【纲】仲景曰。阳脉濡弱。阴脉弦紧者。更遇温气。变为温疫。
【目】苏颂曰。此前热未已。又感温气。温热相合。故变为温疫也。
王肯堂曰。按叔和伤寒例云。伤寒热病未已。再遇风寒湿而各变为一病也。何止于温。既曰再
遇温热变为温毒矣。又曰再遇温气变为温疫。是何温之再遇。而有二病之异。且疫者。特感非时之
气。众人病一般也。如冬应寒而反大温。人感冬温而病。则所谓温疫。如春夏应温热而反大寒。人
感暴寒而病。则所谓寒疫也。何待再遇于异气耶。若云再遇温气。变为温疫。是伤寒再遇异气而变
病也。再遇异气而变病。未必众病相似。安可以疫言。伤寒例云。阳脉濡弱。阴脉弦紧。此温疫之
脉也。活人书注此脉于冬温条下。是以温疫冬温合为一病。殊不知冬温特感非时之气耳。温疫是伤
寒再遇于异气也。岂可合为一病。此理未明。故书此以俟明哲。愚谓感温热而为温毒。感温气而为
温疫。此乃有微甚之分。但疫字疑误。恐当作疾字。若作疫字。则冬温又何一家长幼病相似也。
一家病相似。方可言疫。况此伤寒热病未已。再遇温气而病。何至一家相似哉。
吴绶曰。寒疫。乃天之暴寒为病也。凡四时之中。天令或有暴风寒之作。人感之而即病者。名曰
寒疫。其症与正伤寒
同。但暴寒为轻耳。治法。若初作头痛憎寒拘急。或呕逆恶心。中脘痞闷。或饮食停滞不化。或腹
中作痛。未发热者。藿香正气散。加减一二味主之。已发热者。十味芎苏散汗之。若身痛骨节疼而
发热者。人参羌活散加葱白、葛根、生姜、汗之。或神术汤亦汗。若自汗者。不宜再汗。九味羌活
汤。若热不解。或变别症。宜从正伤寒条内治之。
朱肱曰。仲景云。冬温之毒。与伤寒大异。盖伤寒者。伤寒气而作。冬温者。感温气而作。寒
疫者暴寒折人。非触冒之遇。其治法不同。所施温凉寒热之剂亦异。不可拘以日数。发汗吐下。随
症施治。要之治热以寒。温而行之。治温以清。冷而行之。治寒以热。凉而行之。治清以温。热而
行之。以平为期。不可以过。此为大法。
王肯堂曰。时疫者。乃天行暴厉之气流行。凡四时之令不正者。乃有此气行也。若人感之。则
长幼相似而病。又互相传染。其作与伤寒相似。然伤寒因寒而得。此乃疫气。不可与寒同论也。法
当辟散疫气。扶正气为主。若多日不解。邪热传变何症。宜从伤寒变症条内选用。惟发散药则不同。
凡发散汤剂。藿香正气散、芎芷香苏散、人参败毒散、十味芎苏散、十神汤。皆可用。
韩祗和曰。春应温而清气折之。责邪在肝。或身热头疼目眩呕吐。长幼率相似。升麻葛根汤、
解肌汤。四时通用败毒散。夏应暑而寒气折之。责邪在心。或身热头痛腹满自利。长幼率相似。
射干汤、半夏甘桂汤。秋应凉而大热折之。责邪在肺。湿热相搏。民多病瘅。喘咳。金沸草散、白
虎加苍术汤。病瘅发黄。茵陈五苓散。冬应寒而大温折之。责邪在肾。宜葳蕤汤。
朱震亨曰。冬温为病。非其时而有其气者。冬月严寒。君子当闭藏。而反发泄于外。专用补中
带表药。
陶华曰。春分后夏至前。不恶寒而渴者。为温病。用辛凉之药微解肌。不可大发汗。急症见者。
用寒凉之药。急攻下。切不可误汗误下。当须识此。表症不与正伤寒同治。里症同。
夏至后。有头疼发热。不恶寒而渴者。为温病。愈加热者。
为热病。止用辛凉之药解肌。不宜大汗。里症见。急攻下。表症不与正伤寒同治。里症同。
立秋后。霜降前。有头疼发热。不恶寒。身体痛小便短者。为温病。亦用辛凉之药加燥以解肌。
亦不宜汗。里症见者。宜攻下。表症不与正伤寒同。
【纲】张仲景说：如果阳脉表现为濡弱，阴脉表现为弦紧，此时再遇到温气，就会演变为温疫。
【目】苏颂说：这是之前的热病尚未痊愈，又感受了温气，温热之气相互结合，所以演变为温疫。
王肯堂说：根据叔和《伤寒例》记载，伤寒热病尚未痊愈，再次遇到风寒湿邪，各自会转变为不同的疾病。哪里仅限于温气呢？既然说再次遇到温热之气就变为温毒，又说再次遇到温气就变为温疫，那么这“再次遇到温气”为何会导致两种不同的疾病差异呢？况且，“疫”是指感染了非时令之气，众人患病症状相似。例如冬天应该寒冷却反而大暖，人感染冬温而生病，这就是所谓的温疫；又如春夏季应该温热却反而大寒，人感染暴寒而生病，这就是所谓的寒疫。何必非要等到再次遇到异气才算呢？如果说再次遇到温气就变为温疫，那是指伤寒再次遇到异气而转变病症。再次遇到异气而转变病症，未必会让众人的病症相似，怎么能称之为“疫”呢？《伤寒例》说：“阳脉濡弱，阴脉弦紧”，这是温疫的脉象。《活人书》将此脉象注在冬温条目下，因此将温疫与冬温合为一种病。殊不知冬温只是感染了非时令之气罢了，而温疫是伤寒再次遇到异气所致。怎么可以将它们合为一种病呢？这个道理没有阐明，所以我写下这些以等待明智之士指正。我认为，感受温热之气而成为温毒，感受温气而成为温疫，这其中有轻重程度的区别。但“疫”字恐怕有误，可能应当作“疾”字。如果作“疫”字，那么冬温为什么会出现一家老小症状相似的情况呢？只有当一家人症状相似时，才可以称为“疫”。何况这里是伤寒热病未愈，再次遇到温气而生病，怎么会达到一家人症状相似的境地呢？
吴绶说：寒疫，是由天气突然产生的暴寒所导致的疾病。在四季之中，如果天气出现暴风寒，人感染后立即发病，就叫做寒疫。其症状与正伤寒相同，只是暴寒致病较轻而已。治疗方法：如果是初起时头痛、怕冷、身体拘急，或者呕吐恶心、中脘部痞闷，或者饮食停滞不消化，或者腹中疼痛，且尚未发热的，用藿香正气散，加减一二味药来主治。已经发热的，用十味芎苏散发汗治疗。如果身体疼痛、骨节疼痛且发热的，用人参羌活散加葱白、葛根、生姜，发汗治疗。或者使用神术汤发汗也可以。如果有自汗症状的，不宜再次发汗，可用九味羌活汤。如果热势不退，或出现其他变症，应当参照正伤寒的条文进行治疗。
朱肱说：张仲景说：冬温的毒性与伤寒大不相同。所谓伤寒，是伤于寒气而发作；冬温，是感受温气而发作。寒疫则是暴寒折损人体，并非偶然触犯所致，其治法不同，所使用的温凉寒热药物也各异。不可拘泥于日数，发汗、催吐、攻下等法，应随症状施治。总之，治疗热证用寒药，但要温服；治疗温证用清药，但要冷服；治疗寒证用热药，但要凉服；治疗清（凉）证用温药，但要热服。以平复为度，不可过度。这是基本原则。
