风寒荤腥失禁忌。现点即收不透肌。毒归于内肚角肿。见毒且将毒来医。
麻有至六七日。稍受风寒。未忌荤腥。致四肢面部。略有麻疹影点。点现而即收不见。不能透
发于肌表。以致毒归于里。忽然肚角红肿。似毒非毒。初用玉枢丹与服。令泻数次。继用活命饮服
之。后以人参、黄 、白术、蝉蜕、木通、当归之类。托出大毒。起顶出脓。用外科敷药与膏药治之
自愈。此见毒医毒之法。不可拘泥麻喜清凉。而竟不敢用补也。
玉枢丹（又名太乙紫金锭） 解诸毒。治诸疮。通治百病。有起死回生之功。
山茨菰（洗去皮毛、净） 五倍子（打破、洗净焙干、各二两） 上麝香（拣净皮毛） 明朱砂
明雄黄（各三钱） 红芽大戟（绵大戟、红柴胡、切不可用、去芦根洗净、一两五钱） 千金子
（去壳油、取净者一两） 为细末。秤过等分。配合以糯米粉搅糊和丸。或作锭子听用。
活命饮（又名活命丹） 治麻出即收。忽尔作毒。毒将出及毒出后。并宜。
当归 独活 杜仲 秦艽 细辛 白茯苓 桑寄生 上肉桂 熟地黄 北防风 川芎 黄 甘草 加人参 水煎
服。
经云。痘禀于阴。而成于阳。麻禀于阳。而成于阴。此阴阳互根之妙也。麻乃先天真阳中之胎
毒。然必得阴与之交感。而后能生其化。故曰成于阴也。方其初热三日。必周身 微似有汗。而
苗乃见。汗者阴之液。发热而 者。阴阳交感。施化之验也。苟非有 之汗。营卫干涩。腠理
闭固。其苗何由而得出耶。若已齐苗。务令颗粒红活鲜明。是乃营血附随其气。毓成佳硕。而精
华发见于外也。其后以渐回塌。塌后之暴悍余气。亦必由交感而化。阴得之而为 迹。 迹者。阴
血之所为也。不欲其速收。恐其余毒复返入内。必有后患。是功成于此。岂非成于阴乎。所谓麻
禀阳而成于阴如此。然必内外无邪。方能成功。邪则伤正。有害于麻。法当分经辨证。根据法定方。
使邪去而正无害。则营卫和顺。阴阳交会。无所往而无不得之矣。凡痘症重在养浆。麻症只要齐
苗。苗齐功居八九。其后不过调理而已。形色喜鲜明而嫌暗滞。不妨其多。总要出得透。透则内
无留邪。其症常兼咳嗽及咽喉痛。咽痛治法。以甘草、桔梗为主。相症加减。若红肿恶热口渴尿
赤。宜加黄芩、生地、牛蒡子。外用蕲艾、蛇床子研末。新烟铜盛燃。吸烟。取出痰涎。咽痛渐愈。若
不恶热。舌胎白滑。宜加半夏、南星。外用蕲艾、半夏、南星研末。吸烟取涎。若声音重浊。更加阿
胶、玉竹、鸡子白之类。若不红肿。舌胎滑而冷。不渴。恶寒喜热。宜用半夏、南星、附子、肉桂之
类。外用油蘸大纸捻照其后颈。或用生附子研末吹之自愈。凡此不过但引其端。而未详其法。非
略也。用法不外六经。验证重在本气。毋庸复赘。
附案
曾医老庚者。年二十有七。夏月出疹。头身微热。苗色淡红。咽喉痛甚。时医误用柴、葛、牛
子、甘、桔等药。转加作泄。大泄数次。疹顿沉没。咽喉转闭。口不能言。人事恍忽。晕眩欲绝。时天
有在坐。予谓天有曰。此证全是一团阴寒在里。若用疹家通套药。必不可生。天有曰。何以言之。
予曰。若内实有火。苗当紫赤。何得淡红。且咽喉虽痛。而不赤肿。又无烦渴恶热等证。明明肾脏
虚寒。阴火上攻也。且阳和布令。百体顺昌。麻疹属阳。必纯阳始得出透。见点之时。如萌芽初吐。
遇阴惨肃杀之气。摧残所生。靡有孑遗。今值此阴邪横发。埋没真阳。而疹不沉没者。几希矣。于
是陡进附子、干姜、半夏、甘草、白术、茯苓、肉桂、黄 。温补兼行。以驱阴回阳。俾驳劣悉返冲
和。乃得功收再造。危乎微乎。
从侄经千。年三十出疹。初热时。心中烦躁。腹内疼热。甚为剥床。彼因问三豆汤可服乎。余
曰。可急煎服。于是心腹烦热乃解。苗不出现。人事晕眩。咳逆喘促。鼻靥扇动。详察其证。知其为
热毒壅塞于肺。肺壅则津液不行。肌窍不开。苗故不见。因用黄芩以清里热。阿胶、麦冬以润肺
燥。桔梗开提肺气。紫、葛、蒡、薄清解外热。甘草缓中。杏仁定喘。服二剂。苗虽出透。而色皆紫
黑。人事更觉沉重。饮食一点不能下。余悄谓其家曰。麻书有云。淡红者生。紫黑者死。其家骇怖
无似。余复安之曰。岂真死症耶。但其症极险耳。此为内热甚而血结也。其证舌干口臭。恶热喜
冷。声音响亮。仍用黄芩、麦冬、阿胶。以清内热。而润肺燥。加以丹皮泻血中之热。合红花之活血
者。以散血结。蝉蜕、牛蒡解其外毒。黄连、甘草解其内毒。连进三剂。人事渐安。饮食渐可。紫黑
渐退。而麻疹起矣。然有阴邪内盛者。苗赤紫黑。法宜驱阴回阳。其证舌润不渴。声低息短。恶寒
喜热。与此不同。
朱曰 证之阴阳。务宜细辨。阳证喜寒凉。若阴邪内盛。寒凉即死。
