Library

If a plague persists for six or seven days without resolution, leading to heat entering the Blood Chamber (Blood Chamber: a concept in TCM referring to the uterus and related blood dynamics), jaundice, a body color resembling smoke-stained yellow-black, golden-yellow eyes, dry mouth, and internal heat accumulation, one should use a Bian stone (Bian Stone: an ancient surgical tool made of stone) to prick the Quchi (Quchi: LI11, Hegu point on the Large Intestine meridian) acupoint to release foul blood. Simultaneously administer Tongsheng San (Tongsheng San: A Universal Relief Powder), which acts to both disperse the exterior and purge the interior. If the patient sweats out fluid resembling yellow water and passes stool like black paste, the disease will be cured. This is what is called "Da Han" (Da Han: A local northern term for a specific plague treatment method) in the north. The method involves rubbing both arms with hands to gather blood in the arms, binding them tightly with cloth, then using chopsticks to hold the sharp edge of a porcelain fragment to strike and pierce the large collaterals beside the Quze (Quze: PC3, Pericardium 3) acupoint in the elbow, allowing the pathogenic toxin to exit with the foul blood. This is also a very swift method, extremely effective when used by the poor, although it does not refer to the Quchi acupoint.

Songfeng said: When plague pathogens transmit inward, the heat toxin is deep and severe. Symptoms include delirium, mania, unconsciously grasping at clothes and beds, picking at empty air or imaginary threads, eyes red as fire, appearing drunk or dazed, climbing high places to sing, discarding clothes and running. Locally this is called "Hou'er Bing" (Hou'er Bing: Monkey Disease, a folk name for severe plague symptoms). One can dip small dates in burning wine and perform Guasha (Guasha: Scraping therapy) over the whole body. When Sha (Sha: Petechiae or congestion marks appearing on the skin after scraping) appears, its color is purple-red; those that rise high resemble dates or chestnuts. Then use needles to release foul blood, often achieving efficacy. This is another type of acupuncture method.

Generally, treating plague is not suitable for inducing sweating. The Classics state: "Those who do not feel aversion to cold but instead feel thirsty have Warm Disease." This clarifies that the heat originates from within and reaches outward. Plagues differ in whether they injure Qi, Blood, or Stomach, hence the manifestations vary, and treatments differ slightly. If pathogens enter the Zang organs, the patient will lose consciousness and die. The general principle is to follow symptoms as the standard, rather than relying solely on pulse diagnosis.

Songfeng said: Pathogens entering the Zang organs causing unconsciousness do not necessarily lead to immediate death. It is just more difficult to treat than when pathogens are in the meridians. This statement applies to all three types of plagues.

Humans exist within the intersection of Heaven and Earth's Qi, like fish in water. Not even a trace of impurity can be tolerated. If lime were splashed into rivers and lakes, or oil poured into ponds, few fish would survive. Similarly, how could humans infected with epidemic Qi be any different?

"Epidemic" (Yi) means everyone in the population falls ill. It is named "Yi" because it is considered a disaster caused by "Li Gui" (Li Gui: Leprous ghosts/pathogenic spirits).

Songfeng said: "Yi" is like corvée labor (forced service), implying that every household along the street is affected. In Shandong custom, children getting smallpox is called "Dang Cha" (Dang Cha: Taking up a post/duty), which carries the same meaning as corvée labor.

Heaven and Earth's intent is to generate life. Cold, Heat, Warmth, and Coolness cycle through eternally unchanged. Humans living within this system fall ill upon contact only because their daily routines lack regularity, diet is unregulated, leading to Qi deficiency and physical weakness, thus offending themselves. It is not the fault of cold or heat. If cold and heat were lethal energies that caused illness upon mere contact, humanity would have perished long ago. Is this the intent of Heaven and Earth to generate life? As for climates occurring out of season, calling them "Abnormal Qi" (Abnormal Qi: Climate contrary to the season) is acceptable, but calling them "Epidemic Qi" is incorrect. Why? Because with Abnormal Qi, some people get sick while others do not; it cannot be generalized. However, Epidemic Qi affects everyone regardless of status, wealth, age, gender, or constitution, spreading door-to-door and village-wide, leaving no one exempt. This occurs only during times of war, famine, and drought.

The treatment of plague diseases should favor cool dispersal. However, this is only applicable if there are heat symptoms in both the exterior and interior. If exterior pathogens have not yet resolved, even if the exterior feels hot as fire, but there are no internal heat symptoms to justify it, cool medicines must not be used indiscriminately.

