凡小儿出痘而昼夜啼哭者，当辨其虚实表里而治之。其有内未得出，或外未得散而啼哭者，
此毒瓦斯不解之使然也。有阳邪火盛，红赤 突而啼哭者，此痘盘疼痛之使然也。有心肾本虚，邪
热乘阴而啼哭者，此或以神志不摄，或以烦热不宁之使然也。有饮食不节，或偶停滞而啼哭者，
此胃气不和，腹痛腹胀之使然也。知此之由，而辨得其真，则内未出者表之托之，外未散者
解之化之，火之盛者清其热，神之虚者养其阴。若痘毒本微而无故啼哭者，多由饮食内伤，或二便
秘结，此或去其停滞，或通其壅闭，务令表里和畅，营卫通行，则神魂安泰，而痘无不善矣。
或谓啼哭非痰即热，而不究其本，则失之远矣。
凡痘疹小便欲其清而长，大便欲其润而实，则邪气不伏，正气不病。若小便利者，大便必实，
虽二三日不更衣者无碍也。若小便少则病必进，小便秘则病必甚，以火盛故也。但初热时，大
便不宜太实，若二三日不行，宜微润之，不然恐肠胃不通，则营卫不行，而疮出转密。惟起发
之后，大便却宜坚实，若太实而四五日不行，恐热甚难靥，亦宜微利之。
一、痘疹小水不利而热微者，宜导赤散；热甚而小水不利者，宜八正散。
一、痘疹发热时，大便秘结不行而内外俱热，有不得不通以疏其毒者，轻则柴胡饮子，甚则三
黄丸，再甚则承气汤。
一、自起发后以至收靥，凡大便不行而火不盛，或虚弱不可通利者，只宜用猪胆导法，
或以酱瓜一条如指许导之即出，切不可轻用利药。
一、大小便俱不通而内热甚者，八正散或通关散，酌宜用之。
一、热毒内盛而痘疮干黑倒陷，烦躁便结者，百祥丸或承气汤。然宜慎用，毋轻易也。
一、痘后余热不尽，内陷膀胱而小水不利者，导赤散或五苓散。大便不通者，四顺清凉饮。
陈氏曰∶凡痘疮四五日不大便，用嫩猪脂一块，以白水煮熟，切如豆粒与食之，令脏腑
滋润，亦使疮痂易落。切不可妄投宣泄之药，以致元气内虚，多伤儿也。
薛氏曰∶前证若因热毒内蕴，宜用射干鼠粘子汤解之。或发热作渴，或口舌生疮，咽喉作
痛，并宜用之。
凡是小儿出痘期间出现昼夜啼哭的情况，应当辨别其虚证、实证、表证、里证而进行治疗。那些痘毒在内尚未透发出来，或在体表未能疏散因而啼哭的，这是痘毒之气未得解除所致。有因阳邪火气旺盛，痘疹红赤突起而啼哭的，这是痘盘疼痛所致。有心肾原本虚弱，邪热乘虚侵袭阴分而啼哭的，这是因为神志不能收敛，或因烦热不安所致。有因饮食不节制，或偶然食积停滞而啼哭的，这是胃气不和，导致腹痛腹胀所致。知晓这些病因，并准确辨证，那么对于内未透发的，就采用解表托毒的方法；对于外未疏散的，就采用解毒化滞的方法；火气旺盛的，清泄其热；神气虚弱的，滋养其阴。如果痘毒本来轻微却无故啼哭的，多由饮食内伤，或大小便秘结引起，这时或者去除食积停滞，或者通利壅闭，务必使表里和畅，营卫通行，那么神魂安宁，痘疮也就没有不好的了。有人说啼哭非痰即热，而不探究根本原因，那就差得太远了。
凡是痘疹，小便希望清澈而长，大便希望润泽而结实，这样邪气就不会潜伏，正气就不会受病。如果小便通畅，大便必然结实，即使两三天不大便也没有妨碍。如果尿量少则病情必定进展，小便闭塞则病情必定加重，这是由于火气旺盛的缘故。但在初发热时，大便不宜过于干结，如果两三天不通行，宜微微润肠通便，否则恐怕肠胃不通，营卫运行受阻，痘疮反而出得密集。只有在起发之后，大便却适宜坚实，如果过于干结且四五天不通行，恐怕热势严重难以收靥，也宜微微通下。
一、痘疹小便不利而热势轻微的，宜用导赤散；热势严重而小便不利的，宜用八正散。
一、痘疹发热时，大便秘结不通且内外俱热，有不得不通过通下来疏解毒气的，轻症用柴胡饮子，重症用三黄丸，更重的用承气汤。
一、自起发以后直到收靥阶段，凡是大便不行而火气不盛，或体质虚弱不可使用通利药的，只宜用猪胆导法，或用一条如手指粗细的酱瓜插入肛门引导排便即可排出，切不可轻易使用泻下药。
一、大小便都不通且内热严重的，八正散或通关散，酌情选用。
一、热毒内盛而痘疮干枯黑陷、烦躁便结的，用百祥丸或承气汤。然而宜谨慎使用，不要轻易施用。
一、痘后余热不尽，内陷膀胱导致小便不利的，用导赤散或五苓散。大便不通的，用四顺清凉饮。
陈氏说：凡是痘疮四五日不大便，用嫩猪脂一块，用清水煮熟，切成豆粒大小给患儿吃，使脏腑滋润，也能使疮痂容易脱落。切不可妄投宣泄的药物，以致元气内虚，大多伤害小儿。
薛氏说：前述病症若因热毒内蕴，宜用射干鼠粘子汤来解除。如果有发热口渴，或口舌生疮，咽喉疼痛，都宜用此方。
In cases where infants and children cry day and night during the eruption of smallpox, one must differentiate between deficiency and excess, exterior and interior patterns to determine treatment. Those who cry because the toxin has not yet emerged from within or has not yet dispersed on the exterior are suffering from unresolved toxic qi. Crying accompanied by bright red, protruding pustules due to flourishing yang pathogenic fire is caused by pain in the smallpox base. Crying resulting from inherent deficiency of the Heart and Kidney, with pathogenic heat invading the Yin, is caused by the inability of the spirit to be contained or by restlessness due to irritative heat. Crying due to irregular diet or accidental food stagnation is caused by disharmony of Stomach Qi, leading to abdominal pain and distension. Understanding these causes and accurately differentiating the pattern allows for appropriate interventions: for those whose eruption has not emerged, employ methods to release the exterior and support the eruption; for those whose eruption has not dispersed, employ methods to resolve toxicity and transform stagnation; for flourishing fire, clear the heat; for deficient spirit, nourish the Yin. If the smallpox toxin is inherently mild but crying occurs without cause, it is mostly due to internal injury from diet or constipation of the bowels and bladder. In such cases, remove food stagnation or unblock obstruction, ensuring smooth flow of the exterior and interior and free circulation of Ying (Nutritive) and Wei (Defensive) Qi, so that the Spirit remains peaceful and the smallpox heals well. Some claim that crying is either due to phlegm or heat, failing to investigate the root cause, which is a significant error.
