其一，以叶桂、吴瑭、王士雄、章楠等人为一派，近人如金寿山等亦可隶属之。此派尊叶氏为首，故后人称之为叶派。叶派之外感热病学术观：谓伤寒先伤足太阳，温病先伤手太阴。认为二者在病因、病理、治法上都截然不同。而外感中除狭义伤寒一证之外，其余全是温热。又谓南方无真伤寒，尽是温热。故其辨证另辟卫气营血、三焦之新径，认为：仲景伤寒，先分六经，河间温热，须究三焦。处处以示寒温之对峙。因以温病从上而下，伤寒从外而里，故复倡治上焦如羽，非轻不举等说，药法亦因之以擅用轻清、重视滋阴称。对用辛温燥药如麻、桂之类的治外感，每有痛切之戒。并谓柴胡劫肝阴，葛根竭胃汁，对易于伤阴之品，亦绝不轻用。此派以倡言温热著名于医林，治病多自创新方，凡外感热病初起，如桑菊，银翘之类，最多赏用，故被后人称为温热派或时方派。现由于统一作为全国高等医药院校教材的《温病学》，悉以叶吴之学为尊，加上其他一些原因，其影响之大，固已为其他学派所未能及。
其二，以陆九芝、恽铁樵、祝味菊、孔庆莱、章巨膺等人为—派。此派中人，有—共同之点，即是站在叶派对立面来研究外感热病，故对叶派之理论，尤其是对叶派之治术，每多激烈的批评。因崇尚经学，抨击叶吴，为该派学术上之一大特色，故谓“废伤寒则六经失传，废六经则百病失传，莫谓《指南》所言无关大局也。”并谓“伤寒以《伤寒论》为准，温病亦当以《伤寒论》为准”(个别有主张利用六经名词而加以改革者，如祝味菊之五段代六经说)。此派以维护仲景学说著名于医林，而《伤寒论》为废止派攻击之重点，故有些人都是与废止派进行大论战的名将。其治病亦以善用经方称，故又被称为伤寒派或经方派。但现在由于作为全国统一教材的大中专中医讲义，无论是《温病学》还是《伤寒论》，都没有介绍此派的学术见解，各大医刊，对该派之学术观极少系统介绍，而介绍叶派学术观以及批判该派中人之文则屡见不鲜，加之此派医家之重要著作，如《世补斋医书》、《伤寒质难》、《温病明理》、《温病论衡》等，在近30年中，未见再版，加上其他一些原因，故此派之许多学术见解，已日渐为来者所罕知。但此派著作不少，论证严密，观点新颖，治效确凿，“双百”方针既已确定，一家一派之学长期宰据医坛所造成的沉闷空气，迟早总有一天要打破，故此派今后之影响，实难预料。
其三，以俞根初、何秀山、何廉臣、曹炳章等人为一派，近贤徐荣斋亦可隶属于其中。此派中人，大都厚古而不薄今，既善于继承发扬，亦注重吸收新知，对叶派之学，虽亦时有微词，但指摘较为温和，立论亦较持平，认为叶派药法，亦有可取，仲景之学，应当发扬。其在学术上的特点之一，是立足于寒温一统，不赞成寒温对立，故在此派之代表性著作《通俗伤寒论》中，其对外感热病之命名，就独具特色，如风温伤寒，春温伤寒，湿温伤寒，热证伤寒，伏暑伤寒，秋燥伤寒，冬温伤寒等等，既是温，又是寒，在病名上就反映出了一统寒温之主张。故即此一端，其对寒温之争所持之态度，即可想见。此派认为：“伤寒为外感百病之统称”，但“伏气多，新感少”，“叶氏之论温二十则……吴鞠通之《温病条辨》……立说非不精详，然皆为新感温暑而设，非为伏气温热而言。”但认为叶派清化、清透诸法，治伏火温病，亦有可取，故选方用药，主张崇实黜华，讲究实效，倡言“方求其验，岂判古今，药贵乎灵，何分中外。”此派前人称为绍派伤寒，就其学术观点论，是实实在在的寒温一统派，因该派以讲究实效为原则，实亦可称为求实派。此派寒温一统之主张，潜移默化，已为当今许多学者所继承，且渐有获得中医界一致公认之趋向。
张山雷为《增订通俗伤寒论》作序，曾谓何廉臣与“孟英九芝两家，差堪鼎峙成三而无愧色。”其言虽未必着意三派说，然彼时治外感热病流派之按三分鼎足论，势已成矣！
柴胡解表之争平议
柴胡是外感最常用之药，也是争讼最多之药。关于解表，有温病不可用，伤寒可用；少阳病可用，他经病不可用，以及外感病均可用，他经病亦可用之争执，迄无定论，为求得正确理解，以便临床使用有所依据，本文拟就此作一分析平议。
一、温病应禁用，伤寒必待邪至少阳可用
持这种观点的医家认为：“柴胡为正伤寒要药，不可以概治温热诸感。”①李士材说；“柴胡，少阳经半表半里之药。病在太阳者，服之太早，则引贼入门。病在阴经者，复用柴胡，则重伤其表。世俗不知柴胡之用，每遇伤寒传经未明，以柴胡汤为不汗不吐不下，可以藏拙，辄混用之，杀人不可胜数矣。”②陈修园认为柴胡功主和解，并不发汗，他对景岳用柴胡发散解表的药法，攻排极烈，他说：“《神农本草经》……无一字言及发汗，故少阳证有汗吐下三禁，首禁发汗，仲景小柴胡汤用八两之多，其不发汗可知”，“景岳未读本草经，误认柴胡为散药”，自制柴胡饮六方，列散阵之首，“无知妄作，莫此为甚。”②丁寿昌则撰《温病忌用柴胡论》，谓“《温病条辨》中力戒温病不可用辛温解表，而柴胡为尤甚，何也？柴胡入足少阳，为发表升阳之剂，伤寒初起在太阳，而本病则在阳明，用柴胡引入少阳，谓之殊伐无过。且当春少阳司令之际，人多病温。温病者，阳伤阴也。当救其阴，而反以柴胡升少阳之气，益助其阳，阳火上降，则阴水下涸，是以柴胡下咽，则大汗神昏，遂成不治之证。汗者阴液，汗能亡阳，亦能亡阴。无汗而强发其汗，伤阴而重亡其阴。温病用柴胡，杀人不旋踵。余目击心伤，因撰此论以示人。”④丁氏甚至说：“少用一剂柴胡即多活一人性命”，能“弃而不用，亦保全性命之一道。”这与陈修园说伤寒病一年中因用景岳之柴胡饮诸方枉死几千万人，是同样激烈的调子。此外，如明·兰茂，清·黄宫绣、汪昂等人的医著中，也都有外感初起，无少阳证不可用柴胡之论述。这是一部分医家的意见。
二、外感都可用，且不必局限于少阳一经
景岳认为：“凡病温病热而因于外感者，皆本于寒，即今医家皆谓之为伤寒"，“凡治伤寒，如时寒火衰，内无热邪，而表不解者。宜以辛温热剂散之，时热火盛而表不解者，宜以辛甘平剂散之。"⑤“柴胡之性善泄善散，所以大能走汗”，“用此者用其凉散。”⑥“用得其宜，诸经无不妙也。”⑦基此认识，景岳制散阵诸方，以柴胡作为主药，如证宜凉散，则配黄芩、芍药等为一柴胡饮，“凡六经初感，内外俱有热者宜此”；如证宜温散，则配细辛、生姜等为二柴胡饮，“凡邪感三阳及三阳并病寒胜者宜此主之，三阴初感亦可用。”⑧如证宜平散，则配防风、陈皮等为正柴胡饮，凡此等等，说明景岳用柴胡不拘于少阳，也用以治温病。张志聪对病在太阳不能用柴胡说作了批评，他说，“柴胡，乃从太阴地土、阳明中土而外达于太阳之药也，故仲祖《卒病论》言伤寒中风不从表解，太阳之气逆于中土，不能转枢外出，则用小柴胡汤达太阳之气于肌表，是柴胡并非少阳之主药。后人有病在太阳而用柴胡，则引邪入少阳之说，此无稽之言。”⑧唐迎川也作《论柴胡》，批评了李士材的观点，并说：“柴胡实未印定少阳药也"，“余于风邪初感之轻证，及邪气淹留，表热不解之久病用之，并臻神效”，“景岳《新方》中诸柴胡饮、柴芩煎、柴胡白虎煎诸方，信手拈用，头头是道，是诚知柴胡之用，而先得我心之同然矣。”⑩追溯清前医家，也不乏持此种观点者，如东垣等，都不主张以少阳一经来局限柴胡的使用范围，《本草纲目》中“劳有五劳，病在五脏，……东垣李氏言诸有热者宜加之，无热则不加。又言诸经之疟，皆以柴胡为君。十二经疮疽，须用柴胡以散结聚。则是肺疟肾疟，十二经之疮有热者，皆可用之矣”等这类记载，就是佐证。此外，如近贤吴考槃教授也认为；据经限药的说法，是需要进一步加以研究的。⑾
