痘疮不治之证。总勉强用药。终无生理。初出时从天庭司空太阳印堂方广等处发出。或如蚕
种。或如鱼膘。或发点朱洒墨泼青。成青黑紫斑。或肌肉有成块处。或有青 。成紫黑干枯。
或遍身有瘙疹。或如玳瑁。或头面一片如胭脂。或初出红点带紫。或夹斑如锦纹者。俱危于四五
朝。迟则不过六七朝也。若见青斑者。顷刻危矣。 若遍身不起。俱发紫黑斑点。或初起顶陷。
连肉通红。或如沸无缝。或薄如竹膜。摸之便破。或如蛇壳如鱼皮。顶陷如羊眼。赤亮如汤泡火
烧。或腰腹作痛。上下出血。或如 糕。成片连贯。眼合无浆者。俱危于七八朝。迟则不过十朝
也。 若四五日间。面目浮肿而疮不肿。其痘黑陷紫陷。或灰白。或发紫泡水泡痒塌者。危于十
一二朝。其泡刺破。出黑血黄水者不治。 若四五日诸痘未灌浆。唇上有疮先黄。失于针挑者不
治。 若五六日内。痘白而肿。光亮如水。根脚不红。或声哑气急。或鼻陷啮齿。或目闭忽开。
露白无神。不省人事者不治。 若六七日不能灌浆。但空壳干枯。全无血水。搔破
无脓血而痒塌者。十二日死。有脓血者不死。 二三日根窠不分。红肿如瓜。或如冷粥结面。或
如胖蚕之形。或如油光黍米。内有红紫。或顶陷。有眼如针孔。色紫黑者。俱不治。 若两颊两
颐。多致成片。如涂朱者。此肝乘脾。当十二三朝不食而危。 若七八日间。陷伏焦紫干枯。不能
灌浆。或切牙寒颤。 语狂躁烦闷。呛水错喉。在七日前见者难治。或目闭。口中臭烂成疳。延
及内外者不治。或七八日后。腹胀气喘。有痰如拽锯。啼哭不止者。可治。无啼哭者。不治。
或嫩薄易破。抓塌成饼。堆垛如鸡屎。泄泻不止者不治。 或泻下如豆汁。或便脓血。或乳
食不化痘烂。或口臭唇焦。或目闭反开者。不治。 或不时哽气。如欲大便状。或胸高突起。神
昏闷乱。或舌卷囊缩。咽肿不食。或蜷脚不伸。或憎寒四肢逆冷。或目闭腹胀。厥冷过膝。或先
痘后惊。连发搐不止。及痘后慢惊。目无神而色青者。皆不可治。 当靥痒塌无脓。皮如血壳者
。必发寒颤切牙口噤而死。 妇人经水不止。或堕胎下血。身大热不退者。并不可治。凡发热时
。头温足冷。昏闷如痴。渴饮不止者。其痘必危。 凡腰下见点。腰上不出者不治。 凡斜视之
。脸如橘皮。不分肉地者死。 起胀时色白如饭。平塌不起者死。若此者。乃毒盛血枯。不可认
以为虚寒之候。 至如可畏之证。附列于后。如不食。或多渴寒颤困倦。脾虚也。戛齿噤牙。肾
经热甚也。烦躁体热摇头。肝热生风也。 吐逆泄泻。乳食不化。便脓血者。脾胃虚寒。毒入大
肠也。 疮作黑坑。内无脓血者。肾热脾虚也。 大小便涩。口渴者。心肺热也。 喘急痰盛者
。肺热甚也。 以上可畏之证。内犯一二。用药得效者生。不效者死。若犯三四证。必无生理也。
痘疮（天花）属于不治之证。即使勉强用药，最终也毫无生机。初期出疹时，若从额头正中、两眉之间、太阳穴、印堂等部位发出，形态或像蚕种，或像鱼鳔，或出现朱砂色斑点、墨汁泼洒般的青色，形成青黑紫色的斑片；或者肌肉局部成块，或有青色瘀点，呈现紫黑色且干枯；或者全身出现瘙痒的疹子，或像玳瑁花纹；或者头面部一片红如胭脂；或者初起为红点但带有紫色；或者夹杂斑纹如锦缎纹理者，都在发病第四五朝（天）内病情危重，拖延则不超过六七朝。如果见到青色斑片，顷刻间就会危及生命。
如果全身痘疹不起发，全部发出紫黑色的斑点；或者初起时痘顶凹陷，周围皮肤通红；或者痘体紧绷如沸腾般无缝隙；或者薄如竹膜，一摸就破；或者像蛇皮、鱼皮，痘顶凹陷像羊眼睛；或者颜色赤亮如水泡或火烧状；或者腰腹部疼痛，上下出血；或者痘形像糕饼，成片连贯，眼孔闭合无浆液者，都在发病第七八朝内病情危重，拖延则不超过十朝。
如果在第四五日，面目浮肿但痘疹不肿，痘色黑陷、紫陷，或者灰白色，或者发出水泡、瘙痒塌陷者，在第十一二朝内病情危重。如果水泡刺破后流出黑血、黄水，属于不治之症。
如果在第四五日，各种痘疹尚未灌浆，嘴唇上的疮先变黄，且未及时用针挑破者，属于不治之症。
如果在第五六日内，痘色白而肿胀，光亮如水，根部不红；或者声音嘶哑、气急；或者鼻梁塌陷、咬牙；或者眼睛闭合又突然睁开，露出白眼珠而无神；或者神志不清、人事不省者，属于不治之症。
如果在第六七日仍不能灌浆，只是空壳干枯，完全没有血水，抓破后无脓血反而瘙痒塌陷者，第十二日死亡；如果有脓血则不死。
发病二三日，痘根不分界，红肿如瓜，或者像冷粥结成的面块，或者像胖蚕的形状，或者像油光发亮的黍米，内部有红紫色，或者痘顶凹陷，有眼如针孔，颜色紫黑者，都属于不治之症。
