痘中头痛最堪惊，毒冲风热两分明，稠密壮热连翘饮，疏稀微热清解灵。
[注]
头痛者，乃邪气与真气相搏，壅遏毒气上乾清道而然也。
故毒热上腾，与风热郁闭，皆能为害，
如头面痘出稠密，身体壮热闷乱昏痛者，此毒火上腾也，以大连翘饮主之，
若头面痘出稀疏，微觉身热头痛者，此风热郁闭也，宜清解散治之。
(大连翘饮)方见收靥证治
(清解散)方见发热证治。
%
痘中杂证
痘当未出腰先痛，毒火亢极阴难胜，泻毒不使传肾经，加味归宗宜速用。
[注]
凡痘当发热时而腰痛者，最为恶候，
盖腰为肾之府也，毒火亢极，真阴不能胜邪，故频频作痛，
须用加味归宗汤速泻其毒，不使传于肾经，庶可望生，
治若少缓，毒火冲炽，痘必干桔紫黑，肾阴绝则难救矣。
(加味归宗汤) 当归尾 赤芍药 元参 大黄生 羌活 荆芥穗 青皮炒
穿山甲炙 生地 东山查 牛蒡子炒研 木通 水煎服。
(方歌)
加味归宗治腰疼，归芍元参大黄生，羌穗青皮穿山甲，生地山查蒡木通。
%
痘中杂证
小儿发热腹痛疼，表郁芍药防风从，里郁加味平胃散，阴郁桂枝大黄灵。
[注]
凡出痘腹痛，有因风寒郁结，痘出不快，烦躁而痛者，乃表邪所郁，
以芍药防风汤主之，
有因食滞郁塞，痘出之时，原无腹痛，忽然一时作痛者，
此为里郁，宜加味平胃散治之，
又有初起因毒热郁于阴分，痛在脐下，时作时止者，此属阴郁，
以桂枝大黄汤主之。
(芍药防风汤) 升麻 防风 陈皮 桔梗 川芎 白芍药炒 甘草生
厚朴姜炒 枳实麸炒引用生姜水煎服。
(方歌)
芍药防风解表郁，升麻防风共陈皮，桔梗川芎白芍药，甘草厚朴枳实宜。
(加味平胃散) 陈皮 厚朴姜炒 神麴炒 南苍术米泔水浸炒 麦芽炒
甘草生 香附米制 南山查 引用生姜水煎服
(方歌)
加味平胃治食伤 陈皮厚朴神麴苍 麦芽甘草香附米 山查同煎引生姜。
(桂枝大黄汤) 生大黄 桂枝 生甘草 白芍 引用生姜 煎服。
(方歌)
桂枝大黄疗阴郁 生军泄热效非常 散寒桂枝调中草 白芍和中顺气强。
%
痘中杂证
痘疹中出现头痛是最令人惊惧的症状，这是由于毒邪上冲，分为风热两种证型：痘疹稠密且壮热者属火毒上腾，痘疹稀疏且微热者属风热郁闭。
[注]
头痛，是由于邪气与人体真气相互搏结，壅滞遏阻毒气向上侵犯清阳之道所致。
因此，毒热上腾，以及风热郁闭，都会造成危害。
如果头面部痘疹出得稠密，身体壮热、烦闷扰乱、昏沉疼痛的，这是毒火上腾的表现，应当用大连翘饮主治；
如果头面部痘疹出得稀疏，只是微微觉得身热头痛的，这是风热郁闭的表现，适宜用清解散治疗。
（大连翘饮）方剂见“收靥证治”章节。
（清解散）方剂见“发热证治”章节。
%
痘疹中的杂症
痘疹在尚未发出时，腰部先出现疼痛，这是因为毒火亢盛至极，阴液难以制约，此时泻毒不可使其传入肾经，应迅速使用加味归宗汤。
[注]
凡是痘疹在发热阶段出现腰痛的，是最为凶险的征候，
因为腰是肾的外府，毒火亢盛到了极点，真阴不能战胜邪气，所以频频作痛，
必须使用加味归宗汤迅速泻解毒邪，不让其传入肾经，这样才有望存活，
治疗如果稍有迟缓，毒火冲逆炽盛，痘疹必然干枯结痂、颜色紫黑，肾阴枯竭则难以救治了。
（加味归宗汤）当归尾、赤芍药、元参、生大黄、羌活、荆芥穗、炒青皮、炙穿山甲、生地、东山查、炒研牛蒡子、木通，水煎服。
（方歌）
加味归宗治疗腰痛疼，当归、赤芍、元参、生大黄，羌活、荆芥穗、青皮、穿山甲，生地、山查、牛蒡子、木通。
%
痘疹中的杂症
小儿发热并伴有腹痛，若是表邪郁结，可用芍药防风汤顺从病势治疗；若是里实郁结，用加味平胃散；若是阴分郁结，用桂枝大黄汤疗效显著。
[注]
凡是出痘疹出现腹痛，有因风寒郁结，导致痘疹发出不畅快，烦躁而痛的，这是表邪所郁，
以芍药防风汤主治；
有因食积停滞郁塞，在出痘疹的时候，原本没有腹痛，忽然一时发作疼痛的，
这属于里郁，适宜用加味平胃散治疗；
又有初起时因毒热郁结于阴分，疼痛部位在脐下，时作时止的，这属于阴郁，
以桂枝大黄汤主治。
（芍药防风汤）升麻、防风、陈皮、桔梗、川芎、炒白芍药、生甘草、姜炒厚朴、麸炒枳实，引用生姜水煎服。
（方歌）
芍药防风解除表郁，升麻、防风共配陈皮，桔梗、川芎、白芍药，甘草、厚朴、枳实适宜。
（加味平胃散）陈皮、姜炒厚朴、炒神麴、米泔水浸炒南苍术、炒麦芽、生甘草、制香附米、南山查，引用生姜水煎服。
（方歌）
加味平胃治疗食伤，陈皮、厚朴、神麴、苍术，麦芽、甘草、香附米，山查同煎引生姜。
（桂枝大黄汤）生大黄、桂枝、生甘草、白芍，引用生姜煎服。
（方歌）
桂枝大黄治疗阴郁，生军泄热效果非常，散寒桂枝调和中焦草，白芍和中顺气强。
%
痘疹中的杂症
