喘为恶候。麻疹。尤忌之。如初出未透。无汗喘急者。此表实拂郁其毒也。宜用麻杏石甘汤
发之。疹已出。胸满喘急。此毒瓦斯内攻。肺金受克。宜用清气化毒饮清之。若迟延失治。以
致肺叶焦枯。则难救矣。
麻杏石甘汤（见前）
清气化毒饮
前胡 桔梗 栝蒌仁 连翘(去心) 桑皮 杏仁 黄芩 黄连 元参 甘草 麦冬 重用芦根
廉按此二方。余屡用之而屡效。诚万金良方也。然前云临时权变。神而明之。此语直贯全部
。读是书者。疑其太简。由不能融会贯通耳。如此二方。诚为治喘之良方。然人各异症
。症
各异治。风火痰食。自宜随症加减。余治出未透而喘急者。于麻杏石甘汤内加荆防。桔梗。
桑皮。粘子。知母。葶苈子等药。治已透而喘急。及隐伏而喘急者。于清气化毒汤内加石膏
。枳壳。胆星。大黄等药。皆应手而效。故麻 汇补云。风痰食火四者。皆能气喘。治宜祛
风化痰消食清火是也。但不宜用苏合香丸。抱龙。牛黄等丸。亦不可纯用降气之药。初发
而喘者。三拗汤加淡竹叶。石膏。已出而喘。鼻干口燥者。用白虎汤加疏表药。或羚羊
泻
白散。便闭者。加前胡。蒌仁。杏仁。大黄。粘子。西河柳。火喘。羚羊。蒌仁。石膏。最
妙花粉。海石。次之。此亦脱胎于金鉴二方。但少为加减耳。故备载之。以供采用。至于
麻
后喘急。有虚实之分。楼全善曰。喘而有汗。须扶正气。喘而无汗。须散邪火。虚者气
乏
。身凉。冷痰如冰。实者气壮。胸满身热便闭。麻 汇补曰。虚者宜用补肺化痰之药。如人
参。阿胶熟地。蛤蚧。核桃肉。纳气归元。实者宜用白虎汤。减羚羊泻白散。加减治之。活
人书曰。时医每见喘急。不将麻毒外出。发表清火。而徒用苏子顺气等药。不反耗其血气而
致变。曰有 毒痰喘甚者。宜用栝蒌仁。桔梗。花粉。海石。金沸草等药。消痰清火。如痰
逆壅盛者。可用牛黄珍珠散。气虚者加人参立应。楼全善曰。鼻孔掀开。黑如烟煤。或鼻尖
连人中生疮枯焦。或鼻干胸高者。皆肺绝也。急则三日。缓则十二日。死于丙丁日火克金
也。至于发直如麻。头汗如油。鼻煽如炉。腹胀如鼓。面青唇黑者。死更速。
三拗汤（见前）
羚羊泻白散
生桑皮 地骨皮 甘草 羚羊角
珠黄散
珍珠 牛黄
等分为末。灯心汤冲服。
喘证属于恶候。在麻疹病程中，尤其应当忌讳出现此症。如果疹子初出尚未透发，无汗且伴有喘急，这是表实导致毒邪郁闭所致。适宜使用麻杏石甘汤来发散透疹。如果疹子已经发出，但出现胸满、喘急，这是毒瓦斯内攻，肺金受到克制所致。适宜使用清气化毒饮来清解。如果延误治疗，导致肺叶焦枯，那就难以救治了。
麻杏石甘汤（见前文）
清气化毒饮
前胡 桔梗 栝蒌仁 连翘（去心） 桑白皮 杏仁 黄芩 黄连 玄参 甘草 麦冬 重用芦根
廉按：这两个方剂，我屡次使用且屡次见效，确实是价值万金的良方。然而前文提到“临时权变，神而明之”，这句话贯穿全书。阅读本书的人，可能怀疑内容过于简略，这是因为不能融会贯通罢了。像这两个方剂，确实是治疗喘证的良方。但是，人的病症各不相同，治疗也各异。风、火、痰、食等病因，自然应当随症加减。我治疗疹子未透而喘急的，在麻杏石甘汤中加入荆芥、防风、桔梗、桑白皮、牛蒡子、知母、葶苈子等药；治疗疹子已透而喘急，以及疹子隐伏而喘急的，在清气化毒饮中加入石膏、枳壳、胆南星、大黄等药，都应手而效。所以《麻疹汇补》说，风、痰、食、火四者，都能引起气喘，治疗应当祛风、化痰、消食、清火。但不宜使用苏合香丸、抱龙丸、牛黄丸等丸药，也不可以单纯使用降气药物。初发而喘的，用三拗汤加淡竹叶、石膏；疹已出而喘，鼻干口燥的，用白虎汤加疏表药，或者羚羊角泻白散；大便不通的，加前胡、瓜蒌仁、杏仁、大黄、牛蒡子、西河柳；火喘，用羚羊角、瓜蒌仁、石膏，天花粉最为妙用，海浮石次之。这也是脱胎于《医宗金鉴》的两个方剂，只是稍作加减罢了。所以详细记载于此，以供采用。至于麻疹后的喘急，有虚证和实证的区分。楼全善说：喘而有汗，须扶助正气；喘而无汗，须发散邪火。虚证者气息匮乏，身体凉，冷痰如冰；实证者气壮，胸满身热，大便闭塞。