麻出总要表透，表一透里热虽甚，清之可愈。表未透，毒陷于中，门户一关。发表不可，
养阴又不可，多致因循而死。
表透者非皮毛之表，要从脏腑透出，没得从容，才是表透。亦有火毒甚，外见繁红，没后
犹作牙疳肺痈者，或鼻衄下利者，脏腑之热未透出也。
麻痘之毒由腑脏而出，虽已到表而根蒂在里。解字从表，化字从里，表虽解而里不化，其为后患实多。
解表之药从阳分从气分其效速而易见，化毒之药从阴分从血分其效缓而难成。《金镜
录》养阴退阳四字治麻之要诀也。
麻后咯吐脓血腥臭有肺痈者，有胃脘痈者，皆肺胃遗热为患，亦牙疳口疮之类，循经
而出则为牙疳，着于脏腑则为痈也。当辨其在肺在胃而施治。予用甘桔牛蒡银花 豆枳壳
赤芍数味，在肺加山栀子贝母桑皮，在胃加生地花粉木通之类以佐之，身无大热者可治。
问牙疳肺痈之证可治而愈者，何也？毒已化而出也。毒化而脏腑不败者可治，脏腑腐败
不能治也。
丙辰岁夏令麻证大行因时论治
痘毒出于五脏，麻毒出于六腑。府属阳，冬至阳生，麻毒出焉。故其传染多在严寒之
令，古称庵麻KT 痘，因乎时也。予治麻证五十年所见率多类此，间有延及春深至夏亦无不
止，迩来夏令出麻，令岁盛暑不断，时势何其异也。时势既异，医者即当随时变通以定治
法。庸工不察执守成方，愚夫愚妇更加庵遏，火盛金伤，致成麻喘，殊可悲。为定新方数条，以救时弊，明理者当取则
焉。
第一方
升麻 蝉蜕 荆芥 防风 前胡 桔梗 牛蒡子 甘草 加芫荽少许一服。
一服麻出，去升麻加赤芍连翘，烦加炒栀子，呕加石膏，嗽加杏仁枳壳。夏月表气先开
用表药，只宜轻不宜重，荆防蝉即是表药。一服出未透者，再用升麻加葛根以透之，麻黄夏
月禁用人所共知，羌活亦不得浪用，葛根亦不得再用，面部一透即宜转手。
第二方
荆芥 防风 桔梗 甘草 牛蒡子 连翘 杏仁 炒栀子 木通
此三朝方也。面部已透，即荆防亦宜减去，平守一日，待其缓收最稳。热甚烦渴加石
膏竹叶。壮热不退加枯芩麦冬。若泻减杏仁木通加赤苓。
第三方
生地 麦冬 丹皮 栀仁 连翘 桔梗 甘草 烦渴加竹叶石膏 热甚加枯芩知母。
此四五朝方也。养阴退阳治麻大法，况暑月乎。生地须用二等，原枝洗去土，咀断用。麦
冬捡大而白者，此二味为养阴退阳之要药。丹皮佐之以退热，甘桔以升肺之清气，黄芩以泻
肺之浊气，石膏胃家正药，色白属金西方之象，又为清肺之药，麻出火甚熏灼肺胃，石膏
一物兼清二经至当不易，在乎用者之见机耳。
有麻出四五朝绵密红紫不收者，热甚不退者，此发散太过，火势尽发，急宜养阴退阳。
天寒出麻，寒邪在表，热蕴于中，所见不过数证。急者为呕为喘为衄，缓者为口疮为下
利，甚者为牙疳，此外更无他变。夏令出麻，火毒燔灼，暑邪交炽变证之奇多，有见所未见
者。有双目红肿如桃李，流出血水，急泻肝火，命虽保而目全损者。有两颌红肿如 腮，数日
而溃，流出脓血碗许，内服清胃解毒药，外贴洪少岗膏药而愈者。有通身发泡，皮塌痛楚，
用松花粉扑之而愈者。有手足曲池发肿，如痘毒之鬼肿者。有面部胸背发紫疔数十，其晕大
如棋子，中黑而陷，发热不食，用凉血解毒不应，七日而死者。种种变怪，无非火毒燔灼，尤
有热甚不死之证，无非热伤阴液，热伤正气，俗流不知益气养阴，只知托散，喘汗而脱者，
比比皆是。此等证病家延予至急，进参麦汤所救不少。治麻至老不意逢此一度，若不因时制
宜，重定治法，何以示后而知应变，执成方者盖审诸。
麻证中药引惟芫荽一物为最妙，辛香之中更含生气，合之升麻葛根荆防蝉蜕能升阳
透表，面部一出即宜减去，若辛散太过反能助火。
麻痘的发出，关键在于使邪气从体表透发出来。只要表邪一透，即使体内热毒很重，通过清热治疗也可以痊愈。如果表邪未能透发，毒邪就会内陷于体内，导致病机闭塞。此时既不能再用发表药，也不能单纯养阴，往往会导致病情拖延而死亡。
所谓“表透”，并非仅指皮毛层面的透发，而是要让邪气从脏腑深处透出，过程从容不迫，这才是真正的表透。也有火毒极盛的情况，外部表现为皮疹繁密鲜红，但出疹后仍然出现牙疳（牙龈腐烂坏死）或肺痈（肺部化脓性感染），或者出现鼻出血、腹泻等症状，这说明脏腑内的热毒并没有完全透出。
