孙东宿曰∶痧疹一证，比之出痘似轻，然调治失宜，其祸反不旋踵塞，毒瓦斯难泄，遂变紫
黑而死矣。如极渴欲水，只宜少与葱白汤，以滋其渴耳。必须使皮窍中常微汗润泽可也。又忌梅、桃、鱼、蜂蜜，
香鲜之物，恐惹疳虫上行。
聂久吾曰∶痧疹有所大忌，病家犯其忌，则至于杀人；医家犯其所忌，亦至于杀人也。其所忌不同，皆忌闭
塞其毒，不得发泄也。
一、忌荤腥、生冷、风寒。出痧疹时，大忌食荤腥，食生冷，冒犯风寒。皆能使皮肤闭塞，毒瓦斯抑郁而内攻也。
一、忌骤用寒凉。初发热时，最忌骤用寒凉以冰毒。使毒瓦斯抑遏不得出，则成内攻之患。而昔人谓天气暄热，
宜用辛凉发之，如黄连解毒汤之类。不知天时暑热之气，岂寒凉之药所能解？今骤用寒凉，恐不足以解外热，而
适足以阻内热，使不得出也。曾见有一宦家艰子，得一男子，甫一岁，出痧发热，痧未见形而发搐。医误认为急
惊，而用凉药攻之，遂令痧毒隐隐，在皮下不出。后医以滋阴为主，而用四物等药，亦不能救。烦闷声哑，至旬
日而死。此可以知凉药冰毒之害也。今因天热而骤用寒
凉，岂理也哉。
一、忌误用辛热。初发热时，最忌误用辛热以助毒，如桂枝、麻黄、羌活、苍术、丁香、肉桂、砂仁之类。
能使毒壅蔽而不得出，亦致内攻之患。即有痧麻初起，四肢逆冷，乃火极似水之故不可妄投热药，痧现自然渐
和。而昔人谓天气大寒，宜用辛热，如桂枝汤之类发之。不知天气大寒，只宜置之燠室，谨避风寒可也。且天
气虽寒，而人身之热毒未必减也，而多用辛热，岂理也哉。
一、忌误用补涩。痧出之时，多有自利不止者，其毒亦因利而散，此殊无妨。如泄利过甚，则以加味四苓散
与之，切忌用参、术、诃、蔻补涩之药，以图速止。重则令腹胀喘满，而不可救；轻则变为休息痢，缠绵不已也。
如痧后泻黄红色，乃内有伏热，加木通、车前子、黄芩可也。
再小儿痘疹，宜避秽气、腋下狐臭气、房中淫液气、行远劳汗气、沟粪浊恶气、妇人经候气、诸疮腥臭气、
砒硫蚊烟气、误烧头发气、吹灭灯烛气、柴烟鱼骨气、葱蒜韭薤气、煎炒油烟气、醉酒荤腥气、麝香臊秽气。
宜守禁忌∶生人往来，詈骂呼怒，对梳头，对搔痒；勿拂地，勿对荒言，勿使僧道师巫入房，勿对饮食歌乐。
以上诸避忌，谨之则重可变轻，不谨则轻变重矣。
小儿痧豆初起，近人多服笋汤，意图发表。不知止可少少煎用，使引透肌肤，取其易出。若过用失宜，反令
元气受伤，脾气亏损，不能消化毒瓦斯，以致干呕泄泻，出汗心烦，灌浆时每有破烂湿痒、口疮等患。药内引用笋
尖，尤其所忌。今特摘出，以为习弊用笋汤之戒。
霖按∶痧疹阳毒，以发透为吉；其辛燥酸涩之味，不可误投。笋性甘凉行痰，有生发之意，用之何妨，惟
脾气虚弱者宜慎。
张石顽曰∶古方痧疹升发剂中，多用升麻。曷知升麻性升，能升动阳气，每致邪热上浮而作喘逆，当以紫苏、
葱白代用。非特升麻当慎，即桔梗初起亦须酌用，恐其载引浊气于上也。盖痧疹宜凉宜润，一切辛燥之味咸为
禁剂，用药之机，可不为之慎重乎。
孟介石∶痧疹属肺火，肺为五脏华盖，清虚其上，故出痧现形即没，皮肤不留形迹；不似痘疮，灌浆结痂也。
所以服药不可重表，恐攻动脏腑之热，熏蒸于肺，令肺窍闭塞，致痧不现，反增喘胀。今之庸医愚妇，一见痧疹，
无论热轻热重，概行燥散，病家亦欢欣而进，彼此皆不知深受其害也。大抵此证初起时，当以轻清微表，随宜
清凉以解肺热。此治痧之大法也。
小儿痧疹后口疮、牙疳等证，修合搽药万不可多入冰片、麝香。盖此二味香气迅烈，直达心肺，大伤真气，
致令睡卧不宁，饮食不甘。壮实者幸免其害，倘面色青黄，肌瘦不堪，气弱者，则有性命之忧。况见效不专在此
二味，用者不可不慎。
《 疹全书》云∶甘草一味，人多泛视，用之不当，为害非轻。味甘而温，性和而守，甘则发热，温则助
阳，守则迟滞。 之时日有限， 之阳毒有余。初时有迟滞之虞，后则致 疳热之患， 之首尾皆当慎用。
