与诸疮根瘰 结筋相似。其疮根瘰 因疮而生，似缓无毒。恶核病猝然而起，有毒，若不治，入腹烦闷杀人。
皆由冬受温风，至春夏有暴寒相搏气结成此毒也。”观此论所谓恶核，似即系鼠疫之恶核。观其所谓冬受温
风，至春夏又感寒而发，又似愚所谓伏气化热下陷少阴，由寒温而变鼠疫也。盖伏气化热之后，恒有因薄
受外感而后发者。由斯知鼠疫之证，自唐时已有，特无鼠疫之名耳。
汉皋友人冉雪峰《鼠疫问题解决》，谓水不济火则为阳燥，火不蒸水则又为阴燥，火衰不交于水固为
阴燥，水凝自不与火交亦为阴燥。鼠疫之病，阴凝成燥，燥甚化毒之为病也。又谓∶他证以脉
洪数为热进，微弱为热退，此证则以微弱为热进，洪数为热退，皆与愚所论少阴证可变鼠疫，其病情脉状莫
不吻合。至冉雪峰所着之书，详悉精微，无理不彻，无法不备，洵可为治鼠疫者之金科玉律，而拙论中未采
用其方者，正以全书之方皆宜遵用，非仅可采用其一二也。欲研究鼠疫之治法者，取冉雪峰之书与拙论参观可也。
香山友人刘蔚楚，治鼠疫结核之剧者，曾重用麝香六分，作十余次，用解毒活血清火之药煮汤，连连送
下而愈。冉雪峰治鼠疫方中，亦有用所煮汤药送服麝香，以通络透毒者，又可补吴锡璜方中所未备也。
栾州友人朱钵文告愚曰∶“余有善消鼠疫结核之方，用川大黄五钱，甘草五钱，生牡蛎六钱（捣碎），
栝蒌仁四十粒（捣碎），连翘三钱。煎汤服之，其核必消。”按∶此方大黄五钱似近猛
烈，而与甘草等分并用，其猛烈之性已化为缓和矣，所以能稳善建功也。
绍兴何廉臣所编《全国名医验案类编》，最推重广东罗氏芝园，谓其经验弘富，细心揣摹，剖察病情
如老吏断狱，罗列治法如名将谈兵，以活血去瘀之方，划清鼠疫主治界限，允推卓识，爰为
节述其因、证、方、药，俾后学有所取法。
【一探原因】城市污秽必多，郁而成 ，其毒先见。乡村污秽较少，郁而成 ，其毒次及。故热毒重
蒸，鼠先受之，人随感之，由毛孔气管入达于血管，所以血壅不行也。血已不行，渐红渐肿，微痛微热，结
核如瘰 ，多见于颈胁腌膀大腿之间，亦见于手足头面腹背，尔时体虽不安，犹可支持，病尚浅也。由浅而
深，愈肿愈大，邪气与正气相搏，而热作矣。热作而见为头痛身痹，热甚而见为大汗作渴，则病已重矣。
【二辨证候】鼠疫初起，有先恶寒者，有不恶寒者，既热之后即不恶寒，有先核而后热者，有先热而
后核者，有热核同见者，有见核不见热者，有见热不见核者，有汗有不汗者，有渴有不渴者，皆无不头痛、
身痛、四肢酸痹，其兼见者疗疮、 、疹、衄、嗽、咯、吐，甚则烦躁、懊 、昏谵、癫狂、痞满、腹
痛、便结旁流、舌焦起刺、鼻黑如煤、目瞑耳聋、骨痿足肿、舌唇裂裂、脉厥体厥，种种恶证，几难悉数，
无非热毒迫血成瘀所致。然其间亦有轻重∶核小、色白、不发热，为轻证。核小而红、头微痛、身微热、体
微酸，为稍重证。单核红肿、大热、大渴、头痛、身痛、四肢酸痹，为重证。或陡见热渴痛痹四证，或
初恶寒旋见四证，未见结核，及舌黑起刺，循衣摸床，手足摆舞，脉厥体厥，与疫证盛时，忽手足抽搐，
不省人事，面身红赤，不见结核，感毒最盛，坏人至速，皆至危证。
【三论治法方药】古方如普济消毒饮、银翘败毒散，近方如银翘散、代赈普济散等，虽皆能清热解毒，
而无活血去瘀之药，用之多不效。惟王清任活血解毒汤∶桃仁八钱去皮尖打，红花
五钱，当归钱半，川朴一钱，柴胡一钱，连翘三钱，赤芍三钱，生地五钱，葛根一钱，生甘草一钱。方以
桃仁为君，而辅以当归，去瘀而通壅；连、芍为臣，而兼以地，清热而解毒，朴、甘为佐使，疏气而和药，
气行则血通；柴、葛以解肌退热而拒邪，邪除则病愈。惟其对证用药，故能投无不效。盖此证热毒本也，瘀
血标也，而标实与本同重。故标本未甚者，原方可愈。标本已甚者，传表宜加白虎；传里宜加承气；毒
甚宜加羚、犀。如连进后，汗出热清，可减除柴、葛；毒下瘀少，可减轻桃、红；其他当随证加减。轻证
照原方一服。稍重证，日夜二服，加金银花、竹叶各二钱；如口渴微汗，加石膏五钱，知母三钱。重证、
危证、至危证，于初起恶寒，照原方服，柴胡、葛根各加一钱；若见大热，初加金银花、竹叶各三钱，西
藏红花一钱，危证钱半，或加紫草三钱，苏木三钱。疔疮，加紫花地丁三钱，洋菊叶汁一杯冲。小便不利，加
车前子三钱。痰多加川贝母三钱，生莱菔汁两杯冲。若痰壅神昏，又非前药可治，当加鲜石菖蒲汁一瓢
