脉 脉诀云。瘟病之脉。散而难名。如太阳脉浮。阳明脉长。少阳脉弦。太阴脉细。少阴脉
又云。阳脉濡弱。阴脉弦紧。更遇温气。变为瘟疫。阳脉洪数。阴脉实大。更遇温热。变为瘟毒者危。凡瘟病大热
脉沉涩细小足冷难治。洪大有力。或浮大者。可治。脉不浮者为传染。若左寸浮大。右寸
宜补中带表而治之。
症 夫瘟疫之症。多由房劳太过。腠理闭泄。少阴不藏。触冒冬时杀疠之气。严寒之毒。
即病者。寒毒藏于肌肤。至春变为瘟病。至夏变为热病也。又有时行不
秋应凉而反热。冬应寒而反温。此非其时而有其
疫也。外症头痛。壮热。
治 丹溪云。治法有三。有宜补。宜散。宜降。人参、白术、防风、羌活、苍术、并大黄、
活石、人中黄之类主之。又吴氏云。凡尺寸脉浮者。发于太阳也。宜
汗之。或有自汗身疼者。九味羌活汤主之。尺寸
数者。少阳也。宜小柴胡
考瘟病。先因伤寒热未除。更感时行之气。而为瘟疫也。治与伤寒不同。盖瘟病因春时温气
乃郁热自内而发于外。故宜辛平之剂以发散之。况时令已暖。不可
用麻黄。如时令尚寒。少佐之亦可。凡瘟病发于三阳者多。三阴者少。若发于三阴者。必有
所因也。或食寒物内伤太阴而得之。或因过欲先伤少阴而得之。治制皆与伤寒各条同。惟发
表不同耳。又有大头天行病。乃湿热在高巅之上。并阳明邪热大甚。资实少阳相火而为之。
视其肿势在何部。随经治之。用防风、羌活、酒芩、酒蒸、大黄、随病加减治之。不可用降
药。
方 人参败毒散治瘟疫及大头病初感。服此药散之。
人参（一钱五分） 白术（二钱） 白茯苓（一钱） 甘草（五分） 羌活（一钱五分） 防风（一钱
五分） 柴胡（一钱五分） 前胡（一钱） 黄芩（一钱） 枳壳（八分） 苍术（一钱二分） 桔梗（七分）
上作一服。用生姜三片。枣一枚。水二钟。煎一钟。热服微汗为度。
又方 三黄石膏汤治疫症燥渴。将欲发狂者。
石膏（三钱） 黄芩 黄连 黄柏（各一钱五分） 麻黄（一钱五分寒用多暖用共之） 山栀（一
钱） 热甚者加大黄（三钱）
上用水二钟。粳米一撮。煎服。连进三五服即愈。
又方 普济消毒饮子。治瘟疫热毒。清热解毒。大头病。头面肿。亦可服。
柴胡（一钱五分） 黄连（炒） 黄芩（炒） 玄参 生甘草 桔梗 连翘 鼠粘子 白芷 马勃
川当归（各一钱） 僵蚕（七分） 升麻（七分） 板蓝根（一钱如无以蓝叶代之或真青代亦可）
如虚。加人参（一钱五分）、大便秘。加酒蒸大黄（二钱）。
又方 辟瘟丹凡春夏秋间预服。以免疫气传染。或初感。服此药。得小汗亦愈。
防风（去芦一两五钱） 川芎 当归 白芍药 白术 麻黄 石膏 滑石 黄芩 连翘 栀子
（各一两） 桔梗 荆芥 薄荷（各八分） 玄胡粉（一两五钱） 大黄（煨二两） 鬼箭羽 马勃
管仲（各一两二钱）
上为细末。腊雪水。或冰水为丸。如弹子大。每服一丸。姜葱汤下。得周身微汗即解。此药
用五月五日。六月六日。或冬至腊日。焚香礼斗。至诚修合。无不应验。合时忌与妇人鸡犬
孝子见之。
脉象：《脉诀》中说，瘟疫病的脉象，散乱而难以命名。有的像太阳病脉浮，阳明病脉长，少阳病脉弦，太阴病脉细，少阴病脉……（原文此处似有缺漏或语意未完）。又说，阳脉濡弱，阴脉弦紧，如果再遇到温气侵袭，就会变为瘟疫。如果阳脉洪数，阴脉实大，再遇到温热之气，就会变为瘟毒，这种情况很危险。凡是瘟疫病出现大热症状，如果脉象沉涩细小，且足部发冷，属于难治之症；如果脉象洪大有力，或者浮大，则属于可治之症。脉象不浮的，说明具有传染性。如果左寸口脉浮大，右寸口脉……（原文此处似有缺漏），治疗应当采用补益兼解表的方法。
症状：瘟疫的症状，多由房事过度引起，导致腠理（皮肤毛孔及肌肉间隙）开泄失常，少阴肾气不固，触犯了冬季的杀疠之气、严寒之毒。立即发病的，寒毒潜伏在肌肤之间，到了春天就变为瘟病，到了夏天就变为热病。也有时行疫病，秋天本该凉快却反而炎热，冬天本该寒冷却反而温暖，这是非其时而有其气，从而产生疫病。外在症状包括头痛、高热等。
治法：朱丹溪说，治疗方法有三种：宜用补法，宜用散法，宜用降法。用人参、白术、防风、羌活、苍术，以及大黄、滑石、人中黄等药物为主进行治疗。又吴氏说，凡是尺寸脉浮的，病发于太阳经，宜用发汗法。如果有自汗、身体疼痛的，用九味羌活汤主治。尺寸脉……（原文此处似有缺漏）数者，病发于少阳经，宜用小柴胡汤。考证瘟病，起初是因为伤寒余热未清，又感染了时行之气，从而成为瘟疫。治疗与伤寒不同。因为瘟病因春季温气所致，乃是郁热从内而发于外，所以宜用辛平的药物来发散它。况且时令已经变暖，不可使用麻黄；如果时令尚寒，少量佐用也可以。凡是瘟病发于三阳经的多，发于三阴经的少。如果发于三阴经，必定有所原因。或者是吃了寒物内伤太阴而得病，或者是因纵欲过度先伤少阴而得病。治疗原则都与伤寒各条相同，只有发表的方法不同罢了。又有大头天行病，是湿热在高巅之上，并伴有阳明邪热极盛，资助少阳相火而形成的。根据肿胀部位所在，随经治疗。用防风、羌活、酒炒黄芩、酒蒸大黄，根据病情加减治疗。不可使用降药。
方剂：人参败毒散，治疗瘟疫及大头病初感。服用此药以发散邪气。
人参（一钱五分）、白术（二钱）、白茯苓（一钱）、甘草（五分）、羌活（一钱五分）、防风（一钱五分）、柴胡（一钱五分）、前胡（一钱）、黄芩（一钱）、枳壳（八分）、苍术（一钱二分）、桔梗（七分）。
