之人，其惊忧之气蓄于内，加以饮食失节，多致疾病，近之则邪气传染，为害最大，况年高气弱，尤宜慎也。总帅不听，
至腊月班师大雪，新虏人冻馁，皆病头疼咳嗽，自利腹痛，多致死亡。正月至汴，相公因赴贺宴，痛饮数次，遂病，脉
沉细而弦，三四动一止，见证与新虏人无异，三日而卒。《内经》云∶乘年之虚，遇月之空，失时之和。因而感邪，其气
至骨，可不畏哉！俞惺斋曰∶按喻氏论疫引仲景《辨脉篇》中，“寸口脉阴阳俱紧”者一节，阐发奥理。谓清邪中上，从
鼻而入于阳，浊邪中下，从口而入于阴。在阳，则发热头疼，项强颈挛；在阴，则足膝逆冷，便溺妄出。大凡伤寒之邪，
由外廓而入，故递传六经。疫邪由口鼻而入，故直达三焦，三焦相溷，内外不通，致有口烂食龈，声哑咽塞，痈脓下血，
脐筑湫痛等变。治法∶未病前，预饮芳香正气药，使邪不能入。若邪既入，则以逐秽为第一义，此与吴又可之论暗合，
较之李、罗二家所述，劳疫忧惊，冻馁致病者迥别。然各有至理，医者须详察病因，谛参脉证而施治也。汪按∶据此则
知疫病之因不一。断不能执一方以概治矣。惟云因病致死，病气尸气，混合不正之气、种种恶秽，交结互蒸，人在其中，
无隙可避，斯无人不病，是诚诸疫所同然。曩崇祯十六年，自八月至十月，京城大疫，猝然而死，医祷不及，后有外省
人员到京，能识此证，看膝弯后有筋肿起，紫色无救，红色速刺出血可无患，以此救活多人，病亦渐息。是亦医者所当
知也。盖血出则疫毒外泄，故得生也。按∶又有羊毛瘟者。病患心前背后有黑点如虼蚤斑者是也。以小针于黑处挑之，
即有毛出，须挑拔净尽乃愈。又，《辍耕录》载∶元伯颜平宋后，搜取大黄数十车，满载而去，班师过淮，俘掠之民及降
卒，与北来大兵咸病疫，以大黄疗之，全活甚众。《宋元通鉴》载∶作耶律楚材灭夏之事，则大黄洵治疫之妙品也。又可
《温疫论》赞大黄为起死神丹，原非杜撰。然则李、罗二家之说，又未可为兵后病疫之定法矣。汪按∶李罗二说，虽非
定法，然亦不可不知，近年所见，颇有合于李、罗之说者，但谓之非正疫治法则可，医家大抵各明一义，全在善读书者
融会贯通也。盖今世谓治疫必宜温热之剂。固属谬论。然谓疫病断无宜用温热者。则又胶滞之见矣。要在随证施治用得
其当耳。
雄按∶《续医说》云∶王宇泰谓圣散子方，因东坡先生作序，由是天下神之，宋末辛未年永嘉瘟疫，服此方被害者，
不可胜纪。余阅《石林避暑录话》云∶宣和间，此药盛行于京师，太学生信之尤笃，杀人无算，医顿废之。昔坡翁谪居
黄州时，其地濒江，多卑湿，而黄之居人所感者，或因中湿而病，或因雨水浸淫而得，所以服之多效，以是通行于世，
遗祸无穷也。宏治癸丑年，吴中疫疠大作，吴邑令孙磐，令医人修合圣散子，遍施街衢，并以其方刊行，病者服之，十
无一生，率皆狂躁昏瞀而死。噫！孙公之意，本以活人，殊不知圣散子方中，有附子、良姜、吴萸、豆蔻、麻黄，藿香
等药，皆性味温燥，反助热邪，不死何待？苟不辨证而一概施治，杀人利于刀剑，有能广此说以告人，亦仁者之一端也。
余谓疫疠多属热邪，如老君神明散、务成萤火丸、仓公辟瘟丹、子建杀鬼丸，皆为禁剂。设好仁不好学，轻以传人，其
祸可胜道哉！汪按。曰辨证。曰好学。皆宜着眼。此等温燥之方。本以治寒湿。乃用以治燥热。宜其杀人也。即此论而
反观之。则知遇寒湿之证。而以治燥热之方。投之亦必杀人矣。故传方者。非轻淡平稳之方。切勿妄传。否则有利。亦
必有害也。夫以东坡之淹博，尚有误信圣散子之事，况下此者乎。今之 绅先生，涉猎医书，未经临证，率尔着书立说，
多见其不知量也。汪按∶洄溪有涉猎医书，误人论语皆切中。
这类人，由于惊恐忧虑之气郁结在体内，再加上饮食不节制，很容易导致疾病。如果与患者近距离接触，邪气容易传染，危害极大。尤其是年老体弱之人，更应当谨慎。总帅不听劝告，到了腊月大军凯旋时大雪纷飞，新投降的俘虏因受冻挨饿，都患上头痛咳嗽、腹泻腹痛的病，大多死亡。正月到达汴京时，宰相因为去赴贺宴，多次痛饮，于是生病，脉象沉细而弦，每三四次跳动有一次停顿，症状表现与新投降的俘虏无异，三天后去世。《内经》说：趁着年运虚衰，遇到月廓空虚，违背了时令的和谐。因此感受邪气，邪气深入至骨，能不敬畏吗？俞惺斋说：按喻氏论述疫病引用张仲景《辨脉篇》中“寸口脉阴阳俱紧”这一节，阐发了深奥的道理。认为清邪从上焦侵入，从鼻进入阳分；浊邪从下焦侵入，从口进入阴分。在阳分，则出现发热、头痛、项强颈挛；在阴分，则出现足膝逆冷、大小便失禁。大凡伤寒之邪，由体表而入，所以依次传变六经。疫邪从口鼻而入，所以直达三焦，三焦混杂，内外不通，导致口腔糜烂牙龈溃烂、声音嘶哑咽喉阻塞、痈脓下血、脐腹绞痛等病变。治疗方法：未病之前，预先服用芳香正气药，使邪气不能侵入。如果邪气已经侵入，则以祛除秽浊为第一要义，这与吴又可的观点暗合，与李杲、罗天益两家所述的劳役、忧惊、冻馁致病的情况截然不同。然而各有其道理，医生必须详细考察病因，仔细参详脉证来施治。汪氏按语：据此可知疫病的成因不一。绝不能拘执一方来概括治疗。只是说因病致死，病气尸气，混合不正之气、种种恶秽，交结互蒸，人在其中，没有缝隙可以躲避，这样没有人不生病，这确实是各种疫病共同的特点。从前崇祯十六年，从八月到十月，京城发生大瘟疫，突然死亡，医生祈祷来不及，后来有外省人员到京城，能识别此证，看膝盖弯后有筋肿起，紫色者无救，红色者速刺出血可无患，以此救活多人，病情也逐渐平息。这也是医生所应当知道的。大概血液流出则疫毒外泄，所以得以生存。按语：又有羊毛瘟这种病。病患心前背后有黑点如跳蚤斑的是这种病。用小针在黑处挑之，即有毛出，须挑拔净尽才痊愈。另外，《辍耕录》记载：元朝伯颜平定宋朝后，搜取大黄数十车，满载而去，大军过淮河时，被俘掠的百姓及降卒，与北来的大兵都患上疫病，用大黄治疗，保全性命的人很多。《宋元通鉴》记载：耶律楚材灭夏的事情，则大黄确实是治疗疫病的妙品。吴又可《温疫论》称赞大黄为起死神丹，原本不是杜撰。那么李杲、罗天益两家的说法，又不可以作为兵后患疫病的固定法则。汪氏按语：李杲、罗天益的说法，虽然不是固定法则，但也不可不知道。近年所见，颇有符合李杲、罗天益说法的，只能说这不是正疫的治疗法则，医家大体上各自阐明一个方面，全在于善于读书的人融会贯通。大概当今世人认为治疗疫病必定适宜用温热剂。固然是谬论。如果说疫病绝对不宜用温热剂。则是僵化固执的见解。关键在于随证施治用得恰当罢了。
