头痛目痛，颇似伤寒。然太阳阳明头痛，不至于倾侧难举。而此则头痛如劈，两目昏瞀，势若难支。总因火毒达于
二经，毒参阳位，用釜底抽薪法，彻火下降，其痛立止，其疹自透。宜清瘟败毒饮增石膏、元参，加菊花。误用辛凉表
散，燔灼火焰，必转闷证。
骨节烦疼，腰如被杖。骨与腰皆肾经所属，其痛若此。是淫热之气，已流于肾经。宜本方增石膏、元参，加黄柏。
误用温散，死不终朝矣。
热宜和，不宜躁。若热至遍体炎炎，较之昏沉肢冷者。而此则发扬，以其气血尚堪胜毒，一经清解，而疹自透。妄
肆发表，必至内伏。宜本方增石膏、生地、丹皮、芩、连。
有似乎静而忽躁，有似乎躁而忽静，谓之静躁不常。较之颠狂，彼乃发扬，而此嫌郁遏。总为毒火内扰，以至坐卧
不安。宜本方增石膏、犀角、黄连。
寤，从阳主上；寐，从阴主下。胃为六腑之海，热毒壅遏，阻隔上下，故火扰不寐。宜本方增石膏、犀、连，加琥
珀。
雄按∶火扰不寐，何必琥珀？若欲导下，宜用木通。
初病周身如冰，色如蒙垢，满口如霜，头痛如劈，饮热恶冷，六脉沉细。此阳极似阴，毒之隐伏者也。重清内热，
使毒热外透，身忽大热，脉转洪数，烦躁谵妄，大渴思冰。证虽枭恶，尚可为力。宜本方增石膏、丹皮、犀、连，加黄
柏。若遇庸手，妄投桂、附，药不终剂，死如服毒。
四肢属脾，至于逆冷，杂证见之。是脾经虚寒，元阳将脱之象。惟疫则不然，通身大热，而四肢独冷。此烈毒郁遏
脾经，邪火莫透。重清脾热，手足自温。宜本方增石膏。
雄按∶四肢逆冷，在杂证，不仅脾经虚寒。在疫证，亦非毒壅脾经。增石膏，原是清胃。胃气行则肢自和也。亦有
热伏厥阴而逆冷者，温疫证中最多，不可不知也。
筋属肝，赖血以养，热毒流于肝经，斑疹不能寻窍而出，筋脉受其冲激。则抽惕若惊。宜本方增石膏、丹皮，加胆
草。
杂证，有精液枯涸，水不上升，咽干思饮，不及半杯。而此则思冰饮水，百杯不足。缘毒火熬煎于内，非冰水不足
以救其燥，非石膏不足以制其焰。庸工犹戒生冷，病家奉为至言，即温水亦不敢与。以致唇焦舌黑。宜本方增石膏，加
花粉。
四时百病，胃气为本。至于不食，似难为也。而非所论于疫证，此乃邪火犯胃，热毒上冲，频频干呕者有之。旋食
旋吐者有之。胃气一清，不必强之食，自无不食矣。宜本方增石膏，加枳壳。
雄按∶热壅于胃，杳不知饥，强进粥糜，反助邪气。虽粒米不进，而病势未衰者，不可疑为胃败也。若干呕吐食，
则本方之甘、桔、丹皮，皆不可用。宜加竹茹、枇杷叶、半夏之类。
胸膈乃上焦心肺之地，而邪不易犯。惟火上炎，易及于心，以火济火，移热于肺，金被火灼，其燥愈甚。胸膈郁遏，
而气必长吁矣。宜本方增连、桔、加枳壳、蒌仁。
雄按∶邪火上炎，固能郁遏肺气，而为膈满，第平素有停痰伏饮者。或起病之先，兼有食滞者。本方地、芍，未可
浪投。临证须辨别施治，惟芦菔汁，既清燥火之闭郁，亦开痰食之停留。用得其宜，取效甚捷。
昏闷无声者，心之气出于肺而为声。窍因气闭，气因毒滞，心迷而神不清。窍闭而声不出。宜本方，增石膏、犀角、
芩、连，加羚羊角、桑皮。
雄按∶桑皮虽走肺，而无通气宣窍之能。宜用∶马兜铃、射干、通草之类；清神化毒，当参紫雪之类。
胃气弱者，偏寒偏热，水停食积，皆与真气相搏而痛，此言寻常受病之源也。至于疫证腹痛，或左或右，或痛引小
肠，乃毒火冲突，发泄无门。苦按寻常腹痛分经络而治之，必死。如初起只用败毒散、或凉膈散加黄连，其痛立止。
雄按∶疫证腹痛，固与杂证迥殊，然夹食、夹瘀、夹疝，因病疫而宿疾兼发者，亦正多也。临证处方，岂可不为顾
及。
筋肉 动，在伤寒则为亡阳，而此则不然。盖汗者，心之液，血之所化也。血生于心，藏于肝，统于脾。血被煎熬，
筋失其养，故筋肉为之 动。宜本方增石膏、生地、元参，加黄柏。
雄按∶亡阳 动，宜补土制水。淫热 动，宜泻火息风。本方尚少镇静息风之品，宜去丹、桔，加菊花、胆草。
病患自言胃出冷气，非真冷也。乃上升之气，自肝而出，中挟相火，自下而上，其热尤甚。此火极似水，热极之征，
阳亢逼阴，故有冷气。宜本方增石膏、犀、地、丹、连，加胆草。
雄按∶冷气上升，虽在别证中见之，亦多属火。不知者，妄投温热。贻害可胜道哉！本方桔、芍，亦属非宜。更有
挟痰者，须加海蜇、竹沥、芦菔汁之类。汪按∶此证挟痰者最多。
口中臭气，令人难近，使非毒火熏蒸于内，何以口秽喷人乃尔耶。宜本方增石膏、犀、连。
雄按∶宜加兰草、竹茹、枇杷叶、金银花、蔷薇露、莹白、金汁之类，以导秽浊下行。
舌苔满口如霜，在伤寒为寒证的据，故当温散。而疫证见此，舌必浓大，为火极水化。宜本方增石膏、犀、地、翘、
连，加黄柏。误用温散，旋即变黑。汪按∶凡温热暑疫，见此舌者，病必见重最宜详慎。
雄按∶凡热证疫证见此苔者，固不可误指为寒，良由兼痰挟湿，遏伏热毒使然，清解方中，宜佐开泄之品为治。
咽喉者，水谷之道路，呼吸之出入。毒火熏蒸，至于肿痛，亟当清解以开闭塞。宜本方增石膏、元、桔，加牛蒡、
射干、山豆根。
雄按∶加莹白、金汁最妙。药汁碍咽者，亟以锡类散吹之。
唇者，脾之华。唇 肿，火炎土燥也。宜本方增石膏、翘、连，加天花粉。
头为诸阳之首，头面肿大，此毒火上攻。宜本方增石膏、元参，加银花、马勃、僵蚕、板蓝根、紫花地丁、归尾。
脉实者，量加，酒洗生大黄。
面上燎 ，宛如火烫，大小不一，有红有白，有紫黑相间，痛不可忍，破流清水，亦有流血水者，治同上条。
腮者，肝肾所属，有左肿者，有右肿者，有右及左、左及右者，名曰 腮。不亟清解，必成大头，治同上条。
颈属足太阳膀胱经，热毒入于太阳则颈肿。宜本方增石膏、元参、翘、桔，加银花、夏枯草、牛蒡、紫花地丁、山
豆根。
耳后肾经所属，此处硬肿，其病甚恶。宜本方增石膏、元、地、丹、翘，加银花、花粉、板蓝根、紫花地丁。耳中
出血者，不治。
雄按∶坎为耳，故耳为肾水之外候。然肺经之结穴在耳中，名曰龙葱，专主乎听。金受火烁则耳聋。凡温热暑疫等
证，耳聋者，职是故也。不可泥于伤寒少阳之文，而妄用柴胡以煽其焰。古云∶耳聋治肺，旨哉言乎。
舌乃心之苗。心属火，毒火冲突，二火相并，心苗乃动，而嗒舌弄舌。宜本方增石膏、犀、连、元参，加黄柏。
雄按∶宜加木通、莲子心、朱砂、童溺之类。
红丝绕目，清其浮僭之火而红自退。误以眼科治之，为害不浅。宜本方加菊花、红花、蝉蜕、归尾、谷精。
雄按∶加味亦是眼科之药，不若但加羚羊角、龙胆草二味为精当也。
头为一身之元首，最轻清而邪不易干。通身焦燥，独头汗涌出。此烈毒鼎沸于内，热气上腾，故汗出如淋。宜本方
增石膏、元参。
雄按∶本方宜去芍、桔、丹皮，加童溺、花粉。
齿者，骨之余。杂证 齿为血虚；疫证见之，为肝热。宜本方增石膏、生地、丹、栀，加胆草。
雄按∶齿龈属阳明，不可全责之肝也。
疫证，鼻衄如泉，乃阳明郁热上冲于脑，脑通于鼻，故衄如涌泉。宜本方增石膏、元、地、芩、连，加羚羊角、生
桑皮、棕榈灰。
雄按∶本方宜去桔梗，加白茅根。
舌上白点如珍珠，乃水化之象。较之紫赤黄黑，古人谓之芒刺者，更重。宜本方增石膏、犀、连、元、翘，加花粉、
银花。
雄按∶宜加蔷薇根、莹白、金汁之类。
疫证初起，苔如腻粉，此火极水化。设误认为寒，妄投温燥，其病反剧，其苔愈浓，精液愈耗，水不上升，二火煎
熬，变白为黑，其坚如铁，其浓如甲，敲之戛戛有声，言语不清，非舌卷也。治之得法，其甲整脱。宜本方增石膏、元
