麻疹为小儿常见传染病之一，发病多在冬春季节。由于冬末阳气升发，春季又属肝木主令，如肝气疏泄太过，肺气失其肃降，加之小儿胎毒内蕴，脏腑娇嫩，形气未充，皮毛疏薄，卫外机能不固。当此之际，温邪易犯肺窍，肺主皮毛，以致发为麻疹。故昔人有“痧属火毒，由于胎毒蕴积，独禀肺经为病。”“麻虽胎毒，多带时行，脏腑之伤，肺则为甚。”“麻疹往往兼时气传染而成”等论述。说明麻疹多为火证、阳证．并带有强烈的传染性，故多属有余之证，用药多主清凉。但仅列证方，尚缺乏病理机制之论述。至于不足之症及救逆之方则记载较少。正如龚子才《寿世宝元》所说：“世知痘疹所系之重，而不知疹子杀人尤甚，方书疏忽而不备，良可太息矣。”虽然麻疹多发于冬春季节，属阳证者固然居多，但若执古人之说而不细审小儿体功之有余与不足，仅着眼于阳邪为患，概主清凉，不免有误治变证之虞，或忽视病原性质，仅着眼于小儿机能较弱，概主辛温，亦可导致险逆之变。因而，临床上，由于过清、过温出现险逆之证者，屡见不鲜。余经四十余年之临床实践，对麻疹一证，首辨阴阳，细察患儿体质强弱。何证为阳?何证为阴?阳证有阳证之依据，阴证亦有阴证之依据。兹将余对麻疹一得之见及辨证处方要义略述如下，并附医案四则。
(一)属阳证者
此型患者，虽有风闭、火闭、食闭之分，但多表现为有余之证(实证)。如高热、面赤、唇燥、咳嗽、涕泪交流，脉多洪数，疹色鲜明红润，多属顺证。当疹出隐约醖酿之际，余采用下列数方：
1．加味升麻葛根汤。
小枣6枚(为3至5岁量。下同)
此方为足阳明胃经之药，阳明为表中之里，多气多血。麻疹无论火闭、风闭、食闭，均能使气机壅滞，肺失宣降，疹难外达，转变厄测。方中升麻、葛根辛轻之品，辛能达表，轻可去实。升麻还有解毒功效，芍药敛阴益血，甘草、小枣调胃和中，芫荽气味芳香具升发之性，对气机壅滞，肺气不宣之风闭，尤为切贴。麻疹初起，不可妄投苦寒以攻伐其里，亦不可过汗致虚其表。是方则无此弊。
2．清金一贯饮。
方中荆芥理血祛风，枳壳利气，青皮、赤芍养肝舒郁，前胡利气化痰。木通上能清心降火，下能畅达血行以导伏热从小便而出，黄芩清肺热，桔梗载药上行，舒肺窍以达表，甘草调和诸药而和中。可加薄荷少量，取辛凉达表，疹易外透。如兼食闭，症见呕吐者，加神曲、焦楂以化腑热，消食导滞，宣畅气机，促疹外透。
3．二仙汤。
此方用治火闭。症现高烧，咳剧，气粗体实，病邪较甚，症从火化，脉洪，舌紫，口干思水，烦躁不安，为火热毒邪太甚，表里俱亢之症。黄芩清肺火以制肝木之疏泄太甚，自芍和血养肝以防肺火太甚，肝阴受损。此方可以两者兼顾，药虽二味，取效较良。
若热伏营血，壮热神昏，疹色紫黑，余尝用犀角地黄汤加黑豆、绿豆、黄芩。方中白芍改赤芍。犀角清心火而解热毒，为主药，生地凉血而滋阴液，佐犀角以解血分热毒，赤芍入血清热，配丹皮凉血散瘀。加黑豆养肝，绿豆清热解毒，与黄芩相伍，更增清解热毒之功。
4．扁鹊三豆饮加昧。
方中所用之豆，为粮食类药物，具冲和之性而益中，兼有养肝润肺解毒之功。加桑叶、薄荷疏肺达表、解散风热；芫荽、香菌脚透疹外出。此方不仅用于麻疹顺症初起，亦用于风闭、火闭、食闭之较轻者，勿以药性平淡而忽视之。
此外，民间常用单方，如紫背浮萍，有透疹之力，香菌脚具升发之性，小枣养胃阴，公鸡冠血亦具升发透疹之作用。 四药合煎，可用于疹出不畅者。
以上介绍之方，除犀角地黄汤外，均适用于顺症，临床可根据症情斟酌选用。总之，应以透疹外达为目的。
在出疹过程中，如出现胸闷、心烦，乃疹出未透之故。所谓“胸闷一分未减，痧出一分未透”，此辨麻疹顺逆之关键，实属要诀，临证尤须切记。当此之时，非上述诸法所可奏效，必须视症情另谋应变之策。
(二)属阴证者
此型患儿多现不足之象，如发热不高，面色青暗，虽咳不剧，疹色暗淡，神倦、息短，舌淡润，脉沉或沉紧，或发热三、四日后，疹现不多。此系体功不足之寒闭症象。余用治少阴病脉沉细，但欲寐，反发热之麻黄附子细辛汤，温经达表、透疹为治。处方：
若小儿体质偏虚，发热有汗，麻疹欲出未透，余用三豆饮加味治之。处方：
黑豆10克 绿豆10克 红饭豆10克 潞党参15克 口芪10克
若小儿元气不足，疹出旋即内陷，脉沉面青，咳喘，余用麻黄附子细辛汤加潞党参、口芪、公鸡冠血为治。处方：
(公鸡冠血数滴为引)
若疹刚出即内陷，症见四肢逆冷，面青，脉沉者，余用四逆汤加黑豆、公鸡冠血，扶阳抑阴，温肺透疹，或用白通汤交阴阳，亦托疹外出之法。
若心阳不足，阴寒闭塞，疹出隐没，或疹出即内陷者。可用麻黄附子细辛汤加生姜、桂枝、川芎，温扶心阳，托疹外出。
再有疹出复兼吐泻，腹痛，口不渴者，是脾胃虚寒所致。轻症可用六君汤加黑豆，或用理中汤加黑豆；重症宜用四逆汤回阳救逆，先其所急为治。
关于疹靥之后，有发热持续不退，有突发喘促，有久咳不止等情况者，其治疗方法如下：
若疹靥后，发热持续不退，症见心烦，不眠。治宜育阴清热，用黄连阿胶汤(黄连、黄芩、杭芍、阿胶，鸡子黄)。如发热不高，久热不退，乃阴阳并虚，可用芍药甘草附子汤(杭芍、甘草、附片)，使阴阳互济，则久热可退。如肺燥津虚，久热不退，予上述二仙汤重用芍药，清热润燥而滋液。
若疹靥后，突发喘促鼻煽、声哑，鼻如烟熏，脉微肢冷。此乃脏气不足、津液枯涸、元气暴脱之象，宜速用参附汤(白洋参、附片)，以固元气而滋阴液。
若疹靥后，久咳不止，系肺阴不足，胃阴大虚，余用于姜甘草汤(干姜改用炮姜)加天冬、五味子、白蜜，润肺燥，养胃阴，使肺燥得润，胃阴得养，则肺胃之气自降。而久咳可止。
总之，麻疹一症，顺症易治，初起之时，投以轻清微表之剂，宣肺经郁热，疹即易透。若护理得当，甚至不需服药，数日后疹出顺透即渐消退。至于险逆之证，多系元阳元阴不足，或用药不当，致疹子不易透出，反而内陷。此以患儿体功不足者多，因而属阴证者不少，阳证亦有，临床施治，应把握阴阳，治疗法则各有准则。下附医案四则：
