钱仲阳曰∶小儿在胎十月，食五脏血秽，生下则其毒当出。故疮疹之状，皆五脏之液。肝主泪，肺主涕，心主
血，脾为裹血。其疮出有五名∶肝为水 ，以泪出如水，其色青（而）小；肺为脓 ，以涕稠浊，色白而大，心
为斑，主心血，色赤而小，次于水 ；脾为疹，小次斑疮，其主裹血，故色赤黄浅也。涕泪出多，故脓 、水
皆大；血营于内，所出不多，故斑疹皆小也。病 者涕泪俱少，譬胞中容水，水去则瘦故也。
始发潮热，三日以上，热运入皮肤，即发疮疹，而不甚多者，热留肤腠之间故也。潮热随藏，出如早食，潮
热不已，为水 之类也。疮疹始出之时，五脏证见，惟肾无候，但见平证耳，尻凉、耳凉是也。尻、耳俱属于肾，
其居北方，主冷也。若疮黑陷，而耳尻反热者，为逆也。
《圣济总录》论曰∶小儿禀气纯阳，脏腑蕴热，自内出外，随气熏蒸，散于荣卫肌肉之间，留连内腠，或因
饮热乳，或因遇时疫，热气乘其肌肉嫩弱，遂变疮疹。微者其邪在腑，发为细疹，状似蚊喙所螫，点点赤色，俗
号麸疮；甚者其邪在脏，发为豆疮，状如豌豆，根赤头白，穴出脓水，俗名 疮。皆于未发时，先蒸热如伤寒状，
头痛面赤目黄，遍身皆热，腰背疼痛，小便赤短，大便或溏或涩，烦渴引饮，甚则谵语，其脉浮大洪数
者，是其证也。
李东垣曰∶夫斑疹始出之证，必先见面燥腮赤，目胞亦赤，呵欠烦闷，乍凉乍热，咳嗽嚏喷，足梢冷，多睡
惊。并疮疹之证，或生脓胞，或生小红斑，或生瘾疹，此三等不同，何故俱显上证，而后乃出？盖以上诸证，皆
太阳寒水起于右肾之下，煎熬左肾，足太阳膀胱寒水夹脊逆流，上头下额，逆手太阳丙火，不得传导，逆于面上，
故显是证。盖壬癸寒水，克丙丁热火故也。诸斑证皆从寒水逆流而作也，医者当知此理，乃敢用药。夫胞者一
名赤宫，一名丹田，主男子藏精施化，妇人系胞有孕，俱为生化之源，非五行也，非水亦非火。此天地之异名也，
象坤土之生万物也。夫人之始生也，血海始净，一日二日，精胜其血，则为男子；三日四日五日，血脉已旺，精
不胜血，则为女子。二物相搏，长先身生，谓之神，又谓之精。道、释二门言之，本来面目是也。其子在腹中，十
月之间，随母呼吸。呼吸者，阳气也，而生动作，滋益精气。饥则食母血，渴者饮母血，儿随日长皮肉筋骨血脉。
形气俱足，十月降生。口中尚有恶血，啼声一发，随吸而下。此恶血复归命门胞中，僻于一隅，伏而不发。直至
因内伤乳食，湿热之气下流，合于肾中，二火交攻，致荣气不从，逆于肉理，恶血乃发诸斑疹，皆出于膀胱壬水。
其疡后聚肉理，归于阳明。故三番斑始显之证，皆足太阳壬膀胱克丙小肠，其始出皆见于面，终归于阳明肉理，
热化为脓者也。二火炽甚，反胜寒水，遍身俱出，此皆出从足太阳传变中来也。当外发寒邪，使令消散；内泻二火，
不令交攻其中；令湿气上归，复其本位。可一二服立已，仍令小儿以后再无二番斑出之患。此《内经》之法，览者
详之。
孙东宿曰∶麻疹，浙之呼为 子，又曰痧子；吴地呼为疹子；新安呼为麻。总为有生初之淫火，伏于命门之
间。命门具太极之理，而阴阳五行系焉，脏腑之所由也。盖五行一阴阳，阴阳
一太极也。天之与人，咸相感通。由其通，故天寒而人身寒，天热而人身热也。天之疠气，一动则所禀之毒随感
而发，阳感之则疹出焉，阴感之则痘出焉。阳浮而浅，故疹易出易敛；阴凝而深，故痘难出难痂。阴阳二劫之毒
尽出，则向安矣。余故曰∶人之出疹出痘，犹蚕之一眠二眠三眠也。痘虽出于阴，而实成于阳，以气为之固也；疹虽
出于阴，而实借于阴，以血为之资也。何见之？痘非气行则血不附，安得结痂；疹非血济则气失根据，焉能收敛？
斯阴阳升降之理，一开必一阖。血之附气，气之根据血；阴根于阳，阳根于阴，阴阳互为其根也。前人谓痘出于脏，
不知指何脏；疹出于腑，不知指何腑而云之也。又谓疹出心肺，故鼻涕而咳嗽。余谓此皆臆度套词，而非有真知
一定之见也。既曰疹出于腑，心肺独非脏乎？按《内经》鼻为肺之门户，通天气。阳毒上发，热毒熏蒸。盖心肺
