者。阳明胃经邪热所化。不发于表而发于里。不发于初而发于后。故阳
明当汗不汗。当下不下。不当下而下。其蓄热皆能成 。点有大小稀密。色
有红淡紫黑。或隐或现。或易出易收。或不易出不易收。总以热之微甚。为
毒之轻重。无论粗者为 。细者为疹。稀少为蚊迹。必须葛根托透为主。若
仲景治赤 。用阿胶大青汤。豆豉为君主发。而大青阿胶甘草。乃解毒化
热者也。治温毒发 呕逆。用黑膏。生地倍豉。又加猪膏。纯于解毒。入雄黄
麝香为使。则又兼乎发者也。学人虽不可执其方。得此意而通之。则 之
宜托与化。治法从可推矣。余治一妇。夏月饮火酒。发 面赤烦热。诊其脉
绝无。予曰。此火郁而热极。用栀子豆豉汤加葛根浓朴黄连清之。 大出
而脉遂见矣。又一人伤寒。过经不解。遍体黑 。唇口焦枯。脉大便结。以三
黄石膏汤饮之痊。又一妇热入血室。后发 点。以小柴胡汤加生地丹皮
获愈。又一友嗜烟酒。常腹痛呕逆。身发大块。余以枳壳浓朴等平其湿热。
逾日忽变头粒成 。用解毒凉血而安。凡此皆火热之变也。至于胃邪未
清而发 者。尤多。必胀闷不堪。则当内消为主。不可骤进寒凉。恐 不出
而邪反结也。如 既出而热不甚。无火症。则又不必化而自愈。切勿更投
凉药以伤之。学人其可执乎。
干葛浓朴汤 治胃实胸膈胀满。身发红点。脉大有力。不可服凉药。
葛根 浓朴（姜制） 枳壳（麸炒） 陈皮 桔梗（各一钱） 山楂（一钱半） 甘草（三分）
烦躁。加豆豉。实满。加莱菔子。加姜。水煎。
阿胶大青汤 治赤 。
大青 阿胶 甘草（各一钱） 豆豉（三钱）
水煎。
黑膏 治温毒发 呕逆。使毒从皮中出。
生地黄（二两六钱） 好豉（一两六钱）
猪膏十两。合露煎之。令三分减一。绞去渣。入雄黄麝香如豆大搅和。分三服忌芜荑。
阳毒升麻汤 治阳毒赤 。狂言。吐脓血。
升麻（一钱五分） 犀角（磨） 射干 黄芩 人参 甘草（各八分）
水煎。入犀角汁服。
玄参升麻汤 治咽痛发 。
玄参 升麻（各一钱五分） 甘草（八分）
水煎服。
白虎人参汤（一名化 汤）治赤 。口燥烦渴。中 。
知母 石膏（各三钱） 人参 甘草（各一钱） 粳米（一撮）
水煎。
这是由阳明胃经的邪热所化生。病邪不在体表发作，而在体内发作；不在初期发作，而在后期发作。因此，对于阳明病，该发汗而未发汗，该攻下而未攻下，不该攻下却误用攻下法，这些情况导致的蓄积之热都能形成斑疹。斑疹的点有大小、疏密之分，颜色有红、淡、紫、黑之别，或隐没或显现，或容易发出也容易消退，或不易发出也不易消退。总体以热的轻重来判断毒邪的深浅。无论粗大的是斑，细小的是疹，稀疏如蚊迹般的也是斑疹，治疗必须以葛根托透为主。
如果按照张仲景治疗赤斑的方法，使用阿胶大青汤，以豆豉为君药来发散邪气，而大青、阿胶、甘草则是用来解毒清热的。治疗温毒引起的发斑伴呕吐逆气，使用黑膏方，重用生地配合豆豉，又加入猪脂，纯粹用于解毒，再入雄黄、麝香作为使药，则兼具发散的作用。学习者虽然不可拘泥于这些成方，但若能领会此意并灵活变通，那么关于斑疹宜托透与宜化解的治疗法则就可以推演出来了。
我曾治疗一位妇人，夏季饮用火酒（烈性酒），导致面部发红、烦热，诊其脉搏微弱几乎摸不到。我说：“这是火邪郁结且热势极盛。”于是用栀子豆豉汤加葛根、厚朴、黄连来清热。结果斑疹大量发出，脉搏随即恢复可见。
又有一人患伤寒，过了传经周期仍未痊愈，全身出现黑色斑疹，嘴唇口舌焦枯，脉象涩滞，大便干结。我用三黄石膏汤让他服用，痊愈了。
又有一位妇人，热邪陷入血室，后来发出斑疹，我用小柴胡汤加生地、丹皮而治愈。
又有一位朋友嗜好烟酒，经常腹痛、呕吐逆气，身上发出大块红斑。我用枳壳、厚朴等药物平抑其湿热。过了一天，突然变成颗粒状的斑疹，我用解毒凉血的方法使其安定。
以上这些都是火热之邪变化所致。至于胃中邪热未清而发斑的情况，尤其多见。如果伴有难以忍受的胀闷感，则应当以内消为主，不可骤然进用寒凉药物，恐怕斑疹发不出来，反而导致邪气内结。如果斑疹已经发出，但热势不重，没有火症表现，那么又不必刻意解毒化解，身体可自行痊愈。切勿再投用凉药来损伤正气。学习者岂可固执己见呢？
干葛浓朴汤：治疗胃实胸膈胀满，身上发红点，脉大有力者。不可服用凉药。
组成：葛根、浓朴（姜制）、枳壳（麸炒）、陈皮、桔梗（各一钱），山楂（一钱半），甘草（三分）。
若烦躁，加豆豉；若实满，加莱菔子；加生姜。水煎服。
阿胶大青汤：治疗赤斑。
组成：大青、阿胶、甘草（各一钱），豆豉（三钱）。
水煎服。
黑膏：治疗温毒发斑伴呕吐逆气，使毒邪从皮肤中排出。
组成：生地黄（二两六钱），好豆豉（一两六钱）。
用猪脂十两，合露水煎煮，令药液减少三分之一，绞去药渣，加入雄黄、麝香如豆粒大小，搅匀混合。分三次服用。忌食芜荑。
阳毒升麻汤：治疗阳毒赤斑，狂言乱语，吐脓血。
组成：升麻（一钱五分），犀角（磨汁），射干，黄芩，人参，甘草（各八分）。
水煎服，兑入犀角汁。
玄参升麻汤：治疗咽痛发斑。
组成：玄参、升麻（各一钱五分），甘草（八分）。
水煎服。
白虎人参汤（一名化斑汤）：治疗赤斑，口燥烦渴，心中懊憹。
组成：知母、石膏（各三钱），人参、甘草（各一钱），粳米（一撮）。
水煎服。
