《温热辨惑。自序》说：“余弱冠时雅好方术，初读《伤寒论》，无所得，废然而返。后得天士鞠通之书，喜其清浅入时，以为道在是。越十年，从恽师铁樵氏受业，乃知误入歧途。”章氏认为：在外感热病学方面，当时派别歧出，人自为说，唯陆九芝“于温热病，说理纯正，独排众异，伤寒温病，真理未泯，赖有此书。”但由于紫色夺朱，初学不能辨，而人又每先入为主，致“入此同样之魔道者不知几千万人，顾如吾知误而返者不知几何人。”有慨于此，故他力辟叶、吴学说之谬，阐明陆氏学说之理，“为后世辟榛莽启坦途。”这就是《温热辨惑》的撰作动机。
二、学术渊源
继明末吴又可著《温疫论》，顾景文撰《温证论治》，叶派学说，影响日广，人多不宗仲景之学。吴氏认为《伤寒论》为外感风寒而设，但伤寒稀有，故屠龙之艺虽成而无所施，及其临证，就只好指鹿为马。《温病条辨》中也多次谈到；《伤寒论》专为伤寒而设，此仅六气中之一气，其余五气，概未之及，故以伤寒之法，疗六气之疴，是御风以絺，指鹿为马，殆试而辄困。《伤寒大白》则认为伤寒唯北方冬月有之，江浙东南，患此绝少。按照这种观点，《伤寒论》已无甚大用，这是最为明白不过的了。陆九芝、恽铁樵等人，从维护仲景学说出发，对此大有异议，他们以温热学派中影响最大的叶氏学说为重点，进行了猛烈抨击，乃造成伤寒学派与温热学派的激烈争鸣，余波迄今未绝。章氏从学于恽铁樵，恽氏遵循陆九芝之学，故《温热辨惑》之学术渊源，与《世补斋医书》、《温病明理》，一脉相承。它与祝味菊之《伤寒质难》、谢诵穆之《温病论衡》、张山雷之《湿温病古今医案平议》，以及孔蔼如之《鞠通发挥》，《孟英问难》等，同是研究该派学术思想之重要著作。
三、全书概况
《温热辨惑》近6万字，文笔犀利，措词激烈，是一本极力攻排叶、吴之学的专著。书共上、中、下、附四篇。上篇为病理总论，分“温病之歧途邪说”，“温病之真际定义”，“温病之发热原理”，“温病之病理定名”等四章。中篇为诊断概要，分“温病之主病证候”，“温病之兼见证候”，“温病之特殊证候”，“温病之脉舌证候”等四章。下篇为方剂汇说，分“解表剂”，“清热剂”，“和解剂”，“攻下剂”，“化湿剂”，“清暑剂”，“清补剂”，“温中剂”等八类。附篇为温病治案举例，共载医案十三则，“聊示治疗与理论相印证”。书面由恽铁樵题签。书首有恽氏及陆渊雷所作之序和作者自序。现上海曙光医院图书馆等有藏本。
四、内容特点
章氏认为《世补斋医书》中驳斥叶氏之学的几个篇章，最为精惊，他曾想将这几个篇章单独抽出重印，命名为《世补斋精华集》，但未果。他说：“自叶天士、吴鞠通之书流传于后世，晚近时医，伤寒温病几于不能分别，一例以豆豉、豆卷、石斛、冬桑叶、甘菊花等药，应付一切热病，举国皆然，浸成一派，推崇天士者，谓可以配享仲景，奉鞠通之《温病条辨》，若天书秘宝，三焦之说盛行，六经之旨遂废，天土鞠通始作俑，王孟英章虚谷之徒，复从而铺张扬厉，致造成今日医学晦盲否塞之现状。”他还说陆氏痛诋叶吴之后，仍不迷途知返的时医，是江湖庸伧。从此可见，章氏对叶吴学说的抨击，不略逊于陆九芝、恽铁樵，张山雷诸家。采撷陆恽诸氏之说，加以发挥，猛烈抨击叶吴之学，这可以说就是《温热辨惑》内容之一大特点。
五，论点举隅
1·伏气发温为臆造之说：章氏之时，喻嘉言，叶天士两派之学最为流行，而伏气发温之说详自喻氏，章氏认为：“自此说行，温热病遂有魔障”，故他通过裁剪方星岩、刘松年、恽铁樵诸家之说来驳斥伏气发温之论，认为“冬伤于寒，春必病温”，乃是“冬不藏精，春必病温”之互词，捏造伏气发温说，只能为“温病多一条歧路”。
2·清轻疗法不足愈大病：章氏认为喻氏伏气说虽谬，但用药却不轻泛，麻、桂、附、辛、芩、连、膏、黄、习见应用，时医不敢学步。而叶派清轻之法，成则可以居功，败则可以卸过，社会懵懂，不能审辨，时医觅食，甚觉方便，所以“叶派之说尤为流行。”但实则清轻疗法，只能医治小小感冒，轻证肺胀之类，陆九芝对此详有论述，故章氏在书中不嫌行文笨重，大段节录，以表明自己“清轻疗法不足故大病”的论点。
3·温病本隶于伤寒论中：章氏说：“温热病皆从伤寒来，伤寒是病之初，温热是病之既”，“昧者不知此旨，以为风与寒是《伤寒论》中病，而于温热病谓不可用《伤寒论》中方，将温病剔出于《伤寒论》之外，另为之著书立论，谓仲景书详于治寒，略于治温，不见论中有芩，连、膏、黄之方，怪诞荒谬，莫此为甚。”章氏继承了恽氏关于温病分为伤寒系温病与非伤寒系温病的说法，将非伤寒系温病归纳为五种，并认为伤寒系之温病即伤寒之阳明病，而这六种温病，统隶于广义伤寒之中，仲景书是论广义伤寒之书，故“论温而跳出伤寒范围，即是歧途。”
4·寒邪为六种温病病原：章氏说温热病之分目，见于《温病条辨》者有九，他举了几个例予来诘难和讥笑吴鞠通，说他“自条白辨，还是辨不清楚”。对《温病条辨》中伤寒六经由表入卫，须横看，温病三焦由上及下，须竖看等说法，认为：“简直是神昏詀语”。按章氏意见，从病型以推究病理，从病理以归纳病名，温病不过六种，此六种温病，俱因伤寒邪而得，所不同者，伤寒系之温病，寒邪先伤太阳，逗留于太阳若干日，然后化燥内传入阳明。非伤寒系之温病，寒邪一开始就迳入阳明(书中对寒邪迳入阳明的病理，有详细解释)，所以对柯韵伯提出的“阳明为成温之薮”的论点，同陆九芝等人一样，也是十分的赞赏，认为；“直捷痛快说温热病即阳明证，可以解决许多缴绕问题。”
5·温病下不嫌早说难从：章氏认为不论伤寒、温病，“用下药总须有下证”，若有下证，当下，下之无不获效，若“下之而不通，则下法有未当也。原文屡下不通，然后知有夹邪，治病何得如此荒谬，殆迷信温病下不嫌早之说，轻率从事，以下法试病，幸而屡下未坏，尚有再审夹邪之余地，是岂医法耶。”总之，夹邪下不能通，体虚下不能通等“皆当于事先顾及”若事先不顾及，贸然用下，下之不通，然后知“气虚而屡下不通者，血虚而屡下不通者云云，皆不通之论。”所以章氏说：“伤寒下不嫌迟，温病下不嫌早之说，不可迷信。”
