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
听声气之粗细。声粗者，声音雄粗，此气实也；声细者，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。
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，以手摸过随即转白者，此血虚也。血过者，血过盛也。 者，地界有
晕也。紫黑凝者，谓毒盛则色紫黑凝滞也。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，痘脓水浸渍，湿而不干也。此辨表证
之虚实也。
The fatness or thinness of the body reflects the fullness or deficiency of the Form (Xing); the coarseness or fineness of the voice reflects the excess or deficiency of Qi; the clarity or turbidity of the gaze reflects the strength or weakness of Shen (Spirit); and the excess or deficiency of Stomach Qi determines the ability to eat.
[Note] In treating smallpox/variolae (Dou Zhen), one must first observe whether the child's body is fat or thin. A fat body indicates a Full Form (Xing Sheng); a thin body indicates a Deficient Form (Xing Shuai). Next, listen to the coarseness or fineness of the voice and breath. A coarse voice indicates Excess Qi (Qi Shi); a fine voice indicates Deficient Qi (Qi Xu). Then, observe the Shen in the eyes. Bright and vivid eyes indicate Strong Shen (Shen Qiang); dull and lifeless eyes indicate Weak Shen (Shen Ruo). Furthermore, inquire about their diet. Normal eating and drinking indicate Excess Stomach Qi (Wei Qi Shi); inability to eat indicates Deficient Stomach Qi (Wei Qi Xu). This is how to differentiate the Excess or Deficiency of Form, Shen, Voice/Breath, and Diet.
When Qi is Deficient, the pustule apex is depressed and often soft/thin; when Qi is in Excess, blisters form with little pus/fluid; when Blood is Deficient, the color is pale red and turns white upon touch; when Blood is in Excess, it becomes purple-black and stagnant.
[Note] The appearance and color of the pustules are the external manifestation of Qi and Blood. If the apex is depressed and feels soft/thin to the touch, this is Qi Deficiency. "Qi Excess" refers to excessive Qi. "Blisters" refer to the formation of vesicles. "Little pus/fluid" means the failure to generate fluid/pus. It implies that if Qi is excessively strong, blisters will form but fluid/pus will not be generated. If the pustule color is pale red and turns white immediately after being touched, this is Blood Deficiency. "Blood Excess" refers to excessive Blood. "Yun" (halo/radius) refers to a red halo around the lesion. "Purple-black stagnation" means that when pathogenic toxicity is severe, the color becomes purple-black and stagnant. This differentiates the Excess or Deficiency of Qi and Blood based on the appearance and color of the pustules.
Fever, aversion to cold, and body pain belong to Exterior Syndromes (Biao Zheng); sweating indicates Exterior Deficiency, while no sweating indicates Exterior Excess. In Exterior Excess, the eruption is dense, grayish-red, and stagnant; in Exterior Deficiency, the eruption is flat, collapsed, ulcerated, and wet like water immersion.
[Note] When the eruption is accompanied by fever, aversion to cold, and body pain, it belongs to an Exterior Syndrome. If there is sweating, it is Exterior Deficiency; if there is no sweating, it is Exterior Excess. Exterior Excess causes obstruction, making the toxin latent and difficult to erupt. "Dense" refers to a dense eruption. "Gray" refers to grayish-white color. "Red" refers to reddish color. "Stagnant" refers to the density of the eruption. Regardless of whether gray or red, if the appearance is dull and stagnant, it indicates severe Exterior Toxicity. In cases of Exterior Deficiency, the eruptions are flat, do not rise, are collapsed, itchy, and lack fluid. "Ulcerated" refers to ruptured pustules. "Wet like water immersion" refers to pustules soaked in purulent fluid, remaining wet and not drying. This differentiates the Excess or Deficiency of Exterior Syndromes.