斑疹本为肺胃火毒，故壮热烦渴，喜冷浩饮，此其常也。然即纵其冷冻饮料，则冰遏热
毒在内，且津液遇冷则凝，而燥渴益甚，况胃喜凉饮而恶热，得冷入口，勿论虚实，无
不爽快也。肠喜热饮而恶寒，流寒下焦，勿论虚实无不受伤也。轻则激其虚火上升，寒
热不已，重则迫其热毒下注，泻利无休。更有误以烦渴喜冷为实热，峻用芩连苦寒之
药，殊不知火之有余，由水之不足，即渴者，乃脏腑津液燥槁而为病也。少火变为壮
热，宗气已亡于中，孤阴外覆肌表，荣道已竭于里。若不求阴阳至理而调之，徒以时行
外染之客病为主治，壮者因循日久而愈，弱者悠忽变症而亡，故凡有壮热烦渴，视此可
以例推矣。奈何北方凡患热病喜冷者，谓之咯水病，病家则任饮凉水，医家则峻投寒
药，以致愈饮愈渴、愈寒愈热，逼其浮越之虚阳，尽耗于肌表，必致身冷而已，独不思
温能除大热之语，何也？要知千变万化之病，多由身中之火，不安其位，卫冲巅顶则
头疼，越于肌表则身热，浮于头面则脸红，客于会厌则咽痛，得其平则安其位，外邪不
能入而为真阳之正气。失其常则离其位，外邪得入，即阳气而变为火矣。何时师治热病
者。泛云邪热，日以苦寒为事，岂人身上之热，另有身外之火乎，此即本人身内之火。
发越而为病也。惟出实火太过者，暂以寒凉折之，中病即已，断无有去之理也。未者，
饮水餐冰不已，尽将阳气赶出。以致手足厥冷，龙雷无可藏纳，上迫而为胃烂口臭，睛
红舌黑，荣失气运，凝滞成斑，独现于足。夫斑疹属火，火性上炎，故多见头面。今独
现于足者，阳气已绝阴，气凝位，名死血斑也，不治。是皆阴极似阳之假热而误用寒凉
之过也。至于唇口腐烂，甚至颊穿唇缺，鼻烂目伤者，似乎热毒也。孰知阳气者，所以
充皮毛，坚筋骨，密腠理，以卫护于外者也。阴血者，所以荣脉络，润肌肤，滋阴
髓，以荣养乎里者也。面为诸阳之会，目为至阴之精，鼻为宗气之窍，一身之气血运至
鼻面者，非至清至精者，不能达之。苟一旦阳气耗散于外，失其卫获之权，阴血燥槁于
里，失其荣养之职，于是五官精华衰涸，则阴翳之火乘虚而迷空窍，流灼为害，犹龙雷
之焚毁万物甚速也。况多余热不退而为痧劳者，是昔气血本气为病，有何毒乎？治之
者，能明此理，惟使太阳一照，龙雷顿息，真阳一佥，阴医自消，真阴一生，虚阳自化
而荣卫各得其职矣。盖无形生出有形之假火，须有形生出无形水火之真药以调之。盖
造化之理，皆生于无。凡有形者，皆非真也。奈何一见壮热红点，便作有形实利，以
攻有迹之药而投无形之虚，以致变现百出。病欲不死，焉可得乎！
（张）于乙亥年，因刷印是书，附粮艘北上，时斑疹在行而甚危，诸医或用表托，
或用清解，俱莫能疗。有身体俱见而面上隐隐退缩，壮热喘嗽，烦躁不食泄泻者；有身
面俱见而赤壮热，喘嗽烦躁，不食泄泻者，要知皆阳外越而阴内竭，中气弱而肺气伤，
其火之有余乃由水之不足。昧者，概麻疹余毒，然不知实系气血大伤，即阴阳二气而为
病也。余按其脉寸强尺弱，或细数无力者，并以全真一气汤（方见杂症二十卷药按中）
去人参∶量人大小酌剂轻重投之。一二剂后，喘热俱退，熟睡日余，神爽思食，并向
有口疮目患者，皆从此而愈。可见阳藏阴长之妙用深，感先贤喻嘉言，以人参败毒散而
治斑疹之论，与吴鹤皋所云，以参附而治斑者，法之变也。医不达观，安足语此等语，
信不诬也。惟脉洪有力，人强气壮者，方用连翘。土贝、牛蒡、甘桔、生地、丹皮之类
清解之。若不详阴竭阳浮之理，概投表疹解毒之方，不惟不胜治，终亦不可治，殆至阴
阳并竭，而烦躁喘促，犹云疹毒内攻，元神脱尽而日窜口禁，尚为变惊调治，何其昧之至也！
余长孙大业，年四岁时，当变月，正值家中大小麻疹盛行，长孙亦染其症，因不肯
服药，乃避风静摄听之，热至五六日来，精神甚疲，昏睡露睛，身上隐隐出现，头面甚
微，且额热如烙，腿足温和，饮食不进，焦灼无汗，余曰∶面不起者，乃阳虚不能上托
也。额热倍常者，龙雷之火上乘也。不食神倦者，久热伤中而中气不运也。焦燥无汗
者，久热而真阴枯涸也。昏睡露睛者，神疲而督脉缩急也。若用疏散益耗真阳真阴。虚
