万密斋曰∶凡出疹，热起至收完，但看右手一指，脉洪大有力，虽有别证，亦不为害。此定存亡之要诀也。
霖按∶此即阳证得阳脉之义。若细软无力，则阳证得阴脉也。景岳以诊得阴脉，宜速救元神，用温补托法，
参酌治之，是矣。然有热毒深伏于内，不能透发于外，假寒真热之证，肢冷面青，六脉沉伏细数，若误用温补，
祸不旋踵。痧疹阳邪，热证俱多，安危之机，须细心体认也。
痧为阳毒，首先干肺。肺主气属金，热邪伤气，舌上多见白苔，金之色也，治当清肺。若无虚寒的证，误
治则杀人事矣。不独痧疹为然，夏日忽患咯血，俗名暑瘵，证亦见白苔，宜清络热，同一义也。司命者岂可
忽诸！
《 疹全书》云∶疹之出也，有热三日而即出者，有热四五六日而出者，有热而凉，凉而复热者，有一日寒
热往来数次而出者，有热一日凉一日，复凉复热至五六七日而出者。大抵五日前出者多轻，五日后出者多重；
毒少则热少，毒多则热多；热少则早而易出，热多则迟而难出，大有分别。七日不出，面青鼻煽，喘急生痰，名
曰闷 ，不治。
凡 先从肚腹发起，而后及于四肢者顺；先从手足发起，而后及于肚腹胸背者逆。
凡 于皮肤上发出，成粒者顺；以手摸之碍指尖，红者吉； 上重叠起 者吉。盖 以起发为上也。
痘后 者吉， 后痘者凶。盖痘后出 ，则腠理疏而毒易出，无形之毒瓦斯易泄也； 后出痘，则阴血亏而浆
难灌，有形之营血难成也。此言痘后出 ，因其腠理疏通，毒瓦斯易出，故吉；若 后出痘，则一日三潮，三日
九潮，往来进退，劳动阴血则血
虚，血虚而责其灌浆也，难矣。
痘 一齐出者，所谓 夹痘也，先治其 ，而后治其痘。 潮一日，忽夹痘苗，所谓 喷痘；痘苗初见，忽
又夹 。所谓痘喷 。治宜先发 潮，不论痘苗，三日潮完，痘始蒸长。但治痘药中，必须滋养阴血，切不可用
参、 、甘、芷、术、桂，温补之药，盖 无补阳法也。若痘出一日至四五日内，忽然 出痘中，所谓 合痘也，
发表起痘之药皆同， 发则痘自蒸长。若痘出六七日，内浆未灌，或灌未足，忽然 出痘中，所谓痘离 也，若
助痘浆则 闷而难出，若攻 潮则痘靥而不浆。既欲其潮，又欲其浆，正所谓阴阳困惫，气血奔命者是也。证必
上喘痰壅，下泻脓浆，神昏厥逆，百无一生。若痘少儿大，见 不失时机，连发 潮，痘虽迟滞，至三日潮完，
痘复蒸浆回合。以其元气壮实，等 潮完，痘乃自浆自靥而愈。此盖百中一二也。若痘多儿小，元气怯弱，至此
用补则 闭闷，不补则痘痒塌，施治两难，故曰逆也。若痘至九日，十、十一、十二日后，浆虽回而痂未落，忽
然出 ，所谓 赶痘也。治宜微发表，不可大发汗。如喘急无汗而 不起者，麻黄亦可权用。如服汗药皆成水泡，
亦不妨。至 后复结痂而落，宜多服滋阴养血药。若痘痂落尽而出 者，痘后 也。 潮已完而痘出者， 后痘
也。详见前章。
凡 五液兼见者顺，二三液不见者逆，一液不见者死。汗为心液，泪为肝液，吐为脾液，涕为肺液，泻为肾
液。 发于阳，火毒炎灼；五液皆属水，水能制火，是以轻也。遍身干燥，心液竭也；目无眵泪，肝液少也；
干呕无物，脾液乏也；鼻煽无涕，肺液干也；大便秘结，肾液亏也。五液不全， 后必有余毒。心无液者发热，
肝无液者惊搐，脾无液者牙疳，肺无液者咳嗽，肾无液者下利。五液皆无，不治之证。如少一二液者，当以药
救之。五液以多为妙。
夫 之难出也，为有六因，遂成六闭焉。一曰毒闭，因时气
恶厉，毒盛发热，久不出也。宜挑顶血及手足血，服解毒化毒之药以发之。二曰肌闭，因儿之肌肉坚浓难出。
宜用洗擦刮法，服松肌透表之药以达之。三曰肠闭，因脏腑热甚，大便不通，则经络闭塞难出。宜用导法，服
滋阴润肠之药以通之。四曰寒闭，因天气严寒，风雪凛冽，致令腠理闭密，血脉凝涩，邪滞难出。用胡荽喷
床帐，西河柳烧房中，服麻黄汤以表之。五曰食闭，因将出之时，恣啖饮食，食滞满闭，胃口停滞，不能运动
气血，而送 外出。宜用探吐法、摩熨法，服宽中化食之药以消之。六曰病闭，因儿有本病，复感时气出 ，
为本病而滞 难出者多矣。如夹食、夹惊、杂疹、杂疮、损伤、怀妊等证，皆能滞 难出。宜照本证兼治之，
或从其急者先治之。瘀血喘满，不得不吐，此先治本病之急。痘浆见 ，发 为先，保元大忌；疟疾见 ，
治为急，截疟大凶。此治 之急务也。谨此六闭者吉，犯此六闭者凶。
痘 皆有皮里隐、皮里疔。夫痘之皮里隐，身体头面上先见十数点红紫痘，父母不知，以为痘止此矣。
以火照之，皮里隐隐如菜子密布，宛如疥疮。初出细密，出皮里隐隐成片，皮痘一色，有影无形，此谓皮里隐。
亦有身面上不见红点，神昏烦躁，而成皮里隐者，此谓闷痘，惊搐发喘而死，父母不知其为何病而死也。 之
皮里隐，神昏厥逆，面青烦躁，气喘鼻煽， 全不见。以火照之，头面上、皮肉内隐隐有红点。其头面皮上，
微微有红光出没。或如灯光，瞬息即没，旋有旋无，日有数次。三日不起，必致喘闭而死，父母不知其为何病
而死也。此证必须细心辨视确切，急用大剂麻黄救之。若脉洪身热者，麻黄加石膏汤救之。
痘 皆有皮里疔。夫痘 未出，或微见标皮肉中有硬块，或紫或青或黑，摸之碍手，此谓皮里疔也，百无
一生。
凡痘 之皮里隐，能辨认急治，十中可活一二。若迟延失
治，毒瓦斯凝聚，变成皮里疔，便无生理矣。
渐出及正潮时，因风寒不谨，致令腠理闭塞，气血阻滞， 即隐没者，总名闷 也。 出二日，因风寒
早没者，证犹稍轻。 出一日而早没者，证必重。随出随没，乃危证也。致令咳嗽喘急，面青鼻煽，痰壅声嘶，
