〔万〕疮疹吐利，常候也，经曰∶诸呕吐暴注，皆属于热。盖三焦为水谷传化之道路，热火内迫，则传
化失常，而吐利并作，火性燥动，迅 故也。邪在上焦，但吐而不利，邪在下焦，但利而不吐，邪在中焦，
则上吐下利。又，里气上逆而不下则吐，气下而不上则利。疮疹初发热时有吐利者，不可骤止，令邪气上下得
出也，吐利久不止，方可治之，更宜消息。〔薛〕《痘疹方》云∶痘疹吐泻，盖因脾胃不和，饮食不调，烦渴呕
吐泄泻，并用白术散（渴），然疮疹皆赖脾土，脾土实，则易出易靥，万物得土气温暖而生，吐泻则伤脾土，遂有
更变之证，夏月中暑烦渴，泻或腹痛，或欠筋，用五苓散（惊加）藿香。伤食吐泻，用小异功散（吐泻）。手足并
冷者，用益黄散（脾）、豆蔻丸（泄利）。顶陷灰白，用木香散（渴）。疮正出而吐泻者，或见血者，俱为逆证，
难治。窃谓前证虽因脾胃不和，然邪实上焦，则宜吐，邪实下焦，则宜泻，如吐泻嗳腐吞酸，皆宜宣发，但微甚不同
耳。张翼之云∶若痘疹吐泻少食为里虚，陷伏倒靥灰白为表虚，二者俱见，为表里俱虚，合用十二味异功散救之
（见形），甚至姜、附、灵砂亦可用。若止里虚去官桂，止表虚减肉豆蔻。若能食便秘倒靥为里实，勿
补，当用钱氏及丹溪法下之，皆为能食为里实，里实而补则结痈毒。红活绽凸为表实，表实而补则溃烂不结痂。凡
痘见 ，便忌葛根汤，恐发表虚也，如有更变，当随证治之。〔张〕吐泻有冷热二证，吐而不渴，泻而手足冷，面
色青白，此冷证也，益黄（脾）、理中辈主之，或四君子加木香、豆蔻亦妙。既吐且渴，虽泻而手足心热，
面赤，居处喜冷，此热证也，五苓散（惊）竹叶石膏汤（痘渴）加橘皮等主之。大吐而身热烦渴，腹满而喘，大小便涩，
面赤闷乱，钱氏云此当利小便，不瘥者，宣风散（痘发热）下之。《百问方》用香苏饮，吐加半夏、茯苓、白芍。泻
加白术、茯苓。烦躁呕吐渴泻者，亦热也，白术散（渴）最当，紫草木香汤亦可。
理中汤
人参 白术 干姜 白茯苓 甘草节（各等分）
上 咀。用水一盏，煎五分，不拘时服。如恶寒加附子，名附子理中汤。每帖二钱半。
香苏饮 治小儿痘疹作泻。
香附子 陈皮 紫苏 川芎 甘草 白芷（各等分）
上锉散。每服三钱，生姜葱白煎，或白水煎。泻加白术、茯苓，呕加茯苓、白芍药。
紫草木香汤 治痘出不快，大便泄利。
紫草 木香 茯苓 白术（各等分） 甘草（减半） 一方，无甘草。
上锉散。入糯米百粒，水煎服，每帖三钱。紫草能利大便，白术木香佐之。脾气虚者加人参。
人参胃爱散 治痘疮已发未发，吐泻不止，不思饮食，或吐逆等证。
人参 藿香 紫苏 甘草（炒） 丁香 茯苓 木瓜（各等分） 糯米
上，每服三钱，姜枣水煎。
初发热，自利而吐者，黄芩加半夏汤主之。更详审吐利所出之物，如吐酸水者，利色黄或青绿者，其气臭者，
皆热也。若吐清痰之水，利下清白不臭，未可作热治之，乃内虚也，四君子汤加诃子肉及益黄散（脾）。一云∶痘欲出
未出而吐利者，是中焦停寒，或挟宿食也，四君子汤加砂仁、橘红，或中和散，有宿食者，用紫霜
丸（癖）。发热时吐泻不止，身热口渴者，四苓散加黄连、淡竹叶煎服（五苓）去桂是也。
黄芩加半夏汤
黄芩（一钱半） 甘草（炙，一钱） 白芍药（酒拌晒九次，三钱） 半夏（汤泡七次，二钱） 生姜（一
钱） 大枣（二枚）
上锉细。水一盏，煎七分，温服。渴、去半夏，加枇杷叶去毛炙二钱，芦根、茅根、各三钱。
中和散 治中焦停寒，或夹宿食。
浓朴（一钱） 白术（八分） 干姜（四分） 甘草（三分）
上锉细。作一服，加生姜一片，水煎，稍热服。
起胀灌脓时吐利并作，宜急治之，胃寒者益黄散、理中汤，胃热者黄芩半夏汤调四苓散。
靥后吐泻，亦分冷热，冷者亦宜益黄、理中辈，热者四苓散、竹叶石膏汤（痘渴）加橘皮，或竹茹汤亦可。
竹茹汤
橘红 半夏 白茯苓 黄连（姜炒，各一钱） 甘草（五分） 竹茹（一团） 葛根（一钱五分）
上，水一钟，生姜三片，煎五分，不拘时温服，分二帖。
和中汤 虚吐不止。即镇胃止吐汤加人参。
人参 茯苓 甘草（各五分） 白术 半夏（各八分） 陈皮 藿香 砂仁（各一钱）
上，用生姜水煎服。
藿香正气散 治初热干呕。
藿香 紫苏 大腹皮 陈皮 桔梗 甘草 茯苓 半夏 浓朴 白芷
上，姜枣煎服。
凡疮痘已经大吐大泻之后，上下俱脱，即当用大补之剂，纵有他证，皆以虚论，
庸医每罔顾人元气，用药克削，而致夭枉者，滔滔皆是，可恨也！
[Wan Quan's Discussion] Vomiting and diarrhea appearing during smallpox or chickenpox are common symptoms. The medical classics state: "Various sudden vomiting and acute watery diarrhea all belong to heat syndromes." This is because the Sanjiao (Triple Burner) is the pathway for the transmission and transformation of food and fluids; when pathogenic fire forces inward, it disrupts this transformation, causing simultaneous vomiting and diarrhea. This occurs due to the dry, agitated, and rapid nature of fire. If the pathogen is in the Upper Jiao, there is only vomiting without diarrhea; if in the Lower Jiao, only diarrhea without vomiting; if in the Middle Jiao, both upper vomiting and lower diarrhea occur. Furthermore, if internal Qi rebels upward and fails to descend, vomiting results; if Qi moves downward and fails to ascend, diarrhea results. When vomiting and diarrhea appear during the initial fever stage of rash diseases, they should not be abruptly stopped, so that pathogens may exit through the upper and lower pathways. Treatment should only commence if vomiting and diarrhea persist for a long time, requiring careful assessment of the condition.