火妄炽，风从内起，必有似惊非惊之变，况阴竭而复行疏解，则真阴愈槁，必有烦躁犯
乱之肤，气血根本既败，其为气血无形变现之斑疹，何自而充托于外哉！乃用熟地八
钱，滋水以为君；炒黄白术三钱，固中气以为巨；牛膝二钱四分，使其浊阴下降，炒燥
麦冬二钱，五味子三分，收摄肺气，敛纳龙雷下归，并以为佐；制附子六分，真固丹
田，以为使，则真阳既得，而面上之疹不攻自起矣。额上之火烙，不解自退矣。真阴既
得，则身上之焦灼，自可得汗而和矣。果辰刻服药之后，不超时而面上尽起，额热大
减，身有微汗。神情顿爽，但久热野狼狈，余
晚间以人参八分，麦冬一钱，五味子五粒，煎汤温服，次日精旺神强如故矣。或疑五味
子酸敛为虞，殊不知内有附子大力之药。一敛则其力愈大，真阳一壮于中，阴翳顿解于
外，即所谓一胜则一负也。故滋真水以取汗，汗出裕如壮真阳以散假阳，假阳辗释，
如太阳一照而龙雷自息也。水火既调。百病俱已，再调正气于内，邪气自散于表，故治
有形之百病，皆当于无形之气中求之。则有形之变幻，尽属无形之虚张，谁谓外邪之传
袭，实是本身之发现，不求本而妄行驱逐、其有不败者几希。
斑疹本是由肺胃火毒引起，所以会出现高热、心烦口渴、喜欢喝冷饮的情况，这是正常现象。然而，如果放纵患者大量饮用冷冻饮料，会导致冰寒遏制热毒在体内，并且津液遇到寒冷就会凝结，使得燥渴更加严重。况且胃喜欢凉饮而厌恶热，冷食入口，无论虚实，都会感到爽快。肠道喜欢热饮而厌恶寒，寒气流入下焦，无论虚实都会受到伤害。轻则激发虚火上炎，导致寒热往来不止；重则逼迫热毒下注，导致腹泻痢疾无休。更有甚者，错误地将烦渴喜冷当作实热，猛烈使用黄芩、黄连等苦寒药物，却不知道火的有余，是由于水的不足，所谓的渴，是因为脏腑津液干枯所致。少火变成了壮热，宗气已经在中间耗亡，孤阴覆盖在肌表，营气已经在内部枯竭。如果不探究阴阳至理来调理，仅仅把时行外感病作为主治，强壮的人因为拖延日久反而痊愈，虚弱的人突然发生变症而死亡。所以凡是出现壮热烦渴，看这个就可以类推了。
为什么北方凡是患热病喜欢喝冷水的，叫做咯水病？病人任由喝凉水，医生则猛烈投用寒药，导致越喝越渴、越寒越热，逼迫浮越的虚阳，全部消耗在肌表，必然导致身体冰冷。为什么不思考“温能除大热”这句话呢？要知道千变万化的病，多由身中之火不安其位引起：卫冲巅顶则头痛，越于肌表则身热，浮于头面则脸红，客于会厌则咽痛。得到平衡则安其位，外邪不能入而为真阳之正气。失去常态则离其位，外邪得入，即阳气变为火。何时医生治疗热病，泛泛地说邪热，每天以苦寒为事，难道人身上的热，另有身外的火吗？这就是本人身内之火，发越出来成为病。只有实火太过者，暂时用寒凉折损它，中病即止，断没有彻底去除它的道理。否则，饮水吃冰不停，将阳气全部赶出，导致手足厥冷，龙雷之火无处藏纳，上迫导致胃烂口臭，眼睛红舌头黑，营气失去气运，凝滞成斑，只出现在足部。夫斑疹属火，火性上炎，所以多见头面。现在只出现在足部，是阳气已绝，阴气凝滞，名叫死血斑，不治。这都是阴极似阳的假热而误用寒凉的过错。至于唇口腐烂，甚至脸颊穿孔嘴唇缺损，鼻子腐烂眼睛受伤，似乎像是热毒。谁知道阳气，是用来充实皮毛，坚固筋骨，致密腠理，以卫护在外的。阴血，是用来荣养脉络，滋润肌肤，滋阴髓，以荣养在内的。面部是诸阳之会，眼睛是至阴之精，鼻子是宗气之窍，一身的气血运送到鼻面的，不是至清至精的，不能到达。如果一旦阳气耗散在外，失去卫护的权力，阴血干枯在内，失去荣养的职能，于是五官精华衰涸，阴翳之火乘虚而入迷空窍，流灼为害，就像龙雷之火焚毁万物很快一样。何况余热不退成为痧劳的，是昔日气血本气为病，有什么毒呢？治疗的人，能明白这个道理，只要使太阳一照，龙雷顿息，真阳一振，阴翳自消，真阴一生，虚阳自化而营卫各得其职了。盖无形生出有形之假火，须有形生出无形水火之真药来调理它。盖造化的道理，都生于无。凡有形的，都不是真的。为什么一见壮热红点，就当作有形实利，用攻伐有迹的药去投治无形的虚证，以致变现百出。病想不死，怎么可能呢！
