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Beyond the Six Qi (Six Climatic Factors), there exists another type of pathogenic factor called Li Qi (Plague Pathogen), which is the foul and malignant air of heaven and earth. It enters through the mouth and nose, travels directly along the central pathway, and spreads throughout the San Jiao (Triple Burner).
It differs from Taiyang Bing (Taiyang Disease) involving the Six Channels, where sweating or purging methods can be applied. Mr. Jiayan emphasized that eliminating turbidity is the primary principle. The Upper Jiao is like mist; it should be dispersed upward to eliminate turbidity. The Middle Jiao is like a fermenting vat; it should be regulated and drained to eliminate turbidity. The Lower Jiao is like a ditch; it should be opened and drained to eliminate turbidity. These methods are combined with detoxification. Once Ying Wei (Nutritive and Defensive Qi) circulation is restored, pursue and extract the pathogen while it is in motion, preventing it from lurking and proliferating. This is the methodological essence of Yu (Yuming). Mr. Ye Tianshi stated that epidemic pathogens enter via the mouth and nose, affecting the Heart and Lung in the Upper Jiao first. Symptoms such as hoarseness, sore throat, oral ulcers, and dry tongue indicate the pathogen has initially entered the Lung. Gradual progression to coma and crimson tongue indicates the pathogen has moved from the Lung system to involve the Pericardium (Xin Bao Luo). Therefore, at the onset with sore throat and dry tongue, the greatest fear is obstruction of orifices leading to coma. The prescribed method involves clearing and resolving while assisting with aromatic substances to open orifices and eliminate turbidity, such as Rhinoceros Horn (Xi Jiao), Lonicerae Flos (Jin Yin Hua), Acori Tatarinowii Rhizoma (Shi Chang Pu), and Curcumae Radix (Yu Jin). Zhibao Dan (Treasure of Life Pill) is taken concurrently to use spiritual substances to internally connect with the heart orifices and search out subtle pathogens. He also stated that inhaled epidemic pathogens affect all three Jiaos, moving from the Wei (Defensive) level to the Ying (Nutritive) level. Over time, blood stasis gradually forms in the Blood level, and the pathogen mixes with the San Jiao, becoming more bound as heat increases. Ideally, heavy methods using salty and bitter flavors should be employed. However, fearing the rapid nature of these drugs might cause them to descend directly to the Lower Jiao, light and ascending agents for the Upper Jiao are still used, supplemented by Jin Zhi (Human Excrement Juice) and Lonicerae Flos Dew. This represents a subtle aspect of his methodology.
Shao’s Commentary: The pathogen enters via the mouth and nose, first affecting the Lung and Wei levels, then sequentially transmitting to the Ying level of the Heart, and even counter-transmitting to the Pericardium, spreading from the Upper Jiao to the Middle and Lower Jiaos. Treatment should focus on the Ying level of the Heart and Wei level of the Lung, following the principles of the San Jiao, and treating via the Hand meridians. If the pathogen enters from the Lung into the Stomach channels and organs of the Yangming, treatment can follow Taiyang disease protocols using Foot meridian herbs. All conditions such as Warm Heat, Summer-Heat, and Epidemics should be treated thus. This is what is meant by "treatment methods start differently but end similarly" compared to Cold Damage. The key to treating epidemics is to clarify the Upper, Middle, and Lower Jiaos and use aromatic formulas to eliminate turbidity, detoxify, and open obstructions.
Another Commentary: Generally, after the Wei level, one discusses the Qi level; after the Ying level, one discusses the Blood level. When the pathogen enters the Ying level of the Heart and Wei level of the Lung, it remains in the Upper Jiao. Upon entering the Blood level, the pathogen interferes with the Lower Jiao. Hence, it is said that the three Jiaos are mixed. If the pathogen moves directly to the Lower Jiao, it is unrelated to the pathogen binding in the Pericardium. Thus, light and ascending methods to clear the upper are still advocated, assisted by salty and bitter flavors, balancing both aspects. This distinguishes epidemic pathogens entering the Hand meridians from the previously listed symptoms.
