温病之于风寒。在太阳病初起时。已自不同。仲景于伤寒中风而外。明揭出太阳病发热
而渴
。不恶寒者为温病。太阳中风。啬啬恶寒。翕翕发热。太阳伤寒。或已发热。或未发热。必
恶
寒。太阳温病。但发热。不恶寒。而其辨证最要之诀。又全在渴之一字。盖风寒之邪。由外
而入。必待传变后里热炽盛。方始口渴。若温病初起便渴。此在太阳病时。早与里热相合。
消烁津液。不即善治。真阴之亡。可立而待。且风寒之病。或微汗。或大汗。或战汗。病随
汗解。温病虽汗不解。若汗出热不退而脉反躁盛者。内经即决为死证。阴精亡故也。故凡治
温病者。当以阴精为至宝。此自轩岐以来一脉相传之宗旨。仲景既揭明温病。苦无专方。
后人以意造方。思补仲景之缺。究未可为典要。以予度之。仲景于中风病。以风为阳邪卫气
易泄。尚不取大发其汗。则温病之不宜发汗。此理断然莫易。内经云。温者清之。意者当
以清里为主。而微
兼解肌可乎。
仲景既言太阳病发热而渴不恶寒为温病。更剔出风温之为病。而特申发汗之禁。是有二
说焉。
温邪内发。误责其汗。卫气既疏。风邪又袭。两阳相合。身反灼热。此一说也。温邪内伏。
少阴既病。肾精不藏。内风易动由里出表。汗出之后。身乃灼热。此又一说也。二说可以并
存
。而其不宜发汗则一也。余按温之为病。本有新邪伏邪之不同。新邪者。内热本郁。适与时
令之温邪相感召。身乃灼热。此病之兼内外因者。伏邪者。阴分自病。风自内生。虽见表热
。其
病全属内因。而绝不关外因。若发汗后而身反灼热者。不惟阳脉本浮。即阴津与汗俱泄。阴
脉亦浮。故脉阴阳俱浮。若自汗出。身重。多眠睡。息必鼾。语言难出。何一非津伤之象。
更逆之以误下。则阴虚重泄其阴。逆之以误火。则阳亢益扰其阳。一误再误。不至促命期不
止。仲景禁例。如此森严。能知其所禁而治法可微会矣。然则治温病者。亦当于未发汗之前
。详审病因。慎勿误治焉可矣。
温病与风寒病，在太阳病初起阶段，就已经有所不同。张仲景在论述伤寒和中风之外，明确指出：太阳病出现发热、口渴，且不恶寒的，属于温病。
太阳中风证，表现为怕冷轻微（啬啬恶寒），发热温和（翕翕发热）；太阳伤寒证，有的已经发热，有的尚未发热，但必定恶寒。而太阳温病，仅表现为发热，不恶寒。其辨证最关键的要诀，全在于“渴”这一字。因为风寒之邪，是从体外侵入的，必须等到病邪传变入里，导致里热炽盛时，才会出现口渴。如果温病在初起时就感到口渴，这说明在太阳病阶段，病邪早已与体内的里热相结合，消耗津液。如果不立即进行妥善治疗，真阴的耗竭，是立等可待的。
此外，风寒类疾病，无论是微汗、大汗还是战汗，病情都会随着汗出而解除；而温病即使出汗，病也不会解除。如果汗出后热势不退，且脉象反而躁动旺盛，《内经》即判定为死证，这是因为阴精亡失的缘故。所以，凡是治疗温病的人，应当把保护阴精视为最宝贵的原则。这是自黄帝、岐伯以来一脉相传的宗旨。
张仲景既然明确了温病的概念，却苦于没有专门的方剂。后人凭主观臆造方子，试图弥补张仲景的缺失，但最终都难以作为典范准则。依我推测，张仲景在治疗中风病时，认为风为阳邪，卫气容易外泄，尚且不采用大发汗的方法，那么温病不宜发汗，这个道理是绝对确定不可改变的。《内经》说：“温病应当用清法。”我想，治疗应当以清解里热为主，同时略微兼用解肌的方法，可以吗？
张仲景既已说明太阳病发热而渴、不恶寒的是温病，又特别剔除并阐述了“风温”这种病症，特别强调禁止发汗。这有两种说法：
第一种说法是：温邪从体内发出，如果错误地责成使用发汗法，导致卫气更加疏泄，风邪再次侵袭，两阳相合，身体反而灼热。
第二种说法是：温邪潜伏于体内，少阴肾经先受病，肾精不能固藏，内风容易由里出表。在发汗之后，身体变得灼热。
这两种说法可以并存，但它们都不宜发汗这一点是一致的。我考察温病这种病症，本来就有新感邪气和伏邪的不同。所谓新感邪气，是指体内热邪原本郁结，恰好与时令的温邪相互感召，身体便出现灼热。这是兼具内外因的疾病。所谓伏邪，是指阴分自身生病，风从内生，虽然表现出表热，但其病完全属于内因，绝不关涉外因。
如果在发汗后身体反而更加灼热，不仅阳脉本已浮大，而且阴津随汗液一起泄露，阴脉也会变得浮大，所以脉象呈现阴阳俱浮。如果有自汗出、身体沉重、嗜睡多眠、呼吸必然鼾声、言语困难等症状，哪一个不是津液损伤的表现？如果再逆其病机误用攻下法，则会进一步耗伤阴虚之体，泄露阴液；再逆其病机误用火疗，则会使阳气亢盛，更加扰乱阳气。一误再误，不到危及生命的地步是不会停止的。张仲景的禁忌条例如此森严，能了解他所禁止的内容，治疗方法就可以大致领会了。然而，治疗温病的人，也应当在未发汗之前，详细审察病因，千万不要误治就可以了。
Wenbing (Warm Diseases) differ from Fenghan (Wind-Cold diseases) right from the initial stage of Taiyang disease (disease pattern of the Bladder meridian). Zhang Zhongjing, besides discussing Shanghan (Cold Damage) and Zhongfeng (Wind Strike), explicitly points out that when Taiyang disease presents with fever, thirst, and aversion to cold is absent, it is classified as Wenbing.
