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If inflammation can be stopped by merely employing bitter-cold herbs without applying a method that resolves both exterior and interior, it fails to accommodate the nature of wind-fire pathogens, thereby inciting a prairie-fire momentum. The severity will inevitably become even more intense. As the inflammatory qi increases, the epidemic qi follows wind and fire; since wind and fire generate each other, pathological changes occur with great speed. However, the nature of wind is suitable for dispersal, while the nature of fire requires unblocking and reaching out. Therefore, cooling prescriptions must include herbs that disperse and unblock. This is because the nature of cold herbs is either downward-draining or closing, which is contrary to dispersal and unblocking; in fact, it goes against the nature of wind and fire. No wonder conditions deteriorate rapidly like lightning and galloping wind, triggering complications.

For instance, during extreme summer heat under a scorching sun, even if sudden rain falls without wind, the air does not cool down but becomes hotter due to the rain suppressing the heat. This is because heat is blocked by rain, preventing the release of hot qi. Only when a gentle breeze stirs does the dryness dissipate; combined with rain moisture, a state of harmonious peace is restored. This illustrates why the "Double Resolution Method" (Shuangjie Fa) is rich in application and highly valued.

Although seasonal epidemic qi is easily transmitted to others, infection does not occur simply upon seeing a patient. It is self-attributed. How is it induced? When a person's constitution is inherently weak and their defensive barrier (Wei Qi) is loose, the epidemic qi enters through the mouth and nose, and sha toxin infects through the skin and muscles; this is called "contagion." Alternatively, if a person has sufficient righteous qi but harbors latent pathogens externally, they suffer from pre-existing latent pathogens exacerbated by seasonal epidemic qi; this is called "induced onset." Furthermore, some appear strong externally but are hollow internally; although they lack latent pathogens, their innate endowment is biased, causing qi deviation. The epidemic qi exploits this bias to invade; this is called "cold damage" (Ganmao). One must have abundant internal righteous qi, no chronic diseases, minimal mental distress, and avoid physical exhaustion to achieve non-transmission and non-infection. Only then does one approach health.

Qibo stated: "Those who do not infect each other possess internal righteous qi, making them impervious to evil." Thus, epidemic invasion occurs by exploiting deficiency. Deficiency varies internally and externally, leading to shallow or deep infection; qi bias leads to similar yet distinct symptoms. In cases where internal qi is solid but external qi is deficient, even mild cold damage manifests as minor illness, making symptom identification difficult. Differentiation relies on observing cough, skin itching, wiry and rapid pulse, and faint sha rashes. These are inevitable signs. Pathogens attacking the hair and skin correspond internally to the Lung. Hence, red eyes indicate white sclera belonging to the Lung; skin itching indicates the Lung governs skin and hair; sore throat indicates the throat is the Lung's tube; diarrhea indicates the Large Intestine is the exterior of the Lung; cough resulting from pathogen expulsion indicates pathogen attacking the Lung meridian. All these are manifestations of sha pathogen invading the hair and skin.

Conversely, if the hair and skin are dense, preventing pathogen invasion, but fatigue or limb coldness occurs, it corresponds internally to the Spleen. Since the Spleen and Stomach are exterior-interior partners, limb itching indicates the Spleen governs limbs; dry fluids indicate the Spleen fails to transport fluids; thirst indicates Stomach heat; nausea/vomiting indicates Stomach evil rising; loss of appetite indicates pathogen attacking the Stomach meridian; insomnia indicates dry stool in the Stomach; sha eruption indicates pathogen reaching the muscle layer. These occur when internal righteous qi is strong, repelling external epidemic pathogens so they cannot enter via meridians. Both scenarios present ambiguous symptoms often mistaken for other pathogens, necessitating specific differentiation to clarify misconceptions.

Historically, "sha" was generally categorized under macules and papules. Only "ma" (measles) stems from congenital Yang toxicity. Others include large patches like macules ("ban"), fine woven patterns like papules ("zhen"), and millet-grain-like spots ("sha"). White rash releases Stomach Yang pathogens; crimson sha releases Stomach Yin toxins. Although Yin/Yang and red/white differ, all belong to the Stomach Fu organ, hence ancient texts treated them collectively without distinction. Wu Keyou conflated them with warm diseases; Ye Tianshi and Wu Jutong included them in warm disease discussions. Contemporary experts further distinguished red sha, throat sha, stifled sha, wind sha, and child rash. Despite varied names, meanings remain consistent, as detailed previously.

