闭，其热更甚，于是愈治而病愈重，至死而不悟其所以然，良可慨也。
雄按∶章氏此释，于理颇通，然于病情尚有未协也。其所云分消上下之势者，以杏仁开上，浓朴宣中，茯苓导下，
似指湿温，或其人素有痰饮者而言，故温胆汤亦可用也。杨云∶此释精确，胜章注远甚。试以《指南》温湿各案参之自
见。若风温流连气分，下文已云，到气才可清气。所谓清气者，但宜展气化以轻清，如栀、芩、蒌、苇等味是也。虽不
可遽用寒滞之药，而浓朴、茯苓，亦为禁剂。彼一闻温病，即乱投寒凉，固属可慨，汪按∶今人畏凉药，并轻清凉解每
多疑虑，至温补升燥。则恣用无忌，实此等医人阶之厉也。而不辨其有无湿滞，概用枳、朴，亦岂无遗憾乎？至转疟之
机括一言，原指气机通达，病乃化疟则为邪杀也，从此迎而导之，病自渐愈。奈近日市医，既不知温热为何病？柴、葛、
羌、防，随手浪用，且告病家曰∶须服几剂柴胡，提而为疟，庶无变端，病家闻之，无不乐从，虽至危殆，犹曰提疟不
成，病是犯真，故病家死而无怨，医者误而不悔，彼此梦梦，亦可慨也夫。汪按∶此辨尤精当明析，切中时弊。
又按∶五种伤寒，惟感寒即病者为正伤寒，乃寒邪由表而受，治以温散，尤必佐以甘草、姜、枣之类，俾助中气以
托邪外出，亦杜外邪而不使内入。倘邪在半表半里之界者，治宜和解，可使转而为疟。其所感之风寒较轻而入于少阳之
经者，不为伤寒，则为正疟，脉象必弦，皆以小柴胡汤为主方。设冬伤于寒而不即病则为春温、夏热之证，其较轻者，
则为温疟、瘅疟。轩、岐、仲景，皆有明训，何尝概以小柴胡汤治之耶？若感受风温、湿温、暑热之邪者，重则为时感，
轻则为时疟。而温、热、暑、湿诸感证之邪气流连者，治之得法，亦可使之转疟而出。统而论之，则伤寒有五，疟亦有
五。盖有一气之感证，即有一气之疟疾，不过重轻之别耳！今世温热多而伤寒少，故疟亦时疟多而正疟少。温、热、暑、
湿既不可以正伤寒法治之，时疟岂可以正疟法治之哉？其间二日而作者，正疟有之，时疟亦有之，名曰三阴疟。以邪入
三阴之经也，不可误解为必属阴寒之病。医者不知五气皆能为疟，颟顸施治，罕切病情，故世人患疟，多有变证。或至
缠绵岁月，以致俗人有疟无正治，疑为鬼祟等说。然以徐洄溪、魏玉横之学识，尚不知此，况其他乎！惟叶氏精于温、
热、暑、湿诸感，故其治疟也，一以贯之。余师其意，治疟鲜难愈之证。曩陈仰山封翁询余曰∶君何治疟之神哉？殆别
有秘授也。余谓何秘之有？第不惑于昔人之谬论，而辨其为风温、为湿温、为暑热、为伏邪，仍以时感法清其源耳！近
杨素园大令重刻余案评云∶案中所载多温疟、暑疟，故治多凉解。但温疟、暑疟虽宜凉解，尤当辨其邪之在气在营也。
缪仲谆善治暑疟，而用当归、牛膝、鳖甲、首乌等血分药于阳明证中，亦属非法。若湿温为疟与暑邪挟湿之疟，其湿邪
尚未全从热化者，极要留意。况时疟之外，更有瘀血，顽痰、阳维为病等证，皆有寒热如疟之象，最宜谛审，案中诸治
略备，阅者还须于凉解诸法中，缕析其同异焉！
大凡看法，卫之后，方言气，营之后，方言血。在卫汗之可也，到气才可（唐本作“宜”）清气，入营（唐本作“乍
入营分”）犹可透热转气（唐本作“仍转气分而解”），如犀角、玄参、羚羊角等物（唐本有“是也”二字），入血（唐本
作“至入于血”）就（唐本作“则”）恐耗血动血，直须凉血散血，加生地、丹皮、阿胶、赤芍等物（唐本有“是也”二
字）。否则（唐本作“若”）前后（唐本无此二字）不循缓急之法，虑其动手便错（唐本有“耳”字），反致慌张矣（唐本
无此句）。
仲景辨六经证治，于一经中皆有表里浅深之分，温邪虽与伤寒不同，其始皆由营卫，故先生于营卫中又分气血之浅
深，精细极矣。凡温病初感，发热而微恶寒者，邪在卫分，不恶寒而恶热，小便色黄，已入气分矣。若脉数舌绛，邪入
营分。若舌深绛，烦扰不寐，或夜有谵语，已入血分矣。邪在卫分汗之，宜辛凉轻解。
雄按∶首章本文云∶初用辛凉轻
剂。华岫云注此条云∶辛凉开肺，便是汗剂。章氏注此云∶宜辛平表散，不可用凉。何谬妄乃尔，今特正之。清气热不
可寒滞，反使邪不外达而内闭，则病重矣。故虽入营，犹可开达转出气分而解，倘不如此细辨施治，动手便错矣。故先
生为传仲景之道脉，迥非诸家之立言所能及也。
雄按∶诚如君言，何以屡屡擅改初用辛凉之文乎。
雄按∶外感温病，如此看法，风寒诸感，无不皆然，此古人未达之旨。近惟王清任知之。若伏气温病，自里出表，
乃先从血分而后达于气分。芷卿云∶论伏气之治精识，直过前人，然金针虽度，其如粗工之聋 何。故起病之初，往往
舌润而无苔垢，但察其脉软而或弦、或微数，口未渴而心烦恶热，即宜投以清解营阴之药，迨邪从气分而化，苔始渐布，
然后再清其气分可也。伏邪重者，初起即舌绛咽干，甚有肢冷脉伏之假象，亟宜大清阴分伏邪，继必浓腻黄浊之苔渐生，
此伏邪与新邪先后不同处。更有邪伏深沉，不能一齐外出者，虽治之得法，而苔退舌淡之后，逾一二日舌复干绛，苔复
黄燥，正如抽蕉剥茧，层出不穷，不比外感温邪，由卫及气、自营而血也。杨云∶阅历有得之言，故语语精实，学人所
当领悉也。秋月伏暑证，轻浅者邪伏膜原，深沉者亦多如此。苟阅历不多，未必知其曲折乃尔也，附识以告留心医学人。
余医案中，凡先治血分，后治气分者，皆伏气病也，虽未点明，读者当自得之。且吾吴湿邪害人最广（唐本作“多”）。
如面色白者，须要顾其阳气，湿胜则阳微也。法应清凉（唐本法上有“如”字），然（唐本作“用”）到十分之六七，即
不可过于寒（唐本无此二字）凉。恐成功反弃，何以故耶（唐本无此二句，有“盖恐”二字）？湿热一去，阳亦衰微也。
面色苍者，须要顾其津液，清凉到十分之六七，往往热减身寒者，不可就（唐本作“便”）云虚寒，而投补剂，恐炉烟虽
熄，灰中有火也，须细察精详，方少少与之，慎不可直率（唐本作“漫然”）而往（唐本作“进”）也。又有酒客，里湿
素盛，外邪入里，里湿为合（唐本作“与之相搏”）。在阳旺之躯，胃湿恒多；在阴盛之体，脾湿亦不少，然其化热则一。
热病救阴犹易，通阳最难，救阴不在（唐本有“补”字）血，而在津与汗（唐本作“养津与测汗”）；通阳不在温，而在
利小便。然（唐本无此字）较之杂证，则（唐本无此字）有不同也。
六气之邪，有阴阳不同。其伤人也，又随人身之阴阳强弱变化而为病。面白阳虚之人，其体丰者，本多痰湿。若受
寒湿之邪，非姜、附、参、苓不能去。若湿热亦必粘滞难解，须通阳气以化湿。若过凉则湿闭而阳更困矣。面苍阴虚之