参、犀、连、知、翘，加花粉、黄柏。
雄按∶此证专宜甘寒以充津液，不当参用苦燥。余如梨汁、蔗浆、竹沥、西瓜汁、藕汁，皆可频灌。如得蕉花上露
更良。杨云∶蕉花上露为清热无上妙品，但不可必得。即蕉根取汁，亦极妙也。若邪火已衰，津不能回者。宜用鲜猪肉
数斤，切大块，急火煮清汤，吹净浮油，恣意凉饮，乃急救津液之无上妙品。故友范庆簪，尝谓余云∶酷热炎天，正银
匠熔铸各州县奏销银两之时。而银炉甚高，火光扑面，非壮盛之人，不能为也。口渴不敢啜茗，惟以淡煮猪肉，取汤凉
饮，故裸身近火，而津液不致枯竭。余因推展其义，颇多妙用，拙案中可证也。
舌上发丁，或红或紫，大如马乳，小如樱桃，三五不等，流脓出血，重清心火。宜本方增石膏、犀角、翘、连加银
花。舌上成坑，愈后自平。此二条乃三十六舌未有者。
雄按∶亦宜加蔷薇根、金汁之类；外以锡类散，或珍珠，牛黄研细糁之。则坑易平。
舌衄乃血热上溢心苗。宜本方增石膏、黄连、犀、地、栀、丹，加败棕灰。
雄按∶外宜蒲黄炒黑糁之。
齿衄乃阳明少阴二经之热相并。宜本方增石膏、元参、芩、连、犀、地、丹、栀，加黄柏。心主神，心静则神爽。
心为烈火所燔，则神不清而谵语。宜本方增石膏、犀、连、丹、栀，加黄柏、胆草。
雄按∶须参叶氏《温热论》逆传治法。且此证挟痰者多，最宜谛审。
呃逆，有因胃热上冲者，有因肝胆之火上逆者，有因肺气不能下降者。宜本方增石膏，加竹茹、枇杷叶、柿蒂、羚
羊角、银杏仁。如不止，用沉香、槟榔、乌药、枳壳，各磨数分，名四磨饮，仍以本方调服。
雄按∶此三候固皆实证，尚有痰阻于中者，便秘于下者，另有治法。银杏仁，温涩气分，但可以治虚呃，不宜加入
此方。
邪入于胃则吐，毒犹因吐而得发越，至于干呕则重矣。总由内有伏毒、清解不容少缓。宜本方增石膏、甘、连，加
滑石、伏龙肝。
雄按∶甘草宜去，伏龙肝，温燥之品，但可以治虚寒呕吐，不宜加入此方。本方桔梗、丹、芍，亦当去之。可加旋
覆花、竹茹、半夏、枇杷叶。如用反佐，则生姜汁为妥。汪按∶此方中生姜不可少。
疫毒移于大肠，里急后重，赤白相兼，或下恶垢，或下紫血，虽似痢实非痢也。其人必恶寒发热，小水短赤，但当
清热利水。宜本方增石膏、黄连，加滑石、猪苓、泽泻、木通，其痢自止。误用通利止涩之剂不救。
雄按∶热移大肠，恶垢既下，病有出路，化毒为宜。既知不可通利，何以仍加苓、泽等利水？毋乃疏乎。惟滑石用
得对证，他如金银花、槐蕊、黄柏、青蒿、白头翁、苦参、芦菔之类，皆可采也。
毒火注于大肠，有下恶垢者，有利清水者，有倾肠直注者，有完谷不化者。此邪热不杀谷，非脾虚也。较之似痢者，
稍轻。考其证，身必大热，气必粗壮，小溲必短，唇必焦紫，大渴喜冷，腹痛不已，四肢时而厥逆。宜因其势而清利之。
治同上条。
雄按∶唇焦大渴，津液耗伤，清化为宜，毋过渗利。惟冬瓜煮汤代茶、煎药，恣用甚佳。汪按∶此及上条皆宜用绿
豆。疫证大便不通，因毒火煎熬，大肠枯燥不能润下。不可徒攻其闭结而速其死也。宜本方加生大黄，或外用蜜煎导法。
汪按∶此证宜用麻仁。邪犯五脏，则三阴脉络不和，血乖行度，渗入大肠而便血。宜本方增生地，加槐花、柏叶、棕灰。
雄按∶棕灰温涩，即欲止之，宜易地榆炭。
膀胱热极。小溲短赤而涩，热毒甚者，溲色如油。宜本方加滑石、泽泻、猪苓、木通、通草、扁蓄。
雄按∶苓、泽等药，皆渗利之品。溺阻膀胱者，借以通导，此证既云热毒内炽，则水已耗夺，小溲自然浑赤短涩，
但宜治其所以然，则源清而流洁，岂可强投分利，而为砻糠打油之事乎？或量证少佐一二味，慎毋忽视而泛施也。
溺血，小便出血而不痛。血淋，则小腹阴茎必兼胀痛。在疫证，总由血因热迫。宜本方增生地，加滑石、桃仁、茅
根、琥珀、牛膝、棕灰。
雄按∶设兼痛胀，忌用棕灰。汪按∶亦宜用地榆炭。
发狂骂詈。不避亲疏，甚则登高而歌，弃衣而走，逾垣上屋，力倍常时。或语生平未有之事，未见之人，如有邪附
者，此阳明明邪热，上扰神明，病患亦不自知。僧道巫尼，徒乱人意。宜本方增石膏、犀、连、丹、栀，加黄柏。
雄按∶宜加朱砂、青黛，挟痰，加石菖蒲、竹沥之类。
疫证之痰，皆属于热，痰中带血，热极之征。宜本方增石膏、芩、地，加蒌仁、羚羊角、生桑皮、棕灰。
雄按∶桑皮、棕灰可商，宜加滑石、桃仁、苇茎、瓜瓣之类。
疫证遗溺，非虚不能约，乃热不自持。其人必昏沉谵语，遗不自知。宜本方增石膏、犀、连，加滑石。诸病喘满，
皆属于热，况疫证乎。宜本方增石膏、黄芩、加桑皮、羚羊角。
头痛、目痛，症状很像伤寒。然而，太阳经和阳明经的头痛，不会严重到头部倾斜难以抬起。而此病则是头痛如刀劈般剧烈，两眼昏花模糊，病情似乎难以支撑。这主要是因为火毒侵袭了这两条经络，毒性波及阳位（头面部），治疗应采用“釜底抽薪”法，使火势下降，疼痛立刻停止，皮疹自然透出。宜用清瘟败毒饮，增加石膏、玄参用量，并加入菊花。如果误用辛凉解表发散的药物，会助长火热之势，必然转变为闷证（热毒内闭）。
骨节烦扰疼痛，腰部疼痛如同被棍棒打过一样。骨骼和腰部都属于肾经管辖，疼痛如此剧烈，说明淫热之气已经流入肾经。宜用本方增加石膏、玄参用量，并加入黄柏。如果误用温散药物，病人不到半天就会死亡。
热邪应当调和，不宜躁动。如果热邪导致全身炽热，与那些昏沉、四肢冰冷的情况相比，此病的热势向外发散，这是因为病人的气血尚能抵御毒邪，一旦经过清热解表，皮疹自然透出。如果妄用发汗解表药，会导致热毒内伏。宜用本方增加石膏、生地、丹皮、黄芩、黄连用量。
有的病人看似安静却突然烦躁，有的看似烦躁却突然安静，称为“静躁不常”。这与癫狂不同，癫狂是热势发扬，而此病则是热毒郁遏。总归是毒火在内扰乱，导致坐卧不安。宜用本方增加石膏、犀角、黄连用量。
醒着属阳主升，睡着属阴主降。胃是六腑之海，热毒壅塞，阻隔了上下气机，所以火扰导致失眠。宜用本方增加石膏、犀角、黄连用量，并加入琥珀。
王士雄按：火扰导致的失眠，何必用琥珀？如果想引导热邪下行，宜用木通。
初起时全身冰冷，面色像蒙了污垢，满口感觉像结霜，头痛如劈，想喝热水却厌恶冷水，六脉沉细。这是阳极似阴，毒邪隐伏的表现。重在清除内热，使毒热外透，身体忽然变得大热，脉搏转为洪数，烦躁谵语，极度口渴想喝冰水。虽然病症凶险，但还有救治的可能。宜用本方增加石膏、丹皮、犀角、黄连用量，并加入黄柏。如果遇到庸医，妄投桂枝、附子等温热药，药还没吃完，病人就会像服毒一样死去。
四肢属于脾，出现逆冷，在杂病中多见。这是脾经虚寒，元阳即将脱失的迹象。但疫病不是这样，全身大热，唯独四肢冰冷。这是烈毒郁遏脾经，邪火无法透发。重在清脾热，手足自然会温暖。宜用本方增加石膏用量。
王士雄按：四肢逆冷，在杂病中不仅是脾经虚寒。在疫病中，也不是毒邪壅滞脾经。增加石膏，原本是为了清胃热。胃气运行通畅，四肢自然调和。也有热邪伏于厥阴经导致逆冷的，在温疫证中最多见，不可不知道。
筋属于肝，依赖血液滋养，热毒流入肝经，斑疹不能通过毛孔透出，筋脉受到冲击激荡，就会出现抽搐惊惕。宜用本方增加石膏、丹皮用量，并加入龙胆草。
杂病中，有因精液枯竭，水液不能上升，导致咽干想喝水，但喝不到半杯就止住。而此病则是想喝冰水，喝一百杯都不够。因为毒火在体内煎熬，不是冰水不足以救其燥渴，不是石膏不足以压制其火势。庸医还告诫病人不要吃生冷，病人奉为至理名言，连温水都不敢给喝。以致嘴唇焦裂、舌头变黑。宜用本方增加石膏用量，并加入天花粉。
