治温病初得，头疼，周身骨节酸疼，肌肤壮热，背微恶寒无汗，脉浮滑者。
薄荷叶（四钱） 蝉蜕（三钱，去足土） 生石膏（六钱，捣细） 甘草（一钱五分）
《伤寒论》曰∶“太阳病，发热而渴，不恶寒者，为温病。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，言语难出。”此仲景论温病之提纲也。乃提纲详矣，而后未
明言治温病之方。及反复详细观之，乃知《伤寒论》中，原有治温病方，且亦明言治温病方，特涉猎观之不知
耳。六十一节云∶“发汗后，不可更行桂枝汤。汗出而喘，无大热者，可与麻黄、杏仁、甘草、石膏汤主之。”夫
此证既汗后不解，必是用辛热之药，发不恶寒证之汗，即温病提纲中，所谓若发汗已也（提纲中所谓若发汗，
是用辛热之药强发温病之汗）。其汗出而喘，无大热者，即温病提纲中，所谓若发汗已，身灼热及后所谓自汗
出、多眠睡、息必鼾也。睡而息鼾，醒则喘矣。此证既用辛热之药，误发于前，仲景恐医者见其自汗，再误认
为桂枝汤证，故特戒之曰∶不可更行桂枝汤，而宜治以麻杏甘石汤。此节与温病提纲遥遥相应，合读之则了如
指掌。然麻杏甘石汤，诚为治温病初得之的方矣。而愚于发表药中不用麻黄，而用薄荷、蝉蜕者，曾于葛根黄
芩黄连汤解后详论之，兹不再赘。
今者论温病之书甚伙，而郑卫红紫，适足乱真。愚本《内
经》、仲景，间附以管见，知温病大纲，当分为三端。今逐端详论，胪列于下，庶分途施治，不至错误。
一为春温。其证因冬月薄受外感，不至即病。所受之邪，伏于膜原之间，阻塞脉络，不能宣通，暗生内热。
迨至春日阳生，内蕴之热，原有萌动之机，而复薄受外感，与之相触，则陡然而发，表里俱热，《内经》所谓
“冬伤于寒，春必病温”者是也，
宜治以拙拟凉解汤。热甚者，治以拙拟寒解汤。有汗者，宜仲景葛根黄连黄芩汤，或拙拟和解汤，加生石膏。
若至发于暑月，又名为暑温，其热尤甚。初得即有脉洪长，渴嗜凉水者，宜投以大剂白虎汤，或拙拟仙露汤。
一为风温。犹是外感之风寒也，其时令已温，外感之气已转而为温，故不名曰伤寒、伤风，而名风温，即
《伤寒论》中所谓风温之为病者是也。然其证有得之春初者，有得之春暮者，有得之夏秋者，当随时序之寒热，
参以脉象，而分别治之。若当春初秋末，时令在寒温之间，初得时虽不恶寒，脉但浮而无热象者，宜用拙拟清
解汤，加麻黄一二钱，或用仲景大青龙汤。若当暑热之日，其脉象浮而且洪者，用拙拟凉解汤，或寒解汤。若
有汗者，用拙拟和解汤，或酌加生石膏。
一为湿温。其证多得之溽暑。阴雨连旬，湿气随呼吸之气，传入上焦，窒塞胸中大气。因致营卫之气不相
贯通，其肌表有似外感拘束，而非外感也。其舌苔白而滑腻，微带灰色。当用解肌利便之药，俾湿气由汗与小
便而出，如拙拟宣解汤是也。仲景之猪苓汤，去阿胶，加连翘亦可用。至湿热蓄久，阳明府实，有治以白虎汤，
加苍术者，其方亦佳。而愚则用白虎汤，以滑石易知母，又或不用粳米，而以生薏米代之。至于“冬不藏精，
春必病温”，《内经》虽有明文，其证即寓于风温、春温之中。盖内虚之人，易受外感，而阴虚蕴热之人，尤
易受温病。故无论风温、春
温之兼阴虚者，当其发表、清解、降下之时，皆宜佐以滋阴之品，若生山药、生地黄、玄参、阿胶、生鸡子黄
之类均可酌用，或宜兼用补气之品，若白虎汤之加人参，竹叶石膏汤之用人参，诚以人参与凉润之药并用，不
但补气，实大能滋阴也。
上所论温病，乃别其大纲及其初得治法。至其证之详悉，与治法之随证变通，皆备于后之方案中。至于疫
病，乃天地之疠气，流行传染，与温病迥异。
方中薄荷叶，宜用其嫩绿者。至其梗，宜用于理气药中，若以之发汗，则力减半矣。若其色不绿而苍，则
其力尤减。若果嫩绿之叶，方中用三钱即可。
薄荷气味近于冰片，最善透窍。其力内至脏腑筋骨，外至腠理皮毛，皆能透达，故能治温病中之筋骨作疼
者。若谓其气质清轻，但能发皮肤之汗，则浅之乎视薄荷矣。
蝉蜕去足者，去其前之两大足也。此足甚刚硬，有开破之力。若用之退目翳消疮疡，带此足更佳。若用之
发汗，则宜去之，盖不欲其于发表中，寓开破之力也。
蝉蜕性微凉、味淡，原非辛散之品，而能发汗者，因其以皮达皮也。此乃发汗中之妙药，有身弱不任发表
者，用之最佳。且温病恒有兼瘾疹者，蝉蜕尤善托瘾疹外出也。
石膏性微寒，《神农本草经》原有明文。虽系石药，实为平和之品。且其质甚重，六钱不过一大撮耳。其
