瘟疫六七日不解，以致热入血室，发黄，身如烟熏，目如金色，口燥热结，以
砭针刺曲池，出恶血，仍以通圣散，兼散兼下，得汗如黄水，粪如黑膏即愈。此即北方之所谓打
寒也。其法用手捋两膊，使血聚于臂，以帛缚定，乃用箸夹瓷锋，击刺肘中曲泽旁之大络，使邪毒
随恶血而出，亦最捷之法，穷人用之极效，然非曲池穴也。
松峰曰∶瘟症传里者，热毒深重，其症谵语发狂，循衣摸床，撮空理线，目赤如火，如醉如痴，
或登高而歌，弃衣而走，齐俗谓之猴儿病。用小枣蘸烧酒遍身刮痧，痧出，其色紫赤，其高起者，
状如枣栗，遂用针出恶血，往往取效，此亦一刺法也。
治瘟疫大抵不宜发汗。经曰∶不恶寒而反渴者，温病也。明其热自内达外也。疫有伤气、伤血、
伤胃之殊，故见证不同，治亦稍异。若入脏者，则不知人而死矣。大法以症为则，毋专以脉为据也。
松峰曰∶入脏不知人，亦不必即死。不过较在经者难施治耳，此兼三疫而言。
人在气交之中，如鱼在水，一毫渣滓混杂不得，设川泽泼灰，池溏入油，鱼鲜有得生者，人
受疫气，何以异此。
疫者，民皆病也。疠鬼为灾，斯名疫耳。
松峰曰∶疫如徭役之役，沿门阖户皆病之谓。齐俗谓小儿生痘为当差，亦即徭役之义。
天地以生物为心，寒热温凉，四气递运，万古不易，人生其间，触之而病者，皆因起居无时，
饮食不节，气虚体弱，自行犯之，非寒暑之过。若以寒暑为杀厉之气，触之即病，则人无 类久矣，
岂天地生物之心哉。至于非其时而有其气，谓之不正之气则可，谓之疫气则非也。何者？不正之
气，人感之者，有病有不病，未可一概论也。若夫疫气，则不论贵贱贫富，老幼男女，强弱虚实，
沿门阖境，传染相同，人无得免者。此唯兵荒饥馑之年有之。
瘟病之治，宜从凉散固也。然必表里俱有热症方可用，若表邪未解，虽外热如火而内无热症
可据者，不得概用凉药。
松峰曰∶误投热药犹或可解，若误投凉药，杀人等于操刃。语曰∶姜桂投之不瘥，芩连用之必
当。其不曰芩连投之不瘥，姜桂用之必当者，明乎伤寒妄投凉药则不可救矣。瘟疫虽属邪热，其有
不宜用凉药之时，投剂仍当审慎。
冬有非时之暖，或君相客热之令而病热者，名曰冬温，与冬月正伤寒大异。法宜凉解，此舍时
从症也。若夏有寒者，其宜温亦然。
松峰曰∶冬温之说，吴又可曾非之，然谓冬时绝无温热则又不然，故宜舍时从症。
寒疫乃天时之暴寒，较冬时之严寒，又有轻重之异。时气自是天行疫疠之气，又非寒比也。瘟病
多山泽蒸气。
松峰曰∶冬时亦有热疫，余子秉锦，于深冬时，忽患四肢走注疼痛，余以治周痹之法治之不应，
遂自用银花、草节、羌、防、荆芥、薄荷、桑枝，
黄芩、栀子、生地，凉散败毒之品加减出入，服三四十帖始愈。后闻其时患此症者甚多，
始知此亦疫症也。
时气者，乃天行暴疠之气，不因寒而得，治法当辟散疫气，扶正气为主，若多日不解，邪热
传变杂症，宜从伤寒变症条内采择用之。
经曰∶冬不藏精者，春必病瘟。十月属亥，十一月属子，火气潜伏，当养其真，而为来春发生
之本，此时若恣意戕贼，至春阳气轻浮，必有瘟疫，此两个月为一年之虚。若上弦前、下弦后，
月廓月空为一月之虚。风霾霆电，大寒热，日月蚀，愁怒惊悲，醉饱劳倦，为一日之虚，当此时，
可不养天和远房室哉！
温热病因外感内伤，触动郁火，自内而发之于外，初则表里俱热，宜用凉散之剂，两除表里之
热，久则表热微而里热甚，又宜承气苦寒之剂以泻之，则热退身凉而病自已。（倘认作即病伤寒之
症，用麻黄辛温之剂以发表，则内热愈甚而斑黄、狂乱之症
起矣。或未用辛凉之剂以解表，便用承气苦寒之剂以攻里，则表热未去而结胸虚痞之症见矣。）
松峰曰∶瘟疫不可认作即病之伤寒，便用麻黄固已，余曾经瘟症盛行之时，众人所病略同，
大概宜用凉散攻下之剂。中有一人得病，询其症，不过身热、身痛、头痛、拘急等症，诊其脉却迟
而紧，竟与冬月正伤寒无异。因投麻黄发表之剂，乃得汗解。始悟治病最宜变通，不可拘执，
瘟疫固尔，杂病亦然。
凡伤寒瘟疫其不可治及难治者，必属下元虚症。（松峰按∶间亦有之，亦不必然。）如家中传
染者，缘家有病患，旦夕忧患，饮食少进则气馁，感其病气，从口鼻入，故宜清阳明，舒郁结，兼
理劳伤为要。（松峰按∶此句不可泥。兼字宜重读。）
松峰云∶余家曾有患瘟症者十余人，互相传染。余日与病患伍，饮食少进，旦夕忧患所不待言，
而竟免传染。偶一日，一入疫家，实时而病，求其故不得，因忆伊芳时举家患病，余忙乱终日，夜来
独居一室，闭门焚降真香一块，想以此得力耶。
瘟疫不可先定方，瘟疫之来无方也。
伤寒瘟疫三阳症中，往往多带阳明者。手阳明经属大肠，与肺为表里，同开窍
于鼻。足阳明经属胃，与脾为表里，同开窍于口。凡邪气之入，必从口鼻，故兼阳明症者独多。邪
在三阳，法宜速逐，迟则胃烂发斑。或传入里，则属三阴，邪热炽者，令阴水枯竭，于法不治，
此治之后时之过也。
阴阳失位，寒暑错时，故生疫。
瘟疫之来，多因人事之相召，而天时之气运适相感也。故气机相侵，而地气又复相应，合天地
人之毒瓦斯而瘟疫成焉。
治温热疫疠不可用辛热药，宜清凉辛甘苦寒。
仲景书，王叔和得散亡之余，诠次间有穿凿，成氏因注释，致将冬时伤寒之方，通解温暑，遗
祸至今。温暑别自有方，今失无征，宋龙门所以叹《伤寒》无全书也。
夫病瘟而强之食，病 而饮之寒，此众人之所以为养也，而良医之所以为病也。
时疫感之，必先入胃，故多用阳明胃药。
湿热时毒感于口鼻，传入阳明，邪正交争。阴胜则憎寒，阳胜则壮热，流入百节则一身尽痛，上行
头面则为肿大，名大头瘟。
暑湿热三气门中，推人参败毒散方为第一。三气合邪，岂易当哉，其气互传则
为疫矣。方中所用皆辛平，更有人参大力者，荷正以祛邪。病者日服二三剂，使疫邪不复留，讵
不快哉。奈何俗医减去人参，曾与他方有别耶？
疫，疠也。病气流行，中人如磨砺伤物也。疫，役也。有鬼行役，役不住也。
凡治瘟疫，须先观病患两目，次看口舌，以后以两手按其心胸至小腹有无痛处，再问其大小
便通否，渴与不渴，服过何药，或久或新，并察其脉之端的，脉症相同方可以言吉凶，庶用药无
差。此数者最为紧要，医家之心法。
治暑月温病、热病、疫疠病，不可用辛温热药，宜辛凉、清甘、苦寒，升麻、柴胡、葛根、薄
荷、石膏、芩、连、栀、柏、甘草、芍药之类。
疠疫、痘疹、发斑、热毒等症，但卧阴土湿地，则解凉拔毒，能减其半。土之妙用如此，智者
类而推之。
疫病当分天时寒暑燥湿，因时制宜。如久旱而热疫，忌用燥剂；久雨而寒疫，脾土受湿，忌用
润药。
疫邪自外而入，唯虚人感之必深，如用祛邪药汗下，必先顾元气，则温散、温补、反治、从
治诸法，何可不知。
每见治温热病，误攻其里尚无大害，误发其表变不可言，此足明其热自内达外矣。