四季百病，以胃气为本。至于不吃东西，似乎很难办。但这不适用于疫病讨论，这是因为邪火侵犯胃，热毒上冲，导致频频干呕的有之，刚吃下去就吐出来的有之。只要胃气一清，不必强迫进食，自然就能吃了。宜用本方增加石膏用量，并加入枳壳。
王士雄按：热邪壅滞在胃，完全不知道饥饿，强行进食粥糜，反而助长邪气。即使一粒米不进，但病势没有衰退的，不要怀疑是胃气败坏。如果是干呕吐食，那么本方中的甘草、桔梗、丹皮，都不可使用。宜加入竹茹、枇杷叶、半夏之类。
胸膈是上焦心肺所在之地，邪气不易侵犯。只有火气上炎，容易波及心脏，以火助火，将热转移给肺，肺金被火灼烧，干燥更甚。胸膈郁遏，气机不畅，必然会长吁短叹。宜用本方增加黄连、桔梗用量，并加入枳壳、瓜蒌仁。
王士雄按：邪火上炎，固然能郁遏肺气，导致膈部胀满，但平素有停痰伏饮的人，或者发病前兼有食滞的人，本方中的地黄、芍药，不可随意投放。临证必须辨别施治，只有萝卜汁，既能清解燥火的闭郁，又能开通痰食的停留。用得恰当，取效很快。
昏闷无声，是因为心气出于肺而发声。窍道因气闭阻，气因毒邪停滞，心神迷乱而神志不清，窍闭而声音不出。宜用本方，增加石膏、犀角、黄芩、黄连用量，并加入羚羊角、桑白皮。
王士雄按：桑白皮虽然走肺经，但没有通气宣窍的能力。宜用马兜铃、射干、通草之类；清神化毒，应当参考紫雪丹之类的方剂。
胃气虚弱的人，偏寒偏热，水停食积，都会与真气相搏而疼痛，这是说寻常生病的原因。至于疫病腹痛，或左或右，或疼痛牵引小肠，这是毒火冲突，发泄无门。如果苦于按照寻常腹痛分经络来治疗，必死无疑。如果在初起时只用败毒散，或凉膈散加黄连，疼痛立刻停止。
王士雄按：疫病腹痛，确实与杂病截然不同，但是夹带饮食停滞、夹带瘀血、夹带疝气，因病疫而宿疾兼发的，也正很多。临证处方，怎么能不考虑这些呢？
筋肉跳动，在伤寒中则是亡阳的表现，而此病则不然。汗，是心的体液，由血液所化生。血生于心，藏于肝，统摄于脾。血液被热邪煎熬，筋脉失去滋养，所以筋肉为之跳动。宜用本方增加石膏、生地、玄参用量，并加入黄柏。
王士雄按：亡阳引起的跳动，宜补土制水。淫热引起的跳动，宜泻火息风。本方还缺少镇静息风的药物，宜去掉丹皮、桔梗，加入菊花、龙胆草。
病人自述胃里发出冷气，并非真的冷。这是上升的气，从肝而出，中间夹杂相火，自下而上，其热势尤其厉害。这是火极似水，热极的表现，阳气亢盛逼迫阴气，所以感觉有冷气。宜用本方增加石膏、犀角、生地、丹皮、黄连用量，并加入龙胆草。
王士雄按：冷气上升，虽然在别的证候中也见到，也多属于火。不懂的人，妄投温热药，造成的危害能说尽吗！本方中的桔梗、芍药，也不适宜。更有夹带痰湿的，须加入海蜇、竹沥、萝卜汁之类。汪氏按：这种证候夹痰的最多。
口中臭气，让人难以靠近，如果不是毒火在体内熏蒸，怎么会口臭喷人如此厉害呢。宜用本方增加石膏、犀角、黄连用量。
王士雄按：宜加入兰草、竹茹、枇杷叶、金银花、蔷薇露、莹白、金汁之类，以引导秽浊下行。
舌苔满口像霜一样，在伤寒中是寒证的证据，所以应当温散。而疫病见到这种情况，舌头必定浓大，这是火极转化为水的表现。宜用本方增加石膏、犀角、生地、连翘、黄连用量，并加入黄柏。误用温散，随即变成黑色。汪氏按：凡是温热暑疫，见到这种舌苔的，病情一定最重，最宜详细审慎。
王士雄按：凡是热证疫病见到这种舌苔的，固然不能误指为寒，良原因是兼有痰湿，遏伏热毒所致，在清解方中，宜佐以开泄的药物来治疗。
咽喉是水谷的道路，呼吸的出入通道。毒火熏蒸，导致肿痛，亟需清热解表以开通闭塞。宜用本方增加石膏、玄参、桔梗用量，并加入牛蒡子、射干、山豆根。
王士雄按：加入莹白、金汁最好。药汁难以下咽的，亟需用锡类散吹入咽喉。
嘴唇是脾的外华。嘴唇肿胀，是火炎土燥的表现。宜用本方增加石膏、连翘、黄连用量，并加入天花粉。
头是诸阳之首，头面肿大，这是毒火上攻。宜用本方增加石膏、玄参用量，并加入银花、马勃、僵蚕、板蓝根、紫花地丁、当归尾。
脉象实大的，酌情加入酒洗过的生大黄。
脸上像火烧燎伤一样，宛如火烫，大小不一，有红有白，有紫黑相间，疼痛难以忍受，破溃流出清水，也有流血水的，治疗方法同上一条。
腮部是肝肾所属，有左边肿的，有右边肿的，有右边波及左边、左边波及右边的，名叫“痄腮”。如果不及时清热解表，必然发展成大头瘟，治疗方法同上一条。
颈部属于足太阳膀胱经，热毒进入太阳经则颈部肿胀。宜用本方增加石膏、玄参、连翘、桔梗用量，并加入银花、夏枯草、牛蒡子、紫花地丁、山豆根。
耳后是肾经所属，此处硬肿，病情很恶劣。宜用本方增加石膏、玄参、生地、丹皮、连翘用量，并加入银花、天花粉、板蓝根、紫花地丁。耳朵出血的，不治。
王士雄按：坎卦对应耳朵，所以耳朵是肾水的外部征候。然而肺经的结穴在耳中，名叫龙葱，专门主管听觉。金受火烁则耳聋。凡是温热暑疫等证，耳聋者，就是这个原因。不可拘泥于伤寒少阳经的条文，而妄用柴胡来煽动火势。古话说：“耳聋治肺”，这话真对啊。
舌是心的苗窍。心属火，毒火冲突，两火相并，心苗动摇，而出现咂舌弄舌。宜用本方增加石膏、犀角、黄连、玄参用量，并加入黄柏。
王士雄按：宜加入木通、莲子心、朱砂、童便之类。
红丝绕眼，清除浮越僭上的火气，红色自然消退。误用眼科方法治疗，危害不小。宜用本方加入菊花、红花、蝉蜕、当归尾、谷精草。
王士雄按：加味也是眼科的药，不如只加羚羊角、龙胆草两味更为精当。
头是一身的元首，最轻清而邪气不易干扰。全身焦燥，唯独头部出汗涌出。这是烈毒在体内鼎沸，热气上腾，所以汗出如淋。宜用本方增加石膏、玄参用量。
王士雄按：本方宜去掉芍药、桔梗、丹皮，加入童便、天花粉。
牙齿是骨之余。杂病中牙龈出血是血虚；疫病中见到，是肝热。宜用本方增加石膏、生地、丹皮、栀子用量，并加入龙胆草。
王士雄按：齿龈属于阳明经，不能完全责怪于肝。
疫病中，鼻出血如泉水涌出，是阳明郁热上冲于脑，脑通于鼻，所以出血如涌泉。宜用本方增加石膏、玄参、生地、黄芩、黄连用量，并加入羚羊角、生桑白皮、棕榈灰。
王士雄按：本方宜去掉桔梗，加入白茅根。
舌上有白点像珍珠，这是水化的征象。比起紫赤黄黑，古人称之为芒刺的，病情更重。宜用本方增加石膏、犀角、黄连、玄参、连翘用量，并加入天花粉、银花。
王士雄按：宜加入蔷薇根、莹白、金汁之类。
疫病初起，舌苔像腻粉，这是火极转化为水。如果误认为寒，妄投温燥药，病情反而加重，舌苔更厚，精液更耗损，水液不能上升，二火煎熬，白色变为黑色，坚硬如铁，浓厚如甲，敲击时嘎嘎有声，言语不清，这不是舌卷缩。治疗得法，那层甲壳会整块脱落。宜用本方增加石膏、玄参、犀角、黄连、知母、连翘用量，并加入天花粉、黄柏。
王士雄按：此证专宜甘寒以补充津液，不应当参用苦燥药物。其余如梨汁、蔗浆、竹沥、西瓜汁、藕汁，都可以频繁灌服。如果能得到芭蕉花上的露水更好。杨氏说：芭蕉花上的露水是清热无上妙品，但不可强求。即使是芭蕉根取汁，也极妙。如果邪火已衰，津液不能恢复的，宜用鲜猪肉几斤，切大块，急火煮清汤，撇净浮油，恣意凉饮，这是急救津液的无上妙品。故友范庆簪，曾对我说：酷热炎天，正是银匠熔铸各州县奏销银两的时候。而银炉很高，火光扑面，不是壮盛之人，不能做这个工作。口渴不敢喝茶，只用淡煮猪肉，取汤凉饮，所以裸身靠近火源，而津液不至于枯竭。我因此推展他的意思，有很多妙用，在我的医案中可以证明。
