春应暖反寒，夏应热反凉，秋应凉反热，冬应寒反温，此非其时而有其气，是以一岁之中，长幼之病，多相似者，
为
时行温疫病也。治法用人参败毒散、九味羌活汤、夏加滑石、石膏，冬加麻黄、桂枝，春秋止根据原方，或藿香正气散、
五
积散、防风通圣散亦可，甚者黄连解毒汤、竹叶石膏汤。
霖按∶疫者犹徭役之谓，大则一郡一城，小则一村一镇，比户传染，多见于大凶之后，盖旱潦兵火之余，烈日郁蒸，
尸骸之气，与亢胜之气混合，化为 厉之毒，散漫于天地之间，沿门阖境，最易沾染，若不传染，便非温疫，乃四时常
气
之温热证耳。越人所谓异乎寒热之温病，其脉行在诸经，不知何经之动也，各随其经之所在而取之。缘古无瘟字，温即
瘟
疫之谓也，夫温疫为天地 厉之气，不可以常理测，即不可以常法治。方书温瘟不分，治法多误，良可慨矣。先哲治疫，
有上焦如雾，升逐解毒，中焦如沤，疏逐解毒，下焦如渎，决逐解毒之论，深得治疫要领。故吴又可《温疫论》，
治热湿相搏之疫，首用达原饮，继则三消承气以决逐之。陈锡三二分晰义。杨栗山《寒温条辨》中，亦以升降散升决并
用
为首方，若余师
愚疫疹一得之清温败毒饮，乃专治热淫所胜之温疫，故一意清热，而不兼驱湿也。更有烂喉丹沙，传变甚速，亦不
外乎疏达清散，清化下夺，救液诸法，陈耕道《疫沙草论》之最详。近又出热疫白喉一证，其治法载诸张绍修《白
喉捷要》，此两证亦互相传染，皆温疫之流亚也。庞安常《伤寒总病论》所载，青筋牵、赤脉KT 、黄肉随、白气
狸、黑骨温诸疫，是本于《素问》遗编之五行五疫也，近人约为六证所谓大头瘟、蛤蟆瘟、瓜瓤瘟、疙瘩瘟、软脚
瘟、绞肠瘟是也。斯皆疫之兼于温者，其病层出不穷，其方亦难备载，岂人参败毒、九味羌活两方加减，便可概治，
非常理所能测之温疫哉！
春季本该温暖却反而寒冷，夏季本该炎热却反而凉爽，秋季本该凉爽却反而炎热，冬季本该寒冷却反而温和。这种在非其时却出现相应气候的现象，导致一年之中，无论老少患病症状大多相似，这被称为时行温疫病（流行性温热疫病）。治疗方法可使用人参败毒散、九味羌活汤；夏季加入滑石、石膏，冬季加入麻黄、桂枝，春秋季则仅依据原方使用；或者使用藿香正气散、五积散、防风通圣散也可以；病情严重的，可用黄连解毒汤、竹叶石膏汤。
霖按：所谓“疫”，就像徭役一样（指如服役般普遍传染），大的范围是一郡一城，小的范围是一村一镇，家家户户相互传染。这种情况多见于大灾荒之后，大概是干旱或水涝、战争火灾之后，烈日闷热蒸腾，尸骸之气与亢盛之气混合，化为厉气之毒，弥漫于天地之间，沿门串户，极容易感染。如果不发生传染，那就不是温疫，而是四时常有的温热证罢了。越人（扁鹊）所说的不同于寒热的温病，其脉象运行在诸经之中，不知道是哪一经发生变动，应随其经脉所在部位而进行诊治。因为古代没有“瘟”字，“温”即指瘟疫。夫温疫是天地间的厉气所致，不能用常理来推测，也不能用常规法治疗。医书中将“温”和“瘟”不分，导致治法多有错误，实在令人感慨。先哲治疗疫病，有上焦如雾，宜升提逐邪解毒；中焦如沤，宜疏泄逐邪解毒；下焦如渎，宜决泄逐邪解毒的论述，深得治疗疫病的要领。所以吴又可《温疫论》，治疗热湿相搏的疫病，首先使用达原饮，随后再用三消承气汤以决泄逐邪。陈锡三对此进行了详细的辨析义理。杨栗山《寒温条辨》中，也以升降散作为首方，同时使用升提与决泄之法。至于余师愚《疫疹一得》中的清瘟败毒饮，则是专门治疗热邪过盛的温疫，因此一味清热，而不兼带驱除湿邪。更有烂喉丹痧（一种急性传染病），传变非常迅速，也不外乎疏达清散、清化下夺、救阴液等方法，陈耕道《疫沙草论》记载得最为详细。近来又出现热疫白喉这一病症，其治法记载于张绍修《白喉捷要》中，这两种病症也互相传染，都是温疫的支流同类。庞安常《伤寒总病论》所载的青筋牵、赤脉KT（注：原文此处可能有误或为特定古称，通常对应赤脉动掣等症）、黄肉随、白气狸、黑骨温等五种疫病，是基于《素问》遗篇中的五行五疫理论，近人概括为六种证候，即所谓大头瘟、蛤蟆瘟、瓜瓤瘟、疙瘩瘟、软脚瘟、绞肠瘟。这些都是疫病兼夹温邪的情况，其病症层出不穷，其方剂也难以全部记载，难道用人参败毒散、九味羌活汤两方的加减，就可以概治所有情况吗？这是非常理所能推测的温疫啊！
In spring, warmth should prevail but coldness prevails instead; in summer, heat should prevail but coolness prevails instead; in autumn, coolness should prevail but heat prevails instead; in winter, coldness should prevail but mildness prevails instead. This phenomenon of having the climate of one season occurring out of its proper time leads to a situation where, throughout the year, people of all ages suffer from similar illnesses. This is referred to as *Shi Xing Wen Yi Bing* (Seasonal Epidemic Warmth Disease). The treatment method involves using *Renshen Baidu San* (Ginseng Detoxification Powder), *Jiuwei Qianghuo Tang* (Nine-Ingredient Notopterygia Decoction); add *Huashi* (Talcum) and *Shigao* (Gypsum Fibrosum) in summer, add *Mahuang* (Ephedrae Herba) and *Guizhi* (Cinnamomi Ramulus) in winter, while in spring and autumn, use the original formulas without modification. Alternatively, *Huoxiang Zhengqi San* (Patchouli Powder for Regulating Qi), *Wuji San* (Five-Accumulations Powder), or *Fangfeng Tongsheng San* (Saposhnikovia Powder for Unblocking and Purifying) may also be used. For severe cases, *Huanglian Jiedu Tang* (Coptis Decoction for Resolving Toxicity) or *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) are indicated.
