也。治以宣气泄肺清火解毒之法。乃痧毒火邪郁于气分。上灼肺金之正治。
发喘 凡痧 透发不尽。毒邪干肺。喘急昏闷者。危症也。宜急透之。
焦麻黄（八分） 石膏（四钱） 杏仁（二钱） 牛蒡子（一钱五分）
连翘（一钱五分） 枯芩（一钱五分） 象贝母（一钱五分） 薄荷（八分）
桔梗（八分） 犀角尖（八分） 生甘草（四分） 通草（一钱） 芦根（一握）
邵评∶此痧毒内伏郁闭之症。或着寒冒风。皆能致此。寻常疹子则无此症。盖痧
出而不尽透。毒伏于内。郁闷肺闭。而昏喘气急者。大危之症。非麻黄大开肺气。
则不能救。再用石膏以清火。杏仁以下气。甘草以缓急而泻火毒。加犀角、桔梗等味。提透清化为治。
咳嗽 痧后咳嗽。余热在肺也。宜泻白散。加贝母、橘红、杏仁、枯芩、知母、花粉、甘桔、
梨浆之类清之。
邵评∶此痧疹余邪蕴肺而咳嗽之良法。
伤阴 凡痧 伏邪未清。致伤阴分。而发热不止者。宜甘凉养阴。如沙参、骨皮、麦
冬、玉竹、云苓、金斛、生地、白芍、丹皮、甘草之类。
邵评∶此痧后伏邪伤肺胃之阴液。因而发热之正法。
伏邪 凡痧 等症。外虽透达。易隐易回。而身热不除。渐加喘咳。腹胀咽痛。喉哑
龈烂。神昏欲寐。或兼赤利等症者。此系失潮。伏邪在内。危症也。急宜散邪解毒。如
犀角、连翘、牛蒡、射干、元参、杏仁、楂肉、人中黄、净银花、西黄、通草之类。
邵评∶痧毒内伏。上中下三焦均受其戕也。盖痧子出没有潮数。见点三日方齐。
每日三潮。三日九潮。潮后渐渐退没。则痧毒尽透。若未潮足而早回。则邪伏于内。咳喘龈烂。喉哑咽
痛。毒火上扰也。腹胀赤利。邪火下注也。身热神昏欲寐。痧毒闭伏于中也。上中下三焦俱受
邪侵。必正不胜邪而败矣。急急提透疹邪。清热解毒为治。必使痧毒外散。方有生机。
如痧 隐没太早。以致发热咳喘者。此伏邪在肺也。速宜开宣肺气。迟则不治。如
栀豉、桑杏、羚羊、牛蒡、连翘、前胡、薄荷、桔梗、芦根之类主之。
邵评∶按此等药。虽是开宣肺气为主。然初起即用。或有灵效。若喘热势盛。似乎
嫌轻。当以麻杏汤治之为是。然此条痧隐太早。邪遏于肺。病在上焦。较前条稍轻。故以轻宣法治之。
阴虚 凡少阴水亏之人。感挟时邪。而发 疹。不可过用柴葛升散。缘此症。虽表
不得汗解。或虽得汗。而 疹未透。热仍不解。惟清解中兼养阴液。庶能得汗。而
疹亦易透达。如遇时感。诊得脉象细数。或沉细。外症。欲寐不寐。舌形微白兼红。或
紫色而干。即是少阴虚症。或已经表散不应者。急宜用生地、骨皮、沙参、茯苓、麦冬、
金斛、花粉、牛蒡、连翘、甘草之品。以养阴液。自然疹随汗达。身凉而解。如兼舌燥口
渴而便秘者。加犀角数分。合阳明治之。或加豆豉。
邵评∶此肾水素虚之人。外受湿热暑湿时邪而发 疹。非天行时痧之症。当从三焦立法。用手经药清
透。各随其所受之邪而施治。非足经药之柴葛升散发表者所宜。即使发表得汗。此非风寒表症。其邪不
能从汗而解。 疹何能外达。况本属水亏之人。病是温热。而非风寒。尤忌发汗伤阴。故必清解温暑热邪。
甘凉滋液之法。俾得营卫之邪。从肺达而出疹。阳明之邪。由胃而发 。温热暑邪。随 疹而化解矣。
至脉细数而沉细。温热入少阴之脉象也。欲寐。少阴本症也。复不得寐。烦热也。微白而红。温热初起之舌
也。少阴舌本紫干者。热而津亏也。此少阴温热而阴液素虚之症。急急滋液达邪。阴液充复。则邪气达。
自然得汗。非用药强发而汗出也。
又评∶此阴虚而受温暑时邪之症。当救液达邪。辨明营卫而治。邪从 疹而解。
