粒头尖小收根者。此为尽透表症也。扁阔痒赤不离肉。热邪中伏大非雅。
麻尽透表。方无后患。何以见其透表。但得粒头尖大。离肉收根。及粒头细小收根。二者俱为
尽透表也。其有一种扁阔 赤成块。块上复有小粒。平塌不起。而未见块上离肉。又有一种结成
小块。如风毒遍身瘙痒。偏高而红肿。但粒头不尖者。此二症虽透表。其中必有热邪伏留。后必
变症。并宜用竹叶、石膏、麦冬、连翘、牛蒡子。以滋润之。或以化毒清表汤（见十六条）去桔梗、甘
草、薄荷、防风。加麦冬主之。纵有余热。从此涣散矣。
朱曰 指出尽透表之形状。而后未尽透表者。自易分别。
一齐涌出莫惊惶。顷刻浑身朱锦装。似痘出时随又收。如斑红赤却成疮。
痘以三、四次出。谓之出匀。麻贵一齐涌出。谓之出尽。故凡麻只要得出。毒便轻减。以火照
之。遍身如涂朱之状。此将出之兆。出形细密。与痘相似。但麻则随出随收。非若痘之渐长而渐
大也。出形鲜红。与伤寒之发斑相似。但麻则粒粒成疮。非若斑之皮红成片。如蚊咬之迹也。故凡
麻以一齐涌出为最美候。不须用药。
朱曰 麻虽贵一齐涌出。但当成粒。不当成片。医家务须辨别。
麻亦浑身似锦纹。白色血少要滋营。黑麻一现最凶恶。解毒消斑用大青。
痘疮赤艳痒来攻。麻疹鲜红毒得松。白色血虚犹可治。黑斑恶候莫相逢。
痘麻之色。不可同论。大抵痘怕大红。皮嫩易破。必生瘙痒。麻疹之色。最喜通红。何则。夫麻
发于心。心属火。红者火之正色也。故麻鲜红者。毒得尽发而吉也。若麻色淡白者。乃心血不足
也。治宜养血为主。以养血汤除甘草。或益营汤去人参、赤芍药、甘草。或养血化斑汤去人参治
之。又有以四物汤（见二十五条）加升麻、葛根、治之者。四物虽属血剂。而白芍、川芎。麻症不宜
用。而加升麻。尤为不宜。莫若养血汤。随症加减而用。实为妥当也。若麻色赤如锦纹者。以古方
化斑汤（见二十一条）去人参、升麻、甘草、早米。加元参。或万氏化斑汤（见二十一条）去桔梗、甘
草治之。然俱宜加生黄芩、生黄连治之。如色大红艳或微紫。血热也。或出太甚者。并宜以秘本
大青汤去升麻、桔梗。或以古方大青汤去升麻、桔梗。俱加牛蒡子、连翘、黄芩、黄连、生地黄主
之。黑斑者。死症也。亦当以秘本大青汤去升麻、桔梗。加生地黄、黄连、黄芩、火 人屎末服之。
大便秘者。加酒蒸大黄利之。
朱曰 麻疹之色。最喜通红。其或淡白。或赤如锦纹者。皆证之偏寒偏热。治法尤不可混。
养血汤 治麻出白色。
生地黄 当归身 红花 陈皮 甘草 生姜一片引。
益营汤 治麻色白。
人参 当归（酒炒） 红花（酒炒） 赤芍药（桂水炒） 甘草 水煎服。
养血化斑汤 治白疹。
人参 当归身 生地黄 红花 蝉蜕 生姜引。
秘本大青汤
大青 元参 知母 石膏 木通 栀仁 人中黄（火 研细） 桔梗 升麻 水煎。调人中黄末服。
颗粒顶端尖小、根部收敛的，这是麻疹完全透出体表的证候。颗粒扁平宽阔、瘙痒且颜色红赤，紧贴皮肤不分离的，说明热邪深伏体内，病情并不理想。
麻疹若能完全透出体表，方无后患。如何判断其是否完全透出？只要看到颗粒顶端尖大、离开皮肤且有收根之象，或者颗粒细小但有收根之象，这两种情况都属于麻疹完全透出体表。其中有一种情况是颗粒扁平宽阔、红赤成片，片上又生出小颗粒，平塌不起，且未见颗粒离开皮肤；还有一种情况是结成小块，像风毒一样遍身瘙痒，局部偏高且红肿，但颗粒顶端不尖。这两种证候虽然看似透出体表，但其中必然有热邪伏留，日后必定发生变证。对此，宜用竹叶、石膏、麦冬、连翘、牛蒡子来滋润清热。或者使用化毒清表汤（见第十六条），去掉桔梗、甘草、薄荷、防风，加入麦冬来主治。即使有余热，也会从此消散。
