（附∶大头天行病 虾蟆瘟）
论
《内经》曰∶苍天之气，清净则志意治，顺之则阳气固，虽有贼邪，弗能害也。又曰∶冬不藏精者，春必病瘟。是
以多感于房劳辛苦之人，安乐者未之有也。俗名瘟病，医书曰疫疠，曰黄病，岭南闽广等处曰瘴气，盖指山岚雾露烟瘴
湿热恶气而名之也，一皆触冒四时不正之气而为病焉。《伤寒论》曰∶春应温而反清，夏应热而反寒，秋应凉而反热，冬
应寒而反温。庞安常曰∶疫气之发，大则流行天下，次则一方，次则一乡，次则偏着一家，悉由气运郁发、有胜有伏、
迁正退位之所致也。视斯疾者，其可不推运气而治之乎。陶氏曰∶夫疫气之中人，轻重不一，仲景无治法，后人用败毒
散治，甚得理，然亦有愈不愈者，盖疫气有浅深，资禀有壮怯。怯而受疠气之深者，虽智者尚不能治，况庸劣之士乎。
若资禀壮实，所感又浅，则庶几可愈。切不可作伤寒正治而大汗大下也，但当从乎中治而用少阳、阳明二经药（少阳，
小柴胡汤；阳明，升麻葛根汤也），看所中阴阳经络脉证，而以二方加减和治之，殊为切当。学人宜详察之，毋忽。
脉法
脉阳濡弱，阴弦紧，更遇温气，变为瘟疫。
温病二、三日，体热腹满头痛，食饮如故，脉直而疾，八日死。
温病四、五日，头痛腹满而吐，脉来细而弦，十二日死。
温病八、九日，头身不疼，目不赤，色不变，而反利，脉来涩涩，按之不鼓手，时大，心下坚，十七日死。
温病汗不出，出不至足者死。厥逆汗自出，脉坚强急者生，虚软者死。
温病下利，腹中痛甚者死。
方法
丹溪曰∶众人病一般者，此天行时疫也，治有三法，宜补宜散宜降。用大黄、黄芩、黄连、人参、桔梗、苍术、防
风、滑石、香附、人中黄为末，神曲糊为丸，每服五、七十丸。气虚，以四君子汤下。血虚，以四物汤下。痰多，以二
陈汤下。热甚者，加童便（谓人中黄者，人粪也。今人多有以粪缸中清汁，顿饮一、二碗，病随愈。然但恐畏其臭秽，
不能下咽耳。故丹溪所取人中黄法，于冬月以竹截筒，削去青，两头留节，一头打通一窍，以大甘草纳入筒内，以竹钉
塞其窍，投粪缸中，二、三个月取出，晒干用）。
（以上丹溪方法凡一条）
陶尚文治瘟疫法∶
若病只在少阳经者，小柴胡加防风、羌活微发之而愈。若病兼阳明经者，柴、葛二方合服之（小柴胡对升麻葛根汤
也）。
若见太阳证，大便泄者，以本方（小柴胡也）去黄芩对五苓散，尤当看脉寒热，若无寒去桂留芩。
若小便不利，是膀胱本病，本方加去桂五苓散。
若入太阴经，无热证见者，用理中汤，此证必须腹痛而泻。明日泻止痛止，仍用小柴胡和之。
若入少阴经及厥阴经，用阴证伤寒传经法治之。
若初看未端的，且先以败毒散治之，看归在何经，再随经施治，无不效者。
若发黄，小柴胡合去桂五苓散。未退，茯苓渗湿汤。
瘟疫作渴，本方加石膏、知母。湿温渴，苍术白虎汤。
瘟疫发狂不识人，大柴胡汤加当归。如大便泄者，三黄石膏汤、柴苓汤。
瘟疫胸膈满闷，本方中加枳壳、橘红、黄连。若大便不通，大柴胡汤微利之。
三黄石膏汤
石膏（三钱） 黄芩 黄连 黄柏（各一钱五分） 豆豉（半合） 麻黄（一钱） 栀子（五枚）
上细切，作一服，水二盏，煎至一盏三分，连进三、五剂愈。
败毒散 治瘟疫。（四时通用。）
羌活 独活 前胡 柴胡 川芎 枳壳 桔梗 白茯苓 人参（各等分） 甘草（减半）
上为细末，每服三钱，加生姜三片，水一盏半，煎至一盏，温服，或沸汤点服亦可。此药治伤寒瘟疫，风湿风眩，
四肢痛，憎寒壮热，项强睛疼，不问老人、小儿皆可服。或岭南烟瘴之地，或瘟疫时行，或人多风痰，或处卑湿之地，
香港脚痿弱，此药不可缺也。日三、五服，以知为度。一方加薄荷少许，每服五钱，加姜，水煎服。
九味羌活汤（方见伤寒门。） 治瘟疫初感，一、二日间服之，取汗而愈，其效如神。
黑奴丸 治瘟毒发斑，烦躁大渴，及时行热病，六、七日未得汗，脉洪大而数，面赤目眩，身痛大热，狂言欲
走，
渴甚。又云∶五、六日以上不解，热在胸中，口噤不能言，为坏伤寒，医所不治，弃为死人，精魄已竭，心下尚温，斡
开其口灌药，下咽则活。
黄芩 釜底煤 芒硝 麻黄 梁上尘 小麦奴 灶突墨（各一两） 大黄（一两三钱）
上为细末，炼蜜为丸，如弹子大，新汲水化服，饮水尽足当发寒，寒已汗出，乃瘥。若时顷不汗，再服一丸，须见
微利。若不渴，不可与此药。
神术散（太无） 治四时瘟疫，头痛项强，憎寒壮热，身痛，专主山岚瘴气之妙剂也。
陈皮（二钱） 苍术 浓朴（各一钱） 甘草 藿香 石菖蒲（各一钱五分）
上细切，作一服，加姜三片，大枣一枚，水一盏半，煎至一盏，去渣温服。一方无菖蒲，有香附一钱，名神术散
气散。
附∶大头天行病
丹溪曰∶大头病，乃湿热在高巅之上，用羌活及酒炒黄芩、酒蒸大黄，随病加减，切不可用降药。
东垣曰∶阳明邪热太甚，实资少阳相火而为之也。湿热为肿，火盛为痛，此邪见于头，多在两耳前后先出，皆主其
病也。治法大不宜速药，速则过其病所，谓上热未除，中寒复生，必伤人命。宜用缓药缓服，徐徐少与，当视其肿势在
何部分，随经处治之。阳明为邪首大肿，少阳为邪出于耳项前后也。
二黄汤（东垣） 治大头天行疫病。
黄芩（酒制炒） 黄连（酒制炒） 生甘草（各等分）
上细切，每服三钱，水一盏，煎七分，温服，徐徐呷之。如未退，用鼠粘子不拘多少，水煎，入芒硝等分，亦时时
少与，毋令饮食在后。如未已，只服前药，取大便利、邪气已则止。
前方宜各少加引经药，阳明渴，加石膏，少阳渴，加栝蒌根，阳明行经，升麻、芍药、葛根、甘草，太阳行经，甘
草、荆芥、防风，并与上药相合用之。或云∶头痛酒芩，口渴干葛，身痛羌活、桂枝、防风、芍药，俱宜加之。
普济消毒饮子（东垣） 泰和二年四月，民多疫疠，初觉憎寒壮热体重，次传头面肿盛，目不能开，上喘咽喉
