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Measles is not a single category of disease. There are *sao zhen* (itchy rash), *yin zhen* (urticaria-like rash), and *wen zhen* (warm rash). Along with smallpox (*dou zhen*), none of these are considered "true measles" (*zheng zhen*). Only true measles qualifies as such. It is also the toxin hidden in the fetal origin, lying dormant in the six fu organs. Upon contracting the pathogenic yang fire-waxing qi from heaven and earth, it emerges from the Lung and Spleen. Therefore, it is often accompanied by coughing, sneezing, clear nasal discharge, watery eyes, and swollen eyelids. After fever for two or three days, or four to five days, spots begin to appear on the skin. The shape resembles millet grains, and the color resembles peach blossoms; occasionally, some may be larger, resembling smallpox. This is the initial manifestation of measles.

The spots are initially sharp, sparse, and gradually become dense. They have granules but no root halo, rise slightly and flush without forming pus. This differs significantly from smallpox after the eruption phase. Careful management is required throughout, without any negligence. Although slightly milder than smallpox, its changes occur rapidly, within moments.

Commentary by Lian: If body heat lasts one or two days and spots erupt all at once, the condition is severe. If they appear on the third or fourth day, it is mild. If they appear after the fifth day, it is severe. If, by the sixth or seventh day, the spots are faintly visible between the skin but not distinct, it is particularly severe.

When measles erupts, there are distinctions between mild and severe cases, requiring detailed examination at the time. If the patient's Qi and Blood are harmonious and they have no prior illnesses, although they contract seasonal pathogens, their righteous Qi can control the pathogenic Qi. Thus, the fever is mild, with slight sweating, clear spirit, and regular bowel and bladder movements. The spots emerge thoroughly and dissipate neither too fast nor too slow. This indicates a mild case that is easy to treat.

If the patient has pre-existing wind-cold or food stagnation, with interior and exterior pathogens mixed, touching the pathogenic yang fire-waxing qi causes internal and external factors to erupt together. Since righteous Qi cannot control the pathogenic Qi, symptoms must include high fever without sweat, irritability, thirst, unclear spirit, constipation, and dysuria. The spots fail to emerge thoroughly, and their resolution may be too rapid or tight. This indicates a severe case that is difficult to treat.

Commentary by Lian: For severe wind, prioritize dispersing wind. For cold stagnation, use Ephedrae Herba (Mahuang). For food stagnation, use digestive methods. For severe phlegm, resolve phlegm. For excessive fire, clear fire. No sweat indicates closure by wind-cold. Irritability indicates toxins blocked internally, unable to erupt. Thirst indicates excessive fire. Constipation indicates large intestine fire stagnation combined with food stagnation. Dysuria indicates bladder and heart fire fanning each other. Panting indicates toxins stagnant in the lungs combined with phlegm obstruction. Unclear spirit indicates abundant toxins. Furthermore, regarding the pulse in measles, a floating, large, slippery, rapid pulse with spirit is auspicious; a fine, soft, weak, and spiritless pulse is ominous. Especially if the Lung and Spleen pulses are large and vigorous with spirit, even if other symptoms exist, they are not harmful. If the pulse is fine, soft, and spiritless, it means a Yang syndrome presents with a Yin pulse. The pulse and symptoms do not match, suggesting potential complications. One must first examine deficiency and excess to avoid errors. However, after the rash resolves and fever subsides, even if the pulse is fine, soft, weak, and spiritless, it is not harmful.

A peach-red, lustrous color indicates mildness, as the toxin is slight. A deep red color indicates severity, as fire-toxin is abundant. Purple-black, gray-dull, or obscurely hidden colors indicate extreme severity, as fire-toxin lies dormant in the Zang organs. More Yang areas (exterior, upper) indicate mildness; more Yin areas (interior, lower) indicate severity. The head is the chief of all Yang meridians; the face is Yang within Yang; the back belongs to the Taiyang meridian; the lateral aspects of the limbs are Yang; the chest is Yin within Yin; the medial aspects of the limbs are Yin; the waist is also Yin. More Yang and fewer Yin areas indicate a favorable course; more Yin and fewer Yang areas indicate an unfavorable course, likely leading to later complications. Few in both areas indicate light fire-toxin; abundant in both areas indicate heavy fire-toxin. If the head, face, chest, abdomen, hands, and feet show no rash, only red patches on the back, it is untreatable due to extreme heat. Symptoms such as panting, stomach/chest discomfort, shoulder/hypochondriac pain, delirium, epistaxis, hand clenching, head shaking, picking at empty air, bed-fumbling, hiccups, nausea, constipation, and foul breath are untreatable. Dark, dry, ash-gray complexion is untreatable. Nasal flaring, open mouth, sunken eyelids, and spiritless eyes are untreatable. Phlegm rattle in the throat, panting, and elevated chest are untreatable. Blue-green nose and face, and stool like rotten fish intestines are untreatable. Late-stage gum rot with foul odor and tooth loss without blood are untreatable. Swollen cheeks, blue-black around the mouth, cheek fistulas, loose teeth, collapsed lips, and necrotic nose are untreatable. Fish-mouth deformity with gasping and crow-like sounds are untreatable. Late-stage constipation, panting, and blackening skin/flesh are untreatable. Late-stage residual heat attacking inward, delirium, coma, and loss of will are untreatable. Late-stage Yin deficiency with dry blood, and wasting-thirst emaciation are untreatable.