卫逊亭曰∶此足见瘟病断无发散之理，至云攻里尚无大害，当重看大字。
天地疫疠之气，俗人谓之横病，多不解治，皆曰日满则瘥，致夭枉者多矣。凡觉病即治，折
其毒瓦斯自瘥，切莫令其病气自在，恣意攻人，拱手待毙。
世人误认瘟疫为伤寒，云伤寒是雅士之词，天行瘟疫是田舍间俗语，误亦甚矣。
疫气邪正混合，倘邪胜正衰则危。药之苦寒者伤胃，温补者助邪。如人中黄之类，最为合法。
瘟疫乃天地之邪气，人身正气固，则邪不能干，故避之在节欲节劳，仍毋忍饥以受其气。至于
却邪之法，如经所云∶天牝从来，复得其往，气出于脑，即不干邪是也。盖天牝者，鼻也。鼻受天
之气，故曰天牝。瘟邪之气，自空虚而来，亦欲其由空虚而去，即下句气出于脑之谓也。盖邪气
自鼻通于脑，则流布诸经，令人病瘟。气出于脑谓嚏之，或张鼻以泄之，或受气于室，速泄于外，而大吸清气以易之，
则邪从鼻出，而毒瓦斯自散，此却邪于外之法也。又想心如日等法。（见前。）盖胆属少阳，中正之官，
其气壮，则脏气赖以俱壮，而邪不能入，此强中御邪之法也。凡探病诊疾，知此诸法，虽入秽地，
可保无虞。男病邪气出于口，女病邪气出于前阴，其相对坐立之间，必须知其向背，行动从容，察
位而入方妙。
治瘟疫须分上、中、下三焦。盖人之鼻气通于天，故中雾露之邪为清邪。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。口气通于地，故中水土之邪
者，为饮食浊味，从口舌而下入于阴，入则必先内栗，足膝逆冷，便溺妄出，清便下重，（疑即后重。）
脐筑（向外挣筑。）湫痛，正如俗称绞肠瘟、软脚瘟之说符也。然口鼻所入之邪，必先注中焦，以次
分布上下，不治则胃中为浊，营卫阻而血凝，其酿变即现中焦，俗称瓜瓤瘟。疙瘩瘟等症，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，脏气熏蒸，
上焦怫郁，则口烂食龈矣。若卫气前通者，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。然此幸而营卫渐通，故非危侯。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。治法于未病前，
预饮芳香正气药则邪不能入，倘邪入，则以逐邪为要。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，勿使潜滋，方为
尽善。
瘟邪直行中道，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，必从此分区，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，（上焦之症。）亦复下血如豚肝，（下焦之症。是上下焦症齐见矣。）非定中上不及
下，中下不及上也。
臧卢溪曰∶二节当参看。
夫寒中所以清火，亦能解表，盖阳亢阴衰则火盛水亏，水涸于经，安得作汗？譬之干锅赤裂，
润自何来。但加以水，则郁蒸沛然，而热气上腾矣。汗自水生，亦复如是。用凉药以救水，水生而
汗有不出者乎。
补中亦能散表。夫气虚于内，安能达表，非补其气，肌能解乎，凡脉之微弱无力或两寸短小者，
即其症也。血虚于里，焉能化液，非补其精，汗能生乎，凡脉之浮芤不实或两尺无根者，即其症
也。然补则补矣，更当斟酌尽善，用得其宜，妄补住邪，则大害矣。
瘟疫来路两条，去路三条，治法五条，尽矣。何为来路两条？有在天者，如春应暖而反寒云云。
此非其时而有其气，人受之，从经络入则为头痛发热，咳嗽发颐大头之类。其在人有互相传染者，
其邪则从口鼻入，憎寒壮热，胸膈满闷，口吐黄涎之类，所谓来路两条者此也。何如去路三条？在
天之疫，从经络而入者，宜分寒热，用辛温辛凉之药以散邪，如香苏散，普济消毒饮之类，俾其仍
从经络而出也。在人之疫，从口鼻而入者，宜芳香之药以解秽，如神术正气等散之类，俾其仍从口鼻
而出也。至于经络口鼻所受之邪，传入脏腑渐至潮热谵语，腹满胀痛，是毒瓦斯归内，疏通肠
胃，始解其毒，法当下之，其大便行者则清之，下后而余热不尽者亦清之，所谓去路三条者此也。
何为治法五条？曰发散，曰解秽，曰清中，曰攻下，曰酌补，所谓治法五条者此也。
松峰曰∶此段亦颇为近理，故录之。唯于补法中而改一酌字，以瘟疫用补法，必如吴又可所
谓四损不可正治者方议补。倘不应补，而冒然用之，补住其邪，其害不可胜言矣。
又曰∶余凡阅书并有所见闻，关于疫症者，率皆采录，久而成帙，然其出处，当时亦或不载，
故除引经论外，皆不着其书名姓字，以免 漏之诮，且只图有俾医学，非欲博古也。以上记精言，
以下载故实。
桐乡医生赵某，偶赴病家，请归已暝，又将雨，中途见矮屋，有灯明灭，时已下雨，遂叩门求
宿。内有妇人应曰∶男子不在，不便相留。医恳栖檐下，许之。将更余，妇开门延入，医谢不敢，
妇引之甚力，且求合，医视其灯青黯，且手冷如冰，知遇鬼，亟欲奔避，妇双手挽其颈，以口就医
之口，既而大哕曰∶此人食烧酒生蒜，
臭秽何可近也。遂入。医复冒雨而走，抵家十余日后，经矮屋，则一孤 也。
松峰曰∶足见烧酒大蒜于疫疠盛行所不可阙。
陈宜中梦神人语曰∶天灾流行，人多死于疫疠，唯服大黄得生，因遍以示人时果疫，因服大
黄得生者甚众。
瘟疫病程经过六七天仍未解除，导致热邪深入血室，出现黄疸，身体颜色像烟熏一样黑黄，眼睛呈现金黄色，口干舌燥，体内有热结。此时用砭石针刺曲池穴，放出恶血，同时服用通圣散，既发散表邪又攻下里实，患者出汗如黄水般黏稠，大便排出如黑膏状，病即痊愈。这就是北方所说的“打寒”。这种方法是用双手捋搓两臂，使血液聚集在手臂上，用布带绑紧，然后用筷子夹住瓷片锋利的边缘，击刺肘部曲泽穴旁的大络脉，使邪毒随着恶血排出，这也是非常快捷的方法，贫穷人家使用效果极佳，但这里指的并不是曲池穴。
刘松峰说：瘟疫传入体内的，热毒深重，症状表现为胡言乱语、发狂，手不自觉地抓摸衣被和床沿，手指在空中虚抓或整理线条，眼睛红得像火，像喝醉了一样痴呆，或者登上高处唱歌，脱掉衣服奔跑，当地俗称为“猴儿病”。用小枣蘸烧酒遍身刮痧，痧出后颜色紫赤，高起的部分形状像枣子或栗子，然后用针放出恶血，往往能取得疗效，这也是一种刺法。
治疗瘟疫大抵不宜使用发汗法。《内经》说：“不恶寒反而口渴的，是温病。”这说明热邪是从内部达于外部的。瘟疫有伤气、伤血、伤胃的不同，所以见证不同，治疗方法也稍有差异。如果邪气进入脏腑，人就会昏迷不醒而死。治疗的大法是依据症状为准，不要专门以脉象为依据。