This is transformed from the pathogenic heat of the Yangming Stomach Meridian. The pathogen does not manifest on the exterior but in the interior; it does not appear at the beginning but at a later stage. Therefore, in Yangming disease, if sweating should have been induced but was not, if purgation should have been used but was not, or if purgation was incorrectly applied when it should not have been, the accumulated heat can all lead to the formation of macules and papules (rash). The spots vary in size and density; their colors range from red, pale, purple, to black. They may be hidden or visible, easy to erupt and recede, or difficult to erupt and persist. Generally, the severity of the heat determines the depth of the toxin. Regardless of whether the larger lesions are macules (ban) or the smaller ones are papules (zhen), or even sparse marks resembling mosquito bites, the primary treatment must be to use Puerariae Radix (Gegen) to support and vent the eruption.
If following Zhang Zhongjing’s method for treating red macules, one uses Ejiao Daqing Tang (Cordyceps and Green Indigo Decoction), using Fermented Soybean (Douchi) as the sovereign herb to disperse the pathogen, while Qingdai (Indigo Naturalis), Ejiao (Donkey-hide Gelatin), and Gancao (Licorice Root) serve to resolve toxicity and clear heat. For treating warm toxicity causing macules accompanied by vomiting and regurgitation, Heigao (Black Ointment) is used. It employs a doubled dose of Shengdi Huang (Rehmanniae Radix) combined with Douchi, plus Zhu Gao (Pork Lard), purely for resolving toxicity. Adding Xionghuang (Realgar) and Shexiang (Musk) as guiding herbs adds a dispersing function. Although students should not rigidly adhere to these formulas, understanding this principle allows one to deduce that the treatment of macules involves either supporting their emergence or resolving them internally.
I once treated a woman who drank strong liquor in summer, resulting in facial flushing, irritability, and fever. Her pulse was imperceptible. I said, "This is fire pathogen stagnation with extreme heat." I prescribed Zhizi Chidui Tang (Gardenia and Fermented Soybean Decoction) added with Gegen (Puerariae Radix), Houpo (Magnoliae Officinalis Cortex), and Huanglian (Coptidis Rhizoma) to clear the heat. Consequently, the macules erupted profusely, and her pulse became palpable again.
