名言节录
疹者，痘之末疾也。脾肺二经受病，内应手足太阴，外合肌肉皮毛，犹天地诊戾不正之气，故曰疹也。
然未痘先疹，痘后必复疹，惟痘后而疹者，方为正疹。在苏松曰痧子，浙江曰 子，江右湖广曰麻，山陕曰肤
疮、曰糠疮，名殊而证则一。○初热一日，至次日鸡鸣时，其热即止，惟觉五心微热，咳嗽，流鼻清涕，或腹中
作痛，饮食渐减，到申末酉初，其热复来，如此者四日。手按发际热甚，面热少减，咳嗽连声，腮赤眼泪，嚏
喷频发，或鼻中血出，至第五日，其热不分昼夜。六日早时，疹出颐下，细细红点，至午时，两手背并腰下及
浑身密密俱有。七日普遍掀发，
鼻涕不流，嚏喷不行，至晚，两颐颜色渐淡。此验出疹之要法。○凡疹热起至收完，但看右手一指，脉洪大有
力，虽有别证，亦不为害。此定存亡之要诀。○凡疹发热，六日而出，此常期也。若用药太早，耗伤元气，及
至出时，或嗽止变喘，或出而即隐，或作大泻，或合目而喘，此皆用药太早之过也。治法，必待见疹方可徐徐
升表，然亦有次第。凡药一剂，须分作数次服。盖疹在皮里膜外，若一剂作一次服，药催太急，多致烦躁谵语，
宜慎。○疹热五、六日，势将出矣，病家见医药不效，医家见嗽热不除，或作别证治之，或又更医，此世俗之大
忌，因而误事者不少。○治疹须因时用药∶温暖时月，发以辛凉，防风解毒汤；暄热时月，发以辛寒，黄连解毒
汤；时寒时暖，发以辛平，升麻葛根汤；大寒时月，发以辛温，桂枝解毒汤。○凡疹，多于耳后项上腰腿先
见，其顶尖而不长，其形小而匀净，色以淡红为吉。若色红甚者，兼火化也，化斑汤主之，白虎汤佐之；色白
者，血不足也，治宜养营汤；色紫赤，干燥暗晦者，火毒炽也，滋阴凉血而热自除，所谓养阴退阳之义也，先
用六一散解之，继进四物汤，换生地加柴、芩、干葛、红花、翘、蒡之类，外有大青汤、元参解毒汤皆可选
用；色黑者热毒极矣，为十死一生之候，勿妄施治，不得已，急用大青汤解之，惟宜烧人粪调服，可以转变，
服而不效者不治。○疹出一日忽没者，风寒所迫而然，不急治之，胃烂而死。舌白至唇湿处，是其征也。宜消
毒饮、升麻汤等发之。○疹证多呕吐，不必治呕，但治其疹，而呕自止，况呕中便有发散之义。○初热至五日，
每多腹痛，乃大肠火郁之故。勿认伤食，消导手揉，为害甚重。○疹出之际，不思食者，胃为毒瓦斯所壅故也。
疹尽毒解，即思食矣。不可啖面，惟啜稀粥，宜少而频，俟其气清神爽，身体不热，渐渐加添，庶无他虑。
○凡患麻疹，初起至收，个个好饮凉水，不可禁止，宜少与之，则毒瓦斯渐解。○生生子曰∶麻疹咳嗽喘急，用
痘科大、小无比散，每服五、七分，大者一钱，即
刻喘定而睡，醒后，神安气和而愈，乃热毒从小便出也。○疹初忌泻，亦有始终泄泻不妨者，禀之强弱异也。
疹毒上攻于肺，肺与大肠相表里，外应皮毛，故多咳嗽、泄泻。得之早者，其嗽必减。致变喘逆，嗽实喘虚，
得嗽者出，得喘者入，合目懒倦，其疹时出时没，喉痰胸满，面色变白，疹闭不出，因而告危。○疹出泄泻，
或泻稀水频数者，有吉有凶，要看疹透不透。若遍身稠密红紫者，此乃阳火得泄，吉也。疹一发透，其泻自止。
宜用升麻葛根汤。若疹已收，泻犹未止，验其体热，疹必未透，前药加翘、蒡、黄连、木通，以分利之。若疹
色淡，体不热，口不渴，大小便利，饮食少进，此为凶象，乃虚寒之证，治当温补，或兼收涩。若火毒未净，
喘而泄泻溺涩者，柴芩汤。烦渴作泻者，白虎汤、猪苓汤。疹家不忌泻，泻则阳明之邪热得解，是亦表里分
消之义。○疹出二、三日，两鼻俱干，收完时，毒瓦斯轻者，清涕即来，就思饮食，不必服药。若清涕来迟，不
思食者，仍须清肺解毒。○疹后多嗽，余毒假嗽而散，旬日之内，尚宜有嗽，不可见嗽多而治嗽。○疹后阴血
因受煎熬，故多虚耗，以致身热不已，午后尤甚者，治当滋阴清火，养阴退阳。○疹后余毒入胃，久而不散，
以致牙龈黑烂而成走马牙疳，沿及两颊浮肿，鼻生红点，穿颊破腮，缺唇堕鼻，声哑，不食，而为崩砂狐惑败
坏之证。○疹后烦热呕吐者，毒留肺胃也，化斑汤、解毒汤。壮热干咳，便秘烦渴者，疹邪不解也，三黄丸利
之，或凉膈散、金花丸。虚烦者，竹叶石膏汤去半夏加花粉。热虽退，渴咳不止者，生脉散加甘、桔、二母、
