典藏书目

Qin from Yunjian stated: Measles (Ma Zhen) is caused by abnormal seasonal climates, where warmth and heat appear out of season, leading to infectious disease. Calling it "fetal toxin" (Tai Du) is incorrect. The *Neijing* states: "When Shaoyin prevails, it manifests as sores and rashes." What is meant by Shaoyin prevailing is an excess of Ministerial Fire (Jun Huo), with heat commands dominating, corresponding to the years of Wuzi and Wumu. In the human body, this relates to Heart Fire (Xin Huo). When Heart Fire is excessive, it overacts on the Metal it controls (Lung), burning the Lung Metal. Since the Lung governs the skin and hair, the skin appears red like brocade; this is the color resulting from Heart Fire insulting and attacking the Lung. The classics further state: "Rashes belong to the Spleen." Thus, the *Jing Jian Lu* says toxins are abundant in the Spleen, and heat remains in the Heart. From this, we know that the Heart, Spleen, and Lung are all affected by pathogens and manifest together. During the time when the rash is about to emerge, the cheeks are red, eyes are bloodshot, there is high fever with aversion to cold, body pain, vomiting and diarrhea, cough, irritability, and thirst. These are its signs. The pulse is floating and rapid in the Yang position, and solid and large in the Yin position. It is appropriate to administer Kaihuo Couli Tang (Open and Clear Pores Decoction), containing herbs such as Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Qianhu (Peucedani Radix), Qianghuo (Notopterygii Rhizoma et Radix), Zisu (Perillae Folium), Niubangzi (Arctii Fructus), Chantui (Cicadae Periostracum), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus Immaturus), Gancao (Glycyrrhizae Radix et Rhizoma), and Chenpi (Citri Reticulatae Pericarpium), to facilitate eruption. If the rash on the head and face becomes more numerous, bright, uniform, and clean, with the spirit refreshed and robust, and breathing peaceful, this is an auspicious sign. If the rash is purple-black, dry, dull, and blurred, or has not fully erupted, accompanied by fever, restlessness, hoarseness, and rapid panting, appearing faintly and difficult to emerge, or emerging and then disappearing, this is a critical sign. Immediately add Chao Mahuang (Ephedrae Herba processed), Shigao (Gypsum Fibrosum), and Chengliu (Tamarisci Ramulus) to the previous formula to induce sweating and eruption. If it still does not erupt, or if panting worsens, this is an incurable condition. If the stool is hard and dry, do not lightly use purgatives; instead, use pig bile honey suppositories to guide the bowels, and they will pass naturally. If there is mild diarrhea, no treatment is needed, as this serves to vent heat toxins. However, if diarrhea and dysentery persist after the rash, this is due to heat toxins sinking downward. One should use Wuling San (Five-Ingredient Powder with Poria) minus Guizhi (Cinnamomi Ramulus) plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shaoyao (Paeoniae Radix), and Mutong (Akebiae Caulis). When toxins resolve and heat recedes, diarrhea and dysentery will stop on their own. Do not use drying-dampness or warming-tonifying agents. The ancients said: "Sweating is permissible, purging is not; releasing the exterior is permissible, tonifying is not." This is correct. If high fever and rapid breathing persist after the rash, this indicates lingering residual toxins. One must use formulas that purge heat and clear the Lungs, such as Zhuye Shigao Tang (Leaf of Bamboo and Gypsum Decoction) added with Huangqin, Huanglian, Yuanshen (Scrophulariae Radix), Jiegeng, Zhike, Niubangzi, Huafen (Trichosanthis Radix), and Chantui. For persistent cough after the rash, treat with Erchen Tang (Two-Aged Decoction) added with Gualou (Trichosanthis Fructus), Jiegeng, Yuanshen, Huangqin, and Xiangbei (Fritillariae Thunbergii Bulbus). For thirst, add Huafen and Zhimu (Anemarrhenae Rhizoma); for panting, Tinglizi (Descurainiae Semen), Suzi (Perillae Fructus), Sangbaipi (Mori Cortex), and Xingren (Armeniacae Semen Amarum) are suitable. If the rash persists without fading after three days, this indicates internal excess heat; adding clearing and draining herbs will resolve it. This is the general principle for treating measles. At the initial stage, one must strictly avoid rice, grains, raw/cold foods, meat/fish, wheat products, as well as wind-cold, summerheat-dampness, and turbid qi. Negligence here leads to severe complications. Occasionally, those who violate these rules recover because their innate Qi is strong and the external pathogen is light; one should not rely on this for luck.

