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Shazhen (Scarlet Fever/Rash) is a condition caused by the interaction of fetal toxins with epidemic seasonal pathogens. It differs from smallpox. Its prognosis depends on the pathogenic heat's trajectory: initially originating in the Spleen and flowing to the Heart, it remains harmless if entering the Lung or Kidney; if entering the Liver, it causes uncontrollable tearing; if entering the Lung, it causes persistent runny nose, severe coughing, and restlessness. Under light, the rash appears faintly beneath the skin; upon touch, it feels distinctively raised between the muscle and skin. Its shape resembles scabies, its color resembles cinnabar, appearing and disappearing intermittently. Swelling accompanied by partial concealment, with bright red skin, indicates a favorable outcome; blackness resembling coal is most dreaded, with almost no survivors. Epistaxis (nosebleed) is preferred as it allows toxin release; cooling of the body is auspicious; sore throat is ominous. Treatment should focus on generating fluids and nourishing blood. For poor appetite, rescue the Stomach and harmonize the Spleen; for constipation, promote unblocking and purging; for stagnant heat, resolve the muscle layer to restore harmony. If the rash persists continuously for three to four days without receding, it indicates excessive toxic fire, requiring immediate use of Huaban Tang (Spot-Resolving Decoction) and Jiedu Tang (Detoxification Decoction). Delayed or slow eruption also belongs to unresolved exterior patterns. Acidic substances like vinegar, plum juice, and cold water are strictly contraindicated. Chicken, fish, and five pungent spices are permissible after seven weeks.

"Sha" refers to macular spots. Reddish spots without papules indicate Sha-rash. Small-headed Sha that appears and disappears rapidly, recurring repeatedly, results from Heart Fire invading Lung Metal, complicated by phlegm. Some resemble Taiyang disease erupting from the exterior, treated with Baihu Tang (White Tiger Decoction), Xuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction), or Huaban Tang. Methods involving sweating or purging can be considered within Tongsheng San (Universal Salvation Powder). Black Sha indicates gastric necrosis and is incurable.

Baoyuan Tang contains Ren Shen (Ginseng Radix et Rhizoma) 2 qian, Huang Qi (Astragali Radix) 3 qian, Gan Cao (Licorice Root) 1 qian, water 1.5 zhong, and Ginger 1 jin [Note: likely a textual error for smaller quantity], decocted and taken orally. This formula was originally created by Mr. Li Dongyuan. Its properties are mild and sweet-warm, specifically tonifying Middle Qi, clearing deficient fire, securing the exterior, assisting Yang, protecting internally so Yin Blood adheres. When Qi and Blood are harmonious and true Yuan Qi is intact, smallpox will not deteriorate, which is evident. Hence named Baoyuan Tang. Three days prior to eruption, during tidal fever, adjust dosage according to the child's size. Add Su Ye (Perilla Leaf) 1-2 qian. If anorexic due to Qi stagnation, add Shan Zha (Hawthorn Fruit) and Mu Xiang (Aucklandiae Radix). If heat is severe, add Bo He (Menthae Haplocalycis Herba) and Gan Ge (Puerariae Radix). If toxin obstruction prevents eruption, add Gui Zhi (Cinnamon Twig) for its acrid dispersing action. On the second to third day, when marks appear, the modified main formula uses Ren Shen 8 fen, Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Huang Qi each 1 qian, Gan Cao 3 fen, Wu Wei Zi (Schisandrae Fructus) 3 fen, one slice of Ginger, and two Jujubes, decocted and taken. If the eruption is smooth, add Dang Gui (Angelicae Sinensis Radix) and Gou Qi Zi (Lycii Fructus). If adverse, add Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Gui Zhi each 3 fen. If thirsty, add Mai Men Dong (Ophiopogonis Tuber) and Tian Hua Fen (Trichosanthis Radix). During the pustule formation phase (three days), the modified main formula uses Ren Shen, Huang Qi, Bai Zhu, Gan Cao, Mai Men Dong, Chuan Xiong, Shu Di Huang (Rehmanniae Radix Preparata), Dang Gui, plus Ginger, Jujube, and Glutinous Rice, decocted and taken. For weak stomach, add Shan Zha. If pus fails to form, add Bai Jiu (White Wine) and Ren Ru (Human Milk). If forehead lesions fail to rise, add Chuan Xiong. If facial lesions fail to rise, add Sheng Ma (Cimicifugae Rhizoma). If abdominal lesions fail to rise, add Jie Geng (Platycodonis Radix). If waist and leg lesions fail to rise, add Niu Xi (Achyranthis Bidentatae Radix). If hand lesions fail to rise, add Gui Zhi. For reversal/cold limbs, add Fu Zi (Aconiti Lateralis Radix Preparata). For diarrhea, add Chi Fu Ling (Poria with Hostwood) and Bai Shao (Paeoniae Radix Alba). For cold-type diarrhea, add Chao Gan Jiang (Fried Zingiberis Rhizoma). For rapid scabbing, add Chai Hu (Bupleuri Radix), Lian Qiao (Forsythiae Fructus), Huang Qin (Scutellariae Radix), and Bai Shao. For delayed scabbing, add Gui Zhi and Gan Jiang. During the scab shedding phase, the main formula uses Chen Pi (Citri Reticulatae Pericarpium), Bai Zhu, Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma Preparatum), Dang Gui, Zhi Shi (Aurantii Fructus Immaturus) 8 fen, Gan Cao, plus Ginger, decocted and taken. If scabbing is delayed, add Ren Shen, Huang Qi, Sheng Ma, and Jujube. If scabs fall quickly, add Huang Qin and Lian Qiao. For painful lesions, add Chi Shao (Paeoniae Radix Rubra), Huang Lian (Coptidis Rhizoma), Huang Qin, and Zhi Zi (Gardeniae Fructus fried). For itchy lesions, add Qiang Huo (Notopterygii Rhizoma et Radix), Bai Zhi (Angelicae Dahuricae Radix), Ji Li (Tribuli Fructus), Chi Shao, and Chan Tui (Cicadae Periostracum). For Qi deficiency, add Ren Shen, Huang Qi, Bai Zhu, etc. Other formulas are listed subsequently.