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Tianshi (Heavenly Master) said: The onset of plague (Yiwen, 瘟疫) is unpredictable. However, its occurrence has causes. It may result from human disorder, climatic deviation, infection by corpse qi (尸气), or the transformation and steaming of toxic vapors (毒瓦斯), all of which can lead to plague. Since symptoms vary, treatment cannot be uniform. Nevertheless, most plague patients harbor excessive heat-fire qi (火热之气) within their dwellings. If this heat accumulates in a house, the whole family falls ill; if in a village, the whole township; if in a market, the whole city; if on roads, regions spanning thousands of li are affected. Thus, although symptoms are diverse, if one eliminates the heat-fire qi and adds herbs that dispel pathogens and purge filth, efficacy is invariably achieved. The prescription consists of Da Huang (Rhei Radix et Rhizoma) 3 qian, Xuan Shen (Scrophulariae Radix) 5 qian, Chai Hu (Bupleuri Radix) 1 qian, Shi Gao (Gypsum Fibrosum) 2 qian, Mai Dong (Ophiopogonis Radix) 3 qian, Jing Jie (Schizonepetae Herba) 1 qian, Bai Shao (Paeoniae Radix Alba) 3 qian, Hua Shi (Talcum) 3 qian, and Tian Hua Fen (Trichosanthis Radix) 3 qian. Decoct with water and take orally. This formula can treat plague generally; with appropriate modifications, it is always effective. Its brilliance lies in using Da Huang to purge pathogenic factors from the chest and abdomen, Jing Jie and Chai Hu to disperse pathogenic qi at the half-exterior half-interior level, Tian Hua Fen to resolve phlegm and dissipate nodules, Shi Gao to expel stomach fire, and Bai Shao to soothe Liver wood so as not to overact upon Spleen earth, thereby preserving righteous qi and allowing pathogenic qi to exit. This formula is most secure and miraculous; practitioners of plague should regard it as a secret treasure.

Zhang Gong said: One cannot preset a formula for plague, as its arrival is unpredictable. To leave a gap in medical practice is unacceptable; thus, Tianshi formulated this prescription to save lives. Generally, it can be used to treat seasonal epidemic diseases (Shiqi, 时气), but it should not be relied upon to treat disasters determined by fate.

Tianshi said: Zhangli (瘴疠, miasma/pestilence) arises from the stagnant and steaming climate of Guangdong and Guangxi. The qi there is hot, not cold; symptoms include headache and abdominal fullness. Locals take Bing Lang (Arecae Semen) without adverse effects because its pungent flavor disperses stagnation. Fire qi, when met with cold, becomes depressed and fails to expand; Bing Lang’s pungency allows it to enter easily due to similar properties, and its dispersing nature suits the pathology. However, it only addresses acute emergencies and cannot serve as a long-term solution. I now establish a formula for the chronic management of Zhangli: Ren Shen (Ginseng Radix et Rhizoma) 1 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 qian, Fu Ling (Poria) 3 qian, Chen Pi (Citri Reticulatae Pericarpium) 5 fen, Gan Cao (Glycyrrhizae Radix et Rhizoma) 5 fen, Ban Xia (Pinelliae Rhizoma) 1 qian, Bing Lang 1 qian, Zhi Ke (Aurantii Fructus Immaturus) 5 fen, Chai Hu 5 fen, Wu Wei Zi (Schisandrae Fructus) 5 grains, and Mai Dong 3 qian. Decoct with water and take orally. The merit of this formula lies not in directly treating Zhangli, but in resolving it naturally. By strengthening the Spleen, Qi becomes robust; robust Qi repels Zhangli. Even if infection has occurred, the formula contains agents that eliminate Zhangli, ensuring prompt efficacy. This method for treating Zhangli should be known.

