温热病首用辛凉以解，次用苦寒以清里，终用甘寒以救液，此治温热本症国中末之三法也。然有兼症、
夹症、复症、遗症，
及妇人、小儿种种之不同，不得不多备方法以施治，庶免医家道少之患。兹特分列八法，详言以发明之∶
凡能发汗、发 、发疹、发斑、发丹、发痧、发 、发痘等方，皆谓之发表法。温热病，首贵透解其伏邪，
而伏邪初发，必有着落，方着落在皮肉肌腠时，非发表则邪无出路，故发表法为治温热病之一大法也。其大
要不专在乎发汗，而在乎开其郁闭，宣其气血。郁闭在表，辛凉芳淡以发之；郁闭在半表半里，苦辛和解以发
之。阳亢者饮水以济其液，阴虚者生津以润其燥，气滞者宣其气机，血凝者通其络瘀；庶几有 者则发 ，
有疹斑者则发疹斑，有 者则发 ，有痘者则发痘，必察其表无一毫阻滞，始为发表法之完善，此温热病发
表之法，大不同于风寒也。谨述发表验方，胪列于下∶
一、温热发汗，虽宜辛凉开达；而初起欲其发越，必须注重辛散，佐以轻清，庶免凉遏之弊。方伏邪传
变出表时，轻者亦可得表药而汗散，重者虽大剂麻葛羌防亦无汗。但须清其络热，宣其气机，以治温热；或开
其湿郁，达其募原，以治湿温；必待伏邪尽发，表里全彻，然后或战汗或狂汗而解。亦有不用表药而自汗淋漓
邪终不解者，盖自汗缘里热郁蒸而出，乃邪汗非正汗也，仍宜开达其伏邪为要。风温风热，如邵氏热郁汤（邵
步青四时病机方）、栀豉芩葛汤（陆久芝不谢方）之类，湿温湿热，如连朴饮（王孟英霍乱论方）、新定达原
饮（樊开周先师验方）之类，随症酌用可也。至其发汗诸方，辛凉轻剂如葱豉加葛根汤（王焘外台方）、葛
根葱白汤（和剂局方）刘氏桔梗汤（河间六书方）、加味栀豉汤（樊先师验方）之类，辛凉重剂如麻杏石甘汤
（张仲景伤寒论方）千金清肺汤、千金葳蕤汤（孙思邈千
金方）、葛根橘皮汤（外台方）、知母解肌汤、知母干葛汤（朱肱活人书方）、荷杏石甘汤（叶天士医案方）、
加减三黄石膏汤（顾松园医镜方）、增损三黄石膏汤（杨玉衡寒温条辨方）、葱豉白虎汤（赵晴初医案方）
之类，此皆辛以散风，凉以泄热，为治温热内发风寒外搏之要方。其间有风寒搏束过甚而温热伏邪不能外达者，
则葱豉加葛根麻黄汤（外台方），苏羌饮（刘草窗广嗣全书方）之类，亦可暂用以疏散。亦有风寒遏伏太甚而
湿热伏邪不克外溃者，则藿香正气散（和剂局方）、九味羌活汤（张洁古方）之类，正可暂用以开达，初不必
嫌其辛温化燥也。其芳淡轻剂如葱豉汤调天水散（河间六书方）、茵陈五苓散（金匮要略方）、藿朴夏苓汤
（石芾楠医原方）、藿朴二陈汤（樊师验方）之类，芳淡重剂如六神通解散（局方）、茵陈胃苓汤（万密斋
幼科发挥方）、加味五苓散、加味二陈汤（石氏医原方）之类，此皆芳香辟秽，辛淡化湿，为治湿温湿热湿
重挟秽之初方。若湿开热透热重于湿者，则宜苦辛开泄，治在上中二焦，不在发表之例。外此，又有不求汗而
自汗解者四∶如里热闭甚，用三黄泻心汤（伤寒论方）、许氏大黄汤（外台方）、大柴胡合大承气汤（河间六
书方）之类，以疏通其里结，一不已而再，再不已而三，直待里邪逐尽，表里通彻，多有战汗而解者，此其一。
又如里热燥甚，病者思得凉水，久而不得，忽得痛饮，饮盏落枕而汗大出即解者，此其二。又如平素气虚，屡
用汗药而不得汗，后加人参于解表药中，如参苏饮、人参败毒散（局方）之类，复杯即汗者，此其三。又如阴
虚及夺血液枯之人，用纯表药全然无汗，后用润燥生津药于轻解方中，如七味葱白汤（外台方）、加减葳蕤汤
（一名加减葱豉汤，张氏医通方）之类，而汗出如水者，此其四。谨摘诸汗症列下∶
发热恶寒，无汗，头项痛、背痛、肩背痛、腰痛、膝胫痛、周
身肢节痛。
二、温热发 ，每见于夏秋湿温伏暑之症，春冬风温兼湿症亦间有之，初由湿郁皮腠汗出不彻之故，白
如水晶色者多，但当轻宣肺气，开泄卫分，如五叶芦根汤（薛生白湿热条辨方）最稳而灵。若久延而伤及气液，
白如枯骨样者多凶，急用甘润药以滋气液，如麦门冬汤（金匮要略方）、清燥救肺汤（喻嘉言新方）之类，挽
回万一，切忌苦燥温升，耗气液而速其毙。谨摘发 症如下。
色白点细，形如肌粟，摸之触手而微痒，抓破微有水，状如水晶珠而明润者吉；热势壮则外见，热势缓则
隐伏，出无定期，甚至连发三五次，若干白如枯骨色者大凶。脉必微弱或细数，神倦气怯，粘汗自出。
三、温热发疹，红点高起，与 痧一类，系孙络中血热之病。惟 多发于小儿，痧疹不拘男妇大小皆有，
每见于春夏之间，发于风温风热者十之七八，温毒暑热者十之二三，然亦必夹 带疹。疹虽宜见而不宜多见，
身热二三日而发者轻，四五日而发者重， 疹杂出者尤重。治虽宜疏风散热为先，亦当辨其风与热孰轻孰重，
风重而热郁者，辛散佐以清透，防风解毒汤（王晋三古方选注方）最当。热重而风轻者，清透佐以辛散，加减
银翘散（石氏医原方）、加减普济消毒饮（吴鞠通温病条辨方）二方为妙。若温毒夹 带疹，色赤如丹，甚或
紫红，胃经血热上蒸心包也，急宜缪氏竹叶石膏汤（古方选注方），甚则犀角大青汤（邵步青温病论方）肃
清胃热，凉透血络，使 疹发透，则温毒自解。若因循失治，则血热之毒逆传心包肝络，而变神昏痉厥之危证
矣，此时急救之法，惟有用拔萃犀角地黄汤（温毒论方）或犀连承气汤（吕震伤寒寻源方）凉血攻毒，急下存
阴而已。谨摘发疹证列下∶
风温发疹之候∶琐碎小粒，高出于肤，怕风咳嗽，咽阻喉痛，胸闷心烦或气喘，壮热无汗。
温毒发疹之候∶舌绛如朱，夹 带疹，疹色紫红或深红，紧束有根，环口燥裂，大渴引饮，心神烦躁，便
秘溺涩。
四、温热发 ，或布于胸腹，或现于四肢，平而成片，与丹一类，发于温毒病最多，其次大热病亦恒见
之，系经络血热之毒，窜入肌表而外越。经血热则色红，热毒重则色深红，热毒尤重则色娇红，艳如胭脂，统
名红 。络血热则色紫，名曰紫 ；络血热而毒瘀则色黑，名曰黑 ；甚则色青如蓝，名曰蓝 。更有云头隐隐，
伏而不现于皮肤者，曰伏 ；内发于肠胃咽膈之间，肌肤间不得而见者，曰内 。至若隐隐而微，胸腹略见数点
而色淡红者，曰阴 ；甚或淡红似白者，曰白 ；统名虚 ，多发于湿热大病后，凉泻太过，经脉血涸，元气
虚寒之候。故凡见斑，首要辨明其形色。如斑一出，松浮洒于皮面，起发稀朗，红如朱点纸，黑如墨涂肤，此
毒之松活外现者，虽紫黑成片可生。若形干而滞，或枯而晦，稠密成片，紧束有根，如履透针，如矢贯的，此
毒之有根锢结者，纵不紫黑青亦死。凡斑皆胃家血热，色红而鲜润者顺，色紫而晦滞者凶，紫黑蓝而枯晦者死，
