诒按∶吴氏所论温疫中后治法，大概与伏温相合。故后来张石顽、蒋问斋等治温热病，每每引用。惟方药
粗悍，宜于藜藿壮实之体，而不宜于膏粱虚弱之人耳。所可议者，开手即谓温疫秽浊之邪，由口鼻吸受，藏于
募原而发。将伏气化温之病，概行抹煞。并疑内经冬伤于寒春必病温之语为不足凭。试思募原之邪，专在气分
，即使善于传变，亦何至有先里后表，但里不表，里而又里，如后面所称九传之变证哉！至所叙初起
证情，以及舌苔脉象，大略是暑湿浊邪蒙蔽中焦之证，与疫厉恶毒之邪，沿门阖户，如霍乱烂喉捻颈等险恶之
证，传染不已者，亦不相同。然则又可所指之温，既未得伏温之真谛；所论之疫，又未得疫证之全体∶似无足
取矣。然又可当明季兵荒 至之时，确有是病，以此治病，确乎有效，乃以其所阅历者着为此论。虽不免有粗
疏之弊，亦岂容一概屏弃。况篇中所论应下失下，及下后诸变证，曲折详尽，多阐前人未发之秘，堪为临证圭
臬者，正复不少。爰采论中，与伏温相合者各条，附列于下，并分系于各篇之后而详论之。
温疫之邪，从口鼻而入，不在经络，舍于伏膂之内，去表不远，附近于胃，乃表里之分界，是即内经疟论
所谓横连募原是也。凡人本气充满，邪不易入，适逢亏欠，因而乘之。感之浅者，待有所触而发；感之深者，
中而即病。其始阳气郁伏，凛凛恶寒，甚则四肢厥逆；既而阳气郁发，中外皆热，发即昏昏不爽，壮热自汗。
此邪伏于募原，即使汗之，热不能解。必俟伏邪已溃，表气渐行于内，精元自内达表，此时表里相通，大汗淋
漓，邪从外解，此名战汗，当即脉静身凉而愈。
诒按∶从口鼻吸受者，必系暑湿秽浊之邪。其发也，心有痞闷、呕恶、嘈搅等募原达胃之见证。治之当用
芳香开泄，如藿香正气之类。此不在经络，本非汗能解。若暴受风寒邪在经络者，其邪尚浅，一汗即解而不战
也。若大寒大热，必战而得汗乃能解热者，其邪必深且重。迨郁伏而发，邪正交争则战，正胜邪却则汗，此即
属伏温见证。虽病情万变，不可执一，
伏温之病∶每有兼挟暑湿秽浊，或暴感风寒夹杂而发者∶然医者必须逐层分别，认清来源，方可施治。吴氏于
入手之初，叙述病情，不能分晰清楚，混称之曰温疫，致后人相沿遗误，不容不辨。
若伏邪未尽，必复发热。其热之久暂，视所感之轻重，要皆先寒后热。至伏邪发出，方显变证。
诒按，据此病机，合之下文表里九传，则所云伏邪，必非轻浅之邪，如募原所伏之秽浊矣。
其证或从外解，或从内陷，更有表里先后不同∶有先表而后里者，有先里而后表者，有但表而不里者，有
但里而不表者，有表而再表，有里而再里，有表胜于里者，有里胜于表者，有表里分传者。此为九传。
诒按∶所列九传证情，变幻殊甚。然惟伏气化温，从少阴外达者，每每有之。邪机仅在募原者，未必如是
也。
疫邪初起，脉不浮不沉而数，昼夜皆热，日晡益甚，头疼身痛。不可用辛热药汗之，又未可下，宜用达原
饮以透募原之邪为当。若见少阳、阳明、太阳证，随经加柴胡、葛根、羌活为引，以提其邪出阳分也。
诒按∶若系暑湿浊邪，舌苔白腻者，用达原饮甚合。若伏温从少阴外达者，则达原饮一派辛燥，既不能从
里透邪，而耗气劫津，非徒无益，而又害之矣。学人当细心体认，勿误用也。
邪之轻者，舌上白苔亦薄，脉亦不甚数，一二剂自解。如不得汗，邪气盘错于募原也，只以本方主之。
感之重者，舌上苔如积粉，药后不从外解而反内陷，舌根先黄渐至中央，此邪渐入胃也。前方加大黄下之。
诒按∶以舌苔之浓薄为病之轻重，是暑湿浊邪之的据。若伏温则尽有邪机极重，而舌苔如无病者。缘邪发
于阴，未涉于胃故也。学人于此等处，细心分别，则伏温与疫邪异同之辨，自可了然矣。
若脉长而洪数，大汗多渴，此邪气适离募原，欲表不表，白虎汤证也。如舌上纯黄色，兼见里证，此邪已
入胃，承气汤证也。
诒按∶白虎、承气，均是治热邪犯胃之重剂。凡无形之邪热，燔灼于胃者，用白虎∶有形之垢热，结于胃
腑者，用承气；此一定不易之法。乃以欲表不表，则当以导之出表为要，不当以白虎专清里热矣。
疫邪为病∶有从战汗解者；有从自汗盗汗解者；有无汗竟全归胃腑者；有自汗淋漓，热渴反甚，终得战汗
而解者；有胃气壅遏，必下后始得战汗而解者；有汗解而里和，越三四日复发热者；有已发黄，因下而复热发
