袭芳香之气，重涤秽也。张仲景着《伤寒论》，欲明冬寒、春温、夏秋暑热之正，自不能并入疫病，以混常法，
然至理已毕具于脉法中。叔和不为细绎，究竟所指之疫，仍为伤寒、伤温、伤暑热之正病耳。夫四时不正之气，
感之者因而致病，初不名疫也。因病致死，病气、尸气混合不正之气，斯为疫矣。所以饥馑兵凶之际，疫病盛
行，大率春夏之交为甚。盖温暑湿热之气，交结互蒸，人在其中，无隙可避。病者当之，魄汗淋漓。一人病气，
足充一室，况于沿门阖境。种种恶秽，人受之者，亲上亲下，病从其类，有必然之势。如世俗所称“大头瘟”
者，头面、腮颐肿如瓜瓠者是也；所称“虾蟆瘟”者，喉痹失音，颈筋胀大者是也；所称“瓜瓤瘟”者，胸高
胁起，呕汁如血者是也；所称“疙瘩瘟”者，遍身红肿，发块如瘤者是也；所称“绞肠瘟”者，腹鸣干呕，水
泻不通者是也；所称“软脚瘟”者，便清泻白，足重难移者是也；小儿痘疮尤多。以上疫证，不明治法，
咸委劫运，良可伤悼！大率温、疫、痘、疹，古昔无传，予幸微窥仲景一斑。其《脉法篇》云∶寸口脉阴阳俱
紧者，至脐筑湫痛，命将难全。凡二百六十九字，阐发奥理，全非伤寒中所有事，乃论疫邪从入之门，变病之
总。篇中大意，谓人之鼻气通于天，故阳中雾露之邪者，为清邪，从鼻息而上入于阳，入则发热头痛，项强颈
挛，正与俗称大头瘟、虾蟆瘟之说符也。人之口气通于地，故阴中水土之邪，为饮食浊味，从口舌而下入于阴，
入则其人必先内栗，足膝逆冷，便溺妄出，清便下重，脐筑湫痛，正与俗称绞肠瘟、软脚瘟之说符也。然从鼻
从口所入之邪，必先注于中焦，以次分布上下，故中焦受邪，因而不治则胃中为浊，营卫不通，血凝不流，其
酿变即俗称瓜瓤瘟、疙瘩瘟等证，则又阳毒痈脓、阴毒遍身青紫之类也。此三焦定位之邪也。若三焦邪混为
一，内外不通，藏气熏蒸，上焦怫郁，则口烂食龈。卫气前通者，因热作使，游行经络、脏腑，则为痈脓；营
气前通者，因召客邪，嚏出声 咽塞，热壅不行，则下血如豚肝。然以营卫渐通，故非危候。若上焦之阳、下
焦之阴，两不相接，则脾气于中难以独运，斯五液注下，下焦不阖，而命难全矣。伤寒之邪，先行身之背，
次行身之前，次行身之侧，由外廓而入；瘟疫之邪，则直行中道，流布三焦。上焦为清阳，故清邪从之上入；
下焦为浊阴，故浊邪从之下入；中焦为阴阳交界，凡清浊之邪，必从此区分。甚者，三焦相混，上行极而下，
下行极而上，故声 、咽塞、口烂、食龈者，亦复下血如豚肝，非定中上不及下、中下不及上也。伤寒邪中外
廓，故一表即散；疫邪行在中道，故表之不散。伤寒邪入胃府，则腹满便硬，故不可攻下；疫邪在三焦，散
漫不收，下之复合，此与治伤寒表里诸法有何干涉？治法，未病前预饮芳香，则邪不能入，此为上也；邪既入，
则以逐秽为第一义。上焦如雾，升而逐之，兼以解毒；中焦如沤，疏而逐之，兼以解毒；下焦如渎，决而逐之，
兼以解毒。营卫既通，乘势追
拔，勿令潜滋。或问∶春、夏、秋蒸气成疫，岂冬温独非疫耶？余曰∶冬月过温，肾气不藏，感而成病，正与
不藏精之春温无异。计此时有春无冬，三气即得交蒸成疫，然遇朔风骤发，则蒸气化为乌有矣。是以东南冬月，
患正伤寒者少，患冬温及痘疮者多；西北则秋冬春皆患正伤寒，殊无瘟疫、痘疮之患。此何以故？西北土高地
燥，即春夏，气难上升，何况冬月之凝冱；东南土地卑湿，为雾露之区，蛇龙之窟，其温热之气，得风以播之，
尚有可耐，设旦暮无风，水中之鱼，衣中之虱，且为飞扬，况于人乎？蒸气中，原杂诸秽，益以病气、尸气，
无分老少，触之即病，此时朔风了不可得，故其气转积转暴，虽有熏风，但能送热，不能解凉。叔和以夏应大热
而反大寒为疫，岂知大寒正疫气消弭之候乎？（喻嘉言）
《说文》云∶疫者，民皆病也，厉鬼为灾。《礼记》云∶孟春之月，先王掩骼埋 ，正以是月天气下降，
地气上升，诚恐 骼秽恶之气有害人物，故掩埋之。盖以人在气交之中，如鱼在水，一毫渣滓混杂不得。设川
泽泼灰，池塘入油，鱼鲜有得生者。人受疫气，何以异此？（林北海）
一辨气∶风寒之气，从外入内，初病无臭气触人，必待数日传阳腑证之时，亦只作腐气，不作尸气。瘟
疫之气，从中蒸达于外，初病即有臭气触人，轻则盈于床帐，重则蒸然一室，且专作尸气，不作腐气，以人身
脏腑气血津液，得生气则香，得败气则臭。瘟疫，败气也，人受之自脏腑蒸出于肌表，气血津液逢蒸而败，因
败而溢，溢出有盛衰，充塞有远近也。五行原各有臭气∶木臊、金腥、心焦、脾香、肾腐，以臭得其正，皆可
指而名之。若瘟疫，乃天地之杂气，非臊、腥、焦、香、腐，其触人不可名状，非善者不能辨之。辨之既明，
治之毋惑，知为瘟疫，而非伤
寒，则凡于头痛发热诸表证，不得误用辛温发散；于舌黄烦渴诸里证，当清、当下者，亦不得迟回瞻顾矣。○
二辨色∶风寒主收敛，敛则急，色多绷急光洁；瘟疫主蒸散，散则缓，色多松缓垢晦。人受蒸气，则津液上溢
于面，头目之间，故多垢滞，或如油腻，或如烟熏。望之可憎者，皆瘟疫之色也。○三辨舌∶风寒在表，舌多无
苔，即有白苔，亦薄而滑，渐传入里，方由白而黄，由黄而燥，由燥而黑。瘟疫一见头痛发热，舌上即有白苔，
且浓而不滑，或色兼淡黄，或粗如积粉；若传经入胃，则兼二三色。又有白苔即燥与至黑不燥者，大抵疫邪入
胃，舌苔颇类风寒，以兼湿之故，而不作燥耳。惟在表时，舌苔白浓，异于伤寒。能辨于在表时不用辛温发散，
入里时而用清凉攻下，斯得矣。○四辨神∶风寒之邪伤人，令人心知所苦，而神自清，如头痛、寒热之作，皆
自知之；至传里入胃，始神昏谵语。缘风寒为天地正气，人气与之乖忤而后成病，故其气不昏人神识也。瘟疫
初起，令人神情异常，大概烦躁者居多，或如痴如醉，扰乱惊悸，问其所苦，则不自知，间有神清而能自主者，
亦多梦寐不安，闭目即有所见，此即谵妄之根。缘瘟疫为天地邪气，中人人病，中物物伤，故其气专昏人神志
也。○五辨脉∶瘟疫之脉，传变后与风寒颇同，初起时与风寒迥异。风寒从皮毛而入，一二日脉多浮，或兼紧、
兼缓、兼洪而皆浮，迨传入里，始不见浮，其至数亦清楚而不模糊；瘟疫从中道而变，自里出表，一二日脉多
沉，迨至里出表，脉始不沉，或兼弦、兼大而皆不浮，其至数则模糊而不清楚。其初起，脉沉迟，勿作阴寒断，
沉者邪在里也，迟者邪在阴分也。脉象同于阴寒，而气色、舌苔、神情不同。或数而无力，亦勿作虚视，缘热
蒸气散，故脉不能鼓指，但当解热，不宜补气。受病之因不同，故同脉而异断也。○时疫兼寒，能令病势增剧；
兼风，反令病势易解。以寒主凝泣，则疫邪内郁，郁一分，病势增重一分；风主游扬，则疫邪外疏，疏一分，
病势解散一分。○时疫，
有似疟、转疟、兼疟之不同，用药亦异。似疟者，寒热往来，或一日二三度发，或一日一发而无定时。时疫初
起多有之。转疟者，时疫已经汗、下，余邪不解，复作寒热，转成疟状。时疫末路多有之。兼疟者，乃寒暑时
疫合病，其证寒热有期，疟证全具，但热多寒少，燥渴昏愦。秋令多有之。所以然者，因疫邪盘踞膜原，欲出表
而不能透达，欲陷里而未得空隙，故见半表半里之证也。治宜达原饮加柴胡为主。○时疫与疟证，不甚相远。
疫乃湿、温二气合病，疟乃风、寒、暑、湿四气合病，其邪气之杂而不纯，相类也。疟邪横连膜原，时疫亦盘
踞膜原，其受邪之处，亦相类也。但时疫之温气发，则为亢阳，故宜下、宜清之证多；疟之暑气伏，则为郁滞，
故宜宣、宜利之证多。所以疫之初起方用达原饮，与疟之初起方用清脾饮，药品亦多相类。至其传变，则缓急
轻重，迥乎不同也。○时疫必得汗下而后解。脾虚者表不能作汗，里不任攻下。或得汗矣，而气随汗脱；得下
矣，而气从下脱。治此者，汗勿强汗，发表兼扶元养正，人参败毒散是也；下勿轻下，攻里必兼固气生津，黄
龙汤是也。其外证无大分别，惟脉不任按耳。然邪有进退，当其病进邪张之时，脉亦寻按有力，不可泥也，必
合气色、神情、脉证相参。如面色萎黄，神情倦怠，气息微促，及心悸耳鸣，皆脾虚中气不振之象。○时疫夹
脾虚者为难治，夹肾虚者更难。时疫属热证，肾虚则手足厥冷；时疫属实邪，肾虚则眩晕惊悸，腰膝痿软。肾
虚之中，又当审其阳虚阴虚∶疫邪必待汗下而后解，阳虚者，一经汗下，则脱绝之证随见；阴虚者，一经汗下，
则枯竭之证随见；必须时时谛察。凡在表时，见有腰痛异常，小便频数，膝胫痿软，表药中须加人参，阳虚兼
杜仲，阴虚兼熟地，以照顾肾气。若入里，当下必以黄龙汤为主；当清必以人参白虎汤为主。或屡清屡下而热
更甚，舌燥无苔或有黑苔愈清愈长，或有燥苔愈下愈燥，察其阳明无实邪可据，治以六味地黄汤加知、柏。所
