发热时未出见，咳嗽百十声不已，喘急面浮眼胞肿，时卧时起，火毒内蒸肺叶焦枯，宜
人参白虎汤，或去参，加牛蒡子薄荷叶治之。
发热六七日明是疹子却不见出，此皮肤浓腠理密，或风寒封闭，或曾吐利乃伏也。急
用托里发表以麻黄葛根汤加蝉蜕，或麻黄散主之，外用胡荽酒敷之。如一向大便秘者，毒
甚于里，伏而不出，以桂枝大黄汤主之，外用猪胆导之，再不出者死证也。
客冒风寒致毒郁而不出，喘胀昏愦者，用葛根汤加紫苏柴胡川芎桔梗前胡荆芥防风蝉
蜕，或麻黄桂枝亦可暂用，或败毒散去人参加荆芥防风主之。又以防风煎汤浴头洗面手足，
又以苎麻蘸芫荽酒戛之，或以绢帛蘸热酒搭之俱妙。
疹已出而反没者，乃风寒所迫而然也，若不早治，毒内攻而死矣。急用消毒饮合升麻汤热服，
使疹复出方可无虞。
疹出不透，壮热喘胀，烦躁闷乱，毒内攻也。宜竹叶石膏汤或甘草桔梗干葛荆芥前胡
枳壳牛蒡治之，使疹出尽为妙。头面少者多加川芎，烦渴者黄连解毒汤，呕泄者黄连陈皮木
通泽泻山栀连翘甘草竹茹生姜等治之。
红影初出皮肤切戒风寒生冷，一或犯之则肌肤闭塞毒瓦斯壅滞，遂变为浑身青紫，毒反
内攻，烦躁腹痛，气喘闷乱，痒塌诸证作矣。欲出不出，危亡立至。父母医者其可忽诸。
初出吐泻者乃阳火得泄此吉兆也。宜升麻葛根汤主之，亦有兼伤食吐利者加消食药。
又云疹子吐泻者不须治，止要消毒散热。
疹初起烦躁谵语者，宜升麻葛根汤调辰砂益元散治之。
疹色红焰或微紫或太甚，并宜大青汤主之。黑者死证也，急用烧人屎研细酒调服。
（白马屎黄牛屎白狗屎猫屎猪屎皆可用，猫屎尤捷）须臾若黑变红色可治，人中黄火 代之
亦可，若出不透莫如发散解毒，仍用升麻葛根汤加牛蒡荆防蝉蜕连翘一二进服以清凉继
之，庶毒邪不为寒郁，后来亦易调理矣。疹子既出热甚不解，此毒邪壅遏，宜大青汤解其
表。便闭以黄连解毒汤合白虎汤解其里。大便不通四顺饮主之。
疹出身热咳嗽不止，乃余毒乘肺金也，以清金化毒汤主之。若更有痰宜橘红贝母桔梗
甘草芩连栝蒌仁连翘知母麦冬牛蒡灯心之类。咽喉肿痛加元参，喘者加石膏竹叶紫菀兜
铃苏子，虽喘而壮热者，亦宜竹叶石膏汤起剂而合前诸药，或加杏仁川朴，但不必用紫菀兜
铃苏子耳。石膏止可用一二帖不宜多服。石膏大寒性沉主降，小儿每服一二钱，大人倍
之，寒月煨用，夏月生用，杨氏《直指》曰∶赤疹遇清凉而后化，白疹得温暖而方消。
疹出咳嗽口干心烦者，毒在心肺发未尽也。泻白散加花粉连翘元参黄连以泻心火或黄连杏仁汤。
夏月出疹热甚烦渴是疹兼暑毒也。宜香薷饮合葛根汤，元气虚弱者禁用香薷辛温。
疹既出而发热吐利滞下者乃火邪内迫，上行则吐，下行则利，甚至毒盛则里急后重而
为滞下。吐者宜竹叶石膏汤去半夏主之，利者升麻泽泻汤。邪在中焦则吐利并作宜黄芩汤
加陈皮黄连竹茹。而里急后重者黄连解毒汤合天水散主之，或黄芩芍药汤加黄连生地木
通当归枳壳等治之，或少加大黄以微利之。
疹出时自利不止，或泻粪水频数者，最为恶候。但看疹若遍身稠太甚或紫或红者，则又
不妨。盖毒在大肠非泻则郁遏不解，惟用平胃散加葛根连翘以解之，疹子发透自然泻止；若
已收而泻不止者，疹尤未尽，加连翘黄连牛蒡木通泽泻以分利之。若用诃子肉果罂杰壳等
药，即变腹胀痞满喘急闷乱不治之证矣。
疹出后热不退，连绵三四日不收者，乃毒火太盛外发未尽，内有余邪，以大青汤或化斑
解毒三味消毒饮加元参桔梗石膏治之。
疹出时咽喉作痛不能饮食者，此毒火拂郁上蒸咽喉也，宜甘桔汤加元参牛蒡连翘知
母门冬花粉竹叶，或射干鼠粘子汤徐徐咽服，勿作喉疳同论，妄用针刺。
疹出浑身如锦纹者，化斑汤主之。色淡者血不足也，养血益荣汤主之。若黑斑者，十死
一生，急用大青汤主之。
形如锦纹而间有头粒赤者，壮热烦躁，舌胎或焦黄或燥黑，大便秘结，乃斑疹并行也。
宜调胃承气汤利之，继用白虎汤治之。
疹出而手足发 者，脾热也，宜消毒饮多加白芍药，少加防风即愈。
疹子之轻者，常以六时为度，如子后为阳午后收，午后为阴子后收，乃阳生阴成，阴生
阳化之理也，故渐出渐收者其热亦轻。
发热时疹子尚未透出，咳嗽频繁不止，气喘急促且面部浮肿、眼睑肿胀，时而躺卧时而起身，这是火毒在内熏蒸导致肺叶焦枯，适宜用人参白虎汤，或者去掉人参，加入牛蒡子和薄荷叶来治疗。