Songfeng said: Misusing hot medicines might still be salvageable, but misusing cool medicines kills as surely as wielding a blade. The saying goes: "Ginger and Cinnamon Twig Decoction may fail to cure, but Huangqin and Scutellaria Root will work appropriately." Why isn't it said the reverse? This clearly indicates that wrongly using cool medicines for Cold Damage (Cold Damage: Diseases caused by cold pathogens) is incurable. Although plague belongs to pathogenic heat, there are times when cool medicines are unsuitable; dosage must still be cautious.

Winter warmth occurring out of season, or illnesses caused by ministerial fire guest-heat, is named "Winter Warmth" (Winter Warmth: Warm disease occurring in winter). It differs greatly from true Cold Damage in winter. The treatment should favor cool resolution, which is "discarding the season to follow the symptoms." If cold occurs in summer, warming treatment is similarly appropriate.

Songfeng said: Wu Keyi criticized the concept of "Winter Warmth," but claiming there is absolutely no warmth in winter is incorrect. Therefore, one should discard the season and follow the symptoms.

Cold Plague is sudden severe cold from the weather, differing in severity from the extreme cold of winter. Seasonal Qi is naturally the epidemic Qi of heaven's movement, distinct from cold plague. Plague diseases often arise from steam and vapor in mountains and marshes.

Songfeng said: There was also heat plague in winter. My relative, Zi Bingjin, suddenly suffered wandering pain in his limbs during deep winter. My treatment for Zhou Bi (Zhou Bi: Wandering Bi syndrome) failed. He self-medicated with Yin Hua (Jin Yin Hua/Honeysuckle Flower), Cao Jie (Bamboo Nodes), Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), Jing Jie (Schizonepeta Spike), Bo He (Mint Leaf), Sang Zhi (Mulberry Twig), Huang Qin (Scutellaria Root), Zhi Zi (Gardenia Fruit), and Sheng Di (Rehmannia Root), adjusting cooling, dispersing, and detoxifying herbs. After taking thirty to forty doses, he recovered. Later I heard many others suffered similar symptoms, realizing this too was a plague.

Seasonal Qi is the violent epidemic Qi of heaven's movement, contracted not due to cold. Treatment should focus on dispelling epidemic Qi and supporting healthy Qi. If unresolved for many days, with pathogenic heat transforming into mixed symptoms, one should select treatments from the sections on Cold Damage transformation symptoms.

The Classics state: "Those who do not store essence in winter will suffer plague in spring." The tenth month corresponds to Hai, and the eleventh to Zi. Fire Qi lies dormant. One should nourish True Qi to serve as the root for spring generation. If one recklessly harms the body during this time, when spring arrives and Yang Qi floats lightly, plague will inevitably occur. These two months constitute the year's period of deficiency. Additionally, the period before the first quarter moon and after the last quarter moon, when the moon is waning or absent, represents a monthly deficiency. Wind, haze, thunder, lightning, extreme cold/heat, solar/lunar eclipses, sorrow, anger, fear, grief, drunkenness, overeating, fatigue, and exhaustion represent daily deficiencies. During these times, can one neglect nurturing Harmony with Nature and avoiding sexual activity?

Warm-Heat diseases arise from external contraction and internal injury, stirring stagnant fire to emerge from within to the exterior. Initially, both exterior and interior are hot, requiring cool dispersing agents to clear heat from both levels. Over time, exterior heat becomes mild while interior heat intensifies, requiring bitter-cold agents like Chengqi Decoction (Chengqi Decoction: A class of purgative formulas including Dahuang Chengqi Tang) to purge. Then heat recedes, the body cools, and the disease resolves. (If mistaken for immediate Cold Damage and treated with Ma Huang (Ma Huang: Ephedra Herb) and other acrid-warm agents to release the exterior, internal heat will worsen, leading to macules, jaundice, and mania. Or if Chengqi Decoction is used to purge the interior without first resolving the exterior with acrid-cool agents, exterior heat remains while chest binding and deficiency bloating appear.)

Songfeng said: It is already understood that plague should not be mistaken for immediate Cold Damage treated with Ma Huang. I once experienced a severe plague outbreak where patients' symptoms were largely similar, generally requiring cool dispersing and purging agents. One patient had symptoms of fever, body ache, headache, and stiffness, with a slow and tight pulse, identical to true winter Cold Damage. I administered Ma Huang to release the exterior, resulting in sweating and resolution. I realized then that treating disease requires flexibility and non-rigidity, whether in plague or miscellaneous diseases.