以其胃烂也。故红斑九生一死，紫斑五死五生，黑斑九死一生，若杂蓝斑黑烂者必死。治法∶红斑主凉血透热，
轻剂如五味解毒饮加紫草连翘（周澹然温证指归方）、犀地桑丹汤（吴坤安感症宝筏方）之类，重剂如加味犀
羚白虎汤（樊师验方）、加减犀羚二鲜汤（廉臣验方）之类。紫斑主凉血解毒，如犀角大青汤（邵氏温毒病论
方）、小剂清瘟败毒饮（余师愚疫疹一得方）、增损双解散（杨玉衡寒温条辨方）之类，黑斑蓝斑主凉血攻毒，
如拔萃犀角地黄汤加金汁元明粉（温毒病论方）、十全苦寒救补汤（梁玉瑜舌鉴辨症方）、加味凉膈散、增损三黄
石膏汤加锦纹（寒温条辨方）之类。伏斑内斑，主宣气凉血，解毒透 ，如元参升麻合黑膏（王肯堂证治类方）、
犀角大青汤加紫草皂角刺，甚则清瘟败毒饮加紫草升麻紫雪之类。阴斑白斑，主温补血气，如复脉汤（伤寒论
方）、人参养荣汤（证治类方）之类；甚则主扶阳暖血，如参附养荣汤（吴又可温疫论方）、归 建中汤（叶
氏医案方）之类。总之，凡见发斑，不可专以 治，须察脉之浮沉，病之虚实，而分别用药可也。谨摘发斑症如下∶
温毒及大热病，发汗不出，或虽汗不解，发 轻重之候∶面红目赤，汗出津津，口燥大渴，热盛胸闷，发
纯红、深红、胭脂红不等，若唇口焦燥，舌紫或黄，胸膈烦闷，呕恶不纳，热壮神昏，便秘溺赤，遍体紫
者重；若神昏谵语，或不语如尸厥，口开吹气，臭秽喷人，或咯血鼻衄，足冷耳聋，舌苔焦黑起瓣，或见黑晕，
遍体黑 或蓝 如翠者死。
伏 之候∶表无大热，脉似沉缓，神识不清，或郑声作笑，舌甚灰黑，或黄苔而中心黑晕。
内 之候∶口燥目赤，手足指冷，烦躁气急，不欲见火，恶闻人声，耳热面赤，或寒噤喷嚏，昏不知人，
谵语带笑，六脉似躁非躁，舌紫苔黄，或黄腻带灰。
点隐隐而微，色现淡红，甚或 白，手足逆冷，似寐非寐，神识乍清乍昧，舌苔淡红或紫，舌形胖嫩圆大，
或舌苔白滑，或黑苔胖滑。以上虚 之候。
五、温热发丹，多见于小儿，俗名赤游丹是也，与红 一类。丹与 皆出于肤，平而成片，皆里热血毒
之症。治法∶惟大剂凉血解毒乃克胜任，参用发 诸方可也。至辨法∶凡有丹 痧疹者脘必闷，四者之齐与不
齐，以脘闷之解与未解为辨；且热必壮，四者之解与不解，以汗出之透与未透为辨。
六、温热发痧，由于风温者则为时痧，亦名风痧，俗称红斑痧，病虽传染而症轻；由于温毒者则为疫痧，
亦名喉痧，俗称烂喉痧，病多传染而症重。风痧初起，必须疏达，如荆防败毒散（雷少逸时病论方）、连翘败
毒散（伤寒指掌方）二方均加青松针一两煎汤代水，投无不效；即或宜兼清散，总以散字为重，防风解毒汤加
青松针最效。切忌骤用寒凉。喉痧初起，自须轻散解毒，如加减普济消毒饮（温病条辨方），代赈普济散（鞠
通医案方）二方最当。迨表分之痧毒发透，内蕴之伏火方张，势轻者清化，如陈氏清肺饮、夺命饮、犀羚二鲜
汤（陈继宣疫痧草方）三方酌用；势重者寒泻，如陈氏四虎饮（疫痧草方）、拔萃犀角地黄汤加金汁元明粉
（温毒病论方）二方酌用，方能泻火泄热，热一尽而病自愈。若仍执辛散之方，则火得风而愈炽，炎势燎原，
杀人最暴。谨摘发痧症列下∶
风痧之候∶头痛怕风，身热恶寒，痧现无汗，一身筋骨大痛，咽阻喉痛而不腐，胸痞心烦，舌苔白腻。
喉痧国中末之候∶始恶寒，后但壮热烦渴，痧密肌红宛如锦纹，咽喉疼肿，或但痛不肿不红，甚则白腐喉
烂，胸痞咽阻不能食，挟湿则舌苔滑腻，或渴甚而苔仍白滑，或黄滑而腻，或黄燥，内陷则舌赤或鲜绛，神昏
谵语，灼热无汗，痧隐成片，或厥或痉，口秽喷人，音哑气急，鼻煽呃逆者凶。
七、温热发 ，与痧一类，吴地曰痧子，浙江曰 子，恒发于小儿，年长亦间有之。由风温而发者则为
常，宜散风解热为先，加味翘荷汤、防风解毒汤，二方最良，使 毒发透即愈。由温毒而发者则为时 ，与
治温毒发疹发痧例同，从痧疹中对症选方可也。惟闷 一症最险，宜急急开肺透 ，清热解毒，如新加麻杏石
甘汤（感症宝筏方）、千金苇茎合陈氏清肺饮加瓜霜紫雪（疫痧草方），速使 毒外达，方有生机。气液两亏
者，陈氏清肺饮合黑膏加西洋参毛燕，清补而提透之。谨述发 症列下∶
顺症之候∶身热烦闷，咳嗽鼻塞，面目有水红光，咽痛气急，指尖时冷， 出周身匀朗，色鲜润，
形高突，颗粒分明，一二日见点者轻，三五日见点者稍重；既出后一日三潮，潮则热盛烦躁，超时方退，三日
九潮， 已齐透，然后徐徐回退。
逆险之候∶ 发易隐易回，热壮无汗，喘咳胸闷，咽痛喉哑，齿燥龈烂，神昏欲寐，或兼腹胀赤痢；甚
或虽外达，艳红紫滞，目封 赤，狂躁闷乱，便秘腹痛，或便泄无度者凶；更或见点细碎平塌， 色灰滞淡
白，模糊一片，既出不潮，忽然隐默，喘急昏闷者死。
八、温热发痘，因风温而发者多顺症，因温毒而发者多逆症险症。其病多发于小儿，壮年亦偶有之。
顺症多不必用药，即有必须用药者，亦必先观形察色，辨别其气血虚实为首要。如体肥白而嫩，声音微细，目
少精神，痘形多凹而色淡红者，气弱血虚也。宜急急补托，以催其起胀灌浆，如补中益气汤重用归 （李东垣
内伤辨惑论方）加白雄鸡冠血最良，其次参苏饮加生 川芎龙眼肉亦可酌用，必察其浆充痘起，庶易于结痂收
功。又如体苍瘦而坚实，声音粗壮，目有精彩，痘有斑晕而色紫黑者，气实血滞也。宜宣气活血解肌透毒为先，
如荆防败毒散（雷少逸时病论方），重用大黑豆、杜赤小豆、绿豆、各一两（名稀痘三豆汤，越人扁鹊方）煎
In the early stage of warm-heat diseases, acrid-cool herbs should be used first to release the exterior; then bitter-cold herbs should be used to clear interior heat; finally, sweet-cool herbs should be used to rescue fluids. These are the three methods for treating the primary symptoms of warm-heat diseases in their initial, middle, and terminal stages. However, due to concurrent symptoms, complicated symptoms, recurrent symptoms, sequelae, as well as differences among women and children, it is necessary to prepare various treatment methods to avoid the dilemma of physicians lacking therapeutic options. Here, eight methods are specifically listed and elaborated upon:
