斑疹
有伤寒发斑，有时气发斑，有阳毒发斑，有温毒发斑，四证之中，温毒为重。皆因热邪在表，不当下而
下之，乘虚入胃；或热邪在里，不得疏泄，二者皆能发斑。（《三因方》）
时疫传染多发斑。大抵汗后热不净，烦躁脉伏，便是发斑之候。斑证吐泻者吉，谓毒瓦斯上下俱出也。（《医学六要》）
或朵如锦纹者，为斑；隐隐见红点者，为疹。盖胃热失下，冲入少阳，则助相火而成斑；冲入少阴，则
助君火而成疹。○凡斑疹欲出未出之际，宜服升麻葛根汤以透其毒，不可便服寒剂以攻其热，又不可发汗、攻
下虚其表里之气。如内热甚，加黄连、犀角、青黛、知母、石膏、芩、柏、元参之类；若斑势稍退，潮热谵语，
不大便，可用大柴胡汤，或调胃承气汤下之。（汪 庵）
斑证，轻如疹子，重如锦纹。致病之由，虽分数种，然总因邪毒不解而然。如当汗不汗，则表邪不解；
当下不下，则里邪不解；当清不清，则火盛不解；当补不补，则无力不解；或下之太早，则邪陷不解；或阳证
误用温补，则阳亢不解；或阴证误用寒凉，则阴凝不解。凡邪毒不解，则直入阴分，郁而成热，乃致液涸血枯，
斑见肌表。○成无己曰∶热则伤血。热不散则里实表虚，热邪乘虚出于皮肤而为斑也。不可发汗，重令开泄，
更增斑斓也。予则以为不然。盖凡伤寒之邪，本自外而入，深入不解，则又自内而出，此其表里相乘，势所必
至，原非表虚证也。但使内外通达，则邪必由表而解矣。（《景岳全书》）
凡斑疹初见，须用纸捻照看胸、背、两胁，点大而在皮肤之
上者为斑；或云头隐隐，或琐碎小粒者为疹。方书谓斑色红者属胃热，紫者热极，黑者胃烂。亦必看外证所合，
方可断之。然春夏之间，湿病俱发斑疹，须辨其色。如色淡肢清，口不甚渴，脉不洪数，非虚斑即阴斑也。或
胸腹微见数点，面赤足冷，或下利清谷，此阴盛格阳于上也，当温之。若斑色紫点小者，心包热也；点大而紫
者，胃中热也；黑斑而光亮者，热胜毒盛也。虽属不治，若其人气血充者，或有可救；黑而晦者必死；黑而隐
隐，四旁赤色者，此火郁内伏，大用清凉透发，间有转红可救者。夫斑属血，疹属气，斑疹皆是邪气外露之象，
发出神情清爽为外解里和，如斑疹出而神昏者，此正不胜邪而内陷，或胃津内涸之候也。○斑由失表而致者，
当求之汗；失下而致者，必取乎攻。火甚清之，毒甚化之。营气虚者，助其虚而和之、托之。至于阴斑之说，
甚少。痧者，疹之通称，有头粒而如粟状；瘾者，即疹之属，肿而易痒。须知出要周匀，没宜徐缓。致病不外
乎太阴、阳明，故缪氏专以脾胃论，精且切也。治宜辛凉、甘寒、苦寒、咸寒、淡渗等法。（叶天士）
内伤发斑，形如蚊迹，多在手足，初起无头痛、身热等证，乃劳役过度，胃气虚极，火游于外，或他
证汗、下后，中气虚乏，邪无所归，散于肌表。治宜大建中汤，不可妄施凉药。○阴证发斑，点稀色淡，如蚊
迹状，不似阳斑之红显也。良由肾气虚寒，阴盛于下，迫其无根之火浮游于上。若误作热证而用清凉，危殆
立至。治宜八味汤，阴火收藏，而斑自退。（《明医指掌》）
蚊迹类斑，谬误认作斑治，杀人甚速。辨法先红后黄者，蚊迹也；先淡后红者，斑也；蚊迹多见于手足；
斑多见于胸腹。（朱丹溪）
斑无头粒，如蚊迹、蚤痕，重者如锦纹；疹有头粒，或见或隐。斑发于阳明，疹发于太阴。疹之所由，乃
肺为热灼，故红点见于皮毛，与湿疹白色而无红点者不同。盖疹，感病也，时行也，四时不正之气与膈间素有
之火合而灼肺也。或君火、相火之所致，
或寒、暖、暑、湿之气合而为病。其证寒热呕恶，目多眵痕，耳冷尻冷；其脉或沉而数，或伏而不起，发后始
见洪数者是也。再论治法，斑为胃实，故见点便忌升提，急急清凉化毒。尤虑胃烂，烂则色变紫黑而危。疹为
心包伏热熏肺而出，故首尾但宜清凉解托，凉膈散去硝、黄是其主方，有表证加荆、防、前胡之属。不用羌
活者，因无太阳证也；兼骨节疼痛，始可加入。脉大汗多，兼阳明证，可加葛根；往来寒热，兼少阳证，可加
柴胡。暑令合益元散，寒令合香苏饮。火旺清之，用黄连、石膏必兼甘、桔；末后滋阴，甘、桔仍不可去。更
有要语，但有一毫胸次未宽，便为疹毒未透；首尾无汗，须发一身水泡，膈热方清；虚者忌 、术，可加人参。
治疹之法如此，治斑之法，诸书详尽，不必多赘。（王协中）
斑为三焦无根之火，疹属心脾湿热之火，其上侵于肺则一也。○赤疹因热气乘之，稍凉则消；白疹因寒气
折之，稍暖则消。似白似赤，微黄隐于肌肉之间，四肢重着，此脾经风热挟湿也，多因沐后感风与汗出解衣而
得。（《医学入门》）
疹有头粒，或如粟米，或如蚊迹，或随出随没，或没而又出。又有红点隐密于皮肤不透出者，为瘾疹；颗
粒显透于皮肤者，为沙疹。证各不同，而初起必兼鼻塞流涕，声重咳嗽，头疼胸闷，发热自汗；更有风邪壅肺，
气急鼻扇，咳不能卧。先用润肺利邪之剂。后变潮热而头不疼，胸膈已快，惟咳嗽气急如故，此因本气素虚。
肺邪虽解，阴虚火旺，脉数大者，宜滋阴清肺，不可误投参、 酸敛。（《证治汇补》）
丹痧
丹痧一证，方书未有详言，余究心是证之所由来，不外乎风、寒、温、热、时厉之气而已。故解表清热，
各有所宜，治之得当，愈不移时，治失其宜，祸生反掌，无非宜散宜清之两途。其证初起，凛凛恶寒，身热不
甚，并有壮热仍兼憎寒者，斯时虽咽痛烦渴，先须解表透达，即或宜兼清散，总以散字为重。所谓火郁发
之也。苟漫用寒凉，则外邪益闭，内火益焰，咽痛愈剧，溃腐日甚矣。不明是理，反云如此凉药，尚且火势勃
然，不察失散之误，犹谓寒之未及，愈凉愈遏，以致内陷而毙者有之。或云∶是证专宜表散。所见亦偏，盖初
起寒热之时，散为先务，俾汗畅而丹痧透发，若无恶寒等证，则外闭之风寒已解，内蕴之邪火方张，寒凉泄热，
是所宜投，热尽而病自愈矣。若仍执辛散之方，则火得风而愈炽，肿势反增，腐亦滋蔓，必至滴水下咽，痛如
刀割。间有议用清凉者，乃以郁遏诽之∶炎热燎原，杀人最暴，此偏于散之为害也。彼言散之宜，此言散之祸；
彼言寒之祸，此言寒之宜。要于先后次第之间，随机权变，斯各中其窍耳。再按∶此证愈后，每有四肢酸痛难
以屈伸之状，盖由火烁阴伤而络失所养，法宜滋阴，勿同痹证施治。（《吴医汇讲》）
白
白 一证，考古方书无专条论及，间有斑疹门中发明一二，究未能尽其底蕴。今温热证中，每多发出如
粞如粟，色白形尖者，谓之白 。有初病即见者；有见而即愈者；有见而危殆者，有病经日久，斑疹已见，
补泻已施之后，仍然发此而愈者。世俗泛称时气，殊不知致病之由既异，治疗之法不同，不可不与斑、疹详辨
而审处之也。盖伤寒传经热病，汗出不彻，邪热转属阳明，或由经入腑，受热蒸灼，营伤血热不散，而里实表
虚，热气乘虚出于肤腠，稀如蚊迹，稠如锦纹者，为斑；时行风热之气，侵入肺虚血热之体，失于清透，伤及
手太阴血分，乘虚出于皮肤，如沙如粟而色红琐碎者，为疹。或岁当火运，复感时厉之毒，即咽痛而成丹痧及
烂喉痧之类，为最剧者也。至于白 一证，则温暑病中兼湿为多。盖伏气之发，本从内出，然必因外感，及人
身素蕴之湿，与外触之邪互相蒸发，上甚为热。初病治法，设不用清透、渗解，则肺为热伤，气从中馁，不
能振邪外解，热渐陷于营分；转投清营、滋化，热势稍缓，而肺气亦得借以自复，所留之湿，仍从上焦气分
寻隙而出，于是发为
白。以肺主气，故多发于肩背、胸臆。白为肺之色，光润为湿之余气，至此而邪始尽泄也。若其人根本已虚，
