劳倦伤脾。元气下陷。乃执甘温除热之句。转补壅热。至于不救矣。
疫痢相兼之证最危。夫疫者胃家事也。必从下解。利者大肠事也。大肠既病。失其
传送之职。故粪不行。下脓血。所以向来谷复。停积在胃。直须大肠邪气将退。胃气通行。积粪从此而下。今既大肠失
职。粪尚不行。又何能与胃载毒而出耶。毒既不
行。最能伤败胃气。毒瓦斯在胃。一日有一日之害。在一时有一时之害。耗气抟血。神
气既尽则死。凡遇疫痢兼证者。在痢尤为吃紧。宜槟榔顺气汤。
槟榔顺气汤
大黄 浓朴 芍药 槟榔 枳实 生姜
上六味。水煎温服。
妊娠时疫。设用三承气。须随证施治。不可过虑。慎勿惑于参、 安胎之说也。病家
见用承气。先自惊疑。更加左右有粗知医者。从旁嘈杂。必致掣肘。遂令子母不祥。
若应下之证。反用补剂安胎。热毒愈炽。胎愈不安。耗气抟血。胞胎何赖。是以古人
有悬钟之喻。梁腐而钟未有不落者。惟用承气逐其邪。火毒消散。炎 顿为清凉。气回而胎
自固。当此证候。大黄反为安胎圣药。历治历当。母子俱安。若见腹痛腰疼。则必堕无疑矣。须预言之。
妇人病疫。与男子无异。惟经水适来适断。及崩漏产后。与男子不同。经水适来。邪
不入胃。入于血海。胸膈无邪。勿以胃实攻之。但热随血下自愈。宜小柴胡加生地
黄、牡丹皮、赤芍药主之。如结胸状者。血因邪结。刺期门。经水适断。血室空虚。邪乘
虚入为难治。与适来者有虚实之分。宜柴胡养营汤。新产亡血。冲任空虚。与素病
崩漏。经气久虚者。亦用此汤。若药停不行。加生姜以和其性。中气虚而不运。加人
参以助其行。疫行之时。凡小儿两目上吊。惊搐发痉。十指勾曲。角弓反张。勿认惊
风治。宜同大人。但药剂轻小耳。
应下之证。下后当脉静身凉。今反发热者。因结开气通。郁阳暴伸也。不久自息。如
不息。仍是余邪未尽也。下后自卧二三日。或四五日。汗不止。身微热。此仍属热。其
表有余邪。邪尽汗止。不止者。小柴胡汤加广皮。呕加半夏。虚加人参。斟酌治之。不
可用 、术之属。如脉静身凉。数日后反盗汗。宜用略补。虚实之分。在有热无热也。
下后邪去呕止。今反复呕者。胃虚也。少进粥饮调之。
如人方食肉而病。停积在胃。用承气连下。惟下旁流臭水。其病不退。必加人参一
味。即数十日停积顿行也。应下失下。真气微虚。及投承气下咽。少顷额上汗出发
根搔痒。手足厥冷。甚则战栗。心烦坐卧不安。如狂之状。此中气已亏。不胜药力。名
曰药烦。凡遇此证。药中多加生姜。均二三次服。以防呕吐之患。
病有劳复食复自复。劳者补之养之。食者轻则损谷。重则下夺。自复者。前用何药。根据前增减自愈。
感冒兼疫。先治感冒后治疫。疟疫相兼。治疫而疟自已。
瘟疫九传。
因过度劳累损伤脾胃，导致元气下陷。如果此时拘泥于“甘温除大热”的理论，反而使用补益药物，会导致壅滞化热，最终造成不可挽回的后果。
疫病与痢疾同时并见的证候最为危重。疫病主要关乎胃腑的功能，必须通过通下大便来解除病邪；痢疾主要关乎大肠的功能。大肠既然患病，失去了传导排泄的职责，所以粪便不能下行，排出脓血。因此，以往摄入的谷物停滞积聚在胃中，只有当大肠的邪气消退、胃气恢复通畅后，积存的粪便才能随之排出。如今大肠功能失职，粪便尚且不通，又怎么能帮助胃腑运载毒素排出体外呢？毒素既然无法排出，最能损伤败坏胃气。毒邪在胃中，每一天都有每一天的危害，每一个阶段都有每一个阶段的损害，耗伤正气，瘀阻血液，神气耗尽就会死亡。凡是遇到疫痢兼夹的证候，在治疗痢疾方面尤为关键紧急，适宜使用槟榔顺气汤。
槟榔顺气汤
大黄、厚朴、芍药、槟榔、枳实、生姜
以上六味药，用水煎煮，温服。