斑者；有竟从发斑而愈者；有里证偏重，虽有斑仍非下不愈者；此虽传变不常，要皆意中事也。
诒按∶所列病情传变，颇为详悉。但如汗解后，越日复热；发黄后，因下复热；发斑后，仍非下不愈；此
等证情，伏温每每有之。若邪伏募原之湿温，未必尔也。
又有意外之变，如男子适逢使内，邪热乘虚陷于
下焦，气道不通∶以致小便淋涩，少腹胀满，至夜发热。用导赤、五苓辈，分毫不效；与大承气一服，小便如
注而愈者。
诒按∶此邪热陷入肝肾之部，当从阴分，导泄其热乃愈。导赤、五苓，固与证不合，即承气得效，亦不过
得大黄泄热之力耳。其实方中之枳、朴、芒硝，与证情亦不相合也。
又有女子经水适来适断，以及失血崩带，心痛疝气，痰火喘哮等证，随时挟发者，此皆出于意外者也。大
抵邪行如水，惟HT 处受之，此喻最切要。至因新病而来旧病，但治新病而旧病自已也。
诒按∶因新病牵动旧病，治当以新病为主，此定理也。但其中亦须审察轻重缓急，以定治法，未可执一论
也。
然有大劳、大欲、大病、久病后发病者，此为四损。其正气先亏，每致邪气易陷，多不可救。
诒按∶凡决温热病之生死，总以正气之强弱衡之。病邪虽重，而正气能支，尚可不死，有病邪虽轻，而正
气不能支持，每每猝然蒙陷。不可不知。
吴又可曰∶疫邪一二日，舌上苔如积粉，早服达原饮一剂。午后舌色变黄，随见胸膈满痛，大渴烦扰，此
伏邪已溃，毒传于里也。前方加大黄下之，烦热稍减。傍晚后加躁烦发热，通舌黑刺，鼻如烟煤，此邪毒最重
。待瘀到胃，急接承气汤，抵暮大下，夜半热退，次
早黄刺如失。一日有此三变，数日之法，一日行之。因其毒甚，故传变亦速，投剂不得不紧；设用缓法，必无
及矣。
诒按∶似此传变迅速，疫邪秽毒极重者多有之；若寻常伏气所发，未必若是之重且速也。
又曰∶邪入胃者，非承气不愈。误投白虎，既无破结之能，反抑邪毒，致脉不行，反变细小。倘误认阳证
阴脉，复不敢下，逡巡死耳。当此急投小承气，庶可挽回。
诒按∶必有大热大渴，脉洪多汗，舌无浓浊苔，方为白虎的证。至脉变细小，仍投承气，亦须认清见证。
若胃无垢热，承气岂可妄施。
又曰∶疫邪初发，必在半表半里。至于传变，或表里分传。医执成见，必先解其表，此大谬也。尝见用大
剂麻黄，一毫无汗，转加烦热。盖里气结滞，阳气不得宣达于表，即四肢未免微厥，安有津气蒸蒸而外达乎。
必用承气通其腑。苟里气一通，不待发散，多有自汗而解者。
诒按∶所论虽属疫邪，而温热病热结于胃，津液不行而无汗者，其理与此正同。
柳宝诒按语：吴又可所论述的温疫中后期治法，大体上与伏气温病相吻合。因此后来张石顽、蒋问斋等人治疗温热病时，常常引用他的观点。只是吴氏的方药性质粗犷猛烈，适宜于体质壮实、饮食粗糙之人，而不适宜于体质虚弱、饮食精细之人。其中可以议论的是，吴氏一开始就认为温疫秽浊之邪，是通过口鼻吸入，潜伏在募原（半表半里之间）而发病。这完全抹杀了伏气化温这一类疾病的存在。并且他怀疑《黄帝内经》中“冬季感受寒邪，春季必然发生温病”的说法是不可靠的。试想一想，募原的邪气，专门停留在气分，即使善于传变，又怎么会发展到先出现里证后出现表证、只有里证没有表证、或者里证反复出现的，像后面所说的九种传变证候呢！至于他所叙述的初起病情，以及舌苔和脉象，大略是暑湿浊邪蒙蔽中焦的证候，与那种沿门阖户传染、像霍乱、烂喉丹痧、捻颈等险恶的疫病证候，也不相同。既然这样，那么吴又可所指的温度，既没有得到伏气温病的真谛；他所论述的疫病，又没有得到疫病证候的全貌：似乎没有什么可取之处了。然而吴又可处于明朝末年兵荒马乱的时候，确实有这种病，用这种方法治病，确实有效，他是根据自己经历的情况写下这篇论著的。虽然不免有粗疏的弊端，哪里容得下一概摒弃呢？况且篇中所论述的应当攻下却未攻下，以及攻下后的各种变证，曲折详尽，大多阐发了前人未曾发现的奥秘，足以作为临床诊治的准则的，正不少见。于是摘录论中与伏气温病相合的各条内容，附列在下面，并分别系在各篇之后进行详细论述。