位尊膈上，又肺主毛窍，毒从窍出，是干于肺而非出于肺也。要知痘之与疹，皆出于命门之阴阳也。
霖按∶痧疹，古经方不载。宋元以来，诸贤着述率多拉杂。前明罗田万密斋，始将治法阐明。其论胎毒，在腑在
脏，仍属依样葫芦。惟孙文垣命门之论，允为精当。然痧疹之根原虽明，有非关命门伏气，其形证似是而非者。风隐斑
疹之外，又有烂喉丹痧一证，均当详考，谨列于下，庶免混淆。
风疹初起烦痒，搔之随手垄起，成片成块，愈搔愈甚，由脾虚血热，感风邪而作。治宜调中疏风，不可专用
风药。
隐疹始候，如蚊蚤螫啮，烦痒无头粒，搔之似肿非肿，隐隐然不发，胖甚则发热腹痛。此脾有蓄热，更为风湿
所中。治宜消风清热。较痧疹险证中之皮里隐不同，不可牵混。
按以上二证，即《巢源》所谓邪折于肌，与内热相搏则
为轸；《外台》所谓赤轸如蚊螫烦痒，搔之重沓垄起。斯即赤白二种之风矢隐轸也。
斑有色点而无颗粒，其状或如锦文，或如云霞，抚不涩指，按之晕浅。证有阴阳之别∶阳斑色紫点小者，心
胞热也；色紫点大者，胃中热也。或由温病，或由伤寒，或者汗后，或者血热，各有其因。阴斑色淡红，口不渴，
脉不洪。乃伏寒在下，迫其无根失守之火，聚于胸中，上蒸所致。宜各从本病，以决死生。
按《伤寒总病论》曰∶冬温之气，至春夏而发，肌肉斑斓，隐轸如锦文，俗名麻子疮。《补亡论》曰∶斑形
如丹砂小点，又若锦文灿烂。此即热病之斑轸，与痧麻迥异者也。
麻疹发热，不拘三四日，以火照之，遍身如涂朱之状，此将出之兆也。出则细碎，皮红成片，如蚊蚤螫啮之
迹，抚之涩指，按之起晕，是其证也。亦须从面至胸背手足出透，以红润为佳。重者身膨胀，眼亦封闭。麻色有
赤白微黄不同，只要红活，最嫌黑陷。麻出面目胸腹稠密，缠锁咽喉者逆，发不出而喘闷者凶。麻疹与痧疹异
处，初见遍身发麻，退后脱皮，而治法亦略同。方书不载，惟《景岳全书》有此论治，宜参考。又有遍身但红
而绝无斑点者，谓之火丹，亦其类也。故痘科中有夹痧、夹麻、夹丹等证，总皆热毒所致，俱当详辨也。
按郭白云所云，焦则退皮，状如麸片者，即今之麻疹也。
或问∶痧、麻二证，一云命门伏毒，一非命门伏毒，抑有说欤？曰∶痧疹人人不免，或有未痘之先出者，痘
后仍必复出；麻疹则毕世不出者十之八九，患此者不过十之一二。一为伏藏之毒，一为疫疠之气。以此证之，夫
复何疑。
麻疹之外，又有时痧，亦非伏毒，乃寒温失节，酿为天行
时气，虚人多易感受。邪干经络，则身热有汗，咳嗽，神安，口不甚渴，其发始则三五散布，继则赤 云密。自发
至退，常十余日。兼有便溏，沙足而便溏止。热退则胃气开，病将退矣。治法∶身热咳嗽，痧点未达者，疏解
兼以开肺；继则痧点渐透，达而未足，或兼泄泻者，仍用疏解，不必止泻，痧足泻即止。未足目赤神烦，舌绛脉
数者，疏解兼清热。痧透已足，赤 云密，脉象数大，舌绛神烦者，清火养液。痧足渐回，热退胃开，而咳嗽
未止者，轻清理肺。其有少阴不藏之人，其气必虚，感邪亦重，或痧发早回，而躁热不退；或神机呆倦，腹痛胸
满；或鼻煽气促；或液涸舌干；或正虚脉乱。此等恶候，犯之多危。
烂喉丹痧，古人无此证，古书亦无此方。近时患此者，既多且险。总缘风气 薄， 疠之邪，人易感受。初起
咽喉肿痛，鼻塞喷嚏，咳嗽胸闷，甚则身痛神呆，脉郁心烦等证。遍身痧点，细碎红活，有汗者轻；灼热无汗，
肌如红纸，痧隐成片，不分颗粒者重。若痧色紫滞干枯，喉烂神昏者，为毒火内陷之险证矣。其论治不外疏达、清
化、下夺、救液数法。然次第失宜，流弊无穷。陈静岩《疫痧草》言之甚详，最宜详阅。此证传染易易，不可
不防。王孟英《仁术志》中载有一方∶凡见寒温失序，闾阎有此证时，可用陈白莱菔英及鲜橄榄二味，浓煎当茶
恣饮。试之良验。
按陈静岩《疫痧草》，论证论治已无剩义。惟辨疫邪所由来一篇，归本于种痘之余毒未尽，此臆度之辞，殊
不可信。余留心十余年，见患是证者，非尽种痘之人；不患是证者，亦非尽出天行痘之人。此其明证。徐灵胎曰∶
