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In cases of vomiting and diarrhea caused by variola (smallpox) or rubeola (measles), some do not require treatment, while others require immediate intervention. If vomiting and diarrhea occur during the initial fever stage, provided they are mild and cease spontaneously, it is a favorable sign. This is because vomiting and purging naturally possess a dredging effect, allowing pathogenic factors to be vented; thus, no treatment is needed. However, if vomiting and purging are severe, treatment becomes necessary. Furthermore, in patients with originally weak vital energy who present with these symptoms, failure to promptly tonify and regulate will inevitably lead to exhaustion of Spleen Qi. Consequently, after the eruption of lesions, multiple deficiency syndromes may emerge, making rescue efforts futile. Therefore, regarding vomiting and diarrhea before the appearance of lesions, there is a distinction between those that require treatment and those that do not, based on severity. However, once the macules (spots) appear, vomiting and diarrhea are highly inappropriate and must be rapidly diagnosed for cold-heat and deficiency-excess patterns before treatment.

1. Vomiting and diarrhea associated with smallpox are mostly attributed to the Spleen channel, yet distinctions can be made among the Upper Jiao, Lower Jiao, and the five Zang organs. Pathology in the Upper Jiao manifests as vomiting without diarrhea; pathology in the Lower Jiao manifests as diarrhea without vomiting; pathology in the Middle Jiao presents with both vomiting and diarrhea. Thus, for conditions in the Upper Jiao, one must distinguish the influence of Heart and Lung Qi on the Spleen; for conditions in the Lower Jiao, one must examine the influence of Liver and Kidney Qi on the Spleen. The Qi of the five Zang organs has mechanisms of mutual nourishment and mutual restraint. Failure to understand this leads to frequent misdiagnosis.

1. Most cases of vomiting and diarrhea in smallpox involve deficiency-cold of the Middle Qi, accounting for seven or eight out of ten cases. However, there are also cases caused by excess pathogens, intense toxicity, or dietary injury. These require careful examination of pulse and symptoms for differentiation. If heat-toxin and excess pathogens are indeed present, one must not mistake them for deficiency-cold and lightly use warming-tonifying methods, as this may exacerbate the pathogen, leading to residual toxins causing carbuncles and sores, or difficult-to-heal ulcerations.

Vomiting in smallpox is predominantly deficiency-cold, with few excess-heat cases. Treatment should primarily focus on warming and nourishing the Spleen and Stomach. Even if mixed syndromes exist, there must be evidence of excess pathogens before treating concurrently with the primary condition. Therefore, cooling and draining herbs should not be used lightly.

1. For diseases involving vomiting, the pathology lies in the Upper and Middle Jiaos. One must absolutely avoid using purgatives recklessly, as this damages the vital energy of the Lower Jiao, leading to worsening conditions and danger. Even if constipation is present, one should regulate and tonify Stomach Qi, employing gentle laxative guidance. Once Spleen and Stomach Qi harmonize, ascending and descending functions normalize, and bowel movements resolve naturally. This principle must be understood.

1. In smallpox, if vomiting or dry heaving occurs without other signs such as wind-cold, food stagnation, distension, or pain, it indicates deficiency-cold of the Spleen and Stomach. Formulas such as Liuwei Yigong Decoction (Six-Ingredient Modified Isolated Power Decoction), Wujunzi Decoction (Five Gentlemen Decoction), or Shenjiang Yin (Ginseng and Ginger Drink) should be used. Alternatively, Wenwei Yin (Warm the Stomach Drink) or Lizhong Tang (Regulate the Middle Decoction) may be considered.

1. For slight Spleen deficiency-cold with mild vomiting but no Middle Jiao cold, Wuwei Yigong San (Five-Ingredient Modified Isolated Power Powder) is indicated.

1. For deficiency-cold of the Stomach opening with vomiting accompanied by pain and obstruction, Liuwei Yigong Decoction administered with Shensan San (Divine Fragrance Powder) is suitable, or Tiaozhong Tang (Regulate the Middle Decoction) is also excellent.

1. For simultaneous vomiting and diarrhea due to Spleen-Stomach deficiency-cold, Wenwei Yin is used; for severe cases, Chen’s Twelve-Ingredient Modified Isolated Power San is indicated.

1. For Spleen-Kidney deficiency-cold where Mingmen Fire fails to warm, leading to vomiting and diarrhea, characterized by undigested food, indistinguishable water and grain, and lower abdominal pain, Weiguan Jian (Stomach Gate Decoction) or Linyin Jian (Nourish Yin Decoction) are essential.

1. For vomiting caused by cold pathogen invading the Stomach with abdominal distension and pain, Shensan San or Yihuang San is used, possibly adding Paojiang (Prepared Ginger). If vomiting results from drinking water or consuming raw/cold fruits, Wuling San (Five-Ingredient Powder for Water Metabolism) with Paojiang is indicated.

1. For vomiting caused by dietary overindulgence leading to stagnation at the Stomach opening, with chest and diaphragm fullness, Hewei Yin (Harmonize the Stomach Drink), Dahezhong Yin (Greatly Harmonize the Middle Drink), or Shensan San are appropriate.

1. For vomiting and fullness caused by phlegm-fluid retention in the chest and diaphragm, Erchen Tang (Two-Aged Decoction) or Chupi Tang (Tangerine Peel Decoction) with Paojiang is indicated.

1. For vomiting caused by fire closure in the Three Jiaos, with irritability, heat, and stagnation at the Stomach opening, this is a Yangming Fire syndrome. Chupi Tang with Huanglian (Coptis Rhizome) is used; for severe cases, add Shigao (Gypsum). Alternatively, Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction) may be used. Such cases are rare; do not mistake deficiency-fire for excess-fire.

Master Cheng stated: Regarding vomiting in smallpox, one must differentiate cold and heat. For heat-vomiting, Liujunzi Tang (Six-Gentleman Decoction) with Jiangzhi-fried Huangqin (Scutellaria Root) and Lian (Coptis Rhizome) is indicated. For cold-vomiting, Liujunzi Tang with Dingxiang (Clove), Huoxiang (Patchouli Herb), and Baidoukou (Cardamom Fruit) is indicated.

1. Persistent vomiting in smallpox, characterized by turbid and prolonged sounds, or dry hiccups, constitutes a ominous prognosis for smallpox patients.