人，其形瘦者，内火易动，湿从热化，反伤津液，与阳虚治法正相反也。胃湿脾湿虽化热则一，而治法有阴阳不同。如
仲景云∶身黄如橘子色而鲜明者，此阳黄胃湿，用茵陈蒿汤。其云色如熏黄而沉晦者，此阴黄脾湿，用栀子柏皮汤。或
后世之二妙散亦可。救阴在养津，通阳在利小便，发古未发之至理也。测汗者，测之以审津液之存亡，气机之通塞也。
雄按∶热胜于湿，则黄如橘子色而鲜明；湿胜于热，则色沉晦而如熏黄，皆属阳证，而非阴黄也。
雄按∶所谓六气，风、寒、暑、湿、燥、火也。分其阴阳，则《素问》云∶寒暑六入，暑统风、火，阳也。寒统燥、
湿，阴也。言其变化，则阳中惟风无定体，有寒风、有热风；阴中则燥、湿二气，有寒、有热。至暑乃天之热气，流金
烁石，纯阳无阴。或云阳邪为热，阴邪为暑者，甚属不经。经云∶“热气大来，火之胜也”，阳之动，始于温，盛于暑。
盖在天为热，在地为火，其性为暑，是暑即热也，并非二气。或云，暑为兼湿者亦误也。暑与湿原是二气，虽易兼感，
实非暑中必定有湿也。譬如暑与风亦多兼感，岂可谓暑中必有风耶？若谓热与湿合，始名为暑，然则寒与风合，又将何
称？更有妄立阴暑、阳暑之名者，亦属可笑。如果暑必兼湿，则不可冠以“阳”字。若知暑为热气、则不可冠以“阴”
字。其实彼所谓阴者，即夏月之伤于寒湿者耳！设云暑有阴阳，则寒亦有阴阳矣。不知寒者，水之气也，热者，火之气
也。水火定位，寒热有一定之阴阳，寒邪传变，虽能化热而感于人也，从无阳寒之说。人身虽有阴火，而六气中不闻有
寒火之名。暑字从日，日为天上之火。寒字从 ， 为地下之水。暑邪易入心经，寒邪先犯膀胱，霄壤不同，各从其类。
故寒暑二气，不比风、燥、湿，有可阴可阳之不同也。况夏秋酷热，始名为暑。冬春之热，仅名为温。而风、寒、燥、
湿，皆能化火。今日六气之邪，有阴阳之不同，又随人身之阴阳变化，毋乃太无分别乎。至面白体丰之人，既病湿热，
应用清凉，本文业已明言，但病去六七，不可过用寒凉耳！非谓病未去之初，不可用凉也。今云与面苍形瘦之人治法正
相反，则未去六七之前，亦当如治寒湿之用姜、附、参、术矣。阳奉阴违，殊乖诠释之体。若脾湿阴黄，又岂栀柏汤苦
寒纯阴之药可治哉？本文云∶救阴不在血，而在津与汗，言救阴须用充液之药，以血非易生之物，而汗需津液以化也。
唐本于血津上加“补养”字，已属蛇足，于汗上加“测”字，则更与“救”字不贯，章氏仍之，陋矣！上第三章。
又按∶寒、暑、燥、湿、风，乃五行之气合于五脏者也。惟暑独盛于夏令，火则四时皆有，析而言之，故曰六气。
然三时之暖燠，虽不可以暑称之，亦何莫非丽日之煦照乎？须知暑即日之气也，日为众阳之宗，阳燧承之，火立至焉。
以五行论，言暑则火在其中矣，非五气外另有一气也。若风、寒、燥，湿悉能化火，此由郁遏使然，又不可与天之五气
统同而论矣。
又按∶茅雨人云∶本文谓湿胜则阳微，其实乃阳微故致湿胜也。此辨极是，学人宜知之。
再论三焦不得（唐本无此字）从外解，必致成（唐本无此字）里结。里结于何？在阳明胃与肠也。亦须用下法，不
可以气血之分，就（唐本作“谓其”）不可下也。但（唐本作“惟”）伤寒邪热在里，劫烁津液，下之宜猛；此多湿邪内
搏，下之宜轻。伤寒大便溏为邪已尽，不可再下；湿温病大便溏为邪未尽，必大便硬。慎（唐本作“乃为无湿”始）不
可再攻也，以粪燥为无湿矣（唐本无此句）。
胃为脏腑之海，各脏腑之邪，皆能归胃，况三焦包罗脏腑，其邪之入胃尤易也。伤寒化热，肠胃干结，故下宜峻猛。
湿热凝滞，大便本不干结，以阴邪瘀闭不通。若用承气猛下，其行速而气徒伤，湿仍胶结不去，故当轻法频下。如下文
所云小陷胸、泻心等，皆为轻下之法也。
雄按∶伤寒化热，固是阳邪，湿热凝滞者，大便虽不干结，黑如胶漆者有之，岂可目为阴邪？谓之浊邪可也。惟其
误为阴邪，故复援温脾汤下寒实之例，而自诩下阳虚之湿热，为深得仲景心法，真未经临证之言也。似是而非，删去不
录。再人之体，脘在腹上，其地位处于中（唐本作“其位居中”），按之痛，或自痛，或痞胀，当用苦泄，以其入腹近也。
必验之于舌，或黄、或浊，可与小陷胸汤、或泻心汤随证治之。或（唐本作“若”）白不燥，或黄白相兼，或灰白，不渴，
慎不可乱投苦泄。其中有外邪未解，里先结者，或邪郁未伸，或素属中冷者，虽有脘中痞闷，宜从开泄，宣通气滞，以
达归于肺，如近俗（唐本作“世”）之杏、蔻、橘、桔等，是轻苦微辛（唐本无“是”字），具流动之品可耳！
此言苔白为寒，不燥则有痰湿，其黄白相兼，灰白而不渴者，皆阳气不化，阴邪壅滞。故不可乱投苦寒滑泄以伤阳
也。其外邪未解而里先结，故苔黄白相兼而脘痞，皆宜轻苦微辛以宣通其气滞也。
雄按∶凡视温证，必察胸脘，如拒按者，必先开泄。若苔白，不渴，多挟痰湿。轻者，橘、蔻、菖、薤；重者，枳
实、连、夏，皆可用之。虽舌绛神昏，但胸下拒按，即不可率投凉润，必参以辛开之品，始有效也。上第四章，唐本并
以第十一章连为一章，今订正之。连上章皆申明邪在气分之治法，而分别营卫气血之浅深，身形肥瘦之阴阳，苔色黄白
之寒热，可谓既详且尽矣。而下又申言察苔以辨证，真千古开群朦也。再（唐本无此字）前云∶舌黄或渴（唐本此下有
“当用陷胸泻心”六字），须要有地之黄。若光滑者，乃无形湿热中有虚象（唐本作“已有中虚之象”），大忌前法。其
脐以上为大腹，或满、或胀、或痛，此必邪已入里矣（唐本无“矣”字）。表证多无，或十只存一（唐本作“或存十之一
闭证，其热势更加严重，于是越是治疗病情反而越重，直到死亡都不明白其中的原因，实在令人感慨。
王士雄按语：章氏的这种解释，在理论上颇为通顺，然而与病情的实际表现尚有不符之处。他所说的分消上下之势，是用杏仁宣开上焦，厚朴宣畅中焦，茯苓疏导下焦，这似乎是指湿温病，或者是患者素来有痰饮的情况而言的，所以温胆汤也可以使用。杨云说：这种解释精确，胜过章注很多。试着参考《指南》中关于温湿的各种医案自然就能明白。如果是风温邪气留恋在气分，下文已经说了，到了气分才可以清气。所谓清气，只适宜用展布气化作用的轻清药物，如栀子、黄芩、瓜蒌、芦根等药味是合适的。虽然不可以立刻使用寒凉凝滞的药物，但厚朴、茯苓也是禁忌之剂。那些人一听到温病，就乱投寒凉药物，固然值得感慨，汪按语：现在的人畏惧凉药，对于轻清凉解之法往往多有疑虑，至于温补升燥的药物，则肆意使用毫无顾忌，这实在是这类医生造成的祸害。而不辨别患者是否有湿滞，一概使用枳实、厚朴，难道没有遗憾吗？至于“转疟之机括”这一句话，原本是指气机通达，病邪转化为疟疾从而被消灭的意思，从此顺势引导，病自然会逐渐痊愈。无奈近日的市井医生，既不知道温热是什么病，柴胡、葛根、羌活、防风等药随手滥用，并且告诉病人家属说：必须服用几剂柴胡，将其提引为疟疾，这样才不会有变端，病人家属听了，无不乐意听从，即使到了危险境地，还说是因为提疟不成，病犯真元，所以病人死了也不怨恨，医生误治也不后悔，彼此糊涂，也可以说是令人感慨啊。汪按语：这种辨析尤其精当明析，切中时弊。
