王宇泰曰∶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。余阅叶石林《避暑录》云∶宣和间，此药盛行于京师，太学生信之尤笃，杀人无数，医顿废之。
昔坡翁谪居黄州时，其地濒江，多湿，而黄之居人所感者，或因中湿而病，或因雨水浸淫而得，所以服此
药而多效，是以通行于世，遗祸于无穷也。弘治癸丑年，吴中疫疠大作，吴邑令孙磐，令医人修合圣散子，
遍地街衢，并以其方刊行，病者服之，十无一生，率皆狂躁昏瞀而卒。噫，孙公之意，本以活人，殊不知
圣散子方中有附子、良姜、吴茱萸、豆蔻、麻黄、藿香等剂，皆性味燥热，反助火邪，不死何待？若不辨
阴阳二症，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。《续医说》。
张子和曰∶元光春，京师翰林应泰李屏山，得瘟疫症，头痛身热口干，小便赤涩。渠素嗜饮，医者便与酒
症丸兼巴豆，利十余行。次日头痛诸病仍存，医者不识，复以辛温之剂解之，加之卧于暖炕，强食葱醋汤，图
获一汗。岂知种种客热，叠发并作，目黄斑生，潮热吐泄，大喘大满，后虽用承气下之，已无及矣。至今议者
纷纭，终不知热药之过，往往归罪于承气汤。用承气汤者，不知其病已危，犹复用药，学不明故也，良可罪也。
然议者不归罪于酒症丸，亦可责也。夫瘟症在表不可下，况巴豆丸乎？巴豆不已，况复发以辛热之剂乎？彼随
众毁誉者，皆妄议者也。（文田按∶巴豆下之，阴之伤已极，重以大黄下，而独能生阴乎？此证似当以绿豆解巴
豆之毒，加存阴之品，庶有济耳。然子和不足以论此。）
宋宝庆二年，丙戍冬十一月，耶律文正王，从元太祖下灵武，诸将争掠子女玉帛，王独取书籍数部，大黄
两驼而已。既而军中病疫、得大黄可愈，所活几万人。（《辍耕录》。文田按∶兵卒多饮酒食肉，劳汗
又多，温疫一行，必遽传阳明胃腑。此大黄所以往无不利也。王氏删此案，非是。）
《职方外纪》云∶哥阿岛曩国患疫，有名医名根据卜加得，不以药石，令城内外遍举大火烧一昼夜，火息而病
亦愈矣。盖疫为邪气所侵，火气猛烈，能荡诸邪，邪气尽而疫愈，亦至理也。（《樵书初编》。此法惟
徼外可旋。文田按∶此冬月寒疫，非温疫也。王氏知温之能为疫，独不知冬月亦有寒疫耶？宜其妄删此案也。）
邱汝诚因访友，闻邻家哭声，问何故。曰∶邻某甲，得时疾。邱令汲水置大桶中，以帘横其人于上，病遂
愈。（《挥尘新谈》。文田按∶此温疫证，由中 而得者也。）
苏韬光侍郎云∶予作清流县宰，县 申屠行父之子妇患时疫，三十余日，已成坏症。予令服夺命散，又名
复脉汤。人参一两，水二钟，紧火煎一钟，以井水浸冷服之。少顷，鼻梁有汗出，脉复立瘥。凡伤寒时疫，不
问阴阳老幼，误服药饵，困重垂危，脉沉伏，不省人事，七日以后，皆可服之，百不失一。（《本草纲目》。
《仁和县志》。此阴伤而阳亦将脱，故以复脉得效，是时人参亦可用矣。但云∶七日以后，皆可服。则昧医理之
言，王氏率意拟删，亦未为当。）
吴嗣昌治浙督赵清献公名臣，常遘危疫。吴独排众议，投冰水立苏之，公尊礼若神。曰∶君其不朽。
孙文垣治一老妓，三日患头痛身热，口渴，水泻不止，身重不能反侧，日渐昏沉，耳聋眼合谵语。诸医有
主补中益气者，有主附子理中者，煎成未服。孙诊之，六脉洪大，面色内红外黑，口唇干燥，舌心黑苔，不省
人事。曰∶此疫症也，法当清解，急以小白汤进之，犹可生也。益气理中杀之矣，安可用？问小白何汤也？曰∶
小柴胡合白虎汤即是。或曰∶泄泻如此，石膏可用乎？曰∶此协热下利，当早服之。既服，至夜半，神气苏醒，
惟小水不利，热渴未退。师仲景法，渴而身热，小水不利者，当利其小便，乃以辰砂六一散二两，灯心汤调服
之，两帖而瘳。（藜按∶此阳明少阳合病，用白虎柴胡是矣。但仲景柴胡汤条内，原有渴者去半夏，加栝蒌根
之法，曷不遵而用之？此亦三阳合病之类，一白虎汤足以了之，兼用小柴胡，原不甚谬，但柴胡、半夏，究嫌升
燥，故热渴而小水不利，待六一散之清热而后解，非因其利小便也。读者勿因
其根据傍仲景，遂为所惑。）
张净宇发热腹疼，泄泻口渴，呕吐不止。有认寒者，有认热者，有认伤寒者。孙诊之曰∶此时疫泻也。以
二陈汤倍白术，加青蒿、葛根、酒芩、白芍、猪苓、泽泻、滑石，一剂而安。
一仆病身如火烁，头痛如破，小水赤，口渴，鼻干，不得眠，胸膈膨胀，饥不能食，六脉弦而数。孙与竹
叶石膏汤加知母、枳壳、白芷、葛根、青蒿，一帖而热痛减半，胸膈亦宽。惟口渴，小水短涩，睡卧不安，又
与化瘟丹三钱，井水化下，渴止，少得睡。头晕脚软喘急，与四物汤加青蒿、酒芩、苡仁、木瓜，服之全愈。
一仆病与前相似，医与药，乃大吐大泻，热增益，头痛不可当，烦躁口渴，鼻干呕吐，小水短涩，已十四
日，甚危。孙询所服药，乃藿香正气散，砂仁、浓朴、山楂，大耗元气之品。时五月，火令当权之疫，当以甘
寒之剂治之，何可以辛热香窜，益其火而枯其津也？急投人参白虎汤加竹茹、葛根、青蒿、升麻，一帖热除，
再帖头痛止，诸症尽去。后连治数人皆如此。盖天行之疫，一方多有，先以甘寒清解之剂投之，热退用四物汤
调养阴血，稍加清热之品，而青蒿之功居胜。（治疫症尽此数语。）
吴某妇先感风邪，后伤饮食，发热头痛腹胀。医与巴豆丸泻之，热如初。又以大黄重泻之，热亦如初。再
后者谓泻而热不退者为虚，大用参、 、术补之，四日，神气昏沉，不省人事。孙诊之，左脉弦数，右关尺沉
数有力，舌尖沉香色，舌根焦黑芒刺，语言不清。盖不知饥馑之余，疫气为疠，妄下妄补，误成坏疫，危且殆
矣。姑以柴胡、知母各三钱，石膏六钱，枳实、花粉各五分，甘草、黄芩、麦冬各一钱，山栀、生地各七分，
人参六分，竹叶三十片，姜三分，水煎，饮至中夜后，人事稍清，微有汗，舌柔和。次日，前方去生地，加白
芍，舌心焦黑尽退。大便五日未行，身尚痛，咳嗽，与七制化痰丸二帖，再以石膏二钱，麦冬、贝母各一钱，
前胡、枳壳、黄芩、栀子各六分，甘草三分，桑皮八分，全安。
程氏妇，乃夫殁于疫病，七日疫即至，大热头疼，口渴，胸胁并痛。医与小柴胡汤，夜忽梦夫交泄，而觉