孕妇患时行疫病，如果需要使用三承气汤（调胃承气汤、小承气汤、大承气汤），必须根据具体证候施治，不必过分担忧。千万不要被人参安胎的说法所迷惑。病人看到医生使用承气汤，自己先产生惊恐疑虑，再加上旁边一些略懂医术的人在一旁嘈杂议论，必然导致治疗受阻，致使母子都不吉利。如果是应当使用下法的证候，反而使用补剂来安胎，会使热毒更加炽盛，胎元更加不安，耗伤正气，瘀阻血液，胞胎还有什么可依赖的呢？所以古人有悬挂钟磬的比喻：房梁腐烂了，钟磬没有不坠落的道理。只有使用承气汤驱逐邪气，火毒消散，炎势顿时转为清凉，气机回复，胎元自然稳固。在这种证候下，大黄反而是安胎的圣药，经过多次治疗都有效，母子都能平安。如果见到腹痛腰痛，那么胎儿必定流产无疑，必须预先告知家属。
妇女患疫病，与男子没有不同，只是月经正好来潮或刚结束，以及崩漏（非经期大量出血）和产后，与男子不同。月经正好来潮时，邪气不入胃，而是进入血海（子宫及冲脉等与月经相关的部位），胸膈没有邪气结聚，不要用攻伐胃实的药物治疗，只需让热随血液下行，疾病自然会痊愈。适宜用小柴胡汤加生地黄、牡丹皮、赤芍药为主方治疗。如果出现类似结胸证的症状，是因为血液因邪气结聚，可以针刺期门穴。月经刚结束时，血室空虚，邪气乘虚而入，属于难治之症，这与月经来潮时的情况有虚实之分，适宜使用柴胡养营汤。新产之后失血，冲任二脉空虚，与素来患有崩漏、经气长期虚弱的人，也使用这个方剂。如果服药后药效停滞不行，加入生姜以调和药性；中气虚弱而不能运化药力，加入人参以助其运行。在瘟疫流行期间，凡是小儿出现两眼上翻、惊厥抽搐、十指弯曲、角弓反张等症状，不要误认为是惊风进行治疗，治疗方法同成人，只是药剂剂量要轻小而已。
应当使用下法的证候，使用后应当脉象平静、身体凉爽。现在反而发热的，是因为郁结开通、气机通畅，郁遏的阳气突然伸展所致，不久自然会平息。如果不平息，说明仍有残余邪气未尽。下法后自行静卧两三天，或者四五天，汗出不止，身体微热，这仍然属于热证，是表分还有余邪，邪气尽则汗自止。如果汗不止，可用小柴胡汤加陈皮；呕吐加半夏；体虚加人参，斟酌治疗。不可使用苍术、白术之类的药物。如果脉象平静、身体凉爽，几天后反而出现盗汗，适宜使用轻微的补益剂。区分虚实的关键在于是否有热。
下法后邪气去除、呕吐停止，现在又反复呕吐的，是胃气虚弱的表现。少量进用米粥饮品来调理。
比如有人正在吃肉时生病，食物停滞在胃中，使用承气汤连续攻下，只能拉出旁流的臭水，病情不退，必须加入人参一味药，那么数十日的积滞就能立刻通行。应当使用下法而失于使用下法，导致真气微弱虚弱，以及投用承气汤后，药液咽下不久，额头出汗，发根瘙痒，手脚冰冷，甚至战栗，心烦意乱，坐卧不安，像发狂一样的状态，这是中气已经亏损，承受不住药力，名叫“药烦”。凡是遇到这种证候，在药中多加生姜，分两三次服用，以防止呕吐的发生。
疾病有劳复（因劳累复发）、食复（因饮食不当复发）和自复（自然恢复）。劳复者，用补益滋养的方法治疗；食复者，轻者减少饮食，重者使用下法攻逐；自复者，之前用过什么药，根据之前的方剂增减即可自愈。
感冒兼夹疫病，先治疗感冒，后治疗疫病。疟疾兼夹疫病，治疗疫病，疟疾自然痊愈。
瘟疫病的九种传变规律。
Spleen Qi is injured by overwork and fatigue. Yuan Qi (Primordial Qi) sinks downward. If one rigidly adheres to the principle of "using sweet and warm herbs to eliminate fever," and instead uses tonifying methods, it will lead to stagnation and transformation into heat, resulting in an incurable condition.