宋时，痘疮形证治法甚略 近日愈变愈重，与斑疹绝不相类，治亦迥别。因知天下之病，随时随地，变化无穷，
所以《内经》有五运六气、异法方宜等论。为医者苟不能知天运之转移，及五方之体性，终有偏执之处。此诚
通论也。
钱仲阳说：小儿在母胎中十月，摄取五脏的血秽之气，出生后这些毒素应当排出。所以疮疹的形态，都是五脏之液的表现。肝主泪，肺主涕，心主血，脾统摄血液。其疮疹发出有五种名称：肝发出的称为水痘（此处指类似水疱的疹子），因为泪水流出如水，颜色青而小；肺发出的称为脓痘，因为鼻涕稠浊，颜色白而大；心发出的称为斑，主管心血，颜色赤红而小，次于水痘；脾发出的称为疹，比斑更小，因为它主管裹血，所以颜色是浅赤黄色。涕泪流出多，所以脓痘、水痘都较大；血液营行于内，排出不多，所以斑和疹都较小。患病时如果涕泪很少，就像胞宫中容纳的水被排空后身体消瘦一样。
开始发作时出现潮热，三天以上，热气运行到皮肤，就发出疮疹，而且数量不多的，是因为热邪停留在肤腠之间。潮热随着脏腑变化，出疹如同早饭时间（辰时）那样准时，如果潮热不止，属于水痘一类的病症。疮疹刚开始发出时，五脏的症状都会显现，只有肾脏没有特定的征候，只见到平脉平证，即尻部（尾骨处）凉、耳朵凉。尻部和耳朵都属于肾，位居北方，主冷。如果疮疹黑陷，而耳部和尻部反而发热，这是逆证。
《圣济总录》论述说：小儿禀受纯阳之气，脏腑蕴藏热毒，从体内向外发散，随着气机熏蒸，散落在荣卫肌肉之间，留连在内腠，或者因为喝热的乳汁，或者因为遭遇时疫，热气乘其肌肉嫩弱，于是变成疮疹。轻微的，邪气在腑，发为细疹，形状像蚊子叮咬，点点红色，俗称麸疮；严重的，邪气在脏，发为豆疮，形状像豌豆，根部红白头白色，穴口流出脓水，俗名痘疮。都在未发作之前，先蒸腾发热像伤寒症状，头痛面赤目黄，遍身皆热，腰背疼痛，小便赤短，大便或溏或涩，烦渴引饮，甚至谵语，脉象浮大洪数的，就是这种证候。
李东垣说：斑疹刚发出的证候，必定先见面部干燥腮部红赤，眼睑也红，呵欠烦闷，忽冷忽热，咳嗽喷嚏，脚梢冷，多睡惊悸。并且疮疹的证候，有的生脓疱，有的生小红斑，有的生瘾疹，这三种不同，为什么都显现上述症状，然后才发出？大概因为上述诸证，都是太阳寒水起于右肾之下，煎熬左肾，足太阳膀胱寒水夹脊逆流，上头下额，逆手太阳丙火，不得传导，逆于面上，所以显现这些证候。大概壬癸寒水，克伐丙丁热火所致。各种斑证都是从寒水逆流而作的，医者应当知晓此理，才敢用药。胞宫又名赤宫，又名丹田，主管男子藏精施化，妇人系胞有孕，都是生化之源，不属于五行，既非水也非火。这是天地的异名，象征坤土生养万物。人刚开始生成时，血海清净，一日二日，精胜血，则为男子；三日四日五日，血脉已旺，精不胜血，则为女子。精血两物相搏，长在先身的，称为神，又称为精。道、释二门所说的本来面目即是此意。胎儿在腹中，十个月期间，随母亲呼吸。呼吸者，是阳气，而生动作，滋益精气。饿了吃母血，渴了饮母血，儿随日长皮肉筋骨血脉。形气俱足，十月降生。口中还有恶血，啼声一发，随吸而下。这恶血复归命门胞中，僻居于一隅，伏而不发。直到因内伤乳食，湿热之气下流，合于肾中，二火交攻，导致荣气不从，逆于肉理，恶血乃发为诸斑疹，都出于膀胱壬水。其疡后聚肉理，归于阳明。所以三番斑始显之证，都是足太阳壬膀胱克丙小肠，其始出皆见于面，终归于阳明肉理，热化为脓。二火炽盛，反胜寒水，遍身俱出，这都是从足太阳传变而来。当外发寒邪，使其消散；内泻二火，不令交攻其中；令湿气上归，复其本位。可一二服立愈，仍令小儿以后再无二番斑出之患。这是《内经》之法，读者详察。