（张）在乙亥年，因为刷印这本书，附粮船北上，当时斑疹盛行且非常危险，各位医生或用表托法，或用清解法，都不能治愈。有的全身都见斑疹而面上隐隐退缩，壮热喘嗽，烦躁不食泄泻；有的身面俱见而赤壮热，喘嗽烦躁，不食泄泻。要知道这都是阳外越而阴内竭，中气弱而肺气伤，其火的有余乃由水的不足。愚昧者，一概认为是麻疹余毒，却不知实际是气血大伤，即阴阳二气为病。我按脉象寸强尺弱，或细数无力者，都用全真一气汤（方剂见杂症二十卷药按中），去掉人参，根据人大小斟酌剂量轻重投服。一二剂后，喘热俱退，熟睡一天多，神爽思食，向来有口疮目疾的患者，都从此痊愈。可见阳藏阴长的妙用深，感叹先贤喻嘉言，用人参败毒散治疗斑疹的论述，与吴鹤皋所说，用参附治疗斑疹的方法，是法的变通。医生不达观，怎么值得谈论这些话语，确实不虚假啊。只有脉洪有力，人强气壮的，才用连翘、土贝母、牛蒡子、甘桔梗、生地、丹皮之类清解。如果不详察阴竭阳浮的道理，一概投用表疹解毒的方子，不仅不胜任治疗，最终也不可治，等到阴阳并竭，而烦躁喘促，还说疹毒内攻，元神脱尽而日渐口禁，还以为是变惊调治，多么愚昧至极啊！
我的长孙大业，四岁时，正值换牙月，家中大小麻疹盛行，长孙也染上此症，因为不肯服药，便避风静摄听其自然。热至五六天，精神很疲乏，昏睡露睛，身上隐隐出现，头面很轻微，且额头热如烙铁，腿足温和，饮食不进，焦灼无汗。我说：面不起的，是阳虚不能上托。额热倍常的，是龙雷之火上乘。不食神倦的，是久热伤中而中气不运。焦燥无汗的，是久热而真阴枯涸。昏睡露睛的，是神疲而督脉缩急。如果用疏散益耗真阳真阴，虚火妄炽，风从内起，必有似惊非惊的变症，何况阴竭而复行疏解，则真阴愈干枯，必有烦躁犯乱的肤症，气血根本既败，其为气血无形变现的斑疹，从哪里充托于外呢！于是用熟地八钱，滋水以为君药；炒黄白术三钱，固中气以为臣药；牛膝二钱四分，使其浊阴下降；炒燥麦冬二钱，五味子三分，收摄肺气，敛纳龙雷下归，并以为佐药；制附子六分，真固丹田，以为使药，则真阳既得，而面上的疹不攻自起了。额头上的火烙，不解自退了。真阴既得，则身上的焦灼，自然可得汗而和解了。果然辰刻服药之后，不超时而面上尽起，额头热大减，身有微汗。神情顿爽，但久热野狼狈，我晚间用人参八分，麦冬一钱，五味子五粒，煎汤温服，次日精旺神强如故。有人怀疑五味子酸敛为忧，殊不知内有附子大力之药。一敛则其力愈大，真阳一壮于中，阴翳顿解于外，即所谓一胜则一负也。所以滋真水以取汗，汗出裕如壮真阳以散假阳，假阳辗转释然，如太阳一照而龙雷自息也。水火既调，百病俱已，再调正气于内，邪气自散于表，所以治有形的百病，皆当于无形之气中求之。则有形的变幻，尽属无形的虚张，谁说外邪的传袭，实是本身的发现，不求本而妄行驱逐，有不败的吗？很少了。
Macules and papules (bān zhěn, macules and papules) are originally caused by fire-toxin (huǒ dú, fire toxin) in the Lung and Stomach. Therefore, there is high fever (zhuàng rè, severe fever), irritability, thirst (fán kě, irritability and thirst), and a preference for cold drinks (xǐ lěng hǎo yǐn, liking cold beverages). This is the normal presentation. However, if one indulges in drinking frozen beverages, it will cause ice-coldness to suppress heat-toxin inside, and body fluids (jīn