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(Erythema) erupts outward. If it is a case of kidney meridian smallpox, even with excellent physicians, it cannot be saved. However, if it is erythema (measles/rash), its root lies in the muscle-coupling and skin. The blood of the muscle-coupling originates from the Chong Mai (Penetrating Vessel) and Blood Sea. If cold in the muscle-coupling causes stasis in the uterine blood, symptoms of erythema toxin will appear. By identifying the source and applying flexible treatment methods, or by allowing nature to take its course without reckless intervention, fewer than one in a hundred will die.

Ye Lin's Note: Sha Zhen (toxic rash) belongs to Yang toxins; treatment should focus on clearing heat and resolving toxicity. Occasionally, for patients with weak constitutions or those who have overdosed on bitter-cold herbs, warm-tonifying and pushing-out methods must be used as a remedy for deviation and correction of defects. However, such cases are rare, perhaps only one or two in a thousand. Knowing this method to handle variations is acceptable, but adhering rigidly to it leading to death is unacceptable. The theory that the root is blood, congealed by cold and stagnating between the muscle-couplings, dispersing to form rashes, if used as a basis for universal warm-tonification, misleads future generations and is a major error. Shizong and Zhang Yin'an were both renowned; comparing them based on this reveals their differences in quality.

Zhang Shiwen said: Measles are caused by accumulated heat in the Hand-Taiyin, Foot-Taiyin, and Foot-Yangming meridians. They occur mostly in children, but adults also get them occasionally; this is also a type of seasonal epidemic contagion. During fever, there is often coughing, sneezing, vomiting, tearing eyes, facial swelling, reddish cheeks, diarrhea, phlegm, heat, thirst, irritability, and in severe cases, restlessness, sore throat, cracked lips, and coma. The whole body becomes red, raising into granules, uniform and small. Viewed obliquely, they are faintly visible under the skin; touched by hand, they feel like grains among the muscles. Their shape resembles scabies, and their color resembles cinnabar. Because Yang Qi moves upward, having more eruptions on the head and face indicates a favorable prognosis. The treatment method should primarily use cool and dispersing drugs, using acrid-dispersing agents to ascend and diffuse, and cool-moistening agents to clear and resolve. Sour-astringent drugs must be strictly avoided. Any drugs with moving, dry, and fierce properties, as well as all warm-tonifying drugs, must be handled with caution and not violated; misuse leads to immediate disaster. Acrid-dispersing drugs include Jingjie (Schizonepetae Herba), Bohe (Menthae Haplocalycis Herba), Qianhu (Peucedani Radix), Gegen (Puerariae Lobatae Radix), Mahuang (Ephedrae Herba), Shigao (Gypsum Fibrosum), and Niubangzi (Arctii Fructus). Cool-moistening drugs include Xuanshen (Scrophulariae Radix), Gualougen (Trichosanthis Radix), Weirui (Polygonati Odorati Rhizoma), Maidong (Ophiopogonis Radix), Sheng Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Lianlian (Coptidis Rhizoma), Beimu (Fritillariae Bulbus), Lianqiao (Forsythiae Fructus), and Zhuye (Bambusae Folium); these are all applicable drugs. Furthermore, prescriptions should be adjusted according to the month of onset, considering the child's size and the severity of symptoms. If the rash emerges gradually and recedes gradually, although the condition is mild, the heat has not yet subsided, so one must guard against wheezing urgency. If it persists for three to four days, although the condition seems severe, the heat has been vented, and no other changes are likely; Daqing Tang (Great Blue Decoction) or Xiaodu Yin (Detoxification Drink) added with Xuanshen, Shigao, Maidong, and Zhuye is suitable. If sweating over the whole body or epistaxis occurs during fever, this indicates the resolution of toxin; do not hastily stop it. If sweating is excessive and bleeding does not stop, Qingfei Tang (Clear Lung Decoction) should be used, removing Kuandonghua (Adenophorae Radix) and Xingren (Armeniacae Semen Amarum), adding