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During the eruption of rashes (Measles), if diarrhea persists without stopping, or if frequent watery stools are passed, this is the most ominous sign. At this time, one should only observe the rash: if the rash is dense all over the body and red-purple in color, there is no cause for alarm, because if not for the diarrhea, the stagnant qi would not be resolved; treatment should focus on clearing heat and promoting diuresis. Once the rash fully erupts, the diarrhea will naturally cease. If the rash has subsided but the diarrhea continues, it indicates that the rash toxin has not been completely expelled. It is appropriate to use a method of clearing and supporting (clearing residual toxins while supporting healthy qi) along with methods to separate and promote urination. One must absolutely avoid using astringent drugs such as Chebula Fructus (Hezi) and Myristica Seed (Roukou), lest they lead to abdominal distension, panting, and urgency, which are untreatable conditions.

The emergence and disappearance of rashes usually follow a twelve-hour cycle. For example, rashes emerging after the Zi hour (11 PM - 1 AM) will subside by the Wu hour (11 AM - 1 PM); those emerging in the afternoon will subside at the Zi hour. This is because the afternoon belongs to Yin, and the period after Zi belongs to Yang, conforming to the natural principle of "Yin generates, Yang completes; Yang grows, Yin retracts." Rashes that emerge and quickly subside are considered mild cases. If rashes emerge and do not subside for three to four days, it indicates excessive Yang heat toxin, and Daqing Tang (Great Blue Decoction) should be used to resolve the exterior. However, sores and rashes require heat to erupt; once the rashes have erupted and all other symptoms have resolved with the body cooling down, this is the normal course. If fever remains severe even after the rashes have erupted, it indicates that the toxin is still congested and unremoved. In this case, Daqing Tang should also be used to resolve the exterior; if accompanied by scanty and painful urination, formulas like Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins) should be used to clear interior heat. Furthermore, if there is irritability, restlessness, vomiting, and diarrhea, the principle is similar, requiring flexible adaptation. If rashes fail to emerge for a while, it is due to external constraint by wind-cold and closed skin pores; Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Rescue from Toxicity) should be used. Once the rashes fully emerge, the irritability, vomiting, and diarrhea will naturally heal. However, the emergence of rashes must ensure that the toxin is completely resolved. If not completely resolved, the toxin accumulates internally, leading to prolonged high fever, emaciation, and development of malnutrition syndromes (Gan), or triggering convulsions, diarrhea, and dysentery, hemoptysis, panting, and even death due to Gan syndrome.

Sha Zhen (Scarlet Fever/Measles-like rash) is caused by fire-heat in the Lung and Stomach meridians. It occurs mostly in children, and occasionally in adults; it is likely a type of seasonal epidemic disease. The treatment method should primarily focus on clearing heat and dispersing externally. Medicines should be pungent-cold, sweet-cold, or bitter-cold to open the pores. Astringent flavors are strictly contraindicated, while pungent dispersants are highly suitable. Pungent dispersants include Schizonepeta Spike (Jingjie), Tamarix Herb (Xihe Liu), Kudzu Root (Gegen), Gypsum Fibrosum (Shigao), Arctium Fruit (Niubangzi), and Ephedra Stem (Mahuang); cooling agents include Scrophularia Root (Xuanshen), Bamboo Leaf (Zhuye), Trichosanthes Root (Tianhuafen), Indigo Naturalis (Qingdai), and Mint (Bohe); sweet-cold agents include Ophiopogon Tuber (Maidong), Raw Licorice Root (Sheng Gancao), and Sugarcane Juice (Zhe Jiang); bitter-cold agents include Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Fritillaria Bulb (Beimu), and Forsythia Fruit (Lianqiao). Depending on the severity of the condition, adjust the dosage size. Stop when the disease is cured; do not overdose.

