凡人胃气强盛，可饥可饱，若久病之后，胃气薄弱，最难调理。盖胃体如灶，胃
气如火，谷食如薪，合水谷之精微，升散为血脉者如焰，其糟粕下转为粪者如烬，是以灶大
则薪多火盛，薪断而余焰犹存，虽薪从续而火亦燃。若些小铛锅，正宜薪数茎，稍多则
壅灭，稍断则火绝。死灰而求复燃，不亦难乎？若
夫大病之后，盖客邪新去，胃口方开，几微之气，所以多与、早与、迟与皆不可也。宜先
与粥饮，次糊饮，次糜粥，次软饭，尤当循序渐进，毋先后其时。当设炉火，昼夜勿令断绝，以备不时
之用，思谷即与，稍缓则胃饥如剡，再缓则胃气伤，反不思食矣。既不思食，若照前与之，
虽食而弗化，弗化则伤之又伤，不为食复者，当如初进法，若更多与，及粘硬之
物，胃气壅甚，必胀满难支，若气绝谷存，乃致反复颠倒，形神俱脱而死矣。
夫疫之传有九，然亦不出乎表里之间而已矣。所谓九传者，病患各得其一，非谓
一病而有九传也。盖温疫之来，邪自口鼻而入，感于膜原，伏而未发者，不知不觉。已发之后
，渐加发热，脉洪而数，此众人相同，宜达原饮疏之。继而邪气一离膜原，察其传变，众人
不同者，以其表里各异耳。有但表而不里者，有但里而不表者，有表而再表者，有里而再
里者，有表里分传者，有表里分传而再分传者，有表胜于里者，有里胜于表者，有先表而后
里者，有先里而后表者，凡此九传，其去病一也。医者不知九传之法，不知邪之所在，如盲者
之不任杖，聋者之听宫商，无音可求，无路可适，未免当汗不汗，当下不下，或颠倒误用
，或寻枝摘叶，但治其证，不治其邪，同归于误一也。
所言但表而不里者，其证头疼身痛发热，而复凛凛，内无胸满腹胀等证，谷食不绝，不烦不
渴。此邪气外传，由肌表而出，或自斑消，或从汗解，斑者有斑疹、桃花斑、紫云斑，汗者有
自汗、盗汗、狂汗、战汗之异，此病气之使然，不必较论，但求得斑得汗为愈疾耳。凡自外传者为
顺，勿药亦能自愈。间有汗出不彻，而热不退者，宜白虎汤；斑出不透，而热不退者，宜举
斑汤；有斑汗并行而愈者，若斑出不透，汗出不彻而热不除者，宜白虎合举斑汤。
间有表而再表者，所发未尽，膜原尚有隐伏之邪，或二、三日后，四、五日后，根据前发热，
脉洪而数，及其解也，斑者仍斑，汗者仍汗而愈，未愈者，仍如前法治之，然亦希有。至于
三表者，更希有也。
若但里而不表者，外无头疼身痛，而后亦无三斑四汗，惟胸膈痞闷，欲吐不吐，虽得少吐而
不快，此邪传里之上者，宜瓜蒂散吐之，邪从其减，邪尽病已。邪传里之中下者，心腹胀满
，不呕不吐，或燥结便闭，或热结旁流，或协热下利，或大肠胶闭，并宜承气辈导去其邪，邪
减病减，邪尽病已。上中下皆病者，不可吐，吐之为逆，但宜承气导之，则在上之邪，顺流
而下，呕吐立止，胀满渐除。
有里而再里者，愈后二、三日或四、五日，根据前之证复发，在上者仍吐之，在下者仍下之，
再里者常事，甚有三里者，希有也。虽有上中下之分，皆为里证。
若表里分传者，始则邪气伏于膜原，膜原者，即半表半里也。此传法以邪气平分，半入于里
，则现里证，半出于表，则现表证，此疫家之常事。然表里俱病，内外壅闭，既不得汗，而
复
中气方能达表，向者郁于肌肉之邪，乘势尽发于肌表矣，或斑或吐，盖随其性而升泄之也。
诸证悉去，既无表里证而热不退者，膜原尚有已发之邪未尽也，宜三消饮调之。
若表里分传而再分传者，照前表里俱病，宜三消饮，复下复汗如前而愈，此亦常事。至有
三发者，亦希有也。
若表胜于里者，膜原伏邪发时，传表之邪多，传里之邪少，何以治之？表证多而里证少，当
治其表，里证兼之；若里证多而表证少者，但治其里，表证自愈。
若先表而后里者，始则但有表证而无里证，宜达原饮。有经证者，当用三阳加法。经证不显
，
但发热者不用加法。继而脉洪大而数，自汗而渴，邪离膜原未能出表耳，宜白虎汤辛凉解散
，邪从汗解，脉静身凉而愈。愈后二、三日
或四、五日后，根据前发热，宜达原饮。至后反加胸满腹胀，不思谷食，烦渴，舌上苔刺等证，
加大黄微利之。久而不去，在上者宜瓜蒂散吐之，如在下者，宜承气汤导之。
若先里而后表者，始则发热，渐盖理证，下之里证除，二、三日内复发热，反加头疼身痛
脉浮者，宜白虎汤。若下后热减不甚，三、四日后，精神不慧，脉浮者宜白虎汤汗之。服汤
