麻疹证治法最广。当补当泻须究讲。清解补涩谬兼施。杀人性命如反掌。
麻初出时。多有泄泻不止者。其毒火因泻而减。此殊无妨。若麻出尽之后。而泻红黄色粪者。
乃内有伏热也。与泄泻过甚者。俱宜以加味三苓散与之。一服即愈。切不可用参、术、诃、蔻补涩
之剂。以图速止。医家若不识禁忌。未经讲究。一见有泻。遂用补涩。乃曰吾于清解药中兼用参、
术、诃、蔻。等分又轻。何碍于事。一服不见功效。不知改方医治。又曰参、术、诃、蔻等分轻少。故
不应耳。于是多加参、术、诃、蔻分两而再与服。致麻变证。重则腹胀喘满而不可救。轻则变为休
息痢。而缠绵不已。然非仅麻出齐之后泻红黄色者。不宜兼用补涩。即麻已收之后。而泄泻黄红
色。亦不宜兼用补涩。仍以加味三苓散治之。兼用补涩且不可。若专用补涩者。则杀人不待反掌
之久矣。业斯道者。可不慎欤。
加味三苓散
猪苓 木通 车前子 赤茯苓（各七分） 泽泻（八分）黄芩（酒炒） 牛蒡子（炒研各五分
）黄连（酒炒二分） 灯心五十寸引水煎。食后服。
升发清凉与解毒。此乃治麻之大法。用之须当分先后。次第由来混不得。
治麻用升发清凉解毒。法所宜然。然当分先后而施。不可混用。何也。麻初发热。恐难透表。
故当用升发疏表解肌之剂。使之易出。见标之后。与正出未透之间。宜发表而兼清凉。使血凉肌
解。麻易出透。至麻到通身上下俱红。总成一片。垒垒如珠。手足之末。上下相同。无有空处。此
为出透。斯时则当用清凉解毒之剂。不必兼用发表之药。一解即愈。若于初热正出之际。而即
用寒凉解毒之剂。则气满血凝。肌肤闭密。不得开通。至麻不出。多生危候。是以于初热未出之
时。及正出之际。只宜辛散。如荆芥、葛根、薄荷、前胡、牛蒡子、防风、苏叶、淡竹叶、石膏之类。可
以施用。即麻黄亦当因证而施。使之易透。正收及收后。宜用寒凉解毒之剂。如元参、青黛、麦冬、
黄柏、栝蒌根、黄连、黄芩、连翘、贝母、知母、栀仁、山豆根、淡竹叶等药。俱可施用。使毒火易得
消散。方无后虑。
朱曰 何时当用疏表解肌之剂。何时当用发表兼清凉之剂。何时当用清凉解毒之剂。
作者一一指点。苦口婆心。
麻疹的证治方法最为广泛。应当补益还是应当泻下，必须深入探究和讲究。如果在清解、补益、收敛固涩的方法上错误地同时使用，其致死之快如同翻手掌一般迅速。
在麻疹初出之时，患者多有泄泻不止的情况。此时体内的毒火因泄泻而得以减轻，这完全没有妨碍。如果是在麻疹出尽之后，排泄红黄色的粪便，这是体内有伏热所致。对于这种情形以及泄泻过于严重的情况，都适宜给予加味三苓散治疗，服用一次即可痊愈。切不可使用人参、白术、诃子、肉豆蔻等具有补益和收敛固涩作用的药剂，企图使腹泻迅速停止。
如果医生不了解这些禁忌，未曾深入研究，一见到腹泻症状，就立即使用补涩药物，并辩解说：“我在清解药中兼用人参、白术、诃子、肉豆蔻，且剂量均分且较轻，有什么妨害呢？”当服用一次后不见功效，又不知道更改方剂重新医治，便又说：“是因为人参、白术、诃子、肉豆蔻等药的剂量轻少，所以没有效果。”于是增加人参、白术、诃子、肉豆蔻的用量再次服用，导致麻疹出现变证。病情重的，会导致腹部胀满、气喘胸闷而无法救治；病情轻的，会转变为休息痢（一种时发时止的痢疾），缠绵不断。
然而，不仅仅是麻疹出齐之后出现红黄色大便的不宜兼用补涩药，即使是麻疹已经收没之后，如果出现黄红色泄泻，也不宜兼用补涩药。仍应以加味三苓散进行治疗。兼用补涩药尚且不可，若专门使用补涩药，那么杀人就不需要等到翻手掌那么久了。从事这一行的人，能不谨慎吗？
加味三苓散：猪苓、木通、车前子、赤茯苓（各七分）、泽泻（八分）、黄芩（酒炒）、牛蒡子（炒研，各五分）、黄连（酒炒二分）。以灯心草五十寸为引，用水煎煮，饭后服用。
升发、清凉与解毒，这是治疗麻疹的大法。使用时必须分清先后顺序。次第由来已久，不能混淆。
治疗麻疹使用升发、清凉、解毒的方法，是医理所应当的。然而应当分清先后顺序来施用，不可以混用。为什么呢？麻疹初起发热时，恐怕难以透达体表，因此应当使用升发疏表、解肌的药剂，使其容易透出。在见到麻疹苗头之后，与正发出但未完全透达之间，适宜发表的同时兼用清凉之法，使血液凉爽、肌肤腠理解开，麻疹就容易透出。直到麻疹遍布全身上下都变红，连成一片，颗粒垒垒如珠，手足末端与身体其他部位相同，没有空隙，这才算是出透。此时则应当使用清凉解毒的药剂，不必兼用发表的药物，一经解除即可痊愈。如果在初热正出的时候，就立即使用寒凉解毒的药剂，就会导致气机壅滞、血液凝涩，肌肤闭密，不得开通，致使麻疹无法透出，多产生危重证候。因此在初热未出之时，以及正出之际，只适宜使用辛散药物，如荆芥、葛根、薄荷、前胡、牛蒡子、防风、苏叶、淡竹叶、石膏之类，可以施用。即使麻黄也应当根据证候而施用，使其容易透发。到了麻疹正收及收没之后，适宜使用寒凉解毒的药剂，如玄参、青黛、麦冬、黄柏、栝蒌根、黄连、黄芩、连翘、贝母、知母、栀子仁、山豆根、淡竹叶等药物，都可以施用，使毒火容易消散，方无后顾之忧。
