death, are undecided. Although the lesions may be elongated and round, and halos have formed, they are dry and red with little moisture. This indicates the initial interaction of Yin and Yang, and blood and Qi beginning to intertwine. The outcome is uncertain; one must wait for Qi and Blood to stabilize and adhere, after which the pox will naturally transform into health, indicating good fortune. If the apex is sunken and itchy with a grayish-white color, use Baoyuan Tang (Preserve the Origin Decoction) added with Shengjiang (Zingiberis Rhizoma Recens), Rougui (Cinnamomi Cortex), Chuanxiong (Ligustici Chuanxiong Rhizoma), Mijiao (Glutinis Oryzae Sativae), and Honghua (Carthami Flos). If the color is purple, add a small amount of Baishao (Paeoniae Radix Alba) to mitigate the danger. In critical moments, careful assessment is required. If recovery does not occur, it is ominous; hence it is called "dangerous."

In children suffering from pox, the spirit should be clear and refreshing, not drowsy or confused. Malignant signs include dark coloration, itching, muscle swelling like melons, or lesions merging like eggs; dry redness without pus; diarrhea and teeth grinding; tremors, wheezing, and rapid breathing; hoarseness and irritability; delirium and closed eyes; cyanotic, gray, purple, or black flat and sunken areas on the chest, back, head, and face; inability to eat; abdominal distension like a drum; abdominal and lower back pain; cracked lips and foul breath; black tongue and throat choking; open nostrils; hematochezia (blood in stool); and obstruction of both urination and defecation. Among these malignant signs, if a favorable case presents one or two such symptoms, fear that it may turn critical; if an unfavorable case presents even one symptom, safety is hardest to guarantee. These outcomes are determined by destiny and cannot be escaped.