谓寒之不寒，责其无水，壮水
之主，以制阳光者，此也。倘仍不应，或合生脉散滋水之源；或合四物汤益血之海。似此热势燎原，非杯水所
能拯救，须大作汤液，药味必以两许，汤液必以斗计，方有济耳。（戴麟郊）
伤寒之邪，自表传里；温热之邪，自里达表；疫疠之邪，自阳明中道随表里虚实而发，不循经络传次，故
不能一发便尽。（《张氏医通》）
瘟疫，邪从口鼻而入，故多带阳明证者，以手阳明属大肠，与肺为表里，开窍于鼻；足阳明属胃，开窍
于口也。其不可治者，属下元虚耳。（缪仲淳）
伤寒由表入里，故少阳证见则病甚；时疫由中出表，故少阳证见则病退。斯二者皆以耳聋验之。○病至
少阳即尽者，耳聋而愈；病至阳明方尽者，发斑而愈；病至太阳始尽者，自汗、狂汗、战汗而愈。（《医参》）
瘟疫本即伤寒，无非外邪之病，但染时气少长率相似者，即谓之瘟疫。古云∶瘟疫因春时温气而发，郁
热自内达外，初非寒伤于表，治法于正伤寒不同。此说固若近理，而实有未然。盖瘟疫若非表证，何以必汗而
后解？故余谓∶其先受寒邪，再触则发，理势然也。但时有寒热，证有阴阳，谓因证因时则可，谓非寒伤于表
则不可。○古云∶瘟病在三阳者多，三阴者少。然亦不可拘泥，若见阴证、阴脉，是即三阴病也。宜辨而治之。
○凡治伤寒瘟疫表证，初感速宜取汗，所谓汗不宜迟也。然取汗之法，当察其元气病气之虚实∶若表证已具，
而元未太亏者，但以辛平之剂，散之可也；若兼杂证，则当察其寒、热、温、凉，酌宜施治；若身虽大热，而
脉见虚弱者，必不易汗，此即当详察补法，酌而治之。倘不知标本，而概行强散，营竭必死。○凡治伤寒瘟
疫，有宜吐者，必其上焦有滞，或食、或痰结于胸膈，而邪不得散者，当吐也；或寒邪浊气内陷膈间，而为痞
为痛者，当吐也。盖吐中自有发散之意。若中气虚寒，脉弱无力，及气短虚烦不安
者，皆不可吐。凡用吐药，中病即止，不必尽剂。○凡治伤寒瘟疫，有宜清利者，盖火实者宜清，气实者宜行，
食滞者宜消，痰盛者宜化，皆所谓清利也。凡此数者，滞去则气行，而表邪自解。然此宜用于邪实等证，而本
非虚证之所宜。其有虚中挟实者，不妨少为兼用，此中权度，自有其宜也。○凡治伤寒瘟疫，有宜下者，必阳
明邪实而秘结腹满者，或元气素强而胃气素实者，方可下之。若大便虽数日不行，而无胀满之状，或连日不食，
而脐腹坦然者，此其阳明胃腑本无实邪，不可妄下以泄中气。盖诸误之害，下为尤甚，不可忽也。○凡治伤
寒瘟疫，有宜温者，为其寒邪凝滞，阳不胜阴，非温不能行，非温不能复也。如寒在经者，以邪在表也，宜用
温散；寒在脏者，以阳气虚也，或宜温补，或止温中。然用温法，但察其外虽热而内无热者，便是假热，宜温
不宜凉也；病虽热而元气虚者，亦是假热，宜温不宜凉也。真热者谁不得而知之，惟假热为难辨耳。大都实证
多真热，虚证多假热。真假不识，误人不浅。○凡治伤寒瘟疫，用补之法，与用攻用散者不同。盖攻散所以去
实邪，其力峻，其效速，故取效在一二剂之间，而此不效，必其用之不善也。至若补者，所以补虚，其力柔，
其功缓，但察其服补无碍，或略见相投，便是得力，轻者二三剂，重者十余剂，方得见功。若不知此理，但于
一二剂间未见速效，庸谗起，惑乱生，全功尽弃矣。（张景岳）
古人言“温”而不言“瘟”，特所言之“温”与“瘟”相同，则“温”“瘟”为一病也明矣。后人加以，
运用芳香之气，是为了强力清除秽浊。张仲景撰写《伤寒论》，旨在阐明冬季寒邪、春季温邪、夏秋暑热之正气的规律，自然不能将其并入疫病，以免混淆常规治法，然而其中的至理已在脉法中完备具备。王叔和未能细细推究，究竟所指出的疫，仍然是属于伤寒、伤温、伤暑热的正病罢了。四季不正之气，感染后因而致病，起初并不称为疫。因病致死，病气与尸气混合成不正之气，这才称为疫。所以在饥荒战乱之际，疫病盛行，大体在春夏之交最为严重。因为温暑湿热之气，交结互相蒸腾，人在其中，没有缝隙可以躲避。病人遭受此气，汗出淋漓如魄汗。一个人的病气，足以充满一间屋子，何况是沿着门第遍及整个境域。种种恶秽之气，人受到它，亲上亲下，病从同类而来，这是必然的趋势。比如世俗所称的“大头瘟”，就是头面、腮颊肿胀像瓜瓠一样的；所称的“虾蟆瘟”，就是喉痹失音，颈部筋脉胀大一样的；所称的“瓜瓤瘟”，就是胸部高耸胁肋突起，呕吐汁液如血一样的；所称的“疙瘩瘟”，就是遍身红肿，起块像肿瘤一样的；所称的“绞肠瘟”，就是腹中鸣响干呕，水泻不通一样的；所称的“软脚瘟”，就是大便清稀泻出白色物质，脚沉重难以移动一样的；小儿痘疮尤其多。以上这些疫病证候，如果不明白治疗方法，都推委于劫数命运，实在令人悲伤哀悼！大体上温病、疫病、痘疮、疹病，古昔没有流传，我有幸略微窥见张仲景学说的一个方面。他的《脉法篇》说：寸口脉阴阳俱紧的，疼痛直达肚脐且剧烈跳动，性命将难保全。凡二百六十九字，阐发深奥的道理，完全不是伤寒中所有的事，乃是论述疫邪进入的门径，以及变病的总纲。篇中的大意是说，人的鼻气通于天，所以阳分中雾露之邪，称为清邪，从鼻息而上入于阳分，进入则发热头痛，项强颈挛，正与俗称的大头瘟、虾蟆瘟的说法相符。人的口气通于地，所以阴分中水土之邪，为饮食浊味，从口舌而下入于阴分，进入则其人必先内心战栗，足膝逆冷，大小便失禁，大便下重，肚脐剧烈疼痛，正与俗称的绞肠瘟、软脚瘟的说法相符。然而从鼻从口所入之邪，必须先注入中焦，依次分布上下，所以中焦受邪，如果不治疗，则胃中化为浊气，营卫不通，血液凝滞不流，其酿成的变化即俗称的瓜瓤瘟、疙瘩瘟等证，这又是阳毒痈脓、阴毒遍身青紫之类的情况。这是三焦定位的邪气。如果三焦邪气混为一谈，内外不通，脏腑之气熏蒸，上焦郁闭，则口腔糜烂牙龈受损。卫气先通的，因热而作祟，游行经络脏腑，则为痈脓；营气先通的，因招致客邪，喷嚏声嘶咽喉阻塞，热壅不行，则下血如猪肝。然而因为营卫逐渐通畅，所以不是危重证候。如果上焦之阳、下焦之阴，两者不相连接，则脾气在中焦难以独自运化，于是五液注下，下焦不闭合，而性命难保了。伤寒的邪气，先行身体背部，次行身体前面，次行身体侧面，由外廓而入；瘟疫的邪气，则直行中道，流布三焦。上焦为清阳，所以清邪从上面入；下焦为浊阴，所以浊邪从下面入；中焦为阴阳交界，凡是清浊之邪，必从此区分。严重的，三焦相混，上行至极则下行，下行至极则上行，所以声音嘶哑、咽喉阻塞、口腔糜烂、牙龈受损的，也再次出现下血如猪肝的情况，并非定在中上而不涉及下，或中下而不涉及上。伤寒邪气在外廓，所以一解表就消散；疫邪行在中道，所以解表不散。伤寒邪气入胃腑，则腹满大便硬，所以不可攻下；疫邪在三焦，散漫不收，攻下则复合，这与治疗伤寒表里诸法有什么关系？治疗方法，未病前预先饮用芳香药物，则邪气不能进入，这是上策；邪气既已入内，则以驱逐秽浊为第一要义。上焦如雾，升提而驱逐它，兼以解毒；中焦如沤，疏通而驱逐它，兼以解毒；下焦如渎，决泄而驱逐它，兼以解毒。营卫既已通畅，乘势追拔，不要让它暗中滋生。有人问：春、夏、秋蒸气形成疫病，难道冬温独独不是疫病吗？我说：冬月过温，肾气不藏，感受而成病，正与不藏精的春温无异。计算此时有春无冬，三气即可交蒸形成疫病，然而遇到北风骤发，则蒸气化为乌有了。所以东南地区冬月，患正伤寒的少，患冬温及痘疮的多；西北则秋冬春皆患正伤寒，完全没有瘟疫、痘疮的祸患。这是什么原因？西北土地高燥，即使春夏，气难上升，何况冬月之凝结冰冻；东南土地卑湿，是雾露的区域，蛇龙的洞穴，其温热之气，得风以播散，还有可忍受的，假如早晚无风，水中的鱼，衣中的虱，尚且飞扬起来，何况于人呢？蒸气之中，原本混杂各种秽气，加上病气、尸气，不分老少，触之即病，此时北风完全得不到，所以其气越积聚越暴烈，虽然有和风，只能送热，不能解凉。王叔和认为夏天应大热而反大寒为疫，哪里知道大寒正是疫气消弭的时候呢？（喻嘉言）
《说文》说：疫，是百姓都生病，厉鬼造成灾祸。《礼记》说：孟春之月，先王掩埋枯骨，正是因为这个月天气下降，地气上升，诚恐枯骨秽恶之气有害人物，所以掩埋它们。大概因为人在气交之中，如同鱼在水中，一丝一毫渣滓混杂不得。假如川泽泼灰，池塘入油，鱼很少有能活下来的。人受疫气，与此有什么不同？（林北海）