Mahuang Gen (Ephedrae Radix et Rhizoma) to arrest sweating, and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to stop bleeding. Delay leads to Qi deficiency and spirit exhaustion, making it difficult to treat. If vomiting or spontaneous diarrhea occurs during fever, this is fire pathogen forcing inward, with toxin qi moving up and down; all cases should be treated with clearing heat, detoxifying, and promoting urination. Astringents must absolutely not be used. Generally, in rash syndromes, thirst is inevitable during fever; only Mung Bean and Lampwick decoction should be given. Frozen drinks must be avoided to prevent water accumulation and further complications. Meat, alcohol, noodles, and raw/cold fruits must also be prohibited. Measles often involve hot phlegm in the lungs; coughing is inevitable at the initial stage. Treatment should clear heat and vent the exterior; cough should not be suppressed. For post-measles cough, acrid-warm and sour-astringent drugs must be avoided. Only Qingyan Zipfei Tang (Clear Throat and Nourish Lung Decoction) should be used to clear residual heat, after which phlegm obstruction will resolve spontaneously. Wheezing is due to heat pathogen obstructing the lungs; do not forcibly stop wheezing. Instead, a large dose of Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used, removing Banxia (Pinelliae Rhizoma), and adding Beimu, Xuanshen, and Bohe. In winter, if cold is severe and measles toxin is depressed internally by cold, preventing eruption and causing wheezing, add honey-fried Mahuang; one dose will stop it immediately. In summer, if heat is severe, use Baihu Tang (White Tiger Decoction) with added Zhuye. Shengma (Cimicifugae Rhizoma) must be avoided; misuse inevitably causes wheezing. Wheezing is due to lung Qi obstruction, so wheezing must be accompanied by cough. Opening mouth and lifting shoulders indicates blocked lung orifices, which is untreatable. Hence the proverb: "Wheezing with cough can be treated; wheezing without cough is hard to cure." Additionally, this syndrome often involves diarrhea; do not use astringents. Use Huangqin, Lianlian, and Gegen, and diarrhea will stop naturally. Rash patients do not fear diarrhea; diarrhea resolves Yangming heat pathogen, embodying the principle of distributing elimination between interior and exterior. After the rash subsides, if diet is normal but sudden heart/abdominal colic and icy cold sweat occur, this is Yuanqi (Original Qi) deficiency with evil qi invasion; morning onset means evening death; do not treat recklessly. Generally, bright and brocade-like measles are auspicious; black, dull, coal-like ones are most ominous. Absence on head/face is serious; dark purple/red is serious. Black/dry/withered disappearing immediately upon eruption is untreatable; flaring nostrils and spiritless eyes are untreatable; blue nose and black stool are untreatable; foul rotting gums are untreatable. Gum rot in measles is the hardest to treat; externally apply Wubi San (Peerless Powder); internally administer Jiawei Qingwei San (Modified Stomach-Clearing Powder) with added Jingjie and Shigao. Delay means no rescue. Various complications in measles should not be treated symptomatically but by addressing the root. The root is the heat pathogen in the Hand-Taiyin and Foot-Yangming meridians. Resolving this heat clears all symptoms. Cases with concurrent smallpox occur when toxin qi is too abundant, erupting simultaneously. There is no need to treat the rash; focus on supporting the smallpox. However, treating smallpox requires warmth, while treating measles requires cooling; this distinction must be carefully examined. Adult men and women with measles should be treated alongside exterior syndromes, using cool-clearing and exterior-resolving methods adjusted for seasonal cold/heat. Concurrent measles and smallpox indicate wind-heat affecting the Zang-Fu. Measles is external wind pathogen; smallpox is internal fetal toxin. Mixed together, red halos appear. Often, dense smallpox is mistaken for hopeless cases, unaware it is measles complicating smallpox. Continuously administer Huaban Tang (Spot-Resolving Decoction); once measles toxin resolves, smallpox will rise.