发热六七天，明显是疹子却不见透出，这是因为皮肤致密、腠理紧闭，或者是由于风寒闭塞，或者是之前曾发生呕吐腹泻导致邪气伏留。急需使用托里发表的方法，用麻黄葛根汤加蝉蜕，或者以麻黄散为主方；外用胡荽酒敷涂。如果一直大便秘结，说明毒素在体内很盛，伏留而不出，以桂枝大黄汤为主方，外用猪胆汁导便；如果再用此法仍不出疹，则是死证。
因客感风寒导致毒邪郁结而不能透出，出现气喘腹胀、神志昏沉者，用葛根汤加紫苏、柴胡、川芎、桔梗、前胡、荆芥、防风、蝉蜕，或者暂时使用麻黄桂枝汤，或者用败毒散去人参加荆芥、防风为主方。另外可用防风煎汤洗头洗脸及手足，又或用苎麻蘸取芫荽酒擦拭身体，或者用绢帛蘸热酒搭敷，都很有效。
疹子已经透出却又隐没回去的，是被风寒逼迫所致，如果不尽早治疗，毒邪内攻就会致死。急需使用消毒饮合升麻汤热服，使疹子再次透出才可以没有危险。
疹子透出不彻底，高热气喘腹胀，烦躁闷乱，这是毒邪内攻的表现。适宜用竹叶石膏汤，或者用甘草、桔梗、干葛、荆芥、前胡、枳壳、牛蒡子治疗，以使疹子完全透出为妙。头面部出疹少者多加川芎，烦渴者用黄连解毒汤，呕吐泄泻者用黄连、陈皮、木通、泽泻、山栀、连翘、甘草、竹茹、生姜等药物治疗。
红影刚出现在皮肤上，务必戒除风寒和生冷食物，一旦触犯则肌肤闭塞、毒气壅滞，随即变为浑身青紫，毒反内攻，出现烦躁腹痛、气喘闷乱、瘙痒塌陷等各种症状。想出而出不来，危亡立刻到来。父母和医生怎么可以忽视呢？
初起时出现呕吐泄泻的，是阳火得以宣泄，这是吉兆。适宜用升麻葛根汤为主方，也有兼夹伤食导致吐利的，加上消食药。
疹子初起时出现烦躁谵语的，适宜用升麻葛根汤调服辰砂益元散治疗。
疹色红如火焰，或微紫，或颜色过深，都适宜用大青汤为主方。发黑的是死证，急忙用烧过的死人屎研成细粉，用酒调服。（白马屎、黄牛屎、白狗屎、猫屎、猪屎都可以用，猫屎尤其灵验）片刻之后如果黑色变成红色还可以救治，人中黄代替也可以，如果疹子透出不彻底不如发散解毒，仍然用升麻葛根汤加牛蒡子、荆芥、防风、蝉蜕、连翘，服用一两次后以清凉药继之，这样毒邪就不会被寒邪郁遏，后来也容易调理了。疹子既已透出但高热不退，这是毒邪壅遏，适宜用大青汤解其表邪。大便闭结用黄连解毒汤合白虎汤解其里热。大便不通畅用四顺饮为主方。
疹子透出后身热咳嗽不止，是余毒乘袭肺金，以清金化毒汤为主方。如果还有痰，适宜用橘红、贝母、桔梗、甘草、黄芩、黄连、栝蒌仁、连翘、知母、麦冬、牛蒡子、灯心草之类药物。咽喉肿痛加玄参，气喘加石膏、竹叶、紫菀、兜铃、苏子，虽然气喘但壮热者，也适宜用竹叶石膏汤起剂并配合前述各种药物，或者加杏仁、厚朴，但不必用紫菀、兜铃、苏子。石膏只可用一二帖，不宜多服。石膏大寒性沉主降，小儿每次服用一二钱，成人加倍，寒冬腊月煨用，夏天生用。杨氏《直指》说：赤疹遇到清凉而后化解，白疹得到温暖才消散。
疹出时咳嗽、口干、心烦，是毒邪在心肺未能发散尽净。用泻白散加花粉、连翘、玄参、黄连以泻心火，或者用黄连杏仁汤。
夏季出疹，热甚烦渴，是疹子兼夹暑毒。适宜用香薷饮合葛根汤，元气虚弱者禁用香薷辛温之品。
疹子既已透出而又发热、吐利、痢疾的，是火邪内迫，上行则呕吐，下行则泄泻，甚至毒盛则里急后重而成为痢疾。呕吐者适宜用竹叶石膏汤去半夏为主方，泄泻者用升麻泽泻汤。邪气在中焦则吐利并作，适宜用黄芩汤加陈皮、黄连、竹茹。而里急后重者用黄连解毒汤合天水散为主方，或者用黄芩芍药汤加黄连、生地、木通、当归、枳壳等治疗，或者稍加大黄以轻微通下。
疹出时自利不止，或者泻粪水次数频繁的，是最为凶险的症候。但只要看疹子如果遍身稠密过甚，或者呈紫色或者红色，那么又不妨事。因为毒在大肠，不通过泻下则郁遏不解，只用平胃散加葛根、连翘来解除它，疹子发透自然泻止；如果疹子已经收束而泻不止，说明疹毒未尽，加连翘、黄连、牛蒡子、木通、泽泻来分利它。如果使用诃子肉、肉豆蔻、罂粟壳等药，就会变成腹胀痞满、气喘闷乱无法治疗的证候。
