东汉初，常有疫病流行，但由于当时“天人感应论”泛滥，认为这是疫鬼所致，故形成了一种“岁终逐疫”的风俗。对此，王充(27—97)进行了严词驳斥。王充认为，所谓疫鬼，实是一种“中人多死”的毒烈之气。由于“气困为热”，“热极为毒"(《论衡·言毒篇》)，“毒象人之兵，则其中人，人辄死也”(《订鬼篇》)。这是用唯物主义观点解释病原并批驳谶讳迷信活动的最早文字记载。对后世影响极大。王充认为气有和与不和之分，不和之气统称为邪，邪气除了毒气能流行，还有疫疠之气和腐臭之气等等之分(这可以说是对传染病病原分类之萌芽)，其中疫疠之气是一种很易传染，危害性很大的邪气，而其流行，则往往发生在饥馑之岁，如《命义篇》说：“饥馑之岁，饿者满道，温气疫疠，千户灭门。”这些认识，比笼统地称病原为毒气，可以说是前进了一步。王充还以“草木之中，有巴豆野葛，食之凑满，颇多杀人。"“蜘蛛结网，蜚虫过之，或脱或获”等作比喻，认为“灾气加人，亦此类也。不幸遭触而死，幸者免脱而生”(《幸偶篇》)。从而对避免接触病原的重要性，起了强调作用。此外，王充还认识到传染病可以通过“气相污)，而传播，他认为“死者累，属，葬棺至十，不曰气相污，而曰葬日凶”(《辨祟篇》)，这是很愚蠢的。总之，从《论衡》来看，王充对传染病的认识很为深刻，其医学思想，对后世影响不小，但由于他不是医家，《论衡》又非医学著作，故尚为人们所忽视，实则此书很值得引起研究中医学者的重视。汉代刘熙之《释名》中：“注病，一人死，一人复得，气相灌注也。”其说与王充的“气相污”说相一致。这都说明，我国早在3—4世纪时，就已知道某些传染病是通过空气而传播的。
东汉末年，战乱频繁，而“大兵之后必有大疫，”，从《伤寒论·序》：“余宗属素多，建安纪元以来，犹未十稔，其死亡者，三分有二，伤寒十居其七，”这段文字来看，显然也是有传染病流行，但仲景(150—219)以六气归纳病原，故称之为伤寒。仲景“感往昔之沦丧，伤夭横之莫救，乃勤求古训，博采众方，”撰成《伤寒杂病论》16卷，创立了六经辨证之法，奠定了中医辨证论治的基础，从此对传染病的治疗，始有矩矱可寻。《伤寒论》从现在出眼光来看，虽然其中治疫之法很不全面，但它毕竟是我国治疗传染病的最早方书。
稍后，曹植(192—219)亦认疫原为疠气，《曹集诠评》中“建安二十二年，疠气流行，家家有僵尸之痛，室室有号泣之哀，或阖门而殪，或覆族而丧。"这段文字，亦可佐证仲景所说之广义伤寒，是包括了传染病在内。
迄晋，葛洪(281一341)著《肘后方》，书中记载了多种急性传染病，其对症状的描述，亦较为详细。对病因的认识，基本上是继承了“毒疠之气”为病原的说法，但明确提出了“毒有差别，致病各异”，这可以说是吴又可提出鸡瘟病鸡，猪瘟病猪，—病自有一病之毒说的先声。此书不但有传染病大流行情况的记载(“永微四年此疮从西东流遍于海中”，“以死后复传至旁人乃至灭门”)，而且有详细研究，观察沙虱毒传染媒介恙螨的形态，生活习性、传播疾病方式的记载(“已深者，针挑取虫子，正如疥虫，著爪上映光方见行动")，而其中《治瘴气疫疠温毒诸方第十五》一篇，堪推我国最早的防疫专篇。在治疗上，则不独重视清热解毒法，而且大量运用了表里双解法，这对后人处理疫病，也很有影响。由于此书在汜述疫病的防治方面内容较为丰富，故近代医史学家陈邦贤认为；“葛洪在医学上的贡献，一种是对于传染病的认识；一种是炼丹，为制药化学的先驱。"
至隋·巢元方等著《诸病源候论》(610)，称疫病病原为“乖戾之气”，说“人感乖戾之气而生病，则病气转相染易，乃至灭门。”并认为“此皆因岁时不和，温凉不节。”这种认识，与《札记》，《论衡》中有关疫病的记载，是一脉相承的。以后吴又可的戾气说，就是在前人这些说法的基础上提出来的。
南宋时，战争连年，民不能耕，饥馑荏至，《儒门事亲·倜有所遇》篇说：“会兴定岁大饥，遂采百草而食”，当时饿孚遍野，常有传染病流行，张子和(约1156一1228)说当时的疫原是瘴疠，如《疟》篇说：“盖扰攘之时，政令颊乱，徭役纷冗，朝戈暮戟，略无少暇，内火与外火俱动，在侯百官吏尤甚，岂可与夷静之人，同法而治者。余亲见泰和六年丙寅，征南师旅大举，至明年军回，是岁瘴疠杀人，莫知其数。”这似是指恶性疟的大流行。
迄李东垣(1180—1251)，又是一个兵荒马乱的年代，当时，患病者之多，死亡者之众，可谓前所未有，这是有大疫流行厂可以肯定，《内外伤辨惑论·辨阴证阳证篇》说；“向者壬辰改元，京师戒严，迨三月下旬，受乱者凡半月。解围之后，都人不受病者，万无一二，既病而死者，继踵而不绝。都门十有二所，每日各门所送，多者二千，少者不下一千，似此者几三月，此百万人，岂俱感风寒外伤者耶？大抵人在围城中，饮食不节；乃劳役所伤，不待言而知，由其朝饥暮饱，起居不时，寒温失所，动经三两月，胃气亏乏久矣。一旦饱食太过，感而伤人。”东垣对仲景以来，用六气归纳病原，认为病原是伤寒的说法提出了怀疑，但他忽视了王充以来的疫气相污说，他为了强调脾胃虚弱容易罹患疫疾，主张太过，竟把明明属于外感范畴的传染病，说成是内伤病，这在病原问题的认识上，实在是大错而特错。