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[Liu Tidian] stated: In the treatment of variola and exanthema, it is most crucial to ensure the patency of the bowels and bladder. Therefore, Qian Yi's Four Sages Powder (Sisheng San) uses Tongcao (Akebiae Caulis) and Zhiqiao (Aurantii Fructus) with great efficacy. If the bowels and bladder are naturally unobstructed, there is no need to use harsh purgatives.

[Wan Quan] stated: In all cases of exanthema, urination should be copious and clear, and defecation should be formed. The Classics state: "Those who urinate frequently will inevitably have hard stools." Even if there is no bowel movement for two or three days, one need not be distressed. However, if urine volume is scant, the disease is progressing. This is because the Heart governs exanthema and belongs to Fire; Heart heat transfers to the Small Intestine, and Small Intestine heat transfers to the Bladder. The Bladder is the mansion of body fluids; its function relies on Qi transformation to discharge fluids. When Qi is consumed by Fire, it cannot transmit and transform, causing body fluids to fail to discharge, resulting in dysuria and urinary distress. During the fever stage of exanthema, stools should be moist. If there is no bowel movement for two or three days, urgent purgation is indicated to prevent intestinal obstruction, which would hinder the circulation of Ying and Wei (Nutritive and Defensive Qi), leading to an overly dense eruption of rash. Only after the eruption has risen and developed should the stool become firm. If the patient can eat and has regular bowel movements, dietary restrictions are unnecessary. If there is no bowel movement for four or five days, excessive heat generates dampness, making it difficult for the sores to crust over; mild purgation is then appropriate. If both urine and stool are obstructed, pathogenic toxins accumulate internally, blocking the Triple Burner (San Jiao). The Classics state: "If the breath does not move for a single respiration, the mechanism of life is exhausted." Thus, obstruction of both urine and stool leads to death.

In infantile smallpox, if urination and defecation are regulated, the interior Qi is harmonious, and no pathogenic factors remain stagnant. Therefore, urination should be copious and clear. If urine is red and dysuric, Daochi San (Heart Heat) is used. If urine is scanty, Bazheng San is used. If the eruption is too dense and urination is obstructed, Lianqiao Tang is used. Generally, during the fever of exanthema, heat should not be abruptly cleared; rather, promoting urination helps to subdue the constrained heat. If the smallpox is dense and urine is scant, this indicates deficiency of Qi and Blood, and depletion of body fluids, rather than excess heat. Promoting urination in this case would damage True Yang Qi; instead, Shiquan Dabu Tang (Deficiency after Sweating) should be used as the primary formula. Patients who can eat should have moist stools, as there must be intake and output. Those who cannot eat should have solid stools to preserve old grain Qi to nourish Blood and Qi. If there is no bowel movement for four or five days and the stool is dry and hard, the Gallbladder Suppository Method (Dan Dao Fa) should be used. If still obstructed, Sanhuang Wan (Heat) should be used for mild purgation. If there is severe fecal impaction with abdominal distension, Saiyi Chengqi Tang should be used to purge. If diarrhea occurs, medication should be stopped, as smallpox requires strong interior Qi, and diarrhea may weaken the Spleen and Stomach. For mild cases, Lizhong Tang Pills (Diarrhea), Yihuang San (Spleen), or Doukou Wan are used. For severe cases, Chen's Muxiang San (All Diarrhea) or Yigong San (Slow Eruption) are used.

[Renren Shi] stated: When smallpox is erupting vigorously, accompanied by panting, abdominal fullness, sweating on the palms and axillae, delirium, red urine, and constipation, Xiaochengqi Tang (Shanghan) or similar formulas should be used to purge. If the face is red and yellow, stools are dry and difficult, urine is scant, and vomiting occurs occasionally, Xiao Chaihu Tang (Fever) is appropriate. If heat is severe and Ying and Wei are blocked, toxic vapors spread diffusely. If interior toxicity is severe, there is constipation and hematuria; if exterior toxicity is severe, carbuncles and sores form, and the body ruptures. These result from failure to resolve and promote expulsion early. All such cases should be treated with Xijiao Dihuang Tang (Hemorrhage), Xiao Chaihu Tang plus Shengdihuang, Sishun Yin (Fever), Niuhuang San (Abdominal Pain), or Xuexue (Pediatric High Fever). If toxin coagulates and blood gathers, turning sores black, with constipation, panting, and irritability, refer to the "Examination of Color" section.

For total obstruction of urine and stool: Burn Gleditsiae Sinensis Fruit (Zaojiao) to ash, retain its nature, powder it, and administer with rice water.
Take one heaping measure of Abutilon Seed Powder (Kuizi Mo), boil in one cup of water until half remains, add half an ounce of lard, and take on an empty stomach.

