头痛目痛，颇似伤寒。然太阳阳明头痛，不至于倾侧难举。而此则头痛如劈，两目昏瞀，势若难支。总因火毒达于
二经，毒参阳位，用釜底抽薪法，彻火下降，其痛立止，其疹自透。宜清瘟败毒饮增石膏、元参，加菊花。误用辛凉表
散，燔灼火焰，必转闷证。
骨节烦疼，腰如被杖。骨与腰皆肾经所属，其痛若此。是淫热之气，已流于肾经。宜本方增石膏、元参，加黄柏。
误用温散，死不终朝矣。
热宜和，不宜躁。若热至遍体炎炎，较之昏沉肢冷者。而此则发扬，以其气血尚堪胜毒，一经清解，而疹自透。妄
肆发表，必至内伏。宜本方增石膏、生地、丹皮、芩、连。
有似乎静而忽躁，有似乎躁而忽静，谓之静躁不常。较之颠狂，彼乃发扬，而此嫌郁遏。总为毒火内扰，以至坐卧
不安。宜本方增石膏、犀角、黄连。
寤，从阳主上；寐，从阴主下。胃为六腑之海，热毒壅遏，阻隔上下，故火扰不寐。宜本方增石膏、犀、连，加琥
珀。
雄按∶火扰不寐，何必琥珀？若欲导下，宜用木通。
初病周身如冰，色如蒙垢，满口如霜，头痛如劈，饮热恶冷，六脉沉细。此阳极似阴，毒之隐伏者也。重清内热，
使毒热外透，身忽大热，脉转洪数，烦躁谵妄，大渴思冰。证虽枭恶，尚可为力。宜本方增石膏、丹皮、犀、连，加黄
柏。若遇庸手，妄投桂、附，药不终剂，死如服毒。
四肢属脾，至于逆冷，杂证见之。是脾经虚寒，元阳将脱之象。惟疫则不然，通身大热，而四肢独冷。此烈毒郁遏
脾经，邪火莫透。重清脾热，手足自温。宜本方增石膏。
雄按∶四肢逆冷，在杂证，不仅脾经虚寒。在疫证，亦非毒壅脾经。增石膏，原是清胃。胃气行则肢自和也。亦有
热伏厥阴而逆冷者，温疫证中最多，不可不知也。
筋属肝，赖血以养，热毒流于肝经，斑疹不能寻窍而出，筋脉受其冲激。则抽惕若惊。宜本方增石膏、丹皮，加胆
草。
杂证，有精液枯涸，水不上升，咽干思饮，不及半杯。而此则思冰饮水，百杯不足。缘毒火熬煎于内，非冰水不足
以救其燥，非石膏不足以制其焰。庸工犹戒生冷，病家奉为至言，即温水亦不敢与。以致唇焦舌黑。宜本方增石膏，加
花粉。
四时百病，胃气为本。至于不食，似难为也。而非所论于疫证，此乃邪火犯胃，热毒上冲，频频干呕者有之。旋食
旋吐者有之。胃气一清，不必强之食，自无不食矣。宜本方增石膏，加枳壳。
雄按∶热壅于胃，杳不知饥，强进粥糜，反助邪气。虽粒米不进，而病势未衰者，不可疑为胃败也。若干呕吐食，
则本方之甘、桔、丹皮，皆不可用。宜加竹茹、枇杷叶、半夏之类。
胸膈乃上焦心肺之地，而邪不易犯。惟火上炎，易及于心，以火济火，移热于肺，金被火灼，其燥愈甚。胸膈郁遏，
而气必长吁矣。宜本方增连、桔、加枳壳、蒌仁。
雄按∶邪火上炎，固能郁遏肺气，而为膈满，第平素有停痰伏饮者。或起病之先，兼有食滞者。本方地、芍，未可
浪投。临证须辨别施治，惟芦菔汁，既清燥火之闭郁，亦开痰食之停留。用得其宜，取效甚捷。
昏闷无声者，心之气出于肺而为声。窍因气闭，气因毒滞，心迷而神不清。窍闭而声不出。宜本方，增石膏、犀角、
芩、连，加羚羊角、桑皮。
雄按∶桑皮虽走肺，而无通气宣窍之能。宜用∶马兜铃、射干、通草之类；清神化毒，当参紫雪之类。
胃气弱者，偏寒偏热，水停食积，皆与真气相搏而痛，此言寻常受病之源也。至于疫证腹痛，或左或右，或痛引小
肠，乃毒火冲突，发泄无门。苦按寻常腹痛分经络而治之，必死。如初起只用败毒散、或凉膈散加黄连，其痛立止。
雄按∶疫证腹痛，固与杂证迥殊，然夹食、夹瘀、夹疝，因病疫而宿疾兼发者，亦正多也。临证处方，岂可不为顾
及。
筋肉 动，在伤寒则为亡阳，而此则不然。盖汗者，心之液，血之所化也。血生于心，藏于肝，统于脾。血被煎熬，
筋失其养，故筋肉为之 动。宜本方增石膏、生地、元参，加黄柏。
雄按∶亡阳 动，宜补土制水。淫热 动，宜泻火息风。本方尚少镇静息风之品，宜去丹、桔，加菊花、胆草。
病患自言胃出冷气，非真冷也。乃上升之气，自肝而出，中挟相火，自下而上，其热尤甚。此火极似水，热极之征，
阳亢逼阴，故有冷气。宜本方增石膏、犀、地、丹、连，加胆草。
雄按∶冷气上升，虽在别证中见之，亦多属火。不知者，妄投温热。贻害可胜道哉！本方桔、芍，亦属非宜。更有
挟痰者，须加海蜇、竹沥、芦菔汁之类。汪按∶此证挟痰者最多。
口中臭气，令人难近，使非毒火熏蒸于内，何以口秽喷人乃尔耶。宜本方增石膏、犀、连。
雄按∶宜加兰草、竹茹、枇杷叶、金银花、蔷薇露、莹白、金汁之类，以导秽浊下行。
舌苔满口如霜，在伤寒为寒证的据，故当温散。而疫证见此，舌必浓大，为火极水化。宜本方增石膏、犀、地、翘、
连，加黄柏。误用温散，旋即变黑。汪按∶凡温热暑疫，见此舌者，病必见重最宜详慎。