凉力，不过与知母三钱等。而其清火之力则倍之，因其凉而能散也。尝观后世治温之方，至阳明府实之时，始
敢用石膏五六钱，岂能知石膏者哉！然必须生用方妥， 者用至一两，即足偾事。又此方所主之证，或兼背微
恶寒，乃热郁于中，不能外达之征，非真恶寒也。白虎汤证中，亦恒有如此者，用石膏透达其热，则不恶寒矣。
或问∶外感中于太阳则恶寒，中于阳明则不恶寒而发热。时
至春、夏，气候温热，故外感之来，不与寒水相感召，而与燥金相感召，直从身前阳明经络袭入，而为温病。
后世论温病者，多是此说。而《伤寒论》温病提纲，冠之以太阳病者何也？答曰∶温病初得，亦多在太阳，特
其转阳明甚速耳。
曾治一人，年二十余。当仲夏夜寝，因夜凉，盖单衾冻醒，发懒，仍如此睡去。须臾又冻醒，晨起微觉恶
寒。至巳时已觉表里大热，兼喘促，脉洪长而浮。投以清解汤，方中生石膏，改用两半，又加牛蒡子（炒捣）
三钱，服后得汗而愈。由斯观之，其初非中于太阳乎，然不专在太阳也。人之所以觉凉者，由于衣衾之薄。其
气候究非寒凉，故其中于人不专在太阳，而兼在阳明。且当其时，人多蕴内热，是以转阳明甚速也，然此所论
者风温耳。若至冬受春发，或夏发之温，恒有与太阳无涉者。故《伤寒论》温病提纲中，特别之曰∶风温之为
病，明其异于“冬伤于寒，春必病温”之温病也。又杏仁与牛蒡子，皆能降肺定喘，而杏仁性温、牛蒡子性
凉，伤寒喘证，皆用杏仁，而温病不宜用温药，故以牛蒡子代之。
附录∶
直隶盐山孙××来函∶
一九二五年春，一人来津学木工。因身体单薄，又兼天热，得温病，请为诊视。脉浮数而滑，舌苔白浓，
时时昏睡。为开清解汤，生石膏用一两，为其脉数，又加玄参五钱，一剂病愈。
斯年仲春，俞××之三位女儿皆出瘟疹。生为诊视，皆投以清解汤，加连翘、生地、滑石而愈。同时之患此
证者，势多危险。惟生投以此方，皆能随手奏效。
治疗温病初起，出现头痛，周身骨节酸痛，肌肤高热，背部轻微怕冷且无汗，脉象浮滑的病症。
薄荷叶（四钱） 蝉蜕（三钱，去掉足和泥土杂质） 生石膏（六钱，捣碎成细末） 甘草（一钱五分）
《伤寒论》中说：“太阳病（太阳经受邪所致的病证），发热而且口渴，不怕冷的，称为温病。如果发汗后，身体灼热的，称为风温（感受风热之邪所致的外感热病）。风温这种病，脉象寸关尺三部都浮，自汗出，身体沉重，嗜睡，呼吸一定伴有鼾声，言语困难。”这是张仲景论述温病的提纲。虽然提纲很详细，但后面没有明确说明治疗温病的方剂。等到反复详细观察后，才知道《伤寒论》中原本就有治疗温病的方子，并且也明确提到了治疗温病的方剂，只是粗略浏览的人不知道罢了。第六十一节说：“发汗后，不可再用桂枝汤（调和营卫、解肌发表的经典方剂）。汗出而气喘，没有大热的，可以用麻黄、杏仁、甘草、石膏汤主治。”这个证候既然发汗后没有解除，必定是使用了辛热性质的药物，去发那些本不该恶寒的证候的汗，也就是温病提纲中所说的“若发汗已”（提纲中所说的若发汗，是指用辛热药物强行发温病的汗）。其汗出而气喘，没有大热，就是温病提纲中所说的“若发汗已，身体灼热”以及后来所说的“自汗出、多眠睡、呼吸必伴鼾声”。睡觉时呼吸有鼾声，醒来就会气喘。这个证候既然之前误用了辛热药物发汗，张仲景恐怕医生见到其自汗，再次误认为是桂枝汤证，所以特别告诫说：不可再用桂枝汤，而应该用麻杏甘石汤治疗。这一节与温病提纲遥相呼应，合起来读就一目了然了。然而麻杏甘石汤，确实是治疗温病初起的对症良方。而我对于发表药中不用麻黄，而用薄荷、蝉蜕的原因，曾在解释葛根黄芩黄连汤时详细论述过，这里不再赘述。
现在论述温病的书籍很多，但真伪混杂，足以扰乱视听。我依据《黄帝内经》和张仲景的理论，间或附上个人的见解，认为温病的总纲，应当分为三个方面。现在逐一详细论述，列举如下，以便分途施治，不至于出错。
一是春温。这种病症是因为冬天轻微感受外邪，当时并未立即发病。所受之邪，潜伏在膜原（半表半里之间）之间，阻塞脉络，不能宣通，暗中产生内热。等到春天阳气生发，体内蕴积的热气，本来就有萌动的趋势，如果再轻微感受外邪，与之相触，就会突然发作，表里都热，这就是《内经》所说的“冬天伤害于寒邪，春天必定发生温病”的情况，适宜用我拟定的凉解汤治疗。热势严重的，用我拟定的寒解汤治疗。有汗的，适宜用张仲景的葛根黄连黄芩汤，或者我拟定的和解汤，加生石膏。如果到了暑月发作，又名为暑温，其热势更加严重。初起即有脉象洪大长直，口渴喜欢喝凉水的，适宜投以大剂量的白虎汤（清热生津的重剂），或者我拟定的仙露汤。
