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The disease of plague (Yiwen), in recent times, has been discussed by various experts together with warm diseases (Wenbing), due to the similarity in their names and clinical manifestations. However, plague is caused by the abnormal operation of heaven and earth qi. If treated according to its principles, it may not necessarily lead to death, nor will it necessarily infect many people; therefore, the treatment methods for plague should be discussed separately. Furthermore, there are differences in the annual yun (climate cycles) being excessive or deficient, and variations in weather between constant rain and drought. Thus, the spread of epidemic pestilence also presents distinctions in exterior, interior, cold, heat, and dampness patterns. How can they be generalized? In summary, it can be roughly divided into three categories. If the pathogen affects both exterior and interior but predominates in the exterior, Li Dongyuan's Puji Xiaodu Yin (General Relief and Toxin-Resolving Decoction) method should be used. If the pathogen is neither in the exterior nor in the interior, but resides independently in the "middle pathway" (membrane source/moyuan), Wu Youke's Dayuan Yin (Reach the Source Decoction) method should be used. If exterior heat is already vigorous and interior symptoms are urgent, such that treating only the exterior or only the interior cannot provide timely rescue, Tao Shangwen's Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction) method should be used. These constitute the introductory gateways for treating plague. Additionally, if pathogens prevail exclusively in the exterior without interior heat symptoms, the Baidu San (Defeat Toxin Powder) from *Baiwen Bingzhun* should be used. If cold-dampness acts alone, with pathology located in the skin, muscles, chest, and diaphragm, this corresponds to the syndrome treated by Su Dongpo's Shengsanzi (Holy Dispersion Substances). Combined with the previous three methods, there are five methods in total. Based on my observations, plague rarely occurs without involving the interior; cases presenting with cold-dampness but without accumulated heat account for less than one or two out of ten. Nevertheless, treatment methods must be prepared comprehensively, relying on the practitioner's appropriate application. Therefore, the following five formulas are recorded to illustrate the beginning of plague treatment. If the condition persists for a longer duration, such as six or seven days, or more than ten days, with deep-seated heat that does not resolve, it should be treated according to the methods for Cold Damage (Shanghan) and Warm Diseases.

Puji Xiaodu Yinzi (by Li Dongyuan)
Huangqin (Scutellariae Radix, wine-processed, stir-fried) [5 fen]
Huanglian (Coptidis Rhizoma, wine-stir-fried) [5 fen]
Renshen (Ginseng Radix et Rhizoma) [3 qian]
Chenpi (Citri Reticulatae Pericarpium)
Xuanshen (Scrophulariae Radix) [2 qian]
Gancao (Glycyrrhizae Radix et Rhizoma)
Lianqiao (Forsythiae Fructus)
Banlangen (Isatidis Radix)
Mabo (Belamcandae Stamen)
Niubangzi (Arctii Fructus) [1 qian]
Jiangcan (Bombyx Batryticatus)
Shengma (Cimicifugae Rhizoma) [1 qian]
Chaihu (Bupleuri Radix) [5 fen]

In the fourth month of the Taihe era, many people suffered from epidemics. Initially, patients felt aversion to cold, high fever, and body heaviness. Subsequently, severe swelling occurred on the head and face, eyes could not open, upper airway wheezing developed, throat discomfort, dry mouth, and dry tongue appeared. This was commonly known as "Big Head Cold Damage." Various mixed treatments failed to cure it, leading to critical conditions. Li Dongyuan stated: The upper half of the body belongs to the clear qi of heaven. When evil heat lodges between the Heart and Lungs and attacks upward to the head and eyes, swelling results. It is necessary to use Huangqin and Huanglian, among other herbs, ground into fine powder. Half should be taken as a decoction, administered frequently in small amounts while slightly warm; the other half should be made into honey pills for sucking. Upon completion of the course, recovery occurs, saving many lives. If stool is hard, add Jiu Zheng Dahuang (Rhei Radix et Rhizoma steamed with wine) 1–2 qian to promote bowel movement. For severe swelling, use bian stone (stone needle) acupuncture to bleed, or add Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Bohe (Menthae Haplocalycis Herba), and Danggui (Angelicae Sinensis Radix), each 5 qian, decocted in water and taken frequently.

