吾闻之，天土一代名医也，勤敏好学，淹有众家之长，其著作是否出于本人之手，是乃考据之事。天士亦人也，人尽有智也，焉知今人之不昔若也，吾人就该篇而论，允宜明辨其瑕瑜而不可盲从者也，须知一应著述，半是适应环境之作，后之览者，不思揣摩，而惟师古自荣，不亦愍乎。
苏生曰：甚矣，读书之下可胶柱鼓瑟也，孟子云，尽信书不如无书，良有以也，昔贤著述医论，或为发扬心得，或为叙述经验，或为启迪后学，或为矫正时弊，其立说也，必有真义在焉，其真义之精神，未可言宣词达者，则有术语为之逻辑，逻辑者，罗织也，学说上之组织法也，读古书而不知揣摩其精神，而徒拘执其术语，是乃食古不化也。
人类生活于环境之中，其所得之知识，因人因时因地而不同，著者之主观不同，则其学说之见解亦各异，吾人读书而不知揣摩其精神，一味盲从，如戴有色之镜，以为物尽有色也。
彼深于门户之见者，攻讦异己，曰，我时方派也，叶王之嫡传也，彼持经方疗病者，成功不足，肇祸有余，体质不同，今人岂古人之比哉；经方派曰，时方者，时俗之方也，学之不遵规矩绳墨者，江湖之医也，岂足以疗大病哉。一方之言，不能使彼方折服，则日道不同，不相为谋，各有所宗，各行其道可耳，是不欲求其真也，是不去其镜，而各是其色也。
叶氏之温热篇，适应环境之作也，北山之非难叶氏，亦适应环境之作也，叶氏所说之营卫气血，病理上之逻辑法也，鞠通三焦之辨，又可九传之论，陈无择之三因鼎立，张仲景之六经分治，亦皆病理上之逻辑法也，古人以逻辑目光，解释病理，纯为私人之主观，故不可盲从，其著述，乃临床之记录，纯为客观之描写，足资借镜。
是故，叶氏前后缓急之法，未必可循，营卫气血之称，不可拘执，此即吾师明辨瑕瑜之义也。”，伤寒合度之抵抗为太阳，外视表机之开合，内察正气之盛衰，开表以辛，和表以甘，制亢以凉，扶怯以温，小子亦已默喻之矣，今当进聆少阳之论。(《伤寒质难》)
柴按：祝氏认为：医者不当以能够预知疾病之转归为能，更重要的是要在病势发展中，能够掌握截断的方法。他曾虚心下气地考察过叶派药法的实效，认为叶派药法在逆转病势方面效果令人不能满意，并认为叶派理论也有不正确的地方。所以强调“医之为工，工于救逆”，这无疑是正确的。祝氏治学，具有创新精神，他认为“学说之成立，言之凿凿，往往昨是而今非。”推陈出新本来就是科学发展的必然规律，而“不务实际，澜翻瞽说，中医之所以不进步”的毛病，也正在此。时医以叶派温热之学为圭臬，“以为道在于兹矣，将令天下后世，宗此道以长相守矣，昧者从之，贤者疑之，学者试之而不应，必有从而斥之者矣！”事实就是如此。惜乎中医学术论坛，几为一派所独占，使抨击叶派之学术观，不复为广大医者所了解，这也已成为事实，正是有鉴于以上二个事实，故余有此书之撰作。此书撰旨，非为意在讥弹叶派，求事理之真相而已，冀百家争鸣之兴起而已，此目的，余于自序中已详之，不复赘言。知我罪我，一凭当世可也。
温病学说思想变迁考察后之结论
综上所述，于温病学说之变迁，已略具梗概，此二十七家中，舍奇特不中于理，在温病学说思想上无甚影响者而外，其最可注意者，为王安道叶天士陆九芝三人。温病学说之剧变，王安道启其端，温病名实之淆乱，叶天士为祸首(虽不止天士一人，而天士之过最大)，处叶吴学说积威之下，作大举之驳击，则陆九芝殿其后。王安道以后之变革，约有三端，一为病因(伏气新感)，二为病理(由内达外)，三为治疗(注意清里热)。迹其用药之对象，大抵为胃，至叫‘天士始别创犯师之说，而温病之病所，遂有肺胃二系，此时胃系之温病，虽尚存在，然已处模糊之状态中，渐为医者所淡忘，厥后温热家以温邪上受首先犯肺逆传心包十二字，为温病之纲领，于是胃系温病之起病，不由于犯肺者(如湿温)，亦一律以此十二字兼统之，于是胃系温病初起之病因病理治疗诸学说，一律平空割去，另冠以肺系之证治，此真俗语之所谓张冠李戴，最后胃系温病之中期末期，亦皆以治怖之药治之，而治疗之成绩，遂不可问(陆九芝先生曰：夫人之所病者胃，而医之所言者肺，可以为证)，此种流弊，无形中蔚为风气，流行于时医之腕底，彼等所著之温热书，则兼收并蓄，仍以内难仲景，装点门面，以掩其用药轻淡之陋。其他各种流弊尚多，细考之皆有所从来，陆九芝先生目击其祸，因奋笔著世补斋医书，阐明胃系温病之证治，文词虽不免偏激，然切中肯綮，为救时之良药，惟陆氏一意阐发胃系之温病，置肺系于不顾，甚至谓胃病有神昏，肺病无神昏，此则失之武断，适贻主张犯肺者以口舌，彼必谓尔所说之温病，为胃系之温病，我所说之温病，为肺系之温病，尔阐发胃系温病，纵有若何妙义，排斥肺系温病，纵如何剧烈，皆与我无干，所谓尔亦一是非，我亦一是非，尔为尔，我为我，两不相涉，是则温病肺胃乏问题，仍未解决，而温病肺胃之争，亦将终古而无已。
进一步想，则九芝先生之阐发胃系温病，不可谓不力，批评肺胃温病，亦不可谓不尽，然卒未能荡平叶吴之壁垒，绝叶吴之根株者，盖未捣叶吴之巢穴，斫叶吴之根本耳。
凡批评一种学说，目光必笼罩此学说之全体，从大处落墨，若支支节节，攻其局部，则此剿彼窜，永无宁日，九芝先生之批评，尚为支支节节之铲除，一句一章之芟削，故仅成对抗之形势，无以扼叶吴之要吭，今当进而讨论肺系温病之根本问题。第一点当先问所谓肺系温病，本来是否称为温病。第二点当问所谓肺系温病，是否阑入温病之范围，有否阑入之必要。第三点正名责实，当问所谓肺系温病，应否冒温病之名，应否承认共为温病。第四点，叶氏治此肺系温病之疗法，有无价值。第五点，既不承认此种病为温病，应择何种病名以名之。根据温病学说思想变迁之经过情形，逐点解答如下：
