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Qian Yi stated: For treating chuangzhen (pediatric exanthematous diseases), only mild and neutral medicines should be used; one must not recklessly administer purgatives, nor indiscriminately use attacking or diaphoretic methods. The *Huoren Shu* (Book of Living People) states: Pediatric chuangzhen resembles shanghan (cold damage syndrome); symptoms include headache, body heat, cold feet, and a rapid pulse. In cases of ambiguity, only Shengma Tang (Cimicifugae Decoction) should be given to release the muscle layer and treat the rash; it can be taken whether the rash has erupted or not, but laxative or slippery-purgative drugs must absolutely be avoided. This is the greatest taboo. Body heat caused by shanghan should indeed not be treated with purgation; furthermore, fever from chuangzhen located in the exterior level especially must not be treated with bowel-regulating purgatives. Unlearned people in the world claim that using medicine to induce defecation at the onset is to promote the discharge of toxins, which is erroneous. (Zhang Yuansu stated: Although this theory is correct when applied to pathogenic factors in the meridians, if heat is extreme causing cold feet, or if internal food injury causes abdominal heat with cold feet, cold medicines such as Xixin San (Heart-Washing Powder), Tiaowei Chengqi Tang (Regulate the Stomach and Commanding Qi Decoction), and formulas for resolving food stagnation and clearing the diaphragm should be primarily used. However, one must investigate whether the zang-fu organs are stagnant and examine the pulse condition. Xu Shui stated: Upper heat and lower cold indicate food injury. Rash onset with heat and cold hands/feet differs from shanghan where the whole body is hot without cold feet; this is food injury, not cold injury, so it is not suitable for cold-injury treatments. Wang Defu treated it with Yinggan Wan (Induction Pill).) Once douchuang (smallpox) has erupted, purgatives must not be used. If the eruption is complete and pus/blood is excessive, using laxatives is also incorrect. (Zhang Yuansu stated: This statement applies correctly to pathogenic factors in the meridians with incomplete eruption; however, if there is greasy stagnation in the abdomen/stomach, tenesmus resembling dysentery during defecation, or a slippery pulse indicating interior pathology, mild purgation is appropriate.) Generally, chuangzhen should not be treated with purgatives from beginning to end. (Zhang Yuansu stated: If the zang-fu organs have stagnation, one cannot rigidly adhere to this rule.) If a child has cold ears, buttocks, and cough, and laxatives are immediately administered, it harms the patient. (Zhang Yuansu stated: This refers to a harmonious interior with heat in the Shaoyang meridian; thus, Huadu Xijiao Tang (Detoxifying Rhinoceros Horn Decoction) is used because qi is moving outward. If qi has not fully emerged and the interior is not yet harmonized, seeking mild purgation may also be considered.) When treating rashes and smallpox, any initial diarrhea causes pathogenic factors to sink inward; one must never lightly use purgatives. Only when urination and defecation have been blocked for many days should mild promotion of flow be used. After smallpox pustules have crusted, if residual heat remains, manifesting as fever, sores, or abscesses, Sishun Yin (Four Compliance Drink) should be used to purge. This not only eliminates residual toxins but also prevents other syndromes; repeated trials have verified its efficacy. I often see patients taking Mahuang (Ephedra) to induce sweating for rash/smallpox treatment; this exhausts yang qi to the surface, leading to visceral deficiency. Deficiency causes abdominal pain and spontaneous diarrhea, chills, or yin epilepsy, resulting in many deaths. When chuangzhen signs appear and spots form, if there are no exterior-interior, cold-heat, or deficiency-excess patterns, one should simply nurture the patient and allow nature to take its course. This prevents other syndromes and facilitates regulation. Modern practitioners, upon seeing spots, ignore the severity of internal toxin accumulation and fear non-eruption; they use drugs to force eruption, administering Zicao (Arnebiae Radix et Rhizoma), Chantui (Cicadae Periostracum), human teeth, monkey pears, wine qu, and Yuanxu (Coriandri Fructus), trying everything. They fail to realize that when toxins encounter eruptive drugs, potency increases tenfold; multiple sores merge into one called "lan" (rotting), affecting the five viscera and seven orifices. Severe cases are incurable; mild cases result in hoarseness, eye diseases, skin ulceration, ear blockage, and nasal obstruction. Overuse of diaphoretics often leads to collapse due to lack of interior yang support; this is the fault of reckless diaphoresis. Generally, once chuangzhen erupts, stomach qi is needed to transport and resolve toxins. The best method to clear heat is promoting urination; clear urine allows heart fire to drain, reducing heat even without cold medicines. For mild heat, simply resolve the heat; unresolved mild heat generates severe heat. Since diuresis may damage qi, one should only clear heat. Daoshi San (Guide Out Red Powder) is superior for promoting urination. Detoxifying agents like Dai Mao Tang (Trionyx Decoction), Dusheng San (Sole Victory