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Wind-Cold and dietary taboos were neglected. The rash appeared briefly and then retracted, failing to penetrate the skin. The pathogenic toxin returned inward, causing swelling and redness in the abdominal flanks. When the toxin manifests, one must treat the toxin with medical methods.

If the measles course reaches six or seven days, and the patient is slightly exposed to Wind-Cold or fails to avoid greasy/meaty foods, only faint shadows of measles spots may appear on the limbs and face. Once the spots appear, they immediately retract and disappear, unable to erupt through the muscle layer. This causes the toxin to sink inward, suddenly resulting in redness and swelling in the abdominal flanks, resembling a toxin but not quite. Initially, use Yushu Dan (Jade Pivot Pill) orally to induce several bowel movements. Subsequently, administer Huoming Yin (Life-Sustaining Decoction). Later, use herbs such as Renshen (Ginseng Radix), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chantui (Cicadae Periostracum), Mutong (Akebiae Caulis), and Danggui (Angelicae Sinensis Radix) to support the eruption of severe toxins, raising the pustule tops and inducing suppuration. Treat externally with surgical plasters and ointments until natural recovery. This is the method of "treating the toxin when it appears." One must not rigidly adhere to the notion that measles prefers coolness and therefore dare not use tonification.

Yushu Dan (also known as Taiyi Zijin Ding / Great Unity Purple Gold Ingot): Resolves various toxins, treats various sores, and generally cures hundred diseases, possessing the power to revive the dead.
Shancigu (Swertiae Bulbus, washed to remove skin and hairs, pure) 5 qian, Wubeizi (Galae Chinensis, broken, washed, dried over fire, each 2 liang), Shang Shexiang (Moschus, selected clean), Ming Zhusha (Cinnabaris, purified), Ming Xionghuang (Realgar, each 3 qian), Hongya Daji (Euphorbiae Humifusae Radix [Red-rooted], Mian Daji and Hong Chaihu must not be used; remove rhizome roots, wash clean, 1 liang 5 qian), Qianjinzi (Semina Crotonis, shell and oil removed, pure part 1 liang). Grind into fine powder, weigh equal parts, mix with glutinous rice paste to form pills, or press into ingots for use.

Huoming Yin (also known as Huoming Dan): Treats measles that erupt and immediately retract, suddenly developing into toxic conditions. Suitable for before eruption and after eruption.
Danggui (Angelicae Sinensis Radix), Duhuo (Angelicae Pubescentis Radix), Duzhong (Eucommiae Cortex), Qinjiao (Gentianae Macrophyllae Radix), Xixin (Asari Radix et Rhizoma), Bai Fuling (Poria), Sang Jisheng (Taxilli Herba), Shang Rougui (Cinnamomi Cortex), Shu Dihuang (Rehmanniae Radix Praeparata), Bei Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), add Renshen (Ginseng Radix). Decoct in water and take orally.

