痧疹有外袭寒邪。内蕴伏热者。宜两解肺卫之邪。麻杏石甘汤加桔梗薄荷射干牛蒡主之。
蛰庐注。肺有热邪欲发疹。外受风寒。郁于肌表。疹不透达。肺火内燔。最易闭闷发喘。而成危证。用麻杏石甘
开肺。清热加味散表透疹。
风温客于太阴手经。咳嗽咽痛喉哑。兼发疹。治宜辛凉清润。大忌升葛荆防等。当以羚角连翘薄荷大力元参射
干杏仁桔梗象贝银花芦根之类。继以沙参石斛麦冬花粉知母梨浆之属。养肺胃阴。
蛰庐注。火燥伤金若内挟湿火上蒸咽喉作腐者。是烂喉痧证。亦宜辛凉清透。忌辛温升散。亦不宜寒凉苦
降郁遏其邪。
阳明血热。疹色如丹。舌绛如朱。环口燥烈。大渴引饮。脉洪数。宜犀角连翘鲜生地丹皮赤芍元参花粉银花人中
黄等。继以大小甘露出入。以救肺胃。
痧邪余热郁肺。痰多气急咳嗽。宜宣之开之。如栀豉桑杏桔梗枯芩薄荷象贝蒌皮通草芦根之属。
如痧疹虽透。而咳嗽声哑喉痛者。此痧毒不能尽发。郁于气分也。亦宜宣通肺气。如羚角前胡桑杏连翘大力射
干薄荷银花甘桔黄芩芦根之属。
痧 透发不尽。毒邪犯肺。喘急昏闷者。危证也。宜急透之。
蛰庐注。痧郁不透。内郁肺闭。大危之证。非麻黄大开肺气不能救。用石膏清火。杏仁下气。甘草缓急而泻火。
加犀角等提透清化为治。
痧 伏邪未清。致伤阴分而发热不止者。宜甘寒养阴。如沙参玉竹金斛生地丹皮甘草之属。
阴亏之人。感邪发疹。不可过用柴葛升散。缘此证虽表不得汗解。或虽得汗而疹未透。热仍不解。惟清解中兼养
阴液。庶能得汗。而疹亦透达。
白 见于夏秋暑湿伏邪之证。盖暑必挟湿。为粘腻之邪。病多掩牵。迁延两三候。邪未达而元气受伤。发出白 。
色白点细。形如肌粟。摸之触手而微痒。状如水晶珠而明亮滋润者吉。抓破微有水者。乃湿从外出也。出无定期。
热势壮则外见。缓则隐伏。甚至连发八九次。邪不达而身热不退者。由其人元气亏乏。不能化邪外出。故治白
与治疹异。疹宜提透。白 提透无益。当养正生津。清暑渗湿。使正气充旺。则伏邪渐化。而热得退。若 色干白如
枯骨。大凶之证。津液气竭。邪欲外出。元气亦随之外散。乃邪正并脱之候也。
The etiology of scarlet fever (Sha Zhen) involves external invasion of cold pathogenic factors and internal accumulation of latent heat. Treatment should address both exterior and interior, dispersing pathogenic factors from the Lung and Wei (Defensive) levels. The main prescription is Mahuang Tang with Xingren, Gancao, and Shigao (Mahuang Xinggan Shigao Decoction), added with Jiegeng (Platycodon Root), Bohe (Mint), Yeyan (Belamcanda Rhizome), and Niubangzi (Arctium Fruit).
Zhelu's Note: When there is heat pathogen in the Lung intending to manifest as a rash, but it is externally constrained by wind-cold, the pathogens stagnate at the muscle surface, preventing the rash from emerging. With Lung fire burning internally, it easily leads to closure of the airways and wheezing, resulting in critical conditions. Using Mahuang Xinggan Shigao Decoction opens the Lung Qi and clears heat; with modifications, it disperses the exterior and promotes the eruption of the rash.
When Wind-Warmth pathogens affect the Hand-Taiyin Lung Meridian, symptoms include cough, sore throat, hoarseness, accompanied by a rash. Treatment should employ acrid-cool clearing and moistening methods. It is strictly forbidden to use ascending and dispersing herbs such as Shengma (Cimicifuga Rhizome), Gegen (Pueraria Root), Jingjie (Schizonepeta Spike), and Fangfeng (Saposhnikovia Root). One should select Lingyangjiao (Antelope Horn), Lianqiao (Forsythia Fruit), Bohe (Mint), Danli (Arctium Fruit), Xuanshen (Scrophularia Root), Yeyan (Belamcanda Rhizome), Xingren (Apricot Seed), Jiegeng (Platycodon Root), Xiangbei (Fritillaria Bulb), Yinhua (Honeysuckle Flower), and Lugeng (Reed Rhizome). Subsequently, follow up with Shashen (Glehnia Root), Shihu (Dendrobium Stem), Maidong (Ophiopogon Tuber), Huafen (Trichosanthes Root), Zhimu (Anemarrhena Rhizome), and Pear Juice to nourish the Yin of the Lung and Stomach.
