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Plague diseases rarely occur without thirst, therefore it is essential to discuss this. When the pathogenic factor is in the exterior, there is no thirst; when it is in the interior, there is thirst. Although the Three Yang meridians may also present with thirst, it is not as severe as in the Three Yin meridians. Thus, Taiyin disease (disease of the Foot-Taiyin Spleen meridian) manifests as abdominal fullness and dry throat; Shaoyin disease (disease of the Foot-Shaoyin Kidney meridian) manifests as dry mouth and tongue with thirst; Jueyin disease (disease of the Foot-Jueyin Liver meridian) presents as Xiao Ke (excessive drinking and urination). This is because internal heat consumes body fluids. Thirst in plague diseases is solely due to heat: early transmission involves mild heat and mild thirst, while deep transmission involves severe heat and severe thirst. However, there are no cases of isolated thirst without accompanying symptoms. In treatment, one must first ask whether the patient desires cold or hot drinks, and whether they wish to drink large or small amounts. (Drinking large amounts of cold beverages indicates a Heat syndrome.) One must also examine the location of the disease in terms of exterior/interior, meridians, and zang-fu organs, and whether sweating or purging has already been performed. Within the context of the initial stage of plague, the Nine Transmissions, and the Six Meridians treatment methods, carefully analyze the symptoms and pulse, and deliberate on the medication. By treating the plague pathogen, the thirst will naturally resolve. If ineffective, one should refer to the sections on thirst in Shanghan Lun (Treatise on Cold Damage) for treatment strategies. The most crucial point is to ensure that water intake remains insufficient, never excessive. If one drinks excessively despite minimal thirst, it can lead to palpitations, limb stagnation, asthma, coughing, dysphagia (Yi), hiccups, distension, diarrhea, and difficulty in urination. However, one must not prohibit drinking. In plague cases where the patient desires water as recovery approaches, it is because water harmonizes Stomach Qi and facilitates resolution through sweating. Prohibiting drinking often leads to severe restlessness and death.

Although plague generally belongs to Heat syndromes, abdominal pain can differ between Cold and Heat, with Heat being the norm and Cold the variation. Cold-type abdominal pain usually has specific causes: excessive consumption of cooling medicines, inappropriate use of cooling medicines, indulgence in raw and cold foods, or contracting cold after sweating or purging depletes healthy Qi. It can also result from emotional anger causing Qi stagnation or food retention. Spontaneous pain without cause is rare. Even if it occurs, it is likely triggered by pre-existing abdominal accumulations due to the plague. To test abdominal pain, offer cool water. If pain alleviates slightly after drinking, it indicates a Heat pattern; if pain intensifies severely, it indicates a Cold pattern. Pain around the umbilicus, accompanied by hard stool, irritability, thirst, coarse breathing, and chest oppression, indicates Dry Feces and Excess Heat; urgently use Chengqi Tang (Cinnamon Twig and Rhubarb Decoction) or similar formulas to purge. For pain due to food retention, accompanied by aversion to food, nausea, and foul belching, the treatment is similar. Lower abdominal pain with free urination, black stools, and yellowing of the body and eyes indicates Blood Stasis; treat with cold-natured herbs combined with blood-invigorating agents until black material is expelled, then self-heal. Excess Heat pain always presents with a deep, forceful pulse. If the pulse is weak, careful examination is required, and treatment should be gradual. If pain worsens after drinking water, or presents as continuous mild pain that does not cease but improves with pressure, accompanied by borborygmus, clear and cold diarrhea, and bitter saliva, this is Cold pain; treat with warming herbs to harmonize. If harmonization fails and symptoms progress to cold limbs, vomiting, and diarrhea, urgently use hot herbs to rescue. (This is rare in plague; if present, it is likely due to overconsumption of cold medicines/foods leading to cold contraction.) Carefully assess the pulse strength. Abdominal pain accompanied by high fever, aversion to drinking, vomiting, and borborygmus sounding like flowing water indicates Exterior Heat and Interior Cold; warm the interior first, then release the exterior.