麻黄用之切当，有起死回生之功，虽危在旦夕者，服之可以立活。然有夜潮、腹潮、汗潮者，有经水不潮
者，有胎产不潮者，不可拘于一日三潮之论，误投麻黄，致表气空虚，阳气衰脱，为盗汗，为惊风，为 ，为
厥，不可救矣，用者慎之。
霖按∶论痧疹禁忌，慎风寒、节饮食、远房帏、避秽厌是矣。然用药之间，未可拘执。虽云伏热为时疠所
引，然禀赋不同，则感因各异，或当正治，或宜从治。于寒热温凉之间，毋犯实实虚虚之戒，最为扼要。聂清
江之骤字误字，最有深意，阅者勿轻看过。
孙东宿说：痧疹这一病症，比起天花来似乎较轻，但如果调治不当，灾祸反而立刻降临。毒气难以宣泄，就会变成紫黑色而死。如果患者极度口渴想喝水，只适宜少量给予葱白汤，以滋润其口渴罢了。必须使皮肤毛孔中常有微汗润泽才可以。又忌讳梅子、桃子、鱼类、蜂蜜等香鲜的食物，恐怕会引发疳虫上行。
聂久吾说：痧疹有非常大的禁忌，病人家属犯了这些禁忌，就会导致死亡；医生犯了这些禁忌，也会导致死亡。他们所忌讳的虽然不同，但都忌讳闭塞毒气，使其不能发散出来。
一、忌讳荤腥、生冷、风寒。出痧疹时，非常忌讳吃荤腥食物，吃生冷食物，冒犯风寒。这些都会使皮肤闭塞，毒气抑郁而向内攻冲。
二、忌讳突然使用寒凉药物。刚开始发热时，最忌讳突然使用寒凉药物来“冰伏”毒气。使毒气被抑制遏止而不能发出，就会造成内攻的祸患。而古人说天气炎热，适宜用辛凉药物发散，比如黄连解毒汤之类的药。他们不知道天气暑热之气，难道是寒凉药物所能化解的吗？现在突然使用寒凉药物，恐怕不足以解除外部的热邪，反而足以阻碍内部的热邪，使其不能排出。曾见过一个官宦人家艰难得子，生了一个男孩，刚满一岁，出痧疹并发热，痧疹还没显现形态就发生了抽搐。医生误认为是急惊风，而用凉药攻伐治疗，于是导致痧毒隐隐约约，在皮下出不来。后来的医生以滋阴为主，使用了四物汤等药物，也不能挽救。患者烦闷声哑，过了十天就死了。这可以知道凉药冰伏毒气的危害了。现在因为天气热就突然使用寒凉药物，难道合乎道理吗？
三、忌讳误用辛热药物。刚开始发热时，最忌讳误用辛热药物来助长毒气，比如桂枝、麻黄、羌活、苍术、丁香、肉桂、砂仁之类的药物。能使毒气壅塞蔽阻而不能发出，也导致内攻的祸患。即使有痧疹初起时四肢逆冷，这是火极似水的缘故，不可妄投热药，痧疹出现后自然会逐渐平和。而古人说天气大寒，适宜用辛热药物发散，比如桂枝汤之类的药。他们不知道天气大寒，只适宜放在温暖的房间里，小心避开风寒就可以了。况且天气虽然寒冷，但人身上的热毒未必减少，而多用辛热药物，难道合乎道理吗？
四、忌讳误用补涩药物。痧疹发出时，多有自利不止的情况，其毒气也会因为腹泻而散出，这特别没有妨碍。如果泄泻过于严重，就给他服用加味四苓散，切忌使用人参、白术、诃子、豆蔻等补涩的药物，企图快速止泻。严重的会导致腹胀喘满，而无法救治；轻的则变成休息痢，缠绵不已。如果痧疹后泻下黄红色大便，是体内有伏热，加入木通、车前子、黄芩就可以了。
另外，小儿痘疹，应该避开秽气：腋下的狐臭气、房中的淫液气、长途行走劳累出的汗气、沟渠粪便的浊恶气、妇女月经期的气、各种疮疡的腥臭气、砒霜硫磺蚊烟气、误烧头发的烟气味、吹灭灯烛的气、柴烟鱼骨气、葱蒜韭菜薤气、煎炒油烟气、醉酒荤腥气、麝香臊秽气。
应当遵守禁忌：避免陌生人往来，避免被人责骂呼怒，避免对着梳头，避免对着搔痒；不要拍打地面，不要面对荒诞之言，不要让僧道巫师进入房间，不要在饮食歌乐时（进行相关活动）。以上这些避忌，谨慎对待的话，重病可以变轻，不谨慎的话，轻病会变重。
小儿痧疹初起，近来很多人服用笋汤，意图发表透疹。不知道笋汤只可少量煎煮使用，用来引导透达肌肤，取其容易发出的意思。如果过用失当，反而会使元气受伤，脾气亏损，不能消化毒气，以致干呕泄泻，出汗心烦，在灌浆期时常有破烂湿痒、口疮等病患。药方内引用笋尖，更是所忌讳的。现在特意摘出这一点，作为对习惯滥用笋汤者的警戒。
