夫 之初发，咳嗽喷嚏，鼻流清涕，眼胞微肿微赤，泪欲汪汪，腮赤面肿，皆是出 之兆，一冒风寒食
积，论其大概，不必一一如是。重则遍身膨胀，眼赤封闭，或壮热无汗，气粗气喘，呕吐，惊搐，鼻煤，咳
嗽声哑，至五六七日不见点者，急用表散以升发之，用麻黄汤主之。若 出稠密如云，片疙紫红干
燥，其毒甚重，表时宜表，回时速当清火解毒为要，此时宜用清龙汤或双解汤使之。大便燥实者加生军五
六钱，回时尤宜重用。胃火盛于回后，用生石膏两余。若不出足而回者，须用麻黄、石膏解之。肺火盛于回
后，片芩宜之。回后小便不利，山栀泻之。心火刑克肺金，黄连清之。表若未透，宜慎之戒之。疹出
黑暗者，不起不透也。焦枯惨暗者，血滞也。糊涂者，凶也。手指先见者，犯本位也。头面身上全无者，闭
症也。或感风寒而不出者，须用麻黄重表也。头面不出而体多者，疹后生死难料也，急宜荷鼻、笋尖、升、
羌、芎也。手足尖头不到者， 后变症无穷也，药宜桂枝鞭芽而起之。一热即出，一出即没者重，只要出
足，回速何妨。不进饮食者重，胃火所致也。鼻掀口张，目无神气者，死。鼻乃肺窍，掀则肺绝，口乃
脾窍，张则脾绝，皆难治也。气喘胸前吸者死，天君不宁者，安得不死？发不出者，闭症
也。及腹胀、气喘、烦躁者，毒火不出，反攻于内也。昏睡者，死。脾困者，面黑色滞者，血死也。目无
光彩者，热则冷之，寒
则温之，莫良于眸子也。痰喘音哑者，肺窍塞也。指甲黑色者，血死也。鼻煤项软者，肺火盛也。四支冰冷
者，脾土倾也。睡卧不宁者，内毒伏也。眼红眼障者，肝火甚也。鼻燥者，肺火甚也。唇硬舌红者，胃火攻
心也。口焦者，脾火甚也。或痰或喘者，火壅危也。 若桃红色者，轻正色也。白色而烦者重，血不
足也。紫色而成堆者重，血滞也。点粒者轻，毒散也。一片者重，从上出下者轻，从下出上者重。四肢先见
者不治，此乃脾经阴不转阳也。鼻青粪黑，咳嗽连声，面青声哑者不治，回时虽云可治，然亦难也。白色有
二症∶饮食如常者，不犯胃气也；精神如旧者，不困肺经也。色润体安不大热者，汗透也。无舌胎者，
心火轻也。大小便如常者，此谓顺症也，不必强治，反是则重，为其气弱也，表降宜慎之。未出之时，鼻红出
者，佳兆也，汗流如淋则美，呕吐亦佳。喜三者何也？《经》云∶衄能散毒，汗能松火，吐能解热毒。从
衄消热，以汗透火，以吐松肺。火盛者，则衄血流而不必止，误止者则毒奔于内也。如此者非恶症也。故
汗吐下三者美也，可不药而自愈矣。凡治 之法，三日宜升，四日宜降，倘误降者则不治也。此治顺症之
常规，未言乎变症。然看手足指尖有红点者方为出完，倘不透明而不见者，仍用表方中加桂枝鞭芽以发
之，切不宜降，慎之慎之。若表而不齐，必须 后停药，以待变之来。《经》云∶变症难逆于将来，何能
预料？所谓不药为中医之说也。妇人胎前出 三日之前，用升麻以提之，恐其堕胎也。回后则用黄芩以安胎，
速降以消火，又能解毒。如产后加凌霄花、丹参可也，而人参切不可用，用则杀人。用补亦然，富贵之家常
犯此病，不可不慎。书云∶不可用人参，叮咛如此其切。参歌有云∶肺热还伤肺，为人参能助气与火也，
为肺热者言之，肺火既清，何忌之！有又热补之药断不可用，如疹后日久虚喘坐立不安，可用生甘熟地，若
一月之外，便宜重用。太阴主肺，阳明大肠，肺与大肠相表里，毒从大肠出者为
贵。《经》云∶毒因利减，此之谓也。回后不可久泻，久则肺经移热于大肠，宜凉肠。 出形云片如锦纹者为
斑，其色红赤者胃火热甚而失下也，此冲入足少阳胆经，助相火而成斑矣，必须重
用石膏，以清胃与肝胆可以成功而消斑。隐隐红点为疹，胃火冲入手足少阴心肾经，则助君火而成疹，黄连
能奏效如神。若斑重而疹轻者，初起时最忌寒凉热辣酸冷之味，并忌冒感风寒，急宜麻黄、苍耳二味以托
肌肤之闭密。毒瓦斯阻遏而内攻不出者，初起之药斟酌用之，但麦冬、生地为其补肺敛皮恐不能发越，又参、
、姜、附子、丁、术、桂燥悍酸热之味为其助火伤肺，补气发喘。但痘与疹用药不同，疹出之时泻利不
止者，吉也，盖泻毒不泻元气也。回时自利不止者，又吉也，毒以利减。若利久而至八九日者方谓过多，恐
肺火移热于大肠，必须先下顺利之水，则自止矣。利水者何也？《经》云∶小水愈长而大便愈结也。骤用
补涩如桂、附、术、木、诃、蔻、参、 等药补涩之剂，必须胸腹胀满，重滞而死矣。《经》云利不可止，
疟不可截，其斯之谓欤！疹子未出与正出之时，不进饮食者，谓此毒瓦斯内蕴，实未解也。
出则宜表回，后重用石膏以开其胃，又加竹茹最妙。
麻疹初起时，出现咳嗽、打喷嚏、流清鼻涕、眼睑微肿且发红、眼泪汪汪、两腮发红面部肿胀，这些都是出疹的征兆。但如果受到风寒侵袭或饮食积滞影响，大体情况可能不会完全如此。病情较重者，全身皮肤肿胀，眼睛红肿闭合，或者高热无汗、呼吸粗重气喘、呕吐、惊厥抽搐、鼻头发黑、咳嗽声音嘶哑，到了五六七天还没有发出疹点，必须紧急使用发散升提的方法，主方用麻黄汤。如果疹子发出后稠密如云片，颗粒紫红干燥，说明毒邪很重，在透表阶段应当透表，在回退阶段则必须以清热泻火解毒为关键，此时宜用清龙汤或双解汤来治疗。大便干结燥实者，加入生大黄五到六钱，在回退阶段尤其要重用。如果在回退阶段胃火旺盛，使用生石膏一两以上。如果疹子没有出足就回退，需要用麻黄和石膏来解除郁闭。如果在回退阶段肺火旺盛，适合用黄芩。回退后小便不通利，用山栀来泻火。心火克制肺金，用黄连来清心火。如果透表不透彻，应当谨慎戒除禁忌。疹色发暗发黑的，是疹子不起不透的表现。焦枯惨暗的，是血行瘀滞。模糊不清的，是凶险之兆。手指先见疹点的，是邪气侵犯本位。头面身上完全没有疹子的，是闭症。或者是感受风寒导致不出疹的，必须重用麻黄进行发散。头面不出疹而身体多出的，疹后生死难料，急需使用荷鼻、笋尖、升麻、羌活、川芎等药。手足指尖不到疹点的，疹后变证无穷无尽，药物宜用桂枝芽来托举发起。一发热就出疹，一出疹就消退的病情重，只要出得充足，回退迅速也无妨。不能进食的病情重，是由胃火所致。鼻孔掀动、张口、眼神无光彩的，预后不良（死）。鼻子是肺的窍道，鼻孔掀动说明肺气已绝；口是脾的窍道，张口说明脾气已绝，都难以治疗。气喘且胸部吸气困难的，预后不良（死），心神不安宁的，怎么能不死？发不出疹的，是闭症。以及出现腹胀、气喘、烦躁的，是毒火不能外泄，反而攻冲于内。昏睡的，预后不良（死）。