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Whenever the rash first appears, accompanied by fever, vomiting, and diarrhea, this is purely a heat syndrome and should not be interpreted as a cold syndrome. This occurs because fire pathogenic factors press inward: if they affect the Upper Jiao (Upper Burner), vomiting predominates; if they affect the Lower Jiao (Lower Burner), diarrhea predominates; if they affect the Middle Jiao (Middle Burner), both vomiting and diarrhea occur simultaneously. For cases of pure diarrhea, Huangqin Tang (Scutellaria Decoction) is appropriate. For cases with both vomiting and diarrhea, Huangqin Tang added with 2 qian of Banxia (Pinelliae Rhizoma) and 3 slices of Shengjiang (Zingiberis Rhizoma Recens) is appropriate. For cases of pure diarrhea accompanied by tenesmus (abdominal urgency and heavy sensation in the rectum), Lianhuang Jiedu Tang (Coptis Decoction for Resolving Toxic Heat) combined with Yiyuan San (Benefiting Primordial Powder) is appropriate.

When the rash has been present for one or two days, or three or four days, and suddenly severe diarrhea occurs with abundant coughing, treatment should employ herbs that lift and vent the exterior, combined with methods to separate clear from turbid fluids (promote urination to stop diarrhea). If the diarrhea is acrid and accompanied by wheezing, and symptoms such as restlessness and head shaking reappear, the prognosis is ominous.

First, after the measles rash manifests, if pus and blood appear in the stool, or if diarrhea transforms into dysentery with pus and blood, or if there is spontaneous diarrhea, observe whether the lesions are numerous and red, and whether coughing is abundant. In such cases, only the method of venting the rash should be used. Only after the rash subsides should detoxifying herbs be employed to concurrently treat the dysentery.

Second, during the initial stage of the rash, diarrhea is most contraindicated; however, there are cases where diarrhea persists throughout without hindering recovery, due to differences in constitutional strength. However, if diarrhea causes the cough to subside but transforms into wheezing, the condition becomes critical. Refer to the previous section on "Wheezing and Coughing."

Third, for cases involving body heat, irritability, thirst, and diarrhea, Chailing Tang (Bupleurum and Poria Decoction) or Siling San (Four-Powder Dispersion) is indicated. If the heat is severe or it is summer, Yiyuan San (Benefiting Primordial Powder) is indicated.

Fourth, for dysentery occurring after the rash, or for symptoms such as biting fingernails, tearing lip skin, and biting others, treatment should use detoxifying and fluid-separating herbs. If the discharge consists of thick saliva mixed with red and white substances, detoxifying herbs must definitely be used. If defecation occurs thirty to fifty times a day and night, gradually decreasing to two or three times, while coughing gradually increases, the pulse at the first finger position of the right hand gradually rises, and clear nasal discharge returns, survival is possible. However, if the dysentery turns coal-black, or assumes the color of old blood clots, or resembles green vegetables, with the anus flaccid like a tube, rapid breathing, hoarseness, inability to eat, and redness of the cheeks in the afternoon, these are all incurable conditions.

Zhang Jiebin stated: Since ancient times, medical texts have occasionally contained incomplete explanations or inappropriate treatments, but this is particularly true regarding the syndrome of diarrhea. Why? Because ancients believed that nine out of ten cases of diarrhea were due to heat, thus often using Liu Hejian’s Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) as the primary treatment. They did not realize that most cases of diarrhea are actually due to deficiency-cold of the Spleen and Kidney. Take the case of exanthems (rash diseases): although some diarrhea is caused by rash toxins, if it is truly excess-heat, it rarely causes diarrhea. Diarrhea resulting from exanthems ultimately stems from Spleen-Stomach weakness. If one only knows how to clear fire and resolve toxicity, the Spleen will deteriorate daily, gradually leading to symptoms such as dark red discharge resembling old blood, green vegetable-like stool, shortness of breath, and anorexia—incurable conditions. When the disease reaches this stage, can it still be considered heat? It is entirely a misdiagnosis. Therefore, when treating diarrhea, even in the context of exanthems, one must examine whether there is any heat pathogen. If there are no heat signs or heat pulses, one should seek treatment methods from the section on "Diarrhea in Smallpox/Chickenpox," so that even critically ill patients may have hope for survival. Thus, among various methods, I emphasize these key points as follows.