春温一症，由冬令收藏未固，昔人以冬寒内伏，藏于少阴，入春发于少阳，以春木内应肝胆也。寒邪深伏，已经化
热，昔贤以黄芩汤为主方，苦寒直清里热。热伏于阴，苦味坚阴，乃正治也，知温邪忌散，不与暴感门同法。若因外邪
先受，引动在里伏热，必先辛凉以解新邪，继进苦寒以清里热。
春温病有两种∶冬受寒邪不即病，至春而伏气化热外发者，名曰春温，若春令太热，外受时邪而病者，此感而即发
之春温也。辨症之法∶伏气春温，初起但热不寒而口渴，此自内而发出于外也；感而即发之春温，初起微寒，后则但热
不寒，此外犯肺卫者也。
附时人陆平一语:
五气皆有新感、伏邪，惟寒邪独化热而出，余邪皆仍本气发出，此为异耳。
俞东扶曰∶今之所谓伤寒者，大概皆温热病耳。仲景云∶太阳病，发热而渴，不恶寒者，为温病。在太阳已现热象，
则麻、桂二汤必不可用，与伤寒迥别。《内经》云∶热病者，皆伤寒之类也。是指诸凡骤热之病，当从伤寒例观。二说
似乎不同，因审其义，盖不同者在太阳，其余则无不同也。温热病只究三焦，不讲六经，此是妄言。仲景之六经，百病
不出其范围，岂以伤寒之类，反与伤寒截然两途乎？叶案云∶温邪吸自口鼻。此亦未确，仲景明云伏气之发，李明之、
王安道俱言冬伤于寒，伏邪自内而发，奈何以吴又可《温疫论》牵混耶？惟伤寒则足经为主，温热则手经病多。如风温
之咳嗽息鼾，热病之神昏谵语，或溏泻粘垢，皆手太阴肺，手厥阴心包络，手阳明大肠现证。甚者喉肿肢掣，昏蒙如醉，
躁扰不宁，齿焦舌燥，发斑发颐等症。其邪分布充斥，无复六经可考，故不以六经法治耳。就予生平所验，初时兼挟表
邪者最多，仍宜发散，如防、葛、豉、薄、牛蒡、杏仁、滑石、连翘等，以得汗为病轻，无汗为病重。如有斑，则参入
蝉蜕、桔梗、芦根、西河柳之类；如有痰，则参入土贝、僵蚕、栝蒌、橘红之类；如现阳明证，则白虎承气（生石膏、
大黄、知母、甘草、鲜荷叶、芒硝）；少阳证，则小柴胡（柴胡、半夏、人参、甘草、黄芩、生姜、大枣）去参、半，
加花粉，知母，〔璜按少阳证因于温暑者，雷少逸清营捍疟法（连翘、竹叶、扁豆衣、青蒿、木贼、黄芩、青皮、西瓜
翠衣）较稳；〕少阴证，则黄连阿胶汤（黄连、茯苓、阿胶）、猪苓汤（猪苓、茯苓、泽泻、滑石、阿胶）、猪肤汤〔猪
肤、白粉（即粉锡，一名铅粉）、白蜜〕；俱宗仲景六经成法有效。但温热病之三阴证多死，不比伤寒。盖冬不藏精者，
东垣所谓肾水内竭，孰为滋养也。惟大剂养阴，佐以清热，或可救之。养阴如二地、二冬、阿胶、丹皮、玄参、人乳、
蔗浆、梨汁；清热如三黄（黄连、黄芩、大黄）、石膏、犀角、大青、知母、芦根、茅根、金汁、雪水、西瓜、银花露、
丝瓜汁，随其对证者选用。若三阴经之温药，与温热病非宜。亦间有用真武（附子、白术、茯苓、白芍、生姜）、理中
（白术、人参、干姜、甘草）者，百中之一二而已。大抵温热病最怕发热不退，及痉厥昏蒙。更有无端而发晕，及神清
而忽间以狂言者，往往变生不测。遇此等症，最能惑人，不比阳证阴脉，阳缩舌卷，撮空见鬼者，易烛其危也。要诀在
辨明虚实，辨得真，方可下手。然必非刘河间、吴又可之法所能救，平素精研仲景《伤寒论》者，庶有妙旨。至如叶案
之论温热，有邪传心包，震动君主，神明欲迷，弥漫之邪，攻之不解，清窍既蒙，络内亦闭，豁痰降火无效者，用局方
至宝丹（犀屑、玳瑁屑、琥珀、朱砂、雄黄、龙脑、麝香、牛黄、安息香、银箔、金箔）、或紫雪（黄金、寒水石、石
膏、滑石、磁石、犀角、羚羊、沉香、木香、升麻、玄参、公丁香、甘草、朴硝、硝石、麝香、辰砂）、或牛黄丸（牛
黄、黄连、大黄、麦冬、朱砂、麝香、栀子、牙硝、川芎、黄芩、甘草），宗喻氏芳香逐秽宣窍之说，真足超越前贤，
且不蹈用重药者一匙偶误、覆水难收之弊也。
璜按俞氏此论，确切不移。其间有云无端发晕，神清而忽间以狂言者，往往变生不测，因此症神气半明半昧，察其
舌色淡红而近紫，苔甚薄，或无苔，死期每在五日之间，余于临证见之屡矣。此症在西医，为延髓神经被细菌所侵害也。
