朱济川曰。痘未起发而头面先肿者。此阳火亢盛。阴血不能归附。气血相离之象。若痘疮起
发。头面以渐而肿者。此毒瓦斯发越。聚于三阳。欲作脓血。故宜肿也。设当起发而头而不肿者。必
痘本磊落。毒势轻浅。所以不肿。如痘本稠密。起发应肿不肿。此毒伏于内。不能发越。治宜助
正为主。如痘稀疏。起发不应肿而肿者。此感疫毒之邪。须兼疫气而治。如应肿而平塌如饧饼。
或痘肉齐平。或干焦紫滞者。此毒盛气虚。不治之证也。大凡应肿者。直至浆满结 。毒化而
肿消目开为吉。若浆未充足而肿消目开者。此正气不足。不能化毒成浆。名为倒 。乃凶兆也。闻
人氏云。痘疹属火。面色赤者为顺。赤甚为热。若肝木克脾。面色青者。是为逆也。急用四君子
或附子理中并加升麻。调补脾胃。色正方许可治。有痘毒遇风寒相搏。凝滞于肌肉。遍身皮肤色
青。急用夺命丹发之。然多不救。
朱济川曰。额乃心之部分。若痘出遍处平黯。而正额匀朗。绽凸红润。调理无虞。遍处虽匀
红绽。而正额平塌。灰滞无神者。此元气不足。不能成功于上。凶也。正额虽平塌。而间有数点
尖绽者。险也。又须两颧颊来助。若颧颊不起发。无
润泽。为气血不足。终不可治也。若眉心密簇如钱。而色灰滞。虽遍身朗绽。八九日浆行俱满。
眉心必空壳无水。后必痒塌倒 喘胀而死。
朱济川说：痘疹尚未起发，而头面部先出现肿胀的，这是阳火亢盛，阴血不能依附于阳气，是气血分离的征象。如果痘疮起发后，头面部逐渐肿胀的，这是毒气发散，聚集在太阳、阳明、少阳三阳经，即将化脓成血，所以应当肿胀。假如到了该起发的时候，头面却不肿胀，一定是因为痘疹本身稀疏磊落，毒势轻浅，所以不肿。如果痘疹本来稠密，到了该起发应该肿胀的时候却不肿，这是毒邪伏藏在体内，不能发散出来，治疗应当以扶助正气为主。如果痘疹稀疏，到了不该肿胀的时候却肿胀了，这是感染了疫毒之邪，必须兼顾治疗疫气。如果应当肿胀，但痘形平塌像饧饼一样，或者痘肉与皮肤齐平，或者干枯焦黑、颜色紫暗滞涩的，这是毒盛而气虚，属于不治之症。大凡应当肿胀的，直到浆液充满、结痂脱落，毒邪化解而肿胀消退、眼睛睁开，才是吉兆。如果浆液还未充足，肿胀就消退、眼睛就睁开的，这是正气不足，不能化毒成浆，称为“倒靥”，是凶险的征兆。闻人氏说：痘疹归属于火，面色红润的是顺证，红得过分则是热盛；如果肝木克制脾土，面色发青的，就是逆证，急需使用四君子汤或附子理中汤，并加入升麻，来调补脾胃，颜色正常方正后才可治愈。如果有痘毒遇到风寒相互搏结，凝滞在肌肉之间，导致遍身皮肤颜色发青，急需使用夺命丹来发散毒邪，然而大多难以救治。
朱济川说：额头是心的外候部分。如果痘疹发出遍布全身都平坦色暗，而正额头均匀明朗，绽开凸起且红润，调理就没有忧虑。如果遍身虽然均匀红润绽开，而正额头平塌，色泽灰暗滞涩没有神气的，这是元气不足，不能在头部取得成功，是凶兆。正额头虽然平塌，但间或有几点尖挺绽开的，是险证。又需要两颊颧骨部位来辅助。如果颧颊不起发，没有润泽，这是气血不足，终究不可治愈。如果眉心密集簇拥如铜钱状，而色泽灰暗滞涩，即使遍身明朗绽开，到第八九日浆液运行全部充满，眉心必然变成空壳无水，后来必定因为瘙痒塌陷、倒靥、气喘腹胀而死。
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.