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Similar to the lymph node swellings (scrofula) and tendon knots found at the root of various sores. The lymph node swellings at the root of sores arise from the sores themselves, appearing slow in progression and seemingly non-toxic. The disease known as "Ehe" (Malignant Nodule/Epidemic Nodule) arises suddenly, is toxic, and if untreated, the toxin enters the abdomen causing restlessness and potentially death.
This is all due to contracting warm winds in winter, and then encountering sudden cold in spring and summer; the qi of cold and heat struggles and knots together to form this toxin." Observing this discussion on "Ehe," it seems to correspond to the malignant nodules seen in plague. Observing its description of contracting warm winds in winter and then developing symptoms after feeling cold in spring and summer, it also resembles my theory of latent pathogenic qi transforming into heat and sinking into the Shaoyin channel, changing from cold-warm pathogens into plague. Generally, after latent pathogenic qi transforms into heat, there are often cases where it erupts following a slight external contraction. From this, we know that the syndrome of plague existed since the Tang Dynasty, merely lacking the name "plague."

My friend Ran Xuefeng from Hangan, in his book *Solution to Plague Problems*, states that when water fails to nourish fire, it becomes Yang dryness; when fire fails to evaporate water, it becomes Yin dryness. When fire is deficient and fails to interact with water, it is indeed Yin dryness; when water congeals and naturally does not interact with fire, it is also Yin dryness. The disease of plague is caused by Yin congealing into dryness, and extreme dryness transforming into toxicity. He further states: In other syndromes, a surging and rapid pulse indicates advancing heat, while a weak pulse indicates receding heat; in this syndrome (plague), a weak pulse indicates advancing heat, and a surging/rapid pulse indicates receding heat. All these points align perfectly with my discussion that Shaoyin syndromes can transform into plague, matching both the clinical presentation and pulse conditions. As for Mr. Ran's book, it is detailed, precise, thorough in theory, and comprehensive in treatment methods, truly serving as the golden rule for treating plague. The reason I did not adopt his formulas in my humble treatise is precisely because all formulas in his book should be followed strictly, not just selected individually. Those wishing to study the treatment of plague may refer to Mr. Ran's book alongside my treatise.

My friend Liu Weichu from Xiangshan, in treating severe cases of plague tubercles, once heavily utilized Musk (Moschus) at a dosage of 6 fen, administered over ten occasions, using decoctions of detoxifying, blood-invigorating, and fire-clearing herbs to wash down the Musk, resulting in recovery. Mr. Ran Xuefeng’s plague formulas also include using decoctions to administer Musk to unblock collaterals and penetrate toxins, which supplements what was missing in Wu Xihuang’s formulas.

My friend Zhu Bowen from Luanzhou told me: “I have a formula effective at resolving plague tubercles, using Rhizoma et Radix Rhei (Dahuang) 5 qian, Radix Glycyrrhizae (Gancao) 5 qian, Concha Ostreae (Sheng Muli) 6 qian (crushed), Semen Trichosanthis (Gualou Ren) 40 grains (crushed), and Fructus Forsythiae (Lianqiao) 3 qian. Decoct and take orally; the nodules will surely dissipate.” Note: The use of 5 qian of Dahuang in this formula seems close to being too harsh, but when used in equal proportion with Gancao, its harsh nature is transformed into mildness, thus achieving stable and beneficial results.

He Lianchen from Shaoxing, in compiling *Collection of Verified Cases from Famous Doctors Nationwide*, highly praises Luo Zhiyuan from Guangdong, stating he possesses abundant experience and meticulous analysis, dissecting disease conditions like an experienced judge, and listing treatments like a general discussing warfare. By using blood-invigorating and stasis-resolving formulas, he clearly delineated the main treatment boundaries for plague, demonstrating true insight. Therefore, I briefly recount his etiology, syndromes, formulas, and herbs for future scholars to emulate.

[Exploring Etiology] Cities inevitably have much filth, which stagnates to form miasma, and its toxicity manifests first. Countryside filth is less, stagnating to form miasma, with toxicity spreading secondarily. Thus, when heat and toxicity heavily steam, rats are infected first, and humans contract it subsequently. It enters through pores and respiratory tracts to reach the blood vessels, causing blood congestion and stagnation. Once blood flow ceases, it gradually turns red and swells, becoming slightly painful and hot, forming tubercles similar to scrofula. These are mostly seen between the neck, ribs, armpits, and thighs, but also appear on hands, feet, head, face, abdomen, and back. At this stage, although the body feels uncomfortable, it can still be supported, indicating the disease is superficial. As it moves from superficial to deep, swelling increases, and evil qi struggles with righteous qi, leading to fever. Fever manifests as headache and body bi-syndrome; severe heat manifests as profuse sweating and thirst, indicating the disease has become serious.

