胡 时毒误药成淋，咳嗽声哑，脉细模糊，思面色苍赤，体质属火，时毒谬用补托，溺道不清，淋久肾虚
火炎金燥，致呛嗽失音，遂成重症。今夏初巳火主令，嗜寐健忘恍惚，心神溃散。焉能摄肾。速用滋阴泻火，
冀秋深气肃，得金水相涵，火毒平，音渐复。元参、生地、麦冬、贝母、丹皮、龟甲、茯神、远志、土茯苓、
淡竹叶，井华水煎。二十服淋愈音响。加熟地、阿胶、甜杏仁、枣仁。蜜丸服，症平。
（大头瘟 捻颈瘟 瓜瓤瘟 杨梅瘟 疙瘩瘟 绞肠瘟 软脚瘟附）
疫为时行疠气，有大疫，有常疫，大疫沿门阖境，多发于兵荒之后，不数见。常疫则一隅数家，一家数人。
症多相似，春夏秋三时皆有之，而夏秋为甚。其疠邪之来，皆从湿土郁蒸而发，触之成病，其后更相传染，必
由口鼻吸受，流入募原。募原乃阳明胃络，在夹脊前肠胃后，去表不远，附近于胃，为表里之分界。从鼻吸入，
故头额晕胀，背微恶寒。从口吸入，故呕恶满闷，脐痛下利，足膝逆冷，邪出募原，故壮热。有汗不解，必俟
表气入内，精气达外，大发战汗，然后脉静身凉，亦有自汗而解者，但以出表为顺，陷里为逆。从表解者，战
汗自汗发斑；从里陷者，胸腹痞痛，便秘，热结旁流，协热下利，呕恶谵语，舌黄黑刺。疫证脉不沉不浮而数，
然必右盛于左，以湿土之邪，多犯阳明胃经也。募原亦附胃。阳明居太阳之里，少阳之外，为三阳经之中道。
伤寒之邪，自表传里，温热之邪，自里达表。疫疠之邪，自阳明中道，随表里虚实而发，不循经传也。邪伏
中道，必表里分解，然不能一发便尽。故有得汗热除，二三日复热如前者∶有得下里和，二三日复见表症者；
有表和复见里症者；有表里偏胜者；有表里分传者，吴氏《温疫论》谓疫有九传，综其变也。总由伏
邪既溃，传变不一，故屡夺屡发也。疫症治法，外解如香豉、葱白、连翘、薄荷之属，内清如山栀、芩、连、
人中黄、滑石之属，下夺如芒硝、大黄之属。且疫为秽浊之邪，若熏蒸热痰，蒙蔽心包，则神识渐昏，必用芳香
宣逐，清血络以防结闭。如犀角、菖蒲、银花、郁金、佩兰之属。烦渴多汗，用石膏、知母。斑发咽痛，用犀
角、牛蒡、生地。衄血下血，用山栀、犀角、丹皮。发热自利，用葛根、芩、连。胸膈痞满，用栝蒌、枳、桔。
呕吐呃逆，用藿香、竹茹。邪混三焦，热结血分，宜大制咸苦，用元参、金银花露、金汁之属。而人中黄、
香豉尤为时疫之专药，香豉、黑豆所 ，得湿热之气，酿成败秽之质，能引内邪从巨阳蒸汗而解。人中黄、甘
草所制，渍以滓秽，专解肠腑恶毒，从下而泄，得同气相求之妙，以其总解温热时内联外热毒也。盖疫为燥热
毒疠，从无辛温发散之例，一切风燥辛热，皆不可犯。至于大疫，又宜斟酌司天岁气方向，不拘一辙也。其
发于外者，有大头、捻颈、瓜瓤、杨梅、疙瘩、绞肠、软脚等症，亦条列治法，备查用焉。此症宜与温热同参。
胡姓患者，因患时行毒邪（指具有流行性的温热毒邪），误用药物导致小便淋沥不畅，伴有咳嗽、声音嘶哑。脉象细弱且模糊不清，观察其面色苍老而红赤，体质属于火旺之体。由于对时毒错误地使用了补益托毒的方法，导致尿道不通畅；淋证日久损伤肾气，虚火上炎灼伤肺金，致使肺气干燥，引发呛咳和失音，最终形成重症。
今年初夏时节，巳火当令（五行中火气旺盛的时期），患者嗜睡、健忘、神志恍惚，心神涣散，无法固摄肾精。治疗上应迅速采用滋阴降火之法，期望到了深秋时节，气候肃杀收敛，能够达成金水相生、相互涵养的状态，使火毒平息，声音逐渐恢复。处方：玄参、生地黄、麦冬、贝母、牡丹皮、龟甲、茯神、远志、土茯苓、淡竹叶，用井华水（清晨第一次汲取的井水）煎服。服用二十剂后，淋证痊愈，声音恢复响亮。随后加入熟地黄、阿胶、甜杏仁、酸枣仁，制成蜜丸服用，病症平复。
（附：大头瘟、捻颈瘟、瓜瓤瘟、杨梅瘟、疙瘩瘟、绞肠瘟、软脚瘟）
