结语：温热病并不都“必先犯肺”。“脑炎”等急性热病，昏迷詀妄很常见，叶派说这是“逆入心包”，然实则多属热盛蒸脑。伤风、肺胀等病确乎是“首先犯肺”，但只要稍用些能治病的药，又决然不致“逆入心包”，此所以陆九芝强调“胃病有神昏肺病无神昏”⑨。因此，彼十二字决不能说成是温病之总纲，前八字是指部分呼吸器病言，与后四字实际上并不具有紧密之联系。
参考文献
①姜春华：叶天士的温病，杂病的理论与治疗，中医杂志(8)：8，1978。
②《增补临证指南医案·幼科·伏气》，龙文书局石印。
⑧同②卷三温热门华五五案
④同②卷三暑门某三三案
⑤谢诵穆：《温病论衡》，知行出版社。
⑥时逸人：《中医伤寒与温病》，上海科技出版社，1958
⑦同⑤
⑧杨宇：陆九芝用葛根芩连汤治湿温刍议，陕西中医(2)：3，1983。
⑨陆九芝：《世补斋医书·前集上》
“夏暑发自阳明”质疑
“夏暑发自阳明”是叶天士提出的著名论点，后世咸宗之，如《温病学》说：“暑为火热之气，传变迅速，故其侵犯人体，多径入气分而无卫分过程，所以初起即见高热烦渴，汗多等热盛阳明气分证候。叶天士说；‘夏暑发自阳明。’即概括指出了本病发病的特点。"①余谓此说以偏概全，大可商酌，现质疑如次：
一、与仲景学说相背
仲景论暑，其一曰：“太阳中热者，暍是也。其人汗出恶寒，身热而褐也。”其二曰：“太阳中暍者，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已，洒洒然毛耸，手足逆冷，小有劳身即热，口开，前板齿燥。若发汗则恶寒甚，加温针则发热甚，数下之则淋甚。”其三曰：“太阳中暍者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。"观此可知；仲景认为，暑邪伤人，从太阳始。后之注《伤寒论》者，观点大多同此，如张隐庵说：上“三节，皆暍伤太阳。暍者暑也，暑为热邪，故云太阳中热者，暍是也。”②沈明宗说：“此言正暑病也，邪之伤人，无有不从皮毛而入，故曰太阳中热。”③吴谦说：“中暑热病，亦由太阳表入，故曰太阳中热者，暍是也。”①他如成无己、方有执、程林等注家，其释亦不离乎太阳。叶氏可能是因《金匮·痉湿暍病篇》，见仲景治太阳中热，主以白虎加人参汤，遂有“夏暑发自阳明，古人以白虎汤为主方”之说，实则自虎为阳明病之主刑，并非阳明病之专药(此笔者另有专文)，若不明此义，竟因此而遂谓仲景以夏暑发自阳明，则是置仲景论暑三条俱云太阳之明文于不顾了。显然，仲景以夏暑先伤太阳，叶氏以夏暑发自阳明，二说相背。
二、与诸家经验不合
不少医家认为：夏暑发自手少阴，如戴思恭说：“暑先入心者，心属南方离火，暑气所入，各从其类也。”④陈无择认为暑伤五脏证各不同，但伤心居多，他说：“夫暑，在天为热，在地为火，在人脏为心，故暑喜归心。”⑥王肯堂说；“张氏曰；清邪中上，浊邪中下。其风寒湿者，皆地之气，系浊邪，所以俱中足经。唯暑乃天之气，系清邪，所以中手少阴心经也"⑦他如《澹寮方》、《医方大成》、《永类钤方》、《百病治法》、《济生方》等古籍中，亦均有“暑之中人，先著于心。”⑧等论述。又因暑多夹湿，故一般主张：“治暑之法，清心利小便最好。”⑨王孟英赞同上述观点，也说“暑是火邪，心为火脏，邪易入之，故治中暑者，必以清心之药为君。"⑩
另有不少医家认为：夏暑发自手太阴，如陈修园说：“暑伤气，初感即发，其邪在肺。”⑾何廉臣说：“暑气从鼻吸入，必先犯肺。"⑿邵仙根说：“暑从口鼻吸受，先入于肺。”⒀吴鞠通认为；“暑兼湿热，偏于暑之热者为暑温，多手太阴证而宜清，偏于暑之湿者为湿温，多足太阴证而宜温。”所以他标暑温之大纲说：“形似伤寒，但右脉洪大而数，左脉反小于右，口渴甚，面赤，汗大出者，名曰暑温，在手太阴，白虎汤主之，脉芤甚者，白虎加人参汤主之"⑩(此为白虎非阳明病专剂之一证)。此外，如秦笛桥等人，亦均有“暑之偏于热者，多手太阴证”⑩之类的论述。
以上诸家，意见虽有分歧，但在暑邪先伤上焦这一点上，认识是一致的，而阳明属之中焦，即此可见叶说与诸家经验不合。
三、与临床实践不符
观历代名医医案，夏暑不但发于手太阴者不少，且有发于足厥阴等经者，发自阳明的，实仅为暑邪发病之一端，决不能概言是暑邪发病之大体，此即《临证指南医案》亦如此，现举数案以证之：
1·叶天士治龚六十案云：暑必夹湿，二者皆伤气分，从鼻吸而受，必先犯肺，乃上焦病，治法以辛凉微苦，气分上焦廓清则愈，惜乎专以陶书六经看病，仍是与风寒先表后里之药，致邪在上漫延、结锢四十余日不解，非初受六经，不须再辨其谬。经云，病自上受者，治其上，援引经义以论治病，非邪僻也，宗河间法。杏仁、栝蒌皮、半夏、姜汁、白蔻仁、石膏、知母、竹沥，秋露水煎。⑩
按：从《临证指南医案》来看，叶氏治暑病，多有“暑热湿气，始由肺受”等语。其治案多属暑邪入中手太阴之证，此案即其一。此案暑邪久延，仍在上焦肺经，故以知母、石膏等清手太阴之热，用竹沥，半夏等化其夹杂之湿，并用杏仁、蔻仁等宣展气机，以利于散郁火，化痰浊，药法理路较清晰。吴塘之标暑温大纲，即是从此等治案来。然不知叶氏何以于著书时偏云“夏暑发自阳明，”，若云白虎为阳明经药，用白虎涤暑，必属之暑热已炽，则此案何以又云邪在上焦漫延。即此观之，其理论与实践有矛盾，亦明矣！
2·吴鞠通治王某案云：暑伤二太阴，手太阴之证为多，一以化肺气为主。飞滑石八钱，连翘三钱，白通草一钱，杏仁泥五钱，金银花三钱，白扁豆花一枝，生米仁五钱，厚朴三钱，鲜荷叶(去蒂)一张，藿香叶一钱，白蔻仁(连皮)二钱。煮二杯，分二次服。今晚明早各一帖。⑩
按：吴氏认为暑邪先伤肺经，初病用药，忌犯中下，他说：“若黄连甘草，纯然里药，暑病初起，且不必用，恐引邪深入，故易以连翘、银花，取其辛凉达肺经之表，纯从外走，不必走中也。"⑩此案治法，正是这种治疗主张的反映。《清代名医医案精华·秦笛桥医案》暑证第一案以及《重订全国名医验案类编·暑淫病案》高丝云治魏国安案等案的药法，与之大体相同，此等类案，古籍中俯拾可见，说明夏暑发自手太阴者，确乎不少。
3·何拯华治王姓妇中暑案云：素因血虚旰热，外因猝中暑风，一起即头独摇，手足麻木，甚则痹疯，不能起立，立即晕倒，脉弦小数，舌红兼紫，脉证合参，此暑风直中肝经，治从张畹香成方加减。鲜生地六钱，当归身一钱，宣木瓜一钱，白蒺藜二钱，碧玉散三钱(荷叶包，刺孔)，鲜荷叶梗七寸，连芽桑枝二尺，⑩
按：明·龚信说：夫暑者，相火行令也。夏月人感之自口齿而入，伤心包络之经。其脉虚，或浮大而散，或弦细芤迟：其外证头疼身热，口干烦渴，面垢自汗，倦怠少气，背寒恶热，甚者火盛制金，不能平木，肝邪独旺，以致抽搐不省人事。⑩此案病机，正是属此。诸此类案，足证暑邪伤人，发自何经，每随人体质状况而异，故辨证决不可拘泥发自阳明之说，顾今人竟以暑入阳明为暑温之本病，则上述类案又当为暑温之何证？即此观之，执暑入阳明之一端以概其余，是值得商榷的。
结语：1.暑为六淫之一，其伤人为病，不外新感伏邪二种，新感者称暑温，伏邪者称伏暑，伏暑称之发，医家并不以阳明一经局限之，而暑温一证，反好引“发自阳明”之说。殊不知此说不独与叶氏“温邪上受，首先犯肺"之说自相矛盾，且核稽治案，不合实际，故今予驳正之。
