一夏月亦有病凉者，偶遇暴风怒雨，不及加衣，或夜失覆，或路行冒犯，皆能为凉证，此非其时而有其气，谓之
寒疫。治法与暑症异，亦以九味羌活汤、败毒散、以辛散和解为主，不可专用汗药。此论乃李东垣先生发自十书
中，从来医书罕及，然仅百之一耳，以一律百，以或然为固然，左矣。
霖按∶寒疫多病于金水不敛之年，人气应之，以其毛窍开而寒气闭之也。疫乃天地不正淫 厉气，颇难骤逐，非
风寒之邪，一汗可解。治法宜苏桂杏草等温散，更察其兼湿兼风，消息治之。东坡在黄州，以圣散子治疫甚效，亦
寒疫挟湿之方也。后永嘉宣和间服此方殒命者，不知凡几，盖以寒疫之方，误施于温疫者也。
《脉诀举要》曰∶暑伤于气，所以脉虚弦细芤迟，体状无余。
刘覆真曰∶暑脉虚而微弱，按之无力，又脉来隐伏弦细芤迟，皆暑脉也。脉虚身热，得之伤暑中 ，脉虚而微者是
也。寒病传经，故脉日变，温热不传经，故脉不变。寒病浮洪有力者易治，芤细无力者难治，无脉者不治。若
温热则不然，温有一二部无脉者，暑热有三四部无脉者，被火所逼勒而藏伏耳，非绝无也，于病无妨，攻之亦易。医人
一诊，惊走不知，照经用辛寒药，火散而脉起，脉起而病愈，徒骇何益乎？要在辨之详耳，盖温热病，有中一二
经，始终止在此一二经，更不传递别经者，其一二经或洪数，则别经弱且伏，根据经络调之，则洪者平，伏者起，乃愈征
也。昔在万历丁未三月间，予寓京师，备员太仓库差，忽一日吏部同乡刘蒲亭驰报曰，病剧求救。予就其寓，
吏部同僚诸公环守之，已备后事，谵语抹衣不寐者七八日已。御医院吴思泉，名医也，偕医数人治之。予诊脉止关脉洪
大，
其余皆伏，乃书方竹叶石膏汤。诸公皆惊曰∶吴等已煎附子理中汤，何冰炭如是？予诘之。曰∶吴云阳证阴脉，故用附
子。予曰∶两关洪大，此阳脉也。其余经为火所伏，非阴脉也。吴厉声相争，予亦动色自任，诸公从之。一剂，晡时即
止
谵语抹衣，就寐片时，予视其脉，已洪者平而伏者起。诸公相视曰∶此真张仲景也。又用辛凉药调理痊愈。脉症有相合
者
易知，有相左者难知，脉明而后可以辨证，证真而后可以施药，要在虚心细察，不可执己见而以百药尝试，令
命在反掌间也，慎之慎之！
霖按∶温暑之脉多有伏者，然总不全伏，若诊一二部未伏之脉必洪数，虽不洪数，细按之定必有力，初病尤当于血
气
中以辨寒热。《素问·阴阳应象大论》曰∶左右者，阴阳之道路也。水火者，阴阳之征兆也。此论血气阴阳
之升降，以藏气言，肝木左升，肺金右降，以脉体言，左属血，右属气。凡诊感证之脉，伤寒多盛于左部，寒伤形，伤
其有形
之营血也。温暑多盛于右部，热伤气，伤其无形之卫气也。此水火之征兆，血气之左右，不可不察。若湿甚
热微者，又不可泥此。
又按∶夫血气阴阳，错宗互用，其理渊微，言之不尽。自东垣《辨感论》，强分左为人迎，
右为气口，以人迎脉大于气口属外感，气口脉大于人迎属内伤。然此所云外感者，指外感风寒而言。云内伤者，指
内伤饮食而言。盖寒伤形血，故脉盛左部，食伤胃府，故脉盛右关。后世医家，误会其意，竟谓凡病外感，皆当左
盛，凡病内伤，皆当右盛，血气不分，阴阳莫辨，虽有王安道论之于前，吴又可论之于后，奈积习难反，寒热倒施，
能不遗人夭扎。鲜矣！若夫伤寒传入阳明，右关脉实大者，燥矢填于胃府，宜议下，温暑陷入阴经，左关尺数大者，
肝肾之伏热，与外热相搏，多不治。活法在人，不可拘执，左大风寒，右大温暑也。然而初病风寒，浮紧必盛于左部
，初病温暑，洪数必盛于右部，此又不可不察也。
夏季也有因受寒而发病的，偶然遇到狂风暴雨，来不及添加衣物，或者夜间睡觉没有盖好被子，或者在路上行走时冒犯风寒，这些情况都能导致寒证，这不是正常的时令气候却出现了这种寒气，称为寒疫。治疗方法与暑症不同，也以九味羌活汤、败毒散等方剂为主，以辛温发散和解为主要治法，不可专门使用发汗药物。这一论述是李东垣先生从《十书》中阐发的，以往的医书中很少提及，然而仅仅是一百种情况中的一种，用一种情况来推断所有情况，把可能发生的当作必然发生的，这是错误的。
霖按：寒疫多发生在金水之气不能收敛的年份，人体气息与之相应，因为毛孔张开而寒气闭塞所致。疫病是天地间不正的淫厉之气，很难迅速驱除，不同于风寒之邪，一次发汗即可解除。治疗方法适宜用苏叶、桂枝、杏仁、甘草等药物进行温散，更要观察是否兼夹湿邪或风邪，斟酌病情进行治疗。苏东坡在黄州时，用圣散子治疗疫病非常有效，这也是治疗寒疫挟湿的方剂。后来永嘉宣和年间服用此方死亡的人，不知有多少，这是因为将治疗寒疫的方剂，误用于温疫患者所致。
《脉诀举要》说：暑气损伤正气，所以脉象呈现虚、弦、细、芤、迟的特征，体状没有遗漏。
刘完素（刘河间）说：暑病的脉象虚而微弱，按压时无力，又有脉象隐伏、弦、细、芤、迟的，都是暑病的脉象。脉虚身体发热，是由于伤暑引起的，脉虚而微弱的就是这种情况。寒病会传经，所以脉象每天变化；温热病不传经，所以脉象不变。寒病脉象浮洪有力的容易治疗，芤细无力的难治，无脉的无法治疗。如果是温热病则不是这样，温病有一两个部位无脉的，暑热病有三四个部位无脉的，是被火邪逼迫而潜伏在内罢了，并非完全没有脉象，对病情没有妨碍，攻下也容易。医生一诊脉，惊慌逃走不知道原因，按照经文使用辛寒药物，火邪散去而脉象出现，脉象出现而病痊愈，徒然惊恐有什么益处呢？关键在于详细辨别。大概温热病，有的只涉及一两条经络，始终只在这几条经络，不再传递到其他经络，其涉及的经络脉象或洪数，则其他经络脉象弱且伏，根据经络调理，则洪大的变平和，伏匿的起现，这才是痊愈的征象。过去在万历丁未年三月间，我寓居京城，担任太仓库差事，忽然有一天吏部同乡刘蒲亭骑马报告说，病情严重求救。我去他的住所，吏部同僚各位先生环绕守护，已经准备好后事，胡言乱语、抓挠衣服、不睡觉已经七八天了。御医院吴思泉，是名医，偕同几位医生治疗。我诊脉只见关脉洪大，其余部位都伏匿，于是开方竹叶石膏汤。各位先生都惊讶地说：“吴等人已经煎好附子理中汤，为什么冰炭如此不同？”我质问他们。他们说：“吴医生说阳证见阴脉，所以用附子。”我说：“两关脉洪大，这是阳脉。其余经络被火邪伏匿，不是阴脉。”吴思泉厉声争辩，我也神色严肃地承担责任，各位先生听从了我。一剂药后，傍晚时分即停止胡言乱语和抓挠衣服，入睡片刻，我看他的脉象，已经洪大的变平和，伏匿的起现。各位先生互相看着说：“这真是张仲景再世啊。”又用辛凉药物调理痊愈。脉象与症状有相符合的容易知道，有相违背的难知道，脉象明确后才能辨证，证候真实后才能施药，关键在于虚心细致观察，不可固执己见而以各种药物尝试，让生命在反掌之间丧失，谨慎啊谨慎！