一辨气：风寒之气，从外入内，初病没有臭气触人，必须等到数日传阳腑证之时，也只作腐气，不作尸气。瘟疫之气，从中蒸达于外，初病就有臭气触人，轻则充满床帐，重则蒸然充满一室，且专作尸气，不作腐气，因为人身脏腑气血津液，得生气则香，得败气则臭。瘟疫，是败气，人受到它，自然从脏腑蒸出于肌表，气血津液逢蒸而败，因败而溢出，溢出有盛衰，充塞有远近。五行原各有臭气：木臊、金腥、心焦、脾香、肾腐，以臭得其正，都可以指而命名。若瘟疫，是天地之杂气，非臊、腥、焦、香、腐，其触人不可名状，不是善者不能辨别。辨别既明，治疗就不迷惑，知道是瘟疫，而非伤寒，那么对于头痛发热诸表证，不得误用辛温发散；对于舌黄烦渴诸里证，当清、当下者，也不得迟疑瞻顾。
二辨色：风寒主收敛，敛则急，颜色多绷急光洁；瘟疫主蒸散，散则缓，颜色多松缓垢晦。人受蒸气，则津液上溢于面，头目之间，所以多垢滞，或如油腻，或如烟熏。望之可憎的，都是瘟疫的颜色。
三辨舌：风寒在表，舌多无苔，即使有白苔，也是薄而滑，渐渐传入里，才由白而黄，由黄而燥，由燥而黑。瘟疫一见头痛发热，舌上就有白苔，而且浓而不滑，或色兼淡黄，或粗如积粉；若传经入胃，则兼二三色。又有白苔即燥与至黑不燥的，大体疫邪入胃，舌苔颇类风寒，因为兼湿的缘故，而不作燥耳。只有在表时，舌苔白浓，异于伤寒。能在在表时不用辛温发散，入里时而用清凉攻下，这就对了。
四辨神：风寒之邪伤人，令人心知所苦，而神自清，如头痛、寒热之作，皆自知之；至传里入胃，始神昏谵语。因为风寒为天地正气，人气与之乖忤而后成病，所以其气不昏人神识。瘟疫初起，令人神情异常，大概烦躁者居多，或如痴如醉，扰乱惊悸，问其所苦，则不自知，间有神清而能自主的，也多梦寐不安，闭目即有所见，这就是谵妄的根源。因为瘟疫为天地邪气，中人人病，中物物伤，所以其气专昏人神志。
五辨脉：瘟疫之脉，传变后与风寒颇同，初起时与风寒迥异。风寒从皮毛而入，一二日脉多浮，或兼紧、兼缓、兼洪而皆浮，等到传入里，始不见浮，其至数也清楚而不模糊；瘟疫从中道而变，自里出表，一二日脉多沉，等到至里出表，脉始不沉，或兼弦、兼大而皆不浮，其至数则模糊而不清楚。其初起，脉沉迟，不要作阴寒断，沉者是邪在里，迟者是邪在阴分。脉象同于阴寒，而气色、舌苔、神情不同。或数而无力，也不要作虚视，因为热蒸气散，所以脉不能鼓指，只当解热，不宜补气。受病之因不同，所以同脉而异断。
时疫兼寒，能使病势增剧；兼风，反而使病势易解。因为寒主凝泣，则疫邪内郁，郁一分，病势增重一分；风主游扬，则疫邪外疏，疏一分，病势解散一分。
时疫，有似疟、转疟、兼疟的不同，用药也异。似疟者，寒热往来，或一日二三度发，或一日一发而无定时。时疫初起多有之。转疟者，时疫已经汗、下，余邪不解，复作寒热，转成疟状。时疫末路多有之。兼疟者，乃寒暑时疫合病，其证寒热有期，疟证全具，但热多寒少，燥渴昏愦。秋令多有之。之所以这样，是因为疫邪盘踞膜原，欲出表而不能透达，欲陷里而未得空隙，所以见半表半里之证。治宜达原饮加柴胡为主。
时疫与疟证，不甚相远。疫是湿、温二气合病，疟是风、寒、暑、湿四气合病，其邪气之杂而不纯，相类。疟邪横连膜原，时疫也盘踞膜原，其受邪之处，也相类。但时疫之温气发，则为亢阳，所以宜下、宜清之证多；疟之暑气伏，则为郁滞，所以宜宣、宜利之证多。所以疫之初起方用达原饮，与疟之初起方用清脾饮，药品也多相类。至其传变，则缓急轻重，迥乎不同。
时疫必得汗下而后解。脾虚者表不能作汗，里不任攻下。或得汗矣，而气随汗脱；得下矣，而气从下脱。治此者，汗勿强汗，发表兼扶元养正，人参败毒散是也；下勿轻下，攻里必兼固气生津，黄龙汤是也。其外证无大分别，惟脉不任按耳。然而邪有进退，当其病进邪张之时，脉亦寻按有力，不可泥守，必须合气色、神情、脉证参参。如面色萎黄，神情倦怠，气息微促，及心悸耳鸣，皆是脾虚中气不振之象。
时疫夹脾虚者为难治，夹肾虚者更难。时疫属热证，肾虚则手足厥冷；时疫属实邪，肾虚则眩晕惊悸，腰膝痿软。肾虚之中，又当审其阳虚阴虚：疫邪必待汗下而后解，阳虚者，一经汗下，则脱绝之证随见；阴虚者，一经汗下，则枯竭之证随见；必须时时谛察。凡在表时，见有腰痛异常，小便频数，膝胫痿软，表药中须加人参，阳虚兼杜仲，阴虚兼熟地，以照顾肾气。若入里，当下必以黄龙汤为主；当清必以人参白虎汤为主。或屡清屡下而热更甚，舌燥无苔或有黑苔愈清愈长，或有燥苔愈下愈燥，察其阳明无实邪可据，治以六味地黄汤加知母、黄柏。所谓寒之不寒，责其无水，壮水之主，以制阳光者，此也。倘若仍不应，或合生脉散滋水之源；或合四物汤益血之海。似此热势燎原，非杯水所能拯救，须大作汤液，药味必以两许，汤液必以斗计，方有济耳。（戴麟郊）
伤寒之邪，自表传里；温热之邪，自里达表；疫疠之邪，自阳明中道随表里虚实而发，不循经络传次，所以不能一发便尽。（《张氏医通》）
瘟疫，邪从口鼻而入，所以多带阳明证者，因为手阳明属大肠，与肺为表里，开窍于鼻；足阳明属胃，开窍于口。其不可治者，属下元虚耳。（缪仲淳）
伤寒由表入里，所以少阳证见则病甚；时疫由中出表，所以少阳证见则病退。这两者都以耳聋来验证。○病至少阳即尽的，耳聋而愈；病至阳明方尽的，发斑而愈；病至太阳始尽的，自汗、狂汗、战汗而愈。（《医参》）
瘟疫本即伤寒，无非外邪之病，但染时气少长率相似的，就称为瘟疫。古云：瘟疫因春时温气而发，郁热自内达外，初非寒伤于表，治法于正伤寒不同。此说固然若近理，而实有未然。盖瘟疫若非表证，何以必汗而后解？所以我谓：其先受寒邪，再触则发，理势然也。但时有寒热，证有阴阳，谓因证因时则可，谓非寒伤于表则不可。○古云：瘟病在三阳者多，三阴者少。然而也不可拘泥，若见阴证、阴脉，是即三阴病也。宜辨而治之。○凡治伤寒瘟疫表证，初感速宜取汗，所谓汗不宜迟也。然而取汗之法，当察其元气病气之虚实：若表证已具，而元未太亏者，但以辛平之剂，散之可也；若兼杂证，则当察其寒、热、温、凉，酌宜施治；若身虽大热，而脉见虚弱者，必不易汗，此即当详察补法，酌而治之。倘不知标本，而概行强散，营竭必死。○凡治伤寒瘟疫，有宜吐者，必其上焦有滞，或食、或痰结于胸膈，而邪不得散者，当吐也；或寒邪浊气内陷膈间，而为痞为痛者，当吐也。盖吐中自有发散之意。若中气虚寒，脉弱无力，及气短虚烦不安者，皆不可吐。凡用吐药，中病即止，不必尽剂。○凡治伤寒瘟疫，有宜清利者，盖火实者宜清，气实者宜行，食滞者宜消，痰盛者宜化，皆所谓清利也。凡此数者，滞去则气行，而表邪自解。然而此宜用于邪实等证，而本非虚证之所宜。其有虚中挟实者，不妨少为兼用，此中权度，自有其宜也。○凡治伤寒瘟疫，有宜下者，必阳明邪实而秘结腹满者，或元气素强而胃气素实者，方可下之。若大便虽数日不行，而无胀满之状，或连日不食，而脐腹坦然者，此其阳明胃腑本无实邪，不可妄下以泄中气。盖诸误之害，下为尤甚，不可忽也。○凡治伤寒瘟疫，有宜温者，为其寒邪凝滞，阳不胜阴，非温不能行，非温不能复也。如寒在经者，以邪在表也，宜用温散；寒在脏者，以阳气虚也，或宜温补，或止温中。然而用温法，但察其外虽热而内无热者，便是假热，宜温不宜凉也；病虽热而元气虚者，亦是假热，宜温不宜凉也。真热者谁不得而知之，惟假热为难辨耳。大都实证多真热，虚证多假热。真假不识，误人不浅。○凡治伤寒瘟疫，用补之法，与用攻用散者不同。盖攻散所以去实邪，其力峻，其效速，故取效在一二剂之间，而此不效，必其用之不善也。至若补者，所以补虚，其力柔，其功缓，但察其服补无碍，或略见相投，便是得力，轻者二三剂，重者十余剂，方得见功。若不知此理，但于一二剂间未见速效，庸谗起，惑乱生，全功尽弃矣。（张景岳）
古人言“温”而不言“瘟”，特所言之“温”与“瘟”相同，则“温”“瘟”为一病也明矣。后人加以[注]，
