伤寒与温病的区别，时逸人意见：“以恶寒轻而发热重、口渴者，为‘温病’；反之，恶寒重而发热轻飞口不渴者，为‘伤寒’。”众所周知，伤风(感冒)的辨证，大体上分为风寒感冒与风热感冒两型，前者习惯上称为小伤寒，后者则称为小风温，寒、温之判的依据，主要就是从症状来分析，也就是看其是恶寒重于发热、口不渴，还是发热重于恶寒、口微渴(当然，从脉象的浮紧浮数等方面，还可以有一些区别)。伤寒家遇风寒型感冒，说这是由寒邪所引起，故称之为小伤寒，故治疗主以辛温解表；温热家遇风热型感冒，说这是由温邪所引起，故称之为小风温，故治疗主以辛凉解表，这样辨证论治，俱未有误。但从病因学角度来看，说风寒型感冒的病因是寒邪，说风热型感冒的病因是温邪，这种认识，忽视了人体的应激作用，从果溯因，凭藉主观，把病因与机体互相作用的反应，全归之于外因，实则上是不正确的(而且也是不统一的，如雷少逸就认为风温、春温等都是由寒邪所引起)。
伤风是外感病之一，《景岳全书·伤风》论证的第一句话就是：“伤风之病，本由外感。”时逸人说：“凡内热重之素因(体温增进)，如受外感，必患温病；内热轻之素因(体温衰减)，如受外感，必患伤寒，阅者勿易其言。"(《中医伤寒与温病》)辨证求因的“证”，本是病原体与机体互相作用的反应，恂如时氏言，则伤风感冒之所以有寒热两型之表现，决定的因素主要是内因而不是外因，这与瘦人多火，肥人多湿，主要决于机体的素因，似是同样的道理。
现代医学知道伤风的病因是病毒。吴又可曾将肉眼看不见的致病微生物统称为戾气，并认为鸡瘟病鸡，猪瘟病猪，一病白有一病的戾气，戾气因为种类颇杂，故又称杂气。从吴氏的病因学观点来看，伤风的病因，是一种伤风戾气。中医称伤风戾气，西医称伤风病毒，中西医叫法不一，然名异而实同。故诚如祝味菊所说：“寒、温俱非致病之源”。气候之失调，不过是一种诱因，真正的病原，是有形的言机之邪，即伤风戾气。但由于戾气致病，与气候变化关系很大，气候如适宜于某种戾气繁殖，人就易患某种病，气候如不适宜厂某种戾气生存，人就少患或不患这种病。加之伤风又每以冒风淋雨，受寒疲劳等为诱囚，在科学不发达，戾气无从见的古代，就难免把诱因当病因，故古人认为伤风的病因是风邪、是寒邪(外因)，而“邪之所凑，其气必虚”(内因)，内外相合，其病乃作。故伤风治法，除了辛温解表，辛凉解表，又有益气解表，滋阴解表等多种，这些治法之所以都有效，是因为这都是通过对机体反应状况的分沂而用药，并不是依赖能杀灭或抑制寒邪、温邪的药物来取效。也正因为这样审证求因，辨证论治，用于实践，可以有效，所以将外感病的病因，直接归之于寒、暑、燥、湿、风五气的失常，成了历久相传之习惯。然论外感之病因，不能只讲五气，不讲戾气，如果抽掉戾气致病这一重要的中间环节，就难免有误把诱因当病因之失。
二、关于温邪
五气失常，素称六淫，六淫是寒、暑、燥、湿、风，火。六淫之中，原无温邪之说，但自叶天士倡言“温邪上受”，“温邪"之说，遂大行于世。这样，，六淫实际上是变成了七淫。如果说温邪本不在六淫之外，即包括暑邪、火邪而言，则暑邪、火邪、温邪、热邪，名目愈多，概念愈混，内涵重叠，定义混淆，此六淫原只五气，言六本已不通(火除烧伤外，不能成为外感的病因，此古人早已疑之，陆九芝答袁生问，迂回曲折，实多牵强，连服膺其学的章巨膺都感到不满。1981年第4期山东中医学院学报上亦有专文论此，故不复赘言)，今又添出温邪一项，于中医病因学，实无裨益。人体对正常的气候变化，自能适应，若非太热，太寒，太湿，太燥，一般不足以干扰机体的调节及抗病能力，绐戾气致病形成有利条件。温暖的气候，于人体最适，决不能象寒、暑、燥、湿、风那样，剌激、干扰机体的正常生理活动，而引起疾病。故称温为邪，谓“春月受风，其气已温”，“温邪上受”，“温邪夹风”，实比把风寒等诱因当病因的说法更无稽。温热家所谓由温邪引起的温病，实际上无非是机体反抗戾气产生了应激亢进之表现，故即所谓小风温，亦；非真由温邪所引起，也非温邪夹风所造成，而实是风载戾气，吸入口鼻，犯肺为病。为病之后，因机体反应亢进，辨证属热，所以判断为“小风温”；如为病之后，机体反应不急亢，辨证属寒，就可以判断为“小伤寒”。雷少逸鉴于感冒类病大都由冒风受寒疲劳等诱起，故认为风温、春温也是受寒邪所引起。但诚如祝味菊说：“叶氏之视温热也，以为实有温热之邪也，以为温热之邪，于法宜用寒凉也。”故“其处方虽有前后缓急之法，而赏用清凉，其揆一也。唯其主观以为温邪当凉，故曰‘虽在吴人阳微之体，亦当应用清凉，’明知阳微过清必死，故又曰‘清凉到六七分，即不可过于寒凉，恐成功反弃也。’总是立名不正，遂令其言不顺。”祝氏认为：这是叶氏学说中最不可取部分，亟宜正之。惜此书流布不广，其说尚未为人们所注重。
