喉中 痰 。毒火不得发越者。未出正出十全一。正收收后难为也。
麻属肺胃。如喉中有痰 而鸣者。其症属痰火之候。此因毒火内结之极。邪热阻逆。不得
发越所致也。若见于未出正出之间。治当清肺降火消痰为主。十中可救一二。以除热清肺汤（见
五十条）去赤芍、甘草主之。若见于正收及收后者。必邪热未透。毒火传里。或露风早收。余热内
攻。而肺气受伤也。实为难治。此症宜防之未得之先。
朱曰 此证余热内攻。肺气受伤。十救一二。医者病者。当预先防之。
咳嗽咽伤声喑哑。非与痘疮同例也。此乃麻疹之常候。认作危症是愚者。
麻本属火。喑哑乃麻之常候。多吉无凶。不可以痘疮喑哑比例。盖因肺胃热邪。为风寒所袭。
不能尽达于表。咳甚咽伤。故喑哑也。治宜清肺降火消痰为主。以清咽滋肺汤（见五十条）除去玉
竹、桔梗、甘草。加黄芩、木通主之。若肺热咳嗽声哑者。以万氏清肺饮去菖蒲、诃子仁、桔梗。加
黄芩、贝母主之。若声喑而咽痛者。以射干消毒饮去甘草。加黄芩、山豆根主之。如麻后声音不
清。咳嗽不思饮食。眼目不清。唇口干燥者。以清肺消毒化痰汤（见五十条）去桔梗、甘草。加麦
冬、黄连、天花粉主之。如心虚声音不扬者。以导赤通气汤除去甘草、人参。加沙参主之。如系肺
热。声音不清响者。以甘草清金散主之。兼有咳者。以清金降火汤主之。或以验方治之。
朱曰 音哑声嘶。证颇骇人。读此诗始释然。
射干消毒饮
射干 元参 连翘 荆芥 牛蒡子 甘草 水煎温服。
万氏清肺饮
麦冬 荆芥穗 天花粉 知母 桔梗（各一钱） 石菖蒲 诃子仁（各八分） 水煎服。
导赤通气汤
木通 生地黄 麦冬 当归身 石菖蒲 人参 甘草 灯心引。
甘桔清金散 麻后肺热。声音不清有用之。而喑甚者宜删。
桔梗（一两） 甘草 连翘 诃子皮（各五分） 牛蒡子（七钱） 为末。每用一钱。加薄荷叶少许。水煎服。
清金降火汤 治麻后肺热。声哑咳嗽。
当归 白芍药（酒炒） 生地黄（酒洗） 栝蒌仁 白茯苓 陈皮 贝母（去心姜汁蒸）
桑白皮（蜜炒） 麦冬 黄芩（酒炒） 杏仁（去皮尖） 黄连（酒炒） 栀仁（炒） 元参
苏梗 石膏 天冬 甘草 姜三片引。水煎服。
治麻后咳嗽失音验方
牛蒡子 黄芩 天花粉 薄荷叶 桔梗 甘草 水煎服。
咽喉中有痰鸣声。若因毒火郁结无法向外发散者，在麻疹未出或刚出的阶段，十人中可救一二；若在收没之后出现此症，则难以治疗。
麻毒主要归属于肺胃二经。如果咽喉中有痰鸣声，其病症属于痰火证候。这是因为毒火内结至极，邪热阻滞逆乱，导致无法向外发散所致。如果此症出现在未出或正出的阶段，治疗应当以清肺、降火、消痰为主，十人中可救一二，使用除热清肺汤（见第五十条），去掉赤芍、甘草，作为主方服用。如果此症出现在正收及收没之后，必定是邪热未能透发，毒火传入体内，或者是过早受风导致疹子提前收没，余热向内攻冲，从而损伤肺气。这种情况确实难以治疗。因此，应当在患病之前做好预防。
朱氏说：此证为余热向内攻冲，肺气受损，十人中仅能救一二。医生和患者都应当预先加以防范。
咳嗽、咽喉受伤导致声音喑哑，不能与痘疮的情况混为一谈。这是麻疹的常见症状，将其误认为危重病症是愚者的表现。
麻毒本属火性，声音喑哑往往是麻疹过程中的常见现象，大多吉利而无凶险，不可以与痘疮引起的喑哑相提并论。大概是因为肺胃的热邪，被风寒所侵袭，不能完全达于体表，咳嗽剧烈导致咽喉受伤，所以出现声音喑哑。治疗适宜以清肺、降火、消痰为主。使用清咽滋肺汤（见第五十条），去掉玉竹、桔梗、甘草，加入黄芩、木通作为主方。如果是肺热咳嗽导致声音嘶哑的，使用万氏清肺饮，去掉石菖蒲、诃子仁、桔梗，加入黄芩、贝母作为主方。如果是声音喑哑且伴有咽喉疼痛的，使用射干消毒饮，去掉甘草，加入黄芩、山豆根作为主方。如麻疹后声音不清，伴有咳嗽、不思饮食、眼睛视物不清、嘴唇口腔干燥的，使用清肺消毒化痰汤（见第五十条），去掉桔梗、甘草，加入麦冬、黄连、天花粉作为主方。如果是心气虚弱导致声音不扬亮的，使用导赤通气汤，去掉甘草、人参，加入沙参作为主方。如果是由于肺热导致声音不清响亮的，使用甘草清金散作为主方。兼有咳嗽的，使用清金降火汤作为主方。或者使用经验方进行治疗。
朱氏说：音哑声嘶的症状看起来很吓人，读了这首诗才释然。
射干消毒饮
组成：射干、元参、连翘、荆芥、牛蒡子、甘草。用法：水煎，温服。
万氏清肺饮
组成：麦冬、荆芥穗、天花粉、知母、桔梗（各一钱）、石菖蒲、诃子仁（各八分）。用法：水煎服。
导赤通气汤
组成：木通、生地黄、麦冬、当归身、石菖蒲、人参、甘草。用法：以灯心草为引，水煎服。
甘桔清金散 适用于麻疹后肺热导致的声音不清，但声音喑哑严重者应删去此方。
组成：桔梗（一两）、甘草、连翘、诃子皮（各五分）、牛蒡子（七钱）。用法：研为细末。每次取一钱，加少许薄荷叶，水煎服。
清金降火汤 治疗麻疹后肺热导致的声哑咳嗽。
组成：当归、白芍药（酒炒）、生地黄（酒洗）、栝蒌仁、白茯苓、陈皮、贝母（去心，姜汁蒸）、桑白皮（蜜炒）、麦冬、黄芩（酒炒）、杏仁（去皮尖）、黄连（酒炒）、栀仁（炒）、元参、苏梗、石膏、天冬、甘草。用法：加生姜三片为引，水煎服。
In the throat, there is phlegm and rattling. If toxic heat cannot be vented outward, among those in the pre-eruption or initial eruption stage, one or two out of ten may be saved; however, if this occurs after the resolution phase, it is difficult to treat.
The pathogen of measles primarily belongs to the Lung and Stomach meridians. If there is phlegm rattling in the throat, the syndrome belongs to Phlegm-Fire. This is caused by extreme internal accumulation of toxic heat, where pathogenic heat causes obstruction and rebellion, preventing venting outward. If this symptom appears between the pre-eruption and initial eruption stages, treatment should focus on clearing the Lungs, descending Fire, and resolving Phlegm. One or two out of ten may be saved. The main prescription is Chu Re Qing Fei Tang (Heat-Removing Lung-Clearing Decoction) (see Article 50), with Chi Shao (Red Peony Root) and Gan Cao (Licorice Root) removed. If this symptom appears during the resolution phase or after resolution, it indicates that pathogenic heat has not been fully exfoliated, toxic heat has transmitted inward, or early exposure to wind caused premature resolution, allowing residual heat to attack internally and damage Lung Qi. This condition is indeed difficult to treat. Therefore, prevention should be undertaken before the disease occurs.