Daqing Tang treats macule heat toxin.
Shigao (Raw), Zhimu (Anemarrhenae Rhizoma), Daqing (Isatidis Folium), Xuanshen, Shengdi (Rehmanniae Radix), Gancao (Honey-fried), Mutong (Akebiae Caulis), Jingjie (Schizonepetae Spica), Zhuye. Decoct in water and take.

Xiaodu Yin treats smallpox/measles with sore throat and delayed eruption.
Niubangzi (Crushed, 1.5 qian), Gancao (0.5 qian), Jingjie (1 qian). Decoct in water, take twice daily.

Qingfei Tang treats smallpox/measles lung heat, wheezing, cough, and expectoration.
Jiegeng (Platycodonis Radix), Gancao, Maidong, Kuandonghua (Adenophorae Flos), Xingren, Beimu, Niubangzi. Decoct in water and take.

Xijiao Dihuang Tang treats Shanghan (Cold Damage) and Wenbing (Warm Diseases) where sweating fails to induce perspiration, internal blood stasis, incomplete epistaxis/hematemesis, remaining intra-abdominal blood stasis, hematochezia, yellow complexion, or epigastric pain.
Xijiao (Rhinocerotis Cornu - *Note: Substitute with Water Buffalo Horn/Shuiniujiao in modern practice*), Shengdihuang (Soaked in wine, separately pounded), Mudanpi (Moutan Cortex), Baishao (Paeoniae Radix Alba) in equal parts.
Decoct the first three ingredients, remove dregs, add Dihuagn, boil briefly, filter, and take. For delirium/manic behavior, add Dahuang (Rhei Radix et Rhizoma) and Huangqin. For pulse large but slow, abdominal fullness sensation despite no distension, add Danggui (Angelicae Sinensis Radix) and Rougui (Cinnamomi Cortex). For hematemesis/epistaxis, add Lotus Root Juice, Ce Bai Ye (Biota Tops), and Tongbian (Child's Urine).

Qingyan Zipfei Tang treats post-measles residual heat, cough, and hoarseness.
Xuanshen, Jingjie, Weirui, Niubangzi, Maidong, Beimu (Heart removed), Zhike (Aurantii Fructus), Jiegeng, Gualougen, Madouling (Aristolochiae Radix), Huoxiang (Agastaches Herba), Danpi, Bidou (Dolichoris Semen), Baishao (Equal parts), Gancao (Half dose).
Grind into powder. Take 3-4 qian per dose with one slice of Shengjiang (Zingiberis Rhizoma), decoct in water.

Zhuye Shigao Tang treats irritability and thirst after severe illness.
Zhuye, Renshen (Ginseng Radix et Rhizoma), Gancao (Honey-fried), Shigao (Raw, crushed), Jingmi (Oryza Sativa), Banxia (Pinelliae Rhizoma), Maidong. Decoct in water and take warm.

Baihu Tang treats febrile disease with high fever, irritability, and thirst, as well as Summerheat irritability and thirst.
Shigao (8 qian, Raw, crushed), Zhimu (3 qian), Gancao (1 qian, Honey-fried), Jingmi (0.5 he).
Decoct in water, divide into three warm doses, consume within one day.

Wubi San treats post-measles gum rot.
Take cow dung, calcine until carbonized, add a little Longnao (Borneolum Syntheticum), grind fine, and insufflate.

Jiawei Qingwei San treats macules/rashes with oral ulcers and gum rot.
Shengdihuang, Shengma, Danggui, Mudanpi, Chuanlian (Steamed with wine), Xijiao, Lianqiao, Sheng Gancao.
Grind into powder, decoct in water, remove dregs, sip slowly, repeat after half a day.

Huaban Tang treats concurrent smallpox and macules; use to resolve macules and promote smallpox eruption.
Niubangzi (1 qian), Xuanshen (2 qian), Chaihu (Bupleuri Radix, 0.8 qian), Jingjie (0.6 qian), Sheng Gancao (0.4 qian), Lianqiao (0.7 qian), Fangfeng (Saposhnikoviae Radix, 0.6 qian), Mutong (0.8 qian), Dan Zhuye (15 leaves), Zhike (0.7 qian), Chantui (Cicadae Periostracum, 0.5 qian), Dengxin (Junci Medulla, 20 stems).
Decoct in water, take warm, 2-3 times daily.

