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，壅遏毒瓦斯，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，痘必干枯紫黑，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 东山楂 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，生地山楂蒡木通。
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） 浓朴（姜炒）
枳实（麸炒）
引用生姜，水煎服。
【方歌】芍药防风解表宜，升麻防风共陈皮，桔梗川芎白芍药，甘草浓朴合枳实。
加味平胃散
陈皮 浓朴（姜炒） 神曲（炒） 南苍术（米泔水浸，炒） 麦芽（炒）
甘草（生） 香附米（制） 南山楂
引用生姜，水煎服。
【方歌】加味平胃治食伤，陈皮浓朴神曲苍，麦芽甘草香附米，山楂同煎引生姜。
桂枝大黄汤
生大黄 桂枝 生甘草 生白芍
引用生姜，水煎服。
【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。
痘疹中出现头痛最为令人惊恐，这是毒邪冲击、风热证候表现明显的缘故。若痘疹稠密且伴有高热，应使用连翘饮；若痘疹稀疏且仅有轻微发热，应使用清解灵（即清解散）。
【注】头痛，是由于邪气与人体真气相互搏结，壅滞毒邪之气，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，身体高热，胸闷烦躁、昏沉疼痛，这是毒火上炎的表现，以大连翘饮为主治方剂；如果头面部痘疹出得稀疏，仅感觉身体微热并伴有头痛，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）
痘疹在尚未发出时腰部先痛，是因为毒火亢盛至极，阴液难以制约。泻除毒邪以防止其传入肾经，加味归宗汤应当迅速使用。
【注】凡是痘疹发热期间出现腰痛的情况，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，所以频频发生疼痛。必须使用加味归宗汤迅速泻除毒邪，不让其传入肾经，这样才有望存活。如果治疗稍有迟缓，毒火冲逆炽盛，痘疹必然干枯变为紫黑色，肾阴枯竭则难以救治了！
加味归宗汤
当归尾 赤芍药 元参 大黄（生用） 羌活 荆芥穗 青皮（炒制） 穿山甲（炙制）
生地 东山楂 牛蒡子（炒制、研碎） 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，生地山楂蒡木通。
小儿发热并出现腹痛，若是表邪郁结，可用芍药防风汤顺从病势治疗；若是里邪郁结，用加味平胃散；若是阴分郁结，桂枝大黄汤疗效显著。
【注】凡是出痘疹时出现腹痛，有因风寒郁结，导致痘疹发出不畅，烦躁而疼痛的，这是表邪所郁，以芍药防风汤为主治方剂；有因食积停滞郁塞，在出痘疹时原本没有腹痛，突然一时发作疼痛的，这属于里郁，适宜用加味平胃散治疗；又有起初因毒热郁结于阴分，疼痛位于脐下，时作时止的，这属于阴郁，以桂枝大黄汤为主治方剂。
芍药防风汤
升麻 防风 陈皮 桔梗 川芎 白芍药（炒制） 甘草（生用） 浓朴（姜汁炒制）
枳实（麸皮炒制）
引用生姜，水煎服。
【方歌】芍药防风解表宜，升麻防风共陈皮，桔梗川芎白芍药，甘草浓朴合枳实。
加味平胃散
陈皮 浓朴（姜汁炒制） 神曲（炒制） 南苍术（米泔水浸泡，炒制） 麦芽（炒制）
甘草（生用） 香附米（炮制） 南山楂
引用生姜，水煎服。
Headache in smallpox is most alarming, indicating that the pathogenic factor attacks while wind-heat patterns are distinct. For dense eruptions with high fever, Lianqiao Yin (Forsythia Decoction) is indicated; for sparse eruptions with slight fever, Qingjie Ling (Clearing and Resolving Efficacy, i.e., Qingjie San) is indicated.
[Note] Headache arises from the struggle between pathogenic factors and true qi, causing obstruction of toxic vapors which ascend to invade the clear orifices. Thus, both the upward surge of toxic heat and the stagnation-closure of wind-heat can cause harm. If eruptions on the head and face are dense, accompanied by high fever, chest stuffiness, restlessness, dizziness, and pain, this indicates toxic fire surging upward; Dalianqiao Yin (Great Forsythia Decoction) should be used as the primary formula. If eruptions on the head and face are sparse, accompanied only by slight body heat and headache, this indicates stagnation and closure of wind-heat; Qingjie San (Clearing and Resolving Powder) is suitable for treatment.