Utilizing the aroma of fragrant substances is to vigorously eliminate turbid filth. Zhang Zhongjing authored *Shanghan Lun* (Treatise on Cold Damage) to clarify the regular patterns of winter cold, spring warmth, and summer-autumn summerheat; naturally, he could not merge them into epidemic diseases to avoid confusing standard treatment methods. However, the profound principles were fully contained within the pulse diagnosis section. Wang Shuhe failed to carefully analyze this, and ultimately, what was referred to as "epidemic" still belonged to the regular diseases of cold damage, warm damage, and summerheat damage. The irregular qi of the four seasons, when contracted, causes disease, but initially it is not called an epidemic. Only when death occurs due to the illness, and the qi of the illness mixes with the qi of the corpse to form irregular qi, does it become an epidemic. Therefore, during times of famine and war, epidemics prevail, mostly peaking in the transition between spring and summer. This is because warm, summerheat, dampness, and heat qi interlock and mutually steam; people within this environment have no gap to avoid it. Those afflicted sweat profusely like "po han" (soul sweat). The qi of one sick person is sufficient to fill a room, let alone spreading door-to-door across a region. Various foul odors, when received by humans, affect the upper and lower parts similarly, and diseases follow their kind, which is an inevitable trend. For example, what is commonly called "Big Head Plague" refers to swelling of the head, face, cheeks, and jaw like a gourd; "Toad Plague" refers to throat obstruction with loss of voice and swollen neck tendons; "Melon Rind Plague" refers to high chest and raised ribs, vomiting fluid resembling blood; "Lump Plague" refers to widespread redness and swelling of the body with lumps like tumors; "Intestine Twisting Plague" refers to abdominal borborygmus, dry retching, and watery diarrhea without relief; "Soft Leg Plague" refers to clear white loose stools and heavy legs difficult to move; pediatric smallpox is also particularly common. Regarding these above-mentioned epidemic syndromes, if the treatment methods are not understood, all are attributed to fate, which is truly lamentable! Generally speaking, warm diseases, epidemics, smallpox, and rashes were not transmitted in ancient times; I am fortunate to have glimpsed a fragment of Zhang Zhongjing's teachings. His *Pulse Method Chapter* states: "When both yin and yang pulses at the cunkou position are tight, pain extends to the navel with throbbing, and life will be hard to preserve." These two hundred and sixty-nine characters elucidate profound principles, completely unlike matters found in Shanghan, but rather discussing the gateway for epidemic pathogens to enter and the general overview of transformed diseases. The main idea of the chapter is that human nasal qi connects with heaven; thus, fog and dew pathogens in the yang aspect are called "clear pathogens," entering from the nose upwards into the yang. Upon entry, they cause fever, headache, stiff neck, and cervical spasms, which exactly matches the popular descriptions of Big Head Plague and Toad Plague. Human oral qi connects with earth; thus, water and soil pathogens in the yin aspect, being turbid flavors from diet, enter from the mouth and tongue downwards into the yin. Upon entry, the person first experiences internal shivering, cold feet and knees, involuntary urination and defecation, heaviness in defecation, and severe navel pain, which exactly matches the popular descriptions of Intestine Twisting Plague and Soft Leg Plague. However, pathogens entering from the nose and mouth must first pour into the middle jiao, then distribute up and down. Thus, when the middle jiao receives pathogens and remains untreated, the stomach becomes turbid, Ying and