雄按∶凡热证疫证见此苔者，固不可误指为寒，良由兼痰挟湿，遏伏热毒使然，清解方中，宜佐开泄之品为治。
咽喉者，水谷之道路，呼吸之出入。毒火熏蒸，至于肿痛，亟当清解以开闭塞。宜本方增石膏、元、桔，加牛蒡、
射干、山豆根。
雄按∶加莹白、金汁最妙。药汁碍咽者，亟以锡类散吹之。
唇者，脾之华。唇 肿，火炎土燥也。宜本方增石膏、翘、连，加天花粉。
头为诸阳之首，头面肿大，此毒火上攻。宜本方增石膏、元参，加银花、马勃、僵蚕、板蓝根、紫花地丁、归尾。
脉实者，量加，酒洗生大黄。
面上燎 ，宛如火烫，大小不一，有红有白，有紫黑相间，痛不可忍，破流清水，亦有流血水者，治同上条。
腮者，肝肾所属，有左肿者，有右肿者，有右及左、左及右者，名曰 腮。不亟清解，必成大头，治同上条。
颈属足太阳膀胱经，热毒入于太阳则颈肿。宜本方增石膏、元参、翘、桔，加银花、夏枯草、牛蒡、紫花地丁、山
豆根。
耳后肾经所属，此处硬肿，其病甚恶。宜本方增石膏、元、地、丹、翘，加银花、花粉、板蓝根、紫花地丁。耳中
出血者，不治。
雄按∶坎为耳，故耳为肾水之外候。然肺经之结穴在耳中，名曰龙葱，专主乎听。金受火烁则耳聋。凡温热暑疫等
证，耳聋者，职是故也。不可泥于伤寒少阳之文，而妄用柴胡以煽其焰。古云∶耳聋治肺，旨哉言乎。
舌乃心之苗。心属火，毒火冲突，二火相并，心苗乃动，而嗒舌弄舌。宜本方增石膏、犀、连、元参，加黄柏。
雄按∶宜加木通、莲子心、朱砂、童溺之类。
红丝绕目，清其浮僭之火而红自退。误以眼科治之，为害不浅。宜本方加菊花、红花、蝉蜕、归尾、谷精。
雄按∶加味亦是眼科之药，不若但加羚羊角、龙胆草二味为精当也。
头为一身之元首，最轻清而邪不易干。通身焦燥，独头汗涌出。此烈毒鼎沸于内，热气上腾，故汗出如淋。宜本方
增石膏、元参。
雄按∶本方宜去芍、桔、丹皮，加童溺、花粉。
齿者，骨之余。杂证 齿为血虚；疫证见之，为肝热。宜本方增石膏、生地、丹、栀，加胆草。
雄按∶齿龈属阳明，不可全责之肝也。
疫证，鼻衄如泉，乃阳明郁热上冲于脑，脑通于鼻，故衄如涌泉。宜本方增石膏、元、地、芩、连，加羚羊角、生
桑皮、棕榈灰。
雄按∶本方宜去桔梗，加白茅根。
舌上白点如珍珠，乃水化之象。较之紫赤黄黑，古人谓之芒刺者，更重。宜本方增石膏、犀、连、元、翘，加花粉、
银花。
雄按∶宜加蔷薇根、莹白、金汁之类。
疫证初起，苔如腻粉，此火极水化。设误认为寒，妄投温燥，其病反剧，其苔愈浓，精液愈耗，水不上升，二火煎
熬，变白为黑，其坚如铁，其浓如甲，敲之戛戛有声，言语不清，非舌卷也。治之得法，其甲整脱。宜本方增石膏、元
参、犀、连、知、翘，加花粉、黄柏。
雄按∶此证专宜甘寒以充津液，不当参用苦燥。余如梨汁、蔗浆、竹沥、西瓜汁、藕汁，皆可频灌。如得蕉花上露
更良。杨云∶蕉花上露为清热无上妙品，但不可必得。即蕉根取汁，亦极妙也。若邪火已衰，津不能回者。宜用鲜猪肉
数斤，切大块，急火煮清汤，吹净浮油，恣意凉饮，乃急救津液之无上妙品。故友范庆簪，尝谓余云∶酷热炎天，正银
匠熔铸各州县奏销银两之时。而银炉甚高，火光扑面，非壮盛之人，不能为也。口渴不敢啜茗，惟以淡煮猪肉，取汤凉
饮，故裸身近火，而津液不致枯竭。余因推展其义，颇多妙用，拙案中可证也。
舌上发丁，或红或紫，大如马乳，小如樱桃，三五不等，流脓出血，重清心火。宜本方增石膏、犀角、翘、连加银
花。舌上成坑，愈后自平。此二条乃三十六舌未有者。
雄按∶亦宜加蔷薇根、金汁之类；外以锡类散，或珍珠，牛黄研细糁之。则坑易平。
舌衄乃血热上溢心苗。宜本方增石膏、黄连、犀、地、栀、丹，加败棕灰。
雄按∶外宜蒲黄炒黑糁之。
齿衄乃阳明少阴二经之热相并。宜本方增石膏、元参、芩、连、犀、地、丹、栀，加黄柏。心主神，心静则神爽。
心为烈火所燔，则神不清而谵语。宜本方增石膏、犀、连、丹、栀，加黄柏、胆草。
雄按∶须参叶氏《温热论》逆传治法。且此证挟痰者多，最宜谛审。
呃逆，有因胃热上冲者，有因肝胆之火上逆者，有因肺气不能下降者。宜本方增石膏，加竹茹、枇杷叶、柿蒂、羚
羊角、银杏仁。如不止，用沉香、槟榔、乌药、枳壳，各磨数分，名四磨饮，仍以本方调服。
雄按∶此三候固皆实证，尚有痰阻于中者，便秘于下者，另有治法。银杏仁，温涩气分，但可以治虚呃，不宜加入
此方。
邪入于胃则吐，毒犹因吐而得发越，至于干呕则重矣。总由内有伏毒、清解不容少缓。宜本方增石膏、甘、连，加
滑石、伏龙肝。
雄按∶甘草宜去，伏龙肝，温燥之品，但可以治虚寒呕吐，不宜加入此方。本方桔梗、丹、芍，亦当去之。可加旋
覆花、竹茹、半夏、枇杷叶。如用反佐，则生姜汁为妥。汪按∶此方中生姜不可少。