麻痘的毒邪是从脏腑发出的，虽然已经到了体表，但病根仍在体内。“解”字侧重于从表而解，“化”字侧重于从里而化。如果表邪虽解但里毒未化，留下的后患实在很多。
解表的药物作用于阳分和氣分，见效快且容易观察；化毒的药物作用于阴分和血分，见效慢且难以速成。《金镜录》中提出的“养阴退阳”四个字，是治疗麻痘的要诀。
麻疹后期出现咯吐脓血、气味腥臭的症状，有的属于肺痈，有的属于胃脘痈，这都是肺胃遗留的热毒造成的危害，也类似于牙疳和口疮。如果热毒沿经络外发则形成牙疳，如果滞留于脏腑则形成痈肿。应当辨别病位在肺还是在胃，从而施以不同的治疗。我常用甘草、桔梗、牛蒡子、金银花、枳壳、赤芍这几味药，如果病在肺，加山栀子、贝母、桑白皮；如果病在胃，加生地黄、天花粉、木通等药来辅助治疗，身体没有大热的患者可以治愈。
有人问：牙疳和肺痈这类病症为什么能治愈呢？因为毒邪已经化解并排出体外了。毒邪已化且脏腑功能未败坏的患者可以治愈，如果脏腑已经腐败坏死，就无法治疗了。
丙辰年夏季麻疹盛行，根据时令特点论述治疗方法
痘毒出于五脏，麻毒出于六腑。腑属阳，冬至时阳气初生，麻毒随之而出。所以麻疹多在严寒时节传染，古人称之为“因时而发的麻疹”。我治疗麻疹五十年，所见病例大多与此类似，偶尔有延续到春末夏初才停止的。近来夏季出麻疹，正值盛夏酷暑不断，时势何其不同啊。既然时势不同，医生就应当随时间变化灵活调整治疗方法。庸医不察实情，死守成方，愚昧的百姓更加压抑捂盖，导致火盛金伤，形成麻疹并发气喘，实在可悲。为此制定新方数条，以纠正时弊，明理的人应当以此为准则。
第一方
升麻、蝉蜕、荆芥、防风、前胡、桔梗、牛蒡子、甘草，加少许芫荽，服用一剂。
服用一剂后麻疹发出，去掉升麻，加入赤芍、连翘；烦躁加炒栀子，呕吐加石膏，咳嗽加杏仁、枳壳。夏季毛孔腠理先开，使用解表药只宜轻清不宜重浊，荆芥、防风、蝉蜕就是解表药。服用一剂后若疹出不透，再用升麻加葛根来透发，麻黄在夏季禁用是人所共知的常识，羌活也不得滥用，葛根也不得重复使用，面部疹子一出即应转换治法。
第二方
荆芥、防风、桔梗、甘草、牛蒡子、连翘、杏仁、炒栀子、木通。
这是发病第三天的方子。面部疹子已透发，就连荆芥、防风也应当减去，平稳守方一日，等待其缓缓消退最为稳妥。热甚烦躁口渴加石膏、竹叶。壮热不退加黄芩、麦冬。如果出现腹泻，减去杏仁、木通，加入赤茯苓。
第三方
生地黄、麦冬、牡丹皮、栀子仁、连翘、桔梗、甘草。烦躁口渴加竹叶、石膏；热甚加黄芩、知母。
这是发病第四五天的方子。养阴退阳是治疗麻疹的大法，何况是在暑月呢。生地黄必须选用二等品，保留原枝洗净泥土，切碎使用。麦冬挑选大而白的，这两味药是养阴退阳的关键药物。牡丹皮辅助退热，甘草和桔梗提升肺气的清气，黄芩泻除肺气的浊气，石膏是调理胃部的正药，其色白属金，对应西方之象，又是清肺的药物。麻疹发出时火毒炽盛熏灼肺胃，单用石膏一物即可兼清肺胃二经，非常恰当不易改变，关键在于使用者的见机运用。
如果有麻疹发出四五天，疹点绵密红紫而不收束，热势不退的，这是因为发散太过，火势全部爆发，急需养阴退阳。
天寒时出麻疹，寒邪在表，热蕴于中，所见症状不过几种。急性的表现为呕吐、气喘、鼻衄；缓性的表现为口疮、腹泻；严重的表现为牙疳，此外没有其他变证。夏季出麻疹，火毒燔灼，暑邪交加，变证奇特繁多，有前所未见的情况。有的双眼红肿如桃李，流出血水，急泻肝火，虽然保住了性命但眼睛完全失明；有的两侧下颌红肿如腮帮，几天后溃破，流出约一碗脓血，内服清胃解毒药，外贴洪少岗膏药而痊愈；有的全身发泡，皮肤塌陷疼痛，用松花粉扑洒而痊愈；有的手足曲池穴处肿胀，像痘毒引起的鬼肿；有的面部胸背发出数十个紫色疔疮，晕圈大如棋子，中间黑陷，发热不吃东西，用凉血解毒药无效，七天后死亡。种种怪异现象，无非是火毒燔灼。更有热势极重却不死的证候，无非是热伤阴液、热伤正气。世俗医生不知益气养阴，只知道托毒发散，导致气喘汗出而脱险的，比比皆是。这些重症病人紧急请我去诊治，进服参麦汤救活的不少。治疗麻疹到老，没想到遇到这种情况一次，如果不因时制宜，重新确定治法，怎么能让后人知道如何应变呢？死守成方的医生们应当审慎考虑。