王士雄按语：《续医说》说：王宇泰认为圣散子方，因为苏东坡先生作序，从此天下人视其为神方，宋末辛未年永嘉发生瘟疫，服用此方被害的人，不可胜数。我阅读《石林避暑录话》说：宣和年间，此药在京城盛行，太学生相信它尤其笃诚，杀人无数，医生们顿时废弃不用。昔日苏东坡贬谪居住黄州时，那里临近长江，多卑湿之地，而黄州居民所感染的病，有的因中湿而病，有的因雨水浸淫而得，所以服用此方大多有效，因此通行于世，遗祸无穷。宏治癸丑年，吴中地区疫病大作，吴县县令孙磐，命令医生配制圣散子，遍施于街衢，并把这个方子刊印发行，病人服用，十无一活，都是狂躁昏瞀而死。唉！孙公的本意，本来是救人，却不知道圣散子方中有附子、良姜、吴茱萸、豆蔻、麻黄、藿香等药，皆性味温燥，反而助长热邪，不死还等什么？如果不辨证而一概施治，杀人比刀剑还快，如果有能广泛传播这个说法以告知他人，也是仁者的一个方面。我认为疫病多属热邪，如老君神明散、务成萤火丸、仓公辟瘟丹、子建杀鬼丸，都是禁忌之剂。假设喜好仁爱却不好学，轻易地传授给人，那祸害能说尽吗？汪氏按语：曰辨证，曰好学，都应当着眼。这种温燥的方子，本来是用来治疗寒湿的，乃用来治疗燥热，难怪会杀人。就这个论点反过来看，就知道遇到寒湿的证候，如果用治疗燥热的方子投予，也必然杀人。所以传授方子的人，如果不是轻淡平稳的方子，切勿妄传。否则有利，也必有害。像苏东坡那样渊博，尚有误信圣散子的事情，何况低于他的人呢。现在的绅士先生，涉猎医书，未经临证，轻率地著书立说，多见他们不知量力。汪氏按语：洄溪（徐灵胎）关于涉猎医书误人论语的评论都切中要害。
These individuals, whose qi of fright and anxiety is accumulated internally, combined with irregular diet, are prone to disease. Close contact facilitates the transmission of pathogenic factors, causing the greatest harm. This is especially true for those who are elderly and physically weak, who must be particularly cautious. The Commander-in-Chief did not listen. By the twelfth lunar month, when the army returned in heavy snow, the newly surrendered captives, suffering from cold and hunger, all developed headaches, coughs, diarrhea, and abdominal pain, leading to many deaths. In the first month, upon arriving at Bianjing, the Chancellor fell ill after attending celebratory banquets and drinking heavily. His pulse was deep, fine, and wiry, with a pause every three or four beats. His manifestations were identical to those of the new captives, and he died three days later. *The Inner Canon* states: "When the annual qi is deficient, the lunar phase is empty, and the harmony of the seasons is lost, contracting pathogens causes the evil to penetrate to the bone. Can one not revere this?" Yu Xingzhai stated: Regarding Yu's discussion on epidemics, which cites Zhang Zhongjing's *Treatise on Pulse Differentiation*, specifically the section on "the yin and yang pulses at the cunkou are both tight," elucidating profound principles: it posits that clear pathogens attack the upper jiao, entering through the nose into the Yang; turbid pathogens attack the lower jiao, entering through the mouth into the Yin. When in the Yang, symptoms include fever, headache, neck stiffness, and contraction; when in the Yin, symptoms include cold feet and knees, and incontinence. Generally, Cold Damage pathogens enter from the exterior and transmit sequentially through the six meridians. Epidemic pathogens enter via the mouth and nose, reaching directly to the San Jiao (Triple Burner). When the San Jiao becomes confused, internal and external communication is blocked, leading to complications such as oral ulcers and gingival erosion, hoarseness and throat obstruction, abscesses with pus and bleeding, and severe umbilical pain. Treatment method: Before illness, pre-administer aromatic Qi-rectifying herbs to prevent pathogen entry. If