Lin's Commentary: The term "Yi" (Epidemic) implies a burden akin to corvée labor, spreading extensively from a whole commandery or city down to a single village or town, infecting households sequentially. It is commonly seen after major disasters, following droughts, floods, wars, or fires. Under the scorching sun and stifling heat, the qi of corpses mixes with excessive yang qi, transforming into toxic *Li Qi* (Pestilential Qi), which permeates heaven and earth, spreading from door to door and极易 susceptible to infection. If there is no contagion, it is not a *Wen Yi* (Warmth Epidemic), but merely a common warmth syndrome occurring in the four seasons. Yue Ren (Bian Que) described *Wen Bing* (Warmth Diseases) as distinct from cold and heat diseases; their pulse movements occur within the various meridians, and it is unknown which meridian is affected. Treatment should follow the location of the affected meridian. Since the character "Wen" (Plague) did not exist in ancient times, "Wen" referred to epidemics. *Wen Yi* is caused by the pestilential qi of heaven and earth; it cannot be understood by ordinary logic nor treated by standard methods. Medical texts often fail to distinguish between "Wen" (Warmth) and "Wen" (Plague), leading to many therapeutic errors, which is lamentable. Ancient sages treating epidemics proposed that the Upper Jiao is like mist, requiring ascending and dispelling toxicity; the Middle Jiao is like fermentation, requiring dispersing and purging toxicity; the Lower Jiao is like a drain, requiring draining and purging toxicity. This theory grasps the essence of epidemic treatment. Thus, Wu Keyi in *Wen Yi Lun* (Treatise on Warmth Epidemics) first uses *Dayuan Yin* (Origin-Reaching Drink) for epidemics where heat and dampness struggle, followed by *Sanxiao Chengqi Tang* (Three-Reduction Bowel-Purging Decoction) to drain and purge. Chen Xisan elaborated on this. Yang Lushan in *Hanwen Tiaobian* (Differentiation of Cold and Warmth) also uses *Shengjiang San* (Ascending and Descending Powder) as the primary formula, employing both ascending and purging methods simultaneously. Yu Shiyu's *Qingwen Baidu Yin* (Clearing Warmth and Detoxifying Drink) in *Yizhen Yide* (Insights into Plague Rashes) is specifically for *Wen Yi* caused by excessive heat, focusing solely on clearing heat without dispelling dampness. Additionally, *Lanhou Dansha* (Rotting Throat and Cinnabar Rash) changes rapidly, treated by methods such as dispersing and clearing, purging downward, and preserving fluids, as detailed in Chen Gengdao's *Yisha Caolun*. Recently, *Re Yi Baihou* (Heat Epidemic White Diphtheria) has emerged, with treatments recorded in Zhang Xiuxiu's *Baihou Jieyao*. These two conditions are also contagious and are considered offshoots of *Wen Yi*. Pang Anchang's *Shanghan Zongbing Lun* records five epidemics based on the Five Elements from the *Suwen*: *Qingjin Qian* (Green Sinew Pulling), *Chimai KT* (Red Vessel Pulsation), *Huangrou Sui* (Yellow Flesh Following), *Baiqi Li* (White Qi Fox), and *Heigu Wen* (Black Bone Warmth). Contemporary scholars summarize these into six syndromes: *Datou Wen* (Big Head Plague), *Hamawa Wen* (Toad Plague), *Guanrang Wen* (Melon Rind Plague), *Geda Wen* (Nodule Plague), *Ruanjiao Wen* (Soft Leg Plague), and *Jiaochang Wen* (Intestine Twisting Plague). These are epidemics combined with warmth pathogens. Their manifestations are endless, and their formulas cannot be fully listed. Can the modifications of just *Renshen Baidu San* and *Jiuwei Qianghuo Tang* treat all such cases? No, this is a *Wen Yi* that cannot be measured by ordinary logic!