肺开窍于鼻毒热上冲。肺气载血妄行。则衄作矣。然衄中有发散之义。以毒从衄解。不须止
之
。但不可太过。过则血脱而阴亡也。如衄甚者。宜外用发灰散吹入鼻中。内服犀角地黄汤。
其血可止。
发灰散 以皂角水煮。洗净油气。用新阴阳瓦 成灰。放在地上。去火性。
研末用。
犀角地黄汤（见前）
廉按。麻疹初起衄血。宜用黑荆芥。黑栀子。黄芩。元参。连翘。生地。丹皮。麦冬之
类
。甚者加犀角。茅草根。如用犀角地黄汤。宜去白芍。如口中出血惟用发散。毒清而血自止
。没后衄血。四物汤加茅草根。麦冬等药。又无论国中后衄血。用黄酒汤温以足浸之神效。
咳血嗽血出于肺。吐血咯血出于肾。先痰后血是积热。治宜清肺。先血后痰乃阴虚。法宜滋
补。清肺者。二冬。芩连。川贝。紫菀。元参。百合之类。滋补者。沙参。麦冬。六味地黄
丸之类。最佳者童便。衄血吐血俱可用。如妇人出疹适遇经行。则毒随经解。乃吉兆也。宜
于治疹药中。加生地。丹皮。赤芍。红花之类。如孕妇出疹。竟可照常治法。总以凉表清火
解毒为主。切勿用香砂及补胎之药。用之其胎必坠。余堂弟媳怀孕六七月而出疹。用宣毒发
表汤。去升麻木通。加芩连石膏。上身已透。色紫。而下体绝无半点。以胎横亘于中故也。
忽然谵妄。目直视而冥。余用白虎汤。合承气汤石膏二两。大黄一两。再加芩连灌下。片刻
而苏。二剂。而腰腹两足。俱已出透。故孕妇出疹。以大黄为安胎之圣药。如因出疹落胎。
当以养阴为主。然后随症用药。断断不可温补。至于麻黄。川连。羚羊。犀角。大黄等药。
亦不可用。若石膏仅有用之者。仲景治产后。白虎汤亦所不废也。然有素向阴虚。一经落胎
而汗出。心烦。口燥。潮热。咳嗽。气促。不眠。四肢麻木。是谓阴脱之候。当重用大剂阴
药。如熟地。生地。丹参。沙参。麦冬。川贝。丹皮。元参。枣仁。阿胶。人参。知母。地
骨皮之类。皆当选用。又有孕妇元气不足。一经分娩。气血两脱。手足厥冷。自汗不止。当
以温补为主。又当看其疹色。红活者吉。如产后出疹。半月之前重产。半月之后重疹。重产
。则以当归。川芎。桃仁。红花为主。发表用荆防。前胡。桔梗。葛根之类。清凉用黄芩。
连翘。花粉。知母之类。活血用生地。元参。丹皮。丹参之类。酌量轻重用之。若黄连。
犀
角。大黄。麻黄。桂附。干姜等药。亦不可用。如真阴已竭。当重用补阴之药。与小产参看
。重疹。则于治疹药中。加养阴活血之药可也。又有水蓄之症。孙一奎赤水元珠曰。发热之
时。恣饮冷水。恐生水蓄之症。故水入于肺。为喘。为嗽。宜用桑皮。葶苈子。以泄肺中之
水。水入于脾。为肿。为胀。为自利。水入于胃。为呕。为利。宜用猪苓。泽泻。茯苓。以
泻脾胃之水。水入于心。为惊。为悸。宜赤白茯苓。灯心汤以泄心胸之水。水入于肝。为胁
痛。用芫花以泄之。水入于肾与膀胱。为小便不利。为阴囊肿。宜车前。木通以泄之。皆当
随症而治。又妇人有经水适来适断。寒热往来。神昏语乱。此谓热入血室。宜用小柴胡汤。
去人参半夏。加当归。红花。赤芍丹皮之类。亦有火盛而宜加犀角地黄汤者。酌量用之。小
腹急痛。而小便自利。大便黑色。与蓄血之症。同治。亦有宜用桃仁承气汤者。又有麻后浮
肿者。有身热不热之分。身热者。水气在表。宜用荆防。苏叶。桑皮。茯苓。米仁。广皮。
蒺藜。大腹皮。银花之类。身不热者。宜用茵陈。栀子。滑石。猪苓。泽泻。赤苓。杏仁。
枳壳之类。如系脾虚发肿。加人参。茯苓。扁豆。山药等药。或用金枣儿汤。蒋春圃之弟。
麻后腹胀而硬。四肢亦浮肿。其脉沉迟。舌胎滑白。不思饮食。余用附子理中汤。加大腹皮
。茯苓。数剂而愈。同时赵圣元之孙。亦患此病。外症皆同。其脉洪数有力。舌胎黄浓。余
用承气汤一剂而愈。旨哉金鉴之言曰。临事权变。惟神而明之而已。
承气汤
大黄 枳壳 甘草
金枣儿汤 治肿胀仙方。
红牙大戟(四两) 红枣(十二两)
水煮一日。去戟。取枣。晒干食之立消。
肺开窍于鼻，毒热上冲。肺气推动血液妄行，则发生鼻衄。然而，鼻衄中包含发散邪气的意义，毒素随鼻衄而解除，不需要刻意止血。但不可让出血过多，过多会导致血脱和阴液亡失。如果鼻衄严重，适宜外用发灰散吹入鼻中，内服犀角地黄汤，其血可以止住。