神昏迷闷，身凉无汗，轻者三四日，重者一二日，皆喘急而死。此与皮里隐不同。皮里隐者， 疹全未见点，
隐隐于皮肤之下，面上如电影灯光，忽来忽没，人全不知也。若已潮见 ，因风隐没，但分一日、二日、三日，
轻、重之不同，治法当与早没之时，急与麻黄发表汤，兼熏洗、刮擦法。倘得微潮一二次，喘定身温，方有生
机。《金镜录》云∶痧疹数潮后，见风早没，未清爽者，宜消食饮加散表之药。虽不复出，亦寻愈矣。此谓数
潮而言也。若止一二潮而早没者，其变证必凶，急当委曲调治。如一二潮而止，证必凶恶。身体如常，此必有夜
潮、腹潮、汗潮，减潮、经潮、产潮之类，不可强与发汗，变生他证。谨按因风早没之证急治，十全七八。如
使迟延，不可救矣。
不收敛，其证有二∶一曰血不归经，一曰血死肌表。 疹九潮已完，血回经络，则头面身上血迹渐次而
退。若红久不退，即是血不归经；若血迹变为青紫色，即是血死肌表也。如血不归经，用解毒清凉、敛阴收血
之药，宜养荣解毒汤。如血死肌表，用活血凉血、温经解毒之药。若 出三日后不没者，乃余毒内实也，宜四
物汤加清利之药，则热自解而 自消矣。若血死肌表，色变青紫黑，久则身热发肿，其青紫黑色之处从外溃烂，
脓水淋漓，痛痒不常，宜服清肌化毒汤，洗以苦参汤，敷以三黄散。若潮止一二次，外冒风寒，随出随没，色
变青紫，身冷不烂，必发喘急，不治必死。急宜大发表邪，以麻黄救急汤治之。
妇人经水后五日六日发热见 ，则血室空虚，邪气乘虚入内。重则妄见妄闻，如凭鬼祟，昼则明了，夜则
谵语，此谓热入
血室；轻则常发夜热，久成 怯。宜服清热养血之剂，主以加味逍遥散、调经养营丸。必得经调复行，方无后患
也。若妇人行经七八日见 ，或见 时即便行经，皆为热入血室。二者不同，治法亦异。如经尽后见 ，此热邪
乘虚入内也，令人多发夜热，或午后面红身热，久之则成骨蒸劳热。治当养血清热，宜逍遥散。如见 时行经，
此瘀血蕴结于内也，令人寒热如疟，发作有时。治当消瘀败毒，宜桃仁红花汤。总以经水复行为第一义也。
李豆仙曰∶ 之出也，气载之，血送之，达表则粒粒如麻，甚则叠肿，多则成片。一日三潮，从头而起，
渐渐身体，以及四肢，潮时 脚粒粒肿起皮上，三日九潮方完。潮则气送毒从毛窍而散，血留肌表，渐归经络，
红点以渐而退。头面先潮者色先淡，身腹后起者色后退。头面多者吉，少者凶，色赤者吉，紫黑者凶。
正潮 正潮者，早午晚一日三潮，三日九潮，人尽知也。 属阳，阳从阳类，故不潮于夜之阴，而潮于日之
阳，此正潮也。
夜潮 有夜潮，不可不知。盖 本属阳，然其赤点乃阴血也。男子阳盛，故潮于日之阳；女子阴盛，故潮于
夜之阴。有男子夜潮者，气不足而血有余也；有女子日潮者，血不足而热毒盛也。儿出 时，为父母者必夜观
之。如不知夜观，则九潮已过，犹以为未潮；九潮已足，犹以为未足。疏表之药，发表之物，犹然不彻，有致血
不归经，皮肤肿而色青紫者，有致吐血便血者，有致汗多亡阳者，有致中风发痉者。为父母者不可不知。
腹潮 小儿 疹，乃天行热毒挟少阳相火，蕴蓄于胃。胃主肌肉，故热毒之邪熏蒸于肌肉，先发热数日，然
后透泄于皮肤，粒粒如蛇咬状，乃 疹也。痘出于五脏， 出于六腑。六腑者专指胃腑而言也。既云出于胃腑，
何腑脏多受其邪？胃土传肺金，以前来者为实邪也。胃邪传肺，是腑传脏。如毒邪陷伏不出者死，不治矣。有
止发于肚腹，而头面手足一无所见，一日三潮，
三日九潮，惟在肚腹，粒粒起绽。缘小儿气血孱弱，不能周行遍体，故止在肚腹出 。发潮 根既出，他处虽无，
不足虑也。若用重剂取汗，则虚脱之祸立至矣，可不慎哉。
目潮 潮有从眼白珠先红，头面随红蒸热，一片通红，直待潮过热清，红色渐退，再潮复然，此阳毒之邪
交并于六阳也。六阳皆聚于头面， 毒出于胃腑，运于任脉，交并于六阳，则目睛裹赤，头面通红，潮时令人烦
躁不宁，甚则不省人事，宜以化毒饮、化斑汤加减治之。
斑潮 斑潮者， 发潮时，遍身起云头斑也，潮过则退，再潮复然。此胃腑毒热太甚，壅遏而然，宜以化斑
汤加减治之。若潮过不退者，不治之证也。
累潮 累潮者， 发潮时，遍身累累如疙瘩状，潮过稍平，再潮复肿。此热甚兼风，宜以大连翘饮治之。
隐潮 隐潮者，潮时见赤点于皮肤之上，潮过即没，毫无点迹，与平人同。此乃血和而毒不甚，故未潮则隐
伏于皮肤之中，既潮则发现于皮肤之上矣。若无恶候，宜从轻治，不必重剂。
闹潮 闹潮者， 发潮时，证见狂乱不宁，甚则谵语，目不识人，潮过则神清如旧，再潮复然。此热毒蕴于胃
脏，宜凉膈散加减以清之。大便秘结，少加大黄以通之，或用导法。蚯蚓酒洗去泥，捣汁，将药煎好，入蚓汁
数匙在内，最妙。口鼻衄血多者，名阳毒 也，磨犀角汁入药最妙。
汗潮 汗潮者，见 后止得一二潮，余则早午晚当潮时不见红点，止见身热腮红，江HT HT 汗出而已。此因天
禀
虚弱，阴血不足，或缘病后气血两虚，是以微潮一二次，潮亦不盛。万不可以为潮不足，妄用麻黄重剂，致令
汗多亡阳，变生中风、惊风、发痉、发厥之诸危证也，慎之。
减潮 减潮者，不足之潮也。 之常例，三日九潮，今止一日三潮者，有二日六潮者，有二三日总计止得
四五潮者。此乃
毒原轻，或因天行时气和平。如小儿皮嫩，五液俱全，身安证和者，亦无害也。
劫潮 劫潮者，命在危急，激得一潮，即可回生。 疹初出潮时，因风早没，致令咳嗽痰喘，面青鼻煽，胸
膈迷闷，三日已过，危在旦夕。急用麻黄发表汤，或三酥饼、蟾龙锭、还元复气丹，劫得微微一潮， 毒从汗
孔而出，不致内攻矣。若大便脓血，神昏不省者，逆候也。
