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Chickpox (Smallpox) is contraindicated with diarrhea throughout the course of the disease, and it is particularly severe in the later stages. Only during the initial fever stage, if diarrhea stops spontaneously as the fever subsides, is this considered an auspicious sign. After black spots appear until scabs form, the toxic qi has all been expressed on the surface. At this time, sufficient Yuan Qi (Primordial Qi) must be充盈 (filled/abundant) internally, and the stool must be firm, so that it can support the expulsion of toxins and facilitate their successful resolution. If even slight diarrhea occurs, the Middle Qi (Spleen/Stomach Qi) will become weak, leading to various complications and disasters. If diarrhea appears after the rash first emerges, it will be difficult for the lesions to rise and fill with pus; if diarrhea occurs after the lesions have risen, the pus will stagnate during diarrhea and only fill when diarrhea stops; if diarrhea occurs after the lesions have filled with pus, it will lead to involution, abnormal scabbing, internal ulceration, and internal decay, among other symptoms. This truly concerns life and death and is most terrifying. Nowadays, it is common to see cases ruined by improper medication and misdiagnosis, damaging Spleen Qi to the point of being incurable. These practitioners still claim they want to expel toxins through diarrhea, believing diarrhea is harmless. This is deceptive and ignorant; no quackery is worse than this.

In treating diarrhea caused by chickpox/rash, the key lies in distinguishing between Cold and Heat patterns. Heat patterns are necessarily due to excess Dampness Stagnation, while Cold patterns are necessarily due to insufficiency of Yuan Yang (Primordial Yang). However, nine out of ten cases of diarrhea are Deficiency patterns, with very few being Excess Heat. Therefore, whenever diarrhea, vomiting, and abdominal pain are observed without other Excess Heat symptoms, regardless of whether it is before or after the eruption of the rash, one should promptly employ warming methods to rescue the Spleen and Kidney. This is the general principle and requires careful examination; losing the true nature and misdiagnosing will result in death.

1. Deficiency-Cold Diarrhea: Cases presenting without significant heat, aversion to cold drinks, non-rapid and non-full pulse, absence of abdominal heat/bloating, absence of chest restlessness, reduced appetite, and sudden spontaneous loose stools all belong to Deficiency-Cold. One must absolutely avoid recklessly using cold-cooling agents to further injure Spleen Earth, which would inevitably lead to incurability. Suitable formulas include Weiyin Decoction (Stomach Warming Decoction), Yangzhong Decoction (Nourishing the Center Decoction), Wu Junzi Decoction (Five Gentlemen Decoction), Lizhong Decoction (Regulate the Middle Decoction), or Sijunzi Decoction (Four Gentlemen Decoction), chosen according to circumstances. If there is slight stagnation and bloating in the abdomen causing diarrhea, Liuwei Yigong Decoction (Six-Ingredient Extraordinary Efficacy Decoction) or Wuwei Yigong Powder (Five-Ingredient Extraordinary Efficacy Powder) added with Amomum Fruit (Sharen) is suitable. If diarrhea is accompanied by vomiting and pain with Qi stagnation, Yangzhong Decoction added with Clove (Dingxiang) and Aucklandia Root (Muxiang), or a combination of Sijunzi Decoction and Erxian San (Two Immortals Powder) is suitable. If diarrhea presents with slight blueness at the Shan Gen (root of the nose) and lips/mouth, or slight coldness at the mouth/nose, cool hands/feet, slightly cold fingertips, pale yellow or greenish-white stool color, and sleeping with eyes partially open, these are signs of Spleen-Kidney Deficiency-Cold. Without urgently rescuing the Mingmen Fire (Gate of Life Fire), effectiveness will not be seen. The main prescriptions should be Weiguan Decoction (Stomach Gate Decoction) or Linyin Decoction (Nourishing Yin Decoction); Chen's Shierwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder) is also acceptable. If diarrhea is severe and warming Spleen medicines fail, then Weiguan Decoction or Linyin Decoction must be used as the main treatment. For chronic diarrhea with slipping and inability to stop, Weiguan Decoction, Weiyin Decoction, or Chen's Shierwei Yigong San can be taken with Wude Pill (Five Virtues Pill) or Myristica Seed Pill (Roudoukou Pill). If the Stomach is not originally deficient, but diarrhea is caused by Cold-Damp injuring the Spleen or excessive water intake, Zuoguan Decoction (Assisting the Gate Decoction), Yifu Decoction (Suppressing and Supporting Decoction), Yihuang San (Yellow Protecting Powder) added with Polyporus (Zhuling) and Alisma Rhizome (Zexie), or Wuling San (Five-Ling Powder) are all excellent choices.

