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。
凡是瘟疫病出现舌苔白得像粉末一样的，说明邪气已经进入了膜原。此时如果用发汗法治疗，一定无法解除病邪。应当使用达原饮，来透达膜原的邪气。还要观察兼夹哪一经的病证，加入引导药力到达该经的解表药物。如果兼有太阳经病证，加羌活；兼有阳明经病证，加葛根；兼有少阳经病证，加柴胡。如果舌苔薄而不厚腻，脉象不是特别快，说明感邪较轻，可以从发汗法解除。如果感邪较重，舌苔必然厚腻，脉象必然快。即使服药，邪气也一定会内陷。只要看到舌苔逐渐变黄且干燥，这是邪气逐渐进入胃腑的表现。前面的方剂中加入大黄，用泻下法治疗。如果脉象洪大、长而快，大汗出，这是邪气刚刚离开膜原，初入阳明经，属于白虎汤证。如果舌上全是黄色干燥且有刺状突起，又兼有里实热证，这是邪气已经进入胃腑，选用承气汤治疗。
邵评：邪气从口鼻进入，直行于中道，进入膜原。所以舌苔白得像敷了粉一样。膜原的位置，是脾与胃通过膜相连的地方，属于脾胃的半表半里部位，靠近胃。疫邪先进入膜原，最容易陷入胃中。如果从体表解除，也是从三阳经外出。所以要加入三阳经的引经药。疫病有两三天就离开膜原的，有一旬半月不传变的，有刚得病时，四五天病情轻微，到五六天突然势态猖獗的。疫邪致病，有的通过战汗（先寒战后出汗）解除，有的通过自汗或盗汗不能解除，有的无汗直接归于胃腑，有的因胃气壅滞压抑，必须经过泻下后通过战汗才能解除，有的通过发汗解除但不彻底，过了三四天又发热，有的发黄是因为泻下后又复发热，有的竟然通过发斑而痊愈，有的里实证急重，虽然发了斑也不能痊愈。
疫毒严重的，一天之内会有三次变化。初起一两天，舌苔白如粉末，早上服用一次达原饮，午后舌苔变为黄色，胸膈满闷疼痛，极度口渴烦躁，这是毒邪传入里部。前方剂中加入大黄进行泻下。烦躁稍微减轻，傍晚又加重烦躁和大热，全舌变成黑色且有刺状突起，鼻孔生出如烟煤样的黑垢，这是毒邪最重，复合聚集在胃腑，紧急使用承气汤泻下。到了半夜热退，第二天早上舌苔和刺状物消失。这几天的治疗方法，要在一天内完成。因为毒邪旺盛变化迅速，所以用药不得不紧迫。如果使用缓和的药物，一定无法挽救。常见瘟疫两三天就死亡的，都是这类情况。
邵评：泻下后症状稍缓，到了晚上又发热，其势更甚。热盛而成实邪，灼伤肺胃津液，所以舌黑有刺且鼻孔如烟煤。这是邪毒严重。热实结于胃腑，所以用承气汤紧急泻下，使邪毒从下面解除。如果一天多次变化，用药也要一天执行几天的治法。因为病变极速，治法也要急迫。这就是所谓的急病急攻。延误治疗就会导致津液枯竭、邪气闭阻而死。
疫病失于泻下，出现自利纯臭水，昼夜十几次，口燥、唇干、舌裂，腹部胀满硬痛，这是热结旁流证。紧急用承气汤泻下，以去除宿积污垢，腹泻自然停止。如果胃热失于泻下，郁结而发黄，热势更加不减，搏结血液形成瘀血。所以经气不被热瘀郁滞，就不会发黄。热邪不干扰血分，就不会导致蓄血。如果同时受到这种邪气影响，就会既发黄又兼蓄血，而不是因为蓄血导致发黄。但只要蓄血证出现，热随血走，黄随热泄。所以治疗发黄用茵陈蒿汤，治疗蓄血用桃仁承气汤，去掉桂枝、甘草，加入丹皮、归尾、赤芍。
邵评：胃中热郁结不得宣泄，就会发黄。热甚导致血瘀，就会蓄血。这是邪热进入中焦和下焦所致。至于辨别发黄与蓄血，应当观察小便。如果小便不利，则是热郁膀胱而发黄。如果小便自利，则是热瘀血分而蓄血。这样辨证治疗，万无一失。治疗发黄，渗湿清热并通下；治疗蓄血，消瘀清热并破血。
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.