痘疹夹斑与夹疹不同，盖疹则细碎有形，斑则成片无形也。凡痘疮初出，有片片红肿如绵
纹者，有红晕与地皮相平而全无兴起之意者，是皆夹斑证也。斑以热毒郁于血分，而浮于肌肉
之间，乃足阳明胃经所主，或以寒邪陷入阳明，郁而成热者，亦致发斑，俱宜凉血解毒，但使
斑退而痘见者吉，否则皮肤斑烂，疮易搔痒，而皮嫩易破也。又有赤斑成块，其肉浮肿结
硬者，乃名丹瘤，其毒尤其，疮未成就，此必先溃，不可治也。
一、治斑之法，大抵斑在起发之前者多用表散，在灌脓之后者多用解利。如遍身通红者，
其治亦同。
一、痘出夹斑轻者，只以升麻葛根汤加石膏、玄参，甚者宜人参白虎汤合六味消毒饮。
一、风寒外感，表邪不解而夹斑者，宜荆防败毒散，或加石膏、玄参。
一、斑色紫赤而大便秘结者，宜四顺清凉饮利之。斑既已退，即宜用四君子之类以固
其脾，庶可免其内陷。
程氏曰∶凡治夹斑，急宜凉血解毒，以羌活散加酒炒芍药、紫草、红花、蝉蜕、木通、
官桂、糯米，连进数服。斑退后，以保元汤加木香、豆蔻煎服，以解紫草之寒，防其泄泻。如
痘中夹疹，治亦同此，如稍迟则恐变成黑斑，为难治矣。
一、痘疮结痂之后而见斑者，此余毒煎熬血分，必致溃烂，宜黄连解毒汤加当归、芍药、
黄芩、石膏，甚则大连翘饮。若热毒熏蒸于内，大便脓血臭秽而见斑者，此胃烂之证，不可治。
一、发斑溃烂者，以救苦灭瘢散敷之。
痘疹中夹杂斑点的证候与夹杂疹子的证候不同，因为疹子细小破碎且有形状，而斑点成片且没有固定形状。凡是痘疮刚发出时，出现片片红肿如同棉纹状的，或者红色晕圈与皮肤表面相平而完全没有隆起迹象的，这些都是夹斑的证候。斑点是由于热毒郁结在血分，浮越于肌肉之间，这由足阳明胃经所主；也有因寒邪陷入阳明经，郁积而化热导致的发斑，这些情况都适宜使用凉血解毒的方法，只要能使斑点消退而痘疮显现就是吉兆，否则会导致皮肤斑点溃烂，疮口容易瘙痒，且皮肤娇嫩容易破损。又有赤色斑点结成块状，其肌肉浮肿、坚硬结块的，名叫丹瘤，这种毒气尤其猛烈，疮疡尚未成熟就会先溃破，属于不可治愈的病症。
一、治疗斑点的方法，大致在斑点发出之前多用解表发散法，在灌脓之后多用清热通利法。如果全身通红，治疗方法也与此相同。
一、痘疮夹杂斑点较轻的，只用升麻葛根汤加入石膏、玄参；病情严重的，宜用人参白虎汤合六味消毒饮。
一、因风寒外感，表邪未解而夹杂斑点的，宜用荆防败毒散，或者加入石膏、玄参。
一、斑点颜色紫红且大便秘结的，宜用四顺清凉饮通便泄热。斑点既然已经消退，就应当立即使用四君子汤之类的方剂来固护脾胃，这样可以避免病邪内陷。
程氏说：凡是治疗夹斑，急需凉血解毒，用羌活散加入酒炒芍药、紫草、红花、蝉蜕、木通、官桂、糯米，连续服用几副。斑点消退后，用保元汤加入木香、豆蔻煎服，以解除紫草的寒性，防止腹泻。如果是痘疮中夹杂疹子，治疗方法也与此相同，如果稍晚处理恐怕会变成黑斑，那就难以治疗了。
一、痘疮结痂之后又出现斑点的，这是余毒煎熬血分，必然导致溃烂，宜用黄连解毒汤加入当归、芍药、黄芩、石膏，严重时用大连翘饮。如果热毒熏蒸于体内，大便脓血臭秽并出现斑点，这是胃腑腐烂的证候，不可治愈。
The syndrome of acne with macules (maculae) differs from that with papules (papulae). This is because papules are small, fragmented, and have distinct shapes, whereas macules form in patches without fixed shapes. When acne first erupts, if there are patches of red swelling resembling cotton fibers, or red halos flat against the skin surface with no sign of elevation, these are all syndromes of acne with macules. Macules arise from heat-toxin stagnating in the blood level (blood aspect) and floating between the muscles; this is governed by the Foot-Yangming Stomach Meridian. Alternatively, cold pathogen sinking into the Yangming meridian, stagnating and transforming into heat, can also cause macules. In all such cases, cooling the blood and resolving toxicity are appropriate. If the macules recede and the acne becomes visible, it is auspicious; otherwise, the skin may ulcerate with macules, the sores may itch easily, and the tender skin may break readily. Furthermore, if red macules form lumps with swollen, hard, and knotted flesh, it is named Danliu (red tumor/abscess). The toxin here is particularly severe, and the sores will ulcerate before maturing, which is incurable.
1. The method for treating macules generally involves using exterior-releasing and dispersing methods before the macules emerge, and using clearing and purging methods after suppuration. If the entire body is intensely red, the treatment is similar.
