发热三日热不退，烦渴切牙面赤红，惊啼战栗乳食少，夜不安眠险证明。
【注】发热三日见点者，常候也。若见点热不退者，毒盛也。更兼烦躁口渴，频频咬
牙，面色红赤，惊悸多啼，身体战栗，乳食甚少，不能安眠等证，此是毒盛伏郁难出，其
为险证明矣！急宜随证施治，庶或从险化顺也。
发热神昏闷乱成，妄言喘满腹腰疼，不食不眠搐不止，干呕失血证逆凶。
【注】发热神昏、闷乱妄言，毒伏于心也；喘满喘急，毒伏于肺也；腹疼，毒伏于脾也，
腰疼，毒伏于肾也；不食不眠，毒伏于胃也；惊搐不止，毒伏于肝也。不时干呕失血，吐
血尿血，是毒攻气血内乱也。此皆为不治之逆证，势多凶也。
痘出发热固自内，必固其诱使之然，时气风寒惊食热，表里虚实随证参。表热恶寒
而无汗，里热有汗溲便难，气弱热微不足治，形实热盛有余看。
【注】痘出发热者，谓痘本火毒，故未出先发热也，自内，谓其热自内达外也。必因
其诱使之然者，谓必因其四时不正风寒邪气使之发热也。惊，谓外触异物，跌扑惊吓使
之发热也。食，谓内伤食滞，使之发热也。热，谓内热积久，因而热发于外也。内外既有所
因之邪，又当以表里虚实，随证参详治也。表热者，谓发热在表，则恶寒而无汗也。里热
者，谓发热在里，则有汗，小便短涩，大便燥难也。气弱热微者，谓形气不足，发热微
轻也。形实热盛者，谓形气不余，发热太甚也。医者果能临时详察，因证施治，则汗、下、
清、补之法自得其宜矣。
升麻葛根汤
发热升麻葛根汤，表邪痘疹两得方，升麻葛根赤芍草，随证宜加法最良。无汗表实
加麻薄，便秘腹痛里大黄，形怯气弱参 入，热盛犀连荆蒡防，尿涩通滑车前子，惊搐荆
防钩连羊，烦渴石膏麦冬粉，咳嗽前桔杏苏桑，伤食腹热楂芽积，下利芩连呕半姜，咽
痛蒡梗身羌独，头痛荆穗芎芷羌。
【注】痘出发热当以升麻葛根汤为主，以其能发表邪、透痘疹，两得之良方也。然必
随证加佐使之品，斯为尽善。如身热无汗者，此表实也，本方中加麻黄、薄荷；如大小便
秘，腹作痛者，此里实也，本方中加大黄；如形气怯弱者，禀赋不足也，本方中加人参、黄
；热盛者，内热炽盛也，本方中加犀角、黄连、荆芥、牛蒡子、防风；如小便短涩者，热
结膀胱也，本方中加木通、滑石、车前子；如发惊搐者，肝心有热也，本方中加荆芥、防
风、钩藤钩、川黄连、羚羊角；如烦渴者，内热盛也，本方中加石膏、麦冬、花粉；如咳
嗽喘急者，肺郁风邪也，本方中加前胡、桔梗、杏仁、苏叶、桑皮；如伤食腹皮热者，胃
中停滞也，本方中加山楂、麦芽、枳壳；如下利者，肠胃热滞也，本方中加黄连、黄芩；
如作呕者，胸膈有痰饮也，本方中加半夏、生姜；如咽痛者，火在上焦也，本方中加牛蒡
子、苦桔梗；如遍身酸疼者，外染风寒也，本方中加羌活、独活；如头痛者，上冒风寒也，
本方中加荆芥穗、川芎、白芷、羌活。此治发热之大略，又贵临时详察，融会贯通也。
升麻葛根汤
升麻 葛根 赤芍药 生甘草
引加芫荽，水煎服。
归宗汤
形实无表毒火盛，所以归宗主大黄，地芍楂青通荆蒡，壮热爪紫肢厥凉，恶热头汗
蒸蒸汗，便秘谵语烦躁狂，大渴唇焦舌生刺，失血腰痛不循常。
【注】发热之初，形实者，形气壮实也。无表者，无风寒表邪也。若证见毒火太盛，法
当攻之。所以用归宗汤者，因其以大黄为主也，而佐使生地、赤芍、山楂、青皮、木通、
荆芥穗、牛蒡子也。痘未见点，如壮热不已，毒火炽盛也。爪甲色紫，血热凝滞也。四肢
厥冷，同阳证见者，热深厥深也。恶热，内热盛也。头汗出，胃热上蒸也。通身蒸蒸汗，
毒火内迫津液也。大小便闭，肠胃热结也。谵语，胃热也。烦躁狂乱，毒火扰心神也。大
渴引饮，毒火灼津液也。唇口焦烈，舌生芒刺，毒火胃热并盛也。失血者，口中失血、小
便尿血也。皆缘火毒迫血妄行也。其腰痛不寻常者，毒攻肾位也。已上诸证，非险则逆，
若见之急用此方峻攻火毒，庶可挽回，少有逡巡瞻顾，则无及矣。
归宗汤
大黄 生地黄 赤芍药 东山楂 青皮 木通 荆芥穗 牛蒡子（炒）
引加灯心，水煎服。
清解散
痘惊清解升葛蒡，荆防甘草桔连芩，蝉翘芎前楂通紫，表羌苏芷弱 参。
【注】痘欲出而发惊搐者，皆由其毒不得快然宣发，而郁于经也。其现证则面赤心烦，
口渴，手足抽搐，俱以清解散主之。或因风寒束于表者，其现证则无汗头疼，身体疼痛，
咳嗽喷涕，本方中加羌活、苏叶、白芷，以表发之。若兼形气虚弱者，其现证则面色浅
淡，身体微热，四肢微温，倦怠嗜卧，本方中加人参、黄 以托之。
清解散
防风 荆芥 牛蒡子（炒） 生甘草 升麻 葛根 桔梗 黄连 黄芩 蝉蜕 紫草茸
川芎 前胡 南山楂 木通 连翘（去心）
引加生姜、灯心，水煎服。
宽中透毒饮
伤食宽中透毒饮，葛桔前青朴枳楂，麦蝉翘蒡连荆草，便秘大黄木通加。
【注】痘欲出，发热，有现证呕吐、烦渴、大便酸臭，此兼伤食也，以宽中透毒饮主之。
若更大便秘、小便赤涩、腹热闷通者，此兼滞热也，本方中加大黄、木通通利之。
宽中透毒饮
葛根 桔梗 前胡 青皮 浓朴（姜炒） 枳壳（麸炒） 南山楂 麦芽（炒） 蝉蜕
连翘（去心） 牛蒡子（炒研） 黄连 荆芥穗 甘草（炒）
引加生姜、灯心，水煎服。
If fever persists for three days without subsiding, accompanied by irritability and thirst, teeth grinding, and a red face, along with startled crying, tremors, reduced milk intake, and inability to sleep peacefully at night, these are signs of a dangerous syndrome (Xian Zheng).
