或曰汗出多，体温当由汗放散，何以汗多仍热，其温不因汗散，曰，夏月为湿令，空气含水份多，体温外散有所窒碍，且汗出既多，血液干，口渴引饮自救，然饮水虽多，因汗多之故，小便仍少，故热既不能因汗散，复不能从小便以排泄，肺脏之呼吸以放散体温，遂居重要位置，乃因氧气不足之故，呼吸不利，以致喘促，体温仍不能向外散放，故发热汗出喘满胸闷，为伤暑证特殊症状，通常热壮无汗者方气喘，如麻黄大小青龙证皆是，惟伤暑证虽有汗而见气喘，其理在是，准以上病理，当炎夏汗多之顷，就凉处休息，即可不病，若苦工劳力，长途行走，足以增进体温，一方面外界之高温，又足以使身体增热，而皮肤之蒸发不利，及呼吸不畅，不能使体温外放，于是病作，审是，温热病理，可以不繁言而解，不过多兼湿邪，病形稍行不同，发热汗多胸闷，与伤暑为同具之症状，其不同之点，伤暑则舌红而润，脉搏虚数，湿热则舌润苔白，脉搏濡软，此其大较也。
温热之病理与症状，从生理之形能诠解如上，虽未能纤微尽赅，大份已不外此，反观《温病条辨》之解释，无一语不是向壁虚构之谈，其自序凡例中言，是书虽为温病而设，实可羽翼伤寒，伤寒自以仲景为祖，参考诸家著述可也，温病当于是书中乏辨似处究心，直欲与仲景分庭抗礼。又言伤寒论六经，由表入里，由浅及深，须横看，本论论三焦，由上及下，亦由浅及深，须竖看，与伤寒论为对待文字，有一纵一横之妙云云，简直是神昏诂语。(《温热辨惑》)
柴按：叶派对温热病的分类和命名，是否妥当，有些地方确实值得商榷，如秋燥，就辨证来说，既有温燥，也有凉躁，如果说凉燥可以化热，秋燥就应属温病范畴，则狭义伤寒也不是一寒到底，何必非摒弃于温病范围之外而后可？又如疟疾，就辨证说，既有温疟，也有寒疟。如果因为辨证届热，就可以称为温病，则伤风、痢疾、黄疸、肺胀等病，都有辨证届热者，自然也都可以统隶于温病的范畴，从《温病条辨》来看，叶派确乎是这样做的，此所以造成了温病内容的越来越庞杂。又如风温与冬温，一般认为“发于冬季的风温可称冬温”，则一病二名，病名重叠，也不能令人满意。这些情况，在叶派中人熟视无睹，并不视为缺憾，但章氏则颇为不满，所以他对此提出了批评，并将温病分为六种。分为六种，是否已很妥当，这也来必，但章氏不因循守旧，人云亦云，在温病命名问题上提出己见，进行探索，这种精神是应予肯定的。
太阳伤寒关于温热病之分辨
师曰：温热病者，病之偏广热也，即病者反应之偏于亢盛也，非实有温热之邪也，亢盛之反应，即五段中之阳明也。伤寒可以包括温热，温热仅占伤寒之一格而已，辛凉解表，必表闭而里气盛者，方为合拍，时医恣用清凉，其表虽解，然伤正者多矣。譬如边疆有警，命师空袭，急炸之下，玉石俱焚，强敌虽轩，而我民伤矣，譬犹伤滞而泻，重与泻下，滞去而泻亦止，然正气大伤，或为巾虚，消化不良，或为肠寒，动辄便溏，气不盛而予辛凉解表，亦犹是也，表以辛散而解，正因凉伐而伤，合度之抵抗，因清表而为抵抗不济，再清而为抵抗不足，是以时师治表病，每多淹缠难愈，寒凉伤其正也。
夫太阳伤寒，辛温解表，表解而不伤正，辛凉解表，表解而正气乃伤，若温热之病型，即是阳明抵抗太过，又何厌于清凉哉。
彼天士之好用寒凉，环境使之然也，有清中叶，医者好用人参，习重温补，士大夫以受赐人参为荣，庶人以持赠人参为礼，士多养尊处优，民多安居乐业，浸浸百余年，相习成时风，驯至感冒发热，亦佐以人参，如参苏饮之类，比比皆然，天士出类拔萃，力矫时弊，知感之不宜温补也，创温热之门，以立异于伤寒，其用辛凉，乃为气盛而误补失表之用，所谓时时轻扬法也，彼时之人，气盛者多，疾病之反应，每易趋向太过，故可凉可清者亦多，叶氏力反时尚，独创新法，亦医林之俊杰也，后人不识气盛可清之理，恣用寒凉，去真远矣。
苏生曰：甚矣，环境之足以左右医术也，吾人处天地之间，动焉息焉，饮食起居，喜怒好恶，积之既久，气质多变，气质既变，治法亦易，当叶氏之世，民情失补，医多失表，疾病之反应，每易趋向太过，天士著述温热，取法辛凉，乃适应当时之环境也。
医之用药，所以救弊补偏也，历来方术理论，都是时代之产物，今之以为非者，当其时，以为真理也，今之以为不适于用者，当其时，冈皆应手而效也。
吾人研究医学，当以历史目光，追溯昔贤之环境，与其著书立说之动机，勿拘泥其所用之术语，惟推求其真义之所在，则前人之经验，皆我青囊中物也，叶氏为有清一代名医，声誉噪大江南北，其所著外感温热篇，·后人奉为温热之准绳，今之所谓时医者，其处方用药，皆不离叶氏之范围，吾师谓叶法仅宜于体实气盛，反应有余者，恐时师末能心折也，叶氏创作温热篇之动机，今已了然于心矣，温热篇之著述，其大要如何，疗法如何，何者为可取，何者为不当，原夫子阐明之。
师曰：叶著外感温热篇，其立名之义，乃自别于伏气、伤寒也，言外感，所以别伏气也，言温热，所以别伤寒也。
当时之所谓伤寒，所谓温热，都是一种想象之邪，邪者，害正之物也，本无而忽有，名曰受邪，邪病之用温药而愈者，遂名之曰寒邪，邪病之用凉药而愈者，遂名之曰温邪，其因发汗解肌而愈者，曰邪在于表也，其因清泄攻导而已者，曰邪伏于里也，邪机之推测，乃从药效反溯而得之。
当叶氏之世，误补失表者多，其民体气充实，有感则邪从火化，火化者，人体抗力旺盛，反应敏锐也。
大凡气盛者，激之则怒，阳旺者，激之则亢，亢盛之体，投热则燥，与凉即安。
叶氏适应环境，而著述温热之篇，所以别于适用温药之伤寒，非另有温热之邪也。夫伤寒温病，二而一，一而二也，言刺激则有伤寒之邪，言反应则有亢盛之体，邪正相搏，其抵抗之趋势，倾向太过者，即是温热之病，温热者，病之偏于热也，热者人体反应之偏于亢进也。
叶著外感温热篇者，叙述温热病变之历程也，其所以揭外感二字者，言邪机之趋势多从表解也，因其可从表解，故名曰外感，揭温热二字者，言温病之证候，多从火化也，因其适于寒凉，故名曰温热。
叶氏治温热，其看法，卫之后方言气，营之后方言血，营卫气血，乃代表病机之浅深，如伤寒之有六经也。
温热篇之著述，不外描写四种病变之历程，所谓病变历程者，疾病演变之过程也，疾病之发展，因人而殊，因药而异，体质强弱有强弱之过程，药石当否有当否之演变，叶著之温热篇，非是探求病原之论，实乃应付病变之作也，其所叙之证候；不外各个病变之描写而已，其引用之术语，不过其私人之艺术思想而已，非真有温邪入营入卫入气入血也，凡是术语，皆不可执着，吾于叶著之温热篇，综其大要，如是而已。