[Xue Ji's Discussion] The *Douzhen Fang* (Smallpox and Chickenpox Formulas) states: Vomiting and diarrhea in rash diseases are generally caused by disharmony of the Spleen and Stomach and irregular diet, leading to irritability, thirst, vomiting, and diarrhea. Bai Zhu San (Atractylodes Macrocephala Decoction) should be used for these symptoms (add for thirst). However, the growth of rashes relies on the Earth element of the Spleen; when Spleen Earth is solid, rashes emerge and crust over easily, just as all things grow relying on the warmth of the soil. Vomiting and diarrhea damage Spleen Earth, leading to complicated changes. For summerheat stroke causing irritability and thirst, or diarrhea with abdominal pain or tendon twitching, use Wu Ling San (Five-Ingredient Powder with Poria) (add for convulsions) combined with Huo Xiang (Patchouli). For vomiting and diarrhea due to food stagnation, use Xiao Yi Gong San (Minor Yi Gong Decoction) (for vomiting/diarrhea). For cold hands and feet, use Yi Huang San (Yellow Protecting Powder) (tonify Spleen) and Dou Kou Wan (Cardamom Pill) (for diarrhea). For depressed rash tops with grayish-white color, use Mu Xiang San (Costus Root Powder) (for thirst). If vomiting and diarrhea occur while the rash is erupting, or if bleeding is seen, these are adverse signs and are difficult to treat. I believe that although these conditions arise from Spleen-Stomach disharmony, if excess pathogen is in the Upper Jiao, emesis is indicated; if in the Lower Jiao, purgation is indicated. For symptoms like vomiting foul-smelling matter or acid regurgitation, dispersing and venting methods are appropriate, differing only in degree. Zhang Yizhi stated: If smallpox vomiting/diarrhea with reduced appetite indicates Interior Deficiency, and depressed/inverted crusts with grayish-white color indicate Exterior Deficiency, their simultaneous occurrence signifies both Exterior and Interior Deficiency, requiring Shier Wei Yi Gong San (Twelve-Ingredient Yi Gong Decoction) for rescue (seen in the eruption phase); in severe cases, Ginger, Aconite, and Lingsha may even be used. If only Interior Deficiency exists, remove Gu Gui (Cassia Bark); if only Exterior Deficiency exists, reduce the dosage of Rou Dou Kou (Nutmeg). If the patient can eat but has constipation and inverted crusts, this is Interior Excess; do not tonify, but instead use the purgative methods of Qian Yi and Zhu Danxi. This is because the ability to eat indicates Interior Excess; tonifying an Excess condition leads to carbuncles and toxins. Red, vibrant, and protruding rashes indicate Exterior Excess; tonifying an Excess condition leads to ulceration without crusting. Whenever rashes first appear, Ge Gen Tang (Kudzu Root Decoction) is contraindicated, fearing it may cause deficiency through excessive releasing; if complications arise, treat according to the syndrome.