Wei (nutritive and defensive qi) do not circulate, and blood coagulates and stagnates. The resulting transformations correspond to the popularly known Melon Rind Plague and Lump Plague, which are similar to Yang Du (Yang Toxicity) causing carbuncles and pus, or Yin Du (Yin Toxicity) causing bluish-purple discoloration over the whole body. These are pathogens located in the three jiaos. If the pathogens of the three jiaos mix into one, with internal and external blockage, and organ qi steaming and steaming, causing oppression in the upper jiao, then oral ulcers and gum erosion occur. If Wei Qi (defensive qi) flows forward first, driven by heat, wandering through meridians and organs, it results in carbuncles and pus; if Ying Qi (nutritive qi) flows forward first, attracting external pathogens, causing sneezing, hoarseness, and throat blockage, with heat stagnating and unable to flow, it results in bloody stool resembling pig liver. However, because Ying and Wei gradually connect, it is not a critical condition. If the yang of the upper jiao and the yin of the lower jiao do not connect, then Spleen qi cannot operate independently in the middle, leading to the pouring down of five fluids, closure failure of the lower jiao, and difficulty preserving life. Shanghan pathogens travel first along the back of the body, then the front, then the sides, entering from the exterior framework; Epidemic pathogens travel directly along the central pathway, distributing through the three jiaos. The upper jiao is clear yang, so clear pathogens enter from above; the lower jiao is turbid yin, so turbid pathogens enter from below; the middle jiao is the boundary of yin and yang, so all clear and turbid pathogens must distinguish themselves here. In severe cases, the three jiaos mix; extreme ascent leads to descent, and extreme descent leads to ascent. Thus, those with hoarse voice, throat blockage, oral ulcers, and gum erosion may again present with bloody stool resembling pig liver; it is not fixed to only affecting the upper/middle or middle/lower. Shanghan pathogens are in the exterior framework, so releasing the exterior disperses them; Epidemic pathogens act in the central pathway, so releasing the exterior does not disperse them. When Shanghan pathogens enter the Stomach fu, causing abdominal fullness and hard stool, purgation is contraindicated; Epidemic pathogens are in the three jiaos, scattered and unrestrained, so purgation causes re-aggregation. What connection does this have with the various methods for treating Shanghan exterior and interior? Treatment method: Before illness, pre-drinking aromatic substances prevents pathogen entry, which is the best approach; once pathogens have entered, expelling filth is the primary principle. The upper jiao is like mist, so elevate and expel it, combined with detoxification; the middle jiao is like fermentation vat, so dredge and expel it, combined with detoxification; the lower jiao is like a drain, so drain and expel it, combined with detoxification. Once Ying and Wei are connected, pursue and extract the pathogen using momentum, do not allow it to secretly proliferate. Someone asked: Spring, summer, and autumn vapors form epidemics; is Winter Warmth not an epidemic? I say: Excessive warmth in winter causes Kidney qi to fail to store, contracting disease upon exposure, which is identical to Spring Warmth caused by failing to store essence. At this time, there is spring but no winter, and