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Wang Yutai stated: The Shengsanzi Formula (Holy Dispersion Decoction), because of the preface written by Mr. Su Dongpo (Su Shi), became revered as a divine prescription throughout the world. In the Xinwei year of the late Song Dynasty, during an epidemic in Yongjia, those who took this formula and suffered harm were too numerous to count. I read in Ye Shilin's *Bishu Lu* (Record of Summer Retreat) that during the Xuanhe era, this medicine was prevalent in the capital city. University students believed in it especially fervently, resulting in countless deaths, after which physicians abandoned it. Previously, when Su Dongpo was demoted and resided in Huangzhou, the area was near the river with high humidity. The illnesses contracted by residents there were either due to dampness invading the interior or caused by soaking rainwater. Therefore, taking this medicine was often effective, leading to its widespread circulation and leaving endless detrimental consequences. In the Guichou year of the Hongzhi era, a severe epidemic broke out in the Wuzhong region. Sun Pan, the magistrate of Wu County, ordered physicians to prepare Shengsanzi Formula, distributing it across streets and alleys, and printed the prescription for public use. Among those who took it, not one in ten survived; most died from mania, restlessness, and coma. Alas, although Lord Sun's original intention was to save lives, he did not realize that Shengsanzi Formula contains Aconiti Lateralis Radix Praeparata (Fuzi, Prepared Lateral Root of Monkshood), Alpiniae Officinarum Rhizoma (Liangjiang, Rhizome of Galangal), Evodiae Fructus (Wuzhuyu, Fruit of Evodia), Myristicae Semen (Doukou, Nutmeg), Ephedrae Herba (Mahuang, Herb of Ephedra), and Agastaches Herba (Huoxiang, Herb of Patchouli). These herbs all possess dry and hot properties, which instead exacerbate fire pathogens. How could patients not die? If one does not differentiate between Yin syndromes and Yang syndromes and treats them indiscriminately, killing people is easier than using swords. If anyone can widely disseminate this knowledge to warn others, it would be one aspect of benevolence. From *Xu Yishuo*.

Zhang Zihe said: In the spring of the Yuanguang era, Li Pingshan (Yingtai) of the Hanlin Academy in the capital contracted a plague syndrome. He suffered from headache, fever, dry mouth, and dark, difficult urination. As he had a habit of drinking alcohol, physicians administered Jiuzheng Wan (Alcohol Syndrome Pill) combined with Crotonis Fructus (Badou, Seed of Croton) to induce diarrhea more than ten times. The next day, the headache and other symptoms persisted. The physicians failed to recognize the condition and again used acrid-warm agents to release the exterior. They placed him on a warm kang (heated brick bed) and forced him to drink scallion and vinegar soup, attempting to achieve sweating. Little did they know that various exogenous heat pathogens overlapped and erupted simultaneously, causing yellow eyes, skin spots, tidal fever, vomiting, diarrhea, severe panting, and abdominal fullness. Although Chengqi Tang (Cathartic Decoction) was later used to purge, it was already too late. Discussions continue to this day, yet people fail to realize the fault lay with the hot medicines, often blaming Chengqi Tang instead. Those who used Chengqi Tang did not realize the critical state of the illness and continued medicating, demonstrating a lack of medical understanding, which is indeed culpable. However, critics who do not blame Jiuzheng Wan are also blameworthy. Plague syndromes located at the exterior should not be purged, let alone with Crotonis Fructus pills. After excessive purgation with Badou, how could one further administer acrid-hot agents? Those who follow the crowd in praising or criticizing are merely making baseless remarks. (Wentian notes: Purging with Badou has extremely damaged the Yin fluids. Using Da Huang (Rhubarb) to purge again cannot possibly preserve Yin independently. This case should have been treated with Mung Bean (Lvdou) to detoxify Badou, combined with Yin-nourishing herbs, which might have helped. However, Zhang Zihe is insufficient to comment on this.)