前月其弟字志千者。年二十一岁。疹出甚艰。信任内戚所荐之医。不知解托。概用寒凉。遏郁
苗气。而不能出透。至九日而死。经千谓其弟不自谨慎。起居失节。饮食失调。以致此耳。伤哉。其
弟为庸医所杀。不归罪于医。而反躬自责。足征心地 良。皇天岂无默庇。所以自出麻疹。其证
虽险。而终无害也。窃谓赏善自应罚恶。杀命之医。宁不速诛之耶。抑何日得蒙上天并显诛其荐
医之人。方快吾心焉耳。谚云。贤不荐医。医为贤人所不荐。独愚人可得而荐乎。于是余又痛恨夫
荐医杀人者。
曾医天瑞之子。大热大渴。舌干口苦。咽喉肿痹。气喘腹痛。下痢红白。小便赤热。苗色紫而
暗滞。此为火邪充斥。三焦俱为热壅。伤津而渴。触肺而喘。上攻而为喉痹。下迫而便红白。精津
血脉。受其煎熬。致苗色不红活。口苦者。少阳之里热也。方用柴胡、黄芩。消解少阳。大黄通泻三
焦实热。栀仁引三焦之火。屈曲下行。生地、紫草以解血分之热。杏仁定喘。桔梗开提。甘草和中。
服一剂。诸证略杀。但腹痛未减。小便如故。是夜用神砂六一散二钱。桔梗煎汤化服。使桔梗通天
气于地道。则气不滞而壅自疏。六一散开支河以泻小肠之热。一服而小便通。腹痛即愈。次日苗
转红活。诸证俱已。于是方中减去柴胡、黄芩、大黄、栀仁。更加当归、茯苓。数剂而全愈矣。
曾医国先之孙。苗色淡红。烦躁口渴。唇烂面肿。清涎成流。饮食不思。小便短。大便秘。予细
察之。此证内真寒而外假热。其人恶寒。身倦欲寐。乃少阴证也。内有真寒。舌胎滑而冷。口虽渴
而喜热饮。且不能多饮。小便短大便秘者。以清涎上涌。津液逆而不降也。诸证皆非真热。乃假象
也。方用附子、白术、茯苓、半夏、吴萸。服一剂。苗色略转。人事饮食。亦渐就康。再投一剂。口唇
全愈。清涎亦不吐矣。大便初硬后溏。旋即又行转红白痢。吾知其里邪从下行矣。亦胃气有权。秽
腐当去之征也。但小便仍短。方中重用肉桂末。药内化服。三四剂。诸证皆愈而成功矣。
论 （胥山王琦先生医林指月内 论一篇附证一则）
。犹错也。皮肤甲错之谓也。俗名曰 。实系疹也。红点隐隐。调之隐疹。疹之根源。乃毫毛
之内。皮腠之间。因于寒。致血凝涩。其凝涩之血。散发于皮肤之外。则发而为疹。盖人身通体毫
毛之气。肺所主也。毫毛之内。腠理之外。则秉胞中之血。热肉充肤。淡渗皮毛。肝所主也。皮肤
寒、而血凝涩。始得凝涩。继欲流通。则发热咳嗽。散而为疹。疹之发也。有稀少。有稠密。极稀少
者。不过数点。以及数十点。极稠密者。则周身头面。无有空隙。医者不知其故。见有数点。即行攻
发。若皮肤肌腠之间。果有凝涩。则发热咳嗽。自当涌出。其不能即出者。非肌表不和。即气虚不
振。治之之法。当以红花、归、芎、荆、柴、羌、丹之剂。和其肌表。或以桂枝、 、术、归、芍、苓、甘之
剂。助其气虚。若概以苏、麻、前、杏、芩、连、石膏之剂投之。其气虚不出者。此为虚其原本。本自
稀少者。此为无故受贼。非惟疹不能出。其经脉表里受亏。致身大热。而喘急生。愈热愈表。愈喘
愈发。轻者重。重者死矣。盖痘之发也。见有一二点。其势必出。疹之发也。见有一二点。可出可
不出。若肌表果有凝涩之疹。则身热咳嗽。其势自出。若无疹则止此数点。不能再增。善治者明
乎此理。不行攻发。但调其经络。和其荣卫。虚者补之。寒者温之。则热退身安而愈。无奈蒙昧不
明。当疹毒盛行之时。见有数点。即行攻发。转攻转剧。愈发愈危。必致真藏虚败而死。真可痛
耳。夫痘毒起于肾。不从经脉而出。为肾经痘。虽有良医不能挽回。若疹则其根源在于肌腠皮肤。
肤腠之血。根于胞中血海。肤腠寒而胞血稽迟。则有疹毒之证。得其源而活法以治。或听其自然
而不加妄治。百无一死也。
风寒饮食禁忌失当。麻疹刚现点即内收，未能透发于肌肤。毒邪内陷导致腹部两侧红肿。见到毒邪显现，就应当用医毒的方法来治疗。
麻疹病程到了六七天，稍微受到风寒侵袭，又未忌口荤腥食物，致使四肢和面部仅有少许麻疹的影子。疹点刚出现就立刻消退不见，不能透发于肌表，导致毒邪归于体内。忽然腹部两侧红肿，似毒非毒。初起先用玉枢丹服用，令其腹泻数次；继而又用活命饮服用；后来用人参、黄芪、白术、蝉蜕、木通、当归等药物，托举出大毒，使痘顶高起并化脓，再用外科敷药和膏药治疗，自然痊愈。这是“见毒医毒”的方法，不可拘泥于麻疹喜清凉而竟不敢使用补益药物。
玉枢丹（又名太乙紫金锭）：能解各种毒，治各种疮疡，通治百病，有起死回生的功效。
