发热之时吐利并。任他吐利不须惊。胞胎蓄毒从斯解。肠胃停污自此清。
发热蒸蒸吐利并。或时滞下作肠鸣。火邪内迫宜清解。法向时行麻症寻。
自利甚时多更改。里急后重症随生。须为通利泄其毒。若犯涩剂病更增。
麻症脱肛何所因。火邪内迫后重成。升提清热是神手。若作气虚定伤人。
久泻脱肛气血虚。治法不可一例拘。养血升提成妙用。破滞用下更增危。
麻本胎毒。发热之时。吐利并作。毒火因之而解。此为美候。如吐利并作。或时下滞。或作肠
鸣。亦是火邪内迫而然。纯是热候。不可作寒而治。治法总宜清解。根据麻科凭症施治。庶保无虞。
如上焦火甚者则吐。下焦火甚者则泻。中焦火甚者则吐泻并作。（朱曰 此三句。抉出吐泻之
因。）自利甚者。则必见里急后重、而为滞下矣。如见里急后重之症。而病者不耐。猛力下气催便。
而脱肛之症。又势所必致也。如麻发热之时。吐多者。以竹茹石膏汤、去半夏、加柿蒂主之。自利
甚者。以秘本猪苓汤、去升麻、甘草分利之。发热时、吐利并作者。以三苓散（见三十七条）加竹
茹、柿蒂、滑石主之。（朱曰 柿蒂敛内蕴之热。既有竹茹、石膏以清热。更加柿蒂以敛之。止吐
自速。）下滞以加味黄芩汤。去白芍药、甘草。加枳实、连翘、牛蒡子、青皮以治之。麻收后、热毒未
曾解尽。有下积滞者。当以连石茱萸丸。去升麻、干葛、甘草、白芍药。加枳壳、山楂肉、麦芽、青皮
治之。但方中茱、萸。若非阴寒膈寒而挟有热者。亦须除去。愚按下积滞之症。非仅麻收后有之。
即将出正出之时。亦常有见者。愚谓不拘先后。但麻见有下积者。则当以清热导滞汤（见七十
二条）去白芍药、浓朴、甘草、当归、淡竹叶。加山楂肉、麦芽治之。更为妥当。自利甚、而变为里
急后重者。以黄连解毒汤（见三十五条）加连翘、牛蒡子、青皮治之。若小便短少者。更加木通、
滑石治之。如里急甚者。则当加半生半炒黑白丑牛以利之。或以铜壁山人黄芩汤。去人参、赤芍、
甘草。加连翘、牛蒡子、丑牛以利之。或以加味黄芩汤。去白芍、甘草。加枳实、木通、连翘、牛蒡
子、丑牛以利之。若夫脱肛之症。多见于将收已收之后。而治法有不可一例者。若因毒火内迫。
大肠枯涩。肺金受伤。不能传送。致成里急后重之症。而病者难忍不耐、用力送气催便、以冀稍
松。适肛脱出。不可认作气虚施治。治法总宜清热解毒。导利行滞。泻火清金。兼用升提之品。以
加味导赤散。去薄荷、淡竹叶。加当归尾润肠胃、破恶血、而养心血。牛蒡子以消毒。枯黄芩泻肺
火、以凉肺血。枳壳以破气滞。滑石通利六腑九窍、以荡热散湿。上五味。各八分。丑牛四五分。以
除壅滞。丹皮四五分。以开陷伏之邪、使之外散。升麻五六分。以升散大肠、胃、胆、三焦之火热。
如兼有潮热者。加鲜地骨皮二三钱治之。若因久泻而脱肛者。亦以加味导赤散。去薄荷、竹叶。加
当归身钱许。川芎钱许。升麻六七分。以养血理气。升散大肠、胃、胆、三焦之火热。而枳壳、丑牛。
又不宜概用矣。
朱曰 麻证脱肛与气虚脱肛不同。所示清热解毒诸法。允为合拍。
竹茹石膏汤
竹茹 石膏 黄芩 陈皮 半夏 水煎服。
秘本猪苓汤 治泄。
猪苓 泽泻 滑石 赤茯苓 黄连 升麻 甘草 灯心引。水煎服。并治病患用力催便
脱肛。
加味黄芩汤
黄连 黄芩（各一钱五分） 滑石 白芍（各三钱） 甘草（七分） 水煎服。血痢。加地榆皮二钱。
连石茱萸丸
黄连（酒炒） 滑石（飞过各一两） 黄芩 干葛 白芍（各八分） 茱萸（一两） 升麻（七分）
甘草（四分） 为末。以山药研粉、作糊合丸。梧子大。食远。用白汤送下三五钱。
铜壁山人黄芩汤 治里急后重。
黄芩 黄连 生地黄 木通 枳壳 当归尾 赤芍药 人参 甘草 三剂。水煎服。初
剂。加大黄微利之。
加味导赤散
生地黄（酒洗一钱五分） 川木通 川元参（各五分） 连翘（六分） 川黄连（六分） 薄荷叶（四
分） 淡竹叶（七分） 灯心引。水煎服。
【背景信息】
书名：麻科活人全书 作者：谢玉琼恩 朝代：清 章节：吐利并作下滞里急后重脱肛第七十一 类别：综合
【待处理原文翻译】
发热之时，呕吐与腹泻同时发生。任凭出现呕吐腹泻也不必惊慌。这是因为胞胎中蓄积的毒邪从此得以化解，肠胃中停滞的污秽自此得到清理。
发热蒸蒸（高热持续）时，呕吐与腹泻并见。有时伴有痢疾样排便和肠鸣音。这是火邪内迫所致，应当采用清解法治疗。治疗方法应参照时行麻疹病症来寻找依据。
如果是自发性腹泻严重，往往需要更改治法。里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽）的症状随之产生。必须通过通利的方法来泄出毒邪。如果误用收敛固涩的药物，病情会更加加重。
麻疹病症中出现脱肛是什么原因？这是由于火邪内迫导致后重感而形成的。采用升提和清热的方法是神妙的手术。如果将其当作气虚证治疗，必定会伤害患者。
