一忌荤腥煎炒
疹初出时以至出净之日，俱忌食荤腥即素菜亦忌煎炒，恐荤腥煎炒能助胃火，昔人
云∶荤痘素疹。诚哉是言也。
二忌恣食生冷米粥
疹初出时以至出透之日，未免口渴烦躁，想饮冷水不妨少与饮些，以解其烦渴，然不可
多饮，若土产荸荠甜秋梨甘蔗汁及柿饼有霜者亦不妨间与食之，虽生吃无妨，切不可与米
饮粥汤，及糕饼糖饴面食枝圆蜜饯之类，食之恐助毒火。倘觉饥饿则用开水煮饭，滞小半钟
调匀稀薄，温服少食，淡食为宜。
三忌风寒
当出疹之时必须谨避风寒，若不避忌，风寒外束，疹即收回，要其再出甚为难矣，慎之慎之。
四忌房帏厌秽
人家生儿产女当出疹之时，各宜小心加意，谨慎洁净内外，勿使秽污恶浊气息触犯出
疹之人，一或犯之多致不救。
一忌骤用寒凉
当疹初出之时，虽有身热烦躁，口渴等证，即以宣毒发表汤少加酒炒黄芩三五分以
清之，切不可遽投黄连黄柏栀子等大寒之药，恐冰其毒而内伏，疹不得外出矣，后虽设法宣
表而疹终不得出，可不畏哉。
二忌误用辛热
疹初出时或有呕吐之证，（德按∶王太仆曰内格呕逆，食不得入是有火也。病呕而吐，
食入反出是无火也）医家必用苍术二陈平胃丁香砂仁暖胃，或手足稍冷，必用桂枝肉桂温
其手足，殊不知作呕吐者火热蒸于胃也，今反以辛温之味攻之，是抱薪而救火也。至于手足
稍作冷者，热极似寒之象，俟疹出透而手足自然温和。医不明此反以桂枝可达四支之末，肉
桂可以温经回阳，误之又误，陷人性命可不惧哉。
三忌遽用补涩
疹初出时多有泻而不止者，其毒火亦因泻而减，此殊无妨。倘或泄泻过甚，则用加味
四苓散一服立愈，切不可用参术诃蔻补涩之剂以图速止。医家不思肺与大肠为表里，风邪
热毒伤肺犯胃，火性急速下行，乃曰吾于清解药中兼用些参术诃蔻，分两又少何碍于事，一
服不见立效，且曰分两轻之故耳，于是多加分两再服，而疹忽变证矣，重则腹胀喘满而不可
救，轻则变为休息痢，缠绵不已，终归夭命。不可慎哉。
若麻疹出净之后，泻黄红色，乃内有伏热，仍宜加味四苓散服之可也，且不可专用补涩。记之慎之。
加味四苓散
猪苓（七分） 赤苓（六分） 泽泻（八分） 木通（七分） 黄芩（五分，酒炒） 黄连（二分，
酒炒） 牛蒡子（五分，炒香研细） 车前子（七分，炒）
灯心五十寸同煎服。
初发热，欲出未出时，宜用宣毒发表汤（今以半岁男女为式看其年之小大，随证加减）。
升麻（三分） 干葛（八分） 防风（五分） 桔梗（五分） 薄荷（三分） 前胡（六分） 连翘（六分，去
心） 枳壳（六分，麸炒） 荆芥穗（五分） 牛蒡子（六分，炒研） 木通（六分） 生甘草（三分，去皮）
淡竹叶（一钱），同煎服。
天气大热加酒炒黄芩五分，天气严寒加炒麻黄二分或三分。
麻疹已出面红肿太甚宜用化毒清表汤。
前胡（六分） 干葛（七分） 知母（七分） 连翘（七分，去心） 元参（一钱） 桔梗（六分） 黄连（三
分，酒炒）
黄芩（五分，酒炒） 薄荷（三分） 栀子（五分，炒黑） 木通（六分） 防风（三分，不用亦可） 牛蒡子（七分，
炒研） 天花粉（八分） 地骨皮（八分） 生甘草（三分）
淡竹叶一钱，灯心五十寸为引，同煎服。
若口渴加麦门冬去心一钱，石膏一钱五分，大便秘涩可加酒炒大黄七分。
疹已出透身热未全退，毒瓦斯流注而成痢者，宜用清热导滞汤。
黄连（五分，酒炒） 黄芩（七分，酒炒） 白芍（七分，酒炒） 枳壳（五分，麸炒） 青皮（五分）
山楂（一钱，去核炒） 槟榔（五分） 浓朴（五分，姜汁炒） 当归（五分） 陈
皮（五分） 生甘草（三分） 连翘（八分，去心） 牛蒡子（八分，炒研）（德按∶倪涵初治痢方有木香二分，
无连翘牛蒡子）
淡竹叶一钱，灯心五十寸为引，同煎服。
若红多加红花三分酒炒，地榆五分，桃仁去皮尖炒五分，秘涩甚者，里急后重之极加酒炒大黄八分。