[Differentiating Syndromes] At the onset of plague, some present with initial aversion to cold, others without. After fever sets in, aversion to cold ceases. Some present with tubercles before fever, others with fever before tubercles, some with simultaneous fever and tubercles, some showing only tubercles without fever, others showing only fever without tubercles. Some sweat, others do not; some are thirsty, others are not. However, none lack headache, body pain, and limb soreness/bi-syndrome. Accompanying symptoms may include carbuncles, erysipelas, rashes, epistaxis, cough, hemoptysis, vomiting. Severe cases involve irritability, restlessness, delirium, mania, chest fullness, abdominal pain, constipation with liquid stool leakage, scorched tongue with prickles, nose black as coal, closed eyes and deafness, bone weakness and swollen feet, cracked tongue and lips, pulse syncope and body syncope. Such numerous malignant signs are hard to list exhaustively, all caused by heat and toxicity forcing blood to form stasis. However, there are degrees of severity: Small, white, non-febrile tubercles indicate a mild case. Small, red tubercles with slight headache, slight fever, and slight body soreness indicate a slightly severe case. Single red/swollen tubercle with high fever, extreme thirst, headache, body pain, and limb soreness indicates a severe case. Sudden appearance of the four symptoms (fever, thirst, pain, bi-syndrome), or initial aversion to cold rapidly turning into the four symptoms, absence of tubercles, black tongue with prickles, grasping at clothes, flailing limbs, pulse/body syncope, or sudden convulsions and unconsciousness during epidemic peak with red face and body but no tubercles, indicate the strongest toxin infection and fastest deterioration, representing critical danger.

[Discussing Treatment Methods and Formulas] Ancient formulas such as Puji Xiaodu Yin and Yinqiao Baidu San, and recent formulas like Yinqiao San and Daizhen Puji San, although capable of clearing heat and detoxifying, lack blood-invigorating and stasis-resolving herbs, making them largely ineffective. Only Wang Qingren’s Huoxie Jiedu Tang (Blood Invigorating and Detoxifying Decoction): Tao Ren (Semen Persicae) 8 qian (skin/spit removed, crushed), Hong Hua (Flos Carthami) 5 qian, Dang Gui (Radix Angelicae Sinensis) 1.5 liang, Chuan Houpo (Cortex Magnoliae Officinalis) 1 qian, Chaihu (Radix Bupleuri) 1 qian, Lianqiao (Fructus Forsythiae) 3 qian, Chi Shao (Radix Paeoniae Rubra) 3 qian, Sheng Di Huang (Radix Rehmanniae Preparata) 5 qian, Gegen (Radix Puerariae) 1 qian, Sheng Gancao (Radix Glycyrrhizae Preparata) 1 qian. In this formula, Tao Ren is the Sovereign herb, assisted by Dang Gui to remove stasis and unblock congestion; Lianqiao and Chi Shao are Minister herbs, combined with Sheng Di Huang to clear heat and detoxify; Houpo and Gancao are Assistant-Guide herbs to regulate qi and harmonize the formula; when qi moves, blood flows; Chaihu and Gegen release the muscle layer, reduce fever, and repel evil; when evil is eliminated, the disease heals. Because it matches the syndrome precisely, it is invariably effective. Generally, heat and toxicity are the root, and blood stasis is the branch, with branch excess being as heavy as root deficiency. If neither root nor branch is severe, the original formula suffices. If both are severe, if transmitted to the exterior, add Baihu Tang; if transmitted to the interior, add Chengqi Tang; if toxicity is extreme, add Lingyangjiao (Cornu Saigontarum) and Xijiao (Cornu Bubali). If taken continuously and sweat/heat clear, remove Chaihu and Gegen; if toxin/stasis reduces, reduce Tao Ren and Hong Hua; other adjustments follow the syndrome. Mild cases: one dose of original formula. Slightly severe cases: twice daily, add Jin Yin Hua (Flos Lonicerae) and Zhu Ye (Folium Bambusae) 2 qian each; if thirsty with slight sweat, add Shigao (Gypsum Fibrosum) 5 qian and Zhi Mu (Rhizoma Anemarrhenae) 3 qian. Severe, Critical, and Extremely Critical cases: At initial aversion to cold, take original formula, adding 1 qian each to Chaihu and Gegen; if high fever appears, initially add Jin Yin Hua and Zhu Ye 3 qian each, Zanghonghua (Flos Carthami Tinctorius - Tibetan Safflower) 1 qian (1.5 qian for critical cases), or add Zicao (Radix Arnebiae/Lithospermi) 3 qian and Sumu (Lignum Dalbergiae Odoriferae) 3 qian. For carbuncles, add Zihuadiding (Herba Violae) 3 qian and Yangju Ye Zhi (Juice of Chrysanthemum leaves) 1 cup mixed in. For difficult urination, add Cheqianzi (Semen Plantaginis) 3 qian. For excessive phlegm, add Chuan Beimu (Bulbus Fritillariae Cirrhosae) 3 qian and Sheng Laifu Zhi (Juice of Radish) 2 cups mixed in. If phlegm obstruction causes coma, previous medicines are insufficient; add fresh Shichangpu juice 1 ladle mixed in, fresh Zhuli (Nodus Bambusae in Taeniam) 2 ladles mixed in, or Mengshi Guntan Wan (Mengshi Phyllolithum Pill) 3 qian wrapped in decoction. For mania, combine two doses, intensify Baihu Tang, and add Zhuyexin (Nodus Folii Bambusae), Lingyangjiao, Xijiao, and Zanghonghua 3 qian each. For blood regurgitating upwards (epistaxis/hemoptysis), add Xijiao and Danpi (Cortex Moutan) 3 qian each, fresh Maogen (Radix Imperatae) and fresh Lugeng (Rhizoma Phragmitis) 4 liang each. For erysipelas, add Shigao 1 liang, Zhi Mu 5 qian, Xuanshen (Radix Scrophulariae) 2 qian, Xijiao 2 qian. For rashes, add Jin Yin Hua and Niubangzi (Fructus Arctii) 3 qian each, Zhuye, Daqingye (Folium Isatidis), and Danpi 2 qian each. For elderly, weak, young, or small patients, advance quickly using single doses, twice daily, add Shigao, halve Dahuang. Herbs added should be halved for children. Ages 5-6: one dose decocted together, divided into two servings. For critical cases, one dose per administration. For young children unable to take medicine, puncture tubercles 3-4 times, apply Jingyan Tuhe San (Experience Paste for Tubercles: Shancigu 3 qian, Zhen Qingdai 1 qian, Sheng Huangbai 1.5 liang, Zhebei 1.5 liang, Chixiaodou 2 qian, ground fine) with Ruyi Oil, applied frequently day and night for over ten times until cured. Women treated similarly. Pregnant women add Huangqin (Radix Scutellariae) and Sangjisheng (Ramulus Taxilli) 3 qian each to calm the fetus. Take urgently at onset; if heat is severe, advance urgently, as prolonged heat will cause miscarriage. If concerned about Tao Ren and Hong Hua causing miscarriage, substitute with Zicao and Zi Bei Tiankui 3 qian each. Exclude Mangxiao (Natrii Sulfas) only if purgation is indicated. All above methods derived from repeated trials. Cases are mostly in robust individuals; thus, for robust persons with strong toxicity and heat, especially in critical cases, Lingyangjiao, Xijiao, and Zanghonghua are added for faster effect. Unfortunately, people are often frugal; the wealthy hesitate, and the poor are even worse. To promote treatment, distinguishing between Heat-Dominant and Toxicity-Dominant paths, adding herbs according to syndrome is sufficient. If initially Heat-Dominant, add Shigao, Zhi Mu, Danshenye (Folium Bambusae), Luowiecai (or Leigonggen), Longdancao, Baimaogen, etc., to clear heat. If accompanied by Toxicity-Dominance, add Jin Yin Hua, Niubangzi, Renzhonghuang, etc., to detoxify. If heat-toxin enters the Pericardium, although Lingyangjiao, Xijiao, and Zanghonghua are crucial, adding Zhuyexin, Dengxincao (Medulla Junci), Huangqin, Zhizi, Maidongxin, Lianzixin, Xuanshenxin, etc., clears Pericardium heat-toxin. If heat-toxin enters the interior, add Dahuang, Pomiao (Natrii Sulfas), Zhike (Fructus Aurantii) to purge, clearing gastrointestinal heat-toxin.