冲，鲜竹沥两瓢冲，或礞石滚痰丸三钱包煎。若见癫狂，双剂合服，加重白虎，并竹叶心、羚角、犀角、
西藏红花各三钱。血从上逆，见衄咯等证，加犀角、丹皮各三钱，鲜茅根、鲜芦根各四两。见 加石膏一两，
知母五钱，元参二钱，犀角二钱。见疹加金银花、牛蒡子各三钱，竹叶、大青叶、丹皮各二钱。老弱幼
小，急进只用单剂，日夜惟二服，加石膏，大黄减半。所加各药，小儿皆宜减半。五、六岁，一剂同煎，分
二次服。重危之证，一剂作一服。幼小不能服药，用针刺结核三四刺，以如意油调经验涂核散（山慈菇三钱，
真青黛一钱，生黄柏钱半，浙贝钱半，赤小豆二钱，共研细末）日夜频涂十余次可愈。妇女同治。惟孕
妇加黄芩、桑寄生各三钱以安胎。初起即宜急服，热甚尤宜急进，
热久胎必坠。若疑桃仁、红花坠胎，可改用紫草、紫背天葵各三
钱。惟宜下者除芒硝。以上诸法，俱从屡次试验得来。证以强壮者为多，故于人属强壮，毒盛热旺，每于
重危之证，必加羚角、犀角、西藏红花，取其见效较捷耳。无如人情多俭，富者闻而退缩，贫者更可知矣。
兹为推展，分别热盛毒盛两途，随证加药，亦足以治病。如初系热盛之证，加石膏、知母、淡竹叶或螺
靥菜（或名雷公根）、龙胆草、白茅根之类，便可清热。如兼有毒盛之证，加金银花、牛蒡子、人中黄之类，
便可以解毒。若热毒入心包，羚角、犀角、藏红花虽属紧要，然加生竹叶心、生灯心、黄芩、栀子、麦冬心、
莲子心、元参心之类，便可除心包之热毒。若热毒入里，加大黄、朴硝、枳壳以泻之，便可去肠胃之热毒。
平潭友人李健颐，着有《鼠疫新篇》一书，蒙赠一册。论鼠疫之病，谓系有一种黑蚁传染于鼠，再传
于人。其中所载之医案治法，莫不精良，而遇此证之热甚者，恒放胆重用生石膏，有一剂而用至八两者，
有治愈一证而用至二斤强者，可为有胆有识。爰录其治愈之案一则，以为治斯病者之标准。
平潭蔡××，年五十八岁，初起恶寒，旋即发热，热甚口渴，手足痹疼，胯下赘生一核，热痛非常，胸
胀呕血，目赤神昏，脉数苔黄。因其先触睹死鼠，毛窍大开，毒瓦斯传入血管，潜伏体内；复因外感春阳之
气而为引线，是以胃热则呕逆，肺伤则喷血，热深内窜肺络，肺与心近，影响阻碍，心不守舍，故昏迷谵语。
此证涉危笃，急宜清胃、泻肺、攻毒、解热重剂急进，庶能挽救。方拟用加减解毒活血汤加石膏、芦根。
荆芥穗（三钱） 连翘（三钱） 金银花（五钱） 浙贝母（三钱） 生地黄（五钱） 赤芍药（三
钱） 桃仁（五钱） 川红花（三钱） 紫草（三钱） 生石膏（二两捣细） 鲜芦根（一两）
雄黄精（一钱） 冰片（五分）
将前十一味煎汤两盅，分两次温服。后二味共研细末，分两
次用汤药送服。
将药连服二剂，呕平血止，热退胸舒。将原方减雄黄，加锦纹大黄五钱，以泻胃中余毒，服两剂，诸恙悉解。
与各种疮疡根部的瘰疬、筋结相似。那些疮疡根部的瘰疬是因疮疡而生，看似病势缓慢且无毒害。恶核病（一种急性淋巴结炎或类似病症）突然发作，具有毒性，如果不治疗，毒邪入腹会导致烦闷甚至致死。
这都是因为冬季感受了温风，到了春夏季节又遭遇暴寒，寒热之气搏结而形成了这种毒邪。”观察这段论述中所谓的“恶核”，似乎就是鼠疫中的恶核表现。观察其所说的冬季感受温风，到了春夏又感受寒气而发病，又似乎是我所论述的伏气化热下陷少阴经，由寒温之邪转变为鼠疫。大概伏气化热之后，常常有因为轻微感受外感而后发出来的情况。由此可知鼠疫这种病症，自唐代时就已经存在，只是没有鼠疫这个名称罢了。
汉皋的朋友冉雪峰在《鼠疫问题解决》一书中说，水不能济助火则成为阳燥，火不能蒸腾水则又成为阴燥，火衰微不能与水相交固然属于阴燥，水凝滞自然也不与火相交也属于阴燥。鼠疫这种病，是阴凝而成燥，燥气极盛化为毒邪所导致的疾病。他又说：其他病症以脉象洪数为热邪进展，微弱为热邪消退；此证（鼠疫）则以脉象微弱为热邪进展，洪数为热邪消退，这些都与我论述的少阴证可变为鼠疫，其病情和脉状无不吻合。至于冉雪峰所著的书籍，详细精微，无理论不透彻，无治法不完备，确实是治疗鼠疫者的金科玉律，而我拙劣的论述中没有采用他的方子，正是因为全书的方子都应当遵循使用，不仅仅是可以采用其中的一两个罢了。想要研究鼠疫治法的人，可以取冉雪峰的书与我的论述对照参考即可。
