夫痘疮出自五脏,五脏属阴,故头面宜先见,稀少者为佳。麻疹出自六腑,六腑属
阳,故头面宜多见,成粒淡者为愈。痘疮贵三四次陆续出者为佳,麻疹则贵一齐涌尽而
便觉者为妙。凡以火照之,遍身如涂朱之状者。此乃将出之兆,其形细密,见点鲜红,
与痘疮密者相似,但疹子随出随没,非若痘子以渐长大也。粒粒成疮,非若斑之皮红成
片如蚊密之迹也。然疹痘之色,不可同论,痘色最厌繁红而疹偏喜通红,盖疹发于心,
红者,火之正色也,若色淡白者,是心血不足也,宜养血化斑汤主之。如色太红艳,或
微紫者,是血热也。或出太甚者,并宜大青汤主之。若色黑者,是死症也。如勿鼻血
者,邪从衄解,反为佳兆。
夫疹之妆出,似痘似斑,不必言矣。更有变蒸发热,常见红点者,此腠理开而肌肉
嫩,血分有热,系沸腾见于肌肉也。是虽似疹,治法但宜调和气血而不必疏表也。惊风
愈时,亦见红点者,此气血己和,邪气将散,乃愈兆也。皮肤痒极,搔之肿浓块若云
头者,此风热挟湿,为丹为风,并皆不在疹例也。凡发热而即出者必疹,发热而难出者
必痘,可见毒之深浅也。然从来疹出,以六时为准,朝出暮回,夕形旦没,何今之出,
或热二三日,或四五日,及其没也。必待二三日,或三四日者,何欤?盖昔人淡泊节
爱,腑毒原轻,故虽感时毒易透易回,今人膏粱爆炙,寒暄素逆,禀元则薄,受毒偏
深,是以稍有所触,则势便沉 ,故疹同也,惟人异耳。若疹后入热不退,变成痧
痨,况疹初发,血分大伤,余毒久热,残阴益竭。若不大为壮水,焉能以制阳光。
痘疮源于五脏,五脏属阴,所以痘疮通常先在头面部出现,出得稀疏才是好现象。麻疹源于六腑,六腑属阳,所以麻疹在头面部出现较多,颗粒淡红则是痊愈的征兆。痘疮以分三四次陆续出齐为佳,而麻疹则以一齐涌出并随即消退为妙。凡是经火光照射,全身像涂了朱砂一样的状态,这是疹子即将发出的征兆。其形态细密,出现的点鲜红,与密集的痘疮相似,但疹子是随出随没,不像痘疮那样逐渐长大。颗粒分明形成疮疡,不像斑疹那样皮肤发红成片如蚊子叮咬的痕迹。然而疹和痘的颜色不能一概而论,痘色最忌讳繁复的红艳,而疹子则偏爱通体通红。因为疹发于心,红色是火的本色。如果颜色淡白,说明心血不足,宜用养血化斑汤主治。如果颜色太红艳,或微微发紫,说明血热。或者疹子发出过多的,都宜用大青汤主治。如果颜色发黑,属于死症。如果不流鼻血,邪气通过鼻衄(鼻出血)解除,反而算是佳兆。
疹子的发出,看起来像痘又像斑,这不必多说了。更有变蒸发热时,常见红点的,这是因为腠理开泄而肌肉娇嫩,血分有热,表现为热气沸腾见于肌肉表面。这虽然看似疹子,但治法只宜调和气血,而不必使用疏解表邪的方法。惊风病愈时,也会出现红点,这是气血已经调和,邪气将要消散,是痊愈的征兆。皮肤极度瘙痒,抓挠后肿起脓块状如云头的,这是风热挟带湿气,成为丹毒或风疹,都不在疹子的范畴内。凡发热后立即出的必然是疹,发热后难出的必然是痘,可见毒素深浅不同。然而历来认为疹子的发出,以六个时辰为标准,早晨出来傍晚回去,晚上显现早晨消失。为什么现在的疹子,有的发热两三天才出,有的四五天,等到消退时,也要等两三天或三四天呢?这是因为古人生活淡泊节制,脏腑毒素原本轻微,所以即使感受时行毒邪也容易透出和消退;现代人饮食肥甘厚味、煎炸烧烤,寒暑失调,先天元气薄弱,受毒较深,所以稍微有所触动,病情就深沉潜伏。因此疹是一样的,只是人的体质不同罢了。如果疹子之后余热不退,变成痧痨,况且疹子初发时,血分大伤,余毒久热,残存的阴液更加枯竭。如果不大力滋补肾水(滋阴),怎么能制约亢盛的阳热(虚火)。
Smallpox originates from the five zang organs (solid organs), which belong to Yin; therefore, it should first appear on the head and face, with a sparse eruption being auspicious. Measles originates from the six fu organs (hollow organs), which belong to Yang; therefore, it should appear more abundantly on the head and face, with pale granules indicating recovery. Smallpox is considered optimal when it erupts successively over three or four stages, whereas measles is considered miraculous when it erupts all at once and then quickly subsides. When illuminated by fire, if the entire body resembles a coating of cinnabar, this is a sign that the rash is about to emerge. The morphology is fine and dense, with bright red spots appearing, resembling dense smallpox, but unlike smallpox which gradually enlarges, these rashes appear and disappear simultaneously. They form distinct granular sores, unlike macules where the skin turns red in patches like mosquito bites. However, the color of measles and smallpox cannot be discussed identically. Smallpox most abhors a complex, bright redness, while measles prefers a uniform thorough redness. This is because measles emanates from the Heart; red is the true color of Fire. If the color is pale white, it indicates