拯之，无所顾惜。君又不止以医擅名者！没年八十。配潘孺人。子二∶奕章、龙章，奕章亦善医，以君名掩。孙二人∶
曰堂、曰坚。曾孙三人，习儒业。食君之德，高硕家声，将于是乎在。论曰∶自太史公传仓公件系其事，陈承祚作《华
佗传》因之，后戴九灵、宋景濂仿其体作名医传。君不欲以医自名，并不欲以医传世。临末诫其子曰∶医可为而不可为，
必天资敏悟，又读万卷书，而后可借术济世，不然鲜有不杀人者，是以药饵为刀刃也。吾死，子孙慎毋轻言医。呜呼，
可谓达且仁矣。
随园先生与薛寿鱼书云∶谈何容易！天生一不朽之人，而其子若孙，必欲推而纳之于必朽之地，此吾所为
而悲也。夫所谓不朽者，非必周、孔而后不朽也，羿之射、秋之奕、俞跗之医，皆可以不朽也。使必待周、孔而
后可以不朽，则宇宙间安得有此纷纷之周、孔哉？子之大父一瓢先生，医之不朽者也。高年不禄，仆方思辑其梗概，以
永其人，而不意寄来墓志，无一字及医，反托于与陈文恭公讲学云云。呜呼，自是而一瓢先生不传矣，朽矣！夫学在躬
行，不在讲也。圣学莫如仁，先生能以术仁其民，使无夭扎，是即孔子老安少怀之学也。素位而行，学孰大于是？而何
必舍之以他求。王阳明勋业烂然，胡世宁笑其多一讲学。文恭公亦复为之，于余心犹以为非。然而文恭相公也，子之大
父布衣也。相公借布衣以自重则名高，而布衣挟相公以自尊则甚陋。今执途人而问之曰∶一瓢先生非名医乎？虽子之仇
无异词也。又问之曰∶一瓢先生其理学乎？虽子之戚有异词也。子不以人所共信者传先人，而以人所共疑者传先人，得
毋以艺成而下之说为斤斤乎？不知艺即道之有形者也。精求之，何艺非道？貌袭之，道艺两失。燕哙子之何尝不托尧、
舜以鸣高，而卒为梓匠轮舆所笑。医之为艺，尤非易言。神农始之，黄帝创之，周公使冢宰镇之，其道通于神圣。今天
下医绝矣，惟讲学一流转未绝者何也？医之效立见，故名医百无一人∶学之讲无稽，故村儒举目皆是。子不尊先人于百
无一人之上，而反贱之于举目皆是其中，过矣。即或衰年无俚，有此附会，则亦当牵连书之，而不可尽没其所由来。仆
曾疾病性命危笃，尔时虽十周，程、张、朱何益？而先生独能以一刀圭活之，仆所以心折，而信以为不朽之人也。虑此
外必有异案良方，可以拯人，可以寿世者，辑而传焉，当高出语录陈言万万。而乃讳而不宣，甘舍神奇以就臭腐。在理
学中未必增一伪席，而方伎中转失一真人矣。岂不悖哉？岂不惜哉！
故人沈君辛甫，端恪公曾孙也。尝病吴鞠通混疫于温。余谓不但此也，其《条辨》首列曰∶温病者，有风温、
有温热、有温疫、有温毒、有暑温、有湿温、有秋燥、有冬温、有温疟。凡九项，似无遗义，而不自知其题旨未清也。
夫冬伤于寒，至春而发者曰温病，夏至后发者曰热病。冬春感风热之邪而病者，首先犯肺，名曰风温，其病于冬者
亦曰冬温，病于春者亦曰春温，即叶氏所论者是也。夏至后所发之热病，在《内经》亦曰暑，以其发于暑令也。
故仲景以夏月感暑成病者名曰 ，盖暑、 者，皆热之谓也。今杜撰暑温名目，最属不通。至于疫证，更不可与
温热同治，当从吴又可、余师愚两家为正鹄。而温之为毒为疟，乃温之节目矣。概而论之，宜乎愈辨愈不清矣。
其次条云∶凡病温者，始于上焦，在手太阴。嘻，岂其未读《内经》耶？伏气为病，自内而发，惟冬春风温、
夏、秋燥，皆始于上焦。若此等界限不清，而强欲划界以限病，未免动手即错矣。夫温热究三焦者，非谓病必
在上焦始，而渐及于中、下也。伏气自内而发，则病起于下者有之；胃乃藏垢纳污之所，湿温、疫毒，病起于中
者有之；暑邪挟湿者，亦犯中焦；又暑属火而心为火脏，同气相求，邪极易犯，虽始上焦，亦不能必其在手太阴
一经也。
第四条云∶太阴风温、温热、温疫、冬温，初起恶风寒者，桂枝汤主之。夫鞠通既宗叶氏，当详考叶氏论案
以立言，如《指南》温热门第三案云∶温邪上受，内入乎肺，肺主周身之气，气窒不化，外寒似战栗，其温邪内
郁，必从热化。风温门第五案云∶风温入肺，气不肯降，形寒内热，乃 郁之象。用药皆是辛凉轻剂。至《幼科
要略》，论三时伏气外感尤为详备。于春温证因外邪引动伏热者，必先辛凉以解新邪，自注用葱豉汤。垂训昭然，
何甘违悖？意欲绍述仲圣乎，则祖上之门楣，不可夸为自己之阀阅也。在泾先生云∶温病伏寒变热，少阴之精已被劫夺，
虽有新旧合邪，不得更用用桂枝汤助热而绝其本也。岂吴氏皆未之闻乎？
中焦篇第一条自注云∶肺病逆传，则为心包，上焦失治，则传中焦，始上焦，终下焦。嘻，是鞠通排定路径，
必欲温热病遵其道而行也，有是理乎？彼犯肺之邪若不外解，原以下传于胃为顺，故往往上焦未罢，已及中焦；
惟其不能下行为顺，是以内陷膻中为逆传。章虚谷亦昧此义，乃云火来克金，而肺邪反传于包络，故曰逆。夫从
所胜来者为微邪，胡可反以为逆？岂二公皆未读《难经》耶？其不始于上焦者，更无论矣。
书名《温热条辨》，而所列霍乱，皆是寒证，故余年少时辄不自揣，而有《霍乱论》之作也。沈辛老云∶鞠
通书蓝本叶氏，有前人未见及而补之者，如秋燥增入正化，痉螈别为两条，谈理抑何精细。有前人已见及而忘之
者，如霍乱证自具暑湿门，岫云未经摘出，而伊芳遂不知有热；疝气条当分暴久治，香岩先生业已道明，而伊芳又惟
知有寒。盖心思之用，固各有至不至，虽两间亦缺陷世界，而况人乎？又曰∶鞠通所云之疝多系暴证，而久者又
系宿瘕病，故可一以温下取下。若疝虽有历久不痊，然聚则有形，散即无形，初非真有物焉，如瘀积腹中也。又
云∶干霍乱以生芋杵汁下咽即生，远胜盐汤探吐也。暑疡初起用丝瓜杵汁涂，或荷花瓣贴之，皆妙，不必水仙根
也。
中焦八十四条云∶少阳疟如伤寒证者，小柴胡汤主之，此与温热何与，而乃阑入乎？辛老云∶叶氏知暑湿时
疟与风寒正疟迥别，融会圣言，惟从清解，所见甚超；而洄溪反以不用柴胡屡肆诋訾，食古不化，徐公且然，况
其下乎？噫，辛老长余九岁，与余交最深，品学兼优，真古君子也。尝为余校《温热经纬》，而家贫无子，今墓草宿矣。
遗稿未梓，偶于拙草中检得数条，附录于此，亦可以见其读书具眼、立言忠浓也。
下焦篇之定风珠，一派腥浊浓腻，无病患胃弱者亦难下咽。如果厥哕欲脱而进此药，是速其危矣。
二十四至二十六条，皆冬寒内伏、春温初发之治，乃妄谓温热、温疫，自上、中传下之治，岂非梦呓？
四十二条自注谓宋元以来，不明仲景一书专为伤寒而设。吴氏直未读《伤寒论》也。注《伤寒》者无虑数十
家，皆以为专论伤寒之书，故恒觉支离附会。考论中风、寒、温、 、湿五气为病，古人皆曰伤寒，故《难经》
云∶“伤寒者有五”，而仲圣以伤寒名其书也。此等大纲不清，岂可率尔着书！
五十一条痰湿阻气之阴吹证，实前人所未道及。
五十五条发明蚕砂功用，何其精切，故余治霍乱以为主药也。
吴氏此书不过将《指南》温热、暑湿各案穿插而成，惜未将《内经》、《难经》、《伤寒论》诸书溯本穷源，
即叶氏《温热论》、《幼科要略》亦不汇参，故虽曰发明叶氏，而实未得其精奥也。至采附各方，不但剪裁未善，
去取亦有未当。此余不得已而有《温热经纬》之纂也。
后三卷杂说，解产难、解儿难等篇，皆可传之作，远胜三焦《条辨》多矣。杂说中惟“霍乱不得吐泻，治以
苦辛芳热”一语为可议。《条辨》中可议处甚多，姑举大略如上，庶读者勿随波而逐流也。
阴吹乃妇人常有之事，别无所苦者，自亦不知为病，况系隐微，医更不知。相传产后未弥月而啖葱则有此，不可谓
为病也。惟吹之太喧而大便坚滞者，或由肠燥，或由瘀阻，或由痰滞，以致腑气不通，而逼走前阴也。然亦但宜润其燥，
化其瘀，宣其痰，不必治其吹也。
转女成男之说，自古有之，而验者甚少。钱塘沈君西海云∶有一法每试有效，且甚简易。若停汛而确知为孕，
即取红纸一张，本夫亲书“五更露结桃花实，二月春生燕子巢”十四字于上，书时心中默诵∶“无思也，无为也，
寂然不动，感而遂通”四句，书毕，贴于卧床内隐处。凡书时、贴时，均勿令人见，并勿令人知，验后始可传人
也。
黄锦芳云∶杜仲、续断二味，举世用以安胎，而不知续断味苦，专入血分，活血消肿，故乳痈、 结、肠风、
痔、金疮、跌仆，一切血瘀之证，皆可用也，虽稍有涩性，行不至泄，然误施于气弱、气陷之妇，则顺流而下，
奔迫莫御，而有排山倒海之势，岂区区涩味所能止其万一者乎？杜仲色紫而润，辛甘微温，性专入肝，补气强筋，
筋强则骨亦健，凡肾虚、肾寒脚弱之病，用之最宜，若气陷、气弱之辈，断不可服，以其性最引气下行，而无上
升坚固之意也。夫胎坠本忌血行气陷，其服此二味亦有奏效者，以人身气血贵乎温通，胎坠之因不一，亦有因肾
气不温，经血凝滞，而胞胎失荫者，得此二味，则气煦血濡，不滞不漏，而胎自安矣。止为下虚上实者设也。故
胎坠而尺强寸弱者，动作少气者，表虚恶风汗时出者，心下悬饥得食则止者，一身之气尽欲下坠者，皆在禁例。
奈作俑者既不分辨明晰，流传既久，遂以为安胎圣药，总缘医理不明，药性不晓，证候不知，见方号为神验，虽