三、平议
余谓《金匮·杂疗方》柴胡饮子，用以退五脏之虚热，小柴胡汤置于太阳篇而不置于少阳篇，似可为仲景不以少阳一经来局限柴胡的使用范围作旁证。景岳作《古方八阵》，将小柴胡汤列入散阵而不列和阵，是有一定道理的。但吴仪洛在《成方切用》中，反将景岳新方散阵中的诸要方，全归列于和解门，这完全违背了景岳组方之本义。近代本草书，咸将柴胡列入发散风热药类，这一作法，与景岳“用此者用其凉散”之认识相吻合。“柴胡有良好的解热作用。”⑿已为临床实践所证实。⑩但现在专论外感热病的全国统一教材《温病学》中，竟难得找出一张用柴胡的治方，说明丁氏等“温病禁用柴胡”的论点，影响犹在。何廉臣说：“近世喜用青蒿而畏柴胡如虎”⑩，并非是夸大之言。观前人之用柴胡，如陶节庵治太阳阳明合病的柴葛解肌汤以及景岳的诸柴胡饮，都未曾拘经限药，也用以治疗温病，后人为怕劫阴而几乎弃置不用，实是治感药法之一大损失。用药总要讲辨证，权衡利弊，温热家视辛温之麻、桂如蛇蝎，又畏辛凉之柴胡如虎，甚主张禁绝，这是因噎废食，这与古医家之恣用柴胡补五劳七伤，是各自走向了不能正确认识柴胡的二个极端，由此可见，理性认识的正确与否，对临床用药，有着多么重大的影响！但柴胡凉散郁热之外，疏肝泄满，亦擅胜长，故虽非专主于少阳，毕竟为肝胆二经之要药，徐洄溪疏柴胡，不顾及此，谓“前人指为少阳之药，是知其末而未知其本。”乃直断其为“肠胃之药”(《神农本草经百种录》)，则周岩驳之亦固得。总之，凡立说均不可太过，若一偏即便入歧途，此实论药之亟宜注意者。
参考文献
①转引自《中药大辞典》土837页，上海人民出版社，1977
②李土材，《医宗必读·本草敬要上》
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2：6，1983
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⑩《中药研究文献摘要》463页，1963
⑩俞根初，《通俗伤寒论》卷二，十一页，六也堂书药局
略谈前人对传染病的认识及其防治原则
我国人们对传染病的认识，可以追溯到甲骨文时代，“甲骨文字中的‘降疾’与‘雨疾’，意即上天如雨一般大量降下疾病，所以同时可以有许多人患一种疾病，或且从甲传到乙，这无疑是指传染病或流行性言。"①林乾良氏对甲骨文中的“”字分析说：“第一，不是一个人而是二个人病倒在床上，两个就是多的意思，第二，其下多“”形，即足趾也，足趾为行走之器官，故古代文字中加足趾形者往往有行走，流动的意思，所以这个疾字是强调可以扩散开来，许多人同时患一种病，当然是与传染病，流行性病有关的了。”②由此可见，我国人民在很早就对传染病有了一定的认识，故“”这个字，无疑是有关传染病的最早文字记载。
到西周，随着农业和天文学的发展，人们不仅认识到气候对农作物有影响，同时也认识到了气候对传染病的影响，如《礼记·月令》中，就有“孟春行秋令，则民大疫”，“季春行夏令，则民多疫疾”等记载。“疫”就是传染病。这是认识到传染病的发生与气候有关的最早文字记载。
在我国最早的医方书《五十二病方》中，将狂犬啮人与犬噬人分列，说明古人对狂犬病已有一定认识。再从《左传》“国人逐瘈狗”的记载来看，可见早在春秋时代，人们就已知道用消灭狂犬的办法来预防狂犬病。这是关于预防狂犬病的最早文字记载。以后《肘后方》中“疗狾犬咬人方，取脑敷之，后不复发”，这是狂犬病治法之发展，若就应用免疫反应原理防治疾病来说，这又是世界上最早的文字记载。可见我国人们在对传染病的认识及防治等许多方面，一直都遥遥处于世界领先地位。
至成书于约战国时代的《内经》中，《素问遗篇·剌法论》已有“黄帝问：余闻五疫之至，皆相染易，无问大小，病状相似，不施救疗，如何可得不相移易者？岐伯曰：不相染者，正气存内，邪不可干，避其毒气”的记载。根据这段文字，我们有理由认为：增强机体免疫机能，并避免接触病原，为防止罹患传染病的二大要点，这是中医自古就有之认识。
其一，以叶桂、吴瑭、王士雄、章楠等人为一派，近人如金寿山等亦可隶属之。此派尊叶氏为首，故后人称之为叶派。叶派之外感热病学术观：谓伤寒先伤足太阳（足太阳膀胱经），温病先伤手太阴（手太阴肺经）。认为二者在病因、病理、治法上都截然不同。而外感中除狭义伤寒一证之外，其余全是温热。又谓南方无真伤寒，尽是温热。故其辨证另辟卫气营血、三焦之新径，认为：仲景伤寒，先分六经（太阳、阳明、少阳、太阴、少阴、厥阴），河间温热，须究三焦。处处以示寒温之对峙。因以温病从上而下，伤寒从外而里，故复倡治上焦如羽，非轻不举等说，药法亦因之以擅用轻清、重视滋阴称。对用辛温燥药如麻黄、桂枝之类的治外感，每有痛切之戒。并谓柴胡劫肝阴，葛根竭胃汁，对易于伤阴之品，亦绝不轻用。此派以倡言温热著名于医林，治病多自创新方，凡外感热病初起，如桑菊饮，银翘散之类，最多赏用，故被后人称为温热派或时方派。现由于统一作为全国高等医药院校教材的《温病学》，悉以叶吴之学为尊，加上其他一些原因，其影响之大，固已为其他学派所未能及。
其二，以陆九芝、恽铁樵、祝味菊、孔庆莱、章巨膺等人为—派。此派中人，有—共同之点，即是站在叶派对立面来研究外感热病，故对叶派之理论，尤其是对叶派之治术，每多激烈的批评。因崇尚经学，抨击叶吴，为该派学术上之一大特色，故谓“废伤寒则六经失传，废六经则百病失传，莫谓《指南》所言无关大局也。”并谓“伤寒以《伤寒论》为准，温病亦当以《伤寒论》为准”(个别有主张利用六经名词而加以改革者，如祝味菊之五段代六经说)。此派以维护仲景学说著名于医林，而《伤寒论》为废止派攻击之重点，故有些人都是与废止派进行大论战的名将。其治病亦以善用经方称，故又被称为伤寒派或经方派。但现在由于作为全国统一教材的大中专中医讲义，无论是《温病学》还是《伤寒论》，都没有介绍此派的学术见解，各大医刊，对该派之学术观极少系统介绍，而介绍叶派学术观以及批判该派中人之文则屡见不鲜，加之此派医家之重要著作，如《世补斋医书》、《伤寒质难》、《温病明理》、《温病论衡》等，在近30年中，未见再版，加上其他一些原因，故此派之许多学术见解，已日渐为来者所罕知。但此派著作不少，论证严密，观点新颖，治效确凿，“双百”方针既已确定，一家一派之学长期宰据医坛所造成的沉闷空气，迟早总有一天要打破，故此派今后之影响，实难预料。