一，温邪上受，首先犯肺之温病，考其症状，在叶天士以前，并未称为温病，人谓叶天士所发明，吾谓昨天士所杜撰，人谓叶天士所特创，吾谓叶天士所混称。
二、从温病学说思想之变迁上考察，所谓温邪上受首先犯肺之温病，确是节外生枝，中途平空阑入，温病之涵义，本已复杂(已行复杂，不足为可以阑入理由)，再阑入此漠不相关之温病，益令名实淆乱，故并无阑入之必要。
三、本非温病，中途阑入，不应冒温病之名，不应承认其为温病，当屏之于温病范围之外。
四、叶氏以冶肺之药，治犯肺之病，不误用消导攻伐，克削无辜，意见颇合，惟药力轻不及彀，致常有所谓逆传心包之变，叶氏之意见保留之，用药改革之(以治肺之药治胃，为叶氏以后之流弊，其过不在叶氏之本身，以此责叶氏，叶氏不任其咎)，叶氏治疗意见之合否，与叶氏对于此病之命名，不生关系。
五、此问题于后文详论之(见第五章清代温病书中所包含之疾病)。
要而言之，中医之病名，最为庞杂，所谓温病，非一病也，特以温病括之耳，在犯肺之病，未屏出以前，固极凌乱庞杂之致，已屏出以后，亦未入匣然有序之境，特以犯肺之病，本非温病，屏之温病范围之外，无损于犯肺之病之治疗，而有利于温病学说之整理，所以缩小温病之范围，核其名实之是否相孚，俾易于整理耳，非有所好恶于其问也。
章虚谷等，称叶氏犯肺之病，为外感温病，其实外感之病，不止犯肺一种(如暑病，俗医亦谓之外感温病，至伏暑则另是一种说法)，苟以为屏去犯肺之病，而外感温病即似被完全推翻，仿佛从此温病只有伏气之治法，而无外感温病之治法，以为温病之治疗，缺而不完，心中惶惶无所主者，皆谬见也，盖所谓外感温病者，既不止犯肺一种，则外感温病之大部分，依旧存在，似无所用其杞忧，以此为惧，何惧之有(伏气外感，当于后面批判之，见第三章)，一般心理，多误认叶氏犯肺之病，即温病之全体(此种误会之发生，大抵出于真以为温邪上受十二字，可为温病纲领之故)，以为推翻叶氏犯肺之病，即不啻推翻温病之全体，因之大起恐慌，此种见解，更为谬绝，吾前言叶氏之温病，仅为温病学说之一部分，不足为全体温病学说之代表，则推翻叶氏之温病，仅为推翻温病学说过程中之一部分，决非推翻温病之全体。进一步言，则犯肺之病，尤仅为所谓外感温病中之一部分，多之徒乱耳目，少之无关重要(叶氏胃之一系之温病，虽或背古旨，然尚可附带辨正，故废礼存羊，留而不削)，故吾所屏去之温病，匪特非温病之全体，抑且非叶氏外感温病之全体，芟此赘疣，则温病学说之整理，或将厘然而有序。(《温病论衡》)
柴按：上文为“温病学说思想之变迁”一章的结论。谢氏通过考察二十七家温病之本义后，明确将温病分成肺胃二系，认为叶氏“首先犯肺”云云，讲的是肺系温病，而这种温病，是叶氏杜撰的温病，实际上古人并不称为温病，这种所谓的温病，是温病学说中之赘瘤。而胃系温病，与“首先犯肺”说，可谓是风马牛不相及，谢氏之说若得以成立，叶派温病学说就基本上被推翻了。由于谢氏论证严密，故对叶派温病学说的批判，显得极有力量，因此，《温病论衡》无疑是抨击叶派学说中之一本最有学术价值的专著。谢氏提出的批判，迄今为止，亦未见有予以反驳者。谢氏在晚年曾著《温病要义》，对叶派的温热之学，“朴实地叙述了它的轮廓。”并云：“至于进一步的研究，那有待医界同志。”但从抨击叶派学说到介绍叶派学说，这是如恽铁樵所说，“不狂者非尤而效之亦佯狂不可”呢？还是如章巨膺所说：“乃致误入歧途”，知迷而返呢？细阅《温病要义》，并未见有一语涉及对《温病论衡》中之观点有所反省者，说明谢氏并不是象章巨膺那样，是先信某派之学而后来立场转变者。谢氏于十年动乱中，已被害致死，其因无法再起死人而问之，但《温病论衡》一书的学术价值，并不因谢氏复著《温病要义》而逊色。
叶派温病治术之批评
尝谓天士之学，出于喻西昌为多，而温病滋阴之法，尤与西昌默契而合符也。西昌之论温证曰：
“缘真阴为热邪久耗，无以制亢阳而燎原不熄也，以故温病之人，邪退而阴气犹存一线者，方可得生，然多骨瘦皮干，津枯肉烁，经年始复未病之体。”
以此杂天土鞠通书中，几不辨楮叶，何以神似之至于斯也，天士主张滋阴之说，指南中数见不鲜，剌取而条列之如下：
温邪逆传膻中……必兼滋清——温热门3
0高年热病……当滋清去邪——同上”
甘寒清气药中，必佐存阴——13
邪虽外达，阳气亦泄……当以育阴清热为主——47
阴中伏邪……与育阴清邪热法——53
温邪久伏少阴，古人立治，全以育阴祛热——53
肾阴不承……议以三才汤滋水制热——54
至其所以滋阴之理，则不外阴虚液涸，故云：
风温热灼之后，津液未复——风温门9
温邪发热津伤一—温热门6
邪入心包络中，深怕液涸神昏——19
阴液已涸，舌强音缩—-36
阳根求固，阴液渐涸——57
承叶氏之遗说而祖述之者，皆以滋阴为治温之要著。
吴鞠通曰：“热病未有不耗阴者，其耗之未尽则生，尽则阳无留恋，必脱而死也，真能体味斯言，思过半矣。”汪刃庵曰：“叶氏必以保津液为要。”
王孟英曰：“(阴)耗之而未尽者，尚有一线之生机可望，若耗尽而阴竭，如早苗之根已枯矣，沛然下雨，亦曷济耶。”
吴坤安曰：“大抵温病之证，阴精内耗，阳强无制，新邪一触，则燎原之势，直从里发，故初起即见壮热烦渴口千舌燥等证，而以存津液为要旨。”
叶氏子雨，对滋阴疗法有微词，陆九芝则深致不满，痛加惩创。