山慈菇（洗去皮毛，净）五钱，五倍子（打破，洗净焙干，各二两），上麝香（拣净皮毛），明朱砂，明雄黄（各三钱），红芽大戟（绵大戟、红柴胡切不可用，去芦根洗净，一两五钱），千金子（去壳油，取净者一两）。研为细末，称量过等分，配合糯米粉搅糊和丸，或制成锭子备用。
活命饮（又名活命丹）：治疗麻疹发出后立即收回，忽然发作成毒。毒将出及毒出后，都适宜使用。
当归、独活、杜仲、秦艽、细辛、白茯苓、桑寄生、上肉桂、熟地黄、北防风、川芎、黄芪、甘草，加人参，水煎服。
经书说：天花禀受于阴，而成形于阳；麻疹禀受于阳，而成形于阴。这是阴阳互根的奥妙所在。麻疹乃是先天真阳中的胎毒，但必须得到阴气的交感，然后才能产生变化。所以说“成于阴”。在其初期发热三天时，必定周身微微似有汗出，而疹苗才显现。汗是阴的津液，发热而有汗，是阴阳交感、施化作用的验证。如果没有这样的汗，营卫干涩，腠理闭固，疹苗凭什么而出呢？如果疹苗已经齐整，务必让颗粒红润鲜活鲜明，这是营血跟随其气，孕育成为佳美硕大的表现，精华发见于外。其后逐渐回塌，回塌后的暴悍余气，也必然通过交感而化解。阴气得到它而成为痕迹，痕迹是阴血的作用。不希望它迅速收敛，恐怕余毒复返入内，必有后患。这功成于此，难道不是“成于阴”吗？所谓麻疹禀受于阳而成形于阴，正是如此。然而必须内外没有邪气，方能成功。邪气则伤害正气，对麻疹有害，治疗方法应当分经辨证，根据法定方剂，使邪气去除而正气不受伤害，那么营卫和顺，阴阳交会，无处不得其宜了。凡是天花病症重在养浆，麻疹病症只要疹苗齐整即可。疹苗齐整，功效已居八九，其后不过是调理而已。色泽喜欢鲜明而嫌弃暗滞，数量不妨多些，总要出得透彻。透彻则内部没有留邪，其症状常兼咳嗽及咽喉痛。咽痛的治疗方法，以甘草、桔梗为主，随证加减。若红肿恶热口渴尿赤，宜加黄芩、生地、牛蒡子。外用蕲艾、蛇床子研末，新烟铜盛燃吸烟，取出痰涎，咽痛渐愈。若不恶热，舌苔白滑，宜加半夏、南星。外用蕲艾、半夏、南星研末，吸烟取涎。若声音重浊，更加阿胶、玉竹、鸡蛋清之类。若不红肿，舌苔滑而冷，不渴，恶寒喜热，宜用半夏、南星、附子、肉桂之类。外用油蘸大纸捻照其后颈，或用生附子研末吹之自愈。凡此不过只是引出端倪，而未详述具体方法，并非省略。用法不外乎六经，验证重在根本元气，无需再赘述。
附案：
曾医治老庚，年二十七岁。夏季出疹，头身微热，疹色淡红，咽喉痛甚。当时医生误用柴胡、葛根、牛蒡子、甘草、桔梗等药，反而加重导致泄泻，大泄数次，疹顿然沉没，咽喉转闭，口不能言，神志恍惚，晕眩欲绝。当时天在坐在一旁，我对天在说：“这个证候全是一团阴寒在里，如果用疹家通用的药物，必不可救。”天在问：“为什么这么说？”我说：“如果内实有火，疹苗应当紫赤，怎么能是淡红？而且咽喉虽然痛，却不赤肿，又没有烦渴恶热等症状，明明是肾脏虚寒，阴火上攻。况且阳气布令，百体顺昌。麻疹属阳，必须纯阳始得出透。见点之时，如萌芽初吐，遇到阴惨肃杀之气，摧残所生，毫无遗留。如今值此阴邪横发，埋没真阳，而疹不沉没的，极少见了。”于是陡进附子、干姜、半夏、甘草、白术、茯苓、肉桂、黄芪。温补兼行，以驱阴回阳，使驳劣之气悉返冲和，乃得功收再造。危乎微乎！
从侄经千，年三十岁出疹。初热时，心中烦躁，腹内疼热，甚为痛苦。他问我三豆汤可服吗？我说：“可以急煎服。”于是心腹烦热乃解。但疹苗不出现，人事晕眩，咳逆喘促，鼻翼扇动。详察其证，知其为热毒壅塞于肺，肺壅则津液不行，肌窍不开，故疹苗不见。因用黄芩以清里热，阿胶、麦冬以润肺燥，桔梗开提肺气，紫苏、葛根、牛蒡子、薄荷清解外热，甘草缓中，杏仁定喘。服二剂，疹苗虽出透，而色皆紫黑，人事更觉沉重，饮食一点不能下。我悄悄对其家人说：“麻书有云：淡红者生，紫黑者死。”其家人骇怖无比。我再安慰他们说：“岂真是死症耶？但其症极险耳。此为内热甚而血结也。其证舌干口臭，恶热喜冷，声音响亮。”仍用黄芩、麦冬、阿胶，以清内热，而润肺燥。加以丹皮泻血中之热，合红花之活血者，以散血结。蝉蜕、牛蒡解其外毒，黄连、甘草解其内毒。连进三剂，人事渐安，饮食渐可，紫黑渐退，而麻疹起矣。然而有阴邪内盛者，苗赤紫黑，法宜驱阴回阳。其证舌润不渴，声低息短，恶寒喜热，与此不同。
朱曰：辨证的阴阳，务宜细辨。阳证喜寒凉，若阴邪内盛，寒凉即死。
