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This is transformed from the pathogenic heat of the Yangming Stomach Meridian. The pathogen does not manifest on the exterior but in the interior; it does not appear at the beginning but at a later stage. Therefore, in Yangming disease, if sweating should have been induced but was not, if purgation should have been used but was not, or if purgation was incorrectly applied when it should not have been, the accumulated heat can all lead to the formation of macules and papules (rash). The spots vary in size and density; their colors range from red, pale, purple, to black. They may be hidden or visible, easy to erupt and recede, or difficult to erupt and persist. Generally, the severity of the heat determines the depth of the toxin. Regardless of whether the larger lesions are macules (ban) or the smaller ones are papules (zhen), or even sparse marks resembling mosquito bites, the primary treatment must be to use Puerariae Radix (Gegen) to support and vent the eruption.

If following Zhang Zhongjing’s method for treating red macules, one uses Ejiao Daqing Tang (Cordyceps and Green Indigo Decoction), using Fermented Soybean (Douchi) as the sovereign herb to disperse the pathogen, while Qingdai (Indigo Naturalis), Ejiao (Donkey-hide Gelatin), and Gancao (Licorice Root) serve to resolve toxicity and clear heat. For treating warm toxicity causing macules accompanied by vomiting and regurgitation, Heigao (Black Ointment) is used. It employs a doubled dose of Shengdi Huang (Rehmanniae Radix) combined with Douchi, plus Zhu Gao (Pork Lard), purely for resolving toxicity. Adding Xionghuang (Realgar) and Shexiang (Musk) as guiding herbs adds a dispersing function. Although students should not rigidly adhere to these formulas, understanding this principle allows one to deduce that the treatment of macules involves either supporting their emergence or resolving them internally.

I once treated a woman who drank strong liquor in summer, resulting in facial flushing, irritability, and fever. Her pulse was imperceptible. I said, "This is fire pathogen stagnation with extreme heat." I prescribed Zhizi Chidui Tang (Gardenia and Fermented Soybean Decoction) added with Gegen (Puerariae Radix), Houpo (Magnoliae Officinalis Cortex), and Huanglian (Coptidis Rhizoma) to clear the heat. Consequently, the macules erupted profusely, and her pulse became palpable again.

Another patient suffered from cold damage (Shanghan) that did not resolve after passing through the meridian stages. His entire body developed black macules, his lips and mouth were scorched and dry, his pulse was choppy, and his stool was constipated. I administered Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction), and he recovered.

Another woman had heat entering the Blood Chamber (Xueshi), followed by the eruption of macule spots. I cured her with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Shengdi Huang (Rehmanniae Radix) and Mudan Pi (Moutan Cortex).

A friend of mine, addicted to tobacco and alcohol, often suffered from abdominal pain, vomiting, and large patches of red rash on his body. I used Zhiqiao (Aurantii Fructus) and Houpo (Magnoliae Officinalis Cortex) to calm his damp-heat. The next day, the lesions suddenly changed into granular macules. I stabilized him using methods to resolve toxicity and cool the blood. All these cases are variations of fire and heat pathogens.

Regarding macules caused by uncleared stomach pathogenic factors, this is particularly common. If accompanied by unbearable distension and fullness, internal resolution should be the priority. One must not abruptly administer cold-natured drugs, lest the macules fail to emerge and the pathogen instead becomes knotted internally. If the macules have already emerged but the heat is not severe and there are no signs of fire toxicity, then specific detoxification and resolution are unnecessary; the condition will heal spontaneously. Do not further administer cooling medicines to injure the healthy qi. How can students be so rigid?

**Gegen Nongpo Tang (Pueraria and Magnolia Decoction)**: Treats excess in the stomach with chest and diaphragm distension, red spots on the body, and a large, forceful pulse. Cooling medicines should not be taken.
Ingredients: Gegen (Puerariae Radix), Nongpo (Magnoliae Officinalis Cortex processed with ginger), Zhike (Aurantii Fructus stir-fried with bran), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix) (each 1 qian), Shanzha (Crataegi Fructus) (1.5 qian), Gancao (Licorice Root) (0.3 qian).
For irritability, add Douchi (Fermented Soybean). For excess fullness, add Laifuzi (Raphani Semen). Add ginger. Decoct in water.

**Ejiao Daqing Tang (Ejiao and Qingdai Decoction)**: Treats red macules.
Ingredients: Daqing (Qingdai/Indigo Naturalis), Ejiao (Asini Corii Colla), Gancao (Licorice Root) (each 1 qian), Douchi (Fermented Soybean) (3 qian).
Decoct in water.

**Heigao (Black Ointment)**: Treats warm toxicity causing macules, vomiting, and regurgitation, allowing toxins to exit through the skin.
Ingredients: Sheng Dihuang (Rehmanniae Radix) (2 liang 6 qian), Hao Chi (Good quality Fermented Soybean) (1 liang 6 qian).
Mix with 10 liang of Zhu Gao (Pork Lard). Simmer with dew until the liquid reduces by one-third. Strain to remove dregs. Add Xionghuang (Realgar) and Shexiang (Musk) in amounts the size of a bean, mix well. Divide into three doses. Avoid eating Elaeagnus fruit (Wuyi).

**Yangdu Shengma Tang (Yang Toxin Corydalis Decoction)**: Treats Yang Toxin red macules, delirious speech, and expectoration of pus and blood.
Ingredients: Shengma (Corydalidis Rhizoma) (1.5 qian), Xijiao (Rhinocerotis Cornu, ground/mixed juice), Sheye (Belamcandae Rhizoma), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Gancao (Licorice Root) (each 0.8 qian).
Decoct in water. Administer with Xijiao juice.

**Xuanshen Shengma Tang (Scrophularia and Corydalis Decoction)**: Treats sore throat and macule eruption.
Ingredients: Xuanshen (Scrophulariae Radix), Shengma (Corydalidis Rhizoma) (each 1.5 qian), Gancao (Licorice Root) (0.8 qian).
Decoct in water and take.

**Baitu Renshen Tang (White Tiger Ginseng Decoction)**, also known as **Hua Ban Tang (Macule Resolving Decoction)**: Treats red macules, dry mouth, irritability, thirst, and mental restlessness.
Ingredients: Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum) (each 3 qian), Renshen (Ginseng Radix), Gancao (Licorice Root) (each 1 qian), Jingmi (Oryza Sativa Grain) (a pinch).
Decoct in water.