疫病属于时行疠气所致，有大疫和常疫之分。大疫沿门阖境传播，多发于战乱饥荒之后，不常见。常疫则局限于某一角落的几户人家，或一家数人发病。症状多相似，春夏秋三季都有，而以夏秋两季为甚。疠邪的产生，皆因湿土郁结蒸腾而发，接触后即致病，随后互相传染，必定通过口鼻吸入，病邪流入募原（半表半里之位）。募原是阳明胃经的络脉，位于夹脊前方、肠胃后方，距离体表不远，邻近胃部，是表里之间的分界。病邪从鼻吸入，故出现头额晕胀、背部轻微恶寒；从口吸入，故出现呕吐恶心、胸脘满闷、脐部疼痛、腹泻，足膝逆冷。邪气出于募原，故出现高热。若有汗但热不解，必须等待表气入内，精气达外，发生剧烈的战栗出汗，然后脉象平静、身体凉爽；也有自汗而解的情况，但以邪气从表而出为顺证，陷入体内为逆证。从表而解者，可见战汗、自汗、发斑；从里陷者，可见胸腹痞满疼痛、便秘、热结旁流（燥屎内结而稀水旁出）、协热下利（伴随发热的腹泻）、呕吐恶心、谵语、舌苔黄黑且有刺。疫证的脉象不沉不浮而数，但必然右侧盛于左侧，因为湿土之邪多侵犯阳明胃经。募原也依附于胃。阳明经位于太阳经之里、少阳经之外，是三阳经的中道。伤寒之邪，由表传里；温热之邪，由里达表；疫疠之邪，自阳明中道出发，随表里虚实而变化发作，不遵循经络传变的规律。邪气伏留于中道，必然导致表里分解，但不能一次发散就完全清除。所以有得汗后热除，二三天后又发热如前的；有得下法后里气调和，二三天后又出现表证的；有表证解除后又出现里证的；有表里偏胜的；有表里分传的。吴氏《温疫论》称疫病有九种传变，综合了这些变化。总归是由于伏邪溃散后，传变不一，所以屡次攻夺却屡次复发。
疫症的治疗方法，外解可用香豉、葱白、连翘、薄荷之类；内清可用山栀、黄芩、黄连、人中黄、滑石之类；下夺可用芒硝、大黄之类。而且疫病是秽浊之邪，若熏蒸热痰，蒙蔽心包，则神识逐渐昏迷，必须用芳香宣通逐邪之法，清血络以防结闭。可用犀角、石菖蒲、金银花、郁金、佩兰之类。烦渴多汗，用石膏、知母。发斑咽痛，用犀角、牛蒡子、生地黄。衄血便血，用山栀、犀角、牡丹皮。发热伴腹泻，用葛根、黄芩、黄连。胸膈痞满，用瓜蒌、枳壳、桔梗。呕吐呃逆，用藿香、竹茹。邪气混杂三焦，热结血分，宜用大制咸苦之品，用玄参、金银花露、金汁之类。其中人中黄、香豉尤为治疗时疫的专药。香豉由黑豆发酵而成，得湿热之气，酿成败秽之质，能引内邪从巨阳（太阳经）蒸汗而解。人中黄由甘草浸渍于粪汁等滓秽之物中制成，专解肠腑恶毒，从下而泄，得同气相求之妙，因其能总解温热时邪内外联动的热毒。大概疫病是燥热毒疠，从无使用辛温发散的先例，一切风燥辛热之药，都不可触犯。至于大疫，又宜斟酌当年的司天岁气及方向，不拘泥于一辙。其发于外部的，有大头、捻颈、瓜瓤、杨梅、疙瘩、绞肠、软脚等症状，也已条列治法，供查阅使用。此类病症宜与温热病一同参考。
Patient Hu suffered from *Shi Du* (Seasonal Toxic Heat) and, due to misprescribed medication, developed strangury (dysuria with pain), cough, and hoarseness. The pulse was fine and indistinct. His complexion was dark and ruddy, indicating a constitution prone to Fire. The seasonal toxin was erroneously treated with tonifying and expelling methods, leading to unclear urinary flow. Prolonged strangury depleted Kidney essence; Rising Fire scorched Lung Metal, causing dryness, paroxysmal cough, and aphonia, resulting in a severe condition.