疫毒移于大肠，里急后重，赤白相兼，或下恶垢，或下紫血，虽似痢实非痢也。其人必恶寒发热，小水短赤，但当
清热利水。宜本方增石膏、黄连，加滑石、猪苓、泽泻、木通，其痢自止。误用通利止涩之剂不救。
雄按∶热移大肠，恶垢既下，病有出路，化毒为宜。既知不可通利，何以仍加苓、泽等利水？毋乃疏乎。惟滑石用
得对证，他如金银花、槐蕊、黄柏、青蒿、白头翁、苦参、芦菔之类，皆可采也。
毒火注于大肠，有下恶垢者，有利清水者，有倾肠直注者，有完谷不化者。此邪热不杀谷，非脾虚也。较之似痢者，
稍轻。考其证，身必大热，气必粗壮，小溲必短，唇必焦紫，大渴喜冷，腹痛不已，四肢时而厥逆。宜因其势而清利之。
治同上条。
雄按∶唇焦大渴，津液耗伤，清化为宜，毋过渗利。惟冬瓜煮汤代茶、煎药，恣用甚佳。汪按∶此及上条皆宜用绿
豆。疫证大便不通，因毒火煎熬，大肠枯燥不能润下。不可徒攻其闭结而速其死也。宜本方加生大黄，或外用蜜煎导法。
汪按∶此证宜用麻仁。邪犯五脏，则三阴脉络不和，血乖行度，渗入大肠而便血。宜本方增生地，加槐花、柏叶、棕灰。
雄按∶棕灰温涩，即欲止之，宜易地榆炭。
膀胱热极。小溲短赤而涩，热毒甚者，溲色如油。宜本方加滑石、泽泻、猪苓、木通、通草、扁蓄。
雄按∶苓、泽等药，皆渗利之品。溺阻膀胱者，借以通导，此证既云热毒内炽，则水已耗夺，小溲自然浑赤短涩，
但宜治其所以然，则源清而流洁，岂可强投分利，而为砻糠打油之事乎？或量证少佐一二味，慎毋忽视而泛施也。
溺血，小便出血而不痛。血淋，则小腹阴茎必兼胀痛。在疫证，总由血因热迫。宜本方增生地，加滑石、桃仁、茅
根、琥珀、牛膝、棕灰。
雄按∶设兼痛胀，忌用棕灰。汪按∶亦宜用地榆炭。
发狂骂詈。不避亲疏，甚则登高而歌，弃衣而走，逾垣上屋，力倍常时。或语生平未有之事，未见之人，如有邪附
者，此阳明明邪热，上扰神明，病患亦不自知。僧道巫尼，徒乱人意。宜本方增石膏、犀、连、丹、栀，加黄柏。
雄按∶宜加朱砂、青黛，挟痰，加石菖蒲、竹沥之类。
疫证之痰，皆属于热，痰中带血，热极之征。宜本方增石膏、芩、地，加蒌仁、羚羊角、生桑皮、棕灰。
雄按∶桑皮、棕灰可商，宜加滑石、桃仁、苇茎、瓜瓣之类。
疫证遗溺，非虚不能约，乃热不自持。其人必昏沉谵语，遗不自知。宜本方增石膏、犀、连，加滑石。诸病喘满，
皆属于热，况疫证乎。宜本方增石膏、黄芩、加桑皮、羚羊角。
Headache and eye pain resemble Taiyang-Shanghan (Taiyang Cold Damage). However, headaches in the Taiyang and Yangming meridians do not reach the severity of making the head tilt and difficult to lift. In this disease, the headache is splitting, the eyes are dim and blurred, and the condition seems unbearable. This is primarily due to fire-toxin reaching these two meridians, with toxicity affecting the Yang regions (head and face). The treatment should employ the "pulling wood from under the cauldron" method (clearing heat from the source) to drive the fire downward; the pain will stop immediately, and the rash will naturally emerge. Use Qingwen Baidu Yin (Plague-Dispelling Toxin-Resolving Decoction) with increased doses of Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix), plus Juhua (Chrysanthemi Flos). Misusing acrid-cool diaphoretics will stoke the flames, inevitably leading to a "Men Zheng" (internal closure syndrome).
