胸高而起。呕血如汁是也。生犀饮。
邵评∶此邪在中焦而血热受伤。疫毒深重。故以清营解毒为治。
遍身紫块。忽然发出。霉疮是也。刺块出血。宜清热解毒。人中黄丸。
邵评∶此症毒瘀血分。人中黄丸用苍术之燥烈。专走气分。防风之辛散。专走肝
经者。似为未合。当加银花等解毒之品。并当宣通血分为妥。若清热解毒汤用
羌葛、升麻。皆是躯壳之药。不能疏通三焦。瘟疫诸症。俱当从上中下三焦治。不
当以表里为界也。人中黄丸之苍术。虽芳香逐秽。未免燥烈太甚。宜酌用之。
发块如瘤。遍身流走。旦发夕死者是。用三棱针刺入委中三分。出血。服人中黄散。
邵评∶疙瘩一症。崇祯十六年京城大盛。患者有顷刻即死。其治法与此同。载见
说铃。同时有羊毛瘟。起病必有红点在背。挑破。中有羊毛一缕。无得活者。死有
数百万。当博求千金方、外台秘要、圣济总录等书。或有治法。
肠鸣。腹痛。干呕。水泄不通者。是也。探吐之。宜双解散。
邵评∶此症上下格拒。闭结不通。急急探吐。吐则气通。或有生机。然此湿毒多郁
于下焦。与干霍乱相近。金匮备急丸亦可用。
便清泄白。足肿难移者。是也。即湿温症。宜苍术白虎汤。
邵评∶湿热伏于下焦。脾不营运。用苍术白虎以清湿热。此与上条同是邪在下
焦。上条是寒湿。带中焦症。此条温热。纯是下焦症矣。
胸部高耸突起,呕吐血液如汁液状,这就是(瓜瓤瘟)的表现。使用生犀饮。
邵评:这是邪气在中焦导致血热受伤。疫毒深重。因此以清营解毒作为治疗方法。
全身出现紫色斑块,突然发出,这就是霉疮的表现。刺破斑块使其出血,适宜清热解毒。使用人中黄丸。
邵评:此症是毒瘀在血分。人中黄丸中使用苍术的燥烈之性,专门走气分;防风辛散,专门走肝经,似乎不太合适。应当加入金银花等解毒的药物,并且应当宣通血分才妥当。如果清热解毒汤使用羌活、葛根、升麻,这些都是作用于躯壳表层的药物,不能疏通三焦。瘟疫的各种症状,都应当从上、中、下三焦来治疗,不应当以表里作为界限。人中黄丸中的苍术,虽然能芳香逐秽,但未免燥烈太过,应当酌情使用。
身上长出像瘤子一样的疙瘩,遍身游走流动,早晨发作晚上死亡的,就是这种病。用三棱针刺入委中穴三分深,放出血液,服用人中黄散。
邵评:疙瘩这一病症,在崇祯十六年京城大盛。患者有顷刻间就死亡的,其治法与此相同,记载见于《说铃》。同时还有羊毛瘟,起病时背部必有红点,挑破后,中间有一缕羊毛,没有能存活的,死亡达数百万人。应当广泛寻求《千金方》、《外台秘要》、《圣济总录》等书籍,或许能找到治疗方法。
肠鸣,腹痛,干呕,水泻不通畅的,就是这种病。采用探吐的方法。适宜使用双解散。
邵评:此症上下格拒,闭结不通,急忙探吐,吐出来则气机通畅,或许还有生机。然而这种湿毒多郁结在下焦,与干霍乱相近。《金匮要略》中的备急丸也可以使用。
小便清长,排泄白色物质,足部肿胀难以移动的,就是这种病。即湿温症。适宜使用苍术白虎汤。
邵评:湿热伏藏于下焦,脾脏不能运化,使用苍术白虎汤来清除湿热。这与上一条一样都是邪气在下焦。上一条是寒湿,带有中焦的症状;这一条是温热,纯粹是下焦的症状了。
The chest protrudes upward, and vomiting of blood resembling juice occurs; this is the presentation of *Gua Rang Wen* (Melon Rind Plague). Use *Sheng Xi Yin* (Raw Rhinoceros Horn Decoction).