Zhu stated: This syndrome involves residual heat attacking internally and damaging Lung Qi; only one or two out of ten can be saved. Both physicians and patients should take preventive measures in advance.
Cough and throat injury leading to hoarseness are not analogous to cases of smallpox. This is a common manifestation of measles; mistaking it for a critical condition is foolish.
Measles pathogen inherently belongs to Fire. Hoarseness is often a common occurrence in measles, generally auspicious rather than ominous, and should not be compared to hoarseness caused by smallpox. This is likely because Heat pathogens in the Lung and Stomach were attacked by Wind-Cold, preventing them from fully reaching the exterior. Severe coughing injures the throat, resulting in hoarseness. Treatment should prioritize clearing the Lungs, descending Fire, and resolving Phlegm. Use Qing Yan Zi Fei Tang (Throat-Clearing Lung-Nourishing Decoction) (see Article 50), removing Yu Zhu (Polygonatum Rhizome), Jie Geng (Platycodon Root), and Gan Cao (Licorice Root), and adding Huang Qin (Scutellaria Root) and Mu Tong (Akebia Caulis) as the main prescription. For cough with hoarseness due to Lung Heat, use Wan Shi Qing Fei Yin (Wan’s Lung-Clearing Infusion), removing Shi Chang Pu (Acorus Rhizome), He Zi Ren (Chebula Seed), and Jie Geng (Platycodon Root), and adding Huang Qin (Scutellaria Root) and Bei Mu (Fritillaria Bulb) as the main prescription. For hoarseness accompanied by sore throat, use She Gan Xiao Du Yin (Belamcanda Detoxifying Infusion), removing Gan Cao (Licorice Root), and adding Huang Qin (Scutellaria Root) and Shan Dou Gen (Sophora Tonkinensis Root) as the main prescription. If after measles there is unclear voice, cough, loss of appetite, blurred vision, and dry lips and mouth, use Qing Fei Xiao Du Hua Tan Tang (Lung-Clearing Detoxifying and Phlegm-Resolving Decoction) (see Article 50), removing Jie Geng (Platycodon Root) and Gan Cao (Licorice Root), and adding Mai Dong (Ophiopogon Tuber), Huang Lian (Coptis Rhizome), and Tian Hua Fen (Trichosanthes Root) as the main prescription. If Heart deficiency leads to weak voice, use Dao Chi Tong Qi Tang (Guiding Outward Water and Unblocking Qi Decoction), removing Gan Cao (Licorice Root) and Ren Shen (Ginseng Root), and adding Sha Shen (Glehnia Root) as the main prescription. If Lung Heat causes unclear voice resonance, use Gan Cao Qing Jin San (Licorice Metal-Clearing Powder) as the main prescription. If accompanied by cough, use Qing Jin Jiang Huo Tang (Metal-Clearing Fire-Descending Decoction) as the main prescription. Alternatively, use empirical formulas for treatment.