如见阳明症象。可合阳明法治之。
凡痧 瘾疹。最宜通泄。虽下利五色。亦不妨。惟二便不利。最为凶候。如遇此症。勿实脾止泻。
邵评∶痧疹因受外邪而病。或见吐泻。则内邪由吐下而外泄。此是顺症。若二便
不利。则邪毒壅遏。最多闭结。故为凶候。凡痧疹吐泻。大忌止涩。
罢了。治疗采用宣通肺气、清泄肺火、解毒的方法。这是针对痧毒火邪郁结在气分，向上灼伤肺金的正确治法。
发喘：凡是出痧疹，如果透发不彻底，毒邪侵犯肺部，导致气喘急促、神志昏闷的，属于危重病症。应当紧急透发疹毒。
处方：焦麻黄（八分）、石膏（四钱）、杏仁（二钱）、牛蒡子（一钱五分）、连翘（一钱五分）、枯芩（黄芩去心，一钱五分）、象贝母（浙贝母，一钱五分）、薄荷（八分）、桔梗（八分）、犀角尖（八分）、生甘草（四分）、通草（一钱）、芦根（一握）。
邵评：这是痧毒内伏、郁闭不通的病症。或者因为受寒冒风，都能导致这种情况。普通的疹子不会有这种症状。大概是因为痧疹出而不透，毒邪伏于体内，郁闷肺气闭塞，从而出现昏沉喘息、气急的症状，这是非常危险的病症。如果不使用麻黄大力开宣肺气，就不能挽救。再配合石膏来清泻火热，杏仁来降气，甘草来缓解急迫并泻火毒，加入犀角、桔梗等药物，以提透、清化为治疗原则。
咳嗽：痧疹后的咳嗽，是余热仍在肺部的表现。适宜使用泻白散，加贝母、橘红、杏仁、枯芩、知母、花粉、甘桔、梨浆等药物来清解。
邵评：这是治疗痧疹余邪蕴结在肺部而导致咳嗽的良好方法。
伤阴：凡是出痧疹，如果伏留的邪气未清除干净，导致损伤阴分，而发热不止的，适宜用甘凉的药物滋养阴液。如沙参、地骨皮、麦冬、玉竹、云苓（茯苓）、金斛（石斛）、生地、白芍、丹皮、甘草等类药物。
邵评：这是痧疹后伏留的邪气损伤肺胃阴液的正当治法。
伏邪：凡是出痧疹等病症，虽然外表看似透达，但容易隐没反复，且身热不退，逐渐加重出现气喘咳嗽、腹胀咽痛、声音嘶哑、牙龈腐烂、神志昏沉想睡觉，或者兼有赤色痢疾等症状的。这是由于失于“潮”（指痧疹透发的规律），伏邪留在体内，属于危重病症。应当紧急疏散邪气、解除毒素。如犀角、连翘、牛蒡子、射干、元参（玄参）、杏仁、山楂肉、人中黄、净银花（金银花）、西黄（牛黄）、通草等类药物。
邵评：痧毒内伏，上、中、下三焦都受到它的伤害。大概痧疹的发出有“潮数”的规律，见到斑点三天才齐整，每天三次潮涌，三天九次潮涌，潮涌过后渐渐退没，那么痧毒就完全透发了。如果没有达到应有的潮数就过早回隐，那么邪气就伏留在体内，出现咳嗽气喘、牙龈腐烂、声音嘶哑、咽喉疼痛，这是毒火上扰的表现。腹胀、赤色痢疾，是邪火向下注注的表现。身热、神志昏沉想睡觉，是痧毒闭伏在中焦的表现。上、中、下三焦都受到邪气侵袭，必定是正气不能战胜邪气而导致败亡。必须紧急提升透发疹邪，以清热解毒为治疗原则。一定要使痧毒向外发散，才有生机。
如果是痧疹隐没太早，导致发热、咳嗽、气喘的，这是伏邪在肺部。应当迅速开宣肺气，拖延则无法治愈。如栀子豉汤、桑杏汤、羚羊角、牛蒡子、连翘、前胡、薄荷、桔梗、芦根等药物为主进行治疗。
邵评：按照这些药物，虽然是以开宣肺气为主，但如果初起时就使用，或许会有灵验的效果。如果气喘、热势旺盛，似乎嫌药力轻了，应当用麻杏石甘汤治疗才是正确的。然而这一条讲的是痧疹隐没太早，邪气遏制在肺部，病位在上焦，比前一条稍微轻一些，所以用轻宣法治之。