2. For mild cases of acne with macules, Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) added with Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix) should be used. For severe cases, Renshen Baihu Tang (Ginseng White Tiger Decoction) combined with Liuwei Xiaodu Yin (Six-Ingredient Toxin-Resolving Drink) is suitable.
3. For cases caused by external wind-cold where the exterior pathogen has not been resolved and macules appear, Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Rescue from Toxicity) is indicated, or one may add Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix).
4. If the macules are purple-red and accompanied by constipation, Sishun Qingliang Yin (Four-Obedience Clearing and Cooling Drink) should be used to promote bowel movement. Once the macules have receded, Si Jun Zi Tang (Four Gentlemen Decoction) or similar formulas should be used immediately to strengthen the spleen, thereby preventing the pathogen from sinking inward.
Master Cheng stated: In treating acne with macules, it is urgent to cool the blood and resolve toxicity. Use Qianghuo San (Notopterygii Rhizoma Decoction) added with Jiuchao Shaoyao (Wine-fried Paeoniae Radix), Zicao (Arnebiae seu Lithospermi Radix), Honghua (Carthami Flos), Chantui (Cicadae Periostracum), Mutong (Akebiae Caulis), Guangui (Cinnamomi Cortex), and Nuomi (Oryza Sativa Glutinosa), administered continuously for several doses. After the macules recede, Baoyuan Tang (Preserve the Origin Decoction) added with Muxiang (Aucklandiae Radix) and Doukou (Amomi Fructus Rotundus) should be decocted and taken to counteract the cold nature of Zicao (Arnebiae seu Lithospermi Radix) and prevent diarrhea. If acne is accompanied by papules, the treatment is the same; however, if delayed, it may transform into black macules, which become difficult to treat.
5. If macules appear after the acne has formed scabs, this indicates residual toxins boiling the blood level, inevitably leading to ulceration. Huanglian Jiedu Tang (Coptidis Decoction to Resolve Toxicity) added with Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Huangqin (Scutellariae Radix), and Shigao (Gypsum Fibrosum) is indicated. In severe cases, Da Lianqiao Yin (Large Forsythia Decoction) may be used. If internal heat-toxin steams and boils, resulting in foul-smelling pus and blood in the stool along with macules, this is a syndrome of stomach rot, which is incurable.
6. For macules that have ulcerated, Jiuku Mieban San (Bitter-Saving Scar-Removing Powder) should be applied externally.