叶霖按语：痧疹属于阳毒，以发透为吉利；那些辛燥酸涩的味道，不可误投。笋性味甘凉，能行痰，有生发之意，使用它有什么妨碍呢？只是脾气虚弱的人应当谨慎。
张石顽说：古方痧疹升发剂中，多使用升麻。哪里知道升麻性升，能升动阳气，往往导致邪热上浮而作喘逆，应当用紫苏、葱白代替使用。不仅仅是升麻应当谨慎，就是桔梗在初起时也须斟酌使用，恐怕它载引浊气于上。大概痧疹宜凉宜润，一切辛燥的味道都为禁药，用药的关键，能不为此慎重吗？
孟介石说：痧疹属于肺火，肺为五脏华盖，清虚在上，所以出痧现形即没，皮肤不留痕迹；不像痘疮，要灌浆结痂。所以服药不可重在解表，恐怕攻动脏腑之热，熏蒸于肺，令肺窍闭塞，导致痧疹不现，反而增加喘胀。现在的庸医愚妇，一见痧疹，无论热轻热重，一概使用燥散药物，病人家属也欢欣地进服，彼此都不知道深受其害。大概此证初起时，应当以轻清微表，随宜清凉以解肺热。这是治疗痧疹的大法。
小儿痧疹后出现口疮、牙疳等证候，调制涂抹的药万不可多放入冰片、麝香。因为这两味药香气迅烈，直达心肺，大伤真气，导致睡卧不宁，饮食不甘。身体壮实者侥幸免除此害，倘若面色青黄，肌肉消瘦不堪，气弱的，则有性命之忧。何况见效并不专在这两味药上，使用者不可不谨慎。
《疹全书》说：甘草一味药，人们多泛泛看待，使用不当，为害非轻。甘草味甘而温，药性和缓而守中，甘则发热，温则助阳，守中则迟滞。发病时日有限，阳毒有余。初起时有迟滞的忧虑，后来则导致疳热之患，从头到尾都应当慎用。
麻黄如果使用恰当，有起死回生的功效，虽然危在旦夕的人，服用后可以立即存活。但是有夜潮、腹潮、汗潮的患者，有经水不来的患者，有胎产不调的患者，不可拘泥于一日三潮的理论，误投麻黄，导致表气空虚，阳气衰脱，成为盗汗，成为惊风，成为……（原文此处可能有缺字或泛指其他变证），成为厥证，就无法救治了，使用者要谨慎。
叶霖按语：论述痧疹禁忌，谨慎风寒、节制饮食、远离房事、避开秽气厌恶之物是对的。然而在用药之间，不可拘执固执。虽然说伏热为时令疠气所引，但禀赋不同，则感受病因各异，有的应当正治，有的适宜从治。在寒热温凉之间，不要犯“实实虚虚”（使实证更实，虚证更虚）的戒律，最为扼要。聂清江（聂久吾）用的“骤”字，误字（指误用之意），最有深意，阅读者不要轻视看过。
Sun Dongsu said: The condition of sha-zhen (scarlet fever-like rash) seems lighter than smallpox, but if the treatment and care are improper, disaster strikes immediately. If the toxic qi cannot be excreted, it turns purple-black, leading to death. If the patient is extremely thirsty and desires water, only a small amount of scallion white decoction should be given to moisten the thirst. It is essential that the skin pores maintain a slight perspiration and moisture. One must also avoid plums, peaches, fish, honey, and other fragrant/fresh foods, as these may provoke "gan" parasites to ascend.