孙东宿说：麻疹，浙江呼为痧子，又称痧子；吴地呼为疹子；新安呼为麻。总归是有生之初的淫火，伏于命门之间。命门具太极之理，而阴阳五行系焉，脏腑之所由也。大概五行一阴阳，阴阳一太极也。天与人，咸相感通。由其通，故天寒而人身寒，天热而人身热也。天之疠气，一动则所禀之毒随感而发，阳感之则疹出焉，阴感之则痘出焉。阳浮而浅，故疹易出易敛；阴凝而深，故痘难出难痂。阴阳二劫之毒尽出，则向安矣。我所以说：人之出疹出痘，犹蚕之一眠二眠三眠也。痘虽出于阴，而实成于阳，以气为之固也；疹虽出于阴，而实借于阴，以血为之资也。何以见得？痘非气行则血不附，安得结痂；疹非血济则气失根据，焉能收敛？斯阴阳升降之理，一开必一阖。血之附气，气之根据血；阴根于阳，阳根于阴，阴阳互为其根也。前人谓痘出于脏，不知指何脏；疹出于腑，不知指何腑而云之也。又谓疹出心肺，故鼻涕而咳嗽。我认为这些都是臆度套词，而非有真知一定之见也。既然说疹出于腑，心肺独非脏乎？按《内经》鼻为肺之门户，通天气。阳毒上发，热毒熏蒸。盖心肺位尊膈上，又肺主毛窍，毒从窍出，是干于肺而非出于肺也。要知痘之与疹，皆出于命门之阴阳也。
叶霖按：痧疹，古经方不载。宋元以来，诸贤著述率多拉杂。前明罗田万密斋，始将治法阐明。其论胎毒，在腑在脏，仍属依样葫芦。惟孙文垣命门之论，允为精当。然痧疹之根原虽明，有非关命门伏气，其形证似是而非者。风隐斑疹之外，又有烂喉丹痧一证，均当详考，谨列于下，庶免混淆。
风疹初起烦痒，搔之随手垄起，成片成块，愈搔愈甚，由脾虚血热，感风邪而作。治宜调中疏风，不可专用风药。
隐疹始候，如蚊蚤螫啮，烦痒无头粒，搔之似肿非肿，隐隐然不发，胖甚则发热腹痛。此脾有蓄热，更为风湿所中。治宜消风清热。较痧疹险证中之皮里隐不同，不可牵混。
按以上二证，即《巢源》所谓邪折于肌，与内热相搏则为轸；《外台》所谓赤轸如蚊螫烦痒，搔之重沓垄起。斯即赤白二种之风矢隐轸也。
斑有色点而无颗粒，其状或如锦文，或如云霞，抚不涩指，按之晕浅。证有阴阳之别：阳斑色紫点小者，心胞热也；色紫点大者，胃中热也。或由温病，或由伤寒，或者汗后，或者血热，各有其因。阴斑色淡红，口不渴，脉不洪。乃伏寒在下，迫其无根失守之火，聚于胸中，上蒸所致。宜各从本病，以决死生。
按《伤寒总病论》曰：冬温之气，至春夏而发，肌肉斑斓，隐轸如锦文，俗名麻子疮。《补亡论》曰：斑形如丹砂小点，又若锦文灿烂。此即热病之斑轸，与痧麻迥异者也。
麻疹发热，不拘三四日，以火照之，遍身如涂朱之状，此将出之兆也。出则细碎，皮红成片，如蚊蚤螫啮之迹，抚之涩指，按之起晕，是其证也。亦须从面至胸背手足出透，以红润为佳。重者身膨胀，眼亦封闭。麻色有赤白微黄不同，只要红活，最嫌黑陷。麻出面目胸腹稠密，缠锁咽喉者逆，发不出而喘闷者凶。麻疹与痧疹异处，初见遍身发麻，退后脱皮，而治法亦略同。方书不载，惟《景岳全书》有此论治，宜参考。又有遍身但红而绝无斑点者，谓之火丹，亦其类也。故痘科中有夹痧、夹麻、夹丹等证，总皆热毒所致，俱当详辨也。
有人问：痧、麻二证，一云命门伏毒，一非命门伏毒，抑有说欤？答曰：痧疹人人不免，或有未痘之先出者，痘后仍必复出；麻疹则毕世不出者十之八九，患此者不过十之一二。一为伏藏之毒，一为疫疠之气。以此证之，夫复何疑。
麻疹之外，又有时痧，亦非伏毒，乃寒温失节，酿为天行时气，虚人多易感受。邪干经络，则身热有汗，咳嗽，神安，口不甚渴，其发始则三五散布，继则赤云密。自发自退，常十余日。兼有便溏，沙足而便溏止。热退则胃气开，病将退矣。治法：身热咳嗽，痧点未达者，疏解兼以开肺；继则痧点渐透，达而未足，或兼泄泻者，仍用疏解，不必止泻，痧足泻即止。未足目赤神烦，舌绛脉数者，疏解兼清热。痧透已足，赤云密，脉象数大，舌绛神烦者，清火养液。痧足渐回，热退胃开，而咳嗽未止者，轻清理肺。其有少阴不藏之人，其气必虚，感邪亦重，或痧发早回，而躁热不退；或神机呆倦，腹痛胸满；或鼻煽气促；或液涸舌干；或正虚脉乱。此等恶候，犯之多危。