舌头上长出疔疮，或红或紫，大如马乳，小如樱桃，数量不等，流脓出血，重在清心火。宜用本方增加石膏、犀角、连翘、黄连用量，加入银花。舌头上形成坑洞，痊愈后自然平复。这两条是三十六种舌诊中未曾记载的。
王士雄按：也宜加入蔷薇根、金汁之类；外用锡类散，或珍珠、牛黄研细撒在上面。则坑洞容易平复。
舌衄（舌出血）是血热上溢心苗。宜用本方增加石膏、黄连、犀角、生地、栀子、丹皮用量，加入败棕灰。
王士雄按：外用宜用蒲黄炒黑撒在上面。
齿衄（牙龈出血）是阳明、少阴二经的热邪相并。宜用本方增加石膏、玄参、黄芩、黄连、犀角、生地、丹皮、栀子用量，加入黄柏。
心主神志，心静则神爽。心被烈火焚烧，则神志不清而谵语。宜用本方增加石膏、犀角、黄连、丹皮、栀子用量，加入黄柏、龙胆草。
王士雄按：必须参考叶天士《温热论》中逆传心包的治法。而且此证夹痰的多，最宜仔细审察。
呃逆，有因胃热上冲的，有因肝胆之火上逆的，有因肺气不能下降的。宜用本方增加石膏用量，加入竹茹、枇杷叶、柿蒂、羚羊角、银杏仁。如果不止，用沉香、槟榔、乌药、枳壳，各磨数分，名为四磨饮，仍用本方调服。
王士雄按：这三种情况固然是实证，还有痰阻于中、便秘于下的，另有治法。银杏仁，性温涩气分，只能治疗虚证呃逆，不宜加入此方。
邪气进入胃则呕吐，毒邪还能通过呕吐得以发越，到了干呕的程度就严重了。总归是内有伏毒，清热解表不容迟缓。宜用本方增加石膏、甘草、黄连用量，加入滑石、伏龙肝。
王士雄按：甘草宜去掉，伏龙肝是温燥之品，只能治疗虚寒呕吐，不宜加入此方。本方中的桔梗、丹皮、芍药，也应当去掉。可加入旋覆花、竹茹、半夏、枇杷叶。如果用反佐法，则生姜汁妥当。汪氏按：此方中生姜不可少。
疫毒移于大肠，里急后重，红白相兼，或者下恶垢，或者下紫血，虽然像痢疾其实不是痢疾。此人必定恶寒发热，小便短赤，只应当清热利水。宜用本方增加石膏、黄连用量，加入滑石、猪苓、泽泻、木通，其痢自止。误用通利止涩的药物，无法挽救。
王士雄按：热邪移于大肠，恶垢既已排出，病有出路，化解毒邪为宜。既然知道不可通利，为什么还要加茯苓、泽泻等利水药？岂不是疏忽了吗？只有滑石用得对证，其他的如金银花、槐蕊、黄柏、青蒿、白头翁、苦参、萝卜之类，都可以采用。
毒火注于大肠，有下恶垢的，有利清水的，有倾肠直注的，有完谷不化的。这是邪热不杀谷，不是脾虚。比起像痢疾的，稍微轻一些。考察其证候，身体必定大热，气息必定粗壮，小便必定短，嘴唇必定焦紫，大渴喜冷，腹痛不已，四肢时而厥逆。宜因其势而清利之。治疗方法同上一条。
王士雄按：唇焦大渴，津液耗伤，宜清化为度，不要过度渗利。只有冬瓜煮汤代茶、煎药，恣意使用很好。汪氏按：这一条及上一条都宜用绿豆。疫病大便不通，因毒火煎熬，大肠枯燥不能润下。不可单纯攻其闭结而加速死亡。宜用本方加入生大黄，或外用蜜煎导法。汪氏按：此证宜用麻仁。
邪气侵犯五脏，则三阴脉络不和，血行失常，渗入大肠而便血。宜用本方增加生地用量，加入槐花、侧柏叶、棕榈灰。
王士雄按：棕榈灰温涩，即使想要止血，宜换用地榆炭。
膀胱热极。小便短赤而涩，热毒严重的，尿色如油。宜用本方加入滑石、泽泻、猪苓、木通、通草、扁蓄。
王士雄按：茯苓、泽泻等药，都是渗利之品。溺阻膀胱者，借以通导，此证既然说是热毒内炽，则水已耗夺，小便自然浑赤短涩，只宜治其所以然，则源清而流洁，岂可强投分利，而为徒劳无功之事呢？或者根据证候少量佐用一二味，千万不要忽视而泛施。
溺血，小便出血而不痛。血淋，则小腹阴茎必定兼胀痛。在疫病中，总归是由血因热迫所致。宜用本方增加生地用量，加入滑石、桃仁、茅根、琥珀、牛膝、棕榈灰。
王士雄按：如果兼有痛胀，忌用棕榈灰。汪氏按：也宜用地榆炭。
发狂骂詈，不避亲疏，甚至登高而歌，弃衣而走，翻墙上楼，力气比平时大倍。或者说起生平未有的事，未见的人，好像有邪气附着一样，这是阳明经邪热，上扰神明，病人自己也不知道。僧道巫尼，只会扰乱人心。宜用本方增加石膏、犀角、黄连、丹皮、栀子用量，加入黄柏。
王士雄按：宜加入朱砂、青黛，夹痰的，加入石菖蒲、竹沥之类。
疫病的痰，都属于热，痰中带血，是热极的征象。宜用本方增加石膏、黄芩、生地用量，加入瓜蒌仁、羚羊角、生桑白皮、棕榈灰。
王士雄按：桑白皮、棕榈灰值得商榷，宜加入滑石、桃仁、苇茎、瓜瓣之类。
疫病遗尿，不是因为虚不能约束，而是热不自持。此人必定昏沉谵语，遗尿而自己不知道。宜用本方增加石膏、犀角、黄连用量，加入滑石。各种病喘满，都属于热，何况疫病呢。宜用本方增加石膏、黄芩用量，加入桑白皮、羚羊角。
Headache and eye pain resemble Taiyang-Shanghan (Taiyang Cold Damage). However, headaches in the Taiyang and Yangming meridians do not reach the severity of making the head tilt and difficult to lift. In this disease, the headache is splitting, the eyes are dim and blurred, and the condition seems unbearable. This is primarily due to fire-toxin reaching these two meridians, with toxicity affecting the Yang regions (head and face). The treatment should employ the "pulling wood from under the cauldron" method (clearing heat from the source) to drive the fire downward; the pain will stop immediately, and the rash will naturally emerge. Use Qingwen Baidu Yin (Plague-Dispelling Toxin-Resolving Decoction) with increased doses of Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix), plus Juhua (Chrysanthemi Flos). Misusing acrid-cool diaphoretics will stoke the flames, inevitably leading to a "Men Zheng" (internal closure syndrome).
