麻疹俗名痧子。浙人呼为 子。麻病风热。人或未知。痧之与 。字学不收。皆土音习俗之
讹耳。原其证之轻重。今昔悬殊。吾吴水土濡弱之乡。生气最易萌动。故麻疹之发。自始至终。
不过二三日即安。从古迄今。靡不皆然。迩来风气变迁。有似北方气候。即寻常麻疹。必六七日
乃化消。若热势未尽。或触风寒。或犯饮食。变证百出。其危有甚于痘者。因遍考方书。从无麻
疹专学。间有一二及此。无非附见痘疹之末。一皆简略不详。何怪儿科之莫能举措。且以痘方混治
。曷知麻属阳。阳从阴化。故外出内没而不浆。痘属阴。阴从阳化。当外疏内托以助脓。二者相
去天渊。乌不可辨。然皆为婴孺说也。但今不特婴孺。少壮每多患此。虽当参详诊切。仍不能舍
此绳墨。而临证之机。活法在乎心手。绳
墨又不可拘也。予闻扁鹊入咸阳。秦人爱小儿。即为小儿医。予由是随时兼爱。曲尽一贯之道。
为麻疹特开生面云。发热 麻痘之初。必由发热。但痘热不过二三日即出。麻热有六七日。或
半月乃出。或乍凉乍热。或壮热经日不退。始热之际。必见面赤眼肿。多涕泪。咳嗽连声。是其
候也。热甚经日不退曰壮热。惟正出时为正候。若初发壮热。至已出而热不少衰者。其证必重。
清热透肌汤。出尽而壮热不退者。竹叶石膏汤去半夏加荆芥、黑参。没后而壮热不退者危。急需
凉解为主。其有热数日止而复作者。有早热而暮退者。在初发时为热邪未透。葛根解肌汤。正出
之际而烦热转甚。乃邪热未解而复内攻也。清热退肌汤。没后见者。为余邪未尽。四物汤换生地、
赤芍加连翘、黑参。亦有麻退身凉。越六七日而复热者。非余热未清。即复感风邪。当以意消息。
或因大病之后。中气虚而然者。治本为要。临病之机。不可不审也。部位 麻属府候。发则先动
阳分。而后妇阴经。一身之中。阳部宜多。阴部宜少。阳部宜透。阴部即不透。亦可无虑。若阴
部多而阳部反少不透者。为险。防有他变。阳部者。头面背四肢向外者。皆为阳。阴部者。胸腹
腰四肢向内者。皆为阴也。凡发自头至足为齐。头面多者为顺。先从胸腹暖处起。渐发四肢者顺。
如从手足起。渐发胸腹背者逆。形色 色贵红润。形贵尖耸。若色虽红润而不起。二便艰涩者
。清热透肌汤。如色淡不起。二便如常。此属本虚。当兼培养气血。亦有色黯不起。大便秘结。唇
舌燥赤者。为火邪内郁。白虎汤加黑参、荆芥。其有色白不分肉地。惟点粒高耸。 时即没者。
邪热本轻也。然有表气本虚而色白者。调护温暖。越一二日自变红活也。若正出时为风寒所遏。
而色白如肤。必毛窍竦栗。葛根解肌汤。或麻出成片。一被风寒。便变为白。身不发热而反内攻
。烦躁腹痛。痰喘气急
者危。如毒攻于胃。则呕吐清水。攻于脾。则腹胀不食。攻于肺。则鼻塞喘促。攻于心包。则唇
舌焦燥。不省人事。摇头掣手。攻于肾肝。则变黑而不救也。若色紫赤而黯。是火毒炽盛。顶粒
起者可治。宜凉血饮子。 语烦躁者。黄连解毒汤调益元散。枯燥不起者难治。若顶粒焦者。无
论红淡。皆为热剧之候。并宜白虎汤。重用石膏。干燥无汗。加麻黄以汗之。大便秘者。凉膈散
下之。亦有麻发如云头大片。其形有二。一者大片 赤。一者大片之上复有小红点粒。皆火邪炽
盛所致。白虎汤加黑参、竹叶。若麻出斑烂如锦纹。或出脓血。腥臭不干。心胸烦闷。呕吐清水。
身温热者。白虎汤加黄芩、茅术。若初发时有似斑屑者。乃风寒在表。而成瘾疹。只宜疏解。俟
麻一透。其疹自退。切勿误认为斑而与苦寒之剂。致麻内陷而难救也。咳嗽 麻疹干咳连声不断。
是火邪凌烁肺金所致。然咳则毛窍开而麻易出。故未出之先。最喜咳甚。发透其咳自已。若出尽
及没后而咳仍不止者。清咽滋肺汤。咳嗽多痰。去麦冬加橘皮、茯苓。其有感触风寒。咳嗽烦闷
。呕逆清水。眼赤咽痛。口舌生疮者。甘桔汤加芩、连。没后见者。人参白虎汤去知母易麦冬。
以滋化之。
汗 麻发之际。常宜微汗。微汗则肌腠疏豁。而邪易透。不可复用升发。升发恐汗大
泄。不无亡阳之虑。其有隐陷不透之坏证。用权升发。得大汗而解者。此特语其变也。若壮热无
汗。而皮肤干燥者。必风寒壅滞难出。多成内攻之候。或腹胀痛。或发喘促。宜与葛根解肌汤。
冬月越婢、三拗选用。但不可过剂。亦有因热极火郁。皮肤干燥而难出者。必致唇舌燥裂。二便
秘涩。壮热昏沉。或身体胀痛。喘促痰鸣。无论何时。急宜白虎汤加黑参、牛蒡、芩、栀、竹叶
之类。大抵麻证当以微汗为顺。若始终无汗。虽没后不无余咎。其治总不逾上法也。
嚏 麻疹初起而多嚏者。是内火因风邪激搏而然。正出时有嚏者。其候必轻。如没后尚有嚏
者。邪热尽解。可无余患矣。如嚏而多涕者。浊壅得泄。肺气自清。最为吉兆。若无嚏而鼻塞不
通。必有风邪留滞。宜辛凉之剂以透达之。
呕吐 麻之初起。吐泻交作者顺。干霍乱者逆。欲吐
不吐者危。呕吐是胃中热邪不得发泄而作。葛根解肌汤。正出及正没时见者。消毒饮加枳实、黄
连。多痰者。更加贝母、栝蒌根。若没后而呕者。脾胃虚而热滞也。石斛清胃散。其有呕而吐蛔
者。胃中痰热胶固。虫无所养而上窜也。能食即定。如蛔出多而不能食。为胃败。不治。
泄泻 泄泻为麻疹之常候。热邪得以开泄也。发热时泻而黄赤稠粘。小水短涩者属热。四苓散加木通、
滑石、已出。人参白虎汤去知母易麦冬。其证必多发渴。渴甚不止。热甚不退。虽数剂无妨。如
泻下清稀白沫。腹疼喜得温按者属寒。胃苓汤去苍术加煨姜。泻利窘迫而腹痛胀满。或暖气如败
卵者。为饮食停滞。枳壳汤加楂、柏、木通。大抵麻疹泄泻。属热者多。属寒者少。辨治宜早。
不可令其泻久。泻久则正气下陷。或成肿满。或变下利。并宜枳实理中之类。以理脾胃为主。麻
后泻利不止。口渴目闭。四肢不温者。不治。呕吐不食。洞泄不知者。不治。目 麻疹发热之
时。眼光如水。而多眵泪。或白睛微红。此正候也。若没后犹见红赤。为肺经风热未尽。泻白散
加荆芥、薄荷、黑参、牛蒡。闭不欲开。更加连翘、木通。赤而肿痛者。风热上壅也。导赤散加
荆、蒡、黑参。若为风热所侵而眼眶赤烂者。柴胡饮子。急须治之。否则为终身痼疾。
发不出 初起发热咳嗽。浑身胀痛。有似伤寒之候。惟干咳连声。目赤多泪。呕恶便溏。确为麻疹之验。
若将发之际。或为风寒暴袭。或因肢体坦露。寒郁热邪。不能外出此。全盛之势未萌。与出后没
早不同。如气粗喘促。腹中胀痛。
烦扰不宁而不得出。急与麻杏甘石汤。或越婢汤去枣重用石膏。轻则升麻汤以升发之。若因触犯
雾露风寒。隐现不能发出。以新猪矢冲汤。隔簟蒸之。冷则更添滚者。并取猪矢烧灰。葱白汤下