例一：
施××，男，一岁半。麻疹初起，面青神迷，体温不高，疹色淡，呈块状，脉沉细，舌淡润。此寒气闭阻，心肺阳虚，故疹不易外透。法当以扶心阳、鼓动气机为治。处以麻辛附子汤加昧。处方：
二诊：服一剂，疹出不多，仍呈块状。此因元气虚极，药力不足。予白通汤交阴阳，促疹外达。处方：
三诊：服一剂后，翌日疹点全透，此时体温不仅不退，反而增高。按麻疹一经疹点出齐，体温宜逐渐下降者为顺。此症疹子出齐，体温反增，系肝肾两虚，元气不能收纳，气机涣散之险证。当此之际，急应扶阳滋阴，调平阴阳，予芍药甘草附子汤加黑豆。处方：
四诊：上方连服二剂，热退身凉，疹子渐靥。予三豆汤加味，和肺养肝而愈。处方：
例二：
代××，男，二岁。发热三日，面青、神迷，尿清长，脉沉，疹子隐约不显，疹色晦暗。法当温阳通经，宣肺透疹。予以麻辛附子汤加味。处方：
生姜2片
二诊；上方服一剂，发热减轻，疹子全出，且色鲜明，翌日突然吐泻大作。痧兼吐泻是中焦脾阳虚弱，此时若不急扶中阳，将有导致下焦元气暴脱之危险。急予理中汤加黑豆。处方：
三诊：服一剂，吐止，但仍有水样便，脉仍沉，重按无力。此下焦元阳不足所致。予以桂附八味汤收纳元阳。处方：
四诊：服二剂，泻全止，痧渐靥。易方以六君汤加黑豆、杭芍调治而愈。
例三：
陈××，男，三岁。麻疹出顺利，但迨麻疹渐靥之时，突现喘促，鼻煽，鼻如烟熏，声哑，咳嗽，但不发热，脉细。细审此证，因疹出较厚，脏气不足，津液耗散太甚。急投予参附汤以挽救将脱之元气，并益气阴。处方：
二诊：服一剂，喘平，鼻煽亦止。予生脉散加味，收纳元阴，益气生津。处方：
白洋参10克 麦冬15克 五味子10克 枣皮15克 乌梅3个
(冰糖为引)
此方连服三剂，上症悉平。
例四：
杨××，女，13岁半。麻疹靥后，咳嗽不止，历时一月糸，来室就诊。症现面浮、唇青、舌干无苔，脉弦细。此为肺脾两虚。予以炮姜甘草汤加味。处方：
痧后久咳不止，肺脾两虚。炮姜甘草汤辛甘化阳，为温脾复阳之剂，加麦冬、五味、白蜜，滋肺复津。
二诊：上方连服三剂后，咳止，面浮亦消。予生脉散加乌梅、冰糖、枣皮，益气复津，调治而愈。
[按]：上述医案四则，治法均属变局，附志于此，以备参考。临证应根据证情灵活处理，勿为常规常法所限。否则，墨守成法，难以取效，或导致误治，此又不仅麻疹一证为然也。如《幼幼集成》所谓“麻疹发热吐泻纯属热证，不可作寒论”之说，此其常法，但不可拘执。余治例二，麻兼吐泻属中阳虚寒所致。此属变局，若不急予理中、桂附八味之剂，则有下元暴脱之虞。故医者临证，不仅知常，更应知变，知常达变，庶可免于胶柱。
牙痛论治
牙痛为临床常见疾患之一，虽属小恙，亦能影响工作。此证由于病因各异，处方用药必须辨别寒热虚实，不能执一己之偏见，专主清凉或专主温热。有关牙痛辨证论治，概括分为四型简述于下：
(一)寒闭型
此属寒入少阴经，少阴属肾，肾主骨，齿为骨之余。患者牙痛绵绵不休，痛引头部，得温痛减。多现面青无神，齿龈不肿(齿龈属阳明胃经分布范畴，龈不肿非胃热所致，此为辨证要点)。脉象多沉或沉紧，舌多淡润或滑润，时见畏寒。法当温经散寒止痛。处方：
方中附片温少阴之经脉，促进血行，麻、辛助阳散寒，防风祛风止痛，骨碎补温肾助阳。生姜走而不守，辛温散寒。全方温经散寒，宣畅气机，可达“通则不痛”之功。用治寒入阴分，阴邪上犯所致之牙痛甚佳。
(二)胃热型 《证治准绳》谓：“上龈属足阳明胃经，下龈属手阳明大肠经”。此型多现上下牙龈红肿疼痛较剧，牵引头部，恶热，口渴，烦躁不安。舌红，质干，苔黄腻，或现口臭。便秘，尿短赤，脉象多洪数，或弦数，系阳明伏火与风热之邪相搏，风火上乘所致。法当清热泻火。可予泻黄散或清胃散。
第一方，泻黄散；
(清酒数滴、白蜜一匙为引。若加蜂房10克，骨碎补30克，其效尤佳)
方中生石膏泻阳明胃火，防风发中焦伏火，栀子泻心、肺、三焦郁热。藿香理气调胃，使伏热得清，胃气不伤。甘草泻火调胃。尤妙在酒性升提，蜜性润降，一升一降，能引诸药上行，直达病所，引上炎之火邪得以下降，牙痛得止。
第二方，清胃散：
生地30克 当归15克 粉丹皮10克 川黄连6克 升麻10克
生石膏15至30克
此方用于胃有积热，牙龈出血，红肿溃疡。黄连、石膏泻脾胃实火。因胃乃多气多血之腑，胃中积热，易导致血分瘀血，故用当归活血，生地、丹皮凉血养阴。升麻为阳明引经药，具有清热解毒、升清等作用，佐黄连、石膏宣达郁热。诸药共呈清宣胃火、凉血养阴之效，使实火得清，则血不妄行，阴液得养，则溃疡自除。
凡牙痛由脾胃伏热引起，未涉及血分者，用泻黄散；由胃中积热引起，血分亦热者．用清胃散。前者苔多腻，后者舌质多红，无苔或少苔。
(三)旰肾阴亏
Measles is one of the common infectious diseases in children, with onset mostly occurring in winter and spring. Due to the rising of Yang Qi at the end of winter and the dominance of Liver Wood in spring, if Liver Qi disperses excessively, Lung Qi loses its descending function. Additionally, infants have latent toxins stored internally, delicate Zang-Fu