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Jieguo stated: The manifestations of rash diseases vary. Those presenting with swelling and redness on the exterior belong to Shaoyang Ministerial Fire (fire of the Gallbladder and Sanjiao) and are called "small red spots"; those moving within the skin without emerging externally belong to Shaoyin Sovereign Fire (heart fire) and are called "zhen" (measles-like rash). When symptoms such as vomiting and diarrhea appear, one must not treat indiscriminately; this is generally auspicious because the toxic pathogens are expelled through both upper and lower pathways.

If rashes erupt simultaneously in large quantities, children may not be able to tolerate it, leading to the emergence of other complications. Treatment should avoid purgatives from beginning to end. Generally, formulas that stabilize the interior are more numerous than those that release the exterior. If the pores are closed, they should be gradually unblocked so that pathogenic qi does not stagnate, allowing the rash to emerge in batches, making it easier for the child to endure. A warm body indicates a favorable prognosis (shun), while a cold body indicates an unfavorable prognosis (ni).

The *Lue Li* states: There are four types of rashes associated with wind-cold yang syndromes, among which warm-toxin rashes are the most severe. For example, rashes resembling brocade patterns may appear on the face, back, or limbs. Reddish color indicates stomach heat, while purple-black color indicates stomach decay. The former results from premature purgation, and the latter from delayed purgation; these are rashes caused by external heat pathogens.

Yin syndrome rashes mostly occur on the back and chest, or are sparse on the hands and feet, appearing pale red. Treating them as heat syndromes and administering cooling herbs is a major error. This occurs because rootless and unstable fire gathers in the chest, steaming upward into the lungs and transmitting to the skin, forming rash points shaped like mosquito, flea, or louse bites, rather than brocade patterns.

Chen Wuzhe stated: Physicians discussing urticaria (yin zhen) invariably attribute it to wind-heat in the skin. Since cold and heat are distinguished, they correspond to winter and summer pathogens. Some cases arise from wind-cold invasion after bathing, which implies dampness. Thus, the four climatic factors (wind, cold, summer-heat, dampness) are all present. The *Neijing* classifies various sores as painful when due to excess-heat and itchy when due to deficiency-cold. The Yangming channel governs the muscles and belongs to the Stomach and Large Intestine; there are also distinctions between cold and heat regarding pain and itching, which must be carefully examined. People commonly call white rashes "po mo" and red rashes "xue feng," causing confusion in nomenclature; principles should be used to clarify these terms.

Chen Wuzhe further stated: In typhoid fever, rashes often result from inappropriate purgation, allowing heat to enter the Stomach via the deficiency, or from failure to purge when indicated, preventing the discharge of stomach heat. Both scenarios lead to pure rash eruption with brocade-like patterns. Red rashes are easy to treat; black rashes are difficult because the heat-toxin has penetrated deeply into the Stomach.

For warm-toxin rashes, Xuan Shen Sheng Ma Decoction (Scrophulariae Radix and Cimicifugae Rhizoma Decoction) or Bai Hu Tang (White Tiger Decoction) should be administered. For yin-syndrome rashes, regulating the middle and warming the Stomach is appropriate, adding Fennel Seed (Foeniculi Fructus) and White Peony Root (Paeoniae Radix Alba), using formulas similar to Da Jian Zhong Tang (Major Construct the Middle Decoction). In this way, the fire descends and the rash recedes, addressing the root rather than the branch.

Rashes involving heat and phlegm in the Lungs should be treated by clearing Lung fire, descending phlegm, or releasing the exterior through sweating; purgation may also be applicable in some cases. Urticaria (yin zhen) mostly involves the Spleen, manifesting subtly within the skin, hence the name. Itching or numbness during eruption indicates concurrent wind or dampness. Reddish color indicates concurrent transformation into fire. Some rashes arise from internal cold.

According to the *Lue Li*: General Wan Yan Xiao Jiang Jun suffered from alternating chills and fever, with slight epistaxis, deep and choppy pulses in both wrists, and no significant heat upon palpation of the chest, diaphragm, and limbs. This was internal cold injury. Inquiry revealed he slept near a palace corner in summer, caught wind, and drank water, yogurt, and ice due to thirst. This represents mild external contraction and severe internal injury. From the perspective of internal pathology, all are yin syndromes. Hence, epistaxis occurred first, followed by the manifestation of internal yin-cold and alternating chills and fever. Spleen cold can cause this, but it differs from the alternating chills and fever of Shaoyang syndrome. After taking Tiao Zhong Tang (Regulate the Middle Decoction) several times, he recovered.

Commentary: Rashes indeed present with yin-yang and light-severe variations. Yang syndromes generally require methods to support the interior, clear heat, resolve macules, and cool blood. Yin syndromes require only methods to tonify the middle and warm the Stomach. In this manner, the rash subsides and the patient stabilizes, unlike abscesses that form pus. Although both light and severe cases evolve from fire transformation, the general principle is to treat the branch in acute cases and the root in chronic cases.