又按语：五种伤寒中，只有感寒即发病的为正伤寒，这是寒邪由表受入，治疗用温散法，尤其必须佐以甘草、生姜、大枣之类的药物，以便助益中气以托举邪气外出，也能杜绝外邪不再内入。如果邪气在半表半里的界限，治疗宜用和解法，可以使病情转化为疟疾。所感受的风寒较轻且进入少阳经的，不是伤寒，就是正疟，脉象必定弦，都以小柴胡汤为主方。假设冬天伤于寒邪而不立即发病，就会成为春温、夏热的证候，其中较轻的，就是温疟、瘅疟。轩、岐、仲景都有明确的教导，何尝一概用小柴胡汤来治疗呢？如果是感受风温、湿温、暑热邪气的，重的则为时行感冒，轻的则为时行疟疾。而温、热、暑、湿各种感证的邪气留恋的，治疗得法，也可以使之转化为疟疾而排出体外。统而言之，那么伤寒有五种，疟疾也有五种。大概有一种气的感证，就有一种气的疟疾，不过是轻重之别罢了！当今世界温热病多而伤寒少，所以疟疾也是时疟多而正疟少。温、热、暑、湿既然不能用正伤寒的方法来治疗，时疟难道可以用正疟的方法来治疗吗？其中有两天发作一次的，正疟有，时疟也有，名叫三阴疟。因为邪气进入三阴经，不可误解为一定属于阴寒的病。医生不知道五气都能导致疟疾，糊里糊涂地施治，很少切合病情，所以世人患疟疾，多有变证。有的甚至缠绵数年，以至于俗人有“疟疾没有正治法”、“怀疑是鬼祟”等说法。然而像徐洄溪、魏玉横这样的学识，尚且不知道这些，何况其他人呢？只有叶天士精通温、热、暑、湿各种感证，所以他治疗疟疾，一以贯之。我师从他的意旨，治疗疟疾很少有难愈的病例。从前陈仰山老先生问我：您为什么治疗疟疾如此神奇呢？难道另有秘传吗？我说有什么秘密的呢？只是不被古人的谬论所迷惑，辨别它是风温、湿温、暑热还是伏邪，仍然用治疗时行感证的方法清除源头罢了！最近杨素园大令重刻我的医案评语说：案中记载的多是温疟、暑疟，所以治疗多用凉解法。但温疟、暑疟虽然适宜凉解，更应当辨别邪气是在气分还是在营分。缪仲淳善于治疗暑疟，而在阳明证中使用当归、牛膝、鳖甲、首乌等血分药物，也属于非法。如果是湿温转为疟疾与暑邪挟湿的疟疾，其湿邪尚未完全从热化的，极要注意。况且在时疟之外，更有瘀血、顽痰、阳维为病等证候，都有寒热像疟疾的现象，最应该仔细审察，案中各种治疗方法都具备，读者还须在凉解诸法中，详细分析其同异！
大凡看诊规律，卫分之后，才谈到气分，营分之后，才谈到血分。在卫分，发汗就可以；到了气分才可以清气；刚入营分（唐本作“乍入营分”）还可以透热转气（唐本作“仍转气分而解”），如犀角、玄参、羚羊角等药物（唐本有“是也”二字）；入血分（唐本作“至入于血”）就（唐本作“则”）恐怕耗血动血，必须凉血散血，加生地、丹皮、阿胶、赤芍等药物（唐本有“是也”二字）。否则（唐本作“若”）前后不遵循缓急的方法，担心动手就出错（唐本有“耳”字），反而导致慌张了（唐本无此句）。
张仲景辨析六经证治，在一经中都有表里浅深的区分，温邪虽然与伤寒不同，其开始都由营卫引起，所以先生在营卫中又分气血的浅深，精细极了。凡是温病初感，发热而轻微恶寒的，邪气在卫分，不恶寒而恶热，小便颜色黄，已经入气分了。如果脉数舌绛，邪气入营分。如果舌深绛，烦躁失眠，或者夜间有谵语，已经入血分了。邪气在卫分发汗，适宜辛凉轻解。
王士雄按语：首章原文说：初用辛凉轻剂。华岫云注释这条说：辛凉开肺，就是汗剂。章氏注释这条说：适宜辛平表散，不可用凉。怎么荒谬妄诞到这种地步，现在特别纠正它。清气热不可以寒凉凝滞，反而使邪气不能外达而内闭，那么病就重了。所以即使入营，还可以开达转出气分而解，如果不这样细致辨证施治，动手就错了。所以先生是传承仲景的道脉，绝非各家立言所能比及的。
王士雄按语：确实如您所说，为什么屡次擅自更改“初用辛凉”的文字呢。
王士雄按语：外感温病，像这样看诊规律，风寒各种感证，没有不是这样的，这是古人未达到的旨意。近代只有王清任知道。如果是伏气温病，自里出表，乃先从血分而后到达气分。芷卿说：论述伏气治疗的精识，直超前人，然而金针虽度，奈何对粗工之聋聩有何办法。所以起病之初，往往舌润而无苔垢，只要观察其脉软而或弦、或微数，口不渴而心烦恶热，就适宜投以清解营阴的药物，等到邪气从气分而化，苔才开始渐渐布满，然后再清其气分就可以了。伏邪重的，初起即舌绛咽干，甚至有肢冷脉伏的假象，亟宜大清阴分伏邪，随后必然浓腻黄浊之苔渐渐生出，这是伏邪与新邪先后不同的地方。更有邪伏深沉，不能一齐外出的，虽然治疗得法，而苔退舌淡之后，过了一两天舌又干绛，苔又黄燥，正如抽蕉剥茧，层出不穷，不比外感温邪，由卫及气、自营而血。杨云：阅历有得的言论，所以句句精实，学人应当领会。秋月伏暑证，轻浅者邪伏膜原，深沉者也多如此。如果阅历不多，未必知道其中的曲折竟是这样，附记以此告知留心医学的人。
我的医案中，凡是先治血分，后治气分的，都是伏气病，虽然没有点明，读者应当自己领悟。况且我们吴地湿邪害人最广（唐本作“多”）。如面色白的人，须要顾护其阳气，湿胜则阳微。法应清凉（唐本法上有“如”字），然而（唐本作“用”）到十分之六七，就不可过于寒凉（唐本无此二字）。恐怕成功反弃，为什么呢（唐本无此二句，有“盖恐”二字）？湿热一去，阳亦衰微。面色苍黑的人，须要顾护其津液，清凉到十分之六七，往往热减身寒的，不可以就（唐本作“便”）说是虚寒，而投补剂，恐怕炉烟虽熄，灰中有火，须细察精详，方少少与之，慎不可直率（唐本作“漫然”）而往（唐本作“进”）。又有酒客，体内湿气素盛，外邪入里，里湿为合（唐本作“与之相搏”）。在阳旺之躯，胃湿恒多；在阴盛之体，脾湿也不少，然而其化热则一。热病救阴犹易，通阳最难，救阴不在（唐本有“补”字）血，而在津与汗（唐本作“养津与测汗”）；通阳不在温，而在利小便。然而（唐本无此字）较之杂证，则（唐本无此字）有不同。
