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Qian Zhongyang stated: During the ten months in the womb, the infant consumes the blood and turbidity of the five zang organs. After birth, these toxins must be expelled. Therefore, the manifestations of sores and rashes are all expressions of the fluids of the five zang organs. The Liver governs tears, the Lung governs nasal mucus, the Heart governs blood, and the Spleen envelops/stores blood. There are five names for the eruption of sores and rashes: those from the Liver are called "water sores" (shui dou), as tears flow like water, appearing blue-green and small; those from the Lung are called "pus sores" (nong dou), as nasal mucus is thick and turbid, appearing white and large; those from the Heart are called "macules" (ban), governing heart blood, appearing red and small, secondary to water sores; those from the Spleen are called "papules/rashes" (zhen), smaller than macules, as they govern enveloped blood, thus appearing light red-yellow. Since nasal mucus and tears flow abundantly, pus sores and water sores are larger; since blood circulates within and is not discharged much, macules and papules are smaller. If a patient has little nasal mucus or tears, it is akin to the body becoming emaciated after the fluid in the uterine cavity is drained.

Initially, tidal fever occurs. After three days or more, if heat travels to the skin and causes sores and rashes that are not numerous, it is because heat remains between the skin and interstices. Tidal fever follows the zang organs; eruptions occur around the time of early morning meal (Chen hour). If tidal fever persists, it belongs to the category of water sores. When sores and rashes first erupt, symptoms of the five zang organs appear, except for the Kidney, which shows no specific sign but only normal pulse/symptoms, specifically coolness at the sacrum (couch) and ears. The sacrum and ears belong to the Kidney, situated in the North, governing cold. If sores turn black and sink inward, while the ears and sacrum become hot, this is an adverse condition.

The *Shengji Zonglu* discusses: Infants inherit pure Yang qi, with heat accumulating in the zang-fu organs. This heat moves from inside to outside, steaming along with qi, scattering between Ying-Wei and muscles, lingering in the inner interstices. It may result from drinking hot milk or encountering epidemic pathogens. Heat takes advantage of tender and weak muscles, transforming into sores and rashes. Mild cases involve pathogenic factors in the fu organs, manifesting as fine rashes resembling mosquito bites, dotted red, commonly known as bran sores (fu chuang); severe cases involve pathogenic factors in the zang organs, manifesting as bean-like sores resembling peas, with red roots and white heads, oozing pus and water from pores, commonly named variola (dou chuang). Before eruption, there is always steaming fever resembling Shanghan syndrome, headache, red face, yellow eyes, whole-body heat, back pain, dark short urine, loose or constipated stool, irritability, thirst with desire to drink, even delirium, with a floating, large, surging, and rapid pulse. These are the signs.

Li Dongyuan stated: The initial signs of macules and papules必先 (must first) show dry face, red cheeks, red eyelids, yawning, restlessness, alternating chills and fever, cough, sneezing, cold toes, excessive sleep, and fright. Regarding sores and rashes, whether pustules, small red macules, or urticaria arise, why do these different conditions all display the aforementioned symptoms before eruption? This is because these symptoms stem from Taiyang Cold Water originating below the right Kidney, simmering the left Kidney. Foot-Taiyang Bladder cold water flows counter-current up the spine, to the head and forehead, opposing Hand-Taiyang Bing Fire, unable to conduct, reversing onto the face, thus displaying these signs. Ren-Gui Cold Water overcomes Bing-Ding Hot Fire. All macule syndromes arise from counter-flow of cold water; physicians must understand this principle to dare prescribe medicines. The Bao Gong (Uterus/Womb) is also called Chi Gong or Dantian, governing storage and transformation of essence in men, and pregnancy in women. It is the source of generation and transformation, not belonging to the Five Elements, neither water nor fire. It is a different name for Heaven and Earth, symbolizing Kun Earth generating all things. At conception, the Blood Sea is pure. On day one or two, Jing (Essence) surpasses Blood, forming a male; on days three to five, Blood vessels are vigorous, Jing does not surpass Blood, forming a female. Essence and Blood contend; what grows prior to the body is called Shen (Spirit), also called Jing. Daoism and Buddhism refer to this as the original face. In the womb for ten months, the fetus breathes with the mother. Breathing is Yang Qi, generating movement and nourishing Jing-Qi. Hunger leads to consuming maternal blood, thirst to drinking maternal blood. The child grows skin, flesh, bones, tendons, vessels daily. Form and Qi complete, born after ten months. Evil blood remains in the mouth; upon crying, it is inhaled downward. This evil blood returns to the Mingmen and Bao Gong, hiding in a corner, lying dormant. Until internal injury from milk/food causes damp-heat to flow downward, combining with the Kidney, where two fires attack each other, causing Ying Qi to disobey, reverse in muscle tissue, and evil blood erupts as macules and rashes, all emerging from Bladder Ren Water. Post-ulceration, flesh gathers in the interstices, returning to Yangming. Thus, the initial signs of three waves of macules involve Foot-Taiyang Ren Bladder overcoming Bing Small Intestine. Initial eruption appears on the face, finally returning to Yangming muscle tissue, where heat transforms into pus. When two fires are intense, overcoming cold water, eruption covers the whole body. This all stems from transmission via Foot-Taiyang. One should release exterior cold pathogens to dissipate them; purge internal two fires to prevent mutual attack; guide dampness upward to restore its proper position. One or two doses can cure immediately, preventing future recurrence. This is the method of the *Neijing*; readers should study it carefully.

