痘疮见点之时。先察部位。即可知吉凶轻重矣。痘为阳。故随阳而先见于面。凡口鼻两傍。
人中上下。腮耳年寿之间。出见者吉。若见于天庭司空印堂方广太阳等处。俱非佳兆。大抵见点
于眉以下颐以上。正中阳明部分皆吉。若见点于眉心。上至发际太阳部分多凶。其见点于腮颊耳
傍少阳部分俱险。朱济川曰。余初业时。亦据前论。每每不应。究心三十余年。从正额间两颧先
见者多顺。人中口鼻先见者多险。或口唇目胞。预为浮肿者。此脾胃受毒尤险。太阳颐颊腮耳先
见者多逆。其不能先见于上而反于下部见者。亦元气之不振耳。其起浆收靥亦同。凡初见点于正
面吉部。相去一二寸一颗。尖细淡淡桃红色者。必稀而轻也。若初见点于正面凶部。二三相并。
五六成丛。或赤或白。顶平而少神者。必密而重也。张洁古云。一发稠密如针头者。情势重也。
轻则表而凉其内。连翘升麻汤。然稠密之处。各有经络部分所属。额主心。面主胃。腹与四肢主
脾。胁主肝。两腋主肺。腰足主肾。肩背主膀胱。当随见证治之。若面
色黄。大便黑。烦躁喘渴。或腹胀者。瘀血在内也。犀角地黄汤。或磨生犀汁。但根窠分明肥满
者无妨。其头面最要稀少匀朗。绽凸红泽。肢体虽密。治之可生。若头面稠密平塌。肢体虽稀。
未可轻议其吉。故头额多者为蒙头。颈项多者为锁项。胸前多者为瞒胸。两颊两颐。多致成片。
或如涂朱。则肝盛克脾。八九日当作泻不食而为险候。惟四肢虽多不妨。痘出稠密。虽为险候。
若面痘易起易灌。目封能食者可治。若身痘虽好。面痘浆清平塌者难治。若诸处痘不起。惟面部
及臀上痘有浆起绽者可治。有面痘好。惟鼻上无痘。或有痘不起绽行浆者。皆不治。四肢有痘。
身面无者难治。一身有痘浆足。惟面上不行浆者死。一身痘色红活。惟面部焦枯者死。遍身痘好。
惟两足膝下全无者凶。冬寒不出。胡荽酒热洗多次。内服温解透肌之药加木瓜、薏苡以引之。延
至五日。治无及矣。若面部浆足收靥。肢体尚不行浆。神清能食。可治。有面上左有右无。右有左
无。此气血乖离。必难浆难绽。多不可治。痘出而面半以下稠密灰白。面半以上匀朗红润者。补
中益气汤。若面半以上稠密灰滞。而面半以下匀朗绽泽者。名云掩天庭。不治。痘出左半身稠密
红润。右半身间有数点者。此毒发于阳为顺。补中益气汤。若右半身稠密。灰滞平塌。左半身间有
数点者。此毒发于阴为逆。浆虽行不能收敛。九日死。痘出齐而诸处俱匀朗红润。而腰围稠密灰滞
作痛者。名缠腰。此毒滞于阴。不能成浆。九日死。迟则不过十一朝也。痘出齐而遍身稠密。头
面全无者。此阴毒不能升于阳位。不治。以上诸证。除不治外。俱要疏通营卫。健脾生津。使无
干枯焦黑之患。紫草消毒之味。似不可少。若热甚者。芩、连、地骨皮。渴者。花粉、煨葛根。
气虚者。参、 、木香。大便秘者。枳壳。小便涩者。木通。食少者。山楂、枳、术。痒者。白
芷、蝉蜕。胀者。木香、浓朴。腹痛者。芍药、丁香。然亦看人之大小虚实。大而实者。犹或可
治。小而虚者。多不可救。谚云。树小花多难结果。小船重载定倾
危。可为善喻者矣。
痘疮出现红点的时候，首先要观察其出现的部位，就可以知道病情的吉凶和轻重了。痘疮属于阳邪，所以随着阳气上升而首先出现在面部。凡是出现在口鼻两侧、人中上下、腮部耳朵以及年寿（鼻准）之间的，都是吉兆。如果出现在天庭、司空、印堂、方广、太阳等部位，都不是好征兆。大致来说，痘点出现在眉毛以下、下巴以上，正中阳明经所主的区域，都是吉利的。如果痘点出现在眉心，向上延伸至发际线及太阳经所主的区域，大多凶险。痘点出现在腮颊、耳旁少阳经所主的区域，也都危险。朱济川说：“我初学医时，也依据前面的理论，但往往不灵验。潜心研究三十多年后，发现从正额头和两颧先出现的，大多顺遂；从人中、口鼻先出现的，大多险恶。或者口唇、眼睑预先浮肿的，这是脾胃受毒特别危险。太阳经、颐部、腮颊、耳旁先出现的，大多逆乱。那些不能先在头部出现反而在下部出现的，也是元气不振的表现。痘疮起浆和结痂的过程也是如此。”
凡是初次见到痘点出现在面部的吉利部位，每颗之间相距一二寸，形状尖细、颜色淡淡桃红色的，必定稀疏且病情轻浅。如果初次见到痘点出现在面部的凶险部位，两三颗连在一起，五六颗聚成丛状，或者颜色赤红或苍白，顶部平坦且缺乏神气的，必定密集且病情沉重。张洁古说：“刚发出时就稠密如针头般的，病情严重。轻症则用表凉法治疗内部，选用连翘升麻汤。”然而，在稠密的部位，各有经络所属的区域：额头主心，面部主胃，腹部与四肢主脾，胁肋主肝，两腋主肺，腰足主肾，肩背主膀胱。应当根据见证进行辨证治疗。如果出现面色黄、大便黑、烦躁气喘口渴，或者腹胀的情况，是瘀血在内，可用犀角地黄汤，或者磨取生犀角的汁液服用。但如果痘根清晰、饱满肥大的，就没有妨碍。
