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Since entering summer, scarlet fever has occurred in various places, spreading through infection. The hot weather causes the disease to increase in number and severity; if treated improperly, it often leads to untreatable conditions. Scarlet fever is nothing other than measles (sha zhen) combined with warm diseases (wen bing). I have experimentally observed cases of measles: if not complicated by warm diseases, before the rash emerges, there are only slight chills and fever, or mild headache, slightly swollen eyelids, slight limb soreness and lethargy, or loss of appetite. After the rash emerges, although both exterior and interior feel feverish, there is actually no intense heat. Treatments that consistently use clearing and releasing exterior agents (for measles, releasing exterior agents are always appropriate, but should be acrid-cool rather than acrid-warm) and detoxifying herbs result in recovery without exception. Even if no medication is taken and one allows the rash to emerge and resolve naturally, self-healing can occur within a week. This is because there is only the heat of the rash toxin, without the assisting harm of warm disease heat, so the illness is easy to cure.

However, when measles is complicated by warm diseases, it is completely different. At the onset, before the rash emerges, there is already intense heat in both exterior and interior, because the heat of the rash toxin has not yet sprouted, while the heat of the warm disease is already blazing. Treatment should combine exterior-releasing and rash-promoting herbs such as Bohe (Menthae Haplocalycis Herba), Lianqiao (Forsythiae Fructus), and Chantui (Cicadae Periostracum) with interior-clearing herbs such as Xuanshen (Scrophulariae Radix), Shashen (Glehniae Radix), and Tianhuafen (Trichosanthis Radix). Lianqiao can be used at 3 qian, Bohe Ye and Chantui each at 1.5 qian, and Xuanshen, Shashen, and Tianhuafen each at 5 qian. A small amount of Jinyinhua (Lonicerae Japonicae Flos) and Gancao (Glycyrrhizae Radix et Rhizoma) can be added for detoxification. If concerned that the rash may not fully emerge, fresh Maogen (Imperatae Rhizoma) 2 liang (or fresh Lugeng [Arundininis Caulis] as substitute) can be boiled in water for a few minutes. Take several bowls of the clear decoction to replace water for decocting other herbs. Decoct into one bowl, take warm. The rash will surely emerge completely. Alternatively, boil several liang of fresh Maogen for four or five boils and drink the decoction as tea, which is even better.

If the rash has emerged externally but fire heat remains intense and has penetrated deep into the Yangming Stomach Fu organ, the tongue coating changes from white to yellow. There is extreme restlessness and heat in the heart, coarse breathing with slight panting, flaring of nasal alae, delirium, meningeal inflammation, dry stool, and dark, scanty urine. This indicates a great excess syndrome of the Yangming Stomach Fu. To treat this excess heat in the Yangming Stomach Fu, Baihu Tang (White Tiger Decoction) from *Shanghan Lun* is an eternal excellent formula. Since it is complicated by rash toxin, add Lianqiao 2 qian and Lingyangjiao (Capri Cervi Cornu) 1 qian (decoct separately and mix, or grind into powder and take orally; alternatively, substitute with Jinyinhua 2 qian). Use fresh Maogen or Lugeng decoction to replace water for decocting. If using Sheng Shigao (Gypsum Fibrosum) 2 liang, decoct into two bowls, take warm in two doses. If using Sheng Shigao 3 liang, decoct into three bowls, take warm in three doses. If heat persists after one dose, continue for several doses until heat subsides and stool does not become loose.

If there is great heat in the stomach fu but accompanied by difficult urination leading to loose stools, Baihu Tang should not be administered immediately. Instead, first use Huashi (Talcum), Sheng Huaishanyao (Dioscoreae Hypoglaucae Rhizoma) each 1 liang, Sheng Hangshao (Paeoniae Radix Alba) 8 qian, Lianqiao and Chantui each 1.5 qian, and Gancao 3 qian (this is my formula Ziyin Xuanjie Tang). Decoct into one bowl and take. Loose stools should stop immediately. If heat persists after diarrhea stops, add Huashi 6 qian to the initial formula to reduce heat. Decoct into several bowls and take warm slowly. Once major heat has subsided and the rash has resolved, but residual heat remains strong, treat again with yin-nourishing, heat-clearing, and detoxifying agents, supplemented by a small amount of exterior-releasing herbs. Use Xuanshen 8 qian, Shashen and Tianhuafen each 5 qian, Lianqiao, Jinyinhua, and fresh Lugeng each 3 qian, and Gancao 2 qian. Can be taken continuously for several doses. As heat decreases, dosage should correspondingly decrease until heat is completely eliminated and administration stops. For these formulas, if throat sha (scarlatina-like throat condition) is present, add Shegan (Belamcandae Rhizoma) and Sheng Puhuang (Typhae Pollen) each 3 qian. Do not add these to the formula for treating loose stools. Externally, apply Pengsha (Borax), Sheng Hanshui Shi (Calcitum) each 2 qian, Meipian (Borneolum Syntheticum), and Bohe Bing (Mentholum) each 1 fen, grind finely, and insufflate into the throat.

