吴又可曰∶伤寒必有感冒之因，然后头疼身痛，发热恶寒；时疫原无感冒之因，忽觉凛凛，以后但恶热，
不恶寒。伤寒不传染，时疫多传染；伤寒邪从毛窍入，时疫邪从口鼻入；伤寒感而即发，时疫感久乃发。伤寒
投剂，一汗而解；时疫发散，有汗不解；伤寒汗解在前，时疫汗解在后；伤寒投剂，可使立汗∶时疫俟其内溃，乃
得自汗战汗。疫邪始匿募原，根深蒂固，发时与营卫交并，客邪经由之处，营卫无不受伤，故曰溃。然不溃则
不能传，不传则邪不出，邪不出则疾不瘳。伤寒发斑则病笃，时疫发斑则病衰；伤寒感邪在经，以经传经；时
疫感邪在内，内溢于经，经不自传；伤寒感发甚暴，时疫却淹缠加重；伤寒必先发表，时疫必先疏利；种种不
同。所同者，伤寒时疫皆能传胃，故同用承气汤导邪以出也。然疫症下后，多有未能顿解者，由于表里分传，
一半向外传，邪留肌肉；一半向里传，邪留胃腑；留胃
故里气结，表气因而不通，于是肌肉之邪，不能即达肌表。下后里气通，表气亦顺，向郁肌肉，乃或斑或汗，
脱然而愈。伤寒下后无是矣。
〔疫症〕初起三日，葱豉汤加童便热服，汗之。不汗，少顷更服，以汗出热除为度。三服不解而脉浮，
尚属表症，用白虎汤。见里症，用承气汤、解毒汤。表里不分，用凉膈散、双解散加减。汗下后，复见表症，
再与白虎汤。复见里症，更与承气汤。表里热结，用三黄石膏汤、栀豉汤汗之。有汗下三四次而热退者，有
热退后，忽复壮热，用再汗再下而愈者。若脉症皆虚，用清热解毒汤、人中黄丸调之。非如伤寒，有下早变
症之虑，亦非温热不可频下之比，总当以热除邪尽为度。惟下元虚者，非六味生料补其真阴，不能化其余热。
（纂《张氏医通》）初发邪伏募原，营卫交阻，凛寒发热，甚则厥逆，迨阳郁而通，厥回而中外皆热，不可
发汗，宜透其邪，用达原饮。轻者舌苔白而薄，脉不数，可从汗解。重者舌苔如粉，舌根先黄，延及中央，
邪渐入胃，须下之，达原饮加大黄。若脉长洪而数，大汗而渴，此邪适离募原，欲表未表也，白虎汤。舌黄
兼里症，邪已入胃，大小承气汤。凡舌苔白，邪在募原，不可下；苔黄，邪在胃，宜下；黑而芒刺，急下；目
赤咽干，气喷如火，扬手掷足，脉沉数，下之，俱承气汤。凡失下，循衣摸床，撮空肉惕，目不了了，
邪热愈甚，元气将脱者，宜陶氏黄龙汤。既下，急用生脉散加归、芍。痰滞胸膈，瓜贝养荣汤。斑不透，仍热，
举斑汤。屡汗而液枯，人参白虎汤。表症多，里症少，达原饮加大黄、枳实。里症多，表症少，大柴胡汤。燥
结便秘，热结旁流，日久失下，自利黑水。协热下利，潮热便作泄泻。俱承气汤。疫兼痢者危，槟榔顺气汤。
热结下焦，小便不利，导赤散。热瘀发黄，茵陈蒿汤。血蓄膀胱，夜热谵语，桃仁承气汤。妇人病疫，经水
适来，邪入血海，热随血下自愈。小柴胡汤加赤芍、丹皮、生地黄。如结胸状者，血因邪结也，宜刺期门穴。
经水适断，血室乍空，邪乘虚入，难治。柴胡养荣汤。新产亡血，柴胡养荣汤。孕妇病疫，随症施治，以
安胎保胎为主，亦有宜用承气汤者，用之，反得母子俱全，慎勿生疑
掣肘也。（纂吴氏《温疫论》）
〔大头瘟〕湿热伤巅，肿大如斗，赤 无头，或结核有根，令人多汗气蒸。天行疠气，染之多死，乃邪
热客于心肺，上攻头面而为肿也。初则憎寒壮热，体重，头面痛，目不能开，上喘，咽喉不利。甚则堵塞不能
饮食，舌干口燥，恍惚不安，不速治。十死八九。人中黄丸、普济消毒饮子。便硬，加酒大黄一二钱，缓服，
或沈氏头瘟汤。若溃脓，必染人。若发于面部， 赤肿痛，属阳明，普济消毒饮子加石膏。发于耳前后，
额角旁，红肿，属少阳，普济消毒饮子加柴胡、天花粉。发于脑顶后，并耳后赤热肿痛，属太阳，荆防败毒
散去人参，加芩、连。
〔捻颈瘟〕喉痹失音，项大腹胀如虾蟆状，亦名虾蟆瘟。荆防败毒散。
〔瓜瓤瘟〕胸高肋起，呕血如汁。生犀饮，便结加大黄，渴加花粉，虚加盐水炒人参。表热去苍术，
加桂枝、黄连。便脓血，倍黄土，加黄柏。便滑，以人中黄代金汁。
〔杨梅瘟〕遍身紫块，忽然发出霉疮，清热解毒汤，下人中黄丸，并宜刺块出血。
〔疙瘩瘟〕发块如瘤，遍身流走，旦发夕死。急用三棱针刺入委中三分，出血。服人中黄散。
〔绞肠瘟〕肠鸣干呕，水泄不通，类绞肠痧。急宜探吐，服双解散。
