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In all diseases, if the volume of urine is low, the condition will worsen. Regarding smallpox (Xiaochuan), it occurs when Heart Fire is dominant; thus, Heat transfers from the Heart to the Small Intestine, and from the Small Intestine to the Bladder. Although the Bladder is the Fu-organ responsible for storing fluids, its urination depends on the distribution and transformation by Lung Qi. If Qi is scorched by Fire, it loses its descending function, leading to scanty and difficult urination. Consequently, Heat-Toxin cannot be excreted through urine, inevitably leading to convulsions and spasms. Treatment should not abruptly use cold-natured medicines; instead, one should promote diuresis to guide out the Heat. If mild Heat is not resolved, severe Heat will certainly arise. If the rash is dense and urine is red and scanty, this is due to fluid depletion and blood deficiency in the Lower Jiao. Blind diuresis should be avoided, as it would damage True Yin and merely exacerbate symptoms such as panting and thirst. Furthermore, if accumulated Phlegm resides in the Lungs, and since the Lungs are in the Upper Jiao while the Bladder is in the Lower Jiao, blockage in the Upper Jiao causes obstruction in the Lower Jiao. The treatment should focus on clearing the Lungs. This is analogous to a water-dropping device: only when the upper orifice is open does the water flow from the lower orifice. Therefore, ancient diuretic formulas often include Jingjie (Schizonepetae Herba) or employ emetic methods, based on this principle. Additionally, there are cases where urinary retention is caused by Qi stagnation in the Lower Jiao; these should be treated by raising Qi, as when Qi ascends and moves, Water naturally descends. However, sweating, purging, and diuresis are three methods highly valued and used cautiously by ancients; misuse of any can harm the body.

Regarding abdominal pain, most cases belong to Cold, but abdominal pain associated with smallpox mostly belongs to Fire. Nevertheless, careful differentiation is required. For instance, if the body has little fever, there is no thirst, occasional chills occur, vomiting happens intermittently, borborygmus and spontaneous diarrhea are present, the six pulses are weak and fine, the complexion is cyanotic, and hands and feet are cold, this indicates Spleen-Stomach Deficiency-Cold, which is suitable for warming and tonification. If the face is red, there is thirst, and hands and feet are hot, this indicates Spleen-Stomach Excess-Heat, which is suitable for mild purgation. If there is an aversion to milk or food, belching with a putrid odor, and acid regurgitation, indicating pain due to Food Stagnation, internal resolution via digestion-promoting methods is appropriate. If the eruption is slow and accompanied by sinking/retention pain, restlessness, and crying, urgent exterior-releasing and eruption-promoting methods are needed. If there is constipation, delirium, mania, dry feces accumulation causing pain, mild purgation is indicated. If cold pain results from ingesting raw/cold foods, warm formulas should be administered to resolve it. If Wind-Cold invasion combines with Toxin, preventing complete eruption, causing tremors and pain, dispersing and releasing the exterior is appropriate. If abdominal pain occurs with Heat-Toxin in the Stomach and frequent nausea, clearing and resolving Heat is indicated. If lesions appear and disappear intermittently, with cold extremities and retentive pain, strong support for expelling Toxin is required. If lesions do not erupt at all, no treatment is applied. After scabbing, if there is excessive heat, hard stools, black stool, and abdominal pain, this indicates Blood Stasis, suitable for clearing Heat and promoting diuresis to remove stasis. If breathing is coarse, there is foul breath, white coating on lips and tongue, body tremors, and unceasing pain, this indicates Wind-Cold obstruction, blocking Yin and Yang, with Toxin entering the Zang-Fu organs, leading to internal ulceration and gastric rot/pus formation. If Toxic Miasma spreads widely, Yang-Toxin enters the Stomach, causing profuse bloody stool, abdominal pain, and crying, accompanied by fever, heart/abdominal colic, distress, screaming, sunken lesions, abdominal distension, pain, and panting, these are signs of malignant Qi attacking the intestines and stomach, burning the Zang-Fu organs—extremely adverse conditions that are untreatable. However, continuous pain without cessation indicates Cold; intermittent pain indicates Heat.