[Note] The appearance of measles spots after three days of fever is a normal pattern. If fever persists after the spots appear, it indicates excessive pathogenic toxin. Combined with irritability and thirst, frequent teeth grinding, reddish complexion, palpitations and frequent crying, body tremors, very little milk or food intake, and inability to sleep, this signifies that the toxin is excessive, latent, depressed, and difficult to erupt; this is clearly a dangerous syndrome! Immediate treatment according to the symptoms is required to hopefully transform the dangerous condition into a favorable one.
Fever accompanied by mental confusion, restlessness, delirious speech, wheezing and chest fullness, abdominal and lumbar pain, refusal to eat or sleep, continuous convulsions, dry retching, or bleeding constitutes a retrograde syndrome (Ni Zheng) with a ominous prognosis.
[Note] Fever with mental confusion, restlessness, and delirious speech indicates toxin latent in the Heart; wheezing and chest fullness/urgency indicates toxin latent in the Lung; abdominal pain indicates toxin latent in the Spleen; lumbar pain indicates toxin latent in the Kidney; refusal to eat or sleep indicates toxin latent in the Stomach; continuous startled convulsions indicate toxin latent in the Liver. Occasional dry retching and bleeding, hematemesis, and hematuria indicate toxin attacking the Qi and Blood causing internal chaos. These are all untreatable retrograde syndromes, and the condition is mostly ominous.
Fever following the eruption of measles originates internally [from fire-toxin], but one must consider the inducing factors: seasonal pathogens, wind-cold, fright, food stagnation, and heat. Treatment should be guided by exterior-interior and deficiency-excess patterns. Exterior heat presents with aversion to cold and absence of sweat; interior heat presents with sweating and difficulty in urination and defecation. Cases of weak Qi and mild heat require no specific intervention [referring to mild heat due to insufficiency]; cases of robust form and excessive heat belong to excess patterns.