〔软脚瘟〕便清泄白，足肿难移。此即湿温症，宜苍术白虎汤。
吴又可说：伤寒必定有感受风寒的诱因，然后才会出现头痛、身体疼痛、发热和恶寒；时疫原本没有感受风寒的诱因，突然觉得寒冷战栗，随后只是怕热，不再怕冷。伤寒不传染，时疫多具有传染性；伤寒的病邪从皮肤毛孔侵入，时疫的病邪从口鼻侵入；伤寒感邪后立即发病，时疫感邪后经过一段时间才发病。治疗伤寒投药后，发一次汗即可痊愈；治疗时疫发散表邪，即使出汗也不能痊愈；伤寒的发汗解表发生在病程前期，时疫的发汗解表发生在病程后期；治疗伤寒投药后，可以立即促使出汗；而时疫必须等待病邪在体内溃散，才能自然出汗或出现战栗出汗。疫毒之邪起初潜伏在募原（半表半里之间），根深蒂固，发病时与营卫之气交争搏结，病邪经过的地方，营卫无不受伤，所以称为“溃”。然而如果不溃散就不能传变，不传变则病邪不能排出，病邪不能排出则疾病不能痊愈。伤寒出现发斑则是病情危重，时疫出现发斑则是病情衰退；伤寒感邪在经络，以经传经（由一经传入另一经）；时疫感邪在内脏，内溢于经络，经络之间不自行传变；伤寒感邪发病非常急暴，时疫却缠绵加重；治疗伤寒必须先发表解表，治疗时疫必须先疏利透达；种种不同之处。相同之处在于，伤寒和时疫都能传变到胃腑，所以都使用承气汤来引导病邪排出。然而时疫症用攻下法后，大多不能立刻痊愈，这是由于病邪分向表里传变，一半向外传变，病邪停留在肌肉；一半向内传变，病邪停留在胃腑；病邪停留在胃里导致里气郁结，表气因此不通畅，于是停留在肌肉的病邪，不能立即到达肌表。攻下之后里气通畅，表气也顺达，先前郁滞在肌肉的病邪，或者通过发斑或者通过出汗，豁然痊愈。伤寒用攻下法后没有这种情况。
〔时疫〕初起三天，用葱豉汤加童便热服，以发汗为治。如果不出汗，过一会儿再服用，以出汗且热退为限度。服用三剂仍不解且脉象浮，尚属表证，使用白虎汤。见到里证，使用承气汤、解毒汤。表里证不分，使用凉膈散、双解散加减。发汗和攻下之后，再次出现表证，再给予白虎汤。再次出现里证，更给予承气汤。表里热结，使用三黄石膏汤、栀豉汤发汗。有的经过三四次发汗攻下后热退，有的在热退后，忽然又出现高热，再用发汗和攻下法而痊愈。如果脉象和症状都表现为虚证，使用清热解毒汤、人中黄丸调理。不像伤寒那样，有过早攻下导致变证的顾虑，也不像温热病那样不可频繁攻下，总应当以热退邪尽为限度。只有下焦元气虚弱的人，不用六味地黄丸生料补益真阴，就不能化解残余的热邪。（编纂自《张氏医通》）
初发时邪气潜伏在募原，营卫交阻，出现恶寒发热，甚至四肢厥逆，等到阳气郁闭而通达，厥逆回温而全身内外皆热，此时不可发汗，宜透达邪气，使用达原饮。轻症者舌苔白而薄，脉象不数，可以从汗而解。重症者舌苔如粉，舌根先变黄，蔓延至中央，邪气逐渐进入胃腑，需要攻下，达原饮加大黄。如果脉象长洪而数，大汗出且口渴，这是邪气刚刚离开募原，想要外达但尚未完全外达的表现，使用白虎汤。舌苔黄兼有里证，邪气已进入胃腑，使用大承气汤或小承气汤。凡是舌苔白，邪气在募原，不可攻下；舌苔黄，邪气在胃，宜攻下；舌苔黑且有芒刺，急用攻下法；眼睛红、咽喉干、气息喷吐如火、扬手掷足、脉象沉数，均用攻下法，都用承气汤。凡是延误攻下，出现循衣摸床、撮空理线、肌肉跳动、目光呆滞，邪热愈盛，元气将脱者，宜用陶氏黄龙汤。已经攻下后，急用生脉散加当归、芍药。痰滞胸膈，用瓜贝养荣汤。斑疹不透，仍然发热，用举斑汤。多次发汗导致津液枯竭，用人参白虎汤。表证多，里证少，用达原饮加大黄、枳实。里证多，表证少，用大柴胡汤。燥结便秘，热结旁流，日久失于攻下，自利黑色稀水。协热下利，潮热伴作泄泻，均用承气汤。时疫兼夹痢疾者危重，用槟榔顺气汤。热结下焦，小便不利，用导赤散。热瘀发黄，用茵陈蒿汤。血蓄膀胱，夜间发热谵语，用桃仁承气汤。妇女患时疫，月经适来，邪气进入血海，热随血下行而自愈，用小柴胡汤加赤芍、丹皮、生地黄。如果像结胸状者，是血因邪气凝结所致，宜针刺期门穴。月经刚断，血室乍空，邪气乘虚而入，难治，用柴胡养荣汤。新产后亡血，用柴胡养荣汤。孕妇患时疫，随症施治，以安胎保胎为主，也有适宜使用承气汤的，使用了反而能母子平安，千万不要产生疑虑而掣肘。（编纂自吴氏《温疫论》）
