温病风温 湿 诸证。邪气皆由营卫而入。故仲景皆称太阳病。所以附于太阳之末。
太阳病。发热而渴。不恶寒者为温病。
太阳病者。即首篇所谓头项强痛等证也。因邪由营卫而入。其见证属太阳。故称太阳病。然邪在太阳。
初见表证。虽发热而不渴。然发热亦必恶寒。至邪传阳明而太阳证罢。则发热汗出而不恶寒矣。及至邪入阳
明之里。胃腑热燥。方有渴欲饮水之证。乃中风伤寒之常经也。此则既有太阳见证。则为邪在太阳而非阳明矣。
以发热而即有渴证。又不恶寒。是以谓之温病也。温者。天时温暖之邪气也。在冬则有寒邪。而四时皆有非
时之寒气。感之皆为伤寒。在
春则有风邪。而四时皆有不时之风邪。感之皆为中风。春暖之后。夏至以前。天气已热。未至酷暑。其温暖郁蒸
之气。感之即为温病。是为春温。其冬令有非时之暖。感之则为冬温。至秋肃之时。自应凉风荐爽。若遇不时之
热气郁蒸。感之即为秋温。惟发于春尽夏初者。乃为适当其令之邪气。故内经生气通天论及阴阳应象论。皆曰冬
伤于寒。春必温病。经文之以冬伤于寒而曰春必温病者。盖借天地四时。以喻人身之阴阳脏腑。天人一致之理也。
非谓冬月为寒邪所伤。至春而后为温病也。冬伤于寒之旨。见 症首条。此不多赘。但此条乃温病发源之首。所
以正名定分。言温病之初感。其见证如此。与中风伤寒之首节无异。而未暇立治法也。然其治法终莫之见。岂
当年立法时。竟忘之而未有邪。抑历年久远。散失遗亡而为脱简邪。吾恐忘亦未必竟忘。失也未必尽失。又恐叔
和编次之时。纷杂于六经证治之中而不能辨也。但不知仲景当时作何次序。想汉末至西晋。相去未古。岂遂至遗
亡散失邪。大都为王氏所乱。其所编之书。既行于世。则仲景旧本。皆废弃而无存矣。二千年来。虽名贤继出。
俱无从考正。致后人有仲景长于治伤寒。不长于治温之说。呜呼。仲景医圣。其才力岂遂尽于此邪。今以理揆之。
就此一节。仲景之意。盖谓邪在太阳。以渴而不恶寒者为温病。则其所以别于中风伤寒者固在于此。而其所着意
处。亦在于渴而不恶寒矣。夫渴为温邪所致。而其不恶寒见症。既非阳明。亦是温热之邪所致。所以谓之温病也。
然温邪既有头项强痛之太阳表症。理宜解表。而又有发热而渴。不恶寒等温热之见证。则又当以清解热邪为治矣。
所以麻黄桂枝。皆辛温之药。而麻黄汤但能汗泄其伤寒之阴邪。而不能治温。桂枝但能解散中风之阳邪。而亦不
能治温。非唯不能治温。其温热之性。反足以助邪。故其见证之初。以大青龙汤之凉解。为治温之首剂。而作一大
柱石也。然无汗者宜之耳。其有发
热而渴。不恶寒而汗自出者。不宜更汗。则有桂枝二越婢一汤之法也。其无表证。但热渴而不恶寒者。为已入
阳明。又有白虎汤可用也。至于误汗误下等变。又有中风伤寒篇内之误汗误吐误下之法。可推而变通也。
若见邪归阳明之实热症现。则为热邪入腑。自有舌苔黄黑。燥裂芒刺。谵语神昏。狂乱诸证之可验。则阳
明篇中之承气汤证也。倘有传阴变逆之阴寒证现。则三阴篇中之诸温经法可拟也。其所以但有首条。而
无逐条分治之法者。盖因其所感之邪各异。以六气之偏胜不同。故其初证各自不同。其治法亦不同也。
若其变症。与夫误治传经入阴之证。则其经络脏腑。寒热虚实。与中风伤寒无异。可仿佛求治。世人不知其故。
