〔万〕疮疹吐利，常候也，经曰∶诸呕吐暴注，皆属于热。盖三焦为水谷传化之道路，热火内迫，则传
化失常，而吐利并作，火性燥动，迅 故也。邪在上焦，但吐而不利，邪在下焦，但利而不吐，邪在中焦，
则上吐下利。又，里气上逆而不下则吐，气下而不上则利。疮疹初发热时有吐利者，不可骤止，令邪气上下得
出也，吐利久不止，方可治之，更宜消息。〔薛〕《痘疹方》云∶痘疹吐泻，盖因脾胃不和，饮食不调，烦渴呕
吐泄泻，并用白术散（渴），然疮疹皆赖脾土，脾土实，则易出易靥，万物得土气温暖而生，吐泻则伤脾土，遂有
更变之证，夏月中暑烦渴，泻或腹痛，或欠筋，用五苓散（惊加）藿香。伤食吐泻，用小异功散（吐泻）。手足并
冷者，用益黄散（脾）、豆蔻丸（泄利）。顶陷灰白，用木香散（渴）。疮正出而吐泻者，或见血者，俱为逆证，
难治。窃谓前证虽因脾胃不和，然邪实上焦，则宜吐，邪实下焦，则宜泻，如吐泻嗳腐吞酸，皆宜宣发，但微甚不同
耳。张翼之云∶若痘疹吐泻少食为里虚，陷伏倒靥灰白为表虚，二者俱见，为表里俱虚，合用十二味异功散救之
（见形），甚至姜、附、灵砂亦可用。若止里虚去官桂，止表虚减肉豆蔻。若能食便秘倒靥为里实，勿
补，当用钱氏及丹溪法下之，皆为能食为里实，里实而补则结痈毒。红活绽凸为表实，表实而补则溃烂不结痂。凡
痘见 ，便忌葛根汤，恐发表虚也，如有更变，当随证治之。〔张〕吐泻有冷热二证，吐而不渴，泻而手足冷，面
色青白，此冷证也，益黄（脾）、理中辈主之，或四君子加木香、豆蔻亦妙。既吐且渴，虽泻而手足心热，
面赤，居处喜冷，此热证也，五苓散（惊）竹叶石膏汤（痘渴）加橘皮等主之。大吐而身热烦渴，腹满而喘，大小便涩，
面赤闷乱，钱氏云此当利小便，不瘥者，宣风散（痘发热）下之。《百问方》用香苏饮，吐加半夏、茯苓、白芍。泻
加白术、茯苓。烦躁呕吐渴泻者，亦热也，白术散（渴）最当，紫草木香汤亦可。
理中汤
人参 白术 干姜 白茯苓 甘草节（各等分）
上 咀。用水一盏，煎五分，不拘时服。如恶寒加附子，名附子理中汤。每帖二钱半。
香苏饮 治小儿痘疹作泻。
香附子 陈皮 紫苏 川芎 甘草 白芷（各等分）
上锉散。每服三钱，生姜葱白煎，或白水煎。泻加白术、茯苓，呕加茯苓、白芍药。
紫草木香汤 治痘出不快，大便泄利。
紫草 木香 茯苓 白术（各等分） 甘草（减半） 一方，无甘草。
上锉散。入糯米百粒，水煎服，每帖三钱。紫草能利大便，白术木香佐之。脾气虚者加人参。
人参胃爱散 治痘疮已发未发，吐泻不止，不思饮食，或吐逆等证。
人参 藿香 紫苏 甘草（炒） 丁香 茯苓 木瓜（各等分） 糯米
上，每服三钱，姜枣水煎。
初发热，自利而吐者，黄芩加半夏汤主之。更详审吐利所出之物，如吐酸水者，利色黄或青绿者，其气臭者，
皆热也。若吐清痰之水，利下清白不臭，未可作热治之，乃内虚也，四君子汤加诃子肉及益黄散（脾）。一云∶痘欲出
未出而吐利者，是中焦停寒，或挟宿食也，四君子汤加砂仁、橘红，或中和散，有宿食者，用紫霜
丸（癖）。发热时吐泻不止，身热口渴者，四苓散加黄连、淡竹叶煎服（五苓）去桂是也。
黄芩加半夏汤
黄芩（一钱半） 甘草（炙，一钱） 白芍药（酒拌晒九次，三钱） 半夏（汤泡七次，二钱） 生姜（一
钱） 大枣（二枚）
上锉细。水一盏，煎七分，温服。渴、去半夏，加枇杷叶去毛炙二钱，芦根、茅根、各三钱。
中和散 治中焦停寒，或夹宿食。
浓朴（一钱） 白术（八分） 干姜（四分） 甘草（三分）
上锉细。作一服，加生姜一片，水煎，稍热服。
起胀灌脓时吐利并作，宜急治之，胃寒者益黄散、理中汤，胃热者黄芩半夏汤调四苓散。
靥后吐泻，亦分冷热，冷者亦宜益黄、理中辈，热者四苓散、竹叶石膏汤（痘渴）加橘皮，或竹茹汤亦可。
竹茹汤
橘红 半夏 白茯苓 黄连（姜炒，各一钱） 甘草（五分） 竹茹（一团） 葛根（一钱五分）
上，水一钟，生姜三片，煎五分，不拘时温服，分二帖。
和中汤 虚吐不止。即镇胃止吐汤加人参。
人参 茯苓 甘草（各五分） 白术 半夏（各八分） 陈皮 藿香 砂仁（各一钱）
上，用生姜水煎服。
藿香正气散 治初热干呕。
藿香 紫苏 大腹皮 陈皮 桔梗 甘草 茯苓 半夏 浓朴 白芷
上，姜枣煎服。
凡疮痘已经大吐大泻之后，上下俱脱，即当用大补之剂，纵有他证，皆以虚论，
庸医每罔顾人元气，用药克削，而致夭枉者，滔滔皆是，可恨也！
【万全论述】痘疹出现呕吐和腹泻，是常见的症状。《内经》说：“各种呕吐和突然的剧烈泄泻，都属于热证。”这是因为三焦（运行水谷和元气的通道）是水谷传化的道路，火热之邪内迫，导致传化功能失常，从而呕吐和腹泻同时发生，这是火性燥动、迅猛的缘故。邪气在上焦，只呕吐而不腹泻；邪气在下焦，只腹泻而不呕吐；邪气在中焦，则上吐下利。另外，里气上逆而不能下行就会呕吐，气下行而上逆就会腹泻。痘疹在初起发热时如果出现吐利，不可立即强行止住，要让邪气有上下排出的途径；只有当吐利时间过长不止时，才可以进行治疗，并且需要仔细斟酌病情。