香山的朋友刘蔚楚，治疗鼠疫结核严重的病例，曾重用麝香六分，分十多次服用，用解毒活血清火的药物煮汤，连续送服而痊愈。冉雪峰治疗鼠疫的方子中，也有用所煮汤药送服麝香，以通络透毒的方法，这又可以补充吴锡璜方剂中所未具备的内容。
栾州的朋友朱钵文告诉我：“我有一种善于消除鼠疫结核的方子，用川大黄五钱，甘草五钱，生牡蛎六钱（捣碎），瓜蒌仁四十粒（捣碎），连翘三钱。煎汤服用，那个结核必定会消散。”按：此方中大黄五钱似乎接近猛烈，但与甘草等量并用，其猛烈的性质已经转化为缓和了，所以能够稳妥地取得疗效。
绍兴何廉臣所编纂的《全国名医验案类编》，最推崇广东罗氏芝园，认为他经验宏富，细心揣摩，剖析察看病情的状态如同老练的官吏断案，罗列治法如同名将谈论兵法，以活血去瘀的方剂，划清了鼠疫主治的界限，确实堪称卓识，于是节述其病因、证候、方剂、药物，以便后学者有所取法。
【一探原因】城市污秽必然多，郁结而成疠气，其毒邪首先显现。乡村污秽较少，郁结而成疠气，其毒邪其次波及。所以热毒重重蒸腾，老鼠先受到感染，人随后被传染，由毛孔气管进入到达血管，所以血液壅滞不行。血液已经不行，逐渐变红肿胀，微痛微热，结成结核如瘰疬一般，多见于颈胁腋窝大腿之间，也见于手足头面腹背，此时身体虽然不安，还可以支持，病尚浅表。由浅入深，越肿越大，邪气与正气相搏，于是发热出现。发热而出现头痛身体痹痛，热邪严重而出现大汗口渴，那么病已经很重了。
【二辨证候】鼠疫初起，有先恶寒的，有不恶寒的，既然后发热就不再恶寒，有先出现结核而后发热的，有先发热而后出现结核的，有热与结核同时出现的，有只见结核不见发热的，有只见发热不见结核的，有出汗的，有无汗的，有口渴的，有无渴的，但无不伴有头痛、身痛、四肢酸痹，其兼见的症状有疗疮、丹毒、疹、鼻衄、咳嗽、咯血、呕吐，严重时烦躁、懊恼、昏谵、癫狂、痞满、腹痛、便结旁流、舌焦起刺、鼻黑如煤、闭目耳聋、骨痿足肿、舌唇裂开、脉厥体厥，种种恶证，几乎难以全部列举，无非是热毒迫血成瘀所致。然而其中有轻重之分：结核小、色白、不发热，为轻证。结核小而红、头微痛、身微热、身体微酸，为稍重证。单核红肿、大热、大渴、头痛、身痛、四肢酸痹，为重证。或者突然见到热渴痛痹四证，或者初起恶寒随即见到四证，未见结核，以及舌黑起刺，循衣摸床，手足摆舞，脉厥体厥，与疫病盛行时，忽然手足抽搐，不省人事，面身红赤，不见结核，感毒最盛，败坏人体速度极快，都是至危之证。
【三论治法方药】古方如普济消毒饮、银翘败毒散，近方如银翘散、代赈普济散等，虽然都能清热解毒，但没有活血去瘀的药物，使用大多无效。只有王清任的活血解毒汤：桃仁八钱去皮尖打碎，红花五钱，当归一两半，川朴一钱，柴胡一钱，连翘三钱，赤芍三钱，生地五钱，葛根一钱，生甘草一钱。方中以桃仁为君药，辅以当归，去瘀而通壅滞；连翘、赤芍为臣药，兼用地黄，清热而解毒，厚朴、甘草为佐使药，疏理气机而调和药性，气行则血通；柴胡、葛根以解肌退热而抵御邪气，邪除则病愈。正因为其对证用药，所以投用无不有效。大概此证热毒是本，瘀血是标，而标实与本虚同样重要。所以标本都不严重的，原方可以治愈。如果标本都已经严重，传变到表宜加白虎汤；传变到里宜加大承气汤；毒邪甚宜加羚羊角、犀角。如连续服用后，汗出热清，可以减去柴胡、葛根；毒下瘀血减少，可以减轻桃仁、红花；其他当随证加减。轻证照原方服一剂。稍重证，日夜各服一次，加金银花、竹叶各二钱；如口渴微汗，加石膏五钱，知母三钱。重证、危证、至危证，在初起恶寒时，照原方服用，柴胡、葛根各加一钱；若见到大热，初加金银花、竹叶各三钱，西藏红花一钱，危证加钱半，或加紫草三钱，苏木三钱。若有疗疮，加紫花地丁三钱，洋菊叶汁一杯冲服。小便不利，加车前子三钱。痰多加川贝母三钱，生莱菔汁两杯冲服。若痰壅神昏，又不是前面药物能治疗的，应当加鲜石菖蒲汁一瓢冲服，鲜竹沥两瓢冲服，或者礞石滚痰丸三钱包煎。若见癫狂，双剂合服，加重白虎汤，并加竹叶心、羚角、犀角、西藏红花各三钱。血从上逆，见衄血咯血等证，加犀角、丹皮各三钱，鲜茅根、鲜芦根各四两。见丹毒加石膏一两，知母五钱，元参二钱，犀角二钱。见疹加金银花、牛蒡子各三钱，竹叶、大青叶、丹皮各二钱。老弱幼小，急进只用单剂，日夜只服两次，加石膏，大黄减半。所加各药，小儿皆宜减半。