The syndrome where epidemic disease (Yi) and dysentery occur simultaneously is most critical. Epidemic disease primarily involves the Stomach; it must be resolved through purgation. Dysentery primarily involves the Large Intestine. When the Large Intestine is diseased, it loses its function of transportation and transmission, so feces do not pass, and pus and blood are discharged. Therefore, food previously ingested remains stagnant and accumulated in the Stomach. Only when the pathogenic factors in the Large Intestine recede and Stomach Qi flows freely can the accumulated feces be expelled downwards. Now that the Large Intestine has failed in its duty and feces cannot move downward, how can it assist the Stomach in carrying out toxins? Since the toxins cannot move downward, they severely damage and deteriorate Stomach Qi. Toxins residing in the Stomach cause harm day by day and moment by moment, consuming Qi and congealing Blood. Once Shen Qi (Spiritual Qi) is exhausted, death ensues. In cases where epidemic disease is complicated by dysentery, the dysentery aspect is particularly urgent. The appropriate formula is Binglang Shunqi Tang (Betel Nut Decoction for Directing Qi).
Binglang Shunqi Tang (Betel Nut Decoction for Directing Qi)
Da Huang (Rhei Radix et Rhizoma), Houpo (Magnoliae Officinalis Cortex), Shaoyao (Paeoniae Radix Alba), Binglang (Arecae Semen), Zhishi (Aurantii Fructus Immaturus), Shengjiang (Zingiberis Rhizoma Recens).
These six ingredients are decocted in water and taken warm.
In pregnant women suffering from seasonal epidemics, if San Chengqi Tangs (Three Decoctions of Inheriting Qi: Tiaowei Chengqi Tang, Xiao Chengqi Tang, Da Chengqi Tang) need to be used, treatment must be administered according to the specific syndrome without excessive worry. One must not be confused by theories regarding using Ren Shen (Ginseng Radix) to calm the fetus. Patients often feel alarmed and suspicious when seeing Chengqi Tangs prescribed, and if laypersons with superficial medical knowledge chatter nearby, it inevitably hinders treatment, leading to misfortune for both mother and child. If a syndrome requires purgation but tonics are used instead to calm the fetus, the heat and toxins will become more intense, making the fetus even more unstable, consuming Qi and congealing Blood, leaving the fetal house without support. Thus, ancient physicians used the metaphor of a hanging bell: if the beam rots, the bell inevitably falls. Only by using Chengqi Tangs to drive out pathogens, dissipating fire and toxins, turning inflammation into coolness, and restoring Qi flow, can the fetus be naturally secured. In such syndromes, Da Huang becomes the holy medicine for calming the fetus. Historical treatments confirm this, ensuring safety for both mother and child. However, if abdominal pain and lower back pain appear, miscarriage is inevitable, and this must be forewarned.
