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When epidemic febrile disease presents with macules (rash), it indicates that heat pathogenic factors are exiting through the skin and hair follicles. Its mechanism is similar to sweating, so treatment focuses on dispersing wind and clearing heat. However, this differs from rashes caused by other conditions. In other conditions, there may be no interior heat, but in epidemic febrile disease, interior heat is invariably present. Although dispersing the exterior is key, if symptoms such as irritability, thirst, and a yellow tongue coating appear, purgatives like Rhubarb (Da Huang) and Mirabilite (Mang Xiao) must still be used concurrently. In other conditions, the illness resolves once the rash subsides; in epidemic febrile disease, the condition often persists despite repeated eruptions. Other diseases typically resolve within one or two days, whereas the duration of eruption in epidemic febrile disease is indefinite. Treatment principles must be determined by whether the interior pathogen has been resolved, not merely by the presence of a rash.

When epidemic febrile disease presents with petechiae (spots), it indicates that heat pathogenic factors have entered the meridians. Although less severe than battle-sweat (Zhan Han), there is still a mechanism for external resolution. Treatment focuses on cooling blood and clearing heat, selecting from Baihu Huaban Decoction (White Tiger Decoction Modified to Transform Spots), Wu's Ju Ban Decoction (Dr. Wu's Decoction to Raise Spots), or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). This also differs from petechiae in other conditions: in other conditions, recovery follows the disappearance of spots; in epidemic febrile disease, severity is judged primarily by interior syndromes, not by the presence or absence of spots. It is common for delirium to persist after spots appear, or for lethargy to continue even after spots fade over several days. Recovery occurs only when interior heat is completely cleared and urination and defecation become smooth and clear. Therefore, medications for treating petechiae serve as auxiliaries, not primary agents. Both petechiae and macules indicate heat in the meridians rather than the Stomach. Whenever irritability without thirst, red eyes, and a white tongue coating occur, these are precursors to impending petechiae or macules. Preemptive treatment with cooling, exterior-dispersing, and toxin-transmitting herbs facilitates the easy exit and clearance of pathogens.

The aforementioned exterior syndromes of epidemic febrile disease are all related to interior conditions, unlike other diseases where exterior and interior are unrelated. Thus, each preceding item is prefixed with "epidemic febrile disease" to clarify that these are not signs of other illnesses, cannot be treated with methods for other diseases, nor can epidemic treatments be applied to other diseases. Diagnosis relies entirely on assessing Qi (vital energy), complexion, Spirit (Shen), pulse, and tongue coating, ensuring high accuracy. These five aspects constitute both the general outline and the detailed criteria for diagnosing epidemic febrile disease.

"Irritability" (Fan) refers to mental restlessness, emotional instability, and spiritual unease, while physical movements remain normal. "Restlessness" (Zao) refers to physical agitation, such as flailing arms and kicking legs, with physical unrest accompanied by chaotic spirit. Irritability is mild, whereas restlessness is severe. In other conditions, irritability is attributed to the Heart and Yang, while restlessness is attributed to the Kidney and Yin. However, in epidemic febrile disease, both stem from stagnant heat. If heat is shallow and upper, irritability manifests; if heat is deep and lower, the patient gradually becomes lethargic without irritability. Thus, at the onset of epidemic febrile disease, the severity of transmission can be judged by the degree of irritability. Absence of irritability suggests it is not epidemic febrile disease; even if Qi, complexion, Spirit, pulse, and tongue coating provide strong evidence of epidemic febrile disease, it indicates a mild syndrome confined to the exterior without interior involvement.

When chills, fever, and irritability occur at the onset, the pathogen is in the half-exterior, half-interior stage. Options include Sanxiao Yin (Three Eliminations Drink), Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), or Liushentongjie San (Six-Awakening Exterior-Resolving Powder). In deep winter with severe cold and difficulty sweating, Da Qinglong Tang (Great Blue Dragon Decoction) or Weirui Tang (Asparagus Decoction) may be borrowed. If the tongue coating turns yellow, thirst with desire to drink, body heat, sweating, and irritability occur, the pathogen has entered the Stomach. Options include Baihu Tang (White Tiger Decoction), Huangqin (Scutellaria Root), San Chengqi Tang (Three Receipts of Qi Decoctions), Xiao Xianxiong Tang (Small Chest-Piercing Decoction), Sanhuang Xiexin Tang (Three-Yellow Heart-Draining Decoction), or Liangge San (Cool Diaphragm Powder). If the tongue coating turns black and irritability progresses toward lethargy, the pathogen has entered the Pericardium. Options include Xijiao Dihuang Tang added with Antelope Horn (Lingyang Jiao) or Huanglian Jiedu Tang (Coptis Detoxification Decoction). After repeated diaphoresis, purgation, and cooling treatments, if there is no exterior-interior obstruction but irritability persists, it indicates damage to Yin fluids. Options include Shengmai San (Generate Pulse Powder), Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill), or Wu's various Yingnong Decoctions (Nourishing Blood Decoctions). If diaphoresis, clearing/drainage, and moistening methods fail and irritability worsens, carefully examine the tongue. A patch of white moisture amidst yellow or black coating indicates retained water. Alternatively, phlegm-fluid retention in the chest may exist chronically, or cold drinks/foods were consumed before illness, or excessive cold water/food was ingested during initial irritability, or cooling herbs were used too early. All these cause fluid retention in the chest-diaphragm and epigastrium. Cold fluids obstructing stagnant heat prevent external release and internal transmission to the Stomach, worsening irritability. After examining the tongue, palpate the chest and hypochondrium. Fullness, pain upon pressure, softness, and gurgling sounds (lulu sheng), combined with a wiry-tight or slow pulse at the right Cun and Guan positions, confirm water retention. First eliminate water using Cangzhu (Atractylodes Rhizome), Banxia (Pinellia Tuber), Laifu (Radish Seed), and Houpo (Magnolia Bark), then treat irritability, which will invariably succeed. Regardless of yellow/black coating, if irritability accompanies difficult urination, even without chest-hypochondriac water retention, slight fullness/pain in the lower abdomen indicates the need to promote urination using Daochi San (Guide Out Red Powder), Xiexin Tang (Heart-Draining Decoction), Siling Tang (Four-Ling Decoction), Zhuling Tang (Polyporus Decoction), or Yiyuan San (Benefit Origin Powder). This embodies the principle that Heart pathogenic factors drain via the Small Intestine rather than the Heart itself.