也。治以宣气泄肺清火解毒之法。乃痧毒火邪郁于气分。上灼肺金之正治。
发喘 凡痧 透发不尽。毒邪干肺。喘急昏闷者。危症也。宜急透之。
焦麻黄（八分） 石膏（四钱） 杏仁（二钱） 牛蒡子（一钱五分）
连翘（一钱五分） 枯芩（一钱五分） 象贝母（一钱五分） 薄荷（八分）
桔梗（八分） 犀角尖（八分） 生甘草（四分） 通草（一钱） 芦根（一握）
邵评∶此痧毒内伏郁闭之症。或着寒冒风。皆能致此。寻常疹子则无此症。盖痧
出而不尽透。毒伏于内。郁闷肺闭。而昏喘气急者。大危之症。非麻黄大开肺气。
则不能救。再用石膏以清火。杏仁以下气。甘草以缓急而泻火毒。加犀角、桔梗等味。提透清化为治。
咳嗽 痧后咳嗽。余热在肺也。宜泻白散。加贝母、橘红、杏仁、枯芩、知母、花粉、甘桔、
梨浆之类清之。
邵评∶此痧疹余邪蕴肺而咳嗽之良法。
伤阴 凡痧 伏邪未清。致伤阴分。而发热不止者。宜甘凉养阴。如沙参、骨皮、麦
冬、玉竹、云苓、金斛、生地、白芍、丹皮、甘草之类。
邵评∶此痧后伏邪伤肺胃之阴液。因而发热之正法。
伏邪 凡痧 等症。外虽透达。易隐易回。而身热不除。渐加喘咳。腹胀咽痛。喉哑
龈烂。神昏欲寐。或兼赤利等症者。此系失潮。伏邪在内。危症也。急宜散邪解毒。如
犀角、连翘、牛蒡、射干、元参、杏仁、楂肉、人中黄、净银花、西黄、通草之类。
邵评∶痧毒内伏。上中下三焦均受其戕也。盖痧子出没有潮数。见点三日方齐。
每日三潮。三日九潮。潮后渐渐退没。则痧毒尽透。若未潮足而早回。则邪伏于内。咳喘龈烂。喉哑咽
痛。毒火上扰也。腹胀赤利。邪火下注也。身热神昏欲寐。痧毒闭伏于中也。上中下三焦俱受
邪侵。必正不胜邪而败矣。急急提透疹邪。清热解毒为治。必使痧毒外散。方有生机。
如痧 隐没太早。以致发热咳喘者。此伏邪在肺也。速宜开宣肺气。迟则不治。如
栀豉、桑杏、羚羊、牛蒡、连翘、前胡、薄荷、桔梗、芦根之类主之。
邵评∶按此等药。虽是开宣肺气为主。然初起即用。或有灵效。若喘热势盛。似乎
嫌轻。当以麻杏汤治之为是。然此条痧隐太早。邪遏于肺。病在上焦。较前条稍轻。故以轻宣法治之。
阴虚 凡少阴水亏之人。感挟时邪。而发 疹。不可过用柴葛升散。缘此症。虽表
不得汗解。或虽得汗。而 疹未透。热仍不解。惟清解中兼养阴液。庶能得汗。而
疹亦易透达。如遇时感。诊得脉象细数。或沉细。外症。欲寐不寐。舌形微白兼红。或
紫色而干。即是少阴虚症。或已经表散不应者。急宜用生地、骨皮、沙参、茯苓、麦冬、
金斛、花粉、牛蒡、连翘、甘草之品。以养阴液。自然疹随汗达。身凉而解。如兼舌燥口
渴而便秘者。加犀角数分。合阳明治之。或加豆豉。
邵评∶此肾水素虚之人。外受湿热暑湿时邪而发 疹。非天行时痧之症。当从三焦立法。用手经药清
透。各随其所受之邪而施治。非足经药之柴葛升散发表者所宜。即使发表得汗。此非风寒表症。其邪不
能从汗而解。 疹何能外达。况本属水亏之人。病是温热。而非风寒。尤忌发汗伤阴。故必清解温暑热邪。
甘凉滋液之法。俾得营卫之邪。从肺达而出疹。阳明之邪。由胃而发 。温热暑邪。随 疹而化解矣。
至脉细数而沉细。温热入少阴之脉象也。欲寐。少阴本症也。复不得寐。烦热也。微白而红。温热初起之舌
也。少阴舌本紫干者。热而津亏也。此少阴温热而阴液素虚之症。急急滋液达邪。阴液充复。则邪气达。
自然得汗。非用药强发而汗出也。
又评∶此阴虚而受温暑时邪之症。当救液达邪。辨明营卫而治。邪从 疹而解。
如见阳明症象。可合阳明法治之。
凡痧 瘾疹。最宜通泄。虽下利五色。亦不妨。惟二便不利。最为凶候。如遇此症。勿实脾止泻。
邵评∶痧疹因受外邪而病。或见吐泻。则内邪由吐下而外泄。此是顺症。若二便
不利。则邪毒壅遏。最多闭结。故为凶候。凡痧疹吐泻。大忌止涩。
... [End of treatment]. The treatment employs the method of diffusing Lung Qi, clearing and draining Lung fire, and detoxifying. This is the correct approach for Sha (scarlet fever-like rash) toxin and fire pathogen stagnating in the Qi level, burning upwards to damage Lung Metal.
