麻粒头焦实可惊。热极急将肺胃清。治之若还不及时。变成紫黑命归阴。
麻疹透表而粒头焦者。不论麻色红淡。皆为热极之候。急宜清肺凉胃。分利小便。并且以白
虎解毒汤（见二十六条）重用石膏。加木通、泽泻。或加车前子治之。如干燥无汗。加蜜酒炒麻黄
以汗之。大便燥者。宜于清解剂中。佐以血药而润燥。以全书除热清肺汤加当归、火麻仁、枳壳治
之。如不通者。方以承气汤或河间凉膈散（见二十六条）去甘草下之。倘治之不早。多致紫黑难救
矣。有等原发小疥。而顶焦有似于麻焦。而实非麻焦。临症须详审。
朱曰 紫黯色。粒头焦。皆热极之候。当于清热、解毒、凉血诸法中求之。小疥似焦。尤
须注意。
全书除热清肺汤 清肺金、泻心火主方。
麦冬 黄芩 石膏 元参 生地黄 贝母 赤茯苓 壮热。加地骨皮、黄连。气粗。加炒葶
苈子、栝蒌霜。便闭。加当归、火麻仁、枳壳。
承气汤 治少阳胆经、阳明大肠症。
生大黄（四两） 浓朴（姜汗拌炒六钱） 枳实（面粉拌炒三枚） 水煎服。加芒硝三合。名大承气汤。
麻如云片 红赤。或作腥臭出脓血。一因表火一因里。治分内外免疏失。
麻出有如云头大片。其形微起。此症有二。一证现大片 红赤肿。而微离肉者。一证于红肿
大片之上。复有小红点现于片上者。皆因表火炽甚所致。当分内外。用大寒凉之剂。或分利之。
以白虎解毒汤（见二十六条）加葛根、元参治之。若麻出如锦纹斑烂。或出脓血。腥臭不干。心胸
烦闷。呕吐清水。身温热者。以白虎解毒汤（见二十六条）加贯仲。以散结积诸毒。而除湿热。加
防风、荆芥穗。以治风而消疮毒。（有加苍术治之者。虽云甚当。然似乎当慎。）慎勿迟延。恐致不
救。若麻稠密。身痛烦躁者。以凉血饮子（见四十五条）去赤芍。加紫草、连翘、牛蒡子治之。倘系
瘾疹。遍身状如云头片。斑点乍有乍无者。则当以消风散治之。
朱曰 云头大片。加以腥臭出脓血。外证已极险恶。认定表火炽甚。以散结毒除湿热诸
法治之。自可转危为安。若系瘾疹。虽状如云头片。而斑点若有若无。其分别在此。
消风散
当归 生地黄 防风 蝉蜕 知母 苦参 荆芥 胡麻仁 牛蒡子 石膏（各一钱） 木通
（五分）水煎。食远服。一方有苍术、甘草。
麻疹颗粒顶部焦黑，确实令人惊恐。这是热邪极盛的表现，必须紧急清泻肺胃之火。如果治疗不及时，疹色会变成紫黑色，导致死亡。
麻疹已经透出体表，但颗粒顶部焦黑的，不论疹色是红还是淡，都属于热邪极盛的证候。应当紧急清肺凉胃，分利小便。并且重用白虎解毒汤（见第二十六条）中的石膏，加入木通、泽泻。或者加入车前子来治疗。如果患者干燥无汗，加入用蜜酒炒制的麻黄以发汗。如果大便燥结，应当在清热解表的方剂中，佐以养血活血的药物以润燥，使用全书除热清肺汤加入当归、火麻仁、枳壳来治疗。如果大便不通，才使用承气汤或河间凉膈散（见第二十六条）去掉甘草来攻下。如果治疗不早，大多会导致疹色紫黑而难以救治。有一类原发病是小疥疮，其顶部焦黑看起来像麻疹焦黑，但实际上并非麻疹焦黑。临症时必须详细审察。
朱氏说：疹色紫暗，颗粒顶部焦黑，都是热邪极盛的表现。应当在清热、解毒、凉血等方法中寻找治疗方案。小疥疮看起来像焦黑，尤其需要注意区分。
全书除热清肺汤：是清泻肺金、清泻心火的主方。
药物组成：麦冬、黄芩、石膏、元参、生地黄、贝母、赤茯苓。壮热者，加地骨皮、黄连。气粗者，加炒葶苈子、栝蒌霜。便秘者，加当归、火麻仁、枳壳。
承气汤：治疗少阳胆经、阳明大肠的病症。
药物组成：生大黄（四两）、浓朴（用姜汁拌炒六钱）、枳实（用面粉拌炒三枚）。水煎服。加入芒硝三合，名为大承气汤。
麻疹如云片状，颜色红赤，或者散发腥臭并出脓血。这既因为表火，也因为里热。治疗要分清内外，以免疏漏失误。
麻疹发出如同云头大片，形态微微隆起。这种症状有两种情况：一种证候表现为大片红赤肿胀，且微微高出皮肤；另一种证候是在红肿大片之上，又出现小红点。这都是因为表火炽盛所致。应当分清内外，使用大寒凉的药剂，或者分利小便。使用白虎解毒汤（见第二十六条）加入葛根、元参来治疗。如果麻疹发出如同锦纹斑烂，或者出脓血，腥臭不干，心胸烦闷，呕吐清水，身体发热，使用白虎解毒汤（见第二十六条）加入贯仲，以消散结积的各种毒邪，并清除湿热。加入防风、荆芥穗，以祛风并消除疮毒。（有人加入苍术治疗，虽然认为很恰当，但似乎应当谨慎。）千万不要拖延，恐怕导致无法救治。如果麻疹稠密，身体疼痛烦躁，使用凉血饮子（见第四十五条）去掉赤芍，加入紫草、连翘、牛蒡子来治疗。如果是瘾疹，遍身形状像云头片，斑点时有时无，则应当使用消风散来治疗。
朱氏说：云头大片，加上腥臭出脓血，外证已经极其险恶。认定是表火炽盛，使用散结毒、除湿热等方法治疗，自然可以转危为安。如果是瘾疹，虽然形状像云头片，但斑点若有若无，区别就在这里。
消风散
药物组成：当归、生地黄、防风、蝉蜕、知母、苦参、荆芥、胡麻仁、牛蒡子、石膏（各一钱）、木通（五分）。水煎，饭后服用。另一方中有苍术、甘草。
