凡瘟疫如见舌苔白如粉者。其邪已入膜原。汗之必不解。当用达原饮。以透膜原
之邪。看兼何经。加入引经表药。如兼太阳加羌活。阳明加葛根。少阳加柴胡。如舌
苔薄而不浓。脉不甚数者。感之轻也。可从汗解。如感之重者。舌苔必浓。脉必数。纵
服药。邪必内陷。但看舌苔渐渐黄燥。此邪渐入于胃也。前方加大黄下之。若脉洪
长而数。汗大出。此邪适离膜原。初入阳明。白虎证也。舌上纯黄燥刺。又兼里症。此
邪已入胃腑。承气汤选用。
邵评∶邪从口鼻而入。直行中道。而入膜原。故舌苔白如敷粉。膜原者。脾与胃以膜相联。乃
脾胃之半表半里。附近于胃。疫邪先入膜原。最易陷入于胃。如从表达。亦从三阳经外出。故加三阳引经药。
疫症有两三日即离膜原者。有一旬半月不传者。有初得之。四五日厌厌聂聂。至五六日。陡然势张者。
疫邪为病。有从战汗解者。有从自汗盗汗不解者。有无汗竟归于胃者。有胃气壅
抑。必从下后而得战汗解者。有汗解未尽。越三四日复热者。有发黄因下而复热
发者。有竟从发 而愈者。有里症急。虽得 。不愈者。
疫毒甚者。日有三变。初起一二日。舌苔白如粉。早服达原饮一服。午后舌变黄色。
胸膈满痛。大渴烦躁。此毒邪传里也。前方加大黄下之。烦躁稍减。傍晚复加烦躁
大热。通舌变黑刺。鼻生烟煤。此毒邪最重。复合聚于胃。急用承气汤下之。至夜半
热退。次早苔刺如失。此数日之法。一日行之。因其毒盛变速。故用药不得不紧。设
用缓药。必无救矣。每见瘟疫二三日即死者。皆此类也。
邵评∶下后稍缓。至夜复热。其势更甚。热而成实。灼伤肺胃津液。故舌黑刺而鼻
烟煤。邪毒甚也。热实胃腑。故用承气急下之。使邪毒从下而解。若一日数变。用
药亦一日行数日之法。盖病变极速。治法亦急。所谓急病急攻也。失治则液涸邪秘而死。
疫病失下。自利纯臭水。昼夜十数行。口燥、唇干、舌裂。腹满硬痛。此热结旁流也。急
以承气下之。以去宿垢。其利自止。若胃热失下。郁而为黄。热更不减。搏血为瘀。故
经气不为热瘀郁。不致发黄。热邪不干血分。不致蓄血。若同受其邪。则发黄而兼
蓄血。非蓄血而致发黄也。但蓄血一行。热随血走。黄随热泄。故治黄茵陈蒿汤。治
蓄血桃仁承气汤。去桂枝、甘草。加丹皮、归尾、赤芍。
邵评∶胃中热郁不得泄越。则发黄。热甚血瘀。则蓄血。此邪热入于中下两焦所
致。至辨发黄与蓄血。当察其小便。若小便不利。则热郁膀胱而发黄。若小便自
利。则热瘀血分而蓄血。如此辨治。万无一失。治黄、渗湿清热而通下。治蓄血、消瘀清热而破血。
Whenever plague (Yi Wen) presents with a tongue coating white as powder, the pathogenic factor has entered the Membrane Source (Mo Yuan). Sweating will certainly not resolve it. One should use Dahuang Yin (Origin-Reaching Decoction) to penetrate the pathogen in the Membrane Source. Observe which meridian is involved concurrently and add guiding exterior-resolving herbs: if involving the Taiyang (Greater Yang) meridian, add Qianghuo (Notopterygii Rhizoma et Radix); if involving the Yangming (Yang Brightness) meridian, add Gegen (Puerariae Lobatae Radix); if involving the Shaoyang (Lesser Yang) meridian, add Chaihu (Bupleuri Radix). If the tongue coating is thin and not thick, and the pulse is not particularly rapid, the infection is mild and can be resolved through sweating. If the infection is severe, the tongue coating must be thick, and the pulse must be rapid. Even if medicine is taken, the pathogen will inevitably sink inward. Once the tongue coating gradually turns yellow and dry, this indicates the pathogen is gradually entering the Stomach. Add Dahuang (Rhei Radix et Rhizoma) to the previous formula and apply purgation. If the pulse is surging, long, and rapid, accompanied by profuse sweating, this indicates the pathogen has just left the Membrane Source and entered the Yangming meridian, constituting the Baihu Tang (White Tiger Decoction) syndrome. If the tongue is purely yellow, dry, and prickly, combined with interior excess syndromes, the pathogen has entered the Stomach fu-organ; select Chengqi Tang (Ordering Qi Decoction) for treatment.