In the second year of Baoqing (Song Dynasty), winter, November of the Bingxu year, Yelü Zhengwang followed Emperor Taizu of Yuan to attack Lingwu. While generals fought over women, children, jade, and silk, Yelü Zhengwang alone took several books and two camels loaded with Rheum Palmatum et Pubescens Radix et Rhizoma (Dahuang, Rhubarb). Later, when an epidemic struck the army, Dahuang proved curative, saving nearly ten thousand people. (*Zhuge Lu*. Wentian notes: Soldiers often consume alcohol and meat, and sweat heavily from labor. When warm epidemics spread, pathogens quickly enter the Yangming Stomach Fu organ. This explains why Dahuang was universally effective. Wang's deletion of this case was incorrect.)

*Zhifang Waiji* records: In the Kingdom of Kaoa Island, an epidemic occurred. A famous physician named Genjubujia did not use herbal medicines but ordered large fires to be lit throughout the city and countryside, burning for a day and night. Once the fire extinguished, the disease also healed. Epidemics are caused by invasion of evil qi. Fire qi is fierce and can cleanse various evils. When evil qi is exhausted, the epidemic resolves. This is also sound reasoning. (*Qiao Shu Chubian*. This method is only feasible in border regions. Wentian notes: This was a cold epidemic in winter, not a warm epidemic. Wang knew that warm pathogens cause epidemics but failed to realize that cold epidemics also occur in winter. His arbitrary deletion of this case was wrong.)

Qiu Rucheng visited a friend and heard crying from a neighbor's house. Upon asking the reason, he was told that Neighbor Jia had contracted a seasonal disease. Qiu ordered water to be drawn into a large barrel, placed a curtain horizontally above it, and had the patient sit on top of the curtain (using steam fumigation). The illness subsequently resolved. (*Huichen Xintan*. Wentian notes: This was a warm epidemic syndrome caused by damp-heat in the middle jiao.)

Vice Minister Su Taoguang said: When I served as the magistrate of Qingliu County, the daughter-in-law of Shentu Xingfu from the county contracted a seasonal epidemic. After thirty-plus days, it had become a deteriorated syndrome. I instructed her to take Duoming San (Life-Restoring Powder), also known as Fumai Tang (Pulse-Recovering Decoction). It consisted of Ginseng Radix et Rhizoma (Renshen, Ginseng) one liang, decocted in two zhong of water with strong fire until one zhong remained. It was cooled in well water before administration. Shortly after, sweat appeared on the nasal bridge, the pulse recovered, and she improved immediately. For any typhoid or seasonal epidemic, regardless of Yin/Yang differentiation or age, if medication errors lead to critical condition with deep, hidden pulses and unconsciousness, Fumai Tang can be taken after seven days with a success rate of nearly 100%. (*Bencao Gangmu*, *Renhe County Gazetteer*. This indicates Yin injury with impending Yang collapse, hence the efficacy of Fumai Tang, where Ginseng is appropriate. However, stating "can be taken after seven days" contradicts medical principles. Wang's casual deletion was inappropriate.)

Wu Sichang treated Zhao Qingxian Gong, a prestigious minister of the Zhejiang Governor, who frequently suffered from critical epidemics. Wu disregarded public opinion and administered ice water, causing immediate recovery. The Duke respected him as a deity, saying, "You will be immortal."