二三钱。乃痘疮黑陷用烧人矢之变法。即烧人矢亦能发之。发之仍不出者。神丹不能复图矣。
按古方麻疹升发剂中。多用升麻。曷知升麻性升。能升动阳气。每致邪热上浮而作喘逆。当以紫
苏、葱白代用。非特升麻当慎。即桔梗初起亦须酌用。恐其载引浊气于上也。盖麻疹宜凉宜润。
一切辛燥之味。咸为禁剂。用药之机。可不为之慎重乎。
透表 麻疹无问尖大细小。必得透表。
可无后患。其有一种匾阔 赤成块。块上复有小粒平塌不起者。亦有一片如风毒。偏高红肿。但
头粒不尖。二者虽透。其中必有热邪留伏。防有他变。并宜竹叶石膏汤去半夏以滋化之。纵有余
热。从此涣散矣。
不透表 麻出而皮肤干燥。毛窍竦栗。不能透表者。风寒郁遏也。越婢汤葛
根解肌汤。随轻重取用。其有表虚不胜疏透者。一味葱白浓煎。时时与之。但得微汗即解。若头
粒隐隐红紫一片而不透表者。火毒炽盛也。白虎汤加荆芥黑参。如肌肤不燥。唇色淡白。二便如
常而不透者。中气本虚也。消毒饮加连翘、木通、车前、茯苓。虽有蕴热。不可轻用寒凉。即用
峻剂升发。亦必不能复透。但当解利。使之内化为主。亦有胸背腰腹暖处起发而红。头面手足乍
有乍无。此证必缠绵难已。且有没后五七日。复发如前。两三天而愈者。此气候之异。当非不透
之比。只宜辛凉透表。渐次向安。欲求速效。转增危殆。
没早 麻出未经三日。或为风寒外郁。或热邪内陷。或误食酸收之物。一日半日即没。周身暖处绝无红影。终变
危候。若虽没早。肌肤暖处尚未全没。急需透表。发之不起。即当审其所触而与内解。如外为风
寒所遏。邪反内攻而没早者。消毒饮加葱头热服。复透者吉。甚则加麻黄、穿山甲。或越婢三拗选
用。若不急治。必喘胀而死。亦有遍身青紫热肿喘胀气急。此毒滞血凝。半匿肌表。急投凉膈散
去芒硝加麻黄、石膏以发越之。若腹胀喘促。溺涩脐突者。凉膈散加葶苈。庶或可救一二。若内
挟痰热。火毒亢剧而伏匿烦躁。或腹胀喘急。不省人事者。白虎汤加黑参、竹叶。若误食酸醋收
敛之物。伏匿壮热。喘咳烦闷。以猪胆汁制甘草煎成。续续与之。得吐微汗为效。或苦瓠、生甘
草煎汤灌之。亦能取吐。吐中便有发越之义。误会豕肉。喘胀气急。枳壳汤加山楂、芒硝以下夺
之。误食核桃。喘咳声喑。消毒饮如石膏、马兜铃。若得热退身安。气息渐调者。方可无虑。或
大病之后。或洞泄不止。中气本虚。不能发越而没早。惟当健运中气。略兼解表清热。若没后遍
身搔痒者。露风早也。消风散以疏解之。
难没 西北水土刚劲。禀质亦浓。麻必五七日乃没。东南风气柔弱。麻出不过二三日即化。
迩来地运变迁。未有不绵延数日者。当非难没之比。若三四日后点燥色白。隐隐于肌腠而难没者
。此必卫气素微。不能 发。或衣被单薄。阻其发越之机。以致绵延多日。法当辛散透达。不可
遽用寒凉。蔽其开泄之路也。
渴 渴乃肺胃热盛之候。唇口必红。二便秘涩者。门冬甘露饮。若二便清利。唇色不红而
但渴者。此必寒凉太过。脾虚不生津液而作渴也。七味白术散去木香加糯米。渴而烦躁者。是热
邪凌烁心包。白虎汤加麦冬、竹叶。正没时。竹叶石膏汤去半夏。渴而腹胀者。木虚实滞。为难
治也。
喘 喘者。热邪壅遏肺窍。气道阻塞而然。其证有虚实之分。虚者难治。实者易调。虚则
小便清利。大便溏泄。身无
大热。虽清痰润肺。多难获效。实则大便坚燥。小便赤涩。身发状热。竹叶石膏汤去半夏加蒌仁
、贝母。冬月量加蜜炙麻黄。随手而应。若喘而无涕。兼之鼻扇者。不治。大抵未出而喘者易治。
没后喘者。难治。初发之时喘者。三拗汤加石膏、芽茶。喘而臭干口燥者。白虎汤最捷。若见于
麻后。又宜清咽滋肺汤以滋肺胃。白虎汤又为切禁。故曰。医不执方。活法在人耳。
气促 气促多缘肺热不清所致。初发正出时见之。清热透肌汤。在正没没后。清咽滋肺汤
。如喉中有痰 而鸣者。热邪阻逆不得发越也。见于初发正出之间。除热清肺汤。正没没后见者
。必邪热未透。或露风没早。余热内攻而肺气受伤也。难治。
喑 肺胃热邪。为风寒所袭。不能尽达于表。咳盛咽伤故喑。宜清咽滋肺汤。若喑而肿痛
者。射干消毒饮。然喑为麻疹之常。不可与痘喑比例。
搐 搐为痰热聚于心包。见于初发未透之时。清热透肌汤加蒌仁、竹叶。没后见者难治。
只宜轻清之剂调之。不可误用金石。痰涎壅盛者。一味栝蒌涌吐之。若搐无痰鸣。或自啮指者。
非真搐也。此为正虚不能主持。必死不治。
衄 衄者。火邪炽盛。血随火载。上行而溢于鼻。麻疹初起。是为顺候。其热得以开泄。
不治自已。若衄之不止。或失血者。犀角地黄汤加荆芥穗。正没及没之后。衄仍不止者。四物汤
加茅根、麦冬以滋降之。
谵妄 谵妄是热邪炽盛于心包。若发热正出时见者。为火邪内伏。不得透表而致。白虎汤
加荆芥、鼠粘子。甚则加麻黄以发越之。在正没没后。并宜竹叶石膏汤去半夏加生地黄以清解之。
切牙 痘证切牙。有寒热之分。麻疹切牙。皆为热例。乃阳陷于阴。故多发渴而手足热。喜饮
冷者。麦门冬汤加丹皮。若手足不热而反厥冷。喜饮热汤。此为热邪内亢。后必下血。咽喉作痛。
痰鸣而死。即与白虎汤。多不可救。
唇燥 唇燥多属脾胃之热。淡而燥者。其热轻。赤而燥者。其热深。紫黑而燥者。热剧而重
也。随轻重以清润之。
唇舌破裂 唇舌破裂者。心脾之火上冲也。其色必多深赤。初发正出时见之。白虎汤加芩、连
、黑参、荆芥、薄荷。若正没没后见者。为心脾俱绝。及紫黑枯燥而血不活者。皆难治也。
口气 口气秽浊。乃热邪蕴隆于胃。清胃散加石膏、连翘、生甘草。其有臭不可闻者。此
胃败也。不治。若其人本有是证。不在此例。
麻疹，俗称“痧子”。浙江人称之为“麻子”。麻疹是由风热邪气引起的疾病，但人们往往不了解这一点。“痧”与“麻”这两个字在正统字书中并未收录，都是由于地方口音和习俗造成的误传。考察其病情的轻重，古今差异很大。我们吴地（江浙一带）水土柔弱，人体生气最容易萌动，所以麻疹的发作，从头到尾，不过两三天就能痊愈。从古至今，没有不是这样的。近来风气变迁，气候有点像北方，即使是普通的麻疹，也必须六七天才能消退。如果热势未尽，又触犯风寒，或者饮食不当，就会变证百出，其危险程度甚至超过天花。因此我遍查医书，发现从来没有专门论述麻疹的著作，偶尔有一两部提到，也不过是附在痘疹论的最后，内容简略不详。难怪儿科医生面对此病不知如何下手，甚至用治天花的方子来混治麻疹。哪里知道麻疹属阳，阳气容易从阴分转化，所以麻疹外出或内陷时不会化脓；而天花属阴，阴气容易从阳分转化，应当通过疏解外部、托举内部的方法来助其化脓。这两者相差如天地之远，怎么可以不加以辨别呢？当然，这些主要是针对婴幼儿而言的。但现在不仅婴幼儿患病，青壮年也常患此病。虽然应当详细诊察切脉，但仍不能脱离基本的诊疗原则。然而临床诊治的关键在于灵活变通，心手相应，又不能死守教条。我听说扁鹊进入咸阳，因为秦国人喜爱小儿，他就成为儿科医生。我由此随顺时势，兼爱各年龄段患者，曲尽一贯的治疗之道，特为麻疹开辟新的治疗局面。