从临床实践来看，由于温热家视外感病中机体应激亢进的热化症状，是病邪性质属温所造成，不是看作是戾气与内热重之素因互相作用的机体反应，故不但视麻，桂如蛇蝎(认为温邪化热最速，用之犯以温治温之戒)，而且畏柴、葛如虎(认为温邪最易伤阴，用之犯劫竭阴津之戒)，用药自设藩篱，蹄子变窄，遂流于轻清平淡一支。实际上，麻、桂、柴、葛，都是外感解表之要药，虽其温升之性于机体应激亢进及阴虚体质不相宜，但药用群队，方有相制，如果立法不误，只要妥为配伍，原可扬长抑短(如麻黄杏仁石膏甘草汤以麻黄配石膏，一柴胡饮以柴胡配生地，就可用于治热病及阴虚之外感)，而其宣郁热、散外邪之力，远非桑叶、薄荷、豆豉、豆卷类所可比。须知治寒则以麻黄配桂枝，治热则以麻黄配石膏，此是先人已效之成法。治阴虚犯感，辟拘经限药之非，以柴胡配生地；治应激亢进，或以柴胡配知、膏(如一柴胡饮)，或以羌活合公英(如羌蒡蒲薄汤)，则是后人别开生面之活法。然拘于温邪之说者，对麻、桂、柴、葛类药，常不敢轻用，甚危言耸听，竟说：“少用一剂柴胡即多活一人性命，”“弃而不用，亦保全性命之一道。”①其于辛凉之解表药畏之若是，则于辛温之品，可知矣！另一方面，又每将小风温之治，如桑菊饮，银翘散类之药法，竟移作为一切温病初起之治规，此所以陆九芝有“伤寒一证，至天士而失传，温热一证，亦至天士而失传”之激言也。
三、关于病名
伤风本为中医固有之病名，宋·陈言《三因极一病证方论》、明，皇甫中《明医指掌》以及《景岳全书》、《金匮钩玄》等医著中，均载此病。但后世论外感之专著，如吴鞠通之《温病条辨》及俞根初之《通俗伤寒论》等书中，反不见了伤风之病名。唯彼书虽不用其名而并不遗其实，仅一囊括于风温中，一改称为小伤寒而已。章太炎深不满于病名之乱改，他说；“夫病之治疗，古今或容有异，若以病状定病名，此不能违古而妄更，”这种见解是很有道理的。叶天士所谓“温邪上受，首先犯肺，”“挟风加薄荷、牛蒡之属"的温病，吴鞠通所说；“太阴风温，但咳，身不甚热，微渴者，辛凉轻剂桑菊饮主之”的风温，实际上即风热感冒，不是仲景书中的温病与风温，所以吴氏说是小病，然这正如章太炎先生所说，是悬牛头，卖马脯。伤风这个病名并没有什么不好，笔者赞同谢诵穆的主张：“症状可复核，病名当统一”，伤寒家不应因伤风由受寒而诱发，便不称其为伤风而竟称其为伤寒，温热家亦不应因伤风辨证属风热型，便不称其为伤风而竟称其为温病。有如对象是鹿，其名约定俗成，本已确定，后人妄更，或称为马，或称为牛，反重新就马，牛之名作争论，宁非笑谈。或谓伤风之辨证属寒者称为小伤寒，伤风之辨证属热者称为小风温，其定名从辨证而有据，较笼统称为伤风更入细。其实凡病辨证，莫不有寒热之分，若因此而将一病名分为二名，实竟反因证而忘病。清后医家，或称伤风为伤寒，或称伤风为风温，仅因辨证有寒热之不同，遂使一病变生数名，致反生寒、温之纷争，此则徒乱后人之耳目，故不足以为训。从上述可知，杜撰温邪，是混淆病名之基，而混淆病名，又成寒热争执之因，故欲息二派之争，宜辟温邪说之谬，并即从正名始。
下再举一近人医案析议之，以作为本文之结尾。
“杨XX，女，28岁，入院前四天，气温骤降，患者洗澡当风受凉，次日出现恶寒重，发热轻，流清涕，头痛，无汗，口不渴等，体温38℃，经用复方氨基比林，201注射剂治疗，体温不降。入院前一天恶寒虽减轻，而发热加重，体温达40℃。入院时患者感发热重，微恶风寒，口渴，流浊涕，咽微痛，小便微黄，大便正常，无恶心呕吐及咳嗽，查体：呈急性热病容，咽部轻度充血，舌红苔薄黄，脉浮数。诊断为感冒后期，风寒化热。治当辛凉解表，故以银翘散治之。三天后，体温下降至正常，诸证消失。”②
按：此病在受凉后而发，初起诱因未解，体温调节障碍，故出现寒重热轻，流清涕，口不渴等症状，此时若由伤寒家诊，必诊为伤寒，必谓病因为寒邪。然谓病因为寒邪，实是以诱因为病因。尔后诱因渐解，机体应激亢进，故出现热重寒轻，流浊涕，口渴等症状，此时若由温热家诊，必诊为温病，必谓病因为温邪，盖审证测因，从证溯因，断为温邪致病，这在温热家来说，是极其自然的。如有人以初起曾受凉以诘之，崇信《时病论》之说者，亦可用雷氏谓风温、春温均由感寒诱发来解释。即此一例，已可见寒邪、温邪之说，纯属主观之推论。恽铁樵说：“今有一病于此，甲医曰是伤寒也，乙医曰是温病也，病家茫然不知所从，取决于余，余曰伤寒有五，是温病乃五种伤寒之一，二说皆是，病家益无所适从，则延西医。”在病因病名问题上，伤寒家与温热家，如各存门户之见，于同一对象，彼此凭主观臆测作争论，就恐怕难以征信于病人，恽氏所说的那种情况，是宜当引起我们注意的。而上一病例，若采吴又可、祝味菊诸家之说解释之，则其病名为伤风，其病因为戾气，其诱因为受凉，其病机为初起体温调节障碍，尔后应激机能亢进，……若是之议，始为医理之正。医者若能跳出寒、温二派之圈子，信必以余言为不诬1
参考文献
①转引自《本草害利》，中国古籍出版社，1982
②谢薇西，寒邪在表亦可化热，四川中医，(1)：8，1984
从伤寒名实谈到“仲景书略于治温”说“经云凡热病者皆伤寒之类，有清以前，此议勿失。”但到叶吴之后，该派中人，为与仲景学说分庭抗礼，说：“仲景之书专论伤寒，此六气中之一气耳，其中有兼言风者，亦有兼言温者，然所谓风者，寒中之风，所谓温者，寒中之温，以其书本论伤寒也。”(《温病条辨》)该派中人，既于《伤寒论》“专为伤寒而设，未尝遍及于六淫”，而自叔和以下，“大约皆以伤寒之法，疗六气之疴，御风以絺，指鹿为马，殆试而辄困”(同上)，故“怀救世之心”，“抗志以希古人”，而撰《温病条辨》等著作。迄秦之桢作《伤寒大白》，说仲景书“惟有冬月正伤寒治法，而不及春夏秋三时之证，”又谓南方无真伤寒，全是温热。这样一来，《伤寒论》已经过时，是最明白不过的了。