2.“中暑无问表里，通宜白虎”之说，本不足以为训，若吾人学而不思，拾前人糟粕而张大其言，误以为夏暑必发自阳明，“一概袭用成方”“但清其内，不解其外”，若是而误治，则诚如喻昌所云：此“医之罪也。”
参考文献
①南京中医学院主编，《温病学》(全国高等医药院校试用教材)，上海科技出版社，1981
②张隐庵，《伤寒集注》
⑧丹波元坚等，《金匮玉函要略辑义》，人民卫生出版社，1983
④吴谦等，《医宗金鉴·伤寒论注》，人民卫生出版社，1979
⑤戴思恭，《证治要诀》
⑥陈言，《三因极一病证方论》，人民卫生出版社，1983
⑦王肯堂，《证治准绳》
⑧转引自《医方类聚》
⑨王纶，《明医杂著》
⑩徐衡之等，《宋元明清名医类案·陈修园医案》，国医印书馆
⑩何廉臣，《重订全国名医验案类编》，上海科技出版社，1982
⑩吴坤安，《伤寒指掌·卷四暑证》，上海科技出版社，198
0·i：1··吴鞠通，《温病条辨·上焦篇》，人民卫生出版社，1978
⑩秦伯末，《清代名医医案精华·秦笛桥医案》，上海科技出版社，1981
⑩华岫云等，《临证指南医案·暑》，龙文书局
⑩吴瑭，《吴鞠通医案》，人民卫生出版社，1981
⑩同⒁@
⑩同⑩
⑩转引自《古今图书集成医部全录》
吴鞠通论治上犯中药殊多矛盾
吴鞠通的《温病条辨》，崇拜者捧之为经典。实则此书理论上殊多矛盾，吾人当明辨其瑕瑜而决不可盲从。现就其有关治上犯中药禁的论述，作为举例如次；
吴氏认为：凡病温者，始于上焦，在手太阴。治上焦如羽，非轩不举。故治温病初起，宜纯然清肃上焦，不犯中下。而治上犯中，是为温病初起用药之大禁。这种观点，在下引文字中可得到具体的反映。
《温病条辨·吴又可禁黄连》中说：“余用普济消毒饮于温病初起，必去芩，连，畏其入里而犯中下焦也。"同书上焦篇十八条自辨中也说：“去黄芩、黄连者，芩连里药也，病初起未至中焦，不得先用里药，故犯中焦也。”上焦篇二四条自辨中又说：“黄连甘草，纯然里药，暑病初起，且不必用，恐引邪深入。”鞠通对又可用达原饮治温疫，曾多次给予批评，主要也是嫌其治上犯中，如上焦篇四条银翘散方论中说：“盖其方中首用槟榔，草果，厚朴为君：夫槟榔，子之坚者也，诸子皆降，槟榔苦辛而温，体重而坚，由中走下，直达肛门，中下焦药也，草果亦子也，其气臭烈大热，其味苦，太阴脾经之劫药也，厚朴苦温，亦中焦药也。岂有上焦温病，首用中下焦苦温雄烈劫夺之品，先劫少阴津液之理！知母、黄芩，亦皆中焦苦燥里药，岂可用乎？”按照上引的一些论述，黄芩、黄连，甘草，厚朴，知母等俱当列为治上犯中的禁药，应当说是没有疑问的了。然而，吴氏治太阴风温，温热，温疫、冬温，初起恶风寒者，主以桂枝汤(方中大枣亦是中焦药)，但热不恶寒而渴者，主以银翘散，此二方都有甘草，吴氏治太阴风温，但咳，身不甚热，微渴者，主以桑菊饮，脉浮洪，舌黄，渴甚，大汗，面赤，恶热者，主以白虎汤，此二方亦俱有甘草，白虎汤尚有知母。又吴氏用普济消毒饮之所以必去芩、连，是以其系里药，嫌其犯中，恐引邪深入，然甘草亦“纯然里药”却是不去。我们只要略翻阅一下上焦篇，就可发现，用甘草之方很多，如清络饮原方无甘草，但吴氏治手太阴暑温，但咳无痰，咳声清高者，不但特意加甘草，而且加知母。吴氏不拘经限药，将治阳明病之主剂白虎汤用于治疗手太阴温病，这是可以的，但如果说甘草知母是治上犯中药，就不该用了。
关于黄芩，吴氏在中焦篇九九条自辨中说：“黄连、黄柏，但走中下，黄芩则走中上，盖黄芩手足阳明，手太阴药也。”又吴氏治肺疟，主以杏仁汤，认为：“疟邪始受在肺，逆传心包络。”“肺疟，疟之至浅者。肺疟虽云易解，稍缓则深，最忌用冶疟印板俗例之小柴胡汤，盖肺去少阳半表半里之界尚远，不得引邪深入也。"然而杏仁汤方中却有黄芩、滑石、茯苓块，后二者是否系上焦药姑置不论，黄芩是吴氏明文说过“病初起未至中焦，不得先用”的里药，何以又用之？又吴氏治史男号温案初诊曰：“右脉洪大无伦，暑伤手太阴，有逆传心包之势，喘渴太甚，烦躁不宁，时有詀语，身热且呕，议两清心营肺卫之热。川连一钱、知母一钱，藿香梗一钱、竹叶一钱、丹皮一钱，生甘草八分，日二帖。”①此案病在上焦心肺，其所用藿梗、丹皮是否上焦药亦不妨姑置不论，若黄连但走中下，甘草纯然里药，知母亦中焦药，又何以俱用之？
结语：温热病并不都“必先犯肺”。“脑炎”等急性热病，昏迷谵妄很常见，叶天士学派说这是“逆入心包”，然而实际上多属于热盛蒸脑。伤风、肺胀等疾病确实“首先犯肺”，但只要稍用些能治病的药，又决然不致“逆入心包”，这就是陆九芝强调“胃病有神昏肺病无神昏”的原因。因此，那十二个字（指“夏暑发自阳明”）绝不能说是温病的总纲，前八个字是指部分呼吸系统疾病而言，与后四个字实际上并不具有紧密的联系。
参考文献
①姜春华：叶天士的温病，杂病的理论与治疗，中医杂志(8)：8，1978。
②《增补临证指南医案·幼科·伏气》，龙文书局石印。
③同②卷三温热门华五五案
④同②卷三暑门某三三案
⑤谢诵穆：《温病论衡》，知行出版社。
⑥时逸人：《中医伤寒与温病》，上海科技出版社，1958
⑦同⑤
⑧杨宇：陆九芝用葛根芩连汤治湿温刍议，陕西中医(2)：3，1983。
⑨陆九芝：《世补斋医书·前集上》
对“夏暑发自阳明”的质疑
“夏暑发自阳明”是叶天士提出的著名论点，后世都尊崇它，如《温病学》说：“暑为火热之气，传变迅速，故其侵犯人体，多径入气分而无卫分过程，所以初起即见高热烦渴，汗多等热盛阳明气分证候。叶天士说；‘夏暑发自阳明。’即概括指出了本病发病的特点。”①我认为此说以偏概全，大可商榷，现质疑如下：
一、与仲景学说相背
仲景论述暑邪，其一曰：“太阳中热者，暍是也。其人汗出恶寒，身热而褐也。”其二曰：“太阳中暍者，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已，洒洒然毛耸，手足逆冷，小有劳身即热，口开，前板齿燥。若发汗则恶寒甚，加温针则发热甚，数下之则淋甚。”其三曰：“太阳中暍者，身热疼重，而脉微弱，此亦夏月伤冷水，水行皮中所致也。”观此可知；仲景认为，暑邪伤人，从太阳始。后之注《伤寒论》者，观点大多同此，如张隐庵说：上“三节，皆暍伤太阳。暍者暑也，暑为热邪，故云太阳中热者，暍是也。”②沈明宗说：“此言正暑病也，邪之伤人，无有不从皮毛而入，故曰太阳中热。”③吴谦说：“中暑热病，亦由太阳表入，故曰太阳中热者，暍是也。”④他如成无己、方有执、程林等注家，其释亦不离乎太阳。叶氏可能是因《金匮·痉湿暍病篇》，见仲景治太阳中热，主以白虎加人参汤，遂有“夏暑发自阳明，古人以白虎汤为主方”之说，实则白虎汤为阳明病之主剂，并非阳明病之专药(此笔者另有专文)，若不明此义，竟因此而遂谓仲景以夏暑发自阳明，则是置仲景论暑三条俱云太阳之明文于不顾了。显然，仲景以夏暑先伤太阳，叶氏以夏暑发自阳明，二说相背。
二、与诸家经验不合
