经云∶痒则为虚，痛则为实。内快外痛为外实内虚，外快内痛为内实外虚。今痘疮身痛者，是肤浓理密，或外寒相
搏，或热毒内作，或血虚不能荣养。若热毒而血瘀者，先用
活命饮，次用东垣消毒散。血虚而瘀者，用四物汤之类，遍身啮而色黑者，毒瓦斯壅滞而血凝也，乃是危症。若二便秘
结，喘急烦躁，用栀子仁汤，或猪尾膏、血调片脑，治之自利。不食者不治。
一小儿痘未发，遍身作痛，余谓热毒势盛，先用仙方活命饮一剂，痛缓痘出，用东垣消毒散一剂，末用四圣散而靥。
一小儿痘未出透，遍身作痛，此热毒郁滞，而未尽发于外也，先用活命饮，一剂而痛愈，用参 四圣散而结靥。
一小儿痘疮，遍身作痛，用东垣消毒散而痛愈，用紫草快 汤而脓贯，用托里散而愈。
一小儿痘痈，肢体作痛，发热恶寒，此气虚而寒邪客于表也，用人参羌活散而表解，用参 四圣散而起发，用参
内托散而脓溃。
一妊妇发热作渴，遍身疼痛，用活命饮，二剂诸症稍愈，形气甚倦，用紫草木香散，痘出少许，用白术散，贯脓而
愈。
一男子出痘，根窠赤痛，发热作渴，痘裂出血，肝火炽也，用小柴胡汤加生地、犀角，诸症顿减，又用圣济犀角地
黄汤而结痂。
黄 六一汤 治痘疮，气虚作渴。愈后作渴，尤宜服之。
黄 （炙，六钱） 甘草（炙，一钱）
水煎服。
参 四圣散
参 内托散 治痘疮疼痛，或里虚发痒，或不溃脓，或为倒靥等症。（二方见寒战切牙）
小柴胡汤（加牡丹皮、生地黄，即加味小柴胡汤） 治发热恶风身痛；或四肢劲强，寒热往来。（方见 症）
紫草 汤（方见便出血或黑屎）
七味白术散（方见发热属阴阳）
四物汤（方见痘出迟）
八珍汤
圣济犀角地黄汤（二方见顶陷心烦）
仙方活命饮
托里散
东垣消毒散（三方见夹疹痘）
五苓散（方见小便不利）
制附子法 将附子重一两三四钱，有莲花瓣，头圆底平者，先备童便五六碗，将附子放在灶上热处，或炭火烘
炙，乘热投童便中，浸五七日，候润透，揭去皮，切四块，用粗纸裹数层，埋灰火中煨，候热取出切片，如有白星，瓦
上炙至无星为度。如急用切大片用热瓦炙熟亦可。
《黄帝内经》说：瘙痒属于虚证，疼痛属于实证。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。现在痘疮患者全身疼痛，是因为皮肤腠理致密，或者外感寒邪与正气相搏，或者热毒在体内发作，或者血虚不能濡养肌肤。如果是热毒导致血瘀的，先用仙方活命饮，再用东垣消毒散。如果是血虚兼有血瘀的，用四物汤之类的方剂。如果遍身如虫咬且颜色发黑，这是毒气壅滞、血液凝涩所致，属于危重病症。如果大小便不通畅，气喘急促烦躁，用栀子仁汤，或者猪尾膏、冰片调血服用，治疗后可使二便通利。如果不进食的，则难以治愈。
有一个小儿痘疹尚未发出，全身疼痛，我认为是热毒势盛，先用一剂仙方活命饮，疼痛缓解后痘疹发出，再用一剂东垣消毒散，最后用四圣散结痂痊愈。
有一个小儿痘疹未出透，全身疼痛，这是热毒郁滞，未能完全发散于体表，先用仙方活命饮，一剂后疼痛痊愈，用参芪四圣散结痂。
有一个小儿患痘疮，全身疼痛，用东垣消毒散后疼痛痊愈，用紫草快斑汤使脓液充盈，用托里散后痊愈。
有一个小儿患痘痈，肢体疼痛，发热恶寒，这是气虚而寒邪客居肌表，用人参羌活散解表，用参芪四圣散促使痘疹起发，用参芪内托散使脓液溃破。
有一位孕妇发热口渴，全身疼痛，用仙方活命饮，两剂后诸症稍愈，但形体气息非常疲倦，用紫草木香散，痘疹发出少许，再用白术散，待脓液充盈后痊愈。
有一名男子出痘，痘根红赤疼痛，发热口渴，痘疱破裂出血，这是肝火炽盛，用小柴胡汤加生地黄、犀角，诸症顿时减轻，又用圣济犀角地黄汤结痂。
黄芪六一汤：治疗痘疮因气虚引起的口渴。痘疮愈合后仍口渴，尤其适宜服用此方。
黄芪（炙，六钱），甘草（炙，一钱）。
水煎服。
参芪四圣散
参芪内托散：治疗痘疮疼痛，或里虚发痒，或不化脓，或出现倒靥等症状。（这两个方剂见“寒战切牙”条）
小柴胡汤（加牡丹皮、生地黄，即加味小柴胡汤）：治疗发热恶风身痛；或四肢僵硬强直，寒热往来。（方剂见“惊风”条）
紫草快斑汤（方剂见“便出血或黑屎”条）
圣济犀角地黄汤（这两个方剂见“顶陷心烦”条）
五苓散（方剂见“小便不利”条）