无气蒸达，多有延为衰脱者。故此证以元气未漓，色润晶莹有神者，为吉；枯白乏泽，空壳稀散者，为气竭而
凶。总以形色之枯润，卜其气液之竭否。大抵此证在春末夏初暑湿之令为甚，秋冬则间有之。要不出乎手经受
病，仍从手经发泄，不比足经之邪可从下解也。夫肺为主气之脏，气旺则邪从外解，上泄而病愈；气衰则邪正
并竭，虽发必朽白无神而难治。观《内经》暑与湿同推，仲圣痉、湿、 合论，益知温暑证中多夹湿邪，更无
疑矣。○再有一种白 小粒，如水晶色者，此湿热伤肺，邪虽出而气液枯也，必得甘药补之。或未至久延，伤
及气液，及湿郁卫分，汗出不彻之故，当理气分之邪。若白如枯骨者，多凶，为气液竭也。（《吴医汇讲》）
脉候
凡斑既出，须得脉洪数有力，身温足暖者可治；若脉小足冷，元气虚弱者难治。（周禹载）
选案
一人内寒外热，六脉沉细，肩背、胸胁斑出数点，随出随隐，语言狂乱。乃阳为阴逼，上入于肺，传之
皮毛，故肌表虽热，以手按之，须臾冷透如冰。与姜附等药数剂，大汗而愈。（许叔微）
一人脉虚自汗，误与真武汤，遂至神昏脉伏，肌热灼指。此营热致斑，非阳病阴脉可比。先与白虎加入
参汤化其斑，复以桃仁承气下之而愈。（吕沧州）
胡虎臣元气素虚，时常感冒，予与补中益气汤即愈。一日，发斑遍身，兼见焦黑。医谓阳证误温不救。
予曰∶非也，此胃气虚极，一身之火游行于外。与人参五钱，黄 、麦冬各二钱，五味、花粉、丹皮、木通、
元参、贝母、荆芥各七分，服之而愈。（程华仲）
伤寒引起的发斑，时气病引起的发斑，阳毒引起的发斑，温毒引起的发斑，这四种证候中，以温毒最为严重。都是因为热邪在体表，不应当使用下法却误用下法，导致邪气乘虚进入胃腑；或者热邪在体内，不能疏泄排出，这两种情况都能引起发斑。（《三因方》）
时疫（具有传染性的流行病）多发斑疹。大抵出汗后热势未尽，出现烦躁、脉象沉伏，就是发斑的征兆。发斑证如果出现呕吐腹泻，属于吉兆，说明毒邪通过上下途径都排出了。（《医学六要》）
有的像锦纹一样成朵出现的，称为斑；隐隐约约可见红点的，称为疹。这是因为胃热失于攻下，冲入少阳经，则助长相火而形成斑；冲入少阴经，则助长君火而形成疹。○凡是斑疹欲出未出之际，适宜服用升麻葛根汤（Shengma Gegen Tang, Cinnamon Twig and Kudzu Root Decoction）来透发毒邪，不可立即服用寒凉药物以攻伐热邪，也不可使用发汗或攻下法以免损伤表里之气。如果内热严重，可加入黄连、犀角、青黛、知母、石膏、黄芩、黄柏、玄参等药；若斑势稍退，出现潮热、谵语、大便不通，可用大柴胡汤（Dai Chai Hu Tang, Major Bupleurum Decoction）或调胃承气汤（Tiaowei Chengqi Tang, Regulate the Stomach and Order the Qi Decoction）攻下。（汪 庵）
斑证，轻的像疹子，重的像锦纹。致病的原因虽有几种，但总归是因为邪毒未能解除。如应当发汗而未发汗，则表邪不解；应当攻下而未攻下，则里邪不解；应当清热而未清热，则火势旺盛不解；应当补益而未补益，则正气无力驱邪不解；或者攻下太早，则邪气陷入不解；或者阳证误用温补，则阳气亢盛不解；或者阴证误用寒凉，则阴寒凝滞不解。凡是邪毒不解，就会直接深入阴分，郁结而生热，导致津液枯竭、血液干涸，斑疹显现于肌表。○成无己说：热邪会损伤血分。热邪不散则里实表虚，热邪乘虚出于皮肤而成为斑。此时不可发汗，再次令毛孔开泄，只会增加斑疹的严重程度。我认为并非如此。大概伤寒之邪，本来是从外侵入，深入不解，又会从内向外透出，这是表里相互影响，是必然的趋势，原本不是表虚证。只要使内外通达，邪气必定由表而解。（《景岳全书》）
凡是斑疹刚出现时，必须用纸捻照亮查看胸、背、两胁部位，点大而位于皮肤之上的为斑；或者云头状隐隐约约，或琐碎小粒的为疹。医书说斑色红的属于胃热，紫的属于热极，黑的属于胃烂。但也必须结合外在证候来判断，才能确诊。然而在春夏之间，湿病都会发斑疹，必须辨别其颜色。如颜色淡、四肢清冷、口不很渴、脉不洪数，这不是虚斑就是阴斑。或者胸腹微见几点，面赤足冷，或者下利清谷（完谷不化），这是阴盛格阳于上，应当温补。若斑色紫点小者，是心包热；点大而紫者，是胃中热；黑斑而光亮者，是热胜毒盛。虽然属于不治之症，但如果患者气血充盛，或许还有救；黑而晦暗的必死；黑而隐隐约约、四周有赤色的，这是火郁内伏，大用清凉透发之法，间或有转红可救的。斑属于血，疹属于气，斑疹都是邪气外露的现象，发出后神情清爽为外解里和，如果斑疹出而神志昏蒙，这是正气不胜邪气而内陷，或者是胃津内涸的征候。○斑由失于发表而致的，应当求之于汗法；由失于攻下而致的，必须取法于攻下。火甚则清之，毒甚则化之。营气虚者，助其虚而调和、托举。至于阴斑的说法，很少见。痧，是疹的通称，有头粒且像粟米状；瘾，即疹的一类，肿胀且易痒。需要知道发出要均匀，消退宜缓慢。致病不外乎太阴、阳明二经，所以缪氏专门从脾胃论治，精辟且切中要害。治疗适宜辛凉、甘寒、苦寒、咸寒、淡渗等方法。（叶天士）
内伤引起的发斑，形状像蚊子叮咬的痕迹，多在手足，初起没有头痛、身热等证，这是由于劳役过度，胃气极度虚弱，火游散于外，或者其他证候经过汗、下治疗后，中气虚乏，邪气无处依附，散于肌表。治疗适宜大建中汤（Dajian Zhong Tang, Greatly Establish the Middle Decoction），不可妄施凉药。○阴证发斑，斑点稀疏颜色淡，像蚊子叮咬的痕迹，不像阳斑那样红显。良由肾气虚寒，阴盛于下，逼迫无根之火浮游于上。如果误作热证而用清凉药，危险立刻到来。治疗适宜八味汤（Bawei Tang, Eight-Ingredient Pill），使阴火收藏，斑自退。（《明医指掌》）
蚊迹样类似斑，错误地认作斑来治疗，杀人很快。辨别方法：先红后黄的，是蚊迹；先淡后红的，是斑；蚊迹多见于手足；斑多见于胸腹。（朱丹溪）
斑没有头粒，像蚊迹、跳蚤咬痕，重的像锦纹；疹有头粒，或现或隐。斑发于阳明经，疹发于太阴经。疹的成因，是肺被热灼，所以红点见于皮毛，与湿疹白色而无红点者不同。大概疹，是感受病邪，属于时行病，四时不正之气与膈间素有的火合而灼肺所致。或者由君火、相火所致，或者由寒、暖、暑、湿之气合而为病。其证见寒热呕恶，眼屎多，耳冷尻冷；其脉或沉而数，或伏而不起，发后才见洪数的。再论治法，斑属于胃实，所以见到斑点就忌讳升提，急急用清凉化毒。尤其担心胃烂，烂了则色变紫黑而危重。疹是心包伏热熏肺而出，所以从头到尾只宜清凉解托，凉膈散（Liangge San, Cooling the Diaphragm Powder）去掉硝、黄是其主方，有表证加荆芥、防风、前胡等。不用羌活，因为没有太阳证；兼骨节疼痛，才可加入。脉大汗多，兼阳明证，可加葛根；往来寒热，兼少阳证，可加柴胡。暑令合用益元散（Yiyuan San, Benefit Prime Powder），寒令合用香苏饮（Xiangsu Yin, Fragrant Perilla Decoction）。火旺则清之，用黄连、石膏必兼甘草、桔梗；末后滋阴，甘草、桔梗仍不可去。更有重要话语，只要有一毫胸次未宽，就为疹毒未透；从头到尾无汗，须发一身水泡，膈热才清；虚者忌用苍术、白术，可加人参。治疹的方法如此，治斑的方法，诸书详尽，不必多赘。（王协中）
