《经》曰∶诸寒为痛。又曰∶痛则为实。是故内快外痛，为外实内虚；外快内痛
为内实外虚。然痘疮身痛者，是或皮浓肉密，外寒相搏，或热毒内作，更或血虚不能
荣养者有焉。大抵热毒未尽时者，是血气凝滞毒壅而作痛也。既尽时者，是血虚而热燥
也。若遍身如啮而色黑者，是毒瓦斯壅滞，血凝而危也。如自利不食者，不治。
痢者，湿热郁于肠胃，有伤气血而成也。痘以气血为主，二者咸伤，痘何赖焉？
治法赤用四物汤为主；白用四君子汤为主；赤白相兼者，合而用之。腹痛者，倍加当
归，芍药；后重者，内加木香理气；赤久不愈者，则加阿胶、黑干姜；日久不愈者，则
加黄 、炙干姜；外感者，则加小柴胡发散；小便涩者，则加木通、泽泻，此治痘痢
之大略也。但痢最难捷愈，若非痘之有定期也。且外脓内痢，表里俱虚，元气易陷，故
宜以治痘为主，大用参 补托，兼用升提，毋使元气下陷，毒瓦斯内攻。若专以寻常治痢
之法，行气和血，则毒反假药势，内陷于阴，何能充达在表成功！况有迹之疾病未
除，而无形之元气先竭，则痘不待痢痊而先毙矣。且世间似痢非痢者多，以青皮、槟榔
而致毙者，不可胜举！
夫心经有热，流注不解，热极生风，乃有此候。然痘未出而惊，是热皆疮而不在心
也。既出而犹惊，是热在心而不在疮，危也。故云∶先发搐而后发疮者，生；先发疮
而后发搐者，死。其治之法，先惊而将痘者，以升麻汤发之，痘出而惊自己也。惊厥
太极者，虽全蝎、天麻皆所宜用。痘既见而惊不止者，用五苓散而导其心火，则惊自
止，否则，热蒸太过，疮势必干，浆水不来，难于收靥矣。至于未出而搐搦者，毒热
内蕴也。已出红绽而搐搦者，热毒作痛也。灌脓而搐搦者，血气虚也。靥后而搐搦者，
血气之虚尤甚也。如目 或直视而搐搦者，风火相搏也。口角流涎而搐搦者，木水乘土
也。面赤 泪而搐搦者，肝血虚而生风也。角弓反张者，水不生木也。皆血气内起之
病，切勿误投风药。
痘疮发热之际，正心火妄动之时，切忌举作惊扰，及闻卒然之声，否则，皆能致惊
发搐，及当灌脓，元气升浮，荣阴之散，尤宜静摄，否则，神不守舍，血不循经，轻则
停浆，重为坏症。至于靥后大虚发惊，难愈，更不可不慎也。若所云惊痘为美者。谓
痘自心经而发，故惕惕惊搐，皆少阴见症，从内达外者也。岂以外受惊恐，有伤心气，
反谓之美乎？
《黄帝内经》说：各种寒邪会导致疼痛。又说：疼痛属于实证。因此，内部舒适而外部疼痛，是外实内虚；外部舒适而内部疼痛，是内实外虚。然而痘疮引起身体疼痛的原因，有的是因为皮肤浓密、肌肉坚实，与外寒相搏结；有的是因为热毒在体内发作；还有的是因为血虚不能濡养肌肤所致。大体上，热毒未尽时引起的疼痛，是由于气血凝滞、毒气壅塞而产生的；热毒已尽时引起的疼痛，是由于血虚且燥热所致。如果全身疼痛如被虫咬，且痘色发黑，这是毒气壅滞、血液凝固的危险征象。如果出现自发性腹泻且不进食，则属不治之症。
痢疾，是由于湿热郁结于肠胃，损伤气血而形成的。痘疮以气血为主宰，如果气血都受到损伤，痘疮又依靠什么呢？治疗方法：痘色偏赤的，以四物汤（补血调血方剂）为主；痘色偏白的，以四君子汤（补气健脾方剂）为主；赤白相兼的，将两方合用。伴有腹痛的，加倍使用当归、芍药；伴有里急后重的，在内服方中加入木香以调理气机；赤痢日久不愈的，加入阿胶、黑干姜；病程日久不愈的，加入黄芪、炙干姜；兼有外感表证的，加入小柴胡汤（和解少阳方剂）以发散表邪；小便涩痛的，加入木通、泽泻以利水通淋。这是治疗痘疮合并痢疾的大致原则。但是痢疾最难迅速治愈，因为它不像痘疮那样有固定的周期。况且既有痘疮脓液外透，又有痢疾内作，表里俱虚，元气容易下陷，所以应当以治疗痘疮为主，大剂量使用人参等药物进行补益托毒，同时配合升提之法，不要使元气下陷，毒气内攻。如果专门采用通常治疗痢疾的方法，行气和血，那么毒气反而借助药势，内陷于阴分，怎么能通达体表而成功呢？何况有形的疾病尚未去除，无形的元气已经先竭，那么痘疮不等痢疾痊愈人就已经死亡了。况且世间类似痢疾而非真正痢疾的情况很多，因误用青皮、槟榔而导致死亡的，不可胜数！
