Library

It is stated that the diseases of macules (ban) and papules (zhen) present with various symptoms. Sores erupting with swelling on the exterior belong to the Shaoyang Sanjiao (Triple Burner) Ministerial Fire, and are called "macules" (ban). Small red spots moving within the skin without emerging belong to the Shaoyin Sovereign Fire, and are called "papules" (zhen). In cases where macule symptoms appear, if spontaneous vomiting or diarrhea occurs, one must strictly avoid purgative treatment; this often leads to a favorable prognosis, as the pathogenic factors are expelled from both above and below. Generally, for sores and rashes, purgatives should not be used from beginning to end, lest reckless movement cause complications. This refers to the Shaoyang channel connecting to the exterior, which should be harmonized. One should first stabilize the interior to resolve toxicity, then slightly release the exterior. Stabilizing the interior and resolving toxicity means harmonizing the Five Zang organs, such as using Fangfeng Tang (Saposhnikovia Decoction). If the stool is not constipated, proceed to slightly release the exterior. There are many formulas in Qian Yi's works for slight exterior release, which should be selected. If the stool is severely constipated, mild purgation is appropriate, such as Danggui Wan (Angelica Pill) or Zaibian Baixiang Wan (Jujube-Modified Baixiang Pill).

Upon initially identifying macules and papules, if they are forcefully released immediately, causing all spots to erupt simultaneously, children may not tolerate it, leading to other complications. The statement "no purgatives from beginning to end" refers to the "beginning" as the Upper Jiao and the "end" as the Lower Jiao. If vomiting or diarrhea has already occurred, purgatives are contraindicated; instead, three to five doses of interior-stabilizing medicine should be taken. If the patient can eat and has constipation, indicating internal excess, mild laxation is appropriate. If there is internal deficiency with diarrhea, three to five doses of interior-stabilizing medicine are appropriate. The final dose should be taken with slightly exterior-releasing medicine. Generally, more interior-stabilizing medicine is used, and less exterior-releasing medicine. If constipated, mildly purge; do not let pathogenic factors erupt together, but allow them to come out in batches, making it easier for children to tolerate. A warm body indicates a favorable course (shun), while a cool body indicates an unfavorable course (ni); in the latter case, Fangfeng Tang should be taken to harmonize.

Fangfeng Tang (Saposhnikovia Decoction)
Fangfeng (Radix Saposhnikoviae, 1 liang), Diguxpi (Cortex Lycii Radicis), Huangqin (Radix Scutellariae), Shaoyao (Radix Paeoniae Alba), Zhike (Fructus Aurantii Immaturus), Jingjie Sui (Herba Schizonepetae), Niubangzi (Fructus Arctii). (The above ingredients each weigh half a liang).
Grind into fine powder, take with warm water. Or grind into coarse powder, decoct and take 2-3 qian; this is better.

For severe constipation with internal excess and good appetite, Danggui Wan (Angelica Pill) is appropriate.
Danggui (Radix Angelicae Sinensis, 5 qian), Huanglian (Rhizoma Coptidis, 2.5 qian), Dahuang (Radix et Rhizoma Rhei, 2 qian), Gancao (Radix Glycyrrhizae Uralensis, 1 qian, honey-fried).
First, boil Danggui into a paste, add the other three medicines, and form pills. Take ten pills gradually; this is effective.

For macules and papules with severe constipation, use Zaibian Baixiang Wan (Jujube-Modified Baixiang Pill).
Daji (Radix Euphorbiae Pekinensis, heartwood removed, 1 liang), Zao (Fructus Jujubae, 3 pieces, pitted).
Take these two ingredients, decoct with one bowl of water until the water is exhausted. Remove Daji and discard. Dry the jujubes by baking, and prepare pills as needed. Start with a small amount and increase gradually, stopping when bowel movements become smooth.

