【因】凡伤寒当汗不汗。当下不下。热毒蕴于胃中。血热气盛。从肌透肤而外溃。
乃发 。即温毒、热病、发 者。亦由于血热毒盛而发。此皆谓之阳证发 。有 疹并
发者。甚有 疮并发者。鲜红者为胃热。紫红者为热甚。紫黑者为胃烂。先发于胸背两胁脘腹
。续发于头面项颈四肢。若先由房劳太过。内伤肾阴。及凉遏太过。（如多服凉药
恣食生冷等）内伤脾阳。一经新感寒气。逼其无根失守之火。上熏肺经。浮游于皮肤而
发点者。此皆谓之阴证发 。亦谓之虚 。其形如蚊蚤虱咬痕。稀少而色多淡红。或淡
白微红。亦有淡黑色而仅发于两腰小腹之间者。故发 必察其虚实寒热四端。为临病求源
之首要。
【证】阳证发 。新感伤寒为轻。伏气热病较重。时行温毒尤重。伤寒应汗失汗。其
当欲出未出之际。证尚头疼体痛。壮热无汗。微恶风寒。胸闷不舒。舌苔黄白相兼。
或白薄微燥。边尖已红。应下失下。其 当欲出未透之时。证必热壮脘闷。躁扰不安。
头疼鼻干。咽干口燥。呻吟不寐。便闭溺涩。舌苔由白转黄。轻则嫩黄薄腻。重则深黄
带灰。热病发 。急则发热一二日便出。缓亦发热四五日而出。浅则鲜红起发。松浮皮
面。深则紫赤稠密。坚束有根。证必胸膈烦闷。热壮神昏。呕恶不纳。咽痛喉肿。渴喜
冷冻饮料。口秽喷人。舌苔正黄。轻浅者。黄而糙涩。舌质鲜红。深重者。黄夹灰点。舌本
紫红。温毒发 。当 毒内伏之际。证反身热不扬。神识不清。糊言妄笑。甚或昏厥如
尸。舌苔灰黑。中心黑晕。在 毒暴出之时。每多 疹并发。或 夹 疮。剧则皮肤统
红。 如针头稠密。紫黑成片。或杂烂 黑烂。证必面红咽痛。喉疼赤肿。甚则起腐。
目赤唇焦。脘闷烦灼。大渴引饮。口开吹气。臭秽喷人。耳聋足冷。便闭溺赤。神昏谵
语。甚或不语如尸厥。舌紫苔黄。或黄腻带灰。甚则焦紫起瓣。或见黑晕。此皆发 浅
深轻重之阳证。有实无虚。若阴证发 。皆属内伤夹外感。内伤脾阳者。 点隐隐而稀
。色多淡红。或夹淡灰。或夹 白。多则六七点。少则三五点。形如蚊迹。只见于手足
。或略见于腹部。似 而实为细疹。证多四肢厥冷。神倦嗜卧。喜向里睡。神识似寐非
寐。乍清乍昧。声低息短。少气懒言。大便多溏。溺色清白。或淡黄。舌苔白而嫩滑。
或胖嫩而黑润。内伤肾阴者。 多淡黑而枯。或淡白而嫩。多者十余点。少者八九点。
多发于两腰及少腹部。证多头晕目眩。或头重难举。或目闭畏光。耳鸣似聋。两颧嫩红
。腰酸足冷。精神衰弱。五液干枯。甚则筋惕肉 。手足微微螈 。男多精滑梦遗。
女多带下腰重。舌形圆嫩胖大。苔色淡黑而少津。或舌红而苔如烟煤隐隐。或舌紫绛而
圆。虽干无刺。或紫而
鲜润。间有微白苔。此皆似 非 之阴证。多虚少实。总之发 形状。并无点粒高起。以
手摸之。皆平贴于皮肉之间。不拘或大或小。总无碍手之质。但有触目之形。红色成片
。稠如锦纹者。属胃热血毒。毒盛者色红而紫。毒重者色黑而青。色淡不鲜稀如蚊迹者。
属虚多邪少。气虚者色淡微红。阴虚者色淡微黑。必先辨其病状之寒热虚实。以定病势之
轻重吉凶。（荣斋按。后段的总结。是辨证要诀）。
【脉】左浮弦而急。右浮洪而滑者。此客寒包火。当汗不汗。热毒乘隙而发 也。
右洪盛滑数。数大过于左手者。此胃热大盛。当下不下。火毒外溃而发 也。右长大滑
数。左亦浮弦搏数者。此胃中血热大盛。毒邪传遍三焦而发 也。脉伏而 亦伏。 现
而脉亦现者。此胃中血毒壅结。瘀热凝塞营卫而伏 。 出必夹丹疹。甚则夹发豌豆疮
也。右浮濡而虚。左沉涩欲绝者。此阳为阴逼。不走即飞。故淡红 微发于四肢大腹。
陶节庵所谓内伤寒发 也。左细数而急。右浮大而空者。此阴被阳销。非枯则槁。故淡
黑点微发于两腰少腹。陈念义所谓肾阴虚发 也。总之凡 既出。脉洪滑有力。手足
温而神识清爽者。病势顺而多吉。脉沉弱无神。四肢厥而神识昏沉者。病势逆而多凶。
（荣斋按。后段总结是察脉辨证要诀。）
【治】伤寒应汗失汗者。宜与透 解毒汤（方载疫疟治法中）加生葛根（一钱至钱
半）、辛凉解肌以发表。速使 与汗并达。应下失下者。宜与柴芩清膈煎。去柴胡、加
生葛根（一钱）、炒牛蒡（三钱）、活水芦笋（二两）、鲜茅根（一两、上二味煎汤代
水）、开上达下以清中。务使 与便并出。热病发 。便通者。新加白虎汤。加青连翘、
炒牛蒡（各三钱）。辛凉透 以泄热。便闭者。白虎承气汤。加连翘牛蒡（各三钱）。
活水芦笋、
鲜野菰根尖（各二两、煎汤代水），表里双解以逐热。温毒发 。便通者。宜与犀羚竹
石汤。（方载赤膈治法中）加活水芦笋（二两）、大青叶（五钱）、清凉解毒以透 。
便闭者。解毒承气汤加紫雪。直攻三焦以逐毒。阴证发 。内伤脾阳。阳为阴逼者。缓
则参附三白汤。（老东参、生白术、白茯苓、炒白芍各钱半、黑附块一钱、清炙草八
分、生姜两片、大红枣二枚）。补中益气以扶阳。急则回阳急救汤。益气固脱以追阳。
陶氏引用调中汤。辛散之品太多。反速虚阳外越。未免方不对证。慎勿妄投。内伤肾阴
。阴被阳消者。龟柏地黄汤。滋肾益阴煎。酌用二方以清滋之。若因房劳及阴阳易。热
入精室者。则以陶氏逍遥汤加减之。此二者。皆虚 证。均不必见 治 。总而言之。
凡见 不可专以 治。必须察脉之浮大滑数。沉弱涩微。病患之气血虚实。病状之寒热
湿燥。而分别用药。随证制方。此治 之要诀也。
【秀按】伤寒证汗下适宜。温热病清解得法。邪不壅塞。并不发 。即有隐隐见点
者。亦惟疹子居多。孙络血热者多发红疹。膜留湿热者多发白疹。（白疹后人改曰白
、其实 是疹之俗称。）今世俗通称发 伤寒者。实因发疹误作发 耳。或有发 。大
率由温热兼寒。初起不敢用辛凉开达。仍拘守伤寒成法。恣用辛温燥烈之药。强逼邪热
走入营中而发。故凡伤寒发 。多由于汗下失当。温热发 。多由于应清失清。皆由邪
