时疫发疹，热邪从皮毛出也，与汗同机，以疏散清热为主。然与他证发疹不同。他证或无里热，此则未有不里
热者，虽以疏散为要，而见烦渴、舌苔黄则硝、黄仍须兼用；他证发疹，疹散而病即愈，此则有屡发而病不衰者；
他病发疹不过一、二日为期，此则为期不定。治法必视里邪解否，为用药之准则，不可以疹之一证为据也。
时疫发斑，邪热出于经脉也，虽不及战汗，亦有外解
之机，治以凉血清热为主，白虎化斑汤、吴氏举斑汤、犀角地黄汤选用。此亦与他证发斑有异，他证发斑，斑消则
愈，此总不以斑之消否为轻重，而惟以里证为主。每每斑出而谵妄如故，或斑出数日已消而昏沉如故，必待里热全
清，二便清利而后愈。故治斑药味可为辅，不可为主。发斑、发疹，热皆在经而不在胃，凡遇烦躁而不渴，目赤而
舌白，即是将发斑疹之候，预以清凉、解表、透毒之药治之，使邪易出、易净。
以上时疫表证，皆关乎里，不似他证，表里两不相关。故前列各条，皆冠以时疫二字，以明非他病之见证，
不可以治他病之法治之，亦不可以此法治他病，总凭气、色、神、脉、舌苔辨之，百不失一。是五者，为辨时疫之
大纲，实亦辨时疫之细目也。
烦乃心烦，情思不定，神不安而形如故。躁则形扰，扬手掷足，形不宁而神复乱。烦轻而躁重也。在他证有谓
烦属心，躁属肾者；烦属阳，躁属阴者。在时疫总属郁热。热浅在上，则见烦躁之形；热深在下，则渐近昏沉而
不烦躁。是时疫初起，可即烦躁之轻重，辨病势传变之轻重，不烦躁则非时疫，设气、色、神、脉、
舌苔有时疫确据，亦属但表不里之轻证。
凡初起憎寒发热而烦躁者，邪在半表半里，三消饮、九味羌活汤、六神通解散选用。隆冬寒甚，汗难出者，大
青龙汤、葳蕤汤可借用。舌苔已黄，渴而喜饮，身热汗出而烦躁者，邪入于胃也，白虎、黄芩、三承气、小陷胸、
三黄泻心、凉膈散选用。舌苔已黑，烦躁渐近昏沉者，邪入心包也，犀角地黄汤加羚羊角、黄连解毒汤选用。屡经
汗、下、清凉，表里俱无阻滞而烦躁者，阴液伤也，生脉散、六味地黄汤、吴氏诸养荣汤选用。或用汗解、清利、
滋润诸法不应而烦躁加甚者，当细验舌苔。若黄黑苔中夹一块白润，是为夹水。或平素胸有痰饮；或未病之先，曾
饮冷物；或初烦躁时，过饮冷水，恣啖凉物；或用清凉太
早，皆能停饮于胸膈，胃脘之间。寒饮拂郁其疫热，外不能达表，内不能传胃，故烦躁转甚。验舌之后，更细按胸
胁，满痛而软，漉漉有声，再细察其脉，右寸关或弦紧，或缓，皆停水确据。当以苍术、半夏、莱菔、浓朴先消其
水气，然后治其烦躁，无不应者。不论舌苔有无黄黑，但烦躁而兼小便不利者，虽无水气在胸胁，而少腹略有满痛
处，即当以导赤散、泻心汤、四苓汤、猪苓汤、益元散利其小便，所谓心邪不从心泻，而从小肠泻也。
时疫出现发疹，是热邪从皮毛外泄的表现，其机理与出汗相同，治疗以疏散风邪、清解热毒为主。但这与其他病症引起的发疹不同。其他病症发疹可能没有里热，而时疫发疹则必然伴有里热；虽然疏散表邪是关键，但如果见到烦渴、舌苔发黄等症状，仍须兼用大黄、芒硝等攻下药物；其他病症发疹，疹子消退后疾病即愈，而时疫发疹则往往多次发作而病势不减；其他疾病发疹通常在一两天内结束，而时疫发疹的持续时间不确定。治疗方法必须视里邪是否解除作为用药准则，不能仅凭发疹这一症状来判定。
时疫出现发斑，是邪热出于经脉所致，虽然不如战汗那样剧烈，但也有向外透解的机理，治疗以凉血清热为主，可选用白虎化斑汤、吴氏举斑汤、犀角地黄汤。这也与其他病症的发斑不同，其他病症发斑，斑点消退即痊愈，而时疫发斑并不以斑点是否消退来判断病情轻重，而是以里证为主要依据。常常出现斑点发出后谵语妄言如旧，或者斑点发出数日后已消退但神志昏沉如旧的情况，必须等到里热完全清除，大小便通畅清利之后才能痊愈。因此，治疗发斑的药物只能作为辅助，不能作为主导。发斑和发疹，热邪都在经络而不在胃腑，凡是遇到烦躁但不口渴，眼睛发红而舌苔发白的情况，就是即将发斑或发疹的先兆，预先使用清凉、解表、透毒的药物进行治疗，使邪气容易透出、容易排净。
以上所述的时疫表证，都与里证相关，不像其他病症那样表里互不关联。所以前面列出的各条内容，都冠以“时疫”二字，以明确这不是其他疾病的见证，不能用治疗其他疾病的方法来治疗它，也不能用治疗时疫的方法来治疗其他疾病，总要靠气色、神色、脉象、舌苔来辨别，这样百无一失。这五项（气、色、神、脉、舌苔），既是辨别时疫的大纲，实际上也是辨别时疫的细目。
“烦”是指心烦，情绪不定，神志不安但形体动作如常。“躁”是指形体扰动，扬手掷足，形体不宁且神志混乱。烦轻而躁重。在其他病症中，有说烦属于心，躁属于肾；或者说烦属阳，躁属阴。但在时疫中，总归属于郁热。热邪浅在上方，则表现为烦躁的形态；热邪深伏下方，则逐渐接近昏沉而不表现为烦躁。因此在时疫初起时，可以根据烦躁的轻重，来辨别病势传变的轻重。如果不烦躁，则不是时疫；即使气、色、神、脉、舌苔有时疫的确切证据，也属于只有表证没有里证的轻证。
凡是在初起时憎寒发热并伴有烦躁的，说明邪气在半表半里之间，可选用三消饮、九味羌活汤、六神通解散。隆冬时节寒气很重，汗难以排出的，可借用大青龙汤、葳蕤汤。如果舌苔已经发黄，口渴喜欢饮水，身体发热出汗并伴有烦躁的，说明邪气已进入胃腑，可选用白虎汤、黄芩、三承气汤、小陷胸汤、三黄泻心汤、凉膈散。如果舌苔已经变黑，烦躁逐渐接近昏沉的，说明邪气已进入心包，可选用犀角地黄汤加羚羊角、黄连解毒汤。经过多次发汗、攻下、清凉治疗后，表里都没有阻滞但依然烦躁的，是阴液受损所致，可选用生脉散、六味地黄汤、吴氏诸养荣汤。如果使用发汗解表、清利湿热、滋润等方法无效，反而烦躁加重的，应当仔细查验舌苔。如果在黄黑苔中间夹杂一块白润的区域，这是夹有水饮。或者平素胸中有痰饮；或者在未生病之前，曾饮用冷物；或者在刚开始烦躁时，过量饮用冷水，恣意吃凉的食物；或者过早使用清凉药物，都能导致水饮停滞于胸膈、胃脘之间。寒饮拂郁了疫热，使得邪气外不能达表，内不能传入胃腑，所以烦躁反而加重。查验舌苔之后，再仔细按压胸胁部，如果感到胀满疼痛且按之柔软，听到漉漉的水声，再仔细察脉，右寸关脉或弦紧，或缓，都是停水的确切证据。应当先用苍术、半夏、莱菔、浓朴消除水气，然后再治疗烦躁，没有不应验的。不论舌苔是否有黄黑色，只要烦躁并且兼有小便不利的，即使胸胁没有水气，但少腹部略有胀满疼痛之处，就应当用导赤散、泻心汤、四苓汤、猪苓汤、益元散来通利小便，这就是所谓心经邪气不从心脏泻出，而从小肠泻出的道理。
