朱济川曰。四肢之痘。应出不出。应起不起。应浆而清水。应收 而不痂。应脱靥而粘着不
脱者。皆脾胃虚。不能旁达四肢也。治宜调理脾胃为主。然四肢始终贵乎温暖。若痘出手足冷者。
脾弱也。痘出而手足作痛者。乃毒火乘脾。疏解为上。若遍身浆满。而四肢尚空壳。多有不治者。
临病之际。可不抚按手足之温冷哉。又有自言手足冷。及按之热而夜卧不宁者。此脾弱而虚阳发
露于外也。当补脾调血为主。痘出而两足常动摇不休。此热毒流于阴分。不治。若出七八日足不
伸者。不治。
痘出始终以唇舌红润为吉。若唇口肿胀。紫黑干裂。或有痘先黄。或唇色皎白。或有白泡。或
肿烂流脓者。皆毒火乘脾。极为危候。当先升解以化其毒。次补益以培其本。庶可无虞。若痘出
稠密。唇口疮相粘干黑者。死证也。若臭烂延及牙龈。腮颊肿破。而成走马崩砂。牙宣息露狐惑
等证。皆不易治。即用化慝丸、马鸣散。亦难取效。若初见舌白唇紫。即知实热。急投凉膈散及
马鸣散吹之。庶可急夺其势。若见痰喘作渴者。不治。若气虚火盛。津液不能上行而舌干
口燥者。补益为主。若毒火盛而舌干口燥者。解利为主。若舌上燥黑芒刺者。此热毒内蕴。急用
硝。黄下之。或可十救一二。又舒舌者脾之热。弄舌者心之热。有因唇燥而舒舌者。亦脾之热也。
若痘稠密浆清。唇口摇动。昏沉寒颤者。不治。唇口 动。目眶内陷。足常动摇者。不治。若下唇
有白屑如芝麻。或翻转如葵花。或有紫泡出血。及唇燥裂而见面色枯槁。烦渴不止。及腰足痛者。
皆不可治。
朱济川说：四肢部位的痘疹，该出而不出，该起发而起发不起来，该化脓却呈清水状，该收靥结痂而不结痂，该脱痂却粘连不脱落的情况，都是脾胃虚弱，不能将气血旁达于四肢所致。治疗应当以调理脾胃为主。然而，在痘疹病程中，四肢始终需要保持温暖。如果痘疹发出后手足发冷，这是脾气虚弱的表现；痘疹发出后手足疼痛，这是毒火侵犯脾脏，应以疏风解表、清热解毒为最佳治法。如果全身痘疹浆液饱满，唯独四肢仍是空壳无浆，大多属于不治之症。在面对疾病时，怎能不抚摸按压手足来辨别其温凉呢？又有患者自述手足发冷，但触摸时感觉发热且夜间睡眠不安宁的，这是脾气虚弱导致虚阳外浮的表现。治疗应当以补益脾气、调和血液为主。痘疹发出后双脚经常动摇不止的，这是热毒流入阴分，属于不治之症。如果痘疹发出七八天后脚仍不能伸直，也是不治之症。
痘疹从始至终，以唇舌红润为吉兆。如果嘴唇口角肿胀，颜色紫黑干燥开裂，或者有的痘疹先变黄，或者嘴唇颜色苍白，或者出现白色水泡，或者红肿溃烂流脓的，都是毒火侵犯脾脏，属于极为危险的证候。应当先用升散解毒的方法化解毒素，再用补益的方法培固根本，这样才可以没有忧患。如果痘疹稠密，嘴唇口角的疮疡与痘疹粘连、干燥发黑的，是死证。如果腐烂恶臭蔓延到牙龈，腮帮脸颊肿胀破溃，形成走马牙疳（走马崩砂），牙齿出血、气息外露、狐惑病等证候，都难以治疗。即使使用化慝丸、马鸣散，也难以取得疗效。如果初见舌苔白而嘴唇紫暗，就知道是实热证，应立即投用凉膈散，并用马鸣散吹入患处，或许可以迅速遏制病势。如果出现痰多气喘、口渴的症状，属于不治之症。如果是气虚火旺，津液不能上行滋润而导致舌干口燥的，以补益为主。如果是毒火旺盛导致舌干口燥的，以解毒利窍为主。如果舌面上有干燥的黑苔和芒刺，这是热毒内蕴，应立即用芒硝、大黄攻下泄热，或许能救活十分之一二。另外，伸舌不收是脾热的表现，弄舌（舌头伸缩不定）是心热的表现。有因嘴唇干燥而伸舌的，也是脾热的表现。如果痘疹稠密、浆液清稀，嘴唇口角颤动，神志昏沉、寒战发抖的，属于不治之症。嘴唇口角跳动，眼眶内陷，双脚经常动摇的，属于不治之症。如果下唇有白色碎屑像芝麻一样，或者翻转像葵花花瓣，或者有紫色水泡出血，以及嘴唇干燥开裂并见面色枯槁、烦躁口渴不止，以及腰部和足部疼痛的，都不可治愈。
Zhu Jichuan stated: When smallpox lesions on the four limbs fail to erupt when they should, fail to rise when they should, present as clear fluid instead of pus when they should suppurate, fail to scab when they should resolve, or adhere without shedding when they should detach, these are all due to Spleen-Stomach deficiency, which prevents the distribution of Qi and Blood to the four limbs. Treatment should primarily focus on regulating the Spleen and Stomach. However, throughout the course of smallpox, it is crucial that the four limbs remain warm. If the hands and feet become cold after the eruption of smallpox, this indicates weak Spleen Qi. If the hands and feet ache after eruption, it signifies toxic fire invading the Spleen; the best approach is to disperse and resolve the pathogen. If the body is full of pustules but the four limbs remain empty shells, it is mostly incurable. In clinical practice, one must not neglect palpating the warmth or coldness of the hands and feet. Furthermore, if a patient complains of cold hands and feet but feels heat upon palpation and experiences restlessness at night, this is due to Spleen deficiency causing deficient Yang to float outward. Treatment should primarily tonify the Spleen and harmonize the Blood. If the feet constantly tremble or move involuntarily after eruption, it indicates heat-toxin flowing into the Yin aspect, which is incurable. If the feet cannot extend after seven or eight days of eruption, it is also incurable.
