世间原有一种肺病，其小者如咳呛、喷嚏、颐肿、喉梗之类，其大者如哮喘、咯血、肺痈、肺痿之类，皆不闻有神昏而至诂妄者，既曰肺病，断不能有神昏，既曰神昏，断不仅为肺病，既不神昏，断不病及心包，既不病心，断不需用犀角，是皆可以理断而不必尽通乎医道者也，鞠通所谓上焦病者，即景文所言之肺，鞠通所谓不可用中焦药者，即景文所不言之胃，乃于景文延之数日上，再加缓缓两字，胃不及待，酿成大热，或亦一用膏黄，似乎已胜顾说，而随即以清官增液者，使胃病仍归不治，夫人之所病者胃，而医之所言者肺，神之所以能昏者在胃，而医之所以治神昏者在心，类皆善用移字诀，而此之所移，又为移字诀中最大之祸，明明一部伤寒论，长留天地间，其于急祛邪热，阴始可保，如仲景之白虎承气汤，小之而一去其热，阴即不伤，如仲景之葛根芩连诸方，辛从甘以化阳，苦从甘以化阴，阴阳和而时雨降，顷刻间有嘘枯振槁之能者，概从摈弃，且若恶闻，岂无意乎，风寒温热寻常病耳，似此倘恍迷离，既令人于伤寒方视若畏途，并以一二肯用伤寒方者，目为怪物，登仁寿而免夭札，只看伤寒论之兴替何如，余既合论两家而并畅发此论，所望病家之曾受此害者，一权于肺胃之间，而恍然有悟也。(《世补斋医书》)
柴按：伤风感冒、气管炎、肺痈这一类病，在古人原不隶属温病范畴。此类病极少逆传心包，产生神昏诂语等种种危象，这在今医，已为常识。乙型脑炎等极易见神昏诂语者，又何尝首先犯肺，陆氏意见，明系可取，惜叶派医者只是挑剔，不肯虚心，则陆氏亦无可奈其何。缪希雍说；“凡作医师，宜先虚怀，灵知空洞，本无一物，苟执我见，便与物对，我见坚固，势必轻人，我是人非，与境角立，一灵空窍，动为所塞，虽日亲至人，终不获益，白首如故，良可悲已。”这话是值得我们深思的。
论章虚谷外感温热
叶天士先生一代盛名，既为其门下华邵辈所毁，而顾景文之温证，又为章虚谷取而注之，改作外感温热，其所以改作外感者，想亦嫌其不类论温，故谓其与仲景伏气之温不同，是则天士之温，本非仲景之温，而虚谷之温，又非天士之温矣，然而换一衣冠，不能使其人之性情面貌因之而皆变也，况果如其外感之说，而意出于天士之意，则天士于临证指南既以小风寒抵作伤寒一大法门，天士于温证论治又以小风热抵作温热一大法门，所以伤寒一证，至天士而失传，温热一证，亦至天土而失传，而孰知皆非天士之书耶，此之般流直若傀儡登场，沐猴牵线，不使仲景圣道尽归澌灭不止，而王孟英温热经纬，尽罗而致之，皆不肯为病者计，呜呼，此中之劫运，其何日已耶。
坊间再有医效秘传，亦云是叶先生语，为吴子音所刻，秘传已极不堪，至于叶薛缪三家医案，非特用药之谬，彼此相似，即词句间亦多有雷同，明是一付笔墨，不问可知其伪，志称薛与叶积不相能，尝白署所居日扫叶山庄，则岂有薛而肯从叶派者乎，缪则我之自出不闻其有此方案，偏是此种讆言，最易动听，不托于两先生，置之可耳，乃假借大医，使人信从，以售其欺，害斯大矣，末附陆秋山温热赘言，则即王孟英所收陈乎伯祖恭语，及章虚谷所指薛氏湿热条辨者，一字不移，但改祖恭为余，自称拙著，不值一笑。(《世补斋医书》)
柴按：章巨膺读以上数篇后曾加按说：“以上数篇，最为精惊，席姓案评，就实指谬，昔孔子成春秋，而乱臣贼子惧，陆氏痛诋叶吴，而江湖庸伧曾不醒悟，所谓道高一尺魔高一丈，正道不克邪魔，致令流毒猖獗至于今日，观今日之域中，尽是邪魔当道，守南阳之宗派者，能有几人，医事败坏，行将渐灭，不亦宜者。”这一按语，措词激烈，在讨论学术中，实不可效法。但前人之愤愤，是环境所促成的，我们不必再为此而深责。叶派中人，若能落落大度，对此不加计较，平心静气地来分析陆九芝等人的学术观，在友好的学术争鸣中来共同研讨外感热病之治法，则于开创新局，振兴中医，必将大有裨益。余撰辑此作，即亦以此为希望。
驳吴鞠通三焦说之谬
仲景言伤寒主六经，温病条辨则主三焦，三焦之说，灵枢最详，营卫生会篇所谓上焦如雾，中焦如沤，下焦如渎者是也，就此三语观之，其义盖谓身半以上为上焦，身半以下为下焦，中脘胃腑所居之地为中焦。沤，如诗经可以沤麻之沤，有蕴酿之意，谓脾胃腐熟水谷也，水谷既腐熟，糟粕从下而出，故云下焦如渎，谓二便也，糟粕既下行，精华自当上行，如何上行，必有赖于蒸化，然后能输运于四肢百体。蒸则如雾，故云上焦如雾，古人不知胃壁肠壁，皆能吸收滋养料供给各组织，仅凭理想，故云如雾如渎，此原是笼统语，概括言之，初不指一脏一腑，别无深意，亦与病之传变无与，不能与伤寒六经并论，甚为显明。营卫生会篇又云，上焦出于胃上口，并咽以上贯肠而布胸中，走腑，循太阴之分而行，还至阳明，上至舌，下足阳明，常与营俱行于阳二十五度，行于阴亦二十五度，一周也，故五十度而复会于手太阴矣。中焦亦并胃中，出上焦之后，此所受气者，泌糟粕，蒸精液，化其精微，上注于肺脉，乃化而为血，以奉生身，莫贵于此，故独得行于经隧，命曰营气。下焦者，别回肠注于膀胱而渗入焉(以上为灵枢营卫生会篇原文)。细绎文字，颇觉生涩，文并不古，亦非不通，惟骤视之，所纪颇凌乱无次，其云上焦出于胃上口并咽以上，当是从胃上口直至咽喉以上，此处不过是食道，何物循此食道行，营乎，卫乎，经气乎，血液乎，经未明言，如云上焦循此食道行，则语殊弗解，盖谓从胃上口至咽为上焦之一部分，则语意显明，云上焦出胃上口，并咽以上，上焦是何物？殊不能知其命意所在，咽以上三字之下，接贯肠二字，肠之地位，在中脘以下，自咽至肠，中间距离太远，续云而布胸中，则又自下而上矣。脏腑内景，本不易明，似不宜故捩其辞，使读者索解不得，曰走腑循太阴之分而行，更不知腑字何指，其下之太阴阳明足阳明，无一语不生涩，亦在在不可究诘，似闻某医校列素灵为课本，不知教员对于此等处，如何解释，教员纵能循文敷衍，听讲之学生，又若何了解，如云讲者自讲，听者白听，了解与否，双方均非所注意，则其懵懂又足令人佩羡不置矣。
