○神愦加郁金、远志、柏子仁；潮热虚烦，加鳖甲、青蒿、料豆。○正旺则邪自余。此方滋阴清补最稳。○温热病
后，先宜滋阴，以津液受灼也。若早补阳，恐余热复炽，所谓炉烟虽熄，灰中有火也。若真元大亏，则不拘常法。
荷蜜饮 退热如神。荷叶露一杯，蜜汁三匙，绿豆一两。绿豆煎汤，入露蜜内，温服。
经义
帝曰∶余闻五疫之至，皆相染易，无问大小，病状相似，不施救疗，如何可得不相移易者？岐伯曰∶
不相染者，正气存内，邪不可干，避其毒瓦斯，天牝从来，复得其往，气出于脑，即不干邪。气出于脑，即室先
想心如日；将入疫室，先想青气，自肝而出，左行于东，化作林木；次想白气，自肺而出，右行于西，化作戈
甲；次想赤气，自心而出，南行于上，化作焰明；次想黑气，自肾而出，北行于下，化作水；次想黄气，自脾
而出，存于中央，化作土。五气护身之毕，以想头上如北斗之煌煌，然后可入疫室。（《灵枢》）
哲言
疫疠之邪，从口鼻而入，舍于伏脊之内，去表不远，附近于胃，乃表里之分界，即《内经》所谓“横连
膜原”者也。其热淫不正之气，若本气充者，邪不易入；适有内因，便乘外因。感之浅者，俟有触而发；感之
深者，中而即发。其始阳格于内，营卫营运之机阻抑于表，遂觉凛凛恶寒，甚则四肢厥逆，渐至阳气郁极而通，
厥回而中外皆热，昏昧不爽，壮热自汗。此时邪伏膜原，纵使有汗，热不得解，必俟邪溃自内达表，表里相通，
振栗大汗，邪方外出。此名战汗，脉静身凉而愈也。若伏邪未尽，必复发热，其热有轻有重，因所感之浅深，
元气之盛衰也。至于发出，方显变证，或从外解，或从内陷，外解则顺，内陷则逆，更有先后、表
里不同。有先表后里者；有先里后表者；有但表不里者；有但里不表者；有表而里再表者；有里而表再里者；
有表里分传者；有表多于里者；有里多于表者；此为九传。从外解者，有发斑、战汗、自汗、盗汗、狂汗等证；
从内陷者，有痞闷、胀满、腹痛、便闭、热结旁流、协热下利、呕吐、谵语、舌黄黑苔芒刺等证。因证而知变，
因变而知治，此言其略也。或曰∶子言伤寒与瘟疫有霄壤之隔，今用三承气及抵当诸汤，皆伤寒方也。既用
其方，必同其证，子何言之异也？曰∶夫伤寒必有感冒之因，或单衣露风，或强力入水，或当筵出浴，随觉肌
肤粟起，继而四肢拘急，恶风恶寒，头痛身疼，发热。脉浮紧，无汗，为伤寒；浮缓，有汗，为伤风。至于
瘟疫初起，原无感冒之因，忽觉寒凛以后，但热而不恶寒。然亦有所触而发者，或饥饱劳碌，或焦思气郁，皆
能触动其邪。但不因所触，无故自发者居多。且伤寒之邪，自毛窍入；瘟疫之邪，自口鼻入。伤寒感而即发；
瘟疫多感久而后发。伤寒感邪在经，以经传经；瘟疫感邪在内，内溢于经，经不自传。伤寒感发甚暴；瘟疫
多淹缠二三日，或渐加重。伤寒初起，以发表为先；瘟疫初起，以疏利为主。伤寒投剂，得汗即解；瘟疫发散，
虽汗不解。伤寒投剂，可使立汗；瘟疫汗解，俟其内溃，汗出自然，不可以期。伤寒解以自汗；瘟疫解以战汗。
伤寒汗解在前；瘟疫汗解在后。伤寒发斑，则病笃；瘟疫发斑，则病衰；伤寒不传染；瘟疫传染。各自不同。
其所同者，其邪皆能传胃，至是同归于一，故皆用承气辈导邪而出，始异而终同也。但伤寒之邪，自肌表一迳
传里，如浮云之过太虚，原无根蒂，有进无退，故下后即能脱然；瘟疫之邪，始则匿于膜原，根深蒂固，发时
与营卫并交，客邪经由之处，营卫未有不被其伤者，因其伤故曰溃，然不溃则不传，不传则邪不出，邪不出
则疾不瘳，故瘟疫下后，多有不能顿解者。又瘟邪每有表里分传者，一半向外传，则邪留于肌肉；一半向内
传，则邪留于胃家。邪留于胃，故里气结滞；里气
结滞，表气因而不通，于是肌肉之邪不能即达于表。下后，里气一通，表气亦顺，向郁肌肉之邪方能尽发于表，
或斑、或汗，然后脱然。虽曰终同，及细较之，而终又有不同者矣。○邪之着人，如饮酒然，凡人醉则脉必
洪数，气高身热，面目俱赤，常也。及言其变，各有不同，有醉后妄言妄动者；有虽沉醉而神思不乱者；有
醉后应面赤而反白者；应委弱而反刚强者；应壮热而反寒栗者；有易醉易醒者；有难醉难醒者；有呵欠嚏喷者；
有头眩眼花者。态度百出，总因其气血虚实不同，脏腑禀赋各异，更兼过饮少饮。考其情状，各自不同，至论
其醉则一也。但解其酒，诸态如失。人受邪气，始则昼夜发热，日晡益甚，头疼身痛，舌上白苔，渐加烦渴，
常也。及言其变，各自不同，或纯发热；或发热而兼凛凛；或先恶寒而后发热，后渐寒少热多，以至纯热者；
或昼夜发热；或但潮热，余时热稍缓者；有从外解者；有从内传者；有呕吐哕者；有喘嗽者；有蛔厥者；有浮
肿者；有黄苔、黑苔者；有口燥、舌裂、芒刺紫赤者；有鼻如烟煤者；有发黄、发斑及蓄血、吐衄、大小便血、
汗血、嗽血、齿血者；有发颐疙瘩疮者；有首尾能食者；有绝谷者；有潜消者；有无故反复者；有愈后饮食胜
常者；有愈后退爪脱发者。至论恶证种种，因其气血虚实之殊，脏腑禀赋之异，更兼感重感轻。考其证候，各
自不同，至论受邪则一也。第逐其邪，诸证如失。○瘟邪为病，有从战汗、自汗、盗汗、狂汗而解者；有自汗淋
漓，热渴反甚，终得战汗方解者；有表以汗解，里有余邪，不因他故，越三五日前证复发者；有无汗竟传于胃
者；有胃气壅遏，必因下乃得战汗而解者；有发黄因下而愈者；有发黄因下而斑出者；有竟从发斑而愈者；有
里证急，虽有斑，非下不愈者；又或男子适逢淫欲，或向来下元空虚，邪热乘虚陷于下焦，气道不通，以致小