伤寒与温病的区别，时逸人的观点是：“以恶寒轻而发热重、口渴者，为‘温病’；反之，恶寒重而发热轻且不口渴者，为‘伤寒’。”众所周知，伤风（感冒）的辨证，大体上分为风寒感冒与风热感冒两型，前者习惯上称为小伤寒，后者则称为小风温。寒、温之判别的依据，主要就是从症状来分析，也就是看其是恶寒重于发热、口不渴，还是发热重于恶寒、口微渴（当然，从脉象的浮紧、浮数等方面，还可以有一些区别）。伤寒家遇到风寒型感冒，说这是由寒邪所引起，故称之为小伤寒，故治疗主以辛温解表；温热家遇到风热型感冒，说这是由温邪所引起，故称之为小风温，故治疗主以辛凉解表。这样辨证论治，俱未有误。但从病因学角度来看，说风寒型感冒的病因是寒邪，说风热型感冒的病因是温邪，这种认识，忽视了人体的应激作用，从果溯因，凭藉主观，把病因与机体互相作用的反应，全归之于外因，实则上是不正确的（而且也是不统一的，如雷少逸就认为风温、春温等都是由寒邪所引起）。
伤风是外感病之一，《景岳全书·伤风》论证的第一句话就是：“伤风之病，本由外感。”时逸人说：“凡内热重之素因（体温增进），如受外感，必患温病；内热轻之素因（体温衰减），如受外感，必患伤寒，阅者勿易其言。”（《中医伤寒与温病》）辨证求因的“证”，本是病原体与机体互相作用的反应，恂如时氏言，则伤风感冒之所以有寒热两型之表现，决定的因素主要是内因而不是外因，这与瘦人多火，肥人多湿，主要决于机体的素因，似是同样的道理。
现代医学知道伤风的病因是病毒。吴又可曾将肉眼看不见的致病微生物统称为戾气，并认为鸡瘟病鸡，猪瘟病猪，一病白有一病的戾气，戾气因为种类颇杂，故又称杂气。从吴氏的病因学观点来看，伤风的病因，是一种伤风戾气。中医称伤风戾气，西医称伤风病毒，中西医叫法不一，然名异而实同。故诚如祝味菊所说：“寒、温俱非致病之源”。气候之失调，不过是一种诱因，真正的病原，是有形的言机之邪，即伤风戾气。但由于戾气致病，与气候变化关系很大，气候如适宜于某种戾气繁殖，人就易患某种病，气候如不适宜某种戾气生存，人就少患或不患这种病。加之伤风又每以冒风淋雨，受寒疲劳等为诱囚，在科学不发达，戾气无从见的古代，就难免把诱因当病因，故古人认为伤风的病因是风邪、是寒邪（外因），而“邪之所凑，其气必虚”（内因），内外相合，其病乃作。故伤风治法，除了辛温解表，辛凉解表，又有益气解表，滋阴解表等多种，这些治法之所以都有效，是因为这都是通过对机体反应状况的分沂而用药，并不是依赖能杀灭或抑制寒邪、温邪的药物来取效。也正因为这样审证求因，辨证论治，用于实践，可以有效，所以将外感病的病因，直接归之于寒、暑、燥、湿、风五气的失常，成了历久相传之习惯。然论外感之病因，不能只讲五气，不讲戾气，如果抽掉戾气致病这一重要的中间环节，就难免有误把诱因当病因之失。
二、关于温邪
五气失常，素称六淫，六淫是寒、暑、燥、湿、风，火。六淫之中，原无温邪之说，但自叶天士倡言“温邪上受”，“温邪"之说，遂大行于世。这样，，六淫实际上是变成了七淫。如果说温邪本不在六淫之外，即包括暑邪、火邪而言，则暑邪、火邪、温邪、热邪，名目愈多，概念愈混，内涵重叠，定义混淆，此六淫原只五气，言六本已不通（火除烧伤外，不能成为外感的病因，此古人早已疑之，陆九芝答袁生问，迂回曲折，实多牵强，连服膺其学的章巨膺都感到不满。1981年第4期山东中医学院学报上亦有专文论此，故不复赘言），今又添出温邪一项，于中医病因学，实无裨益。人体对正常的气候变化，自能适应，若非太热，太寒，太湿，太燥，一般不足以干扰机体的调节及抗病能力，绐戾气致病形成有利条件。温暖的气候，于人体最适，决不能象寒、暑、燥、湿、风那样，剌激、干扰机体的正常生理活动，而引起疾病。故称温为邪，谓“春月受风，其气已温”，“温邪上受”，“温邪夹风”，实比把风寒等诱因当病因的说法更无稽。温热家所谓由温邪引起的温病，实际上无非是机体反抗戾气产生了应激亢进之表现，故即所谓小风温，亦；非真由温邪所引起，也非温邪夹风所造成，而实是风载戾气，吸入口鼻，犯肺为病。为病之后，因机体反应亢进，辨证属热，所以判断为“小风温”；如为病之后，机体反应不急亢，辨证属寒，就可以判断为“小伤寒”。雷少逸鉴于感冒类病大都由冒风受寒疲劳等诱起，故认为风温、春温也是受寒邪所引起。但诚如祝味菊说：“叶氏之视温热也，以为实有温热之邪也，以为温热之邪，于法宜用寒凉也。”故“其处方虽有前后缓急之法，而赏用清凉，其揆一也。唯其主观以为温邪当凉，故曰‘虽在吴人阳微之体，亦当应用清凉，’明知阳微过清必死，故又曰‘清凉到六七分，即不可过于寒凉，恐成功反弃也。’总是立名不正，遂令其言不顺。”祝氏认为：这是叶氏学说中最不可取部分，亟宜正之。惜此书流布不广，其说尚未为人们所注重。