五、六岁，一剂同煎，分二次服。重危之证，一剂作一服。幼小不能服药，用针刺结核三四刺，以如意油调经验涂核散（山慈菇三钱，真青黛一钱，生黄柏一两半，浙贝一两半，赤小豆二钱，共研细末）日夜频涂十余次可愈。妇女同治。惟孕妇加黄芩、桑寄生各三钱以安胎。初起即宜急服，热甚尤宜急进，热久胎必坠。若疑桃仁、红花坠胎，可改用紫草、紫背天葵各三钱。惟宜下者除芒硝。以上诸法，俱从屡次试验得来。证以强壮者为多，所以对于人体质强壮，毒盛热旺，每于重危之证，必加羚角、犀角、西藏红花，取其见效较捷耳。无奈人情多节俭，富者听闻而退缩，贫者更可想而知了。现在为了推广，分别热盛毒盛两途，随证加药，也足以治病。如初系热盛之证，加石膏、知母、淡竹叶或螺靥菜（或名雷公根）、龙胆草、白茅根之类，便可清热。如兼有毒盛之证，加金银花、牛蒡子、人中黄之类，便可以解毒。若热毒入心包，羚角、犀角、藏红花虽属紧要，然加生竹叶心、生灯心、黄芩、栀子、麦冬心、莲子心、元参心之类，便可除心包之热毒。若热毒入里，加大黄、朴硝、枳壳以泻之，便可去肠胃之热毒。
平潭的朋友李健颐，著有《鼠疫新篇》一书，赠送我一册。论述鼠疫的病，谓系有一种黑蚁传染于鼠，再传染于人。其中所载的医案治法，无不精良，而遇到此证热甚者，恒放胆重用生石膏，有一剂而用至八两者，有治愈一证而用至二斤强者，可谓有胆有识。于是记录其治愈的一则案例，作为治疗此病的标准。
平潭蔡××，年五十八岁，初起恶寒，旋即发热，热甚口渴，手足痹疼，胯下赘生一核，热痛非常，胸胀呕血，目赤神昏，脉数苔黄。因其先触睹死鼠，毛窍大开，毒瓦斯传入血管，潜伏体内；复因外感春阳之气而为引线，是以胃热则呕逆，肺伤则喷血，热深内窜肺络，肺与心近，影响阻碍，心不守舍，故昏迷谵语。此证涉危笃，急宜清胃、泻肺、攻毒、解热重剂急进，庶能挽救。方拟用加减解毒活血汤加石膏、芦根。荆芥穗（三钱） 连翘（三钱） 金银花（五钱） 浙贝母（三钱） 生地黄（五钱） 赤芍药（三钱） 桃仁（五钱） 川红花（三钱） 紫草（三钱） 生石膏（二两捣细） 鲜芦根（一两） 雄黄精（一钱） 冰片（五分）
将前十一味煎汤两盅，分两次温服。后二味共研细末，分两次用汤药送服。
将药连服二剂，呕平血止，热退胸舒。将原方减雄黄，加锦纹大黄五钱，以泻胃中余毒，服两剂，诸恙悉解。
Similar to the lymph node swellings (scrofula) and tendon knots found at the root of various sores. The lymph node swellings at the root of sores arise from the sores themselves, appearing slow in progression and seemingly non-toxic. The disease known as "Ehe" (Malignant Nodule/Epidemic Nodule) arises suddenly, is toxic, and if untreated, the toxin enters the abdomen causing restlessness and potentially death.
This is all due to contracting warm winds in winter, and then encountering sudden cold in spring and summer; the qi of cold and heat struggles and knots together to form this toxin." Observing this discussion on "Ehe," it seems to correspond to the malignant nodules seen in plague. Observing its description of contracting warm winds in winter and then developing symptoms after feeling cold in