大意
斑属三焦无根之火。疹属心脾湿热之火。其上侵于肺。则一也。（入门）
内因
热则伤血。血热不散。里实表虚。出于皮肤而为斑也。（明理论）
外候
斑势掀发微肿。有色痕而无头粒。小者如芝麻。大者如芡实。轻者如星布。重者如锦纹。其赤色者。胃热也。
紫黑者。胃烂也。（例略）或有青蓝色者。见则不治。要知赤斑。半死半生。黑斑。九死一生。（正传）针头稠密者凶。
喘促自汗者死。气实足暖者易治。气怯足冷者难医。自胸腹散四肢者可治。自四肢入于腹者不治。将发
之先。先自吐泻者吉。既发之后。久泻不止者凶。（汇补）
外感发斑
有伤寒发斑。有时气发斑。有阳毒发斑。有温毒发斑。四症之中。温毒为重。皆因热邪在表。不当下而下之。
乘虚入胃。或热邪在里。胃热不泄。二者皆能发斑也。（三因）初起。必有头疼身热之表症。先宜辛凉彻其表。
后用寒凉清其中。（入门）
内伤发斑
内伤发斑。轻如蚊迹。多在手足。初起无头疼身热表症。（入门）乃劳役过度。胃气虚极。一身之火。游行于外。
或他症汗吐下后。中气虚乏。余邪无所归附。散于肌表。宜补宜降。不可妄行凉药。大建中汤。（指掌）
阴症发斑
阴症发斑。亦出胸背手足。但稀少而淡红。如蚊迹之状。此名阴斑。终不似阳斑之红显。因肾气太虚。阴盛
于下。迫其无根之火。聚于胸中。上熏肺分而为斑。若误作热症而用凉药者。非。宜调中汤温胃。其火自降。
而斑自退。（指掌）
发疹内因
疹属热与痰在肺。发则痒 不仁。多兼风湿之殊。（心法）
发疹外候
疹有豆粒。或如粟米。或如蚊迹。或随出随没。或没而又出。红靥隐密皮肤。不透出者。为瘾疹。颗粒显透皮
肤为痧疹。初起必兼鼻塞流涕。声重咳嗽。头疼胸闷。发热自汗。更有风邪拥肺。气急鼻煽。咳不能卧。先用
润肺利邪之品。后变潮热。而头不疼。胸已快。惟咳嗽气急如故。此因本气素虚。肺邪虽解。而阴火乘旺也。
脉大者。宜滋阴清肺。断不可误投参、 酸敛。以致不救。（汇补）
赤白瘾疹
赤疹因热。燥气乘之。稍凉则消。白疹因寒。冷气折之。稍暖则消。似白似赤。微黄隐于肌肉之间。四肢重着。
此脾经风热挟湿也。多因沐后感风。与汗出解衣而得。（入门）
脉法
斑疹郁热。或伏或绝。或细或散。斑疹热盛。阳浮而数。阴实而大。大率洪数有力者生。沉小无力者死。
治法
疹宜凉解。斑宜清火。痒者祛风。痛者清热。（绳墨）又斑疹并出者。不可纯用风药。恐变痰嗽渴呕疮疡。（汇补）
用药
外感斑势未透。升麻玄参汤发之。已透。人参化斑汤清之。内伤发斑。调中益气汤敛之。风热发疹。消风百
解散散之。疹毒未解。鼠粘子汤清之。脾家风湿发疹。用黄瓜水调伏龙肝散服。
外治法
凡斑欲出未透。用干葛、蝉蜕、苏叶煎汤揩之。或葱白擦。或姜汁喷。使斑势掀发为度。
又法 痧疹发不出。气急鼻煽者。用芫荽捣烂。同酒浆研匀。热揩头面胸背。盖暖自愈。内服西河柳。阴干。
大剂与之。名曰独胜散。
斑疹选方
人参化斑汤 治外感阳实发斑。势如锦纹。
人参（一钱） 知母（二钱） 石膏（五钱） 甘草（一钱） 粳米（一撮）
水煎。
升麻玄参汤 治外感热甚发斑。隐隐未透。
升麻 玄参 干葛 甘草（等分）
水煎。
调中益气汤 治内伤胃气虚而邪火为斑。
黄 人参 甘草 当归 白术（各五分） 白芍 柴胡 升麻（各三分） 橘皮 五味（三粒）
水煎服。
调中汤 治阴斑。
苍术 陈皮 砂仁 藿香 甘草 芍药 桔梗 半夏（各八分） 白芷 羌活 川芎 麻黄 桂枝 枳壳（各七分）
水姜煎。
大建中汤 治阴虚阳气衰而浮越为斑。
黄 当归 桂心 芍药（各二钱） 人参 甘草（各一钱） 半夏 附子（各五分） 生姜 枣子
水煎。
消风百解散 治风热不散。郁于皮肤而为斑。
荆芥 防风 白芷 羌活 陈皮 川芎 蝉蜕 苍术 柴胡 甘草（各等分）
生姜、葱白。水煎。
鼠粘子汤 治疹发不彻。无里症者。
鼠粘子（上） 荆芥穗（中） 甘草（下） 防风（下）
防风通圣散 治瘾疹热甚。状如斑形。稠密不消。用此清表彻里。（方见火症）
【附妊妇斑疹】
妊妇发斑。先用透解。次用清热。不可泥胎孕。执用养血。盖血药凝滞。斑毒不能外透。每致缠绵变症。若已
透而内热未消。恐热侵胎元。宜护胎涂脐法。（汇补）
妊妇发疹。宜清肺透表。亦不可用血药以治疹邪。亦不可用燥药以助疹热。（汇补）
涂脐护胎法 治妊妇外感发斑已透。热未止。恐热入子宫。用此涂之。
以井底泥涂脐以下二寸余。以绵护之。良久再易。
【大意】
斑属于三焦中无根之火。疹属于心脾湿热之火。当它们上侵于肺时，病机是一样的。（出自《入门》）
【内因】
热邪会损伤血液。血热郁结不散，导致里实表虚，邪气出于皮肤而形成斑。（出自《明理论》）
【外候（临床表现）】
斑的形态隆起肿胀，有色泽痕迹但没有颗粒头。小的像芝麻，大的像芡实。轻症像星星散布，重症像锦缎上的花纹。颜色发赤的，是胃热所致。
颜色紫黑的，是胃烂（胃腑严重受损）的表现。（出自《例略》）如果有出现青蓝色的，见到这种征象则难以治愈。必须知道，赤色斑疹，预后半死半生；黑色斑疹，九死一生。针头般大小且稠密的凶险。
伴有气喘急促、自汗的是死证。正气充足、足部温暖的是易治之证。正气虚弱、足部寒冷的是难医之证。斑从胸腹向四肢散开的是可治之证。斑从四肢向内传入腹部的是不治之证。在斑疹将要发出之前，先出现呕吐腹泻的是吉兆。斑疹发出之后，长期腹泻不止的是凶兆。（出自《汇补》）
【外感发斑】
