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The emergence of measles (Ma) and smallpox (Dou) hinges on the thorough resolution of pathogenic factors from the exterior. Once the exterior is resolved, even if internal heat toxicity is severe, it can be cured through clearing heat. If the exterior is not resolved, toxins sink inward, causing a closure of the pathways. At this stage, neither releasing the exterior nor nourishing yin alone is appropriate, often leading to death due to prolonged neglect.

"Resolution of the exterior" does not merely refer to the skin and hair level, but requires pathogens to emerge from the depths of the Zang-Fu organs in a leisurely manner; only then is it truly considered "resolved." There are cases where fire-toxicity is extremely intense, presenting externally with dense, bright red eruptions, yet after eruption, complications such as noma (gangrenous stomatitis) or lung abscess still occur, or symptoms like epistaxis and diarrhea appear. This indicates that the heat-toxin within the Zang-Fu has not been fully resolved.

The toxin of measles and smallpox originates from the Zang-Fu organs. Although it reaches the exterior, its root remains internal. The character "Jie" (resolve) pertains to resolving from the exterior, while "Hua" (transform) pertains to transforming from the interior. If the exterior is resolved but the interior is not transformed, the subsequent complications are numerous.

Medicines for resolving the exterior act on the Yang and Qi levels, yielding rapid and observable effects. Medicines for transforming toxins act on the Yin and Blood levels, yielding slow and difficult-to-achieve results. The four characters "Nourish Yin and Retreat Yang" from *Jin Jing Lu* are the key principles for treating measles.

Post-measles expectoration of purulent, bloody, and foul-smelling sputum may indicate lung abscess or gastric abscess. These are caused by residual heat-toxin in the Lung and Stomach, similar to noma or mouth ulcers. If the toxin follows the meridians outward, it manifests as noma; if it lodges in the Zang-Fu, it forms an abscess. Treatment should be differentiated based on whether the pathology is in the Lung or the Stomach. I commonly use Licorice Root (Gancao), Platycodon Root (Jiegeng), Butterfly Bush Seed (Niubangzi), Honeysuckle Flower (Yinhua), Aurantium Fruit (Zhike), and Red Peony Root (Chishao). If the pathology is in the Lung, add Gardenia Fruit (Shanzhizi), Fritillaria Bulb (Beimu), and Mulberry Bark (Sangpi). If in the Stomach, add Rehmannia Root (Shengdi), Trichosanthes Root (Huafen), and Akebia Stem (Mutong) as adjuncts. Patients without high fever can be cured.

Question: Why can conditions like noma and lung abscess be cured? Because the toxin has been transformed and expelled. If the toxin is transformed and the Zang-Fu function remains intact, cure is possible. If the Zang-Fu are already corrupted and necrotic, they cannot be treated.

In the summer of the Bingchen year, measles were prevalent. This section discusses treatment according to seasonal patterns.

Smallpox toxin originates from the Five Zang organs, while measles toxin originates from the Six Fu organs. Fu organs belong to Yang. At the Winter Solstice, Yang energy begins to generate, and measles toxin emerges. Therefore, transmission often occurs during severe cold periods, which is why ancient texts referred to it as "measles occurring due to the season." In my fifty years of treating measles, most cases resembled this pattern, occasionally extending into late spring or early summer. Recently, however, measles have appeared in summer, persisting through the peak heat. How different the circumstances have become! Since the circumstances differ, physicians must adapt their methods accordingly. Quack doctors fail to observe these changes and rigidly adhere to established formulas. Ignorant people further suppress the eruption by over-bundling, causing excessive fire to injure Metal (Lung), leading to measles complicated by asthma. This is truly pitiable. To correct these abuses, I have formulated several new prescriptions for those who understand the principles to follow.

Prescription 1
Cimicifugae Rhizoma (Shengma), Cicada Slough (Chantui), Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), Peucedani Radix (Qianhu), Platycodon Root (Jiegeng), Butterfly Bush Seed (Niubangzi), Licorice Root (Gancao), plus a small amount of Coriander Seed (Yuansui), taken as one dose.
After one dose, when the eruption appears, remove Cimicifugae Rhizoma (Shengma) and add Red Peony Root (Chishao) and Forsythia Fruit (Lianqiao). For irritability, add Stir-fried Gardenia Fruit (Chao Zhizi); for vomiting, add Gypsum (Shigao); for cough, add Apricot Kernel (Xingren) and Aurantium Fruit (Zhike). In summer, the pores open first; exterior-releasing medicines should be light rather than heavy. Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), and Cicada Slough (Chantui) serve as exterior-releasing agents. If the eruption is not fully resolved after one dose, use Cimicifugae Rhizoma (Shengma) added with Kudzu Root (Gegen) to promote resolution. The use of Ephedra Herb (Mahuang) is contraindicated in summer, a common knowledge. Qianghuo should not be used recklessly, nor should Kudzu Root (Gegen) be reused excessively. Once the facial eruption appears, the treatment strategy should change immediately.

