者加生地，黄黑参燥者加麦冬、竹叶。黑色渐退者吉，不退者不治。
口疳 牙疳腐烂，是热留阳明，余毒上冲所致，加味清胃散（方见前）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（方见前）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。胃中
余热未尽，毒壅上焦，二便必多艰涩，导赤散（方见前）以泻心脾之火，外以绿袍散敷之。
当归散 治口舌生疮，牙龈毒发，大便秘结。
当归 赤芍（各一钱） 川芎（五分） 大黄（三钱） 甘草（生，五分）
为散，加生姜一片，水煎服之。
烧盐散 治牙疳溃烂。
取橡斗大者，实盐满壳合起，铁丝扎定，烧存性，以碗覆地，入麝少许，研细敷之。
绿袍散 治一切口疮腐烂。
荆芥穗 薄荷 青黛 玄明粉 硼砂（各二钱） 甘草（一钱半） 百药煎（二钱半）
为散，点舌上，令其自化。
腹痛 腹痛之由不一，总为火毒内郁，或风寒壅遏，或饮食停滞者，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，麻透自己。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（方见前）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。
四顺清凉饮（一名四顺饮） 治血热便秘脉实者。
当归 赤芍 大黄（酒蒸） 甘草（各一钱五分）
水煎，入生白蜜一匙，热服。
按∶清凉饮治上焦之燥热，故用薄荷之辛散。四顺饮主下焦之燥结，故用大黄之苦寒，功用天渊。
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（方见前）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（方见前）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，加之气喘燥渴，热甚发呃，噤口
不食，麻色紫晦者，皆死不治。
黄芩汤（一名黄芩芍药汤） 治伏气发温，太阳少阳合病自利。
白芍（三钱） 甘草（炙，二钱） 大枣（四枚，擘） 黄芩（三钱）
水煎，温服。
白头翁汤 治热利下重。
白头翁 黄连 黄柏 秦皮
上四味，以水七升，煮取二升，去滓，温服一升，不愈更服。
浓朴汤 治脾胃虚寒作胀，腹中时痛时止。
浓朴（去皮，姜汁炒） 陈皮（泡，去浮白） 甘草（炙） 茯苓 干姜
洁古加半夏、枳实、姜、枣。
干姜黄芩黄连人参汤 治胃虚客热痞满。
干姜（炮） 人参 黄芩 川黄连
水煎，温服。
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（方见前）加荆
芥。麻透热清，自能食也。没后不能食，石斛清胃散（方见前），谅加健运之味。元气委顿者，急需培补，防
有虚羸之患也。
鼻煽 鼻煽者，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。如初出腰已下不热，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（方见前）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，复伤于气，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，食难腐化加砂仁、
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。
双和汤 治麻后虚羸。
熟地黄 白芍（酒炒。各一钱） 黄 （蜜、酒炒） 当归（各七分） 肉桂（三分，有热去之） 生姜（一
片） 炙甘草 川芎（各四分） 红枣（一枚，去核）
水煎，温服。
四君子汤 治胃气虚弱，饮食不思，倦怠少食。
人参（一钱至三钱） 白术（炒黄，一钱至二钱） 茯苓（一钱至钱半） 甘草（炙，六分至一钱）
上四味，水煎，空心温服。
按∶四君子乃胃家气分之专药，胃气虚而用之，功效立见。即血虚用四物亦必兼此。故八珍之主治不独气血
两虚也，即血虚者亦须兼用，但补气则偏于四君，补血则偏于四物。若纯用血药，不得阳生之力，阴无由以化
也。方中白术，若治脾胃虚衰，大便不实，或呕恶不食，合用炒焦，方有健运之力。如肺胃虚燥，咳嗽失血，须
用陈米饭上蒸过十余次者，则转浊为清，转燥为润。是以异功散、八珍汤，及归脾、逍遥等方内，并宜蒸者。即
阴虚干咳嗽、吐白血，总无妨碍。更加白蜜拌蒸，犹为合宜。其于轻重炮制之间，全在用者之活法权变。举此可
以类推三隅矣。
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。
霖按∶石顽论疹，分证施治，各中 窍；辨舌察色，尤多精义。然能与人规矩，不能与人巧。其化裁通便处，
要在良工消息得之，又未可拘守成法也。
叶香岩曰∶痧属阳腑经邪，初起必从表治，证见头痛喘急，咳嗽气粗呕恶。一日二日即发者轻，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。治法宜苦辛清热，凉膈去硝黄。
方书谓足阳明胃疹，如云布密，或大颗如豆，但无根盘。
方书谓手太阴肺疹，但有点粒无片片者，用辛散解肌。冬月无汗，壮热喘气，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，以其升阳明胃津。热甚烦渴，用石膏辛寒解肌，无汗忌用。
凡疮疹辛凉为宜。连翘辛凉，翘出众草，能升能清，最利幼科，能解小儿六经诸热。
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。
疹宜通泄，泄泻为顺，下痢五色者亦无妨。惟二便不利者最多凶证。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，皆属里证不清致变。须分
