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The six excesses (Liu Yin, 六淫) of the heaven and earth invade the human body, mostly causing fever. However, if the hands and feet are slightly cold, there is aversion to cold and no sweating, the complexion is dark blue and uncomfortable, and there are blue streaks on the left cheek, this is heat from Cold Damage (Shanghan, 伤寒). If the hands and feet are slightly cold, there is fever with sweating, and the face is red and lustrous, this is heat from Wind Injury (Shangfeng, 伤风). If the eyelids are swollen, there are visible tendons on the right cheek, symptoms in the head, forehead, abdomen, and belly are worse during fever, or accompanied by vomiting and abdominal pain, this is heat from Food Stagnation (Shangshi, 伤食). If the complexion is mixed blue and red, there are streaks in the center of the forehead, there is sweat on the palms, frequent startles and terrors occur, the hand collaterals move slightly while feverish, this is Heat from Fright (Jingre, 惊热). If the body is hot and appetite is significantly increased, lips are red, cheeks are flushed, stool and urine are constipated, and there is sweat under the hypochondrium, this is Fire Heat (Huore, 火热). If the complexion is red and yellow, fever is accompanied by profuse sweating, abdominal pain, vomiting, and diarrhea, this is caused by Summerheat-Dampness (Shuxie Shire, 暑邪湿热). All these syndromes differ, yet they all involve heat. How then should the heat of Measles (Mazhen, 麻疹) be distinguished? The general principle is to distinguish it by a red face and cold ears, the middle finger of the hand being uniquely cold, eyes containing tears, clear nasal discharge, coughing, and sneezing. Furthermore, from the onset of fever to the appearance of macules, it takes five to six days for those close, seven to eight days for those distant, and severe cases may take over ten days; the number of days is not fixed. In the first one or two days of onset, diaphoresis and resolution should not be performed immediately, nor should cold-cooling medicines be used recklessly. If the heat is mild and harmonious, receding day by day, medication may not be necessary. If the heat persists for consecutive days without abating, accompanied by cough, irritability, and anhidrosis, Xuan Du Fa Biao Tang (Toxin-Releasing Surface-Expelling Decoction) should be administered as the primary treatment, or Sheng Ma Ge Gen Tang (Ephedra and Pueraria Decoction) can be used to induce eruption.

Measles stem from fetal toxin but must also erupt due to seasonal qi. Initially, surface-expelling and supporting methods should be used to allow the toxin to fully reach the skin surface. If cold-cooling medicines are overused, suppressing and trapping the heat-toxin, eruption will inevitably fail to penetrate thoroughly, often leading to internal attack by toxin qi, resulting in panting, oppression, and death. Once the rash has fully erupted, clearing and draining methods should be employed to resolve residual heat, preventing various post-measles complications. Since measles belong to Yang, severe heat damages the Yin aspect, consuming blood; therefore, after the rash subsides, nourishing blood is essential to preserve Yin deficiency-induced dryness, rather than rigidly adhering to clearing and draining methods. If the patient's Qi and Blood are balanced and free of other diseases, although affected by seasonal pathogens, righteous Qi can overcome evil Qi. Fever will be mild, with slight sweating, clear spirit, and regular bowel and bladder movements. Eruption will be thorough, and subsidence neither too fast nor too slow. This constitutes a mild and easily treatable case. Thus, the Wan family method warns against using medicine too early, fearing it might dissipate Yuan Qi (Original Qi, 元气) and cause harm; medication should only be used once macules appear, promoting gradual eruption. However, administration requires order: one dose should be divided into more than ten servings because the rash resides in the skin. Taking it all at once accelerates drug action too rapidly, often causing delirium and irritability; this serves as a good admonition against reckless medication. If there is pre-existing Cold-Wind or Food Stagnation, mixing interior and exterior, triggering Evil Yang and vigorous Fire Qi, causing internal and external simultaneous eruption where Righteous Qi cannot control Evil Qi, there will be high fever, anhidrosis, restlessness, thirst, unclear spirit, constipation, and dysuria. Eruption will be unthorough, and subsidence may be too rapid. This is a severe and difficult case requiring immediate clinical assessment to identify the deviation, reduce excess, support deficiency, without hesitation. This illustrates that the Wan family method should not be rigidly followed. A skilled practitioner uses flexible methods appropriate to the time. During warm weather, acrid-cool diaphoresis is suitable, using Fang Feng Jie Du Tang (Saposhnikovia Detoxification Decoction). During hot weather, acrid-cold treatment is suitable, using Huang Lian Jie Du Tang (Coptis Detoxification Decoction). During severe cold, acrid-warm diaphoresis is suitable, using Gui Zhi Jie Du Tang (Cinnamon Twig Detoxification Decoction) or Ma Huang Tang (Ephedra Decoction). During fluctuating cold and warmth, acrid-neutral diaphoresis is suitable, using Sheng Ma Jie Du Tang (Cimicifuga Detoxification Decoction) or Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Resolving Toxin Powder). Medication should follow the season without violating Heavenly Harmony, and must consider the patient's deficiency or excess. For constipation, restlessness, heavy heat, and failed eruption indicating Excess Syndrome, wine-steamed Da Huang (Rhubarb Rhizome) can be used for mild purgation. For clear bowel/bladder, light heat, continuous vomiting/diarrhea indicating Deficiency Syndrome, Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) can be added to tonify and support. Do not reinforce excess or further weaken deficiency; aim for balance, stopping when the disease is addressed. If prior diaphoretic agents fail to produce eruption after one dose, prepare another dose, decoct in water, and take warm. Externally, apply Yan Xu (Coriander Fruit) wine, and rub with Ramie dipped in wine, ensuring skin pores open and rash erupts fully to avoid abdominal distension and panting obstruction. If still no eruption, it is incurable. However, exceptions exist; careful observation is needed when others give up.

First, initial fever with generalized spontaneous sweating indicates toxin release via sweat, making measles easy to erupt. Excessive sweating suggests excessive Fire forcing fluids out, risking Yang collapse; use Dang Gui Liu Huang Tang (Angelica Six-Huang Decoction) plus Fu Mai (Floating Wheat) to stop sweating.
Second, fever with epistaxis also indicates toxin release via nosebleed; do not treat recklessly. If bleeding is excessive due to Fire forcing blood to flow wildly, use Mao Hua Tang (Thistle Flower Decoction).
Third, fever with vomiting indicates Evil Fire forcing toxin upward; use Zhu Ru Shi Gao Tang (Bamboo Shavings and Gypsum Decoction). Mild vomiting does not require this.
Fourth, severe initial diarrhea indicates intense internal Fire and toxin rushing to the Large Intestine; use Sheng Ma Ze Xie Tang (Cimicifuga and Alisma Decoction).
Fifth, initial heat with tenesmus indicates severe toxin and dysentery; use Huang Qin Shao Yao Tang (Scutellaria and Peony Decoction).
Sixth, initial heat with cough, rapid breathing, and slow eruption: use Ma Huang Tang (Ephedra Decoction), adding Shi Gao (Gypsum Fibrosum) in Spring/Summer/Autumn, Gui Zhi (Cinnamon Twig) in Winter, or Qiang Huo San (Notopterygium Powder), or Xiao Du Yin (Detoxification Drink). Externally, wipe from head to toe with Yan Xu (Coriander Fruit) wine.