出疹之候,初热一日至次日鸡鸣时,其热即止,止存五心微热,渐见咳嗽鼻流清涕,或腹中作
痛,饮食渐减,到申酉之间,其热复来。如此者四日,用手满接发际处甚热,其面上热少减二三分
,咳嗽连声,面燥腮赤,眼中多泪,喷嚏频发,或忽然鼻中出血。至五日,其热不分昼夜。六日早
时,其疹出在两颊下,细细红点,至午时,两手背并腰下及浑昏,密密俱有红点。七日普遍掀发,
其鼻中清涕不流,喷嚏亦不行,七日晚,两颊颜色渐淡。此验出疹之要法。
凡疹热六日而出,一定之规也。若医人无识,用药太早,耗散元气,及至出时,变害多矣。或嗽而变喘,
或出一二日即隐,或作大泻,或合目而喘,此医人用药不当之害也。吾家治法,定不在五日内用药
,必待见疹,方用徐徐升表。然用药亦有次第,凡一剂必作十余次饮之,况疹在皮肤之间,苦作一
次服,则药性催之太急,每致谵语烦躁,故当慎之。
景岳曰∶按此万氏之法,谓医人用药太早,恐致耗散元气,故必待见点而后施治,及作一次
服,恐药性催之太急,皆惟恐无益而反以致害,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,或不嫌早与不早也。尝见庸流之误治者
多,是诚不服药为中医也。此万氏之说所以不可不遵。
凡疹热五六日必出矣,医人用药见不能散,父母见药不效,医人见热嗽不能除,或以别证治之
,主家又或更医,此世之所以误者多矣。
In the manifestation of measles, during the initial fever stage, from the first day until the rooster crowing time on the second day, the fever ceases, leaving only slight heat in the five centers (palms, soles, and chest). Coughing and clear nasal discharge gradually appear, or abdominal pain occurs, and food intake gradually decreases. Between Shen and You hours (3:00 PM to 7:00 PM), the fever returns. Such a condition persists for four days; touching the area near the hairline feels very hot, while the heat on the face decreases slightly by two or three parts. The cough is continuous, the face is dry with red cheeks, eyes are teary, sneezing is frequent, or sudden epistaxis occurs. By the fifth day, the fever continues without distinction between day and night. On the morning of the sixth day, rashes appear below the cheeks as fine red spots; by noon, dense red spots cover both backs of the hands, below the waist, and the entire body. On the seventh day, the rash erupts universally. At this point, clear nasal discharge stops, and sneezing ceases. By the evening of the seventh day, the color of the cheeks gradually fades. This is a key method for verifying the progression of measles.
It is a fixed rule that measles manifest after six days of fever. If physicians lack insight and administer medication too early, depleting Yuan Qi (Primordial Qi), when the rash finally emerges, numerous complications may arise. These include cough transforming into asthma, the rash disappearing after one or two days, severe diarrhea, or panting with closed eyes. These are harms caused by inappropriate medication. Our family's treatment method strictly avoids medication within the first five days. We wait until the rash points are visible before using gentle methods to raise and release the exterior. However, there is an order to medication administration. Each decoction must be administered in more than ten small doses. Since the rash is located in the skin and interstices, administering it all at once causes the medicinal properties to act too urgently, often leading to delirium and irritability. Therefore, caution is required.
Zhang Jingyue stated: According to Wan's method, it is believed that physicians administering medication too early may deplete Yuan Qi; thus, treatment should only begin after the rash points appear. There is also concern that single-dose administration might cause the medicinal properties to act too urgently. These concerns stem from the fear that treatment might be ineffective and harmful, representing his empirical insights. However, from my humble perspective, physicians vary in skill, and medications vary in suitability. Provided the diagnosis is accurate and the eruption is handled appropriately, pre-eruption treatment—whether via releasing the exterior or tonification—can prevent complications and secretly eliminate toxins. Post-eruption, there must be appropriate formulas for regulation without causing excessive urgency. This depends on the physician's competence and whether they disregard the timing of early intervention. I have observed many cases of misdiagnosis and mistreatment by mediocre practitioners, suggesting that "not taking medicine" can sometimes be the most moderate approach. This explains why Wan's theory must be followed.
Measles typically manifest after five to six days of fever. Physicians may find their medications ineffective in dispersing the pathogen; parents may see no improvement; doctors may fail to resolve the fever and cough. They might treat other concurrent conditions instead, and families may change physicians repeatedly. This is why misdiagnosis and mistreatment are common in the world.