痧疹虽云秽液之气，必因风寒时气攻击则出，汗解之宜也，辛散之宜也。其可以苦者
坚之乎，寒者束之乎。经曰∶邪气盛则热，邪既盛矣非汗解何由而除。又曰∶发表不远热，表
既实非辛散何由而解。若表虚自汗疹毒易出，而妄投发表之药，不免蹈虚虚之戒；若表实无
汗大宜表散，则皮肤通畅麻疹易出矣。若犹未出亦不可再汗，恐致亡阳之变，只宜常以葱白
汤饮之，临证审明虚实而治之。
时行出疹发热，以火照之遍身，如涂朱之状，此将出之兆。形细密，与痘细密者相以，但
疹子出而易没，非若痘之以渐长大也。形鲜红与伤寒发斑相似，但疹之粒有小头，非若斑之
皮红成片如蚁蚤之迹也。发热之时遍身汗出者，毒从汗解，玄府开疹易出也。有鼻中血出
者，毒从衄解，俱不可遽止。若汗出太多，血出不止，此又火甚逼迫太过，致液妄流，血妄行，急以当归六黄
汤加浮小麦以止汗，茅花汤加元参百草霜以止衄，迟则汗出多而元气虚，血出多而精神散，转为不治之证矣。
渴喜饮水纯是火邪肺焦胃干心火亢故也。初发热渴者，升麻葛根汤加天花粉；已出
而渴者，加天花粉麦门冬。渴甚，白虎汤合黄连解毒汤主之。然疹发之时未有不口渴者，但当以绿豆灯心炒
陈米汤饮之，白虎汤佐之。若恣饮冷水必生水蓄之证，其有口不渴，渴不欲饮者，脾胃虚濡，有痰湿也。
身热脉浮头疼骨痛咳嗽气急哕恶不食者乃伤寒而兼出疹也。以十神解毒汤或败毒散
主之。如夏月宜升麻葛根汤加羌活荆芥白芷桔梗前胡知母枳壳治之。若得汗而疹透，但身
热者，香薷饮合化斑汤疗之。
痧疹虽然被认为是秽浊之气所致，但必须因风寒或时行疫气侵袭才会发作，适宜采用发汗解表的方法，也适宜采用辛味发散的方法。岂可用苦寒药物来坚阴收敛呢？岂可用寒凉药物来束闭邪气呢？《内经》说：邪气盛实则产生热象，既然邪气已经强盛，除了发汗解表，还有什么途径可以消除它呢？又说：发表散邪不宜远离温热药，既然表证实证已具，除了辛温发散，还有什么途径可以解除呢？如果患者表虚且自汗，疹毒容易透出，此时若妄用发表药物，不免触犯“虚其虚”（使虚弱者更虚弱）的禁忌；如果患者表实且无汗，则非常适宜使用表散法，这样皮肤腠理通畅，麻疹就容易透发出来。如果疹子仍然没有发出，也不可以再强行发汗，恐怕导致亡阳的变证，只宜经常饮用葱白汤，临证时要审明虚实再进行辨证治疗。
时行疫病出疹伴有发热，用火光照看全身，皮肤呈现像涂了朱砂一样的红色，这是疹子即将发出的征兆。疹形细密，与痘疮细密者相似，但疹子发出后容易消退，不像痘疮那样逐渐长大。疹色鲜红，与伤寒病发的斑疹相似，但疹子的颗粒有小头，不像斑疹那样皮红成片，如同蚂蚁或跳蚤叮咬的痕迹。发热时全身出汗的，说明毒邪随汗而解，玄府（汗孔）开启，疹子容易透出。有鼻中出血的，说明毒邪随衄血而解，都不可立即止血。如果汗出太多，或者鼻血不止，这是因为火邪太盛逼迫太过，导致津液妄泄，血液妄行，急需使用当归六黄汤加浮小麦来止汗，使用茅花汤加元参、百草霜来止衄血，如果拖延，汗出过多会导致元气虚弱，出血过多会导致精神涣散，最终转为不治之证。
口渴喜欢喝水，完全是因为火邪炽盛，导致肺焦胃干、心火亢旺的缘故。初起发热时口渴的，用升麻葛根汤加天花粉；疹子发出后仍口渴的，加天花粉、麦门冬。口渴严重的，用白虎汤合黄连解毒汤主治。然而疹子发出时，没有不口渴的，但应当以绿豆、灯心草、炒陈米煮成的汤饮服，辅以白虎汤。如果恣意饮用冷水，必然导致水饮停蓄的证候。那些口不渴，或者口渴但不想喝水的，是脾胃虚弱湿困，体内有痰湿的缘故。
身体发热、脉浮、头痛、骨痛、咳嗽、气急、呃逆、厌恶进食的，这是伤寒兼有出疹的表现。用十神解毒汤或败毒散主治。如果是夏季发病，适宜用升麻葛根汤加羌活、荆芥、白芷、桔梗、前胡、知母、枳壳来治疗。如果已经出汗且疹子透发，仅余身热的，用香薷饮合化斑汤治疗。
Although *shazhen* (scarlet fever/rash) is considered to be caused by turbid pathogenic factors, it must erupt due to attacks by wind-cold or seasonal epidemic qi. It is suitable for treatment via sweating to resolve the exterior and using acrid-dispersing methods. How could bitter-cold herbs be used to firm and astringe? How could cold herbs be used to bind and constrict? The Classics state: "When pathogenic qi is exuberant, heat arises." Since the pathogenic qi is already exuberant, apart from resolving the exterior through sweating, by what other means can it be eliminated? It also states: "Resolving the exterior does not distance itself from heat." Since the exterior excess syndrome is established, apart from acrid-dispersing methods, by what other means can it be resolved? If the exterior is deficient with spontaneous sweating, the rash toxin easily emerges; in such cases, recklessly administering exterior-resolving drugs inevitably violates the prohibition of "depleting the deficient." If the exterior is excess with no sweating, dispersing the exterior is highly appropriate, allowing the skin and pores to become unobstructed so that the measles/rash can easily emerge. If the rash has still not emerged, one must not sweat again, lest it lead to the complication of Yang collapse. One should only frequently administer Scallion White Decoction (*Congbai Tang*), and clinically assess deficiency and excess before treating.