Sun Dongsu stated: Measles are called Sha Zi (sand children) or Sha Zi in Zhejiang, Zhen Zi in Wu region, and Ma in Xin'an. Generally, it is excess fire from early life, hidden in the Mingmen. Mingmen possesses the principle of Taiji, wherein Yin-Yang and Five Elements reside, giving rise to zang-fu organs. Essentially, Five Elements reduce to Yin-Yang, and Yin-Yang reduces to Taiji. Heaven and humanity interact mutually. Due to this interaction, when heaven is cold, the body is cold; when heaven is hot, the body is hot. Epidemic qi moves, and inherent toxins erupt upon contact. Contact with Yang causes rashes (Zhen); contact with Yin causes smallpox (Dou). Yang is floating and shallow, so rashes are easy to erupt and heal; Yin is condensed and deep, so smallpox is hard to erupt and scab. When both Yin-Yang劫 (tribulations/toxins) are fully expelled, health returns. I say: Erupting rashes or smallpox is like silkworms molting multiple times. Smallpox originates from Yin but completes through Yang, secured by Qi; Rashes originate from Yin but rely on Yin, supported by Blood. Why? Without Qi movement, Blood cannot attach, how can scabs form? Without Blood support, Qi loses foundation, how can healing occur? This is the principle of Yin-Yang ascending and descending; one opens, one closes. Blood attaches to Qi; Qi relies on Blood; Yin roots in Yang; Yang roots in Yin; Yin and Yang root each other. Predecessors said smallpox comes from Zang organs but didn't specify which; rashes come from Fu organs but didn't specify which. They also said rashes come from Heart and Lung, hence nasal discharge and cough. I consider these speculative clichés without true insight. If rashes come from Fu organs, are Heart and Lung not Zang organs? According to the *Neijing*, the nose is the gateway of the Lung, connecting to heavenly qi. Yang toxins ascend, heat toxins steam. Heart and Lung are high above the diaphragm; Lung governs hair follicles/pores. Toxins exit through pores, affecting the Lung rather than originating from it. Know that both smallpox and rashes originate from Yin-Yang of Mingmen.

Ye Lin notes: Sha Zhen (sand-rash) is not recorded in ancient classics. Since Song and Yuan dynasties, writings by sages are often杂乱 (disorganized). Luo Tianxi (Wan Muzhai) of Luotian in Ming Dynasty first clarified treatment methods. His discussion on fetal toxin being in Fu or Zang organs is still following old patterns. Only Sun Wenyuan's theory on Mingmen is precise. Although the root of Sha Zhen is clear, there are cases unrelated to Mingmen latent qi, where signs resemble but are not identical. Besides wind-hidden macules/rashes, there is also Rotting Throat Dan Sha syndrome. Both require detailed examination to avoid confusion.

Wind Rash initially presents with irritability and itching. Scratching causes raised lumps instantly, forming patches. More scratching worsens it. Caused by Spleen deficiency and Blood heat, contracting Wind pathogen. Treatment should regulate middle and disperse wind; do not use only wind-dispersing herbs.

Hidden Rash initially resembles mosquito/flea bites, itchy without visible heads. Scratching looks swollen but isn't, appearing hidden. Severe cases cause fever and abdominal pain. This is Spleen storing heat, compounded by Wind-Damp invasion. Treatment should eliminate wind and clear heat. This differs from hidden rashes in dangerous Sha Zhen cases; do not confuse them.

Regarding these two syndromes, they correspond to *Chubing Yuanhou Lun*'s description of pathogens breaking into muscles and contending with internal heat to form Zhen; and *Waitai Miyao*'s description of red Zhen like mosquito bites, itchy, scratching causes layered swelling. These are the red and white types of Wind-Shi Hidden Zhen.

Macules have color spots but no granules. Shapes vary like brocade patterns or clouds. Touching feels smooth, pressing shows faint晕 (halo). Syndromes differ by Yin/Yang: Yang Macules with purple small spots indicate Pericardium heat; purple large spots indicate Stomach heat. Causes include Warm Disease, Shanghan, post-sweating, or Blood heat. Yin Macules are pale red, no thirst, non-surging pulse. Caused by latent cold below forcing rootless/fire-loss fire to gather in chest and steam upward. Treat according to the primary disease to determine prognosis.