从临床实践来看，由于温热家视外感病中机体应激亢进的热化症状，是病邪性质属温所造成，不是看作是戾气与内热重之素因互相作用的机体反应，故不但视麻，桂如蛇蝎（认为温邪化热最速，用之犯以温治温之戒），而且畏柴、葛如虎（认为温邪最易伤阴，用之犯劫竭阴津之戒），用药自设藩篱，蹄子变窄，遂流于轻清平淡一支。实际上，麻、桂、柴、葛，都是外感解表之要药，虽其温升之性于机体应激亢进及阴虚体质不相宜，但药用群队，方有相制，如果立法不误，只要妥为配伍，原可扬长抑短（如麻黄杏仁石膏甘草汤以麻黄配石膏，一柴胡饮以柴胡配生地，就可用于治热病及阴虚之外感），而其宣郁热、散外邪之力，远非桑叶、薄荷、豆豉、豆卷类所可比。须知治寒则以麻黄配桂枝，治热则以麻黄配石膏，此是先人已效之成法。治阴虚犯感，辟拘经限药之非，以柴胡配生地；治应激亢进，或以柴胡配知、膏（如一柴胡饮），或以羌活合公英（如羌蒡蒲薄汤），则是后人别开生面之活法。然拘于温邪之说者，对麻、桂、柴、葛类药，常不敢轻用，甚危言耸听，竟说：“少用一剂柴胡即多活一人性命，”“弃而不用，亦保全性命之一道。”①其于辛凉之解表药畏之若是，则于辛温之品，可知矣！另一方面，又每将小风温之治，如桑菊饮，银翘散类之药法，竟移作为一切温病初起之治规，此所以陆九芝有“伤寒一证，至天士而失传，温热一证，亦至天士而失传”之激言也。
三、关于病名
伤风本为中医固有之病名，宋·陈言《三因极一病证方论》、明，皇甫中《明医指掌》以及《景岳全书》、《金匮钩玄》等医著中，均载此病。但后世论外感之专著，如吴鞠通之《温病条辨》及俞根初之《通俗伤寒论》等书中，反不见了伤风之病名。唯彼书虽不用其名而并不遗其实，仅一囊括于风温中，一改称为小伤寒而已。章太炎深不满于病名之乱改，他说；“夫病之治疗，古今或容有异，若以病状定病名，此不能违古而妄更，”这种见解是很有道理的。叶天士所谓“温邪上受，首先犯肺，”“挟风加薄荷、牛蒡之属"的温病，吴鞠通所说；“太阴风温，但咳，身不甚热，微渴者，辛凉轻剂桑菊饮主之”的风温，实际上即风热感冒，不是仲景书中的温病与风温，所以吴氏说是小病，然这正如章太炎先生所说，是悬牛头，卖马脯。伤风这个病名并没有什么不好，笔者赞同谢诵穆的主张：“症状可复核，病名当统一”，伤寒家不应因伤风由受寒而诱发，便不称其为伤风而竟称其为伤寒，温热家亦不应因伤风辨证属风热型，便不称其为伤风而竟称其为温病。有如对象是鹿，其名约定俗成，本已确定，后人妄更，或称为马，或称为牛，反重新就马，牛之名作争论，宁非笑谈。或谓伤风之辨证属寒者称为小伤寒，伤风之辨证属热者称为小风温，其定名从辨证而有据，较笼统称为伤风更入细。其实凡病辨证，莫不有寒热之分，若因此而将一病名分为二名，实竟反因证而忘病。清后医家，或称伤风为伤寒，或称伤风为风温，仅因辨证有寒热之不同，遂使一病变生数名，致反生寒、温之纷争，此则徒乱后人之耳目，故不足以为训。从上述可知，杜撰温邪，是混淆病名之基，而混淆病名，又成寒热争执之因，故欲息二派之争，宜辟温邪说之谬，并即从正名始。
下再举一近人医案析议之，以作为本文之结尾。
“杨XX，女，28岁，入院前四天，气温骤降，患者洗澡当风受凉，次日出现恶寒重，发热轻，流清涕，头痛，无汗，口不渴等，体温38℃，经用复方氨基比林，201注射剂治疗，体温不降。入院前一天恶寒虽减轻，而发热加重，体温达40℃。入院时患者感发热重，微恶风寒，口渴，流浊涕，咽微痛，小便微黄，大便正常，无恶心呕吐及咳嗽，查体：呈急性热病容，咽部轻度充血，舌红苔薄黄，脉浮数。诊断为感冒后期，风寒化热。治当辛凉解表，故以银翘散治之。三天后，体温下降至正常，诸证消失。”②
按：此病在受凉后而发，初起诱因未解，体温调节障碍，故出现寒重热轻，流清涕，口不渴等症状，此时若由伤寒家诊，必诊为伤寒，必谓病因为寒邪。然谓病因为寒邪，实是以诱因为病因。尔后诱因渐解，机体应激亢进，故出现热重寒轻，流浊涕，口渴等症状，此时若由温热家诊，必诊为温病，必谓病因为温邪，盖审证测因，从证溯因，断为温邪致病，这在温热家来说，是极其自然的。如有人以初起曾受凉以诘之，崇信《时病论》之说者，亦可用雷氏谓风温、春温均由感寒诱发来解释。即此一例，已可见寒邪、温邪之说，纯属主观之推论。恽铁樵说：“今有一病于此，甲医曰是伤寒也，乙医曰是温病也，病家茫然不知所从，取决于余，余曰伤寒有五，是温病乃五种伤寒之一，二说皆是，病家益无所适从，则延西医。”在病因病名问题上，伤寒家与温热家，如各存门户之见，于同一对象，彼此凭主观臆测作争论，就恐怕难以征信于病人，恽氏所说的那种情况，是宜当引起我们注意的。而上一病例，若采吴又可、祝味菊诸家之说解释之，则其病名为伤风，其病因为戾气，其诱因为受凉，其病机为初起体温调节障碍，尔后应激机能亢进，……若是之议，始为医理之正。医者若能跳出寒、温二派之圈子，信必以余言为不诬1
参考文献
①转引自《本草害利》，中国古籍出版社，1982
②谢薇西，寒邪在表亦可化热，四川中医，(1)：8，1984
从伤寒名实谈到“仲景书略于治温”说“经云凡热病者皆伤寒之类，有清以前，此议勿失。”但到叶吴之后，该派中人，为与仲景学说分庭抗礼，说：“仲景之书专论伤寒，此六气中之一气耳，其中有兼言风者，亦有兼言温者，然所谓风者，寒中之风，所谓温者，寒中之温，以其书本论伤寒也。”（《温病条辨》）该派中人，既于《伤寒论》“专为伤寒而设，未尝遍及于六淫”，而自叔和以下，“大约皆以伤寒之法，疗六气之疴，御风以絺，指鹿为马，殆试而辄困”（同上），故“怀救世之心”，“抗志以希古人”，而撰《温病条辨》等著作。迄秦之桢作《伤寒大白》，说仲景书“惟有冬月正伤寒治法，而不及春夏秋三时之证，”又谓南方无真伤寒，全是温热。这样一来，《伤寒论》已经过时，是最明白不过的了。