其三，以俞根初、何秀山、何廉臣、曹炳章等人为一派，近贤徐荣斋亦可隶属于其中。此派中人，大都厚古而不薄今，既善于继承发扬，亦注重吸收新知，对叶派之学，虽亦时有微词，但指摘较为温和，立论亦较持平，认为叶派药法，亦有可取，仲景之学，应当发扬。其在学术上的特点之一，是立足于寒温一统，不赞成寒温对立，故在此派之代表性著作《通俗伤寒论》中，其对外感热病之命名，就独具特色，如风温伤寒，春温伤寒，湿温伤寒，热证伤寒，伏暑伤寒，秋燥伤寒，冬温伤寒等等，既是温，又是寒，在病名上就反映出了一统寒温之主张。故即此一端，其对寒温之争所持之态度，即可想见。此派认为：“伤寒为外感百病之统称”，但“伏气多，新感少”，“叶氏之论温二十则……吴鞠通之《温病条辨》……立说非不精详，然皆为新感温暑而设，非为伏气温热而言。”但认为叶派清化、清透诸法，治伏火温病，亦有可取，故选方用药，主张崇实黜华，讲究实效，倡言“方求其验，岂判古今，药贵乎灵，何分中外。”此派前人称为绍派伤寒，就其学术观点论，是实实在在的寒温一统派，因该派以讲究实效为原则，实亦可称为求实派。此派寒温一统之主张，潜移默化，已为当今许多学者所继承，且渐有获得中医界一致公认之趋向。
张山雷为《增订通俗伤寒论》作序，曾谓何廉臣与“孟英九芝两家，差堪鼎峙成三而无愧色。”其言虽未必着意三派说，然彼时治外感热病流派之按三分鼎足论，势已成矣！
柴胡解表之争平议
柴胡是外感最常用之药，也是争讼最多之药。关于解表，有温病不可用，伤寒可用；少阳病可用，他经病不可用，以及外感病均可用，他经病亦可用之争执，迄无定论，为求得正确理解，以便临床使用有所依据，本文拟就此作一分析平议。
一、温病应禁用，伤寒必待邪至少阳可用
持这种观点的医家认为：“柴胡为正伤寒要药，不可以概治温热诸感。”①李士材说；“柴胡，少阳经半表半里之药。病在太阳者，服之太早，则引贼入门。病在阴经者，复用柴胡，则重伤其表。世俗不知柴胡之用，每遇伤寒传经未明，以柴胡汤为不汗不吐不下，可以藏拙，辄混用之，杀人不可胜数矣。”②陈修园认为柴胡功主和解，并不发汗，他对景岳用柴胡发散解表的药法，攻排极烈，他说：“《神农本草经》……无一字言及发汗，故少阳证有汗吐下三禁，首禁发汗，仲景小柴胡汤用八两之多，其不发汗可知”，“景岳未读本草经，误认柴胡为散药”，自制柴胡饮六方，列散阵之首，“无知妄作，莫此为甚。”②丁寿昌则撰《温病忌用柴胡论》，谓“《温病条辨》中力戒温病不可用辛温解表，而柴胡为尤甚，何也？柴胡入足少阳，为发表升阳之剂，伤寒初起在太阳，而本病则在阳明，用柴胡引入少阳，谓之殊伐无过。且当春少阳司令之际，人多病温。温病者，阳伤阴也。当救其阴，而反以柴胡升少阳之气，益助其阳，阳火上降，则阴水下涸，是以柴胡下咽，则大汗神昏，遂成不治之证。汗者阴液，汗能亡阳，亦能亡阴。无汗而强发其汗，伤阴而重亡其阴。温病用柴胡，杀人不旋踵。余目击心伤，因撰此论以示人。”④丁氏甚至说：“少用一剂柴胡即多活一人性命”，能“弃而不用，亦保全性命之一道。”这与陈修园说伤寒病一年中因用景岳之柴胡饮诸方枉死几千万人，是同样激烈的调子。此外，如明·兰茂，清·黄宫绣、汪昂等人的医著中，也都有外感初起，无少阳证不可用柴胡之论述。这是一部分医家的意见。
二、外感都可用，且不必局限于少阳一经
景岳认为：“凡病温病热而因于外感者，皆本于寒，即今医家皆谓之为伤寒"，“凡治伤寒，如时寒火衰，内无热邪，而表不解者。宜以辛温热剂散之，时热火盛而表不解者，宜以辛甘平剂散之。"⑤“柴胡之性善泄善散，所以大能走汗”，“用此者用其凉散。”⑥“用得其宜，诸经无不妙也。”⑦基此认识，景岳制散阵诸方，以柴胡作为主药，如证宜凉散，则配黄芩、芍药等为一柴胡饮，“凡六经初感，内外俱有热者宜此”；如证宜温散，则配细辛、生姜等为二柴胡饮，“凡邪感三阳及三阳并病寒胜者宜此主之，三阴初感亦可用。”⑧如证宜平散，则配防风、陈皮等为正柴胡饮，凡此等等，说明景岳用柴胡不拘于少阳，也用以治温病。张志聪对病在太阳不能用柴胡说作了批评，他说，“柴胡，乃从太阴地土、阳明中土而外达于太阳之药也，故仲祖《卒病论》言伤寒中风不从表解，太阳之气逆于中土，不能转枢外出，则用小柴胡汤达太阳之气于肌表，是柴胡并非少阳之主药。后人有病在太阳而用柴胡，则引邪入少阳之说，此无稽之言。”⑧唐迎川也作《论柴胡》，批评了李士材的观点，并说：“柴胡实未印定少阳药也"，“余于风邪初感之轻证，及邪气淹留，表热不解之久病用之，并臻神效”，“景岳《新方》中诸柴胡饮、柴芩煎、柴胡白虎煎诸方，信手拈用，头头是道，是诚知柴胡之用，而先得我心之同然矣。”⑩追溯清前医家，也不乏持此种观点者，如东垣等，都不主张以少阳一经来局限柴胡的使用范围，《本草纲目》中“劳有五劳，病在五脏，……东垣李氏言诸有热者宜加之，无热则不加。又言诸经之疟，皆以柴胡为君。十二经疮疽，须用柴胡以散结聚。则是肺疟肾疟，十二经之疮有热者，皆可用之矣”等这类记载，就是佐证。此外，如近贤吴考槃教授也认为；据经限药的说法，是需要进一步加以研究的。⑾
三、平议
余谓《金匮·杂疗方》柴胡饮子，用以退五脏之虚热，小柴胡汤置于太阳篇而不置于少阳篇，似可为仲景不以少阳一经来局限柴胡的使用范围作旁证。景岳作《古方八阵》，将小柴胡汤列入散阵而不列和阵，是有一定道理的。但吴仪洛在《成方切用》中，反将景岳新方散阵中的诸要方，全归列于和解门，这完全违背了景岳组方之本义。近代本草书，咸将柴胡列入发散风热药类，这一作法，与景岳“用此者用其凉散”之认识相吻合。“柴胡有良好的解热作用。”⑿已为临床实践所证实。⑩但现在专论外感热病的全国统一教材《温病学》中，竟难得找出一张用柴胡的治方，说明丁氏等“温病禁用柴胡”的论点，影响犹在。何廉臣说：“近世喜用青蒿而畏柴胡如虎”⑩，并非是夸大之言。观前人之用柴胡，如陶节庵治太阳阳明合病的柴葛解肌汤以及景岳的诸柴胡饮，都未曾拘经限药，也用以治疗温病，后人为怕劫阴而几乎弃置不用，实是治感药法之一大损失。用药总要讲辨证，权衡利弊，温热家视辛温之麻黄、桂枝如蛇蝎，又畏辛凉之柴胡如虎，甚主张禁绝，这是因噎废食，这与古医家之恣用柴胡补五劳七伤，是各自走向了不能正确认识柴胡的二个极端，由此可见，理性认识的正确与否，对临床用药，有着多么重大的影响！但柴胡凉散郁热之外，疏肝泄满，亦擅胜长，故虽非专主于少阳，毕竟为肝胆二经之要药，徐洄溪疏柴胡，不顾及此，谓“前人指为少阳之药，是知其末而未知其本。”乃直断其为“肠胃之药”(《神农本草经百种录》)，则周岩驳之亦固得。总之，凡立说均不可太过，若一偏即便入歧途，此实论药之亟宜注意者。
参考文献
①转引自《中药大辞典》土837页，上海人民出版社，1977
②李土材，《医宗必读·本草敬要上》
⑧陈修园，《景岳新方砭》，上海文华书局，广益书局版
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⑥同⑤，914页
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①吴考盘，新方散阵刍议，《绍兴中医》(内部刊物)
2：6，1983
⑩上海中医学院方药教研组，《中药临床手册》36页，上海人民出版社，1977
⑩《中药研究文献摘要》463页，1963
⑩俞根初，《通俗伤寒论》卷二，十一页，六也堂书药局
略谈前人对传染病的认识及其防治原则
