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The ancients referred to the disease of "Ma" (smallpox-like rash) as Zhen (Rash). The rash emerges like hemp seeds clustering in bunches. The smallpox emerges like beans forming granules. Both are named after their shapes. The fetal toxin is the same. Smallpox originates from the Five Zang Organs. The Zang organs belong to Yin. Yin governs Blood. Therefore, smallpox has form and contains fluid/juice. Its symptoms include both chills and fever. Rash originates from the Six Fu Organs. The Fu organs belong to Yang. Yang governs Qi. Therefore, rash has form but no pulp/fluid. Its nature is mostly excess heat without cold. Since the symptoms differ, the treatment methods also differ. Smallpox should be treated by solidifying the interior, using tonifying formulas. Rash contraindicates internal solidity; it should only be treated with dispersing and resolving methods. Only during the initial fever stage when releasing the exterior is required do they slightly resemble each other. After eruption, smallpox requires tonifying Qi to generate Blood, whereas Rash requires tonifying Yin to restrain Yang. Why? Because the intense heat of the rash boils and fries the Yin aspect, causing significant depletion of Blood. Therefore, treatment focuses on clearing fire and nourishing Yin, without disturbing the Qi even slightly. Consequently, Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), Ban Xia (Pinellia Tuber), and all other drying and harsh agents should be strictly avoided from beginning to end. People know that smallpox is serious, but they do not realize that Rash kills even more severely. Medical texts neglect this and lack detail, which is truly lamentable.

Regarding the initial fever of Rash: It often resembles Shang Feng (Wind-Cold Injury). However, Rash is distinguished by coughing, sneezing, runny clear nasal discharge, swollen eyelids, watery eyes, facial edema, redness of the cheeks, nausea, and dry retching. Upon observing these signs, it is definitely Rash. At this time, one must carefully avoid Wind and Cold, abstain from meat, fish, and strong flavors, and use medication to disperse and vent, ensuring the skin is unobstructed and the Cou Li (interstices) open, allowing the Rash toxin to emerge.

Regarding the initial emergence of Rash: With yawning, fever, aversion to wind/cold, coughing, sneezing, runny nose, and dizziness, Sheng Ma Ge Gen Tang (Cimicifugae et Puerariae Decoction) is indicated. [Ingredients: Sheng Ma (Cimicifugae Rhizoma), Ge Gen (Puerariae Radix), Bai Shao (Paeoniae Radix Alba) 1 qian each; Gan Cao (Glycyrrhizae Radix et Rhizoma) 0.5 qian.] Decoct together with fresh ginger water. Adding Zi Su (Perillae Folium) and Cong Bai (Allii Fistulosi Bulbus) helps resolve the muscle layer. Profuse sweating is strictly forbidden. This formula is also suitable if the spots are not red. It is a divine prescription for the early stage of Rash.

If Rash erupts but disappears within a day, it is due to being struck by Wind-Cold, causing the Me Du (Measles/Rash toxin) to attack inward. If untreated, it leads to rotting of the Stomach and death. Xiao Du Yin (Detoxification Decoction) can be used. [Ingredients: Niu Bang Zi (Arctii Fructus) 4 qian; Jing Jie (Schizonepetae Spica) 2 qian; Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma) 1 qian; Fang Feng (Saposhnikoviae Radix, de-rhizomed) 0.5 qian.] Decoct in water. Adding Wu Xi Jiao (Rhinocerotis Cornu) is especially excellent.

If Rash erupts and then disappears again, or does not fully erupt, accompanied by palpitations and incessant crying, the condition is extremely critical, with death imminent. If accompanied by dysentery and abdominal pain, Er Xian Tang (Two Immortals Decoction) may be used. [Transmitted by Liu Mengmen of Yanling: Huang Qin (Scutellariae Radix, remove rotten parts), Bai Shao Yao (Paeoniae Radix Alba, raw), equal parts. Decoct in water and take warm; efficacy is miraculous.]

If Rash has erupted and the patient experiences delirium, restlessness, and thirst, Bai Hu Jie Du Tang (White Tiger Detoxification Decoction) can be used. [Ingredients: Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), Zhi Zi (Gardeniae Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma).] Decoct in water.

If Rash has erupted and there is constipation of both stool and urine, Fang Feng Tong Sheng San (Saposhnikovia Powder for Unblocking the Supreme) can be taken. (Formula see section on Zhong Han/Cold Damage).

If Rash has erupted and the patient experiences delirium with urinary obstruction, Dao Chi San (Guide Out the Red Powder) is appropriate. [Ingredients: Sheng Di Huang (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Gan Cao (Glycyrrhizae Radix et Rhizoma), Dan Zhu Ye (Lophatheri Herba) 7 leaves.] Decoct in water.

If Rash has erupted and diarrhea persists, Si Ling San (Four Fungi Powder) can be taken. [Ingredients: Zhu Ling (Polypori Sclerotium), Ze Xie (Alismatis Rhizoma), Bai Zhu (Atractylodis Rhizoma, de-rhizomed), Bai Fu Ling (Poria, de-rhizomed), equal parts.] Decoct in water. If the urine is turbid like rice washings, or if urination is obstructed, add Che Qian (Plantaginis Semen) and Mu Tong.