不
利，舌干口燥，俗云大头伤寒，诸药杂治，终莫能愈，渐至危笃。东垣曰∶身半以上，天之气也。邪热客于心肺之间，
上攻头面而为肿耳。须用下项药共为细末，半用汤调时时服之，半用蜜丸噙化，服尽良愈，活者甚众。时人皆曰天方，
谓天仙所制也。遂刻诸石，以传永久。
黄芩（五钱，酒制炒） 黄连（五钱，酒制炒） 人参（三钱） 陈皮（去白，二钱） 甘草（二钱） 连翘（一
钱） 玄参（二钱） 白僵蚕（七分，炒） 升麻（七分） 柴胡（五分） 桔梗（三分） 板蓝根（一钱） 马勃（一
钱） 鼠粘子（一钱）
上为末，服如上法。或加防风、川芎、薄荷、当归身，细切五钱，水二盏，煎至一盏，食后时稍热服之。如大便硬，
加酒蒸大黄一钱或二钱以利之。肿势甚者，以砭针刺之。
附∶虾蟆瘟
丹溪曰∶虾蟆瘟，属风热，防风通圣散加减用之。或用小柴胡加防风、羌活、荆芥、薄荷、桔梗煎服，外以侧柏叶
捣汁，谓火 蚯蚓粪敷之。或用丁香尖、附子尖、南星，醋调敷之。或五叶藤、车前草皆可捣敷之，有效。
甘桔汤 治冬瘟，咽喉肿痛。
甘草 桔梗（各等分。）
上细切，水煎，时时频呷之。
萎蕤散 治冬瘟，头面肿。
萎蕤（二钱五分） 石膏（一钱五分） 麻黄 白薇 羌活 杏仁 甘草
青木香 川芎（各五分） 干菊花（一钱五分）
上细切，作一服，水二盏，煎至一盏，去渣，日三服。
（祖传方）
人黄散 治四时疫疠，大头天行等病。
甘草（三钱） 辰砂 雄黄（各一钱五分） 粪缸岸（置风露中年远者佳，水飞细研，一两重）
上为细末，每服三钱，煎薄荷桔梗汤送下，日三、五服。煎药∶甘草、桔梗、茯苓、 本、白术各五分，水煎服。
疫疠，夏感寒，伏于少阴，咽痛，次必下利，名曰肾伤寒，宜用半夏、桔梗、甘草各一钱，加姜五片，煎服。大头天行
病，从 颔肿热者，又名颅HT 瘟，东垣有方用羌活、酒炒黄芩、酒蒸大黄加减，水煎服。十五、六日，服小柴胡汤不
愈者，仍用陈皮、紫苏发散而愈。又法∶洒炒黄芩、黄连为君，炙甘草为佐，水煎，细细呷之。再加鼠粘子、酒蒸大黄
煎，入芒硝，亦细细频与服之，微利为度。肿减后，去后三味，只服前药。如渴，属阳明，加石膏；属少阳，加栝蒌根。
若阳明行经，加升麻、芍药、葛根、甘草；太阳行经，加羌活、荆芥、防风。如头痛，加黄芩；渴，加葛根；身痛，加
羌活、防风、荆芥、桂枝、芍药，随宜用之，入上药相合煎服。或时疫肿毒疙瘩，或脏腑积热，发于头项，咽嗌堵塞，
水浆不下，或面赤，脉浮洪，热甚，漏芦汤治之。升麻、黄芩、大黄各一两，蓝叶（即大青叶）、玄参各二两，煎服。
（丹溪活套）云∶众人病一般者，乃天行时疫。盖冬月闭藏之时，反行春令，温胜于寒，而发泄真阴，土胜水亏矣。
所胜者妄行，土有余也。所生者受病，所胜者侮之，火土相合，湿热相聚。故春来木长之时，无水滋生化源，故人病瘟。
治有三法，见前。春感清气，无汗恶寒，为疫疠，通用升麻葛根汤。春感清气，发热而渴，不恶寒，宜解肌汤，葛根、
黄芩、芍药各一钱，麻黄一钱半，甘草、桂枝各七分半，大枣一枚，水煎服。春温，发热咳嗽，身疼口燥渴，脉浮洪热
甚，宜小柴胡汤加桂枝治之。咳嗽，加五味子。渴，去半夏，加栝蒌根、人参。脉实渴，宜大柴胡汤下之。渴，加知母、
石膏。凡温病，脉尺寸俱浮，素伤于风，因而伤热，风热相搏。其证四肢不收，身热自汗，头痛喘息，发渴昏睡，或体
重不仁。慎勿发汗，汗之则谵语烦躁，目昧无睛光。病在少阴厥、阴二经，宜萎蕤汤、人参败毒散、葛根龙胆汤、小柴
胡汤。甚者，栝蒌葛根汤。脉浮身肿汗出，汉防己汤。误汗者，防己黄 汤。四时伤寒疫疠，或伤风有汗，或风湿，身
肿体痛，恶风口干，日晡潮热，脉实，并用人参败毒散。夏应热而反寒，夏及秋初而为暴寒，折于盛暑，热结四肢，则
壮热头痛，或寒伤于胃，下利脓血或水泻，脉实者宜下之安。调中汤加∶大黄三钱，葛根、黄芩等药各二钱。
（医案）
东阳李文会内子陈氏，年二十九，三月间得瘟疫证，病三日经水适来，发热愈甚，至七、八日病剧，胸中气筑作痛，
莫能卧。众医技穷辞去，黑夜来迎予延医。病者以绵花袋盛托背而坐于床，令婢磨胸不息，手六脉俱微，数极而无伦次，
又若虾游状。予问曰∶恐下早成结胸耳？主人曰∶未曾下。予再思之，三日而经水适来，致中气虚，与下同。用黄龙汤、
四物汤、小陷胸汤共合一剂，加姜、枣煎服。主人曰∶此药何名？予曰∶三合汤也。一服而诸病悉减，遂能卧。再服，
热退而病全安。愈后，又因食粥太多而病复热，又作内伤处治，而用补中益气汤出入加减调理而愈。
[Appendix: Da Tou Tian Xing Bing (Big Head Plague) and Xia Ma Wen (Toad Plague]
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Qi of Heaven is pure and peaceful, human will and intention are regulated; complying with this climate, Yang Qi becomes solid. Even if there are pathogenic factors, they cannot harm the body. It also states: Those who fail to conserve essence in winter will inevitably suffer from epidemics in spring. Therefore, such