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Measles rashes float and are small, with distinct granular heads, unlike macules (maculae) which appear as patches of uniform color. At the initial stage, fever must occur first; it resembles cold damage (Shanghan) but is distinguishable. Symptoms include clear nasal discharge, coughing, sneezing, and diarrhea. The eyelids swell slightly, and tears fill the eyes. There may be vomiting or diarrhea, and redness spreads to the cheeks and malar regions. These are signs of measles. Neither sweating nor purging methods are required at this stage. Based on these symptoms, this is a disease of the Lung system and also belongs to epidemic contagious diseases, acquired through transmission.

After the body heat rises, the rash appears most rapidly, emerging all at once, and gradually fades within six shi (approximately twelve hours). It is preferable for the rash to fade slowly rather than quickly; it should take two to three days. When the heat clears and the toxin recedes, it is considered an auspicious outcome. Some cases have a slow eruption, taking three days to disappear; others fade too early, leaving no trace in an instant. This is due to intense heat-toxin causing the skin pores to close tightly, which may lead to unpredictable complications. After the rash has subsided, care must be meticulous. One must strictly observe dietary restrictions and avoid wind-cold invasion. Post-measles complications easily involve cough and asthma, as the toxin flows into the Lung orifices, causing wheezing and rapid breathing, potentially evolving into consumptive tuberculosis (Lao Zhai), characterized by bone-steaming fever, emaciation, and weakness. If the toxin invades the Spleen and Kidney, it leads to extreme emaciation; or frequent diarrhea with green and yellow mixed stools, indicating toxin flowing into the intestines and stomach, causing Qi deficiency that is difficult to restore. Oral ulcers and blackened, rotting gums indicate toxin deeply invading the Liver, leading to imminent death. These four severe conditions are prone to occur after measles; do not underestimate them, lest they become critical. Treatment should follow appropriate methods based on symptom analysis.

Qian Yi stated: The shape and symptoms of measles are similar, but some resemble wind-induced urticaria plaques, rising like cloud tops, red and patchy, appearing and disappearing instantly; some resemble millet grains, appearing repeatedly three times without fading, only starting to recede after three days. All are called measles. During the interval when the rash desires to emerge but has not yet done so, dispersing medicines should be used to facilitate eruption, making it easier to heal. In cases where fever persists for over ten days before the rash appears, the primary focus is on dispersing heat-toxin from the Lung Meridian during the initial phase; regulating and tonifying the post-illness Yuan Qi is the final phase. If there are concurrent Wind, Phlegm, or Food Stagnation, add symptomatic herbs accordingly.

Wan Quan stated: Small and fragmented rashes relate to the Fire of the Shaoyin Heart. The Heart and Lung reside in the upper Jiao; excessive Heart Fire affects the Lung. Treatment of measles focuses primarily on the Lung. Coughing indicates Fire flaming upward causing the Lung lobes to dry and wither. Clear nasal discharge occurs because the nose is the orifice of the Lung, and Fire scorching Metal causes fluids to flow freely. Tears from the eyes occur because Lung Heat transfers to the Liver, whose orifice is the eye. Scratching eyebrows, eyes, lips, nose, and face are also signs of Lung Heat. The main concern in treating measles is ensuring the rash erupts fully; once fully erupted, the toxin resolves. Therefore, during fever, one must observe seasonal temperature variations to choose dispersing herbs. In severe cold, use Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction); in severe heat, use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) combined with Renshen Baihu Tang (Ginseng White Tiger Decoction); in mild conditions, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins). If accompanied by epidemic qi, use Renshen Baidu San (Ginseng Powder to Overcome Toxins).

Wenren Long stated: Measles initially resembles cold damage, presenting with fever, cough, nasal congestion, facial swelling, and thick sticky sputum, all being Lung Meridian symptoms. Some later develop diarrhea, while others present with diarrhea from the onset. The Lung and Large Intestine are exterior-interior pairs, so both are diseased. One must avoid wind-cold exposure and eating during peak fever, as this can turn mild cases severe.

Zhu Zhenheng stated: Mottled rash toxins are caused by Lung and Stomach heat-toxin steaming onto the skin, resembling bites from mosquitoes or fleas.

