总括
瘟疫之病,与伤寒之病,传变相同。有冬感于寒而即病者,乃伤寒之名。有冬受寒邪,而未即发,藏于肌肤之内,
伏于荣卫之间,因至春复感春风而发,温病成焉。至夏复感暑热,发为热病。若合门逐户,老幼相传,乃天行瘟疫,其
害更烈。或春夏应暖而反寒,秋冬应寒而反暖,此为四时不正之气,名为时气相感为病,与伤寒同治也。其间或发痧
发疹发瘟 ,要当详明治之。
温病
冬受寒邪,不即为病,至春复感春寒而发,名为温病。现证同于伤寒。用双解通圣汤两解之。若呕吐者,加生姜半
夏均入。
风温
风温者,冬受寒邪,复感春风而发为病。其证发热自汗,身重鼾眠。如汗少者,用荆防败毒散治之;汗多者,以桂
枝白虎汤,煎服清解之。
热病
冬受寒邪,不即为病,至夏复感暑热而成热病。见证与温病相类,但身不恶寒,而口多渴,为少异耳。治法亦与温
病相同也。
瘟疫
天地流行厉气,而成瘟疫之病,不论老小强弱,沿门合境皆同。盖由邪气自口鼻而入,故此传染之速,迅如风火,
当分有在表在里,在阴在阳之毒。其或发,或清,或攻,当因春风、夏热、秋凉、冬寒之四时各异,审人虚实重轻以施
治也。古法皆以攻毒为急者,以邪自口鼻入,在里之病多故也。发以荆防败毒散,清以普济消毒饮,再攻以二圣救苦丹,
则审度医治,庶几临证有功矣。
瘟 疹痧
伤寒发疹、发 、发痧,皆因失于汗下,乃时气感染,即其然也。缘表邪覆郁荣卫之分,外泛出皮脉,而成痧疹
之证。亦由疫之为病,烈而速也。发于卫分,则为痧。卫主气,故色白。发于荣分,则为疹,营主血,故色红,皆如肤
粟。深重为 , 红如豆,甚则成片连连。 疹之色,红者轻,赤者重,黑多死证。以色辨热之浅深,验生死也。若其
色淡红稀暗者,皆邪在三阳,已成 疹,由外入里,邪从阴化,或过服寒凉之药所致,是为阴 。阴痧阴疹,法当从阴
寒治也。 出未透,表热轻者,用升麻葛根汤合消毒犀角饮治之。表热盛者,用三黄石膏汤煎服。已透者,用消 青黛
饮加减清之。瘀疹初起,或表里不清,用双解通圣汤为先。
总括
瘟疫这种病,与伤寒病的传变规律相同。有的是冬天感受寒邪而立即发病的,这属于伤寒的范畴。有的是冬天受寒邪侵袭,但没有立即发作,邪气潜伏在肌肤之内,隐藏在营卫之间,等到春天再次感受春风(风邪)而引发,这就形成了温病。到了夏天再次感受暑热之气,就发为热病。如果一家一户、老幼相传,这就是天行瘟疫,其危害更加猛烈。或者春夏季节本该温暖却反而寒冷,秋冬季节本该寒冷却反而温暖,这是四时不正之气,称为时气相感致病,治疗方法与伤寒相同。其中有的出现痧、疹、瘟等症状,应当详细辨证后进行治疗。
冬天感受寒邪,没有立即发病,到了春天再次感受春寒而引发,称为温病。临床表现与伤寒相同。使用双解通圣汤进行表里双解治疗。如果有呕吐症状的,加入生姜和半夏一起入药煎服。
风温病,是冬天感受寒邪,又再次感受春风(风邪)而引发的疾病。其症状表现为发热、自汗、身体沉重、打鼾嗜睡。如果出汗少的,用荆防败毒散治疗;如果出汗多的,用桂枝白虎汤煎服,以清热解表。
冬天感受寒邪,没有立即发病,到了夏天再次感受暑热之气而形成热病。见证表现与温病相似,只是身体不恶寒,而且口中多渴,这是细微的区别罢了。治疗方法也与温病相同。
天地间流行的厉气,导致了瘟疫的发生,不论老人小孩、体质强弱,沿门合境的人都感染同样的病症。这是因为邪气从口鼻进入人体,所以传染速度极快,迅如风火。应当分辨邪毒是在表还是在里,在阴经还是在阳经。治疗时或发散、或清解、或攻下,应当根据春、夏、秋、冬四季气候的不同,审察患者体质的虚实轻重来施治。古代医法都以攻逐毒邪为急务,是因为邪气从口鼻而入,多在里的缘故。发散用荆防败毒散,清解用普济消毒饮,攻下用二圣救苦丹,这样审慎度势地医治,才能在临证中取得功效。
瘟 疹 痧
伤寒病出现发疹、发斑、发痧,都是因为失于发汗或攻下,导致时气感染,从而形成这样的病症。这是由于表邪郁闭在营卫之分,外泛出于皮肤脉络,从而形成痧疹的证候。这也是因为疫疠之病,性质猛烈且发病迅速。邪气发于卫分,就称为痧。卫主气,所以颜色发白。邪气发于营分,就称为疹,营主血,所以颜色发红,形态都像皮肤上的粟粒一样。病情深重成为斑,斑色红如豆粒,严重时甚至成片连在一起。斑疹的颜色,红色者轻,赤色者重,黑色者多为死证。通过颜色辨别热邪的浅深,以此验证生死预后。如果颜色淡红稀疏晦暗的,都是邪气在三阳经,已经形成斑疹,由外向内传入,邪气从阴化,或者是过服寒凉药物所致,这称为阴斑、阴痧、阴疹。对于阴痧、阴疹,治疗法则应当从阴寒角度论治。斑疹发出但未透达,表热较轻的,用升麻葛根汤合消毒犀角饮治疗。表热盛的,用三黄石膏汤煎服。已经透发的,用消斑青黛饮加减以清解。瘀疹初起,或者表里证候不清的,先用双解通圣汤治疗。
General Overview
The transmission and progression of plague (Wenyi) are identical to those of cold damage (Shanghan). Some cases involve immediate onset after contracting cold pathogenic factors in winter, which falls under the category of cold damage. Other cases involve latent infection where cold pathogenic factors acquired in winter remain dormant within the skin and muscles, hidden between the Ying (Nutritive) and Wei (Defensive) levels, and manifest upon re-exposure to spring wind pathogens in spring, resulting in warm diseases (Wenbing). Upon further exposure to summer heat in summer, these develop into febrile diseases (Rebing). If the disease spreads from household to household among people of all ages, it is termed epidemic plague (Tianxing Wenyi), which is even more severe. Alternatively, if spring and summer should be warm but turn cold, or autumn and winter should be cold but turn warm, this constitutes abnormal Qi of the four seasons, known as illness caused by seasonal atmospheric influence (Shiqi Xianggan), which is treated similarly to cold damage. In such cases, manifestations may include sha (petechiae/rash), zhen (papules/rash), or wen (plague); detailed syndrome differentiation and treatment are required.
