痧疹有外袭寒邪。内蕴伏热者。宜两解肺卫之邪。麻杏石甘汤加桔梗薄荷射干牛蒡主之。
蛰庐注。肺有热邪欲发疹。外受风寒。郁于肌表。疹不透达。肺火内燔。最易闭闷发喘。而成危证。用麻杏石甘
开肺。清热加味散表透疹。
风温客于太阴手经。咳嗽咽痛喉哑。兼发疹。治宜辛凉清润。大忌升葛荆防等。当以羚角连翘薄荷大力元参射
干杏仁桔梗象贝银花芦根之类。继以沙参石斛麦冬花粉知母梨浆之属。养肺胃阴。
蛰庐注。火燥伤金若内挟湿火上蒸咽喉作腐者。是烂喉痧证。亦宜辛凉清透。忌辛温升散。亦不宜寒凉苦
降郁遏其邪。
阳明血热。疹色如丹。舌绛如朱。环口燥烈。大渴引饮。脉洪数。宜犀角连翘鲜生地丹皮赤芍元参花粉银花人中
黄等。继以大小甘露出入。以救肺胃。
痧邪余热郁肺。痰多气急咳嗽。宜宣之开之。如栀豉桑杏桔梗枯芩薄荷象贝蒌皮通草芦根之属。
如痧疹虽透。而咳嗽声哑喉痛者。此痧毒不能尽发。郁于气分也。亦宜宣通肺气。如羚角前胡桑杏连翘大力射
干薄荷银花甘桔黄芩芦根之属。
痧 透发不尽。毒邪犯肺。喘急昏闷者。危证也。宜急透之。
蛰庐注。痧郁不透。内郁肺闭。大危之证。非麻黄大开肺气不能救。用石膏清火。杏仁下气。甘草缓急而泻火。
加犀角等提透清化为治。
痧 伏邪未清。致伤阴分而发热不止者。宜甘寒养阴。如沙参玉竹金斛生地丹皮甘草之属。
阴亏之人。感邪发疹。不可过用柴葛升散。缘此证虽表不得汗解。或虽得汗而疹未透。热仍不解。惟清解中兼养
阴液。庶能得汗。而疹亦透达。
白 见于夏秋暑湿伏邪之证。盖暑必挟湿。为粘腻之邪。病多掩牵。迁延两三候。邪未达而元气受伤。发出白 。
色白点细。形如肌粟。摸之触手而微痒。状如水晶珠而明亮滋润者吉。抓破微有水者。乃湿从外出也。出无定期。
热势壮则外见。缓则隐伏。甚至连发八九次。邪不达而身热不退者。由其人元气亏乏。不能化邪外出。故治白
与治疹异。疹宜提透。白 提透无益。当养正生津。清暑渗湿。使正气充旺。则伏邪渐化。而热得退。若 色干白如
枯骨。大凶之证。津液气竭。邪欲外出。元气亦随之外散。乃邪正并脱之候也。
痧疹的病因，有外感寒邪、内蕴伏热两种情况。治疗应当表里双解，疏散肺卫之邪。主方选用麻杏石甘汤（麻黄杏仁甘草石膏汤），并加入桔梗、薄荷、射干、牛蒡子。
蛰庐按语：肺中有热邪欲发为疹，又外受风寒侵袭，导致邪气郁结于肌表，使疹点不能透发。此时肺火在内焚烧，最容易导致肺气闭塞、喘息发作，从而形成危重证候。使用麻杏石甘汤可以开宣肺气、清热，加味后具有解散表邪、透发疹毒的作用。
风温之邪客居于手太阴肺经，出现咳嗽、咽痛、声音嘶哑，兼见发疹。治疗宜用辛凉清润之法。严禁使用升麻、葛根、荆芥、防风等升散药物。应当选用羚羊角、连翘、薄荷、牛蒡子、玄参、射干、杏仁、桔梗、象贝母、金银花、芦根等药物。随后继以沙参、石斛、麦冬、天花粉、知母、梨浆等药物，以滋养肺胃之阴液。
蛰庐按语：若火燥伤及肺金，且内部夹杂湿火上蒸咽喉，导致咽喉腐烂，这是烂喉痧的证候。也适宜用辛凉清透之法，忌用辛温升散，也不宜用寒凉苦降的药物，以免遏制邪气外出。
阳明经血分热盛，疹色红如丹砂，舌质深红如朱砂，口唇周围干燥烈痛，极度口渴引饮，脉象洪大数急。适宜选用犀角、连翘、鲜生地、牡丹皮、赤芍药、玄参、天花粉、金银花、人中黄等药物。随后根据病情出入调整大小甘露消毒丹，以救肺胃之阴。
痧毒余热郁闭于肺，痰多、气急、咳嗽。治疗宜宣通开泄。可选用栀子、豆豉、桑叶、杏仁、桔梗、枯黄芩、薄荷、象贝母、瓜蒌皮、通草、芦根等药物。
如果痧疹虽然已经透发，但仍有咳嗽、声音嘶哑、咽喉疼痛，这是痧毒未能完全发散，郁结在气分所致。也宜宣通肺气。可选用羚羊角、前胡、桑叶、杏仁、连翘、牛蒡子、射干、薄荷、金银花、甘草、桔梗、黄芩、芦根等药物。
痧疹透发不尽，毒邪侵犯肺部，出现气喘急促、神志昏闷者，属于危重证候。应当紧急透发疹毒。
蛰庐按语：痧毒郁结不透，内闭肺气，是极为危险的证候。非用麻黄大力开宣肺气不能挽救。配合石膏清泻火热，杏仁降气，甘草缓急并泻火，再加犀角等药物提升透达、清热解毒，作为治疗方法。
痧疹伏留之邪未清，损伤阴分而导致发热不止者，宜用甘寒药物滋养阴液。可选用沙参、玉竹、金钗石斛、生地黄、牡丹皮、甘草等药物。
素体阴亏之人，感受邪气而发疹，不可过度使用柴胡、葛根等升散药物。因为此证虽然通过发汗不能解除表邪，或者虽然发了汗但疹点仍未透发，热势仍不消退。只有在清解热毒的同时兼顾滋养阴液，才可能出汗，从而使疹点透发。
白㾦（晶亮的小水泡）多见于夏秋季节暑湿伏邪的证候。因为暑邪必定挟带湿气，属于粘腻之邪，病情往往缠绵牵延，持续两三个候（约15天）。邪气未达体表而元气已受伤，发出白㾦。其形态为白色细点，状如小米粒，触摸时有触感且微痒，形状像水晶珠一样明亮滋润，此为吉兆；抓破后有少量水出，说明湿气从体外排出。白㾦出现没有固定时间，热势壮盛时则外现，热势缓和时则隐伏，甚至连续发作八九次。若邪气未达而身热不退，是因为患者元气亏乏，无法将邪气化除并排出体外。因此，治疗白㾦与治疗痧疹不同。痧疹宜提透，而白㾦提透无效，应当扶助正气、生津液，清暑利湿。使正气充盛旺盛，则伏邪逐渐化解，热势得以退去。若白㾦色泽干枯洁白如枯骨，是大凶之证，表示津液和气机枯竭，邪气欲外出而元气也随之外散，这是邪正俱脱的征候。