When epidemic febrile disease presents with macules (rash), it indicates that heat pathogenic factors are exiting through the skin and hair follicles. Its mechanism is similar to sweating, so treatment focuses on dispersing wind and clearing heat. However, this differs from rashes caused by other conditions. In other conditions, there may be no interior heat, but in epidemic febrile disease, interior heat is invariably present. Although dispersing the exterior is key, if symptoms such as irritability, thirst, and a yellow tongue coating appear, purgatives like Rhubarb (Da Huang) and Mirabilite (Mang Xiao) must still be used concurrently. In other conditions, the illness resolves once the rash subsides; in epidemic febrile disease, the condition often persists despite repeated eruptions. Other diseases typically resolve within one or two days, whereas the duration of eruption in epidemic febrile disease is indefinite. Treatment principles must be determined by whether the interior pathogen has been resolved, not merely by the presence of a rash.
When epidemic febrile disease presents with petechiae (spots), it indicates that heat pathogenic factors have entered the meridians. Although less severe than battle-sweat (Zhan Han), there is still a mechanism for external resolution. Treatment focuses on cooling blood and clearing heat, selecting from Baihu Huaban Decoction (White Tiger Decoction Modified to Transform Spots), Wu's Ju Ban Decoction (Dr. Wu's Decoction to Raise Spots), or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). This also differs from petechiae in other conditions: in other conditions, recovery follows the disappearance of spots; in epidemic febrile disease, severity is judged primarily by interior syndromes, not by the presence or absence of spots. It is common for delirium to persist after spots appear, or for lethargy to continue even after spots fade over several days. Recovery occurs only when interior heat is completely cleared and urination and defecation become smooth and clear. Therefore, medications for treating petechiae serve as auxiliaries, not primary agents. Both petechiae and macules indicate heat in the meridians rather than the Stomach. Whenever irritability without thirst, red eyes, and a white tongue coating occur, these are precursors to impending petechiae or macules. Preemptive treatment with cooling, exterior-dispersing, and toxin-transmitting herbs facilitates the easy exit and clearance of pathogens.