Wind sha, though weak like an exhausted arrow, remains dangerous. Symptoms may lack cough or fever, presenting only slight throat pain and skin itching. Due to mild pathology, people often neglect it, risking progression to stifled sha, which is hard to treat. Neglect allows pores to remain open, weakening Wei Qi and righteous qi, facilitating internal transmission via mouth/nose. If latent epidemic qi exists, it travels through meridians to organs, accelerating rapidly. "A single spark can start a prairie fire," warning against ignoring early signs.

Stifled sha resembles wind sha with slight aversion to cold/heat and faint rashes, but differs significantly with coma, snoring, dark complexion, and clear body temperature. Deep epidemic infection in weak bodies prevents eruption; external pathogens or incorrect cooling herbs cause internal blockage, leading to internal collapse and death.

Commonly called "fa sha" involves summer heatstroke, evil qi stagnation, abdominal pain, and痞气 (pi syndrome). Unlike contagious epidemics, it results from sudden exposure to foul odors (flatulence/fecal gas), which carries yin pathogens. Summer heat pushes yang outward, leaving yin inside, making the body susceptible to yin pathogens entering through pores. Without latent pathogens, symptoms include pale face, abdominal pain, borborygmus, qi obstruction, and cold limbs. Massage promotes blood/qi flow, releasing qi through muscles as sha, potentially healing spontaneously within a week. Drinking water should be avoided initially to prevent pathogen retention. With latent pathogens, symptoms worsen to blood coagulation, disharmony of Ying/Wei, cholera-like vomiting/diarrhea, leg curling, severe pain, coma, and rigidity. Urgent treatment requires pungent-hot herbs to dispel cold and aromatic herbs to open orifices, restoring qi/blood flow. Abdominal pain and cramping stem from cold congealing in the abdomen and intestines blocking qi flow. Leg curling ("diao jiao") results from yin meridian injury at the foot origin. Untreated, it causes rapid death. These non-contagious conditions differ fundamentally from contagious sha.

1. Rotten Throat Sha: Mild throat swelling/pain initially, faint red body rash, hidden pulse, cold limbs, blue face/purple lips, closed mouth with salivation, fixed gaze, purple nails, chest/abdominal fullness, shortness of breath, coma, and limb convulsions indicate stifled sha. Mortality is high, but immediate treatment with Wolong Dan insufflated into nostrils to induce sneezing, followed by Mentha decoction ground with Zijin Ding, is crucial. Avoid pungent-dry insufflations unless closure symptoms persist.

2. Throat Sha: Initial purple-bright rash with aggressive onset responds well to *Yu Yi Da Quan* formulas containing Angelicae Sinensis Radix, Arnebiae Radix, Persicae Semen, Coccidis Pollen, and Violae Herba.

3. Stifled Sha: Often resistant to Wolong Dan. A date-stuffed nasal insufflation method opens the throat effectively.

4. Severe Throat Sha: For uncontrollable throat swelling, purple color, neck swelling, phlegm obstruction, and inability to swallow, puncture high swollen areas on both sides of the throat with a throat needle to drain black-purple toxic blood before administering medication.

5. Sha Puncture: Pricking Shaoshang (LU-11) at the thumb nail root drains purple blood, effectively clearing Lung heat-toxin.

6. Contraindications for Puncture: Do not puncture if swelling/pain is mild, rash is pale, ulceration is deep, or if pulse is thready with coma indicating internalized toxin.

7. Vomiting/Cold Limbs in Throat Sha: Caused by Yangming epidemic pathogen blocking pores and qi. Treat with pungent-warm herbs like Atractylodis Rhizoma, Magnoliae Cortex, Pinelliae Rhizoma, Cinnamomi Cortex, Aconiti Lateralis Radix Praeparata, and Zingiberis Rhizoma, not as cold syndromes.

8. Initial Faint Rash with Convulsions: Avoid cold-calming herbs like Calculus Bovis and Suhe Xiang Wan. Allow sha to vent naturally. Avoid irritants like Elsholtzia, Salvia plebeia, cotton thread, and cherry pits if ulcers exist; these are unsuitable for epidemic sha regardless of ulceration.

9. Xi Jiao Di Huang Tang: Use cautiously after confirmation for rotten throat sha.

[Dispersing Method] For sha pathogen in exterior without internal fire, light heat, clear spirit, and intact throat, use dispersal first, then clearing.

Ge Gen Tang: For fever, clear spirit, sparse hidden rash, white tongue, depressed pulse, and mild throat erosion.
Ingredients: Puerariae Lobatae Radix, Arctii Fructus, Schizonepetae Spica, Bombyx Batryticatus, Forsythiae Fructus, Curcumae Turmericum, Glycyrrhizae Radix et Rhizoma, Platycodonis Radix.