花粉。○疹后自利者，积热移于大肠也，四苓散加木通、芩、连、白芍，或益元散。利下鲜血者，白头翁汤。
此由热邪内陷故也，大忌止涩。○疹后喘嗽痰血者，毒留肺胃也，治用芩、连、山栀、元参、知母、花粉、人
中黄。○疹后潮热干咳，便溏食减者，中气虚也，宜补之，六君汤。微微咳嗽者，余毒未净也，清肺饮、消毒
饮。疹后咳嗽，但清余热，消痰壅，自
愈，如贝母、甘、桔、麦冬、花粉、薄荷、元参之属，勿用收敛。○疹后发热烦躁，闷瞀惊悸者，阴血衰耗，
毒乘心肝也，宜养血安神，四物汤去川芎加麦冬、枣仁、竹叶、灯心、甘草、菖蒲、茯神、黄连、辰砂。亦有
不应药而成疳瘵者。○疹后声哑不出，喘渴身热不退，久不愈者，此热毒未尽，肺金受克故也，清金降火汤、
甘桔牛蒡汤，加知母、元参、竹叶、花粉、麦冬、杏仁。○孕妇出疹，以安胎清热为主，四物汤加味主治，或用
黄芩一味，既能安胎，又能解毒。○热毒蒸胎，胎多受伤，而母常无恙者，何也？盖疹与痘不同，痘宜内实，
故胎落而母亡；疹宜内虚，故胎下而母安。然孰若子母两全之为愈也。（《仁端录》）
按万氏谓医用药太早，恐耗元气，故必待见点而后施治。及作一次服，恐药催之太急，此固其心得之法也。
然以愚见，则医有高下，药有宜否，但使见有确真，发无不当。则于未出之前，或解或补，必有得预防之力，
以潜消其毒者；既出之后，亦必有善调之方，而不致催急者。此在善与不善，不嫌早与不早也。○按万氏治疹
诸条，皆极详妥，其中惟泻、喘二证，则最多疑似。盖二证之由疹毒，固当如其治矣，然有不因疹毒，或以脾
气本弱而过用寒药，或以误食生冷，致伤脾胃而为泄泻者。虽曰由疹而发，然实非疹毒之病，但察其别无热证
热脉，而兼色白气馁者，便须速救脾气，若执谓疹毒，则无不危矣。又如气喘一证，大有虚实，盖十喘九虚，
若察其本非火证，又非外邪，或以大泻，或以大汗而致喘者，必皆气脱之候。凡此二者，不可不加细察。○
按万氏治疹发表之法，极尽随时制宜之善，然发表之义，亦最不易，如营卫不足，而疹有不能出者，其证甚多，
若徒知发之，而不知滋之，非惟不能发，且恐穷其源矣。如伤寒三表之法，实亦有关于此。（张景岳）
疹虽胎毒，多带时行气候，暄热传染而成。其发与痘相类，其变比痘匪轻。先起于阳，后归于阴，毒盛于
脾，热流于心，脏
腑之伤，肺则尤甚，始终之变，肾则无证。初则发热，有类伤寒，眼胞困倦而难起，鼻流清涕而不干，咳嗽少
食，烦渴难安，斜目视之，隐隐皮肤之下，轻手摸之，磊磊肌肉之间，其形若疥，其色若丹。出见三日，渐没
为安，随出随没，喘急须防。根窠若肿兮，疹而兼瘾。皮肤如赤兮，疹尤夹斑。似锦而明，不药可愈，如煤
而黑，百无一安。疮疹既出，调理甚难。坐卧欲暖，饮食宜淡。咳唾涎沫，不禁酸咸。忽生喘急，肺受风寒。
心脾火灼，口舌生疮。肺胃蕴热，津液常干。有此变证，治法不同。微汗毒解，热势少凶，二便清调，气行无
壅。腠理拂郁兮，即当发散。肠胃秘结兮，急与疏通。鼻衄勿忧，邪从衄解。自利勿止，毒以利松。麻后多痢
兮，热毒移于大肠，咳嗽喉痛兮，痰气滞于心胸。口渴心烦，法在生津养血。饮食减少，治宜调胃和中。余证
无常，临期变通。○疹与痘疮，始似终殊，原同证异。痘疮发于五脏，麻疹出于六腑，先动阳分，而后归于阴
经，故标属阴，而本属阳。其热也，气与血搏，故血多虚耗。其治也，先发散行气，而后滋阴补血。凡动气燥
悍之药，皆不可用。○发热之初，憎寒壮热，鼻流清涕，身体疼痛，呕吐泄泻，咳嗽气急，腮红眼赤，审是麻
候，宜服升麻葛根汤表之。得汗则皮肤通畅，腠理开豁，而疹易出矣。○发热咳嗽之时，既明麻疹，其有出不快
者，宜用麻黄汤、羌活汤、消毒饮，发散解毒；外以芫荽酒糟蒸热擦之，自头至足为齐，头面愈多为佳。○麻
疹出后，见风没早，未清爽者，宜消毒饮加发散药，虽不复出，亦寻愈。○疹出三日不没者，乃内有实热，宜
四物汤加清利之药，则热自解而疹自消。○或热或退，五、六日而后出者轻；淡红滋润，头面匀净者轻；发透
三日而渐没者轻。头面不出者重；红紫暗燥者重；咽喉肿痛不食者重；冒风没早者重；移热大肠变痢者重。黑
暗干枯，一出即没者不治；鼻扇口张，目无神者不治；鼻青粪黑者不治；气喘心前吸者不治；麻后牙疳臭烂者
不治。（翁仲仁）