Sun Wenyuan treated an elderly courtesan who, after three days, suffered from headache, fever, thirst, profuse watery diarrhea, heavy body unable to turn over, increasing drowsiness, deafness, closed eyes, and delirium. Physicians proposed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), but the decoctions were not yet administered. Sun examined her and found six pulses surging and large, inner-red and outer-black facial complexion, dry lips, black coating on the center of the tongue, and unconsciousness. He said, "This is a plague syndrome. The method requires clearing and resolving. Urgently administer Xiaobai Tang (Little White Decoction), and life may be saved. Using Qi-tonifying and Lizhong methods would kill her; how could they be used?" Asked what Xiaobai Tang was, he replied, "Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Baihu Tang (White Tiger Decoction)." Someone asked, "With such severe diarrhea, can Shih Gypsum (Shigao) be used?" He replied, "This is diarrhea with coordinated heat; it should be taken early." After administration, by midnight, spirit revived, though urination remained difficult and heat/thirst persisted. Following Zhongjing's method, for thirst, fever, and difficult urination, one should promote urination. Thus, Chen Sha Liuyi San (Cinnabar Six-to-One Powder) two liang was mixed with Dengxin Tang (Juncus Decoction) and administered. Two doses cured her. (Li notes: This is a combination of Yangming and Shaoyang diseases. Using Baihu and Chaihu was correct. However, Zhongjing's Chaihu Tang guidelines state to remove Banxia (Pinellia) and add Gualou Gen (Trichosanthes Root) when thirst is present. Why not follow this? This is also a type of Three-Yang combination. Baihu Tang alone suffices; adding Xiao Chaihu Tang is not very erroneous. However, Chaihu and Banxia are somewhat ascending and drying. Thus, heat/thirst and difficult urination resolved only after Liuyi San cleared heat, not primarily due to diuresis. Readers should not be confused by its reference to Zhongjing.)

Zhang Jingyu suffered from fever, abdominal pain, diarrhea, thirst, and incessant vomiting. Some identified it as cold, some as heat, some as typhoid. Sun diagnosed it as seasonal epidemic diarrhea. He used Erchen Tang (Two-Cured Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma), plus Qinghao (Artemisiae Annuae Herba), Gegen (Puerariae Lobatae Radix), Jiu Qin (Scutellariae Radix prepared with wine), Baishao (Paeoniae Radix Alba), Zhuling (Polyporus), and Zexie (Alismatis Rhizoma). One dose brought peace.

A servant suffered from body heat like burning, headache like splitting, red urine, thirst, dry nose, insomnia, chest/diaphragm distension, hunger without appetite, and wiry-rapid pulses. Sun prescribed Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) plus Zhimu (Anemarrhenae Rhizoma), Zhike (Aurantii Fructus), Baizhi (Angelicae Dahuricae Radix), Gegen, and Qinghao. One dose halved the heat and pain, and relaxed the chest. Thirst and scanty urine remained, along with restless sleep. Sun then gave Huawen Dan (Plague-Transforming Pill) three qian, dissolved in well water. Thirst stopped, and sleep improved. For dizziness, weak legs, and panting, Siwu Tang (Four Substances Decoction) plus Qinghao, Jiu Qin, Yiyiren (Coicis Semen), and Mugua (Chaenomelis Fructus) was given, resulting in full recovery.

Another servant had similar symptoms. Previous doctors administered drugs causing severe vomiting and diarrhea, worsening heat, unbearable headache, irritability, thirst, dry nose, vomiting, and scanty urine for fourteen days, critically ill. Sun asked about previous medications and found they included Huoxiang Zhengqi San (Patchouli Regulate Qi Powder), Sharen (Amomi Fructus), Houpo (Magnoliae Officinalis Cortex), and Shanzha (Crataegi Fructus), all depleting primal qi. In May, when fire authority dominates epidemics, sweet-cold agents should be used. How could acrid-hot aromatic agents be used to increase fire and dry fluids? Sun urgently administered Ren Shen Baihu Tang (Ginseng White Tiger Decoction) plus Zhuru (Bambusae Caulis in Taeniam), Gegen, Qinghao, and Shengma (Cimicifugae Rhizoma). One dose eliminated heat; the second stopped headache, resolving all symptoms. Several subsequent cases were treated similarly. Generally, heavenly movement epidemics affect many in one area. First, administer sweet-cold clearing agents. After heat subsides, use Siwu Tang to nourish Yin blood, adding mild heat-clearing herbs, where Qinghao plays a dominant role. (Treatment of plague syndromes concludes here.)