前月其弟字志千者，年二十一岁。疹出甚艰，信任内戚所荐之医，不知解托，概用寒凉，遏郁苗气，而不能出透，至九日而死。经千谓其弟不自谨慎，起居失节，饮食失调，以致此耳。伤哉！其弟为庸医所杀，不归罪于医，而反躬自责，足征心地善良。皇天岂无默庇？所以自出麻疹，其证虽险，而终无害也。窃谓赏善自应罚恶，杀命之医，宁不速诛之耶？抑何日得蒙上天并显诛其荐医之人，方快吾心焉耳？谚云：“贤不荐医，医为贤人所不荐。”独愚人可得而荐乎？于是余又痛恨夫荐医杀人者。
曾医治天瑞之子，大热大渴，舌干口苦，咽喉肿痹，气喘腹痛，下痢红白，小便赤热，苗色紫而暗滞。此为火邪充斥，三焦俱为热壅，伤津而渴，触肺而喘，上攻而为喉痹，下迫而便红白。精津血脉，受其煎熬，致苗色不红活。口苦者，少阳之里热也。方用柴胡、黄芩，消解少阳；大黄通泻三焦实热；栀仁引三焦之火，屈曲下行；生地、紫草以解血分之热；杏仁定喘，桔梗开提，甘草和中。服一剂，诸证略杀。但腹痛未减，小便如故。是夜用神砂六一散二钱，桔梗煎汤化服，使桔梗通天气于地道，则气不滞而壅自疏。六一散开支河以泻小肠之热，一服而小便通，腹痛即愈。次日苗转红活，诸证俱已。于是方中减去柴胡、黄芩、大黄、栀仁，更加当归、茯苓，数剂而全愈矣。
曾医治国先之孙，苗色淡红，烦躁口渴，唇烂面肿，清涎成流，饮食不思，小便短，大便秘。予细察之，此证内真寒而外假热。其人恶寒，身倦欲寐，乃少阴证也。内有真寒，舌苔滑而冷，口虽渴而喜热饮，且不能多饮。小便短大便秘者，以清涎上涌，津液逆而不降也。诸证皆非真热，乃假象也。方用附子、白术、茯苓、半夏、吴茱萸。服一剂，苗色略转，人事饮食，亦渐就康。再投一剂，口唇全愈，清涎亦不吐矣。大便初硬后溏，旋即又行转红白痢。吾知其里邪从下行矣，亦胃气有权，秽腐当去之征也。但小便仍短，方中重用肉桂末，药内化服。三四剂，诸证皆愈而成功矣。
论（胥山王琦先生《医林指月》内论一篇附证一则）：
痧犹错也。皮肤甲错之谓也。俗名曰痧。实系疹也。红点隐隐，调之隐疹。疹之根源，乃毫毛之内，皮腠之间。因于寒，致血凝涩。其凝涩之血，散发于皮肤之外，则发而为疹。盖人身通体毫毛之气，肺所主也。毫毛之内，腠理之外，则秉胞中之血，热肉充肤，淡渗皮毛，肝所主也。皮肤寒，而血凝涩，始得凝涩，继欲流通，则发热咳嗽，散而为疹。疹之发也，有稀少，有稠密。极稀少者，不过数点，以及数十点。极稠密者，则周身头面，无有空隙。医者不知其故，见有数点，即行攻发。若皮肤肌腠之间，果有凝涩，则发热咳嗽，自当涌出。其不能即出者，非肌表不和，即气虚不振。治之之法，当以红花、归、芎、荆、柴、羌、丹之剂，和其肌表。或以桂枝、芍、术、归、苓、甘之剂，助其气虚。若概以苏、麻、前、杏、芩、连、石膏之剂投之，其气虚不出者，此为虚其原本。本自稀少者，此为无故受贼。非惟疹不能出，其经脉表里受亏，致身大热，而喘急生，愈热愈表，愈喘愈发。轻者重，重者死矣。盖痘之发也，见有一二点，其势必出。疹之发也，见有一二点，可出可不出。若肌表果有凝涩之疹，则身热咳嗽，其势自出。若无疹则止此数点，不能再增。善治者明乎此理，不行攻发，但调其经络，和其荣卫，虚者补之，寒者温之，则热退身安而愈。无奈蒙昧不明，当疹毒盛行之时，见有数点，即行攻发，转攻转剧，愈发愈危，必致真脏虚败而死，真可痛耳。夫痘毒起于肾，不从经脉而出，为肾经痘，虽有良医不能挽回。若疹则其根源在于肌腠皮肤，肤腠之血，根于胞中血海。肤腠寒而胞血稽迟，则有疹毒之证。得其源而活法以治，或听其自然而不加妄治，百无一死也。
Wind-Cold and dietary taboos were neglected. The rash appeared briefly and then retracted, failing to penetrate the skin. The pathogenic toxin returned inward, causing swelling and redness in the abdominal flanks. When the toxin manifests, one must treat the toxin with medical methods.
