麻喜如珠红润泽。红肿太甚又非吉。春火壅遏势堪忧。急治免教变紫黑。
麻出连串如珠。颗粒分朋。红活光润。方为美候。若麻出而红肿太甚者。此毒被壅遏所致。倘
不急治。必变紫黑、干枯、隐伏恶症。宜以化毒清表汤（见十六条）去桔梗、甘草。或清热透肌汤
（见二十五条）去甘草。加黄连、黄芩、枳壳、木通、山豆根、葶苈以治之。
朱曰 红肿太甚。热入血分。清热透肌汤中虽有元参。仍当再加凉血之品。
隐隐藏于皮肤中。欲出不透后多凶。疏托消毒与分利。须详三因始为工。
麻疹不能透表者。谓混身麻疹藏于皮肤之中。欲出而不能透也。古云。隐暗之麻后多凶。为
难治。然此不透之症。有三因。治者当详审而施治。一者因风寒郁遏。未能疏托。以致皮肤干燥。
毛窍竦立而然。此宜以疏托为主。以宣毒发表汤（见第五条）去升麻、桔梗、甘草。合越婢汤（见二
十三条）去炙甘草、生姜、红枣。加葱白、胡荽以发之。或用葛根疏邪汤（第三十三条）加胡荽、葱
白发之亦可。如表虚不胜疏托者。当以葱白一味煎浓汤。时时与服。但得微汗。风寒即解。而麻
自透。一者因火毒内炽。热极不能透表者。此症麻疹根地头粒混成一块。而色红紫。急宜消毒清
热。以白虎解毒汤（见二十六条）加荆芥、元参、连翘、牛蒡子治之。一者因中气本虚而不能透表
者。此症皮肤不燥。唇口淡白。二便如常。虽有蕴热。不可轻用寒凉。即用峻剂升发。亦终不得出
透。但当分利。使之内化可也。宜以消毒饮（见二十二条）去甘草。合三苓散加连翘、枳壳以分
利之。假使虚热内炽。唇口虽红。其色亦淡。此等症候。虽欲透而不能透也。只宜消毒。以消毒饮
（见二十二条）去甘草。加山豆根、连翘主之。又有一等。惟胸腹腰背暖处。止有一二处现有麻疹。
粒头赤红。头面手足之间。乍见乍无。此症必缠绵难已。且有收后五、七日复发如前。两三次而愈
者。此乃气候之异。非不透之症。此只宜辛凉透表。以清热透肌汤（见二十五条）去甘草治之。渐
次求安。欲冀速效。转增危殆。
朱曰 不透表证之风寒火毒二因。尚为易治。惟中气本虚。似宜加入参 。恐非升发分
利所能奏功。
三苓散
茯苓 猪苓（各二钱） 泽泻（三钱） 水煎服 伤暑者用朱砂灯心引。
The color of the measles rash should be lustrous and red like pearls. Excessive redness and swelling are not auspicious. In spring, when fire qi is stagnant and obstructed, the condition is worrying; urgent treatment is required to prevent the rash from turning purple-black.
When the measles erupts, the particles should be continuous like pearls, evenly distributed, with a lively red color and glossy moisture; this constitutes a favorable prognosis. If the rash erupts with excessive redness and swelling, it is caused by the obstruction and stagnation of pathogenic toxins. If not treated promptly, it will inevitably develop into malignant symptoms such as purple-black discoloration, dryness, or hidden eruption. It is appropriate to use Huadu Qingbiao Tang (Detoxifying and Exterior-Resolving Decoction) [see Article 16], removing Jiegeng (Platycodonis Radix) and Gancao (Glycyrrhizae Radix et Rhizoma); or alternatively, use Qingre Touji Tang (Heat-Clearing and Muscle-Penetrating Decoction) [see Article 25], removing Gancao (Glycyrrhizae Radix et Rhizoma), and adding Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhike (Aurantii Fructus), Mutong (Akebiae Caulis), Shandougen (Sophorae Tonkinensis Radix), and Tingli (Semen Lepidii seu Descurainiae) for treatment.
Zhu stated: Excessive redness and swelling indicate that heat has entered the Blood level. Although Xuan Shen (Scrophulariae Radix) is present in Qingre Touji Tang (Heat-Clearing and Muscle-Penetrating Decoction), blood-cooling herbs should still be added.
The measles hide faintly within the skin; if they desire to emerge but fail to penetrate fully, the prognosis is often ominous. Treatment requires methods to disperse, support, detoxify, and promote diuresis; one must carefully examine the "Three Causes" to be considered a skilled physician.