六气之邪，有阴阳不同。其伤人，又随人身之阴阳强弱变化而为病。面白阳虚之人，其体丰者，本多痰湿。若受寒湿之邪，非姜、附、参、苓不能去。若湿热也必粘滞难解，须通阳气以化湿。若过凉则湿闭而阳更困。面苍阴虚之人，其形瘦者，内火易动，湿从热化，反伤津液，与阳虚治法正相反。胃湿脾湿虽化热则一，而治法有阴阳不同。如仲景说：身黄如橘子色而鲜明的，这是阳黄胃湿，用茵陈蒿汤。他说色如熏黄而沉晦的，这是阴黄脾湿，用栀子柏皮汤。或者后世之二妙散也可。救阴在养津，通阳在利小便，发古未发之至理。测汗者，测之以审津液之存亡，气机之通塞。
王士雄按语：热胜于湿，则黄如橘子色而鲜明；湿胜于热，则色沉晦而如熏黄，皆属阳证，而非阴黄。
王士雄按语：所谓六气，风、寒、暑、湿、燥、火。分其阴阳，则《素问》说：寒暑六入，暑统风、火，阳也。寒统燥、湿，阴也。言其变化，则阳中惟风无定体，有寒风、有热风；阴中则燥、湿二气，有寒、有热。至于暑乃是天之热气，流金烁石，纯阳无阴。有人说阳邪为热，阴邪为暑，甚属不经。经云：“热气大来，火之胜也”，阳之动，始于温，盛于暑。盖在天为热，在地为火，其性为暑，是暑即热也，并非二气。有人说暑为兼湿的也误。暑与湿原是二气，虽易兼感，实非暑中必定有湿。譬如暑与风也多兼感，岂可谓暑中必有风？如果说热与湿合，始名为暑，然则寒与风合，又将何称？更有妄立阴暑、阳暑之名的，也属可笑。如果暑必兼湿，则不可冠以“阳”字。若知暑为热气，则不可冠以“阴”字。其实彼所谓阴者，即夏月之伤于寒湿者耳！设云暑有阴阳，则寒亦有阴阳矣。不知寒者，水之气也，热者，火之气也。水火定位，寒热有一定之阴阳，寒邪传变，虽能化热而感于人，从无阳寒之说。人身虽有阴火，而六气中不闻有寒火之名。暑字从日，日为天上之火。寒字从仌，仌为地下之水。暑邪易入心经，寒邪先犯膀胱，霄壤不同，各从其类。故寒暑二气，不比风、燥、湿，有可阴可阳之不同。况夏秋酷热，始名为暑。冬春之热，仅名为温。而风、寒、燥、湿，皆能化火。今日六气之邪，有阴阳之不同，又随人身之阴阳变化，毋乃太无分别乎。至面白体丰之人，既病湿热，应用清凉，本文业已明言，但病去六七，不可过用寒凉耳！非谓病未去之初，不可用凉。今云与面苍形瘦之人治法正相反，则未去六七之前，亦当如治寒湿之用姜、附、参、术矣。阳奉阴违，殊乖诠释之体。若脾湿阴黄，又岂栀柏汤苦寒纯阴之药可治哉？本文说：救阴不在血，而在津与汗，言救阴须用充液之药，以血非易生之物，而汗需津液以化。唐本于血津上加“补养”字，已属蛇足，于汗上加“测”字，则更与“救”字不贯，章氏仍之，陋矣！上第三章。
又按语：寒、暑、燥、湿、风，乃五行之气合于五脏。惟暑独盛于夏令，火则四时皆有，析而言之，故曰六气。然三时之暖燠，虽不可以暑称之，亦何莫非丽日之煦照？须知暑即日之气，日为众阳之宗，阳燧承之，火立至。以五行论，言暑则火在其中，非五气外另有一气。若风、寒、燥、湿悉能化火，此由郁遏使然，又不可与天之五气统同而论。
又按语：茅雨人说：本文谓湿胜则阳微，其实乃阳微故致湿胜。此辨极是，学人宜知之。
再论三焦不得从外解，必致成里结。里结于何？在阳明胃与肠。亦须用下法，不可以气血之分，就（唐本作“谓其”）不可下。但（唐本作“惟”）伤寒邪热在里，劫烁津液，下之宜猛；此多湿邪内搏，下之宜轻。伤寒大便溏为邪已尽，不可再下；湿温病大便溏为邪未尽，必大便硬。慎（唐本作“乃为无湿”始）不可再攻，以粪燥为无湿（唐本无此句）。
胃为脏腑之海，各脏腑之邪，皆能归胃，况三焦包罗脏腑，其邪之入胃尤易。伤寒化热，肠胃干结，故下宜峻猛。湿热凝滞，大便本不干结，以阴邪瘀闭不通。若用承气猛下，其行速而气徒伤，湿仍胶结不去，故当轻法频下。如下文所说小陷胸、泻心等，皆为轻下之法。
王士雄按语：伤寒化热，固是阳邪，湿热凝滞者，大便虽不干结，黑如胶漆者有之，岂可目为阴邪？谓之浊邪可也。惟其误为阴邪，故复援温脾汤下寒实之例，而自诩下阳虚之湿热，为深得仲景心法，真未经临证之言。似是而非，删去不录。再人之体，脘在腹上，其地位处于中（唐本作“其位居中”），按之痛，或自痛，或痞胀，当用苦泄，以其入腹近。必验之于舌，或黄、或浊，可与小陷胸汤、或泻心汤随证治。或（唐本作“若”）白不燥，或黄白相兼，或灰白，不渴，慎不可乱投苦泄。其中有外邪未解，里先结者，或邪郁未伸，或素属中冷者，虽有脘中痞闷，宜从开泄，宣通气滞，以达归于肺，如近俗（唐本作“世”）之杏、蔻、橘、桔等，是轻苦微辛（唐本无“是”字），具流动之品可耳！
此言苔白为寒，不燥则有痰湿，其黄白相兼，灰白而不渴者，皆阳气不化，阴邪壅滞。故不可乱投苦寒滑泄以伤阳。其外邪未解而里先结，故苔黄白相兼而脘痞，皆宜轻苦微辛以宣通其气滞。
王士雄按语：凡视温证，必察胸脘，如拒按者，必先开泄。若苔白，不渴，多挟痰湿。轻者，橘、蔻、菖、薤；重者，枳实、连、夏，皆可用。虽舌绛神昏，但胸下拒按，即不可率投凉润，必参以辛开之品，始有效。上第四章，唐本并以第十一章连为一章，今订正之。连上章皆申明邪在气分之治法，而分别营卫气血之浅深，身形肥瘦之阴阳，苔色黄白之寒热，可谓既详且尽。而下又申言察苔以辨证，真千古开群朦。再（唐本无此字）前云：舌黄或渴（唐本此下有“当用陷胸泻心”六字），须要有地之黄。若光滑者，乃无形湿热中有虚象（唐本作“已有中虚之象”），大忌前法。其脐以上为大腹，或满、或胀、或痛，此必邪已入里（唐本无“矣”字）。表证多无，或十只存一（唐本作“或存十之一”
Obstruction syndrome, the heat becomes even more severe. Thus, the more it is treated, the heavier the disease becomes, until death without realizing the reason, which is truly lamentable.