organs, unfulfilled form and Qi, thin skin and hair pores, and insecure defensive exterior functions. At this time, warm pathogens easily invade the orifices of the Lung. Since the Lung governs the skin and hair, measles develops. Therefore, ancient people stated: "Sha (measles/rash) belongs to fire toxin, caused by the accumulation of latent toxins, uniquely affecting the Lung Meridian." "Although measles stems from latent toxins, it often carries epidemic characteristics; among the injured Zang-Fu organs, the Lung is the most severely affected." "Measles often results from concurrent transmission of seasonal pathogens." These discussions indicate that measles is mostly a Fire Syndrome and Yang Syndrome, with strong contagiousness, thus generally belonging to an Excess Syndrome. Medication usually emphasizes cooling and clearing. However, merely listing syndromes and prescriptions lacks discussion on pathological mechanisms. Records regarding Deficiency Syndromes and emergency rescue prescriptions are scarce. As Gong Zicai said in *Shoushi Baoyuan*: "People know the gravity of smallpox and measles, but do not realize that measles kills even more; medical books are negligent and incomplete, which is truly lamentable." Although measles occurs mostly in winter and spring, and Yang Syndromes are indeed predominant, if one adheres strictly to ancient sayings without carefully examining whether a child's physiological capacity is in excess or deficiency, focusing only on pathogenic Yang factors and universally advocating cooling, there is a risk of misdiagnosis leading to complications. Conversely, ignoring the nature of the pathogen and focusing solely on weak physiological functions, universally advocating pungent-warm methods, can also lead to dangerous reversals. Thus, clinically, cases of dangerous reversals due to excessive cooling or excessive warming are frequent. Through over forty years of clinical practice, regarding measles, I first differentiate Yin and Yang, and carefully observe the strength or weakness of the patient's constitution. What constitutes a Yang Syndrome? What constitutes a Yin Syndrome? Yang Syndromes have their basis, and Yin Syndromes also have their basis. Herein, I briefly outline my insights on measles and the essentials of syndrome differentiation and prescription, accompanied by four medical cases.
