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At the initial stage of fever, when symptoms such as aversion to cold with high fever (Zenghan Zhuangre), runny nose with clear mucus, vomiting and diarrhea, cough with rapid breathing, red cheeks, and tired eyes appear, the exterior should be resolved immediately. If a slight sweat is achieved, the skin becomes unobstructed, the couli (skin pores and texture) open up, and the measles rash easily emerges. How could there then be worries of chest tightness, abdominal distension, or rapid breathing? The initial presentation resembles Taiyang disease (Shanghan), but facial flushing and coldness in the middle finger are distinguishing features.

Main Formula (subsequent doses adjusted according to modifications below): Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus Immaturus), Qianhu (Peucedani Radix), Sangbaipi (Mori Cortex), Xingren (Armeniacae Semen Amarum) (equal parts); Gancao (Glycyrrhizae Radix et Rhizoma) (half dose). Add scallions with roots and scallion heads, decoct in water and take orally.

In warm/hot weather: Add Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), Xuanshen (Scrophulariae Radix), Mutong (Akebiae Caulis), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma); reduce Shengma and Gegen; add Danzhuyez (Lophatheri Herba) and Dengxincao (Junci Medulla), decoct in water.

In mild/warm weather: Add Shigao, Zhimu, Niubangzi (Arctii Fructus), Bohe (Menthae Haplocalycis Herba), Lianqiao (Forsythiae Fructus), Mutong; reduce Shengma, Gegen, and Dengxincao (ten stalks); decoct in water.

When alternating warmth and cold: Add Qianghuo (Notopterygii Rhizoma et Radix), Niubangzi, Lianqiao, Chishao (Paeoniae Radix Rubra); reduce Zhike. Decoct in water and take orally.

In severe cold: Add Mahuang (Ephedrae Herba) (wine-fried), Qianghuo, Chuanxiong (Ligustici Chuanxiong Rhizoma) (add a small amount of Guizhi (Cinnamomi Ramulus)); remove Shengma and Gegen. Decoct in water and take orally.
All four formulas above add Sangbaipi and Xingren.

For cases with vomiting, diarrhea, and inability to eat, no specific treatment for these symptoms is needed. Only resolve the exterior pathogen; once the rash emerges fully, all other symptoms will naturally settle. If constipation occurs, add Dahuang (Rhei Radix et Rhizoma) 5-7 fen, stopping when bowel movement is unobstructed.

When the rash first appears, it usually shows first behind the ears, on the neck, waist, and legs. It is auspicious if the papules have pointed tips but do not elongate, and are small and uniform/clean. At the time of emergence, the color should be pale red and sparse/clear. Deep red or purple indicates transformation into fire. If purple-red and dry, dark and lusterless, it signifies excessive fire and intense toxin. After taking exterior-resolving medicine, shine a paper torch upon the skin; if red shadows appear under the skin, forming patches ready to rise, proceed. Strictly avoid wind, cold, raw/cold foods, and various taboos. Any violation may cause the rash to retract inward, often leading to untreatable conditions. In such emergencies, urgently promote eruption via sweating methods; if still not emerging, vigorously increase diaphoretic herbs, and apply external rubbing methods. If toxins attack internally, itching and collapse may occur, making rescue difficult. Or, due to closed skin and stagnation of toxic qi, it may turn into whole-body cyanosis, restlessness, abdominal pain, rapid breathing, chest tightness, confusion, and death. If spontaneous diarrhea persists or urination is frequent, although these are ominous signs, if the rash is dense and deep red/purple, they are not necessarily detrimental. However, if after three days the fever does not subside and the rash does not recede/converge, it means the toxic fire is too strong and residual pathogens remain. It is appropriate to take heat-clearing and detoxifying medicines, which will allow the rash to converge. According to subsequent formulas:

Mild case: Fever fluctuates; rash appears after five to six days, pale red and moist, uniform and clean on head and face, abundant, erupts on schedule, and converges after three days.
Severe case: Rash does not appear on head/face, color is red-purple, dark, dry; sore throat and swelling, inability to eat, rash retracts early due to wind-cold exposure, heat shifts causing dysentery.