春温这一病症，是由于冬季收藏功能不固所致。古人认为，冬寒之邪内伏，藏于少阴经，到了春季发作时显现于少阳经，这是因为春季的木气在体内对应肝胆的缘故。寒邪深伏体内，已经转化为热邪，所以前代贤人将黄芩汤作为主要方剂，用苦寒之药直接清泄体内的热邪。热邪潜伏在阴分，苦味药物能够坚固阴液，这是正治之法。要知道，温邪忌用发散法，其治疗方法与突然感受外邪的病证不同。如果是先受了外邪，进而引动体内潜伏的热邪，那么必须先使用辛凉的药物来解除新感的外邪，随后再用苦寒的药物来清泄体内的热邪。
春温病有两种类型：冬天感受寒邪而没有立即发病，等到春天伏邪化热向外发散的，称为春温；如果春季气候过于炎热，人体感受当时的邪气而发病的，这种是感邪后立即发作的春温。辨别症状的方法如下：伏气引起的春温，初起时只有发热而没有恶寒，并且口渴，这是病邪从内部发出并向外透达的表现；感邪即发的春温，初起时有轻微的恶寒，随后则只有发热而没有恶寒，这是外邪侵犯肺卫的表现。
附当时人陆平一的话：
五气（风、寒、暑、湿、燥）都有新感和伏邪的区别，只有寒邪独自会化热而出，其余邪气都是保持本来的性质发出，这就是它们的不同之处。
俞东扶说：现在所谓的伤寒病，大概都是温热病罢了。张仲景说：“太阳病，出现发热且口渴，不恶寒的，就是温病。”既然在太阳经阶段就已经表现出热象，那么麻黄汤和桂枝汤这两个方剂就绝对不可使用，这与伤寒病截然不同。《内经》说：“热病，都属于伤寒的范畴。”这是指凡是突然发生的发热性疾病，都应当参照伤寒的法则来观察。这两种说法似乎不同，但仔细推敲其含义，其实不同的地方仅在于太阳经阶段，其余方面并没有不同。认为温热病只研究三焦，不讲六经，这是荒谬的言论。张仲景提出的六经辨证，百种疾病都不出其范围，难道因为属于伤寒类，反而要与伤寒截然分成两途吗？叶天士医案中说：“温邪从口鼻吸入。”这也不准确，张仲景明确说过伏气的发作，李东垣、王履也都说是冬天伤了寒邪，伏邪从内部发出，怎么能把吴又可的《温疫论》混为一谈呢？只有伤寒病以足经病变为主，温热病则以手经病变居多。比如风温病的咳嗽、呼吸有声，热病的神志昏迷、胡言乱语，或者腹泻粘腻污秽，这些都是手太阴肺经、手厥阴心包络、手阳明大肠经现出的证候。严重的会出现咽喉肿痛、肢体抽搐、神志昏蒙像喝醉了一样、烦躁不安、牙齿焦黑、舌苔干燥、皮肤发斑、腮部肿胀等症状。此时邪气分布充斥全身，不再能按照六经的规律来考证，所以不用六经的方法来治疗罢了。根据我生平的经验，初起时兼夹表邪的情况最多，仍然适宜使用发散法，如防风、葛根、豆豉、薄荷、牛蒡子、杏仁、滑石、连翘等药，以出汗为病情减轻的标志，无汗则为病情严重。如果出现发斑，则加入蝉蜕、桔梗、芦根、西河柳等药；如果有痰，则加入土贝母、僵蚕、瓜蒌、橘红等药；如果现出阳明证，则用白虎承气汤（生石膏、大黄、知母、甘草、鲜荷叶、芒硝）；如果现出少阳证，则用小柴胡汤（柴胡、半夏、人参、甘草、黄芩、生姜、大枣），去掉人参、半夏，加入天花粉、知母；[璜按：少阳证因于温暑者，雷少逸的清营捍疟法（连翘、竹叶、扁豆衣、青蒿、木贼、黄芩、青皮、西瓜翠衣）较为稳妥；]如果现出少阴证，则用黄连阿胶汤（黄连、茯苓、阿胶）、猪苓汤（猪苓、茯苓、泽泻、滑石、阿胶）、猪肤汤[猪肤、白粉（即粉锡，一名铅粉）、白蜜]；这些都遵循张仲景六经成法，往往有效。但是温热病的三阴证大多致死，不像伤寒那样。这是因为冬天没有藏精的人，正如李东垣所说肾水在内枯竭，谁来滋养呢？只有用大剂量的养阴药，佐以清热药，或许可以挽救。养阴药如生地、熟地、天冬、麦冬、阿胶、丹皮、玄参、人乳、蔗浆、梨汁；清热药如三黄（黄连、黄芩、大黄）、石膏、犀角、大青叶、知母、芦根、白茅根、金汁、雪水、西瓜、银花露、丝瓜汁，根据具体证候选用。至于三阴经使用的温性药物，并不适合温热病。也偶尔有用真武汤（附子、白术、茯苓、白芍、生姜）、理中汤（白术、人参、干姜、甘草）的情况，但百中只有一二而已。大体上，温热病最怕的是发热不退，以及发生痉厥、神志昏蒙。