长期腹泻导致的脱肛属于气血虚弱。治疗方法不可拘泥于一种模式。养血和升提是妙用。如果使用破气滞、攻下的方法，会增加危险。
麻疹本源于胎毒。在发热的时候，呕吐与腹泻同时发生，毒火因此得以化解，这属于良好的征象。如果呕吐腹泻并见，或者时下痢疾样便，或者出现肠鸣，这也是火邪内迫所致，纯属热证，不可当作寒证治疗。治疗方法总宜清解。根据麻疹科的辨证施治原则，才能确保无虞。
如上焦火盛则呕吐，下焦火盛则腹泻，中焦火盛则呕吐腹泻并见。（朱氏评注：这三句揭示了呕吐腹泻的原因。）自发性腹泻严重时，必然会出现里急后重，从而形成滞下（痢疾）。如果见到里急后重的症状，而患者难以忍受，猛烈用力向下排气催便，那么脱肛的症状也就势所必至了。
如果在麻疹发热时，呕吐较多者，以竹茹石膏汤为主方，去掉半夏，加入柿蒂。自发性腹泻严重者，以秘本猪苓汤为主方，去掉升麻、甘草，分消利湿。发热时呕吐腹泻并见者，以三苓散（见第三十七条）加竹茹、柿蒂、滑石为主方。（朱氏评注：柿蒂收敛内蕴之热。既有竹茹、石膏以清热，再加柿蒂以收敛，止吐自然迅速。）
下痢滞下以加味黄芩汤治疗，去掉白芍药、甘草，加入枳实、连翘、牛蒡子、青皮。麻疹收靥（疹子消退）后，热毒未曾完全解除，有下积滞者，当以连石茱萸丸治疗，去掉升麻、干葛、甘草、白芍药，加入枳壳、山楂肉、麦芽、青皮。但是方中的吴茱萸、山茱萸，如果不是阴寒膈寒且挟有热邪的情况，也必须除去。我按：下积滞的症状，不仅仅在麻疹收靥后有，即使在即将出疹或正出疹的时候，也常有见到。我认为不拘泥于先后，只要麻疹期间见到下有积滞，就应当以清热导滞汤（见第七十二条）治疗，去掉白芍药、浓朴、甘草、当归、淡竹叶，加入山楂肉、麦芽，更为妥当。
自发性腹泻严重，转变为里急后重者，以黄连解毒汤（见第三十五条）加连翘、牛蒡子、青皮治疗。如果小便短少者，再加木通、滑石治疗。如果里急非常严重，则应当加入半生半炒的黑丑、白丑（牵牛子）以利之。或者以铜壁山人黄芩汤治疗，去掉人参、赤芍、甘草，加入连翘、牛蒡子、丑牛以利之。或者以加味黄芩汤治疗，去掉白芍、甘草，加入枳实、木通、连翘、牛蒡子、丑牛以利之。
至于脱肛的症状，多见于将收或已收之后，而治疗方法不可一概而论。如果是因为毒火内迫，大肠枯涩，肺金受伤，不能传送糟粕，导致形成里急后重的症状，而患者难忍不耐，用力送气催便，希望稍微放松，结果适得其反导致肛门脱出。不可认作气虚而施治。治疗方法总宜清热解毒，导利行滞，泻火清金，兼用升提之品。
以加味导赤散为主方，去掉薄荷、淡竹叶，加入当归尾润肠胃、破恶血、而养心血；牛蒡子以消毒；枯黄芩泻肺火、以凉肺血；枳壳以破气滞；滑石通利六腑九窍、以荡热散湿。以上五味药，各八分，丑牛四五分，以除壅滞；丹皮四五分，以开陷伏之邪、使之外散；升麻五六分，以升散大肠、胃、胆、三焦之火热。如果兼有潮热者，加鲜地骨皮二三钱治疗。
如果是因为久泻而脱肛者，也以加味导赤散为主方，去掉薄荷、竹叶，加入当归身一钱许，川芎一钱许，升麻六七分，以养血理气，升散大肠、胃、胆、三焦之火热。而枳壳、丑牛，又不宜一概使用了。
朱氏评注：麻疹证脱肛与气虚脱肛不同。所示清热解毒诸法，确实合乎拍节。
秘本猪苓汤 治泄。
猪苓 泽泻 滑石 赤茯苓 黄连 升麻 甘草 灯心引。水煎服。并治病患用力催便脱肛。
加味黄芩汤
黄连 黄芩（各一钱五分） 滑石 白芍（各三钱） 甘草（七分） 水煎服。血痢。加地榆皮二钱。
连石茱萸丸
黄连（酒炒） 滑石（飞过各一两） 黄芩 干葛 白芍（各八分） 茱萸（一两） 升麻（七分） 甘草（四分） 为末。以山药研粉、作糊合丸。梧子大。食远。用白汤送下三五钱。
铜壁山人黄芩汤 治里急后重。
黄芩 黄连 生地黄 木通 枳壳 当归尾 赤芍药 人参 甘草 三剂。水煎服。初剂。加大黄微利之。
加味导赤散
生地黄（酒洗一钱五分） 川木通 川元参（各五分） 连翘（六分） 川黄连（六分） 薄荷叶（四分） 淡竹叶（七分） 灯心引。水煎服。
During the fever, vomiting and diarrhea occur simultaneously. Do not be alarmed regardless of the vomiting and diarrhea. This is because the toxic heat accumulated in the fetal womb is thereby resolved, and the stagnant filth in the intestines and stomach is thereby cleared.
