麻疹见形。贵乎透彻。出后细密红润。则为佳美有不透彻者。须察所因。如风寒闭塞。必有
身
热无汗。头痛。呕恶。疹色淡红而黯之证。宜用升麻葛根汤。加苏叶川芎。牛蒡子。因毒热
壅
滞者。必面赤身热。谵语烦渴。疹色赤紫滞黯。宜用三黄石膏汤。又有正气虚弱，不能送毒
外出者。必面色 白。身微热精神倦怠。疹色白而不红。以人参败毒散主之。
升麻葛根汤 治风寒闭塞。
升麻 粉葛 甘草
三黄石膏汤 治毒热壅滞。
麻黄 石膏 淡豆豉 黄柏 黄连 栀子 黄芩
人参败毒散 治气虚白麻。
人参 川芎 羌活 独活 前胡 枳壳 桔梗 柴胡 甘草 赤苓
引用生姜
廉按此亦大略也。云有不透彻者。须察所因。则所因者广。不可枚举。下列三项。亦举一反
三之意。如食重则宜消食。痰重则宜化痰之类。触类而旁通之。斯为善读书者矣。或因身体
手足厥冷而不透。经曰厥深热亦深。厥微热亦微。此乃阳气郁遏。热极反寒之象。宜重用升
葛。荆防。甘桔。粘子。蝉蜕之类。甚者加麻杏石甘汤。便闭。加卜子。大黄。使上升下泄
。郁热达外。自然出透。或因切牙而不透。切牙者。胃火盛也。宜用石膏。或因呃逆而不透
。呃逆者。火毒上攻也。疹未出透。于升阳透发中。重加石膏一二三两以救之。疹已出透。
或白
虎汤凉膈散。随症加减治之。疹后气虚而呃逆者。用人参。扁豆。柿蒂。姜。枣之类。或因
沉睡而不透。沉睡者。火郁于内。未得发扬于外也。宜用升阳散火之剂。余治一侄孙。年未
满周。一见形而即隐。既隐而沉睡。重用升。葛。荆。防。前胡。桔梗。杏仁。粘子。蝉蜕。
胡荽。角针。以表之。麻疹略现而又隐。沉睡如故。次日加黄芩。石膏。知母。枳壳。山楂。
服之。
亦略现而又隐。隐而变黑。三日服原方如故。至第四日。用三黄石膏汤。一泻而汗出。神气清
爽。麻终不见而愈。盖毒从泻出。不必复现也。疹后沉睡多属虚。或因吐蛔解蛔而不透。吐
蛔解蛔者。热毒壅迫而出也。胃热则吐蛔。肠热则解蛔。此热极之症。解者稍轻。吐者尤重
。疹未出而吐蛔者。宜于升葛。荆防散中。重用石膏。及栀子。使君子。芦根之类。疹已透
而吐蛔者。宜用白虎汤。加连芩等药。便闭用大黄。又有麻后胃中空虚。闻饮食香气上行而
呕出者。宜用山药。扁豆。茯苓。广皮。使君子。半夏曲。姜炒黄连之类。凡吐蛔不可
用甘草及甜物。余见一人年方八九岁。疹未见点。隐隐在皮肤之间。一日吐蛔十一条。一医
治之。用升。葛。荆防。前胡。桔梗。杏仁。粘子。石膏四钱。知母一钱。服之如故。此由
方是而分两太轻。杯水不能救车薪之火也。一医于表药中用肉桂三分。其疹一涌而出。数日
而死。可不痛哉。或因夹斑而不透。发斑者。胃热也。疹色稀而红绽。斑则大而干塌。色赤
如锦纹。宜石膏托里清热。紫黑者热极也。宜升麻白虎汤。化斑解毒汤。兼以表发之药。青
蓝者胃烂也。十不一生。余三弟染疫发蓝斑。治以十四味延中汤而愈。此亦万死一生之症。
若在麻疹。原由阳毒逼致胃烂。恐难用此。余所见麻疹发青蓝斑者。惟马舒之女。有大如钱
者。如围棋子者。满身青蓝而肿。此亦不救。有疹出已透。而根地颗粒。混成一块。形色红
紫者。用白虎汤之类。有疹出时遍身凹限而黑者。内有伏毒。外有风邪。内服犀角地黄汤加
减。外以羊须豆煎汤。时时洗之。红豆亦可。须要避风为主。又白麻有血虚而色白者。宜于
疏散中加当归。赤芍。丹皮。红花等药。有见点三四日而转红者。有不
红而渐次收没者。有没后而翻出火症者。随症治之可也。切勿拘于初为白麻。而作虚热论。
麻杏石甘汤 治风热厥冷。
麻黄(蜜炙) 杏仁 石膏 甘草
白虎汤 治切牙呃逆。
石膏 知母 甘草
加粳米数十粒
凉膈散 治呃逆。
栀子 连翘 黄芩 薄荷 桔梗 甘草 淡竹叶
本方加大黄。名加减凉膈散。加黄连。黄柏。大黄。芒硝。名凉膈散合解毒汤。
三黄石膏汤（见前）
升麻白虎汤 治斑
石膏 知母 甘草 升麻
化斑解毒汤 治斑。
石膏 升麻 知母 粘子 甘草 元参 淡竹叶
大便闭加大黄。
麻疹出疹期，关键在于透发彻底。皮疹发出后细密、红润，属于佳象。若有透发不彻底的，必须考察其原因。如属风寒闭塞，必然伴有身体发热无汗、头痛、恶心呕吐、皮疹颜色淡红而晦暗等症状。适宜使用升麻葛根汤，加紫苏叶、川芎、牛蒡子。因毒热壅滞的，必然面红身热、胡言乱语、烦躁口渴、皮疹颜色赤紫且滞涩晦暗。适宜使用三黄石膏汤。又有正气虚弱，不能将毒邪送出体外的，必然面色苍白、身体微热、精神倦怠、皮疹色白而不红。以人参败毒散为主治方。