Throughout the entire process of smallpox eruption, moist and red lips and tongue are auspicious signs. If the lips and mouth swell, turn purple-black, dry out, and crack, or if some lesions turn yellow prematurely, or the lips appear bright white, or white blisters form, or swelling and ulceration with pus discharge occur, these all indicate toxic fire invading the Spleen, representing extremely critical conditions. One should first employ ascending and resolving methods to transform the toxin, followed by tonification to strengthen the root, thereby avoiding danger. If the smallpox is dense, and the sores around the lips and mouth adhere, becoming dry and black, it is a death sign. If foul decay spreads to the gums, and the cheeks and jaw swell and rupture, forming "running horse canker" (Zouma Bengsha), bleeding gums, exposed breath, or Huo-Huo syndrome, these are difficult to treat. Even using Huati Wan or Maming San may yield little effect. If initially the tongue coating is white and the lips are purple, indicating excess heat, one should urgently administer Liangge San and apply Maming San powder locally to rapidly curb the disease's momentum. If phlegm, wheezing, and thirst appear, it is incurable. If Qi deficiency with hyperactive fire prevents fluids from ascending, leading to a dry tongue and mouth, treatment should focus on tonification. If excessive toxic fire causes dryness of the tongue and mouth, treatment should focus on resolving toxicity and promoting free flow. If the tongue surface presents with dry black coating and prickles, this indicates internal accumulation of heat-toxin; urgent purgation with Mangxiao (Natrii Sulfas) and Huangqi (Rhei Radix et Rhizoma) may save one or two in ten. Additionally, protruding tongue indicates Spleen heat; playing with the tongue (involuntary tongue movements) indicates Heart heat. Protruding tongue due to dry lips also indicates Spleen heat. If smallpox is dense with clear fluid, the lips and mouth tremble, accompanied by lethargy and chills, it is incurable. Lip twitching, sunken eye sockets, and constant foot movement indicate incurability. If the lower lip has white flakes like sesame seeds, or turns inside out like a sunflower, or has purple blisters that bleed, along with dry cracked lips, sallow complexion, unceasing irritability and thirst, and pain in the waist and feet, these conditions are untreatable.