滑脱之妇，亦尔通用。岂知杜仲、续断原或因于跌仆，或下寒挟瘀而胎动者之妙剂，苟不知审顾区别而妄用之，则不但
不能安胎，反能催胎、坠胎，甚有殒其母命者，可不戒哉！愚按此二药余不甚用，而世人皆视为补益之品，得黄氏此论，
自信管见之未昏。
妇人临产，世俗每虑其饥寒，而不知饱暖以致难产。《治法汇》云∶如饥宜食稀粥，勿令过饱，宜稍饥为佳，
以饥则气下，气下则速产。若食肉及多食，或啖腻滞之物，则碍于上焦，气不得下，故产难，虽产下而食滞中焦，
则生寒热。医者不察，乱投温补，多致危殆。隆冬浅屋，固宜遮蔽密实，添设火盆；若盛暑必择清凉之所，但须
避风，切勿过暖，致生诸患。如无凉室，榻前可以新汲水盆贮映之。
《明史》载光宗谅暗，郑贵妃进美女四人，上不豫，内医崔文升用大黄药，一日夜三四十起，头目眩晕，不
能动履。杨涟疏劾之云∶有心之误耶？无心之误耶？有心则齑粉不足偿，无心则一误岂可再误！上宣涟入，目注
久之。方从哲荐李可灼进红丸。上饮汤辄喘，药进乃受。上喜称忠臣者再，顷之传圣体用药后，暖润舒畅。复进
一丸，明旦驾崩矣。从哲拟旨赏可灼银五十两，以王舜安疏改罚俸一年。于是言者蜂起，谓文升情罪不减张差，
而可灼次之，并劾从哲。从哲疏辨，自请削夺，可灼遣戍，文升发遣南京。愚谓此胜国三大案之一，实千古之大
疑案也。论者纷纷，迄未得其病情，以文人多不知医耳。吾友仁和徐君亚枝尝云∶李可灼进红丸于光宗也，先有
奄人崔文升之用大黄，故尤悔庵拟明史乐府有“大黄一下法不治，红丸虽进补已迟”之句。其谓文升误下固然矣，
而以红丸为补则非是。盖光宗之病，阳明实而太阳未罢之证也。史载进红丸后，圣体暖润舒畅，则前此用大黄时，
必恶寒无汗、周身拘急之证悉具。大黄下之，汤饮不受，明是误下成结胸之证。红丸者丸而色红，莫知所用何药。余意
必是开太阳兼陷胸之品，所以进后暖润舒畅。史载“上不豫”于“进美女”之下，或太阳经府均病，配红铅为经府双解
之剂，故其丸色红，则仍是下法，不是补法。嘉言所谓得其下之之力，非得其补之之力者也。至于明旦驾崩，或因小愈
而复犯女色，宫围邃密，外廷莫知，不然岂有得暖润舒畅之转机，未尝变证而甫隔一夜遽然长逝乎？因慨文人谈医，每
多谬误，如《两般秋雨庵随笔》载咏甘草云∶“历事五朝长乐老，未曾独将汉留候”，皆未读医书之故也。愚谓
虽读医书，而阅历未深者，尚有人为书囿之弊，故论病最非易事。
江阴陈定九《留溪外传》载前明崇明蔡指方神于医，尝云医家心动气浮，志歧欲侈，讹审察之微，失参辨之
宜，而用药舛谬，未有不杀人于顷刻者也。譬之良相治国，必举贤任能，因材器使，其心休休，其如有容，正己
无私，然后鼎鼐和，阴阳燮，而天下治。如或心术匪端，志向偏趋，而用人失当，欲求竣其功业，终其令闻者鲜
矣。故曰为医如为相，用药若用人。医道微矣，非绝欲无私，通神于微妙之乡，穷理尽性，研几于幽明之极者，
不足以传也。
歙吴畹清太守，世精外科，以家传秘法刊行寿世，名《攒花知不足方》。业外科者，当奉为圭臬也。又刻徐、
拯之，无所顾惜。君又不止以医擅名者！没年八十。配潘孺人。子二∶奕章、龙章，奕章亦善医，以君名掩。孙二人∶
曰堂、曰坚。曾孙三人，习儒业。食君之德，高硕家声，将于是乎在。论曰∶自太史公传仓公件系其事，陈承祚作《华
佗传》因之，后戴九灵、宋景濂仿其体作名医传。君不欲以医自名，并不欲以医传世。临末诫其子曰∶医可为而不可为，
必天资敏悟，又读万卷书，而后可借术济世，不然鲜有不杀人者，是以药饵为刀刃也。吾死，子孙慎毋轻言医。呜呼，
可谓达且仁矣。
（我）全力救治，毫不吝惜。您不仅仅因为医术而闻名！去世时享年八十岁。配偶是潘孺人。有两个儿子：奕章、龙章，奕章也擅长医学，但被您的名声所掩盖。孙子两人：一个叫堂，一个叫坚。曾孙三人，研习儒家学业。承受您的恩德，使家族声名显赫，大概就在这里了。评论说：自从司马迁为仓公（淳于意）作传并记录其事迹，陈寿撰写《华佗传》沿袭了这一体例，后来戴良、宋濂模仿这种体裁撰写名医传记。您不愿意凭借医术来标榜自己，也不愿意让医术流传后世。临终前告诫儿子说：医学可以学习，但不能轻易从事，必须天资聪颖悟性高，又博览群书，然后才可以借助医术救济世人，否则很少有不伤人性命的，所以把药物当作锋利的刀刃一样危险。我死后，子孙们千万不要轻易谈论医学。唉，这可以说是通达事理而且仁爱啊。
随园先生与薛寿鱼书云∶谈何容易！天生一不朽之人，而其子若孙，必欲推而纳之于必朽之地，此吾所为
而悲也。夫所谓不朽者，非必周、孔而后不朽也，羿之射、秋之奕、俞跗之医，皆可以不朽也。使必待周、孔而
后可以不朽，则宇宙间安得有此纷纷之周、孔哉？子之大父一瓢先生，医之不朽者也。高年不禄，仆方思辑其梗概，以
永其人，而不意寄来墓志，无一字及医，反托于与陈文恭公讲学云云。呜呼，自是而一瓢先生不传矣，朽矣！夫学在躬
行，不在讲也。圣学莫如仁，先生能以术仁其民，使无夭扎，是即孔子老安少怀之学也。素位而行，学孰大于是？而何
必舍之以他求。王阳明勋业烂然，胡世宁笑其多一讲学。文恭公亦复为之，于余心犹以为非。然而文恭相公也，子之大
父布衣也。相公借布衣以自重则名高，而布衣挟相公以自尊则甚陋。今执途人而问之曰∶一瓢先生非名医乎？虽子之仇
无异词也。又问之曰∶一瓢先生其理学乎？虽子之戚有异词也。子不以人所共信者传先人，而以人所共疑者传先人，得
毋以艺成而下之说为斤斤乎？不知艺即道之有形者也。精求之，何艺非道？貌袭之，道艺两失。燕哙子之何尝不托尧、
舜以鸣高，而卒为梓匠轮舆所笑。医之为艺，尤非易言。神农始之，黄帝创之，周公使冢宰镇之，其道通于神圣。今天
下医绝矣，惟讲学一流转未绝者何也？医之效立见，故名医百无一人∶学之讲无稽，故村儒举目皆是。子不尊先人于百
无一人之上，而反贱之于举目皆是其中，过矣。即或衰年无俚，有此附会，则亦当牵连书之，而不可尽没其所由来。仆
曾疾病性命危笃，尔时虽十周，程、张、朱何益？而先生独能以一刀圭活之，仆所以心折，而信以为不朽之人也。虑此
外必有异案良方，可以拯人，可以寿世者，辑而传焉，当高出语录陈言万万。而乃讳而不宣，甘舍神奇以就臭腐。在理
学中未必增一伪席，而方伎中转失一真人矣。岂不悖哉？岂不惜哉！
袁枚（随园先生）在给薛寿鱼的信中说道：谈论（医学的不朽）哪里那么容易！上天造就了一位不朽的人物，而他的儿子孙子，却一定要把他推向必然腐朽的境地，这就是我之所以悲伤的原因。所谓不朽，不一定非要像周公、孔子那样才算不朽，后羿的射箭、秋子的下棋、俞跗的医术，都可以称为不朽。如果一定要等到成为周公、孔子之后才能不朽，那么宇宙间怎么会有这么多纷纷扰扰的周公、孔子呢？您的祖父一瓢先生，是医学领域不朽的人。他年老去世，我正想着编辑他的生平概要，以使他的名字永存，没想到寄来的墓志铭中，没有一个字提到医学，反而依托于他与陈文恭公讲学之类的内容。唉，从此以后一瓢先生的医术就不流传了，他也随之腐朽了！学问在于亲身实践，不在于空谈。圣人的学问没有比“仁”更大的了，先生能够用医术仁爱百姓，使他们免于早夭和灾祸，这就是孔子所说的“老者安之，少者怀之”的学问。处于本分地位而行动，还有比这更大的学问吗？何必舍弃这个去追求其他的呢？王阳明的功业光辉灿烂，胡世宁笑话他多了一个讲学的身份。陈文恭公也这样做，在我心里仍然认为是不对的。然而陈文恭公是宰相，您的祖父是平民。宰相借助平民来抬高自己的身价，那么名声就高了；而平民挟持宰相来自抬身价，那就非常浅陋了。现在拉着路人问他：一瓢先生不是名医吗？即使是您的仇人也说不出不同的话。再问他：一瓢先生是理学家吗？即使是您的亲戚也会说出不同的话。您不用大家共同相信的事实来记载祖先，却用大家共同怀疑的事情来记载祖先，难道是因为拘泥于“技艺成就而地位低下”的说法而斤斤计较吗？不知道技艺就是“道”的具体表现形式。精心探求它，什么技艺不是道呢？表面模仿它，道和技艺都会丧失。燕哙和子之何尝不是依托尧、舜的名义来显示清高，最终却被木匠车工所嘲笑。医学作为一种技艺，尤其不容易谈论。神农氏开创了它，黄帝创立了它，周公让冢宰（高官）镇守它，它的道理通向神圣。如今天下的医学已经断绝了，只有讲理学的一脉还没有断绝，为什么呢？医学的效果立即显现，所以真正的名医百人中找不出一个；理学讲的没有根据，所以乡村儒生到处都是。您不把祖先尊崇在百中无一的名医之上，反而把他贬低到到处都是的平庸之辈之中，这是错误的。即使晚年无聊，有这样的附会之辞，也应该连带记录下来，而不能完全抹杀他医术的来源。我曾经生病，生命垂危，那时即使有十个周公、程颢、张载、朱熹又有什么益处？而先生唯独能用一小勺药救活了我，所以我心悦诚服，确信他是真正不朽的人。考虑到除此之外一定有其他奇案良方，可以拯救他人，可以造福世间，编辑并流传它们，应当远远高出那些语录和陈词滥调万万倍。竟然避讳而不宣扬，甘愿舍弃神奇的东西去迎合腐朽的风气。在理学中未必能增加一个伪君子席位，而在医学技艺中却失去了一位真人。这难道不荒谬吗？这难道不可惜吗！