三黄石膏汤：治疗毒热壅滞证。
药材：麻黄、石膏、淡豆豉、黄柏、黄连、栀子、黄芩。
人参败毒散：治疗气虚型白麻（皮疹色白的麻疹）。
药材：人参、川芎、羌活、独活、前胡、枳壳、桔梗、柴胡、甘草、赤茯苓。
引用生姜。
廉按：这也是一般性的概述。说“有不透彻者，须察所因”，那么导致不透的原因很广泛，不可一一列举。下列三项，也是举一反三的意思。如食积重则宜消食，痰湿重则宜化痰之类，触类旁通，这才是善于读书的人。或因手足厥冷而透发不畅，《内经》说：“厥深热亦深，厥微热亦微。”这是阳气郁遏，热极反寒的现象。适宜重用升麻、葛根、荆芥、防风、甘草、桔梗、牛蒡子、蝉蜕之类。严重的加用麻杏石甘汤。若大便闭结，加莱菔子、大黄，使气机上升、浊气下降，郁热达于体表，自然透发彻底。或因咬牙关而透发不畅，咬牙关是胃火盛的表现。适宜用石膏。或因呃逆而透发不畅，呃逆是火毒上攻的表现。疹未出透时，在升阳透发的方药中，重用石膏一两至三两来救治。疹已出透后，可用白虎汤或凉膈散，随症状加减治疗。疹后气虚而呃逆的，用人参、扁豆、柿蒂、姜、枣之类。或因沉睡而透发不畅，沉睡是火郁于内，未能发扬于外的表现。适宜用升阳散火的方剂。我治疗一个侄孙，年龄不满周岁，一见形即隐没，隐没后陷入沉睡，重用升麻、葛根、荆芥、防风、前胡、桔梗、杏仁、牛蒡子、蝉蜕、胡荽、角针（皂角刺）等药来发表。麻疹略现而又隐没，沉睡依旧。次日加入黄芩、石膏、知母、枳壳、山楂，服用后，也是略现而又隐没，隐没后变黑。第三日仍服原方。到第四日，改用三黄石膏汤，一泻下便汗出，神气清爽，麻疹虽终未完全显现但病愈了。这是因为毒邪从泻下排出，不必再重新显现。疹后沉睡多属虚证。或因吐蛔虫、解蛔虫而透发不畅，吐蛔、解蛔是热毒壅迫所致。胃热则吐蛔，肠热则解蛔。这是热极之症，解蛔稍轻，吐蛔尤重。疹未出而吐蛔的，适宜在升麻葛根汤、荆防败毒散中，重用石膏及栀子、使君子、芦根之类。疹已透而吐蛔的，适宜用白虎汤，加黄连、黄芩等药。大便闭结用大黄。又有麻疹后胃中空虚，闻到饮食香气上行而呕吐的，适宜用山药、扁豆、茯苓、陈皮、使君子、半夏曲、姜炒黄连之类。凡吐蛔不可用甘草及甜食。我曾见一人年方八九岁，疹未见点，隐隐在皮肤之间，一日吐蛔十一条。一位医生治疗他，用升麻、葛根、荆芥、防风、前胡、桔梗、杏仁、牛蒡子、石膏四钱、知母一钱，服用后无效。这是由于处方对路但分量太轻，杯水车薪救不了车薪之火。另一位医生在解表药中加入肉桂三分，结果皮疹一涌而出，数日后死亡，岂不痛惜！或因夹斑而透发不畅，发斑是胃热的表现。疹色稀而红绽，斑则大而干塌，色赤如锦纹。适宜用石膏托里清热。色紫黑的为热极，适宜用升麻白虎汤、化斑解毒汤，兼用解表发散的药物。色青蓝的为胃烂，十难救一。我的三弟感染疫病发蓝斑，用十四味延中汤治愈。这也是万死一生之症。若在麻疹，原本就是由阳毒逼迫导致胃烂，恐怕难以使用此方。我所见的麻疹发青蓝斑的，只有马舒的女儿，有大如铜钱的，有像围棋子的，满身青蓝而肿，这也无法救治。有疹出已透，但根部颗粒混成一块，形色红紫的，用白虎汤之类。有疹出时遍身凹陷且黑的，内有伏毒，外有风邪，内服犀角地黄汤加减，外用羊须豆煎汤，时时清洗。红豆也可以。必须要以避风为主。又有白麻因血虚而色白的，适宜在疏散药中加入当归、赤芍、丹皮、红花等药。有的见点三四天后转红的，有不红而逐渐收没的，有收没后又出现火症的，随症状治疗即可。切勿拘泥于初起为白麻，就当作虚热论治。
麻杏石甘汤：治疗风热厥冷。
药材：麻黄（蜜炙）、杏仁、石膏、甘草。
白虎汤：治疗切牙、呃逆。
药材：石膏、知母、甘草。
加粳米数十粒。
凉膈散：治疗呃逆。
药材：栀子、连翘、黄芩、薄荷、桔梗、甘草、淡竹叶。
本方加大黄，名加减凉膈散。加黄连、黄柏、大黄、芒硝，名凉膈散合解毒汤。
三黄石膏汤（见前文）。
