前人论疮疹，有大热则当利其小便。盖大热则皮热脉实，大小便皆不利，心热而渴，气
满而喘，能食，不结脓血痂 ，当此里热既盛，惧其生他疾，故利小便。心火有所导引，虽
不用冷药，热亦自减去矣。可待其疮疹至热过，不为冷误，尤为良法。其小热则解毒，盖小
热不解，大热必生，小热而利小便则损气，当此有小热不可利小便，但解热而已，如玳瑁汤
、独胜散、安斑散、如圣散、紫草汤、犀角饮。此虽不利其小便，其热亦不能为害。当思前
人云∶大热者，方利其小便。有小热者，尚不敢利其小便，恐致损气。彼其妄下者，可不慎
乎？
因疮疹伏热在胃，则中有所膈，上则心火不降，故小便赤；下则阴气不能升，故为心腹
胀满。董氏紫草散，发出其毒，胃中热散，自然冰释，详其药味，以紫草发散，以黄 定痛
，解毒生肌，以枳壳治腹胀，令大肠不秘，气通消胀，以木通导心热而利小便，以甘草和之
，古人用药，必有至理焉，可不以意推之。
饮食芳味，虽能益人，用之过亦能害人。况烈毒剽悍之药，又在以下之后，岂可再利
之？此五脏不可再伤故也。盖疮疹未出也，曾先利之，今疮疹始出，则内无壅滞热毒，纵有
亦已轻矣。故云曾经下后，惟有热者但解毒，其热亦庶几矣。大抵疮疹不经下，亦有内虚者
，宜匀气安养之，又况曾下而后疮疹出，若又下之，是重虚也。
前人论述疮疹（天花、麻疹等出疹性疾病）时指出，若出现大热症状，则应当通利小便。因为大热会导致皮肤发热、脉象实大，大小便都不通畅，心中烦热且口渴，气机壅满而喘息，虽然能进食，但无法结痂化脓成疮。此时体内热势已经炽盛，担心因此引发其他疾病，所以采用通利小便的方法。使心火得以疏导引导，即使不使用寒凉药物，热势也会自然减退。可以等待疮疹的热势过去后，避免因误用寒凉药造成损害，这尤为良策。如果是小热症状，则应当解毒。因为小热如果不解除，必然发展为大热；若在仅有小热时就通利小便，则会损伤正气。在此情况下，有小热时不可通利小便，只需清热解毒即可，例如使用玳瑁汤、独胜散、安斑散、如圣散、紫草汤、犀角饮。这些方剂虽然不通利小便，但热势也不能为害。应当思考前人所说：只有在大热时，才通利小便。若有小热，尚且不敢通利小便，恐怕导致损伤正气。那些妄自使用泻下法的人，能不谨慎吗？
由于疮疹的伏热蕴结在胃中，导致中焦气机阻隔，向上则心火不能下降，所以小便颜色深赤；向下则阴气不能上升，所以出现心腹胀满。董氏紫草散，能够透发毒邪，使胃中热邪消散，病情自然像冰融化一样缓解。详细分析其药味：用紫草发散透疹，用黄芩定痛、解毒生肌，用枳壳治疗腹胀，使大肠不秘结，气机通畅从而消除胀满，用木通引导心火之热并通利小便，用甘草调和诸药。古人用药，必有深刻的道理，怎能不用心推究呢？
饮食中的芳香美味，虽然能补益人体，但使用过度也会伤害人体。何况是烈性有毒、剽悍猛烈的药物，又在泻下之后使用，怎么可以再通利小便呢？这是因为五脏不能再受损伤的缘故。大概疮疹未发出之前，曾经先使用过泻下法，现在疮疹刚刚发出，则体内没有壅滞的热毒，即使有也已经轻微了。所以说曾经经过泻下治疗后，如果只有热症，只需清热解毒，热势也就差不多了。大抵疮疹如果没有经过泻下治疗，也有内里虚弱的情况，适宜用匀气安养的方法调理，更何况是已经经过泻下治疗而后疮疹才发出的，如果再次使用泻下法，就是双重虚弱了。
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.