Bone joints are vexingly painful, and the waist feels as if beaten by a staff. Bones and the waist belong to the Kidney Meridian; such severe pain indicates that licentious heat has flowed into the Kidney Meridian. Use the same formula with increased Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix), plus Huangbai (Phellodendri Cortex). Misusing warm dispersants will lead to death within half a day.
Heat should be harmonized, not agitated. If heat causes blazing throughout the body, compared to cases of lethargy and cold limbs, this condition's heat radiates outward because the Qi and Blood can still withstand the toxin. Once cleared and resolved, the rash emerges naturally. Recklessly using diaphoretic agents will cause internal retention of heat. Use the same formula with increased Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Huangqin (Scutellariae Radix), and Lianzi (Coptidis Rhizoma).
Some patients appear calm but suddenly become irritable, or appear irritable but suddenly calm, termed "irregular calmness and agitation." This differs from mania; mania involves radiant heat, whereas this condition involves suppressed heat. It is generally due to internal disturbance by toxic fire, causing restlessness in sitting and lying. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma).
Awakening belongs to Yang and rises; sleeping belongs to Yin and descends. The Stomach is the sea of the Six Fu Organs. Heat-toxin obstruction blocks the upper and lower, causing fire disturbance and insomnia. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma), plus Hupo (Succinum).
Wang Shihiong notes: For insomnia caused by fire disturbance, why use Succinum? To guide heat downward, use Mutong (Akebiae Caulis).
In the early stage, the whole body feels like ice, complexion is dull and grimy, the mouth feels frosted, headache is splitting, there is a desire for hot drinks but aversion to cold, and the six pulses are deep and fine. This is extreme Yang resembling Yin, with hidden toxin. Heavy clearing of internal heat is needed to allow toxic heat to emerge externally. The body suddenly becomes very hot, pulses turn surging and rapid, accompanied by irritability, delirium, and extreme thirst for ice. Although the condition is fierce, it is still treatable. Use the same formula with increased Shigao (Gypsum Fibrosum), Danpi (Moutan Cortex), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma), plus Huangbai (Phellodendri Cortex). If treated by incompetent physicians who recklessly administer Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata), death will occur before the dose is finished, as if poisoned.
The limbs belong to the Spleen. Limb cold reversal in miscellaneous diseases indicates Spleen deficiency-cold and impending collapse of Yuan-Yang. However, plague is different: the whole body is hot, yet only the limbs are cold. This is fierce toxin suppressing the Spleen Meridian, preventing evil fire from penetrating. Heavy clearing of Spleen heat will naturally warm the hands and feet. Use the same formula with increased Shigao (Gypsum Fibrosum).
Wang Shihiong notes: Limb cold reversal in miscellaneous diseases is not solely due to Spleen deficiency-cold. In plague, it is also not due to toxin blocking the Spleen Meridian. Increasing Shigao (Gypsum Fibrosum) originally clears Stomach heat. When Stomach Qi moves, limbs harmonize. There are also cases of cold reversal due to heat latent in the Jueyin Meridian, which is most common in warm plague, and this must be known.
Tendons belong to the Liver and rely on blood for nourishment. Heat-toxin flowing into the Liver Meridian prevents macules and rashes from emerging through pores. The tendons and vessels are impacted, causing twitching and惊惕 (startle/fright). Use the same formula with increased Shigao (Gypsum Fibrosum) and Danpi (Moutan Cortex), plus Longdancao (Gentianae Radix).
In miscellaneous diseases, dry fluids and lack of water rising cause dry throat and desire to drink, but less than half a cup is consumed. Here, the patient desires ice water, drinking hundreds of cups is insufficient. This is because toxic fire boils internally; only ice water can save the dryness, and only Shigao (Gypsum Fibrosum) can control the flame. Quacks warn against raw/cold foods, and patients heed this, even refusing warm water, leading to cracked lips and black tongue. Use the same formula with increased Shigao (Gypsum Fibrosum), plus Huafen (Trichosanthis Radix).