朱氏说：指出了完全透出体表的形态特征，那么尚未完全透出的情况，自然容易区分。
一齐涌出莫惊慌，顷刻间浑身如朱锦装扮。似痘疹发出后又随即消退，如斑疹红赤却形成疮疡。
痘疹分三、四次发出，称为“出匀”。麻疹贵在一齐涌出，称为“出尽”。所以凡是麻疹，只要能够发出，毒气便会减轻。用火照看全身，遍身如同涂了朱砂一般，这是即将发出的征兆。发出的形态细密，与痘疹相似，但麻疹是随出随收，不像痘疹那样逐渐长大。发出的形态鲜红，与伤寒的发斑相似，但麻疹是粒粒成疮，不像斑疹那样皮红成片，如蚊子叮咬的痕迹。所以凡是麻疹，以一齐涌出为最美的征候，不需要用药。
朱氏说：麻疹虽然贵在一齐涌出，但应当呈颗粒状，不应当成片。医生务必仔细辨别。
麻疹也如浑身锦绣纹路。若色白则血少，需要滋养营血。若现黑麻则最为凶恶，解毒消斑需用大青叶。
痘疮颜色赤艳且伴有瘙痒攻痛，麻疹颜色鲜红则毒气得松解。白色麻疹因血虚尚可治疗，黑色斑疹为恶候切勿相逢。
痘疹和麻疹的颜色，不可混为一谈。大体上痘疹怕颜色大红，因为皮嫩易破，必生瘙痒。麻疹的颜色，最喜欢通红。为什么呢？因为麻疹发于心，心属火，红色是火的正色。所以麻疹颜色鲜红的，说明毒气已完全发散，为吉兆。如果麻疹颜色淡白的，乃是心血不足所致。治疗应以养血为主，可用养血汤去掉甘草，或益营汤去掉人参、赤芍药、甘草，或养血化斑汤去掉人参来治疗。又有用四物汤（见第二十五条）加升麻、葛根治疗的。四物汤虽属补血剂，但其中的白芍、川芎，对于麻疹症不宜使用，再加升麻更是尤为不宜。不如使用养血汤，随症状加减应用，实在妥当。如果麻疹颜色赤红如锦纹的，可用古方化斑汤（见第二十一条）去掉人参、升麻、甘草、早米，加入玄参；或万氏化斑汤（见第二十一条）去掉桔梗、甘草来治疗。然而都适宜加入生黄芩、生黄连来治疗。如果颜色大红艳丽或微紫，属于血热，或者发出太甚的，并宜使用秘本大青汤去掉升麻、桔梗，或使用古方大青汤去掉升麻、桔梗，均加入牛蒡子、连翘、黄芩、黄连、生地黄来主治。出现黑斑的，是死症，也当使用秘本大青汤去掉升麻、桔梗，加入生地黄、黄连、黄芩、人中黄末服用。大便秘结的，加入酒蒸大黄以利大便。
朱氏说：麻疹的颜色，最喜欢通红。如果出现淡白，或赤红如锦纹的，都是证候偏寒或偏热的表现，治疗方法尤其不可混淆。
养血汤：治疗麻疹发出呈白色。
组成：生地黄、当归身、红花、陈皮、甘草，生姜一片为引。
益营汤：治疗麻疹颜色白。
组成：人参、当归（酒炒）、红花（酒炒）、赤芍药（桂水炒）、甘草，水煎服。
Granules with pointed tips and small bases that converge are indicative of the **Jin Tou Biao** (Complete Surface Penetration) syndrome. Granules that are flat, broad, itchy, red, and adhere closely to the flesh indicate that heat pathogens are deeply entrenched within, which is not a favorable sign.
