麻疹浮小。而有头粒。非如发斑。成片一色。方其初起。必先发热。都似伤寒。而有分别。鼻流清涕。咳嗽嚏泄。
眼胞微肿。泪汪盈睫。或呕或利。红及腮颊。此麻疹候。汗下不必。按此诸症。乃为肺疾。亦属天行。传染而得。身热
之后。其出最捷。一拥而来。六时渐没。其没贵迟。期两三日。热清毒退。乃为上吉。亦有出迟。三日始灭。亦有没早。
顷刻无迹。皆由热毒。肤浓而合。恐生他变。至不可测。及其既退。调护宜密。切须忌口。风寒莫及。疹后变生。最易
咳逆。毒流肺窍。气喘吸吸。或成痨瘵。骨蒸羸怯。毒淫脾肾。渐至骨立。或频泻利。青黄夹杂。毒流肠胃。气虚难接。
或口生疮。牙龈烂黑。毒深入肝。奄奄命绝。此四大症。疹后易涉。慎勿轻视。致令危急。按症寻求。治之以法。
钱乙曰。麻疹形症亦同。有如发风 疙瘩。拥起如云头。色赤成斑。随见随没者。有如粟米头 。三番俱见而不没。
至三日后方收渐没者。然皆谓麻疹。其于欲出未出之际。当用发表药发之。则易出易愈也。有发热至十余日始见者。大
抵主在发散肺经之热毒。始事也。调理补养病后之元气。终事也。其或兼风兼痰兼食。随宜加对症药。
万全曰。疹小而碎。少阴心火也。心肺位乎上。心火旺则肺受之。治疹专以肺为主。观咳嗽者。火炎则肺叶焦举也。
鼻流清涕者。鼻为肺窍。以火烁金而液自流也。目中泪出者。肺热则移于肝。肝之窍在目也。或手掐眉目唇鼻及面者。
肺热症也。疹子只怕不能得出。若出尽则毒便解。故治疹者。发热时。当察时令寒暄。以药发之。如时大寒。以桂枝葛
根汤发之。大热。以升麻葛根汤合人参白虎汤发之。不寒不热。以荆防败毒散发之。如兼疫疠时行之气。则以人参败毒
散发之。
闻人 曰。麻疹初出。全类伤寒。发热咳嗽。鼻塞面肿。涕唾稠粘。全是肺经之症。有末传泄利者。有一起即兼泄
利者。肺与大肠相表里。表里俱病也。惟不可触冒风寒。及于正蒸热时啖食。能变轻为重。不可不慎。
朱震亨曰。斑驳疹毒之病。是肺胃热毒。熏发于皮肤。状如蚊蚤所咬也。
李 曰。疹者。如粟米。微红。隐隐皮肤不出。作痒。全无痛处。麻子最小。隐隐如麻子。顶平软不碍指。即有清
水。痘多挟疹同出。麻亦多挟疹同出。故曰痘疹麻疹。麻疹以升麻葛根汤加葱白、紫苏。乃麻疹
初起之神方。或苏葛汤亦佳。或以加味败毒散表之。汗后身凉。红痕自灭。麻不出而喘者死。变成黑斑者死。麻疹后。
余毒内攻。循衣摸床。谵语神昏者死。
史演山曰。疹喜清凉。痘喜温暖。人皆知之。然疹子初出。亦须和暖。则易出。所以发苗之初。只要发出得尽。则
其毒便解。大抵疹欲出已出之际。虽寒。勿用桂枝。虽虚。勿用参术。虽呕而有痰。勿用半夏、南星。
王肯堂曰。发热六七日。知是疹子。却不见出。此皮肤坚浓。腠理闭密。又或为风寒袭之。曾有吐利。乃伏也。急
用托里发表之剂。麻黄汤调柏墨散发之。外用胡荽酒麻蘸遍身刮之。疹子发热。或自汗。或鼻衄者。不须止之。亦发散
之义。疹子发热吐利。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
芩汤送香连丸。中焦吐利俱多。黄芩汤多加茅根。芦根。调六一散。滞下。加味黄芩汤调六一散。疹出之时。咽喉肿痛。
乃毒火上熏。勿作喉痹治。甘桔汤加元参、牛蒡、连翘。或射干鼠粘子汤。疹色喜通红。若淡白者。心血不足。养血化
斑汤。色太红。或紫殷者。血热也。或出太暴者。并宜大青汤。黑者死。疹既出。热盛不减。此毒壅遏。大青汤解其表。