the three qi can intermingle and steam to form epidemics; however, if north wind suddenly arises, the vapor disappears. Therefore, in the southeast, few suffer from regular Shanghan in winter, but many suffer from Winter Warmth and smallpox; in the northwest, regular Shanghan occurs in autumn, winter, and spring, with no epidemics or smallpox. Why? Northwest land is high and dry; even in spring and summer, qi struggles to rise, let alone in freezing winter; Southeast land is low and wet, an area of fog and dew, caves of snakes and dragons. Its warm and hot qi, dispersed by wind, is bearable; if there is no wind morning or evening, fish in water and lice in clothes would fly about, let alone humans. Vapors originally contain various filths, added to illness qi and corpse qi, affecting young and old alike upon contact. At this time, north wind is unattainable, so the qi accumulates and becomes violent. Although there is gentle breeze, it only sends heat, it cannot resolve coolness. Wang Shuhe believed that summer should be very hot but instead is very cold constitutes epidemic; how could he know that great cold is precisely the sign of epidemic qi dissipating? (Yu Jiayan)
*Shuowen Jiezi* says: Epidemic means the people all get sick, caused by malevolent ghosts bringing disaster. *Liji* (Book of Rites) says: In the first month of spring, the former kings covered bones and buried skeletons, precisely because in this month heaven qi descends and earth qi ascends, fearing that the foul qi of exposed bones might harm people, so they were buried. It is said that humans exist within the intersection of qi, like fish in water, unable to tolerate even a trace of impurity. If ash is thrown into rivers and lakes, or oil into ponds, few fish survive. How is receiving epidemic qi different? (Lin Beihai)
First, distinguish Qi: Wind-cold qi enters from outside to inside; early in the disease, there is no foul odor touching people, waiting several days until transmitting to yang fu syndromes, it only produces rotting smell, not corpse smell. Epidemic qi steams out from the center to the exterior; early in the disease, there is already a foul odor touching people, light cases fill the bed curtains, heavy cases steam the whole room, and it specifically produces corpse smell, not rotting smell, because human body organs, blood, qi, and body fluids produce fragrance when receiving living qi, and stench when receiving decaying qi. Epidemic is decaying qi; humans receive it, and it naturally steams out from organs to skin surface. Blood, qi, and body fluids encounter steaming and decay, and upon decay, overflow. Overflow has degrees of abundance or scarcity, and filling has degrees of proximity or distance. The Five Elements originally each have specific odors: Wood smells musky, Metal smells fishy, Heart smells scorched, Spleen smells fragrant, Kidney smells putrid. When the smell is correct, it can be named by pointing. If Epidemic, it is the miscellaneous qi of heaven and earth, not musky, fishy, scorched, fragrant, or putrid; its touch on humans is indescribable, only those with discernment can identify it. Once clearly identified, treatment will not be confused. Knowing it is Epidemic, not Shanghan, then for exterior syndromes like headache and fever, one must not mistakenly use acrid-warm dispersants; for interior syndromes like yellow tongue, irritability, and thirst, where clearing or purging is indicated, one must not hesitate.
