麻毒流连热不除。浑身似火毛发枯。 羸渐渐成疳瘵。得遇良工病可苏。
麻疹收后。身有微热者。此虚热也。不须施治。待气血和畅。自然退去。若麻疹既收。其毒不
解。邪火拂郁。浑身发热。昼夜不退。精神倦怠。饮食减少。或咳嗽不止。或便泄不已。或身热不
除。形体羸瘦。毛发枯竖。皆真元虚损所致。若不及时调理。恐成疳瘵之患。倘不早治。以致睡则
扬睛。口鼻气冷。手足厥逆。微微螈 。变为慢风。不救者多矣。并宜以双和汤去川芎以和之。有
嗽。加橘红、贝母。咳。加麦冬、百合。有泻。加土炒白术与炒扁豆。如食难消化。加砂仁、麦芽。
如气血俱虚。以双和汤合四君子汤（见七十二条）。随症调治之。切禁用寒凉伤犯脾胃之药。专力
资培。缓图平复可也。愚按、虚羸之候。虽系真元虚损。故不宜用寒凉伤犯脾胃之药。亦不宜骤用
大补之剂。但当清其余热。滋其阴血。和其脾胃。平其肝气。杀其疳虫。使营卫和畅。脾胃健运。自
然日渐平复。神全体肥。若以双和散而治虚羸。竟用 、桂。是犹抱薪救火。非惟无益。而又害
之矣。曷若以柴胡四物汤（见三十条）去川芎加薏苡仁。与清热除疳丸去川芎加薏苡仁。相间
而服。实为妥当。若麻后元气不复而羸瘦。身无潮热者。乃脾胃虚弱所致。调理脾胃。平其肝木。
必渐渐康强。以白芍汤主之。或以八珍汤去白术、人参。加芡实米、薏苡仁治之。慎勿轻用人参、
白术。恐闭其余邪。致难清理。如麻收之后。失于调理。以致体瘦气弱。且又泄泻。将成疳积者。宜
以奇效神应肥儿丸。或健脾肥儿丸治之。如麻后眼青体弱。精神不如平日。又有咳嗽气急者。以
苏子四君汤加姜汁炒芥子、光杏仁治之。气急甚者。加箩卜子、栝蒌仁治之。若热大甚。或日久不
减。而渐羸瘦者。总宜清热平肝。以柴胡麦门冬散（见三十条）加酒炒黄连、黄芩、骨皮治之。甚则
以古方黄连解毒汤（见三十五条）合人参白虎汤。（见六十四条）与柴胡麦门冬散（见三十条）。相
间而服以治之。
朱曰 清余热、滋阴血、和脾胃、平肝气、杀虫疳。凡此数法。真治小儿麻后虚羸之圣法。
清热除疳丸
黄连 当归（各二钱） 龙胆草 川芎（各一钱） 青皮 陈皮 芦荟（ ） 干蟾头（又名蛤
、即虾蟆、火炙酒淬。） 君子肉（面粉包煨、去壳并黑皮、各钱半。） 为末。神曲糊合丸。米饮下。
白芍汤
白芍药 炙甘草（此二味为君） 莲肉 山药 扁豆 龙眼肉 青黛 麦冬（此六味为臣） 合三四剂。水煎服。
八珍汤
当归 川芎 熟地黄 白芍药 人参 白茯苓 白术 甘草 姜、枣引。
奇效神应肥儿丸 治肌瘦面黄。或面青而白。泄泻少食。肚腹胀大。青筋满腹。或伤饮食。常有吐
泻。尿如米泔。及一切疳症。
人参（三钱、如力微者、用一两、或以乳汁蒸北直参一两代之） 大川黄连（酒炒二钱） 臭芫荑
（炒擦去皮取净者五钱） 君子肉（面粉包煨、去壳、并去内黑皮、四十五粒。） 夜明砂（淘去土砂、
取净砂醋炒干一两。） 漂白术（陈壁土炒五钱、不宜白术者、以薏苡仁炒代之。） 吴神曲（炒五钱）
生麦芽（炒五钱） 天浆子（即五谷虫肉、汤浸洗净炒一两。） 淮山药（炒三钱） 小青皮（醋炒三钱） 胡黄
连（酒炒三钱）
山楂肉（去子汤洗三钱） 干蛤蟆（火炙醋淬极焦三只） 花槟榔（三钱） 等合研为细末。每早空心。
以米饮调下二三钱。
健脾肥儿丸
人参 陈皮 甘草（各五钱） 黄 （蜜炙） 扁豆（炒） 山药（炒） 白术（泔水洗漂土炒）
白苓（炒各一两） 神曲（炒） 楂肉（去子各二两） 百合 当归（去尾各八分） 黄连（酒炒三钱）
白芍（酒炒） 地骨皮（去骨酒洗各六钱） 陈皮（去白五钱） 为末。蜜丸。弹子大。老米为饮。化
下一丸。
双和汤
熟地黄 白芍（酒炒各一钱） 黄 （蜜和酒炒） 当归（各七分） 川芎 炙甘草（各四分）
上肉桂（三分、有热者去之） 生姜一片。红枣一枚去核为引。水煎服。
麻疹毒邪滞留，热势不退。全身发热如火，毛发干枯。
身体逐渐消瘦，演变为疳积、痨瘵（慢性消耗性疾病）。若能遇到良医诊治，病情尚可恢复。