三焦受邪孰多，或兼别病累瘁，须
细体认。上焦药用辛凉，中焦药用苦辛寒，下焦药用咸寒。
上焦药气味宜以轻。肺主气，皮毛属肺之合。外邪宜辛胜，里甚宜苦胜。若不烦渴，病日多，邪郁不清，
可淡渗以泄气分。
中焦药，沙火在中，为阳明燥化，多气多血，用药气味苦寒为宜。若日多胃津消烁，苦则助燥劫津，甘寒
宜用。
下焦药咸苦为主。若热毒下注成痢，不必咸以软坚，但取苦味坚阴燥湿。
古人以痧为经腑之病，忌温燥涩补。所谓痘喜温暖，疹喜清凉也。然常有气弱体虚，表散寒凉非法，淹淹
酿成损怯。但阴伤为多，救阴必扶持胃汁。气衰者亦有之，急当益气。稚年阳体，纯刚之药忌用。幼科方书歌
括曰∶赤疹遇清凉而消，白疹得温暖而解。此温字即后人酒酿、柽木、粗草、纸木、棉纱之属。虽不可不知，
然近年用者多无益。
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。外治另有专方。
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，重则苦寒解毒。
许宣治曰∶疹痘形证大略相似，治者每严于豆，而略于疹。不知痘之境宽，虽见险恶，犹可从容图治；疹
之境促，变生顷刻，多不及救，故不可不预防也。预防之法，在病家，坐卧欲暖，饮食宜淡，二语尽之；在医家，
慎发表三字尽之。所谓慎发表者，其一体实之儿，火毒盛甚，发之太过，热壅于上，多有气粗喘闭者。医家见
其喘闭，复以表药继之，热不能降，焚灼而死。抑思古方升麻葛根汤之用白芍所以和阴也，麻黄石膏汤发中
有降也。其一体虚之儿，出每迟滞，小经发散，元气已浮。医者谓出未透，更重发之，疹虽出而阳气尽拔，无
阴以摄，致喘脱者
多矣。余用地黄汤加人参纳气归元，曾救一二。故凡见体弱之儿，颅开面白，目无神，或疟痢病后出得迟缓，
即当照顾元气，不可过行发表。
或问∶痘出于脏，疹出于腑。胃，腑也，何以痘多胃热发斑之证；肺，脏也，何以疹多肺闭喘促之证？
余曰∶痘出于脏，而赴于胃，是由脏而之腑，胃主肌肉故也。疹出于腑，而甚于肺，是由腑而之脏，肺主皮毛故
也。然则痘之出，五脏之毒而胃总受之；疹之出，六腑之毒而肺总受之。所谓先起于阳者，出于六腑也；后归
于阴者，肺受之也。
痧疹之出，不离肺胃两家，喘闭者肺证也，烦渴者胃证也。冬月因寒喘闭，麻黄、杏仁为救急之药，治之
速，疹出喘定而解。若夏令出疹，麻黄与时不合。庸工不识，一见喘闭，执而用之，每多随药而死。盖痧疹多
火证，火甚克金，夏令金亏，天人皆病，麻黄万不能受。冬月之喘闭，有面青唇黯肢冷者，故可用麻黄。夏月
肺气已亏，表气已开，断无寒证，间有肢冷者，是阳气亏不能四达也，只可荆、防、甘、桔从轻用药。气亏甚
者，可加人参。火甚者，升麻石膏汤。喘定者可治。
胃热烦渴者必多汗。此纯是里热，即荆防葛根亦不可轻使。升麻石膏汤乃对证之药，合之甘桔，则肺胃两
家之热解矣。喘闭证在一二朝见，汗渴证在五六朝见。肺不容邪，其变也速；胃能容受，其变也迟。
疹之出必先咳嗽。不嗽而出，非痧疹也。出喷嚏者吉，肺气通也。
盛夏之令，火旺金伤，保肺为上。轻轻一散，即宜保肺，石膏、梨汁二味最妙。
石膏一味，为痧疹之至宝，色白属金，味甘微辛，升中有降，降中有升，虽为清胃之药，实保肺之灵丹也。
刑金之火，由胃而来。石膏本清胃之药，而清肺者是与之去
路也。
夏月无麻黄证，其有不出者，是正气为热所伤，不能升举，疏托中宜兼益气，是余得心之处。
其有富贵之家，痧毒本甚，更加郁遏太过，火甚金伤，致生喘促者，经谓壮火食气是也。急宜泻火保肺，
不得再行表散。
亦有贫寒之子，破屋当风，衣不蔽膝，沙毒正出，外受寒邪，忽生喘促者，急宜温散，使表气宣通，痧毒得
解。否则痧闭，顷成不救。
寒邪外闭，火甚伤金，二证皆见喘促，医者当知诊视。寒邪外闭者，面色青，四肢冷，痧点隐隐于皮肤之
内，鼻煽而声细，微有恶寒之象，宜麻黄、杏仁、苏叶、防风、胡荽等味急进。一服暖覆，片时喘定面赤，痧
渐出者生。若面色如银者，不可治也。火甚伤金者，壮热面赤，烦躁口渴，四肢热，喘息粗，而脉洪大，心烦
如果患者体质偏燥，可加入生地黄；若黄芩、人参等药性偏燥，可加入麦冬、竹叶。黑色逐渐消退的预后良好，若不消退则难以治愈。
口疳、牙疳：牙龈腐烂，这是热邪滞留阳明经，余毒上冲所致。治疗可用加味清胃散（方剂见前文），加入石膏、荆芥。大便秘结者，服用当归散轻微通下。外用栗根白皮煎汤漱口清洁后，吹入无比散（方剂见前文）或烧盐散。如果牙龈颜色发白，病邪由外向内蔓延，没有脓血，牙齿脱落且口臭，气喘急促且喉间有痰鸣声的，都属于难治之症。如果满口嘴唇舌头黄赤白烂，唯独牙龈完好无损的，这叫口疮，不是牙疳。这是胃中余热未尽，毒气壅塞在上焦，大小便必然多艰涩，可用导赤散（方剂见前文）来泻心脾之火，外用绿袍散敷贴患处。
当归散：治疗口舌生疮，牙龈毒发，大便秘结。
药材：当归、赤芍（各一钱）、川芎（五分）、大黄（三钱）、甘草（生用，五分）。
研为散剂，加生姜一片，水煎服。
烧盐散：治疗牙疳溃烂。
取橡斗（橡树果实外壳）大的，装满盐，合拢后用铁丝扎紧，烧至存性（保留药性），用碗扣在地上，放入少许麝香，研细后敷于患处。
绿袍散：治疗各种口疮腐烂。
药材：荆芥穗、薄荷、青黛、玄明粉、硼砂（各二钱）、甘草（一钱半）、百药煎（二钱半）。
研为散剂，点涂在舌上，令其自行融化。
腹痛：腹痛的原因不一，总归是火毒内郁，或风寒壅遏，或饮食停滞，都能导致疼痛。如果在发热出疹正盛时，因风寒壅遏，毒邪反而内攻引起腹痛的，急需疏解表邪，疹子透发出来疼痛自然停止。如果是饮食过度损伤，腹部胀满疼痛的，用力消食导滞，疼痛自除。正值疹子将没未完全消退时出现腹痛的，兼清内外之热，疼痛自止。疹子消退后出现的腹痛，分利余热，疼痛自愈。另外必须查验是否有其他证候，辨别属虚属实，然后进行治疗。如果是热邪内结引起的腹痛，以通利大便为主。如果有麻疹后脾气不调导致腹胀，面目四肢浮肿的，分利小便是要紧事。至于元气大虚，阴阳不能升降，小便不利，遍身浮肿，兼见气喘急促的，难治。