During seasonal epidemics, when rashes appear accompanied by fever, illuminating the whole body with fire reveals a redness like vermilion paste, which is a sign that the rash is about to emerge. The lesions are fine and dense, resembling fine-dense smallpox, but unlike smallpox which gradually enlarges, these rashes emerge and disappear easily. The bright red color resembles the macules of *Shanghan* (Cold Damage), but unlike macules which form large red patches like ant or flea bites, these rashes have distinct granular heads. When fever occurs with whole-body sweating, the toxin resolves through sweat as the *Xuanfu* (pores) open, facilitating the emergence of the rash. In cases of epistaxis (nosebleed), the toxin resolves through nasal bleeding; neither sweating nor bleeding should be abruptly stopped. However, if sweating is excessive or bleeding continues uncontrollably, this indicates excessive fire forcing fluids and blood to flow recklessly. Urgently use Danggui Liuhuang Tang (Angelica Sinensis and Six Yellow Decoction) with floating wheat (*Fuxiaomai*) to stop sweating, and Maohua Tang (Thrush Flower Decoction) with Xuanshen (Scrophulariae Radix) and Baicaoshuang (Charred Herb Ash) to stop epistaxis. Delaying treatment will result in Qi deficiency from excessive sweating and spirit dispersion from excessive bleeding, turning into an untreatable condition.
Thirst and desire to drink water are solely due to fire pathogen scorching the Lungs, drying the Stomach, and hyperactivity of Heart Fire. For thirst at the initial stage of fever, Shengma Gegen Tang (Kudzu Root and Cimicifuga Decoction) with Tianhuafen (Trichosanthis Radix) is used. For thirst after the rash has emerged, add Tianhuafen and Maimendong (Ophiopogonis Radix). For severe thirst, Baihu Tang (White Tiger Decoction) combined with Huanglian Jiedu Tang (Coptis Detoxification Decoction) is the primary treatment. However, during the eruption of rashes, there is no case without thirst; one should primarily drink soup made from mung beans, rush pith (*Dengxincao*), and stir-fried aged rice, assisted by Baihu Tang. Reckless consumption of cold water will inevitably lead to water retention syndromes. Those who do not feel thirsty, or feel thirsty but do not wish to drink, suffer from Spleen-Stomach deficiency with dampness and phlegm accumulation.
Body heat, floating pulse, headache, bone pain, cough, rapid breathing, hiccups, and aversion to food indicate *Shanghan* complicated by rash eruption. Treat with Shishen Jiedu Tang (Ten Divine Detoxification Decoction) or Baidu San (Defeat Poison Powder). In summer, Shengma Gegen Tang added with Qianghuo (Notopterygii Rhizoma), Jingjie (Schizonepetae Herba), Baizhi (Angelicae Dahuricae Radix), Jiegeng (Platycodonis Radix), Qianhu (Peucedani Radix), Zhimu (Anemarrhenae Rhizoma), and Zhike (Aurantii Fructus) is appropriate. If sweating occurs and the rash fully emerges, leaving only residual body heat, Xiangru Yin (Elsholtzia Drink) combined with Huaban Tang (Resolve Macules Decoction) is used for treatment.