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Rash syndrome, Haizang divided it into four categories: one is Warm Toxin (Wendu), two is Heat Disease (Rebing), three is Seasonal Qi (Shiqi), and four is Cold Damage (Shanghan). In Wu's book, the rash of Heat Disease was changed to Yang Toxin (Yangdu), and internal injury from cold/coolness and Yin syndrome rash were added, totaling six categories. However, in reality, cases of Shanghan and Rebing are common, while Yin syndrome rashes are very rare. Even if the rash is caused by internal injury from cold suppressing Yang fire so that it cannot extend, it merely requires the method of acrid-warm ascending and dispersing, and should not be immediately treated as a primary Yin syndrome. Regarding the rashes occurring currently, one should only base treatment on Haizang's four categories as the standard.

One is called Warm Toxin. Contracting cold toxin in winter, manifesting in spring, it is named "Warm" because it has been stagnant for a long time and transformed into heat. Another situation where winter should be cold but is instead warm is also called Warm Toxin. When humans contract Warm Toxin, external wind-cold binds the exterior, preventing the release of warm qi, resulting in aversion to cold and stiffness, fever with cold feet, no sweat, floating pulse, or hidden pulse. It is appropriate to use Baidu San (Detoxification Powder) and Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) to disperse the exterior pathogen, so that the Warm Toxin exerts outward, the pulse and sweating improve, and the rash qi naturally penetrates. If there is accumulated heat inside, then use Shengma Qingwei Tang (Cimicifugae and Stomach-Clearing Decoction) and Xiaodu Huasha Tang (Detoxification and Rash-Resolving Decoction) to clear heat.

Two is Heat Disease Rash, which is also Yang Toxin Rash. Damp-heat, dryness, and fire harm the blood level, steaming and brewing to cause the rash to emerge. Symptoms include red eyes, delirious speech, sore throat, restlessness, and skin markings like brocade patterns. There is aversion to heat rather than aversion to cold. Initially, the pulse is floating and large; first use Shengma Gegen Tang to ascend and disperse the toxin of the Yangming channel. If the pulse is deep and rapid, and body heat does not subside, subsequently use Xiaodu Xijiao San (Detoxification and Rhinoceros Horn Powder), Shigao Huasha Tang (Gypsum Rash-Resolving Decoction), and Shengma Qingwei Tang to clear interior heat. If stool is constipated and abdomen is distended, with all lower-jiao excess symptoms present, use Danggui Dahuang Wan (Angelica and Rhubarb Pill) plus Chaihu and Gegen to purge downwards.

Three is Seasonal Qi Rash. This is due to seasonal epidemic toxins descending, infecting both young and old. Initially, there is aversion to cold and fever, or deafness and cold feet, restlessness and diarrhea, groaning, vomiting, and nausea. For such rashes with exterior symptoms, use Qianghuo Baidu San (Notopterygii and Detoxification Powder) and Shengma Gegen Tang. For rashes that have already emerged, use Xiaodu Yin (Detoxification Drink) combined with Shengma Qingwei Tang and Huasha Tang to resolve them. If there is food stagnation in the middle jiao, use digestion-promoting methods and avoid cold-cooling herbs. Therefore, treating epidemic pathogens has no fixed method. If cold dominates, treat with acrid-warm; if cold-damp dominates, treat with warm-dry; if damp-heat dominates, treat with bitter-cold; if dry-heat dominates, treat with sweet-cold, adapting to the seasonal qi of each year.

