三朝出齐渐次长，尖圆碍指脚红活，顶渐放白肥润满，顺证饮食二便和。
[注]
三朝出齐者，谓见点三朝俱出齐也，
渐次长者，谓痘形渐次长也，
尖圆碍指者，谓痘形尖圆摸之碍指也，
脚红活者，谓痘根脚红活也，
顶渐放白者，痘顶渐渐放白光莹也，
肥者，谓痘形肥实也，
润者，谓痘色润泽也，
满者，谓痘体充满也，
顺证饮食二便和者，谓饮食二便如常调和也。
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起胀顶陷灰或紫，稠密娇红不绽苍，形色虽顺夹险证，证险神清胃壮康。
[注]
起胀顶陷者，谓痘顶凹陷也，
灰者，谓痘色灰白也，
紫者，痘色赤紫也，
稠密者，痘色稠密成攒也，
娇红者，谓痘色红而娇嫩也，
不绽苍者，谓痘形不舒绽，色不苍老也，此皆起胀险证也，
又有形色虽顺而夹杂病者，虽顺恐变为险也，
若痘之形色虽险，而神气清爽，饮食强美，虽险将化为顺也，
此顺中险，险中顺，不可不详辨之。
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起胀肉肿痘不肿，根血散乱顶平塌，紫黯干枯灰白滞，名为逆证势多差。
[注]
起胀肉肿痘不肿者，谓或头面或过身浮肿如瓠瓜之状，而痘反不肿胀，
此气血不能拘摄毒气，致毒散漫也，
根血散乱者，谓根脚血色散乱，此毒迫血，不归附于痘也，
顶平塌者，谓痘顶不起发也，此毒火锢于气分不能充发也，
紫黯者，痘色紫黯不明，此毒炽血凝也，
干枯者，枯不润泽，此血为毒火燔灼也，
灰白滞者，谓痘色灰白黯滞，此毒火太甚，气血郁滞也，
此皆起胀逆证，势多难救。
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On the third day after eruption, the pustules are fully emerged and gradually growing. The shape is pointed and round, feeling rough to the touch; the base (foot) is red and vibrant; the apex gradually turns white, becoming plump and full. This is a favorable syndrome (Shun Zheng), where the patient's diet and bowel/bladder functions are harmonious and normal.
[Note]
"Fully emerged on the third day" means that three days after the appearance of spots, all pustules have erupted.
"Gradually growing" refers to the progressive enlargement of the pustule shape.
"Pointed, round, and rough to the touch" describes a pustule shape that is pointed and round, creating resistance when touched by fingers.
"Red and vibrant base" indicates that the root area of the pustule is red and lively.
"Apex gradually turning white" means the top of the pustule gradually becomes bright and white.
"Plump" refers to the substantial and solid form of the pustule.
"Glossy/moist" refers to the lustrous color of the pustule.
"Full" means the pustule body is filled and taut.
"Favorable syndrome with harmonious diet and excretions" implies that in a favorable case, the patient's intake of food and drink, as well as urination and defecation, remain regular and balanced.
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During the swelling stage, if the pustule apex is depressed, and the color is gray or purple; if the distribution is dense, the color is tenderly red but not spreading out or appearing mature/cyanotic; although the form and color seem favorable, they contain dangerous signs. However, if the spirit is clear and the stomach qi is strong and healthy, the condition remains manageable.
[Note]
"Depressed apex during swelling" refers to the indentation at the top of the pustule.
"Gray" refers to a grayish-white color of the pustule.
"Purple" refers to a reddish-purple hue.
"Dense" means the pustules are crowded together in clusters.
"Tender red" describes a color that is red yet delicate and fragile.
"Not spreading or mature" indicates that the pustule shape does not expand smoothly, and the color lacks the robustness of maturity; these are all signs of a dangerous syndrome (Xian Zheng) during the swelling phase.
There are cases where the form and color appear favorable but are complicated by other diseases; even if favorable, there is a risk of transformation into a dangerous state.
Conversely, if the form and color of the pustules appear dangerous, but the patient's spirit is clear and fresh, and their appetite is strong and good, then despite the danger, the condition will likely transform into a favorable one.
Thus, one must carefully distinguish between favorable conditions containing danger and dangerous conditions showing signs of recovery.
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During the swelling stage, if the flesh swells but the pustules do not, if the blood at the base is scattered and chaotic, and the apex is flat and collapsed; if the color is purple-dark, dry, and withered, or gray-white and dull/stagnant, this is termed an unfavorable/reverse syndrome (Ni Zheng), and the prognosis is mostly poor.
[Note]
"Flesh swollen but pustules not swollen" refers to edema of the head, face, or entire body resembling a calabash, while the pustules themselves fail to swell.
This occurs because Qi and Blood cannot constrain and hold the toxic pathogen, causing the toxin to scatter diffusely.
"Scattered blood at the base" means the blood color at the root of the pustule is disordered; this is due to the toxin forcing the blood, preventing it from adhering to the pustule.
"Flat and collapsed apex" indicates that the top of the pustule fails to rise; this is because toxic fire is trapped in the Qi level, unable to fill and erupt.
"Purple-dark" refers to a dark, dull purple color of the pustule, indicating intense toxicity and coagulation of blood.
"Dry and withered" means lacking moisture and luster, caused by the blood being scorched by toxic fire.
"Gray-white and stagnant" refers to a grayish-white color that is dull and obstructed, resulting from excessive toxic fire leading to stagnation of Qi and Blood.
These are all reverse syndromes during the swelling stage, and the conditions are mostly difficult to save.
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