冷汗淫淫，四肢如解，神昏谵语，面如土色，舌若焦煤强硬。孙诊之，六脉沉弦而数，大小便俱秘，此亦阴阳
易类也。疫后有是，危已极矣。与生脉汤加柴胡、黄芩、桂枝、甘草，煎成，将乃夫昔穿裤裆烧灰调下，两剂
而神醒，体温汗敛，舌柔焦退。前方加枣仁、竹茹，四肢能运动，乃进粥汤。子女、妯娌、婢仆凡六人，次第
而病，均以六神通解散，解汗而安。
一妇人发热头痛，医与九味羌活汤、十神汤不效，加口渴，舌黑如煤。又医与如神白虎汤、竹叶石膏汤，
亦不效，加泄泻不止，人事昏沉，四肢厥冷，呼吸气微，米粒不进者十四日，具含敛矣。孙诊之，脉细如蛛丝。
曰∶此疫症也。合生脉、理中二汤饮之，连进二帖，夜半神气稍苏，饮粥汤半盏。次早，六脉渐见。喜曰∶脉
绝微续者生，可无虞矣。仍与前药，至晚泻止，口不渴，舌煤退，精神爽。再用人参、白术各五钱，炮姜、炙
草各二钱，麦冬二钱，五味十五粒，（仍是理中、生脉。）不拘时服，数日全愈。（此即坏症也，前医
凉散过当，故以温补奏功。）
吴球泉内人，痢疾后感寒，月水适至，壮热，头微疼，口渴，遍身疼，胸膈饱闷，烦躁耳聋，大便泻，舌
白苔，脉七八至，乱而无序。（脉躁多凶，第此为热郁之极而然，躁极而静，郁极而通。后之伏而战汗，
势也，亦理也。）孙曰∶此三阳合病，春瘟症也。且投三阳药，服之挑察微应，再为区处。以柴胡三钱，葛根、
白芍各二钱，枳实、桔梗、酒芩、竹茹各一钱，天花粉八分，炙甘草、桂枝各五分，服后，遍身如冰，面与四肢
尤甚，六脉俱无，（脉双伏或单伏，而四肢厥冷，欲战汗也。宜熟记。）举家及医者皆叹为故矣。孙曰∶非死
候也。盖夜半阴极阳生，热欲作汗，譬之天将雨，必六合晦冥。诸医咸匿笑。四鼓后，果战而汗出，衣被皆湿，
肢体渐温，神思清爽，且索粥。唯耳尚聋，腹中大响，脉近六至，改以柴苓汤加乌梅，两帖而愈。
族孙醉后房事已，起而小溲，即脐下作痛，水泻肠鸣，一日十余度，发热头痛。医与理中汤一帖，反加呕
逆，烦躁口渴。孙诊之，左脉弦大，右洪大，俱七至，不食不眠，面赤唇燥，舌苔黄浓。自云房劳后阴症伤寒，
小腹痛，且漏底。乃笑曰∶春温症也。族人交口谓的属阴症，故呕吐水泻，不可因其面赤，便认为阳，幸加察
焉。咸拟理中汤，再加附子、肉桂，庶可保全。（房劳外感，视为阴症而与热药，杀人多矣，当与喻嘉言治黄长人
一案同参。喻案见伤寒门。）孙曰∶桂枝下咽，阳盛即毙。阴阳寒热之间，辨之不真，死生反掌，兹当舍症从
脉也。（即症而论，发热头痛，病非阴症。）以温胆汤加姜汁炒黄连、柴胡、干葛，二帖，令当夜饮尽，俾不他传。因畏
竹茹、黄连，只进一服，呕逆止，余症悉在。次日脉之，洪大搏指，与白虎汤加竹茹两帖，亦令服完。因畏石膏，只进
一服，泻止，小腹仍痛。又次日，脉洪长坚硬，邪已入腑，非桃仁承气不可，觌面煎服，连饮二剂，下黑燥矢五六枚，
痛热俱减。再诊，六脉皆缓弱，以四君子汤加白芍、黄连、香附调养数日而愈。
程兄腮颊红肿，呕恶，恶寒发热，不食，下午烦躁，口苦不寐。此俗名鸬 瘟是也，乃少阳阳明二经之症。
法当清解，以柴胡、贯众各一钱，干姜、竹茹、半夏曲各一钱，黄连、枳壳各七分，甘草四分，一帖而减，二帖而安。
喻嘉言治钱仲昭，患时气外感三五日，发热头疼。服表汗药，疼止热不清，口干唇裂，因而下之，遍身红
斑，神昏谵语，食饮不入，大便复秘，小便热赤，脉见紧小而急。曰∶此症前因误治阳明胃经，表里不清，邪
热在内，如火燎原，津液尽干，以故神昏谵妄。若斑转紫黑，即刻死矣。目今本是难救，但其面色不枯，声音
尚朗，乃平日保养肾水有余，如旱田之侧，有下泉未竭，故神虽昏乱，而小水仍通，乃阴气未绝之征，尚可治
之。不用表里，单单只一和法，取七方中小方，而气味甘寒者用之，惟如神白虎汤一方，足以疗此。盖中州元
气已离，大剂、急剂、复剂，俱不敢用，而虚热内炽，必甘寒气味，方可和之耳。但方虽宜小，而服则宜频，
如饥人本欲得食，不得不渐渐与之，必一昼夜频进五七剂，为浸灌之法，庶几邪热以渐而解，元气以渐而生也。
若小其剂，复旷其日，纵用药得当，亦无及矣。如法治之，更一昼夜，热退神清，脉和食进，其斑自化。
金鉴春日病瘟，误治二旬，酿成极重死症，壮热不退，谵语无伦，皮肤枯涩，胸膛板结，舌卷唇焦，身倦
足冷，二便略通，半渴不渴，面上一团黑滞。前医所用之药，不过汗下和温之法，绝无一效。喻曰∶此症与两
感伤寒无异，但彼日传二经，三日传经已尽即死。不死者，又三日再传一周定死矣。此春温症不传经，故虽邪
气留连不退，亦必多延几日，待元气竭绝乃死。观其阴症阳疾，两下混在一区，治阳则碍阴，治阴则碍阳。然
法曰∶发表攻里，本自不同。又谓∶活法在人，神而明之，未尝教人执定勿药也。吾有一法，即以仲景表里二
方为治，虽未经试验，吾天机勃勃自动，若有生变化行鬼神之意，必可效也。于是以麻黄附子细辛汤，两解其
在表阴阳之邪，果然皮间透汗，而热全清。再以附子泻心汤，两解其在里阴阳之邪，果然胸前柔活，而人事明
了，诸症俱退，次日即食粥，以后竟不需药。只在此二剂，而起一生于九死，快哉。（此案后学宜反复详玩之。）
卢不远治永嘉王龙友，望其色黯紫，舌本深红，知其次日当病，果发热。越三日，其叔培竹欲归，将发，
诊其脉沉而散，卢极力挽留，谓龙友虽病，而脉有神理，君虽未病，而邪实深入，病于中路，将奈何？至次晚，
大吐，脉随脱，药以人参三钱，脉复。有以枣仁等剂投之者，其热转盛。十四日，脉八至，舌短神昏。卢谓今
晚非用下，必然胃烂，因用芩、连、大黄，一剂，次日遂愈。盖疫为疠气，人受之多从口鼻入，因人色力盛
衰，以为轻重，审色与脉，可以先知。又疫者，瘟热病之沿漫也。其病之因，由寒郁火，故其色紫，紫为水克
火之色也。火病之发，应心之苗，故舌色深红，杜清碧谓之将瘟舌。而脉体须浮，浮脉象火，病发必顺。若沉
则邪深入里，势必暴焚，河间多用下法，下之中空，而火性自平矣。如当下而失时，必胃烂而死。
