bubble_chart Concept

The appearance of patchy ecchymoses on the skin surface, which do not rise above the skin and are not palpable, is referred to as "fa ban" (發斑). The "Yilin Shengmo" states: "Those with colored spots but no granules are called ban (斑)."

Since fa ban can appear in various diseases, with varying shapes, sizes, and colors, medical practitioners throughout history have proposed many different names for it. The "yin and yang toxin" in "Jingui Yaolue" , the "purpura" in "Waike Qixuan" , the "macula and papule" in "Cold-Damage Disease Ninety Discussions: Fa Ban Syndrome" , the "dry cholera" in "Zabing Pailiu Xizhu" , and the "cat eye-like sore (erythema multiforme)" in "Chuangyang Jingyan Quanshu" all refer to fa ban. "Danxi Xinfa" and "Mingyi Zhizhang" respectively proposed the terms "yin macula" and "yang macula." The so-called yin macula refers to ban associated with deficiency-cold, while yang macula refers to ban associated with excess-heat. Fa ban should be distinguished from "zhen" (疹). The "Warm Diseases: Differentiation of Macula and Papule Chapter" states: "Ban spots are large and form patches, generally not raised above the skin, not palpable, and appear like brocade patterns when viewed; zhen are faint like cloud tops or appear as small fragmented grains, generally raised above the skin, palpable, but some may not be raised and are not palpable." Ban and zhen often appear together in warm febrile diseases, so medical texts often mention ban to include zhen, or collectively refer to them as macula and papule. However, the pathological mechanisms of ban and zhen differ: ban mostly results from heat stagnation in the Yangming, intense stomach heat, internal pressure on nutrient-blood, and external overflow to the skin; zhen is often due to lung heat stagnation, affecting the nutrient aspect, and external spreading to the blood vessels. The scope of discussion in this section is limited to fa ban caused by internal diseases.