后不得汗者，因精液枯竭也，加人参覆卧则汗解。此近表里分传之证，不在此例。
若大下后，大汗后，表里之证悉去，继而一身尽痛，身如被杖，甚则不可反侧，周身骨寒而
痛，非表证也，此不必治，二三日内阳气自回，身痛自愈。
凡疫邪再表再里，或再表里分传者，医家不解，反责病家不善调理，以致反复，病家不解，
每责医家用药有误，致病复起，彼此归咎，胥失之矣！殊不知病势之所当然，盖气性如此，一者不可为二，二者不可为
一，绝非医家病家之过也，但得
病者向赖精神完固，虽再三反复，随复随治，随治随愈。
间有延挨失治，或治之不得其法，日久不除，精神耗竭，嗣后更医，投药固当，现下之邪拔
去，因而得效。殊不知膜原尚有伏邪，在一、二日内，前证复起，反加循衣摸床，神思昏愦，目
中不
及矣。病家不咎于前医耽误时日，反咎于后医既生之而又杀之，良可叹也！
当此之际，攻之则元气几微，是求速死；补之则邪火益炽，精气枯燥；守之则正不胜邪，必
无生理矣。
凡是胃气强盛的人，能够耐受饥饿和饱食；如果是久病之后，胃气变得薄弱，是最难调理的。因为胃体就像灶台，胃气就像火，谷食就像柴薪，将水谷的精微物质升散转化为血脉的就像火焰，而将糟粕向下转化成为粪便的就像灰烬。所以，灶大则柴多火旺，柴断后余焰犹存，虽然重新续上柴薪，火也能再次燃烧。如果是小小的锅铛，正适合几根柴草，稍微多一点就会堵塞使火熄灭，稍微断绝一点火就灭了。死灰想要重新燃烧，不是很难吗？
至于大病之后，外来的邪气刚刚去除，胃口刚刚开启，元气微弱，所以给得太早、太晚都不合适。应该先给予米汤，接着是糊状饮品，然后是稀粥，最后是软饭，尤其应当循序渐进，不要打乱进食的时间顺序。应当像设置炉火一样，昼夜不要让火断绝，以备不时之需。病人想吃东西时就给吃，稍微迟缓一点，胃就会感到饥饿如刀割；再迟缓一点，胃气就会受伤，反而不想吃东西了。既然不想吃东西，如果还按照之前的方法喂食，虽然吃了也不能消化，不能消化就会再次损伤身体，如果不发生“食复”（因饮食不当导致的疾病复发），就当按照最初进补的方法处理；如果给得更多，以及给予粘硬的食物，胃气就会严重壅滞，必然导致胀满难以忍受，如果气绝而谷食滞留体内，就会导致病情反复颠倒，形神俱脱而死。
瘟疫的传变有九种，但也不超出表里之间而已。所谓的九种传变，是指病人各自表现出其中一种情况，并不是说一种病会有九种传变。大概温疫来袭，邪气从口鼻进入，感受于膜原，潜伏而未发作时，人们不知不觉。发作之后，逐渐出现发热，脉象洪大而数，这是众人相同的情况，适宜用达原饮来疏解。继而邪气一旦离开膜原，观察其传变，众人的表现各不相同，这是因为表里的状况各异罢了。有的只在表而不在里，有的只在里而不在表，有的在表又再次在表，有的在里又再次在里，有的表里同时分传，有的表里分传后又再次分传，有的表证重于里证，有的里证重于表证，有的先表而后里，有的先里而后表。凡这九种传变，它们消除疾病的原理是一样的。医生不知道九种传变的方法，不知道邪气所在的位置，就像盲人离不开拐杖，聋人听不到宫商之音，没有声音可以寻求，没有道路可以适应，难免该发汗的不发汗，该攻下的不攻下，或者颠倒误用，或者寻枝摘叶，只治疗症状而不治疗邪气，最终都归于错误。
所谓“只在表而不在里”的情况，症状是头疼身痛发热，并且感到寒冷战栗，内部没有胸满腹胀等症状，饮食正常，不烦躁不口渴。这是邪气向外传变，由肌表而出，有的通过出斑疹消退，有的通过出汗解除。出斑的有斑疹、桃花斑、紫云斑之分，出汗的有自汗、盗汗、狂汗、战汗的区别，这是病气的自然表现，不必过多计较，只要求得斑出或汗出就算病愈。凡是向外传变的属于顺证，不吃药也能自愈。间或有汗出不透彻，而热不退的，适宜用白虎汤；斑出不透，而热不退的，适宜用举斑汤；有斑出和汗出并行而痊愈的，如果斑出不透，汗出不彻而热不除的，适宜用白虎汤合举斑汤。
间或有“在表又再次在表”的情况，所发的邪气未尽，膜原还有隐伏的邪气，或者在两三天后，四五天之后，依据之前的症状再次发热，脉象洪大而数，等到它解除时，出斑的仍然出斑，出汗的仍然出汗而痊愈，未痊愈的，仍然按照前面的方法治疗，但这也很稀少。至于三次在表的，更加稀少。
