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Predecessors discussed chuangzhen (exanthematous diseases such as smallpox and measles), stating that when there is severe heat, one should promote urination. This is because severe heat causes the skin to be hot and the pulse to be full and forceful, with both large and small bowels being obstructed; the heart is hot and thirsty, qi is stagnant causing distension and panting, food intake is possible, but pus and blood do not form scabs. At this time, since internal heat is already rampant, fearing it may cause other ailments, promoting urination is adopted. By guiding the heart fire, even without using cold medicines, the heat will naturally subside. It is a superior method to wait until the heat of the exanthema passes, avoiding damage from erroneous use of cold medicines. If there is mild heat, one should resolve toxicity. If mild heat is not resolved, severe heat will inevitably arise; promoting urination when there is only mild heat would damage qi. Therefore, when there is mild heat, one must not promote urination, but only clear heat and resolve toxicity, such as using Dai Mao Tang (Hornbill Herb Decoction), Du Sheng San (Unique Victory Powder), An Ban San (Pacify Macules Powder), Ru Sheng San (Like Sage Powder), Zi Cao Tang (Arnebia Root Decoction), or Xi Jiao Yin (Rhinoceros Horn Drink). Although these do not promote urination, the heat cannot cause harm. One should reflect on what predecessors said: only in cases of severe heat should one promote urination. In cases of mild heat, one dares not promote urination, lest it damage qi. How can those who recklessly use purgative methods fail to be cautious?

Because latent heat from chuangzhen resides in the stomach, there is obstruction in the middle jiao. Upward, heart fire fails to descend, resulting in dark urine; downward, yin qi fails to ascend, resulting in abdominal distension and fullness. Dong Shi Zi Cao San (Dong's Arnebia Powder) expels the toxin, dissipates stomach heat, and allows the condition to resolve like melting ice. Analyzing its ingredients: Zi Cao (Arnebiae Radix seu Rhizoma) disperses and vents; Huang Qin (Scutellariae Radix) alleviates pain, resolves toxicity, and generates flesh; Zhi Ke (Aurantii Fructus Immaturus) treats abdominal distension, preventing constipation of the large intestine, allowing qi to flow freely to reduce distension; Mu Tong (Akebiae Caulis) guides heart heat out and promotes urination; Gan Cao (Glycyrrhizae Radix et Rhizoma) harmonizes. Ancient physicians' use of herbs must have profound principles; how can one not deduce them by reasoning?

Aromatic and flavorful foods, while beneficial, can harm if overused. Moreover, potent, toxic, and fierce medicines, used after purgation, should certainly not be followed by promoting urination, as the five zang organs cannot withstand further injury. Generally, before chuangzhen erupts, purgatives may have been used previously. Now that chuangzhen has just erupted, there is no longer stagnant heat-toxin internally, or if present, it is mild. Thus, it is said that after prior purgation, if only heat remains, one need only resolve toxicity, and the heat will likely subside. Broadly speaking, chuangzhen cases that have not undergone purgation may still involve internal deficiency, requiring qi-balancing and nourishing care. How much more so for cases where chuangzhen erupts after purgation; applying purgation again would result in double deficiency.