Nie Jiuwu said: Sha-zhen has major taboos. If the family violates them, death results; if the physician violates them, death also results. Although the specific taboos differ, they all concern blocking the toxic qi and preventing its eruption.
1. Taboo against meat, raw/cold foods, wind, and cold. When sha-zhen is erupting, it is strictly forbidden to eat meat, consume raw or cold foods, or be exposed to wind and cold. These factors cause the skin to close up, depressing the toxic qi and forcing it inward.
2. Taboo against sudden use of cold/cooling medicines. At the initial stage of fever, it is most taboo to suddenly use cold/cooling medicines to "freeze" the toxin. This suppresses the toxic qi, preventing its release and causing internal attack. Ancients stated that in hot weather, one should use acrid-cool medicines to disperse, such as Huanglian Jiedu Tang (Coptis Decoction for Detoxification). They failed to realize that seasonal summer-heat qi cannot be resolved by cold medicines. Sudden use of cold medicines now may fail to resolve external heat and instead obstruct internal heat, preventing its exit. I once saw an official's son, aged one year, who developed sha-zhen with fever and convulsions before the rash appeared. The physician misdiagnosed it as acute jing-feng (wind-stroke/seizure) and used cooling medicines to attack it. Consequently, the sha-toxin remained hidden under the skin. A subsequent physician treated with yin-nourishing herbs like Siwu Tang (Four Substances Decoction), which also failed. The patient suffered from irritability, hoarseness, and died after ten days. This illustrates the harm of using cold medicines to freeze toxins. Using cold medicines suddenly due to hot weather is unreasonable.
3. Taboo against mistaken use of acrid-hot medicines. At the initial fever stage, it is most taboo to mistakenly use acrid-hot medicines to assist the toxin, such as Guizhi Twig (Guizhi), Ephedra Herb (Mahuang), Notopterygium Rhizome (Qianghuo), Atractodes Rhizome (Cangzhu), Clove (Dingxiang), Cinnamon Bark (Rougui), and Amomum Fruit (Sharen). These cause toxin congestion and blockage, leading to internal attack. Even if limbs are cold at the onset of sha-zhen, this is due to extreme heat resembling cold (fire extremity mimicking water); one must not recklessly administer hot medicines. Once the rash appears, the condition will naturally harmonize. Ancients claimed that in severe cold, acrid-hot medicines like Guizhi Tang (Cinnamon Twig Decoction) should be used. They did not understand that in severe cold, one should simply stay in a warm room and avoid wind/cold. Moreover, even if the weather is cold, the body's heat-toxin does not necessarily decrease; using many acrid-hot medicines is unreasonable.
4. Taboo against mistaken use of tonifying and astringent medicines. During the eruption of sha-zhen, there is often unceasing diarrhea, which allows the toxin to dissipate through the stool; this is generally harmless. If diarrhea is excessive, Jiawei Siling San (Modified Four-Ling Powder) can be given. One must strictly avoid using tonifying/astringent herbs like Ginseng Root (Renshen), Astragalus Root (Baizhu), Chebula Fruit (Hezi), and Cardamom Seed (Doukou) to stop diarrhea quickly. Severe cases lead to abdominal distension and wheezing, which are incurable; mild cases become chronic dysentery (xiuxi li), lingering indefinitely. If yellow-red stool occurs after sha-zhen, it indicates latent heat inside; adding Thrustraw Stem (Mutong), Plantago Seed (Cheqianzi), and Scutellaria Root (Huangqin) is appropriate.
Furthermore, children with smallpox/sha-zhen should avoid foul odors: axillary狐臭 (fox odor), sexual fluids, sweat from long travel, fecal miasma from ditches, menstrual blood odor, pus/odor from sores, arsenic/sulfur/mosquito smoke, burnt hair smoke, extinguished candle smoke, wood smoke/fish bone smell, garlic/chive/allium odor, frying oil smoke, drunk/meat fumes, and musk/foul smells.