Any formula capable of inducing sweating, releasing white papules (Fei), releasing macules (Zhen), releasing spots (Ban), releasing erysipelas (Dan), releasing sand-pox (Sha), or releasing smallpox (Dou) is referred to as an "Exterior-Releasing Method" (Biao Fa). In warm-heat diseases, the priority is to penetrate and resolve latent pathogens. When latent pathogens initially emerge, they must have a specific location. If the pathogen resides in the skin, flesh, and muscle interstices, without exterior-releasing methods, there is no exit for the pathogen. Therefore, the exterior-releasing method is a major principle in treating warm-heat diseases. The key lies not merely in inducing sweat, but in opening stagnation and promoting the circulation of Qi and Blood. For stagnation at the exterior, use acrid-cool, aromatic, and bland herbs to disperse it; for stagnation at the half-exterior half-interior level, use bitter-acrid harmonizing methods. For those with hyperactive Yang, drink water to replenish fluids; for those with Yin deficiency, generate fluids to moisten dryness; for those with Qi stagnation, promote Qi mechanism; for those with Blood stasis, unblock collateral stasis. Thus, if there are white papules, release them; if there are macules and rashes, release them; if there is erysipelas, release it; if there is smallpox, release it. One must observe that the exterior has no obstruction whatsoever before considering the exterior-releasing method complete. This approach to releasing the exterior in warm-heat diseases differs significantly from that in wind-cold diseases. The following verified formulas for exterior release are listed:
1. Although inducing sweat in warm-heat diseases is suitable with acrid-cool dispersing agents, in the initial stage, emphasis must be placed on acrid dispersal assisted by light and clear herbs to avoid the drawback of cold constriction. When latent pathogens transmit to the exterior, mild cases may resolve with sweat after taking exterior-releasing herbs; severe cases may not sweat even with large doses of Ephedrae Herba (Mahuang), Puerariae Radix (Gegen), Notopterygii Rhizoma et Radix (Qianghuo), and Saposhnikoviae Radix (Fangfeng). One must clear heat from the collaterals and promote Qi mechanism to treat warm-heat diseases; or open damp-stagnation and reach the Mu Yuan to treat damp-warmth. Only