发灰散：用皂角水煮，洗净油气，用新的阴阳瓦烧成灰，放在地上以去除火性。研成粉末使用。
犀角地黄汤（见前文）
廉按：麻疹初起出现鼻衄，适宜使用黑荆芥、黑栀子、黄芩、玄参、连翘、生地、丹皮、麦冬之类。严重的加犀角、茅草根。如果使用犀角地黄汤，适宜去掉白芍。如果是口中出血，只用发散法，毒清而血自然停止。疹退后出现鼻衄，用四物汤加茅草根、麦冬等药。又无论疹退后还是其他情况下的鼻衄，用黄酒汤温热浸泡足部有神奇疗效。
咳血、嗽血出于肺，吐血、咯血出于肾。先痰后血是积热，治疗适宜清肺。先血后痰乃阴虚，治法适宜滋补。清肺的药材如二冬（天冬、麦冬）、黄芩、黄连、川贝母、紫菀、玄参、百合之类。滋补的药材如沙参、麦冬、六味地黄丸之类。最好的是童便，鼻衄、吐血都可用。如果妇女出疹恰逢月经来潮，则毒素随经血而解，这是吉兆。适宜在治疹药中加入生地、丹皮、赤芍、红花之类。如果孕妇出疹，完全可以照常治疗方法，总以凉表、清火、解毒为主。切勿使用香砂及补胎之药，使用它们胎儿必然坠落。我堂弟媳怀孕六七个月时出疹，用宣毒发表汤，去掉升麻、木通，加入黄芩、黄连、石膏。上身已经透发，颜色紫暗，而下体完全没有透出，因为胎儿横亘在中间阻碍的缘故。忽然出现谵语妄言，眼睛直视而昏迷。我用白虎汤合承气汤，石膏二两，大黄一两，再加黄芩、黄连灌下，片刻后苏醒。两剂药后，腰腹两足都已透发出来。所以孕妇出疹，以大黃为安胎的圣药。如果因出疹导致流产，应当以养阴为主，然后随症用药，绝对不可温补。至于麻黄、川连、羚羊角、犀角、大黄等药，也不可使用。只有石膏偶尔有用到的，张仲景治疗产后病，白虎汤也并未废弃。然而有素来阴虚的人，一旦流产而出汗、心烦、口燥、潮热、咳嗽、气促、不眠、四肢麻木，这叫做阴脱的证候。应当重用大剂量滋阴药，如熟地、生地、丹参、沙参、麦冬、川贝母、丹皮、玄参、枣仁、阿胶、人参、知母、地骨皮之类，都应当选用。又有孕妇元气不足，一旦分娩，气血两脱，手足厥冷，自汗不止，应当以温补为主。又要看其疹色，红活者为吉。如果产后出疹，半月之前重产，半月之后重疹。重产，则以当归、川芎、桃仁、红花为主，发表用荆芥、防风、前胡、桔梗、葛根之类，清凉用黄芩、连翘、花粉、知母之类，活血用生地、玄参、丹皮、丹参之类，酌量轻重使用。如果黄连、犀角、大黄、麻黄、桂附、干姜等药，也不可使用。如果真阴已竭，应当重用补阴之药，与小产的情况参照看待。重疹，则在治疹药中加入养阴活血之药即可。又有水蓄的症状，孙一奎在《赤水元珠》中说：发热之时，恣意饮用冷水，恐怕产生水蓄的症状。所以水进入肺，表现为喘、嗽，适宜用桑白皮、葶苈子以泻肺中之水。水进入脾，表现为肿、胀、自利，水进入胃，表现为呕、利，适宜用猪苓、泽泻、茯苓以泻脾胃之水。水进入心，表现为惊、悸，适宜用赤茯苓、白茯苓、灯心草汤以泻心胸之水。水进入肝，表现为胁痛，用芫花以泻之。水进入肾与膀胱，表现为小便不利、阴囊肿，适宜用车前子、木通以泻之。都应当随症而治。又有妇女月经适来适断，寒热往来，神昏语乱，这叫做热入血室，适宜用小柴胡汤，去掉人参、半夏，加入当归、红花、赤芍、丹皮之类。也有火盛而适宜加犀角地黄汤的，酌量使用。小腹急痛，而小便自利，大便黑色，与蓄血的证候，同治。也有适宜用桃仁承气汤的。又有麻疹后浮肿者，有身热和不热的区别。身热的，是水气在表，适宜用荆芥、防风、苏叶、桑白皮、茯苓、薏苡仁、广陈皮、蒺藜、大腹皮、金银花之类。身不热的，适宜用茵陈、栀子、滑石、猪苓、泽泻、赤茯苓、杏仁、枳壳之类。如果是脾虚发肿，加人参、茯苓、扁豆、山药等药。或者用金枣儿汤。蒋春圃的弟弟，麻疹后腹胀而硬，四肢也浮肿，脉沉迟，舌苔滑白，不思饮食。我用附子理中汤，加大腹皮、茯苓，数剂而愈。同时赵圣元的孙子，也患此病，外症皆相同，脉洪数有力，舌苔黄浓。我用承气汤一剂而愈。真是精妙啊，《医宗金鉴》的话说：临事权变，唯有神而明之罢了。