二是风温。仍然是外感的风寒之邪，但其时令已经变暖，外感之气已经转变为温性，所以不叫伤寒、伤风，而叫风温，即《伤寒论》中所说的风温这种病。然而这种病症有的发生在初春，有的发生在春末，有的发生在夏秋季节，应当根据时序的寒热变化，参考脉象，分别治疗。如果在初春或秋末，时令处于寒温之间，初起时虽然不怕冷，脉象仅浮而没有热象的，适宜用我拟定的清解汤，加麻黄一两到二钱，或者用张仲景的大青龙汤（发汗解表，兼清里热的方剂）。如果在暑热天气，其脉象浮而且洪大的，用我拟定的凉解汤，或者寒解汤。如果有汗的，用我拟定的和解汤，或者酌情加生石膏。
三是湿温。这种病症大多得之于潮湿闷热的暑天。阴雨连绵数十日，湿气随着呼吸之气，传入上焦，窒塞胸中的大气（宗气）。导致营卫之气不相贯通，其肌表有类似外感拘束的感觉，但实际上并非外感。其舌苔白而滑腻，微带灰色。应当使用解肌利小便的药物，使湿气通过汗液和小便排出，比如我拟定的宣解汤就是这样。张仲景的猪苓汤（利水渗湿清热方），去掉阿胶，加连翘也可以使用。至于湿热蓄积日久，形成阳明腑实证，有用白虎汤加苍术治疗的，那个方子也很好。而我则用白虎汤，以滑石代替知母，或者不用粳米，而以生薏米代替。至于“冬天不藏精，春天必定生病温”，《内经》虽然有明文记载，但这种证候其实包含在风温、春温之中。大概内虚之人，容易受外感侵袭，而阴虚蕴热之人，尤其容易患温病。所以无论是风温、春温兼有阴虚的，在其发表、清解、降下的时候，都适宜辅助使用滋阴的药物，如生山药、生地黄、玄参、阿胶、生鸡子黄之类都可以酌情使用，或者适宜兼用补气之品，如白虎汤中加入人参，竹叶石膏汤中使用人参，确实因为人参与凉润药物并用，不但补气，实在非常能够滋阴。
上面所论述的温病，是辨别其总纲及其初起的治疗方法。至于病症的详细情况，以及治疗方法随证候变化的灵活性，都备载于后面的方案中。至于疫病，是天地间的疠气，流行传染，与温病截然不同。
方中的薄荷叶，适宜选用嫩绿色的。至于它的梗，适宜用于理气药中，如果用来发汗，药效就要减半了。如果颜色不绿而发苍老，那么药效更是减弱。如果是确切的嫩绿叶，方中用三钱就可以了。
薄荷的气味接近冰片，最善于透达孔窍。其药力内至脏腑筋骨，外至腠理皮毛，都能透达，所以能治疗温病中筋骨疼痛的症状。如果说它气质清轻，只能发皮肤之汗，那就看浅了薄荷的功效了。
蝉蜕去掉足，是去掉前面的两大只脚。这双脚非常刚硬，有开破的力量。如果用它来退目翳、消疮疡，带着这双脚更好。如果用它来发汗，则应该去掉，因为不想它在发表的同时，含有开破的力量。
蝉蜕性质微凉，味道淡，原本不是辛散的药物，却能发汗，是因为它以皮达皮（以虫体之皮对应人体之皮）。这是发汗中的妙药，身体虚弱不能耐受强力发表药的人，用它最佳。而且温病常常兼有瘾疹（荨麻疹类皮肤病），蝉蜕尤其善于托举瘾疹外出。
石膏性质微寒，《神农本草经》原有明文记载。虽然属于石药，实际上是非常平和的药物。而且它的质地很重，六钱不过是一大撮而已。其凉性力量，不过相当于三钱知母。而其清火力量则是知母的两倍，因为它凉而能散。曾观察到后世治疗温病的方子，到了阳明腑实的时候，才敢用石膏五六钱，这哪里算是了解石膏的人呢！然而必须生用才稳妥，煅用的话用到一两，就会坏事。另外此方所主治的证候，有时兼有背部轻微怕冷，这是热气郁结在内部，不能向外通达的表现，并不是真正的恶寒。在白虎汤证中，也常有这种情况，用石膏透达其热，就不怕冷了。
有人问：外感病邪侵入太阳经则怕冷，侵入阳明经则不怕冷而发热。时至春夏，气候温热，所以外感来袭，不与寒水相应，而与燥金相应，直接从身前阳明经络袭入，从而成为温病。后世论述温病的人，多是这种说法。而《伤寒论》温病提纲，冠以“太阳病”名称的原因是什么呢？回答说：温病初起，也多在太阳经，只是其转入阳明经的速度非常快罢了。
