麻疹收没,期以三日为常,不疾不徐,自无后患。若未至三日而没,肌肤暖处,绝无
形影,此为太速,必因调摄不谨,或为风寒所袭,或为邪秽所触,以致毒反内攻,急宜
内服荆防解毒汤,外用胡荽酒熏其衣被,使疹透出,方保无虞。有至二三日,疹虽没而
肌肤暖处还有形迹,此毒尚未尽,失治必致内攻,仍当疏托,佐以清凉。若当散不散者,
内有虚热留滞于肌表也,切不可纯用寒凉之剂,以柴胡四物汤治之,使血分和畅。余热
悉除,疹即没矣。若麻点带白色,隐于肌表,似没而不没者,必因风寒外折,而不能透发,
亦表虚故也,宜温散风寒,使白变红活,免致生变。古云∶白疹温而自消是也。有延至
五六日不没者,此内热未除,以致不能尽没,宜清凉佐以利水。若加烦躁,右关脉洪数有
力,此胃中伏有湿热,宜化斑汤。若疹已没而身犹热,昼夜不退,此邪火伏郁皮肤之间,
久则毛发焦枯,肌表干燥,肉见消瘦,是为骨蒸痨症,宜芦荟肥儿丸治之,迟则不救。如
疹没后身虽不见瘦削,但时发壮热,烦躁不安,搐掣惊悸,神昏志乱者,此阴血虚耗,余
毒入肝而传于心,宜枣麦四物汤主之。
一疹没绵绵发热,不知早治,则成疳症,必致腹胀,午后发热头痛,宜柴苓四物汤。若
口渴少食烦闷,宜小柴胡汤。
一没后潮热,宜升麻葛根汤,烦渴用黄连解毒汤,溺赤如米泔汁宜五苓散加车前子、
木通。若见便血,宜黄连解毒合犀角地黄汤。鼻血用凉膈散,加栀仁、生地童便。
一没后日夕烦躁,谵语狂乱,是余热在肺胃,宜辰砂益元散,灯草煎服下,或辰砂
五苓散,水煎服。
一没后饮食如常,动止如故,卒然心腹绞痛,遍身汗出如水,此元气虚弱,失于调
补,偶为恶气所中,谓之中恶,危在旦夕。用砂仁末二钱,浮麦煎汤冲服,或伏龙肝泡水
温饮,亦百中救一。
一没后腹痛兼泻利,宜连芍汤。若腹胀不食,脾胃受伤,宜柴苏清肺饮。
一面目浮肿,此饮食内伤,或过食生冷,致阴阳不能升降,膀胱之气不行。如见小便
短少,必致气喘,宜五苓散,加木通、滑石、腹皮。若见喘促,又宜四苓,加竹沥、桑皮、
葶苈。喘促甚急者不治。
一没后泄泻,用黄连解毒合导赤散。若泄泻不止,口渴目闭,四肢厥冷者难治。加
以呕吐不食,肛门突出,或大孔直如竹筒者不治。如没后痢疾,是热积大肠,宜四苓加
芩、连、木通、白芍,或香连丸亦可。
一没后咳嗽,宜凉膈散,加桔梗、地骨皮。嗽不止,宜清肺饮,或四物合二陈,加
桔梗、栝蒌、五味。渴加麦冬。喘加桑皮、枳壳、苏子。呛嗽或咳出血,此热毒乘肺,宜
麦冬清肺饮。
一胸高如龟,肩耸而喘,血从口鼻出,摇头摆手,面色时变枯黯者不治。亦有肺气虚,
为毒所遏,而发喘不已者,宜清肺饮,倍人参,不可拘肺热一端,纯用清凉。若声哑喘
咳,身热不退,肺金受克,宜清金降火汤。又有麻毒内攻,喘促胸突,肚急目闭者,九死
一生之症,速用防风消毒饮治之。
一没后发痈毒,肢节疼痛者,乃热毒留结,宜羌活散,微汗利之。或遍身生疮,为
麻风疮,宜大连翘饮。若生疮发热不退,宜解表,用疏风散,不治必每岁应时而发。
一没后眼红目肿,翳膜遮睛,乃麻毒上攻,久必伤目,宜芎归饮。
一口舌生疮肿痛,此心脾有热,必二便结涩,宜清心脾之火,兼润大肠,用猪苓泽
泻汤,泄去余毒,其症自愈。若满口唇舌黄赤白烂,其症最重,速宜清胃凉血,佐以润
肠。
一没后牙疳,乃心脾二经为毒火所攻,若不早治,渐有穿腮落齿之患,甚至痰喘,救
无及矣。又麻后血液伤耗,早食甜物,及感风生虫侵蚀筋骨,口鼻坏烂,先以米泔温洗
净,急用胜金散敷之,或搽牙散亦好,仍以消毒饮煎服,合四物汤加甘草五味更妙。若
烂喉者,以小竹筒装药吹之。如山根发红点者,便不可治。若牙疳肉烂,鼻血横行,并
为失血之症,用四物加山楂、茵陈、木通、犀角治之。如疳及舌苔白色者,则胃已烂,亦
不可治。又有麻毒入胃,结而不散,致成牙龈黑烂出血,是为走马牙疳,久则穿腮破烂,
缺唇崩鼻,遂成危症。外用文蛤散吹之,或雄黄散,先以艾煎汤洗净搽之,再服芦荟黄
连丸,以清胃火。大抵牙疳一症,初见红肿,
俱宜清胃散主之。
麻疹消退,以三日为期为正常情况,不疾不徐,自然没有后患。如果不到三天就消退,在肌肤温暖的地方,完全没有疹子的形迹,这是消退得太快,必定是因为调护不慎,或被风寒侵袭,或被邪秽触碰,导致毒气反而内攻,急需内服荆防解毒汤,外用胡荽酒熏蒸其衣被,使疹子透出,才能确保无虞。有的到了二三天,疹子虽然消退,但在肌肤温暖的地方还有形迹,这说明毒气尚未排尽,失治必然导致内攻,仍然应当疏泄托毒,佐以清凉药物。如果该发散而没有散开的,是体内有虚热留滞于肌表,切不可纯用寒凉药剂,应用柴胡四物汤治疗,使血分和畅。余热全部清除,疹子就会消退。如果麻点带有白色,隐于肌表,似退而未退的,必定是因为风寒外折,不能透发,也是表虚的缘故,适宜温散风寒,使白色变为红活,避免产生变证。古语说:“白疹温而自消”就是这个道理。有的拖延到五六天还不消退的,这是内热未除,导致不能完全消退,宜用清凉药佐以利水药。如果加上烦躁,右关脉洪数有力,这是胃中潜伏湿热,宜用化斑汤。如果疹子已经消退但身体仍然发热,昼夜不退,这是邪火伏郁在皮肤之间,时间久了毛发焦枯,肌表干燥,肌肉消瘦,这就是骨蒸痨症,宜用芦荟肥儿丸治疗,迟了就无法救治。如果疹子消退后身体虽然没有消瘦,但时常发作壮热,烦躁不安,抽搐惊悸,神志昏迷错乱的,这是阴血虚耗,余毒入肝而传于心,宜用枣麦四物汤主治。