以上三方聂氏手定，但其中变化相时看证，或加减一二味药，又或斟酌分两，或稍加减一二分，投之即得应效。
内廷订方总以十三味，为式，只可少决不可多，如满十三味则将淡竹叶 石膏入于药
引之内更觉妥当。予每看疹看其证候，相其时日，闻气听声，观形察色，然后参之以脉，始用
宣毒发表汤表之，继以化毒清表汤清之，总遵此二方加减逐日变化，若麻疹未透则前葛荆
防为必用之药，既透则前葛荆防为可去之剂，气喘除升麻不用，便秘蒸大黄必需，疹色干焦
生地归尾要用，若还紫黑红花紫草宜加，咳嗽气急清肺饮除肺热，口疮口臭败毒散清胃利
咽，成方在此活法由人。麻疹已出透齐，用生犀角磨汁和服大能解毒。
凡疹后咳嗽气粗宜清肺饮。
桑白皮（五分，炙） 地骨皮（五分） 麦门冬（一钱，去心） 柴胡（六分） 元参（八分） 桔梗
（七分） 陈皮（三分） 黄芩（七分，酒炒） 石膏（一钱， ） 天花粉
（八分） 生地黄（一钱） 木通（七分） 生甘草（三分）
灯心淡竹叶为引煎，再磨羚羊角汁和服。
如肺热亟去陈皮加丹皮五分，连翘（去心）六分，牛蒡子（炒研）六分
凡疹后口臭口疮唇烂，兼之咽喉疼痛宜败毒散。
生地黄（一钱五分） 丹皮（七分） 柴胡（七分） 桔梗（八分） 薄荷（五分） 连翘（八分，去
心） 牛蒡子（八分，炒研） 黄柏（五分，蜜水炒） 天花粉（八分） 黄芩（七分，酒炒） 元参
（八分） 赤芍药（五分） 金银花（八分） 生甘草（三分，去皮）
石膏一钱，淡竹叶一钱，灯心五十寸为引同煎，再用生犀角磨汁和服，以上清肺饮败
毒散二方，予每调出疹，因时设法，想理度情用之，辄有效验，敢以鄙见续于聂氏之后。
[Three Taboos for Physicians Treating Rash]
One taboo: Sudden use of cold and cooling medicines.
When the measles rash is just beginning to emerge, although there are symptoms such as fever, restlessness, and thirst, one should use Xuandu Fabiao Tang (Decoction for Dispersing Toxins and Expelling the Exterior) with a small addition of wine-fried Huangqin (Scutellariae Radix, 3-5 fen) to clear heat. One must not abruptly administer large doses of extremely cold herbs such as Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), or Zhizi (Gardeniae Fructus), lest the toxin be frozen and trapped internally, preventing the rash from emerging outward. Even if measures are later taken to disperse the exterior, the rash will ultimately fail to appear; how can this not be feared?
Two taboos: Misuse of pungent and hot medicines.