故人沈君辛甫，端恪公曾孙也。尝病吴鞠通混疫于温。余谓不但此也，其《条辨》首列曰∶温病者，有风温、
有温热、有温疫、有温毒、有暑温、有湿温、有秋燥、有冬温、有温疟。凡九项，似无遗义，而不自知其题旨未清也。
夫冬伤于寒，至春而发者曰温病，夏至后发者曰热病。冬春感风热之邪而病者，首先犯肺，名曰风温，其病于冬者
亦曰冬温，病于春者亦曰春温，即叶氏所论者是也。夏至后所发之热病，在《内经》亦曰暑，以其发于暑令也。
故仲景以夏月感暑成病者名曰 ，盖暑、 者，皆热之谓也。今杜撰暑温名目，最属不通。至于疫证，更不可与
温热同治，当从吴又可、余师愚两家为正鹄。而温之为毒为疟，乃温之节目矣。概而论之，宜乎愈辨愈不清矣。
其次条云∶凡病温者，始于上焦，在手太阴。嘻，岂其未读《内经》耶？伏气为病，自内而发，惟冬春风温、
夏、秋燥，皆始于上焦。若此等界限不清，而强欲划界以限病，未免动手即错矣。夫温热究三焦者，非谓病必
在上焦始，而渐及于中、下也。伏气自内而发，则病起于下者有之；胃乃藏垢纳污之所，湿温、疫毒，病起于中
者有之；暑邪挟湿者，亦犯中焦；又暑属火而心为火脏，同气相求，邪极易犯，虽始上焦，亦不能必其在手太阴
一经也。
老朋友沈辛甫先生，是端恪公的曾孙。曾经批评吴鞠通将疫病混淆在温病中。我认为不仅如此，他的《温热条辨》开头列出：温病，有风温、有温热、有温疫、有温毒、有暑温、有湿温、有秋燥、有冬温、有温疟。总共九项，似乎没有遗漏的意义，但他自己不知道题目的主旨并不清晰。冬天受寒邪侵袭，到了春天发作的叫温病，夏至后发作的叫热病。冬春季节感受风热邪气而发病的，首先侵犯肺脏，名叫风温，在冬天发病的也叫冬温，在春天发病的也叫春温，这就是叶天士所论述的内容。夏至后发作的热病，在《黄帝内经》中也叫暑，因为它发生在暑令期间。所以张仲景把夏天感受暑邪而成病的叫做暑病（原文此处可能有缺字或通假，通常指暑病），大概暑、暑病，都是指热而言。现在杜撰出“暑温”这个名称，最为不通。至于疫病，更不可以与温热病一起治疗，应当以吴又可、余师愚两家的观点为准绳。而温病表现为毒或疟疾，只是温病的分支细节罢了。概括来说，越是辨析就越不清楚了。
其次条款说：凡是患温病的人，开始于上焦，涉及手太阴肺经。唉，难道他没有读过《黄帝内经》吗？伏气温病，从体内发出，只有冬春风温、夏暑、秋燥，都是从上面开始的。如果这些界限不清晰，却强行划定界限来限制疾病，未免一动手就错了。研究温热病的三焦辨证，并不是说病一定从上焦开始，然后逐渐波及中焦、下焦。伏气从体内发出，那么病起于下焦的情况是有的；胃是藏污纳垢的地方，湿温、疫毒，病起于中焦的情况是有的；暑邪夹湿的，也侵犯中焦；另外暑属于火，而心也是火脏，同类气息相互吸引，邪气极容易侵犯，虽然开始于上焦，也不能断定它只在手太阴这一条经脉上。
第四条云∶太阴风温、温热、温疫、冬温，初起恶风寒者，桂枝汤主之。夫鞠通既宗叶氏，当详考叶氏论案
以立言，如《指南》温热门第三案云∶温邪上受，内入乎肺，肺主周身之气，气窒不化，外寒似战栗，其温邪内
郁，必从热化。风温门第五案云∶风温入肺，气不肯降，形寒内热，乃 郁之象。用药皆是辛凉轻剂。至《幼科
要略》，论三时伏气外感尤为详备。于春温证因外邪引动伏热者，必先辛凉以解新邪，自注用葱豉汤。垂训昭然，
何甘违悖？意欲绍述仲圣乎，则祖上之门楣，不可夸为自己之阀阅也。在泾先生云∶温病伏寒变热，少阴之精已被劫夺，
虽有新旧合邪，不得更用用桂枝汤助热而绝其本也。岂吴氏皆未之闻乎？
第四条说：太阴风温、温热、温疫、冬温，初期出现怕冷怕风症状的，主治用桂枝汤。既然吴鞠通尊崇叶天士，就应该详细考察叶天士的论述和医案来确立自己的言论，比如《临证指南医案》温热门第三案说：温邪从上面侵入，进入肺脏，肺主管全身的气，气机阻滞不能化解，外表寒冷好像战栗，其实温邪在内郁结，必然会从热转化。风温门第五案说：风温进入肺脏，气机不肯下降，身体寒冷内部发热，这是气郁的现象。用药都是辛凉轻剂。到了《幼科要略》，论述三个季节的伏气外感尤为详细完备。对于春温证因为外邪引动伏热的，必须先使用辛凉药物来解除新邪，自注中使用葱豉汤。教导非常明显，为什么甘愿违背悖逆？想要继承阐述张仲景吗，那么祖先的门楣，不可以夸耀为自己的功德。在泾先生说：温病伏寒变为热，少阴的精气已经被劫夺，虽然有新旧邪气结合，不能再使用桂枝汤来助热而断绝根本。难道吴鞠通都没有听说过吗？
中焦篇第一条自注云∶肺病逆传，则为心包，上焦失治，则传中焦，始上焦，终下焦。嘻，是鞠通排定路径，
必欲温热病遵其道而行也，有是理乎？彼犯肺之邪若不外解，原以下传于胃为顺，故往往上焦未罢，已及中焦；
惟其不能下行为顺，是以内陷膻中为逆传。章虚谷亦昧此义，乃云火来克金，而肺邪反传于包络，故曰逆。夫从
所胜来者为微邪，胡可反以为逆？岂二公皆未读《难经》耶？其不始于上焦者，更无论矣。
中焦篇第一条自注说：肺病逆传，就会传到心包，上焦治疗失误，就会传到中焦，开始于上焦，结束于下焦。唉，这是吴鞠通排定的路径，一定要让温热病遵循他的道路运行，有这样的道理吗？那些侵犯肺部的邪气如果不从外部解除，原本应该向下传给胃才是顺证，所以往往是上焦的病还没好，就已经波及中焦；只有当它不能向下传导变成顺证时，向内陷入膻中才叫逆传。章虚谷也不明白这个意义，却说火来克金，而肺邪反而传到心包络，所以叫逆。从被克制的一方传来的邪气叫微邪，怎么可以反过来认为是逆呢？难道这两位先生都没有读过《难经》吗？那些不是从上焦开始的，就更不用说了。
书名《温热条辨》，而所列霍乱，皆是寒证，故余年少时辄不自揣，而有《霍乱论》之作也。沈辛老云∶鞠
通书蓝本叶氏，有前人未见及而补之者，如秋燥增入正化，痉螈别为两条，谈理抑何精细。有前人已见及而忘之
者，如霍乱证自具暑湿门，岫云未经摘出，而伊芳遂不知有热；疝气条当分暴久治，香岩先生业已道明，而伊芳又惟
知有寒。盖心思之用，固各有至不至，虽两间亦缺陷世界，而况人乎？又曰∶鞠通所云之疝多系暴证，而久者又
系宿瘕病，故可一以温下取下。若疝虽有历久不痊，然聚则有形，散即无形，初非真有物焉，如瘀积腹中也。又
云∶干霍乱以生芋杵汁下咽即生，远胜盐汤探吐也。暑疡初起用丝瓜杵汁涂，或荷花瓣贴之，皆妙，不必水仙根
也。
书名叫《温热条辨》，而里面列出的霍乱，都是寒证，所以我年轻时就不自量力，写了《霍乱论》。沈辛老说：吴鞠通的书以叶天士著作为蓝本，有前人没有见到而补充的，比如秋燥增加了正化的内容，痉厥单独列为两条，谈论道理非常精细。有前人已经见到而遗忘的，比如霍乱证本来就在暑湿门类中，岫云（可能指某人或误植）没有摘出来，于是他不知道有热证；疝气条应当区分急性和慢性治疗，费伯雄（香岩先生）已经说明白了，而他只知道有寒证。大概心思的运用，确实有达到和不达到的区别，即使是天地之间也是有缺陷的世界，何况是人呢？又说：吴鞠通所说的疝气多属于急性病症，而慢性的又属于宿瘕病，所以可以用温下法来攻下。如果疝气虽然经久不愈，但是聚集时有形，消散时无形，起初并不是真有什么东西，像瘀血积聚在腹部那样。又说：干霍乱用生芋头捣碎取汁吞服就能活命，远远胜过用盐水催吐。暑天疮疡初起用丝瓜捣碎取汁涂抹，或者用荷花花瓣贴敷，都很奇妙，不必用水仙根。
中焦八十四条云∶少阳疟如伤寒证者，小柴胡汤主之，此与温热何与，而乃阑入乎？辛老云∶叶氏知暑湿时
疟与风寒正疟迥别，融会圣言，惟从清解，所见甚超；而洄溪反以不用柴胡屡肆诋訾，食古不化，徐公且然，况
其下乎？噫，辛老长余九岁，与余交最深，品学兼优，真古君子也。尝为余校《温热经纬》，而家贫无子，今墓草宿矣。
遗稿未梓，偶于拙草中检得数条，附录于此，亦可以见其读书具眼、立言忠浓也。
中焦篇第八十四条说：少阳疟疾像伤寒证的，用小柴胡汤主治，这与温热病有什么关系，却混杂进来了呢？辛老说：叶天士知道暑湿时疟与风寒正疟截然不同，融会贯通圣人的言语，只从清热解表入手，见解非常高超；而徐灵胎（洄溪）反而因为不使用柴胡而屡次大肆诋毁，食古不化，连徐公都这样，何况比他差的人呢？唉，辛老比我大九岁，与我交往最深，品德学问都优秀，真是古代的君子啊。曾经帮我校对《温热经纬》，但是家里贫穷没有儿子，现在墓地已经长满野草了。遗稿没有刻印出版，偶然在我的草稿中检查出几条，附录在这里，也可以看出他读书有眼光、立言忠诚深厚。
下焦篇之定风珠，一派腥浊浓腻，无病患胃弱者亦难下咽。如果厥哕欲脱而进此药，是速其危矣。
下焦篇中的定风珠，味道腥浊浓腻，没有患病胃气虚弱的人也难以吞咽。如果真的出现四肢厥冷、呃逆欲脱的症状而服用这个药，是加速他的危险了。
