（山阴陈坤载安注）
寸口脉阴阳俱紧者，法当清邪中于上焦，浊邪中于下焦。清邪中上，名曰洁也；浊邪中下，名曰浑也。阴中于邪，
必内栗也。表气微虚，里气不守，故使邪中于阴也。阳中于邪，必发热头痛，项强颈挛，腰痛胫酸，所谓阳中雾露之气。
故曰清邪中上，浊邪中下。阴气为栗，足膝逆冷，便溺妄出。表气微虚，里气微急，三焦相溷，内外不通，上焦怫郁，
脏气相熏，口烂食断也。中焦不治，胃气上冲，脾气不转，胃中为浊，营卫不通，血凝不流。若卫气前通者，小便亦黄，
与热相搏，因热作使，游于经络，出入脏腑，热气所过，则为痈脓。若阴气前通者，阳气厥微，阴无所使，客气入内，
嚏而出之，声 咽塞。寒厥相逐，为热所拥，血凝自下，状如豚肝。阴阳俱厥，脾气孤弱，五液注下，下焦不阖，清便
下重，令便数难，脐筑湫痛，命将难全。
此一节言受疫之源。疫者，即寒、暑、燥、湿、风夹杂而成，清浊不分，三焦相溷。其曰中上、中下者，是就邪之
清浊而言；曰阴中、阳中者，亦即邪之中上、中下而言。扼要全在中焦得治为主。中焦者，脾胃是也。脾胃之气有权，
若卫气前通者，邪可从经而汗解。若营气前通者，邪可从腑而下解。倘脾胃之气不足，邪必内陷伤脏，五液注下，便难
脐痛，命将难全矣。为痈脓，下豚肝，指其重者而言，未必定当如是也。所以疫证最怕邪伏募原，内壅不溃，为难治。
伤寒，脉阴阳俱紧，恶寒发热，则脉欲厥。厥者，脉初来大，渐渐小，更来渐渐大，是其候也。杨云∶疫病乃秽邪
弥漫，其脉恒模糊不清，此所云渐渐大，渐渐小，正其候也。如此者恶寒，甚者，翕翕汗出，喉中痛。热多者，目赤脉
多，睛不慧。杨云∶凡疫证，目睛必不了了。医复发之，咽中则伤。若复下之，则两目闭，寒多者便清谷，热多者便脓
血。若熏之，则身发黄。若熨之，则咽燥。若小便利者，可救之；小便难者，为危殆。
此节言疫邪初起之证与脉也。阴阳俱紧，恶寒发热，与伤寒同，而渐小渐大之厥脉，是疫之所异也。因邪气深伏，
正气不得宣通，所以先必恶寒，而甚则又形热状汗出，喉痛目赤也。若因恶寒而发汗，则助热上蒸而咽伤。若因内热而
下之，则阳气内陷而目闭。阴邪，多则便清谷；阳邪，多则便脓血。熏之，则湿热郁蒸而身黄。熨之，则热燥津液而咽
燥。总因邪伏募原，故汗、下、熏、熨皆误也。其可救与不救，当于小便利不利验之也。杨云∶温病小便利，则阴气未
竭；疫证小便利，则腑气尚通。邪有出路，故俱可治。
伤寒，发热头痛，微汗出。发汗，则不识人。熏之，则喘，不得小便，心腹满。下之，则短气，小便难，头痛背强。
加温针，则衄。
此节言清邪之中上者，故阳分之证居多，清邪中上，直入募原也。其发热、头痛、微汗，为邪热熏蒸，非在表也。
故发汗，则热盛而神昏。杨云∶汗为心液，过汗则心虚，而邪蔽清阳。熏之，则热壅而作喘，杨云∶熏之则以热益热，
而伤水之上源。不得小便，心腹满者，气不通也，亦非在里。短气，小便难，头痛背强者，下伤津液也。衄者，温针伤
络也。杨云∶邪热入营，故衄。治当先达募原，不致此变。
伤寒，发热，口中勃勃气出，头痛，目黄，衄不可制。贪水者，必呕。杨云∶水积而不运，故呕。恶水者，厥。杨
云∶热盛而无制，故厥。若下之，咽中生疮。杨云∶热遗于上，故生疮。假令手足温者，必下重便脓血。杨云∶四末属
脾，温则热邪充斥脾胃，故下脓血。头痛目黄者，若下，则两目闭。杨云∶温邪非荡涤所能驱，而反虚其正，故目闭。
贪水者，脉必厥，其声嘤，咽喉塞。
杨云∶亦水积泛溢之象。若发汗，则战栗，阴阳俱虚。杨云∶邪在里，不在表，
汗之则徒虚其表。恶水者，若下之，则里冷不嗜食，大便完谷出。杨云∶恶水则湿盛热微，下之则伤其中气。若发汗，
则口中伤，舌上白苔。杨云∶津液外竭，则秽邪上蒸。烦躁，脉数实。杨云∶热盛于内。不大便，六七日后必便血。若
发汗，则小便自利也。杨云∶太阳膀胱主津液，汗之则正虚，而不能约束。
此节言浊邪之中下者，故阴分之证居多。浊邪中下者，非下受也。仍从募原分布。谓阴邪归阴也。邪并于阴，则阴
实阳虚，故有勃勃气出，头痛目黄，衄不可制，贪水咽疮，下重便脓血诸证，此阴实也。其目闭脉厥，声嘤咽塞，战栗
不嗜食，大便完谷，小便自利者，此阳虚也。实为真实，虚为假虚。故非偏阴偏阳可治。
病患无表里证，发热七八日，虽脉浮数者，可下之；假令已下，脉数不解，合热则消谷善饥，至八七日不大便者，
有瘀血也，宜抵当汤。若脉数不解，而下利不止，必协热而便脓血也。
此疫邪之分传者，病无表里证，邪在募原，此指初起而言。脉数者，热盛于内也。浮者，热蒸于外也。发热七八日
而不从汗解，其内热已深，故曰可下。此指见在而言。假令已下，是指下后言也。若下后脉数不解，热传于阳，则消谷
善饥，为卫气前通也；热传于阴，必伤血成瘀，为营气前通也，宜抵当汤。即下如豚肝之类。若脉数不解，而下利便脓
血者，已成脾气孤绝，五液注下，为不治之证也。勿作寻常协热利看。
病在阳，应以汗解之，反以冷水 之，若灌之，其热被却，不得去，弥更益烦，肉上粟起，意欲饮水，反不渴者，
服文蛤散。杨云∶此条温热俱有之，不独疫病。
若不瘥者，与五苓散。寒实结胸，无热证者，与三物小陷胸汤，白散亦可服。
此疫邪之传表者，“却”字疑是“劫”字之误。徐亚枝云∶却，不得前也，热被冷抑，不得外出，转而内攻，故弥更
益烦，却字似非误。杨云∶是。文蛤散当属文蛤汤。病在阳者，谓疫邪已传阳分也，传于阳当从汗解。 ，喷也；灌，
溉也。疫邪热极，原可饮冷水得大汗而解者，乃以之 灌皮毛，内热被冷水外劫，故内烦益甚，肉上粟起也；欲饮而不
渴者，内热为外水所制也。文蛤，性寒气燥，合之麻杏石甘，去外水而清内热，五苓散亦具利水彻热之功，小“陷胸汤
及亦可服”七字疑衍。
伤寒，哕而腹满，视其前后，知何部不利，利之则愈。
此疫邪之传里者。哕，在伤寒多寒，在疫证为热。况见有腹满、前后不利可据，其为邪气壅蔽无疑。前后，二便也。
利二便即疏里法也。
得病六七日，脉迟浮弱，恶风寒，手足温，医二三下之，不能食，而胁下满痛，面目及身黄，颈项强，小便难者，
与柴胡汤，后必下重。本渴而饮水呕者，柴胡汤不中与也，食谷者，哕。
此疫邪之越于三阳者，得病六七日，恶风寒而脉浮弱，非表虚也。手足温而脉迟，非里寒也。合之为疫邪内伏不溃
之证，医者重于疏里，乃二三下之，不能食，小便难，不无伤中。而胁下满痛，少阳也。面目及身黄，阳明也。颈项强，
太阳也。邪已越于三阳，斯时但于清解热毒剂中，按经据证，略加引经达表之药足矣。若拘于胁痛为少阳，与柴胡汤，