麻疹消退后，若身体有轻微发热，这是虚热，不需要进行治疗。待气血调和通畅，热度自然会退去。如果麻疹已经消退，但毒邪未解，邪火拂郁（郁结），导致全身发热，昼夜不退，精神疲倦懈怠，饮食减少，或者咳嗽不止，或者腹泻不停，或者身热不退，形体消瘦，毛发干枯竖立，这些都是真元（人体正气根本）虚损所致。如果不及时调理，恐怕会形成疳积、痨瘵的祸患。倘若不早治疗，以致睡眠时眼睛上翻（扬睛），口鼻气息寒冷，手足冰冷厥逆，出现轻微的抽搐（螈），转变为慢惊风（小儿慢性惊风），大多无法救治。这些情况都适宜用双和汤去掉川芎来调和。如果有咳嗽，加入橘红、贝母；如果是咳喘，加入麦冬、百合；如果有腹泻，加入土炒白术和炒扁豆。如果食物难以消化，加入砂仁、麦芽。如果气血都虚弱，用双和汤合四君子汤（见七十二条），随症状调治。切记禁用寒凉药物损伤脾胃之气，应专力培补元气，缓慢图谋恢复健康。
我按语认为：虚羸（虚弱消瘦）的症状，虽然属于真元虚损，所以不宜使用寒凉药物损伤脾胃，也不宜突然使用大补的药剂。只应当清除残余的热邪，滋养阴血，调和脾胃，平抑肝气，杀灭疳虫，使营卫之气调和通畅，脾胃健运，自然日渐恢复，神气充足，身体肥胖健壮。如果用双和散来治疗虚羸，竟然使用附子、肉桂等大热之药，这就像抱着柴草去救火，不仅没有益处，反而有害。不如用柴胡四物汤（见三十条）去掉川芎加薏苡仁，与清热除疳丸去掉川芎加薏苡仁，交替服用，实在妥当。
如果麻疹后元气不复而身体消瘦，身上没有潮热的，这是脾胃虚弱所致。调理脾胃，平抑肝木，必定渐渐康复强壮。以白芍汤为主方。或者用八珍汤去掉白术、人参，加芡实米、薏苡仁治疗。千万不要轻易用人参、白术，恐怕闭塞残余的邪气，导致难以清理。如果麻疹消退后，失于调理，以致身体瘦弱气短，并且又有腹泻，将要形成疳积的，适宜用奇效神应肥儿丸，或健脾肥儿丸治疗。如果麻疹后眼睛发青，身体虚弱，精神不如平日，又有咳嗽气急的，用苏子四君汤加姜汁炒芥子、光杏仁治疗。气急严重的，加萝卜子、瓜蒌仁治疗。如果热势非常大，或者日久不减，而渐渐消瘦的，总宜清热平肝，用柴胡麦门冬散（见三十条）加酒炒黄连、黄芩、地骨皮治疗。严重的，用古方黄连解毒汤（见三十五条）合人参白虎汤（见六十四条），与柴胡麦门冬散（见三十条），交替服用以治疗。
朱氏说：清余热、滋阴血、和脾胃、平肝气、杀虫疳。凡是这几法，真是治疗小儿麻疹后虚羸的圣明之法。
【方剂】
清热除疳丸
黄连、当归（各二钱），龙胆草、川芎（各一钱），青皮、陈皮、芦荟（适量），干蟾头（又名蛤蟆，即青蛙/蟾蜍，用火烤酒后淬制），君子肉（面粉包裹煨熟，去壳并去掉黑皮，各一钱半）。研为细末，用神曲糊制作成丸，米饮送服。
白芍汤
白芍药、炙甘草（这两味作为君药），莲肉、山药、扁豆、龙眼肉、青黛、麦冬（这六味作为臣药）。合三四剂，水煎服。
八珍汤
当归、川芎、熟地黄、白芍药、人参、白茯苓、白术、甘草，生姜、大枣为引。
奇效神应肥儿丸 治疗肌肉消瘦面色发黄，或者面色青白，腹泻少食，肚腹胀大，腹部青筋暴露，或者伤食，常有呕吐腹泻，尿如米泔水，以及一切疳症。
人参（三钱，如果力气微弱者，用一两，或者用乳汁蒸过的北直参一两代替），大川黄连（酒炒二钱），臭芜荑（炒擦去皮取净的五钱），君子肉（面粉包裹煨熟，去壳，并去掉内部黑皮，四十五粒），夜明砂（淘去土砂，取净砂醋炒干一两），漂白术（陈壁土炒五钱，不宜用白术者，以薏苡仁炒代替），吴神曲（炒五钱），生麦芽（炒五钱），天浆子（即五谷虫肉，热水浸洗净炒一两），淮山药（炒三钱），小青皮（醋炒三钱），胡黄连（酒炒三钱），山楂肉（去子热水洗三钱），干蛤蟆（火烤醋淬极焦三只），花槟榔（三钱）。等一起研为细末。每天早晨空腹，用米饮调下二三钱。
健脾肥儿丸
人参、陈皮、甘草（各五钱），黄芪（蜜炙），扁豆（炒），山药（炒），白术（泔水洗漂土炒），白茯苓（炒各一两），神曲（炒），楂肉（去子各二两），百合、当归（去尾各八分），黄连（酒炒三钱），白芍（酒炒），地骨皮（去骨酒洗各六钱），陈皮（去白五钱）。研为细末，蜜丸，弹子大小。老米汤送服，化开一丸。
双和汤
熟地黄、白芍（酒炒各一钱），黄芪（蜜和酒炒），当归（各七分），川芎、炙甘草（各四分），上肉桂（三分，有热者去掉），生姜一片，红枣一枚去核为引。水煎服。
The measles toxin lingers, and the heat is not eliminated. The whole body feels like fire, and hair becomes dry and withered.
Emaciation gradually develops into *gan* (malnutrition syndrome) and *zhai* (chronic consumption disease). If treated by a skilled physician, the illness can be revived.