不少医家认为：夏暑发自手少阴，如戴思恭说：“暑先入心者，心属南方离火，暑气所入，各从其类也。”④陈无择认为暑伤五脏证各不同，但伤心居多，他说：“夫暑，在天为热，在地为火，在人脏为心，故暑喜归心。”⑤王肯堂说；“张氏曰；清邪中上，浊邪中下。其风寒湿者，皆地之气，系浊邪，所以俱中足经。唯暑乃天之气，系清邪，所以中手少阴心经也”⑥他如《澹寮方》、《医方大成》、《永类钤方》、《百病治法》、《济生方》等古籍中，亦均有“暑之中人，先著于心。”⑦等论述。又因暑多夹湿，故一般主张：“治暑之法，清心利小便最好。”⑧王孟英赞同上述观点，也说“暑是火邪，心为火脏，邪易入之，故治中暑者，必以清心之药为君。”⑨
另有不少医家认为：夏暑发自手太阴，如陈修园说：“暑伤气，初感即发，其邪在肺。”⑽何廉臣说：“暑气从鼻吸入，必先犯肺。”⑾邵仙根说：“暑从口鼻吸受，先入于肺。”⑿吴鞠通认为；“暑兼湿热，偏于暑之热者为暑温，多手太阴证而宜清，偏于暑之湿者为湿温，多足太阴证而宜温。”所以他标暑温之大纲说：“形似伤寒，但右脉洪大而数，左脉反小于右，口渴甚，面赤，汗大出者，名曰暑温，在手太阴，白虎汤主之，脉芤甚者，白虎加人参汤主之”(此为白虎非阳明病专剂之一证)。此外，如秦笛桥等人，亦均有“暑之偏于热者，多手太阴证”之类的论述。
以上诸家，意见虽有分歧，但在暑邪先伤上焦这一点上，认识是一致的，而阳明属之中焦，即此可见叶说与诸家经验不合。
三、与临床实践不符
观历代名医医案，夏暑不但发于手太阴者不少，且有发于足厥阴等经者，发自阳明的，实仅为暑邪发病之一端，决不能概言是暑邪发病之大体，此即《临证指南医案》亦如此，现举数案以证之：
1·叶天士治龚六十案云：暑必夹湿，二者皆伤气分，从鼻吸而受，必先犯肺，乃上焦病，治法以辛凉微苦，气分上焦廓清则愈，惜乎专以陶书六经看病，仍是与风寒先表后里之药，致邪在上漫延、结锢四十余日不解，非初受六经，不须再辨其谬。经云，病自上受者，治其上，援引经义以论治病，非邪僻也，宗河间法。杏仁、栝蒌皮、半夏、姜汁、白蔻仁、石膏、知母、竹沥，秋露水煎。⑿
按：从《临证指南医案》来看，叶氏治暑病，多有“暑热湿气，始由肺受”等语。其治案多属暑邪入中手太阴之证，此案即其一。此案暑邪久延，仍在上焦肺经，故以知母、石膏等清手太阴之热，用竹沥，半夏等化其夹杂之湿，并用杏仁、蔻仁等宣展气机，以利于散郁火，化痰浊，药法理路较清晰。吴塘之标暑温大纲，即是从此等治案来。然不知叶氏何以于著书时偏云“夏暑发自阳明，”，若云白虎为阳明经药，用白虎涤暑，必属之暑热已炽，则此案何以又云邪在上焦漫延。即此观之，其理论与实践有矛盾，亦明矣！
2·吴鞠通治王某案云：暑伤二太阴，手太阴之证为多，一以化肺气为主。飞滑石八钱，连翘三钱，白通草一钱，杏仁泥五钱，金银花三钱，白扁豆花一枝，生米仁五钱，厚朴三钱，鲜荷叶(去蒂)一张，藿香叶一钱，白蔻仁(连皮)二钱。煮二杯，分二次服。今晚明早各一帖。⒀
按：吴氏认为暑邪先伤肺经，初病用药，忌犯中下，他说：“若黄连甘草，纯然里药，暑病初起，且不必用，恐引邪深入，故易以连翘、银花，取其辛凉达肺经之表，纯从外走，不必走中也。”⒁此案治法，正是这种治疗主张的反映。《清代名医医案精华·秦笛桥医案》暑证第一案以及《重订全国名医验案类编·暑淫病案》高丝云治魏国安案等案的药法，与之大体相同，此等类案，古籍中俯拾可见，说明夏暑发自手太阴者，确乎不少。
3·何拯华治王姓妇中暑案云：素因血虚旰热，外因猝中暑风，一起即头独摇，手足麻木，甚则痹疯，不能起立，立即晕倒，脉弦小数，舌红兼紫，脉证合参，此暑风直中肝经，治从张畹香成方加减。鲜生地六钱，当归身一钱，宣木瓜一钱，白蒺藜二钱，碧玉散三钱(荷叶包，刺孔)，鲜荷叶梗七寸，连芽桑枝二尺，⒂
按：明·龚信说：夫暑者，相火行令也。夏月人感之自口齿而入，伤心包络之经。其脉虚，或浮大而散，或弦细芤迟：其外证头疼身热，口干烦渴，面垢自汗，倦怠少气，背寒恶热，甚者火盛制金，不能平木，肝邪独旺，以致抽搐不省人事。⒃此案病机，正是属此。诸此类案，足证暑邪伤人，发自何经，每随人体质状况而异，故辨证决不可拘泥发自阳明之说，顾今人竟以暑入阳明为暑温之本病，则上述类案又当为暑温之何证？即此观之，执暑入阳明之一端以概其余，是值得商榷的。
结语：1.暑为六淫之一，其伤人为病，不外新感伏邪二种，新感者称暑温，伏邪者称伏暑，伏暑称之发，医家并不以阳明一经局限之，而暑温一证，反好引“发自阳明”之说。殊不知此说不独与叶氏“温邪上受，首先犯肺"之说自相矛盾，且核稽治案，不合实际，故今予驳正之。
2.“中暑无问表里，通宜白虎”之说，本不足以为训，若吾人学而不思，拾前人糟粕而张大其言，误以为夏暑必发自阳明，“一概袭用成方”“但清其内，不解其外”，若是而误治，则诚如喻昌所云：此“医之罪也。”
参考文献
①南京中医学院主编，《温病学》(全国高等医药院校试用教材)，上海科技出版社，1981
②张隐庵，《伤寒集注》
③丹波元坚等，《金匮玉函要略辑义》，人民卫生出版社，1983
④吴谦等，《医宗金鉴·伤寒论注》，人民卫生出版社，1979
⑤戴思恭，《证治要诀》
⑥陈言，《三因极一病证方论》，人民卫生出版社，1983
⑦王肯堂，《证治准绳》
⑧转引自《医方类聚》
⑨王纶，《明医杂著》
⑪徐衡之等，《宋元明清名医类案·陈修园医案》，国医印书馆
⑫何廉臣，《重订全国名医验案类编》，上海科技出版社，1982
⑬吴坤安，《伤寒指掌·卷四暑证》，上海科技出版社，198
0·i：1··吴鞠通，《温病条辨·上焦篇》，人民卫生出版社，1978
⑭秦伯末，《清代名医医案精华·秦笛桥医案》，上海科技出版社，1981
⑮华岫云等，《临证指南医案·暑》，龙文书局
⑯吴瑭，《吴鞠通医案》，人民卫生出版社，1981
⑰同⒁@
⑱同⑩
⑲转引自《古今图书集成医部全录》
吴鞠通论治上犯中药殊多矛盾
吴鞠通的《温病条辨》，崇拜者捧之为经典。实则此书理论上殊多矛盾，吾人当明辨其瑕瑜而决不可盲从。现就其有关治上犯中药禁的论述，作为举例如次；
吴氏认为：凡病温者，始于上焦，在手太阴。治上焦如羽，非轻不举。故治温病初起，宜纯然清肃上焦，不犯中下。而治上犯中，是为温病初起用药之大禁。这种观点，在下引文字中可得到具体的反映。
《温病条辨·吴又可禁黄连》中说：“余用普济消毒饮于温病初起，必去芩，连，畏其入里而犯中下焦也。”同书上焦篇十八条自辨中也说：“去黄芩、黄连者，芩连里药也，病初起未至中焦，不得先用里药，故犯中焦也。”上焦篇二四条自辨中又说：“黄连甘草，纯然里药，暑病初起，且不必用，恐引邪深入。”鞠通对又可用达原饮治温疫，曾多次给予批评，主要也是嫌其治上犯中，如上焦篇四条银翘散方论中说：“盖其方中首用槟榔，草果，厚朴为君：夫槟榔，子之坚者也，诸子皆降，槟榔苦辛而温，体重而坚，由中走下，直达肛门，中下焦药也，草果亦子也，其气臭烈大热，其味苦，太阴脾经之劫药也，厚朴苦温，亦中焦药也。岂有上焦温病，首用中下焦苦温雄烈劫夺之品，先劫少阴津液之理！知母、黄芩，亦皆中焦苦燥里药，岂可用乎？”按照上引的一些论述，黄芩、黄连，甘草，厚朴，知母等俱当列为治上犯中的禁药，应当说是没有疑问的了。然而，吴氏治太阴风温，温热，温疫、冬温，初起恶风寒者，主以桂枝汤(方中大枣亦是中焦药)，但热不恶寒而渴者，主以银翘散，此二方都有甘草，吴氏治太阴风温，但咳，身不甚热，微渴者，主以桑菊饮，脉浮洪，舌黄，渴甚，大汗，面赤，恶热者，主以白虎汤，此二方亦俱有甘草，白虎汤尚有知母。又吴氏用普济消毒饮之所以必去芩、连，是以其系里药，嫌其犯中，恐引邪深入，然甘草亦“纯然里药”却是不去。我们只要略翻阅一下上焦篇，就可发现，用甘草之方很多，如清络饮原方无甘草，但吴氏治手太阴暑温，但咳无痰，咳声清高者，不但特意加甘草，而且加知母。吴氏不拘经限药，将治阳明病之主剂白虎汤用于治疗手太阴温病，这是可以的，但如果说甘草知母是治上犯中药，就不该用了。