王宇泰说：圣散子方，因为苏东坡先生写了序言，从此天下人都把它当作神方。宋末辛未年，永嘉发生瘟疫，服用此方而受害的人，多得无法计算。我阅读叶石林的《避暑录》记载：宣和年间，这种药在京城盛行，太学生尤其深信不疑，导致无数人死亡，医生们于是将其废弃。从前苏东坡被贬谪居住在黄州时，那里靠近江边，湿气重，当地居民所患的疾病，有的是因为体内受湿邪所致，有的是因为雨水浸淫而得病，所以服用这种药大多有效，因此流传于世，留下了无穷的后患。弘治癸丑年，吴中地区瘟疫大流行，吴县县令孙磐，命令医生配制圣散子，遍布街巷，并将药方刊印发行，病人服用后，十人中没有一人存活，大都因狂躁、昏迷而死亡。唉，孙公的本意本来是救人，却不知道圣散子方中含有附子、良姜、吴茱萸、豆蔻、麻黄、藿香等药物，这些药物的性味都是燥热的，反而助长火邪，不死还等什么？如果不辨别阴证和阳证这两种病症，一概进行治疗，杀人比刀剑还要快。如果有能广泛传播这个说法来告诫人们，也是仁者的一个方面。出自《续医说》。
张子和说：元光年间春季，京师翰林应泰李屏山，得了瘟疫症，头痛、身体发热、口干、小便赤涩。他平时喜欢喝酒，医生就给他酒症丸兼巴豆，让他腹泻了十多次。第二天头痛等症状仍然存在，医生不认识病情，又用辛温的药物来解表，加上让他睡在温暖的炕上，强行喝葱醋汤，企图通过发汗来治愈。哪里知道各种客热之邪，叠加发作，出现眼睛发黄、身上生斑、潮热、呕吐泄泻、大喘、大满闷，后来虽然用了承气汤攻下，已经来不及了。至今议论纷纷，最终不知道是热药的过错，往往归罪于承气汤。使用承气汤的人，不知道病情已经危重，还继续用药，是因为医学理论不明，确实可罪。然而议论者不归罪于酒症丸，也是可以责备的。瘟症在表不可攻下，何况是巴豆丸呢？巴豆已经过度攻下，何况又再用辛热的药物呢？那些随众毁誉的人，都是妄加议论的人。（文田按：巴豆攻下，阴液损伤已极，再用大黄攻下，难道还能独存阴液吗？此证应当用绿豆解除巴豆的毒性，加入保存阴液的药物，或许还有救。然而张子和不足以评论这个病例。）
宋宝庆二年，丙戌冬十一月，耶律文正王，跟随元太祖攻打灵武，众将领争抢子女玉帛，唯独耶律文正王只取了几部书籍和两驼大黄。后来军中发生疫病，得到大黄可以治愈，救活了几万人。（《辍耕录》。文田按：士兵多饮酒吃肉，劳作出汗又多，温疫一旦流行，必定迅速传入阳明胃腑。这就是大黄之所以无往不利的原因。王氏删除了这个案例，是不对的。）
《职方外纪》记载：哥阿岛曩国遭受瘟疫，有位名医名叫根据卜加得，不用药物治疗，让城内外遍举大火燃烧一昼夜，火熄灭后病也痊愈了。大概瘟疫是被邪气侵袭，火气猛烈，能荡涤各种邪气，邪气尽除而瘟疫痊愈，这也是至理。（《樵书初编》。这种方法只有边疆地区可行。文田按：这是冬季寒疫，不是温疫。王氏知道温邪能导致瘟疫，却唯独不知道冬天也有寒疫吗？所以他随意删除这个案例是错误的。）
邱汝诚去拜访朋友，听到邻居家哭声，问什么原因。回答说：邻居某甲，得了时行疾病。邱汝诚让人打水放在大桶中，用帘子横架在桶上让人坐在上面（利用蒸汽熏蒸），病就好了。（《挥尘新谈》。文田按：这是温疫证，由中焦湿热而得的。）
苏韬光侍郎说：我担任清流县县令时，县申屠行父的儿媳妇患时疫，三十多天，已成坏症。我让她服用夺命散，又名复脉汤。人参一两，水二钟，猛火煎成一钟，用井水浸冷后服用。不久，鼻梁出汗，脉搏恢复，立刻痊愈。凡是伤寒时疫，不论阴阳、老少，误服药饵，困重垂危，脉沉伏，不省人事，七日以后，都可以服用，百无一失。（《本草纲目》。《仁和县志》。这是阴伤而阳也将脱，所以以复脉汤见效，此时人参也可以使用。但说“七日以后，皆可服”，则是违背医理的话，王氏随意拟删，也不恰当。）
吴嗣昌治疗浙督赵清献公这位名臣，常遭遇危重疫病。吴嗣昌独自排除众人异议，投予冰水，立刻苏醒，赵公尊礼他如神。说：您必将不朽。
孙文垣治疗一位老妓女，三天患头痛身热，口渴，水泻不止，身体沉重不能翻身，日渐昏沉，耳聋眼合谵语。各位医生有的主张补中益气，有的主张附子理中，药煎好还没服用。孙文垣诊察，六脉洪大，面色内红外黑，口唇干燥，舌心黑苔，不省人事。说：这是疫症，法当清解，急用小白汤进服，还可以生还。如果用益气理中的方法就会杀死她，怎么可用？问小白是什么汤？说：小柴胡汤合白虎汤就是。有人说：泄泻如此严重，石膏可以用吗？说：这是协热下利，应当早服。服药后，到半夜，神气苏醒，只是小便不利，热渴未退。师法仲景，口渴而身热，小便不利者，应当利其小便，于是用辰砂六一散二两，灯心汤调服，两帖而愈。（藜按：这是阳明少阳合病，用白虎柴胡是对的。但仲景柴胡汤条内，原有渴者去半夏，加栝蒌根的方法，为什么不遵循使用？这也是三阳合病之类，一白虎汤足以解决，兼用小柴胡，原本不太谬误，但柴胡、半夏，终究嫌升燥，所以热渴而小便不利，要等到六一散清热后才解，不是因为它的利小便作用。读者不要因为它依据傍着仲景，就被迷惑。）
张净宇发热腹痛，泄泻口渴，呕吐不止。有人认为是寒，有人认为是热，有人认为是伤寒。孙文垣诊察说：这是时疫泻。用二陈汤倍加白术，加青蒿、葛根、酒芩、白芍、猪苓、泽泻，一剂而安。
一个仆人患病身体如火烧，头痛如破，小便赤，口渴，鼻干，不得眠，胸膈膨胀，饥不能食，六脉弦而数。孙文垣给竹叶石膏汤加知母、枳壳、白芷、葛根、青蒿，一帖而热痛减半，胸膈也宽舒。只是口渴，小便短涩，睡卧不安，又给化瘟丹三钱，井水化开服下，渴止，稍得睡。头晕脚软喘急，给四物汤加青蒿、酒芩、苡仁、木瓜，服之全愈。
一个仆人的病与前相似，医生给药，导致大吐大泻，热势增加，头痛不可忍受，烦躁口渴，鼻干呕吐，小便短涩，已经十四天，非常危险。孙文垣询问所服药物，是藿香正气散，砂仁、浓朴、山楂，这些都是大耗元气的药物。当时是五月，火令当权的疫期，应当用甘寒的药物来治疗，怎么能用辛热香窜的药物，助长火势而枯涸津液呢？急投人参白虎汤加竹茹、葛根、青蒿、升麻，一帖热除，再帖头痛止，诸症尽去。后来连续治疗几个人都这样。大概天行之疫，一方多有，先以甘寒清解之剂投之，热退后用四物汤调养阴血，稍加清热之品，而青蒿的功效居胜。（治疗疫症尽在此数语。）