Main Formula: Fangfeng, Qianhu, Chuanxiong, Zhike, Jiegeng, Sangbaipi, Xingren, Chenpi (Tangerine Peel) (equal parts); Gancao (half dose). Decoct in water and take orally.

If rash has not emerged fully: Add Shengma, Mahuang; use sparingly in summer.
If rash has emerged fully: Add Lianqiao, Niubangzi.
If toxic fire is strong and thirst is severe: Add Shigao, Zhimu, Xuanshen, Huanglian, Huangqin, Zhizi.
If wheezing and coughing: Add Su Zi (Perillae Fructus), Gualou Ren (Trichosanthis Semen), Luobo Zi (Raphani Semen).
If fire closure: Add Dahuang.
If rash color is white: Add Honghua (Carthami Flos) (wine-fried), Chishao (wine-fried).

Deep red rash with thirst: Shigao (2 qian), Zhimu (1 qian), Niubangzi, Lianqiao, Shengma, Digupi (Bark of Lycium Root), Danzhuye, Gancao (each 7 fen). Add Nuomi (Glutinous Rice) (100 grains), decoct in water and take orally.

Hot weather, extreme thirst with continuous drinking: Add Zhizi, Maidong (Ophiopogonis Radix), Tianfen (Tianhuafen/Trichosanthis Radix); drink with Menglü Dengxin Tang (Mung Bean and Juncus Decoction).

Wind-cold closure, rash not emerging fully: Mahuang (wine-washed, 1 or 2 qian, until sweating occurs), Shengma (wine-washed, 1 qian), Renzhonghuang (Human Waste Charcoal) (if unavailable, use Gancao mixed with child's urine), Chantui (Cicada Slough), Niubangzi (each 1 qian). Decoct with Jiang (Ginger) and Cong (Scallion) and take orally. Externally: Steam Huisu (Coriander) with wine lees until hot; rub over the whole body from head to feet in a wind-free, warm place, until slight sweat appears.

Purple-red and dry rash: Chuanxiong, Shengdi (Rehmanniae Radix Preparata), Honghua (wine-washed), Gange (Gegen), Huangqin, Lianqiao, Niubangzi. Decoct in water, mix with Liuyisan (Six-to-One Powder) and take orally.

Rash about to emerge but retracts: Mahuang (wine-washed, 2 qian), Shengma, Gegen, Qianghuo, Fangfeng, Jingjie, Niubangzi, Qianhu, Jiegeng, Gancao. Decoct in water and take orally.

Pregnant woman with measles: Main formula adds Chuanxiong, Shengdi, Tiaohuangqin (Scutellariae Radix), Aiye (Artemisiae Argyi Folium). Focus on calming the fetus, combined with detoxifying herbs; take generously. If fetal qi rushes upward, urgently decoct Zhugen (Radix Boehmeriae Niveae) and Aiye, grind Shengbinglang (Arecae Semen) and take.

Heat-toxin steaming the fetus: The fetus is often injured; internal medication combined with external fetal-protection methods ensures safety. If untreated and the fetus aborts, the mother may remain safe. This is because variola (smallpox) requires interior excess (leading to maternal death if fetus drops), whereas measles requires interior deficiency (allowing maternal safety). (Must ensure both mother and child survive.)

Fetal protection method: Dianqing (Indigo Naturalis), Zaoxintu (Caoline), Jingdini (Mud from bottom of well) ground uniformly; apply to umbilicus and abdomen, thickness of one cun, apply frequently.

Untreatable signs: Black, dark, scorched, and withered appearance; sudden appearance of purple spots that disappear immediately; flaring nostrils, open mouth, staring eyes without spirit, blue nasal bridge, black stool; rapid breathing with anterior chest retraction; foul-smelling rotting gums after rash.