气虚顶陷多软薄，气过成泡少浆脓，血虚淡红摸转白，血过发□紫黑凝。
【注】
痘之形色，乃气血外现也，如顶凹陷，手摸之多软薄者，此气虚也，
气过者，气过盛也，泡者，发水泡也，少浆脓者，不能生浆也，
谓气若过盛，则发水泡而浆不能生也，
如痘色淡红，以手摸过随转白者，此血虚也，
血过者，血过盛也，□者，地界有□晕也，
紫黑凝者，谓毒盛则色黑紫凝滞也，
此就痘□形色，以辨气血之虚实也。
%
发热恶寒身痛表，有汗为虚无汗实，实隐稠密灰红滞，虚平塌烂水浸湿。
[注]
痘出有发热恶寒，身体疼痛者，属表证也，
若有汗，则为表虚，无汗，则为表实，
表实闭塞，痘毒隐伏难出也，
稠密者，痘出稠密也，
灰者，痘色灰白也，
红者，痘色红赤也，
滞者，谓痘稠密，不论灰红，若带滞暗者，皆表毒盛也，
若表虚之证，则痘平不起，塌痒无浆也，
烂者，痘溃烂也，
水浸湿者，痘脓水浸溃，湿而不干也，此辨表证之虚实也。
%
发热恶热□痛里，便秘为实下利虚，实则板实根紧□，虚则倒陷靥收迟。
[注]
痘出发热恶寒者，表证也，
不恶寒恶热者，里证也，
□者，不大便而□也，
痛者，肚腹作痛也，此皆属里热之证，
若便秘，则为里实，
下利，则为里虚，
板实者，痘囊板实不活动也，
根紧□者，根脚紧朿，
坚□不松者，皆里实证也，
倒陷者，痘已出复陷入于内也，
倒靥者，痘正灌浆即收靥也，
收迟者，痘已灌浆，日久不靥，皆里虚证也，此辨里之虚实也。
%
Qi deficiency manifests as a depressed and soft/thin vesicle apex; Qi excess results in blister formation with scanty pus. Blood deficiency presents as pale red color, turning white upon touch; Blood excess leads to purple-black stagnation.
[Note]
The appearance and color of smallpox (or varicella-like eruptions) reflect the state of Qi and Blood externally. If the apex is depressed and feels soft/thin to the touch, this indicates Qi deficiency. "Qi excess" refers to hyperactive Qi; "blister" refers to water-filled vesicles; "scanty pus" means failure to generate pus. It implies that if Qi is excessively active, blisters form but pus fails to develop. If the eruption is pale red and turns white when stroked, this indicates Blood deficiency. "Blood excess" refers to hyperactive Blood; "□" (missing character, likely referring to halo/areola) denotes a halo around the lesion. "Purple-black stagnation" means toxic heat is severe, causing dark purple discoloration and stagnation. This method distinguishes the deficiency or excess of Qi and Blood based on the morphology and color of the lesions.
Fever, aversion to cold, and body pain indicate a Exterior syndrome. Sweating signifies Exterior Deficiency; absence of sweating signifies Exterior Excess. Excess patterns show dense eruptions with grayish or dull red colors; Deficiency patterns show flat, collapsed lesions that are ulcerated and wet like water immersion.
[Note]
Eruptions accompanied by fever, aversion to cold, and body pain belong to an Exterior syndrome. If there is sweating, it is an Exterior Deficiency pattern; if there is no sweating, it is an Exterior Excess pattern. Exterior Excess involves obstruction of the pores, making it difficult for the pathogenic toxin to emerge. "Dense" refers to closely packed eruptions. "Gray" refers to grayish-white color. "Red" refers to bright red color. "Stagnant/dull" means that regardless of whether the color is gray or red, if it appears dull and lifeless due to density, it indicates excessive Exterior toxin. In contrast, an Exterior Deficiency pattern presents with flat, non-elevated eruptions, itching, and lack of pus. "Ulcerated" refers to broken-down lesions. "Wet like water immersion" means the pus exudes and keeps the area moist without drying. This distinguishes the deficiency or excess of the Exterior syndrome.
Fever, aversion to heat, and abdominal pain indicate an Interior syndrome. Constipation signifies Interior Excess; diarrhea signifies Interior Deficiency. Excess patterns present with firm, board-like bases and tight, hard roots; Deficiency patterns present with involution (retraction) and delayed crusting.
[Note]
Eruptions with fever and aversion to cold are Exterior syndromes. Those with aversion to heat but not cold are Interior syndromes. "□" (missing character, likely constipation/obstruction) and "pain" refer to abdominal pain, all belonging to Interior Heat patterns. Constipation indicates Interior Excess; diarrhea indicates Interior Deficiency. "Board-like firmness" means the vesicle base is rigid and immobile. "Tight roots" and "hardness without relaxation" are signs of Interior Excess. "Involution" (Dao Xian) refers to eruptions that have emerged but retract inward. "Premature crusting" (Dao Ye) refers to lesions that crust over while still filling with fluid. "Delayed crusting" refers to lesions that have filled with fluid but take a long time to crust over. These are signs of Interior Deficiency. This distinguishes the deficiency or excess of the Interior syndrome.