清涕之中见白沫。实为胃火旺所致。治宜清胃并降火。莫以白沫作寒治。
吐出痰中有白沫。流涎不止均非虚。都因胃中邪火旺。急宜清胃免倾危。
吐沫者。吐出清痰之中而有白珠是也。乃是胃火旺甚所致。治宜清胃降火为急。宜以加味
清胃散加连翘、牛蒡子主之。其不去升麻者。盖欲用之以开提胃热故也。然亦须斟酌而用。如麻
后有口中流涎不止者。亦是胃火旺甚所致也。宜以河间凉膈散（见二十六条）治之。但方中有大
黄、芒硝。须要察人之虚实强弱大小。及大便之坚涩而施。不可概用。以诛伐无过。
朱曰 口中流涎。乃大人小儿常有之证。亦有终身不愈者。总由胃火旺甚所致。
加味清胃散 治胃中蕴热。中脘作痛。痛后。火气发泄。必作寒热乃止。及齿龈肿痛出血。疼引头脑。
生地黄（四钱） 川升麻（一钱五分） 牡丹皮（五钱） 当归尾（酒洗三钱） 川黄连
（酒蒸三钱） 防风 荆芥 石膏 水煎服。
麻初泄泻最为宜。泻而日久须治之。热寒食冷便脓血。数般当分新与迟。
麻症泄泻。慎勿遽止。盖麻有泻。而胃与大肠之邪热得解。是亦表里分消之义也。初热作泻
者。用猪苓汤去阿胶、甘草。加葛根、连翘、牛蒡子主之。（有用香苏散者。然终不若分利之为当
也。香苏散方仍列。）若麻见二三日泄泻者。以透斑和中汤去升麻、川芎、柴胡、桔梗、半夏、陈皮、
甘草、生姜。加连翘、牛蒡子、地骨皮主之。若身热烦渴泄泻者。用三苓散（见三十七条）加地骨
皮、黄连、黄芩、麦冬主之。夏月用辰砂益元散去甘草治之。如麻后泄泻者。以薏苡仁散去香附、
甘草主之。麻后泄泻及便脓血者。皆由热邪内陷故也。大忌止泄。惟宜用升散之药。以黄连葛根
汤加扁豆、滑石、白芍药。数剂与服当自愈。然麻症泄泻。须分新、久、寒、热、伤食、伤冷、六般。若
初热泻者。用三苓散加木通。以重泻心经之热。寒泻则十中无一。或有伤食伤冷而作寒泻。四肢
冰冷。肚腹不热。口不作渴。小便不赤者。不得已而用理中汤。一剂止之。久泻不止者。以六君子
汤加肉豆蔻。或香蔻丸止之。如再不止。用醒脾散与服。或以五倍子、罂粟壳烧灰。用米饮调下涩
之。凡后数方。盖亦万不得已。从权而用。切不可目为定规而滥用也。
朱曰 泄泻亦非重证。惟不可久耳。
猪苓汤
猪苓 泽泻 赤苓 滑石 阿胶 甘草 水煎服。
香苏散
苏叶 陈皮 白芷 川芎 香附米 甘草 生姜、葱白引。
透斑和中汤
葛根 猪苓 泽泻 茯苓 川芎 升麻（各七分） 前胡 桔梗（各一钱） 柴胡（五分） 陈皮 半夏
（各七分） 甘草（三分） 生姜三片引。水煎。分作数次服。
辰砂益元散 治暑月小便不利。
辰砂（一钱） 桂府滑石（水飞过六两） 甘草（一两） 为细末。清水调下二三钱。老人、
虚人。及病后伤津而小便不利者。不宜用。又治暑月发惊多汗。小便涩痛。兼泻心火。前方加薄荷
叶少许。以清肺热。名鸡苏散。加青黛少许。以散肝火。名碧玉散。加石膏少许。以除胃热。名白
玉散。治同本方。加红曲五钱。以治赤痢。名清六丸。加吴茱萸一两。以治湿热吞酸。（一书治白痢
。）名茱萸六一散。加干姜五钱。以治白痢。（一书消饮食）名温六丸。加生柏叶、生车前、生藕节、
以治血淋。名三生益元散。加葱豉治虚烦不得眠。名葱豉益元散。以水煎服。则兼散表邪。
薏苡仁散
薏苡仁 淮山药 白茯苓 谷麦芽 白扁豆 香附米 山楂肉 甘草 水煎服。
黄连葛根汤
黄连（酒炒） 葛根 升麻 甘草 水煎服。
理中汤
人参 白术 干姜 甘草 水煎服。一书加肉豆蔻去人参。
六君子汤
人参 白术 白茯苓 炙甘草 陈皮 半夏 红枣、姜引。
香蔻丸
黄连（炒） 肉豆蔻（麸包煨） 诃子肉（麸包煨去壳） 木香 砂仁 白茯苓 为末
。饭丸。麻子大。米饮下。十五丸。
醒脾散
北全蝎（五只糯米拌炒） 白附子（乌豆水浸蒸） 人参 木香 白茯苓 天麻（姜汁蒸）
石菖蒲（去尾姜汁蒸） 炙甘草 为末。水调服。
清涕中夹杂白色泡沫，这实际上是胃火旺盛所导致。治疗应当清泻胃火并降火气，切勿将白色泡沫误认为是寒证而按寒证治疗。
呕吐出的痰液中含有白色泡沫，以及流涎不止的症状，都不是虚证。这都是因为胃中邪火旺盛所致，急需清泻胃火以免病情危重。
所谓“吐沫”，是指吐出清澈的痰液中带有白色珠状物，这是胃火极旺所致。治疗应以清胃降火为急务，宜使用加味清胃散，并加入连翘、牛蒡子为主药。方中保留升麻的原因，是想利用它来升提发散胃中的热邪。但也需要根据具体情况斟酌使用。例如麻疹后期出现口中流涎不止的情况，也是由于胃火极旺所致，宜用河间凉膈散（见前文第二十六条）治疗。但该方中含有大黄、芒硝，必须仔细考察患者的虚实强弱、年龄大小以及大便是否干结涩滞来决定是否施用，不可一概而论，以免诛伐无辜损伤正气。
朱氏说：口中流涎，是大人和小儿常见的症状，也有终身不愈的。总归都是由胃火极旺所致。
加味清胃散：治疗胃中蕴积的热邪，导致中脘部位疼痛。疼痛之后，火气发泄出来，必然会出现寒热交替的症状才会停止；以及牙龈肿痛出血，疼痛牵引至头脑。
