麻遇紫黑内热极。光活润泽生可得。紫赤干晦无起意。纵是仙翁也费力。
麻遇紫色。内热极也。但得光活润泽。粒头尖耸者。可治。宜用清凉解毒之剂。佐以消痰定喘
之药。以凉血饮子去赤芍。加贝母、枳壳、葶苈、连翘、牛蒡子主之。谵语烦躁者。以古方黄连解
毒汤。（见三十五条）调辰砂、滑石末治之。若既出之时。而色紫红。干燥晦暗者。乃毒火炽甚。急
以生地芩连汤去白芍、防风、粉葛。加枳壳。紫草、连翘。或凉血地黄汤去甘草。加木通、枳壳、紫
草、连翘、牛蒡子、黄芩、黄柏解之。或以四物汤（见二十五条）加酒炒红花、紫草、地骨皮、黄芩、
连翘、牛蒡子、黄连、粉葛之类。以滋阴凉血。而内热自除。所谓养阴退阳之义也。若麻收之时。身
上麻形肌肤带紫色或青色者。此内毒实热之候。以大连翘饮（见三十五条）去柴胡、赤芍、甘草。
加地骨皮、枳实、黄连、牛蒡子。以利二便。使实热从二便而泄。如热极甚者。再加大黄以治之。
又有一等。见暖则红活。不暖则焦枯。此为风寒所闭。治法虽应凉解。而不可太过。以暖为是。宜
用养阴汤（见三十二条）。用生地黄。去白芍、川芎。加防风、荆芥以治之。若麻紫而不光润。颜色
枯燥而不起者。则难为矣。
凉血饮子
生地黄（一钱五分） 黄连（五分） 黄芩 荆芥 元参（各一钱） 红花（三分） 丹
皮赤芍（各八分） 木通（七分） 水煎温服。
生地芩连汤
生地黄 黄连 黄芩 连翘 红花 防风 粉葛 栀仁 元参 木通 石膏 当归 牡
丹皮 白芍药 灯心引。如大便三四日不通。合河间凉膈散利之（见二十六条）。
凉血地黄汤
生地黄 当归尾 黄连 栀仁 元参 甘草 水煎服。
麻疹若呈现紫黑色，说明体内热毒极盛。如果疹点光亮、鲜活、润泽且颗粒尖耸，尚有生机，可以治愈。若疹色紫赤、干枯晦暗且无起发之意，即使神仙在世也难以救治。
麻疹出现紫色，是内热极盛的表现。只要疹点光亮、鲜活、润泽，且颗粒尖耸，即可治疗。适宜使用具有清凉解毒功效的方剂，并辅以消痰定喘的药物。具体可用凉血饮子（Cooling Blood Decoction）去掉赤芍，加入贝母、枳壳、葶苈子、连翘、牛蒡子来主治。若患者出现谵语（胡言乱语）、烦躁不安的症状，则使用古方黄连解毒汤（见第三十五条），配合辰砂、滑石粉末调服以治疗。
如果在出疹期间，疹色呈紫红色，且干燥晦暗，这是毒火极其炽盛的表现。应立即使用生地芩连汤去掉白芍、防风、粉葛，加入枳壳、紫草、连翘；或者使用凉血地黄汤去掉甘草，加入木通、枳壳、紫草、连翘、牛蒡子、黄芩、黄柏来解清热毒。也可以使用四物汤（见第二十五条）加入酒炒红花、紫草、地骨皮、黄芩、连翘、牛蒡子、黄连、粉葛等药物，以滋养阴液、凉血，从而使内热自然消除。这就是“养阴退阳”的道理。
若在收疹阶段，身上疹形消退后，肌肤仍带紫色或青色，这是内毒实热的征候。可使用大连翘饮（见第三十五条）去掉柴胡、赤芍、甘草，加入地骨皮、枳实、黄连、牛蒡子，以通利大小便，使实热从二便排出。如果热势极盛严重，可再加加大黄来治疗。
还有一种情况，疹子遇暖则红活，不暖则焦枯，这是被风寒邪气闭塞所致。治疗方法虽然应当清凉解表，但不可过于寒凉，以温和为宜。适宜使用养阴汤（见第三十二条），用生地黄为主药，去掉白芍、川芎，加入防风、荆芥来治疗。如果疹色紫暗且不光泽润滑，颜色枯燥且不起发，那就难以救治了。
【凉血饮子】
生地黄（一钱五分）、黄连（五分）、黄芩、荆芥、元参（各一钱）、红花（三分）、丹皮、赤芍（各八分）、木通（七分）。水煎，温服。
【生地芩连汤】
生地黄、黄连、黄芩、连翘、红花、防风、粉葛、栀仁、元参、木通、石膏、当归、牡丹皮、白芍药。以灯心草为引。如果大便三四日不通畅，可合用河间凉膈散（见第二十六条）以通利之。
If the measles rash appears purple or black, it indicates extreme internal heat. If the spots are bright, vibrant, moist, and pointed, there is still a chance of survival, and the condition is treatable. If the rash is purple-red, dry, dull, and lacks the tendency to erupt, even an immortal would find it difficult to save the patient.