以上为一服量。用生姜三片，大枣一枚，水两钟，煎至一钟，热服，以微微出汗为度。
又一方：三黄石膏汤，治疗疫症燥渴，即将发狂的患者。
石膏（三钱）、黄芩、黄连、黄柏（各一钱五分）、麻黄（一钱五分，寒证多用，暖证共用）、山栀（一钱）。热势甚者加大黄（三钱）。
以上用水两钟，粳米一撮，煎服。连续服用三五次即可痊愈。
又一方：普济消毒饮子，治疗瘟疫热毒，清热解毒，治疗大头病，头面肿胀，也可服用。
柴胡（一钱五分）、黄连（炒）、黄芩（炒）、玄参、生甘草、桔梗、连翘、鼠粘子（牛蒡子）、白芷、马勃、川当归（各一钱）、僵蚕（七分）、升麻（七分）、板蓝根（一钱，如无可用蓝叶代替，或用真青黛代替亦可）。如体虚，加人参（一钱五分）；大便秘结，加酒蒸大黄（二钱）。
又一方：辟瘟丹，凡春夏秋间预先服用，以免疫气传染。或者初感疫病，服用此药，得到微汗也能痊愈。
防风（去芦，一两五钱）、川芎、当归、白芍药、白术、麻黄、石膏、滑石、黄芩、连翘、栀子（各一两）、桔梗、荆芥、薄荷（各八分）、玄胡粉（一两五钱）、大黄（煨，二两）、鬼箭羽、马勃、管仲（各一两二钱）。
以上研为细末。用腊雪水或冰水泛丸，如弹子大小。每服一丸，姜葱汤送下，得到周身微汗即解。此药要在五月五日、六月六日，或冬至腊日，焚香礼斗，至诚制作，没有不应验的。制作时忌讳妇人、鸡犬及孝子看见。
Pulse: The *Mai Jue* (Pulse Mantra) states that the pulse of plague diseases is scattered and difficult to name. It may resemble the floating pulse of Taiyang disease, the long pulse of Yangming disease, the wiry pulse of Shaoyang disease, the fine pulse of Taiyin disease, or the pulse of Shaoyin disease... It also states that if the yang pulses are soggy and weak, and the yin pulses are wiry and tight, further exposure to warm qi will transform it into a plague. If the yang pulses are surging and rapid, and the yin pulses are solid and large, further exposure to warm-heat qi will transform it into plague toxin, which is critical. In cases of plague with high fever, if the pulse is deep, choppy, fine, and small, accompanied by cold feet, it is difficult to treat. If the pulse is surging, large, and forceful, or floating and large, it is treatable. A non-floating pulse indicates contagion. If the left cun position is floating and large, and the right cun... [text missing], treatment should employ tonification combined with exterior-resolving methods.
Symptoms: Plague symptoms often arise from excessive sexual activity, leading to dysfunction of the couli (skin pores and interstices), failure of Shaoyin kidney qi to store, and exposure to the killing pestilential qi and severe cold toxins of winter. Those who fall ill immediately harbor cold toxins in the skin and muscles; these transform into plague diseases in spring and heat diseases in summer. There are also seasonal epidemics where autumn should be cool but is hot, and winter should be cold but is warm. This is "qi out of season," generating epidemic diseases. External symptoms include headache and high fever.
