麻疹呕吐由于火邪内迫。胃气冲逆也。须以竹茹石膏汤和中清热。其吐自止。
竹茹石膏汤
法夏 赤苓 广皮 竹茹 甘草 石膏( ) 加姜
廉按刘河涧曰。胃膈热盛则为呕。火气炎上之象。忌用升麻。服之必喘。须以竹茹。葛根。
西河柳。陈皮。石膏。甘草。姜炒。黄连之类。若痰吐如丝。或成块吐清涎而有白沫者。俱
宜清肺消痰降火为主。朱丹溪曰。呕吐药。忌栝蒌仁。杏仁山栀萝卜子。又按初时固宜疏表
。但不可过用升提药。至于麻后呕吐。有实有虚。经云。胃虚则吐是也。胃实宜消食清火。
胃虚用七味白术散。理中汤。
七味白术散
人参 白术(炒) 茯苓 炙甘 木香 藿香 葛根
理中汤
人参 焦术 炮姜 炙草
甚者加附子。
麻疹泻泄。乃毒热移入肠胃。使传化失常也。治者切不可用温热诸剂。疹初作泻者。以升
麻葛根汤加赤苓猪苓泽泻主之。疹已出作泻者。以黄连解毒汤加赤苓木通主之。
升麻葛根汤（见前）
黄连解毒汤（见前）
麻疹作痢。谓之夹疹痢。因毒热未解。移于大肠所致也。有腹痛欲解。或赤或白。与赤白相
兼者。悉用清热导滞汤主之。不可轻投涩剂。
清热导滞汤
山楂 浓朴 甘草 枳壳 槟榔 当归 酒芍 条芩 (酒炙) 连翘 粘子
青皮 黄连(吴萸炒) 引用生姜。
廉按。泄泻则云切不用温热诸剂。痢疾则云不可轻投涩剂。其丁宁惩戒之意深矣。余看麻疹
数十年矣。泄泻痢疾从不见有虚症。但窃意麻后日久。或有脾虚而作泻痢者。必其脉弱唇白
。舌胎滑白。统舌不见紫红。不口渴而精神倦怠者。方可作脾虚论。或四苓散。或四君子汤
。或补中益气汤。谨慎审择用之。张玉潞曰。麻 泻痢。属热者多。但不可令其泻久
。泻久
则中气下陷。或成肿满。宜枳壳理中之类。以理脾胃为主。又有下痢如直肠者。所食何物。
即泻何物。此火盛也。次性急速。故下如直肠。用山栀二十枚。煎汤频服自愈。总之痢疾惟
宜升散。初起可用大黄。火盛再加芩连。或犀角丸。俱可用。如积毒已除。下多亡阴者。六
味亦可。
四苓散
白术(炒) 茯苓 猪苓 泽泻
四君子汤
人参 焦术 茯苓 炙草
补中益气汤
人参 黄 焦术 当归 柴胡 升麻 炙草 广皮
理中汤（见前）
犀角丸 准绳云。但是痢服之无不瘥者。
犀角屑 黄连 苦参 黄柏 当归
各捣研细末。等分和匀。空腹煮糯米饭调方寸大服之。日再服。忌油腻。生冷。
黄连丸。
黄连 羚羊角 黄柏 赤苓(各一两五钱)
共为细末。蜜丸如桐子大。每服二十丸。姜蜜汤下。
六味丸
生地 茯苓 淮药 萸肉 丹皮 泽泻
麻疹引起的呕吐，是由于火邪内迫，导致胃气冲逆所致。应当使用竹茹石膏汤来调和脾胃、清除热邪，呕吐自然就会停止。
竹茹石膏汤
法半夏、赤茯苓、广陈皮、竹茹、甘草、石膏（用量未注明），加入生姜。
廉按：刘河涧说，胃膈热盛就会导致呕吐，这是火气炎上的表现。忌讳使用升麻，服用后必然会导致气喘。应当使用竹茹、葛根、西河柳、陈皮、石膏、甘草，用姜炒黄连等药物。如果痰吐如丝状，或者吐出成块的清涎并带有白沫的，都适宜以清肺、消痰、降火为主要治疗原则。朱丹溪说，治疗呕吐的药物，忌讳使用瓜蒌仁、杏仁、山栀、萝卜子。又按：发病初期固然适宜疏解表邪，但不可过度使用升提类药物。至于麻疹消退后的呕吐，有实证也有虚证，《内经》说：“胃虚则吐”。胃实者适宜消食、清火；胃虚者使用七味白术散或理中汤。
七味白术散
人参、白术（炒）、茯苓、炙甘草、木香、藿香、葛根。
麻疹引起的腹泻，是毒热移入肠胃，导致传导和化生功能失常所致。治疗时切不可使用温热的方剂。疹子初起时发生腹泻的，以升麻葛根汤加赤茯苓、猪苓、泽泻为主治方。疹子已经发出后发生腹泻的，以黄连解毒汤加赤茯苓、木通为主治方。
麻疹并发痢疾，称为“夹疹痢”，是因为毒热未解，移于大肠所致。症状有腹痛想排便，大便颜色或红或白，或红白相间的，全部使用清热导滞汤主治。不可轻易投用收敛固涩的药物。
清热导滞汤
山楂、厚朴、甘草、枳壳、槟榔、当归、酒白芍、条芩（酒炙）、连翘、粘子（车前子）、青皮、黄连（吴茱萸炒），引用生姜煎服。
廉按：对于泄泻说切忌使用温热诸剂，对于痢疾说不可轻易投用涩剂，其中的叮咛惩戒之意很深了。我诊治麻疹数十年，从未见过泄泻痢疾属于虚证的病例。但我私下认为，麻疹痊愈后日久，或许有因脾虚而作泻痢的情况，必须见到脉象弱、嘴唇白、舌苔滑白、全舌不见紫红色、不口渴且精神倦怠的症状，才可以诊断为脾虚。此时可用四苓散、四君子汤或补中益气汤，需谨慎审察后选用。张玉潞说：麻疹引发的泻痢，属热证的多，但不可以让其腹泻时间过长。腹泻久了会导致中气下陷，或者形成肿胀胀满。适宜使用枳壳理中之类的方剂，以调理脾胃为主。又有下痢像直肠一样直下的情况，吃什么就拉什么，这是火盛的表现。其次性质急速，所以排泄像从直肠直接流出。用二十枚山栀煎汤频繁服用，自愈。总之痢疾适宜用升散的方法，初起可用大黄，火盛再加黄芩、黄连，或者犀角丸，都可以使用。如果积毒已除，但因下利过多导致亡阴的，六味地黄丸也可以应用。
补中益气汤
人参、黄芪、焦白术、当归、柴胡、升麻、炙甘草、广陈皮。
理中汤（见前文）
犀角丸：《准绳》说，凡是痢疾服用此药没有不痊愈的。
犀角屑、黄连、苦参、黄柏、当归。
各捣研成细末，等分和匀，空腹煮糯米饭调服方寸大一团，每日服两次。忌食油腻、生冷食物。
Vomiting caused by measles is due to the internal pressure of fire pathogen, leading to rebellious Qi of the Stomach. One should use Zhuru Shigao Tang (Bamboo Shavings and Gypsum Decoction) to harmonize the Middle Jiao and clear heat; the vomiting will stop naturally.
Zhuru Shigao Tang (Bamboo Shavings and Gypsum Decoction)
Fa Banxia (Pinelliae Rhizoma Preparatum), Chiling (Poria Cocos with Red Dye), Guangpi (Exocarpium Citri Reticulatae), Zhuru (Bambusae Caulis in Taeniam), Gancao (Glycyrrhizae Radix et Rhizoma), Shigao (Gypsum Fibrosum) [dosage not specified], add fresh ginger.
