bubble_chart Concept

Measles refers to a pestilence seasonal pathogen, a virulent toxin, which causes fever for 3-4 days, followed by the appearance of red rash spots all over the body, slightly raised, palpable, resembling grains of hemp. A characteristic feature is the appearance of measles mucous membrane spots on the buccal mucosa. It is most commonly seen in infants and young children over six months old.

The so-called "斑" (spots) in ancient times, the "庖疹" (pox rash) mentioned in "Xiao'er Yaozheng Zhijue," the "macula and papule" referred to in "Xiao'er Macula and Papule Bei Emergent Formula Lun," and the "smallpox" mentioned in "Infantile Smallpox Fang Lun," all include this condition. It was not until the Yuan Dynasty's "Ma Zheng Xin Shu" that it was officially named measles.

Due to regional differences, in the Jiangsu and Zhejiang areas, measles is called "痧子" (sha zi) or "瘄子" (cu zi), in North China it is called "疹子" (zhen zi) or "糠瘡" (kang chuang), and in South China it is mostly called "麻子" (ma zi).

bubble_chart Pattern Analysis

In addition, measles can easily be confused with wind-heat common cold before the rash appears. After the eruption, it should be differentiated from other rash symptoms and signs. The analysis is as follows:

At the onset, measles presents with fever, cough, sneezing, and other symptoms similar to common cold. However, the fever in measles is mild in the morning and severe at night, or it may fluctuate several times a day, or rise again after subsiding, often higher than the initial fever. Although the body is hot, the extremities and ear lobes are cold. The eyelids are swollen with watery eyes, and there is sneezing with turbid nasal discharge. The "Yu Ke Zhengzhi Zhunsheng" states: "When illuminated by fire, the whole body appears as if painted with vermilion, which is a sign that the rash is about to emerge." The "Ma Ke Huo Ren Quan Shu" says: "To identify measles, one must carefully examine the area below the ears, the neck and ear junction, and the back down to the waist. There must be three to five red spots, which are the precursors of measles. If there are no red spots as evidence, then other conditions should be treated." If measles mucous membrane spots appear in the mouth, it is even more evidence for early differential diagnosis. Additionally, whether it is the epidemic season, whether the patient has had measles before, and whether there has been contact with measles patients can all serve as references for early differentiation.

Children with rubella, roseola infantum, and scarlatina all present with rashes, which can easily be confused with measles rash. The differences are: rubella has milder systemic symptoms, no measles mucous membrane spots in the mouth before the eruption, and the rash appears on the same day or one day after the fever, with a light red color, small and sparse, and extremely itchy. It first appears on the head and face, then on the trunk and limbs the next day, and disappears within two to three days. After the rash subsides, there is no desquamation or scarring. The lymph nodes behind the ears, neck, and occiput are often swollen and painful, which can appear one day before the eruption and last for two to seven days or longer. Roseola infantum mostly occurs in breastfeeding infants and young children. The rash is similar to measles, but it is characterized by the rash appearing after the fever subsides. The onset is sudden, with high body temperature lasting for three to four days, then the fever subsides on its own. Apart from poor appetite, the child's spirit is good. After the fever subsides, a rose-red, fine, and slightly dense rash appears all over the body, less on the face, and more on the trunk, especially around the waist and buttocks. The rash appears rapidly within a day and disappears within one or two days, leaving no color marks or desquamation. Scarlatina usually starts with a rash appearing within half a day to one day, first on the neck and chest, then spreading all over the body in three to four days, densely distributed like painted cinnabar. The face is flushed but without a rash. After the rash subsides, there is significant skin desquamation, along with sore throat or even ulceration, especially around the mouth, which is pale. The tongue texture is deep red and prickly, resembling Chinese wax myrtle bark, and linear rashes appear in skin folds.

Measles has its constants and variations, its severity and mildness, its favorable and unfavorable courses, and it is easily confused with other rash diseases. The key points of differentiation lie in dividing the symptoms and signs into stages based on the course of the disease, distinguishing the favorable and unfavorable courses based on the severity of symptoms, and differentiating it from other external contraction diseases and rash diseases based on unique symptoms.

bubble_chart Documentation

1. Yizong Jinjian Pediatrics Zabing Xinfa Yaojue．Pestilence Chapter: "The rash is white and the eruption is red like foxtail millet, the patches are red like continuous bean pieces, light red indicates mild illness, deep red indicates severe illness, and black mostly indicates death; pale red, sparse and dark indicates yin macula."
2. 《Pediatrics Interpretation．Measles》: "Measles are small and floating, with head grains, unlike macules which form patches of a single color. At the initial onset, there must be fever, similar to cold-damage disease but with differences. Clear nasal discharge, cough, sneezing, slight swelling of the eye sockets, tears filling the eyelashes, or vomiting or diarrhea, redness reaching the cheeks, these are signs of measles, sweating and purging are not necessary."
3. 《Pediatrics Zhengzhi Zhunsheng．Measles》: "Measles are few and floating with head grains, appearing and disappearing quickly, not forming pus-filled blisters... Those that appear mildly and last for fewer days are called milk rash, those that appear slightly more severe and last for more days are called true rash. Initially, it also resembles smallpox, but smallpox originates from the viscera, while measles originates from the bowels. The viscera belong to yin, their Bingben is deep, hence difficult to appear and disappear, and warm and mild medicine is appropriate; the bowels belong to yang, their Bingben is shallow, hence easy to appear and disappear, and cool and refreshing medicine is appropriate."