形乃气之充。色乃血之华。气旺则顶尖圆。血旺则根盘紧。形贵尖圆起发。疮皮坚浓。若见
平塌皮薄为凶。色贵光明润泽。根窠红活。若见惨淡昏黑为危。然形有起发而致变者。由色不明润。
根不红活故耳。若痘色光泽。根窠红活。虽塌可治。但以红活为贵。而又有圈红 红铺红之别。
圈红者。一线淡红。紧附根下而不散。吉兆也。 红者。血虽似附。根脚隐隐出部。险兆也。铺
红者。痘色与肉不分。平铺散漫。凶兆也。根者血之晕。脓者血之腐。故六日以前。专看根窠。
六日以后。专看脓色。若无根窠。必不灌浆。若无脓色。必难收靥。此必然之势也。然间有色不
明润而根脚好者。仍得收功。以根为痘之本也。若根脚不圆。颜色虽好。须防七朝有变。不可以
色好而转许无事也。有初出色白不红活。若尖圆易起。分颗润泽者。此气血未会。至三四日色转红
活。不宜妄补。反生变端。若色白枯燥。稠密脚散。目微红。唇肿燥。热剧无神。二便秘涩。或
作吐泻。此火盛无血。多致内攻。死在五六日间矣。王肯堂曰。痘疹之中。惟黑者最难识。若初
出时。隐隐有黑点见于头面。自三四朝至六七朝。黑色如故。不见红色。形如圆珠而有光泽。行
浆充满。渐渐黄赤者。名曰黑痘。今人皆以变黑归肾者。指为肾经之痘。不知血热毒盛之痘。初
必干红青紫。至六七日后倒 变黑。与初出便见黑润不同。与一热腰下便见黑点如蚤咬者迥异。
此肾气充实之黑。岂可与寻常痘疹同例而论哉。
The physical form is the manifestation of Qi's fullness. The complexion is the brilliance of Blood. When Qi is vigorous, the apex is round and prominent. When Blood is vigorous, the base is tight and firm. The form should be pointed, round, and raised; the crust should be thick and dense. If flat and thin skin are seen, it indicates an ominous sign. The color should be bright, lustrous, and moist; the root should be red and vital. If pale, dull, or dark black colors are seen, it indicates a critical condition. However, some forms may rise but still undergo transformation due to unclear/lusterless color and non-vital roots. If the pustule color is glossy and the root is red and vital, even if flat, it can be treated, with red vitality being paramount. Furthermore, there are distinctions among "circled red" (Quan Hong), "halo red" (Yun Hong), and "spread red" (Pu Hong). Circled red refers to a line of pale red tightly attached to the base without spreading, which is an auspicious omen. Halo red refers to blood color that seems attached but the root margin subtly protrudes beyond the boundary, which is a dangerous omen. Spread red refers to pustule color indistinguishable from the flesh, lying flat and scattered, which is an inauspicious omen. The root is the halo of Blood, and pus is the corruption of Blood. Therefore, before the sixth day, one specifically observes the root; after the sixth day, one specifically observes the pus color. Without a root, filling with pus will certainly not occur. Without pus color, scabbing will certainly be difficult. This is an inevitable trend. However, occasionally, cases where the color is not lustrous but the root is good can still succeed, because the root is the foundation of the pustule. If the root is not round, even if the color is good, one must guard against changes on the seventh day; one cannot assume safety merely because the color is good. Some present initially with white, non-red/vital color; if they are pointed, round, easily raised, distinct, and moist, this indicates Qi and Blood have not yet harmonized. By the third or fourth day, if the color turns red and vital, inappropriate use of tonification methods should be avoided, as it may cause adverse transformations. If the color is white and dry, dense with scattered roots, eyes slightly red, lips swollen and dry, fever severe without spirit, constipation of urine and stool, or vomiting and diarrhea, this indicates excessive Fire and deficient Blood, often leading to internal attack and death within five to six days. Wang Kentang stated: Among smallpox/rash diseases, only black ones are hardest to identify. If at initial emergence, faint black spots appear on the head and face, remaining black from the third/fourth to sixth/seventh days without turning red, shaped like round pearls with luster, filling with pus, and gradually turning yellow-red, it is named Black Pustule. Modern people attribute blackening to Kidney involvement, calling it Kidmeridian Pustule, unaware that this is actually Blood Heat and Toxicity Excess. Initially, it must be dry, red, cyanotic, or purple. After six/seven days, it inverts and turns black. This differs from those presenting with black luster from the start, and is vastly different from those showing black spots like flea bites below the waist upon onset of heat. This is Black Pustule resulting from sufficient Kidney Qi; how can it be discussed in the same category as ordinary rashes?