疮疹已出，热毒居表而不可疏利，疏利是未出时即疏利之。疏则散其热气，利则滑其肌
窍，使热毒则发泄而不壅遏，其疮疹轻而易出也。及其疮疹已出，即不可疏利，惟以和平匀
气药调服为宜，又曷常令人取转耶？且疏利与取转，相去辽远。疏利者是以轻凉之药，疏散
使易出也，如黄连散、青黛散、当归散，烦躁而卧不安，频煎豆汤，徐徐服之；取转者，是
以峻快之药转下也，如巴豆芒硝轻粉水银之类是也。疏利与取转轻重殊等，不可同日而语。
古言疏利，今乃为取转，得不为误耶。
小儿所禀，有虚有实，病证有寒有温，故良工随宜而治，各得其所。今观董汲与《指迷
方论》，其禀气浓者，或病热而又失于解利，有蕴积热毒者，治法则当利，利之无不愈。此
由小儿禀气已浓，又有病热而失于解利，蕴热在里，则宜利之，利之无不愈矣。此董汲指迷
用药之意，皆热毒未出于表，蕴毒在里时用之也。若非钱氏方与《活人书》用药之意。钱氏
论倒靥，欲脾强而胜肾，得身温而渴，阳气复者，可生也。《活人书》云∶身热耳冷尻冷，
轻用利药则杀人。二人之论，身热为疮疹，毒以在表，气虚在里，故不可利，但以温平解毒
而已。故知伤寒身热而下之早，毒瓦斯入里为结胸，疮疹为热在表，下之早为黑靥，为陷伏。
四人之论，皆不可废，用之要得其宜。后之医者当以董汲《指迷方》治疮疹未出，预截热毒
。若已出了者，解利余毒，则无不愈矣。以钱氏朱氏之意，治疮疹正作，使外不至太过，里
不至陷伏，亦无不愈者。大抵治病皆当随宜用之，最为要法。譬如小儿患有伤生冷者，有伏
热者，有被惊者，有感风寒者，有伤食者，临期分别，岂可泥于一曲。况习医者，又随方而
用之。以愚观之，昧者徒互见其偏，审之四说，皆为可用。
When the sores and rashes have already erupted, the heat-toxin resides in the exterior and should not be treated with purgation (Shu Li). Purgation is a method used when the sores and rashes have not yet erupted. The "dispersing" (Shu) method dissipates heat qi, while the "slippery/purgative" (Li) method lubricates the skin pores, allowing the heat-toxin to vent without being obstructed or suppressed, thereby making the sores and rashes mild and easy to erupt. Once the sores and rashes have erupted, purgation must not be used; it is most appropriate to regulate the qi with mild and harmonizing medicines. Why resort to the "turning/reversing" (Qu Zhuan) method? Moreover, purgation and turning are vastly different. Purgation uses light and cool medicines to disperse pathogens so they can be easily expelled, such as Huanglian San (Coptis Powder), Qingdai San (Indigo Naturalis Powder), and Danggui San (Angelica Sinensis Powder). If the patient is irritable and restless in sleep, bean soup can be frequently decocted and administered slowly. Turning (Qu Zhuan) involves using harsh and rapid purgatives, such as Radix et Rhizoma Rhei Preparata (Dahuang, 大黄 - *Note: Text says Badou/Mangxiao/Qingfen/Shuiyin, usually associated with severe cold accumulation*), Crotonis Fructus (Badou, 巴豆), Natrii Sulfas (Mangxiao, 芒硝), Calomelas (Qingfen, 轻粉), and Hydrargyrum (Shuiyin, 水银). Purgation and turning differ significantly in severity and cannot be compared. What ancients called purgation is now mistaken for turning; is this not an error?
Children's innate constitution varies between deficiency and excess, and their diseases vary between cold and warmth. Therefore, skilled physicians treat according to the specific situation, each finding its proper place. Observing Dong Ji's *Zhi Mi Fang Lun*, for those with robust constitutions, or those suffering from heat diseases where resolution and purgation were neglected, resulting in accumulated heat-toxin within, the treatment method should employ purgation. Purgation leads to recovery in all cases. This is because the child has a robust constitution, suffers from heat disease, and neglects resolution/purgation, leading to latent heat in the interior; thus, purgation is suitable, and recovery follows. This reflects Dong Ji's intent in *Zhi Mi*: these methods are used when heat-toxin has not yet emerged to the exterior and toxin is accumulating in the interior. This differs from the medication principles of Qian Yi's formulas and the *Huo Ren Shu*. Qian Yi discussed inverted sores (Dao Ye), stating that if the Spleen is strong enough to overcome the Kidney, the body becomes warm, thirst appears, and Yang qi recovers, survival is possible. The *Huo Ren Shu* states: if there is body heat but cold ears and buttocks, using purgatives lightly will cause death. These two theories hold that body heat indicates toxin in the exterior and Qi deficiency in the interior, so purgation is contraindicated; only mild and neutral detoxifying herbs should be used. Thus, in Typhoid Fever (Shang Han), if body heat is treated with premature purgation, toxin enters the interior causing Jie Xiong (Chest Binding); whereas in sores and rashes, heat is in the exterior, and premature purgation leads to Hei Ye (Black Sores) or Xian Fu (Collapse/Involution). All four scholars' theories are indispensable, provided they are applied appropriately. Future physicians should use Dong Ji's *Zhi Mi Fang* to preemptively intercept heat-toxin before sores erupt. If they have already erupted, resolving residual toxins ensures recovery. Applying the principles of Qian Yi and Zhu Shi to active sores prevents excessive exterior manifestation and interior collapse, also ensuring recovery. Generally, treating diseases requires adapting to circumstances, which is the most crucial principle. For instance, children may suffer from cold-damage due to raw/cold food, latent heat, fright, wind-cold invasion, or food stagnation. One must differentiate at the time of treatment; how can one stick rigidly to one partial view? Furthermore, practitioners apply formulas accordingly. In my opinion, ignorant people merely see the biases of others. Upon careful examination, all four theories are applicable.