如果“只在里而不在表”，外部没有头疼身痛，后面也没有三种斑四种汗的症状，只有胸膈痞闷，想吐却吐不出来，即使勉强吐出一些也不畅快，这是邪气传入里的上部，适宜用瓜蒂散催吐，邪气随着呕吐减少，邪气尽除则病愈。邪气传入里的中下部，心腹胀满，不呕不吐，或者燥结便秘，或者热结旁流，或者协热下利，或者大肠胶闭，都适宜用承气类方剂导泻以去除邪气，邪气减少则病症减轻，邪气尽除则病愈。上中下三焦都受病的，不可催吐，催吐是逆治，只适宜用承气汤导泻，那么在上部的邪气，顺着水流而下，呕吐立即停止，胀满逐渐消除。
有“在里又再次在里”的情况，痊愈后两三天或四五天，依据之前的症状复发，在上部的仍然催吐，在下部的仍然攻下，再次在里是常事，甚至有三次在里的，也很稀少。虽然有上中下的区分，但都属于里证。
如果“表里分传”，开始时邪气潜伏在膜原，膜原就是半表半里。这种传变是因为邪气平分，一半进入里，就出现里证，一半出于表，就出现表证，这是瘟疫家的常事。然而表里都生病，内外壅闭，既不能发汗，必须等待中气通达才能达表，先前郁积在肌肉的邪气，乘势全部发于肌表了，或者出斑或者呕吐，这都是顺应其性质而升发宣泄。各种症状都去除了，已经没有表里证而热不退的，说明膜原还有已发的邪气未尽，适宜用三消饮调理。
如果“表里分传而又再次分传”，照前例表里都生病，适宜用三消饮，再次攻下再次发汗如同前法而痊愈，这也是常事。至于有三次发作的，也很稀少。
如果“表胜于里”，膜原伏邪发作时，传向表的邪气多，传向里的邪气少，怎么治疗呢？表证多而里证少，应当治疗表证，兼治里证；如果里证多而表证少，只治疗里证，表证自然会好。
如果“先表而后里”，开始只有表证而没有里证，适宜用达原饮。如果有经证，应当用三阳加法。经证不明显，只是发热的不用加法。继而脉象洪大而数，自汗且口渴，邪气离开膜原但未能出表，适宜用白虎汤辛凉解散，邪气从汗解，脉静身凉而痊愈。痊愈后两三天或四五天之后，依据之前再次发热，适宜用达原饮。到了后来反而加上胸满腹胀，不思饮食，烦躁口渴，舌上有芒刺等症状，加大黄轻微通利。时间久了不去除，在上部的适宜用瓜蒂散催吐，如果在下部的，适宜用承气汤导泻。
如果“先里而后表”，开始发热，逐渐变成里证，攻下后里证消除，两三天内再次发热，反而加上头疼身痛脉浮的，适宜用白虎汤。如果攻下后热减但不明显，三、四天后，精神不振，脉浮的，适宜用白虎汤发汗。服药后不出汗的，是因为精液枯竭，加人参覆盖躺卧则会汗解。这接近表里分传的症状，不在此列。
如果在大攻下后，大汗后，表里的症状都去除了，继而全身疼痛，身体像被棍棒打过一样，甚至不能翻身侧卧，周身骨寒而痛，这不是表证，这不需要治疗，两三天内阳气自然恢复，身痛自愈。
凡是疫邪再次在表、再次在里，或者再次表里分传的，医生不理解，反而责怪病人不善调理，以致病情反复；病人不理解，往往责怪医生用药有误，导致疾病复发，彼此归咎，都失之于偏颇！殊不知这是病势发展的必然结果，大概气性就是这样，一者不能变为二者，二者不能变为一者，绝非医生和病人的过错，只要病人向来依靠精神完固，虽然再三反复，随复发随治疗，随治疗随即痊愈。
间或有拖延失治，或者治疗不得法，日久不除，精神耗竭，随后换医生，投药固然得当，现在的邪气拔除，因而见效。殊不知膜原还有伏邪，在一两天内，前证复发，反而加上循衣摸床，神志昏愦，眼睛无法转动等危象。病人不责怪前医耽误时日，反而责怪后医本来生了病却又杀了他，真是令人叹息！
处于这种情况下，攻伐则元气微弱，是求速死；补益则邪火更炽盛，精气干枯；守旧则正气不胜邪气，必定没有生机了。
Any person with strong Stomach Qi (Wei Qi) can tolerate hunger and fullness; however, after a prolonged illness, when Stomach Qi becomes weak, it is most difficult to regulate. The Stomach organ is like a stove, Stomach Qi is like fire, and food is like firewood. The essence of grain and water