吴又可曰∶伤寒必有感冒之因，然后头疼身痛，发热恶寒；时疫原无感冒之因，忽觉凛凛，以后但恶热，
不恶寒。伤寒不传染，时疫多传染；伤寒邪从毛窍入，时疫邪从口鼻入；伤寒感而即发，时疫感久乃发。伤寒
投剂，一汗而解；时疫发散，有汗不解；伤寒汗解在前，时疫汗解在后；伤寒投剂，可使立汗∶时疫俟其内溃，乃
得自汗战汗。疫邪始匿募原，根深蒂固，发时与营卫交并，客邪经由之处，营卫无不受伤，故曰溃。然不溃则
不能传，不传则邪不出，邪不出则疾不瘳。伤寒发斑则病笃，时疫发斑则病衰；伤寒感邪在经，以经传经；时
疫感邪在内，内溢于经，经不自传；伤寒感发甚暴，时疫却淹缠加重；伤寒必先发表，时疫必先疏利；种种不
同。所同者，伤寒时疫皆能传胃，故同用承气汤导邪以出也。然疫症下后，多有未能顿解者，由于表里分传，
一半向外传，邪留肌肉；一半向里传，邪留胃腑；留胃
故里气结，表气因而不通，于是肌肉之邪，不能即达肌表。下后里气通，表气亦顺，向郁肌肉，乃或斑或汗，
脱然而愈。伤寒下后无是矣。
〔疫症〕初起三日，葱豉汤加童便热服，汗之。不汗，少顷更服，以汗出热除为度。三服不解而脉浮，
尚属表症，用白虎汤。见里症，用承气汤、解毒汤。表里不分，用凉膈散、双解散加减。汗下后，复见表症，
再与白虎汤。复见里症，更与承气汤。表里热结，用三黄石膏汤、栀豉汤汗之。有汗下三四次而热退者，有
热退后，忽复壮热，用再汗再下而愈者。若脉症皆虚，用清热解毒汤、人中黄丸调之。非如伤寒，有下早变
症之虑，亦非温热不可频下之比，总当以热除邪尽为度。惟下元虚者，非六味生料补其真阴，不能化其余热。
（纂《张氏医通》）初发邪伏募原，营卫交阻，凛寒发热，甚则厥逆，迨阳郁而通，厥回而中外皆热，不可
发汗，宜透其邪，用达原饮。轻者舌苔白而薄，脉不数，可从汗解。重者舌苔如粉，舌根先黄，延及中央，
邪渐入胃，须下之，达原饮加大黄。若脉长洪而数，大汗而渴，此邪适离募原，欲表未表也，白虎汤。舌黄
兼里症，邪已入胃，大小承气汤。凡舌苔白，邪在募原，不可下；苔黄，邪在胃，宜下；黑而芒刺，急下；目
赤咽干，气喷如火，扬手掷足，脉沉数，下之，俱承气汤。凡失下，循衣摸床，撮空肉惕，目不了了，
邪热愈甚，元气将脱者，宜陶氏黄龙汤。既下，急用生脉散加归、芍。痰滞胸膈，瓜贝养荣汤。斑不透，仍热，
举斑汤。屡汗而液枯，人参白虎汤。表症多，里症少，达原饮加大黄、枳实。里症多，表症少，大柴胡汤。燥
结便秘，热结旁流，日久失下，自利黑水。协热下利，潮热便作泄泻。俱承气汤。疫兼痢者危，槟榔顺气汤。
热结下焦，小便不利，导赤散。热瘀发黄，茵陈蒿汤。血蓄膀胱，夜热谵语，桃仁承气汤。妇人病疫，经水
适来，邪入血海，热随血下自愈。小柴胡汤加赤芍、丹皮、生地黄。如结胸状者，血因邪结也，宜刺期门穴。
经水适断，血室乍空，邪乘虚入，难治。柴胡养荣汤。新产亡血，柴胡养荣汤。孕妇病疫，随症施治，以
安胎保胎为主，亦有宜用承气汤者，用之，反得母子俱全，慎勿生疑
掣肘也。（纂吴氏《温疫论》）
〔大头瘟〕湿热伤巅，肿大如斗，赤 无头，或结核有根，令人多汗气蒸。天行疠气，染之多死，乃邪
热客于心肺，上攻头面而为肿也。初则憎寒壮热，体重，头面痛，目不能开，上喘，咽喉不利。甚则堵塞不能
饮食，舌干口燥，恍惚不安，不速治。十死八九。人中黄丸、普济消毒饮子。便硬，加酒大黄一二钱，缓服，
或沈氏头瘟汤。若溃脓，必染人。若发于面部， 赤肿痛，属阳明，普济消毒饮子加石膏。发于耳前后，
额角旁，红肿，属少阳，普济消毒饮子加柴胡、天花粉。发于脑顶后，并耳后赤热肿痛，属太阳，荆防败毒
散去人参，加芩、连。
〔捻颈瘟〕喉痹失音，项大腹胀如虾蟆状，亦名虾蟆瘟。荆防败毒散。
〔瓜瓤瘟〕胸高肋起，呕血如汁。生犀饮，便结加大黄，渴加花粉，虚加盐水炒人参。表热去苍术，
加桂枝、黄连。便脓血，倍黄土，加黄柏。便滑，以人中黄代金汁。
〔杨梅瘟〕遍身紫块，忽然发出霉疮，清热解毒汤，下人中黄丸，并宜刺块出血。
〔疙瘩瘟〕发块如瘤，遍身流走，旦发夕死。急用三棱针刺入委中三分，出血。服人中黄散。
〔绞肠瘟〕肠鸣干呕，水泄不通，类绞肠痧。急宜探吐，服双解散。
〔软脚瘟〕便清泄白，足肿难移。此即湿温症，宜苍术白虎汤。
Wu Youke stated: Shanghan (Cold Damage) must have a cause of contracting wind-cold, after which headache, body pain, fever, and aversion to cold occur; Shi Yi (Seasonal Epidemic) originally has no cause of contracting wind-cold, suddenly feeling chilly and shivering, followed only by aversion to heat and no longer aversion to cold. Shanghan is not contagious, whereas Shi Yi is often contagious; the pathogen of Shanghan enters through the hair pores (skin surface), while the pathogen of Shi Yi enters through the mouth and nose; Shanghan manifests immediately upon