diseases mostly affect those who have engaged in excessive sexual activity or hard labor, while those living in comfort rarely contract them. Commonly known as "Wen Bing" (Plague Disease), medical texts refer to it as "Yi Li" (Epidemic Pestilence) or "Huang Bing" (Yellow Disease). In regions like Lingnan, Fujian, and Guangdong, it is called "Zhang Qi" (Miasma). This term refers to the foul Qi arising from mountain mists, dew, smoke, dampness, heat, and other turbid environmental factors. All these illnesses result from exposure to the abnormal Qi of the four seasons. The *Shanghan Lun* (Treatise on Cold Damage) states: Spring should be warm but turns cold; summer should be hot but turns cold; autumn should be cool but turns hot; winter should be cold but turns warm. Pang Anchang said: The onset of epidemic Qi can spread across the world, a region, a village, or even just one family. This is caused by the stagnation and eruption of climatic cycles, including excess, deficiency, retention, and the shifting of ruling Qi. When treating such diseases, how can one neglect analyzing the climatic cycles? Tao Shi stated: Epidemic Qi affects people with varying severity. Zhang Zhongjing did not prescribe specific treatments for it. Later physicians used Bai Du San (Decoction to Overcome Toxicity), which aligns well with medical principles, yet some patients do not recover. This is because epidemic Qi has depths of penetration, and constitutional endowments vary in strength. For those with weak constitutions who have absorbed deep-seated epidemic Qi, even wise physicians may struggle to cure them, let alone mediocre ones. However, if the constitution is robust and the infection is superficial, recovery is likely. One must absolutely avoid treating it as ordinary Shang Han (Cold Damage) with drastic sweating or purging methods. Instead, treatment should follow the principle of "treating from the middle," using herbs from the Shaoyang and Yangming meridians (Shaoyang: Xiao Chai Hu Tang; Yangming: Sheng Ma Ge Gen Tang). Based on the affected Yin-Yang meridians and pulse/symptom patterns, these two formulas should be modified and harmonized, which is highly appropriate. Scholars should examine this carefully and not neglect it.
Pulse Diagnosis