以为仲景温病之法。止留此二则。而无下文治例。尽叹为遗失之余。惜哉。
若发汗已。身灼热者。名曰风温。风温为病。脉阴阳俱浮。自汗出。身重多眠。睡息必鼾。语言难出。若被下
者。小便不利。直视失溲。若被火者。微发黄色。剧则如惊痫。时螈 。若火熏之。一逆尚引日。再逆促命
期。
言既有太阳见证而已发其汗。汗后则风寒当解散矣。若发汗已而身犹如火之灼热。尚不解者。非独中风。
亦非伤寒也。乃风邪温气并感之证。故名曰风温。盖风为春令之邪。温则初夏之气。乃春尽夏初。风邪未退。
热气初来。以冬脏之寒水受伤。则寒水不能固养其真阳。失精泄汗。使藏阳败泄。至春令而少阳肝胆。不能布其阳
气于皮肤。以致卫外之阳气衰微。腠理不密。使风邪温气并入。而成风温病也。故曰冬伤于寒。春必温病。
然风温之为病也。其脉与风寒各异。伤寒则寒伤营分。寒邪深入。故脉阴阳俱紧。中风则风邪伤卫。邪气但伤阳气。
故脉阳浮而阴弱。风温之
脉。则风邪伤卫气。而阳脉浮。温热之邪伤阴分而阴脉亦浮也。所谓脉之阴阳者。如辨脉篇所谓寸口脉阴阳俱紧
之阴阳。是以浮候为阳。沉候为阴。此所谓阴阳脉俱浮。则以寸口为阳。尺中为阴。即关前为阳。关后为阴之
法也。阳脉浮。则风邪伤卫。毛孔不闭。故汗自出。即上编阳浮热自发。阴弱汗自出之义也。阴脉浮。则热伤阴分。
温邪熏灼。郁冒神昏。故身重多眠。而昏睡中之鼻息。必 鼾也。其语言难出者。非舌强失音喑哑之病。乃神昏
不语也。若此者。自汗既不宜于麻黄之更发其汗。亦不宜于桂枝之温解敛汗。当以凉解之法治之。若桂枝二越婢一
之类可拟也。风温之邪在经。则里邪未实。自不宜于攻下。若被下者。必里虚邪陷。使太阳之温邪。内入太阳之腑。
热犯膀胱。致热邪癃闭而小便不利也。直视失溲者。足太阳膀胱绝也。始则热邪癃闭而不利。终则膀胱气绝而失溲。
素问胗要经终论云。太阳之脉。其终也。戴眼反折。 。其色白。汗乃出。出则死矣。且温热之邪。岂宜以火济火。
自不当以火劫汗。若被火者。火助风威。热乘火势。微者火热内郁而发黄。阳明篇所谓瘀热在里。必发黄也。其剧者。
则心神昏乱而狂越。如惊骇癫痫之状。太阴阳明论中。以阳明气血盛。邪客之则热。热甚则恶火。前篇太阳伤寒。
加温针尚且必惊。况于温病乎。温病得火。内外充斥。浸淫于脏腑肌肉筋骨之间。所以时时 也。 者。筋骨 动。
十指抽掣。臂 坚劲。转侧而不自知也。若用火熏劫汗之法。是不循法度。不知避忌。谓之逆治。一逆治之。即
不可救。然犹能迁延时日。若再逆之。是促其绝命之期矣。温邪中人。火逆之害如此。以此推之。辛温之治。亦所
当审矣。
形作伤寒。其脉不弦紧而弱。弱者必渴。被火者必谵语。弱者发热。脉浮解之。当汗出愈。
此温病之似伤寒者也。形作伤寒者。谓其形象有似乎伤寒。亦有头项强痛。发热体痛。恶寒无汗之证。而实非伤寒
也。因其脉不似伤寒之弦紧而反弱。弱者。细软无力之谓也。如今之发斑者。每见轻软细数无伦之脉。而其实则口
燥舌焦。齿垢目赤。发热谵语。乃脉不应证之病也。故弱者必渴。以脉虽似弱。而邪热则盛于里。故胃热
而渴也。以邪热炽盛之证。又形似伤寒之无汗。故误用火劫取汗之法。必至温邪得火。邪热愈炽。胃热神昏而
