凡麻疹出贵透彻。宜先用表发。使毒尽达于肌表。若过用寒凉。冰伏毒热。则必不能出透。
多致毒瓦斯内攻。喘闷而毙。至若已出透者。又当用清利之品。使内无余热。以免疹后诸证。
且麻疹属阳。热甚则阴分受伤。血为所耗。故没后须以养血为主。可保万全。此首尾治疹之
大法。至于临时权变。惟神而明之而已。
廉按主治大法。以表发清利养血三项该之。此真的确不磨之论。仲景复起。不能易斯言也。
诚能根据此用药。何有危症。然此其大法也。表发固忌清利。亦有火闭而宜兼用清凉者。食
闭
而宜兼用消导者。痰闭而宜兼用化痰者。没后固宜养血。亦有匿表而宜兼用疏散者。火郁而
宜兼用清凉者。食积而宜兼用
消导者。痰壅而宜兼用化痰者。且有元气本虚。初发而即宜兼补气血。没后而即用温补者。
亦有初发而兼补气血。没后而反用清凉者。麻疹千变万化。医者亦
当以千变万化应之。初非谢氏七十二症所能尽也。故又曰临时权变。惟神而明之而已。旨哉
言乎。此在读其书者。明其意而推展之耳。
麻疹一证。非热不出。故欲出时。身先热也。表里无邪者。热必和缓。毒瓦斯松动。则易出而
易透。若兼风寒食热诸证。其热必壮盛。毒瓦斯郁闭。则难出而难透。治以宣毒发表汤。其间
或有交杂之症。亦照本方随证加减治之。
宣毒发表汤 治麻疹将出未出。
升麻 葛根 前胡 桔梗 枳壳
荆芥 防风 薄荷 木通 连翘
粘子 淡竹叶 甘草
引加芫荽。水煎服。感寒邪者加麻黄。夏月勿用。食滞加南山楂。内热
加黄芩。气急去升麻。加苏叶葱白。甚者并去桔梗。孕妇根据前法。再去木通。
廉按风闭者。面色微青。舌胎微白。洒淅恶寒。毛窍竖起。鼻塞气粗。喘闷不宁。甚至角弓
反张。手足拘挛。眼白足冷。大便清利。重用荆芥。防风。薄荷。升麻。粉葛。前胡。桔梗
。杏仁。蝉蜕。葱白。以发之。冬月用麻黄。火闭者。面红目赤。肌肤焦热。舌燥唇裂。大
便或闭或泻。甚至气喘狂叫。神昏错语。扬手掷足。喜就冷处。宜于表药中重用石膏。黄芩
。知母。或犀角。川连。栀子等药。重甚者加大黄。食闭者。面色微黄。四肢倦怠。吞酸
嗳腐。身热口燥。舌上黄白浓胎。胸膈痞满。甚至肚腹坚实。昏睡气急。大便不通。宜于表
散药中用枳壳。浓朴。山楂。麦芽。以消其食。卜子。大黄。以通其闭。若食火动心。时发
谵语。四肢厥冷。名为食厥。急用芩。连。石膏。蒌仁。大黄。仍佐以发散之药。又有痰闭
者。满口痰涎。喉间有声。气急发喘。咯痰不出。宜重用桔梗。杏仁。桑皮。胆星。蒌仁。
白芥子。竹沥等药。仍佐以疏散之剂。以上四症。已甚者俱谓闷 。宜审其所重而用药或四
症俱全。宜用三黄石膏汤。再加风药痰药消食药。又闷 多痰喘。一法用明亮雄黄。盛以竹
筒。于饭中蒸七次为末。酒浆调服。痰喘即止。闷 之症。有热六七日而不出者。有一出而即
隐者。有头面微出而身上俱无者。有身上微影而头面胸背俱无者。有影迹。在内而外不
见
形者。有皮肤隐隐紫赤者。有红紫遍身紫黑成块者。此皆九死一生之症。然能审其受病之的
。而大剂治之。亦可挽救。切勿弃而不治也。凡遇闷 。分其顶心细看。有红筋红瘰。挑破
即
出。或头面手足有 疔。用银针挑破方出。或顶心中有发。比众发更粗。其色黄赤者。拔去
发根见血即出。又曰有交杂之症。宜随症加减治之。固不止此四症已也。学人当推展之。
三黄石膏汤 治风寒毒热郁滞闷症。
麻黄 石膏 淡竹叶 黄柏
黄连 栀子 黄芩
凡麻疹的发出，贵在透彻。应当先用解表发汗的方法，使毒邪完全透达于肌表。如果过用寒凉药物，导致冰伏毒热（即寒凉药遏制了热毒的外透），则必然不能出透。
多会导致毒瓦斯内攻入里，出现气喘胸闷而死亡。至于已经出透的，又应当使用清利（清热利湿/排毒）的药物，使体内没有余热，以免发生疹后的各种证候。
而且麻疹属于阳证，热势严重则会损伤阴分，血液被耗伤，所以在疹子消退后必须以养血为主，这样可以保证万无一失。这是治疗麻疹从头到尾的大法。至于临时的随机应变，只有靠医者神妙地领悟和明察罢了。
