发斑证，轻则如疹子，重则如锦纹。其致此之由，虽分数种，然总由寒毒不解而然。如当汗不
汗，则表邪不解；当下不下，则里邪不解；当清不清，则火盛不解；当补不补，则无力不解；或下
之太早，则邪陷不解；或以阳证误用温补，则阳亢不解；或以阴证误用寒凉，则阴凝不解。凡邪毒
不解，则直入阴分，郁而成热，乃致液涸血枯，斑见肌表，此实毒邪固结，营卫俱剧之证也。但斑
有微甚，势有重轻，轻者细如蚊迹，或先红而后黄；重者成粒成片，或先红而后赤。轻者只在四肢
，重者乃见胸腹。轻者色淡而隐，重者色紫而显。若见黑斑，或大便自利，或短气，或二便不通，
则十死九矣。凡病伤寒，而汗、下、温、清俱不能解，及足冷耳聋，烦闷咳呕者，便是发斑之候。
一、成无己曰∶大热则伤血，热不散，里实表虚，热邪乘虚出于皮肤而为斑也，慎不可发汗，若
汗之，重令开泄，更增斑烂也。自后诸家所述，皆同此说，予则以为不然。盖凡伤寒之邪，本自
外而入，深入不解，则又自内而出，此其表里相乘，势所必至，原非表虚证也，但使内外通达，则
邪必由表而解矣。即如犀角地黄汤，乃治斑之要药，人知此汤但能凉血清毒，而不知此汤善于解表
散邪，若用之得宜，则必通身大汗，热邪顿解，何为不可汗耶？由此言之，则凡脉数无汗，表证俱
在者，必须仍从解散。
一、凡治发斑，须察表里。如瘟疫不解，热入血室，舌焦，烦热发斑者，犀角地黄汤。内外俱
热，阳明狂躁，大渴发斑者，白虎汤，或加人参。阳毒赤斑，狂言见血者，阳毒升麻汤。疫疠发斑
，大热而燥者，三黄石膏汤。火郁于经，寒邪不解，脉仍滑数而发斑者，一柴胡饮。阳明外邪，阳
毒不解者，升麻汤。脾肾本虚，外邪不解而发斑者，五柴胡饮。阳明表邪不解，温热发斑者，柴胡
白虎煎。温热毒盛，咽痛发斑者，玄参升麻汤。阴虚水亏，血热发斑者，玉女煎。阴虚血燥，大热
大渴发斑者，归葛饮。内虚外实，阴盛格阳发斑者，大温中饮。太阳阳明恶热，大便秘结，邪毒在
腑发斑者，调胃承气汤。
一、凡本非阳证，妄用寒凉者，每令泄泻，邪陷不解，予常用大温中饮、理阴煎之类，解寒托
邪，始得大汗，汗后邪达，多有见赤斑风饼随汗而出，随出随没，顷刻即愈，活者多人矣。凡寒毒
为斑，即此可见，使内托无力，则此毒终无出期，日深日甚，难乎免矣。此理甚微，不可不察。
发斑证，轻的像疹子，重的像锦缎上的花纹。导致这种情况的原因，虽然有好几种，但总归是因为寒毒没有解除。比如该用汗法而没用汗法，表邪就不能解除；该用下法而没用下法，里邪就不能解除；该用清法而没用清法，火热亢盛就不能解除；该用补法而没用补法，正气无力驱邪就不能解除；或者攻下太早，导致邪气内陷不能解除；或者把阳证误用温补药，导致阳气亢盛不能解除；或者把阴证误用寒凉药，导致阴寒凝滞不能解除。凡是邪毒没有解除，就会直接深入阴分，郁结而化热，从而导致津液枯竭、血液干涸，斑点出现在肌肤表面，这实际上是毒邪固结，营气和卫气都严重受损的病证。但是斑有轻微和严重的区别，病情有重和轻的不同，轻的细小像蚊子叮咬的痕迹，或者先红后黄；重的成颗粒成片状，或者先红后赤。轻的只在四肢出现，重的才见于胸腹部。轻的颜色淡且隐约，重的颜色紫暗且明显。如果见到黑斑，或者大便自利（滑脱不禁），或者短气，或者大小便不通，那就十个人里有九个要死了。凡是患伤寒病，经过汗、下、温、清各种治法都不能解除，并且出现脚冷、耳聋、烦闷、咳嗽呕吐的，就是发斑的征候。
一、成无己说：大热会损伤血分，热邪不散，里实表虚，热邪乘虚出于皮肤而形成斑疹，千万不可发汗，如果发汗，再次令腠理开泄，只会增加斑烂的程度。从此以后各家所述，都同这个说法，我却认为不对。大概凡伤寒之邪，本来是从外而入，深入不解，又会从内而出，这是表里相互影响，是形势发展的必然结果，原本不是表虚证，只要使内外通达，邪气必定由表而解。就像犀角地黄汤，是治疗发斑的重要方剂，人们知道此汤只能凉血清毒，却不知道此汤善于解表散邪，如果使用得当，必定通身大汗，热邪顿时解除，为什么说不可发汗呢？由此说来，凡是脉数无汗，表证都在的，必须仍然从解散入手。
一、凡是治疗发斑，必须察辨表里。如瘟疫不解，热入血室，舌苔焦黑，烦热发斑的，用犀角地黄汤。内外俱热，阳明经狂躁，大渴发斑的，用白虎汤，或加人参。阳毒赤斑，胡言乱语见血的，用阳毒升麻汤。疫疠发斑，大热而燥的，用三黄石膏汤。火郁于经络，寒邪不解，脉仍滑数而发斑的，用一柴胡饮。阳明外邪，阳毒不解的，用升麻汤。脾肾本虚，外邪不解而发斑的，用五柴胡饮。阳明表邪不解，温热发斑的，用柴胡白虎煎。温热毒盛，咽痛发斑的，用玄参升麻汤。阴虚水亏，血热发斑的，用玉女煎。阴虚血燥，大热大渴发斑的，用归葛饮。内虚外实，阴盛格阳发斑的，用大温中饮。太阳阳明恶热，大便秘结，邪毒在腑发斑的，用调胃承气汤。
一、凡是本来不是阳证，妄用寒凉药的，往往导致泄泻，邪气内陷不解，我常用大温中饮、理阴煎之类，通过温补内托来解散寒邪，才能得出大汗，汗出后邪气外达，多有红色斑点和风团随汗而出，随出随消，顷刻间痊愈，救活了很多病人。凡是寒毒导致的发斑，从这里就可以看出，如果内托之力不足，那么这种毒邪终究没有出路，日益加深严重，难免死亡了。这个道理很微妙，不可不仔细考察。