that is ascended and dispersed into the blood vessels is like flames, while the dregs that turn downward into feces are like ashes. Therefore, a large stove with much firewood produces strong fire; even if the wood breaks, the residual flame remains, and although new wood is added, the fire burns again. If it is a small pot, only a few stalks of wood are suitable; slightly more will block and extinguish the fire, and slightly less will cause the fire to die out. Is it not difficult to make dead ashes burn again?
As for after a major illness, when pathogenic factors have just been expelled and the appetite has just opened, the vital Qi is minute. Therefore, feeding too early or too late is inappropriate. One should first provide rice soup, then paste-like drinks, then thin porridge, and finally soft rice. It is especially important to proceed step by step without disrupting the timing. One should maintain the fire like a stove, ensuring it never goes out day or night, to be prepared for emergencies. When the patient desires food, give it to them; if delayed slightly, the stomach will feel hungry as if cut; if delayed further, Stomach Qi will be injured, and the patient will lose the desire to eat. Once the desire to eat is lost, if one feeds according to previous methods, although food is ingested, it will not digest. Failure to digest causes further injury. If "food relapse" (recurrence due to improper diet) does not occur, one should follow the initial nourishing method; if more food, especially sticky or hard items, is given, Stomum Qi will be severely obstructed, inevitably leading to unbearable distension. If Qi fails but food remains, it leads to repeated fluctuations, exhaustion of form and spirit, and death.