便秘：大便秘结，是因为火壅血燥耗伤津液，对于麻疹来说非常不宜。无论发病日期前后，都应迅速清热润燥，用四顺清凉饮，严重的用凉膈散（方剂见前文）来通利。千万不要拖延，恐怕疹子变成紫黑色而难以救治。大概麻疹从发出到消退，大小便都不宜秘结，秘结的话稍微通利即可。
四顺清凉饮（又名四顺饮）：治疗血热便秘脉实者。
药材：当归、赤芍、大黄（酒蒸）、甘草（各一钱五分）。
水煎，加入生白蜜一匙，热服。
按语：清凉饮治疗上焦的燥热，所以用薄荷的辛散。四顺饮主治下焦的燥结，所以用大黄的苦寒，功效相差极大。
溺涩：小便赤涩，在初热正出时，热邪涩渗，这是正常征象。疹子消退后出现，是余热隐匿在膀胱，用导赤散（方剂见前文）加麦冬，以滋养气化功能并利小便。仍然不通的，一定是大便秘结郁滞的缘故，大便一通，小便自然通畅。
痢疾：麻疹引发痢疾，是因为热邪内陷。在疹子正没或没后，痢下白色粪便的，用黄芩汤加防风、枳壳。痢下脓血的，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（方剂见前文）加山楂、黄柏、木通。腹中胀气，时痛时止的，用浓朴汤。也有腹泻久了变成痢疾的，用干姜黄芩黄连人参汤。从头到尾痢疾不彻底的，必定有风毒留滞在体内，则应解毒行滞，兼疏风实脾，这样才能见效。如果痢下紫暗，像痈脓，像屋漏水，像鸡肝色，像黑豆汁之类的，加上气喘燥渴，热甚发呃逆，噤口不食，疹色紫晦的，都是死症，无法治愈。
黄芩汤（又名黄芩芍药汤）：治疗伏气发温，太阳少阳合病自利。
药材：白芍（三钱）、甘草（炙，二钱）、大枣（四枚，掰开）、黄芩（三钱）。
水煎，温服。
白头翁汤：治疗热利下重（里急后重）。
药材：白头翁、黄连、黄柏、秦皮。
以上四味，用水七升，煮取二升，去渣，温服一升，不好再服。
浓朴汤：治疗脾胃虚寒作胀，腹中时痛时止。
药材：浓朴（去皮，姜汁炒）、陈皮（泡，去浮白）、甘草（炙）、茯苓、干姜。
洁古先生加半夏、枳实、姜、枣。
干姜黄芩黄连人参汤：治疗胃虚客热痞满。
药材：干姜（炮）、人参、黄芩、川黄连。
水煎，温服。
下虫：排虫多见于疹子消退后。这是因为胃热少食，虫不安稳而下出。这与过食伤中，虫不能容纳而下出不同。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。
睡：麻疹正出时，精神困倦，沉睡不醒的，属于逆证。这是因为正气亏损，邪火内郁，正气不胜所致。如果疹子消退后沉睡不醒的，是气血俱虚，补脾养血是要紧事。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，掐其颊车、合谷穴，不知道疼痛，似睡非睡的，无论正出还是没后，都不是吉兆。应当观察兼见什么证候，然后施治。
不食：不进食是胃中邪热炽盛，不可强行喂食。虽然几天不吃饭，也没有妨害。在初发正出时，用白虎汤（方剂见前文）加荆芥。疹子透发，热清之后，自然能进食。疹子消退后不能进食，用石斛清胃散（方剂见前文），适当加入健运脾胃的药物。元气委顿的，急需培补，防止出现虚羸的病患。
鼻煽：鼻翼扇动，是肺气将绝的表现。如果兼见喘满痰鸣，这必定不治。如果咽喉清利无喘满，而精神不减的，可治，宜以滋培肺气为主。疹子消退后出现鼻煽的，死亡。
胸高：麻疹胸廓高耸，是肺热炽盛而胀。多见于疹子正没或没后，属于肺经坏证，不治。
身冷：麻疹是由肺胃邪热所发，本属于阳证，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故，唯独下肢厥冷过膝的，是肾败，不治。如果刚发出时腰部以下不热，毒不能透发而反而逐渐隐没的，也是逆候，急需温养脾肾，或许有得救的可能。
妊娠：麻疹属火候，最容易堕胎。如果在初发正出时，须查验疹色红淡，热势轻重，给予疏解。在疏解之中，佐以清凉。以滋血安胎为主，用四物汤（方剂见前文）加条芩、艾叶、荆芥、紫苏之类。如果胎气上冲，急用苎根、艾叶煎汤，磨槟榔接续服用以降气。一切实脾行气温燥的药物，既碍麻疹，又伤气，都必须禁止。
虚羸：麻疹患病平息后，形体瘦弱，精神倦怠，饮食减少，或咳嗽不止；或便泄不已，或身热不除，都是真元亏损，恐怕形成劳瘵，都宜用双和汤去掉川芎来调和。咳嗽加橘红、贝母，咳加麦冬、百合，腹泻加白术、扁豆，食物难消化加砂仁、谷芽，气血俱虚合用四君子汤，随证调治。切忌使用寒凉伤犯脾胃的药物。专心致力于滋补，缓慢图谋恢复即可。
双和汤：治疗麻疹后虚羸。
药材：熟地黄、白芍（酒炒，各一钱）、黄芪（蜜、酒炒）、当归（各七分）、肉桂（三分，有热去掉）、生姜（一片）、炙甘草、川芎（各四分）、红枣（一枚，去核）。
水煎，温服。
四君子汤：治疗胃气虚弱，饮食不思，倦怠少食。
药材：人参（一钱至三钱）、白术（炒黄，一钱至二钱）、茯苓（一钱至钱半）、甘草（炙，六分至一钱）。
以上四味，水煎，空腹温服。
按语：四君子汤是调理胃家气分的专药，胃气虚使用它，功效立见。即使是血虚用四物汤，也必兼用此方。所以八珍汤的主治不仅仅是气血两虚，即使是血虚者也须兼用，但补气则偏重于四君子，补血则偏重于四物。如果纯用血药，得不到阳气生长的力量，阴精就无法化生。方中的白术，如果治疗脾胃虚衰，大便不实，或呕恶不食，合用炒焦，才有健运之力。如果是肺胃虚燥，咳嗽失血，须用陈米饭上蒸过十余次的白术，则能转浊为清，转燥为润。因此异功散、八珍汤，及归脾、逍遥等方内，都宜用蒸过的白术。即使是阴虚干咳、吐白血，也没有妨碍。再加上白蜜拌蒸，更为合适。其中的轻重炮制，全在于使用者的灵活变通。举此一端可以类推其余了。
麻疮：麻疹后发疮，多因为生水洗澡太早，水气留泊肌腠而发，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。失治必定每年按期发作。虽说是小病，也必须谨慎对待。
叶霖按语：石顽论述疹病，分证施治，各中肯綮；辨舌察色，尤多精义。然而他能给人规矩，不能给人巧思。其化裁通便之处，关键在于良医斟酌把握，不可拘守成法。
