Measles is an acute and infectious disease mostly occurring in children, which is marked by fever, cough, nasal stuffiness and discharge, lacrimation, small, bright-red spots on the buccal mucosa and skin rashes.

Etiology and Pathogenesis

Physiologically, the lungs are connected with the skin and hair, and have their orifice at the nose. The spleen is responsible for the normal activity of the extremities and muscles. When the lungs are involved, symptoms of lung-wei disorder such as fever, cough, nasal discharge and sneezing appear. When the evil further attacks the spleen from the lungs and extends to qifen from weifen, the healthy qi will expel the evil from the interior to the superficies and the skin rash will erupt thoroughly so that the evil is eliminate, and the case has a favorable prognosis. However, if the healthy qi fails to dispel the evil or the predominant heat changes into fire, the skin rash cannot erupt thoroughly, and the prognosis is unfavorable. This may lead to various critical conditions. In cases where the evil blocking the lungs leads to failure of descending of lung-qi, dyspneic cough may ensue. In cases where fire attacks the throat, hoarseness, cough and even dyspnea may occur. If the heart and liver are involved, there may appear coma, delirium and convulsions. In a few cases where the primordial qi is insufficient and heat is accumulated, there may appear symptoms of collapse-syndrome, such as pallor, deadly cold limbs, listlessness and fading pulse.

Syndrome Differentiation and Therapeutic principles

A. Syndrome differentiation

(a) Case with favorable prognosis: Fever but not too high, slight sweating, mild cough, good spirit, consciousness, no dyspnea, bright-red skin rashes appearing three to four days after fever and beginning from the postauricular hairline and gradually and evenly distributing to the face, neck, trunk, limbs and finally the hands and feet, later becoming dull red and disappearing in the above sequence after three to five days, cough relieved and appetite returned as the fever subsides.

(b) Deteriorated case: Skin rash failing to appear after fever for four to five days or appearing instantaneously or lasting for a long period or erupting without a regular sequence, dark purplish or dark or pale in color, merging together to form masses and accompanies by high fever, irritability, coma, delirium, convulsions, dyspneic cough, hoarseness or even cyanosis, dyspnea and deadly cold limbs.

B. Therapeutic principles

Letting out evil, eliminating toxic materials and nourishing yin are the three main therapeutic principles for measles. As stated by ancient physicians: "Measles evil is a yang evil which should be treated by letting out and by cooling." Hence, the drugs with acrid-cool properties should be applied in the early stage to let out the skin eruptions. During the eruption period, clearing away heat and toxic materials is the main principles, but the acrid-cool drugs should be supplemented at the beginning to promote a thorough eruption of the skin rash and the sweet-cool drugs should be used in the late eruption period to nourish yin and clear away the remaining heat. But in applying the above therapies, it should be emphasized that consumption of body fluids should be avoided in applying the measures of promoting eruption, overuse of drugs of cold and cool nature is inadvisable for clearing heat and toxic materials, and indiscriminate use of greasy tonics is contraindicated for nourishing yin.

Classification and Treatment

A. Case with favorable prognosis

(a) Early febrile period (from the beginning of ever to the appearance of skin rash, about three days)

Manifestation: Fever, mild chilliness, nasal stuffiness and discharge, cough, sneezing, redness of eyes, lacrimation, photophobia, poor appetite, loose stool, oliguria, flushed cheeks, Kophik's spots, thin and white or yellowish tongue coating and floating and rapid pulse.

Therapeutic principles: Let out evil, clear away heat, and release the stagnated lung-qi.

Prescription: The Modified Powder of Forsythiae and Lonicerae

Fructus Forsythiae 10 g
Flos Lonicerae 10 g
Fructus Arctii 3 g
Radix Peucedani 10 g
Periostracum Cicadae 6 g
Semen Sojae Praeparatum 10 g
Herba Lophatheri 6 g
Radix Platycodi 5 g
Rhizoma Phragmitis 10 g

Remarks: Add Radix Puerariae (10 g) and Rhizoma Cimicifugae (3 g) for cases with severe diarrhea. Add Herba Spirodelae (10 g) for cases with high fever and no sweating. Add Semen Armeniacae Amarum (10 g) for cases with severe cough.

(b) The eruption period (from the beginning to thorough eruption of the skin rash, about three to five days)

Manifestations: Continuous high fever, redness of eyes and lips, irritability, thirst, severe cough, mental fatigue, oliguria with deep yellow and gradually increasing and merging together, red tongue with yellow and greasy or dry coating and full and rapid pulse.

Therapeutic principles: Clear away heat and toxic materials, and let out skin eruptions.

Prescription: The Modified Decoction for Clearing Away Heat and Letting Evil Out

Flos Lonicerae 10 g
Fructus Forsythiae 10 g
Folium Mori 10 g
Fructus Arctii 10 g
Radix Arnebiae seu Lithospermi 10 g
Radix Puerariae 10 g
Rhizoma Phragmitis 10 g
Radix Glycyrrhizae 3 g

Remarks: Add Gypsum Fibrosum (30 g, decocted first), Rhizoma Anemarrhenae (5 g) and Radix Trichosanthis (10 g) for cases with high fever and thirst. Add Periostracum Cicadae (6 g), Herba Menthae (3 g) and Herba Spirodelae (10 g) for those with indistinct skin eruption. Add Radix Rehmanniae (10 g), Cortex Moutan Radicis (10 g), and Flos Carthami (3 g) for those with dark purplish rashes merging together. Add Semen Armeniacae Amarum (10 g), Radix Platycodi (3 g) and Cortex Mori Radicis (10 g) for those with severe cough.

