疮疹之证，或吐或泻，或不食者，此由脾胃虚弱也，小儿胃热出斑疮，大抵疮疹多出于
胃，缘热毒方作之际，必多烦渴，燥热引饮，或于风寒处坐卧，遂令冷热相搏，冷气入胃，
故令胃冷则吐，脾冷则泻，脾胃皆虚则不食也。当以治中益黄等，随证与之，甚者随宜增减
，以吐利止为度。又有热吐热泻则不同，何以别之？盖热吐者，手掌心并液下热而 有汗
，发渴而脸赤，而饮冷，未能言而渴者，则一向饮乳，聚其饮乳，满于胸臆，不能消化，吐
射出，是热吐也。才吐了，又急欲食乳，是内热而渴。但不能言其渴，医者不审，见吐利便
用燥药，热极生风者，害人甚众。非特疮疹有此，他证亦不用此。分热吐热泻尤审，热泻者
，小便涩而渴，口燥咽干，皆当用五苓散竹叶半夏汤主之。小儿不食，亦有虚实二证∶或吐
或利，面青而目睛青黑色，而不食乳者为虚，寒而不食也，宜温之。大小便如常，面赤而壅
，或渴或睡中惊，或咬唇，目白睛黄赤气喘，或身热而不食乳者，此为实热，中满而不食乳
也。又如伏热者，亦不思食，胸膈满闷故也，尤宜详审。
伤风与寒以汗解，汗者谷之精气也，疮疹作脓血痂 ，脓血痂 血也。古人以解利药，
如升麻汤之类，皆惧其血热毒甚，则疮疹尤甚，故少凉血以解其毒。疮疹亦易于将理，何尝
以转泻伤其脏腑脾胃也。盖脏腑脾胃既寒，何以营运荣卫？荣卫既迟，疮疹脓血痂 何以蒸
成，故知伤寒则气行汗出而已，尚不可下，况疮痘在血气温浓，内不虚而外不寒，则出而不
伏陷矣。胡不观内补散，治痈疽至验，皆是暖血行荣卫药，今疮疹与痈疽皆疮也，何尝以转
泻而治痈疽也。
疮疹类疾病，如果出现呕吐、腹泻或不能进食的症状，这是由于脾胃虚弱所致。小儿胃中有热而发出斑疮，大抵疮疹多源于胃。因为在热毒刚开始发作的时候，病人必然会有烦躁和口渴的表现，因燥热而大量饮水，或者在受风寒的地方坐卧，从而导致冷热之气相互搏结，冷气进入胃中。因此，胃寒则引起呕吐，脾寒则引起腹泻，如果脾胃都虚弱，就会导致不能进食。此时应当使用治中汤、益黄散等方剂，根据具体证候给予治疗，病情严重的随宜增减药量，以呕吐和腹泻停止为度。
又有热性呕吐和热性腹泻的情况则不同，如何辨别呢？大概热性呕吐的患者，手掌心和腋下发热且有汗出，感到口渴且面色发红，喜欢喝冷水；如果是还不能说话却极度口渴的婴儿，只能一直吃奶，乳汁积聚在胸膈部位，无法消化，从而吐出，这就是热性呕吐。刚吐完，又急着要吃奶，这是体内有热导致口渴。但婴儿不能表达口渴，医生如果不仔细审察，一见呕吐腹泻就使用燥湿的药物，会导致热极生风，危害极大。不仅疮疹病不能用此法，其他病症也不应如此。分辨热吐和热泻要特别审慎，热性腹泻的患者，小便涩滞且口渴，口干燥咽部干涸，都应当用五苓散合竹叶半夏汤来主治。
小儿不能进食，也有虚证和实证两种情况：如果伴有呕吐或腹泻，面色发青且眼珠周围呈青黑色，不能喝奶的，属于虚证，是寒邪导致的不能进食，适宜用温补的方法。如果大小便正常，面色红赤且面部浮肿，或者口渴、睡眠中惊悸，或者咬嘴唇，白睛发黄赤色、气喘，或者身体发热但不能喝奶的，这属于实热证，是中焦胀满导致的不能进食。又如伏热（潜伏的热邪）患者，也不思饮食，是因为胸膈部满闷的缘故，尤其需要详细审察。
伤风和伤寒应当通过发汗来解除，汗液是谷气所化的精气。疮疹化脓、结痂，实质上是营血的变化。古人使用解表透疹的药，如升麻汤之类，都担心如果血分热毒太盛，会使疮疹更加严重，所以会少加一些凉血药来解毒。疮疹也易于调理，何曾有用通泻大便来损伤脏腑脾胃的呢？因为脏腑脾胃既然已经受寒，如何能运行营卫之气？营卫之气既然迟缓，疮疹的脓血痂壳又怎能蒸化形成？所以知道即使是伤寒，也只是气行汗出而已，尚且不可用下法，何况疮痘处于血气浓盛之时，内部不虚而外部不寒，那么疹毒就会透出而不致内陷。为什么不参考内补散呢？它治疗痈疽非常有效，其中都是温养血液、运行营卫的药物。现在的疮疹与痈疽都属于疮疡类疾病，何曾用通泻的方法来治疗痈疽呢？
In cases of **chuang zhen** (variolous eruptions), if symptoms such as vomiting, diarrhea, or anorexia occur, this is due to the deficiency and weakness of the Spleen and Stomach. In children, eruptions arising from heat in the Stomach generally originate from the Stomach channel. When the pathogenic heat-toxin first erupts, it inevitably causes restlessness and thirst. Excessive drinking induced by dryness-heat, combined with sitting or lying in cold wind or cold environments, leads to a struggle between cold and heat pathogens. Cold qi enters the Stomach; thus, cold in the Stomach causes vomiting, cold in the Spleen causes diarrhea, and deficiency-cold in both Spleen and Stomach results in an inability to eat. One should administer formulas such as *Zhizhong Tang* (Regulate the Middle Decoction) or *Yihuang San* (Strengthen the Yellow Powder) according to the specific syndrome. For severe cases, dosages should be adjusted appropriately until vomiting and diarrhea cease.
