脉紧而涩，（燥金主于收敛，其脉紧涩。）或浮而弦，或芤而虚。又脉弦风燥也。脉洪热燥也。脉缓土燥也。脉涩血
燥也。脉迟寒燥也。
雷少逸曰∶经谓冬伤于寒，春必病温，是训人有伏气之为病也。夫冬伤于寒，甚者即病，则为伤寒；微者即不病，
其气伏藏于肌肤，或伏藏于少阴，至春阳气开泄，忽因外邪乘之，触动伏气乃发。又不因外邪而触发者，偶亦有之。其
藏肌肤者，都是冬令劳苦动作汗出之人；其藏少阴者，都是冬不藏精肾脏内亏之辈。此即古人所谓最虚之处，便是容邪
之处。何刘松峰、陈平伯诸公，皆谓并无伏气？悖经之罪。其可逭乎？
又曰∶尝读介宾之书，谓温病即伤寒。又可之书，谓温病即瘟疫。殊不知伤寒乃感冬时之寒邪，瘟疫仍感天地之厉
气，较之伏气温病，大相径庭，岂可同日而语哉？推温病之原，究因冬受寒气，伏而不发，又化为热，必待来年春分之
后，天令温暖，阳气弛张，伏气自内而动，一达于外，表里皆热也。其证口渴引饮，不恶寒而恶热，脉形愈按愈盛者是
也。此病表无风寒，不宜辛散，切忌辛温辛凉之法。若误散之，则变证蜂起矣。如初起无汗者，只宜清凉透邪法；有汗
者，清热保津法；如脉象洪大而数，壮热谵语，此热在三焦也，宜以清凉荡热法；倘脉沉实，而有口渴谵语，舌苔干燥，
此热在胃腑也，宜用润下救津法。凡温病最戒辛温发汗，汗之则狂言脉躁，不可治也。然大热无汗则死；得汗后而反热，
脉躁盛者亦死；又有大热，脉反细小，手足逆冷者亦死；或见痉搐昏乱，脉来促结沉代者皆死。医者不可不知。
程曦曰∶推松峰与平伯，皆谓并无伏气，有由来也，一执《云笈七藏》冬伤于汗之句，一执钱氏冬伤寒水之脏之文。
殊不知两家只顾一面文章，全罔顾春伤、夏伤、秋伤之训作何等解。思二先生天资高迈，亦受其蒙，不正其讹，反助其
说，毋怪后之医者，统称暴感，恣用发散，羌、防、麻、桂，逼汗劫津，误人性命，固所不免，此不得不归咎于作俑之
人也。
陈莲舫曰∶汗出则腠理疏，寒邪即因汗而入，则仍是冬伤于寒也，何必改寒为汗哉？
《金鉴》曰∶《内经》言热病皆伤寒之类也，非谓类乎伤寒，乃谓与伤寒同乎一类之病也。盖伤寒因伤时令之寒而
得名也，温病热病亦随时而易其名耳。经曰∶冬伤于寒，则为病热。此实时而病者也。经曰∶冬伤于寒，春必病温。此
过时而病者也。经曰∶凡病伤寒而成温者，先夏至为病温，后夏至为病暑。暑即热之谓也，此随时而病者也。是则秋分
以前，皆得以热病名之；秋分以后，皆得以伤寒名之矣。此轩岐、仲景立伤寒、温病、热病之名义也。《经》又云∶藏
于精者，春不病温，此明过时不病之原也；经曰∶冬不藏精，春必病温。此明过时必病之故也。于此可知伤寒为病，不
在精之藏与不藏，而但有触犯即得为病，非若温病热病，藏精则不病，不藏精则必病也。但能藏精者，纵偶感于邪，或
温或暑，其病自轻；不藏精者，虽微感其邪，或温或暑，其病必重，差为稍异耳。若专以冬不藏精，毫无外感，为少阴
本病，热从内生，则悖仲景温病之旨矣。仲景论中，但言太阳初病，发热而渴，不恶寒者，为温病，辨其非伤寒，非谓
太阳之寒不由表入，竟从少阴之热内生为病也。
又曰∶所谓伏气之病，即四时令气正病，非四时不正之邪，与非常异气之疫邪也。所为伏气者，如感冬令之风寒，
其重者伤于营卫，实时而发者，名为中风、伤寒是也；其感之轻者，伏藏于肌肤，过时而发，名为温病是也。故时气伏
气之为病，二者不可不辨焉。
杨如侯曰∶仲景着《伤寒论》，提出温病与风寒鼎峙而立，实三大纲也。细玩仲景文法，已于伤寒中风之外，示人
以辨别温病之法。曰发热，是指明邪在肌肉也；曰不恶寒，是指明邪不在皮毛也；曰口渴，即是指明热自内发。因冬月
