研为粗末，每服二钱，加生姜、葱白水煎服。
（二十七）苏合香丸 见前第四节。
（二十八）琥珀抱龙丸 治小儿诸惊，四时感冒，风寒温疫邪热，致烦躁不宁，痰嗽气急，及疮疹
欲出，发搐，常服祛风，化痰，镇心，解热，和脾胃，益精神。
琥珀 天竺黄 檀香 人参 白茯苓（各一两五钱） 生甘草（三两）
枳壳 枳实（各一两） 朱砂（飞净，五两） 山药（一斤） 胆南星（一两） 金箔（一百片）
遵古法为丸如芡实大，用瓦瓶入麝香同收，毋使泄气，每服一二丸，葱汤或薄荷汤化下。
一、痧疹起源
痧子越人称为 ，北人谓之疹子，秦晋之间曰糠疮，南人俗语曰麸疮，闽粤之间皆号麻，盖一病而俱数
名也。近今吴人于小儿出 ，皆称痧子，成人出 ，则号疹子，其实人不论长幼，凡初次发出者皆痧子也，其
后复发者，皆疹子也。疹与痧虽属一类之病，然究有小别，痧子点密而较细，疹子点稀而较粗，痧子
先天之毒为多，疹子后天之毒为多，故北人称痧曰疹，亦有微误。至于病之起源，可以赅括称之曰毒。盖儿
居母腹，以母之气血为气血，夫人孰无饮食之所伤，六淫之所侵，毒之伏于母体者，胎儿莫不感之。且当成
胎之时，精华者供荣养，糟粕者弃胞中，则积渐所蕴，皆足成毒，胎儿日处其间，又安能免于为毒所
染。故胎儿各组织中，悉含有毒素，可以断言，比其生也，其新陈代谢之作用，倍增于往时，故其毒有宣泄之
必要。于是或生而游风丹毒，一时蜂起，或生而腮肿口腐，杂然并作，此皆毒之泄露也。然毒之盛者聚者，自
随初生去毒之法由人力以逗之外出，然毒之轻者散者，则一时不易发出，伏蕴于内，待时而动，于是
乎痧子一症，遂为小儿人人所必经之症矣。至于痧疹触发之期，最盛于春夏，则以时当降藏之后，天气动，地
气泄，时行之邪袭于外，含蕴之毒遂动于中，是以痧疹之发，必有诱因，或一门皆染，或阖境流行，职是
故耳。再者凡痧子之发，必密布周身，无微弗至，则正因胎儿各组织中悉含有毒素，故无处不泄也。若有
一部未发，为一部之毒未透，是以验痧者，恒视透齐与否，以定施治之标也。
二、痧疹病理
痧疹之发，既为人身宣泄邪毒之路，故其发也，由内达外，由血分而达于气分，始于脾终于肺也。何以言
之，考脾主一身肌肉，肺主一身皮毛，痧疹之发，既由肌肉以达肤表，而脾为藏血之脏，肺为主气之脏，故知
其发于血达于气，始于脾终于肺也。准是更可知痧疹当隐现于皮肤之间，即为邪毒已外传于肺之证，
若盛发之时，则邪毒方悉趋于肺以寻出路。其有发而不易透达者，是肺之不宣也，其有旋出即没者，是肺不任
邪，或肺气之闭塞也。是故治痧之法，主重在肺，极痧之变，亦以邪毒陷肺为最剧。至于痧出将没，尤当以
清肺为急，盖向者余毒未免留恋肺脏，清之正以杜其后患也。由此观之，治痧自始至终，总不离于
肺，此法之常也。至若变症蜂起，则邪有不得泄而内陷者，或热甚侵肝者，或热甚灼心者，则须兼脾、肝、
心、肺四脏分治，以消息之。正昔人所谓痧疹一症，四脏俱受其伤也。
三、痧疹症状
痧疹将发，其初并无显著之现状，即偶有发热，不过似寻常之感冒而已，继则身热益甚，口渴而燥（或
间有恶寒者），咳呛时作，涕泪俱有，不时喷嚏，此痧候也。如是者多或七八日，少或二三日，气急烦闷，眼
赤腮红，随即见点矣。甚者干呕恶心，或兼泄泻，或兼吐利，其点初见不多，根据次升序，每间数时，热
较甚则气益粗而痧点益增，当其壮热之时，谓之潮。潮甚者，恒倦卧，重者则竟谵语闷乱焉，每日三五潮（
每潮一次则痧点增多一次），潮三日则颗粒全透，无微弗至，毒发已净，自渐退隐矣。其隐也亦以渐，大约三
日后，颗粒平，而五六日后则隐不复见。当痧疹退隐之后，全身表皮，渐次更换，甚者周身起落屑之
状，轻者亦略有如粉屑之剥落，此生理自然之作用，无足异者。至痧点透齐后，有三四日不没者，或没而迟迟
者，则以内有湿热，故不易回也。痧子颗粒虽多少不一，巨细稍异，然总以鲜明
红润者为佳，粒细颗突者为佳，至粒少而巨，或赤紫干燥晦暗，皆火盛毒炽，宜为早防。若浑身夹红色成片，
则为夹斑，若色白则为血不足，若黑色则九死一生矣。且既没之后，尤须慎避风寒，严戒劳碌，忌口静养，
方无余恙。否则辛辣早嗜，令生惊搐，盐醋过早，令咳不止，鸡鱼早尝，令天行时即重出，不避风
寒，令肤燥痒，此皆终身为患，不可不戒也。
四、痧疹治法
痧疹当未发之时，未必能断为痧疹也。此时切其脉浮数（襁褓儿无脉可寻，则用大拇指按其腕之外侧验
之），听其气息，有时微粗，可与轻清表剂，自无或误。盖诸病发热初起，使非虚热内伤之属，率从表解也，
惟热有轻重，表有分寸，大概热盛而渴而燥者，宜乎辛凉，热不甚而烦而闷者，宜乎辛散，热而挟湿，
湿在上者，宜汗，湿在下者，宜佐以利水，此治痧之初起也。及其热甚之后，咳呛迭作，眼泪汪汪，鼻流清
涕，不时喷嚏，便知痧候，宜急用透达清肺之剂，庶使邪毒易泄，迨至眼赤腮红，痧点隐现，尤当以前法为
准，所以使邪毒泄而易畅也。在此时期中，有兼见之症，不一而足，膈闷懊 者宜舒气散结，头痛昏晕
者宜辛散祛风，呕吐呕痰者宜快气消痰，下利泄泻者宜侧重透达，若大便不爽则宜凉润微利，若气急喘满则
宜开肺泄邪，此治痧之初发也。至于痧子发现之后，迭经透达，点已出齐，仍宜辛散之剂以达余蕴，清凉之
剂以保肺脏。然清凉有不可骤下者，若点稀色白，宜养血助气，辛散有不可恒用者，若点密色紫，或暗
而成片，宜清血解毒，至痧回之后，大抵清凉之剂，荡涤余邪，虚弱者宜补益脾胃，此治痧之大概也。
上述痧疹治法，其简易者也，至于痧症有凶险者，不可执一以例之。
（甲）痧疹有不能透表者，一因风寒郁遏，则皮肤干燥，毛
窍竦栗，宜越婢汤、葛根解肌汤之属，甚则气粗喘促，腹中胀
