壮热不退，宜降火；呕吐烦渴，吐出长虫，宜降火；不食，宜降火；热盛烁金而喘，宜降火；鼻衄，宜降火；小
便不利，宜降火；喉痛腮肿，牙痛口疮，宜降火；牙疳臭烂，宜降火。○麻疹三、四日后，大热不退，宜养阴；
紫点不收，宜养阴；脉来数大，宜养阴；夜热心烦， 齿，宜养阴；音哑不清，宜养阴；目赤羞明，宜养阴；
身痒便燥，宜养阴。○宜升散而不升散，重则
顷成喘闭，轻则余毒淹缠。宜降火而不降火，则肺胃受伤，或音哑烦渴，或牙疳口疮。宜养阴而不养阴，则午
后潮热，肌肤瘦削，渐成疳证。○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，或鼻衄下痢者，脏腑之毒未透出也。○麻痘之毒，由脏腑而
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。○肺主皮毛，麻虽出于
六腑，必从皮毛而解，故不离乎肺。解之不透，久咳潮热，累成麻疳。此疳字非疳积之疳，因其潮热肌瘦，有
似乎疳耳。治宜润肺为主，辛燥药用不得。○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。○养阴退阳，书用四物汤，予少时常习用
之，多不获效，以归、芎辛温之性为不合也。因制生地、丹皮、麦冬、赤芍为麻疹四物汤，节节应手。古方不
必尽泥，师其意可也。○麻后潮热，最为可嫌，发在午后，天明退凉，退时脉平静，发时脉数大，唇红舌赤而
无苔，切牙揉鼻人渐瘦，每多不治。间有能食者，大剂养阴，可救一、二。○胃为受毒之壑，遗热甚多，其急
莫如牙疳。牙疳是失清之证，必须大剂清里。若便闭者可下之，使热毒内泄，与痘后同治。予前集有勒马饮，
甚者加大黄急下之，稍迟不但齿落腮穿，更有唇鼻皆烂者，涂药不过帮扶而已。○麻后音哑者，多由火甚伤金，
治宜甘、桔、牛蒡、山栀之属。麻后口疮，治法同牙疳，臭烂与痘后同治。往年麻证多不损目，迩来有损目者，
其来甚速，二、三日间翳膜遮透，即不能治。缘儿本有肝热，更加郁遏，或病家不知是火，饮以芫荽酒，遂令
热毒攻目。速宜清凉养阴退阳，不可再行疏散。○麻后咯吐脓血腥臭，有肺痈者，有胃痈者，皆肺胃遗毒为患。
循经而出，则为牙疳，着于脏腑，
则为痈也。治当辨其在肺在胃。予用甘、桔、牛蒡、银花、料豆、枳壳、赤芍数味，在肺加山栀、贝母、桑皮，
在胃加生地、花粉、木通以佐之。身无大热者，可治。○问∶牙疳肺痈可治者，何也？此毒已化而出也。毒化
而脏腑不败者可治，脏腑败者不能治也。（《橡村痘诀》）
选案
一儿三岁，病患疟痢，两月未痊，正气大亏，传染出麻。发热咳嗽，麻点隐隐，淡白不见，气不足以息，
目无神，四肢冷。予曰∶麻初见点，原无补法，但此儿正气大虚，又当破格用药。因以荆、防、蝉蜕、前胡各
四分，人参、升麻、甘、桔各三分，加生姜少许，一剂麻透，除升麻加牛蒡，二剂喘定，麻渐退。○张佩西翁孙，
隆冬出麻，发热呕吐，麻点隐隐不透，初用疏托药，呕吐不止，心烦躁渴，加石膏五钱，吐仍不止，共吐长虫
一十八条，忽然昏厥，奄奄欲绝，复切其脉，滑数有力。缘此子胃火本盛，加以红炉密室，叠障重茵，火郁于
内，则肺胃伤，津液竭，以致表气不通，呕甚则虫不安，故随呕而出。其昏闷厥冷者，乃壮火食气，热深厥亦
深。参之唇舌，全是火证，病重药尚轻也。乃用石膏四两，知母、黄连、山栀、花粉各一钱，升、葛、荆、防、
赤芍、牛蒡各六分，芫荽八分，甘草四分，服药后，反令揭去重裘，卧未超时，火势尽发，壮热面赤，麻出
如堆。再剂遍身皆透，热势渐减，药亦当退，乃除荆、防、芫荽、黄连，加入连翘、木通，石膏减半，至晚其
热复甚，心烦躁渴，无可如何，复用黄连、石膏如前数，始得安卧热平。二、三日外，麻色焦紫不退，知其
热甚伤阴，乃用养阴退阳之剂，生地五钱，丹皮、麦冬各三钱，桔梗、牛蒡、栀仁、花粉各一钱，石膏五钱，
甘草五分，守过七朝，计服过石膏二斤，黄连一两。治麻数十年，火证之甚，无过于此，共当时有虑其昏脱者，
欲煎独参汤灌之，非予力主清凉，顷成不救。（许宣治）
壮热不退，应当降火；呕吐且烦渴，吐出长虫，应当降火；食欲不振，应当降火；热势炽盛灼伤肺金导致气喘，应当降火；鼻出血，应当降火；小便不通利，应当降火；咽喉疼痛、腮部肿胀、牙痛、口舌生疮，应当降火；牙龈腐烂发臭，应当降火。○麻疹发病三、四日后，大热不退，应当滋养阴液；紫红色疹点收敛缓慢，应当滋养阴液；脉象来去急促且宏大，应当滋养阴液；夜间发热、心中烦躁、牙齿疼痛，应当滋养阴液；声音嘶哑不清脆，应当滋养阴液；眼睛红赤、畏光，应当滋养阴液；身体瘙痒、大便干燥，应当滋养阴液。○应当使用升散法却未升散，病情重的顷刻间就会形成气喘闭塞，轻的则余毒缠绵难愈。应当使用降火法却未降火，就会损伤肺胃，或者出现声音嘶哑、烦渴，或者牙龈腐烂、口舌生疮。应当滋养阴液却未滋养阴液，就会出现午后潮热，肌肤消瘦，逐渐形成疳证（一种以形体消瘦、饮食异常为特征的儿科病证）。○麻疹发出的总原则是要使邪气从表透发，表气一旦透达，即使里热很盛，通过清热即可痊愈；如果表气未透，毒邪内陷于中焦，门户关闭，此时既不可发表，也不可单纯养阴，多因延误治疗而死。○所谓“表透”，并非仅指皮毛之表，而是要从脏腑深处透出，没有从容不迫的过程，不能算是真正的表透。也有火毒极盛，外表呈现繁密红疹，出疹后仍然发生牙龈腐烂、肺痈的，或者有鼻出血、下痢的，这是脏腑之毒未能透出的缘故。○麻疹和痘疮的毒邪，由脏腑发出，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。○肺主皮毛，麻疹虽然出于六腑，但必须从皮毛而解，所以治疗离不开肺。如果解表不透，久咳不止、午后潮热，最终累成麻疳。这个“疳”字不是疳积病的疳，是因为有潮热肌肉消瘦的症状，看起来像疳病罢了。治疗应当以润肺为主，辛温燥烈的药物不得使用。