夫二便不可太利，亦不可不通，一或闭焉，则肠胃壅塞，脉络凝滞，毒瓦斯无由而
泄，于是眼合声哑，肌肉黧黑，顷刻而告变矣。治之者，惟使气血流行，则大便自无阻
滞，苟因热气燥急于下，或因汗多，或利小便，以致津液干涸，不得滑润。亦有血热血
燥，如老人产妇，血气虚弱，不能传送大肠，以致大便不利者有焉。凡手足心热，胁
下有汗，口干腹胀，身热烦躁者，此热秘也，宜酌斟下之。如不食而呕清水，面青而
腹不胀，不里急后重者，此虚秘也，宜补气血为主，而佐以麻仁丸之类。凡秘结当分三
部，上结则宜降气清凉，中结则宜行气活血，下结则宜蜜导。至于痘在四五日间而不
大便者，乃气血成浆，若无腹胀满闷，勿以便秘为治，盖灌脓之时，元气津液皆为外
用。若得数日不便，尤助中气运育之机，倘有泄泻，即用参、 、炙草、苓、术、姜、
桂之类，佐以升提，使中气不馁，痘毒达表。若独以泄泻治，则痘必倒塌矣。
古人云∶凡痘起胀灌脓之际，而无内症者，在其大便数日不行，不可妄加下剂，以
耗泄其气血。世因以便秘为贵，甚有热壅之症，不特不敢下利，反加补托温暖之剂，以
禁固之，致使热壅愈加，痘毒不得伸越，正气不得舒畅，热毒壅极，走注下焦，忽尔大
泻，元阳骤脱，遂为不救，是皆热壅失治之过也，是宜微下之，以泄其壅热，但审其秘
结之因以治之，不必重在硝黄，有伤元气也。然古方下剂之中，而必佐以风药者，是
兼升发之义也。至如痘后自利黄黑，而表里无恙者，此毒随利下，不必施治，但与化毒
汤服之。
夫疮疹发热，大便宜润。若二三日不行，宜急利之，恐肠胃不通，荣卫不行，疮
出转密也。惟自起发之后，大便常宜坚实，盖小儿脏腑娇脆，大便不行则易实，大便自
利则易虚，故成浆之际，虽数日不便，亦无忧耳。至于不能食者，尤赖旧谷气为养，待
至成脓毒化之后，则解利之。如能食者，则又大便喜润，此赖新谷为养，故欲旧污不
留，则脏腑流利，血气和平，切不可因其便利而用温补，反增里热之症。如即能食，而
其便二三日不通，里无所苦者，亦不必攻之，不得已或用胆导蜜导之法，使气道升降
而无壅塞之患也。惟在靥时而四五不行，以致热甚生湿，其疮难靥，况三焦阻绝，热毒
内蓄，必多变症，则宜利之。如燥粪在大肠而不能下者，以胆汁导之，然胃主腐热水
谷，大肠主传送已化之物，故食多少，可以知人谷气之虚实，大便滑温，可以知人脏腑
之虚实，是以大便如常，最痘中之一顺候
也。如起胀之时，忽然泄泻者，此宜急止之，恐其肠胃虚，真气脱，毒内陷耳。又宜
分其冷热虚实。如泻而手足冷，面色青白，疮不红绽者，冷症也，宜理中汤。如泻下之
物黄又酸臭，手足心热，面赤口渴，而疮红绽 发者，热症也，宜五苓散。如脾胃怯
弱，精神怠慢而不食者为虚，当温养之。如身热中满渴而不食者为实，当清利之。如饮
冷水自利者，此所谓湿胜则濡泻也，宜用温中利水。如因伤食自利而所出酸臭者，此所
谓饮食自倍，肠胃乃伤也，宜用先消后补。若至脏气自脱，或因服寒药，致令疮毒陷
入，泻如痘汁，或便脓血，口出臭气。唇焦目闭，而兼腹胀者，必死之症，及起胀灌浆
之时，泄泻不止，以药止之不已者，死。书云∶六腑气绝于外者，手足寒；五脏气绝于
内者，利不止；正气脱者，必淹延而死；邪气内陷者，必烦躁而死。
二便（大小便）既不能过于通利，也不能完全不通。一旦闭塞，就会导致肠胃壅塞，脉络凝滞，毒邪无法排出，于是出现眼睛闭合、声音嘶哑、肌肉变黑，顷刻间病情就会发生剧变。治疗时，只要使气血流通，大便自然没有阻滞。如果是因为热气燥急在下焦，或者因为出汗过多，或者因为利尿过度，导致津液干涸，肠道失去滑润，从而引起便秘。也有因为血热血燥，如老年人和产妇，气血虚弱，不能推动大肠传导，从而导致大便不利的情况。凡是手足心发热，胁下有汗，口干腹胀，身体发热烦躁的，这是热秘，应当斟酌使用泻下法。如果不吃东西且呕吐清水，面色青而腹部不胀，没有里急后重感的，这是虚秘，应当以补益气血为主，并辅以麻仁丸之类的方剂。
凡是大便秘结应当分为三部：上部结滞则宜降气清凉，中部结滞则宜行气活血，下部结滞则宜用蜜导法（蜂蜜栓剂通便）。至于痘疮在四五日间不大便的，这是因为气血正在化脓成浆，如果没有腹胀满闷的症状，不要按便秘来治疗，因为在灌脓的时候，元气和津液都用于外部化毒生肌了。如果几天不便，反而有助于中气运化养育之机。如果有泄泻，就用人参、[缺字]、炙甘草、茯苓、白术、干姜、肉桂之类，佐以升提药物，使中气不衰弱，痘毒透达体表。如果只把泄泻当作病来治，痘疮必定会塌陷。