语言不伦。遂成至剧难治之病矣。若前所谓其脉不弦紧而弱者。身发热而又见浮脉。乃弱脉变为浮脉。为邪气还
表而复归于太阳也。宜用解散之法。当汗出而愈矣。
病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬气。上冲咽喉不得息者。此为胸有寒也。当吐之。宜瓜
蒂散。
此温病之似中风者也。解见痞症条下。
温病、风温、湿病等各种证候,邪气都是从营卫而入的。所以张仲景都称之为太阳病。因此这些内容附在太阳病的末尾。
太阳病中,发热且口渴,不恶寒的,称为温病。
所谓太阳病,就是首篇所说的头项强痛等证候。因为邪气从营卫而入,其表现属于太阳经,所以称为太阳病。然而邪气在太阳经时,初起虽有表证,虽然发热但并不口渴;而且发热也必然伴随恶寒。等到邪气传入阳明,而太阳证候消失后,才会出现发热、汗出且不恶寒的情况。到了邪气深入阳明之里,胃腑热燥,才会有想要饮水的口渴症状。这是中风和伤寒的正常传变规律。这里既有太阳经的表现,说明邪气还在太阳经而不是阳明经。因为发热同时就伴有口渴,而且不恶寒,所以称之为温病。“温”,是指天时温暖的气候邪气。在冬季有寒邪,而四季都有不合时令的寒气,感受了都称为伤寒。在春季有风邪,而四季都有不合时令的风邪,感受了都称为中风。春暖之后,夏至以前,天气已经炎热,但还未到酷暑的程度,这种温暖郁蒸之气,感受了就会成为温病。这被称为春温。如果在冬季出现不合时令的温暖气候,感受了则称为冬温。到了秋季肃杀之时,本应是凉风送爽,如果遇到不合时令的热气郁蒸,感受了则称为秋温。只有发生在春末夏初的,才是正当令的邪气。所以《内经·生气通天论》和《阴阳应象大论》都说“冬伤于寒,春必温病”。经文之所以说冬天受寒邪伤害,春天必定发生温病,大概是借天地四时的变化,来比喻人身阴阳脏腑的关系,体现天人相应的道理。并不是说冬天被寒邪所伤,到了春天才变成温病。“冬伤于寒”的含义,见本书首条症状描述,这里不再赘述。只是这一条是温病发源的起始,所以要正名定分,说明温病初感时的证候如此,与中风、伤寒的首节没有区别,只是还没来得及确立治疗方法。然而最终也没有看到具体的治法,难道是当年立法时竟然忘记了而没有制定吗?还是因为年代久远,散失遗亡导致简牍脱漏呢?我担心未必是完全忘记,也未必是完全遗失。又恐怕是王叔和编次的时候,混杂在六经证治之中而不能分辨清楚。只是不知道张仲景当时是如何排序的。想从汉末到西晋,时间相隔并不古老,怎么会完全遗散遗失呢?大概是被王叔和搞乱了。他所编纂的书既然流行于世,那么张仲景的原著就都被废弃而不存了。两千年来,虽然名医辈出,都无从考证纠正,导致后人认为张仲景擅长治疗伤寒,却不擅长治疗温病。唉!张仲景是医圣,他的才华难道仅仅局限于此吗?现在根据道理推测,就这一节来看,张仲景的意思大概是:邪气在太阳经,以口渴且不恶寒作为温病的特征,那么它区别于中风和伤寒的地方确实就在这里,而他着重的地方,也在于口渴且不恶寒。口渴是由温邪引起的,而其不恶寒的表现,既然不是阳明病,也是由温热邪气引起的,所以称之为温病。然而温邪既然有头项强痛这样的太阳表证,按理应该解表;但同时又有发热而口渴、不恶寒等温热见证,那么又应当以清解热邪为治疗方法。