Commentary by Lian: Liu Hejian stated that excessive heat in the Stomach and Diaphragm leads to vomiting, which is a manifestation of Fire Qi flaring upward. Shengma (Cimicifugae Rhizoma) should be avoided, as its use will inevitably cause asthma/wheezing. One should use Zhuru (Bambusae Caulis in Taeniam), Gegen (Puerariae Lobatae Radix), Xihe Liu (Salicis Tomentosae Ramulus), Chenpi (Citri Reticulatae Pericarpium), Shigao (Gypsum Fibrosum), Gancao (Glycyrrhizae Radix et Rhizoma), and Huanglian (Coptidis Rhizoma) stir-fried with ginger. If phlegm is expectorated in silk-like strands, or if clear saliva forming clumps with white foam is vomited, treatment should primarily focus on clearing the Lung, resolving phlegm, and descending Fire. Zhu Danxi stated that for medications treating vomiting, one should avoid Gualou Ren (Trichosanthis Semen), Xingren (Armeniacae Semen Amarum), Shanzhi (Gardeniae Fructus), and Luobozhi (Raphani Semen). Furthermore, although it is appropriate to release the exterior at the initial stage, one must not overuse lifting/astringent herbs. Regarding vomiting after the eruption of measles, there are excess patterns and deficiency patterns. The Classic states: "Deficiency of the Stomach leads to vomiting." For Stomach Excess, digestion-promoting and fire-clearing methods are suitable; for Stomach Deficiency, Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) or Lizhong Tang (Regulate the Middle Decoction) are used.
Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder)
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria Cocos), Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma), Muxiang (Aucklandiae Radix), Huoxiang (Agastaches Herba), Gegen (Puerariae Lobatae Radix).
Lizhong Tang (Regulate the Middle Decoction)
Renshen (Ginseng Radix et Rhizoma), Jiaoshu (Fried Atractylodis Rhizoma), Paojiang (Prepared Ginger Rhizome), Zhi Cao (Honey-fried Licorice Root).
In severe cases, add Fuzi (Aconiti Lateralis Radix Praeparata).
Diarrhea caused by measles occurs when toxic heat shifts into the Intestines and Stomach, disrupting their transportation and transformation functions. The practitioner must absolutely avoid using warm and hot formulas. When diarrhea occurs at the initial stage of rash eruption, treat with Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction) added with Chiling (Poria Cocos with Red Dye), Zhuling (Polyporus Umbellatus), and Zexie (Alismatis Rhizoma). When diarrhea occurs after the rash has fully erupted, treat with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) added with Chiling (Poria Cocos with Red Dye) and Mutong (Akebiae Caulis).