when latent pathogens are fully released and the interior and exterior are thoroughly cleared will the disease resolve through chills-and-sweating (Zhan Han) or maniacal sweating (Kuang Han). There are also cases where profuse spontaneous sweating occurs without using exterior-releasing herbs, yet the pathogen remains unresolved. This is because spontaneous sweating arises from internal heat steaming, which is pathogenic sweat rather than physiological sweat. The key remains to open and disperse latent pathogens. For Wind-Warmth and Wind-Heat, such as Shao's Heat-Stagnation Decoction (Shao Buqing's *Four Seasons Pathogenesis* formula), Gardenia and Perilla Seed with Scutellaria and Pueraria Decoction (Lu Jiuzhi's *Bu Xie Fang*), etc., use according to symptoms. For Damp-Warmth and Damp-Heat, such as Lianpo Drink (Wang Mengying's *Huoluan Lun* formula), Newly Revised Daoyin Decoction (Master Fan Kaizhou's verified formula), etc., use according to symptoms. Regarding sweating formulas: Light acrid-cool agents include Scallion and Fermented Soybean with Pueraria Decoction (Wang Tao's *Waitai Mi Yao* formula), Pueraria and Scallion White Decoction (*Heji Jufang* formula), Liu's Platycodon Decoction (Hejian's *Liushu* formula), Modified Gardenia and Perilla Seed Decoction (Master Fan's verified formula), etc. Heavy acrid-cool agents include Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction (Zhang Zhongjing's *Shanghan Lun* formula), Qianjin Lung-Clearing Decoction, Qianjin Asparagus Decoction (Sun Simiao's *Qianjin Fang*), Pueraria and Tangerine Peel Decoction (*Waitai Mi Yao* formula), Anemarrhena Muscle-Relieving Decoction, Anemarrhena and Pueraria Decoction (Zhu Gong's *Huo Ren Shu* formula), Lotus Leaf, Apricot Kernel, and Gypsum Decoction (Ye Tianshi's medical case formula), Modified Sanhuang Shigao Decoction (Gu Songyuan's *Yi Jing* formula), Increased/Decreased Sanhuang Shigao Decoction (Yang Yuheng's *Hanwen Tiaobian* formula), Scallion, Fermented Soybean, and White Tiger Decoction (Zhao Qingchu's medical case formula), etc. These all use acrid to disperse wind and cool to drain heat, serving as essential formulas for treating internal warm-heat with external wind-cold confrontation. In cases where wind-cold binding is too severe preventing external release of warm-heat latent pathogens, Scallion, Fermented Soybean, Pueraria, and Ephedra Decoction (*Waitai Mi Yao* formula), Suqiang Drink (Liu Caochuang's *Guangsi Quanshu* formula), etc., can be temporarily used for dispersion. In cases where wind-cold suppression is too severe preventing external discharge of damp-heat latent