○解表的药物，作用于阳分、气分，见效快且容易看到效果；化解毒邪的药物，作用于阴分、血分，见效慢且难以迅速成功。《金镜录》中提出的“养阴退阳”四个字，是治疗麻疹的要诀。○关于“养阴退阳”，书中推荐使用四物汤，我年轻时经常习用此方，大多不获效，因为当归、川芎性味辛温，与麻疹病机不合。因此我配制了生地、丹皮、麦冬、赤芍组成的“麻疹四物汤”，疗效显著。古方不必完全拘泥，学习其意旨即可。○麻疹后的潮热，最为令人担忧，发作在午后，天亮后退热变凉，退热时脉象平静，发热时脉象数大，嘴唇红、舌头赤而无苔，磨牙揉鼻，人逐渐消瘦，大多难以治愈。偶尔有能进食的，用大剂量养阴药，可以救活一两个。○胃是受纳毒邪的壅滞之处，遗留的热邪很多，其中最急迫的莫过于牙疳。牙疳是失于清热的证候，必须用大剂量清里热的药物。如果大便闭结的可以攻下，使热毒从内部泄出，这与痘疮后的治疗方法相同。我在前集中有“勒马饮”方，病情严重的加大黄急下，稍晚不但牙齿脱落、腮部穿孔，更有嘴唇鼻子都腐烂的，涂抹外药不过起辅助作用而已。○麻疹后声音嘶哑的，多由火毒过盛损伤肺金所致，治疗适宜用甘草、桔梗、牛蒡子、山栀这一类药物。麻疹后口疮，治疗方法同牙疳，腐烂发臭的与痘疮后治疗方法相同。往年麻疹很少损伤眼睛，近来有损伤眼睛的，发病很快，两三天间翳膜遮盖瞳孔，就不能治愈了。这是因为孩子本来就有肝热，再加上郁遏，或者家属不知道这是火证，喂饮芫荽酒，致使热毒攻目。应当速用清凉养阴退阳的方法，不可再行疏散发散。○麻疹后咯吐脓血腥臭，有肺痈的，有胃痈的，都是肺胃遗留的毒邪为害。顺着经络而出，就形成牙疳；附着在脏腑，就形成痈疽。治疗应当辨别是在肺还是在胃。我用甘草、桔梗、牛蒡子、金银花、绿豆衣、枳壳、赤芍几味药，在肺的加山栀、贝母、桑白皮，在胃的加生地、天花粉、木通来辅助。身上没有大热的，可以治愈。○问：牙疳和肺痈可治的原因是什么？这是因为毒邪已经化解并排出体外。毒邪化解且脏腑未败坏的可治，脏腑败坏的不能治。（出自《橡村痘诀》）
选案
一个三岁儿童，患有疟疾和痢疾，两个月未痊愈，正气大亏，传染出麻疹。发热咳嗽，麻疹隐现，颜色淡白不见，气息不足以喘息，眼神无神，四肢冰冷。我说：麻疹初见疹点，原本没有补益之法，但这个孩子正气大虚，又当破格用药。于是用荆芥、防风、蝉蜕、前胡各四分，人参、升麻、甘草、桔梗各三分，加少许生姜，一剂药后麻疹透发，除去升麻加入牛蒡子，二剂药后气喘平息，麻疹逐渐消退。○张佩西老先生的孙子，隆冬时节出麻疹，发热呕吐，麻疹隐现不透，起初用疏托药，呕吐不止，心中烦躁口渴，加入石膏五钱，呕吐仍不止，共吐出长虫十八条，忽然昏厥，奄奄一息，再次切脉，脉象滑数有力。因为这个孩子胃火本盛，加上处于红炉密室之中，层层铺垫重褥，火郁结于内，导致肺胃受伤，津液枯竭，以致表气不通，呕吐剧烈则虫不安宁，所以随呕吐而出。他出现的昏闷厥冷，乃是壮火食气，热深厥亦深的表现。参看他的唇舌，全是火证，病重药轻啊。于是用石膏四两，知母、黄连、山栀、天花粉各一钱，升麻、葛根、荆芥、防风、赤芍、牛蒡子各六分，芫荽八分，甘草四分，服药后，反而让他揭去厚重的裘皮，躺卧不到一小时，火势全部发散，壮热面赤，麻疹如堆般发出。再剂药后遍身皆透，热势渐减，药力也应当减退，于是除去荆芥、防风、芫荽、黄连，加入连翘、木通，石膏减半，到了晚上热势又甚，心中烦躁口渴，无可奈何，再次复用黄连、石膏如前的剂量，才得以安卧热平。二、三日后，麻疹颜色焦紫不退，知道是热甚伤阴，于是用养阴退阳的药剂，生地五钱，丹皮、麦冬各三钱，桔梗、牛蒡子、栀子仁、天花粉各一钱，石膏五钱，甘草五分，坚持过了七个朝日，共计服用石膏二斤，黄连一两。治疗麻疹数十年，火证之严重，没有超过这个病例的，当时大家都担心他会昏脱死亡，想要煎独参汤灌服，幸亏我力主清凉之法，否则顷刻间就不救了。（许宣治）
High fever that does not subside requires Fire-Reducing (Jiang Huo); vomiting with irritability and thirst, expelling long worms, requires Fire-Reducing; anorexia requires Fire-Reducing; excessive heat scorching Metal (Lung) causing wheezing requires Fire-Reducing; epistaxis requires Fire-Reducing; difficult urination requires Fire-Reducing; sore throat, mumps, toothache, mouth ulcers require Fire-Reducing; foul-smelling rotting gums require Fire-Reducing. ○ After three to four days of Measles (Ma Zhen), if high fever persists, Yin-Nourishing (Yang Yin) is indicated; if purple spots fail to retract, Yin-Nourishing is indicated; if the pulse is rapid and large, Yin-Nourishing is indicated; night fever, mental restlessness, and toothache require Yin-Nourishing; hoarseness and unclear voice require Yin-Nourishing; red eyes and