Shao’s Commentary: Pathogens enter via the mouth and nose, travel directly along the central pathway, and enter the Membrane Source. Hence, the tongue coating is white as if dusted with powder. The Membrane Source is where the Spleen and Stomach are connected by membranes, representing the half-exterior, half-interior of the Spleen and Stomach, located near the Stomach. Epidemic pathogens first enter the Membrane Source and easily sink into the Stomach. If resolving from the exterior, they exit through the three Yang meridians. Therefore, add guiding herbs for the three Yang meridians. Some epidemic cases leave the Membrane Source within two or three days; some do not transmit for ten days or half a month; some begin mildly for four or five days, then suddenly become rampant on the fifth or sixth day. In diseases caused by epidemic pathogens, resolution may occur via Zhan Han (shivering sweat), may fail to resolve via spontaneous or night sweats, may have no sweat and go directly to the Stomach, may require purgation followed by shivering sweat due to Stomach qi stagnation, may resolve via sweating but recur after three or four days, may develop jaundice that recurs after purgation, may heal via maculation, or may fail to heal despite maculation if interior excess is urgent.
When epidemic toxin is severe, there are three changes per day. In the initial one or two days, the tongue coating is white as powder. Taking one dose of Dahuang Yin in the morning causes the tongue to turn yellow by afternoon, accompanied by chest and diaphragm fullness and pain, extreme thirst, and irritability. This indicates the toxic pathogen has transmitted inward. Add Dahuang to the previous formula and purge. Irritability subsides slightly, but by evening, irritability and high fever worsen. The entire tongue turns black and prickly, and soot-like material appears in the nostrils. This indicates the heaviest toxic pathogen aggregating in the Stomach; urgently use Chengqi Tang to purge. By midnight, the fever subsides, and by early morning, the coating and prickle disappear. These several days’ treatments are executed in one day because the toxin is abundant and changes rapidly, necessitating urgent medication. Using slow-acting drugs will certainly fail to save the patient. Many deaths from plague within two or three days belong to this category.
Shao’s Commentary: After purgation, symptoms temporarily ease, but fever returns at night with greater intensity. Heat becomes solid, scorching the fluids of the Lung and Stomach, resulting in a black, prickly tongue and soot-like nostril discharge. This signifies severe pathogenic toxin. Heat-solidification in the Stomach fu-organ requires urgent purgation with Chengqi Tang to allow the toxin to exit downward. If changes occur multiple times a day, the treatment method must also be applied multiple times a day. Because the disease changes extremely rapidly, the treatment must be urgent—this is "urgent disease, urgent attack." Failure to treat properly leads to fluid exhaustion and pathogen closure, resulting in death.
If epidemic disease fails to receive purgation, it presents with self-directed diarrhea of pure foul water, occurring more than ten times a day and night, with dry mouth, dry lips, cracked tongue, abdominal fullness, hardness, and pain. This is Re Jie Pang Liu (Heat Binding with Peripheral Flow). Urgently use Chengqi Tang to purge and remove accumulated filth; the diarrhea will stop naturally. If Stomach heat is not purged, it stagnates and causes jaundice. If heat does not subside, it binds with blood to form stasis. Thus, if the channel qi is not obstructed by heat-stasis, jaundice will not occur. If the heat pathogen does not interfere with the blood level, blood accumulation (Xu Xue) will not occur. If both are affected simultaneously, jaundice occurs with blood accumulation, rather than jaundice being caused by blood accumulation. Once blood accumulation occurs, heat follows the blood, and jaundice resolves with the dissipation of heat. Therefore, treat jaundice with Yinchen Hao Tang (Artemisiae Scopariae Herb Decoction), and treat blood accumulation with Tao Ren Chengqi Tang (Persicae Semen Ordering Qi Decoction), removing Guizhi (Cinnamomi Ramulus) and Gancao (Glycyrrhizae Radix et Rhizoma), and adding Danpi (Moutan Cortex), Guiwei (Angelicae Sinensis Radix Tail), and Chishao (Paeoniae Rubra Radix).
Shao’s Commentary: When heat in the Stomach stagnates and cannot vent, jaundice results. When heat is severe and causes blood stasis, blood accumulation results. This is caused by pathogenic heat entering the Middle and Lower Jiao. To differentiate between jaundice and blood accumulation, observe urination. If urination is difficult, heat is stagnant in the Bladder, causing jaundice. If urination is normal, heat is stasis in the blood level, causing blood accumulation. Such differentiation and treatment ensure success without error. Treat jaundice by promoting dampness, clearing heat, and purging; treat blood accumulation by eliminating stasis, clearing heat, and breaking blood stasis.