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All pains belong to excess syndromes, and all itches belong to deficiency syndromes. The term "excess" refers to the fullness of pathogenic factors (Xieqi). The term "deficiency" refers to the weakness of healthy Qi (Zhengqi). Furthermore, sores and rashes are caused by Fire; when Fire is vigorous, there is pain, and when Fire is weak, there is itching. Therefore, those who constantly experience pain have an excess of pathogenic factors. Generally, the toxicity of smallpox erupts between the skin and muscles. Qi binds it, Blood moistens it, and through fermentation, the toxicity reaches the stage of transformation. Healthy Qi circulates around it without leaving, while the toxic gas changes but has not yet fully formed. Stagnation causes pain, which is the normal condition; when the toxicity transforms into pus, 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 that the skin is injured and the flesh is ruined, unable to withstand the toxicity. This is a variation of pain. Constant itching indicates a deficiency of healthy Qi. The Classics state: "The Stomach is the sea of water and grain, and the great source of the six Fu organs." When the five flavors enter the mouth, they are stored in the Stomach to nourish the five Zang organs. If Stomach Qi is deficient, water and grain cannot be transformed, internal fluids become exhausted, and essence cannot be distributed to the skin and hair. Qi loses its defensive function, and Blood loses its nourishing function, failing to ferment the toxic gas to maturity. Consequently, the toxic gas floats and sinks, hides and disperses, suddenly burning the skin and hair, causing itching. This is its unique mechanism; by tonifying Qi and Blood, harmonizing the Middle Jiao, and supporting the interior to expel toxins, the itching will surely cease. If there is persistent itching, varying in intensity, leading to scratching and destruction, with skin peeling and flesh sunken, this indicates the inward sinking of toxic gas and the outward collapse of healthy Qi, leading to sudden changes in the disease shortly thereafter. Pain followed by itching is a normal manifestation. Initially, the toxicity is unresolved and untransformed, and Fire is vigorous, hence pain occurs. Later, pus forms and toxicity resolves, Fire gradually weakens, hence itching occurs.

The *Huoren Shu* treats smallpox pain using Wenjing Wan (Warming the Startling Pill), administered with water. Haicang (Zhang Yuansu) treats irritability and pain upon eruption using Wuwu Muxiang San (Five-Ingredient Costus Powder). Xue Ji states: Pain on the posterior body belongs to the Bladder Meridian, treated with Qianghuo Jingjie Gancao Tang (Notopterygium, Schizonepeta, and Licorice Decoction, equal parts of these three herbs). Pain on the anterior body belongs to Metal of the Lung, treated with Shengma Gegen Zicao Tang (Cimicifuga, Pueraria, and Arnebia Decoction). Pain on the lateral body belongs to the Gallbladder Meridian, treated with Chaihu Zhizi Lianqiao Fangfeng Tang (Bupleurum, Gardenia, Forsythia, and Saposhnikovia Decoction, equal parts of these four herbs). Pain in the four limbs belongs to the Stomach Meridian, treated with Fangfeng Shaoyao Gancao Tang (Saposhnikovia, Peony, and Licorice Decoction, equal parts of these three herbs) to urgently stop the pain, fearing that crying damages Qi and enduring pain damages Blood, leading to complications. For severe heat-toxin, use Dongyuan Xiaodu San (Dongyuan's Toxin-Resolving Powder, general principle) or Xianfang Huoming Yin (Immortal Formula for Saving Lives, 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. For fever with desire for cold drinks and regular bowel movements, use Siwu Tang (Four Substances Decoction) plus Lianqiao (Forsythiae Fructus) and Mudanpi (Moutan Cortex). For fever with desire for cold drinks and constipation, indicating Excess Heat of the Stomach and Spleen, use Qingliang Yin (Cooling Decoction, for fever). For fever with thirst and desire for hot drinks, indicating Deficient Heat of the Stomach and Spleen, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder, for thirst). Generally, patients with smallpox must avoid toxic foods, lest pain arise and damage Yuan Qi, turning mild cases severe and severe cases incurable; this applies to adults as well.

During the eruption phase of smallpox, pain has two causes. One is that pathogenic toxicity desires to emerge, accompanied by Qi and Blood, causing muscle tension and pain; this is treated with Jiawei Shunqi San (Nine-Ingredient Qi-Regulating Powder, for eruption) combined with Huoxue San (Blood-Invigorating Powder, for slow eruption). The other is thick skin and dense flesh texture, where external Cold combats with the interior causing pain; this is treated with Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction, for initial heat).

Wuwu Muxiang San (Five-Ingredient Costus Powder) treats irritability and pain upon eruption.
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 and administer. For severe heat, add Xijiao (Rhinocerotis Cornu, 1 liang); if unavailable, substitute with Shengma (Cimicifugae Rhizoma). For mild cases, one dose yields significant effect.
Another prescription: Mix Mangxiao (Natrii Sulfas) with Zhu Dan (Sus Scrofa Bile) and apply to sores to loosen them. After scabs fall off without scars, applying Huangtu (Yellow Earth) is beneficial. If urine is astringent with blood, it indicates severe deterioration; if the back of the sore is black and crusty without pus, it is a death case and incurable.

Qingdai San (Indigo Naturalis Powder) treats smallpox that has not yet suppurated, with severe pain, irritability in the chest and diaphragm, and restlessness during sleep.
Zhen Qingdai (Indigo Naturalis, size of a jujube pit) is mixed with water and taken orally, bringing immediate relief.
[Shi] When smallpox is about to form scabs, if dry, hard, and painful, apply Su You (Butter Oil) to moisten it. Remove the scab if it can be peeled off. If Su You is unavailable, use Zhu You (Pig Fat) decocted as a substitute. This type of pain cannot be avoided by medication alone.