初起头疼发热恶寒。舌苔白而薄者。邪在表也。败毒散散之。微汗而解。如未解。鼻
干口渴。耳聋胁痛。舌苔白中带黄。此阳明少阳见症。须解肌法。柴葛、连翘、防风、薄
荷、牛蒡、黄芩、木通之类。如再不解。须看有无 疹。或见心烦膈闷。足冷耳聋。身痛
如束。或咳或呕。寸关沉伏。或躁动。便是发 之候。须提透之。以 尽为度。脉伏心烦。谓之欲 。烦
止人静。肌肤中无隐隐之点。始为 尽。 已出而口干。脉洪滑者。宜化 解毒为主。当以 疹门参看。
邵评∶邪入于里。则发 疹。疹出于肺。 发于胃。将发 疹。尚未外透。欲出不出之际。故见症如
此。若 毒滞气。则脉沉伏。伏邪外出。则脉躁动。亦一定之脉理。已汗而热不解。气口脉弦滑。
饱闷恶心。必是胃中宿食为患。消导为主。如生楂肉、麦芽、枳实、连翘、青皮、莱菔子等凉疏之。若脉
弦滑。潮热。谵语。脐腹胀痛。舌苔渐渐黄浓燥刺者。乃燥矢在肠胃中也。大柴、承气。看微甚下之。更
衣舌润为愈。
邵评∶食停胃中。未化糟粕。尚在胃之上脘。宜消化其食滞。切忌早用攻下。食滞已化。而成燥屎。
故用攻下。与前半条停食未化者。治法不同。大宜着眼。如表已解。尚身热脉浮。小便不利者。是热结
膀胱也。五苓去术。合六一利之。
邵评∶身热脉浮。其脉仍在太阳经。表解而小便不利。邪入太阳之府。而热结膀胱也。宜宣化膀胱热结
而利水。如表已解。余热未净。其人如狂不甚。小腹坚痛。而小便自利者。乃血蓄膀胱也。桃仁承气加减。
邵评∶上条热与水结。此条血蓄膀胱。如狂。而小腹硬痛。血蓄下焦之征。辨热结
与蓄血。在小便之利与不利。热结膀胱。小便不利。血蓄膀胱。小便自利。用桃仁
承气破其蓄血。正治也。
若无表里症。但热而泻。或寒热而泻者。此湿邪在于气分也。小柴合五苓主之。渴者去桂留芩。
不渴去芩留桂。疫邪必兼湿者。以当湿热司令之时也。（以上诸条同伤寒施治）
邵评∶但热而泻。湿热在里。寒热而泻。里湿而表有微邪也。用小柴胡以和解其表里之寒热。以五
苓渗其里湿。渴为有热。故去桂留芩。不渴为无热。故去芩留桂。至疫病每发于四五六七月。正在夏天
湿热当权之令。故多挟湿。
疫疠热毒郁极。则发黄。二便俱秘。若投茵陈五苓。小水必不能利。须茵陈蒿汤。加黄柏。则小
便利而黄退矣。
邵评∶热郁发黄。二便俱秘。阳分实热发黄也。用茵陈五苓以利膀胱。无益也。当
用茵陈蒿汤。以泻阳明之实热。二便通利。黄自退矣。
亦有发黄兼发 者。无非热毒郁结所致。宜犀角、连翘、赤芍、栀子、茵陈、黄柏、牛蒡、
薄荷、银花之类主之。
瘟疫发于春夏之间。必热症为多。如初起即大热大渴。目赤唇焦。烦躁不宁。六脉
洪滑。舌苔燥黄焦刺。急用三黄石膏汤。去黄柏。加连翘汗之。取汗在于速。一服无
汗。即再进之。得汗热退为愈。若延至四五日。毒遍三焦。表里俱病。用三黄石膏汤。加连翘、银花。
表里兼解之。其妙在麻黄石膏二味。不可去一。此方通解三焦表里。治疫最妙。
邵评∶疫必兼湿。故致发黄。热毒郁结。则黄而发 矣。用清热渗湿。宣透 毒为治。若外受瘟疫。
表里俱病。火热大盛之时。身虽大热。而无汗泄。此表气外郁。内热不得发泄。故目赤唇焦而烦渴。
表里热盛。则六脉洪滑。火盛灼津。则舌苔燥黄焦刺。此皆热郁不宣之象。此方清内火而宣散表热。表
有汗出。则内之火热亦随汗而外泄矣。此表里热甚两清之法也。倘迁延不治。上中下三焦俱受毒
邪。表里三焦均病。必用此大剂以两解之。
如见目赤唇焦。舌黄燥刺。大热烦渴。汗出津津。此阳明血热火盛。切忌风药升散。宜凉膈散加石膏。
邵评∶见症里热极盛之候。与上条似同。上条无汗。是表郁内火。汗出津津。是邪
入阳明而热盛。故用凉膈散。加石膏以解阳明。
大都疫疠初起。宜辛凉解散。次则和解解毒。必里症全具。脉实口燥。心下坚满。方
可攻下。若胃中饮食未化。虽芩连、栝蒌。尚宜缓进。况硝黄乎。如用寒凉。食为寒凝结而不散。必变
结胸。（以上诸条照温热施治）
邵评∶初起邪在肺卫。故宜辛凉解散。若肺邪入阳明之府。则里症发现。脉实坚满。口燥。均是
里实之症。故可攻下。倘饮食停滞。未化糟粕。早用寒凉。寒药与食互结。防成结胸。况攻下乎。必待
其食化糟粕。结于肠中。方可用下耳。寒凉切忌早用。恐其凝结不化。
疫病当分天时寒暄燥湿。病者虚实劳逸。因事制宜。不可执泥。如久旱天时多燥。
热疫流行。宜清火解毒。忌用燥剂。天久霪雨。湿令大行。脾土受伤。民多寒疫。或兼泻痢。宜渗
湿和脾。忌用润剂。
邵评∶天时寒湿。病多寒疫寒湿。天时暄燥。病多温疫湿热。须分别治之。盖天时旱燥。阳亢热盛。
故多热疫。热则宜清火而忌温燥。天久阴雨。寒湿流行。脾土受伤。故多寒疫寒湿。宜温燥而忌清润。二
者治法大异。最当分辨。春当暖而反寒。夏应热而反凉。感此非时之寒为寒疫。宜太无神术散。加羌活、紫
