总括 斑症总言因胃热，赤生黑死分明别；忽如锦片出肌肤，湿毒发时别两胁。
脉法 脉阳浮而数，阴实而大。
《内经》曰∶少阴所致为疡疹。夫少阴所致者，君火有余，热令火行，戊子戊午之岁也，在人则心主之。心火太过
则制己所胜，而烧灼肺金。又肺主皮毛，故红色如锦，见于皮肤之间，心火侮而乘之之色也。
《经》又曰∶疹属于脾。故《金镜录》谓毒盛于脾，热流于心，乃知心脾肺俱受病而发者，其欲出之时，腮红眼赤，
壮热憎寒，身体疼痛，呕吐泄泻，咳嗽烦渴是其候也。当服开豁腠理汤，使之易出。如头面愈多，鲜明匀净，精神爽朗，
吉之兆也，服前药即愈矣。若痧色紫红干燥暗晦，或未出透，身热烦闷，声哑喘急，隐隐不出，出而复隐，此危急之兆
也。（批∶看时气加之，有云∶火热入内，血化为斑。）急将前方加炒黑麻黄、羌活之类发之，如不复出，或喘更甚，此
不治之症也。
《活幼心书》曰∶斑症有二，有瘟毒发斑，有胃烂发斑。瘟毒发斑者其瘾疹如锦纹片，出于两腋之下，两腋者气之
道路，故瘟毒随气之道路而先出，其症咳嗽烦闷或呕清水，此因冬时感冒寒毒，停于肌肉之间，至春阳气发动而行于外，
名为瘟毒发斑，以百解散及牛蒡汤加陈皮、黄连之类。
胃烂发斑，初因伤寒下早，热毒乘虚入里，乃当下而不下，亦致热毒内蒸于胃，胃受热毒则发于皮肤。斑之赤者可
疗，黑者十死一生，治法同前。其病大便坚燥，不可轻用药下之，或用蜜煎猪胆导之，则自来矣。如微泻者不必治之，
正假此以泄热毒也。若痧发后泻痢不止，此又热毒下陷之故，当以五苓散去桂加芩、连、芍药、木通之类，毒解热退泻
痢自止，不可用燥涩温补之剂。古人云∶可汗不可下，可表不可补是也。
痧后壮热气促不止者，此余毒留连未尽也，须用解火清金之剂，以竹叶、石膏、门冬、知母、芩、连、玄参、桔梗、
陈皮、枳壳、天花粉、牛蒡之类。
痧后咳嗽不止者，二陈加栝蒌、桔梗、玄参、黄芩治之。渴则门冬、花粉，喘则苏子、桑皮可也。
痧出过三日后不没者，此内有实热也，加清利之药则自消矣，四物汤加芩、连、牛蒡之类。
凡出痧之时，大忌生冷荤腥之食、风寒水湿之气，苟有不谨，最为深患。间有犯之而获愈者，此内禀之气实，外感
之邪轻耳。余虽不敏，验之屡矣，当慎守此戒。
有一种初出淡红润色，酷似痘疹，但粒头尖小为异，此为赤痘。有初出尖小而头白光亮有清水，此为水痘，此二者
皆属心火流于脾肺，最为易出易靥，极称轻症。但恐变疮疡，脓水溃坏，此皆不避风绝荤耳，以四物加荆芥、防风、芩、
连之类。
〔附方〕
开豁腠理汤 陈皮 天花粉 防风 荆芥 桔梗 枳壳 前胡 干葛 紫苏 羌活 甘草 升麻
百解散 见热症内。
牛蒡汤 牛蒡 大黄 防风 荆芥 薄荷 甘草
五苓散 见惊风症内。
二陈汤 见诸吐症内。
四物汤 见痢疾症内。
总括：斑疹病症总体说来是因为胃中有热，颜色发红为轻、发黑为重（预后不良），界限分明；突然像锦缎花纹一样出现在肌肤上，这是湿毒发作时特别见于两胁部位的情况。
脉法：脉象表现为阳部浮而数，阴部实而大。
《内经》说：少阴经邪气所致的是疮疡和疹子。所谓少阴经邪气所致，是指君火有余，热令火势流行，对应戊子、戊午年份，在人体则归属于心主。心火太过则会克制其所胜的脏腑，从而烧灼肺金。又因为肺主皮毛，所以红色如锦缎般显现于皮肤之间，这是心火侮乘肺金的色泽表现。
《经书》又说：疹属于脾。所以《金镜录》认为毒盛于脾，热流于心，因此心、脾、肺三脏都受病而发病。其欲出之时，症状包括腮红眼赤、壮热憎寒、身体疼痛、呕吐泄泻、咳嗽烦渴等。应当服用开豁腠理汤，使疹毒容易透出。如果头面部疹点越多，且鲜明匀净，精神爽朗，这是吉兆，服用前面的药物即可痊愈。如果痧色紫红干燥暗晦，或者未出透，身热烦闷，声音嘶哑喘急，隐隐不出，或出而复隐，这是危急的征兆。（批注：观察时气加临，有说法称火热入内，血化为斑。）急需将前方加入炒黑的麻黄、羌活之类以发散之，如果仍不出，或喘息更甚，这是不治之症。
《活幼心书》说：斑症有两种，一种是瘟毒发斑，一种是胃烂发斑。瘟毒发斑者，其瘾疹如锦纹片状，出于两腋之下，两腋是气运行的道路，所以瘟毒随气的道路而先出，症状表现为咳嗽烦闷或呕吐清水，这是因为冬季感冒寒毒，停于肌肉之间，至春季阳气发动而行于外，名为瘟毒发斑，用百解散及牛蒡汤加陈皮、黄连之类治疗。
胃烂发斑，起初因伤寒下法过早，热毒乘虚入里，本该下而未下，也导致热毒内蒸于胃，胃受热毒则发于皮肤。斑色红的可以治疗，黑色的十死一生，治法同前。此病大便坚燥，不可轻易用药攻下，或用蜜煎猪胆导便，则大便自然通下。如果轻微腹泻不必治疗，正是借此以泄热毒。如果痧发后泻痢不止，这又是热毒下陷的缘故，当用五苓散去桂枝加黄芩、黄连、芍药、木通之类，毒解热退泻痢自止，不可用燥涩温补的药物。古人说：可汗不可下，可表不可补，就是这个道理。
痧后壮热气促不止者，这是余毒留连未尽，须用解火清金的药剂，以竹叶、石膏、麦冬、知母、黄芩、黄连、玄参、桔梗、陈皮、枳壳、天花粉、牛蒡之类组成。
痧后咳嗽不止者，用二陈汤加栝蒌、桔梗、玄参、黄芩治疗。口渴则用麦冬、花粉，气喘则用苏子、桑白皮即可。
痧出过三日后不消退者，这是内有实热，加入清利之药则自然消散，可用四物汤加黄芩、黄连、牛蒡之类。
凡出痧之时，大忌生冷荤腥食物、风寒水湿之气，如果有不慎，最为深患。间或有犯禁而获愈者，这是禀赋之气实，外感之邪轻罢了。我虽然不敏，但验证多次，应当谨慎遵守此戒律。
有一种初出淡红润色，酷似痘疹，但粒头尖小为异，此为赤痘。有初出尖小而头白光亮有清水，此为水痘，此二者皆属心火流于脾肺，最为易出易愈，极称为轻症。但恐变疮疡，脓水溃坏，这都是因为不避风绝荤导致的，用四物汤加荆芥、防风、黄芩、黄连之类治疗。
〔附方〕
开豁腠理汤：陈皮、天花粉、防风、荆芥、桔梗、枳壳、前胡、干葛、紫苏、羌活、甘草、升麻。
百解散：见热症内。
牛蒡汤：牛蒡子、大黄、防风、荆芥、薄荷、甘草。
五苓散：见惊风症内。
二陈汤：见诸吐症内。
四物汤：见痢疾症内。
General Overview: The rash syndrome is generally attributed to stomach heat; redness indicates a milder condition while blackening signifies death, with clear distinctions. Sudden appearance like brocade patterns on the skin occurs when damp-toxin erupts, specifically manifesting between the two hypochondria.
Pulse Method: The pulse is floating and rapid in the yang position, and solid and large in the yin position.
The *Neijing* states: Pathogenic factors from the Shaoyin meridian cause sores and rashes. What is caused by Shaoyin refers to an excess of Sovereign Fire (Jun Huo), where heat causes fire to circulate, corresponding to the years of Wu Zi and Wu Wu. In the human body, this belongs to the Heart Master. When Heart Fire is excessive, it overacts on what it controls, burning Lung Metal. Since the Lung governs the skin and hair, the red color appearing like brocade on the skin is the hue of Heart Fire insulting and overcoming Lung Qi.
The Classics also state: Rashes belong to the Spleen. Thus, the *Jingjian Lu* asserts that toxin is abundant in the Spleen and heat flows into the Heart, meaning the Heart, Spleen, and Lungs are all diseased and erupt. At the time of eruption, symptoms include red cheeks and eyes, high fever with aversion to cold, body pain, vomiting and diarrhea, cough, irritability, and thirst. One should administer Kaihuo Couli Tang (Open and Clear Pores Decoction) to facilitate eruption. If the head and face have more spots, bright and uniform, with clear spirit, it is an auspicious sign, and taking the previous medicine will lead to recovery. If the rash color is purple-red, dry, dark, and dull, or not fully erupted, accompanied by fever, irritability, hoarseness, and急促 breathing, faintly appearing then disappearing, this is a critical omen. (Commentary: Observe the seasonal qi addition; some say heat-fire enters internally, transforming blood into macules.) Urgently add stir-fried black Ephedrae Herba (Mahuang, 麻黄) and Notopterygii Rhizoma et Radix (Qianghuo, 羌活) etc., to the above formula to disperse it. If it does not reappear, or if panting worsens, this is an incurable condition.
The *Huoyou Xinshu* states: There are two types of macule syndromes: one is epidemic toxin causing macules, and the other is stomach rot causing macules. For epidemic toxin macules, the urticaria appears like brocade patterns, emerging under the armpits. The armpits are pathways for Qi, so the epidemic toxin follows these pathways to emerge first. Symptoms include cough, irritability, or vomiting clear water. This is due to catching cold toxins in winter, which remain between the muscles, and in spring, when Yang Qi activates and moves outward, it is named epidemic toxin macules. Treat with Baijie San (Hundred Resolutions Powder) and Niubang Tang (Arctium Decoction) plus Tangerine Peel (Chenpi, 陈皮) and Scutellaria Root (Huangqin, 黄芩) etc.
For stomach rot macules, it initially arises from premature purgation in Cold Damage, allowing heat-toxin to enter the interior due to deficiency. Since it should have been purged but was not, heat-toxin steams internally in the Stomach. When the Stomach receives heat-toxin, it erupts on the skin. Red macules can be treated; black ones have ten deaths for every one survival. The treatment method is the same as before. This disease involves hard and dry stools; do not lightly use purgatives. Instead, use honey-suppository or pig gallbladder suppositories to induce bowel movement naturally. If there is mild diarrhea, no treatment is needed, as this serves to vent heat-toxin. If dysentery continues after the rash erupts, this is due to heat-toxin sinking downward. Use Wuling San (Five-Ingredient Poria Powder) minus Cinnamon Twig (Guizhi, 桂枝), adding Scutellaria Root (Huangqin, 黄芩), Phellodendron Bark (Huanglian, 黄连), Peony Root (Shaoyao, 芍药), and Akebia Caulis (Mutong, 木通) etc. Once toxin resolves and heat retreats, dysentery stops naturally. Do not use drying, astringent, or warming-tonifying agents. As the ancients said: "Sweating is permissible, purging is not; releasing the exterior is permissible, tonifying is not."