王肯堂说：时疫，是由于天行暴厉之气流行所致。凡是四季气候不正的时候，就会有这种气运行。如果人感染了它，则长幼老少症状相似而发病，并且互相传染。其发作情况与伤寒相似，然而伤寒是因寒邪而得，此乃疫气，不可与寒邪同论。治法应当以辟散疫气、扶助正气为主。如果多日不解，邪热传变出现何种症状，宜从伤寒变症条文中选用方药。惟独发散类药物则有所不同。凡发散汤剂，如藿香正气散、芎芷香苏散、人参败毒散、十味芎苏散、十神汤，都可以使用。
韩祗和说：春季应当温暖却被清气折损，病责在于肝，可能出现身热、头痛、目眩、呕吐等症状，长幼老少大多相似，可用升麻葛根汤、解肌汤，以及四时通用的败毒散。夏季应当暑热却被寒气折损，病责在于心，可能出现身热、头痛、腹满、自利等症状，长幼老少大多相似，可用射干汤、半夏甘桂汤。秋季应当凉爽却被大热折损，病责在于肺，湿热相搏，百姓多患瘅病（黄疸类疾病），出现喘咳，可用金沸草散、白虎加苍术汤。若患瘅病发黄，可用茵陈五苓散。冬季应当寒冷却被大温折损，病责在于肾，宜用葳蕤汤。
朱震亨说：冬温这种病，是非其时而有其气。冬季严寒，君子本应闭藏精气，却反而发泄于外，治疗应专用补中带表之药。
陶华说：春分后到夏至前，如果不恶寒而口渴，属于温病，用辛凉性质的药物轻微解肌，不可大发汗。急症出现的，用寒凉性质的药物急攻下，切不可误用汗法或下法，必须认清这一点。表证不与正伤寒同治，里证则相同。
夏至以后，如果出现头痛发热，不恶寒而口渴，属于温病；如果热度加重，则称为热病。只需用辛凉性质的药物解肌，不宜大汗。出现里证，急攻下。表证不与正伤寒同治，里证则相同。
立秋后到霜降前，如果出现头痛发热，不恶寒，身体痛、小便短少，属于温病。也用辛凉性质的药物加燥湿药以解肌，也不宜发汗。出现里证者，宜攻下。表证不与正伤寒相同。
[General Principle] Zhang Zhongjing stated: If the Yang pulse is soft and weak (Ru Ruo) and the Yin pulse is string-like and tight (Xuan Jin), and one subsequently encounters warm Qi, it will transform into a Warm Plague (Wen Yi).
[Commentary] Su Song said: This occurs when the previous heat pathogen has not yet subsided, and one again contracts warm Qi. The combination of warm and heat pathogens leads to the transformation into a Warm Plague.
Wang Kentang commented: According to He Huanzhi's "Shanghan Li" (Example of Cold Damage), if cold damage or heat disease has not yet resolved, encountering wind-cold-dampness again will cause it to transform into various diseases. Why limit this only to warmth? It states that encountering warm-heat again transforms it into Warm Toxin (Wen Du), and encountering warm Qi again transforms it into Warm Plague. Why does "encountering warm Qi again" result in two different diseases? Moreover, "Plague" (Yi) refers to contracting non-seasonal Qi, where the majority of people suffer from similar symptoms. For instance, if winter should be cold but is unusually warm, and people contract Winter Warmth (Dong Wen) and become ill, this is called Warm Plague. Similarly, if spring and summer should be warm but are suddenly cold, and people contract violent cold and become ill, this is called Cold Plague (Han Yi). Why must one wait for a second encounter with a different pathogen? If encountering warm Qi again transforms cold damage into Warm Plague, it implies that cold damage transforming upon encountering a different pathogen does not