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Any person who previously suffered from other diseases, was emaciated (emaciation), or had long-term malaria (malaria), or internal injury with blood stasis (blood stasis due to trauma or disease), or hematemesis (vomiting blood), melena (blood in stool), or hemoptysis (coughing up blood); men suffering from spermatorrhea (involuntary emission of semen) and leukorrhea (white discharge), leading to exhaustion of essence and qi; women suffering from metrorrhagia (uterine bleeding not during menstruation), leukorrhea, blood deficiency amenorrhea (amenorrhea due to blood deficiency), etc., resulting in wasting of muscles, with pathogenic fire remaining alone, thus the pulse approaches rapidity (rapid pulse). At this time, if slightly infected by epidemic qi (epidemic pathogen), physicians and patients' families, seeing the sudden cessation of grain and food intake, plus chest and diaphragm fullness and oppression (chest stuffiness), body pain, fever, and insomnia throughout the night, would mistakenly attribute it to the aggravation of the original disease. They erroneously interpreted the lack of appetite as spleen deficiency (spleen qi deficiency), body pain as blood deficiency (blood insufficiency), and insomnia as spirit deficiency (shen deficiency). Consequently, they administered herbs such as Renshen (Ginseng Root), Baizhu (Atractylodis Rhizoma), Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Fushen (Poria with Hostwood), and Suanzaoren (Ziziphi Spinosomi Semen). The more tonification was applied, the more critical the condition became. Those knowledgeable treated it slightly according to epidemic disease methods: fever halved, sleep occurred occasionally, and food intake improved slightly, but the rapid pulse remained, limbs ached intermittently, and chest/hypochondriac pain felt like needle pricks, failing to heal after the expected period. Physicians frequently tried miscellaneous medicines: tonifying intensified the pathogenic fire; purging damaged the spleen and stomach; moistening made the pathogen more firmly adherent; dispersing further weakened the meridians; unblocking further depleted essence and qi; maintaining the status quo led to daily wasting and near-death. It is generally known that the latent pathogen has溃散 (scattered), transmitting between exterior and interior; although interior symptoms are cleared, it is unknown that righteous qi (zheng qi) is weak and cannot push out the pathogen. Exterior pathogens remain and do not depart, merging with blood vessels to form one entity, resulting in stubborn disease (stubborn illness). Intermittent limb pain indicates pathogen battling with Ying Qi (nutritive qi); persistent rapid pulse and fever indicate pathogenic fire gathering and stagnating; hypochondriac stabbing pain indicates fire pathogen knotting in the membrane diaphragm (membrane partition); failure to heal after the period indicates that for epidemic pathogens to exchange/resolve, it takes near 7 days, far 14 days, or even 21 days. If it does not heal beyond this, it is due to incorrect treatment, resulting either in complicated syndrome (bad syndrome) or stubborn disease. Stubborn disease refers to external pathogens firmly adhering in blood vessels, where host and guest become indistinguishable (host-guest entanglement), which is hardest to resolve, and becomes more fixed over time. Treatment should be undertaken while flesh is not yet wasted and true yuan (original qi) is not yet failed, urgently using Sanjia San (Three Shells Powder), with many surviving. Further modifications should be added, adjusting according to the patient's constitution.

Sanjia San (Three Shells Powder)
Biejia (Trionycis Carapax), Guijia (Testudinis Carapax) (both roasted with rendered animal fat until yellow and powdered, each 1 qian; if no fat, roast with vinegar instead), Chuanshanjia (Manis Squama) (soil-roasted until yellow and powdered, 5 fen), E chong (Asiatic Ground Beetle) (3 specimens, dry ones broken, fresh ones mashed with a little wine, juice extracted and added to decoction, dregs boiled with other herbs), Baishao Yao (Paeoniae Radix Alba) (wine-fried, 7 fen), Danggui (Angelicae Sinensis Radix, 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen).
Decoct in 2 zhong of water until 8 fen remains, strain dregs and take warm. If there is chronic malaria or hot malaria (dan malaria), add Niuxi (Achyranthis Bidentatae Radix) 1 qian, Heshouwu (Polygoni Multiflori Radix) 1 qian; if spleen/stomach weakness leads to diarrhea, use nine-steamed nine-dried preparations; if there is stagnant phlegm, add Beimu (Fritillariae Thunbergii Bulbus) 1 qian; if there is old phlegm, add Gualou Shuang (Trichosanthis Fructus Pulvis) 5 fen; if prone to vomiting, do not use; if throat is dry and itchy, add Huafen (Trichosanthis Radix) and Zhimu (Anemarrhenae Rhizoma) each 5 fen; if prone to dry cough, add Xingren (Armeniacae Semen Amarum, mashed) 1.5 qian; if there is internal injury with blood stasis, double the dose of E chong; if E chong is unavailable, substitute with Ganqi (Dry Resin of Commiphora, stir-baked until smoke ceases, powdered) 5 fen and Taoren (Persicae Semen, mashed) 1 qian. After taking, if symptoms halve, stop administration and proceed with conditioning methods.