近日时疫之病，有所谓喉痧者，初起脉俱沉细，三部以两尺为甚，两尺又以左手为甚，
其初
至数尚清，应指有力，一二日后渐见躁疾，模糊伏匿，按之即散。旧谓∶瘟病邪从中道，起
于阳明，其脉右大于左。窃谓∶此乃热浊之毒瓦斯熏蒸肺胃，脉形必是缓长洪大，浑浑不清，
为气浊而中焦湿热也。近时病情，乃邪伏少阴，或冬暖不寒，阳气不潜，阴精消散；或膏粱
无节，脾胃浊热下流，克伤肾水；或房室无度，阴精下夺，至春阳气欲升，阴精不能载阳上
达。故虚阳之已升者，中道而止于咽喉，不能达于大表也。其毒瓦斯之未能全升者，下陷于肾
中，熏蒸燔灼，阴尽而死。所谓逆冬气则少阴不藏，肾气独沉也。治法，尝拟用猪肤汤、麻
辛附子汤，二方并用，减麻黄，附子改用生者，并重加党参，以达其毒，毒散阴可存矣。世
每泥于喉证发于肺胃之成法，用苦寒清降，以清肺胃，故热毒愈无由达也。张石顽曰∶伤寒
以尺寸俱沉为少阴；少阴一经，死证最多，为其邪气深入，正气无由自振也。若夫春夏温病
热病，而见沉小微弱短涩者，此伏热之毒滞于少阴，不能撑出阳分，所以身大热而足不热者
，皆不救也。惟沉而实，见阳明腑实证者，急以承气下之，不可拘于阳证阴脉例也。凡时行
疫疠，而见沉脉，均为毒邪内陷，设无下证，万无生理。此论可谓详矣。至谓脉沉无下证必
死者，为其不可下也，下之亦必死。然则于万死之中，而求一生，宜何道之从?曰∶不从下
夺，而从上；重填其阴，以举其阳，庶有几乎!何者?此人金水并虚，木火并实，实者散之，
虚者滋之；金复则自上而挈之，水复则自下而托之。如此而不生，可告无罪矣。近有自负明
医，专用桂、附、椒、姜，燥阴耗血，谬称托邪外出，引火归原，应手辄毙。其罪与用苦寒
清上者等。
近日流行的瘟疫疾病中，有一种称为“喉痧”的病证，初起时脉象都是沉细的，寸、关、尺三部脉中以两尺脉最为明显，而两尺脉中又以左手脉更为显著。起初脉搏至数尚且清晰，按之有力，一二日后逐渐变得躁动急疾，脉形模糊伏匿，重按即散。
旧说认为：瘟病的邪气从中道侵入，起始于阳明经，其脉象右脉大于左脉。我认为：这是热浊毒气熏蒸肺胃，脉形必定是缓长洪大，浑浊不清，属于气机浊滞和中焦湿热所致。近时的病情，却是邪气潜伏在少阴经，或者因为冬季气候温暖而不寒冷，阳气不能潜藏，阴精消散；或者因为饮食肥甘厚味没有节制，脾胃中的浊热下流，克制损伤肾水；或者因为房事过度，阴精向下耗夺，到了春季阳气想要升发时，阴精不能承载阳气上达。所以已经升发的虚阳，在中道停止于咽喉，不能到达体表。那些未能完全升发的毒气，下陷于肾脏中，熏蒸燔灼，导致阴液耗尽而死。这就是所谓的违背了冬令闭藏之气，则少阴不藏，肾气独自沉陷。治疗方法，我曾拟用猪肤汤和麻辛附子汤，两方合用，减少麻黄的用量，附子改用生品，并重加党参，以透达毒邪，毒邪散去阴液便可保存。世人往往拘泥于喉证发于肺胃的成法，使用苦寒清降的药物来清泻肺胃，所以热毒更加无法透达。张石顽说：伤寒病中尺寸脉俱沉属于少阴病；少阴一经，死证最多，因为邪气深入，正气无法自行振奋。至于春夏季节的温病热病，如果出现沉小微弱短涩的脉象，这是伏热毒气滞留在少阴经，不能透出阳分，所以身体大热而脚不热的，都属于不治之症。只有脉沉而实，出现阳明腑实证候的，才急需使用承气汤攻下，不可拘泥于阳证见阴脉的例子。凡是时行疫病，出现沉脉，都是毒邪内陷，如果没有可下的证候，绝对没有生机。这种论述可以说是很详细了。至于说脉沉而没有可下证候必然死亡的，是因为不可攻下，如果攻下也必然死亡。那么在万死之中寻求一线生机，应该遵循什么原则呢？回答说：不从下面攻夺，而从上面透达；重用滋阴药物，以举托阳气，或许还有一线希望！为什么呢？这是因为此人金（肺）水（肾）并虚，木（肝）火（心）并实，实的要疏散，虚的要滋补；肺气恢复则能自上而提携，肾水恢复则能自下而托举。像这样治疗还不痊愈，就可以说没有罪过了。近来有自诩为明医的人，专门使用桂枝、附子、花椒、干姜等燥烈药物，耗伤阴血，荒谬地声称可以托邪外出、引火归原，结果一用就致死。他们的罪过与使用苦寒清上药的人是一样的。
In recent years, among the epidemic diseases, there is one known as "throat sand" (Housha), which initially presents with a deep and fine pulse. Among the three positions (Cun, Guan, Chi) on both wrists, the Chi position is most pronounced, and within the Chi position, the left wrist is more significant than the right. Initially, the pulse rate is clear and feels forceful upon palpation; however, after one or two days, it gradually becomes restless and rapid, the pulse shape becomes blurred and hidden, and dissipates upon heavy pressure.