叶子雨曰：“治温暑保津液，固为第一义，知泻其阳之有余，即所以补其阴之不足，则进乎道矣。”
陆九芝曰：“急去邪热，阴始可保，一去其热，阴即不伤。”
又曰：“盖人之所病者寒也热也温也，只去其寒与温与热，其人而阴本不虚者，无伤也。即其人而本属阴虚者，亦无恙也。乃不防其阳盛伤阴，而独防阴虚邪恋，于是防其劫津，防其发疹，防其风动，防其热入心包，至末而防其脱，夫既曰劫曰发曰动臼入，则自有劫之发之动之入之之物，在不去其劫之发之动之入之之物，而药反留邪以劫津，引邪以发疹，助邪以动风，领邪以入心包，而同归于脱，防云何哉。阳之方盛，徒曰存阴，阴既不能以些微之药而存，而三五日间阳邪之足以伤阴者，方且势如奔马，涸液枯津，是其阴之伤于药后者，不更甚乎。总之，使病速去，阴始不伤，欲保其阴，必速去病，去病之药，十余味耳，亦甚平常，并非险峻，有历验者，非空言也。”
我听说，叶天士是清代一代名医，勤奋敏捷且好学，广泛吸收了各家的长处。至于他的著作是否完全出于本人之手，那是考据学家的事。叶天士也是人，人都有智慧，怎么知道今人不如古人呢？对于这篇论述，我们应当明辨其优缺点，而不能盲目随从。须知所有的著述，有一半是适应当时环境的作品，后来的读者如果不思考揣摩其中的精神，只是一味师法古人来自我荣耀，不也很可悲吗？
苏生说：读书如果拘泥固执、不知变通，那就太严重了。孟子说：“完全相信书本，还不如没有书本。”这话是有道理的。过去的贤人撰写医学理论，有的是为了发扬心得体会，有的是为了叙述临床经验，有的是为了启迪后学，有的是为了矫正时弊。他们提出的学说，必然有真正的含义在其中。那种真正含义的精神，无法用言辞完全表达清楚的，就用术语作为逻辑载体；所谓逻辑，就是组织编织，是学说上的组织方法。读古书而不知道揣摩其精神，只是拘泥执着于术语，这就是食古不化。
人类生活在环境之中，所获得的知识因人而异、因时因地而不同。作者的主观意识不同，那么他们对学说的见解也就各异。我们读书如果不知道揣摩其精神，一味盲从，就像戴着有色眼镜看东西，以为万物都带有颜色一样。
那些深陷门户之见的人，攻击异己，说：“我是时方派（后世形成的灵活方剂流派），是叶天士、王孟英的嫡传。”而那些坚持使用经方（汉代以前经典方剂）治病的人，成功不足，闯祸有余，因为体质不同，现代人怎能和古人相比呢？经方派则说：“时方只是迎合时俗的方子，学习它不遵守规矩法度的，是江湖医生，哪里足以治疗大病呢？”一方之言不能使另一方折服，就说“道不同，不相为谋”，各自尊崇自己的宗派，各行其道罢了。这是不想探求真理，是不摘下有色眼镜，只认定自己眼中的颜色是对的。
叶天士的《温热论》，是适应环境的作品；北山（陆九芝号北山）非难叶天士，也是适应环境的作品。叶天士所说的营卫气血，是病理上的逻辑方法；吴鞠通的三焦辨证，以及可九传的论述，陈无择的三因鼎立，张仲景的六经分治，也都是病理上的逻辑方法。古人用逻辑的眼光来解释病理，纯粹是私人的主观认识，所以不可盲从。他们的著述，乃是临床的记录，纯粹是客观的描述，足可作为借鉴。
因此，叶天士前后缓急的治疗方法，未必可以遵循；对营卫气血的名称，不可拘泥执着。这就是我老师明辨优缺点的意义所在。“伤寒合乎度数的抵抗反应表现为太阳病，外在观察表机的开合，内在察知正气的盛衰。开表用辛味药，调和表药用甘味药，制约亢盛用凉性药，扶助虚弱用温性药，这些道理我也已经默默领悟了。现在应当进一步聆听关于少阳病的论述。”（出自《伤寒质难》）
柴浩然按：祝味菊先生认为：医者不应当以能够预知疾病的转归为能事，更重要的是在病势发展中，能够掌握截断病势的方法。他曾虚心平和地考察过叶天士一派药法的实效，认为叶派药法在逆转病势方面效果令人不满意，并认为叶派的理论也有不正确之处。所以强调“医之为工，工于救逆”（医生的技艺，高超在于挽救危逆），这无疑是正确的。祝氏治学具有创新精神，他认为“学说的成立，言之凿凿，往往昨天认为是正确的，今天就被证明是错误的。”推陈出新本来就是科学发展的必然规律，而“不务实际，空谈瞎说，中医之所以不进步”的毛病，也正在于此。当时的医生把叶派温热之学当作圭臬（标准），“认为真理就在这里了，要让天下后世都宗奉这道统永远坚守下去。”愚昧的人跟随它，贤能的人怀疑它，学者尝试它却不奏效，必然会有人从而斥责它！事实就是如此。可惜中医学术论坛，几乎被一派所独占，使得抨击叶派学术观的观点，不再为广大医者所了解，这也已成为事实。正是鉴于以上两个事实，所以我撰写了这本书。此书撰写的宗旨，并非意在讥讽弹劾叶派，只求事理的真相而已，希望百家争鸣的局面兴起而已。这个目的，我在自序中已经详细说明，不再赘言。世人知我罪我，全凭当世之人评判即可。
温病学说思想变迁考察后的结论