Second, distinguish Color: Wind-cold governs contraction; contraction leads to tension, so colors are often tense and smooth/shiny. Epidemic governs steaming and scattering; scattering leads to looseness, so colors are often loose, slow, dirty, and dull. Humans receiving vapor have body fluids overflowing to the face, between head and eyes, so often dirty and stagnant, like grease or like smoke staining. What looks repugnant to the eye are all colors of Epidemic.
Third, distinguish Tongue: Wind-cold on the exterior usually has no coating; if there is a white coating, it is thin and slippery. Gradually transmitting to the interior, it changes from white to yellow, from yellow to dry, from dry to black. Epidemic, upon seeing headache and fever, immediately has a white coating on the tongue, thick and not slippery, or color mixed with pale yellow, or coarse like accumulated powder; if transmitting channels and entering the Stomach, it mixes with two or three colors. There are also white coatings that are dry and black coatings that are not dry. Generally, when epidemic pathogens enter the Stomach, tongue coating resembles Wind-cold, due to accompanying dampness, not becoming dry. Only when on the exterior, the white coating is thick, differing from Shanghan. Being able to distinguish this, not using acrid-warm dispersants when on the exterior, and using cooling purgatives when entering the interior, this is correct.
Fourth, distinguish Spirit: Wind-cold pathogens injuring people make the heart know the suffering, but spirit remains clear; such as headache and chills/fever, one knows it oneself; only when transmitting to interior and entering Stomach does spirit become confused with delirious speech. Because Wind-cold is the righteous qi of heaven and earth, human qi conflicts with it before disease forms, so its qi does not confuse human spirit. Epidemic onset makes people's spirit and demeanor abnormal, mostly irritable, or like mad/drunk, disturbed and startled; asking what hurts, they do not know. Occasionally, some have clear spirit and self-control, but mostly sleep restlessly, seeing things when closing eyes; this is the root of delirium. Because Epidemic is the evil qi of heaven and earth, injuring humans and objects alike, its qi specifically confuses human spirit.
Fifth, distinguish Pulse: Epidemic pulse, after transformation, is quite similar to Wind-cold, but at onset, it is vastly different. Wind-cold enters from skin and hair; in one or two days, pulse is mostly floating, or accompanied by tight, slow, or large, but all floating. Until transmitting to interior, it ceases to be floating, and its rate is clear and distinct. Epidemic transforms from the central pathway, emerging from interior to exterior; in one or two days, pulse is mostly deep. Until emerging from interior to exterior, pulse ceases to be deep, or accompanied by wiry or large, but all non-floating, and its rate is vague and indistinct. At onset, pulse is deep and slow; do not diagnose as Yin-Cold. Deep means pathogen is in interior; slow means pathogen is in yin aspect. Pulse appearance is same as Yin-Cold, but qi/color, tongue coating, and spirit differ. Or rapid but weak; do not diagnose as deficiency. Because heat vapor scatters, pulse cannot beat strongly against fingers; one should only clear heat, not tonify qi. Different causes of disease lead to same pulse but different diagnoses.
Seasonal Epidemic combined with Cold intensifies disease severity; combined with Wind, it facilitates disease resolution. Because Cold governs coagulation and stagnation, epidemic pathogens remain internally depressed; depression increases disease severity. Wind governs roaming and spreading, so epidemic pathogens are externally dispersed; dispersion reduces disease severity.
Seasonal Epidemic differs in resembling Malaria, transforming into Malaria, or combining with Malaria, and medications differ. Resembling Malaria: alternating chills and fever, occurring two or three times a day, or once a day without fixed time. Common in early Seasonal Epidemic. Transforming into Malaria: After sweating and purging for Seasonal Epidemic, residual pathogens remain unresolved, chills and fever recur, transforming into Malaria pattern. Common in late Stage Seasonal Epidemic. Combining with Malaria: Simultaneous occurrence of Cold-Heat seasonal epidemic and Malaria, symptoms include periodic chills and fever, full Malaria syndrome, but more heat than cold, dry thirst, and confusion. Common in Autumn. The reason is that epidemic pathogens occupy Mo Yuan (Membrane Source), wanting to exit exterior but unable to penetrate, wanting to sink interior but lacking space, thus presenting half-exterior half-interior syndromes. Treatment should prioritize Da Yuan Yin (Reach the Origin Decoction) plus Chai Hu (Bupleuri Radix).
Seasonal Epidemic and Malaria are not far apart. Epidemic is combination of Dampness and Warmth qi; Malaria is combination of Wind, Cold, Summerheat, and Dampness qi; their pathogens are mixed and impure, similar. Malaria pathogens horizontally connect Mo Yuan; Seasonal Epidemic also occupies Mo Yuan; the location of receiving pathogens is similar. But Seasonal Epidemic's Warmth qi erupts, becoming excessive Yang, so indications for purging and clearing are many; Malaria's Summerheat qi lies dormant, becoming stagnant, so indications for diffusing and draining are many. Thus, early Seasonal Epidemic uses Da Yuan Yin, while early Malaria uses Qing Pi Yin (Clear Spleen Decoction); ingredients are largely similar. However, their transmission differs greatly in speed and severity.
Seasonal Epidemic must resolve through sweating and purging. Spleen deficiency prevents exterior sweating and interior tolerance of purging. Or sweating occurs, but qi escapes with sweat; purging occurs, but qi escapes downward. Treating this: Do not force sweating; releasing exterior must support Yuan Qi and nourish righteousness, e.g., Renshen Baidu San (Ginseng Detoxifying Powder); do not lightly purge; attacking interior must consolidate qi and generate fluids, e.g., Huanglong Tang (Yellow Dragon Decoction). Exterior symptoms have little difference, except pulse is tender to pressure. However, pathogens advance and retreat; when disease advances and pathogens expand, pulse may feel strong upon pressing, do not adhere rigidly; must combine qi/color, spirit, and pulse-symptoms. Yellowish complexion, tired spirit, short breath, palpitations, and tinnitus are signs of Spleen deficiency and weak Middle Qi.
