雄按∶此与下编相传为陈、薛所着。究难考实。姑从俗以标其姓字。俟博雅正之。
盖闻外感不外六淫，而民病当分四气。治伤寒家，徒守发表攻里之成方，不计辛热苦寒之贻害，遂使温热之旨，蒙
昧不明，医门缺典，莫此甚焉。祖恭不敏，博览群书，广搜载籍，而恍然于温热病之不可不讲也。《内经》云∶冬不藏精，
春必病温。盖谓冬令严寒，阳气内敛，人能顺天时而固密，则肾气内充，命门为三焦之别使，亦得固腠理而护皮毛。虽
当春令升泄之时，而我身之真气，则内外弥纶，不随升令之泄而告匮，纵有客邪，安能内侵？是《内经》所以明致病之
原也。然，但云冬不藏精，而不及他时者，以冬为水旺之时，属北方寒水之化，于时为冬，于人为肾。井水温而坚冰至，
阴外阳内，有习坎之义。故立言归重于冬，非谓冬宜藏而他时可不藏精也。
雄按∶喻氏云∶春夏之病，皆起于冬，至秋
冬二时之病，皆起于夏，夏月藏精，则热邪不能侵，与冬月之藏精，而寒邪不能入者无异也。故丹溪谓夏月必独宿淡味，
保养金水二脏，尤为摄生之仪式焉。即春必病温之语，亦是就近指点，总见里虚者表不固，一切时邪，皆易感受。学人
可因此而悟及四时六气之为病矣。
雄按∶此论冬不藏精，春易病温之理甚通，惟不知有伏气为病之温，是其蔽也。陈氏
此篇与鞠通《条辨》，皆叶氏之功臣，然《幼科要略》明言有伏气之温热，二家竟未细绎，毋乃疏乎？二家且然，下此者
更无论矣。《难经》云∶伤寒有五，有伤寒。
雄按∶麻黄汤证是也。有中风。
雄按∶桂枝汤证是也。有风温。
雄按∶冬温春温之外受者。有热病。
雄按∶即暑病也，又谓之 。有湿温。
雄按∶即暑兼湿为病也，亦曰湿热。夫统此风寒湿热之
邪，而皆名之曰伤寒者，亦早鉴于寒脏受伤，外邪得入，故探其本而皆谓之伤寒也。
雄按∶仲景本论，治法原有区别，
界画甚严，后人不察，罔知所措，多致误人，兹余辑此专论，以期了然于学人之心目也。独是西北风高土燥，风寒之为
病居多。
雄按∶亦不尽然。东南地卑水湿，湿热之伤人独甚。从来风寒伤形，伤形者定从表入。湿热伤气，伤气者不尽
从表入。故治伤寒之法，不可用以治温热也。夫温者，暖也、热也，非寒之可比也。风邪外束，则曰风温。湿邪内侵，
则曰湿温。纵有微寒之兼袭，不同栗冽之严威，是以发表宜辛凉，不宜辛热。清里宜泄热，不宜逐热。
雄按∶亦有宜逐
者，总须辨证耳。盖风不兼寒，即为风火，湿虽化热，终属阴邪。
雄按∶湿固阴邪，其兼感热者，则又不可谓之阴矣。
自昔仲景着书，不详温热，遂使后人各呈家伎，漫无成章。而凡大江以南，病温多而病寒少。
雄按∶北省温病，亦多于
伤寒。投以发表不远热，攻里不远寒诸法，以致死亡接踵也。悲夫！
雄按∶篇中非伏气之说，皆为节去，弃瑕录瑜，后
皆仿此。
风温为病，春月与冬季居多。或恶风，或不恶风，必身热，咳嗽，烦渴，此风温证之提纲也。
自注。春月风邪用事，冬初，气暖多风。
雄按∶冬暖不藏，不必定在冬初也。故风温之病，多见于此，但风邪属阳，
阳邪从阳，必伤卫气。人身之中，肺主卫。又胃为卫之本，是以风温外薄，肺胃内应。风温内袭，肺胃受病。其温邪之
内外有异形，而肺胃之专司无二致。故恶风为或有之证，而热、渴、咳嗽，为必有之证也。三复仲景书，言温病者再，
一则曰“太阳病，发热而渴，不恶寒者为温病”，此不过以不恶寒而渴之证，辨伤寒与温病之异，而非专为风温叙证也。
雄按∶此言伏气发为春温，非冬春所感之风温。故曰太阳病，以太阳为少阴之表也。再则曰∶发汗已，身灼热者，名曰
风温。夫灼热因于发汗，其误用辛热发汗可知，仲景复申之曰∶风温为病，脉阴阳俱浮，自汗出，身重，多眠睡，鼻息
必鼾，语言难出。凡此，皆误汗劫液后变见之证，非温病固有之证也。续云∶若被下者，直视失溲；若被火者，发黄色，
剧则如惊痫状，时 ；若火熏之，一逆尚引日，再逆促命期。亦止详用下、用火之变证，而未言风温之本来见证也。
雄按∶此言温病误汗，热极生风，故曰风温，乃内风也。非冬春外感之风温，陈氏不知有伏气春温之病，强为引证，原
可删也。然病之内外虽殊，证之属温则一。姑存之以为后学比例。然从此细参，则知风温为燥热之邪，燥令从金化，燥
热归阳明，故肺胃为温邪必犯之地。且可悟风温为燥热之病，燥则伤阴，热则伤津，泄热和阴，又为风温病一定之治法
也，反此即为逆矣。用是不辞僭越，而于仲景之无文处求文，无治处索治，叙证施治，列为条例，知我罪我，其在斯乎？
雄按∶外感温病，仲圣虽未言，而叶氏已详论矣。
风温证，身热畏风，头痛咳嗽，口渴，脉浮数，舌苔白者，邪在表也。当用薄荷、前胡、杏仁、桔梗、桑叶、川贝
之属，凉解表邪。杨云∶前胡、桔梗，一降一升，以泄肺邪。诚善，然桔梗宜少用。
自注风属阳邪，不挟寒者为风温。阳邪必伤阳络，是以头痛畏风；邪郁肌表，肺胃内应，故咳嗽、口渴、苔白；邪
留于表，故脉浮数。表未解者当先解表，但不同于伤寒之用麻、桂耳。
雄按∶何西池云∶辨痰之法，古人以黄稠者为热，稀白者为寒，此特言其大概，而不可泥也。以外感言之，伤风咳
嗽，痰随嗽出，频数而多，色皆稀白，误作寒治，多致困顿。盖火盛壅逼，频咳频出，停留不久，故未至于黄稠耳？迨
火衰气平，咳嗽渐息，痰之出者，半日一口，反黄而稠。缘火不上壅，痰得久留，受其煎炼使然耳。故黄稠之痰，火气
尚缓而微；稀白之痰，火气反急而盛也。此皆当用辛凉解散，而不宜于温热者，推之内伤亦然。孰谓稀白之痰，必属于
寒哉？总须临证细审，更参以脉，自可见也。
风温证∶身热，咳嗽，自汗，口渴，烦闷，脉数，舌苔微黄者，热在肺胃也。当用川贝、牛蒡、桑皮、连翘、橘皮、
竹叶之属，凉泄里热。
此温邪之内袭者，肺热，则咳嗽汗泄。胃热，则口渴烦闷。苔白转黄，风从火化，故以清泄肺胃为主。
雄按∶苔黄不甚燥者，杨云∶故条中言微黄，亦具见斟酌。治当如是。若黄而已干，则桑皮、橘皮，皆嫌其燥，须
易栝蒌、黄芩，庶不转伤其液也。
风温证∶身灼热，口大渴，咳嗽烦闷，谵语如梦语，脉弦数，干呕者，此热灼肺胃，风火内旋。当用羚羊角、川贝、
连翘、麦冬、石斛、青蒿、知母、花粉之属，以泄热和阴。
此温邪袭入肺胃之络，灼烁阴津，引动木火，故有烦渴呕逆等证，急宜泄去络中之热，庶无风火相煽，走窜包络之