If the measles course reaches six or seven days, and the patient is slightly exposed to Wind-Cold or fails to avoid greasy/meaty foods, only faint shadows of measles spots may appear on the limbs and face. Once the spots appear, they immediately retract and disappear, unable to erupt through the muscle layer. This causes the toxin to sink inward, suddenly resulting in redness and swelling in the abdominal flanks, resembling a toxin but not quite. Initially, use Yushu Dan (Jade Pivot Pill) orally to induce several bowel movements. Subsequently, administer Huoming Yin (Life-Sustaining Decoction). Later, use herbs such as Renshen (Ginseng Radix), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chantui (Cicadae Periostracum), Mutong (Akebiae Caulis), and Danggui (Angelicae Sinensis Radix) to support the eruption of severe toxins, raising the pustule tops and inducing suppuration. Treat externally with surgical plasters and ointments until natural recovery. This is the method of "treating the toxin when it appears." One must not rigidly adhere to the notion that measles prefers coolness and therefore dare not use tonification.
Yushu Dan (also known as Taiyi Zijin Ding / Great Unity Purple Gold Ingot): Resolves various toxins, treats various sores, and generally cures hundred diseases, possessing the power to revive the dead.
Shancigu (Swertiae Bulbus, washed to remove skin and hairs, pure) 5 qian, Wubeizi (Galae Chinensis, broken, washed, dried over fire, each 2 liang), Shang Shexiang (Moschus, selected clean), Ming Zhusha (Cinnabaris, purified), Ming Xionghuang (Realgar, each 3 qian), Hongya Daji (Euphorbiae Humifusae Radix [Red-rooted], Mian Daji and Hong Chaihu must not be used; remove rhizome roots, wash clean, 1 liang 5 qian), Qianjinzi (Semina Crotonis, shell and oil removed, pure part 1 liang). Grind into fine powder, weigh equal parts, mix with glutinous rice paste to form pills, or press into ingots for use.
