凡身发壮热，毛直皮燥，睡卧不宁，腮红睛赤，气粗烦渴，腹胀便秘而喘急者，皆
实症也。如兼呕吐之症，虽似乎虚，然此热盛毒重拥遏在内，不得伸越，故上逆攻冲而
吐。《经》云∶诸逆攻冲皆属于火者，是也。亦有或为寒冷所搏，或为乳食不节，或为风
冷所乘，致使内热不得发越，冷热相拒而吐。然毒不得升越者，则从升阳发散在外。
若相拒而吐者，则宜引之在下。又有泄泻之症兼见者，夫泄泻似虚也。然此热毒拥盛熏
炙脾胃，不得外达，则毒从下陷，寻窍而出。所谓热毒下注者，是也。古曰∶未出而
泻者，生，既出而泻者，死。治宜升提发散，引毒达表，不得误加枳壳之剂，盖毒得
外解，则内泻自止。若伤食而泻者，轻则加消化之，下重则从之。又有不思饮食者，书
曰∶不思饮食，皆属内虚者是矣。然不知郁热之症，因毒瓦斯在内，不得伸越，达于肌
表，是以二便秘结，腠理阻塞，热毒拥盛，腹胀满急，不思饮食者，必然之势也，治法
亦宜升提发散，引毒达表，则热气有所伸越，而脏腑和平，饮食自进矣。若误用丁桂
热药，于泄泻呕吐之症，是以热攻热而转增烦剧。若投参术补剂于腹胀不思饮食之症，
则邪得补而愈盛也。
初热吐泻者，勿即止之，盖毒从上下出也。专托痘为主，痘出而吐泻自己。然久而
不止，则中气亦虚，其毒不能运出，内攻之祸立至矣。治法须分寒热。如身热口渴，烦
燥面赤，见吐如射，大便泄泻，小便赤涩，睛黄咽燥，居处喜冷者，热也，宜泽泻、木
通、猪苓、赤茯、升麻之类。如身体则凉，口气则冷，神气安静者，宜砂仁、肉果、参
苓之类。如吐而不止者，是里气上逆而不下，宜导下之。若泻而不已者，是里气下走
而不上，宜升提之，然经大吐大泻之后，则上下俱脱，即当大补，虽有他症，悉为虚
论，大抵吐则因火因痰因食者为多，泻则因火因寒因食因湿因气虚者为多，初则所因不
一，久则总归一虚。若至吐泻大作不止，蛔其出者，不治。
（书中若有未详尽之处，请参照全书总论中关于痘疹门的内容进行查阅。）
凡是身体出现高热，毛发直立，皮肤干燥，睡眠卧不安稳，两腮发红，眼睛充血，呼吸粗重，烦躁口渴，腹部胀满，大便秘结且喘息急促的，都属于实证。如果兼有呕吐的症状，虽然看似虚证，然而这是因为热盛毒重，郁结阻滞在体内，无法向外透发，所以向上逆乱冲激而导致呕吐。《黄帝内经》说：“各种向上冲逆的病证都归属于火”，指的就是这种情况。也有因为受到寒冷邪气搏击，或者因为乳食不节制，或者因为风冷邪气侵袭，导致体内的热毒不能向外发散，冷热相互抗拒而引起呕吐。但是，如果是毒邪不能升发透越的情况，则应当采用升阳发散的方法，使毒邪从体表排出。如果是因冷热相拒而呕吐的情况，则应当引导病势向下。又有泄泻症状同时出现的，泄泻似乎属于虚证。然而这是因为热毒炽盛，熏灼脾胃，不能向外透达，于是毒邪向下降陷，寻找孔窍而出。这就是所谓的“热毒下注”。古人说：“痘疹未发出之前出现泄泻的，预后良好；痘疹已经发出之后出现泄泻的，预后不良。”治疗方法应当采用升提发散，引导毒邪到达体表，不能错误地加入枳壳等破气降气的药物。因为毒邪一旦从体表解除，内部的泄泻自然就会停止。如果是伤食引起的泄泻，轻症加上消食导滞的药物，重症则顺从其病势通下。又有不想吃东西的情况，书上说：“不想吃东西，都属于内虚”，这是对的。然而不知道的是，郁热病症是因为毒邪热气在体内，不能伸张透越，到达肌表，因此大小便闭塞不通，腠理阻塞，热毒壅盛，腹部胀满急迫，不想吃东西，这是必然的趋势。治疗方法也应当采用升提发散，引导毒邪到达体表，这样热气就有地方伸展透越，脏腑功能恢复平和，饮食自然就能进用。如果错误地使用丁香、肉桂等热性药物，对于泄泻呕吐的症状，是以热攻热，反而增加烦闷剧烈程度。如果投用人参、白术等补益剂治疗腹胀不想吃东西的症状，那么邪气得到补益会更加旺盛。
初期发热伴有吐泻的，不要立即止住，因为毒邪是从上下二窍排出的。专门以托举痘疹为主，痘疹发出后吐泻自然停止。然而如果时间长久不止，中气也会虚弱，毒邪不能运出体外，内攻脏腑的祸患立刻就会到来。治疗方法必须区分寒热。如果身体发热，口渴，烦躁面红，呕吐呈喷射状，大便泄泻，小便赤涩，眼睛发黄，咽喉干燥，喜欢居住在凉爽环境中的，属于热证，适宜使用泽泻、木通、猪苓、赤茯苓、升麻之类的药物。如果身体发凉，口气冷，精神安静的，适宜使用砂仁、肉豆蔻、人参、茯苓之类的药物。如果呕吐不止的，是里气上逆而不能下行，应当引导其下行。如果泄泻不停止的，是里气下走而不能上行，应当升提它。然而在大吐大泻之后，上下之气都脱失，就应当大补元气，即使有其他症状，都按照虚证论治。大抵呕吐多因火、因痰、因食引起，泄泻多因火、因寒、因食、因湿、因气虚引起。初期病因各不相同，日久则总归为虚证。如果到了吐泻大作不止，蛔虫排出的情况，属于不治之症。
(For any details not fully covered herein, please refer to the General Discussion on the Smallpox Chapter in the complete work.)