东汉末年及南宋时，战乱纷繁，民不聊生的历史条件和疫病流行情况，大体上差不多。如要说仲景、子和前后的疫病流行都是寒邪、疠气这一类外邪所致，唯东垣时的几百万人同时生病，都是内伤脾胃引起，这是无论如何也说不通的。何妨东垣自己也说“感而伤人”，既是“感而伤人”，病原当然仍是乖戾之气。饮食不节，胃气亏乏，劳役惊扰，起居不时，引起健康水平下降，免疫机制减弱，这不过是致病条件而已，所以，东垣对传染病病原的认识，实在不能与葛洪、王充等前人相比。但由于传染病病原繁多，针对病原寻找特效药，即使在现在，也不是易事。东垣在当时患者机体抗力普遍衰弱的情况下，采用补脾益气之法，以增强正气抗病能力，其治疗手段，却是十分可取的。这种治术，较之杀灭病原无专药而又轻施攻伐，反伤正气的治疗，合理得多，故就治法论，东垣的治疫病法，较之《伤寒论》的治法和刘河间，张子和等人的治法，显是又有了长足的进展。
明末天下大乱，又屡有传染病大流行，《温疫论》自序说：“崇祯辛巳(1641)，疫气流行，山东、浙江、南北二直患者尤多，至五六月益甚，或至阖门传染。”吴又可否定疫病与六气及四时不正之气有关，他认为疫病病原既不是伤寒，也不同于一般之温热，而是一种杂气，又称戾气或异气，他说：“夫瘟疫之为病，非风，非寒，非暑，非湿，乃天地问别有一种异气所感。”吴氏唯真理是尚，敢于非《内经》，疑仲景，斥叔和，在病原问题上，作了前所未有的详细讨论，他不但确认疫原是杂气，而且指出：“天地之杂气，种种不一"，“疫气亦杂气之一种，但有甚于他气，故为病颇重，因名之曰疠气。”(《杂气论》)他在区别戾气致病各有不同的基础上，还对疫病分为常疫与疠疫二种，所谓疠疫，就是诸如“瓜瓤瘟、疙瘩瘟”这一类来势凶猛，“缓者朝发夕死，急者顷刻而亡，此又诸疫之最重者”，“不可以与常疫并论也。”这是将一般传染病与烈性传染病进行区分的最早文献记载，这种分类方法，与我们现在将传染病分成甲类、乙类，大体相同。但杂气之所以造成流行，与五运六气和气候的异常变化关系极大，吴氏忽视了这一点，也是片面的。吴氏说：“草木有野葛巴豆”，“昆虫有毒蛇猛兽”，气变之中，“万物各有善恶不等，是知杂气之毒亦然。”“众人有触之者，各随其气而为病也，或时众人发颐，或时众人头面浮肿，俗称大头瘟是也。”这些议论，如与《论衡》中“天地之间，毒气流行，人当其冲，则面肿疾”等某些文字相比观，简直如出一辙。据此，我们有理由认为：吴氏作论，显然是受了王充等前人论疫思想之影响。
在清·乾隆年问(1792—1793)，云南发生肺鼠疫流行，洪稚存在《江边诗话》中写道：“时赵州(今云南大理附近的凤仪)有怪鼠，白日入家，即伏地而死。人染其气，亦无不殒者。”据此，鼠类在传播鼠疫中的作用，已为人们所认识，到道光年间(1820—1850)，汪期莲在《瘟疫汇编》中说：“忆昔年入夏，瘟疫大行，有红头青蝇千百为群，凡入人家，必有患瘟而亡者。”据此，苍蝇在传播疫病中的媒介作用，亦为人们所认识。
清·民以还，解放之前，仅上海在50年内，就发生了12次霍乱大流行；鼠疫在1910、1920、1947年三次在东北流行，死亡人数达10万人，此外，血吸虫病，天花、黑热病，伤寒、疟疾等传染病，亦均大肆泛滥。祝味菊(1885—1951)面对一国之内，六气偏胜甚大，而某些传染病，往往不旋踵即纵横南北，且病型相同之客观事实，认为用六气归纳外感病因，无法作出合理的解释，乃融会新知，参西说中，提出了“病原无寒邪温邪之分，但有无机有机之别"的新说法。视氏的病原论认为；传染病一般以“有形有机之邪为主因，无形无机之邪为诱因，彼二邪，每狼狈为奸，伺人于不察也”(《伤寒质难》)。祝氏不排除六气在传染病发生、流行过程中的影响，也把机体抗邪能力下降等因素考虑在内，其对疫病病因病理的解释，融贯中西，立论比较完善，它较之吴又可的杂气论和前人的各种论述，就沟通中西医来说，是更为接近了。惜发掘这份珍贵的遗产，尚未引起应有的重视，故甚连祝氏其人，就较为年轻的中医来说，迄今尚知之者不多。
综上所述，前人对传染病病原虽有毒气，疠气，伤寒、戾气，异气等种种称呼，但基本上都认为这是一种具有传染特性的外邪，故张锡纯说：“疫者，感岁运之戾气，因其岁运失和，中含毒气，人触之即病。”唯其如此，故就预防来说，增强体质与注意避邪，二不可废，就治疗来说，扶益正气与攻击病原，俱应重视。故李东垣健脾益气的治法，祝味菊匡扶正气的主张，在缺乏专病专药的情况下，是很为可取的。如忽视及此，而过于强调外感当攻，也就不无其片面性。从原则上来说，如治病救人则用药要猛要重，取其专而有力，截断逆转，要寻求针对性的特效药，如发觉专药，只要不会伤人，就应当机立断，予以大剂，直接杀灭驱逐病原。如无特效专药，采用治人却病法，则用药要稳要轻，协助自然疗能，务使正气得到扶持，要促使自调自控机能的恢复和加强，只要邪气有去路，体力能支持，不妨期待，使其自衰。如果不知从上述二方面权衡出入，但知按证下药，轻描淡写，就不免疲药塞职之诮。
参考文献
