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Wang Shuangchi in *Yi Lin Tan Yuan* (Exploring the Source of Medicine) stated: Measles is residual toxin retained in the six fu organs, originating from the Foot-Yangming Stomach Meridian, as the stomach is the sea of the six fu organs. Tang Shi said: The macules and papules in children are triggered by epidemic pathogenic qi (seasonal infectious pathogens). When heat cannot be resolved, it accumulates in the stomach. Since the stomach governs muscles, the toxic vapors熏 (smoke/steam) and erupt into the muscles, resembling bites from mosquitoes. This condition differs from "ban" (macules); "ban" resembles brocade patterns with gaps, shaped like cloud heads, whereas "ma" (papules/measles) covers the entire body without gaps, distinguished only by density and severity. I observe that although measles is contracted from epidemic pathogens, it is fundamentally congenital toxin. However, smallpox originates from zang organs and returns to yang, while measles originates from fu organs and returns to yin. The heat floats from the spleen and stomach to the heart, and scorches the lungs from the heart; thus, it often severely damages the lungs. Initial fever resembles symptoms of smallpox and cold damage, such as heavy eyelids, clear nasal discharge, cough, reduced appetite, restlessness, vomiting clear water, yellow-red diarrhea, panting, thirst, rapid breathing, red eyes, and flushed cheeks. These are prodromal signs of measles. Generally, if rash appears after three days of fever, becomes fully erupted after three days, and gradually fades within nine days, this is the norm. If fever or remission lasts five to six days before eruption, and when viewed obliquely, faint spots are visible under the skin, feeling granular upon touch, with pale red moist color, evenly distributed on the head and face, fully erupted and fading within three days, this is a mild case. If the rash appears immediately with fever, or is absent on the head and face, or is dark red tight and dry, or accompanied by sore throat and inability to eat, or if heat transfers to the large intestine causing dysentery, or if suppressed by wind-cold leading to too-rapid disappearance of the rash, these are severe cases. If the color is dark black and dry, disappearing immediately upon appearance, with flaring nostrils, open mouth, spiritless eyes, blue nose, black stool, panting, and sunken chest movement, or post-measles noma (gangrenous stomatitis), these are fatal cases. Generally, measles erupts in the yang aspect; yang implies excessive heat injuring yin. Therefore, treatment should first release the exterior and move qi to dissipate heat, followed by nourishing yin and tonifying blood. Drugs that stir qi and are drying/harsh are contraindicated.

Shi Shi said: For children under three years old, examine the three joints at the tiger's mouth of the left hand (for males) or right hand (for females), called the Three Passes. Purple lines indicate heat, red indicates cold damage, green indicates convulsions, white indicates malnutrition disease (gan syndrome), and yellowish-pale red indicates minor common ailments. The veins should be hidden rather than exposed; black indicates danger. Regarding the position: lower segment Feng Guan (Wind Pass) is mild, middle segment Qi Guan (Qi Pass) is severe, upper segment Ming Guan (Life Pass) is especially severe, and penetrating all three passes is critical.
Sha Zhen (Measles/Rash) (Wu dialect: Sha Zi; Huizhou dialect: Ma Zi; Zhejiang dialect: Zi; Northern dialect: Zhen Dan).

Ye Tianshi said: Sha belongs to pathogenic factors in yang meridians and fu organs. Initial treatment must focus on the exterior. Symptoms include headache, panting, cough, coarse breathing, nausea, and vomiting. Eruption within one or two days is mild; eruption within three to five days is severe. If yang disease persists beyond seven days without clear eruption, pathogens attack inward, causing unceasing panting, abdominal pain, distension, constipation, and oppression, which is dangerous. Treatment should use bitter and acrid herbs to clear heat and cool the diaphragm, avoiding Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma).

Medical texts state: Rash associated with the Foot-Yangming Stomach Meridian is dense like clouds or large like beans but lacks a root base. Rash associated with the Hand-Taiyang Lung Meridian consists only of granules without patches. Use acrid dispersants to resolve the muscle layer. In winter, for no sweat, high fever, and panting, use Mahuang Xingren Gancao Shigao Decoction plus Huagai San and San'ao Tang. In summer, for no sweat, use acrid-cool muscle-resolving herbs such as Gegen (Puerariae Radix), Qianhu (Peucedani Radix), Bohe (Menthae Haplocalycis Herba), Fangfeng (Saposhnikoviae Radix), Xiangru (Elsholtziae Herba), Niubangzi (Arctii Fructus), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix), Mutong (Akebiae Caulis).

