论曰伤寒发斑。阳盛故也，其病在表，或未经发汗，或已发汗未解，或吐下后，邪热不
除。毒瓦斯内盛，因表虚，热毒乘虚出于皮肤，发为斑疹，如锦纹，若色赤及发在五日内者，
可治。若色黑过七日乃发者，难治，甚则喉舌身体皆成疮也。
治伤寒热病十日内，未得汗，表里有热，遂发斑点，或时狂言，眼目俱黄，心中烦热，
大便不利。黄芩汤方
黄芩（去黑心） 大青 升麻 茵陈蒿 大黄（锉炒） 朴硝（各一两） 山栀子仁 黄
连（去须） 甘草（炙各半两）
上九味，粗捣筛，每服五钱匕，用水一盏半，竹叶三七片，同煎至一盏，去滓温服。
治伤寒热毒内盛，身发赤斑。犀角汤方
犀角（镑） 麻黄（去根节） 石膏（各一两） 山栀子仁（一两半） 黄连（去须三
分）
上五味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓温服。
治伤寒发斑，心躁烦乱。山栀子汤方
山栀子仁（三分） 大青 升麻（各一两） 阿胶（炒令燥半两）
上四味，粗捣筛，每服五钱匕，用水一盏半，入豉百粒，同煎至一盏，去滓温服。
治伤寒脏腑毒热，不得宣散，肌肤发斑。黄芩汤方
黄芩（去黑心） 大青 升麻 石膏（各一两） 朴硝 山栀子仁（各半两）
上六味，粗捣筛，每服五钱匕，水一盏半，豉一百粒，葱白并须二寸，生姜半分拍碎，
同煎至八分，去滓温服。
治伤寒发斑，状如锦纹，呕逆烦闷。麻黄葛根汤方
麻黄（去根节） 葛根（锉） 知母（焙） 陈橘皮（汤浸去白焙） 黄芩（去黑心各
一两） 杏仁（汤浸去皮尖双仁炒） 甘草（炙各半两）
上七味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓温服。
治伤寒毒瓦斯外攻皮肤，发狂躁热。犀角散方
犀角（镑） 黄芩（去黑心） 大青 马牙硝（别研） 麦门冬（去心焙各一两） 山
栀子仁 牛黄（别研） 赤茯苓（去黑皮） 天竺黄（别研） 黄连（去须） 甘草（炙各
半两） 麝香（别研一钱）
上一十二味，捣研为散，每服三钱匕，煎竹叶汤调下。
治伤寒热病七日以上，发汗不解，及吐下后，诸热不除，遂至发斑。阿胶汤方
阿胶（炒令燥一两） 大青（二两） 甘草（炙一两）
上三味，粗捣筛，每服五钱匕，水一盏半，豉百粒，煎至一盏，去滓温服。
治伤寒发黑斑石膏汤方
石膏（一两半） 麻黄（一两去根节） 桂（去粗皮半两） 葛根（一两） 黄连（去
须三分） 故鞋（一只去土细锉） 蜀椒（去目并闭口炒出汗一分）
上七味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓温服，衣覆取汗。
治伤寒毒瓦斯滋盛，蒸于肌肤。发为赤斑，通身大热，头重疼痛，精神昏乱。知母汤方
知母（焙） 牵牛子（炒） 山栀子仁 大黄（锉炒） 黄芩（去黑心） 牡丹（去心）
麻黄（去根节各一两荆芥穗） 硝石 虎杖 射干 羌活（去芦头） 杏仁（各一分） 连
翘（半两） 半夏（二钱以生姜二钱同捣捏饼子曝干）
上一十五味，粗捣筛，每服五钱匕，水一盏半，煎至一盏，去滓温服。
治伤寒发斑烦躁，除胃内瘀热。黄芩汤
黄芩（去黑心一两） 山栀子仁（一两） 甘草（炙一两） 马牙硝（半两）
上四味，粗捣筛，每服三钱匕，水一盏，煎至七分，去滓温服，不计时候。
治伤寒发斑。黄连散方
黄连（去须一两） 槟榔（锉） 甘草（炙各半两）
上三味，捣罗为散，每服二钱匕，入蜜少许如汤点、放温服，不计时候。
Commentary states: The manifestation of macules in Shanghan (Cold Damage disease) is due to excessive Yang. The pathology lies in the exterior; it may occur if sweating therapy has not been administered, or if sweating has been performed but the pathogen remains unresolved, or after emesis and purgation therapies where the evil heat persists. Toxic heat accumulates internally; due to deficiency in the exterior, the heat-toxin exploits this deficiency and emerges through the skin, forming macules resembling brocade patterns. If the macules are red and appear within five days of onset, the condition is treatable. If the macules are black and appear only after seven days, the condition is difficult to treat; in severe cases, sores may form on the throat, tongue, and body.