烂喉丹痧，古人无此证，古书亦无此方。近时患此者，既多且险。总缘风气薄，疠之邪，人易感受。初起咽喉肿痛，鼻塞喷嚏，咳嗽胸闷，甚则身痛神呆，脉郁心烦等证。遍身痧点，细碎红活，有汗者轻；灼热无汗，肌如红纸，痧隐成片，不分颗粒者重。若痧色紫滞干枯，喉烂神昏者，为毒火内陷之险证矣。其论治不外疏达、清化、下夺、救液数法。然次第失宜，流弊无穷。陈静岩《疫痧草》言之甚详，最宜详阅。此证传染易易，不可不防。王孟英《仁术志》中载有一方：凡见寒温失序，闾阎有此证时，可用陈白莱菔英及鲜橄榄二味，浓煎当茶恣饮。试之良验。
按陈静岩《疫痧草》，论证论治已无剩义。惟辨疫邪所由来一篇，归本于种痘之余毒未尽，此臆度之辞，殊不可信。余留心十余年，见患是证者，非尽种痘之人；不患是证者，亦非尽出天行痘之人。此其明证。徐灵胎曰：宋时，痘疮形证治法甚略 近日愈变愈重，与斑疹绝不相类，治亦迥别。因知天下之病，随时随地，变化无穷，所以《内经》有五运六气、异法方宜等论。为医者苟不能知天运之转移，及五方之体性，终有偏执之处。此诚通论也。
Qian Zhongyang stated: During the ten months in the womb, the infant consumes the blood and turbidity of the five zang organs. After birth, these toxins must be expelled. Therefore, the manifestations of sores and rashes are all expressions of the fluids of the five zang organs. The Liver governs tears, the Lung governs nasal mucus, the Heart governs blood, and the Spleen envelops/stores blood. There are five names for the eruption of sores and rashes: those from the Liver are called "water sores" (shui dou), as tears flow like water, appearing blue-green and small; those from the Lung are called "pus sores" (nong dou), as nasal mucus is thick and turbid, appearing white and large; those from the Heart are called "macules" (ban), governing heart blood, appearing red and small, secondary to water sores; those from the Spleen are called "papules/rashes" (zhen), smaller than macules, as they govern enveloped blood, thus appearing light red-yellow. Since nasal mucus and tears flow abundantly, pus sores and water sores are larger; since blood circulates within and is not discharged much, macules and papules are smaller. If a patient has little nasal mucus or tears, it is akin to the body becoming emaciated after the fluid in the uterine cavity is drained.