〔大头瘟〕湿热损伤头部，肿大如斗，红肿无头，或者有结核有根，令人多汗且热气蒸腾。天行疠气，感染后多致死，这是邪热客居于心肺，上攻头面而导致肿胀。初起则憎寒壮热，身体沉重，头面痛，眼睛不能睁开，上气喘促，咽喉不利。严重时堵塞不能饮食，舌干口燥，恍惚不安，不迅速治疗，十死八九。用人中黄丸、普济消毒饮子。大便硬，加酒大黄一二钱，缓服，或者用沈氏头瘟汤。如果溃脓，必定传染他人。如果发于面部，红肿疼痛，属阳明经，普济消毒饮子加石膏。发于耳前后、额角旁，红肿，属少阳经，普济消毒饮子加柴胡、天花粉。发于脑顶后，并耳后赤热肿痛，属太阳经，荆防败毒散去人参，加黄芩、黄连。
〔捻颈瘟〕喉痹失音，颈部肿大腹胀如虾蟆状，也称虾蟆瘟。用荆防败毒散。
〔瓜瓤瘟〕胸部高耸肋骨突起，呕血如汁。用生犀饮，大便结加大黄，口渴加花粉，体虚加盐水炒人参。表热去苍术，加桂枝、黄连。大便脓血，倍用黄土，加黄柏。大便滑泄，用人中黄代替金汁。
〔杨梅瘟〕遍身紫块，忽然发出霉疮，用清热解毒汤，服人中黄丸，并适宜刺破肿块出血。
〔疙瘩瘟〕发块如瘤，遍身流走，早晨发作晚上死亡。急用三棱针刺入委中穴三分深，出血。服人中黄散。
〔绞肠瘟〕肠鸣干呕，水泄不通，类似绞肠痧。急宜探吐，服双解散。
〔软脚瘟〕大便清稀泄白，足肿难以移动。这就是湿温症，宜用苍术白虎汤。
Wu Youke stated: Shanghan (Cold Damage) must have a cause of contracting wind-cold, after which headache, body pain, fever, and aversion to cold occur; Shi Yi (Seasonal Epidemic) originally has no cause of contracting wind-cold, suddenly feeling chilly and shivering, followed only by aversion to heat and no longer aversion to cold. Shanghan is not contagious, whereas Shi Yi is often contagious; the pathogen of Shanghan enters through the hair pores (skin surface), while the pathogen of Shi Yi enters through the mouth and nose; Shanghan manifests immediately upon infection, whereas Shi Yi manifests after a period of time following infection. Upon administering medication for Shanghan, one sweat suffices for resolution; for Shi Yi, dispersing the exterior does not resolve even with sweating; the sweating resolution for Shanghan occurs early in the course, while for Shi Yi it occurs late; administering medication for Shanghan can induce immediate sweating, whereas for Shi Yi one must wait for the internal collapse of the pathogen before spontaneous sweating or chills-sweating can occur. The epidemic pathogen initially hides in the Mu Yuan (semi-exterior