The aforementioned exterior syndromes of epidemic febrile disease are all related to interior conditions, unlike other diseases where exterior and interior are unrelated. Thus, each preceding item is prefixed with "epidemic febrile disease" to clarify that these are not signs of other illnesses, cannot be treated with methods for other diseases, nor can epidemic treatments be applied to other diseases. Diagnosis relies entirely on assessing Qi (vital energy), complexion, Spirit (Shen), pulse, and tongue coating, ensuring high accuracy. These five aspects constitute both the general outline and the detailed criteria for diagnosing epidemic febrile disease.
"Irritability" (Fan) refers to mental restlessness, emotional instability, and spiritual unease, while physical movements remain normal. "Restlessness" (Zao) refers to physical agitation, such as flailing arms and kicking legs, with physical unrest accompanied by chaotic spirit. Irritability is mild, whereas restlessness is severe. In other conditions, irritability is attributed to the Heart and Yang, while restlessness is attributed to the Kidney and Yin. However, in epidemic febrile disease, both stem from stagnant heat. If heat is shallow and upper, irritability manifests; if heat is deep and lower, the patient gradually becomes lethargic without irritability. Thus, at the onset of epidemic febrile disease, the severity of transmission can be judged by the degree of irritability. Absence of irritability suggests it is not epidemic febrile disease; even if Qi, complexion, Spirit, pulse, and tongue coating provide strong evidence of epidemic febrile disease, it indicates a mild syndrome confined to the exterior without interior involvement.
When chills, fever, and irritability occur at the onset, the pathogen is in the half-exterior, half-interior stage. Options include Sanxiao Yin (Three Eliminations Drink), Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), or Liushentongjie San (Six-Awakening Exterior-Resolving Powder). In deep winter with severe cold and difficulty sweating, Da Qinglong Tang (Great Blue Dragon Decoction) or Weirui Tang (Asparagus Decoction) may be borrowed. If the tongue coating turns yellow, thirst with desire to drink, body heat, sweating, and irritability occur, the pathogen has entered the Stomach. Options include Baihu Tang (White Tiger Decoction), Huangqin (Scutellaria Root), San Chengqi Tang (Three Receipts of Qi Decoctions), Xiao Xianxiong Tang (Small Chest-Piercing Decoction), Sanhuang Xiexin Tang (Three-Yellow Heart-Draining Decoction), or Liangge San (Cool Diaphragm Powder). If the tongue coating turns black and irritability progresses toward lethargy, the pathogen has entered the Pericardium. Options include Xijiao Dihuang Tang added with Antelope Horn (Lingyang Jiao) or Huanglian Jiedu Tang (Coptis Detoxification Decoction). After repeated diaphoresis, purgation, and cooling treatments, if there is no exterior-interior obstruction but irritability persists, it indicates damage to Yin fluids. Options include Shengmai San (Generate Pulse Powder), Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill), or Wu's various Yingnong Decoctions (Nourishing Blood Decoctions). If diaphoresis, clearing/drainage, and moistening methods fail and irritability worsens, carefully examine the tongue. A patch of white moisture amidst yellow or black coating indicates retained water. Alternatively, phlegm-fluid retention in the chest may exist chronically, or cold drinks/foods were consumed before illness, or excessive cold water/food was ingested during initial irritability, or cooling herbs were used too early. All these cause fluid retention in the chest-diaphragm and epigastrium. Cold fluids obstructing stagnant heat prevent external release and internal transmission to the Stomach, worsening irritability. After examining the tongue, palpate the chest and hypochondrium. Fullness, pain upon pressure, softness, and gurgling sounds (lulu sheng), combined with a wiry-tight or slow pulse at the right Cun and Guan positions, confirm water retention. First eliminate water using Cangzhu (Atractylodes Rhizome), Banxia (Pinellia Tuber), Laifu (Radish Seed), and Houpo (Magnolia Bark), then treat irritability, which will invariably succeed. Regardless of yellow/black coating, if irritability accompanies difficult urination, even without chest-hypochondriac water retention, slight fullness/pain in the lower abdomen indicates the need to promote urination using Daochi San (Guide Out Red Powder), Xiexin Tang (Heart-Draining Decoction), Siling Tang (Four-Ling Decoction), Zhuling Tang (Polyporus Decoction), or Yiyuan San (Benefit Origin Powder). This embodies the principle that Heart pathogenic factors drain via the Small Intestine rather than the Heart itself.