[Zhang's Discussion] Vomiting and diarrhea present as Cold or Heat syndromes. Vomiting without thirst, diarrhea with cold hands and feet, and a bluish-white complexion indicate a Cold syndrome, treated primarily with Yi Huang San (tonify Spleen) or Li Zhong Tang (Regulate the Middle Decoction), or Si Jun Zi Tang (Four Gentlemen Decoction) added with Mu Xiang and Dou Kou. Vomiting accompanied by thirst, diarrhea with hot palms, red face, and preference for cool environments indicate a Heat syndrome, treated primarily with Wu Ling San (add for convulsions) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) (for smallpox thirst) added with Ju Pi (Tangerine Peel). Severe vomiting with body heat and irritability/thirst, abdominal fullness with wheezing, obstructed urination and defecation, red face, and mental confusion: Qian Yi stated this requires promoting urination; if ineffective, use Xuan Feng San (Disperse Wind Powder) (for smallpox fever) to purge. The *Baiwen Fang* uses Xiang Su Yin (Costus and Perilla Infusion); add Ban Xia, Fu Ling, and Bai Shao for vomiting; add Bai Zhu and Fu Ling for diarrhea. Irritability, vomiting, thirst, and diarrhea also indicate Heat; Bai Zhu San (for thirst) is most suitable, and Zi Cao Mu Xiang Tang (Arnebia and Costus Decoction) is also acceptable.
Li Zhong Tang
Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Jiang (Zingiberis Rhizoma), Bai Fu Ling (Poria), Gan Cao Jie (Licorice Node) (equal parts).
Crush into pieces. Decoct one cup of water until reduced to half, take at any time. If aversion to cold is present, add Fu Zi (Aconiti Lateralis Radix Praeparata), named Fuzi Lizhong Tang. Each dose is two qian and a half.
Xiang Su Yin Treats pediatric smallpox diarrhea.
Xiang Fu Zi (Cyperi Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Zi Su (Perillae Folium), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Bai Zhi (Angelicae Dahuricae Radix) (equal parts).
Grind into powder. Take three qian per dose, decoct with fresh ginger and scallion white, or plain water. Add Bai Zhu and Fu Ling for diarrhea; add Fu Ling and Bai Shao Yao for vomiting.
Zi Cao Mu Xiang Tang Treats slow eruption of smallpox and loose stools.
Zi Cao (Arnebiae Radix), Mu Xiang (Aucklandiae Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (equal parts); Gan Cao (Licorice Radix et Rhizoma) (half dosage); one formula excludes Gan Cao.
Grind into powder. Add one hundred grains of glutinous rice, decoct in water, take three qian per dose. Zi Cao promotes bowel movement, assisted by Bai Zhu and Mu Xiang. Add Ren Shen for Spleen Qi deficiency.
Ren Shen Wei Ai San Treats vomiting and diarrhea that does not stop whether the rash has erupted or not, loss of appetite, or retching.
Ren Shen (Ginseng Radix et Rhizoma), Huo Xiang (Agastaches Herba), Zi Su (Perillae Folium), Gan Cao (Licorice Radix et Rhizoma, stir-fried), Ding Xiang (Caryophylli Flos), Fu Ling (Poria), Mu Gua (Chaenomelis Fructus) (equal parts), Glutinous Rice.
Crush, take three qian per dose, decoct with ginger and jujube water.