【薛己论述】《痘疹方》说：痘疹的吐泻，是因为脾胃不和，饮食不调引起的，出现烦渴、呕吐、泄泻等症状，都使用白术散（若口渴明显）。然而痘疹的生长都依赖脾土，脾土充实，则痘疹容易发出且容易结痂愈合，就像万物得到土壤的温暖才能生长一样；吐泻会损伤脾土，于是产生变证。夏季中暑导致的烦渴、腹泻或腹痛、筋脉拘急，使用五苓散（惊风加味）及藿香。伤食导致的吐泻，使用小异功散（针对吐泻）。手足发冷的，使用益黄散（针对脾虚）、豆蔻丸（针对泄利）。痘顶凹陷、颜色灰白的，使用木香散（针对口渴）。痘疹正在发出时出现吐泻，或者见血的，都属于逆证，难以治疗。我认为上述病症虽然因脾胃不和引起，但如果邪实于上焦，则宜用吐法；邪实于下焦，则宜用泻法。如吐泻伴有嗳腐吞酸，都适宜宣发透达，只是程度轻重不同罢了。张翼之说：如果痘疹吐泻且食欲减退，属于里虚；痘陷伏倒靥、颜色灰白，属于表虚。两者同时出现，属于表里俱虚，合用十二味异功散来救治（见于见形期），甚至干姜、附子、灵砂也可以使用。如果只是里虚，去掉官桂；如果只是表虚，减少肉豆蔻用量。如果能进食但便秘、痘陷，属于里实，不要补益，应当采用钱乙及朱丹溪的方法攻下，这都是因为能进食代表里实，里实而误补则会结成痈毒。痘色红活绽凸，属于表实，表实而误补则会溃烂不结痂。凡是见到痘疹，就忌讳使用葛根汤，恐怕发表过度导致虚损，如果有变证，应当随证治疗。
【张景岳论述】吐泻分为冷、热两种证候。呕吐但不口渴，腹泻且手足冰冷，面色青白，这是冷证，以益黄散（针对脾虚）、理中汤类为主治，或者四君子汤加木香、豆蔻也很好。既呕吐又口渴，虽然腹泻但手足心热，面赤，喜欢居住在凉爽的地方，这是热证，以五苓散（惊风加味）、竹叶石膏汤（痘疹口渴）加橘皮等为主治。大吐且身热烦渴，腹部胀满而喘，大小便涩滞，面赤闷乱，钱乙说这应当通利小便，如果不愈，用宣风散（痘疹发热）攻下。《百问方》使用香苏饮，呕吐加半夏、茯苓、白芍；腹泻加白术、茯苓。烦躁、呕吐、口渴、腹泻的，也是热证，白术散（口渴）最为恰当，紫草木香汤也可以。
理中汤
人参、白术、干姜、白茯苓、甘草节（各等分）
以上药材切碎。用水一盏，煎至五分，不拘时候服用。如果恶寒，加附子，名为附子理中汤。每帖二钱半。
香苏饮 治疗小儿痘疹作泻。
香附子、陈皮、紫苏、川芎、甘草、白芷（各等分）
以上锉散。每次服三钱，用生姜、葱白煎服，或用白水煎服。腹泻加白术、茯苓，呕吐加茯苓、白芍药。
紫草木香汤 治疗痘出不快，大便泄利。
紫草、木香、茯苓、白术（各等分），甘草（减半），另一版本无甘草。
以上锉散。加入糯米一百粒，水煎服，每帖三钱。紫草能通利大便，白术、木香辅助它。脾气虚者加人参。
人参胃爱散 治疗痘疮已发或未发，吐泻不止，不思饮食，或呕吐等证。
人参、藿香、紫苏、甘草（炒）、丁香、茯苓、木瓜（各等分），糯米
以上，每次服三钱，用姜枣水煎服。
初起发热，自利而呕吐的，主用黄芩加半夏汤。更详细审察吐利所出之物，如吐酸水的，泻下颜色黄或青绿的，气味臭秽的，都是热证。如果吐出清稀痰水，泻下清白且不臭，暂不能作为热证治疗，这是内虚，用四君子汤加诃子肉及益黄散（针对脾虚）。另一种说法：痘欲出未出而吐利的，是中焦停寒，或夹杂宿食，用四君子汤加砂仁、橘红，或中和散；有宿食的，用紫霜丸（癖积）。发热时吐泻不止，身热口渴的，用四苓散加黄连、淡竹叶煎服（即五苓散去桂枝）。
黄芩加半夏汤
黄芩（一钱半）、甘草（炙，一钱）、白芍药（酒拌晒九次，三钱）、半夏（汤泡七次，二钱）、生姜（一钱）、大枣（二枚）
以上锉细。用水一盏，煎至七分，温服。口渴，去半夏，加枇杷叶去毛炙二钱，芦根、茅根各三钱。
中和散 治疗中焦停寒，或夹宿食。
浓朴（一钱）、白术（八分）、干姜（四分）、甘草（三分）
以上锉细。作一服，加生姜一片，水煎，稍热服。
起胀灌脓时吐利同时发作，应当紧急治疗，胃寒的用益黄散、理中汤，胃热的用黄芩半夏汤调四苓散。
结痂后吐泻，也分冷热，冷的也用益黄散、理中汤类，热的用四苓散、竹叶石膏汤（痘疹口渴）加橘皮，或者竹茹汤也可以。
竹茹汤
橘红、半夏、白茯苓、黄连（姜炒，各一钱）、甘草（五分）、竹茹（一团）、葛根（一钱五分）
以上，用水一钟，生姜三片，煎至五分，不拘时候温服，分两帖。
和中汤 治疗虚性呕吐不止。即镇胃止吐汤加人参。
人参、茯苓、甘草（各五分）、白术、半夏（各八分）、陈皮、藿香、砂仁（各一钱）
以上，用生姜水煎服。
藿香正气散 治疗初热干呕。
藿香、紫苏、大腹皮、陈皮、桔梗、甘草、茯苓、半夏、浓朴、白芷
以上，姜枣煎服。
凡是疮痘已经经过大吐大泻之后，上下元气俱脱，就应当使用大补的药剂，纵然有其他证候，都按虚证论治，庸医往往不顾人的元气，用药克削，而导致夭折枉死的，比比皆是，令人痛恨！