我国人们对传染病的认识，可以追溯到甲骨文时代，“甲骨文字中的‘降疾’与‘雨疾’，意即上天如雨一般大量降下疾病，所以同时可以有许多人患一种疾病，或且从甲传到乙，这无疑是指传染病或流行性言。"①林乾良氏对甲骨文中的“”字分析说：“第一，不是一个人而是二个人病倒在床上，两个就是多的意思，第二，其下多“”形，即足趾也，足趾为行走之器官，故古代文字中加足趾形者往往有行走，流动的意思，所以这个疾字是强调可以扩散开来，许多人同时患一种病，当然是与传染病，流行性病有关的了。”②由此可见，我国人民在很早就对传染病有了一定的认识，故“”这个字，无疑是有关传染病的最早文字记载。
到西周，随着农业和天文学的发展，人们不仅认识到气候对农作物有影响，同时也认识到了气候对传染病的影响，如《礼记·月令》中，就有“孟春行秋令，则民大疫”，“季春行夏令，则民多疫疾”等记载。“疫”就是传染病。这是认识到传染病的发生与气候有关的最早文字记载。
在我国最早的医方书《五十二病方》中，将狂犬啮人与犬噬人分列，说明古人对狂犬病已有一定认识。再从《左传》“国人逐瘈狗”的记载来看，可见早在春秋时代，人们就已知道用消灭狂犬的办法来预防狂犬病。这是关于预防狂犬病的最早文字记载。以后《肘后方》中“疗狾犬咬人方，取脑敷之，后不复发”，这是狂犬病治法之发展，若就应用免疫反应原理防治疾病来说，这又是世界上最早的文字记载。可见我国人们在对传染病的认识及防治等许多方面，一直都遥遥处于世界领先地位。
至成书于约战国时代的《内经》中，《素问遗篇·剌法论》已有“黄帝问：余闻五疫之至，皆相染易，无问大小，病状相似，不施救疗，如何可得不相移易者？岐伯曰：不相染者，正气存内，邪不可干，避其毒气”的记载。根据这段文字，我们有理由认为：增强机体免疫机能，并避免接触病原，为防止罹患传染病的二大要点，这是中医自古就有之认识。
First, a school represented by Ye Gui (Ye Tianshi), Wu Tang (Wu Jutong), Wang Shixiong, and Zhang Nan, with modern figures such as Jin Shoushan also belonging to it. This school reveres Ye Gui as its founder, hence later generations call it the "Ye School." The academic view of this school regarding exogenous febrile diseases is: Cold damage (Shanghan) first injures the Foot-Taiyang (Bladder Meridian), while warm diseases (Wenbing) first injure the Hand-Taiyin (Lung Meridian). They believe that these two differ fundamentally in etiology, pathology, and treatment methods. Furthermore, apart from the specific syndrome of narrow-sense cold damage, all exogenous conditions are considered warm-heat in nature. They also assert that there is no true cold damage in the South, only warm-heat conditions. Therefore, their pattern differentiation opens new paths using the Wei-Qi-Ying-Xue (Defensive, Nutritive, Qi, Blood) and Sanjiao (Triple Burner) frameworks, stating: "Zhongjing's cold damage is first differentiated by the Six Channels; Hejian's warm diseases must be investigated through the Sanjiao." Everywhere, they emphasize the opposition between cold and warm diseases. Since warm diseases descend from above and cold damage progresses from exterior to interior, they again advocate treatments such as "treating the Upper Burner like feathers; without lightness, nothing can be lifted." Their pharmacological methods are characterized by the adept use of light and clear herbs and a strong emphasis on nourishing Yin. They issue stern warnings against using acrid-warm drying herbs like Ephedrae Herba (Mahuang) or Cinnamomi Ramulus (Guizhi) for treating exogenous conditions. They also claim that Bupleuri Radix (Chaihu) depletes Liver Yin and Puerariae Radix (Gegen) exhausts Stomach fluids, thus never lightly employing substances prone to damaging Yin. This school became famous in the medical community for advocating warm-heat theories. In treating diseases, they often created new prescriptions. For early-stage exogenous febrile diseases, formulas such as Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction) and Yinqiao San (Honeysuckle and Forsythia Powder) were most frequently used, leading later generations to call them the Warm-Heat School or the Contemporary Formula School. Currently, due to the unified textbook "Warm Diseases" adopted by national higher medical institutions, which fully respects the learning of Ye and Wu, along with other reasons, their influence is so great that it surpasses that of other schools.
