麻本火候先动阳。阳部多时症候良。阳部若是稀少者。恐有后患须当防。
先动阳分后归阴。阴部阳少症亦轻。胸腹四肢向内者。若逢稀少喜盈盈。
麻症虽肺胃主之。而多属于火。发则先动阳气。而后归于阴经。面本为阳。所以人身之中。麻
疹阳部。宜多而不宜少。阴部宜少。多亦无妨。何为阳部。头为诸阳之首。面乃阳中之阳。背与四
肢。向外者、皆属阳。但得此数处、麻多而透表。则无后患。何为阴部。胸为阴。腹乃阴中之阴。
腰与四肢。向内者、皆为阴。但得阴部少、而阳部多。或阳部透表。而阴部不能尽透。均为顺候。
若阳部少。而阴部多者。须防后患。如解毒汤(见二十六条)除去桔梗。清阳汤(见第九条)除
去升麻、桔梗、甘草、生姜等剂。俱可随症加减而用。若阴阳两部俱少者。此乃麻毒轻也。不在
此例。
红润尖耸如珠状。此等麻疹最为上。若红不起二便涩。急用清热透肌汤。
出而不红发热甚。烦躁头疼或身疼。葛根疏邪解表方。须宜早用莫迟延。
麻疹色贵红润。形贵尖耸。若色虽红润。而麻不起发者。或兼二便艰涩。宜用清热透肌汤(见
二十五条)去甘草治之。如麻色淡而不起。二便如常者。此属本虚。当兼培养气血。以清热透肌
汤(见二十五条)去石膏、甘草。加生地黄、当归治之。若已出而标不红。已现而发热转甚者。或头
痛、身痛、烦躁者。以葛根疏邪汤加元参、麦冬主之。或更加连翘、地骨皮亦可。凡欲解散表邪。但
表实邪甚者。此方最宜。
葛根疏邪汤
葛根 防风 荆芥 苏叶 牛蒡子 连翘 地骨皮 前胡 赤茯苓 枳壳 木通 灯心引。
麻疹的发病,其根本在于火邪先触动阳气。当阳部(头面、背部及四肢外侧)出现的疹点多时,病情通常良好;若阳部疹点稀少,则需警惕并防范后续的隐患。
麻疹的病机是先触动阳分,随后归于阴分。若阴部疹点少而阳部多,症状也较轻。胸腹部及四肢内侧属于阴部,若此处疹点稀少,反而令人欣喜(视为顺证)。
虽然麻疹主要与肺、胃二脏有关,但多归属于火邪范畴。发病时先触动阳气,然后归于阴经。面部属阳,是阳中之阳,因此人体中麻疹在阳部的表现,宜多不宜少;阴部宜少,即便稍多也无妨。什么是阳部?头部为诸阳之首,面部更是阳中之阳;背部和四肢向外的一面,都属于阳。只要这几处疹点多且透发于体表,就不会有后患。什么是阴部?胸部属阴,腹部是阴中之阴;腰部和四肢向内的一面,都属阴。只要阴部疹点少而阳部多,或者阳部透发于体表而阴部未能完全透发,均属于顺证。若阳部疹点少而阴部多,则必须防范后患。此时可使用解毒汤(见第二十六条),去掉桔梗;或使用清阳汤(见第九条),去掉升麻、桔梗、甘草、生姜等药物,均可根据具体症状加减使用。如果阴阳两部疹点都很少,这属于麻毒轻微的情况,不在此类讨论范围内。
疹色红润、尖耸如珠状,这类麻疹最为上乘。若疹色红但不能起发,且大小便涩滞,应紧急使用清热透肌汤。
疹出后颜色不红且发热严重,伴有烦躁、头痛或身体疼痛,应使用葛根疏邪解表方,务必尽早使用,不可迟延。
麻疹的颜色贵在红润,形态贵在尖耸。若颜色虽红润,但疹子不起发,或者兼有大小便艰涩,宜用清热透肌汤(见第二十五条)去掉甘草来治疗。如果疹色淡白且不起发,但大小便正常,这属于本虚,应当兼顾补养气血,使用清热透肌汤(见第二十五条)去掉石膏、甘草,加入生地黄、当归来治疗。若疹已发出但色泽不红,显现后发热反而加重,或者出现头痛、身痛、烦躁等症状,以葛根疏邪汤加玄参、麦冬为主治方。也可以再加连翘、地骨皮。凡是想要解散表邪,特别是表实邪气严重的情况,此方最为适宜。
The origin of measles lies in fire pathogen first stirring the Yang Qi. When the Yang areas exhibit abundant eruptions, the prognosis is generally good; however, if eruptions in the Yang areas are sparse, one must be vigilant and prevent potential subsequent complications.