Each of the Five Zang organs' diseases presents specific signs:
Heat manifests from the Heart, Cold from the Kidney, cough with Qi rebellion from the Lung, Wind from the Liver, and diarrhea from the Spleen. For example, if diarrhea is accompanied by cough and Qi rebellion, it is a disease of the Spleen and Lung. Xiebai San (Pulmonary Heat Resolving Powder) and Yihuang San (Yellow-Resolving Powder) can be combined and taken. Alternatively, Huangqin Houpo Tang (Scutellaria and Magnolia Bark Decoction) or Baizhu Houpo Tang (Atractylodes and Magnolia Bark Decoction) are suitable, because the Spleen dislikes dampness and the Lung dislikes dryness, leading to Qi rebellion. The symptoms start with diarrhea, accompanied by a sallow complexion and rumbling intestines. If thirst and significant heat are observed, Houpo Tang should be taken; if there is no thirst and little heat, Baizhu Houpo Tang should be taken. Other seasonal combinations follow similar logic. However, refer to the detailed explanations below regarding medication adjustments according to the shifting energies of the four seasons.

Before the Spring Equinox, it is Wind-Cold; use Dihuang, Qianghuo, and Fangfeng, or alternate Dihuang Wan and Xieqing Wan. After the Spring Equinox, it is Wind-Heat; use Qianghuo, Fangfeng, and Huangqin, or administer Xieqing Wan with Daochi San. After Start of Summer, it is Heat; use Sanhuang Wan and Daochi San. After Summer Solstice, it is Damp-Heat; combine Daochi San and Xiehuang San, or use herbs like Huangqin, Gancao, Baizhu, and Fuling to overcome dampness. After Start of Autumn, use Yihuang San and Xiebai San, such as Chenpi, Houpo, Renshen, and Muxiang. After the Autumn Equinox, use Xiebai San. After Start of Winter, use Dihuang Wan as the main treatment, because the Kidney does not accept purgation.

Generally, if pediatric macules and papules have erupted with sores and sounds, it means the Form is diseased but the Qi is not. If there are no sores and no sounds, the Qi is diseased but the Form is not. If there are sores but no sounds, both Form and Qi are diseased. In the latter case, clear and benefit Lung Qi using Bafeng Tang or Liangge San; Dahuang and Mangxiao are also acceptable. Or use Rusheng Tang with added Dahuang, or Bawei Qianghuo Tang with added Dahuang. This refers to macules erupting in spring, called "Wind Macules."

Regarding sores and rashes, the *Neijing* states: "Pain, itching, sores, and ulcers all belong to Heart Fire." Macules and papules are produced by the interaction of Ministerial and Sovereign Fires, generated by the True Yang Qi of the Sanjiao. If pathogenic Qi enters the Lung, it becomes pustules; if it enters the Liver, it becomes vesicles; if it affects itself, it becomes macules. The Heart is Sovereign Fire; entering the skin causes urticaria (yin zhen), because the Lung governs the skin and hair. The Heart does not harm Lung Metal, which is the virtue of the Sovereign.

Twitching before sores erupt indicates external Cold invasion triggering internal Heart Heat; treat with Jiedu Wan administered with tea water, or Xijiao Dihuang Tang. If macules erupt densely, resembling pinheads, lightly release the exterior and cool the interior using Lianqiao Shengma Tang. If macules are very dense with slight wheezing and signs of heat upon drinking water, use wind-dispelling herbs with mild purgation. If eruption is slow but stools and urine are normal, the pathogen is in the Exterior, not the Interior; lightly release the exterior using Shengma Gegen Tang. If macules are dry, black, depressed, with low-grade fever and difficult urination/defecation, heat is in the Interior; decoct Dahuang Tang and administer Xuanfeng San. If the body surface is very hot, the Exterior syndrome persists, and purgation is contraindicated. If macules have erupted with slight fever and difficult urination, promote urination. If residual toxicity remains after eruption, causing recurrent fever, abscesses, etc., use detoxifying herbs.