Dalianqiao Yin (Formula see "Treatment of Crusting Stage")
Qingjie San (Formula see "Treatment of Fever")
When smallpox has not yet erupted, if the lower back hurts first, it is because toxic fire is extremely hyperactive and yin fluids cannot overcome it. To drain the toxicity and prevent its transmission 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. The lower back is the mansion of the Kidney. When toxic fire is extremely hyperactive, true yin cannot overcome the pathogen, resulting in frequent pain. One must use Jiawei Guizong Tang to rapidly drain the toxicity, preventing its transmission to the Kidney Meridian, so that survival may be hoped for. If treatment is delayed even slightly, toxic fire will surge and blaze, causing the eruptions to become dry, shriveled, purple, and black. Once Kidney yin is exhausted, rescue will be difficult!
Jiawei Guizong Tang
Dangguiwei (Tail of Angelicae Sinensis Radix), Chishao (Red Peony Root), Yuanshen (Scrophulariae Radix), Dahuang (Rhei Radix et Rhizoma, raw), Qianghuo (Notopterygii Rhizoma et Radix), Jingjiesui (Schizonepetae Spica), Qingpi (Citri Reticulatae Pericarpium Viride, stir-fried), Chuanshanjia (Squama Manis, roasted), Shengdi (Rehmanniae Radix Praeparata), Dongshanzha (Crataegi Fructus), Niubangzi (Arctii Fructus, stir-fried and crushed), Mutong (Akebiae Caulis).
Decoct in water and take orally.
[Prescription Song] Jiawei Guizong treats lower back pain, Dangguiwei, Shaoyao, Yuanshen, and raw Dahuang remain; Qianghuo, Jingjiesui, Qingpi, and Chuanshanjia, along with Shengdi, Shanzha, Niubangzi, and Mutong.
Children with fever and abdominal pain: if due to exterior stagnation, Shaoyao Fangfeng Tang (Peony and Saposhnikovia Decoction) follows the pathogenic trend; if due to interior stagnation, Jiawei Pingwei San (Modified Pingwei Powder) is used; if due to yin stagnation, Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) is effective.
[Note] Abdominal pain during smallpox eruption may arise from cold-wind stagnation and knotting, causing eruptions to fail to emerge smoothly, leading to irritability and pain; this is exterior pathogen stagnation, treated primarily with Shaoyao Fangfeng Tang. It may also arise from food retention and interior blockage; if there was no abdominal pain initially but sudden pain occurs during eruption, this is interior stagnation, treated with Jiawei Pingwei San. Furthermore, if initially caused by toxic heat stagnating in the yin level, with pain below the umbilicus that comes and goes intermittently, this is yin stagnation, treated primarily with Guizhi Dahuang Tang.
Shaoyao Fangfeng Tang
Shengma (Cimicifugae Rhizoma), Fangfeng (Saposhnikoviae Radix), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishaoyao (Paeoniae Radix Alba, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Nongpo (Magnoliae Officinalis Cortex, ginger-stir-fried), Zhishi (Aurantii Fructus Immaturus, bran-stir-fried).
Use fresh ginger as an adjuvant, decoct in water and take orally.
[Prescription Song] Shaoyao and Fangfeng are suitable for resolving the exterior, combined with Shengma, Fangfeng, and Chenpi; Jiegeng, Chuanxiong, and Baishaoyao, along with Gancao, Nongpo, and Zhishi.
Jiawei Pingwei San
Chenpi (Citri Reticulatae Pericarpium), Nongpo (Magnoliae Officinalis Cortex, ginger-stir-fried), Shenqu (Massa Medicata Fermentata, stir-fried), Nan Cangzhu (Atractylodis Rhizoma, soaked in rice wash water and stir-fried), Maiya (Hordei Fructus Germinatus, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, raw), Xiangfumie (Cyperi Rhizoma, processed), Nanshan Zha (Crataegi Fructus, southern variety).
Use fresh ginger as an adjuvant, decoct in water and take orally.
[Prescription Song] Jiawei Pingwei treats food injury, combining Chenpi, Nongpo, Shenqu, and Cangzhu; Maiya, Gancao, Xiangfumie, and Shan Zha are decocted together with fresh ginger as an adjuvant.
Guizhi Dahuang Tang
Sheng Dahuang (Rhei Radix et Rhizoma, raw), Guizhi (Cinnamomi Ramulus), Sheng Gancao (Glycyrrhizae Radix et Rhizoma, raw), Sheng Baishao (Paeoniae Radix Alba, raw).
Use fresh ginger as an adjuvant, decoct in water and take orally.
[Prescription Song] Guizhi and Dahuang treat yin stagnation, raw Jun (Dahuang) drains heat with extraordinary efficacy; Guizhi disperses cold and harmonizes the middle with Gancao, while Baishao harmonizes the middle and strengthens qi flow.