“”字，变“温”为“瘟”，是就病之名目而言，岂可以“温”、“瘟”为两证乎？其曰春温、夏温、秋温、
冬温，总属强立名色，其实皆因四时感“瘟”气而成病耳。其曰风温、湿温、温疟、温暑者，即瘟病而兼风、
湿、暑、疟也。其曰瘟毒者，言瘟病之甚者也。其曰热病者，就瘟病之发于夏者而言也。至于晚发之说，更属
不经。夫冬月寒厉之气，感之即病，哪容藏于肌肤半年无恙，至来岁春夏而
始发者乎？此必无之理也。至于“疫”字，传以民皆疾解之，以其为病，延门阖户皆同，如徭役然。去“彳”
加“ ”，不过取其与疾字相关耳。须知疫病所赅甚广，瘟疫者不过疫中之一证耳。此外尚有藏疫、杂疫之殊，
而瘟疫书中，却遗此二条，强分瘟病、疫病而各立方施治。及细按其方论，漫无差别，不可从也。吁！“瘟疫”二
字，尚不明其义意，又奚以治瘟疫哉？○《景岳全书》各门讲解俱极精详，惟将伤寒、瘟疫二证搅作一团，未
曾分晰。夫瘟疫与伤寒迥乎不同，治法亦异，何谓温疫本即伤寒乎？夫既曰本即伤寒，再立瘟疫一门，岂非赘
瘤乎？且既曰本即伤寒，而又曰染时气而病，吾不知先伤于寒而后为时气所染乎？抑染时气而后为寒所伤乎？
抑二者并集于一人之身乎？总缘伤寒、瘟疫，原未看清。犹做文者，认题不真，下笔便错，虽词藻绚烂而不中
肯綮，总属尘饭土羹。最不敢从者，发汗峻补二条。抑知瘟疫岂强汗之所能解，而峻补岂可施于热毒之人乎？
惟汗、下后，或显虚证，或虚人久病而感瘟者，补法亦自不可少也。○吴又可之《瘟疫论》，世所盛行，其中达
原饮固为治瘟疫之良方，第言瘟邪浮越于某经者，即加某经之药，止有三阳在表治法。至于邪之传里者，仅有
入阳明胃腑一条，三阴略而不及。夫云邪伏膜原，自内达外，不似伤寒之按次传经则可，若曰邪总不入三阴，
是将脏腑经络划然中断，而人身之营卫，扦格而不通矣。每见患瘟疫者，腹满便实，自利发黄，四肢厥逆，非
传入足太阴经乎？舌干口燥，咽痛，但欲寐，非传入足少阴经乎？烦满囊缩，冲逆动摇，胁肋诸痛，非传入足
厥阴经乎？不特此也，有患在皮毛而哮喘咳嗽者，此邪之入肺也；有患在神志而昏冒喜笑者，此邪之入心也。
是则五脏六腑，瘟邪传变，无所不到，谓瘟邪止在三阳经，必无是理。（《说疫》）
疫疠一证，邪从口鼻而入，直行中道，流布三焦，非比伤寒六经可表、可下。夫疫为秽浊之气，古人所以
饮芳香采兰草者，
重涤秽也。及其传变，上行极而下，下行极而上，是以邪在上焦者为喉哑，为口糜；若逆传膻中者，为神昏
舌绛，为喉痛丹疹。治法∶清解之中，必佐芳香宣窍逐秽，如犀角、菖蒲、银花、郁金等类，兼进至宝丹，从
表透里，以有灵之物，内通心窍，搜剔幽隐。若邪入营中，三焦相混，热愈结，邪愈深者，理宜咸苦大制之法，
仍恐性速直走在下，故用元参、金银花露、金汁、栝蒌皮轻扬理上，所谓仿古法而不泥其法者也。考是证，惟
张景岳、喻嘉言、吴又可论之最详。然宗张、喻二氏，恐有遗邪留患，若宗吴氏，又恐邪去正伤，惟在临证权
衡，无盛盛，无虚虚而遗人夭殃，方不愧为司命矣。（《临证指南》）
认疫若何？于闻见中但有两三人病情相同者，便要留心。留心若何？病有怪怪奇奇，不近情理，较诸伤寒、
风温、湿温、温热、暑 等门迥乎大异者，即疫也。脉证不必大凉，而服大凉之药，似有害而终无害者，即疫
也。脉证可进温补，而投温补之剂，始似安而终不安者，即疫也。○春温、夏热、秋燥、冬寒，固病之常。若
夫疫者，秽恶之气，互相传染，吴又可论之详矣。惟吴氏谓从口鼻而入，即踞膜原；愚谓既由口鼻吸受，肺为
出入之门户，无有不先犯肺者。疫皆热毒，肺金所畏，每见此证之身热，先有憎寒者，肺先病也；继而充斥三
焦，或有径入心包者。所云厉气，无非郁热。是以喻西昌所讲“瘟”“温”二字，未尝区别，盖亦有见乎此耳。
况所云上焦如雾，升逐解毒；中焦如沤，疏逐解毒；下焦如渎，决逐解毒。总不脱一“毒”字者，其为郁热，
意在言表矣。更有患此病者，纵饮冷水，亦能汗解，此非热毒之明验乎？至于疫邪虽解，而肺蓄余热，每多咳
呛、肌热、自汗等证，亦所谓肺先受病而未愈之明征也。又有大旱之年，水涸日烈，河水每多热毒，饮其水者，
多发疫痢，以痢门常法治之无效，余于治痢方中加以贯众之苦寒解毒，无不应手。此亦热毒之一验也。○治疫
之法，总以“毒”字为提纲，凭他如妖似怪，
自能体会无疑。君如不信，试观古今治疫之方，何莫非以解毒为主？吴又可之专用大黄，非解毒乎？张路玉之
酷喜人中黄，而以童便配葱、豉为起手方，非解毒乎？叶天士之银花、金汁必同用犀角、黄连、生甘草等味，
十方九用，非解毒乎？故喻氏有要言不繁，观其旨，上中下则有升、疏、决之异，而独于“解毒”一言，叠叠
紧接，不分彼此，岂非反复叮咛，示人真谛也哉？（《吴医汇讲》）
疫病是天地不正之异气，四时皆有，能传染于人，以气感召，从口鼻而入，不比风寒乃天地之正气，从皮
毛而入，不传染于人者也。又与疟相似，但疟乃天地暑热之正气，呆在少阳一经，寒热各半，不比疫病起始凛
凛恶寒，继而大热，昼夜不退。寅卯二时，是疫病交关之所，此时热可暂退，过此又发大热矣。疫病亦有间日
发寒热者，但发时寒短热长，不呵欠，不鼓颔为异耳。医家大病，概认作伤寒施治，误谓邪从毛窍而入，药进
羌、防，以散太阳之邪，又为谓少阳、阳明二经，药进柴、葛，以散少阳、阳明之邪。不知疫邪从口鼻而入，
多在膜原，表散不惟疫邪不能解，反耗津液元气，邪反乘虚入里，或传厥阴，人事昏沉，而元气败坏，血液耗
灼，未有不死者矣。余创立救阴解疫毒一方，初病即用，意谓先补正气，正旺则五内坚固，邪无由而入；阴回
则津液内生，邪不攻而自走，即仲景建中汤之意也。且内有甘草、黑豆、银花、黄泥之属，解热毒之邪于扶正
之中，又何患热不退而病不痊耶？若其人本体素虚，救阴不效，则从用八味以救阳；其人本体脾虚，救阴不
效，则从用补中、异功以救土，此又法之变也。○厉气之来，从鼻而入者，则伏于膜原；从口而入者，则干于
胃腑。其间体实而受邪者，有之；体虚而受邪者，有之，本热而假寒者，有之；本寒而假热者，有之。非可尽
投膏黄，纯用芩、连而专以丹溪、河间为法者也。盖时疫之初发，与伤寒似同而实异，时疫之传，与伤寒似
异而实同。当其邪在三阳也，恶寒
壮热，头痛身痛，口渴引饮，呕吐下利，脉大而数。达原饮乃驱邪离散直达巢穴之药，白虎、承气乃辛凉推
荡清火逐邪之剂，惟壮实之体宜之。倘遇内虚之辈，白虎失其过寒，承气失其过攻。至于邪陷三阴，脏气受敌，
见证神昏目定，撮空捻指，谵妄舌黑，脉沉细而数，种种恶证叠出，元气由邪热而亏，胃气由邪热而耗，脏
气由邪热而伤。不知变计，徒拘攻下一法，虚虚之戒，可不慎欤？余兄广期谓∶疫病乃热毒为害，治以逐疫解
毒为第一义。因立干一老人汤一方，除疫毒而退热邪，正与喻氏所谓升逐、疏逐、决逐兼以解毒之意同，可称
治疫之圣药也。（《会心录》）
疫邪来路两条，去路三条，治法五条尽矣。何为来路两条？有在天者，此非其时而有其气，邪从经络而入，
则为头痛发热、咳嗽发颐、大头之类；有在人者，此互相传染，邪从口鼻而入，则为憎寒壮热、胸膈满闷、口
吐黄涎之类。所谓来路两条者此也。何为出路三条？在天之疫，从经络而入者，宜分寒热，用辛温、辛凉之药
以散邪，如香苏散、普济消毒饮，俾其邪仍从经络而出也；在人之疫，从口鼻而入者，宜芳香之药以解秽，如
神术散、正气散，俾其邪仍从口鼻而出也；至于经络、口鼻所受之邪，传入脏腑，渐至潮热谵语、腹满胀痛，
是毒瓦斯归内，疏通肠胃，始解其毒，法当下之，其大便行者，则清之，下后而余热不尽者，亦清之。所谓去路
三条者此也。何为治法五条？曰发散，曰解秽，曰清，曰下，曰补，所谓治法五条者此也。（程钟龄）
饥荒多疫，气候失和，加以饮食失节，以身之虚，逢天之虚，则病作矣。万历壬午，久旱民饥，热疫流行，
初起寒热拘挛，次变斑黄、狂躁，死者相继。治用人参败毒散先发其表，次用人参柴胡汤以和解。右脉大于左，
