沙参16克 生石膏15克(碎，布乜) 枳壳10克 寸冬16克
厚朴10克 生地13克 幺参10克 大黄6克(泡水兑入)
服二剂后，大便溏泻数次，色由酱黑而渐次转黄，脉静身凉，沣液满口，苔皮退去八、九，烦渴止，已能进稀粥少许。拟方：
沙参20g 杭芍10克 生地13克 寸冬13克 北芪30克 当
归13克甘草6克
连服三剂，食增神健，诸证全瘳。
瘟疫病热盛逼阴证
张××，男，川北人，年二十二岁，在四川省会理县北街参将衙署充当军士。1921年3月，值瘟疫流行，被染者多，渠亦被传染而发病。发高热已十日，延余往诊，刚到该处，见另一军士掺扶病者出门外小解，小便清长如水，旋即目珠上视，其势欲脱。速诊其脉，沉数而细，唇焦口燥，苔黄黑而起刺，以手试之，则口气蒸手，仓卒之时，药石不济，恐阴液脱绝，急以冷水灌之，连喂二碗，目珠始返回如常，神识转清。询及由来，始知病已十日，壮热烦渴，大便不通，小便短赤，曾服发表退热药数剂，汗后身热不退，反见溺多清长。又述及前有两个军士，同患是病，发表之后，亦见小便清长，旋即死去。此系邪热内盛，复被发表劫汗，重伤阴液，逼阴外脱之险象，幸喜急灌冷水以救之，水源不?固竭，真阴未致立亡，急宜凉下以救真阴，主以承气白虎汤治之。
生石膏30克(碎。布包) 知母13克 枳实13克(炒，捣) 生
大黄16克(泡水兑入) 厚朴13克(炒) 芒硝10克 川黄连
10克粳米10克
次日复诊，大便已通，下出酱黑燥屎若干，身热已退六、七，小便反见短赤，此邪热已经溃退，阴液尚未恢复，脉仍沉数，喜饮清凉，照原方去黄连加麦冬26克。
第三日继诊，病者已汗出热退，脉静身凉，烦躁止，口津生，唇舌转润，舌苔已退去大半，稍能进食，小便渐转清长，但仍喜冷饮，以生脉散加味养阴生津而清余热。
沙参15克 寸冬15克 五味子6克 当归16克 生地15克
杭芍15克 生石膏15兑(碎，布包) 甘草6克
连服二剂再诊，舌苔已退净，津液满口，渴饮止，神食较增，小便已清利如常。遂照原方去石膏加口芪26克，生地改为熟地15克，连服三剂而愈。
瘟疫病热深厥深阳极似阴证
马××，男，三十岁，成都人，住四川省会理县北街。
1920年3月患瘟疫病已七、八日，延余诊视，见其张目仰卧，烦躁谵语，头汗如洗，问其所苦不能答，脉象沉伏欲绝，四肢厥逆，遍身肤冷。唇焦齿枯，舌干苔黑，起刺如铁钉，口臭气粗。以手试之，则口气蒸手。小便短赤点滴，大便燥结已数日未通，查其前服之方，系以羌活、紫苏、荆芥、薄荷、山楂、神曲、枳实、厚朴、栀子、黄连、升麻、麻黄及葛根等药连进四剂，辛散发表过甚，真阴被劫，疫邪内壅与阳明燥气相合，复感少阴君火，热化太过，逼其真阴外越，遂成此热深厥深阳极似阴之证，苟不急为扑灭，待至真阴灼尽，必殆无救，拟下方治之。
大黄26克(泡水兑入) 生石膏30克 枳实15克 厚朴15克
芒硝10克 知母12克 生地60克 黄连10克
服一剂，病情如故。服二剂后大便始通，脉息沉而虚数，但仍神识蒙睫，问不能答。照方再服二剂，连下恶臭酱黑粪便，臭不可当，其后口津略生。又照原方再服二剂，大便始渐转黄而溏，舌钉渐软，惟舌中部黑苔钉刺尚硬，唇齿稍润，略识人事，始知其证索饮而渴。进食稀粥少许，照前方去枳实、厚朴，加天冬、麦冬各15克、沙参20克、生地12克、甘草6克，将大黄分量减半。连进四剂后，人事清醒，津液回生，苔皮渐退而唇舌已润，唯仍喜冷饮。继以生脉散加昧，连服三剂而愈。
人参15克 寸冬15克 当归10克 生地15克 杭芍15克 五