叶香岩说：痧疹属于阳腑经邪，初起必从表治，证见头痛喘急，咳嗽气粗呕恶。一日二日即发的轻，三五日发的重。阳病七日外隐伏不透，邪气反而内攻，喘不止，必定腹痛胀秘闷，危险。治法宜苦辛清热，凉膈散去掉硝黄。
方书说足阳明胃疹，如云布密，或大颗如豆，但没有根盘。
方书说手太阴肺疹，只有点粒没有片片的，用辛散解肌。冬月无汗，壮热喘气，用麻杏石甘汤，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，因为它能升提阳明胃津。热甚烦渴，用石膏辛寒解肌，无汗忌用。
凡是疮疹，辛凉为宜。连翘辛凉，翘出众草，能升能清，最利于儿科，能解小儿六经诸热。
春季发痧从风温；夏季从暑风，暑必兼湿；秋季从热烁燥气；冬季从风寒。
疹宜通泄，泄泻为顺，下痢五色者也无妨。惟独大小便不利的最多凶证。治法大忌止泻。
痧本是六气客邪，风寒暑湿，必从火化，痧既然外发，世人都说邪透。谁知道出没之际，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，最终死亡的，都是因为里证不清导致变证。须分辨三焦受邪孰多，或兼别病累及，须仔细体认。上焦药用辛凉，中焦药用苦辛寒，下焦药用咸寒。
上焦药气味宜以轻。肺主气，皮毛属肺之合。外邪宜辛胜，里甚宜苦胜。如果不烦渴，病日多，邪郁不清，可淡渗以泄气分。
中焦药，沙火在中，为阳明燥化，多气多血，用药气味苦寒为宜。如果日多胃津消烁，苦则助燥劫津，甘寒宜用。
下焦药咸苦为主。如果热毒下注成痢，不必咸以软坚，但取苦味坚阴燥湿。
古人认为痧为经腑之病，忌温燥涩补。所谓痘喜温暖，疹喜清凉。然而常有气弱体虚，表散寒凉非法，淹淹酿成损怯。但阴伤为多，救阴必扶持胃汁。气衰者亦有之，急当益气。稚年阳体，纯刚之药忌用。幼科方书歌括说：赤疹遇清凉而消，白疹得温暖而解。这个“温”字即后人用的酒酿、柽木、粗草、纸木、棉纱之类。虽然不可不知，然而近年使用者多无益。
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，死亡的。治疗宜早。外治另有专方。
如果汤药方，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，重则苦寒解毒。
许宣治说：疹痘形证大略相似，医者往往对痘严格，而对疹疏忽。不知道痘的境界宽，即使见到险恶，还可以从容图治；疹的境界紧迫，变化生于顷刻，多来不及救治，所以不可不预防。预防的方法，在病家，坐卧欲暖，饮食宜淡，这两句话概括了；在医家，慎发表三个字概括了。所谓慎发表，其一，体质实的儿童，火毒盛甚，发散太过，热壅于上，多有气粗喘闭的。医者见到其喘闭，又以表药继之，热不能降，焚灼而死。试思考古方升麻葛根汤之用白芍是为了和阴，麻黄石膏汤发中有降。其二，体质虚的儿童，出疹每迟滞，稍经发散，元气已浮。医者谓出未透，更重发之，疹虽出而阳气尽拔，无阴以摄，导致喘脱的多。我用地黄汤加人参纳气归元，曾救活一二。所以凡见到体弱的儿童，颅开面白，目无神，或疟痢病后出得迟缓，就应当照顾元气，不可过行发表。
有人问：痘出于脏，疹出于腑。胃，腑也，为什么痘多有胃热发斑之证；肺，脏也，为什么疹多有肺闭喘促之证？
我说：痘出于脏，而赴于胃，是由脏而之腑，胃主肌肉的缘故。疹出于腑，而甚于肺，是由腑而之脏，肺主皮毛的缘故。那么痘的出，五脏之毒而胃总受之；疹的出，六腑之毒而肺总受之。所谓先起于阳者，出于六腑也；后归于阴者，肺受之也。
痧疹的出，不离肺胃两家，喘闭者是肺证，烦渴者是胃证。冬月因寒喘闭，麻黄、杏仁为救急之药，治之速，疹出喘定而解。如果夏令出疹，麻黄与时不合。庸工不识，一见喘闭，执而用之，每多随药而死。盖痧疹多火证，火甚克金，夏令金亏，天人皆病，麻黄万不能受。冬月的喘闭，有面青唇黯肢冷的，故可用麻黄。夏月肺气已亏，表气已开，断无寒证，间有肢冷的，是阳气亏不能四达也，只可荆芥、防风、甘草、桔梗从轻用药。气亏甚的，可加人参。火甚的，升麻石膏汤。喘定的可治。
胃热烦渴者必多汗。这纯是里热，即荆防葛根也不可轻使。升麻石膏汤乃对证之药，合之甘桔，则肺胃两家之热解矣。喘闭证在一二朝见，汗渴证在五六朝见。肺不容邪，其变也速；胃能容受，其变也迟。
疹的出必先咳嗽。不嗽而出，非痧疹也。出喷嚏者吉，肺气通也。
盛夏之令，火旺金伤，保肺为上。轻轻一散，即宜保肺，石膏、梨汁二味最妙。
石膏一味，为痧疹之至宝，色白属金，味甘微辛，升中有降，降中有升，虽为清胃之药，实保肺之灵丹也。
刑金之火，由胃而来。石膏本清胃之药，而清肺者是与之去路也。
夏月无麻黄证，其有不出者，是正气为热所伤，不能升举，疏托中宜兼益气，这是我心得之处。
其有富贵之家，痧毒本甚，更加郁遏太过，火甚金伤，致生喘促者，经谓壮火食气是也。急宜泻火保肺，不得再行表散。
也有贫寒之子，破屋当风，衣不蔽膝，痧毒正出，外受寒邪，忽生喘促者，急宜温散，使表气宣通，痧毒得解。否则痧闭，顷成不救。
寒邪外闭，火甚伤金，二证皆见喘促，医者当知诊视。寒邪外闭者，面色青，四肢冷，痧点隐隐于皮肤之内，鼻煽而声细，微有恶寒之象，宜麻黄、杏仁、苏叶、防风、胡荽等味急进。一服暖覆，片时喘定面赤，痧渐出者生。若面色如银者，不可治也。火甚伤金者，壮热面赤，烦躁口渴，四肢热，喘息粗，而脉洪大，心烦
If the patient's constitution is dry, add Shengdi Huang (Rehmanniae Radix Recens). If Huang Qin (Scutellariae Radix) and Ren Shen (Ginseng Radix et Rhizoma) are too drying, add Mai Dong (Ophiopogonis Tuber) and Zhu Ye (Bambusae Folium). If the black color gradually recedes, it is auspicious; if it does not recede, it is incurable.