痘疮最要紧的是头面部的痘要稀少均匀明朗，绽凸红润有光泽。即使肢体部分的痘较密，经过治疗也可以痊愈。如果头面部的痘稠密平塌，即使肢体部分的痘稀疏，也不能轻易断定其为吉兆。所以，额头痘多称为“蒙头”，颈项痘多称为“锁项”，胸前痘多称为“瞒胸”，两颊和下颌痘多导致成片，或者像涂了朱砂一样红赤，这是肝气盛克制脾气，到了第八九天如果发生腹泻、不能进食，就会成为险候。只有四肢部分的痘虽然多也不要紧。痘出得稠密，虽然是险候，但如果面部的痘容易起胀、容易灌脓，眼睛能睁开、能进食的，可以治疗。如果身体部分的痘虽然好，但面部的痘浆液清稀、平塌的，难以治疗。如果全身各处的痘都不起胀，只有面部及臀部的痘有浆液起胀绽开的，可以治疗。如果有面部痘好，唯独鼻梁上没有痘，或者有痘不起胀、不行浆液的，都属不治之症。四肢有痘，但身体和面部没有的，难治。全身都有痘且浆液充足，唯独面部不行浆液的，死亡。全身痘色红活，唯独面部焦枯的，死亡。遍身痘都好，唯独两膝以下全无痘的，凶险。冬季寒冷不出痘，可用胡荽酒热洗多次，内服温通解表透肌的药物，并加入木瓜、薏苡仁以引导药力。拖延到第五天，就无药可救了。
如果面部痘浆液充足已结痂，肢体部分尚不行浆，但神志清醒、能进食的，可以治疗。有的面上左边有右边无，右边有左边无，这是气血乖离，必定难行浆难绽开，大多不可治。痘出后面部下半部分稠密灰白，面部上半部分均匀明朗红润的，用补中益气汤。如果面部上半部分稠密灰滞，而面部下半部分均匀明朗绽泽的，名叫“云掩天庭”，不治。痘出左半身稠密红润，右半身间有几点的，这是毒发于阳，为顺证，用补中益气汤。如果右半身稠密灰滞平塌，左半身间有几点的，这是毒发于阴，为逆证，浆液虽行但不能收敛，第九天死亡。痘出齐后全身都均匀明朗红润，唯独腰部周围稠密灰滞作痛的，名叫“缠腰”，这是毒滞于阴，不能成浆，第九天死亡，迟则不超过第十一朝。痘出齐后遍身稠密，头面全无的，这是阴毒不能升于阳位，不治。
以上各种证候，除了不治的以外，都要疏通营卫，健脾生津，使痘疮不出现干枯焦黑的祸患。紫草等消毒的药物，似乎不可缺少。如果热势严重的，用黄芩、黄连、地骨皮；口渴的，用天花粉、煨葛根；气虚的，用人参、[此处原文缺字，通常指黄芪或白术]、木香；大便秘结的，用枳壳；小便涩滞的，用木通；食少的，用山楂、枳实、白术；发痒的，用白芷、蝉蜕；胀满的，用木香、厚朴；腹痛的，用芍药、丁香。但也需看患者体型的壮弱和虚实。体型壮实者，或许还可以治疗；体型瘦小虚弱者，大多不可救药。谚语说：“树小花多难结果，小船重载定倾危。”这可以作为很好的比喻。
At the time when smallpox spots appear, one must first observe their location to determine the auspiciousness or inauspiciousness and severity of the condition. Smallpox is a Yang pathogen; therefore, it manifests on the face first following the ascent of Yang Qi. Spots appearing on both sides of the mouth and nose, above and below the Renzhong (philtrum), between the cheeks, ears, and the Niushou (tip of the nose) are auspicious. If they appear on the Tianting (forehead center), Sikong, Yintang (between eyebrows), Fangguang, or Taiyang (temples) areas, these are not favorable omens. Generally, spots appearing between the eyebrows and the chin, within the central Yangming meridian region, are auspicious. However, spots appearing at the brow center extending up to the hairline and the Taiyang region are mostly inauspicious. Spots appearing on the cheekbones and beside the ears in the Shaoyang region are also dangerous. Zhu Jichuan stated: "When I first practiced medicine, I relied on the previous theories but often found them inaccurate. After studying intently for over thirty