疹喜清凉，痘喜温暖，人皆知之。然疹初出亦须和暖则易出，只要发出得尽，则其毒便解。大抵疹出之际，
虽寒勿用桂枝；虽虚勿用参、术，虽呕而有痰勿用半夏、南星。（史演山）
麻痘形证大略相似，治者每严于痘而略于麻，不知痘之境宽，虽见险恶，犹可从容图治；麻之境促，变生
顷刻，多不及救，故不可不预防也。预防之法，在病家，坐卧欲暖，饮食宜淡，二语尽之；在医家，慎发表，
三字尽之。所谓慎发表者，其一体实之儿，火毒盛甚，发之太过，热壅于上，多有气粗喘闭者。医家见其喘闭，
复以表药继之，热不能降，焚灼而死。抑思古方升麻葛根汤之用白芍，所以和阴也；麻黄石膏汤，发中有降也。
其一体虚之儿，出每迟滞，小经发散，元气已浮，医者谓出未透，更重发之，麻虽出而阳气尽拔，无阴以摄，
致喘脱者多矣。予用地黄汤，加人参纳气归元，曾救一、二。故凡见体弱之儿，颅开面白，目无神，或疟痢病
后，出得迟缓，即当照顾元气，不可过行发表。○或问∶痘出于脏，麻出于腑。胃，腑也，何以痘多胃热发斑
之证？肺，脏也，何以麻多肺闭喘促之证？予曰∶痘出于脏而赴于胃，是由脏而之腑，胃主肌肉故也。麻出于
腑，而甚于肺，是由腑而之脏，肺主皮毛故也。然则痘之出，五脏之毒，而胃总受之。麻之出，六腑之毒，而
肺总受之。所谓先起于阳者，出于六腑也；后归于阴者，肺受之也。○麻疹之出，不离肺胃两家，喘闭者肺证
也，烦渴者胃证也。冬月喘闭，麻黄、杏仁为救急之药，治之速，麻出喘定而解。若夏令出麻，麻黄与时不合，
庸工不识，一见喘闭，执而用之，每多随药而死。盖麻多火证，火甚克金，夏令金亏，天人皆病，麻黄万不能
受。冬月之喘闭，有面青唇黯肢冷者，故可用麻黄。夏月肺气已亏，表气已开，断无寒证。间有肢冷者，是阳
气亏不能四达也，只可荆、防、甘、桔，从轻用药。气亏甚者，可加人参；火甚者，升麻石膏汤。喘定者可治。
○胃热烦渴者必多汗，此纯是里热，即荆、防、葛根亦不
可轻使，升麻石膏汤，乃对证之药，合之甘、桔，则肺胃两家之热解矣。喘闭证在一、二朝见，汗渴证在五、
六朝见。肺不容邪，其变也速。胃能容受，其变也迟。○麻之出必先咳嗽，不嗽而出非麻也。出而喷嚏者吉，
肺气通也。○盛夏之令，火旺金伤，保肺为上，轻轻一散，即宜保肺，石膏、梨汁二味最妙。○石膏一味，为
麻证之至宝。色白属金，味甘微辛，升中有降，降中有升，虽为清胃之药，实保肺之灵丹也。○刑金之火，由胃
而来，石膏本清胃之药，而清肺者是与之去路也。○夏月无麻黄证，其有不出者，是正气为热所伤，不能升举，
疏托中宜兼益气，是予得心之处。○其有富贵之家，麻毒本甚，更加郁遏太过，火甚金伤，致生喘促者，《经》
谓壮火食气是也。急宜泻火保肺，不得再行表散。○亦有贫寒之子，破屋当风，衣不蔽膝，麻毒正出，外受
寒邪，忽生喘促者，急宜温散，使表气宣通，麻毒得解，否则麻闭，顷成不救。○前二证，一经帮助，不难分
辨。复有火毒本甚，外感寒邪，外虽寒而中实热，又宜表里双解，古人有麻黄石膏汤，予仿其法，全活甚多。
又有火毒本甚，父母只知郁遏，医家只知表散，内外交炽，火极似水，反生厥逆之象者，书谓热深厥亦深是
也，宜白虎汤加黄连。若作寒治，殆矣。○治麻有三法∶一升散，一降火，一养阴。善用者，升散之中，即寓
清凉之意；养阴之剂，不离生发之机。○麻点隐隐未透，发热咳嗽，有涕泪，宜升散；两颊不透，宜升散；发热
肢冷，面不赤，唇不燥，宜升散；喘促鼻扇，辨得是表邪，宜升散；泄泻日五、六行，宜升散。○麻疹已出，
Quotations from Famous Sayings
Rash (Zhen) is a minor disease following smallpox. The pathology lies in the Spleen and Lung meridians, internally corresponding to the Hand-Taiyin Lung meridian and Foot-Taiyin Spleen meridian, and externally relating to muscles and skin/hair. It is akin to the aberrant and unhealthy qi of heaven and earth, hence it is called "Zhen".