经潮 经潮者，当分经前经后。凡经后三四日发热见 ，此血室空虚，与伤寒热入血室同。重则潮时妄见
妄闻，如有鬼祟，轻则夜热，久成疳劳。服药调治，月经复行，则无羌矣，宜用清热养血之剂。若染时气，发热
咳嗽喷嚏，三日起至七八日，不论已潮未潮，一遇经行，毒从血化，宜服解毒养血之品。
产潮 产潮者，孕妇发热，正在潮时，热极不安，其胎必下，胎下热退而 愈。盖热极则伤胎元，胎下则
毒从血化， 愈竟不潮矣。产后虽有热象，切勿妄用凉药，恣食寒物，只宜平调气血为要。
弄潮 弄潮者，夺先声也。一日三潮，早午晚熏洗、服药，必在将潮未潮之先，以激其怒。若已潮过，有
何益乎？故 将潮时，令儿不得安睡，先熏洗其面，随洗手足，既饲之以汤饮，随灌煎药，更相搬弄，以俟
其潮，故谓之弄潮。弄潮儿必啼哭怒泣，则内有以激其气；更加熏洗刮擦，则外有以助其势。内外夹攻， 无
不潮矣。
万密斋说：凡是出痧疹，从发热开始到收没完毕，只要看右手寸口脉，若脉象洪大有力，即使有其他兼证，也不会造成危害。这是决定生死存亡的关键要点。
叶霖按语：这就是阳证见到阳脉的道理。如果脉象细软无力，就是阳证见到了阴脉。张景岳认为诊得阴脉时，应当迅速挽救元神，采用温补托毒的方法，参考斟酌进行治疗，这是正确的。然而，如果有热毒深伏在体内，不能透发于体表，出现假寒真热的证候，四肢冰冷、面色青紫，六脉沉伏细数，如果误用温补药物，灾祸立刻就会降临。痧疹属于阳邪，热证居多，安危的关键，必须细心体察认识。
痧气属于阳毒，首先侵犯肺脏。肺主气，五行属金，热邪伤及肺气，舌面上多见白苔，这是金的颜色，治疗应当清肺。如果没有确切的虚寒证据，误治就会危及生命。不仅痧疹是这样，夏天突然患咯血，俗称暑瘵，证候也见白苔，适宜清络热，道理是一样的。作为医生怎么可以忽视呢！
《疹全书》说：出痧疹时，有发热三天就出的，有发热四五天或六七天才出的，有发热后又变凉、凉后又发热的，有一天内寒热往来数次才出的，有发热一天、凉一天，反复冷热至五六七天才出的。大致上前五天内出的病情较轻，五天后出的病情较重；毒少则热势轻，毒多则热势重；热轻则出得早且容易，热重则出得晚且困难，区别很大。如果七天后还不出，面色青紫、鼻翼煽动、气喘急促并生痰，称为“闷痧”，无法治愈。
凡是痧疹先从肚腹发起，然后波及四肢的，为顺证；先从手足发起，然后波及肚腹胸背的，为逆证。
凡是痧疹在皮肤上发出，形成颗粒状的，为顺证；用手摸起来碍手，颜色红的，为吉兆；痧疹重叠隆起的，为吉兆。大概以起发透达为上策。
痘后出痧疹的，为吉；痧后出痘的，为凶。因为痘后出痧，腠理疏松，毒邪容易排出，无形之毒气容易泄散；痧后出痘，则阴血亏虚，痘浆难以灌注，有形之营血难以生成。这里说痘后出痧，因为腠理疏通，毒气易出，所以吉利；若痧后出痘，则一日三潮，三日九潮，进退往复，耗伤阴血导致血虚，血虚却要求灌浆，这就很难了。
痘和痧一齐出的，所谓“夹痘”，先治痧，后治痘。痧初潮时，忽然夹杂痘苗，称为“痧喷痘”；痘苗刚出现，忽然又夹杂痧，称为“痘喷痧”。治疗应当先发痧潮，不论痘苗，待三日痧潮结束后，痘才开始蒸长。但在治疗痘的药中，必须滋养阴血，切不可用人参、黄芪、甘草、白芷、白术、肉桂等温补药物，因为痧没有补阳的治疗方法。如果痘出一日至四五日内，忽然在痘中出痧，称为“痘合痧”，发表起痘的药物都相同，痧发出则痘自然蒸长。如果痘出六七日，内部痘浆未灌满，或灌不满，忽然在痘中出痧，称为“痘离痧”，若想助长痘浆则痧会闷闭难出，若想攻逐痧毒则痘会结痂而不灌浆。既想其出痧，又想其灌浆，这正是阴阳困惫、气血奔命的情况。证候必定表现为上喘痰壅、下泻脓浆、神志昏迷、厥逆，百无一活。如果痘少儿壮实，抓住时机，连续发痧潮，痘虽迟滞，待三日痧潮完后，痘复蒸浆回合痊愈。这是因为元气壮实，等痧潮完，痘自然灌浆结痂而愈。这大概是百中有一二的情况。如果痘多儿小，元气怯弱，到了这个时候，用补药则痧闭闷，不用补药则痘痒塌陷，施治两难，所以称为逆证。如果痘至九日、十、十一、十二日后，痘浆虽然回流但痂未脱落，忽然出痧，称为“痧赶痘”。治疗宜轻微发表，不可大发汗。如气喘急促无汗且痧不起者，麻黄也可权宜使用。如服用发汗药后皆成水泡，也无妨。待痧后重新结痂脱落，宜多服滋阴养血药。若痘痂落尽而出痧的，称为“痘后痧”。痧潮已完而出痘的，称为“痧后痘”。详见前章。
凡是痧疹五液（汗、泪、吐、涕、泻）兼见的为顺证，不见二三种液的为逆证，一种液都不见的为死证。汗为心液，泪为肝液，吐为脾液，涕为肺液，泻为肾液。痧发于阳，火毒炎灼；五液皆属水，水能制火，所以病情较轻。遍身干燥，是心液枯竭；眼睛无眵无泪，是肝液少；干呕无物，是脾液乏；鼻煽无涕，是肺液干；大便秘结，是肾液亏。五液不全，痧后必有残留毒邪。心无液者发热，肝无液者惊搐，脾无液者牙疳，肺无液者咳嗽，肾无液者下利。五液全无，是不治之证。如果缺少一二种液，当用药补救。五液以多为妙。