综上所述，关于温病学说的变迁，已经大致具备梗概。在这二十七家中，除去奇特而不合情理、在温病学说思想上没有什么影响者之外，最值得注意的是王安道、叶天士、陆九芝三人。温病学说的剧烈变化，由王安道开启端倪，温病名实混淆混乱，叶天士是祸首（虽然不止天士一人，但天士的过错最大），处在叶天士、吴鞠通学说积威之下，进行大规模驳击的，则是陆九芝殿后。王安道以后的变革，大约有三端：一为病因（伏气与新感），二为病理（由内达外），三为治疗（注意清里热）。追溯其用药的对象，大抵是针对胃，直到叶天士才开始别创“犯肺”的说法，于是温病的病位就有了肺、胃两个系统。此时胃系温病虽然尚且存在，但已处于模糊的状态中，逐渐被医者淡忘。后来温热家以“温邪上受，首先犯肺，逆传心包”十二字，作为温病的纲领，于是胃系温病的起病，不是由于犯肺的（如湿温），也一律以此十二字兼统之。于是胃系温病初起的病因、病理、治疗诸学说，一律平白无故地被割去，另外冠以肺系的证治。这真是俗语所谓的张冠李戴。最后，胃系温病的中期、末期，也都用治肺的药来治疗，而治疗的成效，就不可问了（陆九芝先生说：“人所患的病是胃病，而医生所说的却是肺病，可以作为证据”）。这种流弊，无形中蔚然成风，流行在当时医生的手腕底下。他们所著的温热书籍，则兼收并蓄，仍然以内经、难经、仲景学说装点门面，以掩盖其用药轻淡浅陋的弊端。其他各种流弊还很多，仔细考究起来，都各有来源。陆九芝先生目睹其祸害，于是奋笔著《世补斋医书》，阐明胃系温病的证治。文词虽然不免偏激，然而切中要害，是救时的良药。只是陆氏一意阐发胃系温病，置肺系于不顾，甚至说胃病有神昏，肺病无神昏，这就失之武断，恰好给了主张犯肺的人以口实。他们必定会说：“你所说的温病，是胃系温病；我所说的温病，是肺系温病。你阐发胃系温病，纵然有如何妙义，排斥肺系温病，纵然如何剧烈，都与我无关。”所谓你亦一是非，我亦一是非，你为你，我为我，两不相涉。这样，温病肺胃的问题仍未解决，而温病肺胃之争，也将终古而无休止。
进一步想，陆九芝先生阐发胃系温病，不能说没用力；批评肺胃温病，也不能说不详尽。然而最终未能荡平叶天士、吴鞠通的壁垒，绝除叶吴的根株，是因为没有捣毁叶吴的巢穴，砍断叶吴的根本。
凡批评一种学说，目光必须笼罩此学说的全体，从大处落墨。如果支支节节地攻其局部，则此处剿灭彼处窜逃，永无宁日。陆九芝先生的批评，尚属支支节节地铲除，一句一章地删削，所以仅形成对抗的形势，无法扼住叶吴的要害。现在应当进而讨论肺系温病的根本问题。第一点应当先问：所谓肺系温病，本来是否称为温病？第二点应当问：所谓肺系温病，是否阑入温病的范围，有没有阑入的必要？第三点正名责实，应当问：所谓肺系温病，应否冒温病之名，应否承认其为温病？第四点，叶天士治疗这种肺系温病的方法，有无价值？第五点，既然不承认此种病为温病，应选择何种病名来命名它？根据温病学说思想变迁的经过情形，逐点解答如下：
一、所谓“温邪上受，首先犯肺”的温病，考证其症状，在叶天士以前，并未称为温病。人说这是叶天士发明的，我认为这是叶天士杜撰的；人说这是叶天士特创的，我认为这是叶天士混称的。
二、从温病学说思想的变迁上考察，所谓“温邪上受，首先犯肺”的温病，确实是节外生枝，中途平白无故地阑入。温病的涵义，本已复杂（已经复杂，不足以成为可以阑入的理由），再阑入这种漠不相关的温病，更加令名实混淆混乱，所以并无阑入的必要。
三、本非温病，中途阑入，不应冒温病之名，不应承认其为温病，应当将其屏除于温病范围之外。
四、叶天士用治肺的药，治疗犯肺的病，不误用消导攻伐之药克削无辜，意见颇为符合常理。只是药力轻淡，不够充分，导致常有所谓的“逆传心包”的变证。叶天士的治疗意见可以保留，但用药需要改革（以治肺的药治胃，是叶天士以后的流弊，过错不在叶天士本身，以此责备叶天士，叶天士不承担这个罪责）。叶天士治疗意见的合否，与叶天士对此病的命名，不发生关系。
五、此问题在后文详细讨论（见第五章清代温病书中包含之疾病）。
总而言之，中医的病名最为庞杂。所谓温病，不是一种病，特以温病概括之罢了。在犯肺之病未被屏除以前，固然极凌乱庞杂；已被屏除以后，也未进入截然有序的境界。只是因为犯肺之病，本非温病，将其屏除于温病范围之外，无损于犯肺之病的治疗，而有利于温病学说的整理。所以缩小温病的范围，核实其名实是否相符，以便易于整理而已，并不是对其有什么好恶之情。
章虚谷等人，称叶天士所说的犯肺之病为外感温病。其实外感之病，不止犯肺一种（如暑病，俗医也称之外感温病，至于伏暑则是另一种说法）。如果认为屏去犯肺之病，而外感温病即似乎被完全推翻，仿佛从此温病只有伏气之治法，而无外感温病之治法，以为温病的治疗残缺不完备，心中惶惶无所适从的，都是谬见。盖所谓外感温病者，既然不止犯肺一种，那么外感温病的大部分依旧存在，似乎无需杞人忧天。以此为惧，有什么可惧的呢？（伏气外感，将在后面批判，见第三章）。一般心理，多误认叶天士所说的犯肺之病，即温病的全体（这种误会的发生，大抵出于真以为“温邪上受”十二字可为温病纲领的缘故），以为推翻叶天士犯肺之病，即不啻推翻温病的全体，因而大起恐慌。这种见解，更为荒谬绝伦。我前文说过，叶天士的温病，仅为温病学说的一部分，不足为代表全体温病学说。那么推翻叶天士的温病，仅为推翻温病学说过程中的一部分，决非推翻温病的全体。进一步说，犯肺之病，尤仅为所谓外感温病中的一部分，多了徒乱耳目，少了无关重要（叶天士胃之一系的温病，虽然或许违背古旨，但尚可附带辨正，故废礼存羊，留而不削）。所以我所屏去的温病，不仅非温病的全体，甚至连叶氏外感温病的全体也不是。剪除此赘疣，则温病学说的整理，或许将厘然而有序。（出自《温病论衡》）
