温疫舌上白苔者，邪在膜原也。舌根渐黄至中央，乃邪渐入胃。设有三阳现证，
用达原饮三阳加法。因有里证，复加大黄，名三消饮。三消者，消内消外消不内外也。此治
疫之全剂，以毒邪表里分传，膜原尚有余结者宜之。
三消饮
槟榔 草果 浓朴 白芍 甘草 知母 黄芩 大黄 葛根 羌活 柴胡 姜、枣煎服。
温疫脉长洪而数，大渴复大汗，通身发热，宜白虎汤。
白虎汤
石膏（一两） 知母（五钱） 甘草（五钱） 炒米（一撮）
加姜煎服。
按∶白虎汤辛凉发散之剂，清肃肌表气分药也。盖毒邪已溃，中结渐开，邪气分离膜原，尚
未出表，然内外之气已通，故多汗，脉长洪而数。白虎辛凉解散，服之或战汗，或自汗而解
。若温疫初起，脉虽数未至洪大，其时邪气盘踞于膜原，宜达原饮。误用白虎，既无破结之
能，但求清热，是犹扬汤止沸也。若邪已入胃，非承气不愈，误用白虎，既无逐邪之能，徒
以刚悍而伐胃气，反抑邪毒，致脉不行，因而细小。又认阳证得阴脉，妄言不治，医见脉
微
欲绝，益不敢议下，日惟杂进寒凉，以为稳当，愈投愈危，至死无悔。此当急投承气缓缓下
之，六脉自复。
邪发于半表半里，一定之法也。至于传变，或出表，或入里，或表里分传，医
见有表复有里，乃引经论，先解其表，乃攻其里，此大谬也。尝见以大剂麻黄连进，一毫无汗
，转见烦躁者何耶？盖发汗之理，自内由中以达表。今里气结滞，阳气不能敷布于外，即四肢未
免厥逆，又安能气液蒸蒸以达表？譬如缚足之鸟，乃欲飞升，其可得乎？盖鸟之将飞，其身
必伏，先足纵而后扬翅，方得升举，此与战汗之义同。又如水注，闭其后窍，则前窍不能涓
滴，与发汗之义同。凡见表里分传之证，务宜承气先通其里，里气一通，不待发散，多有自
能汗解。
温疫病患者舌苔呈白色，说明病邪位于膜原（半表半里的部位）。如果舌根逐渐变黄并延伸至中央，表明病邪正在逐渐进入胃腑。若此时出现太阳、阳明、少阳三阳经的证候，应使用达原饮（疏利透达膜原湿浊之邪的方剂）并加上针对三阳经的药物。因为伴有里实证，再加大黄，此方名为三消饮。“三消”指的是消除内结之邪、外散在表之邪以及不内外之邪。这是治疗瘟疫的完整方剂，适用于毒邪在表里之间分传，且膜原仍有郁结的情况。
三消饮
槟榔、草果、厚朴、白芍、甘草、知母、黄芩、大黄、葛根、羌活、柴胡，加生姜、大枣煎服。
瘟疫患者脉象长、洪大且数，极度口渴并伴有大汗，全身发热，适宜使用白虎汤（清热生津的方剂）。
白虎汤
石膏（一两）、知母（五钱）、甘草（五钱）、炒米（一撮），加生姜煎服。
按语：白虎汤是辛凉发散的药物，能清肃肌表气分的邪热。因为毒邪已经溃散，中焦的结滞逐渐打开，邪气从膜原分离出来，但尚未完全透出体表，然而体内的气机已经通畅，所以会出现多汗、脉象长洪而数的情况。白虎汤具有辛凉解散的作用，服用后可能会通过战汗或自汗的方式痊愈。如果在瘟疫初起时，脉象虽然数但未到洪大的程度，此时邪气盘踞在膜原，应当使用达原饮。误用白虎汤，既没有破除结滞的能力，只是单纯追求清热，这就像扬汤止沸一样无效。如果邪气已经进入胃腑，非用承气汤类方剂不能治愈，误用白虎汤，既没有驱逐邪气的作用，反而因其刚悍之性损伤胃气，压制邪毒，导致脉象无法正常运行，变得细小。又误认为阳证出现阴脉，妄言不可治，医生见到脉微欲绝，更加不敢使用攻下法，每天只混杂使用寒凉药物，以为这样稳妥，结果用药越重病情越危险，直到死亡也不后悔。此时应当紧急投用承气汤缓缓攻下，六脉自然会恢复。
病邪发于半表半里，是一定的规律。至于病邪的传变，有的向外透达至表，有的向内传入里，有的则表里同时传变。医生看到既有表证又有里证，便引用经典理论，主张先解表，后攻里，这是极大的错误。我曾见过使用大剂量麻黄等发汗药，却一点汗也出不来，反而出现烦躁不安，这是什么原因呢？发汗的原理，是从内部经由中部通达体表。现在里气结滞不通，阳气不能布散到外部，即使四肢难免出现厥冷，又怎么能使得气液蒸腾涌出以达体表呢？这就好比绑住脚的鸟，想要飞升，怎么可能做到呢？大概鸟在将要起飞时，身体必定伏低，先舒展双脚然后扬起翅膀，才能升举起来，这与战汗的道理相同。又如水流，如果堵住后面的出口，前面的出口就不能滴出一滴水，这也与发汗的道理相同。凡是见到表里分传的证候，务必先用承气汤通利里气，里气一通，不需要特意发散，大多能自然出汗而痊愈。
When a plague patient presents with a white coating on the tongue, it indicates that the pathogenic factor is located in the *Memran* (the area between the exterior and interior). If the yellowing of the coating gradually spreads from the root to the center of the tongue, it signifies that the pathogen is progressively entering the Stomach. If manifestations of the Taiyang, Yangming, and Shaoyang channels appear simultaneously, *Dajian Yin* (Decoction for Reaching the Source) should be used with modifications for the three Yang channels. Since there are interior excess symptoms, Rhubarb (*Rhei Radix et Rhizoma*) is added, and this formula is named *Sanxiao Yin* (Three-Reduction Decoction). "Sanxiao" refers to eliminating internal stagnation, dispersing exterior pathogens, and resolving pathogens that are neither strictly internal nor external. This is a comprehensive formula for treating plague, suitable for cases where toxic pathogens transmit between the interior and exterior, and residual knots remain in the Memran.