6，治方以大论要略为宗：章氏崇尚仲景学说，认为《伤寒论》中硝、黄、芩、连，栀、膏等，均是为温病设。故主张：“温病应用方剂，当以大论要略为宗。”章氏这一主张，不是墨守成规、守株待兔，也不是固步自封、拒绝新知，这从下述二点，可以得到佐证：(一)反对滥用经方：章氏认为温病初起，用药须辛凉解表，“不宜麻、桂，故《温病条辨》第一方取桂枝汤，荒诞不径。”(二)主张博览广采：章氏对叶、吴之学攻排虽烈，但认为；“其说虽谬，其方间有可取，银翘、桑菊饮二方，于春初风温证，亦有用处。”又说：“三仁汤实为湿热正治之方剂，吴鞠通制此方可以采用。”因为“病变无常，或有不足应付者，仍当博考渚书，不能株守于此也。”
六、结尾简评
1·观点有可取：《温热辨惑》认为温病本隶于广义伤寒之中，《伤寒论》不是只论狭义伤寒之书；以及用下药须以下证为据，不可先有“温病下不嫌早”说横梗胸中等观点，是完全符合客观事实的。认为：“冬伤于寒，春必病温”是“冬不藏精，春必病温”之互词，清轻疗法不足以愈大病，寒邪为六种温病病原等观点，虽是一派之见，但只要我们摒弃门户之见，实亦可备一格，以供研究外感热病之参考。
2·措词常欠酌，满清以降，在寒温之争中，对立双方，措词都相当严厉。《温热辨惑》之攻排叶派，也是如此，这难免使得叶派中人，相当的反感。在学术论争中，不论对古人对今人，观点不同各方，都应心平气和，不宜动感情(如愤慨、痛恨、鄙薄等)，因为学术上的谦虚，并不意味着示弱，这确是值得我们加以注意的。从这一角度看，《温热辨惑》中有些措词，确乎欠酌。本文在此提及这一点，目的是期为今后鉴，余此心之良苦，祈识者鉴之。
卷二叶吴学说驳议
《温热论》扬稗
时逸人认为：《温热论》的优点固应继承发扬，但缺点也不能忽略。笔者完全赞同这一观点。但历来之注《温热论》者，出于对叶氏的崇拜，大多是宁为曲释，讳谈瑕疵，极少直率地指出其中之缺点。实则禾稗不辨，流弊无穷，贻误后世，为害不小。基此认识，现作“《温热论》扬稗”如次。
《温热论》开宗明义就提出了“温邪上受，首先犯肺”之说，吴鞠通又宏其义而敷扬之，谓：“凡病温者，始于上焦，在手太阴。”嗣后这一论点就为该派所公认，并成为当今之通论，如作为全国统一教材的《温病学》①，释“首先犯肺”条之义说；“本条为论证温病证治的总纲。条文首先概述温病的发生发展机理，”但众所周知，叶氏之《温热论》，至少是统风温、湿温二者而言。吴氏之所谓温热病，则有风温、温热、温疫、温毒，暑温、湿温，秋燥、冬温，温疟等九种之多。从现代医学病名来看，叶吴之所谓温病，只少包括了下列一些疾病；“流感”，“脑炎”、“肠伤寒”、肺炎、猩红热，中暑、疟疾，“黄疸肝炎”、腮腺炎、痢疾等。此外，流行性出血热，钩喘螺旋体病等，一般也认为属于叶吴所说之温病范畴。按照“南方无真伤寒，都是温热”的说法，叶吴之所谓温热病，包括甚广。然上述疾病，除了“流感”等少数呼吸器病是首先犯肺外，象“乙脑”，“黄疸肝炎”，“肠伤寒”、“出血热”等。根本就不是首先犯肺的。谢诵穆认为温病大体可分为肺系温病与胃系温病二大类，而“温邪上受，首先犯肺，逆传心包，此十二字者……仅为犯肺温病之纲领，决不能包括湿温等胃系温病，以肺系温病之纲领，兼统胃系之温病，谚所谓张冠李戴，泾谓不分也。”祝味菊也说：《温热论》“风行一时，深入人心，以盲引盲，贻误滋多”，“吾人就该篇而论，允宜明辨其瑕瑜而不可盲从也。”余谓《温热论》之不可盲从，“首先犯肺”说，最为第一。我们如震摄于天士威名，唯随众喧喝，人云亦云，对此不明辨其是非，竟把它当作为温病初起之普遍规律看，就难免会用治肺之方药，去治与肺无关之热病，这样，能不贻误病机亦几稀矣！又安可望在初起阶段即收截断逆转之效哉！若外感热病果真都是“温邪上受，首先犯肺”，则“或透风于热外；或渗湿于热下。不与热相搏，势必孤矣。”是病不应再加重，何以会“辛凉散风，甘淡驱湿，若病仍不解，是渐欲入营”？原因不外二个：一是病本不关肺而以治肺方药治之，无的放矢，二是杯水车薪，病重药轻，所以主观上希望风与热相离，病即向愈，而客观上从卫入气，入营入血，仍然步步加重。说明叶氏治温病，亦常事与愿违，惟彼不自知，故仍以“首先犯肺”立说以诲人。惜乎被王孟英等奉为圭臬之《温热论》，竟开首即错，此客观之事实，无庸为贤者讳。故吾人治外感热病，“不得以首先犯肺，以印定后人眼目，”否则必有“理论与实际脱节的舛误”，“如外感初起，并无呼吸器的症状，一概认为在手太阴，未免无的放矢。”②时逸人的这些说法，无疑是正确的。
【背景信息】
书名：热病衡正 章节：正文(10/49) 类别：伤寒
《温热辨惑·自序》中说：“我二十岁时，一向喜好医术方技，起初阅读《伤寒论》，一无所获，失望而归。后来得到鞠通（吴鞠通）的著作，喜欢它清浅易懂、切合时宜，认为医道就在其中。过了十年，跟随恽铁樵老师学习，才知道自己误入了歧途。”章氏认为：在外感热病学方面，当时派别众多，各持己见，只有陆九芝“对于温热病，说理纯正，独排众异，伤寒与温病的真理没有泯灭，全靠这本书。”但由于紫色混淆了朱色（比喻以假乱真），初学者不能辨别，而人们又往往先入为主，导致“陷入同样迷途的人不知有几千万人，但像我这样知道错误而回头的人不知有多少。”对此感到感慨，所以他极力驳斥叶天士、吴鞠通学说的谬误，阐明陆九芝学说的道理，“为后世开辟荒径，开启坦途。”这就是撰写《温热辨惑》的动机。
二、学术渊源
继明末吴又可著《温疫论》，顾景文撰《温证论治》之后，叶天士一派的学说影响日益扩大，人们大多不再尊崇张仲景的学问。吴又可认为《伤寒论》是为外感风寒而设的，但伤寒罕见，所以虽然掌握了屠龙之技却无处施展，等到临证时，只好指鹿为马。《温病条辨》中也多次谈到：《伤寒论》专门针对伤寒而设，这仅仅是六气中的一种气，其余五气一概未涉及，所以用治疗伤寒的方法去治疗六气引起的疾病，就像穿着细葛布衣服去防风，指鹿为马，尝试后必然困顿。《伤寒大白》则认为伤寒只在北方冬季有，江浙东南地区患此病极少。按照这种观点，《伤寒论》已无太大用处，这是再明白不过的了。陆九芝、恽铁樵等人，从维护张仲景学说出发，对此大有异议，他们以温热学派中影响最大的叶天士学说为重点，进行了猛烈抨击，从而造成了伤寒学派与温热学派的激烈争鸣，余波至今未绝。章氏师从恽铁樵，恽氏遵循陆九芝的学问，因此《温热辨惑》的学术渊源，与《世补斋医书》、《温病明理》一脉相承。它与祝味菊的《伤寒质难》、谢诵穆的《温病论衡》、张山雷的《湿温病古今医案平议》，以及孔蔼如的《鞠通发挥》、《孟英问难》等，都是研究该派学术思想的重要著作。