Wheezing: In cases of Sha, if the rash fails to fully erupt, and the toxic pathogen invades the Lung, leading to urgent wheezing and mental confusion or lethargy, this is a critical condition. It is imperative to urgently promote the eruption of the rash.
Prescription: Jiao Mahuang (Scorched Ephedrae Herba, 8 fen), Shigao (Gypsum Fibrosum, 4 qian), Xingren (Armeniacae Semen Amarum, 2 qian), Niubangzi (Arctii Fructus, 1.5 qian), Lqiao (Forsythiae Fructus, 1.5 qian), Ku Qin (Scutellariae Radix with heart removed, 1.5 qian), Xiang Beimu (Fritillariae Thunbergii Bulbus, 1.5 qian), Bohe (Menthae Haplocalycis Herba, 8 fen), Jiegeng (Platycodonis Radix, 8 fen), Xijiaojian (Rhinocerotis Cornu Apex, 8 fen), Sheng Gancao (Glycyrrhizae Radix et Rhizoma Raw, 4 fen), Tongcao (Tetrapanacis Medulla, 1 qian), Lugeng (Phragmitis Rhizoma, one handful).
Shao's Commentary: This is a condition where Sha toxin is internally latent and obstructed. Contracting cold or wind can also cause this. Ordinary rashes do not present such symptoms. Generally, because the Sha does not fully erupt, the toxin remains latent inside, causing depression and closure of Lung Qi, resulting in lethargy, wheezing, and rapid breathing; this is a highly critical condition. Without Mahuang to vigorously open and diffuse Lung Qi, rescue is impossible. Combined with Shigao to clear fire, Xingren to direct Qi downward, and Gancao to relieve urgency and drain fire toxin, along with Xijiao and Jiegeng, the treatment principle focuses on lifting, diffusing, clearing, and transforming.
Cough: Cough following Sha is due to residual heat remaining in the Lung. Xiebai San (Drain the White Decoction) should be used, added with Beimu, Juhong, Xingren, Ku Qin, Zhimu, Huafen, Ganjie, and Lizhi (Pear Juice) to clear the heat.
Shao's Commentary: This is an excellent method for treating cough caused by residual Sha pathogens accumulating in the Lung.
Yin Injury: In cases of Sha, if latent pathogens are not cleared, leading to injury of the Yin aspect and persistent fever, sweet-cool herbs nourishing Yin should be employed. Examples include Shashen, Gupi (Dugongpi/Goubipi - Cortex Lycii), Maidong, Yuzhu, Yunling (Poria), Jinhu (Dendrobii Caulis), Shengdi, Baishao, Danpi, and Gancao.
Shao's Commentary: This is the proper method for post-Sha latent pathogens injuring the Yin fluids of the Lung and Stomach, thereby causing fever.
Latent Pathogen: In conditions like Sha, although the exterior appears resolved, the rash may easily hide and recur, accompanied by persistent fever that gradually worsens with wheezing and cough, abdominal distension, sore throat, hoarseness, gingival ulceration, mental confusion with drowsiness, or concomitant red dysentery. This results from a failure in the "tide" (regular eruption cycles), leaving latent pathogens inside; it is a critical condition. Urgently disperse pathogens and detoxify using Xijiao, Lqiao, Niubang, Shegan, Yuan Shen, Xingren, Zharou (Hawthorn Flesh), Renzhonghuang, Jing Yinhua (Flos Lonicerae Japonicae Purified), Xi Huang (Bovis Calculus), and Tongcao.
Shao's Commentary: When Sha toxin is latent internally, the Upper, Middle, and Lower Jiao are all damaged. The eruption of Sha follows specific "tides." Points appear over three days until uniform, with three tides daily, totaling nine tides over three days. After the tides subside, the toxin is fully erupted. If the tides are insufficient and the rash retreats early, pathogens remain latent, causing cough, wheezing, gingival ulceration, hoarseness, and sore throat due to toxic fire harassing upward. Abdominal distension and red dysentery indicate evil fire pouring downward. Fever, mental confusion, and drowsiness indicate Sha toxin closed within the Middle Jiao. With invasion of all three Jiaos, righteous Qi will inevitably fail against the pathogen. One must urgently lift and diffuse the rash pathogen, treating with clearing heat and detoxifying. Only when the Sha toxin disperses outward is there hope for survival.