苏生曰：晰乎哉，吾师对于叶著温热篇之评论也，如炽犀烛，洞见幽微，虽起叶氏于地下，当亦为之心折也，师言邪机之推测，乃从药效反溯而得之，温热之著述，不外乎病变历程之描写，可谓超于象外，别具慧眼者矣，然吾师一再否定术语，小子期期以为不可，夫术语者，学术上之代名词也，亦即病理解释上之重要符号也，吾国医学精粹之所在也，临床诊断所赖以融会贯通也，当叶氏之世，不闻科学之原理，不知细菌为何物，其恃以为疗病者，全赖术语为之运用也，师而曰中医之书，言表非表，言里非里，表无风可祛，里无热可清，营卫气血，尽是虚构，是自决其藩篱也，若是则吾人诊疗，究竟将以何者为准绳乎，西医每讥中医为不科学，以其所用术语，为不可解也，而吾中医言之成理，用之有效，祛风则风散，散热则热解，解表则表之症状平，平里则里之宿疴以愈，立竿见影，固可以事实证明者也，术语之应用，彼之不及知，而我之深自知也。
师革新医学，并中医精神所寄之术语而非之，不将为西医所窃笑、中医所齿冷耶。
师曰：吾非有厌于术语也，术语之合符真理者，，吾将阐扬之，其不然者，吾将修正之，真理无国界，宁有术语，永为中医所独有者。
伤寒之形成，一方力致病之菌，一方为受病之人，中医因无科学工具，故对于病原体之形态性能，祗可略焉不详，是诚为缺憾，然吾人于人体应变之能力，则综合分析颇为扼要，中医之言病体，凡是害正者，都名曰邪，其可以感觉意会者，六淫之邪也，其不可以形视目睹而足以危害人体者，都名日毒，所谓疫疠不正之气也，邪也毒也，此皆病菌之代名词也，名虽近乎逻辑，然而约矣，中医之言人也，于体工反应之表现，则有八纲，邪正相争之趋势；则分五段，提纲挈要，有证候可稽，有色脉可合，积数千年之经验，形成各种之术语，有方式，有逻辑，可以观察，可以实验，特略于病而独详于人耳。
吾人但须阐明术语之真义夕本古训而不拘泥，采新知而不狂悖，惟真理是求，则术语何尝不用哉。
古人著书立说，皆有环境色彩，东垣生于戎马仓皇之秋，民多伤于饥饱劳疫，故有补中益气之论，丹溪处于渔盐之乡；地多卑湿，民病内热，故有清利滋阴之说；叶氏之著温热篇，亦为适应当时环境之作也，营卫气血，不过解释叶氏所习见之四种病型而已，此项病型之造成，半为叶氏矫正时医之误，半为叶氏自作聪明之误，故其书有可取，有不可取也。
苏生曰：顾问叶著可取之处。
师曰：叶著所谓温热病者，即余之所谓阳明伤寒也，叶氏所谓外感者，非今之所谓外感也，外感无形之邪，表且不留，何法入营，何法入血，更何法逆传心包耶。
叶氏以临床之经验，知气盛之人，其反应趋向于亢进，故避用温热，知病变之趋势，表者多吉，故法取轻扬，观察病变之过程，斑疹白痞，厥脱詀妄，何者为顺，何者为逆，示人以予后之吉凶，描写证候之状态，舌苔牙齿，色泽声音，以致津汗便溺，何者当清，何者当温，启发辨证之机括，既详且明，足为临床之借镜，此其可取之处也。
苏生曰：然则叶著何法不可取耶。
师曰：叶氏之视温热也，以为实有温热之邪也，以为温热之邪，于法宜用寒凉也，故曰在表初用辛凉，到气才可清气，入营犹可透热转气，入血就恐耗血动血，直须凉血散血，其处方虽有前后缓急之法，而赏用清凉，其揆一也，唯其主观以为温邪当凉，故曰：“虽在吴人阳微之体，亦应用清凉”，明知阳微过清必死，故又曰：“清凉到六七分，即不可过于寒凉，恐成功反弃也”。
总是立名不正，遂令其言不顺。夫外感发热，气盛而表闭者，与辛凉则热退，此热体(气盛之意)之外感也，而口十氏曰此乃外感温邪也，宜辛凉解之，倒因为果，此急需更正者一也。
伤寒内有所激，气盛而表闭者，辛凉解表，则表开气和矣，气不旺者，妄用清凉，则正馁而表气慑矣，表闭而放温障碍，则热更炽矣，热炽则熏灼神经，宜有躁烦不寐之症矣，此误凉失表之咎也。叶氏曰：“温邪热变最速，辛凉不解，是渐欲入营也，营分受热，则血液受劫，心神不安，夜甚无寐，即撤去气药，参入凉血清热，”此一误再误也，表闭里怯，当予辛温，叶氏以为温邪宜凉，岂知不当之凉，将自馁其气，此一误也，凉表则表气不宣，秽毒堵留；生温益亢，热之亢也，意欲冲开痞塞，解表而自舒其困也，不开其表，而反撤去气药，一意于清营，是正欲伸而又抑之也，是不能拯之于涂炭，而反驱之于深渊也，叶氏名重一时，临证甚多，曾见辛凉解表，表解而愈者，亦曾见表开而热不解者，又见表不解而热更炽者，于是口授及门以各种病变之符号，曰营曰卫，曰气曰血，列举症状，朗若列眉，此虽有先见之明，难免失真之咎，此其师心自用，尤须更正者二也。
夫伤寒有五，温病乃伤寒之一种，柯韵伯曰，阳明为成温之薮，陆九芝曰，伤寒传入阳明，遂成温病，其言是也，金元以前，并无温病专书，叶氏温热篇，叙述详明，轻浅入时，宜其为时师所喜也。
叶氏之后，吴鞠通王孟英辈推波助澜，以为叶氏之温热，廷以颜颃仲景之伤寒，疵谬矛盾，不胜枚举，戴北山详评之矣。此篇风行一时，深入人心，以盲引盲，贻误滋多，异日当按条纠正之。
总之，当叶氏生存时代，甚多可凉之体，可寒之证，然其所述病变，强半为叶氏本人所造成，是以遵其法，则见其证，必有其前后缓急之法，乃有其营卫气血之传，其先见之明，正其谬误之处，吾人不当以予测为能，应以救逆为工，顺逆者，胜败之机枢也，医之为工，工于救逆也。吾人观察证候之衷现，洞悉疾病之趋势，而晓之于病家曰，明日当见何证，当见何舌，见何证当危，见何舌当死，知机识变，患者至死而不悔，巧言令色，病家心折而无辞，然司命者，心知其变，目送其危，既不能扶顺，又不能挽逆，将何以为工乎。
有人问：出汗多，体温应当通过汗液散发出去，为什么出汗多仍然发热？体温不因出汗而消散。回答说：夏季是湿气当令的季节，空气中水分含量高，体温向外散发受到阻碍。而且出汗过多，血液变得干涸，口渴想喝水来自救。然而虽然喝了很多水，但因为出汗太多的缘故，小便依然很少。所以，热既不能通过汗液散发，也不能从小便排泄出去。肺脏的呼吸在散发体温方面占据了重要位置，但是因为氧气不足的原因，呼吸不畅，导致气喘急促，体温仍然不能向外散发。因此，发热、出汗、气喘、胸闷，是伤暑证的特殊症状。通常高热无汗的人才会气喘，比如麻黄汤、大青龙汤、小青龙汤的证候都是如此。唯独伤暑证虽然有汗却出现气喘，道理就在这里。根据以上的病理分析，在炎热的夏天出汗多的时候，到阴凉处休息，就可以不生病。如果是辛苦劳作、长途行走，足以增加体温；一方面外界的高温又足以使身体增热，而皮肤的蒸发不利，以及呼吸不畅，不能使体温向外散发，于是疾病发生。审视这一点，温热的病理，可以不繁言而解释清楚。不过多兼夹湿邪，病形稍微有所不同。发热、汗多、胸闷，是与伤暑共同具有的症状。其不同之处在于：伤暑则舌质红而湿润，脉搏虚数；湿热则舌润苔白，脉搏濡软。这是大概的区别。
温热的病理与症状，从生理机能的角度解释如上，虽然未能详尽无遗，但大部分内容不外乎此。反观《温病条辨》的解释，没有一句话不是向壁虚构的空谈。其自序和凡例中说，这本书虽然是针对温病而设，实际上可以辅助伤寒论。伤寒论以张仲景为祖师，可以参考诸家的著述。温病应当在书中那些似是而非的地方用心探究，简直是想与张仲景分庭抗礼。又说伤寒论的六经辨证，是由表入里，由浅入深，需要横向来看；本书论述三焦，是由上及下，也是由浅入深，需要纵向来看，与伤寒论形成对待的文字关系，有一纵一横的妙处等等，简直是神志昏乱时的胡话。（出自《温热辨惑》）
