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Plague (Wenyi) is not Cold Damage (Shanghan); physicians of the world mistakenly treat it as Cold Damage. Cold Damage results from contracting the normal Qi (regular climatic energy) of Heaven and Earth, whereas plague results from contracting the severe/pestilential Qi (epidemic toxic pathogens) of Heaven and Earth.

The pathogenic factor enters via the mouth and nose; internally it does not lodge in the Zang-Fu organs, externally it does not lodge in the meridians, but resides within the Mo Yuan (Membrane Source, located near the spine). This location is not far from the exterior, close to the Stomach, representing the boundary between Exterior and Interior. This corresponds to what the *Needle Classic* (*Zhen Jing*) refers to as "horizontally connecting the membrane source." Generally, when pathogens are in the meridians, it is an Exterior condition; when in the Stomach, it is an Interior condition. Now, with pathogens in the Mo Yuan, they are precisely at the junction where meridians and the Stomach intersect.

At the onset of the disease, there is shivering aversion to cold, which may progress to cold extremities (Jue Ni). When Yang heat becomes extremely stagnant and then unblocks, the cold extremities resolve, and heat manifests throughout the interior and exterior. Initially, there is aversion to cold, followed by fever; this differs from Cold Damage, where fever occurs simultaneously with aversion to cold. At the beginning of plague, there is first intense aversion to cold, then fever, accompanied by headache and body aches. The pulse is surging (Hong) and rapid (Shuo), neither floating nor sunken, because the pathogen is in the Mo Yuan.

It should not be mistaken for a Cold Damage Exterior syndrome treated with sweating methods; since the pathogen is not in the meridians, sweating will only injure healthy Qi in vain. Nor should purgation be used; since the pathogen is not in the Interior, purgation is of no benefit. It is appropriate to use Da Yuan Yin (Reach the Origin Decoction) to disperse and penetrate. The prescription consists of: Areca Seed (Binglang) 2 qian, Magnolia Bark (Houpo) 1 qian, Tsaoko Fruit (Caoguo) 0.5 qian, Anemarrhena Rhizome (Zhimu) 1 qian, Peony Root (Shaoyao) and Scutellaria Root (Huangqin) each 1 qian, Licorice Root (Gancao) 0.5 qian. Take warm in the afternoon. The first three herbs—Areca Seed, Magnolia Bark, and Tsaoko Fruit—eliminate stagnation and break accumulation, working together to drive out pathogens quickly from the Mo Yuan. The latter four herbs nourish fluids, harmonize blood, clear dryness-heat, and harmonize the Middle Jiao. (Note: This decoction is suitable for the initial stage; if the disease progresses to intense heat, this formula may be ineffective. If Exterior symptoms exist, Shuang Jie San (Double Release Powder) by Liu Hejian is appropriate; if no Exterior symptoms exist, Er Sheng Jiu Ku Dan (Two Sages' Saving Bitter Pill) by Li Dongyuan is appropriate. Other formulas such as Liang Ge San, Bai Hu Tang, Huang Lian Jie Du Tang, and Pu Ji Xiao Du Yin are also indicated based on the syndrome and can be used酌情ly.)

If the pathogenic factors overflow into different meridians, modifications to the base formula are as follows: Hypochondriac pain, deafness, alternating chills and fever, vomiting with bitter taste indicate pathogen overflowing into the Shaoyang Meridian; add Bupleurum Root (Chaihu) 1 qian. Pain in the lower back, back, and neck indicates pathogen overflowing into the Taiyang Meridian; add Notopterygium Root (Qianghuo) 1 qian. Eye pain, pain in the supraorbital ridge, orbital pain, dry nose, and insomnia indicate pathogen overflowing into the Yangming Meridian; add Kudzu Root (Gegen) 1 qian. If none of the Three Yang meridian syndromes appear, do not add herbs; follow the original formula. (Above discusses the use of Da Yuan Yin at onset.)