The etiology of scarlet fever (Sha Zhen) involves external invasion of cold pathogenic factors and internal accumulation of latent heat. Treatment should address both exterior and interior, dispersing pathogenic factors from the Lung and Wei (Defensive) levels. The main prescription is Mahuang Tang with Xingren, Gancao, and Shigao (Mahuang Xinggan Shigao Decoction), added with Jiegeng (Platycodon Root), Bohe (Mint), Yeyan (Belamcanda Rhizome), and Niubangzi (Arctium Fruit).
Zhelu's Note: When there is heat pathogen in the Lung intending to manifest as a rash, but it is externally constrained by wind-cold, the pathogens stagnate at the muscle surface, preventing the rash from emerging. With Lung fire burning internally, it easily leads to closure of the airways and wheezing, resulting in critical conditions. Using Mahuang Xinggan Shigao Decoction opens the Lung Qi and clears heat; with modifications, it disperses the exterior and promotes the eruption of the rash.
When Wind-Warmth pathogens affect the Hand-Taiyin Lung Meridian, symptoms include cough, sore throat, hoarseness, accompanied by a rash. Treatment should employ acrid-cool clearing and moistening methods. It is strictly forbidden to use ascending and dispersing herbs such as Shengma (Cimicifuga Rhizome), Gegen (Pueraria Root), Jingjie (Schizonepeta Spike), and Fangfeng (Saposhnikovia Root). One should select Lingyangjiao (Antelope Horn), Lianqiao (Forsythia Fruit), Bohe (Mint), Danli (Arctium Fruit), Xuanshen (Scrophularia Root), Yeyan (Belamcanda Rhizome), Xingren (Apricot Seed), Jiegeng (Platycodon Root), Xiangbei (Fritillaria Bulb), Yinhua (Honeysuckle Flower), and Lugeng (Reed Rhizome). Subsequently, follow up with Shashen (Glehnia Root), Shihu (Dendrobium Stem), Maidong (Ophiopogon Tuber), Huafen (Trichosanthes Root), Zhimu (Anemarrhena Rhizome), and Pear Juice to nourish the Yin of the Lung and Stomach.
Zhelu's Note: If Fire-Dryness injures the Metal (Lung) and internally harbors Damp-Fire steaming upward to the throat causing ulceration, this is the syndrome of Rotting Throat Scarlet Fever (Lanhou Sha). It also requires acrid-cool clearing and venting. Acrid-warm ascending and dispersing methods are contraindicated, as are cold-bitter descending methods that might suppress the pathogen.
