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Both the interior and exterior of smallpox should be kept open and unobstructed; constipation prevents the free flow of Qi and Blood. For unyielding stool, Si Shun Qing Liang Yin is appropriate; for difficult and scanty urination, Ba Zheng San is appropriate.
[Note]
In cases of eruptive diseases like smallpox, the free passage of both stool and urine is highly desirable because the disease is attributed to toxic fire. Only through patency can the meridians be smoothed, allowing the smooth circulation of Qi and Blood without the risk of stagnation and obstruction. If there is any blockage, the toxic fire cannot reach the exterior and will inevitably attack the interior, causing complications. In the initial stage, if constipation occurs, Si Shun Qing Liang Yin (Four-Obedience Cooling Decoction) is the primary formula; if urinary difficulty occurs, Ba Zheng San (Eight-Righteous Powder) is the primary formula. However, during the pustule formation stage, these purgative formulas must not be used lightly.
(Si Shun Qing Liang Yin [Four-Obedience Cooling Decoction]) Bai Shao Yao (Radix Paeoniae Alba), Dang Gui Shen (Radix Angelicae Sinensis - root body), Sheng Gan Cao (Raw Radix Glycyrrhizae), Sheng Da Huang (Raw Radix et Rhizoma Rhei). Decoct in water and take orally.
(Decoction Song)
Si Shun Qing Liang treats constipation, where unyielding stool indicates fierce toxic fire;
Bai Shao, Dang Gui, Da Huang, and Gan Cao,
Decoct urgently and take for the swiftest effect.
(Ba Zheng San [Eight-Righteous Powder]) Che Qian Zi (Semen Plantaginis), Qu Mai (Herba Dianthi), Bian Xu (Herba Polygoni Avicularis), Zhi Zi Ren (Semen Gardeniae), Da Huang (Radix et Rhizoma Rhei), Sheng Gan Cao (Raw Radix Glycyrrhizae), Mu Tong (Caulis Akebiae or Caulis Tetrasepalae Spirematostegiae), Hua Shi (Talcum). Use Deng Xin Cao (Medulla Junci) as a guide, decoct in water and take orally.
(Decoction Song)
Ba Zheng San treats difficult and scanty urination, with Che Qian, Qu Mai, and Bian Xu;
Zhi Zi, Da Huang, Mu Tong, and Gan Cao,
Add Hua Shi, decoct, and take.

Miscellaneous Syndromes in Smallpox

During the initial heat stage, diarrhea is first treated with Chai Ling Tang; for Spleen deficiency cold diarrhea, Mu Xiang San decoction is used; for yellow, sour-smelling stool, Wei Ling Tang is used; for loose, slippery stools during the pustule formation stage due to deficiency, Dou Kou Wan is used.
[Note]
Eruptive diseases are unfavorable for constipation and even more so for diarrhea.
Diarrhea in the initial stage still possesses the function of opening and venting, allowing the pathogenic fire to resolve through evacuation.
If diarrhea is severe, it indicates that pathogenic factors have converged in the intestines and stomach, forcing downward movement and disrupting transportation and transformation functions; Chai Ling Tang is appropriate.
During the swelling stage, if diarrhea occurs accompanied by cold extremities, failure of the eruption to rise, and pale color, this is cold diarrhea.
Chen Shi Mu Xiang San (Mr. Chen's Costus Root Powder) is used.
If there is abdominal fullness, anorexia, yellow and sour-smelling diarrhea, hot palms and soles, red face, and red lesions, this is diarrhea caused by Stomach heat.
Wei Ling Tang is used.
The pustule formation stage is particularly critical. At this stage, the Body Fluids are depleted, and the Spleen and Stomach are weak. If diarrhea is added,
various complications may arise. Dou Kou Wan should be used urgently.
(Chai Ling Tang [Bupleurum and Poria Decoction]) Huang Qin (Radix Scutellariae), Ban Xia Jiang Zhi (Rhizoma Pinelliae Praeparatum cum Zingibere et Alumine), Bai Zhu Tu Chao (Rhizoma Atractylodis Macrocephalae Stir-fried with Earth), Sheng Gan Cao (Raw Radix Glycyrrhizae), Chi Fu Ling (Poria Cum Rosa), Zhu Ling (Poria), Ze Xie (Rhizoma Alismatis), Chai Hu (Radix Bupleuri). Use Sheng Jiang (Fresh Rhizoma Zingiberis) and Deng Xin Cao (Medulla Junci) as guides, decoct in water and take orally.
(Decoction Song)
When the smallpox rash has not yet appeared but diarrhea occurs, Chai Ling Tang's smoothing and draining action is most swift;
Huang Qin, Ban Xia, Bai Zhu, Gan Cao, and Chi Fu Ling,
Zhu Ling, Chai Hu, and Ze Xie work together.
(Chen Shi Mu Xiang San [Mr. Chen's Costus Root Powder]) See the section on Jue Ni (Reversal Cold).
(Wei Ling Tang [Stomach and Poria Decoction]) Chen Pi (Pericarpium Citri Reticulatae), Hou Po Jiang Chao (Cortex Magnoliae Officinalis Stir-fried with Ginger), Chi Fu Ling (Poria Cum Rosa), Cang Zhu Mi Jiang Shui Jin Chao (Rhizoma Atractylodis Lanceae Soaked in Rice Wash Water and Stir-fried), Zhu Ling (Poria), Ze Xie (Rhizoma Alismatis), Bai Zhu Tu Chao (Rhizoma Atractylodis Macrocephalae Stir-fried with Earth). Use Deng Xin Cao (Medulla Junci) as a guide, decoct in water and take orally.
(Decoction Song)
Interior excess causing diarrhea is treated with Wei Ling Tang;
Chen Pi, Hou Po, and Chi Fu Ling,
Cang Zhu, Zhu Ling, and Ze Xie;
Remove Gui Zhi and double the amount of Bai Zhu for endless efficacy.
(Dou Kou Wan [Cardamom Pill]) Bai Long Gu Huan (Fossilized Bones Calcined), Rou Dou Kou Mian Guo Wei Qu You (Nux Vomica Seed wrapped in flour, baked, and oil removed), Mu Xiang Wei (Costus Root baked), Sha Ren (Amomi Fructus), He Li Le Rou (Pericarpium Terminaliae Chebulae) each 5 qian (wrapped in flour);
Chi Shi Zhi Huan (Halloysitum Rubrum calcined) 7.5 qian, Bai Ku Fan (Alumen) 3 qian. Grind into fine powder, make pills with Qu Hu (Malt Paste) the size of millet seeds. Take 30-50 pills per dose, washed down with rice drink.

Miscellaneous Syndromes in Smallpox