If someone contracts pestilential qi and develops Leprosy (Da Ma Feng, 大麻风), this method is inappropriate. Leprosy involves pure heat-toxin qi enveloping the skin and dampness obstructing the muscles and bones. External symptoms include red skin with spots, loss of eyebrows and beard, generalized ulceration, and unbearable odor, causing people to avoid contact. Pitying this condition, I devised a miraculous formula: Yuan Shen (Scrophulariae Radix) 4 liang, Cang Zhu (Atractylodis Rhizoma) 4 liang, Shu Di Huang (Rehmanniae Radix Praeparata) 4 liang, Cang Er Zi (Xanthii Fructus) 4 liang, Yi Yi Ren (Coicis Semen) 4 liang, and Fu Ling 4 liang. Named Si Liu Tang (Four-Six Decoction), grind into powder and form pills with honey. Take 1 liang daily; two courses will ensure complete recovery. The formula’s virtue is tonifying the Kidney and Spleen while dispersing wind and draining dampness. When righteousness is strengthened, pathogens retreat spontaneously; thus, Leprosy heals itself without direct attack. Print this widely for public benefit; the merit is immeasurable. Abstinence from sexual activity is required.

Hua Jun said: My transmitted formula differs: Bing Lang 1 qian, Bai Shao 3 qian, Chai Hu 8 fen, Bai Zhu 3 qian, Fu Ling 3 qian, Che Qian Zi (Plantaginis Semen) 2 qian, Zhi Ke 5 fen, Bai Jie Zi (Sinapis Semen) 3 qian. Decoct with water. For cases with fire, add Huang Lian (Coptidis Rhizoma) 5 fen. Two doses eliminate miasma; it is also an excellent formula.

For Leprosy, I have another miraculous formula: Cang Zhu 2 liang, Shu Di Huang 2 liang, Yuan Shen 2 liang, Cang Er Zi 2 liang, Che Qian Zi 2 liang, Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma) 2 liang, Jin Yin Hua (Lonicerae Japonicae Flos) 10 liang, Pu Gong Ying (Taraxaci Herba) 4 liang, Bai Jie Zi 2 liang. Grind into powder, make honey pills. Two courses ensure recovery. This formula embodies subtle principles within harmony, seemingly superior to Tianshi’s formula. Two additional essays are transmitted herewith.

Essay One: True and False. Diseases have true and false aspects; therefore, medicines must be selected with discernment. False matches false, revealing the true. If one uses true medicine for a false syndrome, the false syndrome may manifest as a true disease, confusing the practitioner. Thus, one must use "false" medicine to treat "false" syndromes. For example, extreme heat in the Upper Jiao with icy cold feet indicates true cold in the Lower Jiao and false heat in the Upper Jiao. If cool medicines are administered, they may feel pleasant initially but will be rejected by the Middle Jiao and descend to the Lower Jiao. Introducing cold into a cold environment leads to freezing and stagnation, requiring spring warmth to melt. Similarly, false heat in the body resists cold medicines. The method is to use Si Ni Tang (Frigid Extremities Decoction) with human urine and bile, cooled before administration. This tricks the throat into acceptance. As it reaches the Middle Jiao, the taste warms, harmonizing with the body. Entering the Lower Jiao, the heat expands, providing a home for Dragon-Lei fire (龙雷之火), which returns to the abyss like a dragon finding its pearl. Si Ni Tang is hot; adding urine and bile disguises it as cold to deceive the false-cold presentation. Clinging strictly to "heat attacks cold" theory without understanding "false-heat formulas" risks trapping the Kidney. Using purely hot medicines for false-heat diseases causes rejection. Understanding this distinction is crucial. This principle applies to treating false-cold syndromes as well.

Essay Two: Internal and External Treatments. Everyone knows internal diseases are treated internally and external diseases externally. However, internal diseases can be treated externally, and external diseases attacked internally. Treating external diseases solely externally yields slow results; internal treatment achieves rapid success. Consider carbuncles and ulcers (Yong Ju, 痈疽). Applying external plasters, incisions, or powders, even with divine skill, cannot cure quickly. Internal medication resolves them within one or two days. Why rely solely on external treatment? Internal medication for internal diseases often yields miraculous results. Combining internal and external treatments accelerates healing. Techniques such as guidance (Dao Yin, 引导) and massage require urgent study.

Tianshi said: These two essays lack clarity and sharpness; they need not be transmitted.