舌胎 舌者心之苗。麻本火候。心属于火。故舌多有胎。白为肺热。黄为胃热。但当清解疏
利。更参外证而为施治。纯黑为心绝。黑而湿者。热淫血分。黑而燥者。热淫气分。皆为危候。
并宜白虎汤。湿者。加生地黄、黑参。燥者。加麦冬、竹叶。黑色渐退者吉。不退者死。
口疳 牙疳腐烂。是热留阳明。余毒上冲所致。加味清胃散加石膏、荆芥。大便秘者。当归
散微利之。外用栗根白皮煎汤漱净。以无比散。或烧盐散吹之。如通龈色白者。自外延入内者。
无脓血者。齿落口臭者。喘促痰鸣者。皆为不治。若满口唇舌黄赤白烂。独牙龈无恙者。此为口
疮。非牙疳也。亦胃中余热未尽。毒壅上焦。二便必多艰涩。导赤散以泻心脾之火。外以绿袍散
敷之。
腹痛 腹痛之由不一。总为火毒内郁。或风寒壅遏。或饮食停滞。皆能致痛。于发热正出时。
风寒壅遏。毒反内攻
而腹痛者。急与疏表。麻透自已。若饮食过伤。腹满胀痛者。力为消导。其痛自除。时当正没。
没未尽而腹痛者。兼清中外。而痛自止。没后见者。分利余热。其痛自愈。又须验其有无他证。
属虚属实而与治之。若热邪内结而腹痛者。通利大便为主。有麻后脾气不调而致腹胀。面目四肢
浮肿。分利小水为要。至若元气大虚。阴阳不能升降。小水不利。遍身浮肿。喘促兼见者难治。
便秘 大便秘结。火壅血燥而耗津液。麻疹大非所宜。无论日期前后。速宜清润。四顺清凉
饮。甚则凉膈散以通利之。慎勿迟延。恐麻变焦紫而难救也大抵麻疹自出至没。二便俱不宜秘。
秘即微利可也。
溺涩 小便赤涩。在初热正出时。热邪涩渗。是为正候。没后见之。为余热下匿膀胱。导赤
散加麦冬以滋气化。利之仍不通者。必大便秘郁之故。大便一通。小便自利。
痢 麻之作痢。为热邪内陷。在正没或没后而痢下色白者。黄芩汤加防风、枳壳。下脓血者。
白头翁汤去黄柏加防风。或因食积而滞下者。枳壳汤加楂、柏、木通。腹中作胀。时痛时止者。
浓朴汤。亦有泻久而成痢者。干姜黄芩黄连人参汤。自始至终痢不彻者。必有风毒留滞于内。则
宜解毒行滞。而兼疏风实脾。庶几克应。如痢下紫黯如痈脓。如屋漏水。如鸡肝色。如黑豆汁之
类。加之气喘躁渴。热甚发呃。噤口不食。麻色紫晦者。皆死不治。
下虫 下虫多见于没后。此以胃热少食。虫不能安而下也。与过食伤中。虫不能容而下不同
。但须调其饮食自愈。非上出之比。不须治之。
睡 麻疹正出时。精神困倦。沉睡不醒者为逆。盖缘正气亏损。邪火内郁。正气不胜所致。
若没后而沉睡不醒者。
为气血俱虚。补脾养血为要。如没后烦扰而反不得寐。是余火复燃。急需滋养阴血。虚阳自敛。
亦有昏睡不知起止。掐其颊车合谷不知疼痛。似寐非寐。无问正出没后。良非吉兆。当察其兼见
何证。而与施治可也。
不食 不食是胃中邪热炽盛。不可强与。虽数日不食。亦无妨害。在初发正出时。白虎汤
加荆芥。麻透热清。自有食也。没后不能食。石斛清胃散。量加健运之味。元气委顿者。急需培补
。防有虚羸之患。
鼻扇 鼻扇者。肺将绝也。若兼喘满痰鸣。此必不治。如咽喉清利。无喘满而精神不减者可
治。宜滋培肺气为主。没后见者死。
胸高 麻疹胸高肺热炽盛而胀也。多见于正没没后。为肺经坏证。不治。
身冷 麻为肺胃邪热所发。本属于阳。肢体常宜温暖。若反清冷如冰。是为逆也。其有没后
遍体温凉如故。独下体厥冷过膝者为肾败。不治。如初出腰以下不热。毒不能透。而反渐没者。
亦为逆候。急当温养脾肾。或有得生者。
妊娠 麻属火候。最易堕胎。若初发正出时。须验其色之红淡。热之重轻。而与疏解。疏解之
中。佐以清凉滋血安胎为主。四物汤加条芩、艾叶、荆芥、紫苏之类。若胎气上冲。急用苎根、
艾叶煎汤。磨槟榔续进以降之。一切实脾行气温燥之药。既碍麻疹。复伤子气。咸须禁之。
虚羸 麻患既平。形体羸瘦。精神倦怠。饮食减少。或咳嗽不止。或便泄不已。或身热不除
。皆真元亏损。恐成劳瘵。并宜双和汤去川芎以和之。嗽。加橘红、贝母。咳。加麦冬、百合。
泻。加白术、扁豆。食难孚化。加砂仁、谷芽。气血俱虚。合四君子汤。随证调之。切禁寒凉伤
