Library

Although epidemics (highly contagious diseases) are formed by the convergence of three categories of causes—internal, external, and neither internal nor external—if they arise from abnormal climatic conditions, often involving the intermingling, stagnation, and damage caused by the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), then given the distinction between Cold Epidemic and Warm Epidemic, how can Wind-Damp Epidemic be left unexamined?

If the symptoms resemble Dampness Injury but the pulse and complexion differ, and if it is a case of mutual infection within a specific region affecting people of all ages, it should be treated as an epidemic. Aside from using methods to ward off miasma, for treating Damp Epidemic, use Wu Ling San (Five-Ingredient Poria Decoction) with added Honey-fried Licorice Root; for treating Wind Epidemic, use Guizhi Tang (Cinnamon Twig Decoction) with added Scutellaria Root. There are no cases that do not heal. As for situations where pathogenic factors intertwine and mesh within the collaterals, one should reason by analogy.

For treating Cold Damage and Warm Febrile Diseases where both exterior and interior patterns remain unresolved, presenting with headache, fever, dry mouth and throat, irritability, thirst prompting water intake, yet vomiting immediately after drinking; or difficulty in urination; or sweating with resolution of the exterior pattern but persistent irritability and thirst, this formula is suitable. It is also used to treat Cholera Dysentery characterized by vomiting and diarrhea. (See the formula under the "Summer Heat Injury" section, add one liang of Honey-fried Licorice Root).

For treating Wind Epidemic, where the pulse is floating and rapid but not weak, accompanied by pain in the head and neck, pain in the lower back and spine, fever, and aversion to wind. These symptoms are similar to Taiyang Wind Strike (a deficiency-cold exterior syndrome caused by Wind invading the Taiyang channel), except that the Yin portion of the pulse is not weak and there is contagion.
Guizhi (Cinnamon Twig, peeled), Shaoyao (Peony Root), Huangqin (Scutellaria Root) (each half liang); Gancao (Licorice Root, honey-fried, one liang).
Grind these into a coarse powder. Take five qian per dose, with one and a half cups of water, three slices of ginger, and one jujube. Decoct until reduced to seven-tenths, strain, and take before meals.

For treating Cold Damage, Warm Epidemic, Damp Epidemic, and Heat Epidemic.
Cangzhu (Atractylodis Rhizoma), Ganjiang (Dried Ginger, processed), Gancao (Licorice Root, honey-fried, each six liang); Fangfeng (Saposhnikoviae Radix), Gange (Puerariae Radix), Houpo (Magnoliae Officinalis Cortex, prepared and stir-fried), Shaoyao (Peony Root) (each four liang).
Grind these into a coarse powder. Take three and a half qian per dose, with two cups of water. Decoct until reduced to seven-tenths, strain, and take.

Malaria (Nue Disease) involves all three categories of causes: internal, external, and neither internal nor external. The external cause is exposure to the four seasonal climates; the internal cause is emotional disturbance of the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright); irregular diet, overeating or hunger, excessive sexual activity, or improper balance of work and rest can all induce malaria. The statement in the *Classic* ("Summer heat injures the body in summer, leading to malaria in autumn") merely describes the sequence according to seasons and should not be viewed narrowly. From this perspective, it is known that Plague Diseases, Sundry Diarrhea (undigested food in stool), and Coughs should not be rigidly confined to fixed patterns.

When Malaria first begins, hair stands on end, followed by yawning and stretching, then chills with teeth chattering, and pain in the waist and spine. When the cold subsides, both interior and exterior become hot, accompanied by headache and thirst, with a strong desire to drink cold water. This occurs because Yin and Yang contend above and below, alternating between excess and deficiency. If Yang merges into Yin, Yin becomes excess and Yang becomes deficient. Deficiency of the Yangming channel leads to chills and teeth chattering; deficiency of the Taiyang channel leads to pain in the lower back, back, head, and neck; deficiency of the Shaoyang channel leads to physical laxity and palpitations; deficiency of all three Yang channels allows Yin Qi to prevail, causing bone cold and pain. If Yin merges into Yang, Yang becomes excess and Yin becomes deficient. Deficiency of the Taiyin channel leads to lack of appetite and frequent vomiting, which subsides after vomiting; deficiency of the Shaoyin channel leads to more heat than cold, severe vomiting, and a difficult-to-treat condition; deficiency of the Jueyin channel leads to abdominal pain and urinary difficulty resembling strangury. Deficiency of all three Yin channels allows Yang Qi to prevail, causing intense heat and depression. Excess Yin generates internal cold, while Yang deficiency generates external cold; since cold originates internally, both interior and exterior feel cold. Excess Yang generates external heat, while Yin deficiency generates internal heat; since heat originates externally, both interior and exterior feel hot. All these result from external contraction of Cold, Summer-heat, Wind, and Dampness; internal stagnation of Joy, Anger, Worry, and Fright; accumulation of phlegm-fluids; and improper diet, hunger/fullness, and work-rest balance.

The pathogenic qi resides together with Wei Qi (Defensive Qi), causing the disease to manifest. Wei Qi travels through the Yang aspects during the day and the Yin aspects at night. When it encounters Yang, it moves outward to the surface; when it encounters Yin, it moves inward to interact with organs. Thus, the disease manifests daily. If the pathogen interacts deeply with the five Zang organs and spreads horizontally to the Mu Yuan (Diaphragmatic Origin), its pathway is long, its depth is great, and its movement is slow. It cannot exit the surface simultaneously with Wei Qi, hence the disease manifests every other day. Because Wei Qi gathers at the Fengfu point once a day and night, moving down one vertebral segment each day, the daily onset time gradually delays. By the twenty-fifth day, it reaches the sacrum; by the twenty-sixth day, it enters the spinal column, and its qi moves upward, causing the onset time to advance progressively.

The malaria pathogen alternates between excess and deficiency. Wherever the pathogen resides, if in Yang, there is heat and agitation; if in Yin, there is cold and stillness. At the extreme, both Yin and Yang decline. When Wei Qi separates, the disease rests; when Wei Qi gathers, the disease recurs. Hence, variations exist in daily onset, alternate-day onset, and timing advances or delays. Furthermore, if the pathogen strikes the head and neck, the disease acts when Qi reaches the head and neck; if it strikes the back, it acts when Qi reaches the back; if it strikes the waist and spine, it acts when Qi reaches the waist and spine. Each acts according to its location, whenever Wei Qi combines with the pathogen. Additionally, Epidemic Malaria and Miasma Malaria are also caused by pathogenic qi disturbing Wei Qi. Except for Dan Nue (Pure Heat without Chills), Wen Nue (Heat precedes Chills), and Pin Nue (No Heat, only Aversion to Cold), all other malarias present with chills preceding heat.

Furthermore, the *Classic* states: Do not needle when the heat is blazing, do not needle when the pulse is chaotic and confused, do not needle when sweat is pouring profusely. These indicate adverse pathological states where treatment is currently inappropriate. Understanding this, one knows that when the disease is approaching, actively manifesting, or receding, treatment should be avoided to prevent damaging True Qi. This must not be overlooked. The specific causes are listed below.