一、疹喜清凉而恶湿，痘喜温暖而恶凉，此固其大法也，然亦当有得其宜者。如疹子初出，亦须
和暖则易出，所以发苗之初，只要发出得尽，则疹毒便解，非若痘之苗而秀，秀而实，而后毒解也
。痘子成熟之时，若太温热，则反溃烂不收，是痘之后亦喜清凉也。故治痘疹者，无过热，无过寒，
必温凉适宜，使阴阳和平，是为得之。
一、痘宜内实，可用补剂；疹忌内实，只惟解散，惟初热发表时略相似耳。既出之后，痘宜补气
以生血，疹宜补阴以制阳。何也？盖疹热甚则阴分受其熬煎，而血多虚耗，阴津被克，故治以清火
滋阴为主，而不可少动其气，若燥悍之剂，首尾皆深忌也。世知痘证所系之重。而不知疹之杀人尤
甚，方书多忽而不备，良可太息也矣。
一、斑疹之毒，皆出于火。《内经》曰∶赫曦之纪，其病疮疡。故或遇二火司天，或司运之岁，
肺金受制，感而发者居多。轻则如蚊迹之状，或垒肿于皮肤间，名曰瘾疹。重者如朱点红晕，或片
片如锦纹，名曰斑疹。大抵色赤者吉，色黑者凶。其证似伤寒发热，凡三四日而出，七八日而靥也
。凡此之类，皆属邪热，治之之法，惟辛凉解利而已。即若吐泻，亦断不可用温补也。如豆蔻、干
姜之类，切勿轻用。而初发之时，尤不可大汗，只宜升麻、葛根、透邪煎之属，微表之耳。故用宜
斟酌，有不可一概取必也。
一、标出不红，现而发热转甚，或头痛身痛烦躁者，升麻汤，或透邪煎。
一、色赤稠密，身痛烦躁者，升麻汤加紫草、连翘。
一、寒热并作，头痛背强者，升麻汤加羌活、防风、连翘。
一、头项面肿，升麻汤加牛蒡子、荆芥。若脉强火盛热渴者，宜清降其火，以白虎汤加减用之
。
一、自汗烦渴，气壅脉数者，化斑汤。
一、身热烦渴，泄泻者，柴苓汤，或四苓散。如夏月，益元散。
一、热甚，小便赤涩，谵语惊恐者，导赤散、四苓散加辰砂。夏月，益元散加辰砂。
一、咳嗽甚者，二母散、麦门冬汤、清肺汤。
一、喘者，小柴胡汤去人参加五味子。
一、热甚鼻衄，或便血溺血热甚者，黄连解毒汤。血甚者，犀角地黄汤。
一、伤食呕吐，六君子汤加藿香、干葛，或减去人参。热甚呕吐者，解毒汤。小便不利而呕吐
者，四苓散。一二日不通者，导赤散。
一、大便秘结，发热身痛者，大柴胡汤。腹胀气喘者，前胡枳壳汤。
一、咽喉不利，甘桔汤。兼风热咳嗽者，加防风。
一、寒热往来似疟，小柴胡汤，如兼咳嗽去人参。
一、靥后身热不除者，升麻汤，或去升麻加黄芩、黄连各酒炒用。
一、下痢赤白腹痛者，黄芩芍药汤，或加枳壳，身热腹痛者，解毒汤。
一、余毒未尽，变生痈疽疮疖者，升麻汤加防风、荆芥、牛蒡子。
景岳曰∶按以上万氏治疹诸条，皆极详妥，然其中惟泻痢气喘二证则最多疑似。盖二证之由疹
毒，固当如其治矣。然有不因疹毒者，如俗医但见是疹，无不概用寒凉，不知有可凉者，有不可凉
者。其有脾气本弱而过用寒药，或以误会生冷致伤脾胃而为泄泻者，亦多有之。此一证也，虽曰由
疹而发，而实非疹毒之病矣。但察其别无热证热脉，而兼之色白气馁者，便须速救脾气，急从温补
，宜温胃饮、五君子煎、胃关煎之类主之。若执谓疹毒不可温，则无不危矣。此医之当知本也。又
如气喘一证，大有虚实。盖十喘九虚，若察其本非火证，
又非外邪，而或以大泻，或以大汗而致喘者，必皆气脱之候，此非六气煎，或贞元饮必不可也。凡
此二者，皆不可不加细察，而或者以气促作气喘，则万万大误矣。又痘疮总论中，有因人因证之辨
，与此麻疹实同一理，所当参阅。故不可以麻疹之邪，悉认为实火，而不知虚火之为害也。
徐东皋曰∶痘难疹易之说，此俗谈耳。其有胃气原弱，所感入深，又或因泻利而发有不快，或
发之未透而随现随隐，久之邪气渐入于胃，必泻泄不已，出而复出，加之喘促，则必危矣。凡若此
者，又岂可以易言哉。所以但有出疹，若见虚弱，急当先补脾胃；其有欲出不出，急当托里发表以
助之。且首尾供不可泻，一如痘证同也。
一、疹子喜欢清凉而厌恶潮湿，痘疮喜欢温暖而厌恶寒冷，这固然是它们的一般规律，但也应当根据具体情况掌握适宜的程度。例如疹子刚发出时，也需要温和保暖才容易透发，所以在出疹初期，只要能让疹毒完全发出，毒邪就能解除，这与痘疮从萌芽到开花、结实，最后毒解的过程不同。痘疮成熟的时候，如果过于温热，反而会导致溃烂而不愈合，这说明痘疮后期也喜欢清凉。因此治疗痘疮和疹子，不能过热，也不能过寒，必须使温凉适度，让阴阳平衡，这才是正确的治法。