Shengma Gegen Tang (Cimicifuga and Kudzu Root Decoction) (See previous section)
Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) (See previous section)
Dysentery accompanying measles is called "Measles-complicated Dysentery" (Jia Zhen Li). It is caused by unresolved toxic heat shifting to the Large Intestine. Symptoms include abdominal pain with an urge to defecate, and stools may be red, white, or mixed red and white. All such cases should be treated primarily with Qingre Daozhi Tang (Clear Heat and Guide Out Stagnation Decoction). Do not lightly administer astringent agents.
Qingre Daozhi Tang (Clear Heat and Guide Out Stagnation Decoction)
Shanzha (Crataegi Fructus), Houpo (Magnoliae Officinalis Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Zhike (Aurantii Fructus Immaturus), Binglang (Arecae Semen), Danggui (Angelicae Sinensis Radix), Jiushaoyao (White Peony Root processed with wine), Tiaoqin (Scutellariae Radix, wine-fried), Lianqiao (Forsythiae Fructus), Qianzi (Plantaginis Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Huanglian (Coptidis Rhizoma, stir-fried with Evodiae Fructus), reference fresh ginger for decoction.
Commentary by Lian: For diarrhea, it is emphasized that warm/hot agents must strictly be avoided; for dysentery, it is emphasized that astringent agents should not be lightly administered. The intent of this earnest warning is profound. I have treated measles for decades and have never seen diarrhea or dysentery presenting as a deficiency pattern. However, I privately speculate that long after measles recovery, there might be cases of diarrhea/dysentery due to Spleen Deficiency. Such cases must present with weak pulse, pale lips, slippery white tongue coating, no purple-red hue on the tongue, no thirst, and mental fatigue. Only then can it be diagnosed as Spleen Deficiency. In such cases, Siling San (Four-Ingredient Powder), Sijunzi Tang (Four-Gentlemen Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) may be used, but selection must be cautious and well-considered. Zhang Yulu stated: Measles-induced diarrhea and dysentery are mostly heat patterns, but one must not allow prolonged diarrhea. Prolonged diarrhea leads to sinking of Middle Qi or results in distension/swelling. It is appropriate to use formulas like Zhike Lizhong Tang variants to regulate the Spleen and Stomach. There is also a condition where stool passes directly out like the rectum itself, expelling whatever was eaten immediately. This indicates Excessive Fire. Due to its rapid nature, the stool exits directly from the rectum. Using twenty Gardenia fruits (Shanzhi) decocted in water and taken frequently will lead to self-healing. In summary, dysentery is best treated with ascending and dispersing methods. At the onset, Dahuang (Rhei Radix et Rhizoma) can be used; if Fire is excessive, add Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma), or Xijiao Wan (Rhino Horn Pill), all of which are applicable. If accumulated toxins are cleared but Yin is lost due to excessive purging, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) can also be applied.
Siling San (Four-Ingredient Powder)
Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria Cocos), Zhuling (Polyporus Umbellatus), Zexie (Alismatis Rhizoma).
Sijunzi Tang (Four-Gentlemen Decoction)
Renshen (Ginseng Radix et Rhizoma), Jiaoshu (Fried Atractylodis Rhizoma), Fuling (Poria Cocos), Zhi Cao (Honey-fried Licorice Root).
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)
Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Jiaoshu (Fried Atractylodis Rhizoma), Danggui (Angelicae Sinensis Radix), Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), Zhi Cao (Honey-fried Licorice Root), Guangpi (Exocarpium Citri Reticulatae).
Lizhong Tang (Regulate the Middle Decoction) (See previous section)
Xijiao Wan (Rhino Horn Pill): *Qiansheng* states that for any dysentery, taking this pill ensures recovery.
Xijiao Xie (Rhino Horn Fragment), Huanglian (Coptidis Rhizoma), Kushen (Sophorae Flavescentis Radix), Huangbai (Phellodendri Cortex), Danggui (Angelicae Sinensis Radix).
Grind each into fine powder, mix equally. Take a dose the size of a square inch on an empty stomach, mixed with cooked glutinous rice porridge. Take twice daily. Avoid greasy and raw/cold foods.
Huanglian Wan (Coptis Pill)
Huanglian (Coptidis Rhizoma), Lingyangjiao (Saiga Tataricae Cornu), Huangbai (Phellodendri Cortex), Chiling (Poria Cocos with Red Dye) [each 1 liang 5 qian].
Grind into fine powder, form pills with honey the size of tung seeds. Take 20 pills per dose, washed down with ginger-honey water.
Liuwei Wan (Six-Ingredient Pill)
Shengdi (Rehmanniae Radix Preparata), Fuling (Poria Cocos), Huaiyao (Dioscoreae Rhizoma), Yurou (Corni Fructus), Danpi (Moutan Cortex), Zexie (Alismatis Rhizoma).