遏于胃而热蒸成 。如果初治不误。何致成 。惟温毒热疫两证。必发 疹。若已成
。当其将发未发之际。首必辨其症候。凡若汗若清若下后。邪仍不解。其人壮热无汗
。胸膈烦闷。喘嗽呕恶。起卧不安。呻吟不寐。耳聋足冷。两寸关脉躁盛。甚或沉伏。
便是 点欲出之候。及其既出。先将红纸蘸香油燃着。照看病患面部、背心、胸膛、四
肢。有大红点平铺于皮肤之上。谓之 。若小红点突起于皮肤之上。谓之疹。 大而疹
小。 平而疹突。 重而疹轻。 夹丹疹并发者重。 夹豌疮并发者尤重。黑 如果实
靥。蓝 如烂青果。极重而必死不
治。至其治法。总以凉血宣气。解毒透 为首要。凉血如犀角、羚角、大青叶、鲜生地
、鲜茅根、青蒿脑、紫草、丹皮、山栀、元参之类。宣气如葱白、豆豉、葛根、薄荷
、嫩桑芽、水芦笋、菰根尖、青箬叶、鲜竹叶卷心、鲜石菖蒲叶之类。解毒如净银花、
鲜菊叶、鲜蒲公英、紫花地丁、生绿豆汁、莹白金汁、人中黄、尿浸石膏。大黑木耳、
紫金锭片之类。透 如牛蒡、连翘、蝉衣、僵蚕、角刺、钩藤钩、刺蒺藜、鲜西河柳叶
之类。（蒺藜河柳二味、配入于清凉药中、善能循经速达、提 最捷、切勿嫌其性温透
、弃而不用。）如 伏而不出。嵌于肉里。非略佐以升麻细辛之升窜。 毒终不得速透
。若毒蕴便闭。又当以解毒承气、犀连承气等汤速下之。必里气通而伏 随出。如果内
伤脾阳。气虚下陷。脉虚大无力者。则以补中益气汤、人参三白汤等。升补中气以提透
之。内伤肾阳。阳被阴遏。脉沉细或沉微者。则以真武汤加高丽参、鹿角尖。通脉四逆
汤加人参、鹿茸。温化阴凝以补托之。二者必阳气通而虚 乃出。盖温毒证内邪壅结。
得凉泻药。疏通其里而 出。与虚寒证阴气寒凝。得温补药。鼓舞其阳而 出。其法虽
殊。其理则一。若脾肾阴虚。冲任阴虚。则以张氏补阴益气煎。陶氏逍遥汤二方为主。
随证加减。一则峻补其下。疏启其中。一则清补其阴。疏启其气。得屡次补托滋垫。而
虚始出。又与阴证发 。得温补以鼓舞而出。同一理也。故凡治 。必察病患元气虚
实。阴阳盛衰。先其所因。辨其现证。察其色脉。庶免草率误人之弊。俞君治 方法。
大致已备。学人由此而推展之。足以尽治 之精微矣。
【廉勘】前清光绪时名医陆九芝。着《丹痧 疹》辩。独操己见。爰节述其说曰。
丹痧 疹四者。丹与 类。痧与疹类。痧轻而丹重。疹轻而 重。丹与 皆出于肤。
平而成片。痧与疹皆高出于肤而成点。痧自痧。丹自丹也。浑言之则通曰痧。亦疹自疹
。自 也。浑言之则通曰疹。而痧之原出于肺。因先有痧邪而始发表热。治痧者当治
肺。以升达为主。而稍佐以清凉。疹之原出于胃。因表热不解。已成里热。而蕴为疹邪
。治疹者当治
胃。以清凉为主。而稍佐以升达。痧于当主表散时。不可早用寒泻。疹于当主苦泄时。不
可更从辛散。大旨升达、主升葛柴之属。清凉、主芩栀桑丹之属。惟宗仲景葛根芩连一
法。出入增减。（方用升、葛、翘、蒡、柴、芩、桅、草、银花、赤芍、元参、或加蚕
、蝉、河柳、升散清凉合法。）则于此际之细微层折。皆能曲中而无差忒。此治痧疹之
要道也。自来治此证者。主辛散则禁寒泄。主寒泄则禁辛散。故两失之。至不仅为痧
与疹而为丹为 。则皆里热之甚。惟大剂寒药。（须用石膏、切忌犀角）。乃克胜任。
非第痧疹之比矣。有是四者脘必闷。四者之齐与不齐。以脘闷之解与未解为辨。有是四
者热必壮。四者之解与不解。以汗出之透与未透为辨。故当正治痧疹时。必兼行升清两
法。表里交治。务使痧疹与汗并达。惟痧疹当发出之际。病患每闷极不可耐。稍一辗转
反侧。其点即隐。病邪反从内陷。此正不必有外来之风也。即袖端被角间略有疏忽。其
汗便缩。一缩之后。旋即周身皆干。此时厥有二弊。一则汗方出时。毛孔尽开。新风易
入。一则汗已大出。不可再汗。非特痧疹之隐。且津液既泄。热必益炽。后此变端。皆
从此起。病家只道未愈。医家亦但说变病。孰知皆汗不如法之故耶。凡病之宜从汗解者
。无不皆然。而兼痧疹者尤甚。故特于此发之。其言如此。窃思痧即麻疹之俗称。故邵
仙根前哲。谓疹即痧 一类。实时毒入肺经而发。邪盛者。点子稠密。肌肤微肿而稍痒
。有红白二种。邪入营者红疹。邪入卫者白疹。大忌冒风凉遏。犯则肺闭内陷。发喘而
死。治法不外辛凉清透。宣肺化邪。观此。则痧与疹二而一。均当横开以轻宣肺气。肺
气宣。则痧疹自从皮肤外出。且其证每兼咽喉肿痛。咳嗽气逆。岂可用升柴葛一意直
升。独不虑其肺痹气喘而死耶。方中宜去升、柴、黄芩、三味。加芦笋、通草、灯心。
斯合轻扬清透之法矣。至其所谓丹与 。皆由里热之甚。法当大剂寒泻。其说甚善。但
谓须用石膏。切忌犀角。将古来犀角大青汤（犀角二钱半、大青五钱、栀子十枚、香豉
一撮。）之治 毒热甚。心烦咽痛。犀角元参汤（犀角、元参、大青、升麻、射干、黄
芩、人参、生甘草、加连柏山栀、去射干人参、亦名犀角大青
汤。）之治发 毒盛。心烦狂言。消毒犀角饮（犀角、牛蒡、荆芥、防风、薄荷、大青
、连翘、桔梗、生甘、内热加芩连。）之治发 瘾疹。咽喉肿痛。一概抹煞。未免执
一偏之见矣。惟余师愚《疫疹一得》。详辩 疹。确有见地。足为近今猩红热疫之标准
。今特节述其说曰。古人言热未入胃。早下之。热乘虚入胃。故发 。热已入胃。不
即下之。胃热不得泄。亦发 。此指伤寒化热。误下失下而言。若疫证未经表下。不一
二日而即发 疹者。若迟至四五日而仍不透者。非胃虚受毒愈深。即发表攻里过当。至
论赤者胃热极。五死一生。紫黑者胃烂。九死一生。余断生死。则又不在 之大小紫黑
。总以其形之松浮紧束为凭。如 一出。松活浮于皮面。红如朱点纸。黑如墨涂肤。此
毒之松活外见者。虽紫黑成片可生。一出虽小如粟。紧束有根。如履透针。如矢贯的。
此毒之有根锢结者。纵不紫黑亦死。其色红而活。荣而润。或淡而润。皆 疹之佳境也
