冬时伏邪,郁伏至春夏,阳气内动,化热外达,此伏气所发之温病也。《内经》云∶冬伤于寒,春必病温。又云∶
凡病伤寒而成温者,先夏至日为病温,后夏至日为病暑。《难经》云∶伤寒有五,有温病,有热病。《伤寒论》云∶太阳
病,发热而渴,不恶寒者,为温病。凡此皆指伏邪所发之温病言也。另有一种风温之邪,当春夏间,感受温风,邪郁于
肺,咳嗽发热,甚则发为痧疹,《内经》所谓风淫于内,治以辛凉;叶氏《温热论》所谓温邪上受,首先犯肺者,皆指
此一种暴感风温而言也。伏气由内而发,治之者以清泄里热为主。其见证至繁且杂,须兼视六经形证,乃可随机立法。
暴感风温,其邪专在于肺,以辛凉清散为主。热重者兼用甘寒清化。其病与伏温病之表里出入,路径各殊,其治法之轻
重深浅,亦属迥异。近人专宗叶氏,将伏气发温之病置而不讲,每遇温邪,无论暴感伏气,概用叶氏辛凉轻浅之法,银
翘、桑菊,随手立方,医家病家,取其简便,无不乐从;设有以伏气之说进者,彼且视为异说,茫然不知伏温为何病,
嗟乎!伏温是外感中常有之病,南方尤多,非怪证也;其病载在《内经》、《难经》、《伤寒论》诸书,非异说也。临证者
竟至茫然莫辨,门径全无,医事尚堪问哉?
冬季潜伏的邪气,郁结伏藏直到春夏季节,体内阳气发动,化热向外发散,这是由伏气引发的温病。《黄帝内经》说:冬天感受寒邪,春天必定发生温病。又说:凡是患伤寒而转化为温病的,在夏至日之前发病的叫温病,在夏至日之后发病的叫暑病。《难经》说:伤寒有五种类型,包括温病和热病。《伤寒论》说:太阳病(太阳经受邪所致的病证),出现发热且口渴、不恶寒的症状,这就是温病。以上这些论述都是指由伏邪引发的温病而言。
另外还有一种风温邪气,在春夏之间,人体感受了温风,邪气郁结在肺脏,导致咳嗽发热,严重时甚至引发痧疹,《黄帝内经》所说的“风邪淫溢于内,用辛凉之法治疗”,以及叶天士《温热论》所说的“温邪从上部侵入,首先侵犯肺脏”,都是指这种突然感受的风温而言。伏气是从体内发出来的,治疗时以清泄里热为主。其临床表现非常繁杂,必须兼看六经(太阳、阳明、少阳、太阴、少阴、厥阴)的形证,才能随机确立治法。
突然感受的风温,邪气专门在于肺脏,治疗以辛凉清散为主。如果热势重者,兼用甘寒清热化浊之法。这种病的表里传变路径,与伏气温病的表里出入路径各不相同,其治疗的轻重深浅也截然不同。近代医生专门尊崇叶天士,将伏气引发的温病搁置不讲,每当遇到温邪,无论是暴感还是伏气,一概使用叶天士那种辛凉轻浅的方法,银翘散、桑菊饮等方剂随手开具,医生和患者都贪图简便,没有不乐意接受的;如果有提出伏气说法的人,他们反而视为异端学说,茫然不知伏温是什么病。唉!伏温是外感病中常见的疾病,南方尤其多见,并不是怪异的病症;它的记载存在于《黄帝内经》、《难经》、《伤寒论》等书中,并非异端学说。临证医生竟然到了茫然无法辨别、毫无门径的地步,医学事务还值得过问吗?
The pathogenic factors latent during winter, suppressed and hidden until spring and summer, are activated by the internal movement of Yang Qi, transforming into heat and reaching outward. This is the warm disease caused by latent Qi (latent pathogenic factor). The *Neijing* (Yellow Emperor's Inner Canon) states: "If one is injured by cold in winter, one will inevitably suffer from warm diseases in spring." It further states: "For those who contract Shaoyang disease and transform into warm diseases, if it occurs before the Summer Solstice, it is called a warm disease; if it occurs after the Summer Solstice, it is called a heat disease." The *Nanjing* (Classic of Difficult Issues) states: "Shaoyang disease encompasses five types, including warm diseases and heat diseases." The *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) states: "In Taiyang disease (a syndrome caused by pathogenic invasion of the Taiyang channel), characterized by fever, thirst, and aversion to cold being absent, this is a warm disease." All these references pertain to warm diseases triggered by latent pathogens.
There is another type of pathogen known as Wind-Warmth. During spring and summer, upon contracting warm winds, the pathogen becomes constrained within the Lung, leading to cough and fever, and in severe cases, manifesting as sand-rash (scarlatiniform rash). What the *Neijing* refers to as "when wind pathogen overflows internally, treat with pungent-cool methods," and what Ye Tianshi (Ye Gui) in his *Wenre Lun* (Treatise on Warm Heat) describes as "warm pathogens enter from above and first attack the Lung," both refer to this type of sudden contraction of Wind-Warmth. Latent Qi emerges from within; therefore, treatment primarily focuses on clearing and purging interior heat. Its clinical manifestations are numerous and complex, requiring simultaneous assessment of the patterns and symptoms of the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) to establish treatment strategies flexibly.
Sudden Wind-Warmth involves pathogens specifically located in the Lung; treatment primarily employs pungent-cool dispersing methods. If heat is severe, sweet-cool methods for clearing and resolving are added. The pathways of exterior-interior transmission in this condition differ significantly from those of latent warm diseases, and consequently, the depth and intensity of treatment are also distinctly different. In recent times, physicians have exclusively adhered to Ye Tianshi’s theories, neglecting the study of warm diseases caused by latent Qi. Whenever encountering warm pathogens, regardless of whether they are suddenly contracted or latent, they uniformly apply Ye Tianshi’s mild and superficial pungent-cool methods, prescribing formulas such as Yinqiao San (Honeysuckle and Forsythia Powder) and Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction) at will. Physicians and patients alike favor this convenience, readily accepting it. However, if anyone proposes the theory of latent Qi, they dismiss it as heterodox, remaining ignorant of what latent warm disease entails. Alas! Latent warm disease is a common external contraction ailment, particularly prevalent in the southern regions, not an aberrant condition. Its records exist in classics such as the *Neijing*, *Nanjing*, and *Shanghan Lun*, not constituting heterodoxy. Yet, clinicians find themselves completely bewildered, lacking any diagnostic approach. How can medical practice be considered competent under such circumstances?