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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出痘后第三天，痘疹全部发出且逐渐生长。痘形尖圆，摸之碍手；痘根红活；痘顶渐渐变白，饱满肥润；这是顺证，患者饮食和二便调和正常。
[注]
“三朝出齐”，是指见到痘点后三天全部发出；
“渐次长”，是指痘形逐渐长大；
“尖圆碍指”，是指痘形尖圆，触摸时有阻碍手指的感觉；
“脚红活”，是指痘的根部颜色红活；
“顶渐放白”，是指痘顶渐渐变得光亮洁白；
“肥”，是指痘形体态肥实；
“润”，是指痘色润泽；
“满”，是指痘体充满饱满；
“顺证饮食二便和”，是指顺证情况下，患者的饮食和二便如常、调和。
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起胀阶段若痘顶凹陷，颜色呈灰色或紫色；痘点稠密，颜色娇嫩鲜红而不舒展苍老；虽然形色看似顺证，但夹杂险证特征。此时若神志清醒，胃气壮盛健康，则尚属可治。
[注]
“起胀顶陷”，是指痘顶出现凹陷；
“灰”，是指痘色灰白；
“紫”，是指痘色赤紫；
“稠密”，是指痘点稠密聚集成簇；
“娇红”，是指痘色红而娇嫩；
“不绽苍”，是指痘形不舒展绽放，颜色不显苍老；以上这些都是起胀阶段的险证表现。
又有虽然形色看似顺证，但夹杂其他疾病的情况，虽然是顺证，恐怕会转变为险证；
如果痘的形色虽然险恶，但神气清爽，饮食强壮美味，虽然是险证，将转化为顺证；
这就是顺中夹险，险中见顺，不可不详细辨别。
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起胀阶段若肌肉肿胀但痘不肿胀，痘根血色散乱，痘顶平塌；颜色紫暗干枯或灰白晦滞，这称为逆证，病情大多预后不良。
[注]
“起胀肉肿痘不肿”，是指头面部或全身浮肿像瓠瓜一样，但痘反而不肿胀；
这是因为气血不能约束摄持毒气，导致毒气散漫；
“根血散乱”，是指痘根部的血色散乱，这是因为毒气逼迫血液，不归附于痘体；
“顶平塌”，是指痘顶不起发，这是因为毒火禁锢在气分，不能充盛发越；
“紫黯”，是指痘色紫暗不明亮，这是因为毒炽盛而血液凝滞；
“干枯”，是指枯槁不润泽，这是因为血液被毒火焚烧灼伤；
“灰白滞”，是指痘色灰白且晦暗停滞，这是因为毒火太甚，导致气血郁滞；
以上这些都是起胀阶段的逆证，病情大多难以救治。
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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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