The therapeutic methods for treating measles are the most extensive. One must thoroughly investigate whether tonification or purgation is indicated. Incorrectly combining clearing, resolving, tonifying, and astringent methods can kill a patient as quickly as flipping one's hand.
When measles first begin to erupt, patients often suffer from incessant diarrhea. In this stage, the pathogenic heat-toxin is reduced through the discharge of stool, which poses no harm. However, if red and yellow stools appear after the measles have fully erupted, it indicates latent heat within the interior. For such cases, as well as those with severe diarrhea, Jiawei Sanling San (Modified Three-Portulaca Powder) should be administered; recovery typically occurs after a single dose. One must absolutely avoid using tonifying and astringent agents containing Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), He Zi (Terminalia Chebulae Fructus), and Dou Kou (Cardamomi Fructus Rotundus) in an attempt to stop the diarrhea rapidly.
If physicians fail to recognize these contraindications and do not study them carefully, upon seeing diarrhea, they immediately employ astringent treatments, justifying themselves by saying, "I am adding small doses of Ren Shen, Bai Zhu, He Zi, and Dou Kou to my clearing and resolving formulas; what harm could that do?" When no effect is seen after one dose, instead of changing the prescription, they might say, "The dosage of Ren Shen, Bai Zhu, He Zi, and Dou Kou was too light, hence the lack of efficacy." Consequently, they increase the dosages of these herbs and administer them again, leading to complicated measles syndromes. Severe cases may result in abdominal distension, wheezing, and chest fullness that are incurable; milder cases may transform into Xiu Xi Li (Resting Dysentery), characterized by chronic, lingering symptoms.