吴某的妻子先感受风邪，后伤饮食，发热头痛腹胀。医生给巴豆丸泻下，热如初。又用大黄重泻，热也如初。再后来的人说泻下而热不退的是虚证，大用参、术补之，四天，神气昏沉，不省人事。孙文垣诊察，左脉弦数，右关尺沉数有力，舌尖沉香色，舌根焦黑芒刺，语言不清。大概不知道饥馑之余，疫气为疠，妄下妄补，误成坏疫，危险且殆。暂且用柴胡、知母各三钱，石膏六钱，枳实、花粉各五分，甘草、黄芩、麦冬各一钱，山栀、生地各七分，人参六分，竹叶三十片，姜三分，水煎，饮至中夜后，人事稍清，微有汗，舌柔和。次日，前方去生地，加白芍，舌心焦黑尽退。大便五日未行，身尚痛，咳嗽，给七制化痰丸二帖，再以石膏二钱，麦冬、贝母各一钱，前胡、枳壳、黄芩、栀子各六分，甘草三分，桑皮八分，全安。
程氏妇人，丈夫死于疫病，七天后疫病即至，大热头疼，口渴，胸胁并痛。医生给小柴胡汤，夜里忽然梦见丈夫交泄，醒来冷汗淋漓，四肢如解，神昏谵语，面如土色，舌若焦煤强硬。孙文垣诊察，六脉沉弦而数，大小便俱秘，这也是阴阳易类。疫后有此，危已极矣。给生脉汤加柴胡、黄芩、桂枝、甘草，煎成，将丈夫以前穿的裤裆烧灰调下，两剂而神醒，体温汗敛，舌柔焦退。前方加枣仁、竹茹，四肢能运动，才进粥汤。子女、妯娌、婢仆凡六人，次第而病，均以六神通解散，解汗而安。
一个妇人发热头痛，医生给九味羌活汤、十神汤不效，加口渴，舌黑如煤。又医生给如神白虎汤、竹叶石膏汤，也不效，加泄泻不止，人事昏沉，四肢厥冷，呼吸气微，米粒不进者十四天，具含敛矣。孙文垣诊察，脉细如蛛丝。说：这是疫症。合生脉、理中二汤饮之，连进二帖，半夜神气稍苏，饮粥汤半盏。次早，六脉渐见。喜曰：脉绝微续者生，可无虞矣。仍与前药，至晚泻止，口不渴，舌煤退，精神爽。再用人参、白术各五钱，炮姜、炙草各二钱，麦冬二钱，五味十五粒，（仍是理中、生脉。）不拘时服，数日全愈。（这就是坏症，前医凉散过当，所以以温补奏功。）
吴球泉的内人，痢疾后感寒，月水适至，壮热，头微疼，口渴，遍身疼，胸膈饱闷，烦躁耳聋，大便泻，舌白苔，脉七八至，乱而无序。（脉躁多凶，但这因为是热郁之极而然，躁极而静，郁极而通。后来的伏而战汗，是形势，也是道理。）孙文垣说：这是三阳合病，春瘟症。且投三阳药，服之后挑察微应，再为区处。用柴胡三钱，葛根、白芍各二钱，枳实、桔梗、酒芩、竹茹各一钱，天花粉八分，炙甘草、桂枝各五分，服后，遍身如冰，面与四肢尤甚，六脉俱无，（脉双伏或单伏，而四肢厥冷，欲战汗也。宜熟记。）举家及医者皆叹为故矣。孙文垣说：非死候也。大概夜半阴极阳生，热欲作汗，譬之天将雨，必六合晦冥。诸医咸匿笑。四鼓后，果战而汗出，衣被皆湿，肢体渐温，神思清爽，且索粥。唯耳尚聋，腹中大响，脉近六至，改以柴苓汤加乌梅，两帖而愈。
族孙醉后房事已，起而小溲，即脐下作痛，水泻肠鸣，一日十余度，发热头痛。医生给理中汤一帖，反加呕逆，烦躁口渴。孙文垣诊察，左脉弦大，右洪大，俱七至，不食不眠，面赤唇燥，舌苔黄浓。自云房劳后阴症伤寒，小腹痛，且漏底。乃笑曰：春温症也。族人交口谓的属阴症，故呕吐水泻，不可因其面赤，便认为阳，幸加察焉。咸拟理中汤，再加附子、肉桂，庶可保全。（房劳外感，视为阴症而与热药，杀人多矣，当与喻嘉言治黄长人一案同参。喻案见伤寒门。）孙文垣说：桂枝下咽，阳盛即毙。阴阳寒热之间，辨之不真，死生反掌，兹当舍症从脉也。（即症而论，发热头痛，病非阴症。）用温胆汤加姜汁炒黄连、柴胡、干葛，二帖，令当夜饮尽，俾不他传。因畏竹茹、黄连，只进一服，呕逆止，余症悉在。次日脉之，洪大搏指，与白虎汤加竹茹两帖，亦令服完。因畏石膏，只进一服，泻止，小腹仍痛。又次日，脉洪长坚硬，邪已入腑，非桃仁承气不可，觌面煎服，连饮二剂，下黑燥矢五六枚，痛热俱减。再诊，六脉皆缓弱，以四君子汤加白芍、黄连、香附调养数日而愈。
程兄腮颊红肿，呕恶，恶寒发热，不食，下午烦躁，口苦不寐。这是俗名鸬 瘟，是少阳阳明二经之症。法当清解，用柴胡、贯众各一钱，干姜、竹茹、半夏曲各一钱，黄连、枳壳各七分，甘草四分，一帖而减，二帖而安。
喻嘉言治疗钱仲昭，患时气外感三五日，发热头疼。服表汗药，疼止热不清，口干唇裂，因而下之，遍身红斑，神昏谵语，食饮不入，大便复秘，小便热赤，脉见紧小而急。说：此症前因误治阳明胃经，表里不清，邪热在内，如火燎原，津液尽干，所以神昏谵妄。如果斑转紫黑，即刻死矣。目前本是难救，但其面色不枯，声音尚朗，是平日保养肾水有余，如旱田之侧，有下泉未竭，所以神虽昏乱，而小水仍通，是阴气未绝之征，尚可治之。不用表里，单单只一和法，取七方中小方，而气味甘寒者用之，惟如神白虎汤一方，足以疗此。大概中州元气已离，大剂、急剂、复剂，俱不敢用，而虚热内炽，必甘寒气味，方可和之耳。但方虽宜小，而服则宜频，如饥人本欲得食，不得不渐渐与之，必一昼夜频进五七剂，为浸灌之法，庶几邪热以渐而解，元气以渐而生也。如果小其剂，复旷其日，纵用药得当，也无及矣。如法治之，更一昼夜，热退神清，脉和食进，其斑自化。
金鉴春日病瘟，误治二旬，酿成极重死症，壮热不退，谵语无伦，皮肤枯涩，胸膛板结，舌卷唇焦，身倦足冷，二便略通，半渴不渴，面上一团黑滞。前医所用之药，不过汗下和温之法，绝无一效。喻嘉言说：此症与两感伤寒无异，但彼日传二经，三日传经已尽即死。不死者，又三日再传一周定死矣。这是春温症不传经，所以虽然邪气留连不退，也必多延几日，待元气竭绝乃死。观其阴症阳疾，两下混在一区，治阳则碍阴，治阴则碍阳。然而法曰：发表攻里，本自不同。又说：活法在人，神而明之，未曾教人执定勿药也。我有一法，即以仲景表里二方为治，虽未经试验，吾天机勃勃自动，若有生变化行鬼神之意，必可效也。于是用麻黄附子细辛汤，两解其在表阴阳之邪，果然皮间透汗，而热全清。再用附子泻心汤，两解其在里阴阳之邪，果然胸前柔活，而人事明了，诸症俱退，次日即食粥，以后竟不需药。只在此二剂，而起一生于九死，快哉。（此案后学宜反复详玩之。）