spring and summer, it also resembles my theory of latent pathogenic qi transforming into heat and sinking into the Shaoyin channel, changing from cold-warm pathogens into plague. Generally, after latent pathogenic qi transforms into heat, there are often cases where it erupts following a slight external contraction. From this, we know that the syndrome of plague existed since the Tang Dynasty, merely lacking the name "plague."
My friend Ran Xuefeng from Hangan, in his book *Solution to Plague Problems*, states that when water fails to nourish fire, it becomes Yang dryness; when fire fails to evaporate water, it becomes Yin dryness. When fire is deficient and fails to interact with water, it is indeed Yin dryness; when water congeals and naturally does not interact with fire, it is also Yin dryness. The disease of plague is caused by Yin congealing into dryness, and extreme dryness transforming into toxicity. He further states: In other syndromes, a surging and rapid pulse indicates advancing heat, while a weak pulse indicates receding heat; in this syndrome (plague), a weak pulse indicates advancing heat, and a surging/rapid pulse indicates receding heat. All these points align perfectly with my discussion that Shaoyin syndromes can transform into plague, matching both the clinical presentation and pulse conditions. As for Mr. Ran's book, it is detailed, precise, thorough in theory, and comprehensive in treatment methods, truly serving as the golden rule for treating plague. The reason I did not adopt his formulas in my humble treatise is precisely because all formulas in his book should be followed strictly, not just selected individually. Those wishing to study the treatment of plague may refer to Mr. Ran's book alongside my treatise.
