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To treat plague where the pathogen transmits from the Lung to the Heart, manifesting as spontaneous laughter without cause, mental confusion, and disordered speech.

Shigao (Gypsum Fibrosum, 1 liang, crushed into fine powder) Renshen (Ginseng Radix et Rhizoma, 2 qian) Xijiao (Rhinocerotis Cornu, 2 qian) Lingyangjiao (Saiga Tataricae Cornu, 2 qian) Zhusha (Cinnabaris, 3 fen, ground into fine powder) Niuhuang (Calculus Bovis, 1 fen, ground into fine powder)

Decoct the first four ingredients together to obtain one teacup of decoction, and use this liquid to administer the powders of Zhusha and Niuhuang.

This syndrome represents a critical condition that cannot be treated with ordinary medicines. Therefore, the prescription uses many precious and rare substances, borrowing their "treasured qi" to resolve the heat-toxin invading the Heart.

When the plague toxin has not yet entered the Heart, the use of Xijiao is strictly contraindicated. However, once the toxin has entered the Heart, Xijiao becomes an essential herb.

The plague toxin enters via respiration and can originally affect the Lung. The Heart and Lung reside together above the diaphragm, and the pulmonary veins in the left atrium and pulmonary arteries in the right atrium are connected to the pulmonary circulation, making transmission between them seemingly easy. This syndrome is uncommon because the Pericardium (Pericardium) protects the Heart, bearing the pathogen on behalf of the Heart. The pathogen transmits downward from the Pericardium to the Sanjiao (Triple Burner), representing a transmission between the Hand-Jueyin Pericardium and Hand-Shaoyang Sanjiao organs; thus, the Heart is difficult to directly invade. In my twenty-plus years of clinical practice, I encountered only one elderly woman with this syndrome, prescribed this formula, and she recovered.

To treat children's measles/rash with exterior and interior heat simultaneously. Or irritability with thirst for drinking, or sore throat with hoarseness, or wheezing and coughing.

Shigao (Gypsum Fibrosum, 1 liang, crushed into fine powder) Zhimu (Anemarrhenae Rhizoma, 6 qian) Lingyangjiao (Saiga Tataricae Cornu, 2 qian) Jinzhong Choulou (Paris polyphylla var. yunnanensis, 1.5 qian, sliced) Boheye (Menthae Haplocalycis Folium, 2 qian) Qing Lianqiao (Forsythiae Fructum, 2 qian) Chantui (Bombyx Batryticatus, 1.5 qian, cleaned of feet and soil) Jiangcan (Bombyx Batryticatus, 2 qian)

Decoct in water to obtain one and a half cups of clear decoction, taken warm in two doses. It is ideal if slight sweating occurs after administration. If slight sweating occurs after one dose, the remaining medicine may still be taken. If profuse sweating occurs after one dose, the remaining medicine should be stopped. These dosages are for children aged seven to eight years or older. For children under seven to eight years old, reduce the dosage according to age. Halving the dose or using one-third is acceptable.

For those with sore throat and hoarseness, increase Shigao by 5 qian, totaling 1.5 liang combined with previous amounts. If the rash fails to erupt smoothly, boil a large handful of fresh Weigen (Reed Rhizome, preferably from living water), removing the nodes, and use this water to decoct the herbs.

Rash syndromes mostly occur in children. It is presumed that children inherently possess this toxin within their zang-fu organs, which erupts upon contracting seasonal toxic vapors externally, resulting in simultaneous exterior and interior heat. If wind-heat disease is severe at onset, the Yangming Channel and Fu-organs are filled with heat-toxin. Thus, treatment begins with releasing the exterior, followed by clearing and resolving heat. For excess heat, Shigao is appropriate. Sore throat and hoarseness indicate heat-toxin rushing upward, warranting bold and increased use of Shigao. However, if there is loose stool/diarrhea, neither Shigao nor Zhimu should be used; remove these two and add Huashi (Talcum, 1 liang) and Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian). Loose stool here is not due to cold syndrome but rather excessive intake of water due to dryness-thirst, overwhelming the Spleen and Stomach's transformation capacity. Huashi promotes urination to drain dampness, while Gancao harmonizes the Spleen and Stomach, slowing the downward rush of fluids. For severe loose stool, use my formulated Ziyin Xuanjie Tang (Nourishing Yin and Venting Decoction), which stops diarrhea and helps vent the rash outward. However, loose stool is most contraindicated in this syndrome, as it risks the toxin sinking inward and preventing outward expulsion. If loose stool persists after taking the above formulas, cook roughly 1 liang of Shanyao (Dioscoreae Rhizoma) into a thick porridge, mix in two or three crushed cooked egg yolks, and consume. The loose stool will stop. After cessation, gradually use cooling and nourishing agents for recovery.