味子3克 生石膏10克 黄连5克 甘草6克
按：阳明急下之证，惠者已严重昏愦不省人事，不能询及渴饮与否，如证见壮热面赤，口气蒸手，唇舌焦燥，鼻如烟熏等则实热证情已具，即当急下，切勿迟疑，以免贻误病机，证变难挽。
瘟疫病误治变证转阳极似阴证
张××之妻，年四旬余，四川省会理县人，体质素弱，患痰饮哮喘咳嗽多年，屡服滋阴清肺之药罔效，余拟以小青龙汤加附子及四逆二陈加麻辛汤等治之，服十多剂后病愈而复健康。数年后，于1920年3月感染时疫。初起发热而渴、头体痛。某医以九昧羌活汤加麻黄、桂枝一剂，服后，则汗出而昏厥。延余诊视，脉沉伏欲绝，肢厥肤冷，唇焦齿枯、口不能张，问其所苦，不能答。此系瘟疫误表过汗伤阴，疫邪传入阳明之腑，复感少阴君火，热化太过，亢阳灼阴，真阴欲绝，邪热内逼致使真阴外越，遂成阳极似阴之证。急与清热养阴生津之剂，方用生脉散煎汁、频频喂服。
米洋参10克 麦门冬26克 北五味子6克 生甘草6克
药汤下咽后数刻，脉来沉数，肢厥渐回，口气仍蒸手。
邪热未溃仍照前方加生石膏50克、生地40克、知母、贝母各30克。
是晚再诊视，脉来洪数，人事稍清，视其苔黄黑而生芒刺，壮热渴喜冷饮，小便短赤，大便燥结不通。《内经》云。
“热深者厥亦深也。”今得前二方以济之，促其真阴内回，阳热始通，故反呈现壮热烦渴饮冷等证，邪热内炽不退燥结阳明，真阴仍有涸竭之虞。当即主以凉下救真阴，拟白虎承气汤加味一剂。
生石膏26克 知母16克 沙参16克 生大黄10克(泡水兑入)
枳实13克 厚朴13克 芒硝6克 生甘草6克 黄连5克
生地16克
服一剂后，大便始通，苔刺渐软，身热稍退。又服二剂，热退六、七，口津稍回，仍渴喜冷饮。续服第三剂，乃下黑燥粪，恶臭已极，热退七、八，已不见渴，稍进稀粥。又照此方去枳、朴，加天冬、麦冬各40克，连进二剂后，脉静身凉，津液满口，惟尚喜冷饮，仍照原方去芒硝，并将石膏、大黄减半，加入当归16克、杭芍13克，连进四剂而愈。继以四物汤加党参、口芪，调理十余日而康复。
按。此阳极似阴危笃之证，连进凉下九剂，始将疫毒邪火扑灭净尽，转危为安。本证燥热合邪，消灼真阴，津液涸竭，危在旦夕。如不用釜底抽薪之法，连用大凉大下之剂，万难奏效。诚言有是病，用是药。如方药对证，石膏、大黄亦妙药也。
瘟疫病小儿热极抽风证
郑××之子，两岁，四川省会理县南门外近郊农民。1921年5月，因邻居患时疫而被传染，某医以祛风解表治之，愈进愈危，延余诊视。时高热已六日，壮热渴饮，唇赤而焦，舌苔黄燥，指纹粗而色紫，脉沉数。大便已三、四日不解，小便短赤，饮食不进，角弓反张之状，时而疭瘛抽掣，喘挣不已，视其证状颇危。此系疫邪传里与阳明燥气相合，热甚伤阴之证，复被祛风解表，更耗散阴血，以致津枯液涸，血不荣筋，血虚筋急风动遂成是状，所谓热极生风之证也。乃拟达原饮去草果加石膏、人黄清热下结，输转达邪治之。
杭芍13克 黄芩6克 榔片6克 知母6克 甘草3克 生
石膏13克(碎，布包) 大黄6克(泡水兑入)
服一剂，二便通利，病退四、五，抽掣筋急已止。再服一剂，则病退七、八。继以生脉散加生地、当归、杭芍、石膏，连进二剂而愈。
沙参10克 寸冬10克 五味子3克 甘草3克 生石膏10克
(碎，布包) 生地6克 当归10克 杭芍10克
瘟疫病狂汗
张××，男，四川人，年廿四岁，住四川省会理县北街，禀赋充盛，1920年4月感瘟疫病邪。病已三日，延余诊视，发热而渴不恶寒，小便短赤，大便三日未解，脉来洪数，舌苔白腻如积粉，舌尖绛红而燥，面部垢腻。此系募原疫邪有渐入于里化热之势，宜输转募原之邪，兼消入里之热，加味达原饮治之。