Second, a school represented by Lu Jiuzhi, Yun Tieqiao, Zhu Weiju, Kong Qinglai, and Zhang Juying. A common point among members of this school is that they study exogenous febrile diseases from an opposing standpoint to the Ye School, thus often offering fierce criticism of the Ye School's theories, especially its treatment techniques. Revering classical studies and attacking Ye and Wu is a major characteristic of this school's academics. Hence, it is said: "If Shanghan is abolished, the Six Channels will be lost; if the Six Channels are lost, hundreds of diseases will be lost. Do not say that what is stated in the 'Zhinan' is irrelevant to the big picture." It is also stated: "Cold damage should take the *Treatise on Cold Damage* (*Shanghan Lun*) as the standard, and warm diseases should also take the *Treatise on Cold Damage* as the standard" (a few individuals advocated reforming the Six Channel terminology, such as Zhu Weiju's theory of replacing the Six Channels with Five Stages). This school is famous in the medical community for defending Zhongjing's学说 (learning/doctrine). Since the *Treatise on Cold Damage* was the main target of attack by the abolitionist faction, some of its members were famous generals in large-scale debates against the abolitionists. Their treatment methods are also known for the adept use of classic formulas (Jingfang), hence they are also called the Cold Damage School or the Classic Formula School. However, currently, due to the unified national textbooks for secondary and tertiary traditional Chinese medicine institutions, neither the *Warm Diseases* nor the *Treatise on Cold Damage* introduces the academic views of this school. Major medical journals rarely systematically introduce this school's academic perspectives, while articles introducing the Ye School's views and criticizing this school's members are commonplace. Additionally, important works by physicians of this school, such as *Shibu Zhai Yishu*, *Shanghan Zhinan*, *Wenbing Mingli*, and *Wenbing Lunheng*, have not been reprinted in the past 30 years, plus other reasons. Consequently, many academic insights of this school are increasingly unknown to future practitioners. Nevertheless, this school has numerous works with rigorous arguments, novel viewpoints, and confirmed therapeutic effects. With the establishment of the "Double Hundred" policy, the stagnant atmosphere caused by one school dominating the medical arena for a long time will inevitably be broken sooner or later. Therefore, the future influence of this school is truly unpredictable.