photophobia require Yin-Nourishing; body itching and dry stool require Yin-Nourishing. ○ If Rising and Dispersing (Sheng San) methods should be used but are not, severe cases may quickly develop wheezing and closure, while mild cases suffer from lingering residual toxins. If Fire-Reducing methods should be used but are not, Lung and Stomach will be injured, leading to hoarseness and irritability/thirst, or gum rot and mouth ulcers. If Yin-Nourishing methods should be used but are not, afternoon tidal fever, emaciation of skin and flesh, and gradual development of Gan Syndrome (a pediatric condition characterized by malnutrition and digestive dysfunction) will occur. ○ The general principle for Measles eruption is to vent through the Exterior (Biao). Once the Exterior is vented, even if Interior Heat is severe, clearing it can lead to recovery; if the Exterior is not vented, toxins sink inward, closing the gates, making both Exterior-releasing and Yin-nourishing ineffective, often leading to death due to delay. ○ "Exterior venting" does not merely refer to the skin and hair level, but must emerge from the Zang-Fu organs. Without a leisurely process, it cannot be considered true Exterior venting. There are cases where Fire-Toxin is extremely severe, presenting with dense red rashes externally, yet still developing gum rot or Lung Abscess after eruption, or suffering from epistaxis and dysentery; this indicates that the toxin within the Zang-Fu has not been vented out. ○ The toxin of Measles and Smallpox originates from the Zang-Fu and emerges outward. Although it reaches the Exterior, its root remains in the Interior. "Jie" (Resolve) refers to resolving from the Exterior, while "Hua" (Transform) refers to transforming from the Interior. If the Exterior is resolved but the Interior is not transformed, many subsequent complications arise. ○ The Lung governs the skin and hair. Although Measles emerges from the Six Fu Organs, it must be resolved through the skin and hair, so treatment cannot depart from the Lung. If Exterior resolution is incomplete, chronic cough and tidal fever may accumulate into Ma-Gan (Measles-related Gan syndrome). This "Gan" character does not refer to Gan Accumulation disease, but implies similarity to Gan syndrome due to tidal fever and emaciation. Treatment should focus on Moisten-Lung (Run Fei); acrid-drying herbs must not be used. ○ Exterior-resolving herbs act on the Yang