阴虚：凡是少阴肾水亏虚的人，感受夹杂时行邪气，而发疹，不可过度使用柴胡、葛根等升散药物。因为这个病症，虽然表证不得通过发汗解决，或者虽然发了汗，但疹子没有透发，热仍然不解。只有在清解的同时兼顾滋养阴液，才能得汗，而且疹子也容易透发。如果遇到时行感邪，诊察脉象细数，或者沉细，外症表现为想睡觉又睡不着，舌形微白兼红，或者紫色而干燥，这就是少阴虚症的征象。或者已经经过表散治疗却无效的，应当紧急使用生地、地骨皮、沙参、茯苓、麦冬、金斛、花粉、牛蒡子、连翘、甘草等药物，来滋养阴液。自然疹随汗而出，身体凉爽而病解。如果兼有舌燥、口渴、便秘的情况，加入犀角数分，合阳明经治法一起治疗。或者加入豆豉。
邵评：这是肾水素来亏虚的人，外受湿热、暑湿时邪而发疹，不是天行时痧的病症。应当从三焦立法，用手经药物清透，各自根据所受的邪气施治，不适合使用足经药物如柴胡、葛根等进行升散发表。即使通过发表得了汗，这也不是风寒表证，邪气不能通过汗液而解，疹子怎么能外达呢？况且本属水亏之人，病是温热性质，而不是风寒，尤其忌讳发汗伤阴。所以必须用清解温暑热邪、甘凉滋液的方法，使得营卫的邪气，从肺脏透出而发疹；阳明的邪气，由胃腑发出；温热暑邪，随着疹子的发出而化解。
至于脉象细数而沉细，是温热邪气进入少阴的脉象。想睡觉，是少阴的本症。却又睡不着，是烦热的表现。舌苔微白而红，是温热初起的舌象。少阴舌本应紫干，是热盛而津液亏损的表现。这是少阴温热而阴液素来亏虚的病症，必须紧急滋润阴液以驱除邪气。阴液充盈恢复，那么邪气就能排出，自然得汗，这不是用药强行发汗而出的。
又评：这是阴虚而感受温暑时邪的病症，应当救阴液以驱除邪气，辨明营卫而治疗。邪气从疹子而解。如果见到阳明症的征象，可以合用阳明经的治法。
凡是出痧疹并发瘾疹，最宜通泄。虽然出现五色痢疾，也不妨碍。只有大小便不利，是最凶险的征候。遇到这种情况，不要实脾止泻。
邵评：痧疹因为感受外邪而发病，如果出现吐泻，那么内邪通过呕吐和腹泻向外排泄，这是顺症。如果大小便不利，那么邪毒壅遏，最多导致闭结，所以是凶候。凡是痧疹伴有吐泻，大忌使用止涩药物。
... [End of treatment]. The treatment employs the method of diffusing Lung Qi, clearing and draining Lung fire, and detoxifying. This is the correct approach for Sha (scarlet fever-like rash) toxin and fire pathogen stagnating in the Qi level, burning upwards to damage Lung Metal.
Wheezing: In cases of Sha, if the rash fails to fully erupt, and the toxic pathogen invades the Lung, leading to urgent wheezing and mental confusion or lethargy, this is a critical condition. It is imperative to urgently promote the eruption of the rash.