Women suffering from epidemics are no different from men, except during menstruation (just starting or just ending), metrorrhagia (profuse uterine bleeding), and postpartum periods. When menstruation just starts, pathogens do not enter the Stomach but enter the Blood Sea (Chong and Ren meridians/Uterus). There is no pathogen in the chest and diaphragm, so one should not use harsh purgatives for fullness in the Stomach. Heat will resolve itself as it follows the menstrual blood downward. The appropriate prescription is Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Sheng Di Huang (Rehmanniae Radix), Mu Dan Pi (Moutan Cortex), and Chi Shao Yao (Paeoniae Radix Rubra). If symptoms resemble Jie Xiong (Chest Binding), it is because blood is bound by pathogens; puncture Qimen (LR14). When menstruation just ends, the Blood House is empty, and pathogens enter due to deficiency, making it difficult to treat. This differs from the "just started" scenario in terms of excess and deficiency; Chaihu Yangying Tang (Bupleurum Nourishing Ying Decoction) is appropriate. For new postpartum hemorrhage, Chong and Ren meridians are empty; for those with chronic metrorrhagia and long-term deficiency of Jing Qi, this same decoction is used. If the medicinal action stagnates, add Sheng Jiang to harmonize its nature. If Middle Qi is deficient and fails to transport, add Ren Shen to assist movement. During epidemic times, if children present with eyes rolling upward, convulsions, spasms, curved fingers, and opisthotonos, do not diagnose it as Wind-Stroke (Jing Feng). Treat it similarly to adults, but with lighter and smaller dosages.
For syndromes requiring purgation, after purging, the pulse should be calm and the body cool. If fever persists, it is because the obstruction has opened, Qi flows, and suppressed Yang suddenly extends; this will subside shortly. If it does not, residual pathogens remain. After purging, if lying quietly for two to three days, or four to five days, sweating continues with slight fever, this still belongs to Heat, indicating residual pathogens on the Exterior. Sweating stops when pathogens are exhausted. If sweating persists, use Xiao Chaihu Tang added with Guang Pi (Citri Reticulatae Pericarpium); if vomiting occurs, add Ban Xia (Pinelliae Rhizoma); if deficient, add Ren Shen. Adjust accordingly. Do not use Cang Zhu (Atractylodis Rhizoma) or Bai Zhu (Atractylodis Macrocephalae Rhizoma). If the pulse is calm and body cool, but night sweats occur days later, mild tonification is appropriate. The distinction between excess and deficiency lies in the presence or absence of Heat.
After purging, if pathogens are gone and vomiting stops, but vomiting recurs, this indicates Stomach Deficiency. Administer small amounts of rice gruel to regulate.
If a person was eating meat when illness struck, causing stagnation in the Stomach, and Chengqi Tang is used continuously for purging, only foul fluid leakage may occur, and the illness will not retreat. One must add Ren Shen. Then, decades of stagnation will immediately clear. If purgation is indicated but missed, causing slight deficiency of True Qi, or if after taking Chengqi Tang, sweat appears on the forehead, roots of hair itch, extremities become cold, shivering occurs, restlessness and agitation resembling mania ensue, this is called "Medication Irritation" (Yao Fan). It indicates Middle Qi is depleted and cannot withstand the drug's force. In such cases, add more Sheng Jiang to the prescription and administer in divided doses twice or thrice to prevent vomiting.
Diseases may relapse due to overwork (Lao Fu), improper diet (Shi Fu), or spontaneous recovery (Zi Fu). For Lao Fu, use tonification and nourishment. For Shi Fu, light cases require dietary restriction, severe cases require purgation. For Zi Fu, adjust previous prescriptions up or down for spontaneous recovery.
When Cold Damage (Gan Mao) complicates an epidemic, treat the Cold Damage first, then the epidemic. When Malaria complicates an epidemic, treating the epidemic resolves the malaria.
The nine transmissions of Plague-Epidemic diseases.