大热则伤血，血热不散，里实表虚，热气乘虚出于皮肤而为斑也，轻则为疹子，甚则为锦纹。
或病本属阳，误投热药，或当汗不汗，当下不下，或汗下未解，皆能致此。大抵有两证∶一者温毒，
即春时发，汗下不解，邪气不散，故发斑也；一者热病，即冬时温暖，乖戾之气，遇春暄热而发斑
也。不可误汗，若发其汗，重令开泄，更加斑烂也。然而斑之方萌，如蚊迹类焉。发斑多见于胸腹，
蚊迹只在于手足。阳脉洪大，病患昏愦，先红后赤者，斑也。脉不洪大，病患自静，先红后黄者，
蚊迹也。其或大便自利，怫郁气短，燥屎不通，又如果实靥者，虽卢扁复生，亦不能施其巧。凡汗
下不解，烦闷，咳嗽呕吐，足冷不温，便是发斑之候。
温毒发斑，黑膏主之；渴而心闷，下利呕吐，下部有疮，或口疮，黄连橘皮汤、葛根汤、橘皮
汤。
阳毒发斑，狂癫妄言，面赤咽痛，身斑如锦，下利赤黄，升麻汤、麦奴丸；有下证，调胃承气
汤。
时气发斑，大青四物汤、猪胆鸡子汤。
发斑通用升麻汤、犀角地黄汤；热多者，玄参升麻汤、黄连一物汤、青木香一物汤。
凡赤斑五死一生，黑斑不救。
动气者，脏气不调，筑筑跳动，随脏所主而形见于脐之左右上下也。《难经》各脏载之。又有
真气内虚，水结不散，气与相搏，即发奔豚。以其从气冲突如豚之奔，皆不宜汗下。然而独不言脾，
当脐之有动气者，脾为中州，以行津液，妄施汗下，必先动脾，是以不言而喻也。左右上下，不宜
汗下，何况中州之气，其敢轻动之乎？伤寒所以看外证为当者，盖不在脉之可见，必待问之可得。发
汗、下，其可轻举哉！
动气通用理中汤去白术，加桂。白术燥肾闭气，故去之，桂泄奔豚，加之。一
法，用柴胡桂枝汤亦良。二方当看有热无热。
动气在左，发汗则头眩，汗下不止，筋惕肉 ，为逆，先宜防风白术牡蛎汤；汗止，与建中汤。
动气在右，发汗则衄而渴，心若烦，饮则吐，先宜五苓散，后与竹叶石膏汤。
动气在上，发汗则气上冲心，桃根汤。动气在下，发汗则心中大烦，骨节疼痛，目晕，食入即
吐，先宜大橘皮汤，后与小建中汤。
动气在左，不可下，下之，则腹满拘急，身虽热，反欲拳，先宜甘草干姜汤，后与小建中汤。
动气在右，下之，则津液竭，咽干鼻燥，头眩心悸，宜竹叶石膏汤。
动气在下，下之，则腹满清谷，心痞头眩，宜甘草泻心汤。
大热会损伤血液，血分热盛而不得消散，导致里实表虚，热气乘虚外发于皮肤而形成斑疹，轻的表现为疹子，重的表现为如锦纹般的斑片。
有的病人本属阳证，误用了热性药物；或者应当发汗却没有发汗，应当攻下却没有攻下；或者经过发汗和攻下治疗后病邪仍未解除，这些情况都能导致发斑。大体上有两种证型：一种是温毒发斑，即在春季发生，经过发汗和攻下治疗无效，邪气未散，因而发斑；另一种是热病发斑，即冬季气候异常温暖，乖戾之气潜伏体内，遇到春季温暖炎热而引发发斑。此时不可误用发汗法，如果强行发汗，使腠理更加开泄，会导致斑疹溃烂加重。然而，斑疹初起时，形状像蚊子叮咬的痕迹。发斑多见于胸腹部，而蚊迹只出现在手足部位。脉象洪大，病人神志昏沉烦躁，颜色先红后赤的，是斑疹；脉象不洪大，病人安静，颜色先红后黄的，是蚊迹。如果出现大便自利（腹泻），烦闷气短，燥屎内结不通，又像果实成熟后的斑点一样，即使扁鹊再生，也无法施展医术。凡是经过发汗、攻下治疗后病不解，出现烦闷、咳嗽、呕吐、足部寒冷不温等症状的，就是发斑的征候。
温毒发斑，用黑膏主治；若口渴且心胸闷痛，伴有腹泻呕吐，下部有疮疡，或口舌生疮，可用黄连橘皮汤、葛根汤、橘皮汤。
阳毒发斑，表现为狂躁癫乱、胡言乱语，面部发红、咽喉疼痛，身上斑片如锦纹，腹泻排出赤黄色粪便，用升麻汤、麦奴丸；如果有可攻下的实证，用调胃承气汤。
发斑通用方剂为升麻汤、犀角地黄汤；热势较重的，用玄参升麻汤、黄连一物汤、青木香一物汤。
凡是出现赤色斑疹的，十死一生；出现黑色斑疹的，无法救治。
动气证，是指脏腑之气不调，感觉腹部筑筑跳动，随着所涉脏腑的主司部位，在脐部的左右上下显现出来。《难经》中对各脏的记载有所涉及。又有真气内虚，水饮结聚不散，气与水相互搏结，从而引发奔豚气。因为这种气从下向上冲逆，如同小猪奔跑一般，所以都不宜使用发汗和攻下法。然而唯独没有提到脾脏，当脐部出现动气时，是因为脾居中焦，负责运行津液，如果妄加发汗或攻下，必定先扰动脾气，这是不言而喻的道理。既然脐部左右上下不宜发汗攻下，何况中焦脾气，怎么敢轻易扰动它呢？伤寒病之所以要看外证是否恰当，是因为这不仅仅在于脉象可见，必须通过询问才能得知。发汗和攻下，怎么可以轻率使用呢！
动气证通用方剂为理中汤去掉白术，加入桂枝。因为白术燥烈伤肾且闭塞气机，所以去掉；桂枝能宣泄奔豚气，所以加入。另一种方法，使用柴胡桂枝汤也很好。这两个方剂要根据是否有热来选择。
动气在左侧，发汗则会导致头晕目眩，汗出不止，筋肉跳动，属于逆证，先用防风白术牡蛎汤；汗止后，给予建中汤。
动气在右侧，发汗则会导致鼻出血且口渴，心中烦闷，饮水即吐，先用五苓散，后给予竹叶石膏汤。
动气在上方，发汗则导致气上冲心胸，用桃根汤。动气在下方，发汗则导致心中极度烦乱，骨节疼痛，头晕眼花，食物入口即吐，先用大橘皮汤，后给予小建中汤。