If Rash has erupted and chills and fever alternate resembling malaria, Chai Ling Tang (Bupleurum and Polyporus Decoction) can be taken. [Ingredients: Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Tuber, halved dose), Zhu Ling (Polypori Sclerotium), Ze Xiang (Alismatis Rhizoma), Bai Zhu (Atractylodis Rhizoma, de-rhizomed), Bai Fu Ling (Poria, peeled), Gan Cao (Glycyrrhizae Radix et Rhizoma).] Decoct with fresh ginger and dates.

If Rash has erupted and there is blood in the stool or urine, hematemesis, epistaxis, or obstruction of both bowels and bladder, with dense rash, turbid heat, redness, and pain, Xi Jiao Jie Du Tang (Rhinoceros Horn Detoxification Decoction) is indicated. [Ingredients: Zhen Xi Jiao (True Rhinocerotis Cornu) 1 qian; if unavailable, substitute Sheng Ma; Sheng Di Huang (Rehmanniae Radix) 0.5 qian; Mu Dan Pi (Moutan Cortex) 1 qian; Chi Shao (Paeoniae Radix Rubra) 1 qian; Huang Lian (Coptidis Rhizoma), Ku Huang Qin (Dried Scutellariae Radix), Huang Bo (Phellodendri Cortex), Zhi Zi (Gardeniae Fructus).] Decoct in water. For hematemesis or epistaxis, add Chao Shan Zhi Zi (Stir-fried Gardeniae Fructus) and administer with Tong Bian (Child's Urine).

If tidal fever persists before and after Rash, indicating Blood deficiency and Blood heat, Si Wu Tang (Four Substances Decoction) can be taken. [Ingredients: Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Bai Shao Yao (Paeoniae Radix Alba), Shu Di Huang (Prepared Rehmanniae Radix). Use Shu Di for Blood deficiency, Sheng Di for Blood heat.] Decoct in water. If thirsty, add Mai Men Dong (Ophiopogonis Tuber) and Xi Jiao Zhi (Rhinocerotis Cornu Juice). If coughing, add Gua Lou Shuang (Trichosanthis Pulvis). If phlegm is present, add Bei Mu (Fritillariae Bulbus) and Chen Pi (Citri Reticulatae Pericarpium, white part removed).

During the active eruption of Rash, even if food intake is poor, as long as the rash color is pale red and moist/lustrous, it is not harmful. This is because the heat toxin is unresolved and excess heat is retained internally, so appetite loss is natural. After resolution, if appetite remains poor, administer two doses of Si Wu Tang added with Shen Qu (Massa Medicata Fermentata) and Sha Ren (Amomi Fructus); appetite will surely return. If Stomach Qi is deficient, reduce the dosage of Di Huang.

If the Rash color is red-purple, dry, and dull after eruption, it indicates excessive Fire and rampant toxin. Use Si Wu Tang with Sheng Di Huang, adding Hong Hua (Carthami Flos) and Jiu Chao Huang Qin (Wine-processed Scutellariae Radix).

If Rash has erupted and fails to disappear after three days, it indicates internal deficiency heat. Use Si Wu Tonifying Decoction. If it is a case of blood loss, add Xi Jiao Zhi (Rhinocerotis Cornu Juice) to resolve toxicity.

After Rash subsides, if gum rot or profuse epistaxis occurs, these are signs of blood loss. Urgently use Si Wu Tang added with Yin Chen (Artemisiae Scopariae Herba), Mu Tong, and Sheng Xi Jiao (Fresh Rhinocerotis Cornu) to promote urination and direct heat downward. If Chan Chuang (infantile malnutrition sores) appear white, it indicates stomach rot, an untreatable condition.

After Rash, one must avoid Wind-Cold and water-dampness. Negligence here may lead to lifelong coughing that never heals.

Before and after Rash, pork, fish, alcohol, and eggs are strictly taboo, as they may provoke lifelong coughing. Only old chicken essence/meat boiled for consumption is suitable, merely to enhance flavor.

For pregnant women suffering from Measles/Rash, use Si Wu Tang with doubled amounts of Bai Zhu and Tiao Qin (Scutellariae Radix), plus Ai Ye (Artemisiae Argyi Folium), focusing on calming the fetus and clearing heat. The fetus will be safe, and the rash will emerge easily. If fetal Qi rushes upward, urgently decoct Zhu Gen (Hemslaea Radix) and Ai Ye, grind raw Bing Lang (Arecae Semen), and take orally. Follow with large doses of Si Wu Tang.

After Rash subsides, if residual heat attacks inward, manifesting as picking at clothes/bedding, delirious speech, confusion, and injury to the spirit, death ensues. If heat is mild and residual toxin remains, observe the complexion. Prevention always prioritizes Sheng Ma Ge Gen Tang. Alternatively, Xiao Du Yin or Jie Du Tang may be selected based on symptoms. Fishy odors, green onions, and garlic remain forbidden.

Huang Lian Jie Du Tang (Coptis Detoxification Decoction): [Ingredients: Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), Zhi Zi (Gardeniae Fructus).] Decoct in water.