①、②林乾良，医学文字源流论(一)，(内部资料)2003-9-1422:24:59北海散人头衔：佛门弟子等级：管理员文章：3797积分：4270注册：2002-12-24
第3楼非湿黄疸论
时医咸谓“无湿不成疸”，而余独有燥疸非湿之论。有闻而诮之者曰：《内经》云：“湿热相交，民当病瘅。”《金匮》云：“黄家所得，从湿得之。”《丹溪心法》、《金匮钩玄》俱谓黄疸“病虽有五，皆湿热也。”此系秉之经旨。子责其非，竟作燥疽非湿之论，悖经违俗，请问何据？
余曰：尝览仲景之治疸，于脉证，有八纲之辨而燥湿未尝不分；于治法，有润利之殊而八法未曾偏废。若拘泥于论湿之文，而不知有燥淤诸疽之证治，是一叶障目，有昧仲师之活法。而内经民当病瘅之瘅，原指热病，非指黄疸，引瘅证疸，系后人之误解。至丹溪所云，仅言其常，景岳尝驳之矣！黄宫绣谓“如苗值于大早，则苗必燥而黄，是苗因燥而黄者也；太涝则苗必湿而黄，是苗因湿而黄者也”(《本草求真·茵陈条》)，此诫乃说明仲景学说之极好比喻，
有鉴于前人论燥淤诸黄者虽多，但迄无非湿黄疸之专文，故现以燥淤黄疸为主，专论非湿黄疸诸证，为谓“黄疸无湿不成”者之棒喝。
热燥黄疸
东汉初年，常有疫病流行。但由于当时“天人感应论”泛滥，人们认为这是疫鬼所致，从而形成了一种“岁末驱疫”的风俗。对此，王充（27—97）进行了严厉驳斥。王充认为，所谓的疫鬼，实际上是一种“使人多数死亡”的毒烈之气。由于“气受困则生热”，“热极则为毒”（《论衡·言毒篇》），“毒象兵器一样伤人，一旦中人，人就会死亡”（《订鬼篇》）。这是用唯物主义观点解释病原并批驳谶纬迷信活动的最早文字记载，对后世影响极大。王充认为气有调和与不调和之分，不调和之气统称为邪气，邪气除了毒气能流行外，还有疫疠之气和腐臭之气等区别（这可以说是对传染病病原分类的萌芽），其中疫疠之气是一种极易传染、危害性很大的邪气，而其流行往往发生在饥荒之年，如《命义篇》所说：“饥荒之年，饿殍遍野，温热之气与疫疠之气盛行，千户人家灭门。”这些认识，比笼统地将病原称为毒气，可以说是前进了一步。王充还以“草木之中，有巴豆、野葛，食用后导致腹部胀满，多致人死亡”、“蜘蛛结网，飞虫经过，有的逃脱，有的被捕”等作比喻，认为“灾气加于人，也属于此类。不幸遭遇而死的，侥幸避开而活的”（《幸偶篇》）。从而强调了避免接触病原的重要性。此外，王充还认识到传染病可以通过“气相污染”而传播，他认为“死者累累，葬棺多达十具，不说是气相污染，而说葬日凶险”（《辨祟篇》），这是很愚蠢的。总之，从《论衡》来看，王充对传染病的认识非常深刻，其医学思想对后世影响不小，但由于他不是医家，《论衡》又非医学著作，故尚为人们所忽视，实则此书很值得引起研究中医者的重视。汉代刘熙的《释名》中记载：“注病，一人死，一人复得，气相灌注也。”其说法与王充的“气相污”说相一致。这都说明，我国早在3—4世纪时，就已知道某些传染病是通过空气而传播的。
东汉末年，战乱频繁，而“大兵之后必有大疫”。从《伤寒论·序》中：“我的宗族原本人口众多，自建安纪元以来，还不到十年，其中死亡的占三分之二，伤寒占了十分之七。”这段文字来看，显然也是有传染病流行，但张仲景（150—219）以六气归纳病原，故称之为伤寒。张仲景“感念往昔宗族的沦丧，哀叹夭折横死无法挽救，于是勤奋探求古训，广泛采集各方药方”，撰成《伤寒杂病论》16卷，创立了六经辨证之法，奠定了中医辨证论治的基础，从此对传染病的治疗，始有规矩法度可循。《伤寒论》从现在的眼光来看，虽然其中治疫之法很不全面，但它毕竟是我国治疗传染病的最早方书。
稍后，曹植（192—219）也认为疫原为疠气，《曹集诠评》中记载：“建安二十二年，疠气流行，家家有僵尸之痛，室室有号泣之哀，或阖门而死，或覆族而丧。”这段文字，亦可佐证张仲景所说的广义伤寒，是包括了传染病在内。
到了晋代，葛洪（281—341）著《肘后方》，书中记载了多种急性传染病，其对症状的描述，亦较为详细。对病因的认识，基本上是继承了“毒疠之气”为病原的说法，但明确提出了“毒有差别，致病各异”，这可以说是吴又可提出鸡瘟病鸡、猪瘟病猪、一病自有一病之毒说的先声。此书不但有传染病大流行情况的记载（“永徽四年此疮从西向东流遍于海中”，“以死后复传至旁人乃至灭门”），而且有详细研究，观察沙虱毒传染媒介恙螨的形态、生活习性、传播疾病方式的记载（“已深者，针挑取虫子，正如疥虫，著爪上映光方见行动”），而其中《治瘴气疫疠温毒诸方第十五》一篇，堪推我国最早的防疫专篇。在治疗上，则不独重视清热解毒法，而且大量运用了表里双解法，这对后人处理疫病，也很有影响。由于此书在泛述疫病的防治方面内容较为丰富，故近代医史学家陈邦贤认为：“葛洪在医学上的贡献，一种是对于传染病的认识；一种是炼丹，为制药化学的先驱。”
到了隋代，巢元方等著《诸病源候论》（610年），称疫病病原为“乖戾之气”，说“人感乖戾之气而生病，则病气转相染易，乃至灭门。”并认为“此皆因岁时不和，温凉不节。”这种认识，与《礼记》、《论衡》中有关疫病的记载，是一脉相承的。以后吴又可的戾气说，就是在前人这些说法的基础上提出来的。