[Wan Quan's Discussion] Vomiting and diarrhea occurring during smallpox or chickenpox are common symptoms. The *Classic of Internal Medicine* states: "All vomiting and sudden, violent diarrhea belong to heat." This is because the Sanjiao (Triple Burner, a pathway for water and grain transformation) is the route for the transmission and transformation of food and fluids. When internal pathogenic fire forces its way, the transformation function becomes abnormal, resulting in simultaneous vomiting and diarrhea; this is due to the dry, agitated, and rapid nature of fire. If the pathogen is in the Upper Jiao, there is only vomiting without diarrhea; if in the Lower Jiao, there is only diarrhea without vomiting; if in the Middle Jiao, both upper vomiting and lower diarrhea occur. Furthermore, when interior Qi rebels upward and fails to descend, vomiting occurs; when Qi descends but fails to ascend, diarrhea occurs. When vomiting and diarrhea appear during the initial fever stage of smallpox/chickenpox, they should not be abruptly stopped, so that pathogenic factors have a way to exit from above and below. Only when vomiting and diarrhea persist for a long time should treatment be initiated, and careful consideration of the condition is required.
[Xue Ji's Discussion] The *Smallpox and Chickenpox Formula Book* states: Vomiting and diarrhea in smallpox/chickenpox are caused by disharmony of the Spleen and Stomach and irregular diet, leading to symptoms such as irritability, thirst, vomiting, and diarrhea. In all these cases, Baizhu San (Atractylodes Macrocephala Decoction) is used (if thirst is prominent). However, the eruption of rashes relies on the Earth element of the Spleen. When the Spleen Earth is solid, eruptions emerge easily and crust over easily, just as all things grow warm with the energy of the soil. Vomiting and diarrhea damage the Spleen Earth, leading to further complications. For summerheat stroke causing irritability, thirst, diarrhea, abdominal pain, or muscle cramps, Wuling San (Five-Ingredient Poria Decoction) [with modifications for fright] and Huoxiang (Patchouli) are used. For vomiting and diarrhea due to food