温疫的邪气，从口鼻进入，不在经络，潜伏在伏膂之内（指胸腹深处），距离体表不远，靠近胃腑，这是表里的分界，也就是《黄帝内经·疟论》所说的横连募原。凡是人体本气充足，邪气不容易侵入，恰好遇到正气亏虚，因而乘虚而入。感受较浅的，等待有所触动才发作；感受较深的，中邪后立即发病。起初阳气郁伏，凛凛恶寒，甚至四肢厥冷；随后阳气郁发，内外皆热，发作时昏沉不爽，高热自汗。这是邪气潜伏在募原，即使使用发汗法，热也不能解除。必须等到伏邪已经溃散，表气逐渐行于体内，精元自然从内达表，此时表里相通，大汗淋漓，邪气从外解除，这叫做战汗，应当随即脉静身凉而痊愈。
柳宝诒按语：从口鼻吸入的，必定是暑湿秽浊之邪。其发作时，会有心下痞闷、呕吐恶心、嘈杂搅动等募原达胃的见证。治疗应当使用芳香开泄的方法，如藿香正气散之类。这不在经络，本来就不是发汗能解的。如果突然感受风寒，邪气在经络，邪气尚浅，一发汗即解而不会发生战栗。如果是大寒大热，必须战栗出汗才能解热的，邪气必定深重。等到郁伏而发，邪正交争则战栗，正气战胜邪气则出汗，这就属于伏气温病的见证。虽然病情万变，不可固执一端，
伏气温病：常常兼挟暑湿秽浊，或突然感受风寒夹杂而发作：但是医生必须逐层分辨，认清来源，才可以施治。吴氏在入手之初，叙述病情，不能分析清楚，混称为温疫，导致后人沿袭遗留错误，不容不加以辨析。
如果伏邪未尽，必定再次发热。发热的久暂，取决于感受邪气的轻重，但都是先寒后热。直到伏邪发出，才显现出变证。
柳宝诒按语：根据这个病机，结合下文的表里九传，那么所说的伏邪，必定不是轻浅的邪气，而是像潜伏在募原的秽浊之气。
其证候有的从外解除，有的从内陷入，更有表里先后不同：有先表而后里的，有先里而后表的，有只表不里的，有只里不表的，有表证再发为表证的，有里证再发为里证的，有表证胜于里证的，有里证胜于表证的，有表里同时传变的。这叫做九传。
柳宝诒按语：所列九种传变的证情，变化非常殊异。然而只有伏气化温，从少阴经外达者，常常会有这种情况。邪气仅仅在募原的，未必会是这样。
疫邪初起，脉象不浮不沉而数，昼夜都发热，傍晚时分更严重，头疼身痛。不可以用辛热药发汗，也不可攻下，适宜使用达原饮来透达募原的邪气为当。如果见到少阳、阳明、太阳证，随经加柴胡、葛根、羌活作为引经药，以提引邪气出于阳分。
柳宝诒按语：如果是暑湿浊邪，舌苔白腻的，使用达原饮很合适。如果是伏温从少阴经外达的，那么达原饮一派辛燥，既不能从里透邪，反而耗气伤津，不仅无益，而且有害。学习者应当细心体认，不要误用。
邪气轻的，舌上白苔也薄，脉象也不怎么数，一二剂药自然解除。如果不得汗，是邪气盘踞在募原，只用本方主治。
感受重的，舌上苔如积粉，服药后不从外解反而内陷，舌根先黄逐渐至中央，这是邪气渐渐入胃。前方加大黄攻下。
柳宝诒按语：以舌苔的浓薄作为病情轻重的依据，是暑湿浊邪的确凿证据。如果是伏温，尽有邪机极重，而舌苔像没病的人。因为邪气发于阴分，未涉及胃腑的缘故。学习者在这些地方，细心分辨，那么伏温与疫邪异同的辨别，自然可以清楚了。
如果脉长而洪数，大汗多渴，这是邪气刚刚离开募原，想要出表却未能出表，是白虎汤证。如果舌上纯黄色，兼见里证，这是邪气已入胃，是承气汤证。
柳宝诒按语：白虎汤、承气汤，都是治疗热邪犯胃的重剂。凡是无形之邪热，燔灼于胃的，用白虎汤；有形之垢热，结于胃腑的，用承气汤；这是确定不变的方法。既然说是欲表不表，那么应当以导邪出表为要务，不应当只用白虎汤专清里热了。
疫邪致病：有通过战汗解除的；有通过自汗盗汗解除的；有无汗竟全归胃腑的；有自汗淋漓，热渴反而加重，最终通过战汗而解除的；有胃气壅遏，必须攻下后才得战汗而解除的；有汗解后里气和顺，过了三四天又发热的；有已经发黄，因攻下后又发热发斑的；有竟然通过发斑而痊愈的；有里证偏重，虽然有斑仍然非攻下不能痊愈的；这些虽然传变不常，但都是意料中的事。
柳宝诒按语：所列病情传变，颇为详细。但是像汗解后，过日又发热；发黄后，因攻下又发热；发斑后，仍然非攻下不能痊愈；这些证情，伏温常常会有。如果是邪伏募原的湿温，未必如此。
又有意外的变故，如男子正好房事，邪热乘虚陷入下焦，气道不通：以致小便淋涩，少腹胀满，夜间发热。用导赤散、五苓散之类，分毫不效；给服大承气汤一剂，小便如注而痊愈。