曾经治疗一个人，二十多岁。正当仲夏之夜睡觉，因为夜凉，盖单被冻醒，感到懒倦，仍然这样睡去。一会儿又被冻醒，早晨起来微微觉得怕冷。到了巳时（上午9-11点）已经觉得表里大热，兼有气喘急促，脉象洪大长直而浮。投以清解汤，方中生石膏，改为一两半，又加牛蒡子（炒熟捣碎）三钱，服药后出汗而痊愈。由此看来，其初起难道不是中于太阳吗？然而并不专在太阳。人之所以觉得凉，是由于衣被单薄。其气候终究不是寒凉的，所以他中于人不仅仅在太阳，也兼涉阳明。而且在这个时候，人多体内蕴积热气，所以转入阳明非常快。然而这里论述的是风温。如果到了冬天受邪春天发作，或者夏天发作的温病，常常有与太阳无关的。所以《伤寒论》温病提纲中，特别指出：风温这种病，明确说明它异于“冬伤于寒，春必病温”的温病。另外杏仁与牛蒡子，都能降肺气定喘，而杏仁性温、牛蒡子性凉，伤寒气喘证，都用杏仁，而温病不宜用温药，所以用牛蒡子代替。
附录：
直隶盐山孙××来信：
一九二五年春天，一个人来天津学木工。因为身体单薄，又加上天气热，得了温病，请我为他诊视。脉象浮数而滑，舌苔白厚浓浊，时时昏睡。为他开了清解汤，生石膏用一两，因为其脉数，又加玄参五钱，一剂病愈。
同年仲春，俞××的三位女儿都出了瘟疹（出疹性传染病）。我为她们诊视，都投以清解汤，加连翘、生地、滑石而痊愈。同时患此证的人，形势大多危险。只有我投以此方，都能随手奏效。
Treatment for the initial stage of warm disease (Wen Bing), characterized by headache, soreness and pain in the joints of the whole body, high fever of the skin and muscles, slight aversion to cold on the back, absence of sweating, and a floating and slippery pulse.
Bohe Ye (Menthae Haplocalycis Folium, Mint Leaf) - 4 qian
Chantui (Cicadae Periostracum, Cicada Slough) - 3 qian (remove feet and earth impurities)
Sheng Shigao (Gypsum Fibrosum, Raw Gypsum) - 6 qian (crushed into fine powder)
Gancao (Glycyrrhizae Radix et Rhizoma, Licorice Root) - 1.5 qian
The *Shanghan Lun* (Treatise on Cold Damage Disorders) states: "Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), with fever and thirst, and no aversion to cold, is called Warm Disease. If after inducing sweating, the body becomes burning hot, it is called Wind-Warmth (Feng Wen). In Wind-Warmth, the pulse is floating at all three positions (cun, guan, chi), there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring during respiration, and difficulty in speaking." This is the outline provided by Zhang Zhongjing for discussing Warm Diseases. Although the outline is detailed, it does not explicitly state the formula for treating Warm Diseases. Upon repeated and careful observation, one realizes that the *Shanghan Lun* originally contains formulas for treating Warm Diseases, and even explicitly mentions them; those