After the measles rash subsides, if there is slight fever in the body, this is deficiency heat. No treatment is required. Wait for the Qi and Blood to harmonize and flow freely; the heat will naturally subside. However, if the measles rash has subsided but the toxin remains unresolved, with evil fire stagnating and郁结 (stagnant), causing whole-body fever that does not cease day or night, accompanied by mental fatigue and lassitude, reduced appetite, persistent cough, or unceasing diarrhea, or lingering fever, emaciated physique, and dry, upright hair, all these are caused by damage to the True Yuan (fundamental vital energy). If not regulated in time, it may lead to complications of *gan* and *zhai*. If not treated early, it may result in eyes rolling upward during sleep, cold breath from mouth and nose, cold and inverted extremities, and mild convulsions (*rong*), transforming into slow wind (chronic infantile convulsion), which are mostly incurable. In such cases, it is appropriate to use Shuanghe Tang (Double Harmony Decoction) with Chuanxiong removed to harmonize. If there is cough, add Juhong (Tangerine Peel) and Beimu (Fritillaria Bulb); if there is wheezing/cough, add Maidong (Ophiopogon Tuber) and Baihe (Lily Bulb); if there is diarrhea, add earth-fried Baizhu (Atractylodes Rhizome) and fried BianDou (Lablab Bean). If food is difficult to digest, add Shenren (Amomum Fruit) and Maiya (Malt). If both Qi and Blood are deficient, combine Shuanghe Tang with Sijunzi Tang (Four Gentlemen Decoction) [see Article 72] and treat according to symptoms. Strictly prohibit the use of cold and cool medicines that injure the Spleen and Stomach; focus solely on nourishing and supporting, and slowly plan for recovery.
