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The pulse of epidemic rash (Yizhen) is invariably rapid. It may be floating, large, and rapid; deep, fine, and rapid; neither floating nor deep but rapid; or it may feel faintly visible upon pressure. This corresponds to the phenomenon described in the *Ling Shu* (Spiritual Pivot) as "the manifestation of Yang toxin hiding and lying low." By examining the pulse, one can ascertain the prognosis of the disease. If the pulse is floating, large, and rapid, the toxin is emerging; a single treatment with cooling and dispersing methods will cause the illness to vanish instantly. If the pulse is deep, fine, and rapid, the toxin has penetrated deeply; however, it can still be extinguished with large doses of clearing and resolving agents. As for pulses that are faintly visible or completely hidden, the toxin is severe, and the condition is critical! Such pulses are occasionally seen at the onset, but frequently appear on the seventh or eighth day. Why? Physicians initially misdiagnose the condition as cold syndrome and heavily employ diaphoretic (sweat-inducing) methods, thereby first damaging Yang Qi. When sweating fails to disperse the pathogen, they subsequently resort to purgative methods, further damaging Yin fluids. They fail to realize that even if Cold Damage (Shanghan) persists beyond five or six days and warrants purgation, one must strictly verify that the pulse is forceful before proceeding. Epidemic heat is a formless toxin. Although the clinical presentation resembles intense heat, the pulse is fine, rapid, and weak—this is what is termed "vigorous fire consuming Qi" (Zhuang Huo Shi Qi). If one uses the fierce potency of Rhubarb (Dahuang) and Mirabilite (Xiaoshuang) against formless fiery heat, how can the heat-toxin not take advantage of the deficiency to penetrate deeper? In frail individuals, this leads either to Yang collapse or Yin collapse. Even in those whose Qi and Blood can somewhat manage the medication, the pulse inevitably turns deep and hidden, and complications arise like swarming insects. Symptoms may include cold extremities, coma with delirious speech, depression with fixed gaze, urinary incontinence or fecal leakage, and in extreme cases, tongue retraction and testicular retraction, hand groping along the bedrail, and various ominous signs resembling Cold Damage. Physicians fail to comprehend that this is inviting the pathogen inward, where extreme Yang mimics Yin, yet they mistakenly diagnose it as Yin syndrome. Prescribing hot herbs such as Ginseng (Renshen) and Cinnamon Twig (Guizhi) results in death as swift as taking poison. The body becomes blue-purple, and bleeding occurs from the mouth and nose. For those who have not taken hot medicines, administering a large dose of Qingwen Baidu Decoction (Plague-Resolving Toxin-Expelling Decoction) with a heavy addition of Gypsum (Shigao) might save them. Having saved many people through these methods, I record this for public awareness.

If the rash appears loose and scattered on the skin surface, varying in color from red to crimson, purple, or black, this indicates the toxin is manifesting outwardly. Even if accompanied by severe symptoms, there is little to worry about. However, if the rash is tight, rooted, appearing as if drilling out from beneath the skin, with a blue-purple color resembling the back of a duckweed, predominantly seen on the chest and back, this signals that stomach heat is causing tissue rot. Immediate treatment should focus on severely clearing stomach heat while simultaneously cooling the blood. Use Qingwen Baidu Decoction (Plague-Resolving Toxin-Expelling Decoction) supplemented with Arnebiae Radix seu Cortex (Zicao), Carthami Flos (Honghua), Persicae Semen (Taoren), and the tail end of Angelicae Sinensis Radix (Guiwei). It is essential that the rash becomes loose and pale in color to allow for recovery. Any hesitation renders the case incurable.