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Shou (a person's name) was once mistakenly treated by a quack doctor; is this not truly heartbreaking! Generally speaking, the initial symptoms of macules and papules (rash) often include coughing, body temperature rising with high fever, redness of the face and all four limbs, headache and lower back pain, yellowish eyes, excessive sleepiness, convulsions during sleep, cold extremities, cold ear tips and sacrum, dark urine, and constipation. The pulse at the cun, guan, and chi positions on both wrists is surging, rapid, extremely large, and irregular. These are the characteristic signs. For infants who are still nursing, the mother may also take the medicine concurrently. If the symptoms are not yet fully manifested or are unclear, only Shengma San (Cimicifugae Powder) should be used to resolve the exterior and vent the rash; if the symptoms are already clear, cooling purgatives such as Dahuang Qingdai San (Rhubarb and Indigo Naturalis Powder) can be used to purge heat via the bowels, followed immediately by Baihu Tang (White Tiger Decoction). (Both Shengma San and Baihu Tang are detailed in the chapter "Macules and Papules: After Eruption but Not Yet Fully Out.") In autumn and winter, or during spring when it is still cold, before using Baihu Tang, one may simply add dates for decoction, without strictly adhering to conventional methods. Zhang Zhongjing stated: "After the fourth month, when the weather becomes very hot, Baihu Tang can be administered." (The formula is the same as above.) This is merely a general guideline. In principle, if the rash has not yet erupted, purgation may be used; if it has erupted, purgation should be avoided; once the eruption is established, promoting urination and defecation is appropriate. For those that have erupted but are not coming out smoothly, Zicao San (Arnebiae Powder), Jiusheng San (Life-Saving Powder), or Dai Mao San (Trionyx Powder) may be given. For severe cases, Niuli Gao (Ox Plum Ointment) can be used to dissipate toxicity. (Both formulas are detailed in the chapter "Macules and Papules: Inverted/Receding.") If toxic heat attacks the throat, a small amount of Zixue (Purple Snow) combined with Rusheng Tang (Like-Sage Decoction) can be administered, which is invariably effective. (Both formulas are detailed in the chapter "Macules and Papules: Attacking the Throat causing Pain.") For residual heat that does not resolve, accompanied by fever, restlessness, thirst, or for the nursing mothers of children with rashes, Ganlu Yin (Sweet Dew Drink) is suitable. (Formula detailed in "Resolving Residual Toxicity after Macules and Papules.") If there is blood in the stool, Niuhuang San (Calculus Bovis Powder) should be used for treatment. (Formula detailed in "Macules and Papules: Pus and Blood in Stool.") Simultaneously, it is advisable to soothe the Liver Qi and resolve stagnant heat. One must worry about toxic heat attacking the Liver, which could then rush upward to the eyes, causing internal opacities (cataracts/pannus); if not treated urgently, the pupil will be damaged, so extra caution is required. However, while the rash has erupted but is not yet settled, it is strictly forbidden to contact unrelated people, lest the exertion of laborers or the odor of fox-smell individuals cause irritation. Until recovery, exposure to wind must be avoided, as wind exposure will lead to sores and scabies. If pus discharges, burning black Choufen (Semen Phaseoli Tomentelli Ash) and applying it to the sore will result in healing without scarring. Around the patient, Coriandrum sativum (Hu Sui) should never be lacking, as it can repel sweat odor and foul air. If the child can eat solid food, grapes may be given occasionally in small amounts, as they promote urination and facilitate the smooth and rapid eruption of the rash like an ear of grain. Pediatric macules and papules are originally caused by accumulated heat in the fetus, combined with over-warming during upbringing, leading to sudden stomach heat that erupts at the opportune time. The *Waitai Mi Yao* states: "When the stomach rots, macules appear; mild cases show red macules; extreme cases show black macules." Red macules indicate five deaths for every one survival. Black macules indicate ten deaths for every one survival. Heat in the fu organs results in papules (zhen), indicating shallow heat. Heat in the zang organs results in pustules/variolae (dou), indicating deep heat. Therefore, the *Zheng Se Lun* states: Large lesions belong to Yin, small lesions belong to Yang. I, Ji, came of age early; due to frequent illness, I took up medicine. In recent years, I have practiced in various places. During the Ren Shen year, there was no heavy snow in winter, and the weather was unusually warm. By early spring, many children were suffering from macules and papules. Physicians generally followed the aforementioned methods, such as administering Baihu Tang. I secretly laughed, thinking: "Baihu Tang is intended for adults." They did not realize that Sun Simiao argued that the treatment principles for adults and children are not different, only the dosage varies. This ignorance of dosing methods leads to many errors. Now, I have selected formulas from various schools and those personally verified as effective, compiling them into this book.

*Liu Family Tradition*: Chu Yushi compared phlegm-saliva to the qi of mountains and marshes, which is incorrect. Mountain and marsh qi is merely steaming and moistening; thus, even mountain rocks can be permeated by it. For example, steam from a steamer pot moistens both inside and out. However, excreted phlegm-saliva is thick, turbid, and obstructive, unlike mountain and marsh qi. Phlegm-saliva in stroke patients is like fish bladder glue, unbreakable; how could it enter the joints? Although Chu Yushi’s *Bi Yong Fang* (Essential Formulas) is highly beneficial to the world, his assertion that stroke patients should not be vomited and that pediatric macules/papules should be converted into diarrhea are two statements that have misled many. Converting pediatric macules/papules into diarrhea causes deficiency, allowing toxic qi to attack internally, resulting in death in nearly all cases.

*Zhang Family Tradition*: Xingxing San (Awakening Powder), originating from the *Tai Ping Hui Min He Ji Ju Fang*, is extremely effective as the first medication for children with typhoid fever and high fever. It should be followed by Renshen Qianghuo San (Ginseng and Notopterygium Powder). If high fever persists, do not administer laxatives or cooling medicines, lest it be mistaken for macules/papules. Administering cooling medicines in this case would be a mistake.