柳宝诒按语：这是邪热陷入肝肾部位，应当从阴分，导泄其热才能痊愈。导赤散、五苓散，固然与证候不合，即使承气汤见效，也不过是得到大黄泄热的力量罢了。其实方中的枳实、厚朴、芒硝，与证候也不相合。
又有女子月经适来适断，以及失血崩漏带下，心痛疝气，痰火喘哮等证，随时夹杂发作的，这都是出于意外的大抵邪气运行如水，只在有空隙的地方受之，这个比喻最切要。至于因新病引发旧病，只要治疗新病而旧病自然就好了。
柳宝诒按语：因新病牵动旧病，治疗应当以新病为主，这是定例。但其中也必须审察轻重缓急，以确定治法，不可固执一端而论。
然而有大劳、大欲、大病、久病后发病的，这叫四损。其正气先亏，往往导致邪气容易陷入，大多不可救。
柳宝诒按语：凡决定温热病生死的关键，总以正气的强弱来衡量。病邪虽重，而正气能支持，还可以不死；有病邪虽轻，而正气不能支持，往往突然蒙陷。不可不知道。
吴又可说：疫邪一二日，舌上苔如积粉，早上服用达原饮一剂。午后舌色变黄，随即出现胸膈满痛，大渴烦扰，这是伏邪已溃，毒气传入里部。前方加大黄攻下，烦热稍减。傍晚后更加躁烦发热，通舌黑刺，鼻如烟煤，这是邪毒最重。等到瘀滞到胃，急忙接续承气汤，傍晚时分大下，夜半热退，次日早晨黄刺消失。一天内有这三种变化，几天的治法，一天施行。因为毒性甚重，所以传变也迅速，投药不得不紧；如果使用缓法，必定来不及了。
柳宝诒按语：像这样传变迅速，疫邪秽毒极重的情况多有发生；如果是寻常伏气所发，未必会这么重且快。
又说：邪气入胃的，不用承气汤不能痊愈。误投白虎汤，既没有破结的能力，反而抑制邪毒，导致脉象不行，反而变得细小。如果误认阳证阴脉，又不敢攻下，犹豫不决就会死亡。当此之时急忙投用小承气汤，或许可以挽回。
柳宝诒按语：必须有大热大渴，脉洪大多汗，舌无浓浊苔，才是白虎汤的确切适应证。至于脉变细小，仍投承气汤，也必须认清见证。如果胃中没有垢热，承气汤岂可妄用。
又说：疫邪初发，必定在半表半里。至于传变，或表里分传。医生固执成见，必须先解其表，这是大错。曾见用大剂量麻黄，一毫无汗，反而加重烦热。因为里气结滞，阳气不得宣达于表，即使四肢未免微厥，哪里有津气蒸蒸而外达呢。必须用承气汤通其腑。如果里气一通，不待发散，多有自汗而解的。
Liu Baozhi's commentary: The treatment methods for the middle and late stages of warm epidemics discussed by Wu Youke generally align with latent warm diseases. Therefore, later physicians such as Zhang Shiweng and Jiang Wenzhai often cited his views when treating warm-heat diseases. However, Wu's prescriptions are coarse and fierce; they are suitable for robust individuals with rough diets but unsuitable for those who are physically weak and consume rich foods. What can be criticized is that Wu immediately asserted that the turbid pathogenic factors of warm epidemics enter through the mouth and nose, lodge in the *Muyuan* (the area between the exterior and interior), and then manifest. This completely negates the existence of diseases where latent pathogens transform into