Initially, tidal fever occurs. After three days or more, if heat travels to the skin and causes sores and rashes that are not numerous, it is because heat remains between the skin and interstices. Tidal fever follows the zang organs; eruptions occur around the time of early morning meal (Chen hour). If tidal fever persists, it belongs to the category of water sores. When sores and rashes first erupt, symptoms of the five zang organs appear, except for the Kidney, which shows no specific sign but only normal pulse/symptoms, specifically coolness at the sacrum (couch) and ears. The sacrum and ears belong to the Kidney, situated in the North, governing cold. If sores turn black and sink inward, while the ears and sacrum become hot, this is an adverse condition.
The *Shengji Zonglu* discusses: Infants inherit pure Yang qi, with heat accumulating in the zang-fu organs. This heat moves from inside to outside, steaming along with qi, scattering between Ying-Wei and muscles, lingering in the inner interstices. It may result from drinking hot milk or encountering epidemic pathogens. Heat takes advantage of tender and weak muscles, transforming into sores and rashes. Mild cases involve pathogenic factors in the fu organs, manifesting as fine rashes resembling mosquito bites, dotted red, commonly known as bran sores (fu chuang); severe cases involve pathogenic factors in the zang organs, manifesting as bean-like sores resembling peas, with red roots and white heads, oozing pus and water from pores, commonly named variola (dou chuang). Before eruption, there is always steaming fever resembling Shanghan syndrome, headache, red face, yellow eyes, whole-body heat, back pain, dark short urine, loose or constipated stool, irritability, thirst with desire to drink, even delirium, with a floating, large, surging, and rapid pulse. These are the signs.
Li Dongyuan stated: The initial signs of macules and papules必先 (must first) show dry face, red cheeks, red eyelids, yawning, restlessness, alternating chills and fever, cough, sneezing, cold toes, excessive sleep, and fright. Regarding sores and rashes, whether pustules, small red macules, or urticaria arise, why do these different conditions all display the aforementioned symptoms before eruption? This is because these symptoms stem from Taiyang Cold Water originating below the right Kidney, simmering the left Kidney. Foot-Taiyang Bladder cold water flows counter-current up the spine, to the head and forehead, opposing Hand-Taiyang Bing Fire, unable to conduct, reversing onto the face, thus displaying these signs. Ren-Gui Cold Water overcomes Bing-Ding Hot Fire. All macule syndromes arise from counter-flow of cold water; physicians must understand this principle to dare prescribe medicines. The Bao Gong (Uterus/Womb) is also called Chi Gong or Dantian, governing storage and transformation of essence in men, and pregnancy in women. It is the source of generation and transformation, not belonging to the Five Elements, neither water nor fire. It is a different name for Heaven and Earth, symbolizing Kun Earth generating all things. At conception, the Blood Sea is pure. On day one or two, Jing (Essence) surpasses Blood, forming a male; on days three to five, Blood vessels are vigorous, Jing does not surpass Blood, forming a female. Essence and Blood contend; what grows prior to the body is called Shen (Spirit), also called Jing. Daoism and Buddhism refer to this as the original face. In the womb for ten months, the fetus breathes with the mother. Breathing is Yang Qi, generating movement and nourishing Jing-Qi. Hunger leads to consuming maternal blood, thirst to drinking maternal blood. The child grows skin, flesh, bones, tendons, vessels daily. Form and Qi complete, born after ten months. Evil blood remains in the mouth; upon crying, it is inhaled downward. This evil blood returns to the Mingmen and Bao Gong, hiding in a corner, lying dormant. Until internal injury from milk/food causes damp-heat to flow downward, combining with the Kidney, where two fires attack each other, causing Ying Qi to disobey, reverse in muscle tissue, and evil blood erupts as macules and rashes, all emerging from Bladder Ren Water. Post-ulceration, flesh gathers in the interstices, returning to Yangming. Thus, the initial signs of three waves of macules involve Foot-Taiyang Ren Bladder overcoming Bing Small Intestine. Initial eruption appears on the face, finally returning to Yangming muscle tissue, where heat transforms into pus. When two fires are intense, overcoming cold water, eruption covers the whole body. This all stems from transmission via Foot-Taiyang. One should release exterior cold pathogens to dissipate them; purge internal two fires to prevent mutual attack; guide dampness upward to restore its proper position. One or two doses can cure immediately, preventing future recurrence. This is the method of the *Neijing*; readers should study it carefully.
