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(For any details not fully covered herein, please refer to the General Discussion on the Smallpox Chapter in the complete work.)

When a patient presents with high fever, erect hair, dry skin, restlessness during sleep, redness of the cheeks, congested eyes, coarse breathing, irritability, thirst, abdominal distension, constipation, and rapid breathing, these are all manifestations of Excess Syndromes (Excess patterns). If accompanied by vomiting, although it may appear as a Deficiency Syndrome, this is actually due to intense heat and heavy toxicity obstructing within, unable to extend outward. Consequently, the pathogenic factors rebel upward and rush against the upper body, causing vomiting. As stated in the *Classic of Medicine* (*Huangdi Neijing*): "All rebellious rushing symptoms belong to Fire," which refers to this situation. There are also cases where cold pathogens strike the body, or where milk and food intake are irregular, or where wind-cold pathogens invade, causing internal heat and toxicity to fail to diffuse outward. The conflict between cold and heat leads to vomiting. However, if the toxicity fails to rise and diffuse, it should be treated by raising Yang and dispersing, allowing the toxicity to exit from the exterior. If the vomiting is caused by the mutual resistance of cold and heat, the treatment should guide the pathogen downward.

There are also cases where diarrhea appears concurrently. Diarrhea seems to indicate Deficiency; however, here, intense heat and toxicity scorch and roast the Spleen and Stomach, preventing outward penetration. Thus, the toxicity sinks downward and exits through orifices. This is what is referred to as "Heat-Toxicity pouring downward." Ancient texts state: "Diarrhea occurring before the eruption of smallpox indicates survival; diarrhea occurring after eruption indicates death." The treatment should involve lifting and ascending, and dispersing, guiding the toxicity to the surface. One must avoid mistakenly using formulas containing Zhiqiao (Fructus Aurantii) that descend Qi. Once the toxicity is resolved from the exterior, the internal diarrhea will naturally cease. If the diarrhea is caused by food stagnation, mild cases require adding herbs for digestion and resolution, while severe cases should be treated by following the pathogen's direction (purging).

Regarding loss of appetite, books state: "Loss of appetite belongs to Internal Deficiency." This is correct. However, one must understand that in cases of Depressed Heat, the toxic qi remains inside, unable to extend and reach the muscle surface. Therefore, both urine and stool become obstructed, the interstices (cou li) are blocked, heat and toxicity are abundant, abdominal distension and urgency occur, and loss of appetite becomes an inevitable trend. The treatment method should also involve lifting and ascending, and dispersing, guiding the toxicity to the surface. In this way, the heat qi has room to extend and diffuse, the Zang-Fu organs return to harmony, and appetite naturally returns. If Dinggui (Clove and Cinnamon Twig) hot herbs are mistakenly used for diarrhea and vomiting, it is using heat to attack heat, thereby worsening the irritability and severity. If Shen-Zhu (Ginseng and Atractylodes) tonifying agents are administered for abdominal distension and loss of appetite, the evil pathogen will gain strength from the tonification and become even more vigorous.

In the initial stage of fever with vomiting and diarrhea, do not immediately stop them, as the toxicity is exiting through the upper and lower orifices. The primary focus should be on supporting the eruption of smallpox; once the rash emerges, vomiting and diarrhea will resolve spontaneously. However, if they persist for a long time, the Middle Qi will also become deficient, the toxicity cannot be transported out, and the disaster of internal attack on the organs will arise immediately. Treatment methods must distinguish between Cold and Heat.

If the body is hot, there is thirst, irritability, red face, projectile vomiting, loose stools, dark and scanty urination, yellow eyes, dry throat, and a preference for cool environments, it is a Heat pattern. Suitable herbs include Zexie (Rhizoma Alismatis), Mutong (Herba Akebiae), Zhuling (Polyporus), Chi Fu Ling (Red Poria), Shengma (Rhizoma Cimicifugae), etc. If the body is cool, breath is cold, and spirit is quiet, suitable herbs include Sharen (Fructus Amomi), Rouguo (Nux Vomica/Myristica), Renshen (Radix Ginseng), Fuling (Poria), etc.

If vomiting does not stop, it indicates Rebellious Qi of the Interior rising instead of descending; it should be guided downward. If diarrhea does not cease, it indicates Qi of the Interior sinking instead of rising; it should be lifted and ascended. However, after severe vomiting and diarrhea, both upper and lower Qi are depleted. At this point, major tonification is required. Regardless of other symptoms, they should all be treated as Deficiency patterns. Generally, vomiting is mostly caused by Fire, Phlegm, or Food; diarrhea is mostly caused by Fire, Cold, Food, Dampness, or Qi Deficiency. Initially, the causes vary, but over time, they all converge into a single Deficiency. If vomiting and diarrhea become severe and unceasing, and roundworms are expelled, the condition is incurable.