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In cases of plague (Wenyi), if the pulse is surging (Hong), large (Da), slippery (Hua), and rapid (Shu), but with a moderate/slack (Huan) quality intermixed within the rapidity, it is treatable. If the pulse is tight (Jin) and rapid to a severe degree, it is difficult to treat.

Shao's Commentary: Plague belongs to Yang syndromes (Yang zheng). Surging, large, slippery, and rapid pulses are Yang pulses. The presence of a slack quality indicates that the Stomach Qi (Wei Qi) is preserved; therefore, it is treatable. A tight pulse indicates the absence of Stomach Qi; therefore, it is difficult to treat.

If the body has high fever, yet the pulse is deep (Chen), choppy (Se), fine (Xi), and small (Xiao), accompanied by cold feet, the condition is critical.

Shao's Commentary: High fever is a manifestation of Yang pathogenic factors. Deep, choppy, fine, and small pulses are Yin pulses. When a Yang disease presents with Yin pulses, the prognosis is critical. Cold feet indicate that the pathogen is excessive while Yang Qi is declining.

When plague progresses to the fourth or fifth day, presenting with fever, abdominal fullness, and vomiting, and the pulse is fine and wiry-strong (Xian Qiang), death is expected on the twelfth day.

Shao's Commentary: By the fourth or fifth day of plague, the pathogen has entered the interior. Abdominal fullness and vomiting indicate pathology in the Spleen and Stomach. Fever combined with a fine pulse represents a Yang syndrome presenting with Yin pulses. A wiry and strong pulse indicates excess pathogen and lack of Stomach Qi; hence, it leads to death.

When plague occurs on the second or third day, presenting with headache and abdominal fullness, and the pulse is straight and rapid (Zhi Ji), death is expected on the eighth day.

Shao's Commentary: Onset on the second or third day shows both exterior and interior symptoms. A pulse that is straight and rapid indicates that the pathogen is excessive while the healthy Qi is deficient; hence, it leads to death.

When plague reaches the eighth or ninth day, with no pain in the head or body, unchanged complexion, but unceasing diarrhea, hardness below the heart (epigastrium), and a large pulse, death is expected on the seventeenth day.

Shao's Commentary: By the eighth or ninth day, the pathogen has left the exterior and entered the interior. Unceasing diarrhea and hardness below the heart indicate the accumulation of deficiency pathogens. The pulse being unexpectedly large in a chronic illness indicates disease progression. With deficient healthy Qi and excessive pathogen, prolongation inevitably leads to death.

Another Commentary: This type of plague involves pestilential qi (Li Qi) from heaven’s movement entering through the mouth and nose. Wind-heat steams and fumes with damp-turbidity, and its qi circulates throughout the Triple Burner (San Jiao). In the Upper Burner, it manifests as Big Head Plague (Datou Wen) and Twisted Neck Plague (Nianjing Wen); in the Middle Burner, it manifests as Melon Rind Plague (Guanrang Wen), Yangmei Plague, and Lump Plague (Geda Wen); in the Lower Burner, it manifests as Intestine-Twisting Plague (Jiaochang Wen) and Soft Leg Plague (Ruanjiao Wen), among other conditions. Treatment should follow He Jian’s theory of the Triple Burner, distinguishing between Heart Ying (Nutritive Level) and Lung Wei (Defensive Level), using acrid-cool herbs from the Hand meridians to clear heat and detoxify. This is the correct treatment. One must not apply the exterior-interior boundaries of Cold Damage (Shanghan) nor use acrid-warm dispersing formulas from the Foot meridians. The listed formulas may be studied by learners according to their own understanding.