Jian from Shanghai noted: Measles and chickenpox are both seasonal infectious diseases, mostly involving the Lung system, necessarily accompanied by cough and wheezing. Only when they erupt thoroughly and transform cleanly can future complications be avoided. The general method treats wind-heat and summerheat-dampness. Medicinals should be light and clear, avoiding pungent-warm and aromatic-dry substances. Dispersing wind medicines are contraindicated because wind medicines stimulate movement and aggravate fire.

Qin from Yunjian stated: If pustules have emerged but are dense and small like millet seeds, this is called "Measles Clashing with Smallpox" (Jia Zhen). The *Xin Jian* says: When smallpox toxin erupts, wind blocks the pores, and heat toxins agitate the fu-organ toxins, causing them to erupt simultaneously with smallpox. This does not harm the smallpox, as rashes emerge from the Fu organs, while smallpox emerges from the Zang organs. Zang belongs to Yin, being a place of accumulation, so its toxins are deep; Fu belongs to Yang, being a place of transmission, so its toxins are shallow. Therefore, smallpox takes about twenty days from start to finish, whereas rashes dissipate in one day. Should one not treat the urgent condition first? The classics say: "Treat the urgent first." Treatment should first disperse the rash, then treat the smallpox. If the rash does not disperse, the smallpox will not rise. If the rash disperses and the smallpox rises, becoming convex, uniform, moist, and red, the prognosis is auspicious. If the rash disperses but the smallpox remains dense, flat, gray-white, or purple-stagnant, the prognosis is dangerous. Thus, it is said that smallpox clashing with measles has half auspicious and half ominous outcomes. Additionally, during smallpox eruption, exposure to wind-cold may prevent spontaneous sweating, leading to rash formation, similar to exogenous rash induction. Again, disperse the rash first, then the smallpox will rise.

Jian from Shanghai noted: Rashes come in two colors: red and white. Red belongs to wind-heat; white belongs to summerheat-dampness. Regardless of the season, they arise from external infections. Measles clashing with rash also follows seasonal qi. At the onset of fever, symptoms like nausea, cough, and sneezing must appear first. Skin showing faint, scattered spots with heads constitutes a rash. One must first support eruption and clear/resolve to transform it, making smallpox easier to rise; this is less severe than macules (Ban). If there is high fever, stupor, redness, and immediate irritability, even if the smallpox color is good, deep toxins indicate ominous signs. One cannot blindly believe that smallpox clashing with rash is mostly auspicious. Predecessors rigidly held that smallpox belongs to Zang and rash to Fu, claiming rash is congenital Yang toxin, macules are rootless fire of the Triple Burner, and rash is Heart fire. These views are plausible yet incorrect. Claiming it is wandering fire of the Spleen and Stomach contradicts external seasonal infections. Ultimately, all are caused by external pathogens entering the Stomach, where heat stagnation forms macules, and pathogens lodging in the Lungs form rashes. Both are meridian-level conditions, proving previous theories as far-fetched. The *Neijing* states: "Wind is a Yang pathogen, injuring the exterior. The skin and hair are the exterior of the Lung. The skin and hair receive pathogens first, which then enter via their association. Thus, rashes must accompany cough and sneezing." Skin and hair are the outermost exterior, so rashes appear and disappear unpredictably, preferring warmth and fearing cold; covering must be careful. Because they grow in light-clear areas, they can be transformed with one sweat. They are not chronic Zang-Fu diseases dragging out time. Use Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction) added with Niubangzi, Xingren, Chantui, Mutong, Gancao, Jiegeng, Qianhu, Shigao, and Chengliu to support transformation. The rash will retreat, and smallpox will rise. Collecting refined points from various experts' discussions, the section on rash was inadequate but indispensable. Taking Qin's point about catching a cold during smallpox eruption as the main theme, further detailed analysis breaks doubts, preventing later generations from falling into confusion. However, one must not recklessly use Qianghuo, Fangfeng, Jingjie, Zhike, Chishao (Red Peony Root) etc., which disperse and break Qi, deplete Blood, causing wind to blaze with fire, preventing rash transformation and smallpox rising, leading to lack of pus and mid-course changes, often causing medical errors.