卢不远治疗永嘉王龙友，望其色黯紫，舌本深红，知其次日当病，果发热。越三日，其叔培竹欲归，将发，诊其脉沉而散，卢极力挽留，谓龙友虽病，而脉有神理，君虽未病，而邪实深入，病于中路，将奈何？至次晚，大吐，脉随脱，药以人参三钱，脉复。有以枣仁等剂投之者，其热转盛。十四日，脉八至，舌短神昏。卢谓今晚非用下，必然胃烂，因用芩、连、大黄，一剂，次日遂愈。大概疫为疠气，人受之多从口鼻入，因人色力盛衰，以为轻重，审色与脉，可以先知。又疫者，瘟热病之沿漫也。其病之因，由寒郁火，所以其色紫，紫为水克火之色也。火病之发，应心之苗，所以舌色深红，杜清碧谓之将瘟舌。而脉体须浮，浮脉象火，病发必顺。若沉则邪深入里，势必暴焚，河间多用下法，下之中空，而火性自平矣。如下而当失时，必胃烂而死。
Wang Yutai stated: The Shengsanzi Formula (Holy Dispersion Decoction), because of the preface written by Mr. Su Dongpo (Su Shi), became revered as a divine prescription throughout the world. In the Xinwei year of the late Song Dynasty, during an epidemic in Yongjia, those who took this formula and suffered harm were too numerous to count. I read in Ye Shilin's *Bishu Lu* (Record of Summer Retreat) that during the Xuanhe era, this medicine was prevalent in the capital city. University students believed in it especially fervently, resulting in countless deaths, after which physicians abandoned it. Previously, when Su Dongpo was demoted and resided in Huangzhou, the area was near the river with high humidity. The illnesses contracted by residents there were either due to dampness invading the interior or caused by soaking rainwater. Therefore, taking this medicine was often effective, leading to its widespread circulation and leaving endless detrimental consequences. In the Guichou year of the Hongzhi era, a severe epidemic broke out in the Wuzhong region. Sun Pan, the magistrate of Wu County, ordered physicians to prepare Shengsanzi Formula, distributing it across streets and alleys, and printed the prescription for public use. Among those who took it, not one in ten survived; most died from mania, restlessness, and coma. Alas, although Lord Sun's original intention was to save lives, he did not realize that Shengsanzi Formula contains Aconiti Lateralis Radix Praeparata (Fuzi, Prepared Lateral Root of Monkshood), Alpiniae Officinarum Rhizoma (Liangjiang, Rhizome of Galangal), Evodiae Fructus (Wuzhuyu, Fruit of Evodia), Myristicae Semen (Doukou, Nutmeg), Ephedrae Herba (Mahuang, Herb of Ephedra), and Agastaches Herba (Huoxiang, Herb of Patchouli). These herbs all possess dry and hot properties, which instead exacerbate fire pathogens. How could patients not die? If one does not differentiate between Yin syndromes and Yang syndromes and treats them indiscriminately, killing people is easier than using swords. If anyone can widely disseminate this knowledge to warn others, it would be one aspect of benevolence. From *Xu Yishuo*.