柴浩然按：上文为“温病学说思想之变迁”一章的结论。谢映庐通过考察二十七家温病的本义后，明确将温病分成肺、胃二系，认为叶天士“首先犯肺”云云，讲的是肺系温病，而这种温病，是叶天士杜撰的温病，实际上古人并不称为温病。这种所谓的温病，是温病学说中的赘瘤。而胃系温病，与“首先犯肺”说，可谓是风马牛不相及。谢氏之说若得以成立，叶派温病学说就基本上被推翻了。由于谢氏论证严密，故对叶派温病学说的批判，显得极有力量。因此，《温病论衡》无疑是抨击叶派学说中一本最有学术价值的专著。谢氏提出的批判，迄今为止，亦未见有予以反驳者。谢氏在晚年曾著《温病要义》，对叶派的温热之学，“朴实地叙述了它的轮廓。”并云：“至于进一步的研究，那有待医界同志。”但从抨击叶派学说到介绍叶派学说，这是如恽铁樵所说，“不狂者非尤而效之亦佯狂不可”呢？还是如章巨膺所说：“乃致误入歧途”，知迷而返呢？细阅《温病要义》，并未见有一语涉及对《温病论衡》中之观点有所反省者，说明谢氏并不是像章巨膺那样，是先信某派之学而后来立场转变者。谢氏于十年动乱中，已被害致死，其因无法再起死人而问之，但《温病论衡》一书的学术价值，并不因谢氏复著《温病要义》而逊色。
叶派温病治术之批评
我曾说，叶天士的学问，大多出于喻昌（喻西昌），而温病滋阴之法，尤其与喻昌默契而合符。喻昌论温证说：
“因为真阴被热邪长久耗损，无以制约亢盛的阳气而导致燎原之火不息。所以温病患者，邪气退去而阴气犹存一线者，方可得生，然而多骨瘦皮干，津枯肉烁，经过一年才能恢复未病时的身体。”
把这些话混杂在叶天士、吴鞠通的书中，几乎分辨不出谁是谁，为何神似到这种地步呢？叶天士主张滋阴之说，在《指南》中屡见不鲜，摘录并条列如下：
温邪逆传膻中……必兼滋清——温热门3
高年热病……当滋清去邪——同上
甘寒清气药中，必佐存阴——13
邪虽外达，阳气亦泄……当以育阴清热为主——47
阴中伏邪……与育阴清邪热法——53
温邪久伏少阴，古人立治，全以育阴祛热——53
肾阴不承……议以三才汤滋水制热——54
至于他所以滋阴的道理，无非是阴虚液涸，所以说：
风温热灼之后，津液未复——风温门9
温邪发热津伤——温热门6
邪入心包络中，深怕液涸神昏——19
阴液已涸，舌强音缩——36
阳根求固，阴液渐涸——57
继承叶天士的遗说而祖述之者，都以滋阴为治疗温病的重要措施。
吴鞠通说：“热病没有不耗伤阴液的，耗伤未尽则生，耗尽则阳无留恋，必脱而死。真能体味这句话，思过半矣。”汪刃庵说：“叶天士必须以保津液为要。”
王孟英说：“(阴)耗伤而未尽者，尚有一线生机可望，若耗尽而阴竭，如同早苗的根已枯死，沛然下雨，又有什么帮助呢？”
吴坤安说：“大抵温病的证候，阴精内耗，阳强无制，新邪一触，则燎原之势，直从里发，所以初起即见壮热烦渴口干舌燥等证，而以存津液为要旨。”
叶天士之子叶雨，对滋阴疗法有微词，陆九芝则深致不满，痛加惩创。
叶子雨说：“治疗温暑保津液，固为第一义，但要知道泻其阳之有余，即所以补其阴之不足，则进乎道矣。”
陆九芝说：“急去邪热，阴始可保，一去其热，阴即不伤。”
又说：“大概人所患的病是寒、是热、是温，只要去掉其寒与温与热，其人而阴本不虚者，无伤也。即使其人而本属阴虚者，亦无恙也。乃不防其阳盛伤阴，而独防阴虚邪恋，于是防其劫津，防其发疹，防其风动，防其热入心包，至末而防其脱。夫既曰劫、曰发、曰动、曰入，则自有劫之、发之、动之、入之之物，在不去其劫之、发之、动之、入之之物，而药反留邪以劫津，引邪以发疹，助邪以动风，领邪以入心包，而同归于脱，防云何哉。阳之方盛，徒曰存阴，阴既不能以些微之药而存，而三五日间阳邪之足以伤阴者，方且势如奔马，涸液枯津，是其阴之伤于药后者，不更甚乎。总之，使病速去，阴始不伤，欲保其阴，必速去病，去病之药，十余味耳，亦甚平常，并非险峻，有历验者，非空言也。”
I have heard that Ye Tianshi (Ye Gui, 1667–1746) was a renowned physician of his generation. He was diligent, agile, and eager to learn, extensively absorbing the strengths of various schools. Whether his writings were entirely authored by himself is a matter for textual research. Ye Tianshi was also a human being; all humans possess wisdom. How can we assume that people today are inferior to those of the past? Regarding this specific discourse, we ought to clearly distinguish its merits and flaws rather than follow it blindly. It must be understood that all writings are, to some extent, adaptations to their environment. Later readers who fail to ponder their underlying spirit, yet only pride themselves on imitating the ancients, are indeed pitiable.