Wang Shixiong's note: Zhang's explanation is quite logical in theory, but it does not fully accord with the actual condition of the disease. His mention of "dispersing the pathogenic factors from the upper and lower jiao" refers to using Xingren (Apricot Seed) to open the upper jiao, Houpo (Magnolia Bark) to promote middle jiao circulation, and Fuling (Poria) to guide downward. This seems to refer to damp-heat or cases where the patient has pre-existing phlegm-fluid retention, so Wendan Tang (Warm Gallbladder Decoction) can also be used. Yang states: This explanation is precise, far surpassing Zhang's commentary. One can see this by referring to the various cases of warm-dampness in *Zhinan* (The Compass). If wind-warmth lingers in the qi level, as stated later, one should only clear the qi once it reaches the qi level. "Clearing the qi" implies using light and pure herbs that facilitate qi transformation, such as Zhizi (Gardenia), Huangqin (Scutellaria), Gualou (Trichosanthes Fruit), and Weijing (Reed Rhizome). Although cold and cloying herbs should not be used abruptly, Houpo (Magnolia Bark) and Fuling (Poria) are also contraindicated. Those who hear of warm diseases and indiscriminately administer cold herbs are indeed lamentable. Wang's note: Nowadays, physicians fear cold herbs and often hesitate about light cooling and resolving methods, yet they use warming, tonifying, ascending, and drying herbs recklessly without restraint. This is truly the disaster caused by such physicians. Furthermore, failing to distinguish whether there is dampness and stagnation and indiscriminately using Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) is also regrettable. The phrase "the mechanism for transforming into malaria" originally referred to the smooth flow of qi mechanism, allowing the pathogen to transform into malaria and then be eliminated. By guiding it accordingly, the disease would gradually heal. However, modern quacks do not know what warm diseases are; they casually use Chaihu (Bupleurum), Gegen (Kudzu Root), Qianghuo (Notopterygium), and Fangfeng (Saposhnikovia) at will. They tell patients' families: "You must take a few doses of Chaihu to draw the pathogen out and transform it into malaria, so there will be no complications." Patients' families, hearing this, always agree willingly. Even when the condition becomes critical, they say it is because the attempt to transform into malaria failed and the true essence was damaged. Thus, patients die without resentment, and doctors err without remorse. Both parties are deluded, which is indeed lamentable. Wang's note: This differentiation is particularly accurate and clear, hitting the nail on the head regarding current medical malpractices.