(1) Cases Belonging to Yang Syndrome
Patients of this type, although divided into Wind Closure, Fire Closure, and Food Closure, mostly manifest as Excess Syndromes (Excess patterns). For example, high fever, flushed face, dry lips, coughing, flowing nasal discharge and tears, pulse mostly surging and rapid, rash color bright and red, mostly belong to favorable prognoses (Shun Zheng). When the rash is emerging vaguely and brewing, I adopt the following prescriptions:
1. Modified Shengma Gegen Decoction (Cimicifugae Rhizoma and Puerariae Radix Decoction).
Shengma (Cimicifugae Rhizoma) 6g, Gegen (Puerariae Radix) 10g, Hangshao (Paeoniae Radix Alba) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Yuanxu (Coriandri Fructus) 5 stalks.
Xiaozao (Jujubae Fructus) 6 pieces (dosage for ages 3-5, same below).
This prescription consists of herbs for the Foot-Yangming Stomach Meridian. Yangming is the interior within the exterior, rich in Qi and Blood. Regardless of Fire, Wind, or Food closure, measles can cause Qi mechanism stagnation, loss of Lung diffusion and descent, difficulty in rash externalization, and unpredictable changes. In this formula, Shengma and Gegen are pungent and light. Pungency reaches the exterior, and lightness dispels excess. Shengma also has detoxifying effects; Shaoyao (Paeoniae Radix) astringes Yin and benefits blood; Gancao and Xiaozao harmonize the Stomach and middle Jiao; Yuanxu has an aromatic odor and ascending properties, making it particularly suitable for Wind Closure characterized by Qi stagnation and non-diffusion of Lung Qi. In the early stage of measles, one should not recklessly administer bitter-cold herbs to attack the interior, nor induce excessive sweating to weaken the exterior. This prescription avoids these drawbacks.
2. Qingjin Yiguan Yin (Clear Metal One-Guidance Decoction).
Jingjie (Schizonepetae Herba) 6g, Qianhu (Peucedani Radix) 6g, Zhike (Aurantii Fructus Immaturus) 6g, Jiegeng (Platycodonis Radix) 6g, Chishao (Paeoniae Radix Rubra) 10g.
Qingpi (Aurantii Fructus Pericarpium) 5g, Huangqin (Scutellariae Radix) 3g, Mutong (Akebiae Caulis) 3g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g.
In this formula, Jingjie regulates blood and dispels wind; Zhike promotes Qi movement; Qingpi and Chishao nourish the Liver and relieve depression; Qianhu promotes Qi movement and transforms phlegm. Mutong clears Heart Fire downwards above and facilitates blood circulation below to guide latent heat out via urination; Huangqin clears Lung Heat; Jiegeng carries medicine upwards, opens Lung orifices to reach the exterior; Gancao harmonizes all medicines and benefits the middle. A small amount of Bohe (Menthae Haplocalycis Herba) can be added to take advantage of its pungent-cool nature to reach the exterior, facilitating rash emergence. If accompanied by Food Closure with vomiting, Shenqu (Massa Medicata Fermentata) and Jiaozha (Ziziphus Jujuba Fructus Carbonized) can be added to transform Fu-Heat, digest food, promote Qi mechanism, and assist rash emergence.
3. Erxian Tang (Two Immortals Decoction).
Huangqin (Scutellariae Radix) 6g, Baishao (Paeoniae Radix Alba) 12g.
This formula treats Fire Closure. Symptoms include high fever, severe cough, rough breathing, robust physique, severe pathogenic factors, transformation into Fire pattern, surging pulse, purple tongue, dry mouth desiring water, and restlessness. This indicates extreme Fire-Toxin pathogens and hyperactivity of both interior and exterior. Huangqin clears Lung Fire to restrain excessive Liver Wood dispersion; Baishao harmonizes blood and nourishes the Liver to prevent damage to Liver Yin caused by excessive Lung Fire. This formula addresses both aspects; although it contains only two herbs, it yields good results.
Secondly, Maxing Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) or Baihu Tang (White Tiger Decoction) can also be used for this syndrome.
If Heat hides in Ying-Blood, causing high fever and coma, with purple-black rash, I once use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) plus Heidou (Phaseoli Semen Nigrum), Lvdou (Phaseoli Semen Mungo), and Huangqin. Baishao in the formula is changed to Chishao. Xijiao (Rhinocerotis Cornu) clears Heart Fire and resolves heat-toxin, serving as the chief herb; Shengdi (Rehmanniae Radix) cools blood and nourishes Yin fluid, assisting Xijiao to resolve blood-level heat-toxin; Chishao enters blood to clear heat, combined with Danpi (Moutan Cortex) to cool blood and dissipate stasis. Added Heidou nourishes the Liver; Lvdou clears heat and detoxifies; combined with Huangqin, it further enhances the effect of clearing and resolving heat-toxin.
