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The intensity of the bright red color varies. The heads of the macules are separated from the skin, and the skin is moist and flat. If the macules are depressed and not elevated, one should clear the Lung and purge fire to ensure peace.

A pale red color for the macules is precisely what is desirable. This is because the toxic heat in the Lung and Stomach is scanty and mild. If the heads of the macules do not separate from the skin, and the color is scorched, a physician should be consulted.

Bright red macules indicate internal heat. "Bright red" refers to a lustrous, vibrant, and active appearance. If the macule heads separate from the skin and the skin is fresh and moist, the condition is relatively mild and peaceful. However, if the macules are depressed and not elevated, the condition is usually severe; it is urgent to clear the Lung and purge fire. Herbs such as Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Tianhuafen (Trichosanthis Radix), Niubangzi (Arctii Fructus), and Shigao (Gypsum Fibrosum) are used to clear Metal (Lung Qi); herbs such as Huanglian (Coptidis Rhizoma), Zhiren (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Yuanshen (Scrophulariae Radix), Daqingye (Isatidis Folium), and Huangbai (Phellodendri Cortex) are used to purge fire. These are essential. One may use Huangqin Xiefei Tang (Scutellaria Decoction to Drain the Lung), removing Jiegeng (Platycodonis Radix), Dahuang (Rhei Radix et Rhizoma), and Gancao (Glycyrrhizae Radix), and adding Maidong, Niubangzi, and Yuanshen as the main prescription. As for pale red macules, this is the most appropriate color for measles. Since the toxic heat in the Lung and Stomach is originally light, the macule color is pale. Furthermore, if the macules are elevated and separated from the skin, this is an auspicious sign. If the macules are depressed and the color is scorched and dry, due to external constraint by Wind-Cold, the treatment should employ dispersing formulas. Use Gegen Jiemo Tang (Pueraria Decoction to Release the Muscles) [see Article 5], removing Chishaoyao (Paeoniae Radix Rubra) and Gancao, to treat it. There is another category: initially, the macules are not elevated, the color is reddish-pale, there is constipation, and the lips and mouth are dry and red. This indicates internal stagnation of Fire-Evil, constituting a severe Heat syndrome. It is urgent to use major cold-cooling formulas combined with dispersing and supporting agents. Use Baihu Jiedu Tang (White Tiger Decoction to Resolve Toxicity) [see Article 26], removing Zhuye (Bambusae Folium), and adding Yuanshen and Jingjie, to treat it. If not treated early, after several days, the color will turn purple-black and become difficult to cure.

Zhu stated: Whether the color is bright red or pale white, one distinguishes between good and bad omens based on whether the macules are elevated or depressed. This examination of symptoms is very accurate.

Huangqin Xiefei Tang treats Lung-Heat with interior excess.
Huangqin, Zhiren, Zhike, Boheye, Lianqiao, Xingren, Dahuang, Jiegeng, Gancao. Decoct in water and take after meals.

When macules erupt in patches and are suppressed by Wind, they suddenly turn white. If the macules are red but the skin is white, it indicates that the toxicity is transforming from the Blood level, which is an auspicious sign.

When the heads of the macules are elevated, the color is red, pale, and moist, and the skin is white, this indicates that the Fire in the Lung and Stomach is originally slight, representing an upper-grade auspicious syndrome. Medication is not required. In cases where toxicity transforms from the Blood level presenting this sign, or when toxic heat resolves through sweating, medication is also unnecessary for recovery. If upon initial eruption, the macule color is white like the skin, without distinct bases, but only the heads are elevated and they quickly recede, this indicates that the pathogenic heat was originally slight. However, some have deficient Wei-Qi at the exterior leading to whiteness; these patients require warm care and protection from Wind-Cold, and within two to three days, the color will naturally become red and vibrant. The ancient saying, "White rashes subside after warming," refers to this. Another category occurs during the eruption phase when constrained by Wind-Cold, causing the macule color to resemble the skin tone. Such patients exhibit piloerection and shivering. This syndrome requires dispersing formulas to resolve toxicity and scatter Wind, allowing the rash to become red and vibrant. Use Gegen Shuxie Tang (Pueraria Decoction to Disperse Pathogens) [see Article 33] or Gegen Jiemo Tang [see Article 5], removing Chishaoyao and Gancao, and adding Zisuye (Perillae Folium), Bohe (Menthae Haplocalycis Herba), Zhike (Aurantii Fructus), and Chi Fuling (Poria cum Radix Glycyrrhizae). If treatment is delayed, toxicity may not be fully expelled, leading to various complications. Another scenario involves macules erupting in patches; once constrained by Wind-Cold, they immediately turn white. The body does not feel feverish, but the toxicity attacks inward, causing restlessness, abdominal pain, phlegm-wheezing, and rapid breathing. This is a critical sign. If toxicity attacks the Stomach, there is vomiting of clear fluid; if it attacks the Spleen, there is abdominal distension and anorexia; if it attacks the Lung, there is nasal congestion and panting; if it attacks the Heart, there are cracked lips and tongue, unconsciousness, head shaking, and limb jerking; if it attacks the Liver and Kidney, the color turns black, and recovery is impossible.

Zhu stated: Regarding whiteness, apart from cases where macules are elevated and pathogenic heat is slight, it is either due to constraint by Wind-Cold or counter-attack of toxicity inward. Physicians must not be careless when encountering this.