The distinction between Shanghan (Cold Damage) and Wenbing (Warm Diseases), according to Shi Yiren's opinion, is: "Those with mild aversion to cold but severe fever and thirst are classified as 'Wenbing'; conversely, those with severe aversion to cold but mild fever and no thirst are classified as 'Shanghan'." It is well known that the syndrome differentiation of Shangfeng (Common Cold) is broadly divided into two types: Fenghan Ganmao (Wind-Cold Common Cold) and Fengre Ganmao (Wind-Heat Common Cold). The former is habitually called Xiaoshanghan (Minor Shanghan), while the latter is called Xiaofengwen (Minor Wind-Warmth). The basis for distinguishing between cold and warmth lies primarily in symptom analysis—specifically, whether aversion to cold outweighs fever with no thirst, or whether fever outweighs aversion to cold with slight thirst (of course, there may be some differences in pulse characteristics such as floating-tight [Fu Jin] or floating-rapid [Fu Shu]). When a Shanghan specialist encounters a Wind-Cold type common cold, they attribute it to Cold Evil (Han Xie) and thus call it Minor Shanghan; consequently, the treatment mainly employs Acrid-Warm Exterior-Releasing methods. Conversely, when a Wenbing specialist encounters a Wind-Heat type common cold, they attribute it to Warmth Evil (Wen Xie) and thus call it Minor Wind-Warmth; consequently, the treatment mainly employs Acrid-Cool Exterior-Releasing methods. Such syndrome differentiation and treatment are both correct. However, from an etiological perspective, attributing the cause of Wind-Cold common cold to Cold Evil and that of Wind-Heat common cold to Warmth Evil ignores the body's stress response. Inferring causes from effects relies on subjectivity, attributing the interaction between pathogenic factors and the organism entirely to external causes, which is actually incorrect (and inconsistent; for instance, Lei Shaoyi believed that Wind-Warmth and Spring-Warmth were all caused by Cold Evil).