。若淡而不荣。或娇而艳。或干而滞。其血最热。若色深红。较淡红稍重。色紫艳如胭
脂。较深红更恶。色紫赤类鸡冠花。较艳红毒火更盛。色青紫如浮萍之背。多见于胸背
。乃胃热将烂之候。其治法。总宜大清胃热。兼凉血解毒。以清瘟败毒饮为主。（生石
膏、知母、犀角、鲜生地、赤芍、丹皮、栀子、黄芩、连翘、元参、桔梗、生甘、鲜竹
【病因】凡是伤寒病，应当发汗却没有发汗，应当攻下却没有攻下，导致热毒蕴结在胃中。血分热盛，热气蒸腾，从肌肉透达皮肤而向外溃散，于是发出斑疹。即温毒、热病引起的发斑发疹，也是由于血热毒盛而引发的。这些都属于阳证发斑发疹。有的同时并发疹子，甚至有并发疮疡的。颜色鲜红的属于胃热，紫红色的属于热势极盛，紫黑色的属于胃腑腐烂。斑疹先发于胸背、两胁、脘腹部位，随后发于头面、项颈及四肢。如果是因为房事过度，内伤肾阴，以及过用寒凉药物遏制（如多服凉药、恣意食用生冷等），内伤脾阳，一旦新感寒气，逼迫体内无根失守的虚火，上熏肺经，浮游于皮肤而发为斑点，这些都属于阴证发斑发疹。也称为虚斑。其形态像蚊子、跳蚤、虱子咬过的痕迹，稀少且颜色多为淡红，或淡白微红。也有呈淡黑色，仅发于两腰和小腹之间的。因此，治疗发斑发疹必须辨别虚实寒热四个方面，这是临证求本的首要任务。
【症状】阳证发斑发疹：新感伤寒较轻，伏气温病较重，时行温毒尤其严重。伤寒应当发汗却失于发汗，在斑疹将要发出但未完全透发之际，症状尚见头痛身体疼痛，高热无汗，轻微恶风怕冷，胸闷不舒，舌苔黄白相间，或白薄而微燥，舌边尖已红。应当攻下却失于攻下，在斑疹将要透出但未透之时，症状必定高热脘腹胀闷，烦躁不安，头痛鼻干，咽干口燥，呻吟无法入睡，大便闭塞，小便涩痛，舌苔由白转黄，轻则嫩黄薄腻，重则深黄带灰。热病发斑发疹，急症发热一二天就发出，缓症也发热四五天才发出。浅表的斑疹鲜红起发，松浮于皮面；深层的斑疹紫赤稠密，坚实束紧且有根。症状必定胸膈烦闷，高热神志昏迷，呕吐恶心不能进食，咽喉疼痛喉部肿胀，口渴喜欢喝冷冻饮料，口气秽臭喷人，舌苔正黄，轻浅者黄而粗糙干燥，舌质鲜红；深重者黄夹灰点，舌根部紫红。温毒发斑发疹，当毒邪内伏之际，症状反而身热不扬，神识不清，胡言乱语妄笑，甚至昏厥如同死尸，舌苔灰黑，中心有黑晕。在斑疹暴出之时，常常多伴有疹子并发，或斑疹夹杂疮疡。剧烈者皮肤全部通红，斑疹如针头般稠密，紫黑成片，或者杂烂发黑腐烂。症状必定面红咽喉痛，喉咙疼赤肿，甚至起腐，眼睛红赤嘴唇焦裂，脘腹胀闷烦热灼痛，大渴引饮，张口吹气，口臭秽臭喷人，耳聋脚冷，大便闭塞小便赤黄，神志昏迷胡言乱语，甚至不语如同尸厥，舌紫苔黄，或黄腻带灰，甚至焦紫起瓣，或出现黑晕。这些都是发斑发疹深浅轻重不同的阳证，只有实证没有虚证。若阴证发斑发疹，都属于内伤兼外感。内伤脾阳的，斑疹隐隐稀疏，颜色多为淡红，或夹杂淡灰，或夹杂白色，多的六七点，少的三五点，形状像蚊子痕迹，只见于手足，或略微见于腹部，似斑而非斑，实为细疹。症状多四肢厥冷，精神疲倦嗜睡，喜欢向里侧卧，神识似睡非睡，时而清醒时而迷糊，声音低微气息短促，少气懒言，大便多溏泄，小便颜色清白或淡黄，舌苔白而嫩滑，或胖嫩而黑润。内伤肾阴的，斑点多呈淡黑而枯槁，或淡白而柔嫩，多的十余点，少的八九点，多发于两腰及少腹部。症状多头晕目眩，或头重难以抬起，或闭眼畏光，耳鸣如同耳聋，两颧嫩红，腰酸脚冷，精神衰弱，津液干枯，甚至筋肉跳动抽搐，手足微微颤动，男性多见精滑梦遗，女性多见带下腰部沉重，舌形圆嫩胖大，苔色淡黑而少津液，或舌红而苔如烟煤隐隐，或舌紫绛而圆，虽然干燥但没有芒刺，或紫而鲜润，间有微白苔。这些都是似斑非斑的阴证，多虚少实。总之，发斑的形状，并没有颗粒高起，用手摸上去，都平贴于皮肉之间，无论大小，总没有碍手的质地，只有触目的形状。红色成片，稠密如锦纹的，属于胃热血毒，毒盛的颜色红而紫，毒重的颜色黑而青。颜色淡而不鲜艳、稀疏如蚊迹的，属于虚多邪少。气虚的颜色淡微红，阴虚的颜色淡微黑。必须先辨别病状的寒热虚实，以确定病势的轻重吉凶。（徐荣斋按：后段的总结，是辨证的要诀。）
【脉象】左手脉浮弦而急，右手脉浮洪而滑的，这是客寒包火，应当发汗却没发汗，热毒乘隙而发斑发疹。右手脉洪盛滑数，数大超过左手的，这是胃热大盛，应当攻下却没攻下，火毒外溃而发斑发疹。右手脉长大滑数，左手也浮弦搏数的，这是胃中血热大盛，毒邪传遍三焦而发斑发疹。脉伏而斑疹也潜伏不出，斑疹显现而脉也显现的，这是胃中血毒壅结，瘀热凝塞营卫而导致斑疹潜伏，斑疹出来必定夹杂丹疹，甚至夹杂发豌豆疮。右手脉浮濡而虚，左手脉沉涩欲绝的，这是阳气被阴邪逼迫，不走散即飞越，所以淡红色斑疹微发于四肢大腹，陶节庵所说的内伤寒发斑。左手脉细数而急，右手脉浮大而空的，这是阴气被阳气消蚀，不是干枯就是槁竭，所以淡黑色斑点微发于两腰少腹，陈念义所说的肾阴虚发斑。总之，凡斑疹已经发出，脉象洪滑有力，手足温暖而神识清爽的，病势顺遂多吉。脉象沉弱无神，四肢厥冷而神识昏沉的，病势逆乱多凶。（徐荣斋按：后段总结是察脉辨证的要诀。）