When a patient presents with high fever, erect hair, dry skin, restlessness during sleep, redness of the cheeks, congested eyes, coarse breathing, irritability, thirst, abdominal distension, constipation, and rapid breathing, these are all manifestations of Excess Syndromes (Excess patterns). If accompanied by vomiting, although it may appear as a Deficiency Syndrome, this is actually due to intense heat and heavy toxicity obstructing within, unable to extend outward. Consequently, the pathogenic factors rebel upward and rush against the upper body, causing vomiting. As stated in the *Classic of Medicine* (*Huangdi Neijing*): "All rebellious rushing symptoms belong to Fire," which refers to this situation. There are also cases where cold pathogens strike the body, or where milk and food intake are irregular, or where wind-cold pathogens invade, causing internal heat and toxicity to fail to diffuse outward. The conflict between cold and heat leads to vomiting. However, if the toxicity fails to rise and diffuse, it should be treated by raising Yang and dispersing, allowing the toxicity to exit from the exterior. If the vomiting is caused by the mutual resistance of cold and heat, the treatment should guide the pathogen downward.
There are also cases where diarrhea appears concurrently. Diarrhea seems to indicate Deficiency; however, here, intense heat and toxicity scorch and roast the Spleen and Stomach, preventing outward penetration. Thus, the toxicity sinks downward and exits through orifices. This is what is referred to as "Heat-Toxicity pouring downward." Ancient texts state: "Diarrhea occurring before the eruption of smallpox indicates survival; diarrhea occurring after eruption indicates death." The treatment should involve lifting and ascending, and dispersing, guiding the toxicity to the surface. One must avoid mistakenly using formulas containing Zhiqiao (Fructus Aurantii) that descend Qi. Once the toxicity is resolved from the exterior, the internal diarrhea will naturally cease. If the diarrhea is caused by food stagnation, mild cases require adding herbs for digestion and resolution, while severe cases should be treated by following the pathogen's direction (purging).
Regarding loss of appetite, books state: "Loss of appetite belongs to Internal Deficiency." This is correct. However, one must understand that in cases of Depressed Heat, the toxic qi remains inside, unable to extend and reach the muscle surface. Therefore, both urine and stool become obstructed, the interstices (cou li) are blocked, heat and toxicity are abundant, abdominal distension and urgency occur, and loss of appetite becomes an inevitable trend. The treatment method should also involve lifting and ascending, and dispersing, guiding the toxicity to the surface. In this way, the heat qi has room to extend and diffuse, the Zang-Fu organs return to harmony, and appetite naturally returns. If Dinggui (Clove and Cinnamon Twig) hot herbs are mistakenly used for diarrhea and vomiting, it is using heat to attack heat, thereby worsening the irritability and severity. If Shen-Zhu (Ginseng and Atractylodes) tonifying agents are administered for abdominal distension and loss of appetite, the evil pathogen will gain strength from the tonification and become even more vigorous.
In the initial stage of fever with vomiting and diarrhea, do not immediately stop them, as the toxicity is exiting through the upper and lower orifices. The primary focus should be on supporting the eruption of smallpox; once the rash emerges, vomiting and diarrhea will resolve spontaneously. However, if they persist for a long time, the Middle Qi will also become deficient, the toxicity cannot be transported out, and the disaster of internal attack on the organs will arise immediately. Treatment methods must distinguish between Cold and Heat.
If the body is hot, there is thirst, irritability, red face, projectile vomiting, loose stools, dark and scanty urination, yellow eyes, dry throat, and a preference for cool environments, it is a Heat pattern. Suitable herbs include Zexie (Rhizoma Alismatis), Mutong (Herba Akebiae), Zhuling (Polyporus), Chi Fu Ling (Red Poria), Shengma (Rhizoma Cimicifugae), etc. If the body is cool, breath is cold, and spirit is quiet, suitable herbs include Sharen (Fructus Amomi), Rouguo (Nux Vomica/Myristica), Renshen (Radix Ginseng), Fuling (Poria), etc.
If vomiting does not stop, it indicates Rebellious Qi of the Interior rising instead of descending; it should be guided downward. If diarrhea does not cease, it indicates Qi of the Interior sinking instead of rising; it should be lifted and ascended. However, after severe vomiting and diarrhea, both upper and lower Qi are depleted. At this point, major tonification is required. Regardless of other symptoms, they should all be treated as Deficiency patterns. Generally, vomiting is mostly caused by Fire, Phlegm, or Food; diarrhea is mostly caused by Fire, Cold, Food, Dampness, or Qi Deficiency. Initially, the causes vary, but over time, they all converge into a single Deficiency. If vomiting and diarrhea become severe and unceasing, and roundworms are expelled, the condition is incurable.