处方：生地黄（四钱）、川升麻（一钱五分）、牡丹皮（五钱）、当归尾（酒洗三钱）、川黄连（酒蒸三钱）、防风、荆芥、石膏。水煎服。
麻疹初期出现的泄泻最为适宜，因为腹泻有助于邪气排出；但如果泄泻日久，则必须进行治疗。泄泻伴有热象、寒象、伤食或受凉，以及大便带脓血等情况，应当区分是新病还是久病。
麻疹引起的泄泻，切忌急于止泻。因为麻疹期间有腹泻，可以使胃与大肠的邪热得以解除，这也符合表里分消的治疗原则。在初热期出现泄泻者，用猪苓汤去掉阿胶、甘草，加入葛根、连翘、牛蒡子为主药。（有人使用香苏散，但终究不如分利小便的方法恰当。香苏散的方剂仍列在后面。）如果麻疹出疹二三天后出现泄泻，用透斑和中汤去掉升麻、川芎、柴胡、桔梗、半夏、陈皮、甘草、生姜，加入连翘、牛蒡子、地骨皮为主药。如果身体发热、烦躁口渴且泄泻者，用三苓散（见前文第三十七条）加入地骨皮、黄连、黄芩、麦冬为主药。夏季使用时，可用辰砂益元散去甘草治疗。如果是麻疹后期出现的泄泻，用薏苡仁散去香附、甘草为主药。麻疹后期的泄泻及大便带脓血，都是由于热邪内陷所致。此时最忌讳使用止泻药，只宜使用具有升散作用的药物，如黄连葛根汤加入扁豆、滑石、白芍药，服用数剂后应当自愈。然而，麻疹引起的泄泻，必须区分新久、寒热、伤食、伤冷等六种情况。若是初热期的泄泻，用三苓散加入木通，以重泻心经的热邪。寒性泄泻十中无一，或者是因伤食、受凉导致的寒性泄泻，表现为四肢冰冷、腹部不热、口不渴、小便颜色不红赤者，不得已时才使用理中汤，一剂即可止泻。久泻不止者，用六君子汤加入肉豆蔻，或者使用香蔻丸来止泻。如果仍然不止，服用醒脾散，或者将五倍子、罂粟壳烧成灰，用米汤调下以收敛止泻。以上几个方剂，也都是万不得已时的权宜之计，切不可将其视为固定规则而滥用。
香苏散：紫苏叶、陈皮、白芷、川芎、香附米、甘草。生姜、葱白为引。
透斑和中汤：葛根、猪苓、泽泻、茯苓、川芎、升麻（各七分）、前胡、桔梗（各一钱）、柴胡（五分）、陈皮、半夏（各七分）、甘草（三分）。生姜三片为引。水煎，分多次服用。
辰砂益元散：治疗暑月小便不利。
处方：辰砂（一钱）、桂府滑石（水飞六两）、甘草（一两）。研为细末，用清水调服二三钱。老人、体虚之人，以及病后津液受损导致小便不利者，不宜使用。此方又治疗暑月受惊多汗、小便涩痛，兼能清泻心火。前方加入少许薄荷叶，以清肺热，名为鸡苏散；加入少许青黛，以疏散肝火，名为碧玉散；加入少许石膏，以清除胃热，名为白玉散。治疗方法同本方。加入红曲五钱，以治疗赤痢，名为清六丸；加入吴茱萸一两，以治疗湿热吞酸（另一本书记载治疗白痢），名为茱萸六一散；加入干姜五钱，以治疗白痢（另一本书记载消食导滞），名为温六丸；加入生柏叶、生车前草、生藕节，以治疗血淋，名为三生益元散；加入葱豉治疗虚烦不得眠，名为葱豉益元散，用水煎服，则兼能发散表邪。
薏苡仁散：薏苡仁、淮山药、白茯苓、谷芽麦芽、白扁豆、香附米、山楂肉、甘草。水煎服。
理中汤：人参、白术、干姜、甘草。水煎服。另一本书记载加入肉豆蔻，去掉人参。
六君子汤：人参、白术、白茯苓、炙甘草、陈皮、半夏。红枣、生姜为引。
香蔻丸：黄连（炒）、肉豆蔻（麸皮包裹煨制）、诃子肉（麸皮包裹煨制去壳）、木香、砂仁、白茯苓。研为细末，用米饭做丸，如麻子大。米汤送服，每次十五丸。
醒脾散：北全蝎（五只，与糯米拌炒）、白附子（黑豆水浸泡蒸制）、人参、木香、白茯苓、天麻（姜汁蒸）、石菖蒲（去尾，姜汁蒸）、炙甘草。研为细末，水调服。
White foam is seen in clear nasal discharge. This is actually caused by excessive stomach fire (Wei Huo). Treatment should focus on clearing the stomach and descending fire. Do not treat white foam as a cold syndrome.
Phlegm vomited contains white foam, and continuous drooling are both non-deficiency conditions. All are due to the flourishing of pathogenic fire in the stomach. It is urgent to clear the stomach to prevent danger.