Zhang Zihe said: In the spring of the Yuanguang era, Li Pingshan (Yingtai) of the Hanlin Academy in the capital contracted a plague syndrome. He suffered from headache, fever, dry mouth, and dark, difficult urination. As he had a habit of drinking alcohol, physicians administered Jiuzheng Wan (Alcohol Syndrome Pill) combined with Crotonis Fructus (Badou, Seed of Croton) to induce diarrhea more than ten times. The next day, the headache and other symptoms persisted. The physicians failed to recognize the condition and again used acrid-warm agents to release the exterior. They placed him on a warm kang (heated brick bed) and forced him to drink scallion and vinegar soup, attempting to achieve sweating. Little did they know that various exogenous heat pathogens overlapped and erupted simultaneously, causing yellow eyes, skin spots, tidal fever, vomiting, diarrhea, severe panting, and abdominal fullness. Although Chengqi Tang (Cathartic Decoction) was later used to purge, it was already too late. Discussions continue to this day, yet people fail to realize the fault lay with the hot medicines, often blaming Chengqi Tang instead. Those who used Chengqi Tang did not realize the critical state of the illness and continued medicating, demonstrating a lack of medical understanding, which is indeed culpable. However, critics who do not blame Jiuzheng Wan are also blameworthy. Plague syndromes located at the exterior should not be purged, let alone with Crotonis Fructus pills. After excessive purgation with Badou, how could one further administer acrid-hot agents? Those who follow the crowd in praising or criticizing are merely making baseless remarks. (Wentian notes: Purging with Badou has extremely damaged the Yin fluids. Using Da Huang (Rhubarb) to purge again cannot possibly preserve Yin independently. This case should have been treated with Mung Bean (Lvdou) to detoxify Badou, combined with Yin-nourishing herbs, which might have helped. However, Zhang Zihe is insufficient to comment on this.)
In the second year of Baoqing (Song Dynasty), winter, November of the Bingxu year, Yelü Zhengwang followed Emperor Taizu of Yuan to attack Lingwu. While generals fought over women, children, jade, and silk, Yelü Zhengwang alone took several books and two camels loaded with Rheum Palmatum et Pubescens Radix et Rhizoma (Dahuang, Rhubarb). Later, when an epidemic struck the army, Dahuang proved curative, saving nearly ten thousand people. (*Zhuge Lu*. Wentian notes: Soldiers often consume alcohol and meat, and sweat heavily from labor. When warm epidemics spread, pathogens quickly enter the Yangming Stomach Fu organ. This explains why Dahuang was universally effective. Wang's deletion of this case was incorrect.)
*Zhifang Waiji* records: In the Kingdom of Kaoa Island, an epidemic occurred. A famous physician named Genjubujia did not use herbal medicines but ordered large fires to be lit throughout the city and countryside, burning for a day and night. Once the fire extinguished, the disease also healed. Epidemics are caused by invasion of evil qi. Fire qi is fierce and can cleanse various evils. When evil qi is exhausted, the epidemic resolves. This is also sound reasoning. (*Qiao Shu Chubian*. This method is only feasible in border regions. Wentian notes: This was a cold epidemic in winter, not a warm epidemic. Wang knew that warm pathogens cause epidemics but failed to realize that cold epidemics also occur in winter. His arbitrary deletion of this case was wrong.)
Qiu Rucheng visited a friend and heard crying from a neighbor's house. Upon asking the reason, he was told that Neighbor Jia had contracted a seasonal disease. Qiu ordered water to be drawn into a large barrel, placed a curtain horizontally above it, and had the patient sit on top of the curtain (using steam fumigation). The illness subsequently resolved. (*Huichen Xintan*. Wentian notes: This was a warm epidemic syndrome caused by damp-heat in the middle jiao.)
Vice Minister Su Taoguang said: When I served as the magistrate of Qingliu County, the daughter-in-law of Shentu Xingfu from the county contracted a seasonal epidemic. After thirty-plus days, it had become a deteriorated syndrome. I instructed her to take Duoming San (Life-Restoring Powder), also known as Fumai Tang (Pulse-Recovering Decoction). It consisted of Ginseng Radix et Rhizoma (Renshen, Ginseng) one liang, decocted in two zhong of water with strong fire until one zhong remained. It was cooled in well water before administration. Shortly after, sweat appeared on the nasal bridge, the pulse recovered, and she improved immediately. For any typhoid or seasonal epidemic, regardless of Yin/Yang differentiation or age, if medication errors lead to critical condition with deep, hidden pulses and unconsciousness, Fumai Tang can be taken after seven days with a success rate of nearly 100%. (*Bencao Gangmu*, *Renhe County Gazetteer*. This indicates Yin injury with impending Yang collapse, hence the efficacy of Fumai Tang, where Ginseng is appropriate. However, stating "can be taken after seven days" contradicts medical principles. Wang's casual deletion was inappropriate.)
Wu Sichang treated Zhao Qingxian Gong, a prestigious minister of the Zhejiang Governor, who frequently suffered from critical epidemics. Wu disregarded public opinion and administered ice water, causing immediate recovery. The Duke respected him as a deity, saying, "You will be immortal."
Sun Wenyuan treated an elderly courtesan who, after three days, suffered from headache, fever, thirst, profuse watery diarrhea, heavy body unable to turn over, increasing drowsiness, deafness, closed eyes, and delirium. Physicians proposed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), but the decoctions were not yet administered. Sun examined her and found six pulses surging and large, inner-red and outer-black facial complexion, dry lips, black coating on the center of the tongue, and unconsciousness. He said, "This is a plague syndrome. The method requires clearing and resolving. Urgently administer Xiaobai Tang (Little White Decoction), and life may be saved. Using Qi-tonifying and Lizhong methods would kill her; how could they be used?" Asked what Xiaobai Tang was, he replied, "Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Baihu Tang (White Tiger Decoction)." Someone asked, "With such severe diarrhea, can Shih Gypsum (Shigao) be used?" He replied, "This is diarrhea with coordinated heat; it should be taken early." After administration, by midnight, spirit revived, though urination remained difficult and heat/thirst persisted. Following Zhongjing's method, for thirst, fever, and difficult urination, one should promote urination. Thus, Chen Sha Liuyi San (Cinnabar Six-to-One Powder) two liang was mixed with Dengxin Tang (Juncus Decoction) and administered. Two doses cured her. (Li notes: This is a combination of Yangming and Shaoyang diseases. Using Baihu and Chaihu was correct. However, Zhongjing's Chaihu Tang guidelines state to remove Banxia (Pinellia) and add Gualou Gen (Trichosanthes Root) when thirst is present. Why not follow this? This is also a type of Three-Yang combination. Baihu Tang alone suffices; adding Xiao Chaihu Tang is not very erroneous. However, Chaihu and Banxia are somewhat ascending and drying. Thus, heat/thirst and difficult urination resolved only after Liuyi San cleared heat, not primarily due to diuresis. Readers should not be confused by its reference to Zhongjing.)
Zhang Jingyu suffered from fever, abdominal pain, diarrhea, thirst, and incessant vomiting. Some identified it as cold, some as heat, some as typhoid. Sun diagnosed it as seasonal epidemic diarrhea. He used Erchen Tang (Two-Cured Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma), plus Qinghao (Artemisiae Annuae Herba), Gegen (Puerariae Lobatae Radix), Jiu Qin (Scutellariae Radix prepared with wine), Baishao (Paeoniae Radix Alba), Zhuling (Polyporus), and Zexie (Alismatis Rhizoma). One dose brought peace.