柴老按语：叶天士学派对温热病的分类和命名，是否妥当，有些地方确实值得商榷。例如秋燥，就辨证来说，既有温燥，也有凉燥。如果说凉燥可以化热，那么秋燥就应属于温病范畴，则狭义伤寒也不是一寒到底，何必非要将其摒弃于温病范围之外才可以呢？又如疟疾，就辨证说，既有温疟，也有寒疟。如果因为辨证属热，就可以称为温病，那么伤风、痢疾、黄疸、肺胀等疾病，都有辨证属热的情况，自然也都应该统辖于温病的范畴。从《温病条辨》来看，叶派确实是这样做的，这就是造成温病内容越来越庞杂的原因。又如风温与冬温，一般认为“发于冬季的风温可称冬温”，则一病二名，病名重叠，也不能令人满意。这些情况，在叶派中人熟视无睹，并不视为缺憾，但章氏对此颇为不满，所以他对此提出了批评，并将温病分为六种。分为六种，是否已经很妥当，也未必，但章氏不墨守成规，人云亦云，在温病命名问题上提出己见，进行探索，这种精神是应予肯定的。
太阳伤寒关于温热病的分辨
老师说：温热病，是病情偏向广泛的热证，即患者反应偏向亢盛的状态，并不是实有名为“温热”的病邪。亢盛的反应，就是五段辨证中的阳明阶段。伤寒可以包括温热，温热仅占伤寒中的一格而已。辛凉解表法，必须是表闭而里气盛者，才适合使用。当时的医生肆意使用清凉药物，虽然表证解除了，但损伤正气的人很多。譬如边疆有警报，命令军队空袭，在紧急轰炸之下，玉石俱焚，强敌虽然消灭了，但我方百姓也受伤了。譬如食积停滞而腹泻，重用泻下药，积滞去除了，腹泻也停止了，但是正气大伤，或者导致中气虚弱，消化不良；或者导致肠寒，动不动就大便溏薄。正气不旺盛而给予辛凉解表，也是同样的道理。表证用辛散之法而解除，正因为凉药攻伐而损伤正气。适度的抵抗，因为清解表邪而导致抵抗不力，再清解则导致抵抗不足。因此当时的医生治疗表病，大多缠绵难愈，是因为寒凉药损伤了正气。
至于太阳伤寒，用辛温解表，表解而不伤正气；用辛凉解表，表解而正气乃伤。如果温热的病型，即是阳明的抵抗太过，又有什么厌恶清凉的呢？
那位叶天士喜欢用寒凉药，是环境使他这样的。清朝中期，医生喜欢用人参，习惯重视温补，士大夫以接受人参赏赐为荣，平民以赠送人参为礼物，士人多养尊处优，民众多安居乐业，渐渐百年，相习成为时风，甚至到了感冒发热，也佐以人参，像参苏饮之类的方剂，比比皆是。叶天士出类拔萃，极力纠正时弊，知道感受外邪不宜温补，创立温热病学门径，以区别于伤寒，他使用辛凉法，是为了应对气盛而误用温补失于解表的病症，也就是所谓的“时时轻扬法”。那时的人，气盛的居多，疾病的反应，每容易趋向太过，所以可用凉可清的也多。叶氏极力反对时尚，独创新法，也是医林中的俊杰。后人不懂气盛可清的道理，肆意使用寒凉药，离真理就远了。
苏生说：环境足以左右医术，太严重了！我们处在天地之间，动息之间，饮食起居，喜怒好恶，积累久了，气质就会多变。气质既然变了，治法也容易改变。当叶氏那个时代，民情缺失补益（指过度进补），医生多失误于解表（指误用温补而失于解表），疾病的反应，每容易趋向太过。叶天士撰写温热篇，取法辛凉，乃是适应当时的环境。
医生用药，是用来救弊补偏的。历来的方术理论，都是时代的产物。现在认为不对的，在当时认为是真理；现在认为不适用的，在当时都应手而效。
我们研究医学，应当用历史的目光，追溯先贤的环境，与其著书立说的动机，不要拘泥于他们使用的术语，只推求其真义所在，那么前人的经验，都是我的囊中之物。叶氏是有清一代名医，声誉噪动大江南北，他所著的《外感温热篇》，被后人奉为温热的准绳。现在的所谓时医，其处方用药，都不离开叶氏的范围。我的老师认为叶法仅适宜于体质实、气盛、反应有余的人，恐怕当时的医生不能心服。叶氏创作《温热篇》的动机，现在已经了然于心了。《温热篇》的著述，大意如何？疗法如何？什么可取，什么不当，请老师阐明。
老师说：叶氏所著的《外感温热篇》，其立名的意义，乃是自我区别于伏气温病和伤寒。说“外感”，是为了区别于伏气；说“温热”，是为了区别于伤寒。
当时所谓的伤寒，所谓的温热，都是一种想象的病邪。邪，是伤害正气的东西。本来没有却忽然有了，名叫受邪。邪病用温药而痊愈的，就名叫寒邪；邪病用凉药而痊愈的，就名叫温邪。因发汗解肌而痊愈的，叫邪在于表；因清泄攻导而痊愈的，叫邪伏于里。对邪机的推测，是从药效反溯而得到的。
当叶氏那个时代，误用温补而失于解表的人很多，百姓体质充实，有感邪则邪从火化。火化，是指人体抗力旺盛，反应敏锐。
大凡气盛的人，激怒他就会愤怒；阳气旺的人，激发他就会亢奋。亢盛的身体，投以热药则燥，给予凉药即安。
叶氏适应环境，而著述温热篇，所以区别于适用温药的伤寒，并非另有名为温热的病邪。夫伤寒和温病，是二而一，一而二的关系。言刺激则有伤寒之邪，言反应则有亢盛之体。邪正相搏，其抵抗的趋势，倾向太过者，即是温热的病。温热，是病偏于热；热，是人体反应偏于亢进。
叶氏著《外感温热篇》，是叙述温热病变的历程。之所以揭示“外感”二字，是说邪机的趋势多从表解。因其可从表解，故名曰外感。揭示“温热”二字，是说温病的证候，多从火化。因其适于寒凉，故名曰温热。
叶氏治疗温热，他的看法是：卫之后方言气，营之后方言情血。营卫气血，乃代表病机的浅深，就像伤寒有六经一样。
《温热篇》的著述，不外乎描写四种病变的历程。所谓病变历程，是疾病演变的过程。疾病的发展，因人而异，因药而异。体质强弱有强弱之过程，药石当否有当否之演变。叶氏所著的《温热篇》，不是探求病原的论述，实在是应付病变的作品。其所叙述的证候，不外乎各个病变的描写而已。其引用的术语，不过是其私人的艺术思想而已，并非真有温邪入营、入卫、入气、入血。凡是术语，皆不可执着。我对于叶氏所著的《温热篇》，综合其大意，就是这样罢了。
苏生说：透彻啊！我的老师对于叶氏所著《温热篇》的评论，如炽犀烛幽，洞见细微。即使叶氏复活于地下，也应当为之心服。老师说邪机的推测，乃是从药效反溯而得，《温热篇》的著述，不外乎病变历程的描写，可谓超于象外，别具慧眼。然而我的老师一再否定术语，学生期期以为不可。夫术语者，学术上的代名词，亦即病理解释上的重要符号，是我国医学精粹之所在，临床诊断所赖以融会贯通的工具。当叶氏那个时代，不闻科学原理，不知细菌为何物，其恃以为疗病者，全赖术语为之运用。老师说中医之书，言表非表，言里非里，表无风可祛，里无热可清，营卫气血尽是虚构，是自决其藩篱。若是这样，那么我们诊疗，究竟将以何者为准则呢？西医常讥笑中医不科学，以其所用术语为不可解。而我们中医言之成理，用之有效，祛风则风散，散热则热解，解表则表之症状平，平里则里之宿疴以愈，立竿见影，固可以事实证明。术语的应用，西医不及知，而我中医深自知。