自汗，胸腹不胀，无表里证见者，治用补中益气汤，活者甚多。此中气先因饥馁受亏，已属内伤不足，若用正
伤寒之法大汗、大下，岂不杀人？○疫病当分天时寒暄、燥湿，病者虚实、安逸，因时制宜，不可拘泥。如
天时久旱，燥令流行，民多热疫，忌用燥剂，治宜解毒润燥；天久淫雨，湿令流行，民多寒疫，忌用润剂，治
宜燥湿理脾。（《医学六要》）
大饥之后，必有大疫。疫邪中人，从口鼻而入，舍于膜原。方书虽有寒疫、热疫两种，而热疫恒多，最为
真阴之贼。其见证也，始则头眩目胀，或痛或不痛，腰腿酸软，胸闷口渴，或但口干而不渴，微恶寒，或有汗，
或无汗；继则不恶寒，而但热无汗，午前热微，午后热炽。初治用达原饮一二剂，感轻者可愈，否则壮热口干、
舌黑谵语等证渐见。时师见热不退，头疼腰酸无汗，则曰表未解也，三阳经表药全施；见舌黑，谵语烦躁，则
曰里证急也，白虎、承气杂进。呜呼！危矣。此证初起，用达原饮不解，即当出入于六味饮、甘露饮、疏肝益
肾汤等方，大剂与之，少加柴胡为向导。（虚者，可用人参）奏效虽迟，稳当之至。其有壮盛之人，服前药四、
五日，仍不从内外解者，诊其脉果沉数有力，则于三承气汤中酌其宜而下之；下后胸仍不宽，用小陷胸汤和之。
若频用表药，则阴气耗；早用下药，则阴液亡，汗终不出，热势更甚。此时急进大剂养阴之品，尚可回生，否
则未有不陨命者。大抵疫病初起之脉，不似伤风、伤寒之浮紧；内即大热，脉象亦不大数；更有一种手足逆冷，
类伤寒、伤风之初起者，断不可妄进热剂。《经》云∶热深厥亦深，热微厥亦微。正谓此也。何以辨之？风寒
手足冷，则必恶风寒，甚则战栗，喜近火日，引衣被自覆；疫证手足虽冷，绝不畏凉，且不乐近衣被，试扪其
前后心烙手可知矣。但用药只宜甘寒以养阴退阳，勿投苦寒以伤胃气。高鼓峰云∶阴气外溢则得汗，阴血下润
则便通，法不离乎三承气，而稳当过之。余遵此以治热病，无不应手，即接治他医误药败证，亦多有生者。
至于用药之轻重，及有兼证变证等事，则在临证时，看老、少、强、弱，宜攻、宜补，酌而用之。圆机之士，
当不须余之多赘也。（郭恕先）
脉候
瘟病怫热在中，脉多见于肌肉之分，而不甚浮；若热郁少阴，则脉沉伏欲绝，非阴脉也，乃阳邪所闭耳。
○瘟病内外皆热，其脉不洪不数，但指下沉伏小急，不可误认虚寒而以温药治之，益其热也。所以伤寒多从脉，
瘟疫多从证。盖伤寒邪从外入，循经传也；瘟病邪从内炽，溢于经也。○诊瘟病，脉洪长滑数者轻；重则脉沉；
甚则闭绝。此辨瘟病脉之要诀。（杨栗山）
选案
一人病瘟发热，烦渴思饮冷水。医者以为凡病须忌生冷，病者苦索弗予，遂至两目火迸，咽喉焦燥，昼
夜不寐，目中见鬼。乘隙匍匐窍取井水一盆，置之枕旁，饮一杯，顿觉清凉；二杯，鬼物潜消；三杯，咽喉声
出；四杯，筋骨舒畅；饮至六杯，不知盏落枕旁，竟尔熟睡，俄而大汗如雨，衣被湿透，脱然而愈。盖因其人
瘦而多火，始则加之以热，经络枯燥；继而邪气传表，不能作正汗而解。今得冷冻饮料，表里和润，所谓除弊便是
兴利矣。○卖卜施幼声，六月患疫，口燥舌干，咽喉肿痛，心腹胀满，渴思冰水，小便赤涩。下证悉备，但通
身如冰，指甲青黑，六脉如丝。医者不究里证热极，但引《全生集》以为阳证但手足厥逆，若冷过肘膝，便是
阴证。今已通身冰冷，比之冷过肘膝更甚；且陶氏以脉分阴、阳二证，全在有力、无力，今脉微欲绝，比之无
力更甚，此阴证而得阴脉之极。其诸阳证，竟置不问，欲投附子理中汤。予以脉证相参，此阳证之最者。盖因
热极，气道壅闭，乃至脉微欲绝，此脉厥也；阳郁则四肢厥逆，今阳亢已极，以致通身冰冷，此体厥也；六脉
如无者，群龙无首之象，证亦危矣。嘱其急投承气。疑而不服，叠延三医，皆言阴证，卜之从阴则吉。竟进理
中汤，下咽如火，烦躁超时而殁。（吴又可）
胡日度头面浮肿。医谓脾虚，用六君子汤数剂，头大如桶，膊大如斗。有知为大头时证者，用九味羌活
汤，口不能言，舌枯
而缩，牙关闭紧，汤药不入，自早至午，眼翻而厥，鼻气如火。出入有声。予用石膏四两，元参一两，花粉五
The character "Yi" (Epidemic) evolved from "Wen" (Warmth), changing to "Wen" (Plague/Contagious Disease); this refers to the nomenclature of the disease. How can one treat "Wen Bing" (Warm Disease) and "Wen Yi" (Plague) as two distinct syndromes? The terms Spring Warmth, Summer Warmth, Autumn Warmth, and Winter Warmth are merely arbitrarily established names; in reality, they all result from contracting "Wen Qi" (Plague Pathogenic Factor) during the four seasons. The terms Wind-Warmth, Damp-Warmth, Warm-Malaria, and Warm-Heat refer to Plague diseases complicated by Wind, Dampness, Summerheat, or Malaria pathogens. The term "Wen Du" (Plague Toxin) refers to severe cases of plague. The term "Re Bing" (Heat Disease) refers specifically to plagues occurring in summer. As for the theory of "late onset," it is absurd. Cold qi in winter causes immediate illness upon contraction; how could it remain latent in the skin and muscles for half a year without harm, only manifesting in the following spring or summer? This is impossible. Regarding the character "Yi," it is said that when the people all suffer from the same illness, it is called "Yi," because the disease affects the entire household uniformly, similar to corvée labor. Removing the "Chi" radical and adding the "Shu" radical simply indicates its relation to disease. It must be understood that "Yi Bing" (Epidemic Disease) covers a broad scope, and "Wen Yi" (Plague) is merely one type within it. There are also distinctions between Zang Yi (Visceral Epidemic) and Za Yi (Miscellaneous Epidemic), yet plague texts omit these two categories, artificially