"Spitting foam" refers to spitting clear phlegm containing white pearl-like particles. This is caused by severe stomach fire. Treatment should urgently clear the stomach and descend fire. The appropriate formula is Jiawei Qingwei San (Modified Stomach-Clearing Powder) with added Qiaoya (Folium Perillae) and Niubangzi (Fructus Arctii). The reason for retaining Shengma (Rhizoma Cimicifugae) is to use it to raise and disperse stomach heat. However, it must be used with discretion. For example, if there is continuous drooling after measles, it is also caused by severe stomach fire. Hejian Liangge San (Cooling Chest Powder from Liu Wansu) should be used (see Article 26). But since this formula contains Dahuang (Radix et Rhizoma Rhei) and Mangxiao (Natrii Sulfas), one must examine the patient's deficiency or excess, strength, age, and whether stool is hard and difficult to pass before administering. It cannot be used indiscriminately to punish the innocent [healthy qi].
Zhu said: Drooling from the mouth is a common symptom in adults and children, and some cases last a lifetime. It is always caused by severe stomach fire.
Jiawei Qingwei San (Modified Stomach-Clearing Powder): Treats heat accumulation in the stomach causing pain in the Zhongwan area (CV12). After the pain, when the fire energy dissipates, chills and fever occur until they stop; also treats swollen, painful, and bleeding gums, with pain radiating to the head.
Ingredients: Shengdihuang (Radix Rehmanniae Preparata, 4 qian), Chuan Shengma (Rhizoma Cimicifugae, 1.5 qian), Mudanpi (Cortex Moutan, 5 qian), Dangguiwei (Radix Angelicae Sinensis Caulis, wine-washed, 3 qian), Chuan Huanglian (Rhizoma Coptidis, wine-steamed, 3 qian), Fangfeng (Radix Saposhnikoviae), Jingjie (Herba Schizonepetae), Shigao (Gypsum Fibrosum). Decoct in water and take orally.
Diarrhea at the beginning of measles is most favorable. If diarrhea persists for a long time, it must be treated. Diarrhea may present with heat, cold, food stagnation, cold injury, or pus and blood in stool. These cases must be distinguished as new or chronic.
