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The types of scarlet-like rashes are roughly as follows:

I. Purulent Vesicular Scarlet Rash
Known as "Xingjiang Zhenzi" (Rash with Flowing Pus), its appearance is somewhat similar to smallpox but actually different. Smallpox must have a distinct central prominence (Dingpan), whereas even if the rash has pus, the granules must not be hard, and the base (Genpan) must lack a red halo. This is caused by excessive dampness in the body during normal times, or by spleen and stomach deficiency. If it does not scab after purulation, this indicates a loss of Yuan Qi (Primordial Qi). Treatment should focus primarily on greatly tonifying the spleen and stomach; one must not mistakenly assume that pathogenic heat remains and administer heat-clearing and fire-reducing agents.

II. Rash Intermingled with Smallpox
This refers to cases where smallpox lesions are intermingled within the scarlet rash. This occurs because the toxic qi is too abundant, causing both to erupt simultaneously. Rashes are mostly caused by toxins from external wind-pathogens, while smallpox is mostly caused by toxins arising internally from fetal toxicity. When these two mix, the symptoms are difficult to treat, as treating smallpox requires warm methods, while treating rashes requires cool methods. However, by carefully observing deficiency/excess and cold/heat, there are flexible treatment approaches. For example, in deficient cases where heat is not intense and both rash and smallpox are sparse, it is appropriate to refer to smallpox treatment methods, focusing on supporting the eruption of smallpox. In excess cases with prominent red halos, it is appropriate to use rash treatment methods, such as frequently administering Huaban Tang (Spot-Resolving Decoction); then the rash toxin will naturally resolve, and the smallpox will emerge on its own.

III. Milk Rash
This occurs when an infant, under one month old, suddenly develops red spots all over the body. This condition arises from heat accumulated in the womb combined with exposure to epidemic pathogens at birth. Since infants' zang-fu organs are delicate, medication for the infant is unnecessary. Instead, a large-dose standard formula for treating scarlet-rash/smallpox should be administered to the nursing mother. The mother should avoid wind and cold, abstain from sexual intercourse, eat a light vegetarian diet, and strictly avoid cold water, melons/fruits, chicken, fish, roasted foods, salty items, vinegar, the "Five Pungent Spices," honey/sugar, and fragrant/fresh foods. Violating these taboos causes pore closure, preventing toxin expulsion, leading to blackening and death. If extremely thirsty, only Scallion White Decoction (Congbai Tang) should be given to moisten.

Additionally, there is the syndrome of "Fa Ban" (Eruptive Macules/Patches), which differs in form from rashes and has slightly different treatment methods. Examining the characteristics: Sha Zhen (Scarlet Rash) presents as dot-shaped, while Ban (Macules/Patches) presents as patch-shaped. Sha Zhen granules protrude, appearing formed visually and palpable physically; Ban appears as a single red-purple patch, visible but not palpable as a distinct object. This distinguishes Ban from Zhen. However, some eruptions involve swelling, mostly being a combination of Ban and Sha Zhen; the slightly protruding upper part is Zhen, while the lower flat part is Ban. Ban is divided into Yang Ban and Yin Ban. Cases with pale color, faint marks like mosquito bites, sparse red dots only on the chest/back or limbs, and a calm patient demeanor are classified as Yin Ban. Yin Ban never intermingles with Sha Zhen and can be temporarily disregarded. Yang Ban may result from stomach heat, boiling blood, spontaneous eruption, or severe stagnant heat in the blood level after the rash has erupted. Generally, bright red is favorable, purple indicates severity, and black like coal is almost invariably fatal. Therefore, once the disease reaches the stage of erupting macules, pungent-warm herbs are strictly contraindicated as they exacerbate heat. Mild cases may still use pungent-cool herbs, following the treatment principles for Sha Zhen. Severe cases generally require cold-cooling agents to quell the intense heat, or blood-invigorating agents to drain obstructive toxins. Mistakenly using warm agents will inevitably cause red patches to turn purple, and purple patches to turn black.