who merely browse may not notice. Section 61 states: "After inducing sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be used again. If there is sweating accompanied by wheezing, without significant heat, Mahuang, Xingren, Gancao, and Shigao can be used as the main treatment." Since this condition was not resolved after sweating, it must have been treated with acrid-warm herbs to induce sweating for a condition that did not originally present with aversion to cold. This corresponds to what the Warm Disease outline calls "if sweating has already been induced" (meaning forcing sweat in Warm Disease using acrid-warm herbs). The sweating accompanied by wheezing and lack of significant heat corresponds to what the Warm Disease outline calls "if sweating has already been induced, the body becomes burning hot," and subsequently described as "spontaneous sweating, excessive sleepiness, and snoring." Snoring occurs during sleep, and wheezing occurs upon waking. Since this condition was previously mishandled with acrid-warm herbs to induce sweating, Zhang Zhongjing feared that physicians might see the spontaneous sweating and mistakenly diagnose it as a Guizhi Tang pattern. Therefore, he specifically warned: "Do not use Guizhi Tang again; instead, treat with Mahxing Ganshi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction)." This section echoes the Warm Disease outline; reading them together makes the connection clear. However, Mahxing Ganshi Tang is indeed an effective formula for the initial stage of Warm Disease. My reason for not using Mahuang (Ephedra) but using Bohe (Mint) and Chantui (Cicada Slough) in releasing-the-exterior formulas was discussed in detail in my explanation of Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction); I will not repeat it here.