斑是三焦无根之火，疹属心脾湿热之火，其上侵于肺是一样的。○赤疹因热气乘之，稍凉则消；白疹因寒气折之，稍暖则消。似白似赤，微黄隐于肌肉之间，四肢重着，这是脾经风热挟湿，多因沐浴后感风与汗出解衣而得。（《医学入门》）
疹有头粒，或像粟米，或像蚊迹，或随出随没，或没而又出。又有红点隐密于皮肤不透出的，为瘾疹；颗粒显透于皮肤的，为沙疹。证候各不相同，但初起必兼鼻塞流涕，声重咳嗽，头疼胸闷，发热自汗；更有风邪壅肺，气急鼻扇，咳不能卧。先用润肺利邪之剂。后变潮热而头不疼，胸膈已快，惟咳嗽气急如故，这是因本气素虚。肺邪虽解，阴虚火旺，脉数大者，宜滋阴清肺，不可误投人参、五味子等酸敛之品。（《证治汇补》）
丹痧这一证候，医书未有详细论述，我研究此证的由来，不外乎风、寒、温、热、时厉之气而已。所以解表清热，各有所宜，治之得当，不久即愈，治失其宜，祸生反掌，无非适宜发散和适宜清凉这两条途径。其证初起，凛凛恶寒，身热不甚，并有壮热仍兼憎寒者，此时即使咽痛烦渴，先须解表透达，即使适宜兼清散，总以散字为重。所谓“火郁发之”。如果漫用寒凉，则外邪更加闭郁，内火更加炽盛，咽痛更剧烈，溃腐日益严重。不明白这个道理，反而说如此凉药，尚且火势勃然，不察失于散法的错误，还认为寒之未及，愈凉愈遏，以致内陷而死的有之。有人说：此证专宜表散。所见亦偏，盖初起寒热之时，散为先务，俾汗畅而丹痧透发，若无恶寒等证，则外闭之风寒已解，内蕴之邪火方张，寒凉泄热，是所宜投，热尽而病自愈矣。若仍执辛散之方，则火得风而愈炽，肿势反增，腐亦滋蔓，必至滴水下咽，痛如刀割。间有议用清凉者，乃以郁遏诽之：炎热燎原，杀人最暴，这是偏于散法的危害。彼言散之宜，此言散之祸；彼言寒之祸，此言寒之宜。要在先后次第之间，随机权变，斯各中其窍耳。再按：此证愈后，每有四肢酸痛难以屈伸之状，盖由火烁阴伤而络失所养，法宜滋阴，勿同痹证施治。（《吴医汇讲》）
白㾦一证，考古方书无专条论及，间有斑疹门中发明一二，究未能尽其底蕴。今温热证中，每多发出如粞如粟，色白形尖者，谓之白㾦。有初病即见者；有见而即愈者；有见而危殆者，有病经日久，斑疹已见，补泻已施之后，仍然发此而愈者。世俗泛称时气，殊不知致病之由既异，治疗之法不同，不可不与斑、疹详辨而审处之也。盖伤寒传经热病，汗出不彻，邪热转属阳明，或由经入腑，受热蒸灼，营伤血热不散，而里实表虚，热气乘虚出于肤腠，稀如蚊迹，稠如锦纹者，为斑；时行风热之气，侵入肺虚血热之体，失于清透，伤及手太阴血分，乘虚出于皮肤，如沙如粟而色红琐碎者，为疹。或岁当火运，复感时厉之毒，即咽痛而成丹痧及烂喉痧之类，为最剧者也。至于白㾦一证，则温暑病中兼湿为多。盖伏气之发，本从内出，然必因外感，及人身素蕴之湿，与外触之邪互相蒸发，上甚为热。初病治法，设不用清透、渗解，则肺为热伤，气从中馁，不能振邪外解，热渐陷于营分；转投清营、滋化，热势稍缓，而肺气亦得借以自复，所留之湿，仍从上焦气分寻隙而出，于是发为白㾦。以肺主气，故多发于肩背、胸臆。白为肺之色，光润为湿之余气，至此而邪始尽泄也。若其人根本已虚，无气蒸达，多有延为衰脱者。故此证以元气未漓，色润晶莹有神者，为吉；枯白乏泽，空壳稀散者，为气竭而凶。总以形色之枯润，卜其气液之竭否。大抵此证在春末夏初暑湿之令为甚，秋冬则间有之。要不出乎手经受病，仍从手经发泄，不比足经之邪可从下解也。夫肺为主气之脏，气旺则邪从外解，上泄而病愈；气衰则邪正并竭，虽发必朽白无神而难治。观《内经》暑与湿同推，仲圣痉、湿、暍合论，益知温暑证中多夹湿邪，更无疑矣。○再有一种白㾦小粒，如水晶色者，此湿热伤肺，邪虽出而气液枯也，必得甘药补之。或未至久延，伤及气液，及湿郁卫分，汗出不彻之故，当理气分之邪。若白如枯骨者，多凶，为气液竭也。（《吴医汇讲》）
脉候
凡斑既出，须得脉洪数有力，身温足暖者可治；若脉小足冷，元气虚弱者难治。（周禹载）
选案
一人内寒外热，六脉沉细，肩背、胸胁斑出数点，随出随隐，语言狂乱。乃阳为阴逼，上入于肺，传之皮毛，故肌表虽热，以手按之，须臾冷透如冰。与姜附等药数剂，大汗而愈。（许叔微）
一人脉虚自汗，误与真武汤（Zhenwu Tang, True Warrior Decoction），遂至神昏脉伏，肌热灼指。此营热致斑，非阳病阴脉可比。先与白虎加入参汤（Baitao Jia Renshen Tang, White Tiger Decoction with Ginseng）化其斑，复以桃仁承气汤（Taoren Chengqi Tang, Peach Kernel Decoction to Order the Qi）下之而愈。（吕沧州）
胡虎臣元气素虚，时常感冒，予与补中益气汤（Buzhong Yiqi Tang, Tonify the Middle and Augment the Qi Decoction）即愈。一日，发斑遍身，兼见焦黑。医谓阳证误温不救。予曰∶非也，此胃气虚极，一身之火游行于外。与人参五钱，黄芪、麦冬各二钱，五味子、花粉、丹皮、木通、玄参、贝母、荆芥各七分，服之而愈。（程华仲）
Mottles and Macules (Ban Zhen)
Mottles caused by Shanghan (Cold Damage), mottles caused by Shiqi (Seasonal Pathogenic Factors), mottles caused by Yangdu (Yang Toxin), and mottles caused by Wendu (Warm Toxin); among these four syndromes, Wendu is the most severe. All are due to heat pathogens in the exterior; if purgation is incorrectly used when not indicated, the pathogen enters the stomach via deficiency; or if heat pathogens are in the interior but cannot be vented, both situations can cause mottles. (San Yin Fang)
Epidemic diseases often present with mottles. Generally, if fever persists after sweating, accompanied by restlessness and a deep pulse, it indicates the onset of mottles. In mottle syndromes, vomiting and diarrhea are auspicious signs, indicating that toxins are being expelled through both upper and lower pathways. (Yixue Liuyao)
Those appearing in clusters like brocade patterns are called Ban (Mottles); those appearing as faint red spots are called Zhen (Macules). This is because gastric heat, left un-purgated, rushes into the Shaoyang channel, assisting the Ministerial Fire to form Ban; if it rushes into the Shaoyin channel, it assists the Sovereign Fire to form Zhen. ○ When Ban and Zhen are about to erupt but have not yet appeared, it is appropriate to administer Shengma Gegen Tang (Cinnamon Twig and Kudzu Root Decoction) to vent the toxin. One must not immediately use cold-natured drugs to attack the heat, nor use diaphoretic or purgative methods that would weaken the Qi of the exterior and interior. If internal heat is severe, add Huanglian (Coptis Rhizome), Xijiao (Rhinoceros Horn - *note: substitute with water buffalo horn in practice*), Qingdai (Indigo Naturalis), Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), Huangqin (Scutellaria Root), Huangbai (Phellodendron Bark), and Xuanshen (Scrophularia Root). If the mottles subside slightly, but tidal fever, delirium, and constipation occur, Dai Chai Hu Tang (Major Bupleurum Decoction) or Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) may be used for purgation. (Wang An)
Ban syndromes range from mild, resembling macules, to severe, resembling brocade patterns. Although there are various causes, they all stem from unresolved pathogenic toxins. If sweating was indicated but not performed, exterior pathogens remain unresolved; if purgation was indicated but not performed, interior pathogens remain unresolved; if clearing heat was indicated but not performed, fire remains excessive; if tonification was indicated but not performed, righteous Qi is too weak to resolve the pathogen; if purgation is performed too early, pathogens sink inward; if Yang syndromes are mistakenly treated with warming and tonifying, Yang becomes hyperactive; if Yin syndromes are mistakenly treated with cold and cooling, Yin becomes stagnant. Whenever pathogenic toxins are unresolved, they penetrate directly into the Yin aspect, stagnate and generate heat, leading to exhaustion of fluids and blood, causing mottles to appear on the skin surface. ○ Cheng Wuji stated: Heat injures the Blood. If heat does not dissipate, the interior becomes full while the exterior becomes deficient; heat pathogens exit through the skin via this deficiency, forming mottles. Sweating should not be induced, as opening the pores further will only increase the severity of the mottles. I disagree. The pathogen of Shanghan originally enters from the exterior; if it penetrates deeply and remains unresolved, it naturally emerges from the interior. This mutual interaction between interior and exterior is inevitable and does not originally constitute an exterior deficiency syndrome. As long as interior and exterior communication is restored, the pathogen will surely resolve via the exterior. (Jingyue Quanshu)
When mottles and macules first appear, one must use a paper torch to illuminate the chest, back, and hypochondrium. Spots that are large and on the skin surface are Ban; those that are cloud-like and faint, or small and granular, are Zhen. Medical texts state that red mottles belong to gastric heat, purple to extreme heat, and black to "rotten stomach." However, external symptoms must also be considered for diagnosis. During spring and summer, dampness diseases often present with mottles and macules; their color must be distinguished. If the color is pale, limbs are cool, thirst is slight, and the pulse is not surging and rapid, it is either a Deficiency Mottle or a Yin Mottle. If only a few spots appear on the chest and abdomen, with a red face and cold feet, or diarrhea with undigested food, this indicates Yin excess repelling Yang upward; warming treatment is required. If mottles are purple and small, it is Heart Protector heat; if large and purple, it is Stomach heat; if black and shiny, it is heat exceeding toxin. Although considered untreatable, if the patient's Qi and Blood are robust, rescue may be possible; if black and dull, death is certain; if black and faint with red surroundings, it is Fire stagnation hidden inside; vigorous cooling and venting may occasionally turn them red and save the patient. Ban belongs to Blood, Zhen belongs to Qi; both are manifestations of pathogens manifesting externally. If the spirit is clear after eruption, it indicates external resolution and internal harmony. If the spirit becomes confused after eruption, it indicates righteous Qi failing to overcome the pathogen with internal sinking, or exhaustion of Stomach fluids. ○ Ban caused by failure to release the exterior requires diaphoresis; Ban caused by failure to purge requires purgation. Excessive fire is cleared; excessive toxin is transformed. If Ying Qi is deficient, tonify and support it. The concept of Yin Mottles is rarely discussed. "Sha" is a general term for macules, having granules like millet seeds; "Yin" refers to a type of macule that is swollen and itchy. Eruption should be uniform, and fading should be gradual. Causes involve primarily the Taiyin and Yangming channels; thus, Master Mou specialized in treating from the Spleen and Stomach, which is precise and pertinent. Treatments include acrid-cool, sweet-cold, bitter-cold, salty-cold, and bland-draining methods. (Ye Tianshi)
Internal injury causing mottles resembles mosquito bites, mostly on hands and feet, without initial headache or fever. This results from overexertion causing extreme Stomach Qi deficiency, allowing fire to wander externally, or from post-sweat/purge deficiency where pathogens scatter on the skin surface. Treatment requires Dajian Zhong Tang (Greatly Establish the Middle Decoction); do not recklessly use cooling drugs. ○ Yin syndrome mottles are sparse and pale, resembling mosquito bites, unlike the bright red of Yang mottles. This is due to Kidney Qi deficiency and cold, with Yin excess below forcing rootless fire to float upward. Mistaking this for heat and using cooling drugs leads to immediate danger. Treatment requires Bawei Tang (Eight-Ingredient Pill) to store the Yin fire, causing mottles to recede. (Mingyi Zhizhang)