aspect and Qi aspect, yielding fast and obvious effects; toxin-transforming herbs act on the Yin aspect and Blood aspect, yielding slow and difficult-to-achieve effects. The four characters "Nourish Yin and Retreat Yang" (Yang Yin Tui Yang) from *Jin Jing Lu* are the key secret to treating Measles. ○ Regarding "Nourish Yin and Retreat Yang," the book recommends Si Wu Tang (Four Substance Decoction). In my youth, I frequently used it but rarely achieved efficacy because the acrid-warm nature of Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) was incompatible. Therefore, I formulated a "Measles Si Wu Tang" using Sheng Di Huang (Rehmanniae Radix), Dan Pi (Moutan Cortex), Mai Dong (Ophiopogonis Radix), and Chi Shao (Paeoniae Radix Rubra), which responded effectively at every stage. Ancient formulas need not be rigidly adhered to; learning their intent is sufficient. ○ Post-measles tidal fever is most concerning. It occurs in the afternoon, subsides with coolness at dawn, with a calm pulse during remission and a rapid-large pulse during flare-ups. Red lips, red tongue without coating, teeth grinding, nose rubbing, and progressive emaciation indicate poor prognosis. Occasionally, patients who can eat may be saved with large doses of Yin-nourishing agents. ○ The Stomach is the reservoir receiving toxins, retaining much residual heat. The most urgent among these is Gum Rot (Ya Gan). Gum Rot is a syndrome resulting from failure to clear heat, requiring large doses of Interior-clearing herbs. If constipation is present, purgation can be used to drain heat and toxins internally, similar to post-smallpox treatment. In my previous collection, there is Le Ma Yin (Horse-Restraining Drink); for severe cases, Da Huang (Rhei Radix et Rhizoma) is added for urgent purgation. Delayed treatment leads not only to tooth loss and perforated cheeks, but also rotting lips and nose; topical applications only provide auxiliary support. ○ Post-measles hoarseness is mostly caused by excessive Fire damaging Metal (Lung). Treatment should use Gan Cao (Glycyrrhizae Radix), Jie Geng (Platycodonis Radix), Niu Bang Zi (Arctii Fructus), and Shan Zhi (Gardeniae Fructus). Post-measles mouth ulcers are treated similarly to Gum Rot; foul rot is treated like post-smallpox conditions. In past years, Measles rarely damaged the eyes; recently, eye damage has occurred rapidly, with nebulae covering the pupil within two to three