Sha's Commentary: This indicates pathogenic factors in the Middle Jiao causing injury to blood heat due to severe epidemic toxins. Therefore, the treatment principle is to clear the Ying (Nutritive) level and detoxify.
Purple patches appear all over the body suddenly; this is *Mei Chuang* (Mold Sore). Prick the patches to bleed them; it is appropriate to clear heat and detoxify using *Ren Zhong Huang Wan* (Human Waste Pill).
Sha's Commentary: In this condition, toxin and blood stasis reside in the Blood level. The *Cang Zhu* (Atractylodis Rhizoma) used in *Ren Zhong Huang Wan* is drying and acrid, acting specifically on the Qi level; *Fang Feng* (Saposhnikoviae Radix) is pungent and dispersing, acting specifically on the Liver Meridian. This seems inappropriate. One should add herbs such as *Jin Yin Hua* (Lonicerae Japonicae Flos) for detoxification and ensure the Blood level is unblocked. If *Qing Re Jie Du Tang* (Heat-Clearing and Toxin-Resolving Decoction) uses *Qiang Huo* (Notopterygii Rhizoma et Radix), *Ge Gen* (Puerariae Lobatae Radix), and *Sheng Ma* (Cimicifugae Rhizoma), these are merely exterior/body surface drugs that cannot unblock the San Jiao. All plague symptoms should be treated according to the Upper, Middle, and Lower San Jiao, not limited by the boundary of Exterior and Interior. Although *Cang Zhu* in *Ren Zhong Huang Wan* can aromaticize and expel turbidity, it is excessively drying and should be used with discretion.
Lumps like tumors emerge on the body and wander all over; if death occurs from morning to evening, this is *Ruan Jiao Wen* (Soft Leg Plague). Use a three-edged needle to puncture the *Weizhong* (BL-40) acupoint at a depth of 0.5 cm (1 cun/3 fen) to release blood, and administer *Ren Zhong Huang San* (Human Waste Powder).
Sha's Commentary: The condition of lumps was prevalent in Beijing during the 16th year of Chongzhen. Patients died within moments, and the treatment method was the same as described here, recorded in *Shuo Ling*. At that time, there was also *Yang Mao Wen* (Sheep Hair Plague); upon onset, there must be red spots on the back. After pricking them, a strand of sheep hair appears inside; survival was impossible, with deaths numbering in the millions. One should extensively consult books such as *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold), *Wai Tai Mi Yao* (Secret Essentials of the Outer Chamber), and *Sheng Ji Zong Lu* (General Records of Holy Relief) to find treatment methods.
Borborygmus (bowel sounds), abdominal pain, dry retching, and watery diarrhea without cessation occur; this is the presentation of *Shi Wen* (Damp-Warmth). Employ induced vomiting; it is appropriate to use *Shuang Jie San* (Double Resolution Powder).
Sha's Commentary: In this condition, there is mutual rejection between the upper and lower parts, resulting in blockage and obstruction. Urgently induce vomiting; once vomited, the Qi mechanism may flow freely, offering a chance for survival. However, this damp-toxin often stagnates in the Lower Jiao, resembling *Gan Huo Luan* (Dry Cholera). *Bei Ji Wan* (Emergency Pill) from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) can also be used.
Clear urination, white loose stools, and swollen feet difficult to move occur; this is the presentation of *Shi Wen* (Damp-Warmth). It is appropriate to use *Cang Zhu Bai Hu Tang* (Atractylodes White Tiger Decoction).
Sha's Commentary: Damp-heat lies hidden in the Lower Jiao, and the Spleen fails to transport and transform. *Cang Zhu Bai Hu Tang* is used to clear damp-heat. Like the previous clause, this involves pathogens in the Lower Jiao. The previous clause involved Cold-Dampness with Middle Jiao symptoms; this clause involves Warmth-Heat, purely constituting a Lower Jiao condition.