吴又可以温作瘟，竟谓古书无瘟字。不知温病古人未尝无书，仲景先师现有温病上中下
三篇
，至刘河间《原病式》，大率皆言温病。其余论温症者，不可枚举，治温之方，亦不可枚举
。所谓温者，大抵六淫之气，人感之而化为温热时邪是也。至论瘟疫，却无专门。吴又可当
兵荒之际，瘟疫传染，欲另辟一书以济世，何不可有助于医，惜以温为瘟，字义不清，意在
论瘟而说在于温。惟急下一说，合乎温症，其他论说，无非时邪之温病，混时邪于瘟疫，其
贻害匪浅。时邪无时不有，瘟疫轻易不见。果系瘟疫，初病即有臭气触人；时邪初起则不然
，必数日传至阳明腑症，或有气味，然亦只作腐气，不作尸气。瘟疫初发，即作尸气，轻则
盈床，重则满室，诚非急下不可；若系时邪，或感风寒，或系暑湿，或系燥火，或由太阳而
入，或由口鼻而入，仍当按经施治，岂可以下字蔽之乎?后戴麟郊《瘟疫明辨》，较胜于吴
又可之论，惟重用下法。书中有二语云，伤寒下不厌迟，时邪下不厌早，则大有语病，若改
为瘟疫下不厌早，则得矣。至又可达原饮一方，最属夹杂不清。若症属寒耶，何以用黄芩、
知母?症属热耶，何以用草果、浓朴?其意固以为热也，行将下其热，何又助其热?芩、芍、
知母之凉，恐难敌草果、浓朴之燥烈。若云非此不能达膜原，夫膜原近在阳明胃经，达之之
药甚多，方欲急下其热，何必用此燥烈达之也?且从不闻草果、浓朴为达膜原之品也。吴又
可一书，卑卑不足道，原可置之勿论，奈为其所误者，几于相习成风，害人而不知悔，非吴
氏之流毒哉!予故不得不明辨而深斥之。
吴又可书二卷，中有正名一条，因其温疫二字，只用温字，不用瘟字，以为后人添设，
只要称
为疫而已。不知瘟疫二字，义本有辨。瘟属阳毒，疫属阴毒，不得概称热症也。道光五年，
大行疫气，但服大热药则生，不及服则死，俗谓之麻脚瘟，其实寒症也，阴毒也。十二年大
行瘟症，得病即壮热非常，神糊妄语，甚则发狂，稍服燥药，立见致命，服犀角地黄汤则愈
，此瘟症也，阳毒也。此二年中《瘟疫论》之方，无所用之。吾故曰∶又可之书，义理粗率
，不求精详也。如云临症悉见温疫，伤寒百无一二，有是理乎?既以温疫为热症，以三承气
汤为主治，何又先用达原饮耶?经云∶冬伤于寒，春必病温。又云∶冬不藏精，春必病温。
内因、外因皆有温症，但可谓之温，不可谓之瘟，然则瘟疫之瘟，亦不得谓之温也。
或问时邪未尝无瘟症，如大头天行、虾蟆瘟等症，不亦谓瘟疫之类乎?然此等瘟症，究
属时
邪，非同兵荒之后，死亡相继，尸气化为厉气而行瘟也。其治法不离乎东垣先生普济消毒饮
。设又可遇此，亦能和达原饮耶?亦能三承气汤下之耶?
或问时邪盛行之时，亦有逢人传染，似乎瘟疫者，究系六淫之气，而非兵荒之后，厉气
所冲
，见症即当用下者也。《景岳全书》亦有瘟疫一门，而施治之方，无异时邪。他书亦未尝无
论瘟疫者，而亦治同时邪。若有高明，于伤寒外定为时邪一门，于时邪外定为时邪之瘟疫一
门，于时邪之瘟疫外另定天地厉气所中真正瘟疫一门，如此分门别类，按症施治，自可无讹
。惜古无是书，致吴氏混瘟疫于伤寒，谓所医之症，止见瘟疫，不见伤寒，殊不知伤寒与瘟
疫，风马牛不相及，何可相提而并论也?
