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Qian Yi stated: For the treatment of chuangzhen (exanthematous diseases such as smallpox and measles), only mild and neutral medicines should be used. One must not recklessly administer purgatives, nor indiscriminately use攻伐 (attacking/draining) or diaphoretic methods. The *Huoren Shu* (Book for Living People) states: Pediatric chuangzhen resembles Shanghan (Cold Damage syndrome). Symptoms include headache, feverish body, cold feet, and rapid pulse. In cases of ambiguity, one should only prescribe Shengma Tang (Cimicifugae Decoction) to resolve the muscle layer, which also treats chuangzhen. It can be taken whether the eruption has appeared or not, but laxative or slippery-purging drugs must strictly be avoided; this is a major prohibition. Fever caused by Shanghan should indeed not be treated with purgation; fever caused by chuangzhen is at the exterior level, so using bowel-relaxing methods is even more contraindicated. Unlearned people in the world claim that at the initial stage, one should use drugs to induce defecation to vent the toxin, which is erroneous. (Zhang Yuansu, aka Haizang, said: Although this theory is correct when the pathogen is in the meridians, if heat is extreme causing cold feet, or if internal food injury causes abdominal heat with cold feet, one should use cold-natured medicines such as Xixin San (Heart-Washing Powder), Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction), or formulas for digesting food and opening the diaphragm. However, one must investigate whether the zang-fu organs are stagnant and examine the pulse condition. Xu Shuwei said: Upper heat and lower cold indicate food injury. At the initial fever of chuangzhen, hands and feet are also cold. Only Shanghan presents with whole-body heat, differing from cold feet. This is food injury, not cold injury; if it were cold injury, these methods would be inappropriate. Wang Defu treated it with Yinggan Wan (Induction Pill).) Once痘chuang (smallpox) has erupted, one must not use laxatives. If the eruption is complete and pus/blood are excessive, using relaxing/purging drugs again is also incorrect. (Zhang Yuansu said: This statement applies when the pathogen is in the meridians and the eruption is incomplete. If there is greasy stagnation in the abdomen and stomach, tenesmus resembling dysentery during defecation, and a slippery pulse indicating interior pathology, mild purgation is appropriate.) Generally speaking, chuangzhen should not be purged at either the beginning or the end. (Zhang Yuansu said: If there is stagnation in the zang-fu organs, one should not rigidly adhere to this rule.) If a child has cold ears, buttocks, and cough, and one readily uses purgative drugs, it will harm the patient. (Zhang Yuansu said: This refers to a harmonious interior with Shaoyang meridian heat in the channels; thus, Huadu Xijiao Tang (Toxin-Resolving Rhinoceros Horn Decoction) is used because qi is emerging outward. If qi has not fully emerged and the interior is not yet harmonized, seeking purgation may also be considered.) In treating rashes and smallpox, once diarrhea occurs, it allows pathogens to sink inward; one must never lightly use purgatives. Only if urination and defecation have been blocked for many days should one mildly promote their flow. Also, after痘chuang has crusted, if residual heat remains, manifesting as fever, sores, or abscesses, Sishun Yin (Four-Obedience Drink) should be administered orally. This not only eliminates residual toxins but also prevents other syndromes; repeated trials have verified its efficacy. I often see patients taking diaphoretic Ephedrae Herba (Mahuang) to sweat, causing all yang qi to escape 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 are formed, 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 not only prevents other syndromes but also facilitates regulation. Nowadays, people, upon seeing spots, disregard the severity of internal accumulation, fearing non-eruption, and use dispersing drugs like Zicao (Arnebiae Radix et Rhizoma), Chantui (Cicadae Periostracum), Renchi (Human Teeth), Houli (Monkey Pear), Jiuqu (Medicated Leaven), and Yuansui (Coriandri Fructus), trying everything. They do not know that when toxins encounter dispersing agents, potency increases tenfold; multiple sores merge into one, called "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 dispersing drugs often leads to deficiency collapse due to lack of interior yang support; this is the fault of reckless dispersion. Generally, once chuangzhen erupts, it relies on Stomach qi to transport and detoxify. To clear heat effectively: if heat is severe, promote urination. Since free urination guides Heart fire, heat decreases naturally even without cold medicines. If heat is mild, resolve the heat directly. If minor heat is not resolved, major heat will arise. Promoting urination for minor heat risks damaging qi, so one should only clear heat. For promoting urination, Daochi San (Guide Out Red Powder) is superior. For detoxification, Daimei Tang (Trionyx Decoction), Dusheng San (Single Victory Powder), Angong San (Palace-Anchoring Powder), Rusheng San (Like-Sage Powder), Zicao Tang (Arnebia Decoction), and Xijiao Yin (Rhinoceros Horn Drink) are selectable. Ignorant people merely state that chuangzhen is a heat syndrome and frequently administer cooling agents, worsening Stomach qi