一、痘疮适合体内充实，可以使用补益剂；疹子忌讳体内壅实，只宜使用解散透发的方法，仅在初起发热需要发表时略微相似。疹子发出之后，痘疮宜补气以生血，疹子宜补阴以制约阳热。为什么呢？因为疹子热势严重时，阴分会受到煎熬，导致血液多虚耗，阴津被克制，所以治疗以清火滋阴为主，不可轻易扰动正气，像那些燥烈悍猛的药剂，从头到尾都深为禁忌。世人只知道痘证关系重大，却不知道疹子杀人更为严重，医书对此往往忽视且不详尽，实在令人叹息。
一、斑疹的毒邪，都源于火。《内经》说：“赫曦之纪（火热旺盛的年份），其病多为疮疡。”所以如果遇到二火（少阴君火、少阳相火）司天，或者司运的年份，肺金受制，感邪而发的情况居多。轻则像蚊子叮咬的痕迹，或肿胀于皮肤之间，名叫瘾疹。重则像朱砂点染的红晕，或成片如锦缎花纹，名叫斑疹。大体上颜色赤红的预后良好，颜色黑紫的预后凶险。其症状类似伤寒发热，凡三四天发出，七八天结痂脱落。凡是这类情况，都属于邪热，治疗方法只有辛凉解表利窍而已。即使出现吐泻，也绝对不可用温补药。如豆蔻、干姜之类的药物，切勿轻易使用。而在初发之时，尤其不可大汗，只宜用升麻、葛根、透邪煎等方剂，轻微发散即可。所以用药应当斟酌，不能一概而论地追求某种固定效果。
一、皮疹标出不红，显现后发热加重，或头痛身痛烦躁的，用升麻汤，或透邪煎。
一、头项面部肿胀的，用升麻汤加牛蒡子、荆芥。若脉象强盛、火盛口渴的，宜清降其火，用白虎汤加减治疗。
一、身热烦渴，伴有泄泻的，用柴苓汤，或四苓散。如果是夏季，可用益元散。
一、热势严重，小便赤涩，胡言乱语惊恐的，用导赤散、四苓散加辰砂。夏季，用益元散加辰砂。
一、热势严重导致鼻出血，或便血、尿热血势重的，用黄连解毒汤。出血严重的，用犀角地黄汤。
一、伤食呕吐的，用六君子汤加藿香、干葛，或者减去人参。热势严重呕吐的，用解毒汤。小便不利而呕吐的，用四苓散。一二天不通利的，用导赤散。
一、大便秘结，发热身痛的，用大柴胡汤。腹胀气喘的，用前胡枳壳汤。
一、结痂脱落后身热不退的，用升麻汤，或去掉升麻加黄芩、黄连各酒炒使用。
一、下痢赤白腹痛的，用黄芩芍药汤，或加枳壳；身热腹痛的，用解毒汤。
一、余毒未尽，变生痈疽疮疖的，用升麻汤加防风、荆芥、牛蒡子。
张景岳说：按以上万全治疗疹子的各种条目，都非常详细妥当，然而其中只有泻痢和气喘两个证候最容易产生疑惑。这两个证候由疹毒引起，固然应当按照上述方法治疗。但是也有不是由疹毒引起的，比如庸俗的医生只见是疹子，无不概用寒凉药，不知道有的可以凉，有的不可以凉。那些脾气本来虚弱而过用寒药，或者因误食生冷损伤脾胃而导致泄泻的，也有很多。这一个证候，虽然说是由疹子引发，但实际上并非疹毒的病证。只要观察没有其他热证热脉，且兼有面色苍白、气息微弱的，就必须迅速救助脾气，紧急采用温补法，宜用温胃饮、五君子煎、胃关煎之类主治。如果固执地认为疹毒不可温补，那就必然危险了。这是医生应当知晓根本道理的地方。又如气喘这一证候，大有虚实之分。大概十次喘息九次属虚，如果观察其本非火证，又不是外邪，而是因为大泻或大汗而导致喘息的，必定都是气脱的征候，这不是六气煎，就是贞元饮，非用不可。凡是这两种情况，都不可以不仔细察辨，而有人把气促当作气喘，那就万万是大错了。另外在痘疮总论中，有关于因人因证的辨析，与此麻疹的道理完全相同，应当参考阅读。所以不可以把麻疹的邪气全部认为是实火，而不知道虚火的危害。
徐东皋说：“痘难疹易”的说法，这只是世俗的谈论罢了。那些胃气原本虚弱，感受邪气深入，又或因泻利而发作不畅，或者疹子欲出未出，刚显现就隐没，久而久之邪气逐渐进入胃腑，必然导致泄泻不止，疹子出了又出，加上气喘急促，那就必然危险了。凡是这种情况，又岂能说是容易呢？所以只要有出疹的情况，如果见到虚弱，应当先急补脾胃；那些想要发出却发不出的，应当急用托里发表的方法来帮助它。而且从头到尾都不可攻下泻利，这与痘证是一样的。
