六气之外。另有一种疠气。乃天地秽恶之气。都从口鼻吸入。直行中道。流布三焦。
非比伤寒六经。可汗可下也。嘉言先生以逐秽为第一义。上焦如雾。升而逐之。中
焦如沤。疏而逐之。下焦如渎。决而逐之。并以解毒兼之。营卫既通。乘势追拔。勿使
潜滋。此喻氏心法也。叶天士先生谓疫邪从口鼻吸入。上焦心肺先受。如喉哑喉
痛口糜舌燥者。先入于肺也。渐至神昏舌绛者。邪由肺系干于心包络也。故初病
喉痛舌燥。最怕窍闭神昏。先生立法。清解中必佐芳香。宣窍逐秽。如犀角、银花、菖
蒲、郁金之类。兼服至宝丹。以有灵之物内通心窍。搜剔幽微。又谓吸入疫邪。三焦
均受。由卫及营。久则血分渐瘀。邪与三焦相溷。愈热愈结。理宜咸苦大制之法。然
恐性速。直走下焦。仍用轻扬理上。加金汁、银花露之类。此又先生法中之妙法也。
邵评∶邪由口鼻吸受。其气先入肺卫。次者递传心营。甚至逆传心包。从上焦而及中下二焦。
当从心营肺卫。宗三焦立法。从手经施治。若自肺而入阳明胃中经腑者。可同伤寒用
足经药施治。凡温热暑疫等症。皆当如是。所谓与伤寒治法始异而终同也。惟治疫之法。当厘清上
中下三焦。用芳香逐秽解毒开泄之剂。是第一要旨。
又评∶凡病卫之后方言气。营之后方言血。邪入心营肺卫。尚在上焦。至入于血分。则邪干下
焦矣。故曰三焦相溷。若直走下焦。与包络中结邪不相干涉。故仍主轻扬清上。而佐
以咸苦之味。两相兼顾。此疫邪入手经。与前列之症不同也。
疫邪入上焦 如口糜、丹疹、喉哑、咽痛。舌苔红中间白。或白中兼红。此邪在肺与
包络也。宜犀角、鲜生地、元参、连翘、石菖蒲、川郁金、牛蒡子、射干、银花、人中黄之类。
邵评∶此邪由肺卫而入心营。尚未传入包络。包络有邪。必神昏谵语。如下条之
见象也。此是营卫交病。用泄卫透营两解之剂。
疫邪入膻中 如见舌苔鲜红。神昏谵语。或发丹疹。或兼喉痛。疫邪逆传膻中也。
非比伤寒客邪。无庸发散。亦非停滞里症。无庸消导。治当清血络以防内闭。大宜
解毒逐秽。宣窍开闭。如犀角、连翘、元参、生地、银花、人中黄、川郁金、石菖蒲、西黄、琥
珀之类。兼用至宝丹。
邵评∶此与伤寒表里之邪大相悬绝。治法大异。此清血络而开闭宣窍逐秽之法。治温热暑疫邪
入包络之要旨。不独疫症然也。
疫邪遍三焦 疫疠秽邪。从口鼻吸入。分布三焦。久则血分渐瘀。其邪愈深。其热
愈结。当以苦咸之制。仍是轻扬理上为治。加犀角水、银花露、白金汁、西瓜翠衣、栝
蒌皮、黑元参之类。（以上参叶案）
邵评∶邪从上受。先肺卫。次心营。此邪在上焦。至入于血。则邪干下焦矣。故曰邪
遍三焦。邪愈深入。则热结而不能外泄。用咸苦以清下焦血热。仍佐轻扬清上
之剂。则三焦同治矣。此咸苦清血之味。余俱轻清上热。为治疫遍三焦之良法。
六气之外，还有一种疠气，这是天地间污秽恶劣的气，都从口鼻吸入，直接沿着中道运行，流布于三焦。
这不同于伤寒六经病证，不能单纯用发汗或攻下的方法治疗。嘉言先生认为逐除秽浊是第一要义。上焦如雾，宜用升散之法以逐秽；中焦如沤，宜用疏利之法以逐秽；下焦如渎，宜用决泄之法以逐秽。同时兼用解毒之法。待营卫通畅后，乘势追击拔除病邪，不要使其潜伏滋生。这是喻氏的心法。叶天士先生认为疫邪从口鼻吸入，上焦的心肺先受邪。如果出现喉哑、喉痛、口糜、舌燥等症状，说明邪气先入于肺。逐渐发展到神志昏迷、舌质绛红的情况，是邪气由肺系波及心包络所致。所以初病时出现喉痛、舌燥，最害怕的是窍闭神昏。先生制定的治法，在清解之中必佐以芳香之品，宣通窍道、逐除秽浊，如犀角、金银花、石菖蒲、郁金之类。兼服至宝丹，利用有灵性的药物内通心窍，搜剔幽微之邪。又认为吸入的疫邪，三焦均受累，由卫分传入营分，日久则血分逐渐瘀滞，邪气与三焦混杂在一起，越热越结聚，按理应当使用咸苦重剂之法。然而担心药性太速，直走下焦，所以仍用轻扬之品治理上焦，加入金汁、金银花露之类。这又是先生治法中的妙法。