deficiency, causing chest fullness and abdominal distension, then using purgatives. Internal deficiency allows toxins to enter, killing quickly; this is the fault of improper purgation. If a child has nasal congestion and dry lips, it indicates latent heat. If the pulse is fine, complexion is sallow or cyanotic, skin is flaccid, and mouth foams green saliva, this is a syndrome caused by mistaken purgation. If there is no internal accumulated heat, how can one purge? In summary, treat heat with warm medicine administered coolly, avoiding excessive cold. Treat cold with warm medicine, avoiding excessive heat. Proceed gradually. Zhang Yuansu said: Generally, chuangzhen should not be purged at the start or end, lest movement cause complications. This refers to Shaoyang connecting to the exterior, requiring harmonization. First, stabilize the interior and detoxify, then mildly disperse. Detoxification requires anchoring the five viscera; Fangfeng Tang (Saposhnikoviae Decoction) serves this purpose. If stool is not constipated, mild dispersion is needed, selecting from Qian’s formulas. If stool is severely constipated, mild purgation is appropriate, using Danggui Wan (Angelica Pill) or Zaobian Baixiang Wan (Date-Transformed Baixiang Pill). At the onset of rash/smallpox, forcing simultaneous eruption overwhelms the child, causing other syndromes. "Start and end cannot be purged" means: Start refers to Upper Jiao, End refers to Lower Jiao. If vomiting and diarrhea have occurred, purging is inadvisable; 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 is excess, promote drainage. If interior is deficient with diarrhea, use interior-stabilizing medicine 1-2 doses, finishing with a mild dispersing agent. Overall, interior-stabilizing herbs should outnumber exterior-dispersing ones. Constipation requires mild unblocking to prevent pathogen aggregation, allowing sequential eruption for easier tolerance. Warm body indicates favorable prognosis; cold body indicates unfavorable. Both cases benefit from frequent Fangfeng Tang administration. (See Fangfeng Tang formula in General Principles.) Zhang Yuansu said: If within five days, symptoms cannot distinguish between various diseases and rash, do not doubt it is rash; dispersion is necessary, but treat according to the specific pathogen. Dispersion does not hinder eruption. Forced dispersion yields countless complications. Predecessors said "start and end cannot be purged" because before rash appears on the surface, purging prevents pathogen expansion. This is a superficial pattern without interior involvement, hence prohibiting early purging. Late purging is prohibited because toxins are external, lacking internal roots, stool is loose, and there are no interior signs; purging causes qi to reverse and sink. Regarding warming and covering to prevent drafts: this applies when rash is un-erupted, or body is cool with aversion to cold, or weather is cold. If erupted, body is hot, and weather is warm, covering and preventing ventilation is unnecessary. Later generations rigidly adhered to these two sentences, fearing purging at start/end and maintaining warmth/ventilation prevention, ignoring seasonal and physiological variations, causing much error. Predecessors' words adapted to times; later generations failed to understand this adaptability, remaining rigid. Alas! "Start and end cannot be purged" assumes no initial internal stagnation. If interior signs or constipation exist, purging is mandatory. Warming/preventing draft applies to winter eruptions; summer eruptions do not require this. Treatment of rash/smallpox primarily relies on pulse diagnosis. Assess floating, middle, and deep pulses via light, medium, and heavy pressure to determine deficiency/excess and interior/exterior location, ensuring safety. [Wan Quan] Current smallpox practitioners claim "start and end cannot be sweated or purged," and followers agree that smallpox requires warming tonification, rejecting sweating and purging. This is the legacy of preferring tonification over attack. Little do they know that the essence of smallpox treatment is detoxification. Whether attacking or tonifying, the goal is resolving toxins. If qi and blood are harmonious, Ying-Wei circulates freely, and there is no exterior-interior pathogen, eruption will be complete, penetration thorough, and resolution timely. In such cases, neither sweating/purging nor warming tonification is needed. If external Wind-Cold constrains skin and closes pores, hindering eruption, sweating is indicated to harmonize Yin-Yang and circulate Ying-Wei, facilitating eruption and toxin release. Without sweating, toxins remain trapped internally, akin to "locking the door and inviting the thief." If high fever persists, irritability and thirst increase, delirium and coma occur, and urination/defecation are blocked, toxins are accumulated in the intestines/stomach, combing with grain qi. Urgent purging is required to unblock viscera and remove waste. Without purging, filth and toxins accumulate and simmer internally, risking "nurturing the tiger and leaving trouble." Thus, the principle states: Carefully observe the disease mechanism, assign responsibilities accordingly, seek causes for existing symptoms, investigate origins of absent ones, address excess and deficiency, understand Five Phases interactions, unblock qi and blood, ensure smooth flow, and achieve harmony. This is the meaning.