The Stomach Qi is the root of all diseases in the four seasons. Not eating seems difficult, but this does not apply to plague. This is due to evil fire invading the Stomach and heat-toxin rushing upward, causing frequent dry retching or immediate vomiting after eating. Once Stomach Qi is cleared, food intake will resume without force. Use the same formula with increased Shigao (Gypsum Fibrosum), plus Zhike (Aurantii Fructus).
Wang Shihiong notes: Heat congestion in the Stomach causes loss of appetite. Forcing congee aids evil. Even if no food is taken, if the pathogen remains strong, do not doubt Stomach failure. If there is dry retching and vomiting, Gancao (Glycyrrhizae Radix), Jiegeng (Platycodonis Radix), and Danpi (Moutan Cortex) in the main formula should be omitted. Add Zhuru (Bambusae Caulis in Taenia), Pipayye (Eriobotryae Folium), and Banxia (Pinelliae Rhizoma).
The chest and diaphragm are the territory of the Upper Jiao Heart and Lung, where evil rarely attacks. Only fire ascending easily affects the Heart. Fire aiding fire transfers heat to the Lung. Metal scorched by fire becomes drier. Chest-diaphragm suppression causes sighing. Use the same formula with increased Lian (Huanglian/Coptidis Rhizoma) and Jie (Jiegeng/Platycodonis Radix), plus Zhike (Aurantii Fructus) and Louren (Trichosanthis Semen).
Wang Shihiong notes: Evil fire ascending suppresses Lung Qi, causing diaphragmatic fullness. However, in those with phlegm-fluid retention or food stagnation prior to onset, Dihuang (Rehmanniae Radix) and Shaoyao (Paeoniae Radix) in the main formula should not be used indiscriminately. Clinical differentiation is required. Radish juice clears dry-fire suppression and opens phlegm-food stagnation. Used appropriately, it is very effective.
Drowsiness and silence occur because Heart Qi exits through the Lung to produce sound. Orifices close due to Qi blockage; Qi stagnates due to toxin. Heart confusion leads to unclear spirit; orifice closure prevents voice. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma), plus Lingyangjiao (Saigae Tataricae Cornu) and Sangbaipi (Mori Cortex).
Wang Shihiong notes: Sangbaipi (Mori Cortex) enters the Lung but lacks the ability to open Qi and orifices. Use Madouling (Aristolochiae Fructus), Shegan (Belamcandae Rhizoma), and Tongcao (Tetrapanacis Medulla). For clearing spirit and resolving toxin, refer to Zixue San (Purple Snow Powder).
Weak Stomach Qi combined with cold/heat bias, water retention, and food stagnation fights with true Qi causing pain—this describes ordinary illness. Plague abdominal pain, varying in location or radiating to the small intestine, is due to toxic fire conflict with no outlet. Treating it like ordinary abdominal pain by meridian classification leads to death. Early use of Baidu San (Toxin-Dispersing Powder) or Liangge San (Cooling the Diaphragm Powder) plus Huanglian (Coptidis Rhizoma) stops pain immediately.
Wang Shihiong notes: Plague abdominal pain differs greatly from miscellaneous diseases, but cases complicated by food stagnation, blood stasis, or hernia triggered by plague are common. Prescriptions must consider these.
Muscle twitching in Shanghan indicates Yang collapse, but not here. Sweat is the fluid of the Heart, transformed from blood. Blood is born in the Heart, stored in the Liver, and controlled by the Spleen. Blood boiled by heat loses nourishment to tendons, causing twitching. Use the same formula with increased Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), and Xuanshen (Scrophulariae Radix), plus Huangbai (Phellodendri Cortex).
Wang Shihiong notes: Twitching from Yang collapse requires tonifying Earth to control Water. Twitching from licentious heat requires draining fire and extinguishing wind. The main formula lacks calming and wind-extinguishing herbs. Remove Danpi (Moutan Cortex) and Jiegeng (Platycodonis Radix); add Juhua (Chrysanthemi Flos) and Longdancao (Gentianae Radix).
Patients report cold air coming from the Stomach, but it is not truly cold. Rising Qi originates from the Liver, carrying Ministerial Fire upward, creating intense heat. This is "extreme fire resembling water," a sign of extreme heat. Yang hyperactivity forces Yin, creating a sensation of cold. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Huanglian (Coptidis Rhizoma), plus Longdancao (Gentianae Radix).
Wang Shihiong notes: Rising cold air, even in other conditions, often relates to fire. Ignorant practitioners wrongly use warm-hot herbs, causing great harm. Jiegeng (Platycodonis Radix) and Shaoyao (Paeoniae Radix) in the main formula are also unsuitable. For cases with phlegm, add Haizhe (Metardula), Zhuli (Bambusae Sap), and Radish juice. Wang An: Phlegm complication is most common here.
Foul breath repels others. Unless toxic fire steams internally, how could oral odor be so pungent? Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma).
Wang Shihiong notes: Add Lancao (Orchidaceae Herb), Zhuru (Bambusae Caulis in Taenia), Pipayye (Eriobotryae Folium), Yinhua (Lonicerae Japonicae Flos), Qiangweilu (Rose Dew), Yingbai (Calcitum), and Jinzhi (Gold Juice) to guide turbidity downward.