Bone joints are vexingly painful, and the waist feels as if beaten by a staff. Bones and the waist belong to the Kidney Meridian; such severe pain indicates that licentious heat has flowed into the Kidney Meridian. Use the same formula with increased Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix), plus Huangbai (Phellodendri Cortex). Misusing warm dispersants will lead to death within half a day.
Heat should be harmonized, not agitated. If heat causes blazing throughout the body, compared to cases of lethargy and cold limbs, this condition's heat radiates outward because the Qi and Blood can still withstand the toxin. Once cleared and resolved, the rash emerges naturally. Recklessly using diaphoretic agents will cause internal retention of heat. Use the same formula with increased Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Huangqin (Scutellariae Radix), and Lianzi (Coptidis Rhizoma).
Some patients appear calm but suddenly become irritable, or appear irritable but suddenly calm, termed "irregular calmness and agitation." This differs from mania; mania involves radiant heat, whereas this condition involves suppressed heat. It is generally due to internal disturbance by toxic fire, causing restlessness in sitting and lying. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma).
Awakening belongs to Yang and rises; sleeping belongs to Yin and descends. The Stomach is the sea of the Six Fu Organs. Heat-toxin obstruction blocks the upper and lower, causing fire disturbance and insomnia. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma), plus Hupo (Succinum).
Wang Shihiong notes: For insomnia caused by fire disturbance, why use Succinum? To guide heat downward, use Mutong (Akebiae Caulis).
In the early stage, the whole body feels like ice, complexion is dull and grimy, the mouth feels frosted, headache is splitting, there is a desire for hot drinks but aversion to cold, and the six pulses are deep and fine. This is extreme Yang resembling Yin, with hidden toxin. Heavy clearing of internal heat is needed to allow toxic heat to emerge externally. The body suddenly becomes very hot, pulses turn surging and rapid, accompanied by irritability, delirium, and extreme thirst for ice. Although the condition is fierce, it is still treatable. Use the same formula with increased Shigao (Gypsum Fibrosum), Danpi (Moutan Cortex), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma), plus Huangbai (Phellodendri Cortex). If treated by incompetent physicians who recklessly administer Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata), death will occur before the dose is finished, as if poisoned.
The limbs belong to the Spleen. Limb cold reversal in miscellaneous diseases indicates Spleen deficiency-cold and impending collapse of Yuan-Yang. However, plague is different: the whole body is hot, yet only the limbs are cold. This is fierce toxin suppressing the Spleen Meridian, preventing evil fire from penetrating. Heavy clearing of Spleen heat will naturally warm the hands and feet. Use the same formula with increased Shigao (Gypsum Fibrosum).