warmth. Furthermore, he doubted the reliability of the statement in the *Huangdi Neijing* ("Winter injury by cold leads to spring warmth"). Consider this: if the pathogen at the *Muyuan* stays exclusively in the Qi level, even if it transmits readily, how could it develop into patterns characterized by interior symptoms preceding exterior ones, or only interior without exterior, or recurring interior symptoms, as described in the subsequent "Nine Transmissions"? As for the initial clinical manifestations, tongue coating, and pulse he described, they roughly correspond to patterns of summer-heat, dampness, and turbidity obstructing the Middle Jiao. These differ from severe epidemic diseases like cholera, scarlet fever-like throat conditions, or neck stiffness, which spread house-to-house and door-to-door. Thus, Wu's concept of "warmth" fails to grasp the essence of latent warm diseases, and his discussion of "epidemics" does not cover the full spectrum of epidemic patterns; consequently, there seems to be little value in his work. Nevertheless, during the chaotic times of the late Ming Dynasty, such diseases did exist, and his treatments were indeed effective. He wrote this treatise based on his personal experience. Although it has flaws of being crude and imprecise, it should not be entirely discarded. Moreover, his detailed discussions on missed opportunities for purgation and the resulting complications after purgation reveal many secrets previously unexplored by predecessors, serving as valuable guidelines for clinical practice. Therefore, I have extracted the sections relevant to latent warm diseases, listed them below, and provided detailed commentaries attached to each chapter.
