夫温疫之为病,非风、非寒、非暑、非湿,乃天地间别有一种异气所感。其传有
九,此治疫紧要关节。奈何自古迄今,从未有发明者。仲景虽有《伤寒论》,然其法始自太
阳,或传阳明,或传少阳,或三阳竟自传胃。盖为外感风寒而设,故其传法与温疫自是迥别。嗣
后论之者纷纷,不止数十家,皆以伤寒为辞。其于温疫证则甚略之。是以业医者所记
所
而无所施,未免指鹿为马矣。余初按诸家咸谓∶春、夏、秋皆是温病,而伤寒必在冬时。然历年较
之,温疫四时皆有。及究伤寒,每至严寒,虽有头疼、身痛、恶寒、无汗、发热,总似太阳证
,至六七日失治,未尝传经。每用发散之剂,一汗即解。间有不药亦自解者,并未尝因失汗
以致发黄、谵语、狂乱、苔刺等证。此皆感冒肤浅之病,非真伤寒也。伤寒,感冒,均系风寒,
不无轻重之殊。究竟感冒居多,伤寒希有。况温疫与伤寒,感受有霄壤之隔。今鹿马攸分,
益见伤寒世所绝少。仲景以伤寒为急病,仓卒失治,多致伤生,因立论以济天下后世,用心
可谓仁矣。然伤寒与温疫,均急病也。以病之少者,尚谆谆告世。至于温疫多于伤寒百倍,
安忍反置勿论?或谓温疫之证,仲景原别有方论,历年既久,兵火湮没,即《伤寒论》乃称
散亡之余,王叔和立方造论,谬称全书。温疫之论,未必不由散亡也明矣。崇祯辛巳,疫气流行
,山东、浙省、南北两直,感者尤多,至五六月益甚,或至阖门传染。始发之际,时师误以伤
寒法治之,未尝见其不殆也。或病家误听七日当自愈,不尔,十四日必瘳,因而失治,有不及
期而死者;或有妄用峻剂,攻补失叙而死者;或遇医家见解不到,心疑胆怯,以急病用缓药
,虽不即受其害,然迁延而致死者,比比皆是。所感轻者,尚获侥幸;感之重者,更加失
治,枉死不可胜记。嗟乎!守古法不合今病,以今病简古书,原无明论,是以投剂不效,医
者彷徨无措,病者日近危笃,病愈急,投药愈乱,不死于病,乃死于医,不死于医,乃死于
圣经之遗亡也。吁!千载以来,何生民不幸如此。余虽固陋,静心穷理,格其所感之气,所
入之门,所受之处,及其传变之体,平日所用历验方法,详述于下,以俟高明者正之。
时崇祯壬午仲秋姑苏洞庭吴有性书于淡淡斋
温疫这种病,不是由风、寒、暑、湿这些常规邪气引起的,而是天地间存在的一种特殊的“异气”(戾气)所致。它的传变规律有九种,这是治疗瘟疫的关键所在。然而从古至今,从未有人对此进行阐发。张仲景虽然著有《伤寒论》,但其治疗方法始于太阳病(外感风寒初期,邪在肌表),或传入阳明病(邪入胃肠化热),或传入少阳病(邪在半表半里),或者三阳经的病证直接传入胃腑。这是因为《伤寒论》是为外感风寒而设立的,所以其传变规律与温疫截然不同。
此后论述此病的学者纷纷出现,不止几十家,都拿伤寒来解释。他们对温疫的证候描述则非常简略。因此,医生们所学的知识虽然记得很多,却无处施展,难免会出现指鹿为马的错误。
我起初按照各家说法:认为春、夏、秋三季都是温病,只有冬季才是伤寒。但经过历年比较发现,温疫四季都有。再研究伤寒,每当严寒之时,虽然有头痛、身痛、恶寒(怕冷)、无汗、发热等症状,总体看起来像太阳病,但到了六七天如果失治,也未曾见其传经(病邪深入脏腑)。每次使用发散解表的药剂,一出汗就痊愈了。偶尔也有不服药自己痊愈的,也从未因为没出汗而导致发黄、说胡话(谵语)、狂乱、舌苔生刺等危重证候。这些都是感冒这种浅表疾病,并非真正的伤寒。伤寒和感冒,都属于感受风寒,只是轻重不同罢了。实际上感冒居多,伤寒很少。况且温疫与伤寒,所感受的邪气有着天壤之别。如今鹿和马已经区分清楚,更可见伤寒在世间极为少见。
张仲景将伤寒视为急症,仓促间若失治,多会导致死亡,因此立论以救济天下后世的人,用心可谓仁爱。然而伤寒与温疫,都是急症。对于较少见的病,他还谆谆告诫世人。至于温疫的数量比伤寒多出百倍,怎么忍心反而置之不论呢?有人说温疫的证候,张仲景原本另有方论,只是因为年代久远,兵火战乱导致湮没,就连《伤寒论》也是称其为散亡之余,王叔和整理立方造论,谎称是全书。温疫的论述未必不是因散佚而失传,这已经很明白了。
崇祯辛巳年(1641年),疫气流行,山东、浙江、南北两直隶地区,感染的人尤其多,到五六月更加严重,甚至导致全家传染。刚开始发病时,当时的医生误用治疗伤寒的方法去救治,没有不见效且危险的。有的病人家属误听信“七日当自愈,否则十四日必愈”的说法,因而延误治疗,有不到期限就死亡的;有的胡乱使用峻猛的药物,攻补无序而死亡的;有的遇到医生见解不到,心里怀疑胆怯,对急病使用缓药,虽然不立即受害,但因拖延而致死的,比比皆是。感受邪气轻的,尚且侥幸存活;感受邪气重的,再加上失治,枉死的人数不胜数。
唉!固守古法不适合当今的疾病,用当今的疾病去简化古书,原书中没有明确的论述,因此投药无效,医生彷徨无措,病人日益危重,病情越急,用药越乱,病人不是死于疾病本身,而是死于医生的误治;不是死于医生的误治,而是死于经典著作的散佚。唉!千载以来,百姓为何如此不幸。我虽然鄙陋,但静心穷究事理,推究其所感受的气、侵入的门径、停留的部位,以及其传变的规律,将我平日所用经过验证的方法,详细叙述如下,以等待高明之士指正。
时间:崇祯壬午年(1642年)仲秋,姑苏洞庭人吴有性(字又可)写于淡淡斋。
The disease known as *Wenyi* (Warm Pestilence) is not caused by wind, cold, summer-heat, or dampness, but by a specific "abnormal qi" (pestilential pathogen) existing in the heaven and earth. Its transmission follows nine patterns, which constitutes the critical juncture in treating pestilence. Yet from ancient times to the present, no one has ever elucidated this. Although Zhang Zhongjing authored the *Treatise on Cold Damage* (*Shanghan Lun*), his methods begin with Taiyang syndrome (an initial stage of external contraction where pathogenic factors affect the exterior), or transmit to Yangming syndrome (pathogen entering the stomach and intestines transforming into heat), or to Shaoyang syndrome (pathogen between the interior and exterior), or the three Yang meridians transmit directly to the Stomach organ. This is because the *Treatise on Cold Damage* was established for external contraction of wind-cold; thus, its transmission pattern is fundamentally different from that of *Wenyi*.
Subsequently, numerous scholars discussed this topic, numbering more than dozens, all interpreting it through the lens of Cold Damage. Their descriptions of *Wenyi* syndromes were extremely brief. Consequently, medical practitioners possessed much recorded knowledge but had nowhere to apply it, inevitably leading to misidentification, such as mistaking a deer for a horse.