If the Yang position pulse is Ru (Soggy) and Ruo (Weak), and the Yin position pulse is Xian (String-taut) and Jin (Tight), compounded by warm Qi, it transforms into an epidemic plague.
In Wen Bing (Warm Disease) lasting two to three days, with fever, abdominal fullness, headache, but normal appetite, and a straight, rapid pulse, death occurs after eight days.
In Wen Bing lasting four to five days, with headache, abdominal fullness, vomiting, and a fine, string-taut pulse, death occurs after twelve days.
In Wen Bing lasting eight to nine days, without head/body pain, red eyes, or color changes, but with diarrhea, a choppy pulse that feels weak upon pressure and fluctuates in size, along with hardness below the heart, death occurs after seventeen days.
In Wen Bing, if sweat does not appear, or if sweating does not reach the feet, death ensues. If limbs are cold with spontaneous sweating, a firm, strong, urgent pulse indicates survival, while a deficient, soft pulse indicates death.
In Wen Bing with diarrhea, severe abdominal pain indicates death.
Methods
Zhu Danxi said: When everyone suffers from similar symptoms, it is a seasonal epidemic. There are three treatment approaches: tonification, dispersion, and descending. Use Da Huang (Rhubarb Root), Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Ren Shen (Ginseng Root), Jie Geng (Platycodon Root), Cang Zhu (Atractylodes Rhizome), Fang Feng (Saposhnikovia Root), Hua Shi (Talcum), Xiang Fu (Cyperus Rhizome), and Ren Zhong Huang (Human Waste Product) powdered together. Form pills with Shen Qu (Medicated Leaven). Take 50-70 pills per dose. For Qi deficiency, administer with Si Jun Zi Tang (Four Gentlemen Decoction). For Blood deficiency, administer with Si Wu Tang (Four Substances Decoction). For excessive phlegm, administer with Er Chen Tang (Two Aged Ingredients Decoction). For severe heat, add Tong Bian (Child's Urine). [Note: Ren Zhong Huang is human feces. Many people now drink clear liquid from fecal pits directly, curing the disease instantly. However, people fear the foul odor. Thus, Danxi's method involves cutting bamboo tubes in winter, removing the green skin, leaving nodes at both ends, drilling a hole in one end, inserting large Gan Cao (Licorice Root), sealing the hole with a bamboo peg, and immersing it in a fecal pit for 2-3 months before drying.]