When Sha Zhen initially erupts with cough, it is appropriate to clear heat and vent toxins; cough should not be suppressed. For post-rash cough, use Fritillaria Bulb (Beimu), Platycodon Root (Kujie/Gancao context implies Platycodon here often referred to as Kujie in some texts, though standard is Jiegeng), Licorice Root (Gancao), Mint (Bohe), Trichosanthes Root (Tianhuafen), Scrophularia Root (Xuanshen), and Ophiopogon Tuber (Maidong) to clear residual heat and eliminate phlegm congestion; the condition will heal itself. Strictly avoid astringent preparations. For significant panting, it is due to pathogenic heat congesting the Lung. Do not use anti-panting medicines; instead, use a large dose of Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), adding approximately one tael of Tamarix Herb (Xihe Liu), and two qian each of Scrophularia Root (Xuanshen) and Mint (Bohe). For intense heart heat, use Baihu Tang (White Tiger Decoction) added with Tamarix Herb (Xihe Liu). Avoid using Angelica Dahurica Root (Shengma), as it will inevitably cause panting. For rashes accompanied by frequent diarrhea, do not stop the diarrhea; use Coptis Rhizome (Huanglian), Kudzu Root (Gegen), Angelica Dahurica Root (Shengma), and Licorice Root (Gancao), and the diarrhea will stop naturally. Patients with rashes do not fear diarrhea, as diarrhea allows the pathogenic heat of the Yangming meridian to be resolved, which aligns with the principle of resolving both interior and exterior. Post-rash diarrhea and bloody/purulent stools are caused by heat pathogens sinking inward. Astringents are strictly forbidden; only ascending and dispersing methods should be used. Formulas may include Ephedra Stem (Mahuang), Licorice Root (Gancao), Kudzu Root (Gegen), Coptis Rhizome (Huanglian), White Peony Root (Baishao), and White Hyacinth Bean (Baibidou). Add Talcum (Huashi) powder for bloody/purulent stools; self-healing is expected. If there is truly upper heat and lower cold, or upper excess and lower deficiency, treat it as a deficiency syndrome using contrary treatment methods (treating false signs with opposite nature drugs), and do not use cold-natured drugs for direct treatment. For instance, in severe winter cold, if rash toxin is constrained internally and cannot emerge, do not mistakenly administer cold drugs like Gypsum Fibrosum (Shigao), Bamboo Leaf (Zhuye), or Tamarix Herb (Xihe Liu). Instead, use Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), Cicada Slough (Chantui), Notopterygium Rhizome (Qianghuo), Green Onion White (Congbai), and Coriander Fruit (Yansui), plus one dose of Ephedra Stem (Mahuang) fried with honey wine. This will stop the condition immediately; do not overuse.

Post-rash gum rot (Ya Gan) is most critical. Externally, apply the tip of fresh yellow cow dung (preserved property), ground into an extremely fine powder, mixed with one fen of real borneol (Pian Nao), and insufflated into the mouth. Internally, decoct Forsythia Fruit (Lianqiao), Kudzu Root (Gegen), Schizonepeta Spike (Jingjie Sui), Angelica Dahurica Root (Shengma), Scrophularia Root (Xuanshen), Coptis Rhizome (Huanglian), Licorice Root (Gancao), and Rehmannia Root (Shengdi) in water, mixed with 20-30 spoons of fresh buffalo horn juice. Delay leads to incurability. If the spleen qi is deficient and cold, failing to anchor the yin fire of the lower jiao, causing gum rot and mouth ulcers, formulas like Lizhong Tang (Regulate the Middle Decoction) are appropriate, and the fire will recede. In general, medication should be based on pulse diagnosis. Do not rigidly assume all measles cases are heat-toxin, as diseases differ significantly in their initial, middle, and terminal stages.

After the rash subsides, slight cough indicates residual toxin. Use Qingfei Yin (Clear the Lung Drink) combined with Xiaodu Yin (Detoxify Toxin Drink). If cough is severe with panting, continuous and unceasing, named Dun Sou (Spasmodic Cough), and severe cases involve vomiting food/fluids or hemoptysis, this is heat-toxin attacking the Lung. Administer Maidong Qingfei Yin (Ophiopogon Clear-Lung Drink) with Forsythia Fruit (Lianqiao). If chest elevation like a mound, shoulder shrugging, bleeding from anus/nose, head shaking, and complexion changes (white, blue, or red/dull) occur, it is untreatable. However, panting due to Lung qi deficiency, continuous without cough/hemoptysis/choking, should be treated with Qingfei Yin (Clear the Lung Drink) with doubled Ginseng (Renshen). Do not stubbornly attribute it solely to lung heat and use only clearing-lung detoxifying drugs.

Rashes appear milder than smallpox, but improper management can lead to rapid disaster. Smallpox arises from fetal toxin, allowing prediction of severity and prognosis. Rashes arise from seasonal pathogens; mild cases can become severe, and severe cases mild, depending on proper management. Therefore, dietary and medicinal taboos must be observed moderately. Smallpox patients especially need balanced medication. Sores after scarlet fever indicate residual heat in the Ying (Nutrient) level. Use Honeysuckle Flower (Jinyinhua), Schizonepeta Spike (Jingjie Sui), Forsythia Fruit (Lianqiao), Scrophularia Root (Xuanshen), Licorice Root (Gancao), Rehmannia Root (Shengdi), Bi Shi Shen (a specific herb name from text), Ephedra Stem (Mahuang), and Akebia Caulis (Mutong), decocted strongly for drinking. Treatment of Sha Zhen should not merely address symptoms but treat the root. The root is the pathogenic heat in the Hand-Taiyin Lung and Hand-Yangming Large Intestine meridians. Resolving this heat causes all symptoms to recede.