凡痘疹吐泻，有不必治者，有当速治者。如初热时即见吐泻，但欲其不甚而随止者吉，盖
吐利中自有疏通之意，邪气赖以宣泄，不必治也。其有吐利之甚者则不得不治。又有元气本
弱而见此证者，使不速为调补，必致脾气困惫则痘出之后，虚证叠见而救无及矣。此痘前之
吐利，其当治不必治，自有轻重之分也。若见点之后，则吐泻大非所宜，速当察其寒热虚实
而调治之。
一、痘疮吐泻，虽曰多属脾经，然亦有二焦五脏之辨。盖病在上焦，但吐而不利；病在
下焦，但利而不吐；病在中焦，则上吐下利。故在上焦者，当辨心肺之脾气；在下焦者，当
察肝肾之脾气。此五脏之气，各有相滋相制之机，设不明此，鲜不误矣。
一、痘疮吐泻，大都中气虚寒者，十居七八，然亦有邪实毒盛，及饮食过伤而为吐泻者，
此宜详审脉证，自有可辨。若果有热毒实邪，则不可误认虚寒，轻用温补，恐反助邪以致余毒痈
肿，或为溃烂难收等证。
痘疮呕吐，大都虚寒者多，实热者少，但当以温养脾胃为主。即或兼杂证者，亦必有实邪可
据，方可因病而兼治之，故不得轻用寒凉及消耗等药。
一、凡呕吐之病，病在上中二焦也，切不可妄用下药，致犯下焦元气，则必反甚而危矣。
即或有大便不通
者，亦当调补胃气，从缓利导，但得脾胃气和，则升降调而便自达，此不可不知也。
一、痘疮别无风寒食滞、胀满疼痛等证，而为呕吐或干呕恶心者，必脾胃虚寒也，宜六味
异功煎、五君子煎、参姜饮之类主之，或温胃饮、理中汤皆可酌用。
一、脾气微寒微呕而中焦不寒者，宜五味异功散。
一、胃口虚寒，呕吐而兼有痛滞者，六味异功煎送神香散，或调中汤亦佳。
一、脾胃虚寒吐泻并行者，温胃饮，甚者陈氏十二味异功散。
一、脾肾虚寒，命门不暖而为吐泻者，必饮食不化，水谷不分而下腹多痛，非胃关煎或理
阴煎不可。
一、凡寒气犯胃，腹胀腹痛而为呕吐者，神香散、益黄散，或加炮姜。若因饮水或食生冷
瓜果而作呕吐者，五苓散加炮姜。
一、饮食过伤，停滞胃口，胸膈胀满而为呕吐者，宜和胃饮，或大和中饮，或神香散。
一、痰饮停蓄胸膈而胀满呕吐者，宜二陈汤，或橘皮汤加炮姜。
一、三焦火闭，烦热壅滞胃口而为呕吐者，此必阳明火证也，宜橘皮汤加黄连，甚者再加石
膏，或用竹叶石膏汤。但此证甚少，勿以虚火作实火也。
程氏曰∶凡痘疮呕吐之证，须辨冷热。热吐者，宜六君子汤加姜汁炒芩、连；冷吐者，
宜六君子汤加丁香、藿香、白豆蔻。
一、痘疮呕吐不已，声浊而长，或干哕者，最是疮家恶候。
凡是痘疹（天花、麻疹等出疹性传染病）引起的呕吐和腹泻，有的不需要治疗，有的则需要迅速治疗。如果在初热期就出现呕吐和腹泻，只要症状不严重且能自行停止，就是吉兆，因为吐泻中自然含有疏通之意，邪气借此得以宣泄，所以不需要治疗。如果吐泻非常严重，则不得不进行治疗。又有元气本来虚弱而见此证候的，如果不迅速进行调补，必然导致脾气困乏疲惫，那么在痘疮发出之后，虚证会接连出现，届时再想救治就来不及了。这是痘疮发出前的吐利，该治的不治与不该治的乱治，自有轻重之分。如果在见点（痘疹显现）之后，那么吐泻就极不适宜，应当迅速辨别其寒热虚实并进行调治。
一、痘疮引起的吐泻，虽然大多属于脾经病变，但也有上焦、下焦及五脏的区别。病在上焦，只呕吐而不腹泻；病在下焦，只腹泻而不呕吐；病在中焦，则上吐下泻。所以在上焦的病，应当辨别心肺对脾的影响；在下焦的病，应当察看肝肾对脾的影响。这五脏之气，各有相互滋生、相互制约的机理，如果不明白这一点，很少有不误诊的。
一、痘疮引起的吐泻，大多是中气虚寒，占十分之七八，但也有因邪气实、毒气盛，以及饮食过度损伤而引起的吐泻，这需要详细审察脉象和证候，自然可以辨别。如果确实有热毒实邪，就不能错误地认定为虚寒，轻易使用温补药物，恐怕反而助长邪气，导致余毒引发痈肿，或者造成溃烂难以收敛等证候。
痘疮呕吐，大多数是虚寒证，实热证较少，但治疗应当以温养脾胃为主。即使兼杂其他证候，也必须有实邪的依据，才可以因病兼治，所以不能轻易使用寒凉及耗伤正气的药物。
一、凡是呕吐的病，病位在上焦和中焦，切不可妄用泻下药，以免损伤下焦元气，那样病情必然加重甚至危及生命。即使有大便不通的情况，也应当调补胃气，从缓通利导泄，只要脾胃之气调和，那么升降功能正常，大便自然通畅，这是不可不知道的。
一、痘疮如果没有风寒、食滞、胀满疼痛等其他证候，而出现呕吐或干呕恶心的，必然是脾胃虚寒，宜用六味异功煎、五君子煎、参姜饮等方剂主治，或者温胃饮、理中汤也可以酌情使用。
一、胃口虚寒，呕吐并兼有痛感阻滞的，用六味异功煎送服神香散，或者调中汤也很好。
一、脾胃虚寒，呕吐和腹泻同时进行的，用温胃饮，严重的用陈氏十二味异功散。
一、脾肾虚寒，命门火衰不暖而导致吐泻的，必然饮食不化，水谷不分，且下腹部多痛，非用胃关煎或理阴煎不可。
一、凡是寒气犯胃，腹胀腹痛而导致呕吐的，用神香散、益黄散，或者加炮姜。如果是因饮水或吃生冷瓜果而引起呕吐的，用五苓散加炮姜。
一、饮食过度损伤，停滞在胃口，胸膈胀满而导致呕吐的，宜用和胃饮，或者大和中饮，或者神香散。
一、痰饮停蓄在胸膈，胀满呕吐的，宜用二陈汤，或者橘皮汤加炮姜。
一、三焦火闭，烦热壅滞胃口而导致呕吐的，这一定是阳明火证，宜用橘皮汤加黄连，严重的再加石膏，或者用竹叶石膏汤。但这种证候很少见，不要把虚火当作实火来治。
程氏说：凡是痘疮呕吐的证候，必须辨别冷（寒）热。热吐的，宜用六君子汤加姜汁炒黄芩、黄连；冷吐的，宜用六君子汤加丁香、藿香、白豆蔻。
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.