时疫之舌，一见黄苔盒饭下，失下则由黄而变酱色、变燥、变黑、变生芒刺；再失下，则变卷、变短，为下证
至急之际，宜大下屡下方和，缓则不救。
时疫胸满而不痛者，为邪未结，为无形之气，稀薄之痰。痛而不满者，为病在经络，有虚有实，有虚
实相兼。满而痛者，为邪已结，须分痰、食、血以施治。
属无形之气者，按之不痛，时疫初起，邪在募原，多有此证，宜达原饮加枳、桔、木香、大腹皮以开豁之。属
稀薄之痰者，时疫二、三日，邪在半表半里，多有此证，宜达原饮加半夏、莱菔子，或小柴胡汤加莱菔子。
病在经络，痛而不满者，初起属实，于解表药中加延胡、乌药，舒其经络之气血。病久屡经汗、下多虚，于养
气血药中倍当归。更有虚中夹实者，于解表清里药中加乳香、没药最妙。
满而痛不可按，邪已结矣。痰结者，牵引窜痛，兼呕，小陷胸汤、大柴胡汤，或二方合用，甚则大陷胸汤、
大陷胸丸。食结者，硬痛成块，不可按，多在心下，宜平胃散加枳实，苏子、莱菔子、白芥子。亦有在膈上者，为
危证，当吐之，宜瓜蒂散。此二者不可便下，须待其转动方可下之。盖结在上焦属气分，下之太急则气逆呕吐，外
用按揉之法为妙。血结者不可按，按之软，脉芤、涩、弦，宜于解表清里药中加桃仁、红花、三七、归尾，甚则桃仁
承气汤。时疫多实多热，至胸膈满痛，又属实邪，非虚证。惟是屡经攻下，胸痛更甚者，乃脾肾两虚，下气上
逆，宜温理脾胃，以建中镇安之，甚则导火归元，纳气归肾皆可。然不多见，须消息斟酌，不可轻试。
The tongue manifestation of epidemic febrile disease: once a yellow coating is observed, purgation (Purgation) should be employed immediately. If purgation is delayed, the coating will change from yellow to sauce-colored, become dry, turn black, and develop prickles; if purgation is further delayed, the tongue will curl and shorten, indicating an urgent need for purgation. At this critical juncture, strong purgative formulas should be administered repeatedly; otherwise, if treatment is slow, recovery will be impossible.
In epidemic febrile disease, chest fullness without pain indicates that the pathogenic factor has not yet consolidated; it is due to formless Qi stagnation or thin phlegm. Pain without fullness indicates the disease is in the meridians and collaterals, which can be deficiency, excess, or a combination of both. Fullness accompanied by pain indicates that the pathogenic factor has consolidated, requiring differentiation into phlegm consolidation, food retention, or blood stasis for treatment.
When caused by formless Qi stagnation, there is no pain upon pressure. In the early stage of epidemic febrile disease, when the pathogen is at the Mo Yuan (Membrane Source), this syndrome is common. It is suitable to use Da Yuan Yin (Reach the Original Decoction) added with Zhi Qiao (Aurantii Fructus), Jie Geng (Platycodonis Radix), Mu Xiang (Aucklandiae Radix), and Da Fu Pi (Arecae Pericarpium) to open and disperse the Qi. When caused by thin phlegm, typically on the second or third day of epidemic febrile disease when the pathogen is between the exterior and interior, this syndrome is common. It is suitable to use Da Yuan Yin (Reach the Original Decoction) added with Ban Xia (Pinelliae Rhizoma) or Lai Fu Zi (Raphani Semen), or Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Lai Fu Zi (Raphani Semen).
When the disease is in the meridians and collaterals, presenting as pain without fullness, the early stage is usually excess. Add Yan Hu Suo (Corydalis Rhizoma) and Wu Yao (Linderae Radix) to exterior-resolving formulas to soothe the Qi and Blood in the meridians. After prolonged illness and repeated sweating and purging, deficiency often prevails; increase the dosage of Dang Gui (Angelicae Sinensis Radix) in tonifying Qi and Blood formulas. For cases of deficiency mixed with excess, adding Ru Xiang (Olibanum) and Mo Yao (Myrrha) to exterior-resolving and interior-clearing formulas is most effective.
Fullness with pain that cannot tolerate pressure indicates consolidation of the pathogen. In phlegm consolidation, pain radiates and shifts, accompanied by vomiting. Use Xiao Xian Xiong Tang (Minor Sinking into the Chest Decoction) or Da Chai Hu Tang (Major Bupleurum Decoction), or a combination of both; in severe cases, use Da Xian Xiong Tang (Major Sinking into the Chest Decoction) or Da Xian Xiong Wan (Major Sinking into the Chest Pill). In food retention consolidation, hard painful masses are present, intolerable to pressure, mostly located in the epigastrium. Use Ping Wei San (Peaceful Stomach Powder) added with Zhi Shi (Aurantii Fructus Immaturus), Su Zi (Perillae Fructus), Lai Fu Zi (Raphani Semen), and Bai Jie Zi (Sinapis Semen). If located above the diaphragm, it is a critical condition requiring emesis; use Gua Di San (Melon Tip Powder). These two types (phlegm and food) should not be treated with immediate purgation; one must wait for signs of downward movement before purging. Since consolidation in the Upper Jiao belongs to the Qi level, aggressive purgation may cause Qi rebellion and vomiting; external massage is advisable. In blood stasis consolidation, pressure is intolerable but feels soft upon palpation, with Kou, Se, or Xian pulses. Add Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), San Qi (Notoginseng Radix et Rhizoma), and Dang Gui Wei (Angelicae Sinensis Radix Cauda) to exterior-resolving and interior-clearing formulas; in severe cases, use Tao Ren Cheng Qi Tang (Tao Ren Bowel-Regulating Decoction).
Epidemic febrile diseases are predominantly excess and heat syndromes. Chest and diaphragm fullness and pain constitute excess pathogens, not deficiency. However, if chest pain worsens after repeated purgation, it indicates deficiency of the Spleen and Kidney with rebellious descending Qi. Warm and regulate the Spleen and Stomach to establish the Middle Jiao and stabilize the body; in severe cases, guiding fire back to its source or drawing Qi back to the Kidney may be used. Such cases are rare and require careful consideration; do not experiment lightly.