顾虽如此，就生理之形能上观之，灵枢之所言，却自有其价值，不过仍与热病之传变无与。凡人口渴甚，饮水则润，渴非口中干，乃胃中燥，得水而润，亦非口中润，乃胃中吸收液体，几经转折，传之唾腺，唾腺分泌唾液，然后润也，审是，所谓自胃上口并咽以上，自非无故，且不曰至咽而曰并咽以上，是指口中津液尤为显明，凡食物入胃，消化之后，胃壁吸收液体，以资营养，由胃入肠，肠壁亦事吸收液体，以资营养，苟从饮食入胃之后，潜心体察，可以不须剖验而得，且人之感饥饿，不在胃中而在腹部，内经云，胃实则肠虚，肠实则胃虚，故肠胃更迭为虚实，其意若日肠实胃实者病，肠虚胃虚者亦病，欲明肠胃不同实不同虚，故其措词如此，若就生理之形能言之，肠实者，胃不妨虚，肠已虚者，胃则非实不可，感饥饿者，不在胃而在肠，故有枵腹饥肠诸成语，不曰枵胃饥胃也，此则胃肠二宇之所由来，回肠间苟有燥屎，则苦不得寐，其甚者躁烦不安，又甚者神昏詀语。神昏诂语谓是心包络病，乃想当然之语，于实际无有是处。谓是脑筋错乱，亦尚可商。盖燥屎结于肠而不寐烦躁者，乃神经节为病，因肠壁纤维神经与交感神经运动神经皆相通之故，阳明腑证之扬手掷足，囚肠壁纤维神经病，影响于运动神经之故，其躁烦不寐，则因肠壁神经影响于交感神经之故，交感神经，听命于神经节，间接受治于大脑，故曰神经节为病，神经节者，胸中之事也，此病之形能也，因病之形能以推测生理之形饀，则知食物入胃，必下于肠，入肠之后，其影响最著者在胸中，必有其输送精微之道，故曰上焦如雾，布于胸中，此布胸中三字之所由来，然则此一节文字译之为今人通用文字，当云上焦从胃上口上行至于咽以上，从胃中部下行至于肠，仍输送其精气布于胸中。
走腑句，腑字颇难索解，若根据素问及难经，则此腑字当指气街，曰循太阴之分，观下文手太阴句，则知此是足太阴。还之阳明句，观下文有足阳明句，则知此处为手阳明，其云常与营俱行于阳二十五度，行于阴亦二十五度，五十度而复会于手太阴，是其所言者，即是卫气(阴阳各二十五度，详灵枢卫气行篇可参考，文繁不备录)，盖惟卫与营俱行，证之他处，无三焦与营卫俱行之文也，惟岐伯谓营出于中焦，卫出于下焦，而言上焦独详，似中下焦统于上焦者。难经谓三焦者，水谷之道路，气之所终始，正与灵枢此节相合，出于胃上口，并咽以上，贯肠，而布胸中，是说水谷之道路，走腑以下至复会于手太阴矣，是说气之所终始，如此解释，未尝不言之成理。
其云中焦是营气，曰泌糟粕，蒸精液也，云化其精微，上注于肺，则仍是上焦如雾之事，不过其所主者，谓营出于中焦，故如此说，不得泥定地位，致与上焦纠缠不清，其云上注于肺者为血，行于经隧者为营，经隧即奚谷谷肌肉之分，脏器得此而滑润，故古人谓营为内部湿润之气。今日有西闽学说，则知微细血管有渗润，淋巴液有循环，可以补我国古书之不足，而营字真确解释，自当以微细血管中之渗出液当之。其言下焦，意义自明，综以上所言者观之，三焦，言水谷之出入，与其精微化为营卫之大略者也，其言上焦自胃上口并于咽以上，自胃上口下至于肠，复自肠上至胸中，不限于中脘以上之地位也。中焦起于胃中，化精微上入于肺，化血复从血中分泌液体，行于偏身之经隧，不限于中脘之地位者也。三焦之可以分别言也，大略如此，与温病条辨之言三焦，丝毫无相通之处，条辨颇推崇叶天士，其云凡病温者，始于上焦，在手太阴，是即天士之温热论开卷第一条，所谓温邪犯肺，逆传心包络者也。以手太阴为上焦地位，未尝不是，肺原属脏腑之最高者，然灵枢则明言中焦化精微上注于肺脉，鞠通岂未之见乎。又其全书用药以轻者归上焦，重者归中焦，尤重者归下焦，纯以地位为主，不问营卫气血，亦与灵枢不合，灵枢固主营卫，不主地位者也，然则苟非鞠通不曾懂得营卫生会篇文字，即彼所谓三焦者，不是生会篇之三焦。吾乃偏考他处之言三焦者。
(一)灵枢本输篇云，三焦者，中渎之腑也，水道出焉，属膀胱，是孤之腑也。是六腑之所与合者。
(二)难经三十八难，腑所以有六者，谓三焦也，有原气之别也，主持诸气，有名而无形，其经属手少阳，此外腑也。
(三)灵枢经脉篇，三焦手少阳之脉，起于小指次指之端，上出两指之间，循手表腕，出臂外两骨之间，上贯肘，循孺外上肩，而交出足少阳之后，入缺盆，布膻中，散络心包，下膈循属三焦。其支者，从膻中上出缺盆，上项系耳后，其上出耳上角，以屈下颊至顺。其支者，从耳后入耳中，出走耳前，过客主人前，交颊至目锐眦，是动则病耳聋，浑浑焞焞嗌肿喉痹；是主气所生病者，汗出，目锐眦痛，颊痛，耳后肩蠕肘臂外皆痛，小指次指不用。
世间原本就有一种肺病，其中轻的表现为咳嗽、喷嚏、面颊肿胀、咽喉梗阻等；重的表现为哮喘、咯血、肺痈（肺部化脓性感染）、肺痿（肺叶枯萎）等。这些病症都没有听说过会出现神志昏迷进而说胡话的情况。既然说是肺病，断然不可能出现神志昏迷；既然出现了神志昏迷，断然不仅仅是肺病；既然没有神志昏迷，断然不会病及心包络；既然没有病及心，断然不需要使用犀角。这些都是可以通过常理推断出来的，不必非要精通医道才能明白。吴鞠通所说的“上焦病”，就是顾景文所说的肺；吴鞠通所说的“不可用中焦药”，就是顾景文没有提到的胃。如果在顾景文提出的基础上再增加“缓缓”二字，胃气无法等待，从而酿成大热，或许暂时看似胜过顾景文的说法，但随即又用清官增液汤来治疗，使得胃病仍然得不到正确救治。病人实际患病的是胃，而医生口中谈论的是肺；导致神志昏迷的原因在胃，而医生治疗神志昏迷却针对心。这都善于运用“移字诀”（偷换概念），而这种偷换是移字诀中最大的祸害。明明有一部《伤寒论》长存于天地之间，其核心在于急祛邪热，阴液才得以保全。比如张仲景的白虎承气汤，小剂量使用以去除热邪，阴液就不会受伤；又如张仲景的葛根芩连诸方，辛味配合甘味以化生阳气，苦味配合甘味以化生阴液，阴阳调和则如及时雨降临，顷刻间就有枯木逢春、重振生机之能。然而这些却被一概摒弃，甚至令人厌恶听闻，难道是有意的吗？风寒温热不过是寻常疾病，像这样恍惚迷离，既让人把伤寒方剂视为畏途，又把一两个肯用伤寒方剂的医生目为怪物。想要达到长寿而避免早夭，只看《伤寒论》的兴衰如何了。我既然综合评论两家并畅发此论，希望那些曾受此害的病人家属，能在肺与胃之间权衡利弊，从而恍然大悟。