(c) The late eruption period (from thorough eruption to disappearance of rash, about five to seven days)

Manifestations: Rash gradually disappearing in the sequence of eruption, fever subsided, cough relieved, appetite, increased, stool and urine returned to normal, furfuraceous desquamation and chromatosis appearing on the skin, red and dry tongue with little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin with sweet-cool drugs and remaining heat.

Prescription: The Modified Decoction of Adenophorae Strictae and Ophiopogonis

Radix Adenophorae Strictae 10 g
Radix Ophiopogonis 10 g
Rhizoma Polygonati Odorati 10 g
Radix Trichosanthis 10 g
Semen Dolichoris 10 g
Folium Mori 10 g
Folium Eriobotryae Praeparata 10 g
Radix Glycyrrhizae 3 g

emarks: Add Cortex Lycii Radicis (10 g) and Radix Scutellariae (6 g) for cases with remaining heat. Add Endothelium Corneum Gigeriae Galli (6 g), Fructus Hordei Germinatus (fried, 10 g) and Fructus Oryzae Germinatus (fried, 10 g) for those with poor appetite.

B. Deteriorated case

(a) Evil invading the lungs

Manifestations: Rashes eruption indistinctly or disappearing instantaneously or appearing densely and purplish, continuous high fever, irritability, cough, dyspnea, moving of alae nasi, cyanotic lips, red and dry tongue with yellow coating, and rapid pulse.

Therapeutic principles: Clear away heat and toxic materials, and release the stagnated lung-qi.

Prescription: The Modified Decoction of Ephedrae, Armeniacae Amarum, Glycyrrhizae and Gypsum Fibrosum

Herba Ephedrae 3 g
Semen Armeniacae Amarum 10 g
Gypsum Fibrosum 30 g
Radix Glycyrrhizae 3 g
Radix Peucedani 10 g
Radix Scutellariae 6 g
Radix Isatidis 10 g
Fructus Perillae 10 g

Remarks: Add Herba Menthae (3 g), Periostracum Cicadae (6 g) and Herba Spirodelae (6 g) for cases with indistinct rashes or instantaneous disappearance of rashes. Add Radix Arnebiae seu Lithospermi (10 g) and Cortex Moutan Radicis (10 g) for those with dense and purplish rashes. Add Bulbus Fritillariae Thunbergii (10 g) and Concretis Silicea Bambusae (10 g) for those with profuse expectoration.

(b) Heat attacking the throat

Manifestations: Swelling and pain of the throat, hoarseness, cough with heavy voice, wheezing sounds in the throat, red tongue with yellow coating and rapid pulse.

Therapeutic principles: Clear away heat and toxic materials, and ease the throat.

Prescription: Decoction of Clearing the Throat and Eliminating Phlegm

Radix Scrophulariae 10 g
Fructus Arctii 10 g
Fructus Trichosanthis 10 g
Rhizoma Belamcandae 6 g
Bulbus Fritillariae Thunbergii 10 g
Fructus Aristolochiae 10 g
Radix Paeoniae Rubra 10 g
Radix Platycodi 5 g
Radix Glycyrrhizae 3 g

Remarks: Pill of Six Miraculous Drugs, one pill for each year of age, thrice daily. Add Radix et Rhizoma Rhei (3 g, decocted later) and Natrii Sulfas (6 g, mixed with the decoction) for those with constipation. For serious cases with signs of laryngeal obstruction such as pallor, irritability, dyspnea, cyanosis, etc., other measures including tracheotomy may be applied.

(c) Retention of heat in the heart and liver

Manifestations: High fever, irritability, coma, delirium or even convulsion rashes becoming purplish red and densely distributed all over the body and failing to disappear, or disappearing instantaneously, crimson tongue and wiry, thready and rapid pulse.

Therapeutic principles: Clear away heat and toxic materials, suppress wind, and wake up patient from unconsciousness.

Prescription: The Modified Decoction of Cornu Saigae Tataricae and Uncariae cum Uncis

Cornu Saigae Tataricae 1 g
Ramulus Uncariae cum Uncis 10 g
Folium Mori 10 g
Lignum Pini Poriaferum 10 g
Radix Rehmanniae 10 g
Cortex Moutan Radicis 10 g
Folium Isatidis 10 g
Radix Scutellariae 10 g
Bulbus Fritillariae Cirrhosae 6 g
Scorpio 1.5 g

Remarks: Purple Snow Pill, 1.5 grams twice daily, or Calculus Bovis Bolus for Resurrection, half bolus twice a day. Add Rhizoma Acori Graminei (10 g), Radix Curcumae (10 g) and Rhizoma Arisaema cum Bile (6 g) or Bolus of Precious Drugs (half bolus twice a day) for cases with deep coma.

C. Collapse of yang-qi

Manifestations: Sudden lowering of body temperature, profuse sweating, pale or blue-gray complexion, shortness of breath, deadly cold limbs, pale and indistinct skin rashes, pale tongue with white coating and fading pulse.

Therapeutic principles: Recuperate the depleted yang, and rescue the patient from danger.

Prescription: Decoction of Ginseng, Aconiti Lateralis Praeparata, etc.

Radix Ginseng (mixed with the decoction) 10 g
Radix Aconiti Lateralis Praeparata 10 g
Os Draconis 15 g
Concha Ostreae 15 g

Experiential Prescriptions

A. Rhizoma Phragmitis (30-60 g); prepared as decoction for daily drinking; applicable to cases during the early febrile period and the eruption period.

 B. Fresh Herba Coriandri Sativi (30 g), Herba Spirodelae (30 g), yellow wine (60 g) and water (q.s.); prepared as decoction for bathing; applicable to cases during the early febrile period and the beginning of eruption period.

Copyright 1995 Hopkins Technology