years, I found that spots appearing first on the central forehead and both zygomatic arches are mostly smooth cases. Those appearing first at the Renzhong and around the mouth and nose are mostly perilous. Pre-existing edema of the lips or eyelids indicates severe poisoning of the Spleen and Stomach, which is particularly dangerous. Appearance in the Taiyang, chin, cheeks, and ear regions is mostly adverse. Cases where spots do not appear on the upper body first but rather on the lower body indicate weak Yuan Qi (Original Qi). The processes of pustule formation and scabbing follow similar patterns."
If the initial spots appear in the auspicious areas of the face, spaced about one to two cun apart, with sharp, fine shapes and a pale peach-red color, the eruption will be sparse and the condition mild. If the initial spots appear in the inauspicious areas of the face, clustering two or three together, or forming groups of five or six, with colors ranging from crimson to pale white, flat tops, and lackluster spirit, the eruption will be dense and the condition severe. Zhang Jiegeng said: "Eruptions that are dense like needle heads immediately upon appearance indicate a serious condition. For mild cases, treat internally with exterior-cooling methods using Lianqiao Shengma Tang (Forsythia and Cimicifuga Decoction)." However, each dense area corresponds to specific meridian regions: the forehead governs the Heart, the face governs the Stomach, the abdomen and limbs govern the Spleen, the hypochondrium governs the Liver, the axillae govern the Lungs, the waist and feet govern the Kidneys, and the shoulders and back govern the Bladder. Treatment should be based on the specific manifestations. If the complexion is yellow, stool is black, accompanied by irritability, panting, thirst, or abdominal distension, this indicates blood stasis inside. Use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or apply fresh rhinoceros horn juice. However, if the base of the pustules is distinct and full, there is no cause for concern.