Treatment Methods: Zhu Danxi stated there are three treatment approaches: tonification, dispersal, and descending. Use Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Cang Zhu (Atractylodis Rhizoma), along with Da Huang (Rhei Radix et Rhizoma), Hua Shi (Talcum), and Ren Zhong Huang (Hominis Excrementus Carbonized) as main agents. Wu stated that if the chi and cun pulses are floating, the disease originates in the Taiyang channel; sweating method is indicated. For those with spontaneous sweating and body pain, Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) is used. If the chi and cun pulses... [text missing] are rapid, the disease originates in the Shaoyang channel; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. Examining plague diseases, they initially stem from unresolved heat from cold damage, compounded by seasonal qi, becoming plague. Treatment differs from cold damage because plague arises from spring warm qi, representing latent heat emerging from within to the exterior; thus, acrid-neutral agents for dispersal are suitable. Since the season is now warm, Ma Huang (Ephedrae Herba) should not be used; if the season is still cold, a small amount may be added. Most plague diseases originate in the three yang channels, few in the three yin channels. If originating in the three yin channels, there must be a cause: either internal injury to Taiyin from eating cold foods, or prior injury to Shaoyin from excessive desire. The treatment principles are the same as various clauses of cold damage, differing only in exterior-resolving methods. Additionally, there is "Big Head Epidemic Disease," caused by damp-heat at the high summit, combined with extreme Yangming pathogenic heat, fueling Shaoyang ministerial fire. Treat according to the channel involved based on the swelling location. Use Fang Feng, Qiang Huo, Jiu Qin (Wine-fried Scutellariae Radix), and Jiu Da Huang (Wine-steamed Rhei Radix et Rhizoma), modified by condition. Do not use descending drugs.
Formulas:
Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxicity) treats early-stage plague and Big Head Disease. Take this formula to disperse pathogens.