痛，烦扰不宁者，宜越婢汤去枣，重用石膏，或麻杏石甘汤之类。二因火毒炽盛，则头上颗粒，隐隐红紫，
其他各处或有或无，此火毒炽则津液少，以致不能畅透，宜白虎汤加荆芥、玄参之属。三因中气本虚，则唇
色淡白，二便如常，虽有蕴热，无力透达，宜消毒饮加木通、车前、茯苓使内化为主。四因内热深
蓄，燔灼血分，虽透而不齐，但见点子扁阔， 赤成块，块上复有小粒平塌不起，亦有一片如风毒者，颗粒不
尖，二者虽透，然热邪之逗留尚多，防有他变，宜竹叶石膏汤去半夏，使内化为主。
（乙）痧疹有已透表而早没者∶一、外为风寒所遏，邪反内攻而没早者，宜消毒饮加葱头热服，
复透者吉。面本红润而骤变苍白，宜越婢汤去枣，以使复透（按透而早没，邪已在肺，故宣
肺为急，若肺邪不得泄，必致喘满）。二、遍身青紫热肿，喘胀气急者，此毒滞血凝，半匿表肌，宜凉膈散去
芒硝加麻黄、石膏以发越之。三、内挟痰热，火郁不发，或腹胀喘急，不省人事者，宜白虎汤加玄参、竹叶。
四、身热烦满，腹胀喘促，溺涩脐突者，宜凉膈散加葶苈。五、误食酸收之物，致伏匿壮热，喘咳
烦闷者，宜猪胆汁、制甘草煎成续续与之，使得吐，或微汗为止。六、误食辛温，以致喘咳声喑者，宜消毒饮
加石膏、马兜铃之属。凡痧疹出未三日而回者，皆为早没，出一日或半日而没者为凶。
（丙）痧疹有邪毒内陷者，最为危候∶一、痧疹未出之时，仅见发热，未必能断为痧也，然发热一二日，
忽然烦满神昏，惊搐狂妄，此邪毒不易透达，即防内陷之变，宜清里解表并进以治之。二、痧疹旋出即没，
唇焦舌燥，谵语谬妄，此毒陷于胃也，宜犀角解毒汤。三、痧疹搦手摇头，寻衣摸床者，或郑声复语，
侧身静卧者，此毒陷心也，宜至宝、紫雪之类，或天麻、羚羊、
犀黄之属。四、痧疹似透非透，气促而喘，喘而身热，随即面红
见点者易治，喘而咳者易治，若喘而痰声呼呼，咳不得出，喘而张口抬肩，喘而无涕者，皆为毒邪陷肺也。
里热甚者宜竹叶石膏汤（去半夏），冬日量加麻黄以发之，咳不能出，痰不能豁者，宜蝉衣、牛蒡、菖蒲、胆
星、前胡、麻黄之类。便艰者，枳实、大黄皆可酌与。至喘而鼻煽，为肺气将绝，鼻鼾沉睡，为肺气壅
塞，皆属险候。此痧疹重症之大概也。
五、痧疹脉法
痧疹属阳邪，故宜见阳脉。本来阴症见阳脉者吉，阳症见阴脉者危，痧疹尤甚。凡脉之洪、浮、滑、数、
弦皆阳象也，脉之细、涩、沉、伏、迟皆阴象也，故痧疹脉伏，使非热极见阴，即属元气怯弱，脾胃衰败，
均为危症。次之即脉之细弱者，虽非危证，亦防变端。然有不可一概而论者，则其人本属阴脏，脉必一
生常细，或其人脾胃无甚实热，脉亦未必洪数，此则当另求真象于脉外者也。考普通痧疹之脉，大率初起
浮数，继则洪数，热方进者，必见弦大，胃热有积者，必见洪实。至于胃家虚热，多见洪滑，内有痰湿，独
见滑象，血分热极，数而兼促，此其纲也。至部位之分，则右寸独浮大者，常为肺热过甚，左寸独浮数者，
当防热入包络。至于两关宁以较实为佳，左关属肝，左弦当防血热之盛，右关属脾，右弦当防积湿，或胃
热之甚。若言两尺，则命门与肾所属，过于洪大，里热必盛，过于细小，邪毒难透，均
所不利。惟小儿痧疹，大都不全恃乎脉法，然有时不得不取资证书决疑者，因录之以备一格。
六、痧疹舌苔
痧疹大都有苔，其色白者属肺热，色黄者属胃热，黄而腻者为湿，黄而糙者为湿热，纯黑者为心绝，黑
而湿者为热淫血分，黑而燥者为热淫气分，皆为危候。验苔之外，又当验本，痧疹以舌本红者为佳，盖
亦阳证应见阳象之谓也。惟红甚变紫变黑，则为火亢心绝，亦属危症。至部位之分，大都红于尖者心肺热，红
于边者肝胆热，红于根者下焦热，若舌红出血，则急当寒凉清血，舌白不红，则宜保全脾胃也。
七、治痧须知
治病用药，贵乎圆活，临证处方，重乎机变。况痧子一症，病变繁复，轻者着手固易，重者到处荆棘，
故关于痧子之宜忌，痧子之顺逆，不可不一一辨明，俾便临证时有所取舍也。谨录如干条于下。
（一）痧疹只怕不能出，若出尽则毒便解，故治痧疹者，当察时令寒暄以药发之。如时大寒，则用桂
枝、葛根，无汗而不易透者，麻黄亦在所必用也。
（二）痧疹之发，由于阳邪热毒，故已有透露之机，切忌辛温之剂。考辛能助热，温能助毒，故大抵
痧疹欲出之际。虽寒勿用桂枝，虽虚勿用参、术也。
（三）痧疹小而碎，少阴心火也。心肺位于上，心火旺则肺受之，故治痧疹，专以肺为主。咳嗽者，
火炎则肺叶焦举也；鼻流清涕，鼻为肺窍，火逼液流也；目中泪出者，肺热则移于肝，肝开窍于目，故热自肝
之窍泄也。心热者，宜连翘心、栀子心、竹叶卷心、灯芯之属；肝热者菊花、桑叶、钩藤、龙胆之属。至于
肺热，则仍以宣泄为主，非热甚或邪毒陷肺者，禁用寒凉也。
（四）痧疹喜清凉，痘喜温暖，然痧疹初出，亦须温暖托出，是以痧疹禁居阴凉之地，并忌见风。
（五）发热六七日，知是痧疹，却不见出，此皮肤坚浓，腠理闭密，或曾有吐利乃伏也，宜用麻黄汤发之。
（六）痧疹发出，一日即没者，乃为风寒所冲，必至毒邪内陷也。此时如肤白身热不甚者，宜麻黄汤以
发之；如身热烦闷，或谵语闷乱，则毒已内归，宜大青汤、羚羊散之类以清里。
（七）痧疹发热吐利，乃火邪内逼，纯是热症，不可作寒论。上焦多吐，黄芩汤加茅根、芦根、枇杷叶；
下焦多利，黄芩
汤、香连丸；吐利俱作，黄芩汤多加茅根、芦根。
（八）痧疹不忌泻，泄泻为邪有出路也。惟二便不利，颇多凶证，故治法大忌止泻。然不泻者，则不必故
意使泻，以免累及无辜也。
（九）痧疹小便赤涩，在初发热盛时，是为正候，热退则小
便自利，若痧后见之，为余热留恋膀胱，宜导赤散以清之。