Third, a school represented by Yu Genchu, He Xiushan, He Lianchen, and Cao Bingzhang, with modern scholar Xu Rongzhai also belonging to it. Most members of this school value the ancient without despising the modern; they are good at inheriting and developing traditions while also focusing on absorbing new knowledge. Although they occasionally have mild criticisms of the Ye School, their critiques are relatively gentle, and their arguments are more balanced. They believe that the Ye School's pharmacological methods have merits and that Zhongjing's learning should be promoted. One of the characteristics of this school's academics is its foundation in the unity of cold and warm diseases, opposing the dichotomy between them. Thus, in this school's representative work, *Putong Shanghan Lun* (Commonly Understood Treatise on Cold Damage), the naming of exogenous febrile diseases is unique, such as Fengwen Shanghan (Wind-Warmth Cold Damage), Chunwen Shanghan (Spring-Warmth Cold Damage), Shiwen Shanghan (Damp-Warmth Cold Damage), Rezhen Shanghan (Heat-Syndrome Cold Damage), Fushu Shanghan (Latent Summerheat Cold Damage), Qiuzao Shanghan (Autumn-Dryness Cold Damage), Dongwen Shanghan (Winter-Warmth Cold Damage), etc. These names reflect both warmth and cold, manifesting the advocacy for the unity of cold and warm diseases in disease nomenclature. From this alone, one can infer their attitude toward the cold-warm debate. This school believes: "Cold damage is the general term for hundreds of exogenous diseases," but "latent qi [pathogens] are common, while new sensation [acute onset] is rare." Regarding Ye's twenty rules on warmth... and Wu Jutong's *Wenbing Tiaobian*... although their theories are precise and detailed, they are established for new-onset warm and summerheat diseases, not for latent warm-heat diseases. However, they acknowledge that the Ye School's methods of clearing transformation and clearing penetration are useful for treating latent fire warm diseases. Therefore, in selecting formulas and prescribing herbs, they advocate valuing substance over formality and emphasizing practical efficacy, proclaiming: "Formulas seek verification; why distinguish between ancient and modern? Herbs value agility; why distinguish between domestic and foreign?" This school was previously called the Shao School of Cold Damage. In terms of academic viewpoint, it is a genuine school of unity between cold and warm diseases. Because this school takes practical efficacy as its principle, it can also be called the Pragmatic School. The主张 (advocacy) of this school for the unity of cold and warm diseases has subtly influenced many contemporary scholars and is gradually gaining consistent recognition within the TCM community.
Zhang Shanlei, in his preface to the *Revised Putong Shanghan Lun*, stated that He Lianchen and the families of Meng and Liu Jiuzhi "could stand as three equal powers without feeling ashamed." Although his words may not have intentionally proposed a theory of three schools, at that time, the perspective of dividing exogenous febrile disease schools into a tripod was already formed!
A Balanced Discussion on the Controversy of Chaihu for Resolving the Exterior
Chaihu (Bupleuri Radix) is the most commonly used herb for exogenous conditions and also the most controversial. Regarding resolving the exterior, there are disputes: whether it cannot be used for warm diseases but can be used for cold damage; whether it can be used for Shaoyang diseases but not for other channels; and whether it can be used for all exogenous diseases and other channel diseases. No definitive conclusion has been reached. To obtain a correct understanding and provide a basis for clinical use, this article intends to analyze and discuss this matter.
I. Warm Diseases Should Be Forbidden from Using Chaihu; Cold Damage Can Only Use It When Pathogens Reach Shaoyang
Physicians holding this view believe: "Chaihu is a crucial herb for true cold damage and cannot generally treat various warm-heat infections." Li Shicai said: "Chaihu is a herb for the half-exterior, half-interior of the Shaoyang Meridian. If taken too early for diseases in the Taiyang, it invites the thief inside. If used again for diseases in the Yin channels, it severely damages the exterior. The common people do not understand the use of Chaihu. Whenever the transmission of cold damage is unclear, they consider Chaihu Tang (Minor Bupleurum Decoction) as a way to hide incompetence because it induces neither sweating, vomiting, nor purgation, and thus mix it indiscriminately, killing countless people." Chen Xiuyuan believed that Chaihu's function is primarily harmonization and does not induce sweating. He fiercely criticized Jingyue's method of using Chaihu to disperse and resolve the exterior, saying: "*Shennong Bencao Jing* ... contains not a single word mentioning inducing sweating. Therefore, the Shaoyang syndrome has three prohibitions: sweating, vomiting, and purgation, with inducing sweating being the primary prohibition. Zhongjing used eight taels of Chaihu in Minor Bupleurum Decoction; it is evident that it does not induce sweating." "Jingyue did not read the *Bencao Jing* and mistakenly recognized Chaihu as a dispersing herb." He self-created six formulas of Chaihu Yin, listing them at the forefront of the Dispersal Array. "Ignorant and reckless actions, none exceed this." Ding Shouchang then wrote *On Prohibiting Chaihu for Warm Diseases*, stating: "*Wenbing Tiaobian* strongly warns against using acrid-warm exterior-resolving herbs for warm diseases, with Chaihu being particularly severe. Why? Chaihu enters the Foot-Shaoyang and is an agent for releasing the exterior and raising Yang. Cold damage begins in Taiyang, but this disease is in Yangming. Using Chaihu to guide pathogens into Shaoyang is called punishing the innocent. Moreover, during the spring when Shaoyang governs, many people suffer from warm diseases. Warm diseases involve Yang injuring Yin. One should save the Yin, but instead, Chaihu raises Shaoyang Qi, further assisting Yang. As Yang fire descends, Yin water dries up. Therefore, once Chaihu is swallowed, profuse sweating and coma occur, becoming an incurable condition. Sweat is Yin fluid; sweating can lead to the loss of Yang, but also to the loss of Yin. Forcing sweating when there is none damages Yin and causes a heavy loss of Yin. Using Chaihu for warm diseases kills people instantly. I witnessed this with heartache and wrote this treatise to show others." Mr. Ding even said: "Using one dose less of Chaihu saves one more life," and "abandoning its use is also a way to preserve life." This is just as intense a tone as Chen Xiuyuan's claim that tens of millions died annually in cold damage cases due to Jingyue's Chaihu Yin formulas. Additionally, in the medical works of Lan Mao (Ming Dynasty), Huang Gongxiu, and Wang Ang (Qing Dynasty), there are discussions stating that Chaihu cannot be used in the early stages of exogenous conditions unless there is a Shaoyang syndrome. These are the opinions of a portion of physicians.