麻疹治疗中的药引，只有芫荽这一味最妙，辛香之中更含有生机，配合升麻、葛根、荆芥、防风、蝉蜕能升阳透表，面部疹子一出就应当减去，如果辛散太过反而助长火势。
The emergence of measles (Ma) and smallpox (Dou) hinges on the thorough resolution of pathogenic factors from the exterior. Once the exterior is resolved, even if internal heat toxicity is severe, it can be cured through clearing heat. If the exterior is not resolved, toxins sink inward, causing a closure of the pathways. At this stage, neither releasing the exterior nor nourishing yin alone is appropriate, often leading to death due to prolonged neglect.
"Resolution of the exterior" does not merely refer to the skin and hair level, but requires pathogens to emerge from the depths of the Zang-Fu organs in a leisurely manner; only then is it truly considered "resolved." There are cases where fire-toxicity is extremely intense, presenting externally with dense, bright red eruptions, yet after eruption, complications such as noma (gangrenous stomatitis) or lung abscess still occur, or symptoms like epistaxis and diarrhea appear. This indicates that the heat-toxin within the Zang-Fu has not been fully resolved.
The toxin of measles and smallpox originates from the Zang-Fu organs. Although it reaches the exterior, its root remains internal. The character "Jie" (resolve) pertains to resolving from the exterior, while "Hua" (transform) pertains to transforming from the interior. If the exterior is resolved but the interior is not transformed, the subsequent complications are numerous.