Mouth Canker and Gum Rot: Ulceration and rotting of the gums indicate heat lingering in the Yangming channel, with residual toxins rushing upward. Use Jiawei Qingwei San (Formula seen previously) added with Shigao (Gypsum Fibrosum) and Jingjie (Schizonepetae Herba). In cases of constipation, administer Danggui San to mildly purge. Externally, rinse thoroughly with a decoction of Ligen Baipi (Celtis Sinensis Root Bark), then insufflate Wubi San or Shaoyan San. If the gums are white, the disease spreads from outside inward, there is no pus or blood, teeth fall out accompanied by foul breath, and there is panting with phlegm rales, these are all signs of incurability. If the entire mouth, lips, and tongue are yellow, red, and white with ulceration, but the gums remain healthy, this is called Mouth Canker, not Gum Rot. This indicates that residual heat in the stomach has not fully cleared, and toxins are congested in the Upper Jiao; urination and defecation will likely be difficult. Use Daochi San (Formula seen previously) to drain fire from the Heart and Spleen, and apply LvPao San externally.
Danggui San: Treats cankers on the mouth and tongue, toxic eruption on the gums, and constipation.
Ingredients: Dang Gui (Radix Angelicae Sinensis), Chi Shao (Radix Paeoniae Rubra) (each 1 qian), Chuan Xiong (Rhizoma Chuanxiong) (0.5 qian), Da Huang (Rhei Radix et Rhizoma) (3 qian), Gan Cao (Radix Glycyrrhizae Preparata, raw) (0.5 qian).
Grind into a powder, add one slice of Sheng Jiang (Zingiberis Rhizoma Recens), decoct in water, and take orally.
Shaoyan San: Treats ulcerated and rotten gum rot.
Take large acorn cups (Xiangdou), fill them with salt, close them, and secure with iron wire. Burn until the medicinal nature remains (Cunxing). Cover with a bowl placed on the ground, add a small amount of She Xiang (Moschus), grind finely, and apply topically.
LvPao San: Treats all types of oral ulcers and rotting.
Ingredients: Jingjie Sui (Schizonepetae Spica), Bo He (Menthae Haplocalycis Herba), Qing Dai (Indici Folium), Xuan Ming Fen (Natrii Sulfas), Peng Sha (Borax) (each 2 qian), Gan Cao (Radix Glycyrrhizae Preparata) (1.5 qian), Bai Yao Jian (Fermum) (2.5 qian).
Grind into a powder, sprinkle on the tongue, and allow to dissolve naturally.
Abdominal Pain: The causes of abdominal pain vary, but generally stem from internal depression of fire-toxin, obstruction by wind-cold, or food stagnation. During the peak of fever and rash eruption, if wind-cold obstruction causes toxins to attack inward resulting in abdominal pain, urgently release the exterior; once the rash emerges, the pain will cease. If excessive eating causes abdominal fullness and distending pain, vigorously promote digestion and the pain will resolve. If abdominal pain occurs when the rash is fading but not yet gone, clear both interior and exterior heat, and the pain will stop. If it appears after the rash has vanished, separate and drain residual heat, and the pain will heal itself. Furthermore, verify if there are other symptoms to determine deficiency or excess before treating. If abdominal pain is caused by internal binding of heat, prioritize unblocking the bowels. If spleen qi dysfunction after measles leads to abdominal distension and edema of the face, eyes, and limbs, promoting diuresis is key. However, if primordial qi is severely deficient, yin and yang cannot ascend and descend, urination is difficult, there is generalized edema, and panting is present, it is difficult to treat.
Constipation: Severe constipation results from fire congestion and blood dryness consuming body fluids, which is highly unsuitable for measles. Regardless of the day of onset, quickly employ clearing and moistening methods. Use Sishun Qingliang Yin; for severe cases, use Liangge San (Formula seen previously) to unblock and purgatively clear. Do not delay, lest the rash turn purple-black and become incurable. Generally, from the emergence to the disappearance of the rash, neither urination nor defecation should be constipated; mild purgation is acceptable if constipated.
Sishun Qingliang Yin (also known as Sishun Yin): Treats blood-heat constipation with a forceful pulse.
Ingredients: Dang Gui (Radix Angelicae Sinensis), Chi Shao (Radix Paeoniae Rubra), Da Huang (Rhei Radix et Rhizoma, steamed with wine), Gan Cao (Radix Glycyrrhizae Preparata) (each 1.5 qian).
Decoct in water, add one spoonful of raw white honey, and take hot.
