疹非一类。有瘙疹。瘾疹。温疹。盖痘疹。皆非正疹也。惟麻疹则为正疹。亦胎元之毒。伏
于六腑。感天地邪阳火旺之气。自肺脾而出。故多咳嗽喷嚏。鼻流清涕。眼泪汪汪。两胞浮
肿
。身热二三日。或四五日。始见点于皮肤之上。形如麻粒。色若桃花。间有类于痘大者。
此麻疹初发之状也。形尖疏稀。渐次稠密。有颗粒而无根晕。微起泛而不生浆。此麻疹见形
之后。大异于痘也。须留神调治。始终不可一毫疏忽。较之于痘虽稍轻。而变化之速
。则在顷刻也。
廉按身热一二日。疹点一齐涌出者重。三四日出者轻。五日后出者重。至六七日隐隐皮肤之
间而不见点者尤重。
麻症出时。有轻重之分。临时须要详察。若气血平和。素无他病者。虽感时气。而正能制邪
。故发热和缓。微微汗出。神气清爽。二便调匀。见点则透彻。散没不疾不徐。为轻而易治
者
也。若素有风寒食滞。表里交杂。一触邪阳火旺之气。内外合发。而正不能制邪。必大热无
汗。烦躁口渴。神气不清。便闭尿涩。见点不能透彻。收散或太紧速。则为重而难治者也。
廉按风甚者。宜疏风为主。寒郁者。宜用麻黄。食滞者。宜用消导。痰甚者。宜化痰。火盛
者
。宜清火。无汗。风寒闭也。烦躁。毒闭于内。发不出也。口渴。火盛也。便闭。大肠火
郁而
兼食滞也。尿涩膀胱与心火相煽也。喘急。毒郁于肺而兼痰壅也。神气不清。毒盛也。又疹
脉。以浮大滑数有神者为吉。细软微弱无神者为凶。尤以肺脾脉洪大有神。虽有别症。
亦
不
为害。若细软无神。则阳症得阴脉矣。脉症不相合。恐有变卦。必先察其虚实。庶乎无误。
至于收完热退。虽细软微弱。无害也。形色桃红润泽者轻。其毒轻微也。深红者重。火毒盛
也
。紫黑灰黯隐伏不明者重极。火毒伏于脏也。阳部多者轻。阴部多者重。头为诸阳之首。面
为
阳中之阳。背为太阳。四肢外向为阳。胸为阴中之阴。四肢内向为阴。腰亦为阴。阳部多而
阴
部少者顺。阴部多而阳部少者逆。必有后患。二部俱少。火毒轻。二部俱多。火毒重。头面
胸腹手足不出。惟背上有红块者不治。热极。喘促。胃胸。肩胁。狂言。衄血。搦手。摇头
。寻衣。摸床。哕恶。便闭。口出尸气者不治。黑暗干枯如灰煤者不治。鼻煽。口张。眼胞
陷。目无神者不治。痰声在喉内。气喘。胸高者不治。鼻面俱青。粪色青黑如烂鱼肠者不治
。后牙疳臭烂。齿落无血者不治。两颊浮肿。环口青黑。颊漏。齿脱。唇崩。鼻坏者
不治。口如鱼嘴。气急作鸦声者不治。 后大便不通。气喘。皮肉渐乌者不治。 后余热内
攻。谵言妄语。神昏丧志者不治。 后阴虚血燥。疳痨肉脱者不治。
麻疹并非单一类型的疾病。有瘙疹、瘾疹、温疹等，这些连同痘疹，都不是真正的“正疹”。只有麻疹才是正疹。它也是胎元中蕴藏的毒邪，潜伏于六腑，感受天地间邪阳火旺之气后，从肺脾两脏发出。因此常伴有咳嗽、喷嚏、流清涕、眼泪汪汪、眼睑浮肿等症状。身体发热二三日，或四五日后，皮疹才开始在皮肤上显现。形态像麻粒一样细小，颜色像桃花一样红润，间或有类似痘疮较大的情况。这是麻疹初发的症状。
皮疹形态尖细稀疏，逐渐变得稠密，有颗粒但没有根部的红晕，微微隆起泛红但不化脓生浆。这与痘疮大不相同。必须小心调理治疗，从头到尾都不能有一丝疏忽。虽然比痘疮稍轻，但病情变化之快，就在顷刻之间。
廉按语：身体发热一两天，疹点就一齐涌出的，病情较重；三四天发出的，病情较轻；五天后才发出的，病情较重；到了六七天，疹点隐隐在皮肤之间却看不见的，尤其严重。
麻疹发作时，有轻重之分，临证时必须详细诊察。如果患者气血平和，平时没有其他疾病，虽然感染了时气（流行性邪气），但正气能制约邪气。所以发热和缓，微微出汗，神志清爽，大小便正常，出疹透彻，消退时不急不慢，属于轻症且容易治疗。
如果患者素有风寒或食积停滞，表里病邪夹杂，一旦触动邪阳火旺之气，内外合发，而正气不能制约邪气。必然出现高热无汗、烦躁口渴、神志不清、大便闭塞、小便涩痛等症状。出疹不能透彻，收没或过于紧速，这就属于重症且难治。
廉按语：风邪严重的，应以疏风为主；寒邪郁闭的，宜用麻黄；食积停滞的，宜用消导法；痰湿严重的，宜化痰；火邪旺盛的，宜清火。无汗，是风寒闭塞所致；烦躁，是毒邪闭阻于内，发不出来；口渴，是火盛；大便闭塞，是大肠火郁兼有食滞；小便涩痛，是膀胱与心火相互煽动；喘急，是毒邪郁闭于肺兼有痰壅；神志不清，是毒邪炽盛。另外，麻疹的脉象，以浮大滑数且有神气的为吉兆，细软微弱无神气的为凶兆。尤其是肺脾脉洪大且有神气，即使有其他病症，也不为害。如果脉象细软无神，则是阳证得了阴脉，脉症不相符合，恐怕会有变故。必须先诊察其虚实，才能避免错误。至于疹子收完、热退之后，虽然脉象细软微弱，也无妨害。