痧疹难出的原因有六种，遂成“六闭”。一曰毒闭，因时行恶厉之气，毒盛发热，久久不出。宜挑破顶部出血及手足出血，服用解毒化毒的药物以发散它。二曰肌闭，因小儿肌肉坚实浓密，难透出。宜用洗擦刮法，服用松肌透表的药物以通达它。三曰肠闭，因脏腑热甚，大便不通，经络闭塞难出。宜用导法，服用滋阴润肠的药物以通利它。四曰寒闭，因天气严寒，风雪凛冽，致使腠理闭密，血脉凝涩，邪气滞留难出。用胡荽喷洒床帐，西河柳烧烟于房中，服用麻黄汤以解表。五曰食闭，因将出之时，恣意饮食，食滞满闭，胃口停滞，不能运动气血，从而送痧外出。宜用探吐法、摩熨法，服用宽中化食的药物以消除它。六曰病闭，因小儿原有本病，又感受时气出痧，因本病而阻滞痧难出者很多。如夹食、夹惊、杂疹、杂疮、损伤、怀孕等证，都能阻滞痧难出。宜按照本证兼治，或从其急者先治。瘀血喘满，不得不吐，这是先治本病的急症。痘浆见痧，先发痧为先，保元汤大忌；疟疾见痧，治痧为急，截疟为大凶。这是治痧的急务。谨守这六闭的吉利，触犯这六闭的凶险。
痘和痧都有皮里隐、皮里疔。所谓痘的皮里隐，身体头面上先见十几点红紫痘，父母不知道，以为痘只此而已。用火照之，皮里隐隐如菜子密布，宛如疥疮。初出细密，出皮里隐隐成片，皮痘一色，有影无形，这叫皮里隐。也有身面上不见红点，神昏烦躁，而成皮里隐的，这叫闷痘，因惊搐发喘而死，父母不知道是什么病死的。痧的皮里隐，神昏厥逆，面青烦躁，气喘鼻煽，痧全不见。用火照之，头面部皮肉内隐隐有红点。头面皮上，微微有红光出没。或如灯光，瞬息即没，旋有旋无，每天有数次。三天不起，必致喘闭而死，父母不知道是什么病死的。此证必须细心辨视确切，急用大剂麻黄救治。若脉洪身热者，用麻黄加石膏汤救治。
痘和痧都有皮里疔。痘或痧未出，或微见标皮肉中有硬块，或紫或青或黑，摸之碍手，这叫皮里疔，百无一生。
凡是痘或痧的皮里隐，能辨认并急治，十人中可活一二。若迟延失治，毒气凝聚，变成皮里疔，便无生理了。
渐出及正潮时，因风寒不慎，致使腠理闭塞，气血阻滞，痧即隐没的，总名闷痧。痧出两天，因风寒早没的，证候尚稍轻。痧出一天而早没的，证候必重。随出随没，是危重证候。致使咳嗽喘急，面青鼻煽，痰壅声嘶，神昏迷闷，身凉无汗，轻者三四日，重者一二日，皆因喘急而死。这与皮里隐不同。皮里隐者，痧疹全然未见点，隐隐于皮肤之下，面上如电影灯光，忽来忽没，人全然不知。若已潮见痧，因风隐没，只分一日、二日、三日，轻重的不同，治法应当与早没之时一样，急用麻黄发表汤，兼熏洗、刮擦法。倘若得微潮一二次，喘定身温，方有生机。《金镜录》说：痧疹数潮后，见风早没，未清爽的，宜消食饮加散表之药。虽不再出，也会寻愈。这是指数潮而言。若仅一二潮而早没的，其变证必凶，急当委曲调治。如一二潮而止，证候必凶恶。身体如常，这必有夜潮、腹潮、汗潮、减潮、经潮、产潮之类，不可强与发汗，变生他证。谨按因风早没的证候急治，十全七八。如使迟延，不可救矣。
不收敛，其证有二：一曰血不归经，一曰血死肌表。痧疹九潮已完，血回经络，则头面身上血迹渐次而退。若红久不退，即是血不归经；若血迹变为青紫色，即是血死肌表也。如血不归经，用解毒清凉、敛阴收血的药物，宜养荣解毒汤。如血死肌表，用活血凉血、温经解毒的药物。若痧出三日后不没者，乃余毒内实也，宜四物汤加清利之药，则热自解而痧自消矣。若血死肌表，色变青紫黑，久则身热发肿，其青紫黑色之处从外溃烂，脓水淋漓，痛痒不常，宜服清肌化毒汤，洗以苦参汤，敷以三黄散。若潮止一二次，外冒风寒，随出随没，色变青紫，身冷不烂，必发喘急，不治必死。急宜大发表邪，以麻黄救急汤治之。
妇人经水后五日六日发热见痧，则血室空虚，邪气乘虚入内。重则妄见妄闻，如凭鬼祟，昼则明了，夜则谵语，这叫热入血室；轻则常发夜热，久成疳怯。宜服清热养血之剂，主以加味逍遥散、调经养营丸。必得经调复行，方无后患也。若妇人行经七八日见痧，或见痧时即便行经，皆为热入血室。二者不同，治法亦异。如经尽后见痧，此热邪乘虚入内也，令人多发夜热，或午后面红身热，久之则成骨蒸劳热。治当养血清热，宜逍遥散。如见痧时行经，此瘀血蕴结于内也，令人寒热如疟，发作有时。治当消瘀败毒，宜桃仁红花汤。总以经水复行为第一义也。
李豆仙说：痧的出，气载之，血送之，达表则粒粒如麻，甚则叠肿，多则成片。一日三潮，从头而起，渐渐身体，以及四肢，潮时痧脚粒粒肿起皮上，三日九潮方完。潮则气送毒从毛窍而散，血留肌表，渐归经络，红点以渐而退。头面先潮者色先淡，身腹后起者色后退。头面多者吉，少者凶，色赤者吉，紫黑者凶。
正潮：正潮者，早午晚一日三潮，三日九潮，人尽知也。痧属阳，阳从阳类，故不潮于夜之阴，而潮于日之阳，此正潮也。
夜潮：有夜潮，不可不知。盖痧本属阳，然其赤点乃阴血也。男子阳盛，故潮于日之阳；女子阴盛，故潮于夜之阴。有男子夜潮者，气不足而血有余也；有女子日潮者，血不足而热毒盛也。儿出痧时，为父母者必夜观之。如不知夜观，则九潮已过，犹以为未潮；九潮已足，犹以为未足。疏表之药，发表之物，犹然不彻，有致血不归经，皮肤肿而色青紫者，有致吐血便血者，有致汗多亡阳者，有致中风发痉者。为父母者不可不知。
腹潮：小儿痧疹，乃天行热毒挟少阳相火，蕴蓄于胃。胃主肌肉，故热毒之邪熏蒸于肌肉，先发热数日，然后透泄于皮肤，粒粒如蛇咬状，乃痧疹也。痘出于五脏，痧出于六腑。六腑者专指胃腑而言也。既云出于胃腑，何腑脏多受其邪？胃土传肺金，以前来者为实邪也。胃邪传肺，是腑传脏。如毒邪陷伏不出者死，不治矣。有止发于肚腹，而头面手足一无所见，一日三潮，三日九潮，惟在肚腹，粒粒起绽。缘小儿气血孱弱，不能周行遍体，故止在肚腹出痧。发潮痧根既出，他处虽无，不足虑也。若用重剂取汗，则虚脱之祸立至矣，可不慎哉。
目潮：潮有从眼白珠先红，头面随红蒸热，一片通红，直待潮过热清，红色渐退，再潮复然，此阳毒之邪交并于六阳也。六阳皆聚于头面，痧毒出于胃腑，运于任脉，交并于六阳，则目睛裹赤，头面通红，潮时令人烦躁不宁，甚则不省人事，宜以化毒饮、化斑汤加减治之。