霖按：温病暑病的脉象多有伏匿的，但总不会完全伏匿，如果诊察一两个部位未伏匿的脉象必定洪数，虽然不洪数，细细按压必定有力，初病尤其应当在血气中辨别寒热。《素问·阴阳应象大论》说：左右，是阴阳的道路。水火，是阴阳的征兆。这一论述讲的是血气阴阳的升降，以脏气来说，肝木向左升，肺金向右降；以脉体来说，左属血，右属气。凡是诊断外感证的脉象，伤寒多盛于左部，因为寒伤形体，伤害其有形的营血。温病暑病多盛于右部，因为热伤气，伤害其无形的卫气。这是水火之征兆，血气之左右，不可不考察。如果湿邪很重而热邪轻微，又不可以拘泥于此。
又按：血气阴阳，错综互用，其道理深奥微妙，言语难以尽述。自从李东垣《辨感论》，强行区分左为人迎，右为气口，以人迎脉大于气口属于外感，气口脉大于人迎属于内伤。然而这里所说的外感，指的是外感风寒。所说的内伤，指的是饮食内伤。因为寒伤形血，所以脉象盛于左部；食伤胃腑，所以脉象盛于右关。后世医家，误解其意，竟然认为凡是外感病，都应当左脉盛；凡是内伤病，都应当右脉盛，血气不分，阴阳莫辨，虽然有王安道在前面论述，吴又可后面论述，无奈积习难改，寒热倒置施用，能不遗留给人早夭吗？太少了！如果伤寒传入阳明经，右关脉实大的，是燥屎填塞胃腑，应当议用下法；温暑陷入阴经，左关尺脉数大的，是肝肾的伏热，与外热相搏，大多不治。活法在于人，不可拘执，左脉大主风寒，右脉大主温暑。然而初病风寒，浮紧脉必盛于左部；初病温暑，洪数脉必盛于右部，这又不可不考察。
There are also cases in summer where illness is caused by cold. Accidentally encountering violent storms and heavy rain, failing to add clothing in time, or sleeping at night without covering oneself properly, or walking on the road and being exposed to wind and cold, can all lead to cold syndromes. This is not the appropriate seasonal climate but rather the appearance of such cold qi, termed Cold Epidemic (Han Yi). The treatment method differs from Summerheat Syndromes (Shu Zheng), primarily utilizing formulas such as Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) and Baidu San (Dispel Toxin Powder), focusing on acrid dispersal and harmonization. One must not exclusively use diaphoretic drugs. This discussion was expounded by Mr. Li Dongyuan from the *Ten Books* (*Shi Shu*). Previous medical texts rarely mentioned it; however, this represents only one out of a hundred scenarios. Applying one rule to a hundred cases, treating possibilities as certainties, is incorrect.
Lin's Note: Cold Epidemics often occur in years when Metal and Water Qi fail to consolidate. Human Qi responds to this, with pores opening while cold Qi closes them. Epidemics are irregular, pernicious Qi from Heaven and Earth, which are difficult to dispel rapidly. They differ from Wind-Cold pathogens, which can be resolved with a single sweating therapy. Treatment should preferably employ warm dispersing herbs such as Perilla Leaf (Zisuye), Cinnamon Twig (Guizhi), Apricot Seed (Xingren), and Licorice Root (Gancao). One must further observe whether Dampness or Wind is concurrent and adjust treatment accordingly. When Su Dongpo was in Huangzhou, he used Shengsan Zi (Holy Dispersion Pill) to treat epidemics with great efficacy; this is also a formula for Cold Epidemic complicated by Dampness. Later, during the Xuanhe era in Yongjia, countless people died after taking this formula because the formula for Cold Epidemic was mistakenly applied to Warm Epidemics (Wen Yi).
*Mai Jue Ju Yao* (Essentials of Pulse Diagnosis) states: Summerheat injures Qi, therefore the pulse presents as Empty (Xu), Wiry (Xian), Fine (Xi), Scallion-Stalk (Kou), or Delayed (Chi), with no other characteristics omitted.
Liu Fushen (Liu Wansu) stated: Summerheat pulses are Empty and weak, powerless upon pressure. Pulses that are Hidden (Yin), Wiry, Fine, Scallion-Stalk, or Delayed are all Summerheat pulses. An Empty pulse with body heat results from Summerheat injury; an Empty and slight pulse is indicative of this. Cold diseases transmit through meridians, so the pulse changes daily; Warm-Heat diseases do not transmit through meridians, so the pulse remains unchanged. For Cold diseases, Floating and Full pulses with strength are easy to treat; Scallion-Stalk and Fine pulses without strength are difficult to treat; absence of pulse is untreatable. However, this is not the case for Warm-Heat diseases. In Warm diseases, there may be no pulse in one or two positions; in Summerheat-Heat diseases, there may be no pulse in three or four positions. This is due to suppression by Fire pathogen causing the pulse to hide internally, not its absolute absence. It does not hinder the disease process, and attacking it is relatively easy. If a physician is startled by the pulse and flees in ignorance, prescribing Acrid-Cold medicines according to classics, once the Fire dissipates and the pulse returns, the disease cures itself. What benefit is there in mere panic? The key lies in detailed differentiation. Generally, Warm-Heat diseases may remain confined to one or two meridians throughout, without transmitting to others. In these meridians, the pulse may be Full and Rapid (Hong Shu), while other meridians show weak and Hidden pulses. Regulating according to the meridians will cause the Full pulse to normalize and the Hidden pulse to reappear, signaling recovery.
