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In the spring of the Jisi year, my eldest son was just six years old, and my second son was just three years old. On the day following the New Year's Day, both developed fever and exanthema (rash). Initially, I did not understand the root cause of the exanthema. I believed that when infants are born, they hold foul blood in their mouths, which is swallowed upon crying, leading to the subsequent manifestation of toxic rash. Therefore, I reasoned that treating exanthema should naturally involve attacking and venting the pathogen. Consequently, I immediately administered cooling and venting decoctions. The next morning, the rash increased by only about ten spots and failed to vent smoothly, causing me great anxiety and confusion.

My eldest son was born prematurely in the seventh lunar month, possessing a congenitally weak constitution. I asked if his chest and diaphragm felt spacious; he replied that he was extremely hungry. I then asked about his taste sensation, whether it was dry and bitter; he replied that it was very bland. From this, I deduced a deficiency pattern and prescribed a formula containing Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao), Cinnamomi Ramulus (Guizhi), and Carthami Flos (Honghua) for one or two doses. The following day, the rash spread over his entire body, and the fever subsided slightly, but his spirit remained irritable. He experienced nighttime fever and frequent coughing, remaining unstable for a month before finally recovering. This outcome resulted from the excessive use of exterior-releasing agents at the onset of the rash, which depleted the meridians.

My second son was too young to comprehend or communicate. In the previous winter, he had suffered from Lung Wind Phlegm-Wheezing Syndrome, for which various medications were ineffective. However, after administering Mahuang Xinggan Shigao Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction), he recovered with a single dose. I considered his constitutional strength slightly superior to that of his elder brother. His failure to vent the rash was attributed to cold coagulation and severe toxicity. Thus, I prescribed herbs including Perillae Folium (Zisu), Ephedrae Herba (Mahuang), Peucedani Radix (Qianhu), Armeniacae Semen Amarum (Xingren), Scutellariae Radix (Huangqin), and Gypsum Fibrosum (Shigao). The red spots did not increase. Subsequently, I used Perillae Folium (Zisu), Allii Tuberosi Bulbus (Congbai), Zingiberis Rhizoma Recens (Shengjiang), and Coriandri Fructus (Yansui) for fumigation and hot compress application, yet the rash still failed to emerge. I consulted with fellow physicians, who unanimously stated that apart from venting methods, there was no other approach. By the fifth day, the child vomited roundworms. The pediatrician remarked, "This is heat extreme generating worms. I have Niuhuang San (Calculus Bovis Powder), which can be given." Niuhuang San, in this context, referred merely to Polygoni Cuspidati Rhizoma et Radix (Dashu/Dahuang) powder. After one dose, the phlegm-wheezing ceased, and his spirit calmed slightly, but he subsequently became aphonic. With all measures exhausted, I acupunctured Baihui GV20, sealed the Yinmen point, administered a small amount of Moschus (Xihei), and tried various single-herb prescriptions. Observing his physical signs and symptoms, survival seemed impossible. My friend Zhang Weisheng came to visit and said, "This is a case of extreme deficiency and cold. Now that he cannot speak or eat, it is likely hopeless." Yet, unable to bear it, I reluctantly administered Ginseng Radix (Renshen) and Aconiti Lateralis Radix Praeparata (Fuzi). He died while holding the medicine. I sighed deeply, saying, "This is the retribution for quack doctors manifesting themselves. It is the will of Heaven. Since I practice medicine myself, how can I blame others?" I regretted my past errors and firmly believed in the principle of seeking the root cause in treatment.

The next day, a relative by marriage, surnamed Wang, whose son had been suffering from exanthema for three days, saw my grief and did not invite me to consult. Instead, he self-administered a decoction of Peucedani Radix (Qianhu), Armeniacae Semen Amarum (Xingren), Ephedrae Herba (Mahuang), and Gypsum Fibrosum (Shigao) for one or two doses. The rash emerged as twenty-plus spots but could not increase further. The child experienced chest distress and restlessness. Forced to do so, he informed me and requested my consultation. I said, "If you continue to attack and vent, your son will meet the same fate as mine." I urgently prescribed a formula containing Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Ramulus (Guizhi), Poria (Fuling), and Carthami Flos (Honghua). After one dose, the fever subsided, and the child stabilized. Only then did I realize the root cause of exanthema: in treating such conditions, one should only regulate Qi and Blood and harmonize the meridians, completely avoiding cooling and attacking/venting agents. This approach ensured repeated success.

In the spring of the following year, the son of my friend Wu Tixian, aged two, developed exanthema. A pediatrician named Ma Shengze was consulted initially. The venting was unsuccessful, resulting in mental confusion and restless wheezing. I was then invited to consult. Upon arriving at the Wu residence, Brother Ma had already seen the patient. I examined him and identified a deficiency pattern. I told the host, "If we only attempt to vent the rash, it will certainly not emerge, and the child's life will be endangered." The host asked, "What should we do?" I replied, "Only a single dose of warming and tonifying medicine can benefit the Zang-Fu organs, calm the intestines and stomach, and assist Qi and Blood." Brother Ma said, "I have treated him for four days without success; I leave it to your judgment." I immediately prescribed a formula containing Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), Zingiberis Rhizoma (Shengjiang), Cinnamomi Ramulus (Guizhi), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao), Lonicerae Japonicae Flos (Jinyinhua), and Carthami Flos (Honghua). The condition stabilized after one dose. The next day, I used the same formula with an addition of one qian of Ginseng Radix (Renshen). Thereafter, no other medication was needed; the child drank Dushen Tang (Single Ginseng Decoction) continuously for several days and made a full recovery.

Another case involved the son of Xia Yaoru, who developed exanthema with a purplish-dark color and unsettled spirit. I stated, "This is a highly ominous condition; treatment must be precise." I consulted twice, using warming and dispersing herbs both times. The next morning, the family reported, "He is vomiting roundworms. Is there another remedy?" I asked, "Did he take both doses of yesterday's prescription?" They replied, "One dose remains." I therefore prescribed eight fen of Aconiti Lateralis Radix Praeparata (Fuzi) to be decocted with the remaining herbs. There was no news thereafter. Three years later, I visited his home and saw the boy had grown up. I asked, "How did you recover from the vomiting of roundworms during the exanthema last year?" The family answered, "After taking your medicine, due to financial inability to hire further doctors, we relied on Heaven's protection, and he gradually recovered." I silently sighed, "Because of my error, my son died, yet another person lived. Regarding the treatment of exanthema, I have no regrets." I appended this record to this volume. Although it may not be accepted by pediatricians, clarifying the correct principles truly benefits the understanding of the root causes of exanthema treatment in pediatrics, and those with children suffering from exanthema should exercise caution.