【治法】伤寒应当发汗却失于发汗的，宜给予透斑解毒汤（方剂记载在疫疟治法中），加生葛根（一钱至钱半），辛凉解肌以发表，速使斑疹与汗并达。应当攻下却失于攻下的，宜给予柴芩清膈煎，去掉柴胡，加生葛根（一钱）、炒牛蒡子（三钱）、活水芦笋（二两）、鲜茅根（一两，这两味煎汤代水），开上达下以清中焦，务必使斑疹与大便并出。热病发斑发疹，大便通畅的，用新加白虎汤，加青连翘、炒牛蒡子（各三钱），辛凉透斑以泄热。大便闭塞的，用白虎承气汤，加连翘牛蒡子（各三钱）、活水芦笋、鲜野菰根尖（各二两，煎汤代水），表里双解以逐热。温毒发斑发疹，大便通畅的，宜给予犀羚竹石汤（方剂记载在赤膈治法中），加活水芦笋（二两）、大青叶（五钱），清凉解毒以透斑。大便闭塞的，用解毒承气汤加紫雪，直攻三焦以逐毒。阴证发斑发疹，内伤脾阳，阳气被阴邪逼迫的，缓症用参附三白汤（老东参、生白术、白茯苓、炒白芍各钱半、黑附块一钱、清炙甘草八分、生姜两片、大红枣二枚），补中益气以扶阳。急症用回阳急救汤，益气固脱以追阳。陶氏引用的调中汤，辛散之品太多，反而加速虚阳外越，未免方不对证，切勿妄投。内伤肾阴，阴气被阳气消蚀的，用龟柏地黄汤、滋肾益阴煎，酌情选用这两个方剂以清滋之。如果是因房劳及阴阳易，热入精室的，则以陶氏逍遥汤加减。这两种情况，都是虚斑证，都不必专门见斑治斑。总而言之，凡见到斑疹，不可专门以治斑疹为主，必须察脉之浮大滑数、沉弱涩微，病患的气血虚实，病状的寒热湿燥，而分别用药，随证制方，这是治斑的要诀。
【秀按】伤寒证汗下适宜，温热病清解得法，邪气不壅塞，并不发斑。即使有隐隐见点的，也多是疹子居多。孙络血热者多发红疹，膜留湿热者多发白疹。（白疹后人改曰白㾦，其实㾦是疹的俗称。）如今世俗通称发斑伤寒的，实在是因为发疹误作发斑罢了。或者有发斑的，大率由温热兼寒，初起不敢用辛凉开达，仍拘守伤寒成法，恣意使用辛温燥烈之药，强逼邪热走入营中而发。所以凡伤寒发斑，多由于汗下失当；温热发斑，多由于应清失清，都是由邪气遏制于胃而热蒸成斑。如果初治不误，何至于成斑？只有温毒热疫两证，必然发斑发疹。如果已成斑，当其将发未发之际，首先必须辨别症候。凡是经过汗、清、下之后，邪气仍然不解，其人壮热无汗，胸膈烦闷，喘嗽呕恶，起卧不安，呻吟不寐，耳聋足冷，两寸关脉躁盛，甚至沉伏，便是斑疹欲出的征候。等到斑疹既出，先用红纸蘸香油燃着，照看病患面部、背心、胸膛、四肢，有大红点平铺于皮肤之上的，称为斑。若小红点突起于皮肤之上的，称为疹。斑大而疹小，斑平而疹突，斑重而疹轻。斑夹丹疹并发者重，斑夹豌豆疮并发者尤重。黑斑如果实靥，蓝斑如烂青果，极重而必死不治。至于治法，总以凉血宣气，解毒透斑为首要。凉血的如犀角、羚角、大青叶、鲜生地、鲜茅根、青蒿脑、紫草、丹皮、山栀、元参之类。宣气的如葱白、豆豉、葛根、薄荷、嫩桑芽、水芦笋、菰根尖、青箬叶、鲜竹叶卷心、鲜石菖蒲叶之类。解毒的如净银花、鲜菊叶、鲜蒲公英、紫花地丁、生绿豆汁、莹白金汁、人中黄、尿浸石膏、大黑木耳、紫金锭片之类。透斑的如牛蒡、连翘、蝉衣、僵蚕、角刺、钩藤钩、刺蒺藜、鲜西河柳叶之类。（蒺藜和河柳这两味药，配入于清凉药中，善于循经速达，提斑最捷，切勿嫌弃其性温透，弃而不用。）如果斑伏而不出，嵌于肉里，非略佐以升麻、细辛的升窜，斑毒终究不得速透。如果毒蕴大便闭塞，又当以解毒承气、犀连承气等汤速下之，必须里气通而伏斑随出。如果内伤脾阳，气虚下陷，脉虚大无力者，则以补中益气汤、人参三白汤等，升补中气以提透之。内伤肾阳，阳气被阴邪遏制，脉沉细或沉微者，则以真武汤加高丽参、鹿角尖，通脉四逆汤加人参、鹿茸，温化阴凝以补托之。这两种情况，必须阳气通而虚斑乃出。盖温毒证内邪壅结，得凉泻药，疏通其里而斑出；与虚寒证阴气寒凝，得温补药，鼓舞其阳而斑出。其法虽殊，其理则一。若脾肾阴虚，冲任阴虚，则以张氏补阴益气煎、陶氏逍遥汤二方为主，随证加减。一则峻补其下，疏启其中；一则清补其阴，疏启其气，得屡次补托滋垫，而虚斑始出。又与阴证发斑，得温补以鼓舞而出，同一理也。所以凡治斑，必须察病患元气虚实，阴阳盛衰，先其所因，辨其现证，察其色脉，庶免草率误人之弊。俞君治斑方法，大致已备，学人由此而推展之，足以尽治斑之精微矣。
【廉勘】前清光绪时名医陆九芝，著《丹痧斑疹》辩，独操己见，于是节述其说曰：丹痧斑疹四者，丹与斑类，痧与疹类。痧轻而丹重，疹轻而斑重。丹与斑皆出于肤，平而成片；痧与疹皆高出于肤而成点。痧自痧，丹自丹也，浑言之则通曰痧。亦疹自疹，斑自斑也，浑言之则通曰疹。而痧的原出于肺，因先有痧邪而始发表热，治痧者当治肺，以升达为主，而稍佐以清凉。疹的原出于胃，因表热不解，已成里热，而蕴为疹邪，治疹者当治胃，以清凉为主，而稍佐以升达。痧于应当主表散时，不可早用寒泻；疹于应当主苦泄时，不可更从辛散。大旨升达，主升葛柴之属；清凉，主芩栀桑丹之属。惟宗仲景葛根芩连一法，出入增减。（方用升麻、葛根、连翘、牛蒡、柴胡、黄芩、山栀、甘草、银花、赤芍、元参，或加蚕、蝉、河柳，升散清凉合法。）则于此际之细微层折，皆能曲中而无差忒。此治痧疹的要道也。自来治此证者，主辛散则禁寒泄，主寒泄则禁辛散，故两失之。至不仅为痧与疹而为丹为斑，则皆里热之甚，惟大剂寒药（须用石膏，切忌犀角），乃克胜任，非第痧疹之比矣。有是四者脘必闷，四者的齐与不齐，以脘闷之解与未解为辨。有是四者热必壮，四者的解与不解，以汗出之透与未透为辨。故当正治痧疹时，必兼行升清两法，表里交治，务使痧疹与汗并达。惟痧疹当发出之际，病患每闷极不可耐，稍一辗转反侧，其点即隐，病邪反从内陷，此正不必有外来之风也。即袖端被角间略有疏忽，其汗便缩，一缩之后，旋即周身皆干。此时厥有二弊，一则汗方出时，毛孔尽开，新风易入；一则汗已大出，不可再汗，非特痧疹之隐，且津液既泄，热必益炽，后此变端，皆从此起。病家只道未愈，医家亦但说变病，孰知皆汗不如法之故耶。凡病之宜从汗解者，无不皆然，而兼痧疹者尤甚，故特于此发之。其言如此，窃思痧即麻疹之俗称，故邵仙根前哲，谓疹即痧斑一类，实时毒入肺经而发，邪盛者，点子稠密，肌肤微肿而稍痒，有红白二种，邪入营者红疹，邪入卫者白疹，大忌冒风凉遏，犯则肺闭内陷，发喘而死。治法不外辛凉清透，宣肺化邪。观此，则痧与疹二而一，均当横开以轻宣肺气，肺气宣，则痧疹自从皮肤外出。且其证每兼咽喉肿痛，咳嗽气逆，岂可用升柴葛一意直升，独不虑其肺痹气喘而死耶？