Note: Qingliang Yin treats dryness-heat in the Upper Jiao, hence using Bo He (Menthae Haplocalycis Herba) for its pungent dispersal. Sishun Yin governs dryness-binding in the Lower Jiao, hence using Da Huang (Rhei Radix et Rhizoma) for its bitter cold; their functions are vastly different.
Difficult Urination: Red and difficult urination during the initial fever and rash eruption indicates heat obstructing fluid metabolism, which is a normal sign. If it appears after the rash vanishes, it indicates residual heat hiding in the Bladder. Use Daochi San (Formula seen previously) added with Mai Dong (Ophiopogonis Tuber) to nourish qi transformation and promote urination. If it still does not flow, it is due to severe constipation and stagnation; once the bowels move, urination will naturally flow freely.
Dysentery: Measles-induced dysentery is caused by heat sinking inward. If dysentery with white stool occurs during the fading or after the rash vanishes, use Huangqin Tang added with Fang Feng (Saposhnikoviae Radix) and Zhi Ke (Aurantii Fructus). If pus and blood are passed, use Baitouweng Tang removing Huang Bo (Phellodendri Cortex) and adding Fang Feng (Saposhnikoviae Radix). If caused by food stagnation, use Zhike Tang (Formula seen previously) added with Shan Zha (Crataegi Fructus), Huang Bo (Phellodendri Cortex), and Mu Tong (Akebiae Caulis). For abdominal bloating with intermittent pain, use Houpo Tang. There are also cases where prolonged diarrhea turns into dysentery, treated with Ganjiang Huangqin Huanglian Renshen Tang. If dysentery persists from start to finish without resolution, wind-toxin must be lingering internally; thus, detoxify and move stagnation while dispersing wind and strengthening the Spleen. If the stool is dark purple, resembling abscess pus, leaking roof water, chicken liver color, or black bean juice, accompanied by panting, dry thirst, hiccups from severe heat, inability to eat due to locked jaw, and dark/dull rash color, these are fatal and incurable.
Huangqin Tang (also known as Huangqin Shaoyao Tang): Treats latent qi inducing warm disease, spontaneous diarrhea from combined Taiyang and Shaoyang syndromes.
Ingredients: Bai Shao (Radix Paeoniae Alba) (3 qian), Gan Cao (Radix Glycyrrhizae Preparata, honey-fried) (2 qian), Da Zao (Jujubae Fructus, four pieces, split), Huang Qin (Scutellariae Radix) (3 qian).
Decoct in water, take warm.
Baitouweng Tang: Treats heat-dysentery with tenesmus.
Ingredients: Baitouweng (Pulsatillae Radix), Huang Lian (Coptidis Rhizoma), Huang Bo (Phellodendri Cortex), Qin Pi (Fraxini Cortex).
These four ingredients, decoct in seven sheng of water to obtain two sheng, remove dregs, take one sheng warm. Repeat if necessary.
Houpo Tang: Treats abdominal distension due to Spleen-Stomach deficiency-cold, with intermittent abdominal pain.
Ingredients: Hou Po (Magnoliae Officinalis Cortex, peeled, stir-fried with ginger juice), Chen Pi (Citri Reticulatae Pericarpium, soaked, remove white pith), Gan Cao (Radix Glycyrrhizae Preparata, honey-fried), Fu Ling (Poria), Gan Jiang (Zingiberis Rhizoma).
Jiegu added Ban Xia (Pinelliae Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Ginger, and Jujube.
Ganjiang Huangqin Huanglian Renshen Tang: Treats epigastric fullness and stuffiness due to Stomach deficiency with guest-heat.
Ingredients: Gan Jiang (Zingiberis Rhizoma, processed), Ren Shen (Ginseng Radix et Rhizoma), Huang Qin (Scutellariae Radix), Chuan Lian Zi (Toosendan Fructus - *Correction*: Text says Chuan Huang Lian, usually Coptidis Rhizoma, but context implies standard formula ingredients. Standard is Huang Lian. Text says "Chuan Huang Lian", likely referring to Coptidis Rhizoma from Sichuan).
Decoct in water, take warm.
Passing Worms: Passing worms is mostly seen after the rash vanishes. This is due to Stomach heat and reduced food intake causing worms to become restless and exit. This differs from worms exiting due to excessive eating damaging the middle jiao. It only requires dietary regulation to heal spontaneously; unlike vomiting, it does not require specific treatment.
Sleep: During the active eruption of measles, mental fatigue and deep, unrousable sleep indicate an adverse condition. This is due to deficiency of righteous qi and internal depression of pathogenic fire, where righteous qi cannot overcome the pathogen. If deep, unrousable sleep occurs after the rash vanishes, it indicates deficiency of both qi and blood; tonifying the Spleen and nourishing blood is key. If restlessness and insomnia occur after the rash vanishes, it indicates reignition of residual fire; urgently nourish yin and blood so that floating yang may敛 (restrain). There are also cases of coma-like sleep without awareness of surroundings, where pinching Jiache (ST6) and Hegu (LI4) elicits no pain response, appearing half-asleep; whether during eruption or post-rash, this is an ominous sign. Observe accompanying symptoms to guide treatment.
Anorexia: Refusal to eat indicates blazing evil heat in the Stomach; do not force feeding. Even several days without food causes no harm. During initial eruption, use Baihu Tang (Formula seen previously) added with Jingjie (Schizonepetae Herba). Once the rash emerges and heat clears, appetite will return naturally. If anorexia persists after the rash vanishes, use Shihu Qingwei San (Formula seen previously), appropriately adding herbs to strengthen transportation and transformation. If primordial qi is exhausted, urgently tonify to prevent emaciation. Avoid cold-cooling herbs that damage the Spleen and Stomach. Focus entirely on nourishment and recovery slowly.
Shuanghe Tang: Treats emaciation after measles.
Ingredients: Shu Di Huang (Rehmanniae Radix Praeparata), Bai Shao (Radix Paeoniae Alba, wine-fried) (each 1 qian), Huang Qi (Astragali Radix, honey/wine fried), Dang Gui (Radix Angelicae Sinensis) (each 0.7 qian), Rou Gui (Cinnamomi Cortex) (0.3 qian, omit if heat is present), Sheng Jiang (Zingiberis Rhizoma Recens, one slice), Zhi Gan Cao (Radix Glycyrrhizae Preparata, honey-fried), Chuan Xiong (Rhizoma Chuanxiong) (each 0.4 qian), Hong Zao (Jujubae Fructus, one piece, pit removed).