Four is Cold Damage Rash. Internal accumulated heat, externally attacked by sudden cold, bound at the muscle surface, evaporating to cause red rashes. Or if sweating should have been induced but wasn't, or purging should have been performed but wasn't, heat-toxin accumulates, also causing rashes, usually appearing after ten days. Regardless of the number of days, if there is headache and cold feet, aversion to cold and fever, floating-large pulse, and Taiyang syndrome symptoms, use Qianghuo Baidu San. If there is alternating chills and fever, deafness, restlessness, coughing, and vomiting, with a wiry-rapid pulse and Shaoyang syndrome symptoms, use Chaihu Tang (Bupleurum Decoction). If there is eye pain and forehead pain, dry nose, and insomnia, with a surging-long pulse and Yangming syndrome symptoms, use Shengma Gan Ge Tang (Cimicifugae and Kudzu Decoction). If resolving exterior and clearing interior heat, with a large-deep-rapid pulse, use Jiedu Huasha Tang (Detoxification and Rash-Resolving Decoction) and Shengma Qingwei Tang. If there are lower-jiao excess symptoms, with a floating-wiry-rapid pulse, use Da Chaihu Tang (Major Bupleurum Decoction); with a large-long-rapid pulse, use Gan Ge Tang (Kudzu Decoction). With a deep-rapid-large pulse, use Sanhua Tang (Three Transformations Decoction) or Dachengqi Tang (Major Order the Qi Decoction).