Furthermore, it is not only inappropriate to combine tonifying and astringent herbs when red-yellow stools appear after the measles have fully erupted, but also when yellow-red diarrhea occurs after the measles have subsided. In such instances, Jiawei Sanling San should still be used. Combining tonifying and astringent herbs is inadvisable; using them exclusively would lead to death even more swiftly than flipping a hand. Practitioners of this art must surely exercise caution.
**Jiawei Sanling San (Modified Three-Portulaca Powder):**
Zhu Ling (Polypori Umbellati Sclerotium), Mu Tong (Akebiae Caulis), Che Qian Zi (Plantaginis Semen), Chi Fu Ling (Poria Cocos with Red Mycelium) (each 0.7 fen); Ze Xie (Alismatis Rhizoma) (0.8 fen); Huang Qin (Scutellariae Radix) (prepared with wine); Niu Bang Zi (Arctii Fructus) (stir-fried and crushed) (each 0.5 fen); Huang Lian (Coptidis Rhizoma) (prepared with wine) (0.2 fen). Decoct with Deng Xin Cao (Junci Medullia, 50 cun) as a guide. Take after meals.
Lifting, clearing, and detoxifying constitute the major principles for treating measles. Their application requires strict adherence to sequence. The order has been established over time and cannot be confused.
While lifting, clearing, and detoxifying are appropriate methods for measles, they must be applied in a specific sequence, not mixed indiscriminately. Why? When measles first present with fever, there is a risk that the rash will fail to penetrate the exterior. Therefore, formulas that lift and release the exterior while releasing the muscle layer should be used to facilitate eruption. After the initial signs appear, but before the rash is fully transparent, methods that release the exterior combined with clearing heat should be employed to cool the blood and open the skin pores, allowing the measles to emerge clearly. Once the measles cover the entire body uniformly, appearing as a continuous red mass with beads-like granularity extending equally to the extremities without gaps, this indicates complete eruption. At this stage, clearing heat and detoxifying formulas should be used, without the need for exterior-releasing drugs; resolution follows quickly.
If cold and cooling detoxifying agents are used prematurely during the initial fever or early eruption phase, Qi stagnation and blood coagulation will occur, causing the skin and muscles to become closed and dense, preventing penetration. This leads to failure of eruption and numerous critical conditions. Therefore, during the initial fever before eruption and during the early eruption phase, only acrid-dispersing herbs such as Jing Jie (Schizonepetae Herba), Ge Gen (Puerariae Lobatae Radix), Bo He (Menthae Haplocalycis Herba), Qian Hu (Peucedani Radix), Niu Bang Zi (Arctii Fructus), Fang Feng (Saposhnikoviae Radix), Su Ye (Perillae Folium), Dan Zhu Ye (Lophatheri Herba), and Shi Gao (Gypsum Fibrosum) should be used. Even Ma Huang (Ephedrae Herba) should be used cautiously according to the syndrome to facilitate penetration. During the receding phase and after recesion, cold and cooling detoxifying herbs such as Yuan Shen (Scrophulariae Radix), Qing Dai (Indicum), Mai Dong (Ophiopogonis Tuber), Huang Bo (Phellodendri Cortex), Gua Lou Gen (Trichosanthis Radix), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Lian Qiao (Forsythiae Fructus), Bei Mu (Fritillariae Bulbus), Zhi Mu (Anemarrhenae Rhizoma), Zhi Ren (Gardeniae Semen), Shan Dou Gen (Sophorae Tonkinensis Radix), and Dan Zhu Ye (Lophatheri Herba) should be employed to facilitate the dissipation of heat-toxins, ensuring no future complications.
Mr. Zhu asked: When should exterior-releasing and muscle-releasing formulas be used? When should exterior-releasing and heat-clearing formulas be used? When should heat-clearing and detoxifying formulas be used? The author provides detailed guidance, speaking with earnest care.