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The purgative method for epidemic febrile diseases (Shi Yi, epidemic warm pathogenic diseases) differs from that for cold damage (Shang Han): In the treatment of cold damage, the use of purgatives is not considered too late; in the treatment of epidemic febrile diseases, the use of purgatives is not considered too early. The pathology of cold damage lies in dry fecal impaction within the interior, whereas the pathology of epidemic febrile diseases lies in stagnant heat within the interior; for cold damage, the purgative method is indicated only when there are interior syndromes, and it must be waited until exterior syndromes have completely resolved; for epidemic febrile diseases, regardless of whether exterior pathogens have resolved or not, the purgative method can be used as long as interior syndromes are present. For cold damage, if pathogens are in the Upper Jiao, purgation is contraindicated; one must wait until the pathogens are consolidated in the Middle and Lower Jiao before using purgation; for epidemic febrile diseases, even if pathogens are in the Upper Jiao, purgation can still be used. If one waits until pathogens consolidate in the Middle and Lower Jiao before purging, it may lead to death due to ineffective purgation. A single application of purgation usually suffices for cold damage, and Zhang Zhongjing's Chengqi Decoction formulas are generally prescribed for no more than three doses; for epidemic febrile diseases, the purgative method requires at least three doses, and sometimes up to ten or twenty doses.

There are six types of purgative methods for epidemic febrile diseases: When pathogens are consolidated in the upper chest, Fritillariae Bulbus (Beimu, 贝母) is used for purgation; although Beimu is not typically a purgative herb, a dose of approximately one tael (approx. 37.5g) can achieve the effect. When pathogens are consolidated in the chest and below the heart (epigastrium), Xiaoxianzhong Tang (Small Trap-Resolving Decoction) is used for purgation. When pathogens are consolidated in the chest and hypochondrium extending to below the heart, Dachaihu Tang (Major Bupleurum Decoction) is used for purgation. When pathogens are consolidated above the umbilicus, Xiao Chengqi Tang (Minor Order the Qi Decoction) is used for purgation. When pathogens are consolidated at the umbilicus and below the umbilicus, Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is used for purgation. When symptoms such as stuffiness, fullness, dryness, and solidity are present, with consolidation throughout the Three Jiaos, Da Chengqi Tang (Major Order the Qi Decoction) is used for purgation. Additionally, for patients with inherent constitutional deficiency, the elderly, those with chronic illnesses, or those who have undergone repeated sweating or purging, where purgative indications are present but they cannot tolerate harsh purgation, Mahuan Wan (Hemp Seed Pill), Mi Jian Dao Method (Honey Suppository Method), and Zhu Dan Dao Method (Pig Gallbladder Suppository Method) are excellent choices.

The lightness, heaviness, slowness, and urgency of the purgative method are always determined by the specific syndrome manifestations, which are detailed below.

Urgent Purgation Syndromes: Dry tongue, curled tongue, short tongue, prickles on the tongue surface, black tongue, dry teeth, nostrils appearing sooty like smoke-coal, abdominal distension and pain, mania, lethargy/coma, fever with profuse sweating, cold body, hiccups.

Indications for Timely Purgation: Yellow tongue coating, delirium (Zhenyu), amnesia, excessive talking, diarrhea accompanied by fever (Xie Re Li), head distension and pain, irritability, restlessness.

Mild Purgation Syndromes: Pale yellow tongue coating, slight thirst, constipation, yellow-red urine, tidal fever, dry teeth.

If the above mild purgation syndromes are not treated with purgation, they will inevitably worsen and transform into timely purgation syndromes. If timely purgation syndromes are treated with mild purgation, they will inevitably worsen and transform into urgent purgation syndromes. If urgent purgation syndromes miss the window for purgation, subsequent purgation will likely fail to clear the bowels. This leads to stagnant heat reversing upward from below, causing distension extending to the epigastrium, then reversing upward through the diaphragm, resulting in chest fullness hard as stone, sawing sounds in the throat, fixed gaze with scleral exposure, blindness, dilated pupils, deafness, and blockage of all nine orifices. At this stage, even divine medicines cannot save the patient. Furthermore, there are other purgative methods for blood accumulation (Xu Xue) and water accumulation (Xu Shui), which have been mentioned scatteredly in previous sections; here they are listed in detail for easy reference.

Water Accumulation Syndrome: Difficult urination, slight loose stools.

Blood Accumulation Syndrome: Normal urination, black stools. Other conditions involving water or blood accumulation in the chest and hypochondrium do not require purgation and are not elaborated upon here.