痘疮夹斑疹而发。是脏腑热毒交盛。故一齐涌出。予尝洗心体会痘证。但有夹麻。而夹斑之
说未果。斑乃伤寒之热毒内蕴而发。安有与痘齐出之理。即前见点例中所言。皮肉鲜红成片者为
夹斑。实麻疹也。细如芥子者为夹疹。则
瘾疹也。然斑则多见于胸腹肢体。头面绝少。于此可以明辨。而举世通谓夹斑。若一齐众楚。
大不合时矣。观先辈治例。首推升麻葛根汤。先散表邪。俟斑退痘起。然后随证施治。遍考方书。
无不皆然。张涵高曰。斑痘齐出。方书俱言先撤斑热。往往痘随斑陷。惟发其痘。则热聚于痘。
痘起其斑自退。两说似乎相左。其实并行不悖。当知斑痘齐发。总由热毒势盛。绝无挟虚之候。
得其旨。则撤斑无非清凉化毒。起痘亦无非清凉化毒。化斑汤一方随证加增。允为斑痘夹出之金
。如斑色紫赤。加大剂石膏以化之。大便秘结。稍加大黄以利之。设不知此。而误认真斑。专
事寒凉。则痘随斑陷。若不化斑。专力升发。则斑随痘起。丛杂不分头粒。两难分解也。黄五芝
云。风寒夹斑。当先表散。则痘自起。大便秘者。宜速下之。大便利者。凉血透肌解毒为主。次
言先痘后麻者轻。麻出以分痘之势也。先麻后痘者重。麻发于肺。表气先虚。失其起灌之力也。
麻痘齐出者险。两毒并发。但看麻之形色。痘之稀密。斟酌而为处治。若斑见紫黑。痘见浆清。
证见喘急。皆不可治。大抵斑痘齐发。总由热毒势盛。不可误用参、 。若元气本虚。痘色淡白。
小剂保元亦不禁也。如六七日内。热毒未尽。而误与之。必身复壮热。痰喘不食而死。否则痈毒
口疳目疾之害。所不免焉。
痘疮与斑疹同时发作。这是脏腑热毒交相亢盛的结果，所以它们一齐涌出皮肤表面。我曾静心体会痘证的规律，发现只有夹带麻疹的情况，而“夹斑”的说法并未得到证实。斑是伤寒病中热毒内蕴而引发的，怎么会有与痘疮同时发出的道理呢？就像前面在“见点例”中所说的那样，皮肉上鲜红成片的是所谓的“夹斑”，实际上就是麻疹；细如芥子粒大小的是所谓的“夹疹”，那其实是瘾疹（风团）。然而，斑通常多见于胸腹和肢体，头面部极少出现，据此可以明确辨别。但世间普遍称之为“夹斑”，如果像众多楚地人一起呼喊那样形容其密集程度，实在是不合时宜的。
观察前人的治疗案例，首先推崇使用升麻葛根汤，先疏散表邪，等到斑退痘起之后，再根据具体证候施治。遍查方书，无不都是这样处理的。张涵高说：斑痘齐出，方书中都说是先撤除斑的热毒，往往导致痘疮随之陷入（塌陷）；只有发越痘疮，热毒就会聚集在痘上，痘起来了斑自然消退。这两种说法看似相反，其实并行不悖。应当知道斑痘同时发作，总归是因为热毒势头旺盛，完全没有挟带虚证的征候。掌握了这个宗旨，那么撤除斑热无非是用清凉药化解毒邪，发起痘疮也无非是用清凉药化解毒邪。化斑汤一方随证加减，确实是斑痘夹杂而出的良方。如果斑色紫赤，加大剂量石膏来化解它；大便秘结，稍加大黄来通利它。假如不知道这个道理，而误认为是真斑，专门从事寒凉药物治疗，那么痘疮就会随着斑的出现而陷入；如果不化解斑毒，专门用力升发透疹，那么斑就会随着痘疮的发出而杂乱无章，分不清头粒，两者就难以分解了。
黄五芝说：风寒夹斑，应当先解表散邪，则痘疮自然能起发。大便秘结的，应当迅速攻下；大便通畅的，以凉血、透肌、解毒为主。其次提到先出痘后出麻疹的病情较轻，因为麻疹发出可以分泄痘疮的势头；先出麻疹后出痘疮的病情较重，因为麻疹发于肺，体表之气先已虚弱，失去了起发灌脓的力量。麻疹与痘疮同时发出的情况危险，因为两种毒邪并发，只需看麻疹的形色、痘疮的稀密，斟酌后进行处置。如果斑呈现紫黑色，痘浆清稀，证候出现喘急，都属于不可治疗的危重症。大抵斑痘同时发作，总归是由热毒势头旺盛所致，不可误用人参、黄芪等补益药。如果元气本来虚弱，痘色淡白，小剂量的保元汤也是不禁受的。如果在六七日内，热毒未尽，而误用补药，必然导致身体再次壮热，因痰喘不食而死；否则痈毒、口疳、目疾等危害也难免发生。
Measles (variolous eruptions) erupting simultaneously with macules (ban). This indicates that the heat-toxin of the zang-fu organs is excessively flourishing, causing them to surge out together. I have carefully reflected on the pathology of variola, and found only cases where it is accompanied by rubeola (measles), while the concept of "accompanied by macules" remains unverified. Macules arise from heat-toxin retained internally in typhoid fevers; how could they possibly erupt simultaneously with variola? As mentioned in the previous section regarding "eruption patterns," bright red patches covering the skin and flesh are referred to as "accompanied macules," but are actually rubeola; those fine as mustard seeds are referred to as "accompanied papules," which are actually urticaria (wind wheals). However, macules are mostly seen on the chest, abdomen, and limbs, rarely on the head and face. Based on this, one can clearly distinguish them. Yet, the world generally calls them "accompanied macules," describing their density as if a crowd were shouting together, which is indeed inappropriate.