柴达益按：伤风感冒、气管炎、肺痈这一类疾病，在古代本来不属于温病范畴。这类病极少发生逆传心包，产生神志昏迷、说胡话等种种危象，这在现代医生看来已是常识。乙型脑炎等疾病极易见到神志昏迷、说胡话的症状，又何尝不是首先侵犯肺脏呢？陆九芝的意见，显然是可取的，可惜叶天士派的医者只是挑剔，不肯虚心接受，那么陆九芝也对他们无可奈何。缪希雍说：“凡是做医生的，应当先虚怀若谷，心灵知觉空明洞彻，本无一物。如果固执己见，就会与外物对立。己见坚固，势必轻视他人，认为我是别人非，与环境对抗。一旦灵明空窍被堵塞，虽然每天亲近高人，最终也获益甚微，直到白头依然故步自封，真是可悲啊。”这话值得我们深思。
驳斥章虚谷关于外感温热的观点
叶天士先生享有盛名，既被他的门下华岫云等人所毁，而顾景文的《温证论治》，又被章虚谷拿来注释，改题为《外感温热篇》。他之所以改为“外感”，想必也是嫌弃原题不像论述温病的样子，所以声称它与张仲景所说的伏气温病不同。如果是这样，那么叶天士的温病理论，本来就不是张仲景的温病理论；而章虚谷理解的温病，又不是叶天士的温病了。然而，换了一身衣服，并不能使人的性格面貌因此全部改变。况且如果真的像他所说的外感理论，且意图出于叶天士的本意，那么叶天士在《临证指南医案》中既把小风寒当作伤寒的一大法门，叶天士在温病论治中又把小风热当作温热的一大法门。所以，伤寒这一证候，到了叶天士那里失传了；温热这一证候，也到了叶天士那里失传了。然而谁知道这些都不是叶天士的真书呢？这种流弊简直像傀儡登场，被人牵线操纵，不使张仲景的圣道彻底消亡不止。王孟英的《温热经纬》罗致了各种学说，都不肯为病人考虑，呜呼，这场劫难，何时才能结束呢？
坊间又有《医效秘传》，也声称是叶天士的话，由吴子音刊刻。《秘传》内容极其不堪。至于叶天士、薛生白、缪希雍三家的医案，不仅用药荒谬，彼此相似，就连词句间也多有雷同，明显是一副笔墨写成，不问可知是伪作。史志记载薛生白与叶天士积不相能，曾自称居所曰“扫叶山庄”，那么薛生白怎么会听从叶派呢？缪希雍则是我自创流派，没听说他有这样的医案。偏偏这种谣言最容易动听，如果不托名于这两位先生，放在一边就可以了，现在却假借大医之名，使人信从，以此行骗，危害太大了。末尾附有陆秋山的《温热赘言》，那就是王孟英收录的陈恭伯祖父的话，以及章虚谷所指出的薛氏《湿热条辨》的内容，一字未改，只把陈恭改为“余”，自称拙著，不值一笑。（出自《世补斋医书》）
柴达益按：章巨膺读完以上几篇后曾加按语说：“以上几篇，最为精警。席姓（指席正甫或相关评者）的案评，就实指谬。昔日孔子成《春秋》，而乱臣贼子惧。陆九芝痛斥叶天士、吴鞠通，而江湖庸医却毫不醒悟。所谓道高一尺魔高一丈，正道不能战胜邪魔，致使流毒猖獗至今。看今日的中国，尽是邪魔当道，坚守张仲景南阳宗派的，能有几人？医事败坏，行将渐灭，不也是应该的吗？”这一按语措辞激烈，在学术讨论中，实在不可效仿。但前人的愤慨，是环境所促成的，我们不必再为此深责。叶派中人，若能落落大方，对此不加计较，平心静气地分析陆九芝等人的学术观点，在友好的学术争鸣中来共同研讨外感热病的治疗方法，那么对于开创新局面、振兴中医，必将大有裨益。我编纂这部著作，也是以此为希望。
驳斥吴鞠通三焦说的谬误
张仲景论述伤寒主要依据六经，《温病条辨》则主要依据三焦。三焦的说法，《灵枢》阐述得最详细。《灵枢·营卫生会篇》所谓“上焦如雾，中焦如沤，下焦如渎”就是说的这个。从这三句话来看，其含义大概是说身体上半部分为上焦，身体下半部分为下焦，中脘部位是胃腑所在之地为中焦。“沤”，如同《诗经》中“可以沤麻”的沤，有蕴酿的意思，指脾胃腐熟水谷。水谷既已腐熟，糟粕从下面排出，所以说下焦如渎，指大小便。糟粕既已下行，精华自然应当上行。如何上行？必须依赖蒸化作用，然后才能输运到四肢百体。蒸腾则如雾，所以说上焦如雾。古人不知道胃壁肠壁都能吸收滋养料供给各组织，仅凭理想推测，所以说如雾如渎。这原是笼统的话，概括而言，起初并不指某一个脏或某一个腑，别无深意，也与疾病的传变无关，不能与伤寒六经相提并论，这是非常明显的。
《营卫生会篇》又说：“上焦出于胃上口，并咽以上，贯膈而布胸中，走腋，循太阴之分而行，还至阳明，上至舌，下足阳明，常与营俱行于阳二十五度，行于阴亦二十五度，一周也，故五十度而复会于手太阴矣。”中焦也并位于胃中，出在上焦之后。这里所受的气，泌出糟粕，蒸化精液，化生精微，上注于肺脉，于是化而为血，以奉养全身，没有比这更宝贵的了，所以独得运行于经脉隧道，命名为营气。下焦者，别回肠，注入膀胱而渗入其中（以上为《灵枢·营卫生会篇》原文）。细细推敲文字，颇觉生涩。文章并不古奥，也不算不通，但乍一看，记录颇为凌乱无次。它说“上焦出于胃上口并咽以上”，应当是从胃上口直至咽喉以上。此处不过是食道，什么东西沿着食道行走？是营气？卫气？经气？还是血液？经文没有明确说明。如果说上焦沿着食道行走，则语意殊难理解。大概意思是说从胃上口至咽为上焦的一部分，则语意显明。但接着说“上焦出胃上口，并咽以上”，上焦是什么东西？实在不能知道它的命意所在。“咽以上”三字之下，接“贯膈”二字。膈的地位，在中脘以下。从咽至膈，中间距离太远。续文说“而布胸中”，则又是自下而上。脏腑内景，本来不易明了，似乎不应该故意扭曲文辞，使读者索解不得。再说“走腋循太阴之分而行”，更不知道“腑”字指什么。其下的太阴、阳明、足阳明，无一语不生涩，处处不可究诘。好像听说某医学院列《素问》《灵枢》为课本，不知教员对于这些地方如何解释。教员纵然能顺着文字敷衍，听讲的学生，又怎能了解？如果说讲者自讲，听者白听，了解与否双方均不在意，那么这种懵懂又足以令人佩服羡慕不已了。