The pathogenic factor of warm epidemics enters through the mouth and nose, does not affect the meridians, and lodges within the deep tissues near the diaphragm (*Fulu*), close to the Stomach. This area represents the boundary between the exterior and interior, corresponding to what the *Neijing·Mallu Lun* refers to as the *Muyuan*. When a person's vital Qi is abundant, pathogens find it difficult to invade; however, if there is a deficiency, the pathogens take advantage. If the infection is shallow, symptoms may appear only after a trigger; if deep, illness occurs immediately upon infection. Initially, Yang Qi is constrained and depressed, causing aversion to cold, potentially progressing to cold limbs. Subsequently, the constrained Yang Qi erupts, causing heat throughout the body, accompanied by lethargy, high fever, and spontaneous sweating. This indicates pathogens lodged in the *Muyuan*; even if sweating methods are used, the heat will not resolve. One must wait until the latent pathogen dissipates, allowing Exterior Qi to move inward and Essence/Yuan Qi to reach the exterior. At this point, the interior and exterior connect, leading to profuse sweating, expulsion of the pathogen from the exterior, a phenomenon known as "chill-sweat" (*Zhan Han*). Recovery follows with a calm pulse and cool body temperature.
Liu Baozhi's commentary: Pathogens entering via the mouth and nose are necessarily summer-heat, dampness, and turbid factors. Their manifestation presents with epigastric fullness, nausea, vomiting, and discomfort, indicating the transmission from *Muyuan* to the Stomach. Treatment should employ aromatic opening and draining methods, such as *Huoxiang Zhengqi San*. Since these pathogens are not in the meridians, sweating alone cannot resolve them. In contrast, sudden exposure to wind-cold affecting the meridians involves shallow pathogens that resolve with a single sweat without chills. Severe cold or heat requiring chills before sweating indicates deep and heavy pathogens. When latent pathogens erupt, the struggle between healthy Qi and pathogenic factors causes chills; victory of healthy Qi results in sweating, characteristic of latent warm diseases. Although clinical presentations vary, one must not adhere rigidly to a single approach.
Latent warm diseases often involve concurrent summer-heat, dampness, and turbidity, or sudden wind-cold invasion mixed with latent pathogens. Physicians must analyze layer by layer and identify the source before treating. Wu Youke failed to clearly distinguish these in his initial descriptions, confusingly labeling them all as "warm epidemics," leading to errors among later practitioners. This requires clarification.
If latent pathogens remain unresolved, fever recurs. The duration depends on the severity of the initial infection, but typically begins with chills followed by heat. Variations become apparent only when the latent pathogen emerges.
Liu Baozhi's commentary: Based on this pathogenesis and the subsequent "Nine Transmissions," the so-called latent pathogen is certainly not a mild one, but rather the turbid qi lurking in the *Muyuan*.
Clinical manifestations may resolve from the exterior or sink inward, with varying sequences of exterior and interior involvement: exterior preceding interior, interior preceding exterior, exterior only, interior only, repeated exterior patterns, repeated interior patterns, exterior dominating interior, interior dominating exterior, and simultaneous exterior-interior transmission. These constitute the "Nine Transmissions."