In Taiyang Zhongfeng, symptoms include mild aversion to cold (se-se e han) and moderate fever (xi xi fa re). In Taiyang Shanghan, fever may or may not be present initially, but aversion to cold is always definite. In contrast, Taiyang Wenbing presents only with fever and no aversion to cold. The most crucial key for differentiation lies entirely in the character "thirst". This is because pathogens of Wind-Cold enter from the exterior and must undergo transmission to the interior, where heat becomes intense, before thirst occurs. If thirst appears at the very onset of Wenbing, it indicates that even during the Taiyang stage, the pathogen has already combined with internal heat, consuming body fluids. Without immediate proper treatment, the depletion of True Yin can happen instantly.
Furthermore, in Wind-Cold diseases, whether through slight sweating, profuse sweating, or chills followed by sweating, the illness resolves with the sweat. However, in Wenbing, sweating does not resolve the condition. If fever persists despite sweating and the pulse becomes restless and vigorous, the *Neijing* (Classic of Internal Medicine) declares this a fatal syndrome due to the loss of Yin essence. Therefore, anyone treating Wenbing should regard the preservation of Yin essence as the utmost treasure. This principle has been passed down continuously since Huangdi (Yellow Emperor) and Qibo. Although Zhang Zhongjing clarified the concept of Wenbing, he lacked specific formulas. Later practitioners created formulas based on their own ideas to fill this gap, yet these could not serve as standard guidelines. In my estimation, Zhang Zhongjing, regarding wind as a Yang pathogen that easily disperses Wei Qi (Defensive Qi), did not employ drastic diaphoresis even for Zhongfeng. Thus, it is logically certain that Wenbing should not be treated with diaphoresis. The *Neijing* states: "For warmth, use cooling." I suggest that treatment should primarily focus on clearing internal heat, possibly accompanied by a mild release of the muscle layer.
After stating that Taiyang disease with fever, thirst, and no aversion to cold constitutes Wenbing, Zhang Zhongjing further isolated the pathology of Fengwen (Wind-Warmth) and specifically emphasized the prohibition of diaphoresis. There are two explanations for this:
The first explanation is: When Warm pathogens originate internally, erroneous use of diaphoresis causes Wei Qi to become more dispersed, allowing Wind pathogens to invade again. The combination of two Yangs results in intense burning heat in the body.
The second explanation is: Warm pathogens lie dormant internally. When Shaoyin (Kidney channel) is affected, Kidney Essence fails to store properly, leading to easy movement of internal wind emerging from the interior to the exterior. After sweating, the body becomes intensely hot.
These two explanations can coexist, but both agree that diaphoresis is contraindicated. Upon examination, Wenbing differs between newly acquired pathogens and latent pathogens. Newly acquired pathogens involve pre-existing internal heat郁 (stagnation) that resonates with seasonal warm pathogens, causing burning heat; this involves both internal and external factors. Latent pathogens arise from disease within the Yin aspect, with wind generated internally. Although surface heat is visible, the pathology belongs entirely to internal factors and has nothing to do with external factors.
If the body becomes intensely hot after diaphoresis, not only are the Yang pulses floating, but Yin fluids are also lost along with sweat, causing the Yin pulses to float as well, resulting in floating pulses in both Yin and Yang positions. Symptoms such as spontaneous sweating, heavy body, excessive sleepiness, snoring respiration, and difficulty speaking are all signs of fluid injury. If one further violates the correct treatment by using purgatives incorrectly, it will severely deplete Yin and leak more Yin fluids. If one uses fire therapy incorrectly, it will exacerbate Yang hyperactivity and disturb Yang further. One error after another will inevitably lead to premature death. Zhang Zhongjing’s prohibitions are so strict. Understanding what is prohibited allows one to grasp the therapeutic methods. Therefore, those treating Wenbing must carefully examine the etiology before administering diaphoresis and must avoid erroneous treatment.