Measles in the eruption stage requires thorough resolution. If the rash appears fine, dense, and ruddy, it is a favorable sign. In cases where resolution is incomplete, the cause must be investigated. For instance, if caused by wind-cold obstruction, there will necessarily be fever without sweat, headache, nausea/vomiting, and the rash color will be pale red and dull. Shengma Gegen Tang (Cinnamon Twig and Kudzu Root Decoction) should be used, added with Perilla Leaf (Suye), Ligusticum Chuanxiong Rhizome (Chuanxiong), and Arctii Fructus (Niubangzi). In cases of toxic heat stagnation, there will necessarily be a red face, body heat, delirium, irritability, thirst, and the rash color will be crimson-purple, stagnant, and dull. Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction) is appropriate. Furthermore, in cases of righteous qi deficiency unable to expel toxins outward, there will necessarily be a pale white complexion, slight body heat, mental fatigue, and the rash will be white and not red. Ren Shen Bai Du San (Ginseng Detoxification Powder) is the primary formula.
Shengma Gegen Tang: Treats wind-cold obstruction.
Herbs: Cimicifugae Rhizoma (Shengma), Puerariae Radix (Fenge), Glycyrrhizae Radix et Rhizoma (Gancao).
Sanhuang Shigao Tang: Treats toxic heat stagnation.
Herbs: Ephedrae Herba (Mahuang), Gypsum Fibrosum (Shigao), Sojae Praeparata (Danshidou), Phellodendri Cortex (Huangbai), Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin).
Ren Shen Bai Du San: Treats Qi-deficiency type White Measles (measles with white rash).
Herbs: Ginseng Radix et Rhizoma (Renshen), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duhuo), Peucedani Radix (Qianhu), Aurantii Fructus (Zhiqiao), Platycodonis Radix (Jiegeng), Bupleuri Radix (Chaihu), Glycyrrhizae Radix et Rhizoma (Gancao), Poria (Chiling).
Reference: Fresh Ginger (Shengjiang).
