灵素言三焦者，大都不外以上三节，自余如素问六节藏象论，灵兰秘典等篇，偶然涉及，无此详也。第三节灵枢经脉篇所言，最不易明了，然中医实以此为根本，不明经络，无以言医，然求之今日医界中人，不过能已诵而已，若深明其理，则自古医籍中已无之，遑论今日，兹为释疑辨惑起见，为言其原理，俾读者可以自修而止。至于详细，余不能言也，凡经络云自某处迄某处，经某处者，皆从病与生理之形能来，例如灵枢经脉篇之言三焦，前半所说，均从后半病形产生，先有耳聋嗌肿喉痹之病，相其阴阳，辨其深浅，定为手少阳之病，复视其兼证有目锐眦痛颊痛，耳后肩孺肘臂外痛，小指次指不用，于是定诸痛处为手少阳之经，其中复有错综交互，如云交出足少阳布膻中散络心包，是手少阳一经，与足少阳手厥阴有交互关系也，所谓经气，亦如血行，如环无端，不知其所自始，然躯体而有病，必有其始病之处，又必有其痛苦之区域，从其区域分之，因有十二种，从其始病言之，因有手六经足六经，例如疟疾之形寒，有从背起者，右从手起者，其明证也。古人最讲究针灸，而砭石又在针灸之前，以事理推断之，必有甚深远之历史，惜鄙人读书不多，不能考证耳。度此事之缘起，必如今日妇竖皆知之刮痧，其后演进而为砭石，再进而为针灸，十二经之井荥经俞，则多从针灸之成效而定名，故今日已不能知其最初得此之所由，嗣后由针灸而汤药，则为道稳而取效亦神，则属最后之进步矣。今日吾人所当之者有二事，其一，古代所传之汤药，其用法皆隶于经络，某经病当用某药，从之则效，违之则否，故当用葛根者，不得用麻黄，当用大黄者，不得用巴豆，非如西药仅言汗下，无复别择，此治中医所以不可不讲十二经。其二，健体之经气不可见，逆之则见，而经气之所以逆，由于气候之六淫者三之一，由于起居饮食者三之一，由于七情者三之一。故寒暑病人、饥饱病人、意志拂逆病人，不逆经气，则能遂其生而尽天年；逆经气，则不能遂其生而夭折，所谓有道之士，善养生者，能遂其生而已矣，上工治未病，能知经气之顺逆及其未病，拨乱返正而已，此十二经原理之大略也。经气不可见，逆则见之于病能，循经治病谓之工，然非上乘，能知若何便逆经气，若何便顺经气，守顺避逆，乃真上乘。素问上古天真论所言，乃上乘也。西国最新发明者曰细胞曰内分泌，其实经气较之二者尤精，惜乎古文太简，灵枢之学说，又真伪参半，果能董而理之，发挥而光大之，则中西携手之后，西国医学当更进一步，此则欲于医学有所发明，尤不可不知经气。今之反对中医者，谓中国医学不能出国门一步，固非定论。而业中医者，惟因饭碗问题，惟恐中医被取谛，妄欲结乌合之众以为党，以与潮流相抗，而号于众曰，吾欲保存国粹，彼等野狐禅之医学，岂是国粹，亦安有保存之希望，若真国粹，决不消灭，何劳保存，谓中医将灭亡者，杞人忧天而已。今姑置此，而言三焦，然则三焦有三种，其一，三焦者，决渎之官，专指分泌尿汁说，其二，三焦者，水谷之道路，气之所终始，专指消化力与卫气说，其三，三焦为手少阳经，为十二经中之一。滑伯仁、徐灵胎皆云，言决渎之官者，为下焦气化之三焦。言手少阳者，是有名无状之三焦。言消化与卫气者，是有名有？状之三焦。准此以谈，是古人定名不讲究也，然无论何种，与温病条辨皆不合，是温病条辨之三焦，乃第四种三焦。
假使有精当之学理，真确之经验，原不妨于古人所言者之外，别树一帜，然必其所言者，与古人相发而后可，如其与古人所言相背，则必古人所说之理论不圆满，吾能证明其误处而后可，若表面崇古，里面反古，用以欺世敛钱，原滔滔皆是，不足深责，著书垂后，则其罪不胜诛矣。今温病条辨上焦篇曰：凡温病者，始于上焦，在手太阴。鞠通自为注曰：“古来但言膀胱主表，殆未尽其义。肺者，皮毛之合也，独不主表乎。……温病由口鼻而入，自上而下，鼻通于肺，始手太阴。"此语实弗解之至，愚按古人言脏腑与经气者有别，盖脏腑是实体，经气是气化，六淫之邪，中人而为病，言气化不言实体，内经言“邪风之至，疾如风雨(此邪风字不问从西北东南来)，故善治者治皮毛，其次治肌肤，其次治筋脉，其次治六腑，其次治五脏，治五脏者，半死半生也。故天之邪气感，则害人五脏。水谷之寒热感，则害于六腑，地之湿气感，则害皮肉筋脉。”此节经文与上文阴阳及东南西北各节息息相通，所谓“阴阳更胜之变，病之形能也。”治皮毛谓病在皮毛也，不是言肺之合，是言躯体之外层，其次在肌肤，言稍进，非言脾之合；其次言筋脉，言更进，非言肝之合；其次在六腑，言入里，其次在五脏，言里之无可再里。假使指皮毛为肺之合，肌肤为脾之合，筋脉为肝之合，则六腑为何者之合乎，是不可迩。又认皮毛为肺之合，是必邪风之害人，初一步肺受之，继一步传之脾，继一步传之肝，继一步传于六腑而后可，证之实际，无论伤寒温病，皆不尔，是更不可通。是故自来释伤寒论者，开口即言太阳是膀胱，鄙人绝对不敢苟同，是故讲义解释太阳病，直曰太阳者，躯体之最外层，今日凡病温者始于上焦，在手太阴，此何说也。其次不可解者，为伤寒从毛窍入，温病从口鼻入。大约鞠通创温病自口鼻入，为其最得意之语，不知此说，绝不可通，试逐层推敲之。(一)内经言凡热病皆伤寒之类，凡邪风之害人，皆始于皮毛，今言从口鼻入，由里出外，是必温病在内经凡热病三字范围之外而后可。(二)既言从口鼻入，鼻通于肺，故在手太阴，然则口通于脾，不在足太阴乎。(三)经言天之邪气感，则害人五脏，此言木治皮毛，即有害五脏之可能，所谓病能也。曰水谷之寒热感，则害于六腑，此真从口入者，更证之于实验，饮冰而洞泄，触秽而为霍乱，空气中微菌传染为各种疫病，此真从口鼻入者，若云天之邪气感，亦有从口鼻入者，于内经无征。(四)鞠通谓伤寒言中风，是西北方之寒风，彼所言之温病，风为火母，乃从东南方来解冻之温风，寒风从毛窍入，温风从口鼻入，不知出何典记，有何理由，诚咄咄怪事。就温病条辨之第一条略为钩稽，其不可通已如此。而党于鞠通者，方浓圈密点，大赞不已，将谓天下后世人无不可欺，不亦慎者。(《温病明理》)
柴按；1·上为温病明理卷二之全文，题为作者所加。此篇对中医原有三焦之本义，探讨颇为详明，恽氏目的，在于先明了中医三焦之本义，然后证明吴鞠通之三焦，出自杜撰。吴鞠通认为温病从上而下，伤寒从外入里，章巨膺曾斥为“神昏沾语”。孰是孰非，值得讨论。叶派并不否定温病有伏气温病、新感温病二种。伏气温病，不是从上而下，这是相当明确的。新感温病是否都首先犯肺？即举湿温先犯足太阴足阳明一例，亦已足证其非。即此论之，恽氏抨击吴鞠通之三焦说，谓开首第一条就已不通，是有道理的。
2·中医在古代把脑的生理病理归属于心，至王清任提出灵机记性在脑不在心的论点后，被后世医家认为是对中医学的一大贡献。恽氏说：“神昏诂语是心包络病，乃想当然之语，于实际无有是处。谓是脑筋错乱，亦尚可商。”这与王清任的观点，可以说是—一脉相承。叶派每将温热病之神昏诂语，说成是逆传心包，从现在的观点来看，这样解释病理，似不及恽氏的解释为合理。又按；营卫生会篇原文贯膈认作贯肠，则误在恽氏。