发热：麻疹和天花初起，必然由发热开始。但天花的热象不过两三天就发出皮疹，麻疹的热象有持续六七天，甚至半个月才发出的；有的忽冷忽热，有的高热整天不退。刚开始发热时，必定见面部发红、眼睛肿胀、多涕泪、连续咳嗽，这是麻疹的先兆。高热经日不退称为“壮热”。只有皮疹正当发出时的发热为正候。如果刚发病时就高热，等到皮疹发出后热势并不减退，病情一定严重。对于皮疹出尽后壮热仍不退的情况，用清热透肌汤；若皮疹出尽后壮热仍不退，用竹叶石膏汤去掉半夏，加入荆芥、玄参；若皮疹隐没后壮热仍不退，则情况危急，急需以清凉解毒为主。有的热症几天停止后又复发，有的早晨发热傍晚退去，这在初发时是因为热邪尚未透出，用葛根解肌汤；在正出之际烦躁热势加重，是邪热未解反而向内攻伐，用清热退肌汤；皮疹隐没后出现的发热，是余邪未尽，用四物汤换用生地黄、赤芍，加入连翘、玄参。也有麻疹退去身体转凉，过了六七天又发热的，这不是余热未清，就是再次感受风邪，应当根据具体情况斟酌处理。或者是大病之后，中气虚弱所致，治疗根本是关键。临证机变，不可不审慎。
部位：麻疹属于腑证的征候，发作时先动阳分，然后波及阴经。全身之中，阳部皮疹宜多，阴部宜少。阳部皮疹宜透出，阴部即使不透出，也不必担忧。如果阴部皮疹多而阳部反而少且不透出的，属于险证，要防止发生其他变化。所谓阳部，是指头面、背部、四肢向外侧的部分；所谓阴部，是指胸腹、腰部、四肢向内侧的部分。凡是皮疹从头到脚分布均匀称为“齐”。头面部多的为顺证。先从胸腹温暖处开始，逐渐发到四肢的为顺证。如果从手足开始，逐渐发到胸腹背部的为逆证。
形色：颜色贵在红润，形态贵在尖耸。如果颜色虽红润但不隆起，大小便艰涩的，用清热透肌汤。如果颜色淡白不隆起，大小便正常，这属于本虚，应当兼补气血。也有颜色暗红不隆起，大便秘结，嘴唇舌头干燥发红的，这是火邪内郁，用白虎汤加玄参、荆芥。有的颜色白而不分肉理，只有点粒高耸，刚出来就隐没的，这是邪热本来轻微。但是有表气本虚而颜色白的，注意保暖调护，过一两天自然会变成红活。如果在正出时被风寒遏制，而颜色白如皮肤，必定毛孔竖立，用葛根解肌汤。或者麻疹成片出现，一旦被风寒侵袭，就变为白色，身体不发热反而邪气内攻，出现烦躁腹痛、痰喘气急的，情况危急。如果毒邪攻胃，则呕吐清水；攻脾，则腹胀不食；攻肺，则鼻塞喘促；攻心包，则嘴唇舌头焦燥，神志不清，摇头甩手；攻肝肾，则变为黑色而无法救治。如果颜色紫赤而暗，是火毒炽盛，顶粒隆起的可以治疗，宜用凉血饮子。说胡话烦躁的，用黄连解毒汤调服益元散。干枯不起的难治。如果顶粒焦枯的，无论颜色红淡，都是热势剧烈的征候，都宜用白虎汤，重用石膏。干燥无汗的，加麻黄以发汗；大便秘结的，用凉膈散泻下。也有麻疹发出如云头大片，其形有两种：一种是大片鲜红，一种是大片之上又有小红点点，这都是火邪炽盛所致，用白虎汤加玄参、竹叶。如果麻疹发出像斑烂的锦纹，或者出脓血，腥臭不干，心胸烦闷，呕吐清水，身体温热的，用白虎汤加黄芩、苍术。如果初发时有类似斑屑的，那是风寒在表，形成了瘾疹，只宜疏解，等麻疹一透出，疹子自然消退，千万不要误认为是斑疹而使用苦寒药物，导致麻疹内陷而难以救治。
咳嗽：麻疹干咳连续不断，是火邪灼伤肺金所致。然而咳嗽则毛孔张开，麻疹容易发出，所以在未发出之前，最喜欢咳得厉害，发透之后咳嗽自然停止。如果皮疹出尽及隐没后咳嗽仍不止，用清咽滋肺汤。咳嗽多痰的，去掉麦冬，加入陈皮、茯苓。如果有感触风寒，咳嗽烦闷，呕逆清水，眼睛红，咽喉痛，口舌生疮的，用甘桔汤加黄芩、黄连。隐没后出现的，用人参白虎汤去掉知母，换用麦冬，以滋养化源。
汗：麻疹发作之际，常宜微汗。微汗则肌肤腠理疏松，邪气容易透出。不可再用升提发散的药物，因为升提发散恐怕导致大汗淋漓，有亡阳的危险。对于那些隐陷不透的坏证，权宜使用升提发散，得到大汗而解的，这只是权变之法。如果高热无汗，而皮肤干燥的，一定是风寒壅滞，难以发出，多成内攻的征候。或者腹胀痛，或者发喘促，宜用葛根解肌汤。冬季可选用越婢汤或三拗汤，但不可过量。也有因热极火郁，皮肤干燥而难出的，必定导致嘴唇舌头干裂，大小便秘涩，高热昏沉，或者身体胀痛，喘促痰鸣，无论何时，急需白虎汤加玄参、牛蒡子、黄芩、栀子、竹叶之类。大抵麻疹证当以微汗为顺，如果始终无汗，即使皮疹隐没后也不免留下后患。治疗总不离上述方法。
嚏：麻疹初起而多打喷嚏的，是内火因风邪激搏所致。正出时有喷嚏的，病情一定轻。如果隐没后还有喷嚏的，说明邪热已尽解，可无遗留病患了。如果打喷嚏且多鼻涕的，浊气得以宣泄，肺气自然清利，是最吉利的征兆。如果没有喷嚏而鼻塞不通的，必有风邪留滞，宜用辛凉药物以透达之。
呕吐：麻疹初起，吐泻交作的为顺证；干霍乱的为逆证；想吐却吐不出来的为危证。呕吐是胃中热邪不得发泄而作，用葛根解肌汤。正出及正隐没时见到的，用消毒饮加枳实、黄连。多痰的，再加贝母、瓜蒌根。如果隐没后呕吐的，是脾胃虚而热滞，用石斛清胃散。其中有呕吐并吐出蛔虫的，是胃中痰热胶固，虫子无处供养而上窜。如果能进食即安定，如果蛔虫出多而不能进食，是胃气败绝，无法救治。
泄泻：泄泻是麻疹的常见征候，热邪得以开泄。发热时腹泻，大便黄赤稠粘，小便短涩的属热，用四苓散加木通、滑石；已出皮疹的，用人参白虎汤去掉知母换用麦冬。这种证候必定多发渴，渴甚不止，热甚不退，虽然服用几剂药也无妨。如果泻下清稀白沫，腹痛喜欢温热按压的属寒，用胃苓汤去掉苍术加煨姜。泻利窘迫而腹痛胀满，或者嗳气像败卵味的，是饮食停滞，用枳壳汤加山楂、黄柏、木通。大抵麻疹泄泻，属热的多，属寒的少，辨证治疗宜早，不可让其久泻。久泻则正气下陷，或者形成肿满，或者变成下痢，都宜用枳实理中汤之类，以调理脾胃为主。麻疹后泻利不止，口渴闭目，四肢不温的，无法救治。呕吐不食，洞泄不知人事的，无法救治。