便闭塞，少腹胀满，每至夜发热者；或原有他病，一隅之亏，邪乘所损而传者。大抵邪行如水，洼处受之，传
变不常，因人而使。○伤寒阴阳二证，
方书皆对待言之，凡论阳证，即继阴证，读者以为阴阳二证，世间均有之病，所以临证之际，先将阴阳二证存
于胸次，甚有不辨脉证，但窥其人多蓄少艾。或房事后得病，便疑为阴证，殊不知瘟病之至，虽僧尼、寡妇、室
女、童男、旷夫、阉宦，皆不得免，与房欲何与焉？即使欲后感瘟，不过体虚，较壮者为难治耳，终是阳证，
与阴证何与焉？瘟疫传入胃家，阳气内郁，不能外布，即便四逆。《经》曰∶厥微热亦微，厥深热亦深。甚至
冷过肘膝，脉沉而微；剧则通身冰冷，脉微欲绝，总为阳厥。夫瘟疫热病也，阴自何来？世间岂有阴证之瘟疫
乎？○凡邪之所客有行伏，故治法有难易，取效有迟速。所谓行邪者，如正伤寒，始自太阳，或传阳明、少阳，
或自三阳入胃，如行人经由某地，本无定处。在经汗解，在胃下愈，药到便可获效。所谓伏邪者，瘟疫之邪伏
于膜原，如鸟栖巢，如兽藏穴，营卫所不关，药石所不及，至其发也，邪势渐张，内侵于腑，外淫于经，诸证
渐显，然后可得而治之。方其浸淫之际，邪毒尚在膜原，此时但可疏利，使伏邪易出。邪毒既离膜原，乃观其
变，或出表，或入里；然后可导邪使去。初发之时，毒势方张，莫之能御，不惟不能即瘳，病证且反加重，病
家更医，医家不解，亦自惊疑。不知先时感受邪甚则病甚，邪微则病微，病之轻重，非关于医。所以瘟邪方
张，势不可遏，但使邪毒速离膜原为贵。治法全在后段工夫，识得表、里、虚、实、轻、重、缓、急，投剂不
瘥，可以万全，即使感之重者，按法治之，亦无殒命之理。若夫久病枯极，酒色耗竭，耆耄风烛，更加瘟疫，
自是难支，又不可同日而语。○诸窍乃人身之户牖，邪自窍入，必由窍出。《经》曰∶未入于腑者，可汗而已；
已入于腑者，可下而已。麻征君汗、吐、下三法，总是导引其邪从门户出，可为大纲。瘟疫首尾一属于热，独
不言清热者，盖热因邪而发，但治其邪，而热自已。夫邪之与热，若形影相根据，形亡而影未有独存者。若纯用
寒凉，专务清热，既无导
引之能，焉能使邪从窍而出？是忘其本，徒治其标，何异捕影！○瘟邪始结膜原，气并为热，胃本无病，及邪
传胃，烦渴口燥，舌干苔刺，气喷如火，心腹痞满，午后潮热，此应下之证也。殊不知热不自成，皆由邪在胃
家，阻碍正气，郁而不通，留积而成。必投承气逐去其邪，气行火泄，而热自已。若概用寒凉，何异扬汤止沸？
今医好用黄连解毒、泻心等汤，热谓淫所胜，治以寒凉，反指大黄能泄损元气，黄连清热，更无下泄之患。凡
遇热证，大剂与之，其病转剧，犹言服黄连热不能清，数也。不知黄连苦而性滞，寒而气燥，与大黄虽均为寒
药，但大黄走而不守，黄连守而不走，一燥一润，一通一塞，相去甚远。瘟疫首尾以通行为治，若用黄连，反
招闭塞之害，邪毒何由泄？病根何由拔耶？○瘟疫可下者，约三十余证，不必悉具，但见舌黄、心腹痞满，
便于达原饮中加大黄下之。余邪入胃，仍用小承气汤彻其余毒。大凡客邪贵乎早治，乘人气血未乱，津液未耗，
投剂不至掣肘，早拔病根为要。但要量人之虚实，度邪之轻重，察病之缓急，揣邪气离膜原之多寡，然后投药，
无太过不及之弊，勿拘拘于下不厌迟之说。应下之证，见下无结粪，或以为下早，或以为不应下之误，殊不知
承气本为逐邪而设，非专为结粪而设也。必俟其粪结，血液为热所搏，变证叠起，是犹养虎贻患，医之咎也。
况多有溏粪失下，但蒸作极臭如败酱，如藕泥，临死不结者，岂徒孜孜粪结而后行哉？试观老人血液衰少，多
生燥结；病后血气未复，亦多燥结。所谓不更衣十日，无所苦者，有何妨害？以是知燥结不致损人，邪毒之为
殒命也。○疫证心下胀满，乃邪毒传于胸胃，以致升降之气不利，因而胀满，实为客邪累及本气。但得客邪一
除，本气自然升降，胀满立消，所谓一窍通而诸窍皆通，向所郁于胸胃之邪，由此而下，譬若河道阻塞，前舟
既行，余舟连尾而下矣。若纯用破气之品，津液愈耗，热结愈固，滞气无门而出，瘟毒无路而泄，乃望其宽胸
利膈，惑矣。○凡人大劳、大欲，及大
病、久病，气血两虚，阴阳并竭，名为四损。此际又加疫邪，并为难治。以正气先亏，邪气日陷，猝难得解。
谚云∶伤寒偏死下虚人。正谓此也。凡遇此证，不可以常法正治，当从其损而调之。○病有纯虚纯实，非补即
泻。设遇既虚且实者，补泻间用，当详孰先孰后，从少从多，可缓可急，随证调之。○病有先虚后实者，宜先
补后泻；先实后虚者，宜先泻后补。所谓先虚后实者，或因他病先亏，或因年高体弱，或因先有劳倦，或因新
产下血过多，或旧有吐血、崩漏等证。瘟疫将发，触动旧疾，并宜先补后泻，初投补剂一二帖，觉虚证稍退，
便宜治邪。若补多助邪，祸害随至。所谓先实后虚者，瘟邪应下失下，血液为热搏尽。原邪尚在，宜急攻邪，
邪退六七，宜急补正，虚回五六，慎勿再补，多补则邪复起矣。攻后虚证见者，方可用补，若意度其虚，误用
补剂，贻害不浅。○有邪不除，淹缠日久，必至 羸。庸医望之，辄用补剂，殊不知邪去而正气得通，何患虚之
不复？今投补剂，邪气日锢，正气日郁，转郁转热，转热转瘦，转瘦转补，乃至骨立而毙，犹言补之不及数也。
终身不悟，杀人多矣。○瘟疫，热病也。邪气内郁，阳气不得宣布，积阳为火，阴血每为热搏。解后余焰尚在，
阴血未复，大忌参、 、白术，得之反助其壅；余邪留伏，不惟目下淹缠，日后必变生他证，皆骤补之为害也。