更有无缘无故突然头晕，以及神志清醒却忽然夹杂胡言乱语的，往往变化产生不可测知的后果。遇到这类病症，最能迷惑医生，不像阳证见阴脉、阳气衰微、舌头卷缩、撮空理线、看见鬼魂等症，容易洞察其危险。关键诀窍在于辨明虚实，辨别得真切，才可以下手治疗。然而，这绝不是刘完素、吴又可的方法所能救治的，只有平时精心钻研张仲景《伤寒论》的人，才可能有精妙的领悟。至于像叶天士医案中论述温热病，有邪气传入心包，震动君主之官，神明将要迷乱，弥漫的邪气，攻伐不能解除，清窍既已蒙蔽，络脉内部也闭塞，豁痰降火无效时，使用局方至宝丹（犀角屑、玳瑁屑、琥珀、朱砂、雄黄、龙脑、麝香、牛黄、安息香、银箔、金箔），或紫雪（黄金、寒水石、石膏、滑石、磁石、犀角、羚羊角、沉香、木香、升麻、玄参、公丁香、甘草、朴硝、硝石、麝香、辰砂），或牛黄丸（牛黄、黄连、大黄、麦冬、朱砂、麝香、栀子、牙硝、川芎、黄芩、甘草），遵循喻嘉言芳香逐秽宣窍的理论，确实足以超越前贤，而且不犯使用重药时一旦误用、覆水难收的弊端。
璜按：俞氏的这番论述，确切不移。其中提到无缘无故头晕，神志清醒却忽然夹杂胡言乱语的，往往变化产生不可测知的后果，因为这种病症神气半明半昧，观察其舌色淡红而近紫色，苔很薄，或者无苔，死亡日期通常在五天之内，我在临证中见过很多次了。此症在西医看来，是延髓神经被细菌侵害所致。
Chunwen (Spring-Warmth Disease) is a condition caused by the failure of storage during winter. Ancient practitioners believed that cold pathogenic factors from winter lie latent within, hiding in the Shaoyin (Lesser Yang) channel, and manifest in the Shaoyang (Lesser Yang) channel when spring arrives, because the Wood energy of spring corresponds internally to the Liver and Gallbladder. The cold pathogen lies deep and has transformed into heat; therefore, former sages used Huangqin Tang (Scutellaria Decoction) as the principal formula, employing bitter-cold herbs to directly clear internal heat. Heat lying latent in the Yin aspect is strengthened in its Yin nature by bitter flavors, which constitutes the orthodox treatment. It must be understood that warm pathogens are contraindicated for dispersing methods, and their treatment differs from that of sudden external infections. If an external pathogen is contracted first, thereby stirring up latent internal heat, one must first use acrid-cool herbs to resolve the new external pathogen, followed by bitter-cold herbs to clear the internal heat.
