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The son of the Yang family developed dysentery with fresh blood after suffering from measles (Shazhen). He was cured using Danggui Shao (Tail of Angelica Sinensis), Dihuang (Rehmannia Root), Baishao (White Peony Root), Chao Tiaoqin (Stir-fried Scutellaria Root), Chao Huanglian (Stir-fried Coptis Rhizome), Renshen (Ginseng), Gancao (Licorice Root), Zhike (Aurantium Fructus), and Wumei (Mume Fruit). This formula is effective for all cases of bleeding during the eruption of rashes.

Qian Yi diagnosed the rash of the Ten Great King in the Muqin Palace, stating: "If the sores and rashes erupt completely from beginning to end without other symptoms, purgation should not be used; only mild and harmonizing medicines should be given frequently along with milk and food, avoiding wind and cold. If the sores do not appear within three days or fail to erupt smoothly, a mild diaphoretic approach should be employed (such as Niubangzi Tang [Arctii Fructus Decoction]). If the sores appear but are sparse, increase the dosage (e.g., from one decoction per day to two). If they still do not appear after increasing the dose, use strong diaphoretics (such as Shengma, Gegen, Qianghuo, Fangfeng, Duhuo, Mahuang, Guizhi). If even after diaphoresis the eruption remains sparse, and the pulse is calm with no symptoms, it indicates that the rash was originally sparse, and forcing further eruption is contraindicated. For high fever, promote urination. For slight heat, resolve toxicity (promoting urination can be done with Sisheng San [Four Saints Powder]). If there is no improvement, avoid aggressive purging; instead, use Baolong Wan [Dragon-Embracing Pill]. If there is high fever but the patient can eat, use Dahuang (Rhubarb) to induce bowel movement once or twice and then stop. If the sores are black, purple, dry, and sunken, use Baixiang Wan [Hundred Auspicious Pills] to purge; if not black, absolutely do not purge. For body heat, irritability, abdominal fullness, wheezing, difficulty in urination and defecation, red face, confusion, and severe vomiting, promote urination. If this fails, use Xuanfeng San [Wind-Releasing Powder] to purge. If scabs do not dry up after five to seven days, it is because internal heat steams the skin, preventing scabbing. Use Xuanfeng San to guide out the heat, and apply Sheng Xijiao (Fresh Rhino Horn) juice to resolve toxicity, ensuring heat does not persist, which will lead to scabbing. (This discussion has valid points and some shortcomings; they should be viewed separately.)"

When the Ten Taifui of Muqin Palace suffered from sores and rashes, various physicians treated him. The Prince asked, "Which organ system does the unemerged rash belong to?" One physician said it was stomach heat; another said it was unresolved cold damage (Shanghan); a third said it was toxin acquired in the womb. Which zang organ is it? The physician replied, "It belongs to the spleen and stomach." Qian Yi asked, "Why is there palpitation and fright?" None could answer. Qian Yi said, "When the fetus is in the womb, by the sixth or seventh month, its form is complete. It swallows impure fluids from the mother's abdomen, entering the infant's five zang organs. By the tenth month, these impure fluids fill the stomach. At birth, the infant's mouth is still unclean; if the mother wipes it clean with her hand, disease will not occur. Common practice uses Huanglian (Scutellaria Root) and Hongfen (Cinnabar powder) to purge the toxic feces, but this allows residual impurity to enter the infant's organs. Originally caused by slight cold, combined with wind-cold, the pathogenic factors struggle, forming acne and rashes. Before eruption, when heat stirs the five zang organs, their symptoms appear first. Initially, there are yawning and restlessness, palpitations, alternating chills and fever, cold extremities, red and dry cheeks, coughing, and sneezing—symptoms of all five zang organs. Yawning and restlessness indicate the liver. Palpitations indicate the heart. Alternating chills/fever and cold limbs indicate the spleen. Red/dry cheeks, cough, and sneezing indicate the lungs. Only the kidney shows no signs because it is located below the fu organs and does not receive food. Sores and rashes are toxins of the five zang organs. If they merge into one symptom, sweat-soaked sores on the heart become macules (Ban), while those on the spleen become papules (Zhen). Although the kidney has no specific sign, if the condition worsens later with inverted, black, and sunken rashes, it returns to the kidney. This is due to exposure to wind-cold and inability to eat, leading to internal deficiency. Since the Taifui's rash has no other symptoms, treat with mild medicines. Several doses of Baolong Wan resulted in recovery. (Haizang noted: Do not mistake 'originally slight cold' or 'internal deficiency from wind-cold/poor appetite' as cold syndromes; using Baolong Wan reveals that macules and rashes are mostly heat syndromes.)"