老师革新医学，并否定中医精神所寄之术语，不将为西医所窃笑、中医所齿冷吗？
老师说：我并非厌恶术语。符合真理的术语，我将阐扬它；不符合真理的，我将修正它。真理无国界，哪有术语永为中医所独有的？
伤寒的形成，一方是致病之菌，一方是受病之人。中医因为没有科学工具，所以对于病原体的形态性能，只能略而不详，这诚然是缺憾。然而我们对人体应变的能力，综合分析颇为扼要。中医之言病体，凡是害正的，都名叫邪。其可以感觉意会的，是六淫之邪；其不可以形视目睹而足以危害人体的，都名叫毒，所谓疫疠不正之气也。邪和毒，这些都是病菌的代名词。名虽近乎逻辑，然而简约。中医之言人，于体工反应的表现，则有八纲；邪正相争的趋势，则分五段。提纲挈要，有证候可稽，有色脉可合，积数千年之经验，形成各种之术语，有方式，有逻辑，可以观察，可以实验，只是略于病而独详于人罢了。
我们只要阐明术语的真义，遵循古训而不拘泥，采新知而不狂悖，惟真理是求，那么术语何尝不用呢？
古人著书立说，皆有环境色彩。李东垣生于戎马仓皇之秋，民众多伤于饥饱劳疫，故有补中益气之论；朱丹溪处于渔盐之乡，地多卑湿，民病内热，故有清利滋阴之说；叶氏之著《温热篇》，也是适应当时环境之作。营卫气血，不过是解释叶氏所习见的四种病型而已。此项病型的造成，半为叶氏矫正时医之误，半为叶氏自作聪明之误，故其书有可取之处，有不可取之处。
苏生说：请问叶著可取之处何在？
老师说：叶氏所谓温热病者，即我所谓阳明伤寒也。叶氏所谓外感者，非今之所谓外感也。外感无形之邪，表且不留，何法入营？何法入血？更何法逆传心包耶？
叶氏以临床经验，知气盛之人，其反应趋向于亢进，故避用温热；知病变之趋势，表者多吉，故法取轻扬。观察病变之过程，斑疹白痞，厥脱谵妄，何者为顺，何者为逆，示人以预后之吉凶。描写证候之状态，舌苔牙齿，色泽声音，以致津汗便溺，何者当清，何者当温，启发辨证之机括，既详且明，足为临床之借镜，此其可取之处也。
苏生说：那么叶著何法不可取呢？
老师说：叶氏看待温热，以为实有温热之邪，以为温热之邪，于法宜用寒凉。故曰：在表初用辛凉，到气才可清气，入营犹可透热转气，入血就恐耗血动血，直须凉血散血。其处方虽有前后缓急之法，而常用清凉，其揆一也。唯其主观以为温邪当凉，故曰：“虽在吴人阳微之体，亦应用清凉。”明知阳微过清必死，故又曰：“清凉到六七分，即不可过于寒凉，恐成功反弃也。”
总是立名不正，遂令其言不顺。夫外感发热，气盛而表闭者，与辛凉则热退，此热体（气盛之意）之外感也，而叶氏曰此乃外感温邪也，宜辛凉解之，倒因为果，此急需更正者一也。
伤寒内有所激，气盛而表闭者，辛凉解表，则表开气和矣。气不旺者，妄用清凉，则正馁而表气慑矣。表闭而放温障碍，则热更炽矣。热炽则熏灼神经，宜有躁烦不寐之症矣，此误凉失表之咎也。叶氏曰：“温邪热变最速，辛凉不解，是渐欲入营也。营分受热，则血液受劫，心神不安，夜甚无寐，即撤去气药，参入凉血清热。”此一误再误也。表闭里怯，当予辛温，叶氏以为温邪宜凉，岂知不当之凉，将自馁其气，此一误也。凉表则表气不宣，秽毒堵留，生温益亢，热之亢也，意欲冲开痞塞，解表而自舒其困也，不开其表，而反撤去气药，一意于清营，是正欲伸而又抑之也，是不能拯之于涂炭，而反驱之于深渊也。叶氏名重一时，临证甚多，曾见辛凉解表，表解而愈者，亦曾见表开而热不解者，又见表不解而热更炽者，于是口授及门以各种病变之符号，曰营曰卫，曰气曰血，列举症状，朗若列眉，此虽有先见之明，难免失真之咎，此其师心自用，尤须更正者二也。
夫伤寒有五，温病乃伤寒之一种。柯韵伯曰，阳明为成温之薮；陆九芝曰，伤寒传入阳明，遂成温病，其言是也。金元以前，并无温病专书，叶氏《温热篇》，叙述详明，轻浅入时，宜其为时师所喜也。
叶氏之后，吴鞠通、王孟英辈推波助澜，以为叶氏之温热，足以颜颃仲景之伤寒，疵谬矛盾，不胜枚举，戴北山详评之矣。此篇风行一时，深入人心，以盲引盲，贻误滋多，异日当按条纠正之。
总之，当叶氏生存时代，甚多可凉之体，可寒之证，然其所述病变，强半为叶氏本人所造成。是以遵其法，则见其证，必有其前后缓急之法，乃有其营卫气血之传。其先见之明，正其谬误之处，吾人不当以预测为能，应以救逆为工。顺逆者，胜败之机枢也。医之为工，工于救逆也。吾人观察证候之表现，洞悉疾病之趋势，而晓之于病家曰，明日当见何证，当见何舌，见何证当危，见何舌当死，知机识变，患者至死而不悔。巧言令色，病家心折而无辞，然司命者，心知其变，目送其危，既不能扶顺，又不能挽逆，将何以为工乎？
Someone asked: When sweating is profuse, body temperature should dissipate through sweat. Why does fever persist despite profuse sweating? Why does the heat not dissipate with sweat? The answer is: In summer, dampness is the prevailing qi. The air contains high moisture content, which hinders the outward dissipation of body temperature. Moreover, excessive sweating leads to dry blood and thirst, prompting the patient to drink water for self-rescue. However, even with abundant water intake, urine output remains scant due to the massive fluid loss from sweating. Consequently, heat cannot dissipate via sweat nor be excreted through urine. Lung respiration plays a crucial role in dissipating body temperature. Due to insufficient oxygen, breathing becomes difficult, leading to panting and shortness of breath. Body temperature still cannot dissipate