身如涂朱眼如火。发斑狂叫无人我。血热不散出乘虚。三黄青黛汤最妥。
发斑者。谓热伤血。血热不散。里实表虚。发于皮肤而为斑也。或渴症误温。或当
汗失
汗。当下失下。或汗下未解。或下早热邪入胃。或下迟热留胃中。皆致发斑。轻如疹子。重
如锦纹。若色紫黑。热极而胃烂者必死。此即伤寒阳毒发斑之症也。凡斑疹将发未发之时。
宜以升麻葛根汤先透其毒。如热甚者。再以犀角地黄汤主之。如青黛大青知母石膏黄连黄柏
黄芩之类。以斑尽为度。如汗吐下后。虚极发斑者。宜以人参白虎汤主之。亦有温毒发斑者
。冬时感寒。至春始发也。宜以元参升麻汤解之。凡斑疹不可发汗。发汗则重令开泄。更增
斑烂。亦不可遽下。遽下。则重损其阴。恐斑毒内陷。多致不救。不可不慎也。
升麻葛根汤四味。攒上芍药甘草是。伤寒发热与头痛。痘疹初热为要剂。
病患肉 并筋惕。汗出过经真无敌。不然邪入大经中。状如螈 癫痫疾。发汗动经
身振摇。宜用茯苓桂枝术。动气在左误下之。忽尔肉 最为逆。
筋惕肉 者。皆由汗下太过。表邪未解。血气虚夺。筋肉失养所致。不然邪入大经者。
谓不
因发汗。而邪热搏于血脉之中。故惕惕而跳动也。张仲景特立真武汤以救其误。又腹中上下
左右有动气。俱不可汗下。否则必筋惕肉 。其在左边动气者。俱不可汗下。若汗下则筋惕
肉。其在右边动气者。尤当以汗下为戒也。
身体像涂了朱砂一样红，眼睛像火一样炽热。出现发斑症状时，患者会狂叫不止，神志不清，失去自我意识。这是因为血分热盛无法消散，趁正气虚弱之时外溢所致。此时使用三黄青黛汤最为妥当。
所谓发斑，是指热邪损伤血分，导致血热郁结不散，表现为里实表虚，热毒发于皮肤而形成斑点。这种情况可能由以下原因引起：口渴病症误用温补疗法；应当发汗却未能及时发汗；应当攻下却未能及时攻下；或者经过发汗、攻下治疗后病邪仍未解除；或者攻下过早导致热邪陷入胃中；或者攻下过迟导致热邪滞留于胃中。这些情况都会导致发斑。轻症如同疹子，重症则如锦纹般密集。如果斑点颜色呈紫黑色，说明热毒极盛且胃气腐烂，必定死亡。这就是伤寒阳毒发斑的症状。凡是斑疹将要发出但尚未完全发出之时，适宜先用升麻葛根汤来透发毒邪。如果热势严重，再以犀角地黄汤为主进行治疗。也可以使用青黛、大青叶、知母、石膏、黄连、黄柏、黄芩等药物，直到斑疹消退为止。如果在发汗、催吐、攻下之后，因极度虚弱而发斑的，适宜用人参白虎汤为主治疗。也有因温毒引起的发斑，这是冬季感受寒邪，到了春季才发作的疾病，适宜用元参升麻汤来解表散毒。凡是斑疹病症，不可使用发汗法，因为发汗会使腠理更加开泄，加重斑烂；也不可急于攻下，因为急于攻下会进一步损伤阴液，恐怕导致斑毒内陷，大多会导致无法救治。必须谨慎对待。
升麻葛根汤由四味药组成，加上芍药和甘草共六味（注：原文此处歌诀表述略有歧义，通常升麻葛根汤为升麻、葛根、芍药、甘草四味，歌诀意为此方基础）。它是治疗伤寒发热与头痛，以及痘疹初起发热的重要方剂。
病患出现肌肉跳动并伴有筋脉抽搐，如果是汗出过多且病程已传变至他经，确实没有对手（指病情危重或难治）；否则是邪气进入了大经脉之中，症状如同抽搐、癫痫发作。如果发汗不当扰动经脉，会导致身体振摇颤抖，适宜使用茯苓桂枝术（即真武汤加减或相关温阳利水方剂，此处依原文直译，实际中医经典中对应真武汤证）。如果腹部动气在左侧，误用攻下法，突然出现的肌肉跳动是最为逆乱的。
所谓筋惕肉瞤，都是由于发汗、攻下太过，导致表邪未解，气血亏虚，筋肉失去滋养所致。如果不是因为发汗，而是邪热搏结于血脉之中，所以会出现惕惕跳动的现象。张仲景特别设立真武汤来补救这种误治造成的后果。另外，腹中上、下、左、右各部位有动气现象的，都不可使用发汗或攻下法，否则必然导致筋惕肉瞤。其中动气在左侧的，都不可发汗或攻下，如果发汗或攻下，就会导致筋惕肉瞤。动气在右侧的，更应当以禁止发汗和攻下为戒。
The body appears red as if coated with cinnabar, and the eyes burn like fire. When macules (skin eruptions) appear, the patient may scream wildly, losing self-awareness due to consciousness disturbance. This occurs because heat in the blood level fails to dissipate and spills out when righteous qi is deficient. In such cases, Sanhuang Qingdai Tang (Three-Yellow and Indigo Decoction) is most appropriate.