4. Bianque Sandou Yin Modified (Bianque Three Beans Decoction Modified).
Heidou (Phaseoli Semen Nigrum) 9g, Lvdou (Phaseoli Semen Mungo) 10g, Dandouchi (Sojae Semen Praeparatum) 9g, Sangye (Mori Folium) 6g, Bohe (Menthae Haplocalycis Herba) 6g.
Yuanxu (Coriandri Fructus) 3 stalks, Xiangjunjiao (Lactarius Viscidus Mycelium) 3g.
The beans used in this formula are grain-type medicines, possessing mild and harmonious properties that benefit the center, and also have effects of nourishing Liver, moistening Lungs, and detoxifying. Added Sangye and Bohe disperse Lung and reach the exterior, resolving Wind-Heat; Yuanxu and Xiangjunjiao promote rash emergence. This formula is not only used for the initial stage of favorable measles cases, but also for milder cases of Wind, Fire, or Food Closure. Do not ignore it because of its mild nature.
Additionally, folk single prescriptions are commonly used, such as Zi Bei Fu Ping (Spirodela Polyrrhiza), which has the power to promote rash emergence; Xiangjunjiao has ascending properties; Xiaozao nourishes Stomach Yin; and Gongji Guanxue (Rooster Comb Blood) also has ascending and rash-promoting effects. Decocting these four together can be used for cases where rash does not emerge smoothly.
Among the introduced formulas, except for Xijiao Dihuang Tang, all apply to favorable syndromes. Clinically, they can be selected according to symptoms. In short, the goal should be promoting rash externalization.
During the rash eruption process, if chest tightness and irritability occur, it is due to incomplete rash emergence. The saying "For every unit of unresolved chest tightness, there is one unit of un-emerged sha" is the key to distinguishing favorable vs. unfavorable measles prognosis, truly an essential principle that must be remembered in clinical practice. At this time, the aforementioned methods may not be effective; one must seek alternative strategies based on the condition.
(2) Cases Belonging to Yin Syndrome
Patients of this type mostly show signs of deficiency, such as low-grade fever, dark-blue complexion, mild cough despite presence of cough, dull rash color, mental fatigue, short breath, pale moist tongue, deep or deep-tight pulse, or few rashes appearing three to four days after fever onset. This is a Cold Closure syndrome image due to insufficient physiological function. I use Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite Root, and Asarum Decoction), indicated for Shaoyin disease with deep-thin pulse, desire to sleep, yet contrary fever, to warm meridians, reach the exterior, and promote rash emergence. Prescription:
Chuan Fupian (Prepared Aconiti Lateralis Radix) 15g, Ma Rong (Ephedrae Herba processed) 3g, Xixin (Asari Radix et Rhizoma) 3g.
If the child's constitution is relatively deficient, with fever and sweating, and measles wanting to emerge but not fully out, I treat with modified Sandou Yin (Three Beans Decoction). Prescription:
Heidou (Phaseoli Semen Nigrum) 10g, Lvdou (Phaseoli Semen Mungo) 10g, Hong Fan Dou (Phaseoli Angularis Semen) 10g, Lu Dangshen (Codonopsis Radix) 15g, Kouqi (Astragali Radix) 10g.
The three beans harmonize Lung, nourish Liver, and benefit Stomach; adding Ginseng and Astragalus stirs Spleen and Lung Qi to assist rash emergence.
If the child's Yuan Qi is insufficient, and rash emerges then quickly sinks inward, with deep blue-green pulse, coughing, and wheezing, I use Mahuang Fuzi Xixin Tang plus Lu Dangshen, Kouqi, and Gongji Guanxue (Rooster Comb Blood). Prescription:
Hei Fupian (Prepared Aconiti Lateralis Radix) 30g, Ma Rong (Ephedrae Herba processed) 3g, Xixin (Asari Radix et Rhizoma) 3g, Lu Dangshen (Codonopsis Radix) 10g, Kouqi (Astragali Radix) 10g.
(Few drops of Rooster Comb Blood as guide).
This formula has the effect of stirring True Yang and pushing inward-sinking measles outward.
If rash just emerges then immediately sinks inward, with cold limbs, blue face, and deep pulse, I use Sini Tang (Frigid Extremities Decoction) plus Heidou and Rooster Comb Blood to support Yang, suppress Yin, warm Lung, and promote rash emergence, or use Baitong Tang (White Onion Decoction) to interact Yin and Yang, which is also a method to push rash outward.
If Heart Yang is insufficient, Yin-Cold blocks, rash emerges faintly or sinks inward immediately upon emergence, one can use Mahuang Fuzi Xixin Tang plus Shengjiang (Zingiberis Rhizoma Recens), Guizhi (Cinnamomi Ramulus), and Chuanxiong (Ligustici Chuanxiong Rhizoma) to warmly support Heart Yang and push rash outward.
Furthermore, if rash emergence is accompanied by vomiting and diarrhea, abdominal pain, and no thirst, this is caused by Spleen-Stomach Deficiency-Cold. Mild cases can use Liujun Tang (Six Gentlemen Decoction) plus Heidou, or Lizhong Tang (Regulate the Middle Decoction) plus Heidou; severe cases should use Sini Tang to return Yang and rescue reversal, addressing the urgency first.