二十四至二十六条，皆冬寒内伏、春温初发之治，乃妄谓温热、温疫，自上、中传下之治，岂非梦呓？
第二十四至二十六条，都是治疗冬天寒气内伏、春天温病初发的方法，却胡乱说是治疗温热病、温疫，从上焦、中焦传到下焦的方法，这难道不是梦话吗？
四十二条自注谓宋元以来，不明仲景一书专为伤寒而设。吴氏直未读《伤寒论》也。注《伤寒》者无虑数十
家，皆以为专论伤寒之书，故恒觉支离附会。考论中风、寒、温、 、湿五气为病，古人皆曰伤寒，故《难经》
云∶“伤寒者有五”，而仲圣以伤寒名其书也。此等大纲不清，岂可率尔着书！
第四十二条自注说宋朝元朝以来，不明白张仲景的书是专门为了伤寒而设立的。吴鞠通简直是没有读过《伤寒论》。注释《伤寒论》的至少有几十家，都认为这是专门论述伤寒的书，所以常常觉得（吴氏的观点）支离破碎、牵强附会。考证讨论中风、寒、温、暑、湿五种邪气致病，古人都称之为伤寒，所以《难经》说：“伤寒有五种”，而张仲圣人以伤寒命名他的书。这种大纲都不清楚，怎么能轻率地写书！
五十一条痰湿阻气之阴吹证，实前人所未道及。
第五十一条关于痰湿阻碍气机导致的阴吹证，确实是前人没有提及过的。
第五十五条阐明了蚕砂的功效，非常精准贴切，所以我治疗霍乱把它作为主药。
吴氏此书不过将《指南》温热、暑湿各案穿插而成，惜未将《内经》、《难经》、《伤寒论》诸书溯本穷源，
即叶氏《温热论》、《幼科要略》亦不汇参，故虽曰发明叶氏，而实未得其精奥也。至采附各方，不但剪裁未善，
去取亦有未当。此余不得已而有《温热经纬》之纂也。
吴鞠通的这本书不过是把《临证指南医案》中温热、暑湿的各个医案穿插组合而成，可惜没有将《黄帝内经》、《难经》、《伤寒论》等书追溯本源，就连叶天士的《温热论》、《幼科要略》也没有综合参考，所以虽然说是在阐发叶天士的学说，但实际上并没有得到其中的精妙深奥之处。至于采集附带的各方，不仅剪裁不当，取舍也有不合适的地方。这是我不得已而编纂《温热经纬》的原因。
后三卷杂说，解产难、解儿难等篇，皆可传之作，远胜三焦《条辨》多矣。杂说中惟“霍乱不得吐泻，治以
苦辛芳热”一语为可议。《条辨》中可议处甚多，姑举大略如上，庶读者勿随波而逐流也。
后三卷的杂说，包括解产难、解儿难等篇章，都是可以流传的作品，远远胜过三焦《条辨》很多。杂说中只有“霍乱不能吐泻，用苦辛芳香热药治疗”这句话值得商榷。《条辨》中值得商榷的地方很多，暂且列举大致如上，希望读者不要随波逐流。
阴吹乃妇人常有之事，别无所苦者，自亦不知为病，况系隐微，医更不知。相传产后未弥月而啖葱则有此，不可谓
为病也。惟吹之太喧而大便坚滞者，或由肠燥，或由瘀阻，或由痰滞，以致腑气不通，而逼走前阴也。然亦但宜润其燥，
化其瘀，宣其痰，不必治其吹也。
阴吹是妇女常有的事情，如果没有其他痛苦，自己也不知道是病，况且情况隐蔽细微，医生更不知道。相传产后未满一个月吃葱就会有这种情况，不可以称之为病。只有吹气声音太大并且大便坚硬停滞的，可能是由于肠燥，也可能是由于瘀血阻滞，或者是由于痰湿停滞，导致腑气不通，从而逼迫气体从前阴排出。但也只需要滋润肠道干燥，化解瘀血，宣通痰湿，不需要专门治疗阴吹。
转女成男之说，自古有之，而验者甚少。钱塘沈君西海云∶有一法每试有效，且甚简易。若停汛而确知为孕，
即取红纸一张，本夫亲书“五更露结桃花实，二月春生燕子巢”十四字于上，书时心中默诵∶“无思也，无为也，
寂然不动，感而遂通”四句，书毕，贴于卧床内隐处。凡书时、贴时，均勿令人见，并勿令人知，验后始可传人
也。
改变胎儿性别为男孩的说法，自古以来就有，但灵验的很少。钱塘沈西海先生说：有一个方法每次尝试都有效，而且非常简单。如果月经停止并且确切知道怀孕，就取一张红纸，由丈夫亲自写上“五更露结桃花实，二月春生燕子巢”这十四个字，写字的时候心中默念：“无思也，无为也，寂然不动，感而遂通”这四句话，写完以后，贴在床铺内部的隐蔽处。凡是写字的时候、张贴的时候，都不要让人看见，也不要让人知道，验证灵验之后才可以传授给别人。
黄锦芳云∶杜仲、续断二味，举世用以安胎，而不知续断味苦，专入血分，活血消肿，故乳痈、 结、肠风、
痔、金疮、跌仆，一切血瘀之证，皆可用也，虽稍有涩性，行不至泄，然误施于气弱、气陷之妇，则顺流而下，
奔迫莫御，而有排山倒海之势，岂区区涩味所能止其万一者乎？杜仲色紫而润，辛甘微温，性专入肝，补气强筋，
筋强则骨亦健，凡肾虚、肾寒脚弱之病，用之最宜，若气陷、气弱之辈，断不可服，以其性最引气下行，而无上
升坚固之意也。夫胎坠本忌血行气陷，其服此二味亦有奏效者，以人身气血贵乎温通，胎坠之因不一，亦有因肾
气不温，经血凝滞，而胞胎失荫者，得此二味，则气煦血濡，不滞不漏，而胎自安矣。止为下虚上实者设也。故
胎坠而尺强寸弱者，动作少气者，表虚恶风汗时出者，心下悬饥得食则止者，一身之气尽欲下坠者，皆在禁例。
奈作俑者既不分辨明晰，流传既久，遂以为安胎圣药，总缘医理不明，药性不晓，证候不知，见方号为神验，虽
滑脱之妇，亦尔通用。岂知杜仲、续断原或因于跌仆，或下寒挟瘀而胎动者之妙剂，苟不知审顾区别而妄用之，则不但
不能安胎，反能催胎、坠胎，甚有殒其母命者，可不戒哉！愚按此二药余不甚用，而世人皆视为补益之品，得黄氏此论，
自信管见之未昏。
黄锦芳说：杜仲、续断这两味药，全世界的人都用来安胎，却不知道续断味道苦，专门进入血分，活血消肿，所以乳痈、乳核结块、肠风、痔疮、刀伤、跌打损伤，一切血瘀的病症，都可以使用，虽然稍微有点涩性，但流通不至于泄泻，然而错误地用在气弱、气陷的妇女身上，就会顺流而下，奔腾紧迫无法控制，有排山倒海的势头，难道区区涩味所能阻止其中万分之一吗？杜仲颜色紫而润泽，辛甘微温，性质专门进入肝脏，补气强筋，筋强健那么骨头也健康，凡是肾虚、肾寒脚弱的病，用它最合适，如果是气陷、气弱的人，绝对不可以服用，因为它的性质最引导气向下行，而没有上升坚固的意思。胎儿坠落本来忌讳血行和气陷，服用这两味药也有奏效的，因为人体气血贵在温和通畅，胎儿坠落的原因不止一种，也有因为肾气不温暖，经血凝滞，而胞胎失去荫蔽的，得到这两味药，那么气温暖血滋润，不滞留不漏泄，而胎儿自然安定。这只是为下虚上实的人准备的。所以胎儿坠落而尺脉强寸脉弱的，活动减少气短的，表虚怕风经常出汗的，心下空虚饥饿吃东西就停止的，全身的气都想下坠的，都在禁忌之列。无奈创始的人既然不分辨清楚，流传久了，就以为是安胎的神药，总原因是医理不明白，药性不了解，证候不知道，看到方子号称神验，即使是滑脱的妇女，也一概通用。哪里知道杜仲、续断原本是用于跌打损伤，或者下寒夹瘀导致胎动的妙药，如果不知道审慎区别而胡乱使用，那么不但不能安胎，反而能催生、堕胎，甚至有丧母性命的，能不警惕吗！我按照这个观点，这两味药我不怎么用，而世人都把它们视为补益的药物，得到黄氏的这个理论，自信我的浅见没有糊涂。
妇人临产，世俗每虑其饥寒，而不知饱暖以致难产。《治法汇》云∶如饥宜食稀粥，勿令过饱，宜稍饥为佳，
以饥则气下，气下则速产。若食肉及多食，或啖腻滞之物，则碍于上焦，气不得下，故产难，虽产下而食滞中焦，
则生寒热。医者不察，乱投温补，多致危殆。隆冬浅屋，固宜遮蔽密实，添设火盆；若盛暑必择清凉之所，但须
避风，切勿过暖，致生诸患。如无凉室，榻前可以新汲水盆贮映之。
妇女临产，世俗常常担心她们饥饿寒冷，却不知道吃饱暖和会导致难产。《治法汇》说：如果饿了应该喝稀粥，不要让吃得过饱，稍微有点饥饿感比较好，因为饥饿则气下沉，气下沉则生产快。如果吃肉以及多吃，或者吃油腻停滞的食物，就会阻碍上焦，气不能下行，所以生产困难，即使生下来了，食物停滞在中焦，就会产生寒热。医生不观察，乱用温补药物，大多导致危险。隆冬季节住在简陋的房屋里，固然应该遮蔽严密，添加火盆；如果在盛夏必须选择清凉的地方，但是必须避开风，千万不要过热，导致产生各种祸患。如果没有凉快的房间，床榻前可以用新打的井水盆存放映照降温。
《明史》载光宗谅暗，郑贵妃进美女四人，上不豫，内医崔文升用大黄药，一日夜三四十起，头目眩晕，不
能动履。杨涟疏劾之云∶有心之误耶？无心之误耶？有心则齑粉不足偿，无心则一误岂可再误！上宣涟入，目注
久之。方从哲荐李可灼进红丸。上饮汤辄喘，药进乃受。上喜称忠臣者再，顷之传圣体用药后，暖润舒畅。复进
一丸，明旦驾崩矣。从哲拟旨赏可灼银五十两，以王舜安疏改罚俸一年。于是言者蜂起，谓文升情罪不减张差，
而可灼次之，并劾从哲。从哲疏辨，自请削夺，可灼遣戍，文升发遣南京。愚谓此胜国三大案之一，实千古之大
疑案也。论者纷纷，迄未得其病情，以文人多不知医耳。吾友仁和徐君亚枝尝云∶李可灼进红丸于光宗也，先有
奄人崔文升之用大黄，故尤悔庵拟明史乐府有“大黄一下法不治，红丸虽进补已迟”之句。其谓文升误下固然矣，
