（热病发斑同此）
发斑因失于汗下。热毒内攻。不得散。蕴于胃腑。而发出肌表。或汗下不解。足冷耳
聋。胸中烦闷。咳嗽呕逆。躁热。起卧不安者。便是发斑之候。春至温病之人。更遇
时热。为未至而至之异气。变为温毒。王叔和云。阳脉洪数。阴脉实大。更感温湿。
变为温毒。伏温与时热交并。表里俱热。温热为病最重也。其脉浮沉俱盛。其证
心烦闷。呕逆喘咳。甚则面赤。身体俱赤色。狂乱躁渴。咽肿痛。狂言下利而发斑。
最为危候。斑如锦纹。身热烦躁。大便燥结者。黄连解毒汤。
若躁闷狂妄而无汗者。三黄石膏汤。
自汗烦渴而发斑。为胃热。人参化斑汤。
烦热错语不眠。白虎合黄连解毒汤。
斑不透。犀角大青汤。已透热不退。本汤去升麻、黄芩。加人参、生地黄、柴胡。凡斑色
紫者为危候。黄连解毒合犀角、地黄。然须与病家言过而用。以此证虽药。十中
仅救二三。若黑色而下陷者。必死也。
发斑虽禁下。若大便秘。躁渴色紫者。可微下之。
若发斑已尽。外势已退。内实不大便谵语。小剂凉膈散。或大柴胡微下之。
凡发斑红赤者为胃热。紫为胃伤。黑为胃烂也。大抵鲜红起发者吉。虽大不妨。稠
密成片紫色者。半死半生。杂色青紫者。十死不一生矣。凡斑既出。须得脉洪数
有力。身温足暖者易治。若脉小足冷。元气虚弱者难治。狂言发斑。大便自利。或
短气燥结不通。而黑斑如果实 者。皆不治。
（热病出现斑疹的情况与此相同）
发斑是由于未能及时使用发汗或攻下法治疗，导致热毒内陷，无法消散，蕴结在胃腑，进而外发于肌肤表面。如果经过发汗或攻下治疗后病情仍未缓解，出现脚冷、耳聋、胸中烦闷、咳嗽呕吐逆气、烦躁发热、坐卧不安等症状，这就是发斑的征候。春季患温病的人，又遇到时令的热邪，这种非其时而有其气的“异气”，会转变为温毒。王叔和说：脉象阳部洪数，阴部实大，再感受温湿之邪，就会变为温毒。伏藏的温邪与时令热邪相互搏结，表里都发热，这是温热病中最严重的类型。其脉象浮取沉取均盛大，症状表现为心烦闷乱、呕吐逆气、气喘咳嗽，严重时面色发红，全身皮肤赤红，狂乱躁动口渴，咽喉肿痛，胡言乱语，腹泻并出现斑疹，这是最为危险的征候。斑纹像锦缎上的花纹，身体发热烦躁，大便干燥结硬的，用黄连解毒汤。
如果斑疹透发不畅，用犀角大青汤。如果斑疹已透出但热势不退，用本方去掉升麻、黄芩，加入人参、生地黄、柴胡。凡是斑色呈紫色的属于危重征候，用黄连解毒汤合犀角、地黄。但是必须事先告知患者家属风险后再用药，因为此证虽然用药，十人中仅能救活二三人。如果斑色变黑且向下凹陷的，必定死亡。
发斑虽然禁忌攻下，但如果大便秘结、烦躁口渴、斑色紫暗的，可以轻微攻下。
如果斑疹已经出尽，外部病势已退，但内部实热导致不大便、胡言乱语的，用小剂量的凉膈散。或者用大柴胡汤轻微攻下。
凡是发斑颜色红赤的，属于胃热；紫色表示胃气受损；黑色表示胃烂。大致来说，颜色鲜红且隆起发散的为吉兆，即使面积大也不要紧；稠密成片呈紫色的，半死半生；杂色青紫的，十人之中无一人生还。凡是斑疹发出后，脉象洪数有力的，身体温暖、脚足温暖的，容易治疗。如果脉象细小、脚足冷的，元气虚弱的，难以治疗。胡言乱语并发斑，大便自利（失禁），或者短气、燥结不通，以及斑色黑如果实的，都属于不治之症。
(The occurrence of macules in febrile diseases is similar to this.)