pathogens, Agastache and Magnolia Bark Powder (*Heji Jufang* formula), Nine-Acrid Notopterygium Decoction (Zhang Jiegu's formula), etc., are suitable for temporary use to open and reach, without initially worrying about their acrid-warm nature drying fluids. Light aromatic-bland agents include Scallion and Fermented Soybean Decoction mixed with Tianshui Powder (Hejian's *Liushu* formula), Yinchen Wuling Powder (*Jinkui Yaolue* formula), Huoxiang, Atractylodes, and Pinellia Cordata Decoction (Shi Feinan's *Yi Yuan* formula), Huoxiang, Atractylodes, and Two-Chen Decoction (Master Fan's verified formula), etc. Heavy aromatic-bland agents include Liutong Shenjie Powder (*Jufang* formula), Yinchen Weiling Decoction (Wan Mizhai's *Youke Fahui* formula), Modified Wuling Powder, Modified Erchen Decoction (Shi Shi's *Yi Yuan* formula), etc. These all use aromatic herbs to repel turbidity and acrid-bbland herbs to transform dampness, serving as initial formulas for treating damp-warmth, damp-heat, and heavy dampness with turbidity. If dampness opens, heat penetrates, and heat outweighs dampness, bitter-acrid opening and draining should be used, targeting the Upper and Middle Jiaos, which does not fall under exterior-releasing methods. Furthermore, there are four scenarios where sweat resolves the disease without seeking it: 1) Severe internal heat closure treated with Sanhuang Xiexin Decoction (*Shanghan Lun* formula), Xu's Rhubarb Decoction (*Waitai Mi Yao* formula), Dachaihu combined with Dachengqi Decoction (Hejian's *Liushu* formula) to unblock internal accumulation; repeated until internal pathogens are expelled and interior/exterior are clear, often resolving via chills-and-sweating. 2) Severe internal heat dryness where the patient craves cold water; sudden abundant drinking leads to profuse sweating upon putting down the cup. 3) Chronic Qi deficiency where previous diaphoretics failed; adding Ginseng Radix et Rhizoma (Renshen) to exterior-releasing formulas like Shen'e Drink or Ginseng Baidu Powder (*Jufang* formula) induces immediate sweating. 4) Yin deficiency or blood depletion where pure exterior herbs fail; adding moisture-nourishing and fluid-generating herbs to mild resolving formulas like Seven-Ingredient Scallion White Decoction (*Waitai Mi Yao* formula) or Modified Weirui Decoction (also known as Modified Scallion-Fermented Soybean Decoction, Zhang Shi's *Yitong* formula) results in copious sweating. Verified sweating syndromes are listed below:
Fever and aversion to cold, absence of sweat, pain in head and neck, back, shoulders, lower back, knees, shins, and whole-body joints.