Powder), Angong San (Peace Palace Powder), Rusheng San (Like Sage Powder), Zicao Tang (Arnebia Decoction), and Xijiao Yin (Rhinoceros Horn Drink) are all selectable. Ignorant people claim chuangzhen is heat and frequently administer cooling agents, worsening stomach qi deficiency, causing chest fullness and abdominal distension, then resort to purgation. Internal deficiency allows toxins to enter, killing rapidly; this is the fault of improper purgation. Nasal congestion and dry lips indicate latent internal heat. Fine pulse, sallow or green complexion, flaccid skin, and spitting of blue saliva indicate misdiagnosis from prior purgation. If there is no internal heat accumulation, how can purgation be justified? In summary, treat heat with warm medicines taken coolly, avoiding excessive cold. Treat cold with warm medicines, avoiding excessive heat. Proceed gradually. Li Dongyuan stated: Generally, chuangzhen should not be purged from start to finish, lest movement cause complications. This refers to Shaoyang meridian patency favoring harmonization. First, stabilize the interior and detoxify; second, mildly erupt. Detoxification requires stabilizing the five viscera; Fangfeng Tang (Saposhnikoviae Decoction) serves this purpose. If stool is not constipated, mild eruption is needed, selecting from Qian Yi's formulas. If stool is severely constipated, mild purgation is indicated; Danggui Wan (Angelica Pill) and Zaobian Baixiang Wan (Date-Transformed Baixiang Pill) are appropriate. At early rash/smallpox onset, forcing simultaneous eruption overwhelms the child, causing other syndromes. "Start and end no purgation": Start refers to Upper Jiao, End to Lower Jiao. If vomiting/diarrhea occur, do not purge; stabilize the interior first. If no vomiting/diarrhea, give interior-stabilizing medicine 3-5 doses. If appetite is good but stool is constipated and interior excess exists, mild purgation is suitable. If interior deficiency with diarrhea exists, use interior-stabilizing medicine 1-2 doses, finishing with a mild eruptive agent. Generally, more interior-stabilizing than exterior-releasing medicine; mild unblocking prevents pathogenic congestion, allowing sequential eruption for better tolerance. Warm body indicates favorable prognosis; cold body indicates unfavorable. Both benefit from frequent Fangfeng Tang administration. (Fangfeng Tang formula seen in General Principles chapter.) Zhang Yuansu stated: If within five days, various symptoms and rash cannot be distinguished, do not doubt it is rash; eruption is necessary, but treat according to specific pathogenic injuries. Allowing natural eruption avoids complications; forced eruption yields countless variations. Predecessors said "start and end no purgation" because before eruption, purgation traps pathogens; this is exterior pattern without interior involvement, forbidding early purgation. Late purgation is forbidden because toxins are external with no root, stool is loose, and no interior signs exist; purgation causes qi reversal and sinking. Also, warming covers and preventing drafts apply when rash is un-erupted, or body is cool/chills present, or weather is cold. If erupted, body hot, weather warm, why cover and prevent ventilation? Later generations rigidly applied these two rules, fearing purgation and enforcing warmth/no-ventilation, ignoring seasonal and physiological changes, causing much harm. Predecessors' words adapted to times; later generations failed to adapt, remaining rigid. Alas! "Start and end no purgation" assumes no initial visceral stagnation; if interior signs or constipation exist, purgation is necessary. Warming/no-ventilation applies to winter eruptions; summer eruptions do not require this. Rash/smallpox medication primarily relies on pulse diagnosis: floating, middle, deep palpation to assess deficiency/excess and determine interior-exterior status ensures safety. [Wan Quan] Current smallpox practitioners say "start and end no sweating or purging," and followers agree "smallpox favors warming tonification, sweating/purging are contraindicated." This is the legacy of preferring tonification over attack. Little do they know that resolving toxins is paramount in smallpox treatment; whether attacking or tonifying, the goal is toxin resolution. If qi-blood is harmonious, ying-wei circulates freely, and no exterior-interior pathogens exist, eruption will be complete, development thorough, and recovery timely; neither sweating/purging nor warming tonification is needed. If external wind-cold constrains skin and closes pores, slowing eruption, sweating is required to harmonize yin-yang and ying-wei, facilitating eruption and toxin release. Without sweating, toxins remain trapped internally, akin to locking the door and keeping the thief inside. If high fever persists, thirst worsens, delirium/coma occurs, and urination/defecation are blocked, toxins accumulate in intestines/stomach mixing with grain qi; urgent purgation is needed to clear viscera and remove filth. Without purgation, toxins ferment internally, inviting disaster. Thus, the essence is: Carefully observe disease mechanisms, assign responsibilities, seek causes for existing signs, investigate origins of absent signs, address excess and deficiency, understand five-element interactions, unblock blood-qii, ensure smooth flow, and achieve harmony. This is the principle.