脾脏困顿的，面色黑而晦滞的，是血败。眼睛没有光彩的，热则用寒凉法，寒则用温补法，没有比观察眸子更好的了。痰喘声音嘶哑的，是肺窍堵塞。指甲黑色的，是血败。鼻头发黑项部柔软的，是肺火旺盛。四肢冰冷的，是脾土衰败。睡卧不安宁的，是内毒潜伏。眼红眼障的，是肝火很盛。鼻燥的，是肺火很盛。嘴唇僵硬舌头红的，是胃火攻心。口舌焦干的，是脾火很盛。或者有痰有喘的，是火邪壅塞危重。如果疹色呈桃红色，是正常的轻症颜色。白色且心烦的病情重，是血不足。紫色且成堆的病情重，是血瘀滞。颗粒分明的病情轻，是毒邪散开。成片融合的病情重，从上往下出的病情轻，从下往上出的病情重。四肢先见疹点的无法治疗，这是脾经阴气不能转阳。鼻青粪黑，咳嗽连声，面青声音嘶哑的无法治疗，回退时虽然说是可治，但也很难。白色有两种情况：饮食正常的，是不犯胃气；精神如旧的，是不困肺经。色泽润泽身体安静不大热的，是汗透表现。没有舌苔的，是心火轻。大小便正常的，这叫顺症，不必强行治疗，反之则重，是因为气弱，透表和降逆时要谨慎。未出疹之前，鼻出血的，是佳兆，出汗淋漓则更好，呕吐也是好的。为什么喜欢这三种情况呢？《内经》说：鼻衄能散发毒邪，出汗能松解火热，呕吐能解热毒。通过鼻衄消热，通过出汗透火，通过呕吐松肺。火盛的，则鼻血流出不必止住，错误地止住则毒邪奔窜于内。像这样的情况不是恶症。所以汗、吐、下三种方法都是好的，可以不靠药物而自愈。凡是治疗麻疹的原则，前三天宜升发，第四天宜降逆，如果误用降法则无法治疗。这是治疗顺症的常规，没有谈到变症。然而看手足指尖有红点才算出完，如果不透明看不见的，仍要在透表方中加入桂枝芽来发散，切忌不宜降逆，务必谨慎。如果透表不均匀，必须在疹退后停药，等待变化到来。《内经》说：变症难以预测将来，怎能预料？所谓“不药”就是中医的高明之处。妇女胎前出疹三天之前，用升麻来提举，恐怕堕胎。疹退后用黄芩来安胎，快速降逆以消火，又能解毒。如果是产后可以加凌霄花、丹参，但人参切不可用，用了会杀人。用补益药也是如此，富贵人家常犯此病，不可不慎。书上说：不可用人参，叮嘱得如此急切。参歌中说：肺热还伤肺，因为人参能助气与火，这是针对肺热而言的，肺火既然清了，有什么忌讳！又有热补的药绝对不可用，如疹后日久虚喘坐立不安，可用生甘草熟地黄，如果一个月之后，才适宜重用。太阴主肺，阳明主大肠，肺与大肠相表里，毒邪从大肠排出的为贵。《内经》说：毒邪因腹泻而减少，说的就是这个道理。疹退后不可久泻，久了则肺经移热于大肠，宜凉肠。出形如云片如锦纹的是斑，其色红赤的是胃火极盛而失于通下，这冲入足少阳胆经，助长相火而成斑，必须重用石膏，以清胃与肝胆才可以成功并消除斑。隐隐红点是疹，胃火冲入手足少阴心肾经，则助君火而成疹，黄连能奏效如神。如果斑重疹轻，初起时最忌寒凉、热辣、酸冷之物，并忌冒受风寒，急需麻黄、苍耳二味药来托举肌肤之闭塞。毒气阻遏而内攻不出者，初起的药物斟酌使用，但麦冬、生地因其补肺敛皮恐怕不能发散，又有人参、附子、干姜、白术、肉桂、丁香等燥悍酸热之味，因其助火伤肺，补气致喘。但痘与疹用药不同，疹出之时腹泻不止的，是吉兆，因为是泻毒而不泻元气。疹退时自利不止的，又是吉兆，毒邪因利而减。如果腹泻长久至八九天才算过多，恐怕肺火移热于大肠，必须先通利水液，则腹泻自止。什么是利水？《内经》说：小便愈长而大便愈结。骤然使用补涩如桂枝、附子、白术、木香、诃子、蔻仁、人参等药的补涩剂，必须胸腹胀满，重滞而死。《内经》说利不可止，疟不可截，说的就是这个意思！疹子未出与正出之时，不进饮食的，是说此毒气内蕴，实证未解。出疹宜透表，疹退后重用石膏以开胃，再加竹茹最好。
At the initial onset of measles (Rash Disease), symptoms such as coughing, sneezing, clear nasal discharge, slight swelling and redness of the eyelids, watery eyes, red cheeks, and swollen face are all signs of eruption. However, if affected by wind-cold or food stagnation, the general presentation may not follow every detail strictly. In severe cases, there is generalized body swelling, red and closed eyes, high fever without sweat, coarse and rapid breathing, vomiting, convulsions, blackening of the nose tip, hoarse cough, and if no rash appears after five to seven days, urgent dispersal and ascending methods should be used, with Mahuang Tang (Ephedra Decoction) as the primary formula. If the rash emerges densely like clouds, with purple-red, dry patches indicating heavy toxicity, while in the eruptive stage one should promote eruption, in the resolving stage clearing heat and detoxifying is crucial; Qinglong Tang (Clear Dragon Decoction) or Shuangjie Tang (Double Resolution Decoction) should be used. For dry and hard stools, add raw Da Huang (Rhubarb