Zhen notes: The key to rash syndrome is the emergence of the rash. However, there are five reasons why the rash may fail to emerge: one is exterior depression by cold pathogen, two is accumulation of fire closing heat, three is internal injury from cold drinks, four is food stagnation in the middle jiao, five is phlegm obstructing the middle epigastrium. If exterior pathogen depresses the surface, dispersing the exterior causes the rash to emerge; if interior evil heat congests, clearing the interior causes the rash to emerge; if internal injury from frozen drinks occurs, warming the middle causes the rash to emerge; if food stagnates in the middle jiao, digesting food causes the rash to emerge; if phlegm condenses in the middle epigastrium, resolving phlegm causes the rash to emerge; this is the initial work of treatment. After the rash emerges, if the rash marks do not dissipate, one must look at what symptoms and causes exist. If exterior pathogen remains, releasing the exterior causes the rash to dissipate; if heat knots in the interior, clearing heat causes the rash to dissipate; if internal injury from frozen drinks occurred, warming the middle causes the rash to dissipate; if food stagnates in the middle jiao, digesting food causes the rash to dissipate; if phlegm condenses in the middle epigastrium, expelling phlegm causes the rash to dissipate; if stool is blocked and abdomen is full and distended, moving stool causes the rash to dissipate. Current doctors, when treating early rash, only know to use ascending methods to induce the rash, not knowing that there are many causes for rash stagnation. People know that inducing rash with ascending methods contraindicates bitter-cold; they do not know that resolving rash with ascending methods also contraindicates bitter-cold. People know that resolving rash with bitter-cold contraindicates ascending methods; they do not know that resolving rash with digestive methods contraindicates bitter-cold. As for cold drink suppression, food stagnation, and phlegm condensation, these are concurrent symptoms outside the main disease that should be treated first, yet everyone ignores them. Shanghan transmits from exterior to interior, with evil heat gathering and knotting in the intestines and stomach, requiring immediate purgative methods. Current rash epidemic pathogens emerge from the intestines and stomach to the exterior; heat evil scatters throughout the body and refuses to gather in the intestines and stomach. Thus, only exterior-releasing and interior-clearing methods are established, without establishing Chengqi downward-purging formulas. If encountering constipation, Danggui Dahuang Wan is established. Because Shanghan heat is in the qi level, Chengqi Tang can be used. Rash heat is in the blood level; damp-fire harms blood, causing bloody diarrhea with heat, treated with Huanglian Shaoyao Tang (Coptis and Peony Decoction). Dry-fire harms blood, causing constipation, treated with Danggui Dahuang Tang/Wan (Angelica and Rhubarb Decoction/Pill). Although this elaborates on points not previously mentioned, it is shallow and easy to understand. Furthermore, in heat disease with mania, if one mistakenly consumes meat and animal products, the sticky and viscous nature binds tightly with the evil heat-toxin, making separation difficult. Lips and mouth become cracked, breath is foul, teeth feel loose, thirst exists but water is not consumed, restlessness and heat lead to drowsiness, making it extremely difficult to save. Use Baohe San (Harmonize the Stomach Powder) mixed with Zhuli (Bamboo Sap) and Lugenzhi (Reed Root Juice) to moisten dryness and promote digestion. If ineffective, use Gan Ge (Kudzu) and Shigao (Gypsum). If lips and mouth are dry and cracked, body heat does not decrease, use Run Chang Xia Shun (Moisten Intestines and Descend Smoothly) treatment, leading to worsened delirium. Baohe San can only digest grain food and phlegm-saliva, not the grease of meat and animal products. Gan Ge Shigao Tang can only clear the formless heat of the Yangming qi level, not the formed accumulated heat of the Yangming intestines and stomach blood level. Chengqi Shun Chang can only resolve the dry-heat knot of the lower large intestine, not the sticky damp-heat knot of the upper jiao stomach. Therefore, accumulated heat from rich foods rushing upward often presents with cracked lips, rotten mouth, ulcerated gums, foul breath, and dry mouth. My family secret does not use Gegen and Shigao, but uses Shengma Qingwei Tang heavily supplemented with Hawthorn flesh (Zharon), slightly assisted by Amomum (Sharen) to move the stagnation of Shengdi, and to vent the accumulated heat of the Yangming blood level. This involves great care. Because heat disease and rash-sha, if one mistakenly eats meat, death is certain; thus I reveal this to seek life amidst death. In short, rash-toxin syndromes are all caused by Yangming accumulated heat; because the heat is in the blood level, red spots appear externally. Ancients used Shengma Gan Ge Tang for early rash induction, which everyone knows; I use Shengma Qingwei Tang for subsequent rash resolution, which people do not know. Using Qingwei Tang heavily supplemented with Hawthorn to rescue damage from meat, assisting with Sharen to move stagnation, and venting latent heat in the gastrointestinal blood level, is a method beyond methods, to be cross-referenced with the Lip Burning section. Lips burnt and dry, thirst with desire to drink, heat in the qi level, causing thirst—using Gan Ge Shigao is known to all; lips burnt and dry, thirst without consuming water, large pulse but not rapid—using digestive methods instead of Gan Ge Shigao is unknown. As for rash-toxin internal knotting, lips burnt and dry, heat in the blood level, no thirst—using Shengma Qingwei Tang to clear Yangming blood-level heat is unknown to all. For early rash-toxin-sha-measles, using Shengma Gan Ge Tang, one must know its wonder lies in combining with Bai Shaoyao (White Peony Root) to vent latent fire in the blood. Early stage does not use Qingwei Tang because Shengma combined with Shengdi and Chuan Lian would cool the blood too excessively. Now I use it in the final stage of resolution, avoiding the risk of resolving too early; this was derived from Shengma Zicao Huadu Tang (Cimicifugae and Lithospermum Detoxification Decoction). Henceforth, treating early rash with Shengma Gan Ge Tang to induce, and later with Shengma Qingwei Tang to resolve, can be an unerasable method for future generations. Ancients used Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) to treat Yangming blood-heat epistaxis, and also used Xijiao to treat Yangming blood-heat rash, saying if Xijiao is unavailable, replace it with Shengma. Because Shengma acts with herbs that scatter Yangming blood-heat and detoxify Yangming blood-heat, Shengma can replace Xijiao. However, I alone believe Xijiao Dihuang Tang is too heavy and thick, suitable only for yin-deficiency syndromes. From the perspective of rash resolution, Shigao, Zhimu, Huangqin, and Huanglian bias towards cooling qi, lacking in cooling blood; Xijiao Dihuang Tang biases towards nourishing yin, lacking in avoiding stagnation. It is better to use Shengma Qingwei Tang for light cooling and blood-clearing, simultaneously inducing and resolving, working in sequence with Shengma Gan Ge Tang. Thus I add notes: it is difficult to use Xijiao, replacing it with Shengma. Only if stagnation is not contraindicated can Xijiao Dihuang Tang be used. This is the skill of entering the inner chamber.

Qianghuo Baidu San See Fever.
Rash syndromes are often due to seasonal epidemic toxins, hence Baidu San is used to first disperse exterior pathogens.

