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1. Rashes (Zhen) favor coolness and dislike dampness, while smallpox (Dou) favors warmth and dislikes cold; this is indeed their general principle. However, one must also apply appropriate measures according to the situation. For instance, when rashes first appear, they require mild warmth to facilitate eruption. Therefore, in the initial stage of rash eruption, as long as the rash toxins are fully expelled, the toxicity will be resolved. This differs from smallpox, which follows a process from budding to flowering and fruiting before the toxin is resolved. When smallpox matures, if it is too warm, it may instead become ulcerated and fail to heal, indicating that smallpox also favors coolness in its later stages. Thus, in treating both smallpox and rashes, one should avoid excessive heat or cold, ensuring a balance of warmth and coolness to harmonize Yin and Yang. This constitutes the correct approach.

2. Smallpox benefits from internal fullness and can utilize tonifying formulas; rashes contraindicate internal stagnation and primarily require dispersing and resolving methods. They are only slightly similar during the initial fever stage when releasing the exterior. After eruption, smallpox benefits from Qi tonification to generate Blood, whereas rashes benefit from Yin tonification to control Yang. Why? Because severe heat in rashes煎熬 (scorches) the Yin aspect, leading to significant depletion of Blood and suppression of Yin fluids. Therefore, treatment focuses on clearing fire and nourishing Yin, without disturbing Qi. Harsh and drying agents are strictly contraindicated from beginning to end. People generally recognize the severity of smallpox but underestimate the lethality of rashes. Medical texts often neglect this, which is lamentable.

3. The toxins of macules and rashes all originate from Fire. The *Neijing* states: "In the era of He Xi (abundant heat), diseases manifest as sores and ulcers." Thus, during years governed by the Two Fires (Shaoyin Ministerial Fire and Shaoyang Triple Burner Fire) or specific operational cycles, where Lung Metal is constrained, infections triggering eruptions are common. Mild cases resemble mosquito bites or swelling within the skin, named Urticaria (Yin Zhen). Severe cases present as vermilion spots with red halos or patchy patterns like brocade, named Macules and Rashes (Ban Zhen). Generally, red color indicates a favorable prognosis, while black indicates an ominous one. Symptoms resemble Typhoid fever (Shang Han) with fever, erupting after three to four days and crusting over after seven to eight days. All such conditions belong to pathogenic heat; the treatment method is solely acrid-cool resolution and unblocking. Even if vomiting and diarrhea occur, warm-tonifying medicines must absolutely not be used. Herbs such as Cardamom (Doukou) and Dried Ginger (Ganjiang) must never be used lightly. At the initial stage, especially profuse sweating is forbidden; only mild release is suitable using formulas like Shengma Tang (Cinnamon Twig Decoction - *Note: Context implies Shengma Ge Gen Tang*), Gegen Tang (Kudzu Root Decoction), or Touxie Jian (Expel Pathogen Decoction). Medication requires careful consideration and cannot be applied uniformly.

4. If the rash marks do not turn red, and upon manifestation fever worsens, accompanied by headache, body pain, and irritability, use Shengma Tang (Cinnabar Root Decoction) or Touxie Jian (Expel Pathogen Decoction).

5. If the color is crimson and dense, with body pain and irritability, use Shengma Tang (Cinnabar Root Decoction) added with Arnebiae Radix seu Rhizoma (Zicao) and Forsythiae Fructus (Lianqiao).

6. If chills and fever occur together, with headache and neck stiffness, use Shengma Tang (Cinnabar Root Decoction) added with Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), and Forsythiae Fructus (Lianqiao).

7. If there is swelling of the head, neck, and face, use Shengma Tang (Cinnabar Root Decoction) added with Armeniacae Semen Amarum (Niubangzi) and Schizonepetae Spica (Jingjie). If the pulse is strong, fire is abundant, and there is thirst, clear and descend the fire using Baihu Tang (White Tiger Decoction) with modifications.

8. If there is spontaneous sweating, irritability, and thirst, with Qi stagnation and a rapid pulse, use Huaban Tang (Transform Macule Decoction).

9. If there is body heat, irritability, thirst, and diarrhea, use Chailing Tang (Bupleurum and Poria Decoction) or Siling San (Four Poria Powder). In summer, Yiyuan San (Benefit Origin Powder) may be used.

10. If heat is severe, with dark scanty urine, delirium, and fright, use Daochi San (Guide Out Red Powder) or Siling San (Four Poria Powder) added with Cinnabar (Chensha). In summer, Yiyuan San (Benefit Origin Powder) added with Cinnabar (Chensha) is used.