When the measles rash first appears, if vomiting occurs, (De notes: Wang Taipu stated that internal obstruction with vomiting and reversal, where food cannot enter, indicates fire; pathological vomiting and spitting out, where food enters but is immediately vomited back, indicates lack of fire.) If physicians insist on using Cangzhu (Atractylodis Rhizoma), Erchen Tang (Two-Cured Decoction), Pingwei San (Powder for Leveling the Stomach), Dingxiang (Caryophylli Flos), and Sharen (Amomi Fructus) to warm the stomach, or if the patient's hands and feet are slightly cold, insisting on using Guizhi (Cinnamomi Ramulus) and Rougui (Cinnamomi Cortex) to warm the limbs, they do not realize that vomiting is caused by fire and heat steaming in the stomach. To attack this with pungent-warm substances now is like carrying firewood to save a fire. As for the slight coldness of the hands and feet, this is an appearance of cold due to extreme heat; once the rash has fully emerged, the hands and feet will naturally become warm. Physicians who do not understand this, believing instead that Guizhi can reach the extremities of the four limbs and Rougui can warm the meridians and restore yang, make mistake upon mistake, endangering lives; is this not terrifying?
Three taboos: Hasty use of tonifying and astringent medicines.
At the initial stage of measles emergence, there is often diarrhea that does not stop. The toxic heat within the body is also reduced through this diarrhea, which poses no harm. However, if the diarrhea is excessive, one dose of Jiawei Siling San (Modified Four-Ling Powder) will cure it immediately. One must absolutely avoid using tonifying and astringent agents containing Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Hezi (Chebulae Fructus), and Kouren (Cardamomi Fructus Rotundus) to seek rapid cessation of diarrhea. Physicians fail to consider that the Lung and Large Intestine are interior-exteriorly related. Wind pathogen and toxic heat injure the Lung and invade the Stomach; the nature of fire moves rapidly downward. They say, "I add some Renshen, Baizhu, Hezi, and Kouren to my clearing and resolving formulas; since the dosage is light, what harm could it do?" Upon seeing no immediate effect after one dose, they claim it is due to the light dosage, increase the amount, and administer again. Consequently, the rash suddenly undergoes transformation into complicated syndromes. Severe cases result in abdominal distension, fullness, and wheezing that are incurable; mild cases transform into chronic dysentery (Xiuxi Li), lingering endlessly, ultimately leading to premature death. Caution is imperative!
If, after the measles have completely emerged, yellow-red stool is passed, this indicates latent heat within; it is still appropriate to administer Jiawei Siling San. Do not exclusively use tonifying and astringent remedies. Remember this and exercise caution.
Jiawei Siling San (Modified Four-Ling Powder)
Zhuling (Polyporus, 7 fen) Chi Ling (Red Poria, 6 fen) Zexie (Alismatis Rhizoma, 8 fen) Mutong (Akebiae Caulis, 7 fen) Huangqin (Scutellariae Radix, 5 fen, wine-fried) Huanglian (Coptidis Rhizoma, 2 fen, wine-fried) Niubangzi (Arctii Fructus, 5 fen, fried until fragrant and ground) Cheqianzi (Plantaginis Semen, 7 fen, fried)
Dengxincao (Junci Medulla, 50 cun) added for decoction and consumption.
During the initial fever, when the rash desires to emerge but has not yet appeared, Xuandu Fabiao Tang (Decoction for Dispersing Toxins and Expelling the Exterior) is suitable. (Currently, taking six-month-old infants as a standard, adjust according to age and syndrome.)
Shengma (Cimicifugae Rhizoma, 3 fen) Gange (Puerariae Radix, 8 fen) Fangfeng (Saposhnikoviae Radix, 5 fen) Jiegeng (Platycodonis Radix, 5 fen) Bohe (Menthae Haplocalycis Herba, 3 fen) Qianhu (Peucedani Radix, 6 fen) Lianqiao (Forsythiae Fructus, 6 fen, heart removed) Zhike (Aurantii Fructus Immaturus, 6 fen, bran-fried) Jingjie Sui (Schizonepetae Spica, 5 fen) Niubangzi (Arctii Fructus, 6 fen, fried and ground) Mutong (Akebiae Caulis, 6 fen) Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen, peeled) Danzhuye (Lophatheri Herba, 1 qian). Decoct together and consume.
In very hot weather, add 5 fen of wine-fried Huangqin. In severe cold weather, add 2-3 fen of fried Mahuang (Ephedrae Herba).
