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Jieguo stated: The disease of macules (Rash) presents with varied syndromes. Sores that swell on the exterior belong to the Shaoyang Sanjiao Ministerial Fire (Xianghuo), known as "small red spots" (Xiaohongye), moving within the skin; those that do not emerge from the surface belong to the Shaoyin Sovereign Fire (Junhuo), known as macules (Zhen). Whenever symptoms such as spontaneous vomiting and diarrhea appear, one must not treat recklessly, as the prognosis is generally auspicious, indicating that pathogenic factors are being expelled through the upper and lower orifices. When macules erupt simultaneously, children may find it difficult to tolerate, leading to the emergence of other syndromes. Treatment should never involve purgatives from beginning to end. Generally, formulas for stabilizing the interior are more numerous than those for releasing the exterior. If constipation occurs, mild laxation should be applied to prevent pathogenic stagnation, allowing the eruption to occur in batches so that the child can better endure it. A warm body indicates a favorable course (Shun), while a cold body indicates an unfavorable course (Ni).

Commentary: This is a general principle. For macules arising from Yang syndromes, treatment should be viewed in conjunction with the discussions in the "Pediatrics Section."

The Brief Examples state: Macules arising from Yang syndromes have four causes: those caused by Cold Damage (Shanghan), those caused by Seasonal Qi (Shiqi/epidemic diseases), those caused by Heat Diseases (Rebing), and those caused by Warm Toxins (Wendu). The macules appear like brocade patterns, erupting on the face, chest, back, or extremities. Red and bright color indicates Stomach Heat; purple-black color indicates Stomach Rot (Wei Lan). These result from either premature or delayed use of purgatives in external contracted heat diseases. One should administer herbs such as Scrophulariae Radix (Xuanshen), Cimicifugae Rhizoma (Shengma), and Baihu Tang (White Tiger Decoction).

Careful Note: Among the four seasonal pathogens, Warm Toxin is the most severe, though Summerheat syndromes also cause macules, varying in severity. Eruptions on the face transmit to the Hand meridians, making diagnosis difficult. It is said: "Wu Earth assists Shaoyin Heart Fire, invading the Hand Taiyin Lung Meridian." Eruptions on the back relate to the Foot Taiyang; those on the chest relate to the Foot Yangming; those on the extremities relate to the Spleen and Heart.

Macules arising from Yin syndromes also appear on the back and chest, extending to the hands and feet, but are sparse and faintly red. Treating them as heat syndromes and administering cooling agents would be a major error. This condition arises from rootless and unanchored fire gathering in the chest, steaming upward solely affecting the Lungs, and transmitting to the skin to form spots resembling bites from mosquitoes, fleas, or lice, rather than brocade patterns. Treatment should regulate the Middle Jiao and warm the Stomach, adding Fennel Fructus (Huixiang) and Paeoniae Radix Alba (Baishao), using formulas similar to Dajianzhong Tang (Great Construct the Middle Decoction). The fire will naturally retreat from below, and the ascending fire will subside. This constitutes treating the root rather than the branch.

Careful Note: Macule syndromes indeed present with differences in Yin/Yang and severity. Yang syndromes generally employ methods to support the interior, clear heat, resolve macules, and cool blood. Yin syndromes only employ methods to regulate the middle and warm the stomach. The macules will resolve spontaneously, and the patient's constitution will stabilize, unlike abscesses which require suppuration. Although both mild and severe cases transform from fire, the general principle is: in acute cases, treat the branch; in chronic cases, treat the root.