Scarlet fever is inherently not dangerous; its danger arises because physicians hesitate to boldly use Baihu Tang when the Baihu Tang syndrome appears. In my treatment, not only can large doses of Baihu Tang be used boldly for great excess in the stomach fu, but even when the rash first appears with intense exterior-interior heat and floating-hong pulse, if the stool is solid, I frequently use Sheng Shigao 1 liang or 1.5 liang decocted to send down Aspirin 2 fen. Profuse slight sweating ensues, the rash fully emerges, and heat subsides.

I once treated a six- or seven-year-old girl who had suffered from a warm disease for half a month without improvement. Her pulse was rapid and forceful, skin hot and dry, mind extremely restless, tossing on the bed unable to sleep. Suspecting yin deficiency from prolonged illness made her intolerant to external heat, or that rash toxin was trapped and unable to emerge, causing this state. Upon inquiry, she had not had a bowel movement for three days. I prescribed a large dose of Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction), substituting Sheng Shanyao (Dioscoreae Rhizoma) for Jingmi (Oryzae Semen Germinalis), adding Lianqiao 2 qian and Chantui 1 qian. Decoct into two bowls, take warm in divided doses. After two doses, stool passed, major heat subsided, but mental restlessness persisted. Re-pulse diagnosis showed the pulse returning to the floating layer. Suspecting residual heat could be resolved via sweating, I gave Aspirin 1 wa dissolved in sugar water. Slight sweating ensued, some white rashes emerged, and the illness cured. Thus, Aspirin can serve as an supreme herb for promoting rash emergence. Shigao, being heavy in substance but light in qi, possesses exterior-releasing properties. Combined with Aspirin, the best exterior-releasing agent, its cooling and dispersing power penetrates outward, transforming into sweat without remaining in the middle jiao (Shigao decoction yields no viscous residue, hence does not remain internally). Therefore, it can be used even when stomach fu heat is not yet excessive. In fifty years of clinical practice, having treated countless such cases, those managed entirely by me were almost all cured.

A student surnamed Xu in Tianjin, eight years old, developed measles in mid-spring of the Gengshen year. The rash appeared for two days then vanished. Family initially disregarded it. Days later, fever returned. His father, knowing medicine, assumed incomplete rash emergence and self-administered exterior-releasing drugs, ineffective. Other doctors also failed. Upon my consultation, pulse was fine, rapid, and forceful; skin very hot; internal heat severe; slight panting; dry cough without phlegm; throat pain; external swelling beside throat like peach pits, painful to touch. This too resulted from trapped rash toxin. Tongue coating was yellow; stool absent for days. Yangming fu heat was confirmed excess. Heat-clearing and exterior-releasing herbs must be combined. Prescription: Fresh Maogen 0.5 jin (chopped), Sheng Shigao 2 liang (crushed), Aspirin 1.5 wa. Boil Maogen and Shigao for four to five boils until Maogen sinks. Take clear decoction, divide into three warm doses. Send down 0.5 wa Aspirin with each dose. Wait two hours between first and second dose. If sweating occurs after first dose, reduce Aspirin for subsequent doses. Following this, next day: upper body showed slight red spots, heat reduced significantly, pulse calmer, throat pain lighter, but stool still unpassed. Adjusted prescription: Maogen 5 liang, Shigao 1.5 liang, Aspirin 1 wa. Decoct first two herbs, divide into three doses with Aspirin. Result: more rash emerged, stool passed, exterior-interior heat reduced by 80-90%, throat pain lighter, but external swellings remained. Fearing rash might vanish quickly as before, prescribed daily fresh Maogen 4 liang boiled as tea. Additionally, Jinyinhua 6 qian, Gancao 3 qian decocted into one cup, taken warm in three doses, sending down one Wan Mei Hua Dian She Dan (Plum Blossom Pointing Tongue Pill) per dose (adults take two pills per dose). After four days, swellings disappeared completely.

Note: The pulse here was fine, rapid, and forceful, not hong-da (large and forceful), suggesting less Shigao might suffice. However, 2 liang or 1.5 liang of Sheng Shigao was used because it was boiled with substantial Maogen, whose residue reduces Shigao's potency. Furthermore, adding Lingyangjiao (Capri Cervi Cornu) 3-4 qian, decocted separately and mixed, could also promote rash emergence. But due to high cost, unaffordable for poor families, I devised using Maogen, Shigao, and Aspirin together as substitutes. Any case suitable for Lingyangjiao can be treated with these three ingredients. Moreover, their combination surpasses using Lingyangjiao alone (see case studies under Lingyangjiao section).