南宋时期，战争连年，民不能耕，饥馑接踵而至，《儒门事亲·倜有所遇》篇说：“适逢兴定年间大饥荒，于是采百草而食”，当时饿殍遍野，常有传染病流行，张子和（约1156—1228）说当时的疫原是瘴疠，如《疟》篇说：“大概是在动荡之时，政令烦乱，徭役纷冗，朝戈暮戟，略无少暇，内火与外火俱动，在侯百官吏尤甚，岂可与夷静之人，同法而治者。我亲眼见到泰和六年丙寅年，征南师旅大举出动，到第二年军队回返，这一年瘴疠杀人，莫知其数。”这似是指恶性疟的大流行。
到了李东垣（1180—1251），又是一个兵荒马乱的年代，当时，患病者之多，死亡者之众，可谓前所未有，这是有大疫流行可以肯定，《内外伤辨惑论·辨阴证阳证篇》说：“先前壬辰改元，京师戒严，等到三月下旬，遭受动乱凡半月。解围之后，都城中不受病的人，万无一二，既病而死者，继踵而不绝。都门十二所，每日各门所送，多者二千，少者不下一千，似此者几三月，这百万人，难道都是感受风寒外伤吗？大抵人在围城中，饮食不节，乃劳役所伤，不待言而知，由其朝饥暮饱，起居不时，寒温失所，动经三两月，胃气亏乏久矣。一旦饱食太过，感而伤人。”李东垣对张仲景以来，用六气归纳病原，认为病原是伤寒的说法提出了怀疑，但他忽视了王充以来的疫气相污说，他为了强调脾胃虚弱容易罹患疫疾，主张太过，竟把明明属于外感范畴的传染病，说成是内伤病，这在病原问题的认识上，实在是大错而特错。东汉末年及南宋时，战乱纷繁，民不聊生的历史条件和疫病流行情况，大体上差不多。如要说张仲景、张子和前后的疫病流行都是寒邪、疠气这一类外邪所致，唯李东垣时的几百万人同时生病，都是内伤脾胃引起，这是无论如何也说不通的。何况李东垣自己也说“感而伤人”，既是“感而伤人”，病原当然仍是乖戾之气。饮食不节，胃气亏乏，劳役惊扰，起居不时，引起健康水平下降，免疫机制减弱，这不过是致病条件而已，所以，李东垣对传染病病原的认识，实在不能与葛洪、王充等前人相比。但由于传染病病原繁多，针对病原寻找特效药，即使在现在，也不是易事。李东垣在当时患者机体抗力普遍衰弱的情况下，采用补脾益气之法，以增强正气抗病能力，其治疗手段，却是十分可取的。这种治术，较之杀灭病原无专药而又轻施攻伐，反伤正气的治疗，合理得多，故就治法论，李东垣的治疫病法，较之《伤寒论》的治法和刘河间、张子和等人的治法，显是又有了长足的进展。
明末天下大乱，又屡有传染病大流行，《温疫论》自序说：“崇祯辛巳（1641年），疫气流行，山东、浙江、南北二直患者尤多，至五六月益甚，或至阖门传染。”吴又可否定疫病与六气及四时不正之气有关，他认为疫病病原既不是伤寒，也不同于一般之温热，而是一种杂气，又称戾气或异气，他说：“夫瘟疫之为病，非风，非寒，非暑，非湿，乃天地间别有一种异气所感。”吴氏唯真理是尚，敢于非《内经》，疑仲景，斥叔和，在病原问题上，作了前所未有的详细讨论，他不但确认疫原是杂气，而且指出：“天地之杂气，种种不一”，“疫气亦杂气之一种，但有甚于他气，故为病颇重，因名之曰疠气。”（《杂气论》）他在区别戾气致病各有不同的基础上，还对疫病分为常疫与疠疫二种，所谓疠疫，就是诸如“瓜瓤瘟、疙瘩瘟”这一类来势凶猛，“缓者朝发夕死，急者顷刻而亡，此又诸疫之最重者”，“不可以与常疫并论也。”这是将一般传染病与烈性传染病进行区分的最早文献记载，这种分类方法，与我们现在将传染病分成甲类、乙类，大体相同。但杂气之所以造成流行，与五运六气和气候的异常变化关系极大，吴氏忽视了这一点，也是片面的。吴氏说：“草木有野葛巴豆”，“昆虫有毒蛇猛兽”，气变之中，“万物各有善恶不等，是知杂气之毒亦然。”“众人有触之者，各随其气而为病也，或时众人发颐，或时众人头面浮肿，俗称大头瘟是也。”这些议论，如与《论衡》中“天地之间，毒气流行，人当其冲，则面肿疾”等某些文字相比观，简直如出一辙。据此，我们有理由认为：吴氏作论，显然是受了王充等前人论疫思想之影响。
在清乾隆年间（1792—1793年），云南发生肺鼠疫流行，洪稚存在《江边诗话》中写道：“当时赵州（今云南大理附近的凤仪）有怪鼠，白日入家，即伏地而死。人染其气，亦无不殒者。”据此，鼠类在传播鼠疫中的作用，已为人们所认识，到道光年间（1820—1850年），汪期莲在《瘟疫汇编》中说：“忆昔年入夏，瘟疫大行，有红头青蝇千百为群，凡入人家，必有患瘟而亡者。”据此，苍蝇在传播疫病中的媒介作用，亦为人们所认识。
清末民初，解放之前，仅上海在50年内，就发生了12次霍乱大流行；鼠疫在1910、1920、1947年三次在东北流行，死亡人数达10万人，此外，血吸虫病、天花、黑热病、伤寒、疟疾等传染病，亦均大肆泛滥。祝味菊（1885—1951）面对一国之内，六气偏胜甚大，而某些传染病，往往不旋踵即纵横南北，且病型相同之客观事实，认为用六气归纳外感病因，无法作出合理的解释，乃融会新知，参西说中，提出了“病原无寒邪温邪之分，但有无机有机之别”的新说法。祝氏的病原论认为：传染病一般以“有形有机之邪为主因，无形无机之邪为诱因，彼二邪，每狼狈为奸，伺人于不察也”（《伤寒质难》）。祝氏不排除六气在传染病发生、流行过程中的影响，也把机体抗邪能力下降等因素考虑在内，其对疫病病因病理的解释，融贯中西，立论比较完善，它较之吴又可的杂气论和前人的各种论述，就沟通中西医来说，是更为接近了。惜发掘这份珍贵的遗产，尚未引起应有的重视，故甚至连祝氏其人，就较为年轻的中医来说，迄今尚知之者不多。