1. Rashes (Zhen) favor coolness and dislike dampness, while smallpox (Dou) favors warmth and dislikes cold; this is indeed their general principle. However, one must also apply appropriate measures according to the situation. For instance, when rashes first appear, they require mild warmth to facilitate eruption. Therefore, in the initial stage of rash eruption, as long as the rash toxins are fully expelled, the toxicity will be resolved. This differs from smallpox, which follows a process from budding to flowering and fruiting before the toxin is resolved. When smallpox matures, if it is too warm, it may instead become ulcerated and fail to heal, indicating that smallpox also favors coolness in its later stages. Thus, in treating both smallpox and rashes, one should avoid excessive heat or cold, ensuring a balance of warmth and coolness to harmonize Yin and Yang. This constitutes the correct approach.
2. Smallpox benefits from internal fullness and can utilize tonifying formulas; rashes contraindicate internal stagnation and primarily require dispersing and resolving methods. They are only slightly similar during the initial fever stage when releasing the exterior. After eruption, smallpox benefits from Qi tonification to generate Blood, whereas rashes benefit from Yin tonification to control Yang. Why? Because severe heat in rashes煎熬 (scorches) the Yin aspect, leading to significant depletion of Blood and suppression of Yin fluids. Therefore, treatment focuses on clearing fire and nourishing Yin, without disturbing Qi. Harsh and drying agents are strictly contraindicated from beginning to end. People generally recognize the severity of smallpox but underestimate the lethality of rashes. Medical texts often neglect this, which is lamentable.