A servant suffered from body heat like burning, headache like splitting, red urine, thirst, dry nose, insomnia, chest/diaphragm distension, hunger without appetite, and wiry-rapid pulses. Sun prescribed Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) plus Zhimu (Anemarrhenae Rhizoma), Zhike (Aurantii Fructus), Baizhi (Angelicae Dahuricae Radix), Gegen, and Qinghao. One dose halved the heat and pain, and relaxed the chest. Thirst and scanty urine remained, along with restless sleep. Sun then gave Huawen Dan (Plague-Transforming Pill) three qian, dissolved in well water. Thirst stopped, and sleep improved. For dizziness, weak legs, and panting, Siwu Tang (Four Substances Decoction) plus Qinghao, Jiu Qin, Yiyiren (Coicis Semen), and Mugua (Chaenomelis Fructus) was given, resulting in full recovery.
Another servant had similar symptoms. Previous doctors administered drugs causing severe vomiting and diarrhea, worsening heat, unbearable headache, irritability, thirst, dry nose, vomiting, and scanty urine for fourteen days, critically ill. Sun asked about previous medications and found they included Huoxiang Zhengqi San (Patchouli Regulate Qi Powder), Sharen (Amomi Fructus), Houpo (Magnoliae Officinalis Cortex), and Shanzha (Crataegi Fructus), all depleting primal qi. In May, when fire authority dominates epidemics, sweet-cold agents should be used. How could acrid-hot aromatic agents be used to increase fire and dry fluids? Sun urgently administered Ren Shen Baihu Tang (Ginseng White Tiger Decoction) plus Zhuru (Bambusae Caulis in Taeniam), Gegen, Qinghao, and Shengma (Cimicifugae Rhizoma). One dose eliminated heat; the second stopped headache, resolving all symptoms. Several subsequent cases were treated similarly. Generally, heavenly movement epidemics affect many in one area. First, administer sweet-cold clearing agents. After heat subsides, use Siwu Tang to nourish Yin blood, adding mild heat-clearing herbs, where Qinghao plays a dominant role. (Treatment of plague syndromes concludes here.)
Mrs. Wu first contracted wind pathogen, then food stagnation, leading to fever, headache, and abdominal distension. Doctors administered Badou pills to purge, but heat remained unchanged. Then Da Huang was used for heavy purging, yet heat remained unchanged. Later practitioners claimed heat persisting after purging indicated deficiency and heavily tonified with Renshen and Baizhu. After four days, spirit was dull, and consciousness lost. Sun diagnosed wiry-rapid left pulse, deep-rapid-strong right guan/chchi pulses, sedge-colored tongue tip, scorched-black thorny tongue root, and unclear speech. Ignorance of post-famine conditions allowed epidemic qi to become pestilence; reckless purging and tonification mistakenly created a deteriorated epidemic, critical and dangerous. Temporarily, Chaihu and Zhimu each three qian, Shigao six qian, Zhishi and Huafen each five fen, Gancao, Huangqin, and Maidong each one qian, Zhizi and Shengdi each seven fen, Renshen six fen, Zhuye thirty leaves, and Jiang three fen were decocted in water. Drinking until midnight, consciousness slightly cleared, slight sweat appeared, tongue softened. Next day, Shengdi was removed from the formula, Baishao added, and black tongue coating receded. No bowel movement for five days, body still painful, coughing. Seven-Processed Phlegm-Resolving Pills (Qizhi Huatan Wan) two doses were given, followed by Shigao two qian, Maidong and Beimu each one qian, Qianhu, Zhike, Huangqin, Zhizi each six fen, Gancao three fen, Sangbai Pi eight fen. Full recovery ensued.
Madam Cheng's husband died of plague. Seven days later, she contracted it: high fever, headache, thirst, chest/hypochondriac pain. Doctors gave Xiao Chaihu Tang. At night, she dreamed of her husband engaging in intercourse, woke up with profuse cold sweat, limbs feeling detached, confusion, delirium, earth-colored face, and hard/scorched-black tongue. Sun diagnosed deep-wiry-rapid six pulses, constipation of both stool and urine. This is a case of Yin-Yang Exchange (Yinyang Yi). Post-plague occurrence is extremely critical. She was given Shengmai Tang (Generate Pulse Decoction) plus Chaihu, Huangqin, Guizhi, and Gancao. The decoction was taken with ash from her husband's former underwear. Two doses restored consciousness, temperature normalized, sweat ceased, tongue softened, black coating receded. Julei (Zizyphi Semen) and Zhuru were added to the previous formula; limb movement returned, allowing congee intake. Six family members/servants subsequently fell ill sequentially and were all treated with Liushentong Jie San (Six-Spirit Unblocking Release Powder), resolving via sweating.
A woman suffered fever and headache. Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) and Shishen Tang (Ten-Gods Decoction) failed, adding thirst and coal-black tongue. Ru Shen Baihu Tang and Zhuye Shigao Tang also failed, adding incessant diarrhea, dullness, cold limbs, faint breathing, and inability to eat for fourteen days, preparing for death. Sun diagnosed thread-like fine pulses. He said, "This is a plague syndrome." Combined Shengmai and Lizhong Decoctions were administered. Two doses led to slight revival at midnight, drinking half a cup of congee. Next morning, six pulses gradually appeared. Joyfully, he said, "When pulse vanishes but faintly continues, life returns; no worry." Continued previous medication. By evening, diarrhea stopped, thirst ceased, black tongue receded, spirit refreshed. Ren Shen and Baizhu each five qian, Pao Jiang (Prepared Ginger), Zhi Gancao each two qian, Maidong two qian, Wuweizi fifteen grains (still Lizhong and Shengmai) were taken irregularly. Full recovery in several days. (This is a deteriorated syndrome; previous cooling/releasing was excessive, so warming/tonification succeeded.)
Wu Qiuquan's wife, after dysentery and cold contraction, menstruation arrived. She had high fever, slight headache, thirst, body ache, chest fullness, irritability, deafness, diarrhea, white tongue coating, and chaotic rapid pulses (7-8 per breath). (Rapid/chaotic pulses usually indicate凶兆, but here it is extreme heat stagnation. Extreme stagnation leads to tranquility/passage. Battle-sweat follows. This is natural law.) Sun said, "This is Three-Yang combination, Spring Plague Syndrome." Administered Three-Yang herbs. After taking, slight response observed. Formula: Chaihu three qian, Gegen and Baishao each two qian, Zhishi, Jiegeng, Jiu Qin, Zhuru each one qian, Tianhuafen eight fen, Zhi Gancao and Guizhi each five fen. After ingestion, body felt like ice, face and limbs worse, six pulses vanished. (Double/single hidden pulses with cold limbs indicate impending battle-sweat. Memorize this.) Family and doctors sighed as if dead. Sun said, "Not a death omen." At midnight, Yin reaches extremity, Yang generates. Heat desires to sweat, like sky darkening before rain. Physicians sneered. After fourth watch, battle-sweat occurred, clothes wet, limbs warmed, spirit clear, requesting congee. Only deafness remained, loud borborygmus, pulse near six beats. Changed to Chai Ling Tang (Bupleurum and Polyporus Decoction) plus Wumei (Mume Fructus). Two doses cured.
