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High heat injures the blood; when blood-heat is not dispersed, interior excess and exterior deficiency occur. The pathogenic heat takes advantage of this deficiency to emerge from the skin, resulting in macules (maculae). Mild cases manifest as papules (rashes), while severe cases present as macules resembling brocade patterns.

In some instances, the disease originally belongs to a Yang pattern, but hot-natured medicines are mistakenly administered. Or, sweating should have been induced but was not, or purging should have been performed but was not. Even if neither sweating nor purging resolves the condition, these factors can all lead to the emergence of macules. Generally, there are two types: one is Warm-Toxin Macules (Wendu Faban), which occur in spring; after failed sweating and purging, the pathogenic factor remains undispersed, causing macules to appear. The other is Heat Disease Macules, caused by abnormal warmth in winter where pernicious qi lingers and emerges with the warming weather of spring. Sweating must not be mistaken for a treatment; if sweating is forced, causing further opening and leakage of the pores, it will exacerbate the macules until they ulcerate. However, when macules first begin to appear, they resemble mosquito bites. Macules typically appear on the chest and abdomen, whereas mosquito-like marks appear only on the hands and feet. If the pulse is surging and large (Hongda), the patient is confused and drowsy, and the color changes from red to dark red, it is macules. If the pulse is not surging and large, the patient is calm, and the color changes from red to yellow, it is merely mosquito-like marks. If there is spontaneous diarrhea, oppression and shortness of breath, dry stool impaction, and spots resembling fruit rind, even if Bian Que were reborn, he could not apply his skill. Whenever sweating and purging fail to resolve the disease, accompanied by irritability, cough, vomiting, and cold feet that do not warm up, these are signs of impending macules.

For Warm-Toxin Macules, Hei Gao (Black Ointment) is the primary prescription. For thirst with chest oppression, diarrhea with vomiting, sores in the lower body, or mouth ulcers, use Huanglian Jupi Tang (Coptis and Tangerine Peel Decoction), Gegen Tang (Kudzu Decoction), or Jupi Tang (Tangerine Peel Decoction).

For Yang-Du Macules, characterized by mania, delirium, incoherent speech, red face, sore throat, macules like brocade on the body, and bloody-yellow diarrhea, use Shengma Tang (Cimicifuga Decoction) or Maitan Wan (Stellaria Pill). If there are indications for purging, use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction).

For Seasonal-Qi Macules, use Daqing Siwu Tang (Great Blue Four Substances Decoction) or Zhudan Jizi Tang (Pig Gallbladder and Chicken Egg Decoction).

The universal prescriptions for macules are Shengma Tang (Cimicifuga Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). For cases with greater heat, use Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction), Huanglian Yi Wu Tang (Coptis Single Herb Decoction), or Qingmuxiang Yi Wu Tang (Aucklandia Single Herb Decoction).

Generally, red macules indicate five deaths for every one survival; black macules are incurable.

Dongqi (Moving Qi) refers to the disharmony of Zang organ qi, perceived as a throbbing sensation ("zhuzhu") that manifests around the umbilicus—left, right, above, or below—according to the affected Zang. This is recorded in the *Nan Jing* (*Classic of Difficult Issues*). Additionally, when true qi is internally deficient and water retention fails to disperse, qi and water contend, triggering Ben Tun (Running Piglet) syndrome. Because the qi rushes upward like a running piglet, both sweating and purging are contraindicated. However, the Spleen is notably absent from this discussion. When moving qi is felt at the umbilicus, it is because the Spleen governs the Central Region (Zhongzhou) and transports fluids. Reckless sweating or purging would inevitably disturb the Spleen, a fact that goes without saying. If moving qi in the four directions around the umbilicus contraindicates sweating and purging, how much more so should the Qi of the Central Region not be lightly disturbed! In Shaoyang diseases, observing external symptoms is crucial because the diagnosis relies not only on visible pulses but also on what can be elicited through inquiry. How can sweating and purging be undertaken lightly?

The universal prescription for Dongqi is Lizhong Tang (Regulate the Middle Decoction) with Baizhu (Atractylodis Macrocephalae Rhizoma) removed and Guizhi (Cinnamon Twig) added. Baizhu is drying and can close off qi flow, harming the Kidney, hence it is removed. Guizhi helps dissipate Ben Tun, hence it is added. Alternatively, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is also effective. These two formulas should be selected based on the presence or absence of heat.

If Dongqi is on the left, sweating causes dizziness and continuous sweating, leading to muscle twitching and palpitations, which is an adverse reaction. First, use Fangfeng Baizhu Muli Tang (Saposhnikovia, Atractylodes, and Oyster Shell Decoction); once sweating stops, administer Jianzhong Tang (Establish the Middle Decoction).

If Dongqi is on the right, sweating causes epistaxis and thirst, mental restlessness, and vomiting upon drinking. First, use Wuling San (Five-Ingredient Powder with Poria), followed by Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).

If Dongqi is above, sweating causes qi rushing up to the heart; use Taogen Tang (Peach Root Decoction). If Dongqi is below, sweating causes severe mental agitation, pain in the bone joints, dizziness, and immediate vomiting after eating. First, use Dajupi Tang (Large Tangerine Peel Decoction), followed by Xiaojianzhong Tang (Small Establish the Middle Decoction).

If Dongqi is on the left, purging is contraindicated. Purging leads to abdominal fullness and cramping. Although the body may be hot, the patient desires to curl up. First, use Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), followed by Xiaojianzhong Tang (Small Establish the Middle Decoction).

If Dongqi is on the right, purging depletes body fluids, causing dry throat and nose, dizziness, and palpitations. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).

If Dongqi is below, purging leads to abdominal fullness and undigested food in the stool, epigastric stuffiness, and dizziness. Use Gancao Xiexin Tang (Licorice and Heart-Purging Decoction).