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In childhood, various febrile diseases (feverish conditions) often occur simultaneously with sand-rash (a type of exanthem). However, febrile diseases are known from the onset; whereas for sand-rash, its pathogenic toxin tends to lie latent internally without external manifestations initially. It may take several days to appear, or it may fail to emerge spontaneously, requiring the administration of herbs that release the exterior to facilitate its emergence. If one wishes to prevent complications proactively, when treating febrile diseases, one should add a small amount of herbs that clear heat and release the exterior to treat sand-rash. Otherwise, there is a risk that the toxin will knot up internally and fail to be expelled, in which case the febrile disease also cannot be cured. In my decades of clinical practice, I have treated countless cases of febrile diseases complicated by sand-rash. In all these cases, I consistently added a small amount of herbs that clear heat and release the exterior to treat sand-rash to the formulas for febrile diseases, to prevent the sand-rash toxin from being retained internally and failing to penetrate outward. Consequently, it often happens that a febrile disease, after ten days of treatment by other physicians without improvement and presenting a critical condition, can be cured once the sand-rash emerges under my care. Herein, I briefly record several cases as evidence.

Case 1: A young girl of the Ma family in Fengtian, aged six or seven, contracted a warm disease. After multiple treatments, her condition worsened after more than ten days. Her family resigned themselves to fate and ceased treatment. Coincidentally, a young boy in her clan house had suffered from a critical condition which I had cured. This led them to reconsider that their daughter’s illness was still treatable, and they earnestly requested my consultation. Her pulse was rapid and forceful; her skin was hot, dry, and rough; she tossed and turned restlessly in bed, and her mind seemed extremely irritable. I reasoned that due to the prolonged illness, yin deficiency had occurred, making her unable to withstand the scorching heat of the external contraction, or perhaps the toxin of sand-rash was hidden internally and had not yet emerged, thus causing this clinical presentation. Upon inquiry, her bowel movements occurred only once every few days. I prescribed the following: Raw Gypsum Powder (Shi Gao) 2 liang, Radix Codonopsis (Lu Dang Shen) 4 qian, Radix Scrophulariae (Xuan Shen), Fructus Asperi (Tian Dong), Rhizoma Anemarrhenae (Zhi Mu), and Raw Dioscoreae Hypoglaucae Caulis (Sheng Huai Shan Yao) each 5 qian, Flos Forsythiae (Lian Qiao) and Radix Glycyrrhizae (Gan Cao) each 2 qian, Periostracum Cicadae (Chan Tui) 1 qian. Decocted in two zhong of water, taken in divided doses while warm. After two doses, the high fever subsided, and bowel movements became regular, but her spirit remained restless and agitated. On re-examination, her pulse was weaker and floating compared to before. I suspected that the pathogen had returned to the exterior and that the remaining residual heat could be resolved through sweating. Therefore, I administered 2 fen of Aspirin dissolved in white sucrose water. She sweated slightly all over her body, and some white sand-rash emerged, leading to recovery. It was then understood that her previous restlessness was due to the unemerged white sand-rash. Because each dose contained herbs that release the exterior, the pathogen easily returned to the surface, and the sand-rash toxin was easily expelled along with the sweat-inducing action of the herbs.

Case 2: Another case involved a five-year-old girl of Liu XX in Fengtian. She presented with generalized fever, upper jiao irritability and thirst, lower jiao loose diarrhea (slippery diarrhea), which persisted for a long time. Her spirit was confused and lethargic, reaching a critical state. Her pulse was rapid and weak, disappearing upon heavy pressure. I prescribed: Raw Dioscoreae Hypoglaucae Caulis (Sheng Huai Shan Yao) 1 liang, Talcum (Hua Shi) 8 qian, Flos Forsythiae (Lian Qiao), Raw Paeoniae Radix Alba (Sheng Bai Shao), and Radix Glycyrrhizae (Gan Cao) each 3 qian, Periostracum Cicadae (Chan Tui) and Cornu Saigae Tataricae (Ling Yang Jiao - decocted separately and drunk as water, retaining efficacy even after repeated decoctions) each 1.5 qian. Decocted in 1.5 zhong of water, taken in three divided doses while warm. Following the medication, white sand-rash emerged all over her body, and both the upper jiao irritability/thirst and lower jiao loose diarrhea were cured.