Tongue coating like frost across the mouth indicates cold in Shanghan, requiring warm dispersal. In plague, the tongue is thick and large, indicating extreme fire transforming into water. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Lianqiao (Forsythiae Fructus), and Huanglian (Coptidis Rhizoma), plus Huangbai (Phellodendri Cortex). Misusing warm dispersal turns it black quickly. Wang An: Severe attention is needed for warm-heat/plague with this tongue.
Wang Shihiong notes: Do not mistake this for cold. It is due to phlegm-dampness suppressing heat-toxin. Add opening-draining herbs to the clearing-resolving formula.
The throat is the pathway for food/water and respiration. Toxic fire steaming causes swelling/pain; urgent clearing/resolving is needed to open blockage. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), and Jiegeng (Platycodonis Radix), plus Niubangzi (Arctii Fructus), Shegan (Belamcandae Rhizoma), and Shandougen (Sophorae Tonkinensis Radix).
Wang Shihiong notes: Adding Yingbai (Calcitum) and Jinzhi (Gold Juice) is best. For difficulty swallowing medicine, spray Xilei San (Xilei Powder).
Lips are the bloom of the Spleen. Lip swelling indicates fire flaring and Earth dryness. Use the same formula with increased Shigao (Gypsum Fibrosum), Lianqiao (Forsythiae Fructus), and Huanglian (Coptidis Rhizoma), plus Tianhuafen (Trichosanthis Radix).
The head is the summit of all Yang. Head/face swelling is due to toxic fire attacking upward. Use the same formula with increased Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix), plus Yinhua (Lonicerae Japonicae Flos), Mabo (Macropodi Spore), Jiangcan (Bombyx Batryticatus), Banlangen (Isatidis Radix), Zihuadiding (Viola Yedoensis), and Guiwei (Angelicae Sinensis Radix).
If pulses are excess, add appropriate amount of Jiuxi Sheng Dahuang (Raw Rhubarb washed in wine).
Facial burns feel like scalding, varying in size, red/white/purple-black, unbearable pain, weeping clear or bloody fluid. Treatment is the same as above.
Swollen cheeks belong to Liver/Kidney. Left, right, or bilateral swelling is called "Zhaisai" (Mumps). Without urgent clearing/resolving, it develops into "Big Head Plague." Treatment is the same as above.
The neck belongs to the Foot-Taiyang Bladder Meridian. Heat-toxin entering Taiyang causes neck swelling. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), and Jiegeng (Platycodonis Radix), plus Yinhua (Lonicerae Japonicae Flos), Xiakucao (Prunellae Spica), Niubangzi (Arctii Fructus), Zihuadiding (Viola Yedoensis), and Shandougen (Sophorae Tonkinensis Radix).
Behind the ears belongs to the Kidney Meridian. Hard swelling here is severe. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Lianqiao (Forsythiae Fructus), plus Yinhua (Lonicerae Japonicae Flos), Huafen (Trichosanthis Radix), Banlangen (Isatidis Radix), and Zihuadiding (Viola Yedoensis). Ear bleeding is untreatable.
Wang Shihiong notes: Kan represents the ear, so the ear reflects Kidney Water. However, the Lung Meridian connects in the ear (Longcong), governing hearing. Metal scorched by fire causes deafness. Deafness in warm-heat/plague is due to this. Do not rigidly follow Shanghan Shaoyang texts and recklessly use Chaihu (Bupleuri Radix) to fan flames. Ancient saying: "Deafness treated via Lung" is profound.
The tongue is the sprout of the Heart. Heart is Fire. Toxic fire conflict merges two fires, moving the Heart sprout, causing tongue protrusion/manipulation. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), and Xuanshen (Scrophulariae Radix), plus Huangbai (Phellodendri Cortex).
Wang Shihiong notes: Add Mutong (Akebiae Caulis), Lianzixin (Nelumbinis Plumula), Zhusha (Cinnabaris), and Tongniao (Infantis Urine).
Red threads around eyes: Clear floating/excessive fire, redness recedes. Misusing ophthalmology treatments causes harm. Use the same formula adding Juhua (Chrysanthemi Flos), Honghua (Carthami Flos), Chantui (Cicadae Periostracum), Guiwei (Angelicae Sinensis Radix), and Gujingcao (Galeopsidis Herba).
Wang Shihiong notes: These additions are also ophthalmic herbs. Better to add only Lingyangjiao (Saigae Tataricae Cornu) and Longdancao (Gentianae Radix) for precision.
The head is the chief of the body, lightest and clearest, resisting evil. Whole-body dryness with only head sweating profusely indicates fierce toxin boiling internally, heat rising, causing sweat like rain. Use the same formula with increased Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix).
Wang Shihiong notes: Remove Shaoyao (Paeoniae Radix), Jiegeng (Platycodonis Radix), and Danpi (Moutan Cortex) from the main formula; add Tongniao (Infantis Urine) and Huafen (Trichosanthis Radix).
Teeth are the surplus of bone. Miscellaneous disease tooth issues indicate blood deficiency; plague indicates Liver heat. Use the same formula with increased Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Zhizi (Gardeniae Fructus), plus Longdancao (Gentianae Radix).
Wang Shihiong notes: Gums belong to Yangming; blame cannot be placed entirely on the Liver.