Rhizome) 5-6 qian; it should be heavily used during the resolving stage. If stomach fire is excessive after resolution, use over 1 liang of raw Shi Gao (Gypsum Fibrosum). If the rash does not fully emerge before resolving, Mahuang (Ephedrae Herba) and Shi Gao (Gypsum Fibrosum) should be used to resolve the constraint. If lung fire is excessive after resolution, Huang Qin (Scutellariae Radix) is suitable. For difficulty in urination after resolution, Zhi Zi (Gardeniae Fructus) is used to drain fire. If heart fire attacks lung metal, Huang Lian (Coptidis Rhizoma) clears the heart. If the exterior is not thoroughly vented, caution and abstinence from contraindications are required. Dark-colored rashes indicate failure to rise and penetrate. Scorched and dull appearances indicate blood stasis. Indistinct rashes indicate a ominous prognosis. Rashes appearing first on fingers indicate invasion of the original position. Absence of rashes on head, face, and body indicates closure syndrome. If caused by wind-cold preventing eruption, heavy doses of Mahuang (Ephedrae Herba) for dispersal are needed. If the head and face lack rashes but the body has many, the outcome is uncertain; urgently use Hebi, Sunjian, Shengma (Cimicifugae Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), and Xiongqiong (Ligusticum Chuanxiong Rhizoma). If rashes do not reach the tips of hands and feet, endless complications may arise post-rash; Guizhi Yaya (Cinnamomi Ramulus Bud) should be used to lift them. Rapid appearance and disappearance indicate severity; as long as they are sufficient, rapid resolution is acceptable. Inability to eat indicates severity due to stomach fire. Flaring nostrils, open mouth, and spiritless eyes indicate death. The nose is the orifice of the lung; flaring indicates lung qi exhaustion. The mouth is the orifice of the spleen; opening indicates spleen qi exhaustion; both are difficult to treat. Chest-pulling asthma indicates death; unsettled mind (Shen) inevitably leads to death. Failure to erupt indicates closure syndrome. Abdominal distension, asthma, and restlessness indicate toxic fire attacking inward. Coma indicates death. Spleen fatigue and dark, dull complexion indicate blood failure. Lack of luster in eyes: cool heat, warm cold; observing the pupils is best. Phlegm-asthma and hoarseness indicate blocked lung orifices. Black nails indicate blood failure. Black nose tip and soft neck indicate excessive lung fire. Cold limbs indicate spleen earth collapse. Restless sleep indicates latent internal toxin. Red eyes and eye obstruction indicate severe