若解后阴枯血燥者，宜清燥养营汤。大抵瘟疫愈后，调理之剂投之不当，不如节饮食静养为上。○向谓伤寒无补
法者，以伤寒、瘟疫均是客邪。彼伤于寒者，乃感天地之正气，尚嫌其填实而不可补；今瘟疫乃感天地之毒瓦斯，
补之壅裹其毒，则邪火愈炽，故误补尤甚。此言其常也。及言其变，则又有应补者，或日久失下，真阴受伤；
或久病先亏；或先受大劳；或老人枯竭。此类皆当补泻兼施。设独泻而增虚证者，急宜峻补；补后虚证不退，
及加变证者危。○孕妇瘟疫，设遇下证，即随证施治，毋惑于安胎之说，反用补剂，致令邪火壅郁，热毒愈炽，
胎愈不安。惟用承气逐去
其邪，火毒消弭，炎 顿转清凉，人安而胎自固，孰谓大黄非安胎之药乎？但宜早而不宜迟，若待腹痛如锥，
腰痛如折，胎欲堕矣，药亦无及。或问孕妇而投承气，设邪未逐，先损其胎，奈何？予曰∶结粪、瘀热，肠胃
间事也；胎附于脊，肠胃之外，子宫内事也。药先入胃，瘀热既通，胎无热逼，而得所养，兴利除害于返掌之
间，何患之有？但毒药治病，衰其大半而止，慎勿过剂。（吴又可）
○若出现神志昏乱，加用郁金、远志、柏子仁；若出现潮热和虚烦，加用鳖甲、青蒿、料豆。○当正气旺盛时，邪气自然消退。此方滋阴清补最为稳妥。○温热病之后，首先应当滋阴，因为津液受到灼伤。如果过早补阳，恐怕余热重新炽盛，这就是所说的“炉烟虽然熄灭，灰烬中还有火”。如果真元大亏，则不拘泥于常规法则。荷蜜饮退热效果神奇。荷叶露一杯，蜂蜜汁三匙，绿豆一两。将绿豆煎汤，加入露水和蜂蜜内，温服。
经义
黄帝说：我听说五种疫病发作时，都会相互传染，不论年龄大小，病症相似，如果不进行救治治疗，怎样才能做到不互相传染呢？岐伯说：不互相传染的原因，是因为正气存在于体内，邪气无法侵犯，避开毒气，从鼻窍进入，又随气从脑出，就不受邪气干扰。气出于脑，就要先想象心如太阳般光明；将要进入疫室，先想象青色之气，从肝而出，向左运行到东方，化作林木；接着想象白色之气，从肺而出，向右运行到西方，化作戈甲；接着想象红色之气，从心而出，向南运行到上方，化作火焰光明；接着想象黑色之气，从肾而出，向北运行到下方，化作水；接着想象黄色之气，从脾而出，存留于中央，化作土。五气护身完毕，再想象头上有北斗星那样辉煌的光芒，然后才可以进入疫室。（出自《灵枢》）
哲言
疫疠之邪，从口鼻进入，停留于伏脊之内，距离体表不远，靠近胃，这是表里的分界，也就是《内经》所说的“横连膜原”。那种热淫不正之气，如果人体本气充盛，邪气不易侵入；恰好有内因，便乘外因而入。感受较浅的，等到有触动才发作；感受较深的，中邪后立即发作。起初阳气格拒于内，营卫运行的机制在体表被阻抑，于是觉得凛凛恶寒，甚至四肢厥逆，逐渐发展到阳气郁极而通，厥逆回返而内外皆热，神志昏昧不清，壮热自汗。此时邪气潜伏在膜原，即使有汗，热也不能解除，必须等待邪气溃散从内达表，表里相通，振栗大汗，邪气方才外出。这名叫战汗，脉象平静身体凉爽而痊愈。如果伏邪未尽，必然再次发热，其热有轻有重，取决于所感邪气的深浅和元气的盛衰。至于邪气发出后，才显现变证，有的从外解，有的从内陷，从外解为顺，从内陷为逆，更有先后、表里不同。有先表后里的；有先里后表的；有只表不里的；有只里不表的；有表而里再表的；有里而表再里的；有表里分传的；有表多于里的；有里多于表的；这叫九传。从外解的，有发斑、战汗、自汗、盗汗、狂汗等证候；从内陷的，有痞闷、胀满、腹痛、便秘、热结旁流、协热下利、呕吐、谵语、舌黄黑苔芒刺等证候。根据证候知道变化，根据变化知道治法，这里只是简略说明。有人说：您说伤寒与瘟疫有天壤之别，现在使用三承气及抵当诸汤，都是伤寒方剂。既然用其方，必定同其证，您为什么说法不同呢？我说：伤寒一定有感冒的原因，或单衣露风，或强力入水，或当筵出浴，随即感觉肌肤粟起，继而四肢拘急，恶风恶寒，头痛身疼，发热。脉浮紧，无汗，为伤寒；脉浮缓，有汗，为伤风。至于瘟疫初起，原本没有感冒的原因，忽然觉得寒凛以后，只有热而不恶寒。但也有一些是有所触动才发作的，或饥饱劳碌，或焦思气郁，都能触动其邪。但不因所触，无故自发者居多。而且伤寒之邪，从毛窍进入；瘟疫之邪，从口鼻进入。伤寒感邪即发；瘟疫多感邪久而后发。伤寒感邪在经，以经传经；瘟疫感邪在内，内溢于经，经不自传。伤寒感发很暴烈；瘟疫多缠绵二三日，或逐渐加重。伤寒初起，以发表为先；瘟疫初起，以疏利为主。伤寒投药，得汗即解；瘟疫发散，虽汗不解。伤寒投药，可使立即出汗；瘟疫汗解，等待其内溃，汗出自然，不可以预期。伤寒通过自汗解；瘟疫通过战汗解。伤寒汗解在前；瘟疫汗解在后。伤寒发斑，则病情危笃；瘟疫发斑，则病情衰退；伤寒不传染；瘟疫传染。各自不同。它们相同的是，邪气都能传入胃，至此同归于一，所以都用承气类方剂导邪而出，开始不同而最终相同。但伤寒之邪，从肌表一直传入里，像浮云经过太虚，原本没有根蒂，有进无退，所以下后即能脱然痊愈；瘟疫之邪，开始时隐匿于膜原，根深蒂固，发作时与营卫并交，客邪经过的地方，营卫没有不被其伤害的，因其受伤故曰溃，然而不溃则不传，不传则邪不出，邪不出则疾病不愈，所以瘟疫下后，多有不能立刻痊愈的。另外瘟邪常有表里分传的，一半向外传，则邪留于肌肉；一半向内传，则邪留于胃家。邪留于胃，故里气结滞；里气结滞，表气因此不通，于是肌肉之邪不能立即达于表。下后，里气一通，表气亦顺，先前郁积在肌肉的邪气才能全部发于表，或斑、或汗，然后脱然痊愈。