Modified Ge Gen Tang: For no sweat, hidden rash, white tongue, depressed pulse, and mild throat erosion.
Ingredients: Puerariae Lobatae Radix, Arctii Fructus, Fermented Soybean, Aurantii Fructus, Menthae Haplocalyx, Malvae Silvestris Flos, Bombyx Batryticatus, Schizonepetae Spica, Saposhnikoviae Radix, Forsythiae Fructus, Scorched Hawthorn Fruit, Red Peony Root, Glycyrrhizae Radix et Rhizoma.

Xiang Chi Yin: For hidden rash, depressed pulse, eroded throat, dry tongue, early stage with insufficient fluids but clear spirit and internal latent fire.
Ingredients: Fermented Soybean, Arctii Fructus, Schizonepetae Spica, Platycodonis Radix, Forsythiae Fructus, Gardeniae Fructus, Malvae Silvestris Flos, Fritillariae Bulbus, Humanis Alumen. Total three formulas.

[Clearing and Dispersing Method] For severe epidemic sha, simultaneous dispersal and clearing is essential. If exterior pathogen persists, dispersal is necessary; if internal epidemic toxin burns, clearing is urgent. Exterior is secondary, internal fire is primary. Burning heat, no sweat, clustered hidden rash, eroded throat, and irritability indicate internal fire dominance. Blindly dispersing without addressing fire leads to worsening symptoms. This section addresses both exterior and interior.

Ge Gen Tang: For burning heat, coma, irritability, eroded throat, wiry pulse, clustered hidden rash, no sweat, and greasy tongue.
Ingredients: Rhinocerotis Cornu (substitute with Water Buffalo Horn), Puerariae Lobatae Radix, Arctii Fructus, Platycodonis Radix, Forsythiae Fructus, Gardeniae Fructus, Bombyx Batryticatus, Schizonepetae Spica, Malvae Silvestris Flos, Charred Hawthorn Fruit, Humanis Alumen.

Xi Jiao Chi Tang: For eroded throat, hidden rash, wiry pulse, coma, irritability, high fever, little sweat, crimson tongue, thirst, and risk of internal collapse. Combine with Wan Shi Niu Huang Wan for severe coma.
Ingredients: Rhinocerotis Cornu (substitute with Water Buffalo Horn), Fermented Soybean, Arctii Fructus, Schizonepetae Spica, Forsythiae Fructus, Gardeniae Fructus, Malvae Silvestris Flos, Fritillariae Bulbus, Bombyx Batryticatus, Red Peony Root, Platycodonis Radix, Glycyrrhizae Radix et Rhizoma. Total two formulas.

[Clearing and Transforming Method] Epidemic sha fire is rapid and fierce; clearing agents must not be delayed or used lightly. If exterior pathogen remains but internal fire burns, transform toxin before fire spreads. If fire flares up, transformation alone fails. Once exterior resolves and fire peaks (rash visible, wiry pulse, eroded throat, crimson tongue, thirst, irritability), heavy clearing is required, akin to saving a burning cart with a cup of water.

Xi Jiao Di Huang Tang: For visible rash, fluid depletion, wiry-rapid-large pulse, eroded throat, and crimson tongue. Add to dispersing herbs if rash is hidden but fire/fluid depletion signs exist. This formula transforms toxin and nourishes fluids.
Ingredients: Rhinocerotis Cornu (substitute with Water Buffalo Horn), Rehmanniae Radix Preparata, Moutan Cortex, Red Peony Root.

Xi Jiao Er Xian Tang: For visible rash but severe throat erosion, wiry-large pulse, thirst, irritability, crimson tongue, dry lips, blazing fire, and depleted fluids.
Ingredients: Rhinocerotis Cornu (substitute with Water Buffalo Horn), Forsythiae Fructus, Fritillariae Bulbus, Scrophulariae Radix, Gardeniae Fructus, Antilopis Cornu, Fresh Rehmanniae Radix, Fresh Glehniae Radix, Humanis Alumen, Humanis Excrementium Dealbatum, Lonicerae Japonicae Flos, Gypsum Fibrosum, Coptidis Rhizoma, Malvae Silvestris Flos, Chen Jin Zhi.