有伤寒引起的发斑，有时气（流行性疫病之气）引起的发斑，有阳毒引起的发斑，有温毒引起的发斑。这四种病症中，温毒最为严重。都是因为热邪在体表，本不应使用下法却误用了下法，导致邪气乘虚进入胃腑；或者是热邪在体内，胃热无法宣泄。这两种情况都能导致发斑。（出自《三因方》）初起时，必定有头痛、身热的表证。先用辛凉药物解除表邪，后用寒凉药物清解里热。（出自《入门》）
【内伤发斑】
内伤引起的发斑，症状轻微如蚊咬痕迹，多出现在手足部位。初起时没有头痛、身热等表证。（出自《入门》）这是由于过度劳累，胃气极度虚弱，全身之火游行于体表之外。或者是其他病症经过发汗、催吐、泻下治疗后，中气虚乏，残余邪气无处依附，散在于肌表。治疗应当宜补益、宜降逆，不可妄用寒凉药物。可用大建中汤。（出自《指掌》）
【阴症发斑】
阴症引起的发斑，也出现在胸背和手足，但数量稀少且颜色淡红，状如蚊咬痕迹。这称为阴斑，终究不像阳斑那样红显。这是因为肾气太虚，阴寒盛于下部，逼迫无根之火聚集于胸中，向上熏蒸肺分而发为斑。如果误当作热症而使用寒凉药物，是错误的。应当用调中汤温养胃气，火气自然下降，斑疹自然消退。（出自《指掌》）
【发疹内因】
疹属于热与痰在肺脏。发作时瘙痒且感觉迟钝（不仁），多兼夹风湿的不同性质。（出自《心法》）
【发疹外候】
疹子有豆粒大小的，或像粟米，或像蚊咬痕迹，有的随出随没，有的退了又出。红色隐密在皮肤之下、不透出的，称为瘾疹。颗粒明显透出皮肤的，称为痧疹。初起时必定兼有鼻塞流涕、声音重浊咳嗽、头痛胸闷、发热自汗等症状。更有风邪壅塞肺部，导致气急鼻煽，咳嗽不能平卧。先用润肺祛邪的药物，后来转变为潮热，且头痛消失，胸部舒适，只有咳嗽气急依旧。这是因为患者本身体质素虚，虽然肺邪已解，但阴火反而旺盛。脉象大的，应当滋阴清肺，绝对不可误投人参及酸敛药物，以免导致不可挽救的后果。（出自《汇补》）
【赤白瘾疹】
赤疹因热，燥气侵袭它，稍加凉爽即可消退。白疹因寒，冷气折损它，稍加温暖即可消退。颜色似白似赤，微黄隐于肌肉之间，四肢沉重。这是脾经风热挟湿所致。多因沐浴后感风，以及出汗后脱衣受凉而得。（出自《入门》）
【脉法】
斑疹郁热，脉象或伏或绝，或细或散。斑疹热盛，阳脉浮数，阴脉实大。大体上，脉象洪数有力者生，沉小无力者死。
【治法】
疹宜凉解，斑宜清火。痒的祛风，痛的清热。（出自《绳墨》）另外，斑疹并发的，不可纯用风药，恐怕变生痰嗽、口渴、呕吐、疮疡等症。（出自《汇补》）
【用药】
外感斑势未透发，用升麻玄参汤发散。已经透发，用人参化斑汤清解。内伤发斑，用调中益气汤收敛。风热发疹，用消风百解散疏散。疹毒未解，用鼠粘子汤清解。脾家风湿发疹，用黄瓜水调服伏龙肝散。
【外治法】
凡是斑欲出而未透发，用干葛、蝉蜕、苏叶煎汤擦拭。或用葱白擦拭，或用姜汁喷洒，使斑势隆起透发为度。
另一种方法：痧疹发不出来，气急鼻煽的，用芫荽捣烂，同酒浆研匀，热敷头面胸背，盖暖后即可自愈。内服西河柳，阴干，大剂量给予，名叫独胜散。
【斑疹选方】
人参化斑汤 治疗外感阳实发斑，斑势如锦纹。
人参（一钱） 知母（二钱） 石膏（五钱） 甘草（一钱） 粳米（一撮）
水煎服。
升麻玄参汤 治疗外感热甚发斑，隐隐未透。
升麻 玄参 干葛 甘草（等分）
水煎服。
调中益气汤 治疗内伤胃气虚而邪火发斑。
黄芪 人参 甘草 当归 白术（各五分） 白芍 柴胡 升麻（各三分） 橘皮 五味子（三粒）
水煎服。
调中汤 治疗阴斑。
苍术 陈皮 砂仁 藿香 甘草 芍药 桔梗 半夏（各八分） 白芷 羌活 川芎 麻黄 桂枝 枳壳（各七分）
加生姜煎服。
大建中汤 治疗阴虚阳气衰而浮越发斑。
黄芪 当归 桂心 芍药（各二钱） 人参 甘草（各一钱） 半夏 附子（各五分） 生姜 枣子
水煎服。
消风百解散 治疗风热不散，郁于皮肤而发斑。
荆芥 防风 白芷 羌活 陈皮 川芎 蝉蜕 苍术 柴胡 甘草（各等分）
加生姜、葱白，水煎服。
鼠粘子汤 治疗疹发不彻底，无里证的。
牛蒡子（上等量） 荆芥穗（中等量） 甘草（下等量） 防风（下等量）
防风通圣散 治疗瘾疹热甚，状如斑形，稠密不消。用此方清表彻里。（方剂见“火症”章节）
【附妊妇斑疹】
孕妇发斑，先用透解法，次用清热法，不可拘泥于胎孕，固执地使用养血药。因为血药性质凝滞，会导致斑毒不能外透，往往导致病情缠绵变生他症。如果已经透发但内热未消，恐怕热邪侵入胎元，宜用护胎涂脐法。（出自《汇补》）
孕妇发疹，宜清肺透表，也不可用血药来治疗疹邪，更不可用燥药以助长疹热。（出自《汇补》）
涂脐护胎法 治疗孕妇外感发斑已透，热未止，恐热邪入子宫，用此法涂抹。
用井底泥涂抹脐以下两寸余处，用绵布保护，过一段时间再更换。
[General Principle]
Macules (Ban, macular rash) belong to the rootless fire of the Sanjiao (Triple Burner). Papules (Zhen, papular rash) belong to the damp-heat fire of the Heart and Spleen. When they invade the Lungs from above, the pathogenesis is the same. (From *Ru Men*)