感寒不即病，至春变而为温，既变以后，寒已化热，不得复言为寒矣。仲景因自解之曰此为温病。凡是热由内发者，皆
以为温病三字括之矣。此温热之真面目，不由外至者也。就仲景文法细玩之，已将温病之来历露出，而其示人以异于伤
寒中风之处，皆在言外。
周禹载曰∶温病无阴阳之分，故病惟有阳而无阴，药必用寒而远热。
柯韵伯曰∶凡病伤寒而成温者，虽由于冬时之伤寒，而根实种于其人之郁火。
又曰∶肝胆为发温之源，阳明为成温之薮。
杨栗山曰∶风寒之邪，始中太阳者十八九；温病之邪，直行中道，而起阳明者十八九。
又曰∶伤寒自表传里，里证皆表证侵入于内也；温病由里达表，表证皆里证浮越于外也。又曰∶温病与伤寒，虽曰
不同，而或清或攻，后一节治法，原无大异；惟初病散表，前一节治法，则有天渊之别。
又曰∶伤寒一发汗，而外邪即解；温病一发汗，而里邪愈炽。麻、桂、青龙，用治伤寒，未有不生者；用治温病，
未有不死者。
脉象紧而涩，（这是因为燥金之气主收敛，所以脉象表现为紧涩。）或者浮而弦，或者芤而虚。另外，脉弦表示风燥；脉洪表示热燥；脉缓表示土燥；脉涩表示血燥；脉迟表示寒燥。
雷少逸说：经典记载“冬天感受寒邪，春天必定发生温病”，这是教导人们有伏气致病的情况。所谓冬天感受寒邪，严重的当时就发病，这就叫伤寒；轻微的当时不发病，寒气潜伏在肌肤之间，或者潜伏在少阴经，到了春天阳气开泄时，忽然因为外邪侵袭，触动伏藏的寒气而发作。也有不因为外邪触发而偶然发作的。潜伏在肌肤的，都是冬天劳累辛苦、动作出汗的人；潜伏在少阴经的，都是冬天没有藏精、肾脏内亏的人。这就是古人所说的最虚弱的地方，就是邪气容纳的地方。为什么刘松峰、陈平伯各位先生，都说并没有伏气？这是违背经典的大罪，难道可以逃脱吗？
又说：曾经读介宾的书，他说温病就是伤寒。又可的书，说温病就是瘟疫。殊不知伤寒是感受冬天的寒邪，瘟疫仍是感受天地的厉气，与伏气温病相比，大相径庭，怎么能相提并论呢？推究温病的根源，究其原因是冬天受了寒气，潜伏而不发作，后来化为热，必须等到来年春分之后，天气温暖，阳气弛张，伏气从内部发动，一旦达于体表，表里都发热。症状是口渴想喝水，不怕冷反而怕热，脉象越按越有力，就是这样。这种病体表没有风寒，不适合用辛散的方法，切忌使用辛温或辛凉的方法。如果误用发散法，那么变证就会蜂拥而起。比如初起无汗的，只宜用清凉透邪法；有汗的，用清热保津法；如果脉象洪大而数，高热说胡话，这是热在三焦，宜用清凉荡热法；倘若脉沉实，而有口渴说胡话，舌苔干燥，这是热在胃腑，宜用润下救津法。凡是温病最忌讳辛温发汗，发汗就会导致狂言乱语、脉象躁动，无法治疗。但是大热无汗则死；出汗后反而更热，脉象躁动的也死；又有大热，脉象反而细小，手脚逆冷的也死；或者出现抽搐昏迷，脉来急促、结代、沉伏的也都死。医生不可不知道这些。
程曦说：推究刘松峰和陈平伯，都说没有伏气，是有原因的，一个执着于《云笈七藏》中“冬天伤害于汗”的句子，一个执着于钱乙书中“冬天伤害寒水之脏”的文字。殊不知这两家只顾一面之词，完全不顾及春天受伤、夏天受伤、秋天受伤的教诲作何解释。思考这两位先生天资高超，也受其蒙蔽，不纠正其中的错误，反而助长他们的说法，难怪后来的医生，统称暴感，肆意使用发散药，羌活、防风、麻黄、桂枝，逼迫出汗劫夺津液，误人性命，固然在所难免，这不得不归咎于始作俑者。
陈莲舫说：出汗则腠理疏松，寒邪就顺着汗孔进入，那仍然是冬天伤害于寒，何必把寒改为汗呢？