心经有热，流注不解，热极生风，于是出现这种惊搐症状。然而痘未发出而出现惊厥，说明热邪在于疮毒而不在于心；痘已发出后仍然惊厥，说明热邪在于心而不在于疮，这是危重证候。所以说：先发生惊搐而后发出痘疮的，可生；先发出痘疮而后发生惊搐的，主死。其治疗方法：先出现惊厥即将出痘的，用升麻汤（发表透疹方剂）发散，因为痘出后惊厥自然停止。惊厥严重的，全蝎、天麻都是适宜使用的药物。痘已显现而惊厥不止的，用五苓散（利水渗湿方剂）引导心火下行，则惊厥自然停止，否则，热气蒸腾太过，疮势必然干枯，浆水不来，难以收靥结痂。至于痘未发出而抽搐的，是毒热内蕴所致；痘已发出红绽而抽搐的，是热毒作痛所致；灌脓期而抽搐的，是气血虚弱所致；结痂后而抽搐的，是气血虚弱更为严重所致。如果眼睛直视或斜视并伴有抽搐的，是风火相搏所致；口角流涎并伴有抽搐的，是肝木乘脾土所致；面赤流泪并伴有抽搐的，是肝血虚而生风所致；角弓反张的，是水不生木所致。这些都是由气血内部病变引起的疾病，切勿误投祛风药物。
痘疮发热之际，正是心火妄动之时，切忌举动惊扰，以及听到突然的声音，否则，都能导致惊发抽搐。到了灌脓期，元气升浮，营阴耗散，尤其应当静养摄护，否则，神不守舍，血不循经，轻则停浆，重则变为坏症。至于结痂后因大虚而发惊，难以痊愈，更不可不慎。至于所谓“惊痘为美”的说法，是指痘从心经发出，所以惕惕惊搐，这都是少阴经见症，是从内达外的表现。难道是因为外受惊恐，损伤心气，反而认为好吗？
The *Classic* (Huangdi Neijing) states: "All pains are caused by cold." It also states: "Pain indicates excess." Therefore, comfort internally and pain externally indicate external excess and internal deficiency; comfort externally and pain internally indicate internal excess and external deficiency. However, body pain caused by smallpox may arise from several causes: either the skin is dense and flesh firm, causing conflict with external cold; or heat-toxin arises internally; or blood deficiency fails to nourish the tissues. Generally, when heat-toxin is not yet exhausted, pain results from stagnation of Qi and blood and obstruction of toxin. When heat-toxin has been exhausted, pain results from blood deficiency and dryness-heat. If the whole body feels as if bitten by insects and the lesions turn black, this indicates dangerous stagnation of toxic qi and coagulation of blood. If spontaneous diarrhea occurs accompanied by anorexia, it is incurable.