槟榔13克 厚朴10克 草果10克 知母1 3克 杭芍16克 黄
芩1 3克 甘草6克 生石膏30克 葛根13克 大黄13克(泡水
兑入)
服一剂后，病者旋即发狂乱奔，病家以为误服凉药之咎，促余再行诊视，见其口舌转润，脉象已较前转平，且有微汗。
当即告知病家，此乃“狂汗”，系病退之征，稍待汗出即愈，遂嘱再服前药。服药一碗，即令使覆卧。俄顷，大汗淋漓，约三刻钟后，狂躁止，脉静身凉，霍然而愈。
按：吴又可《瘟邪论》云：“狂汗者，伏邪中溃，欲作汗解，因其人禀赋充盛，阳气冲击，不能顿开……。”今得药力相助，输转募原之邪以达于表而解，邪随汗去，则狂证焉有再作之理。
瘟疫病战汗
张××，男，年三十岁，住四川省会理县东门外。1924年3月，感瘟疫之邪而病，服前医之方香苏散合升麻葛根汤加羌活、枳壳、白芷、防风、黄芩等二剂未效。病已八、九日，延余诊视，壮热烦渴饮冷，谵语烦躁，大便不通，小便短赤，脉来洪数，舌苔黄而生芒刺，唇赤而焦，鼻如烟煤而干燥。此系瘟疫邪气传里入腑之证，邪热内甚，形成亢阳灼阴，真阴涸竭，急当釜底抽薪凉下以救真阴。拟白虎合承气汤方加减治之。
生石膏30克 知母13克 生甘草6克白粳米13克寸冬16克
生大黄13克(泡水兑入) 芒硝10克 厚朴13克(炒) 枳实
12克(炒、捣碎) 生地13克
服后下出硬结燥屎一次。次日复诊，病状已减，壮热较退，口津略生，因嘱照原方再进一剂。
三日复诊。服药后又解润大便三次，身熟退去其半，谵语止，烦渴已减。拟用加味人参白虎汤，养阴生滓并除余热。
人参24克 生石膏24克(碎，布包) 知母12克 寸冬15克
生地15克黄连5克玄参10克枳壳12克大黄6克(泡水
兑入) 甘草6克粳米一撮
服后当晚夜半，忽而肢冷畏寒，继则抖战不可忍，旋即大汗如洗，热退肤冷，脉微欲绝。斯时病家惶恐不已，促余再诊，视之则患者脉来缓弱，舌润，口生津液，渴饮已止，呼吸平和。当即告之，此名“战汗”，为病退之兆，切勿惊扰，但可温覆，否则战汗出而中止，病当不愈。
四日清晨续诊。唇舌润，苔皮脱，津液满口，已脉静身凉。大病悉退，进稀粥二碗。继以生脉散加当归、生地、杭芍养阴生津，服二剂而愈。
按： “壮火食气”为本病之症结所在。邪热太盛，亢阳灼阴，真阴涸竭，惠者已危在旦夕，今得凉下连进，邪热溃退，真阴来复，正气胜邪， “战汗”之作，实为病愈佳兆。
吴叉可《瘟疫论》曰： “……忽得战汗，经气输泄，当即脉静身凉，烦渴顿除。”证诸临床，乃切实之经验。
Sha Shen (Glehniae Radix) 16g, Sheng Shi Gao (Gypsum Fibrosum, raw) 15g (crushed, wrapped in cloth), Zhi Qiao (Aurantii Fructus) 10g, Mai Dong (Ophiopogonis Radix) 16g, Hou Po (Magnoliae Officinalis Cortex) 10g, Sheng Di Huang (Rehmanniae Radix) 13g, Xi Yang Shen (American Ginseng Radix) 10g, Da Huang (Rhei Radix et Rhizoma, raw) 6g (steeped in water and added to the decoction).
