发斑者，阳明受枭炎之毒所致也。然症有二，阳毒发斑者，必壮热渴燥，五心如
烙，脉洪有力。色红赤者，胃热也，可治。紫黑者，胃烂也，不治。色纯黑者，热毒入
胃已极，尤为不治之症。若热毒壅盛，而大便秘结者，宜急下之，否则，胃热不得以
泄，其斑益炽。但不可下之太早，否则，中气馁弱，其痘难出而为陷伏，且热乘虚入
胃，斑毒更为难疗矣，此与伤寒下法之理相同也。如阴症发斑者，必身无大热，手足指
甲俱青，其脉沉细，其色微红，此乃无根失守之火，聚于胃，熏于肺，传于皮肤而为斑
也。妄投凉剂，则又误矣，故宜温胃调中为主，胃气和则火自下。斑自退而痘自出也。
凡肾症腰疼难立之候，而必有斑者，何也？盖肾为胃之关，如热毒蕴蓄而不得泄，
是以传注胃经，胃主肌肉，故发为斑，宜用鼠粘、升麻之类，于清凉解毒之中，兼以升
提出表为主。如始骤以清胃寒剂，则血不行，肌肉冰，乌能载毒以出？必至沉匿于肾
而为坏症矣。若至身发紫赤黑色等斑，而眼中白睛之内，色如桃花水红色者，盖白晴属
肺，是主内溃，肺胃败坏，必不可治。其色乃内起淡淡一种水红之色，非若筋膜赤障，
外浮于睛也。
痘出而夹疹者，先哲谓之两虎蹲栏，盖痘宜补而不宜泻，泻则不鼎峻，疹则宜泻而
不宜补，补则乃发喘。然在痘初，只宜透托，一既表痘，又兼发疹，疹出即解，故两
安而无碍者也。惟在灌脓之际，不可太发。仅宜助浆剂中，去参 之类，加入粘子、桔
梗、蝉蜕、僵蚕等药，一助灌脓而兼理肺气，肺气既清，而阳毒自彻散于上矣。至于
痘后发者，惟独治疹可也。然凡先见疹子而夹出如水痘者，此是正痘，因疹子耗去荣
血，故白似水痘，但与发散疹子则疹散而痘自成，不可认作水痘，盖疹子从不夹水痘者
耳。
夫肤疹者，是热毒之气发越而然也。其暴出之时，点如麻状，但色鲜赤成片耳，治
宜清凉败毒。若疹散数日而痘随出者，则势稀朗而自美。有隐疹者，多属于脾，以其隐
隐在于皮肤之间，故名之也。其发时多痒或麻木不仁、此兼湿痰之殊，若色红者，又兼
火化也，治宜亦与解毒为主。更有谓痧者，
其形如粟一般，尖圆而稍碍指，中含清水是也。总属热毒之所发，名殊而源一也。
发斑这一病症，是由阳明经受热毒侵袭所致。然而症状分为两种：阳毒发斑者，必然出现高热、口渴烦躁、手足心及心胸像被烙铁烫过一样灼热，脉象洪大有力。斑色红赤的，是胃热所致，可以治疗；斑色紫黑的，是胃腑腐烂的表现，难以治愈；斑色纯黑的，说明热毒深入胃中已达极点，更是无法治疗的重症。如果热毒壅盛且大便秘结，应当紧急使用泻下法，否则胃热无法宣泄，斑疹会更加炽烈。但是不可过早使用泻下法，否则会导致中气虚弱，痘疹难以透出而发生内陷伏匿，并且热邪会乘虚侵入胃中，使斑毒更加难以治疗，这与伤寒病使用下法的原理相同。如果是阴症发斑，必然身体没有大热，手足指甲发青，脉象沉细，斑色微红，这是无根失守的虚火，聚集在胃，熏蒸于肺，传至皮肤而发为斑疹。此时若误用寒凉药剂，就会造成错误，因此应当以温补脾胃、调和中焦为主，胃气调和则虚火自然下行，斑疹自退，痘疹自出。
凡是患有肾症、腰痛难立的患者，如果必然伴有发斑，为什么呢？因为肾是胃的关口，如果热毒蕴蓄而不能宣泄，就会传入胃经。胃主肌肉，所以发为斑疹，适宜使用牛蒡子、升麻等药物，在清凉解毒的基础上，兼以升提透表为主。如果一开始就大量使用清胃寒凉的药剂，就会导致血液运行不畅，肌肉冰冷，怎么能承载毒邪排出体外呢？必然导致毒邪沉匿于肾中而形成坏证。如果发展到身上发出紫、赤、黑等颜色的斑疹，且眼中白睛内部呈现出桃花水样的红色，因为白睛属肺，这主示内脏溃败，肺胃功能败坏，必定不可治疗。这种颜色是从内部泛起的淡淡水红色，不像筋膜赤障那样外浮于眼球表面。
痘疹并发称为“夹疹”，先贤称之为“两虎蹲栏”。大概痘疹宜补而不宜泻，泻则痘出不峻猛；疹子宜泻而不宜补，补则会导致气喘。然而在痘疹初期，只适宜采用透托之法，一方面透发痘疹，一方面兼发疹子，疹子一出，病情即解，所以两者平安而无妨碍。只有在灌脓阶段，不可过于发散。仅应在助浆剂中去掉人参之类补气药，加入牛蒡子、桔梗、蝉蜕、僵蚕等药物，既帮助灌脓又兼顾调理肺气，肺气既然清肃，阳毒自然向上透散。至于痘后发疹的情况，只需单独治疗疹子即可。然而凡是先见疹子，随后夹出类似水痘形态的，这是正痘，因为疹子耗去了营血，所以痘色看起来像水痘，只要发散疹子，疹散之后痘自然长成，不可误认为是水痘，因为疹子从不夹杂水痘。
肤疹，是热毒之气发散所致。其突然发作时，斑点如麻状，只是颜色鲜红成片而已，治疗宜用清凉败毒之法。如果疹子消退数日后痘疹随之而出，那么痘势稀疏明朗，自然美好。有隐疹者，多归属于脾，因为其隐隐存在于皮肤之间，所以得名。发作时大多瘙痒或麻木不仁，这是兼夹湿痰的特殊情况，如果颜色发红，又是兼夹火化，治疗也应以解毒为主。更有称为痧者，形状像粟米一般，尖圆且稍微碍手，中间含有清水。这些都属于热毒所发，名称不同但根源一致。
The manifestation of macules (Ban, 斑) is caused by the invasion of severe heat-toxin into the Yangming channel. However, there are two types of symptoms: In cases of Yang-toxin macules, there must be high fever, thirst, and irritability, with the five centers (palms, soles, and chest) feeling as if scorched by an iron, and the pulse is surging and forceful. If the macules are red, it indicates stomach heat, which is treatable. If they are purple-black, it indicates rotting of the stomach, which is untreatable. If they are purely black, the heat-toxin has entered the stomach to an extreme degree, making it a particularly untreatable condition. If the heat-toxin is abundant and accompanied by constipation, urgent purgation should be employed; otherwise, the stomach heat cannot be vented, and the macules will become more intense. However, purgation must not be used too early, lest the middle Qi become deficient, causing the pustules (Dou, 痘) to fail to emerge and become sunken or hidden, and allowing heat to enter the stomach through this deficiency, making the toxin even harder to treat. This follows the same principle as the purgative method in Shanghan disease. In cases of Yin-syndrome macules, there is no significant body heat, the fingernails and toenails turn blue-green, the pulse is deep and fine, and the macules are slightly red. This is due to rootless and uncontrolled fire gathering in the stomach, steaming the lungs, and transmitting to the skin to form macules. Prescribing cold-natured formulas recklessly would be a mistake; therefore, the primary treatment should be warming the stomach and regulating the middle. When the stomach Qi harmonizes, the fire naturally descends, the macules recede, and the pustules emerge.