（十）痧疹得嚏，最为吉兆。其初起而嚏者，为毒有泄路也；正出时而有嚏者，其候必轻；没后而有
嚏者，则邪毒尽解，可无余患；若嚏而多涕，此浊壅得泄，亦为佳象。至无嚏而鼻塞
不通者，此必有邪毒留滞，不易外达，宜辛凉透达为主。
（十一）痧疹吐虫，此因胃中痰热胶固，虫无所养而上窜也，能食即止。痧疹下虫，此证多见于疹后，因
胃热少食，虫不能安而下也，但须调其饮食自愈。
（十二）痧疹方出，咽喉肿痛，乃毒火上蒸，肺热熏灼所致，宜甘桔汤加玄参、牛蒡、连翘。若咽喉红
肿腐烂，周身斑点如锦纹者，乃血分邪毒沸腾，宜大剂寒凉，以资挽救。
（二十七）苏合香丸：参见前文第四节。
（二十八）琥珀抱龙丸：治疗小儿各种惊风，四季感冒，风寒或温疫邪热引起的烦躁不安，痰多咳嗽气急，以及疮疹欲出未出时的抽搐。常服可祛风、化痰、镇心安神、清热、调和脾胃、补益精神。
药材组成：琥珀、天竺黄、檀香、人参、白茯苓（各一两五钱），生甘草（三两），枳壳、枳实（各一两），朱砂（飞净处理，五两），山药（一斤），胆南星（一两），金箔（一百片）。
遵循古法制成如芡实大小的药丸，用瓦瓶装入麝香一同密封保存，防止香气泄漏。每次服用一至二丸，用葱汤或薄荷汤化开送服。
一、痧疹起源
痧子，越地人称为“痧”，北方人称为“疹子”，秦晋之间称为“糠疮”，南方俗语称为“麸疮”，闽粤之间都叫“麻”。这其实是同一种病却有多个名称。近来吴地人在小儿发病时都称“痧子”，成人发病则称“疹子”。其实无论长幼，凡是初次发出的都叫“痧子”，后来复发的都叫“疹子”。疹与痧虽然属于同一类疾病，但仍有细微区别：痧子皮疹密集且较细，疹子皮疹稀疏且较粗；痧子多因先天胎毒所致，疹子多因后天外感毒邪所致。因此北方人称痧为疹，也有些许偏差。至于疾病的起源，可以概括为“毒”。因为胎儿在母腹中，依靠母亲的气血生存，而每个人难免受到饮食损伤和六淫（风、寒、暑、湿、燥、火）侵袭，潜伏在母体内的毒素，胎儿无不受到影响。而且在受孕之时，精华部分供养胎儿生长，糟粕部分遗弃在胞宫中，日积月累蕴结，足以形成毒素，胎儿终日处于这种环境中，怎能避免被毒素感染？所以胎儿的各组织中，都含有毒素，这是可以断言的。等到出生时，其新陈代谢作用比平时倍增，因此有宣泄毒素的必要。于是有的出生后出现游风丹毒，一时蜂拥而起；有的出生后腮肿口腐，杂然发作，这些都是毒素泄露的表现。然而，那些毒盛且聚集的，自然会随着初生时去毒的方法，通过人力引导向外排出；而那些毒轻且分散的，则一时不易发出，潜伏蕴结在体内，等待时机而动，于是“痧子”这一病症，就成了小儿人人必经的过程。至于痧疹触发的时期，最旺盛于春夏，这是因为时令处于降藏之后，天气发动，地气发泄，时行之邪侵袭于外，蕴藏的毒素遂在内部萌动，所以痧疹的发生，必有诱因，有时一家皆染，有时一地流行，就是这个原因。再者，凡痧子发出，必定密布周身，无孔不入，正因为胎儿各组织中悉含毒素，所以无处不泄。如果有一部位未发，说明该部位的毒素未透达，因此诊断痧疹的人，常常观察是否透发齐全，以此作为施治的标准。
二、痧疹病理
痧疹的发生，既然是人体宣泄邪毒的途径，那么它的发病过程，是由内达外，由血分达到气分，始于脾终于肺。为什么这么说呢？考察中医理论，脾主一身肌肉，肺主一身皮毛。痧疹的发生，既是从肌肉到达肤表，而脾是藏血的脏腑，肺是主气的脏腑，所以知道它是发于血分而达于气分，始于脾终于肺。据此更可推知，当痧疹隐现于皮肤之间时，即为邪毒已外传于肺的证候；若盛大发作之时，则邪毒才全部趋向于肺以寻找出路。如果有发出却不易透达的，是肺气不宣；如果有刚出来就消退的，是肺不能耐受邪气，或者是肺气闭塞。因此治疗痧疹的方法，主要重在肺，痧疹的变证中，以邪毒陷入肺脏最为严重。至于痧疹将退未退之际，尤其应当以清肺为急务，因为残留的余毒未免留恋肺脏，清除它正是为了杜绝后患。由此看来，治疗痧疹自始至终，总离不开肺，这是常规治法。如果遇到变症蜂起，则邪气有不得宣泄而内陷的情况，或者热甚侵犯肝，或者热甚灼伤心，则必须兼用脾、肝、心、肺四脏分别治疗，以权衡轻重。正如古人所说，痧疹这一病症，四脏都会受到伤害。
三、痧疹症状
痧疹将要发出时，起初并没有显著的症状，即使偶尔发热，也不过像寻常感冒而已。随后身体热度更加厉害，口渴而干燥（间或有恶寒者），咳嗽呛逆时常发作，鼻涕眼泪都有，不时打喷嚏，这是痧疹的先兆。像这样的情况，多的持续七八天，少的持续两三天，出现气急烦闷，眼睛红赤，腮部发红，随即出现皮疹点。严重的伴有干呕恶心，或者兼有泄泻，或者兼有呕吐下利。皮疹点初见时不多，按照次序逐渐上升，每隔数小时，热度较高时气息更粗重，痧点也增加。在其高热之时，称为“潮”。潮势严重的，常常疲倦卧床，重的甚至说胡话、神志昏乱。每天发三五次潮（每次潮一次则痧点增多一次），发潮三天则颗粒完全透发，无孔不入，毒素发散干净，自然逐渐退隐。其退隐也是逐渐的，大约三天后，颗粒变平，五六天后则隐没不再见到。当痧疹退隐之后，全身表皮，逐渐更换，严重的周身起落屑状，轻微的也略有如粉屑般的剥落，这是生理自然的作用，不足为奇。至于痧点透齐后，有三四天不退的，或者退了又迟迟不出新的，是因为内有湿热，所以不易消退。痧子颗粒虽然多少不一，大小稍异，但总体以鲜明红润者为佳，颗粒细小突起者为佳。至于颗粒少而大，或者颜色赤紫干燥晦暗，都是火盛毒炽的表现，应当及早预防。如果浑身夹杂红色成片，则为夹斑；如果颜色白，则是血不足；如果颜色黑，则是九死一生之象。而且既然疹退之后，尤其必须谨慎避开风寒，严格戒除劳累，忌口静养，才能没有余留的病恙。否则过早食用辛辣，会导致惊厥抽搐；过早食用盐醋，会导致咳嗽不止；过早尝吃鸡鱼，会导致时行疫病再次发作；不避风寒，会导致皮肤干燥瘙痒，这些都会成为终身的祸患，不可不戒除。