In the third month of Dingwei year during the Wanli reign, I resided in the capital, serving in the Imperial Granary. Suddenly, my fellow official from the Ministry of Personnel, Liu Puting, rode over reporting critical illness. I visited his residence, where colleagues surrounded him, having already prepared funeral arrangements. He had been delirious, scratching clothes, and sleepless for seven or eight days. Wu Siquan from the Imperial Medical Bureau, a renowned physician, treated him along with several other doctors. Upon palpation, I found only the Guan position pulses Full and Large, while all others were Hidden. I prescribed Zhuyegashitang (Bamboo Leaf and Gypsum Decoction). The gentlemen exclaimed in surprise, "Dr. Wu has already decocted Fuzi Lizhong Tang (Aconite and Ginger Decoction to Restore the Middle). Why such opposite approaches?" I questioned them. They replied, "Dr. Wu said Yang syndrome with Yin pulse necessitates Aconite." I said, "The bilateral Guan pulses are Full and Large; this is a Yang pulse. The other meridians are suppressed by Fire, not Yin pulse." Dr. Wu argued fiercely. I stood firm in my diagnosis. The gentlemen followed my advice. After one dose, by dusk, the delirium and scratching ceased, and he slept briefly. Checking his pulse again, the Full ones normalized, and the Hidden ones reappeared. The gentlemen looked at each other and said, "This is truly Zhang Zhongjing reborn." Subsequent treatment with Acrid-Cool medicines led to full recovery. When pulse and symptoms align, differentiation is easy; when they contradict, it is difficult. Only with clear pulse diagnosis can one differentiate syndromes; only with accurate syndrome identification can one prescribe medicine. One must examine with humility and care, never clinging to preconceived notions and experimenting with various drugs, risking life in an instant. Be cautious!
Lin's Note: Pulses in Warm and Summerheat diseases are often Hidden, but rarely completely absent. If one examines the non-Hidden positions in one or two areas, they will likely be Full and Rapid. Even if not Full and Rapid, careful palpation reveals strength. In early stages, one must distinguish Cold from Heat within Blood and Qi. *Suwen: Yin-Yang Yingxiang Dalun* states: Left and Right are the pathways of Yin and Yang. Water and Fire are the manifestations of Yin and Yang. This discusses the ascending and descending of Blood, Qi, Yin, and Yang. Regarding Zang Qi, Liver Wood ascends on the left, Lung Metal descends on the right. Regarding pulse body, Left belongs to Blood, Right belongs to Qi. In diagnosing exterior contraction pulses, Cold Damage (Shang Han) often manifests strongly in the Left position because Cold injures Form, specifically tangible Ying Blood. Warm and Summerheat diseases often manifest strongly in the Right position because Heat injures Qi, specifically intangible Wei Qi. These are the manifestations of Water and Fire, and the lateral distribution of Blood and Qi, which must be observed. However, if Dampness is severe and Heat is mild, one should not rigidly adhere to this rule.
Furthermore: Blood, Qi, Yin, and Yang interweave and utilize each other; their principles are profound and subtle, beyond complete verbal description. Since Li Dongyuan's *Bian Gan Lun*, it was forcibly divided: Left as Renying (Person Welcome) and Right as Qikou (Qi Gate). Renying larger than Qikou indicates Exterior Contraction; Qikou larger than Renying indicates Internal Injury. However, the "Exterior Contraction" referred to here implies Wind-Cold, while "Internal Injury" implies Dietary Injury. Because Cold injures Form and Blood, the pulse is strong on the Left; Food injures the Stomach Fu, so the pulse is strong at the Right Guan. Later physicians misunderstood this, believing that all Exterior Contractions result in Left-strong pulses and all Internal Injuries result in Right-strong pulses, confusing Blood and Qi, and obscuring Yin and Yang. Although Wang Andao discussed this earlier and Wu Youke later, entrenched habits are hard to break, leading to inverted Cold/Heat treatments and premature death. How rare it is to avoid this! If Cold Damage transmits to Yangming, a Solid and Large Right Guan pulse indicates dry stool filling the Stomach Fu, requiring purgation. If Warm/Summerheat sinks into Yin meridians, a Rapid and Large Left Guan-Chi pulse indicates latent Heat in Liver and Kidney combusting with external Heat, often untreatable. Therapeutic flexibility depends on the practitioner; one must not be dogmatic. Left-large indicates Wind-Cold; Right-large indicates Warm-Summerheat. However, in early Wind-Cold, Floating-Tight pulses are strong on the Left; in early Warm-Summerheat, Full-Rapid pulses are strong on the Right. This too must be carefully observed.