所以麻黄、桂枝都是辛温的药物,麻黄汤只能发汗宣泄伤寒的阴邪,而不能治疗温病;桂枝只能解散中风的阳邪,也不能治疗温病。不仅不能治疗温病,它们的温热性质反而足以助长邪气。所以在证候初起时,以大青龙汤的凉解之法,作为治疗温病的首选方剂,作为一个大的支柱。但是,无汗的患者才适宜使用。那些发热而口渴、不恶寒且自然出汗的患者,不宜再发汗,则有桂枝二越婢一汤的方法。那些没有表证,只是热、渴且不恶寒的,说明已经入阳明,又有白虎汤可以使用。至于误汗、误下等变证,又有中风、伤寒篇内的误汗、误吐、误下的方法,可以推演变通。
如果见到邪气归入阳明出现的实热证候,那就是热邪入腑,自然会有舌苔黄黑、干燥开裂生芒刺、谵语神昏、狂乱等证候可以验证,这就是阳明篇中的承气汤证。如果有传变入阴、逆转为阴寒证候出现,那么三阴篇中的各种温经方法可以参考。之所以只有首条,而没有逐条分别的治疗法则,大概是因为所感受的邪气各异,由于六气偏胜不同,所以初起证候各自不同,治疗方法也不同。至于变证,以及误治传经入阴的证候,那么经络脏腑、寒热虚实,与中风、伤寒没有区别,可以仿照寻求治疗。世人不知道其中的缘故,认为张仲景治疗温病的方法只留下这两条,而没有后续的治例,都感叹为遗失的残余,可惜啊。
如果发汗后,身体灼热的,称为风温。风温这个病,脉象寸关尺俱浮,自汗出,身体沉重,多嗜睡,睡觉时呼吸一定打鼾,说话困难。如果被误用攻下法的,会出现小便不利,直视,大小便失禁。如果被误用火疗的,轻微的发黄色,严重的像惊痫一样,时时抽搐。如果用火熏法,一次误治还能拖延时日,再次误治就会加速死亡。
意思是既有太阳经的证候,已经发了汗,汗后风寒应当解散了。如果发汗后身体仍然像火烧一样灼热,还不解除的,不仅仅是中风,也不是伤寒。而是风邪和温气同时感受的证候,所以称为风温。盖因风是春季的邪气,温是初夏的气候,正是春末夏初,风邪未退,热气初来,因为冬季肾脏的寒水受伤,则寒水不能固养真阳,精气外泄、汗液流失,使脏阳败坏泄漏,到了春季少阳肝胆之气,不能将其阳气布散于皮肤,以致卫外的阳气衰微,腠理不致密,使得风邪和温气并入,而成风温病。所以说“冬伤于寒,春必温病”。
然而风温这个病,其脉象与风寒不同。伤寒则是寒伤营分,寒邪深入,所以脉象寸关尺俱紧;中风则是风邪伤卫,邪气只伤阳气,所以脉象阳部浮而阴部弱。风温的脉象,则是风邪伤卫气,阳脉浮;温热邪气伤阴分,阴脉也浮。所谓脉的阴阳,如《辨脉篇》所说的寸口脉阴阳俱紧的阴阳,是以浮取为阳,沉取为阴。这里所说的阴阳脉俱浮,则是以寸口为阳,尺中为阴,即关前为阳,关后阴的方法。阳脉浮,说明风邪伤卫,毛孔不闭合,所以自汗出;也就是上编所说的阳浮热自发,阴弱汗自出的含义。阴脉浮,说明热伤阴分,温邪熏灼,郁冒神昏,所以身体沉重多嗜睡,而在昏睡中的鼻息,一定打鼾。其说话困难的原因,不是舌强失音喑哑的病,而是神昏不语。像这种情况,自汗出既不适合用麻黄再发其汗,也不适合用桂枝温解敛汗,应当用凉解法治之。可以用桂枝二越婢一汤之类参考。风温的邪气在经脉,则里邪未实,自然不适合攻下。