【纲】仲景曰。阳脉濡弱。阴脉弦紧者。更遇温气。变为温疫。
【目】苏颂曰。此前热未已。又感温气。温热相合。故变为温疫也。
王肯堂曰。按叔和伤寒例云。伤寒热病未已。再遇风寒湿而各变为一病也。何止于温。既曰再
遇温热变为温毒矣。又曰再遇温气变为温疫。是何温之再遇。而有二病之异。且疫者。特感非时之
气。众人病一般也。如冬应寒而反大温。人感冬温而病。则所谓温疫。如春夏应温热而反大寒。人
感暴寒而病。则所谓寒疫也。何待再遇于异气耶。若云再遇温气。变为温疫。是伤寒再遇异气而变
病也。再遇异气而变病。未必众病相似。安可以疫言。伤寒例云。阳脉濡弱。阴脉弦紧。此温疫之
脉也。活人书注此脉于冬温条下。是以温疫冬温合为一病。殊不知冬温特感非时之气耳。温疫是伤
寒再遇于异气也。岂可合为一病。此理未明。故书此以俟明哲。愚谓感温热而为温毒。感温气而为
温疫。此乃有微甚之分。但疫字疑误。恐当作疾字。若作疫字。则冬温又何一家长幼病相似也。
一家病相似。方可言疫。况此伤寒热病未已。再遇温气而病。何至一家相似哉。
吴绶曰。寒疫。乃天之暴寒为病也。凡四时之中。天令或有暴风寒之作。人感之而即病者。名曰
寒疫。其症与正伤寒
同。但暴寒为轻耳。治法。若初作头痛憎寒拘急。或呕逆恶心。中脘痞闷。或饮食停滞不化。或腹
中作痛。未发热者。藿香正气散。加减一二味主之。已发热者。十味芎苏散汗之。若身痛骨节疼而
发热者。人参羌活散加葱白、葛根、生姜、汗之。或神术汤亦汗。若自汗者。不宜再汗。九味羌活
汤。若热不解。或变别症。宜从正伤寒条内治之。
朱肱曰。仲景云。冬温之毒。与伤寒大异。盖伤寒者。伤寒气而作。冬温者。感温气而作。寒
疫者暴寒折人。非触冒之遇。其治法不同。所施温凉寒热之剂亦异。不可拘以日数。发汗吐下。随
症施治。要之治热以寒。温而行之。治温以清。冷而行之。治寒以热。凉而行之。治清以温。热而
行之。以平为期。不可以过。此为大法。
王肯堂曰。时疫者。乃天行暴厉之气流行。凡四时之令不正者。乃有此气行也。若人感之。则
长幼相似而病。又互相传染。其作与伤寒相似。然伤寒因寒而得。此乃疫气。不可与寒同论也。法
当辟散疫气。扶正气为主。若多日不解。邪热传变何症。宜从伤寒变症条内选用。惟发散药则不同。
凡发散汤剂。藿香正气散、芎芷香苏散、人参败毒散、十味芎苏散、十神汤。皆可用。
韩祗和曰。春应温而清气折之。责邪在肝。或身热头疼目眩呕吐。长幼率相似。升麻葛根汤、
解肌汤。四时通用败毒散。夏应暑而寒气折之。责邪在心。或身热头痛腹满自利。长幼率相似。
射干汤、半夏甘桂汤。秋应凉而大热折之。责邪在肺。湿热相搏。民多病瘅。喘咳。金沸草散、白
虎加苍术汤。病瘅发黄。茵陈五苓散。冬应寒而大温折之。责邪在肾。宜葳蕤汤。
朱震亨曰。冬温为病。非其时而有其气者。冬月严寒。君子当闭藏。而反发泄于外。专用补中
带表药。
陶华曰。春分后夏至前。不恶寒而渴者。为温病。用辛凉之药微解肌。不可大发汗。急症见者。
用寒凉之药。急攻下。切不可误汗误下。当须识此。表症不与正伤寒同治。里症同。
夏至后。有头疼发热。不恶寒而渴者。为温病。愈加热者。
为热病。止用辛凉之药解肌。不宜大汗。里症见。急攻下。表症不与正伤寒同治。里症同。
立秋后。霜降前。有头疼发热。不恶寒。身体痛小便短者。为温病。亦用辛凉之药加燥以解肌。
亦不宜汗。里症见者。宜攻下。表症不与正伤寒同。
[General Principle] Zhang Zhongjing stated: If the Yang pulse is soft and weak (Ru Ruo) and the Yin pulse is string-like and tight (Xuan Jin), and one subsequently encounters warm Qi, it will transform into a Warm Plague (Wen Yi).