Headache in smallpox is most alarming; the pathogenic toxin rushes upward, clearly distinguishing between wind-heat and fire-toxin patterns. For dense eruptions with high fever, Dalianqiao Yin (Great Lonicola Decoction) is indicated; for sparse eruptions with slight fever, Qingjie San (Clearing and Resolving Powder) is appropriate.
[Note]
Headache occurs when pathogenic factors contend with healthy qi, obstructing and suppressing the toxic qi from ascending to invade the clear orifices.
Therefore, both the upward rushing of toxic heat and the constraint of wind-heat can cause harm.
If the eruptions on the head and face are dense, accompanied by high fever, restlessness, confusion, and severe pain, this indicates the upward rushing of fire-toxin; it should be treated primarily with Dalianqiao Yin (Great Lonicola Decoction).
If the eruptions on the head and face are sparse, accompanied only by slight body heat and headache, this indicates constraint by wind-heat; it should be treated with Qingjie San (Clearing and Resolving Powder).
(The formula Dalianqiao Yin is found in the section on "Treatment of Crusting".)
(The formula Qingjie San is found in the section on "Treatment of Fever".)
%
Miscellaneous Syndromes in Smallpox
When smallpox is about to erupt but lower back pain precedes it, the fire-toxin is extremely hyperactive and yin fluids cannot overcome it. To prevent the toxin from transmitting to the Kidney meridian, Jiawei Guizong Tang (Modified Guizong Decoction) should be used promptly.
[Note]
Whenever lower back pain occurs during the fever stage of smallpox, it is a dire prognostic sign.
Since the lower back is the mansion of the Kidneys, when fire-toxin becomes extremely hyperactive, true yin cannot overcome the pathogen, resulting in frequent pain.
One must use Jiawei Guizong Tang (Modified Guizong Decoction) to rapidly purge the toxin, preventing its transmission to the Kidney meridian, so that survival may be hoped for.
If treatment is delayed even slightly, the fire-toxin will rush and blaze fiercely, causing the pustules to become dry, scabbed, purple, and black. Once Kidney yin is exhausted, rescue is difficult.