疹色桃红润泽的，病情轻，因为毒邪轻微。深红色的，病情重，因为火毒旺盛。紫黑灰暗、隐伏不明的，病情极重，因为火毒伏藏于脏腑。阳部（体表、上部）多的轻，阴部（体内、下部）重的重。头为诸阳之首，面为阳中之阳，背为太阳经所过，四肢向外侧为阳，胸为阴中之阴，四肢向内侧为阴，腰也为阴。阳部多而阴部少的为顺证，阴部多而阳部少的为逆证，必有后患。两部都少，说明火毒轻；两部都多，说明火毒重。如果头面、胸腹、手足不出疹，只有背上有红块的，属不治之症，因为热极。出现喘促、胃胸不适、肩胁疼痛、胡言乱语、鼻出血、手指抽搐、摇头、抓空摸床、呃逆恶心、大便闭塞、口出尸臭的，属不治之症。面色黑暗干枯如灰炭的，属不治之症。鼻翼扇动、口张、眼睑凹陷、眼神无光的，属不治之症。喉内有痰声、气喘、胸部高耸的，属不治之症。鼻部和面部发青、粪便青黑如烂鱼肠的，属不治之症。后期牙疳臭烂、牙齿脱落无血的，属不治之症。两颊浮肿、口周青黑、脸颊溃漏、牙齿脱落、嘴唇崩坏、鼻子坏死的，属不治之症。口形如鱼嘴、气急发出鸦叫声的，属不治之症。后期大便不通、气喘、皮肉逐渐变黑的，属不治之症。后期余热内攻、胡言乱语、神昏丧志的，属不治之症。后期阴虚血燥、疳痨消瘦脱肉的，属不治之症。
Measles is not a single category of disease. There are *sao zhen* (itchy rash), *yin zhen* (urticaria-like rash), and *wen zhen* (warm rash). Along with smallpox (*dou zhen*), none of these are considered "true measles" (*zheng zhen*). Only true measles qualifies as such. It is also the toxin hidden in the fetal origin, lying dormant in the six fu organs. Upon contracting the pathogenic yang fire-waxing qi from heaven and earth, it emerges from the Lung and Spleen. Therefore, it is often accompanied by coughing, sneezing, clear nasal discharge, watery eyes, and swollen eyelids. After fever for two or three days, or four to five days, spots begin to appear on the skin. The shape resembles millet grains, and the color resembles peach blossoms; occasionally, some may be larger, resembling smallpox. This is the initial manifestation of measles.
The spots are initially sharp, sparse, and gradually become dense. They have granules but no root halo, rise slightly and flush without forming pus. This differs significantly from smallpox after the eruption phase. Careful management is required throughout, without any negligence. Although slightly milder than smallpox, its changes occur rapidly, within moments.