Another note: Among the five types of cold damage, only those that manifest immediately after contracting cold are considered "True Cold Damage" (Zheng Shanghan). This occurs when cold pathogens enter from the exterior. Treatment involves warming and dispersing, especially aided by herbs like Gancao (Licorice), Shengjiang (Fresh Ginger), and Dazao (Jujube) to support middle qi and expel pathogens outward, preventing further internal invasion. If pathogens are in the half-exterior, half-interior boundary, treatment should focus on harmonizing, which may cause the condition to transform into malaria. If the contracted wind-cold is mild and enters the Shaoyang channel, it is either not cold damage or is True Malaria, with a wiry pulse, primarily treated with Xiaochaihu Tang (Minor Bupleurum Decoction). If one contracts cold in winter but does not fall ill immediately, it leads to Spring Warmth or Summer Heat syndromes; milder forms become Warm Malaria or Dan Malaria. Xuanyuan, Qibo, and Zhang Zhongjing all provided clear instructions; did they ever treat all cases solely with Xiaochaihu Tang? If one contracts wind-warmth, damp-warmth, or summer-heat pathogens, severe cases result in seasonal infections, while mild cases result in seasonal malaria. For lingering pathogens of warmth, heat, summer-heat, and dampness, proper treatment can also cause them to transform into malaria and exit. In summary, just as there are five types of cold damage, there are five types of malaria. Essentially, for every type of qi-related infection, there is a corresponding type of malaria, differing only in severity. Today, warm diseases are common while cold damage is rare; thus, seasonal malaria is common while true malaria is rare. Since warmth, heat, summer-heat, and dampness cannot be treated with the methods for True Cold Damage, how can seasonal malaria be treated with the methods for True Malaria? Cases occurring every two days exist in both true and seasonal malaria, called San Yin Malaria (Three Yin Malaria) because the pathogen enters the Three Yin channels. It should not be misunderstood as necessarily belonging to yin-cold syndromes. Physicians do not know that all five qi types can cause malaria; they treat blindly and rarely match the condition, leading to many variations in malaria patients. Some suffer for years, leading to folk beliefs that "malaria has no standard treatment" or "it is caused by ghosts." Yet even scholars like Xu Huixi and Wei Yuheng were unaware of this, let alone others. Only Ye Tianshi mastered the treatment of warmth, heat, summer-heat, and dampness infections, applying consistent principles to treating malaria. I followed his intent and rarely encountered difficult-to-cure malaria cases. Previously, Chen Yangshan asked me: "Why are you so miraculous in treating malaria? Do you have a secret transmission?" I replied: "What secret is there? I simply do not confuse myself with ancient erroneous theories. I differentiate whether it is wind-warmth, damp-warmth, summer-heat, or latent pathogen, and clear the source using methods for seasonal infections." Recently, Yang Suyuan commented on my reprinted cases: "The cases recorded mostly involve warm malaria and summer-heat malaria, so treatments often use cooling and resolving. Although warm and summer-heat malaria suit cooling and resolving, one must distinguish whether the pathogen is in the qi or ying level." Miu Zhongchun was skilled in treating summer-heat malaria but used blood-level herbs like Danggui (Angelica Sinensis), Niuxi (Achyranthes), Biejia (Turtle Shell), and Shouwu (Polygonum Multiflorum) in Yangming syndromes, which is illegal. For malaria caused by damp-warmth or summer-heat with dampness, where dampness has not fully transformed into heat, great attention is needed. Besides seasonal malaria, there are also conditions like blood stasis, stubborn phlegm, and Yangwei vessel disorders, which present with chills and fever resembling malaria; these require careful examination. The cases cover various treatments; readers should analyze their similarities and differences among cooling and resolving methods.
Generally speaking, after the wei (defensive) level, one discusses the qi level; after the ying (nutritive) level, one discusses the xue (blood) level. In the wei level, sweating is appropriate. Once in the qi level, clearing the qi is appropriate. Upon entering the ying level (Tang manuscript: "just entered the ying fen"), one can still penetrate the heat and transfer it back to the qi level (Tang manuscript: "still transfer to the qi fen to resolve"), using substances like Xijiao (Rhinoceros Horn - now substituted), Xuanshen (Scrophularia), and Lingyangjiao (Antelope Horn) (Tang manuscript adds "these are suitable"). Upon entering the xue level (Tang manuscript: "upon entering the xue"), one fears damaging the blood and stirring bleeding; one must cool the blood and disperse stasis, adding Shengdi (Rehmannia), Danpi (Moutan), Ejiao (Donkey-hide Gelatin), and Chishao (Red Peony Root) (Tang manuscript adds "these are suitable"). Otherwise (Tang manuscript: "if"), failing to follow the principles of urgency and delay, one risks making mistakes upon acting, leading to panic (Tang manuscript lacks this sentence).
Zhang Zhongjing differentiated the six meridians, distinguishing exterior/interior and shallow/deep within each meridian. Although warm pathogens differ from cold damage, they initially affect the ying and wei levels. Therefore, Mr. Ye further distinguished the shallow and deep aspects of qi and blood within the ying and wei levels, showing extreme precision. Generally, in early warm disease, fever with slight aversion to cold indicates the pathogen is in the wei level. Aversion to heat rather than cold, with yellow urine, indicates entry into the qi level. A rapid pulse and crimson tongue indicate entry into the ying level. A deep crimson tongue, restlessness, insomnia, or night-time delirium indicate entry into the xue level. For pathogens in the wei level, sweating is indicated, preferably with light acrid-cool formulas.
Wang Shixiong's note: The original text of the first chapter states: "Initially use light acrid-cool agents." Hua Xiuyun annotated this line: "Acrid-cool opening of the lungs constitutes a sweating agent." Zhang annotated: "Use acrid-pine surface-dispersing; do not use cooling." How absurd and wrong this is! I correct it here. Clearing qi heat should not use cold and cloying herbs, which prevent pathogen expulsion and cause internal obstruction, worsening the disease. Thus, even if entering the ying level, one can still open and release it to the qi level for resolution. Without such detailed differentiation and treatment, errors occur immediately. Thus, Mr. Ye transmits the lineage of Zhang Zhongjing, far exceeding the statements of other schools.
Wang Shixiong's note: Indeed, as you say, why do you repeatedly alter the text "initially use acrid-cool"?
