欲出不出亡立待。一出即收死反掌。毒归五脏生四症。只因邪留正气伤。
寒郁热邪不得出。隐而不现非早收。宜用汤丸急早治。发而不出一命休。
麻症初起。必发热咳嗽。浑身胀痛。有似伤寒之候。惟干咳连声。目赤多泪。呕恶便溏。确为
麻症之验。然发热之时。既明麻症。而麻于耳后、项上、腰腿上先现。然后遍及手足者为齐。总以
头面更多者为佳。麻顶尖长。形小而匀者。吉也。若麻疹将发之际。或为风寒暴袭。或因肢体坦
露。寒郁热邪。不能外出。此全盛之势未萌。与麻出早收不同。其有初热吐泻交作者。是为顺候。
干呕闷乱者。则为逆症。欲出不出者。危亡可立而待也。一出即收者。死在反掌间矣。何也。夫麻
以出尽则毒解。邪气郁遏。则毒留而不去。正气损伤。则人困而不伸。毒归五脏。而四症生焉。
毒归于脾。则泄泻不止。毒归于肝心。则烦热不退。而生惊搐。毒归于肺。则咳嗽血出。毒归于胃。
则牙龈腐烂。而成疳蚀。凡有出不快者。总宜用解毒之剂。如消毒饮（见二十二条）去甘草。宣
毒发表汤（见第五条）去升麻、甘草、桔梗、淡竹叶。或葛根解毒汤（见第五条）去赤芍、甘草。加
枳壳。或防风败毒散（见第五条）去甘草、桔梗。或用葛根疏邪汤等剂以发之。若无汗而出不彻
者。外用胡荽。同葱捣烂。和酒糟蒸热。以绢包裹。自头面及手足。逐一揩之。勿令见风。衣被温
浓。自然出快。如有气粗喘促。腹中胀痛。烦躁不宁。致麻不出者。急以麻杏甘石汤合三味消毒
饮。俱去甘草以治之。轻则仍以宣毒发表汤（见第五条）去升麻、桔梗、甘草主之。若因触犯风寒
雾露。隐现不能发出者。以新猪粪冲汤。隔水蒸之。冷则更添滚者。并取猪粪烧灰。以葱白汤调
下二、三钱。此乃痘科治痘黑陷用烧人粪之变方。即用烧人粪与服亦可。若发之而仍不出者。则不治矣。
朱曰 出而不快。尚是邪气郁遏。至屡发不出。正气受伤。危险极矣。麻之初出。耳后
项上腰腿上先现。然后遍及手足头面。多者最佳。麻顶尖长形小而匀者。吉也。
葛根疏邪汤
葛根 防风 荆芥 苏叶 牛蒡子 连翘 地骨皮 前胡 赤茯苓 枳壳 木通 灯心引。
麻杏甘石汤 治发汗后。汗出而喘。无大热者。
麻黄（去节三钱） 杏仁（去皮尖研碎二十粒） 石膏（五钱） 炙甘草（一钱） 水煎服
。此乃麻黄汤去桂枝。而兼越婢汤也。专祛上焦湿热痰气。
三味消毒饮
荆芥 牛蒡子（各一钱五分） 甘草（二钱） 水煎服。
欲出不出，死亡立等。一出即收，死在反掌之间。毒邪归入五脏，产生四种病症。只因邪气滞留，正气受损。
寒邪郁闭，热邪不得外发。隐伏不现，并非过早收敛。应当使用汤剂或丸药紧急早治。若麻疹发出却随即消失，则性命难保。
麻疹初起时，必定出现发热、咳嗽，浑身胀痛，症状类似伤寒。唯有干咳连声，眼睛红赤多泪，呕吐恶心，大便稀溏，确为麻疹的征象。然而发热之时，既然明确了是麻疹，那么麻疹先在耳后、颈部、腰部及腿部显现，然后遍及手足四肢的为“齐”（透发均匀）。总体以头面部皮疹更多者为佳。麻疹疹点尖长，形状小而均匀的，为吉兆。如果麻疹将要发出之际，或因风寒突然袭击，或因肢体裸露，导致寒邪郁闭热邪，不能向外发散。这是全盛之势尚未萌发的表现，与麻疹发出过早即消退不同。那些初起发热且吐泻交替发作的，属于顺证。干呕、胸闷烦乱的，则为逆证。欲出而出不畅的，危亡可以立刻等待到；一出即收的，死亡就在眨眼之间了。为什么呢？因为麻疹必须透发尽致，毒邪才能解除。邪气郁遏，则毒邪留存而不散；正气损伤，则人体困顿而不能舒展。毒邪归入五脏，从而产生四种病症。毒邪归于脾，则泄泻不止；毒邪归于肝心，则烦热不退，并产生惊厥抽搐；毒邪归于肺，则咳嗽咯血；毒邪归于胃，则牙龈腐烂，形成疳蚀。凡是出现发出不快的情况，总宜使用解毒的方剂。如消毒饮（见第二十二条），去掉甘草；宣毒发表汤（见第五条），去掉升麻、甘草、桔梗、淡竹叶；或者葛根解毒汤（见第五条），去掉赤芍、甘草，加入枳壳；或者防风败毒散（见第五条），去掉甘草、桔梗；或者使用葛根疏邪汤等方剂来透发。如果没有汗且透发不彻底的，外用胡荽，同葱捣烂，和酒糟蒸热，用绢布包裹，从头面及手足逐一擦拭。不要让它见风，衣被要温暖浓厚，自然就会发得快。如果有气粗喘促，腹部胀痛，烦躁不安，导致麻疹发不出的，紧急使用麻杏甘石汤合三味消毒饮，都去掉甘草来治疗。轻症仍然以宣毒发表汤（见第五条）去掉升麻、桔梗、甘草为主治。如果是因为触犯风寒雾露，导致疹子隐现不能发出的，用新鲜猪粪冲水，隔水蒸之，凉了则再添加滚热的。同时取猪粪烧成灰，用葱白汤调服二、三钱。这是痘科治疗痘疹黑陷所用的烧人粪方的变通方法。也可以用烧过的人粪给患者服用。如果发了出来仍然不能透发的，那就无法治愈了。
朱氏说：出而不快，尚且是邪气郁遏所致。到了屡次发出却发不出来，正气受伤，危险极了。麻疹初出时，先在耳后、颈部、腰部及腿部显现，然后遍及手足头面，多的最佳。麻疹疹点尖长，形状小而均匀的，为吉兆。
葛根疏邪汤
葛根 防风 荆芥 苏叶 牛蒡子 连翘 地骨皮 前胡 赤茯苓 枳壳 木通 灯心草为引。
麻杏甘石汤 治疗发汗后，汗出而喘，没有大热的情况。
麻黄（去节三钱） 杏仁（去皮尖研碎二十粒） 石膏（五钱） 炙甘草（一钱） 水煎服。
此方乃麻黄汤去掉桂枝，兼有越婢汤之意。专门祛除上焦湿热痰气。
If the eruption is hesitant and fails to emerge, death awaits immediately. If it emerges and then quickly recedes, death occurs in the blink of an eye. The toxin returns to the five zang organs, generating four types of syndromes. This is solely due to pathogenic factors lingering and damaging the healthy qi (Zheng Qi).