There are two types of Chunwen disease: One type occurs when cold pathogenic factors are contracted in winter but do not cause immediate illness; instead, the latent pathogen transforms into heat and manifests externally in spring; this is named Chunwen. The other type occurs when the spring climate is excessively hot, and the body contracts seasonal pathogens leading to illness; this is Chunwen that manifests immediately upon contraction. The method for distinguishing symptoms is as follows: For Chunwen caused by latent qi, the initial stage presents with fever without chills and thirst, indicating the pathogen originates from within and moves outward. For Chunwen that manifests immediately upon contraction, the initial stage presents with slight chills, followed by fever without chills, indicating the pathogen attacks the Lung and Defensive-Wei levels from outside.
Attached quote from Lu Pingyi of the time:
The five qi (Wind, Cold, Summer-Heat, Dampness, Dryness) all have distinctions between new contraction and latent pathogen; only the Cold pathogen uniquely transforms into heat to emerge, while the other pathogens emerge retaining their original nature; this is the difference.
Yu Dongfu stated: What is currently referred to as Shanghan (Cold Damage) is generally Warm-Heat disease. Zhang Zhongjing said: "Taiyang disease presenting with fever, thirst, and aversion to cold absent, is Wenbing (Warm Disease)." Since heat signs appear already at the Taiyang stage, the formulas Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) absolutely cannot be used, which is distinctly different from Shanghan. The *Neijing* states: "All heat diseases belong to the category of Shanghan." This refers to observing any acute febrile disease according to the principles of Shanghan. These two statements seem different, but upon examining their meaning, the difference lies only in the Taiyang stage; otherwise, there is no difference. To claim that Warm-Heat disease only investigates the Sanjiao (Triple Burner) and does not discuss the Six Channels is absurd talk. Zhang Zhongjing's Six Channels encompass all hundred diseases; how could diseases belonging to the Shanghan category be completely separated into two distinct paths? Ye Tianshi's medical cases state: "Warm pathogens enter through the mouth and nose." This is also inaccurate. Zhang Zhongjing clearly stated that the manifestation of latent qi comes from within, as did Li Dongyuan and Wang Andao, who both said that injury to cold in winter causes latent pathogens to emerge from within. How can Wu Keyi's *Wenyi Lun* (Treatise on Pestilential Qi) be mixed in? Only Shanghan disease primarily involves the Foot meridians, whereas Warm-Heat disease frequently involves the Hand meridians. For example, coughing and stertorous breathing in Fengwen (Wind-Warmth), or coma and delirium in Rebing (Heat Disease), or loose stools with sticky filth, are manifestations of the Hand-Taiyin Lung Meridian, Hand-Jueyin Pericardium Meridian, and Hand-Yangming Large Intestine Meridian. In severe cases, symptoms include sore throat, limb convulsions, confusion resembling drunkenness, restlessness, scorched teeth, dry tongue, skin eruptions, and mumps-like swelling. At this point, the pathogen is distributed and filling the body, no longer traceable by the Six Channels, hence the Six Channel treatment method is not applied. Based on my lifelong experience, cases initially complicated by exterior pathogens are most common, and dispersing methods are still appropriate, using herbs such as Fangfeng (Saposhnikovia Root), Gegen (Kudzu Root), Chidou (Fermented Soybean), Bohe (Mint), Niubangzi (Arctium Fruit), Xingren (Apricot Seed), Huashi (Talcum), and Lianqiao (Forsythia). Sweating indicates mild disease, while absence of sweating indicates severe disease. If skin eruptions appear, add Chantui (Cicada Slough), Jiegeng (Platycodon Root), Lugeng (Reed Rhizome), and Xihe Liu (Tamarisk Branch); if phlegm is present, add Tubei (Fritillaria Bulb), Jiangcan (Silkworm), Gualou (Trichosanthes Fruit), and Juhong (Aged Tangerine Peel); if Yangming syndrome appears, use Baihu Chengqi Tang (Shigypsum, Dahuang, Zhimu, Gancao, Fresh Lotus