《医宗金鉴》说：《内经》说热病都属于伤寒一类，不是说像伤寒，而是说与伤寒属于同一类疾病。大概伤寒是因为伤于时令的寒而得名，温病热病也是随着季节变化而改变名称罢了。经典说：冬天伤害于寒，就会得热病。这是随季节即时发病的。经典说：冬天伤害于寒，春天必定得温病。这是过时而发病的。经典说：凡是得伤寒而变成温病的，先夏至前得的是温病，后夏至得的是暑病。暑就是热的意思，这是随季节即时发病的。因此秋分以前，都可以称为热病；秋分以后，都可以称为伤寒了。这就是轩辕、岐伯、仲景确立伤寒、温病、热病名义的原因。《内经》又说：精气内藏的人，春天不得温病，这是说明不过时不发病的原因；经典说：冬天不藏精，春天必定得温病。这是说明过时必发病的缘故。从这里可知，伤寒致病，不在于精气的藏与不藏，只要有触犯就能得病，不像温病热病，藏精就不病，不藏精就必病。只要能藏精的人，即使偶尔感受邪气，无论是温还是暑，病情自然较轻；不能藏精的人，虽然轻微感受邪气，无论是温还是暑，病情必然严重，稍微有些不同罢了。如果专门认为冬天不藏精，毫无外感，是少阴本病，热从内生，那就违背了仲景温病的宗旨了。仲景论述中，只说太阳初病，发热而渴，不怕冷的，叫温病，辨别它不是伤寒，并不是说太阳的寒不由表入，竟然从少阴的热内生为病。
又说：所谓的伏气病，就是四时令气的正病，不是四时不正的邪气，也不是非常异气的疫邪。所谓伏气，比如感受冬天的风寒，重的伤害营卫，即时发作的，名叫中风、伤寒；轻的，潜伏在肌肤，过时而发的，名叫温病。所以时气和伏气致病，二者不可不分辨。
杨如侯说：仲景著《伤寒论》，提出温病与风寒鼎立而立，实际上是三大纲领。仔细玩味仲景的文法，已经在伤寒中风之外，告诉人们辨别温病的方法。说发热，是指明邪气在肌肉；说不恶寒，是指明邪气不在皮毛；说口渴，就是指明热从内部发出。因为冬天感受寒邪不立即发病，到春天变成温病，既然变了以后，寒已经化为热，不能再说是寒了。仲景因此自己解释说这叫温病。凡是热由内部发出的，都用温病这两个字概括了。这是温热病的真面目，不是从外部来的。就仲景的文法仔细玩味，已经将温病的来历透露出来，而他告诉人们不同于伤寒中风的地方，都在言外之意。
周禹载说：温病没有阴阳之分，所以病只有阳而无阴，用药必须用寒凉而远离温热。
柯韵伯说：凡是得伤寒而变成温病的，虽然由于冬天的伤寒，但根子实际上种在人的郁火之中。
杨栗山说：风寒邪气，开始中伤太阳经的占十分之八九；温病邪气，直接走中道，而起于阳明经的占十分之八九。
又说：伤寒从表传里，里证都是表证侵入内部；温病由里达表，表证都是里证浮越于外部。又说：温病与伤寒，虽然说不一样，但或者清解或者攻下，后一阶段的治法，原本没有太大差异；只是初病散表，前一阶段的治法，则有天壤之别。
又说：伤寒一发汗，外邪就解除了；温病一发汗，里邪更加炽盛。麻黄、桂枝、青龙汤，用来治疗伤寒，没有不活的；用来治疗温病，没有不死的。
The pulse is tight and choppy (this is because the Metal of Dryness governs contraction, hence the pulse appears tight and choppy), or floating and wiry, or hollow and deficient. Furthermore, a wiry pulse indicates Wind-Dryness; a surging pulse indicates Heat-Dryness; a slow pulse indicates Earth-Dryness; a choppy pulse indicates Blood-Dryness; a delayed pulse indicates Cold-Dryness.