苏、温散之。或藿香正气散加减亦可。从正伤寒治。此条寒疫。
邵评∶应暖热而反寒凉。是非时不正之气。人受其气而病者。为时行寒疫。治以
温散为主。忌用寒凉润药。
秋应凉而反热。冬宜寒而反温。感此非时之暖为温疫。宜犀角、连翘、黄芩、薄荷、银
花、牛蒡之类清解之。宜从温热症治。
邵评∶应寒凉而反温热。是非时之温气。人受之而为冬温秋燥之症。即为瘟疫。治
宜辛凉清解。大忌温燥。
疫症先从颐颔肿起者。阳明热邪也。肿于耳之前后者。少阳风热也。并宜辛凉散
之。二活、荆防、连翘、黄芩、薄荷、元参、牛蒡、桔梗、犀角水汗之。阳明加升麻。少阳加柴
胡、钩藤。解散后。加清火解毒之品。净银花、人中黄之类。
邵评∶风火热毒之邪。故宜辛凉清散。风邪解而火毒未清。故宜清化火毒。此从表里法施治。
时毒从颐肿者。名鸬 瘟。耳下项与咽中肿胀。声不出者。名虾蟆瘟。皆风热不正
之气干于上焦所致。治宜散邪清热。不可一味寒凉。
邵评∶颐与耳下项咽中。俱是上焦部位。邪从口鼻吸受。先入肺胃。宗三焦立法。从手经施治。
必先清解宣散。以泄其邪。如一味寒凉。则郁遏邪热。恐其传里内陷。不可不慎。
疫症有兼咽喉肿痛者。必辛散为主。不可骤用寒凉。反闭其邪。宜荆防败毒散。加桔梗、射干、
马勃、牛蒡之类。
邵评∶咽喉亦属上焦。邪入肺中。先宜辛散。早用寒凉。防其逼邪内陷。最当谨慎。冬应寒而反温。
感之多咽喉肿痛。寸关脉浮洪而数。舌燥唇干。宜甘桔汤。加牛蒡、薄荷、防风、射干、连翘、黄芩、银
花、犀角水之类凉解之。以升阴消阳。
邵评∶冬时不正之气。人受之而即发者。为冬温。温邪入肺。则咽喉肿痛。温邪在
上焦。则寸关脉洪数。阳邪伤阴。则唇舌干燥。法宜提透辛散。清解上焦邪热。
夏应热而反凉。感之。邪伏于少阴之经。每多咽痛。或兼泄泻。舌润不渴。寸口脉沉
而小。宜甘桔汤。加半夏、天虫、陈皮、桂枝、射干、防风、姜皮之类温散之。以助阳消阴。
邵评∶不正之气。乃夏令阴邪。人感其邪。伏于少阴肾中。阴火上升。则咽痛。寒湿
之邪内入。则泄泻。阴邪伤阳。则舌润不渴。邪郁其阳。则脉沉小。宜清肾中阴火而透邪。以辛温药散之。
大头天行 初起憎寒壮热体重。次传头面大肿。目不能开。或咽喉不利。俗名大头伤寒是也。
东垣谓阳明邪热太甚。挟少阳木火而生。阳明湿热甚为肿。少阳木火盛则痛。阳明之邪。首大肿。
少阳之邪。肿于耳之前后也。治法不宜药峻。峻则药过其病。所谓上热未除。中寒复起。其死尤速。
当少与。时时呷之。方用酒制芩连、人中黄以解毒。荆防、薄荷以去风。连翘、天虫、桔梗、牛蒡
以散结。头痛恶寒无汗。加二活以散寒。阳明引经。加升麻、犀角水。少阳引经。加柴胡、花粉、
普济消毒饮妙。十余日表症仍在者。亦用荆防、薄荷微散之。
邵评∶风温时毒。中于头部清空之所。故名大头瘟。病因风火湿痰。邪热由表而入于少阳阳明
二经。以阳明行身前而循首面。少阳行身侧。出于耳之前后。邪在最上。药宜轻清宣解上焦。若用重浊
之味。则入中下。而过病所矣。但天行时毒。必以解毒为先。风温之邪。故必去风。邪结则肿痛。
故当散结。寒郁于表。则无汗头痛而恶寒。当疏表散寒。此方治大头天行极妙。若日数虽多。尚有表
症。仍宜表散。
胃气虚者。于春夏初晴。感山谷蒸气。面肿发寒热者。先用平胃散。加羌活、荆防、桔
梗、藿香之类以散之。次加芩连清热。盖山岚、瘴气、浊雾。皆湿热也。岭南人中之即
死者。缘内多毒蛇所吐之气故耳。
邵评∶胃虚而邪入中焦。感瘴气湿热之邪。入于阳明。法宜运中祛瘴。以宣散中上二焦。
岁荒普患者。不宜峻剂。宜扶正祛邪。调理脾胃为主。
有已汗而热不解。身渍渍汗出。右关脉大无力。舌苔白嫩。四肢倦怠者。此中气素
弱。汗后虚热也。补中益气汤主之。汗止身凉而愈。升柴须蜜炙。（以上参治法汇）
邵评∶忍饥而脾胃中虚。邪乘虚入。宜调中散邪。亦中焦病也。若汗出而余热不
退。是虚热也。脉舌见症。俱是虚象。法宜扶正散邪。此正虚挟邪之治法。
疫邪传里。毒攻肠胃。脐腹大痛。下利鲜血。或黑臭水。小便不利。身热大渴。六脉洪数。舌苔
黄燥如刺。或红刺如杨梅状。当急治之。宜鲜生地二两。生大黄五钱。净银花五钱。黄连一钱。黄芩、
丹皮、赤芍各钱半。生甘草五分。清之下之。
邵评∶此火毒热邪。直入肠胃而伤血络之正法。
疫邪传里。目赤面红。六脉洪大。舌黄燥刺。此热毒传遍三焦。经络闭塞。荣卫不通。
以致汗不得出。 不得透。大热烦渴不解。宜三黄石膏汤。去黄柏。加连翘、银花、牛
蒡子。表里兼解之。俾汗 并透而解。妙在麻黄、石膏。
邵评∶疫邪自表入里。先在阳明气分。若上中下三焦表里俱有热邪。气血经络不通。表间抑遏。
与汗均不外达。热伏于里而燔灼。必用此方解表清里。宣通上中下三焦热邪。汗出 透而愈。