Liu Baozhi's commentary: The variations in the Nine Transmissions are complex. Such patterns frequently occur when latent Qi transforms into warmth and emerges from the Shaoyin channel. Patterns confined solely to the *Muyuan* do not typically exhibit such complexity.
In the early stage of epidemic pathogens, the pulse is neither floating nor sinking but rapid, with constant fever worsening in the late afternoon, headache, and body ache. Acrid-warm herbs for sweating are contraindicated, as are purgatives. *Dayuan Yin* should be used to penetrate the *Muyuan* pathogens. If Shaoyang, Yangming, or Taiyang patterns appear, add Bupleurum (*Chaihu*), Kudzu Root (*Gegen*), or Notopterygium (*Qianghuo*) as guiding herbs to draw the pathogen out to the Yang levels.
Liu Baozhi's commentary: For summer-heat and dampness-turbidity with a white greasy tongue coating, *Dayuan Yin* is appropriate. However, for latent warmth emerging from Shaoyin, *Dayuan Yin* consists of acrid-drying herbs that fail to penetrate pathogens from the interior and instead consume Qi and damage fluids, causing harm rather than benefit. Students must carefully recognize this distinction to avoid misuse.
For mild pathogens, the white tongue coating is thin, and the pulse is not very rapid; resolution occurs within one or two doses. If no sweat occurs, the pathogen is entrenched in the *Muyuan*, and the original formula should be continued.
For severe infections, the tongue coating resembles accumulated powder. After medication, if the pathogen does not resolve from the exterior but sinks inward, the root of the tongue turns yellow, spreading to the center, indicating entry into the Stomach. Add Rhubarb (*Dahuang*) to the previous formula for purgation.
Liu Baozhi's commentary: Using the thickness of the tongue coating as an indicator of disease severity is a reliable sign for summer-heat and dampness-turbidity. In latent warmth, even with severe pathology, the tongue coating may appear normal because the pathogen originates in the Yin levels and has not yet affected the Stomach. Careful differentiation here allows clear distinction between latent warmth and epidemic pathogens.
If the pulse is long, surging, and rapid, with profuse sweating and intense thirst, the pathogen has just left the *Muyuan* but attempts to exit the exterior without success; this is a *Baitao Tang* pattern. If the tongue is purely yellow with interior signs, the pathogen has entered the Stomach, indicating a *Chengqi Tang* pattern.
Liu Baozhi's commentary: Both *Baitao Tang* and *Chengqi Tang* are heavy formulas for treating heat invading the Stomach. For formless heat blazing in the Stomach, use *Baitao Tang*; for tangible turbid heat bound in the Stomach fu-organs, use *Chengqi Tang*. This is an immutable principle. Given the description of "desiring to exit the exterior but failing," the priority should be guiding the pathogen out, not merely clearing interior heat with *Baitao Tang*.
Epidemic pathogens may resolve through chill-sweat, spontaneous or night sweats, or progress directly to the Stomach fu-organs without sweating. Some cases involve profuse sweating with intensified heat and thirst, eventually resolving through chill-sweat. Others feature Stomach Qi obstruction requiring purgation before chill-sweat can occur. Some resolve with sweating and harmonized interior, only to relapse with fever after three to four days. Jaundice may recur after purgation, or macules may appear after purgation. Some recover through macule eruption. Some have dominant interior patterns where purgation is necessary despite the presence of macules. Although transmission varies, these outcomes are predictable.
Liu Baozhi's commentary: The described transmissions are detailed. However, relapses after sweating, jaundice recurrence after purgation, and persistent need for purgation despite macules are common in latent warmth, whereas wet-warmth pathogens lingering in the *Muyuan* rarely present this way.
Unexpected complications may arise, such as in men who engage in sexual activity during illness, allowing heat pathogens to sink into the Lower Jiao due to deficiency, blocking the Qi mechanism. This results in dysuria, lower abdominal fullness, and nighttime fever. Treatments like *Daochi San* or *Wuling San* are ineffective. A single dose of *Da Chengqi Tang* may restore normal urination and cure the condition.