The pathogenesis of measles involves first stirring the Yang aspect, then returning to the Yin aspect. If the Yin areas have few eruptions while the Yang areas have many, the symptoms are relatively mild. The chest and abdomen, as well as the inner sides of the four limbs, belong to the Yin areas; a scarcity of eruptions here is actually a cause for relief (considered a favorable condition).
Although measles is primarily associated with the Lung and Stomach organs, it mostly falls under the category of Fire pathogens. Upon onset, it first stirs the Yang Qi and then returns to the Yin meridians. The face belongs to Yang and is "Yang within Yang." Therefore, regarding measles eruptions on the body, abundance in the Yang areas is preferred over scarcity; scarcity in the Yin areas is preferred, though slight abundance there is also acceptable. What constitutes the Yang areas? The head is the summit of all Yang meridians, and the face is Yang within Yang. The back and the outer aspects of the four limbs all belong to Yang. As long as these areas show abundant eruptions that penetrate the exterior, no subsequent complications will arise. What constitutes the Yin areas? The chest belongs to Yin, and the abdomen is "Yin within Yin." The waist and the inner aspects of the four limbs all belong to Yin. As long as the Yin areas have few eruptions and the Yang areas have many, or if the Yang areas penetrate the exterior while the Yin areas do not fully penetrate, both are considered favorable conditions. However, if the Yang areas have few eruptions and the Yin areas have many, one must guard against subsequent complications. In such cases, Jiedu Tang (Detoxification Decoction) (see Article 26), with Jiegeng removed, may be used; or Qingyang Tang (Clearing Yang Decoction) (see Article 9), with Shengma, Jiegeng, Gancao, and Shengjiang removed, etc., can be applied with modifications according to symptoms. If eruptions are scarce in both Yin and Yang areas, this indicates mild Measles toxin and does not fall into this category.
Eruptions that are ruddy in color and pointed like pearls represent the best type of measles. If the eruptions are red but fail to erupt fully, accompanied by difficult urination and defecation, Qingre Touji Tang (Heat-Clearing and Skin-Penetrating Decoction) should be administered urgently.
If eruptions appear without becoming red, accompanied by severe fever, irritability, headache, or body pain, Gegen Shuxie Jiabiao Fang (Pueraria Decoction to Disperse Pathogens and Release the Exterior) must be used early without delay.
The color of measles eruptions should be ruddy, and their shape should be pointed. If the color is ruddy but the eruptions fail to rise, or if accompanied by difficult urination and defecation, Qingre Touji Tang (Heat-Clearing and Skin-Penetrating Decoction) (see Article 25), with Gancao removed, should be used for treatment. If the eruption color is pale and fails to rise, but urination and defecation are normal, this belongs to Root Deficiency. One should simultaneously nourish Qi and Blood, using Qingre Touji Tang (Heat-Clearing and Skin-Penetrating Decoction) (see Article 25), with Shigao and Gancao removed, and adding Shengdihuang and Danggui. If eruptions have appeared but lack redness, and fever intensifies after manifestation, or if headache, body pain, and irritability occur, Gegen Shuxie Tang (Pueraria Decoction to Disperse Pathogens) added with Yuanshen and Maidong is the primary prescription. Lianqiao and Digupi may also be added. Whenever the goal is to resolve exterior pathogens, especially when exterior excess pathogens are severe, this formula is most suitable.
Gegen Shuxie Tang (Pueraria Decoction to Disperse Pathogens)
Ingredients: Gegen (Radix Puerariae Lobatae), Fangfeng (Radix Saposhnikoviae), Jingjie (Fructus Schizonepetae), Ziyè (Folium Perillae), Niubangzi (Fructus Arctii), Lianqiao (Fructus Forsythiae), Digupi (Cortex Lycii), Qianhu (Radix Peucedani), Chifuling (Poria Cocos with Red Mycelium), Zhike (Fructus Aurantii Immaturus), Mutong (Caulis Akebiae), with Dengxincao (Medulla Junci) as a guide.