廉按（廉泉按语）：主治大法，以表发、清利、养血这三项概括它。这是确实不可动摇的真理。即使张仲景复活，也不能改变这番言论。如果能根据此法用药，哪里有危重病症？然而这只是大原则。解表发汗固然忌讳过早使用清利，但也有因火闭（热毒郁闭）而适宜兼用清凉药的；有因食闭（食积阻滞）而适宜兼用消导药的；有因痰闭（痰浊阻滞）而适宜兼用化痰药的。疹退后固然适宜养血，但也有因邪气隐匿在表而适宜兼用疏散药的；有因火郁而适宜兼用清凉药的；有因食积而适宜兼用消导药的；有因痰壅而适宜兼用化痰药的。并且还有元气本来虚弱，初发时即宜兼补气血的；疹退后即用温补的；也有初发时兼补气血，疹退后反而用清凉药的。麻疹千变万化，医者也应当以千变万化的方法应对它。起初并不是谢氏七十二症所能穷尽的。所以又说临时权变，只有神妙地领悟罢了。这话真深刻啊！这在于读书的人，明白其意旨并推展应用罢了。
麻疹这一证候，不是热就不能发出，所以想要发出时，身体先发热。如果表里都没有邪气干扰，发热必定和缓，毒瓦斯松动，就容易发出且容易透发。如果兼有风寒、食滞、热盛等各种证候，发热必定壮盛，毒瓦斯郁闭，就难发出且难透发。治疗用宣毒发表汤。其间如果有夹杂的其他症状，也按照本方随证加减治疗。
宣毒发表汤 治疗麻疹将要发出尚未发出的情况。
升麻、葛根、前胡、桔梗、枳壳、荆芥、防风、薄荷、木通、连翘、粘子（牛蒡子）、淡竹叶、甘草。
引药加芫荽，水煎服。感受寒邪者加麻黄，夏季不要用。食滞加南山楂。内热加黄芩。气急去升麻，加苏叶、葱白。严重的并去掉桔梗。孕妇根据前面的方法，再去掉木通。
廉按：风闭者，面色微青，舌苔微白，洒淅恶寒（怕冷颤抖），毛孔竖起，鼻塞气粗，气喘胸闷不宁，甚至角弓反张，手足拘挛，眼白足冷，大便清稀通畅。重用荆芥、防风、薄荷、升麻、粉葛、前胡、桔梗、杏仁、蝉蜕、葱白，以发散之。冬季用麻黄。
火闭者，面红目赤，肌肤焦热，舌燥唇裂，大便或闭结或泄泻，甚至气喘狂叫，神昏错语，扬手掷足，喜欢靠近冷处。适宜在解表药中重用石膏、黄芩、知母，或者犀角、川连（黄连）、栀子等药。重者加大黄。
食闭者，面色微黄，四肢倦怠，吞酸嗳腐，身热口燥，舌上黄白厚腻苔，胸膈痞满，甚至肚腹坚实，昏睡气急，大便不通。适宜在解表散邪药中使用枳壳、浓朴（厚朴）、山楂、麦芽，以消导食积。卜子（莱菔子）、大黄，以通其闭塞。如果食火动心，时常发谵语，四肢厥冷，名为食厥。急用黄芩、黄连、石膏、蒌仁（瓜蒌仁）、大黄，仍佐以发散的药物。
又有痰闭者，满口痰涎，喉间有声，气急发喘，咯痰不出。适宜重用桔梗、杏仁、桑皮（桑白皮）、胆星（天南星制）、蒌仁、白芥子、竹沥等药，仍佐以疏散的药剂。以上四种症状，严重的都称为“闷疹”（指麻疹不透，内陷危重）。应当审察其中主要的病因而用药。如果四症俱全，适宜用三黄石膏汤。再加风药、痰药、消食药。另外闷疹多伴有痰喘，有一法是用明亮的雄黄，装在竹筒里，在饭中蒸七次，研为粉末，用酒或浆液调服，痰喘立即停止。
闷疹的症状，有发热六七天而不出透的，有刚一出透就隐没的，有头面微微发出而身上全无的，有身上微微有影迹而头面胸背全无的，有影迹在内而外面不见形色的，有皮肤隐隐紫赤的，有红紫遍身紫黑成块的。这些都是九死一生的重症。然而如果能审察受病的根本原因，用大剂量的药物治疗，也可以挽救。千万不要放弃不治疗。凡是遇到闷疹，分开头顶中心仔细查看，有红筋红瘰（红色结节），挑破即可透出。或者头面手足有疔疮，用银针挑破才能透出。或者头顶心有头发，比众发的更粗，颜色黄赤的，拔去发根见血即可透出。
又说有夹杂的其他症状，适宜随症加减治疗，固然是不止这四种症状而已。学习者应当推展应用。
Whenever measles erupts, it is crucial for the eruption to be thorough. One should initially use methods to release the exterior and induce sweating, so that the pathogenic toxins are completely delivered to the muscle and skin surface. If cold-cooling herbs are overused, causing the heat-toxin to be "ice-locked" (suppressed by excessive cold), the eruption will inevitably fail to be thorough.