Su Sheng said: "It is extremely serious to be rigid and inflexible when reading books." Mencius stated, "To believe everything in books is better than having no books at all," which is well-founded. The sages of old wrote medical theories either to expound upon personal insights, to narrate clinical experiences, to enlighten future students, or to correct contemporary abuses. Their propositions necessarily contained true meanings. Where the spiritual essence of these true meanings could not be fully expressed through words, terminology served as the logical framework. Logic here refers to organization—the method of structuring a theory. To read ancient texts without grasping their spirit, but instead clinging rigidly to terminology, is to digest the past without transforming it (shi gu bu hua).
Humans live within an environment, and the knowledge they acquire varies by individual, time, and place. Differences in authors' subjectivity lead to diverse interpretations of theories. If one reads without contemplating the spirit and follows blindly, it is like viewing objects through colored glasses, believing everything possesses that color.
Those deeply entrenched in sectarian prejudices attack others, claiming, "I belong to the Shi Fang school (the school of later flexible prescriptions), the direct lineage of Ye Tianshi and Wang Mengying." Conversely, those adhering to Jing Fang (classical prescriptions from before the Han Dynasty) argue that while their success may be limited, they cause less harm, noting that constitutions differ and modern people cannot be compared to the ancients. The Jing Fang school retorts, "Shi Fang are merely popular prescriptions; learning them without adhering to rules constitutes practicing as a quack doctor, incapable of treating major diseases." Neither side can convince the other, leading to the sentiment, "Different paths do not plot together." Each respects their own lineage and follows their own way. This reflects a desire not to seek truth, but to keep one's 'colored glasses' on, insisting one's own perspective is correct.
Ye Tianshi's *Wen Re Lun* (Treatise on Warm-Heat Diseases) was an adaptation to its environment. Lu Jiuzhi (Lu Beishan, 1820–1899)'s criticism of Ye Tianshi was also an adaptation to its environment. What Ye Tianshi termed Ying, Wei, Qi, and Blood were logical methods within pathology. Wu Jutong's differentiation of San Jiao (Triple Burner), along with Ke Jiu Zhuan's discussions, Chen Wuze's tripartite classification of Etiology (San Yin), and Zhang Zhongjing's Six Channels differentiation, were all logical frameworks for pathology. The ancients used logic to explain pathology, which was purely subjective. Therefore, it should not be followed blindly. Their writings are clinical records, objective descriptions, sufficient for reference.
Thus, Ye Tianshi's methods of prioritizing urgency versus缓 (slowness/gradualness) may not always be applicable; one should not rigidly adhere to the terms Ying, Wei, Qi, and Blood. This aligns with my teacher's principle of distinguishing merits from flaws. "The resistance response in Shang Han (Cold Damage) that conforms to proper measures manifests as Tai Yang disease. Externally, observe the opening and closing of the exterior mechanism; internally, assess the prosperity or decline of Zheng Qi (Upright Qi). To open the exterior, use acrid herbs; to harmonize the exterior, use sweet herbs; to restrain hyperactivity, use cool herbs; to support deficiency, use warm herbs. I have already silently comprehended these principles. Now, let us proceed to discuss Shaoyang disease." (*Shang Han Zhi Nan*)
Chai Haoran notes: Mr. Zhu Weiju believed that a physician's skill should not lie in predicting disease progression, but rather in mastering methods to intercept the disease process during its development. He carefully examined the efficacy of the Ye school's herbal methods, finding them unsatisfactory in reversing disease trends, and considered parts of their theory incorrect. Thus, he emphasized that "the art of medicine lies in rescuing critical conditions" (Yi zhi wei gong, gong yu jiu ni), which is undoubtedly correct. Mr. Zhu possessed an innovative spirit in scholarship, believing that "theories established with certainty often turn out to be right yesterday and wrong today." Discarding the old for the new is an inevitable law of scientific development. The flaw of "neglecting practicality and engaging in empty talk," which hinders the progress of Traditional Chinese Medicine (TCM), stems from this. Contemporary physicians treated the Ye school's Warm-Heat studies as the ultimate standard, believing "truth resides here, to be upheld by heaven and earth forever." Fools followed, the wise doubted, and scholars found it ineffective, leading to eventual rejection. Such is the reality. Regrettably, the TCM academic forum has been monopolized by one school, causing criticisms of the Ye school's academic views to be unknown to most practitioners. Given these two facts, I wrote this book. Its purpose is not to satirize the Ye school, but to seek the truth and encourage a hundred schools of thought to contend. This aim is detailed in my preface. Let the contemporary world judge me, whether knowing or blaming me.
