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Treats epidemic febrile diseases with heat in both the exterior and interior, swelling and pain of the head and face, where the swelling may extend to the neck and chest. It also treats macules and rashes caused by Yang Toxin (Yang Du).

Lotus Leaf (one piece, preferably floating on the water surface, fresh is best) Raw Gypsum Fibrosum (Shi Gao, 50g, crushed into fine powder) Real Antelope Horn (Lingyang Jiao, 7.5g, decocted separately and mixed into the medicine liquid)
Anemarrhena Rhizome (Zhi Mu, 22.5g) Cicada Slough (Chan Tui, 10g, feet and soil removed) Stiff Silkworm (Jiang Can, 6.5g) Paris Polyphylla (Jin Xian Chong Lou, 6.5g, sliced) Powdered Licorice Root (Fen Gan Cao, 5.6g)

The Lotus Leaf inherits the qi of rising initial yang, acting as a carrier for the various herbs, capable of carrying clearing-fire and detoxifying medicines upward to the head and face. Its fragrance clears stagnation and further detoxifies while removing turbid pathogens, making it particularly suitable for epidemic toxin syndromes. Regarding the leaf, one should select those floating on the water because they grow close to the water surface and absorb the most light and clear qi from the water, thus being good at releasing the exterior. This is similar to Duckweed (Fu Ping) growing on the water surface, which is good at inducing sweating.

Paris Polyphylla, also known as Zao Xiu or Zi He Che Cao. It tastes sweet and bland. Its detoxifying efficacy can be compared to Licorice Root (Gan Cao). However, while Licorice Root is warm in nature, this herb is cool, making it superior to Licorice Root in resolving all kinds of heat toxins, hence the name Zao Xiu (Early Restraint), implying that if poisoned by various gu poisons, or stung by scorpions/snakes, or suffering from sores and ulcers, using it can stop them early. "Zao" and "Zao" were interchangeable in ancient times. An ancient proverb praises Zao Xiu: "Seven leaves, one flower; deep mountains are my home. If carbuncles and sores meet me, they are grasped like clay." This plant has seven leaves opposite each other on the stem waist, resembling a lotus flower. A stem grows from the center of the leaves to the top, blooming into one flower. The flower is flat and yellow, with yellow filaments hanging down, hence the name Jin Xian Chong Lou (Golden Thread Heavy Tower). "Chong Lou" means its leaves and flowers seem to form layers. Its name Zi He Che Cao comes from the fact that purple rivers are its birthplace, where it reproduces abundantly enough to fill a cart; the common name Cao He Che is erroneous. Its shape and skin color resemble dried ginger. If the skin is not yellow but slightly purple, the taste will be slightly spicy and not sweet, containing toxicity, and thus unusable. If high-quality ones are unavailable, this herb may be omitted from the formula.

Antelope Horn (Lingyang Jiao) and Rhinoceros Horn (Xijiao) are both cool in nature and detoxifying. However, Rhinoceros Horn inherits the essence of earth and water. Because it inherits the essence of earth, it enters the stomach to eliminate excess heat in the stomach fu-organ. Because it inherits the essence of water, it uses water to overcome fire and enters the heart to eliminate heat in the heart organ itself. When epidemic pathogens have not yet deeply penetrated, taking Rhinoceros Horn may cause heart qi to become deficient and cold, unable to defend against external pathogens, leading the epidemic pathogens to run rampant and invade the palace of the monarch (the heart). This is a critical relationship that physicians must know. Antelope Horn is good at clearing fire from the liver and gallbladder, and also clears heat from the stomach. The horn naturally contains a woody core, possessing a free-flowing nature. Within its coolness, it possesses strong power to release the exterior. Used together with the acrid-cool Raw Gypsum Fibrosum (Shi Gao), and the light-clearing and ascending Lotus Leaf (He Ye) and Forsythia Fruit (Lian Qiao), it greatly penetrates and releases the toxic fire and stagnant heat of epidemic macules and rashes, and the toxic fire and stagnant heat in swollen areas of the head and face are also thoroughly released and eliminated. I once treated a six-year-old child who, three or four days after rash eruption, suffered from extreme panting due to internal wind-fire. Administering only 15g of Antelope Horn stopped the panting almost instantly, and the rash healed thereafter. The toxic heat of rashes is best treated by releasing the exterior and clearing/resolving. Even when other drugs fail to release and clear, and the condition is critical, administering only Antelope Horn can reverse the situation, proving its ability to clear/resolve and release the exterior. Moreover, it avoids gu poison, as stated in the *Shennong Bencao Jing*. Epidemic macule eruptions all carry toxic miasma qi.