stagnation, Xiaoyigong San (Minor Yi Gong Decoction) is used. For cold hands and feet, Yihuang San (Yellowing-Regulating Decoction) [for Spleen deficiency] and Doukou Wan (Cardamom Pill) [for diarrhea] are used. For depressed rash tops and grayish-white color, Muxiang San (Costus Root Decoction) [for thirst] is used. If vomiting and diarrhea occur while the rash is eruptating, or if bleeding is seen, these are adverse signs and are difficult to treat. I believe that although the aforementioned conditions are caused by Spleen-Stomach disharmony, if pathogenic excess is in the Upper Jiao, emesis is indicated; if in the Lower Jiao, purgation is indicated. For vomiting and diarrhea accompanied by belching with putrid odor and acid regurgitation, venting and dispersing methods are appropriate, differing only in degree. Zhang Yizhi stated: If smallpox/chickenpox presents with vomiting, diarrhea, and reduced appetite, it indicates Interior Deficiency; if the rash collapses, inverts, and turns grayish-white, it indicates Exterior Deficiency. If both are present, it indicates combined Exterior and Interior Deficiency, requiring Shierwei Yigong San (Twelve-Ingredient Yi Gong Decoction) for rescue (during the manifestation stage); even Jiang (Ginger), Fu (Aconite), and Lingsha (Cinnabar) may be used. If only Interior Deficiency exists, remove Guigui (Cassia Bark); if only Exterior Deficiency exists, reduce the dosage of Roudoukou (Nutmeg). If the patient can eat but has constipation and inverted rash, it indicates Interior Excess; do not tonify, but instead use the methods of Qian Yi and Zhu Danxi to purge. This is because the ability to eat suggests Interior Excess; tonifying Interior Excess will lead to carbuncles and sores. Red, vibrant, and protruding rash indicates Exterior Excess; tonifying Exterior Excess will lead to ulceration and failure to crust. Whenever smallpox/chickenpox is visible, Gegen Tang (Kudzu Decoction) is contraindicated, lest excessive exterior-releasing cause deficiency. If complications arise, treat according to the syndrome.