(Jiawei Guizong Tang [Modified Guizong Decoction]): Dangguiwei (Radix Angelicae Sinensis Caudex), Chishao (Radix Paeoniae Rubra), Yuanshen (Radix Scrophulariae), Sheng Dahuang (Radix Rhei Palmati Cruda), Qianghuo (Rhizoma Notopterygii), Jingjiesui (Fructus Schizonepetae), Chao Qingpi (Pericarpium Citri Reticulatae Viride Stir-fried), Zhi Chuanshanjia (Squama Manis Stir-fried), Shengdi (Radix Rehmanniae Glutinosae Preparata), Dongshancha (Fructus Crataegi Pinnatifidae Orientalis), Chaoyan Niubangzi (Fructus Arctii Stir-fried and Crushed), Mutong (Caulis Akebiae Trifoliate); decoct in water and take orally.
(Verse Formula)
Jiawei Guizong treats lower back pain,
Danggui, Chishao, Yuanshen, Sheng Dahuang.
Qianghuo, Jingjiesui, Qingpi, Chuanshanjia,
Shengdi, Shancha, Niubangzi, Mutong.
%
Miscellaneous Syndromes in Smallpox
In children with fever and abdominal pain, if caused by exterior constraint, Shaoyao Fangfeng Tang (Peony and Saposhnikovia Decoction) follows the pathogen; if caused by interior constraint, Jiawei Pingwei San (Modified Pingwei Powder) is used; if caused by yin constraint, Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) is effective.
[Note]
Abdominal pain during smallpox eruption may arise from wind-cold constraint, leading to slow eruption, irritability, and pain; this is exterior pathogen constraint,
treated primarily with Shaoyao Fangfeng Tang (Peony and Saposhnikovia Decoction).
It may also arise from food stagnation and interior obstruction; if there was no abdominal pain initially but sudden pain occurs during eruption,
this is interior constraint, treated appropriately with Jiawei Pingwei San (Modified Pingwei Powder).
Furthermore, if initially due to toxic heat constrained in the yin aspect, with pain below the umbilicus that comes and goes intermittently,
this belongs to yin constraint,
treated primarily with Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction).
(Shaoyao Fangfeng Tang [Peony and Saposhnikovia Decoction]): Shengma (Rhizoma Cimicifugae), Fangfeng (Radix Saposhnikoviae), Chenpi (Pericarpium Citri Reticulatae), Jiegeng (Radix Platycodonis), Chuanxiong (Rhizoma Chuanxiong), Chao Baishaoyao (Radix Paeoniae Albae Stir-fried), Sheng Gancao (Radix Glycyrrhizae Preparata Crude), Jiangchao Houpo (Cortex Magnoliae Officinalis Ginger-stirred), Fuchao Zhishi (Fructus Aurantii Immaturus Bran-stirred); decoct with fresh ginger juice and water.
(Verse Formula)
Shaoyao Fangfeng resolves exterior constraint,
Shengma and Fangfeng combined with Chenpi,
Jiegeng, Chuanxiong, Baishaoyao,
Gancao, Houpo, Zhishi are suitable.
(Jiawei Pingwei San [Modified Pingwei Powder]): Chenpi (Pericarpium Citri Reticulatae), Jiangchao Houpo (Cortex Magnoliae Officinalis Ginger-stirred), Chao Shenqu (Massa Medicata Fermentata Stir-fried), Nan Cangzhu (Rhizoma Atractylodis Lanceatae Soaked in Rice Wash Water and Stir-fried), Chao Maiya (Fructus Hordei Germinatus Stir-fried), Sheng Gancao (Radix Glycyrrhizae Preparata Crude), Zhixiangfumie (Radix Cyperi Rhizoma Processed), Nanshancha (Fructus Crataegi Stir-fried); decoct with fresh ginger juice and water.
(Verse Formula)
Jiawei Pingwei treats food injury,
Chenpi, Houpo, Shenqu, Cangzhu,
Maiya, Gancao, Xiangfumie,
Shancha decocted together with ginger juice.
(Guizhi Dahuang Tang [Cinnamon Twig and Rhubarb Decoction]): Sheng Dahuang (Radix Rhei Palmati Cruda), Guizhi (Ramulus Cinnamomi), Sheng Gancao (Radix Glycyrrhizae Preparata Crude), Baishaoyao (Radix Paeoniae Albae); decoct with fresh ginger and take.
(Verse Formula)
Guizhi Dahuang treats yin constraint,
Shengjun (Rhubarb) purges heat with extraordinary effect,
Sanhan Guizhi (Cinnamon Twig) harmonizes the middle with Gancao,
Baishaoyao harmonizes the middle and strengthens qi flow.
%
Miscellaneous Syndromes in Smallpox