四、痧疹治法
痧疹在未发出之前，未必能断定是痧疹。此时切脉见浮数（襁褓中的婴儿没有明显的脉搏可寻，则用大拇指按其手腕外侧来验证），听其呼吸气息，有时略微粗重，可以给予轻清的解表剂，自然不会出错。盖诸病发热初起，如果不是虚热内伤的类型，大多从表解。只是热有轻重，解表要有分寸。大概热盛而渴而燥的，适宜用辛凉之法；热不甚而烦而闷的，适宜用辛散之法；热而挟湿，湿在上焦的，宜用汗法；湿在下焦的，宜佐以利水法，这是治疗痧疹初起的方法。等到热势很盛之后，咳嗽呛逆接连发作，眼泪汪汪，鼻流清涕，不时打喷嚏，便知道是痧疹先兆，应当急切使用透达清肺的药剂，从而使邪毒容易宣泄。等到眼赤腮红，痧点隐现，尤其应当以前法为准，以便使邪毒宣泄而通畅。在这个时期中，有兼见的症状，不一而足：胸膈闷懊恼的，适宜用舒气散结法；头痛昏晕的，适宜用辛散祛风法；呕吐痰涎的，适宜用快气消痰法；下利泄泻的，适宜侧重透达法；如果大便不爽，则适宜用凉润微利法；如果气急喘满，则适宜用开肺泄邪法，这是治疗痧疹初发的方法。至于痧子发现之后，经过多次透达，点已出齐，仍宜用辛散剂以达出余蕴，用清凉剂以保护肺脏。然而清凉药不可骤下，如果点稀色白，宜养血助气；辛散药不可恒用，如果点密色紫，或暗而成片，宜清血解毒。到痧回之后，大抵用清凉剂荡涤余邪，虚弱者宜补益脾胃，这是治疗痧疹的大概原则。上述痧疹治法，是比较简易的，至于痧症中有凶险的，不可拘执一端来类推。
（甲）痧疹有不能透表的：一因风寒郁遏，则皮肤干燥，毛孔耸立，适宜用越婢汤、葛根解肌汤之类；甚则气粗喘促，腹部胀痛，烦躁不安的，适宜用越婢汤去大枣，重用石膏，或者麻杏石甘汤之类。二因火毒炽盛，则头上颗粒隐隐红紫，其他各处或有或无，这是火毒炽盛导致津液少，以致不能畅透，适宜用白虎汤加荆芥、玄参之类。三因中气本虚，则唇色淡白，二便如常，虽有蕴热，无力透达，适宜用消毒饮加木通、车前子、茯苓，以内化为要。四因内热深蓄，燔灼血分，虽透出不齐，只见点子扁阔，赤色成块，块上又有小粒平塌不起，也有一片如风毒样的，颗粒不尖，二者虽透，但热邪逗留尚多，防有其他变化，适宜用竹叶石膏汤去半夏，以内化为要。
（乙）痧疹有已透表而早没的：一、外为风寒所遏，邪反内攻而早没的，适宜用消毒饮加葱头热服，若能重新透出则吉。面色本红润而骤变苍白，适宜用越婢汤去大枣，以使重新透出（按：透而早没，邪已在肺，故宣肺为急，若肺邪不得宣泄，必致喘满）。二、遍身青紫热肿，喘胀气急的，此乃毒滞血凝，半匿表肌，适宜用凉膈散去芒硝加麻黄、石膏以发越之。三、内挟痰热，火郁不发，或腹胀喘急，不省人事的，适宜用白虎汤加玄参、竹叶。四、身热烦满，腹胀喘促，小便涩脐突的，适宜用凉膈散加葶苈子。五、误食酸收之物，致伏匿壮热，喘咳烦闷的，适宜用猪胆汁、制甘草煎成，徐徐与之，使得吐或微汗为止。六、误食辛温，以致喘咳声哑的，适宜用消毒饮加石膏、马兜铃之类。凡痧疹出未三日而回的，都为早没，出一日或半日而没的为凶。
（丙）痧疹有邪毒内陷的，最为危候：一、痧疹未出之时，仅见发热，未必能断定为痧，但发热一二日，忽然烦满神昏，惊搐狂妄，这是邪毒不易透达，即防内陷之变，适宜清里解表并进以治之。二、痧疹旋出即没，唇焦舌燥，谵语谬妄，这是毒陷于胃，适宜用犀角解毒汤。三、痧疹搦手摇头，寻衣摸床的，或者郑声复语，侧身静卧的，这是毒陷于心，适宜用至宝丹、紫雪丹之类，或者天麻、羚羊角、犀黄之类。四、痧疹似透非透，气促而喘，喘而身热，随即面红见点的易治；喘而咳的易治；若喘而痰声呼呼，咳不得出，喘而张口抬肩，喘而无涕的，皆为毒邪陷肺。里热甚的适宜用竹叶石膏汤（去半夏），冬日量加麻黄以发之；咳不能出，痰不能豁出的，适宜用蝉衣、牛蒡子、菖蒲、胆南星、前胡、麻黄之类。大便艰涩的，枳实、大黄皆可酌情给予。至于喘而鼻煽，为肺气将绝；鼻鼾沉睡，为肺气壅塞，都属于险候。这是痧疹重症的大概情况。
五、痧疹脉法
痧疹属阳邪，所以适宜见到阳脉。本来阴症见阳脉者吉，阳症见阴脉者危，痧疹尤其如此。凡是脉象洪、浮、滑、数、弦都是阳象；脉象细、涩、沉、伏、迟都是阴象。所以痧疹脉伏，如果不是热极见阴，就是元气怯弱，脾胃衰败，均为危症。其次是脉细弱的，虽然不是危证，也要防备变端。然而有不可一概而论的，那就是其人本属阴脏，脉必一生常细；或者其人脾胃无甚实热，脉也未必洪数，这就要在脉象之外另求真象。考察普通痧疹的脉，大致初起浮数，继则洪数，热方进的，必见弦大；胃热有积的，必见洪实。至于胃家虚热，多见洪滑；内有痰湿，独见滑象；血分热极，数而兼促，这是纲领。至于部位之分，右寸独浮大的，常为肺热过甚；左寸独浮数的，当防热入包络。至于两关，宁以较实为佳。左关属肝，左弦当防血热之盛；右关属脾，右弦当防积湿，或胃热之甚。若言两尺，则命门与肾所属，过于洪大，里热必盛；过于细小，邪毒难透，均不利。惟小儿痧疹，大都不全恃乎脉法，但有时不得不取资证书决疑，因此记录以备一格。
六、痧疹舌苔
痧疹大都有苔，其色白的属肺热，色黄的属胃热，黄而腻的为湿，黄而糙的为湿热，纯黑的为心绝，黑而湿的为热淫血分，黑而燥的为热淫气分，都为危候。验苔之外，又当验舌本（舌体根部/整体），痧疹以舌本红者为佳，这也是阳证应见阳象的意思。惟红甚变紫变黑，则为火亢心绝，也属危症。至部位之分，大都红于尖的为心肺热，红于边的为肝胆热，红于根的为下焦热。若舌红出血，则急当寒凉清血；舌白不红，则宜保全脾胃。