Wang Shihiong notes: Limb cold reversal in miscellaneous diseases is not solely due to Spleen deficiency-cold. In plague, it is also not due to toxin blocking the Spleen Meridian. Increasing Shigao (Gypsum Fibrosum) originally clears Stomach heat. When Stomach Qi moves, limbs harmonize. There are also cases of cold reversal due to heat latent in the Jueyin Meridian, which is most common in warm plague, and this must be known.
Tendons belong to the Liver and rely on blood for nourishment. Heat-toxin flowing into the Liver Meridian prevents macules and rashes from emerging through pores. The tendons and vessels are impacted, causing twitching and惊惕 (startle/fright). Use the same formula with increased Shigao (Gypsum Fibrosum) and Danpi (Moutan Cortex), plus Longdancao (Gentianae Radix).
In miscellaneous diseases, dry fluids and lack of water rising cause dry throat and desire to drink, but less than half a cup is consumed. Here, the patient desires ice water, drinking hundreds of cups is insufficient. This is because toxic fire boils internally; only ice water can save the dryness, and only Shigao (Gypsum Fibrosum) can control the flame. Quacks warn against raw/cold foods, and patients heed this, even refusing warm water, leading to cracked lips and black tongue. Use the same formula with increased Shigao (Gypsum Fibrosum), plus Huafen (Trichosanthis Radix).
The Stomach Qi is the root of all diseases in the four seasons. Not eating seems difficult, but this does not apply to plague. This is due to evil fire invading the Stomach and heat-toxin rushing upward, causing frequent dry retching or immediate vomiting after eating. Once Stomach Qi is cleared, food intake will resume without force. Use the same formula with increased Shigao (Gypsum Fibrosum), plus Zhike (Aurantii Fructus).
Wang Shihiong notes: Heat congestion in the Stomach causes loss of appetite. Forcing congee aids evil. Even if no food is taken, if the pathogen remains strong, do not doubt Stomach failure. If there is dry retching and vomiting, Gancao (Glycyrrhizae Radix), Jiegeng (Platycodonis Radix), and Danpi (Moutan Cortex) in the main formula should be omitted. Add Zhuru (Bambusae Caulis in Taenia), Pipayye (Eriobotryae Folium), and Banxia (Pinelliae Rhizoma).
The chest and diaphragm are the territory of the Upper Jiao Heart and Lung, where evil rarely attacks. Only fire ascending easily affects the Heart. Fire aiding fire transfers heat to the Lung. Metal scorched by fire becomes drier. Chest-diaphragm suppression causes sighing. Use the same formula with increased Lian (Huanglian/Coptidis Rhizoma) and Jie (Jiegeng/Platycodonis Radix), plus Zhike (Aurantii Fructus) and Louren (Trichosanthis Semen).
Wang Shihiong notes: Evil fire ascending suppresses Lung Qi, causing diaphragmatic fullness. However, in those with phlegm-fluid retention or food stagnation prior to onset, Dihuang (Rehmanniae Radix) and Shaoyao (Paeoniae Radix) in the main formula should not be used indiscriminately. Clinical differentiation is required. Radish juice clears dry-fire suppression and opens phlegm-food stagnation. Used appropriately, it is very effective.
Drowsiness and silence occur because Heart Qi exits through the Lung to produce sound. Orifices close due to Qi blockage; Qi stagnates due to toxin. Heart confusion leads to unclear spirit; orifice closure prevents voice. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma), plus Lingyangjiao (Saigae Tataricae Cornu) and Sangbaipi (Mori Cortex).
Wang Shihiong notes: Sangbaipi (Mori Cortex) enters the Lung but lacks the ability to open Qi and orifices. Use Madouling (Aristolochiae Fructus), Shegan (Belamcandae Rhizoma), and Tongcao (Tetrapanacis Medulla). For clearing spirit and resolving toxin, refer to Zixue San (Purple Snow Powder).
Weak Stomach Qi combined with cold/heat bias, water retention, and food stagnation fights with true Qi causing pain—this describes ordinary illness. Plague abdominal pain, varying in location or radiating to the small intestine, is due to toxic fire conflict with no outlet. Treating it like ordinary abdominal pain by meridian classification leads to death. Early use of Baidu San (Toxin-Dispersing Powder) or Liangge San (Cooling the Diaphragm Powder) plus Huanglian (Coptidis Rhizoma) stops pain immediately.
Wang Shihiong notes: Plague abdominal pain differs greatly from miscellaneous diseases, but cases complicated by food stagnation, blood stasis, or hernia triggered by plague are common. Prescriptions must consider these.
Muscle twitching in Shanghan indicates Yang collapse, but not here. Sweat is the fluid of the Heart, transformed from blood. Blood is born in the Heart, stored in the Liver, and controlled by the Spleen. Blood boiled by heat loses nourishment to tendons, causing twitching. Use the same formula with increased Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), and Xuanshen (Scrophulariae Radix), plus Huangbai (Phellodendri Cortex).
Wang Shihiong notes: Twitching from Yang collapse requires tonifying Earth to control Water. Twitching from licentious heat requires draining fire and extinguishing wind. The main formula lacks calming and wind-extinguishing herbs. Remove Danpi (Moutan Cortex) and Jiegeng (Platycodonis Radix); add Juhua (Chrysanthemi Flos) and Longdancao (Gentianae Radix).
Patients report cold air coming from the Stomach, but it is not truly cold. Rising Qi originates from the Liver, carrying Ministerial Fire upward, creating intense heat. This is "extreme fire resembling water," a sign of extreme heat. Yang hyperactivity forces Yin, creating a sensation of cold. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Huanglian (Coptidis Rhizoma), plus Longdancao (Gentianae Radix).
Wang Shihiong notes: Rising cold air, even in other conditions, often relates to fire. Ignorant practitioners wrongly use warm-hot herbs, causing great harm. Jiegeng (Platycodonis Radix) and Shaoyao (Paeoniae Radix) in the main formula are also unsuitable. For cases with phlegm, add Haizhe (Metardula), Zhuli (Bambusae Sap), and Radish juice. Wang An: Phlegm complication is most common here.
Foul breath repels others. Unless toxic fire steams internally, how could oral odor be so pungent? Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), and Huanglian (Coptidis Rhizoma).
Wang Shihiong notes: Add Lancao (Orchidaceae Herb), Zhuru (Bambusae Caulis in Taenia), Pipayye (Eriobotryae Folium), Yinhua (Lonicerae Japonicae Flos), Qiangweilu (Rose Dew), Yingbai (Calcitum), and Jinzhi (Gold Juice) to guide turbidity downward.
Tongue coating like frost across the mouth indicates cold in Shanghan, requiring warm dispersal. In plague, the tongue is thick and large, indicating extreme fire transforming into water. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Lianqiao (Forsythiae Fructus), and Huanglian (Coptidis Rhizoma), plus Huangbai (Phellodendri Cortex). Misusing warm dispersal turns it black quickly. Wang An: Severe attention is needed for warm-heat/plague with this tongue.
Wang Shihiong notes: Do not mistake this for cold. It is due to phlegm-dampness suppressing heat-toxin. Add opening-draining herbs to the clearing-resolving formula.
The throat is the pathway for food/water and respiration. Toxic fire steaming causes swelling/pain; urgent clearing/resolving is needed to open blockage. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), and Jiegeng (Platycodonis Radix), plus Niubangzi (Arctii Fructus), Shegan (Belamcandae Rhizoma), and Shandougen (Sophorae Tonkinensis Radix).