如果被误用攻下法,必然导致里虚邪陷,使太阳的温邪内入太阳之腑,热犯膀胱,导致热邪癃闭而小便不利。直视失溲,是足太阳膀胱经气绝的表现。开始是热邪癃闭而小便不利,最终是膀胱气绝而大小便失禁。《素问·诊要经终论》说:“太阳之脉,其终也,戴眼反折,瘛疭,其色白,汗乃出,出则死矣。”况且温热邪气,岂能用火来济火,自然不应当用火劫汗法。如果被误用火疗,火助风威,热乘火势,轻微的火热内郁而发黄,阳明篇所说的瘀热在里,必定发黄。严重的,心神昏乱而狂越,像惊骇癫痫的样子。《太阴阳明论》中,认为阳明气血盛,邪气客居则热,热甚则厌恶火。前篇太阳伤寒,加温针尚且必定惊恐,何况是温病呢?温病得火,内外充斥,浸淫于脏腑肌肉筋骨之间,所以时时抽搐。瘛疭,是指筋骨抽动,十指抽掣,手臂僵硬劲急,转动侧身而不自知。如果用火熏劫汗的方法,是不遵循法度,不知道避忌,称为逆治。一次误治,就不可救药,然而还能迁延时日,如果再误治,就是加速其死亡了。温邪中人,火逆的危害如此,由此推断,辛温的治疗方法,也应当审慎。
外形像伤寒,但其脉不弦紧而弱。脉弱的必定口渴,被误用火疗的必定谵语。脉弱且发热,脉浮的应当解表,当汗出而愈。
这是温病类似伤寒的情况。外形像伤寒,是说其形象似乎有伤寒的特征,也有头项强痛、发热体痛、恶寒无汗的证候,但实际上并非伤寒。因为其脉不像伤寒的弦紧反而弱。弱,是指细软无力。就像如今发斑疹的人,常看见轻软细数无比的脉象,而实际上却是口燥舌焦、齿垢目赤、发热谵语,这是脉象与证候不符的病。所以脉弱必定口渴,因为脉虽似弱,但邪热则盛于里,所以胃热而渴。以邪热炽盛的证候,又外形像伤寒的无汗,所以误用火劫取汗的方法,必然导致温邪得火,邪热更加炽盛,胃热神昏而语言错乱,遂成至剧难治的病。如果前面所说的脉不弦紧而弱,身体发热而又见浮脉,乃是弱脉变为浮脉,为邪气还表而复归于太阳。宜用解散的方法,当汗出而愈。
病症像桂枝证,但头不痛,项不强,寸脉微浮,胸中痞硬,气上冲咽喉不得呼吸的,这是胸中有寒饮。应当用吐法,宜用瓜蒂散。
这是温病类似中风的情况。解释见痞症条目下。
Wenbing (Warm Disease), Fengwen (Wind-Warmth), and various syndromes of Shi (Dampness). The pathogenic factors all enter through Ying (Nutritive) and Wei (Defensive). Therefore, Zhang Zhongjing refers to them all as Taiyang Disease (Disease of the Taiyang/Bladder channel). Hence, they are appended at the end of Taiyang Disease.
In Taiyang Disease, those presenting with fever, thirst, and aversion to cold absent are termed Wenbing (Warm Disease).
