诸痛为实，诸痒为虚。谓之实者，邪气实也。谓之虚者，正气虚也。又，疮疹为火，火盛则痛，火微则痒，故常
作痛者，此邪气之实也。盖痘疮之毒，发于皮肤肌肉之间，气以束之，血以润之，酝酿其毒，以抵于化，正气周
旋而不舍，毒瓦斯变化而未成，郁而作痛，此其常也，毒化脓成，其痛自止。若肉如刀剜，肤如锥刺，一向痛而不止，
大叫多哭，此则皮伤肉败，不胜其毒，又痛之变也。常作痒者，此正气之虚也。经曰∶胃者，水谷之海，六腑之大
原也。五味入口，藏于胃，以养五脏，胃气既虚，则水谷不化，津液内竭，不能输精于皮毛，气失其卫，血失其荣，
不能酝酿毒瓦斯，以至于成，使毒瓦斯浮沉，隐伏聚散，倏忽灼于皮毛，所以痒也，此其为异，补其气血，和中托里，其
痒必止。若一向瘙痒，时甚一时，爬抓破坏，皮脱肉坑者，此毒瓦斯内陷，正气外脱，不旋踵而告变矣。如先痛后
痒者，此常候也，
盖先则毒未解化，其火正盛，宜尔作痛，厥后脓成毒解，火气渐微，宜尔作痒也。
《活人书》治痘疮痛，用温惊丸（惊）水化下。海藏治疮出烦痛，用五物木香散。薛云∶若身后痛，属膀胱经也，
用羌活荆芥甘草汤（即此三味等分）。身前痛，属肺金也，用升麻葛根紫草汤。身侧痛，属胆经也，用柴胡山栀
连翘防风汤（即此四味等分）。四肢痛，属胃经也，用防风芍药甘草汤（即此三味等分）以急止之，盖恐叫号伤气，
忍痛伤血，而变证也。若热毒盛者，用东垣消毒散（大法），或仙方活命饮（痘后余毒）。食鸡鱼葡萄酒物者，
用东垣清胃散、生犀汁。若发热饮冷，大便调和，用四物连翘牡丹皮。若发热饮冷，大便秘结，脾胃实热也，用清
凉饮（发热）。若发热作渴饮汤者，脾胃虚热也，用七味白术散（渴）。大凡痘切不可食毒物，恐作痛致伤元气，轻
者反重，重者难治，大人亦然。
痘疮起发，痛者有二，一则毒邪欲出，气血随之，肌肉 急而痛，九味顺气散（起发）合活血散（出不快）主之。
一则皮肤浓，肉理密，为外寒相搏而痛，桂枝葛根汤主之（初热）。
五物木香散 治疮出烦痛。
青木香（二两） 丁香 零陵香（各一两） 麝香（一分） 白矾（一两）
每服四钱，水一小盏半，煎服之。热盛者，加犀角一两，如无犀角，以升麻代之，轻者，一服大效。
又方 以芒硝和猪胆涂疮上，令动，痂落无瘢，仍用黄土抹之良。此病小便涩有血者，中坏，疮背黑
靥，不出脓者，死不疗。
青黛散 治痘未作脓，痛甚，心膈烦躁，睡卧不安，并宜服之。
真青黛如枣核大，水调服之，即安。
〔世〕痘将结靥，干硬而痛，宜涂酥润之，靥可揭去则去之。如无酥用猪油煎汁代之。此痛非服药可免也。
All pains belong to excess syndromes, and all itches belong to deficiency syndromes. By "excess," it is meant that the pathogenic factor is excessive. By "deficiency," it is meant that the healthy Qi (Zhengqi, 正气) is deficient. Furthermore, sores and rashes are caused by Fire (Huoxie, 火邪). When Fire is vigorous, there is pain; when Fire is weak, there is itching. Therefore, those who constantly experience pain have an excess of pathogenic factors. Generally, the toxin of smallpox erupts between the skin and muscles. Qi binds it, Blood (Xue, 血) moistens it, and they ferment the toxin to reach a state of transformation. The healthy Qi circulates around without leaving, while the toxic gas changes but has not yet fully formed. Stagnation causes pain, which is the normal situation. When the toxin transforms into pus and matures, the pain naturally stops. If the flesh feels as if cut by a knife, and the skin as if pierced by an awl, with continuous pain, loud crying, and frequent weeping, this indicates damage and decay of the skin and flesh, inability to withstand the toxin, representing a variation in pain. Constant itching indicates deficiency of healthy Qi. The Classics state: The Stomach (Wei, 胃) is the sea of water and grain, and the great source of the Six Fu-organs (Liufu, 六腑). The five flavors enter the mouth, are stored in the Stomach, and nourish the Five Zang-organs (Wuzang, 五脏). If Stomach Qi is deficient, water and grain cannot be transformed, internal fluids (Jinye, 津液) become exhausted, and essence cannot be transported to the skin and hair. Qi loses its defensive function, and Blood loses its nourishing function. They cannot ferment the toxic gas to maturity, causing the toxic gas to float and sink, hide and disperse, suddenly burning the skin and hair, thus causing itching. This is the abnormality. Tonifying Qi and Blood, harmonizing the Middle Jiao (Zhongjiao, 中焦), and supporting the interior to expel toxins will surely stop the itching. If there is constant itching, varying in intensity, scratching leads to destruction, skin peeling, and flesh sinking, this indicates the toxin sinking inward and healthy Qi escaping outward, leading to rapid disease transformation. Pain followed by itching is a normal pattern. Initially, the toxin is unresolved and untransformed, and Fire is vigorous, hence pain occurs. Later, pus forms, the toxin resolves, and Fire gradually weakens, hence itching occurs.