If high fever and rapid breathing persist after the rash, this is residual toxin lingering unfinished. Use formulas to clear fire and cool the metal (Lung), such as Bamboo Leaf (Zhuye, 竹叶), Gypsum (Shigao, 石膏), Ophiopogon Tuber (Mendong, 门冬), Anemarrhena Rhizome (Zhimu, 知母), Scutellaria Root (Huangqin, 黄芩), Phellodendron Bark (Huanglian, 黄芩), Scrophularia Root (Xuanshen, 玄参), Platycodon Root (Jiegeng, 桔梗), Tangerine Peel (Chenpi, 陈皮), Bitter Orange (Zhike, 枳壳), Trichosanthes Root (Tianhuafen, 天花粉), and Arctium Fruit (Niubangzi, 牛蒡).
If cough persists after the rash, treat with Erchen Tang (Two-Cured Decoction) plus Trichosanthes Fruit (Gualou, 栝蒌), Platycodon Root (Jiegeng, 桔梗), Scrophularia Root (Xuanshen, 玄参), and Scutellaria Root (Huangqin, 黄芩). For thirst, use Ophiopogon Tuber (Mendong, 门冬) and Trichosanthes Root (Tianhuafen, 天花粉); for panting, use Perilla Seed (Suzi, 苏子) and Mulberry Bark (Sangbai, 桑皮).
If the rash does not fade after three days, this indicates internal excess heat. Add clearing and draining herbs, and it will dissipate naturally. Use Siwu Tang (Four Substances Decoction) plus Scutellaria Root (Huangqin, 黄芩), Phellodendron Bark (Huanglian, 黄芩), and Arctium Fruit (Niubangzi, 牛蒡).
During the eruption of the rash, raw, cold, meaty, and fishy foods, as well as wind-cold and damp-water environments, are strictly forbidden. Negligence leads to severe complications. Occasionally, those who violate these rules recover because their constitutional Qi is strong and the external pathogenic factor is light. Although I am not talented, I have verified this repeatedly; one must strictly observe this prohibition.
There is a type that initially appears pale red and moist, resembling smallpox, but differs by having sharp, small granules; this is called Red Smallpox (Chi Dou, 赤痘). Another type initially appears sharp and small with white, bright heads containing clear fluid; this is called Water Smallpox (Shui Dou, 水痘). Both belong to Heart Fire flowing into the Spleen and Lungs, are easiest to erupt and heal, and are considered mild conditions. However, fear of transformation into sores with pus and tissue destruction exists, often due to failing to avoid wind and abstain from meat. Treat with Siwu Tang (Four Substances Decoction) plus Schizonepeta Spike (Jingjie, 荆芥), Saposhnikovia Root (Fangfeng, 防风), Scutellaria Root (Huangqin, 黄芩), and Phellodendron Bark (Huanglian, 黄芩).
[Attached Formulas]
Kaihuo Couli Tang (Open and Clear Pores Decoction): Citri Reticulatae Pericarpium (Chenpi, 陈皮), Trichosanthes Root (Tianhuafen, 天花粉), Saposhnikovia Root (Fangfeng, 防风), Schizonepeta Spike (Jingjie, 荆芥), Platycodon Root (Jiegeng, 桔梗), Aurantii Fructus (Zhike, 枳壳), Peucedani Radix (Qianhu, 前胡), Puerariae Radix (Gange, 干葛), Perillae Folium (Zisu, 紫苏), Notopterygii Rhizoma et Radix (Qianghuo, 羌活), Licorice Root (Gancao, 甘草), Cimicifugae Rhizoma (Shengma, 升麻).
Baijie San (Hundred Resolutions Powder): See Heat Syndromes section.
Niubang Tang (Arctium Decoction): Arctium Fruit (Niubangzi, 牛蒡), Rheum Palmatum Root and Rhizome (Dahuang, 大黄), Saposhnikovia Root (Fangfeng, 防风), Schizonepeta Spike (Jingjie, 荆芥), Mentha Haplocalyx (Bohe, 薄荷), Licorice Root (Gancao, 甘草).
Wuling San (Five-Ingredient Poria Powder): See Convulsive Disease section.
Erchen Tang (Two-Cured Decoction): See Vomiting Syndromes section.
Siwu Tang (Four Substances Decoction): See Dysentery section.