After taking this medicine, if the pathogen does not transmit to the Interior, it resolves spontaneously after one or two doses. The manifestations include headache and body aches, fever recurring with shivering, but without internal chest fullness or abdominal distension, normal appetite, no irritability or thirst. This indicates the pathogen is transmitting outward, exiting via the muscle layer. It may resolve through spontaneous eruption of macules/papules or through sweating. Macules/papules vary in type: macular rash, peach-blossom spots, purple cloud spots. Sweat varies: spontaneous sweat, night sweat, manic sweat. These differences are due to the nature of the disease qi; there is no need to debate them. As long as macules erupt or sweat appears, the disease is considered cured. This outward transmission is a favorable progression (Shun Zheng); even without medication, it may heal spontaneously.

If sweat is incomplete and fever persists, Bai Hu Tang (White Tiger Decoction) is appropriate: Gypsum (Shigao) 1 liang, Anemarrhena Rhizome (Zhimu) and Licorice Root (Gancao) each 5 qian, Rice (Jingmi) 1 pinch. This formula disperses with acrid-cool properties, resolving via shivering sweat or spontaneous sweat. Previously, Da Yuan Yin had begun to dissolve the toxin cluster, and the pathogen had left the Mo Yuan but had not yet fully reached the Exterior. However, the Qi of the interior and exterior was already communicating, hence the profuse sweating and long, surging, rapid pulse. Therefore, Bai Hu Tang is suitable to dissipate with acrid-cool action.

If macules/papules fail to emerge fully and fever persists, Ju Ban Tang (Lift Macules Decoction) is appropriate: White Peony Root (Baishao) and Angelica Sinensis Root (Danggui) each 1 qian, Cimicifuga Rhizome (Shengma) 0.5 qian, Angelica Dahurica Root (Baizhi) and Bupleurum Root (Chaihu) each 0.7 qian, Pangolin Scales (Chuanshanjia) 2 qian (fried until yellow). Decoct with water and fresh ginger.

If both macules/papules and sweat occur concurrently but fever persists, combine Bai Hu Tang with Ju Ban Tang.

After macules/papules and sweat have resolved, if fever recurs after one or two days or four or five days, without chest fullness or abdominal distension, and with a surging, rapid pulse, this indicates latent pathogens remaining in the Mo Yuan that were not fully dispersed. Without medication, spontaneous sweat or macule eruption should lead to recovery within one or two days. If unresolved, continue with previous methods; however, this is rare. Recurrent fever is even rarer. (Above discusses pathogen transmitting to the Exterior.)

If after taking Da Yuan Yin there is no sweat or macules, no external headache or body ache, but only chest and diaphragm stuffiness/fullness, this indicates pathogen transmitting to the Interior. Cases where there is an urge to vomit but inability to do so, or partial vomiting leaving discomfort, indicate pathogen transmitting to the Upper Interior; Dou Chi San (Melon Peduncle Powder) for emesis is appropriate. Melon Peduncle (Tianguadi) 1 qian, Red Adzuki Bean (Chixiaodou) 2 qian (ground), Gardenia Seed (Zhiren) 2 qian. Decoct 2 zhong of water to 1 zhong, add adzuki beans, simmer to 0.8 zhong. Take 0.4 zhong initially; if no vomiting after one hour, take again until fully vomited. If not fully expelled and irritability/fullness remain, decoct and take again. If melon peduncle is unavailable, substitute with Fermented Soybean (Danshidou) 2 qian. In this disease, inability to eat, chest/diaphragm irritability without abdominal fullness, vomiting reduces pathogen; once pathogen is gone, disease heals. Cases with heart/abdominal fullness, no vomiting, dry constipation, heat-binding with diarrhea, heat-binding with loose stools, or large intestine glue-like obstruction indicate pathogen transmitting to the Middle/Lower Interior; Cheng Qi Tang (Order the Qi Decoction) is appropriate: Rhubarb (Dahuang) 5 qian, Magnolia Bark (Houpo) 1 qian, Immature Bitter Orange (Zhishi) 1 qian, Mirabilite (Mangxiao) 2 qian. If only Upper Jiao stuffiness exists without constipation, remove Mangxiao to form Xiao Cheng Qi Tang (Minor Order the Qi Decoction). Even without hard stool, if feces are sticky and foul-smelling, add Mangxiao. If no stuffiness but only constipation, remove Houpo and Zhishi, use Mangxiao 2.5 qian, add Gancao 1 qian to form Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction). Taking this guides out the pathogen; as pathogen decreases, disease subsides; when pathogen is exhausted, disease cures itself.