疹出后热不退，连绵三四日不收敛的，是毒火太盛外发未尽，内有余邪，以大青汤或化斑解毒三味消毒饮加玄参、桔梗、石膏治疗。
疹出时咽喉作痛不能饮食的，这是毒火拂郁上蒸咽喉，适宜用甘桔汤加玄参、牛蒡子、连翘、知母、门冬、花粉、竹叶，或者用射干鼠粘子汤徐徐咽服，不要当作喉疳同论，妄用针刺。
疹出浑身如锦纹的，用化斑汤为主方。颜色淡的是血不足，用养血益荣汤为主方。如果是黑斑，十死一生，急忙用大青汤为主方。
形状如锦纹而间有颗粒状红色的，壮热烦躁，舌苔或焦黄或燥黑，大便秘结，这是斑疹并行。适宜用调胃承气汤通利，随后用白虎汤治疗。
疹出而手足发冷的，是脾热，适宜用消毒饮多加白芍药，少加防风即愈。
疹子较轻的，通常以六个时辰为限度，如子时后为阳，午后收敛，午后为阴，子时后收敛，这是阳生阴成、阴生阳化的道理，所以渐出渐收的，其热势也轻。
When fever occurs and the rash has not yet appeared, with incessant coughing for dozens or hundreds of times, rapid panting, facial edema, and swollen eyelids, alternating between lying down and getting up, this indicates that fire-toxin is steaming internally, causing the lung lobes to become scorched and dry. It is appropriate to use Renshen Baihu Tang (Ginseng White Tiger Decoction), or remove Ginseng and add Niubangzi (Arctii Fructus) and Boheye (Menthae Haplocalycis Folium) for treatment.
After six or seven days of fever, if it is clearly a rash but does not appear, this is because the skin is dense and the couli (pores and interstices) are tight, or due to closure by wind-cold, or because previous vomiting and diarrhea caused the pathogen to lie latent. Urgently use methods to support the interior and release the exterior using Mahuang Gegen Tang (Ephedra and Pueraria Decoction) added with Chantui (Cicadae Periostracum), or primarily use Mahuang San (Ephedra Powder). Externally apply Huyijiu (Coriander Wine). If there has been persistent constipation, indicating severe toxin accumulation in the interior leading to latent non-appearance, treat primarily with Guizhi Dahuang Tang (Cinnamon Twig and Rhubarb Decoction), and externally use pig bile for enema. If the rash still does not appear after this, it is a death sign.