Mrs. Wu first contracted wind pathogen, then food stagnation, leading to fever, headache, and abdominal distension. Doctors administered Badou pills to purge, but heat remained unchanged. Then Da Huang was used for heavy purging, yet heat remained unchanged. Later practitioners claimed heat persisting after purging indicated deficiency and heavily tonified with Renshen and Baizhu. After four days, spirit was dull, and consciousness lost. Sun diagnosed wiry-rapid left pulse, deep-rapid-strong right guan/chchi pulses, sedge-colored tongue tip, scorched-black thorny tongue root, and unclear speech. Ignorance of post-famine conditions allowed epidemic qi to become pestilence; reckless purging and tonification mistakenly created a deteriorated epidemic, critical and dangerous. Temporarily, Chaihu and Zhimu each three qian, Shigao six qian, Zhishi and Huafen each five fen, Gancao, Huangqin, and Maidong each one qian, Zhizi and Shengdi each seven fen, Renshen six fen, Zhuye thirty leaves, and Jiang three fen were decocted in water. Drinking until midnight, consciousness slightly cleared, slight sweat appeared, tongue softened. Next day, Shengdi was removed from the formula, Baishao added, and black tongue coating receded. No bowel movement for five days, body still painful, coughing. Seven-Processed Phlegm-Resolving Pills (Qizhi Huatan Wan) two doses were given, followed by Shigao two qian, Maidong and Beimu each one qian, Qianhu, Zhike, Huangqin, Zhizi each six fen, Gancao three fen, Sangbai Pi eight fen. Full recovery ensued.

Madam Cheng's husband died of plague. Seven days later, she contracted it: high fever, headache, thirst, chest/hypochondriac pain. Doctors gave Xiao Chaihu Tang. At night, she dreamed of her husband engaging in intercourse, woke up with profuse cold sweat, limbs feeling detached, confusion, delirium, earth-colored face, and hard/scorched-black tongue. Sun diagnosed deep-wiry-rapid six pulses, constipation of both stool and urine. This is a case of Yin-Yang Exchange (Yinyang Yi). Post-plague occurrence is extremely critical. She was given Shengmai Tang (Generate Pulse Decoction) plus Chaihu, Huangqin, Guizhi, and Gancao. The decoction was taken with ash from her husband's former underwear. Two doses restored consciousness, temperature normalized, sweat ceased, tongue softened, black coating receded. Julei (Zizyphi Semen) and Zhuru were added to the previous formula; limb movement returned, allowing congee intake. Six family members/servants subsequently fell ill sequentially and were all treated with Liushentong Jie San (Six-Spirit Unblocking Release Powder), resolving via sweating.

A woman suffered fever and headache. Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) and Shishen Tang (Ten-Gods Decoction) failed, adding thirst and coal-black tongue. Ru Shen Baihu Tang and Zhuye Shigao Tang also failed, adding incessant diarrhea, dullness, cold limbs, faint breathing, and inability to eat for fourteen days, preparing for death. Sun diagnosed thread-like fine pulses. He said, "This is a plague syndrome." Combined Shengmai and Lizhong Decoctions were administered. Two doses led to slight revival at midnight, drinking half a cup of congee. Next morning, six pulses gradually appeared. Joyfully, he said, "When pulse vanishes but faintly continues, life returns; no worry." Continued previous medication. By evening, diarrhea stopped, thirst ceased, black tongue receded, spirit refreshed. Ren Shen and Baizhu each five qian, Pao Jiang (Prepared Ginger), Zhi Gancao each two qian, Maidong two qian, Wuweizi fifteen grains (still Lizhong and Shengmai) were taken irregularly. Full recovery in several days. (This is a deteriorated syndrome; previous cooling/releasing was excessive, so warming/tonification succeeded.)