Jiedu Huasha Tang
Niubangzi (Arctii Fructus), Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Chuanlian (Coptidis Rhizoma), Jiegeng (Platycodonis Radix), Chantui (Cicadae Periostracum), Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma).
When rash emerges and there is interior heat, use this formula to clear heat and resolve rash.

Shengma Gan Ge Tang See Irritability.
When toxic eruption shows Taiyang exterior symptoms, use Baidu San. If Yangming symptoms appear, use this formula to ascend and emit. Using Baidu San disperses back rash hiding; using Shengma Gegen Tang emits chest and face rash that did not penetrate, along with cracked lips/mouth, vomiting, and grinding teeth; this is the subtle interior work.

Xiaodu Xijiao Yin
Jiegeng, Jingjie, Lianqiao (Forsythiae Fructus), Fangfeng, Huangqin (Scutellariae Radix), Xijiao (Rhinocerotis Cornu), Sheng Niubangzi.
After rash has emerged and body heat does not decrease, Jiedu Tang is established to treat severe heat; Xiaodu Yin is established to treat mild heat.

Shigao Huasha Tang
Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Gegen (Puerariae Lobatae Radix).
Jiedu Huasha Tang treats interior heat of all six channels generally. This formula specifically treats Yangming interior heat. For severe cases, combine both formulas. If extreme heat generates rash, use Liangge San (Cool the Diaphragm Powder) or Sanhuang Jiedu Tang (Three Yellows Detoxification Decoction).

Danggui Dahuang Tang
Danggui (Angelicae Sinensis Radix), Sheng Dahuang (Rhei Radix et Rhizoma), Chuanlianhua (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
For severe heat, hard stool, and presence of purgative indications, this formula is established to cool large intestine blood-heat. Since rash belongs to blood, Danggui is added. Since rash should not be heavily purged, Gancao is added.

Da Chaihu Tang See Tidal Fever.
Da Gan Ge Tang See Headache.
For Shaoyang exterior heat with purgative indications, use Da Chaihu Tang for dual resolution. If Yangming exterior heat has purgative indications, my family secret establishes this formula. With these two methods, Shaoyang is dual-resolved, Yangming is dual-resolved, ensuring no confusion.

Sanhua Tang
Dahuang, Zhishi (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex).
For blood-heat constipation with purgative indications, use Danggui Dahuang Wan to purge. If qi-heat constipation has purgative indications, use this formula. Adding Gancao makes Tiaowei Chengqi Tang (Regulate the Stomach Major Order the Qi Decoction).

Xijiao Daqing Tang
Xijiao, Daqing (Isatidis Folium), Zhizi (Gardeniae Fructus), Chidouchi (Sojae Semen Preparatum).
This formula is Zhizi Chidouchi Tang plus Xijiao and Daqing, capable of resolving toxin in Yangming blood, thus being a key herb for rash syndromes.

Shengma Qingwei Tang
Shengma (Cimicifugae Rhizoma), Chuanlian, Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Gancao, Mutong (Akebiae Caulis).
Gegen Qingwei Tang clears Yangming qi-level heat-toxin. This formula clears Yangming blood-level epidemic toxin. Therefore, for rash with dry mouth/lips, heat consuming water, it is qi-level heat, use Gegen Qingwei Tang; if dry mouth/lips, heat not consuming water, it is latent fire in blood, use Shengma Qingwei Tang. Generally, for accumulated heat from rich foods, foul breath, cracked lips, rotting gums, this formula is often used, because meat damages the blood level. Adding Hawthorn and Sharen effectively digests greasy meat. Adding Mutong, combined with Daochi Ban Tang (Half Guide Red Urine Decoction), promotes urination. Adding Zhike (Aurantii Fructus), combined with Chuanlian Zhike Tang, clears large intestine accumulated heat. Evil fire harming blood causes rash; damp-fire harming blood causes diarrhea; dry-fire harming blood causes constipation. Danggui Dahuang Wan clears dry-fire in blood, moistening large intestine constipation. I use this formula for rash resolution, treating dry-fire harming blood, abdominal pain with bloody dysentery, stopping large intestine diarrhea.