诸痛为实，诸痒为虚。谓之实者，邪气实也。谓之虚者，正气虚也。又，疮疹为火，火盛则痛，火微则痒，故常
作痛者，此邪气之实也。盖痘疮之毒，发于皮肤肌肉之间，气以束之，血以润之，酝酿其毒，以抵于化，正气周
旋而不舍，毒瓦斯变化而未成，郁而作痛，此其常也，毒化脓成，其痛自止。若肉如刀剜，肤如锥刺，一向痛而不止，
大叫多哭，此则皮伤肉败，不胜其毒，又痛之变也。常作痒者，此正气之虚也。经曰∶胃者，水谷之海，六腑之大
原也。五味入口，藏于胃，以养五脏，胃气既虚，则水谷不化，津液内竭，不能输精于皮毛，气失其卫，血失其荣，
不能酝酿毒瓦斯，以至于成，使毒瓦斯浮沉，隐伏聚散，倏忽灼于皮毛，所以痒也，此其为异，补其气血，和中托里，其
痒必止。若一向瘙痒，时甚一时，爬抓破坏，皮脱肉坑者，此毒瓦斯内陷，正气外脱，不旋踵而告变矣。如先痛后
痒者，此常候也，
盖先则毒未解化，其火正盛，宜尔作痛，厥后脓成毒解，火气渐微，宜尔作痒也。
《活人书》治痘疮痛，用温惊丸（惊）水化下。海藏治疮出烦痛，用五物木香散。薛云∶若身后痛，属膀胱经也，
用羌活荆芥甘草汤（即此三味等分）。身前痛，属肺金也，用升麻葛根紫草汤。身侧痛，属胆经也，用柴胡山栀
连翘防风汤（即此四味等分）。四肢痛，属胃经也，用防风芍药甘草汤（即此三味等分）以急止之，盖恐叫号伤气，
忍痛伤血，而变证也。若热毒盛者，用东垣消毒散（大法），或仙方活命饮（痘后余毒）。食鸡鱼葡萄酒物者，
用东垣清胃散、生犀汁。若发热饮冷，大便调和，用四物连翘牡丹皮。若发热饮冷，大便秘结，脾胃实热也，用清
凉饮（发热）。若发热作渴饮汤者，脾胃虚热也，用七味白术散（渴）。大凡痘切不可食毒物，恐作痛致伤元气，轻
者反重，重者难治，大人亦然。
痘疮起发，痛者有二，一则毒邪欲出，气血随之，肌肉 急而痛，九味顺气散（起发）合活血散（出不快）主之。
一则皮肤浓，肉理密，为外寒相搏而痛，桂枝葛根汤主之（初热）。
五物木香散 治疮出烦痛。
青木香（二两） 丁香 零陵香（各一两） 麝香（一分） 白矾（一两）
每服四钱，水一小盏半，煎服之。热盛者，加犀角一两，如无犀角，以升麻代之，轻者，一服大效。
又方 以芒硝和猪胆涂疮上，令动，痂落无瘢，仍用黄土抹之良。此病小便涩有血者，中坏，疮背黑
靥，不出脓者，死不疗。
青黛散 治痘未作脓，痛甚，心膈烦躁，睡卧不安，并宜服之。
真青黛如枣核大，水调服之，即安。
〔世〕痘将结靥，干硬而痛，宜涂酥润之，靥可揭去则去之。如无酥用猪油煎汁代之。此痛非服药可免也。
各种疼痛属于实证，各种瘙痒属于虚证。所谓实证，是指邪气盛实。所谓虚证，是指正气虚弱。另外，疮疹是由火邪引起，火邪旺盛则疼痛，火邪微弱则瘙痒，所以经常感到疼痛的，这是邪气盛实的表现。大概痘疮的毒气，发于皮肤肌肉之间，气来约束它，血来滋润它，酝酿其毒性，以达到化脓的阶段，正气周旋其中而不肯离去，毒气变化但尚未完全形成，郁结而作痛，这是通常的情况；当毒气化为脓液时，疼痛自然停止。如果感觉肌肉像被刀割一样，皮肤像被锥子刺一样，一直疼痛不止，大声呼叫、多哭，这是皮肤受伤、肌肉败坏，无法承受毒气的侵袭，这是疼痛的变证。经常感到瘙痒的，这是正气虚弱的表现。《内经》说：胃是水谷之海，是六腑的根本。五味入口，藏于胃中，用来滋养五脏，如果胃气虚弱，那么水谷就不能消化，津液在内枯竭，不能将精微输布到皮毛，气失去了卫外的功能，血失去了荣养的作用，不能酝酿毒气使其成熟，导致毒气浮沉不定，隐伏聚散，忽然灼烧于皮毛，所以产生瘙痒，这是其特殊的机理，通过补益气血、调和脾胃、托毒外出，瘙痒必然停止。如果一直瘙痒，时轻时重，抓挠破坏，皮肤脱落、肌肉凹陷的，这是毒气内陷、正气外脱的表现，很快就会发生病情突变。如先痛后痒的，这是正常的征候，大概是因为起初毒气未解未化，火邪正盛，所以应当疼痛；后来脓成毒解，火气逐渐减弱，所以应当瘙痒。
《活人书》治疗痘疮疼痛，使用温惊丸（惊风类方剂），用水送服。海藏（张元素）治疗疮出而烦痛，使用五物木香散。薛己说：如果身体后面疼痛，属于膀胱经，使用羌活荆芥甘草汤（即这三味药等分）。身体前面疼痛，属于肺金，使用升麻葛根紫草汤。身体侧面疼痛，属于胆经，使用柴胡山栀连翘防风汤（即这四味药等分）。四肢疼痛，属于胃经，使用防风芍药甘草汤（即这三味药等分）以紧急止痛，大概是因为担心叫喊损伤气，忍耐疼痛损伤血，从而导致变证。如果热毒盛的，使用东垣消毒散（基本法则），或仙方活命饮（痘后余毒）。食用鸡、鱼、葡萄酒等食物的，使用东垣清胃散、生犀汁。如果发热想喝冷水，大便调和，使用四物汤加连翘、牡丹皮。如果发热想喝冷水，大便秘结，这是脾胃实热，使用清凉饮（用于发热）。如果发热口渴想喝热水，这是脾胃虚热，使用七味白术散（用于口渴）。大凡痘疮患者不可食用有毒食物，恐怕引起疼痛从而损伤元气，轻症反而加重，重症难以治愈，成人也是如此。
痘疮起发阶段，疼痛有两种情况，一种是毒邪想要发出，气血随之运行，肌肉紧张而疼痛，用九味顺气散（用于起发）合活血散（用于出不快）主治。一种是皮肤厚，肉理密，因受外寒搏击而疼痛，用桂枝葛根汤主治（用于初热阶段）。
五物木香散 治疗疮出而烦痛。
青木香（二两） 丁香 零陵香（各一两） 麝香（一分） 白矾（一两）
每次服用四钱，水一小盏半，煎煮后服用。热势盛的，加犀角一两，如果没有犀角，可以用升麻代替，轻症的，一服就有大效。
又一方 用芒硝和猪胆汁涂在疮上，使其松动，痂皮脱落无疤痕，仍然用黄土涂抹效果良好。此病如果小便涩痛有血，是中坏证，疮背黑靥，不出脓的，死证不可治。
青黛散 治疗痘未化脓，疼痛剧烈，心膈烦躁，睡卧不安，都适宜服用。
真青黛如枣核大小，用水调服，立即安宁。
〔世〕痘即将结痂，干燥坚硬而疼痛，适宜涂酥油润湿它，痂皮可以揭去就揭去它。如果没有酥油，用猪油煎汁代替。这种疼痛不是服药可以避免的。
