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Wu Youke treated Zhu Haichou, aged forty-five, who suffered from an epidemic with symptoms indicating the need for purgation. His limbs were paralyzed, his body lay rigid as a sculpture, eyes closed and mouth open, with prickly moss on the tongue. When asked about his suffering, he could not answer. Wu then asked his son what medicines had been taken in the past two or three days. The son replied: "Three doses of Chengqi Tang (Cassia Decoction), each dose containing approximately one qian of Dahuang (Rhubarb Rhizome), but to no effect. We have no other strategy and can only wait for death." Upon examination, the pulse still showed spirit (vitality), and all symptoms requiring purgation were present; the medication was too mild for the deep-seated disease. Wu first administered five ounces of Dahuang (Rhubarb Rhizome); the patient's eyes occasionally moved slightly. After another dose, the prickle-like moss on the tongue lost its sharpness, the mouth gradually opened, and he could speak. After three doses, the tongue coating subsided slightly, and his mental clarity improved somewhat. On the fourth day, he took Chaihu Qingzao Tang (Bupleurum Decoction to Clear Dryness). On the fifth day, prickles reappeared, and irritability and heat intensified, necessitating another purgative treatment. On the seventh day, Chengqi Tang (Cassia Decoction) and Yangrong Tang (Nourishing Blood Decoction) were administered again, allowing his limbs to move slightly. Over half a month, he consumed a total of twelve taels of Dahuang (Rhubarb Rhizome) before recovering. Several days later, he began consuming congee, and after two months of conditioning, he fully recovered. Among a thousand patients treated, such cases were rare, occurring only three or four times. This case is preserved for reference.

Shi Yousheng, a fortune teller in his forties with a very obese constitution, contracted a seasonal epidemic in June. He presented with dry mouth and tongue, tongue coating with sharp prickles, frequent sighing, swollen and painful throat, abdominal distension and fullness with severe pain upon pressure, intense craving for ice water worsening at dusk, red and scanty urine causing severe pain even with drops. These were symptoms requiring purgation. However, his entire skin surface felt cold as ice, fingernails were cyanotic and black, and the six pulses were thread-thin, palpable only when sought lightly but vanishing with slight pressure. Physicians failed to investigate the extreme internal heat, instead citing Tao Shi’s *Quansheng Ji* to diagnose it as a Yang syndrome. They argued that since his extremities were cold, and colder than passing the elbows and knees, it must be a Yin syndrome. Furthermore, Tao Shi distinguished Yin and Yang syndromes by the strength of the pulse; here, the pulse was faint and nearly absent, worse than mere weakness, thus confirming Yin syndrome. Consequently, Fuzi Lizhong Tang (Aconite Decoction to Warm the Middle) was prescribed. Later, Wu Youke was consulted. Correlating pulse and symptoms, and comparing exterior and interior signs, Wu diagnosed this as the most severe form of a Yang syndrome. Extreme internal heat caused qi obstruction, presenting all purgative symptoms, but the purgation was delayed. The extreme internal heat led to whole-body coldness, termed "body jue" (extremity coldness). The absence of pulse indicated a state of "headless dragons," signaling critical danger. Wu urgently prescribed Dachengqi Tang (Major Order the Qi Decoction), advising slow administration. Once the pulse returned and coldness reversed, survival was possible. The patient's wife, confused by the conflicting diagnoses of Yin and Yang, refused the medicine. Another physician diagnosed "Yin toxicity" and recommended moxibustion at Dantian. Three more physicians agreed it was a Yin syndrome, causing the wife great anxiety. The patient himself suggested divination, which predicted auspiciousness for Yin and misfortune for Yang. Confused by the majority opinion favoring Yin diagnosis, they administered Fuzi Tang (Aconite Decoction). Upon swallowing, it felt like fire, causing extreme irritability. The patient sighed, "I am finished; the medicine has erred me." Before finishing his sentence, his condition worsened rapidly, and he died within the hour.

