40.伤寒疹斑失汗下, 感而即出时气然. 表邪覆郁营卫分, 外泛皮脉
痧疹斑. 痧白疹红如肤粟, 斑红如豆片连连. 红轻赤重黑多死, 淡红
稀暗是阴寒. 未透升麻消毒治, 热盛三黄石膏煎, 巳透青黛消斑饮 ,
双解痧疹法同前.
【注】伤寒发斑, 疹, 痧, 皆因汗下失宜, 外邪复郁, 内热泛出而成
也.惟时气传染, 感而即出, 亦由疫之为病烈而速也. 发于卫分则为
痧,卫主气, 故色白如肤粟也. 发于营分则为疹斑 , 营主血, 故色
红肤浅为疹, 深重为斑. 斑形如豆, 甚则成片连属. 斑疹之色红者轻
,赤者重, 黑者死, 此以热之深浅验死生也. 若其色淡红而稀暗者,
皆因邪在三阳, 巳成斑疹入里, 邪从阴化, 或过服冷药所致, 是为阴
斑,阴痧, 阴疹, 法当从阴寒主治也. 斑出未透, 表热轻者, 宜升麻
葛根汤, 合消毒犀角饮治之. 表热重者, 宜三黄石膏汤发之. 巳透用
青黛消斑饮, 加减清之. 痧疹初起, 表里不清, 用双解散先通表里 ,
余法同前治之可也.
14.阳明衄血热在里, 太阳衄血热瘀经, 太阳头痛目瞑兆, 阳明漱水
不咽征. 衄后身凉知作解, 不解升麻犀角清. 未咽表实麻黄汗, 里热
犀角苓连同.
【注】阳明衄血热在里也. 太阳衄血热瘀经也. 太阳失汗则有头痛目
瞑之兆, 阳明失下则有漱水不欲咽之征. 衄血之后, 身凉脉静, 知作
解也. 若仍不解, 知衄未尽, 热留于营也. 无汗表热, 宜升麻葛根合
犀角地黄汤清解之; 欲作衄未衄者, 表实宜麻黄汤汗之, 里热宜犀角
地黄汤加芩连清之. 若表实里热者, 则又当合二方两解之.
40. 伤寒病中，若出现疹、斑，却因错误地未发汗或误用下法，导致邪气郁闭；若是时行疫气所致，则感邪后即刻发出。表邪覆盖郁滞于营卫之分，外泛于皮肤脉络形成痧、疹、斑。痧点色白如皮肤上的粟粒，疹色红；斑色红如豆片，连绵成片。红色较轻，赤色较重，黑色多主死亡；淡红且稀疏晦暗的属于阴寒证。尚未透发者，用升麻消毒散治疗；热势炽盛者，用三黄石膏汤煎服；已经透发者，用青黛消斑饮治疗；双解法治疗痧疹的方法同前文所述。
【注】伤寒发斑、出疹、起痧，都是因为发汗和下法使用不当，外邪再次郁闭，内热泛溢而出而形成的。只有时行疫气传染，感邪后立即发出，也是因为疫病性质猛烈且迅速。发于卫分则为痧，卫分主气，所以颜色白如皮肤粟粒。发于营分则为疹和斑，营分主血，所以颜色红、位置浅的为疹，位置深重的是斑。斑的形状像豆子，严重时则成片连接。斑疹颜色红的病情轻，赤色的病情重，黑色的预后不良（死），这是通过热的深浅来验证生死。如果颜色淡红且稀疏晦暗的，都是因为邪气在三阳经，已经形成斑疹入里，邪气从阴化，或者过服寒凉药物所致，这称为阴斑、阴痧、阴疹，治法应当从阴寒证主治。斑出但未透发，表热轻微的，宜用升麻葛根汤，配合消毒犀角饮治疗。表热严重的，宜用三黄石膏汤发散。已经透发的，用青黛消斑饮加减清解。痧疹初起，表里不清的，用双解散先通利表里，其余方法同前文治疗即可。
14. 阳明病衄血，是热邪在里；太阳病衄血，是热邪瘀阻经络。太阳病头痛、目瞑是先兆；阳明病漱水不欲咽是征象。衄血之后身体凉爽，知道病将解除；若不解，用升麻犀角地黄汤清解。未咽下（指漱水不咽）且表实者，用麻黄汤发汗；里热者，用犀角地黄汤加黄芩、黄连清解。
【注】阳明病衄血，是因为热邪在里。太阳病衄血，是因为热邪瘀阻经络。太阳病失于发汗，则有头痛、目瞑的先兆；阳明病失于攻下，则有漱水不欲咽的征象。衄血之后，身体凉爽、脉象平静，知道病将解除。如果仍然不解，知道衄血未尽，热邪留在于营分。无汗、表热的，宜用升麻葛根汤合犀角地黄汤清解；欲作衄血而未衄血的，表实证宜用麻黄汤发汗，里热证宜用犀角地黄汤加黄芩、黄连清解。如果表实里热并存的，则又应当合用两方同时解表清里。
40. In typhoid fever (Shanghan), if macules and spots appear due to improper lack of sweating or erroneous purgation, leading to pathogenic constraint; whereas in seasonal epidemic diseases, they appear immediately upon infection. The exterior pathogens cover and constrain the Ying (Nutritive) and Wei (Defensive) levels, manifesting externally on the skin and vessels as Sha (sand-like rash), Zhen (macules), and Ban (spots). Sha points are white like skin millet grains; Zhen are red; Ban are red like bean slices, continuous and extensive. Red indicates mild condition, crimson indicates severe condition, black often indicates death; pale red, sparse, and dull indicate Yin-cold syndrome. For those not yet erupted, Shengma Xiaodu San (Cimicifugae Rhizoma Detoxification Powder) is used; for excessive heat, Sanhuang Shigao Tang (Three Yellows Gypsum Decoction) is decocted and taken; for those already erupted, Qingdai Xiaoban Yin (Indigo Naturalis Spot-Dispersing Drink) is used; the Shuangjie (Double Resolution) method for treating Sha and Zhen follows the previous text.