The lung opens into the nose. When toxic heat rushes upward, the Lung Qi drives blood to flow recklessly, resulting in epistaxis (nosebleed). However, epistaxis contains the meaning of dispersing pathogens; toxins are resolved through bleeding, so there is no need to forcibly stop it. But one must not allow excessive bleeding, as this would lead to blood depletion and Yin exhaustion. If epistaxis is severe, it is appropriate to use Fa Hui San (Hair Ash Powder) blown into the nose externally, and take Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) internally to stop the bleeding.
Fa Hui San: Boil Gleditsiae Sinensis Fructus (Zao Jiao) water, wash away oily residues, burn new Yin-Yang tiles into ash, place them on the ground to remove fire toxicity, grind into powder, and use.
Xi Jiao Di Huang Tang (see previous text).
Lian notes: At the initial stage of measles, if epistaxis occurs, it is appropriate to use Hei Jing Jie (Black Schizonepeta), Hei Zhi Zi (Black Gardenia), Huang Qin (Scutellaria Baicalensis Root), Xuan Shen (Scrophularia Ningpoensis Root), Lian Qiao (Forsythia Fruit), Sheng Di Huang (Rehmannia Glutinosa Root), Mu Dan Pi (Moutan Cortex), and Mai Dong (Ophiopogon Japonicus Tuber). For severe cases, add Xi Jiao (Rhinoceros Horn) and Mao Cao Gen (Imperata Cylindrica Rhizome). If using Xi Jiao Di Huang Tang, Bai Shao (White Peony Root) should be removed. If bleeding occurs from the mouth, only dispersal methods should be used; once toxins are cleared, bleeding will stop naturally. After the rash subsides, if epistaxis occurs, use Si Wu Tang (Four Substances Decoction) added with Mao Cao Gen and Mai Dong. Regardless of whether it is post-rash or other conditions, soaking feet in warm Huang Jiu Tang (Yellow Wine Decoction) yields miraculous effects.