infection, whereas Shi Yi manifests after a period of time following infection. Upon administering medication for Shanghan, one sweat suffices for resolution; for Shi Yi, dispersing the exterior does not resolve even with sweating; the sweating resolution for Shanghan occurs early in the course, while for Shi Yi it occurs late; administering medication for Shanghan can induce immediate sweating, whereas for Shi Yi one must wait for the internal collapse of the pathogen before spontaneous sweating or chills-sweating can occur. The epidemic pathogen initially hides in the Mu Yuan (semi-exterior semi-interior region), taking deep root; upon manifestation, it clashes with Ying and Wei (Nutritive and Defensive Qi), injuring them wherever the guest pathogen passes, hence termed "collapse". However, without collapse, there is no transmission; without transmission, the pathogen cannot exit; if the pathogen does not exit, the disease does not heal. In Shanghan, the appearance of macules indicates severe illness; in Shi Yi, the appearance of macules indicates declining illness; Shanghan involves pathogens in the meridians, transmitting from meridian to meridian; Shi Yi involves pathogens internally, overflowing into the meridians, without self-transmission among meridians; Shanghan onset is violent and sudden, whereas Shi Yi lingers and worsens; treatment for Shanghan requires first releasing the exterior, while treatment for Shi Yi requires first venting and purging; these are various differences. The similarity is that both Shanghan and Shi Yi can transmit to the Stomach, thus both use Chengqi Tang (Gut-Purging Decoction) to guide the pathogen out. However, after purgation in Shi Yi, resolution is often not immediate, due to the pathogen transmitting separately to the interior and exterior: half transmits outward, remaining in the muscles; half transmits inward, remaining in the Stomach. Retention in the Stomach causes interior Qi stagnation, preventing exterior Qi from flowing freely, so the pathogen in the muscles cannot immediately reach the skin surface. After purgation, interior Qi becomes unblocked, and exterior Qi flows smoothly; the pathogen previously stagnant in the muscles then either erupts as macules or sweats out, resolving abruptly. This does not occur after purgation in Shanghan.