方中宜去升麻、柴胡、黄芩三味，加芦笋、通草、灯心，斯合轻扬清透之法矣。至其所谓丹与斑，皆由里热之甚，法当大剂寒泻，其说甚善。但谓须用石膏，切忌犀角，将古来犀角大青汤（犀角二钱半、大青五钱、栀子十枚、香豉一撮）之治斑毒热甚，心烦咽痛；犀角元参汤（犀角、元参、大青、升麻、射干、黄芩、人参、生甘草，加连柏山栀，去射干人参，亦名犀角大青汤）之治发斑毒盛，心烦狂言；消毒犀角饮（犀角、牛蒡、荆芥、防风、薄荷、大青、连翘、桔梗、生甘，内热加芩连）之治发斑瘾疹，咽喉肿痛，一概抹煞，未免执一偏之见矣。惟余师愚《疫疹一得》，详辩斑疹，确有见地，足为近今猩红热疫之标准。今特节述其说曰：古人言热未入胃，早下之，热乘虚入胃，故发斑。热已入胃，不即下之，胃热不得泄，亦发斑。此指伤寒化热，误下失下而言。若疫证未经表下，不一二日而即发斑疹者，若迟至四五日而仍不透者，非胃虚受毒愈深，即发表攻里过当。至论赤者胃热极，五死一生；紫黑者胃烂，九死一生。余断生死，则又在斑之大小紫黑，总以其形之松浮紧束为凭。如斑一出，松活浮于皮面，红如朱点纸，黑如墨涂肤，此毒之松活外见者，虽紫黑成片可生。一出虽小如粟，紧束有根，如履透针，如矢贯的，此毒之有根锢结者，纵不紫黑亦死。其色红而活，荣而润，或淡而润，皆斑疹之佳境也。若淡而不荣，或娇而艳，或干而滞，其血最热。若色深红，较淡红稍重；色紫艳如胭脂，较深红更恶；色紫赤类鸡冠花，较艳红毒火更盛；色青紫如浮萍之背，多见于胸背，乃胃热将烂之候。其治法，总宜大清胃热，兼凉血解毒，以清瘟败毒饮为主。（生石膏、知母、犀角、鲜生地、赤芍、丹皮、栀子、黄芩、连翘、元参、桔梗、生甘、鲜竹
[Causes] Whenever a Shanghan (Cold Damage) patient requires sweating but does not sweat, or requires purgation but does not purge, heat-toxin accumulates in the Stomach. Blood-heat and Qi-heat surge, penetrating from the muscles to the skin and bursting outward, resulting in the eruption of macules and papules (maculae et papulae). Even eruptions caused by Warm-Toxin (Wendu) or Heat Disease (Re Bing) stem from excessive blood-heat and toxin. These are all classified as Yang-type eruptions. Some may have concurrent rashes, and even sores. Fresh red color indicates Stomach-heat; purple-red indicates extreme heat; purple-black indicates rotting of the Stomach tissue. Eruptions first appear on the chest, back, hypochondrium, epigastrium, and abdomen, then spread to the head, face, neck, and limbs. If caused by excessive sexual activity damaging Kidney-Yin internally, or by excessive use of cold medicines (such as taking too many cooling drugs or indulging in raw/cold foods) damaging Spleen-Yang internally, followed by a new contraction of cold pathogen, the rootless and unanchored fire is forced upward, steaming the Lung Meridian, and floating on the skin to form spots. These are all classified as Yin-type eruptions, also known as deficiency macules. Their shape resembles bites from mosquitoes, fleas, or lice: sparse and mostly pale red, or pale white with slight redness. Some may be pale black, appearing only between the two loins and lower abdomen. Therefore, when treating eruptions, one must examine the four aspects of deficiency/excess and cold/heat; this is the primary step in seeking the root cause during clinical practice.
