《内经》云∶冬伤于寒,春必病温。又云∶冬不藏精,春必病温。此论热温病之大原也
。《
伤寒论》云∶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,鼻息必鼾,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。此论温病之大势也。自王叔和论温条中,有风温、温疟、温毒、温疫四变之说,而其旨
反晦。盖冬伤于风,至春始发为风温。冬伤寒,至春始发为温病,其理一也。观仲景于温字
上加一风字,正以别夫伤于寒者耳。汗后身反灼热,脉阴阳俱浮,身重多眠睡,鼻息必鼾,
语言难出,一一尽显伤风之因,则不可复从温病之伤寒施治矣。故温为怫郁,自内达外,不
可发表。风温为卫虚自汗,更不可发表。即误下亦致表邪内陷,误火亦致外助温气,皆为促
其死亡。后人不察,惜其有论无方,讵知森森治法,全具于伤风伤寒证中,正赖后人之因时
设施乎。叔和不究精微之用,谓风温即是温病之变。不知仲景正特出手眼处,见冬不藏精之
人,两肾间先已习习生风,得温风相召,而病发于春。温病中之风温,亦犹冬寒证之有伤风
也。后世喻嘉言别其重感重变之误,诚为卓识,但谓温病发于太阳经,风温中于少阴经,误
之甚矣。风温如果中于少阳,则下之必致死亡,熏之必得少解。焉有初起反发热脉浮,误下
止便不利,误火则一逆再逆哉?至若温疟者,因冬不藏精,邪本轻浅,故止成疟,寒热时发
时止,非外感之正病也。《内经》云∶温疟得之冬中于风,寒气藏于骨髓之中,至春则阳气
大发,邪气不能自出,因遇大暑,脑髓烁,肌肉消,腠理发泄,或有所用力,邪气与汗俱出
,此病藏于肾,其气先从内出之于外,名曰温疟。可见温疟为冬不藏精,故风寒得以入肾。
又见温疟,遇温尚不易发,必大暑大汗始发之也。叔和以重感于寒立说,岂其不读《内经》
乎?又如温毒者,因久病不解,热邪炽甚,亦温病中之一病也。温证之有温毒,亦如伤寒之
有阳毒阴毒耳,仲景不以伤寒中之寒毒另有一证,叔和何得以温病中之温毒别立一名,更如
温疫因时下另感一气,乃温病而加时加疫,又非温证之比矣。其辨详于喻氏《温疫论》中。
《黄帝内经》说:冬天感受寒邪,春天必定发生温病。又说:冬天不能固藏精气,春天必定发生温病。这是论述热性温病的根本原因。
《伤寒论》说:太阳病(太阳经受邪所致的病证),出现发热且口渴,不恶寒的,称为温病。如果经过发汗治疗后,身体灼热的,称为风温。风温这种病,脉象寸关尺三部都浮,自汗出,身体沉重,嗜睡,呼吸时必然打鼾,说话困难。如果被误用攻下法,会导致小便不利,两眼直视,大小便失禁。如果被误用火疗,轻则面色微黄,重则像惊痫发作,时而抽搐,如同火熏一样。一次误治尚能拖延时日,再次误治就会危及生命。这是论述温病的总体大势。
自从王叔和在论述温病的条文中,提出了风温、温疟、温毒、温疫四种变证的理论,但其主旨反而变得晦涩难懂。大概是因为冬天感受风邪,到春天才发作的叫风温;冬天感受寒邪,到春天才发作的叫温病,其中的道理是一样的。看张仲景在“温”字上加一个“风”字,正是为了区分是感受寒邪所致罢了。发汗后身体反而灼热,脉象寸关尺三部都浮,身体沉重,嗜睡,呼吸打鼾,说话困难,这些症状一一显露了是因伤风引起的,那么就不能再按照温病中的伤寒来施治了。所以,温病是气机怫郁,由内达外,不可使用发表法。风温是卫气虚弱导致自汗,更不可使用发表法。即使误用攻下法也会导致表邪内陷,误用火疗也会助长外部的温气,这些都是加速死亡的原因。后人没有察觉,可惜他只有论述而没有方剂,哪里知道高明的治疗方法,完全包含在伤风和伤寒的证候中,正依赖于后人根据时令情况灵活施治。王叔和不探究精微的用法,认为风温就是温病的变证。不知道张仲景特意展现其独特见解的地方在于:见到冬天不能固藏精气的人,两肾之间早已隐隐生风,得到温风的召唤,而在春天发病。温病中的风温,也就像冬寒证中有伤风一样。后世喻嘉言纠正了关于重感和重变的错误,确实是卓越的见识,但他认为温病发于太阳经,风温中于少阴经,这就大错特错了。如果风温真的中于少阳经,那么攻下必致死亡,熏蒸只能稍微缓解。哪有初起反而发热脉浮,误下只导致小便不利,误火就是一次误治、二次误治的呢?至于温疟,是因为冬天不能固藏精气,邪气本来轻浅,所以只形成疟疾,寒热时发时止,不是外感正病。《黄帝内经》说:温疟是由于冬天受了风邪,寒气藏在骨髓之中,到了春天阳气大发,邪气不能自行排出,如果遇到大暑天,脑髓被烤干,肌肉消瘦,腠理开泄,或者有所用力,邪气随着汗水一起出来,这个病藏在肾,其气先从内部发出到外部,称为温疟。可见温疟是因为冬天不能固藏精气,所以风寒得以侵入肾脏。又见温疟,遇到温暖尚且不容易发作,必须是大暑大汗时才发作。王叔和以重感于寒立论,难道他没读过《黄帝内经》吗?又如温毒,是因为久病不解,热邪炽盛,也是温病中的一种病。温证中有温毒,也就像伤寒中有阳毒和阴毒一样,张仲景不把伤寒中的寒毒单独列为一证,王叔和凭什么把温病中的温毒另立一名?又比如温疫,是因为当时另外感受了一种气,是在温病基础上加上时令和疫病的特点,又不是普通温证可以相比的了。这方面的辨析详细记载在喻氏的《温疫论》中。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "If one is injured by cold in winter, one will inevitably suffer from warm diseases in spring." It also states: "If one fails to store essence properly in winter, one will inevitably suffer from warm diseases in spring." This discusses the fundamental origin of heat-type warm diseases.