综上所述，前人对传染病病原虽有毒气、疠气、伤寒、戾气、异气等种种称呼，但基本上都认为这是一种具有传染特性的外邪，故张锡纯说：“疫者，感岁运之戾气，因其岁运失和，中含毒气，人触之即病。”唯其如此，故就预防来说，增强体质与注意避邪，二者不可废，就治疗来说，扶益正气与攻击病原，俱应重视。故李东垣健脾益气的治法，祝味菊匡扶正气的主张，在缺乏专病专药的情况下，是很为可取的。如忽视及此，而过于强调外感当攻，也就不无其片面性。从原则上来说，如治病救人则用药要猛要重，取其专而有力，截断逆转，要寻求针对性的特效药，如发觉专药，只要不会伤人，就应当机立断，予以大剂，直接杀灭驱逐病原。如无特效专药，采用治人却病法，则用药要稳要轻，协助自然疗能，务使正气得到扶持，要促使自调自控机能的恢复和加强，只要邪气有去路，体力能支持，不妨期待，使其自衰。如果不知从上述二方面权衡出入，但知按证下药，轻描淡写，就不免疲药塞职之诮。
参考文献
①、②林乾良，医学文字源流论(一)，(内部资料)2003-9-14 22:24:59北海散人头衔：佛门弟子等级：管理员文章：3797积分：4270注册：2002-12-24
第3楼非湿黄疸论
当代医生都说“无湿不成疸”，而我独有燥疸非湿之论。有听到后讥笑我的人说：《内经》云：“湿热相交，民当病瘅。”《金匮》云：“黄家所得，从湿得之。”《丹溪心法》、《金匮钩玄》俱谓黄疸“病虽有五，皆湿热也。”此系秉承之经旨。你指责其非，竟作燥疽非湿之论，悖经违俗，请问何据？
我说：曾经阅览张仲景之治疸，于脉证，有八纲之辨而燥湿未尝不分；于治法，有润利之殊而八法未曾偏废。若拘泥于论湿之文，而不知有燥淤诸疽之证治，是一叶障目，有昧仲师之活法。而内经民当病瘅之瘅，原指热病，非指黄疸，引瘅证疸，系后人之误解。至丹溪所云，仅言其常，景岳尝驳之矣！黄宫绣谓“如苗值于大旱，则苗必燥而黄，是苗因燥而黄者也；太涝则苗必湿而黄，是苗因湿而黄者也”（《本草求真·茵陈条》），此诚乃说明仲景学说之极好比喻，
有鉴于前人论燥淤诸黄者虽多，但迄无非湿黄疸之专文，故现以燥淤黄疸为主，专论非湿黄疸诸证，为谓“黄疸无湿不成”者之棒喝。
热燥黄疸
In the early Eastern Han Dynasty, epidemics often prevailed. However, due to the prevalence of the theory of "interaction between heaven and humanity" at that time, people believed this was caused by epidemic ghosts, thus forming a custom of "driving away evil spirits at the end of the year." Wang Chong (27–97) refuted this vehemently. Wang Chong believed that so-called epidemic ghosts were actually a toxic and fierce Qi (vital energy/pathogenic factor) that "caused many deaths among those infected." Since "Qi becomes constrained and generates heat," and "extreme heat becomes toxicity" (*Lunheng · Yan Du*), "toxicity attacks humans like weapons; once it strikes a person, they die" (*Ding Gui*). This is the earliest written record explaining pathogens from a materialistic viewpoint and refuting superstitious activities related to omens and prophecies, having a profound impact on later generations. Wang Chong believed that Qi could be harmonious or disharmonious; disharmonious Qi is collectively called Xie (pathogenic