Chapter 7: Macules and Papules

Macules (Ban) arise from wind-heat combined with phlegm, originating internally and manifesting externally. Treatment should refer to the principles of Tongsheng San, dispersing the pathogen through mild diaphoresis; purgation must strictly be avoided. In cases of macules caused by internal injury, where heat pathology manifests externally, mild diaphoresis should also be used for dispersion; irrational use of purgation is inappropriate. Papules (Zhen) are caused by heat combined with phlegm, located in the Lung. Treatment involves clearing Lung fire and descending phlegm, or resolving the exterior to induce sweating. There are instances where purgation may also be applicable. Upon eruption, there is often itching or numbness, indicating a differentiation between concurrent Wind or Warm pathogens. A red color indicates concurrent Fire transformation. Applying cucumber juice mixed with Fulonggan (Caulis Longan / Hearth Earth) can remove red macular spots.

Dai Yun stated: Macules are characterized by red spots without granular heads; papules are slightly raised with granular heads, appearing and disappearing rapidly, reappearing after subsiding, unlike macules which lack granular heads. These must be clearly distinguished.

[Appendix] The manifestations of macule and papule diseases differ significantly. Sores that swell and manifest externally belong to the Shaoyang Triple Burner Ministerial Fire and are termed macules; small red macules moving within the skin without emerging belong to the Shaoyin Sovereign Fire and are termed papules. Furthermore, if purgation is administered too late in external contracted heat diseases, macules may erupt. In such cases, herbs such as Xuanshen (Radix Scrophulariae), Shengma (Rhizoma Cimicifugae), and Baihu Tang (White Tiger Decoction) should be used. When macules erupt due to Yin syndrome, they also appear on the back and chest, extending to the hands and feet, but are sparse and faintly red. If treated as a heat syndrome and cold-natured medicines are administered, it would be a major error. This arises from rootless, uncontrolled fire accumulating in the chest, steaming upwards solely into the Lung, and transmitting to the skin to form spots. Their shape resembles bites from mosquitoes, horseflies, lice, or fleas, rather than brocade-like patterns. Treatment should focus on regulating the Middle Jiao and warming the Stomach, adding Huixiang (Fructus Foeniculi) and Shaoyao (Radix Paeoniae Rubra), or utilizing formulas such as Dajianzhong Tang (Major Construct the Middle Decoction). The fire will naturally descend, and the macules will subside. This constitutes treating the root rather than the branch.

Formulas Included

Tiaozhong Tang (Regulate the Middle Decoction): Treats Yin macules erupted due to internal injury and external contraction.
Cangzhu (Rhizoma Atractylodis Lanceae) (1.5 qian), Chenpi (Pericarpium Citri Reticulatae) (1 qian), Sharen (Fructus Amomi), Huoxiang (Herba Agastachis), Shaoyao (Radix Paeoniae Rubra, stir-fried), Gancao (Radix Glycyrrhizae, honey-fried), Jiegeng (Radix Platycodi), Banxia (Rhizoma Pinelliae), Baizhi (Radix Angelicae Dahuricae), Qianghuo (Rhizoma Notopterygii), Zhiqiao (Fructus Aurantii Immaturus) (each 1 qian), Chuanxiong (Rhizoma Chuanxiong) (0.5 qian), Mahuang (Herba Ephedrae), Guizhi (Ramulus Cinnamomi) (each 0.5 qian).
Decoct these crude pieces with three slices of fresh ginger and water.

Xiaodu Xijiao Yinzi (Detoxifying Rhinoceros Horn Infusion): Treats macules and urticaria (Yinzhen).
Niubangzi (Fructus Arctii), Jingjie (Herba Schizonepetae), Fangfeng (Radix Saposhnikoviae) (each 3 qian), Gancao (Radix Glycyrrhizae) (1 qian).
Decoct these crude pieces with water.

Tongsheng San (Universal Salvation Powder): From Danxi's empirical formula.
Chuanxiong (Rhizoma Chuanxiong), Danggui (Radix Angelicae Sinensis), Mahuang (Herba Ephedrae), Bohe (Herba Menthae), Lianqiao (Fructus Forsythiae), Baishao (Radix Paeoniae Alba), Huangqin (Radix Scutellariae), Shigao (Gypsum Fibrosum), Jiegeng (Radix Platycodi) (1 liang), Huashi (Talcum) (3 liang), Jingjie (Herba Schizonepetae), Zhizi (Fructus Gardeniae), Baizhu (Rhizoma Atractylodis Macrocephalae) (2.5 qian), Gancao (Radix Glycyrrhizae).
Crush these ingredients. Decoct with water. If body pain is present, add Cangzhu (Rhizoma Atractylodis Lanceae) and Qianghuo (Rhizoma Notopterygii); if phlegm-cough is present, add Banxia (Rhizoma Pinelliae). For each dose, take 3 qian of the fine powder, mix with three slices of fresh ginger, crush finely, suspend in water, boil, and consume.

Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction): Treats macules persisting on the body after diaphoresis, emesis, or purgation, where toxins have not dispersed, presenting with exterior deficiency and interior excess manifesting externally, potentially leading to severe restlessness and delirious speech.
Xuanshen (Radix Scrophulariae), Shengma (Rhizoma Cimicifugae), Gancao (Radix Glycyrrhizae) (equal parts).
Decoct these crude pieces with water.

Huaban Tang (Transform Macules Decoction): Treats macules erupting with a deficient pulse after treatment of Cold Damage via diaphoresis, emesis, or purgation.
Baihu Tang (White Tiger Decoction) plus Renshen (Radix Ginseng); Zhu Shouzhen added Baizhu (Rhizoma Atractylodis Macrocephalae).
Decoct these crude pieces and administer frequently.

Dajianzhong Tang (Major Construct the Middle Decoction)
Huangqi (Radix Astragali), Danggui (Radix Angelicae Sinensis), Guixin (Cortex Cinnamomi), Shaoyao (Radix Paeoniae Rubra) (each 2 qian), Renshen (Radix Ginseng), Gancao (Radix Glycyrrhizae) (each 1 qian), Banxia (Rhizoma Pinelliae), Heifu (Radix Aconiti Lateralis Preparata, processed and peeled) (each 2.5 qian).
Crush these ingredients. For each dose, take 5 qian, add two cups of water, three slices of fresh ginger, and two jujubes. Decoct and consume before meals.