关于黄芩，吴氏在中焦篇九九条自辨中说：“黄连、黄柏，但走中下，黄芩则走中上，盖黄芩手足阳明，手太阴药也。”又吴氏治肺疟，主以杏仁汤，认为：“疟邪始受在肺，逆传心包络。”“肺疟，疟之至浅者。肺疟虽云易解，稍缓则深，最忌用冶疟印板俗例之小柴胡汤，盖肺去少阳半表半里之界尚远，不得引邪深入也。”然而杏仁汤方中却有黄芩、滑石、茯苓块，后二者是否系上焦药姑置不论，黄芩是吴氏明文说过“病初起未至中焦，不得先用”的里药，何以又用之？又吴氏治史男号温案初诊曰：“右脉洪大无伦，暑伤手太阴，有逆传心包之势，喘渴太甚，烦躁不宁，时有詀语，身热且呕，议两清心营肺卫之热。川连一钱、知母一钱，藿香梗一钱、竹叶一钱、丹皮一钱，生甘草八分，日二帖。”①此案病在上焦心肺，其所用藿梗、丹皮是否上焦药亦不妨姑置不论，若黄连但走中下，甘草纯然里药，知母亦中焦药，又何以俱用之？
Conclusion: Not all warm-heat diseases (Wenbing, febrile diseases caused by warm-heat pathogens) "must first attack the Lung." In acute febrile diseases such as encephalitis, coma and delirium are very common; the Ye School (followers of Ye Tianshi) claims this is "reversely entering the Pericardium," yet in reality, it mostly belongs to excessive heat steaming the brain. Diseases such as wind-cold (Shangfeng) and lung distension (Feizhang) indeed "first attack the Lung," but with only a slight use of appropriate medicinal treatment, they certainly will not "reversely enter the Pericardium." This is why Lu Jiuzhi emphasized that "stomach disease manifests with clouded spirit, while lung disease does not." Therefore, those twelve characters cannot be said to be the general outline of warm-heat diseases; the first eight characters refer to certain respiratory diseases, which actually do not have a close connection with the last four characters.
References
① Jiang Chunhua: Ye Tianshi's Warm-Heat Diseases, Theory and Treatment of Miscellaneous Diseases, Journal of Traditional Chinese Medicine (8): 8, 1978.
② *Supplement to Linzheng Zhinan Yi'an · Pediatrics · Latent Qi*, Longwen Shuju Stone Print.
③ Ibid., Vol. 3, Warm-Heat Section, Case Hua 55.
④ Ibid., Vol. 3, Summer-Heat Section, Case Mou 33.
⑤ Xie Songmu: *Wenbing Lunheng* (On the Balance of Warm-Heat Diseases), Zhixing Press.
⑥ Shi Yiren: *Zhongyi Shanghan Yu Wenbing* (Traditional Chinese Medicine Shanghan and Wenbing), Shanghai Science and Technology Press, 1958.
⑦ Ibid.
⑧ Yang Yu: Preliminary Discussion on Lu Jiuzhi Using Gegen Qinlian Decoction to Treat Damp-Warmth, Shaanxi Journal of Traditional Chinese Medicine (2): 3, 1983.
⑨ Lu Jiuzhi: *Shibuzhai Yishu · First Collection, Upper Volume*.
Questioning "Summer Heat Originates from the Yangming"
"Summer heat originates from the Yangming" is a famous proposition proposed by Ye Tianshi, which has been universally respected by later generations. For instance, *Wenbingxue* states: "Summer heat is qi of fire and heat, with rapid transmission; thus, when invading the human body, it often enters the Qi level directly without a Wei level process. Therefore, at the onset, symptoms such as high fever, irritability, thirst, and profuse sweating—indicative of heat excess in the Yangming Qi level—are seen. Ye Tianshi said, 'Summer heat originates from the Yangming,' which summarizes the characteristics of the onset of this disease." ① I believe this statement generalizes from partial cases and is open to discussion. My questions are as follows:
I. Contradiction with Zhang Zhongjing's Theory
Zhang Zhongjing discussed summer heat in three instances: The first states: "Taiyang intermediate heat is called Ye. The patient sweats, fears cold, has body heat, and feels heavy." The second states: "Taiyang intermediate Ye presents with fever, aversion to cold, heaviness of the body, and pain. The pulse is string-thin, hollow, and slow. After urination, there is a sensation of shivering and goosebumps; the hands and feet are cold. Slight exertion causes body heat, the mouth opens, and the front teeth are dry. If sweating is induced, aversion to cold becomes severe; if warm needles are added, heat becomes severe; if purgatives are used repeatedly, strangury becomes severe." The third states: "Taiyang intermediate Ye presents with body heat, pain, and heaviness, with a weak and faint pulse. This is also caused by injuring cold water in summer, where water circulates within the skin." From this, it can be seen that Zhang Zhongjing believed that summer heat pathogenic factors injure the body starting from the Taiyang. Later commentators on *Shanghan Lun* mostly shared this view. For example, Zhang Yin'an stated: "The above three sections all describe Ye injuring the Taiyang. Ye is summer heat; summer heat is a heat pathogen, hence it is said that 'Taiyang intermediate heat is Ye.'" Shen Mingzong said: "This refers to true summer heat disease. Pathogens injuring the human body always enter through the skin and hair, hence it is said 'Taiyang intermediate heat.'" Wu Qian stated: "Heatstroke and heat diseases also enter from the Taiyang exterior, hence it is said 'Taiyang intermediate heat is Ye.'" Other commentators such as Cheng Wuji, Fang Youzhi, and Cheng Lin also did not deviate from the Taiyang interpretation. Ye Tianshi might have derived his statement "Summer heat originates from the Yangming, ancients used Baihu Tang as the main formula" from seeing Zhang Zhongjing treat Taiyang intermediate heat primarily with Baizhu Jia Renshen Tang in the *Jingui Yaolue · Spasm, Dampness, and Ye Disease Chapter*. In reality, Baihu Tang is the main agent for Yangming disease, not a specific drug exclusively for Yangming disease (the author has another paper on this). If one does not understand this meaning and consequently claims that Zhang Zhongjing believed summer heat originates from the Yangming, one would be ignoring the explicit text in Zhang Zhongjing's three discussions on summer heat stating it affects the Taiyang. Obviously, Zhang Zhongjing held that summer heat first injures the Taiyang, while Ye Tianshi held that summer heat originates from the Yangming; these two theories contradict each other.