days, rendering it incurable. This is because the child originally had Liver Heat, compounded by depression, or the family mistakenly fed Coriander Wine (Yan Sui Jiu) not recognizing it as a Fire syndrome, allowing Heat-Toxin to attack the eyes. Immediate cooling, Yin-nourishing, and Yang-retreating methods are required; dispersing and diffusing methods must not be used again. ○ Post-measles expectoration of purulent, bloody, and foul-smelling sputum indicates either Lung Abscess or Stomach Abscess, both caused by residual toxins in the Lung and Stomach. Emerging along the meridians leads to Gum Rot; attaching to the Zang-Fu leads to Abscesses. Treatment must distinguish whether the pathology is in the Lung or Stomach. I use Gan Cao, Jie Geng, Niu Bang Zi, Jin Yin Hua (Lonicerae Japonicae Flos), Dou Chi (Sojae Semen Praeparatum), Zhi Ke (Aurantii Fructus), and Chi Shao. For Lung involvement, add Shan Zhi, Bei Mu (Fritillariae Bulbus), and Sang Bai Pi (Mori Cortex); for Stomach involvement, add Sheng Di Huang, Hua Fen (Trichosanthis Radix), and Mu Tong (Akebiae Caulis) as adjuvants. Cases without high fever are treatable. ○ Question: Why are Gum Rot and Lung Abscess treatable? Because the toxin has transformed and exited. If the toxin transforms and the Zang-Fu remain intact, it is treatable; if the Zang-Fu are ruined, it is incurable. (From *Xiang Cun Dou Jue*)
Selected Case 1
A three-year-old child suffered from Malaria and Dysentery for two months without recovery, severely depleting Zheng Qi (Upright Qi), and subsequently contracted Measles. Symptoms included fever, cough, faint measles spots, pale colorless rash, insufficient breath, spiritless eyes, and cold limbs. I stated: Initially, when measles spots first appear, tonification is generally contraindicated. However, given this child's severe Zheng Qi deficiency, extraordinary measures are needed. I prescribed Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Chan Tui (Cicadae Periostracum), and Qian Hu (Peucedani Radix), each 4 fen; Ren Shen (Ginseng Radix), Sheng Ma (Cimicifugae Rhizoma), Gan Cao, and Jie Geng, each 3 fen; plus a small amount of Sheng Jiang (Zingiberis Rhizoma Recens). After one dose, the measles vented. Removing Sheng Ma and adding Niu Bang Zi, after two doses, wheezing ceased, and the measles gradually receded. ○ The grandson of Elder Zhang Peixi developed Measles in deep winter with fever and vomiting. The