necessarily make the symptoms among the masses similar. How can it be called a "Plague"? "Shanghan Li" states: "Yang pulse soft and weak, Yin pulse string-like and tight," which is the pulse of Warm Plague. The "Huangren Shu" (Book of Living People) annotates this pulse under the entry for Winter Warmth, thereby merging Warm Plague and Winter Warmth into one disease. However, Winter Warmth is merely contracting non-seasonal Qi, whereas Warm Plague is cold damage re-encountering a different pathogen. How can they be merged into one disease? This principle is unclear, so I write this to await clarification by wise scholars. I believe that contracting warm-heat becomes Warm Toxin, while contracting warm Qi becomes Warm Plague; there is a distinction in severity. The character "Yi" (Plague) is likely an error and should probably be "Ji" (Disease). If it is "Yi," then why do cases of Winter Warmth show similar symptoms within a family? Only when a whole family exhibits similar symptoms can it be termed a "Plague." Furthermore, here we have cold damage heat disease unresolved, re-encountering warm Qi to cause illness; how could it reach the point of a whole family having similar symptoms?
Wu Shou said: Cold Plague is caused by sudden violent cold from heaven. In any season, if weather produces violent wind-cold, and people contract it and fall ill immediately, it is named Cold Plague. Its symptoms are the same as typical Cold Damage (Zheng Shanghan), but the violence of the cold is milder. Treatment methods: If initially presenting with headache, aversion to cold, stiffness, or vomiting/nausea, epigastric fullness, food stagnation, or abdominal pain, without fever, use Huoxiang Zhengqi San (Agarweed and Magnolia Bark Decoction), modifying one or two herbs. If fever has already appeared, use Shiwei Xiong Su San (Ten-Ingredient Ligusticum and Perilla Decoction) to induce sweating. If body ache, bone/joint pain, and fever are present, use Renshen Qianghuo San (Ginseng and Notopterygium Decoction) added with Congbai (Scallion Stalk), Gegen (Kudzu Root), and Shengjiang (Fresh Ginger) to induce sweating. Or use Shenzhu Tang (Divine Efficacy Decoction) to induce sweating. If spontaneous sweating is present, do not induce sweating again; use Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction). If heat persists or other complications arise, treat according to the chapters on typical Cold Damage.