In early summer, when Si Fire governs the climate, he experienced lethargy, forgetfulness, and mental confusion, indicating scattered Heart Spirit unable to secure the Kidneys. Immediate treatment should employ nourishing Yin and purging Fire, hoping that by late autumn, when Qi becomes crisp, Metal and Water will mutually generate and nourish each other, extinguishing Fire toxins and gradually restoring voice. Prescription: *Xuanshen* (Scrophulariae Radix), *Shengdi Huang* (Rehmanniae Radix), *Maidong* (Ophiopogonis Radix), *Beimu* (Fritillariae Bulbus), *Danpi* (Moutan Cortex), *Guijia* (Testudinis et Chelydrae Carapax et Plastrum), *Fushen* (Poria cum Risus), *Yuanzhi* (Polygalae Radix), *Tufuling* (Smilacis Glabrae Rhizoma), *Dan Zhuye* (Lophatheri Herba). Decoct with *Jinghua Shui* (Well water drawn at dawn). After twenty doses, strangury resolved and voice became clear. Subsequently, add *Shu Di Huang* (Prepared Rehmanniae Radix), *Ejiao* (Colla Corii Asini), *Tian Xingren* (Sweet Apricot Seed), *Zao Ren* (Ziziphi Spinosae Semen). Form into honey pills and take until symptoms subside.
(Attached: *Datou Wen* [Big Head Plague], *Nianjing Wen*, *Guanang Wen* [Melon Rind Plague], *Yangmei Wen* [Bayberry Plague], *Geda Wen* [Lump Plague], *Jiaochang Wen* [Intestine-Twisting Plague], *Ruanjiao Wen* [Soft Leg Plague])
Epidemic diseases are caused by pandemic pestilential qi (*Li Qi*). There are major epidemics and common epidemics. Major epidemics spread door-to-door across regions, often occurring after war and famine, and are rare. Common epidemics affect only a few households or individuals in a corner. Symptoms are similar, occurring in spring, summer, and autumn, but most severe in summer and autumn. Pestilential pathogens arise from the stagnation and steaming of damp earth. Upon contact, disease ensues, followed by contagion. Transmission occurs via inhalation through the nose and mouth, entering the *Mu Yuan* (Sea of Origin, a semi-exterior/semi-interior region). *Mu Yuan* is the collateral network of the Stomach Meridian of Foot-Yangming, located anterior to the spine and posterior to the intestines and stomach, close to the exterior and near the Stomach, serving as the boundary between exterior and interior. Pathogens entering via the nose cause dizziness and distension of the head and forehead, and slight aversion to cold on the back. Pathogens entering via the mouth cause nausea, vomiting, chest fullness, umbilical pain, diarrhea, and cold extremities. When pathogens emerge from *Mu Yuan*, high fever occurs. If sweating does not resolve the heat, one must wait for exterior Qi to enter and Essence-Qi to reach the exterior, triggering a violent chills-and-sweat episode (*Zhan Han*), after which the pulse calms and body temperature normalizes. Some resolve via spontaneous sweating. Resolution via the exterior is favorable; sinking into the interior is adverse. Exterior resolution presents with chills-and-sweat, spontaneous sweating, or macules. Interior sinking presents with chest/abdominal fullness and pain, constipation, heat-binding with peripheral flow, diarrhea accompanying heat, vomiting, delirium, and yellow/black prickly tongue coating. Epidemic pulses are neither deep nor floating but rapid, typically stronger on the right than the left, as damp-earth pathogens often invade the Yangming Stomach Meridian. *Mu Yuan* attaches to the Stomach. Yangming lies interior to Taiyang and exterior to Shaoyang, forming the central