liver fire. Dry nose indicates severe lung fire. Stiff lips and red tongue indicate stomach fire attacking the heart. Scorching mouth indicates severe spleen fire. Phlegm or asthma indicates dangerous fire obstruction. Peach-red color is a mild, normal sign. White color with irritability indicates severity due to blood deficiency. Purple clustered rashes indicate severity due to blood stasis. Distinct granules indicate mildness as toxins disperse. Merged patches indicate severity. Top-down emergence is mild; bottom-up is severe. Limb-first emergence is incurable, representing spleen yin failing to transform into yang. Blue nose, black stool, continuous cough, blue face, and hoarseness are incurable; though resolvable, it is difficult. Two types of white rashes: normal diet indicates uninvaded stomach qi; normal spirit indicates untroubled lung meridian. Moist color, calm body, low fever indicates successful sweating. No tongue coating indicates mild heart fire. Normal bowel/bladder movements indicate favorable syndrome (Shun Zheng); no strong treatment needed. Conversely, severity implies weak qi; caution in venting and descending. Before eruption, epistaxis is auspicious; profuse sweating is excellent; vomiting is also good. Why? The Classic states: epistaxis disperses toxins, sweating loosens fire, vomiting resolves heat toxins. Epistaxis reduces heat, sweating vents fire, vomiting relaxes the lung. With excess fire, allow epistaxis; stopping it causes internal toxin surge. This is not an evil syndrome. Thus, sweating, vomiting, and purging are beneficial; self-healing without drugs is possible. Treatment principles: first three days ascend, fourth day descends; mistaken descent is incurable. This is routine for favorable syndromes, not variable ones. Check fingertips for red dots to confirm completion; if opaque/absent, add Guizhi Yaya to venting formulas; strictly avoid descending. If unevenly vented, stop medication after resolution and await changes. The Classic says: variable syndromes are unpredictable; "no medicine" is the middle way. For pregnant women, Shengma (Cimicifugae Rhizoma) lifts before day three to prevent miscarriage; after resolution, Huang Qin (Scutellariae Radix) calms fetus, descends quickly to clear fire and detoxify. Postpartum, add Lingxiaohua (Lagerstroemiae Flos) and Danshen (Salviae Miltiorrhizae Radix et Rhizoma); Ren Shen (Ginseng Radix) must never be used, as it kills. Tonification similarly dangerous; common among nobles, exercise caution. Books warn against Ren Shen. Song warns: lung heat injured by lung