制附子法：选取重量为一两三四钱的附子，要有莲花瓣形状，头圆底平的。先准备童便五六碗，将附子放在灶上热处，或用炭火烘烤炙烤，趁热投入童便中，浸泡五到七天，等到湿润透彻，揭去外皮，切成四块，用粗纸包裹数层，埋在灰火中煨烤，等热了取出切片，如果有白色星点，要在瓦上炙烤直到没有星点为止。如果急需使用，切大片用热瓦炙熟也可以。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Itching indicates deficiency, while pain indicates excess. Comfort internally with pain externally indicates external excess and internal deficiency; comfort externally with pain internally indicates internal excess and external deficiency. Currently, in cases of smallpox with generalized body pain, the cause is either dense skin pores, or the struggle between external cold pathogens and healthy qi, or the internal manifestation of heat-toxin, or blood deficiency failing to nourish the tissues. If the condition involves heat-toxin causing blood stasis, first administer Xianfang Huoming Yin (Immortal Life Elixir), followed by Dongyuan Xiaodu San (Dongyuan Detoxification Powder). If it involves blood deficiency with stasis, use formulas such as Siwu Tang (Four Substances Decoction). If the entire body feels like being bitten by insects and the color turns black, this is due to the stagnation of toxic factors and coagulation of blood, representing a critical condition. If there is constipation of both stool and urine, accompanied by panting, urgency, and irritability, use Zhizi Ren Tang (Gardenia Seed Decoction), or Pig Tail Paste mixed with blood and Borneol (Bingpian); treatment will result in the free passage of excreta. Cases where the patient refuses food are considered incurable.
A child presented with generalized body pain before the eruption of smallpox. I diagnosed it as excessive heat-toxin. First, one dose of Xianfang Huoming Yin was administered. After the pain subsided and the rash appeared, one dose of Dongyuan Xiaodu San was given. Finally, Six Holy Powders (Sisheng San) were used to facilitate scabbing and recovery.
Another child presented with generalized body pain because the smallpox had not fully erupted. This indicated stagnant heat-toxin that had not completely dispersed to the exterior. First, Xianfang Huoming Yin was administered. After one dose, the pain ceased. Canqi Sisheng San (Codonopsis and Astragalus Six Holy Powders) was then used to form scabs.