而以红丸为补则非是。盖光宗之病，阳明实而太阳未罢之证也。史载进红丸后，圣体暖润舒畅，则前此用大黄时，
必恶寒无汗、周身拘急之证悉具。大黄下之，汤饮不受，明是误下成结胸之证。红丸者丸而色红，莫知所用何药。余意
必是开太阳兼陷胸之品，所以进后暖润舒畅。史载“上不豫”于“进美女”之下，或太阳经府均病，配红铅为经府双解
之剂，故其丸色红，则仍是下法，不是补法。嘉言所谓得其下之之力，非得其补之之力者也。至于明旦驾崩，或因小愈
而复犯女色，宫围邃密，外廷莫知，不然岂有得暖润舒畅之转机，未尝变证而甫隔一夜遽然长逝乎？因慨文人谈医，每
多谬误，如《两般秋雨庵随笔》载咏甘草云∶“历事五朝长乐老，未曾独将汉留候”，皆未读医书之故也。愚谓
虽读医书，而阅历未深者，尚有人为书囿之弊，故论病最非易事。
《明史》记载光宗皇帝居丧期间，郑贵妃进献美女四人，皇上身体不适，宫内医生崔文升用了大黄药，一天一夜拉了三四十次，头晕目眩，不能行动。杨涟上疏弹劾他说：是有意的错误呢？还是无心的错误呢？如果有意的那么粉身碎骨也不足以偿还，如果是无心的那么一次错误难道可以再犯吗！皇上召杨涟进来，注视了很久。方从哲推荐李可灼进献红丸。皇上喝汤就喘息，吃药才接受。皇上高兴称赞他是忠臣两次，不久传言圣体用药后，温暖滋润舒畅。又进献一颗丸子，第二天早上皇帝去世了。方从哲起草旨意赏赐李可灼白银五十两，因为王舜安的奏疏改为罚俸一年。于是谏官们蜂拥而起，说崔文升的情节罪行不亚于张差，而李可灼稍次，一并弹劾方从哲。方从哲上疏辩解，请求削职夺权，李可灼被流放，崔文升被发配到南京。我认为这是明朝灭亡前的三大案件之一，实际上是千古的大疑案。议论的人纷纷扬扬，始终没有弄清楚当时的病情，因为文人大多不懂医学。我的朋友仁和徐亚枝先生曾说：李可灼给光宗进献红丸之前，先有太监崔文升使用大黄，所以尤侗（尤悔庵）拟定明史乐府中有“大黄一下法不治，红丸虽进补已迟”的诗句。他说崔文升误用下法固然正确，但把红丸当作补药就不对了。大概光宗的病，是阳明实证而太阳表证未解的情况。史书记载进献红丸后，圣体温暖滋润舒畅，那么此前使用大黄时，一定具备怕冷无汗、全身拘紧的症状。大黄攻下，汤药饮食都无法接受，明显是误下导致结胸证。红丸是丸子而且颜色红，不知道用了什么药。我猜想一定是开通太阳经兼治疗结胸的药物，所以进服后温暖滋润舒畅。史书记载“皇上身体不适”在“进献美女”之后，也许是太阳经和腑都生病了，配合红铅作为经络腑双重解表的药剂，所以它的丸子颜色红，那么仍然是下法，不是补法。喻昌（嘉言）所说的是得到了它下法的功效，而不是得到了它补法的功效。至于第二天早上皇帝去世，可能是因为稍微好转后又犯了女色，宫廷深邃严密，外面朝廷不知道，不然怎么会有得到温暖滋润舒畅的转机，没有发生病变却刚过一夜就突然离世呢？因此感慨文人谈论医学，常常有很多谬误，比如《两般秋雨庵随笔》记载咏甘草说：“历事五朝长乐老，未曾独将汉留候”，都是没有读过医书的缘故。我认为虽然读了医书，但阅历不深的人，还有人为了书本所局限的弊端，所以谈论病情最不是一件容易的事。
江阴陈定九《留溪外传》载前明崇明蔡指方神于医，尝云医家心动气浮，志歧欲侈，讹审察之微，失参辨之
宜，而用药舛谬，未有不杀人于顷刻者也。譬之良相治国，必举贤任能，因材器使，其心休休，其如有容，正己
无私，然后鼎鼐和，阴阳燮，而天下治。如或心术匪端，志向偏趋，而用人失当，欲求竣其功业，终其令闻者鲜
矣。故曰为医如为相，用药若用人。医道微矣，非绝欲无私，通神于微妙之乡，穷理尽性，研几于幽明之极者，
不足以传也。
江阴陈定九的《留溪外传》记载前明崇明蔡指方在医学上很神奇，曾经说医家心动气浮，志向分歧欲望奢侈，错误地审察细微之处，失去参合辨别的适宜，而用药错误，没有不在顷刻间杀人的。就像好的宰相治理国家，一定要推举贤才任用能人，根据才能使用他们，内心平和宽容，好像有容纳的能力，端正自己无私心，然后调和鼎鼐，协调阴阳，而天下大治。如果心术不正，志向偏颇，而用人失当，想要完成功业，保全美好名声的很少了。所以说做医生就像做宰相，用药就像用人。医道衰微了，如果不是断绝欲望无私心，通晓神灵在微妙的境界，穷尽物理本性，研究细微在幽明极致的人，不足以传承。
歙吴畹清太守，世精外科，以家传秘法刊行寿世，名《攒花知不足方》。业外科者，当奉为圭臬也。又刻徐、
歙县吴畹清太守，世代精通外科，把家传的秘法刊印流行于世，名叫《攒花知不足方》。从事外科的人，应当奉为标准。又刻印徐、
Zhenzhi (rescue/treat), showing no hesitation or sparing. You were not only famous for your medical skills! He died at the age of eighty. His spouse was Lady Pan. They had two sons: Yizhang and Longzhang. Yizhang was also skilled in medicine, but his fame was overshadowed by yours. There were two grandsons: one named Tang, the other Jian. There were three great-grandsons who studied Confucian classics. Benefiting from your virtue, elevating the family reputation, will be found here. Commentary says: Since Sima Qian wrote the biography of Cang Gong (Chunyu Yi) and recorded his cases, Chen Shou followed this model to write the "Biography of Hua Tuo". Later, Dai Liang and Song Lian imitated this style to write biographies of famous doctors. You did not wish to make a name for yourself through medicine, nor did you wish for your medical skills to be passed down. On his deathbed, he admonished his son: Medicine can be learned, but it should not be practiced lightly. One must possess natural intelligence and insight, have read ten thousand books, and only then can one use these skills to benefit the world; otherwise, few will not end up killing people. Thus, medicines are like blades and knives. After I die, my descendants must never speak lightly of medicine. Alas, this can be called being enlightened and benevolent.