古人说：凡是痘疮起胀灌脓之际，而没有内症表现的，即使大便几天不通，也不可妄加泻下药，以免耗泄气血。世人认为便秘是好事，甚至有热壅症状时，不仅不敢用泻下法，反而加上补托温热的药物来固涩，致使热壅更加严重，痘毒不得伸展透发，正气不得舒畅，热毒壅积到极点，流注到下焦，忽然大泻，元阳骤然脱失，于是无法救治，这都是热壅失治的过错。这种情况应当轻微泻下，以泄其壅热，但要审察便秘的原因来治疗，不必重在芒硝、大黄等药，以免损伤元气。然而古方中的泻下剂里，必须佐以风药，这是兼有升发的意义。至于痘后自发性腹泻，排出黄黑色粪便，而表里无其他病症的，这是毒邪随大便排出，不必施治，只需服用化毒汤即可。
疮疹发热期间，大便应当保持润泽。如果两三天不通，应当及时通便，恐怕肠胃不通，营卫之气运行不畅，导致疮疹出得更多更密。只有从起发之后，大便常宜坚实。因为小儿脏腑娇嫩脆弱，大便不通容易变得实滞，大便自利容易变得虚弱，所以在成浆阶段，虽然几天不便，也不必担忧。至于不能进食的，尤其依赖体内原有的谷气来滋养，等到成脓毒化之后，再给予解利之药。如果能进食的，则大便喜欢润泽，这依赖新摄入的食物来滋养，所以想要旧污不留，就要让脏腑流利，血气平和，切不可因为大便通畅而使用温补药物，反而增加里热症状。如果既能进食，而大便两三天不通，但内心没有痛苦不适的，也不必攻下，不得已时用胆导或蜜导的方法，使气道升降而无壅塞之患。只有在痘疮收靥时，如果四五天不便，导致热甚生湿，疮面难以愈合，况且三焦阻绝，热毒内蓄，必然产生多变症候，这时应当通便。如果燥粪在大肠而不能下行，用胆汁导法。胃主腐熟水谷，大肠主传送已消化的食物，所以食量的多少，可以知道人谷气的虚实，大便滑润温和，可以知道人脏腑的虚实，因此大便正常，是痘疮中的一顺证。如果在起胀之时，忽然泄泻的，应当立即止泻，恐怕肠胃虚弱，真气脱失，毒邪内陷。又应当分辨冷热虚实。如果腹泻且手足冷，面色青白，疮疹不红绽开的，是冷症，宜用理中汤。如果泻下的物黄色且酸臭，手足心热，面赤口渴，而疮疹红绽发出的，是热症，宜用五苓散。如果脾胃怯弱，精神怠慢而不进食的是虚证，应当温养。如果身热中满口渴而不进食的是实证，应当清利。如果喝冷水后自发性腹泻的，这就是所谓湿胜则濡泻，宜用温中利水法。如果因伤食导致自发性腹泻且排泄物酸臭的，这就是所谓饮食加倍，肠胃乃受伤，宜先用消导后补益。如果到了脏气自脱，或因服用寒药，导致疮毒陷入，泻下如痘汁，或便脓血，口出臭气，唇焦目闭，兼有腹胀的，是必死的症候。以及在起胀灌浆之时，泄泻不止，用药止泻无效的，也是死证。书上说：六腑之气绝于外者，手足寒冷；五脏之气绝于内者，腹泻不止；正气脱失者，必然拖延而死；邪气内陷者，必然烦躁而死。
The excretion of both urine and feces should not be too profuse, nor should it be completely obstructed. If either becomes blocked, the intestines and stomach will become congested, meridians and collaterals will stagnate, and toxic pathogens will have no way to discharge. Consequently, the eyes may close, voice may become hoarse, muscles may turn dark, and the condition may deteriorate rapidly. Treatment should focus on promoting the circulation of Qi and blood; if this is achieved, bowel obstruction will naturally resolve. Constipation may arise from excessive heat and dryness in the lower jiao, or from excessive sweating, or from over-diuresis, leading to the depletion of body fluids and loss of intestinal lubrication. It may also result from blood-heat and blood-dryness, as seen in the elderly or postpartum women, whose Qi and blood are deficient and unable to propel the large intestine, leading to difficult defecation.