Prescription: Jiao Mahuang (Scorched Ephedrae Herba, 8 fen), Shigao (Gypsum Fibrosum, 4 qian), Xingren (Armeniacae Semen Amarum, 2 qian), Niubangzi (Arctii Fructus, 1.5 qian), Lqiao (Forsythiae Fructus, 1.5 qian), Ku Qin (Scutellariae Radix with heart removed, 1.5 qian), Xiang Beimu (Fritillariae Thunbergii Bulbus, 1.5 qian), Bohe (Menthae Haplocalycis Herba, 8 fen), Jiegeng (Platycodonis Radix, 8 fen), Xijiaojian (Rhinocerotis Cornu Apex, 8 fen), Sheng Gancao (Glycyrrhizae Radix et Rhizoma Raw, 4 fen), Tongcao (Tetrapanacis Medulla, 1 qian), Lugeng (Phragmitis Rhizoma, one handful).
Shao's Commentary: This is a condition where Sha toxin is internally latent and obstructed. Contracting cold or wind can also cause this. Ordinary rashes do not present such symptoms. Generally, because the Sha does not fully erupt, the toxin remains latent inside, causing depression and closure of Lung Qi, resulting in lethargy, wheezing, and rapid breathing; this is a highly critical condition. Without Mahuang to vigorously open and diffuse Lung Qi, rescue is impossible. Combined with Shigao to clear fire, Xingren to direct Qi downward, and Gancao to relieve urgency and drain fire toxin, along with Xijiao and Jiegeng, the treatment principle focuses on lifting, diffusing, clearing, and transforming.
Cough: Cough following Sha is due to residual heat remaining in the Lung. Xiebai San (Drain the White Decoction) should be used, added with Beimu, Juhong, Xingren, Ku Qin, Zhimu, Huafen, Ganjie, and Lizhi (Pear Juice) to clear the heat.
Shao's Commentary: This is an excellent method for treating cough caused by residual Sha pathogens accumulating in the Lung.
Yin Injury: In cases of Sha, if latent pathogens are not cleared, leading to injury of the Yin aspect and persistent fever, sweet-cool herbs nourishing Yin should be employed. Examples include Shashen, Gupi (Dugongpi/Goubipi - Cortex Lycii), Maidong, Yuzhu, Yunling (Poria), Jinhu (Dendrobii Caulis), Shengdi, Baishao, Danpi, and Gancao.
Shao's Commentary: This is the proper method for post-Sha latent pathogens injuring the Yin fluids of the Lung and Stomach, thereby causing fever.
Latent Pathogen: In conditions like Sha, although the exterior appears resolved, the rash may easily hide and recur, accompanied by persistent fever that gradually worsens with wheezing and cough, abdominal distension, sore throat, hoarseness, gingival ulceration, mental confusion with drowsiness, or concomitant red dysentery. This results from a failure in the "tide" (regular eruption cycles), leaving latent pathogens inside; it is a critical condition. Urgently disperse pathogens and detoxify using Xijiao, Lqiao, Niubang, Shegan, Yuan Shen, Xingren, Zharou (Hawthorn Flesh), Renzhonghuang, Jing Yinhua (Flos Lonicerae Japonicae Purified), Xi Huang (Bovis Calculus), and Tongcao.
Shao's Commentary: When Sha toxin is latent internally, the Upper, Middle, and Lower Jiao are all damaged. The eruption of Sha follows specific "tides." Points appear over three days until uniform, with three tides daily, totaling nine tides over three days. After the tides subside, the toxin is fully erupted. If the tides are insufficient and the rash retreats early, pathogens remain latent, causing cough, wheezing, gingival ulceration, hoarseness, and sore throat due to toxic fire harassing upward. Abdominal distension and red dysentery indicate evil fire pouring downward. Fever, mental confusion, and drowsiness indicate Sha toxin closed within the Middle Jiao. With invasion of all three Jiaos, righteous Qi will inevitably fail against the pathogen. One must urgently lift and diffuse the rash pathogen, treating with clearing heat and detoxifying. Only when the Sha toxin disperses outward is there hope for survival.