factors). Besides toxic Qi that can spread, there are also epidemic Li Qi (pestilential Qi) and foul-smelling Qi, etc. (this can be said to be the embryonic stage of classifying infectious disease pathogens). Among them, epidemic Li Qi is a pathogenic factor that is highly contagious and extremely harmful, and its outbreaks often occurred in years of famine. As stated in *Ming Yi Pian*: "In years of famine, the roads are filled with the starving, warm Qi and epidemic Li Qi prevail, wiping out families of thousands." These understandings represented progress compared to the vague attribution of pathogens solely to toxic Qi. Wang Chong used metaphors such as "among plants, there are Croton seed (Badou) and wild Gelsemium (Yege); ingestion causes abdominal fullness and often death," and "spiders spin webs; flying insects pass through, some escape, some are caught," believing that "disaster Qi affecting humans is similar. Those unfortunate enough to encounter it die; those fortunate enough escape and live" (*Xing Ou Pian*). This emphasized the importance of avoiding contact with pathogens. Furthermore, Wang Chong recognized that infectious diseases could spread through "contamination of Qi." He criticized the view that "bodies lie piled up, coffins number in tens, yet people do not say it is contamination of Qi but rather claim the burial date is unlucky" (*Bian Sui Pian*) as foolish. In summary, based on *Lunheng*, Wang Chong's understanding of infectious diseases was profound, and his medical thoughts had a significant impact on later generations. However, since he was not a physician and *Lunheng* was not a medical text, his work was overlooked. It deserves serious attention from researchers of Traditional Chinese Medicine (TCM). Liu Xi's *Shiming* in the Han Dynasty states: "Zhu Bing (infectious disease transmitted by contact/air), when one dies, another gets it, due to the infusion of Qi." This aligns with Wang Chong's theory of "contamination of Qi." This indicates that China already knew as early as the 3rd–4th centuries that certain infectious diseases were transmitted via air.