**Sanxiao Yin (Three-Reduction Decoction)**
Areca Seed (*Arecae Semen*), Tsaoko Cardamom (*Tsaoko Fructus*), Magnolia Bark (*Magnoliae Officinalis Cortex*), White Peony Root (*Paeoniae Radix Alba*), Licorice Root (*Glycyrrhizae Radix et Rhizoma*), Anemarrhena Rhizome (*Anemarrhenae Rhizoma*), Scutellaria Root (*Scutellariae Radix*), Rhubarb (*Rhei Radix et Rhizoma*), Kudzu Root (*Puerariae Lobatae Radix*), Notopterygium Rhizome (*Notopterygii Rhizoma et Radix*), Bupleurum Root (*Bupleuri Radix*). Decoct with Ginger (*Zingiberis Rhizoma Recens*) and Jujube (*Ziziphi Jujubae Fructus*).
In plague patients presenting with a long, surging, and rapid pulse, intense thirst accompanied by profuse sweating, and fever throughout the body, *Baihu Tang* (White Tiger Decoction) is indicated.
**Baihu Tang (White Tiger Decoction)**
Gypsum Fibrosum (*Gypsi Fibrosum*, 1 liang), Anemarrhena Rhizome (*Anemarrhenae Rhizoma*, 5 qian), Licorice Root (*Glycyrrhizae Radix et Rhizoma*, 5 qian), Fried Rice (a handful). Decoct with Ginger (*Zingiberis Rhizoma Recens*).
Note: *Baihu Tang* is an acrid-cool diaphoretic agent that clears and purifies the Qi level of the muscle and surface. Because the toxic pathogen has dispersed and the central knot is gradually opening, the pathogen separates from the Memran but has not yet fully emerged to the exterior. However, the Qi mechanism inside and outside is now connected, resulting in profuse sweating and a long, surging, and rapid pulse. The acrid-cool dispersing action of *Baihu Tang* may induce either a shivering sweat (*Zhanhan*) or spontaneous sweating to resolve the disease. If at the onset of plague, the pulse is rapid but not yet surging and large, and the pathogen is entrenched in the Memran, *Dajian Yin* should be used. Misusing *Baihu Tang* lacks the ability to break up stagnation and merely seeks to clear heat; this is akin to stirring boiling water to stop it from boiling. If the pathogen has entered the Stomach, only *Chengqi* formulas can cure it. Misusing *Baihu Tang* lacks the power to expel pathogens and, due to its harsh nature, damages Stomach Qi, suppressing the toxic pathogen and causing the pulse to become unmanageable and fine. Furthermore, misinterpreting a Yang syndrome presenting with a Yin pulse as incurable, physicians seeing a faint and nearly imperceptible pulse dare not use purgatives. Instead, they daily administer mixed cold-natured drugs, believing it to be safe, but the more they administer, the more critical the condition becomes, leading to death without repentance. In such cases, one must urgently administer *Chengqi* formulas to purge slowly, after which the six pulses will naturally recover.
Pathogens emerging from the half-exterior and half-interior follow a fixed law. Regarding transmission, pathogens may exit to the exterior, enter the interior, or transmit to both simultaneously. When physicians observe both exterior and interior symptoms, they cite classic theories advocating to first release the exterior and then attack the interior; this is a major error. I have seen cases where large doses of Ephedra (*Ephedrae Herba*) and other diaphoretics were administered, yet no sweat occurred, and irritability worsened. Why? The principle of inducing sweating relies on Qi moving from the interior through the middle to reach the exterior. Now, if interior Qi is stagnant and obstructed, Yang Qi cannot distribute to the exterior. Even if the limbs inevitably become cold (*Jueni*), how can Qi and fluids steam upward to reach the exterior? It is like trying to make a bird fly while its feet are tied; is this possible? Generally, when a bird prepares to fly, its body lowers, extending its feet before spreading its wings to lift off. This is analogous to the mechanism of *Zhanhan*. Similarly, if the rear outlet of a water channel is blocked, the front outlet cannot drip a single drop; this also parallels the principle of sweating. In all cases showing simultaneous exterior and interior transmission, one must prioritize using *Chengqi* formulas to unblock the interior. Once the interior Qi is unblocked, without needing specific diaphoretics, patients often spontaneously sweat and recover.