However, if rash appears before smallpox, or inevitably reappears after smallpox, only the rash that appears strictly after smallpox is considered the "True Rash" (Zheng Zhen). In Suzhou and Songjiang regions, it is called "Sha Zi"; in Zhejiang, "Zhen Zi"; in Jiangxi and Huguang regions, "Ma"; in Shanxi and Shaanxi regions, "Fu Chuang" or "Kang Chuang". Although names differ, the clinical manifestations are identical.
○ During the initial fever stage on day one, by the time of Ji Ming (cockcrow), the fever subsides, leaving only slight heat in the five centers (palms, soles, and chest), accompanied by coughing, clear nasal discharge, abdominal pain, and reduced appetite. By the end of Shen hour and beginning of You hour (3:00 PM - 5:00 PM), the fever returns. This pattern persists for four days. Palpation of the hairline reveals significant heat, while facial heat is slightly reduced. There is continuous coughing, redness of the cheeks, tearing, frequent sneezing, and possibly epistaxis. On the fifth day, the fever persists day and night. On the sixth morning, rashes appear below the jaw as fine red dots; by noon, they cover the backs of both hands, below the waist, and densely over the entire body. On the seventh day, the eruption becomes widespread. Nasal discharge ceases, sneezing stops, and by evening, the color of the cheeks gradually fades. This is a key method for verifying the emergence of rash.
○ Regarding any rash from onset to resolution, if the pulse at the first finger position of the right hand is surging (Hong) and forceful, other symptoms will not cause harm. This is the crucial secret for determining survival.