目：麻疹发热之时，眼光如水，且多眼屎眼泪，或者白睛微红，这是正候。如果隐没后仍见红赤，是肺经风热未尽，用泻白散加荆芥、薄荷、玄参、牛蒡子。眼睛闭合不想睁开的，再加连翘、木通。红而肿痛的是风热上壅，用导赤散加荆芥、牛蒡子、玄参。如果是被风热所侵而眼眶赤烂的，用柴胡饮子，必须急治，否则会成为终身痼疾。
发不出：初起发热咳嗽，浑身胀痛，有类似伤寒的征候。只是干咳连续不断，眼睛红多泪，恶心便溏，确是麻疹的验证。如果将要发出之际，或被风寒突然袭击，或因肢体暴露，寒郁热邪，不能外出。此时全盛之势未萌，与出后隐没过早不同。如气粗喘促，腹中胀痛，烦躁不安而不得发出的，急用麻杏甘石汤，或者越婢汤去掉大枣重用石膏。轻症的用升麻汤以升发之。如果因触犯雾露风寒，隐现不能发出的，用新猪矢冲汤，隔着竹席蒸熏，冷了再添加滚热的，并取猪矢烧成灰，葱白汤送服二三钱，这是痘疮黑陷时用烧人矢的变法，即烧人矢也能发出。如果发出仍然不出，神仙丹也不能再图谋救治了。按古方麻疹升发剂中，多用升麻，哪里知道升麻性升，能升动阳气，每致邪热上浮而作喘逆。应当用紫苏、葱白代替，不仅仅是升麻要谨慎，即桔梗在初起时也要斟酌使用，恐怕它载引浊气于上。大概麻疹宜凉宜润，一切辛燥的味道，都是禁忌药物。用药的机变，能不慎重吗？
透表：麻疹不论尖大细小，必须得透表，才可无后患。有一种匾阔鲜红成块，块上又有小粒平塌不起的，也有一片像风毒，偏高红肿，但头粒不尖的，这两种虽然透出，其中必有热邪留伏，要防止发生其他变化，都宜用竹叶石膏汤去掉半夏以滋养化源。纵有余热，从此也就涣散了。
不透表：麻疹发出而皮肤干燥，毛孔竖立，不能透表的，是风寒郁遏。用越婢汤或葛根解肌汤，随轻重选用。有表虚不胜疏透的，一味葱白浓煎，时时喂服，只要得到微汗即解。如果头粒隐隐红紫一片而不透表的，是火毒炽盛，用白虎汤加荆芥、玄参。如果肌肤不干燥，嘴唇色淡白，大小便正常而不透的，是中气本虚，用消毒饮加连翘、木通、车前子、茯苓。虽然有蕴热，不可轻用寒凉。即用峻剂升发，也必定不能复透，只当解利，使之内化为原则。也有胸背腰腹温暖处起发而红，头面手足乍有乍无的，这种证候必定缠绵难愈，且有隐没后五七天，复发如前，两三天而愈的，这是气候的差异，应当不属于不透的表现，只宜辛凉透表，渐次向安。欲求速效，反而增加危殆。
没早：麻疹发出未经三日，或因风寒外郁，或热邪内陷，或误食酸收之物，一日半日即隐没，周身温暖处绝无红影，最终变为危候。如果虽然隐没早，但肌肤温暖处尚未全没，急需透表，发之不起，就应当审察其所触犯的病因而给予内解。如外为风寒所遏，邪反内攻而隐没早的，用消毒饮加葱头热服，复透者为吉，严重的加麻黄、穿山甲，或者越婢汤、三拗汤选用。如果不急治，必因喘胀而死。也有遍身青紫热肿喘胀气急的，这是毒滞血凝，半匿肌表，急投凉膈散去掉芒硝加麻黄、石膏以发越之。如果腹胀喘促，小便涩脐突的，用凉膈散加葶苈子，或许能救一二。如果内挟痰热，火毒亢剧而伏匿烦躁，或者腹胀喘急，神志不清的，用白虎汤加玄参、竹叶。如果误食酸醋收敛之物，伏匿壮热，喘咳烦闷，用猪胆汁制甘草煎成，续续与之，得吐微汗为效。或者苦瓠、生甘草煎汤灌之，也能取吐，吐中便有发越的意义。误会吃猪肉，喘胀气急，用枳壳汤加山楂、芒硝以下夺之。误食核桃，喘咳声哑，用消毒饮如石膏、马兜铃。如果得热退身安，气息渐调的，方可无忧。或者大病之后，或洞泄不止，中气本虚，不能发越而隐没早，只当健运中气，略兼解表清热。如果隐没后遍身搔痒的，是露风早也，用消风散以疏解之。
难没：西北水土刚劲，禀质也浓厚，麻疹必五七天才能隐没。东南风气柔弱，麻疹发出不过两三天就化解。近来地运变迁，没有不绵延数日的，应当不属于难没的情况。如果三四日后点燥色白，隐隐于肌腠而难没的，这必定是卫气素微，不能发越，或者衣被单薄，阻其发越之机，以致绵延多日，法当辛散透达，不可遽用寒凉，蔽其开泄之路。
渴：渴是肺胃热盛的征候，嘴唇口角必红，大小便秘涩的，用门冬甘露饮。如果大小便清利，嘴唇色不红但渴的，这是寒凉太过，脾虚不生津液而作渴，用七味白术汤去掉木香加糯米。渴而烦躁的，是热邪灼伤心包，用白虎汤加麦冬、竹叶。正隐没时，用竹叶石膏汤去掉半夏。渴而腹胀的，是木虚实滞，为难治。
喘：喘是热邪壅遏肺窍，气道阻塞所致。其证有虚实之分，虚者难治，实者易调。虚则小便清利，大便溏泄，身无大热，虽清痰润肺，多难获效。实则大便坚燥，小便赤涩，身发壮热，用竹叶石膏汤去掉半夏加瓜蒌仁、贝母。冬季量加蜜炙麻黄，随手而应。如果喘而无涕，兼之鼻翼扇动的，无法救治。大抵未出而喘的易治，隐没后喘的难治。初发之时喘的，用三拗汤加石膏、芽茶。喘而口臭干口燥的，白虎汤最捷。如果见于麻疹后，又宜清咽滋肺汤以滋肺胃，白虎汤又为禁忌。所以说，医生不执泥于方剂，活法在人罢了。
气促：气促多缘肺热不清所致。初发正出时见到，用清热透肌汤。在正隐没或隐没后，用清咽滋肺汤。如喉中有痰声而鸣响的，是热邪阻逆不得发越，见于初发正出之间，用除热清肺汤。正隐没或隐没后见到的，必定是邪热未透，或露风隐没早，余热内攻而肺气受伤，难治。
喑（失音）：肺胃热邪，被风寒所袭，不能尽达于表，咳盛咽伤故失音，宜用清咽滋肺汤。如果失音而肿痛，用射干消毒饮。然而失音是麻疹的常态，不可与天花失音相提并论。
搐（抽搐）：搐是痰热聚于心包，见于初发未透之时，用清热透肌汤加瓜蒌仁、竹叶。隐没后见到的难治，只宜轻清之剂调之，不可误用金石类药物。痰涎壅盛的，一味瓜蒌涌吐之。如果抽搐无痰鸣，或者自咬手指的，不是真抽搐，这是正虚不能主持，必死不治。
衄（鼻出血）：衄是火邪炽盛，血随火载，上行而溢于鼻。麻疹初起，是为顺候，其热得以开泄，不治自愈。如果衄血不止，或失血的，用犀角地黄汤加荆芥穗。正隐没及隐没之后，衄仍不止的，用四物汤加茅根、麦冬以滋阴降火。
谵妄：谵妄是热邪炽盛于心包，若发热正出时见到，是火邪内伏，不得透表而致，用白虎汤加荆芥、牛蒡子，严重的加麻黄以发越之。在正隐没或隐没后，都宜用竹叶石膏汤去掉半夏加生地黄以清解之。
切牙（磨牙）：天花证切牙，有寒热之分。麻疹切牙，皆为热例，乃阳陷于阴，故多发渴而手足热，喜饮冷者，用麦门冬汤加丹皮。如果手足不热而反厥冷，喜饮热汤，此为热邪内亢，后必下血，咽喉作痛，痰鸣而死，即与白虎汤，多不可救。
