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The variola (smallpox) has completed its course, with pustules crusted and fallen off, and the condition is stable. Suddenly, measles reappears to invade. At this time, although the fetal toxin (congenital toxicity) has been resolved, it is only appropriate to use medication to nourish the Lung Metal (the Lung organ in Five-Phase theory).

After smallpox has crusted and scabbed off, the disease is quiescent. At this juncture, the fetal toxin has been cleared and resolved. Coinciding with an epidemic outbreak of measles appearing, the measles erupts immediately. Treatment should primarily focus on clearing Metal and nourishing the Lung, using Shenbei San (Ginseng and Fritillaria Powder) as the main formula. I observe: Measles appearing after smallpox, although it is said that the fetal toxin has been cleared, during the stage when smallpox was rising and filling with pus, was there not a necessity to use tonifying agents to promote pus formation? Therefore, residual heat and lingering toxins must remain within. The subsequent eruption of measles after smallpox does not necessarily mean there is no toxic fire; it is entirely triggered by epidemic pathogenic factors. Although clearing Metal and nourishing the Lung is suitable, Jiegeng (Platycodon Root) and Gancao (Licorice Root) in the formula must still be discontinued. Even Shashen (Adenophora Root) should be replaced with Xuanshen (Scrophularia Root). It is further advisable to add Kuhuangqin (Dried Scutellaria Root) to drain Lung heat and clear the muscle layer; add Lianqiao (Forsythia Fruit) and Niubangzi (Arctium Seed) to resolve lingering toxins in the Heart and Lung; add Chiling (Red Poria) and Zhike (Immature Bitter Orange) to promote urination and defecation, thereby draining Fire from the Heart and Large Intestine. In this way, Lung Metal becomes clear, and toxins are completely resolved, which is particularly appropriate.

Shenbei San
Shashen (Adenophorae Radix), Beimu (Fritillariae Bulbus), Jiegeng (Platycodonis Radix) (each 1 qian), Xihe Liu (Tamarisci Ramulus) (2 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 qian). Decoct in water and take orally.

Measles presenting with Bi Syndrome (closure syndrome): swollen and red eyes, hoarse voice, dry nose, panting, thirst, lower back and abdominal pain, mental confusion, everted lips, restlessness, bleeding from both bowels.

When measles first appear, the eyelids are swollen, with white sclera mixed with redness; the voice is hoarse; lips are swollen and everted; the nose is dry, alae nasi flare, and there is panting; restlessness and thirst occur; lower back pain and abdominal distension manifest; consciousness is clouded; bleeding occurs from the mouth and nose; there is chaotic agitation and screaming; bleeding occurs from both urine and feces. This is due to toxic fire being constrained within, named Bi Syndrome (Closure Syndrome). It is the most difficult to treat. It is appropriate to use Xuan Du Fa Biao Tang (Toxin-Releasing and Exterior-Dispersing Decoction) (see Item 5), removing Shengma (Cimicifugae Rhizoma), Gancao (Licorizae Radix), and Jiegeng (Platycodonis Radix), adding Jiuchao Huangqin (Scutellariae Radix stir-fried with wine) 0.7 fen, and Jiumi Chao Mahuang (Ephedrae Herba stir-fried with wine and honey) 0.5 fen. Alternatively, add Xuanshen (Scrophulariae Radix) and Shandougen (Sophorae Tonkinensis Radix) to treat it. If the measles can be pushed out to the exterior and gradually emerge, survival may be hoped for. If they remain closed and do not erupt, there is no hope.

Zhu stated: When measles present with Bi Syndrome (Closure Syndrome), it is extremely dangerous. During this terrifying time for the patient's family, it relies entirely on the physician having courage and insight, so as not to mishandle the case.