outwardly. Therefore, fever, profuse sweating, panting, chest tightness, and fullness are characteristic symptoms of Summerheat Injury (Shangshu). Typically, only those with high fever and no sweating experience panting, as seen in patterns such as Mahuang Tang, Da Qinglong Tang, and Xiao Qinglong Tang. Only in Summerheat Injury does panting occur despite sweating; the rationale lies herein. Based on the above pathology, resting in cool places during hot summers when sweating is profuse can prevent illness. Conversely, hard labor or long-distance walking increases body temperature. Simultaneously, external high temperatures further raise body heat. With impaired skin evaporation and poor respiration preventing heat dissipation, illness ensues. Examining this, the pathology of Warmth diseases can be explained without elaborate discourse. However, if dampness is additionally involved, the clinical presentation differs slightly. Fever, profuse sweating, and chest tightness are common to both Summerheat Injury and Damp-Heat. The distinction is: Summerheat Injury presents with a red and moist tongue coating and a deficient-rapid pulse, whereas Damp-Heat presents with a moist tongue, white coating, and soggy-soft pulse. This is the general difference.
The pathology and symptoms of Warmth diseases, interpreted physiologically as above, though not exhaustively detailed, cover the majority of cases. In contrast, the explanations in *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases) are entirely fabricated fantasies. In its preface and examples, it states that although the book is designed for Warm Diseases, it actually supplements the *Shanghan Lun* (Treatise on Cold Damage), which takes Zhang Zhongjing as its ancestor and references various scholarly works. It suggests that for Warm Diseases, one should focus on ambiguous points within this book, essentially aiming to rival Zhang Zhongjing. It further claims that the Six Stages of *Shanghan Lun* move from exterior to interior, shallow to deep, requiring a horizontal view; while this book discusses the Triple Burner moving from upper to lower, also shallow to deep, requiring a vertical view, creating a complementary text with vertical and horizontal subtleties. Such statements are merely delirious ramblings. (From *Re Wen Bian Huo*)
Comment by Chai: Whether Ye Tianshi’s school's classification and naming of Warmth diseases are appropriate is indeed debatable in some aspects. For instance, Autumn Dryness, in terms of pattern differentiation, includes both Warm Dryness and Cool Dryness. If Cool Dryness can transform into Heat, then Autumn Dryness should fall under the category of Warm Diseases. Similarly, Narrow-sense Cold Damage is not always purely cold throughout. Why must it