虞。
雄按∶嗽且闷，麦冬未可即授，嫌其滋也，汪按。徐洄溪谓麦冬能满肺气。非实嗽所宜是也。以为大渴耶。已有知
母、花粉，足胜其任矣。木火上冲而干呕，则青蒿虽清少阳，而嫌乎升矣。宜去此二味，加以栀子、竹茹、枇杷叶，则
妙矣。杨云∶议药细极微芒，读者不可草草读过。
风温证∶身热，咳嗽，口渴，下利，苔黄，谵语，胸痞，脉数，此温邪由肺胃下注大肠。当用黄芩、桔梗、煨葛、
豆卷、甘草、橘皮之属，以升泄温邪。
大肠与胃相连属，与肺相表里，温邪内逼，下注大肠则下利，治之者宜清泄温邪，不必专于治利。按《伤寒论》∶“下
利谵语者，有燥矢也，宜大承气汤”，是实热内结，逼液下趋，必有舌燥苔黄刺，及腹满痛证兼见，故可下以逐热。若温
邪下利，是风热内迫，虽有谵语一证，仍是无形之热，蕴蓄于中，而非实满之邪，盘结于内，故用葛根之升提，不任硝、
黄之下逐也。汪按。升提亦所不任。
雄按∶伤寒为阴邪，未曾传腑化热，最虑邪气下陷，治必升提温散，而有早下之戒。温热为阳邪，火必克金，故先
犯肺，火性炎上，难得下行。若肺气肃降有权，移其邪由腑出，正是病之去路，升提胡可妄投？杨云∶小儿患疹，必下
利，与此正同。故温病多有发疹者，误升则邪入肺络，必喘吼而死？既云∶宜清泄其邪，不必专于治利矣。况有咳嗽胸
痞之兼证，岂葛根、豆卷、桔梗之所宜乎？当易以黄连、桑叶、银花。须知利不因寒，润药亦多可用。仲圣以猪肤、白
蜜治温病下利，《寓意草》论肺热下利最详，学人宜究心焉。且伤寒与温热，邪虽不同，皆属无形之气。伤寒之有燥矢，
并非是气结，乃寒邪化热，津液耗伤，糟粕炼成燥矢耳。温热病之大便不闭为易治者，以脏热移腑，邪有下行之路，所
谓腑气通则脏气安也。设大便闭者，热烁胃津，日久亦何尝无燥矢宜下之证哉？惟伤寒之大便不宜早解，故必邪入于腑，
始可下其燥矢。温热由肺及胃，虽不比疫证之下不嫌早，而喜其便通，宜用清凉，故结成燥矢者较少耳。忆嘉庆己卯春，
先君子病温而大便自利，彼时，吾杭诸名医咸宗陶节庵书以治伤寒，不知所谓温证也，见其下利，悉用柴葛升提，提而
不应，或云是漏底证，渐投温补，病日以剧，将治木矣。父执翁七丈，忘其字矣。似是“立贤”二字。荐浦上林先生来
视，浦年甚少，诊毕，即曰是温证也，殆误作伤寒治，而多服温燥之药乎？幸而自利不止，热势尚有宣泄，否则早成灰
烬，奚待今日耶？即用大剂犀角、石膏、银花、花粉、鲜生地、麦冬等药，嘱煎三大碗，置于榻前频频灌之。药未煎成
之际，先笮蔗浆恣饮之。诸戚长见方，相顾莫决，赖金履思丈力持煎其药，至一周时服竣，病有起色，遂以渐愈。时（雄）
年甫十二，聆其言而心识之，逾二年先君捐馆，（雄）糊口远游，闻浦先生以善用清凉，为众口所铄，乃从事于景岳，而
以温补称。枉道徇人，惜哉然！（雄）之究心于温热，实浦先生有以启之也。浦今尚在，因其远徙于乡，竟未遑往质疑义
为恨，附记于此，聊志感仰之意云尔。
风温证∶热久不愈，咳嗽，唇肿，口渴，胸闷，不知饥，身发白疹如寒粟状，自汗脉数者，此风邪挟太阴脾湿，发
为风疹。杨云∶白疹乃肺胃湿热也，与脾无涉，亦与风无涉。用牛蒡、荆芥、防风、连翘、橘皮、甘草之属凉解之。
风温本留肺胃，若太阴旧有伏湿者，风热之邪，与湿热相合，流连不解，日数虽多，仍留气分，由肌肉而外达皮毛，
发为白疹。盖风邪与阳明营热相并，则发斑。与太阴湿邪相合，则发疹也。又有病久中虚，气分大亏而发白疹者，必脉
微弱而气倦怯，多成死候，不可不知。汪按∶前说即白如水晶色之白 ，后说即白如枯骨之白 也。
雄按∶白疹即白 也，虽挟湿邪久不愈而从热化，且汗渴脉数，似非荆防之可再表，杨云∶此湿亦不必用橘皮之燥。
宜易滑石、苇茎、通草，杨云∶精当。斯合凉解之法矣。若有虚象，当与甘药以滋气液。
风温证∶身热，咳嗽，口渴，胸痞，头目胀大，面发泡疮者，风毒上壅阳络。当用荆芥、薄荷、连翘、元参、牛蒡、
马勃、青黛、银花之属，以清热散邪。
此即世俗所谓大头病也，古人用三黄汤主治。然风热壅遏，致络气不宣，头肿如斗，终不若仿普济消毒饮之宣络涤
热为佳。汪按∶方附见九十五。
风温证∶身大热，口大渴，目赤唇肿，气粗烦躁，舌绛齿板，痰咳，甚至神昏谵语，下利黄水者，风温热毒，深入
阳明营分，最为危候。用犀角、连翘、葛根、元参、赤芍、丹皮、麦冬、紫草、川贝、人中黄，解毒提斑，间有生者。
杨云∶葛根、麦冬俱与证不甚登对。
此风温热毒，内壅肺胃，侵入营分，上下内外，充斥肆逆。若其毒不甚重，或气体壮实者，犹可挽回，否则必坏。
风温毒邪，始得之，便身热口渴，目赤咽痛，卧起不安，手足厥冷，泄泻，脉伏者，热毒内壅，络气阻遏。当用升
麻。杨云∶凡涉咽痛者，一用升麻，则邪入肺络，必喘吼而声如曳锯，陈氏想未之见耳。黄芩、犀角、银花、甘草、豆
卷之属，升散热毒。
此风温毒之壅于阳明气分者，杨云∶仍是肺病。即仲景所云阳毒病是也，五日可治，七日不可治。乘其邪犯气分，
未入营阴，故可升散而愈。
风温证∶身热自汗，面赤神迷，身重难转侧，多眠睡，鼻鼾，语难出，脉数者，温邪内逼，阳明精液劫夺，神机不
运。用石膏、知母、麦冬、半夏、竹叶、甘草之属，泄热救津。
鼻鼾、面赤，胃热极盛。人之阴气，根据胃为养，热邪内灼，胃液干枯，阴气复有何资，而能渗诸阳灌诸络，是以筋
骨懈怠，机关失运，急用甘凉之品以清热濡津，或有济也。
雄按∶宜加西洋参、百合、竹沥。
风温证∶身热痰咳，口渴神迷，手足 ，状若惊痫，脉弦数者，此热劫津液，金囚木旺。当用羚羊、川贝、青蒿、
连翘、知母、麦冬、钩藤之属，以息风清热。
肺属金而畏火，赖胃津之濡养，以肃降令而溉百脉者也。热邪内盛，胃津被劫，肺失所资。木为火之母，子能令母
王士雄按语：这一段与下编的内容，相传是由陈平伯、薛生白所著。但终究难以考证确凿。姑且顺从世俗习惯，标出他们的姓氏名字。等待博学雅正之人来纠正。