如果两颊和两腮多处连成片，像涂了朱砂一样，这是肝木乘脾土的表现，当在第十二三朝因不进食而陷入危险。
如果在第七八日间，痘疹陷伏、焦紫、干枯，不能灌浆；或者咬牙寒战；或者胡言乱语、狂躁烦闷；或者呛水、误入喉中，这些症状在七日前出现的难治。或者眼睛闭合，口中臭烂形成疳疮，蔓延至内外者，属于不治之症。或者七八日后，腹胀气喘，痰声如拉锯，啼哭不止者，可治；没有啼哭者，不治。
或者痘疹嫩薄易破，抓塌后成饼状，堆积如鸡屎，泄泻不止者，不治。或者腹泻如豆汁，或者大便脓血，或者乳食不化导致痘烂，或者口臭唇焦，或者眼睛闭合又反常睁开者，不治。
或者不时噎气，像想要大便的样子；或者胸部高突，神志昏迷、烦闷混乱；或者舌头卷缩、阴囊收缩，咽喉肿痛不能进食；或者蜷缩双脚不能伸直；或者憎恶寒冷、四肢逆冷；或者眼睛闭合、腹胀，厥冷超过膝盖；或者先出痘后惊风，连续抽搐不止，以及痘后慢惊风，眼睛无神且面色青者，都不可治。
当痘疹结痂时瘙痒塌陷无脓，皮肤像血壳一样，必然会出现寒战、咬牙、口噤而死。
妇女经血不止，或者堕胎下血，身体大热不退者，都不可治。凡是发热时，头部温热而足部冰冷，昏闷如痴，口渴饮水不止者，其痘必危。
凡是腰部以下见痘点，腰部以上不出者，不治。凡是斜视，脸部如橘皮，肌肉纹理不分者死。
在起胀阶段，颜色白如饭粒，平塌不起者死。如果是这种情况，乃是毒盛血枯，不可误认为是虚寒之候。
至于那些令人畏惧的证候，附录如下：如果不进食，或多渴、寒战、困倦，是脾虚。咬牙口噤，是肾经热甚。烦躁、体热、摇头，是肝热生风。呕吐逆乱、泄泻、乳食不化、便脓血，是脾胃虚寒，毒入大肠。疮疡变成黑坑，内无脓血，是肾热脾虚。大小便涩滞、口渴，是心肺热。喘急痰多，是肺热甚。
以上令人畏惧的证候，内犯一二个，用药得效的能生，无效的死。如果犯了三四个证候，必定没有生机。
**Prognosis of Incurable Smallpox (Variola)**
Smallpox presenting as incurable conditions: even if medication is forcibly administered, there is ultimately no hope for survival. During the initial eruption, if lesions appear from the forehead center (Tianting), between the eyebrows (Sikong), Taiyang acupoints, or Yintang area, and present in forms resembling silkworm eggs, fish swim bladders, or exhibit cinnabar-red spots, ink-splashed cyan hues, forming cyan-black-purple macules; or where muscle tissue forms clumps, or presents with cyan ecchymoses turning purple-black and dry; or generalized pruritic rashes resembling tortoiseshell patterns; or the entire head and face appearing red like rouge; or initial red dots tinged with purple; or mixed macular patterns like brocade textures—all these indicate critical danger on the 4th or 5th day (chaos/periods), and if delayed, death will occur by the 6th or 7th day. The appearance of cyan macules indicates imminent peril within moments.
