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The tops of the measles papules are scorched and black, which is indeed alarming. This indicates extreme heat; one must urgently clear the Lung and Stomach. If treatment is not timely, the rash will turn purple-black, leading to death.

When measles have erupted through the exterior but the tops of the papules are scorched, regardless of whether the rash color is red or pale, it signifies a condition of extreme heat. One should urgently clear the Lung and cool the Stomach, and promote diuresis to separate turbid fluids. Furthermore, use Baihu Jiedu Tang (White Tiger Decoction for Detoxification) (see Article 26) with a heavy dose of Shigao (Gypsum Fibrosum), adding Mutong (Akebiae Caulis) and Zexie (Alismatis Rhizoma). Alternatively, add Cheqianzi (Plantaginis Semen) for treatment. If there is dryness and no sweat, add Mahuang (Ephedrae Herba) stir-fried with honey wine to induce sweating. If the stool is dry and hard, in a formula for clearing heat and resolving the exterior, assist with blood-invigorating herbs to moisten dryness; treat with Quan Chu Re Qing Fei Tang (Complete Book Decoction for Clearing Heat and Purifying the Lung) added with Danggui (Angelicae Sinensis Radix), Huomaren (Cannabis Fructus), and Zhike (Aurantii Fructus Immaturus). If there is constipation, only then use Chengqi Tang (Chengqi Decoction) or Hejian Liangge San (Liangge Powder from Liu Wansu) (see Article 26) without Gancao (Glycyrrhizae Radix et Rhizoma) to purge downward. If treatment is delayed, it often leads to purple-black discoloration that is difficult to save. There are cases where the original disease is small sores, and the scorched tops resemble scorched measles, but they are actually not scorched measles. In clinical practice, one must examine carefully.

Zhu said: Purple-dark color and scorched papule tops are both signs of extreme heat. One should seek solutions among methods such as clearing heat, detoxifying, and cooling blood. Small sores resembling scorched spots require particular attention.

Quan Chu Re Qing Fei Tang (Complete Book Decoction for Clearing Heat and Purifying the Lung): The main formula for clearing Lung Metal and draining Heart Fire.
Ingredients: Maidong (Ophiopogonis Tuber), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Yuanshen (Scrophulariae Radix), Sheng Dihuang (Rehmanniae Radix Fresh), Beimu (Fritillariae Bulbus), Chi Fuling (Poria with Red Mycelium). For high fever, add Digupi (Lycopersici Cortex) and Huanglian (Coptidis Rhizoma). For rough breathing, add Chao Tinglizi (Semen Lepidii et Descurainiae Stir-fried) and Gualou Shuang (Trichosanthis Fructus Powder). For constipation, add Danggui (Angelicae Sinensis Radix), Huomaren (Cannabis Fructus), and Zhike (Aurantii Fructus Immaturus).

Chengqi Tang (Chengqi Decoction): Treats syndromes of the Shaoyang Gallbladder Meridian and Yangming Large Intestine.
Ingredients: Sheng Dahuang (Rhei Radix et Rhizoma Fresh) (4 liang), Nongpo (Magnoliae Officinalis Cortex stir-fried with ginger juice, 6 qian), Zhishi (Aurantii Fructus Immaturus stir-fried with flour, 3 pieces). Decoct in water and take orally. Add Mangxiao (Natrii Sulfas) 3 he, named Da Chengqi Tang (Major Chengqi Decoction).

Measles appearing like cloud patches, red and crimson, or discharging pus and blood with a foul odor. This is due to both exterior fire and interior heat. Treatment must distinguish between interior and exterior to avoid errors.

Measles erupting like large cloud-head patches, slightly raised. This syndrome has two presentations: one presents as large patches of red, swollen, and slightly elevated skin; the other presents with small red spots appearing on top of the large red and swollen patches. Both are caused by intense exterior fire. One should distinguish between interior and exterior, using major cold-cooling agents or promoting diuresis. Use Baihu Jiedu Tang (White Tiger Decoction for Detoxification) (see Article 26) added with Gegen (Puerariae Lobatae Radix) and Yuanshen (Scrophulariae Radix) for treatment. If the measles appear like brocade patterns or ulcers, or discharge pus and blood with a foul odor that does not dry up, accompanied by chest distress, vomiting clear fluid, and body heat, use Baihu Jiedu Tang (White Tiger Decoction for Detoxification) (see Article 26) added with Guanzhong (Aspidistrae Rhizoma) to dissipate accumulated toxins and remove damp-heat. Add Fangfeng (Saposhnikoviae Radix) and Jingjie Sui (Schizonepetae Spica) to dispel wind and eliminate carbuncle toxins. (Some add Cangzhu (Atractylodis Rhizoma); although considered appropriate, caution is advised.) Do not delay, lest it become incurable. If the measles are dense, with body pain and irritability, use Liangxue Yinzi (Cooling Blood Infusion) (see Article 45) removing Chishao (Paeoniae Radix Rubra), adding Zicao (Arnebiae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), and Niubangzi (Arctii Fructus) for treatment. If it is urticaria, with the whole body resembling cloud-head patches and spots appearing and disappearing intermittently, then use Xiaofeng San (Eliminate Wind Powder) for treatment.

Zhu said: Large cloud-head patches, combined with foul-smelling pus and blood discharge, indicate extremely dangerous external symptoms. Identifying intense exterior fire, treating with methods to dissipate accumulated toxins and remove damp-heat can naturally turn danger into safety. If it is urticaria, although it resembles cloud-head patches, the spots are faint and intermittent; this is the distinction.

Xiaofeng San (Eliminate Wind Powder)
Ingredients: Danggui (Angelicae Sinensis Radix), Sheng Dihuang (Rehmanniae Radix Fresh), Fangfeng (Saposhnikoviae Radix), Chantui (Cicadae Periostracum), Zhimu (Anemarrhenae Rhizoma), Kushen (Sophorae Flavescentis Radix), Jingjie (Schizonepetae Spica), Humaoren (Cannabis Fructus), Niubangzi (Arctii Fructus), Shigao (Gypsum Fibrosum) (each 1 qian), Mutong (Akebiae Caulis) (0.5 qian). Decoct in water and take well after meals. Another prescription includes Cangzhu (Atractylodis Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma).