章虚谷曰∶仲景论六经外感，止有风、寒、暑、湿之邪。论温病由伏气所发，而不及外感。或因书有残缺，皆未可
知，后人因而穿凿附会，以大青龙、越脾等汤证治为温病，而不知其实治风寒化热之证也。其所云∶太阳病，发热而渴
为温病。是少阴伏邪出于太阳，以其热从内发，故渴而不恶寒。若外感温病，初起却有微恶寒者，以风邪在表也。亦不
渴，以内无热也。似伤寒而实非伤寒，如辨别不清，多致误治，因不悟仲景理法故也。盖风为百病之长，而无定体，如
天时寒冷，则风从寒化而成伤寒。温暖则风从热化而为温病。以其同为外感，故证状相似，而邪之寒热不同，治法迥异，
岂可混哉？二千年来，纷纷议论，不能剖析明白，我朝叶天士始辩其源流，明其变化，不独为后学指南，而实补仲景之
残缺，厥功大矣。爰释其义，以便览焉！
温邪上受，首先犯肺，逆传心包。肺主气，属卫；心主血，属营。辨营卫气血，虽与伤寒同，若论治法，则与伤寒
大异也。
华岫云曰∶邪从口鼻而入，故曰上受。但春温冬时伏寒藏于少阴，遇春时温气而发，非必上受之邪也。则此所论温
邪，乃是风温、湿温之由于外感者也。
吴鞠通曰∶温病由口鼻而入，自上而下，鼻通于肺。肺者，皮毛之合也。经云∶皮应天，为万物之大表。天属金，
人之肺亦属金。温者火之气，风者火之母，火未有不克金者，故病始于此。
诸邪伤人，风为领袖，故称百病之长。即随寒、热、温、凉、之气，变化为病，故经言其“善行而数变”也。身半
以上，天气主之，为阳。身半以下，地气主之，为阴。风从寒化属阴，故先受于足经；风从热化属阳，故先受于手经。
所以言温邪上受，首先犯肺者，由卫分而入肺经也。以卫气通肺，营气通心，而邪自卫入营，故逆传心包也。《内经》言∶
“心为一身之大主”而不受邪，受邪则神去而死。凡言邪之在心者，皆心之包络受之，盖包络为心之衣也。心属火，肺
属金，火本克金，而肺邪反传于心，故曰逆传也。风寒先受于足经，当用辛温发汗。风温先受于手经，宜用辛凉解表。
上下部异，寒温不同，故治法大异。此伤寒与温病，其初感与传变皆不同也。不标姓氏者，皆章氏原释。
雄按∶《难经》从所胜来者为微邪，章氏引为逆传心包解，误矣！盖温邪始从上受，病在卫分，得从外解，则不传矣。
第四章云∶不从外解，必致里结，是由上焦气分以及中、下二焦者为顺传。惟包络上居膻中，邪不外解，又不下行，易
于袭入，是以内陷营分者为逆传也。然则温病之顺传，天士虽未点出，杨云∶肺与心相通，故肺热最易入心，天士有见
于此，故未言顺传，而先言逆传也。而细绎其议论，则以邪从气分下行为顺，邪入营分内陷为逆也。杨云∶二语最精确。
汪按∶既从气分下行为顺，是必非升提所宜矣。俗医辄云∶防其内陷，妄用升提，不知此内陷，乃邪入营分，非真气下
陷可比。苟无其顺，何以为逆？章氏不能深究，而以生克为解，既乖本旨，又悖经文，岂越人之书竟未读耶！？
盖伤寒之邪，留恋在表，然后化热入里，温邪则热变。
雄按∶唐本作化热。最速。未传心包，邪尚在肺，肺主气，其合皮毛（唐本作“肺合皮毛而主气”）。故云在表。在
表（唐本无此二字），初用辛凉（何以首节章释改“辛平”，今
订正之）轻剂，挟风，则加入（唐本无“则”’“入”二字）。薄荷、牛蒡之属；挟湿，加芦根、滑石之流。或透风于
热外或渗湿于热下，不与热相搏，势必孤矣。
伤寒邪在太阳，必恶寒甚，其身热者，阳郁不伸之故，而邪未化热也。传至阳明，其邪化热，则不恶寒，始可用凉
解之法。若有一分恶寒，仍当温散。盖以寒邪阴凝，故须麻桂猛剂。若温邪为阳，则宜轻散。倘重剂大汗而伤津液，反
化燥火，则难治矣。始初解表用辛凉，须避寒凝之品，恐遏其邪，反不易解也。或遇阴雨连绵，湿气感于皮毛，须解其
表湿，使热外透易解。否则，湿闭其热而内侵，病必重矣。其挟内湿者，清热必兼渗化之法，不使湿热相搏，则易解也。
略参拙意。
不尔，风挟温热而燥生，清窍必干，谓水主之气，不能上荣，两阳相劫也。湿与温合，蒸郁而蒙蔽于上，清窍为之
壅塞，浊邪害清也。其病有类伤寒，其（唐本无此字）验之之法，伤寒多有变证；温热虽久，在一经不移。以此为辨。
（唐本作“总在一经为辨”；章本作“而少传变为辨”较妥）。
胃中水谷，由阳气化生津液。故阳虚而寒者，无津液上升，停饮于胃，遏其阳气，亦无津液上升。而皆燥渴。仲景
已备论之。此言风热两阳邪劫其津液而成燥渴，其因各不同，则治法迥异也。至风雨雾露之邪，受于上焦，与温邪蒸郁，
上蒙清窍，如仲景所云“头中寒湿”，头痛鼻塞，纳药鼻中一条，虽与温邪蒙蔽相同，又有寒热不同也。伤寒先受于足经，
足经脉长而多传变；温邪先受于手经，手经脉短，故少传变。是温病、伤寒之不同，皆有可辨也。
雄按∶上第一章，统言风温、湿温与伤寒证治之不同，而章氏分三节以释之也。
前言辛凉散风，甘淡驱湿，若病仍不解，是渐欲入营也。营分受热，则血液受（章本作“被”）劫，心神不安，夜甚
无寐，成斑点隐隐，即撤去气药。如从风热陷入者，用犀角、竹叶之属；如从湿热陷入者（唐本者下有“用”字），犀角、
花露之品，参入凉血清热方中。若加烦躁，大便不通，金汁亦可加入。老年或平素有寒者，以人中黄代之，急急（唐本
作“速”）透斑为要。
热入于营，舌色必绛。风热无湿者，舌无苔，或有苔亦薄也。热兼湿者，必有浊苔而多痰也。然湿在表分者，亦无
苔。
雄按∶亦有薄苔。其脉浮部必细涩也。此论先生口授及门，以吴人气质薄弱，故用药多轻淡，是因地制宜之法，与
仲景之理法同，而方药不同。或不明其理法，而但仿用轻淡之药，是效颦也。或又以吴又可为宗者，又谓叶法轻淡如儿
戏不可用，是皆坐井论天者也。
雄按∶又可亦是吴人。
雄按∶仲景论伤寒，又可论疫证，麻桂、达原不嫌峻猛。此论温病，仅宜轻解。况本条所列，乃上焦之治，药重则
过病所。吴茭山云∶凡气中有热者，当行清凉薄剂。吴鞠通亦云∶治上焦如羽，非轻不举也。观后章论中、下焦之治，
何尝不用白虎承气等法乎？章氏未深探讨，曲为盖护，毋乃视河海为不足，而欲以泪益之耶？华岫云尝云∶或疑此法仅
可治南方柔弱之躯，不能治北方刚劲之质。余谓不然，其用药有极轻清、极平淡者，取效更捷。苟能悟其理则药味分量，
或可权衡轻重，至于治法则不可移易。盖先生立法之所在，即理之所在，不遵其法，则治不循理矣。南北之人，强弱虽
殊，感病之由则一也。其补泻温凉，岂可废绳墨而出范围之外乎？况姑苏商旅云集，所治岂皆吴地之人哉！不必因其轻
淡而疑之也。又叶氏《景岳发挥》云∶西北人亦有弱者，东南人亦有强者，不可执一而论。故医者，必先议病而后议药。
上焦温证，治必轻清，此一定不易之理法，天士独得之心传，不必章氏曲为遮饰也。
汪按∶急急透斑，不过凉血清热解毒。俗医必以胡荽、浮萍、樱桃核西河柳为透法，大谬。
若斑出热不解者，胃津亡也。主以甘寒，重则如玉女煎（唐本无“如”字），轻则如梨皮、蔗浆之类。或其人肾水素
亏，虽未及下焦（唐本虽上有“病”字），先自彷徨矣（唐本作“每多先事彷徨”），必验之于舌（唐本必上有“此”字），
如甘寒之中，加入咸寒，务在先安未受邪之地，恐其陷入易易（唐本无此二字）耳。
尤拙吾曰∶芦根、梨汁、蔗浆之属，味甘凉而性濡润，能使肌热除而风自息，即《内经》“风淫于内，治以甘寒”之
旨也。斑出则邪已透发，理当退热，其热仍不解，故知其胃津亡，水不济火，当以甘寒生津。若肾水亏者，热尤难退，
故必加咸寒，如元参、知母、阿胶、龟版之类，所谓壮水之主，以制阳光也。如仲景之治少阴伤寒，邪本在经，必用附
子温脏，即是先安未受邪之地，恐其陷入也。热邪用咸寒滋水，寒邪用咸热助火，药不同而理法一也。验舌之法详后。
雄按∶此虽先生口授及门之论，然言简义赅，不可轻移一字，本条主以甘寒，重则如玉女煎者，言如玉女煎之石膏、地黄同用，以清未尽之热，而救已亡之液，以上文曾言邪已入营，故变白虎加人参法，而为白虎加地黄法。杨云∶慧心
明眼，绝世聪明。不曰白虎加地黄，而曰如玉女煎者，以简捷为言耳！唐本删一“如”字，径作重则玉女煎，是印定为
玉女煎之原方矣。鞠通、虚谷因而袭误，岂知胃液虽亡，身热未退，熟地、牛膝安可投乎？余治此证，立案必先正名，
曰“白虎加地黄汤”，斯为清气血两燔之正法。至必验之于舌，乃治温热之要旨，故先发之于此，而后文乃详言之，唐氏
于必上加一“此”字，则验舌之法，似仅指此条而言者，可见一言半语之间，未可轻为增损也。汪按∶此条辨析甚当，
心细如发，斯能胆大于身也。
若其邪始终在气分流连者，可冀其战汗透邪，法宜益胃，令邪与汗并，热达腠开，邪从汗出。解后胃气空虚，当肤
冷一昼夜，待气还自温暖如常矣。盖战汗而解，邪退正虚，阳从汗泄，故渐肤冷，未必即成脱证。此时宜令病者（唐本
无此三字）
安舒静卧，以养阳气来复。旁人切勿惊惶，频频呼唤，扰其元神（唐本作“气”），使其烦躁（唐本无此句）。但诊其
脉，若虚软和缓，虽倦卧不语，汗出肤冷，却非脱证。若脉急疾，躁扰不卧，肤冷汗出，便为气脱之证矣。杨云∶辨证
精悉。更有邪盛正虚，不能一战而解，停一、二日再战汗而愈者，不可不知。
魏柳洲曰∶脉象忽然双伏或单伏，而四肢厥冷，或爪甲青紫，欲战汗也，宜熟记之。
邪在气分，可冀战汗，法宜益胃者，以汗由胃中水谷之气所化，水谷气旺，与邪相并而化汗，邪与汗俱出矣！故仲
景用桂枝汤治风伤卫，服汤后令啜稀粥以助出汗。若胃虚而发战，邪不能出，反从内入也，故要在辨邪之浅深。若邪已
入内而助胃，是助邪反害矣。故如风、寒、温、热之邪，初在表者，可用助胃以托邪。若暑疫等邪，初受即在膜原而当
胃口，无助胃之法可施，虽虚人亦必先用开达。若误补，其害匪轻也。战解后肤冷复温，亦不可骤进补药，恐余邪未净，
复炽也。至气脱之证，尤当细辨。若脉急疾，躁扰不卧，而身热无汗者，此邪正相争，吉凶判在此际，如其正能胜邪却，
即汗出身凉，脉静安卧矣。倘汗出肤冷而脉反急疾，躁扰不安，即为气脱之候，或汗已出而身仍热，其脉急疾而烦躁者，
此正不胜邪，即《内经》所云∶“阴阳交，交者死也。”
雄按∶上第二章，以心肺同居膈上，温邪不从外解，易于逆传，故首节言内陷之治，次明救液之法，末言不传营者，
可以战汗而解也。第邪既始终流连气分，岂可但以初在表者为释？盖章氏疑益胃为补益胃气，故未能尽合题旨。夫温热
之邪，迥异风寒，其感人也，自口鼻入，先犯于肺，不从外解，则里结而顺传于胃。胃为阳土，宜降宜通，所谓腑以通
为补也。故下章即有分消走泄，以开战汗之门户云云。可见益胃者，在疏瀹其枢机，灌溉汤水，俾邪气松达，与汗偕行，
则一战可以成功也。杨云∶此与章注，均有至理，不可偏废，学人兼观并识，而于临证时择宜而用之，则善矣。即暑疫
之邪在膜原者，治必使其邪热溃散，直待将战之时，始令多饮米汤或白汤，以助其作汗之资，审如章氏之言，则疫证无
战汗之解矣。且战汗在六七朝或旬余者居多，岂竟未之见耶？若待补益而始战解者，间亦有之，以其正气素弱耳！然亦
必非初在表之候也。
再论气病有不传血分，而邪留三焦，亦如（唐本作“犹之”）伤寒中少阳病也。彼则和解表里之半，此则分消上下之
势，随证变法，如近时杏、朴、苓等类，或如温胆汤之走泄。因其仍在气分，犹可望其（唐本作“犹有”）。战汗之门
户，转疟之机括（唐本有“也”字）。
沈尧封曰∶邪气中人，所入之道不一。风寒由皮毛而入，故自外渐及于里；温热由口鼻而入，伏于脾胃之膜原，与
胃至近，故邪气向外，则由太阳、少阳转出。邪气向里，则径入阳明。经言三焦膀胱者，腠理毫毛其应，而皮毛为肺之
合，故肺经之邪，不入营而传心包，即传于三焦。其与伤寒之由太阳传阳明者不同，伤寒传阳明，寒邪化热，即用白虎
等法，以阳明阳气最盛故也。凡表里之气，莫不由三焦升降出入，而水道由三焦而行。故邪初入三焦，或胸胁满闷，或
小便不利，此当展其气机，虽温邪不可用寒凉遏之。如杏、朴、温胆之类，辛平甘苦以利升降而转气机，开战汗之门户，
为化疟之丹头，此中妙理，非先生不能道出，以启后学之性灵也。不明此理，一闻温病之名，即乱投寒凉，反使表邪内
章虚谷说：张仲景在论述六经外感病时，只涉及风、寒、暑、湿四种邪气。他论述温病是由体内伏藏的邪气发作所致，而没有涉及外感引起的温病。这可能是因为书籍有残缺，具体情况不得而知。后人因此牵强附会，将大青龙汤、越婢汤等方证的治法当作治疗温病的方法，却不知道这些实际上治疗的是风寒之邪化热后的证候。张仲景所说的“太阳病（太阳经受邪所致的病证），发热且口渴，这是温病”，是指少阴（肾脏及其经络）伏藏的邪气出于太阳经，因为热邪从内部发出，所以口渴而不恶寒（怕冷）。如果是外感引起的温病，初起时却有轻微恶寒，这是因为风邪在体表。此时也不口渴，因为体内没有热邪。这种病看起来像伤寒（由寒邪引起的外感病），但实际上不是伤寒，如果辨别不清楚，很容易导致误治，这就是因为没有领悟张仲景的理法缘故。大概风是百病的先导，但没有固定的形态，如果天时寒冷，风邪就从寒化而形成伤寒；如果天气温暖，风邪就从热化而成为温病。因为它们都是外感病，所以症状相似，但邪气的寒热性质不同，治疗方法截然不同，怎么可以混淆呢？两千年来，议论纷纷，不能剖析明白，我朝叶天士才开始辨明其源流，阐明其变化，这不仅为后学者指明了方向，而且实际上弥补了张仲景著作中的残缺，功劳很大啊！于是解释其含义，以便读者阅览！
温邪（致病的热性邪气）从上焦口鼻侵入，首先侵犯肺脏，若病情恶化，可逆传至心包（心脏外围的保护组织，代心受邪）。肺主气，属于卫分（人体防御外邪的第一道防线，行于脉外）；心主血，属于营分（营养人体的精微物质，行于脉中）。辨别营分和卫分、气分和血分的病变，虽然与伤寒相同，但如果论及治疗方法，则与伤寒大不相同。
华岫云说：邪气从口鼻进入，所以说“上受”。但是春温病是冬季伏寒藏于少阴，遇到春季温气而发作，不一定是上受的邪气。那么这里所讨论的温邪，乃是风温（感受风热邪气引起的急性外感热病）、湿温（感受湿热邪气引起的急性外感热病）由于外感引起的。
吴鞠通说：温病从口鼻而入，自上而下，鼻子通于肺。肺，是皮毛的合应器官。《内经》说：皮对应天，是万物的最大表象。天属金，人的肺也属金。温是火的气，风是火的母体，火没有不克金的，所以病开始于此。
各种邪气伤人，风是领袖，所以称为百病之长。它随着寒、热、温、凉之气，变化形成疾病，所以经文说它“善于行走且变化多端”。身半以上，由天气主宰，属于阳。身半以下，由地气主宰，属于阴。风从寒化属于阴，所以先受于足经（下肢经脉）；风从热化属于阳，所以先受于手经（上肢经脉）。所以说温邪上受，首先犯肺，是因为由卫分进入肺经。因为卫气通于肺，营气通于心，而邪气从卫分进入营分，所以逆传心包。《内经》说：“心是一身的大主”而不受邪，受邪则神志离去而死。凡是说邪气在心里的，都是心包络受邪，大概包络是心的衣服。心属火，肺属金，火本来克金，而肺邪反而传于心，所以叫逆传。风寒先受于足经，应当用辛温发汗法。风温先受于手经，宜用辛凉解表法。上下部位不同，寒温性质不同，所以治疗方法大不相同。这就是伤寒与温病，其初感与传变都不同的原因。不标姓氏的，都是章氏原来的解释。
王士雄按：《难经》说从所胜（被克）而来的邪气为微邪，章氏引用这个来解释逆传心包，是错误的！大概温邪开始从上受，病在卫分，如果能从外部解除，就不会传变了。第四章说：不从外部解除，必定导致内部结滞，这是由上焦气分以及中、下二焦的为顺传。只有包络上居膻中（胸中），邪气不外解，又不下行，容易袭入，所以内陷营分为逆传。既然如此，温病的顺传，叶天士虽然没有点出，杨云说：肺与心相通，所以肺热最容易入心，叶天士有见于此，所以没有说顺传，而先说逆传。而仔细推究他的议论，则是以邪气从气分下行为顺，邪气入营分内陷为逆。杨云说：这两句话最精确。
汪氏按：既然从气分下行为顺，那就一定不适合使用升提药了。庸医总是说：防止其内陷，胡乱使用升提药，不知道这种内陷，是邪气入营分，不能与真气下陷相比。如果没有顺，怎么会有逆？章氏不能深入探究，而以五行生克来解释，既违背了本旨，又悖逆了经文，难道连《难经》都没读过吗！？
大概伤寒的邪气，留恋在体表，然后化热入里；温邪则热变迅速。
王士雄按：唐本作“化热”。最快。未传心包，邪气尚在肺，肺主气，其合应皮毛（唐本作“肺合皮毛而主气”）。所以说在表。在表（唐本无此二字），初用辛凉（为什么首节章氏解释改为“辛平”，现在订正它）轻剂，挟风，则加入（唐本无“则”、“入”二字）薄荷、牛蒡之类；挟湿，加芦根、滑石之类。或者透风于热外，或渗湿于热下，不与热相搏，邪气势必孤立。
伤寒邪气在太阳经，必定非常恶寒，其身热，是阳气郁结不能伸展的缘故，而邪气尚未化热。传到阳明经，邪气化热，就不恶寒，才可用凉解之法。如果有一分恶寒，仍当用温散法。大概因为寒邪阴凝，所以需要用麻黄、桂枝猛剂。如果温邪为阳邪，则宜用轻散法。如果用重剂大汗而伤津液，反而化燥火，就难治了。始初解表用辛凉，必须避开寒凝之品，恐怕遏制邪气，反而不易解除。如果遇到阴雨连绵，湿气感于皮毛，须解除其表湿，使热外透易解。否则，湿闭其热而内侵，病必定加重。其挟内湿者，清热必兼渗化之法，不使湿热相搏，就容易解除了。略微参考我的意见。
不然，风挟温热而燥生，清窍（眼、耳、鼻、口等上部孔窍）必定干燥，说是水主之气，不能上荣，两阳（风与温均为阳邪）相劫（相互煎熬）也。湿与温合，蒸郁而蒙蔽于上，清窍为之壅塞，浊邪害清也。这种病有类似伤寒的地方，其验证的方法是，伤寒多有变证；温热病即使久了，也在一经不移。以此作为辨别。（唐本作“总在一经为辨”；章本作“而少传变为辨”较妥当）。
胃中的水谷，由阳气化生津液。所以阳虚而寒者，没有津液上升，停饮于胃，遏制其阳气，也没有津液上升。而都表现为燥渴。张仲景已经详细论述过。这里说的是风热两阳邪劫夺其津液而成燥渴，其原因各不相同，则治疗方法截然不同。至于风雨雾露之邪，受于上焦，与温邪蒸郁，上蒙清窍，如张仲景所说“头中寒湿”，头痛鼻塞，纳药鼻中一条，虽然与温邪蒙蔽相同，又有寒热不同。伤寒先受于足经，足经脉长而多传变；温邪先受于手经，手经脉短，所以少传变。这是温病、伤寒的不同，都有可以辨别的地方。
王士雄按：上面第一章，总述风温、湿温与伤寒证治的不同，而章氏分三节来解释它。
前面说辛凉散风，甘淡驱湿，如果病仍不解，是逐渐要入营分了。营分受热，则血液受（章本作“被”）劫夺，心神不安，夜间严重失眠，身上出现斑点隐隐，就撤去气药。如从风热陷入者，用犀角、竹叶之类；如从湿热陷入者（唐本“者”下有“用”字），犀角、花露之品，参入凉血清热方中。如果加烦躁，大便不通，金汁（人粪清）也可加入。老年或平素有寒者，以人中黄（甘草末装入竹筒内，悬于粪坑中浸渍制成）代之，急急（唐本作“速”）透斑为要。
热入于营，舌色必定绛红。风热无湿者，舌无苔，或有苔也是薄的。热兼湿者，必有浊苔而且多痰。然而湿在表分者，也无苔。
王士雄按：也有薄苔。其脉浮部必定细涩。这是论述先生口授给门徒，因为吴地人气质薄弱，所以用药多轻淡，这是因地制宜的方法，与张仲景的理法相同，而方药不同。有人不明白其理法，只是模仿使用轻淡的药，这是东施效颦。有人又以吴又可（明代医家，著有《温疫论》）为宗，又说叶氏法轻淡如儿戏不可用，这都是坐井观天的人。
王士雄按：吴可可是吴地人。
王士雄按：张仲景论伤寒，吴又可论疫证，麻黄汤、桂枝汤、达原饮不嫌峻猛。这里论温病，仅宜轻解。况且本条所列，乃上焦的治疗，药重则超过病所。吴茭山说：凡气中有热者，当行清凉薄剂。吴鞠通也说：治上焦如羽，非轻不举也。看后面章节论中、下焦的治疗，何尝不是用白虎汤、承气汤等方法呢？章氏未深入探讨，曲意庇护，莫非是把河海看作不足，而想用眼泪来增添它吗？华岫云曾说：有人怀疑这种方法只能治疗南方柔弱之躯，不能治疗北方刚劲之体质。我认为不是这样，其用药有极轻清、极平淡者，取效更捷。如果能领悟其理，则药味分量，或许可以权衡轻重，至于治法则不可移易。大概先生立法的地方，就是理所在的地方，不遵循其法，则治疗就不循理了。南北之人，强弱虽殊，感病的原因则一也。其补泻温凉，怎么可以废弃绳墨而出范围之外呢？况且姑苏商旅云集，所治哪里都是吴地之人呢！不必因其轻淡而怀疑它。又叶氏《景岳发挥》说：西北人也有弱的，东南人也有强的，不可执一而论。所以医者，必先议病而后议药。上焦温证，治必轻清，这是一定不易的理法，叶天士独得之心传，不必章氏曲意为之遮饰。
汪氏按：急急透斑，不过是凉血清热解毒。庸医一定用胡荽、浮萍、樱桃核、西河柳作为透法，大错特错。
如果斑出热不解者，是胃津亡失。主治以甘寒，重则如玉女煎（唐本无“如”字），轻则如梨皮、蔗浆之类。或者其人肾水素亏，虽未及下焦（唐本“虽”上有“病”字），先自彷徨矣（唐本作“每多先事彷徨”），必验之于舌（唐本“必”上有“此”字），如甘寒之中，加入咸寒，务必在先安未受邪之地，恐怕其陷入太容易（唐本无此二字）罢了。
尤拙吾说：芦根、梨汁、蔗浆之类，味甘凉而性濡润，能使肌热除而风自息，即《内经》“风淫于内，治以甘寒”的宗旨。斑出则邪已透发，理当退热，其热仍不解，所以知道其胃津亡，水不济火，当以甘寒生津。若肾水亏者，热尤其难退，所以必加咸寒，如玄参、知母、阿胶、龟版之类，所谓壮水之主，以制阳光也。如张仲景治疗少阴伤寒，邪本在经，必用附子温脏，即是先安未受邪之地，恐怕其陷入。热邪用咸寒滋水，寒邪用咸热助火，药不同而理法一也。验舌之法详见后文。
王士雄按：这虽然是先生口授给门徒的论述，然而言简义赅，不可轻易移动一字。本条主以甘寒，重则如玉女煎者，是说如玉女煎中石膏、地黄同用，以清未尽之热，而救已亡之液，以上文曾言邪已入营，所以变白虎加人参法，而为白虎加地黄法。杨云：慧心明眼，绝世聪明。不说白虎加地黄，而说如玉女煎，是以简捷而言！唐本删去一个“如”字，径作重则玉女煎，是印定为玉女煎的原方了。鞠通、虚谷因而沿袭错误，难道不知道胃液虽亡，身热未退，熟地、牛膝怎么可以投用呢？我治疗此证，立案必先正名，曰“白虎加地黄汤”，这才是清气血两燔的正法。至于必验之于舌，乃是治温热之要旨，所以先发之于此，而后文乃详言之，唐氏于“必”上加一“此”字，则验舌之法，似乎仅指此条而言，可见一言半语之间，不可轻易增损。汪氏按：此条辨析甚当，心细如发，斯能胆大于身也。
如果其邪始终在气分流连者，可期望其战汗透邪，法宜益胃，令邪与汗并，热达腠开，邪从汗出。解后胃气空虚，当肤冷一昼夜，待气还自温暖如常矣。大概战汗而解，邪退正虚，阳从汗泄，所以渐渐肤冷，未必即成脱证（虚脱危证）。此时宜令病者（唐本无此三字）安舒静卧，以养阳气来复。旁人切勿惊惶，频频呼唤，扰其元神（唐本作“气”），使其烦躁（唐本无此句）。但诊其脉，若虚软和缓，虽倦卧不语，汗出肤冷，却非脱证。若脉急疾，躁扰不卧，肤冷汗出，便为气脱之证了。杨云：辨证精悉。更有邪盛正虚，不能一战而解，停一、二日再战汗而愈者，不可不知。
魏柳洲说：脉象忽然双伏或单伏，而四肢厥冷，或爪甲青紫，欲战汗也，宜熟记之。
邪在气分，可冀战汗，法宜益胃者，因为汗由胃中水谷之气所化，水谷气旺，与邪相并而化汗，邪与汗俱出矣！所以张仲景用桂枝汤治风伤卫，服汤后令喝稀粥以助出汗。若胃虚而发战，邪不能出，反从内入也，所以要在辨邪之浅深。若邪已入内而助胃，是助邪反害矣。所以如风、寒、温、热之邪，初在表者，可用助胃以托邪。若暑疫等邪，初受即在膜原（半表半里之位）而当胃口，无助胃之法可施，虽虚人亦必先用开达。若误补，其害匪轻也。战解后肤冷复温，亦不可骤进补药，恐余邪未净，复炽也。至气脱之证，尤当细辨。若脉急疾，躁扰不卧，而身热无汗者，此邪正相争，吉凶判在此际，如其正能胜邪却，即汗出身凉，脉静安卧矣。倘汗出肤冷而脉反急疾，躁扰不安，即为气脱之候，或汗已出而身仍热，其脉急疾而烦躁者，此正不胜邪，即《内经》所说：“阴阳交，交者死也。”
王士雄按：上面第二章，以心肺同居膈上，温邪不从外解，易于逆传，所以首节言内陷之治，次明救液之法，末言不传营者，可以战汗而解也。第邪既始终流连气分，岂可但以初在表者为释？因为章氏疑益胃为补益胃气，所以未能尽合题旨。夫温热之邪，迥异风寒，其感人也，自口鼻入，先犯于肺，不从外解，则里结而顺传于胃。胃为阳土，宜降宜通，所谓腑以通为补也。所以下章即有分消走泄，以开战汗之门户云云。可见益胃者，在疏瀹其枢机，灌溉汤水，俾邪气松达，与汗偕行，则一战可以成功也。杨云：这与章注，均有至理，不可偏废，学人兼观并识，而于临证时择宜而用之，则善矣。即暑疫之邪在膜原者，治必使其邪热溃散，直待将战之时，始令多饮米汤或白汤，以助其作汗之资，审如章氏之言，则疫证无战汗之解矣。且战汗在六七朝或旬余者居多，岂竟未之见耶？若待补益而始战解者，间亦有之，以其正气素弱耳！然亦必非初在表之候也。
再论气病有不传血分，而邪留三焦，也像（唐本作“犹之”）伤寒中少阳病一样。彼则和解表里之半，此则分消上下之势，随证变法，如近时杏、朴、苓等类，或如温胆汤之走泄。因其仍在气分，犹可望其（唐本作“犹有”）战汗之门户，转疟之机括（唐本有“也”字）。
沈尧封说：邪气中人，所入之道不一。风寒由皮毛而入，故自外渐及于里；温热由口鼻而入，伏于脾胃之膜原，与胃至近，故邪气向外，则由太阳、少阳转出。邪气向里，则径入阳明。经言三焦膀胱者，腠理毫毛其应，而皮毛为肺之合，故肺经之邪，不入营而传心包，即传于三焦。其与伤寒之由太阳传阳明者不同，伤寒传阳明，寒邪化热，即用白虎等法，以阳明阳气最盛故也。凡表里之气，莫不由三焦升降出入，而水道由三焦而行。故邪初入三焦，或胸胁满闷，或小便不利，此当展其气机，虽温邪不可用寒凉遏之。如杏、朴、温胆之类，辛平甘苦以利升降而转气机，开战汗之门户，为化疟之丹头，此中妙理，非先生不能道出，以启后学之性灵也。不明此理，一闻温病之名，即乱投寒凉，反使表邪内
Zhang Xugu stated: Zhang Zhongjing's discussion on the six meridians regarding exogenous diseases only covers pathogens of wind, cold, summer-heat, and dampness. His discussion on warm diseases attributes them to latent pathogens erupting from within, omitting exogenous causes. This may be due to textual lacunae in his works, or it is uncertain. Later scholars consequently forced interpretations, treating the patterns and treatments of Da Qing Long Tang (Major Green Dragon Decoction) and Yue Bi Tang (Crossing the Spleen Decoction) as methods for warm diseases, not realizing that these actually treat conditions where wind-cold has transformed into heat. When he said, "Taiyang disease (disease of the Taiyang channel), with fever and thirst, is a warm disease," he referred to latent pathogens from Shaoyin (the Kidney channel) emerging through the Taiyang channel. Because the heat originates internally, there is thirst but no aversion to cold. In contrast, exogenous warm diseases at their onset often present with slight aversion to cold due to wind pathogen remaining in the exterior. At this stage, there is no thirst because there is no internal heat. Although resembling cold damage (Shanghan), it is fundamentally different. Failure to distinguish clearly often leads to mismanagement, stemming from a lack of understanding of Zhang Zhongjing's principles. Wind is the leader of a hundred diseases but has no fixed form; if the weather is cold, wind transforms into cold, causing cold damage; if the weather is warm, wind transforms into heat, causing warm diseases. Since both are exogenous, symptoms are similar, yet the nature of the pathogen (cold vs. heat) differs, leading to vastly different treatments. How can they be confused? For two thousand years, debates have been endless without clear resolution. It was our dynasty's Ye Tianshi who first clarified their origins and changes, serving not only as a guide for students but also effectively supplementing Zhang Zhongjing's incomplete works. His merit is great. Therefore, I explain its meaning for readers' convenience.
Warm pathogens enter from above (the mouth and nose), first attacking the Lung. If severe, they may transmit reversely to the Pericardium. The Lung governs Qi and belongs to the Wei (Defensive) level; the Heart governs Blood and belongs to the Ying (Nutritive) level. Differentiating between Ying/Wei and Qi/Blood levels follows the same logic as in cold damage, but the treatment methods differ significantly.
