经曰。诸寒为痛。又曰。甚热则痛。又曰。诸痛为实。三说不同。各有其理。当热作之时。毒
始营运。忽遇暴寒折之。毒邪壅于皮肤之间。不能宣发。此因寒而痛也。宜透肌运表。如烦躁渴
甚。狂言 语。便秘溺赤。更值春暄夏炎之令。痘见干红焦紫。就火热而痛甚。就阴凉而痛衰。
此因热而痛也。宜清凉化毒。若身不壮热。口不烦渴。饮食如常。二便清调。痘见尖绽红泽。至
七八日浆极充满。惟觉根窠胀痛。此诸痛为实。宜平和疏养。若初出而身痛者。为发未尽。升麻
汤。冬月加蜜炙麻黄二三分。既出稠密而身痛。为毒盛瘀血也。犀角消毒饮倍连翘加紫草。兼腰
背痛者。肝盛血凝也。泻青丸减大黄加甘草、防风。便秘腹胀。四肢厥冷。腰痛疮色紫黑者。难
治。百祥丸。若遍身如啮而色紫者。瘀毒壅滞。最危之兆。若二便秘结。喘急烦躁。栀子仁散。
自利不食者。不治。若身后痛属太阳经。用羌活、防风、甘草。身前痛属阳明经。用升麻、葛根、
紫草。身侧痛属少阳经。用连翘、柴胡、防风。四肢痛属脾经。用防风、芍药、甘草急止之。盖
恐叫号伤气。
忍痛伤血。而致变证也。若食鸡鱼酒物而致者。清胃散加生犀汁。大凡痘疮。切不可食毒物。恐
作痛致伤元气。轻者反重。重者难治。然有专取毒物以攻其毒。如猪尾膏、鸡冠血、攻毒汤等方
之义。不可以此碍彼也。
The *Yellow Emperor's Inner Classic* states: "Various cold pathogens cause pain." It also states: "Extreme heat causes pain." Furthermore, it states: "Various pains belong to excess patterns." Although these three statements differ, each has its own rationale.
When the fever of smallpox erupts, the pathogenic toxin begins to circulate. If suddenly encountered by violent cold that obstructs it, the toxic pathogen becomes stagnant between the skin and muscles, unable to be diffused and released. This is pain caused by cold. The appropriate treatment is to vent the muscle layer and move the exterior, such as using Shengma Tang (Corydalis Decoction). If accompanied by restlessness, extreme thirst, delirious speech, constipation, and dark urine, and if this occurs during the warm spring or hot summer seasons, with the pustules appearing dry, red, purple, and scorched, where pain intensifies in heat and subsides in coolness, this is pain caused by heat. The appropriate treatment is to clear heat and resolve toxicity.
If there is no high fever, no irritability or thirst in the mouth, normal diet, and clear and regulated urination and defecation, and if the pustule tips have opened with a ruddy and lustrous color, reaching the seventh or eighth day with the pus extremely full, yet only feeling distending pain at the root of the pustules, this falls under the category of "various pains belong to excess." The appropriate treatment is peaceful regulation and nourishment.
If body pain occurs immediately upon the eruption of the rash, it indicates that the toxin has not fully emerged; use Shengma Tang (Corydalis Decoction), adding two to three fen of honey-fried Ephedrae Herba (Mahuang) in winter. If body pain occurs after the rash has erupted densely, it indicates abundant toxin and blood stasis; use Xijiao Xiaodu Yin (Rhino Horn Detoxification Drink), doubling the dosage of Forsythiae Fructus (Lianqiao) and adding Lithospermi Radix et Rhizoma (Zicao).
If accompanied by lower back and back pain, it indicates liver qi excess and blood coagulation; use Xieqing Wan (Draining the Liver Pill), removing Rheum Palmatum Radix et Rhizoma (Dahuang) and adding Glycyrrhizae Radix et Rhizoma (Gancao) and Saposhnikoviae Radix (Fangfeng).
If constipation, abdominal distension, cold limbs, lower back pain, and purple-black lesion color are present, it is difficult to treat; use Baixiang Wan (Hundred Auspicious Pills).
If the entire body feels pain as if bitten by insects, with a purple-dark color, it indicates stagnation of stasis-toxin, which is a sign of critical danger. If both urination and defecation are obstructed, accompanied by panting, urgency, and restlessness, use Zhizi Ren San (Gardenia Seed Powder).
If spontaneous diarrhea occurs and the patient cannot eat, it is incurable.
Pain in the posterior part of the body belongs to the Taiyang Meridian; use Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), and Glycyrrhizae Radix et Rhizoma (Gancao). Pain in the anterior part of the body belongs to the Yangming Meridian; use Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), and Lithospermi Radix et Rhizoma (Zicao). Pain on the lateral side of the body belongs to the Shaoyang Meridian; use Forsythiae Fructus (Lianqiao), Bupleuri Radix (Chaihu), and Saposhnikoviae Radix (Fangfeng). Pain in the four limbs belongs to the Spleen Meridian; use Saposhnikoviae Radix (Fangfeng), Paeoniae Radix Alba (Shaoyao), and Glycyrrhizae Radix et Rhizoma (Gancao) to stop the pain urgently. This is because crying out loudly damages Qi, while enduring pain damages Blood, potentially leading to complicated changes.
If the pain is caused by consuming chicken, fish, or alcohol, use Qingwei San (Clear Stomach Powder) added with fresh Rhinoceros Cornu juice. Generally, patients with smallpox must absolutely avoid eating toxic substances, lest they induce pain and damage Yuan Qi, causing mild cases to become severe and severe cases to become untreatable. However, there are principles of specifically using toxic substances to attack toxins, such as those found in formulas like Zhuwei Gao (Pig Tail Paste), Jiguan Xue (Chicken Comb Blood), and Gongdu Tang (Toxin-Attacking Decoction); one should not let one principle hinder another.