[Symptoms] For Yang-type eruptions: Newly contracted Shanghan is mild; latent Qi Heat Disease is more severe; epidemic Warm-Toxin is especially severe. In Shanghan where sweating was indicated but missed, at the stage where eruptions are about to emerge but not fully transparent, symptoms include headache and body pain, high fever without sweat, slight aversion to wind and cold, chest stuffiness and discomfort, tongue coating yellow-white mixed, or thin white slightly dry, with red edges and tip. Where purgation was indicated but missed, at the stage where eruptions are about to penetrate but not yet out, symptoms must include high fever, epigastric stuffiness, restlessness, headache, dry nose, dry throat, dry mouth, groaning, insomnia, constipation, and dysuria. The tongue coating turns from white to yellow: lightly tender yellow and thin greasy, heavily deep yellow with gray. In Heat Disease eruptions, acute cases erupt after 1-2 days of fever, chronic cases after 4-5 days. Superficial eruptions are fresh red, raised, and loose on the skin surface; deep eruptions are purple-red, dense, firm, bound, and rooted. Symptoms must include chest oppression, high fever with coma, vomiting, inability to eat, sore throat, swollen throat, thirst preferring cold drinks, foul breath, tongue coating bright yellow (lightly rough and dry with bright red tongue body; heavily yellow with gray spots and purple-red tongue root). In Warm-Toxin eruptions, while the toxin is latent internally, symptoms may show low-grade fever not obvious to touch, unclear consciousness, delirious laughter, or even coma resembling death, with gray-black tongue coating and a black halo in the center. When eruptions burst out violently, they often accompany rashes or sores. Severe cases show uniform redness of the skin, eruptions dense like needle heads, purple-black patches, or mixed rotten black decay. Symptoms include red face, sore throat, swollen red throat possibly with necrosis, red eyes, scorched lips, epigastric stuffiness and burning, extreme thirst, open-mouth breathing with foul odor, deafness, cold feet, constipation, dark urine, coma with delirium or mutism resembling shock, purple tongue with yellow coating (or yellow-greasy with gray), even scorched purple with peeling or black halos. These are all Yang-type eruptions of varying depth and severity, characterized by excess rather than deficiency.
For Yin-type eruptions, they belong to internal injury complicated by external contraction. Those with damaged Spleen-Yang show faint, sparse eruptions, mostly pale red, or mixed with pale gray or white, ranging from 3-5 to 6-7 spots, shaped like mosquito bites, visible only on hands and feet or slightly on the abdomen; they resemble macules but are actually fine papules. Symptoms include cold extremities, mental fatigue and drowsiness, preference for sleeping curled up, consciousness fluctuating between clear and confused, low voice, short breath, reluctance to speak, loose stools, clear or pale yellow urine, white and tender-slippery tongue coating, or fat-tender black-moist coating. Those with damaged Kidney-Yin show spots that are mostly pale black and withered, or pale white and tender, ranging from 8-9 to over 10 spots, mostly appearing on the loins and lower abdomen. Symptoms include dizziness, heavy head difficult to lift, closed eyes with photophobia, tinnitus resembling deafness, tender red malar flush, sore waist, cold feet, mental depletion, dryness of the five fluids, muscle twitching and tremors, slight convulsions of hands and feet, frequent seminal emissions in men, leukorrhea and heavy waist in women, round-tender-fat tongue, pale black coating with little moisture, or red tongue with smoke-like hidden coating, or purple-crimson round tongue, dry but without prickles, or purple and fresh-moist, occasionally with slight white coating. These are Yin-type eruptions that resemble macules but are not true macules, characterized by deficiency rather than excess.
In summary, true macules do not have raised granules; touching them feels flat against the skin and flesh, regardless of size, lacking any rough texture, presenting only visual forms. Red patches dense like brocade patterns indicate Stomach-blood heat and toxin; intense toxin makes them red-purple, heavy toxin makes them black-blue. Pale, non-vivid, sparse spots like mosquito bites indicate deficiency predominating over pathogen. Qi-deficiency presents as pale-light red; Yin-deficiency presents as pale-light black. One must first distinguish the cold/heat and deficiency/excess of the disease state to determine the severity and prognosis. (Xu Rongzhai notes: The summary in the latter part is the key to syndrome differentiation.)
[Pulse] Left pulse floating, wiry, and rapid; right pulse floating, surging, and slippery: This indicates exterior cold trapping interior fire. Due to missed sweating, heat-toxin exploits the gap to cause eruptions. Right pulse surging, full, slippery, and rapid, exceeding the left hand in magnitude: This indicates excessive Stomach-heat. Due to missed purgation, fire-toxin bursts outward causing eruptions. Right pulse long, large, slippery, and rapid; left pulse also floating, wiry, and fighting-rapid: This indicates excessive blood-heat in the Stomach, with toxin spreading through the Triple Burner causing eruptions. Pulse is hidden/fu, and eruptions are also hidden/fu; eruptions appear, and pulse appears: This indicates Stomach blood-toxin congestion and stasis-heat blocking Ying and Wei, causing eruptions to hide. When eruptions appear, they will likely mix with Dan-rash (scarlet rash), or even pea-pox. Right pulse floating, soggy, and deficient; left pulse deep, choppy, nearly absent: This indicates Yang being forced by Yin, leading to dispersion or flight. Thus, pale-red eruptions appear slightly on limbs and large abdomen, known as Tao Jie'an's "Internal Cold Injury Macules." Left pulse fine, rapid, and urgent; right pulse floating, large, and empty: This indicates Yin being consumed by Yang, leading to withering or desiccation. Thus, pale-black spots appear slightly on loins and lower abdomen, known as Chen Nianyi's "Kidney Yin Deficiency Macules."