尽管如此，就从生理功能形态上观察，《灵枢》所言，却自有其价值，不过仍与热病的传变无关。凡人口渴得很，喝水则润。渴不是口中干，而是胃中燥，得水而润，也不是口中润，而是胃中吸收液体，几经转折，传至唾腺，唾腺分泌唾液，然后才润。审视这一点，所谓“自胃上口并咽以上”，并非无故。且不称“至咽”而称“并咽以上”，是指口中津液尤为显明。凡食物入胃，消化之后，胃壁吸收液体以资营养，由胃入肠，肠壁也从事吸收液体以资营养。如果从饮食入胃之后，潜心体察，可以不须剖验而得知。而且人感到饥饿，不在胃中而在腹部。《内经》说：“胃实则肠虚，肠实则胃虚。”所以肠胃更迭为虚实。其意思似乎是说肠实胃实是病，肠虚胃虚也是病。为了阐明肠胃不同实也不同虚，所以措词如此。若就生理功能形态而言，肠实时，胃不妨虚；肠已虚时，胃则非实不可。感到饥饿的，不在胃而在肠，所以有“枵腹饥肠”等成语，不说“枵胃饥胃”。这就是胃肠二字由来。回肠间如果有燥屎，则痛苦难以入睡，严重的烦躁不安，更严重的则神志昏迷、说胡话。说神志昏迷、说胡话是心包络的病，乃是想当然之语，于实际无有是处。说是脑筋错乱，也还可以商量。因为燥屎结于肠而不寐烦躁，乃神经节为病，因肠壁纤维神经与交感神经、运动神经皆相通之故。阳明腑证的扬手掷足，因肠壁纤维神经病变影响于运动神经之故；其躁烦不寐，则因肠壁神经影响于交感神经之故。交感神经，听命于神经节，间接受治于大脑，所以说神经节为病。神经节者，是胸中之事也。这是病的形态。因病之形态以推测生理之形态，则知食物入胃，必下于肠，入肠之后，其影响最著者在胸中，必有其输送精微之道，所以说“上焦如雾”，布于胸中。这就是“布胸中”三字由来。然而这一节文字译为今人通用文字，应当说：上焦从胃上口上行至于咽以上，从胃中部下行至于肠，仍输送其精气布于胸中。
“走腑”句，“腑”字颇难索解。若根据《素问》及《难经》，则此“腑”字当指气街。曰“循太阴之分”，观下文“手太阴”句，则知此处是足太阴。还至阳明句，观下文有“足阳明”句，则知此处为手阳明。其云“常与营俱行于阳二十五度，行于阴亦二十五度，五十度而复会于手太阴”，是其所言者，即是卫气（阴阳各二十五度，详见《灵枢·卫气行篇》可参考，文繁不备录）。盖只有卫气与营气俱行，验证他处，没有三焦与营卫俱行之文。只有岐伯说营出于中焦，卫出于下焦，而言上焦独详，似中下焦统于上焦者。《难经》谓三焦者，水谷之道路，气之所终始，正与《灵枢》此节相合。“出于胃上口，并咽以上，贯膈，而布胸中”，是说水谷之道路；“走腑”以下至复会于手太阴矣，是说气之所终始。如此解释，未尝不言之成理。
其云“中焦是营气”，曰“泌糟粕，蒸精液也”，云“化其精微，上注于肺”，则仍是上焦如雾之事，不过其所主者，谓营出于中焦，故如此说。不得泥定地位，致与上焦纠缠不清。其云“上注于肺者为血，行于经隧者为营”，经隧即溪谷肌肉之分，脏器得此而滑润，故古人谓营为内部湿润之气。今日有西医学说，则知微细血管有渗润，淋巴液有循环，可以补我国古书之不足，而“营”字真确解释，自当以微细血管中之渗出液当之。其言下焦，意义自明。综以上所言者观之，三焦，言水谷之出入，与其精微化为营卫之大略者也。其言上焦自胃上口并于咽以上，自胃上口下至于肠，复自肠上至胸中，不限于中脘以上之地位也。中焦起于胃中，化精微上入于肺，化血复从血中分泌液体，行于遍身之经隧，不限于中脘之地位者也。三焦之可以分别言也，大略如此，与《温病条辨》之言三焦，丝毫无相通之处。《条辨》颇推崇叶天士，其云“凡病温者，始于上焦，在手太阴”，是即天士之《温热论》开卷第一条，所谓“温邪犯肺，逆传心包络”者也。以手太阴为上焦地位，未尝不是，肺原属脏腑之最高者，然《灵枢》则明言中焦化精微上注于肺脉，鞠通岂未之见乎？又其全书用药以轻者归上焦，重者归中焦，尤重者归下焦，纯以地位为主，不问营卫气血，亦与《灵枢》不合。《灵枢》固主营卫，不主地位者也。然则苟非鞠通不曾懂得《营卫生会篇》文字，即彼所谓三焦者，不是《生会篇》之三焦。吾乃偏考他处之言三焦者。
(一) 《灵枢·本输篇》云：三焦者，中渎之腑也，水道出焉，属膀胱，是孤之腑也。是六腑之所与合者。
(二) 《难经·三十八难》：腑所以有六者，谓三焦也。有原气之别也，主持诸气，有名而无形，其经属手少阳，此外腑也。
(三) 《灵枢·经脉篇》：三焦手少阳之脉，起于小指次指之端，上出两指之间，循手表腕，出臂外两骨之间，上贯肘，循臑外上肩，而交出足少阳之后，入缺盆，布膻中，散络心包，下膈循属三焦。其支者，从膻中上出缺盆，上项系耳后，其上出耳上角，以屈下颊至顖。其支者，从耳后入耳中，出走耳前，过客主人前，交颊至目锐眦，是动则病耳聋，浑浑焞焞嗌肿喉痹；是主气所生病者，汗出，目锐眦痛，颊痛，耳后肩臑肘臂外皆痛，小指次指不用。
There originally exists in the world a type of Lung disease. Its milder forms manifest as coughing, sneezing, swelling of the cheeks (Yi Zhong), and throat obstruction; its more severe forms manifest as asthma, hemoptysis, lung abscess (Fei Yong), and lung atrophy (Fei Wei). None of these are known to progress to coma and delirium. If it is stated as a Lung disease, it absolutely cannot involve coma; if there is coma, it absolutely is not merely a Lung