Wang Shihiong notes: Adding Yingbai (Calcitum) and Jinzhi (Gold Juice) is best. For difficulty swallowing medicine, spray Xilei San (Xilei Powder).
Lips are the bloom of the Spleen. Lip swelling indicates fire flaring and Earth dryness. Use the same formula with increased Shigao (Gypsum Fibrosum), Lianqiao (Forsythiae Fructus), and Huanglian (Coptidis Rhizoma), plus Tianhuafen (Trichosanthis Radix).
The head is the summit of all Yang. Head/face swelling is due to toxic fire attacking upward. Use the same formula with increased Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix), plus Yinhua (Lonicerae Japonicae Flos), Mabo (Macropodi Spore), Jiangcan (Bombyx Batryticatus), Banlangen (Isatidis Radix), Zihuadiding (Viola Yedoensis), and Guiwei (Angelicae Sinensis Radix).
If pulses are excess, add appropriate amount of Jiuxi Sheng Dahuang (Raw Rhubarb washed in wine).
Facial burns feel like scalding, varying in size, red/white/purple-black, unbearable pain, weeping clear or bloody fluid. Treatment is the same as above.
Swollen cheeks belong to Liver/Kidney. Left, right, or bilateral swelling is called "Zhaisai" (Mumps). Without urgent clearing/resolving, it develops into "Big Head Plague." Treatment is the same as above.
The neck belongs to the Foot-Taiyang Bladder Meridian. Heat-toxin entering Taiyang causes neck swelling. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructus), and Jiegeng (Platycodonis Radix), plus Yinhua (Lonicerae Japonicae Flos), Xiakucao (Prunellae Spica), Niubangzi (Arctii Fructus), Zihuadiding (Viola Yedoensis), and Shandougen (Sophorae Tonkinensis Radix).
Behind the ears belongs to the Kidney Meridian. Hard swelling here is severe. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Lianqiao (Forsythiae Fructus), plus Yinhua (Lonicerae Japonicae Flos), Huafen (Trichosanthis Radix), Banlangen (Isatidis Radix), and Zihuadiding (Viola Yedoensis). Ear bleeding is untreatable.
Wang Shihiong notes: Kan represents the ear, so the ear reflects Kidney Water. However, the Lung Meridian connects in the ear (Longcong), governing hearing. Metal scorched by fire causes deafness. Deafness in warm-heat/plague is due to this. Do not rigidly follow Shanghan Shaoyang texts and recklessly use Chaihu (Bupleuri Radix) to fan flames. Ancient saying: "Deafness treated via Lung" is profound.
The tongue is the sprout of the Heart. Heart is Fire. Toxic fire conflict merges two fires, moving the Heart sprout, causing tongue protrusion/manipulation. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), and Xuanshen (Scrophulariae Radix), plus Huangbai (Phellodendri Cortex).
Wang Shihiong notes: Add Mutong (Akebiae Caulis), Lianzixin (Nelumbinis Plumula), Zhusha (Cinnabaris), and Tongniao (Infantis Urine).
Red threads around eyes: Clear floating/excessive fire, redness recedes. Misusing ophthalmology treatments causes harm. Use the same formula adding Juhua (Chrysanthemi Flos), Honghua (Carthami Flos), Chantui (Cicadae Periostracum), Guiwei (Angelicae Sinensis Radix), and Gujingcao (Galeopsidis Herba).
Wang Shihiong notes: These additions are also ophthalmic herbs. Better to add only Lingyangjiao (Saigae Tataricae Cornu) and Longdancao (Gentianae Radix) for precision.
The head is the chief of the body, lightest and clearest, resisting evil. Whole-body dryness with only head sweating profusely indicates fierce toxin boiling internally, heat rising, causing sweat like rain. Use the same formula with increased Shigao (Gypsum Fibrosum) and Xuanshen (Scrophulariae Radix).
Wang Shihiong notes: Remove Shaoyao (Paeoniae Radix), Jiegeng (Platycodonis Radix), and Danpi (Moutan Cortex) from the main formula; add Tongniao (Infantis Urine) and Huafen (Trichosanthis Radix).
Teeth are the surplus of bone. Miscellaneous disease tooth issues indicate blood deficiency; plague indicates Liver heat. Use the same formula with increased Shigao (Gypsum Fibrosum), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Zhizi (Gardeniae Fructus), plus Longdancao (Gentianae Radix).
Wang Shihiong notes: Gums belong to Yangming; blame cannot be placed entirely on the Liver.
Plague epistaxis gushing like a spring is Yangming constrained heat rushing to the brain (connected to nose). Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Shengdi (Rehmanniae Radix), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma), plus Lingyangjiao (Saigae Tataricae Cornu), Sheng Sangbaipi (Fresh Mori Cortex), and Zongluhui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: Remove Jiegeng (Platycodonis Radix); add Baimaogen (Imperatae Rhizoma).
White pearl-like spots on the tongue indicate water transformation. Heavier than purple/red/yellow/black "thorn" tongues described by ancients. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Xuanshen (Scrophulariae Radix), and Lianqiao (Forsythiae Fructus), plus Huafen (Trichosanthis Radix) and Yinhua (Lonicerae Japonicae Flos).
Wang Shihiong notes: Add Qiangweigen (Rosae Laevigatae Radix), Yingbai (Calcitum), and Jinzhi (Gold Juice).
Early plague with greasy powder-like coating indicates extreme fire transforming into water. Mistaking for cold and using warm-dry herbs worsens the condition, thickens coating, consumes fluids, prevents water rising, and allows dual-fire boiling. White turns black, hard as iron, thick as armor, clattering when struck, speech unclear (not tongue curling). Proper treatment causes armor shedding. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), and Lianqiao (Forsythiae Fructus), plus Huafen (Trichosanthis Radix) and Huangbai (Phellodendri Cortex).
Wang Shihiong notes: This condition strictly requires sweet-cold herbs to replenish fluids; avoid bitter-dry herbs. Pear juice, sugarcane juice, bamboo sap, watermelon juice, lotus root juice can be frequently administered. Banana flower dew is excellent. Yang says: Banana flower dew is supreme for clearing heat but rare. Banana root juice is also good. If fire declines and fluids don't return, use fresh pork (several jin), boiled rapidly in clear soup, skimmed oil, drunk cold. This is supreme for emergency fluid rescue. Friend Fan Qingzan said: In extreme heat, silversmiths melt silver. High furnaces, facing fire, require robust health. Thirsty but avoiding tea, they drink cool pork broth, staying near fire without fluid depletion. I expanded this idea with many applications, proven in my cases.
Tongue carbuncles, red or purple, horse-milk to cherry sized, pus/blood discharge, requires heavy clearing of Heart fire. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Lianqiao (Forsythiae Fructus), and Huanglian (Coptidis Rhizoma), plus Yinhua (Lonicerae Japonicae Flos). Tongue pits flatten after healing. These two are new in 36-tongue diagnostics.
Wang Shihiong notes: Also add Qiangweigen (Rosae Laevigatae Radix) and Jinzhi (Gold Juice). Externally use Xilei San (Xilei Powder) or Pearl/Bovis Calculus powder. Pits heal faster.
Tongue bleeding is blood heat overflowing to the Heart sprout. Use the same formula with increased Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Zhizi (Gardeniae Fructus), and Danpi (Moutan Cortex), plus Baizonghui (Old Palm Fiber Ash).
Wang Shihiong notes: Externally use fried Black Puhuang (Lygodii Spora).
Tooth bleeding is combined heat of Yangming and Shaoyin meridians. Use the same formula with increased Shigao (Gypsum Fibrosum), Xuanshen (Scrophulariae Radix), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Xijiao (Rhinocerotis Cornu), Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Zhizi (Gardeniae Fructus), plus Huangbai (Phellodendri Cortex).
