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A person said to me, "The onset of Sha Zhang (Sha Distension) is precisely Measles. You employ the method of bloodletting (Fang Sha) extensively for Sha Zhang, unaware that the 'Sha' released is merely the distending Qi of Measles. How can you claim that Measles is not a manifestation of Sha Zhang, nor that Sha Zhang is not the root of Measles?" I replied, "I have seen Measles arising from Wind-Cold injury accompanied by coughing, but I have never heard of Measles being caused by inhaling foul odors or summer-heat. Does this not prove that Measles has its own distinct pathology, and Sha Zhang has its own? Moreover, if Sha Zhang were identical to Measles, why would Measles remain latent due to invasion by foul odors and summer-heat, only erupting after bloodletting or scraping? This indicates that Measles and Sha Zhang are not the same. Therefore, in various types of Sha Zhang treated by scraping or bloodletting, even if Sha spots appear, they cannot be immediately identified as Measles; their pathology differs from Measles. Only those arising from Wind-Cold constitute true Measles, which is fundamentally different. However, there exists a type of Sha Zhang that arises without Wind-Cold, fever, or cough. I have observed cases where, after scraping, bloodletting, and medication, rashes resembling Measles appeared all over the body. Although similar in appearance, they are not true Measles; hence, they are termed 'Measles-like Rashes'." The person asked, "Are there conditions other than Measles that present with a morphology similar to Measles?" I said, "This is akin to Sha toxins manifesting as abscesses or purple macules; what is there to doubt?"

Clinical Cases:

1. A female member of the imperial household suffered abdominal pain. Her right pulse was faint and wiry, while her left pulse was fine and choppy. Her maid performed bloodletting at three points on the popliteal fossa, releasing dark purple-black blood, but she did not recover. She was administered Baohua San (Precious Flower Powder) and Jiuku Dan (Bitterness-Saving Pill), taken with slightly chilled clear tea. Additionally, Heping Xuanhua Yin (Spleen-Harmonizing and Transformation-Decoction) was prescribed with added Qiancao (Rubia cordifolia Root) and Taoren (Peach Seed), also taken slightly chilled. Subsequently, a Measles-like rash erupted all over her body. I then treated her with Fangfeng Sansha Tang (Saposhnikovia Decoction for Dispersing Sha), modifying it by removing Xixin (Asarum) and adding Lianqiao (Forsythia Fruit), Honghua (Carthamus Flower), Jinyinhua (Lonicera Flower), and Taoren (Peach Seed). She recovered.

2. The granddaughter of Shi Junji presented with fever, cough, abdominal distension, and lethargy, showing slight signs of Measles. She had diarrhea with yellow watery stools. Previous treatments using ascending and dispersing herbs were ineffective. Upon my examination, the pulse was excess in the upper position and deficient in the lower position. I determined that although the fever and cough originated from Wind-Cold, the Measles-like signs were not truly due to Wind-Cold. Bloodletting was performed at more than twenty points on the fingertips. Yuanhong San (Round Red Powder) was mixed with brown sugar and administered with slightly cool water. After feeling somewhat refreshed, Duhuo Honghua Tang (Angelica Pubescens and Carthamus Decoction) was prescribed with added Shanzha (Hawthorn Fruit), Boluoz (Radish Seed), and Zelan (Lycopus Herb). Two doses were given consecutively. Black material was passed in the stool, and she recovered.

3. The third son of Zhang Lianyi suffered from fever, lethargy, and slight rash-like shadows on the waist and hypochondrium resembling Measles. Previous treatments used ascending and penetrating agents, but there was concern that the pathogen might not fully emerge. On the following day, he summoned me. His six pulses exhibited intermittent pauses (Xi Zhi). I stated, "Why should the pulse of Measles suddenly show such pauses? Although he is lethargic and panting, there is no phlegm sound in the throat, and the pulse does not match the symptoms. This must be a case of Sha Zhang presenting as Measles-like rash." Bloodletting was performed on the vertex, along with three points on the left Taiyang (Bladder Meridian) point and above the breast. The condition did not improve initially. Jingjie Tang (Schizonepeta Decoction) was prescribed with added Sanleng (Sparganium Rhizome), Pengzhu (Curcuma Rhizome), and Baijili (Tribulus Fruit), taken slightly chilled. A Measles-like rash erupted all over the body, and he stabilized.

4. Xue Sigao presented with fever, mental confusion, stifled Qi, and rash-like shadows on the chest, abdomen, head, and face. Palpation revealed both Guan positions of the pulses were Kou (hollow, like a scallion stalk). This indicated Sha Zhang presenting as Measles-like rash. More than ten points were bled, followed by scraping. Chenxiang Yujin San (Agarwood and Curcuma Powder) was administered with slightly chilled clear tea. He recovered.

5. The son of Zhang Shengyuan suffered from chest and abdominal fullness and oppression, lethargy, and unconsciousness. Sha veins were not visible, though slight Measles-like shadows were present. The Cun and Guan positions of the left hand were deep and fine, almost imperceptible, and the Cun position of the right hand was hidden (Fu). I reasoned that the pulse of Measles would not present this way. His family members lit a lamp wick dipped in vegetable oil and cauterized his nose, upon which he regained consciousness. However, the fullness and oppression remained unresolved. Baohua San (Precious Flower Powder) was administered with added Chenxiang (Agarwood) and Puhuang (Tamarix Pollen), taken with slightly chilled clear tea. Heehjie Yin (Harmonizing and Resolving Decoction) was prescribed, modifying it by removing Shanyao (Dioscorea Rhizome), Renshen (Ginseng Root), and Gancao (Licorice Root), and adding Taoren (Peach Seed) and Honghua (Carthamus Flower). He recovered.