凡痘疮将出未出而猝然昏睡者，其痘必重，当察其脉证虚实，预为治之。若痘后喜睡，
此毒瓦斯已解，元气将复，故邪退而神安，乃否极泰来之象，不须服药妄治。如见寂然气虚，
但以调元汤、保元汤、六物煎之类，察其寒热，渐以调之，自然平复，不可妄行消耗，致伤
其神，反必害矣。
经曰∶腰者肾之府。又曰∶太阳所至为腰痛。盖足太阳之脉，夹脊络肾，而痘疮之毒，
多出于肾，循足太阳膀胱散行诸经，乃邪之由里传表也。如初见热而腰即痛，或日以渐甚者，
此邪由膀胱直入于肾，而毒有不能达也，急宜解毒，以泄少阴之邪，以通太阳之经，务令邪
气不得深入，则痘虽稠密，亦可愈也。若不速治，则邪必日陷而表里俱甚，营卫之脉不行，
脏腑之气皆绝，或为痒 ，成为黑陷，终莫能救矣。
一、凡痘毒自阴传阳，自里传外者为顺，自上传下，自外传里者为逆。若毒由太阳传入少
阴，则毒陷而不升，伏于骨髓之中，不能外达，所以腰痛。大凡疮疹之毒，归肾则死。故但见
腰痛，急宜治疗，若毒陷不起，即宜发散解毒，令其复出太阳而达乎阳道，斯无害也，宜人参
败毒散，或五积散主之。若肾气虚陷，不能传送外达者，必用理阴煎加细辛、官桂、杜仲、
独活之类主之。
一、治发热便见腰痛者，以热麻油按痛处揉之可止，仍急服前药之类。如小水不利者，宜
五苓散；如火毒内盛而小水不利者，宜四苓散加栀子、木通。
凡是痘疮即将发出但尚未完全透出时，突然陷入昏睡状态的，其痘症必然严重，应当观察患者的脉象和症状以辨别虚实，提前进行干预治疗。如果是痘疹发出之后出现喜欢睡觉的情况，这是因为毒气已经解除，元气正在恢复，所以邪气退去而神志安宁，这是坏运过去好运到来的征兆，不需要服药乱治。如果见到患者气息微弱、精神寂静（气虚表现），只需使用调元汤、保元汤、六物煎等方剂，根据寒热情况，逐渐调理，自然就能平复痊愈，不可胡乱使用耗损正气的药物，以免损伤神气，反而造成危害。
经典医籍记载：“腰部是肾脏的外府。”又说：“足太阳经气异常可导致腰痛。”因为足太阳膀胱经的经脉，夹行于脊柱两侧并联络肾脏，而痘疮的毒邪，多源于肾脏，沿着足太阳膀胱经散布运行于各条经络，这是邪气由体内向体表传变的过程。如果在发病初期就出现发热且腰部立即疼痛，或者疼痛逐日加重的，这是邪气从膀胱直接侵入肾脏，导致毒邪不能向外透达，应当紧急解毒，以泄除少阴肾经的邪气，疏通足太阳膀胱经的经脉，务必使邪气不得深入，那么即使痘疹密集，也可以治愈。如果不迅速治疗，邪气就会日益内陷，导致表里病情都加重，营气和卫气的经脉运行停滞，脏腑之气全部衰竭，或者出现瘙痒溃烂，变成黑陷（痘色紫黑下陷），最终就无法挽救了。
第一点：凡是痘毒从阴经传向阳经，从体内传到体外的属于顺证；从上往下传，从体外传入体内的属于逆证。如果毒邪由太阳经传入少阴经，则毒邪内陷而不能升发，潜伏在骨髓之中，不能向外透达，所以出现腰痛。大凡疮疹的毒邪，归并于肾脏就会导致死亡。所以只要见到腰痛，就应紧急治疗，如果毒邪内陷不起，就应当采用发散解毒的方法，使其重新透出太阳经而达于阳道，这样就没有危害了，适宜用人参败毒散，或者五积散为主方。如果是肾气虚弱导致毒邪内陷，不能传送外达的，必须使用理阴煎加入细辛、官桂、杜仲、独活等药材为主方。
第二点：治疗发热同时就出现腰痛的，可以用热麻油涂抹并按摩疼痛部位来缓解疼痛，同时仍要紧急服用前面的药物。如果小便不通利的，适宜用五苓散；如果是火毒内盛而导致小便不通利的，适宜用四苓散加入栀子、木通。
In cases where a patient falls into sudden lethargy or coma before the smallpox rash has fully erupted, the condition is severe. One must examine the pulse and symptoms to differentiate between deficiency and excess, and intervene preemptively. If drowsiness occurs after the eruption of the rash, it indicates that the pathogenic factors (toxins) have been resolved and the primordial Qi (vital energy) is recovering; thus, the evil qi has retreated and the spirit is at peace. This is a sign of transition from adversity to prosperity, and no medication is required. However, if signs of quietude and Qi deficiency are observed, formulas such as *Tianyuan Decoction* (Regenerate Origin Decoction), *Baoyuan Decoction* (Protect Primordial Decoction), or *Liuyue Decoction* (Six Ingredients Decoction) should be used. Based on the presence of cold or heat, gradual regulation will lead to natural recovery. One must not recklessly use drugs that consume and weaken the body, as this would damage the spirit and cause harm.