○ Typically, rash fever lasts six days before eruption. If medication is administered too early, it depletes Yuan Qi (Primordial Qi). When the rash finally erupts, complications may arise such as cessation of cough leading to wheezing, immediate disappearance of the rash, severe diarrhea, or closed-eye wheezing. These are all errors caused by premature treatment. The therapeutic principle is to wait until rash spots are visible before gently promoting exterior release. However, this must be done with proper sequence. A single dose of herbal decoction should be divided into several administrations. Since the rash resides between the skin and the fascia, administering a full dose at once accelerates the drug action too rapidly, often causing restlessness and delirium. Caution is required.
○ When rash fever reaches five or six days and is about to erupt, if families see no effect from medicine, or doctors see persistent cough and fever, they may treat it as a different condition or change physicians. This is a common secular taboo that leads to many medical errors.
○ Treatment of rash must adapt to seasonal conditions: In warm months, use acrid-cool methods to vent, such as Fangfeng Jiedu Tang (Saposhnikovia Decoction for Resolving Toxicity); in hot months, use acrid-cold methods, such as Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity); in fluctuating cold/warm weather, use acrid-neutral methods, such as Shengma Gegen Tang (Cimicifuga and Pueraria Decoction); in severe cold months, use acrid-warm methods, such as Guizhi Jiedu Tang (Cinnamon Twig Decoction for Resolving Toxicity).
○ Rashes typically first appear behind the ears, on the neck, waist, and legs. The papules are pointed but not elongated, small, and uniform. A pale red color is auspicious. Intense redness indicates Fire transformation; treat primarily with Huaban Tang (Spot-Resolving Decoction) assisted by Baihu Tang (White Tiger Decoction). White color indicates Blood deficiency; treat with Yangying Tang (Nourishing Camp Decoction). Purple-red, dry, and dull colors indicate intense Fire-Toxin; nourish Yin and cool Blood to resolve heat, embodying the principle of "Nourishing Yin to Retreat Yang". First use Liuyi San (Six-to-One Powder) to resolve, then advance Siwu Tang (Four Substances Decoction), substituting Sheng Dihuang (Rehmanniae Radix) and adding Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Ge Gen (Puerariae Radix), Honghua (Carthami Flos), Lianqiao (Forsythiae Fructus), and Niubangzi (Arctii Fructus). External options include Daqing Tang (Isatidis Decoction) or Yuanshen Jiedu Tang (Scrophulariae Decoction for Resolving Toxicity). Black color indicates extreme Heat-Toxin, a sign of ten deaths to one survival. Do not treat recklessly. If necessary, urgently use Daqing Tang, preferably mixed with burnt human feces powder to transform the condition. If ineffective, it is untreatable.
○ If rash disappears suddenly one day after eruption, it is forced inward by Wind-Cold. Without urgent treatment, gastric rot and death will occur. A white tongue coating extending to the moist part of the lips is a sign. Use Xiaodu Yin (Detoxifying Drink) or Shengma Tang to vent.
○ Rash cases often involve vomiting. There is no need to specifically treat vomiting; treating the rash will stop it naturally, as vomiting itself contains a dispersing function.
○ Abdominal pain from initial fever to day five is due to Liver/Gallbladder or Intestinal Fire stagnation. Do not mistake it for food stagnation and use digestive rubs, which causes great harm.
○ Loss of appetite during eruption is due to Toxin-Qi obstructing the Stomach. Appetite returns when the rash resolves and toxins clear. Avoid wheat products; consume thin rice gruel in small, frequent amounts. Gradually increase food intake only when spirit is clear, body is cool, and there are no other concerns.
○ Patients with measles invariably desire cold water from onset to resolution. Do not forbid this; give it in small amounts to gradually resolve toxins.
○ Shengshengzi states: For measles with cough and acute wheezing, use Dabi Wu San or Xiao Bi Wu San from Smallpox protocols. Adults take 1 qian; children take 5-7 fen. Wheezing stops immediately, sleep ensues, and recovery follows as Heat-Toxin exits via urination.
○ Diarrhea is contraindicated in early rash stages. However, persistent diarrhea may be acceptable depending on constitutional strength. Rash toxin attacks the Lung; since Lung and Large Intestine are interior-exterior paired, and Lung manifests in skin/hair, cough and diarrhea are common. Early onset reduces cough. Transformation into wheezing involves excess cough and deficiency wheezing. Cough allows eruption; wheezing indicates inward collapse. Symptoms like closed eyes, lethargy, intermittent rash, throat phlegm, chest fullness, and pale face indicate critical closure of rash.