Li Chen stated: Rashes resemble millet, are slightly red, hidden under the skin, cause itching, and have no pain. "Ma" (smallpox-like rash) is smallest, hidden like hemp seeds, flat and soft to the touch, possibly with clear fluid. Smallpox often accompanies rashes, and measles often accompanies rashes, hence the term "Douzhen Ma". For early-stage measles, Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) with Congbai (Scallion Stem) and Zisu (Perilla Leaf) is a divine formula. Su Ge Tang is also good, or Jiawei Baidu San (Modified Powder to Overcome Toxins) for dispersion. After sweating, if the body cools and red marks vanish, it is good. Death occurs if measles do not erupt and asthma develops, or if black spots form. Death also occurs if residual toxin attacks internally after measles, causing picking at clothes, delirium, and coma.

Shi Yanshan stated: Rashes prefer coolness, while pustules prefer warmth. However, early-stage rashes require warmth to facilitate eruption. Once fully erupted, the toxin resolves. Generally, during the emergence phase, even if cold, do not use Guizhi (Cinnamon Twig); even if deficient, do not use Renshen (Ginseng) and Baizhu (Atractylodes); even if vomiting with phlegm, do not use Banxia (Pinellia) and Nanting (Arisaema).

Wang Kentang stated: Fever for six to seven days indicates measles, but if it does not erupt, it is due to dense skin and closed pores, or wind-cold invasion, or prior vomiting/diarrhea indicating latent pathogen. Urgently use formulas that support interior and disperse exterior, such as Mahuang Tang (Ephedra Decoction) mixed with Baimo San (Black Ink Powder). Externally, apply Huixu Jiu (Coriander Wine) and scrape the body. Sweating or epistaxis during measles fever need not be stopped, as this is part of the dispersing process. Fever with vomiting/diarrhea indicates internal逼迫 by Fire Evil, purely a heat syndrome, not cold. For upper Jiao vomiting, use Huangqin Tang (Scutellaria Decoction) with Maogen (Imperata Rhizome), Lugen (Reed Rhizome), and Pipaye (Loquat Leaf). For lower Jiao diarrhea, use Huangqin Tang with Xianglian Wan (Fragrant Coptis Pill). For middle Jiao vomiting and diarrhea, use Huangqin Tang with more Maogen and Lugen, mixed with Liuyi San (Six-to-One Powder). For dysentery, use Jiawei Huangqin Tang with Liuyi San. Sore throat during eruption is due to toxic fire ascending; treat with Ganjie Tang (Licorice and Platycodon Decoction) plus Yuanshen (Scrophularia), Niubangzi (Arctium Seed), and Lianqiao (Forsythia), or Shegan Niuzibangzi Tang (Belamcanda and Arctium Decoction). Reddish rash is preferred; pale white indicates insufficient Heart Blood, treat with Yangxue Huaban Tang (Nourish Blood and Resolve Macules Decoction). Deep red or purple indicates Blood Heat, or violent eruption, treat with Daqing Tang (Isatis Decoction). Black indicates death. If high fever persists after eruption, toxin is blocked; use Daqing Tang to resolve the exterior. If urine is scanty, use Huanglian Jiedu Tang (Coptis Detoxification Decoction) combined with Baihu Tang (White Tiger Decoction) to resolve the interior. If constipated, use Sishun Qingliang Yin (Four-Obedience Cooling Drink). Post-measles fever with sudden convulsions is not acute wind-stroke; use Daochi San (Guide Out Red Powder) with Renshen and Maidong, sending Anshen Wan (Calming Spirit Pill). Do not eat while high fever persists, same as cold damage.

Gong Xin stated: Drink Congbai Tang (Scallion Decoction) to induce eruption. If thirsty, only use Congbai Tang to moisten, keeping pores slightly moist. If not resolving after three days, there is excess internal heat; use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to resolve it.

Weng Zhongren stated: Measles and smallpox start similarly but end differently; origins are same, symptoms differ. Smallpox arises from the Five Zang organs, measles from the Six Fu organs. Measles first moves in the Yang divisions, then returns to Yin meridians; thus, its manifestation is Yin, but its root is Yang. During fever, Qi and Blood struggle, leading to Blood depletion. Treatment first disperses and moves Qi, then nourishes Yin and tonifies Blood. Drugs that move Qi aggressively are contraindicated.

Shen Jin'ao commented: Mr. Weng's theory comprehensively covers the etiology and treatment of measles, constituting a famous discourse.

In observing measles, signs often first appear behind the ears, on the crown, and in the waist-kidney area. The granules are large but not elongated, small and uniform. After eruption, if the color is purple-red, dry, dark, and dull, it indicates excessive Fire and intense toxin; treat with Liuyi San (Six-to-One Powder). Use Siwu Tang (Four Substances Decoction) replacing Shudi with Shengdi, adding Chaihu, Huangqin, Lianqiao, Gegen, Niubangzi, Honghua, etc., to nourish Yin and cool Blood, eliminating heat—this is the meaning of "nourishing Yin to retreat Yang." If the rash disappears early upon exposure to wind and is not clear, use Xiaodu Yin (Detoxification Drink) with dispersing herbs. Although it may not re-emerge, recovery will follow.