11. If cough is severe, use Ermu San (Two Mothers Powder), Maimendong Tang (Ophiopogon Decoction), or Qingfei Tang (Clear Lung Decoction).

12. If there is wheezing, use Xiaochaihu Tang (Minor Bupleurum Decoction) with Ginseng removed and Schisandrae Fructus (Wuweizi) added.

13. If heat is severe causing epistaxis, or hematochezia/hematuria with severe heat, use Huanglian Jiedu Tang (Coptis Detoxification Decoction). If bleeding is severe, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction).

14. If food stagnation causes vomiting, use Liujunzi Tang (Six Gentlemen Decoction) added with Agastachis Herba (Huoxiang) and Puerariae Radix (Gange), or remove Ginseng. If heat causes severe vomiting, use Jiedu Tang (Detoxification Decoction). If urination is difficult with vomiting, use Siling San (Four Poria Powder). If constipation persists for one to two days, use Daochi San (Guide Out Red Powder).

15. If there is fecal impaction with fever and body pain, use Dachaihu Tang (Major Bupleurum Decoction). If there is abdominal distension and wheezing, use Qianhu Zhike Tang (Peucedani and Aurantium Decoction).

16. If there is throat obstruction, use Ganjie Tang (Licorice and Platycodon Decoction). If accompanied by wind-heat cough, add Saposhnikoviae Radix (Fangfeng).

17. If there are alternating chills and fever resembling malaria, use Xiaochaihu Tang (Minor Bupleurum Decoction); if accompanied by cough, remove Ginseng.

18. If fever persists after crusting falls off, use Shengma Tang (Cinnabar Root Decoction), or remove Shengma and add Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian), each prepared with wine.

19. If there is dysentery with red and white stool and abdominal pain, use Huangqin Shaoyao Tang (Scutellaria and Peony Decoction), or add Aurantium (Zhike). If there is body heat and abdominal pain, use Jiedu Tang (Detoxification Decoction).

20. If residual toxins remain, transforming into carbuncles, ulcers, or boils, use Shengma Tang (Cinnabar Root Decoction) added with Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), and Armeniacae Semen Amarum (Niubangzi).

Zhang Jingyue stated: Regarding Wan Quan's various entries for treating rashes above, they are extremely detailed and appropriate. However, among them, diarrhea/dysentery and wheezing are the most prone to confusion. These conditions caused by rash toxins should indeed be treated as described. However, some are not caused by rash toxins. Quack doctors see a rash and indiscriminately use cold-natured herbs, not knowing that some cases can be cooled while others cannot. Many patients have weak Spleen Qi and suffer from diarrhea due to excessive use of cold herbs or accidental ingestion of raw/cold foods damaging the Spleen and Stomach. Although this condition arises from the rash, it is essentially not a rash-toxin disease. If there are no other heat signs or pulses, and the complexion is pale with weak Qi, one must quickly rescue Spleen Qi using urgent warm-tonification, such as Wenwei Yin (Warm Stomach Drink), Wu Junzi Jian (Five Gentlemen Decoction), or Weiguan Jian (Stomach Gate Decoction). Insisting that rash toxins cannot be treated with warmth leads to danger. This is what physicians must understand fundamentally. Furthermore, regarding wheezing, there is a great distinction between deficiency and excess. Most wheezing is deficiency-based. If it is not a fire syndrome nor external pathogen, but results from severe purging or sweating, it indicates Qi collapse. In such cases, Liuqi Jian (Six Qi Decoction) or Zhenyuan Yin (True Origin Drink) are indispensable. Both these scenarios require careful differentiation; mistaking shortness of breath for wheezing is a grave error. Refer to the discussion on individual constitution and syndrome differentiation in the General Treatise on Smallpox, as the principles are identical. One must not assume all rash pathogens are excess fire, ignoring the harm of deficiency fire.

Xu Donggao said: The saying "smallpox is difficult, rashes are easy" is merely popular talk. If a patient has originally weak Stomach Qi, deep infection, or slow eruption due to diarrhea, or if the rash appears and disappears rapidly without fully emerging, the pathogen gradually enters the Stomac, leading to persistent diarrhea, recurrent eruptions, and rapid breathing, resulting in critical danger. Such cases are certainly not "easy." Therefore, whenever rashes appear with weakness, one must urgently tonify the Spleen and Stomach first. If the rash desires to emerge but fails, one must urgently use interior-supporting and exterior-releasing methods to assist it. Throughout the course, purgatives must be avoided, just as with smallpox.