刘松峰说：邪气入脏导致昏迷不醒，也不一定立即死亡。只是比邪气在经络时更难治疗罢了，这是兼论三种疫病而言。
人生活在天地气交之中，就像鱼生活在水中一样，容不得丝毫杂质混杂。假如往河流湖泊中泼洒石灰，往池塘里倒入油污，鱼很少有能活下来的，人感染了疫气，有什么不同呢？
所谓“疫”，就是百姓都生病。“疠鬼”作祟造成灾害，这才叫“疫”。
刘松峰说：“疫”就像徭役一样，指挨家挨户都生病的意思。山东风俗称小儿出痘为“当差”，也就是徭役的含义。
天地的本心是化生万物，寒、热、温、凉四气交替运行，万古不变。人生在其中，因接触而生病，都是因为起居没有定时，饮食不加节制，导致气虚体弱，自己触犯所致，并非寒暑之过。如果把寒暑当作杀人的厉气，一接触就生病，那么人类早就灭绝了，这难道是天地化生万物的心意吗？至于不合时令而出现的气候，称之为“不正之气”是可以的，称之为“疫气”就不对了。为什么呢？不正之气，人感受到的，有的有病，有的没病，不能一概而论。至于疫气，则不论贵贱贫富、老幼男女、强弱虚实，沿门阖境，传染相同，没有人能免除。这种情况只有在兵荒马乱、饥荒之年才有。
瘟病的治疗，适宜采用清凉发散的方法。但是必须表里都有热症才可以应用，如果表邪未解，虽然外表发热如火，但内部没有热症可依据的，不得一概使用凉药。
刘松峰说：误投热药或许还可以解救，如果误投凉药，杀人如同用刀砍一样快。俗话说：“姜、桂（温热药）投用无效，黄芩、黄连（寒凉药）使用恰当。”为什么不说是“黄芩、黄连投用无效，姜、桂使用恰当”呢？这是因为明明白白地知道，伤寒妄投凉药则是不可救药的。瘟疫虽然属于邪热，但也有不适合用凉药的时候，用药仍然应当审慎。
冬天出现非时令的温暖，或者是君火、相火客热的时令而导致生病的，名叫“冬温”，与冬天的正伤寒大不相同。治法适宜清凉解表，这是舍弃时令而从症状论治。如果夏天出现寒冷，其适宜温补也是一样的道理。
刘松峰说：关于“冬温”的说法，吴又可曾加以非议，然而如果说冬天绝对没有温热之病，那又不正确，所以适宜舍弃时令而从症状论治。
寒疫是天时突然产生的严寒，比起冬天的严寒，又有轻重的区别。时气自然是天行疫疠之气，又不是寒疫可以比拟的。瘟病多由山泽间的蒸气引起。
刘松峰说：冬天也有热疫，我的族人子秉锦，在深冬时节，忽然患四肢游走性疼痛，我用治疗周痹的方法治疗无效，于是他自己服用金银花、竹节（草节）、羌活、防风、荆芥、薄荷、桑枝、黄芩、栀子、生地等清凉发散败毒的药物加减出入，服了三四十帖才痊愈。后来听说当时患这种病症的人很多，才知道这也是疫病。
时气，是天行暴戾的疠气，不因寒冷而得病，治法应当以辟散疫气、扶助正气为主，如果多日不解，邪热传变夹杂其他病症，适宜从伤寒变症的条文中采择使用。
《内经》说：“冬天不藏精气的，春天必定患瘟病。”十月属亥，十一月属子，火气潜伏，应当保养真气，作为来年春天生发的根本，这个时候如果肆意伤害身体，到了春天阳气轻浮，必然会有瘟疫，这两个月是一年中的虚弱时期。如果在农历每月上旬之前、下旬之后，月亮亏缺的时候，是一个月的虚弱期。风霾雷霆闪电、大寒大热、日月食、忧愁愤怒惊恐悲伤、醉酒饱食劳累疲倦，是一天的虚弱期，在这个时候，能不保养天和、远离房事吗！
温热病因外感内伤，触动郁积之火，从内部发之于外部，初起则表里俱热，适宜使用清凉散表的药剂，同时清除表里之热；日久则表热轻微而里热严重，又适宜使用承气汤等苦寒药剂来泻下，这样热退身凉，病自然痊愈。（倘若误认为是即病伤寒的症状，使用麻黄等辛温药剂发表，则内热更甚，出现发斑、发黄、狂乱等症状；或者未使用辛凉药剂解表，便使用承气汤等苦寒药剂攻里，则表热未去而结胸、虚痞等症状出现。）
刘松峰说：瘟疫不可误认为即病伤寒，从而使用麻黄，这已经是常识了。我曾经经历瘟疫盛行之时，众人所患大致相同，大概适宜使用清凉发散和攻下的药剂。其中有一人得病，询问他的症状，不过是身热、身痛、头痛、拘急等症状，诊其脉却迟而紧，竟然与冬天的正伤寒无异。因此我投用麻黄发表的药剂，结果出汗而解。这才领悟到治病最宜变通，不可拘泥固执，瘟疫如此，杂病也是如此。
凡是伤寒瘟疫中不可治及难治的，一定属于下元虚症。（刘松峰按：间或有这种情况，但也并非必然。）如家中互相传染的，是因为家里有病患，早晚忧患，饮食减少，导致气馁，感染病气，从口鼻而入，所以适宜清阳明经，舒展郁结，兼理劳伤为关键。（刘松峰按：这句话不可死板理解。“兼”字应重读。）
刘松峰说：我家曾经有十多人患瘟疫，互相传染。我每天与病患相处，饮食减少，早晚忧患不必多说，竟然免除了传染。偶然有一天，我进入一家疫区，当时就生病了，寻找原因不得，于是想起那时他全家患病，我忙乱终日，夜里独居一室，闭门焚烧一块降真香，想是以此得力吧。
瘟疫不可预先定好方子，瘟疫的到来是没有固定模式的。
伤寒瘟疫在三阳症中，往往多兼带阳明症。手阳明经属大肠，与肺互为表里，同开窍于鼻。足阳明经属胃，与脾互为表里，同开窍于口。凡邪气入侵，必从口鼻而入，所以兼阳明症的特别多。邪气在三阳，治法适宜迅速驱逐，迟缓则会导致胃烂发斑。或者传入体内，则属于三阴，邪热炽盛的，会导致阴水枯竭，按治法已无法救治，这是治疗太晚造成的过错。
阴阳失位，寒暑错时，所以产生疫病。
瘟疫的到来，多因人事相互招致，而天时的气运恰好相应。所以气机相互侵扰，地气又复相应，合天地人之毒瓦斯而成瘟疫。
治疗温热疫疠不可使用辛热药，适宜使用清凉、辛甘、苦寒的药。
张仲景的书，王叔和得到散亡之余，编次之间有些穿凿附会，成无己因为注释，导致将冬天伤寒的方子，通用于温暑，遗祸至今。温暑自有其方，如今已失传无据，宋代的龙门氏所以感叹《伤寒论》不是全书。
患瘟病强行喂食，患病时饮用寒凉之物，这是普通人所谓的养生，却是良医眼中的致病因素。
时疫感染，必先入胃，所以多用阳明胃药。
湿热时毒从口鼻侵入，传入阳明，邪正交争。阴胜则憎寒，阳胜则壮热，流入百节则一身尽痛，上行头面则为肿大，名叫大头瘟。
在暑、湿、热三门中，推举人参败毒散方为第一。三气合邪，岂容易抵挡哉，其气互传则为疫。方中所用皆辛平，更有人参大力者，扶持正气以祛除邪气。病人每日服用二三剂，使疫邪不再停留，难道不快哉。奈何庸医减去人参，这与其它方子有什么区别呢？
疫，就是疠。病气流行，中人如同磨砺损伤物体。疫，就是役。有鬼行役，役不停止。
凡是治疗瘟疫，须先观察病患的两目，其次看口舌，然后以两手按其心胸至小腹有无痛处，再问其大小便通否，渴与不渴，服过何药，或久或新，并察其脉的确切情况，脉症相同才可以谈论吉凶，这样用药才无差错。这几项最为紧要，是医家的心法。