Wang Shixiong's note: External contraction warm diseases follow this diagnostic pattern; wind-cold and other external contractions are no different. This is a principle unattained by ancients, known only recently by Wang Qingren. For latent warm diseases emerging from the interior to the exterior, they first arise from the xue level and then reach the qi level. Zhiqing said: "His insights on treating latent qi surpass predecessors. Although the golden needle is passed, what can be done about deaf coarse practitioners?" Thus, at the onset, the tongue is often moist without coating. Observing a soft pulse, possibly wiry or slightly rapid, with thirstlessness but irritability and aversion to heat, one should administer herbs that clear and resolve ying-yin. When the pathogen transforms via the qi level, the coating gradually appears, and only then should the qi level be cleared. Severe latent pathogens present with a crimson tongue and dry throat at onset, sometimes with false signs of cold limbs and hidden pulse. One must urgently clear the latent pathogen in the yin division. Subsequently, a thick, greasy, yellow turbid coating will gradually appear. This distinguishes latent pathogens from new pathogens. For pathogens deeply latent and unable to exit all at once, even with proper treatment, after the coating recedes and the tongue becomes pale, the tongue may again become dry and crimson, and the coating yellow and dry after one or two days. This is like peeling a banana or cocoon, endless. This differs from external warm pathogens moving from wei to qi, and ying to xue. Yang said: "These are words gained from experience, precise and solid; students should understand them." Autumn latent summer-heat cases, if mild, have pathogens latent in the Membrane Source (Mo Yuan); if deep, they are mostly like this. Without sufficient experience, one might not know such complexities. I record this for those attentive to medicine. In my case records, cases treating the xue level before the qi level are all latent qi diseases. Although not explicitly stated, readers should deduce this. Moreover, dampness in our Wu region harms people most widely (Tang manuscript: "many"). For those with white complexions, one must protect yang qi; excessive dampness leads to weak yang. The method should be cooling (Tang manuscript adds "like"), but (Tang manuscript: "use") when 60-70% resolved, one must not overuse cold (Tang manuscript lacks these two characters). Why? Because removing damp-heat also diminishes yang. For those with dark complexions, one must protect fluids. When cooling resolves 60-70%, and heat decreases with body coldness, one must not (Tang manuscript: "then") assume deficiency-cold and administer tonics, fearing that although the stove smoke has ceased, fire remains in the ashes. One must observe carefully and administer sparingly, avoiding rash action (Tang manuscript: "careless advancement"). For wine drinkers, internal dampness is abundant. When external pathogens enter the interior, internal dampness combines (Tang manuscript: "battles with it"). In constitutions with strong yang, stomach dampness is prevalent; in constitutions with strong yin, spleen dampness is significant. However, their transformation into heat is the same. Resolving yin in heat diseases is relatively easy; promoting yang is hardest. Resolving yin does not lie in (Tang manuscript: "tonifying") blood, but in fluids and sweat (Tang manuscript: "nourishing fluids and measuring sweat"); promoting yang does not lie in warming, but in promoting urination. However (Tang manuscript lacks this character), compared to miscellaneous diseases, (Tang manuscript lacks this character) there are differences.
Pathogens of the six qi have different yin and yang natures. Their injury to humans varies according to the strength of the individual's yin and yang. Individuals with white complexions and yang deficiency, especially those with robust builds, naturally have much phlegm-dampness. If they contract cold-damp pathogens, only Jiang (Ginger), Fu (Aconite), Shen (Ginseng), and Ling (Poria) can remove them. If damp-heat, it is also sticky and hard to resolve, requiring promotion of yang qi to transform dampness. Over-cooling causes dampness to obstruct and yang to become more trapped. Individuals with dark complexions and yin deficiency, especially those with thin builds, easily move internal fire; dampness transforms from heat, injuring fluids, opposite to the treatment for yang deficiency. Although stomach and spleen dampness transform into heat similarly, their treatments differ in yin and yang. As Zhang Zhongjing said: "Body yellow like orange peel and bright" is Yang Huang (Yang Jaundice) due to stomach dampness, treated with Yinchen Hao Tang. "Color like smoked yellow and dull" is Yin Huang (Yin Jaundice) due to spleen dampness, treated with Zhizi Baipi Tang. Or Er Miao San from later generations can also be used. Resolving yin lies in nourishing fluids; promoting yang lies in promoting urination. This reveals profound truths never previously expressed. Measuring sweat assesses the survival of fluids and the patency of qi mechanisms.
Wang Shixiong's note: When heat exceeds dampness, the yellow is bright like an orange peel; when dampness exceeds heat, the color is dull and like smoked yellow. Both are yang syndromes, not yin jaundice.
Wang Shixiong's note: The so-called six qi are wind, cold, summer-heat, dampness, dryness, and fire. Differentiating their yin and yang, *Suwen* states: "Cold and summer-heat enter six times; summer-heat governs wind and fire, which are yang. Cold governs dryness and dampness, which are yin." Regarding their changes, among yang, only wind has no fixed form, having cold wind and hot wind; among yin, dryness and dampness have cold and hot forms. Summer-heat is the hot qi of heaven, melting metals and stones, purely yang without yin. Some say yang pathogen is heat and yin pathogen is summer-heat; this is very irregular. The Classics state: "Great arrival of hot qi is the victory of fire." Yang movement begins with warmth and peaks with summer-heat. Heaven has heat, earth has fire, its nature is summer-heat. Thus, summer-heat is heat, not two separate qis. Some say summer-heat includes dampness; this is also wrong. Summer-heat and dampness are originally two qis; although easily combined, summer-heat does not necessarily contain dampness. For example, summer-heat and wind often combine; can we say summer-heat must contain wind? If heat combining with dampness is named summer-heat, then what is cold combining with wind called? It is ridiculous to arbitrarily establish names for Yin Summer-Heat and Yang Summer-Heat. If summer-heat must include dampness, it cannot be prefixed with "Yang." If one knows summer-heat is hot qi, it cannot be prefixed with "Yin." What they call "yin" is actually cold-damp injury in summer. If summer-heat has yin and yang, then cold must also have yin and yang. Not knowing that cold is the qi of water and heat is the qi of fire. Water and fire have fixed positions; cold and heat have definite yin and yang. Although cold pathogens can transform into heat upon transmission, there is never a concept of "yang cold." Although the human body has yin fire, the six qi do not mention "cold fire." The character 'Shu' (Summer-heat) contains 'Sun', the sun is fire in heaven. The character 'Han' (Cold) contains 'Bing' (Ice), ice is water in earth. Summer-heat pathogens easily enter the Heart channel; cold pathogens first attack the Bladder. Heaven and earth are different; each follows its kind. Thus, cold and summer-heat qis do not differ like wind, dryness, and dampness, which can be yin or yang. Moreover, only intense heat in summer and autumn is named summer-heat. Heat in winter and spring is merely named warmth. Wind, cold, dryness, and dampness can all transform into fire. To say today that the six qi pathogens have different yin and yang, and change according to the human body's yin and yang, is too indistinct. For individuals with white complexions and robust builds suffering from damp-heat, cooling is applied as stated in the text, but once 60-70% of the disease is gone, one must not overuse cold herbs. It is not that cooling cannot be used at the beginning. Now saying the treatment is exactly opposite to that for dark-complexioned, thin individuals implies that before 60-70% resolution, one should use Jiang, Fu, Shen, and Zhu as for cold-damp. This contradicts the interpretation. Can bitter-cold pure yin herbs like Zhizi Baipi Tang treat spleen dampness yin jaundice? The text says: "Resolving yin does not lie in blood, but in fluids and sweat," meaning resolving yin requires fluid-nourishing herbs, as blood is not easily generated, and sweat requires fluids to transform. The Tang manuscript added "tonify/nourish" to blood and fluids, which is superfluous. Adding "measure" to sweat makes it inconsistent with "resolve." Zhang retained this, which is crude. End of Chapter 3.