我听说外感病不外乎六淫之邪，而百姓患病应当区分四时之气。治疗伤寒的医生，仅仅死守发表攻里的固定方剂，不考虑辛热或苦寒药物可能带来的危害，致使温病的宗旨被蒙蔽而不明，医门中缺失的经典典籍，没有比这更严重的了。我（王士雄）虽然不敏，但博览群书，广泛搜集文献，从而恍然大悟，认为温热病是不可不讲求的。《内经》说：“冬天如果不藏精，春天必定会得温病。”这是说在冬季严寒之时，阳气内敛，人若能顺应天时使身体固密，那么肾气就会内充，命门作为三焦的别使，也能固护腠理而保护皮毛。即使正当春季阳气升发疏泄的时候，而我身体的真气，则内外周流贯通，不会随着升发之令的疏泄而告罄，纵然有客邪入侵，怎么能深入体内呢？这就是《内经》阐明致病原因的道理。然而，只说冬天不藏精，而不提及其他季节的原因，是因为冬季是水气旺盛的时候，属于北方寒水的化生，在时令上对应冬季，在人体对应肾脏。井水温暖而坚冰到来，阴在外阳在内，有习坎卦的含义。所以立言着重于冬季，并不是说只有冬季应该藏精而其他季节可以不藏精。
王士雄按语：喻嘉言说：“春夏的疾病，都起源于冬季；到秋冬两季的疾病，都起源于夏季。夏季能够藏精，那么热邪就不能侵入，这与冬季藏精而寒邪不能进入是一样的。所以朱丹溪说夏季必须独居、饮食清淡，保养肺金和肾水两脏，更是养生的典范。即使是‘春天必得温病’这句话，也是就近指点，总归是说明里虚的人表气不固，一切时行邪气都容易感受。学习者可以由此领悟到四时六气致病的道理。”
王士雄按语：这段论述冬天不藏精、春天易患温病的道理非常通顺，只是不知道还有伏气温病这一种情况，这是他的局限之处。陈氏这篇与吴鞠通的《温病条辨》，都是叶天士学说的功臣，但是《幼科要略》明确说有伏气温热病，这两家竟然没有细细推演，难道不是疏忽吗？这两家尚且如此，后来的学者就更不用说了。《难经》说：“伤寒有五，有伤寒。”
王士雄按语：指麻黄汤证。有中风。
王士雄按语：指桂枝汤证。有风温。
王士雄按语：指冬温和春温的外感类型。有热病。
王士雄按语：即暑病，又谓之暑湿。有湿温。
王士雄按语：即暑兼湿为病，也称为湿热。统括这些风寒湿热之邪，都称之为伤寒，也是因为早就鉴于寒邪伤及内脏，外邪得以进入，所以探究其根本而都称之为伤寒。
王士雄按语：张仲景的本论，治法原本有区别，界限非常严格，后人没有察觉，茫然不知所措，多导致误人，现在我辑录这篇专门论述，希望让学习者在心中了然清楚。只是西北风高土燥，风寒导致的病居多。
王士雄按语：也不尽然。东南地势低洼水湿重，湿热伤人特别严重。历来风寒伤形，伤形的必定从表入里。湿热伤气，伤气的不一定全从表入里。所以治疗伤寒的方法，不可以用来治疗温热病。所谓“温”，就是暖、就是热，不能与寒相比。风邪外束，就称为风温。湿邪内侵，就称为湿温。纵有轻微寒邪兼袭，也不同凛冽的严威，所以发表宜用辛凉，不宜用辛热。清里宜泄热，不宜逐热。
王士雄按语：也有适宜逐热的，总须辨证罢了。大概风不兼寒，就成为风火，湿虽然化热，终究属于阴邪。
王士雄按语：湿确实是阴邪，如果兼感热邪，那么又不能称之为阴了。
自古以来张仲景著书，没有详细论述温热病，致使后人各自施展技艺，漫无章法。而且凡是大江以南，患温病的多，患寒病的少。
王士雄按语：北方省份的温病，也多于伤寒。使用发表不远热、攻里不远寒等各种方法，以致死亡接踵而至。可悲啊！
王士雄按语：篇中非伏气之说，都被删节去除了，弃瑕录瑜，后面都仿照这个体例。
风温病，在春季和冬季最多见。有的怕风，有的不怕风，一定会有身热、咳嗽、心烦口渴，这是风温证的提纲。
自注：春季风邪当令，初冬时节，气候温暖多风。
王士雄按语：冬季温暖不藏精，不一定只在初冬。所以风温的病，多见于此时，但风邪属阳，阳邪从阳分受邪，必定损伤卫气。人体之中，肺主卫气。另外胃是卫气的根本，所以风温外迫，肺胃在内相应。风温内袭，肺胃受病。温邪的内外表现虽有不同，但肺胃专司其职没有二致。所以恶风是可能出现的症状，而热、渴、咳嗽，是必然出现的症状。反复研读仲景的书，提到温病的有两次，一次说“太阳病，发热而渴，不恶寒的是温病”，这不过是以不恶寒且渴的症状，来辨别伤寒与温病的不同，而不是专门为风温叙述证候。
王士雄按语：这里说的是伏气发为春温，不是冬春所感的风温。所以说太阳病，因为太阳是少阴的表。第二次说：“发汗后，身体灼热的，名叫风温。”灼热是因为发汗引起的，可知误用了辛热发汗，仲景又重申道：风温病，脉象阴阳俱浮，自汗出，身体沉重，多眠睡，鼻息一定打鼾，语言难出。凡是这些，都是误汗劫夺津液后变见的症状，不是温病固有的症状。接着说：如果被攻下的，会出现直视失禁小便；如果被用火疗的，会发黄，严重时像惊痫的样子，时而抽搐；如果用火熏的，一逆还拖延时日，再逆就加速死亡。也只是详细记载了用下法、用火的变证，而没有说风温本来的见证。
王士雄按语：这里说的是温病误汗，热极生风，所以叫风温，这是内风。不是冬春外感的风温，陈氏不知道有伏气春温的病，强行引用论证，本来可以删除。然而病的内外虽然不同，证候属于温则一致。暂且保留它作为后学的比例参考。然而从此仔细参详，就知道风温是燥热之邪，燥令从金化，燥热归于阳明，所以肺胃是温邪必犯之地。并且可以悟到风温是燥热病，燥则伤阴，热则伤津，泄热和阴，又是风温病一定的治法，违背这个就是逆治了。因此我不辞僭越，而在仲景无文字处求文字，无治法处索治法，叙述证候施治，列为条例，知我罪我，大概就在这里吧？
王士雄按语：外感温病，仲圣虽然没有说，但叶氏已经详细论述了。
风温证，身热畏风，头痛咳嗽，口渴，脉浮数，舌苔白的，是邪在表。应当用薄荷、前胡、杏仁、桔梗、桑叶、川贝之类，凉解表邪。杨云：前胡、桔梗，一降一升，以宣泄肺邪。确实好，但桔梗宜少用。
自注：风属阳邪，不挟寒的叫风温。阳邪必伤阳络，所以头痛畏风；邪郁肌表，肺胃在内相应，所以咳嗽、口渴、苔白；邪留在表，所以脉浮数。表未解的应当先解表，但不像伤寒用麻黄、桂枝那样。
王士雄按语：何西池说：辨别痰的方法，古人以黄稠的为热，稀白的为寒，这只是说大概，不可拘泥。以外感来说，伤风咳嗽，痰随咳出，频数而多，颜色都是稀白，误作寒治，多导致困顿。大概是火盛壅逼，频咳频出，停留不久，所以未到黄稠的地步？等到火衰气平，咳嗽渐止，痰出来的，半天一口，反而黄而稠。因为火不上壅，痰得以久留，受其煎炼所致。所以黄稠的痰，火气尚缓而微；稀白的痰，火气反急而盛。这些都应当用辛凉解散，而不宜于温热，推之内伤也是如此。谁说稀白的痰，一定属于寒呢？总须临证细审，再参以脉象，自然可见。