Cold stagnation traps heat pathogens, preventing their release. The rash remains hidden and does not appear; this is not due to premature contraction. One should urgently treat with decoctions or pills early on. If the measles erupts but then vanishes, life is lost.
At the initial stage of measles, fever and cough are inevitable, accompanied by generalized body pain and distension, resembling symptoms of Shanghan (Cold Damage Syndrome). However, persistent dry coughing, red eyes with excessive tearing, vomiting and nausea, and loose stools are definitive signs of measles. When fever occurs, once measles is identified, the rash appearing first behind the ears, on the neck, waist, and legs, and then spreading to the hands and feet indicates a uniform eruption ("Qi"). Generally, having more eruptions on the head and face is auspicious. Measles spots that are pointed and elongated, small in shape and even in distribution, are a good omen.
If, at the time when measles are about to erupt, sudden attack by wind-cold occurs, or limbs are exposed to cold, causing cold to stagnate and trap heat pathogens so they cannot be released externally, this represents a state where the full vigor has not yet arisen. This differs from measles that erupt early and recede prematurely. Cases where initial fever is accompanied by alternating vomiting and diarrhea constitute favorable conditions ("Shun"). Dry retching, chest oppression, and restlessness indicate adverse conditions ("Ni"). Hesitant eruption portends imminent danger; rapid emergence followed by immediate recession leads to death instantly. Why? Because measles must fully erupt for the toxin to resolve. If pathogenic factors are constrained, the toxin remains and does not disperse; if healthy qi is damaged, the body becomes lethargic and unable to expand. Toxin returning to the five zang organs generates four specific syndromes: Toxin returning to the Spleen causes incessant diarrhea; toxin returning to the Liver and Heart causes persistent irritability and heat, leading to fright and convulsions; toxin returning to the Lung causes coughing and hemoptysis; toxin returning to the Stomach causes gum rot and gan erosion (ulcerative lesions).