Qin from Yunjian stated: Macules (Ban) resemble flea bites, having spots without heads. Cloud-like shapes, red patches floating on skin without granules are called Dan (erythema). Generally, these are manifestations of Blood. Fire-toxin obstruction and boiling Yin-Blood, with blood-heat struggling, clashing with smallpox to erupt. Urgently use cooling-blood and detoxifying methods. Mild and small cases can be resolved with cooling-clearing. Purple, green, or black indicate severe toxin aggregation. Facial swelling and lip cracking mean ten out of ten die. I occasionally treated successfully because although various colored macules appeared, the smallpox rose independently, and the patient could sleep and eat peacefully. Administering lots of Zicao (Arnebiae Radix et Rhizoma), Xijiao (Rhinocerotis Cornu - note: substitute with water buffalo horn in modern practice), and Shigao, along with other cooling-blood detoxifiers, yields rare success. Do not apply uniformly, lest you incur blame.

Jian from Shanghai noted: Macules usually arise from seasonal infection, with evil toxins obstructing the Yangming channel, heat struggling with blood, erupting during smallpox. Vomiting accompanies emergence. This is not inherent to smallpox. Smallpox is the toxin of innate righteous Qi; macules are the evil of acquired seasonal Qi. Light infection causes small red spots; heavy infection causes red-purple or blue-black large spots. Light cases use Shengma Gegen Tang plus Shigao, Douchi (Sojae Semen Praeparatum), and Chantui to support, plus Lianqiao (Forsythiae Flos) and Huafen to transform. Heavy purple-red cases add Xijiao, Huanglian (Coptidis Rhizoma), Daqing (Isatidis Folium), and Zicao. Blue-black indicates severe toxin and stomach rot; even doubling cooling agents is futile. If only two or three spots exist, and smallpox color is moist with clear spirit, treatment is possible. Predecessors did not detail the origin of seasonal Qi, so I highlight it. Although smallpox quality is innate, it erupts triggered by seasonal Qi, hence called "Seasonal Smallpox" (Shi Dou). Seasonal Qi refers to contagious atmospheric changes. A year divides into four seasons, each into six terms. As these terms change, outcomes vary based on cold/heat and brightness/darkness. Humans live in the intersection of Qi. Feeling good Qi means heavy smallpox without clashing; feeling bad Qi means light smallpox mixed with macules/rashes. If smallpox is inherently bad and meets bad timing, toxic discoloration appears on limbs and lips/tongue first. Excess evil and exhausted Zheng lead to death within a morning. Seasonal Qi transmission changes term by term. I have witnessed this extensively in villages. Encountering bad Qi leaves one helpless; avoidance is the only way to escape disaster. People attribute this to innate toxins, missing the mark. Investigating "Seasonal Smallpox" reveals secrets of auspiciousness and danger. "Clashing Dan" arises from a child's usual fetal toxin or blood-heat/wind-damp struggle, erupting concurrently. This wandering fire gathers in skin/hair, lacking blue-black color, making it lighter than macules. Adding Chengliu, Lugeng (Reed Rhizome), Maogen (Imperatae Rhizoma), Fuping (Spirodela), and Winter Pear Juice to previous formulas transforms it, allowing smallpox to rise. I dare to tell future practitioners.

Editor Zheng Jin Shangde noted: The classics state: "One Yin and One Yang knotting is called Hou Bi (throat obstruction)." One Yin is the Heart Master pulse; One Yang is the Sanjiao pulse. Both traverse the throat. Internal knotting of Qi-Heat causes Hou Bi. Ultimately, this belongs to Kidney Water insufficiency, with Jun Huo and Xiang Huo causing disease. If constitutionally Yin-deficient and fatigued, with external wind-pathogen invasion, presenting aversion to cold, sore throat, pulse not floating-large-rapid-numerous, no body烦热 (restless heat), cough, no thirst, constipation, the method should be nourishing Yin and clearing heat. If tidal fever occurs in spring/summer coinciding with epidemic pestilence, mistaking hidden rash for suspected Lanhou Dansha (rotten throat erythema rash), and using Mahuang, Douchi, Shengma, Chaihu, Qianghuo, Gegen, Jingjie, Fangfeng etc. to lift and release the exterior, fire follows wind power, flames raging uncontrollably, seizing fluids and triggering transformation syndromes. Thus, *Yi Men Fa Lv* clarifies: Wind-Warmth cannot be sweated; Damp-Warmth cannot be sweated. Generally, wind-heat struggling causes Wind-Warmth; heat-dampness combining causes Damp-Warmth. Among Six Evils transforming into fire, none is faster than wind. Treating by inducing sweat kills patients; thus, such deaths are physician-killed.

Recorded respectfully by Yijie Daoren on Xin-Chou day, first day of intercalary second month, Geng-Yin year of Guangxu reign.