If external contraction of wind-cold causes toxin stagnation preventing eruption, accompanied by panting, distension, and coma, use Gegen Tang (Pueraria Decoction) added with Zisu (Perillae Folium), Chaihu (Bupleuri Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), and Chantui. Alternatively, Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction) may be temporarily used, or Baidu San (Toxin-Resolving Powder) with Ren Shen removed and Jingjie and Fangfeng added as the primary formula. Additionally, wash the head, face, hands, and feet with decoction of Fangfeng; rub the body with Zhuma (Ramie Stem) dipped in Huyijiu; or apply hot wine-soaked silk cloth. All these methods are excellent.
If the rash has erupted but retracts, it is forced back by wind-cold. If not treated early, internal attack by toxin will cause death. Urgently use Xiaodu Yin (Toxin-Resolving Drink) combined with Shengma Tang (Cimicifugae Decoction) taken hot, so that the rash re-emerges, ensuring safety.
Incomplete eruption of the rash, with high fever, panting, distension, restlessness, and confusion, indicates internal attack by toxin. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), or treat with Gancao (Glycyrrhizae Radix), Jiegeng, Gange (Puerariae Radix), Jingjie, Qianhu, Zhike (Aurantii Fructus), and Niubangzi, aiming for complete eruption. For few eruptions on the head and face, add more Chuanxiong; for irritability and thirst, use Huanglian Jiedu Tang (Coptis Detoxification Decoction); for vomiting and diarrhea, treat with Huanglian, Chenpi (Citri Reticulatae Pericarpium), Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Gancao, Zhuru (Bambusae Caulis in Taenia), and Shengjiang (Zingiberis Rhizoma Recens).
When red shadows first appear on the skin, strictly avoid wind-cold and raw/cold foods. Violating this causes skin closure and toxin stagnation, turning into whole-body cyanosis, internal toxin attack, irritability, abdominal pain, panting, confusion, itching, and collapse. Failure to erupt leads to immediate peril. Parents and physicians must not ignore this.
Vomiting and diarrhea at the initial stage indicate the release of yang-fire, which is an auspicious sign. Use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) as the primary formula. In cases complicated by food stagnation causing vomiting and diarrhea, add digestive herbs.
It is also said that vomiting and diarrhea during rash eruption require no specific treatment; only detoxification and heat-clearing are needed.
For irritability and delirium at the onset of rash, use Shengma Gegen Tang mixed with Chen Sha Yiyuan San (Cinnabar and Yi Yuan Powder).
For rash color bright red like flames, slightly purple, or excessively dark, use Daqing Tang (Isatidis Decoction) as the primary formula. Black color indicates a death sign; urgently administer finely ground calcined human feces mixed with wine. (Horse, cow, white dog, cat, and pig feces can all be used; cat feces is particularly effective.) If the black color turns red shortly after, it is treatable. Renzhonghu (Human Middle Yellow) can substitute. If eruption is incomplete, dispersal and detoxification are best; continue using Shengma Gegen Tang added with Niubangzi, Jingjie, Fangfeng, Chantui, and Lianqiao, followed by cooling agents to prevent cold-stagnation of toxin, facilitating later recovery.
If high fever persists after eruption, indicating toxin stagnation, use Daqing Tang to resolve the exterior. For constipation, use Huanglian Jiedu Tang combined with Baihu Tang to resolve the interior. For unsmooth bowel movements, use Sishun Yin (Four Harmonizing Drink).
Persistent fever and cough after eruption indicate residual toxin attacking the Lung Metal. Treat primarily with Qingjin Huadu Tang (Clear Metal and Resolve Toxin Decoction). If phlegm is present, use Juhong (Tangerine Peel), Beimu (Fritillariae Bulbus), Jiegeng, Gancao, Huangqin (Scutellariae Radix), Huanglian, Gualouren (Trichosanthis Semen), Lianqiao, Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Radix), Niubangzi, and Dengxincao (Junci Medulla). Add Xuanshen (Scrophulariae Radix) for sore throat; add Shigao (Gypsum), Zhuye (Bamboo Leaf), Ziwan (Asternis Radix), Doulou (Stemonae Radix), and Suzi (Perillae Fructus) for panting. Even with panting and high fever, Zhuye Shigao Tang can be used as a base combined with the above herbs, or add Xingren (Pruni Semen) and Houpo (Magnoliae Officinalis Cortex), but avoid Ziwan, Doulou, and Suzi. Shigao should only be used for one or two doses, not excessively, as it is very cold and heavy, directing downwards. Children take 1-2 qian per dose, adults double; roast in winter, use raw in summer. Yang Shi's *Zhizhi* states: Red rashes transform upon encountering cooling; white rashes dissipate upon receiving warmth.