Measles-induced diarrhea should not be stopped abruptly. Because diarrhea during measles allows pathogenic heat in the stomach and large intestine to resolve, this aligns with the principle of resolving exterior and interior simultaneously. For diarrhea occurring during the initial heat stage, use Zhu Ling Tang (Polyporus Decoction) removing Ejiao (Colla Corii Asini) and Gancao (Radix Glycyrrhizae), adding Gegen (Puerariae Lobatae Radix), Lianqiao (Forsythiae Fructus), and Niubangzi (Fructus Arctii). (Some use Xiangsu San (Aromatic Perilla Powder), but ultimately, promoting diuresis is more appropriate. Xiangsu San formula is listed below.) If diarrhea occurs two to three days after the appearance of measles rash, use Touban Hezhong Tang (Rash-Permeating Middle-Harmonizing Decoction) removing Shengma, Chuanxiong (Rhizoma Chuanxiong), Chaihu (Radix Bupleuri), Jiegeng (Platycodonis Radix), Banxia (Rhizoma Pinelliae), Chenpi (Pericarpium Citri Reticulatae), Gancao, and Shengjiang (Zingiberis Rhizoma Recens), adding Lianqiao, Niubangzi, and Digupi (Cortex Lycii). If accompanied by fever, irritability, thirst, and diarrhea, use Sanling San (Three-Ling Powder) (see Article 37) adding Digupi, Huanglian, Huangqin (Scutellariae Radix), and Maidong (Ophiopogonis Radix). In summer, use Chensha Yiyuan San (Cinnabar Yi-Yuan Powder) removing Gancao. If diarrhea occurs after measles, use Yiyiren San (Coix Seed Powder) removing Xiangfu (Cyperi Rhizoma) and Gancao. Post-measles diarrhea and dysentery with pus and blood are all caused by pathogenic heat sinking inward. Stopping diarrhea is strictly contraindicated. Instead, herbs that ascend and disperse should be used, such as Huanglian Gegen Tang (Coptis and Pueraria Decoction) adding Bian Dou (Phaseoli Semen), Huashi (Talcum), and Baishao Yao (Radix Paeoniae Alba). Taking several doses should lead to self-healing. However, measles-related diarrhea must be differentiated into six types: new/chronic, cold/heat, food stagnation, and cold injury. For initial heat-stage diarrhea, use Sanling San adding Mutong (Akebiae Caulis) to heavily drain heart heat. Cold-type diarrhea is rare (one in ten). If caused by food stagnation or cold injury resulting in cold diarrhea, characterized by cold limbs, cold abdomen, no thirst, and non-red urine, Lizhong Tang (Regulate the Middle Decoction) may be used reluctantly; one dose will stop it. For chronic persistent diarrhea, use Liujunzi Tang (Six-Gentlemen Decoction) adding Roudoukou (Myristicae Semen), or Xiang Kou Wan (Aromatic Cardamom Pill) to stop it. If still uncontrolled, use Xingpi San (Spleen-Awakening Powder), or burn Wubeizi (Terminalia Chebula Retusa) and Yingsuke (Psidii Fructus) to ash, mixing with rice water to administer for astringency. The aforementioned formulas are emergency measures of last resort. They must not be regarded as fixed rules and abused.
Zhu said: Diarrhea is not a severe condition, but it should not persist for a long time.
Zhu Ling Tang (Polyporus Decoction): Zhu Ling (Polyporus), Zexie (Alismatis Rhizoma), Chiling (Polyporus, red variant), Huashi (Talcum), Ejiao (Colla Corii Asini), Gancao (Radix Glycyrrhizae). Decoct in water and take orally.
Xiangsu San (Aromatic Perilla Powder): Ziye (Folium Perillae), Chenpi (Pericarpium Citri Reticulatae), Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Rhizoma Chuanxiong), Xiangfum (Cyperi Rhizoma), Gancao (Radix Glycyrrhizae). Use Shengjiang (Zingiberis Rhizoma Recens) and Congbai (Allii Fistulosi Bulbus) as guides.
Touban Hezhong Tang (Rash-Permeating Middle-Harmonizing Decoction): Gegen (Puerariae Lobatae Radix), Zhu Ling (Polyporus), Zexie (Alismatis Rhizoma), Fuling (Poria), Chuanxiong (Rhizoma Chuanxiong), Shengma (Rhizoma Cimicifugae) (each 7 fen), Qianhu (Peucedani Radix), Jiegeng (Platycodonis Radix) (each 1 qian), Chaihu (Radix Bupleuri) (5 fen), Chenpi (Pericarpium Citri Reticulatae), Banxia (Rhizoma Pinelliae) (each 7 fen), Gancao (Radix Glycyrrhizae) (3 fen). Use three slices of Shengjiang (Zingiberis Rhizoma Recens) as a guide. Decoct in water and take in divided doses multiple times.