When high fever persists (Zhengzheng), vomiting and diarrhea appear together. Sometimes accompanied by dysentery-like stools and borborygmus. This is caused by internal pressure from fire pathogen; the treatment method should seek guidance from the patterns of epidemic measles.
If spontaneous diarrhea is severe, the treatment strategy often needs to be changed. The symptom of tenesmus (urgency with heavy sensation in the anus) arises subsequently. One must use purgative methods to drain the toxin. If astringent agents are mistakenly used, the disease will worsen.
What is the cause of rectal prolapse in measles? It is formed due to internal pressure from fire pathogen causing tenesmus. Using lifting and clearing heat methods is a divine technique. If treated as Qi deficiency, it will surely harm the patient.
Rectal prolapse caused by chronic diarrhea belongs to Qi and Blood deficiency. Treatment methods cannot be rigidly applied. Nourishing blood and lifting are the subtle applications. Using methods that break stagnation and purge will increase danger.
Measles originates from fetal toxicity. During fever, vomiting and diarrhea occur simultaneously, and the toxic fire is thereby resolved; this is a favorable sign. If vomiting and diarrhea occur together, or if there is occasional dysentery-like stool, or borborygmus, this is also due to internal pressure from fire pathogen. It is purely a heat pattern and should not be treated as cold. The general treatment principle should be clearing and resolving. Following the syndrome differentiation principles of Measles Science ensures safety.
If Fire is excessive in the Upper Jiao, vomiting occurs; if Fire is excessive in the Lower Jiao, diarrhea occurs; if Fire is excessive in the Middle Jiao, both vomiting and diarrhea occur. (Commentary by Zhu: These three sentences reveal the causes of vomiting and diarrhea.) When spontaneous diarrhea is severe, tenesmus inevitably appears, forming dysentery. If tenesmus is observed, and the patient cannot endure it, forcefully straining to expel stool will inevitably lead to rectal prolapse.
