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Zhu Jichuan said: If the head and face swell before the smallpox (Xiaozhen, 痘疹) erupts, this indicates hyperactive Yang fire (Yang Huo, 阳火), where Yin blood (Yin Xue, 阴血) cannot adhere to Qi, presenting a sign of separation between Qi and Blood. If the head and face gradually swell as the lesions erupt, this indicates that the pathogenic toxins (Du Wa, 毒瓦斯) are dispersing and accumulating in the Taiyang, Yangming, and Shaoyang meridians, preparing to suppurate; thus, swelling is appropriate. If the lesions should be erupting but the head and face do not swell, it implies that the lesions are naturally sparse and distinct, with mild and superficial toxin intensity, hence no swelling. If the lesions are originally dense but fail to swell when they should, the toxins are latent internally and unable to disperse; treatment should primarily focus on supporting healthy Qi (Zheng Qi, 正气). If the lesions are sparse but swell when they should not, this indicates infection by epidemic toxic pathogens (Yi Du, 疫毒); one must treat both the epidemic Qi (Yi Qi, 疫气) and the condition. If swelling is indicated but the lesions remain flat like a pancake, or if the lesion flesh is level with the skin, or dry, scorched, and purple-stagnant, this indicates excessive toxins and deficient Qi, constituting an incurable syndrome. Generally, for cases requiring swelling, auspiciousness is seen when the pustules fill completely, scabs form, toxins resolve, swelling subsides, and the eyes open. If swelling subsides and eyes open before the pus is sufficiently filled, this indicates insufficient healthy Qi unable to transform toxins into pus, termed "Dao Ye" (Inverted Crusting, 倒靥), which is an ominous sign. Wenren Shi stated: Smallpox belongs to Fire. A ruddy complexion indicates a favorable course; extreme redness indicates heat. If Liver Wood overacts on Spleen Earth, resulting in a bluish complexion, this is an unfavorable course. One must urgently use Si Jun Zi Tang (Four Gentlemen Decoction) or Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) added with Shengma (Cimicifugae Rhizoma), to regulate and tonify the Spleen and Stomach. Treatment is permissible only when the color becomes normal and upright. If smallpox toxins contend with Wind-Cold, stagnating in the muscles and causing the entire body's skin to turn blue, one must urgently use Duoming Dan (Life-Rescuing Pill) to vent the toxins, though most cases remain untreatable.

Zhu Jichuan said: The forehead is the external manifestation area of the Heart. If lesions erupt uniformly flat and dark across the body, but the central forehead is even, bright, protruding, and ruddy, there is no worry in management. If the body is uniformly ruddy and erupting, but the central forehead is flat, grayish, stagnant, and spiritless, this indicates insufficient Yuan Qi (Primordial Qi, 元气) failing to achieve success in the upper region, which is ominous. If the central forehead is flat but has a few points that are sharp and erupting, it is dangerous. Assistance from the cheekbones is also required. If the cheekbones fail to erupt and lack moisture/luster, indicating deficiency of Qi and Blood, it is ultimately incurable. If the glabella is densely clustered like coins with a grayish, stagnant color, even if the rest of the body is bright and erupting, and by the eighth or ninth day the pus is fully formed, the glabella will inevitably become an empty shell without fluid. Subsequently, death will occur due to itching, collapse, inverted crusting, wheezing, and abdominal distension.