2. Warm-heat diseases releasing white papules (Fei) are common in summer-autumn damp-warmth and latent summerheat, and occasionally in spring-winter wind-warmth with dampness. Initially caused by damp-stagnation in skin/flesh and incomplete sweating, colors are mostly white like crystal. Treatment should lightly ventilate Lung Qi and open the Wei (Defensive) layer, such as Five-Leaf and Reed Rhizome Decoction (Xue Shengbai's *Shire Tiaobian* formula), which is most stable and effective. If prolonged injury to Qi and fluids occurs, resulting in colors white like dead bone, prognosis is ominous. Urgently use sweet-moistening herbs to nourish Qi and fluids, such as Ophiopogon Decoction (*Jinkui Yaolue* formula) or Clear Dryness and Save Lung Decoction (Yu Jiayan's new formula), to salvage the situation. Avoid bitter-dry and warm-rising herbs that consume Qi/fluids and hasten death. Verified white papule symptoms are listed below.
White, fine dots, resembling skin gooseflesh, touching hands with slight itching, breaking slightly with water, resembling bright crystal beads is auspicious; strong heat causes external appearance, weak heat causes hidden state, irregular emergence, possibly recurring 3-5 times; dry white like dead bone is ominous. Pulse must be weak/fine or rapid; spirit fatigue, Qi timidity, sticky spontaneous sweating.
3. Warm-heat diseases releasing macules (Zhen) present as raised red dots, similar to Sha (sand-pox), originating from blood-heat in Sun Collaterals. Sha mainly affects children; Zhen affects all ages/genders, mostly in spring-summer. 70-80% are Wind-Warmth/Wind-Heat; 20-30% are Warm-Toxin/Summerheat, but often accompanied by Sha/Zhen. Macules should appear but not excessively. Appearing after 2-3 days of fever is mild; after 4-5 days is severe; mixed Sha/Zhen is particularly severe. Treatment prioritizes dispelling wind and clearing heat, distinguishing wind vs. heat severity. For wind-heavy with heat-stagnation, acrid-dispersing with clearing-penetrating assistance, Fangfeng Jiedu Decoction (Wang Jinshan's *Gufang Xuanzhu* formula) is appropriate. For heat-heavy with light wind, clearing-penetrating with acrid-dispersing assistance, Modified Yinqiao Powder (Shi Shi's *Yi Yuan* formula) or Modified Puji Xiaodu Decoction (Wu Jutong's *Wenbing Tiaobian* formula) are excellent. If Warm-Toxin accompanies macules, red like cinnabar or purple-red, indicating Stomach channel blood-heat steaming pericardium, urgently use Miao's Bamboo Leaf and Gypsum Decoction (*Gufang Xuanzhu* formula); if severe, Rhinoceros Horn and Isatis Root Decoction (Shao Buqing's *Wenbing Lun* formula) to clear Stomach heat, cool-penetrate blood collaterals, ensuring Sha/Zhen release to resolve Warm-Toxin. Neglect leads to blood-heat toxin counter-flow to pericardium/liver collaterals, causing coma/spasm/collapse. Emergency rescue requires Bichui Xijiao Dihuang Decoction (*Wendu Lun* formula) or Xijiao Lian Chengqi Decoction (Lv Zhen's *Shanghan Xunyuan* formula) to cool-blood attack toxin and purge to preserve Yin. Verified macule syndromes are listed below:
Wind-Warmth Macule Syndrome: Tiny granules raised above skin, fear of wind, cough, throat obstruction/pain, chest tightness/irritability or asthma, high fever without sweat.
Warm-Toxin Macule Syndrome: Tongue crimson like vermilion, accompanied by Sha/Zhen, macules purple-red or deep red, tight-rooted, dry/cracked mouth corners, extreme thirst, mental restlessness, constipation/difficult urination.