Hua Xiuyun stated: Pathogens enter via the mouth and nose, hence "entering from above." However, Spring Warmth arises from latent cold stored in Shaoyin during winter, triggered by spring warmth; it is not necessarily an exogenous pathogen entering from above. Thus, the warm pathogens discussed here refer specifically to Wind-Warmth and Damp-Warmth caused by exogenous factors.
Wu Jutong stated: Warm diseases enter via the mouth and nose, moving from top to bottom. The nose connects to the Lung. The Lung is the exterior counterpart of the skin and hair. The Classic states: "Skin corresponds to Heaven, the greatest exterior manifestation of all things." Heaven belongs to Metal, and human Lungs also belong to Metal. Warmth is the qi of Fire, and Wind is the mother of Fire. Fire invariably overcomes Metal; therefore, disease begins here.
Among various pathogens, wind is the leader, hence called the "leader of a hundred diseases." It transforms into disease according to cold, heat, warmth, or coolness, which is why the Classic describes it as "agile and changeable." The upper half of the body is governed by heavenly qi (Yang); the lower half by earthly qi (Yin). Wind transforming into cold belongs to Yin, thus affecting the Foot meridians first; wind transforming into heat belongs to Yang, thus affecting the Hand meridians first. Hence, "warm pathogens enter from above, first attacking the Lung" means entering the Lung meridian via the Wei level. Since Wei qi connects to the Lung and Ying qi connects to the Heart, when pathogens move from Wei to Ying, they transmit reversely to the Pericardium. The Classic says: "The Heart is the Great Master of the body" and does not accept pathogens; if it does, spirit departs and death ensues. Whenever pathology is described as being in the Heart, it is actually the Pericardium Meridian accepting the pathogen, as the Pericardium is the "clothing" of the Heart. The Heart belongs to Fire, the Lung to Metal. Fire overcomes Metal, so when Lung pathology transmits to the Heart, it is called "reverse transmission." Cold-wind affects the Foot meridians first and requires acrid-warm sweating methods. Wind-warmth affects the Hand meridians first and requires acrid-cool exterior-resolving methods. Due to differences in location (upper/lower) and nature (cold/warm), treatments differ greatly. This explains why the initial infection and progression of cold damage and warm diseases are distinct. Passages without author attribution are original explanations by Mr. Zhang.
