苍淳娇艳老嫩色，肥实浮虚老嫩形，浓浊稀清浆老嫩，厚薄痂之老嫩明。
[注]
痘之一证，自始至终喜老恶嫩，
如苍淳娇艳，此色之老嫩也，
肥实浮虚，此形之老嫩也，
浓浊稀清，此浆之老嫩也，
薄软厚坚，此痂之老嫩也，
总之老者多顺，易于成功，嫩多险逆，难于施治也。
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头项胸背痘□吉，手足虽密不为凶，□兼阳热须防变，密若磊落不必惊。
【注】
头面清阳元首，颈项管籥咽喉，胸背乃藏府所附，惟稀□则吉也，
至于手足无甚关系，虽多不为凶也，□固是顺也，
若见阳证谵妄，大渴大热，唇舌燥裂，烦躁不宁，大小便秘等证，
此毒壅遏不出，虽□未为吉也，密固是逆，
若铺排磊落，大小匀净，精神寝食二便如常，虽密亦不须惊也。
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躯之肥瘦形衰盛，声之粗细气虚实，目了不了神强弱，胃气虚实食不食。
【注】
欲治痘者，先看儿体之肥瘦，
体肥者，形盛可知也，体瘦者，形衰可知也，
次声气之粗细，
粗者，声音雄粗，此气实也，细者，声音微细，此气虚也，
再观其目中之神，
了了精彩者，此神强也，目不了不精彩者，此神弱也，
更问其饮食能否，饮食如常者，胃气实也，不能饮食者，胃气虚也，
此辨形神声气饮食之虚实也。
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Observing the color of the variola (smallpox) eruptions, distinguishing between those that are mature and robust versus those that are tender and delicate; observing the shape, distinguishing between those that are plump and solid versus those that are floating and deficient; observing the consistency of the pus, distinguishing between those that are thick and turbid versus those that are thin and clear; observing the scabs, distinguishing between those that are thick and hard versus those that are thin and soft, thereby clarifying whether the variola is mature or tender.
[Note]
In cases of variola, from onset to resolution, one prefers a "mature" presentation and dislikes a "tender" one.
"Mature and robust" versus "tender and delicate" refers to the maturity of the color;
"Plump and solid" versus "floating and deficient" refers to the maturity of the shape;
"Thick and turbid" versus "thin and clear" refers to the maturity of the pus;
"Thin and soft" versus "thick and hard" refers to the maturity of the scabs.
In summary, cases presenting with "mature" signs are mostly favorable (Shun), leading to easier recovery; cases presenting with "tender" signs are mostly dangerous and adverse (Ni), making treatment difficult.
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Variola eruptions on the head, neck, chest, and back being sparse indicates a good omen; even if eruptions are dense on the hands and feet, it does not necessarily indicate a bad prognosis. However, if accompanied by Yang heat symptoms, changes in condition must be guarded against. If the eruptions are arranged clearly and distinctly, there is no need for alarm.
[Note]
The head and face belong to the realm of clear Yang, serving as the "head"; the neck acts like a lock connecting to the throat; the chest and back are where the Zang-Fu organs attach. Eruptions being sparse in these areas is auspicious.
As for the hands and feet, they have less direct relation to the internal organs, so even numerous eruptions here do not portend misfortune.
Sparse eruptions are indeed a favorable sign.
However, if Yang syndrome symptoms appear, such as delirium, extreme thirst, high fever, dry and cracked lips and tongue, restlessness, and constipation of both urine and stool,
this indicates that the pathogenic toxin is obstructed and cannot be expelled outward. Even if the eruptions are sparse, it is not auspicious.
Dense eruptions are indeed an adverse sign.
Yet, if the eruptions are distributed clearly and distinctly, uniform in size and clean, and the patient's spirit, sleep, diet, and bowel/bladder functions remain normal, there is no need for alarm even if they are dense.
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The fatness or leanness of the trunk reflects the abundance or decline of physical form; the coarseness or fineness of the voice reflects the excess or deficiency of Qi; the clarity or cloudiness of the gaze reflects the strength or weakness of Shen (Spirit); the excess or deficiency of Stomach Qi determines the ability to eat.
[Note]
To treat variola, one must first observe whether the child's body is fat or lean.
A fat body indicates abundant physical form; a lean body indicates declining physical form.
Next, listen to the coarseness or fineness of the voice and breath.
A loud and coarse voice indicates Excess Qi; a faint and fine voice indicates Deficient Qi.
Then, observe the Shen (Spirit) in the eyes.
Clear and bright eyes indicate strong Shen; dull and lackluster eyes indicate weak Shen.
Furthermore, inquire about the ability to eat.
Normal appetite indicates Excess Stomach Qi; inability to eat indicates Deficient Stomach Qi.
This constitutes the differentiation of Excess and Deficiency regarding physical form, Shen, voice/breath, and diet.
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