Tu Gui stated: Rashes belong to exterior pathogens of Yang Fu meridians; initial treatment must be from the exterior. Symptoms include headache, asthma, cough, coarse breath, and vomiting. Eruption within one to two days is mild; three to five days is severe. If Yang disease persists beyond seven days without clear eruption, the pathogen turns inward, causing unceasing asthma, abdominal pain, distension, constipation, and danger. Treatment should use bitter-pungent clearing heat, such as Liangge San removing Xiaoshi and Dahuang. Formulas state that Foot-Yangming Stomach rashes are dense like clouds or large like pustules but lack roots. Hand-Taiyin Lung rashes have only granules, not patches. Use pungent-dispersing muscle-relaxing methods. In winter, with no sweat, high fever, and asthma, use Mahuang Xingren formulas like Huagai San or Sansao Tang. In summer, use pungent-cool muscle-relaxing methods with Gegen, Qianhu, Bohe, Fangfeng, Xiangru, Niubangzi, Zhike, Jiegeng, Mutong, etc. Ancients added Gegen for thirst due to exterior pathogen to raise Stomach fluids. For severe heat-thirst, use Shigao (Gypsum) for pungent-cool dispersion; contraindicated if no sweat. Lianqiao is pungent-cool, superior among herbs, capable of ascending and clearing, best for pediatrics. Treating six-meridian heat in children. Rashes should be purged; diarrhea is favorable; dysentery with five colors is acceptable. Only difficulty in urination and defecation indicates fatal prognosis. Purging diarrhea is strictly forbidden. Sha originates from six climatic evils, transforming into Fire. When Sha erupts externally, people say the pathogen penetrates, but emergence involves descent and reversal. Often, external Sha eruption fails to reduce fever, leading to hoarseness, gum rot, asthma, abdominal distension, dysentery, anorexia, irritability, and coma, resulting in death. This is due to unclear interior syndromes. Differentiate which Jiao is affected most. Upper Jiao uses pungent-cool; Middle Jiao uses bitter-pungent-cold; Lower Jiao uses salty-cold. Spring Sha follows Wind-Warmth; Summer follows Summer-Wind (dampness included); Autumn follows Heat-Dryness; Winter follows Wind-Cold. Sha-Guan with damp-heat steaming causes oral-pharyngeal erosion; if not treated quickly, it leads to cheek perforation, airway closure, and death. Treat early. External treatments use specific formulas. Internal decoctions should be light and bland to resolve upper diseases, or clearing and dispersing. Sha-dysentery is heat-toxin sinking internally, treated similarly to cold damage with協熱 dysentery where stopping occurs when evil is exhausted. Avoid ascending and astringent methods. Mild cases use separating and promoting circulation; severe cases use bitter-cold detoxification.

Shen Jin'ao commented: Formulas call it "Meashei"; Northerners call it "Zhen", Wu people call it "Sha Zi", Zhejiang people call it "Yin Zi". Names differ, but essence is one. Sha-Zhen originates from Lung-Stomach toxin but is primarily a Lung Meridian disease. Thus, formulas mention Hand-Taiyin Lung rashes having only granules. Current cases show distinct granules. Formulas mention Foot-Yangming Stomach rashes dense like clouds, likely referring to Ban Du (Macule-Toxin), which forms patches due to Yangming郁热毒蒸. Sha does not originate from Stomach but specifically from Lung. Even if Sha toxin sinks internally, affecting Stomach, Spleen, Liver, Kidney, these are transformations after incomplete eruption, not the initial meridian. Ancient texts linking "Ban" and "Zhen" imply "Stomach Zhen" refers to Ban, and "Lung Zhen" refers to Sha/Measles. Ye Tianshi stated Sha should be purged, diarrhea is favorable. While Sha should be purged, excessive diarrhea risks incomplete downward expulsion of toxin and blocking upward eruption, deepening toxin entrapment and worsening diarrhea, depleting Zheng Qi. At this point, treatment is difficult. However, Ye's warning against ascending/astringent methods is a golden rule for Sha-dysentery. Treatment should focus on detoxification, dispersing intestinal stagnation. Since Lung and Large Intestine are exterior-interior, clearing intestinal stagnation resolves Lung toxin, without harming Stomach Qi to preserve life force.