My commentary: The condition of Xu Lei (weakness and emaciation), although stemming from True Yuan deficiency, should not be treated with cold and cool medicines that injure the Spleen and Stomach, nor should large-tonifying agents be used abruptly. One should only clear residual heat, nourish Yin and Blood, harmonize the Spleen and Stomach, calm Liver Qi, eliminate *gan* parasites, so that Ying (Nutritive) and Wei (Defensive) Qi flow smoothly, and the Spleen and Stomach function vigorously. Naturally, health will return day by day, with spirit restored and body becoming robust. If treating Xu Lei with Shuanghe San (Double Harmony Powder) by actually using Fuzi (Aconite Root) and Rougui (Cinnamon Bark), it is like carrying firewood to save a fire; not only is it useless, but it is also harmful. It would be better to use Chaihu Siwu Tang (Bupleurum Four Substances Decoction) [see Article 30] with Chuanxiong removed and Yiyiren (Coix Seed) added, alternating with Qingre Chengan Wan (Heat-Clearing and Parasite-Removing Pill) with Chuanxiong removed and Yiyiren added. This is truly appropriate.
If after measles, Yuan Qi fails to recover leading to emaciation, without tidal fever, this is caused by Spleen and Stomach weakness. Regulate the Spleen and Stomach and calm Liver Wood; recovery will gradually occur. Use Baishao Tang (White Peony Decoction) as the main formula. Alternatively, use Bazhen Tang (Eight Treasures Decoction) removing Baizhu and Renshen, adding Qianshi (Euryale Seed) and Yiyiren (Coix Seed) for treatment. Do not lightly use Renshen (Ginseng) and Baizhu, lest they close off residual pathogens, making them difficult to clear. If after measles subsides, neglect in regulation leads to thinness, weak Qi, and diarrhea, approaching *gan* accumulation, use Qixiao Shenyin Fei'er Wan (Miraculous Efficacy Divine Response Child-Nourishing Pill) or Jianpi Fei'er Wan (Spleen-Strengthening Child-Nourishing Pill). If after measles, eyes appear blue/green, body is weak, spirit is inferior to usual, with cough and rapid breathing, use Suzi Sijun Tang (Perilla Seed Four Gentlemen Decoction) plus Jiangzhi fried Jiezi (Mustard Seed) and Guang Xingren (Apricot Kernel). For severe rapid breathing, add Luobozi (Radish Seed) and Gualou Ren (Trichosanthes Seed). If heat is very severe, or persists for a long time without reduction, leading to gradual emaciation, generally clear heat and calm the Liver using Chaihu Maimendong San (Bupleurum Ophiopogon Powder) [see Article 30] plus Jiuchao Huanglian (Alcohol-fried Coptis Rhizome), Huangqin (Scutellaria Root), and Gupi (Phellodendron Bark). For severe cases, use ancient Fang Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) [see Article 35] combined with Renshen Baitu Tang (Ginseng White Tiger Decoction) [see Article 64], alternating with Chaihu Maimendong San [see Article 30] for treatment.
Zhu said: Clear residual heat, nourish Yin and Blood, harmonize Spleen and Stomach, calm Liver Qi, kill parasites and treat *gan*. These methods are indeed the supreme techniques for treating post-measles Xu Lei in children.
[Formulas]
Qingre Chengan Wan (Heat-Clearing and Parasite-Removing Pill)
Huanglian (Coptis Rhizome), Danggui (Angelica Sinensis Root) (each 2 qian); Longdancao (Gentiana Root), Chuanxiong (Ligusticum Rhizome) (each 1 qian); Qingpi (Green Tangerine Peel), Chenpi (Aged Tangerine Peel), Lushen (Aloe); Gan Chan Tou (Dried Toad Head, also known as Hamax, i.e., frog/toad, roasted over fire and quenched in wine); Junzi Rou (Areca Seed Kernel, wrapped in flour and baked, shell and black skin removed, each 1.5 qian). Grind into powder, bind with Shenqu (Medicated Leaven) paste into pills, take with rice drink.
Baishao Tang (White Peony Decoction)
Baishaoyao (White Peony Root), Zhigancao (Prepared Licorice Root) (these two are Jun/Chief herbs); Lianrou (Lotus Seed Meat), Shanyao (Dioscorea Rhizome), Biandou (Lablab Bean), Longyanrou (Longan Aril), Qingdai (Indigo Naturalis), Maidong (Ophiopogon Tuber) (these six are Chen/Minister herbs). Combine three to four doses, decoct in water and take.