Zhelu's Note: If Fire-Dryness injures the Metal (Lung) and internally harbors Damp-Fire steaming upward to the throat causing ulceration, this is the syndrome of Rotting Throat Scarlet Fever (Lanhou Sha). It also requires acrid-cool clearing and venting. Acrid-warm ascending and dispersing methods are contraindicated, as are cold-bitter descending methods that might suppress the pathogen.
When Yangming Blood Heat is excessive, the rash color resembles cinnabar, the tongue body is deep red like vermilion, the area around the mouth is dry and burning, there is extreme thirst with desire to drink, and the pulse is surging and rapid. Suitable ingredients include Xijiao (Rhinoceros Horn - *note: substitute with water buffalo horn in modern practice*), Lianqiao (Forsythia Fruit), Xianshengdi (Fresh Rehmannia Root), Mudanpi (Moutan Bark), Chishao (Red Peony Root), Xuanshen (Scrophularia Root), Huafen (Trichosanthes Root), Yinhua (Honeysuckle Flower), and Renzhonghuang (Human Feces Carbon). Follow up with modified Da or Xiao Ganlu Xiaodu Dan (Great or Little Sweet Dew Detoxifying Decoction) to rescue the Lung and Stomach Yin.
When residual Sha pathogen heat stagnates in the Lung, causing excessive phlegm, shortness of breath, and cough, treatment should involve diffusing and opening. Options include Zhizi (Gardenia Fruit), Chidou (Fermented Soybean), Sangye (Mulberry Leaf), Xingren (Apricot Seed), Jiegeng (Platycodon Root), Ku Huangqin (Dried Scutellaria Root), Bohe (Mint), Xiangbei (Fritillaria Bulb), Loupi (Trichosanthes Peel), Tongcao (Tetrapanax Pith), and Lugeng (Reed Rhizome).
If the rash has erupted but cough, hoarseness, and sore throat persist, this indicates that Sha toxins have not fully dispersed and are stagnating in the Qi level. It is also appropriate to diffuse and unblock Lung Qi. Options include Lingyangjiao (Antelope Horn), Qianhu (Peucedanum Root), Sangye (Mulberry Leaf), Xingren (Apricot Seed), Lianqiao (Forsythia Fruit), Danli (Arctium Fruit), Yeyan (Belamcanda Rhizome), Bohe (Mint), Yinhua (Honeysuckle Flower), Gancao (Licorice Root), Jiegeng (Platycodon Root), Huangqin (Scutellaria Root), and Lugeng (Reed Rhizome).
If the Sha rash does not fully erupt, and toxic pathogens invade the Lung causing急促 panting, coma, and chest oppression, this is a critical condition. Urgent venting of the rash is required.
Zhelu's Note: When Sha toxins are stagnant and fail to erupt, leading to internal Lung closure, it is a highly critical condition. Only strong opening of Lung Qi by Mahuang can save the patient. Combined with Shigao (Gypsum) to clear fire, Xingren (Apricot Seed) to descend Qi, and Gancao (Licorice Root) to relieve urgency and drain fire, along with Xijiao (Rhinoceros Horn) and others to lift, vent, clear, and transform, constitutes the treatment.
If latent Sha pathogens remain uncleared, damaging the Yin branch and causing persistent fever, sweet-cold Yin-nourishing methods should be used. Options include Shashen (Glehnia Root), Yuzhu (Polygonatum Rhizome), Jinshihu (Dendrobium Stem), Shengdi (Rehmannia Root), Mudanpi (Moutan Bark), and Gancao (Licorice Root).
In individuals with inherent Yin deficiency who contract pathogens and develop a rash, one must not overuse Chaihu (Bupleurum Root) and Gegen (Pueraria Root) for ascending and dispersing. Although this syndrome cannot be resolved through sweating, or even if sweat occurs, the rash may not emerge and heat persists. Only by clearing and resolving heat while simultaneously nourishing Yin fluids can sweat be induced, allowing the rash to emerge.
White miliary eruptions (Bai Mo) often appear in cases of latent Summerheat-Dampness pathogens during summer and autumn. Since Summerheat invariably carries Dampness, which is a sticky and lingering pathogen, the disease tends to drag on for two or three ten-day periods. The pathogen fails to reach the exterior while the Healthy Qi (Yuan Qi) is injured, leading to the emergence of Bai Mo. These present as small white spots, resembling millet grains, tactile upon touch and slightly itchy, looking like bright, moist crystal beads—this is auspicious. If broken, slight fluid exudation indicates dampness exiting the body. There is no fixed timing for their appearance; they manifest when heat is vigorous and hide when heat is mild, potentially recurring eight or nine times. If the pathogen fails to exit and fever persists, it is due to deficient Healthy Qi unable to transform and expel the pathogen. Therefore, treating Bai Mo differs from treating Sha Rash. While Sha Rash requires lifting and venting, lifting and venting is ineffective for Bai Mo. Instead, one should support Righteous Qi, generate fluids, clear Summerheat, and leach out Dampness. When Righteous Qi becomes robust, latent pathogens gradually resolve, and heat subsides. If the Bai Mo appears dry and white like dead bone, it is a dire prognosis, indicating exhaustion of fluids and Qi. The pathogen attempts to exit, but Healthy Qi scatters outward with it, representing a state of simultaneous collapse of Pathogen and Righteous Qi.