唇燥：唇燥多属脾胃之热，淡而燥的，其热轻，赤而燥的，其热深，紫黑而燥的，热剧而重也。随轻重以清润之。
唇舌破裂：唇舌破裂的，是心脾之火上冲，其色必多深赤。初发正出时见到，用白虎汤加黄芩、黄连、玄参、荆芥、薄荷。如果正隐没或隐没后见到，是心脾俱绝，及紫黑枯燥而血不活的，都难治。
口气：口气秽浊，是热邪蕴隆于胃，用清胃散加石膏、连翘、生甘草。其有臭不可闻的，这是胃败，无法救治。如果其人本有此证，不在此例。
Measles, commonly known as "Sha Zi" (sand rash). In Zhejiang, it is called "Ma Zi" (hemp seed rash). Measles is caused by wind-heat pathogenic factors, yet people often fail to understand this. The characters "Sha" and "Ma" are not recorded in standard dictionaries; they are merely errors arising from local accents and customs. Examining the severity of the condition, there is a significant difference between ancient times and the present. Our Wu region (Jiangsu and Zhejiang areas) has soft and weak water and soil, where the vital qi (Sheng Qi) is easily stirred. Therefore, the onset of measles lasts only two or three days from beginning to end before recovery. This has been the case since ancient times. Recently, due to changes in climate resembling that of the North, even ordinary measles requires six or seven days to resolve. If the heat pathogen is not fully cleared, and one is exposed to wind-cold or suffers from dietary indiscretion, myriad complications may arise, posing a danger greater than smallpox. Thus, I have reviewed medical texts extensively and found no specialized treatise on measles. Occasional mentions are merely appended at the end of smallpox discussions, being brief and unclear. No wonder pediatricians do not know how to handle it, sometimes even treating measles with formulas for smallpox. They fail to realize that measles belongs to Yang, and Yang tends to transform through Yin, so when measles erupts externally or collapses internally, it does not suppurate. Smallpox belongs to Yin, and Yin tends to transform through Yang, requiring external dispersal and internal support to aid suppuration. These two conditions differ as much as heaven and earth; how can they not be distinguished? Of course, these remarks primarily concern infants and children. However, nowadays, not only infants but also young adults frequently suffer from this disease. Although detailed diagnosis and pulse-taking are necessary, one cannot abandon fundamental principles. Yet, the key to clinical practice lies in flexibility and mental agility, and one must not rigidly adhere to dogmas. I heard that Bian Que entered Xianyang and, because the Qin people loved children, he became a pediatrician. From this, I follow the times and show care for patients of all ages, adhering to the consistent Dao of treatment, specifically opening a new approach for measles.