For any case of slow or incomplete eruption, detoxifying agents should generally be used. For example, Xiaodu Yin (Dispel Toxin Decoction) (see Article 22), removing Gancao (Licorice); Xuandu Fabiao Tang (Vent Toxins and Release the Exterior Decoction) (see Article 5), removing Shengma (Cimicifugae Rhizoma), Gancao (Licorice), Jiegeng (Platycodonis Radix), and Danzhuyeqian (Lophatheri Herba); or Gegen Jiedu Tang (Kudzu Root Detoxification Decoction) (see Article 5), removing Chishao (Paeoniae Radix Rubra) and Gancao (Licorice), adding Zhike (Aurantii Fructus); or Fangfeng Baidu San (Saposhnikoviae Powder for Overcoming Toxicity) (see Article 5), removing Gancao (Licorice) and Jiegeng (Platycodonis Radix); or using Gegen Shuxie Tang (Kudzu Root Dispersing Pathogens Decoction) and other formulas to promote eruption.
If there is no sweat and the eruption is incomplete, externally apply Huisu (Coriandri Fructus) mashed with Congbai (Allii Fistulosus Bulbus), mixed with Jiuzao (Distiller’s Grains), steamed hot, wrapped in silk cloth, and wiped over the head, face, hands, and feet one by one. Avoid exposure to wind. Keep clothing and bedding warm and thick; the eruption will naturally proceed quickly.
If there is coarse breathing and panting, abdominal distension and pain, and restlessness preventing eruption, urgently treat with Maxing Ganshi Tang combined with Sanwei Xiaodu Yin, both removing Gancao (Licorice). For mild cases, continue with Xuandu Fabiao Tang (see Article 5), removing Shengma (Cimicifugae Rhizoma), Jiegeng (Platycodonis Radix), and Gancao (Licorice).
If the eruption is hindered by contact with wind-cold or fog/dew, causing the rash to appear intermittently without fully emerging, use fresh pig manure steeped in water, steamed over boiling water. If it cools, add more boiling water. Additionally, burn the pig manure to ash, mix with Congbai Tang (Scallion White Decoction), and administer two to three qian. This is a modified formula from the Smallpox specialty for treating black sunken smallpox, originally using burned human feces. Using burned human feces directly is also acceptable. If the eruption still fails to emerge after attempts to induce it, the condition is incurable.
Zhu stated: Eruption that is slow is still due to pathogenic constraint. Repeated failure to erupt indicates damage to healthy qi, which is extremely dangerous. At the initial stage of measles, the rash appears first behind the ears, on the neck, waist, and legs, then spreads to the hands, feet, head, and face. Abundance is best. Pointed, elongated, small, and evenly distributed measles spots are auspicious.
Gegen Shuxie Tang (Kudzu Root Dispersing Pathogens Decoction)
Gegen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Ziyeh (Perillae Folium), Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Digupi (Lycii Cortex), Qianhu (Peucedani Radix), Chi Fuling (Polyporus with Hostwood), Zhike (Aurantii Fructus), Mutong (Akebiae Caulis), Dengxincao (Junci Medulla) as guide.
Maxing Ganshi Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction)
Treats post-sweating syndrome characterized by sweating, wheezing, and absence of high fever.
Mahuang (Ephedrae Herba) (3 qian, nodes removed), Xingren (Armeniacae Semen Amarum) (20 grains, skin and tips removed, crushed), Shigao (Gypsum Fibrosum) (5 qian), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) (1 qian). Decoct in water and take orally.
This formula is Mahuang Tang (Ephedra Decoction) minus Guizhi (Cinnamomi Ramulus), incorporating elements of Yuespi Tang. It specifically dispels damp-heat and phlegm-qiang in the Upper Jiao.
Sanwei Xiaodu Yin (Three-Ingredient Toxin-Dispelling Decoction)
Jingjie (Schizonepetae Spica), Niubangzi (Arctii Fructus) (each 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (2 qian). Decoct in water and take orally.