《活人书》云∶小儿疮疹，与伤寒相类，头痛身热，足冷脉数。疑似之间，只与升麻解肌
，兼治疮子，已发未发皆可服，但不可下，疮疹发热在表，尤不可转泻。世人不学，乃云初觉以
药利之，宜其毒也，误矣。又云∶疹痘已出，不可疏转。出得已定，或脓血大甚，却用疏利，亦
非也。大抵疮疹，首尾不可下。小儿身热，耳尻冷，咳嗽，而用利药，即毒瓦斯入内，杀人！钱氏
曰∶疮疹始出之时，五脏诃见，惟肾无候，但见平证耳，尻冷耳凉是也。论疮疹，尻耳俱属肾，
其居北方，主冷也。若疮黑陷，耳尻反热者，为逆是也，若用牛李膏、百祥丸各三服不愈者，
死。病此疮疹，当乳母慎口，不可令饥，受风冷，必归于肾，变黑难治也。有大热，利小便，有
小热，宜解毒。若黑紫干陷者，百祥丸下之，不黑者，慎勿下。更时月轻重，故春夏为顺，秋冬
为逆，冬月肾旺，又盛寒，病多归肾。变黑者，无问何时，十难救一。又曰∶疮疹始出，未有他
证，不可下也，但当用平和之药，频用乳食，不受风冷耳。如疮疹三日不出，出
不快者，即微发之。微发不出，即加药发之。加药不出，即大发之。出后不多，若反脉平无证
者，即疮疹稀少，不可更发也。肾旺发薄，土不克水，故脾虚寒战，则难治矣。所以百祥丸者，
泻膀胱之腑，腑若不实，脏自不盛也。何以不泻肾？曰∶肾主虚，不受泻，故二服不效，反加寒
而死矣。守真云∶小儿疮疹未出，误以热药汗之致阳气转甚，则重密出不快，多致黑陷而死。恐
是斑疹，未敢服药，以误小儿诸病多矣。亦不知古人留寒凉之药，通治惊风热积。设是斑疹，使
热稍退而稀少出快，得痊除愈也，若用凉膈散，为妙耳。《阎孝忠集·小儿论》未达钱氏本意
，不明造化之理，反妄言黑陷为寒，及云斑疮始终不可服凉泻之药。后人因之，反致热甚黑陷而
死者。阎公岂不详钱氏本方，治斑疮黑陷者牛李丸、百祥丸，寒药利之，而多获痊可，不救必死，
为热岂不明哉！夫斑疮黑陷者，无不腹满喘急，而小便赤而不通，岂非热极者也，岂反能为寒耶
！《素问》云∶诸痛痒疮疡，皆属于火。
《活人书》说：小儿的疮疹（天花、麻疹等出疹性疾病），与伤寒相似，表现为头痛、身体发热、脚部发冷、脉搏快速。在疑似难辨的情况下，只给予升麻葛根汤来解肌发表，同时治疗疮疹，无论疹子是否发出都可以服用，但绝对不可使用泻下法。因为疮疹发热属于表证，尤其不能通过泻下导致邪气内陷。世人不学习医理，声称初起时用药通利大便，这是错误的，会导致毒邪滞留。又说：疹痘已经发出后，不可再用疏利通便的方法。如果疹子已经透发完全，或者脓血症状非常严重，却仍然使用疏利药物，这也是不对的。大抵来说，疮疹从头到尾都不可使用泻下法。小儿身体发热，耳朵和尾骶部发冷，咳嗽，如果使用泻利药物，就会导致毒瓦斯内陷攻心，危及生命！钱乙说：疮疹刚开始发出的时候，五脏对应的征象大多显现，只有肾脏没有特定的候象，只看到平证的迹象，比如尾骶部和耳朵发凉就是这种情况。论述疮疹时，尾骶和耳朵都属于肾，肾位居北方，主寒。如果疮疹颜色变黑且内陷，耳朵和尾骶反而发热，这就是逆证（预后不良）。如果使用牛李膏、百祥丸各服用三次仍不痊愈的，就会死亡。患这种疮疹时，应当让乳母注意饮食禁忌，不要让婴儿饥饿，避免受风冷侵袭，否则病邪必归于肾，导致疮色变黑而难以治疗。如果有大热，应利小便；如果有小热，宜用解毒药。如果疮色黑紫干枯内陷，用百祥丸泻下；如果不黑，千万不要泻下。还要根据季节判断轻重，所以春夏为顺证，秋冬为逆证。冬季肾气旺盛，又逢盛寒，病情多归于肾。变成黑色的，无论何时发生，十个人里难得救活一个。又说：疮疹刚发出，没有其他兼证时，不可泻下，只应当用平和的药物，频繁喂奶进食，避免受风冷即可。如果疮疹三天不出，或者出得不顺畅，就轻微发汗。轻微发汗仍不出，就增加药量发汗。增加药量仍不出，就大力发汗。发出后数量不多，如果反而脉象平和没有病症，说明疮疹稀少，不可再强行发汗。肾气旺则发疹稀薄，土不能克水，所以脾虚寒战，就难以治疗了。之所以用百祥丸，是因为它能泻膀胱之腑，腑气不实，脏气自然就不盛了。为什么不泻肾？回答说：肾主虚，不耐受泻法，所以如果两服无效，反而因加用寒凉药而导致死亡。刘完素说：小儿疮疹未发出时，误用热药发汗，导致阳气转盛，则疹点重密而出不畅，多导致黑陷而死。恐怕是斑疹，不敢服药，以免误治小儿，这样的错误太多了。也不知道古人保留寒凉药物，通用治疗惊风和热积。如果是斑疹，使热势稍退而疹点稀少且出得顺畅，就能痊愈。如果用凉膈散，就非常妙了。《阎孝忠集·小儿论》没有领会钱乙的本意，不明白造化之理，反而妄言黑陷是寒证，以及说斑疮从头到尾不可服用凉泻药物。后人因此跟随，反而导致热势极盛、黑陷而死的情况。阎公难道没有详细查看钱乙的原方吗？治疗斑疮黑陷用的是牛李丸、百祥丸，用寒药利之，却大多获得痊愈，救不活的必定是死证，这难道不是明确表明是热证吗！凡是斑疮黑陷的，无不腹部胀满、气喘急促，而且小便赤红不通，这难道不是热极的表现吗？怎么反而是寒证呢！《素问》说：各种疼痛、瘙痒、疮疡，都属于火。
The *Huoren Shu* (Book of Living People) states: Infantile exanthems (exanthematous diseases such as smallpox and measles) resemble Shaoyang disease (diseases affecting the Shaoyang channel). The symptoms include headache, feverish body, cold feet, and a rapid pulse. In cases of doubt, only Shengma Ge Gen Tang (Pueraria and Cimicifuga Decoction) should be administered to release the muscle layer and resolve the exterior, treating the exanthems simultaneously. It can be taken whether the eruption has appeared or not, but purgation must never be used. Since the fever associated with exanthems is at the exterior level, it is especially inadvisable to use purgatives that might drive pathogens inward. Unlearned people in the world claim that one should use laxatives at the initial stage; this is erroneous and leads to the retention of toxicity. It is also stated: Once rashes and pox have erupted, they should not be treated with draining or purging methods. If the eruption is complete, or if there is excessive pus and blood, yet draining methods are still employed, this is also incorrect. Generally speaking, exanthems should never be treated with purgatives from beginning to end. If an infant has a feverish body, cold ears and sacrum, and coughing, using purgative drugs will cause toxic heat to sink inward, which can be fatal. Qian Yi stated: At the initial stage of exanthem eruption, signs corresponding to the five Zang organs mostly appear, except for the Kidney, which shows no specific sign but rather appears as a normal condition, such as coldness in the sacrum and ears. Regarding exanthems, both the sacrum and ears belong to the Kidney. The Kidney resides in the North and governs cold. If the exanthems turn black and sink inward, while the ears and sacrum become hot instead, this indicates a counter-indication (adverse