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Although measles (Ma, 麻疹) originates from fetal toxin (Tai Du, 胎毒), it often carries epidemic qi (Shi Xing Qi, 时行疫气). It is transmitted and formed due to warm and hot climate. Its onset is similar to smallpox (Dou, 痘), but its changes are more severe than those of smallpox. The pathogen first arises in the Yang aspect and later returns to the Yin aspect; the toxin is abundant in the Spleen (Pi, 脾), and heat flows into the Heart (Xin, 心). Among the damage to Zang-Fu organs, the Lungs (Fei, 肺) are particularly severely injured. Throughout the changes of the disease, the Kidneys (Shen, 肾) usually show no symptoms.

Initially, there is fever, resembling Taiyang syndrome (Taiyang Bing, 太阳病). The eyelids are heavy and difficult to open, nasal discharge is clear and unceasing, accompanied by cough, loss of appetite, irritability, thirst, and restlessness. Observing closely under the skin, rashes are faintly visible; touching with hands, granules are distinct between muscles. Their shape resembles mustard seeds, and their color resembles cinnabar. After eruption, if they persist for three days and gradually fade, it indicates safety; if they appear and disappear immediately, wheezing and urgency may occur. If the base is swollen, it is a rash combined with urticaria (Yin Zhen, 瘾疹); if the skin is red, it is a rash combined with macules (Ban, 斑); if the rash is bright like brocade, it may heal without medication; if the rash is black like coal, almost no one will recover.

After the eruption of measles, care is very difficult. One should keep warm when sitting or lying, and the diet should be bland. If there is cough and salivation, sour and salty foods must be prohibited. Sudden wheezing indicates Lung invasion by Wind-Cold (Feng Han, 风寒); burning of Heart and Spleen fire leads to mouth and tongue sores; accumulation of heat in Lung and Stomach leads to excessive flow of body fluids (Jin Ye, 津液). For these different symptoms, treatments differ: mild sweating prevents pathogen accumulation; promoting bowel movement prevents toxin stagnation. For sore throat, irritability, and thirst, detoxification is primary; for delirium and confusion, clearing the Heart is preferred. If pores are blocked and depressed, dispersing and releasing the exterior is immediate; if intestines and stomach are constipated, urgent dredging and unblocking are needed. For purple-dark complexion and coagulated blood, resolving stagnation and cooling blood is required; for swelling of head and face and stagnant Qi, venting, supporting, and lifting are indicated. Epistaxis (Bi Nie, 鼻衄) need not be worried about as the pathogen resolves through bleeding; spontaneous diarrhea should not be forcibly stopped as the toxin loosens through evacuation. Post-measles dysentery often occurs because heat toxin shifts to the Large Intestine (Da Chang, 大肠); cough and sore throat indicate phlegm-heat stagnating in the Heart and Chest. Thirst and irritability require generating fluids and nourishing blood; reduced appetite requires regulating the Stomach and harmonizing the Middle Jiao (Zhong Jiao, 中焦). This is the general principle of measles treatment, requiring profound understanding.

Measles is essentially Rash. Toxin is essentially Fire. Both smallpox and measles erupt from fetal toxin. Smallpox lesions are large and swollen due to Fire of Shaoyang Sanjiao (San Jiao Huo, 三焦火); since Yang aspects are often abundant, they are large and swollen. Measles lesions are small and dense due to Fire of Shaoyin Heart (Xin Huo, 心火); since Yin aspects are often deficient, they are small and dense. Smallpox toxin emerges from Zang organs, while measles toxin emerges from Fu organs. Zang belongs to Yin, which governs Blood, so smallpox has form and fluid; Fu belongs to Yang, which governs Qi, so measles has form but no pus. Smallpox presents both Cold and Heat patterns, whereas measles presents only Heat without Cold. Since symptoms differ, methods differ. Smallpox benefits from internal strengthening and can use tonifying formulas; measles contraindicates internal fullness and only requires dispersion. Although the toxin source is the same, the eruption differs, leading to varied treatments. At the initial stage, prevent exterior deficiency in smallpox and avoid excessive diaphoresis; for measles, ensure complete eruption, where moderate diaphoresis is safe. After eruption, nourish Yin to control Yang for measles, and tonify Qi to generate Blood for smallpox. Severe measles heat boils Yin, causing significant blood depletion; since measles resolves upon eruption, concern lies in Yin deficiency with moving fire and lingering heat, thus nourishing Yin and clearing fire is appropriate. Harsh and drying agents should be strictly avoided throughout. Once smallpox erupts, Qi must hold Blood, and Blood must attach to Qi, achieving success through mutual support during swelling, suppuration, and scabbing, unlike measles which resolves after complete eruption.

However, measles often shows Lung symptoms because Heart and Lungs belong to Yang and reside in the Upper Jiao (Shang Jiao, 上焦). Excessive Heart fire affects the Lungs, causing cough due to fire flaring up and scorching lung tissue. Clear nasal discharge occurs because the nose is the opening of the Lungs. Scratching eyebrows, eyes, lips, nose, and face indicates Lung heat. Therefore, treating measles focuses on Heart and Lungs. Initially, fever resembles Taiyang syndrome, but measles features facial puffiness, red cheeks, cough, sneezing, clear nasal discharge, watery eyes, swollen eyelids, nausea, dry heaving, yawning, sleepiness, vomiting/diarrhea, or scratching face/eyes. These are measles signs, treated with Shengma Gegen Tang (Pueraria Root and Rhizome Decoction). Do not use Guizhi Tang (Cinnamon Twig Decoction) even if cold signs exist; do not use Renshen and Baizhu (Ginseng and Atractylodes Macrocephala) even if deficiency exists; do not use Banxia and Nanxing (Pinellia and Arisaema) if vomiting with phlegm exists. Avoid misdiagnosing as Taiyang syndrome and using sweating or purging methods. Sweating increases heat, leading to epistaxis, hemoptysis, mouth sores, sore throat, irritability, red eyes, and urinary/fecal retention. Purging causes interior deficiency, leading to incontinence or dysentery. This is the summary of treatment.

If fingertips are slightly warm, whole body feverish, aversion to cold, anhidrosis, and bluish-purple complexion indicate Taiyang syndrome heat. If fingertips are slightly warm, fever with sweating, red shiny face, and clear nasal discharge indicate Wind-Cold injury heat. If fever before noon, high swollen yellow eyelids, vomiting/diarrhea, abdominal pain, hot forehead/abdomen, or day-night temperature variation indicates Food Injury heat. If sweaty palms, slight movement of hand collaterals with blue-red color, and frequent startle indicate Shock heat. If red lips, closed bowels/bladder, sweaty hypochondrium, fever, and increased appetite indicate Wind-Heat. Only measles/smallpox heat shows symptoms of all four Zang organs. However, if any of the above symptoms persist, internal and external pathogens interact, and stored toxin may erupt opportunistically.