参、甘、姜、枣锢蔽。疫邪，必下重作利也。若先渴后呕，为水饮内停，非少阳喜呕，柴胡汤必不可与，食谷者，哕，
亦属邪蔽使然，非内寒也。末句之义，似有脱简。
太阳病未解，脉阴阳俱停，先必振栗汗出而解。但阳脉微者，先汗出而解；但阴脉微者，下之而解。若欲下之，宜
调胃承气汤。
此疫邪之越于太阳者，太阳病不解，系疫邪浮越，非太阳经病也。停，匀也。脉阴阳俱停，是尺寸、浮、沉、迟、
速、大、小同等也。其正气有权，足以化邪，故从汗解。振栗者，战汗也。脉微，谓邪气衰也。阳邪先退，先从汗解。
阴邪先退，先从下解。汗法不一，而下法宜调胃承气，以疫邪虽热，不必尽实也。
太阳病，下之而不愈，因复发汗，以此表里俱虚，其人因致冒，冒家汗出自愈。所以然者，汗出表和故也。得里未
和，然后下之。
此言疫邪传表，先下后汗之误。疫邪达表，当从汗解，乃拘于疏里而先下之，徒虚其里，故不愈。因复发汗，是又
虚其表，故汗出而作冒也。必俟表气已和，再和里气。疫证汗后，往往有宜下者，有下后必汗出而始解者，总由邪气分
传，而无一定之治法也。
太阳病下之，其脉促，不结胸者，此为欲解也。脉浮者，必结胸也；脉紧者，必咽痛；脉弦者，必两胁拘急；脉细
数者，头痛未止；脉沉紧者，必欲呕；脉沉滑者，协热利；脉浮滑者，必下血。
此言疫邪误下之变。治疫虽宜疏里，但既越于太阳，自当从表，一误下之，其变有不可胜言者。促，为阳盛，下之
必致结胸；不结者，阳邪外散也，为欲解。浮为在表，下之则内陷为结胸；紧，为邪实，下之则邪上浮为咽痛；弦者，
挟风，下之则引风入肝，故两胁拘急；细数者，热郁于内也，下之则邪火上冲，故头痛未止；沉紧，多饮，下之必动其
饮，故欲呕；沉滑者，热为湿滞也，下之则湿热下流，故协热利；浮滑者，热盛于表也，下之则热邪内攻，故下血。
阳毒之为病，面赤斑斑如锦纹，咽喉痛，唾脓血。五日可治，七日不可治。升麻鳖甲汤主之。
阳毒者，疫邪犯于阳分也。阳邪上壅，故面赤。热极伤血，故遍体斑斑如锦纹也。咽喉痛，唾脓血，皆邪热烁津，
有立时腐败之势。五日经气未周，毒犹未遍，故可治。七日则邪气遍而正气消矣，故曰不可治。方用升麻鳖甲者，所以
解阳分之毒，即所以救阴分之血也。
阴毒之为病，面目青，身痛如被杖，咽喉痛。五日可治，七日不可治。升麻鳖甲汤去雄黄蜀椒主之。
阴毒者，疫邪入于阴分也。阴中于邪，故面目青。邪闭经络，故身痛如被杖。咽喉痛者，阴分热毒上壅也。故其日
数与阳经同，而治法原方去雄黄、蜀椒者，阴分已受热邪，不堪再用热药也。
雄按∶王安道云∶阴者，非阴寒之病，乃感天地恶毒异气，入于阴经，故曰阴毒耳！后人谓阴寒极盛，称为阴毒。
引仲景所叙“面目青，身痛如被杖，咽喉痛”数语，却用附子散、正阳散等药。窃谓阴寒极盛之证，固可名为阴毒，然
终非仲景所以立名之本意。后人所叙阴毒，与仲景所叙阴毒，自是两般，岂可混论？盖后人所叙阴毒，是内伤生冷，或
暴寒所中，或过服寒凉药，或内外俱伤于寒而成，非天地恶毒异气所中也。又赵养葵云∶此阴阳二毒，是感天地疫疠非
常之气，沿家传染，所谓时疫也。
又按∶雄黄、蜀椒二物，用治阳毒，解者谓毒邪在阳分，以阳从阳，欲其速散也。余谓雄黄尚属解毒之品，用之治
毒，理或有之。至蜀椒岂面赤发斑，咽痛、唾血所可试乎？必有错简，未可曲为之说也。杨云∶通人之论，《伤寒论》中，
此类甚多，俱不必强作解事也。
又按∶倪冲之《伤寒汇言》附载袁云龙云∶仲景之书，前叙六经诸条，其中文义，前后起止，多有缺失，历代医哲，
并未深勘。至于阳毒、阴毒二条，更可诧异，俱用升麻鳖甲汤，阴毒但无雄黄、蜀椒，此坊刻之伪本也。宋·庞安常阴
毒、阳毒概用全方，阴毒不去椒、黄，于理稍近。余于万历乙亥，得南阳旧本，其阴毒条，于去雄黄下，作倍蜀椒加半
主之，于理为是。盖阳毒、阴毒二证，良由平素将息失宜，耗疲精髓，逆乱气血，所以卒受山林、水泽、瘴厉恶气所中，
感而成疾。余当壮年北游燕邸以及辽阳之外，南游闽、广、黔、甸，以及交 之区。大抵南方多阳毒，北方多阴毒。时
医按法施治，曾无一验。中州等处，有人患此，亦罕能救。细按二证，俱有“咽喉痛”三字，以余窃论疡科书，有锁喉
风、缠喉风、铁蛾缠三证，其状相似，有面色赤如斑者，有面色青而凄惨者，有吐脓血者，有身痛如被杖者，有气喘急
促者，有发谵语烦乱者。虽有兼证如此，总以咽喉闭痛为苦，卒发之间，三五日可治，至七日不减，即无生理，岂非阳
毒、阴毒二证之类乎？再察其脉，缓大者生，细数紧促者死。余见此二证，不论阳毒阴毒，概用喉科方，以蓬砂二钱，
火硝六分，米醋一盏，姜汁小半盏，用鹅翎探入喉中，吐痰碗许，活者百数。据袁公之论，则阳毒为阳邪，阴毒为阴邪
矣。阴邪固宜倍蜀椒之半，而以蜀椒施之阳邪，终嫌未妥，改从喉科法引吐却稳当。以余度之，阳毒即后世之烂喉痧耳！
叔和谓之温毒是已。治法忌用温散，宜用清化。陈继宣《疫痧草》专论此证。
论曰∶百合病者，百脉一宗，悉致其病也。意欲食复不能食，常默然，欲卧不能卧，欲行不能行，饮食或有美时，
或有不用，得药则剧吐利，如有神灵者。身形如和，其脉微数。每溺时头痛者，六十日乃愈；若溺时头不痛淅淅然者，
四十日愈；若溺快然，但头眩者，二十日愈。其证或未病而预见，或病四五日而出，或二十日、或一月微见者，各随证
治之。杨云∶《金匮》中论此证，最为明显完善。
（山阴陈坤载安注）
寸口脉的寸、关、尺三部及浮、沉取均见紧脉，按照医理，这是清邪侵犯上焦，浊邪侵犯下焦。清邪侵犯上部，称为“洁”；浊邪侵犯下部，称为“浑”。阴分受到邪气侵袭，必然出现体内战栗。这是因为表气微弱虚弱，里气不能固守，所以导致邪气侵入阴分。阳分受到邪气侵袭，必然出现发热、头痛、项强、颈部拘挛、腰痛、小腿酸痛等症状，这就是所谓的阳分受到雾露之气的侵袭。所以说清邪侵犯上部，浊邪侵犯下部。阴气受邪表现为战栗，足膝逆冷，大小便失禁。表气微弱虚弱，里气轻微紧急，三焦混杂不清，内外气机不通畅，上焦郁结，脏腑之气相互熏蒸，导致口腔溃烂、食物中断（无法进食）。中焦功能失调，胃气上冲，脾气不运化，胃中形成浊气，营卫之气运行受阻，血液凝滞不流动。如果卫气先通畅，小便也会发黄，与热邪相搏结，因热邪而致病，游走于经络，出入于脏腑，热气经过的地方，就会形成痈脓。如果阴气先通畅，阳气厥逆微弱，阴气无所依附，客气进入体内，通过打喷嚏排出，声音嘶哑、咽喉阻塞。寒厥与邪气相逐，被热邪所壅遏，血液凝滞而下泄，状如猪肝。阴阳之气都发生厥逆，脾气孤弱，五液灌注下行，下焦不能闭合，大便清稀且伴有肛门重坠感，导致排便次数多而困难，脐腹绞痛，性命难保。