Conclusion after Investigating the Ideological Changes in Warm Disease Theory
In summary, the evolution of Warm Disease theory has been roughly outlined. Among the twenty-seven schools examined, excluding those peculiar and unreasonable ones with little impact on Warm Disease ideology, the most notable figures are Wang Andao, Ye Tianshi, and Lu Jiuzhi. Wang Andao initiated the drastic changes in Warm Disease theory. Ye Tianshi was the primary culprit in confusing the names and realities of Warm Diseases (though not the only one, his fault was greatest). Following the dominant influence of Ye Tianshi and Wu Jutong, Lu Jiuzhi led the large-scale rebuttal. Post-Wang Andao reforms focused on three aspects: etiology (latent qi vs. new sensation), pathology (from interior to exterior), and treatment (focusing on clearing interior heat). Tracing the targets of their medications, they largely addressed the Stomach. It was Ye Tianshi who innovated the concept of "attacking the Lung," thereby dividing Warm Diseases into Lung and Stomach systems. Although Stomach-system Warm Diseases still existed, they became blurred and gradually forgotten. Later Warm-Heat proponents adopted the twelve-character mantra "Warm pathogenic factors enter from above, first attacking the Lung, then reversely transmitting to the Pericardium" as the guideline for Warm Diseases. Consequently, even Stomach-system Warm Diseases not originating from Lung attack (such as Damp-Warmth) were subsumed under this mantra. The etiologies, pathologies, and treatments for early-stage Stomach-system Warm Diseases were arbitrarily discarded and replaced with Lung-system diagnoses. This is akin to "putting a hat on a donkey's head." Finally, mid-to-late stage Stomach-system Warm Diseases were treated with Lung-targeting drugs, rendering therapeutic outcomes unpredictable ("What patients suffer from is Stomach disease, but what doctors discuss is Lung disease," said Lu Jiuzhi). This malpractice became a prevailing trend. Physicians compiled Warm-Heat books eclectically, using the *Neijing*, *Nanjing*, and Zhang Zhongjing's works as facades to cover up their tendency toward light and mild prescriptions. Many other flaws existed, each with origins. Witnessing these disasters, Lu Jiuzhi wrote *Shi Bu Zhai Yi Shu* to clarify the diagnosis and treatment of Stomach-system Warm Diseases. Although his language was somewhat extreme, it hit the mark and served as a timely remedy. However, Lu Jiuzhi focused solely on Stomach-system Warm Diseases, ignoring the Lung system, even claiming "Stomach disease causes coma, Lung disease does not." This was arbitrary and provided ammunition for proponents of Lung attack. They would argue, "Your Warm Disease is Stomach-system; mine is Lung-system. Your arguments about Stomach, however brilliant, and your attacks on Lung, however fierce, do not concern me." Thus, "you have your truths, I have mine," remaining unrelated. The issue of Lung vs. Stomach in Warm Diseases remains unresolved, and the debate will likely continue indefinitely.
Furthermore, while Lu Jiuzhi exerted great effort in elucidating Stomach-system Warm Diseases and thoroughly criticized both Lung and Stomach systems, he failed to dismantle the Ye-Wu fortress or eradicate their roots because he did not strike at their core. Critiquing a theory requires viewing its entirety and addressing major issues. Attacking piecemeal leads to endless conflict. Lu Jiuzhi's critique was piecemeal, resulting only in confrontation without strangling the Ye-Wu school's vital points. We must now discuss the fundamental issues of Lung-system Warm Diseases. First, was Lung-system Warm Disease originally called Warm Disease? Second, did it improperly intrude into the scope of Warm Disease, and was such intrusion necessary? Third, regarding naming and substance, should it claim the name Warm Disease, and should it be recognized as such? Fourth, does Ye Tianshi's treatment for this Lung-system Warm Disease have value? Fifth, if not recognized as Warm Disease, what name should be assigned? Based on the historical evolution of Warm Disease theory, the answers are as follows:
1. The so-called "Warm pathogenic factors enter from above, first attacking the Lung" disease was not called Warm Disease before Ye Tianshi. People say Ye invented it; I say he fabricated it. People say he created it uniquely; I say he conflated terms.
2. Examining the ideological changes in Warm Disease theory, the so-called "Warm pathogenic factors enter from above, first attacking the Lung" disease is an extraneous addition, intruding midway. The meaning of Warm Disease was already complex; adding this unrelated entity further confuses names and realities. Thus, there was no necessity for such intrusion.
3. Since it was not originally Warm Disease and intruded midway, it should not claim the name Warm Disease nor be recognized as such. It should be excluded from the scope of Warm Disease.
4. Ye Tianshi used Lung-treating herbs for Lung-attacking diseases, avoiding harsh purgatives and unnecessary depletion, which was reasonable. However, the medication was too mild, leading to complications like "reversive transmission to the Pericardium." Ye's conceptual approach can be retained, but the prescription needs reform (Using Lung herbs to treat Stomach disease is a post-Ye flaw; Ye himself is not responsible for this error). Whether Ye's treatment ideas were correct is unrelated to his naming of the disease.
5. This issue is discussed in detail later (see Chapter 5: Diseases Included in Qing Dynasty Warm Disease Books).
In short, TCM disease names are highly complex. "Warm Disease" is not a single disease but a category. Before excluding Lung-attacking diseases, the field was chaotic. Even after exclusion, order was not immediately achieved. However, since Lung-attacking diseases are not truly Warm Diseases, excluding them aids the organization of Warm Disease theory without harming the treatment of Lung diseases. Narrowing the scope of Warm Disease ensures consistency between name and reality for easier management, devoid of personal bias.
