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High fever that does not subside requires Fire-Reducing (Jiang Huo); vomiting with irritability and thirst, expelling long worms, requires Fire-Reducing; anorexia requires Fire-Reducing; excessive heat scorching Metal (Lung) causing wheezing requires Fire-Reducing; epistaxis requires Fire-Reducing; difficult urination requires Fire-Reducing; sore throat, mumps, toothache, mouth ulcers require Fire-Reducing; foul-smelling rotting gums require Fire-Reducing. ○ After three to four days of Measles (Ma Zhen), if high fever persists, Yin-Nourishing (Yang Yin) is indicated; if purple spots fail to retract, Yin-Nourishing is indicated; if the pulse is rapid and large, Yin-Nourishing is indicated; night fever, mental restlessness, and toothache require Yin-Nourishing; hoarseness and unclear voice require Yin-Nourishing; red eyes and photophobia require Yin-Nourishing; body itching and dry stool require Yin-Nourishing. ○ If Rising and Dispersing (Sheng San) methods should be used but are not, severe cases may quickly develop wheezing and closure, while mild cases suffer from lingering residual toxins. If Fire-Reducing methods should be used but are not, Lung and Stomach will be injured, leading to hoarseness and irritability/thirst, or gum rot and mouth ulcers. If Yin-Nourishing methods should be used but are not, afternoon tidal fever, emaciation of skin and flesh, and gradual development of Gan Syndrome (a pediatric condition characterized by malnutrition and digestive dysfunction) will occur. ○ The general principle for Measles eruption is to vent through the Exterior (Biao). Once the Exterior is vented, even if Interior Heat is severe, clearing it can lead to recovery; if the Exterior is not vented, toxins sink inward, closing the gates, making both Exterior-releasing and Yin-nourishing ineffective, often leading to death due to delay. ○ "Exterior venting" does not merely refer to the skin and hair level, but must emerge from the Zang-Fu organs. Without a leisurely process, it cannot be considered true Exterior venting. There are cases where Fire-Toxin is extremely severe, presenting with dense red rashes externally, yet still developing gum rot or Lung Abscess after eruption, or suffering from epistaxis and dysentery; this indicates that the toxin within the Zang-Fu has not been vented out. ○ The toxin of Measles and Smallpox originates from the Zang-Fu and emerges outward. Although it reaches the Exterior, its root remains in the Interior. "Jie" (Resolve) refers to resolving from the Exterior, while "Hua" (Transform) refers to transforming from the Interior. If the Exterior is resolved but the Interior is not transformed, many subsequent complications arise. ○ The Lung governs the skin and hair. Although Measles emerges from the Six Fu Organs, it must be resolved through the skin and hair, so treatment cannot depart from the Lung. If Exterior resolution is incomplete, chronic cough and tidal fever may accumulate into Ma-Gan (Measles-related Gan syndrome). This "Gan" character does not refer to Gan Accumulation disease, but implies similarity to Gan syndrome due to tidal fever and emaciation. Treatment should focus on Moisten-Lung (Run Fei); acrid-drying herbs must not be used. ○ Exterior-resolving herbs act on the Yang aspect and Qi aspect, yielding fast and obvious effects; toxin-transforming herbs act on the Yin aspect and Blood aspect, yielding slow and difficult-to-achieve effects. The four characters "Nourish Yin and Retreat Yang" (Yang Yin Tui Yang) from *Jin Jing Lu* are the key secret to treating Measles. ○ Regarding "Nourish Yin and Retreat Yang," the book recommends Si Wu Tang (Four Substance Decoction). In my youth, I frequently used it but rarely achieved efficacy because the acrid-warm nature of Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) was incompatible. Therefore, I formulated a "Measles Si Wu Tang" using Sheng Di Huang (Rehmanniae Radix), Dan Pi (Moutan Cortex), Mai Dong (Ophiopogonis Radix), and Chi Shao (Paeoniae Radix Rubra), which responded effectively at every stage. Ancient formulas need not be rigidly adhered to; learning their intent is sufficient. ○ Post-measles tidal fever is most concerning. It occurs in the afternoon, subsides with coolness at dawn, with a calm pulse during remission and a rapid-large pulse during flare-ups. Red lips, red tongue without coating, teeth grinding, nose rubbing, and progressive emaciation indicate poor prognosis. Occasionally, patients who can eat may be saved with large doses of Yin-nourishing agents. ○ The Stomach is the reservoir receiving toxins, retaining much residual heat. The most urgent among these is Gum Rot (Ya Gan). Gum Rot is a syndrome resulting from failure to clear heat, requiring large doses of Interior-clearing herbs. If constipation is present, purgation can be used to drain heat and toxins internally, similar to post-smallpox treatment. In my previous collection, there is Le Ma Yin (Horse-Restraining Drink); for severe cases, Da Huang (Rhei Radix et Rhizoma) is added for urgent purgation. Delayed treatment leads not only to tooth loss and perforated cheeks, but also rotting lips and nose; topical applications only provide auxiliary support. ○ Post-measles hoarseness is mostly