三、全书概况
《温热辨惑》近6万字，文笔犀利，措词激烈，是一本极力攻讦排斥叶天士、吴鞠通学说的专著。全书共分上、中、下、附四篇。上篇为病理总论，分“温病之歧途邪说”、“温病之真际定义”、“温病之发热原理”、“温病之病理定名”等四章。中篇为诊断概要，分“温病之主病证候”、“温病之兼见证候”、“温病之特殊证候”、“温病之脉舌证候”等四章。下篇为方剂汇说，分“解表剂”、“清热剂”、“和解剂”、“攻下剂”、“化湿剂”、“清暑剂”、“清补剂”、“温中剂”等八类。附篇为温病治案举例，共载医案十三则，“聊示治疗与理论相印证”。封面由恽铁樵题签。书首有恽氏及陆渊雷所作的序和作者自序。现上海曙光医院图书馆等有藏本。
四、内容特点
章氏认为《世补斋医书》中驳斥叶天士学说的几个篇章最为精警，他曾想将这些篇章单独抽出重印，命名为《世补斋精华集》，但未果。他说：“自从叶天士、吴鞠通的书籍流传于后世，近代时医，伤寒与温病几乎无法区分，一律用豆豉、豆卷、石斛、冬桑叶、甘菊花等药物来应付一切热病，举国皆然，逐渐形成一派，推崇叶天士的人，认为可以配享张仲景的地位，奉吴鞠通的《温病条辨》为天书秘宝，三焦之说盛行，六经的宗旨遂被废弃，叶天士、吴鞠通始作俑者，王孟英、章虚谷之流，又加以铺张扬厉，导致造成今日医学晦盲否塞的现状。”他还说，陆九芝痛斥叶天士、吴鞠通之后，仍不迷途知返的时医，是江湖庸医。从此可见，章氏对叶吴学说的抨击，不亚于陆九芝、恽铁樵、张山雷诸家。采撷陆九芝、恽铁樵等人的学说，加以发挥，猛烈抨击叶吴之学，这可以说就是《温热辨惑》内容的一大特点。
五、论点举隅
1. 伏气发温为臆造之说：章氏之时，喻嘉言、叶天士两派之学最为流行，而伏气发温之说详细出自喻氏，章氏认为：“自从此说流行，温热病遂有了魔障”，所以他通过裁剪方星岩、刘松年、恽铁樵诸家的说法来驳斥伏气发温之论，认为“冬伤于寒，春必病温”，乃是“冬不藏精，春必病温”的互词，捏造伏气发温说，只能为“温病多一条歧路”。
2. 清轻疗法不足愈大病：章氏认为喻氏伏气说虽谬，但用药却不轻泛，麻黄、桂枝、附子、细辛、黄芩、黄连、石膏、大黄等，习见应用，时医不敢学步。而叶派清轻之法，成功则可以居功，失败则可以卸过，社会懵懂，不能审辨，时医觅食，甚觉方便，所以“叶派之说尤为流行。”但实则清轻疗法，只能医治小小感冒，轻证肺胀之类，陆九芝对此详有论述，故章氏在书中不嫌行文笨重，大段节录，以表明自己“清轻疗法不足以治愈大病”的论点。
3. 温病本隶于伤寒论中：章氏说：“温热病皆从伤寒来，伤寒是病之初，温热是病之既”，“愚昧者不知此旨，以为风与寒是《伤寒论》中的病，而对于温热病谓不可用《伤寒论》中的方，将温病剔出于《伤寒论》之外，另为之著书立论，谓仲景书详于治寒，略于治温，不见论中有黄芩、黄连、石膏、大黄的方，怪诞荒谬，莫此为甚。”章氏继承了恽铁樵关于温病分为伤寒系温病与非伤寒系温病的说法，将非伤寒系温病归纳为五种，并认为伤寒系之温病即伤寒之阳明病，而这六种温病，统隶于广义伤寒之中，仲景书是论广义伤寒之书，故“论温而跳出伤寒范围，即是歧途。”
4. 寒邪为六种温病病原：章氏说温热病之分目，见于《温病条辨》者有九，他举了几个例子来诘难和讥笑吴鞠通，说他“自条白辨，还是辨不清楚”。对《温病条辨》中伤寒六经由表入卫，须横看，温病三焦由上及下，须竖看等说法，认为：“简直是神昏谵语”。按章氏意见，从病型以推究病理，从病理以归纳病名，温病不过六种，此六种温病，俱因伤寒邪而得，所不同者，伤寒系之温病，寒邪先伤太阳，逗留于太阳若干日，然后化燥内传入阳明。非伤寒系之温病，寒邪一开始就迳入阳明（书中对寒邪迳入阳明的病理，有详细解释），所以对柯韵伯提出的“阳明为成温之薮”的论点，同陆九芝等人一样，也是十分的赞赏，认为：“直捷痛快说温热病即阳明证，可以解决许多缠绕问题。”
5. 温病下不嫌早说难从：章氏认为不论伤寒、温病，“用下药总须有下证”，若有下证，当下，下之无不获效，若“下之而不通，则下法有未当也。原文屡下不通，然后知有夹邪，治病何得如此荒谬，殆迷信温病下不嫌早之说，轻率从事，以下法试病，幸而屡下未坏，尚有再审夹邪之余地，是岂医法耶。”总之，夹邪下不能通，体虚下不能通等“皆当于事先顾及”若事先不顾及，贸然用下，下之不通，然后知“气虚而屡下不通者，血虚而屡下不通者云云，皆不通之论。”所以章氏说：“伤寒下不嫌迟，温病下不嫌早之说，不可迷信。”
6. 治方以大论要略为宗：章氏崇尚仲景学说，认为《伤寒论》中硝石、大黄、黄芩、黄连、栀子、石膏等，均是为温病设。故主张：“温病应用方剂，当以大论要略为宗。”章氏这一主张，不是墨守成规、守株待兔，也不是固步自封、拒绝新知，这从下述二点，可以得到佐证：(一)反对滥用经方：章氏认为温病初起，用药须辛凉解表，“不宜麻黄、桂枝，故《温病条辨》第一方取桂枝汤，荒诞不经。”(二)主张博览广采：章氏对叶、吴之学攻排虽烈，但认为：“其说虽谬，其方间有可取，银翘散、桑菊饮二方，于春初风温证，亦有用处。”又说：“三仁汤实为湿热正治之方剂，吴鞠通制此方可以采用。”因为“病变无常，或有不足应付者，仍当博考诸书，不能株守于此也。”
六、结尾简评
1. 观点有可取：《温热辨惑》认为温病本隶于广义伤寒之中，《伤寒论》不是只论狭义伤寒之书；以及用下药须以下证为据，不可先有“温病下不嫌早”说横梗胸中等观点，是完全符合客观事实的。认为：“冬伤于寒，春必病温”是“冬不藏精，春必病温”之互词，清轻疗法不足以愈大病，寒邪为六种温病病原等观点，虽是一派之见，但只要我们摒弃门户之见，实亦可备一格，以供研究外感热病之参考。
