（第三十三）
小儿发斑有二∶有温毒发斑，有胃烂发斑。温毒发斑者，冬月温暖，人感乖戾之气未即病，
至春或被积寒所折，毒瓦斯不能泄，至天气暄热，温毒始发，则肌肉斑烂，疹如锦纹。治法用葛根
橘皮汤、黄连橘皮汤主之。若胃烂发斑者，伤寒未下即发斑，下早亦发斑，盖不当下而下之，热
乘虚而入胃，当下而失下，则胃热不得泄，所以皆发斑。不可用表药，盖表虚里实，若发其汗，
重令升泄，更增斑烂，表虚故也，玄参升麻汤、化斑汤主之。伤寒发斑只是热在脏腑，先攻肠
胃，里蕴成疮，方发出外。赤者易冶，黑者难治。盖毒瓦斯入胃之深故也。羌活散（见伤寒）加蝉蜕治
赤斑。
葛根橘皮汤 治小儿发斑瘾疹如锦纹，呕吐清汁，发热。
葛根 橘皮 杏仁 麻黄 知母 黄芩 甘草（各等分）
上咀，每服二钱，白水煎。有热不吐去陈皮，不热去黄芩、知母。
黄连橘皮汤温毒发斑，兼治麻证泄泻并去血。
黄连 陈皮 杏仁（去皮尖） 枳实（炒） 麻黄 葛根（各半两） 浓朴（炒） 甘草（炙。各钱半）
上咀，每服二钱，白水煎服。
玄参升麻汤 治伤寒汗、下后，毒瓦斯不散，表虚里实，身发锦斑，甚则烦躁谵语。
玄参 升麻 甘草（各等分）
每服二钱，水煎服。
化斑汤（方见伤寒门）
（第三十三）
小儿出现发斑症状有两种情况：一种是温毒引起的发斑，另一种是胃烂引起的发斑。所谓温毒发斑，是指在冬季气候异常温暖时，人体感染了乖戾之气（指反常的致病邪气），当时并未立即发病；到了春季，如果又被积存的寒气所遏制，体内的毒热之气无法宣泄；等到天气变得炎热时，温毒才开始发作，表现为肌肉腐烂、皮疹如同锦缎上的花纹一样。治疗方法主要使用葛根橘皮汤或黄连橘皮汤。如果是胃烂引起的发斑，通常是因为伤寒病尚未进行攻下治疗就出现了发斑，或者攻下过早也会导致发斑。这是因为本不该攻下的情况下误用了攻下法，导致热邪乘虚侵入胃部；而本该攻下却延误了治疗，则导致胃中热邪无法宣泄，所以都会引发发斑。这种情况不能使用解表药物，因为此时属于表虚里实，如果使用发汗药强行升散泄越，会加重肌肉腐烂，这是由于表气虚弱所致。治疗应选用玄参升麻汤或化斑汤。伤寒引起的发斑，仅仅是因为热邪蕴结在脏腑内部，先要攻逐肠胃中的实热，待体内蕴结的热毒形成疮疡后，才会向外透发出来。颜色发红的容易治疗，颜色发黑的难以治疗。这是因为毒热之气深入胃部的缘故。可以使用羌活散（见伤寒章节）加入蝉蜕来治疗红色发斑。
葛根橘皮汤 用于治疗小儿发斑瘾疹，皮疹如锦纹，伴有呕吐清稀液体、发热等症状。
药材组成：葛根、橘皮、杏仁、麻黄、知母、黄芩、甘草（各等分）。
制法用法：将药材切碎，每次服用二钱，用白水煎煮。如果有热象但不呕吐，去掉陈皮；如果没有热象，去掉黄芩和知母。
黄连橘皮汤 用于治疗温毒发斑，兼治麻疹证候中的泄泻及便血。
药材组成：黄连、陈皮、杏仁（去皮尖）、枳实（炒制）、麻黄、葛根（各半两）、浓朴（炒制）、甘草（炙制，各钱半）。
制法用法：将药材切碎，每次服用二钱，用白水煎服。
玄参升麻汤 用于治疗伤寒经过发汗或攻下治疗后，毒热之气仍未消散，表现为表虚里实，身体发出如锦缎花纹般的斑疹，严重时会烦躁不安、说胡话。
药材组成：玄参、升麻、甘草（各等分）。
制法用法：每次服用二钱，用水煎服。
(Chapter 33)
There are two types of macule eruption (rash with flat lesions) in children: one is caused by warm-toxin, and the other by stomach rot. Warm-toxin macule eruption occurs when, during an abnormally warm winter, the body contracts a pestilential qi (pathogenic factors causing epidemic diseases), but does not fall ill immediately. In spring, if constrained by accumulated cold, the toxic heat cannot be vented. When the weather becomes hot, the warm-toxin erupts, manifesting as muscle decay and rashes resembling brocade patterns. The treatment method primarily employs Gegen Jupi Tang (Pueraria and Tangerine Peel Decoction) or Huanglian Jupi Tang (Coptis and Tangerine Peel Decoction). If the macule eruption is caused by stomach rot, it may occur because purgation was not performed when indicated in Shaoyang disease (a stage of Cold Damage), or because purgation was performed too early. This is because inappropriate purgation allows heat to enter the stomach due to deficiency, while delayed purgation prevents the venting of stomach heat, both leading to macule eruption. Surface-releasing drugs should not be used, as this condition presents with exterior deficiency and interior excess. Inducing sweating would cause further ascending and