Bazhen Tang (Eight Treasures Decoction)
Danggui (Angelica Sinensis Root), Chuanxiong (Ligusticum Rhizome), Shudihuang (Prepared Rehmannia Root), Baishaoyao (White Peony Root), Renshen (Ginseng Root), Bai Fuling (Poria), Baizhu (Atractylodes Rhizome), Gancao (Licorice Root). Use Shengjiang (Fresh Ginger) and Zao (Jujube) as guides.
Qixiao Shenyin Fei'er Wan (Miraculous Efficacy Divine Response Child-Nourishing Pill)
Treats muscle wasting, yellow complexion, or cyanotic-white face, diarrhea, poor appetite, abdominal distension, prominent abdominal veins, food injury with frequent vomiting/diarrhea, urine like rice washings, and all types of *gan* syndromes.
Renshen (Ginseng Root) (3 qian; if Qi is weak, use 1 liang, or substitute with 1 liang of North Zhili Ginseng steamed in milk); Da Chuan Huanglian (Large Sichuan Coptis Rhizome) (wine-fried 2 qian); Chou Yuanyi (Toxic Wormseed Fruit) (fried, rubbed to remove skin, pure part 5 qian); Junzi Rou (Areca Seed Kernel) (wrapped in flour, baked, shell and inner black skin removed, 45 grains); Yeming Sha (Stool of Owls/Bats) (washed free of sand, pure sand dried after vinegar-frying 1 liang); Piao Baizhu (White Atractylodes Rhizome) (fried with old wall soil 5 qian; if Baizhu is unsuitable, substitute with fried Yiyiren); Wu Shenqu (Wu Medicated Leaven) (fried 5 qian); Sheng Maiya (Raw Malt) (fried 5 qian); Tian Jiangzi (Heavenly Pulp Seeds, i.e., larvae of grain beetles) (soaked in hot water, washed, fried 1 liang); Huai Shanyao (Chinese Yam) (fried 3 qian); Xiao Qingpi (Small Green Tangerine Peel) (vinegar-fried 3 qian); Hu Huanglian (Picrorhiza Rhizome) (wine-fried 3 qian); Shan Zha Rou (Hawthorn Flesh) (pitted, washed in hot water 3 qian); Gan Hamax (Dried Toad) (roasted over fire, quenched in vinegar until extremely charred, 3 pieces); Hua Binglang (Flowered Areca Nut) (3 qian). Grind all into fine powder. Every morning on an empty stomach, mix 2-3 qian with rice drink and take.
Jianpi Fei'er Wan (Spleen-Strengthening Child-Nourishing Pill)
Renshen (Ginseng Root), Chenpi (Aged Tangerine Peel), Gancao (Licorice Root) (each 5 qian); Huangqi (Astragalus Root) (honey-roasted); Biandou (Lablab Bean) (fried); Shanyao (Dioscorea Rhizome) (fried); Baizhu (Atractylodes Rhizome) (washed with rice water,漂, fried with soil); Bai Ling (Poria) (fried, each 1 liang); Shenqu (Medicated Leaven) (fried); Zha Rou (Hawthorn Flesh) (pitted, each 2 liang); Baihe (Lily Bulb), Danggui (Angelica Sinensis Root) (tails removed, each 8 fen); Huanglian (Coptis Rhizome) (wine-fried 3 qian); Baishao (White Peony Root) (wine-fried); Digupi (Dogwood Cortex) (bone removed, wine-washed, each 6 qian); Chenpi (Aged Tangerine Peel) (albedo removed 5 qian). Grind into powder, bind with honey into pills the size of quail eggs. Take one pill dissolved in old rice drink.
Shuanghe Tang (Double Harmony Decoction)
Shudihuang (Prepared Rehmannia Root), Baishao (White Peony Root) (wine-fried, each 1 qian); Huangqi (Astragalus Root) (honey-mixed and wine-fried); Danggui (Angelica Sinensis Root) (each 7 fen); Chuanxiong (Ligusticum Rhizome), Zhigancao (Prepared Licorice Root) (each 4 fen); Shang Rougui (Top-grade Cinnamon Bark) (3 fen; remove if heat is present); 1 slice of Shengjiang (Fresh Ginger), 1 Zao (Jujube) pitted as guide. Decoct in water and take.