The term "measles failing to penetrate the exterior" refers to the condition where the entire body's measles are concealed within the skin, desiring to erupt but unable to do so. Ancient texts state: Measles with a dark and obscure appearance often have an ominous outcome later on and are difficult to treat. However, there are three causes for this failure to penetrate, and physicians must examine them carefully before treating. The first cause is stagnation and obstruction by Wind-Cold, failing to disperse and support, leading to dry skin and erect hair follicles. This situation should be primarily treated with dispersing and supporting methods, using Xuandu Fabiao Tang (Toxin-Releasing and Exterior-Resolving Decoction) [see Article 5], removing Shengma (Cimicifugae Rhizoma), Jiegeng (Platycodonis Radix), and Gancao (Glycyrrhizae Radix et Rhizoma), combined with Yuespi Tang (Yue Bi Decoction) [see Article 23], removing Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), and Hongzao (Jujubae Fructus), and adding Congbai (Allii Fistulosi Bulbus) and Husheng (Coriandri Fructus) to induce sweating and release the exterior. Alternatively, Gegen Shuxie Tang (Puerariae Radix Dispersing Pathogens Decoction) [Article 33] with added Husheng (Coriandri Fructus) and Congbai (Allii Fistulosi Bulbus) may also be used. If the exterior deficiency cannot tolerate dispersing and supporting therapies, decocting a strong solution of Congbai (Allii Fistulosi Bulbus) alone and administering it frequently is appropriate; once slight sweating occurs, the Wind-Cold will resolve, and the measles will naturally penetrate. The second cause is internal blazing of Fire-Toxin, where extreme heat prevents penetration. In this symptom presentation, the base and particles of the measles merge into a single mass with a red-purple color; urgent detoxification and heat-clearing are required, using Baihu Jiedu Tang (White Tiger Detoxifying Decoction) [see Article 26] with added Jingjie (Schizonepetae Herba), Xuan Shen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), and Niubangzi (Arctii Fructus). The third cause is inherent deficiency of Middle Qi preventing penetration. Symptoms include non-dry skin, pale lips and mouth, and normal urination and defecation. Although there is latent heat, cold-natured drugs should not be lightly used. Even potent ascending and releasing agents will ultimately fail to bring out the rash. Only diversion and drainage methods should be employed to transform the pathogen internally. It is suitable to use Xiaodu Yin (Detoxifying Infusion) [see Article 22], removing Gancao (Glycyrrhizae Radix et Rhizoma), combined with Sanling San (Three Poria Powder) with added Lianqiao (Forsythiae Fructus) and Zhike (Aurantii Fructus) for diversion and drainage. Suppose there is internal blazing of Deficiency-Heat; although the lips and mouth appear red, the color is pale. For such conditions, although one wishes for penetration, it is impossible; only detoxification is appropriate, using Xiaodu Yin (Detoxifying Infusion) [see Article 22], removing Gancao (Glycyrrhizae Radix et Rhizoma), and adding Shandougen (Sophorae Tonkinensis Radix) and Lianqiao (Forsythiae Fructus) as the main treatment. There is another category where measles appear only in one or two warm areas of the chest, abdomen, waist, and back, with red-purple heads, while appearing intermittently on the head, face, hands, and feet. This condition will surely be lingering and difficult to resolve, and may recur five to seven days after resolution, repeating two or three times before healing. This is due to climatic anomalies, not a failure to penetrate the exterior. Such cases require acrid-cool exterior-releasing methods, using Qingre Touji Tang (Heat-Clearing and Muscle-Penetrating Decoction) [see Article 25], removing Gancao (Glycyrrhizae Radix et Rhizoma), seeking gradual recovery. Seeking rapid effects will instead increase danger.
Zhu stated: Among the causes of failure to penetrate the exterior, Wind-Cold and Fire-Toxin are relatively easy to treat. Only inherent deficiency of Middle Qi suggests the addition of Renshen (Ginseng Radix et Rhizoma). It is feared that ascending/dispersing or diversion/drainage methods alone may not achieve success.
Sanling San (Three Poria Powder)
Fuling (Poria), Zhuling (Polyporus) (each 2 qian), Zexie (Alismatis Rhizoma) (3 qian). Decoct in water and take orally. For Heatstroke injuries, use Zhusha Dengxincao (Cinnabaris and Juncus Effusus Aerial Part) as the guide drug.