My friend Liu Weichu from Xiangshan, in treating severe cases of plague tubercles, once heavily utilized Musk (Moschus) at a dosage of 6 fen, administered over ten occasions, using decoctions of detoxifying, blood-invigorating, and fire-clearing herbs to wash down the Musk, resulting in recovery. Mr. Ran Xuefeng’s plague formulas also include using decoctions to administer Musk to unblock collaterals and penetrate toxins, which supplements what was missing in Wu Xihuang’s formulas.
My friend Zhu Bowen from Luanzhou told me: “I have a formula effective at resolving plague tubercles, using Rhizoma et Radix Rhei (Dahuang) 5 qian, Radix Glycyrrhizae (Gancao) 5 qian, Concha Ostreae (Sheng Muli) 6 qian (crushed), Semen Trichosanthis (Gualou Ren) 40 grains (crushed), and Fructus Forsythiae (Lianqiao) 3 qian. Decoct and take orally; the nodules will surely dissipate.” Note: The use of 5 qian of Dahuang in this formula seems close to being too harsh, but when used in equal proportion with Gancao, its harsh nature is transformed into mildness, thus achieving stable and beneficial results.
He Lianchen from Shaoxing, in compiling *Collection of Verified Cases from Famous Doctors Nationwide*, highly praises Luo Zhiyuan from Guangdong, stating he possesses abundant experience and meticulous analysis, dissecting disease conditions like an experienced judge, and listing treatments like a general discussing warfare. By using blood-invigorating and stasis-resolving formulas, he clearly delineated the main treatment boundaries for plague, demonstrating true insight. Therefore, I briefly recount his etiology, syndromes, formulas, and herbs for future scholars to emulate.
[Exploring Etiology] Cities inevitably have much filth, which stagnates to form miasma, and its toxicity manifests first. Countryside filth is less, stagnating to form miasma, with toxicity spreading secondarily. Thus, when heat and toxicity heavily steam, rats are infected first, and humans contract it subsequently. It enters through pores and respiratory tracts to reach the blood vessels, causing blood congestion and stagnation. Once blood flow ceases, it gradually turns red and swells, becoming slightly painful and hot, forming tubercles similar to scrofula. These are mostly seen between the neck, ribs, armpits, and thighs, but also appear on hands, feet, head, face, abdomen, and back. At this stage, although the body feels uncomfortable, it can still be supported, indicating the disease is superficial. As it moves from superficial to deep, swelling increases, and evil qi struggles with righteous qi, leading to fever. Fever manifests as headache and body bi-syndrome; severe heat manifests as profuse sweating and thirst, indicating the disease has become serious.
[Differentiating Syndromes] At the onset of plague, some present with initial aversion to cold, others without. After fever sets in, aversion to cold ceases. Some present with tubercles before fever, others with fever before tubercles, some with simultaneous fever and tubercles, some showing only tubercles without fever, others showing only fever without tubercles. Some sweat, others do not; some are thirsty, others are not. However, none lack headache, body pain, and limb soreness/bi-syndrome. Accompanying symptoms may include carbuncles, erysipelas, rashes, epistaxis, cough, hemoptysis, vomiting. Severe cases involve irritability, restlessness, delirium, mania, chest fullness, abdominal pain, constipation with liquid stool leakage, scorched tongue with prickles, nose black as coal, closed eyes and deafness, bone weakness and swollen feet, cracked tongue and lips, pulse syncope and body syncope. Such numerous malignant signs are hard to list exhaustively, all caused by heat and toxicity forcing blood to form stasis. However, there are degrees of severity: Small, white, non-febrile tubercles indicate a mild case. Small, red tubercles with slight headache, slight fever, and slight body soreness indicate a slightly severe case. Single red/swollen tubercle with high fever, extreme thirst, headache, body pain, and limb soreness indicates a severe case. Sudden appearance of the four symptoms (fever, thirst, pain, bi-syndrome), or initial aversion to cold rapidly turning into the four symptoms, absence of tubercles, black tongue with prickles, grasping at clothes, flailing limbs, pulse/body syncope, or sudden convulsions and unconsciousness during epidemic peak with red face and body but no tubercles, indicate the strongest toxin infection and fastest deterioration, representing critical danger.