这一段论述了感受疫毒的根源。所谓疫毒，就是由寒、暑、燥、湿、风夹杂而成，清浊不分，三焦混杂。文中所说的“中上、中下”，是从邪气的清浊性质而言的；所说的“阴中、阳中”，也就是指邪气侵犯上部和下部。关键在于中焦能够恢复正常治疗为主。中焦指的是脾胃。如果脾胃之气有权衡调节能力，若卫气先通畅，邪气可以从经络通过发汗解除；若营气先通畅，邪气可以从腑脏通过泻下解除。倘若脾胃之气不足，邪气必然内陷损伤脏腑，导致五液灌注下行，排便困难、脐腹痛，性命难保。至于形成痈脓、排出如猪肝般的血块，是指病情严重的情况，未必一定如此。所以疫病最可怕的是邪气潜伏在募原，内部壅塞而不溃散，难以治疗。伤寒病，脉象阴阳俱紧，恶寒发热，则脉象会出现厥逆的变化。厥逆的脉象，初来时大，渐渐变小，再来的时候又渐渐变大，这就是其征候。杨氏说：疫病是秽浊邪气弥漫，其脉象通常模糊不清，这里所说的渐渐大、渐渐小，正是其征候。像这种情况会恶寒，严重的，会有翕翕出汗，喉咙痛。热邪多的，眼睛红赤，脉象多数，眼神不明亮。杨氏说：凡是疫病，眼神必定不明亮。医生如果误用发汗法，咽喉就会受伤。如果误用泻下法，就会导致两眼闭合。寒邪多的，大便排出未消化的食物；热邪多的，大便排出脓血。如果用火熏法，身体会发黄。如果用火熨法，咽喉干燥。如果小便通利的，可以救治；小便困难的，病情危殆。
这一节论述了疫邪初起的证候与脉象。脉象阴阳俱紧，恶寒发热，与伤寒相同，但脉象渐小渐大的厥脉，是疫病所不同的地方。因为邪气深伏，正气不得宣通，所以起初必然恶寒，严重时又出现发热出汗、喉痛目赤的症状。如果因为恶寒而发汗，则会助长热邪上蒸而损伤咽喉。如果因为内热而泻下，则会导致阳气内陷而两眼闭合。阴邪多，则大便排出未消化的食物；阳邪多，则大便排出脓血。用火熏，则湿热郁蒸而身体发黄。用火熨，则热燥伤津液而咽喉干燥。总的原因是邪气潜伏在募原，所以汗、下、熏、熨都是误治。其可救与不可救，应当从小便的通利与否来验证。杨氏说：温病小便通利，说明阴气未竭；疫病小便通利，说明腑气尚通。邪气有出路，所以都可以治疗。
伤寒病，发热、头痛、微微出汗。如果发汗，会导致神志不清不认识人。用火熏，会导致气喘，小便不通，心腹胀满。如果泻下，会导致气短，小便困难，头痛、背部僵硬。加上温针，会导致鼻出血。
这一节论述了清邪侵犯上部的情况，所以阳分的证候居多。清邪侵犯上部，直接入于募原。其发热、头痛、微汗，是邪热熏蒸所致，并非邪气在表。所以发汗，则热盛而神志昏迷。杨氏说：汗为心之液，过汗则心虚，而邪气蒙蔽清阳。用火熏，则热壅而作喘，杨氏说：熏法是以热助热，而损伤水之上源（肺）。小便不通、心腹胀满，是气机不通，也非邪气在里。气短、小便困难、头痛背强，是泻下伤了津液。鼻出血，是温针损伤络脉。杨氏说：邪热入营，所以鼻出血。治疗应当先通达募原，才不会发生这些变证。
伤寒病，发热，口中勃勃热气外出，头痛，目黄，鼻出血不止。想喝水的，必然呕吐。杨氏说：水积滞而不运化，所以呕吐。厌恶喝水的，四肢厥冷。杨氏说：热盛而无制约，所以厥冷。如果泻下，咽喉生疮。杨氏说：热邪遗留于上，所以生疮。假如手足温暖的，必然大便重坠、排出脓血。杨氏说：四肢属脾，温暖则热邪充斥脾胃，所以下脓血。头痛目黄的，如果泻下，则两眼闭合。杨氏说：温邪不是荡涤所能驱除的，反而损伤正气，所以目闭。想喝水的，脉象必现厥逆，声音低微，咽喉阻塞。
杨氏说：这也是水积泛溢的现象。如果发汗，则战栗，阴阳俱虚。杨氏说：邪气在里，不在表，发汗则徒然使表气虚弱。厌恶喝水的，如果泻下，则里寒不想吃东西，大便完谷不化。杨氏说：厌恶喝水则湿盛热微，泻下则损伤中气。如果发汗，则口腔受伤，舌上白苔。杨氏说：津液外竭，则秽邪上蒸。烦躁，脉数实。杨氏说：热盛于内。不大便，六七日后必然便血。如果发汗，则小便自利。杨氏说：太阳膀胱主司津液，发汗则正气虚弱，而不能约束。
这一节论述了浊邪侵犯下部的情况，所以阴分的证候居多。浊邪侵犯下部，并非从下部受邪。仍是从募原分布。说是阴邪归于阴分。邪气并入阴分，则阴实阳虚，所以有口中勃勃热气出、头痛目黄、鼻出血不止、想喝水却咽喉生疮、大便重坠便脓血等证候，这是阴实。其两眼闭合、脉象厥逆、声音低微、咽喉阻塞、战栗、不想吃东西、大便完谷不化、小便自利的，这是阳虚。实为真实，虚为假虚。所以不能偏于治阴或治阳。
患者没有表证和里证，发热七八天，虽然脉象浮数，可以用泻下法；假如已经用了泻下法，脉数仍未解除，合并热邪则消谷善饥，到了八九天不大便的，是有瘀血，适宜用抵当汤。如果脉数仍未解除，而下利不止，必然协热而便脓血。
这一节论述了疫邪的分传，病无表里证，邪气在募原，这是指初起而言。脉数，是热盛于内。浮，是热蒸于外。发热七八天而不从汗解，其内热已深，所以说可用泻下法。这是指现在的情况而言。假如已经用了泻下法，是指下后而言。如果下后脉数仍未解除，热传于阳，则消谷善饥，这是卫气先通畅；热传于阴，必然伤血成瘀，这是营气先通畅，适宜用抵当汤。即排出如猪肝般的血块之类。如果脉数仍未解除，而下利便脓血者，已成脾气孤绝，五液灌注下行，为不治之证。不要当作寻常的协热利来看待。
病在阳分，应该用汗法解表，反而用冷水喷灌，或者浇灌，其热被冷水遏制，不能去除，更加烦闷，皮肤起粟粒，想要喝水，反而不渴的，服用文蛤散。杨氏说：这一条温热病都有，不独是疫病。
如果不痊愈的，给予五苓散。寒实结胸，没有热证的，给予三物小陷胸汤，白散也可以服用。
这一节论述了疫邪传表的情况，“却”字怀疑是“劫”字的误写。徐亚枝说：却，是不能前进的意思，热被冷抑制，不能外出，转而内攻，所以更加烦闷，却字似乎不是误写。杨氏说：是的。文蛤散应当属于文蛤汤。病在阳分，是说疫邪已经传入阳分。传入阳分应当从汗解。喷，是喷洒；灌，是灌溉。疫邪热极，原本可以饮冷水得大汗而解的，竟然用它喷洒浇灌皮毛，内热被冷水从外部遏制，所以内烦更甚，皮肤起粟粒；想要喝而不渴，是因为内热被外水所制约。文蛤，性寒气燥，配合麻杏石甘汤，去除外水而清内热，五苓散也具有利水彻热的功效，小“陷胸汤及亦可服”七个字怀疑是衍文。
伤寒病，呃逆而且腹部胀满，观察前后二便，知道哪一部不利，通利它就好了。
这一节论述了疫邪传里的情况。呃逆，在伤寒多属寒，在疫病属热。况且见到有腹满、前后二便不利作为依据，这肯定是邪气壅蔽无疑。前后，指二便。通利二便即是疏里法。
得病六七天，脉迟浮弱，恶风寒，手足温，医生多次泻下，不能进食，而且胁下满痛，面目及全身发黄，颈项强，小便难的，给予柴胡汤，之后必然出现大便重坠。本来口渴而饮水呕吐的，柴胡汤不适合给予，进食的，呃逆。
这一节论述了疫邪越于三阳的情况，得病六七天，恶风寒而脉浮弱，不是表虚。手足温而脉迟，不是里寒。合起来看是疫邪内伏不溃散的证候，医者重于疏里，于是多次泻下，导致不能进食，小便难，无不损伤中气。而胁下满痛，属少阳。面目及全身发黄，属阳明。颈项强，属太阳。邪气已经越于三阳，此时只要在清热解毒剂中，按经据证，略加引经达表的药物就够了。如果拘泥于胁痛为少阳，给予柴胡汤，人参、甘草、生姜、大枣会锢蔽邪气。疫邪，必然导致下重作利。如果先渴后呕，是水饮内停，不是少阳喜呕，柴胡汤必不可给予，进食的呃逆，也属于邪气遮蔽所致，不是内寒。末句的意义，似乎有脱简。
太阳病未解，脉象阴阳俱停，先必须战栗出汗而解。只是阳脉微弱的，先出汗而解；只是阴脉微弱的，泻下而解。如果想要泻下，适宜用调胃承气汤。
这一节论述了疫邪越于太阳的情况，太阳病不解，系疫邪浮越，不是太阳经病。停，是均匀的意思。脉象阴阳俱停，是尺寸、浮、沉、迟、速、大、小同等。其正气有权衡调节能力，足以化解邪气，所以从汗解。战栗，是战汗。脉微，是说邪气衰退。阳邪先退，先从汗解。阴邪先退，先从下解。汗法不一，而下法宜用调胃承气汤，因为疫邪虽热，不必全是实证。
太阳病，泻下后不愈，因此再次发汗，这样表里俱虚，其人因此导致头昏目眩，头昏目眩的人出汗后自然痊愈。之所以这样，是因为出汗后表气调和的缘故。得到里气未和，然后才用泻下法。
这一节论述了疫邪传表，先下后汗的错误。疫邪达表，应当从汗解，乃拘泥于疏里而先泻下，徒然使里气虚弱，所以不愈。因此再次发汗，又是使表气虚弱，所以出汗而作头昏目眩。必须等待表气已和，再调和里气。疫病发汗后，往往有宜用泻下的，有泻下后必须出汗才解的，总由邪气分传，而没有一定的治法。
太阳病泻下后，脉象促，不结胸的，这是欲解。脉浮的，必结胸；脉紧的，必咽痛；脉弦的，必两胁拘急；脉细数的，头痛未止；脉沉紧的，必欲呕；脉沉滑的，协热利；脉浮滑的，必下血。
这一节论述了疫邪误下后的变证。治疗疫病虽然宜疏里，但既然越于太阳，自当从表，一旦误下，其变证有不可胜言者。促，为阳盛，泻下必致结胸；不结的，阳邪外散，为欲解。浮为在表，泻下则内陷为结胸；紧，为邪实，泻下则邪上浮为咽痛；弦者，挟风，泻下则引风入肝，故两胁拘急；细数者，热郁于内，泻下则邪火上冲，故头痛未止；沉紧，多饮，泻下必动其饮，故欲呕；沉滑者，热为湿滞，泻下则湿热下流，故协热利；浮滑者，热盛于表，泻下则热邪内攻，故下血。
阳毒的病，面部红赤，斑斑如锦纹，咽喉痛，吐脓血。五天可治，七天不可治。升麻鳖甲汤主治。
阳毒，是疫邪侵犯阳分。阳邪上壅，所以面赤。热极伤血，所以遍体斑斑如锦纹。咽喉痛，吐脓血，都是邪热灼伤津液，有立即腐败的趋势。五天经气未周遍，毒犹未遍，所以可治。七天则邪气遍而正气消矣，所以说不可治。方用升麻鳖甲，是为了清除阳分之毒，也就是为了拯救阴分之血。
阴毒的病，面目青，身痛如被杖打，咽喉痛。五天可治，七天不可治。升麻鳖甲汤去雄黄、蜀椒主治。
阴毒，是疫邪进入阴分。阴分受到邪气侵袭，所以面目青。邪气闭塞经络，所以身痛如被杖打。咽喉痛，是阴分热毒上壅。所以日数与阳经相同，而治法原方去掉雄黄、蜀椒，是因为阴分已受热邪，不堪再用热药。
王士雄按：王安道说：阴，不是阴寒的病，而是感天地恶毒异气，进入阴经，所以叫阴毒！后人认为阴寒极盛，称为阴毒。引用仲景所述“面目青，身痛如被杖，咽喉痛”几句话，却用附子散、正阳散等药。我认为阴寒极盛的证，固然可以名为阴毒，然而终究不是仲景立名的本意。后人所叙阴毒，与仲景所叙阴毒，自然是两回事，岂可混淆？盖后人所叙阴毒，是内伤生冷，或暴寒所中，或过服寒凉药，或内外俱伤于寒而成，不是天地恶毒异气所中。又赵养葵说：此阴阳二毒，是感天地疫疠非常之气，沿家传染，所谓时疫。
又按：雄黄、蜀椒二物，用于治疗阳毒，解者认为毒邪在阳分，以阳从阳，希望其迅速消散。我认为雄黄尚属解毒之品，用来治毒，道理或许有之。至于蜀椒，难道是面赤发斑、咽痛、唾血所可以尝试的吗？必有错简，不可曲为之说。杨氏说：通达之人的议论，《伤寒论》中，此类很多，都不必强行解释。
又按：倪冲之《伤寒汇言》附载袁云龙说：仲景的书，前叙六经诸条，其中文义，前后起止，多有缺失，历代医哲，并未深勘。至于阳毒、阴毒二条，更可诧异，都用升麻鳖甲汤，阴毒只是没有雄黄、蜀椒，这是坊刻的伪本。宋·庞安常阴毒、阳毒概用全方，阴毒不去椒、黄，于理稍近。我在万历乙亥年，得到南阳旧本，其阴毒条，在去雄黄下，作倍蜀椒加半主治，于理为是。盖阳毒、阴毒二证，确实是由于平素将息失宜，耗疲精髓，逆乱气血，所以突然受到山林、水泽、瘴厉恶气所中，感而成疾。我在壮年北游燕邸以及辽阳之外，南游闽、广、黔、甸，以及交趾之区。大致南方多阳毒，北方多阴毒。当时医生按法施治，曾无一验。中州等处，有人患此，也罕能救。仔细分析二证，都有“咽喉痛”三字，以我私下研究疡科书，有锁喉风、缠喉风、铁蛾缠三证，其状相似，有面色赤如斑的，有面色青而凄惨的，有吐脓血的，有身痛如被杖的，有气喘急促的，有发谵语烦乱的。虽然有兼证如此，总以咽喉闭痛为苦，卒发之间，三五日可治，至七日不减，即无生理，难道不是阳毒、阴毒二证之类吗？再察其脉，缓大者生，细数紧促者死。我见此二证，不论阳毒阴毒，概用喉科方，以硼砂二钱，火硝六分，米醋一盏，姜汁小半盏，用鹅翎探入喉中，吐痰碗许，活者百数。据袁公之论，则阳毒为阳邪，阴毒为阴邪矣。阴邪固宜倍蜀椒之半，而以蜀椒施之阳邪，终嫌未妥，改从喉科法引吐却稳当。以我推测，阳毒即后世的烂喉痧耳！叔和称之为温毒是正确的。治法忌用温散，宜用清化。陈继宣《疫痧草》专论此证。