若遇天时亢旱。热疫流行。毒蕴三焦。目赤舌绛。 疹丹赤。汗出津津。阳明血热便
闭。宜凉膈散。去芒硝。加鲜生地、牛蒡子、人中黄清之。
邵评∶天旱热毒而成疫。三焦均受。邪热入营。而阳明热实也。宜清膈间邪热。此
条邪在中上二焦。热侵营分。而阳明热实。上条表里同治。此宗心营肺卫。分三焦治法。
疫邪发于岁荒之后。凡流离饥民。无不一病即死者。由于劳役饥寒。脾胃早伤。虽
感微邪。亦不禁也。故治此者。须调补脾胃为主。补中益气、六君子之类。微加表药治之。
邵评∶中虚受邪。正气不能胜邪。每多邪陷正脱。故必补正以托邪。正气充复。邪
自外达耳。
凡遇疫症。诊得右关脉虚大或软弱者。即中气虚也。当补以汗之。补中益气加羌
活、紫苏。如诊得寸软尺迟者。此营卫两虚之症也。当以归 建中汤加防风汗之。
邵评∶此条营卫虚而受邪。
凡治虚症。宜外邪轻可治。若外见重症。而脉虚细无神者死。
邵评∶正气大虚。不能胜邪。则死。
凡治虚症。详于景岳瘟疫门汗、补、温、清、吐、下六法中。须阅之。（以上诸条系新
法前三条实症后三条虚症）
邵评∶景岳论治虚症。最为详细。宜参考之。
At the onset, headache, fever, and aversion to cold occur. A white and thin tongue coating indicates that the pathogenic factor is at the exterior. Use Baidu San (Dissolve Toxin Powder) to disperse it; a slight sweating will resolve the condition. If unresolved, symptoms such as dry nose, thirst, deafness, and hypochondriac pain appear, with a tongue coating white turning yellow. These are signs of Yangming and Shaoyang involvement. The muscle-releasing method must be employed. Herbs such as Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Lianqiao (Forsythiae Fructus), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), Niubangzi (Arctii Fructus), Huangqin (Scutellariae Radix), and Mutong (Akebiae Caulis) may be used. If still unresolved, check for the emergence of macules or papules. Alternatively, observe irritability, chest oppression, cold feet, deafness, body pain as if bound, cough, or vomiting. The Cun and Guan pulses may be deep and hidden or restless. These are signs of impending eruption. The toxin must be raised and vented until fully expressed. Deep pulse and irritability indicate the desire to erupt. When irritability ceases and the person becomes quiet, and no faint red spots are seen on the skin, the eruption is considered complete. If the mouth is dry after eruption and the pulse is surging and slippery, resolving toxicity should be the primary treatment. Refer to the section on Macules and Papules.