Lei Shaoyi stated: The classics state "if one is injured by Cold in winter, one will inevitably suffer from Warmth diseases in spring," which teaches that there are latent pathogens causing illness. Regarding being injured by Cold in winter, if severe, it manifests immediately as Shanghan (Cold Damage); if mild, it does not manifest immediately. The pathogen lies dormant in the skin and muscles, or hides in the Shaoyin channel. When Yang Qi opens and dissipates in spring, an external pathogen may suddenly invade, stirring up the latent pathogen to cause disease. There are also rare cases where it is triggered without external invasion. Those with pathogens lying in the skin and muscles are those who labored and sweated during winter; those with pathogens hiding in the Shaoyin are those who failed to conserve essence and suffered internal kidney deficiency during winter. This is what the ancients meant when they said, "the most deficient place is where evil resides." Why did Liu Songfeng, Chen Pingbo, and other scholars claim there is no such thing as a latent pathogen? This is a crime against the classics; how can one escape this blame?
He further stated: I once read Jiebin's book, which claims that Warmth diseases are identical to Shanghan. Keyi's book claims that Warmth diseases are identical to Plagues. Little do they know that Shanghan results from contracting Cold pathogens in winter, while Plagues result from contracting pestilential Qi from heaven and earth. Compared to latent Warmth diseases, these are vastly different; how can they be compared? Tracing the origin of Warmth diseases, the root cause is contracting Cold in winter, which lies dormant and unmanifested, later transforming into Heat. It must wait until after the Spring Equinox, when the weather warms and Yang Qi expands, for the latent pathogen to move from within and reach the exterior, resulting in heat in both the interior and exterior. Symptoms include thirst with desire to drink, aversion to heat rather than cold, and a pulse that becomes stronger upon deep pressure. In this disease, there is no Wind-Cold on the exterior, so acrid-dispersing methods are unsuitable, and one must strictly avoid acrid-warm or acrid-cool methods. If dispersing methods are mistakenly used, complications will arise like swarms of insects. For example, if there is no sweating at the onset, only cooling methods to vent the pathogen should be used; if there is sweating, methods to clear heat and preserve fluids should be used. If the pulse is surging, large, and rapid, accompanied by high fever and delirium, this indicates Heat in the Sanjiao (Triple Burner), and cooling methods to purge heat should be employed. If the pulse is deep and solid, accompanied by thirst, delirium, and a dry tongue coating, this indicates Heat in the Stomach Fu organ, and moistening purgatives to save fluids should be used. Warmth diseases strictly prohibit acrid-warm diaphoresis; inducing sweat leads to delirious speech and a restless pulse, which is incurable. However, death occurs if there is high fever without sweat; death also occurs if fever worsens after sweating with a restless pulse; death occurs if there is high fever but the pulse is surprisingly fine and small with cold extremities; death also occurs if convulsions, coma, and confusion appear with a hurried, knotted, deep, or intermittent pulse. Physicians must know this.
Cheng Xi stated: Investigating why Liu Songfeng and Chen Pingbo claimed there is no latent pathogen, the reason lies in their adherence to specific texts. One clung to the phrase "winter injury due to sweat" in the *Yunji Qiqian*, and the other to Qian Yi's text regarding "winter injury to the Cold-Water organ." Little did they realize that both sides only considered one aspect, completely ignoring the teachings regarding injuries in spring, summer, and autumn. Although these two gentlemen possessed high intellectual capacity, they were misled. Instead of correcting these errors, they supported them. No wonder later physicians uniformly referred to these as sudden infections, recklessly using dispersing herbs such as Qianghuo, Fangfeng, Mahuang, and Guizhi to force sweat and deplete fluids, leading to fatal mistakes. This blame must fall on the originators of these theories.
Chen Lianfang stated: When one sweats, the pores open, allowing Cold pathogens to enter through the sweat; thus, it remains an injury by Cold in winter. Why change "Cold" to "Sweat"?