论曰：百合病，百脉一宗，悉致其病也。想要吃饭却又不能吃，常常沉默不语，想要睡觉却又不能睡，想要行走却又不能走，饮食有时觉得美味，有时又不想吃，服药则剧烈呕吐腹泻，好像有神灵一样。身形如常，脉象微数。每次小便时头痛的，六十日痊愈；如果小便时头不痛，感觉淅淅然的，四十日痊愈；如果小便畅快，只是头晕的，二十日痊愈。其证候或未病而预先见到，或病四五日而出，或二十日、或一月微见的，各随证治之。杨氏说：《金匮》中论述此证，最为明显完善。
(Annotation by Chen Kunzai of Shanyin)
When the pulse at the cunkou (radial artery) is tight in both yin and yang positions, according to medical principles, this indicates that clear pathogenic factors attack the upper jiao, while turbid pathogenic factors attack the lower jiao. Clear pathogens attacking the upper part are called "Jie" (pure); turbid pathogens attacking the lower part are called "Hun" (turbid). When the yin aspect is attacked by pathogens, internal shivering must occur. This is because the exterior qi is slightly deficient and the interior qi fails to maintain its post, thus allowing pathogens to invade the yin aspect. When the yang aspect is attacked by pathogens, fever, headache, stiffness of the neck and nape, soreness and pain in the lower back and calves must occur; this is referred to as the yang aspect being attacked by mist and dew. Hence it is said that clear pathogens attack the upper part, and turbid pathogens attack the lower part. Yin qi affected by pathogens manifests as shivering, cold reversal of the feet and knees, and incontinence of urine and feces. The exterior qi is slightly deficient, the interior qi is slightly tense, the three jiaos are mixed and confused, and the internal and external pathways are obstructed. The upper jiao becomes stagnant, and the qi of the zang organs熏 (fumes upon) each other, leading to oral ulceration and inability to eat. If the middle jiao fails to regulate, stomach qi rebels upward, spleen qi fails to transform, turbidity forms in the stomach, Ying and Wei qi do not circulate smoothly, and blood coagulates and stagnates. If Wei qi flows freely first, urine will also be yellow; combing with heat, acting as a vehicle for heat, it wanders through the meridians, entering and exiting the zang-fu organs. Wherever the hot qi passes, abscesses and pus form. If Yin qi flows freely first, Yang qi becomes厥逆 (rebellious and weak), and Yin has no agent to act upon. Exogenous pathogens enter internally, expelled by sneezing, accompanied by hoarseness and throat obstruction. Cold reversal chases the pathogens, which are constrained by heat, causing blood to coagulate and flow downward, resembling pig liver. If both Yin and Yang qi experience reversal, Spleen qi becomes isolated and weak, the five fluids pour downward, the lower jiao fails to close, resulting in clear stools with a sensation of heaviness in the anus, frequent but difficult defecation, colic-like pain in the umbilical region, and a life-threatening condition.