Huoming Yin (also known as Huoming Dan): Treats measles that erupt and immediately retract, suddenly developing into toxic conditions. Suitable for before eruption and after eruption.
Danggui (Angelicae Sinensis Radix), Duhuo (Angelicae Pubescentis Radix), Duzhong (Eucommiae Cortex), Qinjiao (Gentianae Macrophyllae Radix), Xixin (Asari Radix et Rhizoma), Bai Fuling (Poria), Sang Jisheng (Taxilli Herba), Shang Rougui (Cinnamomi Cortex), Shu Dihuang (Rehmanniae Radix Praeparata), Bei Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), add Renshen (Ginseng Radix). Decoct in water and take orally.
The Classics state: Smallpox is endowed by Yin and formed by Yang; measles are endowed by Yang and formed by Yin. This is the wonder of Yin and Yang mutually rooting each other. Measles are essentially fetal toxins within the innate True Yang, but they must interact with Yin to generate transformation. Hence, it is said "formed by Yin." During the initial three days of fever, there must be slight sweating over the whole body for the measles seeds (rash buds) to appear. Sweat is the fluid of Yin. Fever accompanied by sweating is the verification of Yin-Yang interaction and transformation. Without such sweat, if Ying and Wei are dry and rough, and the pores are closed and solid, how can the seeds emerge? If the seeds are fully uniform, they must be bright red and vivid, indicating that Ying blood follows Qi, nurturing excellent growth, with essence manifesting outwardly. Afterwards, they gradually recede. The violent residual qi after recession must also transform through interaction. Yin receives it to become traces, which are the work of Yin blood. We do not desire rapid contraction, fearing the residual toxin will return inward, causing future trouble. Thus, success is achieved here; is this not "formed by Yin"? This is what is meant by measles being endowed by Yang and formed by Yin. However, internal and external pathogenic factors must be absent for success. Pathogens harm Zheng Qi and are detrimental to measles. The treatment method should differentiate meridians and syndromes, following established formulas to eliminate pathogens without harming Zheng Qi, thereby harmonizing Ying and Wei, allowing Yin and Yang to intersect, achieving benefit everywhere. Regarding smallpox, emphasis is on nourishing the pus; regarding measles, the goal is merely uniform seed appearance. Once seeds are uniform, nine-tenths of the work is done; afterwards, only regulation is needed. Colors should be bright and lively, avoiding dullness. Abundance is acceptable provided the eruption is thorough. Thorough eruption means no lingering pathogens internally. Symptoms often include cough and sore throat. For sore throat, use Gancao (Glycyrrhizae Radix et Rhizoma) and Jiegeng (Platycodonis Radix) as mainstays, modifying according to symptoms. If red, swollen, aversion to heat, thirst, and dark urine are present, add Huangqin (Scutellariae Radix), Shengdi (Rehmanniae Radix), and Niubangzi (Arctii Fructus). Externally, grind Qiai (Artemisia argyi) and Shechuangzi (Cnidii Fructus) into powder, burn in a new copper smoker, inhale the smoke to expectorate phlegm-saliva; the sore throat will gradually heal. If there is no aversion to heat, but white slippery tongue coating, add Banxia (Pinelliae Rhizoma) and Nanxing (Arisaematis Rhizoma). Externally, grind Qiai, Banxia, and Nanxing into powder, inhale smoke to extract saliva. If voice is hoarse, add Ejiao (Colla Corii Asini), Yuzhu (Polygonati Odorati Rhizoma), and egg white. If not red/swollen, with slippery cold tongue coating, no thirst, aversion to cold, and preference for warmth, use Banxia, Nanxing, Fuzi (Aconiti Lateralis Radix Praeparata), and Rougui (Cinnamomi Cortex). Externally, dip large paper twists in oil and cauterize the back of the neck, or blow powdered raw Fuzi into the nose for self-healing. These are merely introductory points, not detailed methods, nor omissions. Usage does not exceed the Six Meridians; verification focuses on root Qi, requiring no further elaboration.
