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When Yin and Yang interact, fire toxins remain. In men, who are predominantly Yang, excessive fire invades the Qi level, causing measles toxins to manifest in the Six Fu Organs (Six Bowels). Since the Fu Organs belong to Yang and govern Qi, rashes appear with form but without sweat. Therefore, at the onset of fever, there is intense interaction with the Blood level; treatment from beginning to end should primarily focus on nourishing Yin and tonifying Blood, avoiding any disturbance to Qi. In women, who are predominantly Yin, excessive fire invades the Blood level, causing smallpox toxins to manifest in the Five Zang Organs (Five Viscera). Since the Zang Organs belong to Yin and govern Blood, pustules appear with form and contain pus. Thus, at the onset of fever, there is intense interaction with the Qi level; treatment should primarily focus on cooling Blood and tonifying Qi. This describes the general principles for smallpox and measles; however, since Qi and Blood conditions vary in deficiency and excess, one cannot apply a single rule universally.

In observing measles, lesions typically first appear behind the ears, on the neck, waist, and legs. If the rash tips are pointed but not elevated, small, uniform, and clean, with a red color, it indicates an accompanying Fire transformation. Treatment should utilize herbs such as *Arctii Fructus* (Niubangzi), *Forsythiae Fructus* (Lianqiao), *Bupleuri Radix* (Shengma), *Paeceae Cortex* (Gupi), and *Anemarrhenae Rhizoma* (Zhimu). If the color is white, it indicates Blood deficiency; herbs such as *Angelicae Sinensis Radix* (Danggui), *Paeoniae Rubra Radix* (Chishao), and *Carthami Flos* (Honghua) are particularly suitable. If the color is purple, dry, dark, and dull, it indicates excessive Fire and rampant toxin. The treatment should involve releasing the exterior and resolving toxins, combined with nourishing Yin and cooling Blood, so that heat will naturally subside. This is referred to as "nourishing Yin to retreat Yang." If the color turns black, the heat toxin is extremely severe and difficult to treat; only purgation may offer a slim chance of survival.

During the eruption of rashes, exposure to wind-cold and consumption of raw/cold foods must be strictly avoided. Otherwise, skin pores close, trapping toxic gases, leading to cyanosis of the whole body or the re-absorption of rashes. Toxins may attack internally, causing restlessness, abdominal pain, wheezing, and confusion, leading to imminent death. If rashes emerge and then disappear immediately, without other malignant symptoms, increasing the dosage of diaphoretic agents may save the patient. Although most maculopapular eruptions belong to Yang syndromes, they often stem from internal injury due to improper diet, spleen-stomach deficiency, causing Ying-Qi to flow retrograde. Thus, deficient fire blazes internally, scorching Yin fluids which manifest externally. Internal blazing fire indicates extreme Yin deficiency; external manifestation of Yin indicates Yang also escaping outward.

Commentary by Zhang: Ancients attributed measles to Shaoyin Heart Fire due to their red color, noting they often affect the Lung, presenting with coughs. Macules were attributed to Yangming Stomach Fire, as the Stomach governs muscles. It was established that measles are mostly Excess-Heat, while macules may present as False Yang. However, both macules and rashes generally belong to Fu organ syndromes, representing surplus Blood; rashes appear on muscles with form but no fluid. Recently, cases where fever persists for days before rash appearance are due to extreme heat in the Ying level and boiling Yin blood, resembling macules. Therefore, differentiation should not rely on distinguishing between macules and rashes, but rather on Deficiency and Excess. Excess patterns require direct treatment; Deficiency patterns require following treatment. For Excess macules, use ancient methods for treating measles; for Deficient measles, use methods for False Yang macules. As heavenly Qi becomes thinner and human Yuan Qi diminishes, even apparent Excess syndromes are not truly Excess. Once the pathogen recedes, Zheng Qi (Upright Qi) becomes deficient, which is true Deficiency. Modern physicians blindly adhere to the theory that measles are mostly Excess-Heat, administering cold-cooling drugs indiscriminately. Robust individuals, having solid roots, recover quickly from mild clearing treatments. Weak individuals, already suffering from Yin deficiency and Qi weakness after prolonged high fever, suffer further from diaphoretic, detoxifying, and cold-cooling herbs. Using substantial, draining herbs to attack intangible Deficiency ignores that apparent Excess Yang toxin stems from Yin Blood insufficiency. Discarding appropriate decoctions and Ginseng (*Ren Shen*) in favor of dangerous measles protocols, yet claiming miraculous effects, proves that assuming all difficult cases are Excess-Heat is incorrect.