This section discusses the origin of contracting epidemic diseases. Epidemic pathogens are formed by a mixture of cold, summer-heat, dryness, dampness, and wind, where clear and turbid distinctions are lost, and the three jiaos become mixed. The terms "attacking upper/lower" refer to the nature of the pathogens' clarity or turbidity; "yin/yang attack" refers to their invasion of the upper or lower parts. The key lies in restoring the function of the middle jiao. The middle jiao refers to the Spleen and Stomach. If the Qi of the Spleen and Stomach maintains its regulatory power, if Wei Qi flows freely first, pathogens can be resolved through sweating via the meridians; if Ying Qi flows freely first, pathogens can be resolved through purgation via the fu organs. However, if the Qi of the Spleen and Stomach is insufficient, pathogens will inevitably sink inward and damage the zang organs, causing the five fluids to pour downward, difficult defecation, and umbilical pain, leading to a life-threatening situation. The formation of abscesses and the passage of blood clots resembling pig liver refer to severe cases and may not always present exactly so. Therefore, the greatest fear in epidemic syndromes is pathogens lying dormant in the Mu Yuan (Omen Plain), causing internal blockage without resolution, making them difficult to treat. In Taiyang disease, when the pulse is tight in both yin and yang positions, with aversion to cold and fever, the pulse exhibits signs of Jue (reversal). The characteristic of Jue pulse is that it initially appears large, gradually becomes smaller, then gradually becomes larger again. Mr. Yang states: Epidemic diseases involve the diffusion of foul pathogens, and their pulses are usually indistinct and blurry; the gradual enlargement and contraction mentioned here precisely describe this sign. Such cases involve aversion to cold; in severe instances, there is slight sweating, sore throat, and excessive heat leads to red eyes and rapid pulses with dull vision. Mr. Yang notes: In all epidemic syndromes, the eyes appear dull. If the physician erroneously induces sweating, the throat will be injured. If erroneously purged, the eyes will close. Predominance of cold pathogens results in undigested food in stool; predominance of heat pathogens results in pus and blood in stool. Moxibustion/fumigation causes jaundice; ironing/pressing causes dry throat. If urination is free, the condition is salvageable; if urination is difficult, the condition is critical.
This section discusses the initial symptoms and pulse of epidemic pathogens. Tightness in both yin and yang pulses, along with aversion to cold and fever, are similar to Taiyang disease, but the Jue pulse that gradually contracts and enlarges distinguishes epidemics. Because pathogens lie deep and Zheng Qi cannot circulate freely, aversion to cold occurs initially, progressing to fever, sweating, sore throat, and red eyes. Inducing sweat due to aversion to cold aids heat and steams upward, injuring the throat. Purging due to internal heat causes Yang Qi to sink inward, closing the eyes. Excess Yin pathogens lead to undigested food in stool; excess Yang pathogens lead to pus and blood in stool. Fumigation causes damp-heat to stagnate and jaundice; pressing causes heat to dry fluids and injure the throat. The root cause is pathogens lying dormant in the Mu Yuan, rendering sweating, purging, fumigation, and pressing all erroneous treatments. Salvageability depends on the patency of urination. Mr. Yang states: Free urination in warm diseases indicates Yin Qi is not exhausted; free urination in epidemics indicates Fu organ Qi is still patent. With an exit for pathogens, both are treatable.
In Taiyang disease, presenting with fever, headache, and slight sweating, inducing sweating leads to confusion and inability to recognize people. Fumigation causes asthma, inability to urinate, and abdominal fullness. Purging causes shortness of breath, difficulty urinating, headache, and stiff back. Adding warm needle therapy causes epistaxis.
This section discusses clear pathogens attacking the upper jiao, hence predominantly Yang branch syndromes. Clear pathogens attacking the upper jiao enter directly into the Mu Yuan. Fever, headache, and slight sweating result from pathogenic heat steaming, indicating the pathogen is not in the exterior. Thus, sweating causes intense heat and coma. Mr. Yang states: Sweat is the fluid of the Heart; excessive sweating depletes Heart Qi, allowing pathogens to obscure the clear Yang. Fumigation causes heat congestion and asthma; Mr. Yang states: Fumigation adds heat to heat, damaging the upper source of water (Lung). Inability to urinate and abdominal fullness indicate Qi obstruction, not interior pathology. Shortness of breath, difficulty urinating, headache, and stiff back result from purging damaging body fluids. Epistaxis results from warm needles damaging collaterals. Mr. Yang states: Pathogenic heat enters the Ying level, causing epistaxis. Treatment should first unblock the Mu Yuan to prevent these complications.
In Taiyang disease, fever, forceful expulsion of Qi from the mouth, headache, yellow eyes, and uncontrollable epistaxis occur. Those desiring water will vomit. Mr. Yang states: Water accumulation without transformation causes vomiting. Those repulsed by water experience cold reversal. Mr. Yang states: Unchecked intense heat causes reversal. Purging causes ulcers in the throat. Mr. Yang states: Heat lingering in the upper jiao causes ulcers. If hands and feet are warm, heavy bearing down and pus/blood in stool will occur. Mr. Yang states: Extremities belong to the Spleen; warmth indicates heat pathogens filling the Spleen and Stomach, causing pus/blood in stool. For headache and yellow eyes, purging causes closed eyes. Mr. Yang states: Warm pathogens cannot be cleared by scouring; instead, it damages Zheng Qi, causing eye closure. Those desiring water have a Jue pulse, low voice, and throat obstruction.
Mr. Yang states: This is also a sign of water accumulation and overflow. Sweating causes shivering and deficiency of both Yin and Yang. Mr. Yang states: Pathogens are in the interior, not the exterior; sweating only depletes the exterior. Those repulsed by water, if purged, develop interior cold, anorexia, and undigested food in stool. Mr. Yang states: Repulsion of water indicates dampness predominance and mild heat; purging damages Middle Qi. Sweating causes oral injury and white tongue coating. Mr. Yang states: Exhaustion of fluids allows foul pathogens to steam upward. Restlessness and rapid, solid pulses indicate intense internal heat. Constipation for six to seven days leads to bloody stool. Sweating causes free urination. Mr. Yang states: The Taiyang Bladder governs fluids; sweating depletes Zheng Qi, losing control.