4. Warm-heat diseases releasing spots (Ban) appear on chest/abdomen or limbs, flat and patchy, similar to Dan (erysipelas). Most common in Warm-Toxin diseases,其次 in high-fever diseases. Caused by meridian blood-heat toxin invading skin surface. Meridian blood-heat is red; heavy heat-toxin is dark red; extremely heavy is tender red like rouge, collectively called Red Spots. Collateral blood-heat is purple, called Purple Spots; collateral blood-heat with toxin-stasis is black, called Black Spots; bluish-black is Blue Spots. Hidden under skin like cloud patterns is Hidden Spot (Fu Ban); internal in gut/throat invisible externally is Internal Spot (Nei Ban). Faint, few pale red spots on chest/abdomen is Yin Spot (Yin Ban); pale red resembling white is White Spot (Bai Ban), collectively called Deficiency Spots (Xu Ban), occurring after severe damp-heat illness over-treated with cooling/purging, leading to depleted meridians/blood and deficient-cold Yuan Qi. First, distinguish spot color/form. Loose, floating on skin, sparse, red like vermilion dots on paper, black like ink on skin indicates loose toxin release; survival possible even if purple/black patches. Dry, stagnant, dull, dense, tight-rooted like needle-through-shoe or arrow-in-target indicates rooted/toxin-binding; death likely regardless of color. All spots stem from Stomach blood-heat. Red/fresh is favorable; purple/dull is ominous; black/blue/dull/dead implies stomach rotting. Red spots: 9 survive, 1 dies. Purple spots: 5 die, 5 survive. Black spots: 9 die, 1 survives. Mixed blue/black rotten spots: certain death. Treatment: Red spots - cool-blood clear-heat. Light: Wuwei Jiedu Yin plus Arnebiae Radix et Rhizoma (Zicao) and Forsythiae Fructus (Lianqiao) (Zhou Danshan's *Wenzheng Zhigui* formula), Xidi Sangdan Decoction (Wu Kun'an's *Ganzheng Baofa* formula). Heavy: Modified Xiling Baihu Decoction (Master Fan's verified formula), Modified Xiling Erxian Decoction (Lianchen's verified formula). Purple spots - cool-blood detoxify. Xijiao Daqing Decoction (Shao Shi's *Wendu Binglun* formula), Small dose Qingwen Baidu Decoction (Yu Shiyu's *Yizhen Yide* formula), Zengsun Shuangjie Decoction (Yang Yuheng's *Hanwen Tiaobian* formula). Black/Blue spots - cool-blood attack toxin. Bichui Xijiao Dihuang Decoction plus Jinzhi and Yuanmingfen (*Wendu Binglun* formula), Shiquan Kuhang Jiubu Decoction (Liang Yuyu's *Shejian Bianzheng* formula), Modified Liangge San, Zengsan Sanhuang Shigao Decoction plus Jinwen (*Hanwen Tiaobian* formula). Fu Ban/Nei Ban - promote Qi cool-blood, detoxify release spots. Yuanshen Shengma combined with Heigao (Wang Kentang's *Zhengzhi Leifang*), Xijiao Daqing Decoction plus Zicao and Gleditsiae Sinensis Spina (Gouci), or Qingwen Baidu Decoction plus Zicao, Shengma, and Zixue. Yin/Bai Ban - warm-nourish Qi/Blood. Fumai Tang (*Shanghan Lun* formula), Renshen Yangrong Decoction (*Zhengzhi Leifang*). Severe: Support Yang warm-blood. Shenfu Yangrong Decoction (Wu Youke's *Wenyi Lun* formula), Guipi Jianzhong Decoction (Ye Shi's medical case formula). Generally, do not treat spots solely by spot characteristics; observe pulse depth/superficiality and disease deficiency/excess to prescribe separately. Verified spot syndromes are listed below:
Warm-Toxin/High Fever: No sweat or sweat ineffective. Spot severity signs: Red face/eyes, profuse sweat, dry mouth/extreme thirst, chest tightness/heavy heat. Pure red, deep red, or rouge red spots. Severe if lips/mouth dry/cracked, purple/yellow tongue, chest/sternum oppression, vomiting/refusal to eat, high fever/coma, constipation/red urine, whole-body purple. Critical if coma/delirium, mute like corpse-collapse, open mouth/blowing air, foul odor, hemoptysis/epistaxis, cold feet/deafness, scorched black peeling tongue coating or black halo, whole-body black/blue spots like kingfisher feathers (death).
Hidden Spot Syndrome: No significant exterior heat, pulse seemingly deep/slow, unclear consciousness, muttering/laughing, very gray-black tongue or yellow coating with central black halo.
Internal Spot Syndrome: Dry mouth/red eyes, cold fingers/toes, irritability/rapid breathing, dislike fire, fear human voices, hot ears/red face, chills/sneezing, unconsciousness, delirium/laughter, six pulses seemingly restless but not, purple tongue/yellow coating or yellow-greasy-gray.
Deficiency Spot Syndrome: Faint points, pale red or white spots, cold extremities, sleepiness/unconsciousness alternating, pale red/purple tongue coating, fat/tender/round tongue or white slippery coating or black slippery coating.
5. Warm-heat diseases releasing erysipelas (Dan) are common in children, commonly called Chiyoudan (Red Roaming Erysipelas), similar to Red Spots. Dan and Ban both originate from skin, flat and patchy, representing internal blood-heat toxin. Treatment: Large doses of cool-blood detoxifying herbs are required; refer to spot-releasing formulas. Differentiation: Abdominal distension always accompanies Dan/Ban/Sha/Zhen. Resolution depends on abdominal distension relief. High fever resolution depends on sweat penetration.