Shao's Commentary: When pathogenic factors enter the interior, eruptions occur. Eruptions originate from the Lung, while pustules originate from the Stomach. Before eruption, when they have not yet emerged externally, in the stage of wanting to emerge but unable to do so, these symptoms appear. If toxin stagnates in the Qi mechanism, the pulse is deep and hidden; when latent pathogens exit, the pulse becomes restless. This is a fixed principle of pulse diagnosis. After sweating, if heat does not resolve, and the Qi Kou pulse is wiry and slippery, accompanied by fullness and nausea, it is caused by retained food in the Stomach. Treatment should focus on digestion and guidance. Cool and dispersing herbs such as raw Hawthorn Fruit, Malt, Immature Bitter Orange, Forsythia, Green Tangerine Peel, and Radish Seed may be used. If the pulse is wiry and slippery, with tidal fever, delirious speech, abdominal distension and pain, and a tongue coating gradually becoming thick, yellow, dry, and prickly, this indicates dry feces in the intestines and stomach. Da Chai Hu Tang (Major Bupleurum Decoction) or Cheng Qi Tang (Order the Qi Decoction) should be used to purge, depending on severity. Recovery is indicated by moistening of the tongue after defecation.
Shao's Commentary: Food stagnating in the Stomach has not yet transformed into waste and remains in the upper Jiao of the Stomach. It should be digested. Early use of purgatives is strictly contraindicated. Once food stagnation transforms into dry feces, purgatives are then used. This differs from the treatment of undigested food stagnation mentioned earlier. This distinction is crucial. If the exterior syndrome is resolved but fever and floating pulse persist, along with difficult urination, this indicates Heat binding in the Bladder. Wuling San (Five-Ingredient Poria Decoction) without Baizhu (Atractylodis Macrocephalae Rhizoma), combined with Liuyi San (Six-to-One Powder), should be used to promote urination.
Shao's Commentary: Fever and floating pulse indicate the pathogen is still in the Taiyang channel. With the exterior resolved but urination difficult, the pathogen has entered the Taiyang Fu organ, causing Heat binding in the Bladder. Promoting the transformation of Bladder Heat and diuresis is appropriate. If the exterior is resolved but residual heat remains, with mild mania, hardness and pain in the lower abdomen, and free urination, this indicates Blood stasis in the Bladder. Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) with modifications should be used.
Shao's Commentary: The previous case involved Heat binding with Water; this case involves Blood stasis in the Bladder. Mania and hard, painful lower abdomen are signs of Blood stasis in the Lower Jiao. Differentiating between Heat binding and Blood stasis depends on whether urination is difficult or free. In Heat binding of the Bladder, urination is difficult; in Blood stasis of the Bladder, urination is free. Using Tao Ren Cheng Qi Tang to break up the stasis is the correct treatment.
If there are no exterior or interior syndromes, but only fever with diarrhea, or alternating chills and fever with diarrhea, this indicates Dampness in the Qi level. Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Wuling San (Five-Ingredient Poria Decoction) is indicated. If thirsty, remove Guizhi (Cinnamon Twig) and keep Huangqin (Scutellariae Radix); if not thirsty, remove Huangqin and keep Guizhi. Epidemic pathogens must combine with Dampness because this occurs during the season when Damp-Heat commands. (The above cases are treated similarly to Shanghan.)
