沉睡昏睡似寐同。却有分别在其中。更有烦躁不眠者。临症无讹是良工。
沉睡者。谓沉沉熟睡。精神意志清白者、是也。夫麻原属火候。火症得安静沉睡。本为上吉。
然当分首尾而治。正热出现之时。其人精神困倦。沉睡少醒者。则为逆候。何则。盖缘正气亏损。
邪火内郁。而未能发扬于外。乃正气不胜所致。后必变大发烦躁者有之。宜以养阴汤（见三十二
条）去熟地黄、川芎、白芍。加生地黄主之。若正收及收后。能食而安静沉睡者。盖缘气血俱虚。火
毒退去而得安宁。此为顺候。治法、当以补脾养血为要。以四物汤（见二十五条）加薏苡仁、白茯
苓主之。又有一等名曰昏睡。昏睡者。调昏昏而睡。不知起止。虽睡多久。醒来不知人事。掐其颊
车、合谷二穴。而不知痛者。是也。又有一等似寐非寐者。此两症、无问正出收后。见之良非吉兆。
多难治疗。当察其兼见何症而施治之。夫沉睡昏睡两症。虽相仿佛。而实不同。昏沉二字。医家
最当详辨。庶几临症无讹。又有麻疹挟热。作麻不出。烦躁不眠者。法当解毒清凉。以白虎解毒汤
（见二十六条）加连翘、牛蒡子以清解之。热除麻出。而烦躁自宁。可以安寝矣。若收后烦扰。而反
不得寐者。是余火复燃。急须滋阴养血。以六味地黄汤（见七十八条）合四物汤（见二十五条）。加
生枣仁二三钱与服。则阳自敛而得寐矣。
朱曰 麻后烦扰不寐。用六味丸加减。亦是一法。
沉睡与昏睡，表面上看似乎相同，但其中其实存在区别。此外还有烦躁不眠的情况，临证时若能准确辨别，便是高明的医生。
所谓“沉睡”，是指深沉熟睡，且精神意志保持清醒洁白的状态。麻疹原本属于火（热）证范畴，火热之症如果能得到安静沉睡，这本是上等的吉兆。
然而治疗时必须区分发病初期和后期。在正气发热、疹毒外透的时期，如果患者精神困倦，沉睡而很少醒来，这属于逆证（不良征兆）。为什么呢？这是因为正气亏损，邪火郁结在内，无法向外发散，是由于正气不能胜任所致。这种情况后来必然会出现大发烦躁的症状。适宜使用养阴汤（见第三十二条），去掉熟地黄、川芎、白芍，加入生地黄来主治。如果在疹子正收（消退）及收后阶段，患者能进食且安静沉睡，这是因为气血俱虚，火毒退去后得以安宁，这属于顺证（良好征兆）。治疗方法，应当以补脾养血为关键。使用四物汤（见第二十五条）加薏苡仁、白茯苓来主治。
另外有一类病症称为“昏睡”。昏睡，是指头昏沉地睡觉，不知道起止时间。即使睡了很久，醒来后也不知道人事，掐按颊车穴、合谷穴两个穴位，患者却不知道疼痛，这就是昏睡。还有一类称为“似寐非寐”（想睡又没完全睡着，或半梦半醒）的情况。这两种症状，无论出现在出疹期还是收疹后，见到都是很不吉利的征兆，大多难以治疗。应当观察其伴随的其他症状来进行施治。
沉睡和昏睡两种症状，虽然看起来相似，但实际上不同。“昏沉”二字，医生们最应当详细辨别，这样临证时才不会出错。
另外有麻疹夹杂热邪，导致疹子发不出来，出现烦躁不眠的情况，治法应当解毒清凉，使用白虎解毒汤（见第二十六条）加连翘、牛蒡子来清解。热邪去除，疹子发出，烦躁自然平息，就可以安稳入睡了。如果在收疹后仍然烦扰，反而不能入睡，这是余火复燃，急需滋阴养血，使用六味地黄汤（见第七十八条）合四物汤（见第二十五条），加入生枣仁二三钱服用，则阳气自然收敛而能入睡。
Deep sleep (Chen Shui) and lethargic sleep (Hun Shui) appear similar on the surface, yet there are distinctions within them. Furthermore, there is the condition of irritability and insomnia; accurate differentiation during clinical practice marks a skilled physician.
"Deep sleep" refers to a state of profound, sound slumber where the spirit and will remain clear and bright. Measles inherently belongs to the category of fire (heat) syndromes. For heat syndromes, achieving quiet, deep sleep is originally an auspicious sign.
However, treatment must distinguish between the onset and the resolution phases. During the period when the pathogenic heat manifests and the rash erupts, if the patient appears mentally fatigued, sleeping deeply with little awakening, this constitutes a "counter-indication" (Ni Hou - adverse prognosis). Why? This is due to the deficiency of healthy Qi, causing pathogenic fire to be depressed internally without being able to diffuse outward, resulting from the inability of healthy Qi to overcome the pathogen. Such cases may subsequently develop severe irritability. The appropriate prescription is Yang Yin Tang (Nourishing Yin Decoction) [see Article 32], removing Shu Di Huang (Prepared Rehmannia Root), Chuan Xiong (Szechwan Lovage Rhizome), and Bai Shao (White Peony Root), and adding Sheng Di Huang (Raw Rehmannia Root) as the primary treatment. If during the resolution phase or after the rash has subsided, the patient can eat and sleeps quietly, this is because both Qi and Blood are deficient, and the fire toxin has retreated, leading to tranquility. This is a "favorable indication" (Shun Hou - good prognosis). The treatment principle should focus on tonifying the Spleen and nourishing the Blood. Si Wu Tang (Four Substance Decoction) [see Article 25] added with Yi Yi Ren (Coix Seed) and Bai Fu Ling (Poria) should be used.
Additionally, there is a condition termed "lethargic sleep" (Hun Shui). Lethargic sleep involves drowsiness while sleeping, lacking awareness of time passing. Even after long periods of sleep, upon waking, the patient is unaware of their surroundings. Pinching the Jiache (ST6) and Hegu (LI4) acupoints elicits no pain response in the patient; this defines lethargic sleep. There is also a condition described as "semi-sleeping" (Si Mei Fei Mei), where the patient is neither fully asleep nor awake. Both of these conditions, whether appearing during the eruption phase or after resolution, are ominous signs and are often difficult to treat. One must observe accompanying symptoms to determine the treatment strategy.
Although deep sleep and lethargic sleep seem similar, they are fundamentally different. Physicians must carefully differentiate the term "lethargy/obscurity" (Hun Chen) to avoid diagnostic errors in clinical practice.
In cases where measles are complicated by heat, preventing the rash from erupting, accompanied by irritability and insomnia, the treatment method should involve detoxification and cooling. Bai Hu Jie Du Tang (White Tiger Detoxification Decoction) [see Article 26] added with Lian Qiao (Forsythia Fruit) and Niu Bang Zi (Arctium Fruit) should be used for clearing and resolving. Once the heat is eliminated and the rash emerges, the irritability will naturally subside, allowing for peaceful sleep.
If irritability persists after the rash has resolved, leading to insomnia, this indicates the reignition of residual fire. It is urgent to nourish Yin and blood using Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill) [see Article 78] combined with Si Wu Tang (Four Substance Decoction) [see Article 25], adding Sheng Zao Ren (Raw Jujube Seed) in doses of two to three qian. This will allow the Yang to naturally consolidate and enable sleep.
Zhu stated: For post-measles irritability and insomnia, modifying Liu Wei Wan (Six-Ingredient Rehmannia Pill) is also a valid method.