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Measles (variolous eruptions) erupting simultaneously with macules (ban). This indicates that the heat-toxin of the zang-fu organs is excessively flourishing, causing them to surge out together. I have carefully reflected on the pathology of variola, and found only cases where it is accompanied by rubeola (measles), while the concept of "accompanied by macules" remains unverified. Macules arise from heat-toxin retained internally in typhoid fevers; how could they possibly erupt simultaneously with variola? As mentioned in the previous section regarding "eruption patterns," bright red patches covering the skin and flesh are referred to as "accompanied macules," but are actually rubeola; those fine as mustard seeds are referred to as "accompanied papules," which are actually urticaria (wind wheals). However, macules are mostly seen on the chest, abdomen, and limbs, rarely on the head and face. Based on this, one can clearly distinguish them. Yet, the world generally calls them "accompanied macules," describing their density as if a crowd were shouting together, which is indeed inappropriate.

Observing the treatment examples of predecessors, the first recommendation is Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) to first disperse exterior pathogens. Wait until the macules recede and the variola rises, then treat according to the specific syndrome. A thorough review of medical texts confirms this approach universally. Zhang Hangao stated: When macules and variola erupt simultaneously, texts advise removing macule-heat first, often causing the variola to collapse inward. Only by promoting the eruption of variola does the heat gather into the pustules, allowing the variola to rise and the macules to recede naturally. These two theories seem contradictory but are actually complementary. One must understand that simultaneous eruption of macules and variola is always due to the overwhelming momentum of heat-toxin, with absolutely no signs of deficiency. Grasping this principle, removing macule-heat is merely using cooling agents to resolve toxins, just as promoting variola eruption is also using cooling agents to resolve toxins. Huaban Tang (Macule-Resolving Decoction), modified according to symptoms, is truly the golden standard for simultaneous macule and variola eruption. If the macules are purple-red, increase the dosage of Shigao (Gypsum Fibrosum) to resolve them. If constipation occurs, slightly add Dahuang (Rhei Radix et Rhizoma) to promote bowel movement. If one fails to understand this and mistakenly treats true macules solely with cold-natured herbs, the variola will collapse with the macules. If one fails to resolve the macules and focuses solely on ascending and venting, the macules will become chaotic and indistinguishable among the erupting variola, making separation difficult.

Huang Wuzhi said: For wind-cold accompanied by macules, one should first release the exterior, after which the variola will naturally rise. In cases of constipation, rapid purgation is suitable; in cases of normal bowel movements, the focus should be on cooling blood, venting through the skin, and resolving toxins. Furthermore, variola appearing before rubeola indicates a milder condition, as rubeola helps dissipate the momentum of variola. Rubeola appearing before variola indicates a severe condition, because rubeola originates in the Lung, depleting the defensive Qi first and losing the strength to support the filling of pustules. Simultaneous eruption of rubeola and variola is dangerous, as both toxins attack concurrently. Treatment depends on assessing the appearance of rubeola and the density of variola. If macules are purple-black, variola pus is clear/thin, and the patient exhibits panting/urgency, these are untreatable conditions. Generally, simultaneous eruption of macules and variola is caused by excessive heat-toxin momentum; one must not mistakenly use Renshen (Ginseng Radix) or Huangqi (Astragali Radix). If the primordial Qi is inherently deficient and the variola color is pale-white, a small dose of Baoyuan Tang (Protect the Origin Decoction) may be tolerated. However, if heat-toxin is not yet exhausted within six or seven days, and tonics are mistakenly administered, the patient will inevitably suffer from recurrent high fever, phlegm-panting, anorexia, and death. Otherwise, complications such as carbuncles, oral ulcers, and eye diseases are unavoidable.