Prescription 2
Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), Platycodon Root (Jiegeng), Licorice Root (Gancao), Butterfly Bush Seed (Niubangzi), Forsythia Fruit (Lianqiao), Apricot Kernel (Xingren), Stir-fried Gardenia Fruit (Chao Zhizi), Akebia Stem (Mutong).
This is the prescription for the third day of illness. Once the facial eruption is resolved, even Schizonepeta Spike (Jingjie) and Saposhnikovia Root (Fangfeng) should be reduced. Maintain stability for one day, waiting for the rash to recede slowly, which is the safest approach. For severe heat, irritability, and thirst, add Gypsum (Shigao) and Bamboo Leaf (Zhuye). For persistent high fever, add Scutellaria Root (Kuhuang) and Ophiopogon Tuber (Maidong). If diarrhea occurs, remove Apricot Kernel (Xingren) and Akebia Stem (Mutong), and add Poria (Chiling).

Prescription 3
Rehmannia Root (Shengdi), Ophiopogon Tuber (Maidong), Moutan Cortex (Danpi), Gardenia Seed (Zhiren), Forsythia Fruit (Lianqiao), Platycodon Root (Jiegeng), Licorice Root (Gancao). For irritability and thirst, add Bamboo Leaf (Zhuye) and Gypsum (Shigao); for severe heat, add Scutellaria Root (Kuhuang) and Anemarrhena Rhizome (Zhimu).
This is the prescription for the fourth and fifth days. Nourishing Yin and Retreating Yang is the major principle for treating measles, especially in the summer months. Rehmannia Root (Shengdi) must be of second-grade quality, kept in original branches, washed clean of soil, and chopped. Ophiopogon Tuber (Maidong) should be selected large and white. These two are essential for nourishing Yin and retreating Yang. Moutan Cortex (Danpi) assists in reducing heat. Licorice Root (Gancao) and Platycodon Root (Jiegeng) ascend the clear Qi of the Lung. Scutellaria Root (Huangqin) drains turbid Qi from the Lung. Gypsum (Shigao) is the primary medicine for the Stomach; its white color corresponds to Metal and the West, and it clears the Lung. When measles erupt with intense fire-toxin scorching the Lung and Stomach, Gypsum alone can clear both meridians effectively. Its success depends on the physician's discernment.

If the eruption persists for four to five days, appearing dense, red-purple, and unresolving, with unremitting heat, it is due to excessive dispersal, causing all fire energy to flare up. Immediate nourishment of Yin and retreat of Yang is required.

When measles occur in cold weather, cold pathogen remains at the exterior while heat accumulates internally. Symptoms are limited. Acute cases present with vomiting, asthma, or epistaxis; chronic cases with mouth ulcers or diarrhea; severe cases with noma. No other variations occur. However, in summer, fire-toxin blazes and summerheat intertwines, creating bizarre and unprecedented variations. Some present with eyes swollen red like peaches and plums, oozing blood and water; urgent draining of Liver fire saves life but causes total blindness. Some have swollen jaws like mumps, ulcerating after days, oozing bowlfuls of pus and blood; cured by internal Stomach-clearing detoxifying herbs and external application of Hong Shaogang Plaster. Some develop generalized blisters with collapsed, painful skin; cured by dusting with Pine Pollen. Some have swelling at the Quchi acupoint on hands and feet, resembling the "ghost swelling" of smallpox toxin. Some develop dozens of purple ding (carbuncles) on the face, chest, and back, with halos as large as chess pieces, black and sunken centers, accompanied by fever and anorexia; fatal after seven days despite cooling-blood and detoxifying treatments. All these anomalies stem from blazing fire-toxin. Even cases with extreme heat that do not result in death are due to heat injuring Yin fluids and healthy Qi. Unskilled practitioners, ignorant of tonifying Qi and nourishing Yin, rely solely on pushing out toxins, leading to asthma, sweating, and collapse. Such cases are common. When urgently summoned for these critical conditions, administering Ginseng and Ophiopogon Decoction (Shenmai Tang) has saved many lives. Having treated measles until old age, I never expected to encounter such a situation. Without adapting to the times and redefining treatment methods, how can I guide future generations to respond flexibly? Physicians who rigidly stick to old formulas should consider this carefully.

Among medicinal guides for treating measles, only Coriander Seed (Yuansui) is superior. Its pungent aroma contains vital energy. Combined with Cimicifugae Rhizoma (Shengma), Kudzu Root (Gegen), Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), and Cicada Slough (Chantui), it raises Yang and resolves the exterior. It should be removed once the facial eruption appears; otherwise, excessive pungent dispersion will aid fire.