一种情况是疹子消退后绵绵发热,不知道及早治疗,就会形成疳症,必然导致腹胀,午后发热头痛,宜用柴苓四物汤。如果口渴少食烦闷,宜用小柴胡汤。
一种情况是消退后潮热,宜用升麻葛根汤,烦渴用黄连解毒汤,小便赤如米泔汁宜用五苓散加车前子、木通。如果出现便血,宜用黄连解毒汤合犀角地黄汤。鼻出血用凉膈散,加栀仁、生地、童便。
一种情况是消退后傍晚烦躁,谵语狂乱,这是余热在肺胃,宜用辰砂益元散,灯草煎服下,或者辰砂五苓散,水煎服。
一种情况是消退后饮食如常,行动如故,突然心腹绞痛,遍身汗出如水,这是元气虚弱,失于调补,偶然被恶气所中,称为中恶,危在旦夕。用砂仁末二钱,浮小麦煎汤冲服,或者伏龙肝泡水温饮,也是一百次中能救一次的方子。
一种情况是消退后腹痛兼腹泻,宜用连芍汤。如果腹胀不食,脾胃受伤,宜用柴苏清肺饮。
一种情况是面目浮肿,这是饮食内伤,或者过食生冷,导致阴阳不能升降,膀胱之气不行。如果见到小便短少,必然导致气喘,宜用五苓散,加木通、滑石、腹皮。如果见到喘促,又宜用四苓散,加竹沥、桑皮、葶苈。喘促非常急迫的无法救治。
一种情况是消退后泄泻,用黄连解毒汤合导赤散。如果泄泻不止,口渴目闭,四肢厥冷的难治。加上呕吐不食,肛门突出,或者大孔直如竹筒的无法救治。如果消退后痢疾,是热积大肠,宜用四苓散加黄芩、黄连、木通、白芍,或者香连丸也可以。
一种情况是消退后咳嗽,宜用凉膈散,加桔梗、地骨皮。咳嗽不止,宜用清肺饮,或者四物汤合二陈汤,加桔梗、栝蒌、五味子。口渴加麦冬。喘加桑皮、枳壳、苏子。呛咳或咳出血,这是热毒乘肺,宜用麦冬清肺饮。
一种情况是胸高如龟背,耸肩而喘,血从口鼻出,摇头摆手,面色时而变得枯黯的无法救治。也有肺气虚,被毒气遏制,而发喘不止的,宜用清肺饮,倍用人参,不可拘泥于肺热一端,纯用清凉药。如果声音嘶哑喘咳,身热不退,肺金受克,宜用清金降火汤。又有麻毒内攻,喘促胸突,肚子急迫眼睛闭合的,九死一生的病症,速用防风消毒饮治疗。
一种情况是消退后发痈毒,肢节疼痛的,是热毒留结,宜用羌活散,微汗利之。或者遍身生疮,为麻风疮,宜用大连翘饮。如果生疮发热不退,宜解表,用疏风散,不治必然每年应时而发。
一种情况是消退后眼红目肿,翳膜遮睛,是麻毒上攻,久了必伤目,宜用芎归饮。
一种情况是口舌生疮肿痛,这是心脾有热,必然二便结涩,宜清心脾之火,兼润大肠,用猪苓泽泻汤,泄去余毒,其症自愈。如果满口唇舌黄赤白烂,其症最重,速宜清胃凉血,佐以润肠。
一种情况是消退后牙疳,是心脾二经为毒火所攻,如果不早治,渐渐有穿腮落齿的祸患,甚至痰喘,救无可救了。又因麻后血液伤耗,早食甜物,以及感风生虫侵蚀筋骨,口鼻坏烂,先用米泔水洗净,急用胜金散敷之,或者搽牙散也好,仍以消毒饮煎服,合四物汤加甘草五味更妙。如果烂喉的,用小竹筒装药吹之。如山根发红点的,便不可治。如果牙疳肉烂,鼻血横行,并为失血的病症,用四物汤加山楂、茵陈、木通、犀角治疗。如果疳及舌苔白色,则胃已烂,也不可治。又有麻毒入胃,结而不散,致成牙龈黑烂出血,是为走马牙疳,久了穿腮破烂,缺唇崩鼻,遂成危症。外用文蛤散吹之,或者雄黄散,先用艾叶煎汤洗净搽之,再服芦荟黄连丸,以清胃火。大抵牙疳一症,初见红肿,俱宜清胃散主治。
The resolution of measles is considered normal if it takes three days, proceeding neither too fast nor too slow, thereby avoiding sequelae. If the rash disappears in less than three days and no trace remains on warm areas of the skin, this indicates an excessively rapid disappearance. This is likely due to improper care, invasion by wind-cold, or contact with pathogenic filth, causing the toxin to retreat inward. Urgent internal administration of Jingfang Jiedu Tang (Jingfang Detoxification Decoction) is required, along with external fumigation of clothing and bedding with Huqi Wine (Coriander Wine), to force the rash to re-emerge, ensuring safety. In cases where two to three days have passed and although the rash has seemingly