There is a type of vesicular rash resembling smallpox, very difficult to diagnose. Smallpox always has a distinct crown/base; although rashes may have fluid, the head/granule is never firm, and the base lacks a red halo. If smallpox fails to crust after rash, it is due to Yuanqi deficiency; treat by strongly tonifying Spleen and Stomach. Do not mistake this for lingering heat pathogen and administer heat-clearing/fire-reducing drugs again.

Measles is commonly called Shazi; Zhejiang people call it "Sha" zi. Measles involves wind-heat, though people may not know this. "Sha" and "Sha" are not in standard dictionaries; they are local dialects, errors of custom. Comparing the severity of symptoms then and now shows great disparity. Our Wu region has soft/water-rich soil where Shengqi (Vital Energy) easily stirs, so measles usually resolves within 2-3 days from start to finish. This has been true since ancient times. Recently, climate has changed, resembling the North. Even common measles now takes 6-7 days to resolve. If heat is not fully cleared, or if exposed to wind/cold or improper diet, myriad complications arise, potentially more dangerous than smallpox. Having reviewed medical texts, there is no specialized study on measles; mentions are brief appendices to smallpox chapters, lacking detail. No wonder pediatricians struggle and confuse smallpox formulas with measles. Know that Measles is Yang, transforming via Yin, thus erupting outward or sinking inward without forming pus; Smallpox is Yin, transforming via Yang, requiring exterior dispersion and interior support to aid pus formation. The difference is vast; how can they not be distinguished? This applies to infants. Now, however, young and strong adults also suffer. Although detailed diagnosis is needed, one cannot abandon principles. Yet clinical flexibility lies in mind and hand; principles should not be rigidly bound.

Ye Lin's Note: "Zhengzitong" states: "Ma [Measles] is a wind-heat disease. Originally written as 'Sha'." "Yupian" states: "Yinzhen [Hidden Rash] refers to small bumps on the skin surface." Thus, Douzhen (Smallpox/Rash), Shazhen (Sha Rash), and Mazhen (Measles) all refer to morphological similarity. Adhering strictly to philology would lead to treating only specific wind-heat epidemics with variable eruption, ignoring the latent Qi Sha Zhen that everyone is susceptible to. Letting characters harm meaning, Shiwen Laoren was somewhat negligent.

Fever: Both measles and smallpox begin with fever. Smallpox fever lasts 2-3 days before eruption; measles fever may last 6-7 days or half a month, or fluctuate, or remain high continuously. Initial fever presents with red face, swollen eyes, runny nose/tears, continuous cough. High fever lasting days is called Zhuang Re (Intense Heat), occurring mainly during active eruption. If intense heat persists after eruption without abating, the condition is severe; use Qingre Touji Tang (Heat-Clearing and Skin-Venting Decoction). If intense heat persists after complete eruption, use Zhuye Shigao Tang (formula above) removing Banxia, adding Jingjie and Xuanshen. If intense heat persists after resolution, it is critical; prioritize cooling and resolving. Some fevers stop for days then recur; some are early heat fading at dusk. At initial stage, if heat pathogen is not fully penetrated, use Gegen Jieji Tang (Kudzu Muscle-Relieving Decoction). During active eruption, if irritability worsens, heat pathogen has not resolved and is attacking inward; use Qingre Touji Tang. After resolution, if seen, residual pathogen remains; use Siwu Tang replacing Shengdi with Chishao, adding Lianqiao and Xuanshen. Sometimes rash fades, body cools, then fever returns after 6-7 days; this is either unresolved residual heat or new wind pathogen invasion; judge accordingly. Or it results from Middle Qi deficiency after severe illness; treating the root is key. Clinical judgment must be prudent.

