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(Chapter 33)

There are two types of macule eruption (rash with flat lesions) in children: one is caused by warm-toxin, and the other by stomach rot. Warm-toxin macule eruption occurs when, during an abnormally warm winter, the body contracts a pestilential qi (pathogenic factors causing epidemic diseases), but does not fall ill immediately. In spring, if constrained by accumulated cold, the toxic heat cannot be vented. When the weather becomes hot, the warm-toxin erupts, manifesting as muscle decay and rashes resembling brocade patterns. The treatment method primarily employs Gegen Jupi Tang (Pueraria and Tangerine Peel Decoction) or Huanglian Jupi Tang (Coptis and Tangerine Peel Decoction). If the macule eruption is caused by stomach rot, it may occur because purgation was not performed when indicated in Shaoyang disease (a stage of Cold Damage), or because purgation was performed too early. This is because inappropriate purgation allows heat to enter the stomach due to deficiency, while delayed purgation prevents the venting of stomach heat, both leading to macule eruption. Surface-releasing drugs should not be used, as this condition presents with exterior deficiency and interior excess. Inducing sweating would cause further ascending and dispersing, worsening the macule decay due to the weak exterior. Treatment should utilize Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) or Huaban Tang (Macule-Resolving Decoction). Macule eruption in Cold Damage is merely due to heat accumulating in the Zang-Fu organs. One must first attack the intestines and stomach; once the interior accumulation forms sores, they will then manifest externally. Red macules are easy to treat, while black macules are difficult to treat, because the toxic heat has penetrated deeply into the stomach. Qianghuo San (Qianghuo Powder, see Cold Damage chapter) added with Chantui (Cicada Slough) can be used to treat red macules.

Gegen Jupi Tang (Pueraria and Tangerine Peel Decoction): Treats pediatric macule eruption and hives resembling brocade patterns, accompanied by vomiting of clear fluid and fever.
Ingredients: Ge Gen (Radix Puerariae Lobatae), Ju Pi (Pericarpium Citri Reticulatae), Xing Ren (Semen Armeniacae Amarum), Ma Huang (Herba Ephedrae), Zhi Mu (Rhizoma Anemarrhenae), Huang Qin (Radix Scutellariae), Gan Cao (Radix Glycyrrhizae) (equal parts).
Preparation and Administration: Coarsely crush the herbs. Take 2 qian per dose, decoct in plain water. If there is heat but no vomiting, remove Chen Pi (Tangerine Peel); if there is no heat, remove Huang Qin and Zhi Mu.

Huanglian Jupi Tang (Coptis and Tangerine Peel Decoction): Treats warm-toxin macule eruption, and also addresses diarrhea and bloody stool associated with measles-like conditions.
Ingredients: Huang Lian (Rhizoma Coptidis), Chen Pi (Pericarpium Citri Reticulatae), Xing Ren (Semen Armeniacae Amarum, skin and tip removed), Zhi Shi (Fructus Aurantii Immaturus, stir-fried), Ma Huang (Herba Ephedrae), Ge Gen (Radix Puerariae Lobatae) (each 0.5 liang), Hou Po (Cortex Magnoliae Officinalis, stir-fried), Gan Cao (Radix Glycyrrhizae, honey-fried) (each 1.5 qian).
Preparation and Administration: Coarsely crush the herbs. Take 2 qian per dose, decoct in plain water and administer.

Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction): Treats cases where, after sweating or purging in Cold Damage, toxic heat remains unresolved, presenting with exterior deficiency and interior excess, body eruptions resembling brocade patterns, and in severe cases, irritability and delirious speech.
Ingredients: Xuan Shen (Radix Scrophulariae), Sheng Ma (Rhizoma Cimicifugae Foetidae), Gan Cao (Radix Glycyrrhizae) (equal parts).
Preparation and Administration: Take 2 qian per dose, decoct in water and administer.

Huaban Tang (Macule-Resolving Decoction) (Formula see Cold Damage Chapter)