Zhang Xugou and others referred to Ye's Lung-attacking disease as "Exterior-Contracting Warm Disease." In fact, Exterior-Contracting diseases include more than just Lung attacks (e.g., Summerheat is also called Exterior-Contracting Warm Disease by vulgar doctors, while Latent Summerheat is different). If one believes that excluding Lung attacks completely overturns Exterior-Contracting Warm Disease, implying only Latent Qi treatments remain, causing anxiety about incomplete treatments, this is a fallacy. Since Exterior-Contracting Warm Disease includes more than just Lung attacks, the majority remains intact. There is no need for worry. (Latent Qi and Exterior Contracting will be critiqued later in Chapter 3). Generally, people mistakenly equate Ye's Lung-attacking disease with the entirety of Warm Disease (due to accepting the twelve-character mantra as the guideline). They fear that overturning Ye's theory means overturning all of Warm Disease, leading to panic. This view is absurd. As stated earlier, Ye's Warm Disease is only part of the theory, not the whole. Overturning it is only part of the theoretical evolution, not the destruction of all Warm Disease. Furthermore, Lung-attacking disease is only a part of Exterior-Contracting Warm Disease. Removing this redundancy helps organize Warm Disease theory orderly. (*Wen Bing Lun Heng*)
Chai Haoran notes: The above is the conclusion of the chapter "Ideological Changes in Warm Disease Theory." After examining the original meanings of Warm Diseases across twenty-seven schools, Xie Yinglu explicitly divided Warm Diseases into Lung and Stomach systems. He argued that Ye Tianshi's "first attacking the Lung" refers to Lung-system Warm Disease, which Ye fabricated and which ancients did not call Warm Disease. This so-called Warm Disease is a tumor in Warm Disease theory. Stomach-system Warm Disease is unrelated to "first attacking the Lung." If Xie's theory holds, the Ye school's Warm Disease theory is essentially overturned. Due to Xie's rigorous argumentation, his critique of the Ye school is powerful. Thus, *Wen Bing Lun Heng* is undoubtedly the most academically valuable monograph criticizing the Ye school. To date, no refutation of Xie's critiques has appeared. In his later years, Xie wrote *Wen Bing Yao Yi*, simply outlining the contours of the Ye school's Warm-Heat studies, stating, "Further research awaits colleagues in the medical field." Did he shift from criticizing to introducing the Ye school, as Yun Tieqiao suggested ("one who is not mad but imitates madness acts like a madman"), or as Zhang Juying claimed ("leading astray")? Reading *Wen Bing Yao Yi* reveals no reflection on the viewpoints in *Wen Bing Lun Heng*. This indicates Xie did not change his stance like Zhang Juying. Xie died during the Cultural Revolution, so we cannot ask him directly. However, the academic value of *Wen Bing Lun Heng* is not diminished by *Wen Bing Yao Yi*.
Critique of the Ye School's Warm Disease Therapeutics
I have said that Ye Tianshi's learning derived largely from Yu Chang (Yu Xichang), and his method of nourishing Yin in Warm Diseases aligns closely with Yu Chang's. Yu Chang discussed Warm Syndromes:
"Because True Yin is long consumed by Heat Pathogens, unable to control Hyperactive Yang, leading to unextinguished flames. Therefore, Warm Disease patients whose pathogens recede but retain a thread of Yin energy may survive, though they often remain emaciated, with dry skin, depleted fluids, and wasted flesh, taking a year to recover their pre-illness state."
Mixing these words into Ye Tianshi and Wu Jutong's books makes it hard to distinguish authorship; why are they so similar? Ye Tianshi advocated nourishing Yin, frequently seen in *Zhi Nan*. Extracts listed below:
Warm pathogens reversely transmit to Danzhong... must combine with Nourishing Clarity — Warm Heat Section 3
Elderly heat diseases... should use Nourishing Clarity to expel pathogens — Ibid.
Among Sweet-Cool Clearing Qi herbs, must assist with Preserving Yin — 13
Although pathogens exit outward, Yang Qi also leaks... should primarily use Nourishing Yin and Clearing Heat — 47
Latent pathogens in Yin... use Nourishing Yin and Clearing Pathogen Heat method — 53
Warm pathogens latent in Shaoyin for a long time; ancient treatments relied entirely on Nourishing Yin and Dispelling Heat — 53
Kidney Yin fails to ascend... propose San Cai Tang to Nourish Water and Control Heat — 54
Regarding the rationale for nourishing Yin, it is simply Yin Deficiency and Fluid Depletion, hence:
After Wind-Warmth scorches, fluids are not restored — Wind-Warmth Section 9
Warm pathogens cause fever and fluid injury — Warm Heat Section 6
Pathogens enter Heart Pericardium; fear fluid depletion and coma — 19
Yin fluids exhausted, tongue stiff and voice constricted — 36
Yang root seeks stability, Yin fluids gradually deplete — 57
Successors inheriting Ye Tianshi's legacy regarded nourishing Yin as the key to treating Warm Diseases.
Wu Jutong said: "Heat diseases invariably consume Yin. If consumption is incomplete, life is possible; if complete, Yang has no attachment, leading to collapse and death. Truly understanding this statement covers half the problem." Wang Ren'an said: "Ye Tianshi must prioritize preserving body fluids."
Wang Mengying said: "If (Yin) is consumed but not exhausted, there is hope for survival. If exhausted and Yin枯竭 (dry), like seedlings with dead roots, even heavy rain cannot help."
Wu Kun'an said: "Generally, Warm Disease syndromes involve internal consumption of Yin essence and uncontrolled Yang hyperactivity. Upon contact with new pathogens, the flame-spread momentum arises from the interior. Thus, early stages show high fever, irritability, thirst, dry mouth, and dry tongue, making preservation of body fluids the main principle."
Ye Tianshi's son, Ye Yu, had reservations about nourishing Yin therapy, while Lu Jiuzhi expressed deep dissatisfaction and severe criticism.
Ye Yu said: "Preserving body fluids in treating Warm and Summerheat is indeed the first priority. But knowing that draining excess Yang supplements insufficient Yin advances one to the Dao."
Lu Jiuzhi said: "Urgently eliminate pathogenic heat, then Yin can be preserved. Once heat is gone, Yin is not injured."
He added: "Generally, diseases are Cold, Heat, or Warm. Remove Cold, Warm, and Heat, and if one's Yin is not inherently deficient, there is no injury. Even if one is inherently Yin-deficient, there is no harm. Instead of preventing Yang excess from injuring Yin, they exclusively prevent Yin deficiency from harboring pathogens. Thus, they fear fluid robbery, rash eruption, wind stirring, and heat entering the Pericardium, finally fearing collapse. Since terms like 'rob,' 'erupt,' 'stir,' and 'enter' imply agents doing these actions, if one does not remove these agents, but medicines instead retain pathogens to rob fluids, draw pathogens to erupt rashes, aid pathogens to stir wind, and lead pathogens into the Pericardium, all leading to collapse, how can one 'prevent'? When Yang is flourishing, merely saying 'preserve Yin' is futile. Yin cannot be preserved by slight medication, while in three to five days, Yang pathogens injure Yin with the speed of a galloping horse, drying fluids and withering juices. Is the Yin injury caused by subsequent medication not even worse? In short, if the disease is removed quickly, Yin is not injured. To preserve Yin, one must quickly remove the disease. Medicines to remove the disease are merely ten or so common herbs, not dangerous, but verified by experience, not empty talk."