pathogens have already entered, removing turbidity is the primary principle. This aligns with Wu Youke's theory and differs significantly from the accounts of Li Gao and Luo Tianyi regarding diseases caused by overwork, worry, fright, cold, and hunger. However, each has its rationale; physicians must carefully investigate the etiology and meticulously analyze pulse and symptoms to treat accordingly. Wang's commentary: Based on this, we know that the causes of epidemics vary. One cannot rigidly adhere to a single formula for treatment. It is said that death results from the mixing of pathogenic qi and corpse qi with abnormal qi and various foul odors, steaming and intertwining, leaving no escape for people within, thus everyone falls ill. This is indeed common to all epidemics. Previously, during the 16th year of Chongzhen, from August to October, a major epidemic struck the capital, causing sudden death where medical prayer was too late. Later, officials from other provinces arrived in the capital who could identify this syndrome: if tendons swelled behind the knee and appeared purple, there was no hope; if red, rapid bloodletting could prevent disaster, saving many lives, and the disease gradually subsided. This is knowledge physicians should possess. Essentially, bloodletting allows epidemic toxins to exit externally, ensuring survival. Commentary: There is also "Wool Plague." Patients present with black spots like flea bites on the chest and back. Using a small needle to prick these black spots releases hair; thorough removal is required for cure. Additionally, *Zhuo Geng Lu* records: After Yuan general Bayan conquered Song, dozens of carts of Rheum palmatum (Dahuang) were seized and taken away. When the army crossed the Huai River, captured civilians, surrendered soldiers, and northern troops all contracted epidemics, treated successfully with Rheum palmatum. *Song-Yuan Tongjian* records events involving Yelü Chucai destroying Xia, confirming that Rheum palmatum is indeed a miraculous product for treating epidemics. Wu Youke's *Treatise on Warm Epidemics* praises Rheum palmatum as a divine elixir capable of reviving the dying, which is not fabricated. Thus, the theories of Li Gao and Luo Tianyi cannot be considered fixed laws for post-war epidemics. Wang's commentary: Although the theories of Li and Luo are not fixed laws, they should not be ignored. Recent observations show cases fitting their descriptions, though these may not represent standard epidemic treatments. Physicians generally master specific aspects; it is up to those skilled in reading to integrate them comprehensively. Currently, it is believed that treating epidemics requires warm and hot agents. This is undoubtedly erroneous. However, claiming that warm and hot agents are absolutely contraindicated in epidemics is also a rigid view. The key lies in appropriate treatment based on syndrome differentiation.