Taiyang Disease refers to the symptoms mentioned in the first chapter, such as stiffness and pain in the head and neck. Because the pathogen enters via Ying and Wei, and the manifestations belong to the Taiyang channel, it is called Taiyang Disease. However, when the pathogen is in Taiyang, although there are initial exterior signs and fever, there is no thirst yet; moreover, fever must be accompanied by aversion to cold. Only when the pathogen transmits to Yangming and the Taiyang signs resolve will there be fever, sweating, and absence of aversion to cold. When the pathogen enters the interior of Yangming, causing heat and dryness in the stomach fu-organ, only then does the symptom of thirst desire for water appear. This is the normal progression of Zhongfeng (Wind Strike) and Shanghan (Cold Damage). Here, since there are Taiyang manifestations, it indicates the pathogen is still in Taiyang, not Yangming. Because fever occurs simultaneously with thirst, and there is no aversion to cold, it is called Wenbing. "Wen" (Warm) refers to the pathogenic factor of warm weather. In winter, there is Cold pathogen; however, throughout the four seasons, there are also out-of-season cold air, which, if contracted, is called Shanghan. In spring, there is Wind pathogen; however, throughout the four seasons, there are also out-of-season wind, which, if contracted, is called Zhongfeng. After spring warmth arrives, before Summer Solstice, the weather is already hot but not yet scorching. Contracting this warm, muggy, and steaming qi results in Wenbing. This is called Chunwen (Spring Warmth). If there is unseasonable warmth during winter, contracting it results in Dongwen (Winter Warmth). In autumn, when the air should be crisp and cool due to its肃 (desiccating/clearing) nature, encountering unseasonable hot, muggy qi results in Qiuwen (Autumn Warmth). Only that which arises at the end of spring and beginning of summer corresponds to the appropriate seasonal pathogen. Thus, both *Shengqi Tongtian Lun* (Treatise on Living Qi and Heaven's Connection) and *Yinyang Yingxiang Lun* (Treatise on Yin-Yang Correspondences) in the *Neijing* state: "If injured by Cold in winter, one will inevitably suffer from Warm Disease in spring." The scripture's statement that winter injury by Cold leads to spring Warm Disease is likely using the changes of heaven and earth across the four seasons to metaphorically illustrate the relationship between human Yin-Yang and Zang-Fu organs, reflecting the principle of consistency between Heaven and Humanity. It does not mean that being injured by Cold in winter directly transforms into Warm Disease in spring. The meaning of "Winter Injury by Cold" is seen in the first symptom entry; I will not elaborate further here. This section serves as the origin of Wenbing, establishing its name and classification, describing the initial manifestations upon contraction, which are no different from the initial stages of Zhongfeng and Shanghan, yet no treatment method is established at this point. However, the specific treatment methods are ultimately absent. Was it simply forgotten or never formulated when the laws were originally established? Or has it been lost due to the passage of time, resulting in missing bamboo slips? I fear it was not entirely forgotten, nor completely lost. I suspect that when Wang Shuhe compiled the text, he may have mixed it within the Six Channels' syndrome treatments without being able to distinguish it clearly. I do not know how Zhang Zhongjing ordered it originally. From the late Han Dynasty to the Western Jin Dynasty, the time gap was not ancient; how could it have been so thoroughly lost? It is largely believed that Wang Shuhe disrupted the order. Since his compiled book became popular, Zhang Zhongjing's original texts were discarded and lost. For two thousand years, although famous physicians emerged successively, none could verify and correct this, leading later generations to believe Zhang Zhongjing excelled in treating Shanghan but not Wenbing. Alas! Zhang Zhongjing is the Sage of Medicine; surely his talent did not end here? Now, reasoning based on principles, regarding this section, Zhang Zhongjing's intent seems to be: When the pathogen is in Taiyang, identifying Wenbing by the presence of thirst and absence of aversion to cold distinguishes it from Zhongfeng and Shanghan. His focus lies precisely in these symptoms. Thirst is caused by Warm pathogen; the absence of aversion to cold, given it is not Yangming disease, is also caused by Warm-Heat pathogen, hence the name Wenbing. Although Wen pathogen presents with Taiyang exterior signs like head and neck stiffness, requiring exterior resolution, the simultaneous presence of fever, thirst, and absence of aversion to cold indicates that clearing and resolving Heat is necessary. Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) are both acrid-warm medicines. Mahuang Tang can only induce sweating to vent the Yin pathogen of Shanghan, but cannot treat Wenbing; Guizhi Tang can only disperse the Yang pathogen of Zhongfeng, but also cannot treat Wenbing. Not only can they not treat Wenbing, their warm-natured properties may actually assist the pathogen. Therefore, at the onset of symptoms, Da Qinglong Tang (Major Green Dragon Decoction) for cooling resolution is used as the primary formula for treating Wenbing, serving as a major pillar. However, this is suitable only for those without sweating. For those with fever, thirst, absence of aversion to cold, and spontaneous sweating, further sweating is inappropriate; thus, the method of Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Mason Jar Decoction) applies. For those without exterior signs, presenting only with heat, thirst, and absence of aversion to cold, the pathogen has entered Yangming, where Baihu Tang (White Tiger Decoction) is applicable. As for complications from erroneous sweating, purging, etc., the methods for erroneous sweating, vomiting, and purging found in the Zhongfeng and Shanghan chapters can be deduced and adapted.