温热之病理与定名温热病之分目，见于温病条辨者有九，曰风温、温热、温疫，温毒、暑温、湿温、秋灿、冬温、温疟。自注云：风温者，初春阳气始开，厥阴行令，风挟温也。温热者，春末夏初，阳气弛张，温盛为热也。温疫者，疠气流行，多兼秽浊，家家如是，若役使然也。温毒者，诸温挟毒，秽浊太甚也。暑温者，正夏之时，暑之偏于热者也。湿温者，长夏初秋，湿中生热，即暑之偏于湿者也。秋燥者，秋金燥烈之气也。冬温者，冬应寒而反温，阳不潜藏，民病温也。温疟者，阴气先伤，又因于暑，阳气独发。以上云云，似可解，实不可解。风温、温热，以春初春末为别，阳气开始与阳气弛张为异，不知阳气弛张至如何程度为温热，更不知春之半病温者，为风温抑为温热，虽经解释，仍不可辨也。多兼秽浊，秽浊太甚，同是秽浊，何以一则流行的为温疫，一则不流行为温毒。暑之偏于热者句，不辞已甚，秋金燥烈之气，与热病何干。自条自辨，还是辨不清楚。不究病之原理，不详病之症状，故不能言之真切，只得望文生义，作此模糊影响之谈而已。
本书论温，如前章所列表，只有温热、春温、暑温、湿温，伤暑、湿热六种，别无其他冬温、秋燥、温疟诸名，何以与时俗所称者相差如此之多，则因从病之原理与症状归纳之，无须多立名目，徒乱人意，今当从病型以推究病理，从病理以归纳病名。
前人论伤寒温病之异，谓伤寒由外入里，温病由里出表，陆氏亦为此言，此实不可通，伤寒温病同是外感，仲圣言发热而渴不恶寒者为温病，条上冠以太阳病三字，其义可见也。然则何以别异。曰其不同之点，只在恶寒与不恶寒，有汗与无污之分。凡病发热恶寒无汗者，无论春夏秋冬，均为伤寒，发热不恶寒或恶寒时间甚短，有汗者，为温病。在春曰春温，在夏曰暑温，在长夏曰湿温，此所谓温病，仍是伤寒，因伤于寒而得之病也，其说详下。
冬日外界空气冷，人体为适于冷空气中生存，皮下血管及肌肤均收束，毛窍固闭，卫气致密，体温浓集外层以抵御外寒，人之伤于寒也，寒邪不得深入，止于外层，为振栗恶寒，根据第二个发热原因，全身体温均奔集表层，以事驱逐，体温逾适当之量，遂为发热状态，在理体内热高，当汗出以放散体温，然因有寒邪在表，毛窍固闭，抵抗愈甚，不得疏泄，所以壮热恶寒无汗，是为伤寒太阳证之原理。寒邪在表不解，化燥内传，寒邪已透过表层；故不恶寒反恶热。第一道防线破，重心不在表而在里，体工自起调节作用，放散体温，毛窍开，汗自出，汗出液少，故口渴，是伤寒阳明证之原理。
若外界空气和暖，与人体体温温度相若，毛窍开阖之作用，在不甚重要之列，伤于寒，寒邪得以深入，体温集表以为抵抗，故发热。毛窍本倾向于开，因热高，故汗自出，寒邪中外层，例当洒淅恶寒，卒以外层抵抗力薄弱，寒邪在表时间甚暂，故恶寒时间甚短，过表入里，重心在里，是为温病之原理。
伤寒阳明证与温病，同一蹊径，一则寒邪经过太阳，逗留太阳若干日，然后化燥内传入阳明，一则寒邪经过太阳迳入阳明，故温病开始在阳明。
同是寒伤躯体表层，何以一则逗留于太阳，一则迳入于阳明，则因时令之异六气之殊故也。冬伤于寒，振栗恶寒，发热无汗，其原理已如上述。春为风，其气和煦，肌肤毛窍不如冬令之固密，寒邪中人，兼风化，迳入阳明，发热汗出为春温。假如春月，天气冱寒不去，应暖不暖，至而不至，则肌肤毛窍固密，抵御外界冷空气之能耐，依然存在，则寒伤躯体，格拒于表，恶寒发热无汗，仍属伤寒，假如冬日气候和暖，应寒反暖，未至而至，人体体温与外界空气温度不甚相差，肌肤毛窍，防御外寒，不在重要之列，寒邪中人，迳入阳明为温病，发热汗出者，以病理论之与春混同，故不须另立冬温之名。
夏日外界空气热，高于人体，肌肤毛窍非但无须抵抗，并且有待于疏泄，故夏月炎热，汗出疏泄以调节体温，是故夏月樊篱尽撤，边防空虚，伤于寒发热汗出，表层无抵抗，些微觉恶寒即发热，是为暑温，其在长夏时令，气候兼湿化，伤于寒而热者曰湿温，病机同暑温。
读者须知，肌肤毛窍之启闭，所以调节体温，其作用甚敏活，严冬冱寒，毛窍虽闭，若剧劳奔走，体温增高，毛窍遂开，汗出以放散，反之夏月炎热，毛窍虽开，若贪凉过度，毛窍能闭，以拒寒凉，知此原理，则冬月有春温无足奇，夏月有伤寒亦非例外，故暑月发热无汗恶寒，与冬月伤寒同法，冬月发热有汗不恶寒，与春日春温同法。
是故伤寒温病，恶寒不恶寒，有汗无汗，为病之大关键，其发热则基于第一第二个原理，若湿热与伤暑，相当于《伤寒论》之湿与暍，是夏令之时行病，因湿邪发热，俗混称湿温，发热则基于第三个原理，病理与前绝不相同。详述于下：
空气含氧气十分之二强，氮气十分之八弱，此外有少许炭酸气，氧气为人体生活所必需，当吸入之时，外面空气达于肺泡中，其中之氧气由微血管送入血液中，同时吸入无用之炭酸气，由肺呼出于外，呼吸不停，保持健康之状态，至夏月空气稀薄，氧气之比例成份亦稀少，从外吸入之氧气量不足，复因气候炎热，汗山多，血液干，体内存积之氧气量亦不足，于是呼吸不利，而感胸闷窒息，呼吸不利，则放温之机能失职，若中暑而热者，体内温度不能放散于外，遂为发热汗多胸闷之状，是为伤暑之病理。
《灵枢》与《素问》中关于三焦的论述，大体上不外乎以上三个层面的解释。其余如《素问·六节藏象论》、《灵兰秘典论》等篇章，偶尔涉及三焦，但没有如此详尽。第三层含义出自《灵枢·经脉篇》，最为难以理解，然而中医实际上以此为根本，如果不明白经络，就无法谈论医学。然而探求当今医界人士，不过能够背诵罢了，若能深明其理，则自古以来的医籍中也已失传，更不必说今日了。现在为了消除疑惑、辨明困惑起见，阐述其原理，使读者可以自行修习而止。至于详细之处，我不能详述。凡是说经络从某处到某处，经过某处的，都是从疾病与生理的功能形态而来。例如《灵枢·经脉篇》中关于三焦的论述，前半部分所说的内容，均是从后半部分的病形产生出来的。先有耳聋、咽喉肿痛、喉痹等疾病，观察其阴阳属性，辨别其深浅程度，定为手少阳经的病证；再观察其兼证有目锐眦痛、颊痛、耳后肩臂肘外侧痛、小指次指不能活动，于是确定这些疼痛部位属于手少阳经。其中又有错综交互的情况，如说“交出足少阳，布散于膻中，络于心包”，这是手少阳一经与足少阳、手厥阴有交互关系。所谓经气，也像血液运行一样，如环无端，不知道它的起始点在哪里。然而躯体若有疾病，必有其发病的起始之处，也必有其痛苦的区域。从其痛苦区域来划分，因而有十二种；从其发病起始来说，因而分为手六经和足六经。例如疟疾出现的恶寒症状，有的从背部开始，有的从手部开始，这就是明显的证据。古人最讲究针灸，而砭石又在针灸之前，从事理推断，必然有很深远的历史，可惜我读书不多，不能考证此事的缘起。推测此事的起源，必定像今日妇孺皆知的刮痧，其后演进而为砭石，再进而为针灸。十二经的井、荥、经、俞穴，大多是从针灸的成效而定名的，所以今日已不能知道最初获得这些名称的原因。此后由针灸发展到汤药，则道路稳妥且取效神奇，这属于最后的进步了。
