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In the context of Shanghan (Cold Damage) disease, where the body is hot, purgation (using laxatives to clear heat and accumulation) is inherently contraindicated. Similarly, for Chu Zhen (exanthematous diseases such as smallpox and measles), the heat pathogen remains at the exterior level, making purgation especially inadvisable; this is because the heat toxin has already manifested at the exterior. The *Huoren Shu* (Book of Living People) states: "If a child presents with fever but cold ears and cold buttocks, accompanied by coughing, and one indiscriminately uses purgative medicines, it will inevitably cause toxic factors to penetrate inward, leading to death." This is because when heat is at the exterior, the exterior is excess while the interior is deficient. Thus, although the body is hot, there are no signs of interior excess requiring purgation. If purgation is forced, the interior Yang Qi becomes insufficient to support the exterior against the pathogen, often resulting in the collapse and internal entrapment of the pathogen, leading to death. Generally, if the Qi and Blood flow smoothly and the Spleen and Stomach are warm during exanthematous diseases, eruption occurs easily. Conversely, if there is no interior heat but one mistakenly uses draining or purgative methods, it leads to weak Qi, stagnant Blood, and cold Spleen. The Ying and Wei (Nutritive and Defensive Qi) lose their ability to transform and transport, making it difficult to expel the toxic factors, immediately bringing danger. Therefore, careful examination is paramount. Furthermore, nasal congestion and dry, cracked lips in children indicate latent interior heat. A fine pulse, sallow or bluish complexion, flaccid skin, and spitting of clear saliva are signs of erroneous purgation. If excessive cold-natured medicines have been taken, or if there is no interior heat stagnation, purgation must not be used.

Regarding various syndromes of exanthematous diseases caused by Wind-Cold, Wind-Heat, or Food Retention, if the patient has fever and has not had a bowel movement for four to six or seven days, mild laxatives should be used to moisten the intestines, not to achieve a drastic purgative effect. External symptoms must also be considered, and careful differentiation is appropriate. As Zhang Zhongjing stated: In cases of Yang Knotting or Yin Knotting causing constipation, symptoms may worsen on the fourteenth or seventeenth day. However, if by the fourteenth or seventeenth day, fluid depletion from other illnesses results in no hardened feces, and the abdomen is not distended nor is there tenesmus (straining without relief), then attack/purgation is contraindicated because there is no hardened stool in the intestines. The current text suggests moistening after six or seven days; if Qi ascends and descends normally, fever will not give rise to other diseases. Since children are of "Pure Yang" constitution, fever with constipation tends toward Excess, while spontaneous diarrhea tends toward Deficiency, both predisposing them to other ailments. Therefore, regulating bowel movements to normalcy is a crucial method for assessing the Deficiency or Excess of the Zang-Fu organs. Although constipation is not a single syndrome—there are Wind Constipation, Qi Constipation, Heat Constipation, Deficiency Constipation, and Cold Constipation—the prescription of medicines requires detailed differentiation. If the patient can eat but suffers from constipation with dry stools resembling chestnut pieces, it is Wind Constipation; if there is irritability, thirst, red urine, constipation, and sweating in the axillae and palms, it is Heat Constipation; if there is abdominal distension, borborygmus (rumbling in the intestines), chest and hypochondriac discomfort, and radiating pain in the waist and abdomen, it is Qi Constipation; if there is vomiting of clear water, anorexia, bluish complexion, and emaciation, it is Cold Constipation; if a chronically ill patient cannot take milk or food, has no abdominal distension or tenesmus, yet has not had a bowel movement for a long time, it is Deficiency Constipation. All five types of constipation should be treated according to their specific syndromes. If bowel movements are normal, cold-natured medicines should not be administered, lest they freeze the Stomach meridians and obstruct the circulation of Ying and Wei, thereby preventing the eruption of exanthems. Additionally, if a patient naturally experiences diarrhea between the fifth and seventh days of illness, warming agents for the middle Jiao, such as Lizhong Wan (Regulate the Middle Pill), should be used. Once the diarrhea stops, subsequent administration should cease; this is not an overuse of purgation but rather a case requiring warming therapy. Finally, if exanthems are erupting vigorously, accompanied by coarse breathing, shortness of breath, abdominal distension, dark and scanty urination, sweating in the palms and axillae, somnolence with delirium, and constipation, Sixun Yinzi (Four-Obedience Decoction) should be used. When Qi flows freely, panting subsides, and abdominal distension resolves, the condition improves. If purgation results in bright red and smooth eruption of the exanthems, further purgation is unnecessary.