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。
**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.