be excluded from the scope of Warm Diseases? Regarding Malaria, pattern differentiation includes Warm Malaria and Cold Malaria. If a pattern classified as Heat qualifies as a Warm Disease, then Wind Strike, Dysentery, Jaundice, and Lung Distension, which also have Heat patterns, should naturally be subsumed under Warm Diseases. From *Wen Bing Tiao Bian*, it appears the Ye School did exactly this, leading to the increasingly complex content of Warm Diseases. Regarding Fengwen (Wind-Warmth) and Dongwen (Winter-Warmth), generally, "Fengwen occurring in winter is called Dongwen," resulting in one disease with two names, causing redundancy and dissatisfaction. These issues were overlooked by the Ye School but criticized by Zhang, who proposed dividing Warm Diseases into six categories. Whether this division is fully appropriate is uncertain, but Zhang’s spirit of independent exploration rather than blind conformity in naming Warm Diseases deserves affirmation.
Differentiation of Warmth Diseases from Taiyang Cold Damage
The Master said: Warmth Disease refers to a condition biased towards widespread heat, representing an exaggerated physiological response, rather than the presence of a specific pathogen named "Warmth." This exaggerated response corresponds to the Yangming stage in the Five Stages differentiation. Shanghan (Cold Damage) encompasses Warmth; Warmth occupies only one segment within Shanghan. Acrid-Cool Exterior-Releasing methods are suitable only when there is exterior closure and interior Qi excess. Contemporary physicians indiscriminately use cooling agents; although the exterior may resolve, many suffer damage to their Zheng Qi (Upright Qi). It is like border defense calling for airstrikes; in urgent bombing, good and bad are destroyed together. Though the enemy is eliminated, our people are injured. Or like treating stagnation-induced diarrhea with heavy purgatives; while stagnation clears and diarrhea stops, Zheng Qi is severely damaged, potentially leading to Spleen deficiency with indigestion or Intestinal cold with frequent loose stools. Using Acrid-Cool exterior release on patients with deficient Qi is analogous. The exterior resolves with Acrid-Dispersing methods because Cooling attacks damage Zheng Qi. Moderate resistance is compromised by clearing the exterior; further clearing leads to insufficient resistance. Thus, contemporary physicians often find exterior diseases lingering and difficult to cure because Cold-Cool agents injure Zheng Qi.
For Taiyang Cold Damage, Acrid-Warm exterior release resolves the exterior without injuring Zheng Qi. Acrid-Cool exterior release resolves the exterior but injures Zheng Qi. If the Warmth disease pattern represents excessive Yangming resistance, why would one disdain cooling?
