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The color of the smallpox/rash lesions gradually turning red like peach blossoms indicates a favorable prognosis; pale white, withered, or dark purple and dull colors often indicate an ominous prognosis. During the swelling stage (Qi Zhang), a white apex with a ruddy root is favorable; a grayish apex, scattered root, or deep red base indicates an unfavorable prognosis. During the pus formation stage, the fluid turning from white to thick yellow is favorable; grayish dryness or thin, clear fluid is most taboo. For scabbing (Ye), a color resembling chestnut shells is preferred, while a wheat-bran-like white color is avoided; for scar formation, ruddy and full scars are favorable, whereas pale and flat scars are unfavorable.

[Note] The color of the lesions reflects the state of the blood. If blood qi is strong enough to overcome the toxin, the toxin is carried by the blood and resolved, indicating a favorable course; if the toxin overwhelms the blood, causing blood stagnation and depletion, it indicates an unfavorable course. If blood and toxin are in equilibrium, the condition is precarious, depending on the physician's appropriate regulation and treatment. Lesions appearing initially like peach blossoms and becoming increasingly moist indicate that blood overcomes the toxin, which is favorable. Lesions appearing initially as pale white, dry, or dark purple, dull and lacking luster, indicate that the toxin overcomes the blood, which is unfavorable. During the swelling stage, a whitening apex and ruddy, moist root indicate blood overcoming the toxin, which is favorable; a grayish, stagnant apex, scattered root blood, or deep red base indicate the toxin overcoming the blood, which is unfavorable. During pus formation, a transition from white to yellow, appearing mature and thick, indicates blood overcoming the toxin, which is favorable; grayish, dry, unmoistened, or thin, clear fluid indicates the toxin overcoming the blood, which is unfavorable. At the scabbing stage, a color mature like chestnut shells indicates blood overcoming the toxin, which is favorable; a scab color like wheat bran indicates the toxin overcoming the blood, which is unfavorable. Ruddy, raised scars are favorable; pale white, black-purple, flat, and depressed scars without elevation are all unfavorable signs, requiring careful observation by the physician.

Mature and rich versus delicate and tender colors, substantial and floating forms, thick and turbid versus thin and clear pus, and thick versus thin scabs clearly distinguish between "mature" (Lao) and "tender" (Nen) presentations of the disease.

[Note] In the case of smallpox/rash, from beginning to end, maturity (Lao) is preferred over tenderness (Nen). Mature and rich versus delicate and tender colors refer to the maturity of the hue; substantial/fat versus floating/empty forms refer to the maturity of the shape; thick/turbid versus thin/clear pus refers to the maturity of the fluid; thin/soft versus thick/firm scabs refer to the maturity of the crust. In summary, mature cases are mostly favorable and easy to cure; tender cases are mostly dangerous and unfavorable, making treatment difficult.

Sparse lesions on the head, neck, chest, and back are auspicious; dense lesions on the hands and feet are not necessarily ominous. However, sparse lesions accompanied by Yang heat syndromes require vigilance against transformation; dense but well-arranged lesions need not cause alarm.

[Note] The head and face are the residence of clear Yang, the neck connects to the throat, and the chest and back are attached to the Zang-Fu organs; thus, sparsity in these areas is auspicious. The hands and feet have less significance, so density there is not ominous. Sparsity is generally favorable, but if accompanied by Yang syndrome symptoms such as delirium, extreme thirst, high fever, dry and cracked lips and tongue, restlessness, and constipation of both bowels and bladder, it indicates toxin obstruction preventing expulsion; even if sparse, it is not auspicious. Density is generally unfavorable, but if evenly distributed and neat, with normal spirit, sleep, diet, and excretion, even if dense, there is no need for alarm.