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After the rash subsides, although there is no obvious emaciation or weakness in the body, frequent high fever, irritability, restlessness, convulsions, palpitations with fright, coma, and mental confusion occur. This is caused by the depletion of Yin fire, allowing residual toxins to enter the Liver and transmit to the Heart. The appropriate treatment is to nourish blood and calm the spirit, using Siwu Tang (Four Substances Decoction) added with Ophiopogonis Radix (Maidong), Ziziphi Spinosae Semen (Suanzaoren), Bambusae Folium (Zhuye), Junci Medulla (Dengxincao), Glycyrrhizae Radix et Rhizoma (Gancao), Acori Tatarinowii Rhizoma (Shichangpu), Gentianae Radix (Longdancao), Alismae Rhizoma (Fuling/Fushen context implies Fushen here for calming), Coptidis Rhizoma (Huanglian). Alternatively, these herbs can be ground into powder, mixed with steamed dough and pig heart blood to form pills, which are also effective.

If fever persists after the rash and sudden convulsions occur, it should not be discussed as acute wind-stroke (Ji Jing Feng). Use Daochi San (Guide Out Redness Powder) added with Ophiopogonis Radix (Maidong), administered with Anshen Wan (Calming Spirit Pill). If urine is clear and long, the condition is easy to treat; if short, it is difficult.

Throat pain, choking on water, thick tongue coating, and dry lips after the rash indicate that toxic heat has flowed into the Heart and Stomach meridians. It is suitable to use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins) added with Forsythiae Fructum (Lianqiao) and Arctii Fructus (Niubangzi).

Dysentery with pus and blood, tenesmus, after the rash indicates toxin entering the Large Intestine. First, use Sanhuang Wan (Three Yellows Pill) to purge, then treat with Huanglian Shaoyao Tang (Coptis and Peony Decoction).

If diarrhea and dysentery occurred during the eruption and were not thoroughly cleared, transforming into intermittent dysentery (Xiuxi Li) after the rash recedes—regardless of red or white stool, tenesmus, occurring day and night without limit—it is residual toxin in the Large Intestine. One must differentiate deficiency and excess. For excess, use Sanhuang Wan to purge; for deficiency, use Xianglian Wan to harmonize. Afterwards, use Huangqin Tang (Scutellaria Decoction) to nourish blood and move qi.

Persistent dysentery after the rash, loss of appetite, slow pulse, and cold limbs indicate Spleen and Stomach Qi deficiency. First, use Lizhong Tang (Regulate the Middle Decoction), followed by Xionggui Liujunzi Tang (Chuanxiong and Angelica Six Gentlemen Decoction).

High fever, thirst, and passage of bright red blood after the rash should be treated with Baitouweng Tang (Pulsatilla Decoction) or herbs such as Scutellariae Radix (Qin), Gardeniae Fructus (Zhi), Anemarrhenae Rhizoma (Zhimu), Fritillariae Bulbus (Beimu), Trichosanthis Radix (Tianguafen), Scrophulariae Radix (Yuanshen), and Humanis Placenta (Renzhonghuang).

If residual heat remains after the rash, severe heat causes bleeding. Use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Siwu Tang added with Artemisiae Scopariae Herba (Yinchen), Akebiae Caulis (Mutong), and Rhinoceros Cornu (Xijiao) to promote urination, allowing heat to descend via urine for recovery.

Whole-body fever persisting day and night after the rash indicates unresolved toxin, with evil fire stagnating between muscles. Prolonged cases lead to scorched hair, withered skin, and emaciated muscles, constituting a bone-steaming consumptive disease (Gu Zheng Lao Zhai). Urgently administer Lushu Feier Wan (Aloe and Child-Nourishing Pill) added with Gentianae Radix (Longdancao), Angelicae Sinensis Radix (Danggui), and Forsythiae Fructum (Lianqiao). Delay leads to slow spleen wind (Man Pi Feng), characterized by eyes half-open during sleep, cold breath from mouth/nose, and cold extremities, an untreatable condition. Qingre Chu Gan Wan (Clear Heat and Remove Malnutrition Pill) may also be used.

Residual heat after the rash causing day-and-night irritability, delirium, and madness can be treated with Dengxin Tang (Juncus Decoction) to deliver Chensha Yiyuan San (Cinnabar and Yuan Formula) or Chensha Wuling San (remove Guizhi and Baizhu) added with Huangqin, Huanglian, and Cortex Lycii (Digupi).