2. 措词常欠酌，满清以降，在寒温之争中，对立双方，措词都相当严厉。《温热辨惑》之攻排叶派，也是如此，这难免使得叶派中人，相当的反感。在学术论争中，不论对古人对今人，观点不同各方，都应心平气和，不宜动感情（如愤慨、痛恨、鄙薄等），因为学术上的谦虚，并不意味着示弱，这确是值得我们加以注意的。从这一角度看，《温热辨惑》中有些措词，确乎欠酌。本文在此提及这一点，目的是期为今后鉴，余此心之良苦，祈识者鉴之。
卷二叶吴学说驳议
《温热论》扬稗
时逸人认为：《温热论》的优点固应继承发扬，但缺点也不能忽略。笔者完全赞同这一观点。但历来之注《温热论》者，出于对叶氏的崇拜，大多是宁为曲释，讳谈瑕疵，极少直率地指出其中之缺点。实则禾稗不辨，流弊无穷，贻误后世，为害不小。基此认识，现作“《温热论》扬稗”如次。
《温热论》开宗明义就提出了“温邪上受，首先犯肺”之说，吴鞠通又宏其义而敷扬之，谓：“凡病温者，始于上焦，在手太阴。”嗣后这一论点就为该派所公认，并成为当今之通论，如作为全国统一教材的《温病学》，释“首先犯肺”条之义说：“本条为论证温病证治的总纲。条文首先概述温病的发生发展机理，”但众所周知，叶氏之《温热论》，至少是统风温、湿温二者而言。吴氏之所谓温热病，则有风温、温热、温疫、温毒，暑温、湿温，秋燥、冬温，温疟等九种之多。从现代医学病名来看，叶吴之所谓温病，至少包括了下列一些疾病：“流感”，“脑炎”、“肠伤寒”、肺炎、猩红热，中暑、疟疾，“黄疸肝炎”、腮腺炎、痢疾等。此外，流行性出血热，钩端螺旋体病等，一般也认为属于叶吴所说之温病范畴。按照“南方无真伤寒，都是温热”的说法，叶吴之所谓温热病，包括甚广。然上述疾病，除了“流感”等少数呼吸器病是首先犯肺外，象“乙脑”，“黄疸肝炎”，“肠伤寒”、“出血热”等。根本就不是首先犯肺的。谢诵穆认为温病大体可分为肺系温病与胃系温病二大类，而“温邪上受，首先犯肺，逆传心包，此十二字者……仅为犯肺温病之纲领，决不能包括湿温等胃系温病，以肺系温病之纲领，兼统胃系之温病，谚所谓张冠李戴，泾渭不分也。”祝味菊也说：《温热论》“风行一时，深入人心，以盲引盲，贻误滋多”，“吾人就该篇而论，允宜明辨其瑕瑜而不可盲从也。”余谓《温热论》之不可盲从，“首先犯肺”说，最为第一。我们如震摄于天士威名，唯随众喧喝，人云亦云，对此不明辨其是非，竟把它当作为温病初起之普遍规律看，就难免会用治肺之方药，去治与肺无关之热病，这样，能不贻误病机亦几稀矣！又安可望在初起阶段即收截断逆转之效哉！若外感热病果真都是“温邪上受，首先犯肺”，则“或透风于热外；或渗湿于热下。不与热相搏，势必孤矣。”是病不应再加重，何以会“辛凉散风，甘淡驱湿，若病仍不解，是渐欲入营”？原因不外二个：一是病本不关肺而以治肺方药治之，无的放矢，二是杯水车薪，病重药轻，所以主观上希望风与热相离，病即向愈，而客观上从卫入气，入营入血，仍然步步加重。说明叶氏治温病，亦常事与愿违，惟彼不自知，故仍以“首先犯肺”立说以诲人。惜乎被王孟英等奉为圭臬之《温热论》，竟开首即错，此客观之事实，无庸为贤者讳。故吾人治外感热病，“不得以首先犯肺，以印定后人眼目，”否则必有“理论与实际脱节的舛误”，“如外感初起，并无呼吸器的症状，一概认为在手太阴，未免无的放矢。”②时逸人的这些说法，无疑是正确的。
[Background Information]
Book Title: Re Bing Heng Zheng (Standardization of Heat Disease) Chapter: Main Text (10/49) Category: Shang Han (Cold Damage)
In the "Self-Introduction" of *Re Wen Bian Huo* (Clarifying Doubts on Warm Diseases), it is stated: "When I was in my twenties, I had a strong interest in medical arts and techniques. Initially, I read the *Shang Han Lun* (Treatise on Cold Damage) but gained nothing from it, returning in disappointment. Later, I obtained the works of Ju Tong (Wu Jutong). I appreciated their clarity, simplicity, and relevance to the times, believing that the Way of medicine lay therein. Ten years later, while studying under Master Yun Tieqiao, I realized I had strayed onto a wrong path." Mr. Zhang believes that in the field of external contraction heat diseases, there were numerous divergent schools at the time, each with its own theories. Only Lu Jiuzhi "provided sound reasoning for warm diseases, stood alone against diverse opinions, and preserved the truth of both Shang Han and Wen Bing through this book." However, because purple can confuse vermilion (a metaphor for confusing false with true), beginners