If lesions fail to erupt over the whole body, presenting only as purple-black macules; or initially show depressed crowns with surrounding erythema; or appear tense and seamless like boiling water; or thin as bamboo membrane, rupturing upon touch; or resembling snake skin/fish scales with depressed crowns like sheep's eyes; or bright red like scalded blisters; accompanied by abdominal pain and bleeding from above and below; or cake-like confluent lesions with closed pores lacking fluid—all indicate critical danger on the 7th or 8th day, and if delayed, death by the 10th day.
If during days 4–5, the face and eyes are edematous but lesions do not swell, showing black depression, purple depression, gray-white coloration, or blister formation with pruritus and collapse—critical danger occurs on days 10–12. Puncture of blisters yielding black blood or yellow fluid signifies an incurable condition.
If by days 4–5 pustulation has not begun, and lesions on the lips turn yellow first without timely needle puncture—incurable.
If during days 5–6, lesions are white and swollen, glistening like water, with non-erythematous bases; accompanied by hoarseness, dyspnea, nasal depression, teeth grinding, sudden opening of closed eyes revealing sclera without spirit, unconsciousness—incurable.
If by days 6–7, pustulation fails, leaving empty, dry shells devoid of blood/fluid; scratching yields no pus/blood but causes pruritus and collapse—death on day 12. Presence of pus/blood ensures survival.
On days 2–3, indistinct lesion bases, swelling like melons, or congealed cold porridge-like masses, or plump silkworm shapes, or oily millet-like grains with internal purple-red hues, or depressed crowns with needle-hole-like pores and purple-black color—incurable.
Confluent lesions on cheeks and jawlines resembling applied rouge indicate Liver Wood overacting on Spleen Earth; danger arises on days 12–13 due to anorexia.
During days 7–8, if lesions are collapsed, scorched-purple, dry, and unable to pustulate; accompanied by teeth grinding, chills, delirium, mania, restlessness, choking on fluids/inhalation—if seen before day 7, difficult to treat. Eye closure with fetid oral decay progressing to canker sores spreading internally/externally—incurable. Abdominal distension, asthma, rattling phlegm (like sawing wood), incessant crying after day 7—treatable; absence of crying—incurable.
Delicate, easily ruptured lesions collapsing into cakes, piled like chicken droppings, with intractable diarrhea—incurable. Diarrhea resembling bean juice, hematochezia, undigested food causing lesion rot, halitosis, scorched lips, or paradoxical eye opening—incurable.
Frequent hiccups resembling defecation urges, chest protrusion, coma/confusion, tongue retraction, testicular retraction, throat swelling/anorexia, curled legs inability to extend, aversion to cold with cold limbs, eye closure with abdominal distension and coldness extending past knees, post-variolous convulsions with continuous spasms, or slow post-variolous convulsions with spiritless eyes and cyan complexion—all incurable.
During crusting phase, if pruritus and collapse occur without pus, and skin resembles blood crusts—death ensues via chills, teeth grinding, and trismus.
In women, persistent menstruation, miscarriage with hemorrhage, and unremitting high fever—incurable. During fever, if head is warm but feet cold, stupor resembling dementia, and unquenchable thirst—the prognosis is critical.
Lesions appearing only below the waist while absent above—incurable. Strabismus with orange-peel texture facial skin and indistinct muscle boundaries—fatal.
During the swelling stage, lesions white as rice grains, flat and non-elevated—fatal. Such presentations indicate excessive toxin and depleted blood; do not misdiagnose as deficiency-cold syndrome.
**Appendix: Dreadful Prognostic Signs**
* Anorexia, polydipsia, chills, fatigue: Spleen Qi Deficiency.
* Teeth grinding and trismus: Excessive Heat in Kidney Meridian.
* Restlessness, body heat, head shaking: Liver Heat generating Wind.
* Vomiting, diarrhea, undigested food, hematochezia: Spleen-Stomach Deficiency-Cold with Toxin entering Large Intestine.
* Lesions becoming black pits without pus/blood: Kidney Heat with Spleen Deficiency.
* Dysuria/constipation, thirst: Heart-Lung Heat.
* Asthma, profuse phlegm: Severe Lung Heat.
If one or two of these dreadful signs are present and respond to treatment, survival is possible; if ineffective, death follows. If three or four signs are present, there is no hope for life.