heat, as Ren Shen aids qi and fire; this applies to lung heat. Once cleared, no taboo. Hot tonics absolutely forbidden. For prolonged deficiency asthma post-rash, use raw Gan Cao (Glycyrrhizae Radix) and cooked Di Huang (Rehmanniae Radix); heavy use only after one month. Taiyin governs Lung, Yangming governs Large Intestine; Lung and LI are interior-exterior pairs; toxin exiting via LI is precious. Classic: toxin reduced by diarrhea. Avoid prolonged diarrhea post-resolution to prevent lung heat transferring to LI; cool the intestine. Ban (Maculae) appear as cloud-like brocade patterns; red indicates extreme stomach fire from missed purgation, entering Shaoyang Gallbladder, assisting ministerial fire; heavy Shi Gao (Gypsum Fibrosum) clears stomach/liver/gallbladder to eliminate maculae. Hidden red dots are Zhen (Papules); stomach fire enters Shaoyin Heart/Kidney, assisting sovereign fire; Huang Lian (Coptidis Rhizoma) is effective. For heavy ban/light zhen, avoid cold/hot/sour/cold foods and wind-cold initially; use Mahuang (Ephedrae Herba) and Cang Er Zi (Xanthii Fructus) to open skin pores. For trapped toxins, adjust initial meds cautiously; avoid Mai Dong (Ophiopogonis Tuber) and Sheng Di Huang (Rehmanniae Radix) which tonify lung/astringe skin hindering eruption; avoid Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Preparata), Gan Jiang (Zingiberis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Rou Gui (Cinnamomi Cortex), Ding Xiang (Caryophylli Flos) which are drying/hot and aid fire/injure lung/causing asthma. Acne and papules differ in treatment. During eruption, persistent diarrhea is auspicious as it drains toxin without draining yuan qi. Persistent diarrhea during resolution is also auspicious as toxin reduces via stool. Prolonged diarrhea (8-9 days) is excessive; risk of lung heat transferring to LI; first promote urination to stop diarrhea. Promoting urination? Classic: longer urination leads to firmer stool. Sudden use of astringents like Guizhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Preparata), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Mu Xiang (Aucklandiae Radix), He Zi (Terminalia Chebulae Fructus), Dou Kou (Tsaoko Fructus), Ren Shen (Ginseng Radix) causes abdominal distension/heaviness and death. Classic: diarrhea cannot be stopped, malaria cannot be intercepted. During pre-eruption and eruption, anorexia indicates internal toxin accumulation, excess not resolved. Venting during eruption, heavy Shi Gao (Gypsum Fibrosum) to open stomach post-resolution, plus Zhu Ru (Bambusae Caulis in Taenia) is best.