Shangfeng is one of the Exogenous Diseases. The first sentence of the argument in *Jingyue Quanshu · Shangfeng* states: "The disease of Shangfeng originates from external contraction." Shi Yiren said: "For individuals with a predisposing factor of heavy internal heat (increased body temperature), if exposed to external contraction, they will inevitably suffer from Wenbing; for those with a predisposing factor of light internal heat (decreased body temperature), if exposed to external contraction, they will inevitably suffer from Shanghan. Readers should not take these words lightly." (*Zhongyi Shanghan Yu Wenbing*). The "syndrome" in syndrome-based etiology refers to the reaction between pathogens and the organism. As Shi stated, the determining factor for the cold or heat manifestations in Shangfeng common cold is mainly the internal factor rather than the external factor. This is similar to the principle that thin people tend to have more fire and fat people tend to have more dampness, which is determined by the body's predisposing factors.
Modern medicine knows that the cause of Shangfeng is viruses. Wu Youke once collectively referred to invisible pathogenic microorganisms as Liqi (Pestilential Qi), believing that chicken plague affects chickens, swine plague affects pigs, each disease having its own specific Liqi. Because Liqi comprises various types, it is also called Zaqi (Miscellaneous Qi). From Wu's etiological viewpoint, the cause of Shangfeng is a specific Shangfeng Liqi. Traditional Chinese Medicine calls it Shangfeng Liqi, while Western medicine calls it Shangfeng virus. Although the terminology differs, the reality is the same. Thus, as Zhu Weiju stated: "Neither Cold nor Warmth is the source of disease." Climate imbalance is merely a triggering factor; the true pathogen is tangible pathogenic Qi, i.e., Shangfeng Liqi. However, since Liqi-induced diseases are closely related to climate changes, if the climate is suitable for the reproduction of a certain Liqi, people are prone to that disease; if the climate is unsuitable for the survival of a certain Liqi, people rarely or never contract that disease. Additionally, Shangfeng is often triggered by exposure to wind and rain, cold, and fatigue. In ancient times, when science was undeveloped and Liqi could not be seen, it was inevitable to mistake triggering factors for causes. Therefore, ancients believed the cause of Shangfeng was Wind Evil or Cold Evil (external factors), while "where evil gathers, qi must be deficient" (internal factor). The combination of internal and external factors leads to disease. Thus, treatments for Shangfeng include not only Acrid-Warm and Acrid-Cool Exterior-Releasing methods but also Qi-Nourishing and Yin-Nourishing Exterior-Releasing methods. These treatments are effective because they are prescribed based on the analysis of the body's reactive state, not relying on drugs that kill or inhibit Cold or Warmth Evil. Precisely because this method of investigating causes through syndrome differentiation is effective in practice, the habit of directly attributing the cause of exogenous diseases to the abnormality of the Five Qi (Cold, Summer-Heat, Dryness, Dampness, Wind) has been passed down for generations. However, when discussing the causes of exogenous diseases, one cannot speak only of the Five Qi and ignore Liqi. If this important intermediate link of Liqi-induced disease is removed, one risks mistaking triggering factors for causes.
II. Regarding Warmth Evil
The abnormality of the Five Qi is traditionally called Liu Yin (Six Excesses), which includes Cold, Summer-Heat, Dryness, Dampness, Wind, and Fire. Originally, there was no concept of "Warmth Evil" within the Six Excesses. However, since Ye Tianshi advocated "Warmth Evil enters from above," the concept of "Warmth Evil" became widely popular. Thus, the Six Excesses effectively became Seven Excesses. If Warmth Evil is considered to be included within the Six Excesses (i.e., encompassing Summer-Heat Evil and Fire Evil), then the terms Summer-Heat Evil, Fire Evil, Warmth Evil, and Heat Evil become numerous, concepts become confused, connotations overlap, and definitions blur. The Six Excesses originally referred to only five Qi; speaking of six was already illogical (Fire, except for burns, cannot be a cause of exogenous disease; the ancients had long suspected this. Lu Jiuzhi's answer to Yuan Sheng was circuitous and forced, causing even Zhang Juying, who deeply respected his learning, to feel dissatisfied. A special article discussing this appeared in the 4th issue of the Journal of Shandong College of Traditional Chinese Medicine in 1981, so I will not elaborate further). Adding Warmth Evil now provides no benefit to TCM etiology. The human body can naturally adapt to normal climate changes. Unless the weather is excessively hot, cold, damp, or dry, it generally does not interfere with the body's regulation and抗病 ability, creating favorable conditions for Liqi-induced diseases. Warm climate is most suitable for the human body and cannot stimulate or interfere with normal physiological activities like Cold, Summer-Heat, Dryness, Dampness, or Wind, thereby causing disease. Therefore, calling Warmth a "Evil" and stating "In spring, wind carries warmth," "Warmth Evil enters from above," or "Warmth Evil combines with Wind" is even more absurd than treating triggering factors like Wind and Cold as causes. The Wenbing practitioners' claim that Wenbing is caused by Warmth Evil is essentially just the manifestation of the body's hyperactive stress response against Liqi. Thus, what is called "Minor Wind-Warmth" is not truly caused by Warmth Evil or Warmth Evil combining with Wind, but rather by Wind carrying Liqi, which is inhaled into the nose and mouth, attacking the Lung. After contracting the disease, due to hyperactive bodily reactions, the syndrome differentiation belongs to Heat, so it is judged as "Minor Wind-Warmth"; if the bodily reaction is not hyperactive after contracting the disease, and the syndrome differentiation belongs to Cold, it can be judged as "Minor Shanghan." Lei Shaoyi, noting that most cold-like illnesses are triggered by exposure to wind, cold, and fatigue, believed that Wind-Warmth and Spring-Warmth were also caused by Cold Evil. But as Zhu Weiju said: "Ye regarded Warmth as an actual pathogenic factor, believing that Warmth Evil should be treated with Cold/Cool methods." Thus, "although his prescriptions have methods of sequence and urgency, his preference for cooling agents is consistent. Only because he subjectively believed Warmth Evil requires cooling did he say, 'Even in bodies with weak Yang, cooling should be applied,' knowing that excessive cooling in weak Yang bodies leads to death, he added, 'When cooling reaches sixty or seventy percent, do not overuse cold/cool herbs, lest success be lost.' Always establishing improper names leads to unreasonable statements." Zhu believed this was the least acceptable part of Ye's theory and urgently needed correction. Unfortunately, this book did not circulate widely, and his views have not received much attention.