斑潮：斑潮者，痧发潮时，遍身起云头斑也，潮过则退，再潮复然。此胃腑毒热太甚，壅遏而然，宜以化斑汤加减治之。若潮过不退者，不治之证也。
累潮：累潮者，痧发潮时，遍身累累如疙瘩状，潮过稍平，再潮复肿。此热甚兼风，宜以大连翘饮治之。
隐潮：隐潮者，潮时见赤点于皮肤之上，潮过即没，毫无点迹，与平人同。此乃血和而毒不甚，故未潮则隐伏于皮肤之中，既潮则发现于皮肤之上矣。若无恶候，宜从轻治，不必重剂。
闹潮：闹潮者，痧发潮时，证见狂乱不宁，甚则谵语，目不识人，潮过则神清如旧，再潮复然。此热毒蕴于胃脏，宜凉膈散加减以清之。大便秘结，少加大黄以通之，或用导法。蚯蚓酒洗去泥，捣汁，将药煎好，入蚓汁数匙在内，最妙。口鼻衄血多者，名阳毒痧也，磨犀角汁入药最妙。
汗潮：汗潮者，见痧后止得一二潮，余则早午晚当潮时不见红点，止见身热腮红，只是汗出而已。此因天禀虚弱，阴血不足，或缘病后气血两虚，是以微潮一二次，潮亦不盛。万不可以为潮不足，妄用麻黄重剂，致令汗多亡阳，变生中风、惊风、发痉、发厥之诸危证也，慎之。
减潮：减潮者，不足之潮也。痧之常例，三日九潮，今止一日三潮者，有二日六潮者，有二三日总计止得四五潮者。此乃毒原轻，或因天行时气和平。如小儿皮嫩，五液俱全，身安证和者，亦无害也。
劫潮：劫潮者，命在危急，激得一潮，即可回生。痧疹初出潮时，因风早没，致令咳嗽痰喘，面青鼻煽，胸膈迷闷，三日已过，危在旦夕。急用麻黄发表汤，或三酥饼、蟾龙锭、还元复气丹，劫得微微一潮，痧毒从汗孔而出，不致内攻矣。若大便脓血，神昏不省者，逆候也。
经潮：经潮者，当分经前经后。凡经后三四日发热见痧，此血室空虚，与伤寒热入血室同。重则潮时妄见妄闻，如有鬼祟，轻则夜热，久成疳劳。服药调治，月经复行，则无羌矣，宜用清热养血之剂。若染时气，发热咳嗽喷嚏，三日起至七八日，不论已潮未潮，一遇经行，毒从血化，宜服解毒养血之品。
产潮：产潮者，孕妇发热，正在潮时，热极不安，其胎必下，胎下热退而痧愈。盖热极则伤胎元，胎下则毒从血化，痧愈竟不潮矣。产后虽有热象，切勿妄用凉药，恣食寒物，只宜平调气血为要。
弄潮：弄潮者，夺先声也。一日三潮，早午晚熏洗、服药，必在将潮未潮之先，以激其怒。若已潮过，有何益乎？故痧将潮时，令儿不得安睡，先熏洗其面，随洗手足，既饲之以汤饮，随灌煎药，更相搬弄，以俟其潮，故谓之弄潮。弄潮儿必啼哭怒泣，则内有以激其气；更加熏洗刮擦，则外有以助其势。内外夹攻，痧无不潮矣。
Wan Mizhai said: Whenever sand rash (Sha Zhen) erupts, from the onset of fever until it fully subsides, one should observe the pulse at the Cun position of the right hand. If the pulse is surging (Hong), large, and forceful, even if there are other accompanying symptoms, they will not cause harm. This is the crucial key to determining survival or death.
Ye Lin commented: This is the meaning of a Yang syndrome presenting with a Yang pulse. If the pulse is fine, soft, and weak, it indicates a Yang syndrome presenting with a Yin pulse. Zhang Jingyue believed that when a Yin pulse is diagnosed, one should quickly rescue the Yuan Shen (Original Spirit) by employing warming and tonifying methods to support the eruption, which is correct. However, in cases where heat toxin is deeply concealed within the interior and cannot penetrate to the exterior, presenting as false cold and true heat—with cold limbs, cyanotic complexion, and deep, hidden, fine, and rapid pulses—mistakenly using warming and tonifying drugs will bring disaster immediately. Sand rash belongs to Yang pathogens, and heat syndromes are common; the mechanism of safety and danger must be carefully observed and understood.
