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。
痘疹已经发出，热毒停留在体表，此时不可使用疏利法；疏利法是在痘疹未发出之前使用的。疏法能发散热气，利法能滑利肌肤孔窍，使热毒得以发泄而不被壅滞遏制，这样痘疹就会轻微且容易发出。等到痘疹已经发出，就不可再用疏利法，只宜用平和调气的药物调理服用，又何必让人使用取转法呢？况且疏利与取转，相差甚远。疏利法是用轻清凉性的药物，疏散邪气使其容易发出，如黄连散、青黛散、当归散等，若患者烦躁且卧睡不安，可频繁煎煮豆汤，慢慢服用；取转法，是用峻猛快速的药物进行攻下，如巴豆、芒硝、轻粉、水银之类。疏利与取转在药力轻重上截然不同，不可相提并论。古人所说的疏利，现在却被当作取转来用，这难道不是错误吗？
小儿先天禀赋，有虚有实，病证有寒有温，所以高明的医生会根据具体情况治疗，各得其所。如今看董汲的《指迷方论》，对于禀赋厚实的人，或者患热病而又失于解表疏利的，体内有蕴积热毒的，治法应当采用利法，利之没有不痊愈的。这是因为小儿禀赋已厚，又有热病而失于解表疏利，蕴热在体内，则适宜用利法，利之没有不痊愈的。这是董汲在《指迷》中用药的意图，都是在热毒尚未透出体表，毒邪蕴结在体内时使用。如果不是钱乙的方子与《活人书》的用药意图。钱乙论述痘疹倒靥（痘疹内陷），认为要使脾强胜肾，身体温暖且口渴，阳气恢复的，可以存活。《活人书》说：身体发热但耳朵和臀部发冷，轻易使用利药会致死。这两人的观点，认为身热是疮疹毒邪在体表，气虚在体内，所以不可用利法，只用温和平正的解毒药即可。因此知道伤寒身热如果过早攻下，毒邪入里形成结胸；疮疹则是热在体表，过早攻下会导致黑靥（痘色变黑）、陷伏（痘疹内陷）。这四个人的理论，都不可废弃，使用时要掌握得当。后世的医生应当用董汲《指迷方》治疗疮疹未出时，预先截断热毒；如果已经发出的，解除残留的热毒，就没有不痊愈的。以钱乙、朱氏的意思，治疗正在发作的疮疹，使外邪不至于太过，内陷不至于陷伏，也没有不痊愈的。大抵治病都应当根据情况适当使用，这是最重要的法则。譬如小儿患有伤生冷病的，有伏热的，有受惊的，有感风寒的，有伤食的，临症时要分别对待，岂可拘泥于某一种片面之见？何况学习医术的人，又是根据方剂来使用的。在我看来，愚昧的人只是互相看到对方的偏颇，仔细审察这四种说法，都是可用的。
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.