The Classics state: Smallpox is endowed by Yin and formed by Yang; measles are endowed by Yang and formed by Yin. This is the wonder of Yin and Yang mutually rooting each other. Measles are essentially fetal toxins within the innate True Yang, but they must interact with Yin to generate transformation. Hence, it is said "formed by Yin." During the initial three days of fever, there must be slight sweating over the whole body for the measles seeds (rash buds) to appear. Sweat is the fluid of Yin. Fever accompanied by sweating is the verification of Yin-Yang interaction and transformation. Without such sweat, if Ying and Wei are dry and rough, and the pores are closed and solid, how can the seeds emerge? If the seeds are fully uniform, they must be bright red and vivid, indicating that Ying blood follows Qi, nurturing excellent growth, with essence manifesting outwardly. Afterwards, they gradually recede. The violent residual qi after recession must also transform through interaction. Yin receives it to become traces, which are the work of Yin blood. We do not desire rapid contraction, fearing the residual toxin will return inward, causing future trouble. Thus, success is achieved here; is this not "formed by Yin"? This is what is meant by measles being endowed by Yang and formed by Yin. However, internal and external pathogenic factors must be absent for success. Pathogens harm Zheng Qi and are detrimental to measles. The treatment method should differentiate meridians and syndromes, following established formulas to eliminate pathogens without harming Zheng Qi, thereby harmonizing Ying and Wei, allowing Yin and Yang to intersect, achieving benefit everywhere. Regarding smallpox, emphasis is on nourishing the pus; regarding measles, the goal is merely uniform seed appearance. Once seeds are uniform, nine-tenths of the work is done; afterwards, only regulation is needed. Colors should be bright and lively, avoiding dullness. Abundance is acceptable provided the eruption is thorough. Thorough eruption means no lingering pathogens internally. Symptoms often include cough and sore throat. For sore throat, use Gancao (Glycyrrhizae Radix et Rhizoma) and Jiegeng (Platycodonis Radix) as mainstays, modifying according to symptoms. If red, swollen, aversion to heat, thirst, and dark urine are present, add Huangqin (Scutellariae Radix), Shengdi (Rehmanniae Radix), and Niubangzi (Arctii Fructus). Externally, grind Qiai (Artemisia argyi) and Shechuangzi (Cnidii Fructus) into powder, burn in a new copper smoker, inhale the smoke to expectorate phlegm-saliva; the sore throat will gradually heal. If there is no aversion to heat, but white slippery tongue coating, add Banxia (Pinelliae Rhizoma) and Nanxing (Arisaematis Rhizoma). Externally, grind Qiai, Banxia, and Nanxing into powder, inhale smoke to extract saliva. If voice is hoarse, add Ejiao (Colla Corii Asini), Yuzhu (Polygonati Odorati Rhizoma), and egg white. If not red/swollen, with slippery cold tongue coating, no thirst, aversion to cold, and preference for warmth, use Banxia, Nanxing, Fuzi (Aconiti Lateralis Radix Praeparata), and Rougui (Cinnamomi Cortex). Externally, dip large paper twists in oil and cauterize the back of the neck, or blow powdered raw Fuzi into the nose for self-healing. These are merely introductory points, not detailed methods, nor omissions. Usage does not exceed the Six Meridians; verification focuses on root Qi, requiring no further elaboration.

Attached Case:
I once treated Lao Geng, aged twenty-seven. In summer, he developed measles with slight head and body heat, pale red rash color, and severe sore throat. Contemporary physicians mistakenly used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Niubangzi, Gancao, and Jiegeng, which worsened the condition into diarrhea. After several episodes of severe diarrhea, the rash sank and disappeared completely, the throat closed up, speech became impossible, consciousness was confused, and dizziness threatened collapse. Tian Zai was present. I told Tian Zai, "This syndrome is entirely a mass of Yin-Cold inside. Using standard measles remedies will certainly result in death." Tian Zai asked why. I replied, "If there were internal Fire, the rash would be purple-red, not pale red. Although the throat hurts, it is not red or swollen, and there are no signs of irritability, thirst, or aversion to heat. Clearly, this is Kidney deficiency-cold with Yin Fire attacking upward. Yang energy promotes harmony throughout the body. Measles belong to Yang and require pure Yang to erupt thoroughly. At the point of appearance, like a sprouting seedling, encountering Yin-cold and killing air destroys life. Now, with rampant Yin-pathogen burying True Yang, it is rare for the rash not to sink." Therefore, I abruptly administered Fuzi, Ganjiang (Zingiberis Rhizoma), Banxia, Gancao, Baizhu, Fuling, Rougui, and Huangqi. Warmth and tonification were combined to expel Yin and restore Yang, turning chaotic Qi back to harmony, thus achieving miraculous recovery. How precarious!