Cough, dry mouth, and irritability during rash eruption indicate unresolved toxin in the Heart and Lung. Use Xiebai San (Drain White Powder) added with Huafen (Trichosanthis Radix), Lianqiao, Xuanshen, and Huanglian to drain Heart fire, or use Huanglian Xingren Tang (Coptis and Apricot Seed Decoction).
Rash in summer with severe heat, irritability, and thirst indicates rash combined with summerheat-toxin. Use Xiangru Yin (Elsholtzia Drink) combined with Gegen Tang. Contraindicated for those with weak yuanqi due to Xiangru's acrid-warm nature.
Fever, vomiting, diarrhea, and dysentery after rash eruption indicate internal pressure by fire-pathogen. Upward flow causes vomiting; downward flow causes diarrhea. Severe toxin causes tenesmus and dysentery. For vomiting, use Zhuye Shigao Tang removing Banxia (Pinelliae Rhizoma); for diarrhea, use Shengma Zexie Tang (Cimicifuga and Alisma Decoction). For pathogens in the middle jiao causing both, use Huangqin Tang (Scutellaria Decoction) added with Chenpi, Huanglian, and Zhuru. For tenesmus, use Huanglian Jiedu Tang combined with Tiansan San (Heavenly Three Powder), or Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) added with Huanglian, Shengdi (Rehmanniae Radix), Mutong, Danggui (Angelicae Sinensis Radix), and Zhike, possibly adding Dahuang (Rhei Radix et Rhizoma) for mild purgation.
Unremitting diarrhea or frequent watery stools during rash eruption is a dire prognosis. However, if the rash is dense, excessive, purple, or red, it is acceptable because the toxin is in the Large Intestine; without diarrhea, stagnation cannot resolve. Use Pingwei San (Peace the Stomach Powder) added with Gegen and Lianqiao to resolve it; once the rash fully emerges, diarrhea stops naturally. If diarrhea continues after rash resolution, the toxin is not fully cleared; add Lianqiao, Huanglian, Niubangzi, Mutong, and Zexie to separate and drain. Using Hesou Rou (Arecae Semen Preparatum), Rou Doukou (Myristicae Semen), and Yingjia Ke (Papaveris Pericarpium) will lead to abdominal distension, fullness, panting, and confusion, becoming untreatable.
Persistent fever for three to four days after rash eruption indicates excessive fire-toxin not fully released externally with residual pathogens internally. Use Daqing Tang or Huaban Jiedu Sanwei Xiaodu Yin (Three-Ingredient Toxin-Resolving Drink for Macule Resolution) added with Xuanshen, Jiegeng, and Shigao.
Sore throat and inability to eat during rash eruption indicate fire-toxin stagnating and steaming upward to the throat. Use Ganjie Tang (Licorice and Platycodon Decoction) added with Xuanshen, Niubangzi, Lianqiao, Zhimu, Mendong (Asparagi Radix), Huafen, and Zhuye; or slowly swallow Shegan Shuniuizi Tang (Belamcanda and Arctii Decoction). Do not confuse with Hougan (throat gangrene) or use blind needle pricking.
Whole-body rash resembling brocade patterns is treated primarily with Huaban Tang (Macule-Resolving Decoction). Pale color indicates blood deficiency; treat with Yangxue Yirong Tang (Nourish Blood and Enrich Prosperity Decoction). Black macules indicate ten deaths to one survival; urgently use Daqing Tang.
Brocade-like pattern interspersed with red granules, high fever, irritability, scorched yellow or dry black tongue coating, and constipation indicate simultaneous macules and rash. Use Tiaowei Chengqi Tang (Regulate the Stomach and Order Qi Decoction) to purge, followed by Baihu Tang.
Cold hands and feet during rash eruption indicate spleen heat. Use Xiaodu Yin adding more Shaoyao (Paeoniae Radix Alba) and less Fangfeng for cure.
Mild rashes typically last six shichen (twelve hours). Eruption after Zi hour (yang) resolves in Wu hour (afternoon/yin); eruption after Wu hour (yin) resolves in Zi hour (yang). This follows the principle of yang generating yin and yin transforming yang. Gradual emergence and resolution indicate milder heat.