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When fever occurs and the rash has not yet appeared, with incessant coughing for dozens or hundreds of times, rapid panting, facial edema, and swollen eyelids, alternating between lying down and getting up, this indicates that fire-toxin is steaming internally, causing the lung lobes to become scorched and dry. It is appropriate to use Renshen Baihu Tang (Ginseng White Tiger Decoction), or remove Ginseng and add Niubangzi (Arctii Fructus) and Boheye (Menthae Haplocalycis Folium) for treatment.

After six or seven days of fever, if it is clearly a rash but does not appear, this is because the skin is dense and the couli (pores and interstices) are tight, or due to closure by wind-cold, or because previous vomiting and diarrhea caused the pathogen to lie latent. Urgently use methods to support the interior and release the exterior using Mahuang Gegen Tang (Ephedra and Pueraria Decoction) added with Chantui (Cicadae Periostracum), or primarily use Mahuang San (Ephedra Powder). Externally apply Huyijiu (Coriander Wine). If there has been persistent constipation, indicating severe toxin accumulation in the interior leading to latent non-appearance, treat primarily with Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction), and externally use pig bile for enema. If the rash still does not appear after this, it is a death sign.

If external contraction of wind-cold causes toxin stagnation preventing eruption, accompanied by panting, distension, and coma, use Gegen Tang (Pueraria Decoction) added with Zisu (Perillae Folium), Chaihu (Bupleuri Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), and Chantui. Alternatively, Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) may be temporarily used, or Baidu San (Toxin-Resolving Powder) with Ren Shen removed and Jingjie and Fangfeng added as the primary formula. Additionally, wash the head, face, hands, and feet with decoction of Fangfeng; rub the body with Zhuma (Ramie Stem) dipped in Huyijiu; or apply hot wine-soaked silk cloth. All these methods are excellent.

If the rash has erupted but retracts, it is forced back by wind-cold. If not treated early, internal attack by toxin will cause death. Urgently use Xiaodu Yin (Toxin-Resolving Drink) combined with Shengma Tang (Cimicifugae Decoction) taken hot, so that the rash re-emerges, ensuring safety.

Incomplete eruption of the rash, with high fever, panting, distension, restlessness, and confusion, indicates internal attack by toxin. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), or treat with Gancao (Glycyrrhizae Radix), Jiegeng, Gange (Puerariae Radix), Jingjie, Qianhu, Zhike (Aurantii Fructus), and Niubangzi, aiming for complete eruption. For few eruptions on the head and face, add more Chuanxiong; for irritability and thirst, use Huanglian Jiedu Tang (Coptis Detoxification Decoction); for vomiting and diarrhea, treat with Huanglian, Chenpi (Citri Reticulatae Pericarpium), Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Gancao, Zhuru (Bambusae Caulis in Taenia), and Shengjiang (Zingiberis Rhizoma Recens).

When red shadows first appear on the skin, strictly avoid wind-cold and raw/cold foods. Violating this causes skin closure and toxin stagnation, turning into whole-body cyanosis, internal toxin attack, irritability, abdominal pain, panting, confusion, itching, and collapse. Failure to erupt leads to immediate peril. Parents and physicians must not ignore this.

Vomiting and diarrhea at the initial stage indicate the release of yang-fire, which is an auspicious sign. Use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) as the primary formula. In cases complicated by food stagnation causing vomiting and diarrhea, add digestive herbs.

It is also said that vomiting and diarrhea during rash eruption require no specific treatment; only detoxification and heat-clearing are needed.

For irritability and delirium at the onset of rash, use Shengma Gegen Tang mixed with Chen Sha Yiyuan San (Cinnabar and Yi Yuan Powder).

For rash color bright red like flames, slightly purple, or excessively dark, use Daqing Tang (Isatidis Decoction) as the primary formula. Black color indicates a death sign; urgently administer finely ground calcined human feces mixed with wine. (Horse, cow, white dog, cat, and pig feces can all be used; cat feces is particularly effective.) If the black color turns red shortly after, it is treatable. Renzhonghu (Human Middle Yellow) can substitute. If eruption is incomplete, dispersal and detoxification are best; continue using Shengma Gegen Tang added with Niubangzi, Jingjie, Fangfeng, Chantui, and Lianqiao, followed by cooling agents to prevent cold-stagnation of toxin, facilitating later recovery.

If high fever persists after eruption, indicating toxin stagnation, use Daqing Tang to resolve the exterior. For constipation, use Huanglian Jiedu Tang combined with Baihu Tang to resolve the interior. For unsmooth bowel movements, use Sishun Yin (Four Harmonizing Drink).