The wife of Mr. Shen in Wujiang, a young widow prone to depression and anger, suffered from hemoptysis recurring three or four times a year, resolving after bleeding. In March, she had mild fever, headache, and body ache without aversion to cold but with slight thirst. The next day, her old condition flared severely with excessive hemoptysis, dizziness, hand tremors, irritability, loss of appetite, and increased heat. Physicians saw only the hemoptysis, attributing it to her chronic condition, unaware it was an epidemic. They attributed fever to Yin deficiency and body ache to blood deficiency, ignoring that fever and headache preceded the bleeding. The consensus was to use tonification. When asked if this was appropriate, Wu Youke replied: "Tonifying deficiency after blood loss is acceptable as a temporary measure, but now she has an epidemic complication, unlike before." Thus, Qianren (Ginseng Radix) 2 qian, along with Fuling (Poria), Danggui (Angelica Sinensis), and Baishao (White Peony Root) were used. After two doses, deficiency symptoms receded, and heat decreased by 60-70%. Both doctors and patient believed Ginseng was effective and wanted to increase the dose, but Wu prohibited it. Subsequently, she experienced chest oppression, abdominal discomfort, inability to belch, and insomnia all night. This occurred because deficiency pathogens retreated with tonification, while excess pathogens intensified. A small amount of Chengqi Tang (Cassia Decoction) was given to mildly promote bowel movement, leading to recovery. Note: If laxatives were not used, rest would have sufficed, as her bowel movements were regular every one to two days, indicating natural qi flow and downward movement of pathogens via stomach qi.

Madam Yan, aged thirty, developed limb edema suddenly after recovering from an epidemic, with stable pulse and symptoms and increasing appetite, but no other discomfort. This was due to qi restoration. After severe illness, blood had not yet regenerated, but qi restored abruptly. Since blood is the foundation of qi, the unanchored qi caused edema. As diet improved, edema subsided. Prescribing qi-moving and diuretic herbs would have been erroneous. (Based on this, blood-nourishing formulas would be appropriate.)

A man infected with an epidemic presented with fever, irritability, and thirst, desiring ice water. Physicians strictly forbade cold foods/drinks. The patient, frustrated, developed burning eyes, scorched throat, insomnia day and night, and visual hallucinations. Desperate, he crawled to steal well water, placing it by his pillow. Drinking one cup cleared his vision; two cups dispelled hallucinations; three cups restored his voice; four cups relaxed his muscles and bones, leading to deep sleep. Soon, profuse sweating soaked his clothes, and he recovered effortlessly. Being thin and fiery-natured with a Yang-predominant constitution, previous dispersing herbs failed to induce sweat, worsening the condition. The cold drink harmonized the interior and exterior, naturally inducing sweat resolution.

Zhang Luyu treated Miss Hong in early winter with fever, headache, chest fullness, and anorexia. After four doses of dispersing and digesting herbs, by day six, she had全身 pain, abdominal pain, borborygmus, tenesmus without stool passage, and black patches appearing on the lips and nose, shiny like lacquer or hawksbill turtle shell, frightening the attending physicians. Zhang diagnosed panting, sweating, rapid pulse, and confusion. Although critical, the black patches had red halos, fresh and moist like pockmark roots, tightly attached, with normal surrounding skin, suggesting treatability. Initially, Gegen (Kudzu Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Xijiao (Rhinoceros Horn - substitute usually used today), Lianqiao (Forsythia Fruit), Jingjie (Schizonepeta), Fangfeng (Saposhnikovia Root), Zijingpi (Buddleja Bark), and Renzhonghuang (Human Excrement Charcoal) were used to resolve exterior toxic pathogens. Once the black patches emerged fully, Liangge San (Cool the Chest Powder) plus Renzhonghuang, Zijingpi, and Wuxi (Black Rhinoceros Horn) was used for mild purgation twice. Then, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) with Renzhonghuang was used for conditioning over half a month. This condition is rarely recorded; Pang Anchang mentioned "Hawksbill Turtle Shell Plague," but treatments were incomplete. Previously, a similar case with bleeding from orifices was fatal. Generally, dry, dark, ash-colored black patches without red halos are incurable. Blackness typically starts from nose/mouth to cheeks/eyelids/ears, arms/legs, or chest/abdomen, never appearing on the forehead, shoulders, or back (Yang areas).

