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1. The emergence and disappearance of rashes are usually measured by the twelve two-hour periods (Shichen). If rashes appear after the Zi hour (11:00 PM–1:00 AM), they will recede by Wu hour (11:00 AM–1:00 PM); if they appear at Wu hour, they will recede after Zi hour. This represents the natural law of creation where Yang generates and Yin completes, or Yin generates and Yang completes. Cases where rashes emerge and quickly recede are mild. However, if rashes persist continuously for three to four days without receding, it indicates excessive Yang pathogenic heat/toxin; Da Qing Tang (Great Blue Decoction) should be used, or a prescription primarily composed of Jingjie (Schizonepetae Spica), Niubangzi (Arctii Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Xuanshen (Scrophulariae Radix), Shigao (Gypsum Fibrosum), and Jiegeng (Platycodonis Radix). If rashes hesitate to emerge, it is due to Wind-Cold constraining the exterior and closing the skin pores (Couli); Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxicity) is indicated.

2. When rashes have emerged but then disappear again, it is caused by being forced inward by Wind-Cold. If not treated promptly, the toxin will attack internally, leading to death from itching. Urgently administer Shengma Tang (Cimicifugae Decoction) with added Jingjie, Niubangzi, and Gancao, taken hot; this will cause the rashes to re-emerge and ensure recovery.

3. After six or seven days of fever, if rashes clearly should be present but do not appear, it is likely due to thick and dense skin with closed pores, or invasion by Wind-Cold, or previous vomiting and diarrhea, all of which can cause the toxin to lie latent. Urgently use formulas that support the interior and release the exterior, such as Mahuang Tang (Ephedra Decoction) with Xingren (Prunus Seed) removed, plus Chantui (Cicada Slough) and Shengma, applied externally with Huisu Jiu (Coriander Wine). If there has been no bowel movement for some time, the internal toxin is severe and lying latent; Liangge San (Cooling the Chest Powder) from Ju Fang (Formulas of the Bureau), with added Niubangzi, is indicated.

4. The only concern with rashes is their failure to erupt; once fully erupted, the toxin is resolved. Therefore, when treating rashes during fever, one must observe the seasonal climate (cold or warm) and treat accordingly. In cases of severe cold patterns, Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction) or Mahuang Tang should be used to release the exterior. In cases of severe heat patterns, Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) or a combination with Renshen Baihu Tang (Ginseng White Tiger Decoction) should be used. For patterns neither cold nor hot, Jingfang Baidu San should be used. If epidemic Qi is involved, Renshen Baidu San (Ginseng Powder to Overcome Toxicity) should be used. If one dose fails to produce eruptions, another dose of the same decoction should be taken, along with external application of Huisu Jiu and rubbing the entire body with Ramie fiber dipped in wine, striving to force rapid eruption. If after three or four attempts the rash still does not appear, accompanied by abdominal distension and pain, asthma, and drowsiness/confusion, it is a fatal sign.

Zhang Jingyue stated: Regarding Wan Quan’s method, it excellently embodies the principle of adapting to circumstances and seasons, fully realizing the meaning of releasing the exterior. However, the art of releasing the exterior is most difficult. For instance, when Ying and Wei deficiency prevents rashes from emerging, there are many such patterns. If one only knows how to release the exterior without nourishing, those with weak Ying and Wei will not only fail to erupt but may also exhaust their root source. The key lies either in the Spleen and Stomach or in Blood and Qi; one must grasp the subtlety to achieve benefit. The three methods of releasing the exterior in Shanghan (Cold Damage) are indeed relevant here.

5. Once the rash toxin is fully erupted, the pathogenic qi dissipates, and the healthy qi naturally returns to harmony. Symptoms such as fever with restlessness and oppression, vomiting, or diarrhea indicate that the toxin is obstructed and has not yet fully erupted. For restlessness and heat, Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) is used. For vomiting and diarrhea, Chaihu Jupi Tang (Bupleurum and Tangerine Peel Decoction) is used. External applications of Huisu Jiu and the Ramie rubbing method should be employed as before. Once the rashes are fully erupted, the restlessness and heat will naturally subside, and vomiting will cease.

6. If rashes have receded but residual toxin remains, causing them to reappear after three days, or recurring five or six times without stopping, it is because Wind-Cold was not avoided during the fever, causing pathogenic qi to stagnate between the muscles and linger without dispersing. Although previously dispersed, the condition remains unsmooth. If complicated by other syndromes, treatment should follow the specific symptoms.