疫之传有九。然亦不出表里之间而已。但表不里者。其证头疼身痛发热。而复凛
凛。内无胸满等证。谷食如常。此邪传外。由肌表而出。或斑消。或汗解为顺。轻剂可愈。有汗出不彻。
而热不退者。宜白虎汤。或斑出不透。而热不退者。宜举斑汤。有斑汗并行。而并不透。合用煎汤。
但里不表者。惟胸膈痞闷。欲吐不吐。吐而不快。宜瓜蒂散吐之。若邪传里之中下
二焦。则心腹胀满。不吐不呕。或燥结便闭。或热结旁流。或热结下利。或大肠胶闭。
并宜承气辈。有里而再里。或至于三。皆根据前法。
邵评∶吐下未净。复聚于中。故曰里而再里。至三里之症。少有也。
表而再表者。所发未尽。膜原尚有隐伏之邪。故三四日后。根据前发热。脉洪而数。及
其解也。斑者仍斑。汗者仍汗而愈。至于三表者。亦稀有也。
邵评∶瘟疫之邪。由膜原达表。或 或汗之表。表邪化而膜原尚有未尽之邪。复出于表。故曰表而再
表。此与伤寒先表后里之治迥别。须使出表之邪。仍从 汗而解。至三表之症。实罕见焉。
表里分传。始则邪气伏于膜原。尚在半表半里。二证俱见。必先通其里。令里邪去。
自能达表。或斑或汗。随其性而升泄之。病退而热未除者。膜原尚有未尽之邪也。
宜三消饮调之。若分传至再至三。未之频见。照前同治。
邵评∶疫邪自口鼻吸受。直行中道。流布三焦。伏于膜原。为半表半里之界。邪在于此。或表里分传。
表里二症同见者。治宜先通其里。里通则表达。与伤寒先表后里之法大异。从表解者。或 或汗两门。
随症治之。膜原之邪。未能尽传。表里症并见者。用三消饮内外并解之。若分传再三之症。亦属稀少。治法同前。
The transmission of epidemic diseases encompasses nine patterns. However, these do not extend beyond the categories of Exterior (Biao) and Interior (Li).
When the pathogen affects only the Exterior without involving the Interior, the symptoms include headache, body pain, fever, accompanied by distinct aversion to cold (lin lin). There are no internal signs such as chest fullness, and appetite remains normal. This indicates that the pathogen is transmitting outward from the muscle layer and skin surface. Recovery may occur through the emergence of macules (ban) or through sweating, which are considered favorable outcomes (shun). Mild prescriptions can cure this condition. If sweating is incomplete and fever persists, Baihu Tang (White Tiger Decoction) is indicated. If the emergence of macules is incomplete and fever persists, Jubang Tang (Macule-Ascending Decoction) is indicated. If both macules and sweating occur but remain incomplete, a combined decoction should be used.
When the pathogen affects only the Interior without involving the Exterior, the primary symptoms are stuffiness and oppression in the chest and diaphragm, with an urge to vomit but inability to do so effectively, or vomiting without relief. Gudisan (Melon Stalk Powder) for emesis is indicated. If the pathogen transmits to the Middle and Lower Jiao (Triple Burner) within the Interior, symptoms include abdominal distension and fullness, absence of vomiting, dry constipation, heat-binding with paralogous flow (rejection of fluids due to heat accumulation), heat-binding with diarrhea, or fecal impaction (jiao bi) in the large intestine. In all these cases, Chengqi Tang (Gut-Purging Decoction) category formulas are indicated. If the Interior syndrome recurs deeper into the Interior, or even reaches a third level, the preceding methods should be followed.
Shao's Commentary: When emetic and purgative treatments fail to clear the pathogen completely, it re-aggregates in the Middle Jiao; hence it is called "Interior recurring to Interior." Symptoms of "Interior reaching the third level" are rarely seen.
When the Exterior syndrome recurs as an Exterior syndrome, it indicates that the previously expelled pathogen was not fully cleared, and latent pathogens remain in the Mo Yuan (Membrane Source). Therefore, after three or four days, fever recurs with a surging and rapid pulse. Upon resolution, those who should have macules will still have them emerge, and those who should sweat will still sweat to recover. Cases of "Exterior reaching the third level" are also extremely rare.
Shao's Commentary: The epidemic pathogen travels from the Mo Yuan to the Exterior, or is released via sweating. Even if the Exterior pathogen dissipates, residual pathogens in the Mo Yuan may re-emerge at the Exterior, hence termed "Exterior recurring to Exterior." This differs significantly from the Shanghan (Cold Damage) treatment principle of treating the Exterior first and then the Interior. It is essential to allow the pathogen emerging at the Exterior to be resolved through sweating. Symptoms of "Exterior reaching the third level" are indeed rare.
In Exterior-Interior simultaneous transmission (Biao Li Fen Chuan), initially, the pathogen lies dormant in the Mo Yuan, occupying the semi-Exterior semi-Interior position, presenting both Exterior and Interior symptoms. Treatment must first unblock the Interior to eliminate Interior pathogens, allowing them to reach the Exterior naturally. They may then exit via macules or sweating, following their nature to ascend and vent. If the disease recedes but fever persists, it indicates residual pathogens in the Mo Yuan; Sanxiao Yin (Three-Clearing Decoction) is indicated for regulation. If transmission occurs repeatedly to the second or third degree, though rarely seen, the same treatment principles apply.
Shao's Commentary: Epidemic pathogens enter via the mouth and nose, travel directly along the central pathway, distribute throughout the Three Jiao, and lie dormant in the Mo Yuan, which serves as the boundary of semi-Exterior semi-Interior. Pathogens residing here may transmit simultaneously to the Exterior and Interior, presenting concurrent symptoms. Treatment should prioritize unblocking the Interior; once the Interior is clear, the Exterior can be expressed. This contrasts sharply with the Shanghan method of treating the Exterior before the Interior. For resolution via the Exterior, treatment follows either the macule-emergence or sweating protocols based on symptoms. When Mo Yuan pathogens fail to fully transmit, presenting concurrent Exterior and Interior symptoms, Sanxiao Yin is used to resolve both internally and externally. Cases of repeated simultaneous transmission are also scarce, and the treatment remains consistent with previous methods.