虽然说最终相同，但仔细比较，最终又有不同之处了。○邪气附着于人，就像饮酒一样，凡人醉后脉必洪数，气高身热，面目俱赤，这是常理。及至谈论其变化，各有不同，有醉后妄言妄动的；有虽沉醉而神思不乱的；有醉后应面赤而反白的；应委弱而反刚强的；应壮热而反寒栗的；有易醉易醒的；有难醉难醒的；有呵欠嚏喷的；有头眩眼花的。态度百出，总因其气血虚实不同，脏腑禀赋各异，更兼过饮少饮。考察其情状，各自不同，至于论其醉则一也。只要解其酒，诸态如失。人受邪气，开始昼夜发热，日晡益甚，头疼身痛，舌上白苔，渐加烦渴，这是常理。及至谈论其变化，各自不同，或纯发热；或发热而兼凛凛；或先恶寒而后发热，后渐寒少热多，以至纯热的；或昼夜发热；或但潮热，余时热稍缓的；有从外解的；有从内传的；有呕吐哕的；有喘嗽的；有蛔厥的；有浮肿的；有黄苔、黑苔的；有口燥、舌裂、芒刺紫赤的；有鼻如烟煤的；有发黄、发斑及蓄血、吐衄、大小便血、汗血、嗽血、齿血的；有发颐疙瘩疮的；有首尾能食的；有绝谷的；有潜消的；有无故反复的；有愈后饮食胜常的；有愈后退爪脱发的。至于论恶证种种，因其气血虚实之殊，脏腑禀赋之异，更兼感重感轻。考察其证候，各自不同，至于论受邪则一也。只要逐其邪，诸证如失。○瘟邪为病，有从战汗、自汗、盗汗、狂汗而解的；有自汗淋漓，热渴反甚，终得战汗方解的；有表以汗解，里有余邪，不因他故，越三五日前证复发的；有无汗竟传于胃的；有胃气壅遏，必因下乃得战汗而解的；有发黄因下而愈的；有发黄因下而斑出的；有竟从发斑而愈的；有里证急，虽有斑，非下不愈的；又或男子适逢淫欲，或向来下元空虚，邪热乘虚陷于下焦，气道不通，以致小便闭塞，少腹胀满，每至夜发热的；或原有他病，一隅之亏，邪乘所损而传的。大抵邪行如水，洼处受之，传变不常，因人而使。○伤寒阴阳二证，方书皆对待言之，凡论阳证，即继阴证，读者以为阴阳二证，世间均有之病，所以临证之际，先将阴阳二证存于胸次，甚有不辨脉证，但窥其人多蓄少艾。或房事后得病，便疑为阴证，殊不知瘟病之至，虽僧尼、寡妇、室女、童男、旷夫、阉宦，皆不得免，与房欲何与焉？即使欲后感瘟，不过体虚，较壮者为难治耳，终是阳证，与阴证何与焉？瘟疫传入胃家，阳气内郁，不能外布，即便四逆。《经》曰∶厥微热亦微，厥深热亦深。甚至冷过肘膝，脉沉而微；剧则通身冰冷，脉微欲绝，总为阳厥。夫瘟疫热病也，阴自何来？世间岂有阴证之瘟疫乎？○凡邪之所客有行伏，故治法有难易，取效有迟速。所谓行邪者，如正伤寒，始自太阳，或传阳明、少阳，或自三阳入胃，如行人经由某地，本无定处。在经汗解，在胃下愈，药到便可获效。所谓伏邪者，瘟疫之邪伏于膜原，如鸟栖巢，如兽藏穴，营卫所不关，药石所不及，至其发也，邪势渐张，内侵于腑，外淫于经，诸证渐显，然后可得而治之。方其浸淫之际，邪毒尚在膜原，此时但可疏利，使伏邪易出。邪毒既离膜原，乃观其变，或出表，或入里；然后可导邪使去。初发之时，毒势方张，莫之能御，不惟不能即瘳，病证且反加重，病家更医，医家不解，亦自惊疑。不知先时感受邪甚则病甚，邪微则病微，病之轻重，非关于医。所以瘟邪方张，势不可遏，但使邪毒速离膜原为贵。治法全在后段工夫，识得表、里、虚、实、轻、重、缓、急，投剂不瘥，可以万全，即使感之重者，按法治之，亦无殒命之理。若夫久病枯极，酒色耗竭，耆耄风烛，更加瘟疫，自是难支，又不可同日而语。○诸窍乃人身之户牖，邪自窍入，必由窍出。《经》曰∶未入于腑者，可汗而已；已入于腑者，可下而已。麻征君汗、吐、下三法，总是导引其邪从门户出，可为大纲。瘟疫首尾一属于热，独不言清热者，盖热因邪而发，但治其邪，而热自已。夫邪之与热，若形影相根据，形亡而影未有独存者。若纯用寒凉，专务清热，既无导引之能，焉能使邪从窍而出？是忘其本，徒治其标，何异捕影！○瘟邪始结膜原，气并为热，胃本无病，及邪传胃，烦渴口燥，舌干苔刺，气喷如火，心腹痞满，午后潮热，此应下之证也。殊不知热不自成，皆由邪在胃家，阻碍正气，郁而不通，留积而成。必投承气逐去其邪，气行火泄，而热自已。若概用寒凉，何异扬汤止沸？今医好用黄连解毒、泻心等汤，热谓淫所胜，治以寒凉，反指大黄能泄损元气，黄连清热，更无下泄之患。凡遇热证，大剂与之，其病转剧，犹言服黄连热不能清，数也。不知黄连苦而性滞，寒而气燥，与大黄虽均为寒药，但大黄走而不守，黄连守而不走，一燥一润，一通一塞，相去甚远。瘟疫首尾以通行为治，若用黄连，反招闭塞之害，邪毒何由泄？病根何由拔耶？○瘟疫可下者，约三十余证，不必悉具，但见舌黄、心腹痞满，便于达原饮中加大黄下之。余邪入胃，仍用小承气汤彻其余毒。大凡客邪贵乎早治，乘人气血未乱，津液未耗，投剂不至掣肘，早拔病根为要。但要量人之虚实，度邪之轻重，察病之缓急，揣邪气离膜原之多寡，然后投药，无太过不及之弊，勿拘拘于下不厌迟之说。应下之证，见下无结粪，或以为下早，或以为不应下之误，殊不知承气本为逐邪而设，非专为结粪而设也。必俟其粪结，血液为热所搏，变证叠起，是犹养虎贻患，医之咎也。况多有溏粪失下，但蒸作极臭如败酱，如藕泥，临死不结者，岂徒孜孜粪结而后行哉？试观老人血液衰少，多生燥结；病后血气未复，亦多燥结。所谓不更衣十日，无所苦者，有何妨害？以是知燥结不致损人，邪毒之为殒命也。○疫证心下胀满，乃邪毒传于胸胃，以致升降之气不利，因而胀满，实为客邪累及本气。