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The ancient formulas such as Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity), Sanhuang Tang (Three Yellows Decoction), Liangge San (Cooling the Chest Powder), and Xiexin Tang (Drain the Heart Decoction) were not used because the ancients favored cold medicines, but rather because their constitutions were robust; thus, using these remedies incurred no risk of damaging the middle jiao with cold, yet achieved the merit of subduing excess fire. Modern individuals possess thinner constitutions, inferior to those of the ancients, and further suffer from depletion due to excessive indulgence. If one employs strongly bitter and cold agents, how could the body withstand them? Moreover, the fire of plague arises from pathogenic factors; once the pathogens are dispersed, the fire naturally subsides. If strongly cold agents are used to directly suppress the fire, there is no capacity to expel pathogens, but rather one first suffers the harm of cold injury. Cold causes stagnation in both the exterior and interior, making it difficult to resolve the pathogens. In summary, strongly bitter and cold herbs such as Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Longdancao (Gentianae Radix), and Kushen (Sophorae Flavescentis Radix) should all be used with caution. The addition or subtraction of herbs like Shengdi Huang (Rehmanniae Radix), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Yuan Shen (Scrophulariae Radix), Danpi (Moutan Cortex), Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Yinhua (Lonicerae Flos), Xijiao (Rhinocerotis Cornu), Maogen (Imperatae Rhizoma), Zhuli (Bambusa Textilis Caulis Juice), Tongbian (Infantis Urine), Gegen (Puerariae Lobatae Radix), Shigao (Gypsum Fibrosum), and Renzhonghuang (Human Medicated Soil) is sufficient to clear heat and drain fire with ample margin. If, based on profound insight, the use of Huanglian and similar herbs is deemed indispensable, the dosage should be minimal, measured in fen (0.1 tael) for small amounts or qian (3.73 grams) for larger ones, and must not be excessive.

One might ask: Since strongly bitter and cold agents are contraindicated, why are San Chengqi Tang (Three Draining Qi Decoctions) and Baihu Tang (White Tiger Decoction) used in treating plague? The answer is: Although Shigao (Gypsum Fibrosum) is strongly cold, it contains yang within yin. Its nature is cool yet dispersing; its acridity induces sweating and releases the muscle layer, effectively driving out the vexatious heat caused by warm summerheat, generating fluids, and quenching thirst. Its sweetness moderates the spleen and excels at clearing fire from the lung and triple burner, making it a crucial herb for the Yangming channel. It is suitable for conditions such as manic delirium, yellowish macules, blood rising due to fire pressure, deep-seated heat, and constipation. One should merely choose between raw or calcined forms according to the severity of the disease. Dahuang (Rhei Radix et Rhizoma) is strongly cold and slightly toxic, yet it promotes the elimination of old matter and generation of new, moving freely without staying fixed. For plague symptoms such as manic delirium, yellowish macules, delirious speech, dry impaction, and blood stasis, this herb is indispensable for removal. Fearing its harshness, prepared Dahuang is preferred. As for Mangxiao (Natrii Sulfas), although it is a drastic agent, materia medica praises its efficacy in dispelling epidemic heat, and its ability to soften hardness and break up accumulations cannot be replaced by other herbs. However, compared to Shigao and Dahuang, its use requires greater prudence. Given the evident functions of Dahuang and Shigao, how different are they from those possessing only cold and stagnant properties! This is indeed indispensable for those treating plague.