Dayuan Yin
Binglang (Arecae Semen) [2 qian]
Caoguo (Tsaoko Fructus) [5 fen]
Houpo (Magnoliae Officinalis Cortex) [1 qian]
Shaoyao (Paeoniae Radix Alba) [1 qian]
Gancao (Glycyrrhizae Radix et Rhizoma) [5 fen]
Huangqin (Scutellariae Radix) [1 qian]

These seven ingredients are decocted in two cups of water until reduced to eight-tenths volume, then taken.

Wu Youke stated: The pathogenic factors of epidemic pestilence enter through the mouth and nose, lodging in the area behind the spine. This location is close to the exterior and near the Stomach, representing the boundary between exterior and interior, which corresponds to the "horizontal connection to the membrane source" mentioned in the *Neijing*'s discussion on malaria. Those infected lightly may develop symptoms only upon stimulation; those infected deeply fall ill immediately. Initially, yang qi is blocked internally, and the circulation mechanism of Ying and Wei (nutritive and defensive qi) is obstructed at the exterior, causing shivering chills, even to the point of cold extremities. Once the constrained yang qi unblocks, the cold extremities reverse to warmth, resulting in internal and external heat, mental confusion, high fever, and spontaneous sweating. At this stage, when pathogens lie dormant in the membrane source, even if sweating occurs, the heat cannot resolve. One must wait for the latent pathogens to dissipate, for exterior qi to penetrate inward, and for essence-qi to reach the exterior from within, establishing communication between interior and exterior. This leads to shaking chills followed by profuse sweating, allowing pathogens to exit outward. This is called "Zhanhan" (battle sweat); when the pulse becomes calm and the body cools, recovery ensues. If latent pathogens remain, fever will recur. The depth and duration of fever depend on the severity of infection and the strength of yuan qi (original qi). Generally, it begins with chills, followed by fever, and changes manifest upon eruption. Symptoms may resolve from the exterior or sink into the interior. Resolution from the exterior is easier; sinking into the interior is dangerous. There are various sequences of exterior-interior transmission: exterior first then interior; interior first then exterior; exterior only without returning to interior; interior only without returning to exterior; exterior followed by repeated exterior; interior followed by repeated exterior; simultaneous exterior-interior transmission; exterior predominant over interior; interior predominant over exterior. These are termed the "Nine Transmissions." Resolution from the exterior may present as macules or battle sweat/spontaneous sweating. Sinking into the interior presents as chest and diaphragm fullness, epigastric distension, abdominal pain, dry constipation, heat-binding with peripheral flow, diarrhea with heat, vomiting, nausea, delirium, yellow tongue coating, black coating with prickles, etc. Treatment depends on symptoms. The pulse is neither floating nor sinking but rapid; fever persists day and night, worsening in the late afternoon; headache and body ache occur.辛热 (acrid-warm) herbs for sweating are contraindicated, as are purgatives. Dayuan Yin is appropriate to penetrate the membrane source pathogens. If symptoms of specific meridians appear, add guiding herbs for those meridians; do not be rigid. Light infections show thin tongue coating and non-rapid pulse; these must resolve via sweating. If sweating fails, pathogens are entrenched in the membrane source, preventing exterior-interior communication. Forced sweating via clothing wrapping or fire/water coercion is erroneous. Heavy infections show pinkish-greasy tongue coating; after medication, pathogens may sink inward, starting with yellow root of tongue spreading to center, indicating entry into the Stomach. Add Dahuang to purge. If pulse is long, flooding, and rapid, with profuse sweat and extreme thirst, pathogens have just left the membrane source, attempting to reach the exterior but not yet fully there; this is Baihu Tang (White Tiger Decoction) pattern. If tongue is purely yellow with interior signs, pathogens have entered the Stomach; this is Chengqi Tang (Order the Qi Decoction) pattern. Some leave the membrane source in two to three days; some do not transmit for half a month or ten days; some linger weakly for four to five days, then suddenly surge on the fifth or sixth day. Strong yuan qi facilitates toxin transformation and transmission. Weak yuan qi hinders transformation and transmission; stagnant pathogens deepen and hide. Contemporary doctors mistakenly diagnose this as deficiency syndromes and administer Renshen (Ginseng) and Huangqi (Astragali Radix), causing further stagnation and consolidation, leading to death.