cannot distinguish them, and people often have preconceived notions, leading to "tens of millions falling into the same delusion, while the number of those who realize their error and return, like myself, is unknown." Moved by this, he vigorously refuted the fallacies of Ye Tianshi and Wu Jutong's theories, elucidated the principles of Lu Jiuzhi's school, and "cleared the wilderness and opened a smooth path for future generations." This was the motivation for writing *Re Wen Bian Huo*.
II. Academic Origins
Following Wu Keyi's *Wen Yi Lun* (Treatise on Pestilential Qi) in the late Ming Dynasty, and Gu Jingwen's *Wen Zheng Lun Zhi*, the school of Ye Tianshi gained widespread influence, and many ceased to follow the learning of Zhang Zhongjing. Wu Keyi believed that the *Shang Han Lun* was designed for external contraction of wind-cold. Since cold damage was rare, although one might master the skill of slaying dragons, there would be no opportunity to use it; thus, in clinical practice, one might as well mistake a deer for a horse. The *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases) also mentions multiple times: The *Shang Han Lun* is specifically for treating Shang Han; this covers only one of the six qi, leaving the other five unaddressed. Therefore, using methods for Shang Han to treat diseases caused by the six qi is like wearing fine muslin to ward off wind, or mistaking a deer for a horse—attempting this will inevitably lead to difficulty. The *Shang Han Da Bai* argues that Shang Han occurs only in winter in the north, and is extremely rare in Jiangsu and Zhejiang in the southeast. According to this view, the *Shang Han Lun* has little practical use, which is self-evident. Lu Jiuzhi and Yun Tieqiao, aiming to uphold Zhang Zhongjing's teachings, strongly objected to this. They focused their fierce attacks on Ye Tianshi's theory, the most influential within the warm disease school, causing intense debate between the Shang Han school and the Wen Bing school, the repercussions of which continue to this day. Mr. Zhang studied under Yun Tieqiao, who followed Lu Jiuzhi's scholarship. Therefore, the academic origins of *Re Wen Bian Huo* are consistent with those of *Shi Bu Zhai Yi Shu* and *Wen Bing Ming Li*. Along with Zhu Weiju's *Shang Han Zhi Nan*, Xie Songmu's *Wen Bing Lun Heng*, Zhang Shanlei's *Shi Wen Bing Gu Jin Yi An Ping Yi*, and Kong Airu's *Ju Tong Fa Hui* and *Meng Ying Wen Nan*, these are important works studying the academic thoughts of this school.