吴又可认为“温”就是“瘟”，竟然说古书中没有“瘟”这个字。却不知道古人关于温病的著作并非没有，张仲景先师现有《伤寒论》中温病上、中、下三篇，到了刘河间的《原病式》，大体上都在论述温病。其余论述温症的书籍，多得数不过来，治疗温病的方剂，也多得数不过来。所谓的“温”，大抵是六淫之气，人感受了它而化为温热性质的时行邪气罢了。至于论述瘟疫，却没有专门的著作。吴又可处于战乱饥荒之际，瘟疫传染流行，想要另外写一本书来救济世人，这有什么不可以帮助医学的呢？可惜他把“温”当作“瘟”，字义不清晰，本意是想论述瘟疫，但说的却在于温病。只有他提出的“急下（用峻下药攻逐）”这一说法，符合温症的治疗，其他的论述，无非是将时行的温病混同于瘟疫，把时行邪气混杂在瘟疫之中，其造成的危害不小。时行邪气随时随地都有，而瘟疫轻易不会见到。如果是真正的瘟疫，初发病时就有臭气冲人；时行邪气初起则不是这样，必须经过几天传变到阳明腑实证，才可能有气味，但也只是腐臭味，而不是尸臭味。瘟疫刚发作，就散发尸臭味，轻则充满床铺周围，重则充满整个房间，确实非用急下法不可；如果是时行邪气，有的是感受风寒，有的是暑湿，有的是燥火，有的由太阳经传入，有的由口鼻而入，仍然应当按照经络辨证施治，怎么能用一个“下”字来概括呢？后来戴麟郊的《瘟疫明辨》，比吴又可的论述要好一些，只是过于重用下法。书中有两句话：“伤寒下不厌迟，时邪下不厌早”，这就有很大的语病，如果改为“瘟疫下不厌早”，那就对了。至于吴又可的达原饮一方，最为杂乱不清。如果症状属于寒证，为什么用黄芩、知母？症状属于热证，为什么用草果、厚朴？他的本意固然是认为这是热证，打算用下法来清热，为什么又要助长热势？黄芩、白芍、知母的凉性，恐怕难以抵挡草果、厚朴的燥烈之性。如果说不用这些药就不能到达膜原，其实膜原就在阳明胃经附近，能到达膜原的药物很多，既然想急下其热，何必用这种燥烈的药物来通达呢？况且从未听说过草果、厚朴是通达膜原的药物。吴又可的这本书，浅薄不足道，本来可以搁置不论，无奈被它误导的人，几乎习以为常，害人而不知悔改，这不是吴氏留下的流毒吗！所以我不得不明确辨析并深深斥责它。
吴又可的书共二卷，其中有一条讲正名，因为他觉得“温疫”二字，只用“温”字，不用“瘟”字，认为是后人增设的，只要称为“疫”就可以了。却不知道“瘟疫”二字，含义本来有区别。“瘟”属于阳毒，“疫”属于阴毒，不能一概称为热症。道光五年，大行疫气流行，只服用大热药才能生存，不及时服用就会死亡，俗称为“麻脚瘟”，其实是寒症，属于阴毒。道光十二年大行瘟症，得病即壮热非常，神志模糊胡言乱语，甚至发狂，稍微服用燥药，立刻导致致命，服用犀角地黄汤则痊愈，这是瘟症，属于阳毒。在这两年中，《瘟疫论》中的方子，没有一处用得上的。所以我所以说：吴又可的书，义理粗糙草率，不求精细详实。如果说临症所见全是温疫，伤寒百无一二，有这样的道理吗？既然把温疫当作热症，以三承气汤为主治方剂，为什么又先用达原饮呢？《内经》说：“冬伤于寒，春必病温。”又说：“冬不藏精，春必病温。”内因、外因都有温症，只能称之为“温”，不能称之为“瘟”，那么瘟疫的“瘟”，也不能称之为“温”了。
有人问：时行邪气未尝没有瘟症，如大头天行、虾蟆瘟等症，不也是属于瘟疫之类吗？然而这些瘟症，终究属于时行邪气，不同于兵荒马乱之后，死亡相继，尸气化为厉气而行瘟。它们的治疗方法离不开李东垣先生的普济消毒饮。假设吴又可遇到这种情况，他能用达原饮吗？能用三承气汤攻下吗？
有人问：时行邪气盛行之时，也有逢人传染，似乎像瘟疫的情况，但这终究是六淫之气，而非兵荒马乱之后，厉气所冲，见症就应当用下法的。《景岳全书》也有瘟疫一门，而施治的方剂，与时行邪气无异。其他书籍也未尝没有论述瘟疫的，但也按时行邪气来治疗。如果有高明之人，在伤寒之外定为时行邪气一门，在时行邪气之外定为时行邪气的瘟疫一门，在时行邪气的瘟疫之外另定天地厉气所中的真正瘟疫一门，如此分门别类，按症施治，自然可以不出差错。可惜古代没有这样的书，导致吴氏将瘟疫混同于伤寒，说他所治疗的病症，只见瘟疫，不见伤寒，殊不知伤寒与瘟疫，风马牛不相及，怎么可以相提并论呢？
Wu Youke claimed that "wen" (warmth) is the same as "wen" (pestilence), and even asserted that ancient texts do not contain the character for "pestilence." He was unaware that there were indeed ancient books on warm diseases. Zhang Zhongjing, our revered master, has three chapters on warm diseases in his work (Upper, Middle, and Lower). Later, Liu Wansu's *Yuan Bing Shi* (Original Formulas of Diseases) largely discusses warm diseases. There are countless other treatises on warm conditions, and an unenumerable number of formulas for treating them. The term "wen" generally refers to the six exogenous pathogenic factors; when humans contract these, they transform into warm-heat seasonal pathogens. However, regarding pestilence, there was no specialized monograph. Wu Youke lived during a time of war and famine, where pestilence spread contagiously. He wished to write a new book to save lives, which certainly could have contributed to medicine. Regrettably, he conflated "wen" (warmth) with "wen" (pestilence), making