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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.