Sha (Sand) is a Yang toxin that first affects the Lung. The Lung governs Qi and corresponds to Metal in the Five Elements. Heat pathogenic factors damage Qi, often resulting in a white coating on the tongue, which is the color of Metal. Treatment should focus on clearing the Lung. Without definitive signs of deficiency-cold, mistaken treatment can be fatal. This applies not only to sand rash but also to sudden hemoptysis in summer, commonly known as Summer Consumption (Shu Zhai), which also presents with a white coating and requires clearing collateral heat; the principle is the same. How can physicians ignore this!
The *Complete Book of Rash* states: Regarding the eruption of sand rash, some appear after three days of fever, some after four, five, or six days, some present with alternating fever and coolness, some have multiple episodes of alternating chills and fever before appearing, and some alternate between fever and coolness for one day each, continuing for five to seven days before appearing. Generally, those appearing within five days are mild, while those appearing after five days are severe. Less toxin results in less fever, and more toxin results in more fever. Less fever leads to early and easy eruption, while more fever leads to delayed and difficult eruption; the distinction is significant. If it does not appear after seven days, accompanied by a cyanotic face, flaring nostrils, panting, and phlegm, it is called "Stifled Sha" (Men Sha) and is untreatable.
If the rash starts from the abdomen and then spreads to the four limbs, it is a favorable progression (Shun); if it starts from the hands and feet and then spreads to the abdomen, chest, and back, it is an unfavorable progression (Ni).
If the rash appears on the skin forming distinct granules, it is favorable; if it feels rough to the touch and is red, it is auspicious; if the lesions overlap and elevate, it is auspicious. Generally, successful eruption and elevation are considered superior.
Sand rash appearing after smallpox is auspicious; smallpox appearing after sand rash is ominous. Because after smallpox, the pores are loose, allowing toxins to exit easily, and invisible toxic qi can dissipate; whereas after sand rash, Yin blood is deficient, making it difficult to fill the pustules with fluid, and visible Ying blood is hard to generate. Here, sand rash after smallpox is auspicious because the pores are open and toxins exit easily. If smallpox follows sand rash, with three tides daily and nine tides over three days, advancing and retreating, it consumes Yin blood leading to blood deficiency. Expecting pustule filling under such conditions is difficult.
When smallpox and sand rash erupt simultaneously, it is called "Smallpox Clamped by Sand Rash" (Jia Dou). Treat the sand rash first, then the smallpox. When sand rash begins its tide, suddenly smallpox seeds appear, it is called "Sand Rash Spraying Smallpox" (Sha Pen Dou); when smallpox seeds first appear, suddenly sand rash emerges, it is called "Smallpox Spraying Sand Rash" (Dou Pen Sha). Treatment should prioritize inducing the sand rash tide, regardless of the smallpox seeds. After three days when the sand rash tide completes, the smallpox begins to steam and grow. In medications for smallpox, one must nourish Yin and blood, strictly avoiding warming and tonifying herbs like Ginseng (Renshen), Astragalus (Huangqi), Licorice (Gancao), Angelica Dahurica (Baizhi), Atractylodes (Baizhu), and Cinnamon Twig (Guizhi), as there is no method to tonify Yang for sand rash. If smallpox has erupted for one to four days and suddenly sand rash appears within the pustules, it is called "Smallpox Combining with Sand Rash" (Dou He Sha). The medications for releasing the exterior and promoting smallpox eruption are the same; once the sand rash emits, the smallpox naturally steams and grows. If smallpox has erupted for six to seven days, and the internal fluid is not yet filled or insufficient, suddenly sand rash appears within the pustules, it is called "Smallpox Separating from Sand Rash" (Dou Li Sha). If one tries to assist the smallpox fluid, the sand rash becomes stifled and difficult to emit; if one attacks the sand rash tide, the smallpox crusts without filling. Desiring both sand rash emission and smallpox filling represents a state of exhaustion of Yin and Yang and frantic movement of Qi and Blood. Symptoms must include upper panting and phlegm obstruction, lower purulent diarrhea, coma, and reversal, with almost no chance of survival. If the patient has few pustules and strong constitution, seizing the opportunity to continuously induce sand rash tides, even if smallpox is delayed, after three days of sand rash completion, the smallpox resumes steaming and filling, leading to recovery. This is due to robust Yuan Qi; waiting for the sand rash tide to complete allows the smallpox to naturally fill and crust. This occurs in one or two out of a hundred cases. If there are many pustules and the child is small with weak Yuan Qi, using tonics causes sand rash stifling, while not using them causes itching and collapse of smallpox; treatment is difficult, hence termed unfavorable. If smallpox reaches the ninth, tenth, eleventh, or twelfth day, and although fluid returns, scabs have not fallen, suddenly sand rash appears, it is called "Sand Rash Chasing Smallpox" (Sha Gan Dou). Treatment should mildly release the exterior, avoiding heavy sweating. If there is panting, urgency, no sweat, and sand rash does not rise, Ephedra Decoction (Mahuang Tang) may be used judiciously. If sweating agents result in blisters, it is acceptable. After sand rash resolves and scabs fall, take plenty of Yin-nourishing and blood-tonifying medicines. If sand rash appears after all smallpox scabs have fallen, it is "Sand Rash after Smallpox" (Dou Hou Sha). If sand rash tide completes and then smallpox appears, it is "Smallpox after Sand Rash" (Sha Hou Dou). See previous chapters.
If the five fluids (Sweat, Tears, Vomit, Nasal Mucus, Diarrhea) are all present during sand rash, it is favorable; if two or three are absent, it is unfavorable; if none are present, it is fatal. Sweat is the fluid of the Heart, tears of the Liver, vomit of the Spleen, nasal mucus of the Lung, and diarrhea of the Kidney. Sand rash originates in Yang, with fire toxins burning upward; the five fluids belong to Water, and Water controls Fire, so the condition is mild. General dryness indicates depletion of Heart fluid; lack of eye discharge and tears indicates deficiency of Liver fluid; dry heaving without substance indicates deficiency of Spleen fluid; flaring nostrils without mucus indicates dryness of Lung fluid; constipation indicates deficiency of Kidney fluid. Incomplete five fluids leave residual toxins after sand rash. Lack of Heart fluid causes fever; lack of Liver fluid causes convulsions; lack of Spleen fluid causes gingival rot; lack of Lung fluid causes cough; lack of Kidney fluid causes diarrhea. Complete absence of five fluids is untreatable. If one or two are missing, medication should be used to rescue them. Abundance of five fluids is ideal.