风温证：身热，咳嗽，自汗，口渴，烦闷，脉数，舌苔微黄的，是热在肺胃。应当用川贝、牛蒡、桑皮、连翘、橘皮、竹叶之类，凉泄里热。
这是温邪内袭，肺热则咳嗽汗泄。胃热则口渴烦闷。苔白转黄，风从火化，所以以清泄肺胃为主。
王士雄按语：苔黄不甚干燥的，杨云：所以条文中说微黄，也体现了斟酌。治应当这样。如果黄而已经干燥，那么桑皮、橘皮，都嫌其燥，须换成瓜蒌、黄芩，才不至于转伤津液。
风温证：身灼热，口大渴，咳嗽烦闷，谵语如梦语，脉弦数，干呕的，这是热灼肺胃，风火内旋。应当用羚羊角、川贝、连翘、麦冬、石斛、青蒿、知母、花粉之类，以泄热和阴。
这是温邪袭入肺胃之络，灼烁阴津，引动木火，所以有烦渴呕逆等证，急宜泄去络中之热，才没有风火相煽，走窜包络的忧虑。
王士雄按语：咳嗽且闷，麦冬不可立即给予，嫌其滋腻。汪按：徐洄溪说麦冬能满肺气。不适合实嗽。认为是大渴吗？已有知母、花粉，足以胜任。木火上冲而干呕，那么青蒿虽清少阳，但嫌其升散。应去掉这两味，加上栀子、竹茹、枇杷叶，就妙了。杨云：议药极其细微，读者不可草草读过。
风温证：身热，咳嗽，口渴，下利，苔黄，谵语，胸痞，脉数，这是温邪由肺胃下注大肠。应当用黄芩、桔梗、煨葛根、豆卷、甘草、橘皮之类，以升泄温邪。
大肠与胃相连属，与肺相表里，温邪内逼，下注大肠则下利，治疗者宜清泄温邪，不必专门治利。按《伤寒论》：“下利谵语的，有燥屎，宜大承气汤”，这是实热内结，逼液下趋，必有舌燥苔黄刺，及腹满痛证兼见，故可下以逐热。若温邪下利，是风热内迫，虽有谵语一证，仍是无形之热，蕴蓄于中，而非实满之邪，盘结于内，故用葛根的升提，不用硝、黄的下逐。汪按：升提也不适用。
王士雄按语：伤寒为阴邪，未曾传腑化热，最虑邪气下陷，治必升提温散，而有早下的戒律。温热为阳邪，火必克金，所以先犯肺，火性炎上，难得下行。若肺气肃降有权，移其邪由腑出，正是病之去路，升提怎么可以妄投？杨云：小儿患疹，必下利，与此正同。所以温病多有发疹的，误用升提则邪入肺络，必喘吼而死？既然说：宜清泄其邪，不必专门治利了。况且有咳嗽胸痞的兼证，难道是葛根、豆卷、桔梗所适宜的么？应当换成黄连、桑叶、银花。须知利不因寒，润药也多可用。仲圣用猪肤、白蜜治温病下利，《寓意草》论肺热下利最详，学习者应用心研究。且伤寒与温热，邪虽不同，皆属无形之气。伤寒的有燥屎，并非是气结，乃寒邪化热，津液耗伤，糟粕炼成燥屎罢了。温热病的大便不通为易治的，因为脏热移腑，邪有下行之路，所谓腑气通则脏气安。设大便闭的，热烁胃津，日久又何尝没有燥屎宜下的证候呢？只是伤寒的大便不宜早解，所以必邪入于腑，始可下其燥屎。温热由肺及胃，虽不比疫证之下不嫌早，而喜其便通，宜用清凉，所以结成燥屎的较少耳。回忆嘉庆己卯年春，先父患温病而大便自利，那时，我们杭州的名医都宗奉陶节庵的书以治伤寒，不知道什么是温证，见其下利，都用柴胡、葛根升提，提而不应，有人说这是漏底证，渐渐投用温补，病日益加重，几乎不治了。父亲的朋友翁七丈，忘了他的字了。好像是“立贤”二字。推荐浦上的林先生来看诊，浦上人很年轻，诊毕，就说这是温证，恐怕是误作伤寒治，而多服温燥的药吗？幸好自利不止，热势尚有宣泄，否则早就成灰烬，哪等到今天呢？就用大剂犀角、石膏、银花、花粉、鲜生地、麦冬等药，嘱咐煎三大碗，放在榻前频频灌之。药未煎成之际，先榨蔗浆恣饮之。各位长辈见方，面面相觑不能决断，赖金履思丈力持煎其药，至一周时服完，病有起色，遂逐渐痊愈。当时（我）年仅十二岁，听其言而心记之，过了两年先父去世，（我）糊口远游，听说浦先生以善用清凉，被众人毁谤，于是从事于张景岳，而以温补著称。枉道徇人，可惜啊！（我）研究温热，实在是浦先生启发了我。浦先生现在还在，因为他远徙于乡，竟没空去质疑义理为恨，附记于此，聊表感仰之意罢了。
风温证：热久不愈，咳嗽，唇肿，口渴，胸闷，不知饥，身发白疹如寒粟状，自汗脉数的，这是风邪挟太阴脾湿，发为风疹。杨云：白疹乃肺胃湿热，与脾无关，也与风无关。用牛蒡、荆芥、防风、连翘、橘皮、甘草之类凉解。
风温本留肺胃，若太阴旧有伏湿者，风热之邪，与湿热相合，流连不解，日数虽多，仍留气分，由肌肉而外达皮毛，发为白疹。大概风邪与阳明营热相并，则发斑。与太阴湿邪相合，则发疹。又有病久中虚，气分大亏而发白疹的，必脉微弱而气倦怯，多成死候，不可不知。汪按：前说即白如水晶色的白疹，后说即白如枯骨的白疹。
王士雄按语：白疹即白疹，虽挟湿邪久不愈而从热化，且汗渴脉数，似非荆防可以再表，杨云：此湿也不必用橘皮的燥。宜换滑石、苇茎、通草，杨云：精当。这才符合凉解之法。若有虚象，当与甘药以滋气液。
风温证：身热，咳嗽，口渴，胸痞，头目胀大，面发泡疮的，风毒上壅阳络。应当用荆芥、薄荷、连翘、元参、牛蒡、马勃、青黛、银花之类，以清热散邪。
这就是世俗所谓的大头病，古人用三黄汤主治。但风热壅遏，致络气不宣，头肿如斗，终不如仿普济消毒饮之宣络涤热为佳。汪按：方附见九十五。
风温证：身大热，口大渴，目赤唇肿，气粗烦躁，舌绛齿板，痰咳，甚至神昏谵语，下利黄水的，风温热毒，深入阳明营分，最为危候。用犀角、连翘、葛根、元参、赤芍、丹皮、麦冬、紫草、川贝、人中黄，解毒提斑，间有生者。
杨云：葛根、麦冬都与证候不太对。
这是风温热毒，内壅肺胃，侵入营分，上下内外，充斥肆逆。若其毒不甚重，或气体壮实的，还可挽回，否则必坏。
风温毒邪，刚得病，就身热口渴，目赤咽痛，卧起不安，手足厥冷，泄泻，脉伏的，热毒内壅，络气阻遏。应当用升麻。杨云：凡涉及咽痛的，一用升麻，则邪入肺络，必喘吼而声如曳锯，陈氏想必没见过。黄芩、犀角、银花、甘草、豆卷之类，升散热毒。
这是风温毒之壅于阳明气分的，杨云：仍是肺病。即仲景所说的阳毒病，五日可治，七日不可治。乘其邪犯气分，未入营阴，故可升散而愈。
风温证：身热自汗，面赤神迷，身重难转侧，多眠睡，鼻鼾，语难出，脉数的，温邪内逼，阳明精液劫夺，神机不运。用石膏、知母、麦冬、半夏、竹叶、甘草之类，泄热救津。
