典藏书目

In diseases caused by epidemic pathogens, some are resolved through *zhan han* (shivering sweat); some are resolved through spontaneous sweating (*zi han*), night sweating (*dao han*), or manic sweating (*kuang han*); some have no sweating but the pathogen directly transmits to the Stomach; some experience profuse spontaneous sweating yet heat and thirst worsen, requiring shivering sweat for resolution; some have Stomach Qi stagnation and depression, requiring purgation to induce shivering sweat for resolution; some have exterior symptoms resolved by sweating, yet residual interior pathogens remain, causing recurrence of previous symptoms after three to five days without other causes; some jaundice cases heal due to purgation; some jaundice cases develop macules (*ban*) due to purgation; some heal directly through the emergence of macules; some have urgent interior syndromes where, despite the presence of macules, healing is impossible without purgation. Although these represent irregular transmission patterns, they are common variations within epidemics.

There are also variations outside the standard patterns: In men who have recently engaged in excessive sexual activity, or who inherently have deficiency in the Lower Yuan (Kidney and lower jiao), the pathogenic heat sinks into the Lower Jiao due to deficiency, impairing the movement of Qi channels, resulting in urinary retention and lower abdominal distension, with fever worsening at night. Treatments such as Dao Chi San (Guide Out Redness Powder), Wu Ling San (Five-Ingredient Powder with Poria), and Wu Pi Yin (Five-Peel Decoction) prove ineffective. However, a single dose of Da Cheng Qi Tang (Major Order the Yang Decoction) results in copious urination and recovery. Alternatively, if the patient has pre-existing conditions with localized deficiency, the pathogen may transmit to the damaged area. Examples include blood loss, metrorrhagia, leukorrhea, menstruation just starting or stopping, heart pain, hernia, and wheezing/urgency due to phlegm-fire. All these are irregular transmissions. Generally, pathogenic factors flow like water, affecting only where it accumulates. Irregular transmission occurs due to individual constitution, often triggering old diseases upon contracting an epidemic. The treatment principle is regardless of the meridian or specific disease, one must treat the epidemic itself, and the old disease will resolve spontaneously.

In warm epidemics, after one or two days of fever, the tongue coating appears white like accumulated powder. Taking one dose of Da Yuan Yin (Reach the Origin Drink) in the morning causes the coating to turn yellow by midday, followed by chest and diaphragm fullness/pain, severe thirst, and irritability. This indicates the latent pathogen is breaking out and the toxic heat is transmitting to the Stomach. Adding Rhubarb (*Da Huang*, *Rhei Radix et Rhizoma*) to the previous formula to purge leads to slight reduction in irritability and thirst, with fever decreasing by 60-70%. However, in the afternoon, irritability and fever recur, the entire tongue turns black with prickles, and the nostrils appear sooty black. This signifies the heaviest pathogenic toxicity re-stagnating in the Stomach, necessitating immediate administration of Da Cheng Qi Tang (Major Order the Yang Decoction). Profuse purgation in the evening leads to fever subsiding by midnight. By the next morning, the black nostrils and tongue prickles disappear. This represents three changes within one day, compressing several days' pathology into one day. Due to the severity of the toxin and rapid transmission, medication must be administered urgently. If untreated, or if mild agents are used delaying treatment by two to three days, death is inevitable. Even if survival occurs, late medication would be futile. Cases of death from warm epidemics within two to three days belong to this category.