Stiff Silkworm (Jiang Can) is a silkworm that dies stiffly because it cannot shed its skin due to wind invasion during molting. Because it becomes stiff due to wind pathogen, it serves as a guide for exterior-releasing medicines and possesses exterior-releasing power itself. Therefore, for cases where pustules or rashes do not erupt, Stiff Silcoworm is best at bringing them out. Furthermore, Stiff Silkworm remains stiff without rotting. For any human swelling and pain, fearing it might turn into rotting tissue, Stiff Silkworm can treat it. This is the wonder of mutual induction of qi transformation.

Epidemic diseases differ from Cold-Warm diseases. Cold-Warm diseases result from contracting the regular qi of the seasons. Due to improper hygiene regarding seasonal temperature changes, one contracts the qi and falls ill. Those affected are occasionally one or two individuals, without contagion. Epidemic diseases result from contracting the aberrant qi of the year's movement. Due to disharmony in the year's movement, containing toxic vapors, contracting it causes illness immediately. As described in the *Neijing* Treatise on Acupuncture Methods: regardless of age, symptoms are similar. Those affected spread house to house, village to village, like messengers, hence named "Yi" (Epidemic), and they are contagious. The *Neijing* Treatise on Original Diseases mentions five types of Yi, later roughly divided into Cold Yi and Warm Yi. To treat Warm Yi, the world habitually uses Dong Yuan's Pu Ji Xiao Du Yin. To treat Cold Yi, the world habitually uses Chao Gu's Shi Sheng San Zi. However, Warm Yi is more common than Cold Yi. My proposed Qing Yu Tang is specifically designed to treat Warm Yi.

A woman, around forty years old, suffered from Da Tou Wen (Big Head Plague). Her head and face swelled and pained, eyes swollen shut, upper jiao烦热 (irritated heat), and palpitations. Her family mistakenly thought it was sore toxin and consulted a surgeon. The surgeon applied his own powder to the head and face, slightly relieving pain. When asked for a prescription for the irritability and palpitations, he said he specialized in surgery and did not treat internal heart conditions. At that time, I was invited by another family in the same village and agreed to see her. Her pulse was surging, slippery, and forceful, especially at the Guan position. I administered Qing Yu Tang, changing the Raw Gypsum Fibrosum (Shi Gao) to 100g. Decocted into two teacups of liquid, taken warm in two doses. She recovered after finishing the dose.

A man, over twenty years old, contracted Warm Yi. Within three or four days, his head and face completely swelled. The swollen skin contained yellow fluid, breaking open and ulcerating. Spots appeared intermittently on his body. Hearing people call this Da Tou Wen, and seeing the ulceration resembled Gua Rang Wen (Melon Rind Plague), which is hardest to treat, he was terrified and sought my diagnosis. His pulse was surging, slippery, and long. Tongue coating was white and slightly yellow. He reported feeling only irritated heat and craving cold foods. I told him this case is not difficult to treat. The swelling and ulceration of the head and face, and spots on the body, are merely manifestations of heat toxin entering the stomach and emerging externally following stomach qi. By boldly taking Raw Gypsum Fibrosum (Shi Gao), full recovery can be ensured. I administered Qing Yu Tang, changing Raw Gypsum Fibrosum (Shi Gao) to 150g and Anemarrhena Rhizome (Zhi Mu) to 30g. Decocted into a large bowl, taken warm in multiple doses. After one dose, half the illness was cured. The next day, Lotus Leaf (He Ye) and Cicada Slough (Chan Tui) were removed from the formula, and after one more dose, complete recovery occurred.

Note: Macule eruptions differ from rashes in that their raised sites are not elevated; touching them feels level with the skin. This syndrome is divided into Yang Toxin and Yin Toxin. Yang Toxin macule eruption is caused by Yangming toxic heat injuring blood.
Yin Toxin macule eruption is either due to Cold Yi toxin, or deficiency of middle qi after sweating, vomiting, or purging, or excessive use of cold medicines leading to Yin syndrome. Cold hides below, forcing rootless fire upward to burn the lungs alone, causing macules. The color is pale red, faintly visible on the muscle surface, differing from the purple-red color of Yang syndrome macules. All macule cases I have treated in my life were Yang syndromes. I have never seen Yin syndrome cases, indicating their rarity. However, precisely because Yin cases are rare, one must not fail to distinguish carefully between Yin and Yang. Below are collected several ancient cases of treating Yang/Yin Toxin macule eruptions for reference, so that one has firm views and avoids misdiagnosis clinically.