disease; if there is no coma, it absolutely does not affect the Pericardium; if it does not affect the Heart, there is absolutely no need to use Rhinoceros Horn (Xijiao). These can all be deduced by common sense, without needing to fully master medical arts. What Wu Jutong calls "Upper Jiao disease" is what Gu Jingwen refers to as the Lung; what Wu Jutong calls "medicines of the Middle Jiao must not be used" is what Gu Jingwen did not mention, which is the Stomach. If one adds the words "slowly and gradually" to Gu Jingwen's points, the Stomach Qi cannot wait, leading to severe heat. Perhaps this temporarily seems superior to Gu Jingwen's theory, but subsequently using Qing Guan Zeng Ye Tang (Clear the Official and Increase Fluids Decoction) means the Stomach disease remains untreated. The patient suffers from Stomach disease, yet the doctor speaks of the Lung; the cause of coma lies in the Stomach, yet the doctor treats the coma by targeting the Heart. All these instances demonstrate a skillful use of the "Shift Character Technique" (substituting concepts), and this substitution is the greatest disaster among such techniques. Clearly, the *Shanghan Lun* (Treatise on Cold Damage) remains in the world, emphasizing the urgent expulsion of pathogenic heat so that Yin fluids may be preserved. For example, Zhang Zhongjing's Baihu Chengqi Tang (White Tiger and Major Order the Qi Decoction), when used in small doses to remove heat, ensures Yin is not injured; similarly, Zhang Zhongjing's Gegen Qinlian Tang (Kudzu and Scute and Coptis Decoction) and other formulas use acrid flavors combined with sweet flavors to transform Yang, and bitter flavors combined with sweet flavors to transform Yin. When Yin and Yang harmonize, it is like timely rain falling, instantly possessing the ability to revive withered wood and dry branches. Yet these are all discarded, and even hearing about them causes disgust. Is this intentional? Wind-cold and wind-heat are ordinary diseases. Such confusion makes people view Shanghan formulas as a fearful path, and labels those few doctors willing to use Shanghan formulas as monsters. To achieve longevity and avoid premature death, it depends entirely on the rise and fall of the *Shanghan Lun*. Since I have synthesized and expounded upon both schools, I hope patients' families who have suffered from this will weigh the issues between the Lung and Stomach and suddenly realize the truth.