2. Accumulated Heat Diarrhea: This is rare but occasionally occurs. However, there must be evidence of Heat patterns before using clearing and draining herbs. Examples include a full and rapid pulse, high fever, intense thirst preferring cold drinks and disliking heat, restlessness with profuse sweating, chest fullness with coarse breathing, swollen red-purple lesions, hot/red mouth and nose, or painful/difficult urination—all are Heat signs. Furthermore, Heat diarrhea tends to be sudden and severe, while Cold diarrhea tends to be gradual and slow, allowing for differentiation. However, when treating Heat, one must observe the degree of Fire pathogen to ensure the medicine does not exceed the illness, lest it injure the Spleen and cause harm. For internal accumulation of Damp-Heat with difficult urination, mild fever, and diarrhea, Wuling San, Siling San (Four-Ling Powder), or Xiaoliqing Yin (Minor Clearing Decoction) added with Akebia Stem (Mutong) is suitable. If Damp-Heat is slightly more severe, causing confusion between clear and turbid fluids leading to diarrhea, Siling San added with Ginger-fried Coptis Rhizome (Huanglian), or combined with Huangqin Tang (Scutellaria Decoction), is suitable. If diarrhea is caused by food retention with a strong pulse and robust Qi, treat from the Heat perspective using Huangqin Tang added with Huanglian. If Heat is in the Lower Jiao (Lower Burner) with red, scanty, and painful urination accompanying diarrhea, Daliquing Yin (Major Clearing Decoction) or combined with Yiyuan San (Benefit Origin Powder) is suitable. If Damp-Heat is in the Spleen, with diarrhea, internal heat, and abdominal pain, Xianglian Wan (Aucklandia-Coptis Pill) is suitable. If cheeks are red, body is hot, headache and sore throat occur, along with mouth ulcers, restlessness, and diarrhea, this is a Yangming Fire pattern; Xiexuang San (Draining Yellow Powder) is suitable. If Damp-Heat is in the Spleen, with diarrhea and vomiting, Huangqin Tang added with Pinellia Tuber (Banxia) and Fresh Ginger (Shengjiang), or Banxiaren Tang (Large Pinellia Decoction) from *Yuyao Fang* added with Huangqin, is suitable. If internal heat diarrhea is accompanied by Qi Deficiency, Sijunzi Decoction added with Paeonia Root (Shaoyao), Huanglian, and Muxiang is suitable.

3. Thirst: Thirst is a common accompaniment to diarrhea because fluid loss from below leads to dryness above. Thus, patients with diarrhea often experience dry mouth and thirst. However, "dryness" (Gan) differs from "thirst" (Ke). Thirst implies a desire to drink, whereas dryness implies no desire to drink. Thirst belongs to Yang, and dryness belongs to Yin; this is the distinction. Some desire to drink water, indicating a Fire (Heat) pattern. Some desire to drink hot soup, indicating no Fire pattern. Some desire to drink but cannot consume much, or desire coolness but fear cold in the chest and abdomen; these are not Fire patterns. Since thirst itself has Yin-Yang distinctions, how much more so for those who are merely dry without thirst? This is actually due to Water Deficiency (Yin Deficiency). Treating it as Fire will rarely fail to cause harm. Therefore, for chronic diarrhea resulting in fluid loss and thirst, one must ascertain that it is not Heat and must tonify the Water (Yin).

Master Cheng said: Diarrhea must be distinguished by Cold and Heat. In Cold patterns, urine is clear; Lizhong Decoction or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is suitable. However, Atractylodes Macrocephala Rhizome (Baizhu) and Poria (Fuling) are not suitable for diarrhea accompanied by blistering, due to their draining properties. According to this view, even draining methods are contraindicated in treating chickpox; how much less should one recklessly use dispersing and reducing methods to damage Qi, Blood, and Body Fluids?

Master Chen said: Frequent diarrhea consumes fluids, causing Qi and Blood to fail to nourish the body. Even if the rash rises, it will be difficult to resolve. Symptoms such as warm body but abdominal distension, shortness of breath, teeth grinding, restlessness, and delirium are difficult to treat because excessive loss of grain essence leads to exhaustion of Body Fluids, often resulting in death. Quickly administer Shiyiwei Muxiang San (Eleven-Ingredient Aucklandia Powder) or Shierwei Yigong San (Twelve-Ingredient Extraordinary Efficacy Powder).

Master Wan said: If diarrhea occurs before the rash erupts, the pathogen has merged into the interior, representing an Excess pattern; treatment should focus on clearing toxins. If diarrhea occurs after the rash erupts, the pathogen has reached the exterior, and the interior is Deficient; treatment should address the Deficiency. The greatest taboo in chickpox is internal Deficiency with diarrhea. If warming and consolidating methods do not cure it, this is an incurable condition.