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。
起胀顶陷灰或紫，稠密娇红不绽苍，形色虽顺夹杂险，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。
起胀肉肿痘不肿，根血散乱顶平塌，紫黯干枯灰自滞，名为逆证势多差。
【注】起胀肉肿痘不肿者，谓或头面或周身浮肿如瓠瓜之状，而痘反不肿胀。此气血
不能拘摄毒瓦斯，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。
On the third day after eruption, the pustules are fully erupted and gradually rising. The shape is pointed and round, feeling obstructive to the touch; the base is red and vibrant. The apex gradually turns white, becoming plump, moist, and full. This indicates a favorable course (Shun Zheng), with normal diet and harmonious bowel and bladder functions.
[Note] "Fully erupted on the third day" means that three days after the appearance of spots, all pustules have emerged. "Gradually rising" refers to the progressive elevation of the pustule shape. "Pointed, round, and obstructive to the touch" describes a pustule shape that is pointed and round, feeling solid against the finger. "Red and vibrant base" refers to the healthy, reddish coloration at the root of the pustule. "Apex gradually turning white" means the top of the pustule becomes bright and lustrous white. "Plump" refers to the substantial body of the pustule. "Moist" refers to the glossy texture of the pustule surface. "Full" indicates the pustule is completely filled. "Favorable course with harmonious diet and excretions" signifies that in a favorable case, the patient's appetite and elimination functions remain regular and balanced.
During the swelling stage, if the pustule apex is depressed, or the color is gray or purple; if the distribution is dense and clustered, the color is tenderly red but lacks expansion and maturity, these are signs of a dangerous course (Xian Zheng). Although the form and color may appear favorable, they contain dangerous elements. However, if the spirit is clear and the stomach qi is strong, there is still health potential.
[Note] "Depressed apex during swelling" refers to the indentation of the pustule top. "Gray" refers to a grayish-white pustule color. "Purple" refers to a crimson-purple color. "Dense" indicates the pustules are crowded together in clusters. "Tender red" describes a redness that is delicate and fragile. "Lacking expansion and maturity" means the shape does not spread out smoothly, and the color is not robust or mature. These are all considered dangerous courses during the swelling phase. There are also cases where the form and color seem favorable but are complicated by other pathogenic factors; even if seemingly favorable, they may transform into dangerous conditions. Conversely, if the form and color appear dangerous, but the patient's spirit is refreshing, and appetite is strong and good, the condition may transform from dangerous to favorable. Thus, favorableness contains danger, and danger contains favorableness; this must be distinguished in detail.
During the swelling stage, if the flesh swells but the pustules do not, the blood at the base is scattered and disordered, the apex is flat and collapsed, the color is purple-dark and dry, or grayish-white and stagnant, this is named an adverse course (Ni Zheng), and the prognosis is generally poor.
[Note] "Swollen flesh but non-swollen pustules" refers to edema of the head, face, or whole body resembling a gourd, while the pustules themselves fail to swell. This indicates that Qi and Blood cannot constrain the toxic vapors, causing the toxin to scatter. "Scattered blood at the base" refers to disordered blood coloration at the root, indicating that toxins are forcing blood away from adhering to the pustule. "Flat and collapsed apex" means the pustule fails to elevate. This suggests toxic fire is confined within the Qi level, preventing proper expansion. "Purple-dark" refers to a dull, dark purple color, indicating intense toxicity causing blood stasis. "Dry and withered" implies a lack of moisture, caused by blood being scorched by toxic fire. "Grayish-white and stagnant" refers to a dull, sluggish grayish-white color, resulting from excessive toxic fire leading to Qi and Blood stagnation. These are all adverse courses during the swelling phase, and the conditions are mostly difficult to save.