After taking two doses, loose stools occurred several times, changing from sauce-black to gradually yellow. The pulse became calm, the body cooled, saliva filled the mouth, the tongue coating receded by eight or nine tenths, thirst and irritability ceased, and the patient could consume a small amount of thin porridge. Proposed prescription:
Sha Shen (Glehniae Radix) 20g, Hang Shao (Paeoniae Radix Alba) 10g, Sheng Di Huang (Rehmanniae Radix) 13g, Mai Dong (Ophiopogonis Radix) 13g, Bei Qi (Astragali Radix) 30g, Dang Gui (Angelicae Sinensis Radix) 13g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
After continuously taking three doses, appetite increased, spirit became robust, and all symptoms completely resolved.
Plague Disease with Excessive Heat Forcing Yin Outward
Zhang XX, male, 22 years old, from northern Sichuan, served as a soldier at the Canjiang Yamen on North Street, Huili County, Sichuan Province. In March 1921, during a plague epidemic with many infections, he contracted the disease. He had suffered from high fever for ten days when I was invited to diagnose him. Upon arrival, I saw another soldier supporting the patient outside to urinate; the urine was clear and copious like water. Immediately after, his eyes rolled upward, indicating a critical state of collapse. I urgently palpated his pulse: deep, rapid, and fine. His lips were cracked and dry, tongue coating yellow-black with prickles. Testing with my hand, his breath felt hot. In this emergency, medicines were not yet ready. Fearing the exhaustion of Yin fluids, I urgently fed him cold water, two bowls in total. Only then did his eyes return to normal and his consciousness clear. Inquiry revealed that for ten days he had suffered from severe fever, irritability, and thirst, with constipation and scanty dark urine. He had taken several doses of diaphoretic antipyretics. After sweating, his fever did not subside; instead, polyuria with clear urine appeared. He mentioned that two other soldiers had the same illness; after diaphoresis, they also developed clear polyuria and subsequently died. This is a dangerous sign where internal excess heat, compounded by forced sweating which severely damaged Yin fluids, forces Yin outward. Fortunately, the urgent administration of cold water saved him; the source of fluids was not completely exhausted, and True Yin did not perish immediately. Urgent cooling purgation is needed to save True Yin, primarily using Chengqi Baihu Tang.
Sheng Shi Gao (Gypsum Fibrosum, raw) 30g (crushed, wrapped in cloth), Zhi Mu (Anemarrhenae Rhizoma) 13g, Zhi Shi (Aurantii Fructus Immaturus) 13g (stir-fried, crushed), Sheng Da Huang (Rhei Radix et Rhizoma, raw) 16g (steeped in water and added to the decoction), Hou Po (Magnoliae Officinalis Cortex) 13g (stir-fried), Mang Xiao (Natrii Sulfas) 10g, Chuan Lian Lian (Coptidis Rhizoma) 10g, Jing Mi (Oryza Sativa) 10g.
On the next day's follow-up, bowel movements had resumed, passing some sauce-black dry feces. Body heat had subsided by six or seven tenths. Urine became scanty and dark again. This indicates that pathogenic heat has retreated, but Yin fluids have not yet recovered. The pulse remains deep and rapid. He prefers cool drinks. Following the original formula, remove Lian Lian and add Mai Dong (Ophiopogonis Radix) 26g.
On the third day, the patient sweated and fever subsided. Pulse calm, body cool. Irritability stopped, saliva generated, lips and tongue moistened. Tongue coating receded by more than half. He could eat slightly. Urine gradually became clear and copious, though he still preferred cold drinks. Use Shengmai San with modifications to nourish Yin, generate fluids, and clear residual heat.
Sha Shen (Glehniae Radix) 15g, Mai Dong (Ophiopogonis Radix) 15g, Wu Wei Zi (Schisandrae Chinensis Fructus) 6g, Dang Gui (Angelicae Sinensis Radix) 16g, Sheng Di Huang (Rehmanniae Radix) 15g, Hang Shao (Paeoniae Radix Alba) 15g, Sheng Shi Gao (Gypsum Fibrosum, raw) 15g (crushed, wrapped in cloth), Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
After taking two more doses, tongue coating completely disappeared, saliva filled the mouth, thirst ceased, spirit and appetite improved, and urination returned to normal clarity. Remove Shi Gao from the original formula, add Bei Qi (Astragali Radix) 26g, change Sheng Di Huang (Rehmanniae Radix) to Shu Di Huang (Rehmanniae Radix Praeparata) 15g. Take three consecutive doses to recover.