The *Shanghan Lun* (Treatise on Cold Damage) states: "In Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang channel), if there is fever and thirst without aversion to cold, it is called a warm disease. If after inducing sweating, the body becomes burning hot, it is called Fengwen (Wind-Warmth). In Fengwen disease, the pulse is floating at all three positions (cun, guan, chi); there is spontaneous sweating; the body feels heavy; there is excessive sleepiness; breathing is necessarily accompanied by snoring; and speech is difficult. If purgation is mistakenly applied, it leads to difficulty in urination, staring gaze, and loss of control over urination and defecation. If fire therapy is mistakenly applied, mild cases result in slight yellowing of the face, while severe cases resemble convulsive epilepsy with occasional spasms, resembling being smoked by fire. One error may prolong the illness for days, but a second error will hasten death. This discusses the general trend of warm diseases.
Since Wang Shuhe discussed four variations of warm diseases—Fengwen (Wind-Warmth), Wen Nue (Warm Malaria), Wendu (Warm Toxin), and Wenyi (Warm Epidemic)—in his commentary, the underlying principle has become obscure. Essentially, contracting wind in winter and manifesting in spring is Fengwen; contracting cold in winter and manifesting in spring is a warm disease; the logic is the same. Observing that Zhang Zhongjing added the character 'wind' to 'warm,' he precisely distinguished it from injuries caused by cold. After sweating, the body becomes burning hot; the pulse is floating at all three positions; the body is heavy; there is excessive sleepiness; snoring occurs during breathing; and speech is difficult. These symptoms fully reveal the cause as wind injury. Therefore, treatment should no longer follow the methods for cold damage within warm diseases. Thus, warm disease involves qi stagnation and obstruction, moving from interior to exterior, and cannot be treated with diaphoretic (sweating) methods. Fengwen involves deficiency of Wei Qi (Defensive Qi) leading to spontaneous sweating, making diaphoretic methods even more contraindicated. Mistaken purgation causes exterior pathogens to sink inward; mistaken fire therapy assists external warm qi. Both accelerate death. Later generations failed to realize that although only discussions were provided without formulas, comprehensive treatment methods are fully contained within the syndromes of wind injury and cold damage, relying on later practitioners to apply them flexibly according to seasonal conditions. Wang Shuhe did not investigate the subtle applications, claiming that Fengwen is merely a variation of warm disease. He failed to see Zhang Zhongjing's unique insight: in individuals who fail to store essence in winter, wind arises subtly between the two kidneys; when summoned by warm winds, the disease manifests in spring. Fengwen within warm diseases is analogous to wind injury within winter cold syndromes. Yu Jiayan of later generations correctly identified errors regarding double contraction and secondary changes, showing profound insight. However, his claim that warm disease originates in the Taiyang channel and Fengwen invades the Shaoyin channel is a grave error. If Fengwen truly invaded the Shaoyang channel, purgation would certainly lead to death, and fumigation would provide only slight relief. How could initial symptoms present with fever and a floating pulse, where mistaken purgation results only in urinary difficulty, and mistaken fire therapy constitutes one then a second error?
Regarding Warm Malaria (Wen Nue): because essence was not stored in winter, the pathogen is initially light and shallow, resulting only in malaria, with chills and fever alternating intermittently. It is not a standard exogenous disease. The *Neijing* states: "Warm malaria results from wind injury in winter; cold qi hides in the bone marrow. In spring, when Yang qi expands greatly, the pathogen cannot exit spontaneously. If encountering intense summer heat, brain marrow is scorched, muscles waste away, pores open and sweat is released, or due to physical exertion, the pathogen exits with the sweat. This disease resides in the Kidney, and its qi moves from the interior to the exterior first, hence named Warm Malaria." This shows that Warm Malaria occurs because essence was not stored in winter, allowing wind-cold to enter the Kidneys. Furthermore, Warm Malaria does not easily manifest even in warmth; it requires intense summer heat and profuse sweating to erupt. Wang Shuhe based his theory on double contraction by cold; did he not read the *Neijing*?
As for Warm Toxin (Wendu): it arises from prolonged unresolved illness with intense heat pathogens. It is also a type of warm disease. The presence of Warm Toxin in warm syndromes is like the presence of Yang Toxin and Yin Toxin in cold damage. Zhang Zhongjing did not list cold toxin in cold damage as a separate syndrome; why should Wang Shuhe create a new name for warm toxin in warm diseases? Similarly, Warm Epidemic (Wenyi) results from contracting a specific pathogenic qi due to current seasonal conditions. It adds temporal and epidemic characteristics to warm disease, distinguishing it from ordinary warm syndromes. Detailed differentiation can be found in Yu’s *Wenyi Lun* (Treatise on Warm Epidemics).