prognosis). If Niu Li Gao (Ox Plum Paste) and Baixiang Wan (Hundred Fragrance Pill) are administered three times each without improvement, death will ensue. For infants suffering from these exanthems, the nursing mother must observe dietary restrictions. The infant should not be allowed to go hungry nor exposed to wind-cold; otherwise, the pathogen will inevitably return to the Kidney, causing the lesions to turn black and becoming difficult to treat. If there is high fever, promote urination; if there is mild fever, use detoxifying herbs. If the lesions are black, purple, dry, and sunken, use Baixiang Wan to purge; if they are not black, do not purge under any circumstances. Severity also depends on the season; thus, spring and summer are favorable (shun), while autumn and winter are unfavorable (ni). In winter, Kidney Qi is prosperous, and severe cold prevails, so diseases often relate to the Kidney. Cases turning black are rarely curable regardless of the time, with fewer than one in ten surviving. It is further stated: When exanthems first erupt without other complications, purgation is contraindicated. One should only use mild and harmonizing medicines, frequently provide breast milk and food, and avoid exposure to wind-cold. If exanthems do not appear after three days, or appear slowly, induce slight sweating. If slight sweating fails to produce eruption, increase the dosage to induce sweating. If increased dosage fails, induce strong sweating. If the eruption is sparse after appearing, and the pulse is calm without other symptoms, it indicates few eruptions, and forcing further sweating is contraindicated. Prosperous Kidney Qi leads to thin eruptions; when Earth fails to control Water, Spleen deficiency with chills becomes difficult to treat. Baixiang Wan is used because it drains the Bladder Fu organ. If the Fu organ is not full/excess, the Zang organ naturally will not be hyperactive. Why not drain the Kidney? The answer is: The Kidney governs deficiency and cannot tolerate draining. Thus, if two doses are ineffective, adding cold medicines may lead to death due to cold injury. Liu Wansu stated: If infantile exanthems have not yet erupted and hot medicines are mistakenly used to induce sweating, Yang Qi becomes excessively vigorous, leading to dense eruptions that fail to emerge properly, often resulting in black sinking and death. Perhaps suspecting macules and rashes, one refrains from medication to avoid mistreating various pediatric illnesses, which causes many errors. One should also know that ancients preserved cold-natured medicines to universally treat convulsions and heat accumulation. If it is indeed macules and rashes, allowing the heat to subside slightly so that eruptions are sparse and emerge smoothly can lead to recovery. Using Liangge San (Cool the Diaphragm Powder) would be excellent. *Yan Xiaozhong Ji · Xiao'er Lun* (Collection of Yan Xiaozhong · Discussion on Children) failed to grasp Qian Yi's original intent and did not understand the principles of creation. Instead, it rashly claimed that black sinking is caused by cold, and stated that macules and sores should never be treated with cold-draining medicines throughout the course. Later generations followed this error, resulting in deaths due to extreme heat and black sinking. Did Mr. Yan not carefully examine Qian Yi's original prescriptions? To treat black sinking of macules and sores, he used Niuli Wan and Baixiang Wan, employing cold medicines to drain, yet achieving many recoveries. Those who could not be saved were destined to die. Does this not clearly indicate a heat syndrome? All cases of black sinking in macules and sores present with abdominal distension, panting, and dark, obstructed urination. Is this not the manifestation of extreme heat? How could it be cold? The *Suwen* (Basic Questions) states: All pain, itching, sores, and ulcers belong to Fire.