disappeared, traces remain on warm skin areas, it indicates that the toxin is not yet fully expelled. Failure to treat properly will lead to inward attack; therefore, one should still employ methods to vent and support the exterior, assisted by cooling agents. If the rash fails to disperse when it should, it is due to deficient heat lingering at the surface. One must absolutely avoid using purely cold-natured medicines; instead, Chaihu Siwu Tang (Bupleurum Four Substances Decoction) should be used to harmonize the blood level. Once residual heat is completely cleared, the rash will resolve. If the measles spots appear white and are hidden beneath the skin, appearing as if resolved but not truly so, it is caused by wind-cold obstructing the exterior, preventing eruption, which is also a sign of exterior deficiency. It is appropriate to use warming dispersants to transform the white color into vibrant red, preventing complications. As the ancients said: "White rashes resolve naturally through warming." If the rash persists for five to six days without resolving, it is because internal heat remains, preventing complete resolution; cooling herbs combined with diuretics should be used. If accompanied by irritability and a surging, rapid, and forceful pulse at the right Guan position, damp-heat is latent in the stomach; Huaban Tang (Hua Ban Decoction) is indicated. If the body remains feverish after the rash has vanished, with no relief day or night, evil fire is stagnant between the skin and muscles. Over time, hair becomes brittle and dry, the skin dries out, and muscles waste away, constituting Gu Zheng Lao Syndrome (Bone-steaming Consumption Disease); Lushui Fei'er Wan (Lushui Fatten-the-Child Pill) should be administered, as delay renders it incurable. If, after the rash vanishes, the body does not emaciate but experiences periodic high fever, irritability, convulsions, palpitations, delirium, and mental confusion, this indicates depletion of Yin-blood, with residual toxins entering the Liver and transmitting to the Heart; Zaomai Siwu Tang (Jujube and Wheat Four Substances Decoction) is the primary treatment.