鼻鼾、面赤，胃热极盛。人的阴气，根据胃为养，热邪内灼，胃液干枯，阴气复有何资，而能渗诸阳灌诸络，所以筋骨懈怠，机关失运，急用甘凉之品以清热濡津，或许有救。
王士雄按语：宜加西洋参、百合、竹沥。
风温证：身热痰咳，口渴神迷，手足抽搐，状若惊痫，脉弦数的，这是热劫津液，金囚木旺。应当用羚羊、川贝、青蒿、连翘、知母、麦冬、钩藤之类，以息风清热。
肺属金而畏火，赖胃津之濡养，以肃降令而溉百脉。热邪内盛，胃津被劫，肺失所资。木为火之母，子能令母
Wang Shixiong's commentary: This section and the following are traditionally attributed to Chen Pingbo and Xue Shengbai. However, it is difficult to verify this with certainty. For now, I shall follow common practice and list their surnames, awaiting correction from scholars of broad learning and elegance.
I have heard that exogenous diseases are not beyond the Six Evils (Liu Yin), yet illnesses among the people should be distinguished according to the Four Qi (seasonal climates). Physicians treating Shanghan (Cold Damage) merely adhere to established formulas for releasing the exterior and purging the interior, without considering the harm caused by acrid-hot or bitter-cold herbs. Consequently, the principles of Warm Diseases (Wen Bing) remain obscured and unclear; there is no greater deficiency in medical classics than this. Although I am unskilled, having read extensively and searched widely through records, I have suddenly realized that Warm Diseases must be studied. The *Neijing* states: "If one does not store essence during winter, one will inevitably contract a Warm Disease in spring." This means that during the severe cold of winter, Yang Qi is stored inward. If one can conform to the natural rhythm and maintain solidity, Kidney Qi will be充盈 (full) internally. Mingmen acts as an envoy for the Sanjiao (Triple Burner), thereby securing the Couli (pores) and protecting the skin and hair. Even when the spring season arrives—a time of rising and dispersing—my body's True Qi circulates internally and externally, preventing depletion due to this dispersal. Thus, even if external pathogens invade, how can they penetrate deeply? This explains the etiology of disease as elucidated in the *Neijing*. However, it mentions only failing to store essence in winter, neglecting other seasons, because winter is when Water Qi is prosperous, corresponding to the transformation of Northern Cold Water. In terms of seasons, it is winter; in terms of the human body, it corresponds to the Kidneys. Well water remains warm while thick ice forms; Yin is on the outside, Yang on the inside, embodying the meaning of the Kan hexagram. Therefore, emphasis is placed on winter, not implying that only winter requires storing essence while other seasons do not.
