凡痘疹起发痛者，其症有数。一则毒邪欲出，气血随之，是以肌肉绷急而痛者，宜
用活血散。一则皮浓肉密，又为外寒相搏而痛者，宜用葛根汤。若热毒甚者，宜用消毒
散。若食鸡鱼酒物者，宜用清胃散。若发热饮冷，大便调和者，仅宜四物连翘之类。若
发热饮冷，大便秘结而脾胃实热者，是可清胃润燥。若发热作渴饮汤而属脾胃虚热者，
又宜白术散投之，六日以前，多用发散，六日之后，多用活血，因干滞而痛者，以水杨
汤浴之。若靥时痛甚，治之不愈者，凶。然大抵身前痛者，属肺，身后痛者，属膀胱，
身侧痛者，属胆，四肢痛者，属胃，总宜急止，否则，叫号伤气，忍痛伤血而多变症
矣。故痘疮不可过食毒物者，即此之谓也。若至结靥干硬而痛者，外宜涂酥以润之，内
服清凉解毒可也。
（碎锦）
凡报痘三日，当逐渐起胀，先出先起，后出后起，痘胖一分，则毒出一分，痘胖已
尽，则毒出亦完，根窠红绽，顶肥碍手，面目渐肿，饮食二便如常，而无他症者，吉。
此是气盛血荣于内，发扬于外，毒已受制，自当化毒成浆，不治自愈。一凡痘疮，自初
至结靥，并宜痘内暗晦，其外光润。所谓外阳内阴，少阴君火之象，反此为凶。若内外
皆先，为纯阳无阴，治当补血；内外皆暗，为纯阴无阳，治当补气。一凡痘疮之毒，必
气以煦之，血以濡之而后可得成熟也。故于起发之时，光壮者，气有余也。肥泽者，血
有余也。气血有余表里俱和，不须服药。一痘至起胀，其痘顶必有小凹，名为痘眼。若
根脚散大，浆色浅白，顶无痘眼者，此名为水痘。
凡是痘疹在起发阶段出现疼痛症状的，其病因有好几种。一种是毒邪想要排出体外，气血随之运行，导致肌肉紧绷拘急而疼痛的，适宜使用活血散。一种是皮肤厚实、肌肉致密，又受到外寒侵袭搏结而疼痛的，适宜使用葛根汤。如果是热毒严重的，适宜使用消毒散。如果是食用了鸡肉、鱼肉、酒类等食物引起的，适宜使用清胃散。如果是发热且想喝冷饮，但大便调和正常的，仅适宜使用四物汤加连翘之类的方剂。如果是发热且想喝冷饮，大便秘结且脾胃有实热的，可以清泻胃火、滋润燥热。如果是发热、口渴想喝热汤且属于脾胃虚热的，又适宜投用白术散。发病六日以前，多用发散表邪的方法；六日以后，多用活血化瘀的方法。因干涩滞涩而疼痛的，用水杨汤洗浴。如果在收靥（结痂）时疼痛剧烈，治疗不愈的，预后凶险。但大体上前身疼痛的，病位在肺；后身疼痛的，病位在膀胱；身体两侧疼痛的，病位在胆；四肢疼痛的，病位在胃。总宜尽快止痛，否则，大声呼叫会耗伤气，强忍疼痛会耗伤血，从而产生多种变症。所以痘疮患者不可过量食用有毒或刺激性食物，说的就是这个道理。如果到了结痂干燥坚硬而疼痛的阶段，外宜涂抹酥油以滋润患处，内服清凉解毒的药物即可。
（碎锦部分）
凡是出痘三天后，应当逐渐起胀，先发出的痘先起胀，后发出的痘后起胀，痘粒每隆起一分，毒邪就排出一分，痘粒完全隆起，毒邪也就排尽。此时痘根红赤绽开，痘顶饱满碍手，面目逐渐肿胀，饮食和二便如常，没有其他病症的，为吉兆。这是正气旺盛、血液充盈于内，向外发扬，毒邪已被制约，自然会将毒转化为浆液，不用治疗也能自愈。凡是痘疮，从初发到结痂，都适宜痘体内部色泽暗晦，外部光润明亮。这叫做“外阳内阴”，是少阴君火的征象，与此相反则为凶兆。如果内外都光亮，是纯阳无阴，治疗应当补血；如果内外都暗晦，是纯阴无阳，治疗应当补气。凡是痘疮的毒邪，必须依靠气的温煦和血的濡养才能成熟。所以在起发阶段，痘体光亮壮实的，说明气有余；痘体肥厚润泽的，说明血有余。气血充足且表里调和，不需要服药。痘发展到起胀阶段，痘顶必然有小凹陷，称为“痘眼”。如果痘根脚散大，浆色浅白，痘顶没有痘眼的，这种称为“水痘”。
Whenever pox (smallpox/chickenpox) presents with pain during the eruption phase, there are several patterns. One pattern is where pathogenic toxins desire to exit, and Qi and Blood follow, causing muscle tension and tightness leading to pain; Huoxue San (Blood-Invigorating Powder) is appropriate. Another pattern is where the skin is thick and flesh dense, combined with external cold attacking and clashing, causing pain; Gegen Tang (Kudzu Decoction) is appropriate. If heat-toxin is severe, Xiaodu San (Toxin-Clearing Powder) is appropriate. If caused by consuming chicken, fish, or alcohol, Qingwei San (Stomach-Clearing Powder) is appropriate. If there is fever with a desire for cold drinks but bowel movements are harmonious, only Siwu Tang (Four Substances Decoction) combined with Lianqiao (Forsythiae Fructus) is appropriate. If there is fever with a desire for cold drinks, constipation, and excess heat in the Spleen and Stomach, one may clear Stomach heat and moisten dryness. If there is fever, thirst, and a desire for hot soups due to deficient heat in the Spleen and Stomach, Baizhu San (Atractylodes Macrocephala Powder) should be administered. Within six days of onset, dispersing methods are mostly used; after six days, blood-invigorating