However, heat-type vomiting and heat-type diarrhea are different. How can they be distinguished? Generally, patients with heat vomiting present with heat in the palms and axillae accompanied by sweating, thirst, flushed face, and a preference for cold drinks. In infants who cannot yet speak but are extremely thirsty, continuous nursing leads to milk accumulation in the chest and epigastrium which cannot be digested, resulting in vomiting; this is heat vomiting. The infant immediately desires more milk after vomiting, indicating internal heat causing thirst. If physicians fail to examine carefully and indiscriminately use drying agents upon seeing vomiting and diarrhea, it may lead to "wind generated from extreme heat," causing significant harm. This principle applies not only to variolous eruptions but also to other syndromes. Differentiating heat vomiting from heat diarrhea requires particular caution. Patients with heat diarrhea present with scanty, difficult urination, thirst, dry mouth, and dry throat; these should be treated primarily with *Wuling San* (Five-Ingredient Powder with Poria) combined with *Zhuye Banxia Tang* (Bamboo Leaf and Pinellia Decoction).
Anorexia in children can also be classified into deficiency and excess syndromes. If accompanied by vomiting or diarrhea, with a cyanotic complexion and dark cyanotic color around the eyes, and an inability to nurse, this is a deficiency syndrome caused by cold, requiring warming treatment. If bowel movements and urination are normal, with a flushed and puffy face, thirst, night terrors, lip-biting, yellowish-red sclera, wheezing, fever, and an inability to nurse, this is an excess-heat syndrome caused by fullness in the middle jiao. Furthermore, patients with latent heat also lose their appetite due to fullness and oppression in the chest and diaphragm; this requires detailed examination.
Wind-cold and cold-pathogen invasions should be resolved through sweating. Sweat is the essence derived from grain qi. The formation of pus, blood, and scabs in variolous eruptions relates to the transformation of nutritive blood. Ancient practitioners used resolving and venting formulas like *Shengma Tang* (Cimicifuga Decoction) but were cautious that if blood-heat toxin was too severe, it would exacerbate the eruptions; therefore, they added small amounts of blood-cooling herbs to resolve the toxin. Variolous eruptions are easy to manage; why should one damage the Zang-Fu organs and Spleen-Stomach by inducing diarrhea? Since the Zang-Fu and Spleen-Stomach are cold, how can they circulate Ying and Wei (nutritive and defensive) Qi? If Ying and Wei circulation is sluggish, how can the pus, blood, and scabs of the eruptions be steamed and formed? Thus, even in Taiyang cold damage, the treatment is merely promoting Qi circulation and sweating; purgation is contraindicated. How much more so for variolous eruptions, which occur when blood and Qi are abundant, internal deficiency is absent, and external cold is not present, allowing the eruption to emerge without sinking inward? Why not observe *Neibu San* (Internal Nourishing Powder)? It is highly effective for treating carbuncles and ulcers, consisting mainly of herbs that warm the blood and promote Ying-Wei circulation. Since variolous eruptions and carbuncles/ulcers are both types of sores, why is purgation never used to treat carbuncles and ulcers?