治疗暑月温病、热病、疫疠病，不可用辛温热药，宜用辛凉、清甘、苦寒药，如升麻、柴胡、葛根、薄荷、石膏、黄芩、黄连、栀子、黄柏、甘草、芍药之类。
疠疫、痘疹、发斑、热毒等症，只要躺在阴土湿地，就能解凉拔毒，能减轻一半痛苦。土的妙用如此，智者类推即可。
疫病应当分天时寒暑燥湿，因时制宜。如久旱而热疫，忌用燥剂；久雨而寒疫，脾土受湿，忌用润药。
疫邪自外而入，只有虚人感之必深，如用祛邪药汗下，必须先顾护元气，那么温散、温补、反治、从治诸法，怎么可以不知道。
常见治疗温热病，误攻其里尚无大害，误发其表变不可言，这足以证明热邪是从内部达于外部的。
卫逊亭说：这足以说明瘟病断无发散的道理，至于说攻里尚无大害，应当重看“尚”字。
天地疫疠之气，俗人谓之横病，大多不解治，都说日子满了就会好转，导致夭折枉死者很多。凡觉得生病就治疗，折损其毒瓦斯自然痊愈，切莫让病气自在，肆意攻人，拱手待毙。
世人误认瘟疫为伤寒，说伤寒是雅士之词，天行瘟疫是田舍间俗语，错误也很严重了。
疫气邪正混合，倘若邪胜正衰则危。药之苦寒者伤胃，温补者助邪。如人中黄之类，最为合法。
瘟疫乃天地之邪气，人身正气固，则邪不能干，所以避之在于节欲节劳，仍不要忍饥以受其气。至于驱邪之法，如经所说：“天牝从来，复得其往，气出于脑，即不干邪。”天牝，就是鼻。鼻受天之空气，故曰天牝。瘟邪之气，自空虚而来，也希望它由空虚而去，即下句“气出于脑”的意思。盖邪气自鼻通于脑，则流布诸经，令人病瘟。气出于脑谓嚏之，或张鼻以泄之，或受气于室，速泄于外，而大吸清气以易之，则邪从鼻出，而毒瓦斯自散，这是却邪于外的方法。又想心如日等方法。（见前文。）盖胆属少阳，中正之官，其气壮，则脏气赖以俱壮，而邪不能入，这是强中御邪的方法。凡探病诊疾，知此诸法，虽入秽地，可保无虞。男病邪气出于口，女病邪气出于前阴，其相对坐立之间，必须知其向背，行动从容，察位而入方妙。
治疗瘟疫须分上、中、下三焦。人的鼻气通于天，所以中雾露之邪为清邪。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、虾蟆瘟之说相符。口气通于地，所以中水土之邪者，为饮食浊味，从口舌而下入于阴，入则必先内栗，足膝逆冷，便溺妄出，清便下重，（疑即后重。）脐筑（向外挣筑。）湫痛，正如俗称绞肠瘟、软脚瘟之说相符。然而口鼻所入之邪，必先注中焦，以次分布上下，不治则胃中为浊，营卫阻而血凝，其酿变即现中焦，俗称瓜瓤瘟、疙瘩瘟等症，则又是阳毒痈脓，阴毒遍身青紫之类。此三焦定位之邪也。若三焦邪混为一，内外不通，脏气熏蒸，上焦怫郁，则口烂食龈矣。若卫气前通者，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。然此幸而营卫渐通，故非危侯。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。治法于未病前，预饮芳香正气药则邪不能入，倘邪入，则以逐邪为要。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，勿使潜滋，方为尽善。
瘟邪直行中道，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，必从此分区，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，（上焦之症。）亦复下血如豚肝，（下焦之症。是上下焦症齐见矣。）非定中上不及下，中下不及上也。
臧卢溪说：这两节应当参看。
夫寒中所以清火，亦能解表，盖阳亢阴衰则火盛水亏，水涸于经，安得作汗？譬之干锅赤裂，润自何来。但加以水，则郁蒸沛然，而热气上腾矣。汗自水生，亦复如是。用凉药以救水，水生而汗有不出者乎。
补中亦能散表。夫气虚于内，安能达表，非补其气，肌能解乎，凡脉之微弱无力或两寸短小者，即其症也。血虚于里，焉能化液，非补其精，汗能生乎，凡脉之浮芤不实或两尺无根者，即其症也。然补则补矣，更当斟酌尽善，用得其宜，妄补住邪，则大害矣。
瘟疫来路两条，去路三条，治法五条，尽矣。何为来路两条？有在天者，如春应暖而反寒云云。此非其时而有其气，人受之，从经络入则为头痛发热，咳嗽发颐大头之类。其在人有互相传染者，其邪则从口鼻入，憎寒壮热，胸膈满闷，口吐黄涎之类，所谓来路两条者此也。何如去路三条？在天之疫，从经络而入者，宜分寒热，用辛温辛凉之药以散邪，如香苏散，普济消毒饮之类，俾其仍从经络而出也。在人之疫，从口鼻而入者，宜芳香之药以解秽，如神术正气等散之类，俾其仍从口鼻而出也。至于经络口鼻所受之邪，传入脏腑渐至潮热谵语，腹满胀痛，是毒瓦斯归内，疏通肠胃，始解其毒，法当下之，其大便行者则清之，下后而余热不尽者亦清之，所谓去路三条者此也。何为治法五条？曰发散，曰解秽，曰清中，曰攻下，曰酌补，所谓治法五条者此也。
刘松峰说：这段也颇为近理，所以收录。只是在补法中改一个“酌”字，因为瘟疫用补法，必须像吴又可所说的“四损不可正治”者才商议补。如果不应当补，而冒然用之，补住其邪，其害不可胜言矣。
又说：我凡是阅书并有所见闻，关于疫症的，大都采录，久而成帙，然而其出处，当时亦或不载，所以除引经论外，皆不着其书名姓字，以免遗漏之讥，且只图有益医学，非欲博古也。以上记精言，以下载故实。
桐乡医生赵某，偶然赴病家，请归已暝，又将雨，中途见矮屋，有灯明灭，时已下雨，遂叩门求宿。内有妇人应曰：“男子不在，不便相留。”医恳栖檐下，许之。将更余，妇开门延入，医谢不敢，妇引之甚力，且求合，医视其灯青黯，且手冷如冰，知遇鬼，亟欲奔避，妇双手挽其颈，以口就医之口，既而大哕曰：“此人食烧酒生蒜，臭秽何可近也。”遂入。医复冒雨而走，抵家十余日后，经矮屋，则一孤坟也。
刘松峰说：足见烧酒大蒜于疫疠盛行所不可阙。
陈宜中梦神人语曰：“天灾流行，人多死于疫疠，唯服大黄得生”，因遍以示人时果疫，因服大黄得生者甚众。
