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When latent warm pathogenic factors transform into heat, they scorch and burn the collateral vessels, causing blood within the collaterals to extravasate. The evil heat then dissipates along with the blood, which is considered a favorable sign in the disease mechanism. However, there are cases where evil heat stagnates in the blood collaterals and cannot reach the exterior. If the heat resides in the Lung, since the Lung governs the skin and hair, macules (rash) will appear; if it resides in the Stomach, since the Stomach governs the muscles, patches (purpura/macules) will appear. Some patients present with macules and rashes appearing separately without intermingling; others have them appearing simultaneously, making them difficult to distinguish clearly. The general treatment principle focuses on clearing the Ying level (nutritive level), venting the pathogen, unblocking the collaterals, and resolving the patches. Generally, if the external macules and rashes are fully erupted, accompanied by clear spirit and resolved heat, it is an auspicious sign. If the macules and rashes are erupted but the interior heat remains unresolved, it indicates severe heat stagnation, and complications are inevitable. One must carefully consider the specific manifestations.

There is also a condition known as "Rotting Throat Dan Sha" (scarlet fever-like illness with throat ulceration). This arises from latent warm pathogens complicated by epidemic toxic factors of the season. After one or two days of fever, slight scarlet rash may appear on the head, face, and chest, while the throat has already begun to ulcerate. This condition is common in children. In acute cases, deteriorating signs may appear within one or two days. Symptoms such as a cyanotic and dull complexion, phlegm obstruction with hoarseness, shortness of breath, and abdominal hardness represent various ominous signs that appear suddenly; those presenting these signs often die. For such acute conditions, large doses of herbs to clear the Ying level and detoxify should be used at the onset to perhaps salvage the situation. Any delay renders treatment ineffective.

Fresh Sheng Di Huang (Rehmanniae Radix Recens) is an essential herb for clearing the Ying level and draining heat in this condition. To incorporate dispersing properties, for severe cases, use Dou Chi (Fermented Soybean) pounded together; for mild cases, use Bo He Ye (Menthae Haplocalycis Folium) pounded together; both are acceptable. Dan Pi (Moutan Cortex) clears latent heat in the blood and, being pungent and dispersing, is best used when stir-fried until blacked. Jin Yin Hua (Lonicerae Japonicae Flos) clears the Ying level and transforms toxicity; Xuan Shen (Scrophulariae Radix) clears the throat and nourishes Yin/water; both are necessary for this syndrome.

For treating early-stage Lung rashes requiring venting and dissemination, add Niu Bang Zi (Arctii Fructus) and Chan Yi (Bombyx Batryticatus) to the Ying-clearing formula to promote eruption. Ancient formulas for treating patch-toxin use Hua Ban Tang (White Tiger Decoction combined with Xi Jiao/Rhinoceros Horn and Sheng Di Huang/Rehmannia Root) or Yu Nu Jian (Jade Woman Decoction). However, these are only suitable if the patient presents with irritability, heat, and profuse sweating. If the heat is not intense and sweating is inadequate, administering Shi Gao (Gypsum Fibrosum) abruptly may cause the pathogen to become "ice-frozen" (stagnant); thus, caution is required during application. Huang Yu Qiu suggested using Fu Ping (Urticae Flos) as an exterior-releasing agent for this condition, which shows good clinical reasoning and can be adopted.

The eldest son of Sun Yunzhi from Tangshi was exceptionally intelligent. At just ten years old, he could recite the Thirteen Classics and summarize their main ideas. His father, Mr. Sun, cherished him like a pearl in his palm. In the autumn of the Dinghai year, Mr. Sun sent a special letter inviting me for consultation. I traveled by night boat and arrived in Tangshi the next morning, but it was too late to save him. Mr. Sun said, "My eldest son has died. My second son fell ill the day after, and it has now been two days. His symptoms are identical to his brother's. Based on my eldest son's death, my second son will likely die by the fifth watch (3-5 AM) tonight. Please examine him; is there any hope of rescue?"

Upon examination, the boy had a cyanotic and dull complexion and did not speak, only experiencing paroxysmal irritability. During episodes of irritability, he scratched the inner sides of his arms as if feeling no pain. The scratched areas showed dark purple blood that did not flow. His tongue was purple with prickles, resembling a strawberry tongue, and his throat appeared plate-like yellow without necrosis. Upon careful scrutiny, I determined that epidemic toxin was closed within the Ying level, unable to vent outward, and attacking the Heart and Lungs, leading to such rapid death. This condition belongs to the category of Yin Toxin or Yang Toxin. Although ancient texts lack definitive treatments for it, by inference, to attempt a rescue, one must provide a pathway for the epidemic toxin to exit externally, thereby creating a chance for survival. I prescribed grinding Xi Jiao (Rhinoceros Cornu - *Note: Substitute with Water Buffalo Horn in modern practice*) into juice, squeezing fresh Sheng Di Huang (Rehmanniae Radix Recens) and Da Huang (Rhei Radix et Rhizoma) juice, and combining them with Xuan Shen (Scrophulariae Radix), Dan Pi (Moutan Cortex), and Jin Yin Hua (Lonicerae Japonicae Flos) to transform toxicity and drain heat, administered continuously. By dusk, the patient passed loose, black stool twice. Medication continued until dawn; after consuming two tea cups of medicine, he passed loose, black stool twice more. Re-examining him, his mental state became more alert. A floating, greasy yellow coating appeared on the tongue, and necrotic tissue formed in the throat. I maintained the previous method, adding Jin Zhi (Golden Juice - *fermented human feces filtrate*), incorporating Yin-nourishing principles, and administered as before. Over one day and night, he consumed three to four bowls. His urination and defecation finally became smooth, and abdominal distension subsided. Areas where purple marks and stiff masses previously existed—such as the neck, shoulders, elbows, waist, spine, hips, and knees, particularly at joint junctions—became red, swollen, and suppurated. Not only did the throat ulcerate, but the anus also ulcerated and discharged pus. I strictly adhered to the formula for nourishing Yin, invigorating blood, draining heat, and transforming toxicity. After twenty days, the ulcers throughout the throat and body healed. However, pus and blood clots still mixed in the stool. Referencing treatment methods for internal abscesses, he recovered after another month. In this case, I used large doses of Xi Jiao (Rhinoceros Horn), Sheng Di Huang (Rehmannia Root), and Da Huang (Rhubarb Root), continuing administration without withdrawal. People were shocked by this approach. They did not realize that the heat-toxin in this condition was extraordinary. Had I hesitated, exercised excessive caution, or attempted to address deficiency simultaneously, I would certainly not have saved him from critical danger. Even if I had managed to stabilize him initially, the subsequent turbulent course of the disease would have made complete recovery impossible.