Wu Qiao treated his nephew's young child who had been feverish for several days with convulsions and confusion. Physicians did not know the cause. Wu Qiao said, "This is measles. External cold pathogens have blocked the pores, preventing eruption. It is merely an infant's illness. Medications have damaged the middle qi and are no longer reliable. Place a bottle of boiling water, remove the lid, and have the nurse hold the child beside it, covering them slightly with a blanket. The steam will gently fumigate the child. Administer small amounts of internal-supporting medicine. Once the measles eruptate, the illness will resolve. Later, Wang's son had similar symptoms and was also cured by this method."

Xue Lizhai treated a child with painful, feverish, and thirsty rashes. The parents wanted to use Qingliang Yin [Cooling Drink] to purge. Xue found the pulse neither solid nor rapid, indicating the pathogen was in the meridians, not suitable for purging. He used Jiedu Fangfeng Tang [Detoxifying Saposhnikovia Decoction], and the child recovered in two doses. This condition is common in children; treatment must distinguish between exterior and interior locations and the severity of the pathogen. Wang Haizang stated: "Why do predecessors say purging is forbidden at both the beginning and end? Purging is forbidden at the beginning because macules have not yet appeared on the surface; purging prevents the pathogen from extending outward. This presents exterior symptoms without interior excess, hence purging is forbidden. Purging is forbidden at the end because the macule toxin is already manifest externally, lacking an internal root, with loose stools and no interior symptoms. Purging would cause the macules to collapse inward, hence it is forbidden."

A child with itchy fever was treated with Xiaodu Xijiao Yin [Toxin-Resolving Rhinoceros Horn Decoction]. After one dose, he vomited and had diarrhea, indicating the pathogen was exiting through both upper and lower orifices, resolving the toxicity. Soon after, vomiting and diarrhea stopped, and symptoms subsided. The pulse showed seven beats per breath, a normal pediatric pulse, indicating the pathogen was exhausted. No further treatment was needed, and the child recovered. Jiegu stated: "Symptoms of macules and rashes vary. Swelling on the exterior belongs to the Shaoyang Sanjiao Minister Fire, called macules. Small red spots remaining within the skin belong to the Shaoyin Sovereign Fire, called rashes. If macules/rashes appear with spontaneous vomiting/diarrhea, do not interfere; this is auspicious as the fire exits both ways. When macules and rashes erupt together, purging is contraindicated as it may cause other complications. Generally, harmonizing medicines are preferred over diaphoretics. If constipated, mildly loosen the bowels to prevent pathogen stagnation and allow orderly eruption. Warm body indicates favorable prognosis; cool body indicates unfavorable. Shen Mingsheng treated Shen Hanchen's wife for cough and fever. Others assumed deficiency and used Liuwei Dihuang Tang [Six-Ingredient Rehmannia Decoction] to nourish yin, worsening the cough. Shen found a floating and rapid pulse, diagnosing wind-heat attacking the lungs. He used exterior-releasing agents. After two doses, red rashes appeared all over, and cough improved but did not fully clear. He added acrid-cool herbs to clear exterior heat. Cough persisted, followed by persistent diarrhea. Everyone blamed the cold-natured medicines. Shen laughed, "Incorrect. Lung affected by wind transforms into heat. As the Classics state, when pathogen combines with yang, yang becomes hot and yin deficient. Initially, the rash was about to emerge, fire flared upward to the Hand-Taiyin Lung mer causing cough. Now, as the rash recedes, heat shifts downward to the Hand-Yangming Large Intestine meridian causing diarrhea. This is a common course of macules/rashes, nothing strange. It will stop soon." Indeed, after two days, cough ceased, diarrhea stopped, body cooled, and rashes faded. Note: While manifestations differ, treatments are similar. In the Dingwei year, damp-earth governed the heaven, but spring/summer were extremely dry, likely inheriting last year's dry-metal earth energy. Thus, initial treatment requires cooling resolution, not warming dispersion; subsequent treatment requires cold-moistening, not warming-tonifying. Liuwei Dihuang Wan [Six-Ingredient Rehmannia Pill], though seemingly appropriate, is heavy and cloying, failing to reach the exterior and instead trapping pathogens. It might be suitable only when rashes fade and residual heat remains. Using it initially for heat/cough is not nourishing yin but nourishing harm. Converting pills to decoctions deviates from ancient intent, and blind application exploits pathological changes. Even Xue Lizhai, known for using Liuwei well, arguably abused it. If he were alive today, seeing the prevalence of such decoctions, he would surely cover his mouth in dismay.