Ear pain, redness, swelling, and suppuration after the rash: grind Alum (Kufan), Chrysalis (Yemingcha), and Carminous Edge (Yanzhibian) each 1 qian, with Moschus (Shexiang) 2 fen. Clean the ear canal with cotton-wrapped stick, then insufficate a small amount of powder. If chronic, take Xijiao Yin (Rhinoceros Horn Drink) to resolve toxicity.

Unceasing fever and thirst after the rash indicate empty irritability. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), remove Banxia, add Puerariae Radix (Gange), Trichosanthis Radix (Tianguafen), and Ophiopogonis Radix (Maidong).

High fever, wheezing, cough, and hemoptysis after the rash indicate toxin lingering in Lung and Stomach. Treat with Huangqin, Gardeniae Fructus (Zhizi), Anemarrhenae Rhizoma (Zhimu), Fritillariae Bulbus (Beimu), Trichosanthis Radix (Tianguafen), Scrophulariae Radix (Yuanshen), and Humanis Placenta (Renzhonghuang).

Recurrence of mild irritability and frequent vomiting after the rash indicates incomplete toxin resolution lingering in Lung and Stomach. Use Huaban Tang (Spot-Resolving Decoction) as main formula; if constipated, add minor amount of Rhei Radix et Rhizoma (Dahuang) for mild purgation.

Loose stools, dry cough, fever, emaciation, and withered skin after the rash indicate malnutrition-consumption (Gan Zhai). Use Sijunzi Tang (Four Gentlemen Decoction) added with Citri Reticulatae Pericarpium (Chenpi), Fritillariae Bulbus (Beimu), Coptidis Rhizoma (Huanglian), Cortex Lycii (Digupi), Artemisiae Annuae Herba (Qinghaozi), Gentianae Radix (Longdancao), and Paeoniae Radix Alba (Shaoyao). If whole-body high fever exists without emaciation, only with convulsions and irritability, heat is in Heart and Liver; alternate Dangui Yangxue Tang (Angelica Blood-Nourishing Decoction) and Huanglian Anshen Wan (Coptis Calming Spirit Pill).

Mild cough after rash: use Qingfei Yin (Lung-Clearing Drink) added with Xiaodu Yin (Detoxification Drink).

Unceasing dry cough due to excessive dispersal leading to Lung Qi deficiency: focus on tonifying Spleen and Lung. Use Sijunzi Tang added with Citri Reticulatae Pericarpium (Chenpi), Fritillariae Bulbus (Beimu), Angelicae Sinensis Radix (Guishen), Paeoniae Radix Alba (Shaoyao), Coicis Semen (Yiren), and Dendrobii Caulis (Shihu). Misuse of cooling/cough-suppressing drugs may cause kyphosis and thin limbs. Chronic cough leading to chest protrusion like turtle back indicates Lung Metal deficiency failing to generate Kidney Water to control Liver Wood, resulting in Wood-Fire attacking Metal. Since Kidney governs marrow, lack of Kidney Qi leads to bone withering and marrow reduction, allowing Wind-Cold to invade marrow, stagnating and causing inability to lift waist/spine. Treat first with Fangfeng San (Saposhnikovia Powder) to expel pathogen, then Bayi Dihuang Wan (Eight-Ingredient Rehmannia Pill) added with Ginseng Radix et Rhizoma (Renshen), Eucommiae Cortex (Duzhong), Achyranthis Bidentatae Radix (Niuxi), Angelicae Sinensis Radix (Danggui), Dendrobii Caulis (Huoshihu), Polygoni Multiflori Radix (Heshouwu), Coicis Semen (Yiren), Soybean (Yheidou), Cuscutae Semen (Tusizi), Lycii Fructus (Gouqizi), Morinda Officinalis Radix (Bajirou), Dioscoreae Hypoglauca Rhizoma (Bixie), Taxilli Herba (Sangjisheng), and Cervi Cornu (Lurong), honey-pilled. Apply Qufeng Zhuangjin Huoxue Gao (Wind-Expelling, Tendon-Strengthening, Blood-Activating Paste) to protrusions. Moxibustion on Feishu (BL13, 1.5 cun lateral to lower border of 3rd thoracic vertebra) and Geshu (BL17, 1.5 cun lateral to lower border of 7th thoracic vertebra).