My nephew Jing Qian, aged thirty, developed measles. During initial fever, he felt irritable and painful heat in the abdomen. He asked if Sandou Tang (Three Bean Decoction) could be taken. I said, "Boil and take it urgently." His chest and abdominal heat resolved, but the rash did not appear. He experienced dizziness, coughing with reversed Qi, panting, and nasal flaring. Detailed examination revealed Heat-Toxin obstructing the Lung. Lung obstruction prevents fluid distribution and pore opening, hence the rash fails to appear. I used Huangqin to clear interior heat, Ejiao and Maidong (Ophiopogonis Radix) to moisten Lung dryness, Jiegeng to raise Lung Qi, Zisu (Perillae Folium), Gegen, Niubangzi, and Bohe (Menthae Haplocalycis Herba) to clear exterior heat, Gancao to moderate the middle, and Xingren (Armeniacae Semen Amarum) to calm panting. After two doses, the rash erupted thoroughly but turned purple-black. His condition worsened significantly, unable to eat. I quietly told his family, "Measles books say: Pale red indicates survival; purple-black indicates death." They were terrified. I reassured them, "Is it truly a death case? It is extremely dangerous. This is severe internal heat causing Blood stasis. Signs include dry tongue, foul breath, aversion to heat, preference for cold, and loud voice." I continued using Huangqin, Maidong, and Ejiao to clear internal heat and moisten dryness. Added Mudanpi (Moutan Cortex) to drain Heat from Blood, and Honghua (Carthami Flos) to invigorate Blood and resolve stasis. Chantui and Niubangzi resolved exterior toxins; Huanglian (Coptidis Rhizoma) and Gancao resolved interior toxins. After three consecutive doses, his consciousness stabilized, appetite improved, purple-black color faded, and measles emerged. Note: In cases of internal Yin-Excess with purple-black rash, the method is to expel Yin and restore Yang. Signs include moist tongue, no thirst, low voice, short breath, aversion to cold, and preference for warmth, which differs from this case.

Zhu stated: Differentiating Yin and Yang syndromes requires careful distinction. Yang syndromes prefer coolness; if Yin-Pathogen is internally excessive, coolness leads to death.

Last month, his younger brother, named Zhi Qian, aged twenty-one, had great difficulty erupting measles. Trusting a physician recommended by relatives, who lacked understanding of resolving and supporting, he used exclusively cooling herbs, suppressing the rash Qi and preventing eruption, leading to death on the ninth day. Jing Qian attributed this to his brother's lack of caution, irregular lifestyle, and improper diet. Alas! His brother was killed by an incompetent physician, yet instead of blaming the doctor, he blamed himself, proving his kind heart. Does Heaven not silently protect? Thus, when he later developed measles, although dangerous, he ultimately suffered no harm. I believe rewarding good and punishing evil is proper. Should not physicians who kill quickly be punished? When will Heaven visibly punish those who recommend such doctors, bringing me relief? The proverb says, "The wise do not recommend physicians; physicians are not recommended by the wise." Only fools get recommended? Thus, I deeply hate those who recommend physicians that kill.

I once treated the son of Tian Rui, presenting with high fever, extreme thirst, dry tongue, bitter taste, swollen and blocked throat, panting, abdominal pain, dysentery with red and white discharge, hot red urine, and purple-dark dull rash color. This indicated Fire-Pathogen filling the San Jiao (Triple Burner), all obstructed by Heat, damaging fluids causing thirst, touching the Lung causing panting, attacking upward causing throat blockage, pressing downward causing dysentery. Essence, fluids, and blood vessels were boiled, causing the rash to lose its red vitality. Bitter taste indicates Shaoyang interior Heat. Formula: Chaihu and Huangqin to resolve Shaoyang; Dahuang (Rhei Radix et Rhizoma) to purge San Jiao excess Heat; Zhiren (Gardeniae Semen) to guide San Jiao Fire downward; Shengdi and Zicao (Leonuri Herba) to resolve Blood-level Heat; Xingren to calm panting, Jiegeng to raise Qi, Gancao to harmonize the middle. After one dose, symptoms subsided slightly, but abdominal pain persisted and urination remained unchanged. That night, use Liuyi San (Six-to-One Powder) with Shensha (Cinnabaris) 2 qian, dissolved in Jiegeng decoction. Jiegeng connects Heaven Qi to Earth Qi, unblocking stagnation and relieving obstruction. Liuyi San opens channels to drain Small Intestine Heat. One dose allowed urination, and abdominal pain healed. Next day, the rash turned red and vibrant, all symptoms resolved. Remove Chaihu, Huangqin, Dahuang, and Zhiren from the formula; add Danggui and Fuling. Several doses led to full recovery.