Wang Shixiong noted: The *Nan Jing* states that pathogens coming from the overcome element are "minor pathogens." Mr. Zhang cited this to explain reverse transmission to the Pericardium, which is incorrect. Initially, warm pathogens enter from above and reside in the Wei level; if resolved externally, transmission ceases. Chapter 4 states: If not resolved externally, it must lead to internal binding. Transmission from the Upper Jiao Qi level to the Middle and Lower Jiaos is "forward transmission." The Pericardium resides high in the Danzhong (Chest); if pathogens do not exit externally nor descend downward, they easily invade inward. Thus, invasion into the Ying level is "reverse transmission." Although Ye Tianshi did not explicitly mention forward transmission, Mr. Yang noted: "The Lung and Heart are connected, so Lung heat easily enters the Heart." Ye Tianshi recognized this, hence mentioning reverse transmission first. Careful analysis reveals that downward movement from the Qi level is forward transmission, while invasion into the Ying level is reverse. Mr. Yang’s statement is precise.
Mr. Wang noted: If downward movement from the Qi level is forward, lifting therapies are inappropriate. Quack doctors often say, "Prevent internal collapse," and recklessly use lifting herbs, failing to realize that this "collapse" refers to pathogen invasion into the Ying level, distinct from true Qi sinking. Without forward transmission, how could there be reverse? Mr. Zhang failed to investigate deeply, relying instead on Five Phase generation/restriction, contradicting both the original intent and the Classics. Did he never read the *Nan Jing*?
Generally, cold damage pathogens linger in the exterior before transforming into heat and entering the interior; warm pathogens transform into heat rapidly.
Wang Shixiong noted: The Tang edition reads "transforms into heat." It is very fast. Before transmitting to the Pericardium, the pathogen remains in the Lung. The Lung governs Qi and controls the skin/hair (Tang edition: "Lung controls skin/hair and governs Qi"). Thus, it is considered in the exterior. In the exterior (omitted in Tang edition), initially use mild acrid-cool preparations. If accompanied by wind, add Menthae Haplocalycis Herba (Bohe) and Arctii Fructus (Niubangzi). If accompanied by dampness, add Phragmitis Rhizoma (Lugen) and Talcum (Huashi). Either vent wind outside the heat, or drain dampness below the heat, preventing them from clashing with heat, thereby isolating the pathogen.
In cold damage, when the pathogen is in the Taiyang channel, aversion to cold is severe. Fever results from Yang qi stagnation and inability to extend, indicating the pathogen has not yet transformed into heat. Upon transmission to the Yangming channel, the pathogen transforms into heat, aversion to cold disappears, and cooling methods can be used. If even slight aversion to cold persists, warm dispersal is still required. Cold pathogens are yin and coagulating, requiring potent agents like Ephedrae Herba (Mahuang) and Cinnamomi Ramulus (Guizhi). Warm pathogens are yang, requiring mild dispersal. Heavy sweating damages fluids, potentially transforming into dryness-fire, making treatment difficult. Initial exterior resolution with acrid-cool agents must avoid cold-congealing substances that might trap the pathogen. During rainy seasons, dampness may affect the skin; resolve exterior dampness to facilitate heat release. Otherwise, dampness closing heat leads to internal invasion and severe illness. For internal dampness, clearing heat must include draining and transforming methods to prevent damp-heat interaction. My humble opinion is added here.
Otherwise, wind carrying warmth generates dryness, drying the clear orifices. This occurs because the water-element qi cannot nourish the upper regions; the two yangs (wind and warmth) mutually deplete fluids. Dampness combined with warmth steams and obscures the upper orifices, blocking them; turbid pathogens harm the clear. These illnesses resemble cold damage. To differentiate: cold damage often presents with variable syndromes; warm diseases, even if prolonged, remain in one channel. Use this for differentiation (Tang edition: "remains in one channel"; Zhang edition: "fewer transmissions," which is more appropriate).
Stomach grain and water are transformed by Yang qi into body fluids. In Yang deficiency with cold, fluids do not rise, stagnating in the stomach, obstructing Yang qi, resulting in no fluid ascent and dry-thirst. Zhang Zhongjing discussed this extensively. Here, wind-heat (two yang pathogens) depletes fluids causing dry-thirst. Causes differ, so treatments differ. Pathogens like wind, rain, fog, and dew affect the Upper Jiao, combining with warm pathogens to obscure clear orifices. Similar to Zhang Zhongjing’s description of "cold-damp in the head" causing headache and nasal congestion, treated by nasal administration, the mechanism is similar, but the nature (cold vs. warm) differs. Cold damage affects Foot meridians first (long channels, frequent transmission); warm diseases affect Hand meridians first (short channels, less transmission). Thus, warm diseases and cold damage are distinguishable.
Wang Shixiong noted: The first chapter generally discusses differences between Wind-Warmth, Damp-Warmth, and Cold Damage. Mr. Zhang explained this in three sections.
Previously mentioned: Acrid-cool disperses wind, sweet-bland drives dampness. If unresolved, the pathogen is gradually entering the Ying level. Heat in the Ying level depletes blood, disturbing the Spirit, causing severe insomnia at night and faint macules. At this point, discontinue Qi-level medicines. If entered from Wind-Heat, use Rhinocerotis Cornu (Xijiao) and Bambusae Folium (Zhuye). If entered from Damp-Heat, use Rhinocerotis Cornu (Xijiao) and floral dew, incorporated into blood-cooling and heat-clearing formulas. If irritability and constipation occur, Jin Zhi (Human Feces Clear) may be added. For the elderly or those with chronic cold, Ren Zhong Huang (Indigo Naturalis processed in bamboo) substitutes it. Urgently resolve macules.
When heat enters the Ying level, the tongue becomes crimson. With Wind-Heat and no dampness, the tongue has no coating or a thin coating. With heat and dampness, there is a turbid coating and phlegm. However, dampness in the exterior level also presents with no coating.
Wang Shixiong noted: There can be a thin coating. The pulse at the floating position is fine and choppy. This discussion reflects Mr. Ye’s oral teachings to disciples. Wu people have delicate constitutions, so medications are light and bland—a method adapted to local geography. This aligns with Zhang Zhongjing’s principles but uses different formulas. Blindly imitating light/bland drugs without understanding the rationale is mere mimicry. Others revering Wu Youke criticize Ye’s methods as too light/trivial. Both are narrow-minded.
Wang Shixiong noted: Wu Youke was also from Wu.