Seasonal Epidemic complicated by Spleen deficiency is difficult to treat; complicated by Kidney deficiency is even harder. Seasonal Epidemic belongs to Heat syndromes; Kidney deficiency causes cold hands and feet. Seasonal Epidemic belongs to Excess pathogens; Kidney deficiency causes dizziness, palpitations, and weak waist/knees. Within Kidney deficiency, one must examine Yang vs. Yin deficiency: Epidemic pathogens require sweating and purging to resolve; Yang deficiency, once sweated/purged, shows collapse symptoms; Yin deficiency, once sweated/purged, shows exhaustion symptoms; must observe carefully at all times. When on exterior, if abnormal lower back pain, frequent urination, weak calves/thighs appear, add Renshen (Ginseng Radix et Rhizoma) to exterior formulas; Yang deficiency add Duzhong (Eucommiae Cortex), Yin deficiency add Shudi (Rehmanniae Radix Praeparata) to care for Kidney qi. If entering interior, purging must primarily use Huanglong Tang; clearing must primarily use Renshen Baihu Tang (Ginseng White Tiger Decoction). If repeated clearing/purging increases heat, tongue dry without coating or black coating grows longer with clearing, or dry coating becomes drier with purging, and observing no Excess pathogens in Yangming, treat with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Zhimu (Anemarrhenae Rhizoma) and Haba (Phellodendri Cortex). This is what is meant by "cold does not cure cold, blame lack of water; strengthen the master of water to control sunlight." If still ineffective, combine with Shengmai San (Generate Pulse Powder) to nourish water source; or combine with Siwu Tang (Four-Substance Decoction) to benefit blood sea. With such raging heat, a cup of water cannot save; must prepare large decoctions, medicinal ingredients in taels, liquid in dou, to be effective. (Dai Linjiao)
Shanghan pathogens transmit from exterior to interior; Warm-Heat pathogens transmit from interior to exterior; Yi Li (Plague) pathogens emerge from Yangming central pathway according to exterior-interior excess-deficiency, not following meridian transmission sequence, thus cannot be exhausted in one outbreak. (*Zhangshi Yitong*)
Epidemic pathogens enter from mouth and nose, thus often carrying Yangming syndromes, because Hand Yangming belongs to Large Intestine, exterior-interior related to Lung, opening at nose; Foot Yangming belongs to Stomach, opening at mouth. Cases incurable are due to Lower Yuan deficiency. (Miu Zhongchun)
Shanghan enters from exterior to interior, so Shaoyang syndrome indicates worsening disease; Seasonal Epidemic emerges from center to exterior, so Shaoyang syndrome indicates improving disease. Both verified by deafness. ○ Disease ending at Shaoyang resolves with deafness healing; Disease ending at Yangming resolves with macules appearing; Disease ending at Taiyang resolves with spontaneous sweating, wild sweating, or battle sweating. (*Yican*)
Epidemic is essentially Shanghan, merely external pathogen disease, but contracting seasonal qi with similar age/duration is called Epidemic. Ancient saying: Epidemic develops from spring warmth qi,郁热 (stagnant heat) reaches exterior from interior, initially not cold damaging exterior; treatment differs from regular Shanghan. This theory seems reasonable but is actually incorrect. If Epidemic were not an exterior syndrome, why must it resolve through sweating? Thus I say: Initially receiving Cold pathogen, then triggering upon re-exposure, this is logical. Seasons have cold/heat, syndromes have yin/yang; attributing to syndrome/season is acceptable, denying cold damages exterior is unacceptable. ○ Ancient saying: Plague diseases are mostly in Three Yang, rarely in Three Yin. However, do not be rigid; if Yin syndrome/Yin pulse appears, it is Three Yin disease. Must differentiate and treat. ○ For treating Shanghan/Epidemic exterior syndromes, early infection requires rapid sweating, meaning sweating should not be delayed. However, method of sweating must observe deficiency/excess of Yuan Qi and Pathogen Qi: If exterior syndrome established but Yuan Qi not too depleted, acrid-neutral agents can disperse; if mixed syndromes, observe cold/heat/warm/cool, treat appropriately; if body very hot but pulse weak, sweating unlikely, must detail tonification methods and treat accordingly. If ignoring root/branch and forcibly dispersing, Ying depletion leads to death. ○ For treating Shanghan/Epidemic, emesis is suitable if Upper Jiao has stagnation, food/phlegm knotting chest-diaphragm preventing pathogen dispersion, or Cold pathogen/turbid qi sinking diaphragm causing痞 (fullness) or pain; emesis is indicated. Emesis contains dispersing intent. If Middle Qi deficient/cold, pulse weak/powerless, or short breath/virtual irritability/restlessness, emesis is contraindicated. Use emetic herbs, stop when hitting target, do not finish dose. ○ For treating Shanghan/Epidemic, clearing/draining is suitable: Fire excess needs clearing, Qi excess needs moving, Food stagnation needs digesting, Phlegm abundance needs resolving, all called clearing/draining. When stagnation goes, Qi moves, exterior pathogen resolves. This suits Excess pathogens, not Deficiency syndromes. For Deficiency with Excess, slight combination is acceptable, weighing pros/cons appropriately. ○ For treating Shanghan/Epidemic, purging is suitable only for Yangming Excess pathogens with constipation/abdominal fullness, or constitutionally strong Qi/Stomach Qi. If stool not passing for days but no fullness, or not eating for days but abdomen soft, Yangming Stomach fu lacks Excess pathogens, do not blindly purge to drain Middle Qi. Among errors, purging is most harmful, do not ignore. ○ For treating Shanghan/Epidemic, warming is suitable because Cold pathogen stagnates, Yang cannot overcome Yin, warming is needed to move and restore. Cold in meridians (exterior) needs warm dispersal; Cold in zang organs (Yang deficiency) needs warm tonification or warm middle. Using warming method, observe if exterior heat but interior no heat = false heat, warm not cool; disease hot but Yuan Qi deficient = false heat, warm not cool. True heat is obvious, false heat is hard to distinguish. Mostly Excess is true heat, Deficiency is false heat. Mistaking true/false harms people deeply. ○ Tonification method for Shanghan/Epidemic differs from attacking/dispersing. Attacking/dispersing removes Excess pathogens, force is strong, effect fast,见效 in 1-2 doses; if not effective, usage is poor. Tonification supplements deficiency, force is gentle, effect slow, observe tolerance or slight agreement for efficacy, mild cases 2-3 doses, severe 10+ doses to see result. Ignoring this, expecting quick effect in 1-2 doses, quacks arise, confusion ensues, total effort wasted. (Zhang Jingyue)
Ancients spoke of "Wen" (Warmth) not "Wen" (Plague), specifically the "Wen" spoken of is same as "Wen", thus "Wen" and "Wen" are one disease is clear. Later generations added [notes],