Old theories state: The pathogenic factor of plague enters from the middle pathway, originating in the Yangming channel, with the right pulse being larger than the left. I contend: This condition results from the steaming and steaming of heat-turbid toxic qi affecting the Lung and Stomach. The pulse shape must be slow, long, surging, and large, yet turbid and unclear, indicating turbid Qi and damp-heat in the Middle Jiao. In contemporary cases, the pathogenic factor lies latent in the Shaoyin channel. This may occur due to warm winters lacking cold, causing Yang Qi to fail in submerging and Yin Essence to dissipate; or due to unregulated consumption of rich and sweet foods, leading to turbid heat in the Spleen and Stomach flowing downward and damaging Kidney Water; or due to excessive sexual activity, depleting Yin Essence downward. When Spring arrives and Yang Qi attempts to ascend, the insufficient Yin Essence cannot carry the Yang upward. Consequently, the already ascended deficient Yang stops midway at the throat and fails to reach the exterior. The toxic qi that fails to fully ascend sinks into the Kidneys, where it steams and burns, leading to death when Yin fluids are exhausted. This corresponds to the principle: violating the winter storage leads to Shaoyin failing to store, with Kidney Qi sinking alone.
The treatment method I have proposed involves using Zhufu Tang (Pig Skin Decoction) and Maxing Fuzi Tang (Ephedra, Cinnamon Twig, and Aconite Decoction) together. The dosage of Mahuang (Ephedrae Herba) is reduced, Sheng Fuzi (Raw Radix Aconiti Lateralis Preparata) is used instead of processed Aconite, and Dangshen (Codonopsis Radix) is heavily added to vent the toxicity; once the toxicity disperses, Yin can be preserved. People often rigidly adhere to the established rule that throat disorders originate in the Lung and Stomach, using bitter-cold descending herbs to clear the Lung and Stomach. Consequently, the heat-toxicity has no way to vent. Zhang Shiwan stated: In Shanghan (Cold Damage), a deep pulse at both Cun and Chi indicates Shaoyin involvement; the Shaoyin channel has the most fatal syndromes because the pathogenic factor has penetrated deeply, and the healthy Qi lacks the strength to recover spontaneously. Regarding Warm diseases and Heat diseases in Spring and Summer, if a deep, small, weak, short, or choppy pulse appears, this indicates latent heat-toxicity stagnating in the Shaoyin channel, unable to emerge into the Yang divisions. Thus, patients presenting with high fever but cold feet are incurable. Only if the pulse is deep and solid, accompanied by Yangming Fu organ excess syndrome, should Chengqi Tang (Gastro Drainage Decoction) be urgently administered for purgation; one must not rigidly apply the example of Yang syndrome with Yin pulse. Generally, in seasonal epidemics, a deep pulse indicates internal entrapment of toxic pathogens. If there are no indications for purgation, there is absolutely no hope for survival. This discussion is quite detailed.
Regarding the assertion that a deep pulse without purgative indications inevitably leads to death: this is because purgation is contraindicated; if purged, death will still ensue. Then, how does one seek a sliver of life amidst certain death? The answer is: Do not rely on downward purgation, but rather vent from above; heavily tonify Yin to lift Yang, and there might be a chance. Why? Because this patient suffers from simultaneous deficiency of Metal (Lung) and Water (Kidney), and simultaneous excess of Wood (Liver) and Fire (Heart). Excess should be dispersed, deficiency should be nourished. When Lung Qi recovers, it lifts from above; when Kidney Water recovers, it supports from below. If such treatment fails, then one can claim innocence. Recently, some self-proclaimed skilled physicians have exclusively used Guizhi (Cinnamomi Ramulus), Fuzi (Radix Aconiti Lateralis Preparata), Huajiao (Zanthoxyli Pericarpium), and Jiang (Zingiberis Rhizoma), drying Yin and consuming Blood, falsely claiming these herbs expel pathogens outward and guide fire back to its source. These treatments result in immediate death. Their fault is equal to those who use bitter-cold herbs to clear the upper burner.