When the measles present with a purple color, it signifies extreme internal heat. As long as the spots are bright, vibrant, moist, and pointed, treatment is feasible. It is appropriate to use formulas that clear heat and detoxify, assisted by herbs that resolve phlegm and calm wheezing. Specifically, Liangxue Yinzi (Cooling Blood Decoction) should be used without Chi Shao (Radix Paeoniae Rubra), adding Bei Mu (Bulbus Fritillariae Cirrhosae), Zhi Ke (Fructus Aurantii), Ting Li Zi (Semen Lepidii seu Descurainiae), Lian Qiao (Fructus Forsythiae), and Niu Bang Zi (Fructus Arctii). For patients presenting with delirium and irritability, Gu Fang Huanglian Jiedu Tang (Ancient Formula: Coptis Decoction for Resolving Toxicity; see Article 35) should be administered, mixed with powder of Chen Sha (Cinnabar) and Hua Shi (Talcum).
If during the eruption phase the rash is purple-red, dry, and dull, this indicates extremely blazing toxic fire. One should urgently administer Shengdi Qinlian Tang (Rehmannia, Scutellaria, and Coptis Decoction) without Bai Shao (Radix Paeoniae Alba), Fang Feng (Radix Saposhnikoviae), and Fen Ge (Rhizoma Bupleuri), adding Zhi Ke, Zi Cao (Radix Arnebiae seu Lithospermi), and Lian Qiao. Alternatively, Liangxue Dihuang Tang (Cooling Blood and Rehmannia Decoction) can be used without Gan Cao (Radix Glycyrrhizae), adding Mu Tong (Caulis Akebiae), Zhi Ke, Zi Cao, Lian Qiao, Niu Bang Zi, Huang Qin (Radix Scutellariae), and Huang Bo (Cortex Phellodendri) to resolve the toxicity. Another option is Siwu Tang (Four Substances Decoction; see Article 25) modified with Jiu Chao Honghua (Alcohol-fried Safflower), Zi Cao, Digupi (Cortex Lycii), Huang Qin, Lian Qiao, Niu Bang Zi, Huang Lian (Rhizoma Coptidis), and Fen Ge, to nourish yin and cool blood, thereby eliminating internal heat naturally. This embodies the principle of "nourishing yin to retreat yang."
If at the resolution stage of the measles, the skin retains a purple or bluish hue after the rash subsides, this is a sign of excess internal heat from toxins. Dalianqiao Yin (Great Forsythia Decoction; see Article 35) should be used without Chai Hu (Radix Bupleuri), Chi Shao, and Gan Cao, adding Digupi, Zhi Shi (Fructus Aurantii Immaturus), Huang Lian, and Niu Bang Zi to promote urination and defecation, allowing the excess heat to drain through the bowels and urine. If the heat is extremely severe, Da Huang (Radix et Rhizoma Rhei) may be added.
There is another pattern where the rash appears red and vibrant when warm, but scorched and withered when cold. This is caused by closure due to wind-cold pathogens. Although the treatment method should involve clearing heat and resolving the exterior, it must not be overly cold; warmth is preferred. Yangyin Tang (Nourishing Yin Decoction; see Article 32) should be used, primarily with Sheng Di Huang (Radix Rehmanniae Recens), without Bai Shao and Chuan Xiong (Rhizoma Chuanxiong), adding Fang Feng and Jing Jie (Herba Schizonepetae). If the rash is purple, lacking luster and moisture, appearing dry and dull without erupting, it is difficult to treat.
[Liangxue Yinzi]
Sheng Di Huang (1.5 qian), Huang Lian (0.5 qian), Huang Qin, Jing Jie, Yuan Shen (each 1 qian), Hong Hua (0.3 qian), Dan Pi, Chi Shao (each 0.8 qian), Mu Tong (0.7 qian). Decoct in water and take warm.
[Shengdi Qinlian Tang]
Sheng Di Huang, Huang Lian, Huang Qin, Lian Qiao, Hong Hua, Fang Feng, Fen Ge, Zhi Ren, Yuan Shen, Mu Tong, Shi Gao (Gypsum Fibrosum), Dang Gui (Radix Angelicae Sinensis), Mu Dan Pi, Bai Shao Yao (Radix Paeoniae Alba). Use Deng Xin Cao (Medulla Junci) as a guide. If stool has not passed for three to four days, combine with Hejian Liangge San (Cooling Chest Powder from Liu Wansu's School; see Article 26) to promote purgation.
[Liangxue Dihuang Tang]
Sheng Di Huang, Dang Gui Wei (Tail of Radix Angelicae Sinensis), Huang Lian, Zhi Ren, Yuan Shen, Gan Cao. Decoct in water and take.