This often leads to the pathogenic qi attacking inwardly, resulting in wheezing, chest oppression, and death. As for cases where the eruption has already become thorough, one should then use clearing and draining agents to ensure there is no residual heat internally, thereby avoiding various post-measles syndromes.
Moreover, measles belongs to the Yang category; severe heat damages the Yin aspect, and blood is consumed by it. Therefore, after the rash subsides, treatment must focus primarily on nourishing the blood to ensure complete safety. This constitutes the general principle for treating measles from beginning to end. Regarding temporary flexibility and adaptation, one must rely on divine perception and clear understanding.
Lian's Commentary: The general principles of treatment are summarized by three aspects: releasing the exterior, clearing/draining, and nourishing blood. This is an undeniable truth. Even if Zhang Zhongjing were resurrected, he could not alter these words. If one prescribes medication according to this method, how could there be critical conditions? However, this is merely the general principle. While releasing the exterior generally contraindicates early use of clearing/draining methods, there are cases of "Fire Closure" (heat-toxin stagnation) where cooling herbs are suitable as adjuncts; cases of "Food Closure" (food stagnation obstruction) where digestive-promoting herbs are suitable; and cases of "Phlegm Closure" (phlegm turbidity obstruction) where phlegm-resolving herbs are suitable. Although nourishing blood is appropriate after the rash subsides, there are cases where pathogens are concealed in the exterior, requiring dispersing herbs as adjuncts; cases of Fire Stagnation requiring cooling herbs; cases of Food Accumulation requiring digestive herbs; and cases of Phlegm Obstruction requiring phlegm-resolving herbs. Furthermore, there are cases where the primordial Qi is inherently deficient, requiring simultaneous tonification of Qi and Blood at the initial stage, or warm tonification after the rash subsides; and cases where Qi and Blood are tonified initially, but cooling herbs are used after the rash subsides. Measles presents with myriad changes, and physicians must also respond with myriad adaptations. Initially, Xie's seventy-two syndromes cannot exhaustively cover them. Hence, it is said that temporary flexibility relies on divine perception. These words are profound! It lies in the reader to understand the intent and extend its application.
Measles as a syndrome does not erupt without heat; thus, when it is about to erupt, the body first becomes hot. If there is no pathogen in the interior or exterior, the fever will be mild and harmonious, the pathogenic qi will loosen, making eruption easy and thorough. If accompanied by wind-cold, food stagnation, or excess heat syndromes, the fever will be vigorous, the pathogenic qi will be stagnant and closed, making eruption difficult and incomplete. Treatment utilizes Xuandu Fabiao Tang (Toxin-Releasing Exterior-Release Decoction). If there are mixed symptoms in between, they should also be treated with modifications of this formula according to the syndrome.
Xuandu Fabiao Tang (Toxin-Releasing Exterior-Release Decoction): Treats measles that are about to erupt but have not yet appeared.
Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Qianhu (Peucedani Radix), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus Immaturus), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), Mutong (Akebiae Caulis), Lianqiao (Forsythiae Fructum), Niu Bang Zi (Arctii Fructus), Dan Zhu Ye (Lophatheri Herba), Gancao (Glycyrrhizae Radix et Rhizoma).