For Shanghan febrile diseases lasting ten days without perspiration, presenting with interior and exterior heat, leading to the emergence of macules, occasional delirium, yellowing of the eyes and complexion, mental restlessness and heat sensation in the chest, and difficulty in defecation: Huangqin Tang (Scutellaria Decoction).
Huangqin (Scutellariae Radix, remove black heart), Daqing (Polygoni Tinctorii Folium), Shengma (Cimicifugae Rhizoma), Yinchenhao (Artemisiae Scopariae Herba), Dahuang (Rhei Radix et Rhizoma, crushed and stir-fried), Puxiao (Natrii Sulfas, each 1 liang), Shanzhizi Ren (Gardeniae Fructus), Huanglian (Coptidis Rhizoma, remove mustache), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang).
The above nine ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water and 37 leaves of Zhuye (Bambusae Folium), decoct together until 1 zhan remains, strain, and take warm.
For Shanghan with internal accumulation of heat-toxin causing red macules on the body: Xijiao Tang (Rhinoceri Cornu Decoction).
Xijiao (Rhinoceri Cornu, shaved), Mahuang (Ephedrae Herba, remove root and joints), Shigao (Gypsum Fibrosum, each 1 liang), Shanzhizi Ren (Gardeniae Fructus, 1.5 liang), Huanglian (Coptidis Rhizoma, remove mustache, 3 fen).
The above five ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water, decoct until 1 zhan remains, strain, and take warm.
For Shanghan macules accompanied by mental restlessness and confusion: Shanzhizi Tang (Gardenia Decoction).
Shanzhizi Ren (Gardeniae Fructus, 3 fen), Daqing (Polygoni Tinctorii Folium), Shengma (Cimicifugae Rhizoma, each 1 liang), Ejiao (Asini Corii Colla, fried until dry, 0.5 liang).
The above four ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water and 100 grains of Chi (Faber Semen Sojae Preparatum), decoct together until 1 zhan remains, strain, and take warm.
For Shanghan with toxic heat in the zang-fu organs that cannot be dispersed, causing macules on the skin: Huangqin Tang (Scutellaria Decoction).
Huangqin (Scutellariae Radix, remove black heart), Daqing (Polygoni Tinctorii Folium), Shengma (Cimicifugae Rhizoma), Shigao (Gypsum Fibrosum, each 1 liang), Puxiao (Natrii Sulfas), Shanzhizi Ren (Gardeniae Fructus, each 0.5 liang).
The above six ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water, 100 grains of Chi (Faber Semen Sojae Preparatum), 2 cun of Congbai (Allii Cepae Bulbus including roots), and 0.5 fen of Shengjiang (Zingiberis Rhizoma, crushed), decoct together until 0.8 zhan remains, strain, and take warm.
For Shanghan macules resembling brocade patterns, accompanied by vomiting, regurgitation, and mental oppression: Mahuang Gegen Tang (Ephedra and Pueraria Decoction).
Mahuang (Ephedrae Herba, remove root and joints), Gegen (Puerariae Radix, crushed), Zhimu (Anemarrhenae Rhizoma, baked), Chenpi (Citri Reticulatae Pericarpium, soaked in hot water, white pith removed, baked), Huangqin (Scutellariae Radix, remove black heart, each 1 liang), Xingren (Pruni Semen, soaked in hot water, peel and tips removed, double-kernel stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang).
The above seven ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water, decoct until 1 zhan remains, strain, and take warm.
For Shanghan where toxic heat attacks the skin externally, causing mania, agitation, and fever: Xijiao San (Rhinoceros Horn Powder).