(Above: Danxi's method, one entry)
Tao Shangwen's method for treating plague:
If the disease is confined to the Shaoyang Meridian, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Fang Feng (Saposhnikovia Root) and Qiang Huo (Notopterygium Rhizome) to induce slight sweating for recovery. If the disease involves the Yangming Meridian, combine Xiao Chai Hu Tang and Sheng Ma Ge Gen Tang (Bunge Magnolia Bud and Kudzu Root Decoction).
If Taiyang syndrome is present with loose stools, remove Huang Qin from the base formula (Xiao Chai Hu Tang) and combine with Wu Ling San (Five-Ingredient Powder with Poria). Pay close attention to pulse indications of cold/heat; if no cold signs exist, remove Gui Zhi (Cinnamon Twig) and retain Huang Qin.
If urination is difficult, indicating a primary Bladder issue, add Wu Ling San (without Gui Zhi) to the base formula.
If the disease enters the Taiyin Meridian without heat signs, use Li Zhong Tang (Regulate the Middle Decoction). This condition must involve abdominal pain and diarrhea. If diarrhea and pain cease the next day, resume Xiao Chai Hu Tang to harmonize.
If the disease enters the Shaoyin or Jueyin meridians, treat according to the transmission rules of Yin-pattern Cold Damage.
If the initial diagnosis is unclear, first treat with Bai Du San (Decoction to Overcome Toxicity). Observe which meridian the pathogen settles in, then treat accordingly. This approach is invariably effective.
If jaundice appears, combine Xiao Chai Hu Tang with Wu Ling San (without Gui Zhi). If unresolved, use Fu Ling Shen Shi Tang (Poria Dampness-Draining Decoction).
For plague-induced thirst, add Shi Gao (Gypsum Fibrosum) and Zhi Mu (Anemarrhena Rhizome) to the base formula. For damp-warmth-induced thirst, use Cang Zhu Bai Hu Tang (Atractylodes White Tiger Decoction).
For plague-induced mania and confusion, use Da Chai Hu Tang (Major Bupleurum Decoction) plus Dang Gui (Angelica Sinensis Root). If accompanied by diarrhea, use San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction) or Chai Ling Tang (Bupleurum and Poria Decoction).
For plague-induced chest/epigastric fullness and oppression, add Zhi Ke (Aurantii Fructus), Ju Hong (Citretum Reticulatum Pericarpium Rubrum), and Huang Lian to the base formula. If constipation exists, use Da Chai Hu Tang to mildly purge.
San Huang Shi Gao Tang (Three Yellows and Gypsum Decoction)
Shi Gao (Gypsum Fibrosum, 3 qian), Huang Qin (Scutellaria Root, 1.5 qian), Huang Lian (Coptis Rhizome, 1.5 qian), Huang Bo (Phellodendron Bark, 1.5 qian), Dou Chi (Prepared Soybean, 0.5 he), Ma Huang (Ephedra Herb, 1 qian), Zhi Zi (Gardenia Fruit, 5 pieces).
Cut finely, decoct one dose in 2 cups of water until 1.3 cups remain. Administer continuously for 3-5 doses until cured.
Bai Du San (Decoction to Overcome Toxicity) - Treats plague. (Universal for all seasons.)
Qiang Huo (Notopterygium Rhizome), Du Huo (Angelica Pubescens Root), Qian Hu (Peucedani Radix), Chai Hu (Bupleuri Radix), Chuan Xiong (Ligusticum Rhizome), Zhi Ke (Aurantii Fructus), Jie Geng (Platycodon Root), Bai Fu Ling (Poria with Hostwood), Ren Shen (Ginseng Root) [all equal parts]; Gan Cao (Licorice Root) [half amount].
Powder finely. Take 3 qian per dose with 3 slices of fresh ginger and 1.5 cups of water, decoct to 1 cup. Take warm, or mix with boiling water. This medicine treats Shang Han, plague, wind-dampness, wind-dizziness, limb pain, aversion to cold with high fever, stiff neck, eye pain. Suitable for elderly and children alike. Essential in Lingnan miasma regions, during plague outbreaks, for those with wind-phlegm, in low/damp areas, or for foot weakness (Hong Kong Foot). Take 3-5 times daily until effective. Another variation adds mint; take 5 qian with ginger and water.
Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) [See Shang Han Section] - Treats early-stage plague. Take within 1-2 days to induce sweating and cure. Effect is miraculous.
Hei Nu Wan (Black Slave Pill) - Treats plague-toxic macules, irritability, extreme thirst, and seasonal febrile diseases where no sweat has occurred after 6-7 days, with surging, rapid pulse, red face, dizzy eyes, body pain, high fever, delirium, restlessness, and extreme thirst. Also for cases unresolved after 5-6 days, heat in the chest, locked jaw unable to speak, classified as "ruined Shang Han" deemed untreatable and abandoned. If the spirit is exhausted but the epigastrium remains warm, pry open the mouth and administer; survival is possible.
Huang Qin (Scutellaria Root, 1 liang), Fu Di Mei (Soot from Cauldron Bottom, 1 liang), Mang Xiao (Mirabilite, 1 liang), Ma Huang (Ephedra Herb, 1 liang), Liang Shang Chen (Dust from Roof Beam, 1 liang), Xiao Mai Nu (Sprouts of Wheat, 1 liang), Zao Tu Mo (Soot from Chimney Flue, 1 liang); Da Huang (Rhubarb Root, 1.3 liang).
Powder finely, form pills with honey the size of a bullet. Dissolve in fresh well water and ingest. After drinking enough water, chills should occur, followed by sweating, indicating recovery. If no sweat occurs shortly, administer another pill; mild diarrhea should ensue. Do not use if the patient is not thirsty.
Shen Shu San (Divine Artisan Powder) [Taiwu Formula] - Treats four-season plagues, headache, stiff neck, aversion to cold with high fever, body pain. Specifically excellent for mountain miasma.
Chen Pi (Aged Tangerine Peel, 2 qian), Cang Zhu (Atractylodes Rhizome, 1 qian), Hou Po (Magnolia Bark, 1 qian), Gan Cao (Licorice Root, 1.5 qian), Huo Xiang (Patchouli Herb, 1.5 qian), Shi Chang Pu (Acorus Rhizome, 1.5 qian).
Cut finely, decoct one dose with 3 slices of ginger and 1 jujube in 1.5 cups of water until 1 cup remains. Strain and take warm. Another variant replaces Shi Chang Pu with 1 qian Xiang Fu, named Shen Shu San Qi San.
Appendix: Da Tou Tian Xing Bing (Big Head Plague)
Zhu Danxi said: Big Head Disease is caused by damp-heat rising to the highest points. Use Qiang Huo, wine-fried Huang Qin, and wine-steamed Da Huang, modified according to the condition. Absolutely avoid descending medicines.
Li Dongyuan said: Excessive Yangming pathogenic heat relies on Shaoyang Minister Fire to manifest. Damp-heat causes swelling; fire excess causes pain. This pathogen manifests on the head, often appearing first around both ears. Treatment should avoid rapid/strong drugs; speed causes the remedy to overshoot the pathology, leading to residual upper heat and new middle cold, potentially fatal. Use slow-acting drugs administered slowly in small amounts. Observe the location of swelling to treat via the relevant meridian. Yangming involvement causes major head swelling; Shaoyinvolution causes swelling around ears and neck.
Er Huang Tang (Two Yellows Decoction) [Dongyuan Formula] - Treats Big Head Plague.
Huang Qin (Scutellaria Root, wine-fried), Huang Lian (Coptis Rhizome, wine-fried), Sheng Gan Cao (Raw Licorice Root) [equal parts].
Cut finely. Take 3 qian per dose in 1 cup of water, decoct to 0.7 cups. Take warm, sipping slowly. If unresolved, use Niu Bang Zi (Arctii Fructus) in any amount, decocted with equal parts Mang Xiao. Administer frequently in small amounts, avoiding food intake afterwards. If still unresolved, continue the previous formula until bowel movements become free and pathogenic Qi is expelled.
Add meridian-guiding herbs to the above formulas: For Yangming thirst, add Shi Gao; for Shaoyang thirst, add Gua Lou Gen (Trichosanthes Root). For Yangming meridian guidance, use Sheng Ma, Shao Yao, Ge Gen, Gan Cao; for Taiyang, use Gan Cao, Jing Jie, Fang Feng. Alternatively: Wine-fried Huang Qin for headache; Ge Gen for thirst; Qiang Huo, Gui Zhi, Fang Feng, Shao Yao for body pain.