Chen Ruizhi contracted an epidemic in July, presenting with isolated fever without chills, lasting two to three days continuously or intermittently. During fever, he had irritability, thirst, and no sweat; during remission, profuse sweating. He attributed it to sexual exertion followed by cooling exposure. He took over ten doses of Shiwei Xiangru, Jiuwei Qianghuo, Chaihu, Zhike, and Jiegeng, worsening irritability and high fever. Zhang diagnosed surging, forceful pulses in all six positions, scorched and dry tongue coating, cracked lips and mouth, and constipation for five to six days. Although initiated by Yin factors, the pathogenic heat was extreme, showing signs of stomach fu decomposition. Urgent treatment with Liangge San plus Huanglian, Shigao (Gypsum), and Renzhonghuang resulted in three bowel movements and immediate fever reduction. The next evening, fever and thirst returned; Baihu Tang (White Tiger Decoction) with Renzhonghuang and Huanglian stopped them. Two days later, parotid swelling appeared on the left cheek, resolved quickly, but was followed by shortness of breath and confusion due to sinking yuan qi. Baihu Tang plus Renshen (Ginseng), Xijiao, and Lianqiao was given. Swelling recurred; treatment included Xijiao, Lianqiao, Shengma, Chaihu, Gancao, Jiegeng, Niubangzi, and Mabo. After two doses, a toxic swelling appeared on the right cheek. A surgeon treated it for forty days until recovery. Many others suffered similarly because contemporary physicians misunderstood the damp-earth pathogen, failing to purge early and using dispersing/harmonizing methods, causing pathogen overflow into the parotids. Extensive swelling resembling flowing abscesses was incurable even with purgation and detoxification; parotid swelling should not be neglected as minor.

A northerner with an epidemic had persistent alternating chills and fever, yellow-moist tongue coating. Dachaihu Tang (Minor Bupleurum Decoction) was used for purgation, causing irritability and confusion. Mixed administration of Renshen Baihu Tang and Buzhong Yiqi Tang worsened the heat. Frequent use of Huangqin, Huanglian, and Zhimu failed. Zhang diagnosed wiry-rapid-strong left pulse and double-right pulse, generalized erythematous macules except for a bright white patch at Zhongwan (CV12). Physicians did not understand the white patch. Zhang explained: "Overuse of bitter-cold herbs impaired middle jiao yang qi. The method should be to diffuse the macules and regulate qi transformation; do not worry about color change." Xiijiao, Lianqiao, Zhizi, and Renzhonghuang were administered day and night. After two doses, urination and defecation normalized, macules transformed, heat subsided, consciousness cleared, appetite returned, and mobility resumed. His brothers, similarly infected, were treated with Congbai, Jiangchi, Renzhonghuang, Lianqiao, and Bohe, recovering immediately.

Huang Yikuan suffered from Wind-Warmth for over ten days with high fever, confusion, difficulty speaking, loose dark stools, black-dry tongue coating, scorched lips, and sooty nose. Initial misuse of dispersing/digesting herbs worsened irritability and thirst despite excessive drinking. This was latent qi stagnation triggered by wind, becoming Wind-Warmth. Wind-Warmth pulses are typically floating; however, due to long-term heat retention, Shaoyin transformed into fire and emerged to Taiyang, constituting "Lianggan" (Dual Contraction). Fortunately, being young and strong, he passed the critical third and sixth days. Although critical, wind herbs' ascending nature stirred yuan qi into fire, damaging true yin. Shaoyin pulse failed to store internally, hence floating. Ancient texts lacked specific treatment, except for Shaoyin cases involving saving heat/storing yin or purging with Chengqi Tang. Regrettably, this case required clearing long-latent pathogens. Nasal breathing was not stertorous, indicating upper source of water was intact, ruling out fixed gaze/incontinence. Liangge San plus Renzhonghuang and Shengdi was used to save impending yin collapse. After three episodes of dark loose stools, tongue remained dry, irritability persisted. Larger doses of Liangge San with Dahuang increased to two liang, plus Huanglian and Xijiao, removed heat after three doses. Subsequently, large doses of fluids-generating and thirst-quenching herbs cleared the tongue coating, restored fluids, and cured the patient.