如今我们面临两件事：其一，古代流传下来的汤药，其用法都隶属于经络，某经生病应当用某药，遵循它则有效，违背它则无效。所以当用葛根时，不能用麻黄；当用大黄时，不能用巴豆。不像西药仅言发汗或泻下，没有其他的分别选择，因此研究中医的人不可不讲十二经的原理。其二，健康的经气是不可见的，只有逆乱时才显现出来。而经气之所以逆乱，三分之一是由于气候之六淫（风、寒、暑、湿、燥、火），三分之一是由于起居饮食，三分之一是由于七情（喜、怒、忧、思、悲、恐、惊）。所以因寒暑致病的人、因饥饱致病的人、因意志拂逆致病的人，如果不逆乱经气，就能顺应生命规律而享尽天年；如果逆乱经气，就不能顺应生命规律而早夭。所谓有道之士、善于养生的人，只是能顺应生命规律而已。高明的医生治疗未病，能知道经气的顺逆及其在未病阶段的状态，拨乱反正罢了，这就是十二经原理的大略。经气不可见，逆乱时就会表现为病态功能，循经治病称为工，但这并非上乘境界。能知道如何使经气逆乱、如何使经气顺遂，坚守顺遂而避免逆乱，才是真正的高明境界。《素问·上古天真论》所言的，就是这种上乘境界。西方国家最新的发明是细胞和内分泌，其实经气比这两者更为精微，可惜古文太简略，《灵枢》的学说又真伪参半，如果能整理并发挥光大它，那么中西携手之后，西方医学应当更进一步，这对于想要在医学上有所发明的人来说，尤其不可不知经气。如今反对中医的人，说中国医学不能出国门一步，这固然是不确定的结论。而从事中医的人，只因为饭碗问题，唯恐中医被取缔，妄图结集乌合之众以为党派，以与潮流相抗，并向大众宣称：“我要保存国粹。”那些野狐禅般的医学，难道是国粹吗？哪里有保存的希望？如果是真正的国粹，绝不会消灭，何劳保存？说中医将灭亡的人，不过是杞人忧天罢了。
现在暂且放下这些不谈，来说三焦。然而三焦有三种含义：其一，三焦是决渎之官，专指分泌尿汁而言；其二，三焦是水谷的道路，气之所终始，专指消化力与卫气而言；其三，三焦是手少阳经，是十二经中的一条。滑伯仁、徐灵胎都说：说它是决渎之官的，是指下焦气化之三焦；说它是手少阳的，是有名无状之三焦；说它是消化与卫气的，是有名有状之三焦。据此来谈，是古人定名不讲究啊。然而无论哪种含义，都与《温病条辨》不合，《温病条辨》中的三焦，乃是第四种三焦。
假使有精当的学理、真实的经验，原本不妨在古人所言之外，另树一帜，但必须其所言者与古人相互印证才可以。如果与古人所言相违背，那就必须是古人所说的理论不圆满，我能证明其错误之处才可以。如果表面崇古，里面反古，用来欺世敛财，原是大有人在，不值得深责；但著书留传后世，那罪过就不可诛灭了。如今《温病条辨·上焦篇》说：“凡温病者，始于上焦，在手太阴。”鞠通自己作注说：“古来只说膀胱主表，大概没有完全阐明其义。肺是皮毛的合应，难道不主表吗？……温病由口鼻而入，自上而下，鼻通于肺，始于手太阴。”这句话实在令人无法理解。我认为古人对脏腑与经气的说法是有区别的。脏腑是实体，经气是气化。六淫之邪侵入人体而致病，说的是气化而不是实体。《内经》说：“邪风之至，疾如风雨（这个邪风字不问从西北东南哪个方向来），所以善于治疗的人治疗皮毛，其次治疗肌肤，其次治疗筋脉，其次治疗六腑，其次治疗五脏。治疗五脏的，一半死亡一半生存。所以天之邪气感受，则伤害五脏；水谷的寒热感受，则伤害六腑；地的湿气感受，则伤害皮肉筋脉。”这段经文与上文阴阳及东南西北各节息息相关，所谓“阴阳更胜之变，病之形能也”。治皮毛是说病在皮毛，不是指肺的合应，而是指躯体的外层；其次在肌肤，是说病情稍进，不是指脾的合应；其次在筋脉，是说病情更深，不是指肝的合应；其次在六腑，是说病入里；其次在五脏，是说病在里之无可再里。假如指皮毛为肺之合，肌肤为脾之合，筋脉为肝之合，那么六腑是谁的合应呢？这是讲不通的。又认为皮毛为肺之合，那就一定是邪风害人，第一步肺受之，第二步传给脾，第三步传给肝，第四步传给六腑才可以。验证实际情况，无论是伤寒还是温病，都不是这样，这更是讲不通的。因此自来解释《伤寒论》的人，开口就说太阳是膀胱，我绝对不敢苟同。所以讲义解释太阳病，直接说太阳者是躯体之最外层。如今凡是得温病的人始于上焦，在手太阴，这是什么说法？
其次不可理解的是，伤寒从毛窍入，温病从口鼻入。大约鞠通创立温病自口鼻入的说法，是他最得意的言论，却不知道此说绝不可通，试逐层推敲一下：(一)《内经》说凡热病皆属伤寒之类，凡邪风害人，皆始于皮毛。如今说从口鼻入，由里出外，那必须是温病在《内经》“凡热病”三字范围之外才可以。(二)既然说从口鼻入，鼻通于肺，所以在手太阴；然则口通于脾，不在足太阴吗？(三)经书说天之邪气感受，则伤害五脏。这里说治疗皮毛，即有害五脏的可能性，所谓病能也。说水谷的寒热感受，则伤害六腑，这才是真正从口入者。更验证于实验，饮冰导致洞泄，触秽导致霍乱，空气中微菌传染为各种疫病，这才是真正从口鼻入者。如果说天之邪气感受，也有从口鼻入者，在《内经》中没有依据。(四)鞠通说伤寒言中风，是西北方的寒风；他所言的温病，风为火母，乃是从东南方来的解冻之温风。寒风从毛窍入，温风从口鼻入，不知出自何典记，有何理由，真是咄咄怪事。就《温病条辨》的第一条略加钩稽，其不可通已如此。而依附于鞠通的人，才浓圈密点，大赞不已，将谓天下后世之人无不欺瞒，不也太谨慎了吗？
柴按：1. 上面是《温病明理》卷二的全文，标题为作者所加。此篇对中医原有三焦的本义探讨颇为详明，恽氏的目的，在于先明了中医三焦的本义，然后证明吴鞠通的三焦说是出于杜撰。吴鞠通认为温病从上而下，伤寒从外入里，章巨膺曾斥之为“神昏谵语”。孰是孰非，值得讨论。叶派并不否定温病有伏气温病、新感温病两种。伏气温病，不是从上而下，这是相当明确的。新感温病是否都首先犯肺？即举湿温先犯足太阴、足阳明一例，也已足以证明其非。就此论之，恽氏抨击吴鞠通的三焦说，谓开首第一条就已不通，是有道理的。
2. 中医在古代把脑的生理病理归属于心，至王清任提出灵机记性在脑不在心的论点后，被后世医家认为是对中医学的一大贡献。恽氏说：“神昏谵语是心包络病，是想当然的话，于实际无有是处。谓是脑筋错乱，也还可以商量。”这与王清任的观点，可以说是一脉相承。叶派每将温热病的神昏谵语，说成是逆传心包，从现在的观点来看，这样解释病理，似乎不如恽氏的解释为合理。又按：营卫生会篇原文“贯膈”误认为“贯肠”，则错误在恽氏。
温热病的病理与定名。温热病的分目，见于《温病条辨》的有九种：曰风温、温热、温疫、温毒、暑温、湿温、秋燥、冬温、温疟。自注说：风温者，初春阳气始开，厥阴行令，风挟温也。温热者，春末夏初，阳气弛张，温盛为热也。温疫者，疠气流行，多兼秽浊，家家如是，若役使然也。温毒者，诸温挟毒，秽浊太甚也。暑温者，正夏之时，暑之偏于热者也。湿温者，长夏初秋，湿中生热，即暑之偏于湿者也。秋燥者，秋金燥烈之气也。冬温者，冬应寒而反温，阳不潜藏，民病温也。温疟者，阴气先伤，又因于暑，阳气独发。以上云云，似可解，实不可解。风温、温热，以春初春末为区别，阳气开始与阳气弛张为差异，不知阳气弛张至如何程度为温热，更不知春之半病温者，是风温还是温热，虽经解释，仍不可分辨也。多兼秽浊，秽浊太甚，同是秽浊，何以一则流行的为温疫，一则不流行为温毒。暑之偏于热者句，不辞已甚，秋金燥烈之气，与热病何干。自条自辨，还是辨不清楚。不究病之原理，不详病之症状，故不能言之真切，只得望文生义，作此模糊影响之谈而已。