In one scenario, continuous low-grade fever persists after rash resolution. Failure to treat early leads to Gan Syndrome (Infantile Malnutrition), inevitably causing abdominal distension, afternoon fever, and headache; Chaoling Siwu Tang (Bupleurum and Pinellia Four Substances Decoction) is indicated. For thirst, poor appetite, and vexation, Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable.
In another scenario, tidal fever occurs after resolution; Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) is indicated. For vexation and thirst, Huanglian Jiedu Tang (Coptis Detoxification Decoction) is used. For dark urine resembling rice-washing water, Wuling San (Five-Ingredient Powder with Poria) plus Cheqianzi (Plantago Seed) and Mutong (Akebia Stem) are prescribed. If hematochezia appears, Huanglian Jiedu Tang combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is indicated. For epistaxis, Liangge San (Cool the Upper Jiao Powder) plus Zhiren (Gardenia Kernel), Shengdi (Rehmannia Root), and Tongbian (Child's Urine) is used.
In another scenario, evening irritability, delirium, and mania indicate residual heat in the Lung and Stomach; Chen Sha Yiyuan San (Cinnabar Yi Yuan Powder) decocted with Dengcao (Juncus Effusus Stem) is taken orally, or Chen Sha Wuling San (Cinnabar Five-Ingredient Powder with Poria) decocted in water.
In another scenario, diet and activity remain normal post-resolution, but sudden severe heart and abdominal pain occur with profuse sweating like water. This indicates Qi-Yuan deficiency due to lack of regulation and tonification, compounded by accidental exposure to malignant qi, termed Zhong E (Sudden Collapse from Evil Qi). The patient is critically ill. Administer 2 qian of Shenren powder (Amomum Fruit Powder) mixed with Fu Mai decoction (Floating Wheat Decoction), or drink warm water infused with Fulonggan (Dragon's House Earth). This saves one in a hundred cases.
In another scenario, abdominal pain with diarrhea post-resolution requires Lianshao Tang (Coptis and Peony Decoction). If abdominal distension and anorexia occur due to Spleen-Stomach injury, Chaisu Qingfei Yin (Bupleurum and Perilla Lung-Clearing Decoction) is indicated.
Facial and ocular edema results from dietary injury or excessive consumption of raw/cold foods, leading to failure of Yin-Yang ascent/descent and stagnation of Bladder Qi. If oliguria occurs, asthma may follow; Wuling San plus Mutong, Huashi (Talcum), and Fupi (Mandarin Orange Peel) is prescribed. If wheezing occurs, Siling San (Four-Ingredient Powder with Poria) plus Zhuli (Bamboo Sap), Sangpi (Mulberry Bark), and Tingli (Periploca Seed) is used. Severe acute wheezing is incurable.
Diarrhea post-resolution is treated with Huanglian Jiedu Tang combined with Daochi San (Guide Out Redness Powder). If diarrhea is unceasing, accompanied by thirst, closed eyes, and cold limbs, the prognosis is poor. If vomiting and anorexia are added, with prolapsed anus or a rectum straight as a bamboo tube, it is incurable. Dysentery post-resolution indicates heat accumulation in the Large Intestine; Siling San plus Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Mutong, and Baishao (White Peony Root) is used, or Xianglian Wan (Fragrant Coptis Pill) is acceptable.