This section discusses turbid pathogens attacking the lower jiao, hence predominantly Yin branch syndromes. Turbid pathogens attacking the lower jiao do not mean infection from below; they still distribute from the Mu Yuan, meaning Yin pathogens return to the Yin aspect. Pathogens merging into Yin cause Yin excess and Yang deficiency, manifesting as forceful Qi expulsion, headache, yellow eyes, uncontrollable epistaxis, desire for water with throat ulcers, heavy bearing down with pus/blood in stool—this is Yin excess. Closed eyes, Jue pulse, low voice, throat obstruction, shivering, anorexia, undigested food in stool, and free urination constitute Yang deficiency. Excess is true excess; deficiency is false deficiency. Thus, treatment cannot focus solely on Yin or Yang.
Patients with no exterior or interior signs, febrile for seven to eight days, even with floating and rapid pulses, may be treated with purgation. If purged and the rapid pulse persists, combined heat causes polyphagia. By the eighth or ninth day, if constipation persists, blood stasis is present, requiring Dishui Tang. If the rapid pulse persists with unremitting diarrhea, heat-collateral dysentery with pus and blood ensues.
This section discusses the divergent transmission of epidemic pathogens. No exterior or interior signs indicate pathogens in the Mu Yuan (initial stage). Rapid pulse indicates intense internal heat; floating indicates heat steaming outward. Fever for seven to eight days without resolution via sweating indicates deep internal heat, warranting purgation (current state). If already purged and rapid pulse persists, heat transmitting to Yang causes polyphagia (Wei Qi flowing freely); heat transmitting to Yin damages blood forming stasis (Ying Qi flowing freely), requiring Dishui Tang (passing clots like pig liver). If rapid pulse persists with pus/blood in stool, Spleen Qi is isolated, five fluids pour downward, constituting an untreatable condition. Do not mistake this for ordinary heat-collateral diarrhea.
Disease in the Yang aspect should be resolved by sweating; erroneously spraying or pouring cold water suppresses the heat, preventing its release, increasing irritability, causing gooseflesh, thirst without actual desire to drink. Administer Wenli San. Mr. Yang states: This applies to both warm and heat diseases, not just epidemics.
If unresolved, administer Wuling San. For Cold-Excess Jie Xiong (Chest Binding) without heat signs, administer Sanwu Xiaoxianxiong Tang; Baisan may also be used.
This section discusses epidemic pathogens transmitting to the exterior. The character "Que" (retreat) is suspected to be a typo for "Jie" (rob/seize). Xu Yazhi argues: "Que" means unable to advance; heat suppressed by cold cannot exit, turning inward, causing increased irritability, so "Que" is likely correct. Mr. Yang agrees. Wenli San likely belongs to Wenli Decoction. Disease in the Yang aspect means epidemic pathogens have entered the Yang branch. Transmission to Yang requires sweating. "Pen" means spray; "Guan" means irrigate. Extreme epidemic heat could normally be resolved by drinking cold water to induce sweating; instead, spraying/irrigating the skin suppresses internal heat externally, worsening internal irritability and causing gooseflesh. Thirst without desire to drink indicates internal heat controlled by external water. Wenli (Clam Shell) is cold and drying; combined with Mahuang Xingren Shigan Tang, it removes external water and clears internal heat. Wuling San also promotes diuresis to eliminate heat. The phrase "Xiaoxianxiong Tang and Ke Yi Fu" (Seven characters) is suspected to be superfluous.
Taiyang disease with hiccups and abdominal fullness: Observe the anterior and posterior orifices to determine which is obstructed; unblocking it cures the condition.
This section discusses epidemic pathogens transmitting to the interior. Hiccups are often cold in Taiyang disease but heat in epidemics. Given abdominal fullness and obstruction of anterior/posterior orifices, pathogenic congestion is certain. Anterior/posterior refer to urination and defecation. Unblocking both is the method of draining the interior.
After six to seven days of illness, with slow, floating, weak pulses, aversion to wind/cold, and warm hands/feet, if the physician purges multiple times, leading to anorexia, hypochondriac fullness/pain, jaundice of face/body, stiff neck, and difficulty urinating, administering Chaihu Tang will cause heavy bearing down. If originally thirsty but vomiting after drinking water, Chaihu Tang is contraindicated; eating triggers hiccups.
This section discusses epidemic pathogens transcending the Three Yang branches. Six to seven days of illness with aversion to wind/cold and floating/weak pulses is not exterior deficiency. Warm hands/feet with slow pulse is not interior cold. Combined, this indicates epidemic pathogens lying dormant internally. Physicians focusing on draining the interior purge repeatedly, damaging Middle Qi, causing anorexia and difficulty urinating. Hypochondriac fullness/pain indicates Shaoyang; jaundice indicates Yangming; stiff neck indicates Taiyang. With pathogens transcending the Three Yangs, one should use heat-clearing and detoxifying formulas, adding meridian-guiding herbs based on syndrome. Clinging to hypochondriac pain as Shaoyang and using Chaihu Tang traps pathogens with Ginseng, Licorice, Ginger, and Dates, causing dysentery. Thirst followed by vomiting indicates internal fluid retention, not Shaoyang vomiting; Chaihu Tang is contraindicated. Hiccups after eating result from pathogenic obstruction, not interior cold. The final sentence likely has missing text.
Taiyang disease unresolved, with pulses appearing equalized/stopped in both Yin and Yang positions: Shivering and sweating precede resolution. If only Yang pulse is micro, resolve via sweating; if only Yin pulse is micro, resolve via purgation. If purging is indicated, Tiaowei Chengqi Tang is suitable.
This section discusses epidemic pathogens transcending Taiyang. Unresolved Taiyang disease here refers to floating epidemic pathogens, not Taiyang Meridian disease. "Ting" means uniform/equal. Equalized pulses in Yin/Yang positions (Chi/Cun, Floating/Sinking, Slow/Rapid, Large/Small) indicate sufficient Zheng Qi to transform pathogens, resolving via sweating. Shivering is Zhan Han (battle sweat). Micro pulse indicates declining pathogens. Yang pathogens retreating first resolve via sweating; Yin pathogens retreating first resolve via purgation. While sweating methods vary, purgation should use Tiaowei Chengqi Tang, as epidemic heat is not necessarily excess-solid.
Taiyang disease, purged without resolution, then sweated again, resulting in dual deficiency of exterior and interior, leading to Mao (vertigo/dizziness). Mao resolves spontaneously with sweating because the exterior harmonizes. Only after interior harmony is achieved should purgation be considered.