There are six causes for difficulty in sand rash eruption, leading to "Six Stiflings" (Liu Bi). 1. Toxin Stifling: Due to epidemic malignant qi, excessive toxin and fever causing prolonged non-eruption. Prick the top of the head and extremities to bleed, and administer detoxifying and resolving herbs. 2. Muscle Stifling: Due to thick and firm muscles preventing eruption. Use washing, rubbing, and scraping methods, and administer herbs to loosen muscles and penetrate the exterior. 3. Intestinal Stifling: Due to excessive internal heat and constipation blocking meridians. Use enema methods and administer Yin-nourishing and intestinal-moistening herbs. 4. Cold Stifling: Due to severe cold weather closing pores and stagnating blood vessels. Spray perilla on bed curtains, burn Chinese Willow (Xihe Liu) in the room, and administer Mahuang Decoction to release the exterior. 5. Food Stifling: Due to overeating during the pre-eruption phase, causing food stagnation and blocking Qi and Blood movement. Use induced vomiting and abdominal massage methods, and administer mid-regulating and food-resolving herbs. 6. Disease Stifling: Due to pre-existing conditions combined with epidemic qi, hindering eruption. Conditions like food retention, fright, mixed rashes, wounds, pregnancy, etc., can hinder eruption. Treat according to the primary condition or address urgent symptoms first. For blood stasis with panting and fullness, vomiting is necessary to treat the acute primary disease. For smallpox fluid mixed with sand rash, emitting sand rash is priority; Baoyuan Decoction is contraindicated. For malaria with sand rash, treating sand rash is urgent; antimalarial drugs are dangerous. These are the urgent matters in treating sand rash. Adhering to these six stiflings brings luck; violating them brings misfortune.
Both smallpox and sand rash can present as "Hidden Under Skin" (Pi Li Yin) and "Carbuncle Under Skin" (Pi Li Ding). Pi Li Yin in smallpox: Initially, ten or more red-purple spots appear on the body and head, which parents mistake for the end of the eruption. Using light, one sees dense, seed-like spots hidden under the skin, resembling scabies. Initially fine and dense, they merge into patches under the skin, matching skin color, having shadow but no form. Some cases show no red spots on the surface, but with coma, irritability, becoming Pi Li Yin, called "Stifled Smallpox," leading to death from convulsions and panting, unknown to parents. Pi Li Yin in sand rash: Coma, reversal, cyanotic face, irritability, panting, flaring nostrils, with no visible sand rash. Using light reveals red spots hidden under the skin of the head and face. Faint red light flickers on the skin surface, disappearing instantly, recurring several times a day. If not rising in three days, death from panting and stifling ensues, unknown to parents. This condition requires careful differentiation and immediate treatment with large doses of Mahuang. If the pulse is surging and the body is hot, use Mahuang plus Gypsum Decoction.
Both smallpox and sand rash can present as Pi Li Ding. Before eruption, or upon slight appearance, hard lumps under the skin or in flesh, purple, blue, or black, feeling rough to touch, are called Pi Li Ding, with almost no chance of survival.
Recognizing and urgently treating Pi Li Yin in smallpox or sand rash can save one or two out of ten. Delay leads to toxin coagulation turning into Pi Li Ding, with no hope of life.
During gradual eruption and main tide, if carelessness against wind-cold causes pore closure and Qi-Blood stagnation, causing the rash to disappear, it is generally called "Stifled Sha." If Sha disappears early after two days of eruption due to wind-cold, the syndrome is slightly lighter. If it disappears after one day, the syndrome is severe. Disappearing as it emerges is critical. It leads to cough, panting, cyanosis, flaring nostrils, phlegm obstruction, hoarseness, coma, cool body, and no sweat. Mild cases die in 3-4 days, severe in 1-2 days. This differs from Pi Li Yin. Pi Li Yin has no visible points, hidden under skin, flickering like light, unnoticed. If Sha has emerged and tide started, but disappears due to wind, differentiate by 1, 2, or 3 days for severity. Treatment is the same as early disappearance: urgently use Mahuang Exterior-Releasing Decoction, combined with fumigation, washing, scraping. If mild tide occurs 1-2 times, panting stops, and body warms, there is hope. *Golden Mirror Record* states: After several tides of sand rash, if wind causes early disappearance and lack of clarity, use Digestion-Resolving Drink with exterior-releasing herbs. Even if it does not re-emerge, it will heal. This refers to multiple tides. If only 1-2 tides occur and disappear early, complications are fierce; treat carefully. If stopping at 1-2 tides, prognosis is bad. If the body seems normal, there may be night tides, abdominal tides, sweat tides, reduced tides, menstrual tides, or postpartum tides. Do not forcibly induce sweating, lest other syndromes arise. Urgent treatment for wind-induced early disappearance yields 70-80% success. Delay makes it incurable.
Non-resolution has two syndromes: 1. Blood failing to return to vessels; 2. Blood dying in the muscle layer. After nine tides of sand rash, blood returns to vessels, and red marks fade. If redness persists, it is blood failing to return to vessels; if marks turn blue-purple, it is blood dying in the muscle layer. For blood failing to return to vessels, use detoxifying, cooling, Yin-astringing, and blood-stopping herbs, such as Yangrong Jiedu Decoction. For blood dying in the muscle layer, use blood-invigorating, blood-cooling, meridian-warming, and detoxifying herbs. If sand rash does not subside after three days, it is residual toxin solidified internally; use Siwu Decoction with clearing and draining herbs to resolve heat and eliminate sand rash. If blood dies in the muscle layer, turning blue-purple-black, prolonged heat and swelling occur, with external ulceration, dripping pus, and variable pain/itching. Take Qingji Huadu Decoction, wash with Sophora Decoction, and apply Sanhuang Powder. If tide stops after 1-2 times, exposed to wind-cold, disappearing as it emerges, turning blue-purple, with cold body and no ulceration, panting ensues, leading to death if untreated. Urgently release exterior pathogen with Mahuang Jiujie Decoction.
Five to six days after menstruation, if fever and sand rash appear, the Blood Chamber is empty, allowing evil to enter. Severe cases involve hallucinations, hearing voices, seeming possessed, lucid by day, delirious by night, called "Heat Entering Blood Chamber." Mild cases have nightly fever, progressing to consumption. Use heat-clearing and blood-nourishing agents, primarily Jiawei Xiaoyao San and Tiaojing Yangying Wan. Menstruation must resume to prevent future issues. If menstruation occurs 7-8 days after seeing sand rash, or sand rash appears during menstruation, both are Heat Entering Blood Chamber, but treatments differ. Sand rash after menstruation ends: Heat enters deficiency, causing nightly fever or afternoon flushing, progressing to bone-steaming consumption. Nourish blood and clear heat, use Xiaoyao San. Sand rash during menstruation: Blood stasis accumulates internally, causing chills and fever like malaria at fixed times. Resolve stasis and defeat toxin, use Tao Hong Decoction. The primary goal is resumption of menstruation.
