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During the course of measles, chills and fever alternating may resemble malaria. In such cases, Chai Ling Tang (Bupleurum and Poria Decoction) should be modified for treatment. If malaria develops after the resolution of measles, Biejia Yin (Turtle Shell Decoction) is indicated. By applying wisdom and flexibility, one becomes a sage in medicine.

When measles are in their initial stage of fever and just beginning to erupt, if there are symptoms resembling malaria with alternating chills and fever, it is absolutely crucial not to treat them solely as malaria. It is appropriate to use Gegen Shuxie Tang (Kudzu Root Decoction for Dispersing Pathogens) (see Article 33) added with Bohe Ye (Menthae Haplocalycis Folium). When the rash has completely erupted, if symptoms resembling malaria persist, use Chai Ling Tang (Bupleurum and Poria Decoction), removing Renshen (Ginseng Radix et Rhizoma), Banxia (Pinelliae Rhizoma), Rougui (Cinnamomi Cortex), and Baizhu (Atractylodis Macrocephalae Rhizoma), and adding Bei Mu (Fritillariae Bulbus) and Gu Pi (Phellodendri Cortex). If malaria actually forms after the measles, the treatment principle should focus on clearing heat, strengthening the spleen, and stimulating appetite. Jingyuan Zhuren's Biejia Yin (Turtle Shell Decoction by Master Jingyuan) is indicated. For those with thirst, add a small amount of Shu Shigao (Prepared Gypsum Fibrosum); for those without thirst, remove Maidong (Ophiopogonis Radix) and Zhimu (Anemarrhenae Rhizoma) from the formula. Malaria often arises due to phlegm generation caused by spleen deficiency. If, after the eruption of measles, it is indeed malaria and there is no residual toxic heat remaining, then why could Renshen (Ginseng Radix et Rhizoma) and Banxia (Pinelliae Rhizoma) in Chai Ling Tang (Bupleurum and Poria Decoction) not be used? However, Rougui (Cinnamomi Cortex) and Baizhu (Atractylodis Macrocephalae Rhizoma) should not be lightly administered. Why must one rigidly adhere to the common methods for early-stage measles or assume that formulas containing drying and harsh herbs are unsuitable for residual pathogenic factors after measles? Xiao Chai Hu Tang (Minor Bupleurum Decoction) (see Article 22) is precisely what should be used. This is what is meant by "divine illumination depends on the individual."

Zhu stated: The causes of malaria are numerous. Treatment should be based on the observed syndromes. One need not be confined to a single syndrome pattern nor restricted to a single formula.

Chai Ling Tang (Bupleurum and Poria Decoction)
Ingredients: Chai Hu (Bupleuri Radix), Ban Xia (Pinelliae Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Bai Fu Ling (Poria cum Risus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Rou Gui (Cinnamomi Cortex). Administration: Use Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) as guides.

Jingyuan Zhuren Biejia Yin (Turtle Shell Decoction by Master Jingyuan)
Ingredients: Jiu Lei Bie Jia (Testudinis Carapax et Plastrum, specifically nine-ribbed turtle shell, baked on a new tile, quenched several times in vinegar until yellow, ground into powder, then stir-fried dry with vinegar, 2 qian), Shan Zha Rou (Crataegi Fructus, pitted, 3 qian), Mai Dong (Ophiopogonis Radix), Yi Yi Ren (Coicis Semen, stir-fried, each 5 qian), Bai Fu Ling (Poria cum Risus, 2 qian), Ju Hong (Citri Reticulatae Pericarpium Rubrum, 2.5 qian), Zhi Mu (Anemarrhenae Rhizoma, 1.2 qian), Gan Ge (Puerariae Lobatae Radix), Bai Shao (Paeoniae Radix Alba, each 1.5 qian), Chai Hu (Bupleuri Radix, 2 qian), Bei Mu (Fritillariae Bulbus, 3 qian), Dan Zhu Ye (Lophatheri Herba, 1 qian), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, 0.7 qian). Administration: Use Sheng Jiang (Zingiberis Rhizoma Recens) as a guide; decoct in water and take orally.