门人又问曰。夫子向言吴又可温疫论。其所列温疫各证。即今之湿温病。今言湿温初起
治法
。但当于化湿之中。佐以清温。则吴氏达原饮。当必有合。而今人每訾吴氏为偏于用下。夫
子亦言湿温初起。不宜妄下。若吴氏之书。其不能无弊与。答曰。吴又可觑破此等证。与风
寒之邪。由外而入者不同。其所定达原饮一方。浓朴槟榔草果。破结以化湿。知母黄芩芍药
甘草。和阴以清温。当时服之者称为仙方。然吴氏目此病为温疫。指为异气所致。未尝明言
湿温。至喻嘉言辨明温疫。谓湿温即包疫而言。今以吴氏所列种种各证与今病相参。始知
其所指温疫。即今之湿温病。此则无心暗合。至于传变之后。仍不离仲景种种救逆诸法。故
吾谓吴氏立论。虽似撇开仲景。反足为仲景之功臣。至湿家病。仲景本有下早之禁。而吴氏
亦有邪
未入胃不宜妄下之戒。若入胃之后。不予以急下大下。则津液立涸。且风寒之邪传入阳明。
而成胃实可攻之证。一下即解。湿温系粘着之邪多有下之未尽。仍须再下者。此实病机之使
然。而不得议其偏于用下也。倘不传入胃。便不得妄下。凡风寒之种种传变。湿温病皆得有
之。并有转属寒证。宜用温药而愈者。此又吴氏论中之所未及。亟当从仲景追寻渊源矣。
门人又问道:“老师先前提到吴又可的《温疫论》,其中所列出的温疫各种证候,就是现在的湿温病。现在说湿温初起的治法,应当在化湿之中,佐以清热祛湿的方法,那么吴氏的达原饮方剂,应当是适用的。然而现在的人常常指责吴氏偏重于使用攻下法。老师您也说过湿温初起,不应当妄用攻下法。如果吴氏的书中有弊端吗?”
我回答说:“吴又可洞察到这类证候,与风寒之邪由外侵入的不同。他所制定的达原饮一方中,厚朴、槟榔、草果,能破结滞以化湿;知母、黄芩、芍药、甘草,能和养阴液以清温。当时服用此方的人称之为‘仙方’。然而吴氏将此病称为温疫,指认为是异气(特殊的致病邪气)所致,未曾明确说明是湿温。直到喻嘉言辨明温疫,认为湿温包含在疫病之中。如今将吴氏所列的各种证候与现在的疾病相互参照,才知道他所指的温疫,就是现在的湿温病。这可以说是无心之中的暗合。至于病情传变之后,仍然离不开张仲景种种救逆的治疗方法。所以我称吴氏的立论,虽然看似撇开了张仲景的理论,反而足以成为张仲景的功臣。
至于患湿家病(素体有湿或感受湿邪之人),张仲景原本就有过早使用攻下法的禁忌,而吴氏也有邪气未入胃腑时不应当妄用攻下法的告诫。如果邪气进入胃腑之后,不给以急下、大下的治疗,那么津液就会立刻枯竭。况且风寒之邪传入阳明经,形成可以攻下的胃实证,一下就能解除。湿温属于粘着难解的邪气,多有攻下未尽的情况,仍然需要再次攻下。这是病机使然,不能指责他偏重于使用攻下法。倘若邪气没有传入胃腑,就不可以妄用攻下法。凡是风寒之邪的种种传变,湿温病也都可能出现。并且还有转化为寒证,适宜使用温药而痊愈的情况。这又是吴氏论述中所未涉及到的,急切地应当从张仲景那里追寻渊源了。”
The disciple asked again, "Master previously mentioned Wu Youke's *Treatise on Warm Epidemics* (*Wenyi Lun*). The various syndromes of warm epidemics listed therein are precisely what we now call damp-warmth disease. Regarding the treatment of damp-warmth at its onset, it is stated that one should assist in clearing warmth while resolving dampness. Therefore, Wu's *Danyuan Yin* (Origin-Reaching Decoction) should be applicable. However, contemporary practitioners often criticize Wu for being biased towards using purgatives. You also stated that damp-warmth at its onset should not be treated with reckless purging. Does this imply that Wu's book has flaws?"
I replied, "Wu Youke discerned that such syndromes differ from wind-cold pathogens entering from the exterior. In his prescribed formula *Danyuan Yin* (Origin-Reaching Decoction), Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), and Caoguo (Tsaoko Fructus) break stagnation to resolve dampness; Zhimu (Anemarrhenae Rhizoma), Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix Alba), and Gancao (Glycyrrhizae Radix et Rhizoma) harmonize and nourish yin to clear warmth. At that time, those who took it called it a 'fairy prescription' (*Xian Fang*). However, Wu designated this disease as 'warm epidemic' (*Wen Yi*), attributing it to 'heterogeneous qi' (*Yi Qi*, specific pathogenic factors), and did not explicitly state it was 'damp-warmth'. It was not until Yu Jiayan clarified warm epidemics, asserting that damp-warmth is encompassed within epidemics, that the connection became clear. By cross-referencing the various syndromes listed by Wu with current diseases, we realize that the 'warm epidemics' he referred to are indeed today's damp-warmth disease. This appears to be an unconscious coincidence. As for subsequent transmission, the treatments still rely on Zhang Zhongjing's various methods for rescuing deviations. Thus, I argue that although Wu's theoretical stance seems to depart from Zhang Zhongjing, he actually serves as a meritorious contributor to Zhang's legacy.
Regarding patients with chronic dampness (*Shi Jia*), Zhang Zhongjing originally established a prohibition against premature purging. Wu also cautioned against reckless purging when pathogens have not yet entered the stomach. However, once pathogens enter the stomach, failing to employ urgent or heavy purging would cause body fluids to dry up immediately. Furthermore, when wind-cold pathogens transmit to the Yangming channel, forming excess conditions in the stomach suitable for attack, a single purge suffices. Damp-warmth involves sticky and adherent pathogens; often, one purge is insufficient, requiring repeated purging. This is dictated by the pathology of the disease, and one cannot accuse him of bias towards purging. If pathogens have not transmitted to the stomach, reckless purging must not be used. All manner of transmissions seen in wind-cold can also occur in damp-warmth. Moreover, there are cases where the condition transforms into a cold syndrome, which heals with warming herbs. These aspects were not covered in Wu's treatise and urgently require tracing back to the origins in Zhang Zhongjing's works."