○ Diarrhea accompanying rash can be auspicious or ominous depending on transparency. Dense, red-purple rash indicates venting of Yang-Fire (auspicious); diarrhea stops upon full eruption. Use Shengma Gegen Tang. If rash has resolved but diarrhea persists, check for residual heat indicating incomplete eruption. Add Lianqiao, Niubangzi, Huanglian, and Mutong to previous formulas to drain dampness. Pale rash, no fever, no thirst, normal urination/defecation, and poor appetite indicate ominous deficiency-cold; treat with warming tonification or astringents. If Fire-Toxin remains with wheezing, diarrhea, and dysuria, use Chaiqin Tang. For irritability, thirst, and diarrhea, use Baihu Tang or Zhuling Tang. Measles patients do not fear diarrhea; it resolves Yangming Heat, embodying the principle of resolving exterior and interior simultaneously.
○ Dry nostrils on days two-three of eruption: If clear rhinorrhea returns late with loss of appetite, clear Lung and resolve toxicity. If it returns promptly with restored appetite, no medication is needed.
○ Post-rash cough is common; residual toxins disperse through cough. Cough within ten days is normal; do not treat excessive cough aggressively.
○ Post-rash Yin-Blood depletion causes lingering fever, worse in the afternoon. Treat by nourishing Yin and clearing Fire ("Nourishing Yin to Retreat Yang").
→ Residual toxin entering the Stomach causes gangrenous stomatitis (Zouma Yagan), cheek swelling, nasal red spots, cheek perforation, lip/nose loss, hoarseness, and anorexia, leading to severe degeneration.
○ Post-rash irritability, fever, and vomiting indicate toxin remaining in Lung/Stomach; use Huaban Tang or Jiedu Tang. High fever, dry cough, constipation, and irritability indicate unresolved rash pathogen; use Sanhuang Wan, Liangge San, or Jinhua Wan. For deficiency irritability, use Zhuye Shigao Tang removing Banxia and adding Tianhuafen. If fever subsides but thirst/cough persist, use Shengmai San plus Gancao, Jiegeng, Zhimu, Bei Mu, and Tianhuafen.
○ Post-rash spontaneous diarrhea indicates accumulated heat moving to Large Intestine; use Siling San plus Mutong, Huangqin, Huanglian, Baishao, or YiYuan San. Bloody stool requires Baitouweng Tang due to heat sinking inward; astringents are strictly forbidden.
○ Post-rash wheezing, cough, and blood-streaked sputum indicate toxin in Lung/Stomach; treat with Huangqin, Huanglian, Zhizi, Yuanshen, Zhimu, Tianhuafen, and Renzhonghuang.
○ Post-rash tidal fever, dry cough, loose stools, and reduced appetite indicate Middle Qi deficiency; tonify with Liu Jun Zi Tang. Mild cough indicates residual toxin; use Qingfei Yin or Xiaodu Yin. Post-rash cough resolves by clearing residual heat and resolving phlegm congestion using Beimu, Gancao, Jiegeng, Maidong, Tianhuafen, Bohe, and Yuanshen; avoid astringents.
○ Post-rash fever, irritability, mental cloudiness, and palpitations indicate Yin-Blood depletion with toxin attacking Heart/Liver; nourish Blood and calm Spirit using Siwu Tang removing Chuanxiong, adding Maidong, Suanzaoren, Zhuye, Dengxin Cao, Gancao, Shichangpu, Fushen, Huanglian, and ChenSha. Some cases develop into consumption (Gan Zhai).
○ Hoarseness, wheezing, thirst, and persistent fever post-rash indicate incomplete Heat-Toxin and suppression of Metal by Fire; use Qingjin Jianghuo Tang or Ganjie Niubang Tang plus Zhimu, Yuanshen, Zhuye, Tianhuafen, Maidong, and Xingren.
○ Pregnant women with rash require fetal calming and heat clearing; use modified Siwu Tang or solely Huangqin, which calms the fetus and resolves toxicity.