Mr. Suiyuan (Yuan Mei) wrote to Xue Shouyu: "How easy is it to talk about! Heaven produces an immortal person, yet his sons and grandsons insist on pushing him into a place of inevitable decay. This is why I grieve. What is meant by 'immortal' does not necessarily require being like Duke Zhou or Confucius. The archery of Yi, the chess playing of Qiu, and the medicine of Yufu can all be considered immortal. If one must wait until becoming Duke Zhou or Confucius to be immortal, then how could there be so many Duke Zhous and Confucius figures in the universe? Your grandfather, Mr. Yipiao, is an immortal in the field of medicine. He passed away at an old age. I was just thinking of compiling his general biography to preserve his memory, but unexpectedly received a tombstone inscription that contained not a single word about medicine, instead attributing it to his lectures with Lord Chongwen. Alas, from now on, Mr. Yipiao's legacy will not be transmitted; he will rot! Learning lies in personal practice, not in lecturing. The highest learning is Ren (benevolence). The gentleman used his skills to show benevolence to the people, preventing premature death and disaster. This is exactly the learning of Confucius regarding 'making the old comfortable and cherishing the young.' Acting according to one's position, what learning is greater than this? Why abandon this to seek others? Wang Yangming's achievements were brilliant, yet Hu Shining mocked him for having an extra role as a lecturer. Lord Chongwen also did this, which I still consider incorrect in my heart. However, Lord Chongwen was a Grand Secretary, while your grandfather was a commoner. A Grand Secretary borrowing a commoner to elevate himself gains high reputation, whereas a commoner leveraging a Grand Secretary to exalt himself is very vulgar. Now, if I ask a passerby: 'Is Mr. Yipiao not a famous doctor?' Even your enemies would agree. If I ask: 'Is Mr. Yipiao a Neo-Confucian scholar?' Even your relatives would disagree. Why do you not transmit your ancestor using what everyone believes, but instead using what everyone doubts? Are you perhaps clinging to the saying that 'artistic skill places one low'? Do you not know that art is the tangible form of the Dao? Seek it diligently, and what art is not the Dao? Mimic it superficially, and both Dao and art are lost. Yan Kuai and Zi Zhi once claimed to follow Yao and Shun to show their loftiness, yet were ultimately laughed at by carpenters and wheelwrights. Medicine as an art is especially difficult to discuss. Shennong started it, Huangdi created it, and the Duke of Zhou appointed the Minister of Works to guard it; its principles connect to the sacred and divine. Today, medicine in the world has ceased, yet only the school of lecturing remains unbroken. Why? Medical effects are seen immediately, so among hundreds, there is hardly one famous doctor; lectures lack substance, so village scholars are everywhere. You do not honor your ancestor above the one-in-a-hundred famous doctors, but instead degrade him among the ubiquitous mediocre scholars. This is wrong. Even if it is merely idle talk in old age, such associations should be recorded, and the source of his skills should not be completely erased. I once suffered from a critical illness where my life was in danger. At that time, even if there were ten Duke Zhous, Cheng Hao, Zhang Zai, and Zhu Xi, what good would they do? Only Mr. Yipiao could save me with a small dose of medicine. Therefore, I am convinced he is truly an immortal person. Considering there must be other extraordinary cases and good prescriptions outside this that can save people and prolong life, compiling and transmitting them would far exceed the thousands of words in typical aphorisms. Yet he kept it hidden and did not proclaim it, willingly abandoning the miraculous for the rotten. In Neo-Confucianism, it might not add a seat for a hypocrite, but in the arts and crafts, a true master is lost. Is this not contradictory? Is this not regrettable!