Heart governs Spirit. Calm Heart brings clear Spirit. Heart scorched by fierce fire causes unclear Spirit and delirium. Use the same formula with increased Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Danpi (Moutan Cortex), and Zhizi (Gardeniae Fructus), plus Huangbai (Phellodendri Cortex) and Longdancao (Gentianae Radix).
Wang Shihiong notes: Refer to Ye Tianshi's "Warm Disease Treatise" for reverse transmission treatment. This condition often has phlegm; careful examination is vital.
Hiccups: Due to Stomach heat rushing up, Liver/Gallbladder fire reversing, or Lung Qi failing to descend. Use the same formula with increased Shigao (Gypsum Fibrosum), plus Zhuru (Bambusae Caulis in Taenia), Pipayye (Eriobotryae Folium), Shidi (Diospyri Fructus Pedunculus), Lingyangjiao (Saigae Tataricae Cornu), and Yinxingren (Ginkgo Seed). If persistent, use Chenxiang (Aquilariae Lignum Resinatum), Binglang (Arecae Semen), Wuyao (Linderae Radix), Zhike (Aurantii Fructus), ground finely (Simopo Yin), mixed with main formula.
Wang Shihiong notes: These three are excess patterns. Phlegm obstruction or constipation have different treatments. Yinxingren (Ginkgo Seed) is warm/astringent for Qi, suitable only for deficiency hiccups, not this formula.
Evil in Stomach causes vomiting; toxin can vent through vomiting. Dry retching is severe. Internal latent toxin requires urgent clearing/resolving. Use the same formula with increased Shigao (Gypsum Fibrosum), Gancao (Glycyrrhizae Radix), and Huanglian (Coptidis Rhizoma), plus Huashi (Talcum) and Fulonggan (Dragon's Liver).
Wang Shihiong notes: Remove Gancao (Glycyrrhizae Radix). Fulonggan (Dragon's Liver) is warm-dry, for deficiency-cold vomiting only, not this formula. Remove Jiegeng (Platycodonis Radix), Danpi (Moutan Cortex), Shaoyao (Paeoniae Radix). Add Xuanfuhua (Inulae Flos), Zhuru (Bambusae Caulis in Taenia), Banxia (Pinelliae Rhizoma), Pipayye (Eriobotryae Folium). For counteracting, Shengjiang汁 (Fresh Ginger Juice) is appropriate. Wang An: Ginger is essential here.
Plague toxin moving to Large Intestine causes tenesmus, red-white mixture, foul matter, or purple blood. Looks like dysentery but isn't. Patient has chills/fever, short/scanty urine. Clear heat and promote urination. Use the same formula with increased Shigao (Gypsum Fibrosum) and Huanglian (Coptidis Rhizoma), plus Huashi (Talcum), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), and Mutong (Akebiae Caulis). Dysentery stops. Misusing purgatives/astringents is fatal.
Wang Shihiong notes: Heat moving to Large Intestine with foul matter expulsion has an exit; resolve toxin. Why add Polyporus/Alisma if purgation is contraindicated? Slippery stone (Huashi) is correct; others like Yinhua (Lonicerae Japonicae Flos), Hua Rui (Strobili Lupini), Huangbai (Phellodendri Cortex), Qinghao (Artemisiae Annuae Herba), Baitouweng (Pulsatillae Radix), Kushen (Sophorae Flavescentis Radix), Radish are usable.
Toxic fire pouring into Large Intestine: foul discharge, clear water, direct pouring, undigested food. This is evil heat failing to digest grain, not Spleen deficiency. Lighter than dysentery-like cases. Signs: high fever, coarse breath, short urine, cracked purple lips, extreme cold-thirst, constant abdominal pain, intermittent limb cold. Clear and drain according to trend. Treatment same as above.
Wang Shihiong notes: Cracked lips/extreme thirst indicate fluid depletion; clear and transform, avoid excessive draining. Winter melon soup for tea/decoction is excellent. Wang An: Mung beans suitable for both. Constipation in plague due to toxin boiling drying intestines. Do not just attack blockage to hasten death. Add Raw Dahuang (Rhei Radix et Rhizoma) to main formula, or use Honey Suppository externally. Wang An: Hemp seed suitable.
Evil invading Five Zang disrupts Three Yin meridians, blood flow disorder, leaking into Large Intestine causing hematochezia. Use main formula with increased Shengdi (Rehmanniae Radix), plus Huaihua (Sophorae Flos), Baiye (Platycladi Cacumen), and Zonghui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: Zonghui (Palmae Fructus Cinchonae Cinchonae Ash) is warm-astringent. To stop bleeding, replace with Diyutan (Sanguisorbae Radix Carbonized).
Bladder extreme heat: scanty red/dysuric urine. Severe toxin: urine oily. Add Huashi (Talcum), Zexie (Alismatis Rhizoma), Zhuling (Polyporus), Mutong (Akebiae Caulis), Tongcao (Tetrapanacis Medulla), and Bianxu (Polygoni Avicularis Herba) to main formula.
Wang Shihiong notes: Polyporus/Alisma are draining. For bladder obstruction, they guide flow. But here, heat-toxin blazes, fluids consumed, urine naturally red/scanty. Treat the cause; clear source, clean stream. Do not force diuresis futilely. Use sparingly if needed, do not overuse.
Hematuria (painless): blood in urine without pain. Blood strangury (painful): lower abdomen/penis distension/pain. In plague, both due to heat forcing blood. Increase Shengdi (Rehmanniae Radix) in main formula, add Huashi (Talcum), Tao Ren (Persicae Semen), Maogen (Imperatae Rhizoma), Hupo (Succinum), Niuxi (Achyranthis Bidentatae Radix), Zonghui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: If pain/distension present, avoid Zonghui (Palmae Fructus Cinchonae Cinchonae Ash). Wang An: Also suitable to use Diyutan (Sanguisorbae Radix Carbonized).
Madness, cursing, ignoring kin, climbing/singing, stripping/walking, jumping walls/roofs, superhuman strength. Speaking of unseen things/people, as if possessed. This is Yangming evil heat disturbing Spirit. Patient unaware. Shamans confuse matters. Increase Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma), Danpi (Moutan Cortex), Zhizi (Gardeniae Fructus) in main formula, add Huangbai (Phellodendri Cortex).
Wang Shihiong notes: Add Zhusha (Cinnabaris), Qingdai (Indigo Naturalis). If phlegm, add Shichangpu (Acori Tatarinowii Rhizoma), Zhuli (Bambusae Sap).
Plague phlegm is heat-related. Blood in phlegm indicates extreme heat. Increase Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), Shengdi (Rehmanniae Radix) in main formula, add Louren (Trichosanthis Semen), Lingyangjiao (Saigae Tataricae Cornu), Sheng Sangbaipi (Fresh Mori Cortex), Zonghui (Palmae Fructus Cinchonae Cinchonae Ash).
Wang Shihiong notes: Sangbaipi (Mori Cortex) and Zonghui (Palmae Fructus Cinchonae Cinchonae Ash) debatable. Add Huashi (Talcum), Tao Ren (Persicae Semen), Weijing (Phragmitis Rhizoma), Guban (Benincasae Semen).
Plague enuresis is not deficiency inability to hold, but heat loss of control. Patient lethargic/delirious, unaware of enuresis. Increase Shigao (Gypsum Fibrosum), Xijiao (Rhinocerotis Cornu), Huanglian (Coptidis Rhizoma) in main formula, add Huashi (Talcum). All wheezing/fullness belongs to heat, especially in plague. Increase Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix) in main formula, add Sangbaipi (Mori Cortex), Lingyangjiao (Saigae Tataricae Cornu).