[Urinary Difficulty] *Douzhen Fang* states: Before the eruption of smallpox and measles, if urination is difficult and heat is severe, fearing the onset of convulsions, use Daochi San to mildly resolve it. If heat enters the Bladder, presenting as bloody strangury, use Xijiao Dihuang Tang (Hemorrhage). If eruption is slow with red, dysuric urine, use Sisheng San (Appearance/Slow Eruption). If already erupted with red, dysuric urine, use Baizhu San (Thirst) plus Tongcao, or Wuling San plus Muxiang (Danyuan used Wuling San plus Maidong decocted). After crusting, if urination is difficult with irritability, heat, and thirst, use Zhuling San (Post-Varicella). [Xue Ji] stated that previous symptoms should be differentiated by cause: Small Intestine heat accumulation uses Daochi San; Liver Meridian heat uses Chaihu Maidong Tang (Post-Varicella); Spleen Meridian heat uses Xijiao Dihuang Tang; Lung Meridian heat uses Shengdihuang Tang (Measles Cough); Kidney Meridian heat uses Dihuang Wan (Kidney). Post-crusting Qi and Blood deficiency uses Bazhen Tang (Emaciation); Middle Qi deficiency uses Wuwei Yigong San (Vomiting/Diarrhea). [Wan Quan] stated: For scant urination in exanthema, mild heat uses Daochi San plus Zhizi Ren; severe heat uses Bazheng San as the primary formula.

Bazheng San treats lower Jiao accumulated heat, obstruction of urine and stool, or dysuric strangury, with pulse and symptoms indicating excess.
Rhubarb (stir-fried with wine), Plantago Seed (stir-fried), Dianthus Flower, Polygonum Knotweed, Gardenia (stir-fried), Akebia Stem (each 1 qian), Talcum (roasted, 2 qian), Licorice Root (1 qian).
Powder these. Take 2 qian per dose, decoct in water.

Zishen Wan
Phellodendron Bark (charred stir-fry), Anemarrhena Rhizome (charred stir-fry, each 2 liang), Cinnamon Twig (2 qian).
Grind into powder, bind with water paste into pills.

Huangqin Qingfei Yin
Scutellaria Root (stir-fried), Gardenia Fruit (stir-fried, equal parts).
Take 2 qian per dose, decoct in water.

Zicao Mutong Tang treats slow eruption of smallpox and urinary difficulty.
Arnebia Root, Ginseng, Akebia Stem, Poria, Glutinous Rice (equal parts), Licorice Root (half amount).
Decoct in water and take.

Tongguan San opens the Heart Meridian and promotes urination.
Gardenia Seed, Rhubarb (stir-fried, each 1 fen), Akebia Stem, Licorice Root (honey-fried), Plantago Seed (stir-fried), Red Poria, Dianthus Flower, Ginseng, Talcum (each 3 fen), Polygonum Knotweed (stir-fried, 5 fen).
Cut finely. Decoct one cup of water with ten roots of Centella Asiatica (Dengxin) until half remains, take warm.

Lianqiao Tang
Forsythia Fruit, Saposhnikovia Root, Dianthus Flower, Schizonepeta Spikelet, Akebia Stem, Plantago Seed, Angelica Sinensis, Bupleurum Root, Red Peony Root, White Talcum, Cicada Slough, Scutellaria Root, Gardenia Fruit, Licorice Root (each 5 fen).
Cut finely. Add 5 fen of Arnebia Root, decoct one and a half cups of water until one cup remains, strain, and take warm before meals.

Zicao Dongkui Tang treats urinary obstruction due to toxic vapor blockage.
Arnebia Flos, Gardenia Fruit, Scutellaria Root (each 1.2 qian), Gentiana Macrophylla, Sophora Flavescens Root (each 1.1 qian), Abutilon Seed (1.5 qian), Honeycomb, White Poria, Akebia Stem, White Peony Root, Alisma Rhizome, Plantago Seed (each 1 qian), Cicada Slough (0.8 fen).
Cut into pieces. Take 4-5 qian per dose, decoct in water, take warm long after meals. If painful urination is urgent, add Licorice Root Tip (0.8 fen) and Melia Toosendan Fruit (1 qian). If pain is severe and life-threatening, add Cyathula Root (1.3 qian). If urine is bloody, add Picrorhiza Rhizome (1.3 qian). If hematuria, add Angelica Sinensis (1 qian), Ligusticum Chuanxiong Rhizome (1 qian), Dragon Bone (calcined), Cuscuta Seed (each 1 qian); if very red, add Rehmannia Root. If urine is white, add Quisqualis Indica Fruit (1.3 qian), Coptis Rhizome (1.1 qian), Leek Seed powder (1.2 qian). If turbid, add Mantis Egg Case (1 qian).