Wang Shixiong's commentary: Yu Jia Yan stated: "Diseases in spring and summer all originate in winter; diseases in autumn and winter all originate in summer. If one stores essence in summer, heat pathogens cannot invade, just as storing essence in winter prevents cold pathogens from entering. Thus, Zhu Danxi said that in summer, one must live alone and eat bland food to nourish the Metal (Lung) and Water (Kidney) organs, which serves as a model for health preservation. Even the phrase 'spring brings warm diseases' points proximally, indicating that those with internal deficiency have insecure exterior defenses, making them susceptible to all seasonal pathogens. Students may thus comprehend the pathogenic effects of the Six Qi across the four seasons."
Wang Shixiong's commentary: This discussion on why failing to store essence in winter leads to warm diseases in spring is very logical, but it fails to recognize Warm Diseases caused by latent pathogens (Fu Qi), which is its limitation. Chen's essay and Wu Jutong's *Tiaobian* are both merits of Ye Tianshi's school, yet *Youke Yaolüe* explicitly mentions latent warm-heat diseases, neither of which these two authors elaborated upon carefully. Is this not negligence? If even they were so, later scholars need not be mentioned. The *Nan Jing* states: "Shanghan encompasses five types: there is Shanghan..."
Wang Shixiong's commentary: Referring to Mahuang Tang syndrome. There is Zhongfeng...
Wang Shixiong's commentary: Referring to Guizhi Tang syndrome. There is Fengwen (Wind-Warmth)...
Wang Shiong's commentary: Referring to external contraction of Dongwen (Winter-Warmth) and Chunwen (Spring-Warmth). There is Rebing (Heat Disease)...
Wang Shixiong's commentary: This is Shubing (Summerheat Disease), also known as Shushi (Summerheat-Dampness). There is Shiwen (Damp-Warmth)...
Wang Shixiong's commentary: This refers to diseases caused by Summerheat combined with Dampness, also called Shi-Re (Damp-Heat). Unifying these Wind-Cold, Damp-Heat pathogens under the name Shanghan is because it was long recognized that when Cold injures the Zang organs, external pathogens enter. Thus, investigating the root, they are all called Shanghan.
Wang Shixiong's commentary: Zhang Zhongjing's original treatise had distinct treatment methods with strict boundaries. Later physicians failed to observe this, leading to confusion and frequent errors. I compile this specific treatise to clarify matters for students. However, in the Northwest, winds are high and soil dry, so Wind-Cold diseases are predominant.
Wang Shixiong's commentary: Not entirely so. In the Southeast, the land is low and waters damp; Damp-Heat injures people particularly severely. Historically, Wind-Cold injures the Form (Xing); injuries to form always enter from the exterior. Damp-Heat injures Qi; injuries to Qi do not necessarily enter from the exterior. Therefore, methods for treating Shanghan cannot be used for Warm Diseases. "Wen" means warmth or heat, incomparable to Cold. When Wind pathogens bind the exterior, it is called Fengwen. When Damp pathogens invade internally, it is called Shiwen. Even if slight Cold accompanies them, it differs from biting frost. Hence, releasing the exterior should use Acrid-Cool herbs, not Acrid-Hot. Clearing the interior should vent Heat, not purge Heat aggressively.
Wang Shixiong's commentary: There are cases where purging is appropriate, but differentiation of symptoms is essential. Generally, Wind without Cold becomes Wind-Fire. Although Damp may transform into Heat, it ultimately belongs to Yin pathogens.
Wang Shixiong's commentary: Damp is indeed a Yin pathogen, but if accompanied by Heat, it cannot be called Yin.
Since ancient times, Zhang Zhongjing's writings did not detail Warm Diseases, causing later generations to display their own skills without coherent structure. South of the Great River, Warm Diseases are more common than Cold Diseases.
Wang Shixiong's commentary: In northern provinces, Warm Diseases also outnumber Cold Diseases. Using methods like "releasing the exterior without avoiding Heat, purging the interior without avoiding Cold" has led to continuous deaths. How sad!
Wang Shixiong's commentary: Sections in this chapter not related to latent pathogens have been removed, preserving the valuable and discarding the flawed. The following follows this pattern.
Fengwen disease is most common in spring and winter. Some patients experience aversion to wind, others do not, but all present with fever, cough, and irritability with thirst. This constitutes the outline of Fengwen syndrome.
Self-note: In spring, Wind Qi dominates; in early winter, the air is warm and windy.
Wang Shixiong's commentary: Winter warmth leading to failure to store essence is not limited to early winter. Thus, Fengwen is common then. However, Wind is a Yang pathogen; Yang pathogens affect Yang levels, inevitably injuring Wei Qi. In the human body, the Lung governs Wei Qi. The Stomach is the root of Wei Qi. Therefore, when Fengwen presses externally, the Lung and Stomach respond internally. When Fengwen invades internally, the Lung and Stomach are diseased. Although the manifestation of Warm pathogens differs internally and externally, the Lung and Stomach share the same primary responsibility. Thus, aversion to wind is an occasional symptom, whereas fever, thirst, and cough are mandatory symptoms. Repeatedly studying Zhongjing's books, he mentions Warm Disease twice. First: "Taiyang disease, with fever and thirst but no aversion to cold, is Warm Disease." This merely distinguishes Shanghan from Warm Disease based on the absence of aversion to cold and presence of thirst, not specifically describing Fengwen.
Wang Shixiong's commentary: This refers to Spring-Warmth arising from latent pathogens, not the Wind-Warmth contracted in winter/spring. It says Taiyang disease because Taiyang is the exterior of Shaoyin. Second: "After sweating, if the body burns with heat, it is named Fengwen." The burning heat results from sweating, indicating the erroneous use of Acrid-Hot diaphoretics. Zhongjing reiterates: "In Fengwen, pulse is floating at both cun and chi positions, spontaneous sweating, heavy body, excessive sleepiness, snoring breath, and difficulty speaking. All these are post-error symptoms after sweating depletes fluids, not inherent symptoms of Warm Disease." He continues: "If treated with purgatives, eyes stare straight and incontinence occurs; if treated with fire therapy, jaundice develops; severely, it resembles convulsions; if smoked with fire, one error prolongs life, a second hastens death." These detail complications of purgation and fire therapy, not the original presentation of Fengwen.
Wang Shixiong's commentary: This describes Wind-Warmth resulting from extreme heat generating internal wind after erroneous sweating, hence called Fengwen (internal wind). It is not the external Wind-Warmth of winter/spring. Chen's ignorance of latent Spring-Warmth led him to force this citation, which could have been deleted. However, although internal and external diseases differ, both belong to Warmth. I retain it as a reference for students. Careful study reveals Fengwen is a Dry-Heat pathogen. Dryness transforms via Metal, Dry-Heat returns to Yangming. Thus, Lung and Stomach are the sites attacked by Warm pathogens. One can realize Fengwen is a Dry-Heat disease; Dryness injures Yin, Heat injures Fluids. Venting Heat and harmonizing Yin is the fixed treatment for Fengwen; opposing this is adverse. Therefore, I dare to overstep, seeking text where Zhongjing omitted it, seeking treatment where none existed, listing syndromes and treatments as regulations. Whether I am blamed or praised lies here.