My old friend Shen Xinpu, a great-grandson of Duanke Gong, once criticized Wu Jutong for conflating epidemics with warm diseases. I said it is not just this. His *Tiaobian* (Differentiation of Warm Diseases) begins by listing: Warm diseases include Fengwen (Wind-Warmth), Wenre (Warm-Thermal), Wenyi (Warm Epidemic), Wendu (Warm Toxin), Shuwen (Summer-Heat Warmth), Shiwen (Damp-Warmth), Qiuzao (Autumn Dryness), Dongwen (Winter Warmth), and Wenma (Warm Malaria). These nine items seem comprehensive, but he did not realize his theme was unclear. Those injured by cold in winter and manifesting in spring are called Warm Diseases; those manifesting after the Summer Solstice are called Heat Diseases. Those contracting wind-heat pathogens in winter and spring and falling ill first attack the Lung, named Fengwen. Those ill in winter are also called Dongwen, and those ill in spring are called Chunwen, which is what Ye Tianshi discussed. Heat diseases occurring after the Summer Solstice are also called Shu (Summer-Heat) in the *Neijing* because they occur during the summer season. Therefore, Zhang Zhongjing named illnesses contracted from summer heat as Shu Bing (Summer-Heat Disease). Shu and Shu Bing both refer to heat. Inventing the term "Shuwen" is most illogical. As for epidemic diseases, they certainly cannot be treated together with warm diseases; one should take the approaches of Wu Youke and Yu Shiyu as the standard. That warmth manifests as toxin or malaria are merely sub-categories of warmth. Generally speaking, the more one differentiates, the less clear it becomes.
The next clause states: All warm diseases begin in the Upper Jiao, involving the Hand Taiyin Lung Meridian. Hah, did he not read the *Neijing*? Diseases caused by latent qi emerge from within. Only Dongchun Fengwen, Xiashu (Summer Heat), and Qiuzao begin in the Upper Jiao. If these boundaries are unclear, yet one insists on drawing lines to limit diseases, mistakes will be made from the start. Investigating the Three Jiao in warm diseases does not mean the disease must start in the Upper Jiao and gradually spread to the Middle and Lower Jiao. Latent qi emerging from within means diseases can originate in the Lower Jiao; the stomach is a place of filth and waste, so Shiwen (Damp-Warmth) and Yidu (Epidemic Toxin) can originate in the Middle Jiao; Shuxie (Summer-Heat Pathogen) carrying dampness also attacks the Middle Jiao; furthermore, summer heat belongs to Fire, and the Heart is a Fire organ; similar energies attract, so pathogens easily invade. Although starting in the Upper Jiao, it cannot be certain it is confined to the Hand Taiyin meridian alone.
Clause Four states: For Hand Taiyin Fengwen, Wenre, Wenyi, and Dongwen, if there is initial aversion to wind and cold, Guizhi Tang (Cinnamon Twig Decoction) should be used. Since Jutong follows Ye Tianshi, he should have carefully examined Ye's cases to establish his statements. For example, in the third case of the Warmth section in *Linzheng Zhinan* (Guide to Clinical Practice), it says: Warm pathogens enter from above and go inward to the Lung. The Lung governs the qi of the whole body. When qi is obstructed and fails to transform, external cold resembles shivering, but the internal warm pathogen stagnates and must transform into heat. In the fifth case of the Wind-Warmth section: Wind-warmth enters the Lung, qi refuses to descend, causing chills externally and heat internally, which is a sign of Qi Stagnation. Medications used are all mild acrid-cool agents. In *Youke Yaolüe* (Essentials for Pediatrics), the discussion of latent qi and external contraction across three seasons is particularly detailed. For Spring Warmth cases triggered by external pathogens moving latent heat, one must first use acrid-cool methods to resolve the new pathogen, noting the use of Congchi Tang (Scallion and Fermented Soybean Decoction). The instruction is clear; why willingly violate it? Did he intend to inherit Zhang Zhongsheng? Then the ancestral gate cannot be boasted as one's own merit. Mr. Zaijing said: In warm diseases, latent cold transforms into heat, and the essence of Shaoyin has already been robbed. Even with combined new and old pathogens, one must not use Guizhi Tang to assist heat and cut off the root. Did Wu not hear of this?
The self-note in Clause One of the Middle Jiao Chapter states: Lung disease reversing transmission goes to the Pericardium. Failure to treat the Upper Jiao leads to transmission to the Middle Jiao; it starts in the Upper Jiao and ends in the Lower Jiao. Hah, this is Jutong arranging a path, insisting that warm diseases must follow his route. Is there such logic? If the pathogen attacking the Lung is not resolved externally, it originally transmits downward to the Stomach as a favorable progression. Thus, often when the Upper Jiao is not finished, it has already reached the Middle Jiao. Only when it cannot move downward favorably does it fall inward to the Danzhong (Chest Center) as reverse transmission. Zhang Xugu also misunderstood this meaning, claiming Fire overcomes Metal, so Lung pathogen reverses to the Pericardium, hence called reverse. But pathogens coming from the overcome element are minor pathogens; how can they be considered reverse? Did both gentlemen not read the *Nanjing*? Those not starting in the Upper Jiao need not be mentioned.
The book is titled *Wenre Tiaobian*, yet the listed Huoluan (Cholera-like disorder) cases are all Cold patterns. Therefore, when I was young, I presumptuously wrote *Huoluan Lun* (Treatise on Cholera). Old Man Shen said: Jutong's book uses Ye Tianshi as its blueprint. There are things predecessors missed that he supplemented, such as adding Zhenghua (True Transformation) to Autumn Dryness, and separating Jingyuan (Spasm and Convulsion) into two clauses; his theoretical discussion is extremely refined. There are things predecessors saw but forgot, such as Huoluan cases naturally belonging in the Damp-Heat section; Xiu Yun did not extract them, so he did not know there was Heat; for Hernia clauses, treatment should distinguish between acute and chronic; Mr. Xiangyan had already clarified this, yet he only knew of Cold. The application of mind indeed varies in depth. Even the universe is a flawed world, let alone humans. He also said: The hernias Jutong spoke of were mostly acute conditions, while chronic ones were old masses (Xujia). Thus, warming and purging can be used uniformly. If hernias persist for a long time without healing, they gather to form shape and scatter to become formless; initially, there is no real object, unlike blood stasis accumulating in the abdomen. He also said: For Ganhuoluan (Dry Cholera), swallowing juice pounded from raw taro brings immediate survival, far surpassing salt water-induced vomiting. For early-stage summer sores, applying pounded loofah juice or lotus petals is excellent; Narcissus root is unnecessary.
Clause Eighty-Four of the Middle Jiao states: For Shaoyang Malaria resembling Taiyang Cold Damage syndrome, Xiaochaihu Tang (Minor Bupleurum Decoction) should be used. What does this have to do with Warm Diseases, yet it is inserted here? Old Man Shen said: Ye Tianshi knew that Summer-Damp seasonal malaria is vastly different from Wind-Cold regular malaria. Integrating sage words, he only focused on clearing and resolving, showing superior insight. However, Huixi (Xu Lingtai) repeatedly slandered him for not using Chaihu, being unable to digest the ancients. Even Master Xu was like this, let alone those below him. Alas, Old Man Shen was nine years older than me, our friendship was deepest, his character and learning were outstanding; he was truly a gentleman of antiquity. He once helped me proofread *Wenre Jingwei*. Poor and without sons, his grave is now overgrown with grass. His manuscripts were not printed. Occasionally finding a few entries in my rough drafts, I append them here, which also shows his discerning eye in reading and loyal depth in speech.
Dingfeng Zhu (Stabilizing Wind Pearl) in the Lower Jiao Chapter is a mixture of fishy, turbid, thick, and greasy substances. Even patients with weak stomachs find it hard to swallow. If one administers this medicine when there are cold limbs, hiccups, and impending collapse, it accelerates the danger.
Clauses Twenty-Four to Twenty-Six describe treatments for latent winter cold and initial spring warmth. Claiming these are treatments for warm diseases and epidemics transmitting from Upper/Middle to Lower Jiao is nothing but babbling.
The self-note in Clause Forty-Two claims that since the Song and Yuan dynasties, people have not understood that Zhang Zhongjing's book was specifically designed for Cold Damage. Wu simply has not read the *Shanghan Lun*. Dozens have annotated the *Shanghan Lun*, all considering it a book exclusively discussing Cold Damage, thus always feeling [Wu's views] are disjointed and forced. Examining the five qi (Wind, Cold, Warmth, Summer-Heat, Dampness) causing disease, ancients all called it Shanghan (Cold Damage). Thus, the *Nanjing* says: "There are five types of Shanghan," and Zhang Zhongsheng named his book Shanghan. With such major outlines unclear, how can one rashly write a book!
Clause Fifty-One discusses Yin Chui (Vaginal Flatulence) caused by Phlegm-Damp obstructing Qi, which was indeed not mentioned by predecessors.
Clause Fifty-Five elucidates the function of Can Sha (Bombyx Batryticatus) with such precision, which is why I use it as the main herb for treating Huoluan.
Wu's book merely intersperses cases from *Zhinnan* (Warmth and Summer-Damp sections). It is a pity he did not trace the roots through the *Neijing*, *Nanjing*, and *Shanghan Lun*, nor did he synthesize Ye Tianshi's *Wenre Lun* and *Youke Yaolüe*. Thus, although he claims to expound on Ye Tianshi, he actually failed to grasp the essence. Regarding the collected formulas, not only is the editing poor, but the selection is also inappropriate. This is why I was compelled to compile *Wenre Jingwei*.