[Shi Yi] In the initial three days, use Congchi Tang (Scallion and Fermented Soybean Decoction) with child's urine taken hot to induce sweating. If no sweat occurs, administer again shortly thereafter, stopping when sweat appears and heat subsides. If unresolved after three doses but the pulse is floating, it still belongs to an exterior syndrome, use Baihu Tang (White Tiger Decoction). If interior signs appear, use Chengqi Tang or Jiedu Tang (Detoxification Decoction). If exterior and interior are indistinguishable, use Liangge San (Cooling the Diaphragm Powder) or Shuangjie San (Double-Release Powder) with modifications. After sweating and purging, if exterior signs reappear, administer Baihu Tang again. If interior signs reappear, administer Chengqi Tang again. For exterior-interior heat binding, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) or Zhichi Tang (Gardenia and Soybean Decoction) to induce sweating. Some cases resolve after three or four rounds of sweating and purging; some experience sudden high fever after heat subsides, requiring further sweating and purging to resolve. If pulse and symptoms both indicate deficiency, use Qingre Jiedu Tang (Heat-Clearing Detoxification Decoction) and Renzhonghuang Wan (Human-Middle-Yellow Pill) to regulate. Unlike Shanghan, there is no concern about premature purgation causing transformation syndromes, nor is it comparable to warm-heat diseases where frequent purgation is contraindicated; the ultimate goal is always the elimination of heat and pathogens. Only in cases of lower jiao (lower burner) deficiency, using Liuwei Disheng San (Six-Ingredient Replenishing Decoction) to tonify true Yin is necessary to transform residual heat. (Compiled from *Zhangshi Yitong*)
At onset, pathogens hide in the Mu Yuan, obstructing Ying and Wei, causing chills and fever, even extremity reversal (Jue Ni); once Yang Qi is blocked and then unblocked, reversal resolves and interior/exterior become hot. At this stage, sweating is contraindicated; instead, vent the pathogen using Daoyin Yin (Reach the Origin Decoction). In mild cases, tongue coating is white and thin, pulse is not rapid, allowing resolution via sweating. In severe cases, tongue coating resembles powder, tongue root turns yellow first, spreading to the center, indicating pathogens gradually entering the Stomach, requiring purgation: Daoyin Yin plus Dahuang (Rhubarb). If the pulse is long, surging, and rapid, with profuse sweating and thirst, this indicates pathogens just leaving the Mu Yuan, attempting to reach the exterior but not yet fully there; use Baihu Tang. Yellow tongue coating with interior signs indicates pathogens have entered the Stomach; use Dachengqi Tang (Major Gut-Purging Decoction) or Xiaochengqi Tang (Minor Gut-Purging Decoction). Generally, white tongue coating means pathogens are in the Mu Yuan, do not purge; yellow coating means pathogens are in the Stomach, purge; black coating with prickles requires urgent purgation; red eyes, dry throat, breath like fire, tossing limbs, deep-rapid pulse all require purgation with Chengqi Tang. If purgation is delayed, leading to grasping at bedclothes, empty hand movements, muscle twitching, and unclear vision, with worsening pathogenic heat and impending exhaustion of Yuan Qi (Primal Qi), use Taoshi Huanglong Tang (Master Tao's Yellow Dragon Decoction). After purgation, urgently use Shengmai San (Generate Pulse Powder) plus Danggui (Angelica Sinensis) and Shaoyao (Peony). For phlegm-stagnation in the chest/diaphragm, use Guabei Yangrong Tang (Melon Seed and Fritillaria Nourishing Righteousness Decoction). For macules not erupting with persistent heat, use Juban Tang (Raise Macules Decoction). For fluid depletion after repeated sweating, use Renshen Baihu Tang (Ginseng White Tiger Decoction). When exterior signs predominate over interior, use Daoyin Yin plus Dahuang and Zhishi (Immature Bitter Orange). When interior signs predominate over exterior, use Chaihu Shugan Tang (Bupleurum Soothing Liver Decoction) - *Note: Text says Dachaihu Tang*. For dry constipation, heat-binding with peripheral flow, or prolonged failure to purge