If a plague persists for six or seven days without resolution, leading to heat entering the Blood Chamber (Blood Chamber: a concept in TCM referring to the uterus and related blood dynamics), jaundice, a body color resembling smoke-stained yellow-black, golden-yellow eyes, dry mouth, and internal heat accumulation, one should use a Bian stone (Bian Stone: an ancient surgical tool made of stone) to prick the Quchi (Quchi: LI11, Hegu point on the Large Intestine meridian) acupoint to release foul blood. Simultaneously administer Tongsheng San (Tongsheng San: A Universal Relief Powder), which acts to both disperse the exterior and purge the interior. If the patient sweats out fluid resembling yellow water and passes stool like black paste, the disease will be cured. This is what is called "Da Han" (Da Han: A local northern term for a specific plague treatment method) in the north. The method involves rubbing both arms with hands to gather blood in the arms, binding them tightly with cloth, then using chopsticks to hold the sharp edge of a porcelain fragment to strike and pierce the large collaterals beside the Quze (Quze: PC3, Pericardium 3) acupoint in the elbow, allowing the pathogenic toxin to exit with the foul blood. This is also a very swift method, extremely effective when used by the poor, although it does not refer to the Quchi acupoint.
Songfeng said: When plague pathogens transmit inward, the heat toxin is deep and severe. Symptoms include delirium, mania, unconsciously grasping at clothes and beds, picking at empty air or imaginary threads, eyes red as fire, appearing drunk or dazed, climbing high places to sing, discarding clothes and running. Locally this is called "Hou'er Bing" (Hou'er Bing: Monkey Disease, a folk name for severe plague symptoms). One can dip small dates in burning wine and perform Guasha (Guasha: Scraping therapy) over the whole body. When Sha (Sha: Petechiae or congestion marks appearing on the skin after scraping) appears, its color is purple-red; those that rise high resemble dates or chestnuts. Then use needles to release foul blood, often achieving efficacy. This is another type of acupuncture method.
Generally, treating plague is not suitable for inducing sweating. The Classics state: "Those who do not feel aversion to cold but instead feel thirsty have Warm Disease." This clarifies that the heat originates from within and reaches outward. Plagues differ in whether they injure Qi, Blood, or Stomach, hence the manifestations vary, and treatments differ slightly. If pathogens enter the Zang organs, the patient will lose consciousness and die. The general principle is to follow symptoms as the standard, rather than relying solely on pulse diagnosis.
Songfeng said: Pathogens entering the Zang organs causing unconsciousness do not necessarily lead to immediate death. It is just more difficult to treat than when pathogens are in the meridians. This statement applies to all three types of plagues.