Li Douxian said: Sand rash is carried by Qi and sent by Blood. Reaching the surface, it forms granules like hemp seeds, sometimes overlapping and swollen, merging into patches. Three tides daily, starting from the head, spreading to body and limbs. During tide, roots swell on skin. Nine tides over three days complete. Tide sends toxin out through hair follicles via Qi; Blood remains in muscle layer, gradually returning to vessels; red marks fade. Head/face tiding first fades first; body/abdomen tiding later fades later. Abundant head/face is auspicious; scarce is ominous. Red is auspicious; purple-black is ominous.
Regular Tide: Three tides daily (morning, noon, evening), nine tides over three days, widely known. Sand rash belongs to Yang, following Yang class, so it tides during Yang day, not Yin night. This is Regular Tide.
Night Tide: Must be known. Although sand rash is Yang, its red dots are Yin Blood. Men have excess Yang, so they tide during Yang day; women have excess Yin, so they tide during Yin night. Men night-tiding indicates Qi deficiency and Blood excess; women day-tiding indicates Blood deficiency and Heat-Toxin excess. Parents must observe children at night during eruption. Ignoring night observation leads to mistaking completed nine tides as incomplete, or sufficient as insufficient. Inadequate exterior-releasing drugs lead to blood failing to return to vessels, skin swelling with blue-purple color, hematemesis, melena, excessive sweating causing Yang collapse, wind-stroke, and convulsions. Parents must know this.
Abdominal Tide: Children's sand rash is epidemic heat-toxin carrying Shaoyang Ministerial Fire, accumulating in the Stomach. Stomach governs muscles, so heat-toxin steams muscles. Fever for several days, then penetrates skin, granules like snake bites. Smallpox comes from Five Zang, sand rash from Six Fu. Six Fu specifically refers to Stomach. Why do other organs suffer? Stomach Earth transmits to Lung Metal; incoming pathogen is Excess Evil. Stomach evil transmitting to Lung is Fu transmitting to Zang. If toxin sinks and fails to emerge, death ensues. Some only erupt on abdomen, none on head/limbs, three tides daily, nine tides over three days, only on abdomen, granules bursting. Due to weak Qi and Blood in children, unable to circulate throughout body, eruption is limited to abdomen. Once abdominal tide roots emerge, absence elsewhere is not concerning. Heavy sweating agents cause collapse; caution is needed.
Eye Tide: Tide starts with redness in whites of eyes, followed by head/face steaming heat, general redness. Only after tide passes and heat clears does redness fade, repeating with next tide. This is Yang-Toxin combining with Six Yang Meridians. Six Yang gather at head/face. Sand rash toxin from Stomach, transported via Ren Mai, combines with Six Yang, causing red eyes and flushed face. Tide causes irritability, even unconsciousness. Use Huadu Yin and Huaban Tang modified.
Patch Tide: During sand rash tide, cloud-head patches appear all over, fading after tide, repeating. Stomach heat-toxin is excessive, causing blockage. Use Huaban Tang modified. If patches do not fade after tide, it is untreatable.
Lumpy Tide: During sand rash tide, body becomes lumpy like nodules, flattening slightly after tide, swelling again. Heat excess combined with Wind. Use Dalianqiao Yin.
Hidden Tide: During tide, red dots appear on skin, disappearing completely after tide, leaving no trace, like healthy person. Blood is harmonious, toxin is not severe. Hidden before tide, revealed during tide. If no bad omens, treat lightly, no need for heavy doses.
Noisy Tide: During sand rash tide, agitation, delirium, unrecognized people. Mind clears after tide, repeats next tide. Heat-toxin stored in Stomach. Use Liangge San modified to clear. Constipation: add Rhubarb or use enema. Earthworm juice added to decoction is excellent. Frequent nosebleeds indicate Yang-Du Sha; adding Rhinoceros Horn juice is best.
Sweat Tide: After seeing sand rash, only 1-2 tides occur. At usual tide times, no red dots, only body heat, flushed cheeks, and sweating. Constitutionally weak, Yin blood deficient, or Qi-Blood deficient post-illness. Mild tides are not vigorous. Do not mistake for insufficient tide and misuse heavy Mahuang, causing Yang collapse, wind-stroke, convulsions, or reversal. Caution!
Reduced Tide: Insufficient tide. Normal is nine tides in three days. Now only three in one day, or six in two days, or 4-5 total in 2-3 days. Toxin was originally mild, or epidemic qi was peaceful. If child has tender skin, complete five fluids, stable body and syndrome, no harm.
Snatching Tide: Life in critical danger, stimulating one tide can restore life. Early sand rash tide stopped by wind, causing cough, phlegm-panting, cyanosis, flaring nostrils, chest stuffiness. After three days, imminent death. Urgently use Mahuang Exterior-Releasing Decoction, Sansu Bing, Chanlong Ding, or Huanyuan Fuqi Dan to snatch a mild tide. Toxin exits through sweat pores, preventing internal attack. Bloody stool and coma are adverse signs.
Menstrual Tide: Differentiate pre- and post-menstruation. Fever and sand rash 3-4 days after menstruation: Blood Chamber empty, similar to Cold Damage Heat Entering Blood Chamber. Severe: hallucinations during tide; mild: nightly fever, progressing to consumption. Medication restores menstruation, preventing issues. Use heat-clearing, blood-nourishing agents. If contracting epidemic qi, fever, cough, sneezing, 3-7 days, regardless of tide status, if menstruation occurs, toxin transforms via blood. Use detoxifying, blood-nourishing products.
Postpartum Tide: Pregnant woman fever, during tide, extreme heat causes fetal expulsion. Fetal expulsion reduces heat, sand rash heals. Extreme heat damages fetus; expulsion allows toxin to transform via blood. Sand rash heals without further tiding. Postpartum heat signs: avoid cold medicines and foods; regulate Qi and Blood gently.
Playing Tide: Seizing initiative. Three tides daily. Fumigation, washing, medication must occur before tide starts to stimulate anger. If tide passed, what is the benefit? Before sand rash tide, keep child awake, wash face, wash hands/feet, give soup, administer decoction, manipulate repeatedly to await tide. Hence "Playing Tide." Child cries and wails, stimulating Qi internally; external washing/scraping assists momentum. Internal and external attack ensures sand rash tides.