All untreatable or difficult cases of Cold Damage and plague belong to deficiency of the Lower Yuan (Lower Yuan: Kidney and Essence). (Songfeng notes: This happens occasionally, but not always.) In family transmissions, because there is a sick person at home, causing morning and evening worry, reduced food intake leads to Qi depletion. Contracting the pathogenic Qi via nose and mouth requires clearing the Yangming channel, relieving stagnation, and managing consumption injuries as key priorities. (Songfeng notes: Do not take this sentence literally. Emphasize the word 'simultaneously'.)

Songfeng said: More than ten members of my family once contracted plague, infecting each other. I lived among the sick, ate little, and worried constantly, yet avoided infection. Once, I entered an infected house and fell ill immediately. Seeking the cause, I recalled that during that time, their whole family was sick, and I had been busy all day. That night, sleeping alone in a room, I burned a piece of Jiangzhen Xiang (Jiangzhen Xiang: Aquilaria Agallocha Wood). Perhaps this helped.

One must not fixate on a single formula for plague, as plague has no fixed pattern.

In the Three Yang syndromes of Cold Damage and plague, Yangming syndromes are often present. the Hand-Yangming channel belongs to the Large Intestine, paired with the Lung, opening at the nose. the Foot-Yangming channel belongs to the Stomach, paired with the Spleen, opening at the mouth. Since pathogens enter via mouth and nose, Yangming involvement is common. Pathogens in the Three Yang should be expelled quickly; delay leads to rotting stomach and macules. If transmitting inward to the Three Yin, intense heat depletes Yin fluids, making it untreatable. This is the fault of delayed treatment.

Displacement of Yin and Yang, and mistiming of cold and heat, generate epidemics.

Plagues often arise from human actions attracting heavenly Qi movements. When Qi mechanisms invade and Earthly Qi responds, combining the toxic vapors of Heaven, Earth, and Humanity, plague forms.

Treating warm-heat epidemics contraindicates acrid-hot medicines; cool, acrid-sweet, and bitter-cold medicines are preferred.

Zhang Zhongjing's texts, recovered and edited by Wang Shuhe, contain some forced interpretations. Cheng Wuji's commentary further confused winter Cold Damage formulas with Warm-Summer applications, causing harm to this day. Warm-Summer diseases have their own formulas, now lost. Hence Song Longmen sighed that *Shanghan Lun* is incomplete.

Forcing food on plague patients or giving cold drinks to the sick is what laypeople consider "nourishing," but what good physicians consider causing disease.

Seasonal epidemics first enter the Stomach, so Yangming Stomach medicines are commonly used.

Damp-heat seasonal toxins enter via mouth and nose, transmitting to Yangming, where pathogen and healthy Qi contend. Yin excess causes aversion to cold; Yang excess causes high fever. Entering joints causes whole-body pain; rising to head and face causes swelling, named Da Tou Wen (Da Tou Wen: Big Head Plague/Mumps-like plague).

Among the categories of Summer-Heat, Dampness, and Heat, Ren Shen Bai Du San (Ren Shen Bai Du San: Ginseng and White Tiger Powder) is ranked first. When three evils combine, they are hard to resist; their mutual transmission creates plague. The formula uses acrid-ping substances, plus powerful Ren Shen (Ren Shen: Panax Ginseng Root) to support righteousness and expel evil. Patients taking two to three doses daily ensure no plague pathogen remains. How delightful! Yet vulgar doctors remove Ren Shen, differing from other formulas.

"Epidemic" (Yi) means "Li" (pestilence). Pathogenic Qi spreads, harming people like grinding damages objects. "Yi" also means "Yi" (service/corvee). Ghosts perform service, never stopping.

When treating plague, first observe the patient's eyes, then the tongue and mouth, then press the chest, heart, and lower abdomen for pain, ask about bowel/bladder function, thirst, previous medications, duration, and examine the pulse accurately. Only when pulse and symptoms match can one predict outcome and prescribe safely. These steps are crucial physician skills.

Treating summer warm-heat, heat, and epidemic diseases contraindicates acrid-hot medicines. Use acrid-cool, clear-sweet, bitter-cold agents like Sheng Ma (Cimicifugae Rhizome), Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), Bo He (Menthae Haplocalycis Herba), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Lian Qiao (Forsythiae Fructus - *Note: Text says Qin Lian, usually Huang Qin and Huang Lian*), Zhi Zi (Gardeniae Fructus), Bai Zhu (Atractylodis Macrocephalae Rhizome - *Note: Text says Bo, likely Huang Bo*), Gan Cao (Licorice Root), and Shao Yao (Paeoniae Radix).

