疹发最怕毒火盛，热昏心神谵妄生，末出三黄石膏治，已出黄连解毒灵。
[注]
谵妄一证，乃毒火太盛，热昏心神而然也，
疹未出而谵妄者，三黄石膏汤主之，
疹已出而谵妄者，黄连解毒汤主之。
(三黄石膏汤)方见麻疹见形证治 。
(黄连解毒汤)方见痘门结痂落痂证治。
%
疹初无汗作喘急，宣发麻杏石甘宜，毒热内攻全受克，保肺清气化毒医。
[注]
喘为恶候，麻疹尤怠之，
如初出未透，无汗喘急者，此表实拂郁其毒也，宜用麻杏石甘汤发之，
疹已出，胸满喘急，此毒气内攻，肺金受克，宜用清气化毒饮清之，
若迟延失治，以致肺叶焦举，则难救矣。
(麻杏石甘汤) 石膏煆 麻黄蜜炒 杏仁去皮尖炒 生甘草 引用生姜水煎服。
(方歌)
喘用麻杏石甘汤，石膏火煆合麻黄，杏仁去尖须微炒，甘草相配引生姜。
(清毒化毒饮) 前胡 桔梗 栝篓仁 连翘去心 桑皮炙 杏仁去皮尖炒
黄芩 黄连 元参 生甘草 麦冬去心 引用芦根水煎服。
(方歌)
毒热内攻肺喘满，清气化毒饮最灵，前桔栝篓翘桑杏，芩连元参草麦冬。
%
疹初咳嗽风邪郁，加味升麻葛根良，毒热熏蒸金受制，清金宁嗽自堪尝。
[注]
麻疹发自脾肺，故多咳嗽，
若欬嗽太甚者，当分初没治之，
初起欬嗽，此为风邪所郁，以升麻葛根汤，
加前胡，桔梗，苏叶，杏仁，治之，
已出欬嗽，乃肺为火灼，以清金宁嗽汤主之。
(升麻葛根汤) 方见痘门发热证治。
(清金宁嗽汤) 橘红 前胡 生甘草 杏仁去皮尖炒 桑皮蜜炙 川连
栝蒌仁 桔梗 浙贝母去心 引用生姜红枣水煎服。
(方歌)
嗽用清金宁嗽汤，橘红前草杏仁桑，川连栝篓桔贝母，引用红枣共生姜。
%
The emergence of rash is most feared when the toxic fire is excessive, leading to heat confusing the heart-mind and causing delirium (mental confusion with incoherent speech). If the rash has not yet erupted, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) should be used for treatment; if the rash has already erupted, Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) should be used.
[Note]
Delirium is a syndrome caused by excessive toxic fire, where heat confounds the heart-mind.
For delirium occurring before the rash erupts, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) is the primary formula.
For delirium occurring after the rash has erupted, Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) is the primary formula.
(Sanhuang Shigao Tang [Three-Yellow Gypsum Decoction]) See the section on "Treatment of Rash Manifestation" for the formula.
(Huanglian Jiedu Tang [Coptis Decoction for Resolving Toxicity]) See the section on "Scab Formation and Falling in Smallpox Section" for the formula.
%
When the rash first appears without sweat accompanied by wheezing and urgency, Xuanfa Mahuang Xinggan Shigan Yi (the appropriate use of MaXingShiGan Decoction to diffuse and vent) is suitable. If toxic heat attacks internally and completely overcomes Lung Qi, one must use methods to protect the Lung and clear Qi to resolve toxicity.
[Note]
Wheezing is an ominous sign, particularly concerning in measles.
If the rash has just begun to appear but has not fully penetrated, presenting with no sweat and urgent wheezing, this indicates exterior excess and constraint causing toxin accumulation; it is appropriate to use Mahuang Xinggan Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) to diffuse and vent.