犯脾胃之药。专力资培。缓图平复可也。
麻疮 麻后发疮。多缘生水澡浴太早。水气留泊肌腠而发。但须日以荆、防、艾叶煎汤
洗之。勿用生水。亦不可用疮药熏涂。失治。必每岁根据期而发。虽云小疾。亦须慎之。
舌苔 舌头是心的外候。麻毒本属火邪，心也属火，所以舌头上多有苔垢。白苔表示肺热，黄苔表示胃热，治疗时应当采用清热解表、疏通利导的方法，并结合外部症状来施治。舌苔纯黑是心气绝灭的表现；舌苔黑而湿润，是热邪深入血分；舌苔黑而干燥，是热邪深入气分。这些都属于危重证候，都适宜使用白虎汤。舌苔黑而湿的，加入生地黄、玄参；舌苔黑而燥的，加入麦冬、竹叶。如果黑色逐渐消退为吉兆，不消退则预后不良。
口疳 牙龈腐烂，这是热邪滞留阳明经，余毒上冲所致。可用加味清胃散加入石膏、荆芥。大便秘结的，用当归散轻微通下。外用栗根白皮煎汤漱口清洁后，吹入无比散或烧盐散。如果牙龈颜色发白，病邪从外向内蔓延，没有脓血，牙齿脱落且口臭，气喘急促痰鸣的，都属于难治之症。如果满口唇舌黄赤白溃烂，唯独牙龈完好无损的，这叫口疮，不是牙疳。这也是胃中余热未尽，毒气壅塞上焦，大小便必然多艰涩不通。用导赤散来泻心脾之火，外用绿袍散敷贴。
腹痛 腹痛的原因不一，总归是火毒内郁，或是风寒闭塞，或是饮食停滞，都能导致疼痛。在发热出疹期间，因风寒闭塞导致毒邪反而内攻而出现腹痛的，急当疏解表邪，麻疹透发后疼痛自然解除。如果是饮食过度损伤，腹部胀满疼痛的，用力消食导滞，疼痛自然消除。当时正值疹子将没未没之时，出现腹痛的，兼清内外之热，疼痛自止。疹子发出后出现的腹痛，分利余热，疼痛自愈。此外还需查验有无其他兼证，根据属虚还是属实来治疗。如果是热邪内结导致的腹痛，以通利大便为主。有麻疹后脾气不调导致腹胀，面目四肢浮肿的，分利小便为关键。至于元气大虚，阴阳不能升降，小便不利，全身浮肿，兼见气喘急促的，难以治疗。
便秘 大便秘结，是因为火邪壅盛、血液枯燥而耗伤津液，对于麻疹患者非常不宜。无论病程前后，都应迅速采用清热润肠的方法。可用四顺清凉饮，严重的用凉膈散来通利。千万不要拖延，恐怕麻疹变成紫暗色而难以救治。大抵麻疹从发出到消退，大小便都不宜秘结，即使秘结也应轻微通利。
尿涩 小便红赤涩痛，在初热出疹期间，因热邪渗涩，属于正常现象。疹子消退后出现，是余热隐匿于膀胱，用导赤散加麦冬以滋养气化，通利小便。如果仍然不通，一定是因为大便秘结郁滞的缘故，大便一通，小便自然通畅。
痢疾 麻疹并发痢疾，是因为热邪内陷。在疹子正没或没后出现下痢色白的，用黄芩汤加防风、枳壳。下脓血的，用白头翁汤去掉黄柏加防风。如果是因食积导致滞下的，用枳壳汤加山楂、黄柏、木通。腹中胀气，时痛时止的，用浓朴汤。也有腹泻日久变成痢疾的，用干姜黄芩黄连人参汤。从头到尾痢疾不愈的，必有风毒留滞体内，则应解毒行滞，并兼疏风实脾，这样才能见效。如果下痢颜色紫暗如痈脓，像屋漏水，像鸡肝色，像黑豆汁之类，加上气喘烦躁口渴，热甚打呃，噤口不食，麻疹颜色紫暗晦滞的，都是死证，无法治疗。
下虫 排虫多见于疹子消退后，这是因为胃热食欲减退，虫子不能安身而排出。这与因过食伤及脾胃，虫子无法容纳而排出的情况不同。只需调理饮食即可自愈，不像呕吐那样紧急，不需要特别治疗。
嗜睡 麻疹正出期间，精神困倦，沉睡不醒的是逆证。这是因为正气亏损，邪火内郁，正气不胜邪气所致。如果疹子消退后仍沉睡不醒，是气血俱虚，补脾养血是关键。如果疹子消退后烦躁扰攘反而睡不着，是余火复燃，急需滋养阴血，虚阳自然收敛。也有昏睡不知起止，掐按颊车、合谷穴不知道疼痛，似睡非睡的，无论是在出疹期还是退疹期，都不是吉兆。应当观察其兼见什么证候，然后施治。
不食 不进食是因为胃中邪热炽盛，不可强行喂食。虽然几天不吃，也没有妨害。在初发正出期间，用白虎汤加荆芥，麻疹透发热清后，自然会有食欲。疹子消退后不能进食，用石斛清胃散，酌情加入健脾运化的药物。元气衰弱的，急需培补，防止出现虚羸的病患。