[Constipation] [Xue Ji] Mr. Chen Wensu said: If smallpox/measles patients do not defecate for four to five days, cook lean pork in plain water until soft, cut into bean-sized pieces (5-7 pieces), and feed them. This moistens the organs and facilitates falling of scabs. Do not recklessly administer purgatives, lest internal True Qi become deficient and toxin enter the interior. If there is high fever for six to seven days without defecation, and the pulse is tight and vigorous, give Sanwei Xiaodu Yin (Appearance) for mild purgation. I believe that if toxin is in the muscle layer and not fully erupted, with a floating and tight pulse, this formula best disperses the toxin. If the pulse is sunken and tight, use Qianhu Zhiqiao San (Panting) to unblock toxic vapors and cut off the source. If mouth, tongue, and throat are swollen and painful, toxin is severe; use Shegan Niu Bang Zi Tang (Throat). If bowels open but thirst for soup occurs, it is Spleen-Stomach Qi deficiency; use Renshen Baizhu San (Thirst). If dry feces are stuck in the rectum, use pig bile suppositories. Avoid purgatives lest they further damage Stomach Qi, preventing un-erupted sores from rising and erupted sores from crusting. Generally, differentiate deficiency and excess by checking hand/foot temperature or desire for cold/hot drinks. [Wan Quan] If constipation occurs during fever, mild heat uses Sanhuang Wan (Fever); severe heat uses Chengqi Tang. From rising to crusting, if constipation persists, use the Gallbladder Suppository Method; do not hastily use laxatives. If sores are dry, black, and sunken, with constipation and irritability, use Baixiang Wan or Niuli Gao (Black Sunken Sores). If unavailable, substitute with Chengqi Tang.

Danggui Wan
Angelica Sinensis (0.5 liang), Licorice Root (1 fen), Coptis Rhizome, Rhubarb (each 2.5 qian).
First, decoct Angelica Sinensis into a paste, mix with the other three powdered herbs, form pills, and take. Stop when bowel movement occurs.

Zao Bian Baixiang Wan treats severe constipation in smallpox/measles.
Red-spined Spurge Root (bone removed, 1 liang), Qingzhou Dates (pitted, 10).
Decoct in two cups of water until water is gone. Remove Spurge, bake dates until dry, and form pills as needed. Start with small doses, increase gradually, stopping at bowel movement.

Xixin San treats high fever in smallpox, difficulty in urination and defecation, delirium, and excessive thirst.
Rhubarb, Licorice Root, Angelica Sinensis, Ephedra Stem (deprived of joints), Atractylodes Macrocephala Rhizome, Peony Root, Schizonepeta Spikelet (equal parts).
Cut into coarse pieces. Decoct with ginger and mint according to severity. Warm administration stabilizes; hot administration causes loose stools.

Saiyi Chengqi Tang
Rhubarb, Mirabilite, Magnolia Bark, Immature Bitter Orange (each 1 qian), Licorice Root (0.5 qian).
Cut finely. Decoct one cup of water with one slice of ginger until 0.7 cup remains, strain, and take hot before meals.

Dan Dao Fa (Gallbladder Suppository Method)
Take one large pig gallbladder. Cut a goose quill tube evenly at both ends. Insert one end into the gallbladder, tie securely with thread, blow air to inflate, insert into the anus, wait for gas passage, then remove.

Jiawei Sijunzi Tang
Ginseng, Atractylodes Macrocephala Rhizome, Astragalus Root, White Poria, Licorice Root, Trichosanthes Root, Platycodon Root (equal parts).
Decoct in water and take. Haizang used this for smallpox/measles whether erupted or not, with constipation or occasional thirst. Patients may have insufficient congenital constitution, or suffer from vomiting/diarrhea, excessive sweating, or diuresis, leading to deficient Yuan Qi and dry body fluids, causing constipation. Reckless purging is like wielding a knife blindly; this formula is essential. Physicians must examine carefully to avoid error.

Runchang Tang treats deficiency-type constipation.
Angelica Sinensis Tail, Licorice Root, Rehmannia Root, Hemp Seed, Peach Kernel Paste.
Decoct in water and take.

Zicao Maren Tang treats constipation in exanthema causing toxic vapor blockage.
Sophora Tonkinensis Root, Arnebia Root (each 1.1 qian), Burdock Fruit, Honeycomb, Raw Rhinoceros Horn (substitute with alternative), Green Tangerina Peel, Peach Kernel, Hemp Seed, Biota Tops, Scutellaria Root (each 1 qian), Apricot Kernel (1.2 qian).
Cut into pieces. Take 4-5 qian per dose, decoct in water, take long after meals. For severe constipation, add 0.7 fen of Sour Plum Flesh. If ineffective, add another 1.5 qian of Abutilon Seed.