My friend Li Jianyi from Pingtan authored *New Chapter on Plague* and gifted me a copy. Discussing plague etiology, he attributes it to a type of black ant transmitting to rats, then to humans. The medical cases and treatments recorded therein are excellent. For severe heat cases, he boldly uses heavy doses of raw Shigao, with one dose reaching 8 liang, or curing a case using over 2 jin, demonstrating courage and insight. I record one cured case as a standard for treating this disease.

Cai XX from Pingtan, aged 58, initially had aversion to cold, rapidly followed by fever, extreme thirst, numbness/pain in limbs, a nodule growing under the groin with intense heat/pain, chest distension, hematemesis, red eyes, coma/delirium, rapid pulse, yellow coating. Because he previously touched a dead rat, pores opened wide, allowing toxic vapors to enter blood vessels and lie latent in the body; compounded by external contraction of Spring Yang Qi acting as a guide, stomach heat caused vomiting/regurgitation, lung injury caused spitting blood, deep heat penetrated lung collaterals, affecting the nearby heart, disturbing the Heart Spirit, hence coma and delirium. This case is critically dangerous; urgent heavy doses clearing stomach, purging lung, attacking toxin, and resolving heat are needed to save him. Formula proposed: Modified Jiedu Huoxue Tang plus Shigao and Lugeng. Jingjie Sui (3 qian), Lianqiao (3 qian), Jin Yin Hua (5 qian), Zhe Beimu (3 qian), Sheng Di Huang (5 qian), Chi Shao Yao (3 qian), Tao Ren (5 qian), Chuan Hong Hua (3 qian), Zicao (3 qian), Sheng Shigao (2 liang, finely crushed), Fresh Lugeng (1 liang), Xionghuangjing (1 qian), Bingpian (5 fen).
Decoct the first eleven ingredients in two bowls of water, divide into two warm doses. Grind the last two ingredients into fine powder, divide into two doses, taken with the decoction.
After taking two doses, vomiting stopped, bleeding ceased, fever subsided, chest relaxed. Remove Xionghuang from original formula, add Jinwen Dahuang 5 qian to purge residual stomach toxin, take two doses, all ailments resolved.