Library

Granules with pointed tips and small bases that converge are indicative of the **Jin Tou Biao** (Complete Surface Penetration) syndrome. Granules that are flat, broad, itchy, red, and adhere closely to the flesh indicate that heat pathogens are deeply entrenched within, which is not a favorable sign.

If measles fully penetrate the surface, there will be no subsequent complications. How can one determine if the surface penetration is complete? If the granules have pointed, large tips, detach from the skin, and show convergence at the base, or if they are small but show convergence at the base, both conditions constitute complete surface penetration. In one type, the granules are flat, broad, red, and form patches; upon these patches, smaller granules appear, lying flat without elevation, and the granules on the patches do not detach from the skin. In another type, small patches form, accompanied by generalized itching resembling wind-toxin, with localized elevation, redness, and swelling, but the granule tips are not pointed. Although these two syndromes appear to have penetrated the surface, heat pathogens must be lingering internally, leading to subsequent transformation syndromes. For these, it is appropriate to use *Zhuye* (Lophatheri Herba), *Shigao* (Gypsum Fibrosum), *Maidong* (Ophiopogonis Radix), *Lianqiao* (Forsythiae Fructus), and *Niubangzi* (Arctii Fructus) to moisten and clear heat. Alternatively, use *Huadu Qingbiao Tang* (Detoxifying and Surface-Clearing Decoction) (see Article 16), removing *Jiegeng* (Platycodonis Radix), *Gancao* (Glycyrrhizae Radix et Rhizoma), *Bohe* (Menthae Haplocalycis Herba), and *Fangfeng* (Saposhnikoviae Radix), and adding *Maidong*. Even if residual heat remains, it will dissipate from this point onward.

Zhu stated: By pointing out the morphology of complete surface penetration, those cases where penetration is incomplete become easily distinguishable.

Do not panic when they surge forth together; in an instant, the whole body is adorned like vermilion brocade. Similar to pustules appearing and then receding, like macules turning red yet forming sores.

Pustules erupting over three or four stages are called "even eruption." Measles, however, are prized for surging forth all at once, termed "complete eruption." Therefore, as long as measles erupt, the toxin is alleviated. When illuminated by fire, the entire body appears coated in vermilion, signaling impending eruption. The erupted forms are fine and dense, resembling pustules, but measles erupt and recede simultaneously, unlike pustules which gradually grow larger. The erupted forms are bright red, resembling the macules of cold damage (*Shanghan*), but each grain of measles forms a distinct sore, unlike macules which present as continuous red patches resembling mosquito bites. Thus, for measles, a simultaneous surge is the most auspicious presentation, requiring no medication.

Zhu stated: Although measles are prized for surging forth together, they should form distinct grains, not continuous patches. Physicians must carefully distinguish between them.

Measles also resemble brocade patterns across the body. White coloration indicates blood deficiency and requires nourishing the Ying (Nutritive) level. The appearance of black measles is extremely ominous; to resolve toxicity and eliminate macules, use *Daqing* (Indigo Naturalis).

Pustules are crimson and itchy; measles are bright red, indicating loosened toxicity. White measles due to blood deficiency are treatable; black macules are malignant signs to be avoided.