Zhu Gong said: Zhang Zhongjing stated: The toxicity of Winter Warmth is vastly different from Cold Damage. Cold Damage arises from injuring cold Qi; Winter Warmth arises from contracting warm Qi. Cold Plague is caused by violent cold overwhelming the body, not merely accidental exposure. Their treatments differ, and the administration of warming, cooling, cold, and hot agents varies. One should not be bound by the number of days; sweating, emesis, and purging should be applied according to symptoms. Generally, treating heat with cold drugs requires warm administration; treating warmth with clearing drugs requires cold administration; treating cold with hot drugs requires cool administration; treating coolness with warming drugs requires hot administration. The goal is balance, avoiding excess. This is the major principle.
Wang Kentang said: Seasonal Plague (Shi Yi) results from the prevalence of violent heavenly Qi. When the seasonal climate is abnormal, such Qi circulates. Upon contraction, symptoms are similar across ages, and it spreads through contagion. Its onset resembles Cold Damage, but since Cold Damage is caused by cold and this is epidemic Qi, they cannot be discussed together. The method should focus on dispersing epidemic Qi and supporting healthy Qi. If unresolved after many days and evil heat transmits causing specific symptoms, select treatments from the sections on Cold Damage complications. However, dispersing agents differ. All dispersing decoctions, such as Huoxiang Zhengqi San, Xiong Zhi Xiang Su San, Renshen Baidu San, Shiwei Xiong Su San, and Shishen Tang, may be used.
Han Zhihe said: If spring should be warm but is chilled by clear/cold Qi, the pathology lies in the Liver. Symptoms may include fever, headache, dizziness, vomiting, with similarity across ages. Use Shengma Gegen Tang (Cimicifuga and Kudzu Decoction), Ji Ji Tang (Muscle-Releasing Decoction), or the universal Baidu San for all seasons. If summer should be hot but is chilled by cold Qi, the pathology lies in the Heart. Symptoms may include fever, headache, abdominal fullness, spontaneous diarrhea, with similarity across ages. Use Shegan Tang (Belamcanda Decoction) or Banxia Gan Gui Tang (Pinellia, Licorice, and Cinnamon Twig Decoction). If autumn should be cool but is scorched by great heat, the pathology lies in the Lung. Damp-heat struggles, causing many to suffer from Dan disease (jaundice-type illness) with wheezing and coughing. Use Jinfei Cao San (Boiling Grass Decoction) or Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Macrocephala Decoction). If Dan disease causes yellowing, use Yinchin Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction). If winter should be cold but is warmed by great heat, the pathology lies in the Kidney. Use Weirui Tang (Polyporus Decoction).
Zhu Zhenheng said: Winter Warmth is a disease occurring when its season does not match its Qi. In the deep cold of winter, gentlemen should conserve and store essence, but instead, it leaks outward. Treatment should exclusively use formulas that tonify the center while releasing the exterior.
Tao Hua said: From after Spring Equinox to before Summer Solstice, if there is no aversion to cold but thirst exists, it is Warm Disease. Use acrid-cool medicines to mildly release the muscle layer; do not induce heavy sweating. If acute symptoms appear, use cold-cooling medicines to urgently purge the interior. Do not mistakenly use sweating or purging methods; this must be recognized. Exterior syndromes are not treated like typical Cold Damage, but interior syndromes are treated similarly.
After Summer Solstice, if headache and fever occur without aversion to cold but with thirst, it is Warm Disease; if heat intensifies, it is called Heat Disease. Use only acrid-cool medicines to release the muscle layer; do not induce heavy sweating. If interior symptoms appear, urgently purge the interior. Exterior syndromes are not treated like typical Cold Damage, but interior syndromes are treated similarly.
From after Autumn Equinox to before Frost Descent, if headache and fever occur without aversion to cold, accompanied by body pain and short urine, it is Warm Disease. Use acrid-cool medicines combined with drying agents to release the muscle layer; do not induce sweating. If interior symptoms appear, purging is appropriate. Exterior syndromes are not identical to typical Cold Damage.