Persistent fever and cough after eruption indicate residual toxin attacking the Lung Metal. Treat primarily with Qingjin Huadu Tang (Clear Metal and Resolve Toxin Decoction). If phlegm is present, use Juhong (Tangerine Peel), Beimu (Fritillariae Bulbus), Jiegeng, Gancao, Huangqin (Scutellariae Radix), Huanglian, Gualouren (Trichosanthis Semen), Lianqiao, Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Niubangzi, and Dengxincao (Junci Medulla). Add Xuanshen (Scrophulariae Radix) for sore throat; add Shigao (Gypsum), Zhuye (Bamboo Leaf), Ziwan (Asternis Radix), Doulou (Stemonae Radix), and Suzi (Perillae Fructus) for panting. Even with panting and high fever, Zhuye Shigao Tang can be used as a base combined with the above herbs, or add Xingren (Pruni Semen) and Houpo (Magnoliae Officinalis Cortex), but avoid Ziwan, Doulou, and Suzi. Shigao should only be used for one or two doses, not excessively, as it is very cold and heavy, directing downwards. Children take 1-2 qian per dose, adults double; roast in winter, use raw in summer. Yang Shi's *Zhizhi* states: Red rashes transform upon encountering cooling; white rashes dissipate upon receiving warmth.

Cough, dry mouth, and irritability during rash eruption indicate unresolved toxin in the Heart and Lung. Use Xiebai San (Drain White Powder) added with Huafen (Trichosanthis Radix), Lianqiao, Xuanshen, and Huanglian to drain Heart fire, or use Huanglian Xingren Tang (Coptis and Apricot Seed Decoction).

Rash in summer with severe heat, irritability, and thirst indicates rash combined with summerheat-toxin. Use Xiangru Yin (Elsholtzia Drink) combined with Gegen Tang. Contraindicated for those with weak yuanqi due to Xiangru's acrid-warm nature.

Fever, vomiting, diarrhea, and dysentery after rash eruption indicate internal pressure by fire-pathogen. Upward flow causes vomiting; downward flow causes diarrhea. Severe toxin causes tenesmus and dysentery. For vomiting, use Zhuye Shigao Tang removing Banxia (Pinelliae Rhizoma); for diarrhea, use Shengma Zexie Tang (Cimicifuga and Alisma Decoction). For pathogens in the middle jiao causing both, use Huangqin Tang (Scutellaria Decoction) added with Chenpi, Huanglian, and Zhuru. For tenesmus, use Huanglian Jiedu Tang combined with Tiansan San (Heavenly Three Powder), or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) added with Huanglian, Shengdi (Rehmanniae Radix), Mutong, Danggui (Angelicae Sinensis Radix), and Zhike, possibly adding Dahuang (Rhei Radix et Rhizoma) for mild purgation.

Unremitting diarrhea or frequent watery stools during rash eruption is a dire prognosis. However, if the rash is dense, excessive, purple, or red, it is acceptable because the toxin is in the Large Intestine; without diarrhea, stagnation cannot resolve. Use Pingwei San (Peace the Stomach Powder) added with Gegen and Lianqiao to resolve it; once the rash fully emerges, diarrhea stops naturally. If diarrhea continues after rash resolution, the toxin is not fully cleared; add Lianqiao, Huanglian, Niubangzi, Mutong, and Zexie to separate and drain. Using Hesou Rou (Arecae Semen Preparatum), Rou Doukou (Myristicae Semen), and Yingjia Ke (Papaveris Pericarpium) will lead to abdominal distension, fullness, panting, and confusion, becoming untreatable.

Persistent fever for three to four days after rash eruption indicates excessive fire-toxin not fully released externally with residual pathogens internally. Use Daqing Tang or Huaban Jiedu Sanwei Xiaodu Yin (Three-Ingredient Toxin-Resolving Drink for Macule Resolution) added with Xuanshen, Jiegeng, and Shigao.

Sore throat and inability to eat during rash eruption indicate fire-toxin stagnating and steaming upward to the throat. Use Ganjie Tang (Licorice and Platycodon Decoction) added with Xuanshen, Niubangzi, Lianqiao, Zhimu, Mendong (Asparagi Radix), Huafen, and Zhuye; or slowly swallow Shegan Shuniuizi Tang (Belamcanda and Arctii Decoction). Do not confuse with Hougan (throat gangrene) or use blind needle pricking.

Whole-body rash resembling brocade patterns is treated primarily with Huaban Tang (Macule-Resolving Decoction). Pale color indicates blood deficiency; treat with Yangxue Yirong Tang (Nourish Blood and Enrich Prosperity Decoction). Black macules indicate ten deaths to one survival; urgently use Daqing Tang.

Brocade-like pattern interspersed with red granules, high fever, irritability, scorched yellow or dry black tongue coating, and constipation indicate simultaneous macules and rash. Use Tiaowei Chengqi Tang (Regulate the Stomach and Order Qi Decoction) to purge, followed by Baihu Tang.

Cold hands and feet during rash eruption indicate spleen heat. Use Xiaodu Yin adding more Shaoyao (Paeoniae Radix Alba) and less Fangfeng for cure.

Mild rashes typically last six shichen (twelve hours). Eruption after Zi hour (yang) resolves in Wu hour (afternoon/yin); eruption after Wu hour (yin) resolves in Zi hour (yang). This follows the principle of yang generating yin and yin transforming yang. Gradual emergence and resolution indicate milder heat.