○ Heat-toxin damaging the fetus while sparing the mother occurs because rash favors internal emptiness (unlike smallpox which favors internal fullness). Thus, fetal expulsion spares the mother, but maternal-fetal unity is superior. (From *Ren Duan Lu*)
Commentary: Wan Shi argues against early medication to preserve Yuan Qi, waiting for visible spots. He also advises dividing doses to prevent overly rapid drug action. This is his empirical insight.
However, I believe treatment depends on the physician's skill and appropriateness of herbs. Accurate diagnosis allows for preventive measures (resolving or tonifying) before eruption to subdue toxins, and proper regulation after eruption without forcing. Skill matters more than timing.
Wan Shi’s guidelines are detailed, except for diarrhea and wheezing, which are easily confused. Diarrhea may stem from weak Spleen Qi exacerbated by cold herbs or raw food, not just rash toxin. If no heat signs/pulse exist, and pallor/weakness are present, save the Spleen Qi immediately; misdiagnosing as rash toxin is dangerous.
Wheezing has excess and deficiency types; mostly deficiency. If not Fire or external pathogen, but caused by severe diarrhea/sweating, it indicates Qi collapse. Careful differentiation is essential.
Wan Shi’s venting methods are excellent, but venting is difficult. If Ying-Wei is deficient, rash won't emerge despite venting; nourishment is needed to avoid exhausting the source. This relates to the three exterior-resolving methods in Cold Damage. (Zhang Jingyue)
Measles, though congenital toxin, spreads via epidemic climate and warmth. It resembles smallpox but changes are more severe. It starts in Yang, ends in Yin; toxin盛 in Spleen, heat flows to Heart. Lung injury is most severe; Kidney shows no symptoms. Initial fever resembles Cold Damage: heavy eyelids, clear runny nose, cough, poor appetite, irritability/thirst. Rash appears faintly under skin, palpable in muscles, resembling scabies, colored like cinnabar. Visible for three days, then fading is safe. Rapid appearance/disappearance warns of wheezing. Swollen bases indicate rash with urticaria. Red skin indicates rash with macules. Bright/rich color heals without meds; black/coal-like color is fatal. Post-eruption care is hard: keep warm, eat bland, avoid sour/spicy, manage phlegm. Wheezing indicates Wind-Cold in Lung; mouth ulcers indicate Heart/Spleen Fire; dry fluids indicate Lung/Stomach heat. Treatments vary: mild sweat resolves toxin; regulate bowels/bladder; vent if pores are blocked; unblock intestines if constipated; epistaxis releases evil; diarrhea loosens toxin. Post-measles dysentery moves heat to Large Intestine; cough/sore throat traps phlegm in Chest. Thirst/irritability needs fluid/Blood generation; poor appetite needs Stomach harmonization. Adapt to changing conditions.
Smallpox and measles start similarly but end differently; origins are same, presentations differ. Smallpox originates in Five Zang; measles in Six Fu. Starts in Yang, returns to Yin; marked by Yin, rooted in Yang. Heat involves Qi-Blood struggle, depleting Blood. Treatment: vent/move Qi first, then nourish Yin/Blood. Avoid harsh/drying drugs.
Initial fever with chills, high heat, runny nose, body ache, vomiting/diarrhea, cough/wheezing, red cheeks/eyes: confirm measles, use Shengma Gegen Tang to vent. Sweating opens pores, facilitating eruption.
During fever/cough, if eruption is slow, use Mahuang Tang, Qianghuo Tang, or Xiaodu Yin to vent/resolve toxicity. Externally, rub with warm radish wine from head to toe; more on face/head is better.
If rash disappears early due to wind exposure, use Xiaodu Yin plus venting herbs; it will recover even if it doesn't reappear.
Rash persisting three days indicates internal excess heat; use Siwu Tang plus draining/clearing herbs to resolve heat/rash.
Mild cases: fever breaks, eruption delayed 5-6 days; pale red/moist; uniform face; fades after 3 days. Severe cases: absent on face; dark purple/dry; sore throat/anorexia; wind-induced early disappearance; heat moving to intestine causing dysentery. Untreatable: black/dry/immediate disappearance; flaring nostrils/open mouth/dull eyes; blue nose/black stool; heart-prefecture wheezing; gangrenous teeth post-rash. (Weng Zhongren)
Measles prefers coolness; smallpox prefers warmth. However, early measles needs mild warmth to erupt fully, resolving toxin. Avoid Guizhi even in cold; avoid Renshen/Atractylodes even in deficiency; avoid Banxia/Arisaema even with vomiting/phlegm. (Shi Yanshan)
Measles and smallpox look similar, but doctors treat smallpox strictly and measles loosely. Smallpox has a wider scope, allowing time for treatment; measles changes instantly, requiring prevention. Prevention for families: keep warm, eat bland. For doctors: cautiously vent exterior.