Mosquito-bite-like lesions mistaken for mottles kill quickly. Differentiation: Red then yellow indicates mosquito bites; pale then red indicates mottles; mosquito bites are common on hands/feet; mottles are common on chest/abdomen. (Zhu Danxi)
Ban has no granules, resembling mosquito bites or flea marks, severe cases like brocade; Zhen has granules, appearing and disappearing. Ban originates in the Yangming channel; Zhen originates in the Taiyin channel. Zhen is caused by Lung heat scorching, resulting in red spots on skin/hair, differing from eczema which is white without red spots. Zhen is a contagious seasonal disease, where irregular seasonal Qi combines with latent fire in the diaphragm to scorch the Lung. It may be caused by Sovereign or Ministerial Fire, or by Cold, Warmth, Summerheat, or Dampness. Symptoms include chills, fever, vomiting, aversion to nausea, excessive eye discharge, cold ears and buttocks; pulses may be deep and rapid, or hidden and unrising, becoming surging and rapid only after eruption. Regarding treatment: Ban indicates Stomach excess, so lifting agents are contraindicated upon appearance; urgent cooling and toxin transformation are needed. Fear of "Stomach rot," which turns purple/black and is critical. Zhen is Heart Protector latent heat steaming the Lung; throughout, cooling and resolving/supporting are suitable. Liangge San (Cooling the Diaphragm Powder) minus Mangxiao and Dahuang is the main formula. Add Jingjie, Fangfeng, Qianhu for exterior symptoms. Do not use Qianghuo unless Taiyang symptoms exist; add only if joint pain is present. For surging pulse, profuse sweat, and Yangming symptoms, add Gegen. For alternating chills/fever and Shaoyang symptoms, add Chaihu. In summerheat, combine with Yiyuan San; in cold, combine with Xiangsu Yin. Clear fire with Huanglian and Shigao, always combined with Gancao and Jiegeng. Later, nourish Yin, keeping Gancao and Jiegeng. Crucially, any chest tightness indicates unvented toxin; lack of sweating throughout requires inducing generalized blistering to clear diaphragmatic heat; for deficiency, avoid Baizhu and Cangzhu, add Renshen. This is the method for Zhen; methods for Ban are detailed elsewhere. (Wang Xiezhi)
Ban is rootless fire of the Sanjiao; Zhen is damp-heat fire of the Heart and Spleen; both invade the Lung similarly. ○ Red macules dissipate with slight cooling; white macules dissipate with slight warming. Pale-red/yellow spots hidden in muscles with heavy limbs indicate Wind-Heat with Dampness in the Spleen channel, often from bathing followed by wind exposure and removing clothes while sweating. (Yixue Rumen)