Attached Case:
I once treated Lao Geng, aged twenty-seven. In summer, he developed measles with slight head and body heat, pale red rash color, and severe sore throat. Contemporary physicians mistakenly used Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Niubangzi, Gancao, and Jiegeng, which worsened the condition into diarrhea. After several episodes of severe diarrhea, the rash sank and disappeared completely, the throat closed up, speech became impossible, consciousness was confused, and dizziness threatened collapse. Tian Zai was present. I told Tian Zai, "This syndrome is entirely a mass of Yin-Cold inside. Using standard measles remedies will certainly result in death." Tian Zai asked why. I replied, "If there were internal Fire, the rash would be purple-red, not pale red. Although the throat hurts, it is not red or swollen, and there are no signs of irritability, thirst, or aversion to heat. Clearly, this is Kidney deficiency-cold with Yin Fire attacking upward. Yang energy promotes harmony throughout the body. Measles belong to Yang and require pure Yang to erupt thoroughly. At the point of appearance, like a sprouting seedling, encountering Yin-cold and killing air destroys life. Now, with rampant Yin-pathogen burying True Yang, it is rare for the rash not to sink." Therefore, I abruptly administered Fuzi, Ganjiang (Zingiberis Rhizoma), Banxia, Gancao, Baizhu, Fuling, Rougui, and Huangqi. Warmth and tonification were combined to expel Yin and restore Yang, turning chaotic Qi back to harmony, thus achieving miraculous recovery. How precarious!
My nephew Jing Qian, aged thirty, developed measles. During initial fever, he felt irritable and painful heat in the abdomen. He asked if Sandou Tang (Three Bean Decoction) could be taken. I said, "Boil and take it urgently." His chest and abdominal heat resolved, but the rash did not appear. He experienced dizziness, coughing with reversed Qi, panting, and nasal flaring. Detailed examination revealed Heat-Toxin obstructing the Lung. Lung obstruction prevents fluid distribution and pore opening, hence the rash fails to appear. I used Huangqin to clear interior heat, Ejiao and Maidong (Ophiopogonis Radix) to moisten Lung dryness, Jiegeng to raise Lung Qi, Zisu (Perillae Folium), Gegen, Niubangzi, and Bohe (Menthae Haplocalycis Herba) to clear exterior heat, Gancao to moderate the middle, and Xingren (Armeniacae Semen Amarum) to calm panting. After two doses, the rash erupted thoroughly but turned purple-black. His condition worsened significantly, unable to eat. I quietly told his family, "Measles books say: Pale red indicates survival; purple-black indicates death." They were terrified. I reassured them, "Is it truly a death case? It is extremely dangerous. This is severe internal heat causing Blood stasis. Signs include dry tongue, foul breath, aversion to heat, preference for cold, and loud voice." I continued using Huangqin, Maidong, and Ejiao to clear internal heat and moisten dryness. Added Mudanpi (Moutan Cortex) to drain Heat from Blood, and Honghua (Carthami Flos) to invigorate Blood and resolve stasis. Chantui and Niubangzi resolved exterior toxins; Huanglian (Coptidis Rhizoma) and Gancao resolved interior toxins. After three consecutive doses, his consciousness stabilized, appetite improved, purple-black color faded, and measles emerged. Note: In cases of internal Yin-Excess with purple-black rash, the method is to expel Yin and restore Yang. Signs include moist tongue, no thirst, low voice, short breath, aversion to cold, and preference for warmth, which differs from this case.
Zhu stated: Differentiating Yin and Yang syndromes requires careful distinction. Yang syndromes prefer coolness; if Yin-Pathogen is internally excessive, coolness leads to death.
Last month, his younger brother, named Zhi Qian, aged twenty-one, had great difficulty erupting measles. Trusting a physician recommended by relatives, who lacked understanding of resolving and supporting, he used exclusively cooling herbs, suppressing the rash Qi and preventing eruption, leading to death on the ninth day. Jing Qian attributed this to his brother's lack of caution, irregular lifestyle, and improper diet. Alas! His brother was killed by an incompetent physician, yet instead of blaming the doctor, he blamed himself, proving his kind heart. Does Heaven not silently protect? Thus, when he later developed measles, although dangerous, he ultimately suffered no harm. I believe rewarding good and punishing evil is proper. Should not physicians who kill quickly be punished? When will Heaven visibly punish those who recommend such doctors, bringing me relief? The proverb says, "The wise do not recommend physicians; physicians are not recommended by the wise." Only fools get recommended? Thus, I deeply hate those who recommend physicians that kill.
I once treated the son of Tian Rui, presenting with high fever, extreme thirst, dry tongue, bitter taste, swollen and blocked throat, panting, abdominal pain, dysentery with red and white discharge, hot red urine, and purple-dark dull rash color. This indicated Fire-Pathogen filling the San Jiao (Triple Burner), all obstructed by Heat, damaging fluids causing thirst, touching the Lung causing panting, attacking upward causing throat blockage, pressing downward causing dysentery. Essence, fluids, and blood vessels were boiled, causing the rash to lose its red vitality. Bitter taste indicates Shaoyang interior Heat. Formula: Chaihu and Huangqin to resolve Shaoyang; Dahuang (Rhei Radix et Rhizoma) to purge San Jiao excess Heat; Zhiren (Gardeniae Semen) to guide San Jiao Fire downward; Shengdi and Zicao (Leonuri Herba) to resolve Blood-level Heat; Xingren to calm panting, Jiegeng to raise Qi, Gancao to harmonize the middle. After one dose, symptoms subsided slightly, but abdominal pain persisted and urination remained unchanged. That night, use Liuyi San (Six-to-One Powder) with Shensha (Cinnabaris) 2 qian, dissolved in Jiegeng decoction. Jiegeng connects Heaven Qi to Earth Qi, unblocking stagnation and relieving obstruction. Liuyi San opens channels to drain Small Intestine Heat. One dose allowed urination, and abdominal pain healed. Next day, the rash turned red and vibrant, all symptoms resolved. Remove Chaihu, Huangqin, Dahuang, and Zhiren from the formula; add Danggui and Fuling. Several doses led to full recovery.