Chai Da Yi commented: Diseases such as common cold, tracheitis, and lung abscess were originally not classified under Warm Disease categories in ancient times. Such diseases rarely transmit counterflow to the Pericardium, producing critical signs like coma and delirious speech, which is common knowledge for modern physicians. Epidemic encephalitis B, etc., frequently presents with coma and delirious speech; how could they first attack the Lung? Lu Jiuzhi's opinion is clearly acceptable. Unfortunately, physicians of the Ye Tianshi school are merely critical and unwilling to be humble, leaving Lu Jiuzhi helpless against them. Miu Xiyong said: "Any physician should first cultivate an open mind, with a spirit clear and empty, containing nothing. If one clings to personal views, one opposes external things. If personal views are rigid, one inevitably despises others, believing oneself right and others wrong, standing in opposition to circumstances. Once the spiritual aperture is blocked, although one may daily approach sages, one ultimately gains little benefit, remaining unchanged until old age, which is truly sorrowful." This statement deserves our deep reflection.
Refuting Zhang Xugu's Views on External Contracted Warmth
Mr. Ye Tianshi enjoyed great fame, which was ruined by his disciples such as Hua Xiuyun. Furthermore, Gu Jingwen's *Wen Zheng Lun Zhi* (Discussion on Warm Disorders) was annotated by Zhang Xugu, retitled as *Wai Gan Wen Re Pian* (Essay on External Contracted Warmth). His reason for changing it to "External Contracted" was likely because he felt the original title did not resemble a discussion on Warmth, thus claiming it differed from Zhang Zhongjing's latent warmth due to internal qi stagnation. If so, then Ye Tianshi's warmth theory was originally not Zhang Zhongjing's warmth theory; and Zhang Xugu's understanding of warmth was not Ye Tianshi's warmth theory either. However, changing clothes does not change a person's character or appearance. Moreover, if indeed his theory of external contraction aligns with Ye Tianshi's intent, then Ye Tianshi, in *Lin Zheng Zhi Nan Yi An* (Medical Cases from the Guide to Clinical Practice), treated minor wind-cold as a major method for Shanghan, and in treating warmth disorders, treated minor wind-heat as a major method for Warmth. Thus, the Shanghan syndrome was lost after Ye Tianshi, and the Warmth syndrome was also lost after Ye Tianshi. Yet who would know these are not Ye Tianshi's true books? This degeneration is like puppets on stage, manipulated by strings, stopping only when Zhang Zhongjing's sacred teachings are completely extinguished. Wang Mengying's *Wen Re Jing Wei* (Latitude and Longitude of Warmth and Heat) gathered various theories but refused to consider the patients' interests. Alas, when will this calamity end?
Another book, *Yi Xiao Mi Chuan* (Secret Transmission of Medical Efficacy), circulating in the market, also claims to be Ye Tianshi's words, engraved by Wu Zi Yin. The *Mi Chuan* content is extremely unacceptable. Regarding the medical cases of Ye Tianshi, Xue Shengbai, and Miu Xiyong, not only are their medication errors similar to each other, but their phrasing also has many similarities, obviously written with the same brushwork, proving they are forgeries without asking. Historical records state that Xue Shengbai and Ye Tianshi had long-standing animosity, and Xue once named his residence "Sao Ye Shan Zhuang" (Sweeping Leaves Mountain Villa). How could Xue Shengbai follow the Ye school? Miu Xiyong created his own independent school, and there is no record of him having such cases. Yet these rumors are most pleasing to hear. If not attributed to these two masters, they could be ignored. Now, borrowing the name of great physicians to make people believe and follow, thereby selling deception, the harm is great. At the end, Lu Qiushan's *Wen Re Zhui Yan* (Additional Remarks on Warmth and Heat) is actually the words of Chen Gong Bo's grandfather collected by Wang Mengying, and the content pointed out by Zhang Xugu regarding Xue's *Shi Re Tiao Bian* (Regulations on Damp-Heat), copied word for word, only changing Chen Gong to "Yu" (me), calling it my clumsy work. It is not worth a smile. (From *Shi Bu Zhai Yi Shu*)
Chai Da Yi commented: After reading the above articles, Zhang Juying added a comment: "The above articles are most profound and alerting. Xi's commentary points out errors based on facts. In ancient times, when Confucius completed the *Spring and Autumn Annals*, rebellious ministers and traitors feared. Lu Jiuzhi severely criticized Ye Tianshi and Wu Jutong, yet mediocre doctors in the Jianghu do not awaken. It is said that virtue rises one foot, while demons rise ten feet; the righteous way cannot defeat the demonic, causing poison to spread rampant to this day. Looking at China today, demonic paths dominate. How many still adhere to Zhang Zhongjing's Nanyang lineage? Medical affairs are ruined and on the verge of extinction; is this not appropriate?" This comment is harshly worded and truly not to be imitated in academic discussions. However, the indignation of predecessors was provoked by the environment, and we need not blame them deeply. If members of the Ye school could be magnanimous, not dwelling on this, and calmly analyze the academic views of Lu Jiuzhi and others, jointly discussing treatment methods for external contracted febrile diseases in friendly academic debate, it would greatly benefit opening new situations and revitalizing Traditional Chinese Medicine. I compiled this work with this hope.
Refuting the Errors in Wu Jutong's Theory of the Three Burners
Zhang Zhongjing discussed Shanghan primarily based on the Six Meridians, while *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases) primarily bases itself on the Three Burners. The concept of the Three Burners is detailed most extensively in *Ling Shu*. The phrase "Upper Jiao is like mist, Middle Jiao is like soaking, Lower Jiao is like a ditch" from *Ling Shu · Ying Wei Sheng Hui Pian* refers to this. Observing these three phrases, the meaning implies that the upper half of the body is the Upper Jiao, the lower half is the Lower Jiao, and the area of Zhongwan, where the Stomach resides, is the Middle Jiao. "Soaking" (Ou), as in "soaking hemp" from the *Book of Songs*, implies fermentation/酝酿, referring to the Stomach and Spleen rotting and ripening food and water. Once food and water are rotted and ripened, dregs exit from below, hence "Lower Jiao is like a ditch," referring to urine and feces. Once dregs descend downward, essence must naturally ascend upward. How does it ascend? It relies on steaming/transformation, then can be transported to the four limbs and hundred vessels. Steaming is like mist, hence "Upper Jiao is like mist." Ancient people did not know that stomach and intestinal walls absorb nutrients to supply tissues; they relied on ideal speculation, hence saying "like mist" and "like a ditch." This was originally a general statement, summarizing that initially it did not refer to a specific Zang or Fu organ, holding no deep meaning, and had nothing to do with disease transmission, making it clear it cannot be compared with the Six Meridians of Shanghan.
*Ling Shu · Ying Wei Sheng Hui Pian* further states: "Upper Jiao originates from the upper orifice of the Stomach, runs along with the pharynx upwards, pierces the diaphragm, and spreads in the chest, travels through the axilla, follows the Taiyin division, returns to Yangming, ascends to the tongue, descends to Foot Yangming, often traveling with Ying [Nutrient] Qi twenty-five cycles in Yang and twenty-five cycles in Yin. One cycle completes, thus after fifty cycles it reunites at Hand Taiyin." The Middle Jiao also resides within the Stomach, emerging after the Upper Jiao. The Qi received here separates dregs, steams essence, transforms fine essences, and pours them upward into the Lung vessels, thereby transforming into Blood to nourish the living body. Nothing is more precious than this, so it alone travels through the meridians and collaterals, named Ying Qi. The Lower Jiao separates from the ileum, pours into the Bladder, and seeps in (above is the original text from *Ling Shu · Ying Wei Sheng Hui Pian*). Examining the text closely, it feels somewhat awkward. The writing is not archaic nor incomprehensible, but superficially, the record appears chaotic. It says "Upper Jiao originates from the upper orifice of the Stomach and runs along with the pharynx upwards." This should mean from the upper orifice of the Stomach up to the pharynx. This place is merely the esophagus. What travels along this esophagus? Ying Qi? Wei [Defensive] Qi? Jing [Channel] Qi? Or Blood? The text does not explicitly state. If Upper Jiao travels along the esophagus, the meaning is hard to understand. Presumably, it means from the upper orifice of the Stomach to the pharynx is part of the Upper Jiao, making the meaning clear. But then it asks, "Upper Jiao comes from the upper orifice of the Stomach, running along with the pharynx upwards"—what is the Upper Jiao? Its intention is unclear. Below the three characters "pharynx upwards," it connects with "pierces the diaphragm." The diaphragm's location is below Zhongwan. The distance from the pharynx to the diaphragm is too far. Continuing, "and spreads in the chest," implies moving from bottom to top again. Internal organs are inherently difficult to clarify; it seems inappropriate to deliberately twist the wording, making readers unable to find solutions. Regarding "travels through the fu organs, follows the Taiyin division," it is unknown what "fu organ" refers to. The following Taiyin, Yangming, and Foot Yangming contain no non-awkward phrases, everywhere unexplainable. It is heard that some medical schools list *Su Wen* and *Ling Shu* as textbooks; I wonder how teachers explain these parts. Even if teachers can perfunctorily go through the text, how can listening students understand? If lecturers lecture and listeners listen blankly, caring neither about understanding nor not, this ignorance is enough to make one admire and envy endlessly.
Nevertheless, observing from the perspective of physiological function and form, what *Ling Shu* says has its own value, though still unrelated to the transmission of febrile diseases. Whenever a person is extremely thirsty, drinking water moistens them. Thirst is not dryness in the mouth, but dryness in the Stomach; obtaining water brings moisture, not to the mouth, but the Stomach absorbs liquid. After several turns, it transmits to the salivary glands, which secrete saliva, then moistening occurs. Considering this, "from the upper orifice of the Stomach along with the pharynx upwards" is not without reason. And saying "along with the pharynx upwards" rather than "to the pharynx" clearly indicates oral saliva. Whenever food enters the Stomach, after digestion, the stomach wall absorbs liquid for nutrition. From Stomach to Intestine, the intestinal wall also engages in absorbing liquid for nutrition. If one carefully observes after food enters the Stomach, one can know this without dissection. Moreover, human hunger is felt not in the Stomach but in the abdomen. *Nei Jing* says: "When Stomach is full, Intestine is empty; when Intestine is full, Stomach is empty." Thus Stomach and Intestine alternate between fullness and emptiness. The meaning seems to be that full Stomach and full Intestine is disease, and empty Stomach and empty Intestine is also disease. To clarify that Stomach and Intestine differ in fullness and emptiness, the wording is thus. Speaking physiologically, when Intestine is full, Stomach need not be empty; when Intestine is empty, Stomach must be full. Feeling hunger is not in the Stomach but in the Intestine, hence idioms like "empty belly and hungry intestines" exist, not "empty stomach and hungry stomach." This is the origin of the words Stomach and Intestine. If there is dry stool in the ileum, one suffers insomnia; severe cases involve restlessness and anxiety; even worse involves coma and delirious speech. Saying coma and delirious speech is a Pericardium disease is presumptuous and factually incorrect. Saying it is brain disorder is debatable. Because dry stool binding in the Intestine causes insomnia and restlessness due to nerve ganglia pathology, as intestinal wall fibrous nerves connect with sympathetic and motor nerves. Yangming Fu syndrome's throwing hands and feet results from intestinal wall fibrous nerve pathology affecting motor nerves; its restlessness and insomnia result from intestinal wall nerves affecting sympathetic nerves. Sympathetic nerves obey nerve ganglia and are indirectly controlled by the cerebrum, hence called nerve ganglia pathology. Nerve ganglia are matters of the chest. This is the pathology's form. Inferring physiological form from pathological form, we know food entering the Stomach must go down to the Intestine. After entering the Intestine, its most significant impact is in the chest, requiring a channel to transport fine essences. Hence "Upper Jiao is like mist," spreading in the chest. This is the origin of "spreading in the chest." Therefore, translating this section into modern common language should say: Upper Jiao ascends from the upper orifice of the Stomach to above the pharynx, descends from the middle of the Stomach to the Intestine, and still transports its essence and qi to spread in the chest.
