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The physical form is the manifestation of Qi (Vital Energy) being filled, and the complexion is the splendor of Blood. A sharp and round shape with thick skin is auspicious, while thin skin with partial collapse is inauspicious. A lustrous, moist, red, and vibrant complexion is auspicious, whereas a dull, dark, and lifeless one is inauspicious. However, the redness and vitality of smallpox lesions vary into three types: red halo, red晕 (halo/radius), and spreading redness. The "red halo" presents as a faint red line tightly attached to the base without any tendency to spread, which is an omen of good prognosis. The "red晕" indicates that although the blood seems attached, the color at the root subtly emerges beyond the lesion, which is an omen of danger. The "spreading redness" means the pathological color is level with the surrounding flesh, with redness scattered and diffuse, which is an omen of bad prognosis. Therefore, the *genke* (base/areola of the pustule) is the halo formed by blood, and pus is the corruption of blood. Before the sixth day, one must specifically observe the *genke*; if there is no *genke*, pus formation will inevitably fail. After the sixth day, one must specifically observe the color of the pus; if there is no pus color, healing and scabbing (*shouye*) will be difficult. This is an inevitable trend and must be examined in detail.

The round shape formed by enclosing blood represents the image of Heaven; when toxins exit via blood and interact with Qi, the roundness must be complete and clean, demonstrating that Qi controls the toxin and fulfills its function. The halo shape adhering to Qi represents the form of Blood and the image of Earth; when toxins exit via Qi and converge with Blood, the halo must be bright, demonstrating that Blood controls the toxin and achieves understanding. This signifies the harmony of Qi and Blood, jointly expelling toxins, with evil and righteous energies clearly distinguished, allowing smallpox to heal spontaneously without treatment. Thus it is said: When True Qi surpasses the toxin, the course is favorable (Shun); when toxin-fire surpasses True Qi, the course is unfavorable (Ni). Lesions that are crooked, depressed, or sunken, resembling bran or millet grains, are attributed to Qi disorders. Variations in the depth of the halo's color, whether moist or dry, are attributed to Blood disorders.

In cases of deficiency-type smallpox characterized by mental fatigue and a cyan-white complexion, the fatigue results from Qi insufficiency, and the cyan-white complexion results from Blood failing to nourish. Why does treatment focus on tonifying Qi rather than Blood? Qi possesses spiritual efficacy but lacks fixed form, so tonifying it leads to easy replenishment. Blood has fixed form but lacks spiritual efficacy, so blood-tonifying herbs rarely yield rapid results. Moreover, Qi is Yang and Blood is Yin; Yin follows Yang, and Blood follows Qi. If Qi becomes abundant and full, Blood will naturally follow and flourish. Furthermore, conditions of Qi deficiency are prone to diarrhea. Blood-tonifying agents have lubricating and downward-moving properties; excessive use may cause loose stools. Without achieving the effect of blood tonification, the harm of Qi deficiency would deepen. However, in cases of white, depressed, and non-nourishing lesions, Guizhi Tang (Cinnamon Twig Decoction) [Note: Text says Gui/Shao, likely Danggui/Baishao] blood-tonifying formulas may be used out of necessity. In cases of profusely red lesions, Honghua (Carthami Flos, Safflower), Zicao (Arnebiae Radix et Rhizoma, Arnebia Root), and Shengdi Huang (Rehmanniae Radix, Rehmannia Root) for invigorating blood and cooling blood may be used out of necessity. These should all be stir-fried with wine to suppress their lubricating and downward properties, utilizing the power of wine to reach the exterior. Thus, within blood tonification and cooling, ascending and reaching-the-exterior effects can still be achieved, avoiding the risk of intestinal lubrication and loose stools. Only in cases of true Blood Heat is the wine-frying method not restricted. For patients with severe Yin and Blood deficiency, one cannot rigidly adhere to the principle of "Yin grows from Yang" and solely tonify Qi, lest Wei Qi (Defensive Qi) become excessively strong and act autonomously, leading to the hazard of empty shells (pustules lacking content). Moreover, Qi-warming herbs would inevitably hinder the suitability of Yin Blood, further causing desiccation.