caused by excessive Fire damaging Metal (Lung). Treatment should use Gan Cao (Glycyrrhizae Radix), Jie Geng (Platycodonis Radix), Niu Bang Zi (Arctii Fructus), and Shan Zhi (Gardeniae Fructus). Post-measles mouth ulcers are treated similarly to Gum Rot; foul rot is treated like post-smallpox conditions. In past years, Measles rarely damaged the eyes; recently, eye damage has occurred rapidly, with nebulae covering the pupil within two to three days, rendering it incurable. This is because the child originally had Liver Heat, compounded by depression, or the family mistakenly fed Coriander Wine (Yan Sui Jiu) not recognizing it as a Fire syndrome, allowing Heat-Toxin to attack the eyes. Immediate cooling, Yin-nourishing, and Yang-retreating methods are required; dispersing and diffusing methods must not be used again. ○ Post-measles expectoration of purulent, bloody, and foul-smelling sputum indicates either Lung Abscess or Stomach Abscess, both caused by residual toxins in the Lung and Stomach. Emerging along the meridians leads to Gum Rot; attaching to the Zang-Fu leads to Abscesses. Treatment must distinguish whether the pathology is in the Lung or Stomach. I use Gan Cao, Jie Geng, Niu Bang Zi, Jin Yin Hua (Lonicerae Japonicae Flos), Dou Chi (Sojae Semen Praeparatum), Zhi Ke (Aurantii Fructus), and Chi Shao. For Lung involvement, add Shan Zhi, Bei Mu (Fritillariae Bulbus), and Sang Bai Pi (Mori Cortex); for Stomach involvement, add Sheng Di Huang, Hua Fen (Trichosanthis Radix), and Mu Tong (Akebiae Caulis) as adjuvants. Cases without high fever are treatable. ○ Question: Why are Gum Rot and Lung Abscess treatable? Because the toxin has transformed and exited. If the toxin transforms and the Zang-Fu remain intact, it is treatable; if the Zang-Fu are ruined, it is incurable. (From *Xiang Cun Dou Jue*)

Selected Case 1
A three-year-old child suffered from Malaria and Dysentery for two months without recovery, severely depleting Zheng Qi (Upright Qi), and subsequently contracted Measles. Symptoms included fever, cough, faint measles spots, pale colorless rash, insufficient breath, spiritless eyes, and cold limbs. I stated: Initially, when measles spots first appear, tonification is generally contraindicated. However, given this child's severe Zheng Qi deficiency, extraordinary measures are needed. I prescribed Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Chan Tui (Cicadae Periostracum), and Qian Hu (Peucedani Radix), each 4 fen; Ren Shen (Ginseng Radix), Sheng Ma (Cimicifugae Rhizoma), Gan Cao, and Jie Geng, each 3 fen; plus a small amount of Sheng Jiang (Zingiberis Rhizoma Recens). After one dose, the measles vented. Removing Sheng Ma and adding Niu Bang Zi, after two doses, wheezing ceased, and the measles gradually receded. ○ The grandson of Elder Zhang Peixi developed Measles in deep winter with fever and vomiting. The measles spots were faint and failed to vent. Initial use of dispersing and supporting herbs failed to stop vomiting. Irritability and thirst increased, and Shi Gao (Gypsum Fibrosum) 5 qian was added, but vomiting persisted, expelling eighteen long worms. Suddenly, he fainted and appeared near death. Re-palpation revealed a slippery, rapid, and forceful pulse. This child had inherent Stomach Fire, exacerbated by staying in a hot room with heavy bedding, causing Fire to stagnate internally, injuring Lung and Stomach, and exhausting fluids. This blocked the Exterior Qi. Severe vomiting disturbed the worms, causing them to exit. His fainting and cold limbs resulted from Strong Fire consuming Qi and Deep Heat causing Deep Cold (Re Shen Jue Shen). Examination of lips and tongue confirmed a Fire syndrome; the disease was severe, but the medication was too light. I prescribed Shi Gao 4 liang, Zhi Mu (Anemarrhenae Rhizoma), Huang Lian (Coptidis Rhizoma), Shan Zhi, and Hua Fen, each 1 qian; Sheng Ma, Ge Gen (Puerariae Lobatae Radix), Jing Jie, Fang Feng, Chi Shao, and Niu Bang Zi, each 6 fen; Yan Sui (Coriandri Fructus) 8 fen; Gan Cao 4 fen. After taking the medicine, he was instructed to remove heavy furs. Within an hour, the Fire fully erupted, presenting with high fever, red face, and stacked-like measles eruption. After a second dose, the whole body vented, heat decreased, and the prescription was adjusted by removing Jing Jie, Fang Feng, Yan Sui, and Huang Lian, adding Lian Qiao (Forsythiae Fructus) and Mu Tong, and halving the Shi Gao. By evening, heat surged again with irritability and thirst. Desperate, I reused Huang Lian and Shi Gao at previous dosages, finally allowing him to sleep peacefully with reduced heat. Two to three days later, the measles remained dark purple and scorched, indicating Heat severely damaging Yin. I then used a Yin-Nourishing and Yang-Retreating formula: Sheng Di Huang 5 qian, Dan Pi and Mai Dong, each 3 qian; Jie Geng, Niu Bang Zi, Zhi Ren (Gardeniae Semen), and Hua Fen, each 1 qian; Shi Gao 5 qian; Gan Cao 5 fen. Over seven days, he consumed 2 jin of Shi Gao and 1 liang of Huang Lian. In decades of treating Measles, no Fire syndrome was more severe than this case. Everyone feared he would faint and collapse, suggesting Du Shen Tang (Single Ginseng Decoction) for infusion. Fortunately, I insisted on cooling methods; otherwise, he would have died instantly. (Xu Xuanzhi)