The most critical aspect is that facial eruptions should be sparse, even, clear, protruding, red, and lustrous. Even if limb eruptions are dense, the patient can survive with proper treatment. Conversely, if facial eruptions are dense and flat, even if limb eruptions are sparse, one cannot lightly deem the prognosis good. Therefore, excessive eruptions on the forehead are called "Meng Tou" (Head Covered), on the neck "Suo Xiang" (Neck Locked), on the chest "Man Xiong" (Chest Concealed), and on the cheeks and jaw leading to confluent patches or vermilion-like redness indicates Liver excess suppressing the Spleen. By the eighth or ninth day, if diarrhea occurs and the patient refuses food, it becomes a critical condition. Eruptions on the limbs, though numerous, are less concerning. Although dense eruptions are generally critical, if facial pustules rise and fill easily, eyes open, and the patient can eat, it is treatable. If body eruptions are good but facial pustules are clear, flat, and unfilled, it is difficult to treat. If eruptions everywhere fail to rise, except for those on the face and buttocks which fill and open, it is treatable. If facial eruptions are good but absent on the nose, or present but fail to rise/fill, it is untreatable. Limb eruptions without body or facial eruptions are difficult to treat. Full-body eruptions with sufficient pus but none on the face result in death. Red and vibrant eruptions throughout the body but scorched and dry on the face result in death. Good eruptions everywhere but completely absent below the knees are ominous. In winter cold preventing eruption, wash repeatedly with warm Huixu Wine (Coriander Wine) and administer internal warming, resolving, and muscle-releasing herbs, adding Mugua (Chaenomeles) and Yiyiren (Coix Seed) to guide them. If delayed until the fifth day, treatment is futile.
If facial pustules are full and scabbed while limb eruptions have not yet filled, but the patient is lucid and eating, it is treatable. Asymmetry, such as presence on the left side of the face but absence on the right, or vice versa, indicates disconnection of Qi and Blood, making filling and opening difficult; these are mostly untreatable. Dense, gray-white eruptions on the lower half of the face with uniform, bright, red eruptions on the upper half should be treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If the upper half is dense, gray, and stagnant while the lower half is uniform, bright, and open, it is named "Yun Yan Tian Ting" (Cloud Covering the Heavenly Court) and is untreatable. Dense, red eruptions on the left half of the body with scattered points on the right indicate toxin manifesting in Yang (favorable); use Buzhong Yiqi Tang. Dense, gray, flat eruptions on the right half with scattered points on the left indicate toxin manifesting in Yin (adverse); although pus forms, it cannot consolidate, leading to death on the ninth day. Uniform, red eruptions all over the body but dense, gray, painful eruptions around the waist are named "Chan Yao" (Wrapping the Waist); toxin stagnates in Yin, fails to form pus, leading to death on the ninth day, or no later than the eleventh day. Dense eruptions all over the body but absent on the head and face indicate Yin toxin failing to ascend to Yang positions; this is untreatable.
For all the above conditions, except those deemed untreatable, one must unblock Ying and Wei (Nutritive and Defensive Qi), strengthen the Spleen, and generate fluids to prevent dryness, scorching, and blackening. Herbs for detoxification like Zicao (Arnebiae Radix et Rhizoma) are indispensable. For severe heat, use Huangqin (Scutellariae Radix), Lianqiao (Forsythiae Fructus), and Digupi (Lycii Cortex); for thirst, use Huafen (Trichosanthis Radix) and Wei Gegen (Prepared Puerariae Radix); for Qi deficiency, use Renshen (Ginseng Radix), [text missing, likely Huangqi or Baizhu], and Muxiang (Aucklandiae Radix); for constipation, use Zhike (Aurantii Fructus); for dysuria, use Mutong (Akebiae Caulis); for poor appetite, use Shanzha (Crataegi Fructus), Zhishi (Aurantii Fructus Immaturus), and Baizhu (Atractylodis Macrocephalae Rhizoma); for itching, use Baizhi (Angelicae Dahuricae Radix) and Chantui (Cicadae Periostracum); for distension, use Muxiang and Houpo (Magnoliae Officinalis Cortex); for abdominal pain, use Shaoyao (Paeoniae Radix) and Dingxiang (Caryophylli Flos). One must also assess the patient's constitution (large/strong vs. small/weak). Strong constitutions may still be treatable; weak constitutions are mostly incurable. As the proverb says: "A tree with few flowers bears little fruit; a small boat overloaded capsizes." This serves as an apt analogy.