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Typhoid fever (Shanghan) and plague (Wenyi) are both conditions caused by external pathogenic invasions. Only those with sufficient internal righteous Qi (Zhengqi, the body's resistance to disease) can repel them. Even if infection occurs, since pathogens cannot overcome righteous Qi, although illness ensues, it causes no harm. The most feared scenario involves individuals with deficient internal righteous Qi, where righteous Qi fails to overcome pathogens, allowing pathogens to penetrate deeply due to deficiency, causing immense harm. Hence it is said: "Typhoid fever tends to injure those with lower jiao deficiency." Moreover, nowadays many people are weak, while few are strong and robust. If one encounters typhoid fever complicated by deficiency and fails to rapidly rescue the root (Yuanqi, primordial qi), survival rates would be extremely low. Thus, texts on typhoid state: "Yang syndromes presenting with Yin pulses indicate death." This is because Yin pulses signify deficiency. To distinguish this, pulse diagnosis is primary, supplemented by physical signs and symptoms, ensuring accuracy. Generally, when encountering external heat symptoms of typhoid, if the pulse appears weak, floating and empty, and powerless upon both light and heavy pressure, it indicates a deficiency syndrome. This is difficult to manage and absolutely contraindicates purgative or attacking methods. Even if sweating is desired, sweat will be hard to produce. Any slight sweat produced would merely be forced out from the skin pores (Couli) through coercion, not generated by the smooth circulation of Ying (Nutritive) and Wei (Defensive) Qi. Ignoring deficiency versus excess and coercing sweating too severely will lead to exhaustion of Middle Qi (Zhongqi, spleen and stomach qi), resulting in immediate peril.

However, treating deficiency requires assessing the severity of the deficiency. In cases of moderate deficiency, tonification should be the main approach, combined with dispersing pathogens. In cases of severe deficiency, treating the pathogen is entirely inappropriate; instead, focus solely on protecting the root. Protecting the root means preserving life; once life is preserved, Yuanqi will gradually recover, either after seven days, fourteen days, or even twenty days in severe cases. Once Yuanqi prevails, pathogens will collapse without direct attack, leading to resolution through profuse sweating. To recognize this sign, observe the pulse: if a weak pulse becomes stronger, a small pulse becomes larger, a wiry pulse becomes slippery, and a tight pulse becomes relaxed, it indicates that profuse sweating is about to occur, signaling impending recovery.

When employing tonification, examine the chest and diaphragm. If there is stagnation in the chest and abdomen, tonification is contraindicated. Young individuals with robust Qi and blood should not be tonified. If Qi is inherently deficient but there is no stagnation in the chest and abdomen, tonification may be used boldly. Furthermore, if there is no internal heat pathogen and the patient generally responds well to warming herbs, or if Qi movement is obstructed, warming the Stomach (Wei) must be added before tonifying. Tonics act more effectively when warmed, and pathogens dissipate faster with warmth. It is crucial not to mix in cooling herbs that consume Qi, as this would dilute the warming and tonifying power. If initially exposed to cold pathogens, and true deficiency signs are present with difficulty in dispersing pathogens, herbs like Ren Shen (Ginseng Root) and Shu Di Huang (Prepared Rehmannia Root) should be used immediately at the start of treatment; earlier is better. Hesitation allows pathogens to deepen their invasion, becoming harder to control. This is the optimal method for treating deficiency-type pathogens. I have saved many lives using this method.

It is often heard that ignorant practitioners claim "tonification is contraindicated in typhoid." They fail to understand that tonification supports the Middle Jiao (Zhongjiao, digestive system), which is equivalent to supporting the interior. Just as cold pathogens are like thieves coming from outside, and Yuanqi is like citizens guarding the inside, strengthening the citizens strengthens the interior, which in turn defends against the exterior. The secret to preserving life lies in this strategy. How could tonification trap pathogens? Such absurd errors mislead people gravely. I elaborate here to supplement the incomplete discussion on tonification in typhoid treatments. As practice increases, its efficacy becomes apparent. From now on, many will undoubtedly benefit from my advice and survive.

1. For typhoid patients with inherent essence and blood deficiency, or insufficient Yang within Yin, presenting with fine, weak pulses and aversion to cold, it is essential to strongly assist True Yin (Zhenyin). This allows Yang to emerge from Yin, enabling rapid resolution of exterior pathogens. Li Yin Jian (Cinnamon Twig and Rehmannia Decoction) added with Chai Hu (Bupleurum Root) and Ma Huang (Ephedra Herb), or modified according to symptoms, is most effective. If, after seven or eight days of typhoid, the pulse is rapid yet powerless, accompanied by mental confusion, fatigue, or restlessness, and neither dispersing nor clearing methods work, large doses of Li Yin Jian should be administered. It is a miraculous formula for restoring life. If both Qi and Blood are deficient and pathogens persist, mild tonification is indicated, primarily using Wu Fu Yin (Five Blessings Decoction), modified as needed. Da Bu Yuan Jian (Great Tonify Origin Decoction), Liu Wu Jian (Six Ingredients Decoction), or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) are also applicable. If Spleen-Stomach Middle Qi is weak with persistent pathogens, Si Jun Zi Tang (Four Gentlemen Decoction) modified is suitable. If Middle Qi deficiency involves Spleen Cold, or is accompanied by vomiting/nausea, Wu Jun Zi Jian (Five Gentlemen Decoction) or Wen Wei Yin (Warm Stomach Drink) should be used. If labor and fatigue damage the Spleen, causing cold pathogens to sink inward with persistent fever requiring ascending dispersion, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is appropriate. If cold pathogens sink into the Yin aspect, with Blood deficiency preventing outward expression requiring ascending dispersion, Bu Yin Yi Qi Jian (Tonify Yin and Augment Qi Decoction) is indicated. For Yin deficiency with fever, red face, thirst, irritability, and a floating, surging yet powerless pulse, large doses of Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) should be given, often curing after one dose. For Middle Qi deficiency-cold with unresolved exterior pathogens, or long-term medication aversion, or ineffectiveness of other drugs, Du Shen Tang (Single Ginseng Decoction) is recommended. Regardless of concentration or temperature, it can be taken frequently like tea, day after day without interruption, allowing Ying Qi to gradually recover and pathogens to recede. This has great curative power; do not neglect it.

2. The use of tonification in typhoid differs from purgative or dispersing methods. Purgatives and dispersants remove excess pathogens; their action is potent and rapid. For instance, Chai Hu and Ma Huang typically show effects within two to three doses; Da Huang (Rhubarb Root) and Mang Xiao (Mirabilite) within one dose. Failure in these cases usually stems from improper usage, not overuse. Conversely, tonification addresses deficiency; its action is gentle and slow. Although some see results in one or two doses, it is common for chronic depletion of Qi and Blood to require prolonged treatment for recovery. Observe whether the patient tolerates tonification or if pulse/symptoms show slight improvement; this indicates the tonic is taking effect. Mild cases may take two to three doses; severe cases may require ten-plus doses before sweating occurs, pathogens retreat, and recovery happens. Without understanding this, expecting rapid results in one or two doses leads to doubt, interference from quacks, and abandonment of therapy. This principle must be deeply understood.