痘疮止宜单出，若与疹并出者，谓之夹疹。盖痘、疹之发，皆有时气，而二者并见，其毒必
甚。《心鉴》曰∶夹疹者，即痘之两感证也，大为不顺之候。若痘本稀少而夹疹者，名为麻
夹痘，其证则轻；若痘本稠密而更加以疹，彼此相混，些碎莫辨，其证则凶。急宜以辛凉
之剂解散为先，而托里次之。但得疹毒渐消，痘见垒落者，乃为可治。若痘疹相杂，毒不少
减者，必危无疑。
一、治夹疹之法，先当察痘之稀密，疹之微甚。若疹轻热微者，但当以痘为主，痘获吉而
疹无虑也。若疹多热甚者，即当急解疹毒，务令疹散而后痘可保也。
一、痘疮初出，内有细密如蚕子者，即夹疹证也。若痘稀疹多者，宜但解疹毒为主。如表
邪不解，外热甚，内火不甚而夹疹者，宜疏邪饮、升麻葛根汤、荆防败毒散，或十味羌活散。
如表里俱热，毒盛而夹疹者，柴葛
煎、解毒防风汤、或十三味羌活散。如内热毒盛而夹疹者，六味消毒饮，或合黄连解毒汤。如阳明火盛，多热
多渴，或烦躁而夹疹者，白虎汤、化斑汤，或葛根麦门冬散。
以上诸治如法，而疹散痘出者可治然后随证调。
理之。若疹不散毒不解者难治。
一、痘疹俱多者，毒必大盛，虽治得其法，疹毒已解，亦必气血重伤，终难为力。凡遇此者，
惟当以保养脾胃，调和气血为主，庶克有济。
一、收靥后复出疹者，此余毒解散之兆，不必治之。
痘疮应当单独发出，如果与疹同时发出，就称为夹疹。大概痘和疹的发作，都受到时气（流行性致病因素）的影响，而两者同时出现，其毒邪必然非常严重。《心鉴》说：夹疹，就是痘疮的两感证（表里同病），是非常不顺利的征候。如果痘疮本来稀少而夹杂疹子，叫做麻夹痘，这种证候相对较轻；如果痘疮本来稠密而又加上疹子，彼此混杂，细碎难辨，这种证候则很凶险。此时急需用辛凉性质的方剂来解散表邪为先，托补里气为次。只要能让疹毒逐渐消退，痘疮能够依次结痂脱落，这才是可以治疗的。如果痘疹相互混杂，毒邪没有丝毫减少，必定危险无疑。
一、治疗夹疹的方法，首先应当观察痘疮的稀密程度，以及疹子的轻重情况。如果疹子轻微、热象微弱，就应当以治疗痘疮为主，痘疮获得痊愈而疹子也就无需担忧了。如果疹子多且热象严重，就应当紧急解除疹毒，务必让疹子消散之后，痘疮才能保住。
一、痘疮刚发出时，内部有细密如蚕子般的皮疹，这就是夹疹证。如果痘少疹多，适宜只以解除疹毒为主。如果是表邪未解，外部热象严重，内部火气不盛而夹杂疹子的，适宜用疏邪饮、升麻葛根汤、荆防败毒散，或者十味羌活散。如果是表里俱热，毒邪旺盛而夹杂疹子的，用柴葛煎、解毒防风汤，或者十三味羌活散。如果是内部热毒旺盛而夹杂疹子的，用六味消毒饮，或者配合黄连解毒汤。如果是阳明经火气旺盛，多热多渴，或者烦躁而夹杂疹子的，用白虎汤、化斑汤，或者葛根麦门冬散。以上各种治疗方法如果得当，疹子消散、痘疮发出的就可以治疗，然后随证调理。如果疹子不散、毒邪不解的就难以治疗。
一、如果痘疹都很多，毒邪必然非常旺盛，即使治疗方法得当，疹毒已经解除，也必定导致气血严重受伤，最终很难挽回。凡是遇到这种情况，只应当以保养脾胃、调和气血为主，这样才可能有所救助。
Smallpox should ideally erupt alone; if it erupts simultaneously with measles, it is termed "Jia Zhen" (Measles-Complicated Smallpox). Generally, the eruption of both smallpox and measles is influenced by seasonal pathogenic factors (Shi Qi); when both appear together, their toxicity must be severe. The *Xin Jian* states: "Jia Zhen" refers to the "Liang Gan Zheng" (Two-Factor Syndrome affecting both exterior and interior) of smallpox, which is a highly unfavorable prognosis. If smallpox is originally sparse but complicated by measles, it is named "Ma Jia Dou" (Measles Complicating Smallpox), and the condition is relatively mild; if smallpox is originally dense and further complicated by measles, mixing indistinguishably in fine fragments, the condition is ominous. Urgent treatment should prioritize dispersing the exterior with acrid-cool formulas, followed by supporting the interior. Only when the measles toxin gradually subsides and the smallpox lesions can be seen crusting and falling off is the case treatable. If smallpox and measles remain mixed without any reduction in toxicity, the case is undoubtedly critical.
1. The method for treating Jia Zhen first requires examining the density of the smallpox and the severity of the measles. If the measles are mild with slight heat, treatment should focus primarily on the smallpox; if the smallpox resolves favorably, the measles need not be a concern. If the measles are numerous with severe heat, urgent resolution of the measles toxin is required; only after the measles have dispersed can the smallpox be preserved.
1. When smallpox first erupts, if there are fine, dense eruptions resembling silkworm eggs within, this indicates Jia Zhen. If smallpox is sparse and measles are numerous, priority should be given to resolving the measles toxin. In cases where exterior pathogens are unresolved, external heat is severe, internal fire is not excessive, and measles are present, suitable formulas include Shu Xie Yin (Dispersing Pathogen Decoction), Sheng Ma Ge Gen Tang (Cimicifugae et Puerariae Decoction), Jing Fang Bai Du San (Schizonepetae et Saposhnikoviae Detoxifying Powder), or Shi Wei Qiang Huo San (Ten-Ingredient Notopterygii Powder). In cases where both exterior and interior are hot, toxicity is abundant, and measles are present, use Chai Ge Jian (Bupleuri et Puerariae Decoction), Jie Du Fang Feng Tang (Detoxifying Saposhnikoviae Decoction), or Shi San Wei Qiang Huo San (Thirteen-Ingredient Notopterygii Powder). In cases where internal heat-toxicity is abundant and measles are present, use Liu Wei Xiao Du Yin (Six-Ingredient Detoxifying Decoction) or combine it with Huang Lian Jie Du Tang (Coptidis Detoxifying Decoction). In cases where Yangming Fire is excessive, presenting with much heat, thirst, irritability, and measles, use Bai Hu Tang (White Tiger Decoction), Hua Ban Tang (Transforming Maculae Decoction), or Ge Gen Mai Men Dong San (Puerariae et Ophiopogonis Powder). If the above treatments are applied correctly, resulting in the dispersion of measles and eruption of smallpox, the case is treatable and can then be regulated according to symptoms. If the measles do not disperse and the toxin does not resolve, the case is difficult to treat.
1. When both smallpox and measles are numerous, toxicity must be extremely abundant. Even if the treatment method is correct and the measles toxin is resolved, the vital qi and blood will inevitably suffer severe injury, making recovery difficult. In such cases, one must primarily focus on nourishing and protecting the spleen and stomach, and harmonizing vital qi and blood, so that assistance may be achieved.
1. If measles reappear after the smallpox has crusted and healed (Shou Ye), this is a sign that residual toxins are being dispersed; no treatment is necessary.