If Sha hides too early, causing fever, cough, and wheezing, the latent pathogen is in the Lung. Quickly open and diffuse Lung Qi; delay renders it untreatable. Use Zhichi (Gardeniae Fructus and Fermented Soybean), Sangxing (Mulberry Leaf and Apricot Kernel decoction), Lingyang (Capri Cervi Cornu), Niubang, Lqiao, Qianhu, Bohe, Jiegeng, and Lugeng as main treatments.
Shao's Commentary: Although these herbs primarily open and diffuse Lung Qi, they may be effective if used at the onset. However, if wheezing and heat are severe, the formula might be too light; Maxing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) would be appropriate. Nevertheless, this clause describes Sha hiding too early, with pathogens constrained in the Lung (Upper Jiao), which is slightly milder than the previous case, hence the use of a light diffusing method.
Yin Deficiency: For individuals with inherent Kidney Water deficiency contracting seasonal pathogens who develop rashes, one must avoid excessive use of Chaihu and Gegen (Bupleuri Radix and Puerariae Radix) for ascending and dispersing. In this condition, even if the exterior cannot be resolved via sweating, or if sweating occurs but the rash does not erupt and heat persists, one must combine clearing/detoxifying with nourishing Yin fluids. Only then can sweat occur, allowing the rash to erupt easily. When encountering seasonal infections, if the pulse is fine and rapid or deep and fine, and external symptoms include drowsiness alternating with wakefulness, a tongue coating slightly white mixed with red, or purple and dry, this indicates Shaoyin deficiency. If surface-dispersing treatments have failed, urgently use Shengdi, Gupi, Shashen, Fuling, Maidong, Jinhu, Huafen, Niubang, Lqiao, and Gancao to nourish Yin fluids. Naturally, the rash will emerge with sweat, and the body will cool and resolve. If accompanied by dry tongue, thirst, and constipation, add several fen of Xijiao and treat according to the Yangming pattern. Alternatively, add Douchi (Fermented Soybean).
Shao's Commentary: This refers to rashes in individuals with constitutionally deficient Kidney Water due to external damp-heat or summer-heat seasonal pathogens, not epidemic Sha. Treatment should follow the Three Jiao principles, using Hand-Jiao herbs to clear and diffuse, tailored to the specific pathogen. It is unsuitable to use Foot-Jiao herbs like Chai and Gegen for ascending and dispersing the exterior. Even if sweating is achieved through dispersal, this is not a Wind-Cold exterior syndrome; the pathogen cannot exit via sweat, nor can the rash emerge. Moreover, since the root is Water deficiency and the disease is Warm-Heat rather than Wind-Cold, sweating that injures Yin is strictly contraindicated. Therefore, one must clear and resolve warm-summer heat pathogens using sweet-cool methods to moisten fluids, allowing Ying and Wei pathogens to exit via the Lung as rash, Yangming pathogens to emerge from the Stomach, and warm-summer heat pathogens to dissolve with the rash.
Fine, rapid, and deep pulses indicate Warm-Heat entering Shaoyin. Drowsiness is a primary Shaoyin symptom; inability to sleep indicates irritability and heat. A coating slightly white and red indicates early Warm-Heat. A Shaoyin tongue being purple and dry indicates heat consuming fluids. This is a Shaoyin Warm-Heat condition with inherent Yin deficiency. Urgently moisten fluids to drive out pathogens. Once Yin fluids are replenished, pathogens exit, and natural sweating occurs; this is not forced sweating via medication.
Additional Commentary: This is a condition of Yin deficiency contracting warm-summer seasonal pathogens. One must rescue fluids and drive out pathogens, distinguishing between Ying and Wei levels. The pathogen resolves via the rash. If Yangming symptoms appear, combine with Yangming treatment methods.
In all Sha and Urticaria cases, unblocking and purging are most suitable. Even if five-colored dysentery occurs, it is not necessarily detrimental. However, obstruction of urination and defecation is the most ominous sign. In such cases, do not tonify the Spleen to stop diarrhea.
Shao's Commentary: Sha arises from external pathogens. Vomiting and diarrhea allow internal pathogens to exit via the gastrointestinal tract, representing a favorable progression. Conversely, obstruction of urination and defecation leads to entrapment and accumulation of toxic pathogens, often resulting in constipation/obstruction, making it an ominous sign. In Sha with vomiting and diarrhea, astringents are strictly forbidden.