[Zhang Jingyue's Discussion] Vomiting and diarrhea are divided into Cold and Hot syndromes. Vomiting without thirst, diarrhea with cold hands and feet, and bluish-white complexion indicate a Cold Syndrome, treated primarily with Yihuang San [for Spleen deficiency], Lizhong Tang (Regulate the Middle Decoction), or Sizjunzi Tang (Four Gentlemen Decoction) added with Muxiang (Costus Root) and Doukou (Cardamom). Vomiting accompanied by thirst, diarrhea with hot palms and soles, red face, and preference for cool environments indicate a Hot Syndrome, treated primarily with Wuling San [with modifications for fright], Zhuye Shigao Tang (Leaf and Gypsum Decoction) [for smallpox thirst] added with Chenpi (Tangerine Peel). Profuse vomiting with body heat, irritability, and thirst, abdominal fullness with wheezing, scanty urination and defecation, red face, and mental confusion: Qian Yi stated this requires promoting diuresis. If ineffective, Xuanfeng San (Dispel Wind Powder) [for fever] is used to purge. The *Baiwen Fang* uses Xiangsu Yin (Fragrant Perilla Infusion); add Banxia (Pinellia), Fuling (Poria), and Shaoyao (Peony) for vomiting; add Baizhu (Atractylodes) and Fuling (Poria) for diarrhea. Irritability, vomiting, thirst, and diarrhea also indicate Heat; Baizhu San [for thirst] is most suitable, and Zicao Muxiang Tang (Arnebia and Costus Decoction) is also acceptable.
Lizhong Tang
Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), Ganjiang (Dried Ginger), Baifuling (White Poria), Gancao Jie (Licorice Knot) (equal parts)
Crush the ingredients. Decoct one cup of water until five-tenths remain. Take at any time. If aversion to cold is present, add Fuzi (Aconite), named Fuzi Lizhong Tang. Each dose is two qian and half.
Xiangsu Yin Treats pediatric smallpox/chickenpox with diarrhea.
Xiangfu (Cyperus), Chenpi (Tangerine Peel), Zisu (Perilla), Chuanxiong (Ligusticum), Gancao (Licorice), Baizhi (Angelica Dahurica) (equal parts)
Cut into pieces. Take three qian per dose, decocted with Shengjiang (Fresh Ginger) and Congbai (Scallion White), or plain water. Add Baizhu and Fuling for diarrhea; add Fuling and Shaoyao for vomiting.
Zicao Muxiang Tang Treats slow eruption of smallpox/chickenpox and loose stools.
Zicao (Arnebia), Muxiang (Costus), Fuling (Poria), Baizhu (Atractylodes Macrocephala) (equal parts); Gancao (Licorice) (half dose). Another version has no Licorice.
Cut into pieces. Add one hundred grains of Nuomi (Glutinous Rice), decoct in water, and take. Each dose is three qian. Zicao promotes bowel movement, assisted by Baizhu and Muxiang. Add Renshen for Spleen Qi deficiency.
Renshen Weiai San Treats persistent vomiting and diarrhea whether the smallpox/chickenpox has erupted or not, loss of appetite, or vomiting.
Renshen (Ginseng), Huoxiang (Patchouli), Zisu (Perilla), Gancao (Licorice, stir-fried), Dingxiang (Clove), Fuling (Poria), Mugua (Chaenomeles) (equal parts), Nuomi (Glutinous Rice)
Take three qian per dose, decocted with Shengjiang and Dazao (Jujube).