Fever: Both measles and smallpox initially present with fever. However, smallpox fever lasts only two to three days before eruption, whereas measles fever may last six to seven days or even half a month before eruption. It may alternate between cold and hot, or remain high fever throughout the day. At the onset of fever, symptoms such as facial redness, swollen eyes, excessive tearing and nasal discharge, and continuous coughing appear, which are prodromal signs of measles. High fever persisting for days is termed "Zhuang Re" (vigorous fever). Fever during the proper eruption phase is the normal pattern. If vigorous fever persists after eruption without abating, the condition is severe. For vigorous fever persisting after eruption is complete, use Qingre Touji Tang (Clear Heat and Unblock Skin Decoction); if it persists after eruption is complete, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) removing Banxia (Pinellia Rhizome), adding Jingjie (Schizonepeta Twig) and Heishen (Scrophularia Root). If vigorous fever persists after the rash has vanished, the condition is critical, requiring urgent cooling and detoxification. If fever stops for a few days and then recurs, or occurs in the morning and subsides in the evening, during initial onset it indicates heat pathogen not yet released, treated with Gegen Jieji Tang (Kudzu Root Muscle-Releasing Decoction). If irritability and heat worsen during the peak eruption phase, it indicates unresolved heat pathogen attacking inward, treated with Qingre Tuiji Tang (Clear Heat and Retreat Muscle Decoction). Fever appearing after the rash vanishes indicates residual pathogens, treated with Siwu Tang (Four Substances Decoction) substituting Shengdi Huang (Rehmannia Root) for Di Huang, Chi Shao (Red Peony Root), adding Lianqiao (Forsythia Fruit) and Heishen. There are cases where the body cools after the rash fades, but fever returns after six or seven days; this is either residual heat not cleared or a new contraction of wind pathogen, requiring judgment based on circumstances. It may also result from deficiency of Middle Qi after a major illness, making tonification of the root essential. Clinical judgment must be prudent.
Location: Measles manifests as a Fu organ syndrome, initially affecting the Yang divisions before involving the Yin meridians. In the body, Yang areas should have more rashes, and Yin areas fewer. Rashes in Yang areas should erupt; if they do not in Yin areas, there is little cause for worry. However, if Yin areas have many rashes while Yang areas have few and do not erupt, it is a dangerous sign, warning of potential complications. Yang areas refer to the head, face, back, and outer limbs; Yin areas refer to the chest, abdomen, waist, and inner limbs. Even distribution from head to foot is called "Qi". Abundance on the head and face is a favorable sign. Eruption starting from the warm areas of the chest and abdomen and spreading to the limbs is favorable. Eruption starting from the hands and feet and spreading to the chest, abdomen, and back is unfavorable.
Color and Shape: Color should be rosy and red; shape should be pointed and erect. If the color is rosy but flat, with difficult urination and defecation, use Qingre Touji Tang. If the color is pale and flat, with normal excretions, it indicates constitutional deficiency, requiring supplementation of Qi and Blood. If the color is dark and flat, with constipation, dry lips, and red tongue, it indicates internal depression of fire pathogen, treated with Baihu Tang (White Tiger Decoction) adding Heishen and Jingjie. If the color is white without distinct skin texture, with only raised spots that quickly vanish, the heat pathogen is mild. However, if the exterior Qi is deficient and the color is white, keep warm; it will turn rosy within one or two days. If blocked by wind-cold during eruption, resulting in white skin and piloerection, use Gegen Jieji Tang. If measles erupt in patches and turn white upon exposure to wind-cold, accompanied by lack of fever but internal attack causing irritability, abdominal pain, phlegm, wheezing, and shortness of breath, the condition is critical. If toxin attacks the Stomach, vomiting clear fluid occurs; if it attacks the Spleen, abdominal distension and anorexia occur; if it attacks the Lung, nasal congestion and panting occur; if it attacks the Pericardium, dry scorched lips and tongue, unconsciousness, head shaking, and limb jerking occur; if it attacks the Liver and Kidney, turning black, it is incurable. If the color is purple-red and dark, indicating blazing fire-toxin, raised spots are treatable with Liangxue Yinzi (Cool Blood Infusion). Delirium and irritability are treated with Huanglian Jiedu Tang (Coptis Decoction for Detoxifying Three Burners) mixed with Yiyuan San (Benefit Origin Powder). Dry and flat lesions are difficult to treat. Scorched tops indicate severe heat regardless of base color, treated with Baihu Tang using heavy doses of Shigao (Gypsum). Dryness without sweat requires Mahuang (Ephedra Herb) to induce sweating; constipation requires Liangge San (Cooling the Chest Powder) to purge. Some eruptions appear as large cloud-like patches: either large red patches or large patches with small red dots, both caused by blazing fire pathogen, treated with Baihu Tang adding Heishen and Zhuye (Bamboo Leaf). If eruptions resemble brocade patterns, or produce pus/blood with foul odor, chest stuffiness, vomiting clear fluid, and warmth, use Baihu Tang adding Huangqin (Scutellaria Root) and Cangzhu (Atractylodes Rhizome). If initial eruptions resemble macules, it is wind-cold on the exterior forming wind-rash; only disperse and release. Once measles erupt, the rash will fade. Do not mistake it for macules and use bitter-cold herbs, which could cause measles to collapse inward, becoming incurable.