七、治痧须知
治病用药，贵在圆活，临证处方，重在机变。况且痧子这一病症，病变繁复，轻者着手固易，重者到处荆棘，所以关于痧子的宜忌、顺逆，不可不一一辨明，以便临证时有所取舍。谨录若干条如下。
（一）痧疹只怕不能出，若出尽则毒便解，所以治痧疹者，应当察时令寒暄以药发之。如时值大寒，则用桂枝、葛根，无汗而不易透的，麻黄也在所必用。
（二）痧疹的发，由于阳邪热毒，所以已有透露之机，切忌辛温之剂。考辛能助热，温能助毒，所以大抵痧疹欲出之际，虽寒勿用桂枝，虽虚勿用参、术。
（三）痧疹小而碎，属少阴心火。心肺位于上，心火旺则肺受之，所以治痧疹，专以肺为主。咳嗽者，火炎则肺叶焦举；鼻流清涕，鼻为肺窍，火逼液流；目中泪出者，肺热则移于肝，肝开窍于目，故热自肝之窍泄。心热者，宜连翘心、栀子心、竹叶卷心、灯芯之类；肝热者菊花、桑叶、钩藤、龙胆之类。至于肺热，则仍以宣泄为主，若非热甚或邪毒陷肺者，禁用寒凉。
（四）痧疹喜清凉，痘喜温暖，然而痧疹初出，亦须温暖托出，是以痧疹禁居阴凉之地，并忌见风。
（五）发热六七日，知是痧疹，却不见出，此皮肤坚浓，腠理闭密，或曾有吐利乃伏也，宜用麻黄汤发之。
（六）痧疹发出，一日即没的，乃为风寒所冲，必至毒邪内陷。此时如肤白身热不甚的，宜麻黄汤以发之；如身热烦闷，或谵语闷乱的，则毒已内归，宜大青汤、羚羊散之类以清里。
（七）痧疹发热吐利，乃火邪内逼，纯是热症，不可作寒论。上焦多吐，黄芩汤加茅根、芦根、枇杷叶；下焦多利，黄芩汤、香连丸；吐利俱作，黄芩汤多加茅根、芦根。
（八）痧疹不忌泻，泄泻为邪有出路。惟二便不利，颇多凶证，故治法大忌止泻。然不泻者，则不必故意使泻，以免累及无辜。
（九）痧疹小便赤涩，在初发热盛时，是为正候，热退则小便自利。若痧后见之，为余热留恋膀胱，宜导赤散以清之。
（十）痧疹得嚏，最为吉兆。其初起而嚏者，为毒有泄路；正出时而有嚏者，其候必轻；没后而有嚏者，则邪毒尽解，可无余患；若嚏而多涕，此浊壅得泄，亦为佳象。至无嚏而鼻塞不通者，此必有邪毒留滞，不易外达，宜辛凉透达为主。
（十一）痧疹吐虫，此因胃中痰热胶固，虫无所养而上窜也，能食即止。痧疹下虫，此证多见于疹后，因胃热少食，虫不能安而下也，但须调其饮食自愈。
（十二）痧疹方出，咽喉肿痛，乃毒火上蒸，肺热熏灼所致，宜甘桔汤加玄参、牛蒡、连翘。若咽喉红肿腐烂，周身斑点如锦纹者，乃血分邪毒沸腾，宜大剂寒凉，以资挽救。
Crush into coarse powder. Take two qian per dose, add fresh ginger and scallion white, decoct with water, and take orally.
(27) Suhexiang Wan (Suhexiang Pill): See Section 4 above.
(28) Hupo Baolong Wan (Amber Embracing Dragon Pill): Treats various types of infantile convulsions (Jing), common colds in all four seasons, and irritability/restlessness caused by wind-cold or warm epidemic pathogenic heat. It also treats phlegm-cough with rapid breathing, and convulsions when sores/rashes are about to erupt. Regular use can dispel wind, resolve phlegm, calm the heart and spirit, clear heat, harmonize the spleen and stomach, and benefit the spirit.
Ingredients: Hu Po (Amber), Tian Zhu Huang (Calculus Boliti), Tan Xiang (Sandalwood), Ren Shen (Ginseng), Bai Fu Ling (Poria), each 1 liang 5 qian; Sheng Gan Cao (Raw Licorice Root) 3 liang; Zhi Qiao (Aurantium Fructus Immaturus), Zhi Shi (Aurantium Fructus Immaturus), each 1 liang; Zhu Sha (Cinnabar, purified) 5 liang; Shan Yao (Dioscoreae Rhizoma) 1 jin; Dan Nan Xing (Arisaematis Cum Bile) 1 liang; Jin Bo (Gold Leaf) 100 pieces.
Follow ancient methods to make pills the size of Euryale seed (Qianshi). Store in a clay bottle with She Xiang (Musk) to prevent loss of aroma. Take one or two pills per dose, dissolved in scallion soup or mint tea.