《麻疹汇补》说：虚证适宜使用补肺化痰的药物，如人参、阿胶、熟地黄、蛤蚧、核桃肉，以纳气归元；实证适宜使用白虎汤或羚羊角泻白散，加减治疗。《活人书》说：当时的医生每每见到喘急，不把麻疹毒邪向外发散，不发表清火，却徒然使用苏子顺气等药物，不仅反而耗损其血气而导致变证。如果有毒痰喘严重的，适宜使用瓜蒌仁、桔梗、天花粉、海浮石、金沸草等药，消痰清火。如果痰逆壅盛，可以使用牛黄珍珠散，气虚者加入人参，立即见效。楼全善说：鼻孔掀开，颜色黑如烟煤，或者鼻尖连人中部位生疮枯焦，或者鼻干胸高的，都是肺气绝的表现。急则三日死，缓则十二日死，死于丙丁日（火克金）。至于头发直竖如麻，头汗如油，鼻翼煽动如火炉，腹胀如鼓，面色青唇黑的，死亡更快。
三拗汤（见前文）
等分为末，灯心草汤冲服。
Wheezing is a malignant symptom. In the course of measles, this symptom is particularly contraindicated. If the rash has just emerged but not yet fully exanthematized, accompanied by anhidrosis and wheezing, this indicates exterior excess causing the entrapment of the toxin. It is appropriate to use Mahuang Xinggan Shigan Decoction (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) to disperse and vent the rash. If the rash has already erupted but is accompanied by chest fullness and wheezing, this indicates that the toxic qi is attacking internally, and the Metal of the Lung is being overcome. It is appropriate to use Qingqi Huadu Yin (Clear Qi and Transform Toxin Drink) to clear the condition. If treatment is delayed, leading to the withering and drying of the lung lobes, it will be difficult to save the patient.
Mahuang Xinggan Shigan Decoction (see previous section)
Qingqi Huadu Yin
Peucedani Radix (Qianhu), Platycodonis Radix (Jiegeng), Trichosanthis Semen (Gualouren), Forsythiae Fructus (Lianqiao, heart removed), Morus Cortex (Sangpi), Armeniacae Semen Amarum (Xingren), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Scrophulariae Radix (Yuan Shen), Glycyrrhizae Radix et Rhizoma (Gancao), Ophiopogonis Tuber (Maidong), with heavy use of Phragmitis Rhizoma (Lugen).