Sha Zhen (Scarlet Rash) is fire-heat of the Hand-Taiyin Lung and Foot-Yangming Stomach meridians. It is common in children but occurs in adults too. It resembles seasonal warm epidemics. Symptoms include cough, sneezing, tearing, diarrhea, phlegm, fever, thirst, irritability, and in severe cases, agitation, sore throat, cracked lips, and coma. Treatment focuses on cooling and dispersing, using acrid-cold, sweet-cold, and bitter-cold herbs to ascend and release. Avoid sour-astringents; prefer acrid-dispersants. Mistaken use of warming-tonics leads to disaster. Acrid-dispersants include Jingjie Sui (Schizonepeta Spike), Genge (Pueraria Root), Xihe Liu (Tamarix Twig), Shigao (Gypsum), Mahuang (Ephedra), Niubang Zi (Arctium Fruit). Cooling herbs include Xuanshen (Scrophularia Root), Gualou Gen (Trichosanthes Root), Bohe (Mint), Zhuye (Bamboo Leaf), Qingdai (Indigo Naturalis). Sweet-cold herbs include Maidong (Ophiopogon Root), Sheng Gancao (Raw Licorice), Zhe Jiang (Sugarcane Juice). Bitter-cold herbs include Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Beimu (Fritillaria Bulb), Lianqiao (Forsythia Fruit). Dosage depends on severity; stop when the disease is addressed, avoiding excess.

Sha Zhen is caused by lung-stomach heat. Early cough requires clearing heat and venting toxicity, not stopping cough. Post-rash cough should be treated with Beimu, Gualou Gen, Gancao, Maidong, Jiegeng (Platycodon Root), Xuanshen, Bohe to clear residual heat and resolve phlegm; avoid Wuweizi (Schisandra Berry) astringents. Wheezing indicates heat congesting the lungs; avoid anti-wheezing drugs. Use large doses of Zhuye, Shigao, plus Xihe Liu, Xuanshen, Bohe. In winter, if cold traps toxin internally, add Honey-Wine Stir-fried Mahuang. For severe heat, use Baihu Tang [White Tiger Decoction] plus Xihe Liu; avoid excessive Shengma (Cimicifuga), which causes wheezing. Diarrhea should not be stopped; use Huanglian, Shengma, Genge, Gancao to resolve it naturally. (Li notes: This is imperfect; diarrhea results from lung heat transferring to large intestine; focus on clearing lung heat.) Measles patients do not fear diarrhea; it resolves yangming heat, representing simultaneous exterior-interior resolution. Post-rash diarrhea and bloody stool result from heat sinking; avoid astringents. Use Shengma, Genge, Baishao, Gancao, Bian Dou (Lablab Bean), Huanglian. Add Huashi (Talcum) for bloody stool. Post-rash gum rot (Yagan) is urgent. Externally, use Xionghuang (Realgar), Niu Fen (Cow Manure) calcined, finely ground, mixed with Bingpian (Borneol), blown into gums. Internally, use Lianqiao, Jingjie Sui, Xuanshen, Genge, Shengma, Huanglian, Gancao, Dihuang decocted, mixed with Xijiao (Rhino Horn) juice. Delay is fatal. Post-rash weakness and spleen/stomach deficiency require Baishao and Zhi Gancao (Roasted Licorice) as sovereigns, with Lian Rou (Lotus Seed), Bian Dou, Shanyao (Dioscorea Rhizome), Qingdai, Maidong, Longyan Rou (Longan Aril) as ministers. Take frequently for gradual recovery; avoid Renshen (Ginseng) and Baizhu (Atractylodes). Persistent sores post-rash indicate residual toxin; use Jinyinhua (Honeysuckle), Lianqiao, Jingjie Sui, Xuanshen, Gancao, Dihuang, Bieshi (Tortoise Shell), Huma (Sesame), Huanglian, Mutong (Akebia Stem) decocted strongly. (From *Guang Biji*.)