pathway of the Three Yang meridians. Cold pathogen transmits from exterior to interior; Warm-heat pathogen transmits from interior to exterior; Epidemic pestilence originates from the Yangming central pathway and manifests according to exterior/interior and deficiency/excess, without following meridian transmission rules. Pathogens lodged in the central pathway cause exterior-interior separation but cannot be cleared in one release. Thus, heat may return after sweating; interior harmony may return after purgation, followed by exterior symptoms; exterior symptoms may resolve then interior symptoms appear; there may be exterior-interior predominance or simultaneous transmission. Wu’s *Wen Yi Lun* describes nine types of transmission, summarizing these variations. Ultimately, because latent pathogens disperse and transmit variably, repeated attacks occur despite repeated interventions.
Treatment for epidemic diseases: Exterior release uses Fangfei Douchi (Fermented Soybean), Congbai (Scallion White), Lianqiao (Forsythiae Fructus), Bohe (Menthae Haplocalycis Herba). Interior clearing uses Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Renzhonghuang (Human Middle Yellow), Huashi (Talcum). Purging uses Mangxiao (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma). Since epidemics involve turbid pathogens, if they steam hot phlegm and obscure the Pericardium, causing gradual loss of consciousness, aromatic dispersing and draining methods must be used to clear blood collaterals and prevent blockage. Use Xijiao (Rhinocerotis Cornu - note: now substituted with Buffalo Horn), Shichangpu (Acori Tatarinowii Rhizoma), Yinhua (Lonicerae Japonicae Flos), Yujin (Curcumae Radix), Peilan (Agastaches Herba). For irritability, thirst, and excessive sweating, use Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma). For macules and sore throat, use Xijiao, Niubangzi (Arctii Fructus), Shengdi Huang. For epistaxis and lower bleeding, use Zhizi, Xijiao, Danpi. For fever with diarrhea, use Gegen (Puerariae Lobatae Radix), Huangqin, Huanglian. For chest/diaphragm fullness, use Gualou (Trichosanthis Fructus), Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix). For vomiting and hiccups, use Huoxiang (Pogostemonis Herba), Zhuru (Bambusae Caulis in Taenia). When pathogens mix in the Triple Burner and heat binds in the Blood aspect, strong salty-bitter agents are needed: Xuanshen, Jinyinhua Lu (Honeysuckle Dew), Jinzhi (Golden Juice). Among these, Renzhonghuang and Fangfei Douchi are specific medicines for seasonal epidemics. Fangfei Douchi, fermented from black beans, acquires damp-heat energy, becoming turbid, capable of drawing internal pathogens out via Taiyang sweating. Renzhonghuang, prepared with licorice root soaked in waste matter, specifically resolves intestinal toxicity, evacuating downward, utilizing the principle of like attracting like, thereby resolving both internal and external heat toxins of warm-heat seasonal diseases. Generally, epidemics are dry-heat toxic pestilences; there is no precedent for using acrid-warm dispersants. All acrid-hot drugs for wind-dryness are contraindicated. For major epidemics, one must consider the governing Qi of the year and direction, avoiding rigid adherence to fixed formulas. External manifestations include Datou, Nianjing, Guanang, Yangmei, Geda, Jiaochang, and Ruanjiao syndromes, with their respective treatments listed for reference. These conditions should be studied alongside warm-heat diseases.