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The natural color of blood is red. When blood flow is smooth, the rash appears bright red, vibrant, lustrous, and moist, spreading abundantly; this represents the optimal condition for a rash. ○ A pale red color has both favorable and unfavorable aspects: if the color is pale yet moist, it is considered superior; however, if it is pale without luster, or delicate and overly bright but dry and stagnant, it indicates extreme heat in the blood. ○ A deep red color is slightly more severe than pale red and also signifies blood heat. Cooling the blood will cause it to revert to pale red. ○ A color as vivid as rouge indicates extreme blood heat, which is worse than deep red. Large doses of blood-cooling herbs are required to first turn it deep red, and further cooling will eventually restore it to pale red. ○ Small, millet-grain-sized spots that are red are called "Red Sand" (Hong Sha); those that are white are called "White Sand" (Bai Sha). This condition often occurs after the rash has erupted, representing the most favorable state where residual toxins are fully expelled. The skin will peel off after recovery. If the disease was not recognized as an epidemic at the onset, and the rash appears only ten days or half a month later, accompanied by irritability, thirst, persistent high fever, and toxins manifesting on the jaw, it is a fatal condition that cannot be saved.

Epidemic toxin causing macules (Ban) represents the dispersion of toxins; epidemic toxin causing sores (Chuang) represents the aggregation of toxins. At the initial stage, if there is aversion to cold and fever with local redness, swelling, hardness, and pain, this indicates the toxins are being expelled outward. If there is aversion to cold without fever, and the sores are flat and do not rise, this indicates the toxins are lying latent internally. Whether they appear in critical areas, nameless places, on the head and face, or on the limbs, despite various shapes, they all belong to sore syndromes. How can one determine that this is caused by aggregated epidemic toxins? The pulse of ordinary sores is surging (Hong), large, and rapid; whereas the pulse of epidemic toxins is deep (Chen), fine, and rapid. In ordinary sore syndromes, the head may not hurt; but with epidemic toxins, the headache is severe as if split open, heavy, and unable to lift the head, which serves as verification. Examining the symptoms, some present with red eyes and a red face with a cyan hue, some experience alternating sweating and vomiting, some are confused and comatose, some have body heat but cold limbs, some suffer from unceasing abdominal pain, some have violent dry heaving, some have profuse watery diarrhea, some speak deliriously without stopping, some hear and see hallucinations, some have extreme thirst desiring water, some are irritable and manic, and some shout intermittently, appearing frightened and alarmed. The pathological manifestations are diverse but generally similar. Misidentifying these as ordinary sore syndromes and recklessly applying warming and supporting methods will certainly lead to death.

Wang Shixiong notes: Various diseases such as summerheat, dampness, heat, and epidemics can all externally manifest as carbuncles and sores. However, patients are often unaware of the cause of their condition. Surgeons, seeing only the external sores, frequently make errors. People generally only know that the patient died from external signs. Alas!