Add Yuanxi (Coriandri Fructus) as a guide, decoct in water and take orally. For those affected by cold pathogens, add Mahuang (Ephedrae Herba); do not use in summer. For food stagnation, add Nan Shan Zha (Crataegi Fructus). For internal heat, add Huangqin (Scutellariae Radix). For rapid breathing, remove Shengma and add Suye (Perillae Folium) and Congbai (Allii Fistulosi Bulbus). In severe cases, also remove Jiegeng. For pregnant women, follow the previous method but additionally remove Mutong.
Lian's Commentary: Wind Closure manifests as slightly bluish complexion, slightly white tongue coating, aversion to cold with shivering, erect hair follicles, nasal congestion, coarse breathing, wheezing and chest oppression with restlessness, even opisthotonos, limb spasms, cold feet, and clear loose stools. Heavily use Jingjie, Fangfeng, Bohe, Shengma, Fenge (Gegen), Qianhu, Jiegeng, Xingren (Pruni Semen), Chantui (Cicadae Periostracum), and Congbai to disperse. Use Mahuang in winter.
Fire Closure manifests as red face and eyes, scorched-hot skin, dry tongue and cracked lips, constipation or diarrhea, even wheezing, screaming, delirium, throwing hands and feet, preference for cold places. It is suitable to heavily use Shigao (Gypsum Fibrosum), Huangqin, Zhimu (Anemarrhenae Rhizoma) in the exterior-releasing formulas, or Xijiao (Rhinocerotis Cornu - note: substitute with Buffalo Horn in modern practice), Chuanlian (Coptidis Rhizoma), Zhizi (Gardeniae Fructum), etc. In severe cases, add Dahuang (Rhei Radix et Rhizoma).
Food Closure manifests as slightly yellow complexion, fatigue in limbs, acid regurgitation and belching of rotten food, body heat and dry mouth, thick yellow-white greasy tongue coating, chest and diaphragm fullness, even hard abdomen, lethargy, rapid breathing, and constipation. It is suitable to use Zhike, Houpo (Magnoliae Officinalis Cortex), Shan Zha (Crataegi Fructus), Mai Ya (Hordei Fructus Germinatus) in the exterior-dispersing drugs to digest the food. Bobzi (Raphani Semen) and Dahuang to open the obstruction. If food-fire disturbs the Heart, causing occasional delirium and cold extremities, it is named Food Jue (Syncope due to Food). Urgently use Huangqin, Chuanlian, Shigao, Lou Ren (Trichosanthis Semen), Dahuang, still assisting with dispersing drugs.
There is also Phlegm Closure, characterized by mouth full of salivary phlegm, sounds in the throat, rapid breathing and wheezing, inability to expectorate phlegm. It is suitable to heavily use Jiegeng, Xingren, Sangpi (Mori Cortex), Dansheng (Arisaematis Cum Bile), Lou Ren, Baijiezhi (Sinapis Semen), Zhuli (Bambusae Succus Liquidus), etc., still assisting with dispersing agents. The above four syndromes, if severe, are all called "Men Zhen" (Stifled Measles). One should examine the predominant cause and prescribe accordingly. If all four syndromes are present, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) is suitable, adding wind-drugs, phlegm-drugs, and food-digesting drugs. Another method for Men Zhen with much phlegm and wheezing is to use bright Xionghuang (Realgar), place it in a bamboo tube, steam it seven times in rice, grind into powder, and take mixed with wine or liquid. Phlegm and wheezing will stop immediately.
The symptoms of Men Zhen include: fever for six or seven days without eruption; eruption appearing and then immediately disappearing; slight eruption on the head and face but none on the body; slight shadows on the body but none on the head, face, chest, or back; shadows inside but no visible form outside; faint purple-red skin; or widespread red-purple turning black in patches. These are all critical conditions with nine deaths for every one survival. However, if one accurately diagnoses the root cause and uses large doses of medication, rescue is possible. Do not abandon treatment. Whenever encountering Men Zhen, carefully inspect the crown of the head. If there are red veins or red nodules, puncture them to allow eruption. Or if there are ding (carbuncles) on the head, face, hands, or feet, puncture them with a silver needle to allow eruption. Or if there is a hair on the crown thicker than others with a yellow-red color, pluck it out until bleeding occurs, and eruption will follow.
It is also said that there are mixed syndromes, which should be treated with modifications according to the syndrome. This certainly includes more than just these four syndromes. Students should extend their understanding.
Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction): Treats Men Zhen syndrome caused by stagnation of wind-cold and toxin-heat.
Mahuang (Ephedrae Herba), Shigao (Gypsum Fibrosum), Dan Zhu Ye (Lophatheri Herba), Huangbai (Phellodendri Cortex), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructum), Huangqin (Scutellariae Radix).