Ye Tianshi’s preference for cold-cool herbs was shaped by his environment. In the mid-Qing Dynasty, physicians favored Ginseng, emphasizing warm-tonifying methods. Scholars took receiving Ginseng as an honor, and commoners gave it as gifts. Scholars lived luxuriously, and people lived peacefully. Over a century, this became custom. Even for common colds with fever, Ginseng was added, as in Shen Su Yin. Ye Tianshi, outstanding among his peers, sought to correct these abuses. Knowing that exogenous pathogens should not be treated with warm tonics, he established the school of Warmth diseases to distinguish them from Shanghan. His use of Acrid-Cool methods addressed conditions where Qi excess was mistakenly treated with warm tonics, neglecting exterior release—what he called the "frequently light and揚 (rising)" method. At that time, most people had excess Qi, and disease responses tended toward exaggeration, making cooling and clearing frequently applicable. Ye opposed the fashion and innovated new methods, becoming a hero in the medical field. Later generations, misunderstanding the principle that excess Qi can be cleared, used cold-cool agents recklessly, deviating far from truth.
Su Sheng said: The influence of environment on medical practice is profound. We exist between Heaven and Earth, moving and resting, eating and drinking, experiencing emotions. Over time, our constitution changes, and thus treatment methods must adapt. In Ye’s era, people suffered from over-tonification and missed exterior releases; disease responses tended toward exaggeration. Ye’s writing on Warmth, adopting Acrid-Cool methods, adapted to the environment.
Physicians use medicine to correct deviations and save from errors. Historical formulas and theories are products of their times. What is considered incorrect today was once considered truth; what is deemed ineffective today was once effective. Studying medicine requires a historical perspective, tracing the environment and motivations of past sages, without being bound by their terminology, but seeking their true meaning. Then, past experiences become our assets. Ye was a famous physician of the Qing Dynasty, renowned nationwide. His *Wai Gan Wen Re Pian* (Essay on Exogenous Warmth Diseases) is revered as the standard for Warmth diseases. Contemporary physicians’ prescriptions rarely stray from Ye’s scope. My teacher believes Ye’s methods are only suitable for those with strong constitutions, excess Qi, and robust responses, doubting contemporaries will accept this. The motivation behind Ye’s *Wen Re Pian* is now clear. What are its main points and therapies? What is valuable and what is inappropriate? Please elucidate.
The Master said: Ye’s *Wai Gan Wen Re Pian* distinguishes itself from Fu Qi (Hidden Qi) and Shanghan. "Exogenous" distinguishes it from Hidden Qi; "Warmth" distinguishes it from Shanghan.
At that time, "Shanghan" and "Warmth" were conceptual pathogens. "Pathogen" (Xie) harms Zheng Qi. It appears suddenly where none existed. Diseases cured by warm herbs were named Cold Pathogens; those cured by cool herbs, Warm Pathogens. Cured by sweating/muscle-relaxing, the pathogen was in the Exterior; cured by clearing/purging, it was hidden in the Interior. The speculation on pathogenic mechanisms was derived retroactively from therapeutic effects.
In Ye’s era, many were misused with warm tonics and neglected exterior release. People had solid constitutions; upon infection, pathogens transformed into Fire. Fire transformation indicates robust resistance and sensitive response.
Generally, those with excess Qi become angry when provoked; those with vigorous Yang become hyperactive when stimulated. Hyperactive bodies become燥 (dry/hot) with heat-inducing herbs and settle with cool herbs.
Ye adapted to the environment and wrote on Warmth to distinguish it from Shanghan treated with warm herbs, positing no separate "Warmth Pathogen." Shanghan and Warmth are two aspects of one reality. Stimulus implies Shanghan pathogen; response implies hyperactive constitution. When Xie and Zheng contend, if resistance trends toward excess, it is a Warmth disease. Warmth is disease biased toward Heat; Heat is bodily response biased toward hyperactivity.
Ye’s *Wai Gan Wen Re Pian* narrates the progression of Warmth pathology. "Exogenous" indicates pathogens often resolve from the exterior. "Warmth" indicates syndromes often transform into Fire, suiting cold-cool treatments.
Ye’s view on treating Warmth: After Wei (Defensive), discuss Qi; after Ying (Nutritive), discuss Blood. Ying, Wei, Qi, and Blood represent the depth of pathogenesis, akin to the Six Stages of Shanghan.
*Wen Re Pian* describes four pathological progressions. Disease evolution varies by individual and treatment. Strong/weak constitutions have different processes; appropriate/inappropriate treatments have different outcomes. Ye’s work is not about etiology but managing pathology. Described syndromes are depictions of pathological stages. Terminology reflects his personal artistic thought, not literal entry of pathogens into Ying, Wei, Qi, or Blood. Terminology should not be rigidly adhered to. Summarizing Ye’s *Wen Re Pian*, this is my view.
Su Sheng said: Profound is your commentary on Ye’s work, illuminating the subtle. Even Ye resurrected would agree. You state pathogenic speculation is retroactive from effects, and *Wen Re Pian* depicts pathological progression, showing unique insight. However, I disagree with rejecting terminology. Terminology is academic shorthand and crucial for pathological explanation, embodying Chinese Medicine’s essence and facilitating clinical integration. In Ye’s time, lacking scientific principles and knowledge of bacteria, therapy relied entirely on terminology. Saying Chinese medicine talks of Exterior but has no wind to dispel, Interior but no heat to clear, and Ying/Wei/Qi/Blood are fictional, destroys its own boundaries. Then, what standard do we use for diagnosis? Westerners mock Chinese medicine as unscientific due to incomprehensible terminology. Yet Chinese medicine is logical and effective: dispelling wind disperses wind, clearing heat resolves heat, releasing exterior calms exterior symptoms, calming interior heals internal ailments. Results are evident. Terminology application is known deeply to us, though unknown to them.
If you innovate medicine and reject terminology, won’t you be mocked by Westerners and scorned by Chinese practitioners?