insufficiency of Heart Blood, and one should primarily administer Yangxue Huaban Tang (Blood-Nourishing Macule-Transforming Decoction). If the color is too bright red or slightly purple, it indicates Heat in the Blood. In cases of excessive eruption, Daying Tang (Great Blue Decoction) should be used for all such conditions. If the color is black, it signifies a fatal condition. If there is no epistaxis (nosebleed), the pathogenic factor resolves through nasal discharge, which is actually an auspicious sign.
The emergence of measles resembles both smallpox and macules, which needs no further elaboration. Furthermore, during fever caused by transformation and evaporation, red spots are commonly seen. This occurs because the couli (pores/skin texture) are open and the muscles are tender, with Heat in the Blood manifesting as boiling heat visible on the muscle surface. Although this resembles measles, the treatment method should only focus on harmonizing Qi and Blood, without the need to release the exterior. When convulsions due to wind (Jingfeng) subside, red spots may also appear; this indicates that Qi and Blood have harmonized and the pathogenic factor is dissipating, serving as a sign of recovery. If the skin itches extremely, and scratching results in swollen, purulent lumps resembling cloud patterns, this is Wind-Heat combined with Dampness, manifesting as erysipelas or urticaria, neither of which falls under the category of measles. Generally, fever followed immediately by eruption indicates measles, while fever followed by difficulty in eruption indicates smallpox, revealing the depth of the toxin. Historically, the eruption of measles was standardized within six shichen (twelve-hour periods); emerging in the morning and receding by evening, appearing at dusk and disappearing by dawn. Why do current cases take two or three days of fever before eruption, or even four to five days, and require two to three or three to four days to resolve? This is because ancients lived simply and moderately, possessing light internal toxicity; thus, even when contracting seasonal toxins, they were easily transmitted and resolved. Modern people consume rich, greasy, fried foods, suffer from irregular climate adaptation, have thin innate vitality, and harbor deeper toxins. Therefore, upon slight contact, the condition becomes deep and latent. Thus, the measles are the same, but the individuals differ. If residual heat persists after measles, transforming into sha-lao (sha-tuberculosis), considering that the initial eruption severely injures the Blood, and prolonged residual heat exhausts the remaining Yin, how can one control the hyperactive Yang without vigorously nourishing Water (Kidney Yin)?