斑属风热挟痰而作，自里而发于外，通圣散中消息，当以微汗散之，切不可下。内
伤斑者，
热之病发于外，微汗以散之，若下之非理。疹属热与痰，在肺清肺火降痰，或解散出汗，亦有可
下
也。发则多痒或不仁者，是兼风兼温之殊，色红者，兼火化也。黄瓜水调伏龙肝去红点斑。
戴云∶斑有色点而无头粒者是也；疹浮小有头粒者，随出即收，收则又出是也，非若斑
之无头粒者，当明辨之。
〔附录〕斑疹之病，其为证各异。疮发 肿于外者
，属少阳三焦相火也，谓之斑；小红靥行皮肤之中不出者，属少阴君火也，谓之疹。又
伤
下之晚，乃外感热病发斑也，以玄参、升麻、白虎等药服之。阴症发斑，亦出背胸，又出手足
亦稀少而微红，若作热症，投之凉药大误矣。此无根失守之火，聚于胸中，上独熏肺，传
皮肤而为斑点，但如蚊蚋、虱、蚤咬形状，而非锦纹也。只宜调中温胃，加以茴香、芍药
，或以大建中之类，其火自下，斑自消退，可谓治本而不治标也。
入方
调中汤 治内伤外感而发阴斑。
苍术（一钱半） 陈皮（一钱） 砂仁 藿香 芍药（炒） 甘草（炙） 桔梗 半夏 白芷 羌活
枳壳（各一钱） 川芎（半钱） 麻黄 桂枝（各半钱）
上 咀。姜三片，水煎服。
消毒犀角饮子 治斑及瘾疹。
牛蒡子（六钱） 荆芥 防风（各三钱） 甘草（一钱）
上 咀。水煎。
通圣散 出丹溪经验方。
川芎 当归 麻黄 薄荷 连翘 白芍 黄芩 石膏 桔梗（一两） 滑石（三两） 荆芥 栀
子白术（二钱半）甘草
上锉。水煎服。如身疼，加苍术、羌活；痰嗽，加半
夏。每服细末三钱，生姜三片，擂细荡起，煎沸服之。
玄参升麻汤 斑在身，治汗下吐后毒不散，表虚里实发于外，甚则烦燥谵妄。
玄参 升麻 甘草（等分）
上 咀。水煎。
化斑汤 治伤寒汗吐下后，斑发脉虚。
白虎汤加人参，守真再加白术。
上 咀。时时煎服。
大建中汤
黄 当归 桂心 芍药（各二钱） 人参 甘草（各一钱） 半夏 黑附（炮去皮，各二钱半）
上 咀。每服五钱，水二盏，姜三片，枣二枚
煎，食前服。
斑是由于风热挟带痰邪而发作，病邪从体内发于体表。治疗时应参考通圣散的方义，通过微微发汗来疏散邪气，绝对不可使用泻下法。如果是内伤导致的斑，是热邪病发于体表，也应通过微微发汗来疏散，如果错误地使用泻下法是不合理的。疹是由热与痰引起，病位在肺，应清泄肺火、降化痰浊，或者通过解散表邪令其出汗，也有可以使用泻下法的情况。皮疹发出后多伴有瘙痒或感觉麻木不仁，这是兼夹风邪或温邪的不同表现；颜色发红，是兼夹火邪化热的表现。用黄瓜汁调服伏龙肝（灶心土），可以去除红色的斑点。
戴元礼说：斑是有红色色点但没有颗粒头部的；疹是浮起较小且有颗粒头部，随出随收，收了又出的，不像斑那样没有颗粒头部，应当明确辨别它们。
〔附录〕斑和疹这两种病，它们的证候表现各不相同。疮疡肿大发于体表的，属于少阳三焦相火，称为斑；小红点隐行在皮肤之中不出来的，属于少阴君火，称为疹。又有因误下太晚，导致外感热病发斑的，服用玄参、升麻、白虎汤等药物。阴症发斑，也出现在背胸部，同时也出现在手足上，且稀少而微红，如果当作热症处理，投用凉药就大错特错了。这是由于无根失守之火，聚集在胸中，向上单独熏蒸肺部，传至皮肤形成斑点，形状只像蚊子、虻虫、虱子、跳蚤咬的痕迹，而不是锦缎般的纹路。只适宜调理中气、温暖胃腑，加上茴香、芍药，或者使用大建中汤之类的方剂，虚火自然下行，斑点自然消退，这可以说是治本而不治标的方法。
入方
调中汤：治疗内伤外感而引发的阴斑。
苍术（一钱半）、陈皮（一钱）、砂仁、藿香、炒芍药、炙甘草、桔梗、半夏、白芷、羌活、枳壳（各一钱）、川芎（半钱）、麻黄、桂枝（各半钱）。
以上药材切碎。加生姜三片，水煎服。
消毒犀角饮子：治疗斑及瘾疹（风团）。
牛蒡子（六钱）、荆芥、防风（各三钱）、甘草（一钱）。
以上药材切碎。水煎。
通圣散：出自丹溪经验方。
川芎、当归、麻黄、薄荷、连翘、白芍、黄芩、石膏、桔梗（一两）、滑石（三两）、荆芥、栀子、白术（二钱半）、甘草。
以上药材锉碎。水煎服。如果身体疼痛，加苍术、羌活；如果有痰嗽，加半夏。每次服用细末三钱，生姜三片，捣碎后用水冲荡起沫，煮沸后服用。
玄参升麻汤：治疗斑在身，针对汗、吐、下之后毒邪未散，表虚里实发于体表，严重时出现烦躁谵妄。
玄参、升麻、甘草（等分）。
以上药材切碎。水煎。
化斑汤：治疗伤寒经过汗、吐、下治疗后，斑发出且脉象虚弱。
白虎汤加入人参，朱守真再加白术。
以上药材切碎，时时煎服。
大建中汤
黄芪、当归、桂心、芍药（各二钱）、人参、甘草（各一钱）、半夏、黑附子（炮制去皮，各二钱半）。
以上药材切碎。每次服用五钱，水两盏，生姜三片，大枣二枚，煎煮，饭前服用。
Chapter 7: Macules and Papules
Macules (Ban) arise from wind-heat combined with phlegm, originating internally and manifesting externally. Treatment should refer to the principles of Tongsheng San, dispersing the pathogen through mild diaphoresis; purgation must strictly be avoided. In cases of macules caused by internal injury, where heat pathology manifests externally, mild diaphoresis