Sun Dongsu stated: Measles are called Sha Zi (sand children) or Sha Zi in Zhejiang, Zhen Zi in Wu region, and Ma in Xin'an. Generally, it is excess fire from early life, hidden in the Mingmen. Mingmen possesses the principle of Taiji, wherein Yin-Yang and Five Elements reside, giving rise to zang-fu organs. Essentially, Five Elements reduce to Yin-Yang, and Yin-Yang reduces to Taiji. Heaven and humanity interact mutually. Due to this interaction, when heaven is cold, the body is cold; when heaven is hot, the body is hot. Epidemic qi moves, and inherent toxins erupt upon contact. Contact with Yang causes rashes (Zhen); contact with Yin causes smallpox (Dou). Yang is floating and shallow, so rashes are easy to erupt and heal; Yin is condensed and deep, so smallpox is hard to erupt and scab. When both Yin-Yang劫 (tribulations/toxins) are fully expelled, health returns. I say: Erupting rashes or smallpox is like silkworms molting multiple times. Smallpox originates from Yin but completes through Yang, secured by Qi; Rashes originate from Yin but rely on Yin, supported by Blood. Why? Without Qi movement, Blood cannot attach, how can scabs form? Without Blood support, Qi loses foundation, how can healing occur? This is the principle of Yin-Yang ascending and descending; one opens, one closes. Blood attaches to Qi; Qi relies on Blood; Yin roots in Yang; Yang roots in Yin; Yin and Yang root each other. Predecessors said smallpox comes from Zang organs but didn't specify which; rashes come from Fu organs but didn't specify which. They also said rashes come from Heart and Lung, hence nasal discharge and cough. I consider these speculative clichés without true insight. If rashes come from Fu organs, are Heart and Lung not Zang organs? According to the *Neijing*, the nose is the gateway of the Lung, connecting to heavenly qi. Yang toxins ascend, heat toxins steam. Heart and Lung are high above the diaphragm; Lung governs hair follicles/pores. Toxins exit through pores, affecting the Lung rather than originating from it. Know that both smallpox and rashes originate from Yin-Yang of Mingmen.
Ye Lin notes: Sha Zhen (sand-rash) is not recorded in ancient classics. Since Song and Yuan dynasties, writings by sages are often杂乱 (disorganized). Luo Tianxi (Wan Muzhai) of Luotian in Ming Dynasty first clarified treatment methods. His discussion on fetal toxin being in Fu or Zang organs is still following old patterns. Only Sun Wenyuan's theory on Mingmen is precise. Although the root of Sha Zhen is clear, there are cases unrelated to Mingmen latent qi, where signs resemble but are not identical. Besides wind-hidden macules/rashes, there is also Rotting Throat Dan Sha syndrome. Both require detailed examination to avoid confusion.
Wind Rash initially presents with irritability and itching. Scratching causes raised lumps instantly, forming patches. More scratching worsens it. Caused by Spleen deficiency and Blood heat, contracting Wind pathogen. Treatment should regulate middle and disperse wind; do not use only wind-dispersing herbs.
Hidden Rash initially resembles mosquito/flea bites, itchy without visible heads. Scratching looks swollen but isn't, appearing hidden. Severe cases cause fever and abdominal pain. This is Spleen storing heat, compounded by Wind-Damp invasion. Treatment should eliminate wind and clear heat. This differs from hidden rashes in dangerous Sha Zhen cases; do not confuse them.
Regarding these two syndromes, they correspond to *Chubing Yuanhou Lun*'s description of pathogens breaking into muscles and contending with internal heat to form Zhen; and *Waitai Miyao*'s description of red Zhen like mosquito bites, itchy, scratching causes layered swelling. These are the red and white types of Wind-Shi Hidden Zhen.
Macules have color spots but no granules. Shapes vary like brocade patterns or clouds. Touching feels smooth, pressing shows faint晕 (halo). Syndromes differ by Yin/Yang: Yang Macules with purple small spots indicate Pericardium heat; purple large spots indicate Stomach heat. Causes include Warm Disease, Shanghan, post-sweating, or Blood heat. Yin Macules are pale red, no thirst, non-surging pulse. Caused by latent cold below forcing rootless/fire-loss fire to gather in chest and steam upward. Treat according to the primary disease to determine prognosis.
According to *Shanghan Zongbing Lun*: Winter-warm qi erupts in spring/summer, muscles become mottled, hidden Zhen like brocade, commonly called Ma Zi Chuang. *Buwang Lun* states: Macule shapes like cinnabar dots or brilliant brocade. These are heat disease macules/Zhen, distinct from Sha/Ma.