the semantic meaning unclear. His intent was to discuss pestilence, but his discourse focused on warmth. Only his theory of "urgent purgation" aligns with warm conditions; his other discussions merely confuse seasonal warm diseases with pestilence, mixing seasonal pathogens with pestilential ones, causing significant harm. Seasonal pathogens exist at all times, whereas pestilence is rarely seen. If it is truly a pestilence, foul odor strikes people from the onset; if it is a seasonal pathogen, this is not the case initially. It takes several days to transmit to the Yangming Fu syndrome (Yangming organ syndrome), where odors might appear, but these are only putrid smells, not the smell of decaying corpses. When pestilence first erupts, it emits the smell of decaying corpses; mildly, it fills the bed area; severely, it fills the room. Urgent purgation is indeed necessary. If it is a seasonal pathogen, whether caused by wind-cold, summerheat-dampness, or dryness-fire, entering via the Taiyang channel or the mouth and nose, treatment should still follow channel differentiation. How can one cover all cases with the single concept of "purgation"? Later, Dai Linjiao's *Yan Yi Ming Bian* (Clarification of Pestilence) was superior to Wu Youke's arguments, though it overemphasized purgation. The book contains two sentences: "For Shanghan (Cold Damage), purgation is never too late; for seasonal pathogens, purgation is never too early." This contains a major logical flaw. If changed to "For pestilence, purgation is never too early," it would be correct. As for Wu Youke's formula, Da Yuan Yin (Reach the Membrane Source Decoction), it is most confused and mixed. If the condition belongs to cold, why use Huangqin (Scutellariae Radix) and Zhimu (Anemarrhenae Rhizoma)? If it belongs to heat, why use Caoguo (Tsaoko Fructus) and Houpo (Magnoliae Officinalis Cortex)? His intention was clearly to treat heat, intending to purge the heat downward, so why assist the heat? The cooling nature of Huangqin, Baishao (Paeoniae Radix Alba), and Zhimu may hardly counteract the drying and acrid nature of Caoguo and Houpo. If one claims these are necessary to reach the membrane source, the membrane source is close to the Stomach channel of Foot-Yangming. Many drugs can reach the membrane source. Since the goal is to urgently purge heat, why use such drying and acrid drugs to reach it? Moreover, it is unheard of that Caoguo and Houpo are herbs that reach the membrane source. Wu Youke's book is shallow and unworthy of discussion; it could have been ignored. However, those misled by it have made it a custom, harming people without remorse. Is this not the toxic legacy of the Wu school! Therefore, I must clearly distinguish and deeply condemn it.