Commentary by Lian: I have used these two formulas repeatedly with consistent efficacy; they are indeed precious prescriptions worth ten thousand gold. However, as mentioned earlier, "adapting to circumstances and understanding them spiritually," this phrase runs through the entire book. Readers who doubt its brevity fail to integrate and comprehend it thoroughly. While these two formulas are excellent for treating wheezing, patients present with different symptoms requiring different treatments. Etiologies such as wind, fire, phlegm, and food stagnation should naturally be modified according to the specific presentation. When I treat wheezing due to incomplete eruption, I add Schizonepetae Herba (Jingjie), Saposhnikoviae Radix (Fangfeng), Platycodonis Radix (Jiegeng), Morus Cortex (Sangpi), Arctii Fructus (Niuzi), Anemarrhenae Rhizoma (Zhimu), and Descurainiae Semen Lepidii seu Lepidii Semen (Tinglizi) to Mahuang Xinggan Shigan Decoction. For wheezing after complete eruption or when the rash is latent, I add Gypsum (Shigao), Aurantii Fructus (Zhike), Arecae Semen cum Bile (Danning), and Rheomi Radix et Rhizoma (Dahuang) to Qingqi Huadu Yin. These modifications yield immediate results. Thus, *Measles Hui Bu* states that wind, phlegm, food, and fire can all cause wheezing, and treatment should involve dispelling wind, resolving phlegm, digesting food, and clearing fire. However, Suhexiang Wan (Styrax Pill), Baolong Wan (Embrace Dragon Pill), and Niuhuang Wan (Calculus Bovis Pill) should not be used, nor should purely descending qi medications be employed exclusively. For initial onset with wheezing, San'ao Tang (Three Unobstructed Decoction) is used with added Menthae Haplocalycis Herba (Dan Zhuye) and Gypsum (Shigao). For wheezing after eruption with dry nose and mouth, Baihu Tang (White Tiger Decoction) with exterior-dispersing herbs, or Lingyangji Xiebai San (Antelope Horn and White Tiger Powder), is indicated. For constipation, add Peucedani Radix (Qianhu), Trichosanthis Semen (Lou Ren), Armeniacae Semen Amarum (Xingren), Rheomi Radix et Rhizoma (Dahuang), Arctii Fructus (Niu Zi), and Salicis Matsudanae Ramulus (Xihe Liu). For fire-induced wheezing, Lingyangji (Antelope Horn), Trichosanthis Semen (Lou Ren), and Gypsum (Shigao) are best, followed by Trichosanthis Radix (Huafen) and Magnitio Calcitritum (Haishi). This approach is derived from the two formulas in *Yizong Jinjian* with minor modifications. Therefore, it is recorded here for reference. Regarding post-measles wheezing, there is a distinction between deficiency and excess syndromes. Lou Quanshan stated: Wheezing with sweating requires supporting healthy qi; wheezing without sweating requires dispersing pathogenic fire. Deficiency syndromes feature shortness of breath, cool body, and cold phlegm like ice; excess syndromes feature robust qi, chest fullness, fever, and constipation. *Measles Hui Bu* states: Deficiency syndromes should be treated with tonifying lung and resolving phlegm herbs, such as Ginseng Radix et Rhizoma (Renshen), Asini Corii Colla (Ejiao), Rehmanniae Radix Praeparata (Shudi), Geckus (Gejie), and Juglandis Semen (Hetourou) to draw qi back to its source. Excess syndromes should be treated with Baihu Tang or Lingyangji Xiebai San with modifications. *Huoren Shu* states: Contemporary physicians often see wheezing but fail to expel the measles toxin via exterior dispersion and fire clearing, instead using Su Zi Shun Qi (Perilla Fruit Regulating Qi) medicines, which deplete blood and qi and lead to complications. For severe toxic phlegm wheezing, Trichosanthis Semen (Gualou Ren), Platycodonis Radix (Jiegeng), Trichosanthis Radix (Huafen), Magnitio Calcitritum (Haishi), and Antennariae Herba (Jinfecao) should be used to resolve phlegm and clear fire. For severe rebellious phlegm obstruction, Niuhuang Zhenzhu San (Calculus Bovis and Pearl Powder) can be used; adding Ginseng Radix et Rhizoma (Renshen) for qi deficiency yields immediate results. Lou Quanshan stated: Flaring nostrils black as soot, ulcers and necrosis at the tip of the nose connecting to the philtrum, or dry nose with high chest indicate lung qi exhaustion. Death occurs in three days if acute, or twelve days if chronic, on Bing-Ding days (Fire overcoming Metal). Straight hair like hemp, oily sweat on the head, flaring nostrils like a furnace, drum-like abdominal distension, cyanotic face, and black lips indicate even faster death.
San'ao Tang (see previous section)
Lingyangji Xiebai San
Mori Cortex (Sheng Sangpi), Bupleuri Radix? No, Dendrobii Caulis? No, Di Gu Pi (Bark of Lycium Root), Glycyrrhizae Radix et Rhizoma (Gancao), Saigae Tataricae Cornu (Lingyangjiao)
Zhuhuang San
Perla (Pearl), Calculus Bovis (Niuhuang)
Pulverize equally, take with Nymphcae Nelumbinis Rhizomatis Nodus (Dengxin Cao) decoction.