From a clinical perspective, because Wenbing practitioners view the heat-syndromes resulting from hyperactive stress responses in exogenous diseases as being caused by the nature of the pathogen being Warmth, rather than seeing them as the body's reaction to the interaction between Liqi and a predisposition of heavy internal heat, they regard Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) as snakes and scorpions (believing Warmth Evil transforms into heat fastest, and using them violates the prohibition of treating warmth with warmth). They fear Chaihu (Bupleuri Radix) and Ge Gen (Puerariae Lobatae Radix) as tigers (believing Warmth Evil easily damages Yin, and using them violates the prohibition of exhausting Yin fluids). By setting up these barriers in medication, their scope narrows, leading to a reliance on light, clear, and bland remedies. In reality, Mahuang, Guizhi, Chaihu, and Ge Gen are essential herbs for releasing the exterior in exogenous diseases. Although their warming and ascending properties are unsuitable for hyperactive stress responses and Yin-deficient constitutions, when used in combinations, they can mutually restrain each other. If the therapeutic principle is correct and appropriate compatibility is used, their strengths can be utilized while minimizing weaknesses (e.g., Mahuang Xingren Shigao Gancao Tang uses Mahuang combined with Shigao [Gypsum Fibrosum]; Yi Chaihu Yin uses Chaihu combined with Shengdi [Rehmanniae Radix], making them usable for treating febrile diseases and exogenous diseases in Yin-deficient patients). Their power to vent depressed heat and scatter external evils far surpasses that of Sangye (Mori Folium), Bohe (Menthae Haplocalycis Herba), Douchi (Sojae Semen Preparatum), and Doujuan (Vigna Radiata Germinatus). It must be understood that treating cold involves combining Mahuang with Guizhi, and treating heat involves combining Mahuang with Shigao; this is an established method proven by predecessors. Treating Yin deficiency complicated by exogenous invasion, avoiding the limitations of fixed formulas, involves combining Chaihu with Shengdi; treating hyperactive stress responses involves either combining Chaihu with Zhimu (Anemarrhenae Rhizoma) and Shigao (as in Yi Chaihu Yin) or combining Qianghuo (Notopterygii Rhizoma et Radix) with Gongying (Taraxaci Herba) (as in Qiang Bang Pu Bo Tang). These are innovative methods developed by later generations. However, those constrained by the theory of Warmth Evil often dare not lightly use herbs like Mahuang, Guizhi, Chaihu, and Ge Gen. Some even make alarming claims: "Using one dose less of Chaihu saves one life," or "Abandoning their use is also a way to preserve life."① If they fear Acrid-Cool exterior-releasing herbs so much, how much more so Acrid-Warm ones! On the other hand, they often apply the herbal methods of formulas like Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction) and Yinqiao San (Honeysuckle and Forsythia Powder) for Minor Wind-Warmth as the standard treatment for the initial stage of all Wenbing. This is why Lu Jiuzji made the passionate statement: "Shanghan was lost with Ye Tianshi, and Wenbing was also lost with Ye Tianshi."
III. Regarding Disease Names
Shangfeng is an inherent disease name in TCM. It is recorded in medical works such as Chen Yan's *Sanyin Jiyi Bingzheng Fanglun* (Song Dynasty), Huangfu Zhong's *Mingyi Zhizhang* (Ming Dynasty), as well as *Jingyue Quanshu* and *Jinkui Gouxuan*. However, in later specialized books on exogenous diseases, such as Wu Jutong's *Wenbing Tiaobian* and Yu Genchu's *Tongsu Shanghan Lun*, the disease name Shangfeng disappears. Although these books do not use the name, they do not omit the reality; they simply encompass it under Fengwen (Wind-Warmth) and rename it Xiaoshanghan. Zhang Taiyan was deeply dissatisfied with the arbitrary alteration of disease names, stating: "Treatment of diseases may differ between ancient and modern times, but if disease names are defined by symptoms, one cannot violate antiquity and arbitrarily change them." This view is very reasonable. The Wenbing described by Ye Tianshi as "Warmth Evil enters from above, initially attacking the Lung," and "combined with Wind, add Bohe and Niubangzi," and the Fengwen described by Wu Jutong as "Taiyin Fengwen, characterized by cough only, slight fever, and slight thirst, treated with the mild Acrid-Cool agent Sangju Yin," are actually Wind-Heat common colds, not the Wenbing and Fengwen found in Zhang Zhongjing's texts. Therefore, Wu called them minor diseases. However, as Mr. Zhang Taiyan said, this is like hanging a bull's head but selling horse meat. There is nothing wrong with the disease name Shangfeng. The author agrees with Xie Songmu's proposition: "Symptoms can be verified, disease names should be unified." Shanghan practitioners should not stop calling it Shangfeng and instead call it Shanghan just because Shangfeng is triggered by cold exposure. Wenbing practitioners should not stop calling it Shangfeng and instead call it Wenbing just because Shangfeng differentiates as Wind-Heat type. It is like an object being a deer; its name is established by convention. Later generations arbitrarily changing it, calling it a horse or a cow, and then arguing over the names of horses and cows, is surely a joke. Some argue that Shangfeng differentiating as cold is called Minor Shanghan, and Shangfeng differentiating as heat is called Minor Wind-Warmth; naming based on syndrome differentiation is evidence-based and more detailed than the general term Shangfeng. In fact, all disease syndrome differentiation involves distinctions between cold and heat. If this leads to splitting one disease name into two, it ultimately forgets the disease due to the syndrome. Later Qing dynasty physicians, calling Shangfeng Shanghan or Fengwen depending on cold or heat differentiation, caused one disease to generate multiple names, leading to disputes between cold and warmth. This only confuses later generations and is not worthy of instruction. From the above, it can be seen that fabricating Warmth Evil is the foundation for confusing disease names, and confusing disease names becomes the cause of cold-heat disputes. Therefore, to end the dispute between the two schools, one should refute the fallacy of the Warmth Evil theory and start with correcting the names.