At the end of the Eastern Han Dynasty, warfare was frequent, and "after great wars, great epidemics must follow." From the Preface to *Shanghan Lun*: "My clan originally had many members. Since the Jian'an era began, less than ten years have passed, yet two-thirds have died, seven-tenths of whom suffered from Shanghan (Cold Damage)." This clearly indicates an epidemic outbreak. Zhang Zhongjing (150–219) categorized pathogens using the Six Qi (Six Excesses), hence naming it Shanghan. Moved by the loss of his clan and lamenting the untimely deaths that could not be saved, he diligently sought ancient teachings and collected various prescriptions, compiling the *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases) in 16 volumes. He established the method of Six Meridian Syndrome Differentiation, laying the foundation for TCM syndrome differentiation and treatment. From then on, the treatment of infectious diseases had standards to follow. Although viewed from a modern perspective, the methods for treating epidemics in *Shanghan Lun* are not comprehensive, it remains China's earliest prescription book for treating infectious diseases.
Later, Cao Zhi (192–219) also identified the source of epidemics as Li Qi (pestilential Qi). The *Cao Ji Quanping* records: "In the 22nd year of Jian'an, Li Qi prevailed. Every home mourned the dead, every room echoed with weeping. Some entire families perished, some whole clans were wiped out." This text corroborates that Zhang Zhongjing's broad concept of Shanghan included infectious diseases.
By the Jin Dynasty, Ge Hong (281–341) wrote *Zhouhou Beiji Fang* (Handbook of Prescriptions for Emergencies), which recorded various acute infectious diseases with relatively detailed symptom descriptions. His understanding of etiology basically inherited the idea that "toxic Li Qi" was the pathogen, but he explicitly proposed "toxins differ, causing different diseases." This can be seen as a precursor to Wu Youke's later theory that chicken plague affects chickens, swine plague affects pigs, and each disease has its own specific toxin. This book not only recorded large-scale epidemic situations ("In the 4th year of Yonghui, this sore spread from west to east across the seas," "transmitted from the dead to others, even wiping out families") but also included detailed studies observing the morphology, habits, and transmission modes of chiggers (the vector for sandfly fever/spotted fever group rickettsioses) carrying Sha Shi Du (sandfly poison) ("If deep, pick out the insect with a needle, just like scabies mites; attach to the fingernail and hold up to light to see movement"). The chapter "Formulas for Treating Miasma, Epidemic Pestilence, Warm Toxins, etc., Chapter 15" is considered China's earliest specialized section on epidemic prevention. In treatment, it not only valued clearing heat and detoxifying methods but also extensively applied methods for resolving both exterior and interior syndromes simultaneously, significantly influencing later practitioners in handling epidemics. Due to its rich content on the prevention and treatment of epidemics, modern medical historian Chen Bangxian believed: "Ge Hong's contribution to medicine lies in two aspects: one is the understanding of infectious diseases; the other is alchemy, acting as a pioneer in pharmaceutical chemistry."
During the Sui Dynasty, Chao Yuanfang et al. authored *Zhubing Yuanhou Lun* (General Treatise on the Origins and Symptoms of All Diseases, 610 AD), referring to epidemic pathogens as "Guai Li Qi" (aberrant pestilential Qi), stating, "When humans contract Guai Li Qi and become ill, the disease Qi transmits from person to person, even wiping out families." They believed, "This is all due to the disarray of seasons and improper regulation of warmth and coolness." This understanding was consistent with records in *Liji* (Book of Rites) and *Lunheng*. Later, Wu Youke's theory of Li Qi was built upon these previous theories.
During the Southern Song Dynasty, continuous wars prevented farming, leading to successive famines. The *Rumen Shiqin · Ti You Suo Yu* chapter states: "During the Xingding year, a great famine struck, forcing people to eat hundred herbs." With corpses filling the fields, infectious diseases often prevailed. Zhang Hezi (c. 1156–1228) stated that the epidemic source at that time was Zhang Li (miasma pestilence). In the *Nue* (Malaria) chapter, he said: "Generally, during chaotic times, government orders were confused, corvée labor was burdensome, weapons clashed day and night, leaving no rest. Internal fire and external fire moved together, especially among officials. How could they be treated with the same methods as peaceful people? I personally witnessed the Bingyin year of Taihe 6. When the southern expeditionary army mobilized massively, and returned the following year, Zhang Li killed countless people that year." This likely refers to a major outbreak of malignant malaria.