Wang Shixiong noted: Zhang Zhongjing discussed Cold Damage; Wu Youke discussed Epidemic Febrile Diseases. Mahuang Tang and Guizhi Tang, along with Damai Yuan, are not afraid of being harsh. Here, discussing Warm Diseases, only mild resolution is suitable. Moreover, this section addresses the Upper Jiao; heavy drugs would overshoot the target. Wu Jiaoshan said: "For heat in the Qi, use cool and light preparations." Wu Jutong also said: "Treating the Upper Jiao is like feathers; only lightness can lift it." Looking at later chapters on Middle and Lower Jiao treatments, Bai Hu Tang and Cheng Qi Tang are certainly used. Mr. Zhang did not explore deeply, offering apologetic coverings. Is he viewing rivers and seas as insufficient and trying to fill them with tears? Hua Xiuyun once said: Some doubt this method only treats southern weak constitutions, not northern strong ones. I disagree. Medications can be extremely light/clear/plain yet effective. Understanding the principle allows adjusting dosages, but the method itself is immutable. Where Mr. Ye established laws, there lies the Principle. Deviating from the law deviates from reason. North/South differences in constitution exist, but the cause of disease is the same. How can tonification/draining and warming/cooling abandon standard measures? Furthermore, Suzhou attracts merchants globally; patients are not exclusively from Wu. Do not doubt due to lightness. Ye’s *Jingyue Fahui* states: Northwest people can be weak; Southeast people can be strong. One must discuss disease before medication. Treating Upper Jiao warm diseases requires light/clear methods—this is an unchangeable principle, uniquely understood by Ye Tianshi. No need for Mr. Zhang’s defensive explanations.
Mr. Wang noted: Urgently resolving macules simply means cooling blood and clearing heat/toxins. Quacks use Coriandri Fructus (Huisu), Lemna Minor (Fuping), Prunus pseudocerasus seeds (Yingtao He), and Salix integra bark (Xihe Liu) as "macule-resolving" methods. This is grossly erroneous.
If macules appear but fever persists, Stomach fluids are exhausted. Treat with Sweet-Cold. Severe cases: Yu Nu Jian (Jade Woman Decoction). Mild cases: Pear Skin (Lipi) and Sugarcane Juice (Zheshuang). If the patient has inherent Kidney Water deficiency, even before reaching the Lower Jiao, hesitation may occur. Verify via tongue. Add Salty-Cold to Sweet-Cold formulas. Prioritize stabilizing areas not yet affected to prevent easy invasion.
You Zhuowu stated: Lugen, Pear Juice, and Sugarcane Juice are sweet, cool, and moistening. They remove muscle heat and extinguish wind, following the Classic’s principle: "Wind rampant inside, treat with Sweet-Cold." Once macules appear, pathogens are expelled, and fever should subside. Persistence indicates Stomach fluid exhaustion and Water failing to control Fire. Sweet-Cold generates fluids. If Kidney Water is deficient, heat is harder to retreat; add Salty-Cold like Scrophulariae Radix (Xuanshen), Anemarrhenae Rhizoma (Zhimu), E-Jiao, and Testudinis Carapax et Plastrum (Guiban). This is "strengthening the root of Water to control Solar Flare." Similar to Zhang Zhongjing treating Shaoyin Cold Damage with Aconitum Latifolium (Fuzi) to warm organs—stabilizing unaffected areas to prevent invasion. Heat uses Salty-Cold to nourish Water; Cold uses Salty-Hot to assist Fire. Drugs differ, principles are identical. Tongue diagnosis details follow.
Wang Shixiong noted: Though orally taught, this text is concise and comprehensive. Do not alter words lightly. "Sweet-Cold" is primary. "Severe like Yu Nu Jian" implies using Shi Gao and Di Huang together (like in Yu Nu Jian) to clear residual heat and rescue lost fluids. Since pathogens entered the Ying level earlier, Bai Hu Jia Renshen Tang is modified to Bai Hu Jia Dihuang Tang. Mr. Yang praised this insight. Not saying "Bai Hu Jia Dihuang" but "Like Yu Nu Jian" emphasizes simplicity. The Tang edition deleted "Like," fixing it as Yu Nu Jian formula. Jutong and Xugu followed this error. Don't they know that with Stomach fluid loss but persistent fever, Shu Di Huang and Niuxi are contraindicated? In my practice, I name this "Bai Hu Jia Dihuang Tang," the correct method for simultaneous clearing of Qi and Blood heat. Verifying the tongue is crucial in warm diseases, hence mentioned early. Adding "This" before "Verify" limits tongue diagnosis to this specific case, showing carelessness in editing. Mr. Wang noted: This analysis is precise; such detail requires boldness.
If pathogens linger in the Qi level without entering the Blood level, they remain in the Three Jiaos, similar to Shaoyang disease in cold damage. There, harmonize half-exterior/half-interior; here, distribute and eliminate upper/lower tendencies. Modify based on syndrome. Use Apricot Kernel (Xingren), Magnolia Bark (Houpo), Poria (Fuling), etc., or Wendan Tang to drain. Since still in the Qi level, expect battle-sweat resolution.
Shen Yaofeng stated: Pathogens enter via different routes. Cold/Wind enter via skin/hair, moving from exterior to interior. Warmth enters via mouth/nose, lying latent in the Membrane Source (Mo Yuan) of the Spleen/Stomach, close to the Stomach. Externally, it exits via Taiyang/Shaoyang; internally, it enters Yangming directly. The Classic links Three Jiao/Bladder to pores/hair. Hair is Lung’s exterior. Thus, Lung pathogens, if not entering Ying/Pericardium, transmit to the Three Jiaos. Unlike cold damage transmitting Taiyang to Yangming (where cold transforms to heat, treated with Bai Hu due to abundant Yang qi). All exterior/interior Qi moves via Three Jiao ascending/descending. Water pathways flow through the Three Jiao. Early Three Jiao involvement causes chest/flank fullness or urinary difficulty. Expand Qi mechanism. Do not use cold/cool herbs to suppress warm pathogens. Use Xingren, Houpo, Wendan Tang (acrid-neutral/sweet-bitter) to facilitate ascending/descending, open battle-sweat portals, and resolve malaria-like patterns. This profound theory was revealed by Mr. Ye to inspire students. Misunderstanding this, doctors rashly use cold/cool herbs upon hearing "warm disease," trapping exterior pathogens internally.