semi-interior region), taking deep root; upon manifestation, it clashes with Ying and Wei (Nutritive and Defensive Qi), injuring them wherever the guest pathogen passes, hence termed "collapse". However, without collapse, there is no transmission; without transmission, the pathogen cannot exit; if the pathogen does not exit, the disease does not heal. In Shanghan, the appearance of macules indicates severe illness; in Shi Yi, the appearance of macules indicates declining illness; Shanghan involves pathogens in the meridians, transmitting from meridian to meridian; Shi Yi involves pathogens internally, overflowing into the meridians, without self-transmission among meridians; Shanghan onset is violent and sudden, whereas Shi Yi lingers and worsens; treatment for Shanghan requires first releasing the exterior, while treatment for Shi Yi requires first venting and purging; these are various differences. The similarity is that both Shanghan and Shi Yi can transmit to the Stomach, thus both use Chengqi Tang (Gut-Purging Decoction) to guide the pathogen out. However, after purgation in Shi Yi, resolution is often not immediate, due to the pathogen transmitting separately to the interior and exterior: half transmits outward, remaining in the muscles; half transmits inward, remaining in the Stomach. Retention in the Stomach causes interior Qi stagnation, preventing exterior Qi from flowing freely, so the pathogen in the muscles cannot immediately reach the skin surface. After purgation, interior Qi becomes unblocked, and exterior Qi flows smoothly; the pathogen previously stagnant in the muscles then either erupts as macules or sweats out, resolving abruptly. This does not occur after purgation in Shanghan.