II. Exogenous Conditions Can All Use It, and There Is No Need to Limit It to the Shaoyang Channel Alone
Jingyue believed: "All warm and heat diseases caused by exogenous factors originate from cold, which is what current physicians call 'cold damage.'" "When treating cold damage, if external cold is strong and internal fire is weak, with no internal heat pathogen and the exterior not resolved, one should disperse it with acrid-warm-hot agents. If external heat/fire is strong and the exterior is not resolved, one should disperse it with acrid-sweet-neutral agents." "Chaihu's nature is good at draining and dispersing, so it greatly promotes sweating." "Those who use it utilize its cool dispersal." "Used appropriately, there is no merit it cannot achieve in any channel." Based on this understanding, Jingyue created various formulas in the Dispersal Array, using Chaihu as the main herb. If the syndrome requires cool dispersal, he paired it with Scutellariae Radix (Huangqin) and Paeoniae Radix Alba (Baishao) to create First Chaihu Yin: "Suitable for initial infection of the Six Channels where both interior and exterior have heat." If the syndrome requires warm dispersal, he paired it with Asari Radix (Xixin) and Zingiberis Rhizoma Recens (Shengjiang) to create Second Chaihu Yin: "Suitable for pathogens affecting the Three Yang channels, combined diseases of the Three Yang with dominant cold, and initial infection of the Three Yin." If the syndrome requires neutral dispersal, he paired it with Saposhnikoviae Radix (Fangfeng) and Citri Reticulatae Pericarpium (Chenpi) to create Zheng Chaihu Yin. All these illustrate that Jingyue did not limit Chaihu to the Shaoyang channel but also used it to treat warm diseases. Zhang Zhicong criticized the statement that Chaihu cannot be used for diseases in Taiyang, saying, "Chaihu is a herb that reaches Taiyang from the earth of Taiyin and the middle soil of Yangming. Therefore, Zhongzu's *Zhubing Yuanhou Lun* states that if cold damage and wind strike do not resolve from the exterior, and Taiyang Qi reverses into the middle soil, unable to pivot outward, then Minor Bupleurum Decoction is used to reach Taiyang Qi to the muscle surface. Thus, Chaihu is not the master herb of Shaoyang. Later people's claim that using Chaihu for diseases in Taiyang draws pathogens into Shaoyang is baseless talk." Tang Yingchuan also wrote *On Chaihu*, criticizing Li Shicai's viewpoint, and said: "Chaihu is indeed not fixed as a Shaoyang herb." "I use it for mild cases of initial wind-strike and for chronic diseases where pathogens linger and exterior heat does not resolve, achieving miraculous effects." "The various Chaihu Yin, Chaiqin Jian, and Chaihu Baihu Jian formulas in Jingyue's *New Formulas* are used effortlessly and logically. This truly shows knowledge of Chaihu's use and aligns with my own thoughts." Tracing back to pre-Qing physicians, there are also those holding this view. For example, Dongyuan did not advocate limiting the use of Chaihu to the Shaoyang channel. Records in *Bencao Gangmu* such as "There are five types of fatigue, diseases in the five zang organs... Dongyuan's Mr. Li said that all cases with heat should add it, and without heat, do not add it. He also said that malaria of all channels should use Chaihu as the sovereign herb. Carbuncles and sores of the twelve channels require Chaihu to dissipate accumulations. Thus, lung malaria, kidney malaria, and carbuncles of the twelve channels with heat can all use it" serve as evidence. Additionally, modern scholar Professor Wu Kaopan also believes that the theory of restricting herbs based on channels needs further research.