Observing the treatment examples of predecessors, the first recommendation is Shengma Gegen Tang (Cimicifugae Rhizoma and Puerariae Radix Decoction) to first disperse exterior pathogens. Wait until the macules recede and the variola rises, then treat according to the specific syndrome. A thorough review of medical texts confirms this approach universally. Zhang Hangao stated: When macules and variola erupt simultaneously, texts advise removing macule-heat first, often causing the variola to collapse inward. Only by promoting the eruption of variola does the heat gather into the pustules, allowing the variola to rise and the macules to recede naturally. These two theories seem contradictory but are actually complementary. One must understand that simultaneous eruption of macules and variola is always due to the overwhelming momentum of heat-toxin, with absolutely no signs of deficiency. Grasping this principle, removing macule-heat is merely using cooling agents to resolve toxins, just as promoting variola eruption is also using cooling agents to resolve toxins. Huaban Tang (Macule-Resolving Decoction), modified according to symptoms, is truly the golden standard for simultaneous macule and variola eruption. If the macules are purple-red, increase the dosage of Shigao (Gypsum Fibrosum) to resolve them. If constipation occurs, slightly add Dahuang (Rhei Radix et Rhizoma) to promote bowel movement. If one fails to understand this and mistakenly treats true macules solely with cold-natured herbs, the variola will collapse with the macules. If one fails to resolve the macules and focuses solely on ascending and venting, the macules will become chaotic and indistinguishable among the erupting variola, making separation difficult.
Huang Wuzhi said: For wind-cold accompanied by macules, one should first release the exterior, after which the variola will naturally rise. In cases of constipation, rapid purgation is suitable; in cases of normal bowel movements, the focus should be on cooling blood, venting through the skin, and resolving toxins. Furthermore, variola appearing before rubeola indicates a milder condition, as rubeola helps dissipate the momentum of variola. Rubeola appearing before variola indicates a severe condition, because rubeola originates in the Lung, depleting the defensive Qi first and losing the strength to support the filling of pustules. Simultaneous eruption of rubeola and variola is dangerous, as both toxins attack concurrently. Treatment depends on assessing the appearance of rubeola and the density of variola. If macules are purple-black, variola pus is clear/thin, and the patient exhibits panting/urgency, these are untreatable conditions. Generally, simultaneous eruption of macules and variola is caused by excessive heat-toxin momentum; one must not mistakenly use Renshen (Ginseng Radix) or Huangqi (Astragali Radix). If the primordial Qi is inherently deficient and the variola color is pale-white, a small dose of Baoyuan Tang (Protect the Origin Decoction) may be tolerated. However, if heat-toxin is not yet exhausted within six or seven days, and tonics are mistakenly administered, the patient will inevitably suffer from recurrent high fever, phlegm-panting, anorexia, and death. Otherwise, complications such as carbuncles, oral ulcers, and eye diseases are unavoidable.