If the measles have emerged but swelling and redness are excessive, Huadu Qingbiao Tang (Decoction for Resolving Toxins and Clearing the Exterior) is suitable.
Qianhu (Peucedani Radix, 6 fen) Gange (Puerariae Radix, 7 fen) Zhimu (Anemarrhenae Rhizoma, 7 fen) Lianqiao (Forsythiae Fructus, 7 fen, heart removed) Yuanshen (Scrophulariae Radix, 1 qian) Jiegeng (Platycodonis Radix, 6 fen) Huanglian (Coptidis Rhizoma, 3 fen, wine-fried)
Huangqin (Scutellariae Radix, 5 fen, wine-fried) Bohe (Menthae Haplocalycis Herba, 3 fen) Zhizi (Gardeniae Fructus, 5 fen, fried black) Mutong (Akebiae Caulis, 6 fen) Fangfeng (Saposhnikoviae Radix, 3 fen, optional) Niubangzi (Arctii Fructus, 7 fen, fried and ground) Tianhuafen (Trichosanthis Radix, 8 fen) Digupi (Lycii Cortex, 8 fen) Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen)
Danzhuye (Lophatheri Herba, 1 qian) and Dengxincao (Junci Medulla, 50 cun) as guides, decoct together and consume.
If thirsty, add Maidong (Ophiopogonis Radix, 1 qian, heart removed) and Shigao (Gypsum Fibrosum, 1.5 qian); if constipation is severe, add 7 fen of wine-fried Dahuang (Rhei Radix et Rhizoma).
If the rash has fully emerged but body heat has not completely subsided, and toxic vapors flow into the intestines causing dysentery, Qingre Daozhi Tang (Decoction for Clearing Heat and Guiding Out Stagnation) is suitable.
Huanglian (Coptidis Rhizoma, 5 fen, wine-fried) Huangqin (Scutellariae Radix, 7 fen, wine-fried) Baishao (Paeoniae Radix Alba, 7 fen, wine-fried) Zhike (Aurantii Fructus Immaturus, 5 fen, bran-fried) Qingpi (Citri Reticulatae Pericarpium Viride, 5 fen)
Shanzha (Crataegi Fructus, 1 qian, pitted and fried) Binglang (Arecae Semen, 5 fen) Houpo (Magnoliae Officinalis Cortex, 5 fen, ginger juice-fried) Danggui (Angelicae Sinensis Radix, 5 fen) Chenpi (Citri Reticulatae Pericarpium, 5 fen) Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen) Lianqiao (Forsythiae Fructus, 8 fen, heart removed) Niubangzi (Arctii Fructus, 8 fen, fried and ground) (De notes: Ni Han Chu’s dysentery formula contains 2 fen of Muxiang (Aucklandiae Radix) and lacks Lianqiao and Niubangzi.)
Danzhuye (Lophatheri Herba, 1 qian) and Dengxincao (Junci Medulla, 50 cun) as guides, decoct together and consume.
If redness is prominent, add Honghua (Carthami Flos, 3 fen, wine-fried), Diyü (Sanguisorbae Radix, 5 fen), and Taoren (Persicae Semen, 5 fen, skin and tip removed, fried); if constipation is severe with extreme tenesmus, add 8 fen of wine-fried Dahuang (Rhei Radix et Rhizoma).
The above three formulas were finalized by Mr. Nie personally, but their variations depend on the season and syndrome. One may add or subtract one or two herbs, adjust dosages, or modify them slightly by one or two fen; administration will yield effective results.