Note: Yu Jiayan’s treatment of "Lianggan" in *Jinjian* is similar, but presents with curled tongue/cold feet/coiled body with slight stool passage. This case had black tongue/scorched lips/sooty nose with dark loose stools. Thus, Jin Gui used Mahuang Fuzi Xixin Tang and Fuzi Xixin Tang, whereas this case used Liangge San exclusively, demonstrating different therapeutic approaches.

Yang Chengliu treated a man with epidemic featuring high fever/thirst, scorched lips/red eyes, rosy malar flush, delirious speech, mental dullness, cold hands past elbows, cold feet past knees, black-slippery-swollen tongue, and surging-empty pulse. He diagnosed "Daiyang Syndrome" (Floating Yang). Exterior heat with interior cold: though body hot as iron, he desired covering; thirsty for drinks but intolerant of cold; red face but tender/migratory; black tongue but swollen/moist/not dry. Similar to Baihu Tang syndrome, but Baihu cases do not have cold extending past elbows/knees. Large doses of Bawei Wan (Eight-Ingredient Pill) plus Renshen, decocted thick, served cool, resolved symptoms. Followed by Lizhong Tang, Fuzi, Liujun Zi Tang, Danggui, and Baishao for conditioning. Previously, Baihu Tang was considered but fortunately not administered.

Zhang Xuehai, a physician, contracted an epidemic from exhaustion: mild chills/high fever, headache/confusion. Dispersing herbs caused staring/deafness, worsening heat, thirst, and constipation. Fire-clearing/stomach-cooling/detoxifying herbs intensified heat, causing oily sweat, delirium, grasping at empty air, and ominous signs. Yang diagnosed surging-rapid-empty pulse and dry-yellow-swollen tongue. All physicians present proposed Baihu Chengqi Tang. Yang used Yangrong Tang with Renshen and Fuzi (3 qian each), predicting sleep would calm pulses/symptoms and turn tongue tender-red-smooth. Next day, prognosis held. Disease truth relies on pulse; pulse truth relies on tongue. True excess shows surging-rapid pulse strengthening on deep pressure; true fire shows dry-yellow tongue firm/constricted. How could an empty pulse and swollen tongue indicate excess? Original formula continued with half dose of Renshen/Fuzi, curing after several doses.

Lu Yangyu treated Feicun with epidemic: headache, fever, thirst, asthma, worse afternoon heat. Huoxiang Zhengqi San caused severe irritability, black-scalded tongue center, delirium, and macules. Chai Ling Tang worsened vomiting/belching and spontaneous sweating. Pulse floating-rapid-faint indicated Shaoyang-Yangming combined deficiency heat. Baihu Tang plus Renshen, Huangqi, Gegen, Chaihu, Dengxin, and Zhuye reduced heat by 70% and stopped sweating. Subsequent Ren Shen, Maidong, Wuweizi, Huangqin, Zhizi, and Gancao cleared macules in two doses.

Chen Haogu suffered bilateral Taiyang headache, left hypochondriac pain, thirst, watery diarrhea, scanty red urine, dusty complexion. Lu diagnosed slippery-large-rapid pulse, prominent at Right Guan. Late spring/early summer indicated epidemic. Chen rejected the term "plague" and left. Weiping Tang caused abnormal thirst/confusion. Re-evaluation showed critical-looking symptoms but actually extreme heat stagnation causing confusion. Diarrhea resulted from exterior qi constraint failing to secure interior qi. Baihu Tang combined with Jieji Tang resolved it in four doses. (Li notes: Lung heat transferred to Large Intestine causes diarrhea, not interior insecurity.)

Ding Chengchuan’s concubine died of plague. Half a month later, Ding fell ill with headache, fever, thirst, irritability. Xiaochaihu Tang induced a dream of intercourse with the deceased concubine, waking with seminal emission, profuse sweating, immobility, confusion, and delirium. Lu diagnosed thread-like faint pulse, muddy complexion, cold limbs (not past elbows/knees), but erect penis. Cutting the concubine’s old underwear, burning it to ash, and mixing with Fuzi Lizhong Tang cleared mind and restrained yang in two doses. Conditioning with Renshen, Maidong, Wuweizi, Baishao, Huanglian, Suanzaoren, Zhimu, and Huangbai ensured recovery. (Wentian notes: Chaihu disturbed Liver pathogen, shaking Kidney essence, causing loss of control.)