Wang Shixiong's commentary: Although Zhongjing did not discuss exogenous Warm Diseases, Ye Tianshi detailed them.
Fengwen syndrome: Fever, aversion to wind, headache, cough, thirst, floating-rapid pulse, white tongue coating indicate pathogen at the exterior. Use Bohe (Mint), Qianhu (Peucedani Radix), Xingren (Apricot Seed), Jiegeng (Platycodon Root), Sangye (Mulberry Leaf), Chuanbei (Fritillaria Bulb) etc., to cool-release exterior pathogens. Yang noted: Qianhu and Jiegeng descend and ascend respectively to vent Lung pathogens. This is good, but Jiegeng should be used sparingly.
Self-note: Wind is a Yang pathogen; without Cold, it is Fengwen. Yang pathogens injure Yang collaterals, causing headache and aversion to wind; pathogens stagnate in muscle-surface, Lung-Stomach respond internally, causing cough, thirst, white coating; pathogens remain at exterior, causing floating-rapid pulse. If exterior is unresolved, release it first, but not using Mahuang (Ephedra) and Guizhi (Cinnamon Twig) as in Shanghan.
Wang Shixiong's commentary: He Xichi said: To differentiate phlegm, ancients considered yellow-thick as Heat and white-thin as Cold. This is general and should not be rigidly applied. Regarding exogenous diseases, Wind-Cold cough produces frequent, abundant, thin-white phlegm. Misdiagnosing as Cold causes distress. Likely, excessive Fire oppression causes frequent coughing and expulsion, leaving little time for phlegm to thicken. Later, as Fire subsides and cough stops, phlegm appears less frequently but becomes yellow and thick because it stays longer and is refined by residual heat. Thus, yellow-thick phlegm indicates slower, milder Fire; thin-white phlegm indicates urgent, vigorous Fire. Both require Acrid-Cool dispersal, not Warm-Hot herbs. This applies to internal injuries too. Who says thin-white phlegm must be Cold? One must examine closely clinically and correlate with pulse.
Fengwen syndrome: Fever, cough, spontaneous sweating, thirst, irritability, rapid pulse, slightly yellow tongue coating indicate Heat in Lung and Stomach. Use Chuanbei, Niubangzi (Arctii Fructus), Sangbaipi (Morus Bark), Lianqiao (Forsythia Fruit), Juapi (Tangerine Peel), Zhuye (Bamboo Leaf) etc., to cool-purge interior Heat.
This is internal invasion by Warm pathogens. Lung Heat causes cough and sweating; Stomach Heat causes thirst and irritability. Coating turns from white to yellow as Wind transforms into Fire. Treatment focuses on clearing Lung and Stomach.
Wang Shixiong's commentary: If coating is yellow but not dry, Yang noted the text specifies "slightly yellow" showing caution. Treatment should be as described. If yellow and already dry, Sangbaipi and Juapi are too drying; replace with Gualou (Trichosanthes Fruit) and Huangqin (Scutellaria Root) to avoid damaging fluids.
Fengwen syndrome: Burning fever, severe thirst, cough, irritability, delirious speech resembling dreams, wiry-rapid pulse, dry retching indicate Heat scorching Lung and Stomach, internal rotation of Wind-Fire. Use Lingyangjiao (Antelope Horn), Chuanbei, Lianqiao, Maidong (Ophiopogon Root), Shihu (Dendrobium Stem), Qinghao (Artemisia Annua), Zhimu (Anemarrhena Rhizome), Huafen (Trichosanthes Root) etc., to vent Heat and harmonize Yin.
This is Warm pathogens invading Lung-Stomach collaterals, scorching Yin fluids, stirring Wood-Fire. Symptoms include irritability, thirst, vomiting. Urgently vent collateral Heat to prevent Wind-Fire from fanning each other and disturbing the Pericardium.
Wang Shixiong's commentary: With cough and fullness, Maidong should not be given immediately due to its cloying nature. Wang noted: Xu Huxi said Maidong fills Lung Qi, unsuitable for excess cough. If severe thirst, Zhimu and Huafen suffice. For dry retching due to Wood-Fire rushing up, Qinghao clears Shaoyang but is ascending. Remove these two; add Zhizi (Gardenia Fruit), Zhuru (Bamboo Shavings), Pipaye (Loquat Leaf) for better effect. Yang noted: Medication analysis is extremely subtle; readers must not skim.
Fengwen syndrome: Fever, cough, thirst, diarrhea, yellow coating, delirium, chest stuffiness, rapid pulse indicate Warm pathogens descending from Lung/Stomach to Large Intestine. Use Huangqin, Jiegeng, Weige (Prepared Kudzu Root), Doujuan (Soybean Sprouts), Gancao (Licorice Root), Juapi etc., to ascend and vent Warm pathogens.
Large Intestine connects to Stomach and is exterior-interior with Lung. Internal pressure from Warm pathogens causes diarrhea. Treatment should clear Warm pathogens, not solely treat diarrhea. According to *Shanghan Lun*: "Diarrhea with delirium indicates dry feces; use Dachengqi Tang." This is excess Heat binding internally, forcing fluids downward, accompanied by dry tongue, yellow prickly coating, abdominal fullness/pain, allowing purgation to drive out Heat. If Warm pathogen causes diarrhea, it is internal pressure from Wind-Heat. Despite delirium, it is formless Heat accumulating internally, not solid accumulation. Thus, use Ge Gen's ascending action, not Xiaoshi (Mirabilite) or Dahuang (Rhubarb) for purging. Wang noted: Ascending is also inappropriate.