methods are mostly used. For pain caused by dryness and stagnation, bathing in Shuiyang Tang (Willow Bark Decoction) is recommended. If pain is severe during the crusting stage and treatment fails to resolve it, the prognosis is ominous. Generally speaking, pain in the anterior body indicates involvement of the Lung; pain in the posterior body indicates involvement of the Bladder; pain on the sides of the body indicates involvement of the Gallbladder; pain in the four limbs indicates involvement of the Stomach. It is imperative to stop the pain promptly; otherwise, shouting will damage Qi, and enduring pain will damage Blood, leading to various complications. Thus, patients with pox should not overconsume toxic or irritating foods, which refers to this principle. If the crusts become dry and hard and painful, applying butter externally to moisten the area and taking internally cooling and detoxifying herbs is sufficient.
(Suijin Section)
Three days after the appearance of pox, the lesions should gradually swell. Those that appeared first swell first, and those that appeared later swell later. For every unit of swelling in the lesion, one unit of toxin is expelled. When the lesions have fully swollen, the toxin is completely expelled. If the roots are red and blooming, the tops are full and protruding, the face and eyes are gradually swollen, diet and excretion are normal, and there are no other symptoms, this is auspicious. This indicates abundant Qi and flourishing Blood internally, manifesting outwardly, with toxins controlled, naturally transforming into pus without needing treatment. For all pox lesions, from initial appearance to crusting, the interior of the lesion should appear dark/dull while the exterior remains lustrous. This is called "Yang on the outside, Yin on the inside," representing the image of Shaoyin Junhuo (Ministerial Fire). The reverse is ominous. If both interior and exterior are bright/lustrous, it is pure Yang without Yin, requiring blood-nourishing treatment. If both interior and exterior are dark/dull, it is pure Yin without Yang, requiring Qi-tonifying treatment. The toxin of pox must be warmed by Qi and moistened by Blood to mature. Therefore, during the swelling phase, if the lesions are bright and robust, Qi is in excess. If they are plump and lustrous, Blood is in excess. If Qi and Blood are sufficient and the interior and exterior are harmonious, no medication is needed. When pox reaches the swelling phase, the top of each lesion must have a small depression, known as the "pox eye." If the base is wide and spreading, the pus color is pale white, and there is no pox eye on the top, this is termed "Water Pox" (likely referring to a mild form or chickenpox-like presentation).