Shao's Commentary: Fever alone with diarrhea indicates Damp-Heat in the interior; alternating chills and fever with diarrhea indicates interior Dampness with slight exterior pathogen. Xiao Chai Hu Tang harmonizes the exterior and interior chills and fevers, while Wuling San drains interior Dampness. Thirst indicates Heat, hence removing Cinnamon Twig and keeping Scutellaria; lack of thirst indicates no Heat, hence removing Scutellaria and keeping Cinnamon Twig. Epidemics often occur in the fourth, fifth, sixth, and seventh months, during summer when Damp-Heat is dominant, hence they often involve Dampness.
When epidemic pestilence Heat-Toxin is extremely constrained, jaundice appears, and both bowel movements and urination are obstructed. If Yinchen Wuling San (Inula and Five-Ingredient Poria Decoction) is administered, urination will not improve. Instead, Yinchen Hao Tang (Artemisia Capillaris Decoction) with Huangbai (Phellodendri Cortex) should be used; then urination will flow freely and jaundice will recede.
Shao's Commentary: Jaundice due to constrained Heat, with obstructed bowels and urine, is excess Heat in the Yang aspect. Using Yinchen Wuling San to benefit the Bladder is ineffective. Yinchen Hao Tang should be used to drain excess Heat in Yangming. Once bowels and urine are unobstructed, jaundice will naturally recede.
Jaundice may also accompany the eruption of macules/papules, caused solely by constrained Heat-Toxin. Rhinoceros Horn (Rhinocerotis Cornu), Forsythia, Red Peony Root (Paeoniae Radix Rubra), Gardenia (Gardeniae Fructus), Inula Flower (Inulae Flos), Phellodendron Bark (Phellodendri Cortex), Arctium Fruit (Arctii Fructus), Mint (Menthae Haplocalycis Herba), and Honeysuckle (Lonicerae Japonicae Flos) are indicated.
Plague occurring in spring and summer is mostly Heat syndromes. If onset presents with high fever, severe thirst, red eyes, cracked lips, restlessness, surging and slippery pulses in all six positions, and a dry, yellow, scorched, and prickly tongue coating, urgently use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction). Remove Huangbai (Phellodendri Cortex), add Lianqiao (Forsythiae Fructus), and induce sweating. Speed is essential in inducing sweat. If no sweat occurs after one dose, administer another. Resolution is achieved when sweat appears and heat subsides. If delayed to the fourth or fifth day, toxin spreads through the Three Jiao, affecting both exterior and interior. Use Sanhuang Shigao Tang with added Forsythia and Honeysuckle to resolve both exterior and interior. The efficacy lies in Mahuang (Ephedrae Herba) and Shigao (Gypsi Fibrum), neither of which should be omitted. This formula resolves the exterior and interior of the Three Jiao and is excellent for treating plague.
Shao's Commentary: Plague must involve Dampness, leading to jaundice. Constrained Heat-Toxin causes jaundice and eruption. Treatment involves clearing Heat, draining Dampness, and venting toxin. If external plague affects both exterior and interior, with intense Fire-Heat, high fever without sweat indicates exterior Qi constraint preventing internal Heat release, causing red eyes, cracked lips, irritability, and thirst. Surging and slippery pulses indicate excess Heat in exterior and interior. Scorched tongue coating indicates Fluid consumption by Fire. These are signs of constrained Heat not vented. This formula clears internal Fire and disperses exterior Heat. Sweating allows internal Fire to escape externally. This is a method of simultaneously clearing extreme Heat in both exterior and interior. If neglected, toxins affect all Three Jiao, requiring large doses to resolve both.
If red eyes, cracked lips, dry yellow prickly tongue, high fever, irritability, thirst, and continuous sweating are seen, this indicates Yangming Blood Heat and Fire Excess. Wind-dispersing herbs must be avoided. Liang Ge San (Cool the Diaphragm Powder) with Gypsum is indicated.
Shao's Commentary: These signs indicate extreme interior Heat. Similar to the previous case, but the previous had no sweat (exterior constraint with internal fire), whereas here continuous sweating indicates Heat entering Yangming. Thus, Liang Ge San with Gypsum is used to resolve Yangming.
Generally, early epidemic pestilence should be treated with Acrid-Cool dispersion. Next, harmonize and detoxify. Purging is only appropriate when interior syndromes are fully present, with solid pulses, dry mouth, and hardness/fullness below the heart. If food in the Stomach is undigested, even Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Gualou (Trichosanthis Fructus) should be used cautiously, let alone Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma). Using Cold herbs when food is present causes congealing and condensation, potentially transforming into Jie Xiong (Chest Binding). (These cases are treated according to Warm Disease principles.)