Epidemic Pathogen Entering the Upper Jiao: Manifestations include oral ulcers, erysipelas-like rashes, hoarseness, and sore throat. The tongue coating is red with a white center, or white with interspersed red. This indicates the pathogen is in the Lung and Pericardium. Suitable herbs include Rhinoceros Horn (Xi Jiao), fresh Rehmanniae Radix (Xian Sheng Di), Scrophulariae Radix (Xuan Shen), Forsythiae Fructus (Lian Qiao), Acori Tatarinowii Rhizoma (Shi Chang Pu), Curcumae Radix (Chuan Yu Jin), Arctii Fructus (Niu Bang Zi), Belamcandae Rhizoma (She Gan), Lonicerae Flos (Jin Yin Hua), and Human Excrement Powder (Ren Zhong Huang).
Shao’s Commentary: Here, the pathogen enters the Ying level of the Heart from the Wei level of the Lung but has not yet transmitted to the Pericardium. If the Pericardium is affected, coma and delirious speech must occur, as seen in the next case. This is a simultaneous disease of Ying and Wei, requiring a formula that drains the Wei and reveals the Ying for a dual resolution.
Epidemic Pathogen Entering the Tan Zhong (Chest Center/Pericardium): Manifestations include bright red tongue coating, coma, delirious speech, erysipelas-like rashes, or concurrent sore throat. This indicates the epidemic pathogen has counter-transmitted to the Tan Zhong. Unlike external pathogens in Cold Damage, dispersing is unnecessary. Nor is it a stagnant interior excess condition requiring digestion-promoting methods. Treatment should clear the blood collaterals to prevent internal closure, strongly favoring detoxification, elimination of turbidity, opening of orifices, and relief of obstruction. Herbs include Rhinoceros Horn (Xi Jiao), Forsythiae Fructus (Lian Qiao), Scrophulariae Radix (Xuan Shen), Rehmanniae Radix (Sheng Di), Lonicerae Flos (Jin Yin Hua), Human Excrement Powder (Ren Zhong Huang), Curcumae Radix (Chuan Yu Jin), Acori Tatarinowii Rhizoma (Shi Chang Pu), Moschus (Xi Huang/Niu Huang), and Succinum (Hu Po). Zhibao Dan (Treasure of Life Pill) is used concurrently.
Shao’s Commentary: This is vastly different from exterior-interior pathogens in Cold Damage, and the treatment method is entirely distinct. This method of clearing blood collaterals, opening orifices, and eliminating turbidity is the essential principle for treating Warm Heat, Summer-Heat, and Epidemic pathogens entering the Pericardium, applicable not only to epidemics.
Epidemic Pathogen Spreading Throughout the Three Jiaos: Plague and turbid pathogens enter via the mouth and nose, distributing throughout the San Jiao. Over time, blood stasis gradually forms in the Blood level. The deeper the pathogen, the tighter the heat binds. Methods using bitter and salty flavors should be employed, yet treatment still prioritizes light and ascending actions for the Upper Jiao. Additions include Rhinoceros Horn Water, Lonicerae Flos Dew, Bai Jin Zhi (White Metal Juice), Citrullae Cortex (Xi Gua Cui Yi), Benincasae Pericarpium (Gua Lou Pi), and dark-colored Scrophulariae Radix (Hei Xuan Shen). (Referencing Ye’s cases above)
Shao’s Commentary: The pathogen enters from above, first affecting the Lung and Wei, then the Heart and Ying. This pathogen is in the Upper Jiao; upon entering the Blood level, it interferes with the Lower Jiao. Hence, it is said the pathogen pervades the three Jiaos. The deeper the pathogen penetrates, the more the heat binds and cannot vent outward. Salty and bitter substances are used to clear heat in the blood of the Lower Jiao, assisted by light and ascending agents to clear the upper, thereby treating the three Jiaos simultaneously. These salty and bitter blood-clearing agents, combined with other light and clear upper-heat-cleaning agents, constitute an excellent method for treating epidemics pervading the three Jiaos.