Wang Shiyong's commentary: *Xu Yi Shuo* states: Wang Yutai noted that the Sheng San Zi Formula became revered worldwide due to Su Dongpo's preface. During the plague in Yongjia in the Xinwei year of the late Song Dynasty, countless people were harmed by taking this formula. I read *Shilin Bishu Luhuazhi*: During the Xuanhe era, this medicine was prevalent in the capital, especially trusted by imperial students, killing countless people, until physicians abandoned it. When Su Dongpo was exiled to Huangzhou, located near the river with damp and low terrain, residents suffered from dampness or rain-induced illnesses, so the formula was effective there and spread widely, causing endless misfortune. In the Guichou year of Hongzhi, a severe epidemic broke out in Wuzhong. Sun Pan, the magistrate of Wu County, ordered physicians to prepare Sheng San Zi Formula and distribute it widely, even printing the prescription. Those who took it mostly died, succumbing to mania and coma. Alas! Lord Sun's intention was to save lives, but he did not realize that Sheng San Zi Formula contains Aconiti Lateralis Radix Praeparata (Fuzi), Alpiniae Officinarum Rhizoma (Liangjiang), Evodiae Fructus (Wuyu), Cardamomi Fructus (Doukou), Ephedrae Herba (Mahuang), and Agastaches Herba (Huoxiang), all of which are warm and dry in nature, exacerbating heat pathogens. How could patients not die? Treating indiscriminately without syndrome differentiation kills faster than swords. Spreading this warning is an act of benevolence. I believe most epidemics involve heat pathogens. Formulas such as Laojun Shenming San, Wucheng Yinghuo Wan, Cangong Biwen Dan, and Zijian Sha Gui Wan are strictly contraindicated. If one loves benevolence but neglects study, and lightly transmits such formulas, the disaster would be incalculable. Wang's commentary: Emphasizing syndrome differentiation and diligent study is crucial. These warm and dry formulas are originally intended for cold-dampness; using them for dry-heat conditions naturally leads to death. Conversely, using formulas for dry-heat on cold-damp syndromes will also kill. Therefore, those transmitting formulas should never disseminate non-mild and stable prescriptions recklessly. Otherwise, benefits may turn to harm. Even someone as erudite as Su Dongpo erred in trusting Sheng San Zi; how much more so for others? Gentlemen today who skim medical texts without clinical experience rashly publish books, revealing their lack of self-awareness. Wang's commentary: Xu Lingtai's (Hui Xi) critiques on how skimming medical texts harms people via the Analects are highly pertinent.