Duo Ming Yin: For excessive phlegm, dried fluids, crimson tongue, thirst, irritability, eroded throat, wiry-large pulse, and cloud-like dense rash.
Ingredients: Coptidis Rhizoma, Gypsum Fibrosum, Rhinocerotis Cornu (substitute with Water Buffalo Horn), Rehmanniae Radix, Moutan Cortex, Red Peony Root, Indigo Naturalis, Malvae Silvestris Flos, Fritillariae Bulbus, Forsythiae Fructus, Scrophulariae Radix, Jin Zhi, Antilopis Cornu, Glehniae Radix, Humanis Alumen.

Qing Fei Yin: For visible rash, improving throat erosion, clear spirit, reduced heat, and persistent cough.
Ingredients: Mori Folium, Glehniae Radix, Antilopis Cornu, Forsythiae Fructus, Platycodonis Radix, Glycyrrhizae Radix et Rhizoma, Citri Reticulatae Pericarpium, Fritillariae Bulbus. Total four formulas.

[Downward Expulsion Agents] Used reluctantly. If exterior pathogen remains and internal fire burns, Shuangjie San assists dispersal as a "gate-breaking general." If exterior resolves and fire remains intense, Si Hu Yin aids clearing as a "door-snatching agent." Heavy agents suit strong patients with excess pathogens. Unresolved exterior presents with no sweat, hidden rash, eroded throat, irritability, constipation, and solid pulse; Shuangjie San is appropriate. Resolved exterior presents with sweat, dense rash, eroded throat, dry spirit, solid pulse, and constipation; Si Hu Yin is appropriate.

Shuangjie San: For faint rash, eroded throat, foul odor, irritability, constipation, red eyes, solid pulse, early stage, strong constitution, and excess pathogens.
Ingredients: Rheii Radix et Rhizoma, Mirabilite, Puerariae Lobatae Radix, Arctii Fructus, Schizonepetae Spica, Forsythiae Fructus, Menthae Haplocalyx, Bombyx Batryticatus, Aurantii Fructus, Humanis Alumen, Platycodonis Radix.

Si Hu Yin: For visible rash but severe throat erosion, wiry-rapid pulse, red eyes, constipation, irritability, crimson tongue, and severe phlegm-fire.
Ingredients: Rheii Radix et Rhizoma, Coptidis Rhizoma, Rhinocerotis Cornu (substitute with Water Buffalo Horn), Gypsum Fibrosum, Anemarrhenae Rhizoma, Scrophulariae Radix, Rehmanniae Radix, Indigo Naturalis, Malvae Silvestris Flos. Total two formulas.

[Nourishing Fluids] A supportive method. Fire excess depletes fluids; epidemic sha involves fire, so severe fire depletes fluids, endangering life. Nourishing fluids transforms toxin gently and preserves yin before depletion, complementing dispersing/clearing herbs without causing cold stagnation or fluid exhaustion.

Wu Xian Yin: For crimson dry tongue, wiry-rapid-large pulse, hidden rash, and mild throat erosion. Take with Ge Gen Tang; if erosion exists, take with Xi Jiao Chi Tang.
Ingredients: Fresh Glehniae Radix, Fresh Rehmanniae Radix, Fresh Imperatae Rhizoma, Fresh Phragmitis Rhizoma, Sacchari Canis Juice.

Yu Yin Jian: For visible rash, dry skin, crimson tongue, dried fluids, eroded throat, constipation, wiry pulse, and lack of spirit.
Ingredients: Chelonis Carapax et Plastrum, Trionycis Carapax, Rehmanniae Radix, Moutan Cortex, Fritillariae Bulbus, Jin Zhi, Ophiopogonis Radix, Anemarrhenae Rhizoma, Glehniae Radix, Bletillae Rhizoma, Scrophulariae Radix, Rhinocerotis Cornu (substitute with Water Buffalo Horn). Total two formulas.

Chui Hou Shi Bao Dan: Specifically for rotten throat, whether ulcerated or not, with bright swelling. Also treats smallpox toxin, post-sha gum disease, and post-syphilis throat nodules. Reduces swelling, stops pain, transforms toxin, and generates flesh. Do not alter ingredients.
Ingredients: Calculus Bovis (3 fen), Fritillariae Bulbus (3 fen), Humanis Excrementium Dealbatum (5 fen), Succinum (5 fen), Cyprini Carassii Bilis (5 fen, large), Margarita (6 fen), Borax (4 fen), Humanis Unguis (4 fen), Malvae Silvestris Flos (3 fen), Menthol (0.5 li). Grind to fine powder. Not for general throat ailments.

Fu Xiang Jing Fang: From Real Toxicology, Er Wei Ba Du San (Realgar and Alum). Treats post-sha toxin nodules on neck, hard and warm, regardless of color.

