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Shazhen (Scarlet-like rash) is a condition where, if the eruption can be thoroughly resolved and toxins completely expelled, and if dietary and lifestyle taboos are strictly observed during the course of the disease, there would essentially be no residual ailments. However, human negligence occurs in seven or eight out of ten cases; furthermore, individuals with weak constitutions who cannot withstand the disease are also common. Therefore, residual conditions following Shazhen arising from prior causes are not few in number. Among them, four major syndromes cause severe harm:

The first is called "Shazhen La" (Post-rash consumption). After the rash subsides, pathogenic toxins remain stagnant between the muscles, causing fever day and night. This gradually progresses to scorched hair, shriveled skin, and emaciation resembling firewood. This occurs because acrid-warm herbs were mistakenly taken during the rash period, preventing toxin clearance; or due to original constitutional weakness leaving residual toxins; or from excessive use of cold-cooling herbs, preventing complete toxin expulsion. All these situations are suitable for treatment using methods that clear fire and detoxify, along with formulas that support stomach qi and strengthen the spleen. If treatment is delayed, symptoms such as cold breath from mouth and nose, eyes half-open during sleep (loujing), cold extremities, and convulsions will appear, inevitably leading to death. Even in cases where the patient was originally emaciated but presents with high fever all over the body, convulsions, and irritability, this is actually due to yin deficiency and blood depletion, with residual toxins entering the Liver and transmitting to the Heart. Treatment should employ formulas that nourish and invigorate blood.

The second is called "Shazhen Gan" (Post-rash malnutrition/gan syndrome). This disease arises from unresolved residual toxins sinking into the Stomach, or from overconsumption of roasted foods, where toxins capitalize on internal heat to suddenly trigger Zouma Gan (a rapidly spreading necrotic oral disease). Symptoms include foul-smelling rotting gums, bleeding, swollen cheeks, and cyanotic-black discoloration around the mouth. In time, this leads to perforated cheeks, lost teeth, missing lips, and destroyed noses. Urgent treatment is required without delay. Internal treatment focuses on rapidly clearing Stomach fire, while external treatment focuses on dissipating toxins and removing necrotic tissue. If the sores are white or black, they are considered incurable.

The third is called "Shazhen Li" (Post-rash dysentery). This disease occurs because diarrhea or dysentery existed before the rash, and regulation was incomplete. By this stage, it transforms into Xiuxi Li (chronic/recurrent dysentery), occurring day and night without limit, with tenesmus. This is caused by residual toxins flowing into the Large Intestine. Regardless of whether stools contain blood or pus, the general principle is to nourish blood and move qi. When blood harmonizes, dysentery stops naturally; when qi moves, tenesmus is eliminated. However, one must distinguish between excess and deficiency patterns. Excess patterns may tolerate mild purgation, while deficiency patterns require only harmonization.

The fourth is called "Shazhen Ke" (Post-rash cough). After the rash, breathing becomes rapid and shallow, with continuous coughing, even to the point of hemoptysis or choking on food and drink. This indicates toxins have returned to the Lungs, named Dunke (Pertussis/Whooping cough). Treatment should primarily focus on clearing Lung heat. If symptoms include a protruding chest, shrugging shoulders, swinging hands, shaking head, bleeding from mouth/nose, and complexions that are cyanotic-red, withered-white, or dull-dark, these are signs of incurability. For those with extreme Lung qi deficiency where toxins obstruct leading to wheezing, but without choking or hemoptysis, one must not solely blame Lung heat. Besides detoxification, Lung qi must be supplemented. These four conditions are all severe post-rash syndromes involving life and death; reckless treatment must be avoided.

Beyond these four syndromes, there are other presentations: Fever persisting without abatement indicates Blood deficiency and Blood heat; simply nourishing yin and tonifying blood will resolve the heat. Persistent fever with vomiting and irritability indicates toxins are not yet cleared and lingering between the Lungs and Stomach. Constipation indicates residual fire knotting internally. Diarrhea indicates accumulated heat shifting to the Large Intestine, which will eventually injure the Spleen if prolonged. Inability to eat after rash resolution and heat clearance indicates weak Stomach qi. Swelling, pain, and suppurative discharge in the ears indicate residual toxins entering the ears. Incomplete rash eruption with residual toxins blocking the "Ling Qiao" (spiritual orifices/senses), resulting in stiff tongue and inability to speak, or ear roaring and deafness, all require symptom-based treatment. The primary method should treat the specific syndrome, assisted by methods to resolve post-rash residual toxins.

Furthermore, if the rash reappears three or four days after subsiding, recurring five, six, or even nine times, it is due to wind-cold invasion during the febrile stage, with pathogens stagnating in the muscles. Although previous medication forced an eruption, it was forced rather than natural, causing residual toxins to linger and recur repeatedly. Treat according to the standard methods for Shazhen. Ultimately, the general principle is to clear and regulate the Lungs and Stomach. This is a brief overview of post-rash syndrome differentiation and treatment.

Attached Formulas

(1) Post-Shazhen Clearing Formula (Self-made): Treats unresolved residual toxins after Shazhen to prevent further complications.
Jiegeng (Platycodon Root), Lianqiao (Forsythia Fruit), Dan Qin (Light Scutellaria Root), Fuling (Poria), Yinhua (Honeysuckle Flower), Zhizi (Gardenia Fruit), Zhimu (Anemarrhena Rhizome).
Add Tianhuafen (Trichosanthes Root) for dry mouth; add Beimu (Fritillaria Bulb) and Pipaye (Loquat Leaf) for severe cough; add Chuanlian (Coptis Rhizome), Yimi (Coix Seed), and Dafupi (Areca Peel) for heavy damp-heat; remove Zhimu and add Chunpo (Magnolia Bark), Jiang Banxia (Prepared Pinellia), or Guizhi (Cinnamon Twig), Yinchen (Artemisia Capillaris) for heavy cold-damp; add Xuanfuhua (Inula Flower), Shashen (Glehnia Root) for chronic cough; add Niubangzi (Arctium Seed) and Shandougen (Sophora Tonkinensis Root) for sore throat; add Dahuang (Rhubarb Root) or Chuanlian for solid stool; add Xianshengdi (Fresh Rehmannia Root) and Danpi (Moutan Bark) for blood heat; add Tianzhuhuang (Calamus Tuber), Xingren (Apricot Seed), or Gualoupi (Trichosanthes Peel), Beimu, Zhuru (Bamboo Shavings) for phlegm-heat; add Shenqu (Medicated Leaven), Maiya (Barley Sprout) for food stagnation; add Xuanshen (Scrophularia Root) and Digupi (Groundcherry Bark) for yin deficiency with hyperactive fire; add Shihu (Dendrobium Stem) and Digupi for empty heat in Stomach with dry tongue and no coating; add Longdancao (Gentiana Root) and Ganju (Chrysanthemum Flower) for Liver heat with red eyes; add Chuanlianzi (Evodia Fruit) and Cheqianzi (Plantago Seed) for scanty dark urine; add Guizhi or Zisu (Perilla Leaf) for aversion to cold; add Baizhu (Atractylodes Rhizome) and Jizhoupi (Chicken Gizzard Membrane) for weak Spleen with diarrhea; remove Jiegeng and add Xianshengdi and Maogen (Imperata Rhizome) for hemorrhage; add Renshen (Ginseng Root) and Huangqi (Astragalus Root) for Lung deficiency or Yuanqi (Original Qi) weakness.

(2) Jinhua Wan (Golden Flower Pill): Treats residual pathogens still stagnant in muscles after Shazhen, with fever and difficult defecation.
Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Huangqin (Scutellaria Root), Dahuang (Rhubarb Root).

(3) Qinghuo Xiaodu Tang (Fire-Clearing Detoxifying Decoction): Treats post-Shazhen day-and-night fever progressing to scorched hair, shriveled skin, and emaciation.
Huangqin, Huanglian, Shanzhi (Gardenia Fruit), Yujin (Turmeric Tuber), Longdancao, Xionghuang (Realgar), Digupi, Dengxincao (Juncus Medulla).
Danggui (Angelica Sinensis), Lianqiao, Chuanxiong (Sichuan Lovage Rhizome), Lushui (Aloe), Shijunzi (Quisqualis Fruit) may be added as needed.

(4) Weiling Tang (Stomach-Ling Decoction): Treats post-Shazhen weak Stomach, emaciation, and fever.
Fuling, Zhuling (Polyporus), Baizhu, Zexie (Alisma Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Chenpi (Tangerine Peel), Gancao (Licorice Root), Chunpo.
Or add a small amount of Rougui (Cinnamon Bark).

(5) Danggui Yangrong Tang (Angelica Nourishing Glory Decoction): Treats post-Shazhen high fever all over the body, convulsions, and irritability due to yin deficiency and blood depletion.
Danggui, Shanzhi, Chuanxiong, Shengdi (Rehmannia Root), Maidong (Ophiopogon Tuber), Gancao, Zhuye (Bamboo Leaf), Dengxincao.
Add Dahuang for constipation.

(6) Huanglian Anshen Tang (Coptis Calming Spirit Decoction): Treats post-Shazhen whole-body high fever and convulsions.
Huanglian, Danggui, Longdancao, Quanxie (Scorpion, de-toxicated), Changpu (Acorus Rhizome), Fushen (Poria with Hostwood).

(7) Maru Yin (White Horse Milk Drink): Treats Zouma Gangrene (Zouma Ya Gan).
Use milk squeezed from a white horse to drink.

(8) Qingwei Tang (Clear Stomach Decoction): Treats post-Shazhen Gan syndrome with foul-smelling rotting gums, bleeding, swollen cheeks, and cyanotic-black discoloration around the mouth.
Shengma (Cimicifuga Rhizome), Shengdi, Huanglian, Danggui, Danpi.