Shao's Commentary: Initially, pathogen is in Lung and Wei levels, so Acrid-Cool dispersion is suitable. If Lung pathogen enters Yangming Fu, interior signs appear. Solid pulses, hardness, and dry mouth indicate excess interior, allowing purging. However, if food stagnation exists and has not transformed into waste, early use of Cold herbs causes them to bind with food, risking Jie Xiong. Purging is even more dangerous. Wait until food transforms into waste and binds in the intestines before purging. Cold herbs must not be used early to avoid congealing.
Epidemics must be differentiated by seasonal climate (cold/warm, dry/damp) and patient constitution (deficiency/excess, labor/rest). Treatment must be adapted accordingly. During prolonged droughts, Dryness prevails, and Heat epidemics spread. Clear Fire and detoxify; avoid drying agents. During prolonged rain, Dampness dominates, damaging Spleen Earth, leading to Cold epidemics or dysentery. Drain Dampness and harmonize Spleen; avoid moistening agents.
Shao's Commentary: Cold/Damp weather leads to Cold epidemics; Warm/Dry weather leads to Warm epidemics. Differentiate treatments. Drought implies Yang hyperactivity and Heat, favoring Heat epidemics; clear Heat, avoid warm-drying. Rain implies Cold-Damp, damaging Spleen, favoring Cold epidemics; warm-dry, avoid cool-moistening. Treatments differ greatly. If Spring is warm but turns cold, or Summer hot but turns cool, contracting this abnormal Cold is a Cold Epidemic. Taiwu Shenzhu San (Taiwu Divine Power Powder) with Qianghuo (Notopterygii Rhizoma et Radix) and Zisu (Perillae Folium) warms and disperses. Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) with modifications is also acceptable. Treat as standard Shanghan.
Shao's Commentary: Expected warmth turning cold is abnormal Qi. Contracting this causes Seasonal Cold Epidemic. Treatment focuses on warming dispersion; avoid cool-moistening.
If Autumn should be cool but turns hot, or Winter should be cold but turns warm, contracting this abnormal Warmth is a Warm Epidemic. Rhinoceros Horn, Forsythia, Scutellaria, Mint, Honeysuckle, and Arctium Fruit clear and resolve. Treat as Warm Disease.
Shao's Commentary: Expected coolness turning warm is abnormal Warm Qi. Contracting this causes Winter Warmth or Autumn Dryness syndromes, classified as plague. Treatment requires Acrid-Cool clearing; warm-drying is strictly forbidden.
If epidemic swelling starts at the jaw and chin, it is Yangming Heat pathogen. Swelling around the ears is Shaoyang Wind-Heat. Both require Acrid-Cool dispersion. Qianghuo (Notopterygii Rhizoma et Radix), Duohuo (Angelicae Pubescentis Radix), Jingjie (Schizonepetae Spica), Fangfeng, Forsythia, Scutellaria, Mint, Yuan Shen (Scrophulariae Radix), Arctium, Platycodon (Platycodi Radix), and Rhinoceros Horn water induce sweating. Add Shengma (Cimicifugae Rhizoma) for Yangming; add Chaihu (Bupleuri Radix) and Gouteng (Uncariae Ramulus cum Uncis) for Shaoyang. After dispersion, add Fire-clearing and detoxifying herbs like Silver Flower (Lonicerae Japonicae Flos) and Ren Zhong Huang (Human Coprolite).
Shao's Commentary: Wind-Fire-Toxin requires Acrid-Cool clearing and dispersion. After Wind resolves, remaining Fire-Toxin must be cleared. This follows exterior-interior treatment methods.
When toxic swelling starts at the jaw, it is called Lu Ci Wen (Ibis Plague). Swelling under the ear, neck, and throat with voice loss is called Xia Ma Wen (Toad Plague). Both are caused by abnormal Wind-Heat attacking the Upper Jiao. Treatment should disperse pathogen and clear Heat; do not use purely Cold herbs.
Shao's Commentary: Jaw, neck, and throat belong to the Upper Jiao. Pathogen enters via mouth/nose into Lung/Stomach. Following Sanjiao theory, treat via Hand channels. Must first clear, resolve, and disperse to vent pathogen. Purely Cold herbs constrain Heat, risking transmission inward. Caution is required.
If epidemic includes sore throat, Acrid dispersion is primary; do not abruptly use Cold herbs, which may trap pathogen. Jingfang Baidu San (Jing Jie and Fang Feng Dissolve Toxin Powder) with Platycodon, Belamcanda (Belamcandae Rhizoma), Poliothyrsis (Poliothyrsidis Folium), and Arctium is indicated.