II. Inconsistency with Various Experts' Experience
Many medical experts believe that summer heat originates from the Hand-Shaoyin channel. For example, Dai Sigong said: "When summer heat first enters the Heart, the Heart belongs to the Li Fire of the South; the qi of summer heat enters according to its kind." Chen Wuyue believed that summer heat injuring the five zang organs presents differently, but mostly injures the Heart. He said: "Summer heat, in heaven is heat, in earth is fire, and in human viscera is the Heart; thus, summer heat tends to return to the Heart." Wang Kentang said: "Zhang [Zhongjing] said: Clear pathogens strike the upper, turbid pathogens strike the lower. Wind, cold, and dampness are qi of the earth, classified as turbid pathogens, so they all strike the foot meridians. Only summer heat is qi of heaven, classified as clear pathogens, so it strikes the Hand-Shaoyin Heart meridian." Other ancient texts such as *Danliao Fang*, *Yifang Dacheng*, *Yonglei Qianfang*, *Baibing Zhifa*, and *Jisheng Fang* also contain statements like "summer heat striking humans first attaches to the Heart." Furthermore, because summer heat often combines with dampness, it is generally advocated: "The method for treating summer heat is best to clear the Heart and promote urination." Wang Mengying agreed with the above views, saying, "Summer heat is a fire pathogen, and the Heart is a fire zang organ; the pathogen easily enters it. Thus, when treating heatstroke, one must use herbs that clear the Heart as the sovereign drug."
Another group of experts believes that summer heat originates from the Hand-Taiyin channel. For example, Chen Xiuyuan said: "Summer heat injures qi; upon initial infection, it manifests immediately, with the pathogen in the Lung." He Lianchen said: "Summer heat qi is inhaled through the nose and must first attack the Lung." Shao Xiangen said: "Summer heat is absorbed through the mouth and nose and first enters the Lung." Wu Jutong believed: "Summer heat combines with damp-heat. Those biased towards the heat aspect of summer heat are called summer-warmth, mostly presenting Hand-Taiyin syndromes suitable for clearing; those biased towards the damp aspect are called damp-warmth, mostly presenting Foot-Taiyin syndromes suitable for warming." Therefore, he outlined the general principle of summer-warmth: "Resembling Shanghan, but with a large, rapid right pulse and a left pulse smaller than the right, extreme thirst, red face, and profuse sweating is named summer-warmth, located in the Hand-Taiyin, treated with Baihu Tang. If the pulse is extremely hollow, Baihu Jia Renshen Tang is used." (This is one case where Baihu Tang is not a specific agent for Yangming disease). Additionally, figures like Qin Diqiao also had statements like "summer heat biased towards heat mostly presents Hand-Taiyin syndromes."
Although the opinions of the above experts diverged, their understanding was consistent regarding the summer heat pathogen first injuring the Upper Jiao. Since the Yangming belongs to the Middle Jiao, it can be seen here that Ye's theory is inconsistent with the experience of various experts.
III. Incompatibility with Clinical Practice
Observing medical records of famous doctors throughout history, summer heat not only frequently originates from the Hand-Taiyin but also from the Foot-Jueyin and other meridians. Cases originating from the Yangming are merely one aspect of summer heat pathogenesis and certainly cannot be generalized as the main pattern. Even *Linzheng Zhinan Yi'an* reflects this. Several cases are cited below as proof:
1. Ye Tianshi treated Patient Gong, age 60, stating: "Summer heat must combine with dampness; both injure the Qi level. Absorbed through the nose, it must first attack the Lung, constituting an Upper Jiao disease. The treatment method uses acrid-cool and slightly bitter herbs; once the Qi level and Upper Jiao are cleared, recovery occurs. Unfortunately, relying solely on Tao Hongjing's Six Meridians framework for diagnosis, he still used medicines for wind-cold that address the exterior first and interior later, causing the pathogen to spread in the upper part and become entrenched for over forty days without resolution. This is not the initial acquisition of Six Meridians patterns; there is no need to further debate its errors. The Classics state: 'Diseases received from above should be treated from above.' Citing classic principles to discuss treatment is not heretical; following Liu Wansu's method. Apricot Kernel, Trichosanthes Peel, Pinellia, Ginger Juice, White Cardamom Seed, Gypsum, Anemarrhena, Bamboo Sap, decocted in autumn dew water."
Commentary: From *Linzheng Zhinan Yi'an*, Ye's treatment of summer heat diseases often includes phrases like "summer heat and dampness qi initially received by the Lung." His treated cases mostly belong to syndromes where summer heat pathogen enters the Hand-Taiyin. This case is one of them. In this case, the summer heat pathogen has lingered for a long time but remains in the Lung meridian of the Upper Jiao. Therefore, Anemarrhena and Gypsum were used to clear the heat of the Hand-Taiyin; Bamboo Sap and Pinellia were used to resolve the mixed dampness; Apricot Kernel and Cardamom Seed were used to diffuse Qi mechanism, facilitating the dispersal of stagnant fire and transformation of turbid phlegm. The herbal logic is relatively clear. Wu Tang's outline of summer-warmth was derived from such treated cases. However, it is unknown why Ye specifically claimed "Summer heat originates from the Yangming" when writing his book. If Baihu Tang is considered a Yangming meridian drug, using it to cleanse summer heat implies that summer heat fire is already blazing. Then why does this case state the pathogen is spreading in the Upper Jiao? From this perspective, the contradiction between his theory and practice is evident!