Regarding conditions after rash fading (Ye), such as persistent fever, sudden panting, or chronic cough, the treatment methods are as follows:
If fever persists after rash fading, with irritability and insomnia, treatment should nourish Yin and clear heat, using Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) (Huanglian, Huangqin, Hangshao, Ejiao, Ji Zi Huang). If fever is not high but long-lasting, indicating simultaneous deficiency of Yin and Yang, Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) can be used to allow mutual assistance between Yin and Yang, so long-term fever subsides. If Lung Dryness and Fluid Deficiency cause long-term fever, use the aforementioned Erxian Tang with heavy Shaoyao to clear heat, moisten dryness, and nourish fluids.
If after rash fading, sudden panting with nasal flaring, hoarseness, nose smelling like smoke, thready pulse, and cold limbs occur, this is a sign of insufficient Zang-Qi, dried-up body fluids, and sudden collapse of Yuan Qi. One should quickly use Shenfu Tang (Ginseng and Aconite Decoction) (Baiyangshen, Fupian) to consolidate Yuan Qi and nourish Yin fluids.
If after rash fading, chronic cough persists, due to Lung Yin insufficiency and great Stomach Yin deficiency, I use Jianggan Caotang (Ginger and Licorice Decoction) (using Paojiang instead of Ganjiang) plus Tiandong (Asparagi Radix), Wuweizi (Schisandrae Fructus), and Baimi (Mel) to moisten Lung dryness and nourish Stomach Yin. Once Lung dryness is moistened and Stomach Yin nourished, Lung and Stomach Qi naturally descend, and chronic cough stops.
In summary, for measles, favorable syndromes are easy to treat. At the beginning, administering light, clear, slightly releasing agents diffuses Lung Meridian stagnant heat, making rash easy to emerge. With proper care, medication may not even be needed; after a few days, if rash emerges smoothly, it gradually recedes. Dangerous/unfavorable syndromes are mostly due to insufficiency of Original Yang/Yin or improper medication, causing rash to fail to emerge and sink inward. This is mostly due to insufficient physiological function in patients, hence many Yin Syndromes, though some Yang Syndromes exist. Clinical treatment should grasp Yin and Yang, with specific principles for each. Below are four medical cases:
Case 1:
Shi XX, Male, 1.5 years old. Early measles, blue face, confused spirit, low temperature, pale rash in patches, deep-thin pulse, pale moist tongue. This is Cold Qi blocking, Heart-Lung Yang Deficiency, thus rash difficult to emerge externally. Method: Support Heart Yang and stir Qi mechanism. Prescribe Modified Maxin Fuzi Tang. Prescription:
Fupian (Prepared Aconiti Lateralis Radix) 30g, Ma Rong (Ephedrae Herba processed) 5g, Xixin (Asari Radix et Rhizoma) 2g, Guizhi (Cinnamomi Ramulus) 6g, Shengjiang (Zingiberis Rhizoma Recens) 2 slices.
Second visit: After one dose, rash emerged little, still in patches. This is due to extreme Yuan Qi deficiency and insufficient medicinal power. Prescribe Baitong Tang to interact Yin and Yang, promoting rash externalization. Prescription:
Fupian (Prepared Aconiti Lateralis Radix) 30g, Ganjiang (Zingiberis Rhizoma) 5g, Congbai (Allii Fistulosi Bulbus) 1 piece.
Third visit: After one dose, next day all rash points emerged completely. At this time, temperature did not drop but increased. According to measles, once rash points are complete, temperature should gradually decrease for a favorable outcome. This case, rash complete but temperature increased, indicates Liver-Kidney dual deficiency, inability of Yuan Qi to receive/hold, and scattering of Qi mechanism—a dangerous syndrome. At this moment, urgently support Yang and nourish Yin, balance Yin and Yang, prescribe Shaoyao Gancao Fuzi Tang plus Heidou. Prescription:
Fupian (Prepared Aconiti Lateralis Radix) 30g, Hangshao (Paeoniae Radix Alba) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Heidou (Phaseoli Semen Nigrum) 10g.
Fourth visit: After taking the above prescription for two doses continuously, heat retreated, body cooled, rash gradually faded. Prescribe modified Sandou Tang (Three Beans Decoction) to harmonize Lung and nourish Liver, resulting in recovery. Prescription:
Heidou (Phaseoli Semen Nigrum) 10g, Lvdou (Phaseoli Semen Mungo) 10g, Hong Fan Dou (Phaseoli Angularis Semen) 10g, Wumei (Mume Fructus) 3 pieces (Bingtang as guide).
Case 2:
Dai XX, Male, 2 years old. Fever for three days, blue face, confused spirit, clear long urine, deep pulse, rash vague and indistinct, dull rash color. Method: Warm Yang, unblock meridians, diffuse Lung, promote rash. Prescribe Modified Maxin Fuzi Tang. Prescription:
Fupian (Prepared Aconiti Lateralis Radix) 30g, Ma Rong (Ephedrae Herba processed) 4g, Xixin (Asari Radix et Rhizoma) 3g, Guizhi (Cinnamomi Ramulus) 6g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 5g.