separating Wen Bing and Yi Bing and prescribing different formulas for each. Upon careful examination of their formulas and discussions, there is no significant difference, so they should not be adopted. Alas! If the meaning of "Wen Yi" is not clear, how can one treat it? ○ Jingyue Quanshu provides detailed explanations for various sections, but it conflates Shanghan (Cold Damage) and Wen Yi (Plague) without distinction. Plague and Shanghan are fundamentally different, with distinct treatment methods. Why claim that Warm Epidemic is originally Shanghan? If it is originally Shanghan, establishing a separate category for Plague is redundant. Furthermore, if it is originally Shanghan, yet caused by contracting seasonal qi, I do not know whether one is first injured by cold and then infected by seasonal qi, or infected by seasonal qi and then injured by cold, or if both occur simultaneously. This stems from a failure to clearly distinguish between Shanghan and Plague. It is like an essayist who misinterprets the topic; although the language may be ornate, it misses the point entirely, amounting to nothing but dust and earth soup. The most unacceptable points are the recommendations for aggressive sweating and strong tonification. Does one not know that plague cannot be resolved by forced sweating, nor can strong tonification be applied to those suffering from heat toxin? Tonification is only necessary after sweating or purging, if deficiency signs appear, or if a person with weak constitution contracts plague after a long illness. ○ Wu Ke-yi's Lun Yuwen (Treatise on Plague) is widely circulated. Da Yuan Yin (Reach the Origin Decoction) is indeed an excellent formula for treating plague. However, his statement that adding herbs of a specific meridian addresses pathogenic factors floating in that meridian only covers the treatment for exterior syndromes of the Three Yang meridians. Regarding the transmission of pathogens to the interior, he only mentions entry into the Yangming Stomach Fu organ, briefly neglecting the Three Yin meridians. While it is acceptable to say that pathogens hide in the Mo Yuan (Membrane Source) and move from inside out, unlike the sequential transmission of Shanghan, claiming that pathogens never enter the Three Yin meridians severs the connection between Zang-Fu organs and meridians, causing Ying and Wei (Nutritive and Defensive Qi) to become obstructed. I often see plague patients with abdominal fullness, solid stools, spontaneous diarrhea with jaundice, and cold limbs—hasn't this transmitted to the Foot-Taiyin Spleen Meridian? Dry tongue and mouth, sore throat, and desire to sleep—hasn't this transmitted to the Foot-Shaoyin Kidney Meridian? Irritability, fullness, retraction of the genitals, rebellious qi, shaking, and pain in the hypochondrium—hasn't this transmitted to the Foot-Jueyin Liver Meridian? Moreover, some present with asthma and cough due to skin/hair involvement, indicating lung invasion; others show confusion and inappropriate laughter, indicating heart invasion. Thus, plague pathogens can transmit to all five Zang and six Fu organs. Claiming they stay only in the Three Yang meridians is certainly incorrect. (From Shuo Yi)