I once treated the grandson of Guo Xian, presenting with pale red rash, irritability, thirst, cracked lips, swollen face, profuse clear saliva, loss of appetite, short urination, and constipation. Upon careful observation, this was True Cold internally with False Heat externally. The patient had aversion to cold, fatigue, and desire to sleep, indicating Shaoyin Syndrome. Internal True Cold manifested as slippery cold tongue coating. Although thirsty, he preferred hot drinks and could not drink much. Short urination and constipation resulted from clear saliva surging upward, reversing fluid descent. All symptoms were not True Heat but false appearances. Formula: Fuzi, Baizhu, Fuling, Banxia, and Wuyu (Evodiae Fructus). After one dose, rash color slightly changed, and general condition/diet improved. After another dose, lips healed completely, and clear saliva stopped. Stool was initially hard then loose, followed by red-white dysentery. I knew the interior pathogen was moving downward, a sign of strong Stomach Qi eliminating filth. However, urination remained short. Add heavy dosage of Rougui powder dissolved in medicine. Over three to four doses, all symptoms resolved successfully.

Discussion (From Mr. Wang Qi of Xushan's *Yilin Zhiyue*, one discussion plus one attached case):
Sha (sand/scratch) refers to rough, scaly skin. Commonly called Sha, it actually refers to rash. Faint red spots are called hidden rash. The root of rash lies within the hair follicles and between skin pores. Due to Cold, Blood becomes congealed and sluggish. This congealed Blood disperses outside the skin, manifesting as rash. The Qi of hair follicles over the body is governed by the Lung. Inside the follicles, outside the pores, Blood from the uterus/womb heats flesh, fills skin, and permeates hair/skin, governed by the Liver. Skin Cold causes Blood congestion/sluggishness. Initially congested, then attempting to flow freely causes fever and cough, dispersing as rash. Rash eruption varies from sparse to dense. Extremely sparse: just a few to dozens of spots. Extremely dense: covering entire body and face with no gaps. Physicians unaware of this cause, seeing a few spots, immediately attack and force eruption. If there is indeed congestion in skin/pores, fever and cough should naturally surge out. If it does not erupt immediately, it is either surface disharmony or Qi deficiency failing to uplift. Treatment should use agents like Honghua, Danggui, Chuanxiong, Jingjie (Schizonepetae Herba), Chaihu, Qianghuo (Notopterygii Rhizoma), and Danshen (Salviae Miltiorrhizae Radix) to harmonize the surface. Or use Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix), Baizhu, Danggui, Fuling, and Gancao to assist Qi deficiency. If broadly prescribing Suzi, Mahuang (Ephedrae Herba), Qianhu (Peucedani Radix), Xingren, Huangqin, Huanglian, and Shigao (Gypsum Fibrosum), for those with Qi deficiency unable to erupt, this empties the root. Originally sparse cases suffer unjust aggression. Not only can the rash not erupt, but meridians and interior/exterior are depleted, causing high fever, panting urgency. More heat leads to more surface exposure; more panting leads to more eruption. Mild becomes severe, severe becomes fatal. Smallpox eruption, once one or two spots appear, inevitably erupts. Rash eruption, seeing one or two spots, may or may not erupt. If there is indeed congested rash at the surface, fever and cough naturally drive eruption. If no rash, these few spots stop increasing. Good practitioners understand this, do not aggressively force eruption, but regulate meridians, harmonize Ying and Wei, tonify deficiency, warm cold. Then heat retreats, body rests, and healing occurs. Unfortunately, ignorant people, during peak rash toxin times, see a few spots and immediately attack. More attack, worse severity; more eruption, greater danger, inevitably leading to visceral deficiency/collapse and death. Truly painful! Smallpox toxin originates in the Kidney, not emerging via meridians; even good physicians cannot save Kidney-channel smallpox. Rash, however, originates in skin/pores. Blood in skin/pores roots in the Sea of Blood (Uterus/Womb). Skin/Cold causes uterine Blood stagnation, leading to rash toxin. Treating based on the source with flexible methods, or letting nature take its course without reckless intervention, results in almost no deaths.