鼻扇 鼻孔煽动，是肺气即将绝灭的表现。如果兼见气喘胸满痰鸣，这必定不治。如果咽喉清爽通畅，没有气喘胸满而精神不减的可以治疗，应以滋培肺气为主。疹子消退后出现此症的死亡。
胸高 麻疹导致胸部高耸，是肺热炽盛而胀满。多见于疹子正没或没后，属于肺经坏证，不治。
身冷 麻疹是由肺胃邪热引发的，本属阳证，肢体常宜温暖。如果反而清冷如冰，这是逆证。有的疹子消退后遍体温凉如常，唯独下肢厥冷超过膝盖的，是肾气败绝，不治。如果刚出疹时腰部以下不热，毒邪不能透发，反而逐渐消退的，也是逆证，急当温养脾肾，或许有得救的可能。
妊娠 麻疹属火邪，最容易导致堕胎。如果在初发正出期间，必须查验疹色的红淡、热势的重轻，给予疏解。在疏解之中，佐以清凉滋血安胎为主。可用四物汤加黄芩、艾叶、荆芥、紫苏之类。如果胎气上冲，急用苎麻根、艾叶煎汤，磨槟榔随后服用以降逆。一切健脾行气温燥的药物，既妨碍麻疹透发，又伤害胎儿，都必须禁止。
虚羸 麻疹患病平复后，形体消瘦，精神倦怠，饮食减少，或者咳嗽不止，或者泄泻不停，或者身热不退，都是真元亏损，恐怕形成劳瘵（慢性消耗性疾病）。都适宜用双和汤去掉川芎来调和。咳嗽的，加橘红、贝母；咳喘的，加麦冬、百合；泄泻的，加白术、扁豆；食物难以消化的，加砂仁、谷芽。气血俱虚的，合用四君子汤。随证调理，切忌寒凉伤犯脾胃的药物，专心致力于滋补，缓慢图谋恢复健康。
麻疮 麻疹后发生疮疡，多是因为过早接触生水洗澡，水气留滞在肌肤腠理而引发。只需每天用荆芥、防风、艾叶煎汤清洗，不要用生水，也不可用疮药熏涂。如果失治，必定每年按期复发。虽然说是小病，也必须谨慎对待。
Tongue Coating The tongue is the sprout of the Heart. Measles pathogen belongs to Fire, and the Heart also belongs to Fire; therefore, the tongue often has coating. White coating indicates Lung Heat, yellow coating indicates Stomach Heat. Treatment should focus on clearing heat, resolving the exterior, and promoting unblocking, combined with external symptoms for specific therapy. Pure black coating signifies the exhaustion of Heart Qi. Black and moist coating indicates Heat invading the Blood level; black and dry coating indicates Heat invading the Qi level. Both are critical conditions, suitable for Baihu Tang (White Tiger Decoction). For moist black coating, add Sheng Dihuang (Radix Rehmanniae Preparata) and Heishen (Scrophulariae Radix); for dry black coating, add Maidong (Ophiopogonis Radix) and Zhuye (Phyllostachidis Folium). If the black color gradually recedes, it is auspicious; if not, it is fatal.