2. Wu Jutong treated Patient Wang, stating: "Summer heat injures both Taiyin channels, with Hand-Taiyin syndromes being more common; the primary approach is to transform Lung Qi. Flying Talc 8 qian, Forsythia 3 qian, White Akebia Stem 1 qian, Almond Paste 5 qian, Honeysuckle Flower 3 qian, White Hyacinth Bean Flower 1 branch, Coix Seed 5 qian, Magnolia Bark 3 qian, Fresh Lotus Leaf (remove stem) 1 sheet, Agastache Leaf 1 qian, White Cardamom Seed (with skin) 2 qian. Boil to yield two cups, take in two doses. One prescription tonight and one tomorrow morning."
Commentary: Wu believed that summer heat pathogen first injures the Lung meridian. In early-stage treatment, one must avoid affecting the Middle and Lower Jiao. He stated: "If Coptis and Licorice, purely interior drugs, are used for early summer heat, they should not be used initially, lest they draw the pathogen deeper. Therefore, replace them with Forsythia and Honeysuckle, taking advantage of their acrid-cool nature to reach the exterior of the Lung meridian, moving purely outward, not inward." The treatment method of this case precisely reflects this therapeutic advocacy. The herbal methods in the first summer syndrome case of *Qingdai Mingyi An Jinghua · Qin Diqiao Yi'an* and the case of Gao Siyun treating Wei Guo'an in *Chongding Quanguo Mingyi Yan'an Bianlei · Summer Yin Disease Cases* are largely similar to this. Such cases are abundant in ancient texts, indicating that cases where summer heat originates from the Hand-Taiyin are indeed numerous.
3. He Zhenghua treated a female surnamed Wang suffering from heatstroke, stating: "Due to inherent blood deficiency and liver heat, and external sudden exposure to summer wind, upon onset, only the head trembled, hands and feet were numb, progressing to spasms and inability to stand, followed by immediate fainting. The pulse was string-thin and slightly rapid; the tongue was red with purple hues. Combining pulse and symptoms, this is summer wind directly striking the Liver meridian. Treatment follows modified formulas from Zhang Wanxiang. Fresh Rehmannia Root 6 qian, Angelica Sinensis Body 1 qian, Prepared Kudzu Root 1 qian, Tribulus 2 qian, Biyu San 3 qian (wrapped in lotus leaf, pierced), Fresh Lotus Leaf Stem 7 cun, Mulberry Branch with buds 2 chi."
Commentary: Ming dynasty physician Gong Xin stated: "Summer heat is the command of Ministerial Fire. In summer, humans contract it entering from the mouth and teeth, injuring the Pericardium meridian. The pulse may be empty, or floating-large and scattered, or string-thin, hollow, and slow. External symptoms include headache, body heat, dry mouth, irritability, thirst, greasy face, spontaneous sweating, fatigue, shortness of breath, cold back, aversion to heat. In severe cases, fire excess controls Metal, failing to control Wood, leading to exclusive dominance of Liver pathogen, resulting in convulsions and loss of consciousness. The pathology of this case belongs exactly to this. These types of cases sufficiently prove that which meridian the summer heat pathogen injures first varies according to the individual's constitution. Therefore, differentiation of syndromes must not be rigidly adhered to the theory of originating from the Yangming. Yet modern people竟然 (actually) consider summer heat entering the Yangming as the fundamental disease of summer-warmth. Then what syndrome would the above cases be classified as summer-warmth? From this observation, holding to the single aspect of summer heat entering the Yangming to generalize the rest is worthy of discussion.
Conclusion: 1. Summer heat is one of the Six Excesses. Its injury to humans results in illness, encompassing only two types: new contraction and latent evil. New contractions are called summer-warmth; latent evils are called latent summer heat. Physicians do not limit latent summer heat to the Yangming meridian alone, yet for summer-warmth, they favor citing the theory of "originating from the Yangming." Little do they know that this theory not only contradicts Ye Tianshi's statement "Warm pathogens are received from above, first attacking the Lung," but also, upon checking treated cases, does not align with reality. Therefore, I hereby refute it.
2. The statement "For heatstroke, regardless of exterior or interior, Baihu is generally suitable" is fundamentally insufficient as a guideline. If we learn without thinking, pick up the dregs of predecessors and exaggerate their words, mistakenly believing that summer heat must originate from the Yangming, "blindly copying established formulas," "only clearing the interior without resolving the exterior," and thus mistreating patients, then as Yu Chang said, this is "the sin of the physician."
References
① Nanjing University of Traditional Chinese Medicine, ed., *Wenbingxue* (Trial Textbook for National Higher Medical Institutions), Shanghai Science and Technology Press, 1981.
② Zhang Yin'an, *Shanghan Jizhu*.
③ Danbo Yuanjian et al., *Jingui Yuhan Yaolue Jiyi*, People's Medical Publishing House, 1983.
④ Wu Qian et al., *Yizong Jinjian · Shanghan Lun Zhu*, People's Medical Publishing House, 1979.
⑤ Dai Sigong, *Zhengzhi Yaojue*.
⑥ Chen Yan, *Sanyin Jiyi Bingzheng Fanglun*, People's Medical Publishing House, 1983.
⑦ Wang Kentang, *Zhengzhi Zhunsheng*.
⑧ Cited from *Yifang Leiju*.
⑨ Wang Lun, *Mingyi Zazhu*.
⑩ Wang Mengying, *Wenre Jingwei*.
⑪ Xu Hengzhi et al., *Song Yuan Ming Qing Mingyi Lei'an · Chen Xiuyuan Yi'an*, Guoyou Yinshuguan.
⑫ He Lianchen, *Chongding Quanguo Mingyi Yan'an Bianlei*, Shanghai Science and Technology Press, 1982.
⑬ Wu Kun'an, *Shanghan Zhizhang · Vol. 4 Summer Syndrome*, Shanghai Science and Technology Press, 198...
0·i:1·· Wu Jutong, *Wenbing Tiaobian · Upper Jiao Chapter*, People's Medical Publishing House, 1978.
⑭ Qin Bomo, *Qingdai Mingyi An Jinghua · Qin Diqiao Yi'an*, Shanghai Science and Technology Press, 1981.
⑮ Hua Xiuyun et al., *Linzheng Zhinan Yi'an · Summer*, Longwen Shuju.
