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In the second year of Taihe (1202 AD), in the fourth month, many people in the population suffered from an epidemic disease. Initially, they felt aversion to cold, high fever, and heaviness of the body. Subsequently, severe swelling developed on the head and face, eyes could not open, upward panting occurred, the throat was obstructed, the tongue was dry, and the mouth was parched. This was commonly known as "Big Head Cold Syndrome" (Datu Shanghan). Most infected individuals could not be saved. County Magistrate Zhang contracted this illness. Physicians treated him with Chengqi Tang (Cathartic Decoction) plus Isatidis Radix (Banlangen) to purge the bowels. His condition eased slightly. The next day, the symptoms remained unchanged. After purging again, the symptoms eased somewhat, but ultimately he did not recover. His condition gradually became critical. Li Dongyuan was invited to examine him. Li said: "The upper half of the body is governed by the Qi of Heaven. Pathogenic heat lodges between the Heart and Lung, attacking upwards to the head and face, causing swelling. Using Chengqi Tang to purge the Stomach is punishing what is not at fault. One must not fail to treat according to the location of the disease." Therefore, Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma), each 5 qian, were used for their bitter-cold nature to clear fire from the Heart and Lung; Xuanshen (Scrophulariae Radix) 2 qian; Lianqiao (Forsythiae Fructus), Banlangen (Isatidis Radix), Mabo (Polyporus), and Niuzibei (Arctii Fructus), each 1 qian, with a bitter-pungent neutral nature to clear fire, dissipate swelling, and detoxify; Jiangcan (Bombyx Batryticatus) 7 fen to clear phlegm and benefit the diaphragm; Gancao (Glycyrrhizae Radix et Rhizoma) 2 qian to moderate the action; Jiegeng (Platycodonis Radix) 3 fen to carry the herbs upward, ensuring the medications float rather than sink; Shengma ( Cimicifugae Rhizoma) 7 fen to ascend Qi on the right; Chaihu (Bupleuri Radix) 5 fen to ascend Qi on the left. By ascending the Clear Yang to the highest peaks, turbid pathogens cannot occupy their positions. The Classic says: "Where pathogenic factors gather, the Zheng Qi (Upright Qi) must be deficient." Thus, Renshen (Ginseng Radix et Rhizoma) 2 qian was used to tonify deficiency, assisted by Chenpi (Citri Reticulatae Pericarpium) 2 qian to promote the flow of stagnant Qi. This formula was named Puji Xiaodu Yinzi (Universal Benefit Detoxification Decoction). If constipation was present, Dahuang (Rhei Radix et Rhizoma) was added. All ingredients were ground into fine powder. Half was mixed with water and taken frequently; half was made into honey pills to be held in the mouth until dissolved. The formula was distributed widely, saving many lives.

Luo Qianfu treated Yao Gongmao, Right Vice Director of the Secretariat, who was sixty-seven years old. He had a history of latent seasonal toxic pathogens. In the spring of the Wuchen year of Zhiyuan, the condition recurred due to alcohol consumption. His head and face were swollen, especially around the ears. He experienced chest oppression and difficulty in the throat. The lower half of his body was cold, particularly the calves. Consequently, he slept with his upper body on a bed connected to a heated kang (brick bed), while his lower body lay on the kang. His appetite decreased, he was mentally fatigued, and physically weak. Luo diagnosed a floating and rapid pulse, which felt wiry and thin upon deep pressure, indicating clear Upper Heat and Lower Cold. The Inner Canon states: "Excess heat causes swelling." It also says: "Spring Qi diseases manifest in the head." The Classic of Difficult Issues states: "Accumulation leads to swelling and heat, which can be treated with bloodletting using bi stones." Luo performed approximately fifty needle pricks on the swollen areas, releasing dark purple blood resembling dewdrops. The swelling and pain subsided almost immediately. He then moxa-burned the Qihai (CV-6) acupoint with large cones for one hundred burns to assist the deficiency of Yang Qi in the Lower Jiao and dispel Yin cold. Next, he moxa-burned the Zusanli (ST-36) acupoints, thirty-seven burns each, to treat cold feet and guide the heat downwards. Finally, he prescribed a formula named Jiji Jiedu Tang (Ji Ji Detoxification Decoction). Huangqin and Huanglian, bitter and cold, were processed with wine and stir-fried, serving as the Sovereign drugs to clear Upper Heat. Jiegeng and Gancao, pungent, sweet, and warm, ascend, assisting the bitter drugs to treat heat, serving as Minister drugs. Chaihu and Shengma, bitter and neutral, have light flavors and represent Yang within Yin, dispersing Upper Heat as Assistant drugs. Lianqiao, bitter, pungent, and neutral, dissipates nodules and reduces swelling. Danggui (Angelicae Sinensis Radix), pungent and warm, harmonizes Blood and relieves pain. Wine-wrapped Dahuang, bitter and cold, guides the bitter nature upward to the vertex and drives heat downward, serving as Envoy drugs. After administration, swelling subsided, pain decreased, and bowel movements became smooth. Upon re-administration, Dahuang was reduced. He recovered completely within ten days.