The transmission of plague has nine types, yet it does not go beyond the exterior and interior. The so-called nine transmissions refer to patients manifesting each type individually, not that one disease has nine transmissions. Generally, when warm plague arrives, pathogens enter via the mouth and nose and lodge in the Membrane Source (Mo Yuan), lying dormant without manifestation, unnoticed by people. After manifestation, fever gradually increases, and the pulse is surging and rapid; this is common among all. It is appropriate to use Da Yuan Yin (Reach the Original Drink) to disperse it. Subsequently, once pathogens leave the Membrane Source, observing their transmission reveals differences among individuals due to varying conditions of the exterior and interior. Some are only in the exterior and not the interior; some only in the interior and not the exterior; some in the exterior and again in the exterior; some in the interior and again in the interior; some transmit simultaneously in both exterior and interior; some transmit simultaneously in both and then again; some have exterior syndrome predominating over interior; some have interior syndrome predominating over exterior; some manifest exterior first then interior; some manifest interior first then exterior. All these nine transmissions share the same principle of eliminating disease. If physicians do not know the methods of the nine transmissions and do not know where the pathogens lie, they are like blind men unable to manage a cane or deaf men unable to hear musical tones, having no sound to seek and no path to follow. They inevitably fail to apply sweating therapy when indicated, or purgation when indicated, or use them incorrectly, or treat symptoms without addressing pathogens, ultimately all resulting in error.
Regarding "only in the exterior and not the interior," symptoms include headache, body pain, fever, and chills, without internal chest fullness or abdominal distension, normal eating habits, no irritability, and no thirst. This indicates pathogens transmitting outward from the muscle layer. Resolution occurs either through the appearance of macules (ban zhen, peach-blossom macules, purple-cloud macules) or through sweating (spontaneous sweating, night sweats, manic sweating, battle sweating). These are natural manifestations of the disease qi and need not be overly debated; recovery is achieved when macules appear or sweat is released. Outward transmission is considered favorable and may resolve spontaneously without medication. Occasionally, if sweating is incomplete and fever persists, Bai Hu Tang (White Tiger Decoction) is appropriate; if macules are incomplete and fever persists, Ju Ban Tang (Raise Macules Decoction) is appropriate; if both macules and sweat occur concurrently for recovery, but macules are incomplete and sweating is insufficient with persistent fever, Bai Hu Tang combined with Ju Ban Tang is appropriate.
Occasionally, there is "in the exterior and again in the exterior." The emitted pathogens are not exhausted, and hidden pathogens remain in the Membrane Source. Two to three days or four to five days later, fever recurs with a surging and rapid pulse. Upon resolution, those with macules still have macules, and those with sweat still sweat, leading to recovery. Those not recovered are treated as before, though this is rare. Three times in the exterior is even rarer.
If "only in the interior and not the exterior," there are no external headaches or body pains, nor the three macules or four types of sweat. There is only epigastric stuffiness, a desire to vomit without success, and discomfort even after slight vomiting. This indicates pathogens transmitting to the upper interior. Gua Di San (Melon Sepal Powder) is appropriate to induce vomiting; as pathogens decrease with vomiting, the disease ends when pathogens are exhausted. For pathogens transmitting to the middle and lower interior, there is heart and abdominal distension, no vomiting, dry constipation, heat-binding with diarrhea, heat-collateral diarrhea, or intestinal glue-blockage. Cheng Qi class formulas (e.g., Da Cheng Qi Tang) are appropriate to guide out pathogens; as pathogens decrease, symptoms lessen, and the disease ends when pathogens are exhausted. If all three jiao are affected, vomiting is contraindicated as it is adverse treatment. Only Cheng Qi formulas should be used to guide pathogens downward; thus, upper pathogens flow down, vomiting stops immediately, and distension gradually resolves.
There is "in the interior and again in the interior." Two to three or four to five days after recovery, symptoms recur. Upper cases are still vomited, lower cases are still purged. Re-involvement of the interior is common; triple involvement is rare. Although divided into upper, middle, and lower, all are interior syndromes.
