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When epidemic pathogens remain in the Qi level (Qi Fen), resolution occurs through chills and sweating (Zhan Han); when they remain in the Blood level (Xue Fen), resolution occurs through macules (Fa Ban). Qi belongs to Yang and is light and clear; Blood belongs to Yin and is heavy and turbid. Therefore, when pathogens are in the Qi level, they are easily dispersed and vented; when in the Blood level, they tend to be sticky and stagnant. Thus, Yang governs speed while Yin governs slowness. Consequently, those resolving via chills and sweating can experience immediate cure; those resolving via macules should seek gradual recovery.

Epidemic pathogens first transmit to the exterior and then to the interior. If chills and sweating occur suddenly, the meridional Qi is transported and excreted, resulting immediately in a calm pulse and cool body, with sudden relief of irritability and thirst. After three to five days, as Yang Qi gradually accumulates, recurrence may occur even without dietary indiscretion or overexertion. This is because the exterior pathogens have been resolved but the interior pathogens remain; once fever is felt again, purgation will resolve it. When epidemic pathogens transmit simultaneously to the exterior and interior, causing interior Qi stagnation and closure, neither diaphoresis nor purgation alone is sufficient; both are required. If diaphoresis and purgation do not fully eliminate the pathogens, fever may recur later, requiring repeated application of purgation and diaphoresis. After purgation for warm plague, if irritability and thirst decrease, abdominal fullness disappears, or appetite returns with the ability to taste, this indicates harmonization of the interior Qi. If body heat persists and the pulse approaches floating, this indicates pathogenic factors are constrained within the meridians and the exterior is not yet resolved; diaphoresis is indicated. If sweating does not occur, administer Chaihu Qingzao Tang (Bupleurum Decoction for Clearing Dryness) to harmonize. If sweating still does not occur, resolution will be gradual; do not insist on inducing sweating. Failure to purge when indicated leads to depletion of Qi and exhaustion of Blood. If purgation has been administered and chills and sweating are desired, but only chills occur without sweating, the condition is critical. This is due to deficiency and weakness of Middle Qi, which can descend but cannot ascend and emerge. On the next day, another episode of chills and sweating is expected; if cold extremities reverse and sweating occurs, life is preserved; if extremities remain cold and no sweating occurs, death ensues due to collapse of Righteous Qi unable to overcome the pathogens. If chills occur, extremities warm, but no sweating occurs, True Yang remains, but Exterior Qi is withered and dry; gradual recovery is possible. If chills cease and convulsions (Jing Bing) suddenly appear, death is certain. Convulsions manifest as a corpse-like stiff body, locked jaw, and upward staring eyes. During chills and sweating, disturbance must be avoided; only warm covering is permitted. Disturbance will interrupt the process, requiring expectation of chills and sweating again the next day. If purgation is applied after chills and sweating, and abdominal pain persists unremittingly two or three days later, it suggests impending dysentery (Zhi Xia). Regardless of whether bloody stools or mucous stools are present, Shaoyao Tang (Peony Decoction) is appropriate.

Shaoyao Tang (Peony Decoction):
Bai Shao (Paeoniae Radix Alba, White Peony Root) 1 qian
Dang Gui (Angelicae Sinensis Radix, Dong Quai) 1 qian
Bing Lang (Arecae Semen, Areca Nut) 2 qian
Nong Po (Magnoliae Officinalis Cortex, Magnolia Bark) 1 qian
Gan Cao (Glycyrrhizae Radix et Rhizoma, Licorice Root) 0.7 qian
Decoct with water and fresh ginger. For tenesmus (Li Ji Hou Zhong), add Da Huang (Rhei Radix et Rhizoma, Rhubarb) 3 qian. For red dysentery (bloody stools), double the dosage of Bai Shao. For white dysentery (mucous stools), double the dosage of Bing Lang.