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Outside of variola (smallpox) there is exanthema, and outside of exanthema there is measles. Measles is also a type of exanthema, namely maculopapular rash. However, typical exanthema erupts all at once after the heat pathogen reaches the fifth or sixth day, with each lesion forming a pustule; this is unlike measles, where the skin becomes red and confluent. Furthermore, the eruption of measles is not restricted to the third or fourth day. When illuminated by fire, the body appears as if coated with cinnabar, which is a sign that it is about to erupt. Once erupted, the lesions are fine and scattered, with the skin red and confluent, resembling marks left by mosquito or flea bites; this is measles. There are cases where eruption occurs only on the sixth day, appearing and disappearing repeatedly within approximately one week. Secular belief holds that it erupts three times in one day, nine times in three days, and finally erupts thoroughly. However, some cases do not follow this pattern; as long as within three days, from the face to the chest, back, hands, and feet, although they appear and disappear, if they erupt thoroughly and the whole body is ruddy and vibrant, it is considered auspicious. In severe cases, the whole body swells, and the eyes are closed. The color may vary between red, white, and slightly yellow; ruddy and vibrant is best, while black depression is most abhorrent. Confluent lesions on the face, eyes, chest, and abdomen, or those obstructing the throat, are adverse signs. Failure to erupt accompanied by wheezing indicates death. The term "measles" refers to the fact that the body is covered with fine, scattered spots like hemp seeds, leaving no empty space. However, there are cases where the body is merely red without any spots; this is called "fire carbuncle" (huo dan), which also belongs to this category. Therefore, in variology, there are conditions such as variola complicated with exanthema, variola complicated with measles, and variola complicated with fire carbuncle. All are caused by heat-toxin and must be carefully differentiated.

1. At the initial stage of measles, characterized by yawning, fever, aversion to cold, cough, sneezing, and runny nose, Shengma Gegen Tang (Ephedra and Pueraria Decoction) should be used with Perilla Leaf (Zi Su Ye) and Scallion White (Cong Bai) to release the muscle layer. Profuse sweating must be strictly avoided. If tidal fever is severe, add Huang Qin (Scutellaria Root), Lian Zi (Coptis Rhizome), and Di Gu Pi (Lycium Bark). For delirium, Chen Sha Yi Yuan San (Cinnabar and Yuan Zhi Powder) should be administered. For cough, add Ma Huang (Ephedra Herb), Xing Ren (Apricot Seed), Mai Men Dong (Ophiopogon Tuber), and Shi Gao (Gypsum Fibrosum). For severe cough and high fever, Liang Ge San (Cool the Upper Jiao Powder) should be used with Jie Geng (Platycodon Root) and Di Gu Pi. For diarrhea, Si Ling San (Four-Poria Powder) is appropriate. For blood in stool, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) should be combined. For hematemesis and epistaxis, Xi Jiao Di Huang Tang should be used with Shan Zhi (Gardenia Fruit). For dark urine, Mu Tong (Akebia Stem) should be added.

For chills and fever alternating like malaria, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.

1. After the eruption of measles, if irritability and thirst occur, Jiedu Tang (Detoxification Decoction) combined with Bai Hu Tang (White Tiger Decoction) should be used. For wheezing with constipation, Qian Hu Gen Ke Tang (Peucedanum Root and Shell Decoction) with Wu Wei Zi (Schisandra Berry) should be administered. For severe constipation, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is indicated. For delirium with urinary retention, Dao Chi San (Guide Out the Red Powder) should be used. For turbid urine resembling rice water, Si Ling San should be used with Che Qian Zi (Plantago Seed) and Mu Tong. For delirium resembling mania, Jiedu Tang should be taken with Chen Sha Yi Yuan San. For bleeding from both large and small bowels, Xi Jiao Di Huang Tang combined with Jiedu Tang should be used. For hematemesis and epistaxis, Jiedu Tang should be used with fried Shan Zhi and Tong Bian (Child's Urine). For diarrhea, Jiedu Tang or Si Ling San should be used. For wheezing accompanied by diarrhea and dark, painful urination, Chai Ling Tang (Bupleurum and Poria Decoction) is indicated. For irritability, heat, intense thirst, and diarrhea, Bai Hu Tang should be used with Cang Zhu (Atractylodes Rhizome) and Zhu Ling (Polyporus). For dry retching due to excessive heat, Jiedu Tang should be used. For vomiting due to food stagnation, Si Jun Zi Tang (Four Gentlemen Decoction) is indicated. For vomiting due to heat in summer, Si Ling San should be used with Ren Shen (Ginseng Root).

1. The initial stage of measles, as well as the stages after eruption and resolution, present miscellaneous symptoms largely similar to those of variola and exanthema. However, the medication throughout should generally be cooling. Although it is said that measles prefers cooling and variola prefers warming, these are not fixed rules. Rather, deficiency should be tonified, excess should be purged, cold should be warmed, and heat should be cooled; this is the profound art of medicine. Therefore, in treating measles, Si Wu Tang (Four Substances Decoction) may be used for blood deficiency, Si Jun Zi Tang for qi deficiency, and warming and regulating middle-jiao herbs for cold injury; all should be applied according to the specific syndrome.

1. After the resolution of measles, if residual toxins invade internally, leading to picking at clothes and beds, delirious speech, confusion of spirit, and disordered consciousness, the prognosis is fatal. If the heat is mild but residual toxins remain, one must first observe the complexion and qi color. If abnormalities are seen, preventive measures must be taken. The treatment should primarily rely on Shengma Gegen Tang, or Si Wei Xiaodu Yin (Four-Ingredient Detoxification Drink), Liu Wei Xiaodu Yin (Six-Ingredient Detoxification Drink), or Jiedu Tang, selected according to the syndrome. Foods such as fish, seafood, scallions, and garlic should still be avoided.