Decoct in water, take warm.
Sijunzi Tang: Treats weak Stomach qi, lack of appetite, fatigue, and reduced food intake.
Ingredients: Ren Shen (Ginseng Radix et Rhizoma) (1-3 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried until yellow) (1-2 qian), Fu Ling (Poria) (1-1.5 qian), Zhi Gan Cao (Radix Glycyrrhizae Preparata, honey-fried) (0.6-1 qian).
These four ingredients, decoct in water, take warm on an empty stomach.
Note: Sijunzi Tang is a specialized medicine for regulating Stomach qi. Its efficacy is immediate for Stomach qi deficiency. Even when treating blood deficiency with Siwu Tang, it is often combined with this formula. Thus, Bazhen Tang is not only for dual qi-blood deficiency; even for blood deficiency alone, it should be combined. Qi tonification leans towards Sijunzi, while blood tonification leans towards Siwu. Pure blood tonics lack the power of yang generation to transform yin. Bai Zhu in the formula, if used for Spleen-Stomach deficiency with loose stools or nausea/anorexia, should be charred to enhance digestive strength. For Lung-Stomach deficiency-dryness with cough and hemoptysis, Bai Zhu steamed over rice for over ten times transforms turbidity to clarity and dryness to moisture. Therefore, steamed Bai Zhu is suitable in Yigong San, Bazhen Tang, Guipi Tang, and Xiaoyao San. It is also safe for yin-deficiency dry cough or expectoration of white blood. Adding white honey for steaming is even more appropriate. The choice of processing degrees depends on the practitioner's flexibility. This example illustrates the principle.
Measles Sores: Sores appearing after measles are often due to bathing in raw water too early, allowing water qi to lodge in the muscle layer. Wash daily with a decoction of Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), and Ai Ye (Artemisiae Argyi Folium). Do not use raw water, nor apply topical sore medicines. Untreated, they will recur annually on schedule. Though minor, caution is required.
Ye Lin's Note: Shiwan’s discussion on rashes divides syndromes for treatment, hitting the mark; tongue and color differentiation offer profound insights. However, he provides rules but not ingenuity. His modifications for purgation depend on the skilled physician's discretion; one should not rigidly adhere to established formulas.
Ye Tianshi said: Sha-zhen belongs to Yang-Fu channel pathogens. Initial treatment must address the exterior. Symptoms include headache, panting, rough cough, and vomiting. Eruption within one to two days is mild; three to five days is severe. If Yang pathogens remain hidden beyond seven days without emerging, pathogens attack inward, causing persistent panting, abdominal pain, distension, constipation, and oppression—this is critical. Treatment should use bitter-pungent clearing-heat, Liangge San removing Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma).
Medical texts state: Foot-Yangming Stomach sha-zhen appears densely like clouds or large like beans, but lacks a root base.
Hand-Taiyin Lung sha-zhen presents as distinct spots without patches; treat with pungent-dispersing muscle-relieving methods. In winter, with no sweat, high fever, and panting, use Mahuang Xingren... such as Huagai San or San'ao Tang.
In summer, with no sweat, use pungent-cool muscle-relieving methods: Gegen (Puerariae Lobatae Radix), Qianhu (Peucedani Radix), Bo He (Menthae Haplocalycis Herba), Fangfeng (Saposhnikoviae Radix), Xiangru (Elsholtziae Herba), Niuxiang (Arctii Fructus), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix), Mutong (Akebiae Caulis).
Ancients added Gegen for exterior-pathogen thirst because it raises Yangming Stomach fluids. For severe heat and thirst, use Shigao (Gypsum Fibrosum) for pungent-cool muscle-relief; contraindicated if no sweat.
For all sores and rashes, pungent-cool is appropriate. Lianqiao (Forsythiae Fructum) is pungent-cool, surpassing other herbs, capable of ascending and clearing, most beneficial for pediatrics, resolving heat in all six channels of children.
Spring sha follows Wind-Warmth; Summer follows Summer-Heat-Wind (Summer-Heat always includes Dampness); Autumn follows Heat scorching Dryness; Winter follows Wind-Cold.
Rashes benefit from draining and purging; diarrhea is favorable; dysentery with five colors is also acceptable. Only difficulty in urination and defecation indicates many凶 (ominous) signs. Treatment strictly forbids stopping diarrhea.
Sha originates from Six Qi invading pathogens. Wind, Cold, Summer-Heat, Dampness must transform into Fire. Once Sha erupts externally, people say pathogens have penetrated. But emergence and disappearance involve ascent/descent and victory/repulsion.
Often, Sha erupts externally, fever persists, leading to hoarseness, gum rot, panting, abdominal distension, dysentery, anorexia, restlessness, and coma, resulting in death. These are changes due to unclear Interior syndromes. Differentiate which Jiao is more affected by pathogens, or if other diseases complicate the condition. Upper Jiao herbs should be pungent-cool; Middle Jiao herbs, bitter-pungent-cold; Lower Jiao herbs, salty-cold.
Upper Jiao herbs should have light aroma/flavor. Lung governs Qi, skin/hair are Lung's exterior. Exterior pathogens respond best to Pungent; severe Interior responds to Bitter. If no thirst/restlessness, and illness prolongs with unclear depression, use bland-leaching to drain Qi level.
Middle Jiao: Fire/Dryness is central, transforming via Yangming (Dryness). It has abundant Qi and Blood; bitter-cold aroma/flavor is appropriate. If days pass and Stomach fluids consume, bitter aids dryness and damages fluids; Sweet-Cold is preferred.
Lower Jiao: Salty-Bitter is primary. If heat-toxin sinks downward causing dysentery, no need for salty to soften hardness; just use bitter to firm Yin and dry Dampness.