Initially, I followed the prevailing view: that spring, summer, and autumn involve warm diseases, while only winter involves Cold Damage. However, upon comparing years, I found that *Wenyi* occurs in all four seasons. Investigating Cold Damage further, during severe cold, although symptoms such as headache, body pain, aversion to cold, absence of sweating, and fever appeared—generally resembling Taiyang syndrome—if left untreated until the sixth or seventh day, transmission to other stages rarely occurred. Each time dispersing and releasing agents were used, recovery followed immediately after sweating. Occasionally, some recovered without medication. Never did failure to sweat result in severe conditions like jaundice, delirium, mania, or prickly tongue coating. These are merely superficial ailments of common colds, not true Cold Damage. Both Cold Damage and common colds involve contracting wind-cold, differing only in severity. In reality, common colds are frequent, while true Cold Damage is rare. Moreover, the pathogens contracted in *Wenyi* and Cold Damage differ vastly. Now that the distinction between deer and horse is clear, it becomes even more evident that Cold Damage is extremely scarce in the world.
Zhang Zhongjing regarded Cold Damage as an urgent condition; hasty neglect often led to death, so he formulated treatises to benefit future generations, demonstrating great benevolence. However, both Cold Damage and *Wenyi* are urgent conditions. For the rarer disease, he earnestly advised the world. Given that *Wenyi* is a hundred times more prevalent than Cold Damage, how could one bear to ignore it? Some argue that Zhang Zhongjing originally had separate treatises for *Wenyi*, but due to the passage of time and destruction by war, they were lost. Even the *Treatise on Cold Damage* is considered a remnant of scattered texts, compiled and fabricated by Wang Shuhe, who falsely claimed it was the complete work. It is clear that discussions on *Wenyi* may also have been lost due to scattering.
In the Xinsi year of the Chongzhen reign (1641), pestilential qi spread widely. Shandong, Zhejiang, and the two Directly Governed Prefectures (Beizhili and Nanzhili) saw high infection rates, worsening in May and June, sometimes infecting entire households. At the onset, contemporary physicians mistakenly treated these cases using methods for Cold Damage, resulting invariably in danger. Some families, misled by the belief that "the seventh day brings self-healing, otherwise the fourteenth day cures," delayed treatment, causing deaths before the expected period. Others recklessly used harsh purgatives or tonics without proper sequence, leading to death. Some encountered physicians lacking insight, who, due to doubt and timidity, used mild remedies for urgent conditions. Although immediate harm was avoided, delays often proved fatal, a phenomenon seen everywhere. Those with mild infections survived by luck; those with severe infections, compounded by mismanagement, died in uncountable numbers.
Alas! Adhering to ancient methods does not suit current diseases. Reducing current diseases to fit ancient texts, which lack explicit discussions, leads to ineffective prescriptions. Physicians wander aimlessly, patients grow increasingly critical, and as urgency increases, medication becomes chaotic. Patients do not die from the disease itself, but from physician error; nor do they die from physician error, but from the loss of canonical wisdom. Alas! How unfortunate the people have been for millennia. Though I am humble and uncultured, I have calmly investigated the principles, analyzing the nature of the contracted qi, the portals of entry, the sites of residence, and the patterns of transmission. Below, I detail the methods I have personally verified and applied, awaiting correction by superior experts.
Written in mid-autumn of the Renwu year of the Chongzhen reign (1642) at Dan Dan Zhai by Wu Youxing (courtesy name Ke Yi) of Dongting, Gusu.