A friend from Fengtian, Mr. Zhu XX, had a five-year-old son. After Start of Summer in the Gengshen year, he presented with high fever, dense rash, surging and rapid pulse, and thick white tongue coating, indicating rash complicated by plague toxin. Intending to use cooling herbs to clear heat, I hesitated due to his history of epigastric pain and recent consumption of fresh fruits causing pain the day prior, avoiding heavy doses. I reluctantly prescribed Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix) 6 qian each, Boheye (Menthae Haplocalycis Folium) and Chantui (Bombyx Batryticatus) 1 qian each, and Lianqiao (Forsythiae Fructum) 2 qian. Evening administration led to worsening fever, sore throat, coarse breathing, nasal flaring, slight epistaxis, and irritability by the next afternoon. Compelled, I heavily prescribed Shigao (Gypsum Fibrosum) 3 liang, Xuanshen (Scrophulariae Radix) and Maidong (Ophiopogonis Radix, retaining the heart) 4 qian each, with minor additions of Boheye and Lianqiao. Decocted into two teacups, taken warm in three doses. By the next day, symptoms alleviated. Residual heat remained intense; although one bowel movement occurred, the stool was dry. Inquiry revealed continued internal heat and a forceful pulse. I continued Shigao (Gypsum Fibrosum) 1 liang within the cooling/resolving formula for two doses, finally reducing the high fever. Subsequent treatment with cooling, moistening, and clearing agents led to full recovery.

Note: Initially prescribing 6 qian each of Shigao and Xuanshen failed to reduce fever, proving Shigao's nature is mild/neutral, not severely cold. Conversely, boldly prescribing 3 liang of Shigao amidst critical signs immediately reversed the condition, demonstrating Shigao's superiority over gold pills for exterior excess heat syndromes. Due to pre-existing epigastric pain, initial doses were conservative. Hesitation would have prevented even these modest doses, leading to reliance on dispersing herbs to vent toxin, likely exacerbating danger and rendering later heavy cooling ineffective. Witnessing many pediatric plague-rash cases mismanaged by quacks, I elaborate on this case record.

Plague syndromes require heavy cooling herbs, but diarrhea must be guarded against. Diarrhea causes qi mechanism to sink inward, losing the power to expel toxin. Therefore, when using large doses of cold herbs, I divide them into three or four small, warm doses to keep medicinal strength in the Upper Jiao. By the time it reaches the Lower Jiao, the cold nature is transformed by internal heat, avoiding diarrhea. Always assist with exterior-dispersing herbs like Boheye, Lianqiao, Chantui, and Jiangcan. Once fire is cleared and toxin eliminated, no further complications arise post-rash. Herbs like Shengma (Cimicifugae Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix) are strictly avoided. Friend Liu XX, proficient in medicine, treated a child whose rash appeared then retreated. Other doctors failed to vent it; toxic vapors attacked inward, creating critical urgency. Liu XX prescribed Maxing Gan Shi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) from Shanghan Lun. One dose caused complete eruption and cure. Maxing Gan Shi Tang is indicated for post-sweat/post-purge cases with sweating, wheezing, and no significant fever. Liu XX's successful application demonstrates mastery of ancient formulas (Dosage adjustment based on temperature: High temp - Shigao 1 liang, Mahuang 1 qian; Low temp - Shigao 1 liang, Mahuang 2 qian).