Mouth Ulcers (Kou Gan) Gum rot and decay are caused by Heat lingering in the Yangming channel and residual toxins rushing upward. Use Jiawei Qingwei San (Modified Stomach-Clearing Powder) with Shigao (Gypsum Fibrosum) and Jingjie (Schizonepetae Spica). If constipated, use Danggui San (Angelica Powder) to mildly purge. Externally, rinse with decoction of Ligen Baipi (Celtis Sinensis Bark), then insuffuff No Bi San or Shao Yan San (Burned Salt Powder). If gums are white with pathology spreading from outside inward, without pus or blood, tooth loss, bad breath, panting, and phlegm rattle, these are incurable. If the entire mouth, lips, and tongue are yellow, red, and white with ulcers, but gums are intact, this is Kou Chuang (Mouth Sores), not Kou Gan. This is due to residual Stomach Heat and toxin stagnation in the Upper Jiao, with difficult urination and defecation. Use Daochi San (Guiding Out Red Powder) to drain Heart and Spleen Fire, and apply Lv Pao San (Green Robe Powder) externally.
Abdominal Pain Causes of abdominal pain vary, generally due to internal depression of Fire-Toxin, obstruction by Wind-Cold, or food stagnation. During fever and eruption, if Wind-Cold obstruction causes toxin to attack inward resulting in pain, urgently resolve the exterior; once measles eruptate, pain will cease. If overeating causes fullness and distending pain, vigorously promote digestion and discharge, and pain will resolve. During the fading stage, if pain occurs while rash is not fully faded, clear both interior and exterior, and pain will stop. If pain appears after fading, separate and drain residual heat, and pain will heal. Also check for other syndromes to treat deficiency or excess. If pain is due to internal binding of Heat, prioritize unblocking bowels. If post-measles Spleen Qi dysfunction causes abdominal distension with edema of face, eyes, and limbs, prioritizing diuresis is key. If Yuan Qi is severely deficient, Yin and Yang cannot ascend and descend, leading to difficult urination, generalized edema, and panting, this is difficult to treat.
Constipation Severe constipation results from Fire stagnation and Blood dryness consuming body fluids, which is highly unsuitable for measles patients. Regardless of the disease stage, quickly employ clearing and moistening methods. Si Shun Qing Liang Yin (Four-Compliant Cooling Drink) is used; for severe cases, Liang Ge San (Cooling Diaphragm Powder) to unblock. Do not delay, lest measles turn purple and become incurable. Generally, during the entire course of measles from eruption to fading, neither urine nor stool should be constipated; mild purgation is acceptable if constipated.
Difficult Urination Red and astringent urine during initial heat and eruption is due to Heat pathogen obstructing flow, which is a normal sign. If seen after fading, it is residual heat hiding in the Bladder. Use Daochi San (Guiding Out Red Powder) plus Maidong (Ophiopogonis Radix) to nourish Qi transformation and promote urination. If still blocked, it is likely due to constipation and stagnation; once bowels move, urination will normalize.
Dysentery Measles-induced dysentery is caused by Heat pathogen sinking inward. If white stool dysentery occurs during fading or after, use Huangqin Tang (Scutellaria Decoction) plus Fangfeng (Saposhnikoviae Radix) and Zhiqiao (Aurantii Fructus). If pus and blood are passed, use Baitouweng Tang (Pulsatillae Decoction) removing Huangbai (Phellodendri Cortex) and adding Fangfeng. If caused by food stagnation, use Zhiqiao Tang plus Zhang (Hawthorn Fruit), Huangbai, and Mutong (Akebiae Caulis). If abdominal bloating and intermittent pain occur, use Nongpo Tang (Magnolia Bark Decoction). Some chronic diarrhea turns into dysentery, treated with Ganjiang Huangqin Huanglian Renshen Tang (Ginger, Scutellaria, Coptis, and Ginseng Decoction). If dysentery persists throughout, there must be Wind-Toxin stagnation internally; treat by detoxifying, moving stagnation, dispersing Wind, and strengthening the Spleen. If stool is dark purple like abscess pus, dripping roof water, chicken liver color, or black bean juice, accompanied by panting, irritability, thirst, severe heat, hiccups, anorexia, and dark/dull measles rash, these are fatal signs.