[Note] Typhoid fever causing spots, rashes, or sand-like eruptions all result from improper use of sweating and purging methods, causing external pathogens to re-constrain and internal heat to overflow outward. Only seasonal epidemics transmit and erupt immediately upon infection, due to the fierce and rapid nature of the epidemic disease. Manifesting at the Wei level results in Sha; since Wei governs Qi, the color is white like skin millet grains. Manifesting at the Ying level results in Zhen and Ban; since Ying governs Blood, shallow redness is Zhen, while deep and severe presentation is Ban. Ban shapes resemble beans, and when severe, they connect into large patches. Red color in Ban/Zhen indicates mild illness, crimson indicates severe illness, black indicates death; this verifies life and death based on the depth of heat. If the color is pale red, sparse, and dull, it is because the pathogen was in the Three Yang channels, has entered the interior forming Ban/Zhen, the pathogen transformed into Yin, or resulted from excessive consumption of cold medicines. This is called Yin-Ban, Yin-Sha, Yin-Zhen, and the treatment method should follow the principle of treating Yin-cold. For Ban that have erupted but not fully penetrated, with mild exterior heat, Shengma Gegen Tang (Cimicifugae and Puerariae Root Decoction) combined with Xiaodu Xijiao Yin (Detoxification and Rhinoceros Horn Drink) should be used. For severe exterior heat, Sanhuang Shigao Tang should be used to disperse. For those already penetrated, Qingdai Xiaoban Yin with modifications should be used to clear. For early-stage Sha/Zhen where interior and exterior are unclear, Shuangjie San (Double Resolution Powder) should be used first to unblock interior and exterior, and other methods follow the previous text.
14. Yangming disease epistaxis indicates heat in the interior; Taiyang disease epistaxis indicates heat stagnating in the meridians. Taiyang disease headache and dizziness are precursors; Yangming disease rinsing water without swallowing is a sign. After epistaxis, if the body cools, it indicates resolution; if unresolved, Shengma Xijiao Qing (Cimicifuga and Rhinoceros Horn Clearing) is used. If water is not swallowed and the exterior is excess, Mahuang Tang (Ephedra Decoction) induces sweating; for interior heat, Xijiao Ling Lian (Rhinoceros Horn, Scutellaria, and Coptis) clears it.
[Note] Yangming disease epistaxis is due to heat in the interior. Taiyang disease epistaxis is due to heat stagnating in the meridians. Taiyang disease lacking sweat leads to precursors of headache and dizziness; Yangming disease lacking purgation leads to signs of rinsing water without desire to swallow. After epistaxis, if the body is cool and pulse quiet, it indicates impending resolution. If still unresolved, it indicates incomplete epistaxis and heat remaining in the Ying level. With no sweat and exterior heat, Shengma Gegen Tang combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used to clear and resolve; for those about to have epistaxis but not yet, if the exterior is excess, Mahuang Tang should induce sweating; for interior heat, Xijiao Dihuang Tang added with Huangqin and Huanglian (Scutellaria and Coptis) should clear it. If both exterior excess and interior heat exist, the two formulas should be combined to resolve both simultaneously.