III. Overview of the Book
*Re Wen Bian Huo* is nearly 60,000 words long, with sharp writing and vehement language, serving as a monograph dedicated to refuting the studies of Ye Tianshi and Wu Jutong. The book is divided into four parts: Upper, Middle, Lower, and Appendix. The Upper Part is a general discussion on pathology, divided into four chapters: "Deviant and Heretical Sayings on Warm Diseases," "True Definition of Warm Diseases," "Principles of Fever in Warm Diseases," and "Standardized Names for Pathologies of Warm Diseases." The Middle Part is a summary of diagnosis, divided into four chapters: "Main Symptom Patterns of Warm Diseases," "Accompanying Symptom Patterns," "Special Symptom Patterns," and "Pulse and Tongue Symptom Patterns." The Lower Part compiles formulas, categorized into eight types: "Exterior-Releasing Formulas," "Heat-Clearing Formulas," "Harmonizing Formulas," "Purgative Formulas," "Dampness-Resolving Formulas," "Summerheat-Clearing Formulas," "Heat-Clearing and Tonifying Formulas," and "Middle-Warming Formulas." The Appendix provides examples of warm disease treatment cases, containing thirteen medical records, "merely to demonstrate the correspondence between treatment and theory." The cover was inscribed by Yun Tieqiao. Prefaces by Yun Tieqiao and Lu Yuanlei, along with the author's self-introduction, appear at the beginning. Copies are held in libraries such as the Shanghai Shuguang Hospital Library.
IV. Content Characteristics
Mr. Zhang considered several chapters in *Shi Bu Zhai Yi Shu* refuting Ye Tianshi's theories to be particularly insightful. He once intended to extract and reprint these chapters separately, naming them *Shi Bu Zhai Jing Hua Ji*, but this did not come to fruition. He said: "Since the books of Ye Tianshi and Wu Jutong circulated in later generations, contemporary physicians have hardly been able to distinguish between Shang Han and Wen Bing. They uniformly use herbs such as fermented soybean (Chidou Chi), soybean sprouts (Doujuan), Dendrobium (Shihu), mulberry leaves in winter (Dongsangye), and chrysanthemum (Ganjuhua) to treat all heat diseases. This has become a nationwide trend, forming a distinct faction. Those who revere Ye Tianshi believe he deserves to be worshipped alongside Zhang Zhongjing, and they revere Wu Jutong's *Wen Bing Tiao Bian* as a heavenly secret treasure. The theory of the Triple Burner prevails, while the principles of the Six Channels are abandoned. Ye Tianshi and Wu Jutong started this trend, and Wang Mengying, Zhang Xugu, and others amplified it, resulting in the current obscure and blocked state of medicine." He also stated that contemporary physicians who, after Lu Jiuzhi's harsh criticism of Ye and Wu, still fail to correct their ways, are quack doctors. From this, it is evident that Mr. Zhang's attack on the Ye-Wu theories was no less severe than that of Lu Jiuzhi, Yun Tieqiao, and Zhang Shanlei. Collecting and expanding upon the theories of Lu and Yun, and fiercely attacking the Ye-Wu school, constitutes a major characteristic of the content of *Re Wen Bian Huo*.
V. Examples of Arguments
1. The Theory of Latent Qi Causing Warmth is Fabricated: During Mr. Zhang's time, the schools of Yu Jiayan and Ye Tianshi were most popular. The theory of latent qi causing warmth originated in detail from Yu. Mr. Zhang believed: "Since this theory spread, warm diseases acquired an obstacle/delusion." Therefore, he refuted the theory of latent qi causing warmth by citing the views of Fang Xingyan, Liu Songnian, and Yun Tieqiao. He argued that "Winter injury by cold leads to spring warmth" is merely a reciprocal phrase for "Failure to store essence in winter leads to spring warmth." Fabricating the theory of latent qi causes only "an additional deviant path for warm diseases."
2. Light and Pure Therapies Are Insufficient for Serious Illness: Mr. Zhang believed that although Yu's theory of latent qi was erroneous, his medication was not overly light or superficial. Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), Asari Radix (Xixin), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Gypsum Fibrosum (Shigao), and Rheii Radix et Rhizoma (Dahuang) were commonly used, yet contemporary physicians dared not follow suit. In contrast, the light and pure methods of the Ye school allowed practitioners to claim credit for success and shift blame for failure. Due to societal ignorance and inability to discern, this approach was convenient for physicians seeking livelihood, making "the Ye school's theory particularly popular." In reality, light and pure therapies can only treat minor colds or mild cases of lung distension. Lu Jiuzhi discussed this in detail. Thus, Mr. Zhang did not mind the cumbersome writing style in the book, quoting large sections to demonstrate his point that "light and pure therapies are insufficient to cure serious illnesses."