Wu Qiuquan's wife, after dysentery and cold contraction, menstruation arrived. She had high fever, slight headache, thirst, body ache, chest fullness, irritability, deafness, diarrhea, white tongue coating, and chaotic rapid pulses (7-8 per breath). (Rapid/chaotic pulses usually indicate凶兆, but here it is extreme heat stagnation. Extreme stagnation leads to tranquility/passage. Battle-sweat follows. This is natural law.) Sun said, "This is Three-Yang combination, Spring Plague Syndrome." Administered Three-Yang herbs. After taking, slight response observed. Formula: Chaihu three qian, Gegen and Baishao each two qian, Zhishi, Jiegeng, Jiu Qin, Zhuru each one qian, Tianhuafen eight fen, Zhi Gancao and Guizhi each five fen. After ingestion, body felt like ice, face and limbs worse, six pulses vanished. (Double/single hidden pulses with cold limbs indicate impending battle-sweat. Memorize this.) Family and doctors sighed as if dead. Sun said, "Not a death omen." At midnight, Yin reaches extremity, Yang generates. Heat desires to sweat, like sky darkening before rain. Physicians sneered. After fourth watch, battle-sweat occurred, clothes wet, limbs warmed, spirit clear, requesting congee. Only deafness remained, loud borborygmus, pulse near six beats. Changed to Chai Ling Tang (Bupleurum and Polyporus Decoction) plus Wumei (Mume Fructus). Two doses cured.

Clansman grandson, after drunken intercourse and urinating, developed umbilical pain, watery diarrhea with borborygmus (>10 times/day), fever, and headache. Doctor gave Lizhong Tang one dose, worsening vomiting, irritability, and thirst. Sun diagnosed wiry-large left pulse, surging-large right pulse, seven beats, no eating/sleeping, red face, dry lips, thick yellow coating. Patient claimed post-coital Yin Typhoid with lower abdominal pain and leakage. Sun laughed, "Spring Warmth Syndrome." Clansmen insisted on Yin syndrome due to vomiting/diarrhea, warning against diagnosing Yang just due to red face, suggesting Lizhong Tang plus Fuzi and Rougui (Cinnamon Bark) for preservation. (Post-coital external contraction misdiagnosed as Yin and treated with hot herbs kills many. Compare with Yu Jiayan's case of Huang Changren in Typhoid section.) Sun said, "Once Guizhi enters the throat, Yang excess leads to death." Differentiating Yin/Yang and Cold/Heat accurately determines life/death. Here, abandon symptoms for pulses. (Symptomatically, fever/headache is not Yin syndrome.) Wendan Tang (Warm Gallbladder Decoction) plus Jiang Zhi Chuanlian (Ginger-fried Coptis), Chaihu, and Ge Gen (Kudzu) were given. Two doses to be consumed overnight to prevent transmission. Fearful of Zhuru and Huanglian, only one dose taken. Vomiting stopped, other symptoms remained. Next day, surging-large pulses beating fingers. Baihu Tang plus Zhuru two doses prescribed. Fearful of Shigao, only one dose taken. Diarrhea stopped, lower abdominal pain persisted. Next day, surging-long-hard pulses, pathogen entered Fu organs. Tao Ren Chengqi Tang (Peach Kernel Cathartic Decoction) was necessary. Decocted and administered immediately. Two doses passed 5-6 black dry stools. Pain and heat reduced. Re-diagnosis showed slow-weak six pulses. Sijunzi Tang (Four Gentlemen Decoction) plus Baishao, Huanglian, and Xiangfu (Cyperi Rhizoma) tonified for several days until cured.

Brother Cheng had swollen/red cheeks, nausea, aversion to cold/fever, anorexia, afternoon irritability, bitter taste, and insomnia. This is commonly called Lu [Bird] Plague, involving Shaoyang and Yangming meridians. Method requires clearing/resolving. Chaihu and Guanzhong (Illicium Coronarium) each one qian, Ganjiang (Dried Ginger), Zhuru, Banxia Qu (Pinellia Fermented Paste) each one qian, Huanglian, Zhike each seven fen, Gancao four fen. One dose reduced symptoms; two doses resolved them.