yè, body fluids) will congeal when encountering cold, making dryness and thirst even worse. Moreover, the Stomach likes cool drinks but dislikes heat; when cold enters the mouth, regardless of deficiency or excess, it feels refreshing. The Intestines like hot drinks but dislike cold; when cold flows to the lower Jiao (xià jiāo, lower abdomen/lower burner), regardless of deficiency or excess, injury occurs. Mildly, it stimulates rising deficient fire (xū huǒ, deficient fire), causing unceasing alternating chills and fever; severely, it forces heat-toxin to descend, causing endless diarrhea and dysentery. Furthermore, mistakenly treating irritability, thirst, and preference for cold as excess heat (shí rè, excess heat), and fiercely using bitter-cold herbs like Scutellariae Radix (Huángqín, Huangqin) and Coptidis Rhizoma (Liánzǐ, Lianzi), one does not know that the surplus of fire stems from the insufficiency of water. Thirst is actually a disease caused by the dryness and withering of organ-fluids. Shao-huo (minor fire/physiological fire) transforms into Zhuang-re (severe fever/pathological fire), Zong Qi (pectoral qi) is already lost in the middle, Gu Yin (solitary yin) covers the muscle surface, and Ying Wei (nutritive and defensive qi) is exhausted internally. If one does not seek the profound truth of Yin and Yang to regulate them, but merely treats seasonal external pathogens as the main issue, strong individuals may recover after prolonged neglect, while weak individuals may die suddenly due to transformation symptoms. Thus, whenever there is severe fever and irritability with thirst, this principle can be extrapolated.