If real-heat symptoms of Yangming are observed, indicating Heat pathogen entering the Fu organs, there will naturally be yellow or black tongue coating, dryness, cracking, prickles, delirium, coma, and mania, verifying the Chengqi Tang (Gut-Clearing Decoction) syndromes in the Yangming chapter. If transmission to Yin channels occurs, presenting with Yin-Cold reversal syndromes, the various warming meridian methods in the Three Yin chapters can be referenced. The reason there is only the initial entry without itemized treatment methods is likely because the contracted pathogens vary, and the excesses of the Six Qi differ, leading to distinct initial syndromes and varying treatment approaches. Regarding subsequent complicated syndromes and syndromes resulting from erroneous treatment transmitting to Yin channels, the meridians, Zang-Fu organs, Cold-Heat, and Deficiency-Excess patterns are no different from Zhongfeng and Shanghan, allowing for similar therapeutic strategies. People unaware of this reason believe Zhang Zhongjing's methods for Wenbing consist only of these two entries, lamenting the lack of subsequent treatment examples as lost remnants. What a pity!
If after inducing sweating, the body becomes burning hot, it is named Fengwen (Wind-Warmth). In Fengwen disease, the pulse is floating at all positions (Cun, Guan, Chi); there is spontaneous sweating; the body feels heavy; there is excessive sleepiness; breathing during sleep is necessarily snoring; and speech is difficult. If erroneously treated with purgatives, there will be difficulty urinating, fixed staring, and loss of bowel/bladder control. If erroneously treated with fire therapy, mild cases present with yellowish discoloration; severe cases resemble convulsive epilepsy with periodic spasms. If treated with moxibustion/fumigation, one error may prolong life slightly, but a second error will hasten death.
This means that although there were Taiyang signs and sweating was induced, after sweating, Wind-Cold should have resolved. If the body remains burning hot after sweating, it is neither Zhongfeng nor Shanghan. It is a syndrome of simultaneous contraction of Wind pathogen and Warm Qi, hence named Fengwen. Wind is the pathogen of Spring; Warmth is the climate of early Summer. At the end of Spring and beginning of Summer, Wind pathogen has not receded, and Warm Qi begins to arrive. Because the Kidney Water (associated with Winter) was injured, it cannot properly nourish True Yang, leading to leakage of Essence and sweat, causing the failure of Zang Yang. By Spring, the Shaoyang Liver and Gallbladder cannot distribute Yang Qi to the skin, resulting in weak defensive Yang and loose interstices, allowing Wind and Warm Qi to combine and form Fengwen disease. Hence, "Winter injury by Cold leads to Spring Warm Disease."
However, the pulse in Fengwen differs from Wind-Cold. In Shanghan, Cold injures Ying, penetrating deeply, so the pulse is tight at all positions. In Zhongfeng, Wind injures Wei, affecting only Yang Qi, so the pulse is floating at Yang positions and weak at Yin positions. In Fengwen, Wind injures Wei Qi, making the Yang pulse float; Warm-Heat injures Yin Fen, making the Yin pulse also float. The "Yin and Yang" of the pulse, as described in *Bian Mai Pian* (Differentiating Pulse Chapter) regarding "tight pulse at all positions," refers to superficial (Yang) and deep (Yin) palpation. Here, "floating at both Yin and Yang pulses" refers to Cun (Yang) and Chi (Yin), i.e., anterior to Guan (Yang) and posterior to Guan (Yin). A floating Yang pulse indicates Wind injuring Wei, pores not closing, leading to spontaneous sweating—consistent with the earlier concept of "Yang floating causes spontaneous heat, Yin weak causes spontaneous sweating." A floating Yin pulse indicates Heat injuring Yin Fen; Warm pathogen steams and scorches, causing oppression, dizziness, and mental clouding, leading to heaviness and sleepiness, with snoring during sleep. Difficulty speaking is not due to tongue stiffness or aphonia, but rather mental clouding preventing speech. In such