All pains belong to excess syndromes, and all itches belong to deficiency syndromes. The term "excess" refers to the fullness of pathogenic factors (Xieqi). The term "deficiency" refers to the weakness of healthy Qi (Zhengqi). Furthermore, sores and rashes are caused by Fire; when Fire is vigorous, there is pain, and when Fire is weak, there is itching. Therefore, those who constantly experience pain have an excess of pathogenic factors. Generally, the toxicity of smallpox erupts between the skin and muscles. Qi binds it, Blood moistens it, and through fermentation, the toxicity reaches the stage of transformation. Healthy Qi circulates around it without leaving, while the toxic gas changes but has not yet fully formed. Stagnation causes pain, which is the normal condition; when the toxicity transforms into pus, the pain naturally stops. If the flesh feels as if cut by a knife and the skin as if pierced by an awl, with continuous pain, loud crying, and frequent weeping, this indicates that the skin is injured and the flesh is ruined, unable to withstand the toxicity. This is a variation of pain. Constant itching indicates a deficiency of healthy Qi. The Classics state: "The Stomach is the sea of water and grain, and the great source of the six Fu organs." When the five flavors enter the mouth, they are stored in the Stomach to nourish the five Zang organs. If Stomach Qi is deficient, water and grain cannot be transformed, internal fluids become exhausted, and essence cannot be distributed to the skin and hair. Qi loses its defensive function, and Blood loses its nourishing function, failing to ferment the toxic gas to maturity. Consequently, the toxic gas floats and sinks, hides and disperses, suddenly burning the skin and hair, causing itching. This is its unique mechanism; by tonifying Qi and Blood, harmonizing the Middle Jiao, and supporting the interior to expel toxins, the itching will surely cease. If there is persistent itching, varying in intensity, leading to scratching and destruction, with skin peeling and flesh sunken, this indicates the inward sinking of toxic gas and the outward collapse of healthy Qi, leading to sudden changes in the disease shortly thereafter. Pain followed by itching is a normal manifestation. Initially, the toxicity is unresolved and untransformed, and Fire is vigorous, hence pain occurs. Later, pus forms and toxicity resolves, Fire gradually weakens, hence itching occurs.