Macules (skin eruptions) occur due to the failure to apply sweating or purgative methods in time. Heat-toxin (pathogenic heat accumulating into toxicity) attacks internally and cannot dissipate, stagnating in the Stomach Fu-organ (stomach), and subsequently erupting onto the skin surface. If the condition remains unresolved after sweating or purgation, accompanied by cold feet, deafness, chest oppression and irritability, cough, vomiting and regurgitation, restlessness and fever, and inability to sit or lie still comfortably, these are signs of macules. In spring, patients suffering from warm diseases who encounter seasonal heat may be affected by an "abnormal qi" (atypical pathogenic factor appearing out of season), transforming into warm toxin (warmth-toxin). Wang Shuhe stated: When the Yang pulse (radial artery at the cun position) is flooding and rapid, and the Yin pulse (radial artery at the chi position) is solid and large, combined with the contraction of warm-dampness, it transforms into warm toxin. Latent warmth interacts with seasonal heat, causing heat in both the exterior and interior; this represents the most severe type of warm-heat disease. The pulse is vigorous upon both superficial and deep palpation. Symptoms include mental restlessness and oppression, vomiting and regurgitation, wheezing and coughing. In severe cases, the face turns red, the entire body becomes crimson, there is delirium, extreme restlessness and thirst, soreness and swelling of the throat, incoherent speech, diarrhea, and the appearance of macules. This is a critical prognosis. The macules resemble patterns on brocade. For cases with high fever, irritability, and dry, constipated stool, use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity).
For cases characterized by restlessness, oppression, delirium, and absence of sweat, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction).
For cases with spontaneous sweating, irritability, thirst, and macules, indicating Stomach heat, use Renshen Huaban Tang (Ginseng Macule-Transforming Decoction).
For cases with烦热 (vexing heat), incoherent speech, and insomnia, use Baihu Tang (White Tiger Decoction) combined with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity).
If the macules fail to erupt fully, use Xijiao Daqing Tang (Rhinoceros Horn and Isatis Decoction). If the macules have erupted but the fever persists, remove Shengma (Cimicifugae Rhizoma) and Huangqin (Scutellariae Radix) from the above formula, and add Renshen (Ginseng Radix et Rhizoma), Shengdihuang (Rehmanniae Radix Recens), and Chaihu (Bupleuri Radix). Any case where the macules are purple indicates a critical prognosis; treat with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) combined with Xijiao (Rhinocerotis Cornu) and Dihuang (Rehmanniae Radix). However, one must warn the patient's family beforehand before administering treatment, as although medication is used, only two or three out of ten patients may be saved. If the macules turn black and sink inward, death is inevitable.
Although purgatives are generally contraindicated in macule formation, if there is fecal impaction, extreme restlessness and thirst, and purple macules, a mild purgative action may be employed.
If the macules have fully erupted and the external pathogenic influence has subsided, yet internal excess causes constipation and delirium, administer a small dose of Liangge San (Cooling the Diaphragm Powder). Alternatively, use Da Chaihu Tang (Major Bupleurum Decoction) to induce mild purgation.
Generally, red and bright macules indicate Stomach heat; purple indicates damage to the Stomach Qi; black indicates necrosis of the Stomach tissue. In general, fresh red macules that rise and spread are auspicious, even if extensive. Dense, patchy purple macules indicate a prognosis of half-life, half-death. Mixed green-purple colors indicate a mortality rate of nearly 100%. After macules appear, if the pulse is flooding, rapid, and forceful, and the body is warm with warm feet, the condition is easy to treat. If the pulse is minute and the feet are cold, indicating deficiency of Yuanqi (Original Qi), the condition is difficult to treat. Delirium accompanying macules, spontaneous diarrhea, shortness of breath, obstinate constipation, or black macules resembling dried fruit are all considered untreatable.