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Macules and papules (bān zhěn, macules and papules) are originally caused by fire-toxin (huǒ dú, fire toxin) in the Lung and Stomach. Therefore, there is high fever (zhuàng rè, severe fever), irritability, thirst (fán kě, irritability and thirst), and a preference for cold drinks (xǐ lěng hǎo yǐn, liking cold beverages). This is the normal presentation. However, if one indulges in drinking frozen beverages, it will cause ice-coldness to suppress heat-toxin inside, and body fluids (jīn yè, body fluids) will congeal when encountering cold, making dryness and thirst even worse. Moreover, the Stomach likes cool drinks but dislikes heat; when cold enters the mouth, regardless of deficiency or excess, it feels refreshing. The Intestines like hot drinks but dislike cold; when cold flows to the lower Jiao (xià jiāo, lower abdomen/lower burner), regardless of deficiency or excess, injury occurs. Mildly, it stimulates rising deficient fire (xū huǒ, deficient fire), causing unceasing alternating chills and fever; severely, it forces heat-toxin to descend, causing endless diarrhea and dysentery. Furthermore, mistakenly treating irritability, thirst, and preference for cold as excess heat (shí rè, excess heat), and fiercely using bitter-cold herbs like Scutellariae Radix (Huángqín, Huangqin) and Coptidis Rhizoma (Liánzǐ, Lianzi), one does not know that the surplus of fire stems from the insufficiency of water. Thirst is actually a disease caused by the dryness and withering of organ-fluids. Shao-huo (minor fire/physiological fire) transforms into Zhuang-re (severe fever/pathological fire), Zong Qi (pectoral qi) is already lost in the middle, Gu Yin (solitary yin) covers the muscle surface, and Ying Wei (nutritive and defensive qi) is exhausted internally. If one does not seek the profound truth of Yin and Yang to regulate them, but merely treats seasonal external pathogens as the main issue, strong individuals may recover after prolonged neglect, while weak individuals may die suddenly due to transformation symptoms. Thus, whenever there is severe fever and irritability with thirst, this principle can be extrapolated.

Why is it that in the North, those suffering from heat diseases who prefer cold drinks are called "Ge Shui Bing" (water-spitting disease)? Patients drink cold water freely, while physicians fiercely administer cold-natured medicines, resulting in increased thirst with more drinking, and increased coldness with more heat, forcing floating and rebellious Deficient Yang (xū yáng, deficient yang) to be entirely consumed at the muscle surface, inevitably leading to a cold body. Why do they not ponder the saying "Warmth can eliminate great heat"? Know that thousands of changing diseases mostly arise from internal fire losing its proper position: if it rushes to the vertex, there is headache; if it spreads to the muscle surface, there is body heat; if it floats to the head and face, there is facial redness; if it lodges in the epiglottis, there is sore throat. When balanced, it stays in position, preventing external pathogens from entering, becoming the righteous Qi of True Yang (zhēn yáng, true yang). When失常 (abnormal), it leaves its position, allowing external pathogens to enter, transforming Yang Qi into fire. Why do physicians treat heat diseases by vaguely speaking of "evil heat" and daily focusing on bitter-cold herbs? Is there a fire outside the body distinct from the heat within? This is the internal fire of the person itself, emerging pathologically. Only when Excess Fire (shí huǒ, excess fire) is excessive should cold-natured herbs be temporarily used to subdue it, stopping once the disease is addressed; there is absolutely no reason to eradicate it completely. Otherwise, incessant drinking of water and eating of ice drives all Yang Qi out, causing cold limbs (jué lěng, cold extremities), leaving Long-Lei fire (dragon-thunder fire, referring to ministerial fire) nowhere to reside. It presses upward, causing stomach rot and bad breath, red eyes, black tongue, loss of Ying Qi movement, stagnation forming macules/papules appearing only on the feet. Macules and papules belong to fire, and fire nature ascends, so they usually appear on the head and face. Now appearing only on the feet indicates Yang Qi is exhausted, Yin Qi is stagnant, named "Si Xue Ban" (dead blood macules), untreatable. These are all errors due to mistaking extreme Yin simulating Yang (false heat) and using cold-natured treatments. As for rotting lips and mouth, even cheek perforation and lip defect, nose rot and eye damage, it seems like heat-toxin. But who knows that Yang Qi fills skin/hair, strengthens bones/tendons, tightens pores, and protects externally? Yin Blood nourishes collaterals, moistens skin/flesh, nourishes marrow, and sustains internally. The face is the meeting of all Yang, eyes are the essence of extreme Yin, nose is the orifice of Zong Qi. Only the purest and finest Qi and Blood can reach the nose and face. If Yang Qi dissipates externally, losing its protective power, and Yin Blood dries up internally, losing its nourishing function, then the essence of the five organs withers. Yin-shade fire takes advantage of the void to confuse the orifices, burning and damaging rapidly, like dragon-thunder fire destroying everything quickly. Moreover, residual heat remaining as Sha-Lao (sha-labor) is a disease of original Qi and Blood, what poison is there? Healers who understand this principle will make the Sun shine, instantly extinguishing dragon-thunder fire; when True Yang revives, Yin-shade vanishes; when True Yin generates, deficient Yang transforms naturally, and Ying-Wei perform their duties. Formless gives rise to formless false fire; one must use tangible herbs generating formless Water-Fire true medicine to regulate it. Creation's principle arises from the formless. All tangible things are not true. Why, upon seeing severe fever and red spots, treat them as tangible excess, using tangible attacking drugs for formless deficiency, causing myriad transformations? How can the patient survive!