Cases presenting with heat in the palms and soles, sweating under the hypochondrium, dry mouth, abdominal distension, fever, and restlessness constitute "Heat Constipation" (Re Mi). These should be treated with a judicious purgative approach. Conversely, cases involving anorexia, vomiting of clear fluid, blueish complexion, abdominal non-distension, and absence of tenesmus constitute "Deficiency Constipation" (Xu Mi). These should be primarily treated by tonifying Qi and blood, supplemented by formulas such as *Maren Wan* (Hemp Seed Pill).
Generally, constipation should be categorized into three sections: upper blockage requires descending Qi and cooling; middle blockage requires moving Qi and invigorating blood; lower blockage requires honey suppositories (*Mi Dao*). Regarding smallpox, if there is no bowel movement for four to five days during the eruption phase, it is because Qi and blood are being transformed into pus. If there is no abdominal fullness or oppression, constipation should not be treated directly, as Yuan Qi and body fluids are utilized externally for pus formation. A few days without stool may actually aid the mechanism of Middle Jiao nourishment. However, if diarrhea occurs, herbs such as Renshen (Ginseng), [missing character], Zhi Gancao (Honey-fried Licorice), Fuling (Poria), Baizhu (Atractylodes Macrocephala), Ganjiang (Dried Ginger), and Rougui (Cinnamon Bark) should be used, assisted by ascending agents, to prevent the weakening of Middle Jiao Qi and to allow smallpox toxins to reach the surface. Treating only the diarrhea may cause the smallpox lesions to collapse.