cases, since there is spontaneous sweating, Ma Huang Tang is inappropriate for further sweating, and Guizhi Tang is inappropriate for warm resolution and sweat retention. Cooling resolution is required, such as Guizhi Er Yuebi Yi Tang. With Fengwen pathogen in the meridians, interior excess is absent, so purgation is unsuitable. Erroneous purgation leads to interior deficiency and pathogen sinking, causing Taiyang Warm pathogen to enter the Taiyang Fu organ (Bladder), where Heat attacks the Bladder, leading to urinary obstruction and difficulty urinating. Fixed staring and loss of bowel/bladder control indicate the exhaustion of Foot-Taiyang Bladder channel Qi. Initially, Heat causes urinary obstruction; finally, Bladder Qi exhaustion causes incontinence. *Suwen: Zhen Yao Jing Zhong Lun* states: "When the Taiyang pulse terminates, eyes roll back, opisthotonos, spasms, color turns white, sweat appears, and death follows." Moreover, Warm-Heat pathogen should not be treated with Fire to add Heat. Erroneous fire therapy allows Fire to boost Wind and Heat to ride the Fire's momentum. Mild cases result in internal stagnation of Fire-Heat causing jaundice ("stagnant Heat in the interior causes jaundice" per Yangming chapter). Severe cases cause mental confusion and mania, resembling fright-induced epilepsy. *Taiyin Yangming Lun* notes that Yangming has abundant Qi and Blood; when pathogen invades, Heat generates; extreme Heat repels Fire. In the previous Shanghan chapter, even adding acupuncture to Taiyang Cold causes fright; how much more so for Wenbing? Fire applied to Wenbing fills the interior and exterior, permeating Zang-Fu, muscles, sinews, bones, and tendons, causing frequent spasms. Spasms (*Chi Zong*) refer to twitching of sinews and bones, pulling of ten fingers, stiffness of arms, and involuntary turning of the body. Using fire fumigation to induce sweating violates medical principles and taboos, termed "reverse treatment." One reverse treatment may be incurable but delay death; a second reverse treatment accelerates demise. The harm of Fire reversal in Wenpathogen invasion is thus; by analogy, acrid-warm treatments must also be scrutinized carefully.
The appearance resembles Shanghan, but the pulse is not wiry-tight but weak. Weakness implies thirst; if treated with Fire, delirium ensues. Weakness with fever: if the pulse floats, resolve the exterior; sweating should occur for recovery.
This describes Wenbing mimicking Shanghan. "Resembling Shanghan" means the presentation appears similar, with head/neck stiffness, fever, body ache, aversion to cold, and anhidrosis, yet it is not truly Shanghan. The pulse differs from Shanghan's wiry-tightness, appearing weak instead. "Weak" means fine, soft, and forceless. Similar to patients with macules/purpura who often show extremely fine, rapid, and soft pulses despite having dry mouth, scorched tongue, dental plaque, red eyes, fever, and delirium—a mismatch between pulse and syndrome. Thus, weakness implies thirst because, although the pulse seems weak, the pathogenic Heat is abundant internally, causing Stomach Heat and thirst. Given the intense Heat and apparent Shanghan-like anhidrosis, erroneous use of Fire therapy to induce sweating causes the Warm pathogen to merge with Fire, intensifying Heat, leading to Stomach Heat, mental clouding, and incoherent speech, becoming a severe, difficult-to-treat condition. If the previously mentioned pulse shifts from weak to floating while the body remains febrile, it indicates the pathogen returning to the exterior and reverting to Taiyang. Exterior-resolving methods should be used, and recovery follows with sweating.
Symptoms resemble Guizhi Tang syndrome, but without headache or neck stiffness. The Cun pulse is slightly floating. There is chest fullness and hardness, with Qi rushing up to the throat, obstructing respiration. This indicates Cold-Phlegm in the Chest. Vomiting is indicated; Gua Di San (Melon Sepal Powder) is appropriate.
This describes Wenbing mimicking Zhongfeng. Explanation is found under the Pi Syndrome (Fullness Syndrome) entry.