Regarding patients with Kidney syndrome who suffer from severe lower back pain preventing them from standing, why do they invariably develop macules? The Kidney serves as the gate for the Stomach. If heat-toxin accumulates and cannot be excreted, it transmits to the Stomach channel. Since the Stomach governs the muscles, macules appear. It is appropriate to use herbs such as Arctii Fructus (Niubangzi, 牛蒡子) and Cimicifugae Rhizoma (Shengma, 升麻), focusing on lifting and releasing the exterior within a framework of cooling and detoxifying. If one initially uses heavy stomach-cooling cold agents, blood circulation will stagnate, and the muscles will become icy cold, unable to carry the toxin out. This will inevitably lead to the toxin sinking into the Kidneys and forming a disastrous syndrome. If the condition progresses to purple, red, or black macules on the body, and the white part of the eye (Sclera) shows a peach-blossom water-red hue internally, this indicates internal collapse. The sclera belongs to the Lung; thus, this signifies the failure of the Lung and Stomach, which is untreatable. This color arises faintly from within as a water-red hue, distinct from the red membrane barrier floating externally on the eye.
When pustules are accompanied by rashes (Zhen, 疹), ancient sages called it "Two Tigers Guarding the Gate." Generally, pustules benefit from tonification rather than purgation; purgation prevents them from erupting vigorously. Rashes benefit from purgation rather than tonification; tonification can induce wheezing. However, in the early stage of pustules, only the method of venting and supporting should be used. This simultaneously releases the pustules and induces the rash. Once the rash emerges, the condition resolves, ensuring safety for both. During the suppuration phase, excessive dispersal should be avoided. One should remove Ginseng Radix et Rhizoma (Renshen, 人参) from the formula that assists in pus formation and instead add Arctii Fructus (Niubangzi, 牛蒡子), Platycodonis Radix (Jiegeng, 桔梗), Bombyx Batryticatus (Chantui, 蝉蜕), and Bombyx Batryticatus (Jiangcan, 僵蚕). This aids suppuration while regulating Lung Qi. Once the Lung Qi is clear, the Yang-toxin will naturally dissipate upwards. For rashes appearing after the pustules have resolved, only the rash needs specific treatment. However, if rashes appear first and are followed by lesions resembling water-pox, these are normal pustules. Because the rash has consumed Ying-blood, the pustules appear pale like water-pox. By dispersing the rash, the rash clears, and the pustules mature naturally. They should not be mistaken for water-pox, as rashes never accompany true water-pox.
Skin rashes (Fuzhen, 肤疹) result from the eruption of heat-toxin qi. When they appear suddenly, the spots resemble hemp seeds but are bright red and成片 (in patches). Treatment should focus on cooling and defeating toxicity. If the rash subsides after several days and the pustules follow, the eruption will be sparse and clear, which is auspicious. Hidden rashes (Yinzhen, 隐疹) are mostly related to the Spleen, named so because they hide between the skin layers. They often present with itching or numbness, indicating a complication of damp-phlegm. If the color is red, it also involves fire transformation, and treatment should still prioritize detoxification. There is also what is called Sha (痧), which resembles millet grains, being pointed and round, slightly rough to the touch, and containing clear fluid inside. All these belong to the eruption of heat-toxin; although the names differ, their source is identical.