[Internal Causes]
Heat injures the Blood. When Blood Heat stagnates and does not dissipate, it results in interior excess and exterior deficiency, causing the pathogen to emerge on the skin as macules. (From *Ming Li Lun*)
[External Manifestations]
The tendency of macules is to swell and protrude slightly, showing color traces but no granular heads. Small ones are like sesame seeds, large ones like Euryale seed (Qianshi). Mild cases resemble scattered stars, severe cases resemble brocade patterns. Reddish color indicates Stomach Heat.
Purple-black color indicates rotting of the Stomach (severe damage to the Stomach organ). (From *Li Lüe*) If blue-green color appears, it is untreatable. It must be known that red macules indicate a prognosis of half-dead, half-alive; black macules indicate nine deaths for one survival. Dense, needle-head-sized spots are ominous.
Accompanied by panting, shortness of breath, and spontaneous sweating indicates death. Abundant Qi and warm feet indicate easy treatment. Deficient Qi and cold feet indicate difficult treatment. Spreading from the chest and abdomen to the four limbs is treatable. Entering the abdomen from the four limbs is untreatable. Before eruption, vomiting and diarrhea initially indicate a good omen. After eruption, persistent long-term diarrhea indicates an ominous omen. (From *Hui Bu*)
[Ectogenic Macules]
There are macules caused by Cold Damage (Shanghan), epidemic Qi (Shiqi), Yang Toxin (Yangdu), and Warm Toxin (Wendu). Among these four conditions, Warm Toxin is the most severe. All are caused by heat pathogens in the exterior; if purgatives are mistakenly used when not indicated, the pathogen enters the Stomach via the deficiency. Or, if the heat pathogen is in the interior and Stomach Heat cannot vent, both situations can cause macules. (From *San Yin Fang*) At the onset, there must be exterior symptoms such as headache and fever. Initially, acrid-cool herbs should be used to resolve the exterior, followed by cold-cool herbs to clear the interior. (From *Ru Men*)
[Internally Generated Macules]