但得客邪一除，本气自然升降，胀满立消，所谓一窍通而诸窍皆通，向所郁于胸胃之邪，由此而下，譬若河道阻塞，前舟既行，余舟连尾而下矣。若纯用破气之品，津液愈耗，热结愈固，滞气无门而出，瘟毒无路而泄，乃望其宽胸利膈，惑矣。○凡人大劳、大欲，及大病、久病，气血两虚，阴阳并竭，名为四损。此际又加疫邪，并为难治。以正气先亏，邪气日陷，猝难得解。谚云∶伤寒偏死下虚人。正谓此也。凡遇此证，不可以常法正治，当从其损而调之。○病有纯虚纯实，非补即泻。设遇既虚且实者，补泻间用，当详孰先孰后，从少从多，可缓可急，随证调之。○病有先虚后实者，宜先补后泻；先实后虚者，宜先泻后补。所谓先虚后实者，或因他病先亏，或因年高体弱，或因先有劳倦，或因新产下血过多，或旧有吐血、崩漏等证。瘟疫将发，触动旧疾，并宜先补后泻，初投补剂一二帖，觉虚证稍退，便宜治邪。若补多助邪，祸害随至。所谓先实后虚者，瘟邪应下失下，血液为热搏尽。原邪尚在，宜急攻邪，邪退六七，宜急补正，虚回五六，慎勿再补，多补则邪复起矣。攻后虚证见者，方可用补，若意度其虚，误用补剂，贻害不浅。○有邪不除，淹缠日久，必至 羸。庸医望之，辄用补剂，殊不知邪去而正气得通，何患虚之不复？今投补剂，邪气日锢，正气日郁，转郁转热，转热转瘦，转瘦转补，乃至骨立而毙，犹言补之不及数也。终身不悟，杀人多矣。○瘟疫，热病也。邪气内郁，阳气不得宣布，积阳为火，阴血每为热搏。解后余焰尚在，阴血未复，大忌参、 、白术，得之反助其壅；余邪留伏，不惟目下淹缠，日后必变生他证，皆骤补之为害也。若解后阴枯血燥者，宜清燥养营汤。大抵瘟疫愈后，调理之剂投之不当，不如节饮食静养为上。○向谓伤寒无补法者，以伤寒、瘟疫均是客邪。彼伤于寒者，乃感天地之正气，尚嫌其填实而不可补；今瘟疫乃感天地之毒瓦斯，补之壅裹其毒，则邪火愈炽，故误补尤甚。此言其常也。及言其变，则又有应补者，或日久失下，真阴受伤；或久病先亏；或先受大劳；或老人枯竭。此类皆当补泻兼施。设独泻而增虚证者，急宜峻补；补后虚证不退，及加变证者危。○孕妇瘟疫，设遇下证，即随证施治，毋惑于安胎之说，反用补剂，致令邪火壅郁，热毒愈炽，胎愈不安。惟用承气逐去其邪，火毒消弭，炎 顿转清凉，人安而胎自固，孰谓大黄非安胎之药乎？但宜早而不宜迟，若待腹痛如锥，腰痛如折，胎欲堕矣，药亦无及。或问孕妇而投承气，设邪未逐，先损其胎，奈何？予曰∶结粪、瘀热，肠胃间事也；胎附于脊，肠胃之外，子宫内事也。药先入胃，瘀热既通，胎无热逼，而得所养，兴利除害于返掌之间，何患之有？但毒药治病，衰其大半而止，慎勿过剂。（吴又可）
○ If mental confusion (Shen Kui) occurs, add Curcuma Aromatica Rhizome (Yujin), Polygala Tenuifolia Root (Yuanzhi), and Biota Seed (Baiziren); if tidal fever (Chao Re) and deficiency vexation (Xu Fan) occur, add Softshell Turtle Shell (Biejia), Artemisia Annua Herb (Qinghao), and Vigna Angularis Seed (Liaodou). ○ When righteous Qi (Zheng Qi) is vigorous, evil naturally subsides. This formula for nourishing Yin and clearing deficiency with tonification is the most stable. ○ After a warm-heat disease (Wen Re Bing), one should first nourish Yin, because body fluids (Jin Ye) have been scorched. If Yang is tonified too early, it is feared that residual heat will flare up again, as described: "Although the smoke from the stove has extinguished, there is still fire in the ashes." If the True Yuan (Zhen Yuan) is severely depleted, one does not adhere to conventional methods. He Mi Yin (Lotus Leaf and Honey Drink) is miraculous for reducing fever. One cup of Lotus Leaf Dew (Heye Lu), three spoons of honey juice, and one liang of Mung Bean (Lv Dou). Decoct the mung beans in water, add the dew and honey, and take warm.