The tops of the measles papules are scorched and black, which is indeed alarming. This indicates extreme heat; one must urgently clear the Lung and Stomach. If treatment is not timely, the rash will turn purple-black, leading to death.
When measles have erupted through the exterior but the tops of the papules are scorched, regardless of whether the rash color is red or pale, it signifies a condition of extreme heat. One should urgently clear the Lung and cool the Stomach, and promote diuresis to separate turbid fluids. Furthermore, use Baihu Jiedu Tang (White Tiger Decoction for Detoxification) (see Article 26) with a heavy dose of Shigao (Gypsum Fibrosum), adding Mutong (Akebiae Caulis) and Zexie (Alismatis Rhizoma). Alternatively, add Cheqianzi (Plantaginis Semen) for treatment. If there is dryness and no sweat, add Mahuang (Ephedrae Herba) stir-fried with honey wine to induce sweating. If the stool is dry and hard, in a formula for clearing heat and resolving the exterior, assist with blood-invigorating herbs to moisten dryness; treat with Quan Chu Re Qing Fei Tang (Complete Book Decoction for Clearing Heat and Purifying the Lung) added with Danggui (Angelicae Sinensis Radix), Huomaren (Cannabis Fructus), and Zhike (Aurantii Fructus Immaturus). If there is constipation, only then use Chengqi Tang (Chengqi Decoction) or Hejian Liangge San (Liangge Powder from Liu Wansu) (see Article 26) without Gancao (Glycyrrhizae Radix et Rhizoma) to purge downward. If treatment is delayed, it often leads to purple-black discoloration that is difficult to save. There are cases where the original disease is small sores, and the scorched tops resemble scorched measles, but they are actually not scorched measles. In clinical practice, one must examine carefully.
Zhu said: Purple-dark color and scorched papule tops are both signs of extreme heat. One should seek solutions among methods such as clearing heat, detoxifying, and cooling blood. Small sores resembling scorched spots require particular attention.
Quan Chu Re Qing Fei Tang (Complete Book Decoction for Clearing Heat and Purifying the Lung): The main formula for clearing Lung Metal and draining Heart Fire.