Furthermore, there is "Feng Zhen" (Wind Rash), caused by spleen deficiency with blood heat or wind-pathogen invasion. Its form is swollen, appearing in patches or blocks, worsening with scratching. It requires herbs that regulate qi and drain dampness, not solely wind-dispelling drugs. There is also "Yin Zhen" (Hidden Rash), caused by heat accumulation in the spleen combined with wind-dampness. It presents as faintly emerging granules, seemingly swollen but not truly so, often causing itching or numbness. Because it hides within the muscles, it is called Yin Zhen. It may present with high fever and aversion to cold resembling a rash, but is not a true rash; it should be treated primarily by diffusing wind and dampness. There is also "Fei Zhen" (Prickly Heat), which is the most severe form of summer prickly heat. The granules are as large as millet seeds, the skin is entirely red, and it commonly occurs in the neck, axillae, and groin. Obese children are prone to it; surgical texts call it Summer-Toxicity. It is best managed by staying in cool places without medication. If scratched open, it easily becomes pustules; topical powder application is recommended to prevent ulceration. There is also "Dong Zhen" (Cold Rash), caused by the closure of heaven-and-earth qi in deep winter, followed by spring winds invading the pores of deficient individuals. It presents as white, fish-roe-like spots, not covering the whole body, resolving within a week without traces. It is also treated primarily by diffusing wind and dampness. These several types, though not orthodox Sha Zhen, are similar enough to be discussed together as a category.

Attached Formulas

(1) Baoyuan Modified Decoction (Baoyuan Jiajian Tang)
Indications: Deficiency in smallpox cases, and Xingjiang Zhenzi (Purulent Rash) where scabbing fails to occur after purulation. (Note: Not for typical smallpox/rash or chickenpox blisters).
Ingredients: Roasted Astragali Radix (Huangqi, 3 qian), Ginseng Radix (Renshen, 3 qian), Roasted Glycyrrhizae Radix et Rhizoma (Gancao, 1 qian), Cinnamomi Cortex (Rougui, 5 fen), Angelicae Sinensis Radix (Danggui, 2 qian), Atractylodis Macrocephalae Rhizoma (Baizhu, 2 qian).
Modifications: If residual toxin remains, add Forsythiae Fructus (Lianqiao) and Vigna radiata (Lvdou). If ascending action is needed, add Cimicifugae Rhizoma (Shengma). If qi-regulating action is needed, add Citri Reticulatae Pericarpium (Chenpi). If astringent action is needed, add Paeoniae Radix Alba (Baishao).

(2) Huaban Tang (Spot-Resolving Decoction)
Indications: Toxin retained in Lung and Stomach.
Ingredients: Ginseng Radix (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), Platycodonis Radix (Jiegeng), Forsythiae Fructus (Lianqiao), Cimicifugae Rhizoma (Shengma), Bambusae Folium (Zhuye), Arctii Fructus (Niubang), Lycii Cortex (Digupi).
Alternative Prescription: Contains Scrophulariae Radix (Xuanshen), Rhinocerotis Cornu (Xijiao), Oryza Sativa (Jingmi); lacks Jiegeng, Lianqiao, Shengma, Zhuye, Niubang, Digupi, Renshen. For robust constitutions, remove Renshen. For intense heat, add Rehmanniae Radix Recens (Xianshengdi) and Rhinocerotis Cornu (Xijiao).

(3) Xiaofeng San (Wind-Dispersing Powder)
Indications: Spleen heat with wind-dampness, Yin Zhen, Dong Zhen.
Ingredients: Poria (Fuling), Bombyx Batryticatus (Chanyi), Chuanxiong Rhizome (Chuanxiong), Bombyx Batryticatus (Jiangcan), Ginseng Radix (Renshen), Agastaches Herba (Huoxiang), Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao).
Preparation: Decoct in clear water and take orally.

(4) Tiaozhong San (Middle-Regulating Powder)
Indications: Feng Zhen (Wind Rash).
Ingredients: Agastaches Herba (Huoxiang), Immature Bitter Orange (Zhishi), Amomi Fructus (Sharen), Glycyrrhizae Radix et Rhizoma (Gancao), Atractylodis Rhizoma (Cangzhu), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Citri Reticulatae Pericarpium Viride (Qingpi), Pinelliae Rhizoma (Banxia), Magnoliae Officinalis Cortex (Houpo).
Preparation: Decoct in clear water and take orally.

(5) Kushen Tang (Sophora Decoction)
Indications: Fei Zhen (Prickly Heat).
Preparation: Decoct in water for washing. Add 4-5 pig gallbladders immediately before washing.
Ingredients: Sophorae Flavescentis Radix (Kushen), Acori Tatarinowii Rhizoma (Changpu).

(6) Ehuang San (Goose-Yellow Powder)
Usage: External application. Indications: Fei Zhen, used as a dusting powder.
Ingredients: Vigna Radiatae Semen Pulvis (Lvdou Fen), Talcum (Huashi), Phellodendri Cortex (Huangbai), Calomelas (Qingfen).