In epidemic diseases, pathogens enter through the mouth and nose, travel directly along the central pathway, and spread throughout the San Jiao (Triple Burner). Unlike Shanghan, which involves the Six Meridians and can be treated with sweating or purging, epidemics require different approaches. Since epidemic qi is turbid and foul, ancients drank aromatic substances and picked fragrant orchids to thoroughly cleanse turbidity. During transmission, if it reaches the extreme upward, it goes downward, and vice versa. Therefore, pathogens in the Upper Jiao cause hoarseness and oral ulcers; if they reverse-transmit to Dan Zhong (Conception Vessel at chest), they cause coma, crimson tongue, sore throat, and carbuncles. Treatment: In clearing and resolving, one must assist with aromatic herbs to open orifices and expel turbidity, such as Xi Jiao (Rhinoceros Horn), Shi Chang Pu (Acorus), Jin Yin Hua (Honeysuckle), and Yu Jin (Curcuma), combined with Zhi Bao Dan (Treasure Treasure Pill) to penetrate from exterior to interior. Using spiritual substances to internally open heart orifices and search out hidden pathogens. If pathogens enter the Ying level, mixing in the San Jiao with deepening heat and pathogens, one should ideally use salty and bitter major purgation methods. However, fearing the properties act too quickly and descend, one uses Xuan Shen (Scrophularia), Jin Yin Hua Lu (Honeysuckle Dew), Jin Zhi (Human Excrement Juice), and Gua Lou Pi (Trichosanthes Peel) to gently regulate the upper burner. This is emulating ancient methods without being bound by them. Examining this syndrome, Zhang Jingyue, Yu Jiayan, and Wu Ke-yi discussed it most thoroughly. Following Zhang and Yu risks leaving pathogens and causing lingering issues; following Wu risks damaging healthy Qi while eliminating pathogens. One must weigh options clinically, avoiding excessing the excess and emptying the deficient, to avoid causing premature death, thus deserving the title of guardian of life. (From Lin Zheng Zhi Nan)
How to recognize epidemic disease? Pay attention if two or three people have identical symptoms. How to pay attention? If symptoms are bizarre and unreasonable, significantly different from Shanghan, Feng Wen, Shi Wen, Wen Re, or Shu Shi categories, it is an epidemic. If pulse and symptoms do not indicate severe heat, but taking cooling medicines seems harmful yet ultimately harmless, it is an epidemic. If pulse and symptoms suggest warming and tonifying, but taking warming tonics initially seems soothing yet ultimately fails, it is an epidemic. ○ Spring warmth, summer heat, autumn dryness, and winter cold are normal disease patterns. Epidemics, however, involve foul qi transmitting mutually, as detailed by Wu Ke-yi. Wu claims entry via mouth/nose leads to occupation of Mo Yuan; I argue that since inhalation occurs via mouth/nose, and the Lung is the portal of entry, the Lung is always affected first. Epidemics are heat toxins, feared by Metal (Lung). Often, fever is preceded by aversion to cold, indicating initial Lung pathology; subsequently filling the San Jiao or entering the Pericardium directly. The so-called Li Qi (Malignant Qi) is essentially stagnant heat. Thus, Yu Xichang’s lack of distinction between "Wen" and "Wen" likely stems from this observation. Moreover, the Upper Jiao is like mist (ascending and dispersing detoxification); Middle Jiao is like fermentation (venting and dispersing detoxification); Lower Jiao is like a ditch (draining and dispersing detoxification). All revolve around the concept of "Toxin," implying stagnant heat. Some patients drinking cold water can sweat and resolve, verifying heat toxin. Even after the epidemic pathogen resolves, residual heat in the Lung often causes cough, muscle heat, and spontaneous sweating, proving initial Lung injury. In drought years, hot river water causes epidemic dysentery; standard treatments fail, but adding Guan Zhong (Swallowwort Rhizome) for bitter-cold detoxification works instantly. This is another verification of heat toxin. ○ The key to treating epidemics is the character "Du" (Toxin). Regardless of how strange the presentation, understanding this principle ensures correct diagnosis.不信? Look at ancient and modern formulas; do they not all prioritize detoxification? Wu Ke-yi’s exclusive use of Da Huang (Rhubarb) is for detoxification. Zhang Luyu’s preference for Ren Zhong Huang (Human Manure Yellow) combined with Tong Bian (Child’s Urine) and Cong Chi (Green Onion and Fermented Soybean) as a starting regimen is for detoxification. Ye Tianshi’s combination of Jin Yin Hua (Honeysuckle) and Jin Zhi (Human Excrement Juice) with Xi Jiao (Rhinoceros Horn), Huang Lian (Coptis), and Sheng Gan Cao (Raw Licorice) in nine out of ten prescriptions is for detoxification. Therefore, Yu’s concise statements emphasize ascending, venting, and draining, but repeatedly stress "detoxification," showing the true essence. (From Wu Yi Hui Jiang)
Epidemic disease is abnormal Qi from Heaven and Earth, present in all seasons, transmissible to humans via Qi resonance, entering through mouth and nose. Unlike Wind-Cold, which is righteous Qi entering via skin/hair and is non-contagious. It resembles malaria, but malaria is righteous Summerheat staying in the Shaoyang meridian with alternating chills and fever. Epidemics start with severe chills, followed by high fever persisting day and night. Yin and Mao hours are critical transition times; fever may temporarily subside then return severely. Some epidemics have intermittent chills and fever, but with shorter chills and longer fever, no yawning, and no jaw clenching. Physicians often mistake major illnesses for Shanghan, treating with Qiang Huo (Notopterygium) and Fang Feng (Saposhnikovia) to disperse Taiyang, or Chai Hu (Bupleurum) and Ge Gen (Kudzu) for Shaoyang/Yangming. Ignoring that epidemic pathogens enter via mouth/nose and reside in Mo Yuan, exterior dispersion fails to resolve the pathogen, consumes fluids and Yuan Qi, allowing pathogens to enter deeper, potentially transmitting to Jueyin, causing coma, Qi collapse, and blood consumption, leading to death. I created Jiu Yin Jie Yi Du (Rescue Yin and Resolve Epidemic Toxin) formula. Used early, it supplements Zheng Qi (Upright Qi); strong Zheng Qi strengthens internal organs, preventing pathogen entry. Returning Yin generates fluids, causing pathogens to exit spontaneously, akin to Zhongjing’s Jian Zhong Tang. It contains Gan Cao (Licorice), Hei Dou (Black