I. Origin of Sha-Rash
Sha-Zi is called "Sha" by people in Yue, "Zhen-Zi" by people in the North, "Kang Chuang" between Qin and Jin, "Fu Chuang" in southern colloquialisms, and "Ma" in Fujian and Guangdong. It is actually one disease with multiple names. Recently, in Wu region, it is called "Sha-Zi" for children and "Zhen-Zi" for adults. In fact, regardless of age, those erupting for the first time are called "Sha-Zi", while recurrent eruptions are called "Zhen-Zi". Although Zhen and Sha belong to the same category of diseases, there are slight differences: Sha-Zi spots are dense and finer, while Zhen-Zi spots are sparse and coarser. Sha-Zi is mostly due to congenital toxin, while Zhen-Zi is mostly due to acquired toxin. Therefore, northerners calling Sha as Zhen is slightly inaccurate. Regarding the origin of the disease, it can be summarized as "Toxin". Since the fetus relies on the mother's Qi and Blood, and everyone is inevitably affected by dietary injury and Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), toxins latent in the mother's body affect the fetus. At conception, essence nourishes the fetus, while dregs are discarded in the uterus, accumulating over time to form toxins. The fetus resides in this environment and cannot avoid infection. Thus, fetal tissues contain toxins. Upon birth, metabolic activity doubles, necessitating toxin excretion. Some manifest as migratory urticaria or erysipelas immediately after birth; others present with swollen cheeks and mouth ulcers. These are leaks of toxin. However, concentrated toxins naturally exit via postnatal detoxification methods guided by human intervention. Lighter, dispersed toxins remain latent internally, waiting for the right time to move, making "Sha-Zi" a necessary stage for every child. The peak occurrence is in spring and summer, when weather activates and earth qi releases, allowing seasonal pathogens to attack externally and latent toxins to stir internally. Hence, outbreaks often affect families or regions. Furthermore, Sha-Zi must cover the whole body because toxins exist everywhere in the tissues. If any part does not erupt, that area's toxin has not cleared. Therefore, diagnosis relies on whether eruption is complete.