Another patient suffered from cold damage (Shanghan) that did not resolve after passing through the meridian stages. His entire body developed black macules, his lips and mouth were scorched and dry, his pulse was choppy, and his stool was constipated. I administered Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction), and he recovered.
Another woman had heat entering the Blood Chamber (Xueshi), followed by the eruption of macule spots. I cured her with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shengdi Huang (Rehmanniae Radix) and Mudan Pi (Moutan Cortex).
A friend of mine, addicted to tobacco and alcohol, often suffered from abdominal pain, vomiting, and large patches of red rash on his body. I used Zhiqiao (Aurantii Fructus) and Houpo (Magnoliae Officinalis Cortex) to calm his damp-heat. The next day, the lesions suddenly changed into granular macules. I stabilized him using methods to resolve toxicity and cool the blood. All these cases are variations of fire and heat pathogens.
Regarding macules caused by uncleared stomach pathogenic factors, this is particularly common. If accompanied by unbearable distension and fullness, internal resolution should be the priority. One must not abruptly administer cold-natured drugs, lest the macules fail to emerge and the pathogen instead becomes knotted internally. If the macules have already emerged but the heat is not severe and there are no signs of fire toxicity, then specific detoxification and resolution are unnecessary; the condition will heal spontaneously. Do not further administer cooling medicines to injure the healthy qi. How can students be so rigid?
**Gegen Nongpo Tang (Pueraria and Magnolia Decoction)**: Treats excess in the stomach with chest and diaphragm distension, red spots on the body, and a large, forceful pulse. Cooling medicines should not be taken.
Ingredients: Gegen (Puerariae Radix), Nongpo (Magnoliae Officinalis Cortex processed with ginger), Zhike (Aurantii Fructus stir-fried with bran), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix) (each 1 qian), Shanzha (Crataegi Fructus) (1.5 qian), Gancao (Licorice Root) (0.3 qian).
For irritability, add Douchi (Fermented Soybean). For excess fullness, add Laifuzi (Raphani Semen). Add ginger. Decoct in water.
**Ejiao Daqing Tang (Ejiao and Qingdai Decoction)**: Treats red macules.
Ingredients: Daqing (Qingdai/Indigo Naturalis), Ejiao (Asini Corii Colla), Gancao (Licorice Root) (each 1 qian), Douchi (Fermented Soybean) (3 qian).
Decoct in water.
**Heigao (Black Ointment)**: Treats warm toxicity causing macules, vomiting, and regurgitation, allowing toxins to exit through the skin.
Ingredients: Sheng Dihuang (Rehmanniae Radix) (2 liang 6 qian), Hao Chi (Good quality Fermented Soybean) (1 liang 6 qian).
Mix with 10 liang of Zhu Gao (Pork Lard). Simmer with dew until the liquid reduces by one-third. Strain to remove dregs. Add Xionghuang (Realgar) and Shexiang (Musk) in amounts the size of a bean, mix well. Divide into three doses. Avoid eating Elaeagnus fruit (Wuyi).
**Yangdu Shengma Tang (Yang Toxin Corydalis Decoction)**: Treats Yang Toxin red macules, delirious speech, and expectoration of pus and blood.
Ingredients: Shengma (Corydalidis Rhizoma) (1.5 qian), Xijiao (Rhinocerotis Cornu, ground/mixed juice), Sheye (Belamcandae Rhizoma), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Gancao (Licorice Root) (each 0.8 qian).
Decoct in water. Administer with Xijiao juice.
**Xuanshen Shengma Tang (Scrophularia and Corydalis Decoction)**: Treats sore throat and macule eruption.
Ingredients: Xuanshen (Scrophulariae Radix), Shengma (Corydalidis Rhizoma) (each 1.5 qian), Gancao (Licorice Root) (0.8 qian).
Decoct in water and take.
**Baitu Renshen Tang (White Tiger Ginseng Decoction)**, also known as **Hua Ban Tang (Macule Resolving Decoction)**: Treats red macules, dry mouth, irritability, thirst, and mental restlessness.
Ingredients: Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum) (each 3 qian), Renshen (Ginseng Radix), Gancao (Licorice Root) (each 1 qian), Jingmi (Oryza Sativa Grain) (a pinch).
Decoct in water.