Ancient texts state: During the swelling and pus-forming stages of smallpox, if there are no internal symptoms, even if stool is retained for several days, one must not recklessly administer purgatives, as this depletes Qi and blood. Some mistakenly consider constipation favorable; in cases of heat congestion, instead of purging, they add tonifying, supporting, warming, and heating agents to consolidate, thereby worsening heat congestion. This prevents toxins from venting and Qi from flowing smoothly. When heat-toxin reaches extreme congestion, it flows downward to the Lower Jiao, causing sudden severe diarrhea and abrupt collapse of Yuan Yang, leading to death. This is due to mismanagement of heat congestion. In such cases, mild purgation should be used to drain heat congestion, but treatment must address the root cause of constipation. One need not rely heavily on Mangxiao (Natrii Sulfas) or Dahuang (Rhei Radix et Rhizoma) to avoid damaging Yuan Qi. Ancient purgative formulas often include wind-dispersing herbs to incorporate the principle of ascending and dispersing.
If, after smallpox, spontaneous diarrhea occurs with yellow-black stools, but the exterior and interior are otherwise sound, this indicates toxins discharging via stool; no specific treatment is needed, only *Huadu Tang* (Detoxification Decoction).
During fever from sores and rashes, stool should remain moist. If unpassed for two to three days, prompt laxation is advised to prevent intestinal blockage, which would hinder Ying and Wei circulation and cause more dense eruptions. After the initial eruption, stool should ideally be firm. Because children's zang-fu organs are delicate, retention leads to excess/stagnation, while spontaneous loose stools lead to deficiency. Thus, during the pus-forming stage, several days without stool is not a concern. For those who cannot eat, nourishment relies on residual grain Qi; after pus formation and toxin resolution, resolving and purging methods can be applied. For those who can eat, stool prefers moisture, relying on new food intake. To ensure old waste does not remain, zang-fu must flow freely and Qi/blood must be balanced. One must not use warming-tonifying herbs simply because stool is smooth, as this increases internal heat. If eating well but stool is retained for two to three days without internal discomfort, aggressive purgation is unnecessary. Honey or bile suppositories may be used if necessary to maintain Qi dynamic ascent/descent without obstruction.
However, if during the crusting stage (Yan), stool is retained for four to five days, causing intense heat and dampness, hindering healing, and blocking the San Jiao with internal heat-toxin, multiple complications may arise; in this case, purgation is indicated. For dry feces stuck in the large intestine, bile suppositories are used. The Stomach governs the rotting and ripening of water and grain; the Large Intestine governs the transmission of digested matter. Thus, food intake reflects the deficiency/excess of Grain Qi, and stool consistency reflects the deficiency/excess of Zang-Fu. Normal stool is a favorable sign in smallpox.
Sudden diarrhea during the swelling stage requires immediate cessation to prevent intestinal weakness, Qi collapse, and toxin internalization. Differentiate cold/heat and deficiency/excess. Diarrhea with cold limbs, blue-white complexion, and non-red/non-protruding lesions indicates Cold Syndrome; treat with Lizhong Tang (Regulate the Middle Decoction). Diarrhea with yellow, sour-smelling stool, heat in palms/soles, red face, thirst, and red/protruding lesions indicates Heat Syndrome; treat with Wuling San (Five-Ingredient Powder with Poria). Weak Spleen/Stomach with lethargy and anorexia indicates Deficiency; treat with warming and nourishing methods. Fever, abdominal fullness, thirst, and anorexia indicate Excess; treat with clearing and draining methods. Diarrhea after drinking cold water indicates Dampness prevailing causing loose stools; treat with warming the middle and promoting diuresis. Diarrhea with sour-smelling excrement due to food stagnation indicates injury from excessive eating; treat first with digestion-promoting methods, then tonification.
If organ Qi collapses spontaneously, or if cold herbs caused toxin sinking, resulting in diarrhea resembling pus, bloody/purulent stool, foul breath, cracked lips, closed eyes, and abdominal distension, the prognosis is fatal. Similarly, persistent diarrhea during swelling/pus stages that resists medication is fatal. Texts state: Six Fu organs failing externally manifest as cold limbs; Five Zang organs failing internally manifest as incessant diarrhea; collapse of Righteous Qi leads to lingering death; sinking of Pathogenic Qi leads to death from restlessness.