便涩者。黄连解毒汤合白虎汤解其里。大便不通。四顺清凉饮。疹后热不除。忽发搐。不可与急惊同论。用导赤散加人
参、麦冬、送安神丸。大热未退。不可与食。与伤寒同。
龚信曰。当以葱白汤饮之。其麻自出。如渴。只宜葱白汤以滋其渴。使毛窍中常微润可也。过三日不没者。内有实
热。犀角地黄汤解之。
翁仲仁曰。麻疹与痘疮。始似终殊。原同症异。痘疮发于五脏。麻疹出于六腑。然麻疹一症。先动阳分。而后归于
阴经。故标属阴。而本属阳。其热也。气与血分相搏。故血多虚耗。其治也。先发散行气。而后滋阴补血。凡动气燥悍
之药。皆不可下也。
鳌按。翁氏此说。已举麻疹之原由症治。包括详尽。名论也。
凡看麻疹之法。多于耳后顶上腰眼先见。其颗大而不长。其形小而匀净。既出。色紫红干燥暗晦。乃火盛毒炽。宜
六一散解之。四物汤换生地加柴、芩、翘、葛、牛蒡、红花等。滋阴凉血。而热似除。所谓养阴退阳之义也。如疹出。
见风早没。不清爽者。宜消毒饮。加发散之药。虽不复出。亦寻愈矣。
吐桂曰。疹属阳腑经邪。初起必从表治。症见头痛喘咳。气粗呕逆。一二日即发者轻。三五日者重。阳病七日外。
隐伏不透。邪反内攻。喘不止。必腹痛胀秘闷危矣。治宜苦辛清热。凉膈去硝黄。方书谓足阳明胃疹。如云布密。或大
颗如痘。但无根盘。又谓手太阴肺疹。但有点粒。无片片者。用辛散解肌。冬月无汗。壮热喘急。用麻杏。如华盖散、
三拗汤。夏月无汗。用辛凉解肌。葛根、前胡、薄荷、防风、香薷、牛蒡、枳壳、桔梗、木通之属。古人以表邪口渴。
即加葛根。以其升胃津。热甚烦渴。用石膏辛凉解肌。无汗忌用。连翘辛凉。翘出众草。能升能清。最利幼科。治小儿
六经诸热。疹宜通泄。泄泻为顺。下痢五色者亦无妨。惟二便不利。最多凶症。治法大忌止泻。痧本六气客邪。风寒暑
湿。必从火化。痧既外发。世人皆云邪透。孰谓出没之际。升必有降。胜必有复。常有痧外发。身热不除。致咽哑龈腐。
喘急腹胀。下痢不食。烦躁昏沉。竟以告毙者。皆属里症不清致变。须分三焦受邪孰多。或兼别病累瘁。须细体认。上
焦药用辛凉。中焦苦辛寒。下焦咸寒。春令发痧从风温。夏季从暑风。暑必兼湿。秋令从热烁燥气。冬月从风寒。痧疳
湿盛热蒸。口舌咽喉疳蚀。若不速治。有穿腮破颊。咽闭喘促。告毙矣。治之宜早。外治另用专方。若汤药方法。必轻
淡能解上病。或清散亦可。痧痢乃热毒内陷。与伤寒协热邪尽则痢止同法。忌升提。忌补涩。轻则分利宣通。重则宜用
苦寒解毒。
鳌按。方书名麻疹者。北人单谓之疹。吴人谓之痧子。浙人谓之喑子。名各不同。其实则一也。痧疹虽由肺胃
间毒。毕竟是肺经所发之疾。故方书言手太阴肺疹。但有点粒无片片者。今时所患。皆是点粒分明者也。至方书言
足阳明胃疹。如云布密。恐是斑毒。故一片如云密布。且斑毒之发。亦由阳明郁热毒蒸所致。痧不发于胃。而专发
于肺也。即使痧毒内陷。或亦入胃入脾入肝入肾。各有变症。然此是痧发不透后。其毒转注之脏腑经络。非初发之
经也。方书谓胃疹者。古人每斑疹二字连用。其谓胃疹。当即是斑。其谓肺疹。乃是痧子。即麻疹也。叶氏以痧宜
通泄。泄泻为顺云云。夫痧固宜通泄。然太泄痢。又恐毒之下注者未尽。而毒之外发者。复因下泄而多阻滞。
以致毒陷益深。泻痢愈不止。正气遂日益虚。此际正难措手。然叶氏忌升提忌补涩二语。又为痧痢金科玉律。切不
可犯。则于此而斟酌求治。惟以解毒为主。兼散肠间郁积。而肺大肠表里。肠间之郁积清。肺经之毒自解。却不可
