时疫初起，项强酸兼发热，乃邪越于太阳经也，羌活为主。狂躁正盛而项强者，热壅其经脉也，石膏、黄芩为
主。屡经汗、下，发热已退而复项强者，血燥而筋无养也，四物、六味为主。外此若伤寒发痉之项强，亡阳漏风
之项强，则又有仲景之法在。
时疫初起，背痛兼发热者，邪浮于太阳也，羌活为主。背痛而胀，兼胸胁胀者，邪客募原也，草果、浓朴、
槟榔、莱菔子、大腹皮为主。屡经汗、下后，发热已退，背痛不止者，经脉血亡也，六味、生脉、四物为主。又有
平素劳倦内伤而背痛在膏肓二穴者，当于东垣内伤诸论察之。（肓音荒。）
时疫初起，腰痛兼发热者，太阳受病也，独活为主。兼胀者，气滞也，加槟榔。兼重者，夹湿也，加苍术。牵
引少腹及两胁者，气滞血瘀也，加青皮、乌药、赤芍、元胡，兼理气血，疏通肾肝。此皆初起实证治法。
又有即夹肾虚阴伤者，腰痛独甚于周身，兼酸萎无力。若尺脉无力，后来传变必危，当于初起在表时，加
人参、知母、生地，预顾其阴则危殆差减。若徒用伐邪之品，邪之深入者未必去，而阴液大伤，则昏沉、舌黑、
直视、失尿诸证见，阴伤气脱，则厥逆证见。盖腰乃肾府，为先天根本，腰痛则肾虚，不可不察。要知此时疫初
起，腰痛尚有虚实之分。若汗、下后而见腰痛，其为肾虚，不待言矣。宜六味、四物，不可疏通。
In the early stage of epidemic pestilence (Epidemic Pestilence), if there is stiffness and soreness in the neck accompanied by fever, it indicates that the pathogen has invaded the Taiyang Meridian (Taiyang Channel Disease); Qianghuo (Notopterygii Rhizoma et Radix) is the principal herb. If mania and restlessness are at their peak along with neck stiffness, it is due to heat obstructing the meridians; Shigao (Gypsum Fibrosum) and Huangqin (Scutellariae Radix) are the principal herbs. After repeated sweating and purging treatments, if the fever has subsided but neck stiffness recurs, it is due to blood dryness causing malnourishment of the sinews; Siwu Tang (Four Substances Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) are the principal formulas. Apart from these, for neck stiffness caused by spasm in Cold Damage (Shanghan) or by Yang collapse and wind leakage, the methods of Zhang Zhongjing are applicable.
In the early stage of epidemic pestilence, if back pain is accompanied by fever, it indicates that the pathogen is floating on the Taiyang Meridian; Qianghuo (Notopterygii Rhizoma et Radix) is the principal herb. If back pain is accompanied by distension, along with chest and hypochondriac fullness, it indicates that the pathogen has lodged in the Mu Yuan (Membranous Origin); Caoguo (Tsaoko Fructus), Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), Laifuzi (Raphani Semen), and Dafupi (Tangerine Pericarpium Cum Spina) are the principal herbs. After repeated sweating and purging treatments, if the fever has subsided but back pain persists, it indicates that the blood in the meridians has been depleted; Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Shengmai San (Generate the Pulse Powder), and Siwu Tang (Four Substances Decoction) are the principal formulas. Additionally, for those who suffer from internal injury due to chronic fatigue and overwork, resulting in pain in the Gohuang acupoints (Bleak Bladder area), one should consult Li Dongyuan’s various treatises on internal injuries. ("Huang" is pronounced like "Huang".)
In the early stage of epidemic pestilence, if lower back pain is accompanied by fever, it indicates that the Taiyang Meridian is affected; Duhuo (Angelicae Pubescentis Radix) is the principal herb. If accompanied by distension, it indicates Qi stagnation; add Binglang (Arecae Semen). If accompanied by heaviness, it indicates dampness; add Cangzhu (Atractylodis Rhizoma). If the pain radiates to the lower abdomen and both hypochondria, it indicates Qi stagnation and Blood stasis; add Qingpi (Citri Reticulatae Pericarpium Viride), Wuyao (Linderae Radix), Chishao (Paeoniae Radix Rubra), and Yuanhu (Corydalis Rhizoma), to regulate Qi and Blood and unblock the Kidney and Liver meridians. These are all treatment methods for excess patterns in the early stage. There are also cases where Kidney deficiency and Yin injury are simultaneously present; the lower back pain is more severe than anywhere else in the body, accompanied by soreness, flaccidity, and weakness. If the Chi pulse (Kidney pulse) is weak, subsequent progression of the disease will be critical. In the early stage when the pathogen is still in the exterior, add Renshen (Ginseng Radix), Zhimu (Anemarrhenae Rhizoma), and Shengdi Huang (Rehmanniae Radix Preparata) to preemptively protect the Yin, thereby reducing the severity of the crisis. If only drugs that attack the pathogen are used, the deeply seated pathogen may not be eliminated, while the Yin fluids will be severely damaged, leading to symptoms such as lethargy, black tongue coating, fixed gaze, and urinary incontinence. When Yin injury leads to Qi collapse, signs of cold extremities (Jue Ni) will appear. The waist is the residence of the Kidney and the root of congenital constitution; lower back pain indicates Kidney deficiency, which must be carefully examined. It must be understood that even in the early stage of epidemic pestilence, lower back pain can be distinguished into excess and deficiency patterns. If lower back pain appears after sweating or purging, it is undoubtedly due to Kidney deficiency. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Siwu Tang (Four Substances Decoction) are appropriate; unblocking and draining methods should not be used.