Plague Disease with Deep Heat and Deep Cold, Extreme Yang Mimicking Yin
Ma XX, male, 30 years old, from Chengdu, living on North Street, Huili County, Sichuan Province.
In March 1920, he had suffered from plague for seven or eight days. Upon diagnosis, he lay supine with eyes open, irritable and delirious, head sweating profusely. He could not answer questions about his suffering. Pulse was deep, hidden, and nearly imperceptible. Limbs were cold, whole body skin cold. Lips cracked, teeth dry, tongue dry with black coating and prickles like iron nails. Bad breath, coarse respiration. Breath felt hot to the touch. Urine was scanty and dark, dropping drop by drop. Stool was dry and hard, unpassed for several days. Previous prescriptions included Qiang Huo (Notopterygii Rhizoma et Radix), Zi Su Ye (Perillae Folium), Jing Jie (Schizonepetae Spica), Bo He (Menthae Haplocalycis Herba), Shan Zha (Crataegi Fructus), Shen Qu (Massa Medicata Fermentata), Zhi Shi (Aurantii Fructus Immaturus), Hou Po (Magnoliae Officinalis Cortex), Zhi Zi (Gardeniae Fructus), Huang Lian (Coptidis Rhizoma), Sheng Ma (Cimicifugae Rhizoma), Ma Huang (Ephedrae Herba), and Ge Gen (Puerariae Lobatae Radix) administered for four doses. The excessive acrid-warm diaphoresis robbed True Yin. Plague pathogens accumulated internally, combining with Yangming dryness, and further affected by Shaoyin Minister Fire, leading to excessive heat transformation. This forced True Yin outward, resulting in this condition of deep heat and deep cold, extreme Yang mimicking Yin. If not extinguished urgently, once True Yin is scorched away, there will be no hope. Prescribed the following:
Da Huang (Rhei Radix et Rhizoma) 26g (steeped in water and added to the decoction), Sheng Shi Gao (Gypsum Fibrosum, raw) 30g, Zhi Shi (Aurantii Fructus Immaturus) 15g, Hou Po (Magnoliae Officinalis Cortex) 15g, Mang Xiao (Natrii Sulfas) 10g, Zhi Mu (Anemarrhenae Rhizoma) 12g, Sheng Di Huang (Rehmanniae Radix) 60g, Huang Lian (Coptidis Rhizoma) 10g.
After one dose, condition remained unchanged. After two doses, bowels opened. Pulse deep and deficient-rapid. Consciousness still clouded, unable to answer. Continue original formula for two more doses. Passed foul-smelling sauce-black stool, extremely odorous. Saliva began to generate slightly. Continue original formula for two more doses. Bowels gradually turned yellow and soft. Tongue prickles softened, except those in the middle of the tongue which remained hard. Lips and teeth slightly moist. Slightly recognized people, indicating thirst and desire for water. Ate a little thin porridge. Remove Zhi Shi and Hou Po from previous formula, add Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix) 15g each, Sha Shen (Glehniae Radix) 20g, Sheng Di Huang (Rehmanniae Radix) 12g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g. Reduce Da Huang dosage by half. Take four consecutive doses. Consciousness cleared, fluids regenerated, coating receded, lips and tongue moist. Still prefers cold drinks. Continue with Shengmai San with modifications. Take three doses to recover.
Ren Shen (Ginseng Radix) 15g, Mai Dong (Ophiopogonis Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 10g, Sheng Di Huang (Rehmanniae Radix) 15g, Hang Shao (Paeoniae Radix Alba) 15g, Wu Wei Zi (Schisandrae Chinensis Fructus) 3g, Sheng Shi Gao (Gypsum Fibrosum, raw) 10g, Huang Lian (Coptidis Rhizoma) 5g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
Note: In Yangming urgent purgation cases, if the patient is severely comatose and cannot indicate thirst, look for signs of excess heat: severe fever, red face, hot breath, cracked and dry lips/tongue, nose looking like smoke-stained. If these are present, urgent purgation is required without delay to avoid missing the therapeutic window and irreversible changes.