犯胃气以绝生气。
麻疹的皮疹浮起且细小，有明显的颗粒感，不像发斑那样成片呈现单一颜色。在疾病刚开始发作时，必定先出现发热症状，看起来很像伤寒病，但两者是有区别的。患者会出现流清鼻涕、咳嗽、打喷嚏、腹泻等症状；眼睑微微肿胀，眼泪汪汪充满睫毛；有时伴有呕吐或腹泻，面色红赤波及腮部和脸颊。这是麻疹的典型征候。此时既不需要用发汗法，也不需要使用泻下法。根据这些症状来看，这属于肺系的疾病，也属于具有传染性的时行疫病，通过接触传染而得病。
在身体发热之后，皮疹出得最快，一下子全部涌出，大约六个时辰（十二小时）后逐渐消退。皮疹消退宜迟不宜急，通常需要两三天时间，等到热退毒消，才是上等的吉兆。也有出疹较慢的，要三天才完全消退；也有消退过早的，顷刻间就无迹可寻。这都是因为热毒炽盛，皮肤腠理致密导致皮疹闭合，恐怕会产生其他不可预测的变证。等皮疹已经消退，护理应当严密，务必忌口，避免受风寒侵袭。麻疹之后容易引发咳嗽气逆，这是因为毒邪流入肺窍，导致气喘呼吸急促，甚至可能演变成虚劳痨瘵，出现骨蒸潮热、身体消瘦虚弱等症状。如果毒邪侵犯脾肾，会逐渐导致身体极度消瘦；或者频繁腹泻，大便青黄夹杂，这是毒邪流入肠胃，导致气虚难以接续。或者口腔生疮，牙龈腐烂发黑，这是毒邪深入肝脏，会导致生命垂危。这四种严重症状是麻疹后期容易出现的，千万不要轻视，以免导致病情危急。应当根据症状寻求治疗方法。
钱乙说：麻疹的形状和症状虽然相似，但有的像风团疙瘩，隆起如云头，颜色红赤成斑，随见随没；有的像粟米头，反复出现三次都不消退；直到三天后才开始收敛逐渐消退。这些都称为麻疹。在皮疹想要出来 yet 还没出来的时候，应当使用发表药来发散，这样皮疹就容易发出且容易痊愈。有发热十多天才见到皮疹的，大体上主要在于发散肺经的热毒，这是治疗初期的事务；调理补养病后的元气，是治疗后期的事务。如果有兼夹风邪、痰湿或食积的情况，根据具体情况加入对症的药物。
万全说：皮疹小而碎，与少阴心火有关。心和肺位于人体上部，心火旺盛则会灼伤肺金。治疗麻疹专门以肺为主。观察那些咳嗽的患者，是因为火炎上炎导致肺叶焦枯；流清鼻涕的，是因为鼻为肺之窍，火热灼烧肺金导致津液自流；眼中流泪的，是因为肺热移于肝，肝之窍在目。或者用手抓挠眉毛、眼睛、嘴唇、鼻子及面部的，也是肺热的症状。治麻疹只怕皮疹不能透发出来，如果出尽了，毒邪自然解除。所以治疗麻疹，在发热的时候，应当观察时令的寒暖，用药发散。如果时令大寒，用桂枝葛根汤发散；大热，用升麻葛根汤合人参白虎汤发散；不寒不热，用荆防败毒散发散。如果兼夹疫疠时行之气，则用人参败毒散发散。
闻人龙说：麻疹初起，完全类似伤寒，出现发热、咳嗽、鼻塞、面部肿胀、鼻涕唾液稠粘等症状，全是肺经的症状。有的后来传变为泄利，有的从一开始就兼有泄利。肺与大肠相表里，表里同时生病。只不可触犯风寒，以及在正蒸发热时进食，否则能使轻症变为重症，不可不谨慎。
朱震亨说：斑驳疹毒这类病，是肺胃热毒熏蒸发于皮肤，形状像被蚊子跳蚤叮咬一样。
李梴说：疹子像粟米，微红，隐隐约约在皮肤下出不来，感到瘙痒，完全没有疼痛之处。麻子最小，隐隐约约像麻子，顶端平坦柔软不碍手指，即使有清水流出。痘多挟带疹子一起发出，麻也多挟带疹子一起发出，所以说痘疹麻疹。麻疹初期用升麻葛根汤加葱白、紫苏，这是麻疹初起的神方。或者苏葛汤也很好。或者用加味败毒散发散。出汗后身体凉爽，红色痕迹自然消失。麻不出而且喘息的会死，变成黑斑的会死。麻疹后，余毒内攻，出现循衣摸床、胡言乱语、神志昏迷的会死。