Pu Ji Xiao Du Yin Zi (Universal Benefit Detoxifying Decoction) [Dongyuan Formula] - In the second year of Taihe, April, many suffered epidles. Initially feeling aversion to cold, high fever, and heaviness, progressing to severe head/face swelling, inability to open eyes, upper wheezing, throat obstruction, dry tongue/mouth. Commonly called "Big Head Shang Han." Various treatments failed, leading to critical conditions. Dongyuan stated: The upper half of the body corresponds to Heaven's Qi. Pathogenic heat lodging between Heart and Lung attacks the head/face causing swelling. Use the following ingredients powdered: Half taken as a tea decoction frequently; half formed into honey pills for sucking. Full recovery was achieved, saving many lives. People called it "Tian Fang" (Heavenly Prescription), believing it was made by immortals. It was carved on stone for posterity.
Huang Qin (5 qian, wine-fried), Huang Lian (5 qian, wine-fried), Ren Shen (3 qian), Chen Pi (2 qian, pith removed), Gan Cao (2 qian), Lian Qiao (1 qian), Xuan Shen (2 qian), Bai Jiang Can (0.7 qian, fried), Sheng Ma (0.7 qian), Chai Hu (0.5 qian), Jie Geng (0.3 qian), Ban Lan Gen (1 qian), Ma Bo (1 qian), Niu Bang Zi (1 qian).
Powder finely. Administer as described. Alternatively, add Fang Feng, Chuan Xiong, Bo He, Dang Gui Shen, cut 5 qian total, decoct in 2 cups water to 1 cup. Take warm after meals. If stool is hard, add 1-2 qian wine-steamed Da Huang. For severe swelling, use Bian Ci (stone needle) puncture.
Appendix: Xia Ma Wen (Toad Plague)
Zhu Danxi said: Toad Plague belongs to Wind-Heat. Use Fang Feng Tong Sheng San (Wind-Barrier Releasing Strength Decoction) modified. Or use Xiao Chai Hu Tang plus Fang Feng, Qiang Huo, Jing Jie, Bo He, Jie Geng decocted externally apply crushed Ce Bai Ye (Biota Tops) juice mixed with Earthworm excrement. Or apply Ding Xiang Jian (Clove Tip), Fu Zi Jian (Aconite Tip), Nan Xing (Arisaema Rhizome) mixed with vinegar. Or crush Wu Ye Teng (Uncaria Vine) or Che Qian Cao (Plantago Herb) for external application. Effective.
Gan Jie Tang (Licorice and Platycodon Decoction) - Treats Winter Plague, sore/swollen throat.
Gan Cao, Jie Geng [equal parts].
Cut finely, decoct in water, sip frequently.
Wei Yu San (Polygonatum Powder) - Treats Winter Plague, head/face swelling.
Wei Yu (Polygonatum Rhizome, 2.5 qian), Shi Gao (Gypsum Fibrosum, 1.5 qian), Ma Huang (Ephedra Herb), Bai Wei (Cynanchum Root), Qiang Huo (Notopterygium Rhizome), Xing Ren (Apricot Seed), Gan Cao (Licorice Root), Qing Mu Xiang (Costus Root), Chuan Xiong (Ligusticum Rhizome) [all 0.5 qian], Gan Ju Hua (Chrysanthemum Flower, 1.5 qian).
Cut finely, decoct one dose in 2 cups water to 1 cup. Strain. Take 3 times daily.
(Ancestral Formula)
Ren Huang San (Human Yellow Powder) - Treats four-season plagues, Big Head Plague, etc.
Gan Cao (3 qian), Chen Sha (Cinnabar), Xiong Huang (Realgar) [each 1.5 qian], Fen Gang An (Fecal Pit Bank Soil, aged in wind/dew for years, water-pulverized fine, 1 liang).
Powder finely. Take 3 qian per dose, washed down with Bo He Jie Geng Tang (Mint and Platycodon Decoction). Take 3-5 times daily. Decoction for washing: Gan Cao, Jie Geng, Fu Ling, Ben Cao, Bai Zhu [each 0.5 qian], decoct in water.