"Macules" refer to skin eruptions caused by heat damaging the blood level. When blood heat stagnates and does not disperse, it manifests as interior excess and exterior deficiency, emerging on the skin as spots. Causes include: mistakenly using warming therapies for thirst syndromes; failing to induce sweating when indicated; failing to purge when indicated; or pathogenic factors remaining unresolved after sweating or purging methods. Additionally, premature purging may drive heat into the stomach, while delayed purging may leave heat lingering in the stomach. All these conditions can lead to macules. Mild cases resemble rashes, while severe cases present as dense patterns like brocade. If the macules turn purple-black, indicating extreme heat and rotting of the stomach qi, death is inevitable. This constitutes the syndrome of Yang-toxin macules in Shanghan (Cold Damage). Whenever macules are about to emerge but have not fully erupted, Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) should be used first to vent the toxin. If the heat is severe, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be administered as the primary treatment. Herbs such as Qingdai (Indigo Naturalis), Daqingye (Isatidis Leaf), Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), and Huangqin (Scutellariae Radix) may also be used until the macules resolve. If macules appear after excessive sweating, vomiting, or purging due to extreme deficiency, Renshen Baitu Tang (Ginseng and White Talc Decoction) is appropriate. There are also cases of macules caused by Warm-Toxin, which result from contracting cold in winter and manifesting in spring; Yuan Shen Shengma Tang (Scrophulariae et Cimicifugae Decoction) is suitable for resolving this. Macule syndromes must never be treated with sweating methods, as this would further open the pores and worsen the eruption. Nor should one hastily use purging methods, as this would severely damage Yin fluids and risk the internal collapse of the toxin, often leading to untreatable conditions. Caution is essential.
Shengma Gegen Tang consists of four ingredients; combined with Shaoyao (Paeoniae Radix Alba) and Gancao (Glycyrrhizae Radix et Rhizoma), it forms a key formula. It is a crucial prescription for treating fever and headache in Shanghan, as well as initial fever in smallpox and rashes.
If the patient experiences muscle twitching (Rou Yu) and tendon tremors (Jin Ti) after excessive sweating and transmission to another meridian, the condition is indeed difficult to treat; otherwise, it indicates that pathogenic factors have entered the large meridians, presenting with symptoms resembling convulsions or epilepsy. If improper sweating disturbs the meridians, causing body tremors and shaking, Fuling Guizhi Zhu (Poria, Cinnamon Twig, and Atractylodes combination, referring to Zhenwu Tang context) is indicated. If there is "moving qi" (Dong Qi) in the left abdomen and purging was mistakenly applied, sudden muscle twitching is a particularly adverse sign.
"Tendon tremors and muscle twitching" are caused by excessive sweating or purging, leaving exterior pathogens unresolved and depleting qi and blood, thereby depriving muscles and tendons of nourishment. Alternatively, if not caused by sweating, it results from pathogenic heat clashing within the blood vessels, causing palpitations and throbbing. Zhang Zhongjing specifically established Zhenwu Tang (True Warrior Decoction) to remedy errors resulting from such treatments. Furthermore, if there is "moving qi" in the upper, lower, left, or right regions of the abdomen, neither sweating nor purging methods should be used; otherwise, tendon tremors and muscle twitching will inevitably occur. Specifically, moving qi in the left abdomen contraindicates both sweating and purging; applying them will cause these symptoms. Moving qi in the right abdomen is even more strictly a contraindication for sweating and purging.