3. Warm Diseases Belong Within the Shang Han Lun: Mr. Zhang stated: "Warm diseases all originate from Shang Han; Shang Han is the beginning of the disease, while warmth is the advanced stage." "Ignorant people do not understand this principle. They believe that wind and cold are diseases in the *Shang Han Lun*, but that warm diseases should not be treated with formulas from the *Shang Han Lun*. They exclude warm diseases from the *Shang Han Lun*, writing separate books and theories, claiming that Zhang Zhongjing's book details the treatment of cold but neglects warmth, noting the absence of formulas containing Scutellariae Radix, Coptidis Rhizoma, Gypsum Fibrosum, and Rheii Radix et Rhizoma in the text. This is absurd and ridiculous, surpassing anything else." Mr. Zhang inherited Yun Tieqiao's classification of warm diseases into Shang Han-type and non-Shang Han-type. He categorized non-Shang Han-type warm diseases into five types and believed that Shang Han-type warm diseases correspond to Yangming disease in Shang Han. These six types of warm diseases all fall under the scope of Broad Sense Shang Han. Since Zhang Zhongjing's book discusses Broad Sense Shang Han, "discussing warmth while stepping outside the scope of Shang Han is a deviant path."
4. Cold Pathogen as the Source of Six Types of Warm Diseases: Mr. Zhang noted that the categorization of warm diseases appears in nine forms in the *Wen Bing Tiao Bian*. He cited examples to challenge and mock Wu Jutong, saying he "could not clarify things even after itemizing them." Regarding the statements in the *Wen Bing Tiao Bian* that the Six Channels of Shang Han move from exterior to interior horizontally, while the Triple Burner of warm diseases moves from top to bottom vertically, he considered this: "Simply delirious speech." According to Mr. Zhang, deducing pathology from disease patterns and summarizing disease names from pathology reveals only six types of warm diseases. All six arise from the Shang Han pathogen. The difference lies in the fact that for Shang Han-type warm diseases, the cold pathogen first injures the Taiyang channel, remains there for several days, then transforms into dryness and transmits internally to Yangming. For non-Shang Han-type warm diseases, the cold pathogen enters Yangming directly from the start (the book explains the pathology of direct entry into Yangming in detail). Therefore, like Lu Jiuzhi and others, he highly praised Ke Yunbo's argument that "Yangming is the breeding ground for warmth," stating: "It is straightforward and satisfying to say that warm diseases are essentially Yangming syndromes, which can resolve many convoluted issues."
5. The Idea That Purgation in Warm Diseases Should Not Be Delayed is Difficult to Follow: Mr. Zhang believed that regardless of Shang Han or warm diseases, "purgatives must only be used when there are purgative indications." If indications exist, purgation should be performed, and it will invariably be effective. If "purgation fails to produce bowel movements, then the method of purgation was inappropriate." If the original text shows repeated failures of purgation, only then should one suspect mixed pathogens. How can treatment be so absurd? It likely stems from superstitiously following the idea that "purgation in warm diseases should not be delayed," acting rashly, and testing the disease with purgatives. Fortunately, if repeated purgation does not worsen the condition, there may still be room to re-examine for mixed pathogens. Is this truly a medical method? In short, situations where purgation fails due to mixed pathogens or deficiency must be considered beforehand. If not considered, and purgation is used rashly, leading to failure, and then one realizes "qi deficiency causes repeated failure of purgation, blood deficiency causes repeated failure," etc., these are all invalid arguments. Therefore, Mr. Zhang said: "The ideas that 'purgation in Shang Han should not be delayed' and 'purgation in warm diseases should not be delayed' should not be blindly believed."
6. Treatment Formulas Should Adhere to the Shang Han Lun and Yao Lue: Mr. Zhang revered Zhang Zhongjing's teachings, believing that formulas containing Nitre (Xiaoshuo), Rheii Radix et Rhizoma, Scutellariae Radix, Coptidis Rhizoma, Gardeniae Fructus, and Gypsum Fibrosum in the *Shang Han Lun* were all designed for warm diseases. Thus, he advocated: "Formulas applied for warm diseases should adhere to the *Shang Han Lun* and *Yao Lue*." This advocacy was not rigid adherence or refusal of new knowledge, as evidenced by two points: (1) Opposing the abuse of classical formulas: Mr. Zhang believed that at the onset of warm diseases, medication should release the exterior with acrid-cool properties. "Ephedrae Herba and Cinnamomi Ramulus are unsuitable. Therefore, taking Guizhi Tang (Cinnamon Twig Decoction) as the first formula in the *Wen Bing Tiao Bian* is absurd and unjustified." (2) Advocating broad learning and collection: Although Mr. Zhang fiercely attacked the Ye-Wu theories, he believed: "Although their theories are flawed, some of their formulas are valuable. Yin Qiao San (Honeysuckle and Forsythia Powder) and Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction) are useful for wind-warmth syndromes in early spring." He also said: "San Ren Tang (Three Seeds Decoction) is indeed a correct formula for damp-heat. Wu Jutong's formulation of this prescription can be adopted." Because "disease changes unpredictably; if existing formulas are insufficient, one must consult various books extensively and cannot stick rigidly to just these."
VI. Brief Evaluation at the End
1. Valuable Points: The views in *Re Wen Bian Huo* that warm diseases belong within Broad Sense Shang Han, that the *Shang Han Lun* is not solely about Narrow Sense Shang Han, and that purgatives must be based on purgative indications rather than having the preconception of "purgation in warm diseases should not be delayed" in mind, are completely consistent with objective facts. Views such as "Winter injury by cold leads to spring warmth" being a reciprocal phrase for "Failure to store essence in winter leads to spring warmth," that light and pure therapies are insufficient for serious illness, and that the cold pathogen is the source of six types of warm diseases, although representing one school's perspective, can serve as a unique reference for researching external contraction heat diseases, provided we discard sectarian prejudices.