III. Balanced Discussion
I state that Chaihu Yin Zi in the *Jingui Yaolue·Miscellaneous Therapeutic Methods* is used to retreat deficiency heat of the five zang organs, and Minor Bupleurum Decoction is placed in the Taiyang chapter rather than the Shaoyang chapter. This seems to serve as collateral evidence that Zhongjing did not limit the use of Chaihu to the Shaoyang channel. Jingyue, in *Gufang Bazhen* (Ancient Formulas Eight Arrays), listed Minor Bupleurum Decoction in the Dispersal Array rather than the Harmonizing Array, which is reasonable. However, Wu Yiluo in *Chengfang Qieyong* reversed this, placing all the key formulas from Jingyue's new Dispersal Array into the Harmonizing category, which completely violates Jingyue's original intent in formulating these recipes. Modern materia medica books all classify Chaihu under herbs that disperse wind-heat, a practice that aligns with Jingyue's understanding of "using it for its cool dispersal." "Chaihu has a good antipyretic effect," which has been confirmed by clinical practice. Yet, in the unified national textbook *Warm Diseases* dedicated to exogenous febrile diseases, it is hard to find a single formula using Chaihu, indicating that the argument of Ding et al. that "Chaihu is forbidden for warm diseases" still has influence. He Lianchen said: "In recent times, people prefer using Artemisiae Annuae Herba (Qinghao) and fear Chaihu like tigers," which is not an exaggeration. Observing the predecessors' use of Chaihu, such as Tao Jie'an's Chaige Jieji Tang for combined Taiyang-Yangming disease and Jingyue's various Chaihu Yin formulas, none restricted the use of herbs by channel, and they were also used to treat warm diseases. Later generations, fearing the depletion of Yin, almost abandoned its use, which is actually a major loss in the pharmacological methods for treating infections. Medication always requires pattern differentiation and weighing pros and cons. Warm-heat physicians view acrid-warm Mahuang and Guizhi as snakes and scorpions, and fear acrid-cool Chaihu like tigers, even advocating its absolute prohibition. This is giving up eating for fear of choking. This contrasts with ancient physicians who recklessly used Chaihu to tonify the five fatigues and seven injuries, representing two extremes of failing to correctly understand Chaihu. This shows how crucial correct rational understanding is for clinical medication! Besides cooling and dispersing constrained heat, Chaihu excels in soothing the Liver and relieving fullness. Therefore, although it is not exclusively for Shaoyang, it is undoubtedly a key herb for the Liver and Gallbladder channels. Xu Huixi, in annotating Chaihu, disregarded this, stating, "Predecessors identified it as a Shaoyang herb; they knew its end but not its root." He directly concluded it is a "Stomach and Intestine herb" (*Shennong Bencao Jing Baizhong Lu*), which Zhou Yan refuted effectively. In summary, all theories should not be excessive; if biased, one falls into error. This is indeed something that urgently needs attention when discussing herbs.
References
① Quoted from *Dictionary of Chinese Materia Medica*, p. 837, Shanghai People's Publishing House, 1977.
② Li Shicai, *Yizong Bidu·Bencao Yao Yao Shang*.
③ Chen Xiuyuan, *Jingyue Xinfang Bian*, Shanghai Wenhua Book Bureau, Guangyi Book Bureau Edition.
④ Quoted from *Bencao Haili*, p. 34, China Ancient Books Publishing House, 1982.
⑤ Zhang Jingyue, *Jingyue Quanshu*, p. 132, Yuezhilou Collection Edition.
⑥ Ibid., p. 914.
⑦ Ibid., p. 976.
⑧ Ibid., p. 155.
⑨ Quoted from *Dictionary of Chinese Materia Medica*, p. 1836, same as ①.
⑩ Tang Lishan, *Wu Yi Hui Jiang*, p. 35, Shanghai Science and Technology Press, 1983.
⑪ Wu Kaopan, "Discussion on the New Formula Dispersal Array," *Shaoxing Traditional Chinese Medicine* (Internal Publication), 2:6, 1983.
⑫ Shanghai College of Traditional Medicine Pharmacology Research Group, *Clinical Manual of Chinese Materia Medica*, p. 36, Shanghai People's Publishing House, 1977.
⑬ *Abstracts of Literature on Chinese Materia Medica Research*, p. 463, 1963.
⑭ Yu Genchu, *Putong Shanghan Lun*, Vol. 2, p. 11, Liuyetang Pharmacy.
Brief Discussion on Predecessors' Understanding of Infectious Diseases and Their Prevention and Treatment Principles
The understanding of infectious diseases in China can be traced back to the Oracle Bone Script era. "The characters 'Jiang Ji' (descending illness) and 'Yu Ji' (rain illness) in oracle bone script mean that heaven rains down illnesses heavily, so many people can suffer from one disease simultaneously, or it can spread from person A to person B. This undoubtedly refers to infectious or epidemic diseases." Mr. Lin Qianliang analyzed the character "Ji" (illness/disease) in oracle bone scripts, saying: "First, it is not one person but two people lying sick in bed; two implies many. Second, below it is the shape of 'foot/toe,' which is the organ of walking. Therefore, in ancient texts, adding the foot/toe shape often implies walking or flowing. Thus, this character emphasizes spreading out; many people suffering from one disease simultaneously is naturally related to infectious and epidemic diseases." From this, we can see that the Chinese people had a certain understanding of infectious diseases very early on. Therefore, this character is undoubtedly the earliest written record concerning infectious diseases.
By the Western Zhou Dynasty, with the development of agriculture and astronomy, people not only realized the impact of climate on crops but also recognized the impact of climate on infectious diseases. For example, in *Li Ji·Yueling* (Record of Rites·Monthly Ordinances), there are records such as "If autumn ordinances are followed in early spring, the people will suffer a great epidemic," and "If summer ordinances are followed in late spring, the people will suffer many epidemics." "Yi" refers to infectious diseases. This is the earliest written record recognizing the relationship between the occurrence of infectious diseases and climate.
In China's earliest medical prescription book, *Wushi'er Bingfang* (Prescriptions for Fifty-Two Diseases), bites from rabid dogs biting humans and dogs biting humans are listed separately, indicating that the ancients had a certain understanding of rabies. Furthermore, from the record in *Zuo Zhuan* ("the citizens chased mad dogs"), it can be seen that as early as the Spring and Autumn period, people already knew to prevent rabies by eliminating mad dogs. This is the earliest written record regarding the prevention of rabies. Later, in *Zhouhou Beiji Fang* (Handbook of Prescriptions for Emergencies), the formula "Treating Dog Bites: Take brain tissue and apply it; it will not recur afterwards" represents the development of rabies treatment methods. If considering the application of immune response principles for disease prevention and treatment, this is again the earliest written record in the world. It is evident that in many aspects of understanding and preventing/treating infectious diseases, the Chinese people have always been far ahead of the world.
In the *Neijing* (Inner Canon), compiled around the Warring States period, the *Suwen Yipian·Cifa Lun* (Supplement to Basic Questions·Chapter on Acupuncture Methods) already contains the record: "Yellow Emperor asked: I have heard that when the five plagues arrive, they all infect each other, regardless of age, and the symptoms are similar. Without rescue treatment, how can one avoid transmission? Qibo answered: Those who do not get infected have righteous Qi stored within, and evil cannot interfere. Avoid the toxic qi." Based on this text, we have reason to believe that enhancing the body's immune function and avoiding contact with pathogens are the two key points for preventing infectious diseases. This is a recognition inherent in TCM since ancient times.