(Zhang) In the Yi-Hai year, while printing this book and traveling north on grain ships, macules/papules were prevalent and critical. Physicians used exterior-expelling support or clearing-resolving methods, none effective. Some had macules/papules all over the body but faintly receding on the face, severe fever, wheezing/cough, irritability, anorexia, and diarrhea; others had bright red severe fever, wheezing/cough, irritability, anorexia, and diarrhea with visible macules/papules on body and face. Know these are all Yang floating outward and Yin exhausting inward, weak Middle Qi and injured Lung Qi, where fire surplus is due to water insufficiency. Ignorant people generally attribute this to measles residual toxin, not realizing it is actually severe Qi-Blood injury, a disease of Yin-Yang imbalance. I palpated pulses: Cun (inch) strong, Chi (cubit) weak, or fine-rapid and powerless. I prescribed Quan Zhen Yi Qi Tang (Complete True One Qi Decoction - see Miscellaneous Diseases Vol 20) without Ginseng, adjusting dosage based on age and severity. After 1-2 doses, wheezing and fever subsided, deep sleep for over a day, spirit refreshed, appetite returned. Previous cases of mouth ulcers and eye issues also recovered. This shows the profound utility of Yang storing and Yin growing. I admire Master Yu Jiayan's discussion on using Ren Shen Bai Du San (Ginseng and Coix Seed Decoction to Overcome Pathogenic Factors) for macules/papules, and Wu Hegao's claim of using Renshen and Fu Zi (Ginseng and Aconite) for macules, demonstrating methodological variation. Physicians lacking broad vision cannot discuss such matters; this trust is not unfounded. Only for those with surging powerful pulses and robust constitution should one use Qingjie (clearing/resolving) herbs like Forsythiae Fructus (Lian Qiao, Lianqiao), Fritillariae Thunbergii Bulbus (Tu Bei Mu, Tubeimumu), Arctii Fructus (Niu Bang Zi, Niubangzi), Glycyrrhizae Radix et Rhizoma (Gan Cao, Gancao), Scrophulariae Radix (Sheng Di Huang, Shengdihuang), and Paeoniae Rubra Radix (Dan Pi, Danpi). If one fails to understand Yin exhaustion and Yang floating, and indiscriminately uses exterior-macule detox formulas, not only will treatment fail, but it will become incurable, leading to simultaneous Yin-Yang exhaustion, irritability, panting, yet still claiming internal attack of macule toxin, complete loss of Yuan Shen (original spirit), progressing to lockjaw, and still treating as convulsive transformation—how ignorant!

My eldest grandson Daye, aged four, during the tooth-changing month, when household measles were rampant, contracted the disease. Refusing medicine, he rested quietly avoiding wind. By day 5-6 of fever, spirit was very fatigued, sleeping deeply with eyes open, faint macules appeared mainly on the body, slight on face, forehead hot as iron, legs/feet warm, no food intake, anxious with no sweat. I said: Face not rising indicates Yang deficiency failing to lift. Forehead excessively hot indicates Dragon-Thunder fire ascending. Anorexia and fatigue indicate Middle Qi failure from prolonged heat. Anxiety and no sweat indicate True Yin depletion from prolonged heat. Deep sleep with open eyes indicates spirit fatigue and Governing Vessel contraction. Using dispersing methods would further deplete True Yang and Yin, causing deficient fire to blaze and internal wind to rise, leading to seizure-like changes. Especially with Yin exhaustion followed by dispersing, True Yin becomes drier, leading to irritability and chaotic skin manifestations. With root Qi-Blood defeated, how can formless Qi-Blood macules emerge externally? I used Shu Di Huang (Prepared Rehmannia Root) 8 qian as Sovereign to nourish Water; Chao Huang Bai Zhu (Stir-fried Atractylodes Macrocephala Rhizome) 3 qian as Minister to secure Middle Qi; Niu Xi (Achyranthes Bidentata Root) 2.4 qian to direct turbid Yin downward; Chao Zao Mai Dong (Stir-fried Ophiopogon Tuber) 2 qian and Wu Wei Zi (Schisandra Berry) 0.3 fen to collect Lung Qi and gather Dragon-Thunder fire downward as Assistants; Zhi Fu Zi (Prepared Aconite Lateral Root) 0.6 fen as Envoy to solidify Dantian. Thus, True Yang obtained, facial macules rose spontaneously. Forehead heat retreated spontaneously. True Yin obtained, body anxiety resolved with mild sweat. Indeed, after morning dose, macules fully emerged, forehead heat greatly reduced, mild sweat appeared. Spirit refreshed. Due to lingering weakness, I gave Ren Shen (Ginseng Root) 0.8 fen, Mai Dong 1 qian, Wu Wei Zi 5 berries decocted in warm soup in the evening. Next day, vigor and spirit restored. Some worried about Wu Wei Zi's sour astringency, not knowing Fu Zi's powerful nature enhances its effect when astringed. True Yang strengthens internally, Yin-shade resolves externally, illustrating "one wins, one loses." Thus, nourishing True Water induces sweat; abundant sweat strengthens True Yang to scatter false Yang; false Yang dissipates like sun shining, extinguishing dragon-thunder fire. Once Water-Fire regulated, hundred diseases cease. Regulate righteous Qi internally, evil Qi scatters externally. Therefore, treating tangible diseases requires seeking the formless Qi. Tangible transformations belong to formless deficiency. Who says external pathogen transmission is merely external invasion? It is essentially internal manifestation. Seeking root rather than blindly expelling prevents defeat.