动气在左侧，不可攻下，如果攻下，则会导致腹部胀满拘急，身体虽然发热，反而想蜷缩，先用甘草干姜汤，后给予小建中汤。
High heat injures the blood; when blood-heat is not dispersed, interior excess and exterior deficiency occur. The pathogenic heat takes advantage of this deficiency to emerge from the skin, resulting in macules (maculae). Mild cases manifest as papules (rashes), while severe cases present as macules resembling brocade patterns.
In some instances, the disease originally belongs to a Yang pattern, but hot-natured medicines are mistakenly administered. Or, sweating should have been induced but was not, or purging should have been performed but was not. Even if neither sweating nor purging resolves the condition, these factors can all lead to the emergence of macules. Generally, there are two types: one is Warm-Toxin Macules (Wendu Faban), which occur in spring; after failed sweating and purging, the pathogenic factor remains undispersed, causing macules to appear. The other is Heat Disease Macules, caused by abnormal warmth in winter where pernicious qi lingers and emerges with the warming weather of spring. Sweating must not be mistaken for a treatment; if sweating is forced, causing further opening and leakage of the pores, it will exacerbate the macules until they ulcerate. However, when macules first begin to appear, they resemble mosquito bites. Macules typically appear on the chest and abdomen, whereas mosquito-like marks appear only on the hands and feet. If the pulse is surging and large (Hongda), the patient is confused and drowsy, and the color changes from red to dark red, it is macules. If the pulse is not surging and large, the patient is calm, and the color changes from red to yellow, it is merely mosquito-like marks. If there is spontaneous diarrhea, oppression and shortness of breath, dry stool impaction, and spots resembling fruit rind, even if Bian Que were reborn, he could not apply his skill. Whenever sweating and purging fail to resolve the disease, accompanied by irritability, cough, vomiting, and cold feet that do not warm up, these are signs of impending macules.