Soybean), Yin Hua (Honeysuckle), and Huang Ni (Yellow Mud) to resolve heat toxin while supporting righteousness. For those with inherent deficiency failing Yin rescue, Ba Wei Wan (Eight-Ingredient Pill) rescues Yang; for Spleen deficiency, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) or Yi Gong San (Exquisite Formula) rescues Earth. These are methodological variations. ○ Li Qi entering via nose hides in Mo Yuan; entering via mouth disturbs the Stomach Fu. Cases vary: strong constitution vs. weak, true heat vs. false cold, true cold vs. false heat. One cannot simply use Gao Huang (Ointments/Honey) or purely Qin Lian (Scutellaria/Coptis) following Danxi and Hejian. Early epidemic resembles Shanghan but differs essentially; transmission differs superficially but is similar essentially. When in Three Yang: chills, high fever, headache, body ache, thirst, vomiting, diarrhea, large rapid pulse. Da Yuan Yin drives pathogens to their nest; Bai Hu Tang (White Tiger Decoction) and Cheng Qi Tang (Descending Qi Decoction) clear fire and purge pathogens, suitable only for strong constitutions. For deficient individuals, Bai Hu is too cold, Cheng Qi is too purgative. When pathogens sink to Three Yin, Zang Qi is attacked: coma, fixed eyes, grasping at air, delirium, black tongue, deep fine rapid pulse. Various evil signs emerge. Yuan Qi depleted by heat, Stomach Qi consumed, Zang Qi injured. Failing to adjust and sticking to purgation violates the warning against emptying the deficient. My brother Guangqi stated: Epidemic is harm by heat toxin; primary treatment is expelling epidemic and detoxifying. He formulated Gan Yi Lao Ren Tang, removing toxin and reducing heat, aligning with Yu’s ascending, venting, draining, and detoxifying principles, making it a holy medicine for epidemics. (From Hui Xin Lu)
Two paths of entry, three paths of exit, five treatment methods cover epidemics completely. Two entry paths: Heavenly (abnormal Qi in wrong season, entering meridians causing headache, fever, cough, mumps, big head plague); Human (mutual transmission, entering mouth/nose causing chills, high fever, chest oppression, yellow saliva). Three exit paths: Heavenly pathogens entering meridians should be dispersed using warm/acrid or cool/acrid herbs like Xiang Su San (Fragrant Perilla Powder) or Pu Ji Xiao Du Yin (Universal Benefit Detoxification Decoction) to exit via meridians; Human pathogens entering mouth/nose should be resolved with aromatic herbs like Shen Shu San (Divine Atractylodes Powder) or Zheng Qi San (Rectify Qi Powder) to exit via mouth/nose; Pathogens entering Zang-Fu via meridities/mouth-nose causing tidal fever, delirium, abdominal fullness/pain indicate toxin returning inward. Purge to resolve toxin; if stool passes, clear heat; if residual heat remains after purging, clear heat. Five treatment methods: Dispersing, Resolving Turbidity, Clearing, Purging, Tonifying. (Cheng Zhongling)