[Commentary] Su Song said: This occurs when the previous heat pathogen has not yet subsided, and one again contracts warm Qi. The combination of warm and heat pathogens leads to the transformation into a Warm Plague.
Wang Kentang commented: According to He Huanzhi's "Shanghan Li" (Example of Cold Damage), if cold damage or heat disease has not yet resolved, encountering wind-cold-dampness again will cause it to transform into various diseases. Why limit this only to warmth? It states that encountering warm-heat again transforms it into Warm Toxin (Wen Du), and encountering warm Qi again transforms it into Warm Plague. Why does "encountering warm Qi again" result in two different diseases? Moreover, "Plague" (Yi) refers to contracting non-seasonal Qi, where the majority of people suffer from similar symptoms. For instance, if winter should be cold but is unusually warm, and people contract Winter Warmth (Dong Wen) and become ill, this is called Warm Plague. Similarly, if spring and summer should be warm but are suddenly cold, and people contract violent cold and become ill, this is called Cold Plague (Han Yi). Why must one wait for a second encounter with a different pathogen? If encountering warm Qi again transforms cold damage into Warm Plague, it implies that cold damage transforming upon encountering a different pathogen does not necessarily make the symptoms among the masses similar. How can it be called a "Plague"? "Shanghan Li" states: "Yang pulse soft and weak, Yin pulse string-like and tight," which is the pulse of Warm Plague. The "Huangren Shu" (Book of Living People) annotates this pulse under the entry for Winter Warmth, thereby merging Warm Plague and Winter Warmth into one disease. However, Winter Warmth is merely contracting non-seasonal Qi, whereas Warm Plague is cold damage re-encountering a different pathogen. How can they be merged into one disease? This principle is unclear, so I write this to await clarification by wise scholars. I believe that contracting warm-heat becomes Warm Toxin, while contracting warm Qi becomes Warm Plague; there is a distinction in severity. The character "Yi" (Plague) is likely an error and should probably be "Ji" (Disease). If it is "Yi," then why do cases of Winter Warmth show similar symptoms within a family? Only when a whole family exhibits similar symptoms can it be termed a "Plague." Furthermore, here we have cold damage heat disease unresolved, re-encountering warm Qi to cause illness; how could it reach the point of a whole family having similar symptoms?
Wu Shou said: Cold Plague is caused by sudden violent cold from heaven. In any season, if weather produces violent wind-cold, and people contract it and fall ill immediately, it is named Cold Plague. Its symptoms are the same as typical Cold Damage (Zheng Shanghan), but the violence of the cold is milder. Treatment methods: If initially presenting with headache, aversion to cold, stiffness, or vomiting/nausea, epigastric fullness, food stagnation, or abdominal pain, without fever, use Huoxiang Zhengqi San (Agarweed and Magnolia Bark Decoction), modifying one or two herbs. If fever has already appeared, use Shiwei Xiong Su San (Ten-Ingredient Ligusticum and Perilla Decoction) to induce sweating. If body ache, bone/joint pain, and fever are present, use Renshen Qianghuo San (Ginseng and Notopterygium Decoction) added with Congbai (Scallion Stalk), Gegen (Kudzu Root), and Shengjiang (Fresh Ginger) to induce sweating. Or use Shenzhu Tang (Divine Efficacy Decoction) to induce sweating. If spontaneous sweating is present, do not induce sweating again; use Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction). If heat persists or other complications arise, treat according to the chapters on typical Cold Damage.