Qingre Touji Tang treats measles not fully erupted, with intense heat and cough.
Xuanshen, Shigao, Niubangzi, Jingjie, Fangfeng, Qianhu, Gegen, Xingren (Equal parts), Sheng Gancao (Half dose).
Decoct in water, take hot.

Gegen Jieji Tang treats early measles with fever, cough, or alternating chills/fever.
Gegen, Qianhu, Niubangzi, Jingjie, Lianqiao, Chishao, Chantui, Mutong (Equal parts), Sheng Gancao (Half dose).
Decoct in water, take hot.

Siwu Tang treats Ying-Blood deficiency heat.
Shudihuang (2 qian), Dangguishen (1 qian), Baishao (1.5 qian), Chuanxiong (0.8 qian).
Decoct the four ingredients in water, take warm. Contraindicated for obese individuals with damp-phlegm, or those with nausea, poor appetite, and loose stools.

Location: Measles belongs to Fu organ manifestations; eruption first affects Yang divisions, then Yin meridians. In the body, Yang areas should have more eruptions, Yin areas fewer. Yang areas should vent; if Yin areas do not vent, it is not worrying. If Yin areas have many eruptions while Yang areas have few/unvented, it is dangerous; watch for complications. Yang areas: Head, face, back, extensor surfaces of limbs. Yin areas: Chest, abdomen, waist, flexor surfaces of limbs. Eruption from head to foot evenly is complete; more on head/face is favorable. Starting from warm chest/abdomen spreading to limbs is favorable. Starting from hands/feet spreading to chest/abdomen/back is unfavorable.

Color and Shape: Color should be rosy/red; shape should be pointed/upright. If rosy but flat, with difficult urination/bowel movements, use Qingre Touji Tang. If pale and flat, with normal excretion, this is Root Deficiency; nourish Qi and Blood. If dark and flat, with constipation and dry red lips/tongue, this is internal Fire depression; use Baihu Tang adding Xuanshen and Jingjie. If white, indistinct, with only raised dots that disappear quickly, the heat pathogen is light. However, if Wei Qi is deficient and color is white, keep warm; it will turn red/active in 1-2 days. If venting is blocked by wind-cold, turning skin-white with shivering, use Gegen Jieji Tang. If measles merge into patches, turning white upon wind-cold exposure, without fever but with internal attack, irritability, abdominal pain, phlegm-wheezing, it is critical. Toxin attacking Stomach causes vomiting clear water; attacking Spleen causes abdominal distension/anorexia; attacking Lungs causes nasal congestion/wheezing; attacking Pericardium causes dry scorched lips/tongue, unconsciousness, head shaking/hand twitching; attacking Kidney/Liver turns black and is untreatable. Purple-dark red indicates intense Fire toxin; if granules rise, it is treatable; use Liangxue Yinzi (Cool Blood Decoction). Delirium/irritability: Use Huanglian Jiedu Tang mixed with Yiyuan San. Dry/flattened is hard to treat. Scorched granules, regardless of color, indicate extreme heat; use Baihu Tang with heavy Shigao. Dry/no sweat: Add Mahuang to induce sweating. Constipation: Use Liangge San to purge. Large cloud-like patches: Either large red patches or small red dots on large patches; both indicate intense Fire toxin; use Baihu Tang adding Xuanshen and Zhuye. Brocade-like patterns or purulent bloody foul-smelling discharge with chest oppression, vomiting clear water, and warmth: Use Baihu Tang adding Huangqin and Maoyu Zhu (Imperata Rhizoma - *Text says Mao Zhu, likely Imperata or similar*). Early eruption resembling macules/scabs is wind-cold in exterior causing hidden rash; only disperse. Once measles vent, rash retreats. Do not mistake for macules and use bitter-cold drugs, causing measles to sink inward and become untreatable.

Liangxue Yinzi treats measles with intense Fire toxin, purple-dark red.
Huanglian (0.5 qian), Huangqin (1 qian), Da Shengdi (1.5 qian), Jingjie (1 qian), Xuanshen (1 qian), Chishao Yao (0.8 qian), Honghua (Carthami Flos, 0.3 qian), Mutong (0.7 qian), Mudanpi (0.8 qian).
Decoct in water, take warm.