Yu Jiayan treated Qian Zhongzhao, who had seasonal external contraction for 3-5 days with fever and headache. Surface-releasing herbs stopped pain but not heat, causing dry mouth/cracked lips. Downward purging followed, resulting in whole-body red spots, confusion, delirium, inability to eat/drink, constipation, hot red urine, and tight-small-rapid pulses. Yu said, "Previous mistreatment of Yangming Stomach channel left interior/exterior unclear. Evil heat inside burns like a prairie, drying fluids, causing confusion. If spots turn purple-black, death is immediate. Currently difficult to save, but complexion not withered, voice clear, indicating sufficient Kidney Water preservation (like underground springs in dry fields). Spirit confused but urine flows, showing Yin not exhausted. Treatable." Do not use surface or interior methods, only Harmonizing method. Use small formulas from Seven Forms with sweet-cold properties. Ru Shen Baihu Tang is sufficient. Central Yuan Qi has separated; large/urgent/repeated doses are unsafe. Internal deficient heat requires sweet-cold aromatics to harmonize. Although formula should be small, frequency should be high. Like feeding a starving person gradually. Administer 5-7 doses daily for immersion. Gradually resolve heat and regenerate Qi. Reducing dose or extending days renders even correct medication useless. Treatment resulted in heat subsiding, spirit clearing, pulse harmonizing, appetite returning, and spots dissolving within another day-night.

Jin Jian contracted plague in spring, mistreated for twenty days, developing critical fatal syndrome: unremitting high fever, incoherent delirium, dry skin, rigid chest, curled tongue, scorched lips, fatigue, cold feet, slight bowel/bladder passage, partial thirst, dark stagnant face. Previous treatments (sweating, purging, harmonizing, warming) failed completely. Yu said, "Similar to Lianggan Typhoid (Dual-Infection Typhoid). That transmits two channels daily, dying after three days if not cured. If surviving, dies after another three-day cycle. This Spring Warmth does not transmit channels, so evil lingers longer, waiting for Yuan Qi exhaustion for death. Yin and Yang diseases mixed. Treating Yang hinders Yin; treating Yin hinders Yang. Yet law states: releasing exterior and attacking interior differ. Living method depends on human wisdom, not forbidding medication. I have a method: use Zhongjing's exterior-interior formulas. Though untested, my intuition urges action, resembling divine change. Likely effective." Used Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to resolve exterior Yin/Yang evil. Sweat penetrated skin, heat cleared. Then Fu Zi Xie Xin Tang (Aconite Draining Epigastric Decoction) resolved interior Yin/Yang evil. Chest softened, consciousness returned, symptoms retreated. Ate congee next day, no further medication needed. Just these two doses rescued life from nine deaths. Delightful! (Students should study this case carefully.)

Lu Bu Yuan treated Wang Longyou of Yongjia. Observed dark-purple complexion and deep-red tongue root, predicting illness next day. Fever occurred. Three days later, uncle Peizhu wanted to leave. Pulse was deep-scattered. Lu urged him to stay, saying Longyou had disease but spirit-pulse intact; Peizhu had no disease but evil deeply invaded. Illness en route would be disastrous. Next evening, severe vomiting, pulse collapsed. Renshen three qian restored pulse. Others administered Julei etc., heat intensified. Fourteen days: pulse eight beats, short tongue, confusion. Lu said, "Must purge tonight, else stomach rots." Used Huangqin, Huanglian, Dahuang. One dose cured next day. Epidemic is pestilential qi, entering via mouth/nose. Severity depends on complexion/strength. Observing color/pulse allows prediction. Epidemic is spreading warm-heat disease. Cause: cold suppressing fire. Color purple (Water overcoming Fire). Fire disease manifests in Heart sprout (tongue), hence deep red. Du Qingbi calls this "Pre-Plague Tongue." Pulse must be floating (Fire image); smooth onset. Deep means evil enters interior, violent burning. Hejian often uses purging. Emptying interior calms fire nature. Missing purge timing leads to stomach rot and death.