Zhu Gong said: Zhang Zhongjing stated: The toxicity of Winter Warmth is vastly different from Cold Damage. Cold Damage arises from injuring cold Qi; Winter Warmth arises from contracting warm Qi. Cold Plague is caused by violent cold overwhelming the body, not merely accidental exposure. Their treatments differ, and the administration of warming, cooling, cold, and hot agents varies. One should not be bound by the number of days; sweating, emesis, and purging should be applied according to symptoms. Generally, treating heat with cold drugs requires warm administration; treating warmth with clearing drugs requires cold administration; treating cold with hot drugs requires cool administration; treating coolness with warming drugs requires hot administration. The goal is balance, avoiding excess. This is the major principle.
Wang Kentang said: Seasonal Plague (Shi Yi) results from the prevalence of violent heavenly Qi. When the seasonal climate is abnormal, such Qi circulates. Upon contraction, symptoms are similar across ages, and it spreads through contagion. Its onset resembles Cold Damage, but since Cold Damage is caused by cold and this is epidemic Qi, they cannot be discussed together. The method should focus on dispersing epidemic Qi and supporting healthy Qi. If unresolved after many days and evil heat transmits causing specific symptoms, select treatments from the sections on Cold Damage complications. However, dispersing agents differ. All dispersing decoctions, such as Huoxiang Zhengqi San, Xiong Zhi Xiang Su San, Renshen Baidu San, Shiwei Xiong Su San, and Shishen Tang, may be used.
Han Zhihe said: If spring should be warm but is chilled by clear/cold Qi, the pathology lies in the Liver. Symptoms may include fever, headache, dizziness, vomiting, with similarity across ages. Use Shengma Gegen Tang (Cimicifuga and Kudzu Decoction), Ji Ji Tang (Muscle-Releasing Decoction), or the universal Baidu San for all seasons. If summer should be hot but is chilled by cold Qi, the pathology lies in the Heart. Symptoms may include fever, headache, abdominal fullness, spontaneous diarrhea, with similarity across ages. Use Shegan Tang (Belamcanda Decoction) or Banxia Gan Gui Tang (Pinellia, Licorice, and Cinnamon Twig Decoction). If autumn should be cool but is scorched by great heat, the pathology lies in the Lung. Damp-heat struggles, causing many to suffer from Dan disease (jaundice-type illness) with wheezing and coughing. Use Jinfei Cao San (Boiling Grass Decoction) or Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Macrocephala Decoction). If Dan disease causes yellowing, use Yinchin Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction). If winter should be cold but is warmed by great heat, the pathology lies in the Kidney. Use Weirui Tang (Polyporus Decoction).
Zhu Zhenheng said: Winter Warmth is a disease occurring when its season does not match its Qi. In the deep cold of winter, gentlemen should conserve and store essence, but instead, it leaks outward. Treatment should exclusively use formulas that tonify the center while releasing the exterior.
Tao Hua said: From after Spring Equinox to before Summer Solstice, if there is no aversion to cold but thirst exists, it is Warm Disease. Use acrid-cool medicines to mildly release the muscle layer; do not induce heavy sweating. If acute symptoms appear, use cold-cooling medicines to urgently purge the interior. Do not mistakenly use sweating or purging methods; this must be recognized. Exterior syndromes are not treated like typical Cold Damage, but interior syndromes are treated similarly.
After Summer Solstice, if headache and fever occur without aversion to cold but with thirst, it is Warm Disease; if heat intensifies, it is called Heat Disease. Use only acrid-cool medicines to release the muscle layer; do not induce heavy sweating. If interior symptoms appear, urgently purge the interior. Exterior syndromes are not treated like typical Cold Damage, but interior syndromes are treated similarly.
From after Autumn Equinox to before Frost Descent, if headache and fever occur without aversion to cold, accompanied by body pain and short urine, it is Warm Disease. Use acrid-cool medicines combined with drying agents to release the muscle layer; do not induce sweating. If interior symptoms appear, purging is appropriate. Exterior syndromes are not identical to typical Cold Damage.