Plague Disease Complication due to Misdiagnosis Turning into Extreme Yang Mimicking Yin
Wife of Zhang XX, over 40 years old, from Huili County, Sichuan Province. Constitutionally weak, suffered from phlegm-fluid asthma and cough for years. Multiple treatments with Yin-nourishing lung-clearing herbs failed. I prescribed Xiao Qing Long Tang plus Fu Zi (Aconiti Lateralis Radix Praeparata) and Si Ni Er Chen Tang plus Ma Xin Tang. After over ten doses, she recovered health. Years later, in March 1920, she contracted seasonal plague. Initially fever, thirst, headache, and body ache. A doctor used Jiu Wei Qiang Huo Tang plus Ma Huang (Ephedrae Herba) and Gui Zhi (Cinnamomi Ramulus) for one dose. After ingestion, she sweated and fainted. I diagnosed her pulse as deep, hidden, and nearly imperceptible. Limbs cold, skin cold, lips cracked, teeth dry, mouth unable to open. She could not answer questions. This is plague misdiagnosed with excessive diaphoresis damaging Yin. Pathogens entered Yangming Fu organs, combined with Shaoyin Minister Fire, excessive heat transformation, hyperactive Yang scorching Yin, True Yin nearly exhausted. Internal pathogenic heat forced True Yin outward, resulting in extreme Yang mimicking Yin. Urgently administer heat-clearing, Yin-nourishing, fluid-generating agents. Use Shengmai San decoction, fed frequently.
Xi Yang Shen (American Ginseng Radix) 10g, Mai Men Dong (Ophiopogonis Tuber) 26g, Bei Wu Wei Zi (Schisandrae Chinensis Fructus) 6g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
Minutes after swallowing the medicine, pulse became deep and rapid. Limb coldness gradually resolved. Breath still hot.
Pathogenic heat not yet cleared. Add Sheng Shi Gao (Gypsum Fibrosum, raw) 50g, Sheng Di Huang (Rehmanniae Radix) 40g, Zhi Mu (Anemarrhenae Rhizoma) and Bei Mu (Fritillariae Cirrhosae Bulbus) 30g each to the previous formula.
Evening follow-up: Pulse surging and rapid. Consciousness slightly clearer. Tongue coating yellow-black with prickles. Severe fever, thirst preferring cold drinks. Scanty dark urine. Dry hard stool unpassed. *Neijing* states: "The deeper the heat, the deeper the cold." With the help of the previous formulas, True Yin returns internally, Yang heat begins to circulate. Thus, symptoms of severe fever, irritability, and thirst for cold drinks appear. Pathogenic heat burns internally, causing Yangming dryness accumulation. True Yin is still at risk of exhaustion. Urgently use cooling purgation to save True Yin. Prescribe Baihu Chengqi Tang with modifications.
Sheng Shi Gao (Gypsum Fibrosum, raw) 26g, Zhi Mu (Anemarrhenae Rhizoma) 16g, Sha Shen (Glehniae Radix) 16g, Sheng Da Huang (Rhei Radix et Rhizoma, raw) 10g (steeped in water and added to the decoction), Zhi Shi (Aurantii Fructus Immaturus) 13g, Hou Po (Magnoliae Officinalis Cortex) 13g, Mang Xiao (Natrii Sulfas) 6g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Huang Lian (Coptidis Rhizoma) 5g, Sheng Di Huang (Rehmanniae Radix) 16g.
After one dose, bowels opened, tongue prickles softened, fever slightly reduced. Take two more doses. Fever reduced by six or seven tenths, saliva slightly returned, still thirsty for cold drinks. Take third dose. Pass black hard stool, extremely foul. Fever reduced by seven or eight tenths, no longer thirsty, ate a little thin porridge. Remove Zhi Shi and Hou Po from this formula, add Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix) 40g each. Take two consecutive doses. Pulse calm, body cool, saliva fills mouth, still prefers cold drinks. Remove Mang Xiao from original formula, reduce Shi Gao and Da Huang by half, add Dang Gui (Angelicae Sinensis Radix) 16g, Hang Shao (Paeoniae Radix Alba) 13g. Take four consecutive doses to recover. Then regulate with Si Wu Tang plus Dang Shen (Codonopsis Radix) and Huang Qi (Astragali Radix) for over ten days until fully recovered.
