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(The occurrence of macules in febrile diseases is similar to this.)

Macules (skin eruptions) occur due to the failure to apply sweating or purgative methods in time. Heat-toxin (pathogenic heat accumulating into toxicity) attacks internally and cannot dissipate, stagnating in the Stomach Fu-organ (stomach), and subsequently erupting onto the skin surface. If the condition remains unresolved after sweating or purgation, accompanied by cold feet, deafness, chest oppression and irritability, cough, vomiting and regurgitation, restlessness and fever, and inability to sit or lie still comfortably, these are signs of macules. In spring, patients suffering from warm diseases who encounter seasonal heat may be affected by an "abnormal qi" (atypical pathogenic factor appearing out of season), transforming into warm toxin (warmth-toxin). Wang Shuhe stated: When the Yang pulse (radial artery at the cun position) is flooding and rapid, and the Yin pulse (radial artery at the chi position) is solid and large, combined with the contraction of warm-dampness, it transforms into warm toxin. Latent warmth interacts with seasonal heat, causing heat in both the exterior and interior; this represents the most severe type of warm-heat disease. The pulse is vigorous upon both superficial and deep palpation. Symptoms include mental restlessness and oppression, vomiting and regurgitation, wheezing and coughing. In severe cases, the face turns red, the entire body becomes crimson, there is delirium, extreme restlessness and thirst, soreness and swelling of the throat, incoherent speech, diarrhea, and the appearance of macules. This is a critical prognosis. The macules resemble patterns on brocade. For cases with high fever, irritability, and dry, constipated stool, use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity).

For cases characterized by restlessness, oppression, delirium, and absence of sweat, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction).

For cases with spontaneous sweating, irritability, thirst, and macules, indicating Stomach heat, use Renshen Huaban Tang (Ginseng Macule-Transforming Decoction).

For cases with烦热 (vexing heat), incoherent speech, and insomnia, use Baihu Tang (White Tiger Decoction) combined with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity).

If the macules fail to erupt fully, use Xijiao Daqing Tang (Rhinoceros Horn and Isatis Decoction). If the macules have erupted but the fever persists, remove Shengma (Cimicifugae Rhizoma) and Huangqin (Scutellariae Radix) from the above formula, and add Renshen (Ginseng Radix et Rhizoma), Shengdihuang (Rehmanniae Radix Recens), and Chaihu (Bupleuri Radix). Any case where the macules are purple indicates a critical prognosis; treat with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) combined with Xijiao (Rhinocerotis Cornu) and Dihuang (Rehmanniae Radix). However, one must warn the patient's family beforehand before administering treatment, as although medication is used, only two or three out of ten patients may be saved. If the macules turn black and sink inward, death is inevitable.

Although purgatives are generally contraindicated in macule formation, if there is fecal impaction, extreme restlessness and thirst, and purple macules, a mild purgative action may be employed.

If the macules have fully erupted and the external pathogenic influence has subsided, yet internal excess causes constipation and delirium, administer a small dose of Liangge San (Cooling the Diaphragm Powder). Alternatively, use Da Chaihu Tang (Major Bupleurum Decoction) to induce mild purgation.

Generally, red and bright macules indicate Stomach heat; purple indicates damage to the Stomach Qi; black indicates necrosis of the Stomach tissue. In general, fresh red macules that rise and spread are auspicious, even if extensive. Dense, patchy purple macules indicate a prognosis of half-life, half-death. Mixed green-purple colors indicate a mortality rate of nearly 100%. After macules appear, if the pulse is flooding, rapid, and forceful, and the body is warm with warm feet, the condition is easy to treat. If the pulse is minute and the feet are cold, indicating deficiency of Yuanqi (Original Qi), the condition is difficult to treat. Delirium accompanying macules, spontaneous diarrhea, shortness of breath, obstinate constipation, or black macules resembling dried fruit are all considered untreatable.