Chai Yuqing treated Madam Wu with plague. Family blamed anger; physicians used Chenxiang, Wuyao, Daizheshi, and exterior-resolving herbs for twenty days, causing chest oppression and persistent high fever. Left pulse slightly smoothed; Right three positions surging-rapid indicated epidemic heat entering Fu organs. Exterior dispersing injured Wei qi without resolving disease. Genti San (Melon Twig Powder) was administered twice to vomit phlegm. Seeing pathogen remained, Xiao Chengqi Tang was given twice to purge old feces, reducing heat. Pulse normalized after ten days of conditioning.

Miao Zhongchun treated Historian Shi Heting in spring of Dinghai year with plague: headache, fever, thirst, continuous white foam vomiting (Stomach heat). Misdiagnosed as post-retirement depression, treated with Qi-regulating herbs ineffectively. Siwu Tang worsened condition. Physicians gave up. Miao arrived after twenty days. Diagnosing epidemic (seasonal aberrant qi, akin to Cold Damage starting in Spring), he noted failure to clear or purge allowed heat to linger in intestines/stomach. Yuan qi was sufficient to prevent death. He prescribed fried Dan Dou Chi, Maidong, Zhimu, and Shigao. One dose induced profuse sweating and resolution. Constipation persisted due to fluid depletion, not pathogen. Recommended sugarcane and Maidong tea. Within three days, sixty pieces of dry stool passed, and he recovered.

Zhang Fengkui, residing in Beijing in March of Dingwei year, treated Minister Liu Puting, who was prepared for death, with delirium, picking at clothes, and insomnia for seven-eight days. Imperial Physician Wu Siquan and others prescribed Fuzi Lizhong Tang. Zhang diagnosed only surging Guan pulses, others hidden. Prescribed Zhuye Shigao Tang. Others questioned the contrast between Ice (cold) and Coal (hot). Wu claimed "Yang syndrome with Yin pulse." Zhang countered: "Surging Guan pulses are Yang. Other meridians are suppressed by fire, not Yin." One dose stopped delirium and induced sleep. Second visit showed normalization of surging and rising of hidden pulses. Xin-Liang (Acrid-Cool) herbs completed recovery.

In Yuan dynasty, Taixian County, Jiangxi, plague raged. A physician returning at midnight met a divine figure guiding him. Recognizing he was not human, the physician bowed. The deity asked what medicine he used. Physician replied: "According to cold/heat severity." Deity said: "Incorrect. Tianyi category uses Xiangsu San." The physician followed this advice with success. Formula: Chao Qu Pi Xiangfu and Zisu leaves 2 liang each; Chenpi and Gancao 1 qian each. Coarse powder, 3 qian per dose, decocted in one cup water to 70%, taken hot anytime, three times daily. Avoid meat/alcohol. All responded well.

Another record: During a city-wide plague, a white-haired old man taught a wealthy family to prepare Xiangsu San, distributing it to cure all patients. Later, plague ghosts asked the wealthy family, who confessed. Ghosts said: "This old man has taught three people," bowed, and departed. (From Wan Mizhai’s *Baoming Ge Kua*. Wentian notes: This is also Cold Plague.)

Physician Qiao, devout follower of Lü Dongbin, dreamed Lü advised storing duckweed (Ping) for curing diseases. Qiao collected ten carts. During a major epidemic, adding a pinch of Ping to prescriptions cured everyone instantly. Business boomed, making him rich. Other physicians copying this failed. (*Yunjian Zazhi*, anonymous).

Qian Guobin treated Wang Yuan, a boat manager, with sudden illness: headache, fever, lethargy, aversion to heat only, red tongue/yellow muscle, difficult urination/defecation, floating-surging pulses. Diagnosed as plague. Cooling/dispersing herbs failed for eight days. Careful review showed no chest/abdominal/flank issues, only thirst and desire to lie outward. Patient was moved outside, clothes removed...