[Discussing Treatment Methods and Formulas] Ancient formulas such as Puji Xiaodu Yin and Yinqiao Baidu San, and recent formulas like Yinqiao San and Daizhen Puji San, although capable of clearing heat and detoxifying, lack blood-invigorating and stasis-resolving herbs, making them largely ineffective. Only Wang Qingren’s Huoxie Jiedu Tang (Blood Invigorating and Detoxifying Decoction): Tao Ren (Semen Persicae) 8 qian (skin/spit removed, crushed), Hong Hua (Flos Carthami) 5 qian, Dang Gui (Radix Angelicae Sinensis) 1.5 liang, Chuan Houpo (Cortex Magnoliae Officinalis) 1 qian, Chaihu (Radix Bupleuri) 1 qian, Lianqiao (Fructus Forsythiae) 3 qian, Chi Shao (Radix Paeoniae Rubra) 3 qian, Sheng Di Huang (Radix Rehmanniae Preparata) 5 qian, Gegen (Radix Puerariae) 1 qian, Sheng Gancao (Radix Glycyrrhizae Preparata) 1 qian. In this formula, Tao Ren is the Sovereign herb, assisted by Dang Gui to remove stasis and unblock congestion; Lianqiao and Chi Shao are Minister herbs, combined with Sheng Di Huang to clear heat and detoxify; Houpo and Gancao are Assistant-Guide herbs to regulate qi and harmonize the formula; when qi moves, blood flows; Chaihu and Gegen release the muscle layer, reduce fever, and repel evil; when evil is eliminated, the disease heals. Because it matches the syndrome precisely, it is invariably effective. Generally, heat and toxicity are the root, and blood stasis is the branch, with branch excess being as heavy as root deficiency. If neither root nor branch is severe, the original formula suffices. If both are severe, if transmitted to the exterior, add Baihu Tang; if transmitted to the interior, add Chengqi Tang; if toxicity is extreme, add Lingyangjiao (Cornu Saigontarum) and Xijiao (Cornu Bubali). If taken continuously and sweat/heat clear, remove Chaihu and Gegen; if toxin/stasis reduces, reduce Tao Ren and Hong Hua; other adjustments follow the syndrome. Mild cases: one dose of original formula. Slightly severe cases: twice daily, add Jin Yin Hua (Flos Lonicerae) and Zhu Ye (Folium Bambusae) 2 qian each; if thirsty with slight sweat, add Shigao (Gypsum Fibrosum) 5 qian and Zhi Mu (Rhizoma Anemarrhenae) 3 qian. Severe, Critical, and Extremely Critical cases: At initial aversion to cold, take original formula, adding 1 qian each to Chaihu and Gegen; if high fever appears, initially add Jin Yin Hua and Zhu Ye 3 qian each, Zanghonghua (Flos Carthami Tinctorius - Tibetan Safflower) 1 qian (1.5 qian for critical cases), or add Zicao (Radix Arnebiae/Lithospermi) 3 qian and Sumu (Lignum Dalbergiae Odoriferae) 3 qian. For carbuncles, add Zihuadiding (Herba Violae) 3 qian and Yangju Ye Zhi (Juice of Chrysanthemum leaves) 1 cup mixed in. For difficult urination, add Cheqianzi (Semen Plantaginis) 3 qian. For excessive phlegm, add Chuan Beimu (Bulbus Fritillariae Cirrhosae) 3 qian and Sheng Laifu Zhi (Juice of Radish) 2 cups mixed in. If phlegm obstruction causes coma, previous medicines are insufficient; add fresh Shichangpu juice 1 ladle mixed in, fresh Zhuli (Nodus Bambusae in Taeniam) 2 ladles mixed in, or Mengshi Guntan Wan (Mengshi Phyllolithum Pill) 3 qian wrapped in decoction. For mania, combine two doses, intensify Baihu Tang, and add Zhuyexin (Nodus Folii Bambusae), Lingyangjiao, Xijiao, and Zanghonghua 3 qian each. For blood regurgitating upwards (epistaxis/hemoptysis), add Xijiao and Danpi (Cortex Moutan) 3 qian each, fresh Maogen (Radix Imperatae) and fresh Lugeng (Rhizoma Phragmitis) 4 liang each. For erysipelas, add Shigao 1 liang, Zhi Mu 5 qian, Xuanshen (Radix Scrophulariae) 2 qian, Xijiao 2 qian. For rashes, add Jin Yin Hua and Niubangzi (Fructus Arctii) 3 qian each, Zhuye, Daqingye (Folium Isatidis), and Danpi 2 qian each. For elderly, weak, young, or small patients, advance quickly using single doses, twice daily, add Shigao, halve Dahuang. Herbs added should be halved for children. Ages 5-6: one dose decocted together, divided into two servings. For critical cases, one