[Note] Fever after the onset of measles refers to the fact that measles are fundamentally fire-toxin, hence fever precedes eruption. "From within" means the heat radiates from the interior to the exterior. "Induced by certain causes" means it is necessarily caused by irregular wind-cold pathogens of the four seasons leading to fever. "Fright" refers to external contact with strange objects or falls/startle causing fever. "Food" refers to internal injury from food stagnation causing fever. "Heat" refers to accumulated internal heat over time, manifesting externally. Since there are pathogenic factors both inside and outside, treatment must be detailed according to exterior-interior and deficiency-excess patterns. Exterior heat means heat is at the exterior level, presenting with aversion to cold and anhidrosis. Interior heat means heat is at the interior level, presenting with sweating, scanty dark urine, and dry difficult defecation. Weak Qi and mild heat mean insufficient constitution and mild fever. Robust form and excessive heat mean sufficient constitution and severe fever. If physicians can carefully observe at the moment and treat according to the syndrome, the methods of sweating, purging, clearing, and tonifying will naturally be appropriate.
Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction)
For fever, use Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction), a formula that benefits both releasing the exterior and venting measles. Ingredients: Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Paeoniae Radix Rubra (Chishao), Glycyrrhizae Radix et Rhizoma (Gancao). Modification according to symptoms yields the best results. For anhidrosis and exterior excess, add Ephedrae Herba (Mahuang) and Menthae Haplocalycis Herba (Bohe); for constipation and abdominal pain indicating interior excess, add Rhei Radix et Rhizoma (Dahuang); for timidity and Qi deficiency, add Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi); for excessive heat, add Rhinocerotis Cornu (Xijiao), Coptidis Rhizoma (Huanglian), Schizonepetae Spica (Jingjie), Arctii Fructus (Niubangzi), and Saposhnikoviae Radix (Fangfeng); for dysuria, add Plantaginis Semen (Cheqianzi); for convulsions, add Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Uncariae Ramulus cum Uncis (Gouteng), Coptidis Rhizoma (Huanglian), and Saigae Tataricae Cornu (Lingyangjiao); for irritability and thirst, add Gypsum Fibrosum (Shigao), Ophiopogonis Radix (Maidong), and Platycodonis Radix (Huafen); for cough, add Peucedani Radix (Qianhu), Platycodonis Radix (Jiegeng), Armeniacae Semen Amarum (Xingren), Perillae Folium (Ziyè), and Morus Cortex (Sangbai pi); for food stagnation with abdominal heat, add Crataegi Fructus (Zhāshā), Maltae Fructus (Maiya), and Aurantii Fructus Immaturus (Zhīké); for diarrhea, add Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian); for vomiting, add Pinelliae Rhizoma Preparatum (Banxia) and Zingiberis Rhizoma Recens (Shengjiang); for sore throat, add Arctii Fructus (Niubangzi), Platycodonis Radix (Jiegeng); for body ache, add Notopterygii Rhizoma et Radix (Qianghuo) and Angelicae Pubescentis Radix (Duhuo); for headache, add Schizonepetae Spica (Jingsui), Ligustici Chuanxiong Rhizoma (Chuanxiong), Angelicae Dahuricae Radix (Baizhi), and Notopterygii Rhizoma et Radix (Qianghuo).
[Note] For fever accompanying measles, Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction) should be the primary formula because it releases exterior pathogens and vents measles, making it an excellent dual-purpose formula. However, auxiliary herbs must be added according to symptoms for perfection. For example, if there is fever without sweat, this is exterior excess; add Ephedrae Herba (Mahuang) and Menthae Haplocalycis Herba (Bohe) to the base formula. If there is constipation and abdominal pain, this is interior excess; add Rhei Radix et Rhizoma (Dahuang). If the constitution is timid and Qi is weak, indicating innate insufficiency, add Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi). If heat is excessive, indicating blazing internal heat, add Rhinocerotis Cornu (Xijiao), Coptidis Rhizoma (Huanglian), Schizonepetae Spica (Jingjie), Arctii Fructus (Niubangzi), and Saposhnikoviae Radix (Fangfeng). If urine is scanty and difficult, indicating heat binding in the Bladder, add Akebiae Caulis (Mutong), Talcum (Huashi), and Plantaginis Semen (Cheqianzi). If convulsions occur, indicating heat in the Liver and Heart, add Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Uncariae Ramulus cum Uncis (Gouteng), Coptidis Rhizoma (Huanglian), and Saigae Tataricae Cornu (Lingyangjiao). If there is irritability and thirst, indicating excessive internal heat, add Gypsum Fibrosum (Shigao), Ophiopogonis Radix (Maidong), and Platycodonis Radix (Huafen). If there is cough and wheezing, indicating Wind-Cold depressing the Lung, add Peucedani Radix (Qianhu), Platycodonis Radix (Jiegeng), Armeniacae Semen Amarum (Xingren), Perillae Folium (Ziyè), and Morus Cortex (Sangbai pi). If there is food stagnation with hot abdomen, indicating gastric retention, add Crataegi Fructus (Zhāshā), Maltae Fructus (Maiya), and Aurantii Fructus Immaturus (Zhīké). If there is diarrhea, indicating intestinal-thermal stagnation, add Coptidis Rhizoma (Huanglian) and Scutellariae Radix (Huangqin). If there is vomiting, indicating phlegm-fluid in the chest and diaphragm, add Pinelliae Rhizoma Preparatum (Banxia) and Zingiberis Rhizoma Recens (Shengjiang). If there is sore throat, indicating fire in the Upper Jiao, add Arctii Fructus (Niubangzi) and Platycodonis Radix (Jiegeng). If there is generalized body ache, indicating external contraction of Wind-Cold, add Notopterygii Rhizoma et Radix (Qianghuo) and Angelicae Pubescentis Radix (Duhuo). If there is headache, indicating invasion of Wind-Cold on the head, add Schizonepetae Spica (Jingsui), Ligustici Chuanxiong Rhizoma (Chuanxiong), Angelicae Dahuricae Radix (Baizhi), and Notopterygii Rhizoma et Radix (Qianghuo). This is the general principle for treating fever, emphasizing careful observation and integration at the time of treatment.