If the rash has already erupted, presenting with chest fullness and urgent wheezing, this indicates internal attack by toxic qi, where Metal (Lung) is overcome; it is appropriate to use Qingqi Huadu Yin (Clear Qi and Transform Toxin Decoction) to clear.
If treatment is delayed, leading to the lungs becoming dry and withered (pulmonary yin exhaustion), rescue will be difficult.
(Mahuang Xinggan Shigan Tang [Ephedra, Apricot Seed, Gypsum, and Licorice Decoction]): ShiGao (Gypsum Fibrosum) calcined, MaHuang (Ephedrae Herba) honey-fried, XingRen (Armeniacae Semen Amarum) peeled and core removed, stir-fried; Sheng GanCao (Raw Radix Glycyrrhizae); decoct with fresh Ginger water as a guide.
(Formula Song)
For wheezing, use Mahuang Xinggan Shigan Tang; Calcined Gypsum combined with Ephedra,
Apricot seeds peeled and lightly fried, Licorice paired with Ginger as a guide.
(Qingqi Huadu Yin [Clear Qi and Transform Toxin Decoction]): QianHu (Peucedani Radix), JieGeng (Platycodonis Radix), GuaLouRen (Trichosanthis Semen), LianQiao (Forsythiae Fructus) core removed, SangBaiPi (Mori Cortex) stir-baked, XingRen (Armeniacae Semen Amarum) peeled and core removed, stir-fried, HuangQin (Scutellariae Radix), HuangLian (Coptidis Rhizoma), YuanShen (Scrophulariae Radix), Sheng GanCao (Raw Radix Glycyrrhizae), MaiDong (Ophiopogonis Radix) core removed; decoct with Reed Rhizome water as a guide.
(Formula Song)
Toxic heat attacking internally causes lung wheezing and fullness, Qingqi Huadu Yin is most effective,
QianHu, JieGeng, GuaLou, LianQiao, SangBaiPi, XingRen, HuangQin, HuangLian, YuanShen, GanCao, MaiDong.
%
Cough at the initial stage of rash is often due to wind-pathogen constraint; Jiawei Shengma Gegen Tang (Modified Bupleurum and Kudzu Root Decoction) is excellent. If toxic heat steams and constrains Metal (Lung), Qingjin Ningsou Tang (Clear Metal and Calm Cough Decoction) is naturally worth trying.
[Note]
Measles originates from the Spleen and Lung, so cough is common.
If the cough is excessively severe, treatment should be differentiated based on the early or late stage.
Initial cough is due to constraint by wind-pathogen; treat with Shengma Gegen Tang (Bupleurum and Kudzu Root Decoction),
adding QianHu (Peucedani Radix), JieGeng (Platycodonis Radix), SuYe (Perillae Folium), and XingRen (Armeniacae Semen Amarum).
Cough after eruption is due to Lung being scorched by fire; treat primarily with Qingjin Ningsou Tang (Clear Metal and Calm Cough Decoction).
(Shengma Gegen Tang [Bupleurum and Kudzu Root Decoction]) See the section on "Fever in Smallpox Section" for the formula.
(Qingjin Ningsou Tang [Clear Metal and Calm Cough Decoction]): JuHong (Citri Reticulatae Pericarpium Viride), QianHu (Peucedani Radix), Sheng GanCao (Raw Radix Glycyrrhizae), XingRen (Armeniacae Semen Amarum) peeled and core removed, stir-fried, SangBaiPi (Mori Cortex) honey-baked, Chuan Lian (Coptidis Rhizoma), GuaLouRen (Trichosanthis Semen), JieGeng (Platycodonis Radix), Zhe BeiMu (Fritillariae Thunbergii Bulbus) core removed; decoct with fresh Ginger and Red Date water as a guide.
(Formula Song)
For cough, use Qingjin Ningsou Tang; JuHong, QianHu, GanCao, XingRen, SangBaiPi,
Chuan Lian, GuaLou, JieGeng, Zhe BeiMu, decoct with Red Dates and Ginger together.