史演山说：疹子喜欢清凉，痘子喜欢温暖，人们都知道。然而疹子初出，也需要温和保暖，这样容易发出。所以在发苗之初，只要发出得尽，其毒邪便解。大体上在疹子欲出已出之际，虽然是寒证，不要用桂枝；虽然是虚证，不要用参术；虽然有呕吐且有痰，不要用半夏、南星。
王肯堂说：发热六七天，知道是疹子，却不见发出，这是因为皮肤坚厚，腠理闭密，又或被风寒袭击，曾经有吐利，这是伏邪。急用托里发表的药剂，用麻黄汤调柏墨散发散。外用胡荽酒蘸遍全身刮拭。疹子发热，或者自汗，或者鼻出血的，不需要止住，这也是发散的意思。疹子发热吐利，是火邪内逼，纯是热症，不可当作寒证论治。上焦多呕吐，用黄芩汤加茅根、芦根、枇杷叶；下焦多泄利，用黄芩汤送服香连丸；中焦吐利都多，用黄芩汤多加茅根、芦根，调服六一散。滞下（痢疾），用加味黄芩汤调服六一散。疹出之时，咽喉肿痛，是毒火上熏，不要当作喉痹治疗，用甘桔汤加元参、牛蒡、连翘。或者射干鼠粘子汤。疹色喜欢通红，如果淡白的，是心血不足，用养血化斑汤；颜色太红，或紫暗的，是血热，或者出得太暴烈的，都适宜用大青汤。黑色的会死。疹既发出，热势盛大不减，这是毒邪壅遏，用大青汤解其表；小便涩滞的，用黄连解毒汤合白虎汤解其里；大便不通的，用四顺清凉饮。疹后热不退，忽然发生抽搐，不可与急惊风同论，用导赤散加人参、麦冬，送服安神丸。大热未退，不可进食，这与伤寒相同。
龚信说：应当用葱白汤饮用，其麻自出。如果口渴，只宜用葱白汤来滋润口渴，使毛孔中常保持微润即可。过三天不消退的，内有实热，用犀角地黄汤解之。
翁仲仁说：麻疹与痘疮，开始相似最终不同，起源相同症状各异。痘疮发于五脏，麻疹出于六腑。然而麻疹一症，先动阳分，而后归于阴经，所以标属阴，而本属阳。其发热时，气与血分相搏，所以血多虚耗。其治疗，先发散行气，而后滋阴补血。凡是动气燥悍的药物，都是不可用的。
沈金鳌按：翁氏的这个说法，已经列举了麻疹的原由和症治，包括详尽，是著名的论述。
凡看麻疹的方法，多于耳后、头顶、腰眼先见到。其颗粒大而不长，形状小而匀净。既出之后，颜色紫红干燥暗晦，这是火盛毒炽，宜用六一散解之。用四物汤换生地加柴胡、黄芩、连翘、葛根、牛蒡、红花等，滋阴凉血，而热势似乎消除。这就是所谓“养阴退阳”的意义。如果疹子一出，见风早没，不清爽的，宜用消毒饮，加发散之药。虽然不再复出，也会寻找痊愈之道。
吐桂说：疹属于阳腑经邪，初起必须从表治。症见头痛、喘咳、气粗、呕逆，一二日即发的轻，三五日发的重。阳病七日外，隐伏不透，邪反内攻，喘息不止，必然腹痛胀满便秘闷绝，危险了。治疗宜用苦辛清热，凉膈散去硝黄。方书说足阳明胃疹，如云布密，或大颗如痘，但没有根盘。又说手太阴肺疹，只有点粒，没有片片者，用辛散解肌。冬月无汗，壮热喘急，用麻杏，如华盖散、三拗汤。夏月无汗，用辛凉解肌，葛根、前胡、薄荷、防风、香薷、牛蒡、枳壳、桔梗、木通之类。古人认为表邪口渴，就加葛根，因为它能升胃津。热甚烦渴，用石膏辛凉解肌，无汗忌用。连翘辛凉，翘出众草，能升能清，最利于儿科。治小儿六经诸热。疹宜通泄，泄泻为顺，下痢五色者也无妨。惟独二便不利，最多凶症。治法大忌止泻。