Cases with chest/diaphragm fullness, heart/abdominal distension, and Lower Jiao heat-binding with stickiness involve both Upper and Middle Jiao. Emesis is contraindicated as it is adverse treatment. Using Cheng Qi Tang allows Upper pathogen to flow downward, stopping vomiting immediately and gradually relieving distension.

If after emesis or purgation the patient recovers, but relapses after two to five days according to previous symptoms, use emetics for Upper involvement and purgatives for Lower involvement. This recurrence of Interior transmission is common. Triple recurrence is rare. (Above discusses pathogen transmitting to the Interior.)

If after taking Da Yuan Yin, or due to mismanagement, all Three Yang symptoms and Interior symptoms present, and the tongue root shows white coating initially, progressing to yellow spreading to the center, this is simultaneous Exterior-Interior transmission. Manifestations: Externally, fever, headache, body ache, back/neck pain, supraorbital pain, bitter taste, deafness, dry nose; Internally, chest/diaphragm/heart/abdominal fullness, Lower Jiao heat-binding. This is common in plague. Do not force sweating. Use Cheng Qi Tang to first open the Interior. Once Interior pathogen is removed and Qi flows freely,顺势 release all pathogen to the muscle layer. If Exterior and Interior symptoms resolve but fever persists (indicating residual Mo Yuan pathogen), San Xiao Yin (Three Eliminations Decoction) is appropriate: Areca Seed (Binglang), Tsaoko Fruit (Caoguo), Magnolia Bark (Houpo), White Peony Root (Baishao), Licorice Root (Gancao), Anemarrhena Rhizome (Zhimu), Scutellaria Root (Huangqin), Rhubarb (Dahuang), Kudzu Root (Gegen), Notopterygium Root (Qianghuo), Bupleurum Root (Chaihu), Ginger, Jujube. Decoct and take; regulation leads to cure. If relapse occurs after two to three days post-cure, repeat San Xiao Yin for purgation and sweating as before; this is common. Triple recurrence is rare. If Exterior pathogen predominates over Interior syndrome, treat Exterior while addressing Interior using San Xiao Yin with minimal Dahuang. If Interior syndrome predominates over Exterior, treat only Interior using emesis or purgation; Exterior symptoms will resolve spontaneously. (Above discusses simultaneous Exterior-Interior transmission.)

If initial illness presents only with fever, headache, body ache, bitter taste, dry nose, without Interior symptoms, use modified Da Yuan Yin. If no Three Meridian syndromes appear and only fever exists, do not add herbs. If subsequently the pulse becomes surging, large, and rapid, with spontaneous sweat and thirst, the pathogen has left the Mo Yuan but cannot reach the Exterior; use Bai Hu Tang to disperse with acrid-cool action. Recovery occurs when pulse calms and body cools. If fever recurs several days after recovery, use Da Yuan Yin again. If later chest/abdominal fullness, anorexia, irritability/thirst, and prickly tongue coating appear, these result from Exterior transmitting to Interior; add Dahuang to Da Yuan Yin for mild purgation. If prolonged without resolution, use emetics for Upper involvement and Cheng Qi Tang for Lower involvement. If initial fever gradually becomes Interior disease, and Cheng Qi Tang etc. are used to purge, Interior disease is cleared. If fever recurs within a few days, accompanied by headache and body ache, this is Interior transmitting to Exterior; if pulse is floating, use Bai Hu Tang. If after purgation fever decreases slightly, or fever is absent but headache/body ache persist, and after three to four days spirit is dull with floating pulse, use Bai Hu Tang to induce sweating. If Bai Hu Tang fails to induce sweat, it is due to depletion of essence/fluids; add Ginseng (Renshen), cover the patient, lie supine, and sweat will resolve. After severe purgation or profuse sweating, if all Exterior-Interior symptoms resolve, followed by generalized body pain, feeling as if beaten by a club, inability to turn, and cold painful bones throughout the body (due to deficiency of Qi and Blood), this is not an Exterior syndrome; it will heal spontaneously. (Above discusses sequential Exterior-Interior transmission.)