Cough: Continuous dry cough in measles is caused by fire pathogen scorching Metal (Lung). Coughing opens pores, facilitating eruption; thus, severe coughing before eruption is desirable and ceases once erupted. If cough persists after eruption or resolution, use Qingyan Zifei Tang (Clear Throat and Nourish Lung Decoction). For cough with profuse phlegm, remove Maidong (Ophiopogon Tuber) and add Chenpi (Tangerine Peel) and Fuling (Poria). If contracted wind-cold causing cough, irritability, vomiting clear fluid, red eyes, sore throat, and mouth ulcers, use Ganjie Tang (Licorice and Platycodon Decoction) adding Huangqin and Lianhua (Coptis Rhizome). Appearing after resolution, use Ren Shen Baihu Tang (Ginseng White Tiger Decoction) removing Zhimu (Anemarrhena Rhizome), substituting Maidong to nourish transformation.
Sweat: During measles eruption, slight sweating is appropriate. Slight sweating loosens the interstices, allowing easy expulsion of pathogens. Avoid strong ascending and dispersing agents, as they may cause excessive sweating and risk Yang collapse. For collapsed/incomplete eruptions, temporary use of ascending/dispersing methods to achieve heavy sweating is a specific variation. If high fever with no sweat and dry skin, wind-cold obstruction prevents eruption, leading to internal attack, abdominal pain, or panting; use Gegen Jieji Tang. In winter, Yuebi Tang (Yue Bi Decoction) or San'ao Tang (Three Unblocking Decoction) may be used, but not excessively. Cases of extreme heat/fire depression causing dry skin and difficulty erupting, with cracked lips/tongue, constipation, high fever, lethargy, body pain, or wheezing, require urgent Baihu Tang adding Heishen, Niubangzi (Arctium Fruit), Huangqin, Zhizi (Gardenia Fruit), and Zhuye. Generally, slight sweating is favorable in measles. Persistent lack of sweating, even after resolution, leaves sequelae. Treatment generally follows the above methods.
Sneezing: Frequent sneezing at onset indicates internal fire agitated by wind pathogen. Sneezing during proper eruption indicates mild condition. Sneezing after resolution indicates complete clearance of heat pathogen. Sneezing with abundant mucus indicates turbid accumulation releasing and Lung Qi clearing, a very auspicious sign. Lack of sneezing with nasal congestion indicates lingering wind pathogen, treated with acrid-cool agents to penetrate and reach.
Vomiting: Vomiting and diarrhea together at onset is favorable; Gan Huoluan (Dry Cholera) is unfavorable; desire to vomit without success is critical. Vomiting results from Stomach heat pathogen unable to vent, treated with Gegen Jieji Tang. Appearing during proper eruption/resolution, use Xiaodu Yin (Detoxify Toxin Infusion) adding Zhishi (Immature Bitter Orange) and Huanglian. With profuse phlegm, add Beimu (Fritillaria Bulb) and Gualougen (Trichosanthes Root). Vomiting after resolution indicates Spleen/Stomach deficiency with heat stagnation, treated with Shihu Qingwei San (Dendrobium Clear Stomach Powder). Vomiting roundworms indicates sticky phlegm-heat in Stomach forcing worms upward; if eating resumes, it stabilizes; if worms exit excessively and eating fails, Stomach Qi is exhausted, incurable.
Diarrhea: Diarrhea is common in measles, allowing heat pathogen to drain. Yellow, thick, sticky stool with scanty urine during fever indicates heat, treated with Siling San (Four Powders Powder) adding Mutong (Akebia Stem) and Huashi (Talcum). After eruption, use Ren Shen Baihu Tang removing Zhimu, substituting Maidong; expect thirst and persistent heat, multiple doses are acceptable. Clear, thin, white frothy stool with abdominal pain relieved by warmth indicates cold, treated with Weiling Tang (Wei Ling Decoction) removing Cangzhu, adding Wei Jiang (Roasted Ginger). Urgent diarrhea with bloating or belching like rotten eggs indicates food stagnation, treated with Zhike Tang (Citrus Aurantium Decoction) adding Zhang (Hawthorn Seed), Bo (Phellodendron Bark), and Mutong. Most measles diarrhea is heat-type; early differentiation is crucial. Prolonged diarrhea sinks Zheng Qi, potentially causing swelling or dysentery; treat with Zhishi Lizhong Wan (Immature Bitter Orange and Middle-Tonifying Pill) to regulate Spleen/Stomach. Post-measles diarrhea with thirst, closed eyes, and cold limbs is incurable. Vomiting, anorexia, and profuse watery diarrhea with loss of consciousness is incurable.
Eyes: Watery eyes, excessive discharge/tears, or slightly red sclera during fever are normal. Redness persisting after resolution indicates unresolved Lung wind-heat, treated with Xiebai San (Drain White Powder) adding Jingjie, Bohe (Mint), Heishen, and Niubangzi. Eyes closed unwilling to open add Lianqiao and Mutong. Redness with swelling/pain indicates wind-heat rising, treated with Daochi San (Guide Out Red Powder) adding Jingjie, Niubangzi, and Heishen. Red/rotten eye orbits from wind-heat invasion require Chaihu Yinzi (Bupleurum Infusion); urgent treatment prevents chronic disability.
Failure to Erupt: Initial fever, cough, body pain resembles Taiyang disease. Key differentiators are continuous dry cough, red eyes with tears, nausea, and loose stools. If impending eruption is blocked by sudden wind-cold or exposure, trapping heat, full momentum is not yet generated, differing from post-eruption premature resolution. Gasping, abdominal pain/distension, irritability, and inability to erupt require Mahuang Xinggan Shigao Tang (Ephedra, Apricot Kernel, Gypsum, Licorice Decoction) or Yuebi Tang removing Dazao (Jujube) with heavy Shigao. Mild cases use Shengma Tang (Cimicifuga Decoction) to ascend. Blocked by fog/cold/mist, use fresh pig manure infusion, steaming over bamboo mat, replacing when cool. Also burn pig manure to ash, take with Scallion White Decoction. This is a variation of burning human feces for black sunken smallpox; human feces ash also works. If still unerupted, no medicine can save. Ancient ascending formulas use Shengma (Cimicifuga Rhizome), but its ascending nature may raise heat causing wheezing. Substitute with Zisu (Perilla Leaf) and Congbai (Scallion White). Be cautious with Shengma and Jiegeng (Platycodon Root) initially to avoid carrying turbidity upward. Measles prefers cool/moist; all acrid-dry herbs are contraindicated. Medication requires caution.
Surface Penetration: Regardless of size, measles must penetrate the surface to avoid sequelae. Flat, broad red patches with flat small granules, or patchy wind-toxin with asymmetric swelling but non-pointed heads, though penetrated, retain latent heat pathogen, risking complications. Use Zhuye Shigao Tang removing Banxia to nourish and transform. Residual heat will dissipate.