Commentary by Lian: This is a general overview. The statement "incomplete resolution requires investigating the cause" implies that causes are numerous and cannot be exhaustively listed. The following three items serve as examples for drawing inferences. For example, if food stagnation is heavy, digestion-promoting methods should be used; if phlegm-dampness is heavy, phlegm-resolving methods should be used. One should apply knowledge analogously; this is how one reads well.
If resolution is hindered by cold extremities (Jue Leng), the *Neijing* states: "The deeper the Jue, the deeper the heat; the milder the Jue, the milder the heat." This indicates yang qi depression with extreme heat manifesting as cold. It is appropriate to heavily use Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Glycyrrhizae Radix et Rhizoma (Gancao), Platycodonis Radix (Jiegeng), Arctii Fructus (Niubangzi), and Bombyx Batryticatus (Chantui). In severe cases, Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) is added. If constipation occurs, add Raphani Semen (Laifuzi) and Rheum Palmatum (Dahuang) to promote ascending clear qi and descending turbid qi, allowing depressed heat to reach the exterior, ensuring thorough resolution.
If resolution is hindered by teeth grinding (Qie Ya), this indicates excess stomach fire. Gypsum (Shigao) is appropriate. If resolution is hindered by hiccups (E Ni), this indicates fire-toxin attacking upward. Before the rash is fully resolved, add 1-3 liang of Gypsum (Shigao) to yang-raising and resolving formulas. After the rash has resolved, Baibu Tang (White Tiger Decoction) or Liangge San (Cool the Chest Powder) can be used with modifications based on symptoms. For post-measles qi deficiency causing hiccups, use Ginseng Radix et Rhizoma (Renshen), Dolichos Lablab Seed (Bian Dou), Persimmon Calyx (Shidi), Ginger (Jiang), and Jujube (Zao).
If resolution is hindered by deep sleep (Chen Shui), this indicates fire depression within, failing to expand outward. Yang-raising and fire-scattering formulas are appropriate. I treated my nephew who was under one year old. Upon appearance, the rash immediately receded, followed by deep sleep. I heavily used Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Peucedani Radix (Qianhu), Platycodonis Radix (Jiegeng), Armeniacae Semen Amarum (Xingren), Arctii Fructus (Niubangzi), Bombyx Batryticatus (Chantui), Coriandri Fructus (Huisu), and Gleditsiae Sinensis Spina (Jiaozhen) to release the exterior. The measles appeared slightly then receded again, with sleep continuing. The next day, I added Scutellariae Radix (Huangqin), Gypsum (Shigao), Anemarrhenae Rhizoma (Zhimu), Aurantii Fructus (Zhiqiao), and Crataegi Fructus (Shanzha). The patient still showed slight appearance and recession. On the third day, the original formula was continued. On the fourth day, Sanhuang Shigao Tang was used. After one purgative action, sweat appeared, and the spirit became clear. The measles did not fully reappear but the disease resolved because the toxin was expelled via purgation. Post-measles deep sleep is mostly due to deficiency.
If resolution is hindered by vomiting or passing roundworms (Tu He/Jie He), this is due to heat-toxin stagnation and pressure. Stomach heat causes vomiting worms; intestinal heat causes passing worms. This is an extreme heat syndrome; passing worms is lighter, vomiting worms is heavier. If worms are vomited before the rash resolves, heavily use Gypsum (Shigao), Gardeniae Fructus (Zhizi), Quisqualis Fructus (Shijunzi), and Phragmitis Rhizoma (Lugen) in Shengma Gegen Tang or Jingfang San. If worms are vomited after the rash resolves, Baibu Tang (White Tiger Decoction) with Coptidis Rhizoma (Huanglian) and Scutellariae Radix (Huangqin) is appropriate. Use Rheum Palmatum (Dahuang) for constipation.