Shengjiang (Zingiberis Rhizoma Recens) 2 slices.
Second visit: After one dose of the above prescription, fever reduced, rash fully emerged and bright colored. Next day, suddenly severe vomiting and diarrhea occurred. Sha accompanied by vomiting/diarrhea indicates Middle Jiao Spleen Yang deficiency. At this time, if Middle Yang is not urgently supported, there is danger of Lower Jiao Yuan Qi sudden collapse. Urgently prescribe Lizhong Tang plus Heidou. Prescription:
Dangshen (Codonopsis Radix) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 6g, Ganjiang (Zingiberis Rhizoma) 6g, Heidou (Phaseoli Semen Nigrum) 10g.
Third visit: After one dose, vomiting stopped, but watery stool remained, pulse still deep, powerless on heavy pressure. This is caused by Lower Jiao Original Yang deficiency. Prescribe Guifu Bawei Tang (Cinnamon and Aconite Eight-Ingredient Decoction) to receive Original Yang. Prescription:
Fupian (Prepared Aconiti Lateralis Radix) 30g, Shang Rougui (Cinnamomi Cortex) 6g, Shudi (Rehmanniae Radix Preparata) 9g, Fuling (Poria) 15g, Huaishanyao (Dioscoreae Rhizoma) 15g.
Fen Danpi (Moutan Cortex) 6g, Zexie (Alismatis Rhizoma) 9g, Shanzhuyu (Corni Fructus) 6g.
Fourth visit: After two doses, diarrhea completely stopped, rash gradually faded. Change prescription to Liujun Tang plus Heidou and Hangshao for regulation and recovery.
Case 3:
Chen XX, Male, 3 years old. Measles emerged smoothly, but when measles was gradually fading, suddenly appeared panting, nasal flaring, nose smelling like smoke, hoarseness, coughing, but no fever, thready pulse. Carefully examining this syndrome, because rash emerged thickly, Zang Qi was insufficient, and body fluids were exhausted excessively. Urgently administer Shenfu Tang to save impending collapsed Yuan Qi and benefit Qi and Yin. Prescription:
Baiyangshen (Codonopsis Radix / Panax Ginseng - context implies Codonopsis here given 'Bai' prefix often used for lighter tonics in some regions, but literally White American Ginseng or similar, text says 'Bai Yang Shen' which usually refers to Codonopsis in some local contexts or specifically Panax quinquefolius. Given WHO standards, I will use Codonopsis Radix or Panax Quinquefolius Radix. Text says 'Bai Yang Shen', likely referring to Codonopsis or American Ginseng. I will use Codonopsis Radix as per common usage in such contexts unless specified otherwise, but strictly 'Bai Yang Shen' is often American Ginseng. Let's stick to literal translation or standard equivalent. Actually, in many TCM texts, Bai Yang Shen refers to Codonopsis. I will use Codonopsis Radix.) 10g, Fupian (Prepared Aconiti Lateralis Radix) 15g.
Second visit: After one dose, panting stopped, nasal flaring ceased. Prescribe modified Shengmai San (Generate Pulse Powder) to receive Original Yin, benefit Qi, and generate fluids. Prescription:
Baiyangshen (Codonopsis Radix) 10g, Maidong (Ophiopogonis Radix) 15g, Wuweizi (Schisandrae Fructus) 10g, Zaopi (Corni Fructus) 15g, Wumei (Mume Fructus) 3 pieces.
(Bingtang as guide).
After taking this prescription for three doses continuously, above symptoms completely resolved.
Case 4:
Yang XX, Female, 13.5 years old. After measles fading, chronic cough lasting over a month, visited clinic. Symptoms: puffy face, blue lips, dry tongue without coating, string-thin pulse. This is Lung-Spleen dual deficiency. Prescribe Paojiang Gancao Tang (Roasted Ginger and Licorice Decoction) modified. Prescription:
Paojiang (Zingiberis Rhizoma Preparata) 9g, Zhigancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 10g, Tiandong (Asparagi Radix) 10g, Wuweizi (Schisandrae Fructus) 10g, Baimi (Mel) 1 spoon.
Chronic cough after Sha, Lung-Spleen dual deficiency. Paojiang Gancao Tang is pungent-sweet transforming Yang, a formula to warm Spleen and restore Yang. Added Maidong, Wuwei, and Baimi to nourish Lung and restore fluids.
Second visit: After taking the above prescription for three doses continuously, cough stopped, facial puffiness disappeared. Prescribe Shengmai San plus Wumei, Bingtang, and Zaopi to benefit Qi, restore fluids, regulate, and recover.
[Note]: The treatment methods in the above four medical cases all belong to variable situations (Bian Ju), recorded here for reference. Clinical practice should handle flexibly according to syndrome conditions, not limited by routine methods. Otherwise, sticking to established rules makes it difficult to achieve efficacy or leads to misdiagnosis. This applies not only to measles. As stated in *Youyou Jicheng*: "Measles fever with vomiting/diarrhea is purely Heat Syndrome, cannot be treated as Cold." This is the routine method, but one cannot rigidly adhere to it. In my treatment of Case 2, measles with vomiting/diarrhea was caused by Middle Yang Deficiency-Cold. This is a variable situation. If Lizhong or Guifu Bawei formulas were not urgently administered, there would be danger of Lower Yuan sudden collapse. Therefore, physicians in clinical practice must not only know the routine but also know the variable. Knowing routine and reaching variability prevents being stuck.