痧本是六气客邪，风寒暑湿，必从火化。痧既外发，世人皆云邪透，孰谓出没之际，升必有降，胜必有复。常有痧外发，身热不除，导致咽哑龈腐，喘急腹胀，下痢不食，烦躁昏沉，竟然因此告毙的。这都是属里症不清导致变证。须分三焦受邪孰多，或兼别病累及憔悴。须细体认。上焦药用辛凉，中焦苦辛寒，下焦咸寒。春令发痧从风温，夏季从暑风，暑必兼湿，秋令从热烁燥气，冬月从风寒。痧疳湿盛热蒸，口舌咽喉疳蚀，若不速治，有穿腮破颊，咽闭喘促，告毙矣。治之宜早。外治另用专方。若汤药方法，必轻淡能解上病，或清散亦可。痧痢乃热毒内陷，与伤寒协热邪尽则痢止同法。忌升提，忌补涩。轻则分利宣通，重则宜用苦寒解毒。
沈金鳌按：方书中称麻疹的，北方人单称之为疹，吴地人称之为痧子，浙江人称之为喑子，名称各不相同。其实则是同一回事。痧疹虽然由肺胃间毒引起，毕竟是肺经所发之疾。所以方书言手太阴肺疹，只有点粒无片片者。今时所患，皆是点粒分明者也。至于方书言足阳明胃疹，如云布密，恐怕是斑毒，所以一片如云密布。且斑毒之发，亦由阳明郁热毒蒸所致。痧不发于胃，而专发于肺也。即使痧毒内陷，或亦入胃入脾入肝入肾，各有变症。然此是痧发不透后，其毒转注之脏腑经络，非初发之经也。方书谓胃疹者，古人每斑疹二字连用，其谓胃疹，当即是斑。其谓肺疹，乃是痧子，即麻疹也。叶氏以痧宜通泄，泄泻为顺云云。夫痧固宜通泄，然太泄痢，又恐毒之下注者未尽，而毒之外发者，复因下泄而多阻滞，以致毒陷益深，泻痢愈不止，正气遂日益虚。此际正难措手。然叶氏忌升提忌补涩二语，又为痧痢金科玉律，切不可犯。则于此而斟酌求治，惟以解毒为主，兼散肠间郁积，而肺大肠表里，肠间之郁积清，肺经之毒自解，却不可犯胃气以绝生气。
Measles rashes float and are small, with distinct granular heads, unlike macules (maculae) which appear as patches of uniform color. At the initial stage, fever must occur first; it resembles cold damage (Shanghan) but is distinguishable. Symptoms include clear nasal discharge, coughing, sneezing, and diarrhea. The eyelids swell slightly, and tears fill the eyes. There may be vomiting or diarrhea, and redness spreads to the cheeks and malar regions. These are signs of measles. Neither sweating nor purging methods are required at this stage. Based on these symptoms, this is a disease of the Lung system and also belongs to epidemic contagious diseases, acquired through transmission.