[Shi Yi] In the initial three days, use Congchi Tang (Scallion and Fermented Soybean Decoction) with child's urine taken hot to induce sweating. If no sweat occurs, administer again shortly thereafter, stopping when sweat appears and heat subsides. If unresolved after three doses but the pulse is floating, it still belongs to an exterior syndrome, use Baihu Tang (White Tiger Decoction). If interior signs appear, use Chengqi Tang or Jiedu Tang (Detoxification Decoction). If exterior and interior are indistinguishable, use Liangge San (Cooling the Diaphragm Powder) or Shuangjie San (Double-Release Powder) with modifications. After sweating and purging, if exterior signs reappear, administer Baihu Tang again. If interior signs reappear, administer Chengqi Tang again. For exterior-interior heat binding, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) or Zhichi Tang (Gardenia and Soybean Decoction) to induce sweating. Some cases resolve after three or four rounds of sweating and purging; some experience sudden high fever after heat subsides, requiring further sweating and purging to resolve. If pulse and symptoms both indicate deficiency, use Qingre Jiedu Tang (Heat-Clearing Detoxification Decoction) and Renzhonghuang Wan (Human-Middle-Yellow Pill) to regulate. Unlike Shanghan, there is no concern about premature purgation causing transformation syndromes, nor is it comparable to warm-heat diseases where frequent purgation is contraindicated; the ultimate goal is always the elimination of heat and pathogens. Only in cases of lower jiao (lower burner) deficiency, using Liuwei Disheng San (Six-Ingredient Replenishing Decoction) to tonify true Yin is necessary to transform residual heat. (Compiled from *Zhangshi Yitong*)
At onset, pathogens hide in the Mu Yuan, obstructing Ying and Wei, causing chills and fever, even extremity reversal (Jue Ni); once Yang Qi is blocked and then unblocked, reversal resolves and interior/exterior become hot. At this stage, sweating is contraindicated; instead, vent the pathogen using Daoyin Yin (Reach the Origin Decoction). In mild cases, tongue coating is white and thin, pulse is not rapid, allowing resolution via sweating. In severe cases, tongue coating resembles powder, tongue root turns yellow first, spreading to the center, indicating pathogens gradually entering the Stomach, requiring purgation: Daoyin Yin plus Dahuang (Rhubarb). If the pulse is long, surging, and rapid, with profuse sweating and thirst, this indicates pathogens just leaving the Mu Yuan, attempting to reach the exterior but not yet fully there; use Baihu Tang. Yellow tongue coating with interior signs indicates pathogens have entered the Stomach; use Dachengqi Tang (Major Gut-Purging Decoction) or Xiaochengqi Tang (Minor Gut-Purging Decoction). Generally, white tongue coating means pathogens are in the Mu Yuan, do not purge; yellow coating means pathogens are in the Stomach, purge; black coating with prickles requires urgent purgation; red eyes, dry throat, breath like fire, tossing limbs, deep-rapid pulse all require purgation with Chengqi Tang. If purgation is delayed, leading to grasping at bedclothes, empty hand movements, muscle twitching, and unclear vision, with worsening pathogenic heat and impending exhaustion of Yuan Qi (Primal Qi), use Taoshi Huanglong Tang (Master Tao's Yellow Dragon Decoction). After purgation, urgently use Shengmai San (Generate Pulse Powder) plus Danggui (Angelica Sinensis) and Shaoyao (Peony). For phlegm-stagnation in the chest/diaphragm, use Guabei Yangrong Tang (Melon Seed and Fritillaria Nourishing Righteousness Decoction). For macules not erupting with persistent heat, use Juban Tang (Raise Macules Decoction). For fluid depletion after repeated sweating, use Renshen Baihu Tang (Ginseng White Tiger Decoction). When exterior signs predominate over interior, use Daoyin Yin plus Dahuang and Zhishi (Immature Bitter Orange). When interior signs predominate over exterior, use Chaihu Shugan Tang (Bupleurum Soothing Liver Decoction) - *Note: Text says Dachaihu Tang*. For dry constipation, heat-binding with peripheral flow, or prolonged failure to purge