Currently, there are many books discussing Warm Diseases, but truth and falsehood are mixed, which only serves to confuse. Based on the *Neijing* (Inner Canon of the Yellow Emperor) and Zhang Zhongjing's theories, and interspersed with my own insights, I believe the general outline of Warm Diseases should be divided into three categories. I will discuss each category in detail below, so that treatments can be applied according to specific paths, avoiding errors.
The first is Spring-Warmth (Chun Wen). This condition arises from a mild external contraction in winter that does not cause immediate illness. The contracted pathogen lies dormant between the membrane source (Mo Yuan, the space between the interior and exterior), blocking the collaterals and preventing free circulation, thereby secretly generating internal heat. When spring arrives and yang energy rises, the internally accumulated heat has a tendency to stir. If further mildly contracted with external pathogens, they interact and suddenly erupt, causing heat in both the interior and exterior. This is what the *Neijing* refers to as "Winter injury by cold leads to Warm Disease in Spring." It is appropriate to treat this with my proposed Liangjie Tang (Cooling and Resolving Decoction). For severe heat, treat with my proposed Hanjie Tang (Cold Resolving Decoction). For cases with sweating, Zhongjing's Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) or my proposed Hejie Tang (Harmonizing and Resolving Decoction) with added Shigao (Raw Gypsum) is suitable. If it occurs during the summer months, it is named Summer-Warmth (Shu Wen), with even more severe heat. If at the onset there is a surging, long pulse, thirst, and a preference for cold water, a large dose of Baihu Tang (White Tiger Decoction) or my proposed Xianlu Tang (Immortal Dew Decoction) is appropriate.
The second is Wind-Warmth (Feng Wen). This is still an external contraction of wind and cold, but because the season has warmed, the external pathogenic qi has transformed into warmth. Therefore, it is not called Cold Damage (Shang Han) or Wind Injury (Shang Feng), but Wind-Warmth, which is what the *Shanghan Lun* refers to as Wind-Warmth disease. However, this condition may occur in early spring, late spring, or even summer and autumn. Treatment should vary according to the seasonal changes in cold and heat, combined with pulse diagnosis. If in early spring or late autumn, when the climate is between cold and warm, and at onset there is no aversion to cold, only a floating pulse without heat signs, my proposed Qingjie Tang (Clearing and Resolving Decoction) with 1-2 qian of Mahuang (Ephedra) or Zhongjing's Daqinglong Tang (Major Green Dragon Decoction) is suitable. If during hot summer days, the pulse is floating and surging, use my proposed Liangjie Tang or Hanjie Tang. If there is sweating, use my proposed Hejie Tang, or add Shigao (Raw Gypsum) as appropriate.