Ancients added Gegen for exterior pathogen with thirst because it raises Yangming stomach fluids. For severe heat and thirst, use Shigao (Gypsum Fibrosum) for acrid-cool muscle resolution; it is contraindicated when there is no sweat. For all sores and rashes, acrid-cool is appropriate. Lianqiao (Forsythiae Fructus) is acrid-cool, superior among herbs, capable of ascending and clearing, most beneficial for pediatrics, resolving heat in all six meridians of children.

Spring sha follows wind-warmth; summer follows summer-heat wind, where summer-heat always combines with dampness; autumn follows heat scorching dryness; winter follows wind-cold.

Rash should be purged and drained; diarrhea is a favorable sign. Dysentery with five colors is also acceptable. Only obstruction of urination and defecation indicates many critical cases; treatment strictly forbids stopping diarrhea.

Sha is originally pathogenic invasion of the six qi; wind, cold, summer-heat, and dampness must transform into fire. Once sha erupts externally, people say pathogens have exited. Who knows that during emergence and disappearance, ascent must be followed by descent, victory by recurrence. Often, external sha eruption fails to reduce body heat, leading to hoarseness, gum rot, panting, abdominal distension, diarrhea, anorexia, irritability, and lethargy, resulting in death. These belong to unclear interior conditions causing transformation. One must distinguish which jiao (upper, middle, lower) bears more pathogen, or if other diseases complicate the condition, requiring careful assessment.

Upper jiao drugs should be acrid-cool; middle jiao drugs should be bitter-acrid-cold; lower jiao drugs should be salty-cold. (Xu Huixi said: Methods to clear and wash out internal pathogens should be used.)

Upper jiao drugs: Flavor and aroma should be light, as lung governs qi and skin/hair is the exterior of lung. Exterior pathogens are best treated with acrid dominance; severe interior conditions with bitter dominance. If no thirst and prolonged illness with stagnant pathogens, use bland-draining herbs to vent qi-level pathogens.

Middle jiao drugs: Sha fire is in the middle, transforming via Yangming dryness, abundant in qi and blood. Bitter-cold flavor is appropriate. However, if stomach fluids are consumed over time, bitter herbs aid dryness and consume fluids; sweet-cold herbs should be used.

Lower jiao drugs: Salty-bitter is primary. If heat-toxin sinks downward causing dysentery, salinity for softening hardness is unnecessary; instead, bitterness to firm yin and dry dampness is taken.

Ancients considered sha a disease of meridians and fu organs, contraindicating warm-drying, astringent, and tonifying methods. It is said smallpox prefers warmth, while rash prefers coolness. However, due to weak qi and deficiency, illegal use of dispersing and cooling methods can lead to chronic wasting. Yin injury is common; saving yin requires supporting stomach fluids. Qi deficiency also occurs; urgent qi tonification is needed. Young children have yang constitutions; pure-gang (extremely hot/pungent) drugs are contraindicated. *You Ke Fang Shu Ge Kuo* states: Red rash resolves with coolness; white rash resolves with warmth. This "warmth" refers to later uses of fermented rice wine, Chuanxincao (Tectariae Rhizoma? Note: Text says Zhengmu, likely referring to warming agents), coarse paper, cotton yarn, etc. While knowledge is useful, recent usage is mostly ineffective.

Sha gan (malnutrition with rash) involves dampness excess and heat steaming, causing erosion of mouth, tongue, and throat. Without rapid treatment, cheek perforation, jaw breakage, airway closure, and panting may cause death. Early treatment is essential. External treatment has separate formulas for panting. (De notes: Ice borneol and rhino horn substitute are contraindicated for internal collapse of rash). Herbal decoctions must be light and bland to resolve upper pathology, or clearing/dispersing methods may suffice.

Sha dysentery results from heat-toxin sinking internally combined with cold damage协同 heat. Dysentery stops when pathogens are exhausted. Same method: contraindicate lifting and tonifying/astringing. Mild cases use separation/draining and unblocking; severe cases use bitter-cold detoxification.