夫木枯则折，土燥则裂，痘之囊房，不甚充满，则爬破之症，所自来矣。但爬破不
关乎要处，则脓血虽少，犹可全活。若爬破要所，如观脸头面，是五脏精华之所聚，痘
毒藉之为囊房，犹人之有舍，物之有巢，鱼得水而肥，鸟得食而进也。今囊房既破，毒
无栖止之所，况荣阴耗竭，元气外亡，安得不乘虚而内入耶！有效女娲补天之法，用纸
封固者，亦必赖夫脾胃内强而能食，气血未残而能溃，斯有济耳。
歌曰∶水试浆来未满囊，疮头有孔漏脓浆，依然转聚封疮孔，泄去真津毒瓦斯藏。淡
痘作脓窠之时，最要皮浓，包果完固，如脓未成，而头有孔，其水漏出，结聚成团，堆
于孔外者，或水去囊空而干黑者，此名漏疮，其症必死。若脓热之后，囊皮亦热，是
以浆水沸出，因而结靥者，此头额正面之间，屡多有之，此俗谓堆屎收不可以漏疮论
也。盖漏疮则脓未成，堆尿收则因脓过熟也。
凡至养脓而饱满者，脓已成也。混浊者，脓之形也。黄白者，脓之色也。若至期
而犹然空壳者，此气载毒行而血不附气，实因气弱而血衰，不能互相其用以化毒。然毒
本无形，假于血也。血既不至，则毒犹伏于中而不出，治宜补血托脓。如已成水而清淡
灰白，不能浓浓者，此气血皆虚，即所有之水，乃初出一点之血，今解而为水，是非内
潮后起之水也，治宜大补气血。若正将作脓而感受风寒，乃停浆者，治宜温散而兼托
里。若因触犯秽气而停浆者，宜外熏解而内攻托。若因便秘而不作脓者，宜微利下。若
灰白或痒，而脓不贯者，宜温补其气。若紫赤，或痒而脓不贯者，宜凉补其血、否则，
甚为痒塌不救，轻为痈毒余愆矣。
痘有空壳无浆者，多因三五日之间，身热太盛气血蒸干，是以不能流通而为浆。更
有热难起胀，翳用峻攻之剂，虽已劫成浮 ，然气血已竭，不能续其后来，是以浆水
不生者。然头乃诸阳之会，故浆必先于此满足，次及胸胁腰膝之间，有至八九日来，头
上方有微浆，色即苍腊而欲收靥，身上之浆稍灌，腰膝之处全无者，是皆血气已竭，生
意绝矣。更有面上才少有浆而即肿消 退，两眼开闭不宁，舌头伸缩无度，此系毒瓦斯入
内之状，不旋重而告变矣。
树木干枯就会折断，土壤干燥就会龟裂。痘疹的囊房（痘疱）如果不甚充满，爬破的症状也就由此产生了。但是，如果爬破的部位不关乎要害之处，那么即使脓血很少，仍然可以保全生命。如果爬破的是要害部位，比如头面五官，这是五脏精华汇聚的地方，痘毒借这里作为囊房，就像人有房舍、物有巢穴，鱼得水而肥壮，鸟得食而进食一样。如今囊房既然破裂，毒邪就没有栖息停留的地方了，况且营阴耗竭，元气外泄流失，毒邪怎么能不乘虚内陷呢！如果有采用女娲补天那样的方法，用纸封固疮口的，也必定要依赖脾胃内部强健且能进食，气血没有残损且能化脓溃破，这样才有救治的希望。
歌诀说：水试浆来未满囊，疮头有孔漏脓浆，依然转聚封疮孔，泄去真津毒瓦斯藏。淡痘在作脓窠的时候，最要紧的是皮肉浓密，包裹果实完好坚固。如果脓还没有形成，而痘头有孔，其中的水液漏出，结聚成团，堆积在孔外的，或者水液流去后囊房变空而干黑的，这名叫漏疮，这种病症必然致死。如果在脓热之后，囊皮也发热，因此浆水沸腾涌出，因而结痂的，这在头额正面之间屡见不鲜，这是世俗所说的“堆屎收”（指痘顶平塌如堆屎），不可以当作漏疮来论述。因为漏疮是脓未形成，堆屎收是因为脓过熟所致。
凡是到了养脓阶段而饱满的，说明脓已经形成了。浑浊的，是脓的形态。黄白色的，是脓的颜色。如果到了该期却仍然是空壳的，这是因为气载毒行而血不附气，实在是因为气弱而血衰，不能互相作用以化解毒邪。然而毒本来是无形的，假借于血而存在。血既然不到达，那么毒就潜伏在体内而不能排出，治疗应当补血托毒排脓。如果已经化成水但清淡灰白，不能浓稠的，这是气血都虚弱，即使有的水，也是初出的一点血，现在分解为水，这不是内潮之后生成的水，治疗应当大补气血。如果正准备作脓时感受风寒，导致停浆（停止化脓）的，治疗应当温散兼以托里。如果因触犯秽气而导致停浆的，适宜外用熏洗解毒而内服攻托之剂。如果因便秘而不作脓的，适宜轻微通下。如果颜色灰白或发痒，而脓不透发的，适宜温补气机。如果颜色紫赤，或发痒而脓不透发的，适宜凉补血液，否则，严重时会因瘙痒塌陷而无法救治，轻则会留下痈毒的后患。
痘疹有空壳无浆的情况，多因为在三到五天之间，身体发热太盛，气血被蒸干，所以不能流通化为浆液。更有甚者，因热势难起胀，误用峻猛攻下的药剂，虽然已劫夺成浮痘，然而气血已经枯竭，不能接续后续的生发，所以浆水不生。然而头部是诸阳经会合之处，所以浆液必须先在这里满足，其次才波及胸胁腰膝之间。有到了八九天，头上方只有微量浆液，颜色苍老蜡黄而欲结痂，身上浆液稍灌，腰膝处完全没有的，这都是气血已竭，生机断绝了。更有面上刚有一点少浆就肿消退去，两眼开闭不安宁，舌头伸缩无度的，这是毒邪瓦斯入内的征象，不久就会病情加重而发生变化。
When wood is withered, it breaks; when soil is dry, it cracks. If the vesicles (pustules) of smallpox are not sufficiently filled, the condition of rupture by scratching naturally arises. However, if the rupture does not occur at critical locations, even if there is little pus and blood, life can still be preserved. If the rupture occurs at critical locations, such as the face and head, which are the gathering places of the essence of the Five Zang organs, where the smallpox toxin uses as a vesicle—just as humans have houses and objects have nests, fish become fat in water, and birds advance when they have food—now that the vesicle has broken, the toxin has no place to reside. Moreover, since Ying-Yin (nutritive Yin) is exhausted and Yuan-Qi (original Qi) escapes outward, how can the toxin not penetrate inward taking advantage of the deficiency? Even if methods similar to Nuwa mending the sky are employed, sealing the wound with paper, one must still rely on strong Spleen and Stomach function allowing for eating, and un-depleted Qi and Blood capable of suppuration and ulceration, for there to be any hope of rescue.
