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40. In typhoid fever (Shanghan), if macules and spots appear due to improper lack of sweating or erroneous purgation, leading to pathogenic constraint; whereas in seasonal epidemic diseases, they appear immediately upon infection. The exterior pathogens cover and constrain the Ying (Nutritive) and Wei (Defensive) levels, manifesting externally on the skin and vessels as Sha (sand-like rash), Zhen (macules), and Ban (spots). Sha points are white like skin millet grains; Zhen are red; Ban are red like bean slices, continuous and extensive. Red indicates mild condition, crimson indicates severe condition, black often indicates death; pale red, sparse, and dull indicate Yin-cold syndrome. For those not yet erupted, Shengma Xiaodu San (Cimicifugae Rhizoma Detoxification Powder) is used; for excessive heat, Sanhuang Shigao Tang (Three Yellows Gypsum Decoction) is decocted and taken; for those already erupted, Qingdai Xiaoban Yin (Indigo Naturalis Spot-Dispersing Drink) is used; the Shuangjie (Double Resolution) method for treating Sha and Zhen follows the previous text.

[Note] Typhoid fever causing spots, rashes, or sand-like eruptions all result from improper use of sweating and purging methods, causing external pathogens to re-constrain and internal heat to overflow outward. Only seasonal epidemics transmit and erupt immediately upon infection, due to the fierce and rapid nature of the epidemic disease. Manifesting at the Wei level results in Sha; since Wei governs Qi, the color is white like skin millet grains. Manifesting at the Ying level results in Zhen and Ban; since Ying governs Blood, shallow redness is Zhen, while deep and severe presentation is Ban. Ban shapes resemble beans, and when severe, they connect into large patches. Red color in Ban/Zhen indicates mild illness, crimson indicates severe illness, black indicates death; this verifies life and death based on the depth of heat. If the color is pale red, sparse, and dull, it is because the pathogen was in the Three Yang channels, has entered the interior forming Ban/Zhen, the pathogen transformed into Yin, or resulted from excessive consumption of cold medicines. This is called Yin-Ban, Yin-Sha, Yin-Zhen, and the treatment method should follow the principle of treating Yin-cold. For Ban that have erupted but not fully penetrated, with mild exterior heat, Shengma Gegen Tang (Cimicifugae and Puerariae Root Decoction) combined with Xiaodu Xijiao Yin (Detoxification and Rhinoceros Horn Drink) should be used. For severe exterior heat, Sanhuang Shigao Tang should be used to disperse. For those already penetrated, Qingdai Xiaoban Yin with modifications should be used to clear. For early-stage Sha/Zhen where interior and exterior are unclear, Shuangjie San (Double Resolution Powder) should be used first to unblock interior and exterior, and other methods follow the previous text.

14. Yangming disease epistaxis indicates heat in the interior; Taiyang disease epistaxis indicates heat stagnating in the meridians. Taiyang disease headache and dizziness are precursors; Yangming disease rinsing water without swallowing is a sign. After epistaxis, if the body cools, it indicates resolution; if unresolved, Shengma Xijiao Qing (Cimicifuga and Rhinoceros Horn Clearing) is used. If water is not swallowed and the exterior is excess, Mahuang Tang (Ephedra Decoction) induces sweating; for interior heat, Xijiao Ling Lian (Rhinoceros Horn, Scutellaria, and Coptis) clears it.

[Note] Yangming disease epistaxis is due to heat in the interior. Taiyang disease epistaxis is due to heat stagnating in the meridians. Taiyang disease lacking sweat leads to precursors of headache and dizziness; Yangming disease lacking purgation leads to signs of rinsing water without desire to swallow. After epistaxis, if the body is cool and pulse quiet, it indicates impending resolution. If still unresolved, it indicates incomplete epistaxis and heat remaining in the Ying level. With no sweat and exterior heat, Shengma Gegen Tang combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used to clear and resolve; for those about to have epistaxis but not yet, if the exterior is excess, Mahuang Tang should induce sweating; for interior heat, Xijiao Dihuang Tang added with Huangqin and Huanglian (Scutellaria and Coptis) should clear it. If both exterior excess and interior heat exist, the two formulas should be combined to resolve both simultaneously.