After the body heat rises, the rash appears most rapidly, emerging all at once, and gradually fades within six shi (approximately twelve hours). It is preferable for the rash to fade slowly rather than quickly; it should take two to three days. When the heat clears and the toxin recedes, it is considered an auspicious outcome. Some cases have a slow eruption, taking three days to disappear; others fade too early, leaving no trace in an instant. This is due to intense heat-toxin causing the skin pores to close tightly, which may lead to unpredictable complications. After the rash has subsided, care must be meticulous. One must strictly observe dietary restrictions and avoid wind-cold invasion. Post-measles complications easily involve cough and asthma, as the toxin flows into the Lung orifices, causing wheezing and rapid breathing, potentially evolving into consumptive tuberculosis (Lao Zhai), characterized by bone-steaming fever, emaciation, and weakness. If the toxin invades the Spleen and Kidney, it leads to extreme emaciation; or frequent diarrhea with green and yellow mixed stools, indicating toxin flowing into the intestines and stomach, causing Qi deficiency that is difficult to restore. Oral ulcers and blackened, rotting gums indicate toxin deeply invading the Liver, leading to imminent death. These four severe conditions are prone to occur after measles; do not underestimate them, lest they become critical. Treatment should follow appropriate methods based on symptom analysis.
Qian Yi stated: The shape and symptoms of measles are similar, but some resemble wind-induced urticaria plaques, rising like cloud tops, red and patchy, appearing and disappearing instantly; some resemble millet grains, appearing repeatedly three times without fading, only starting to recede after three days. All are called measles. During the interval when the rash desires to emerge but has not yet done so, dispersing medicines should be used to facilitate eruption, making it easier to heal. In cases where fever persists for over ten days before the rash appears, the primary focus is on dispersing heat-toxin from the Lung Meridian during the initial phase; regulating and tonifying the post-illness Yuan Qi is the final phase. If there are concurrent Wind, Phlegm, or Food Stagnation, add symptomatic herbs accordingly.
Wan Quan stated: Small and fragmented rashes relate to the Fire of the Shaoyin Heart. The Heart and Lung reside in the upper Jiao; excessive Heart Fire affects the Lung. Treatment of measles focuses primarily on the Lung. Coughing indicates Fire flaming upward causing the Lung lobes to dry and wither. Clear nasal discharge occurs because the nose is the orifice of the Lung, and Fire scorching Metal causes fluids to flow freely. Tears from the eyes occur because Lung Heat transfers to the Liver, whose orifice is the eye. Scratching eyebrows, eyes, lips, nose, and face are also signs of Lung Heat. The main concern in treating measles is ensuring the rash erupts fully; once fully erupted, the toxin resolves. Therefore, during fever, one must observe seasonal temperature variations to choose dispersing herbs. In severe cold, use Guizhi Gegen Tang (Cinnamon Twig and Pueraria Decoction); in severe heat, use Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) combined with Renshen Baihu Tang (Ginseng White Tiger Decoction); in mild conditions, use Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins). If accompanied by epidemic qi, use Renshen Baidu San (Ginseng Powder to Overcome Toxins).
Wenren Long stated: Measles initially resembles cold damage, presenting with fever, cough, nasal congestion, facial swelling, and thick sticky sputum, all being Lung Meridian symptoms. Some later develop diarrhea, while others present with diarrhea from the onset. The Lung and Large Intestine are exterior-interior pairs, so both are diseased. One must avoid wind-cold exposure and eating during peak fever, as this can turn mild cases severe.
Zhu Zhenheng stated: Mottled rash toxins are caused by Lung and Stomach heat-toxin steaming onto the skin, resembling bites from mosquitoes or fleas.
Li Chen stated: Rashes resemble millet, are slightly red, hidden under the skin, cause itching, and have no pain. "Ma" (smallpox-like rash) is smallest, hidden like hemp seeds, flat and soft to the touch, possibly with clear fluid. Smallpox often accompanies rashes, and measles often accompanies rashes, hence the term "Douzhen Ma". For early-stage measles, Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) with Congbai (Scallion Stem) and Zisu (Perilla Leaf) is a divine formula. Su Ge Tang is also good, or Jiawei Baidu San (Modified Powder to Overcome Toxins) for dispersion. After sweating, if the body cools and red marks vanish, it is good. Death occurs if measles do not erupt and asthma develops, or if black spots form. Death also occurs if residual toxin attacks internally after measles, causing picking at clothes, delirium, and coma.