本书论温，如前章所列表，只有温热、春温、暑温、湿温、伤暑、湿热六种，别无其他冬温、秋燥、温疟诸名，何以与时俗所称者相差如此之多？则因从病之原理与症状归纳之，无须多立名目，徒乱人意。今当从病型以推究病理，从病理以归纳病名。
前人论伤寒温病之异，谓伤寒由外入里，温病由里出表，陆氏亦为此言，这实在不可通。伤寒温病同是外感，仲圣说发热而渴不恶寒者为温病，条上冠以太阳病三字，其义可见也。然则何以别异？曰其不同之点，只在恶寒与不恶寒，有汗与无汗之分。凡病发热恶寒无汗者，无论春夏秋冬，均为伤寒；发热不恶寒或恶寒时间甚短，有汗者，为温病。在春曰春温，在夏曰暑温，在长夏曰湿温，此所谓温病，仍是伤寒，因伤于寒而得之病也，其说详下。
冬日外界空气冷，人体为适于冷空气中生存，皮下血管及肌肤均收束，毛窍固闭，卫气致密，体温浓集外层以抵御外寒。人之伤于寒也，寒邪不得深入，止于外层，为振栗恶寒。根据第二个发热原因，全身体温均奔集表层，以事驱逐，体温逾适当之量，遂为发热状态。在理体内热高，当汗出以放散体温，然因有寒邪在表，毛窍固闭，抵抗愈甚，不得疏泄，所以壮热恶寒无汗，是为伤寒太阳证之原理。寒邪在表不解，化燥内传，寒邪已透过表层，故不恶寒反恶热。第一道防线破，重心不在表而在里，体工自起调节作用，放散体温，毛窍开，汗自出，汗出液少，故口渴，是伤寒阳明证之原理。
若外界空气和暖，与人体体温温度相若，毛窍开阖之作用，在不甚重要之列。伤于寒，寒邪得以深入，体温集表以为抵抗，故发热。毛窍本倾向于开，因热高，故汗自出。寒邪中外层，例当洒淅恶寒，卒以外层抵抗力薄弱，寒邪在表时间甚暂，故恶寒时间甚短，过表入里，重心在里，是为温病之原理。
伤寒阳明证与温病，同一蹊径，一则寒邪经过太阳，逗留太阳若干日，然后化燥内传入阳明；一则寒邪经过太阳迳入阳明，故温病开始在阳明。
同是寒伤躯体表层，何以一则逗留于太阳，一则迳入于阳明？则因时令之异、六气之殊故也。冬伤于寒，振栗恶寒，发热无汗，其原理已如上述。春为风，其气和煦，肌肤毛窍不如冬令之固密，寒邪中人，兼风化，迳入阳明，发热汗出为春温。假如春月，天气冱寒不去，应暖不暖，至而不至，则肌肤毛窍固密，抵御外界冷空气之能耐，依然存在，则寒伤躯体，格拒于表，恶寒发热无汗，仍属伤寒。假如冬日气候和暖，应寒反暖，未至而至，人体体温与外界空气温度不甚相差，肌肤毛窍防御外寒，不在重要之列，寒邪中人，迳入阳明为温病，发热汗出者，以病理论之与春混同，故不须另立冬温之名。
夏日外界空气热，高于人体，肌肤毛窍非但无须抵抗，并且有待于疏泄，故夏月炎热，汗出疏泄以调节体温。是故夏月樊篱尽撤，边防空虚，伤于寒发热汗出，表层无抵抗，些微觉恶寒即发热，是为暑温。其在长夏时令，气候兼湿化，伤于寒而热者曰湿温，病机同暑温。
读者须知，肌肤毛窍之启闭，所以调节体温，其作用甚敏活。严冬冱寒，毛窍虽闭，若剧劳奔走，体温增高，毛窍遂开，汗出以放散；反之夏月炎热，毛窍虽开，若贪凉过度，毛窍能闭，以拒寒凉。知此原理，则冬月有春温无足奇，夏月有伤寒亦非例外。故暑月发热无汗恶寒，与冬月伤寒同法；冬月发热有汗不恶寒，与春日春温同法。
是故伤寒温病，恶寒不恶寒，有汗无汗，为病之大关键。其发热则基于第一、第二个原理。若湿热与伤暑，相当于《伤寒论》之湿与暍，是夏令之时行病，因湿邪发热，俗混称湿温，发热则基于第三个原理，病理与前绝不相同。详述于下：
空气含氧气十分之二强，氮气十分之八弱，此外有少许炭酸气。氧气为人体生活所必需，当吸入之时，外面空气达于肺泡中，其中之氧气由微血管送入血液中，同时吸入无用之炭酸气，由肺呼出于外，呼吸不停，保持健康之状态。至夏月空气稀薄，氧气之比例成份亦稀少，从外吸入之氧气量不足，复因气候炎热，汗出多，血液干，体内存积之氧气量亦不足，于是呼吸不利，而感胸闷窒息。呼吸不利，则放温之机能失职，若中暑而热者，体内温度不能放散于外，遂为发热汗多胸闷之状，是为伤暑之病理。
The discussions on the Sanjiao (Triple Burner) in the *Ling Shu* and *Su Wen* generally do not exceed the above three levels. Other chapters such as the *Six Jie Zang Xiang Lun* and *Lan Qin Mi Dian Lun* in the *Su Wen* occasionally mention it, but not with such detail. The third level, described in the *Jing Mai Pian* of the *Ling Shu*, is the most difficult to understand. However, Traditional Chinese Medicine (TCM) actually takes this as its foundation; without understanding the meridians, one cannot speak of medicine. Yet, among today's medical practitioners, few can do more than recite by heart. If one could deeply comprehend its principles, they would be lost even in ancient medical texts, let alone today. Now, to dispel doubts and clarify confusion, I will explain its principles so that readers may study them independently. As for details, I cannot elaborate. Whenever it is said that a meridian runs from one place to another or passes through a certain area, this is derived from the pathological and physiological functions. For example, in the *Jing Mai Pian* of the *Ling Shu*, the first half of the discussion on the Sanjiao is generated from the pathological manifestations described in the second half. One first identifies diseases such as deafness, swelling of the throat, and bi-syndrome of the throat. By observing Yin and Yang and distinguishing depth, it is determined to be a disease of the Hand-Shaoyang meridian. Then, observing accompanying symptoms such as pain at the outer canthus of the eye, cheek pain, pain behind the ear, shoulder, arm, and lateral elbow, and inability to use the fourth finger, these painful areas are defined as belonging to the Hand-Shaoyang meridian. There are also complex interactions, such as "exiting to intersect with the Foot-Shaoyang, spreading to the Danzhong (Chest Center), and connecting with the Pericardium." This indicates an interactive relationship between the Hand-Shaoyang meridian and the Foot-Shaoyang and Hand-Jueyin meridians. The so-called Meridian Qi (Jing Qi) flows like blood circulation, in a circle without end, unknown of its origin. However, if the body has a disease, there must be an initial site of onset and a specific area of pain. Dividing based on these pain areas yields twelve types; speaking from the point of onset, they are divided into six Hand meridians and six Foot meridians. For instance, in malaria, chills may start from the back or from the hand, which is clear evidence. The ancients valued acupuncture highly, while Bian stones (Stone needles) preceded acupuncture. Reasoning from events, there must be a profound history. Alas, I have read little and cannot verify the origins. Speculating on the origin, it must have started like modern scraping therapy (Gua Sha), known to women and children alike, then evolved into Bian stones, and further into acupuncture. The Jing, Ying, Jing, and Shu acupoints of the twelve meridians were mostly named based on the efficacy of acupuncture, so today we cannot know the original reasons for these names. Later, decoctions (Tang Yao) developed from acupuncture, representing the final progress due to its stability and miraculous effects.
Today, we face two matters. First, ancient decoctions were used according to meridian theory: for a disease in a specific meridian, specific herbs should be used. Following this yields efficacy; violating it does not. Thus, when Ge Gen (Puerariae Radix) should be used, Ma Huang (Ephedrae Herba) cannot be used; when Da Huang (Rhei Radix et Rhizoma) should be used, Ba Dou (Crotonis Fructus) cannot be used. Unlike Western medicine, which merely speaks of sweating or purging without further distinction, TCM requires discussing the twelve meridians. Second, healthy Meridian Qi is invisible; it becomes visible only when rebellious. The rebellion of Meridian Qi is caused one-third by Six Excesses (Liu Yin, climatic pathogens: wind, cold, summerheat, dampness, dryness, fire), one-third by daily life and diet, and one-third by Seven Emotions (Qi Qing). Therefore, those ill from cold/heat, hunger/fullness, or frustrated wills, if they do not rebel against Meridian Qi, can follow the course of life and fulfill their natural lifespan; if they rebel, they cannot follow the course of life and die prematurely. Those who know the Dao and excel in health preservation simply follow the course of life. Superior physicians treat disease before it arises, knowing the smoothness or rebellion of Meridian Qi before illness occurs, correcting chaos to restore order. This is the general principle of the twelve meridians. Since Meridian Qi is invisible, its rebellion manifests as pathological function. Treating along meridians is called "Gong" (skillful), but it is not the highest level. Knowing how to cause rebellion or smoothness of Meridian Qi, adhering to smoothness and avoiding rebellion, is the true highest level. What is stated in the *Shang Gu Tian Zhen Lun* of the *Su Wen* is this highest level. The latest Western inventions are cells and endocrine glands; actually, Meridian Qi is more refined than these. Alas, ancient texts are too concise, and the theories of the *Ling Shu* are half true and half false. If they could be organized and expanded, after East-West cooperation, Western medicine would advance further. For those wishing to make medical discoveries, knowing Meridian Qi is essential. Today, opponents of TCM say Chinese medicine cannot cross the border, which is not a definitive conclusion. Practitioners of TCM, fearing for their livelihoods and worried about being banned, foolishly gather disorganized crowds to form parties to resist the trend, claiming, "I want to preserve national essence." Such heretical medicine is not national essence, nor is there hope for preservation. True national essence will never perish; why bother preserving? Those who say TCM will perish are like the man from Qi worrying about the sky falling.
Let us set this aside and discuss the Sanjiao. There are three meanings of Sanjiao: First, Sanjiao is the official of drainage, specifically referring to urine secretion. Second, Sanjiao is the pathway of water and grain, where Qi begins and ends, specifically referring to digestive power and Wei Qi (Defensive Qi). Third, Sanjiao is the Hand-Shaoyang meridian, one of the twelve meridians. Hua Borren and Xu Lingtai both said: Referring to it as the official of drainage refers to the lower Jiao Qi transformation; referring to it as Hand-Shaoyang refers to the Sanjiao with name but no form; referring to digestion and Wei Qi refers to the Sanjiao with name and form. Based on this, ancient naming was not rigorous. However, regardless of which meaning, it does not match the *Wen Bing Tiao Bian*. The Sanjiao in the *Wen Bing Tiao Bian* is a fourth type.
