痘形见点喜尖圆，恶隐蚊迹痱粟蚕，起胀惭绽充肥顺，顶平不突板实难，
生浆敛束形完固，緛嫩皮薄痒塌缠，结痂如螺先后落，最忌麸薄溃烂粘。
[注]
痘形气之为也，气胜毒，则毒为气驭其毒解矣，故顺也。
毒胜气，则气为毒蚀，其气竭矣，故逆也，
气毒相平，则势界于险，惟在医者调治得宜，使险变顺也，
如始出之形顶尖而根圆，此气胜毒，为顺也，
若隐如蚊咬，或如热痱，寒粟蚕种，此毒胜气，为逆也，
起胀之形，渐绽充肥，此气胜毒，为顺也，
若顶平不突，板实不绽，此毒胜气，为逆也，
出浆之形，根红敛束，痘壳完固，此气胜毒，为顺也，
若壳软皮簿，则必痒塌，此毒胜气，为逆也，
结痂之形，痂如螺壳，先结先落，后结后落，此气胜毒，为顺也，
若痂薄如麸，溃烂粘聚，此毒胜气为逆也，此痘形顺逆之大略也。
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痘色桃花渐渐红，淡白桔紫晦多凶，起胀顶白根红润，顶灰根散或深红，
生浆由白而黄厚，最忌灰干与薄清，靥喜苍粟恶麸白，疤喜红满恶白平．
[注]
痘色血之为也，血胜毒，则毒为血载，其毒化矣，故顺也，
毒胜血，则血为毒滞，其血涸矣，故逆也，
血毒相平，则势界于险，亦在医者之调治得宜也，
始出之色如桃花，而渐加滋润，此血胜毒，为顺也，
若初出之即淡白干紫晦而不亮，此毒胜血，为逆也，
起胀之色，顶渐放白，根红光润，此血胜毒，为顺也，
若顶色灰滞，根血散漫，或地角深红，此毒胜血，为逆也，
生浆之色，白而渐黄，苍而淳厚，此血胜毒，为顺也，
若灰干不润，或浆薄清稀，此毒胜血，为逆也，
结痂之色，苍如粟壳，此血胜毒，为顺也，
若痂色麸白，此毒胜血，为逆也，
疤痕之色，红润凸起为顺，
若淡白黑紫，平凹无突起之状，皆为不顺之色，医者详之。
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The morphology of smallpox (Variola) at the spot-emergence stage is favored when it is pointed and round; it is dreaded when it hides like mosquito bites, heat pricks, cold shivers, or silkworm eggs. During the swelling stage, gradual expansion and plumpness indicate a favorable course (Shun); flat tops without protrusion and hard, solid textures that fail to expand indicate a difficult/unfavorable course (Ni). During the pus-formation stage, convergence with tight boundaries and complete, solid forms indicate a favorable course; tender, thin skin accompanied by itching and collapse indicates a lingering/unfavorable course. During the scabbing stage, scabs resembling snail shells falling off in sequence (first-formed first-fallen, last-formed last-fallen) indicate a favorable course; the most taboo is thin scabs like bran, accompanied by ulceration and adhesion.
[Note]
The morphology of smallpox is governed by Qi (Vital Energy). When Qi is strong and Pathogenic Toxin (Du) is weak, the toxin is controlled and resolved by Qi, thus indicating a favorable course.
When Pathogenic Toxin is strong and Qi is weak, Qi is eroded by the toxin, leading to exhaustion of Qi, thus indicating an unfavorable course.
When Qi and Pathogenic Toxin are balanced, the condition is precarious; it depends on the physician's appropriate regulation and treatment to transform danger into safety.
For example, if the initial form has a pointed tip and a round base, this signifies Qi overcoming Pathogenic Toxin, which is a favorable course.
If the form is hidden like mosquito bites, or resembles heat pricks, cold shivers, or silkworm eggs, this signifies Pathogenic Toxin overcoming Qi, which is an unfavorable course.
During the swelling stage, gradual expansion and plumpness signify Qi overcoming Pathogenic Toxin, which is a favorable course.
If the top is flat and non-protruding, and the texture is hard and solid without expanding, this signifies Pathogenic Toxin overcoming Qi, which is an unfavorable course.
During the pus-formation stage, a red root, convergent boundaries, and a complete, solid pustule shell signify Qi overcoming Pathogenic Toxin, which is a favorable course.
If the shell is soft and the skin thin, itching and collapse will inevitably occur; this signifies Pathogenic Toxin overcoming Qi, which is an unfavorable course.
During the scabbing stage, scabs like snail shells falling off in order signify Qi overcoming Pathogenic Toxin, which is a favorable course.
If the scabs are thin like bran, with ulceration and aggregation, this signifies Pathogenic Toxin overcoming Qi, which is an unfavorable course. This summarizes the general principles of favorable and unfavorable morphologies in smallpox.
The color of smallpox spots gradually turning red like peach blossoms is auspicious; pale white, orange-red, or dull purple colors often portend misfortune. During the swelling stage, a white top and red root indicate a favorable course; a grayish top, scattered root, or deep red base indicate an unfavorable course. During pus formation, a transition from white to yellow and thickness indicates a favorable course; grayish dryness or thin, clear fluid is most dreaded. During the crusting stage, a苍 (dark/greenish-black) color like millet husks is favored, while white like bran is dreaded; for scars, red fullness is favored, while white flatness is dreaded.
[Note]
The color of smallpox is governed by Blood. When Blood is strong and Pathogenic Toxin is weak, the toxin is carried and transformed by Blood, thus indicating a favorable course.
When Pathogenic Toxin is strong and Blood is weak, Blood is stagnated by the toxin, leading to depletion of Blood, thus indicating an unfavorable course.
When Blood and Pathogenic Toxin are balanced, the condition is precarious; it also depends on the physician's appropriate regulation and treatment.
The initial color like peach blossoms, becoming increasingly moist, signifies Blood overcoming Pathogenic Toxin, which is a favorable course.
If the initial color is pale white, dry purple, and dull/lusterless, this signifies Pathogenic Toxin overcoming Blood, which is an unfavorable course.
During the swelling stage, the top gradually whitens and the root becomes red and lustrous, signifying Blood overcoming Pathogenic Toxin, which is a favorable course.
If the top color is gray and stagnant, the root blood is scattered, or the base is deep red, this signifies Pathogenic Toxin overcoming Blood, which is an unfavorable course.
During pus formation, the color changes from white to yellow, becoming dark and thick/rich, signifying Blood overcoming Pathogenic Toxin, which is a favorable course.
If the color is gray and dry without moisture, or the pus is thin and clear, this signifies Pathogenic Toxin overcoming Blood, which is an unfavorable course.
During scabbing, a dark color like millet husks signifies Blood overcoming Pathogenic Toxin, which is a favorable course.
If the scab color is white like bran, this signifies Pathogenic Toxin overcoming Blood, which is an unfavorable course.
For scars, redness and elevation indicate a favorable course.
Pale white, black, or purple colors, along with flat, depressed surfaces without elevation, are all unfavorable colors; physicians must examine these carefully.