Ingredients: Maidong (Ophiopogonis Tuber), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Yuanshen (Scrophulariae Radix), Sheng Dihuang (Rehmanniae Radix Fresh), Beimu (Fritillariae Bulbus), Chi Fuling (Poria with Red Mycelium). For high fever, add Digupi (Lycopersici Cortex) and Huanglian (Coptidis Rhizoma). For rough breathing, add Chao Tinglizi (Semen Lepidii et Descurainiae Stir-fried) and Gualou Shuang (Trichosanthis Fructus Powder). For constipation, add Danggui (Angelicae Sinensis Radix), Huomaren (Cannabis Fructus), and Zhike (Aurantii Fructus Immaturus).
Chengqi Tang (Chengqi Decoction): Treats syndromes of the Shaoyang Gallbladder Meridian and Yangming Large Intestine.
Ingredients: Sheng Dahuang (Rhei Radix et Rhizoma Fresh) (4 liang), Nongpo (Magnoliae Officinalis Cortex stir-fried with ginger juice, 6 qian), Zhishi (Aurantii Fructus Immaturus stir-fried with flour, 3 pieces). Decoct in water and take orally. Add Mangxiao (Natrii Sulfas) 3 he, named Da Chengqi Tang (Major Chengqi Decoction).
Measles appearing like cloud patches, red and crimson, or discharging pus and blood with a foul odor. This is due to both exterior fire and interior heat. Treatment must distinguish between interior and exterior to avoid errors.
Measles erupting like large cloud-head patches, slightly raised. This syndrome has two presentations: one presents as large patches of red, swollen, and slightly elevated skin; the other presents with small red spots appearing on top of the large red and swollen patches. Both are caused by intense exterior fire. One should distinguish between interior and exterior, using major cold-cooling agents or promoting diuresis. Use Baihu Jiedu Tang (White Tiger Decoction for Detoxification) (see Article 26) added with Gegen (Puerariae Lobatae Radix) and Yuanshen (Scrophulariae Radix) for treatment. If the measles appear like brocade patterns or ulcers, or discharge pus and blood with a foul odor that does not dry up, accompanied by chest distress, vomiting clear fluid, and body heat, use Baihu Jiedu Tang (White Tiger Decoction for Detoxification) (see Article 26) added with Guanzhong (Aspidistrae Rhizoma) to dissipate accumulated toxins and remove damp-heat. Add Fangfeng (Saposhnikoviae Radix) and Jingjie Sui (Schizonepetae Spica) to dispel wind and eliminate carbuncle toxins. (Some add Cangzhu (Atractylodis Rhizoma); although considered appropriate, caution is advised.) Do not delay, lest it become incurable. If the measles are dense, with body pain and irritability, use Liangxue Yinzi (Cooling Blood Infusion) (see Article 45) removing Chishao (Paeoniae Radix Rubra), adding Zicao (Arnebiae Radix et Rhizoma), Lianqiao (Forsythiae Fructus), and Niubangzi (Arctii Fructus) for treatment. If it is urticaria, with the whole body resembling cloud-head patches and spots appearing and disappearing intermittently, then use Xiaofeng San (Eliminate Wind Powder) for treatment.
Zhu said: Large cloud-head patches, combined with foul-smelling pus and blood discharge, indicate extremely dangerous external symptoms. Identifying intense exterior fire, treating with methods to dissipate accumulated toxins and remove damp-heat can naturally turn danger into safety. If it is urticaria, although it resembles cloud-head patches, the spots are faint and intermittent; this is the distinction.
Xiaofeng San (Eliminate Wind Powder)
Ingredients: Danggui (Angelicae Sinensis Radix), Sheng Dihuang (Rehmanniae Radix Fresh), Fangfeng (Saposhnikoviae Radix), Chantui (Cicadae Periostracum), Zhimu (Anemarrhenae Rhizoma), Kushen (Sophorae Flavescentis Radix), Jingjie (Schizonepetae Spica), Humaoren (Cannabis Fructus), Niubangzi (Arctii Fructus), Shigao (Gypsum Fibrosum) (each 1 qian), Mutong (Akebiae Caulis) (0.5 qian). Decoct in water and take well after meals. Another prescription includes Cangzhu (Atractylodis Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma).