2·燥的属阴属阳，医界争论不少，但以主阴说居多，鞠通也持这种观点，故若非治其复气，例用温热。余则谓阴阳学说是相对的，若论燥气之属性，应先问其前提如何。如所周知：六气分主四时，风为春季主气，春季气候温暖；燥为秋季主气，秋季气候凉爽，若基于这一前提上，以春秋之主气相对言，燥确是应该属阴的。但如果换一个前提，以燥与湿相对言，燥就应该属阳，所以燥字从火，湿字从水，水火相对，为阴阳之征兆，也是十分明显的。前人争燥气之属性，往往前提不统一，故都是各执一面谈理，鞠通之谓燥为阴邪，实际上也是如此。正因为阴阳属性的相对性原理，鞠通在论燥时未能顾到，所以他只是从胜气复气角度来谈燥气之凉温。然而，即如其所说，燥属阴邪、乃小寒，当以温热为治燥之正法，则秋燥就不应占九种温病之一格。既以秋燥为温病之一种、既云温邪伤人从上而下，寒邪伤人从下而上，出方就不应再用杏苏散治肺，凡此等等，略一思之，就可见其理论上之矛盾，可谓是不胜其多。
二、湿燥二气，混淆不清，名曰治燥，竟是治湿。
对燥与寒二气，鞠通在理性认识上是有错误的，所以在实践中混同一治。对燥与湿二气，鞠通在理性认识上知道二者是对立的，但在实践中仍然分划不清楚。他感到寒、湿、燥三气同属阴邪，很容易混淆，因此说：“盖以燥为寒之始，与寒相似，故(易)混入寒门。又阳明之上，燥气治之，中见太阴，而阳明从中，以中气为化，故又易混入湿门。但学医之士，必须眉目清楚，复《内经》之旧，而后中有定见，方不越乎规矩也。”这番话，他是在斥责前人“非将寒燥混入一门，即混入湿门”时说的，实际上他自己又何尝不是如此！鞠通既以此责前人，而我今仍以此责鞠通。
最明显的事实是：从《吴鞠通医案》中燥门诸案来分析，鞠通用的最多的是二种药：一是温热刚燥药，如吴萸、丁香、桂枝、附子、川椒、干姜、良姜、益智仁之类；二是淡渗芳化药，如茯苓、猪苓、半夏、陈皮、米仁、厚朴、苍术、泽泻之类。而禀柔润之性，具生津之功的治燥品，中燥门几无不用，这种药法，怎么能说是治燥呢？我们将这种药法和寒湿门的药法及《温病条辨》中治寒湿的药法略加比较，就可发觉：二者几乎是完全一致的。如中燥门传五十七案，感受燥金之气为病，药用云苓块、姜半夏、生苡仁各五钱，川椒炭，广皮各三钱，吴萸、良姜、益智仁各二钱，公丁香一钱，后连续数诊，或加佳枝、倍吴萸、良姜，或减川椒、吴萸、良姜，方药基本不变。其他如谢氏案、李氏案、余氏案等，药法大都类同。而寒湿门郭三十二案，病系太阴中湿，药用生姜一两，姜半夏六钱，桂枝、茯苓皮、生苡仁、茅术各五钱，厚朴四钱，川椒目、枳实、广皮、草果各三钱。其二诊用药，也大体如此。二二比观，治法可以说是如出一辙。正因为鞠通对湿燥分划不清，所以他将应属于寒湿门的治案都归入到了中燥门，以致寒湿门形同虚设(实际上寒湿门只有上述一案)，因此只好将痹证医案(本可另立一门)来顶充寒湿案。而从中燥门医案来看，治湿方药几乎替代了治燥方药，从这一事实来说，鞠通燥湿混淆不清，这一点是十分明显的。
又鞠通为治中燥吐泻而制之霹雳散，《温病条辨》及《吴鞠通医案》中两见之，此方“立方会萃温三阴经刚燥苦热之品”为之主，这种药法，也反映出鞠通对治燥湿药法异同认识之模糊。这一问题，诚如《医门法律》所云；“凡秋月燥病，误以为湿治之者，操刃之事也。从前未明，咎犹可诿，今明知故犯，伤人必多，孽镜当前，悔之无及。”显然，湿病误认作燥、燥病误作湿治，都是操刃之事，故吾人当注意分辨之。
又仲景治柔痉用枯萎桂枝汤，君以栝萎之生津润燥，后人治凉燥用桂枝杏仁汤，君以杏仁之微苦温润。就运用桂枝汤治燥证来说，这样子的化裁，很可宗法。但唯独鞠通用桂枝汤治燥，不加柔润之品，反加淡渗之药(如上案)，这样子加减，就治燥来说，是很不得法的，这也是燥湿混淆不清的一种表现。所以，中燥门的治案，就治燥来说，是不足以为训的。相反，如作为寒湿治案看，到可参考。
三、苦燥峻下，攻结忘虚，名曰治燥，实是治实
何廉臣说：“燥与火不同，火为实证，热盛阳亢，身热多汗，法宜苦寒夺其实而泻其热；燥为虚证，阴亏失润，肌肤叹燥，法宜甘寒养其阴而润其燥。”但鞠通治燥，独重攻实，他说：“阳明燥证，里实而坚，未以热化，下之以苦温。已从热化，下之以苦寒。”其自注云：“苦温下法，如《金匮》大黄附子汤，新方天台乌药散加巴豆霜之类。”“苦寒下法，如三承气汤之类。”《温病条辨》中附有其治燥之医案，如车姓案，前医用大承气下之不通，鞠通断为秋金燥气，小邪中里，认为证属寒燥，主以温下，药用天台乌药散加巴豆霜，先加一分，第二次加半分，第三次加二分，三服后始得便。后十五日又不大便，仍用上法治之。现对这种理法，略述不同意见如下：
1·阳明燥证不独要分寒热，而且应分虚实，不可因病在阳明，便谓均属实证。须知阳明燥证，津亏液涸，最多虚实相兼，虽实多虚少者亦有之，但在秋燥一证，究以虚多实少者为多，故凡热化而津液亏乏者，当重养阴生津，增水亦能行舟，若寒化而肠燥液枯者，当重润燥滑肠，润导亦能通便。若忽视甘寒增液、甘温润肠诸法，偏执峻攻，恣投苦燥刚剂，则决非治燥之正法。
2·老人便秘，以精血虚亏，肠燥液涸者居多，若非在外感热病过程中发生，当以杂病视之。鞠通根据“凡坚结牢固，皆属金象”的认识，认为是感受燥气而致，实系误会之言。因一，此证四季均可遇见，若不在秋季，与燥气何涉？二，寒湿门郭案是“寒湿为病，误用硝黄，致浊阴蟠踞，坚凝如石。”既如此，“凡坚结牢固，皆属金象”之说亦不攻而白破。所以治老人燥闭，总以五仁丸、半硫丸之类为正法。车姓案之听以暂效，是因不大便已四十九日，不能不“急则治标”，峻下后未至于脱，亦幸赖其体质之尚可。此案得便后若能以柔润滋养：继之，后当不致复结，结而再用峻攻，恐于正气不能无损。擅用巴豆、大黄，反复峻攻，决非治燥之良法。此诚如何廉臣云：“凡津液素亏者，胃肠本燥，大便每多秘结，适逢秋燥伤肺，气机不宣，则大便不通矣。若用承气猛攻，往往水泻洞泄，中气愈伤，津液益于，而燥屎不下，每致液涸动风，险证丛生。”吾人当注意之。巴豆攻下之力，较承气更为峻猛，老人燥闭，尤宜慎用。车姓案乃治实，非治燥，吾人治老人燥闭，不可以此为口实而轻投峻攻。
3·河间云，“热胜燥，燥自金生，热为火化，金余则制之以火，肺胜则制之以苦。"故治燥非不可用苦，但须知“苦能化燥"，故以苦治燥，唯属实者宜之。观喻昌之制清燥救肺汤，明知“知母能滋肾水，清肺金，亦以苦而不用。”燥病多虚，前人治燥，连性润之品尚谨慎如此，吾人于苦燥刚烈药岂可轻用。然观《温病条辨·补秋燥胜气论》后诸条及中燥门治案，柔润之品，几乎不用，苦燥刚烈，在所不忌，竟是治燥而忘燥！
4·就燥屎内结一证论，属实属虚均有之。而在秋燥一证。则每虚实相兼、有虚有实，实多虚少者固有之，虚多实少者亦不少，故临证必须细辨。就治疗方药论，诸如大黄附了细辛汤、巴豆霜以及承气汤之类，俱系治实而非治燥。大凡燥病，阴津必虚，即见侄闭，峻攻亦当慎用，且只可暂用，不可屡用，更不可独重攻下，竞只分寒热，不办虚实而恣用。须知因燥致结、虚多实少之便闭，所在皆有，若不以猪膏发煎，蜜煎导、济川煎等已效之成法为意，以峻攻治实偶效案视作为治燥之大法，即违背重津保阴之要旨。经云“以苦下之”，是治其实，实非治其燥。仲景云：小便利，大便粳，不可攻下，以脾约麻仁丸润之，，此正戒轻下而恐重伤津液之意也。
结语：治燥大法，诚如前人云：“上燥治气，下燥治血。”气谓津气，补津气可用北沙参、麦冬、五味子之类；血谓精血，滋精血可用当归、地黄、苁蓉之属。而“燥者润之”一语，总不失为治燥之大法。今鞠通冶燥，于此略之，于苦热刚燥峻下诸法独详之，则索隐行怪，流入异端矣！故余谓中燥门诸案及《补秋燥胜气论》后诸条，实不足为后人法。
卷四抨叶医论选辑
论叶天士临证指南伤寒门方
叶先生临证指南卷五，以风寒分门，而寒门所有者六方，并非伤寒大证，即在太阳一经，亦仅言其至小，此书行后，遂不闻以伤寒论治病，今之置寒水六气于不讲者，大抵即由于此，而伤寒论中之细微曲折，亦更无能道其片语者矣。乃有门人华玉堂者，于此一门后，大放厥词，谓人但拘仲景之法，皆为见闻不广，胶柱鼓瑟，不知变通，以明仲景之不足法，而以此六方为治伤寒之一大宗。徐灵胎曰：此即俗名着寒之病，偶尔小恙，不入经络者也，何必牵引伤寒大证，发诸议论，及细阅此篇，竟无伤寒之门，即此为伤寒之法，不禁失笑，夫医者之学问，全在明伤寒之理，则万病皆通，故伤寒为病中第一证，而学医者之第一功夫也，此编独阙此一门，则平日所习何书，所治何病，此非此老之过，抑编此书者，胸中茫无定见矣。灵胎说如此，尚不知此案与此药，亦未必定出自先生也，昔梁苣林中丞浪迹丛谈，载叶先生轶事一则，为龙虎山张真人在吴，于万年桥停舆，让桥下天医星过去，而是日是的，不先不后，天士小舟适从桥下摇橹行来，中丞于此，不溢一词，而其下即引纪文达语，谓天士不事著述，今所有医案十卷，为门人取其治验，附以论断，非天士本意也，石琢堂殿撰，亦谓先生少所著作，指南一编，冗杂不足以传，乃先生弃世后，门下学者，荟萃而成，其方不尽出先生之手，然则此书，明是及门假托，为一时渔利之物，奇在所作医案，每以不了语气，及上下文不联属，又每以也字易矣字，谓是其师汉魏文章，然号无害于病者，若此伤寒一门，则俗医正怕读伤寒书，正谓伤寒方难用，遂若照此六方，法已大备，更不必问途于仲景，而又因此作江南无伤寒之说，非皆不辨真赝而徒震其名之害耶，呜呼！自有李士材医宗必读，而世不知有血证，白有此临证指南，而世不知有伤寒，叶先生为吾苏大医，享盛名于雍乾时，必不至此，彼华玉堂邵新甫辈，造此大孽，且坏先生生后名，安得不为先生一雪此愤哉！(《世补斋医书》)
柴按：考《临证指南》寒门治案，是普通感冒类病之辨证属寒者，叶氏用辛温解表、宣肺化痰类药治疗，治未尝误。感冒又称伤风，乃轻浅小病，陆九芝谓不传经。汪琥认为与《伤寒论》中之伤寒、中风不同。然华岫云辈“牵引伤寒大证，大发议论”，又无的放矢，曰“拘仲景之法而施治，此乃见闻不广。”这在医界竟谓学《伤寒论》是学屠龙之技的历史条件下，极易使人误以为“照此六方，法已大备，更不必问途于仲景”，故陆氏特作此论以针砭时弊，这对发扬仲景学说，是具有积极意义的。
论临证指南温热门席姓七案
席姓脉左数，右缓弱（此为温热病脉）阳根未固（温热与阳根无涉，）阴液渐涸（阳邪之甚，）舌赤微渴（亦阳邪也）喘促，自利溲数（三焦大热）晡刻自热，神烦呓语（日哺所阳明王时也，初诊只有晡刻神烦，）夫温邪久伏少阴（此沿喻氏之说，其误即始于此，）古人立法，全以育阴祛热（古人治温，决不育阴，全以下语气未了，）但今见证，阴分固有伏邪（阳伏于胃，病在阳分，）真阳亦不肯收纳（乃阳邪之充斥，非真阳之不纳，）议仿刘河间浊药轻投（河间从无此法，）不为上焦热阻（独此用未一药，）下焦根柢自立（与下焦根蒂无关，）冀其烦躁热蒸渐缓（不去其热何由缓，）熟地炭茯苓淡苁蓉远志炭川石斛五味（方谬。）
又再诊晚诊阴中伏邪（阳伏于胃，）晡时而升（的是阳明，）目赤羞明（睛不和也，）舌绛而渴（渴为温病，）与育阴清邪法（以阳邪而育阴，阴愈育阳邪念固，而云法乎）生地炭（生熟地之所贵在滋膏，而炒为炭则无用，亦断无先熟后生之理，）元参心川石斛炒麦冬（麦冬无炒用者）犀角石菖蒲（二味并开心窍，送邪入心）
又三诊脉左数右软（此时脉尚未变，）舌干苔白，小溲淋沥（腻滋之效，）吸气喘促（呼气促是脱，吸气促，乃是闭，）烦汗（的是阳明，）肾阴不承（非也，）心神热灼蒙闭（一去胃热蒙闭即开，）议以三才汤滋水制热（岂阴虚而火炎耶，此时之邪热，非滋水所能制）三才加茯神黄柏金箔（邪必益锢）晚进周少川牛黄清心丸一服（助犀角送邪入内·）
2. 关于燥气属于阴还是属于阳，医学界争论很多，但主张属阴的观点占多数。吴鞠通也持这种观点，因此如果不是治疗其复气（即病邪亢盛后的反作之气），通常例用温热药物。我却认为阴阳学说是相对的。如果讨论燥气的属性，应先问其前提条件如何。如众所周知：六气分主四时，风是春季的主气，春季气候温暖；燥是秋季的主气，秋季气候凉爽。若基于这一前提，以春秋两季的主气相对而言，燥确实应该属于阴。但如果换一个前提，以燥与湿相对而言，燥就应该属于阳。所以“燥”字从火，“湿”字从水，水火相对，是阴阳征兆的明显体现。前人争论燥气的属性，往往前提不统一，所以都是各执一面谈理。吴鞠通说燥为阴邪，实际上也是如此。正因为忽略了阴阳属性的相对性原理，吴鞠通在论述燥时未能顾及这一点，所以他只是从胜气（致病之气）和复气的角度来谈论燥气的凉温。然而，即使按照他的说法，燥属于阴邪、相当于小寒，当以温热作为治燥的正法，那么秋燥就不应占据九种温病之一格。既然将秋燥列为温病的一种，又声称温邪伤人从上而下，寒邪伤人从下而上，开方时就不应再用杏苏散治疗肺病。凡此种种，略加思考，就能看出其理论上的矛盾，可谓不胜枚举。
二、湿气和燥气混淆不清，名义上叫治燥，实际上是治湿。
对于燥气和寒气，吴鞠通在理性认识上是错误的，所以在实践中混为一治。对于燥气和湿气，吴鞠通在理性认识上知道二者是对立的，但在实践中仍然划分不清楚。他感到寒、湿、燥三气同属阴邪，很容易混淆，因此说：“大概因为燥是寒的开始，与寒相似，所以容易混入寒门。另外阳明之上，由燥气主治，中见太阴湿土，而阳明从中气化，所以又容易混入湿门。但是学医的人，必须眉目清楚，恢复《黄帝内经》的旧制，然后心中才有定见，才不会越出规矩。”这番话，他是斥责前人“不是将寒燥混入一门，就是混入湿门”时说的，实际上他自己又何尝不是如此！吴鞠通用此责备前人，而我今天仍以此责备吴鞠通。
最明显的事实是：从《吴鞠通医案》中燥门诸案来分析，吴鞠通用药最多的是两种：一是温热刚燥药，如吴茱萸、丁香、桂枝、附子、川椒、干姜、高良姜、益智仁之类；二是淡渗芳化药，如茯苓、猪苓、半夏、陈皮、薏苡仁、厚朴、苍术、泽泻之类。而禀受柔润之性、具有生津功效的治燥药物，在中燥门几乎无不用到，这种用药方法，怎么能说是治燥呢？我们将这种药法和寒湿门的药法及《温病条辨》中治寒湿的药法略加比较，就可发觉：二者几乎是完全一致的。例如中燥门传录五十七案，感受燥金之气为病，药用云苓块、姜半夏、生薏苡仁各五钱，川椒炭，广皮各三钱，吴茱萸、高良姜、益智仁各二钱，公丁香一钱，后连续数诊，或加桂枝、倍用吴茱萸、高良姜，或减去川椒、吴茱萸、高良姜，方药基本不变。其他如谢氏案、李氏案、余氏案等，药法大都类似。而寒湿门郭三十二案，病系太阴中湿，药用生姜一两，姜半夏六钱，桂枝、茯苓皮、生薏苡仁、茅术各五钱，厚朴四钱，川椒目、枳实、广皮、草果各三钱。其二诊用药，也大体如此。二者相比，治法可以说是如出一辙。正因为吴鞠通对湿燥划分不清，所以他将应属于寒湿门的治案都归入到了中燥门，以致寒湿门形同虚设（实际上寒湿门只有上述一案），因此只好将痹证医案（本可另立一门）来顶充寒湿案。而从中燥门医案来看，治湿方药几乎替代了治燥方药，从这一事实来说，吴鞠通燥湿混淆不清，这一点是十分明显的。
另外吴鞠通为治疗中焦燥证引起的吐泻而创制的霹雳散，《温病条辨》及《吴鞠通医案》中两次出现，此方“立方会萃温三阴经刚燥苦热之品”为主，这种药法，也反映出吴鞠通对治燥湿药法异同认识的模糊。这一问题，诚如《医门法律》所说：“凡是秋月燥病，误以为湿来治疗的，如同操刀杀人一样。从前不明白，过错还可以推诿，现在明知故犯，伤人必多，孽镜当前，后悔也来不及了。”显然，湿病误认作燥、燥病误作湿治，都是操刀杀人的事，所以我们应当注意分辨。
另外张仲景治疗柔痉用瓜蒌桂枝汤，以栝楼生津润燥为君药，后人治疗凉燥用桂枝杏仁汤，以杏仁微苦温润为君药。就运用桂枝汤治疗燥证来说，这样的化裁，很值得效法。但唯独吴鞠通用桂枝汤治燥，不加柔润之品，反而加淡渗之药（如上案），这样子加减，就治燥来说，是很不得法的，这也是燥湿混淆不清的一种表现。所以，中燥门的治案，就治燥来说，是不足以为训的。相反，如果作为寒湿治案看，倒可以参考。
三、苦燥峻下，攻结忘虚，名义上叫治燥，实际上是治实
何廉臣说：“燥与火不同，火为实证，热盛阳亢，身热多汗，法宜苦寒夺其实而泻其热；燥为虚证，阴亏失润，肌肤叹燥，法宜甘寒养其阴而润其燥。”但吴鞠通治燥，独重攻实，他说：“阳明燥证，里实而坚，未以热化，下之以苦温。已从热化，下之以苦寒。”其自注云：“苦温下法，如《金匮要略》大黄附子汤，新方天台乌药散加巴豆霜之类。”“苦寒下法，如三承气汤之类。”《温病条辨》中附有其治燥之医案，如车姓案，前医用大承气汤下之不通，吴鞠通断为秋金燥气，小邪中里，认为证属寒燥，主以温下，药用天台乌药散加巴豆霜，先加一分，第二次加半分，第三次加二分，三服后始得便。后十五日又不大便，仍用上法治之。现对这种理法，略述不同意见如下：
1. 阳明燥证不仅要分寒热，而且应分虚实，不可因病在阳明，便谓均属实证。须知阳明燥证，津亏液涸，最多虚实相兼，虽实多虚少者亦有之，但在秋燥一证，究以虚多实少者为多，故凡热化而津液亏乏者，当重养阴生津，增水亦能行舟，若寒化而肠燥液枯者，当重润燥滑肠，润导亦能通便。若忽视甘寒增液、甘温润肠诸法，偏执峻攻，恣投苦燥刚剂，则决非治燥之正法。
2. 老人便秘，以精血虚亏，肠燥液涸者居多，若非在外感热病过程中发生，当以杂病视之。吴鞠通根据“凡坚结牢固，皆属金象”的认识，认为是感受燥气而致，实系误会之言。因一，此证四季均可遇见，若不在秋季，与燥气何涉？二，寒湿门郭案是“寒湿为病，误用硝黄，致浊阴蟠踞，坚凝如石。”既如此，“凡坚结牢固，皆属金象”之说亦不攻自破。所以治老人燥闭，总以五仁丸、半硫丸之类为正法。车姓案之所以暂效，是因不大便已四十九日，不能不“急则治标”，峻下后未至于脱，亦幸赖其体质之尚可。此案得便后若能以柔润滋养继之，后当不致复结，结而再用峻攻，恐于正气不能无损。擅用巴豆、大黄，反复峻攻，决非治燥之良法。这诚如何廉臣所说：“凡津液素亏者，胃肠本燥，大便每多秘结，适逢秋燥伤肺，气机不宣，则大便不通矣。若用承气猛攻，往往水泻洞泄，中气愈伤，津液益亏，而燥屎不下，每致液涸动风，险证丛生。”我们应当注意。巴豆攻下之力，较承气更为峻猛，老人燥闭，尤宜慎用。车姓案乃治实，非治燥，我们治老人燥闭，不可以此为口实而轻投峻攻。
3. 刘河间说，“热胜燥，燥自金生，热为火化，金余则制之以火，肺胜则制之以苦。”故治燥非不可用苦，但须知“苦能化燥”，故以苦治燥，唯属实者宜之。观喻昌之制清燥救肺汤，明知“知母能滋肾水，清肺金，亦以苦而不用。”燥病多虚，前人治燥，连性润之品尚谨慎如此，我们于苦燥刚烈药岂可轻用。然观《温病条辨·补秋燥胜气论》后诸条及中燥门治案，柔润之品，几乎不用，苦燥刚烈，在所不忌，竟是治燥而忘燥！
4. 就燥屎内结一证论，属实属虚均有之。而在秋燥一证，则每虚实相兼、有虚有实，实多虚少者固有之，虚多实少者亦不少，故临证必须细辨。就治疗方药论，诸如大黄附子细辛汤、巴豆霜以及承气汤之类，俱系治实而非治燥。大凡燥病，阴津必虚，即见便闭，峻攻亦当慎用，且只可暂用，不可屡用，更不可独重攻下，竟只分寒热，不分虚实而恣用。须知因燥致结、虚多实少之便闭，所在皆有，若不以猪膏发煎、蜜煎导、济川煎等已效之成法为意，以峻攻治实偶效案视作为治燥之大法，即违背重津保阴之要旨。经云“以苦下之”，是治其实，实非治其燥。仲景云：小便利，大便硬，不可攻下，以脾约麻仁丸润之，此正戒轻下而恐重伤津液之意也。
结语：治燥大法，诚如前人所说：“上燥治气，下燥治血。”气谓津气，补津气可用北沙参、麦冬、五味子之类；血谓精血，滋精血可用当归、地黄、肉苁蓉之属。而“燥者润之”一语，总不失为治燥之大法。如今吴鞠通治燥，于此略之，于苦热刚燥峻下诸法独详之，则是索隐行怪，流入异端了！所以我谓中燥门诸案及《补秋燥胜气论》后诸条，实在不足为后人法。
卷四抨叶医论选辑
论叶天士《临证指南》伤寒门方
叶先生《临证指南》卷五，以风寒分门，而寒门所有者六方，并非伤寒大证，即在太阳一经，亦仅言其至小，此书行后，遂不闻以《伤寒论》治病，今之置寒水六气于不讲者，大抵即由于此，而《伤寒论》中之细微曲折，亦更无能道其片语者矣。乃有门人华玉堂者，于此一门后，大放厥词，谓人但拘仲景之法，皆为见闻不广，胶柱鼓瑟，不知变通，以明仲景之不足法，而以此六方为治伤寒之一大宗。徐灵胎曰：此即俗名着寒之病，偶尔小恙，不入经络者也，何必牵引伤寒大证，发诸议论，及细阅此篇，竟无伤寒之门，即此为伤寒之法，不禁失笑，夫医者之学问，全在明伤寒之理，则万病皆通，故伤寒为病中第一证，而学医者之第一功夫也，此编独阙此一门，则平日所习何书，所治何病，此非此老之过，抑编此书者，胸中茫无定见矣。灵胎说如此，尚不知此案与此药，亦未必定出自先生也，昔梁芷林中丞浪迹丛谈，载叶先生轶事一则，为龙虎山张真人在吴，于万年桥停舆，让桥下天医星过去，而是日是的，不先不后，天士小舟适从桥下摇橹行来，中丞于此，不溢一词，而其下即引纪文达语，谓天士不事著述，今所有医案十卷，为门人取其治验，附以论断，非天士本意也，石琢堂殿撰，亦谓先生少所著作，指南一编，冗杂不足以传，乃先生弃世后，门下学者，荟萃而成，其方不尽出先生之手，然则此书，明是及门假托，为一时渔利之物，奇在所作医案，每以不了语气，及上下文不联属，又每以也字易矣字，谓是其师汉魏文章，然号无害于病者，若此伤寒一门，则俗医正怕读伤寒书，正谓伤寒方难用，遂若照此六方，法已大备，更不必问途于仲景，而又因此作江南无伤寒之说，非皆不辨真赝而徒震其名之害耶，呜呼！自有李士材《医宗必读》，而世不知有血证，白有此《临证指南》，而世不知有伤寒，叶先生为吾苏大医，享盛名于雍乾时，必不至此，彼华玉堂邵新甫辈，造此大孽，且坏先生生后名，安得不为先生一雪此愤哉！（《世补斋医书》）
柴按：考《临证指南》寒门治案，是普通感冒类病之辨证属寒者，叶氏用辛温解表、宣肺化痰类药治疗，治未尝误。感冒又称伤风，乃轻浅小病，陆九芝谓不传经。汪琥认为与《伤寒论》中之伤寒、中风不同。然华岫云辈“牵引伤寒大证，大发议论”，又无的放矢，曰“拘仲景之法而施治，此乃见闻不广。”这在医界竟谓学《伤寒论》是学屠龙之技的历史条件下，极易使人误以为“照此六方，法已大备，更不必问途于仲景”，故陆氏特作此论以针砭时弊，这对发扬仲景学说，是具有积极意义的。
论《临证指南》温热门席姓七案
席姓脉左数，右缓弱（此为温热病脉）阳根未固（温热与阳根无涉，）阴液渐涸（阳邪之甚，）舌赤微渴（亦阳邪也）喘促，自利溲数（三焦大热）晡刻自热，神烦呓语（日哺所阳明王时也，初诊只有晡刻神烦，）夫温邪久伏少阴（此沿喻氏之说，其误即始于此，）古人立法，全以育阴祛热（古人治温，决不育阴，全以下语气未了，）但今见证，阴分固有伏邪（阳伏于胃，病在阳分，）真阳亦不肯收纳（乃阳邪之充斥，非真阳之不纳，）议仿刘河间浊药轻投（河间从无此法，）不为上焦热阻（独此用未一药，）下焦根柢自立（与下焦根蒂无关，）冀其烦躁热蒸渐缓（不去其热何由缓，）熟地炭茯苓淡苁蓉远志炭川石斛五味（方谬。）
又再诊晚诊阴中伏邪（阳伏于胃，）晡时而升（的是阳明，）目赤羞明（睛不和也，）舌绛而渴（渴为温病，）与育阴清邪法（以阳邪而育阴，阴愈育阳邪念固，而云法乎）生地炭（生熟地之所贵在滋膏，而炒为炭则无用，亦断无先熟后生之理，）元参心川石斛炒麦冬（麦冬无炒用者）犀角石菖蒲（二味并开心窍，送邪入心）
又三诊脉左数右软（此时脉尚未变，）舌干苔白，小溲淋沥（腻滋之效，）吸气喘促（呼气促是脱，吸气促，乃是闭，）烦汗（的是阳明，）肾阴不承（非也，）心神热灼蒙闭（一去胃热蒙闭即开，）议以三才汤滋水制热（岂阴虚而火炎耶，此时之邪热，非滋水所能制）三才加茯神黄柏金箔（邪必益锢）晚进周少川牛黄清心丸一服（助犀角送邪入内·）
2. Regarding whether the pathogenic factor of Dryness (Zao) belongs to Yin or Yang, there has been much debate in the medical community, but the view that it belongs to Yin prevails. Wu Jutong also held this view; therefore, unless treating its Fu Qi (rebound pathogenic factor), warm and hot herbs are typically used by example. I, however, believe that the theory of Yin and Yang is relative. If discussing the attribute of Dryness, one must first ask about the premise. As is well known: the Six Qi (Liu Qi) govern the four seasons respectively; Wind (Feng) is the dominant Qi of Spring, and the climate of Spring is warm; Dryness is the dominant Qi of Autumn, and the climate of Autumn is cool. Based on this premise, comparing the dominant Qi of Spring and Autumn relatively speaking, Dryness indeed should belong to Yin. But if changing the premise to compare Dryness with Dampness (Shi), Dryness should belong to Yang. Thus, the character "Dryness" contains the radical for Fire, and "Dampness" contains the radical for Water; Water and Fire are opposite, which is a clear omen of Yin and Yang. Predecessors debating the attribute of Dryness often lacked a unified premise, so they all discussed principles from their own biased perspectives. Wu Jutong's statement that Dryness is a Yin pathogen is, in fact, based on such reasoning. Precisely because he failed to consider the principle of the relativity of Yin and Yang attributes, when discussing Dryness, Wu Jutong only talked about the coolness and warmth of Dryness from the perspective of Sheng Qi (victorious pathogen) and Fu Qi. However, even according to his statement, if Dryness is a Yin pathogen, equivalent to Minor Cold, and warm therapy should be the orthodox method for treating Dryness, then Autumn Dryness should not occupy one of the nine types of Warm Diseases (Wen Bing). Since Autumn Dryness is classified as a type of Warm Disease, and it is claimed that Warm pathogens injure the body from top to bottom while Cold pathogens injure from bottom to top, prescriptions should not use Xing Su San (Apricot and Perilla Decoction) to treat the Lung. All these points, upon slight reflection, reveal theoretical contradictions, which are too numerous to enumerate.
II. Dampness and Dryness are confused; nominally called treating Dryness, it is actually treating Dampness.
Regarding Dryness and Cold, Wu Jutong had erroneous rational understanding, thus treating them identically in practice. Regarding Dryness and Dampness, although Wu Jutong knew rationally that the two were opposed, he still could not distinguish them clearly in practice. He felt that Cold, Dampness, and Dryness all belong to Yin pathogens and are easily confused, so he said: "Generally, because Dryness is the beginning of Cold and resembles Cold, it is easily mixed into the Cold category. Furthermore, above Yangming, Dryness governs, revealing Taiyin internally, and Yangming transforms via the middle Qi, so it is also easily mixed into the Dampness category. However, those who study medicine must have clear distinctions, restore the old standards of the Huangdi Neijing, so that one has firm convictions and does not deviate from the rules." These words were spoken when he criticized predecessors for "either mixing Cold and Dryness into one category or mixing them into the Dampness category," but in reality, was he not doing the same? Wu Jutong blamed predecessors with this, and I now blame Wu Jutong with the same.
The most obvious fact is: analyzing the cases in the Dryness section of *Wu Jutong's Medical Cases*, the herbs Wu Jutong used most frequently were of two types: one was warm and hot, rigid and drying herbs, such as Evodiae Fructus (Wuyu), Eugeniae Flos (Dingxiang), Cinnamomi Ramulus (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), Zanthoxyli Fructus (Chuanjiao), Zingiberis Rhizoma (Ganjiang), Zingiberis Rhizoma (Liangjiang), Alpiniae Oxyphyllae Fructus (Yizhiren), etc.; the other was light-leaching and aromatic-transforming herbs, such as Poria (Fuling), Polyporus (Zhuling), Pinelliae Rhizoma (Banxia), Citri Reticulatae Pericarpium (Chenpi), Coicis Semen (Yiren), Magnoliae Officinalis Cortex (Houpo), Atractylodis Macrocephalae Rhizoma (Cangzhu), Alismatis Rhizoma (Zexie), etc. Herbs with soft and moist nature and efficacy of generating fluids, which are used to treat Dryness, were almost never used in the Middle Dryness section. How can such a prescription method be called treating Dryness? Comparing this prescription method with that of the Cold-Dampness section and the method for treating Cold-Dampness in *Wenbing Tiaobian* (Systematic Differentiation and Treatment of Warm Diseases), we can discover that the two are almost identical. For example, in Case 57 of the Middle Dryness section, where illness was caused by Dryness Metal Qi, the herbs used included Poria Block (Yunlingkuai), Ginger-processed Pinellia (Jiang Banxia), Raw Coix Seed (Sheng Yiren) each at 5 qian, Charred Zanthoxylum (Chuanjiao Tan), Broad-leaved Orange Peel (Guangpi) each at 3 qian, Evodia (Wuyu), Galangal (Liangjiang), Alpinia (Yizhiren) each at 2 qian, Clove (Gong Dingxiang) at 1 qian. In subsequent consultations, either Cinnamon Twig (Guizhi) was added or Evodia and Galangal were doubled, or Zanthoxylum, Evodia, and Galangal were reduced, but the basic formula remained unchanged. Other cases, such as those of Xie, Li, and Yu, had similar prescription methods. In Case 32 of the Cold-Dampness section (Guo case), the disease was Dampness invading Taiyin, using Fresh Ginger (Shengjiang) at 1 liang, Ginger-processed Pinellia (Jiang Banxia) at 6 qian, Cinnamon Twig (Guizhi), Poria Skin (Fuling Pi), Raw Coix Seed (Sheng Yiren), Atractylodes (Maozhu) each at 5 qian, Magnolia Bark (Houpo) at 4 qian, Zanthoxylum Seed (Chuanjiao Mu), Immature Bitter Orange (Zhishi), Broad-leaved Orange Peel (Guangpi), Black Cardamom (Caoguo) each at 3 qian. The second consultation medication was largely the same. Comparing the two, the treatment methods are exactly alike. Precisely because Wu Jutong could not distinguish between Dampness and Dryness, he categorized cases belonging to the Cold-Dampness section into the Middle Dryness section, rendering the Cold-Dampness section virtually non-existent (in fact, there was only the aforementioned Guo case in the Cold-Dampness section). Therefore, he had to use Bi Syndrome (Obstruction Syndrome) cases (which could have been established as a separate category) to fill the Cold-Dampness section. From the Middle Dryness cases, dampness-treating formulas almost replaced dryness-treating formulas. From this fact, it is very clear that Wu Jutong confused Dampness and Dryness.
Furthermore, Wu Jutong created Pili San (Thunderbolt Powder) to treat vomiting and diarrhea caused by Middle Dryness, which appears twice in *Wenbing Tiaobian* and *Wu Jutong's Medical Cases*. This formula is primarily composed of "rigid, drying, bitter, and hot substances warming the three Yin meridians." This prescription method also reflects Wu Jutong's blurred understanding of the similarities and differences between treating Dryness and Dampness. As stated in *Yimen Falü* (Medical Laws): "For autumn Dryness diseases, mistaking them for Dampness and treating them accordingly is like wielding a knife to kill people. In the past, ignorance could be excused, but now, knowingly committing this error will harm many people; facing the mirror of karma, regret will be useless." Obviously, mistaking Dampness for Dryness and mistaking Dryness for Dampness are both acts of wielding a knife to kill; thus, we must pay attention to distinguishing them.
Additionally, Zhang Zhongjing used Gualou Guizhi Tang (Trichosanthes and Cinnamon Twig Decoction) to treat Rou Jing (Soft Spasm), using Trichosanthis Radix (Gualou) as the sovereign herb to generate fluids and moisten Dryness. Later generations used Guizhi Xingren Tang (Cinnamon Twig and Apricot Kernel Decoction) to treat Cool Dryness, using Apricot Kernel (Xingren) as the sovereign herb for its slightly bitter and warm-moistening properties. Regarding the application of Guizhi Tang to treat Dryness syndromes, such modifications are worthy of emulation. However, Wu Jutong used Guizhi Tang to treat Dryness without adding soft-moistening herbs, but instead added light-leaching herbs (as in the aforementioned case). Such modifications are inappropriate for treating Dryness and are another manifestation of confusing Dryness and Dampness. Therefore, the cases in the Middle Dryness section are not instructive for treating Dryness. Conversely, if viewed as Cold-Dampness cases, they are reference-worthy.
III. Bitter-drying and severe purgation, attacking accumulation while forgetting deficiency; nominally called treating Dryness, it is actually treating Excess.
He Lianchen said: "Dryness differs from Fire. Fire is an Excess syndrome, with excessive heat and hyperactive Yang, presenting with fever and profuse sweating; the method should employ bitter-cold herbs to drain its excess and dissipate its heat. Dryness is a Deficiency syndrome, with Yin deficiency and loss of moisture, presenting with dry skin; the method should employ sweet-cold herbs to nourish Yin and moisten Dryness." However, Wu Jutong focused solely on attacking Excess when treating Dryness, stating: "Yangming Dryness syndrome involves internal Excess and hardness; if not transformed by Heat, purge with bitter-warm. If already transformed by Heat, purge with bitter-cold." His self-note states: "Bitter-warm purgation method, such as Dahuang Fuzi Tang in *Jingui Yaolue*, or the new formula Tiantai Wuyao San plus Croton Seed (Badousha), etc." "Bitter-cold purgation method, such as the Three Chengqi Decoctions." *Wenbing Tiaobian* includes his medical cases for treating Dryness, such as the Che family case. The previous physician failed to achieve bowel movement with Dachengqi Tang. Wu Jutong diagnosed it as Autumn Metal Dryness Qi, with minor pathogen entering the interior, determining the syndrome as Cold-Dryness, and prescribed warm purgation using Tiantai Wuyao San plus Badousha. The dose started at 1 fen, increased to 0.5 fen for the second time, and 2 fen for the third time. Bowel movement occurred only after three doses. Fifteen days later, constipation recurred, and the same treatment was applied again. Regarding this rationale and method, I briefly state my differing opinions below:
1. Yangming Dryness syndrome requires differentiation not only by Cold and Heat but also by Deficiency and Excess. One cannot assume all cases involving Yangming are Excess syndromes. It must be understood that Yangming Dryness syndrome involves fluid depletion and exhaustion, mostly presenting with combined Deficiency and Excess. Although Excess-dominant cases exist, in Autumn Dryness, Deficiency-dominant cases are more common. Therefore, for Heat-transformed cases with fluid deficiency, emphasis should be placed on nourishing Yin and generating fluids; increasing water can help move the boat. For Cold-transformed cases with intestinal dryness and fluid exhaustion, emphasis should be placed on moistening Dryness and lubricating the intestines; moistening and guiding can also relieve constipation. Ignoring methods like sweet-cold fluid-enrichment and sweet-warm intestinal-lubrication, and adhering strictly to severe purgation and indiscriminately administering bitter-drying rigid agents, is definitely not the orthodox method for treating Dryness.
2. Elderly constipation is mostly due to essence and blood deficiency, leading to intestinal dryness and fluid exhaustion. Unless occurring during an exogenous febrile disease, it should be viewed as an internal disease. Wu Jutong, based on the understanding that "all hard, knotted, and firm conditions belong to the image of Metal," attributed it to contracting Dryness Qi, which is a misunderstanding. Firstly, this condition can be encountered in all four seasons; if not in Autumn, what does it have to do with Dryness Qi? Secondly, in the Cold-Dampness section Guo case, it was described as "Cold-Dampness disease, mistakenly treated with Mirabilite and Rhubarb, causing turbid Yin to stagnate, becoming hard and solid like stone." Given this, the saying "all hard, knotted, and firm conditions belong to the image of Metal" collapses without argument. Therefore, the orthodox method for treating elderly Dryness constipation is always formulas like Wuren Wan (Five Seeds Pill) or Banshen Wan (Half-Sulfur Pill). The temporary efficacy of the Che case was because the patient had not had a bowel movement for 49 days, necessitating "treating the acute symptom first"; after severe purgation, collapse did not occur, fortunately relying on the patient's acceptable constitution. If, after obtaining stool, soft-moistening nourishment had been continued, recurrence would likely have been avoided. Using severe purgation again upon recurrence may damage righteous Qi. Indiscriminate use of Croton and Rhubarb for repeated severe purgation is certainly not a good method for treating Dryness. This is precisely what He Lianchen said: "Those whose fluids are chronically deficient have naturally dry stomach and intestines, and constipation is common. When encountering Autumn Dryness injuring the Lung, with impaired Qi mechanism, bowel obstruction occurs. If strong purgatives like Chengqi are used aggressively, it often causes watery diarrhea, further damaging Middle Qi, depleting fluids even more, failing to pass dry feces, and often leading to fluid exhaustion and wind stirring, resulting in multiple dangerous syndromes." We must take note. Croton's purgative power is more severe than Chengqi; for elderly Dryness constipation, it should be used with particular caution. The Che case treated Excess, not Dryness. We should not use this as an excuse to lightly administer severe purgatives for elderly Dryness constipation.
3. Liu Wansu said, "Heat overcomes Dryness; Dryness arises from Metal; Heat is transformed by Fire. If Metal is excessive, it is controlled by Fire; if Lung is excessive, it is controlled by Bitter." Thus, using Bitter to treat Dryness is not impossible, but one must know that "Bitter can transform into Dryness." Therefore, using Bitter to treat Dryness is suitable only for Excess syndromes. Observing Yu Chang's formulation of Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction), he knew that "Tianmazi can nourish Kidney Water and clear Lung Metal, but he did not use it because it is Bitter." Dryness diseases are mostly Deficiency; predecessors were so cautious even with moistening herbs when treating Dryness, how much less should we lightly use bitter-drying rigid herbs? However, observing the subsequent articles in *Wenbing Tiaobian · Supplement to Autumn Dryness Overcoming Superior Qi Theory* and the cases in the Middle Dryness section, soft-moistening herbs are hardly used, while bitter-drying rigid herbs are used without taboo. It is treating Dryness while forgetting Dryness!
4. Regarding the syndrome of dry feces accumulating internally, it can be either Excess or Deficiency. In Autumn Dryness, it is often combined Deficiency and Excess, with some cases being Excess-dominant and others Deficiency-dominant. Therefore, careful differentiation is necessary during clinical practice. Regarding treatment formulas, such as Dahuang Fuzi Xixin Tang, Badousha, and Chengqi Tang, they all treat Excess, not Dryness. Generally, Dryness diseases involve Yin-Jin deficiency; even if constipation is present, severe purgation should be used cautiously, only temporarily, not repeatedly, and certainly not focusing solely on purgation, dividing only by Cold and Heat without distinguishing Deficiency and Excess. It must be known that constipation due to Dryness causing accumulation, with Deficiency-dominant and Excess-minor characteristics, is common everywhere. If one does not pay attention to effective established methods like Zhigao Faxian Jian (Pork Fat and Hair Decoction), Mi Jian Dao (Honey Suppository), or Jichuan Jian (Benefit River Decoction), but instead views occasional efficacy of severe purgation for Excess cases as the major method for treating Dryness, it violates the essential principle of preserving Jin-Yin. The Classic states "purge with Bitter," which treats Excess, not Dryness. Zhongjing said: "If urination is free and stool is hard, do not purge; moisten with Miyuan Maren Wan (Hemp Seed Pill for Spleen Constriction)." This is precisely to warn against light purgation and fear of severely damaging Jin-Yin.
Conclusion: The major method for treating Dryness is indeed as predecessors said: "Treat Qi for Upper Dryness, treat Blood for Lower Dryness." Qi refers to Jin-Qi; tonifying Jin-Qi can use Glehniae Radix (Beishashen), Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), etc. Blood refers to Essence-Blood; nourishing Essence-Blood can use Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Dihuang), Cynomorii Herba (Rongrong), etc. And the phrase "Moisten what is Dry" remains the major method for treating Dryness. Now, Wu Jutong neglects this in treating Dryness, detailing only bitter-hot, rigid-drying, and severe purgation methods. This is seeking hidden mysteries and acting strangely, falling into heterodoxy! Therefore, I say that the cases in the Middle Dryness section and the subsequent articles in *Supplement to Autumn Dryness Overcoming Superior Qi Theory* are truly insufficient for future generations to follow.