Coughing up blood (Ke Xue) and spitting phlegm-blood (Sou Xue) originate from the Lung. Vomiting blood (Tu Xue) and spitting blood (Ka Xue) originate from the Kidney. Phlegm preceding blood indicates accumulated heat; treatment should focus on clearing the Lung. Blood preceding phlegm indicates Yin deficiency; treatment should focus on nourishing and tonifying. Herbs for clearing the Lung include Er Dong (Tian Dong and Mai Dong), Huang Qin, Huang Lian, Chuan Bei Mu (Fritillaria Cirrhosa Bulb), Zi Wan (Aster Tataricus Root), Xuan Shen, and Bai He (Lily Bulb). Herbs for nourishing include Sha Shen (Glehnia Root), Mai Dong, and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). The best remedy is Tong Bian (Child's Urine), which can be used for both epistaxis and hematemesis. If a woman develops measles coinciding with her menstrual period, toxins are resolved through menstruation, which is an auspicious sign. It is appropriate to add Sheng Di Huang, Mu Dan Pi, Chi Shao (Red Peony Root), and Hong Hua (Safflower) to the measles treatment formula. If a pregnant woman develops measles, standard treatment methods can be followed generally, focusing primarily on cooling the exterior, clearing fire, and detoxifying. One must absolutely avoid using Xiang Sha (Aucklandia and Amomum) and fetal-nourishing herbs, as their use may cause miscarriage. My cousin's wife developed measles at six or seven months of pregnancy. I used Xuan Du Fa Biao Tang (Decoction to Disperse Toxics and Release the Exterior), removing Sheng Ma (Cimicifuga Rhizome) and Mu Tong (Akebia Caulis), and adding Huang Qin, Huang Lian, and Shi Gao (Gypsum Fibrosum). The upper body erupted fully with dark purple coloration, but the lower body showed no eruption because the fetus obstructed the middle. Suddenly, she became delirious, stared fixedly, and fell unconscious. I administered Bai Hu Tang (White Tiger Decoction) combined with Cheng Qi Tang (Purgative Decoction), using two liang of Shi Gao, one liang of Da Huang (Rhubarb Radix et Rhizoma), plus Huang Qin and Huang Lian,灌ed down. She revived within moments. After two doses, her waist, abdomen, and legs erupted fully. Thus, for pregnant women with measles, Da Huang is considered the supreme herb for stabilizing the fetus. If miscarriage occurs due to measles, the primary approach should be nourishing Yin, followed by symptom-specific medication. Absolutely avoid warming and tonifying methods. Herbs such as Ma Huang (Ephedra Herb), Chuan Lian (Corydalis Yanhusuo), Ling Yang Jiao (Antelope Horn), Xi Jiao, and Da Huang should also be avoided. Only Shi Gao is occasionally indicated; Zhang Zhongjing did not discard Bai Hu Tang even in postpartum cases. However, individuals with inherent Yin deficiency who experience miscarriage and subsequently exhibit sweating, restlessness, dry mouth, tidal fever, cough, shortness of breath, insomnia, and numbness in the four limbs are suffering from Yin collapse. In such cases, large doses of Yin-nourishing herbs should be heavily employed, such as Shu Di Huang (Prepared Rehmannia Root), Sheng Di Huang, Dan Shen (Salvia Miltiorrhiza Root), Sha Shen, Mai Dong, Chuan Bei Mu, Mu Dan Pi, Xuan Shen, Suan Zao Ren (Ziziphus Seed), E Jiao (Donkey-hide Gelatin), Ren Shen (Ginseng Radix et Rhizoma), Zhi Mu (Anemarrhena Rhizome), and Di Gu Pi (Lycium Bark). All these should be selected appropriately. Additionally, pregnant women with insufficient Yuan Qi who undergo delivery and suffer from simultaneous Qi and Blood depletion, presenting with cold extremities and continuous spontaneous sweating, require warming and tonifying as the primary method. One must also observe the rash color; bright red indicates good prognosis. If measles occur postpartum, the first half-month prioritizes treating childbirth sequelae, while the second half-month prioritizes treating measles. For childbirth-related issues, prioritize Dang Gui (Angelica Sinensis Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Tao Ren (Prunus Persica Seed), and Hong Hua. For releasing the exterior, use Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Qian Hu (Peucedani Radix), Jie Geng (Platycodon Root), and Ge Gen (Pueraria Lobata Root). For cooling, use Huang Qin, Lian Qiao, Hua Fen (Trichosanthes Root), and Zhi Mu. For invigorating blood, use Sheng Di Huang, Xuan Shen, Mu Dan Pi, and Dan Shen. Use these according to severity. Herbs such as Huang Lian (Coptis Rhizome), Xi Jiao, Da Huang, Ma Huang, Gui Fu (Cinnamon Twig and Aconite Root), and Gan Jiang (Dried Ginger Rhizome) should not be used. If True Yin is exhausted, heavy doses of Yin-tonifying herbs should be used, similar to managing spontaneous abortion. For severe measles, add Yin-nourishing and blood-invigorating herbs to the measles treatment formula.