The third is Damp-Warmth (Shi Wen). This condition often results from humid and muggy summer weather. During continuous rainy days, dampness enters the upper jiao through respiration, obstructing the great qi (Zong Qi) in the chest. This causes Ying (Nutritive) and Wei (Defensive) qi to fail to circulate smoothly. The surface feels constrained like an external contraction, but it is not actually an external contraction. The tongue coating is white, slippery, and greasy, slightly grayish. One should use herbs that release the muscle layer and promote urination to allow dampness to exit via sweat and urine, such as my proposed Xuanjie Tang (Ventilating and Resolving Decoction). Zhongjing's Zhuling Tang (Polyporus Decoction), with Ejiao (Donkey-hide Gelatin) removed and Lianqiao (Forsythia Fruit) added, is also usable. As for damp-heat accumulating over time leading to Yangming Fu organ excess, some treat with Baihu Tang (White Tiger Decoction) plus Cangzhu (Atractylodes Rhizome), which is also a good formula. I, however, use Baihu Tang, replacing Zhimu (Anemarrhenae Rhizoma) with Huashi (Hualshi, Talcum), or omitting Jingmi (Oryzae Semen, Rice) and substituting it with Sheng Yimi (Coicis Semen, Raw Coix Seed). Regarding the statement "If winter storage of essence fails, Warm Disease will occur in spring," although explicitly stated in the *Neijing*, this condition is actually contained within Wind-Warmth and Spring-Warmth. Generally, those with internal deficiency are prone to external contractions, and those with yin deficiency and internal heat accumulation are particularly susceptible to Warm Diseases. Therefore, whether in Wind-Warmth or Spring-Warmth accompanied by yin deficiency, during the stages of releasing the exterior, clearing and resolving, or purging downward, it is appropriate to assist with yin-nourishing herbs. Examples include Sheng Shanyao (Dioscoreae Rhizoma, Raw Yam), Sheng Dihuang (Rehmanniae Radix, Raw Rehmannia), Xuanshen (Scrophulariae Radix, Figwort Root), Ejiao (Donkey-hide Gelatin), and Sheng Jizihuang (Galli Ovi Vitellus, Raw Egg Yolk), which can be used as appropriate. Alternatively, qi-tonifying herbs may be used concurrently, such as adding Renshen (Ginseng Radix) to Baihu Tang or using Renshen in Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Indeed, when Renshen is used with cooling and moistening herbs, it not only tonifies qi but greatly nourishes yin.
The above discussion covers the general outline of Warm Diseases and their initial treatment methods. Detailed symptoms and flexible treatment adjustments based on specific conditions are prepared in the subsequent case records. Epidemic diseases (Yi Bing), caused by pestilential qi of heaven and earth and spreading through contagion, are completely different from Warm Diseases.
In the formula, Bohe Ye (Mint Leaf) should be tender and green. Its stem is suitable for regulating qi; if used for inducing sweating, its efficacy is halved. If the color is not green but dull, its efficacy is further reduced. If truly tender green leaves are used, 3 qian in the formula is sufficient.
Bohe (Mint) has a scent similar to Bingpian (Borneolum Syntheticum, Borneol) and is excellent at penetrating orifices. Its power reaches internally to the zang-fu organs and sinews/bones, and externally to the couli (pores/skin texture), allowing it to treat bone and joint pain in Warm Diseases. To say it is light and clear and only induces sweat on the skin is to underestimate Bohe.
Removing the feet from Chantui (Cicada Slough) means removing the two large front legs. These legs are very hard and have a breaking/opening force. If used to remove nebulae or resolve sores, keeping the legs is better. If used for inducing sweating, they should be removed, as we do not want the breaking force in the process of releasing the exterior.
Chantui (Cicada Slough) is slightly cool in nature and bland in taste; it is originally not an acrid-dispersing herb, yet it can induce sweating because "skin reaches skin" (using the insect's exoskeleton to target human skin). This is a miraculous herb for inducing sweating, especially best for those with weak constitutions who cannot tolerate strong exterior-releasing herbs. Furthermore, Warm Diseases often accompany urticaria (Yin Zhen); Chantui is particularly good at pushing urticaria outward.