The *Huoren Shu* treats smallpox pain using Wenjing Wan (Warm Shock Pill) taken with water. Haizang treats irritability and pain from erupting sores using Wuwu Muxiang San (Five-Ingredient Costus Powder). Xue Ji stated: Pain on the posterior body belongs to the Bladder Meridian (Pangguang Jing, 膀胱经); use Qianghuo Jingjie Gancao Tang (Notopterygium, Schizonepeta, and Licorice Decoction, consisting of equal parts of these three herbs). Pain on the anterior body belongs to Lung Metal (Fei Jin, 肺金); use Shengma Gegen Zicao Tang (Cimicifuga, Pueraria, and Arnebia Decoction). Pain on the lateral body belongs to the Gallbladder Meridian (Dan Jing, 胆经); use Chaihu Zhizi Lianqiao Fangfeng Tang (Bupleurum, Gardenia, Forsythia, and Saposhnikovia Decoction, consisting of equal parts of these four herbs). Pain in the four limbs belongs to the Stomach Meridian (Wei Jing, 胃经); use Fangfeng Shaoyao Gancao Tang (Saposhnikovia, Peony, and Licorice Decoction, consisting of equal parts of these three herbs) to stop it urgently, lest crying injure Qi and enduring pain injure Blood, leading to complications. For severe heat-toxin, use Dongyuan Xiaodu San (Dongyuan's Toxin-Resolving Powder, based on general principles) or Xianfang Huoming Yin (Immortal Formula for Life Preservation, for residual toxin after smallpox). For consumption of chicken, fish, wine, or grapes, use Dongyuan Qingwei San (Dongyuan's Stomach-Clearing Powder) or raw Rhinoceros Horn Juice (Sheng Xi Zhi, 生犀汁). For fever with desire for cold drinks and regular bowel movements, use Siwu Tang (Four Substances Decoction) plus Lianqiao (Forsythia) and Mudanpi (Tree Peony Bark). For fever with desire for cold drinks and constipation, indicating Stomach-Spleen excess-heat, use Qingliang Yin (Cooling Decoction, for fever). For fever with thirst and desire for hot drinks, indicating Stomach-Spleen deficiency-heat, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder, for thirst). Generally, patients with smallpox must avoid toxic foods, lest pain arise and injure Yuan Qi (Primary Qi, 元气), turning mild cases severe and severe cases incurable; this applies to adults as well.
During the eruption stage of smallpox, there are two types of pain. One type is where the pathogenic toxin desires to emerge, Qi and Blood follow, causing muscle tension and pain; treat with Jiawei Shunqi San (Nine-Ingredient Qi-Regulating Powder, for eruption) combined with Huoxue San (Blood-Invigorating Powder, for slow eruption). The other type is where the skin is thick and texture dense, attacked by external Cold (Waihan, 外寒), causing pain; treat with Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction, for initial heat stage).
Wuwu Muxiang San (Five-Ingredient Costus Powder): Treats irritability and pain from erupting sores.
Qingmuxiang (Aucklandiae Radix, 2 liang), Dingxiang (Caryophylli Flos, 1 liang each), Linglingxiang (Lingzhi Fragrant Herb, 1 liang each), Shexiang (Moschus, 1 fen), Baijian (Alumen, 1 liang).
Take 4 qian per dose, decoct in 1.5 small cups of water. For severe heat, add 1 liang of Xijiao (Rhinocerotis Cornu, 犀角); if unavailable, substitute with Shengma (Cimicifugae Rhizoma, 升麻). For mild cases, one dose yields significant effect.
Another prescription: Mix Mangxiao (Natrii Sulfas, 芒硝) with pig bile and apply to the sores to promote movement; scabs will fall off without scars. Applying yellow earth afterwards is also beneficial. If urine is astringent with blood, it indicates severe deterioration. If the back of the sore is black and crusted without pus, it is fatal and untreatable.
Qingdai San (Indigo Naturalis Powder): Treats smallpox that has not yet suppurated, with severe pain, irritability in the chest and diaphragm, and restlessness in sleep.
Zhen Qingdai (Indigo Naturalis, 真青黛) the size of a jujube pit, mixed with water and taken orally brings immediate relief.
[Shi] When smallpox is about to form scabs, if dry, hard, and painful, apply butter to moisten it. Remove the scab if it can be peeled off. If butter is unavailable, use rendered lard instead. This type of pain cannot be avoided by medication alone.