Warm Diseases (Wenbing)
Cold pathogenic factors contracted in winter do not immediately cause illness but manifest upon re-exposure to cold spring winds in spring, termed warm diseases. The clinical presentation is identical to cold damage. Treat with Shuangjie Tongsheng Tang (Double-Resolving Universal Sage Decoction) to resolve both exterior and interior. For patients with vomiting, add fresh ginger (Shengjiang) and Pinellia Rhizome (Banxia).
Wind-Warmth (Fengwen)
Wind-warmth arises when cold pathogenic factors contracted in winter are reactivated by exposure to spring winds. Symptoms include fever, spontaneous sweating, heaviness of the body, snoring, and somnolence. For cases with scanty sweating, treat with Jingfang Baidu San (Aucklandia and Saposhnikovia Powder to Relieve Toxicity). For cases with profuse sweating, administer Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction) to clear heat and resolve the exterior.
Febrile Diseases (Rebing)
Cold pathogenic factors contracted in winter do not immediately cause illness but manifest upon re-exposure to summer heat in summer, forming febrile diseases. The clinical signs are similar to warm diseases, with the slight difference that there is no aversion to cold and there is excessive thirst. The treatment method is also the same as for warm diseases.
Plague (Wenyi)
Malignant Qi circulating in heaven and earth causes plague. It affects everyone regardless of age or constitution, spreading through communities. This is because pathogenic factors enter via the mouth and nose, making transmission rapid like wind and fire. One must differentiate whether the toxin is in the exterior or interior, and in the Yin or Yang channels. Treatment involves dispersing, clearing, or purging, adapted to the specific seasonal conditions of spring, summer, autumn, and winter, and tailored to the patient's deficiency or excess and severity. Ancient methods prioritized purging toxins because pathogens entering via the mouth and nose tend to reside in the interior. Disperse with Jingfang Baidu San; clear with Puji Xiaodu Yin (Universal Benefit Toxin-Resolving Drink); purge with Ersheng Jiuku Dan (Two Sages' Salvation and Suffering-Relief Pill). Such prudent and measured treatment will yield success in clinical practice.
Plague, Rash, and Sha
Cold damage presenting with rash (Zhen), macules/purpura (Ban), or sha (Petechiae/Rash) results from failure to induce sweating or purge, leading to seasonal atmospheric infection. This occurs because exterior pathogens stagnate at the boundary of Ying and Wei, emerging onto the skin and vessels to form sha and zhen. This reflects the fierce and rapid nature of epidemic diseases. When pathogens emerge at the Wei (Defensive) level, it is called sha. Since Wei governs Qi, the color is white. When pathogens emerge at the Ying (Nutritive) level, it is called zhen. Since Ying governs Blood, the color is red, resembling millet grains on the skin. Severe cases result in ban (macules/purpura), which appear red like beans and may coalesce into large patches. Regarding the color of ban and zhen: red indicates mildness, crimson indicates severity, and black indicates a critical/fatal prognosis. Color helps determine the depth of heat and predict survival. If the color is pale red, sparse, and dull, the pathogen remains in the Three Yang channels; the ban/zhen has formed and moved from exterior to interior, transforming into Yin due to overuse of cold-cooling herbs. This is termed Yin-sha, Yin-zhen, or Yin-ban. The treatment principle for Yin-sha and Yin-zhen is to address the Yin-cold pattern. If the eruption is incomplete and exterior heat is mild, use Shengma Gegen Tang (Kudzu Root and Cimicifuga Decoction) combined with Xiaodu Xijiao Yin (Toxin-Resolving Rhinoceros Horn Drink). If exterior heat is intense, use Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction). If the eruption is fully expressed, use Xiaoban Qingdai Yin (Macule-Resolving Indigo Naturalis Drink) with modifications to clear heat. For early-stage yuzhen (stagnant rash) or unclear exterior-interior patterns, start with Shuangjie Tongsheng Tang.