dispersing, worsening the macule decay due to the weak exterior. Treatment should utilize Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) or Huaban Tang (Macule-Resolving Decoction). Macule eruption in Cold Damage is merely due to heat accumulating in the Zang-Fu organs. One must first attack the intestines and stomach; once the interior accumulation forms sores, they will then manifest externally. Red macules are easy to treat, while black macules are difficult to treat, because the toxic heat has penetrated deeply into the stomach. Qianghuo San (Qianghuo Powder, see Cold Damage chapter) added with Chantui (Cicada Slough) can be used to treat red macules.
Gegen Jupi Tang (Pueraria and Tangerine Peel Decoction): Treats pediatric macule eruption and hives resembling brocade patterns, accompanied by vomiting of clear fluid and fever.
Ingredients: Ge Gen (Radix Puerariae Lobatae), Ju Pi (Pericarpium Citri Reticulatae), Xing Ren (Semen Armeniacae Amarum), Ma Huang (Herba Ephedrae), Zhi Mu (Rhizoma Anemarrhenae), Huang Qin (Radix Scutellariae), Gan Cao (Radix Glycyrrhizae) (equal parts).
Preparation and Administration: Coarsely crush the herbs. Take 2 qian per dose, decoct in plain water. If there is heat but no vomiting, remove Chen Pi (Tangerine Peel); if there is no heat, remove Huang Qin and Zhi Mu.
Huanglian Jupi Tang (Coptis and Tangerine Peel Decoction): Treats warm-toxin macule eruption, and also addresses diarrhea and bloody stool associated with measles-like conditions.
Ingredients: Huang Lian (Rhizoma Coptidis), Chen Pi (Pericarpium Citri Reticulatae), Xing Ren (Semen Armeniacae Amarum, skin and tip removed), Zhi Shi (Fructus Aurantii Immaturus, stir-fried), Ma Huang (Herba Ephedrae), Ge Gen (Radix Puerariae Lobatae) (each 0.5 liang), Hou Po (Cortex Magnoliae Officinalis, stir-fried), Gan Cao (Radix Glycyrrhizae, honey-fried) (each 1.5 qian).
Preparation and Administration: Coarsely crush the herbs. Take 2 qian per dose, decoct in plain water and administer.
Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction): Treats cases where, after sweating or purging in Cold Damage, toxic heat remains unresolved, presenting with exterior deficiency and interior excess, body eruptions resembling brocade patterns, and in severe cases, irritability and delirious speech.
Ingredients: Xuan Shen (Radix Scrophulariae), Sheng Ma (Rhizoma Cimicifugae Foetidae), Gan Cao (Radix Glycyrrhizae) (equal parts).
Preparation and Administration: Take 2 qian per dose, decoct in water and administer.
Huaban Tang (Macule-Resolving Decoction) (Formula see Cold Damage Chapter)