The *Jianzhong Jinjian* (Golden Mirror of Medicine) stated: The *Neijing* says that all Heat diseases belong to the category of Shanghan. This does not mean they are merely similar to Shanghan, but that they belong to the same category of disease. Shanghan gets its name from injuring the seasonal Cold. Warmth and Heat diseases also change their names according to the season. The classics state: "Injury by Cold in winter leads to Heat disease." This refers to illness occurring in season. The classics state: "Injury by Cold in winter leads to Warmth disease in spring." This refers to illness occurring out of season. The classics state: "For those who contract Shanghan and develop into Warmth, those before the Summer Solstice suffer from Warmth, and those after the Summer Solstice suffer from Shu (Summer Heat)." Shu means Heat. This refers to illness occurring in season. Therefore, before the Autumn Equinox, all can be named Heat diseases; after the Autumn Equinox, all can be named Shanghan. This is how Xuanyuan, Qibo, and Zhang Zhongjing established the definitions of Shanghan, Warmth, and Heat diseases. The classics further say: "Those who store Essence will not suffer from Warmth in spring," explaining the reason for not getting ill when out of season. The classics say: "Failure to store Essence in winter leads to Warmth disease in spring," explaining the reason for inevitable illness when out of season. From this, we know that Shanghan pathology depends not on whether Essence is stored or not, but simply on contact with the pathogen. Unlike Warmth/Heat diseases, where storing Essence prevents illness and failing to store it causes illness. Those who can store Essence, even if occasionally exposed to pathogens, whether Warmth or Summer Heat, will have milder illness; those who cannot store Essence, even with slight exposure, will have severe illness. The difference is slight. However, if one specifically argues that failure to store Essence in winter, without any external infection, constitutes a primary Shaoyin disease with internally generated Heat, this contradicts Zhang Zhongjing's principles on Warmth diseases. In his treatise, Zhongjing only states that initial Taiyang disease with fever, thirst, and aversion to cold is called Warmth disease, distinguishing it from Shanghan. He did not mean that Taiyang Cold does not enter from the exterior, nor that it arises solely from internally generated Heat in the Shaoyin.
He further stated: The so-called latent pathogen disease refers to the normal Qi of the four seasons, not the abnormal pathogens of the four seasons, nor the unusual pestilential pathogens. Regarding latent pathogens, for instance, if one contracts Winter Wind-Cold, the severe cases injure Ying and Wei and manifest immediately, named Fengzhong (Wind Strike) or Shanghan; the mild cases lie dormant in the skin and muscles and manifest later, named Warmth disease. Therefore, the distinction between seasonal Qi and latent pathogen diseases must not be overlooked.
Yang Ruhou stated: Zhang Zhongjing, in writing the *Shanghan Lun*, placed Warmth disease on equal footing with Wind and Cold, establishing three major categories. Carefully studying Zhongjing's textual style reveals methods to distinguish Warmth disease beyond Shanghan and Fengzhong. "Fever" indicates the pathogen is in the muscle layer; "aversion to cold is absent" indicates the pathogen is not in the skin and hair; "thirst" indicates Heat originating from within. Because Cold contracted in winter does not manifest immediately, but transforms into Warmth in spring, after transformation, the Cold has turned to Heat and can no longer be called Cold. Zhongjing explained this himself, calling it Warmth disease. Any Heat originating from within is encompassed by the term "Warmth disease." This is the true nature of Warmth-Heat diseases, which do not come from the exterior. A close study of Zhongjing's text reveals the origin of Warmth disease, while the distinctions from Shanghan and Fengzhong are implied.
Zhou Yuzai stated: Warmth diseases have no Yin-Yang differentiation; thus, the disease is purely Yang without Yin, and medications must be cold in nature, avoiding heat.
Ke Yunbo stated: For those who contract Shanghan and develop into Warmth, although it stems from winter Shanghan, the root actually lies in the person's stagnant Fire.
He further stated: The Liver and Gallbladder are the source of generating Warmth; the Yangming is the gathering place of forming Warmth.
Yang Lisshan stated: Eight or nine out of ten cases of Wind-Cold pathogens initially attack the Taiyang channel; eight or nine out of ten cases of Warmth pathogens travel directly through the central pathway and originate in the Yangming channel.
He further stated: Shanghan transmits from the exterior to the interior, so interior symptoms are exterior pathogens invading inward; Warmth disease moves from the interior to the exterior, so exterior symptoms are interior pathogens floating outward. He further stated: Although Warmth disease and Shanghan are different, the treatment methods in the latter stage (clearing or purging) are not significantly different; however, the treatment methods in the initial stage (dispersing the exterior) are worlds apart.
He further stated: In Shanghan, one dose of diaphoresis resolves the exterior pathogen; in Warmth disease, one dose of diaphoresis intensifies the interior pathogen. Mahuang Tang, Guizhi Tang, and Qinglong Tang, when used for Shanghan, never fail to save lives; when used for Warmth disease, they never fail to cause death.