The Classics state: "The loins are the mansion of the Kidneys." It also states: "Manifestations of the Taiyang (Greater Yang) channel can result in lumbar pain." The Foot-Taiyang Bladder meridian runs alongside the spine and connects with the Kidneys. The toxins of smallpox often originate from the Kidneys and spread through the various meridians via the Foot-Taiyang Bladder channel, representing the transmission of pathogenic factors from the interior to the exterior. If fever and lumbar pain appear simultaneously at the onset, or if the pain worsens progressively day by day, this indicates that the pathogen has entered directly from the Bladder into the Kidneys, preventing the toxin from being expelled. Urgent detoxification is required to drain the Shaoyin (Lesser Yin) kidney pathogen and unblock the Taiyang bladder meridian, ensuring the pathogen does not penetrate deeper. Even if the rash is dense, recovery is possible. If treatment is not prompt, the pathogen will sink deeper daily, exacerbating both exterior and interior conditions. The circulation of Ying (Nutritive) and Wei (Defensive) vessels will cease, and the Qi of the Zang-Fu organs will fail. This may lead to itching and ulceration, or black depression (dark, sunken lesions), which ultimately becomes incurable.
First: Generally, when smallpox toxins transmit from Yin channels to Yang channels, or from the interior to the exterior, it is considered a favorable progression (Shun). Transmission from upper to lower, or from exterior to interior, is unfavorable (Ni). If the toxin transmits from the Taiyang channel to the Shaoyin channel, the toxin sinks and fails to ascend, hiding within the bone marrow and unable to reach the exterior, resulting in lumbar pain. In general, if the toxins of sores and rashes converge into the Kidneys, death ensues. Therefore, upon observing lumbar pain, urgent treatment is necessary. If the toxin is sunken and cannot rise, dispersing and detoxifying methods should be employed to force it back out through the Taiyang channel and into the Yang pathways, thereby avoiding harm. *Renshen Baidu San* (Ginseng Rescue Powder) or *Wuji San* (Five Accumulations Powder) are appropriate. If Kidney Qi is deficient and unable to transport the toxin outward, *Liyin Jian* (Yin-Regulating Decoction) added with *Xixin* (Asarum), *Guigui* (Cinnamon Twig), *Duzhong* (Eucommia Bark), and *Duohuo* (Angelica Pubescens) should be used.
Second: For cases where lumbar pain appears concurrently with fever, applying warm Sesame Oil (Sesamum indicum) to the painful area and massaging it can alleviate the pain. Simultaneously, the aforementioned medications should be taken urgently. If urination is difficult, *Wuling San* (Five-Ingredient Powder with Poria) is suitable. If internal fire-toxin is abundant causing difficulty in urination, *Siling San* (Four-Ingredient Powder with Poria) added with *Zhizi* (Gardenia Fruit) and *Mutong* (Akebia Caulis) is indicated.