Humans exist within the intersection of Heaven and Earth's Qi, like fish in water. Not even a trace of impurity can be tolerated. If lime were splashed into rivers and lakes, or oil poured into ponds, few fish would survive. Similarly, how could humans infected with epidemic Qi be any different?
"Epidemic" (Yi) means everyone in the population falls ill. It is named "Yi" because it is considered a disaster caused by "Li Gui" (Li Gui: Leprous ghosts/pathogenic spirits).
Songfeng said: "Yi" is like corvée labor (forced service), implying that every household along the street is affected. In Shandong custom, children getting smallpox is called "Dang Cha" (Dang Cha: Taking up a post/duty), which carries the same meaning as corvée labor.
Heaven and Earth's intent is to generate life. Cold, Heat, Warmth, and Coolness cycle through eternally unchanged. Humans living within this system fall ill upon contact only because their daily routines lack regularity, diet is unregulated, leading to Qi deficiency and physical weakness, thus offending themselves. It is not the fault of cold or heat. If cold and heat were lethal energies that caused illness upon mere contact, humanity would have perished long ago. Is this the intent of Heaven and Earth to generate life? As for climates occurring out of season, calling them "Abnormal Qi" (Abnormal Qi: Climate contrary to the season) is acceptable, but calling them "Epidemic Qi" is incorrect. Why? Because with Abnormal Qi, some people get sick while others do not; it cannot be generalized. However, Epidemic Qi affects everyone regardless of status, wealth, age, gender, or constitution, spreading door-to-door and village-wide, leaving no one exempt. This occurs only during times of war, famine, and drought.
The treatment of plague diseases should favor cool dispersal. However, this is only applicable if there are heat symptoms in both the exterior and interior. If exterior pathogens have not yet resolved, even if the exterior feels hot as fire, but there are no internal heat symptoms to justify it, cool medicines must not be used indiscriminately.
Songfeng said: Misusing hot medicines might still be salvageable, but misusing cool medicines kills as surely as wielding a blade. The saying goes: "Ginger and Cinnamon Twig Decoction may fail to cure, but Huangqin and Scutellaria Root will work appropriately." Why isn't it said the reverse? This clearly indicates that wrongly using cool medicines for Cold Damage (Cold Damage: Diseases caused by cold pathogens) is incurable. Although plague belongs to pathogenic heat, there are times when cool medicines are unsuitable; dosage must still be cautious.
Winter warmth occurring out of season, or illnesses caused by ministerial fire guest-heat, is named "Winter Warmth" (Winter Warmth: Warm disease occurring in winter). It differs greatly from true Cold Damage in winter. The treatment should favor cool resolution, which is "discarding the season to follow the symptoms." If cold occurs in summer, warming treatment is similarly appropriate.
Songfeng said: Wu Keyi criticized the concept of "Winter Warmth," but claiming there is absolutely no warmth in winter is incorrect. Therefore, one should discard the season and follow the symptoms.
Cold Plague is sudden severe cold from the weather, differing in severity from the extreme cold of winter. Seasonal Qi is naturally the epidemic Qi of heaven's movement, distinct from cold plague. Plague diseases often arise from steam and vapor in mountains and marshes.
Songfeng said: There was also heat plague in winter. My relative, Zi Bingjin, suddenly suffered wandering pain in his limbs during deep winter. My treatment for Zhou Bi (Zhou Bi: Wandering Bi syndrome) failed. He self-medicated with Yin Hua (Jin Yin Hua/Honeysuckle Flower), Cao Jie (Bamboo Nodes), Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), Jing Jie (Schizonepeta Spike), Bo He (Mint Leaf), Sang Zhi (Mulberry Twig), Huang Qin (Scutellaria Root), Zhi Zi (Gardenia Fruit), and Sheng Di (Rehmannia Root), adjusting cooling, dispersing, and detoxifying herbs. After taking thirty to forty doses, he recovered. Later I heard many others suffered similar symptoms, realizing this too was a plague.
Seasonal Qi is the violent epidemic Qi of heaven's movement, contracted not due to cold. Treatment should focus on dispelling epidemic Qi and supporting healthy Qi. If unresolved for many days, with pathogenic heat transforming into mixed symptoms, one should select treatments from the sections on Cold Damage transformation symptoms.
The Classics state: "Those who do not store essence in winter will suffer plague in spring." The tenth month corresponds to Hai, and the eleventh to Zi. Fire Qi lies dormant. One should nourish True Qi to serve as the root for spring generation. If one recklessly harms the body during this time, when spring arrives and Yang Qi floats lightly, plague will inevitably occur. These two months constitute the year's period of deficiency. Additionally, the period before the first quarter moon and after the last quarter moon, when the moon is waning or absent, represents a monthly deficiency. Wind, haze, thunder, lightning, extreme cold/heat, solar/lunar eclipses, sorrow, anger, fear, grief, drunkenness, overeating, fatigue, and exhaustion represent daily deficiencies. During these times, can one neglect nurturing Harmony with Nature and avoiding sexual activity?
Warm-Heat diseases arise from external contraction and internal injury, stirring stagnant fire to emerge from within to the exterior. Initially, both exterior and interior are hot, requiring cool dispersing agents to clear heat from both levels. Over time, exterior heat becomes mild while interior heat intensifies, requiring bitter-cold agents like Chengqi Decoction (Chengqi Decoction: A class of purgative formulas including Dahuang Chengqi Tang) to purge. Then heat recedes, the body cools, and the disease resolves. (If mistaken for immediate Cold Damage and treated with Ma Huang (Ma Huang: Ephedra Herb) and other acrid-warm agents to release the exterior, internal heat will worsen, leading to macules, jaundice, and mania. Or if Chengqi Decoction is used to purge the interior without first resolving the exterior with acrid-cool agents, exterior heat remains while chest binding and deficiency bloating appear.)
Songfeng said: It is already understood that plague should not be mistaken for immediate Cold Damage treated with Ma Huang. I once experienced a severe plague outbreak where patients' symptoms were largely similar, generally requiring cool dispersing and purging agents. One patient had symptoms of fever, body ache, headache, and stiffness, with a slow and tight pulse, identical to true winter Cold Damage. I administered Ma Huang to release the exterior, resulting in sweating and resolution. I realized then that treating disease requires flexibility and non-rigidity, whether in plague or miscellaneous diseases.
All untreatable or difficult cases of Cold Damage and plague belong to deficiency of the Lower Yuan (Lower Yuan: Kidney and Essence). (Songfeng notes: This happens occasionally, but not always.) In family transmissions, because there is a sick person at home, causing morning and evening worry, reduced food intake leads to Qi depletion. Contracting the pathogenic Qi via nose and mouth requires clearing the Yangming channel, relieving stagnation, and managing consumption injuries as key priorities. (Songfeng notes: Do not take this sentence literally. Emphasize the word 'simultaneously'.)