The song states: "Water test reveals the sac is not full, sores have holes leaking pus and fluid; gather again to seal the sore hole, draining true essence while toxins hide." When pale smallpox forms pustular sacs, it is most crucial that the skin be thick and the covering intact. If pus has not yet formed but there are holes on the sore heads, causing fluid to leak out, gather into clumps, and pile outside the holes, or if the fluid drains away leaving empty sacs that turn dry and black, this is named "Leaking Sores" (Lou Chuang), a condition that is invariably fatal. If after the heat of pus formation, the sac skin is also hot, causing the fluid to boil out and subsequently form scabs, this frequently occurs on the front of the forehead and face. This is colloquially known as "Pile-Shit Scabbing" (Dui Shi Shou) and should not be discussed as Leaking Sores. The reason is that Leaking Sores involve unformed pus, whereas Pile-Shit Scabbing results from over-mature pus.
When the stage of nourishing pus is reached and the lesions are full, it indicates that pus has formed. Turbid appearance is the shape of the pus; yellowish-white color is the hue of the pus. If, upon reaching the appropriate time, the lesions remain empty shells, this is because Qi carries the toxin while Blood fails to adhere to Qi, truly due to weak Qi and declining Blood, unable to mutually assist in transforming the toxin. Since toxin is originally formless and relies on Blood, if Blood does not arrive, the toxin remains latent within and cannot exit. Treatment should focus on tonifying Blood to support pus expulsion. If the fluid has already formed but is clear, pale, and grayish-white, lacking thickness, this indicates both Qi and Blood are deficient. Even the existing fluid is merely an initial drop of Blood now dissolved into water, not water generated after internal tide onset; treatment requires major tonification of Qi and Blood. If wind-cold is contracted just as pus is about to form, causing stagnation of fluid, treatment should involve warming and dispersing combined with interior support. If stagnation of fluid is caused by contact with foul odors, external fumigation for detoxification combined with internal attacking and supporting agents is suitable. If constipation prevents pus formation, mild purgation is indicated. If the color is grayish-white or itchy, with non-penetrating pus, warming and tonifying Qi is appropriate. If the color is purple-red or itchy, with non-penetrating pus, cooling and tonifying Blood is required; otherwise, severe cases may result in intractable itching and collapse, while mild cases leave behind residual carbuncle-toxin liabilities.
Empty shells without fluid in smallpox often occur because excessive body heat between the third and fifth days steams and dries up Qi and Blood, preventing them from circulating and transforming into fluid. Furthermore, if heat makes distension difficult and harsh purgative formulas are mistakenly used, although floating pustules may temporarily form, Qi and Blood are already exhausted and cannot sustain subsequent generation, resulting in no fluid production. The head is the meeting point of all Yang meridians; therefore, fluid must first fill here before spreading to the chest, hypochondrium, waist, and knees. In cases lasting eight or nine days, if only slight fluid appears on the upper head, turning old and waxy-yellow ready for scabbing, while the body has some fluid and the waist/knees have none, this signifies exhaustion of Qi and Blood and cessation of vital energy. Additionally, if facial swelling subsides quickly after minimal fluid appears, eyes open and close restlessly, and the tongue extends and retracts uncontrollably, these are signs of toxin entering internally, indicating imminent deterioration.