For Li Yi (Leprosy/Epidemic), Dou Zhen (Smallpox/Rash), Fa Ban (Macule eruption), and Re Du (Heat Toxin), lying on cool, damp earth releases coolness and draws out toxins, reducing suffering by half. Earth's utility is profound; wise men extrapolate from this.

Epidemics must be differentiated by seasonal cold/heat/dryness/dampness, adapting to time. For prolonged drought and heat plague, avoid drying agents. For prolonged rain and cold plague affecting Spleen Earth with dampness, avoid moistening agents.

Pathogens enter from outside; deficiency constitutions are deeply affected. When using diaphoretic or purgative methods to expel evil, one must first protect Original Qi. Thus, warming dispersal, warming tonification, counter-treatment, and following-treatment methods must be known.

Often, mistakenly purging the interior in warm-heat diseases causes little harm, but mistakenly releasing the exterior causes unpredictable changes, proving heat originates internally and moves outward.

Wei Xuting said: This proves plague has no rationale for diaphoresis. Regarding "purging interior causes little harm," emphasize the word "little."

Heavenly and earthly epidemic Qi, commonly called "Heng Bing" (Heng Bing: Horizontal/Sudden Illness), is often ignored with the belief that it will resolve on its own, leading to many premature deaths. Treat illness immediately to break the toxic vapor and recover. Do not let pathogenic Qi attack freely, waiting passively for death.

People mistakenly identify plague as Cold Damage, calling Cold Damage a scholar's term and Tianxing Plague a peasant's slang. This error is severe.

Epidemic Qi mixes pathogen and righteous Qi; if pathogen exceeds righteousness, it is critical. Bitter-cold medicines damage the Stomach; warm-tonifying medicines assist the pathogen. Ren Zhong Huang (Ren Zhong Huang: Human Waste Carbon) is most appropriate.

Plague is Heavenly pathogenic Qi. If human righteous Qi is solid, pathogens cannot interfere. Prevention lies in moderating desire and labor, and not enduring hunger to inhale pathogenic Qi. Expelling methods include: "From Tian Pin (Tian Pin: Nose, literally 'Heaven Nostril'), return to where it came. Qi exits the brain, thus not interfering with pathogens." Tian Pin refers to the nose, receiving Heaven's Qi. Plague Qi comes from emptiness and should leave through emptiness, i.e., "Qi exits the brain." Sneezing, flaring nostrils to vent, or breathing fresh air rapidly to replace stale air allows pathogen exit via nose, dispersing toxic vapor. This is expelling evil externally. Also, visualize the heart like the sun (see earlier). Gallbladder belongs to Shaoyang, the official of justice; strong Qi here strengthens organ Qi, preventing invasion. This is strengthening the center to resist evil. Knowing these methods protects one even in foul places. Male pathogen exits via mouth; female via anterior yin. When sitting/standing opposite, know orientation, move calmly, and enter observing position for best results.

Treat plague by differentiating Upper, Middle, and Lower Jiao. Nasal Qi connects to Heaven; mist/dew pathogens are Clear Evil. Entering Yang via nose causes fever, headache, stiff neck, and convulsions, matching folk names Da Tou Wen (Big Head Plague) and Xia Ma Wen (Toad Plague). Oral Qi connects to Earth; soil/water pathogens are Turbid Evil from food/drink. Entering Yin via mouth/tongue causes internal trembling, cold feet/knees, involuntary urination/defecation, heavy sensation in clear stool (likely tenesmus), abdominal drawing pain, and colic pain, matching Jiao Chang Wen (Intestinal Twisting Plague) and Ruan Jiao Wen (Soft Leg Plague). Pathogens from mouth/nose first settle in Middle Jiao, then distribute upper/lower. Untreated, Stomach becomes turbid, Ying and Wei block, blood coagulates, manifesting in Middle Jiao as Gua Rang Wen (Melon Rind Plague) and Ge Da Wen (Lump Plague), resembling Yang Du abscess pus or Yin Du full-body cyanosis. These are Jiao-localized pathogens. If Jiao pathogens mix, blocking interior/exterior, organ Qi steams, Upper Jiao stagnates, causing mouth ulcers and gum erosion. If Wei Qi flows forward, driven by heat, roaming channels/organs, it causes abscesses. If Ying Qi flows forward, inviting guest pathogens, sneezing, throat obstruction, and heat stagnation cause bloody stool like pig liver. Fortunately, if Ying/Wei gradually connect, it is not critical. If Upper Yang and Lower Yin disconnect, Spleen Qi cannot operate alone, five fluids pour down, Lower Yin fails to close, and life is endangered. Pre-treatment involves drinking aromatic righteous Qi medicines to prevent entry. If entered, expel evil. Upper Jiao is like mist; lift and expel, adding detoxification. Middle Jiao is like fermentation; dredge and expel, adding detoxification. Lower Jiao is like a drain; drain and expel, adding detoxification. Once Ying/Wei connect, pursue and extract evil forcefully, preventing hidden proliferation, achieving perfection.

