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The *Classic* states: Diarrhea accompanied by heat implies that the feces will be turbid and foul; diarrhea accompanied by cold implies that the stool will be watery and thin. For cold-type diarrhea, warming and astringing methods are used; for heat-type diarrhea, clearing and purging methods are used. This is the treatment principle of ancient physicians. During the stage of pustule formation in smallpox, if diarrhea occurs, it is strictly contraindicated, as there is fear that deficiency of Middle Qi (Spleen and Stomach energy) will cause the pathogenic toxin to sink inward and become latent. Therefore, the orthodox treatment is specifically to use warming, tonifying, and astringing methods. However, there is another type involving the discharge of clear water or pus and blood, which cannot be discussed together with cold-heat patterns nor treated simply with astringents. For instance, if a patient previously drank excessive amounts of water due to intense thirst, causing water accumulation in the middle jiao, flooding the intestines and stomach, leading to the discharge of clear water, this condition is named "Water Accumulation" (Shui Ji). The diarrhea will stop once the accumulated water is discharged. Furthermore, if the smallpox fails to heal properly, resulting in inverted lesions (Dao Ye), but fortunately the Middle Qi is sufficient so the toxin cannot remain, the pus and blood may be discharged via the stool. This is called "Inverted Lesion Diarrhea." Once the pus and blood are exhausted, indicating the toxin has exited, the disease will heal spontaneously. If one does not understand these two scenarios and recklessly administers astringents, the root cause remains, allowing the pathology to branch out and grow; blocking the source of the spring leads to deeper collapse and rupture.

During the eruption and rising stages of smallpox, diarrhea is generally inadvisable, fearing that interior Qi deficiency will prevent the toxin from being expelled outward, instead causing it to sink and become latent. However, during the stage of fluid filling (becoming pustules), the situation is even more critical than before. Previously, the illness was recent, and the Spleen and Stomach were still strong, capable of bearing the burden; now, after a prolonged illness, body fluids are depleted, and the Spleen and Stomach are weak. If diarrhea recurs, it doubly exhausts the interior, and the flourishing toxin cannot mature externally. Consequently, symptoms such as itching and collapsing, inverted lesions, chills with teeth grinding, and death from extreme debility may occur. Treatment should involve mild cases using *Renshen* (Ginseng Root), *Guizhi* (Cinnamon Twig), and *Fuling* (Poria); severe cases should use *Muxiang Yigong San* (Aucklandia Decoction for Overcoming Attack). However, upon reaching the pus-filling stage, Yuan Qi (Original Qi) is largely consumed at the exterior, and Middle Qi must be deficient. Deficiency leads to sinking Qi, manifesting as borborygmus (intestinal rumbling), flatus, and loose stools or diarrhea, which are common occurrences. Practitioners using medicinal regulation must exercise utmost caution in advance.

Abdominal pain occurring when smallpox first emerges indicates that the toxin is in the interior. Abdominal pain during incomplete eruption indicates internal sinking and latent pathogens. However, during the pus-forming stage, the toxin has already emerged, and there is no sinking or latency. If abdominal pain suddenly occurs and the patient has constipation, it is certainly due to dry fecal impaction, requiring purgative and guiding methods. If the stool is clear and watery, it is due to cold invasion, requiring warming and astringing methods. If the eruption is complete, the rising phase is thorough, and pus has formed, there is no pathogen on the exterior. Combined with the ability to eat and clear urination, there is no pathogen in the interior. If sudden abdominal distension and pain occur, accompanied by irritability, panting, and changes in the color of the smallpox lesions to a dull, wood-like gray, this is certainly caused by food stagnation. One should first employ digestion-promoting methods, followed by spleen-nourishing treatments.