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The manifestation of macules (Ban, 斑) is caused by the invasion of severe heat-toxin into the Yangming channel. However, there are two types of symptoms: In cases of Yang-toxin macules, there must be high fever, thirst, and irritability, with the five centers (palms, soles, and chest) feeling as if scorched by an iron, and the pulse is surging and forceful. If the macules are red, it indicates stomach heat, which is treatable. If they are purple-black, it indicates rotting of the stomach, which is untreatable. If they are purely black, the heat-toxin has entered the stomach to an extreme degree, making it a particularly untreatable condition. If the heat-toxin is abundant and accompanied by constipation, urgent purgation should be employed; otherwise, the stomach heat cannot be vented, and the macules will become more intense. However, purgation must not be used too early, lest the middle Qi become deficient, causing the pustules (Dou, 痘) to fail to emerge and become sunken or hidden, and allowing heat to enter the stomach through this deficiency, making the toxin even harder to treat. This follows the same principle as the purgative method in Shanghan disease. In cases of Yin-syndrome macules, there is no significant body heat, the fingernails and toenails turn blue-green, the pulse is deep and fine, and the macules are slightly red. This is due to rootless and uncontrolled fire gathering in the stomach, steaming the lungs, and transmitting to the skin to form macules. Prescribing cold-natured formulas recklessly would be a mistake; therefore, the primary treatment should be warming the stomach and regulating the middle. When the stomach Qi harmonizes, the fire naturally descends, the macules recede, and the pustules emerge.

Regarding patients with Kidney syndrome who suffer from severe lower back pain preventing them from standing, why do they invariably develop macules? The Kidney serves as the gate for the Stomach. If heat-toxin accumulates and cannot be excreted, it transmits to the Stomach channel. Since the Stomach governs the muscles, macules appear. It is appropriate to use herbs such as Arctii Fructus (Niubangzi, 牛蒡子) and Cimicifugae Rhizoma (Shengma, 升麻), focusing on lifting and releasing the exterior within a framework of cooling and detoxifying. If one initially uses heavy stomach-cooling cold agents, blood circulation will stagnate, and the muscles will become icy cold, unable to carry the toxin out. This will inevitably lead to the toxin sinking into the Kidneys and forming a disastrous syndrome. If the condition progresses to purple, red, or black macules on the body, and the white part of the eye (Sclera) shows a peach-blossom water-red hue internally, this indicates internal collapse. The sclera belongs to the Lung; thus, this signifies the failure of the Lung and Stomach, which is untreatable. This color arises faintly from within as a water-red hue, distinct from the red membrane barrier floating externally on the eye.

When pustules are accompanied by rashes (Zhen, 疹), ancient sages called it "Two Tigers Guarding the Gate." Generally, pustules benefit from tonification rather than purgation; purgation prevents them from erupting vigorously. Rashes benefit from purgation rather than tonification; tonification can induce wheezing. However, in the early stage of pustules, only the method of venting and supporting should be used. This simultaneously releases the pustules and induces the rash. Once the rash emerges, the condition resolves, ensuring safety for both. During the suppuration phase, excessive dispersal should be avoided. One should remove Ginseng Radix et Rhizoma (Renshen, 人参) from the formula that assists in pus formation and instead add Arctii Fructus (Niubangzi, 牛蒡子), Platycodonis Radix (Jiegeng, 桔梗), Bombyx Batryticatus (Chantui, 蝉蜕), and Bombyx Batryticatus (Jiangcan, 僵蚕). This aids suppuration while regulating Lung Qi. Once the Lung Qi is clear, the Yang-toxin will naturally dissipate upwards. For rashes appearing after the pustules have resolved, only the rash needs specific treatment. However, if rashes appear first and are followed by lesions resembling water-pox, these are normal pustules. Because the rash has consumed Ying-blood, the pustules appear pale like water-pox. By dispersing the rash, the rash clears, and the pustules mature naturally. They should not be mistaken for water-pox, as rashes never accompany true water-pox.

Skin rashes (Fuzhen, 肤疹) result from the eruption of heat-toxin qi. When they appear suddenly, the spots resemble hemp seeds but are bright red and成片 (in patches). Treatment should focus on cooling and defeating toxicity. If the rash subsides after several days and the pustules follow, the eruption will be sparse and clear, which is auspicious. Hidden rashes (Yinzhen, 隐疹) are mostly related to the Spleen, named so because they hide between the skin layers. They often present with itching or numbness, indicating a complication of damp-phlegm. If the color is red, it also involves fire transformation, and treatment should still prioritize detoxification. There is also what is called Sha (痧), which resembles millet grains, being pointed and round, slightly rough to the touch, and containing clear fluid inside. All these belong to the eruption of heat-toxin; although the names differ, their source is identical.