Shao's Commentary: Throat belongs to Upper Jiao; pathogen enters Lung. Acrid dispersion is first. Early Cold herbs risk trapping pathogen inward. Caution is vital. Winter warmth causing sore throat, floating/surging/rapid pulses at Cun/Guan, dry tongue/lips, indicates Ganjie Tang (Licorice and Platycodon Decoction) with Arctium, Mint, Fangfeng, Belamcanda, Forsythia, Scutellaria, Honeysuckle, and Rhinoceros Horn water to cool and resolve. This raises Yin and dissipates Yang.
Shao's Commentary: Abnormal Winter Qi causing immediate sore throat is Winter Warmth. Warm pathogen in Lung causes sore throat. Upper Jiao involvement causes surging/rapid pulses. Yang pathogen damages Yin, causing dry tongue/lips. Method: raise and vent with Acrid dispersion, clear Upper Jiao Heat.
If Summer should be hot but turns cool, pathogen hides in Shaoyin channel, often causing sore throat or diarrhea, moist tongue without thirst, and deep/small Chi pulse. Ganjie Tang with Banxia (Pinelliae Rhizoma), Tianchong (Isatidis Folium), Chenpi (Citri Reticulatae Pericarpium), Guizhi (Cinnamon Twig), Belamcanda, Fangfeng, and Ginger Peel warms and disperses. This assists Yang and dissipates Yin.
Shao's Commentary: Abnormal Qi is Summer Yin pathogen. Contracting it hides pathogen in Shaoyin Kidney. Yin Fire rising causes sore throat. Cold-Damp entering internally causes diarrhea. Yin pathogen damages Yang, causing moist tongue/thirstlessness. Pathogen constrains Yang, causing deep/small pulse. Clear Kidney Yin Fire and vent pathogen with Acrid-Warm herbs.
Da Tou Tian Xing (Great Head Epidemic) begins with aversion to cold, high fever, and heaviness, progressing to massive head/face swelling, inability to open eyes, or throat obstruction. Commonly known as Great Head Shanghan. Dongyuan stated Yangming Heat excess combines with Shaoyang Wood-Fire. Yangming Damp-Heat causes swelling; Shaoyang Wood-Fire causes pain. Yangming pathogen causes major head swelling; Shaoyang pathogen causes swelling around ears. Treatment should not use harsh drugs; harshness exceeds the disease, causing middle Cold before upper Heat clears, leading to rapid death. Administer small amounts frequently. Formula: Wine-processed Huangqin/Huanglian and Ren Zhong Huang to detoxify; Jingjie/Fangfeng/Mint to dispel Wind; Forsythia, Tianchong, Platycodon, Arctium to disperse nodules. For headache, aversion to cold, no sweat, add Qianghuo/Duohuo to disperse Cold. Add Shengma/Rhinoceros Horn for Yangming guiding; Chaihu/Shihu (Dendrobii Caulis) for Shaoyang guiding. Puji Xiaodu Yin (Universal Benefit Detoxification Decoction) is excellent. If exterior signs persist after ten days, gently disperse with Jingjie/Mint.
Shao's Commentary: Wind-Warmth seasonal toxin strikes the clear spaces of the head, hence "Great Head Plague." Etiology is Wind-Fire-Damp-Phlegm; Heat enters Shaoyang/Yangming. Yangming runs front to head/face; Shaoyang runs sides to ears. Pathogen is highest; drugs should be light, clear, and vent Upper Jiao. Heavy drugs sink to Middle/Lower Jiao, missing the target. Seasonal toxin requires detoxification first. Wind-Warmth requires Wind-dispelling. Nodules cause pain/swelling, requiring dispersion. Exterior Cold constraint causes no sweat/headache/aversion to cold, requiring exterior dispersion. This formula is excellent. If exterior signs persist despite duration, exterior dispersion is still needed.
Those with deficient Stomach Qi, feeling mountain vapors on sunny spring/summer days, presenting with facial swelling, chills, and fever, should first use Pingwei San (Peaceful Stomach Powder) with Qianghuo, Jingjie, Fangfeng, Platycodon, and Huoxiang (Patchouli) to disperse. Then add Huangqin/Huanglian to clear Heat. Mountain mists and miasmas are Damp-Heat. People in Lingnan dying upon exposure do so because their interiors contain gases exhaled by venomous snakes.
Shao's Commentary: Stomach deficiency allows pathogen into Middle Jiao. Contracting miasma Damp-Heat enters Yangming. Method: regulate Middle, expel miasma, vent Middle/Upper Jiao.
During famines, widespread patients should not receive harsh formulas. Support Righteousness, expel pathogen, and regulate Spleen/Stomach primarily.
If fever persists after sweating, with profuse sweating, large but weak You Guan pulse, tender white tongue coating, and limb fatigue, this is chronic Middle Qi weakness causing post-sweat deficiency Heat. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is indicated. Recovery occurs when sweating stops and body cools. Shengma and Chaihu must be honey-fried. (Refer to Treatment Methods Compilation.)