Note: This critical case of extreme Yang mimicking Yin required nine consecutive doses of cooling purgation to completely extinguish plague toxin and fire, turning danger into safety. Dry-heat complex evil consumes True Yin, exhausting fluids, life hanging by a thread. Without the method of removing firewood from under the cauldron (removing the root cause), using large doses of cold and purgative herbs would rarely succeed. Indeed, match the disease with the medicine. If the prescription matches the syndrome, Shi Gao and Da Huang are miraculous drugs.
Pediatric Plague Disease with Extreme Heat Causing Convulsions
Son of Zheng XX, 2 years old, farmer near South Gate, Huili County, Sichuan Province. In May 1921, infected by a neighbor with seasonal plague. A doctor treated with wind-dispelling and exterior-releasing methods, worsening the condition. I diagnosed him. High fever for six days. Severe fever, thirst, red cracked lips, yellow dry tongue coating, coarse purple fingerprint pulse, deep rapid pulse. Constipation for three to four days. Scanty dark urine. No food intake. Opisthotonos. Intermittent convulsions. Panting and struggling. Symptoms were critical. This is plague pathogens transmitting inward, combining with Yangming dryness, severe heat damaging Yin. Wind-dispelling exterior release further depleted Yin blood, causing fluid exhaustion, blood failing to nourish tendons, blood deficiency leading to tendon tension and wind movement. This is "extreme heat generating wind." Prescribed Dayuan Yin removing Cao Guo, adding Shi Gao and Da Huang to clear heat and purge accumulation, guiding pathogens out.
Hang Shao (Paeoniae Radix Alba) 13g, Huang Qin (Scutellariae Radix) 6g, Bang Lang Pian (Arecae Semen) 6g, Zhi Mu (Anemarrhenae Rhizoma) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Sheng Shi Gao (Gypsum Fibrosum, raw) 13g (crushed, wrapped in cloth), Da Huang (Rhei Radix et Rhizoma) 6g (steeped in water and added to the decoction).
After one dose, urination and defecation unblocked, condition improved by four or five tenths, convulsions and tendon tension stopped. Take one more dose, condition improves by seven or eight tenths. Continue with Shengmai San adding Sheng Di Huang (Rehmanniae Radix), Dang Gui (Angelicae Sinensis Radix), Hang Shao (Paeoniae Radix Alba), Shi Gao (Gypsum Fibrosum). Take two consecutive doses to recover.
Sha Shen (Glehniae Radix) 10g, Mai Dong (Ophiopogonis Radix) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Sheng Shi Gao (Gypsum Fibrosum, raw) 10g (crushed, wrapped in cloth), Sheng Di Huang (Rehmanniae Radix) 6g, Dang Gui (Angelicae Sinensis Radix) 10g, Hang Shao (Paeoniae Radix Alba) 10g.
Plague Disease: Manic Sweating
Zhang XX, male, 24 years old, from Sichuan, living on North Street, Huili County. Strong constitution. Contracted plague pathogen in April 1920. Ill for three days. Fever and thirst, no aversion to cold. Scanty dark urine. Constipation for three days. Surging rapid pulse. Tongue coating white and greasy like accumulated powder. Tongue tip crimson and dry. Face dirty and greasy. Moxia plague pathogen showing tendency to enter interior and transform into heat. Should guide Moxia pathogens out, simultaneously clearing interior heat. Use modified Dayuan Yin.
Bang Lang (Arecae Semen) 13g, Hou Po (Magnoliae Officinalis Cortex) 10g, Cao Guo (Tsaoko Fructus) 10g, Zhi Mu (Anemarrhenae Rhizoma) 13g, Hang Shao (Paeoniae Radix Alba) 16g, Huang Qin (Scutellariae Radix) 13g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Shi Gao (Gypsum Fibrosum, raw) 30g, Ge Gen (Puerariae Lobatae Radix) 13g, Da Huang (Rhei Radix et Rhizoma) 13g (steeped in water and added to the decoction).
After one dose, the patient suddenly ran around wildly. Family blamed the cold medicine. Urged re-diagnosis. Mouth and tongue moistened, pulse calmer, slight sweat present.
Informed family this is "Manic Sweating," a sign of recovery. Wait for sweat to complete, then heal. Advised continuing previous medicine. After one bowl, instructed patient to lie prone. Soon, profuse sweating. After about three quarters of an hour, mania stopped, pulse calm, body cool, sudden recovery.