⑯ Wu Tang, *Wujutong Yi'an*, People's Medical Publishing House, 1981.
⑰ Ibid.
⑱ Ibid.
⑲ Cited from *Gujin Tushu Jicheng Yibu Quanlu*.
Wu Jutong's Discussion on Treating Upper Jiao Invading Middle Jiao Contains Many Contradictions
Wu Jutong's *Wenbing Tiaobian* is hailed as a classic by admirers. In reality, this book contains many theoretical contradictions. We must clearly distinguish its flaws and merits and must not follow blindly. Taking his discussions on the prohibition of herbs that treat the Upper Jiao by invading the Middle Jiao as examples:
Wu believed: "All warm diseases begin in the Upper Jiao, involving the Hand-Taiyin. Treating the Upper Jiao is like feathers; only light substances can lift it. Therefore, for the initial stage of warm diseases, one should purely clear and purge the Upper Jiao without affecting the Middle and Lower. Treating the Upper by invading the Middle is the major prohibition in medication for the initial stage of warm diseases." This viewpoint is reflected concretely in the following texts.
In *Wenbing Tiaobian · Wu Keji Prohibits Coptis*, it says: "When I use Puji Xiaodu Yin for the initial stage of warm diseases, I must remove Huangqin and Lianxin, fearing they will enter the interior and invade the Middle and Lower Jiao." In the self-commentary of Article 18 of the Upper Jiao Chapter of the same book, it says: "Removing Huangqin and Lianxin: Qin and Lian are interior drugs. When the disease is in its initial stage and has not reached the Middle Jiao, one must not use interior drugs first, thus invading the Middle Jiao." In the self-commentary of Article 24 of the Upper Jiao Chapter, it again says: "Lianxin and Gancao are purely interior drugs. For early summer heat, they need not be used, lest they draw the pathogen deeper." Jutong criticized You Keji's use of Daoyuan Yin to treat warm epidemics multiple times, mainly because he disliked its tendency to treat the Upper by invading the Middle. For example, in the formula discussion of Yinqiao San in Article 4 of the Upper Jiao Chapter, he said: "In this formula, Areca Nut, Tsaoko Fruit, and Magnolia Bark are used as sovereigns. Areca nut is hard among seeds; all seeds descend. Areca nut is acrid, pungent, and warm, heavy-bodied and hard, moving from the middle downwards, reaching directly to the anus; it is a Middle and Lower Jiao drug. Tsaoko fruit is also a seed; its qi is foul, intense, and hot, its taste bitter, a plundering drug for the Taiyin Spleen meridian. Magnolia Bark is bitter and warm, also a Middle Jiao drug. How could an Upper Jiao warm disease start with Middle and Lower Jiao bitter, warm, fierce, and plundering products, first plundering the Shaoyin fluids! Anemarrhena and Huangqin are also Middle Jiao bitter, dry, and interior drugs; how can they be used?" According to some of the above citations, Huangqin, Lianxin, Gancao, Houpo, and Zhimu should all be listed as prohibited drugs for treating the Upper by invading the Middle, which is unquestionable. However, when Wu treated Taiyin Fengwen, Wenre, Wenyi, and Dongwen with initial aversion to wind and cold, he primarily used Guizhi Tang (Jujube in the formula is also a Middle Jiao drug); for those with heat but no aversion to cold and thirst, he primarily used Yinqiao San; both formulas contain Gancao. When Wu treated Taiyin Fengwen with only cough, slight body heat, and mild thirst, he primarily used Sangju Yin. For those with floating-hong pulse, yellow tongue, extreme thirst, profuse sweating, red face, and aversion to heat, he primarily used Baihu Tang; both formulas contain Gancao, and Baihu Tang also contains Zhimu. Furthermore, the reason Wu insisted on removing Huangqin and Lianxin from Puji Xiaodu Yin was because they are interior drugs, feared to invade the Middle, and draw the pathogen deeper. Yet Gancao, also a "purely interior drug," was not removed. As long as one briefly flips through the Upper Jiao Chapter, one can discover that many formulas use Gancao. For example, the original formula of Qingluo Yin does not contain Gancao, but when Wu treated Hand-Taiyin summer-warmth with only cough, no phlegm, and clear, high-pitched coughing, he not only specifically added Gancao but also added Zhimu. Wu did not restrict herbs by meridian boundaries, using Baihu Tang, the main agent for Yangming disease, to treat Hand-Taiyin warm disease; this is acceptable. But if one says Gancao and Zhimu are drugs that treat the Upper by invading the Middle, they should not be used.
Regarding Huangqin, in the self-commentary of Article 99 of the Middle Jiao Chapter, Wu said: "Lianxin and Huangbai only move to the Middle and Lower; Huangqin moves to the Middle and Upper. For Huangqin is a drug of the Hand and Foot Yangming and Hand-Taiyin." Also, when Wu treated Fei Nüe (Lung Malaria) primarily using Xingren Tang, he believed: "The malaria pathogen is initially received in the Lung, reversely transmitting to the Pericardium meridian." "Lung Malaria is the shallowest form of malaria. Although Lung Malaria is said to be easy to resolve, if delayed slightly, it goes deep. It is most taboo to use the standard, clichéd Xiao Chaihu Tang for malaria treatment, because the Lung is far from the Shaoyang half-exterior half-interior boundary, and one must not draw the pathogen deeper." However, the Xingren Tang formula contains Huangqin, Talcum, and Poria Blocks. Whether the latter two are Upper Jiao drugs can be set aside for now; Huangqin is an interior drug that Wu explicitly stated "should not be used first when the disease is in its initial stage and has not reached the Middle Jiao." Why was it used again? Also, in the initial diagnosis of Wu's treatment of Patient Shi's warm disease case, he said: "The right pulse is overwhelmingly hong-da. Summer heat injures the Hand-Taiyin, showing signs of reversely transmitting to the Pericardium. Severe panting and thirst, restlessness and agitation, occasional delirium, body heat and vomiting. Proposal: Simultaneously clear the heat of the Heart Ying and Lung Wei. Chuanlian 1 qian, Zhimu 1 qian, Huoxiang Stem 1 qian, Bamboo Leaf 1 qian, Moutan Cortex 1 qian, Raw Gancao 8 fen, two prescriptions per day." ① The pathology of this case is in the Upper Jiao Heart and Lung. Whether the Huoxiang Stem and Moutan Cortex used are Upper Jiao drugs can also be set aside. If Lianxin only moves to the Middle and Lower, Gancao is purely an interior drug, and Zhimu is also a Middle Jiao drug, why were they all used?