Chensha Yiyuan San (Cinnabar Yi-Yuan Powder): Treats difficulty in urination during summer heat.
Ingredients: Chensha (Cinnabar, 1 qian), Guifu Huashi (Talcum from Guilin, water-flowered, 6 liang), Gancao (Radix Glycyrrhizae, 1 liang). Grind into fine powder, mix with clear water, and take 2-3 qian. Not suitable for the elderly, deficient persons, or those with fluid depletion after illness causing urinary difficulty. It also treats fright and excessive sweating in summer, painful and scanty urination, and clears heart fire. Adding a small amount of Bohe Ye (Menthae Haplocalycis Folium) to the above formula clears lung heat, named Jisu San (Chicken Mint Powder). Adding Qingdai (Indigo Naturalis) disperses liver fire, named Biyu San (Jasper Powder). Adding Shigao (Gypsum Fibrosum) clears stomach heat, named Baiyu San (White Jade Powder). Treatment is the same as the main formula. Adding Hongqu (Monascus Ruber, 5 qian) treats red dysentery, named Qingliu Wan (Clear Six Pills). Adding Wuzhuyu (Evodiae Fructus, 1 liang) treats damp-heat acid regurgitation (another book says treats white dysentery), named Zhuyu Liuyi San (Evodia Six-One Powder). Adding Ganjiang (Zingiberis Rhizoma, 5 qian) treats white dysentery (another book says aids digestion), named Wenliu Wan (Warm Six Pills). Adding Sheng Baiye (Cupressi Cacumen), Sheng Cheqian Cao (Plantaginis Herba), and Sheng Oujie (Nelumbinis Nodus) treats hematuria, named Sansheng Yiyuan San (Three Fresh Yi-Yuan Powder). Adding Congchi (Scallion and Fermented Soybean) treats deficiency vexation and insomnia, named Congchi Yiyuan San. Decoct in water to also release exterior pathogens.
Yiyiren San (Coix Seed Powder): Yiyiren (Coicis Semen), Huaishanyao (Dioscoreae Hypoglaucae Rhizoma), Baifuling (Poria), Guyamai (Hordei Fructus Germinatus and Maydis Semen), Baibian Dou (Phaseoli Semen), Xiangfum (Cyperi Rhizoma), Shanzhourou (Crataegi Fructus), Gancao (Radix Glycyrrhizae). Decoct in water and take orally.
Huanglian Gegen Tang (Coptis and Pueraria Decoction): Huanglian (Rhizoma Coptidis, wine-fried), Gegen (Puerariae Lobatae Radix), Shengma (Rhizoma Cimicifugae), Gancao (Radix Glycyrrhizae). Decoct in water and take orally.
Lizhong Tang (Regulate the Middle Decoction): Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), Gancao (Radix Glycyrrhizae). Decoct in water and take orally. Another book adds Roudoukou (Myristicae Semen) and removes Renshen (Ginseng Radix).
Liujunzi Tang (Six-Gentlemen Decoction): Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria), Zhigancao (Radix Glycyrrhizae, honey-fried), Chenpi (Pericarpium Citri Reticulatae), Banxia (Rhizoma Pinelliae). Use Hongzao (Jujubae Fructus) and Jiang (Zingiberis Rhizoma Recens) as guides.
Xiang Kou Wan (Aromatic Cardamom Pill): Huanglian (Rhizoma Coptidis, fried), Roudoukou (Myristicae Semen, flour-coated and roasted), Hezirou (Arecae Semen, flour-coated, roasted, shell removed), Muxiang (Vladimiriae Radix), Sharen (Amomi Fructus), Baifuling (Poria). Grind into powder, make pills with rice paste, size of hemp seeds. Take 15 pills with rice water.
Xingpi San (Spleen-Awakening Powder): Bei Quanxie (Scorpio, five pieces, stir-fried with glutinous rice), Baifuzi (Typhonii Rhizoma, soaked in black soybean water and steamed), Renshen (Ginseng Radix), Muxiang (Vladimiriae Radix), Baifuling (Poria), Tianma (Gastrodiae Rhizoma, steamed with ginger juice), Shichangpu (Acori Tatarinowii Rhizoma, tail removed, steamed with ginger juice), Zhigancao (Radix Glycyrrhizae, honey-fried). Grind into powder, mix with water and take orally.