Shao's Commentary: Starvation causes Spleen/Stomach deficiency; pathogen enters via deficiency. Regulate Middle and disperse pathogen; this is a Middle Jiao disease. Persistent heat after sweating is deficiency Heat. Pulse, tongue, and signs indicate deficiency. Method: support Righteousness and disperse pathogen; this treats Righteousness deficiency with pathogen retention.
When epidemic pathogen transmits to interior, toxin attacks intestines/stomach, causing severe umbilical/abdominal pain, bloody diarrhea or foul black water, difficult urination, fever, severe thirst, surging/rapid pulses in all positions, and yellow/dry/prickly tongue coating or red prickles like bayberry. Urgent treatment is required. Fresh Rehmannia Root (Rehmanniae Radix) 2 liang, Raw Rhubarb (Rhei Radix et Rhizoma) 5 qian, Silver Flower 5 qian, Coptis (Coptidis Rhizoma) 1 qian, Scutellaria, Moutan Cortex (Moutani Cortex), and Red Peony Root each 1.5 qian, Raw Licorice (Glycyrrhizae Radix et Rhizoma) 0.5 qian. Clear and purge.
Shao's Commentary: This is the correct method for Fire-Toxin Heat pathogen directly entering intestines/stomach and damaging blood collaterals.
When epidemic pathogen transmits to interior, with red eyes, red face, surging/large pulses, and yellow/dry/prickly tongue, Heat-Toxin has spread through Three Jiao, meridians are blocked, Ying/Wei circulation is obstructed, preventing sweat and eruption. High fever, irritability, and thirst persist. Use Sanhuang Shigao Tang, remove Huangbai, add Forsythia, Honeysuckle, and Arctium Seed. Resolve exterior and interior simultaneously. Allow sweat and eruption to express together. The efficacy lies in Ephedra and Gypsum.
Shao's Commentary: Epidemic pathogen enters interior from exterior, initially in Yangming Qi level. If Heat exists in exterior/interior of all Three Jiao, Qi/Blood/meridians are blocked, preventing exterior release. Heat concealed in interior burns fiercely. This formula resolves exterior, clears interior, and vents Heat in all Three Jiao. Recovery occurs with sweat and eruption.
If drought causes Heat epidemic, toxin constrains Three Jiao, red eyes, crimson tongue, red macules/papules, continuous sweating, Yangming Blood Heat with constipation, use Liang Ge San, remove Mangxiao, add Fresh Rehmannia, Arctium Seed, and Human Coprolite to clear.
Shao's Commentary: Drought Heat-Toxin forms plague, affecting all Three Jiao. Pathogen Heat enters Ying level, with Yangming Heat excess. Clear Heat in Diaphragm. This case involves Middle/Upper Jiao, Heat invading Ying, with Yangming excess. Previous case treated exterior/interior together; this follows Heart-Ying/Lung-Wei theory, treating Sanjiao separately.
Epidemics following years of famine, where displaced starving people die immediately upon illness, result from labor/famine/cold damaging Spleen/Stomach early. Even slight pathogen cannot be tolerated. Treatment must primarily tonify/regulate Spleen/Stomach using Buzhong Yiqi Tang or Liujunzi Tang (Six-Gentlemen Decoction), with slight addition of exterior-dispersing herbs.
Shao's Commentary: Middle deficiency with pathogen invasion means Righteousness cannot overcome pathogen, often leading to pathogen sinking and Righteousness collapse. Tonify Righteousness to support expulsion. Once Righteousness is restored, pathogen exits externally.
In any epidemic, if You Guan pulse is deficient/large or soft/weak, it indicates Middle Qi deficiency. Tonify and then disperse: Buzhong Yiqi Tang with Qianghuo and Zisu. If Cun is soft and Chi is slow, this is Ying/Wei dual deficiency. Gui Pi Jian Zhong Tang (Guipi and Build the Middle Decoction) with Fangfeng induces sweating.
Shao's Commentary: This case involves Ying/Wei deficiency with pathogen invasion.
In treating deficiency syndromes, mild exterior pathogen is treatable. If severe exterior signs appear with deficient/thin/Spiritless pulse, death ensues.
Shao's Commentary: Severe Righteousness deficiency cannot overcome pathogen, leading to death.
For treating deficiency syndromes, refer to Jingyue’s Plague section on Six Methods: Sweat, Tonify, Warm, Clear, Vomit, Purge. Review this. (The above cases include three new methods: first three excess syndromes, last three deficiency syndromes.)
Shao's Commentary: Jingyue’s discussion on deficiency syndromes is most detailed; reference it.