Xijiao (Rhinoceri Cornu, shaved), Huangqin (Scutellariae Radix, remove black heart), Daqing (Polygoni Tinctorii Folium), Mayaxiao (Natrii Sulfas, separately ground), Maimendong (Ophiopogonis Radix, remove heart and bake, each 1 liang), Shanzhizi Ren (Gardeniae Fructus), Niuhuang (Bovis Calculus, separately ground), Chifuling (Polyporus, remove black skin), Tianzhuhuang (Bambusae Calamus), Huanglian (Coptidis Rhizoma, remove mustache), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang), Shexiang (Moschus, separately ground, 1 qian).
The above twelve ingredients are pounded and ground into a powder. Take 3 qianbi per dose, mix with Zhu Ye Tang (Bamboo Leaf Decoction) for administration.
For Shanghan febrile diseases lasting more than seven days, where sweating fails to resolve the condition, and after emesis/purgation therapies various heats persist, eventually leading to macules: Ejiao Tang (Donkey-hide Gelatin Decoction).
Ejiao (Asini Corii Colla, fried until dry, 1 liang), Daqing (Polygoni Tinctorii Folium, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 liang).
The above three ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water and 100 grains of Chi (Faber Semen Sojae Preparatum), decoct until 1 zhan remains, strain, and take warm.
Shigao Tang (Gypsum Decoction) for Shanghan black macules:
Shigao (Gypsum Fibrosum, 1.5 liang), Mahuang (Ephedrae Herba, 1 liang, remove root and joints), Gui (Cinnamomi Ramulus, remove rough bark, 0.5 liang), Gegen (Puerariae Radix, 1 liang), Huanglian (Coptidis Rhizoma, remove mustache, 3 fen), Gu Xie (Old Shoe Sole, 1 piece, clean dirt and finely chop), Shujiao (Sichuan Pepper, remove eyes and closed-mouth ones, stir-fry until oil appears, 1 fen).
The above seven ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water, decoct until 1 zhan remains, strain, and take warm. Cover with clothing to induce sweating.
For Shanghan where toxic heat proliferates and steams the skin, causing red macules, high fever throughout the body, heavy head and pain, and mental confusion: Zhimu Tang (Anemarrhena Decoction).
Zhimu (Anemarrhenae Rhizoma, baked), Qianniuzi (Pharbitidis Semen, stir-fried), Shanzhizi Ren (Gardeniae Fructus), Dahuang (Rhei Radix et Rhizoma, crushed and stir-fried), Huangqin (Scutellariae Radix, remove black heart), Mudan (Moutan Cortex, remove heart), Mahuang (Ephedrae Herba, remove root and joints, each 1 liang), Jingjie Sui (Schizonepetae Spica), Xiaoshi (Natrii Nitras), Huzhang (Polygoni Cuspidati Rhizoma et Radix), Shegan (Belamcandae Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix, remove rhizome head), Xingren (Pruni Semen, each 1 fen), Lianqiao (Forsythiae Fructus, 0.5 liang), Banxia (Pinelliae Rhizoma, 2 qian, pounded with 2 qian of Shengjiang (Zingiberis Rhizoma) into cakes and dried).
The above fifteen ingredients are coarsely pounded and sieved. Take 5 qianbi per dose, add 1.5 zhan of water, decoct until 1 zhan remains, strain, and take warm.
For Shanghan macules with irritability, clearing stasis-heat from the stomach: Huangqin Tang (Scutellaria Decoction).
Huangqin (Scutellariae Radix, remove black heart, 1 liang), Shanzhizi Ren (Gardeniae Fructus, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 liang), Mayaxiao (Natrii Sulfas, 0.5 liang).
The above four ingredients are coarsely pounded and sieved. Take 3 qianbi per dose, add 1 zhan of water, decoct until 0.7 zhan remains, strain, and take warm at any time.
Lianhua San (Coptis Powder) for Shanghan macules:
Huanglian (Coptidis Rhizoma, remove mustache, 1 liang), Binglang (Arecae Semen, crushed), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang).
The above three ingredients are pounded and sifted into a powder. Take 2 qianbi per dose, add a small amount of honey, dissolve in hot water like tea, let cool to warm temperature, and take at any time.