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The excretion of both urine and feces should not be too profuse, nor should it be completely obstructed. If either becomes blocked, the intestines and stomach will become congested, meridians and collaterals will stagnate, and toxic pathogens will have no way to discharge. Consequently, the eyes may close, voice may become hoarse, muscles may turn dark, and the condition may deteriorate rapidly. Treatment should focus on promoting the circulation of Qi and blood; if this is achieved, bowel obstruction will naturally resolve. Constipation may arise from excessive heat and dryness in the lower jiao, or from excessive sweating, or from over-diuresis, leading to the depletion of body fluids and loss of intestinal lubrication. It may also result from blood-heat and blood-dryness, as seen in the elderly or postpartum women, whose Qi and blood are deficient and unable to propel the large intestine, leading to difficult defecation.

Cases presenting with heat in the palms and soles, sweating under the hypochondrium, dry mouth, abdominal distension, fever, and restlessness constitute "Heat Constipation" (Re Mi). These should be treated with a judicious purgative approach. Conversely, cases involving anorexia, vomiting of clear fluid, blueish complexion, abdominal non-distension, and absence of tenesmus constitute "Deficiency Constipation" (Xu Mi). These should be primarily treated by tonifying Qi and blood, supplemented by formulas such as *Maren Wan* (Hemp Seed Pill).

Generally, constipation should be categorized into three sections: upper blockage requires descending Qi and cooling; middle blockage requires moving Qi and invigorating blood; lower blockage requires honey suppositories (*Mi Dao*). Regarding smallpox, if there is no bowel movement for four to five days during the eruption phase, it is because Qi and blood are being transformed into pus. If there is no abdominal fullness or oppression, constipation should not be treated directly, as Yuan Qi and body fluids are utilized externally for pus formation. A few days without stool may actually aid the mechanism of Middle Jiao nourishment. However, if diarrhea occurs, herbs such as Renshen (Ginseng), [missing character], Zhi Gancao (Honey-fried Licorice), Fuling (Poria), Baizhu (Atractylodes Macrocephala), Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark) should be used, assisted by ascending agents, to prevent the weakening of Middle Jiao Qi and to allow smallpox toxins to reach the surface. Treating only the diarrhea may cause the smallpox lesions to collapse.

Ancient texts state: During the swelling and pus-forming stages of smallpox, if there are no internal symptoms, even if stool is retained for several days, one must not recklessly administer purgatives, as this depletes Qi and blood. Some mistakenly consider constipation favorable; in cases of heat congestion, instead of purging, they add tonifying, supporting, warming, and heating agents to consolidate, thereby worsening heat congestion. This prevents toxins from venting and Qi from flowing smoothly. When heat-toxin reaches extreme congestion, it flows downward to the Lower Jiao, causing sudden severe diarrhea and abrupt collapse of Yuan Yang, leading to death. This is due to mismanagement of heat congestion. In such cases, mild purgation should be used to drain heat congestion, but treatment must address the root cause of constipation. One need not rely heavily on Mangxiao (Natrii Sulfas) or Dahuang (Rhei Radix et Rhizoma) to avoid damaging Yuan Qi. Ancient purgative formulas often include wind-dispersing herbs to incorporate the principle of ascending and dispersing.

If, after smallpox, spontaneous diarrhea occurs with yellow-black stools, but the exterior and interior are otherwise sound, this indicates toxins discharging via stool; no specific treatment is needed, only *Huadu Tang* (Detoxification Decoction).

During fever from sores and rashes, stool should remain moist. If unpassed for two to three days, prompt laxation is advised to prevent intestinal blockage, which would hinder Ying and Wei circulation and cause more dense eruptions. After the initial eruption, stool should ideally be firm. Because children's zang-fu organs are delicate, retention leads to excess/stagnation, while spontaneous loose stools lead to deficiency. Thus, during the pus-forming stage, several days without stool is not a concern. For those who cannot eat, nourishment relies on residual grain Qi; after pus formation and toxin resolution, resolving and purging methods can be applied. For those who can eat, stool prefers moisture, relying on new food intake. To ensure old waste does not remain, zang-fu must flow freely and Qi/blood must be balanced. One must not use warming-tonifying herbs simply because stool is smooth, as this increases internal heat. If eating well but stool is retained for two to three days without internal discomfort, aggressive purgation is unnecessary. Honey or bile suppositories may be used if necessary to maintain Qi dynamic ascent/descent without obstruction.

However, if during the crusting stage (Yan), stool is retained for four to five days, causing intense heat and dampness, hindering healing, and blocking the San Jiao with internal heat-toxin, multiple complications may arise; in this case, purgation is indicated. For dry feces stuck in the large intestine, bile suppositories are used. The Stomach governs the rotting and ripening of water and grain; the Large Intestine governs the transmission of digested matter. Thus, food intake reflects the deficiency/excess of Grain Qi, and stool consistency reflects the deficiency/excess of Zang-Fu. Normal stool is a favorable sign in smallpox.

Sudden diarrhea during the swelling stage requires immediate cessation to prevent intestinal weakness, Qi collapse, and toxin internalization. Differentiate cold/heat and deficiency/excess. Diarrhea with cold limbs, blue-white complexion, and non-red/non-protruding lesions indicates Cold Syndrome; treat with Lizhong Tang (Regulate the Middle Decoction). Diarrhea with yellow, sour-smelling stool, heat in palms/soles, red face, thirst, and red/protruding lesions indicates Heat Syndrome; treat with Wuling San (Five-Ingredient Powder with Poria). Weak Spleen/Stomach with lethargy and anorexia indicates Deficiency; treat with warming and nourishing methods. Fever, abdominal fullness, thirst, and anorexia indicate Excess; treat with clearing and draining methods. Diarrhea after drinking cold water indicates Dampness prevailing causing loose stools; treat with warming the middle and promoting diuresis. Diarrhea with sour-smelling excrement due to food stagnation indicates injury from excessive eating; treat first with digestion-promoting methods, then tonification.

If organ Qi collapses spontaneously, or if cold herbs caused toxin sinking, resulting in diarrhea resembling pus, bloody/purulent stool, foul breath, cracked lips, closed eyes, and abdominal distension, the prognosis is fatal. Similarly, persistent diarrhea during swelling/pus stages that resists medication is fatal. Texts state: Six Fu organs failing externally manifest as cold limbs; Five Zang organs failing internally manifest as incessant diarrhea; collapse of Righteous Qi leads to lingering death; sinking of Pathogenic Qi leads to death from restlessness.