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Zhu Yutang stated: When measles (Mazhen) have not yet manifested their typical signs, the patient must first experience fever (Shenre), headache (Toutong), and cough (Kesou), possibly accompanied by vomiting (Tou) or diarrhea (Xie), nasal congestion (Bisai), runny clear nose (Biliu Qingti), snoring breathing (Penhan), swollen eyelids (Yanbao Zhong), red cheeks (Sai Chi), and restlessness (Fanzao Buning). Carefully inspecting below the ear roots, between the neck and ears, and from the lower back to the waist, one will inevitably find three to five red spots. This is the "reporting sign" (Biao) of measles. If these symptoms occur without red spots, it should be treated as a different condition; this has been repeatedly verified. If red spots are indeed present along with the aforementioned symptoms, it is appropriate to use Xuandu Fabiao Tang (Toxin-Releasing Exterior-Dispersing Decoction) added with Yuanxu (Coriandrum Fruit) as a guiding drug to help push the rash outward, without being rigidly bound by fixed protocols. If vomiting and diarrhea accompany the eruption of the rash, they will naturally cease. Heat steaming the Stomach causes vomiting, while heat rushing into the Large Intestine causes diarrhea; this is a common manifestation of measles, so there is no need to worry about persistent vomiting or diarrhea. Ancients said that measles toxins originate from the Six Fu Organs, perhaps due to such symptoms.

After the measles erupt and show signs, the lesions resemble millet grains, being large and pointed, sparse and distinct. Later, if they form patches of moist red color, it is a favorable course (Shun); if the spirit is clear and complexion is fresh, it is even more favorable. If initially erupting all at once without distinct grains, appearing deep purple indicates a dangerous condition, and black indicates an adverse condition (Ni). These should not be considered ordinary. Medication order must not be lost, exterior-dispersing methods should not be overused, and cold-cooling drugs should not be applied abruptly. The method of care involves avoiding wind, avoiding meat, and avoiding foul odors. The key lies in using medication to ventilate and disperse the toxin, allowing it to fully emerge externally. Even if swelling and redness are severe, resembling lacquer dermatitis, there is no need to worry, because the toxin has emerged externally, preventing internal attack. If managed correctly with appropriate medication, success is nearly certain; if mismanaged, death can occur easily. How can one not be cautious?

At the initial stage of fever, exterior-dispersing methods must be used. After signs appear, dispersing should be combined with cooling. If the entire body becomes uniformly red, including the extremities of hands and feet, with no gaps, this is called "fully erupted." At this stage, cooling and detoxifying agents can be used without additional exterior-dispersing drugs; recovery follows quickly.

There is another type of measles where, upon initial eruption, eyelids are swollen, white mixed with red, voice is hoarse, lips are swollen and everted, nostrils are dry, alae nasi flaring with asthma, mouth dry with irritability and thirst, lower back pain, abdominal distension, mental confusion, bleeding from mouth and nose, agitation with狂叫 (wild shouting), and bleeding from both bowels and urine. This is caused by toxic qi stagnating internally, named "Closed Syndrome" (Bi Zheng), which is the most difficult to treat. Use Xuandu Fabiao Tang added with wine-fried Huangqin (Scutellariae Radix) 7 fen and Mahuang (Ephedrae Herba) 5 fen. If the rash can be pushed out gradually, survival may be hoped for; otherwise, there is no rescue. Generally, nasal bleeding in measles indicates heavy toxin; oral bleeding indicates heavier toxin; bleeding from bowels and urine indicates even heavier toxin and critical danger. Hot palms and soles at onset indicate heavy toxin; ice-cold feet at onset indicate even heavier toxin.

If the rash signs are seen but not fully erupted, and clearing/resolving measures are neglected, mistakenly using bitter-cold or hot agents causing toxin accumulation in the Stomach, leading to foul breath from mouth and nose and likely developing gangrenous gums (Yagan), use Huadu Qingbiao Tang added with Shigao (Gypsum Fibrosum) 2 qian. If the rash has fully erupted but rapidly recedes, with persistent fever, residual toxin flowing into the Large Intestine causing tenesmus (Liji Houzhong) and dysentery-like stool (red and white mixed), use Qingre Daozhi Tang.

For individuals with inherent weakness, if excessive dispersing is used during eruption, followed by excessive cold-cooling detoxification after full eruption, leading to extreme weakness, emaciation, fatigue, pale complexion, inability to eat much, and vomiting after eating, urgently use Xiangsha Liujunzi Tang (Aucklandia and Amomum Six Gentlemen Decoction) removing Banxia (Pinelliae Rhizoma) and adding Maidong (Ophiopogonis Radix) to tonify. Various deteriorated conditions require great caution.

Strong's commentary from Shanghai states: If it is not Spleen-Stomach weakness causing poor appetite or vomiting, but rather fundamental deficiency manifesting as morning coolness and evening fever, copious phlegm cough, progressing to skeletal emaciation (commonly known as Sha Lao), tonifying Spleen might hinder Lung Qi, making Xiangsha pills unsuitable.

Measles typically take three days to fully erupt. Erupting twice daily: those erupting at Zi hour dissipate at Si hour; those at Wu hour dissipate at Hai hour. After three days, six eruptions fully dispersed, dense without gaps, is an auspicious sign. Ancients said chickenpox prefers sparsity, while measles prefers density. Even if resembling lacquer dermatitis with uniform redness, it is not a cause for concern.

For infants aged one month to half a year or one year, during hot weather, if they develop milk rash, sha rash, or wind hives, these are not classified as standard measles nor caused by fetal toxin. Medication is generally unnecessary (De notes: boiling 3 cun of Congbai [Allii Fistulosi Bulbus] in water for consumption can help); the rash will dissipate on its own. These arise from internal physiological changes (Bianzheng) and external wind-heat invasion, constituting minor skin ailments. It is common to see them erupt multiple times consecutively without harm. If medication is desired, mild wind-dispersing and heat-clearing agents suffice for quick recovery. Fever lasting three days with visible signs is favorable; delay to five or six days without signs is adverse. Clear spirit is favorable; lethargy is adverse. Families observing taboos can turn adverse cases favorable; ignoring taboos can turn favorable cases adverse. One must clearly instruct families to prevent issues proactively.