Plague epistaxis gushing like a spring is Yangming constrained heat rushing to the brain (connected to nose). Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Shengdi (Rehmanniae Radix), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma), plus Lingyangjiao (Saigae Tataricae Cornu), Sheng Sangbaipi (Fresh Mori Cortex), and Zongluhui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: Remove Jiegeng (Platycodonis Radix); add Baimaogen (Imperatae Rhizoma).
White pearl-like spots on the tongue indicate water transformation. Heavier than purple/red/yellow/black "thorn" tongues described by ancients. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Xuanshen (Scrophulariae Radix), and Lianqiao (Forsythiae Fructus), plus Huafen (Trichosanthis Radix) and Yinhua (Lonicerae Japonicae Flos).
Wang Shihiong notes: Add Qiangweigen (Rosae Laevigatae Radix), Yingbai (Calcitum), and Jinzhi (Gold Juice).
Early plague with greasy powder-like coating indicates extreme fire transforming into water. Mistaking for cold and using warm-dry herbs worsens the condition, thickens coating, consumes fluids, prevents water rising, and allows dual-fire boiling. White turns black, hard as iron, thick as armor, clattering when struck, speech unclear (not tongue curling). Proper treatment causes armor shedding. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Lianqiao (Forsythiae Fructus), plus Huafen (Trichosanthis Radix) and Huangbai (Phellodendri Cortex).
Wang Shihiong notes: This condition strictly requires sweet-cold herbs to replenish fluids; avoid bitter-dry herbs. Pear juice, sugarcane juice, bamboo sap, watermelon juice, lotus root juice can be frequently administered. Banana flower dew is excellent. Yang says: Banana flower dew is supreme for clearing heat but rare. Banana root juice is also good. If fire declines and fluids don't return, use fresh pork (several jin), boiled rapidly in clear soup, skimmed oil, drunk cold. This is supreme for emergency fluid rescue. Friend Fan Qingzan said: In extreme heat, silversmiths melt silver. High furnaces, facing fire, require robust health. Thirsty but avoiding tea, they drink cool pork broth, staying near fire without fluid depletion. I expanded this idea with many applications, proven in my cases.
Tongue carbuncles, red or purple, horse-milk to cherry sized, pus/blood discharge, requires heavy clearing of Heart fire. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Lianqiao (Forsythiae Fructus), and Huanglian (Coptidis Rhizoma), plus Yinhua (Lonicerae Japonicae Flos). Tongue pits flatten after healing. These two are new in 36-tongue diagnostics.
Wang Shihiong notes: Also add Qiangweigen (Rosae Laevigatae Radix) and Jinzhi (Gold Juice). Externally use Xilei San (Xilei Powder) or Pearl/Bovis Calculus powder. Pits heal faster.
Tongue bleeding is blood heat overflowing to the Heart sprout. Use the same formula with increased Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Zhizi (Gardeniae Fructus), and Danpi (Moutan Cortex), plus Baizonghui (Old Palm Fiber Ash).
Wang Shihiong notes: Externally use fried Black Puhuang (Lygodii Spora).
Tooth bleeding is combined heat of Yangming and Shaoyin meridians. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Zhizi (Gardeniae Fructus), plus Huangbai (Phellodendri Cortex).
Heart governs Spirit. Calm Heart brings clear Spirit. Heart scorched by fierce fire causes unclear Spirit and delirium. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Danpi (Moutan Cortex), and Zhizi (Gardeniae Fructus), plus Huangbai (Phellodendri Cortex) and Longdancao (Gentianae Radix).
Wang Shihiong notes: Refer to Ye Tianshi's "Warm Disease Treatise" for reverse transmission treatment. This condition often has phlegm; careful examination is vital.
Hiccups: Due to Stomach heat rushing up, Liver/Gallbladder fire reversing, or Lung Qi failing to descend. Use the same formula with increased Shigao (Gypsum Fibrosum), plus Zhuru (Bambusae Caulis in Taenia), Pipayye (Eriobotryae Folium), Shidi (Diospyri Fructus Pedunculus), Lingyangjiao (Saigae Tataricae Cornu), and Yinxingren (Ginkgo Seed). If persistent, use Chenxiang (Aquilariae Lignum Resinatum), Binglang (Arecae Semen), Wuyao (Linderae Radix), Zhike (Aurantii Fructus), ground finely (Simopo Yin), mixed with main formula.
Wang Shihiong notes: These three are excess patterns. Phlegm obstruction or constipation have different treatments. Yinxingren (Ginkgo Seed) is warm/astringent for Qi, suitable only for deficiency hiccups, not this formula.
Evil in Stomach causes vomiting; toxin can vent through vomiting. Dry retching is severe. Internal latent toxin requires urgent clearing/resolving. Use the same formula with increased Shigao (Gypsum Fibrosum), Gancao (Glycyrrhizae Radix), and Huanglian (Coptidis Rhizoma), plus Huashi (Talcum) and Fulonggan (Dragon's Liver).
Wang Shihiong notes: Remove Gancao (Glycyrrhizae Radix). Fulonggan (Dragon's Liver) is warm-dry, for deficiency-cold vomiting only, not this formula. Remove Jiegeng (Platycodonis Radix), Danpi (Moutan Cortex), Shaoyao (Paeoniae Radix). Add Xuanfuhua (Inulae Flos), Zhuru (Bambusae Caulis in Taenia), Banxia (Pinelliae Rhizoma), Pipayye (Eriobotryae Folium). For counteracting, Shengjiang汁 (Fresh Ginger Juice) is appropriate. Wang An: Ginger is essential here.