Ren Shen (1.5 qian), Bai Zhu (2 qian), Bai Fu Ling (Poria, 1 qian), Gan Cao (Licorice Root, 0.5 qian), Qiang Huo (1.5 qian), Fang Feng (1.5 qian), Chai Hu (Bupleuri Radix, 1.5 qian), Qian Hu (Peucedani Radix, 1 qian), Huang Qin (Scutellariae Radix, 1 qian), Zhi Ke (Aurantii Fructus, 0.8 qian), Cang Zhu (1.2 qian), Jie Geng (Platycodonis Radix, 0.7 qian).
Take as one dose. Add 3 slices of Sheng Jiang (Zingiberis Rhizoma Recens), 1 Zao (Jujubae Fructus), and 2 zhong of water. Decoct to 1 zhong. Take hot until slight perspiration occurs.
Another Formula: San Huang Shi Gao Tang (Three-Yellow and Gypsum Decoction) treats plague with dryness and thirst, approaching mania.
Shi Gao (Gypsum Fibrosum, 3 qian), Huang Qin (1.5 qian), Huang Lian (Coptidis Rhizoma, 1.5 qian), Huang Bo (Phellodendri Cortex, 1.5 qian), Ma Huang (1.5 qian; use more for cold conditions, standard for warm), Shan Zhi (Gardeniae Fructus, 1 qian). For severe heat, add Da Huang (3 qian).
Decoct with 2 zhong of water and a pinch of Jing Mi (Oryza Sativa Germ). Take orally. Continuous administration for 3–5 doses leads to cure.
Another Formula: Pu Ji Xiao Du Yin Zi (Universal Benefit Detoxifying Decoction) treats plague heat-toxin, clearing heat and detoxifying, for Big Head Disease with head and face swelling.
Chai Hu (1.5 qian), Huang Lian (Stir-fried, 1 qian), Huang Qin (Stir-fried, 1 qian), Xuan Shen (Scrophulariae Radix, 1 qian), Sheng Gan Cao (Raw Licorice Root, 1 qian), Jie Geng (1 qian), Lian Qiao (Forsythiae Fructum, 1 qian), Niu Bang Zi (Arctii Fructus, 1 qian), Bai Zhi (Angelicae Dahuricae Radix, 1 qian), Ma Bo (Pilulae, 1 qian), Chuan Dang Gui (Angelicae Sinensis Radix, 1 qian), Jiang Can (Bombyx Batryticatus, 0.7 qian), Sheng Ma ( Cimicifugae Rhizoma, 0.7 qian), Ban Lan Gen (Isatidis Radix, 1 qian; substitute with Isatidis Folium or Qing Dai if unavailable). For deficiency, add Ren Shen (1.5 qian); for constipation, add Jiu Da Huang (2 qian).
Another Formula: Pi Wen Dan (Plague-Repelling Pill) taken prophylactically in spring, summer, and autumn to prevent plague contagion. Or taken upon initial infection, inducing slight sweat for cure.
Fang Feng (deprived of radix tip, 1.5 liang), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 1 liang), Dang Gui (1 liang), Bai Shao Yao (Paeoniae Radix Alba, 1 liang), Bai Zhu (1 liang), Ma Huang (1 liang), Shi Gao (1 liang), Hua Shi (1 liang), Huang Qin (1 liang), Lian Qiao (1 liang), Zhi Zi (Gardeniae Fructus, 1 liang), Jie Geng (0.8 fen), Jing Jie (Schizonepetae Spica, 0.8 fen), Bo He (Menthae Haplocalycis Herba, 0.8 fen), Xuan Hu Fen (Curcumae Radix powder, 1.5 liang), Da Huang (baked, 2 liang), Gui Jian Yu (Ardisiae Caulifloris Ramulus, 1.2 liang), Ma Bo (1.2 liang), Guan Zhong (Matteuccii Rhizoma, 1.2 liang).
Grind into fine powder. Form pills using snow water from December or ice water, size of a bullet. Take one pill per dose with Ginger and Scallion soup. Cure occurs with slight whole-body sweat. This medicine should be prepared on the 5th day of the 5th lunar month, 6th day of the 6th lunar month, or Winter Solstice/La Day. Burn incense, bow to the Dipper, and prepare with utmost sincerity. No failures are expected. During preparation, avoid letting women, chickens, dogs, or mourners see the process.