Why is it that in the North, those suffering from heat diseases who prefer cold drinks are called "Ge Shui Bing" (water-spitting disease)? Patients drink cold water freely, while physicians fiercely administer cold-natured medicines, resulting in increased thirst with more drinking, and increased coldness with more heat, forcing floating and rebellious Deficient Yang (xū yáng, deficient yang) to be entirely consumed at the muscle surface, inevitably leading to a cold body. Why do they not ponder the saying "Warmth can eliminate great heat"? Know that thousands of changing diseases mostly arise from internal fire losing its proper position: if it rushes to the vertex, there is headache; if it spreads to the muscle surface, there is body heat; if it floats to the head and face, there is facial redness; if it lodges in the epiglottis, there is sore throat. When balanced, it stays in position, preventing external pathogens from entering, becoming the righteous Qi of True Yang (zhēn yáng, true yang). When失常 (abnormal), it leaves its position, allowing external pathogens to enter, transforming Yang Qi into fire. Why do physicians treat heat diseases by vaguely speaking of "evil heat" and daily focusing on bitter-cold herbs? Is there a fire outside the body distinct from the heat within? This is the internal fire of the person itself, emerging pathologically. Only when Excess Fire (shí huǒ, excess fire) is excessive should cold-natured herbs be temporarily used to subdue it, stopping once the disease is addressed; there is absolutely no reason to eradicate it completely. Otherwise, incessant drinking of water and eating of ice drives all Yang Qi out, causing cold limbs (jué lěng, cold extremities), leaving Long-Lei fire (dragon-thunder fire, referring to ministerial fire) nowhere to reside. It presses upward, causing stomach rot and bad breath, red eyes, black tongue, loss of Ying Qi movement, stagnation forming macules/papules appearing only on the feet. Macules and papules belong to fire, and fire nature ascends, so they usually appear on the head and face. Now appearing only on the feet indicates Yang Qi is exhausted, Yin Qi is stagnant, named "Si Xue Ban" (dead blood macules), untreatable. These are all errors due to mistaking extreme Yin simulating Yang (false heat) and using cold-natured treatments. As for rotting lips and mouth, even cheek perforation and lip defect, nose rot and eye damage, it seems like heat-toxin. But who knows that Yang Qi fills skin/hair, strengthens bones/tendons, tightens pores, and protects externally? Yin Blood nourishes collaterals, moistens skin/flesh, nourishes marrow, and sustains internally. The face is the meeting of all Yang, eyes are the essence of extreme Yin, nose is the orifice of Zong Qi. Only the purest and finest Qi and Blood can reach the nose and face. If Yang Qi dissipates externally, losing its protective power, and Yin Blood dries up internally, losing its nourishing function, then the essence of the five organs withers. Yin-shade fire takes advantage of the void to confuse the orifices, burning and damaging rapidly, like dragon-thunder fire destroying everything quickly. Moreover, residual heat remaining as Sha-Lao (sha-labor) is a disease of original Qi and Blood, what poison is there? Healers who understand this principle will make the Sun shine, instantly extinguishing dragon-thunder fire; when True Yang revives, Yin-shade vanishes; when True Yin generates, deficient Yang transforms naturally, and Ying-Wei perform their duties. Formless gives rise to formless false fire; one must use tangible herbs generating formless Water-Fire true medicine to regulate it. Creation's principle arises from the formless. All tangible things are not true. Why, upon seeing severe fever and red spots, treat them as tangible excess, using tangible attacking drugs for formless deficiency, causing myriad transformations? How can the patient survive!
(Zhang) In the Yi-Hai year, while printing this book and traveling north on grain ships, macules/papules were prevalent and critical. Physicians used exterior-expelling support or clearing-resolving methods, none effective. Some had macules/papules all over the body but faintly receding on the face, severe fever, wheezing/cough, irritability, anorexia, and diarrhea; others had bright red severe fever, wheezing/cough, irritability, anorexia, and diarrhea with visible macules/papules on body and face. Know these are all Yang floating outward and Yin exhausting inward, weak Middle Qi and injured Lung Qi, where fire surplus is due to water insufficiency. Ignorant people generally attribute this to measles residual toxin, not realizing it is actually severe Qi-Blood injury, a disease of Yin-Yang imbalance. I palpated pulses: Cun (inch) strong, Chi (cubit) weak, or fine-rapid and powerless. I prescribed Quan Zhen Yi Qi Tang (Complete True One Qi Decoction - see Miscellaneous Diseases Vol 20) without Ginseng, adjusting dosage based on age and severity. After 1-2 doses, wheezing and fever subsided, deep sleep for over a day, spirit refreshed, appetite returned. Previous cases of mouth ulcers and eye issues also recovered. This shows the profound utility of Yang storing and Yin growing. I admire Master Yu Jiayan's discussion on using Ren Shen Bai Du San (Ginseng and Coix Seed Decoction to Overcome Pathogenic Factors) for macules/papules, and Wu Hegao's claim of using Renshen and Fu Zi (Ginseng and Aconite) for macules, demonstrating methodological variation. Physicians lacking broad vision cannot discuss such matters; this trust is not unfounded. Only for those with surging powerful pulses and robust constitution should one use Qingjie (clearing/resolving) herbs like Forsythiae Fructus (Lian Qiao, Lianqiao), Fritillariae Thunbergii Bulbus (Tu Bei Mu, Tubeimumu), Arctii Fructus (Niu Bang Zi, Niubangzi), Glycyrrhizae Radix et Rhizoma (Gan Cao, Gancao), Scrophulariae Radix (Sheng Di Huang, Shengdihuang), and Paeoniae Rubra Radix (Dan Pi, Danpi). If one fails to understand Yin exhaustion and Yang floating, and indiscriminately uses exterior-macule detox formulas, not only will treatment fail, but it will become incurable, leading to simultaneous Yin-Yang exhaustion, irritability, panting, yet still claiming internal attack of macule toxin, complete loss of Yuan Shen (original spirit), progressing to lockjaw, and still treating as convulsive transformation—how ignorant!