If there were sound theory and true experience, it would be acceptable to establish a new school outside what the ancients said, provided it complements rather contradicts them. If it contradicts the ancients, one must prove the ancients' theory was incomplete and demonstrate their errors. Surface reverence for antiquity while internally opposing it, used to deceive the world and gain money, is common and not worth severe blame; but writing books for posterity with such intent is unpardonable. In the *Upper Jiao Pian* of the *Wen Bing Tiao Bian*, it says: "All warm diseases begin in the Upper Jiao, involving the Hand-Taiyin." Ju Tong annotated: "Anciently, only the Bladder was said to govern the exterior, which did not fully capture the meaning. The Lung combines with the skin and hair; does it not govern the exterior? ... Warm diseases enter via the mouth and nose, descending from above. The nose connects to the Lung, starting in the Hand-Taiyin." This statement is extremely inexplicable. I believe the ancients distinguished between Zang-Fu organs and Meridian Qi. Zang-Fu are physical entities; Meridian Qi is Qi transformation. When Six Excesses invade and cause disease, it refers to Qi transformation, not physical entities. The *Nei Jing* says: "When pathogenic wind arrives, it is swift as wind and rain... The skilled healer treats the skin and hair; next, the muscles; next, the sinews and vessels; next, the Fu organs; next, the Zang organs. Treating the Zang organs results in half death, half survival. Thus, Heaven's pathogenic Qi harms the five Zang organs; Water and Grain's cold/heat harm the six Fu organs; Earth's dampness harms the skin, flesh, sinews, and vessels." This verse connects intimately with the previous sections on Yin-Yang and directions, describing "the changes of alternating Yin-Yang dominance and the forms/functions of disease." Treating skin and hair means the disease is in the skin and hair, not referring to the Lung's combination, but the body's outer layer. Next in muscles means slightly advanced, not the Spleen's combination. Next in sinews means deeper, not the Liver's combination. Next in Fu organs means entering the interior. Next in Zang organs means the deepest interior. If skin/hair were the Lung's combination, muscles the Spleen's, and sinews the Liver's, whose combination would the Fu organs be? This is untenable. Also, considering skin/hair as the Lung's combination implies pathogenic wind harms the Lung first, then spreads to the Spleen, then Liver, then Fu organs. In reality, neither Shang Han nor Wen Bing follows this, making it even less logical. Therefore, commentators on the *Shang Han Lun* who immediately say Taiyang is the Bladder, I absolutely cannot agree with. Thus, in lectures explaining Taiyang disease, it is directly stated that Taiyang is the outermost layer of the body. Today, saying all warm diseases begin in the Upper Jiao, involving the Hand-Taiyin, what explanation is this?
Secondly, inexplicable is the idea that Shang Han enters via pores, while Wen Bing enters via mouth and nose. Ju Tong's creation of Wen Bing entering via mouth and nose seems his proudest statement, yet it is utterly illogical. Let us scrutinize it layer by layer: (1) The *Nei Jing* states all heat diseases belong to Shang Han, and pathogenic wind harming humans always starts at the skin and hair. Saying it enters via mouth/nose and emerges from inside out means Wen Bing must be outside the scope of "all heat diseases" in the *Nei Jing*. (2) If it enters via mouth/nose, and the nose connects to the Lung (Hand-Taiyin), then the mouth connects to the Spleen (Foot-Taiyin), right? (3) The classics say Heaven's pathogenic Qi harms the five Zang organs. Here, treating skin/hair implies potential harm to the five Zang organs, i.e., pathological function. It says Water/Grain's cold/heat harms the six Fu organs; this truly enters via the mouth. Experimentally, drinking ice causes diarrhea, touching filth causes cholera, airborne microbes cause epidemics; these truly enter via mouth/nose. If Heaven's pathogenic Qi also enters via mouth/nose, there is no evidence in the *Nei Jing*. (4) Ju Tong says Shang Han mentions Wind Strike, which is cold wind from the northwest; his Wen Bing involves wind as the mother of fire, coming from the southeast as warming wind. Cold wind enters via pores, warm wind via mouth/nose. From what classic does this come? What reason? It is indeed strange. Scrutinizing the first article of the *Wen Bing Tiao Bian*, its illogic is evident. Yet followers of Ju Tong circle and praise it endlessly, thinking they can deceive future generations. Is this not too cautious?
Chai notes: 1. The above is the full text of Volume 2 of *Wen Bing Ming Li*, titled by the author. This piece explores the original meaning of Sanjiao in TCM in detail. Yun's purpose is to first clarify the original meaning of Sanjiao, then prove that Wu Juzhong's Sanjiao is fabricated. Wu Juzhong believed Wen Bing descends from top to bottom, while Shang Han enters from outside in. Zhang Juying criticized this as "confusion and delirious speech." Who is right or wrong is debatable. The Ye School does not deny that Wen Bing includes latent warm disease and newly acquired warm disease. Latent warm disease does not descend from top to bottom, which is clear. Does newly acquired warm disease always attack the Lung first? Taking Damp-Warm attacking Foot-Taiyin and Foot-Yangming first as an example suffices to prove otherwise. Thus, Yun's criticism that Wu Juzhong's Sanjiao theory is flawed from the very first article is reasonable.
2. Ancient TCM attributed brain physiology and pathology to the Heart. After Wang Qingren proposed that spiritual activity and memory reside in the Brain, not the Heart, later physicians considered this a major contribution to TCM. Yun said: "Delirious speech is a disease of the Pericardium Luo, which is presumptuous and factually incorrect. Saying it is brain disorder is still debatable." This aligns with Wang Qingren's view. The Ye School often attributes delirious speech in warm-heat diseases to reverse transmission to the Pericardium. From a modern perspective, Yun's explanation of pathology seems more reasonable than attributing it to the Pericardium. Note: The error of reading "guan ge" (pass through diaphragm) as "guan chang" (pass through intestine) in the *Ying Wei Sheng Hui Pian* lies with Yun.
Pathology and Naming of Warm-Heat Diseases. The categories of warm-heat diseases in the *Wen Bing Tiao Bian* include nine: Feng Wen (Wind-Warmth), Wen Re (Warm-Heat), Wen Yi (Warm Epidemic), Wen Du (Warm Toxin), Shu Wen (Summerheat-Warmth), Shi Wen (Damp-Warmth), Qiu Zao (Autumn Dryness), Dong Wen (Winter Warmth), and Wen Nue (Warm Malaria). Annotations state: Feng Wen occurs in early spring when Yang Qi begins to open, governed by Jueyin, with wind carrying warmth. Wen Re occurs in late spring/early summer when Yang Qi expands, with warmth intensifying into heat. Wen Yi is epidemic pestilence, often mixed with turbidity, affecting everyone like servitude. Wen Du is various warmths carrying toxins, with excessive turbidity. Shu Wen occurs in midsummer, where summerheat leans towards heat. Shi Wen occurs in late summer/early autumn, where dampness generates heat, i.e., summerheat leaning towards dampness. Qiu Zao is the dry and fierce Qi of Autumn Metal. Dong Wen is winter when cold should prevail but warmth returns, Yang fails to hide, causing people to suffer warmth. Wen Nue occurs when Yin Qi is damaged first, then affected by summerheat, causing Yang Qi to flare alone. These explanations seem understandable but are actually not. Distinguishing Feng Wen and Wen Re by early vs. late spring, and Yang opening vs. expanding, leaves unclear at what degree of expansion it becomes Wen Re, and whether mid-spring warmth is Feng Wen or Wen Re. Despite explanation, they remain indistinguishable. "Mixed with turbidity" vs. "excessive turbidity" – both are turbid, yet one flowing is Wen Yi, non-flowing is Wen Du. "Summerheat leaning towards heat" is poorly phrased. "Dry and fierce Qi of Autumn Metal" has nothing to do with heat diseases. Self-defining and self-distinguishing still fails to clarify. Without investigating disease principles and detailing symptoms, one cannot speak precisely, resorting to literal interpretation and vague talk.