Volume IV: Selected Critiques of Ye Tianshi's Medical Theories
On the Formulas in the Cold Damage Section of Ye Tianshi's *Guide to Clinical Practice*
In Volume 5 of Mr. Ye's *Guide to Clinical Practice*, Cold and Wind are separated into categories. The Cold category contains only six formulas, which are not major Cold Damage syndromes. Even within the Taiyang meridian, they only address the smallest aspects. After this book circulated, no one was heard to treat diseases using the *Shanghan Lun* (Treatise on Cold Damage). Those who today ignore the Six Qi of Cold and Water probably owe this to this book, and no one can utter a single word regarding the subtle intricacies of the *Shanghan Lun*. Then, a disciple named Hua Yutang, after this category, spoke wildly, claiming that anyone who merely adheres to Zhongjing's methods lacks broad experience, is rigid like a fixed tuning peg, and does not know how to adapt, thereby demonstrating that Zhongjing's methods are not worth following, and promoting these six formulas as a major category for treating Cold Damage. Xu Lingtai said: "This is simply the disease commonly known as catching cold, a minor ailment that does not enter the meridians. Why drag in major Cold Damage syndromes and make such discussions?" Upon carefully reading this section, there is not even a Cold Damage category; taking this as the method for Cold Damage makes one unable to suppress laughter. A physician's learning lies entirely in understanding the principles of Cold Damage, through which all diseases become clear. Thus, Cold Damage is the primary syndrome among diseases and the first skill for students of medicine. This compilation lacks this category entirely. What books did this old man usually study, and what diseases did he treat? This is not this old man's fault, but rather the compiler of this book had no firm convictions in mind. Xu Lingtai said this, yet he did not even know whether these cases and medicines necessarily originated from Mr. Ye himself. Previously, Liang Zhilin, Vice Minister of Ceremonies, in *Langji Congtan*, recorded an anecdote about Mr. Ye. When the True Man of Longhu Mountain was in Wu, he stopped his carriage at Wannian Bridge to let the 'Star of Heavenly Doctors' pass under the bridge. On that day, just before or after, Mr. Tianshi's small boat happened to row under the bridge. The Vice Minister did not say a word about this. Below this, he quotes Ji Wenda, stating that Tianshi did not engage in writing; the ten volumes of medical cases currently existing were collected by disciples from his treatments, with appended judgments, which was not Tianshi's original intent. Shi Zhuotang, Hanlin Academician, also stated that the先生 wrote little. *The Guide*, being verbose and miscellaneous, is not worthy of transmission. After the先生 passed away, scholars in his school compiled it, and his formulas did not all come from his hand. Therefore, this book is clearly a forgery by his disciples for temporary profit. Strangely, the medical cases written often end with incomplete sentences, and the context does not connect. They often replace the particle 'ye' with 'yi', claiming it imitates the style of Han and Wei literature. However, if the number [of patients] is harmless to the disease, for this Cold Damage category, vulgar physicians are afraid to read Cold Damage books, precisely because Cold Damage formulas are difficult to use. Thus, if following these six formulas, the methods are considered complete, and there is no need to seek guidance from Zhongjing. Furthermore, this led to the claim that there is no Cold Damage in Jiangnan. Is this not the harm of not distinguishing true from false and merely being awed by his name? Alas! Since Li Shicai's *Yizong Bidu* (Essential Readings for Medical Ancestors), the world has forgotten Blood Syndromes. Since *The Guide to Clinical Practice*, the world has forgotten Cold Damage. Mr. Ye was a great physician of our Suzhou, enjoying great fame during the Yongzheng and Qianlong reigns. He certainly would not have reached this state. Those like Hua Yutang and Shao Xinpu created this great calamity and damaged the先生's posthumous reputation. How can we not clear this anger for the先生! (*Shibuzhai Yishu*)
Chai's Note: Examining the Cold category cases in *The Guide to Clinical Practice*, they are common cold-like diseases differentiated as Cold. Mr. Ye used acrid-warm exterior-releasing and lung-dispersing phlegm-resolving herbs for treatment, and the treatment was never mistaken. Common cold, also known as Shangfeng (Wind Injury), is a mild and superficial minor disease. Lu Jiuzhi stated it does not transmit meridians. Wang Hu believed it differs from Shanghan and Fengzhong in the *Shanghan Lun*. However, Hua Xiuyun and others "dragged in major Cold Damage syndromes and made grand discussions," aiming at nothing, saying "adhering to Zhongjing's methods for treatment shows narrow experience." Under the historical condition where the medical community claimed that studying the *Shanghan Lun* was learning the art of slaughtering dragons, it was very easy to mislead people into thinking "following these six formulas, the methods are complete, and there is no need to seek guidance from Zhongjing." Therefore, Lu specifically wrote this critique to point out contemporary evils, which has positive significance for promoting Zhongjing's theories.
On the Seven Cases of the Xi Family in the Warm-Heat Section of *The Guide to Clinical Practice*
Xi's pulse: Left rapid, Right slow and weak (this is the pulse of a Warm-Heat disease). Yang root is not solid (Warm-Heat has nothing to do with Yang root). Yin fluids are gradually exhausted (due to severe Yang pathogen). Tongue is red with slight thirst (also Yang pathogen). Panting and distress, spontaneous diarrhea, frequent urination (severe heat in the Triple Burner). Fever starting in the afternoon, mental restlessness and sleep-talking (at dusk, Yangming is at its peak; initial diagnosis only showed afternoon mental restlessness). The Warm pathogen has been lurking in Shaoyin for a long time (this follows Yu's theory; the error starts here). Ancient legislation relied entirely on nourishing Yin and dispelling Heat (Ancient practitioners treating Warm diseases certainly did not nourish Yin... sentence unfinished). But given current manifestations, there is indeed latent pathogen in the Yin aspect (Yang lurks in the Stomach, disease is in the Yang aspect). True Yang also refuses to receive/retain it (it is the filling of Yang pathogen, not the failure of True Yang to retain). Proposed to imitate Liu Hejian's method of lightly administering heavy/turbid drugs (Hejian never had this method). Not obstructed by upper Jiao heat (only this one drug used... sentence unfinished). The lower Jiao foundation stands on its own (irrelevant to lower Jiao root). Hoping that irritability and steaming heat will gradually subside (without removing the heat, how can it subside?). Prepared: Charred Rehmannia, Poria, Light Cynomorium, Charred Polygala, Chuan Shihu, Schisandra. (Prescription is erroneous.)
Second consultation, evening consultation: Latent pathogen in Yin (Yang lurks in Stomach). Rises at dusk (indeed Yangming). Red eyes, aversion to light (eyes are not harmonious). Crimson tongue with thirst (thirst indicates Warm disease). Administer method of nourishing Yin and clearing pathogen (Nourishing Yin with Yang pathogen makes Yin more nourished and Yang pathogen more solid, how can this be called a method?). Prepared: Charred Raw Rehmannia (The value of raw and cooked Rehmannia lies in their nourishing paste; frying into charcoal renders it useless. There is absolutely no logic of using cooked first then raw.). Yuan Shen Xin (Scrophulariae Radix Heart), Chuan Shihu, Stir-fried Ophiopogon (Ophiopogon is not stir-fried). Rhinoceros Horn (Xi Jiao), Acorus (Shichangpu) (These two open the heart orifices, sending pathogen into the Heart.)
Third consultation: Pulse Left rapid, Right soft (pulse has not changed yet). Dry tongue with white coating, dribbling scanty urine (effect of cloying/nourishing). Inspiratory panting (Expiratory distress is collapse; inspiratory distress is closure). Irritable sweating (indeed Yangming). Kidney Yin does not ascend/support (Incorrect). Heart spirit scorched by heat and obscured/closed (Once Stomach heat obscuration is removed, it opens immediately). Proposed to use Sancai Tang (Three Talent Decoction) to nourish Water to control Heat (Is it Yin deficiency with flaming fire? The pathogenic heat at this time cannot be controlled by nourishing water.). Sancai plus Poria Spirit (Fushen), Phellodendron (Huangbai), Gold Leaf (Jinpiao) (Pathogen will be further entrenched). Evening administration: One dose of Zhou Shaochuan Niuhuang Qingxin Wan (Buffalo Calculus Clearing Heart Pill) (Assists Xi Jiao in sending pathogen inward.)