This section discusses the error of purging then sweating for epidemic pathogens transmitting to the exterior. Epidemics reaching the exterior require sweating; premature purging depletes interior Qi, failing to resolve. Subsequent sweating depletes exterior Qi, causing vertigo. One must wait for exterior harmony before addressing the interior. Post-sweat epidemics may require purgation, or post-purgation may require sweating to resolve, depending on divergent transmission, lacking a fixed method.
Taiyang disease purged: Pulse Cu (surging/interrupted) without Jie Xiong indicates impending resolution. Floating pulse indicates Jie Xiong; tight pulse indicates sore throat; wiry pulse indicates hypochondriac spasm; fine-rapid pulse indicates persistent headache; sinking-tight pulse indicates nausea; sinking-slippery pulse indicates heat-collateral diarrhea; floating-slippery pulse indicates bloody stool.
This section discusses complications of erroneous purgation in epidemics. Although draining the interior is suitable, once pathogens transcend Taiyang, treatment should target the exterior. Erroneous purgation causes numerous complications. Cu indicates Yang excess; purging leads to Jie Xiong. Absence of Jie Xiong indicates Yang pathogens dispersing outward (resolution). Floating indicates exterior; purging sinks pathogens inward causing Jie Xiong. Tight indicates pathogenic excess; purging pushes pathogens upward causing sore throat. Wiry indicates wind-carrying; purging draws wind into Liver causing hypochondriac spasm. Fine-rapid indicates internal heat stagnation; purging drives fire upward causing persistent headache. Sinking-tight indicates fluid retention; purging agitates fluids causing nausea. Sinking-slippery indicates heat-damp stagnation; purging directs damp-heat downward causing heat-collateral diarrhea. Floating-slippery indicates exterior heat excess; purging drives heat inward causing bloody stool.
Yang Du (Poison) presents with facial redness, mottled rash like brocade, sore throat, and expectoration of pus/blood. Treatable within five days; untreatable after seven days. Shengma Biejia Tang is indicated.
Yang Du involves epidemic pathogens invading the Yang aspect. Yang pathogens congesting upward cause facial redness. Intense heat damaging blood causes widespread mottled rash. Sore throat and pus/blood expectoration indicate pathogenic heat scorching fluids with imminent putrefaction. Within five days, Jing Qi has not fully circulated, toxin is not widespread, hence treatable. After seven days, pathogens are widespread and Zheng Qi depleted, hence untreatable. Shengma Biejia Tang clears Yang toxicity, thereby saving Yin blood.
Yin Du presents with blueish face/eyes, body pain like being beaten with a club, and sore throat. Treatable within five days; untreatable after seven days. Shengma Biejia Tang minus Xionghuang and Shujiao is indicated.
Yin Du involves epidemic pathogens entering the Yin aspect. Yin invaded by pathogens causes blueish complexion. Pathogens blocking meridians cause body pain like beating. Sore throat indicates Yin-level heat-toxin congesting upward. Days match Yang channels, but Xionghuang and Shujiao are removed because Yin levels already suffer heat pathogens and cannot tolerate further heating herbs.
Wang Shiong annotates: Wang Andao states: Yin does not mean Yin-cold disease, but rather contracting heaven-earth foul toxic異气 (strange Qi) entering Yin meridians, hence named Yin Du. Later generations equated extreme Yin-cold with Yin Du, citing Zhang Zhongjing's "blueish face, body pain like beating, sore throat," yet prescribing Fuzi San or Zhengyang San. I argue that while extreme Yin-cold can be named Yin Du, it contradicts Zhongjing's original intent. Later Yin Du descriptions differ fundamentally from Zhongjing's. Later Yin Du arises from internal injury to cold/raw foods, sudden cold exposure, overuse of cold-cooling herbs, or dual cold injury, not heaven-earth toxic Qi. Zhao Yangkui states: These Yin/Yang Dues stem from heaven-earth epidemic Qi, contagious within families, termed seasonal epidemics.
Further annotation: Regarding Xionghuang and Shujiao for Yang Du, commentators suggest using Yang herbs for Yang pathogens to disperse quickly. I consider Xionghuang a detoxifier, so its use is plausible. However, Shujiao seems inappropriate for red face, rash, sore throat, and hemoptysis. Likely textual errors exist; forced explanations are invalid. Mr. Yang states: A reasonable view. Such ambiguities abound in Shanghan Lun; do not force interpretations.
Further annotation: Ni Chongzhi's Shanghan Huiyan cites Yuan Yunlong: Zhongjing's text lacks consistency across Six Channels. The Yang/Yin Du sections are particularly puzzling. Both use Shengma Biejia Tang; Yin Du merely omits Xionghuang/Shujiao, suggesting a later forged edition. Song dynasty Pang Anchang used the full formula for both, omitting nothing, which aligns better with logic. Obtaining a Nanyang old edition in Wanli Yihai year, the Yin Du section reads: "Remove Xionghuang, add half dose of Shujiao," which makes more sense. Yang/Yin Dues arise from improper lifestyle, essence depletion, Qi/Blood chaos, suddenly contracting mountain/water/miasma toxic Qi. Traveling North to Yan/Liaoyang and South to Min/Guang/Qian/Jiaozhi, I observed more Yang Du in the South, Yin Du in the North. Contemporary physicians failed to cure them. Central Plains cases were also rare successes. Analyzing both syndromes, "sore throat" is common. My study of surgical texts reveals Suohou Feng, Chanhou Feng, Tie'e Chan, similar in presentation: red rash-like face, blue miserable face, pus/blood expectoration, clubbed body pain, asthma, delirium. All share throat obstruction/pain as primary suffering. Acute onset: treatable in 3-5 days; if unchanged by day 7, fatal. Are these not variants of Yang/Yin Du? Pulse analysis: slow-large indicates survival; fine-rapid-tight-interrupted indicates death. Treating both regardless of type with throat remedies (Borax 2 qian, Fire Nitrate 6 fen, Rice Vinegar 1 liang, Ginger Juice small half liang), probing throat with goose feather to expel phlegm, saved hundreds. According to Mr. Yuan, Yang Du is Yang pathogen, Yin Du is Yin pathogen. Yin pathogens suit doubled Shujiao; applying Shujiao to Yang pathogens is questionable. Changing to throat-induced vomiting is safer. I speculate Yang Du corresponds to modern Lanhou Sha (Rotten Throat Sand), termed Wendu by Shuhe. Treatment forbids warm-dispersing; prefers clearing-transforming. Chen Jixuan's Yisha Cao specializes in this.
Discourse: Baihe Bing (Lily Disease) involves all vessels originating from one source, collectively diseased. Desire to eat but unable; constant silence; desire to sleep but unable; desire to walk but unable. Diet varies between palatable and rejected. Medication causes severe vomiting/diarrhea, as if possessed. Body shape appears normal; pulse is micro-rapid. Headache during urination heals in 60 days; non-headache with chilliness heals in 40 days; dizziness after smooth urination heals in 20 days. Symptoms may appear pre-onset, 4-5 days into illness, or after 20 days/months. Treat according to syndrome. Mr. Yang states: Jin Gui treats this syndrome most clearly and completely.