In general, once eruptions have appeared, if the pulse is surging, slippery, and forceful, hands and feet are warm, and consciousness is clear, the disease course is smooth and auspicious. If the pulse is deep, weak, and spiritless, extremities are cold, and consciousness is dim, the disease course is adverse and ominous. (Xu Rongzhai notes: The latter summary is the key to pulse diagnosis and syndrome differentiation.)
[Treatment] For Shanghan requiring sweating but missed: Use Tou Ban Jie Du Tang (Macule-Releasing Toxin-Detoxifying Decoction, see Epidemic Malaria treatment) plus Sheng Ge Gen (Radix Puerariae Lobatae, 1-1.5 qian). Use acrid-cool muscle-releasing methods to release the exterior, ensuring eruptions reach the surface simultaneously with sweat. For those requiring purgation but missed: Use Chai Qin Qing Ge Jian (Bupleurum and Scutellaria Clearing Diaphragm Decoction), remove Chai Hu, add Sheng Ge Gen (1 qian), Chao Niu Bang Zi (Fructus Arctii Lappae, 3 qian), Huo Shui Lu Sun (Shoots of Phragmites Communis, 2 liang), Xian Mao Gen (Rhizoma Imperatae Cylindricae, 1 liang; decoct these two to replace water). Open upper and descend lower to clear the middle, ensuring eruptions exit with stool.
For Heat Disease eruptions: If bowels are open, use Xin Jia Bai Hu Tang (Newly Modified White Tiger Decoction) plus Qing Lian Qiao (Flos Lonicerae Japonicae, 3 qian), Chao Niu Bang Zi (3 qian). Use acrid-cool macule-releasing to drain heat. If bowels are closed, use Bai Hu Cheng Qi Tang (White Tiger and Da Huang Purgative Decoction) plus Lian Qiao and Niu Bang Zi (3 qian each), Huo Shui Lu Sun, Xian Ye Gu Gen Jian (Tips of Rhizoma Ziziphi Spinosae? Note: Text says Ye Gu Gen, likely Ziziphus or similar root, 2 liang each; decoct to replace water). Resolve both exterior and interior to expel heat.
For Warm-Toxin eruptions: If bowels are open, use Xi Ling Zhu Shi Tang (Rhinoceros Horn, Antelope Horn, Bamboo Resin, and Gypsum Decoction, see Red Diaphragm treatment) plus Huo Shui Lu Sun (2 liang), Da Qing Ye (Folium Isatidis, 5 qian). Use cool-clearing detoxification to release macules. If bowels are closed, use Jie Du Cheng Qi Tang (Detoxifying Purgative Decoction) plus Zi Xue (Purple Snow). Attack the Triple Burner directly to expel toxin.
For Yin-type eruptions with damaged Spleen-Yang and Yang forced by Yin: Chronic cases use Shen Fu San Bai Tang (Ginseng, Aconite, and Three Whites Decoction: Lao Dong Shen, Sheng Bai Zhu, Bai Fu Ling, Chao Bai Shao each 1.5 qian, Hei Fu Kuai 1 qian, Qing Zhi Gan Cao 8 fen, Sheng Jiang 2 slices, Da Hong Zao 2 pieces). Tonify middle and boost Qi to support Yang. Acute cases use Hui Yang Ji Jiu Tang (Restore Yang Emergency Rescue Decoction). Boost Qi and secure collapse to retrieve Yang. Tao's Tiao Zhong Tang contains too many acrid-dispersing herbs, accelerating the escape of deficient Yang; it is mismatched and should not be used recklessly.
For damaged Kidney-Yin and Yin consumed by Yang: Use Gui Bai Di Huang Tang (Tortoise Shell, Phellodendron, and Rehmannia Decoction) or Zi Shen Yi Yin Jian (Nourish Kidney and Benefit Yin Decoction), choosing appropriately to clear and nourish. If due to sexual exhaustion or Yin-Yang exchange with heat entering the Essence Chamber, modify Tao's Xiao Yao Tang. Both are deficiency macule syndromes; do not treat merely by seeing macules. In summary, never treat macules solely based on their presence. Must examine pulse (floating-large-slippery-rapid vs. deep-weak-choppy-micro), patient's Qi/Blood deficiency/excess, and disease state cold/heat/damp/dry to prescribe individually. This is the essence of treating macules.
[Commentary by Xiu] In Shanghan, if sweating and purgation are appropriate, and in Warm diseases, if clearing and resolving are effective, pathogens do not stagnate, and no macules appear. Even if faint spots appear, they are mostly rashes. Sun-luo blood-heat causes red rashes; membrane-dwelling damp-heat causes white rashes (Bai Pi, later called Bai Fei, is actually a common name for rashes). Modern colloquialism calls macular Shanghan "Fa Ban Shanghan," mistakenly confusing rashes with macules. True macules usually arise from Warm-Heat combined with Cold. Initially fearing acrid-cool opening, practitioners stick to old Shanghan formulas, using excessive acrid-warm drying-hot drugs, forcing evil-heat into the Ying level to cause eruptions. Thus, Shanghan macules result from improper sweating/purgation; Warm disease macules result from missed clearing. All stem from pathogen stagnation in Stomach and heat steaming into macules. If initial treatment were correct, how would macules form? Only Warm-Toxin and Heat-Epidemic inevitably cause macules/rashes.
When macules are forming but not yet out, first differentiate symptoms. After sweating, clearing, or purging, if pathogen remains unresolved, and patient has high fever, no sweat, chest oppression, cough/vomiting, restlessness, insomnia, deafness, cold feet, and hyperactive Cun/Guan pulses (even hidden), this indicates impending eruption. Once erupted, use red paper dipped in sesame oil lit to illuminate face, back, chest, limbs. Large red spots flat on skin are Macules (Ban). Small red spots raised on skin are Rashes (Zhen). Ban is larger, Zhen smaller; Ban is flat, Zhen raised; Ban is severe, Zhen mild. Ban with Dan-rash is severe; Ban with Pea-pox is worse. Black Ban like fruit scabs, Blue Ban like rotten green fruit are extremely severe and fatal.
Treatment priority: Cool blood, promote Qi circulation, detoxify, and release macules. Cooling blood: Xi Jiao, Ling Jiao, Da Qing Ye, Xian Sheng Di, Xian Mao Gen, Qing Hao Nao, Zi Cao, Dan Pi, Shan Zhi, Yuan Shen. Promoting Qi: Cong Bai, Dou Chi, Ge Gen, Bo He, Nen Sang Ya, Shui Lu Sun, Gu Gen Jian, Qing Ruo Ye, Xian Zhu Ye Juan Xin, Xian Shi Chang Pu Ye. Detoxifying: Jing Yin Hua, Xian Ju Ye, Xian Pu Gong Ying, Zi Hua Di Ding, Sheng Lv Dou Zhi, Ying Bai Jin Zhi, Ren Zhong Huang, Niao Jin Shi Gao, Da Hei Mu Er, Zi Jin Ding Pian. Releasing macules: Niu Bang, Lian Qiao, Chan Yi, Jiang Can, Jiao Ci, Gou Teng Gou, Ci Ji Li, Xian Xi He Liu Ye. (Ji Li and Xi He Liu, when paired with cool-clearing herbs, rapidly reach meridians and extract macules efficiently; do not discard due to warmth). If macules hide embedded in flesh, add Sheng Ma and Xi Xin to ascend and disperse, otherwise toxin won't release quickly. If toxin stagnates with constipation, use Jie Du Cheng Qi or Xi Lian Cheng Qi to purge rapidly; interior must open for hidden macules to emerge.