Plague pathogens travel the central pathway, distributing through Jiao. Upper Jiao is Clear Yang, so Clear Evil enters from above. Lower Jiao is Turbid Yin, so Turbid Evil enters from below. Middle Jiao is the boundary of Yin/Yang; Clear/Turbid evils partition here. Severe cases mix all three Jiao; extreme upward movement goes down, extreme downward goes up. Thus, throat obstruction and mouth ulcers (Upper Jiao symptoms) may coincide with bloody stool like pig liver (Lower Jiao symptoms). It is not that Upper/Middle misses Lower, or Middle/Lower misses Upper.

Zang Luxi said: Refer to these two sections together.

Cold penetrating clears fire and can also release the exterior. When Yang hyperactivity and Yin decline cause fire excess and water deficiency, water dries in channels, how can sweat form? Like a dry, cracked red pot, where does moisture come? Adding water creates abundant steam and rising heat. Sweat originates from water, similarly. Using cool medicines to save water generates water, ensuring sweat production.

Tonifying internally can also release the exterior. Internal Qi deficiency cannot reach the exterior; without tonifying Qi, how can muscles relax? Weak or powerless pulses, or short pulses at Cun positions, indicate this symptom. Internal Blood deficiency cannot transform fluids; without tonifying Essence, how can sweat generate? Floating, hollow, or empty pulses, or rootless pulses at Chi positions, indicate this symptom. Tonification is good, but must be carefully weighed and applied correctly. Wrongful tonification traps evil, causing great harm.

Plague has two entry paths, three exit paths, and five treatment methods. What are the two entry paths? One is Heavenly: e.g., Spring should be warm but is cold. This is abnormal Qi; humans contract it, entering via meridians causing headache, fever, cough, swollen parotids, and big head plague. The other is Human: mutual transmission, pathogens enter via mouth/nose causing aversion to cold, high fever, chest oppression, and vomiting yellow saliva. These are the two entry paths. What are the three exit paths? Heavenly plague entering via meridians should be differentiated by cold/heat, using acrid-warm or acrid-cool medicines to disperse evil (e.g., Xiang Su San, Pu Ji Xiao Du Yin), allowing exit via meridians. Human plague entering via mouth/nose should use aromatic medicines to resolve filth (e.g., Shen Zhen Zheng Qi San), allowing exit via mouth/nose. Pathogens from meridians/mouth-nose transmitting to organs, causing tidal fever, delirium, abdominal fullness/pain, indicate toxic vapors returning inward. Dredging intestines/stomachs begins detoxification, requiring purgation. If bowels move, clear heat. If residual heat remains after purgation, clear heat. These are the three exit paths. What are the five treatment methods? Dispersing, Resolving Filth, Clearing Middle, Purging Downward, and Prudent Tonification. These are the five methods.

Songfeng said: This section is quite reasonable, so recorded. Changed "tonify" to "prudent tonify" because plague tonification should only be considered as Wu Keyi stated for "Four Deficiencies unable to be treated directly." If tonification is inappropriate and used rashly, trapping evil, the harm is incalculable.

Also said: I have collected books and observations regarding plague, compiling them over time. Sources were often uncited to avoid criticism of omission, aiming only to benefit medicine, not to display erudition. Above records precise words; below records historical facts.

Doctor Zhao from Tongxiang visited a patient, returned at dusk, rain imminent. Saw a low house with flickering light, rain started, knocked for shelter. A woman answered: "Men are not here, inconvenient to stay." Doctor begged to sleep under eaves, agreed. Near midnight, woman opened door, invited him in. Doctor declined politely, woman insisted strongly, seeking intimacy. Doctor saw dim blue lamp and ice-cold hands, realized it was a ghost, wanted to flee. Woman grabbed his neck, pressed mouth to his. Suddenly she retched: "This person ate raw garlic and liquor, how can such stench approach me?" She entered. Doctor fled in rain. Ten days later, passing the low house, found it was a lone grave.

Songfeng said: This shows liquor and garlic are indispensable during plague prevalence.

Chen Yizhong dreamed a spirit said: "Heavenly disasters spread, many die of plague, only taking Da Huang (Rhei Radix et Rhizoma) saves life." He showed this to people. When plague struck, many survived by taking Da Huang.