Songfeng said: More than ten members of my family once contracted plague, infecting each other. I lived among the sick, ate little, and worried constantly, yet avoided infection. Once, I entered an infected house and fell ill immediately. Seeking the cause, I recalled that during that time, their whole family was sick, and I had been busy all day. That night, sleeping alone in a room, I burned a piece of Jiangzhen Xiang (Jiangzhen Xiang: Aquilaria Agallocha Wood). Perhaps this helped.
One must not fixate on a single formula for plague, as plague has no fixed pattern.
In the Three Yang syndromes of Cold Damage and plague, Yangming syndromes are often present. the Hand-Yangming channel belongs to the Large Intestine, paired with the Lung, opening at the nose. the Foot-Yangming channel belongs to the Stomach, paired with the Spleen, opening at the mouth. Since pathogens enter via mouth and nose, Yangming involvement is common. Pathogens in the Three Yang should be expelled quickly; delay leads to rotting stomach and macules. If transmitting inward to the Three Yin, intense heat depletes Yin fluids, making it untreatable. This is the fault of delayed treatment.
Displacement of Yin and Yang, and mistiming of cold and heat, generate epidemics.
Plagues often arise from human actions attracting heavenly Qi movements. When Qi mechanisms invade and Earthly Qi responds, combining the toxic vapors of Heaven, Earth, and Humanity, plague forms.
Treating warm-heat epidemics contraindicates acrid-hot medicines; cool, acrid-sweet, and bitter-cold medicines are preferred.
Zhang Zhongjing's texts, recovered and edited by Wang Shuhe, contain some forced interpretations. Cheng Wuji's commentary further confused winter Cold Damage formulas with Warm-Summer applications, causing harm to this day. Warm-Summer diseases have their own formulas, now lost. Hence Song Longmen sighed that *Shanghan Lun* is incomplete.
Forcing food on plague patients or giving cold drinks to the sick is what laypeople consider "nourishing," but what good physicians consider causing disease.
Seasonal epidemics first enter the Stomach, so Yangming Stomach medicines are commonly used.
Damp-heat seasonal toxins enter via mouth and nose, transmitting to Yangming, where pathogen and healthy Qi contend. Yin excess causes aversion to cold; Yang excess causes high fever. Entering joints causes whole-body pain; rising to head and face causes swelling, named Da Tou Wen (Da Tou Wen: Big Head Plague/Mumps-like plague).
Among the categories of Summer-Heat, Dampness, and Heat, Ren Shen Bai Du San (Ren Shen Bai Du San: Ginseng and White Tiger Powder) is ranked first. When three evils combine, they are hard to resist; their mutual transmission creates plague. The formula uses acrid-ping substances, plus powerful Ren Shen (Ren Shen: Panax Ginseng Root) to support righteousness and expel evil. Patients taking two to three doses daily ensure no plague pathogen remains. How delightful! Yet vulgar doctors remove Ren Shen, differing from other formulas.
"Epidemic" (Yi) means "Li" (pestilence). Pathogenic Qi spreads, harming people like grinding damages objects. "Yi" also means "Yi" (service/corvee). Ghosts perform service, never stopping.
When treating plague, first observe the patient's eyes, then the tongue and mouth, then press the chest, heart, and lower abdomen for pain, ask about bowel/bladder function, thirst, previous medications, duration, and examine the pulse accurately. Only when pulse and symptoms match can one predict outcome and prescribe safely. These steps are crucial physician skills.
Treating summer warm-heat, heat, and epidemic diseases contraindicates acrid-hot medicines. Use acrid-cool, clear-sweet, bitter-cold agents like Sheng Ma (Cimicifugae Rhizome), Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), Bo He (Menthae Haplocalycis Herba), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Lian Qiao (Forsythiae Fructus - *Note: Text says Qin Lian, usually Huang Qin and Huang Lian*), Zhi Zi (Gardeniae Fructus), Bai Zhu (Atractylodis Macrocephalae Rhizome - *Note: Text says Bo, likely Huang Bo*), Gan Cao (Licorice Root), and Shao Yao (Paeoniae Radix).
For Li Yi (Leprosy/Epidemic), Dou Zhen (Smallpox/Rash), Fa Ban (Macule eruption), and Re Du (Heat Toxin), lying on cool, damp earth releases coolness and draws out toxins, reducing suffering by half. Earth's utility is profound; wise men extrapolate from this.
Epidemics must be differentiated by seasonal cold/heat/dryness/dampness, adapting to time. For prolonged drought and heat plague, avoid drying agents. For prolonged rain and cold plague affecting Spleen Earth with dampness, avoid moistening agents.
Pathogens enter from outside; deficiency constitutions are deeply affected. When using diaphoretic or purgative methods to expel evil, one must first protect Original Qi. Thus, warming dispersal, warming tonification, counter-treatment, and following-treatment methods must be known.
Often, mistakenly purging the interior in warm-heat diseases causes little harm, but mistakenly releasing the exterior causes unpredictable changes, proving heat originates internally and moves outward.
Wei Xuting said: This proves plague has no rationale for diaphoresis. Regarding "purging interior causes little harm," emphasize the word "little."
Heavenly and earthly epidemic Qi, commonly called "Heng Bing" (Heng Bing: Horizontal/Sudden Illness), is often ignored with the belief that it will resolve on its own, leading to many premature deaths. Treat illness immediately to break the toxic vapor and recover. Do not let pathogenic Qi attack freely, waiting passively for death.
People mistakenly identify plague as Cold Damage, calling Cold Damage a scholar's term and Tianxing Plague a peasant's slang. This error is severe.
Epidemic Qi mixes pathogen and righteous Qi; if pathogen exceeds righteousness, it is critical. Bitter-cold medicines damage the Stomach; warm-tonifying medicines assist the pathogen. Ren Zhong Huang (Ren Zhong Huang: Human Waste Carbon) is most appropriate.
Plague is Heavenly pathogenic Qi. If human righteous Qi is solid, pathogens cannot interfere. Prevention lies in moderating desire and labor, and not enduring hunger to inhale pathogenic Qi. Expelling methods include: "From Tian Pin (Tian Pin: Nose, literally 'Heaven Nostril'), return to where it came. Qi exits the brain, thus not interfering with pathogens." Tian Pin refers to the nose, receiving Heaven's Qi. Plague Qi comes from emptiness and should leave through emptiness, i.e., "Qi exits the brain." Sneezing, flaring nostrils to vent, or breathing fresh air rapidly to replace stale air allows pathogen exit via nose, dispersing toxic vapor. This is expelling evil externally. Also, visualize the heart like the sun (see earlier). Gallbladder belongs to Shaoyang, the official of justice; strong Qi here strengthens organ Qi, preventing invasion. This is strengthening the center to resist evil. Knowing these methods protects one even in foul places. Male pathogen exits via mouth; female via anterior yin. When sitting/standing opposite, know orientation, move calmly, and enter observing position for best results.