Zhen has granules, like millet or mosquito bites, appearing/disappearing rapidly. Red spots hidden under skin are Yin Zhen; prominent granules are Sha Zhen. Syndromes differ, but initially accompany nasal congestion, runny nose, hoarse cough, headache, chest tightness, fever, and spontaneous sweating. Severe cases involve Wind obstructing the Lung, causing shortness of breath, flaring nostrils, and inability to lie down due to cough. First use moistening Lung and eliminating pathogen formulas. Later, if tidal fever appears without headache and chest discomfort improves, but cough/shortness of breath persist, it is due to constitutional deficiency. Although Lung pathogens are resolved, Yin deficiency with Hyperactive Fire and rapid/large pulse require nourishing Yin and clearing Lung heat; do not mistakenly use Renshen or sour/astringent herbs. (Zhengzhi Huibu)
Dan Sha (Scarlet Fever-like Rash)
Medical texts rarely discuss Dan Sha in detail. My research shows its origin lies in Wind, Cold, Warmth, Heat, or Epidemic Qi. Thus, releasing the exterior and clearing heat are appropriate depending on the stage. Proper treatment cures quickly; improper treatment brings disaster. There are essentially two paths: dispersing and clearing. Initially, there is aversion to cold, slight fever, or high fever with chills. Even with sore throat and thirst, the priority is releasing the exterior and venting. Dispersing is key, following the principle "Vent Fire Stagnation." Indiscriminate use of cold drugs closes exterior pathogens and intensifies internal fire, worsening throat ulceration. Misunderstanding this, some blame cooling drugs for persistent fire, failing to see the error of neglecting dispersal, continuing to cool until internal sinking and death occur. Others argue for exclusive dispersal, which is biased. Initially, during chills/fever, dispersal is urgent to induce sweating and vent Dan Sha. If chills cease, exterior Wind-Cold is resolved, and internal pathogenic fire flares; then cooling and draining heat is appropriate until the disease resolves. Persisting with acrid-dispersants when fire is dominant exacerbates swelling and ulceration. Those advocating cooling criticize dispersal as causing stagnation. Both views have merit depending on timing. Post-recovery, limb pain/stiffness may occur due to Yin injury from fire; treat by nourishing Yin, not as Bi Syndrome. (Wu Yi Huijiang)
Bai Fei (White Vesicles)
Ancient texts lack specific sections on Bai Fei, mentioning it briefly under mottles/macules. In warm-heat syndromes, white, pointed, rice-like vesicles appear. Some resolve immediately, some are critical, some appear late after tonification/purgation. Laypeople call it "seasonal qi," but etiology and treatment differ from mottles/macules. Shanghan transmitting heat with incomplete sweating shifts to Yangming; heat steams, injuring Ying and Blood, causing interior fullness/exterior deficiency; heat exits skin as mottles (sparse like mosquito bites, dense like brocade). Seasonal Wind-Heat invading a Lung-deficient/Blood-heat body, lacking clearing/venting, injures Hand Taiyin Blood; heat exits skin as red, granular