Caution in venting:
1. Strong constitution with intense Fire-Toxin: Over-venting causes upper heat congestion and wheezing. Doctors mistakenly add more venting herbs, leading to death by burning. Note: Shengma Gegen Tang uses Baishao to harmonize Yin; Mahuang Shigao Tang vents while descending.
2. Weak constitution: Delayed eruption. Slight venting floats Yuan Qi. Doctors, seeing incomplete eruption, vent heavily, pulling out Yang Qi without Yin to anchor, causing wheezing/collapse. I used Dihuang Tang plus Renshen to gather Qi, saving some. For weak children (open fontanelle, pale face, dull eyes, post-malaria/dysentery), protect Yuan Qi; do not over-vent.
Q&A: Why does smallpox (from Zang) show Stomach heat/macules? Why does measles (from Fu) show Lung closure/wheezing?
A: Smallpox moves from Zang to Stomach (Fu); Stomach governs muscle. Measles moves from Fu to Lung (Zang); Lung governs skin/hair. Smallpox toxin gathers in Stomach; Measles toxin gathers in Lung. "Starting in Yang" means exiting Six Fu; "Returning to Yin" means affecting Lung.
Measles involves Lung/Stomach. Wheezing is Lung syndrome; thirst is Stomach syndrome.
Winter wheezing: Mahuang/Xingren are emergency drugs; quick treatment resolves wheezing upon eruption.
Summer measles: Mahuang is inappropriate. Unskilled doctors use it for wheezing, causing death. Summer implies Metal deficiency; Heaven/Human both suffer. Winter wheezing may have cold signs (blue lips/cold limbs), allowing Mahuang. Summer Lung Qi is deficient, exterior open; no cold syndrome exists. Cold limbs indicate Yang deficiency failing to reach extremities. Use Jingjie, Fangfeng, Gancao, Jiegeng lightly. Add Renshen for Qi deficiency; use Shengma Shigao Tang for Fire. Wheezing resolution indicates treatability.
Stomach heat/thirst/sweating is pure interior heat; avoid Jingjie/Fangfeng/Gegen. Shengma Shigao Tang plus Gancao/Jiegeng clears Lung/Stomach heat. Wheezing appears days 1-2; sweating/thirst days 5-6. Lung rejects pathogens quickly; Stomach tolerates slowly.
Measles must start with cough; no cough, no measles. Sneezing upon eruption is auspicious (Lung Qi open).
Midsummer: Fire strong, Metal injured. Protect Lung. Light venting followed by Lung protection. Shigao and Pear Juice are best.
Shigao is the treasure for measles. White/Metal nature, sweet/acrid taste, ascending/descending properties. Clears Stomach but truly protects Lung.
Fire injuring Metal comes from Stomach; Shigao clears Stomach and provides an exit for Lung clearing.
Summer: No Mahuang indications. If rash doesn't emerge, Righteous Qi is damaged by heat, unable to ascend. Tonify Qi during dispersal/support.
Wealthy families: Intense toxin + suppression = Fire injuring Metal = wheezing. "Strong Fire consumes Qi." Urgently clear Fire, protect Lung; no more venting.
Poor families: Cold exposure during eruption = sudden wheezing. Urgently warm/vent to open exterior and resolve toxin; otherwise, closure leads to death.
Differentiation:
1. Fire-Toxin + External Cold (Internal Heat): Use Ma Huang Shi Gao Tang (Table-Interior Dual Resolution).
2. Extreme Fire-Toxin + Suppression + Venting = Internal/External blazing = Heat deep/Cold extremities (Re Shen Jue Shen). Use Baihu Tang plus Huanglian. Do not treat as cold.
Three methods for measles: 1. Ascend/Vent; 2. Descend/Clear Fire; 3. Nourish Yin. Skilled use: Venting contains cooling; Nourishing Yin contains generating mechanisms.
Indications for Venting:
- Faint rash, fever/cough, tears/runny nose.
- Cheeks not transparent.
- Fever/cold limbs, non-red face, non-dry lips.
- Wheezing/flaring nostrils (confirmed as exterior pathogen).
- Diarrhea 5-6 times/day.
Measles erupted,