Next, I will present a recent medical case for analysis as the conclusion of this article.
"Yang XX, female, 28 years old. Four days before admission, the temperature dropped sharply. The patient caught a chill while bathing in the wind. The next day, she presented with severe aversion to cold, mild fever, runny clear nasal discharge, headache, anhidrosis, and no thirst. Body temperature was 38°C. Treatment with Compound Aminopyrine Injection 201 failed to lower the temperature. One day before admission, although aversion to cold decreased, fever intensified, reaching 40°C. Upon admission, the patient felt severe fever, slight aversion to wind and cold, thirst, turbid nasal discharge, slight sore throat, slightly yellow urine, normal stool, no nausea/vomiting, and no cough. Physical examination showed an acute febrile appearance, mild pharyngeal congestion, red tongue with thin yellow coating, and floating-rapid pulse. Diagnosed as late-stage common cold, Wind-Cold transforming into Heat. Treatment required Acrid-Cool Exterior-Releasing, so Yinqiao San was administered. Three days later, temperature returned to normal, and all symptoms disappeared."②
Commentary: This disease developed after chilling. Initially, the trigger was unresolved, causing thermoregulatory dysfunction, hence symptoms of heavy cold and light fever, runny clear nose, and no thirst. At this time, a Shanghan practitioner would diagnose Shanghan and attribute the cause to Cold Evil. However, attributing the cause to Cold Evil is actually mistaking a trigger for a cause. Subsequently, as the trigger gradually resolved, the body's stress response became hyperactive, leading to symptoms of heavy heat and light cold, turbid nasal discharge, and thirst. At this time, a Wenbing practitioner would diagnose Wenbing and attribute the cause to Warmth Evil. Inferring causes from syndromes and concluding Warmth Evil as the cause is natural for Wenbing practitioners. If someone questions this by pointing out the initial chilling, believers in *Shi Bing Lun* could also use Lei's explanation that Wind-Warmth and Spring-Warmth are induced by catching cold. This single case shows that the theories of Cold Evil and Warmth Evil are purely subjective deductions. Yun Tieqiao said: "If there is a disease here, Doctor A says it is Shanghan, Doctor B says it is Wenbing, the patient is bewildered and doesn't know whom to follow, asks me for a decision. I say Shanghan has five types, and Wenbing is one of the five types of Shanghan. Both statements are correct, leaving the patient even more at a loss, so they seek Western medicine." On issues of etiology and disease names, if Shanghan and Wenbing practitioners maintain sectarian views and argue subjectively about the same object, it is feared that credibility with patients will be lost. The situation described by Yun should attract our attention. If the above case were explained using the theories of Wu Youke, Zhu Weiju, and others, the disease name would be Shangfeng, the cause Liqi, the trigger chilling, and the pathogenesis initial thermoregulatory dysfunction followed by hyperactive stress function... Such discussion would be the correct medical theory. If physicians can step out of the circle of the Cold and Warm schools, believing my words will not be false.
References
① Cited from *Bencao Haili*, China Ancient Books Publishing House, 1982.
② Xie Weixi, Cold Evil on the Exterior Can Also Transform into Heat, Sichuan Journal of TCM, (1): 8, 1984.
Discussing the name and reality of Shanghan and the saying "Zhongjing's Book Neglects the Treatment of Warmth": "The Classics state: All febrile diseases are categories of Shanghan. Before the Qing Dynasty, this discussion should not be lost." But after Ye and Wu, members of that school, to rival Zhongjing's theory, said: "Zhongjing's book specifically discusses Shanghan, which is one of the Six Qi. Among them, there are mentions of Wind and Warmth, but the so-called Wind is Wind within Cold, and the so-called Warmth is Warmth within Cold, because the book discusses Shanghan." (*Wenbing Tiaobian*). Since these members believed *Shanghan Lun* was "set up specifically for Shanghan and did not cover the Six Excesses," and that since He Huanzhong (Shuhe) onwards, "roughly all used Shanghan methods to treat diseases of the Six Qi, controlling wind with [incorrect methods], mistaking deer for horses, trials always fail" (ibid.), they "harbored hearts to save the world," "strived to emulate the ancients," and wrote works like *Wenbing Tiaobian*. Until Qin Zhizhen wrote *Shanghan Dabai*, stating that Zhongjing's book "only has treatment methods for true Shanghan in winter months and does not cover symptoms in spring, summer, and autumn," and claiming there is no true Shanghan in the South, only Warmth. In this way, *Shanghan Lun* is obviously outdated.