II. Pathology of Sha-Rash
The eruption of Sha-Rash is the body's pathway to expel pathogenic toxins. Its progression is from interior to exterior, from Blood level to Qi level, starting in the Spleen and ending in the Lung. Why? The Spleen governs muscles, and the Lung governs skin and hair. Sha-Rash emerges from muscles to the surface. Since the Spleen stores Blood and the Lung governs Qi, its emergence is from Blood to Qi, starting in Spleen and ending in Lung. When Sha-Rash appears faintly on the skin, it indicates pathogenic toxins have transferred externally to the Lung. During severe eruption, toxins gather in the Lung to find an exit. Difficulty in eruption indicates Lung Qi stagnation; rapid disappearance indicates Lung inability to resist pathogens or Lung Qi blockage. Therefore, treating Sha-Rash focuses primarily on the Lung. The most severe complication is toxin sinking into the Lung. As rash fades, clearing the Lung is urgent to prevent residual toxins lingering. Thus, treatment always involves the Lung, which is the standard method. If complications arise, toxins may sink internally, invade the Liver, or scorch the Heart. Then, simultaneous treatment of Spleen, Liver, Heart, and Lung is required, as ancients stated that Sha-Rash injures all four organs.
III. Symptoms of Sha-Rash
Before eruption, Sha-Rash shows no significant signs. Occasional fever resembles a common cold. Subsequently, fever intensifies, accompanied by thirst and dryness (sometimes aversion to cold), coughing, runny nose, tearing, and sneezing. This is the prodromal stage. It lasts 7-8 days or 2-3 days, followed by rapid breathing, irritability, red eyes, and flushed cheeks, then spots appear. Severe cases include dry heaving, nausea, diarrhea, or vomiting/diarrhea. Initially few spots, they rise sequentially. Every few hours, higher fever brings rougher breathing and more spots. High fever periods are called "Tides". Severe tides cause lethargy or delirium. Tides occur 3-5 times daily (each tide increases spots). After three days of tides, spots fully erupt, toxins exhaust, and fading begins gradually. Spots flatten after three days and disappear after five to six days. Post-fading, skin peels like powder, a natural physiological process. If spots linger or recur, it is due to internal damp-heat. Fine, raised, bright red spots are good. Few, large, dark purple/dry spots indicate excessive fire/toxin, requiring early prevention. Red patches indicate mixed macules; white color indicates blood deficiency; black color indicates critical condition (nine deaths, one life). After fading, avoid wind/cold, rest, and diet control to prevent sequelae. Early spicy food causes convulsions; early salt/vinegar causes chronic cough; early chicken/fish causes recurrence; exposure to wind causes dry/itchy skin. These are lifelong hazards.
IV. Treatment of Sha-Rash
Before eruption, diagnosis is difficult. Pulse is floating and rapid. For infants without distinct pulses, check the radial artery lateral side. Breath may be slightly coarse. Use light, clear exterior-releasing formulas. Most fevers resolve via exterior unless deficient-heat. Heat severity dictates treatment: intense heat/thirst/dryness requires acrid-cool; mild heat/irritation requires acrid-dispersing; heat with upper dampness requires sweating; lower dampness requires diuresis. This is initial treatment. After high fever, with cough, tearing, runny nose, and sneezing, use penetrating and Lung-clearing formulas to facilitate toxin expulsion. When eyes are red and spots appear, continue previous methods to ensure smooth toxin release. Accompanying symptoms require specific treatments: chest oppression needs Qi-moving; headache/dizziness needs wind-dispelling; vomiting phlegm needs Qi-regulating/phlegm-resolving; diarrhea needs penetration focus; constipation needs cooling/moistening; wheezing needs Lung-opening. This is early eruption treatment. After full eruption, use acrid dispersants for remaining pathogens and cooling agents to protect the Lung. Cooling agents should not be used abruptly if spots are sparse/white (nourish blood/Qi); acrid dispersants should not be used continuously if spots are dense/purple (clear blood/resolve toxin). After fading, cooling agents clear residual pathogens; tonify Spleen/Stomach for weakness. This is general treatment. Dangerous cases require flexible approaches.
(A) Sha-Rash failing to erupt:
1. Wind-cold constraint: dry skin, piloerection. Use Yuespi Tang or Gegen Jieji Tang. Severe wheezing/abdominal pain/restlessness: Yuespi Tang minus Jujube, heavy Shigao (Gypsum), or Maxing Shigan Tang.
2. Blazing fire-toxin: reddish-purple spots on head, sparse elsewhere. Fluid deficiency prevents eruption. Use Baihu Tang plus Jingjie, Xuanshen.
3. Middle Qi deficiency: pale lips, normal bowels/bladder, weak eruption despite heat. Use Xiaodu Yin plus Mutong, Cheqianzi, Fuling.
4. Deep internal heat burning Blood: incomplete eruption, flat/wide spots, purple clumps. Use Zhuye Shigao Tang minus Banxia.
(B) Sha-Rash erupting but disappearing early:
1. Wind-cold constraint causing internal attack: Xiaodu Yin plus Scallion Head, taken hot. Re-eruption is auspicious. Pale face after redness: Yuespi Tang minus Jujube. (Note: Early disappearance means toxin in Lung; open Lung urgently).
2. Whole body cyanosis/swelling/wheezing: toxin stagnation/blood coagulation. Liangge San minus Mangxiao plus Mahuang, Shigao.
3. Internal phlegm-heat/fire depression: Baihu Tang plus Xuanshen, Zhuye.
4. Fever/irritation/abdominal distension/wheezing/scanty urine/protruding umbilicus: Liangge San plus Tinglizi.
5. Ingestion of astringents causing hidden fever/wheezing: Pig bile + processed Gancao, administered slowly until vomiting/sweating occurs.
6. Ingestion of acrid-warm substances causing hoarseness: Xiaodu Yin plus Shigao, Muduling.
Any return within three days is early disappearance; returning within one day is ominous.
(C) Sha-Rash with toxin sinking (Critical):
1. Fever only initially, then sudden irritability/coma/convulsions: Toxin fails to erupt, risks sinking. Clear interior and release exterior simultaneously.