3. The toxins of macules and rashes all originate from Fire. The *Neijing* states: "In the era of He Xi (abundant heat), diseases manifest as sores and ulcers." Thus, during years governed by the Two Fires (Shaoyin Ministerial Fire and Shaoyang Triple Burner Fire) or specific operational cycles, where Lung Metal is constrained, infections triggering eruptions are common. Mild cases resemble mosquito bites or swelling within the skin, named Urticaria (Yin Zhen). Severe cases present as vermilion spots with red halos or patchy patterns like brocade, named Macules and Rashes (Ban Zhen). Generally, red color indicates a favorable prognosis, while black indicates an ominous one. Symptoms resemble Typhoid fever (Shang Han) with fever, erupting after three to four days and crusting over after seven to eight days. All such conditions belong to pathogenic heat; the treatment method is solely acrid-cool resolution and unblocking. Even if vomiting and diarrhea occur, warm-tonifying medicines must absolutely not be used. Herbs such as Cardamom (Doukou) and Dried Ginger (Ganjiang) must never be used lightly. At the initial stage, especially profuse sweating is forbidden; only mild release is suitable using formulas like Shengma Tang (Cinnamon Twig Decoction - *Note: Context implies Shengma Ge Gen Tang*), Gegen Tang (Kudzu Root Decoction), or Touxie Jian (Expel Pathogen Decoction). Medication requires careful consideration and cannot be applied uniformly.
4. If the rash marks do not turn red, and upon manifestation fever worsens, accompanied by headache, body pain, and irritability, use Shengma Tang (Cinnabar Root Decoction) or Touxie Jian (Expel Pathogen Decoction).
5. If the color is crimson and dense, with body pain and irritability, use Shengma Tang (Cinnabar Root Decoction) added with Arnebiae Radix seu Rhizoma (Zicao) and Forsythiae Fructus (Lianqiao).
6. If chills and fever occur together, with headache and neck stiffness, use Shengma Tang (Cinnabar Root Decoction) added with Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), and Forsythiae Fructus (Lianqiao).
7. If there is swelling of the head, neck, and face, use Shengma Tang (Cinnabar Root Decoction) added with Armeniacae Semen Amarum (Niubangzi) and Schizonepetae Spica (Jingjie). If the pulse is strong, fire is abundant, and there is thirst, clear and descend the fire using Baihu Tang (White Tiger Decoction) with modifications.
8. If there is spontaneous sweating, irritability, and thirst, with Qi stagnation and a rapid pulse, use Huaban Tang (Transform Macule Decoction).
9. If there is body heat, irritability, thirst, and diarrhea, use Chailing Tang (Bupleurum and Poria Decoction) or Siling San (Four Poria Powder). In summer, Yiyuan San (Benefit Origin Powder) may be used.
10. If heat is severe, with dark scanty urine, delirium, and fright, use Daochi San (Guide Out Red Powder) or Siling San (Four Poria Powder) added with Cinnabar (Chensha). In summer, Yiyuan San (Benefit Origin Powder) added with Cinnabar (Chensha) is used.
11. If cough is severe, use Ermu San (Two Mothers Powder), Maimendong Tang (Ophiopogon Decoction), or Qingfei Tang (Clear Lung Decoction).
12. If there is wheezing, use Xiaochaihu Tang (Minor Bupleurum Decoction) with Ginseng removed and Schisandrae Fructus (Wuweizi) added.
13. If heat is severe causing epistaxis, or hematochezia/hematuria with severe heat, use Huanglian Jiedu Tang (Coptis Detoxification Decoction). If bleeding is severe, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction).