Liu Baozhi's commentary: This indicates heat pathogens sinking into the Liver and Kidney regions. Treatment should drain heat from the Yin levels. While *Daochi San* and *Wuling San* are mismatched, the efficacy of *Chengqi Tang* stems primarily from Rhubarb's heat-draining properties. The other ingredients—Immature Bitter Orange (*Zhishi*), Magnolia Bark (*Houpo*), and Mirabilite (*Mangxiao*)—are less relevant to this specific presentation.
Other unexpected complications include women experiencing menstrual irregularities (onset or cessation), hemorrhage, leukorrhea, heart pain, hernia, phlegm-fire, wheezing, and asthma triggered by the new illness. Generally, pathogens flow like water, lodging wherever there is weakness. This analogy is crucial. If old diseases are triggered by new illnesses, treating the new illness usually resolves the old one.
Liu Baozhi's commentary: When new illnesses trigger old ones, treatment should prioritize the new illness. However, one must assess severity and urgency to determine the method, avoiding rigid adherence to rules.
Illnesses occurring after excessive labor, excessive desire, severe acute illness, or chronic prolonged illness are termed "Four Deficiencies." Pre-existing Qi deficiency makes patients susceptible to pathogen sinking, often resulting in untreatable conditions.
Liu Baozhi's commentary: The prognosis of warm-heat diseases depends on the strength of Healthy Qi. Even with heavy pathogens, if Healthy Qi can withstand them, death may be avoided. Conversely, even light pathogens can cause sudden collapse if Healthy Qi is insufficient. This must be understood.
Wu Youke stated: On the first or second day of an epidemic, the tongue coating resembles accumulated powder. Taking one dose of *Dayuan Yin* in the morning may result in a yellow tongue color by afternoon, accompanied by chest/diaphragm fullness/pain, intense thirst, and restlessness. This indicates the latent pathogen has ruptured and toxins have transmitted inward. Adding Rhubarb to the previous formula for purgation reduces restlessness and heat. By evening, agitation and fever worsen, the entire tongue becomes black with prickles, and the nose appears like burnt coal, indicating extreme toxicity. Once stasis reaches the Stomach, urgently administer *Chengqi Tang*. Profuse purgation by dusk leads to fever subsiding by midnight, and the black prickles disappear by the next morning. Three changes occur in one day, compressing several days' treatment into one. Due to high toxicity, transmission is rapid, necessitating aggressive dosing; slow methods would be futile.
Liu Baozhi's commentary: Rapid transmission is common in severe epidemic toxins, but typical latent Qi transformations are rarely this severe or fast.
He also stated: Pathogens entering the Stomach require *Chengqi Tang* for cure. Misusing *Baitao Tang* lacks breaking power, suppresses toxins, causes pulse disappearance, and makes the pulse fine/small. Mistaking Yang-pattern Yin-pulse for a reason to avoid purgation leads to hesitation and death. Urgently administering *Xiao Chengqi Tang* may save the patient.
Liu Baozhi's commentary: *Baitao Tang* is indicated only for high fever, intense thirst, surging pulse, profuse sweating, and absence of thick/greasy tongue coating. If the pulse becomes fine/small, *Chengqi Tang* should still be used cautiously after confirming indications. Without tangible turbid heat in the Stomach, *Chengqi Tang* must not be used recklessly.
He further stated: Epidemic pathogens initially reside in the half-exterior/half-interior. During transmission, they may affect both simultaneously. Doctors clinging to convention must first release the exterior, which is a major error. I have seen large doses of Ephedra (*Mahuang*) fail to produce sweat, instead worsening restlessness. This is because interior Qi stagnation prevents Yang Qi from reaching the exterior, causing slight cold limbs and preventing fluid/Qi from steaming outward. Purging the fu-organs with *Chengqi Tang* is essential. Once interior Qi flows freely, spontaneous sweating and resolution often occur without dispersing herbs.
Liu Baozhi's commentary: Although discussing epidemic pathogens, the principle applies equally to warm-heat diseases where heat binds in the Stomach, preventing fluid circulation and causing anhidrosis.