Shi Yanshan stated: Rashes prefer coolness, while pustules prefer warmth. However, early-stage rashes require warmth to facilitate eruption. Once fully erupted, the toxin resolves. Generally, during the emergence phase, even if cold, do not use Guizhi (Cinnamon Twig); even if deficient, do not use Renshen (Ginseng) and Baizhu (Atractylodes); even if vomiting with phlegm, do not use Banxia (Pinellia) and Nanting (Arisaema).
Wang Kentang stated: Fever for six to seven days indicates measles, but if it does not erupt, it is due to dense skin and closed pores, or wind-cold invasion, or prior vomiting/diarrhea indicating latent pathogen. Urgently use formulas that support interior and disperse exterior, such as Mahuang Tang (Ephedra Decoction) mixed with Baimo San (Black Ink Powder). Externally, apply Huixu Jiu (Coriander Wine) and scrape the body. Sweating or epistaxis during measles fever need not be stopped, as this is part of the dispersing process. Fever with vomiting/diarrhea indicates internal逼迫 by Fire Evil, purely a heat syndrome, not cold. For upper Jiao vomiting, use Huangqin Tang (Scutellaria Decoction) with Maogen (Imperata Rhizome), Lugen (Reed Rhizome), and Pipaye (Loquat Leaf). For lower Jiao diarrhea, use Huangqin Tang with Xianglian Wan (Fragrant Coptis Pill). For middle Jiao vomiting and diarrhea, use Huangqin Tang with more Maogen and Lugen, mixed with Liuyi San (Six-to-One Powder). For dysentery, use Jiawei Huangqin Tang with Liuyi San. Sore throat during eruption is due to toxic fire ascending; treat with Ganjie Tang (Licorice and Platycodon Decoction) plus Yuanshen (Scrophularia), Niubangzi (Arctium Seed), and Lianqiao (Forsythia), or Shegan Niuzibangzi Tang (Belamcanda and Arctium Decoction). Reddish rash is preferred; pale white indicates insufficient Heart Blood, treat with Yangxue Huaban Tang (Nourish Blood and Resolve Macules Decoction). Deep red or purple indicates Blood Heat, or violent eruption, treat with Daqing Tang (Isatis Decoction). Black indicates death. If high fever persists after eruption, toxin is blocked; use Daqing Tang to resolve the exterior. If urine is scanty, use Huanglian Jiedu Tang (Coptis Detoxification Decoction) combined with Baihu Tang (White Tiger Decoction) to resolve the interior. If constipated, use Sishun Qingliang Yin (Four-Obedience Cooling Drink). Post-measles fever with sudden convulsions is not acute wind-stroke; use Daochi San (Guide Out Red Powder) with Renshen and Maidong, sending Anshen Wan (Calming Spirit Pill). Do not eat while high fever persists, same as cold damage.
Gong Xin stated: Drink Congbai Tang (Scallion Decoction) to induce eruption. If thirsty, only use Congbai Tang to moisten, keeping pores slightly moist. If not resolving after three days, there is excess internal heat; use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to resolve it.
Weng Zhongren stated: Measles and smallpox start similarly but end differently; origins are same, symptoms differ. Smallpox arises from the Five Zang organs, measles from the Six Fu organs. Measles first moves in the Yang divisions, then returns to Yin meridians; thus, its manifestation is Yin, but its root is Yang. During fever, Qi and Blood struggle, leading to Blood depletion. Treatment first disperses and moves Qi, then nourishes Yin and tonifies Blood. Drugs that move Qi aggressively are contraindicated.
Shen Jin'ao commented: Mr. Weng's theory comprehensively covers the etiology and treatment of measles, constituting a famous discourse.
In observing measles, signs often first appear behind the ears, on the crown, and in the waist-kidney area. The granules are large but not elongated, small and uniform. After eruption, if the color is purple-red, dry, dark, and dull, it indicates excessive Fire and intense toxin; treat with Liuyi San (Six-to-One Powder). Use Siwu Tang (Four Substances Decoction) replacing Shudi with Shengdi, adding Chaihu, Huangqin, Lianqiao, Gegen, Niubangzi, Honghua, etc., to nourish Yin and cool Blood, eliminating heat—this is the meaning of "nourishing Yin to retreat Yang." If the rash disappears early upon exposure to wind and is not clear, use Xiaodu Yin (Detoxification Drink) with dispersing herbs. Although it may not re-emerge, recovery will follow.