Plague contracted in summer due to cold lying hidden in Shaoyin causes sore throat, followed by diarrhea, named "Kidney Shang Han." Use Ban Xia, Jie Geng, Gan Cao [each 1 qian] plus 5 slices ginger, decoct. For Big Head Plague with submandibular swelling/hotness, also called "Skull HT Plague," Dongyuan's formula uses Qiang Huo, wine-fried Huang Qin, wine-steamed Da Huang modified, decocted. If unresolved after 15-16 days on Xiao Chai Hu Tang, use Chen Pi and Zi Su for dispersion. Another method: Wine-fried Huang Qin and Huang Lian as sovereign, roasted Gan Cao as minister, decoct and sip slowly. Add Niu Bang Zi and wine-steamed Da Huang decocted with Mang Xiao, sip frequently until mild diarrhea. After swelling reduces, stop the last three ingredients, continue previous formula. For thirst: Yangming pattern add Shi Gao; Shaoyang pattern add Gua Lou Gen. For Yangming meridian guidance, add Sheng Ma, Shao Yao, Ge Gen, Gan Cao; for Taiyang, add Qiang Huo, Jing Jie, Fang Feng. For headache, add Huang Qin; for thirst, add Ge Gen; for body pain, add Qiang Huo, Fang Feng, Jing Jie, Gui Zhi, Shao Yao. Combine with main formula. For epidemic toxic nodules or internal organ heat erupting on head/neck causing throat blockage preventing swallowing, red face, floating/surging pulse, severe heat, use Lu Lu Tang. Sheng Ma, Huang Qin, Da Huang [each 1 liang], Lan Ye (Da Qing Ye, 2 liang), Xuan Shen (2 liang), decoct.
(Danxi's Flexible Approach) states: When everyone suffers similarly, it is a seasonal epidemic. Winter is for storage, but if Spring-like warmth prevails over cold, True Yin is leaked, Earth overcomes Water. Excess Earth acts recklessly. Generated elements suffer; overcoming elements insult. Fire and Earth combine, creating damp-heat. When Spring Wood grows, lacking Water to nourish the source, humans get plague. Three treatment methods exist (see above). Spring清气 (Clear Qi) with no sweat/aversion to cold = Plague, use Sheng Ma Ge Gen Tang. Spring Clear Qi with fever/thirst/no aversion to cold = Use Jie Ji Tang (Ge Gen, Huang Qin, Shao Yao each 1 qian; Ma Huang 1.5 qian; Gan Cao, Gui Zhi each 0.75 qian; 1 Jujube; decoct). Spring Warmth with fever/cough/body pain/thirst/floating/surging pulse = Xiao Chai Hu Tang plus Gui Zhi. For cough, add Wu Wei Zi. For thirst, remove Ban Xia, add Gua Lou Gen, Ren Shen. For excess pulse/thirst, use Da Chai Hu Tang to purge. For thirst, add Zhi Mu, Shi Gao. Generally, Wen Bing with floating Chi/Cun pulses indicates prior Wind injury compounded by Heat, Wind-Heat combusting. Symptoms: limbs flaccid, fever/sweating, headache/wheezing, thirst/coma, heavy/unresponsive body. Do NOT induce sweating; sweating leads to delirium/irritability, dull eyes. Disease in Shaoyin/Jueyin meridians: use Wei Yu Tang, Ren Shen Bai Du San, Ge Gen Long Dan Tang, Xiao Chai Hu Tang. Severe cases: Gua Lou Ge Gen Tang. Floating pulse/body swelling/sweating: Han Fang Ji Tang. Mistaken sweating: Fang Ji Huang Qi Tang. Four-season Shang Han/Plague, Wind injury with sweat, Wind-Damp, swelling/pain, aversion to cold/dry mouth, afternoon tidal fever, excess pulse: Ren Shen Bai Du San. Summer should be hot but turns cold (early Autumn violent cold), heat binding limbs causing high fever/headache, or Stomach cold causing dysentery/water diarrhea, excess pulse: Purge with Tiao Zhong Tang plus Da Huang (3 qian), Ge Gen, Huang Qin [each 2 qian].
Medical Case
Li Wenhui of Dongyang's wife, Ms. Chen, aged 29, contracted plague in March. On the third day of illness, menstruation began, fever intensified. By days 7-8, condition worsened: chest Qi stabbing pain, unable to lie down. Physicians gave up and left. Summoned at night. Patient sat propped on cotton bags, maid constantly massaged chest. Six pulses were minute, extremely rapid and irregular, resembling shrimp swimming. I asked: "Did premature purging cause Jie Xiong (Chest Binding)?" Owner: "No purging done." I reasoned: Menstruation on day 3 depleted Middle Qi, allowing pathogen to descend. Combined Huang Long Tang, Si Wu Tang, Xiao Xian Xiong Tang into one dose, added ginger/jujube, decocted. Owner asked name. I said: "San He Tang" (Three-Harmonies Decoction). After one dose, symptoms reduced, able to lie down. Second dose: fever subsided, full recovery. Post-recovery, relapse due to overeating porridge. Treated as Internal Injury, regulated with Bu Zhong Yi Qi Tang modifications until cured.