If Spleen-Yang is injured with Qi sinking and pulse large/weak/powerless, use Bu Zhong Yi Qi Tang or Ren Shen San Bai Tang to raise and tonify middle Qi to lift macules. If Kidney-Yang is injured with Yang blocked by Yin and pulse deep/fine/micro, use Zhen Wu Tang + Gao Li Shen, Lu Jiao Jian; Tong Mai Si Ni Tang + Ren Shen, Lu Rong. Warm and transform Yin-stagnation to tonify and support. Yang must flow for deficiency macules to emerge. Warm-Toxin involves interior stagnation resolved by cool-purgatives; Deficiency-Cold involves Yin-stagnation resolved by warm-tonics. Methods differ, principle is same. For Spleen/Kidney Yin deficiency, use Zhang's Bu Yin Yi Qi Jian or Tao's Xiao Yao Tang. One tonifies lower and opens middle; one clears/nourishes Yin and opens Qi. Repeated tonification allows deficiency macules to emerge, similar to Yin-type eruptions responding to warm-tonics. Thus, treating macules requires assessing Yuan-Qi deficiency/excess, Yin/Yang prosperity/decline, identifying causes, differentiating current signs, and observing color/pulse to avoid hasty errors. Yu's methods are comprehensive; students expanding upon them can master the subtleties of macule treatment.
[Commentary by Lian] During the Guangxu era, famous physician Lu Jiuzhi wrote "Dan Sha Ban Zhen Bian," holding unique views. Excerpt: Dan, Sha, Ban, Zhen. Dan and Ban are similar (flat, patchy); Sha and Zhen are similar (raised, dotted). Sha is mild, Dan severe; Zhen is mild, Ban severe. Dan/Ban originate from skin, flat patches; Sha/Zhen rise from skin, dotted. Sha originates from Lung, treated by ascending/releasing with slight cooling. Zhen originates from Stomach, treated by cooling with slight ascending. Do not use cold-purgatives early for Sha; do not use acrid-dispersion late for Zhen. Base treatment on Ge Gen Qin Lian Tang principles, modifying ingredients (Sheng Ma, Ge Gen, Lian Qiao, Niu Bang, Chai Hu, Huang Qin, Shan Zhi, Gan Cao, Yin Hua, Chi Shao, Yuan Shen, optionally Can, Chan, Xi He Liu). This handles nuances accurately. Historically, treating with acrid-dispersion forbids cold-purgation, and vice versa, leading to failure. For Dan/Ban (severe interior heat), large doses of cold herbs (Shi Gao essential, Xi Jiao forbidden) are needed, beyond simple Sha/Zhen treatment. All four cause epigastric stuffiness; resolution depends on clearing stuffiness. All four cause high fever; resolution depends on sweat transparency. Treat Sha/Zhen by combining ascending/clearing and exterior/interior therapy, ensuring Sha/Zhen exit with sweat. Patients suffer unbearable stuffiness during eruption; moving hides spots, causing interior collapse. Negligence in covering/sleeves stops sweat, drying body. Two dangers: open pores invite wind; excessive sweating depletes fluids, increasing heat. Variations stem from improper sweating. This applies generally but critically to Sha/Zhen.
Sha is commonly known as Measles. Qianzhe Shao Xianggen stated Zhen and Sha are similar, entering Lung via seasonal toxins. Pathogen excess causes dense spots, slight swelling/itching, red/white types. Ying-level = Red Zhen; Wei-level = White Zhen. Avoid wind/cold constraint causing Lung closure, asthma, death. Treatment: Acrid-cool clear-release, diffuse Lung, resolve pathogen. Sha and Zhen are essentially one, requiring light dispersal to diffuse Lung Qi. Lung Qi diffusing allows exit via skin. Often accompanied by sore throat, cough, reverse Qi. Using only Sheng Ma/Chai Hu/Ge Gen to ascend blindly risks Lung obstruction and asthma death. Remove Sheng Ma, Chai Hu, Huang Qin; add Lu Sun, Tong Cao, Deng Xin for light-yang clear-release method.
Regarding Dan/Ban from severe interior heat, large cold-purgation is good. But forbidding Xi Jiao ignores ancient formulas: Xi Jiao Da Qing Tang (for severe toxin, irritability, sore throat); Xi Jiao Yuan Shen Tang (for severe toxin, mania); Xiao Du Xi Jiao Yin (for macules/rashes, sore throat). Dismissing these is biased. Yu Shiyu's "Yi Zhen Yi De" details Ban/Zhen differentiation well, serving as standard for Scarlet Fever/Epidemic. Excerpt: Ancient texts say premature purgation lets heat enter Stomach causing Ban; delayed purgation lets Stomach heat accumulate causing Ban. This refers to Shanghan transforming to heat with mis-purgation. For Epidemic diseases, eruption within 1-2 days without prior release/purge indicates deep toxin absorption; delay until 4-5 days indicates excessive release/purge. Red indicates extreme Stomach heat (5 deaths, 1 life); Purple-black indicates Stomach rot (9 deaths, 1 life). However, prognosis depends not on size/color but on looseness/tightness. Loose, floating eruptions (red like cinnabar on paper, black like ink on skin) indicate toxin releasing externally; even purple-black patches can survive. Tight, rooted eruptions (small like millet, tight like needle piercing target) indicate toxin anchored internally; even without purple-black, death ensues. Red, vibrant, moist, or pale-moist are favorable. Pale-non-vibrant, delicate-bright, or dry-stagnant indicate hottest blood. Deep red heavier than pale; Purple-bright like rouge worse than deep red; Purple-red like cockscomb flower stronger fire than bright red; Purple-blue like duckweed back (often on chest/back) indicates impending Stomach rot. Treatment: Clear Stomach heat massively, cool blood, detoxify. Main formula: Qing Wen Bai Du Yin (Shi Gao, Zhi Mu, Xi Jiao, Xian Sheng Di, Chi Shao, Dan Pi, Shan Zhi, Huang Qin, Lian Qiao, Yuan Shen, Jie Geng, Sheng Gan Cao, Xian Zhu...)