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Mild cases occur because the child's Qi and Blood are harmonious, with no prior illnesses. Although exposed to seasonal pathogens, the healthy Qi can control the pathogenic factors. The fever is mild, with slight sweating, clear spirit, and regular bowel and bladder movements. When the rash appears, it penetrates easily and thoroughly; when it fades, it does so neither too fast nor too slow. This constitutes a mild case, which is easy to treat.

Severe cases arise because the child previously suffered from wind-cold or food stagnation, resulting in mixed exterior and interior pathologies. Upon exposure to intense Yang-fire pathogenic energy, internal and external factors combine to erupt, while the healthy Qi fails to control the pathogens. Symptoms must include high fever without sweating, irritability, thirst, unclear spirit, constipation, and dysuria. The rash points are difficult to penetrate thoroughly, and their fading may be either too tight/constricted or irregular. This constitutes a severe case, which is difficult to treat.

The symptoms of measles, during the initial fever stage, resemble those of cold damage (Shanghan). However, in measles, the face is notably red, accompanied by coughing, sneezing, runny nose with clear mucus, tearing eyes, yawning, drowsiness, vomiting or diarrhea, or scratching at the eyebrows, eyes, nose, and face. These differences distinguish it from cold damage. It must not be mistaken for cold damage and treated with reckless diaphoresis (sweating) or purgation.

Reckless diaphoresis will increase heat, altering the syndrome: symptoms may include epistaxis, cough, mouth ulcers, sore throat, red and painful eyes, irritability, or obstruction of urination and defecation.

Reckless purgation will empty the interior, further altering the syndrome: symptoms may include slippery diarrhea or dysentery.

The Classics state: "First consider the annual climate qi, do not violate the harmony of Heaven (natural vitality)." This means one must not recklessly use diaphoresis or purgation. Therefore, in treating measles, before the eruption, one should employ methods to release the exterior and promote eruption, avoiding excessive use of cold-cooling herbs. Otherwise, the toxic heat may be frozen inside like ice; even if the rash emerges, it may not fully penetrate, and the toxin may attack the Heart internally. If the rash has already fully erupted, one should then use clearing and draining agents to remove residual internal heat. Moreover, since measles belongs to Yang, retained heat damages Yin; damage to the Yin aspect leads to blood consumption. Thus, nourishing blood is the fundamental treatment principle at the end stage. As for temporary adaptive formulas, they must shift according to the specific syndrome, which cannot be exhaustively described in writing.

During the initial onset of measles, before typical signs appear, there is invariably body heat with aversion to cold, headache, cough, vomiting, dry heaving, diarrhea, abdominal pain, nasal congestion, runny nose with clear mucus, sneezing, yawning, swollen eyelids, watery eyes, flushed cheeks, and irritability. Ancient methods advocate using Xuan Du Fa Biao Tang (Disperse Toxicity and Release Exterior Decoction), containing Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Qianhu (Peucedani Radix), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus), Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), Mutong (Akebiae Caulis), Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Danzhuye (Lophatheri Herba), and Sheng Gancao (Glycyrrhizae Radix et Rhizoma Preparata), with Yuansui (Coriandri Fructus) as an引 (guide).

[Commentary by Zhen] Rashes also erupt from fetal toxins. Their color is red and dense, moving within the skin, belonging to the Jun Fire of the Hand-Shaoyin Heart Meridian. The Heart and Lung are connected; the Lung resides in the upper jiao. When Heart Fire flares up, the Lung is affected, so the Lung bears the heaviest toxic burden.

Coughing occurs because Lung Fire flares upward due to Heart Fire, causing the lung tissue to become scorched and elevated.

Runny nose with clear mucus occurs because the nose is the opening of the Lung; fire scorching Metal (Lung) causes fluids to flow freely.

Tearing occurs because Lung heat transfers to the Liver, and the Liver opens into the eyes.

Yawning occurs because the Liver belongs to Wood, and Wood generates Wind.

Vomiting and dry heaving occur because Heart Fire flows into the Stomach.

Swollen eyelids, abdominal pain, and diarrhea occur because Lung heat flows into the Large Intestine, as the Lung and Large Intestine are exterior-interior paired organs.

Flushed cheeks and irritability indicate vigorous Heart Fire.

Sneezing indicates Fire-pathogens in the Lung Meridian.

Scratching at the eyebrows, eyes, lips, nose, and face indicates Lung heat.

Carefully examine the area between the roots of both ears, the neck connecting to the ears, the lower back, and the waist. There will inevitably be three to five red spots; these are the herald signs (bao biao) of measles. The formula used is: Bohe Ye (Menthae Haplocalycis Folium) 8 fen, Fengehua (Puerariae Flos) 5 fen, Jingjie Sui (Schizonepetae Spica) 5 fen, Lianqiao Qiao (Forsythiae Fructus) 1.5 qian, Niubangzi (Arctii Fructus) 1 qian, Xi Mutong (Akebiae Caulis) 1 qian, Yan Zhike (Aurantii Fructus cum Sale) 6 fen, Danzhuye (Lophatheri Herba) 1.5 qian, with Dengxin (Junci Medulla) 7 strands as a guide.

Modifications:
If there is no cough, add Liubai Chenpi (Citri Reticulatae Pericarpium prepared with white residue) 1 qian to intensify the cough (Note: Textual logic implies preventing premature suppression or specific context); if there is a cough, do not add this. For alternating tidal fever, remove Danzhuye, add Ziye (Perillae Folium) 5 fen and Congbai (Allii Fistulosi Bulbus) 1 cun to release the exterior; if tidal fever is severe, add Chifuling (Polypori Cum Poria Rubra) 8 fen, Shengdi (Rehmanniae Radix Preparata) 1.5 qian, and Huangqin (Scutellariae Radix) 1 qian. For absence of sweat, add Congbai 3 cun to induce sweating. For panting/wheezing, add Gualouren (Trichosanthis Semen) 1.5 qian, Tiantingli (Descurainiae Semen seu Lepidii Semen) 3 fen, and Laofuzi (Radish Seed) 3 fen. For vomiting, add Zhuru (Bambusae Caulis in Taenia) 1.5 qian and Shishuang (Diospyros Frost) 1 qian. For hiccups, add Xin Pipaye (Eriobotryae Folium) 1 leaf and Xin Zhuru (Bambusae Caulis in Taenia) 1 qian. For epistaxis, add Mao Gen (Imperatae Rhizoma) 3 qian. For sore throat, add Shegan (Belamcandae Rhizoma) 1 qian, and double the dose of Niubangzi from the original formula. For dry lips, dry teeth, withered yellow tongue coating, and thirst, add Maidong (Ophiopogonis Radix) 1.5 qian, Tianhuafen (Trichosanthis Radix) 8 fen, Sheng Tiaoqin (Scutellariae Radix) 8 fen, and Hei Zhiren (Gardeniae Fructus Preparata) 5 fen. For intense heat and hard stool, add Huomaren (Cannabis Semen) 2 qian and Chao Zhishi (Aurantii Fructus Preparatus) 8 fen. For loose stool, remove Zhike. For loose stool with slight sweating, remove Bohe and Zhu Ye. For profuse watery diarrhea, add Zhuling (Polyporus) 1.5 qian and Zexie (Alismatis Rhizoma) 1.5 qian. For red urine, remove Bohe Ye, add Chifuling 1.5 qian, and Cheqianzi (Plantaginis Semen) 6 fen. For urinary obstruction, add Xi Shengdi (Rehmanniae Radix Preparata) 3 qian, Mutong 8 fen, and double the dose of Danzhuye from the original formula.