Formulas revised by the Imperial Court generally consist of thirteen ingredients as a standard format; the number should only be reduced, never increased. If reaching thirteen ingredients, placing Danzhuye (Lophatheri Herba) and Shigao (Gypsum Fibrosum) within the herbal guide is more appropriate. When I examine rashes, I observe the syndrome, assess the timing, listen to sounds, inspect complexion, and then correlate with the pulse before administering Xuandu Fabiao Tang (Decoction for Dispersing Toxins and Expelling the Exterior) to release the exterior, followed by Huadu Qingbiao Tang (Decoction for Resolving Toxins and Clearing the Exterior) to clear heat. I always follow these two formulas for daily adjustments. If the measles have not penetrated, Shengma (Cimicifugae Rhizoma), Gange (Puerariae Radix), Jingjie (Schizonepetae Herba), and Fangfeng (Saposhnikoviae Radix) are essential; once penetrated, these four may be removed. For wheezing, exclude Shengma (Cimicifugae Rhizoma); for constipation, steamed Dahuang (Rhei Radix et Rhizoma) is necessary; for dry and scorched rash color, Shengdi (Rehmanniae Radix Preparata) and Guiwei (Angelicae Sinensis Radix tail) are required; if the color remains purple-black, add Honghua (Carthami Flos) and Zicao (Leonuri Herba); for cough and急促 breathing, Qingfei Yin (Infusion for Clearing the Lung) clears lung heat; for mouth ulcers and bad breath, Baidu San (Powder for Resolving Toxins) clears the stomach and benefits the throat. Standard formulas are here; flexible application depends on the practitioner. Once the measles have fully emerged and spread evenly, grinding Sheng Xijiao (Rhino Ceratossis Cornu - *Note: Use substitutes in modern practice*) with water and mixing it for ingestion greatly resolves toxins.
For post-rash cough with coarse breathing, Qingfei Yin (Infusion for Clearing the Lung) is suitable.
Sangbaipi (Mori Cortex, 5 fen, processed) Digupi (Lycii Cortex, 5 fen) Maidong (Ophiopogonis Radix, 1 qian, heart removed) Chaihu (Bupleuri Radix, 6 fen) Yuanshen (Scrophulariae Radix, 8 fen) Jiegeng (Platycodonis Radix, 7 fen) Chenpi (Citri Reticulatae Pericarpium, 3 fen) Huangqin (Scutellariae Radix, 7 fen, wine-fried) Shigao (Gypsum Fibrosum, 1 qian) Tianhuafen (Trichosanthis Radix, 8 fen) Sheng Di Huang (Rehmanniae Radix, 1 qian) Mutong (Akebiae Caulis, 7 fen) Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen)
Dengxincao (Junci Medulla) and Danzhuye (Lophatheri Herba) as guides for decoction; grind Lingyangjiao (Saigae Tataricae Cornu) juice and mix for consumption.
If lung heat is urgent, remove Chenpi (Citri Reticulatae Pericarpium) and add Danpi (Moutan Cortex, 5 fen), Lianqiao (Forsythiae Fructus, 6 fen, heart removed), and Niubangzi (Arctii Fructus, 6 fen, fried and ground).
For post-rash bad breath, mouth ulcers, lip rot, accompanied by sore throat, Baidu San (Powder for Resolving Toxins) is suitable.
Sheng Di Huang (Rehmanniae Radix, 1.5 qian) Danpi (Moutan Cortex, 7 fen) Chaihu (Bupleuri Radix, 7 fen) Jiegeng (Platycodonis Radix, 8 fen) Bohe (Menthae Haplocalycis Herba, 5 fen) Lianqiao (Forsythiae Fructus, 8 fen, heart removed) Niubangzi (Arctii Fructus, 8 fen, fried and ground) Huangbai (Phellodendri Cortex, 5 fen, honey-water fried) Tianhuafen (Trichosanthis Radix, 8 fen) Huangqin (Scutellariae Radix, 7 fen, wine-fried) Yuanshen (Scrophulariae Radix, 8 fen) Chi Shaoyao (Paeoniae Radix Rubra, 5 fen) Jinyinhua (Lonicerae Japonicae Flos, 8 fen) Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen, peeled)
Shigao (Gypsum Fibrosum, 1 qian), Danzhuye (Lophatheri Herba, 1 qian), and Dengxincao (Junci Medulla, 50 cun) as guides for decoction; grind Sheng Xijiao (Rhino Ceratossis Cornu - *Note: Use substitutes in modern practice*) with water and mix for consumption. Regarding the above two formulas, Qingfei Yin (Infusion for Clearing the Lung) and Baidu San (Powder for Resolving Toxins), whenever I treat rashes, I adapt methods according to the times, deduce principles and circumstances, and they invariably prove effective. I dare to add my humble opinions following Mr. Nie.