macules. If Fire Luck year plus epidemic toxin, sore throat leads to Dan Sha/Rotten Throat Sha (most severe). Bai Fei usually involves Dampness in Warmth/Summerheat diseases. Latent Qi emerges internally but requires external contraction and inherent Dampness evaporating together, generating heat. Initial treatment must clear/vent and drain; otherwise, Lung is injured, Qi fails, heat sinks to Ying. Switching to clearing Ying/nourishing transforms slows heat and restores Lung Qi; residual Dampness exits from Upper Jiao Qi level, forming Bai Fei. Since Lung governs Qi, it appears on shoulders/back/chest. White is Lung color; moisture is residual Dampness; here pathogens fully exit. If constitution is weak, it may lead to collapse. Auspicious: vibrant, moist, spirited; Inauspicious: dry, white, hollow, sparse. Judge Qi/fluid status by texture/color. Common in late spring/early summer dampness; rare in autumn/winter. Disease affects Hand meridians, exits via Hand meridians, unlike Foot meridians which can be drained downward. Lung governs Qi; strong Qi resolves pathogens externally/upward; weak Qi leads to exhaustion/death. Neijing links Summerheat/Dampness; Zhang Zhongjing links Spasm/Dampness/Heatstroke; confirming Dampness in Warmth/Summerheat. Small crystal-like Bai Fei indicates Damp-Heat injuring Lung, Qi/fluids exhausted; needs sweet tonics. If not prolonged, due to Dampness stagnating in Wei level/incomplete sweating, regulate Qi level pathogens. White like dead bone is inauspicious, Qi/fluid exhaustion. (Wu Yi Huijiang)
Pulse Signs
After mottles erupt, a surging, rapid, forceful pulse with warm body and feet indicates treatability; a small pulse with cold feet and weak Yuan Qi indicates difficulty. (Zhou Yuzaï)
Selected Cases
A patient with internal cold/external heat, deep/fine pulses, scattered mottles on shoulder/back/chest that appeared and disappeared, with delirious speech. Yang was forced by Yin, entering Lung and skin. Skin felt hot but turned ice-cold to touch. Given Jiangfu (Ginger and Aconite) medicines, cured with profuse sweating. (Xu Shumi)
A patient with deficient pulse and spontaneous sweating was mistakenly given Zhenwu Tang, leading to coma, hidden pulse, and burning skin heat. This was Ying heat causing mottles, not comparable to Yang disease with Yin pulse. First given Baitao Jia Renshen Tang (White Tiger Decoction with Ginseng) to resolve mottles, then Taoren Chengqi Tang (Peach Kernel Decoction to Order the Qi) for purgation; cured. (Lu Cangzhou)
Hu Huchen had chronic Yuan Qi deficiency and frequent colds; cured with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). One day, widespread mottles with blackened centers appeared. Physicians said Yang syndrome mistreated with warmth was incurable. I said: No, this is extreme Stomach Qi deficiency with fire wandering externally. Given Renshen (5 qian), Huangqi and Maidong (2 qian each), Wuweizi, Huafen, Danpi, Mutong, Xuanshen, Beimu, Jingjie (0.7 qian each); cured. (Cheng Huazhong)