Incomplete Surface Penetration: Dry skin and piloerection with incomplete eruption indicate wind-cold depression. Use Yuebi Tang or Gegen Jieji Tang according to severity. Exterior deficiency unable to withstand dispersion requires strong Congbai (Scallion White) decoction taken frequently until slight sweating resolves it. Hiding red-purple patches without eruption indicate blazing fire-toxin, treated with Baihu Tang adding Jingjie and Heishen. Non-dry skin, pale lips, normal excretions without eruption indicate Middle Qi deficiency, treated with Xiaodu Yin adding Lianqiao, Mutong, Cheqianzi (Plantago Seed), and Fuling. Despite latent heat, avoid cold herbs. Strong ascending agents will fail; focus on resolving and internal transformation. Eruption in warm trunk areas with intermittent head/limb appearance indicates lingering condition, possibly recurring 5-7 days post-resolution for 2-3 days due to climate differences. Treat with acrid-cool surface penetration; seek gradual recovery. Seeking rapid cure increases danger.
Premature Resolution: Rash disappearing within three days due to external wind-cold depression, internal heat collapse, or ingestion of sour/astringent foods, leaving no red traces in warm areas, becomes critical. If warm areas still show some redness, urgently penetrate surface. If unresponsive, investigate cause and treat internally. Wind-cold blockage with internal attack: Xiaodu Yin with Congtou (Scallion Head) hot, re-eruption is auspicious. Severe cases add Mahuang and Chuanshanjia (Pangolin Scale), or use Yuebi/San'ao Tang. Untreated leads to death from wheezing/bloating. Blue-purple hot swelling with wheezing indicates stagnant toxin/blood; use Liangge San removing Mangxiao (Mirabilite) adding Mahuang and Shigao. Abdominal bloating, panting, scanty urine, protruding umbilicus: Liangge San adding Tingli (Descurainia Seed). Internal phlegm-heat with blazing fire-toxin causing restlessness/unconsciousness: Baihu Tang adding Heishen and Zhuye. Ingestion of sour/astringent foods causing hidden high fever/wheezing: Pig bile processed Gancao (Licorice Root) decoction, inducing vomiting/sweating. Or Ku Hu (Bitter Gourd) and raw Gancao decoction to induce vomiting, achieving dispersion. Mistaken pork ingestion causing bloating/panting: Zhike Tang adding Zhang and Mangxiao to purge. Walnut ingestion causing hoarse cough: Xiaodu Yin with Shigao and Madouling (Aristolochia Root). Recovery indicates safety. Post-major illness or profuse diarrhea with Middle Qi deficiency preventing eruption: Tonify Middle Qi, mildly dispel exterior/clear heat. Itching after resolution indicates early exposure to wind; use Xiaofeng San (Eliminate Wind Powder) to disperse.
Difficulty Resolving: Northwest hard soil/constitution requires 5-7 days for resolution. Southeast soft climate resolves in 2-3 days. Recent climatic shifts prolong duration, not considered "difficulty resolving". Dry, white spots lingering on skin after 3-4 days indicate weak Wei Qi or insufficient clothing blocking dispersion. Treat with acrid-dispersing penetration; avoid cold herbs closing the pathway.
Thirst: Thirst indicates Lung/Stomach heat. Red lips/mouth with constipation: Mendong Ganlu Yin (Ophiopogon Sweet Dew Infusion). Normal excretions, non-red lips but thirsty: Excessive cold damaging Spleen failing to generate fluids; Qiwai Baizhu San (Seven-Ingredient Atractylodes Powder) removing Muxiang (Aucklandia Root), adding Nuomi (Glutinous Rice). Thirst with irritability: Heat scorching Pericardium; Baihu Tang adding Maidong and Zhuye. At resolution: Zhuye Shigao Tang removing Banxia. Thirst with abdominal distension: Wood deficiency/stagnation, difficult to treat.
Wheezing: Wheezing results from heat pathogen obstructing Lung orifices. Differentiate deficiency/excess. Deficiency: clear urine, loose stool, no high fever; phlegm-clearing/lung-nourishing ineffective. Excess: hard stool, red/scanty urine, high fever; Zhuye Shigao Tang removing Banxia, adding Gualouren (Trichosanthes Seed) and Beimu. Winter: add Zhi Mahuang (Honey-fried Ephedra). Wheezing without nasal discharge plus flaring nostrils is incurable. Pre-eruption wheezing is easier to treat; post-resolution is harder. Initial wheezing: San'ao Tang adding Shigao and Yacha (Tea Sprout). Wheezing with foul breath/dry mouth: Baihu Tang is most effective. Post-measles wheezing: Qingyan Zifei Tang; Baihu Tang is contraindicated. Medicine must be flexible.
Shortness of Breath: Caused by unresolved Lung heat. During initial eruption: Qingre Touji Tang. During/after resolution: Qingyan Zifei Tang. Phlegm rattling in throat during eruption: Heat obstruction; Chure Qingfei Tang (Clear Heat Purify Lung Decoction). Post-resolution: Unresolved heat or early wind exposure damaging Lung Qi; difficult to treat.
Hoarseness: Lung/Stomach heat attacked by wind-cold, unable to reach surface, severe cough damages throat. Use Qingyan Zifei Tang. Hoarseness with swelling/pain: Shegan Xiaodu Yin (Belamcanda Detoxify Toxin Decoction). Hoarseness is common in measles, unlike smallpox.
Convulsions: Phlegm-heat gathering in Pericardium during pre-eruption. Qingre Touji Tang adding Gualouren and Zhuye. Post-resolution is difficult; use light/clear agents. Avoid mineral drugs. Profuse phlegm: Gualou alone to induce vomiting. Convulsions without phlegm or self-biting indicate true deficiency, fatal.
Nosebleed: Blazing fire forcing blood upward. Initial nosebleed is favorable, allowing heat release, self-resolves. Persistent bleeding: Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) adding Jingjie Sui (Schizonepeta Tip). During/after resolution: Siwu Tang adding Maogen (Imperata Rhizome) and Maidong to nourish/descend.
Delirium: Blazing heat in Pericardium. During eruption: Heat trapped inside; Baihu Tang adding Jingjie and Niubangzi. Severe: add Mahuang. During/after resolution: Zhuye Shigao Tang removing Banxia, adding Shengdi Huang to clear/resolve.
Teeth Grinding: Smallpox grinding varies by cold/heat; measles is always heat. Yang sinking into Yin causes thirst, hot extremities, preference for cold drinks. Mai Men Dong Tang (Ophiopogon Decoction) adding Danpi (Moutan Cortex). Cold extremities, preference for hot drinks: Internal hyperactive heat, followed by bloody stool, sore throat, phlegm death. Baihu Tang rarely saves.
Dry Lips: Stomach/Spleen heat. Pale/dry: mild heat. Red/dry: deep heat. Purple-black/dry: severe heat. Treat with cooling/moistening accordingly.
Cracked Lips/Tongue: Heart/Spleen fire rushing up. Deep red color. During eruption: Baihu Tang adding Huangqin, Lianhua, Heishen, Jingjie, Bohe. During/after resolution: Heart/Spleen exhaustion. Purple-black/dry/non-vital blood: difficult to treat.
Bad Breath: Heat accumulating in Stomach. Qingwei San (Clear Stomach Powder) adding Shigao, Lianqiao, raw Gancao. Unbearable odor: Stomach exhaustion, incurable. Exception for pre-existing conditions.