Zhu stated: Hoarseness and raspy voice appear alarming, but reading this poem brings relief.
She Gan Xiao Du Yin (Belamcanda Detoxifying Infusion)
Ingredients: She Gan (Belamcanda Rhizome), Yuan Shen (Scrophularia Root), Lian Qiao (Forsythia Fruit), Jing Jie (Schizonepeta Spike), Niu Bang Zi (Arctium Seed), Gan Cao (Licorice Root). Preparation: Decoct in water and take warm.
Wan Shi Qing Fei Yin (Wan’s Lung-Clearing Infusion)
Ingredients: Mai Dong (Ophiopogon Tuber), Jing Jie Sui (Schizonepeta Spike Tip), Tian Hua Fen (Trichosanthes Root), Zhi Mu (Anemarrhena Rhizome), Jie Geng (Platycodon Root) (1 qian each), Shi Chang Pu (Acorus Rhizome), He Zi Ren (Chebula Seed) (0.8 fen each). Preparation: Decoct in water and take.
Dao Chi Tong Qi Tang (Guiding Outward Water and Unblocking Qi Decoction)
Ingredients: Mu Tong (Akebia Caulis), Sheng Di Huang (Rehmannia Root), Mai Dong (Ophiopogon Tuber), Dang Gui Shen (Angelica Sinensis Root Body), Shi Chang Pu (Acorus Rhizome), Ren Shen (Ginseng Root), Gan Cao (Licorice Root). Preparation: Use Deng Xin Cao (Juncus Effusus Pith) as an guide, decoct in water and take.
Gan Jie Qing Jin San (Licorice and Platycodon Metal-Clearing Powder)
Indication: Used for unclear voice due to Lung Heat after measles; remove for severe hoarseness.
Ingredients: Jie Geng (Platycodon Root) (1 liang), Gan Cao (Licorice Root), Lian Qiao (Forsythia Fruit), Ke Zi Pi (Chebula Pericarp) (5 fen each), Niu Bang Zi (Arctium Seed) (7 qian). Preparation: Grind into powder. Take 1 qian per dose, add a little Bo He Ye (Mint Leaf), decoct in water and take.
Qing Jin Jiang Huo Tang (Metal-Clearing Fire-Descending Decoction)
Indication: Treats hoarseness and cough due to Lung Heat after measles.
Ingredients: Dang Gui (Angelica Sinensis Root), Bai Shao Yao (White Peony Root) (stir-fried with wine), Sheng Di Huang (Rehmannia Root) (washed with wine), Gua Lou Ren (Trichosanthes Seed), Bai Fu Ling (Poria), Chen Pi (Tangerine Peel), Bei Mu (Fritillaria Bulb) (core removed, steamed with ginger juice), Sang Bai Pi (Mulberry Root Bark) (honey-fried), Mai Dong (Ophiopogon Tuber), Huang Qin (Scutellaria Root) (stir-fried with wine), Xing Ren (Apricot Seed) (skin and tip removed), Huang Lian (Coptis Rhizome) (stir-fried with wine), Zhi Ren (Gardenia Seed) (fried), Yuan Shen (Scrophularia Root), Su Geng (Perilla Stem), Shi Gao (Gypsum Fibrosum), Tian Dong (Asparagus Tuber), Gan Cao (Licorice Root). Preparation: Add three slices of Sheng Jiang (Fresh Ginger) as a guide, decoct in water and take.
Empirical Formula for Cough and Aphonia After Measles
Ingredients: Niu Bang Zi (Arctium Seed), Huang Qin (Scutellaria Root), Tian Hua Fen (Trichosanthes Root), Bo He Ye (Mint Leaf), Jie Geng (Platycodon Root), Gan Cao (Licorice Root). Preparation: Decoct in water and take.