During initial fever, if spontaneous diarrhea and vomiting occur, Huang Qin Jia Ban Xia Tang (Scutellaria Decoction with Pinellia) is primary. Carefully examine the vomitus and stool: sour vomit, yellow or greenish-blue stool, and foul odor all indicate Heat. If clear phlegm-water is vomited, and stool is clear/white and odorless, do not treat as Heat; this is Internal Deficiency, treat with Si Jun Zi Tang (Four Gentlemen Decoction) added with He Zi Rou (Terminalia Chebula Retocarpus) and Yi Huang San (tonify Spleen). Another view: Vomiting and diarrhea before rash eruption indicate Cold retention in the Middle Jiao or retained food, treat with Si Jun Zi Tang added with Sha Ren (Amomi Fructus Rotundus) and Ju Hong (Citri Reticulatae Pericarpium Rubrum), or Zhong He San; for retained food, use Zi Shuang Wan (Purple Frost Pill) (for masses). During fever, if vomiting/diarrhea persists with body heat and thirst, use Si Ling San (Four-Poria Powder) added with Huang Qin (Scutellariae Radix) and Dan Zhu Ye (Lophatheri Herba) (this is Wu Ling San minus Gui Zhi).
Huang Qin Jia Ban Xia Tang
Huang Qin (Scutellariae Radix, 1.5 qian), Gan Cao (Licorice Radix et Rhizoma, honey-fried, 1 qian), Bai Shao Yao (Paeoniae Radix Alba, wine-mixed and sun-dried nine times, 3 qian), Ban Xia (Pinelliae Tuber, boiled seven times, 2 qian), Sheng Jiang (Zingiberis Rhizoma Recens, 1 qian), Da Zao (Jujubae Fructus, 2 pieces).
Cut finely. Decoct one cup of water until reduced to seventy percent, take warm. For thirst, remove Ban Xia, add Pi Pa Ye (Loquat Leaf, de-haired and fried, 2 qian), Lu Gen (Phragmitis Rhizoma), and Mao Gen (Imperatae Rhizoma, 3 qian each).
Zhong He San Treats Cold retention in the Middle Jiao or mixed with retained food.
Nou Po (Magnoliae Officinalis Cortex, 1 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 8 fen), Gan Jiang (Zingiberis Rhizoma, 4 fen), Gan Cao (Licorice Radix et Rhizoma, 3 fen).
Cut finely. One dose, add one slice of fresh ginger, decoct in water, take slightly warm.
When swelling and pus formation occur, if vomiting and diarrhea happen simultaneously, urgent treatment is needed. For Stomach Cold, use Yi Huang San or Li Zhong Tang; for Stomach Heat, use Huang Qin Ban Xia Tang blended with Si Ling San.
After crusting, vomiting and diarrhea are also divided into Cold and Heat. Cold types use Yi Huang San or Li Zhong Tang; Heat types use Si Ling San or Zhu Ye Shi Gao Tang (for smallpox thirst) added with Ju Pi, or Zhu Ru Tang (Bamboo Shavings Decoction) is also acceptable.
Zhu Ru Tang
Ju Hong (Citri Reticulatae Pericarpium Rubrum), Ban Xia (Pinelliae Tuber), Bai Fu Ling (Poria), Huang Qin (Scutellariae Radix, ginger-fried, 1 qian each), Gan Cao (Licorice Radix et Rhizoma, 5 fen), Zhu Ru (Bambusa Textilis Caulis, one ball), Ge Gen (Puerariae Lobatae Radix, 1.5 qian).
Cut, decoct one zhong of water with three slices of fresh ginger until reduced to fifty percent, take warm at any time, divide into two doses.
He Zhong Tang Treats persistent vomiting due to deficiency. This is Zhen Wei Zhi Tu Tang (Stabilize Stomach Stop Vomit Decoction) added with Ren Shen.
Ren Shen (Ginseng Radix et Rhizoma), Fu Ling (Poria), Gan Cao (Licorice Radix et Rhizoma, 5 fen each), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ban Xia (Pinelliae Tuber, 8 fen each), Chen Pi (Citri Reticulatae Pericarpium), Huo Xiang (Agastaches Herba), Sha Ren (Amomi Fructus Rotundus, 1 qian each).
Decoct in water with fresh ginger.
Huo Xiang Zheng Qi San Treats dry retching during initial heat.
Huo Xiang (Agastaches Herba), Zi Su (Perillae Folium), Da Fu Pi (Arecae Pericarpium), Chen Pi (Citri Reticulatae Pericarpium), Jie Geng (Platycodonis Radix), Gan Cao (Licorice Radix et Rhizoma), Fu Ling (Poria), Ban Xia (Pinelliae Tuber), Nou Po (Magnoliae Officinalis Cortex), Bai Zhi (Angelicae Dahuricae Radix).
Decoct with ginger and jujube.
Whenever sores or smallpox have undergone severe vomiting and diarrhea, with depletion of Qi above and below, large tonifying agents must be used immediately. Even if other syndromes exist, they should all be discussed as deficiency. Quack doctors often disregard the patient's Yuan Qi (Original Qi), using harsh draining medicines, leading to premature death, which is abundant and detestable!