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Whenever pox (smallpox/chickenpox) presents with pain during the eruption phase, there are several patterns. One pattern is where pathogenic toxins desire to exit, and Qi and Blood follow, causing muscle tension and tightness leading to pain; Huoxue San (Blood-Invigorating Powder) is appropriate. Another pattern is where the skin is thick and flesh dense, combined with external cold attacking and clashing, causing pain; Gegen Tang (Kudzu Decoction) is appropriate. If heat-toxin is severe, Xiaodu San (Toxin-Clearing Powder) is appropriate. If caused by consuming chicken, fish, or alcohol, Qingwei San (Stomach-Clearing Powder) is appropriate. If there is fever with a desire for cold drinks but bowel movements are harmonious, only Siwu Tang (Four Substances Decoction) combined with Lianqiao (Forsythiae Fructus) is appropriate. If there is fever with a desire for cold drinks, constipation, and excess heat in the Spleen and Stomach, one may clear Stomach heat and moisten dryness. If there is fever, thirst, and a desire for hot soups due to deficient heat in the Spleen and Stomach, Baizhu San (Atractylodes Macrocephala Powder) should be administered. Within six days of onset, dispersing methods are mostly used; after six days, blood-invigorating methods are mostly used. For pain caused by dryness and stagnation, bathing in Shuiyang Tang (Willow Bark Decoction) is recommended. If pain is severe during the crusting stage and treatment fails to resolve it, the prognosis is ominous. Generally speaking, pain in the anterior body indicates involvement of the Lung; pain in the posterior body indicates involvement of the Bladder; pain on the sides of the body indicates involvement of the Gallbladder; pain in the four limbs indicates involvement of the Stomach. It is imperative to stop the pain promptly; otherwise, shouting will damage Qi, and enduring pain will damage Blood, leading to various complications. Thus, patients with pox should not overconsume toxic or irritating foods, which refers to this principle. If the crusts become dry and hard and painful, applying butter externally to moisten the area and taking internally cooling and detoxifying herbs is sufficient.

(Suijin Section)

Three days after the appearance of pox, the lesions should gradually swell. Those that appeared first swell first, and those that appeared later swell later. For every unit of swelling in the lesion, one unit of toxin is expelled. When the lesions have fully swollen, the toxin is completely expelled. If the roots are red and blooming, the tops are full and protruding, the face and eyes are gradually swollen, diet and excretion are normal, and there are no other symptoms, this is auspicious. This indicates abundant Qi and flourishing Blood internally, manifesting outwardly, with toxins controlled, naturally transforming into pus without needing treatment. For all pox lesions, from initial appearance to crusting, the interior of the lesion should appear dark/dull while the exterior remains lustrous. This is called "Yang on the outside, Yin on the inside," representing the image of Shaoyin Junhuo (Ministerial Fire). The reverse is ominous. If both interior and exterior are bright/lustrous, it is pure Yang without Yin, requiring blood-nourishing treatment. If both interior and exterior are dark/dull, it is pure Yin without Yang, requiring Qi-tonifying treatment. The toxin of pox must be warmed by Qi and moistened by Blood to mature. Therefore, during the swelling phase, if the lesions are bright and robust, Qi is in excess. If they are plump and lustrous, Blood is in excess. If Qi and Blood are sufficient and the interior and exterior are harmonious, no medication is needed. When pox reaches the swelling phase, the top of each lesion must have a small depression, known as the "pox eye." If the base is wide and spreading, the pus color is pale white, and there is no pox eye on the top, this is termed "Water Pox" (likely referring to a mild form or chickenpox-like presentation).