Zhuan Fu Xiang Man Zhong (Zijin Dan): Made from old urine-pool bricks fired and soaked in vinegar 5-6 times, ground to powder. Add 1 fen Musk per liang. Boil with equal parts vinegar and white honey, apply topically. For collapsed skin/purple color, use vegetable oil and egg white. Suitable for throat wind and neck swelling.

Fresh Achyranthes Bidentata Root juice, warmed and drunk, treats all throat ailments, reducing swelling and resolving phlegm/pain miraculously.

Qu Wen Pi Xie Fa: Rheii Radix et Rhizoma (2 liang), Artemisiae Scopariae Herba (1 liang), Atractylodis Rhizoma (5 qian), Costi Radix (1 liang). Grind and burn for fumigation. Avoid in patient's bedroom to prevent choking.

Hou Bi Sai Bi Fang: For throat closure preventing swallowing. Stuff medicine into a date, insert into nostril opposite the painful side. Medicine is harsh; do not touch mucosa directly. For children, wrap in cotton. For severe cases, stuff both nostrils. Effective for various throat closures and critical conditions.
Ingredients: Chan Su (7 fen), Asari Radix et Rhizoma (4 fen), Cinnabaris (3 fen), Moschus (2.5 li), Borax (2.5 li), Gleditsiae Sinensis Spina (4 fen), Pinelliae Rhizoma Crude (3 fen), Xanthii Fructus (4 fen), Crotonis Fructus (4 fen, oil removed), Calculus Bovis (2 fen), Realgar (4 fen). Grind fine, store.

Hou Bi Syndrome: Qi blockage prevents swallowing. Even skilled doctors fail if sneezing isn't induced by Wolong Dan/Zijin Ding. This nasal insufflation works if chest pulsates and breath exists, loosening phlegm and restoring consciousness within hours to days.

Ren Zhong Bai San: For oral/throat ulcers, gangrenous stomatitis, throat swelling, and gum erosion.
Ingredients: Indigo Naturalis (1 qian), Humanis Excrementium Dealbatum (1 qian), Camelliae Seed Tea (1 qian), Menthae Haplocalyx (5 fen), Menthol (2 fen), Humanis Excrementium Dealbatum (1 qian), Natrii Sulfas (5 fen), Oxis Gallae (3 fen), Margarita (5 fen). Grind fine, apply locally.

Ya Gan Shen Fang: For sha/gangrenous stomatitis. Rinse with Wintergreen leaf decoction, then apply.
Ingredients: Indigo Naturalis (1 qian), Calculus Bovis (2 fen), Humanis Excrementium Dealbatum (1 qian), Fossil Bone (1 qian), Hair Charcoal (1 qian), Menthol (3 fen), Margarita (5 fen), Old Red Carpet Charcoal (1 qian), Small Red Dates (7, pitted with Realgar). Grind fine, seal tightly.

Note: Previous formulas target epidemic sha/rotten throat specifically. Zhu Tieshan's additions address cold/damp complications. He advises adjusting for seasonal cold using Gui Zhi, Ge Gen, or Ma Huang if needed, respecting seasonal qi. Formulas containing Sheng Ma, Bai Zhi, Cang Zhu, Chai Hu are recorded despite being contraindicated in typical epidemic treatment, as they address specific concurrent symptoms.

Jing Fang Ge Gen Tang: For wind-cold blocking pores, delaying sha eruption. Also for chills, intermittent fever, throat swelling, cough, chest tightness, nasal congestion, vomiting, watery eyes, cold fingers, and soggy-rapid or floating-rapid pulse.
Ingredients: Schizonepetae Spica (1.5 qian), Saposhnikoviae Radix (1.5 qian), Glycyrrhizae Radix et Rhizoma (4 fen), Platycodonis Radix (1.5 qian), Arctii Fructus (3 qian), Bombyx Batryticatus (1 qian), Aurantii Fructus (1 qian), Fritillariae Bulbus (1.5 qian), Puerariae Lobatae Radix (1.5 qian), Armeniacae Semen Amarum (3 qian, avoid if loose stools).

Sheng Ma Ge Gen Tang: For weak constitutions with incomplete sha eruption.
Ingredients: Cimicifugae Rhizoma (1 qian), Puerariae Lobatae Radix (1 qian), Red Peony Root (8 fen), Glycyrrhizae Radix et Rhizoma (4 fen).

Jiajian Tou Xie Tang: For sha failing to erupt after Sheng Ma Ge Gen Tang.