Ancients viewed Sha as a Meridian-Fu disease, avoiding warm-drying, astringent, and tonifying methods. "Smallpox likes warmth, Rash likes coolness." However, those with weak Qi and deficiency may suffer from improper cold/pungent dispersion, leading to chronic decline. Yin injury is common; saving Yin requires supporting Stomach fluids. Qi decline also occurs; urgently tonify Qi. Children's Yang bodies should avoid pure-gang (harsh) drugs. Pediatric rhymes state: "Red rash dissipates with coolness; White rash resolves with warmth." This "warmth" refers to later uses like fermented rice wine, Zhengmu, etc. While known, recent usage is often ineffective.
Sha-Gan with dampness and steaming heat causes erosion of mouth, tongue, and throat. Without rapid treatment, it leads to cheek perforation, throat closure, panting, and death. Treat early. External treatment has specific formulas.
Internal decoctions must be light and bland to resolve Upper Jiao issues, or use clearing-dispersing methods.
Sha-dysentery is heat-toxin sinking inward, similar to Shaoyang syndrome where dysentery stops when pathogens exhaust. Avoid lifting and astringing. Mild cases: separate and unblock; severe cases: bitter-cold detoxify.
Xu Xuanzhi said: Rash and Smallpox shapes/syndromes are roughly similar, but physicians are strict with Smallpox and lax with Rash. Smallpox has a wider scope; even dangerous signs allow time for treatment. Rash is urgent; changes happen instantly, often too late to save. Prevention is essential. For families: keep warm sitting/lying, eat bland diet. For physicians: "Caution in Dispersion" covers it. Caution in dispersion means: 1. For strong children with intense fire-toxin, excessive dispersion causes heat congestion above, leading to rough breathing and closure. Physicians seeing closure may add more dispersants, failing to lower heat, leading to burning death. Recall Shengma Gegen Tang uses Baishao to harmonize Yin; Mahuang Shigao Tang disperses while descending. 2. For weak children, eruption is delayed. Mild dispersion floats Yuanqi. Physicians thinking eruption is incomplete may disperse heavily, exhausting Yang without Yin to anchor, leading to panting/collapse. I used Dihuang Tang added with Renshen to gather Qi and return to origin, saving some. Thus, for weak children (open skull, pale face, dull eyes, or slow eruption post-malaria/dysentery), protect Yuanqi; do not over-disperse.
Question: Smallpox comes from Zang, Rash from Fu. Stomach is Fu, why does Smallpox often show Stomach-heat macules? Lung is Zang, why does Rash often show Lung-closure panting?
Answer: Smallpox comes from Zang but moves to Stomach (Zang to Fu); Stomach governs flesh. Rash comes from Fu but worsens in Lung (Fu to Zang); Lung governs skin/hair. Thus, Smallpox eruption involves Five Zang toxins gathered in Stomach; Rash eruption involves Six Fu toxins gathered in Lung. What arises first in Yang comes from Six Fu; what returns later to Yin is received by Lung.
Sha-Zhen eruption involves Lung and Stomach. Panting/closure is Lung syndrome; Restlessness/thirst is Stomach syndrome. In winter, cold-induced panting/closure uses Mahuang (Ephedrae Herba) and Xingren (Armeniacae Semen Amarum) as emergency meds; quick treatment allows rash emergence and relief. In summer, Mahuang is inappropriate. Unskilled doctors see closure and use it blindly, often causing death. Sha-Zhen is mostly Fire syndrome; Fire conquers Metal. In summer, Metal is weak; Heaven and Man are ill; Mahuang is absolutely contraindicated. Winter closure with blue face, dark lips, cold limbs can use Mahuang. Summer Lung Qi is deficient, exterior pores open; no Cold syndrome exists. Occasional cold limbs indicate Yang deficiency failing to reach extremities. Use Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Gancao (Radix Glycyrrhizae Preparata), Jiegeng (Platycodonis Radix) lightly. If Qi deficiency is severe, add Renshen (Ginseng Radix et Rhizoma). If Fire is severe, use Shengma Shigao Tang. Relief of panting indicates treatability.
Stomach-heat restlessness/thirst causes sweating. This is pure Interior heat; even Jingjie/Fangfeng/Gegen should not be used lightly. Shengma Shigao Tang is the correct formula; combined with Gan/Jie, it clears Lung-Stomach heat. Panting/closure appears in days 1-2; sweating/thirst in days 5-6. Lung cannot tolerate pathogens, changes are fast; Stomach accommodates, changes are slow.
Rash eruption must begin with cough. Eruption without cough is not Sha-Zhen. Sneezing upon eruption is auspicious, indicating Lung Qi opening.
In midsummer, Fire is strong, Metal is injured; protecting Lung is paramount. After mild dispersion, immediately protect Lung; Shigao (Gypsum Fibrosum) and Lizhi (Pyrifoliae Fructus Juice) are best.
Shigao (Gypsum Fibrosum) is the treasure of Sha-Zhen. White corresponds to Metal, sweet and slightly pungent, ascending yet descending, descending yet ascending. Though a Stomach-clearing herb, it is truly a spiritual pill for protecting Lung.
Fire injuring Metal comes from Stomach. Shigao clears Stomach, but clearing Lung provides an exit path.
In summer, there is no Mahuang syndrome. If rash does not emerge, it is because Righteous Qi is damaged by heat and cannot ascend. In dispersing/supporting, adding Qi-tonification is my insight.
In wealthy families, Sha-toxin is severe, compounded by excessive depression, Fire injures Metal causing panting. Classic says: "Blazing Fire consumes Qi." Urgently clear Fire and protect Lung; do not disperse further.
In poor families, living in drafty houses with thin clothes, Sha-toxin is emerging but exposed to Cold, suddenly causing panting. Urgently use Warm-Dispersion to open exterior and resolve Sha-toxin. Otherwise, Sha closure becomes incurable quickly.
Cold blocking exterior vs. Fire injuring Metal both cause panting. Physicians must differentiate. Cold blocking: Blue face, cold limbs, faint rash under skin, fine nasal flapping sound, slight aversion to cold. Urgently use Mahuang (Ephedrae Herba), Xingren (Armeniacae Semen Amarum), Zi Su Ye (Perillae Folium), Fangfeng (Saposhnikoviae Radix), Huy sui (Coriandri Fructus). One dose, cover warmly; if panting stops, face reddens, and rash emerges, survival is likely. If face is silver-white, incurable. Fire injuring Metal: High fever, red face, restlessness, thirst, hot limbs, coarse panting, surging pulse, irritability...