Another note: Cold, summer-heat, dryness, dampness, and wind are the qi of the Five Elements combined with the Five Zang organs. Summer-heat alone flourishes in summer; fire exists in all four seasons. Analyzed separately, hence called six qi. However, the warmth of the three non-summer seasons, though not named summer-heat, is none less than the warmth of the bright sun. Know that summer-heat is the qi of the sun. The sun is the ancestor of all yang; catching sunlight with a bronze mirror brings fire instantly. From the perspective of Five Elements, mentioning summer-heat implies fire is included; it is not a separate qi outside the five. If wind, cold, dryness, and dampness can all transform into fire, this is due to stagnation, and cannot be discussed uniformly with the heavenly five qis.
Another note: Mao Yuren said: "The text says dampness excess leads to weak yang; actually, it is weak yang that leads to dampness excess." This differentiation is very correct; students should know this.
Furthermore, discuss that San Jiao pathogens cannot resolve from the exterior and must lead to interior knotting. Where does the interior knotting occur? In the Yangming Stomach and Intestines. One must also use purgative methods; one cannot say purgatives are contraindicated based on the distinction between qi and blood levels. But (Tang manuscript: "only") in cold damage, pathogenic heat in the interior consumes fluids, so purgation should be vigorous; here, damp pathogens interact internally, so purgation should be mild. In cold damage, loose stool means the pathogen is exhausted, and purgation should not be repeated; in damp-warmth disease, loose stool means the pathogen is not exhausted, and one must wait for hard stool. Carefully (Tang manuscript: "only when there is no dampness") do not attack again, considering dry feces indicates no dampness (Tang manuscript lacks this sentence).
The Stomach is the sea of the zang-fu organs; pathogens from all organs can return to the Stomach. Since the San Jiao encompasses the zang-fu, pathogens entering the Stomach are even easier. In cold damage transforming into heat, the intestines and stomach become dry and knotted, so purgation should be harsh. In damp-heat stagnation, stool is not inherently dry; it is blocked by yin pathogens. If using Chengqi decoctions for harsh purgation, the action is fast, damaging qi in vain, while dampness remains sticky and unresolved. Thus, one should use mild methods frequently. As mentioned below, Xiao Xianxiong Tang and Xiexin Tang are mild purgative methods.
Wang Shixiong's note: Cold damage transforming into heat is indeed a yang pathogen. In damp-heat stagnation, although stool is not dry, it can be black like glue or lacquer; how can it be viewed as a yin pathogen? It can be called a turbid pathogen. Because it was mistaken for a yin pathogen, some cited the example of Wenspi Tang purging cold-solidity to boast that purging yang-deficient damp-heat obtains Zhang Zhongjing's core method. This is truly unverified clinical talk. Similar yet incorrect; delete and do not record. Again, the human body, the epigastrium is above the abdomen, located in the center (Tang manuscript: "its position is central"). Tenderness upon pressing, spontaneous pain, or fullness/distension require bitter-draining herbs because it is close to the abdomen. One must verify with the tongue: if yellow or turbid, one can use Xiao Xianxiong Tang or Xiexin Tang according to the syndrome. Or (Tang manuscript: "if") white and not dry, or yellow-white mixed, or gray-white, without thirst, one must not rashly administer bitter-draining herbs. Among these, there are cases where exterior pathogens are unresolved but interior knots form first, or pathogen depression is not extended, or the constitution is inherently middle-jiao cold. Although there is epigastric stuffiness, one should use opening and draining methods to circulate qi stagnation, directing it to return to the lungs, using common herbs like Xingren (Apricot Seed), Kouren (Cardamom), Juhua (Citrus Peel), and Jiegeng (Platycodon), which are light bitter and slightly acrid (Tang manuscript lacks "shi"), possessing mobile properties.
This states that a white coating indicates cold; if not dry, there is phlegm-dampness. Yellow-white mixed, gray-white without thirst, all indicate yang qi failure to transform and yin pathogen stagnation. Thus, one must not rashly administer bitter-cold slippery-draining herbs to injure yang. For exterior pathogens unresolved and interior knots forming first, resulting in yellow-white mixed coating and epigastric fullness, light bitter and slightly acrid herbs should be used to circulate qi stagnation.
Wang Shixiong's note: Whenever viewing warm syndromes, one must examine the chest and epigastrium. If tenderness upon pressure exists, one must first use opening and draining. If the coating is white and there is no thirst, it often involves phlegm-dampness. Mild cases: Juhua (Citrus Peel), Kouren (Cardamom), Shichangpu (Acorus), Xiebai (Allium Macrostemon); severe cases: Zhishi (Immature Bitter Orange), Lianqin (Scutellaria), Banxia (Pinellia) can all be used. Even with a crimson tongue and spirit confusion, if there is tenderness below the chest, one must not rashly administer cooling-moistening herbs. One must add acrid-opening substances to be effective. End of Chapter 4. The Tang manuscript merges this with Chapter 11; I correct this here. Connecting with the previous chapter, it clarifies the treatment for pathogens in the qi level, differentiating the shallow and deep aspects of ying, wei, qi, and blood, the yin and yang of body fat/thinness, and the cold/heat of yellow/white coatings. It is detailed and thorough. Below, it reiterates examining the coating to differentiate syndromes, truly enlightening the masses since antiquity. Again (Tang manuscript lacks this character), previously stated: "Yellow coating or thirst" (Tang manuscript has "should use Xianxiong and Xiexin" six characters here), one must look for a grounded yellow. If smooth, it indicates deficiency signs within formless damp-heat (Tang manuscript: "already has middle-jiao deficiency signs"); the previous methods are strictly forbidden. Above the umbilicus is the large abdomen. Fullness, distension, or pain here indicate the pathogen has entered the interior (Tang manuscript lacks "yi"). Exterior symptoms are mostly absent, or only one in ten remains (Tang manuscript: "or one in ten remains").