The colors of pustules and measles cannot be discussed interchangeably. Generally, pustules fear excessive redness because the skin is tender and prone to rupture, inevitably causing itching. Measles prefer a uniform red color. Why? Because measles originate from the Heart, and the Heart belongs to Fire; red is the true color of Fire. Therefore, bright red measles indicate that toxins have been fully expelled, which is auspicious. If the measles color is pale white, it indicates insufficiency of Heart Blood. Treatment should focus on nourishing blood, using *Yangxue Tang* (Blood-Nourishing Decoction) removing *Gancao*, or *Yiyng Tang* (Nourishing Ying Decoction) removing *Renshen* (Ginseng Radix), *Chishaoyao* (Paeoniae Radix Rubra), and *Gancao*, or *Yangxue Huaban Tang* (Blood-Nourishing and Macule-Resolving Decoction) removing *Renshen*. Some use *Siwu Tang* (Four Substances Decoction) (see Article 25) added with *Shengma* (Cimicifugae Rhizoma) and *Gegen* (Puerariae Lobatae Radix). Although *Siwu Tang* is a blood-tonifying formula, *Baishao* (Paeoniae Radix Alba) and *Chuanxiong* (Ligustici Chuanxiong Rhizoma) are unsuitable for measles, and adding *Shengma* is particularly inadvisable. It is better to use *Yangxue Tang* with modifications based on symptoms, which is truly appropriate. If the measles color is crimson like brocade, use the ancient *Huaban Tang* (Macule-Resolving Decoction) (see Article 21) removing *Renshen*, *Shengma*, *Gancao*, and *Zaomi* (Early Rice), adding *Yuanshen* (Scrophulariae Radix); or *Wan's Huaban Tang* (see Article 21) removing *Jiegeng* and *Gancao*. However, it is advisable to add *Sheng Huangqin* (Scutellariae Radix) and *Sheng Huanglian* (Coptidis Rhizoma). If the color is bright red and glossy or slightly purple, it indicates blood heat, or excessive eruption. In such cases, use *Miben Daqing Tang* (Secret Version Big Indigo Decoction) removing *Shengma* and *Jiegeng*, or the ancient *Daqing Tang* removing *Shengma* and *Jiegeng*, both added with *Niubangzi*, *Lianqiao*, *Huangqin*, *Huanglian*, and *Shengdihuang* (Rehmanniae Radix). Black macules indicate a fatal condition; use *Miben Daqing Tang* removing *Shengma* and *Jiegeng*, adding *Shengdihuang*, *Huanglian*, *Huangqin*, and *Ren Zhonghuang* (Human Excrement Ash) powder. If constipation exists, add *Jiu Zheng Dahuang* (Rhubarb Radix et Rhizoma steamed with wine) to promote bowel movement.

Zhu stated: The ideal color for measles is uniform red. Pale white or crimson-brocade-like colors indicate cold or heat deviations in the syndrome; treatment methods must not be confused.

*Yangxue Tang*: Treats white measles.
Ingredients: *Shengdihuang* (Rehmanniae Radix), *Dangguishen* (Angelicae Sinensis Radix), *Honghua* (Carthami Flos), *Chenpi* (Citri Reticulatae Pericarpium), *Gancao* (Glycyrrhizae Radix et Rhizoma), with one slice of *Shengjiang* (Zingiberis Rhizoma Recens) as a guide.

*Yiyng Tang*: Treats white measles color.
Ingredients: *Renshen* (Ginseng Radix), *Danggui* (Angelicae Sinensis Radix, stir-fried with wine), *Honghua* (Carthami Flos, stir-fried with wine), *Chishaoyao* (Paeoniae Radix Rubra, stir-fried with cinnamon water), *Gancao* (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.

*Yangxue Huaban Tang*: Treats white rashes.
Ingredients: *Renshen* (Ginseng Radix), *Dangguishen* (Angelicae Sinensis Radix), *Shengdihuang* (Rehmanniae Radix), *Honghua* (Carthami Flos), *Chantui* (Cicadae Periostracum), with *Shengjiang* (Zingiberis Rhizoma Recens) as a guide.

*Miben Daqing Tang*
Ingredients: *Daqing* (Indigo Naturalis), *Yuanshen* (Scrophulariae Radix), *Zhimu* (Anemarrhenae Rhizoma), *Shigao* (Gypsum Fibrosum), *Mutong* (Akebiae Caulis), *Zhiren* (Gardeniae Semen), *Renzhonghuang* (Human Excrement Ash, calcined and ground fine), *Jiegeng* (Platycodonis Radix), *Shengma* (Cimicifugae Rhizoma). Decoct in water and take with *Renzhonghuang* powder mixed in.