If Sha hides too early, causing fever, cough, and wheezing, the latent pathogen is in the Lung. Quickly open and diffuse Lung Qi; delay renders it untreatable. Use Zhichi (Gardeniae Fructus and Fermented Soybean), Sangxing (Mulberry Leaf and Apricot Kernel decoction), Lingyang (Capri Cervi Cornu), Niubang, Lqiao, Qianhu, Bohe, Jiegeng, and Lugeng as main treatments.
Shao's Commentary: Although these herbs primarily open and diffuse Lung Qi, they may be effective if used at the onset. However, if wheezing and heat are severe, the formula might be too light; Maxing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) would be appropriate. Nevertheless, this clause describes Sha hiding too early, with pathogens constrained in the Lung (Upper Jiao), which is slightly milder than the previous case, hence the use of a light diffusing method.
Yin Deficiency: For individuals with inherent Kidney Water deficiency contracting seasonal pathogens who develop rashes, one must avoid excessive use of Chaihu and Gegen (Bupleuri Radix and Puerariae Radix) for ascending and dispersing. In this condition, even if the exterior cannot be resolved via sweating, or if sweating occurs but the rash does not erupt and heat persists, one must combine clearing/detoxifying with nourishing Yin fluids. Only then can sweat occur, allowing the rash to erupt easily. When encountering seasonal infections, if the pulse is fine and rapid or deep and fine, and external symptoms include drowsiness alternating with wakefulness, a tongue coating slightly white mixed with red, or purple and dry, this indicates Shaoyin deficiency. If surface-dispersing treatments have failed, urgently use Shengdi, Gupi, Shashen, Fuling, Maidong, Jinhu, Huafen, Niubang, Lqiao, and Gancao to nourish Yin fluids. Naturally, the rash will emerge with sweat, and the body will cool and resolve. If accompanied by dry tongue, thirst, and constipation, add several fen of Xijiao and treat according to the Yangming pattern. Alternatively, add Douchi (Fermented Soybean).
Shao's Commentary: This refers to rashes in individuals with constitutionally deficient Kidney Water due to external damp-heat or summer-heat seasonal pathogens, not epidemic Sha. Treatment should follow the Three Jiao principles, using Hand-Jiao herbs to clear and diffuse, tailored to the specific pathogen. It is unsuitable to use Foot-Jiao herbs like Chai and Gegen for ascending and dispersing the exterior. Even if sweating is achieved through dispersal, this is not a Wind-Cold exterior syndrome; the pathogen cannot exit via sweat, nor can the rash emerge. Moreover, since the root is Water deficiency and the disease is Warm-Heat rather than Wind-Cold, sweating that injures Yin is strictly contraindicated. Therefore, one must clear and resolve warm-summer heat pathogens using sweet-cool methods to moisten fluids, allowing Ying and Wei pathogens to exit via the Lung as rash, Yangming pathogens to emerge from the Stomach, and warm-summer heat pathogens to dissolve with the rash.
Fine, rapid, and deep pulses indicate Warm-Heat entering Shaoyin. Drowsiness is a primary Shaoyin symptom; inability to sleep indicates irritability and heat. A coating slightly white and red indicates early Warm-Heat. A Shaoyin tongue being purple and dry indicates heat consuming fluids. This is a Shaoyin Warm-Heat condition with inherent Yin deficiency. Urgently moisten fluids to drive out pathogens. Once Yin fluids are replenished, pathogens exit, and natural sweating occurs; this is not forced sweating via medication.
Additional Commentary: This is a condition of Yin deficiency contracting warm-summer seasonal pathogens. One must rescue fluids and drive out pathogens, distinguishing between Ying and Wei levels. The pathogen resolves via the rash. If Yangming symptoms appear, combine with Yangming treatment methods.
In all Sha and Urticaria cases, unblocking and purging are most suitable. Even if five-colored dysentery occurs, it is not necessarily detrimental. However, obstruction of urination and defecation is the most ominous sign. In such cases, do not tonify the Spleen to stop diarrhea.
Shao's Commentary: Sha arises from external pathogens. Vomiting and diarrhea allow internal pathogens to exit via the gastrointestinal tract, representing a favorable progression. Conversely, obstruction of urination and defecation leads to entrapment and accumulation of toxic pathogens, often resulting in constipation/obstruction, making it an ominous sign. In Sha with vomiting and diarrhea, astringents are strictly forbidden.