2. Language Often Lacks Moderation: Since the late Qing Dynasty, in the controversy between Shang Han and Wen Bing, the language used by opposing sides was quite severe. The attack on the Ye school in *Re Wen Bian Huo* was no exception, inevitably causing considerable resentment among followers of the Ye school. In academic debates, whether regarding ancient or modern figures, parties with differing viewpoints should remain calm and avoid emotional reactions (such as indignation, hatred, or contempt). Academic humility does not imply weakness, a point worthy of our attention. From this perspective, some wording in *Re Wen Bian Huo* is indeed immoderate. Mentioning this here aims to serve as a warning for the future. May those who understand appreciate my good intentions.
Volume II: Refutation of Ye-Wu Theories
"Praising and Critiquing the *Wen Re Lun*"
Shi Yiren believed: While the merits of the *Wen Re Lun* should certainly be inherited and promoted, its shortcomings cannot be ignored. The author fully agrees with this viewpoint. However, commentators on the *Wen Re Lun* throughout history, out of reverence for Ye Tianshi, mostly preferred to interpret errors charitably and avoided discussing flaws, rarely pointing out deficiencies frankly. In reality, failing to distinguish between grain and weeds leads to endless detrimental effects, misleading future generations and causing significant harm. Based on this understanding, the following "Praising and Critiquing the *Wen Re Lun*" is presented.
I. Not All Warm Diseases First Invade the Lung
The *Wen Re Lun* opens with the proposition that "warm pathogens enter from above and first invade the Lung." Wu Jutong expanded on this meaning, stating: "All cases of warm diseases begin in the Upper Jiao, affecting the Hand-Taiyin [Lung]." Subsequently, this viewpoint was accepted by the school and became a common theory today. For example, the national unified textbook *Wen Bing Xue* interprets the clause "first invades the Lung" as: "This clause serves as the general outline for demonstrating the syndrome differentiation and treatment of warm diseases. The clause first summarizes the mechanism of occurrence and development of warm diseases." However, it is well known that Ye Tianshi's *Wen Re Lun* at least encompasses Wind-Warmth and Damp-Warmth. Wu's concept of warm diseases includes nine types: Wind-Warmth, Warmth, Pestilential Qi, Warm Toxin, Summerheat-Warmth, Damp-Warmth, Autumn Dryness, Winter Warmth, and Warm Malaria. From the perspective of modern medical terminology, the warm diseases referred to by Ye and Wu include at least the following diseases: Influenza, Encephalitis, Typhoid Fever, Pneumonia, Scarlet Fever, Heat Stroke, Malaria, Jaundice Hepatitis, Mumps, Dysentery, etc. Additionally, Epidemic Hemorrhagic Fever and Leptospirosis are generally considered within the scope of warm diseases described by Ye and Wu. According to the saying "There is no true Shang Han in the South, only warmth," the term warm diseases used by Ye and Wu covers a very wide range. However, among the aforementioned diseases, except for a few respiratory diseases like Influenza that first invade the Lung, diseases such as Japanese Encephalitis, Jaundice Hepatitis, Typhoid Fever, and Hemorrhagic Fever do not primarily involve the Lung initially. Xie Songmu believed that warm diseases can broadly be divided into two categories: Lung-system warm diseases and Stomach-system warm diseases. The twelve characters "Warm pathogens enter from above, first invade the Lung, and reverse transmit to the Pericardium... are merely the guideline for Lung-invading warm diseases and absolutely cannot include Stomach-system warm diseases like Damp-Warmth. Using the guideline for Lung-system warm diseases to govern Stomach-system warm diseases is like putting someone else's hat on one's own head, failing to distinguish clearly." Zhu Weiju also stated: The *Wen Re Lun* "was popular for a time, deeply rooted in people's minds, leading the blind to lead the blind, causing much misunderstanding." "Regarding this chapter, we ought to clearly distinguish its merits and flaws and not follow it blindly." I consider the "first invades the Lung" theory in the *Wen Re Lun* to be the primary reason why it should not be followed blindly. If we are awed by Tianshi's reputation, merely joining the chorus, repeating what others say, and failing to clearly discern its correctness, treating it as a universal law for the initial stage of warm diseases, we will inevitably use lung-treating formulas to treat heat diseases unrelated to the lung. In doing so, how could we not miss the critical moment of the disease? How could we expect to achieve the effect of intercepting and reversing the disease in its early stages? If all external contraction heat diseases were truly "warm pathogens entering from above and first invading the Lung," then "if wind is released from heat externally, or dampness is drained from heat below, without clashing with heat, the pathogen will inevitably become isolated." The disease should not worsen further. Why would "acrid-cool dispersing wind and sweet-bland driving away dampness, if the disease still does not resolve, indicate gradual entry into the Ying (Nutrient) level"? There are only two reasons: First, the disease originally did not concern the Lung, so treating it with lung formulas is shooting without a target. Second, it is like pouring a cup of water on a burning cartload of firewood—the disease is severe, and the medication is too light. Thus, subjectively hoping for wind and heat to separate and the disease to heal, objectively, however, the pathogen progresses from Wei (Defensive) to Qi, then to Ying and Blood, worsening step by step. This shows that Ye's treatment of warm diseases often went against expectations, though he was unaware of it himself. Hence, he still established his theory based on "first invades the Lung" to instruct others. Regrettably, the *Wen Re Lun*, revered by Wang Mengying and others as the standard, begins with an error. This is an objective fact, and there is no need to conceal it for the sake of sages. Therefore, when treating external contraction heat diseases, "we must not use 'first invades the Lung' to fix the eyes of future generations." Otherwise, there will inevitably be "errors of disconnect between theory and practice." "For example, if there are no respiratory symptoms at the initial stage of external contraction, assuming it all affects the Hand-Taiyin is undoubtedly shooting without a target." Shi Yiren's statements are undoubtedly correct.
II. Distinguishing Wei-Qi-Ying-Blood from Shang Han