The phrase "travel through fu organs" makes the character "Fu" hard to interpret. Based on *Su Wen* and *Nan Jing*, this "Fu" character should refer to Qi Street (Qi Jie). "Follows the Taiyin division," observing the following "Hand Taiyin" sentence, indicates this is Foot Taiyin. "Returns to Yangming," observing the following "Foot Yangming" sentence, indicates this is Hand Yangming. "Often traveling with Ying Qi twenty-five cycles in Yang, twenty-five cycles in Yin, fifty cycles and then reuniting at Hand Taiyin"—what it describes is Wei [Defensive] Qi (detailed in *Ling Shu · Wei Qi Xing Pian*, text too long to quote). Only Wei and Ying travel together; verifying elsewhere, there is no text stating San Jiao travels with Ying and Wei. Only Qibo said Ying originates from Middle Jiao, Wei originates from Lower Jiao, yet spoke in detail only about Upper Jiao, implying Middle and Lower Jiao are unified under Upper Jiao. *Nan Jing* states San Jiao is the pathway of food and water, the beginning and end of Qi, which matches this section of *Ling Shu*. "Originating from the upper orifice of the Stomach, along with pharynx upwards, piercing diaphragm, and spreading in the chest" describes the pathway of food and water; "traveling through fu organs" below to reuniting at Hand Taiyin describes the beginning and end of Qi. Explaining it this way is reasonable.
It says "Middle Jiao is Ying Qi," "separates dregs, steams essence," and "transforms fine essences, pouring upward into Lung." This is still the matter of "Upper Jiao is like mist," but since it governs that Ying originates from Middle Jiao, it speaks thus. One must not stick to fixed locations, causing entanglement with Upper Jiao. It says "pouring upward into Lung becomes Blood, traveling through meridians is Ying." Meridians are the divisions of muscles and valleys; organs gain lubrication from this, hence ancients called Ying the internal moistening Qi. With modern Western medical theories, we know microvessels have exudation and lymph fluid has circulation, supplementing deficiencies in ancient Chinese books. The precise explanation of "Ying" should correspond to exudate in microvessels. Its statement on Lower Jiao is self-evident. Summarizing the above, San Jiao discusses the entry and exit of food and water, and the general transformation of fine essences into Ying and Wei. Its description of Upper Jiao from the upper orifice of the Stomach along with pharynx upwards, from upper orifice down to Intestine, and back up to Chest, is not limited to the position above Zhongwan. Middle Jiao starts in the Stomach, transforms fine essences upward into Lung, transforms blood, and secretes liquid from blood to travel through meridians of the whole body, not limited to Zhongwan. The distinction of San Jiao is roughly as described, having no connection whatsoever with the San Jiao mentioned in *Wen Bing Tiao Bian*. *Tiao Bian* highly praises Ye Tianshi, stating "All warm diseases begin in Upper Jiao, at Hand Taiyin." This is Ye Tianshi's *Wen Re Lun* opening line: "Warm pathogen attacks Lung, counterflows to Pericardium." Using Hand Taiyin as Upper Jiao position is not incorrect, as Lung belongs to the highest Zang-Fu. However, *Ling Shu* clearly states Middle Jiao transforms fine essences and pours upward into Lung vessels. Did Jutong not see this? Also, in his entire book, light medicines are assigned to Upper Jiao, heavy to Middle Jiao, and especially heavy to Lower Jiao, purely based on location, ignoring Ying, Wei, Qi, and Blood, which also conflicts with *Ling Shu*. *Ling Shu* certainly manages Ying and Wei, not location. Thus, unless Jutong did not understand the text of *Ying Wei Sheng Hui Pian*, his so-called San Jiao is not the San Jiao of *Sheng Hui Pian*. I will now examine other mentions of San Jiao.
(1) *Ling Shu · Ben Shu Pian* states: San Jiao is the large ditch Fu organ, water pathways emerge from it, connecting to Bladder; it is the solitary Fu organ. It combines with the six Fu organs.
(2) *Nan Jing · Thirty-Eighth Difficulty*: Why are there six Fu organs? It refers to San Jiao. It is a branch of Yuan Qi, governing all Qi, having a name but no form. Its meridian belongs to Hand Shaoyang, an external Fu organ.
(3) *Ling Shu · Jing Mai Pian*: The meridian of San Jiao, Hand Shaoyang, originates from the tip of the fourth finger, emerges between the two fingers, follows the back of the hand and wrist, emerges between the two bones of the forearm, ascends through the elbow, follows the outer arm to the shoulder, crosses behind Foot Shaoyang, enters the supraclavicular fossa, spreads in Danzhong, disperses and connects to Pericardium, passes through diaphragm, and belongs to San Jiao. Its branch emerges from Danzhong, goes up supraclavicular fossa, ascends neck, ties behind ear, emerges above ear angle, curves down cheek to chin. Another branch enters ear from behind ear, exits front of ear, passes before Guest Master point, crosses cheek to outer canthus. Pathogenic movement causes deafness, muffled hearing, swollen throat, and sore throat. Governing Qi diseases include sweating, pain at outer canthus, cheek pain, pain behind ear, shoulder, arm, elbow, and outer arm, and dysfunction of the fourth finger.