Leaf, Mangxiao); if Shaoyang syndrome appears, use Xiaochaihu Tang (Chaihu, Banxia, Renshen, Gancao, Huangqin, Shengjiang, Dazao), removing Renshen and Banxia, and adding Huafen (Trichosanthes Root) and Zhimu; [Huang notes: For Shaoyang syndrome due to Warmth and Summer-Heat, Lei Shaoyi's Qingying Hanmie Fa (Lianqiao, Zhuye, Biandouyi, Qinghao, Muzei, Huangqin, Qingpi, Xiguacuiyi) is more stable;] if Shaoyin syndrome appears, use Huanglian Ejiao Tang (Huanglian, Fuling, Ejiao), Zhu Ling Tang (Zhuling, Fuling, Zexie, Huashi, Ejiao), or Zhufu Tang [Zhufu, Baifen (Stannum Oxide, also known as Lead Powder), Baimi]; all follow Zhang Zhongjing's established Six Channel methods and are effective. However, Shaoyin (Three Yin) syndromes in Warm-Heat disease often result in death, unlike Shanghan. This is because those who failed to store essence in winter suffer from exhaustion of Kidney Water internally, as described by Li Dongyuan; who then provides nourishment? Only large doses of Yin-nourishing herbs, assisted by heat-clearing herbs, may save them. Yin-nourishing herbs include Dihuang (Rehmannia Root), Donghua (Asparagus Root), Ejiao, Danpi (Moutan Bark), Xuanshen (Scrophularia Root), Renru (Human Milk), Zheshuang (Sugarcane Juice), Lizhi (Pear Juice); heat-clearing herbs include Sanhuang (Huanglian, Huangqin, Dahuang), Shigypsum, Xijiao (Rhinoceros Horn), Daqingye (Isatis Leaf), Zhimu, Lugeng, Maogen (Imperata Rhizome), Jinzhi (Gold Filtrate), Xueshui (Snow Water), Xigua (Watermelon), Yinhualu (Honeysuckle Dew), Sigua Zhi (Luffa Juice), selected according to the specific syndrome. Warm-tonifying herbs for the Three Yin channels are not suitable for Warm-Heat disease. Occasionally, Zhenwu Tang (Fuzi, Baizhu, Fuling, Baishao, Shengjiang) or Lizhong Tang (Baizhu, Renshen, Ganjiang, Gancao) are used, but this happens in only one or two out of a hundred cases. Generally, Warm-Heat disease fears most persistent fever, as well as spasms, convulsions, and mental confusion. There are also cases of unprovoked dizziness, or lucidity interrupted by sudden delirium, where changes often become unpredictable. Such conditions are most confusing to physicians, unlike Yang syndromes with Yin pulses, retraction of genitals, curling of the tongue, grasping at empty air, or seeing ghosts, which make the danger easier to discern. The key principle lies in distinguishing deficiency from excess; only when the diagnosis is precise can treatment begin. However, this cannot be cured by the methods of Liu Hejian or Wu Keyi; only those who have meticulously studied Zhang Zhongjing's *Shanghan Lun* will grasp the profound insights. Regarding Ye Tianshi's discussion of Warm-Heat disease, when pathogens transmit to the Pericardium, disturbing the Sovereign Mind, causing near-confusion of spirit, and diffuse pathogens resist attack, clearing orifices remain blocked, collaterals close internally, and phlegm-resolving and fire-reducing methods fail, one should use Ju Fang Zhibao Dan (Xijiao, Dai Mao, Hupo, Zhusha, Xionghuang, Longnao, Shexiang, Niuhuang, Anshixiang, Yinpiao, Jinping), or Zixue (Huangjin, Hanshuishi, Shigypsum, Huashi, Cishi, Xijiao, Lingyangjiao, Chenxiang, Muxiang, Shengma, Xuanshen, Gongdingxiang, Gancao, Puxiao, Xiaoshi, Shexiang, Chensha), or Niuhuang Wan (Niuhuang, Huanglian, Dahuang, Maidong, Zhusha, Shexiang, Zhizi, Yaxiao, Chuanxiong, Huangqin, Gancao), following Yu Jiayou's theory of aromatic purification to expel turbidity and open orifices. This truly surpasses former sages and avoids the弊 (drawback) of using heavy medicines where a single spoonful error leads to irreparable consequences.
Huang notes: Yu's argument is accurate and unshakable. Among these, he mentions unprovoked dizziness and lucidity interrupted by sudden delirium, where changes often become unpredictable. Because in this condition, the spirit is half-lucid and half-obscure, observing the tongue color as pale red approaching purple, with very thin coating or no coating, the time of death usually falls within five days. I have witnessed this repeatedly in clinical practice. In Western medicine, this condition is attributed to bacterial invasion of the medulla oblongata nerves.