邵评：邪气从口鼻吸入，其气先入肺卫，其次递传心营，甚至逆传心包，从上焦波及中下二焦。应当从心营肺卫入手，遵循三焦立法的原则，从手经施治。如果邪气从肺而入阳明胃的经腑，可以同伤寒一样用足经的药物施治。凡是温热、暑湿、疫病等病症，都应当如此。这就是所谓与伤寒治法开始不同而最终相同的原因。只有治疗疫病的方法，应当厘清上、中、下三焦，使用芳香逐秽、解毒开泄的方剂，这是第一要旨。
又评：凡是病在卫分之后才谈到气分，在营分之后才谈到血分。邪气进入心营肺卫，尚在上焦；到了进入血分，则是邪气干扰下焦了。所以说三焦相混。如果邪气直走下焦，与心包络中结聚的邪气没有关联，所以仍然主张用轻扬之品清上，并佐以咸苦之味，两相兼顾。这是疫邪侵入手经，与前面所列的症状不同之处。
疫邪入上焦：如出现口糜、丹疹、喉哑、咽痛，舌苔红中间白，或者白中兼红。这是邪气在肺与心包络。适宜使用犀角、鲜生地、玄参、连翘、石菖蒲、川郁金、牛蒡子、射干、金银花、人中黄之类。
邵评：这是邪气由肺卫进入心营，尚未传入心包络。心包络有邪，必然出现神志昏迷、胡言乱语，如下条所示的现象。这是营卫交病，使用泄卫透营、两解的方剂。
疫邪入膻中：如见舌苔鲜红，神志昏迷、胡言乱语，或者发丹疹，或者兼有喉痛。这是疫邪逆传膻中。不同于伤寒的客邪，不需要发散；也不是停滞在里的实证，不需要消导。治疗应当清解血络以防内闭，非常适宜解毒逐秽、宣通窍道、开闭醒神。如犀角、连翘、玄参、生地、金银花、人中黄、川郁金、石菖蒲、西黄（牛黄）、琥珀之类。兼用至宝丹。
邵评：这与伤寒表里之邪大相径庭，治法完全不同。这是清血络而开闭宣窍逐秽的方法，是治疗温热暑疫邪气进入心包络的要旨，不仅仅适用于疫病。
疫邪遍三焦：疫疠秽邪，从口鼻吸入，分布三焦，日久则血分逐渐瘀滞，邪气越深，热结越重。应当使用苦咸的制剂，但仍以轻扬理上为治法，加入犀角水、金银花露、白金汁、西瓜翠衣、瓜蒌皮、黑玄参之类。（以上参考叶案）
邵评：邪气从上受入，先犯肺卫，次犯心营。此邪在上焦，到了进入血分，则是邪气干扰下焦了。所以说邪遍三焦。邪气越深入，则热结而不能外泄。使用咸苦之品以清下焦血热，仍佐以轻扬清上的方剂，则三焦同治了。这些咸苦清血的药物，其余都是轻清上热的，这是治疗疫邪遍三焦的良好方法。
Beyond the Six Qi (Six Climatic Factors), there exists another type of pathogenic factor called Li Qi (Plague Pathogen), which is the foul and malignant air of heaven and earth. It enters through the mouth and nose, travels directly along the central pathway, and spreads throughout the San Jiao (Triple Burner).