If measles fully penetrate the surface, there will be no subsequent complications. How can one determine if the surface penetration is complete? If the granules have pointed, large tips, detach from the skin, and show convergence at the base, or if they are small but show convergence at the base, both conditions constitute complete surface penetration. In one type, the granules are flat, broad, red, and form patches; upon these patches, smaller granules appear, lying flat without elevation, and the granules on the patches do not detach from the skin. In another type, small patches form, accompanied by generalized itching resembling wind-toxin, with localized elevation, redness, and swelling, but the granule tips are not pointed. Although these two syndromes appear to have penetrated the surface, heat pathogens must be lingering internally, leading to subsequent transformation syndromes. For these, it is appropriate to use *Zhuye* (Lophatheri Herba), *Shigao* (Gypsum Fibrosum), *Maidong* (Ophiopogonis Radix), *Lianqiao* (Forsythiae Fructus), and *Niubangzi* (Arctii Fructus) to moisten and clear heat. Alternatively, use *Huadu Qingbiao Tang* (Detoxifying and Surface-Clearing Decoction) (see Article 16), removing *Jiegeng* (Platycodonis Radix), *Gancao* (Glycyrrhizae Radix et Rhizoma), *Bohe* (Menthae Haplocalycis Herba), and *Fangfeng* (Saposhnikoviae Radix), and adding *Maidong*. Even if residual heat remains, it will dissipate from this point onward.
Zhu stated: By pointing out the morphology of complete surface penetration, those cases where penetration is incomplete become easily distinguishable.
Do not panic when they surge forth together; in an instant, the whole body is adorned like vermilion brocade. Similar to pustules appearing and then receding, like macules turning red yet forming sores.
Pustules erupting over three or four stages are called "even eruption." Measles, however, are prized for surging forth all at once, termed "complete eruption." Therefore, as long as measles erupt, the toxin is alleviated. When illuminated by fire, the entire body appears coated in vermilion, signaling impending eruption. The erupted forms are fine and dense, resembling pustules, but measles erupt and recede simultaneously, unlike pustules which gradually grow larger. The erupted forms are bright red, resembling the macules of cold damage (*Shanghan*), but each grain of measles forms a distinct sore, unlike macules which present as continuous red patches resembling mosquito bites. Thus, for measles, a simultaneous surge is the most auspicious presentation, requiring no medication.
Zhu stated: Although measles are prized for surging forth together, they should form distinct grains, not continuous patches. Physicians must carefully distinguish between them.
Measles also resemble brocade patterns across the body. White coloration indicates blood deficiency and requires nourishing the Ying (Nutritive) level. The appearance of black measles is extremely ominous; to resolve toxicity and eliminate macules, use *Daqing* (Indigo Naturalis).
Pustules are crimson and itchy; measles are bright red, indicating loosened toxicity. White measles due to blood deficiency are treatable; black macules are malignant signs to be avoided.