Dysentery is formed by damp-heat郁结 (stagnating) in the intestines and stomach, damaging Qi and blood. Smallpox relies primarily on Qi and blood; if both are damaged, what can support the smallpox? The treatment principle is: for red lesions, use Siwu Tang (Four Substances Decoction) as the main formula; for white lesions, use Sijunzi Tang (Four Gentlemen Decoction) as the main formula; for mixed red and white, combine both formulas. If abdominal pain is present, double the dosage of Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix); if tenesmus is present, add Muxiang (Aucklandiae Radix) within the formula to regulate Qi; if red dysentery persists for a long time, add Ejiao (Colla Corii Asini) and Hei Ganjiang (Scorched Ginger); if the condition persists for a long time, add Huangqi (Astragali Radix) and Zhi Ganjiang (Honey-fried Ginger); if there is an external contraction, add Xiaochaihu Tang (Minor Bupleurum Decoction) to disperse the exterior; if urination is difficult and painful, add Mutong (Akebiae Caulis) and Zexie (Alismatis Rhizoma). This is the general approach for treating smallpox complicated by dysentery. However, dysentery is the most difficult to cure quickly, as it does not have a fixed cycle like smallpox. Moreover, with pus forming externally and dysentery occurring internally, both the exterior and interior are deficient, and Yuanqi (Original Qi) is prone to sinking. Therefore, treatment should focus on smallpox, using large doses of Renshen (Ginseng Radix et Rhizoma) to tonify and support, combined with lifting methods, to prevent Yuanqi from sinking and toxin from attacking inward. If one solely uses ordinary methods for treating dysentery, moving Qi and harmonizing Blood, the toxin will instead borrow the momentum of the herbs to sink into the Yin level, making it impossible to reach the surface and succeed! Furthermore, if visible diseases are not removed while invisible Yuanqi is exhausted first, death will occur before the dysentery heals. Also, many conditions resemble dysentery but are not true dysentery; deaths caused by the misuse of Qingpi (Citri Reticulatae Pericarpium Viride) and Binglang (Arecae Semen) are countless.
Heat in the Heart Meridian flowing and unresolved, leading to extreme heat generating wind, produces these convulsive symptoms. However, if convulsions occur before the rash appears, the heat lies in the sores, not in the Heart. If convulsions persist after the rash has appeared, the heat lies in the Heart, not in the sores, which is critical. Thus it is said: convulsions preceding the rash indicate survival; rash preceding convulsions indicates death. The treatment method is: for those who experience convulsions just before the rash emerges, use Shengma Tang (Cimicifugae Decoction) to disperse, as the convulsions will cease once the rash appears. For severe convulsions, Quanxie (Scorpio) and Tianma (Gastrodiae Rhizoma) are appropriate. If the rash has appeared but convulsions do not stop, use Wuling San (Five-Ingredient Powder with Poria) to guide Heart Fire downward, and the convulsions will stop naturally; otherwise, excessive steaming heat will cause the sores to dry up, preventing plasma formation and making crusting difficult. For convulsions before the rash emerges, it is due to internal accumulation of toxic heat. For convulsions when the rash is red and blooming, it is due to pain from heat-toxin. For convulsions during the suppuration stage, it is due to Qi and blood deficiency. For convulsions after crusting, Qi and blood deficiency is even more severe. If eyes are fixed or deviated with convulsions, it is due to wind-fire battling. If saliva flows from the corners of the mouth with convulsions, it is due to Liver Wood overacting on Spleen Earth. If the face is red with tears and convulsions, it is due to Liver Blood deficiency generating wind. Opisthotonos indicates Water failing to generate Wood. All these are diseases arising from internal Qi and blood disturbances; do not mistakenly administer wind-dispelling herbs.
During the fever phase of smallpox, when Heart Fire is acting recklessly, one must strictly avoid agitation and sudden noises, otherwise, they can induce convulsions. During the suppuration stage, when Yuanqi floats upward and Ying-Yin (Nutritive Yin) dissipates, quiet rest is especially necessary; otherwise, Shen (Spirit) will not reside in its house, and Blood will not follow its vessels, leading to stopped plasma in mild cases or fatal complications in severe cases. Convulsions due to severe deficiency after crusting are difficult to cure and require utmost caution. Regarding the notion that "convulsive smallpox is auspicious," this refers to smallpox originating from the Heart Meridian, where fearful convulsions are signs of the Shaoyin meridian manifesting from within to the outside. How could it be considered auspicious simply because external fright damages Heart Qi?