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Madam, the wife of the Vice Governor of Anhui Province, contracted an epidemic plague. Initially, she experienced only chills without fever, dizziness, blurred vision, and pain in her waist and body. The physician mistakenly diagnosed it as a deficiency-cold syndrome and prescribed Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) augmented with Duzhong (Eucommia Bark), Xuduan (Dipsacus Root), Niuxi (Achyranthes Root), and Mugua (Chaenomeles Fruit). After two doses, she fell into a coma resembling drunkenness, her breathing became faint and nearly ceased, and she was unaware of the suffering caused by the illness. Her uncle, Mr. Wu, currently serving as a Director in the Ministry of War, invited me to examine her.

I palpated her pulse, which was deep, fine, and rapid; I observed her symptoms: her face was red, sweat poured from her head like rain, her body was hot while her limbs were cold, and her tongue was dry with cracked lips. I said, "This is not a deficiency syndrome, but an epidemic plague." Mr. Wu asked, "All these manifestations appear to be deficiency; why do you say it is an epidemic?" I replied, "If this were a deficiency syndrome, her face would not be red, her tongue would not be scorched, nor her lips dry. Profuse sweating over the entire body would indicate the impending collapse of Primordial Yang. How could it be merely head sweating like rain, with body heat and cold limbs? I dare not administer large doses [of warming tonics]. For now, I will use Liangge San (Cooling the Chest Powder) to clear internal heat. Tomorrow, if macules and papules emerge slightly, the nature of the disease will become clear."

The next day, spots appeared faintly beneath the skin. Mr. Wu was horrified, saying, "We almost made a mistake." He immediately administered a medium dose of Baidu San (Defeat Poison Powder), adding Dayeqingye (Isatis Leaf) 1.5 qian and Shengma (Cimicifuga Rhizome) 5 fen. On the second day, macules appeared all over the body, purple-red and loose-floating. Her body suddenly became extremely hot, and her limbs were no longer cold. She suffered from irritability and extreme thirst. Therefore, I switched to a large-dose prescription: Shigao (Gypsum Fibrosum) 8 liang, Xijiao (Rhinoceros Horn - *Note: Use substitutes in modern practice*) 6 qian, Huanglian (Coptis Rhizome) 5 qian, plus Shengdi (Rehmannia Root) 1 liang, Zicao (Arnebiae Radix seu Lithospermi Radix) 3 qian, and Dayeqingye 3 qian. After two doses, the macules turned bright red. However, coughing persisted, and pink blood appeared in the sputum. This indicated that Metal (Lung) was being scorched by Fire. Following the original formula, I added Lingyangjiao (Antelope Horn - *Note: Use substitutes in modern practice*) 3 qian, Sangbaipi (Morus Cortex) 3 qian, Zongtan (Pinus Carbonized) 3 qian, and Danpi (Moutan Cortex) 2 qian. After another two doses, the cough subsided, bleeding stopped, the color of the blood turned dark red, and the heat significantly decreased.

According to the base formula, I removed Zicao, Lingyangjiao, Sangbaipi, and Zongtan; reduced Shengdi by 5 qian, Shigao by 2 liang, and Xijiao by 2 qian; and added Mutong (Akebia Caulis) 1.5 qian and Huashi (Talcum) 5 qian, due to difficult urination. After two more doses, all symptoms had diminished by six-tenths. I continued using Shigao 2.4 liang, Xijiao 2 qian, Huanglian 1.5 qian, and Shengdi 4 qian, removing Mutong and Huashi. After another two doses, I used Xijiao 1.5 qian, Huanglian 0.8 fen, Shigao 8 qian, and added Renshen (Ginseng Radix et Rhizoma) 1 qian, Danggui (Angelica Sinensis Radix) 1 qian, Maidong (Ophiopogon Tuber) 3 qian, and Wuweizi (Schisandra Fruit) 0.5 fen. After taking two prescriptions continuously, her food intake doubled, and her spirit gradually recovered strength.