If vomiting is predominant during measles fever, use Zhuru Shigao Tang (Bamboo Shavings and Gypsum Decoction), removing Banxia (Pinellia Rhizome), adding Shidi (Persimmon Calyx). If spontaneous diarrhea is severe, use Miben Zhuling Tang (Secret Version Poria Decoction), removing Shengma (Cimicifugae Rhizoma) and Gancao (Licorice Root), using draining and diuresis methods. If vomiting and diarrhea occur together during fever, use Sanling San (Three Poria Powder) [see Article 37] adding Zhuru (Bamboo Shavings), Shidi (Persimmon Calyx), and Huashi (Talcum). (Commentary by Zhu: Shidi (Persimmon Calyx) consolidates internal heat. With Zhuru and Shigao clearing heat, adding Shidi to consolidate stops vomiting quickly.)
For dysentery/stagnant downflow, treat with Jiawei Huangqin Tang (Modified Scutellaria Decoction), removing Baishao (White Peony Root) and Gancao (Licorice Root), adding Zhishi (Immature Bitter Orange), Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), and Qingpi (Aurantii Fructus Pericarpium). After measles resolution, if heat toxin is not fully cleared and there is lower accumulation/stagnation, treat with Lianshi Zhuyu Wan (Coptis, Talcum, and Cornus Pill), removing Shengma (Cimicifugae Rhizoma), Gange (Puerariae Radix), Gancao (Licorice Root), and Baishao (White Peony Root), adding Zhike (Aurantii Fructus), Shanzha Rou (Crataegi Fructus Flesh), Maiya (Hordei Fructus Germinatus), and Qingpi (Aurantii Fructus Pericarpium). However, Zhuyu (Cornus) and Zhuyu (Evodiae Fructus) in the formula must be removed unless there is Yin-Cold or Diaphragm-Cold complicated with Heat. I note: Lower accumulation/stagnation is not only seen after measles resolution but also frequently during the eruption phase. I suggest that regardless of timing, if lower stagnation is seen during measles, treat with Qingre Daozhi Tang (Clear Heat and Guide Out Stagnation Decoction) [see Article 72], removing Baishao (White Peony Root), Houpo (Magnoliae Officinalis Cortex), Gancao (Licorice Root), Danggui (Angelicae Sinensis Radix), and Danzhuye (Lophatheri Herba), adding Shanzha Rou (Crataegi Fructus Flesh) and Maiya (Hordei Fructus Germinatus), which is more appropriate.
If spontaneous diarrhea becomes severe and turns into tenesmus, treat with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) [see Article 35] adding Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), and Qingpi (Aurantii Fructus Pericarpium). If urine is scanty, add Mutong (Akebiae Caulis) and Huashi (Talcum). If tenesmus is severe, add raw and stir-fried Heiqiu and Baiqiu (Semen Kochiae/Convolvuli, i.e., Convolvulus Seeds) to promote drainage. Alternatively, use Tongbi Shanren Huangqin Tang (Dr. Tongbi's Scutellaria Decoction), removing Renshen (Ginseng Radix), Chishao (Red Peony Root), and Gancao (Licorice Root), adding Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), and Qiuniu (Convolvulus Seeds) to promote drainage. Or use Jiawei Huangqin Tang (Modified Scutellaria Decoction), removing Baishao (White Peony Root) and Gancao (Licorice Root), adding Zhishi (Immature Bitter Orange), Mutong (Akebiae Caulis), Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), and Qiuniu (Convolvulus Seeds) to promote drainage.
Regarding rectal prolapse, it mostly occurs when measles is about to resolve or has resolved, but treatment methods vary. If caused by internal pressure from toxic fire, dryness of the Large Intestine, injury to Lung Metal, and inability to transport waste, leading to tenesmus, and the patient strains forcefully hoping for relief, causing the anus to prolapse, do not treat it as Qi deficiency. The treatment principle should generally be clearing heat and detoxifying, guiding out stagnation, draining fire and clearing the Lungs, combined with lifting agents.
Use Jiawei Daochi San (Modified Guiding Out Redness Powder), removing Bohe (Menthae Haplocalycis Herba) and Danzhuye (Lophatheri Herba), adding Danggui Wei (Angelicae Sinensis Radix Tail) to moisten intestines/stomach, break bad blood, and nourish Heart blood; Niubangzi (Arctii Fructus) to eliminate toxins; Ku Huangqin (Dried Scutellariae Radix) to drain Lung fire and cool Lung blood; Zhike (Aurantii Fructus) to break Qi stagnation; Huashi (Talcum) to unblock the six Fu organs and nine orifices, sweeping away heat and dampness. The above five herbs, each 8 fen, Qiuniu (Convolvulus Seeds) 4-5 fen, to remove obstruction; Danpi (Moutan Cortex) 4-5 fen, to open trapped pathogens and disperse them outward; Shengma (Cimicifugae Rhizoma) 5-6 fen, to lift and disperse fire-heat from the Large Intestine, Stomach, Gallbladder, and Sanjiao. If tidal fever is present, add Xian Digupi (Fresh Lycii Cortex) 2-3 qian.