Shigao (Raw Gypsum) is slightly cold in nature, as explicitly stated in the *Shennong Bencao Jing*. Although it is a mineral drug, it is actually very mild. Moreover, its texture is heavy; 6 qian is only a large pinch. Its cooling power is equivalent to about 3 qian of Zhimu (Anemarrhenae Rhizoma), but its fire-clearing power is double that, because it is cooling and dispersing. I have observed that later generations' formulas for treating Warm Diseases dare to use only 5-6 qian of Shigao only when Yangming Fu excess sets in. How can such people claim to understand Shigao! However, it must be used raw to be safe; calcined Shigao used up to 1 liang would cause harm. Additionally, the condition governed by this formula may occasionally present with slight aversion to cold on the back. This is a sign of heat郁结 (stagnation) in the interior failing to reach the exterior, not true aversion to cold. In Baihu Tang (White Tiger Decoction) patterns, this is also common; using Shigao to vent the heat resolves the aversion to cold.
Question: External pathogens attacking the Taiyang meridian cause aversion to cold, while those attacking the Yangming meridian cause fever without aversion to cold. In spring and summer, the climate is warm, so external pathogens do not resonate with cold-water but with dry-metal, entering directly through the Yangming meridians at the front of the body, thus becoming Warm Disease. Most later discussions on Warm Disease follow this theory. Why does the Warm Disease outline in the *Shanghan Lun* begin with "Taiyang Disease"? Answer: At the initial stage of Warm Disease, the pathogen is often in the Taiyang meridian, but it transforms into Yangming very quickly.
I once treated a man in his twenties. During midsummer night sleep, due to the cool night air, he woke up shivering under a single blanket. Feeling lazy, he went back to sleep. Soon he woke up shivering again. In the morning, he felt slightly chilly. By Si hour (9-11 AM), he felt intense heat in both interior and exterior, accompanied by wheezing and shortness of breath. His pulse was surging, long, and floating. I administered Qingjie Tang (Clearing and Resolving Decoction), increasing Shigao (Raw Gypsum) to 1.5 liang, and added Niu Bang Zi (Arctii Fructus, Burdock Fruit) - stir-fried and crushed - 3 qian. After taking the medicine, he sweated and recovered. From this, we see that initially, did he not contract Taiyang? Yet it was not exclusively Taiyang. The reason he felt cold was due to thin bedding. The climate itself was not cold; thus, the pathogen affected him not only in Taiyang but also in Yangming. Moreover, at that time, people generally had internal heat accumulation, hence the rapid transformation to Yangming. However, this discussion pertains to Wind-Warmth. If Winter-contracted pathogens manifest in Spring or Summer, there are often cases unrelated to Taiyang. Therefore, the *Shanghan Lun* Warm Disease outline specifically states: "Wind-Warmth disease," clarifying its difference from the Warm Disease caused by "Winter injury by cold leading to Spring Warmth." Also, Xingren (Apricot Seed) and Niu Bang Zi (Burdock Fruit) both descend lung qi and stop wheezing. Xingren is warm, while Niu Bang Zi is cool. For Cold Damage wheezing, Xingren is used; for Warm Disease, warm herbs are unsuitable, so Niu Bang Zi is substituted.
Appendix:
Letter from Sun XX of Yanshan, Zhili:
In the spring of 1925, a man came to Tianjin to learn carpentry. Due to his frail constitution and the hot weather, he contracted Warm Disease. I examined him. His pulse was floating, rapid, and slippery; his tongue coating was thick, white, and dense; he experienced frequent drowsiness. I prescribed Qingjie Tang (Clearing and Resolving Decoction), using 1 liang of Shigao (Raw Gypsum). Because his pulse was rapid, I added 5 qian of Xuanshen (Figwort Root). One dose cured the illness.
In mid-spring of the same year, three daughters of Yu XX all developed epidemic rashes (Wen Zhen). I examined them and prescribed Qingjie Tang (Clearing and Resolving Decoction) with added Lianqiao (Forsythia Fruit), Sheng Dihuang (Raw Rehmannia), and Huashi (Talcum). They recovered. Others suffering from this condition at the same time were in dangerous situations. Only my prescription achieved immediate results.