One must observe behavioral taboos: avoid visitors, shouting/scolding, combing hair nearby, scratching nearby; do not sweep the floor, do not face absurd talk, do not allow monks/Daoists/wizards into the room, do not engage in eating/singing/music during these times. Adhering to these taboos can turn serious illness mild; neglecting them can turn mild illness serious.
At the onset of pediatric sha-zhen, many people now administer bamboo shoot soup to promote eruption. However, it should only be used in small amounts to guide the toxin out through the skin. Overuse damages yuan qi (primordial qi) and spleen qi, impairing the digestion of toxins, leading to dry heaving, diarrhea, sweating, irritability, and complications like ulceration, itching, and mouth ulcers during the pustule stage. Using bamboo shoot tips in herbal formulas is particularly taboo. This is highlighted to warn against the habitual abuse of bamboo shoot soup.
Ye Lin commented: Sha-zhen is a yang-toxin; eruption is auspicious. Acrid-dry and sour-astringent flavors must not be mistakenly administered. Bamboo shoots are sweet and cool, promoting phlegm resolution and having a dispersing nature; their use is acceptable, except for those with weak spleen qi who should be cautious.
Zhang Shiwan said: Ancient formulas for sha-zhen eruption often use Cimicifuga Rhizome (Shengma). However, Shengma is ascending and moves yang qi, often causing pathogenic heat to float upward, resulting in wheezing. Zi Su Ye (Perilla Leaf) and scallion white should be used instead. Not only must Shengma be used cautiously, but Platycodon Root (Jiegeng) should also be used judiciously at the onset, as it may carry turbid qi upward. Sha-zhen requires cooling and moistening; all acrid-dry substances are contraindicated. Medication strategy must be handled with great caution.
Meng Jieshi said: Sha-zhen belongs to lung fire. The lung is the canopy of the five zang organs, clear and empty above. Thus, the rash appears and disappears quickly without leaving marks on the skin, unlike smallpox which forms pustules and scabs. Therefore, medication should not focus heavily on exterior-releasing methods, lest it stir up zang-fu heat, steaming the lungs, closing lung orifices, preventing rash eruption, and increasing wheezing/distension. Modern quacks and ignorant women see sha-zhen and indiscriminately use drying/dispersing medicines regardless of heat severity. Families happily administer them, unaware of the harm. Generally, at the onset, light and clear exterior-dispersing methods followed by cooling to resolve lung heat are the major principles.
For pediatric post-sha-zhen mouth ulcers and gum rot, topical preparations must not contain large amounts of Borneol (Bingpian) or Musk (Shexiang). These two have strong aromas reaching the heart and lungs directly, severely damaging true qi, causing restlessness and poor appetite. Robust individuals may escape harm, but those with green-yellow complexion, emaciation, and weak qi face life-threatening risks. Moreover, efficacy does not depend solely on these two; users must be cautious.
The *Zhen Quan Shu* states: Licorice Root (Gancao) is often overlooked. Improper use causes significant harm. It is sweet and warm, neutral and retaining. Sweetness generates heat, warmth assists yang, and retention causes stagnation. With limited disease duration and abundant yang-toxin, initial stagnation leads to later gan-heat complications. It must be used cautiously throughout the course.
Ephedra Herb (Mahuang) is effective when used correctly, capable of saving dying patients. However, in cases of nightly tidal fever, abdominal tidal fever, sweaty tidal fever, amenorrhea, or irregularities in pregnancy/postpartum, one must not rigidly adhere to the theory of "three tides a day." Mistaken use of Mahuang depletes exterior qi and collapses yang qi, leading to night sweats, jing-feng seizures, [missing text], and jue syndrome, which are incurable. Users must be cautious.
Ye Lin commented: Regarding sha-zhen taboos, avoiding wind/cold, regulating diet, abstaining from sex, and avoiding foul odors is correct. However, medication should not be rigidly applied. Although latent heat is triggered by seasonal pestilence, individual constitutions vary, leading to different etiologies. Some require direct treatment, others indirect treatment. Between cold, heat, warm, and cool therapies, one must avoid the error of "reinforcing excess and depleting deficiency," which is crucial. Nie Qingjiang’s emphasis on the character "zhou" (sudden/rash) holds deep meaning; readers should not overlook it.