Wang Shixiong's commentary: Shanghan is Yin pathogen, rarely transforming to Heat in Fu organs; fear of pathogen sinking requires ascending/warming dispersion and warns against early purgation. Warm diseases are Yang pathogens; Fire conquers Metal, attacking Lung first. Fire flares upward, hard to descend. If Lung Qi descends properly, moving pathogens via Fu organs is the exit route; ascending herbs should not be used rashly. Yang noted: Children with rashes often have diarrhea, similar here. Thus, many Warm diseases present with rashes; erroneous ascending sends pathogen into Lung collaterals, causing wheezing death. Since it says clear/vent pathogens, not specifically treat diarrhea, and with cough/chest stuffiness, are Ge Gen, Doujuan, Jiegeng appropriate? Replace with Huanglian (Coptis Rhizome), Sangye, Yinhua (Honeysuckle Flower). Note: Diarrhea not due to Cold allows moistening herbs. Zhongjing used Zhufu (Swine Skin) and Bami (White Honey) for Warm disease diarrhea; *Yuyi Cao* details Lung Heat diarrhea thoroughly; students should study this. Although Shanghan and Warm diseases differ in pathogens, both involve formless Qi. Shanghan's dry feces result from Cold transforming to Heat, consuming fluids, refining waste—not Qi knotting. Warm disease constipation is easier to treat because organ Heat transfers to Fu, providing an exit; "Fu Qi free, Zang Qi safe." If constipated, prolonged Heat scorching Stomach fluids eventually creates dry feces requiring purgation. Shanghan forbids early purgation until pathogen enters Fu. Warm disease moves Lung to Stomach; unlike epidemics where early purgation is acceptable, it prefers bowel movement via cooling, so dry feces formation is rare. Recall Jiamao Spring of Jiaqing era, my father had Warm disease with spontaneous diarrhea. Hangzhou doctors followed Tao Jian'an's Shanghan methods, unaware of Warm disease. Seeing diarrhea, they used Chaihu and Ge Gen to ascend. When ineffective, some called it "leaky bottom," gradually adding Warm tonics, worsening condition. Father's friend, Uncle Weng (name forgotten, possibly Li Xian), recommended Mr. Pu from Pushang. Young, he diagnosed Warm disease, suspecting misdiagnosis as Shanghan led to excessive Warm-Hot drugs. Fortunately, persistent diarrhea allowed Heat to vent; otherwise, he would have perished. I prescribed large doses of Xijiao (Rhinoceros Horn - substitute with Shui Niu Jiao Buffalo Horn), Shigao (Gypsum), Yinhua, Huafen, Xianshengdi (Fresh Rehmannia Root), Maidong etc., decocted in three bowls, administered frequently. Before decoction finished, sugarcane juice was given freely. Elders hesitated, but Jin Lusiz insisted on brewing. After one week, condition improved, then recovered. I was twelve, memorized his words. Two years later, father died. I traveled for livelihood, hearing Mr. Pu was slandered for using Cooling, then switched to Zhang Jingyue's Warm Tonics. Regrettable! My study of Warm diseases was inspired by Mr. Pu. He lives in rural area; I regret not consulting him. Record this to express gratitude.
Fengwen syndrome: Prolonged fever, cough, swollen lips, thirst, chest fullness, loss of appetite, white rash like goosebumps, spontaneous sweating, rapid pulse indicate Wind pathogen combining with Taiyin Spleen Dampness, manifesting as Wind Rash. Yang noted: White rash is Lung-Stomach Damp-Heat, unrelated to Spleen or Wind. Use Niubangzi, Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Lianqiao, Juapi, Gancao etc., to cool-release.
Fengwen stays in Lung/Stomach. If Taiyin has latent Damp, Wind-Heat combines with Damp-Heat, lingering in Qi level, reaching skin from muscles, causing white rash. Wind combining with Yangming Ying Heat causes macules; combining with Taiyin Damp causes rash. Also, late-stage deficiency with Qi depletion causes white rash; weak pulse and fatigue indicate fatal prognosis. Wang noted: Former refers to crystal-clear white rash; latter to bone-dry white rash.
Wang Shixiong's commentary: White rash, though Damp-Heat persists and transforms to Heat, with sweating/thirst/rapid pulse, suggests Jingjie/Fangfeng are inappropriate for further releasing. Yang noted: Damp need not be treated with drying Juapi. Use Huashi (Talcum), Weijing (Reed Rhizome), Tongcao (Tetrapanax Pith) for precision, fitting Cool-Release method. If deficiency exists, use Sweet herbs to nourish Qi/Fluids.
Fengwen syndrome: Fever, cough, thirst, chest stuffiness, swollen head/eyes, facial pustules indicate Wind-Toxin obstructing Yang collaterals. Use Jingjie, Bohe, Lianqiao, Yuanshen (Polymnia Root), Niubangzi, Mabo (Amanita Mushroom), Qingdai (Indigo Naturalis), Yinhua etc., to clear Heat and scatter pathogens.
This is the popular "Big Head Disease." Ancients used Sanhuang Tang. But Wind-Heat obstruction blocks Collateral Qi, causing massive head swelling. Better to imitate Puji Xiaodu Yin to vent collaterals and wash out Heat. Wang noted: Formula attached to item 95.
Fengwen syndrome: High fever, severe thirst, red eyes, swollen lips, rough breathing, irritability, crimson tongue with stiff teeth, phlegm cough, even coma/delirium, yellow watery diarrhea indicate Wind-Warmth-Toxin penetrating Yangming Ying level, critical condition. Use Xijiao, Lianqiao, Ge Gen, Yuanshen, Chishao (Red Peony Root), Danpi (Moutan Bark), Maidong, Zicao (Arnebia Root), Chuanbei, Renzhonghuang (Human Waste Charcoal) to detoxify and raise macules; survival possible.
Yang noted: Ge Gen and Maidong do not match syndrome well.
This is Wind-Warmth-Toxin blocking Lung/Stomach, invading Ying level, filling upper/lower/internal/external. If toxin mild or constitution strong, recovery possible; otherwise, deterioration.
Wind-Warmth-Toxin initially presents with fever, thirst, red eyes, sore throat, restlessness, cold limbs, diarrhea, hidden pulse, indicating Heat-Toxin blocking internally, obstructing Collateral Qi. Use Shengma (Cimicifuga Rhizome). Yang noted: For sore throat, Shengma sends pathogen into Lung collaterals, causing wheezing death; Chen likely hasn't seen this. Huangqin, Xijiao, Yinhua, Gancao, Doujuan etc., ascend and vent Heat-Toxin.
This is Wind-Warmth-Toxin blocking Yangming Qi level. Yang noted: Still Lung disease. Equivalent to Zhongjing's Yangdu Disease. Treatable in 5 days, not 7. Exploit pathogen in Qi level before entering Ying/Yin, allowing ascending/dispersing cure.
Fengwen syndrome: Fever, spontaneous sweating, red face, mental confusion, heavy body difficult to turn, excessive sleepiness, snoring, difficulty speaking, rapid pulse indicate Warm pathogens pressing internally, Yangming Essence/Fluids depleted, Shen mechanism stagnant. Use Shigao, Zhimu, Maidong, Banxia (Pinellia Tuber), Zhuye, Gancao etc., to vent Heat and save fluids.
Snoring/red face indicate extreme Stomach Heat. Yin relies on Stomach for nourishment. Internal Heat scorches Stomach fluids dry; Yin lacks resources to irrigate Yang/Collaterals, causing muscle weakness and joint dysfunction. Urgently use Sweet-Cool herbs to clear Heat and moisten fluids for salvation.
Wang Shixiong's commentary: Add Xiyangshen (American Ginseng), Baihe (Lily Bulb), Zhuli (Bamboo Juice).
Fengwen syndrome: Fever, phlegm cough, thirst, mental confusion, limb spasms resembling convulsions, wiry-rapid pulse indicate Heat depleting fluids, Metal imprisoned, Wood flourishing. Use Lingyang, Chuanbei, Qinghao, Lianqiao, Zhimu, Maidong, Gouteng (Uncaria Ramulus) etc., to extinguish Wind and clear Heat.
Lung belongs to Metal, fears Fire, relies on Stomach fluids for descent and irrigation. Excess Heat consumes Stomach fluids, Lung loses support. Wood is Mother of Fire; Child makes Mother