The Master said: I do not despise terminology. I will promote terminology aligning with truth and correct that which does not. Truth has no borders; no terminology belongs exclusively to Chinese medicine.
Shanghan formation involves pathogenic bacteria and the susceptible host. Lacking scientific tools, Chinese medicine details little on pathogen morphology/performance, a regrettable gap. However, comprehensive analysis of human adaptive capacity is concise. Anything harming Zheng Qi is called Xie. Perceptible Xie includes the Six Evils (Liu Yin); imperceptible but harmful Xie is called Du (Toxin), such as epidemic miasma. Xie and Du are synonyms for bacteria. Though logical, they are simplified. Regarding humans, reaction manifestations are categorized by Eight Principles; Xie-Zheng contention trends are divided into Five Stages. Concise, with observable syndromes and combinable color/pulse signs, millennia of experience formed various terminologies, possessing logic, observability, and experimental potential, focusing more on the person than the disease.
As long as we clarify the true meaning of terminology, follow ancient teachings without rigidity, adopt new knowledge without arrogance, and seek truth, why not use terminology?
Ancient writings reflect their environments. Li Dongyuan lived in turbulent times with famine/labor injuries, proposing Bu Zhong Yi Qi Tang. Zhu Danxi lived in damp coastal areas with internal heat diseases, proposing clearing/drying and yin-nourishing methods. Ye’s *Wen Re Pian* also adapted to his environment. Ying, Wei, Qi, and Blood merely explained the four disease patterns Ye commonly saw. These patterns resulted partly from correcting contemporary errors and partly from Ye’s own assumptions. Thus, his book has merits and flaws.
Su Sheng asked: What are the merits of Ye’s work?
The Master said: Ye’s "Warmth Disease" is my "Yangming Shanghan." Ye’s "Exogenous" is not modern "exogenous." Exogenous formless pathogens do not linger in the exterior; how can they enter Ying or Blood? How can they reverse-transmit to the Pericardium?
Ye knew from clinical experience that those with excess Qi respond with hyperactivity, avoiding warm herbs. Knowing exterior resolution is auspicious, he adopted light/rising methods. Observing pathology, he distinguished favorable/unfavorable outcomes of macules, papules, milia, collapse, and delirium. He described syndromes via tongue coating, teeth, voice, fluids, sweat, stool, and urine, guiding differentiation clearly. This serves as a clinical reference, which is valuable.
Su Sheng asked: What is inappropriate in Ye’s work?
The Master said: Ye believed in a real "Warmth Pathogen" treatable with cold-cool herbs. Hence: "Initially use Acrid-Cool at the exterior; only clear Qi at the Qi level; penetrate Heat from Ying to Qi; cool Blood and disperse Blood at the Blood level." Although prescribing has sequence and urgency, the core is using cooling. Subjectively believing Warmth Pathogens require cooling, he stated: "Even in Wu people with weak Yang, cooling should be used." Knowing excessive cooling kills weak Yang, he added: "When cooling reaches 60-70%, avoid excessive cold-cool to prevent ruining success."
Incorrect naming leads to illogical statements. Exogenous fever with Qi excess and exterior closure resolves with Acrid-Cool. This is exogenous disease of a "Hot Constitution" (Qi excess), yet Ye calls it "Exogenous Warmth Pathogen" requiring Acrid-Cool release. This reverses cause and effect, needing correction.
In Shanghan, internal stimulation causes Qi excess and exterior closure. Acrid-Cool release opens the exterior and harmonizes Qi. In those with weak Qi, reckless cooling depletes Zheng Qi and suppresses exterior Qi. Exterior closure impedes heat dissipation, intensifying heat. Heat harasses nerves, causing restlessness and insomnia. This is the fault of mistaken cooling and missed exterior release. Ye stated: "Warmth Pathogen heat changes fastest. If Acrid-Cool fails, it gradually enters Ying. Ying Heat劫 (steals) Blood, disturbing Heart Spirit, causing worse night insomnia. Remove Qi-clearing herbs, add Blood-cooling/clearing." This is a double error. Exterior closure with interior deficiency requires Acrid-Warm. Ye assumes Warmth Pathogens need cooling, unaware improper cooling depletes Qi. Another error. Cooling the exterior prevents Qi circulation, trapping turbid toxins, generating more heat. To relieve obstruction, one should release the exterior, not remove Qi herbs and focus solely on clearing Ying. This suppresses what should extend, driving patients from misery to abyss. Ye, famous and experienced, saw cases cured by Acrid-Cool, cases where exterior opened but heat persisted, and cases where exterior didn't open and heat intensified. He taught disciples symbols of pathology: Ying, Wei, Qi, Blood, listing symptoms clearly. While prescient, this lacks accuracy. This subjective approach needs correction.
Shanghan has five types; Warmth is one type. Ke Yunbo said Yangming is the source of Warmth; Lu Jiuzhi said Shanghan transmitting to Yangming becomes Warmth. Their words are correct. Before Jin-Yuan dynasties, no specialized Warmth books existed. Ye’s *Wen Re Pian* was detailed and popular, pleasing contemporaries.
After Ye, Wu Jutong and Wang Mengying amplified his views, claiming Ye’s Warmth rivals Zhang’s Shanghan. Errors and contradictions are numerous, detailed by Dai Beishan. This essay spread widely, misleading many. Corrections will follow item by item.
In summary, in Ye’s era, many bodies could tolerate cooling, and many syndromes were cold. However, half the pathology described was created by Ye himself. Following his methods yields his syndromes, with specific sequences and Ying/Wei/Qi/Blood transmission. His foresight highlights his errors. We should not pride ourselves on prediction but excel in saving from reversal. Favorable/unfavorable trends determine victory/defeat. A physician excels in saving from reversal. Observing syndromes and disease trends, informing patients of future signs (syndromes, tongue, danger, death), knowing opportunities and changes, ensures patients do not regret until death. Flattering words win patient submission, but a life-guardian knowing change and danger, unable to support favorable trends or reverse unfavorable ones, fails as a physician.