leading to spontaneous passage of black water, or heat-collateral diarrhea with tidal fever and loose stools, use Chengqi Tang. Shi Yi complicated by dysentery is critical; use Binglang Shunqi Tang (Areca Nut Regulating Qi Decoction). Heat-binding in the lower jiao with difficult urination uses Daochi San (Guide Redness Powder). Heat-stasis causing jaundice uses Yinchen Hao Tang (Artemisia Capillaris Decoction). Blood stasis in the Bladder with night fever and delirium uses Taoren Chengqi Tang (Peach Kernel Gut-Purging Decoction). In women with Shi Yi, if menstruation arrives, pathogens enter the Blood Sea, and heat follows blood downward for natural healing; use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Chishao (Red Peony Root), Danpi (Moutan Bark), and Sheng Dihuang (Raw Rehmannia). If resembling Jie Xiong (Chest Binding), it is blood coagulated by pathogens; puncture Qimen Acupoint. If menstruation just ceased, Blood Chamber is temporarily empty, pathogens enter due to deficiency, difficult to treat; use Chaihu Yangrong Tang (Bupleurum Nourishing Righteousness Decoction). Postpartum blood loss uses Chaihu Yangrong Tang. Pregnant women with Shi Yi are treated according to symptoms, prioritizing calming and protecting the fetus; sometimes Chengqi Tang is appropriate, and its use may ensure safety for both mother and child, so do not hesitate or hinder treatment. (Compiled from Wu Shi *Wenyi Lun*)
[Datou Wen / Big Head Plague] Damp-heat damages the vertex, swelling large as a bucket, red and swollen without distinct head, or nodular with roots, causing excessive sweating and steaming heat. Seasonal pestilential qi, if contracted, often leads to death; this is pathogenic heat lodging in Heart and Lungs, attacking the head and face causing swelling. Initially, aversion to cold with high fever, heavy body, head and face pain, inability to open eyes, upper asthma, and throat obstruction. Severe cases lead to blockage preventing eating/drinking, dry tongue, parched mouth, restlessness; without rapid treatment, 80-90% mortality. Use Renzhonghuang Wan or Puji Xiaodu Yinzi (Universal Benefit Detoxification Decoction). If stool is hard, add Jiuhuang (Wine-processed Rhubarb) 1-2 qian, take slowly, or use Shen's Datou Wen Tang. If suppurating, it is infectious. If occurring on the face, red/swollen/painful, belongs to Yangming channel, Puji Xiaodu Yinzi plus Shigao (Gypsum). If occurring around ears/forehead angles, red/swollen, belongs to Shaoyang channel, Puji Xiaodu Yinzi plus Chaihu (Bupleurum) and Tianhuafen (Trichosanthes Root). If occurring on back of head/behind ears, red/hot/swollen/painful, belongs to Taiyang channel, Jingfang Baidu San minus Renshen, plus Huangqin (Scutellaria) and Huanglian (Coptis).
[Nianjing Wen / Twisted Neck Plague] Throat bi (obstruction) with aphonia, neck swelling and abdominal distension like a toad, also called Hamawen. Use Jingfang Baidu San.
[Guanrang Wen / Melon Rind Plague] Chest elevation and rib protrusion, vomiting blood like juice. Use Shengxi Yin (Raw Rhinoceros Horn Decoction); add Dahuang for constipation, Huafen for thirst, salt-fried Renshen for deficiency. Remove Cangzhu (Atractylodes) for exterior heat, add Guizhi (Cinnamon Twig) and Huanglian. Add doubled Houtu (Yellow Earth) and Huangbai (Phellodendron) for bloody/purulent stool. Replace Jinzhi (Golden Juice) with Renzhonghuang for slippery stool.
[Yangmei Wen / Bayberry Plague] Purple patches all over body, suddenly appearing as mold sores. Use Qingre Jiedu Tang, take Renzhonghuang Wan, and puncture patches to bleed.
[Geda Wen / Lump Plague] Lumps like tumors moving all over the body, morning onset evening death. Urgently puncture Weizhong Acupoint 3 cun deep with three-edged needle to bleed. Take Renzhonghuang San.
[Jiaochang Wen / Intestine-Twisting Plague) Bowel sounds, dry retching, complete obstruction of water/stool, similar to Jiaochang Sha. Urgently induce vomiting, take Shuangjie San.
[Ruanjiao Wen / Soft Leg Plague) Clear white diarrhea, foot swelling making movement difficult. This is Wet-Warmth Syndrome; use Cangzhu Baihu Tang (Atractylodes White Tiger Decoction).