Severe cough with continuous wheezing, choking on fluids/food, or hemoptysis after rash indicates heat-toxin invading Lung. Take Mendong Qingfei Yin (Asparagus Lung-Clearing Drink) added with Forsythiae Fructum (Lianqiao). If chest protrudes like turtle back, shoulders shrug while wheezing, blood flows from mouth/nose, head shakes, neck sways, complexion varies but looks withered/dark, it is untreatable. However, if asthma results from Lung Qi deficiency obstructed by toxin, without cough/hemoptysis/choking, use Qingfei Yin with doubled Ginseng Radix et Rhizoma (Renshen). Do not rigidly adhere to lung-heat alone and use only clearing/ detoxifying drugs.

Phlegm-cough unceasing with afternoon fever after rash indicates Yin deficiency with uncontrolled flaming fire. Treatment focuses on strengthening Water (Kidney): Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Ophiopogonis Radix (Mendong) and Anemarrhenae Rhizoma (Zhimu).

Red swollen eyes, high fever, and thirst after rash indicate toxin attacking Lung and Stomach. Use Qingwei Jiedu Tang (Stomach-Clearing and Detoxifying Decoction).

Phlegm-cough, oral ulcers, fever, and abdominal fullness after rash: use Qingwei Tang (Stomach-Clearing Decoction) added with Arecae Pericarpium (Dafupi) and Aurantii Fructus (Zhike).

Hoarseness/aphonia, cough/wheezing, persistent fever after rash, chronic non-healing, indicates heat-toxin suppressing Lung Metal. Use Qingjin Jianghuo Tang (Metal-Clearing and Fire-Descending Decoction) added with Phragmitis Rhizoma Juice (Zhuli) and Zingiberis Rhizoma Recens Juice (Jiangzhi).

Unresolved heat-toxin after rash causing carbuncles/furuncles and joint pain: use Qianghuo San (Notopterygii Rhizome Powder) for mild sweating and mild purgation.

Unresolved heat-toxin after rash with high fever, irritability, and generalized sores: first use Gegen Tang (Kudzu Decoction) added with Schizonepetae Herba (Jingjie) to release exterior, then use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction).

Black rash color, black rotten gums, rotting flesh with bleeding, foul breath: roast natural white horse hoof on hot tile until charred externally but raw internally, grind fine, apply to lesion. Or use Sanmiao Gan Fang (Three Wonders Malnutrition Formula) or Ma Ming San (Horse Cry Powder). For tooth decay/nasal perforation unresponsive to other drugs: urgently scrape scale from cow dung on sharp tile, mix with Naringinis Pericarpium Rubrum (Renzhongbai), calcine together, mix with Phellodendri Cortex (Chuanbai), grind fine, insufflate into nose. Ulcerated apertures will heal, gums regenerate. If cheeks swell, perioral area turns cyanotic/black, lips collapse, nose rots, cheek/jaw perforates, prognosis is fatal. Multiple lip/mouth ulcers with hoarseness is called Huhu (Fox Infestation); treat with Huati Wan (Evil-Transforming Pill). If accompanied by irritability and voice loss, prognosis is fatal. Externally apply Wen Ge San (Clam Shell Powder) and Xionghuang San (Realgar Powder); internally use Humanis Placenta (Renzhonghuang), Quisqualis Fructus (Shijunzi), Gentianae Radix (Longdancao), Coptidis Rhizoma (Chuanhuilian), Trogopterori Faeces (Wulingzhi), soaked in steamed dough to form pills, taken with boiling water to clear Stomach fire. Survival is rare. Pregnant women with rash should primarily use Siwu Tang (Four Substances Decoction) added with Atractylodis Macrocephalae Rhizoma (Dongzhu), Scutellariae Radix (Tiaoqin), Perillae Caulis (Sugeng), and Zingiberis Rhizoma Praeparatum (Aiye) to calm fetus and clear heat, facilitating rash eruption. If fetal Qi rebels upward, urgently use Thladianthae Fructus (Ku Tingli) and Aiye decoction with Arecae Semen (Binglang) juice. More of the above herbs is advisable.

Pregnant women with sand-rash: heat-toxin steams the fetus, often injuring the fetus while the mother remains largely unharmed. Rash differs from smallpox: smallpox requires internal solidity, so if fetus falls, mother dies; rash requires internal emptiness, so if fetus is lost, mother survives. Ideally, both mother and child should survive.