Shengma Gegen Tang (Cinnamon Twig and Pueraria Decoction)
Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Paeoniae Radix Rubra (Chishao), Glycyrrhizae Radix et Rhizoma (Sheng Gancao).
Guide herb: Coriandri Fructus (Yansui). Decoct in water and take orally.
Guizong Tang (Return to the Ancestral Formula)
For robust constitution without exterior pathogens but with excessive toxin-fire, Guizong Tang uses Rhei Radix et Rhizoma (Dahuang) as the chief ingredient. Ingredients: Rehmanniae Radix Preparata (Shengdi), Paeoniae Radix Rubra (Chishao), Crataegi Fructus (Zhāshā), Aurantii Pericarpium Viride (Qingpi), Akebiae Caulis (Mutong), Schizonepetae Spica (Jingjie), Arctii Fructus (Niubangzi). Symptoms include high fever, purple nail beds, cold limbs, aversion to heat, profuse head sweating, generalized steaming sweat, constipation, delirium, irritability, mania, extreme thirst, cracked lips, prickly tongue, bleeding, and atypical lower back pain.
[Note] At the beginning of fever, "robust form" refers to strong Qi and physical strength. "No exterior" means absence of Wind-Cold exterior pathogens. If the syndrome shows excessive toxin-fire, the method should be purgation. Therefore, Guizong Tang is used because it takes Rhei Radix et Rhizoma (Dahuang) as the chief herb, assisted by Rehmanniae Radix Preparata (Shengdi), Paeoniae Radix Rubra (Chishao), Crataegi Fructus (Zhāshā), Aurantii Pericarpium Viride (Qingpi), Akebiae Caulis (Mutong), Schizonepetae Spica (Jingjie), and Arctii Fructus (Niubangzi). If measles spots have not yet appeared but high fever persists, it indicates blazing toxin-fire. Purple nail beds indicate blood heat and stasis. Cold limbs, when seen with Yang syndromes, indicate "deep heat leads to deep cold" (Re Shen Jue Shen). Aversion to heat indicates excessive internal heat. Head sweating indicates Stomach heat steaming upward. Generalized steaming sweat indicates toxin-fire forcing fluids outward. Constipation indicates heat binding in the intestines and stomach. Delirium indicates Stomach heat. Irritability and mania indicate toxin-fire disturbing the Heart Spirit. Extreme thirst with desire to drink indicates toxin-fire scorching fluids. Cracked lips and prickly tongue indicate simultaneous excess of toxin-fire and Stomach heat. Bleeding (oral or urinary) is due to fire-toxin forcing blood to move recklessly. Atypical lower back pain indicates toxin attacking the Kidney region. All the above syndromes are either dangerous or retrograde. If seen, urgently use this formula to vigorously purge fire-toxin to potentially save the patient; any hesitation will render treatment futile.
Guizong Tang (Return to the Ancestral Formula)
Rhei Radix et Rhizoma (Dahuang), Rehmanniae Radix Preparata (Shengdi), Paeoniae Radix Rubra (Chishao), Crataegi Fructus (Dong Zhāshā), Aurantii Pericarpium Viride (Qingpi), Akebiae Caulis (Mutong), Schizonepetae Spica (Jingjie), Arctii Fructus (Niubangzi, stir-fried).