measles spots were faint and failed to vent. Initial use of dispersing and supporting herbs failed to stop vomiting. Irritability and thirst increased, and Shi Gao (Gypsum Fibrosum) 5 qian was added, but vomiting persisted, expelling eighteen long worms. Suddenly, he fainted and appeared near death. Re-palpation revealed a slippery, rapid, and forceful pulse. This child had inherent Stomach Fire, exacerbated by staying in a hot room with heavy bedding, causing Fire to stagnate internally, injuring Lung and Stomach, and exhausting fluids. This blocked the Exterior Qi. Severe vomiting disturbed the worms, causing them to exit. His fainting and cold limbs resulted from Strong Fire consuming Qi and Deep Heat causing Deep Cold (Re Shen Jue Shen). Examination of lips and tongue confirmed a Fire syndrome; the disease was severe, but the medication was too light. I prescribed Shi Gao 4 liang, Zhi Mu (Anemarrhenae Rhizoma), Huang Lian (Coptidis Rhizoma), Shan Zhi, and Hua Fen, each 1 qian; Sheng Ma, Ge Gen (Puerariae Lobatae Radix), Jing Jie, Fang Feng, Chi Shao, and Niu Bang Zi, each 6 fen; Yan Sui (Coriandri Fructus) 8 fen; Gan Cao 4 fen. After taking the medicine, he was instructed to remove heavy furs. Within an hour, the Fire fully erupted, presenting with high fever, red face, and stacked-like measles eruption. After a second dose, the whole body vented, heat decreased, and the prescription was adjusted by removing Jing Jie, Fang Feng, Yan Sui, and Huang Lian, adding Lian Qiao (Forsythiae Fructus) and Mu Tong, and halving the Shi Gao. By evening, heat surged again with irritability and thirst. Desperate, I reused Huang Lian and Shi Gao at previous dosages, finally allowing him to sleep peacefully with reduced heat. Two to three days later, the measles remained dark purple and scorched, indicating Heat severely damaging Yin. I then used a Yin-Nourishing and Yang-Retreating formula: Sheng Di Huang 5 qian, Dan Pi and Mai Dong, each 3 qian; Jie Geng, Niu Bang Zi, Zhi Ren (Gardeniae Semen), and Hua Fen, each 1 qian; Shi Gao 5 qian; Gan Cao 5 fen. Over seven days, he consumed 2 jin of Shi Gao and 1 liang of Huang Lian. In decades of treating Measles, no Fire syndrome was more severe than this case. Everyone feared he would faint and collapse, suggesting Du Shen Tang (Single Ginseng Decoction) for infusion. Fortunately, I insisted on cooling methods; otherwise, he would have died instantly. (Xu Xuanzhi)