I once treated the grandson of Guo Xian, presenting with pale red rash, irritability, thirst, cracked lips, swollen face, profuse clear saliva, loss of appetite, short urination, and constipation. Upon careful observation, this was True Cold internally with False Heat externally. The patient had aversion to cold, fatigue, and desire to sleep, indicating Shaoyin Syndrome. Internal True Cold manifested as slippery cold tongue coating. Although thirsty, he preferred hot drinks and could not drink much. Short urination and constipation resulted from clear saliva surging upward, reversing fluid descent. All symptoms were not True Heat but false appearances. Formula: Fuzi, Baizhu, Fuling, Banxia, and Wuyu (Evodiae Fructus). After one dose, rash color slightly changed, and general condition/diet improved. After another dose, lips healed completely, and clear saliva stopped. Stool was initially hard then loose, followed by red-white dysentery. I knew the interior pathogen was moving downward, a sign of strong Stomach Qi eliminating filth. However, urination remained short. Add heavy dosage of Rougui powder dissolved in medicine. Over three to four doses, all symptoms resolved successfully.
Discussion (From Mr. Wang Qi of Xushan's *Yilin Zhiyue*, one discussion plus one attached case):
Sha (sand/scratch) refers to rough, scaly skin. Commonly called Sha, it actually refers to rash. Faint red spots are called hidden rash. The root of rash lies within the hair follicles and between skin pores. Due to Cold, Blood becomes congealed and sluggish. This congealed Blood disperses outside the skin, manifesting as rash. The Qi of hair follicles over the body is governed by the Lung. Inside the follicles, outside the pores, Blood from the uterus/womb heats flesh, fills skin, and permeates hair/skin, governed by the Liver. Skin Cold causes Blood congestion/sluggishness. Initially congested, then attempting to flow freely causes fever and cough, dispersing as rash. Rash eruption varies from sparse to dense. Extremely sparse: just a few to dozens of spots. Extremely dense: covering entire body and face with no gaps. Physicians unaware of this cause, seeing a few spots, immediately attack and force eruption. If there is indeed congestion in skin/pores, fever and cough should naturally surge out. If it does not erupt immediately, it is either surface disharmony or Qi deficiency failing to uplift. Treatment should use agents like Honghua, Danggui, Chuanxiong, Jingjie (Schizonepetae Herba), Chaihu, Qianghuo (Notopterygii Rhizoma), and Danshen (Salviae Miltiorrhizae Radix) to harmonize the surface. Or use Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix), Baizhu, Danggui, Fuling, and Gancao to assist Qi deficiency. If broadly prescribing Suzi, Mahuang (Ephedrae Herba), Qianhu (Peucedani Radix), Xingren, Huangqin, Huanglian, and Shigao (Gypsum Fibrosum), for those with Qi deficiency unable to erupt, this empties the root. Originally sparse cases suffer unjust aggression. Not only can the rash not erupt, but meridians and interior/exterior are depleted, causing high fever, panting urgency. More heat leads to more surface exposure; more panting leads to more eruption. Mild becomes severe, severe becomes fatal. Smallpox eruption, once one or two spots appear, inevitably erupts. Rash eruption, seeing one or two spots, may or may not erupt. If there is indeed congested rash at the surface, fever and cough naturally drive eruption. If no rash, these few spots stop increasing. Good practitioners understand this, do not aggressively force eruption, but regulate meridians, harmonize Ying and Wei, tonify deficiency, warm cold. Then heat retreats, body rests, and healing occurs. Unfortunately, ignorant people, during peak rash toxin times, see a few spots and immediately attack. More attack, worse severity; more eruption, greater danger, inevitably leading to visceral deficiency/collapse and death. Truly painful! Smallpox toxin originates in the Kidney, not emerging via meridians; even good physicians cannot save Kidney-channel smallpox. Rash, however, originates in skin/pores. Blood in skin/pores roots in the Sea of Blood (Uterus/Womb). Skin/Cold causes uterine Blood stagnation, leading to rash toxin. Treating based on the source with flexible methods, or letting nature take its course without reckless intervention, results in almost no deaths.