Guide herb: Juncus Effusus (Dengxin). Decoct in water and take orally.
Qingjie San (Clear and Resolve Powder)
For measles with impending eruption and convulsions, use Qingjie San (Clear and Resolve Powder), containing Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Arctii Fructus (Niubangzi), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Glycyrrhizae Radix et Rhizoma (Gancao), Platycodonis Radix (Jiegeng), Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Cicadae Periostracum (Chantui), Forsythiae Fructus (Lianqiao), Ligustici Chuanxiong Rhizoma (Chuanxiong), Peucedani Radix (Qianhu), Crataegi Fructus (Zhāshā), Akebiae Caulis (Mutong), Lithospermi Radix et Rhizoma (Zicao). Add Notopterygii Rhizoma et Radix (Qianghuo), Perillae Folium (Ziyè), and Angelicae Dahuricae Radix (Baizhi) for exterior patterns; add Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) for deficiency patterns.
[Note] Convulsions occurring when measles are about to erupt are caused by toxin failing to vent smoothly and becoming depressed in the meridians. Presenting symptoms include red face, vexation, thirst, and convulsions of hands and feet; Qingjie San (Clear and Resolve Powder) is the main treatment. If caused by Wind-Cold binding the exterior, presenting with anhidrosis, headache, body ache, cough, and sneezing, add Notopterygii Rhizoma et Radix (Qianghuo), Perillae Folium (Ziyè), and Angelicae Dahuricae Radix (Baizhi) to the base formula to release the exterior. If accompanied by weak Qi and constitution, presenting with pale complexion, slight fever, slightly warm limbs, fatigue, and desire to lie down, add Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) to the base formula to support and expel toxin.
Qingjie San (Clear and Resolve Powder)
Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Arctii Fructus (Niubangzi, stir-fried), Glycyrrhizae Radix et Rhizoma (Sheng Gancao), Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Platycodonis Radix (Jiegeng), Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Cicadae Periostracum (Chantui), Lithospermi Radix et Rhizoma (Zicao Rong), Ligustici Chuanxiong Rhizoma (Chuanxiong), Peucedani Radix (Qianhu), Crataegi Fructus (Nan Zhāshā), Akebiae Caulis (Mutong), Forsythiae Fructus (Lianqiao, heart removed).
Guide herbs: Zingiberis Rhizoma Recens (Shengjiang), Juncus Effusus (Dengxin). Decoct in water and take orally.
Kuanzhong Toutu Yin (Broad the Middle and Vent Toxin Decoction)
For food stagnation, use Kuanzhong Toutu Yin (Broad the Middle and Vent Toxin Decoction), containing Puerariae Radix (Gegen), Platycodonis Radix (Jiegeng), Peucedani Radix (Qianhu), Aurantii Pericarpium Viride (Qingpi), Magnoliae Officinalis Cortex (Houpo), Aurantii Fructus Immaturus (Zhike), Crataegi Fructus (Zhāshā), Maltae Fructus (Maiya), Cicadae Periostracum (Chantui), Forsythiae Fructus (Lianqiao), Arctii Fructus (Niubangzi), Coptidis Rhizoma (Huanglian), Schizonepetae Spica (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao). Add Rhei Radix et Rhizoma (Dahuang) and Akebiae Caulis (Mutong) for constipation.
[Note] When measles are about to erupt, accompanied by fever, vomiting, irritability, thirst, and sour-smelling feces, this involves food stagnation; Kuanzhong Toutu Yin (Broad the Middle and Vent Toxin Decoction) is the main treatment. If there is also severe constipation, dark scanty urine, and abdominal heat/distension, this involves stagnant heat; add Rhei Radix et Rhizoma (Dahuang) and Akebiae Caulis (Mutong) to the base formula to promote unblocking and purging.
Kuanzhong Toutu Yin (Broad the Middle and Vent Toxin Decoction)
Puerariae Radix (Gegen), Platycodonis Radix (Jiegeng), Peucedani Radix (Qianhu), Aurantii Pericarpium Viride (Qingpi), Magnoliae Officinalis Cortex (Houpo, stir-fried with ginger juice), Aurantii Fructus Immaturus (Zhike, bran-stir-fried), Crataegi Fructus (Nan Zhāshā), Maltae Fructus (Maiya, stir-fried), Cicadae Periostracum (Chantui), Forsythiae Fructus (Lianqiao, heart removed), Arctii Fructus (Niubangzi, stir-fried and ground), Coptidis Rhizoma (Huanglian), Schizonepetae Spica (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao, stir-fried).
Guide herbs: Zingiberis Rhizoma Recens (Shengjiang), Juncus Effusus (Dengxin). Decoct in water and take orally.