The colors of pustules and measles cannot be discussed interchangeably. Generally, pustules fear excessive redness because the skin is tender and prone to rupture, inevitably causing itching. Measles prefer a uniform red color. Why? Because measles originate from the Heart, and the Heart belongs to Fire; red is the true color of Fire. Therefore, bright red measles indicate that toxins have been fully expelled, which is auspicious. If the measles color is pale white, it indicates insufficiency of Heart Blood. Treatment should focus on nourishing blood, using *Yangxue Tang* (Blood-Nourishing Decoction) removing *Gancao*, or *Yiyng Tang* (Nourishing Ying Decoction) removing *Renshen* (Ginseng Radix), *Chishaoyao* (Paeoniae Radix Rubra), and *Gancao*, or *Yangxue Huaban Tang* (Blood-Nourishing and Macule-Resolving Decoction) removing *Renshen*. Some use *Siwu Tang* (Four Substances Decoction) (see Article 25) added with *Shengma* (Cimicifugae Rhizoma) and *Gegen* (Puerariae Lobatae Radix). Although *Siwu Tang* is a blood-tonifying formula, *Baishao* (Paeoniae Radix Alba) and *Chuanxiong* (Ligustici Chuanxiong Rhizoma) are unsuitable for measles, and adding *Shengma* is particularly inadvisable. It is better to use *Yangxue Tang* with modifications based on symptoms, which is truly appropriate. If the measles color is crimson like brocade, use the ancient *Huaban Tang* (Macule-Resolving Decoction) (see Article 21) removing *Renshen*, *Shengma*, *Gancao*, and *Zaomi* (Early Rice), adding *Yuanshen* (Scrophulariae Radix); or *Wan's Huaban Tang* (see Article 21) removing *Jiegeng* and *Gancao*. However, it is advisable to add *Sheng Huangqin* (Scutellariae Radix) and *Sheng Huanglian* (Coptidis Rhizoma). If the color is bright red and glossy or slightly purple, it indicates blood heat, or excessive eruption. In such cases, use *Miben Daqing Tang* (Secret Version Big Indigo Decoction) removing *Shengma* and *Jiegeng*, or the ancient *Daqing Tang* removing *Shengma* and *Jiegeng*, both added with *Niubangzi*, *Lianqiao*, *Huangqin*, *Huanglian*, and *Shengdihuang* (Rehmanniae Radix). Black macules indicate a fatal condition; use *Miben Daqing Tang* removing *Shengma* and *Jiegeng*, adding *Shengdihuang*, *Huanglian*, *Huangqin*, and *Ren Zhonghuang* (Human Excrement Ash) powder. If constipation exists, add *Jiu Zheng Dahuang* (Rhubarb Radix et Rhizoma steamed with wine) to promote bowel movement.
Zhu stated: The ideal color for measles is uniform red. Pale white or crimson-brocade-like colors indicate cold or heat deviations in the syndrome; treatment methods must not be confused.
*Yangxue Tang*: Treats white measles.
Ingredients: *Shengdihuang* (Rehmanniae Radix), *Dangguishen* (Angelicae Sinensis Radix), *Honghua* (Carthami Flos), *Chenpi* (Citri Reticulatae Pericarpium), *Gancao* (Glycyrrhizae Radix et Rhizoma), with one slice of *Shengjiang* (Zingiberis Rhizoma Recens) as a guide.
*Yiyng Tang*: Treats white measles color.
Ingredients: *Renshen* (Ginseng Radix), *Danggui* (Angelicae Sinensis Radix, stir-fried with wine), *Honghua* (Carthami Flos, stir-fried with wine), *Chishaoyao* (Paeoniae Radix Rubra, stir-fried with cinnamon water), *Gancao* (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
*Yangxue Huaban Tang*: Treats white rashes.
Ingredients: *Renshen* (Ginseng Radix), *Dangguishen* (Angelicae Sinensis Radix), *Shengdihuang* (Rehmanniae Radix), *Honghua* (Carthami Flos), *Chantui* (Cicadae Periostracum), with *Shengjiang* (Zingiberis Rhizoma Recens) as a guide.
*Miben Daqing Tang*
Ingredients: *Daqing* (Indigo Naturalis), *Yuanshen* (Scrophulariae Radix), *Zhimu* (Anemarrhenae Rhizoma), *Shigao* (Gypsum Fibrosum), *Mutong* (Akebiae Caulis), *Zhiren* (Gardeniae Semen), *Renzhonghuang* (Human Excrement Ash, calcined and ground fine), *Jiegeng* (Platycodonis Radix), *Shengma* (Cimicifugae Rhizoma). Decoct in water and take with *Renzhonghuang* powder mixed in.