According to *Shanghan Zongbing Lun*: Winter-warm qi erupts in spring/summer, muscles become mottled, hidden Zhen like brocade, commonly called Ma Zi Chuang. *Buwang Lun* states: Macule shapes like cinnabar dots or brilliant brocade. These are heat disease macules/Zhen, distinct from Sha/Ma.

Measles fever, regardless of day 3 or 4, shining a light reveals body covered like vermilion paint, a sign of impending eruption. Eruption is fine/dotted, skin red in patches, like bite marks, rough to touch, halo upon pressing. Must erupt from face to chest/back/hands/feet thoroughly; rosy-red is best. Severe cases cause body swelling and closed eyes. Measle colors vary red/white/light yellow; as long as rosy and active, black sinking is dreaded. Dense eruption on face/chest/abdomen, locking throat is adverse; failure to erupt with wheezing/stuffiness is ominous. Difference between Measles and Sha Zhen: Measles shows whole-body numbness initially, peeling after resolution; treatments are similar. Not recorded in formula books, only discussed in *Jingyue Quanshu*, refer to it. Also, whole-body redness without spots is called Huo Dan (Fire Dan), related category. In smallpox department, complications like Jia Sha, Jia Ma, Jia Dan exist, all caused by heat-toxin, requiring detailed differentiation.

Guo Baiyun noted: Peeling like bran flakes indicates current measles.

Question: Sha and Ma syndromes, one says Mingmen latent toxin, one says not, is there an explanation? Answer: Sha Zhen is unavoidable for everyone; some erupt before smallpox, others recur after smallpox. Measles, 80-90% never erupt in lifetime, only 10-20% suffer. One is latent toxin, one is epidemic qi. Based on this, doubt is unnecessary.

Besides Measles, there is Shi Sha (Seasonal Sha), also not latent toxin, but due to irregular cold/warmth brewing into epidemic qi, vulnerable people easily contract. Pathogen affects meridians: body heat with sweat, cough, calm spirit, slight thirst. Eruption starts scattered (3-5 spots), then dense red clouds. From onset to resolution takes ~10 days. Accompanied by loose stools; stops when Sha is sufficient. Heat retreats, Stomach Qi opens, illness recedes. Treatment: Body heat/cough, Sha points not reached, disperse/resolve plus open Lung; subsequently Sha points penetrate but insufficient, or with diarrhea, continue dispersing/resolving, do not stop diarrhea, Sha sufficient stops diarrhea. Insufficient, red eyes/restless spirit, crimson tongue/rapid pulse, disperse/resolve plus clear heat. Sha sufficient, dense red clouds, surging-large pulse, crimson tongue/restless spirit, clear fire nourish fluids. Sha retreating, heat gone, Stomach open, cough persists, lightly clear/resolve Lung. Those with Shao Yin failing to store, Qi is deficient, pathogen heavy. Early retreat of Sha with persistent irritability/heat; dull spirit/abdominal pain/chest fullness; nasal flaring/breathlessness; fluid depletion/dry tongue; righteous deficiency/chaotic pulse. These bad omens are dangerous if encountered.

Rotting Throat Dan Sha: No such syndrome/formula in ancient texts. Recent cases are numerous and severe. Due to thin wind/qi, epidemic pathogens easily contracted. Initial sore/swollen throat, nasal congestion/sneezing, cough/chest oppression, severe body pain/dull spirit/depressed pulse/irritability. Whole-body Sha points, fine/red-active, with sweat mild; burning/no sweat, skin like red paper, Sha hidden in patches without granules severe. If Sha purple-stagnant-dry, throat rotting/delirious, dangerous toxic-fire sinking inward. Treatment involves dispersing/reaching, clearing/transforming, purging/lowering, saving fluids. Improper sequence causes endless complications. Chen Jingyan's *Yi Sha Cao* details this well, highly recommended reading. This syndrome is highly contagious, prevention essential. Wang Mengying's *Ren Shu Zhi* records a formula: For irregular cold/warmth when this syndrome appears in villages, use aged white radish greens and fresh olives, decoct strongly, drink freely as tea. Tested effective.

Note on Chen Jingyan's *Yi Sha Cao*: Discussion on syndrome/treatment is exhaustive. However, the section on origin of epidemic pathogen attributing it to residual toxin from vaccination is speculative and unconvincing. I observed for over ten years: patients with this syndrome are not all vaccinated; those without are not all natural smallpox survivors. Clear evidence. Xu Lingtai stated: Song dynasty smallpox signs/treatments were simple; recently became heavier, unlike macules/rashes, treatment distinct. Knowing diseases change infinitely with time/place explains *Neijing*'s discussions on Five Movements/Six Qi and diverse methods/appropriateness. Physicians who don't know celestial shifts and regional characteristics remain biased. This is indeed a universal truth.