Medicines for resolving the exterior act on the Yang and Qi levels, yielding rapid and observable effects. Medicines for transforming toxins act on the Yin and Blood levels, yielding slow and difficult-to-achieve results. The four characters "Nourish Yin and Retreat Yang" from *Jin Jing Lu* are the key principles for treating measles.
Post-measles expectoration of purulent, bloody, and foul-smelling sputum may indicate lung abscess or gastric abscess. These are caused by residual heat-toxin in the Lung and Stomach, similar to noma or mouth ulcers. If the toxin follows the meridians outward, it manifests as noma; if it lodges in the Zang-Fu, it forms an abscess. Treatment should be differentiated based on whether the pathology is in the Lung or the Stomach. I commonly use Licorice Root (Gancao), Platycodon Root (Jiegeng), Butterfly Bush Seed (Niubangzi), Honeysuckle Flower (Yinhua), Aurantium Fruit (Zhike), and Red Peony Root (Chishao). If the pathology is in the Lung, add Gardenia Fruit (Shanzhizi), Fritillaria Bulb (Beimu), and Mulberry Bark (Sangpi). If in the Stomach, add Rehmannia Root (Shengdi), Trichosanthes Root (Huafen), and Akebia Stem (Mutong) as adjuncts. Patients without high fever can be cured.
Question: Why can conditions like noma and lung abscess be cured? Because the toxin has been transformed and expelled. If the toxin is transformed and the Zang-Fu function remains intact, cure is possible. If the Zang-Fu are already corrupted and necrotic, they cannot be treated.
In the summer of the Bingchen year, measles were prevalent. This section discusses treatment according to seasonal patterns.
Smallpox toxin originates from the Five Zang organs, while measles toxin originates from the Six Fu organs. Fu organs belong to Yang. At the Winter Solstice, Yang energy begins to generate, and measles toxin emerges. Therefore, transmission often occurs during severe cold periods, which is why ancient texts referred to it as "measles occurring due to the season." In my fifty years of treating measles, most cases resembled this pattern, occasionally extending into late spring or early summer. Recently, however, measles have appeared in summer, persisting through the peak heat. How different the circumstances have become! Since the circumstances differ, physicians must adapt their methods accordingly. Quack doctors fail to observe these changes and rigidly adhere to established formulas. Ignorant people further suppress the eruption by over-bundling, causing excessive fire to injure Metal (Lung), leading to measles complicated by asthma. This is truly pitiable. To correct these abuses, I have formulated several new prescriptions for those who understand the principles to follow.
Prescription 1
Cimicifugae Rhizoma (Shengma), Cicada Slough (Chantui), Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), Peucedani Radix (Qianhu), Platycodon Root (Jiegeng), Butterfly Bush Seed (Niubangzi), Licorice Root (Gancao), plus a small amount of Coriander Seed (Yuansui), taken as one dose.
After one dose, when the eruption appears, remove Cimicifugae Rhizoma (Shengma) and add Red Peony Root (Chishao) and Forsythia Fruit (Lianqiao). For irritability, add Stir-fried Gardenia Fruit (Chao Zhizi); for vomiting, add Gypsum (Shigao); for cough, add Apricot Kernel (Xingren) and Aurantium Fruit (Zhike). In summer, the pores open first; exterior-releasing medicines should be light rather than heavy. Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), and Cicada Slough (Chantui) serve as exterior-releasing agents. If the eruption is not fully resolved after one dose, use Cimicifugae Rhizoma (Shengma) added with Kudzu Root (Gegen) to promote resolution. The use of Ephedra Herb (Mahuang) is contraindicated in summer, a common knowledge. Qianghuo should not be used recklessly, nor should Kudzu Root (Gegen) be reused excessively. Once the facial eruption appears, the treatment strategy should change immediately.
Prescription 2
Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), Platycodon Root (Jiegeng), Licorice Root (Gancao), Butterfly Bush Seed (Niubangzi), Forsythia Fruit (Lianqiao), Apricot Kernel (Xingren), Stir-fried Gardenia Fruit (Chao Zhizi), Akebia Stem (Mutong).