The last three volumes of miscellaneous sayings, including chapters on Resolving Difficult Childbirth and Resolving Pediatric Difficulties, are works worthy of transmission, far surpassing the Three Jiao *Tiaobian*. Among the miscellaneous sayings, only the phrase "Huoluan without vomiting or diarrhea, treated with bitter, acrid, aromatic, and hot herbs" is debatable. There are many debatable points in the *Tiaobian*; I have briefly listed them above so readers do not follow the crowd.
Yin Chui is a common occurrence in women. If there is no other discomfort, they do not even know it is a disease, let alone physicians due to its subtle nature. It is said that eating green onions within a month postpartum causes this; it cannot be called a disease. Only when the sound is too loud and stool is hard and stagnant, possibly due to intestinal dryness, blood stasis obstruction, or phlegm stagnation, causing Fu Qi (Bowels Qi) to not flow freely and forcing exit through the anterior yin, should it be addressed. However, one should only moisten dryness, resolve stasis, and ventilate phlegm; there is no need to treat the flatulence itself.
The theory of changing female to male has existed since ancient times, but few are verified. Shen Xihai of Qiantang said: There is a method that is always effective and very simple. If menstruation stops and pregnancy is confirmed, take a sheet of red paper. The husband personally writes the fourteen characters "Five-dew forms peach fruit, Second-month spring births swallow nest." While writing, silently recite: "No thought, no action, silent and unmoving, responsive and connecting." After writing, paste it in a hidden place inside the bed. During writing and pasting, do not let anyone see or know. Only after verification may it be passed on.
Huang Jinfang said: Du Zhong (Eucommia Bark) and Xu Duan (Teasel Root) are used by the world to calm the fetus, but people do not know that Xu Duan is bitter, enters the Blood aspect specifically, invigorates blood, and reduces swelling. Thus, it can be used for mastitis, breast nodules, intestinal wind, hemorrhoids, metal wounds, and falls—all blood stasis conditions. Although slightly astringent, it moves without causing leakage. However, mistakenly applied to women with weak or sinking Qi, it flows downward uncontrollably with overwhelming force. How can mere astringency stop even a fraction of this? Du Zhong is purple and moist, acrid-sweet and slightly warm, entering the Liver specifically. It tonifies Qi and strengthens sinews. Strong sinews lead to strong bones. It is most suitable for Kidney deficiency and Kidney cold causing weak legs. However, those with sinking or weak Qi must absolutely not take it, as its nature guides Qi downward without any intention of ascending and stabilizing. Fetal miscarriage inherently fears blood movement and Qi sinking. Taking these two herbs can sometimes work because human Qi and Blood value warm circulation. Causes of miscarriage vary; some are due to Kidney Qi not being warm, menstrual blood stagnating, and the conception house losing nourishment. Getting these two herbs warms the Qi and moistens the Blood, preventing stagnation and leakage, thus calming the fetus. This is only set for those with lower deficiency and upper excess. Therefore, fetal miscarriage with strong Chi pulse and weak Cun pulse, shortness of breath upon movement, exterior deficiency with aversion to wind and sweating, hunger pain under the heart relieved by eating, and a sensation of all Qi wanting to sink—all are contraindications. Regrettably, the originators did not distinguish clearly. After long dissemination, they became regarded as holy medicines for calming the fetus. This stems from unclear medical principles, ignorance of drug properties, and unawareness of syndromes. Seeing a formula hailed as miraculous, they use it universally even for women with slipping/depletion. Do they not know Du Zhong and Xu Duan are excellent formulas for miscarriage caused by falls or lower cold with blood stasis? If one does not examine and distinguish before using them recklessly, not only will they fail to calm the fetus, but they may induce labor or cause miscarriage, even endangering the mother's life. Must one not beware! I note that I rarely use these two drugs, while the world regards them as tonics. Obtaining Huang's argument, I am confident my limited view is not confused.
Women approaching childbirth, custom worries about hunger and cold, not knowing that fullness and warmth cause difficult labor. *Zhifa Hui* says: If hungry, eat thin porridge; do not overeat. Slight hunger is best, because hunger causes Qi to descend, and descending Qi speeds delivery. If eating meat or overeating, or consuming greasy/stagnant foods, it obstructs the Upper Jiao, Qi cannot descend, hence difficult birth. Even after birth, food stagnation in the Middle Jiao generates cold and heat. Physicians failing to observe this indiscriminately administer warming and tonifying herbs, often leading to danger. In deep winter, shallow houses should be sealed tightly with fire pots added; in midsummer, one must choose cool places, avoiding wind, never allowing excessive heat to cause various ailments. If no cool room exists, placing basins of fresh well water near the bed helps cool the area.
*Ming Shi* records that during Emperor Guangzong's mourning period, Noble Consort Zheng presented four beauties. The Emperor felt unwell. Internal physician Cui Wensheng used Rhubarb (Dahuang). In one day and night, he defecated thirty to forty times, suffering dizziness and inability to move. Yang Lian memorialized impeaching him: Was it intentional error or unintentional? Intentional errors deserve death; unintentional errors should not be repeated! The Emperor summoned Yang Lian, staring at him for a long time. Fang Congzhe recommended Li Kezhuo present Red Pills. Whenever the Emperor drank soup, he panted; he accepted the medicine. The Emperor happily called him a loyal minister twice. Soon, it was reported that after taking the medicine, the Sacred Body felt warm, moist, and comfortable. Another pill was administered. The next morning, the Emperor passed away. Fang Congzhe drafted an edict rewarding Li Kezhuo with fifty taels of silver. Due to Wang Shunan's memorial, this was changed to a one-year salary deduction. Critics rose like bees, stating Cui Wensheng's crime was no less than Zhang Cha's, and Li Kezhuo was secondary, impeaching Fang Congzhe as well. Fang Congzhe submitted a defense, requesting dismissal. Li Kezhuo was exiled; Cui Wensheng was sent to Nanjing. I consider this one of the Three Major Cases of the fallen dynasty, truly a千古 (eternal) mystery. Discussants argue endlessly, never determining the actual condition, largely because literati rarely understand medicine. My friend Xu Yazhi of Renhe once said: When Li Kezhuo presented the Red Pill to Guangzong, it followed Cui Wensheng's use of Rhubarb. Hence You Huan'an's *Ming Shi Yuefu* contains the line: "Once Rhubarb is taken, the method fails to cure; though Red Pill is given, tonification is too late." Saying Cui erred with purgatives is correct, but calling the Red Pill a tonic is incorrect. Guangzong's illness was Yangming Excess with unresolved Taiyang symptoms. Records state that after the Red Pill, the body felt warm and comfortable. Thus, before using Rhubarb, he must have had aversion to cold, anhidrosis, and generalized stiffness. Rhubarb purged, yet soups/drinks were rejected. Clearly, erroneous purging led to Jie Xiong (Chest Binding) syndrome. The Red Pill was round and red; no one knew the ingredients. I suspect it contained herbs to open Taiyang and resolve Chest Binding, hence the warm comfort after administration. Records place "Emperor unwell" after "presenting beauties." Perhaps both Taiyang Meridian and Fu organs were diseased. Paired with Hongqian (Red Lead), it served as a dual-resolving agent for Meridian and Fu, hence the red color. It remained a purgative method, not a tonic. Jiayan (Yu Chang) said it obtained the power of purging, not tonifying. As for passing away the next morning, perhaps he recovered slightly then indulged in women again. The palace was secluded; the outer court knew not. Otherwise, how could there be a turning point of warmth and comfort, without symptom change, yet sudden death after one night? Thus sighing that literati discussing medicine often err. For example, *Liangban Qiuyu An Suibi* records a poem on Licorice: "Serving five dynasties, the Ever-Happy Old Man, never solely acting as Han's Marquis Liu Hou." Both are due to not reading medical books. I believe even reading medical books, those with shallow experience suffer from being bounded by texts. Thus, discussing disease is hardest of all.
Jiangyin Chen Dingjiu's *Liuxi Waizhuan* records Cai Zhifang of Chongming in the previous Ming Dynasty as miraculous in medicine. He once said: If a physician's heart moves and Qi floats, ambitions diverge and desires expand, misjudging subtle examinations and losing appropriate differentiation, leading to erroneous medication, none will not kill people in an instant. It is like a good minister governing the state: promoting the virtuous and capable, utilizing talents appropriately, maintaining a peaceful and tolerant heart, rectifying oneself without selfishness, thereby harmonizing the cauldron, adjusting Yin and Yang, and ruling the world. If the heart is crooked and intentions biased, misusing people, seeking complete success and lasting fame is rare. Thus, practicing medicine is like being a minister; using medicine is like employing people. The Way of Medicine is subtle. Without extinguishing desires and being selfless, communicating with the divine in subtle realms, exhausting principles and nature, and studying the minute in the extreme of dark and light, one is unworthy of transmission.
Wu Wanqing, Prefect of She, descended from a family specializing in surgery. He published family secret methods for longevity, titled *Zanhua Zhibuzu Fang*. Practitioners of surgery should regard it as the standard. He also printed Xu...