Internally generated macules are mild, resembling mosquito bites, mostly appearing on the hands and feet. At onset, there are no exterior symptoms like headache or fever. (From *Ru Men*) This is due to excessive labor causing extreme deficiency of Stomach Qi, allowing the fire of the whole body to wander outside. Or, after other diseases have been treated with sweating, vomiting, or purging, the Middle Qi becomes deficient, and residual pathogens have nowhere to attach, scattering into the muscle layer. Treatment should involve tonification and descending, and cold herbs should never be used recklessly. Da Jian Zhong Tang may be used. (From *Zhi Zhang*)
[Yin Syndrome Macules]
Macules caused by Yin syndrome also appear on the chest, back, hands, and feet, but are sparse and pale red, resembling mosquito bites. This is called Yin Macule. It is ultimately not as vividly red as Yang Macule. This is because Kidney Qi is too deficient, Yin-Cold is abundant below, forcing the rootless fire to gather in the chest, steaming upwards into the Lung region to form macules. If mistakenly treated as a heat condition using cold herbs, it is incorrect. One should use Tiao Zhong Tang to warm the Stomach; the fire will naturally descend, and the macules will recede. (From *Zhi Zhang*)
[Internal Causes of Rash Eruption]
Rash belongs to Heat and Phlegm in the Lungs. Upon eruption, it causes itching and insensitivity (lack of sensation), often accompanied by wind-damp variations. (From *Xin Fa*)
[External Manifestations of Rash]
Rashes may be bean-sized, millet-sized, or like mosquito bites. Some appear and disappear quickly, others disappear and reappear. Red rashes hidden within the skin without emerging are called Urticaria (Yinzhen). Granules clearly penetrating the skin are called Sha Zhen (Scarlet-like rash). At onset, there must be accompanying nasal congestion, runny nose, heavy voice, cough, headache, chest fullness, fever, and spontaneous sweating. Furthermore, wind pathogens congesting the Lungs cause rapid breathing and nasal flaring, coughing preventing lying down. Initially, use moistening-the-Lung and expelling-pathogen herbs. Later, tidal fever develops, headache ceases, chest feels comfortable, but cough and rapid breathing persist. This is because the patient's original Qi was always deficient; although the Lung pathogen is resolved, Yin Fire becomes vigorous. If the pulse is large, nourish Yin and clear the Lungs. Absolutely do not mistakenly administer Ginseng or sour-astringent herbs, which would lead to untreatable conditions. (From *Hui Bu*)
