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Although the variola (smallpox) lesions appear plump, they are internally dry and completely lack blood and fluid; this is termed "Empty Granary" (Kong Cang). If the lesions are hard, it is called "Iron Shell Empty Granary"; when the condition reaches this stage, death is inevitable. In such cases, although Qi appears abundant, Blood must be deficient. Furthermore, if prior treatment failed to resolve toxicity, causing toxic fire to blaze internally, the Blood becomes even more depleted. Since pus/fluid is transformed from Blood, the depletion of Blood results in the "Empty Granaries." A child with a severe outbreak of variola, who was also constitutionally weak, was treated by a physician who did not understand the principles of Qi and Blood. The physician assumed that Baoyuan Tang (Preserve Origin Decoction) was the most stable formula for treating variola and used Ren Shen (Ginseng Root) up to several qian. Consequently, the child's lesions produced no pus or sweat. I was invited to examine the patient and stated: "This is 'Empty Granary.' Try pricking the lesions with a needle." Upon piercing the lesions, there was no blood or fluid. The family was greatly alarmed. I said: "Do not worry; this indicates excess Qi and insufficient Blood. Ren Shen (Ginseng Root) should not be used. Instead, use Chuan Xiong (Sichuan Lovage Rhizome), Zhi Huang Qi (Honey-fried Astragalus Root), Bai Zhi (Angelica Dahurica Root), Niu Bang Zi (Arctium Fruit), and Rou Gui (Cinnamon Bark), each 8 fen; Dang Gui Shen (Angelica Sinensis Root Body) and Lu Rong (Deer Antler Velvet), each 2 qian; Da Sheng Di (Rehmannia Root), 3 qian; Bai Shao (White Peony Root), 1 qian; and Shan Jia Chuan (Pangolin Scales), 4 fen. After administering two doses, the pus began to form." Subsequently, Niu Bang Zi (Arctium Fruit) was removed, and the treatment focused on nourishing Blood as the sovereign herb and tonifying Qi as the minister herb. With sufficient pus formation, the patient recovered.

If the lesions do not swell significantly, with the periphery raised but the center slightly depressed, and if chaotic patterns appear on the apex resembling cornel fruit (Zhu Yu), it is named "Cornel Variola" (Zhu Yu Dou). This condition inevitably leads to empty pus and inversion, resulting in death. This occurs because the pathogenic factor is excessive while the Middle Qi is deficient, causing the lesion apex to have patterns rather than being sharp and round. A child presented with such symptoms, and all physicians deemed it difficult to treat. Upon examination, I observed many black centers (Hei Yan) within the lesions. I stated: "Due to coagulated toxicity preventing Qi from ascending, the toxicity is about to invade the Zang-Fu organs. Urgent resolution of toxicity and promotion of Qi circulation can still save the patient. It has only been six days since onset." Therefore, I prescribed Sheng Huang Qi (Astragalus Root), Niu Bang Zi (Arctium Fruit), and Lian Qiao (Forsythia Fruit), each 1 qian; Chi Shao (Red Peony Root), 8 fen; Sheng Ma (Cimicifuga Rhizome) and Bai Zhi (Angelica Dahurica Root), each 6 fen; Huang Qin (Scutellaria Root), 5 fen; Huang Lian (Coptis Rhizome), 2 fen; Gan Cao (Licorice Root), 2 fen; Chuan Xiong (Sichuan Lovage Rhizome), 1 fen; and Chan Tui (Cicada Slough), two pieces. Externally, the area was washed with decoction made from Yang Liu (Willow Branch). After several doses, the lesions gradually became round and clean, and the patterns and black centers disappeared. Thereafter, treatment focused on tonifying Qi as the sovereign herb and nourishing Blood as the minister herb, leading to complete recovery. I have treated many such cases; initially, resolving toxicity and promoting Qi circulation is essential to eliminate the cornel-like patterns.