There is also a condition of Water Accumulation. Sun Yikui stated in "Chi Shui Yuan Zhu": During fever, indulging in cold water may cause water accumulation. If water enters the Lung, it causes wheezing and coughing; treat with Sang Bai Pi (Morus Root Bark) and Ting Li Zi (Descurainia Seed) to drain Lung water. If water enters the Spleen, it causes edema, distension, and spontaneous diarrhea; if water enters the Stomach, it causes vomiting and diarrhea; treat with Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome), and Fu Ling (Poria) to drain Spleen and Stomach water. If water enters the Heart, it causes fright and palpitations; treat with Chi Fu Ling (Red Poria) and Bai Fu Ling (White Poria) with Deng Xin Cao (Juncus Medulla) decoction to drain Heart and Chest water. If water enters the Liver, it causes hypochondriac pain; treat with Yuan Hua (Kadua Flower) to drain it. If water enters the Kidney and Bladder, it causes difficult urination and scrotal swelling; treat with Che Qian Zi (Plantago Seed) and Mu Tong (Akebia Caulis) to drain it. Treatment must follow symptoms.
Furthermore, women whose menstruation has just started or stopped, experiencing alternating chills and fever, mental confusion, and disordered speech, suffer from Heat Entering the Blood Chamber. Treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction), removing Ren Shen and Ban Xia, and adding Dang Gui, Hong Hua, Chi Shao, and Mu Dan Pi. In cases of excessive Fire, Xi Jiao Di Huang Tang may be added; use according to judgment. Urgent pain in the lower abdomen with free urination and black stools indicates Blood Stasis, treated similarly. Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Purgative Decoction) may be appropriate.
Regarding edema after measles, distinguish between those with body heat and those without. Those with body heat have Water Qi in the exterior; treat with Jing Jie, Fang Feng, Su Ye (Perilla Leaf), Sang Bai Pi, Fu Ling, Yi Yi Ren (Coix Seed), Guang Pi (Citrus Reticulata Peel), Ji Li (Tribulus Fruit), Da Fu Pi (Areca Pericarpium), and Jin Yin Hua (Honeysuckle Flower). Those without body heat should be treated with Yin Chen (Artemisia Capillaris), Zhi Zi (Gardenia Fruit), Hua Shi (Talcum), Zhu Ling, Ze Xie, Chi Fu Ling, Xing Ren (Apricot Seed), and Zhi Ke (Bitter Orange). If edema is due to Spleen Deficiency, add Ren Shen, Fu Ling, Bian Dou (Lablab Bean), and Shan Yao (Dioscorea Rhizome). Alternatively, use Jin Zao Er Tang (Golden Date Decoction). Jiang Chunpu's brother suffered abdominal distension and hardness with limb edema after measles; his pulse was deep and slow, tongue coating slippery and white, with no appetite. I used Fu Zi Li Zhong Tang (Aconite and Poria Decoction to Warm the Middle) added with Da Fu Pi and Fu Ling, curing him after several doses. Zhao Shengyuan's grandson had identical external symptoms but a surging, rapid, and forceful pulse with a thick yellow tongue coating. I cured him with one dose of Cheng Qi Tang. As the "Yi Zong Jin Jian" wisely states: Adaptation in practice requires divine understanding.
Cheng Qi Tang: Da Huang, Zhi Ke, Gan Cao.
Jin Zao Er Tang: A miraculous prescription for swelling.
Hong Ya Da Ji (4 liang), Hong Zao (12 liang).
Boil in water for one day, remove Da Ji, take the dates, dry them, and eat them for immediate resolution.