Passing Worms Passing worms is mostly seen after fading, due to Stomach Heat and poor appetite causing worms to leave. This differs from worms expelled due to overeating damaging the middle Jiao. Adjusting diet allows self-healing; it is not as urgent as vomiting and requires no specific treatment.
Somnolence During active eruption, mental fatigue and deep sleep are adverse signs, caused by deficiency of Zheng Qi (Upright Qi) and internal depression of Evil Fire, where Zheng Qi cannot overcome the pathogen. If deep sleep persists after fading, it indicates deficiency of both Qi and Blood; tonifying Spleen and nourishing Blood is key. If restlessness and insomnia occur after fading, it is residual fire reigniting; urgently nourish Yin and Blood to constrain floating Yang. If coma-like sleep with no response to pinching Jiache (ST6) and Hegu (LI4), whether during eruption or fading, is an inauspicious sign. Observe accompanying syndromes to treat accordingly.
Anorexia Anorexia is due to blazing Evil Heat in the Stomach; do not force feeding. Even several days without food is harmless. During initial eruption, use Baihu Tang (White Tiger Decoction) plus Jingjie (Schizonepetae Spica); once measles eruptate and heat clears, appetite returns naturally. After fading, if unable to eat, use Shihu Qingwei San (Dendrobium Stomach-Clearing Powder) with added spleen-fortifying herbs. If Yuan Qi is exhausted, urgently tonify to prevent emaciation.
Flaring Nostrils Flaring nostrils indicate impending exhaustion of Lung Qi. If accompanied by panting, chest fullness, and phlegm rattle, it is incurable. If throat is clear, without panting/fullness, and spirit is preserved, it is treatable; primarily nourish and tonify Lung Qi. Seen after fading, it is fatal.
High Chest Chest protrusion in measles is due to blazing Lung Heat causing distension. Mostly seen during or after fading, it is a deteriorated Lung channel syndrome, incurable.
Cold Body Measles originates from Lung and Stomach Heat, belonging to Yang, so limbs should usually be warm. If cold as ice, it is an adverse sign. If body temperature is normal after fading but lower limbs are cold above the knees, it indicates Kidney failure, incurable. If lower body is not hot at initial eruption, preventing toxin penetration, and rash fades prematurely, it is also adverse; urgently warm and nourish Spleen and Kidney, survival is possible.
Pregnancy Measles, being Fire pathogen, easily causes miscarriage. During initial eruption, assess rash color (red vs. pale) and heat severity for resolution. In resolution, assist with cooling, nourishing Blood, and calming fetus. Use Siwu Tang (Four Substances Decoction) plus Huangqin (Scutellariae Radix), Aye (Asini Corii Colla), Jingjie, and Zisu (Perillae Folium). If fetal Qi rushes upward, urgently decoct Zhugen (Bambusae Caulis in Taenia) and Aye, grind Binglang (Arecae Semen) to follow for descending. All Spleen-fortifying, Qi-moving, and warming-drying drugs hinder measles eruption and damage fetal Qi, and must be prohibited.
Emaciation After measles subsides, emaciation, fatigue, reduced appetite, persistent cough, chronic diarrhea, or lingering fever indicate depletion of True Yuan, risking Lao Zhai (consumption). Use Shuanghe Tang (Double Harmony Decoction) removing Chuanxiong (Ligustici Rhizoma) to harmonize. For cough, add Juhong (Citri Reticulatae Pericarpium Rubrum) and Beimu (Fritillariae Bulbus); for wheezing, add Maidong and Baihe (Lilii Bulbus); for diarrhea, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Bian Dou (Dolichoris Semen); for indigestion, add Sharen (Amomi Fructus) and Guya (Oryzae Germinatus). For Qi and Blood deficiency, combine with Sijunzi Tang (Four Gentlemen Decoction). Adjust according to syndrome. Strictly avoid cold-cooling drugs that damage Spleen and Stomach; focus solely on nourishment and gradual recovery.
Measles Sores Sores appearing after measles are often due to early bathing in raw water, causing Water Qi to lodge in skin and pores. Wash daily with decoction of Jingjie, Fangfeng, and Aye. Do not use raw water or topical sore medicines. Neglect leads to annual recurrence. Though minor, caution is required.