Famine brings epidemics; climate imbalance plus dietary irregularity, combined with bodily weakness and heavenly weakness, causes disease. In Wanhli Renwu year, drought and famine led to heat epidemic. Initial chills, fever, spasms; later macules, jaundice, mania; deaths followed. Treated with Ren Shen Bai Du San (Ginseng White Tiger Decoction) to release exterior, then Ren Shen Chai Hu Tang (Ginseng Bupleurum Decoction) to harmonize. Right pulse larger than left, spontaneous sweating, no chest/abdominal distension, no exterior/interior signs: treated with Bu Zhong Yi Qi Tang, saving many. This is because middle Qi was already damaged by hunger (internal deficiency). Using heavy sweating/purging for Shanghan would kill. ○ Epidemics must be differentiated by seasonal cold/warmth, dryness/dampness, and patient’s deficiency/excess, leisure/busyness. Adapt to time; do not be rigid. Long drought/dryness leads to heat epidemic; avoid drying agents, use detoxification and moistening. Long rain/dampness leads to cold epidemic; avoid moistening agents, use drying and Spleen-regulating methods. (From Yi Xue Liu Yao)
After great famine, great epidemic follows. Pathogens enter via mouth/nose, settle in Mo Yuan. Texts mention cold and heat epidemics, but heat epidemics are more common and are thieves of True Yin. Symptoms: Initially dizziness, eye swelling, headache (present or absent), sore waist/legs, chest tightness, thirst (or dry mouth without thirst), slight chills, sweating or no sweating. Later, no chills, only heat without sweating; mild heat before noon, intense heat after noon. Initial treatment: Da Yuan Yin 1-2 doses; mild cases heal. Otherwise, high fever, dry mouth, black tongue, delirium appear. Contemporary doctors seeing persistent fever, headache, backache, no sweating claim exterior unresolved, applying all Three Yang exterior drugs. Seeing black tongue, delirium, irritability claim urgent interior syndrome, mixing Bai Hu and Cheng Qi. Alas! Dangerous. If Da Yuan Yin fails initially, modify Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), Gan Lu Yin (Sweet Dew Decoction), or Shu Gan Yi Shen Tang (Soothe Liver and Benefit Kidney Decoction), giving large doses with minor Chai Hu as guide. (For deficiency, add Ren Shen). Effect may be slow but is very stable. For robust individuals taking previous herbs 4-5 days without resolution, if pulse is deep, rapid, and forceful, choose appropriate Cheng Qi Tang to purge. If chest remains tight after purging, use Xiao Xian Xiong Tang (Small Chest-Thrashing Decoction) to harmonize. Frequent exterior drugs consume Yin; early purging destroys Yin fluids; sweat will not come, heat worsens. At this stage, urgently administer large doses of Yin-nourishing agents to save life; otherwise, death is certain. Generally, initial epidemic pulse is not floating/tight like wind-cold/Shanghan; internal heat is high, but pulse is not necessarily large/rapid. Some have cold extremities resembling early Shanghan/Wind-Cold; absolutely do not give hot agents. Jing says: Deep heat causes deep cold limbs; slight heat causes slight cold limbs. How to differentiate? Wind-Cold cold limbs accompany aversion to wind/cold, trembling, desire for fire/sun, covering with blankets. Epidemic cold limbs do not fear cold, dislike covering; touching chest/back reveals burning heat. Use sweet-cold to nourish Yin and reduce Yang; avoid bitter-cold to protect Stomach Qi. Gao Gufeng said: Yin overflowing externally causes sweat; Yin blood moistening internally causes bowel movement. Method relies on Three Cheng Qi but is safer. I follow this for heat diseases, succeeding often, even correcting other doctors' errors. Dosage and modifications depend on age, strength, and need for attacking/tonifying. Wise physicians need no further elaboration. (Guo Shuxian)