leading to spontaneous passage of black water, or heat-collateral diarrhea with tidal fever and loose stools, use Chengqi Tang. Shi Yi complicated by dysentery is critical; use Binglang Shunqi Tang (Areca Nut Regulating Qi Decoction). Heat-binding in the lower jiao with difficult urination uses Daochi San (Guide Redness Powder). Heat-stasis causing jaundice uses Yinchen Hao Tang (Artemisia Capillaris Decoction). Blood stasis in the Bladder with night fever and delirium uses Taoren Chengqi Tang (Peach Kernel Gut-Purging Decoction). In women with Shi Yi, if menstruation arrives, pathogens enter the Blood Sea, and heat follows blood downward for natural healing; use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Chishao (Red Peony Root), Danpi (Moutan Bark), and Sheng Dihuang (Raw Rehmannia). If resembling Jie Xiong (Chest Binding), it is blood coagulated by pathogens; puncture Qimen Acupoint. If menstruation just ceased, Blood Chamber is temporarily empty, pathogens enter due to deficiency, difficult to treat; use Chaihu Yangrong Tang (Bupleurum Nourishing Righteousness Decoction). Postpartum blood loss uses Chaihu Yangrong Tang. Pregnant women with Shi Yi are treated according to symptoms, prioritizing calming and protecting the fetus; sometimes Chengqi Tang is appropriate, and its use may ensure safety for both mother and child, so do not hesitate or hinder treatment. (Compiled from Wu Shi *Wenyi Lun*)
[Datou Wen / Big Head Plague] Damp-heat damages the vertex, swelling large as a bucket, red and swollen without distinct head, or nodular with roots, causing excessive sweating and steaming heat. Seasonal pestilential qi, if contracted, often leads to death; this is pathogenic heat lodging in Heart and Lungs, attacking the head and face causing swelling. Initially, aversion to cold with high fever, heavy body, head and face pain, inability to open eyes, upper asthma, and throat obstruction. Severe cases lead to blockage preventing eating/drinking, dry tongue, parched mouth, restlessness; without rapid treatment, 80-90% mortality. Use Renzhonghuang Wan or Puji Xiaodu Yinzi (Universal Benefit Detoxification Decoction). If stool is hard, add Jiuhuang (Wine-processed Rhubarb) 1-2 qian, take slowly, or use Shen's Datou Wen Tang. If suppurating, it is infectious. If occurring on the face, red/swollen/painful, belongs to Yangming channel, Puji Xiaodu Yinzi plus Shigao (Gypsum). If occurring around ears/forehead angles, red/swollen, belongs to Shaoyang channel, Puji Xiaodu Yinzi plus Chaihu (Bupleurum) and Tianhuafen (Trichosanthes Root). If occurring on back of head/behind ears, red/hot/swollen/painful, belongs to Taiyang channel, Jingfang Baidu San minus Renshen, plus Huangqin (Scutellaria) and Huanglian (Coptis).
[Nianjing Wen / Twisted Neck Plague] Throat bi (obstruction) with aphonia, neck swelling and abdominal distension like a toad, also called Hamawen. Use Jingfang Baidu San.
[Guanrang Wen / Melon Rind Plague] Chest elevation and rib protrusion, vomiting blood like juice. Use Shengxi Yin (Raw Rhinoceros Horn Decoction); add Dahuang for constipation, Huafen for thirst, salt-fried Renshen for deficiency. Remove Cangzhu (Atractylodes) for exterior heat, add Guizhi (Cinnamon Twig) and Huanglian. Add doubled Houtu (Yellow Earth) and Huangbai (Phellodendron) for bloody/purulent stool. Replace Jinzhi (Golden Juice) with Renzhonghuang for slippery stool.
[Yangmei Wen / Bayberry Plague] Purple patches all over body, suddenly appearing as mold sores. Use Qingre Jiedu Tang, take Renzhonghuang Wan, and puncture patches to bleed.
[Geda Wen / Lump Plague] Lumps like tumors moving all over the body, morning onset evening death. Urgently puncture Weizhong Acupoint 3 cun deep with three-edged needle to bleed. Take Renzhonghuang San.
[Jiaochang Wen / Intestine-Twisting Plague) Bowel sounds, dry retching, complete obstruction of water/stool, similar to Jiaochang Sha. Urgently induce vomiting, take Shuangjie San.
[Ruanjiao Wen / Soft Leg Plague) Clear white diarrhea, foot swelling making movement difficult. This is Wet-Warmth Syndrome; use Cangzhu Baihu Tang (Atractylodes White Tiger Decoction).