(9) Wen Ge San (Clam Powder): External use. Treats post-Shazhen Gan syndrome; wash sores with rice water before application.
Xionghuang, Kufan (Alum), Cantui (Silkworm Molt), Zhihui (Paper Ash).
Use double the amount of Wenge (Clam Shell), ground into fine powder.

(10) Post-Shazhen Dysentery Formula (Self-made): Treats post-Shazhen dysentery with slight abdominal pain and tenesmus.
Danggui Tan (Charred Angelica Root), Dan Qin Tan (Charred Light Scutellaria Root), Jinyinhua (Honeysuckle Flower), Baishao (White Peony Root), Yadanzi (Brucea Fruit).
Add Chunpo or Chuanlian酌情ly for heavy dampness; add Binglang (Betel Nut) or Dahuang酌情ly for tenesmus.

(11) Sanhuang Tang (Three Yellows Decoction): Treats post-Shazhen bloody and purulent dysentery with excess patterns.
Chao Chuanlian (Stir-fried Coptis), Chao Huangqin (Stir-fried Scutellaria), Zheng Dahuang (Steamed Rhubarb).

(12) Xianglian Wan (Costus and Coptis Pill): Treats post-Shazhen bloody and purulent dysentery, serving as a harmonizing agent.
One liang of Huanglian, stir-fried with five qian of Wuyu (Evodia Fruit), remove Wuyu, take three qian of Muxiang (Aucklandia Root), and form pills.

(13) Post-Shazhen Dunke Formula (Self-made): Treats sudden paroxysmal coughing after Shazhen, continuous until choking on food/drink, lasting long without cure.
Xuanfuhua (wrapped), Zhi Juhong (Roasted Tangerine Red Peel), Zhi Kuandong (Roasted Coltsfoot Flower), Beishashen (Northern Glehnia Root), Laifuzi (Radish Seed), Dan Qin.
Honey-processed Sangpiao (Mulberry Bark), Renshen, Maidong, Beimu, Pipaye, etc., may be added according to syndrome.

(14) Post-Shazhen Ear Pain Formula (Self-made): Treats post-Shazhen ear pain with internal suppuration.
Chaihu (Bupleurum Root), Shengdi, Chishao (Red Peony Root), Niubangzi, Danggui, Lianqiao, Zhizi, Huafen (Trichosanthes Root), Fangfeng (Saposhnikovia Root), Chuanxiong, Gancao, Qingpi (Green Tangerine Peel).
Decoct in clear water and drink. Externally, grind Yanzhi (Vermilion), Kufan, Bingpian (Borneol), Ercha (Catechu) into powder, insufflate into the ear, and wipe clean pus with a cotton swab.

(15) Ningfei Tang (Lung-Calming Decoction): Treats post-Shazhen cough, clearing Lung heat.
Huangqin, Sangye (Mulberry Leaf), Beimu, Zhimu, Xingren, Huafen, Tiandong (Asparagus Tuber), Shashen, Pipaye.

(16) Maidong Qingfei Tang (Ophiopogon Clearing Lung Decoction): Treats post-Shazhen Lung deficiency Dunke.
Maidong, Renshen, Gancao, Chishao, Jiegeng, Chenpi, Binglang, Chiling (Red Poria).
Note: Chishao in the formula can be changed to Baishao; if cough is severe, Jiegeng may be omitted and replaced with Xuanfuhua; add Lianqiao for slight fever and thirst.

(17) Siwu Tang (Four Substance Decoction): Treats post-Shazhen blood deficiency and blood heat. See Chapter 3, Section 5 for the formula.
Add Maidong and Xijiao (Rhinoceros Horn - *note: substitute with Buffalo Horn in modern practice*) for thirst; add Gualou Shuang (Trichosanthes Frost) for cough; add Beimu and Chenpi for phlegm. Avoid Renshen, Baizhu, and Banxia.

(18) Siling San (Four Porias Powder): Treats heat shifting to Large Intestine, causing new-onset hot diarrhea.
Fuling, Zhuling, Zexie, Cangzhu, Zhi Gancao (Honey-fried Licorice).
Another version contains Chenpi instead of Cangzhu and Gancao. For chronic diarrhea injuring the Spleen, add Muxiang, Sharen (Amomum Fruit), Hezi (Chebulic Myrobalan), and Roudoukou (Nutmeg).

(19) Post-Shazhen Ling Qiao Obstruction Formula (Self-made): Treats post-Shazhen obstruction of spiritual orifices, stiff tongue, or deafness.
Gan Changpu (Dried Acorus Rhizome), Chan Yi (Cicada Slough), Lianqiao Xin (Gardenia Stamen), Sangzhi (Mulberry Twig), Bai Jiangcan (White Silkworm), Zhuye Xin (Bamboo Leaf Heart).
Other herbs such as Quanxie, Chuanshanjia (Pangolin Scales), Dansheng (Arisaema with Bile), Mengshi (Fluorite), Longdancao, Shexiang (Musk), Longnao (Camphor), Zhusha (Cinnabar) may be added discretionarily.