Tu Gui stated: Rashes belong to exterior pathogens of Yang Fu meridians; initial treatment must be from the exterior. Symptoms include headache, asthma, cough, coarse breath, and vomiting. Eruption within one to two days is mild; three to five days is severe. If Yang disease persists beyond seven days without clear eruption, the pathogen turns inward, causing unceasing asthma, abdominal pain, distension, constipation, and danger. Treatment should use bitter-pungent clearing heat, such as Liangge San removing Xiaoshi and Dahuang. Formulas state that Foot-Yangming Stomach rashes are dense like clouds or large like pustules but lack roots. Hand-Taiyin Lung rashes have only granules, not patches. Use pungent-dispersing muscle-relaxing methods. In winter, with no sweat, high fever, and asthma, use Mahuang Xingren formulas like Huagai San or Sansao Tang. In summer, use pungent-cool muscle-relaxing methods with Gegen, Qianhu, Bohe, Fangfeng, Xiangru, Niubangzi, Zhike, Jiegeng, Mutong, etc. Ancients added Gegen for thirst due to exterior pathogen to raise Stomach fluids. For severe heat-thirst, use Shigao (Gypsum) for pungent-cool dispersion; contraindicated if no sweat. Lianqiao is pungent-cool, superior among herbs, capable of ascending and clearing, best for pediatrics. Treating six-meridian heat in children. Rashes should be purged; diarrhea is favorable; dysentery with five colors is acceptable. Only difficulty in urination and defecation indicates fatal prognosis. Purging diarrhea is strictly forbidden. Sha originates from six climatic evils, transforming into Fire. When Sha erupts externally, people say the pathogen penetrates, but emergence involves descent and reversal. Often, external Sha eruption fails to reduce fever, leading to hoarseness, gum rot, asthma, abdominal distension, dysentery, anorexia, irritability, and coma, resulting in death. This is due to unclear interior syndromes. Differentiate which Jiao is affected most. Upper Jiao uses pungent-cool; Middle Jiao uses bitter-pungent-cold; Lower Jiao uses salty-cold. Spring Sha follows Wind-Warmth; Summer follows Summer-Wind (dampness included); Autumn follows Heat-Dryness; Winter follows Wind-Cold. Sha-Guan with damp-heat steaming causes oral-pharyngeal erosion; if not treated quickly, it leads to cheek perforation, airway closure, and death. Treat early. External treatments use specific formulas. Internal decoctions should be light and bland to resolve upper diseases, or clearing and dispersing. Sha-dysentery is heat-toxin sinking internally, treated similarly to cold damage with協熱 dysentery where stopping occurs when evil is exhausted. Avoid ascending and astringent methods. Mild cases use separating and promoting circulation; severe cases use bitter-cold detoxification.
Shen Jin'ao commented: Formulas call it "Meashei"; Northerners call it "Zhen", Wu people call it "Sha Zi", Zhejiang people call it "Yin Zi". Names differ, but essence is one. Sha-Zhen originates from Lung-Stomach toxin but is primarily a Lung Meridian disease. Thus, formulas mention Hand-Taiyin Lung rashes having only granules. Current cases show distinct granules. Formulas mention Foot-Yangming Stomach rashes dense like clouds, likely referring to Ban Du (Macule-Toxin), which forms patches due to Yangming郁热毒蒸. Sha does not originate from Stomach but specifically from Lung. Even if Sha toxin sinks internally, affecting Stomach, Spleen, Liver, Kidney, these are transformations after incomplete eruption, not the initial meridian. Ancient texts linking "Ban" and "Zhen" imply "Stomach Zhen" refers to Ban, and "Lung Zhen" refers to Sha/Measles. Ye Tianshi stated Sha should be purged, diarrhea is favorable. While Sha should be purged, excessive diarrhea risks incomplete downward expulsion of toxin and blocking upward eruption, deepening toxin entrapment and worsening diarrhea, depleting Zheng Qi. At this point, treatment is difficult. However, Ye's warning against ascending/astringent methods is a golden rule for Sha-dysentery. Treatment should focus on detoxification, dispersing intestinal stagnation. Since Lung and Large Intestine are exterior-interior, clearing intestinal stagnation resolves Lung toxin, without harming Stomach Qi to preserve life force.