Regarding smallpox and measles, urine should ideally be clear and long, and stool should be moist and firm, indicating that pathogenic factors are not latent and healthy Qi is not compromised. If urination is smooth, stool will likely be firm; even if there is no bowel movement for two or three days, it is not a concern. However, if urine volume is low, the disease will inevitably progress; if urination is obstructed, the condition will worsen, due to excessive fire. During the initial fever stage, stool should not be too dry; if there is no bowel movement for two or three days, mild lubrication is advisable. Otherwise, blockage of the intestines and stomach may impede the circulation of Ying and Wei Qi, causing the rash to appear more densely. After the eruption begins to rise, stool should be firmer. If it is too dry and there is no movement for four or five days, excessive heat may hinder scabbing, so mild purgation is appropriate.
1. For smallpox/measles with difficult urination and mild heat, Dao Chi San (Ledebouriella Decoction) is indicated. For difficult urination with severe heat, Ba Zheng San (Eight-Ingredient Polygonum Decoction) is indicated.
2. During fever from smallpox/measles, if stool is constipated and both interior and exterior exhibit heat, requiring purgation to vent toxicity: for mild cases, Chai Hu Yin Zi (Bupleurum Drink); for severe cases, San Huang Wan (Three-Yellow Pill); for very severe cases, Cheng Qi Tang (Descending the Qi Decoction).
3. From the rising phase until scabbing, if stool does not pass and fire is not strong, or if the patient is weak and cannot tolerate purgatives, only Zhu Dan Dao Fa (Pig Gallbladder Suppository Method) should be used, or inserting a sauce-pickled cucumber strip about the thickness of a finger into the anus to guide evacuation. Do not lightly use laxatives.
4. For complete obstruction of both stool and urine with severe internal heat, Ba Zheng San (Eight-Ingredient Polygonum Decoction) or Tong Guan San (Unblocking the Pass Powder) may be used according to suitability.
5. For severe internal heat toxicity causing dry, black, inverted smallpox lesions, restlessness, and constipation, Bai Xiang Wan (Hundred-Auspicious Pill) or Cheng Qi Tang (Descending the Qi Decoction) may be used. However, caution is required; do not use them lightly.
6. For lingering residual heat after smallpox/measles sinking into the Bladder causing difficult urination, Dao Chi San (Ledebouriella Decoction) or Wu Ling San (Five-Ingredient Powder with Poria) is indicated. For constipation, Si Shun Qing Liang Yin (Four-Obedience Cooling and Clearing Drink) is indicated.
Mr. Chen stated: For smallpox cases where there is no bowel movement for four or five days, boil a piece of tender pork fat in plain water, cut it into bean-sized pieces, and feed it to the child to moisten the viscera, facilitating the falling of scabs. Do not recklessly administer draining medicines, as this depletes Yuan Qi (Original Qi) internally and harms the child.
Mr. Xue stated: For the aforementioned conditions caused by internal accumulation of heat toxicity, She Gan Niu Bang Zi Tang (Belamcanda and Bubble Gum Seed Decoction) should be used to resolve it. It is also suitable for symptoms such as fever with thirst, mouth and tongue ulcers, and sore throat.