Measles fever, regardless of day 3 or 4, shining a light reveals body covered like vermilion paint, a sign of impending eruption. Eruption is fine/dotted, skin red in patches, like bite marks, rough to touch, halo upon pressing. Must erupt from face to chest/back/hands/feet thoroughly; rosy-red is best. Severe cases cause body swelling and closed eyes. Measle colors vary red/white/light yellow; as long as rosy and active, black sinking is dreaded. Dense eruption on face/chest/abdomen, locking throat is adverse; failure to erupt with wheezing/stuffiness is ominous. Difference between Measles and Sha Zhen: Measles shows whole-body numbness initially, peeling after resolution; treatments are similar. Not recorded in formula books, only discussed in *Jingyue Quanshu*, refer to it. Also, whole-body redness without spots is called Huo Dan (Fire Dan), related category. In smallpox department, complications like Jia Sha, Jia Ma, Jia Dan exist, all caused by heat-toxin, requiring detailed differentiation.
Guo Baiyun noted: Peeling like bran flakes indicates current measles.
Question: Sha and Ma syndromes, one says Mingmen latent toxin, one says not, is there an explanation? Answer: Sha Zhen is unavoidable for everyone; some erupt before smallpox, others recur after smallpox. Measles, 80-90% never erupt in lifetime, only 10-20% suffer. One is latent toxin, one is epidemic qi. Based on this, doubt is unnecessary.
Besides Measles, there is Shi Sha (Seasonal Sha), also not latent toxin, but due to irregular cold/warmth brewing into epidemic qi, vulnerable people easily contract. Pathogen affects meridians: body heat with sweat, cough, calm spirit, slight thirst. Eruption starts scattered (3-5 spots), then dense red clouds. From onset to resolution takes ~10 days. Accompanied by loose stools; stops when Sha is sufficient. Heat retreats, Stomach Qi opens, illness recedes. Treatment: Body heat/cough, Sha points not reached, disperse/resolve plus open Lung; subsequently Sha points penetrate but insufficient, or with diarrhea, continue dispersing/resolving, do not stop diarrhea, Sha sufficient stops diarrhea. Insufficient, red eyes/restless spirit, crimson tongue/rapid pulse, disperse/resolve plus clear heat. Sha sufficient, dense red clouds, surging-large pulse, crimson tongue/restless spirit, clear fire nourish fluids. Sha retreating, heat gone, Stomach open, cough persists, lightly clear/resolve Lung. Those with Shao Yin failing to store, Qi is deficient, pathogen heavy. Early retreat of Sha with persistent irritability/heat; dull spirit/abdominal pain/chest fullness; nasal flaring/breathlessness; fluid depletion/dry tongue; righteous deficiency/chaotic pulse. These bad omens are dangerous if encountered.
Rotting Throat Dan Sha: No such syndrome/formula in ancient texts. Recent cases are numerous and severe. Due to thin wind/qi, epidemic pathogens easily contracted. Initial sore/swollen throat, nasal congestion/sneezing, cough/chest oppression, severe body pain/dull spirit/depressed pulse/irritability. Whole-body Sha points, fine/red-active, with sweat mild; burning/no sweat, skin like red paper, Sha hidden in patches without granules severe. If Sha purple-stagnant-dry, throat rotting/delirious, dangerous toxic-fire sinking inward. Treatment involves dispersing/reaching, clearing/transforming, purging/lowering, saving fluids. Improper sequence causes endless complications. Chen Jingyan's *Yi Sha Cao* details this well, highly recommended reading. This syndrome is highly contagious, prevention essential. Wang Mengying's *Ren Shu Zhi* records a formula: For irregular cold/warmth when this syndrome appears in villages, use aged white radish greens and fresh olives, decoct strongly, drink freely as tea. Tested effective.
Note on Chen Jingyan's *Yi Sha Cao*: Discussion on syndrome/treatment is exhaustive. However, the section on origin of epidemic pathogen attributing it to residual toxin from vaccination is speculative and unconvincing. I observed for over ten years: patients with this syndrome are not all vaccinated; those without are not all natural smallpox survivors. Clear evidence. Xu Lingtai stated: Song dynasty smallpox signs/treatments were simple; recently became heavier, unlike macules/rashes, treatment distinct. Knowing diseases change infinitely with time/place explains *Neijing*'s discussions on Five Movements/Six Qi and diverse methods/appropriateness. Physicians who don't know celestial shifts and regional characteristics remain biased. This is indeed a universal truth.