Cough post-resolution is treated with Liangge San plus Jiegeng (Platycodon Root) and Digupi (Groundsel Root). If cough persists, Qingfei Yin (Lung-Clearing Decoction) or Siwu Tang combined with Erchen Tang (Two-Aged Decoction) plus Jiegeng, Gualou (Trichosanthes Fruit), and Wuwei (Schisandra Berry) is used. Add Maidong (Ophiopogon Tuber) for thirst. Add Sangpi, Zhike (Aurantii Fructus), and Suzi (Perilla Fruit) for wheezing. Irritative cough or hemoptysis indicates heat-toxin attacking the Lung; Maidong Qingfei Yin (Ophiopogon Lung-Clearing Decoction) is indicated.
A chest protruding like a tortoise shell, shoulder shrugging during breathing, bleeding from mouth/nose, head shaking, hand waving, and waxing/waning sallow complexion are signs of incurability. However, if asthma persists due to Lung-Qi deficiency obstructed by toxin, Qingfei Yin with doubled Renshen (Ginseng Root) is used; do not rigidly adhere to the concept of Lung-Heat and use only cooling agents. Hoarseness, asthma, cough, and persistent fever indicate Lung-Metal being overcome; Qingjin Jianghuo Tang (Clear Metal and Descend Fire Decoction) is indicated. Internal attack of measles toxin causing wheezing, chest protrusion, abdominal tension, and closed eyes is a nine-deaths-one-life condition; Fangfeng Xiaodu Yin (Saposhnikovia Detoxification Decoction) must be used immediately.
Abscesses and joint pain post-resolution indicate retained heat-toxin; Qianghuo San (Notopterygium Powder) is used to induce slight sweating and promote urination. Generalized sores termed Ma Feng Chuang (Measle Wind Sores) require Da Lianqiao Yin (Large Forsythia Decoction). If sores persist with fever, exterior-release with Shufeng San (Wind-Dispersing Powder) is needed; otherwise, they will recur annually.
Red eyes and swelling with corneal opacity post-resolution indicate measles toxin attacking upward, eventually damaging vision; Xionggui Yin (Angelica and Ligusticum Decoction) is indicated.
Painful swelling of ulcers on the tongue and mouth indicates Heat in the Heart and Spleen, inevitably causing constipation and difficult urination. Clear Heart-Spleen Heat and moisten the Large Intestine using Zhuling Zexie Tang (Polyporus and Alisma Decoction) to drain residual toxin; symptoms will resolve spontaneously. Severe yellow-red-white ulceration of lips and tongue requires urgent clearing of Stomach Heat and cooling Blood, assisted by intestinal moistening.
Yagen (Gum Rot) post-resolution indicates toxin-fire attacking the Heart and Spleen meridians. Delayed treatment leads to cheek perforation and tooth loss, even phlegm-asthma, rendering rescue impossible. Post-measles blood depletion, early consumption of sweets, and wind-induced worm erosion of bones/tissues cause oral/nasal necrosis. Wash thoroughly with rice-water, then apply Shengjin San (Shengjin Powder) urgently, or Ya San (Tooth Powder). Continue with Xiaodu Yin combined with Siwu Tang plus Gancao (Licorice Root) and Wuwei Zi (Schisandra Berry) for better effect. For throat rot, insufflate medicine via a small bamboo tube. Red spots on the Shan Gen (Root of Nose) indicate incurability. Flesh rot from Yagen with rampant epistaxis and hemorrhage are treated with Siwu Tang plus Shanzha (Hawthorn Fruit), Yinchern (Artemisia Capillaris), Mutong, and Xijiao (Rhinoceros Horn - *Note: Use substitutes in modern practice*). White coating on the tongue from Gan syndrome indicates gastric rot, which is incurable. Measle toxin entering the Stomach, knotting and failing to disperse, causes black, rotting, bleeding gums, known as Zouma Yagen (Running Horse Gum Rot). Long-term progression leads to cheek perforation, lip retraction, and nasal collapse, becoming critical. Externally, Wen Ge San (Clam Shell Powder) or Xionghuang San (Realgar Powder) applied after washing with Mugwort decoction is used, followed internally by Lushui Huanglian Wan (Lushui Coptis Pill) to clear Stomach Fire. Generally, for initial redness and swelling of Yagen, Qingwei San (Clear Stomach Powder) is the primary treatment.