This book discusses warmth, as listed in the previous chapter, covering only six types: Wen Re, Chun Wen, Shu Wen, Shi Wen, Shang Shu, and Shi Re. Why the discrepancy with common terms? Because categorizing by principles and symptoms avoids unnecessary names that confuse people. We should deduce pathology from disease patterns and summarize disease names from pathology.
Predecessors differing Shang Han and Wen Bing claimed Shang Han enters from outside in, Wen Bing from inside out. Lu also held this view, which is untenable. Both are external contractions. Zhongjing said fever with thirst and no aversion to cold is Wen Bing, prefixed with Taiyang Disease, revealing its meaning. How to distinguish? The difference lies in aversion to cold vs. none, and sweating vs. none. Fever, aversion to cold, and no sweating, regardless of season, is Shang Han. Fever, no aversion to cold (or short duration), and sweating is Wen Bing. In Spring, Chun Wen; in Summer, Shu Wen; in Late Summer, Shi Wen. This so-called Wen Bing is still Shang Han, a disease contracted from cold, detailed below.
In winter, external air is cold. To survive, subcutaneous vessels and skin constrict, pores close tightly, Wei Qi becomes dense, concentrating body heat at the periphery to resist cold. When injured by cold, pathogenic cold cannot penetrate deeply, stopping at the periphery, causing shivering and aversion to cold. According to the second mechanism of fever, whole-body heat rushes to the surface to expel it. When heat exceeds appropriate levels, fever occurs. Logically, high internal heat should dissipate via sweat, but with cold pathogen at the exterior and closed pores, resistance increases, preventing release. Thus, high fever, aversion to cold, and no sweating occur, which is the principle of Shang Han Taiyang syndrome. If cold pathogen remains unresolved at the exterior, it transforms into dryness and transmits inward. Having penetrated the surface, aversion to cold ceases, replaced by aversion to heat. The first line of defense breaks; focus shifts from exterior to interior. The body regulates itself, releasing heat, opening pores, causing spontaneous sweating. Fluid loss leads to thirst, which is the principle of Shang Han Yangming syndrome.
If external air is warm, similar to body temperature, pore opening/closing is less critical. Injury by cold allows cold pathogen to penetrate deeply. Heat concentrates at the surface for resistance, causing fever. Pores tend to open; due to high heat, sweat occurs spontaneously. Cold pathogen affects the outer layer, usually causing slight chills, but due to weak peripheral resistance, cold stays briefly at the exterior, so aversion to cold is short-lived. Passing beyond the exterior, focus shifts inward, which is the principle of Wen Bing.
Shang Han Yangming syndrome and Wen Bing follow the same path. In one, cold pathogen passes through Taiyang, lingers for days, then transforms into dryness and transmits to Yangming. In the other, cold pathogen passes through Taiyang directly into Yangming, so Wen Bing starts in Yangming.
Both involve cold injuring the body's surface. Why does one linger in Taiyang and the other go directly to Yangming? Due to seasonal differences and Six Qi variations. Winter cold injury causes shivering, aversion to cold, fever, no sweating, as explained. Spring is wind, mild climate, skin/pores less tight than winter. Cold invading mixes with wind, goes directly to Yangming, causing fever and sweating (Chun Wen). If spring weather remains freezing, unseasonably cold, skin/pores stay tight, retaining ability to resist cold. Cold injures the body, blocked at the exterior, causing aversion to cold, fever, no sweating, remaining Shang Han. If winter weather is warm, unseasonably hot, body temp differs little from external air, skin/pore defense is less important. Cold invading goes directly to Yangming as Wen Bing, with fever and sweating. Pathologically similar to spring, so no need for separate Dong Wen name.
Summer external air is hot, higher than body temp. Skin/pores need not resist but must dissipate. Summer heat causes sweating to regulate temperature. Summer defenses are down, borders empty. Injury by cold causes fever and sweating. No surface resistance, slight chills quickly turn to fever, which is Shu Wen. In late summer, climate adds dampness. Injury by cold resulting in heat is Shi Wen, with same pathology as Shu Wen.
Readers must know: Skin/pore opening/closing regulates temperature sensitively. In deep winter, though pores are closed, strenuous exercise raises body temp, opening pores to sweat. Conversely, in summer heat, though pores are open, excessive cooling closes them to reject cold. Knowing this, winter having Chun Wen is not strange, summer having Shang Han is not exceptional. Thus, summer fever, no sweating, aversion to cold treated same as winter Shang Han; winter fever, sweating, no aversion to cold treated same as spring Chun Wen.
Therefore, aversion to cold vs. none, sweating vs. none, are key to Shang Han and Wen Bing. Fever is based on the first two principles. Shi Re and Shang Shu correspond to Shi and Ye in the *Shang Han Lun*, are summer seasonal diseases, fever caused by dampness, commonly confused as Shi Wen. Fever is based on the third principle, pathology completely different from before, detailed below:
Air contains over 20% oxygen, nearly 80% nitrogen, plus some carbon dioxide. Oxygen is essential for life. Upon inhalation, air reaches alveoli, oxygen enters blood via capillaries, while useless carbon dioxide is exhaled. Continuous breathing maintains health. In summer, air is thin, oxygen proportion low. Insufficient oxygen intake, plus heavy sweating and thickened blood, depletes stored oxygen. Breathing becomes difficult, causing chest tightness and suffocation. Impaired breathing disables heat dissipation. If heatstroke occurs, internal heat cannot dissipate externally, leading to fever, heavy sweating, and chest tightness. This is the pathology of Shang Shu.