The eruption of macules (skin eruptions) ranges from mild cases resembling rashes to severe cases resembling patterns on brocade. Although the causes vary, they all stem fundamentally from the failure to resolve cold pathogens (Cold Pathogens). For instance, if sweating therapy is not applied when indicated, exterior pathogens remain unresolved; if purgation is not applied when indicated, interior pathogens remain unresolved; if clearing heat is not applied when indicated, excessive fire remains unresolved; if tonification is not applied when indicated, deficiency prevents the expulsion of pathogens; if purgation is applied too early, pathogens sink inward and remain unresolved; if Yang-patterns are mistakenly treated with warming and tonifying herbs, Yang hyperactivity remains unresolved; or if Yin-patterns are mistakenly treated with cooling herbs, Yin stagnation remains unresolved. Whenever pathogenic toxins remain unresolved, they penetrate directly into the Yin aspect, stagnate and transform into heat, leading to exhaustion of body fluids and depletion of blood. Consequently, macules appear on the skin surface. This represents a condition where pathogenic toxins are firmly consolidated, and both Ying (Nutritive Qi) and Wei (Defensive Qi) are severely compromised. However, macules vary in severity, and the disease course varies in intensity. Mild cases present as fine spots like mosquito bites, initially red then turning yellow; severe cases present as granular or patchy eruptions, initially red then turning crimson. Mild cases appear only on the limbs, while severe cases appear on the chest and abdomen. Mild cases have pale, faint colors, while severe cases have dark purple, prominent colors. If black macules appear, accompanied by spontaneous diarrhea, shortness of breath, or obstruction of both urination and defecation, nine out of ten patients will die. In cases of Cold Damage (Shanghan), if sweating, purgation, warming, and clearing therapies fail to resolve the condition, and symptoms such as cold feet, deafness, restlessness, cough, and vomiting occur, these are signs of macule eruption.