bubble_chart Pattern Analysis

1. Heat Entering the Nutrient-Blood Level︰It often occurs during the acute Rebing process. The spots are bright red or purplish-red, with persistent fever or fever worsening at night, accompanied by restlessness and insomnia, thirst and dry throat, or even unconsciousness and delirious speech, convulsions, scanty dark urine, dry stools or sloppy diarrhea, or accompanied by hematemesis, epistaxis, a crimson tongue texture, and a rapid pulse. It commonly appears during high fever illnesses, where warm heat toxin epidemic pathogens invade the body, penetrate inward to the nutrient-blood level, damage the yin collaterals, force blood to recklessly flow outward, and spill over the skin, causing spots. Its characteristics include fever, dark purple spots, or even unconsciousness and delirious speech, convulsive syncope or convulsions, or vomiting blood and epistaxis, bloody stool. Treatment should focus on clearing the nutrient aspect, cooling the blood, and dissipating stasis. Either Rhinoceros Horn and Rehmannia Decoction or Ecchymosis-Dissipating Decoction can be selected. For high fever with unconsciousness, add Peaceful Palace Bovine Bezoar Pill or Supreme Treasured Pill.
2. Yin Deficiency︰The spots are bright red, appearing intermittently, accompanied by restlessness, dry mouth and throat, feverish feeling in palms and soles, or afternoon tidal fever, night sweat, dizziness, tinnitus, and possibly nosebleeds or gum bleeding. The tongue is glossy red with scant coating, and the pulse is thin and rapid. The condition has a prolonged course, with bright red spots caused by chronic illness damaging yin or Rebing depleting fluids, leading to yin deficiency with effulgent fire forcing blood to spill out to the skin and manifest as spots. Symptoms such as dizziness, tinnitus, dry mouth and throat, tidal fever, night sweat, and a red tongue with scant coating indicate yin deficiency. The treatment principle should focus on enriching yin, reducing fire, and dispersing stasis, using Qian Gen San or Anemarrhena, Phelloendron and Rehmannia Pill with modifications.
3. Spleen Failing to Control Blood︰The erythema recurs repeatedly, with pale red patches that are faint and indistinct. The complexion is shallow yellow, accompanied by mental fatigue and timidity. There is reduced appetite, abdominal distension and fullness, hypermenorrhea with light-colored menstrual flow, and loose stools. The tongue texture is pale and swollen, and the pulse is thin, weak, and feeble. The spleen governs transportation and transformation and has the function of controlling blood. Improper dietary habits in later life lead to spleen qi deficiency and decline, impairing its blood-controlling function. As a result, blood fails to circulate normally within the vessels and spills outside, forming patches. The characteristic features include erythema accompanied by reduced appetite, abdominal distension and fullness, epigastric stuffiness, anorexia, and loose stools—manifestations of the pattern of spleen deficiency. The treatment focuses on fortifying the spleen, supplemented by tonifying qi and blood. Returning to Spleen Decoction is modified for use.
4. Yang Qi Deficiency︰The spots are pale and faint, commonly seen on the chest and abdomen, palpitation severe palpitation, fatigue lack of strength, reversal cold of limbs, or diarrhea with undigested food, complexion pale or puffy. Poor appetite loose stool, tongue texture swollen and tender with tooth marks on the edges, clear and profuse urine, weak and feeble pulse. Often seen in deficiency fatigue, after prolonged illness, or patients with yang deficiency and weak qi. Generally due to innate constitutional insufficiency, or excessive indulgence damaging both the spleen and kidneys, leading to yang qi deficiency. In yang deficiency, qi is inevitably weak, resulting in failure of qi to control blood, which may also cause spots. Suwen. Yinyang Yingxiang Da Lun: "Yin resides within, guarded by yang; yang acts externally, directed by yin." Mutual rooting of yin and yang means yang deficiency leads to yin failing to guard internally, causing blood to spill and form spots. Thus, symptoms include reversal cold of limbs, palpitation severe palpitation, haggard appearance, mental fatigue and exhaustion, pale and puffy face. Treatment should focus on warming yang and replenishing qi, while also addressing the spleen and kidneys, modified with Right-Restoring Pill. For kidney yang deficiency, add Aconite Lateral Root, Morinda Root, Pilose Antler; for kidney yin deficiency, add Scrophularia Root, Asparagus Root, Unprocessed Rehmannia Root, glossy privet fruit, Yerbadetajo Herb, etc.
5. Qi Stagnation and Blood Stasis︰Patients with abdominal mass often present with cyanotic patches, a dull or sallow complexion, visible veins on the abdomen, spider angiomas, hematemesis, bloody stool, or gingival bleeding, a purplish tongue color, and a wiry or slow-choppy pulse. This is commonly seen in patients with abdominal mass. Due to stagnation of the seven emotions, imbalance of cold and warmth, or improper diet, the functions of the zang-fu organs become disharmonious, leading to obstruction of qi movement, sluggish blood circulation, and the formation of stasis patches. Symptoms include a dark complexion, visible veins on the abdomen, spider angiomas, a distended abdomen with palpable masses, and hematemesis or bloody stool. This syndrome is often characterized by deficiency of healthy qi and excess of pathogenic factors. Treatment primarily focuses on reinforcing healthy qi and eliminating pathogenic factors, supplemented by invigorating blood and resolving stasis. Use Eight Precious Ingredients Decoction with additions such as Carthamus, Red Peony Root, turtle carapace, and Salvia.
6. Wind-dampnessheat Stagnation︰The spots are mostly ring-shaped or accompanied by subcutaneous nodules, recurring frequently and commonly appearing on the limbs. The spots vary in size, with pale centers and raised edges. Patients may experience joint pain or swelling throughout the body, pale complexion, profuse sweating, and in severe cases, chest tightness, shortness of breath, and rapid pulse. Wind-cold and damp pathogens invade the body, lingering in the skin, muscles, and meridians. Over time, stagnation transforms into heat, which accumulates in the blood vessels, causing blood to extravasate and form spots. The spots are often ring-shaped, accompanied by systemic joint pain, fever, thirst, and other symptoms of wind-dampness-heat stagnation. Treatment should focus on dispersing wind, clearing heat, invigorating blood, and unblocking collaterals. Use Juanbi Tang (Joint-Pain-Relieving Decoction) with added Honeysuckle Stem, Stephania Tetrandra, and Floweringquince Fruit.

Spleen failing to control blood and yang qi deficiency: The spleen is the acquired foundation, the source of qi and blood generation and transformation. Spleen deficiency can also lead to qi deficiency or yang deficiency. Therefore, in treatment, they can complement each other.

The symptom of macules is extremely complex in terms of disease causes, involving both internal and external factors, dysfunction of the five zang-organs, and diseases of the six fu-organs. Generally speaking, macules that are red, lively, moist, loosely floating, and sparse, without high fever or unconsciousness, are considered favorable signs; if the macules are purple-black, tightly bound, fused into patches, with high fever and unconsciousness, then it is considered an unfavorable pattern.

bubble_chart Documentation

1. Zabing Yuanliu Xizhu．"The Origin of Yang Toxin and Yin Toxin": "Yang toxin causes macules, which is a disease of extreme yang pathogen. It may also be caused by mistakenly consuming pungent and hot substances. The 'Golden Chamber' states: 'The disease caused by yang toxin is characterized by a face with red macules like brocade patterns, sore throat, and spitting of pus and blood. It can be treated within five days, but not after seven days. Cimicifuga and Turtle Carapace Decoction is the main treatment.' Yin toxin causes macules, which is a disease of deeply rooted yin pathogen. The 'Golden Chamber' states: 'The disease caused by yin toxin is characterized by a bluish complexion, body pain as if beaten, and sore throat. It can be treated within five days, but not after seven days. Cimicifuga and Turtle Carapace Decoction, with Realgar and Shuzhu removed, is the main treatment.'"