For Warm-Toxin Macules, Hei Gao (Black Ointment) is the primary prescription. For thirst with chest oppression, diarrhea with vomiting, sores in the lower body, or mouth ulcers, use Huanglian Jupi Tang (Coptis and Tangerine Peel Decoction), Gegen Tang (Kudzu Decoction), or Jupi Tang (Tangerine Peel Decoction).
For Yang-Du Macules, characterized by mania, delirium, incoherent speech, red face, sore throat, macules like brocade on the body, and bloody-yellow diarrhea, use Shengma Tang (Cimicifuga Decoction) or Maitan Wan (Stellaria Pill). If there are indications for purging, use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction).
For Seasonal-Qi Macules, use Daqing Siwu Tang (Great Blue Four Substances Decoction) or Zhudan Jizi Tang (Pig Gallbladder and Chicken Egg Decoction).
The universal prescriptions for macules are Shengma Tang (Cimicifuga Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). For cases with greater heat, use Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction), Huanglian Yi Wu Tang (Coptis Single Herb Decoction), or Qingmuxiang Yi Wu Tang (Aucklandia Single Herb Decoction).
Generally, red macules indicate five deaths for every one survival; black macules are incurable.
Dongqi (Moving Qi) refers to the disharmony of Zang organ qi, perceived as a throbbing sensation ("zhuzhu") that manifests around the umbilicus—left, right, above, or below—according to the affected Zang. This is recorded in the *Nan Jing* (*Classic of Difficult Issues*). Additionally, when true qi is internally deficient and water retention fails to disperse, qi and water contend, triggering Ben Tun (Running Piglet) syndrome. Because the qi rushes upward like a running piglet, both sweating and purging are contraindicated. However, the Spleen is notably absent from this discussion. When moving qi is felt at the umbilicus, it is because the Spleen governs the Central Region (Zhongzhou) and transports fluids. Reckless sweating or purging would inevitably disturb the Spleen, a fact that goes without saying. If moving qi in the four directions around the umbilicus contraindicates sweating and purging, how much more so should the Qi of the Central Region not be lightly disturbed! In Shaoyang diseases, observing external symptoms is crucial because the diagnosis relies not only on visible pulses but also on what can be elicited through inquiry. How can sweating and purging be undertaken lightly?
The universal prescription for Dongqi is Lizhong Tang (Regulate the Middle Decoction) with Baizhu (Atractylodis Macrocephalae Rhizoma) removed and Guizhi (Cinnamon Twig) added. Baizhu is drying and can close off qi flow, harming the Kidney, hence it is removed. Guizhi helps dissipate Ben Tun, hence it is added. Alternatively, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is also effective. These two formulas should be selected based on the presence or absence of heat.
If Dongqi is on the left, sweating causes dizziness and continuous sweating, leading to muscle twitching and palpitations, which is an adverse reaction. First, use Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes, and Oyster Shell Decoction); once sweating stops, administer Jianzhong Tang (Establish the Middle Decoction).
If Dongqi is on the right, sweating causes epistaxis and thirst, mental restlessness, and vomiting upon drinking. First, use Wuling San (Five-Ingredient Powder with Poria), followed by Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).
If Dongqi is above, sweating causes qi rushing up to the heart; use Taogen Tang (Peach Root Decoction). If Dongqi is below, sweating causes severe mental agitation, pain in the bone joints, dizziness, and immediate vomiting after eating. First, use Dajupi Tang (Large Tangerine Peel Decoction), followed by Xiaojianzhong Tang (Small Establish the Middle Decoction).
If Dongqi is on the left, purging is contraindicated. Purging leads to abdominal fullness and cramping. Although the body may be hot, the patient desires to curl up. First, use Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), followed by Xiaojianzhong Tang (Small Establish the Middle Decoction).
If Dongqi is on the right, purging depletes body fluids, causing dry throat and nose, dizziness, and palpitations. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).
If Dongqi is below, purging leads to abdominal fullness and undigested food in the stool, epigastric stuffiness, and dizziness. Use Gancao Xiexin Tang (Licorice and Heart-Purging Decoction).