Lu Cangzhou said: A person had Taiyang disease for ten-plus days, body heat but quiet spirit, both hands' pulses completely hidden. Physicians considered it a deteriorated syndrome and gave no medicine. I examined him; all three positions' pulses were imperceptible upon lifting and pressing. Tongue coating was slippery. Both cheeks were red like fire. Speech was coherent. I told him: This youth will definitely develop severe red macules, covering the body like brocade patterns. Blood vessels have waves. Now blood is agitated by evil heat, shaking into macules, appearing externally on the skin. Breath qi has no form to rely on, just as canal water cannot form waves even with wind. Once macules disappear, pulses will emerge. Upon uncovering him, bright red macules were clearly visible. Given Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction), the macules dissolved and pulses returned to normal. Note: Macule eruption reaching a state of no pulse is indeed dangerous. Even if an expert diagnoses it as treatable, they would surely think toxic fire and stagnant heat are entrenched in meridians blocking the pulse pathway. But Cangzhou uniquely determined that macule eruption injures blood, and blood injury leads to invisible pulses. This is indeed Cangzhou's innovative theory, yet his words are credible and verified. I recall in the spring of the Ji Hai year, treating a young man with hematemesis. He vomited large amounts of blood continuously for days. Pulse was faint. After using medicine to stop bleeding, as fire subsided, the pulse became imperceptible. I boldly used tonic medicine to regulate him, and he recovered safely (detailed case under Han Jiang Tang). Excessive blood loss can lead to no pulse, confirming Cangzhou's theory of blood injury causing invisible pulses. This is Yang Toxin macule eruption.

Xu Shumi treated a person with internal cold and external heat causing macule eruption. Six pulses were deep and thin. Several spots of macules appeared on shoulders, back, chest, and ribs, disappearing and reappearing cyclically. Speech was manic, not delirious. Skin surface was hot, but upon touch, quickly became cold as ice. After several doses of Ginger and Aconite medicines, profuse sweating occurred and he recovered. This is Yin Toxin macule eruption.

Wu Renzhai treated a person with Taiyang disease for seven-eight days. Due to excessive cooling medicine intake, body temperature dropped, limbs became cold and inverted, whole body black macules appeared, only the heart area remained warm, indicating hidden fire. Pulses were deep and thin. Patient was comatose, unresponsive, unable to speak, resembling corpse rigidity. Administered Ren Shen San Bai Tang (Ginseng Three Whites Decoction) plus half a cooked Aconite Root (Shu Fu Zi) and 7.5g Dried Ginger (Gan Jiang), decocted in water. After about an hour, macule color gradually turned red, limbs warmed.
After regaining consciousness, residual heat remained unclear, a recurrence of hidden fire. Regulated with Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) and Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) until recovered. This is Yin Toxin macule eruption with hidden Yang.

Yu Tianmin said: There are internal injury syndromes that also produce macules/rashes, but only faint redness appears. This is extreme deficiency of stomach qi, with fire of the whole body wandering externally. One should tonify qi and blood. Then there is a master within, preventing qi from wandering outward; Ying has nourishment, preventing blood from scattering outward. This syndrome requires especially careful differentiation. Hong Jiren explained: According to this, the syndrome differs from Yang Toxin macule eruption and Yin Toxin macule eruption. The formula should use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Angelica Sinensis (Dang Gui) and Paeonia Lactiflora (Bai Shao).

Plague toxin diseases include what is called Yang Mao Wen (Wool Plague), also known as Yang Mao Zhen (Wool Rash). This syndrome is also an epidemic, accompanied by mental agitation. If small acne-like bumps (commonly called疙瘩) are seen on the front and back corresponding to the heart area, pricked with a needle tip, the top sinks and does not rise, revealing white hairs inside. These should be picked out with a needle. If afraid of incomplete removal, take dough bread peeled of skin, mix with hair, dip slightly in sesame oil, and rub over the whole body. Then examine the syndrome for deficiency/excess and cold/heat, administer epidemic treatment medicine, and recover. This syndrome is not recorded in ancient books, but many people suffer from it today. Those white hairs are actually body hair. Generally, sweat exposure to wind closes pores, preventing hair from exiting. Because it cannot exit, it turns white (rubbing with yellow wine and buckwheat flour is better).