Wu Youke's book consists of two volumes. One section addresses naming conventions. Because he used "Wen" in "Wen Yi" (Warm Pestilence) instead of "Wen" (Pestilence), he believed later generations added characters and that it should simply be called "Yi" (Pestilence). He did not realize that "Wen" and "Yi" have distinct meanings. "Wen" (Pestilence) belongs to Yang Toxicity, while "Yi" belongs to Yin Toxicity; thus, they cannot be broadly classified as heat syndromes. In the fifth year of Daoguang, a severe epidemic prevailed. Patients survived only if given strongly heating medicines; otherwise, they died. Commonly called "Ma Jiao Wen" (Numb-Foot Pestilence), it was actually a Cold Syndrome, belonging to Yin Toxicity. In the twelfth year, a widespread plague occurred. Patients suffered extreme high fever immediately upon infection, confusion, delirium, and even madness. Slightly using drying/acrid medicines led to fatal consequences, but treatment with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) resulted in recovery. This was a "Wen" (Plague) syndrome, belonging to Yang Toxicity. During these two years, none of the formulas from *Wen Yi Lun* (Treatise on Warm Pestilence) were applicable. Thus, I say: Wu Youke's book is rough in principle and lacks precision. Can it be true that clinically observed cases were entirely warm pestilence, with cold damage being one in a hundred? If warm pestilence is considered a heat syndrome and San Chengqi Tang (Three Adjuvant Decoctions) is the main treatment, why use Da Yuan Yin first? The *Classic of Internal Medicine* states: "If harmed by cold in winter, warmth disease will occur in spring." And again: "If essence is not stored in winter, warmth disease will occur in spring." Both internal and external causes can produce warm syndromes. They can be called "Wen" (Warmth), but not "Wen" (Plague). Therefore, the "Wen" in "Wen Yi" cannot be called "Wen" (Warmth).
One might ask: Do seasonal pathogens not include plague-like symptoms, such as Big Head Plague or Mumps? Are these not types of pestilence? However, these plague-like symptoms ultimately belong to seasonal pathogens, differing from the situation after war and famine, where continuous death leads to corpse qi transforming into malignant qi to cause pestilence. Their treatment relies on Li Dongyuan's Pu Ji Xiao Du Yin (Universal Rescue Detoxification Decoction). If Wu Youke encountered this, could he use Da Yuan Yin? Could he use San Chengqi Tang to purge?
Another question: During the peak of seasonal pathogens, there is person-to-person transmission, resembling pestilence. Yet, it remains the six exogenous factors, not the malignant qi of post-war/famine eras requiring immediate purgation. *Jing Yue Quan Shu* (Complete Works of Jingyue) also has a section on pestilence, but its treatments are identical to those for seasonal pathogens. Other books discussing pestilence also treat it like seasonal pathogens. If a skilled physician were to categorize: outside of Shanghan, define a category for seasonal pathogens; outside of seasonal pathogens, define a sub-category for pestilential seasonal pathogens; and outside of that, define a separate category for true pestilence caused by heaven and earth's malignant qi. By classifying thus and treating according to symptoms, errors could be avoided. Unfortunately, ancient texts lacked such classification, leading Wu to confuse pestilence with Shanghan, claiming he only saw pestilence and no Shanghan. Little did he know that Shanghan and pestilence are as unrelated as horses and oxen; how can they be compared?