A third child suffered from smallpox with generalized body pain. Dongyuan Xiaodu San relieved the pain. Zicao Kuaban Tang (Arnebia Rapid-Eruption Decoction) promoted pus formation. Tuoli San (Supporting Interior Powder) led to full recovery.
A fourth child suffered from smallpox carbuncles, with limb pain, fever, and aversion to cold. This indicated qi deficiency with cold pathogens lodging in the exterior. Ren Shen Qianghuo San (Ginseng and Notopterygium Powder) resolved the exterior syndrome. Canqi Sisheng San promoted the eruption of the rash. Canqi Neituo San (Ginseng and Astragalus Supporting Interior Powder) facilitated pus rupture.
A pregnant woman presented with fever, thirst, and generalized body pain. Xianfang Huoming Yin was administered for two doses, after which symptoms slightly improved, but she exhibited severe fatigue in form and qi. Zicao Muxiang San (Arnebia and Aucklandia Powder) was used. A few spots of smallpox emerged. Baizhu San (Atractylodes Macrocephala Powder) was then administered, leading to recovery after pus formation.
A male patient presented with red, painful smallpox bases, fever, thirst, and bleeding from ruptured pustules. This indicated blazing Liver fire. Xiao Chaihu Tang (Minor Bupleurum Decoction) was modified with Sheng Dihuang (Fresh Rehmannia Root) and Xijiao (Rhinoceros Horn) to reduce symptoms instantly. Shengji Xijiao Dihuang Tang (Shengji Rhinoceros Horn and Rehmannia Decoction) was subsequently used to form scabs.
Huangqi Liuyi Tang (Astragalus Six-One Decoction): Treats smallpox-induced thirst due to qi deficiency. It is especially suitable for post-recovery thirst.
Huangqi (Astragali Radix, honey-fried, 6 qian), Gancao (Licorice Root, honey-fried, 1 qian).
Decoct in water and take orally.
Canqi Sisheng San (Codonopsis and Astragalus Six Holy Powders)
Canqi Neituo San (Ginseng and Astragalus Supporting Interior Powder): Treats smallpox pain, itching due to interior deficiency, failure to suppurate, or inverted scabbing. (See "Chills and Teeth Grinding" for these formulas.)
Xiao Chaihu Tang (Modified with Mudanpi and Shengdihuang, i.e., Modified Minor Bupleurum Decoction): Treats fever, aversion to wind, and body pain; or stiffness of the four limbs, alternating chills and fever. (See "Convulsions" for the formula.)
Zicao Kuaban Tang (Arnebia Rapid-Eruption Decoction) (See "Blood in Stool or Black Stool" for the formula.)
Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) (See "Fever Belonging to Yin and Yang" for the formula.)
Siwu Tang (Four Substances Decoction) (See "Delayed Smallpox Eruption" for the formula.)
Bazhen Tang (Eight Treasures Decoction)
Shengji Xijiao Dihuang Tang (Shengji Rhinoceros Horn and Rehmannia Decoction) (See "Sunken Crown and Heart Restlessness" for these formulas.)
Xianfang Huoming Yin (Immortal Life Elixir)
Tuoli San (Supporting Interior Powder)
Dongyuan Xiaodu San (Dongyuan Detoxification Powder) (See "Smallpox Complicated with Rash" for these three formulas.)
Wuling San (Five-Ingredient Powder) (See "Difficult Urination" for the formula.)
Preparation Method for Zhi Fuzi (Prepared Aconite Lateral Root): Select an Aconite lateral root weighing 1 liang 3-4 qian, with a lotus-petal shape, round head, and flat base. Prepare 5-6 bowls of children's urine. Place the Aconite on a hot part of the stove or roast it over charcoal embers. While hot, immerse it in the children's urine for 5-7 days until thoroughly moistened. Peel off the skin, cut into four pieces, wrap in several layers of coarse paper, and bake in ash-fire. Remove when hot, slice, and roast on a tile until white star-like spots disappear. For urgent use, large slices can be roasted on a hot tile until cooked.