Commentary by Lian: If body heat lasts one or two days and spots erupt all at once, the condition is severe. If they appear on the third or fourth day, it is mild. If they appear after the fifth day, it is severe. If, by the sixth or seventh day, the spots are faintly visible between the skin but not distinct, it is particularly severe.
When measles erupts, there are distinctions between mild and severe cases, requiring detailed examination at the time. If the patient's Qi and Blood are harmonious and they have no prior illnesses, although they contract seasonal pathogens, their righteous Qi can control the pathogenic Qi. Thus, the fever is mild, with slight sweating, clear spirit, and regular bowel and bladder movements. The spots emerge thoroughly and dissipate neither too fast nor too slow. This indicates a mild case that is easy to treat.
If the patient has pre-existing wind-cold or food stagnation, with interior and exterior pathogens mixed, touching the pathogenic yang fire-waxing qi causes internal and external factors to erupt together. Since righteous Qi cannot control the pathogenic Qi, symptoms must include high fever without sweat, irritability, thirst, unclear spirit, constipation, and dysuria. The spots fail to emerge thoroughly, and their resolution may be too rapid or tight. This indicates a severe case that is difficult to treat.
Commentary by Lian: For severe wind, prioritize dispersing wind. For cold stagnation, use Ephedrae Herba (Mahuang). For food stagnation, use digestive methods. For severe phlegm, resolve phlegm. For excessive fire, clear fire. No sweat indicates closure by wind-cold. Irritability indicates toxins blocked internally, unable to erupt. Thirst indicates excessive fire. Constipation indicates large intestine fire stagnation combined with food stagnation. Dysuria indicates bladder and heart fire fanning each other. Panting indicates toxins stagnant in the lungs combined with phlegm obstruction. Unclear spirit indicates abundant toxins. Furthermore, regarding the pulse in measles, a floating, large, slippery, rapid pulse with spirit is auspicious; a fine, soft, weak, and spiritless pulse is ominous. Especially if the Lung and Spleen pulses are large and vigorous with spirit, even if other symptoms exist, they are not harmful. If the pulse is fine, soft, and spiritless, it means a Yang syndrome presents with a Yin pulse. The pulse and symptoms do not match, suggesting potential complications. One must first examine deficiency and excess to avoid errors. However, after the rash resolves and fever subsides, even if the pulse is fine, soft, weak, and spiritless, it is not harmful.
A peach-red, lustrous color indicates mildness, as the toxin is slight. A deep red color indicates severity, as fire-toxin is abundant. Purple-black, gray-dull, or obscurely hidden colors indicate extreme severity, as fire-toxin lies dormant in the Zang organs. More Yang areas (exterior, upper) indicate mildness; more Yin areas (interior, lower) indicate severity. The head is the chief of all Yang meridians; the face is Yang within Yang; the back belongs to the Taiyang meridian; the lateral aspects of the limbs are Yang; the chest is Yin within Yin; the medial aspects of the limbs are Yin; the waist is also Yin. More Yang and fewer Yin areas indicate a favorable course; more Yin and fewer Yang areas indicate an unfavorable course, likely leading to later complications. Few in both areas indicate light fire-toxin; abundant in both areas indicate heavy fire-toxin. If the head, face, chest, abdomen, hands, and feet show no rash, only red patches on the back, it is untreatable due to extreme heat. Symptoms such as panting, stomach/chest discomfort, shoulder/hypochondriac pain, delirium, epistaxis, hand clenching, head shaking, picking at empty air, bed-fumbling, hiccups, nausea, constipation, and foul breath are untreatable. Dark, dry, ash-gray complexion is untreatable. Nasal flaring, open mouth, sunken eyelids, and spiritless eyes are untreatable. Phlegm rattle in the throat, panting, and elevated chest are untreatable. Blue-green nose and face, and stool like rotten fish intestines are untreatable. Late-stage gum rot with foul odor and tooth loss without blood are untreatable. Swollen cheeks, blue-black around the mouth, cheek fistulas, loose teeth, collapsed lips, and necrotic nose are untreatable. Fish-mouth deformity with gasping and crow-like sounds are untreatable. Late-stage constipation, panting, and blackening skin/flesh are untreatable. Late-stage residual heat attacking inward, delirium, coma, and loss of will are untreatable. Late-stage Yin deficiency with dry blood, and wasting-thirst emaciation are untreatable.