Note: This formula is Ziyin Xuanjie Tang (Nourishing Yin and Releasing Resolution Decoction) plus Cornu Saigae Tataricae (Ling Yang Jiao). For children who develop slippery diarrhea immediately upon contracting a warm disease, it is especially necessary to prevent the sand-rash toxin from lying latent internally and failing to exit (since slippery diarrhea weakens the body, often leaving insufficient strength to push the sand-rash toxin outward). This formula can both clear heat and stop diarrhea, and expel the toxin via the exterior, hence curing the disease with a single prescription.

Case 3: The son of Wang XX in Fengtian, aged twenty-eight, presented with generalized fever and dense white sand-rash. Due to improper medical management, the condition persisted for ten days and worsened. The physician intended to use Da Qing Long Tang (Major Blue Green Dragon Decoction) minus Raw Gypsum. Mr. Wang suspected the formula's heating nature and dared not use it, so he invited me to consult. He had generalized fever, but not severe heat; his pulse was rapid at five beats per breath, seemingly forceful but not surging and solid; his tongue coating was dry and black; his speech was incoherent; his heart seemed palpitations (palpitation) and irritable; he felt unbearable discomfort. His family stated that before falling ill, he had indeed overworked his mind, leading to this disease. Considering the pulse and symptoms, I determined that his true yin was deficient internally, and the external excess heat was further consuming and burning him, resulting in such dryness of the tongue and such palpitations/irritability. Inquiry revealed no bowel movement for several days; he felt the urge to defecate but could not pass stool. I prescribed: Raw Gypsum Powder (Shi Gao) 3 liang, Radix Codonopsis (Lu Dang Shen) 5 qian, Raw Dioscoreae Hypoglaucae Caulis (Sheng Shan Yao) 5 qian, Rhizoma Anemarrhenae (Zhi Mu) and Radix Trichosanthis (Tian Hua Fen) each 8 qian, Flos Forsythiae (Lian Qiao) and Radix Glycyrrhizae (Gan Cao) each 2 qian, Raw Rehmanniae Radix (Sheng Di Huang) 1.5 liang, Periostracum Cicadae (Chan Tui) 1 qian. Decocted in three zhong of water, taken in three divided doses while warm. I also instructed that after taking the medicine, enema with a mixture of pig bile and vinegar be administered to promote bowel movement, which the family did. The next day, upon examination, his bowels had moved, and the burning heat, palpitations, and irritability had improved by more than half. The tongue coating remained, but the dryness and blackness had slightly improved. I then reduced the dosage of Raw Gypsum in the cooling formula by half and changed Raw Rehmanniae Radix to 1 liang. After three consecutive doses, suddenly, a rash appeared all over his body, and his bowels moved again, at which point the burning heat, palpitations, and irritability completely resolved. Fearing the rash might emerge too rapidly, I prescribed another formula to clear toxicity and support the exterior to ensure a smooth recovery.

Note: Although this case already presented with sand-rash, I did not anticipate the subsequent appearance of a rash. The inclusion of exterior-releasing herbs in every dose was truly to prevent any remaining sand-rash toxin from being retained internally. The eventual emergence of the rash relied on this strategy. However, if I had not carefully observed the situation at the time and meticulously formulated the prescription, how could such unexpected efficacy have been achieved?

Furthermore, this case does not belong to pediatrics, but since it involved warmth complicated by a rash, I included it here to inform readers that warmth complicated by a rash occurs not only in children but also occasionally in adults.