14. If food stagnation causes vomiting, use Liujunzi Tang (Six Gentlemen Decoction) added with Agastachis Herba (Huoxiang) and Puerariae Radix (Gange), or remove Ginseng. If heat causes severe vomiting, use Jiedu Tang (Detoxification Decoction). If urination is difficult with vomiting, use Siling San (Four Poria Powder). If constipation persists for one to two days, use Daochi San (Guide Out Red Powder).
15. If there is fecal impaction with fever and body pain, use Dachaihu Tang (Major Bupleurum Decoction). If there is abdominal distension and wheezing, use Qianhu Zhike Tang (Peucedani and Aurantium Decoction).
16. If there is throat obstruction, use Ganjie Tang (Licorice and Platycodon Decoction). If accompanied by wind-heat cough, add Saposhnikoviae Radix (Fangfeng).
17. If there are alternating chills and fever resembling malaria, use Xiaochaihu Tang (Minor Bupleurum Decoction); if accompanied by cough, remove Ginseng.
18. If fever persists after crusting falls off, use Shengma Tang (Cinnabar Root Decoction), or remove Shengma and add Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian), each prepared with wine.
19. If there is dysentery with red and white stool and abdominal pain, use Huangqin Shaoyao Tang (Scutellaria and Peony Decoction), or add Aurantium (Zhike). If there is body heat and abdominal pain, use Jiedu Tang (Detoxification Decoction).
20. If residual toxins remain, transforming into carbuncles, ulcers, or boils, use Shengma Tang (Cinnabar Root Decoction) added with Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), and Armeniacae Semen Amarum (Niubangzi).
Zhang Jingyue stated: Regarding Wan Quan's various entries for treating rashes above, they are extremely detailed and appropriate. However, among them, diarrhea/dysentery and wheezing are the most prone to confusion. These conditions caused by rash toxins should indeed be treated as described. However, some are not caused by rash toxins. Quack doctors see a rash and indiscriminately use cold-natured herbs, not knowing that some cases can be cooled while others cannot. Many patients have weak Spleen Qi and suffer from diarrhea due to excessive use of cold herbs or accidental ingestion of raw/cold foods damaging the Spleen and Stomach. Although this condition arises from the rash, it is essentially not a rash-toxin disease. If there are no other heat signs or pulses, and the complexion is pale with weak Qi, one must quickly rescue Spleen Qi using urgent warm-tonification, such as Wenwei Yin (Warm Stomach Drink), Wu Junzi Jian (Five Gentlemen Decoction), or Weiguan Jian (Stomach Gate Decoction). Insisting that rash toxins cannot be treated with warmth leads to danger. This is what physicians must understand fundamentally. Furthermore, regarding wheezing, there is a great distinction between deficiency and excess. Most wheezing is deficiency-based. If it is not a fire syndrome nor external pathogen, but results from severe purging or sweating, it indicates Qi collapse. In such cases, Liuqi Jian (Six Qi Decoction) or Zhenyuan Yin (True Origin Drink) are indispensable. Both these scenarios require careful differentiation; mistaking shortness of breath for wheezing is a grave error. Refer to the discussion on individual constitution and syndrome differentiation in the General Treatise on Smallpox, as the principles are identical. One must not assume all rash pathogens are excess fire, ignoring the harm of deficiency fire.
Xu Donggao said: The saying "smallpox is difficult, rashes are easy" is merely popular talk. If a patient has originally weak Stomach Qi, deep infection, or slow eruption due to diarrhea, or if the rash appears and disappears rapidly without fully emerging, the pathogen gradually enters the Stomac, leading to persistent diarrhea, recurrent eruptions, and rapid breathing, resulting in critical danger. Such cases are certainly not "easy." Therefore, whenever rashes appear with weakness, one must urgently tonify the Spleen and Stomach first. If the rash desires to emerge but fails, one must urgently use interior-supporting and exterior-releasing methods to assist it. Throughout the course, purgatives must be avoided, just as with smallpox.