6. Warm-heat diseases releasing Sha (sand-pox): Due to Wind-Warmth is Time-Sha (Wind-Sha, Red-Rash Sha), contagious but mild. Due to Warm-Toxin is Epidemic-Sha (Throat-Sha, Rot-Throat Sha), highly contagious and severe. Initial Wind-Sha requires dispersion: Jingfang Baidu Powder (Lei Shaoyi's *Shibing Lun* formula) or Lianqiao Baidu Powder (*Shanghan Zhizhang* formula) with 1 liang Green Pine Needle decocted as water substitute are effective. Even if clearing/dispersing is needed, dispersion is key; Fangfeng Jiedu Decoction with Green Pine Needle is most effective. Avoid sudden cold herbs. Initial Throat-Sha requires light dispersion/detoxification: Modified Puji Xiaodu Decoction (*Wenbing Tiaobian* formula) or Daizhen Puji Powder (Jutong's medical case formula) are appropriate. Once exterior Sha-toxin is released and internal latent fire flares, mild cases use clearing/transformation: Chen's Lung-Clearing Decoction, Duoming Drink, Xiling Erxian Decoction (Chen Jixuan's *Yisha Cao* formula). Severe cases use cold purging: Chen's Sihou Drink (*Yisha Cao* formula) or Bichui Xijiao Dihuang Decoction plus Jinzhi/Yuanmingfen (*Wendu Binglun* formula) to drain fire/heat. Persisting with acrid-dispersing formulas worsens fire ("fire meets wind"), causing devastation. Verified Sha syndromes are listed below:
Wind-Sha Syndrome: Headache/fear of wind, fever/aversion to cold, rash/no sweat, severe body/joint pain, throat obstruction/pain without ulceration, chest stuffiness/irritability, white greasy tongue coating.
Throat-Sha Initial/Middle Syndrome: Initial aversion to cold, later high fever/irritability/thirst, dense rash/red skin like brocade, sore/swollen throat (or pain only), white ulceration/rotten throat, chest/stuffiness/inability to eat. With dampness: slippery/greasy coating, or extreme thirst with white slippery coating, or yellow slippery/greasy, or yellow dry. Internal collapse: red/fresh crimson tongue, coma/delirium, burning/no sweat, hidden rash patches, collapse/spasm, foul breath, hoarseness/rapid breathing, nasal flapping/hiccups (ominous).
7. Warm-heat diseases releasing Dou (smallpox-like eruptions), similar to Sha. Called Shazi in Wu region, Douzi in Zhejiang. Common in children, rare in adults. Due to Wind-Warmth is normal; prioritize dispelling wind/clearing heat. Modified Qiaohu Decoction, Fangfeng Jiedu Decoction are best; ensure Dou-toxin releases for cure. Due to Warm-Toxin is Time-Dou, treated similarly to Warm-Toxin macules/Sha.闷Dou (Stifled Dou) is most dangerous; urgently open Lung/release Dou, clear heat/detoxify. Xinjia Ma杏Shi Gan Decoction (*Ganzheng Baofa* formula), Qianjin Weijing combined with Chen's Lung-Clearing Decoction plus Gua Frost Zixue (*Yisha Cao* formula) to rapidly expel Dou-toxin. Qi/Fluid deficiency: Chen's Lung-Clearing Decoction combined with Heigao plus American Ginseng and Bird's Nest, clear-tonify and lift-release. Verified Dou syndromes are listed below:
Favorable Syndrome: Fever/restlessness, cough/nasal congestion, watery-red glow on face/eyes, sore throat/rapid breathing, cold fingertips. Eruptions uniform/bright, fresh red, raised distinct grains. Appearance in 1-2 days is mild; 3-5 days is slightly severe. After eruption, 3 tides/day; tide brings high fever/restlessness, subsiding after time. 3 days, 9 tides, eruptions fully released, then slowly recede.
Adverse/Critical Syndrome: Eruptions easily hide/recede, high fever/no sweat, asthma/cough/chest tightness, sore throat/hoarseness, dry teeth/rotten gums, coma/sleepiness, or abdominal distension/red dysentery. Even if external, bright red/purple stagnant, eyes sealed with red discharge, maniacal/restless, constipation/abdominal pain, or profuse diarrhea (ominous). Or tiny flat points, gray/dull/white color, blurred mass, no tidal pattern, sudden hiding, rapid breathing/coma (death).
8. Warm-heat diseases releasing Dou: Due to Wind-Warmth is mostly favorable; due to Warm-Toxin is mostly adverse/critical. Mostly in children, occasionally adults. Favorable cases need no medicine; if needed, first observe form/color to distinguish Qi/Blood deficiency/excess. Fat/white/tender, soft voice, dull eyes, concave pale red eruptions indicate weak Qi/blood deficiency. Urgently tonify/support to promote swelling/filling, e.g., Buzhong Yiqi Decoction with heavy Danggui (Li Dongyuan's *Neishang Bianhuo Lun* formula) plus white rooster comb blood (best); or Shen'e Drink plus raw Chuanxiong and Longan meat. Observe full pus/rise for scabbing. Lean/firm, rough voice, bright eyes, purple-black spotted eruptions indicate excess Qi/blood stagnation. Prioritize promoting Qi/blood, releasing muscle, penetrating toxin. Jingfang Baidu Powder (Lei Shaoyi's *Shibing Lun* formula), heavy doses of Black Bean, Adzuki Bean, Mung Bean (1 liang each, named Xidou Sandou Decoction, Yue Ren Bianque's formula), decocted...