It differs from Taiyang Bing (Taiyang Disease) involving the Six Channels, where sweating or purging methods can be applied. Mr. Jiayan emphasized that eliminating turbidity is the primary principle. The Upper Jiao is like mist; it should be dispersed upward to eliminate turbidity. The Middle Jiao is like a fermenting vat; it should be regulated and drained to eliminate turbidity. The Lower Jiao is like a ditch; it should be opened and drained to eliminate turbidity. These methods are combined with detoxification. Once Ying Wei (Nutritive and Defensive Qi) circulation is restored, pursue and extract the pathogen while it is in motion, preventing it from lurking and proliferating. This is the methodological essence of Yu (Yuming). Mr. Ye Tianshi stated that epidemic pathogens enter via the mouth and nose, affecting the Heart and Lung in the Upper Jiao first. Symptoms such as hoarseness, sore throat, oral ulcers, and dry tongue indicate the pathogen has initially entered the Lung. Gradual progression to coma and crimson tongue indicates the pathogen has moved from the Lung system to involve the Pericardium (Xin Bao Luo). Therefore, at the onset with sore throat and dry tongue, the greatest fear is obstruction of orifices leading to coma. The prescribed method involves clearing and resolving while assisting with aromatic substances to open orifices and eliminate turbidity, such as Rhinoceros Horn (Xi Jiao), Lonicerae Flos (Jin Yin Hua), Acori Tatarinowii Rhizoma (Shi Chang Pu), and Curcumae Radix (Yu Jin). Zhibao Dan (Treasure of Life Pill) is taken concurrently to use spiritual substances to internally connect with the heart orifices and search out subtle pathogens. He also stated that inhaled epidemic pathogens affect all three Jiaos, moving from the Wei (Defensive) level to the Ying (Nutritive) level. Over time, blood stasis gradually forms in the Blood level, and the pathogen mixes with the San Jiao, becoming more bound as heat increases. Ideally, heavy methods using salty and bitter flavors should be employed. However, fearing the rapid nature of these drugs might cause them to descend directly to the Lower Jiao, light and ascending agents for the Upper Jiao are still used, supplemented by Jin Zhi (Human Excrement Juice) and Lonicerae Flos Dew. This represents a subtle aspect of his methodology.
Shao’s Commentary: The pathogen enters via the mouth and nose, first affecting the Lung and Wei levels, then sequentially transmitting to the Ying level of the Heart, and even counter-transmitting to the Pericardium, spreading from the Upper Jiao to the Middle and Lower Jiaos. Treatment should focus on the Ying level of the Heart and Wei level of the Lung, following the principles of the San Jiao, and treating via the Hand meridians. If the pathogen enters from the Lung into the Stomach channels and organs of the Yangming, treatment can follow Taiyang disease protocols using Foot meridian herbs. All conditions such as Warm Heat, Summer-Heat, and Epidemics should be treated thus. This is what is meant by "treatment methods start differently but end similarly" compared to Cold Damage. The key to treating epidemics is to clarify the Upper, Middle, and Lower Jiaos and use aromatic formulas to eliminate turbidity, detoxify, and open obstructions.
Another Commentary: Generally, after the Wei level, one discusses the Qi level; after the Ying level, one discusses the Blood level. When the pathogen enters the Ying level of the Heart and Wei level of the Lung, it remains in the Upper Jiao. Upon entering the Blood level, the pathogen interferes with the Lower Jiao. Hence, it is said that the three Jiaos are mixed. If the pathogen moves directly to the Lower Jiao, it is unrelated to the pathogen binding in the Pericardium. Thus, light and ascending methods to clear the upper are still advocated, assisted by salty and bitter flavors, balancing both aspects. This distinguishes epidemic pathogens entering the Hand meridians from the previously listed symptoms.