2. Rapid eruption/disappearance, dry lips/tongue, delirium: Toxin sinks in Stomach. Xijiao Jiedu Tang.
3. Hand grasping/head shaking, seeking clothes, muttering, lying on side: Toxin sinks in Heart. Zhibao Dan, Zixue Dan, or Tianma, Lingyangjiao, Xihuang.
4. Semi-erupted, shortness of breath/wheezing:
- Wheezing with fever/red face/spots: Easy to treat.
- Wheezing with cough: Easy to treat.
- Wheezing with rattling phlegm/unable to cough out/open mouth/shoulder lifting/no nasal discharge: Toxin sinks in Lung. Heavy interior heat: Zhuye Shigao Tang (minus Banxia), add Mahuang in winter. Phlegm retention: Chan Yi, Niubang Zi, Changpu, Dan Nan Xing, Qianhu, Mahuang. Constipation: Zhishi, Dahuang.
- Nasal flaring: Lung Qi exhaustion. Snoring/sleeping: Lung Qi obstruction. Both are dangerous.
V. Pulse Diagnosis of Sha-Rash
Sha-Rash is Yang pathogen; Yang pulses are favorable. Yin disease with Yang pulse is auspicious; Yang disease with Yin pulse is critical. Hong, Fu, Hua, Shu, Xian are Yang pulses. Xi, Se, Chen, Fu, Chi are Yin pulses. Hidden pulse (Fu) indicates extreme heat-Yin conversion or weak Yuan Qi/Spleen-Stomach failure (critical). Thin/weak pulse warns of complications. Exceptions: Constitutionally Yin-type individuals have thin pulses; those without excess heat may not have rapid pulses. Seek truth beyond pulse. General pattern: Initial floating-rapid; subsequent洪-rapid; advancing heat string-taut/large; Stomach heat accumulation洪-solid. Deficient Stomach heat:洪-slippery; Phlegm-damp: slippery; Extreme Blood heat: rapid-hurried. Location specifics: Right Cun floating-large indicates Lung heat; Left Cun floating-rapid warns of Pericardium heat. Guan pulses should be solid. Left Xian warns of Liver blood heat; Right Xian warns of Spleen damp/Stomach heat. Chi pulses relate to Mingmen/Kidney. Excessive Hong-da indicates strong interior heat; too small indicates difficulty in toxin eruption. Pediatric Sha-Rash relies less on pulse but uses it for confirmation.
VI. Tongue Coating of Sha-Rash
Most have coating. White: Lung heat. Yellow: Stomach heat. Yellow-greasy: Damp. Yellow-rough: Damp-heat. Pure black: Heart exhaustion. Black-wet: Heat invading Blood. Black-dry: Heat invading Qi. All critical. Check tongue body: Red is good (Yang sign). Turning purple/black indicates extreme fire/Heart exhaustion (critical). Location: Tip red = Heart/Lung heat; Edges red = Liver/Gallbladder heat; Root red = Lower Jiao heat. Bleeding red tongue: Urgent cooling-blood. White non-red tongue: Protect Spleen/Stomach.
VII. Notes on Treating Sha-Rash
Treatment requires flexibility. Sha-Rash changes are complex. Clarify indications/contraindications and favorable/unfavorable signs.
(1) Fear of non-eruption. Complete eruption resolves toxin. Adjust herbs by season. Severe cold: Guizhi, Gegen. No sweat/hard eruption: Mahuang essential.
(2) Caution against acrid-warm herbs once eruption begins. Acrid aids heat; Warm aids toxin. Avoid Guizhi even if cold; avoid Renshen, Baizhu even if deficient.
(3) Small/fractured spots indicate Shaoyin Heart Fire. Heart/Lung are superior; Heart fire affects Lung. Focus treatment on Lung. Cough: Fire scorches Lung leaves. Runny nose: Fire forces fluids from Lung orifice. Tearing: Lung heat transfers to Liver (opens to eyes). Heart heat: Lianqiao Xin, Zhizi Xin, Zhuye Juan Xin, Dengxin. Liver heat: Juhua, Sangye, Gouteng, Longdan. Lung heat: Focus on venting. Avoid cold/cool unless severe heat or toxin sinks in Lung.
(4) Sha-Rash prefers cool; Pox prefers warm. But initial Sha-Rash needs warmth to support eruption. Avoid cool places and wind.
(5) Fever 6-7 days, known as Sha-Rash but not erupting: Thick skin, closed pores, or prior vomiting/diarrhea hiding toxin. Use Mahuang Tang.
(6) Erupts and disappears in one day: Wind-cold冲击, toxin sinks. Pale skin/mild heat: Mahuang Tang. Fever/irritation/delirium: Toxin internalized. Daqing Tang, Lingyang San.
(7) Fever/vomiting/diarrhea: Fire forcing inward, pure heat syndrome. Upper Jiao vomiting: Huangqin Tang plus Maogen, Lugeng, Pipaye. Lower Jiao diarrhea: Huangqin Tang, Xianglian Wan. Both: Huangqin Tang plus Maogen, Lugeng.
(8) Diarrhea is not contraindicated; it provides an exit. Obstruction of urine/stool is ominous. Avoid stopping diarrhea. Do not induce diarrhea unnecessarily.
(9) Dark/scanty urine during high fever is normal. Clears when fever subsides. Post-rash appearance: Residual heat in Bladder. Daochi San.
(10) Sneezing is auspicious. Initial sneezing: Toxin has exit. Active eruption sneezing: Mild case. Post-fading sneezing: Toxin resolved. Sneezing with mucus: Turbidity expelled. No sneezing/nasal congestion: Toxin滞留, hard to exit. Acrid-cool penetration.
(11) Vomiting worms: Phlegm-heat in Stomach, worms migrate up. Stops when eating resumes. Passing worms: Post-rash, Stomach heat/low intake, worms descend. Regulate diet.
(12) Sore throat upon eruption: Toxin fire steaming, Lung heat scorching. Ganjie Tang plus Xuanshen, Niubang Zi, Lianqiao. Red/swollen/ulcerated throat with brocade-like spots: Blood-level toxin boiling. Large dose of cold/cool herbs.