My eldest grandson Daye, aged four, during the tooth-changing month, when household measles were rampant, contracted the disease. Refusing medicine, he rested quietly avoiding wind. By day 5-6 of fever, spirit was very fatigued, sleeping deeply with eyes open, faint macules appeared mainly on the body, slight on face, forehead hot as iron, legs/feet warm, no food intake, anxious with no sweat. I said: Face not rising indicates Yang deficiency failing to lift. Forehead excessively hot indicates Dragon-Thunder fire ascending. Anorexia and fatigue indicate Middle Qi failure from prolonged heat. Anxiety and no sweat indicate True Yin depletion from prolonged heat. Deep sleep with open eyes indicates spirit fatigue and Governing Vessel contraction. Using dispersing methods would further deplete True Yang and Yin, causing deficient fire to blaze and internal wind to rise, leading to seizure-like changes. Especially with Yin exhaustion followed by dispersing, True Yin becomes drier, leading to irritability and chaotic skin manifestations. With root Qi-Blood defeated, how can formless Qi-Blood macules emerge externally? I used Shu Di Huang (Prepared Rehmannia Root) 8 qian as Sovereign to nourish Water; Chao Huang Bai Zhu (Stir-fried Atractylodes Macrocephala Rhizome) 3 qian as Minister to secure Middle Qi; Niu Xi (Achyranthes Bidentata Root) 2.4 qian to direct turbid Yin downward; Chao Zao Mai Dong (Stir-fried Ophiopogon Tuber) 2 qian and Wu Wei Zi (Schisandra Berry) 0.3 fen to collect Lung Qi and gather Dragon-Thunder fire downward as Assistants; Zhi Fu Zi (Prepared Aconite Lateral Root) 0.6 fen as Envoy to solidify Dantian. Thus, True Yang obtained, facial macules rose spontaneously. Forehead heat retreated spontaneously. True Yin obtained, body anxiety resolved with mild sweat. Indeed, after morning dose, macules fully emerged, forehead heat greatly reduced, mild sweat appeared. Spirit refreshed. Due to lingering weakness, I gave Ren Shen (Ginseng Root) 0.8 fen, Mai Dong 1 qian, Wu Wei Zi 5 berries decocted in warm soup in the evening. Next day, vigor and spirit restored. Some worried about Wu Wei Zi's sour astringency, not knowing Fu Zi's powerful nature enhances its effect when astringed. True Yang strengthens internally, Yin-shade resolves externally, illustrating "one wins, one loses." Thus, nourishing True Water induces sweat; abundant sweat strengthens True Yang to scatter false Yang; false Yang dissipates like sun shining, extinguishing dragon-thunder fire. Once Water-Fire regulated, hundred diseases cease. Regulate righteous Qi internally, evil Qi scatters externally. Therefore, treating tangible diseases requires seeking the formless Qi. Tangible transformations belong to formless deficiency. Who says external pathogen transmission is merely external invasion? It is essentially internal manifestation. Seeking root rather than blindly expelling prevents defeat.