麻虽胎毒,多带时行,气候寒暄,非令男女,传染而成。其发也与痘相似,其变也比痘
匪轻。愚夫愚妇每视为泛常,若死若生总归于天命。不知毒起于胃,热流于心,始终之变,肾
则无证,脏腑之伤,肺则尤甚。闭户问涂,何若出门寻径;扬汤止沸,不如去火抽薪。
初时发热,俨以伤目出泪而不止,鼻流涕而不干,咳嗽太急,烦躁难安,以火照之隐隐
皮肤之下,以手抹之亭亭肌肉之间。其形如疥,其色若丹,随出随没,乍隐乍现。根窠若肿
兮麻而兼瘾,皮肤加赤兮麻以夹斑。似锦而明兮十有九吉,如煤而黯兮百无一痊。
麻毒最重治法不同,微汗常润热势越而
不容,清便自调毒瓦斯行而无壅。腠理怫郁兮即当发散,肠胃秘结兮急与疏通。苟忽大而若细
恐变吉而为凶。故衄血不必忧,邪从衄解;利血不必止,毒以利松。所喜者身上清凉,可畏
者咽中肿痛,渴饮不休法在生津养液,常餐若减调宜清胃和中。
又如出之太迟发表为贵,出之过甚解毒堪宜。母伐天和,常观岁气。寒威凛凛毒瓦斯郁
而不行,火势炎炎热邪乘之作戾,设施温补勿助其邪,若用寒凉休犯其胃。制其亢但得其
平,诛其暴无伤其正。远寒远热阴阳之胜负不齐,责实责虚人禀之强弱或异。
麻疹既出将息尤难,坐卧欲暖饮食宜淡。风寒若袭兮为肿为热,咸酸不禁兮为嗽为喘。
异气纵因外感,变象仍究内端。喉肿音哑,毒疠深陷,气促鼻扇,风寒闭关。便多脓血兮仓
廪有热,咳多涎沫兮华盖有痰。胸闷烦冤麻未出透,身凉气爽终保无虞。苟不详于临证,何以望其来苏。
麻疹虽然源于胎毒,但多夹杂时行疫气,因气候寒热失调,无论男女,通过传染而发病。其发作情形与痘疹相似,但其病情变化比痘疹更为严重。愚昧的百姓常将其视为平常之事,无论生死都归结于天命。却不知道毒邪起于胃,热邪流注于心,整个病程的变化中,肾脏通常没有明显证候,而在脏腑损伤方面,肺脏受损最为严重。这就好比关着门问路,不如出门寻找路径;扬汤止沸,不如抽去柴火灭火。
初期发热时,眼睛红肿流泪不止,鼻涕流出不干,咳嗽剧烈,烦躁不安难以平静。用火光照射,可见皮疹隐隐在皮肤之下;用手抚摸,可见疹子亭亭立于肌肉之间。疹形像疥疮,颜色像丹砂,随出随没,忽隐忽现。如果根部肿胀,则是麻兼瘾疹;如果皮肤更加红赤,则是麻夹斑疹。如果疹色红润鲜明,十有八九预后良好;如果疹色黑如煤炭且晦暗,则百无一治。
麻疹毒邪最重,治疗方法各不相同。轻微出汗并保持滋润,热势才能得以宣泄而不致壅滞;大小便自然调和,毒邪瓦斯才能运行通畅而无阻塞。如果腠理郁闭,就应当发散解表;如果肠胃秘结,就急需疏通导滞。如果忽视脉象由大转细,恐怕会将吉兆变为凶险。所以鼻出血不必担忧,因为邪气可以通过衄血而解除;下利脓血不必强行止住,因为毒邪可以通过下利而松动。令人欣慰的是身上清凉,值得畏惧的是咽喉肿痛。口渴饮水不止,治法在于生津养液;食欲减退,调理宜清胃和中。
又如疹发出太迟,以发表透疹为贵;疹发出过甚,以解毒为宜。不要伐害天和之气,要常观察岁气变化。如果寒气凛冽,毒邪瓦斯郁滞而不能运行;如果火势炎炎,热邪乘势作乱,此时施用温补之法不要助长邪气,如果使用寒凉药物不要损伤胃气。抑制亢盛之气只需达到平衡,诛伐暴烈之邪不要伤害正气。远离寒冷或炎热,是因为阴阳胜负情况不同;责求实证或虚证,是因为人体禀赋强弱各异。
麻疹既然发出,调护尤为困难。坐卧要注意保暖,饮食宜清淡。如果风寒侵袭,会导致肿胀发热;咸酸食物如果不适应,会导致咳嗽气喘。异气虽然因外感而起,但变象仍需探究内在原因。咽喉肿痛声音嘶哑,是毒疠深陷;气促鼻翼扇动,是风寒闭塞关口。大便多脓血,说明肠胃有热;咳嗽多涎沫,说明肺(华盖)有痰。胸闷烦冤,是麻疹未出透;身凉气爽,最终可保无虞。如果不详细考察临证表现,怎么能指望患者康复呢?