1. Cheng Wuji stated: "Intense heat damages the Blood. If heat does not dissipate, interior excess and exterior deficiency arise, allowing heat pathogens to exit through the skin due to deficiency, forming macules. Sweating must absolutely be avoided; if sweating is induced, causing further opening and leakage, it will only exacerbate the macule erosion." Subsequent scholars generally agreed with this view, but I disagree. Generally, pathogens of Cold Damage enter from the exterior; if they penetrate deeply and remain unresolved, they subsequently emerge from the interior. This mutual interaction between interior and exterior is inevitable and does not originally constitute an exterior deficiency pattern. As long as interior and exterior circulation is unobstructed, pathogens will surely resolve via the exterior. Take Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), a crucial formula for treating macules. People know this formula cools the Blood and clears toxins, but fail to realize it is also effective in resolving the exterior and dispersing pathogens. If used appropriately, it induces profuse sweating throughout the body, instantly resolving heat pathogens. Why say sweating is impossible? Therefore, in cases with rapid pulse and no sweat, where exterior signs are still present, one must still employ dispersing methods.
1. When treating macule eruption, one must always examine the interior and exterior.
- If plague pathogens remain unresolved, heat enters the Blood Chamber, the tongue is scorched, and macules erupt due to irritability and heat, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehnamia Decoction).
- If there is interior and exterior heat, Yangming syndrome with mania and agitation, intense thirst, and macule eruption, use Baihu Tang (White Tiger Decoction), or add Renshen (Ginseng).
- For Yang Toxin with red macules, delirious speech, and bleeding, use Yangdu Shengma Tang (Yang Toxin Corydalis Decoction).
- For epidemic macule eruption with intense heat and dryness, use Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction).
- If fire is constrained within the meridians, cold pathogens remain unresolved, the pulse remains slippery and rapid, and macules erupt, use Yi Chaihu Yin (Single Bupleurum Infusion).
- For exterior pathogens of the Yangming channel and unresolved Yang Toxin, use Shengma Tang (Corydalis Decoction).
- If the Spleen and Kidney are inherently deficient, and exterior pathogens remain unresolved leading to macule eruption, use Wu Chaihu Yin (Five Bupleurum Infusion).
- If exterior pathogens of the Yangming channel remain unresolved, and heat-warmth leads to macule eruption, use Chaihu Baihu Jian (Bupleurum and White Tiger Decoction).
- If heat-warmth toxins are abundant, throat pain occurs, and macules erupt, use Xuanshen Shengma Tang (Scrophularia and Corydalis Decoction).
- If Yin deficiency with water depletion, blood heat leads to macule eruption, use Yvnu Jian (Jade Woman Decoction).
- If Yin deficiency with blood dryness, intense heat and thirst lead to macule eruption, use Guige Yin (Angelica and Pueraria Infusion).
- If interior deficiency with exterior excess, Yin excess repelling Yang leads to macule eruption, use Da Wenzhong Yin (Great Warming the Middle Infusion).
- If Taiyang and Yangming present with aversion to heat, constipation, and pathogenic toxins in the Fu organs lead to macule eruption, use Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction).
1. Cases that are originally non-Yang patterns but were mistakenly treated with cooling herbs often result in diarrhea, causing pathogens to sink inward and remain unresolved. I commonly use formulas such as Da Wenzhong Yin (Great Warming the Middle Infusion) or Liyin Jian (Nourishing Yin Decoction) to warm the interior and support the body's resistance to expel pathogens. This allows for profuse sweating; after sweating, pathogens reach the exterior. Often, red macules and wind-blisters appear with the sweat, emerging and disappearing quickly, leading to recovery within moments, saving many lives. From this, we can see the nature of macules caused by cold toxins. If internal support is insufficient, these toxins will never find an exit, becoming progressively deeper and more severe, making death difficult to avoid. This principle is subtle and must be carefully examined.