Scriptural Meaning
The Yellow Emperor said: I have heard that when the five plagues (Wu Yi) arrive, they all infect each other, regardless of age, and the symptoms are similar. If no treatment is provided, how can one avoid mutual infection? Qibo said: Those who do not infect each other do so because their righteous Qi (Zheng Qi) is preserved within, making it impossible for evil to invade. By avoiding the toxic vapors, which enter through the nasal aperture (Tian Ping) and exit via the brain, the Qi emerges from the brain and thus is not disturbed by evil. When Qi emerges from the brain, one must first imagine the heart shining like the sun; before entering a plague room, one should first visualize green Qi emerging from the Liver, moving left to the East, transforming into forests and trees; then visualize white Qi emerging from the Lungs, moving right to the West, transforming into weapons and armor; then visualize red Qi emerging from the Heart, moving south to the upper part, transforming into bright flames; then visualize black Qi emerging from the Kidneys, moving north to the lower part, transforming into water; then visualize yellow Qi emerging from the Spleen, remaining in the Center, transforming into earth. After completing the protection of the Five Qi, one should imagine the brilliance of the Big Dipper above the head, and only then may one enter the plague room. (From *Ling Shu*)
Philosophical Remarks
The pathogenic factor of epidemic pestilence (Yi Li) enters through the mouth and nose, settles inside the hidden spine, is not far from the exterior, and is close to the Stomach, marking the boundary between exterior and interior, which is what the *Nei Jing* refers to as "horizontally connecting to the Membrane Source" (Mo Yuan). The abnormal qi of excessive heat, if the person's original Qi is robust, is difficult for pathogens to enter; however, if there is an internal cause, it takes advantage of the external cause. Those infected superficially wait for a trigger to manifest; those infected deeply manifest immediately upon infection. Initially, Yang is blocked internally, and the mechanism of Ying and Wei circulation is inhibited at the exterior, leading to a feeling of severe chills, even cold limbs (Si Zhi Jue Ni). Gradually, Yang becomes extremely stagnant and then unblocks, the cold reverses, and both interior and exterior become hot, with mental cloudiness and spontaneous sweating due to high fever. At this time, the pathogen is latent in the Mo Yuan. Even if there is sweating, the heat cannot resolve. One must wait for the pathogen to溃 (break out) from the interior to the exterior, allowing the interior and exterior to communicate, resulting in shaking chills and profuse sweating, after which the pathogen exits externally. This is called "Zhan Han" (Battle Sweating), and recovery occurs when the pulse calms and the body cools. If latent pathogens remain, fever will recur, varying in severity depending on the depth of infection and the strength of Yuan Qi. Only when the pathogen emerges do complications appear: some resolve from the exterior, others sink inward. Resolution from the exterior is favorable; sinking inward is adverse. There are various patterns of transmission: exterior then interior; interior then exterior; only exterior without interior; only interior without exterior; exterior then interior then exterior again; interior then exterior then interior again; simultaneous exterior and interior transmission; more exterior than interior; more interior than exterior. These are called the "Nine Transmissions." Resolution from the exterior presents as macules (Fa Ban), battle sweating, spontaneous sweating, night sweats, or manic sweating. Sinking inward presents as chest oppression, bloating, abdominal pain, constipation, heat-binding with diarrhea (Re Jie Pang Liu), heat-collateral diarrhea, vomiting, delirium, yellow or black tongue coating with prickles, etc. By observing symptoms, one understands changes; by understanding changes, one determines treatment. This is a brief overview. Someone might ask: You say Shang Han (Cold Damage) and Wen Yi (Plague) are worlds apart, yet you use San Cheng Qi Tang and Di Dang Tang, which are formulas for Shang Han. Since you use these formulas, mustn't the syndromes be the same? Why do you say they differ? I reply: Shang Han always has a cause of exposure, such as wearing thin clothes in the wind, forcing oneself into cold water, or bathing after drinking. Immediately, one feels goosebumps, followed by limb stiffness, aversion to wind and cold, headache, body ache, and fever. A floating-tight pulse without sweat indicates Shang Han; a floating-slow pulse with sweat indicates Shang Feng (Wind Strike). In contrast, Wen Yi initially has no exposure cause. After an initial chill, there is only heat without aversion to cold. However, some are triggered by factors like hunger/fullness, overwork, or emotional stagnation. But most arise spontaneously without a specific trigger. Furthermore, Shang Han pathogens enter through hair follicles, while Wen Yi pathogens enter through the mouth and nose. Shang Han manifests immediately upon infection; Wen Yi often manifests after a delay. Shang Han pathogens affect the meridians and transmit from meridian to meridian; Wen Yi pathogens affect the interior and overflow into the meridians, but do not transmit directly between meridians. Shang Han onset is sudden; Wen Yi is lingering for two to three days or worsens gradually. Initial treatment for Shang Han prioritizes releasing the exterior; initial treatment for Wen Yi prioritizes venting and draining. For Shang Han, sweating leads to resolution; for Wen Yi, sweating alone does not resolve the condition. Shang Han can induce immediate sweating; Wen Yi sweating occurs naturally after internal breakdown, which cannot be forced. Shang Han resolves via spontaneous sweating; Wen Yi resolves via battle sweating. Shang Han sweating occurs early; Wen Yi sweating occurs late. Macules in Shang Han indicate critical illness; macules in Wen Yi indicate declining illness. Shang Han is not contagious; Wen Yi is contagious. They differ in these aspects. What they share is that pathogens can transmit to the Stomach, at which point they converge, so Cheng Qi class formulas are used to guide the pathogen out. Thus, they start differently but end similarly. However, Shang Han pathogens travel directly from the exterior to the interior, like clouds passing through the sky, rootless and advancing only, so purgation leads to immediate recovery. Wen Yi pathogens hide in the Mo Yuan, taking deep root. Upon manifestation, they interact with Ying and Wei. Wherever the pathogen passes, Ying and Wei are injured; this injury is called "kui" (breakdown). Without breakdown, there is no transmission; without transmission, the pathogen does not exit; without exiting, the disease does not heal. Therefore, after purgation in Wen Yi, immediate resolution is rare. Additionally, Wen Yi often involves simultaneous exterior and interior transmission: half transmits outward, leaving pathogens in the muscles; half transmits inward, leaving pathogens in the Stomach family. Pathogens in the Stomach cause interior Qi stagnation; interior stagnation blocks exterior Qi, preventing muscle pathogens from reaching the