If rectal prolapse is caused by chronic diarrhea, also use Jiawei Daochi San (Modified Guiding Out Redness Powder), removing Bohe (Menthae Haplocalycis Herba) and Zhuye (Bambusae Folium), adding Danggui Shen (Angelicae Sinensis Radix Head) approx. 1 qian, Chuanxiong (Chuanxiong Rhizoma) approx. 1 qian, and Shengma (Cimicifugae Rhizoma) 6-7 fen, to nourish blood and regulate Qi, lifting and dispersing fire-heat from the Large Intestine, Stomach, Gallbladder, and Sanjiao. In this case, Zhike (Aurantii Fructus) and Qiuniu (Convolvulus Seeds) should not be used indiscriminately.
Commentary by Zhu: Rectal prolapse in measles differs from rectal prolapse due to Qi deficiency. The aforementioned methods of clearing heat and detoxifying are indeed appropriate.
Zhuru Shigao Tang (Bamboo Shavings and Gypsum Decoction)
Zhuru (Bamboo Shavings), Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma). Decoct in water and take orally.
Miben Zhuling Tang (Secret Version Poria Decoction) Treats diarrhea.
Zhuling (Polypori Umbilicati Sclerotium), Zexie (Alismatis Rhizoma), Huashi (Talcum), Chifuling (Polypori Cum Mycelio), Huanglian (Coptidis Rhizoma), Shengma (Cimicifugae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma). Use Dengxin (Junci Medullia) as guide. Decoct in water and take orally. Also treats rectal prolapse caused by patients straining to defecate.
Jiawei Huangqin Tang (Modified Scutellaria Decoction)
Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix) (each 1.5 qian), Huashi (Talcum), Baishao (Paeoniae Radix Alba) (each 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (0.7 qian). Decoct in water and take orally. For bloody dysentery, add Diyupi (Stemonae Radix Bark) 2 qian.
Lianshi Zhuyu Wan (Coptis, Talcum, and Cornus Pill)
Huanglian (Coptidis Rhizoma, wine-fried), Huashi (Talcum, water-suspended, each 1 liang), Huangqin (Scutellariae Radix), Gange (Puerariae Radix), Baishao (Paeoniae Radix Alba) (each 8 fen), Zhuyu (Euodiae Fructus/Corni Fructus - context implies Evodiae for cold/heat mix, but text says Zhuyu usually Corni in pills, here likely Evodiae given "Yin Cold" context earlier, however standard pill names vary. Text lists Zhuyu separately from Lianshi. Given "Yin Han", likely Evodiae Wu Zhu Yu), Shengma (Cimicifugae Rhizoma) (0.7 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (0.4 qian). Grind into powder. Use Shan Yao (Dioscoreae Rhizoma) powder mixed with paste to form pills, size of wu zi (sesame seeds). Take far from meals, washed down with warm water, 3-5 qian per dose.
Tongbi Shanren Huangqin Tang (Dr. Tongbi's Scutellaria Decoction) Treats tenesmus.
Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shengdihuang (Rehmanniae Radix Recens), Mutong (Akebiae Caulis), Zhike (Aurantii Fructus), Danggui Wei (Angelicae Sinensis Radix Tail), Chishao (Paeoniae Radix Rubra), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma). Three doses. Decoct in water and take orally. First dose, add Dahuang (Rhei Radix et Rhizoma) to slightly promote drainage.
Jiawei Daochi San (Modified Guiding Out Redness Powder)
Shengdihuang (Rehmanniae Radix Recens, wine-washed 1.5 qian), Chuanmutong (Akebiae Caulis), Chuanyuan Shen (Scrophulariae Radix) (each 5 fen), Lianqiao (Forsythiae Fructus) (6 fen), Chuanhuanglian (Coptidis Rhizoma) (6 fen), Bohe Ye (Menthae Haplocalycis Herba) (4 fen), Danzhuye (Lophatheri Herba) (7 fen). Use Dengxin (Junci Medullia) as guide. Decoct in water and take orally.