During initial fever, if spontaneous diarrhea and vomiting occur, Huangqin Banxia Tang (Scutellaria and Pinellia Decoction) is primary. Carefully examine the vomitus and stool: sour vomit, yellow or greenish-blue stool, and foul odor all indicate Heat. If clear phlegm-water is vomited, and stool is clear, white, and odorless, do not treat as Heat initially; this is Interior Deficiency. Use Sizjunzi Tang (Four Gentlemen Decoction) added with Hezi Rou (Chebulic Myrobalan Flesh) and Yihuang San [for Spleen deficiency]. Another view: Vomiting and diarrhea before eruption indicate Cold stagnation in the Middle Jiao or retained food. Use Sizjunzi Tang added with Sharen (Amomum) and Juhong (Exocarpium Citri Grandis), or Zhonghe San (Harmonizing Decoction); for retained food, use Zishuang Wan (Purple Frost Pill) [for masses]. During fever, if vomiting and diarrhea persist with body heat and thirst, use Siling San (Four-Poria Decoction) added with Huanglian (Coptis) and Danzhuye (Bamboo Leaf) (this is Wuling San without Gui Zhi/Cinnamon Twig).
Huangqin Banxia Tang
Huangqin (Scutellaria, 1.5 qian), Gancao (Licorice, honey-fried, 1 qian), Shaoyao (Peony, wine-soaked and sun-dried nine times, 3 qian), Banxia (Pinellia, boiled seven times, 2 qian), Shengjiang (Fresh Ginger, 1 qian), Dazao (Jujube, 2 pieces)
Cut finely. Decoct one cup of water until seven-tenths remain. Take warm. For thirst, remove Banxia, add Pipaye (Loquat Leaf, de-hairy and fried, 2 qian), Lugen (Reed Rhizome), and Maogen (Imperata Rhizome) (3 qian each).
Zhonghe San Treats Cold stagnation in the Middle Jiao or retained food.
Houpo (Magnolia Bark, 1 qian), Baizhu (Atractylodes Macrocephala, 0.8 qian), Ganjiang (Dried Ginger, 0.4 qian), Gancao (Licorice, 0.3 qian)
Cut finely. One dose, add one slice of Shengjiang, decoct in water, and take slightly warm.
During the swelling and suppuration stages, if vomiting and diarrhea occur simultaneously, urgent treatment is needed. For Stomach Cold, use Yihuang San or Lizhong Tang; for Stomach Heat, use Huangqin Banxia Tang blended with Siling San.
After crusting, vomiting and diarrhea are also divided into Cold and Hot. Cold types are treated with Yihuang San or Lizhong Tang; Hot types are treated with Siling San, Zhuye Shigao Tang [for smallpox thirst] added with Chenpi, or Zhuru Tang (Bamboo Shavings Decoction).
Zhuru Tang
Juhong (Citrus Exocarp), Banxia (Pinellia), Baifuling (White Poria), Huanglian (Coptis, ginger-fried, 1 qian each), Gancao (Licorice, 0.5 qian), Zhuru (Bamboo Shavings, one ball), Gegen (Kudzu, 1.5 qian)
Decoct one zhong of water with three slices of Shengjiang until five-tenths remain. Take warm at any time, divided into two doses.
Hezhong Tang Treats persistent vomiting due to deficiency. It is Zhenwei Zhitu Tang (Stabilize Stomach Stop-Vomit Decoction) added with Renshen.
Renshen (Ginseng), Fuling (Poria), Gancao (Licorice) (0.5 qian each), Baizhu (Atractylodes Macrocephala), Banxia (Pinellia) (0.8 qian each), Chenpi (Tangerine Peel), Huoxiang (Patchouli), Sharen (Amomum) (1 qian each)
Decoct in water with Shengjiang and take.
Huoxiang Zhengqi San Treats dry heaving during initial heat.
Huoxiang (Patchouli), Zisu (Perilla), Dafupi (Areca Peel), Chenpi (Tangerine Peel), Jiegeng (Platycodon), Gancao (Licorice), Fuling (Poria), Banxia (Pinellia), Houpo (Magnolia Bark), Baizhi (Angelica Dahurica)
Decoct with Shengjiang and Dazao.
After severe vomiting and diarrhea from smallpox/chickenpox, both upper and lower Yuan Qi are depleted. Large tonifying agents must be used immediately. Even if other symptoms exist, they should all be treated as Deficiency. Quack doctors often disregard the patient's Yuan Qi, using harsh draining medicines, leading to premature death. This is ubiquitous and lamentable!