[Appendix] My late friend, Brother Ding Hanqi, was fond of drinking. In early December, after getting drunk, he walked about two li at night. The next day, he coughed, had a slight fever, and his eyes swelled. He self-medicated with Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Xiong (Ligustici Chuanxiong Rhizoma), and Huangqin. His cheeks swelled. After another dose, the swelling spread to his throat, shoulders, and chest. His cough was frequent but ineffective, breathing slightly rapid, with rattling sounds in the throat. The swelling resembled a gourd, hot and painful to touch. His eyes were red as blood, yet he had diarrhea and cold feet. The six pulses were fine and rapid, with the right hand pulse being particularly fine and soft, disappearing even with slight pressure. Some suggested using Puji Xiaodu Yinzi. I suspected his pulse indicated deficiency and feared that Huangqin, Huanglian, and Shengma were unsuitable. I advised inviting Mr. Shen Yaofeng to diagnose him. Shen said: "This is Deficient Yang attacking upwards. Do not treat it as Big Head Epidemic." The patient said: "My wife returned to her natal home; I have abstained from sex for two months. How can I be deficient?" Shen said: "There is a black mark above the lip, looking dry and scorched. The tongue is white as if dusted with powder, and the tip is not red. These are definitive signs of Deficiency Cold. Moreover, diarrhea and cold feet, along with a soggy and minute right pulse, are definitely not signs of Wind-Fire. If there were Wind-Fire, there would be chest fullness, irritability, heat, dry thirst, and restlessness. How could the exterior be so swollen while the interior remains comfortable like a healthy person?" He prescribed Tusizi (Cuscutae Semen), Gouqi (Lycii Fructus), Niuxi (Achyranthis Bidentatae Radix), Fuling (Poria), Yizhiren (Alpinia Oxyphylla Fructus), and Longgu (Fossilia Ossis Mastodi). After one dose, the swelling stabilized; after two doses, it gradually subsided, the right pulse rose slightly, and the black mark faded. However, the tongue remained thick and white, trembling upon extension, and the hands trembled slightly. He then prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) with Chenxiang (Aquilariae Lignum Resinatum). The major swelling subsided, eye redness decreased, cough slowed, phlegm thinned, and most of the white coating disappeared. On the next day's visit, the right pulse was no longer minute upon palpation, though still empty upon deep pressure. Liver Qi moved occasionally, malar flush persisted, and there was slight thirst. He prescribed Renshen, Fuling, Gouqi, Shaoyao (Paeoniae Radix Alba), Juhong (Citri Reticulatae Pericarpium Rubrum), Longgu, and Shayuji (Astrotocarpus Fructus) to tonify Yuan Qi, benefit the Kidney, and astringe Liver Qi, leading to complete recovery.

Yu Zhen commented: This case resembles Zhang Jingyue's treatment of Zhu Pengque's Sore Throat. The medication is steadier and more ingenious, beyond the reach of most. Had Guizhi (Cinnamomi Ramulus) or Fuzi (Aconiti Lateralis Radix Praeparata) been used, or Dihuang (Rehmanniae Radix) mixed in, it would not have matched the pathology accurately.

Sun Dongsu treated Xiao Lian Zhang, who suffered from an epidemic. His head was as large as a bucket, his neck was invisible, lips hung down to the breasts, complexion was like pig liver, and he was comatose and unaware of his surroundings. People were terrified and fled. Sun diagnosed a floating, wiry, and rapid pulse throughout. Initially, he prescribed Chaihu 1 liang, Huangqin and Xuanshen each 3 qian, Bohe (Menthae Haplocalycis Herba), Lianqiao, and Gegen (Puerariae Lobatae Radix) each 2 qian, and Gancao 1 qian. After three doses, chills and fever subsided, the wiry pulse diminished, but the pulse remained洪大 (surging and large), indicating transmission to the Yangming channel. He changed the prescription to Guanzhong (Cyperi Rhizoma) 1 liang, Gegen and Huafen (Trichosanthis Radix) each 3 qian, Gancao 1 qian, and 49 Black Beans (Soybean seeds). He recovered after three doses.