[Red and White Urticaria]
Red rash is due to Heat; dry air attacks it, and slight cooling makes it subside. White rash is due to Cold; cold air damages it, and slight warming makes it subside. Color appearing neither white nor red, slightly yellow, hidden between muscles, with heavy limbs. This is Wind-Heat of the Spleen channel carrying Dampness. It is often obtained from catching wind after bathing, or taking off clothes while sweating. (From *Ru Men*)
[Pulse Diagnosis]
For macules and rashes with stagnant heat, pulses may be deep/fixed (Fu), absent (Jue), fine (Xi), or scattered (San). For macules and rashes with intense heat, the Yang pulse is floating and rapid, and the Yin pulse is solid and large. Generally, a洪 (Hong/Surging) and rapid pulse with strength indicates life; a deep (Chen) and small pulse without strength indicates death.
[Therapeutic Methods]
Rash should be cooled and resolved; macules should have their fire cleared. Itching requires dispelling wind; pain requires clearing heat. (From *Sheng Mo*) Additionally, when macules and rashes occur together, wind-dispelling herbs should not be used purely, lest they transform into phlegm-cough, thirst, vomiting, or sores/ulcers. (From *Hui Bu*)
[Medication Usage]
For ectogenic macules not yet fully erupted, use Shengma Xuanshen Tang to promote eruption. Once erupted, use Renshen Huaban Tang to clear them. For internally generated macules, use Tiaozhong Yiqi Tang to consolidate. For wind-heat rash, use Xiaofeng Baijie San to disperse. For unresolved rash toxin, use Niubangzi Tang to clear. For Spleen-related wind-damp rash, take Fulonggan San mixed with cucumber juice.
[External Treatments]
Whenever macules desire to erupt but have not done so, use Puerariae Radix (Gegen), Bombyx Batryticatus (Chantui), and Perilla Leaf (Suye) decoction to wipe the skin. Or rub with scallion white, or spray with ginger juice, until the macules swell and erupt.