Ye Tianshi stated: "Sha belongs to yang. Early lung meridian pathogens must be treated from the exterior. Symptoms include headache, wheezing, rough cough, aversion to cold. Eruption in 1-2 days is mild; 3-5 days is severe. If yang illness persists beyond 7 days without clear eruption, pathogen attacks inward, causing continuous wheezing, abdominal pain, and constipation—critical condition. Treatment uses acrid-bitter to clear heat, Liangge San [Cooling Chest Powder] without Xiaoshi (Mirabilite) and Dahuang. Texts describe Foot-Yangming Stomach rashes as dense like clouds or large like smallpox but without roots. Hand-Taiyin Lung rashes appear as dots without patches; treat with acrid-dispersants to resolve muscle layer. In winter, with no sweat, high fever, and wheezing, use Mahuang and Xingren (Apricot Seed) as in Huagai San [Canopy Powder] or San'ao Tang [Three Unblocking Decoction]. In summer, with no sweat, use acrid-cool dispersants like Genge, Qianhu (Peucedanum Root), Bohe, Fangfeng, Xiangru (Elsholtzia), Niubang Zi, Jiegeng, Mutong. Ancients added Genge for thirst due to exterior pathogen to raise yangming stomach fluids. For severe heat/thirst, use Shigao (acrid-cold) to resolve muscle; contraindicated if no sweat. All sores/rashes suit acrid-cools. Lianqiao is acrid-cool, rising above grasses, capable of ascending and clearing, beneficial for pediatrics, resolving heat in all six meridians. Spring rashes follow wind-warmth; summer follows summer-heat (often retaining dampness); autumn follows heat-drying; winter follows wind-cold. Rashes benefit from patency; diarrhea is favorable. Dysentery with five colors is acceptable. Only obstruction of urination/defecation indicates凶 (ominous) prognosis; purging diarrhea is taboo. Rashes stem from six qi pathogens transforming into fire. Though external eruption suggests pathogen exit, emergence involves descent and reversal. Often, external eruption leaves internal heat, causing hoarseness, gum rot, wheezing, abdominal distension, dysentery, anorexia, agitation, coma, and death—all due to unclear interior symptoms. Differentiate sanjiao involvement or concurrent diseases. Upper jiao uses cooling; middle jiao uses acrid-bitter-cold; lower jiao uses salty. (Xu Lingtai: Should use methods to clear internal pathogens.) Upper jiao herbs should be light in aroma/taste as lung governs qi and skin/hair are its exterior. Exterior pathogens favor acrid; severe interior favors bitter. If no thirst/irritability but prolonged illness with stagnant pathogen, use bland-leaching to drain qi level. (Xu Lingtai: Ye emphasizes aroma/taste based on *Neijing* and *Shennong Bencao*. However, one must deeply understand each herb's specific function before selecting by aroma/taste to truly grasp the classics. Knowing only aroma/taste lacks independent judgment.) Middle jiao rash fire is yangming dry transformation, abundant qi/blood. Bitter-cold is suitable. If prolonged, stomach fluids deplete; bitter aids dryness and consumes fluids; sweet-cold is preferred. Lower jiao uses salty-bitter. If heat-toxin sinks causing dysentery, do not use salty to soften hardness; use bitter to firm yin and dry dampness. Ancients viewed rashes as meridian/fu diseases, avoiding warming/dry/astringent/tonic methods—"smallpox suits warmth, rashes suit cooling." However, weak/vitality-depleted patients mishandled with cold-dispersants may develop chronic deficiency. Mostly yin injury; rescue yin by supporting stomach fluids. Qi deficiency exists; tonify qi. Children are yang bodies; avoid pure-gang (hot) drugs. Pediatric texts say: "Red rashes消 with cooling; white rashes resolve with warmth." This 'warmth' refers to post-era methods like fermented rice wine, Changmu (Cudrania) coarse paper, cotton gauze. (Xu Lingtai: Not this warming method.) Though sometimes necessary, recent use is often ineffective. (Xu Lingtai: Many external pediatric treatments exist.) Gan Zhen (Malnutrition Rash) with damp-heat steaming causes oral/pharyngeal erosion. Without prompt treatment, it leads to cheek perforation, airway closure, wheezing, and death. Treat early; external methods have specific formulas. Decoctions must be light/bland to resolve upper pathology or use clearing/dispersing. Rash-dysentery is heat-toxin sinking. Like Shanghan with coordinated heat where dysentery stops when pathogen exhausts, clear heat. Avoid lifting/astringent-tonics. Mild cases: separate and promote circulation; severe cases: bitter-cold detoxification."