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Outside of variola (smallpox) there is exanthema, and outside of exanthema there is measles. Measles is also a type of exanthema, namely maculopapular rash. However, typical exanthema erupts all at once after fever reaches the fifth or sixth day, appearing as granular pustules, unlike measles which presents as red patches on the skin. Moreover, the eruption of measles is not confined to the third or fourth day; when illuminated by fire, the whole body appears like it has been daubed with cinnabar, which is a sign that it is about to erupt. When it does erupt, it is fine and scattered, with red patches on the skin, resembling marks left by mosquito or flea bites; this is measles. (De notes: This refers to measles as an epidemic sha syndrome, not typical sha eruption.) Some may erupt only on the sixth day, disappearing and reappearing, lasting about a week. Secular belief holds that after three eruptions in one day and nine in three days, it finally erupts thoroughly. However, some do not follow this pattern; within three days, from the face to the chest, back, hands, and feet, although they appear and disappear quickly, as long as they are fully erupted, a rosy complexion over the whole body is considered auspicious. In severe cases, the whole body swells, eyes are closed, and colors vary between red, white, and slightly yellow; as long as it is rosy and vibrant, it is good. The most undesirable signs are black depression, density on the face, eyes, chest, and abdomen, and involvement of the throat, which indicate adverse prognosis. If it fails to erupt and causes panting, death ensues. The term "measles" implies that the whole body is covered with fine spots like hemp seeds, leaving no empty space. However, there are cases where the whole body is merely red without any spots, called dantou (scarlet fever-like rash), which is also of the same category. Therefore, in variola medicine, there are syndromes involving combined maculae, exanthema, and dantou, all caused by heat-toxin, and must be carefully differentiated.

At the onset of measles, with yawning, fever, aversion to cold, cough, sneezing, and runny nose, Shengma Gegen Tang (Bupleurum and Pueraria Decoction) plus Perilla Leaf and Scallion White should be used to release the muscle layer; profuse sweating must be strictly avoided. If tidal fever is severe, add Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Digupi (Groundcherry Bark). For delirium, Chen Sha Yi Yuan San (Cinnabar and Yiyuan Powder) should be regulated. For cough, add Huanglian, Xingren (Apricot Kernel), Maimendong (Ophiopogon Tuber), and Shigao (Gypsum). For severe cough and high fever, Liangge San (Cool the Diaphragm Powder) plus Jiegeng (Platycodon Root) and Digupi is used. For diarrhea, Siling San (Four-Poria Powder) is appropriate. For blood in stool, combine Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction). (De notes: Rhino horn and Antelope horn are strictly contraindicated at the onset of measles; Gegen Qinlian Tang can be used with Faba Flower and Camellia Flower instead.) For hematemesis and epistaxis, use Xijiao Dihuang Tang plus Zhizi (Gardenia Fruit). For dark urine, add Mutong (Akebia Stem). (De notes: If constipation is present, Sanhuang Xiexin Tang can be used with Shengdi (Rehmannia Root) and Zhidan (Gardenia processed with alum).) For chills and fever resembling malaria, use Xiaochaihu Tang (Minor Bupleurum Decoction).

After measles have erupted, for irritability and thirst, use Jiedu Tang (Detoxification Decoction) combined with Baihu Tang (White Tiger Decoction). For panting with constipation, use Qianhu Zhike Tang (Peucedanum and Aurantium Decoction) plus Wuweizi (Schisandra Berry). (De notes: Wuweizi is too astringent; Xingren, Houpo (Magnolia Bark), Suzi (Perilla Seed), and Sangbaipi (Mulberry Bark) can be used instead.) For severe constipation, use Xiao Chengqi Tang (Minor Order the Qi Decoction). For delirium with urinary retention, use Daochi San (Guide Out Redness Powder). For urine resembling rice water, use Siling San plus Cheqianzi (Plantago Seed) and Mutong. For delirium resembling madness, use Jiedu Tang mixed with Chen Sha Yi Yuan San. For bleeding from both bowels and bladder, combine Xijiao Dihuang Tang with Jiedu Tang. For hematemesis and epistaxis, use Jiedu Tang plus fried Zhizi and Tongbian (Child's Urine). For diarrhea, use Jiedu Tang or Siling San. For panting accompanied by diarrhea and dark, painful urination, use Chailing Tang (Bupleurum and Poria Decoction). For irritability, heat, extreme thirst, and diarrhea, use Baihu Tang plus Cangzhu (Atractylodes Rhizome) and Zhuling (Polyporus). For high fever with dry retching, use Jiedu Tang. For vomiting due to food stagnation, use Sijunzi Tang (Four Gentlemen Decoction). For vomiting in summer due to heat, use Siling San plus Renshen (Ginseng Root).

The initial stage of measles and all miscellaneous syndromes after eruption or resolution are largely similar to those of variola, but medications should always be cooling in nature. Although it is said that measles prefers cooling and variola prefers warming, this is not an immutable rule. Rather, tonify deficiency, drain excess, warm cold, and cool heat; this is the profound art of medicine. Thus, treating measles may involve Siwu Tang (Four Substances Decoction) for blood deficiency, Sijunzi Tang for qi deficiency, and warming middle-jiao regulating formulas for cold injury, all to be used according to the specific syndrome.

After measles resolve, if residual toxin attacks internally, leading to picking at clothes and bedclothes, delirious speech, confusion of spirit and mind, the prognosis is fatal. If heat is mild but residual pathogen remains, it will first manifest in facial complexion and qi color; if such signs appear, prevention is necessary. Always prioritize Shengma Gegen Tang, or choose Siwei Xiaodu Yin (Four-Ingredient Detoxification Drink), Liuwei Xiaodu Yin (Six-Ingredient Detoxification Drink), or Jiedu Tang according to the syndrome. Fishy odors, green onions, and garlic should still be avoided.