Treat plague by differentiating Upper, Middle, and Lower Jiao. Nasal Qi connects to Heaven; mist/dew pathogens are Clear Evil. Entering Yang via nose causes fever, headache, stiff neck, and convulsions, matching folk names Da Tou Wen (Big Head Plague) and Xia Ma Wen (Toad Plague). Oral Qi connects to Earth; soil/water pathogens are Turbid Evil from food/drink. Entering Yin via mouth/tongue causes internal trembling, cold feet/knees, involuntary urination/defecation, heavy sensation in clear stool (likely tenesmus), abdominal drawing pain, and colic pain, matching Jiao Chang Wen (Intestinal Twisting Plague) and Ruan Jiao Wen (Soft Leg Plague). Pathogens from mouth/nose first settle in Middle Jiao, then distribute upper/lower. Untreated, Stomach becomes turbid, Ying and Wei block, blood coagulates, manifesting in Middle Jiao as Gua Rang Wen (Melon Rind Plague) and Ge Da Wen (Lump Plague), resembling Yang Du abscess pus or Yin Du full-body cyanosis. These are Jiao-localized pathogens. If Jiao pathogens mix, blocking interior/exterior, organ Qi steams, Upper Jiao stagnates, causing mouth ulcers and gum erosion. If Wei Qi flows forward, driven by heat, roaming channels/organs, it causes abscesses. If Ying Qi flows forward, inviting guest pathogens, sneezing, throat obstruction, and heat stagnation cause bloody stool like pig liver. Fortunately, if Ying/Wei gradually connect, it is not critical. If Upper Yang and Lower Yin disconnect, Spleen Qi cannot operate alone, five fluids pour down, Lower Yin fails to close, and life is endangered. Pre-treatment involves drinking aromatic righteous Qi medicines to prevent entry. If entered, expel evil. Upper Jiao is like mist; lift and expel, adding detoxification. Middle Jiao is like fermentation; dredge and expel, adding detoxification. Lower Jiao is like a drain; drain and expel, adding detoxification. Once Ying/Wei connect, pursue and extract evil forcefully, preventing hidden proliferation, achieving perfection.
Plague pathogens travel the central pathway, distributing through Jiao. Upper Jiao is Clear Yang, so Clear Evil enters from above. Lower Jiao is Turbid Yin, so Turbid Evil enters from below. Middle Jiao is the boundary of Yin/Yang; Clear/Turbid evils partition here. Severe cases mix all three Jiao; extreme upward movement goes down, extreme downward goes up. Thus, throat obstruction and mouth ulcers (Upper Jiao symptoms) may coincide with bloody stool like pig liver (Lower Jiao symptoms). It is not that Upper/Middle misses Lower, or Middle/Lower misses Upper.
Zang Luxi said: Refer to these two sections together.
Cold penetrating clears fire and can also release the exterior. When Yang hyperactivity and Yin decline cause fire excess and water deficiency, water dries in channels, how can sweat form? Like a dry, cracked red pot, where does moisture come? Adding water creates abundant steam and rising heat. Sweat originates from water, similarly. Using cool medicines to save water generates water, ensuring sweat production.
Tonifying internally can also release the exterior. Internal Qi deficiency cannot reach the exterior; without tonifying Qi, how can muscles relax? Weak or powerless pulses, or short pulses at Cun positions, indicate this symptom. Internal Blood deficiency cannot transform fluids; without tonifying Essence, how can sweat generate? Floating, hollow, or empty pulses, or rootless pulses at Chi positions, indicate this symptom. Tonification is good, but must be carefully weighed and applied correctly. Wrongful tonification traps evil, causing great harm.
Plague has two entry paths, three exit paths, and five treatment methods. What are the two entry paths? One is Heavenly: e.g., Spring should be warm but is cold. This is abnormal Qi; humans contract it, entering via meridians causing headache, fever, cough, swollen parotids, and big head plague. The other is Human: mutual transmission, pathogens enter via mouth/nose causing aversion to cold, high fever, chest oppression, and vomiting yellow saliva. These are the two entry paths. What are the three exit paths? Heavenly plague entering via meridians should be differentiated by cold/heat, using acrid-warm or acrid-cool medicines to disperse evil (e.g., Xiang Su San, Pu Ji Xiao Du Yin), allowing exit via meridians. Human plague entering via mouth/nose should use aromatic medicines to resolve filth (e.g., Shen Zhen Zheng Qi San), allowing exit via mouth/nose. Pathogens from meridians/mouth-nose transmitting to organs, causing tidal fever, delirium, abdominal fullness/pain, indicate toxic vapors returning inward. Dredging intestines/stomachs begins detoxification, requiring purgation. If bowels move, clear heat. If residual heat remains after purgation, clear heat. These are the three exit paths. What are the five treatment methods? Dispersing, Resolving Filth, Clearing Middle, Purging Downward, and Prudent Tonification. These are the five methods.
Songfeng said: This section is quite reasonable, so recorded. Changed "tonify" to "prudent tonify" because plague tonification should only be considered as Wu Keyi stated for "Four Deficiencies unable to be treated directly." If tonification is inappropriate and used rashly, trapping evil, the harm is incalculable.
Also said: I have collected books and observations regarding plague, compiling them over time. Sources were often uncited to avoid criticism of omission, aiming only to benefit medicine, not to display erudition. Above records precise words; below records historical facts.
Doctor Zhao from Tongxiang visited a patient, returned at dusk, rain imminent. Saw a low house with flickering light, rain started, knocked for shelter. A woman answered: "Men are not here, inconvenient to stay." Doctor begged to sleep under eaves, agreed. Near midnight, woman opened door, invited him in. Doctor declined politely, woman insisted strongly, seeking intimacy. Doctor saw dim blue lamp and ice-cold hands, realized it was a ghost, wanted to flee. Woman grabbed his neck, pressed mouth to his. Suddenly she retched: "This person ate raw garlic and liquor, how can such stench approach me?" She entered. Doctor fled in rain. Ten days later, passing the low house, found it was a lone grave.
Songfeng said: This shows liquor and garlic are indispensable during plague prevalence.
Chen Yizhong dreamed a spirit said: "Heavenly disasters spread, many die of plague, only taking Da Huang (Rhei Radix et Rhizoma) saves life." He showed this to people. When plague struck, many survived by taking Da Huang.