Pulse Signs
Wen Bing (Plague Disease) has stagnant heat inside; pulse appears in muscle layer, not very floating. If heat stagnates in Shaoyin, pulse is deep/faint/almost absent, not Yin pulse, but blocked by Yang pathogen. ○ Wen Bing has heat inside and out; pulse is not surging/rapid, but deep/faint/small/urgent. Do not mistake for deficiency-cold and treat with warming herbs, increasing heat. Thus, Shanghan relies more on pulse; Plague relies more on symptoms. Shanghan pathogen enters from outside, transmitting via meridians; Wen Bing pathogen ignites from inside, overflowing into meridians. ○ Diagnosing Wen Bing: Surging, long, slippery, rapid pulse indicates mild case; deep pulse indicates severe; closed/absent pulse indicates critical. This is the key to distinguishing Wen Bing pulses. (Yang Lisshan)
Selected Cases
One patient had plague fever, irritability, thirst for cold water. Doctor forbade cold/raw foods. Patient suffered, demanded water, denied. Eyes bulged with fire, throat dried, insomnia, hallucinations. Sneaked well water, placed by pillow. Drank one cup: felt cool; two cups: ghosts vanished; three cups: voice returned; four cups: bones/joints relaxed; six cups: fell asleep deeply, woke up sweating profusely, clothes soaked, recovered fully. Reason: Patient was thin with excessive fire. Heat dried meridines; pathogen moved to exterior, unable to produce proper sweat. Cold drink harmonized interior/exterior, resolving toxicity. ○ Fortune teller Shi Yousheng, June plague: dry mouth/tongue, swollen painful throat, abdominal fullness, craving ice water, red scanty urine. Interior excess signs present, but whole body ice-cold, nails blue-black, threads-like pulse. Doctor ignored interior heat, cited Quansheng Ji: Yang syndrome with cold limbs past elbows/knees is Yin syndrome. Whole body cold is worse than elbow/knee cold; Tao’s pulse differentiation requires forcefulness; thread-like pulse is weaker than forceless, indicating extreme Yin syndrome with Yin pulse. Ignored Yang signs, proposed Fu Zi Li Zhong Tang. I analyzed pulse/symptoms: Extreme Yang syndrome. Extreme heat blocked Qi channels, causing faint pulse (Pulse Jue); Yang depression causing limb cold (Body Jue); pulse absent like dragons without leader, critical condition. Urged Cheng Qi Tang. Patient doubted, consulted three doctors, all said Yin syndrome, divination favored Yin. Took Li Zhong Tang, burned like fire, died of restlessness. (Wu Ke-yi)
Hu Ridu had facial/head swelling. Doctor said Spleen deficiency, used Liu Jun Zi Tang several doses. Head became barrel-sized, shoulders bucket-sized. Someone recognized Big Head Plague, used Jiu Wei Qiang Huo Tang. Patient couldn't speak, tongue withered/shrunk, teeth clenched, couldn't take medicine. From morning to noon, eyes rolled back, collapsed, breath like fire, noisy breathing. I used Shi Gao (Gypsum) 4 liang, Xuan Shen (Scrophularia) 1 liang, Hua Fen (Trichosanthes Root) 5 [liang]...