Yiyuan San (also known as Tianshui San, Liuyi San) treats difficult urination in summer.
Huashi (Talcum, water-flowered, 6 liang), Gancao (Honey-fried 6 qian, Raw 4 qian).
Grind into powder, mix with clear water, take 2-3 qian. For dispersing Wenbing/Febrile disease, add 5-7 Congbai (Allii Fistulosi Bulbus) and 4 he Xiangchi (Fermented Soybean), decoct and take warm. Contraindicated for elderly, deficient persons, and post-illness Yin depletion with difficult urination. Adding Congchi decocts disperses exterior pathogens. Adding Wuzhuyu treats white dysentery. Adding Hongqu treats bloody dysentery. Adding Paojiang eliminates fluid retention. Adding Zhusha clears Heart fire. Adding Qingdai disperses Liver fire. Adding Bohe clears Lung heat. Adding Shigao removes Stomach heat. Combined with Tongsheng, Shuangjie, Jiedu formulas as needed.

Liangge San treats warm-heat epidemics, exterior-interior excess heat, Hyperactive Heart Fire, red eyes, constipation, Stomach heat causing macules.
Dahuang (Wine-soaked, 2 liang), Mangxiao (Natrii Sulfas, 1 liang), Lianqiao (1 liang), Huangqin (1 liang), Gancao (Honey-fried, 6 qian), Shanzhi (Gardeniae Fructus, 8 qian), Bohe (Menthae Haplocalycis Herba, 7 qian).
Grind into powder. Take 4-5 qian per dose with 15 Zhuye, decoct warm. Take 3 times day, 2 times night. Stop when heat resolves and bowels move. (Modern versions lack Zhuye, adding Ginger, Jujube, Scallion).
Mangxiao and Dahuang, aided by Zhi/Po's heaviness, guide lower heat downward smoothly; aided by Qin/Zhi/Qiao's lightness, they suppress upper heat while clearing below. This distinguishes Chengqi from Liangge. Gancao reflects the intent of Tiaowei Chengqi Tang. "Ju Fang" focuses on warm-heat epidemics, hence Zhuye. For common cold, follow modern version with Congbai, Ginger, Jujube.

Cough: Continuous dry cough in measles is caused by Fire pathogen scorching Lung Metal. Copening pores facilitates measles eruption. Thus, vigorous coughing before eruption is desirable; eruption stops the cough. If cough persists after eruption/resolution, use Qingyan Zipfei Tang. For cough with much phlegm, remove Maidong, add Chenpi (Citri Reticulatae Pericarpium) and Fuling (Poria). For wind-cold invasion with cough, irritability, vomiting clear water, red eyes, sore throat, oral ulcers, use Ganjie Tang adding Huangqin/Huanglian. Post-resolution: Ren Shen Baihu Tang removing Zhimu, substituting Maidong to nourish.

Ganjie Tang treats measles sore throat and oral ulcers.
Gancao, Jiegeng, Shandougen (Toosendan Fructus), Xuanshen, Niubangzi, Jingjie (Equal parts), Maidong (Double dose).
Decoct in water, take warm.

Renshen Baihu Tang treats febrile disease with dry tongue/thirst, fever, and chills in back.
Renshen (1 qian), Shigao (8 qian, Raw, crushed), Zhimu (3 qian), Jingmi (0.5 he), Gancao (1 qian, Honey-fried).
Decoct in water, take warm, divide into three doses, consume within one day.

Sweat: During measles eruption, slight sweating is ideal; it opens muscle-couplings, facilitating pathogen exit. Do not use ascending/dispersing drugs again, as excessive sweating risks Yang collapse. For sunk/unvented bad cases, using ascending/dispersing drugs to induce heavy sweat is a special variation. If high fever with no sweat and dry skin, wind-cold obstruction prevents eruption, often...