Epidemic Pathogen Entering the Upper Jiao: Manifestations include oral ulcers, erysipelas-like rashes, hoarseness, and sore throat. The tongue coating is red with a white center, or white with interspersed red. This indicates the pathogen is in the Lung and Pericardium. Suitable herbs include Rhinoceros Horn (Xi Jiao), fresh Rehmanniae Radix (Xian Sheng Di), Scrophulariae Radix (Xuan Shen), Forsythiae Fructus (Lian Qiao), Acori Tatarinowii Rhizoma (Shi Chang Pu), Curcumae Radix (Chuan Yu Jin), Arctii Fructus (Niu Bang Zi), Belamcandae Rhizoma (She Gan), Lonicerae Flos (Jin Yin Hua), and Human Excrement Powder (Ren Zhong Huang).
Shao’s Commentary: Here, the pathogen enters the Ying level of the Heart from the Wei level of the Lung but has not yet transmitted to the Pericardium. If the Pericardium is affected, coma and delirious speech must occur, as seen in the next case. This is a simultaneous disease of Ying and Wei, requiring a formula that drains the Wei and reveals the Ying for a dual resolution.
Epidemic Pathogen Entering the Tan Zhong (Chest Center/Pericardium): Manifestations include bright red tongue coating, coma, delirious speech, erysipelas-like rashes, or concurrent sore throat. This indicates the epidemic pathogen has counter-transmitted to the Tan Zhong. Unlike external pathogens in Cold Damage, dispersing is unnecessary. Nor is it a stagnant interior excess condition requiring digestion-promoting methods. Treatment should clear the blood collaterals to prevent internal closure, strongly favoring detoxification, elimination of turbidity, opening of orifices, and relief of obstruction. Herbs include Rhinoceros Horn (Xi Jiao), Forsythiae Fructus (Lian Qiao), Scrophulariae Radix (Xuan Shen), Rehmanniae Radix (Sheng Di), Lonicerae Flos (Jin Yin Hua), Human Excrement Powder (Ren Zhong Huang), Curcumae Radix (Chuan Yu Jin), Acori Tatarinowii Rhizoma (Shi Chang Pu), Moschus (Xi Huang/Niu Huang), and Succinum (Hu Po). Zhibao Dan (Treasure of Life Pill) is used concurrently.
Shao’s Commentary: This is vastly different from exterior-interior pathogens in Cold Damage, and the treatment method is entirely distinct. This method of clearing blood collaterals, opening orifices, and eliminating turbidity is the essential principle for treating Warm Heat, Summer-Heat, and Epidemic pathogens entering the Pericardium, applicable not only to epidemics.
Epidemic Pathogen Spreading Throughout the Three Jiaos: Plague and turbid pathogens enter via the mouth and nose, distributing throughout the San Jiao. Over time, blood stasis gradually forms in the Blood level. The deeper the pathogen, the tighter the heat binds. Methods using bitter and salty flavors should be employed, yet treatment still prioritizes light and ascending actions for the Upper Jiao. Additions include Rhinoceros Horn Water, Lonicerae Flos Dew, Bai Jin Zhi (White Metal Juice), Citrullae Cortex (Xi Gua Cui Yi), Benincasae Pericarpium (Gua Lou Pi), and dark-colored Scrophulariae Radix (Hei Xuan Shen). (Referencing Ye’s cases above)
Shao’s Commentary: The pathogen enters from above, first affecting the Lung and Wei, then the Heart and Ying. This pathogen is in the Upper Jiao; upon entering the Blood level, it interferes with the Lower Jiao. Hence, it is said the pathogen pervades the three Jiaos. The deeper the pathogen penetrates, the more the heat binds and cannot vent outward. Salty and bitter substances are used to clear heat in the blood of the Lower Jiao, assisted by light and ascending agents to clear the upper, thereby treating the three Jiaos simultaneously. These salty and bitter blood-clearing agents, combined with other light and clear upper-heat-cleaning agents, constitute an excellent method for treating epidemics pervading the three Jiaos.