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In cases of **chuang zhen** (variolous eruptions), if symptoms such as vomiting, diarrhea, or anorexia occur, this is due to the deficiency and weakness of the Spleen and Stomach. In children, eruptions arising from heat in the Stomach generally originate from the Stomach channel. When the pathogenic heat-toxin first erupts, it inevitably causes restlessness and thirst. Excessive drinking induced by dryness-heat, combined with sitting or lying in cold wind or cold environments, leads to a struggle between cold and heat pathogens. Cold qi enters the Stomach; thus, cold in the Stomach causes vomiting, cold in the Spleen causes diarrhea, and deficiency-cold in both Spleen and Stomach results in an inability to eat. One should administer formulas such as *Zhizhong Tang* (Regulate the Middle Decoction) or *Yihuang San* (Strengthen the Yellow Powder) according to the specific syndrome. For severe cases, dosages should be adjusted appropriately until vomiting and diarrhea cease.

However, heat-type vomiting and heat-type diarrhea are different. How can they be distinguished? Generally, patients with heat vomiting present with heat in the palms and axillae accompanied by sweating, thirst, flushed face, and a preference for cold drinks. In infants who cannot yet speak but are extremely thirsty, continuous nursing leads to milk accumulation in the chest and epigastrium which cannot be digested, resulting in vomiting; this is heat vomiting. The infant immediately desires more milk after vomiting, indicating internal heat causing thirst. If physicians fail to examine carefully and indiscriminately use drying agents upon seeing vomiting and diarrhea, it may lead to "wind generated from extreme heat," causing significant harm. This principle applies not only to variolous eruptions but also to other syndromes. Differentiating heat vomiting from heat diarrhea requires particular caution. Patients with heat diarrhea present with scanty, difficult urination, thirst, dry mouth, and dry throat; these should be treated primarily with *Wuling San* (Five-Ingredient Powder with Poria) combined with *Zhuye Banxia Tang* (Bamboo Leaf and Pinellia Decoction).

Anorexia in children can also be classified into deficiency and excess syndromes. If accompanied by vomiting or diarrhea, with a cyanotic complexion and dark cyanotic color around the eyes, and an inability to nurse, this is a deficiency syndrome caused by cold, requiring warming treatment. If bowel movements and urination are normal, with a flushed and puffy face, thirst, night terrors, lip-biting, yellowish-red sclera, wheezing, fever, and an inability to nurse, this is an excess-heat syndrome caused by fullness in the middle jiao. Furthermore, patients with latent heat also lose their appetite due to fullness and oppression in the chest and diaphragm; this requires detailed examination.

Wind-cold and cold-pathogen invasions should be resolved through sweating. Sweat is the essence derived from grain qi. The formation of pus, blood, and scabs in variolous eruptions relates to the transformation of nutritive blood. Ancient practitioners used resolving and venting formulas like *Shengma Tang* (Cimicifuga Decoction) but were cautious that if blood-heat toxin was too severe, it would exacerbate the eruptions; therefore, they added small amounts of blood-cooling herbs to resolve the toxin. Variolous eruptions are easy to manage; why should one damage the Zang-Fu organs and Spleen-Stomach by inducing diarrhea? Since the Zang-Fu and Spleen-Stomach are cold, how can they circulate Ying and Wei (nutritive and defensive) Qi? If Ying and Wei circulation is sluggish, how can the pus, blood, and scabs of the eruptions be steamed and formed? Thus, even in Taiyang cold damage, the treatment is merely promoting Qi circulation and sweating; purgation is contraindicated. How much more so for variolous eruptions, which occur when blood and Qi are abundant, internal deficiency is absent, and external cold is not present, allowing the eruption to emerge without sinking inward? Why not observe *Neibu San* (Internal Nourishing Powder)? It is highly effective for treating carbuncles and ulcers, consisting mainly of herbs that warm the blood and promote Ying-Wei circulation. Since variolous eruptions and carbuncles/ulcers are both types of sores, why is purgation never used to treat carbuncles and ulcers?