exterior. After purgation, interior Qi flows, exterior Qi follows, and previously stagnant muscle pathogens fully emerge to the exterior, either as macules or sweat, leading to recovery. Although ultimately similar, careful comparison reveals differences. ○ Pathogen attachment to the body is like intoxication. Normally, a drunk person has a surging-rapid pulse, elevated Qi, hot body, and red face. However, variations exist: some talk and move wildly; some remain mentally clear despite heavy intoxication; some should have red faces but appear pale; some should be weak but appear strong; some should have high fever but experience chills; some get drunk easily and wake easily; some get drunk hard and wake hard; some yawn and sneeze; some feel dizzy and see spots. Behaviors vary greatly due to differences in Qi and Blood deficiency/excess and organ constitution, as well as amount of alcohol consumed. Examining these states shows individual differences, yet the state of intoxication is the same. Once the alcohol is resolved, all states disappear. Similarly, when a person receives pathogenic Qi, they initially have day-and-night fever worsening at dusk, headache, body ache, white tongue coating, and increasing thirst/vexation—this is normal. Variations include: pure fever; fever with chills; initial chills then fever, progressing to less chills and more heat, eventually pure heat; day-and-night fever; only tidal fever with slight relief otherwise; resolution from exterior; transmission from interior; vomiting/hiccups; wheezing/cough; ascariasis convulsion; edema; yellow/black tongue coating; dry mouth, cracked tongue, prickles, purple-red color; nose like burnt coal; jaundice, macules, blood stasis, hematemesis, epistaxis, hematochezia, hematuria, bloody sweat, bloody cough, gingival bleeding; parotitis/sores; ability to eat throughout the illness; inability to eat; gradual dissipation; spontaneous recurrence; increased appetite after recovery; nail retraction and hair loss after recovery. Various severe symptoms arise due to Qi/Blood differences and organ constitutions, plus severity of infection. Examining symptoms shows differences, yet receiving the pathogen is the same. Once the pathogen is expelled, all symptoms vanish. ○ Wen Yi diseases resolve via battle sweating, spontaneous sweating, night sweats, or manic sweating; some have profuse sweating with intensified thirst/heat, resolving only after battle sweating; some resolve exteriorly via sweating but have residual interior pathogens, causing recurrence after 3-5 days without other causes; some have no sweating and transmit directly to the Stomach; some have Stomach Qi obstruction requiring purgation to achieve battle sweating for resolution; some resolve jaundice via purgation; some develop macules after purgation for jaundice; some resolve entirely via macules; some have urgent interior symptoms where purgation is required despite macules; men may encounter sexual excess or congenital lower Yuan deficiency, allowing heat pathogens to sink into the Lower Jiao, blocking Qi flow, causing urinary retention, lower abdominal fullness, and nightly fever; or pre-existing conditions in one area allow pathogens to transmit via the deficit. Generally, pathogens move like water, filling depressions, transmitting unpredictably based on the individual. ○ Regarding Yin and Yang syndromes in Shang Han, medical texts discuss them comparatively. Readers assume both exist in the world, so clinicians keep both in mind, sometimes failing to differentiate pulse/symptoms, merely noting if the patient has many concubines. If illness follows intercourse, they suspect Yin syndrome. Unknowingly, Wen Yi affects everyone—monks, nuns, widows, virgins, bachelors, eunuchs alike—and has nothing to do with sexual desire. Even if contracted after sex, it is merely deficiency, harder to treat than in robust individuals, but ultimately a Yang syndrome, unrelated to Yin syndrome. When Wen Yi transmits to the Stomach, Yang Qi is internally blocked and cannot distribute outward, causing cold limbs (*Jue*). The *Classic* says: "Mild Jue means mild heat; deep Jue means deep heat." It can even reach past elbows and knees, with deep-micro pulse; severely, the whole body is cold with a faint pulse nearing extinction. All are Yang Jue. Wen Yi is a heat disease; where does Yin come from? Can there be Yin syndrome Wen Yi? ○ Pathogens reside either actively or latently, hence treatment difficulty and speed of effect vary. "Active pathogens," like standard Shang Han, start in Tai Yang, may transmit to Yang Ming/Shao Yang, or from Three Yangs to Stomach, like a traveler passing through places without fixed residence. Resolving via sweating in meridians, or purgation in Stomach, yields quick effects. "Latent pathogens," like Wen Yi, hide in the Mo Yuan, like birds in nests or beasts in holes, untouched by Ying/Wei and medicines. Upon manifestation, pathogenic force expands, invading viscera internally and overflowing into meridians externally, showing symptoms gradually, allowing treatment. During infiltration, pathogens remain in Mo Yuan; only venting/drainage can facilitate their exit. Once pathogens leave Mo Yuan, observe changes: exiting exterior or entering interior, then guide them out. At initial onset, pathogenic force is strong and uncontrollable; not only can it not be cured immediately, symptoms may worsen. Families change doctors; doctors, lacking understanding, are also alarmed. They do not know that severe initial infection leads to severe illness, mild infection to mild illness; severity depends on the pathogen, not the doctor. Thus, when Wen Yi force is unrestrained, the priority is rapid expulsion from Mo Yuan. Treatment skill lies in subsequent steps: understanding exterior/interior, deficiency/excess, light/heavy, slow/fast. Correct prescription ensures safety; even severe cases treated correctly rarely die. However, chronic exhaustion, alcohol/lust depletion, elderly frailty, combined with Wen Yi, are indeed difficult to support and cannot be compared to usual cases. ○ Orifices are doors/windows of the body; pathogens enter via orifices and must exit via orifices. The *Classic* says: "Not yet entered viscera, resolve via sweating; entered viscera, resolve via purgation." Ma Zheng Jun's sweating, emetic, and purgative methods all guide pathogens out through portals, serving as a general principle. Wen Yi is consistently heat from start to finish; why not mention clearing heat? Heat arises from pathogens; treating pathogens clears heat. Pathogens and heat are like form and shadow; if form dies, shadow cannot exist alone. Purely using cold/cool herbs to clear heat lacks guiding power, unable to expel pathogens via orifices. This ignores the root, treating only the branch, akin to catching shadows! ○ Wen Yi initially binds in Mo Yuan, Qi combines into heat; Stomach is originally healthy. When pathogens transmit to Stomach, symptoms include vexation/thirst, dry mouth/tongue, prickly coating, breath like fire, chest/abdominal fullness, afternoon tidal fever. These indicate need for purgation. Unknowingly, heat does not form independently; it results from pathogens in Stomach obstructing righteous Qi, causing stagnation and accumulation. Must use Cheng Qi to expel pathogens; as Qi moves and fire