Note: Wu Youke's *Wen Yi Lun* states: "Manic sweating occurs when latent pathogens break down internally, attempting to resolve via sweat. Due to strong constitution, Yang Qi attacks but cannot open instantly..." Now aided by medicine, Moxia pathogens are guided to the surface and resolved. Pathogens leave with sweat, so mania will not recur.
Plague Disease: Battle Sweat
Zhang XX, male, 30 years old, living east of Huili County, Sichuan Province. In March 1924, contracted plague. Took Xiang Su San combined with Sheng Ma Ge Gen Tang plus Qiang Huo, Zhi Qiao, Bai Zhi, Fang Feng, Huang Qin for two doses without effect. Ill for eight or nine days. Severe fever, irritability, thirst for cold drinks, delirium, restlessness. Constipation. Scanty dark urine. Surging rapid pulse. Yellow tongue coating with prickles. Red cracked lips. Nose dry like coal smoke. Plague pathogens transmitted inward to Fu organs. Internal pathogenic heat excessive, hyperactive Yang scorching Yin, True Yin exhausted. Urgently need to remove firewood from under the cauldron (cooling purgation) to save True Yin. Prescribe Baihu combined with Chengqi Tang with modifications.
Sheng Shi Gao (Gypsum Fibrosum, raw) 30g, Zhi Mu (Anemarrhenae Rhizoma) 13g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Bai Jing Mi (Oryza Sativa) 13g, Mai Dong (Ophiopogonis Radix) 16g, Sheng Da Huang (Rhei Radix et Rhizoma, raw) 13g (steeped in water and added to the decoction), Mang Xiao (Natrii Sulfas) 10g, Hou Po (Magnoliae Officinalis Cortex) 13g (stir-fried), Zhi Shi (Aurantii Fructus Immaturus) 12g (stir-fried, crushed), Sheng Di Huang (Rehmanniae Radix) 13g.
Passed hard dry stool once. Next day follow-up: symptoms reduced, severe fever subsided, saliva slightly generated. Advised continuing original formula for one more dose.
Third day follow-up. Passed three soft stools. Body heat reduced by half. Delirium stopped, irritability/thirst reduced. Prescribe modified Renshen Baihu Tang to nourish Yin, generate fluids, and clear residual heat.
Ren Shen (Ginseng Radix) 24g, Sheng Shi Gao (Gypsum Fibrosum, raw) 24g (crushed, wrapped in cloth), Zhi Mu (Anemarrhenae Rhizoma) 12g, Mai Dong (Ophiopogonis Radix) 15g, Sheng Di Huang (Rehmanniae Radix) 15g, Huang Lian (Coptidis Rhizoma) 5g, Xuan Shen (Scrophulariae Radix) 10g, Zhi Qiao (Aurantii Fructus) 12g, Da Huang (Rhei Radix et Rhizoma) 6g (steeped in water and added to the decoction), Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Jing Mi (Oryza Sativa) a pinch.
That night at midnight, limbs suddenly cold, shivering unbearable. Then profuse sweating like washing. Fever subsided, skin cold, pulse faint and nearly imperceptible. Family panicked, urged re-diagnosis. Pulse slow and weak, tongue moist, saliva generated, thirst stopped, breathing peaceful. Informed them this is "Battle Sweat," a sign of recovery. Do not disturb. Keep warm. Otherwise, battle sweat may stop prematurely, and illness will not heal.
Fourth morning follow-up. Lips and tongue moist, coating shed, saliva fills mouth, pulse calm, body cool. Major illness resolved. Ate two bowls of thin porridge. Continue Shengmai San adding Dang Gui (Angelicae Sinensis Radix), Sheng Di Huang (Rehmanniae Radix), Hang Shao (Paeoniae Radix Alba) to nourish Yin and generate fluids. Take two doses to recover.
Note: "Strong fire consumes Qi" is the crux of this disease. Pathogenic heat too excessive, hyperactive Yang scorches Yin, True Yin exhausted. Patient critically ill. With continuous cooling purgation, pathogenic heat retreats, True Yin recovers, righteous Qi defeats evil. "Battle sweat" is indeed a good omen for recovery.
Wu Youke's *Wen Yi Lun* says: "...Suddenly obtaining battle sweat, meridian Qi drains, immediately pulse becomes calm and body cool, irritability and thirst instantly removed." Clinical evidence confirms this as practical experience.