Plague toxin moving to Large Intestine causes tenesmus, red-white mixture, foul matter, or purple blood. Looks like dysentery but isn't. Patient has chills/fever, short/scanty urine. Clear heat and promote urination. Use the same formula with increased Shigao (Gypsum Fibrosum) and Huanglian (Coptidis Rhizoma), plus Huashi (Talcum), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), and Mutong (Akebiae Caulis). Dysentery stops. Misusing purgatives/astringents is fatal.
Wang Shihiong notes: Heat moving to Large Intestine with foul matter expulsion has an exit; resolve toxin. Why add Polyporus/Alisma if purgation is contraindicated? Slippery stone (Huashi) is correct; others like Yinhua (Lonicerae Japonicae Flos), Hua Rui (Strobili Lupini), Huangbai (Phellodendri Cortex), Qinghao (Artemisiae Annuae Herba), Baitouweng (Pulsatillae Radix), Kushen (Sophorae Flavescentis Radix), Radish are usable.
Toxic fire pouring into Large Intestine: foul discharge, clear water, direct pouring, undigested food. This is evil heat failing to digest grain, not Spleen deficiency. Lighter than dysentery-like cases. Signs: high fever, coarse breath, short urine, cracked purple lips, extreme cold-thirst, constant abdominal pain, intermittent limb cold. Clear and drain according to trend. Treatment same as above.
Wang Shihiong notes: Cracked lips/extreme thirst indicate fluid depletion; clear and transform, avoid excessive draining. Winter melon soup for tea/decoction is excellent. Wang An: Mung beans suitable for both. Constipation in plague due to toxin boiling drying intestines. Do not just attack blockage to hasten death. Add Raw Dahuang (Rhei Radix et Rhizoma) to main formula, or use Honey Suppository externally. Wang An: Hemp seed suitable.
Evil invading Five Zang disrupts Three Yin meridians, blood flow disorder, leaking into Large Intestine causing hematochezia. Use main formula with increased Shengdi (Rehmanniae Radix), plus Huaihua (Sophorae Flos), Baiye (Platycladi Cacumen), and Zonghui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: Zonghui (Palmae Fructus Cinchonae Cinchonae Ash) is warm-astringent. To stop bleeding, replace with Diyutan (Sanguisorbae Radix Carbonized).
Bladder extreme heat: scanty red/dysuric urine. Severe toxin: urine oily. Add Huashi (Talcum), Zexie (Alismatis Rhizoma), Zhuling (Polyporus), Mutong (Akebiae Caulis), Tongcao (Tetrapanacis Medulla), and Bianxu (Polygoni Avicularis Herba) to main formula.
Wang Shihiong notes: Polyporus/Alisma are draining. For bladder obstruction, they guide flow. But here, heat-toxin blazes, fluids consumed, urine naturally red/scanty. Treat the cause; clear source, clean stream. Do not force diuresis futilely. Use sparingly if needed, do not overuse.
Hematuria (painless): blood in urine without pain. Blood strangury (painful): lower abdomen/penis distension/pain. In plague, both due to heat forcing blood. Increase Shengdi (Rehmanniae Radix) in main formula, add Huashi (Talcum), Tao Ren (Persicae Semen), Maogen (Imperatae Rhizoma), Hupo (Succinum), Niuxi (Achyranthis Bidentatae Radix), Zonghui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: If pain/distension present, avoid Zonghui (Palmae Fructus Cinchonae Cinchonae Ash). Wang An: Also suitable to use Diyutan (Sanguisorbae Radix Carbonized).
Madness, cursing, ignoring kin, climbing/singing, stripping/walking, jumping walls/roofs, superhuman strength. Speaking of unseen things/people, as if possessed. This is Yangming evil heat disturbing Spirit. Patient unaware. Shamans confuse matters. Increase Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Danpi (Moutan Cortex), Zhizi (Gardeniae Fructus) in main formula, add Huangbai (Phellodendri Cortex).
Wang Shihiong notes: Add Zhusha (Cinnabaris), Qingdai (Indigo Naturalis). If phlegm, add Shichangpu (Acori Tatarinowii Rhizoma), Zhuli (Bambusae Sap).
Plague phlegm is heat-related. Blood in phlegm indicates extreme heat. Increase Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), Shengdi (Rehmanniae Radix) in main formula, add Louren (Trichosanthis Semen), Lingyangjiao (Saigae Tataricae Cornu), Sheng Sangbaipi (Fresh Mori Cortex), Zonghui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: Sangbaipi (Mori Cortex) and Zonghui (Palmae Fructus Cinchonae Cinchonae Ash) debatable. Add Huashi (Talcum), Tao Ren (Persicae Semen), Weijing (Phragmitis Rhizoma), Guban (Benincasae Semen).
Plague enuresis is not deficiency inability to hold, but heat loss of control. Patient lethargic/delirious, unaware of enuresis. Increase Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma) in main formula, add Huashi (Talcum). All wheezing/fullness belongs to heat, especially in plague. Increase Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix) in main formula, add Sangbaipi (Mori Cortex), Lingyangjiao (Saigae Tataricae Cornu).