dose per administration. For young children unable to take medicine, puncture tubercles 3-4 times, apply Jingyan Tuhe San (Experience Paste for Tubercles: Shancigu 3 qian, Zhen Qingdai 1 qian, Sheng Huangbai 1.5 liang, Zhebei 1.5 liang, Chixiaodou 2 qian, ground fine) with Ruyi Oil, applied frequently day and night for over ten times until cured. Women treated similarly. Pregnant women add Huangqin (Radix Scutellariae) and Sangjisheng (Ramulus Taxilli) 3 qian each to calm the fetus. Take urgently at onset; if heat is severe, advance urgently, as prolonged heat will cause miscarriage. If concerned about Tao Ren and Hong Hua causing miscarriage, substitute with Zicao and Zi Bei Tiankui 3 qian each. Exclude Mangxiao (Natrii Sulfas) only if purgation is indicated. All above methods derived from repeated trials. Cases are mostly in robust individuals; thus, for robust persons with strong toxicity and heat, especially in critical cases, Lingyangjiao, Xijiao, and Zanghonghua are added for faster effect. Unfortunately, people are often frugal; the wealthy hesitate, and the poor are even worse. To promote treatment, distinguishing between Heat-Dominant and Toxicity-Dominant paths, adding herbs according to syndrome is sufficient. If initially Heat-Dominant, add Shigao, Zhi Mu, Danshenye (Folium Bambusae), Luowiecai (or Leigonggen), Longdancao, Baimaogen, etc., to clear heat. If accompanied by Toxicity-Dominance, add Jin Yin Hua, Niubangzi, Renzhonghuang, etc., to detoxify. If heat-toxin enters the Pericardium, although Lingyangjiao, Xijiao, and Zanghonghua are crucial, adding Zhuyexin, Dengxincao (Medulla Junci), Huangqin, Zhizi, Maidongxin, Lianzixin, Xuanshenxin, etc., clears Pericardium heat-toxin. If heat-toxin enters the interior, add Dahuang, Pomiao (Natrii Sulfas), Zhike (Fructus Aurantii) to purge, clearing gastrointestinal heat-toxin.
My friend Li Jianyi from Pingtan authored *New Chapter on Plague* and gifted me a copy. Discussing plague etiology, he attributes it to a type of black ant transmitting to rats, then to humans. The medical cases and treatments recorded therein are excellent. For severe heat cases, he boldly uses heavy doses of raw Shigao, with one dose reaching 8 liang, or curing a case using over 2 jin, demonstrating courage and insight. I record one cured case as a standard for treating this disease.
Cai XX from Pingtan, aged 58, initially had aversion to cold, rapidly followed by fever, extreme thirst, numbness/pain in limbs, a nodule growing under the groin with intense heat/pain, chest distension, hematemesis, red eyes, coma/delirium, rapid pulse, yellow coating. Because he previously touched a dead rat, pores opened wide, allowing toxic vapors to enter blood vessels and lie latent in the body; compounded by external contraction of Spring Yang Qi acting as a guide, stomach heat caused vomiting/regurgitation, lung injury caused spitting blood, deep heat penetrated lung collaterals, affecting the nearby heart, disturbing the Heart Spirit, hence coma and delirium. This case is critically dangerous; urgent heavy doses clearing stomach, purging lung, attacking toxin, and resolving heat are needed to save him. Formula proposed: Modified Jiedu Huoxue Tang plus Shigao and Lugeng. Jingjie Sui (3 qian), Lianqiao (3 qian), Jin Yin Hua (5 qian), Zhe Beimu (3 qian), Sheng Di Huang (5 qian), Chi Shao Yao (3 qian), Tao Ren (5 qian), Chuan Hong Hua (3 qian), Zicao (3 qian), Sheng Shigao (2 liang, finely crushed), Fresh Lugeng (1 liang), Xionghuangjing (1 qian), Bingpian (5 fen).
Decoct the first eleven ingredients in two bowls of water, divide into two warm doses. Grind the last two ingredients into fine powder, divide into two doses, taken with the decoction.
After taking two doses, vomiting stopped, bleeding ceased, fever subsided, chest relaxed. Remove Xionghuang from original formula, add Jinwen Dahuang 5 qian to purge residual stomach toxin, take two doses, all ailments resolved.