After measles, if the stomach is empty and smelling food aromas triggers vomiting, use Dioscoreae Rhizoma (Shanyao), Dolichos Lablab Seed (Bian Dou), Poria (Fuling), Citri Reticulatae Pericarpium (Guangpi), Quisqualis Fructus (Shijunzi), Massae Fermentatae Medicinalis (Banxiaqu), and Ginger-fried Coptidis Rhizoma (Jiangchao Huanglian). Roundworm vomiting contraindicates Glycyrrhizae Radix et Rhizoma (Gancao) and sweet substances. I once saw an 8-9 year old child with faintly visible measles under the skin who vomited eleven roundworms in one day. One doctor prescribed Cimicifugae Rhizoma (Shengma), Puerariae Radix (Gegen), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), Peucedani Radix (Qianhu), Platycodonis Radix (Jiegeng), Armeniacae Semen Amarum (Xingren), Arctii Fructus (Niubangzi), Gypsum (Shigao, 4 qian), and Anemarrhenae Rhizoma (Zhimu, 1 qian), but there was no effect. This was because the dosage was too light relative to the prescription ("a cup of water cannot save a cartload of burning wood"). Another doctor added Cinnamomi Cortex (Rougui, 3 fen) to the exterior-releasing herbs. The rash surged out, and the child died days later. How painful!
If resolution is hindered by macules (Ban), this indicates stomach heat. Macules are large, dry, flat, and red like brocade patterns, whereas measles are sparse and red/blooming. Use Gypsum (Shigao) to support the interior and clear heat. Purple-black macules indicate extreme heat; use Shengma Baibu Tang (Cimicifuga and White Tiger Decoction) or Huaban Jiedu Tang (Macule-Resolving and Toxin-Clearing Decoction) combined with exterior-releasing herbs. Blue-green macules indicate stomach rot, with less than one in ten survivors. My third brother contracted an epidemic with blue macules and recovered using Shisiwei Yanzhong Tang (Fourteen-Ingredient Yanzhong Decoction). This is also a critical condition. However, in measles caused by yang-toxin forcing stomach rot, this formula may be difficult to use. I only saw one case of measles with blue-green macules, in Ma Shu's daughter, with lesions the size of coins or chess pieces, swollen all over; she could not be saved.
If the rash has resolved but the base particles merge into one mass with a crimson-purple color, use Baibu Tang (White Tiger Decoction) type formulas. If the rash appears sunken and black all over, it indicates latent toxin internally and wind pathogen externally. Internally use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) with modifications. Externally wash frequently with a decoction of Vicia Faba (Yangshudou) or Red Bean (Hongdou). Wind avoidance is paramount.
For white measles due to blood deficiency with white color, add Angelicae Sinensis Radix (Danggui), Paeoniae Radix Rubra (Chishao), Moutan Cortex (Danpi), and Carthami Flos (Honghua) to dispersing formulas. Some rashes turn red after 3-4 days; some do not turn red and gradually fade; some present with fire symptoms after fading. Treat according to symptoms. Do not rigidly classify initial white measles as deficient-heat.
Maxing Shigan Tang: Treats wind-heat with cold extremities.
Herbs: Ephedrae Herba (Mahuang, honey-fried), Armeniacae Semen Amarum (Xingren), Gypsum Fibrosum (Shigao), Glycyrrhizae Radix et Rhizoma (Gancao).
Baibu Tang: Treats teeth grinding and hiccups.
Herbs: Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), Glycyrrhizae Radix et Rhizoma (Gancao).
Add dozens of Oryza Sativa (Jingmi).
Liangge San: Treats hiccups.
Herbs: Gardeniae Fructus (Zhizi), Forsythiae Fructus (Lianqiao), Scutellariae Radix (Huangqin), Menthae Haplocalycis Herba (Bohe), Platycodonis Radix (Jiegeng), Glycyrrhizae Radix et Rhizoma (Gancao), Lophatheri Herba (Danzhuye).
Adding Rheum Palmatum (Dahuang) makes Jiajian Liangge San. Adding Coptidis Rhizoma (Huanglian), Phellodendri Cortex (Huangbai), Rheum Palmatum (Dahuang), and Mirabilite (Mangxiao) makes Liangge San combined with Jiedu Tang.
Sanhuang Shigao Tang (See above).
Shengma Baibu Tang: Treats macules.
Herbs: Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), Glycyrrhizae Radix et Rhizoma (Gancao), Cimicifugae Rhizoma (Shengma).
Huaban Jiedu Tang: Treats macules.
Herbs: Gypsum Fibrosum (Shigao), Cimicifugae Rhizoma (Shengma), Anemarrhenae Rhizoma (Zhimu), Arctii Fructus (Niubangzi), Glycyrrhizae Radix et Rhizoma (Gancao), Scrophulariae Radix (Yuanshen), Lophatheri Herba (Danzhuye).
Add Rheum Palmatum (Dahuang) for constipation.