Sanhuang Shigao Tang treats plague with high fever, anhidrosis, mania, and inability to recognize people.
Shigao (Gypsi Fibrosus) [3 qian]
Huangqin (Scutellariae Radix) [1.5 qian]
Huanglian (Coptidis Rhizoma) [1.5 qian]
Huangbai (Phellodendri Cortex) [1.5 qian]
Douchi (Sojae Preparata) [half he]
Mahuang (Ephedrae Herba) [1 qian]
Zhizi (Gardeniae Fructus)

Take as one dose, decoct in two cups of water until one cup and three-tenths remain. Administer continuously for three to five doses until cured.

Note: Epidemic pathogens fill the interior and exterior, causing headache, body heat, irritability, thirst, restlessness, mania, and disorientation. Attempting to release the exterior aggravates the interior urgency; clearing the interior fails to resolve the exterior. This formula clears the interior and releases the exterior simultaneously, like an army besieging a lone city from all sides; collapse is inevitable. Alternatively, Xuejian (Snow Decoction) from *Qianjin Fang* or Mainu Wan (Wheat Slave Pill) from *Gujin Luyan* are also excellent. For milder cases, Daqing Xiaodu Tang (Great Blue Toxin-Resolving Decoction) is suitable.

Another Formula for Severe Exterior-Interior Heat in Seasonal Diseases
Dahuang (Rhei Radix et Rhizoma)
Han Shuishishi (Halloysitum Rubrum)
Mangxiao (Natrii Sulfas)
Shigao (Gypsi Fibrosus)
Shengma (Cimicifugae Rhizoma)
Mahuang (Ephedrae Herba)
Gegen (Puerariae Lobatae Radix)
Zige (Pseudostellariae Radix) (Equal parts)

Grind into fine powder. Take one fang cun bi (square-inch scoop) with water, twice daily.

Shengsanzi (by Su Dongpo) treats all mountain miasma, seasonal epidemics, cold damage, wind-dampness, etc., with extraordinary efficacy. Records by Li Daizhao are numerous. Su Dongpo carved stones to disseminate it, enhancing its fame. Chancellor Zheng of Huizhou used it in Jinling to treat cold damage, saving many. It effectively disperses cold-dampness and eliminates malarial miasma.
Cangzhu (Atractylodis Rhizoma, processed)
Fangfeng (Saposhnikoviae Radix)
Houpo (Magnoliae Officinalis Cortex, ginger-processed)
Zhuling (Polyporus)
Zexie (Alismatis Rhizoma, baked) [2 liang each]
Baizhi (Angelicae Dahuricae Radix)
Chuanxiong (Ligustici Chuanxiong Rhizoma)
Chishao (Paeoniae Radix Rubra)
Huoxiang (Agastaches Herba)
Chaihu (Bupleuri Radix) [0.5 liang each]
Mahuang (Ephedrae Herba)
Shengma (Cimicifugae Rhizoma)
Qianghuo (Notopterygii Rhizoma et Radix)
Duhuo (Angelicae Pubescentis Radix)
Zhike (Aurantii Fructus Immaturus)
Xixin (Asari Radix et Rhizoma)
Wuzhuyu (Evodiae Fructus, soaked)
Ben (Ligustici Wallichii Rhizoma et Radix)
Fuling (Poria) [7 qian each]
Shichangpu (Acori Tatarinowii Rhizoma)
Caodoukou (Amomi Fructus Rotundus)
Liangjiang (Alpiniae Officinarum Rhizoma)
Zhigancao (Glycyrrhizae Radix et Rhizoma, honey-fried) [2 liang each]

Grind into coarse powder. Take 3 qian per dose, decoct in two cups of water with one jujube until eight-tenths remain. Take slightly warm.

Baidu San (Defeat Toxin Powder)
Qianghuo (Notopterygii Rhizoma et Radix)
Duhuo (Angelicae Pubescentis Radix)
Qianhu (Peucedani Radix)
Chaihu (Bupleuri Radix)
Zhike (Aurantii Fructus Immaturus)
Baifuling (Poria)
Jiegeng (Platycodonis Radix)
Renshen (Ginseng Radix et Rhizoma) [1 liang each]
Chuanxiong (Ligustici Chuanxiong Rhizoma) [2 qian]

Grind into fine powder. Take 2 qian per dose, decoct in two cups of water with two slices of fresh ginger until seven-tenths remain. Take warm, or brew with boiling water.