The *Huoren Shu* treats smallpox pain using Wenjing Wan (Warming the Startling Pill), administered with water. Haicang (Zhang Yuansu) treats irritability and pain upon eruption using Wuwu Muxiang San (Five-Ingredient Costus Powder). Xue Ji states: Pain on the posterior body belongs to the Bladder Meridian, treated with Qianghuo Jingjie Gancao Tang (Notopterygium, Schizonepeta, and Licorice Decoction, equal parts of these three herbs). Pain on the anterior body belongs to Metal of the Lung, treated with Shengma Gegen Zicao Tang (Cimicifuga, Pueraria, and Arnebia Decoction). Pain on the lateral body belongs to the Gallbladder Meridian, treated with Chaihu Zhizi Lianqiao Fangfeng Tang (Bupleurum, Gardenia, Forsythia, and Saposhnikovia Decoction, equal parts of these four herbs). Pain in the four limbs belongs to the Stomach Meridian, treated with Fangfeng Shaoyao Gancao Tang (Saposhnikovia, Peony, and Licorice Decoction, equal parts of these three herbs) to urgently stop the pain, fearing that crying damages Qi and enduring pain damages Blood, leading to complications. For severe heat-toxin, use Dongyuan Xiaodu San (Dongyuan's Toxin-Resolving Powder, general principle) or Xianfang Huoming Yin (Immortal Formula for Saving Lives, for residual toxin after smallpox). For consumption of chicken, fish, wine, or grapes, use Dongyuan Qingwei San (Dongyuan's Stomach-Clearing Powder) or Raw Rhinoceros Horn Juice. For fever with desire for cold drinks and regular bowel movements, use Siwu Tang (Four Substances Decoction) plus Lianqiao (Forsythiae Fructus) and Mudanpi (Moutan Cortex). For fever with desire for cold drinks and constipation, indicating Excess Heat of the Stomach and Spleen, use Qingliang Yin (Cooling Decoction, for fever). For fever with thirst and desire for hot drinks, indicating Deficient Heat of the Stomach and Spleen, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder, for thirst). Generally, patients with smallpox must avoid toxic foods, lest pain arise and damage Yuan Qi, turning mild cases severe and severe cases incurable; this applies to adults as well.
During the eruption phase of smallpox, pain has two causes. One is that pathogenic toxicity desires to emerge, accompanied by Qi and Blood, causing muscle tension and pain; this is treated with Jiawei Shunqi San (Nine-Ingredient Qi-Regulating Powder, for eruption) combined with Huoxue San (Blood-Invigorating Powder, for slow eruption). The other is thick skin and dense flesh texture, where external Cold combats with the interior causing pain; this is treated with Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction, for initial heat).
Wuwu Muxiang San (Five-Ingredient Costus Powder) treats irritability and pain upon eruption.
Qingmuxiang (Aucklandiae Radix, 2 liang) Dingxiang (Caryophylli Flos, 1 liang each) Linglingxiang (Lingzhi Fragrant Herb, 1 liang each) Shexiang (Moschus, 1 fen) Baijian (Alumen, 1 liang).
Take 4 qian per dose, decoct in 1.5 small cups of water and administer. For severe heat, add Xijiao (Rhinocerotis Cornu, 1 liang); if unavailable, substitute with Shengma (Cimicifugae Rhizoma). For mild cases, one dose yields significant effect.
Another prescription: Mix Mangxiao (Natrii Sulfas) with Zhu Dan (Sus Scrofa Bile) and apply to sores to loosen them. After scabs fall off without scars, applying Huangtu (Yellow Earth) is beneficial. If urine is astringent with blood, it indicates severe deterioration; if the back of the sore is black and crusty without pus, it is a death case and incurable.
Qingdai San (Indigo Naturalis Powder) treats smallpox that has not yet suppurated, with severe pain, irritability in the chest and diaphragm, and restlessness during sleep.
Zhen Qingdai (Indigo Naturalis, size of a jujube pit) is mixed with water and taken orally, bringing immediate relief.
[Shi] When smallpox is about to form scabs, if dry, hard, and painful, apply Su You (Butter Oil) to moisten it. Remove the scab if it can be peeled off. If Su You is unavailable, use Zhu You (Pig Fat) decocted as a substitute. This type of pain cannot be avoided by medication alone.