dissipates, heat clears. Using cold/cool herbs generally is like stirring boiling soup to stop boiling. Current doctors favor Huang Lian Jie Du Tang and Xie Xin Tang, believing heat is excessive and should be treated with cold/cool, arguing Da Huang damages Yuan Qi and Huang Lian clears heat without purgative risk. Giving large doses for heat syndromes worsens illness, claiming Huang Lian fails to clear heat. Ignorance: Huang Lian is bitter, stagnant, cold, drying; Da Huang is cold but moving/unsticking, while Huang Lian is cold but sticking/stagnant. One drying/moistening, one unblocking/blocking—they are far apart. Wen Yi treatment prioritizes movement/unblocking throughout; using Huang Lian causes blockage, how can pathogens drain? How can disease root be pulled? ○ About thirty Wen Yi syndromes require purgation; not all need be present. If yellow tongue and chest/abdominal fullness appear, add Da Huang to Da Yuan Yin for purgation. If residual pathogens enter Stomach, use Xiao Cheng Qi Tang to clear remaining toxins. Generally, external pathogens should be treated early, while Qi/Blood is undisturbed and fluids unconsumed, avoiding hesitation, to remove disease root early. Measure patient deficiency/excess, pathogen severity, disease urgency, and extent of pathogen departure from Mo Yuan before prescribing, avoiding excess/deficiency errors, and do not rigidly adhere to "purgation should not be delayed." For indicated purgation, if no hardened stool appears, some think purgation was too early or mistaken. Unknowingly, Cheng Qi is set to expel pathogens, not just for hardened stool. Waiting for stool binding allows blood to be seized by heat, causing successive complications, like raising a tiger inviting disaster—doctor's fault. Moreover, many have loose stools lost to purgation, steaming foul like spoiled sauce or lotus mud, never hardening even near death. Why obsess only over hardened stool? Observe elderly with deficient blood often have dry binding; post-illness with unrecovered Qi/blood also often have dry binding. "Ten days without bowel movement without discomfort"—what harm? Thus, dry binding does not harm people; pathogenic toxicity causes death. ○ Plague syndrome with subcardiac fullness is due to pathogenic toxin transmitting to chest/Stomach, impairing ascending/descending Qi, causing fullness. This is external pathogen affecting original Qi. Once external pathogen is removed, original Qi naturally ascends/descends, fullness vanishes instantly. As one orifice opens, all open; previously stagnant chest/Stomach pathogens descend below, like blocked river: once front boat moves, following boats follow. Purely using Qi-breaking herbs consumes fluids, fixes heat binding, leaves stagnant Qi no outlet, plague toxin no release path, hoping for chest-opening/diaphragm-clearing is confused. ○ General fatigue, excessive desire, major illness, chronic illness lead to dual Qi/Blood deficiency and Yin/Yang exhaustion, named "Four Damages." Adding epidemic pathogen here makes it hard to treat. Original Qi deficient first, pathogen sinks daily, sudden resolution is rare. Proverb: "Shang Han tends to kill those with lower deficiency." This refers to this. For such syndromes, do not use standard correct treatment; adjust according to damage. ○ Diseases are pure deficiency or pure excess, requiring tonification or purgation. If both deficiency and excess exist, alternate tonification/purgation, detailing sequence, proportion, pace, adjusting per syndrome. ○ Diseases starting with deficiency then excess: tonify first, purge later. Starting with excess then deficiency: purge first, tonify later. "Deficiency then excess" caused by prior illness deficiency, old age/weakness, prior fatigue, postpartum blood loss, or history of hematemesis/metrorrhagia. Impending Wen Yi triggering old ailments requires tonifying first, purging later. Initial 1-2 doses of tonics, if deficiency recedes slightly, promptly treat pathogen. Too much tonification aids pathogen, bringing disaster. "Excess then deficiency": Wen Yi requiring purgation missed, blood seized by heat. Original pathogen remains; urgently attack pathogen. When pathogen retreats 60-70%, urgently tonify righteousness. When deficiency recovers 50-60%, beware further tonification, as excess tonification restarts pathogen. Use tonification only after seeing deficiency post-attack; guessing deficiency and misusing tonics causes harm. ○ If pathogen remains, lingering long leads to emaciation. Quack doctors see this and use tonics, unknowing that removing pathogen allows righteous Qi to flow, why worry about non-recovery of deficiency? Now giving tonics, pathogen solidifies daily, righteous Qi stagnates daily, stagnation turns to heat, heat turns to emaciation, emaciation turns to tonification, until skeletal death, claiming insufficient tonification. Lifelong ignorance, killing many. ○ Wen Yi is a heat disease. Pathogens internally stagnant, Yang Qi cannot announce, accumulated Yang becomes fire, Yin blood often seized by heat. After resolution, residual flame remains, Yin blood not recovered. Strictly avoid Ren Shen, [Missing Character likely Dang Gui or similar], Bai Zhu; using them aids stagnation. Residual pathogens linger, not only prolonging current illness but causing future complications, all due to sudden tonification harm. If Yin dried/blood dry post-resolution, use Qing Zao Yang Ying Tang. Generally, improper conditioning agents post-Wen Yi resolution are worse than dietary restraint and quiet rest. ○ Previously said Shang Han has no tonification method because both Shang Han and Wen Yi are external pathogens. Those injured by cold feel Heaven/Earth's righteous Qi, still disliked for being clogging and untonifiable; now Wen Yi feels Heaven/Earth's toxic vapor, tonification wraps toxin, making pathogenic fire fiercer, so mistaken tonification is worse. This discusses normalcy. Discussing variation, there are cases needing tonification: long-term missed purgation injuring True Yin; chronic illness prior deficiency; prior major fatigue; elderly depletion. These require combined tonification/purgation. If purging alone increases deficiency, urgently tonify strongly; if tonification fails to reduce deficiency or adds complications, danger. ○ Pregnant women with Wen Yi, if purgation indications appear, treat per syndrome, do not be confused by "fetus-protecting" theories, nor use tonics causing pathogenic fire stagnation, heat toxin intensification, and fetal insecurity. Only use Cheng Qi to expel pathogen; as fire/toxin dissipates, inflammation turns cool, person safe, fetus naturally secured. Who says Da Huang is not a fetus-protecting herb? But early is better than late. If waiting for cone-like abdominal pain, break-like back pain, impending miscarriage, medicine is useless. Question: If giving Cheng Qi to pregnant woman, and pathogen not expelled, damaging fetus first, what then? Reply: Hardened stool/stagnant heat are matters of intestines/stomach; fetus attaches to spine, outside intestines/stomach, matter of uterus. Medicine enters stomach first; once stagnant heat clears, fetus free from heat pressure, gets nourishment, promoting benefit/removing harm in a moment, what worry? But toxic drugs for illness: stop when pathogen reduced by majority, beware overdose. (Wu You Ke)