If "simultaneous exterior-interior transmission," initially pathogens hide in the Membrane Source, which is half-exterior half-interior. This transmission occurs because pathogens divide equally: half entering the interior presents interior symptoms, half exiting the exterior presents exterior symptoms. This is common in plague. However, with both exterior and interior affected and internal-external obstruction, sweating is impossible until Middle Qi reaches the exterior. Previously stagnated pathogens in the muscles erupt onto the skin surface, manifesting as macules or vomiting, following their nature to ascend and vent. When all symptoms cease but fever persists without exterior-interior signs, it indicates unexhausted pathogens in the Membrane Source. San Xiao Yin (Three Eliminations Drink) is appropriate for regulation.
If "simultaneous exterior-interior transmission and again simultaneous transmission," treating simultaneous exterior-interior illness with San Xiao Yin, followed by purgation and sweating as before, leads to recovery. This is common. Triple eruption is rare.
If "exterior predominates over interior," when Membrane Source latent pathogens erupt, more transmit to the exterior and fewer to the interior. How to treat? If exterior symptoms predominate and interior symptoms are few, treat the exterior primarily and address the interior secondarily; if interior symptoms predominate and exterior symptoms are few, treat the interior primarily, and the exterior will resolve spontaneously.
If "exterior first then interior," initially there are only exterior symptoms without interior symptoms. Da Yuan Yin is appropriate. If channel syndromes exist, add the Three Yang modifications. If channel symptoms are not obvious and only fever exists, do not add modifications. Subsequently, with a surging, rapid pulse, spontaneous sweating, and thirst, pathogens have left the Membrane Source but cannot exit the exterior. Bai Hu Tang is appropriate for acrid-cool dispersion; pathogens resolve via sweating, and the patient recovers with a calm pulse and cool body. Two to three or four to five days after recovery, if fever recurs, Da Yuan Yin is appropriate. Later, if chest/abdominal fullness, loss of appetite, irritability, thirst, and prickly tongue coating appear, add Rhubarb (Da Huang) for mild purgation. If lingering, upper cases use Gua Di San to vomit, lower cases use Cheng Qi Tang to guide out.
If "interior first then exterior," initially fever gradually becomes an interior syndrome. After purgation removes interior symptoms, fever returns within two to three days, accompanied by headache, body pain, and floating pulse. Bai Hu Tang is appropriate. If fever decreases slightly after purgation, and after three to four days, mental spirit is dull with a floating pulse, Bai Hu Tang is appropriate to induce sweating. If no sweat occurs after taking the decoction, it is due to exhaustion of fluids and essence; add Ginseng (Ren Shen), cover, and lie down to induce sweating. This resembles simultaneous exterior-interior transmission and is excluded here.
After severe purgation and profuse sweating, if all exterior-interior symptoms disappear, followed by whole-body pain, feeling beaten, inability to turn over, and bone cold/pain throughout, this is not an exterior syndrome. No treatment is needed; Yang Qi returns naturally within two to three days, and pain resolves.
When plague pathogens re-involve the exterior, re-involve the interior, or re-transmit simultaneously in exterior-interior, physicians who do not understand blame patients for poor regulation causing recurrence; patients who do not understand blame physicians for erroneous medication causing relapse. Both blame each other and err. They do not realize this is the inevitable course of the disease's momentum. Nature dictates that one cannot become two, nor two become one. It is neither physician nor patient fault. As long as the patient relies on solid spiritual essence, despite repeated recurrences, timely treatment leads to immediate recovery.
Occasionally, delay in treatment or incorrect methods lead to prolonged illness and exhaustion of spirit. Subsequent physicians may prescribe correctly, removing current pathogens and achieving effect. However, latent pathogens in the Membrane Source remain. Within one to two days, previous symptoms recur, accompanied by grasping at bedclothes, mental confusion, and fixed gaze. Patients blame subsequent physicians for killing them rather than blaming prior physicians for delays. This is lamentable!
At this stage, attacking depletes fragile Yuan Qi, seeking rapid death; tonifying intensifies pathogenic fire, drying essence; maintaining status quo allows Zheng Qi to fail against pathogens, leaving no hope for life.