夫血痘者，是先气损而气不至，则五日前，血载毒入炮炽脏腑而为内攻，如硕果之
腐仁矣，世无可治之理。陷痘者，是气至不满，不能续其后来，是以七日之后，血悖不
附而毒不化浆乃为外剥，如佳水之无肤矣、然气至虽为不满。若血附有力，辅翊得人，
虽功亏一篑于九仞，亦可以修。
夫顶陷者，是阳虚阴实之象，是以其性好不陷也。总七日前后五陷者，是气不足而
不能拘，血胜毒以成浆也，宜保元汤，加芎归糯米，温胃助气，又以水杨沃洗之，则至
十一二日而浆足者有矣。若血气光泽，有起势者，亦不可过于治也。深恐满而过，盛反
虐百骸。若血死如灰，浆不满足，或血虽归
附不荣而兼有内症者，则生命必不可保矣。
夫倒陷者，是痘既圆晕，充足饱满，势在行浆，忽因泄泻，内虚气陷，故毒亦随其
气血而反陷焉。是气血势离，内外皆虚之象，故满而复陷也。如血不散走，归附鲜
明，则卫获之力，犹在必有可救之理。若血亦罔顾而夹毒攻内者，祸复起于萧墙，其可
救乎。又有峻用发泄毒剂，致伤元气，是以药力一缓，则气血及毒势即陷伏者有之。
凡七日前内溃者，胃烂也。盖因风寒所中，腠理固密，阴阳之分，壅塞不通，是以
气既不能拘血，而血又不能载毒，因乃其毒内攻脏腑之间，毒火炮炽，溃而成脓，其候
唇口与舌皆白，是其验也。故智者，如痘毒未出之时，或有风寒阻隔，气粗热盛，肚腹
急疼而身战动者，急防此患，以升麻汤类，遂散寒邪开泄腠理，纵毒而出，岂有是症也
哉！
血痘，是指先有气虚导致气机不能到达，因此在出痘前五日，血液携带毒邪进入体内，使脏腑受热毒炽盛而内攻，就像果实腐烂后果仁也坏掉一样，这是世间无法治疗的道理。陷痘，是指气机到达但力量不足，不能持续支持后续的化脓过程，因此在出痘七日后，血液悖逆不依附，毒邪不能化为脓浆从而向外剥落，就像好水没有表皮一样。然而，虽然气机到达不足，如果血液依附有力，辅助得当，即使像堆九仞高的山只差一筐土那样功亏一篑，也是可以补救的。
痘顶凹陷，是阳气虚弱、阴邪实盛的征象，所以这种病性容易下陷。总括而言，出痘前后七日内的五种下陷情况，都是由于气不足而不能约束血液，导致血胜毒而难以成浆，适宜使用保元汤，加入川芎、当归和糯米，以温补胃气、助益元气，同时用水杨叶煎汤清洗患处，这样到十一二天脓浆充足的情况是有的。如果血色气血光泽，有起发之势，也不可以过度治疗，深恐药力过猛反而伤害全身百骸。如果血色死灰，脓浆不满，或者血液虽然归附但不荣润且兼有内症者，那么生命就必不可保了。
倒陷，是指痘疹已经圆晕饱满，势在行浆化脓之时，忽然因为腹泻，导致内虚气陷，所以毒邪也随着气血的反陷而陷入。这是气血形势分离，内外皆虚的征象，所以原本饱满却又下陷。如果血液不散走，归附鲜明，那么卫气的力量，必定还有可救的道理。如果血液也不顾惜而夹杂毒邪攻入体内，祸患就会从内部兴起，这还能救治吗？又有因峻烈使用发散解毒药物，损伤元气，因此药力一缓和，气血及毒势就陷入潜伏的情况也是有的。
凡是出痘七日内发生内溃的，是胃烂的表现。大概是因为风寒侵袭，腠理固密，阴阳之气分隔壅塞不通，因此气既不能约束血，血又不能载毒外出，于是毒邪内攻于脏腑之间，毒火炽盛，溃烂而成脓，其候诊表现为嘴唇、口腔和舌头都变白，这就是验证。所以明智的人，在痘毒尚未发出之时，如果有风寒阻隔，出现气粗热盛、肚腹急痛且身体战动的症状，要紧急预防此患，用升麻汤之类的方剂，疏散寒邪，开泄腠理，让毒邪随汗而出，怎么会有这种病症呢！
Blood pox (Xuedou) refers to a condition where Qi deficiency occurs first, preventing Qi from reaching the surface. Consequently, within five days before eruption, blood carries toxic pathogens inward, causing intense heat and fire in the Zang-Fu organs leading to internal attack. This is akin to the kernel rotting when the fruit rots; it is considered incurable in worldly medicine. Sunken pox (Xiandou) refers to a situation where Qi reaches but is insufficient, failing to sustain subsequent pus formation. Thus, after seven days, blood becomes rebellious and fails to adhere, preventing toxins from transforming into pus for external shedding. This is like good water lacking an epidermis. However, although Qi arrival is insufficient, if blood adhesion is strong and support is adequate, even if success is lost by one basketful at nine ren's height (a metaphor for near-complete failure), recovery is still possible.
A sunken apex indicates Yang deficiency and Yin excess. Generally, the five types of sinking occurring around the seventh day are due to insufficient Qi failing to constrain blood, resulting in blood overpowering toxins and hindering pus formation. Baoyuan Tang (Preserve the Origin Decoction) should be used, added with Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), and Glutinous Rice (Nuomi) to warm the Stomach and assist Qi. Washing with a decoction of Populus euphratica leaves (Shuiyang) can lead to sufficient pus by the eleventh or twelfth day. If the blood and Qi appear lustrous and there is a tendency to rise, over-treatment should be avoided to prevent excessive force from harming the entire body. If the blood appears dead like ash, pus is insufficient, or although blood adheres, it lacks nourishment and is accompanied by internal symptoms, life cannot be guaranteed.
Inverted sinking occurs when the pox has formed a complete circle, is full and plump, and is in the stage of pus formation, but suddenly, due to diarrhea, internal deficiency causes Qi to sink. Consequently, toxins also sink along with the Qi and Blood. This is a sign of separation between Qi and Blood dynamics, indicating both internal and external deficiency, hence the transition from fullness to sinking. If blood does not scatter but adheres clearly, the power of Defensive Qi (Wei Qi) remains, suggesting there is still hope for rescue. If blood disregards this and toxins invade internally, disaster arises from within, making rescue difficult. Furthermore, the harsh use of dispersing and detoxifying agents may damage Yuan Qi; thus, when the medicinal effect wanes, Qi, Blood, and toxin trends may sink and lie latent.
Internal ulceration occurring within seven days of eruption indicates rotting of the Stomach. This is typically caused by Wind-Cold invasion, which solidifies the Cou Li (pores/skin texture), blocking the separation of Yin and Yang. Consequently, Qi cannot constrain Blood, and Blood cannot carry toxins outward. Toxins then attack internally within the Zang-Fu organs, where toxic fire blazes, leading to ulceration and pus formation. The diagnostic sign is that the lips, mouth, and tongue turn white. Therefore, wise practitioners, upon observing signs such as rough breathing, high fever, acute abdominal pain, and body tremors during the pre-eruption phase when Wind-Cold obstruction is present, should urgently prevent this complication. Using formulas like Shengma Tang (Cimicifugae Rhizoma Decoction) to disperse Cold pathogens and open the Cou Li allows toxins to exit via sweating, thereby avoiding such conditions.