Discussion on Toothache Treatment
Toothache is one of the common clinical diseases. Although minor, it can affect work. Due to various etiologies, prescription and medication must differentiate Cold, Heat, Excess, and Deficiency. One cannot hold personal bias, exclusively advocating cooling or exclusively advocating warming. Regarding syndrome differentiation and treatment of toothache, it is summarized into four types as follows:
(1) Cold Closure Type
This belongs to Cold entering the Shaoyin Meridian. Shaoyin belongs to Kidney. Kidney governs bone, and teeth are the surplus of bone. Patients suffer from continuous toothache, pain radiating to the head, relieved by warmth. Often presents with blue, spiritless face, non-swollen gums (Gums belong to the distribution scope of Yangming Stomach Meridian; non-swollen gums are not caused by Stomach Heat, this is a key point for differentiation). Pulse is mostly deep or deep-tight, tongue mostly pale-moist or slippery-moist, sometimes aversion to cold. Method: Warm meridians, scatter Cold, stop pain. Prescription:
Chuan Fupian (Prepared Aconiti Lateralis Radix) 30g, Ma Rong (Ephedrae Herba processed) 6g, Xixin (Asari Radix et Rhizoma) 3g, Fangfeng (Saposhnikoviae Radix) 6g.
Chao Gusuibu (Drynariae Rhizoma Stir-fried) 10g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices.
In this formula, Fupian warms Shaoyin meridians, promotes blood circulation; Ma and Xixin assist Yang and scatter Cold; Fangfeng dispels Wind and stops pain; Gusuibu warms Kidney and assists Yang. Shengjiang moves without staying, pungent-warm scattering Cold. The whole formula warms meridians, scatters Cold, promotes Qi mechanism smoothness, achieving the effect of "patency leads to no pain". It is excellent for treating toothache caused by Cold entering Yin level and Yin pathogens attacking upward.
(2) Stomach Heat Type *Zhengzhi Zhunsheng* states: "Upper gums belong to Foot-Yangming Stomach Meridian, lower gums belong to Hand-Yangming Large Intestine Meridian." This type mostly presents with severe redness, swelling, and pain in upper and lower gums, radiating to head, aversion to heat, thirst, restlessness. Tongue red, dry texture, yellow greasy coating, or bad breath. Constipation, short red urine, pulse mostly surging-rapid or string-rapid. This is caused by Yangming latent Fire fighting with Wind-Heat pathogens, Wind-Fire ascending. Method: Clear Heat and purge Fire. Can use Xiehuang San (Drain Yellow Powder) or Qingwei San (Clear Stomach Powder).
First Formula, Xiehuang San:
Huoxiang (Agastaches Herba) 6g, Zhizi (Gardeniae Fructus) 9g, Fangfeng (Saposhnikoviae Radix) 9g, Sheng Shigao (Gypsum Fibrosum) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
(Few drops of Qingjiu/White Wine and one spoon of Baimi/Honey as guide. If adding Fengfang (Terebrantis Nidus) 10g and Gusuibu 30g, effect is even better).
In this formula, Sheng Shigao purges Yangming Stomach Fire; Fangfeng releases latent Fire in Middle Jiao; Zhizi drains Heart, Lung, and Sanjiao stagnant Heat. Huoxiang regulates Qi and harmonizes Stomach, allowing latent Heat to clear without damaging Stomach Qi. Gancao purges Fire and harmonizes Stomach. Particularly clever is wine's ascending nature and honey's descending/moistening nature; one ascends, one descends, guiding medicines upward to reach the disease site, leading flaming Fire downward, stopping toothache.
Second Formula, Qingwei San:
Shengdi (Rehmanniae Radix) 30g, Danggui (Angelicae Sinensis Radix) 15g, Fen Danpi (Moutan Cortex) 10g, Chuan Huanglian (Coptidis Rhizoma) 6g, Shengma (Cimicifugae Rhizoma) 10g.
Sheng Shigao (Gypsum Fibrosum) 15-30g.
This formula is used for Stomach accumulated Heat, gum bleeding, redness/swelling/ulcers. Huanglian and Shigao purge Spleen-Stomach Excess Fire. Since Stomach is a Fu organ rich in Qi and Blood, accumulated Heat in Stomach easily leads to Blood-level stasis, thus Danggui is used to invigorate blood, Shengdi and Danpi cool blood and nourish Yin. Shengma is a Yangming guiding herb, having effects of clearing heat, detoxifying, and ascending clear Qi, assisting Huanglian and Shigao to diffuse stagnant Heat. All medicines together present the effect of clearing and diffusing Stomach Fire, cooling blood and nourishing Yin. When Excess Fire clears, blood does not move recklessly; when Yin fluids are nourished, ulcers heal themselves.
For toothache caused by Spleen-Stomach latent Heat not involving Blood level, use Xiehuang San; for toothache caused by Stomach accumulated Heat involving Blood level Heat, use Qingwei San. The former usually has greasy coating; the latter usually has red tongue texture, no coating or scanty coating.
(3) Liver-Kidney Yin Deficiency