Another method: For Sha Zhen that cannot erupt, accompanied by rapid breathing and nasal flaring, crush Coriandrum Sativum (Yuansu), mix evenly with wine/grain mash, apply hot compresses to the head, face, chest, and back. Cover warmly to heal spontaneously. Internally, give Xihe Liu (Tamarix Herba), dried in shade, in large doses. This is named Duseng San.
[Selected Formulas for Macules and Rashes]
Renshen Huaban Tang (Ginseng Decoction for Transforming Macules)
Indications: Ectogenic Yang-excess macules, appearance like brocade patterns.
Ingredients: Renshen (1 qian), Zhimu (2 qian), Shigao (5 qian), Gancao (1 qian), Jingsmi (a pinch).
Preparation: Decoct in water.
Shengma Xuanshen Tang (Kudzu and Scrophularia Decoction)
Indications: Ectogenic intense heat causing macules, faint and not yet fully erupted.
Ingredients: Shengma, Xuanshen, Gegen, Gancao (equal parts).
Preparation: Decoct in water.
Tiaozhong Yiqi Tang (Regulate Middle and Boost Qi Decoction)
Indications: Internal injury with deficient Stomach Qi causing macules from evil fire.
Ingredients: Huangqi, Renshen, Gancao, Danggui, Baizhu (each 5 fen), Baishao, Chaihu, Shengma (each 3 fen), Chenpi, Wuweizi (3 grains).
Preparation: Decoct in water and take.
Tiaozhong Tang (Regulate Middle Decoction)
Indications: Yin macules.
Ingredients: Cangzhu, Chenpi, Sharen, Huoxiang, Gancao, Shaoyao, Jiegeng, Banxia (each 8 fen), Baizhi, Qianghuo, Chuanxiong, Mahuang, Guizhi, Zhike (each 7 fen).
Preparation: Decoct with fresh ginger.
Da Jian Zhong Tang (Great Construct the Middle Decoction)
Indications: Yin deficiency with declining Yang floating outward causing macules.
Ingredients: Huangqi, Danggui, Guixin, Shaoyao (each 2 qian), Renshen, Gancao (each 1 qian), Banxia, Fuzi (each 5 fen), Shengjiang, Zaozi.
Preparation: Decoct in water.
Xiaofeng Baijie San (Eliminate Wind Hundred-Resolve Powder)
Indications: Wind-heat not dispersing, stagnating in the skin causing macules.
Ingredients: Jingjie, Fangfeng, Baizhi, Qianghuo, Chenpi, Chuanxiong, Chantui, Cangzhu, Chaihu, Gancao (equal parts).
Preparation: Add Shengjiang and Congbai, decoct in water.
Niubangzi Tang (Arctium Decoction)
Indications: Rash not fully erupted, without interior syndrome.
Ingredients: Niubangzi (upper grade amount), Jingjiesui (medium grade amount), Gancao (lower grade amount), Fangfeng (lower grade amount).
Fangfeng Tongsheng San (Saposhnikovia Unblocking and Rescuing Decoction)
Indications: Urticaria with intense heat, resembling macule shape, dense and not subsiding. Use this to clear the exterior and penetrate the interior. (Formula see "Fire Syndromes" chapter)
[Appendix: Macules and Rashes in Pregnant Women]
When pregnant women develop macules, first use resolution/promotion methods, then clear heat. Do not stick to the pregnancy and insist on using blood-nourishing herbs. Because blood herbs are cloying/stagnant, they prevent the macule toxin from externalizing, often leading to lingering and complicated syndromes. If already erupted but internal heat remains, fearing heat invading the fetal source, use the Umbilical Smearing Fetal Protection Method. (From *Hui Bu*)
When pregnant women develop rashes, clear the Lungs and promote the exterior. Do not use blood herbs to treat rash pathogens, nor drying herbs to assist rash heat. (From *Hui Bu*)
Umbilical Smearing Fetal Protection Method
Indications: Pregnant women with ectogenic macules already erupted, heat not stopped, fearing heat entering the uterus. Apply this smearing method.
Method: Apply mud from the bottom of a well to the area two inches below the umbilicus. Protect with cotton cloth. Change after a while.