This is the prescription for the third day of illness. Once the facial eruption is resolved, even Schizonepeta Spike (Jingjie) and Saposhnikovia Root (Fangfeng) should be reduced. Maintain stability for one day, waiting for the rash to recede slowly, which is the safest approach. For severe heat, irritability, and thirst, add Gypsum (Shigao) and Bamboo Leaf (Zhuye). For persistent high fever, add Scutellaria Root (Kuhuang) and Ophiopogon Tuber (Maidong). If diarrhea occurs, remove Apricot Kernel (Xingren) and Akebia Stem (Mutong), and add Poria (Chiling).
Prescription 3
Rehmannia Root (Shengdi), Ophiopogon Tuber (Maidong), Moutan Cortex (Danpi), Gardenia Seed (Zhiren), Forsythia Fruit (Lianqiao), Platycodon Root (Jiegeng), Licorice Root (Gancao). For irritability and thirst, add Bamboo Leaf (Zhuye) and Gypsum (Shigao); for severe heat, add Scutellaria Root (Kuhuang) and Anemarrhena Rhizome (Zhimu).
This is the prescription for the fourth and fifth days. Nourishing Yin and Retreating Yang is the major principle for treating measles, especially in the summer months. Rehmannia Root (Shengdi) must be of second-grade quality, kept in original branches, washed clean of soil, and chopped. Ophiopogon Tuber (Maidong) should be selected large and white. These two are essential for nourishing Yin and retreating Yang. Moutan Cortex (Danpi) assists in reducing heat. Licorice Root (Gancao) and Platycodon Root (Jiegeng) ascend the clear Qi of the Lung. Scutellaria Root (Huangqin) drains turbid Qi from the Lung. Gypsum (Shigao) is the primary medicine for the Stomach; its white color corresponds to Metal and the West, and it clears the Lung. When measles erupt with intense fire-toxin scorching the Lung and Stomach, Gypsum alone can clear both meridians effectively. Its success depends on the physician's discernment.
If the eruption persists for four to five days, appearing dense, red-purple, and unresolving, with unremitting heat, it is due to excessive dispersal, causing all fire energy to flare up. Immediate nourishment of Yin and retreat of Yang is required.
When measles occur in cold weather, cold pathogen remains at the exterior while heat accumulates internally. Symptoms are limited. Acute cases present with vomiting, asthma, or epistaxis; chronic cases with mouth ulcers or diarrhea; severe cases with noma. No other variations occur. However, in summer, fire-toxin blazes and summerheat intertwines, creating bizarre and unprecedented variations. Some present with eyes swollen red like peaches and plums, oozing blood and water; urgent draining of Liver fire saves life but causes total blindness. Some have swollen jaws like mumps, ulcerating after days, oozing bowlfuls of pus and blood; cured by internal Stomach-clearing detoxifying herbs and external application of Hong Shaogang Plaster. Some develop generalized blisters with collapsed, painful skin; cured by dusting with Pine Pollen. Some have swelling at the Quchi acupoint on hands and feet, resembling the "ghost swelling" of smallpox toxin. Some develop dozens of purple ding (carbuncles) on the face, chest, and back, with halos as large as chess pieces, black and sunken centers, accompanied by fever and anorexia; fatal after seven days despite cooling-blood and detoxifying treatments. All these anomalies stem from blazing fire-toxin. Even cases with extreme heat that do not result in death are due to heat injuring Yin fluids and healthy Qi. Unskilled practitioners, ignorant of tonifying Qi and nourishing Yin, rely solely on pushing out toxins, leading to asthma, sweating, and collapse. Such cases are common. When urgently summoned for these critical conditions, administering Ginseng and Ophiopogon Decoction (Shenmai Tang) has saved many lives. Having treated measles until old age, I never expected to encounter such a situation. Without adapting to the times and redefining treatment methods, how can I guide future generations to respond flexibly? Physicians who rigidly stick to old formulas should consider this carefully.
Among medicinal guides for treating measles, only Coriander Seed (Yuansui) is superior. Its pungent aroma contains vital energy. Combined with Cimicifugae Rhizoma (Shengma), Kudzu Root (Gegen), Schizonepeta Spike (Jingjie), Saposhnikovia Root (Fangfeng), and Cicada Slough (Chantui), it raises Yang and resolves the exterior. It should be removed once the facial eruption appears; otherwise, excessive pungent dispersion will aid fire.