should also be used for dispersion; irrational use of purgation is inappropriate. Papules (Zhen) are caused by heat combined with phlegm, located in the Lung. Treatment involves clearing Lung fire and descending phlegm, or resolving the exterior to induce sweating. There are instances where purgation may also be applicable. Upon eruption, there is often itching or numbness, indicating a differentiation between concurrent Wind or Warm pathogens. A red color indicates concurrent Fire transformation. Applying cucumber juice mixed with Fulonggan (Caulis Longan / Hearth Earth) can remove red macular spots.
Dai Yun stated: Macules are characterized by red spots without granular heads; papules are slightly raised with granular heads, appearing and disappearing rapidly, reappearing after subsiding, unlike macules which lack granular heads. These must be clearly distinguished.
[Appendix] The manifestations of macule and papule diseases differ significantly. Sores that swell and manifest externally belong to the Shaoyang Triple Burner Ministerial Fire and are termed macules; small red macules moving within the skin without emerging belong to the Shaoyin Sovereign Fire and are termed papules. Furthermore, if purgation is administered too late in external contracted heat diseases, macules may erupt. In such cases, herbs such as Xuanshen (Radix Scrophulariae), Shengma (Rhizoma Cimicifugae), and Baihu Tang (White Tiger Decoction) should be used. When macules erupt due to Yin syndrome, they also appear on the back and chest, extending to the hands and feet, but are sparse and faintly red. If treated as a heat syndrome and cold-natured medicines are administered, it would be a major error. This arises from rootless, uncontrolled fire accumulating in the chest, steaming upwards solely into the Lung, and transmitting to the skin to form spots. Their shape resembles bites from mosquitoes, horseflies, lice, or fleas, rather than brocade-like patterns. Treatment should focus on regulating the Middle Jiao and warming the Stomach, adding Huixiang (Fructus Foeniculi) and Shaoyao (Radix Paeoniae Rubra), or utilizing formulas such as Dajianzhong Tang (Major Construct the Middle Decoction). The fire will naturally descend, and the macules will subside. This constitutes treating the root rather than the branch.