When Yangming Blood Heat is excessive, the rash color resembles cinnabar, the tongue body is deep red like vermilion, the area around the mouth is dry and burning, there is extreme thirst with desire to drink, and the pulse is surging and rapid. Suitable ingredients include Xijiao (Rhinoceros Horn - *note: substitute with water buffalo horn in modern practice*), Lianqiao (Forsythia Fruit), Xianshengdi (Fresh Rehmannia Root), Mudanpi (Moutan Bark), Chishao (Red Peony Root), Xuanshen (Scrophularia Root), Huafen (Trichosanthes Root), Yinhua (Honeysuckle Flower), and Renzhonghuang (Human Feces Carbon). Follow up with modified Da or Xiao Ganlu Xiaodu Dan (Great or Little Sweet Dew Detoxifying Decoction) to rescue the Lung and Stomach Yin.
When residual Sha pathogen heat stagnates in the Lung, causing excessive phlegm, shortness of breath, and cough, treatment should involve diffusing and opening. Options include Zhizi (Gardenia Fruit), Chidou (Fermented Soybean), Sangye (Mulberry Leaf), Xingren (Apricot Seed), Jiegeng (Platycodon Root), Ku Huangqin (Dried Scutellaria Root), Bohe (Mint), Xiangbei (Fritillaria Bulb), Loupi (Trichosanthes Peel), Tongcao (Tetrapanax Pith), and Lugeng (Reed Rhizome).
If the rash has erupted but cough, hoarseness, and sore throat persist, this indicates that Sha toxins have not fully dispersed and are stagnating in the Qi level. It is also appropriate to diffuse and unblock Lung Qi. Options include Lingyangjiao (Antelope Horn), Qianhu (Peucedanum Root), Sangye (Mulberry Leaf), Xingren (Apricot Seed), Lianqiao (Forsythia Fruit), Danli (Arctium Fruit), Yeyan (Belamcanda Rhizome), Bohe (Mint), Yinhua (Honeysuckle Flower), Gancao (Licorice Root), Jiegeng (Platycodon Root), Huangqin (Scutellaria Root), and Lugeng (Reed Rhizome).
If the Sha rash does not fully erupt, and toxic pathogens invade the Lung causing急促 panting, coma, and chest oppression, this is a critical condition. Urgent venting of the rash is required.
Zhelu's Note: When Sha toxins are stagnant and fail to erupt, leading to internal Lung closure, it is a highly critical condition. Only strong opening of Lung Qi by Mahuang can save the patient. Combined with Shigao (Gypsum) to clear fire, Xingren (Apricot Seed) to descend Qi, and Gancao (Licorice Root) to relieve urgency and drain fire, along with Xijiao (Rhinoceros Horn) and others to lift, vent, clear, and transform, constitutes the treatment.
If latent Sha pathogens remain uncleared, damaging the Yin branch and causing persistent fever, sweet-cold Yin-nourishing methods should be used. Options include Shashen (Glehnia Root), Yuzhu (Polygonatum Rhizome), Jinshihu (Dendrobium Stem), Shengdi (Rehmannia Root), Mudanpi (Moutan Bark), and Gancao (Licorice Root).
In individuals with inherent Yin deficiency who contract pathogens and develop a rash, one must not overuse Chaihu (Bupleurum Root) and Gegen (Pueraria Root) for ascending and dispersing. Although this syndrome cannot be resolved through sweating, or even if sweat occurs, the rash may not emerge and heat persists. Only by clearing and resolving heat while simultaneously nourishing Yin fluids can sweat be induced, allowing the rash to emerge.
White miliary eruptions (Bai Mo) often appear in cases of latent Summerheat-Dampness pathogens during summer and autumn. Since Summerheat invariably carries Dampness, which is a sticky and lingering pathogen, the disease tends to drag on for two or three ten-day periods. The pathogen fails to reach the exterior while the Healthy Qi (Yuan Qi) is injured, leading to the emergence of Bai Mo. These present as small white spots, resembling millet grains, tactile upon touch and slightly itchy, looking like bright, moist crystal beads—this is auspicious. If broken, slight fluid exudation indicates dampness exiting the body. There is no fixed timing for their appearance; they manifest when heat is vigorous and hide when heat is mild, potentially recurring eight or nine times. If the pathogen fails to exit and fever persists, it is due to deficient Healthy Qi unable to transform and expel the pathogen. Therefore, treating Bai Mo differs from treating Sha Rash. While Sha Rash requires lifting and venting, lifting and venting is ineffective for Bai Mo. Instead, one should support Righteous Qi, generate fluids, clear Summerheat, and leach out Dampness. When Righteous Qi becomes robust, latent pathogens gradually resolve, and heat subsides. If the Bai Mo appears dry and white like dead bone, it is a dire prognosis, indicating exhaustion of fluids and Qi. The pathogen attempts to exit, but Healthy Qi scatters outward with it, representing a state of simultaneous collapse of Pathogen and Righteous Qi.