Although measles originates from fetal toxin (Tai Du), it is often accompanied by epidemic qi (Shi Xing). Due to irregular climate changes in cold and warmth, regardless of gender, it is contracted through transmission. Its onset resembles that of smallpox, but its pathological changes are more severe than those of smallpox. Ignorant people often regard it as ordinary, attributing life and death to fate. They do not know that the toxin arises from the Stomach, heat flows into the Heart, and throughout the course of the disease, there are no specific signs involving the Kidney. Among the internal organs, the Lung suffers the most damage. Asking for directions with closed doors is inferior to going out to find a path; stirring boiling water to stop boiling is inferior to removing the firewood to extinguish the fire.
In the initial stage, fever occurs. The eyes appear red with continuous tearing, nasal discharge flows without drying, coughing is severe, and restlessness makes it difficult to find peace. Shining a light reveals the rash faintly beneath the skin; touching it shows the papules standing out among the muscles. The shape resembles scabies, and the color resembles cinnabar. They appear and disappear intermittently, suddenly hidden and then visible. If the base is swollen, it indicates measles combined with urticaria (Yin Zhen); if the skin becomes redder, it indicates measles mixed with macules/purpura (Ban). If the rash is bright and lustrous like brocade, nine out of ten cases will be auspicious (favorable prognosis); if the rash is dark and dull like coal, none out of a hundred will recover.
The toxicity of measles is heaviest, and treatment methods differ accordingly. Mild sweating and constant moistening allow the heat pathogen to dissipate without obstruction. Natural regulation of urination and defecation ensures the smooth circulation of toxic vapors without stagnation. If the pores are congested and depressed, dispersing and releasing the exterior is indicated; if the intestines and stomach are constipated, urgent unblocking and dredging are required. Neglecting a pulse changing from large to fine may turn an auspicious sign into an ominous one. Therefore, epistaxis need not be feared, as the evil can be resolved through bleeding; bloody diarrhea need not be stopped forcibly, as the toxin can be loosened through purgation. What is pleasing is the coolness of the body; what is fearful is swelling and pain in the throat. Unremitting thirst and drinking require methods to generate fluids and nourish yin. A decrease in regular meals requires regulation to clear the stomach and harmonize the middle jiao.
Furthermore, if the eruption is too delayed, releasing the exterior is paramount; if the eruption is excessive, detoxification is appropriate. Do not harm the harmony of heaven and earth; always observe the annual qi. If the cold is biting, toxic vapors are depressed and fail to circulate; if the fire is blazing, heat pathogens take advantage to cause havoc. When applying warming and tonifying methods, do not assist the evil; when using cooling and purging methods, do not injure the stomach. Suppressing excess only needs to achieve balance; punishing violence must not damage the upright qi. Avoiding cold or heat depends on the uneven victory of yin and yang; determining excess or deficiency depends on the varying strength of constitutional endowment.
Once measles have erupted, nursing care is particularly difficult. Sitting and lying should keep warm, and diet should be bland. If wind-cold attacks, it causes swelling and heat; if salty and sour foods are intolerable, it causes cough and asthma. Although heterogenous qi arises from external contraction, pathological changes still require investigation of internal origins. Swollen throat and hoarseness indicate deep penetration of toxic pestilence; shortness of breath and nasal flapping indicate wind-cold closing the gates. Frequent pus and blood in stool indicates heat in the granary (intestines/stomach); frequent phlegm and saliva in cough indicates phlegm in the canopy (Lung). Chest fullness and vexation indicate measles not fully erupted; cool body and fresh breath ultimately ensure safety. Without detailed examination during clinical practice, how can one hope for recovery?