Formulas Included
Tiaozhong Tang (Regulate the Middle Decoction): Treats Yin macules erupted due to internal injury and external contraction.
Cangzhu (Rhizoma Atractylodis Lanceae) (1.5 qian), Chenpi (Pericarpium Citri Reticulatae) (1 qian), Sharen (Fructus Amomi), Huoxiang (Herba Agastachis), Shaoyao (Radix Paeoniae Rubra, stir-fried), Gancao (Radix Glycyrrhizae, honey-fried), Jiegeng (Radix Platycodi), Banxia (Rhizoma Pinelliae), Baizhi (Radix Angelicae Dahuricae), Qianghuo (Rhizoma Notopterygii), Zhiqiao (Fructus Aurantii Immaturus) (each 1 qian), Chuanxiong (Rhizoma Chuanxiong) (0.5 qian), Mahuang (Herba Ephedrae), Guizhi (Ramulus Cinnamomi) (each 0.5 qian).
Decoct these crude pieces with three slices of fresh ginger and water.
Xiaodu Xijiao Yinzi (Detoxifying Rhinoceros Horn Infusion): Treats macules and urticaria (Yinzhen).
Niubangzi (Fructus Arctii), Jingjie (Herba Schizonepetae), Fangfeng (Radix Saposhnikoviae) (each 3 qian), Gancao (Radix Glycyrrhizae) (1 qian).
Decoct these crude pieces with water.
Tongsheng San (Universal Salvation Powder): From Danxi's empirical formula.
Chuanxiong (Rhizoma Chuanxiong), Danggui (Radix Angelicae Sinensis), Mahuang (Herba Ephedrae), Bohe (Herba Menthae), Lianqiao (Fructus Forsythiae), Baishao (Radix Paeoniae Alba), Huangqin (Radix Scutellariae), Shigao (Gypsum Fibrosum), Jiegeng (Radix Platycodi) (1 liang), Huashi (Talcum) (3 liang), Jingjie (Herba Schizonepetae), Zhizi (Fructus Gardeniae), Baizhu (Rhizoma Atractylodis Macrocephalae) (2.5 qian), Gancao (Radix Glycyrrhizae).
Crush these ingredients. Decoct with water. If body pain is present, add Cangzhu (Rhizoma Atractylodis Lanceae) and Qianghuo (Rhizoma Notopterygii); if phlegm-cough is present, add Banxia (Rhizoma Pinelliae). For each dose, take 3 qian of the fine powder, mix with three slices of fresh ginger, crush finely, suspend in water, boil, and consume.
Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction): Treats macules persisting on the body after diaphoresis, emesis, or purgation, where toxins have not dispersed, presenting with exterior deficiency and interior excess manifesting externally, potentially leading to severe restlessness and delirious speech.
Xuanshen (Radix Scrophulariae), Shengma (Rhizoma Cimicifugae), Gancao (Radix Glycyrrhizae) (equal parts).
Decoct these crude pieces with water.
Huaban Tang (Transform Macules Decoction): Treats macules erupting with a deficient pulse after treatment of Cold Damage via diaphoresis, emesis, or purgation.
Baihu Tang (White Tiger Decoction) plus Renshen (Radix Ginseng); Zhu Shouzhen added Baizhu (Rhizoma Atractylodis Macrocephalae).
Decoct these crude pieces and administer frequently.
Dajianzhong Tang (Major Construct the Middle Decoction)
Huangqi (Radix Astragali), Danggui (Radix Angelicae Sinensis), Guixin (Cortex Cinnamomi), Shaoyao (Radix Paeoniae Rubra) (each 2 qian), Renshen (Radix Ginseng), Gancao (Radix Glycyrrhizae) (each 1 qian), Banxia (Rhizoma Pinelliae), Heifu (Radix Aconiti Lateralis Preparata, processed and peeled) (each 2.5 qian).
Crush these ingredients. For each dose, take 5 qian, add two cups of water, three slices of fresh ginger, and two jujubes. Decoct and consume before meals.