Clansman grandson, after drunken intercourse and urinating, developed umbilical pain, watery diarrhea with borborygmus (>10 times/day), fever, and headache. Doctor gave Lizhong Tang one dose, worsening vomiting, irritability, and thirst. Sun diagnosed wiry-large left pulse, surging-large right pulse, seven beats, no eating/sleeping, red face, dry lips, thick yellow coating. Patient claimed post-coital Yin Typhoid with lower abdominal pain and leakage. Sun laughed, "Spring Warmth Syndrome." Clansmen insisted on Yin syndrome due to vomiting/diarrhea, warning against diagnosing Yang just due to red face, suggesting Lizhong Tang plus Fuzi and Rougui (Cinnamon Bark) for preservation. (Post-coital external contraction misdiagnosed as Yin and treated with hot herbs kills many. Compare with Yu Jiayan's case of Huang Changren in Typhoid section.) Sun said, "Once Guizhi enters the throat, Yang excess leads to death." Differentiating Yin/Yang and Cold/Heat accurately determines life/death. Here, abandon symptoms for pulses. (Symptomatically, fever/headache is not Yin syndrome.) Wendan Tang (Warm Gallbladder Decoction) plus Jiang Zhi Chuanlian (Ginger-fried Coptis), Chaihu, and Ge Gen (Kudzu) were given. Two doses to be consumed overnight to prevent transmission. Fearful of Zhuru and Huanglian, only one dose taken. Vomiting stopped, other symptoms remained. Next day, surging-large pulses beating fingers. Baihu Tang plus Zhuru two doses prescribed. Fearful of Shigao, only one dose taken. Diarrhea stopped, lower abdominal pain persisted. Next day, surging-long-hard pulses, pathogen entered Fu organs. Tao Ren Chengqi Tang (Peach Kernel Cathartic Decoction) was necessary. Decocted and administered immediately. Two doses passed 5-6 black dry stools. Pain and heat reduced. Re-diagnosis showed slow-weak six pulses. Sijunzi Tang (Four Gentlemen Decoction) plus Baishao, Huanglian, and Xiangfu (Cyperi Rhizoma) tonified for several days until cured.
Brother Cheng had swollen/red cheeks, nausea, aversion to cold/fever, anorexia, afternoon irritability, bitter taste, and insomnia. This is commonly called Lu [Bird] Plague, involving Shaoyang and Yangming meridians. Method requires clearing/resolving. Chaihu and Guanzhong (Illicium Coronarium) each one qian, Ganjiang (Dried Ginger), Zhuru, Banxia Qu (Pinellia Fermented Paste) each one qian, Huanglian, Zhike each seven fen, Gancao four fen. One dose reduced symptoms; two doses resolved them.
Yu Jiayan treated Qian Zhongzhao, who had seasonal external contraction for 3-5 days with fever and headache. Surface-releasing herbs stopped pain but not heat, causing dry mouth/cracked lips. Downward purging followed, resulting in whole-body red spots, confusion, delirium, inability to eat/drink, constipation, hot red urine, and tight-small-rapid pulses. Yu said, "Previous mistreatment of Yangming Stomach channel left interior/exterior unclear. Evil heat inside burns like a prairie, drying fluids, causing confusion. If spots turn purple-black, death is immediate. Currently difficult to save, but complexion not withered, voice clear, indicating sufficient Kidney Water preservation (like underground springs in dry fields). Spirit confused but urine flows, showing Yin not exhausted. Treatable." Do not use surface or interior methods, only Harmonizing method. Use small formulas from Seven Forms with sweet-cold properties. Ru Shen Baihu Tang is sufficient. Central Yuan Qi has separated; large/urgent/repeated doses are unsafe. Internal deficient heat requires sweet-cold aromatics to harmonize. Although formula should be small, frequency should be high. Like feeding a starving person gradually. Administer 5-7 doses daily for immersion. Gradually resolve heat and regenerate Qi. Reducing dose or extending days renders even correct medication useless. Treatment resulted in heat subsiding, spirit clearing, pulse harmonizing, appetite returning, and spots dissolving within another day-night.
Jin Jian contracted plague in spring, mistreated for twenty days, developing critical fatal syndrome: unremitting high fever, incoherent delirium, dry skin, rigid chest, curled tongue, scorched lips, fatigue, cold feet, slight bowel/bladder passage, partial thirst, dark stagnant face. Previous treatments (sweating, purging, harmonizing, warming) failed completely. Yu said, "Similar to Lianggan Typhoid (Dual-Infection Typhoid). That transmits two channels daily, dying after three days if not cured. If surviving, dies after another three-day cycle. This Spring Warmth does not transmit channels, so evil lingers longer, waiting for Yuan Qi exhaustion for death. Yin and Yang diseases mixed. Treating Yang hinders Yin; treating Yin hinders Yang. Yet law states: releasing exterior and attacking interior differ. Living method depends on human wisdom, not forbidding medication. I have a method: use Zhongjing's exterior-interior formulas. Though untested, my intuition urges action, resembling divine change. Likely effective." Used Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to resolve exterior Yin/Yang evil. Sweat penetrated skin, heat cleared. Then Fu Zi Xie Xin Tang (Aconite Draining Epigastric Decoction) resolved interior Yin/Yang evil. Chest softened, consciousness returned, symptoms retreated. Ate congee next day, no further medication needed. Just these two doses rescued life from nine deaths. Delightful! (Students should study this case carefully.)
Lu Bu Yuan treated Wang Longyou of Yongjia. Observed dark-purple complexion and deep-red tongue root, predicting illness next day. Fever occurred. Three days later, uncle Peizhu wanted to leave. Pulse was deep-scattered. Lu urged him to stay, saying Longyou had disease but spirit-pulse intact; Peizhu had no disease but evil deeply invaded. Illness en route would be disastrous. Next evening, severe vomiting, pulse collapsed. Renshen three qian restored pulse. Others administered Julei etc., heat intensified. Fourteen days: pulse eight beats, short tongue, confusion. Lu said, "Must purge tonight, else stomach rots." Used Huangqin, Huanglian, Dahuang. One dose cured next day. Epidemic is pestilential qi, entering via mouth/nose. Severity depends on complexion/strength. Observing color/pulse allows prediction. Epidemic is spreading warm-heat disease. Cause: cold suppressing fire. Color purple (Water overcoming Fire). Fire disease manifests in Heart sprout (tongue), hence deep red. Du Qingbi calls this "Pre-Plague Tongue." Pulse must be floating (Fire image); smooth onset. Deep means evil enters interior, violent burning. Hejian often uses purging. Emptying interior calms fire nature. Missing purge timing leads to stomach rot and death.