Yu Zhen commented: The spread of epidemics is necessarily determined by Yunqi (Five Movements and Six Qi). The Inner Canon mentions that if Gang (Yang stems) and Rou (Yin stems) do not take their proper turns, an epidemic may arise after three years. Generally, Yang stems are Gang, and Yin stems are Rou. When a Yang stem governs the Si Tian (Heavenly Command), the corresponding Yin stem governs the Zai Quan (Earthly Repository), and vice versa. They combine appropriately, such as Jia combining with Ji, called "Gang and Rou in position." Loss of position occurs, for example, in the Jiazi year when Shaoyin governs Si Tian. If the previous Guihai year had excess days, although the year changes to Jiazi, Jueyin has not yet withdrawn, while the Earth's Yangming Jiyin has already advanced. Thus, the Si Tian of Guihai oversees the Zai Quan of Jiazi. Upper Gui and Lower Ji constitute a loss of Gang-Rou position, transforming into Earth Epidemic after three years. Or if Shaoyin has entered Si Tian but the Earth has not advanced, the previous Wuyin Shaoyang remains in Zai Quan. Jia and Wu oppose each other and do not combine, transforming into Earth Li (pestilence) after three years. Extending this logic: Bing-Xin loss transforms into Water Epidemic; Geng-Yi loss transforms into Metal Epidemic; Ding-Ren loss transforms into Wood Epidemic; Wu-Gui loss transforms into Fire Epidemic. The four Li follow similar examples, verifiable in the texts. I personally believe this theory is too shallow and may not always verify.

Wang Kentang said: Yunqi theories occupy nearly half of the Inner Canon. If one sticks to the constant without understanding change, one will find it unverified. What Yunqi governs is the constant; what abnormal Qi governs is the change. The constant is like the intrinsic Qi; the change is ubiquitous and has specific prognoses. Thus, manifestations include following/reversing, excessive/stagnant, victorious/repelling, excess/deficiency variations, all differing in onset. If Jueyin acts, there is much wind, and flora flourishes; this is Following. Weather is clear, dry, and windless; this is Reversal. Sky is dusty, flowing water does not freeze; this is Excessive. Strong winds break trees, clouds and objects are chaotic; this is Stagnation. Mountains and marshes are scorched, flora withers; this is Victorious. Great heat burns, locusts cause disaster; this is Repelling. Earthquakes and landslides, constant dust haze; this is Excess. Gloomy anytime, heavy clouds darken the day; this is Deficiency. Diseases respond to these changes, depending on the local climate. Even within a few miles, different climates yield entirely different outcomes. How can one adhere rigidly to fixed rules? During the Xining era, the capital suffered prolonged drought despite extensive prayers. Continuous overcast led people to expect rain. Suddenly, it cleared with intense sun. Shen Kuo answered imperial inquiries, stating rain was imminent tomorrow. Others doubted this given the dry heat. Yet, it rained heavily the next day. At that time, Wet Earth was acting. The continuous overcast showed the effect of the Following Qi, but suppressed by Jueyin, preventing rain. The sudden clearing brought Dry Metal, breaking Jueyin, allowing Taiyin to extend. The next day, Yunqi were favorable, hence the rain. Alas, how rare are those like Shen Cunzhong to discuss Yunqi! Yu Zhen reflects that such speculation holds profound truth. Those who explore carefully can understand the origin of epidemics and thus the method of treatment. Sheng San Zi was an effective formula of Dongpo and Shen Cunzhong, published to save lives, likely suited to that year's Yunqi. Puji Xiaodu Yin was also carved on stone. Gong Yunlin, residing in Daliang during the Wanli era of Ming, faced a severe outbreak of Big Head Plague. He used the secret formula Er Sheng Jiu Ku Wan (Two Saviors Relief Pills), achieving 100% success. Now, these formulas do not always work. Thus, we know diseases have no fixed formulas, and physicians have no rigid methods. The key lies in divine illumination and adaptability.