By the time of Li Dongyuan (1180–1251), it was another era of war and chaos. The number of patients and deaths was unprecedented, confirming a major epidemic. The *Nei Wai Shang Bian Huo Lun · Bian Yin Zheng Yang Zheng Pian* states: "Previously, when Renchen changed eras, the capital declared martial law. By late March, we endured turmoil for half a month. After the siege was lifted, fewer than one in ten thousand in the city avoided illness. Those who fell ill and died followed one after another. At the twelve gates of the capital, daily deliveries ranged from over two thousand to at least one thousand per gate. For nearly three months, millions of people... could they all have contracted external Wind-Cold? Essentially, people within the besieged city suffered from irregular diet and physical exhaustion. Morning hunger and evening gluttony, irregular living habits, and exposure to inappropriate temperatures persisted for months, depleting Stomach Qi long ago. Once overeating occurred, the pathogen attacked the body." Li Dongyuan questioned the traditional view since Zhang Zhongjing of categorizing pathogens via Six Qi as Shanghan. However, he ignored Wang Chong's theory of contaminating Qi. Emphasizing that Spleen-Stomach deficiency makes one susceptible to epidemics, he went too far, misclassifying infectious diseases (which belong to external contraction) as internal injury diseases. This was a major error in understanding pathogens. The historical conditions of war and suffering in the late Eastern Han and Southern Song were similar. If one argues that epidemics before Zhang Zhongjing and Zhang Hezi were caused by external pathogens like Cold Evil or Li Qi, it is illogical to claim that the millions sick during Li Dongyuan's time were caused solely by internal Spleen-Stomach injury. Moreover, Li Dongyuan himself said "the pathogen attacks the body"; if it is "attacking," the pathogen is still Guai Li Qi. Irregular diet, depleted Stomach Qi, physical exhaustion, and irregular living habits lowered health levels and weakened immune mechanisms, serving merely as predisposing conditions. Thus, Li Dongyuan's understanding of infectious disease pathogens cannot compare to predecessors like Ge Hong and Wang Chong. However, given the diversity of pathogens and the difficulty in finding specific effective drugs even today, Li Dongyuan's use of Spleen-tonifying and Qi-supplementing methods to enhance Zheng Qi (healthy Qi) resistance under conditions of widespread physiological weakness was highly commendable. This therapeutic approach was more reasonable than attacking pathogens without specific drugs, which often damaged Zheng Qi. Therefore, regarding therapy, Li Dongyuan's methods showed significant progress compared to those in *Shanghan Lun* and those of Liu Wanhe and Zhang Hezi.
At the end of the Ming Dynasty, amidst chaos and recurrent epidemics, the Preface to *Wenyi Lun* states: "In Xin Si of Chongzhen (1641), epidemic Qi prevailed, especially in Shandong, Zhejiang, and the Two Direct-administered Regions. It worsened in May and June, sometimes infecting entire households." Wu Youke denied the connection between epidemics and Six Qi or abnormal seasonal Qi. He believed epidemic pathogens were neither Shanghan nor typical Warm diseases, but a type of Za Qi (miscellaneous Qi), also called Li Qi or Yi Qi. He stated: "Epidemic plague is not Wind, not Cold, not Summerheat, not Dampness, but is caused by a distinct Yi Qi in heaven and earth." Wu prioritized truth, daring to critique *Neijing*, doubt Zhang Zhongjing, and rebuke Wang Shuhe. He discussed etiology in unprecedented detail, confirming the epidemic source as Za Qi, and pointed out: "The Za Qi of heaven and earth is diverse," "Epidemic Qi is a type of Za Qi, but more severe than other Qi, causing heavier disease, hence named Li Qi" (*Za Qi Lun*). Based on the principle that Li Qi causes different diseases differently, he divided epidemics into Chang Yi (common epidemics) and Li Yi (pestilential epidemics). Li Yi referred to aggressive diseases like "Melon Pulp Plague" and "Glandular Plague," where "slow cases die by evening after morning onset, rapid cases die instantly; these are the most severe of all epidemics" and "cannot be discussed alongside common epidemics." This is the earliest literature distinguishing general infectious diseases from lethal ones, similar to modern Class A and B classifications. However, Wu ignored the significant role of Five Movements and Six Qi and abnormal climate changes in the spread of Za Qi, which was one-sided. Wu stated: "Plants include wild Gelsemium and Croton," "insects include venomous snakes and fierce beasts." Amidst Qi changes, "all things vary in good and evil, knowing that the toxicity of Za Qi is likewise." "Those who touch it fall ill according to the specific Qi. Sometimes everyone develops parotitis, sometimes facial swelling, commonly known as Big Head Plague." These arguments closely resemble passages in *Lunheng* like "Toxic Qi prevails in the world; those hit by it suffer facial swelling." Thus, we have reason to believe Wu's theories were influenced by Wang Chong and others.
During the Qianlong reign of the Qing Dynasty (1792–1793), a pneumonic plague outbreak occurred in Yunnan. Hong Zhicun wrote in *Jiangbian Shihua*: "At that time, strange rats appeared in Zhaozhou (near Fengyi, Dali, Yunnan), entering homes by day and dying on the floor. Humans contracting their Qi also invariably died." This shows the role of rodents in transmitting plague was recognized. By the Daoguang era (1820–1850), Wang Qilian in *Wenyi Huibian* recalled: "Remembering past summers, plague ran rampant. Red-headed houseflies gathered in thousands. Whenever they entered homes, someone would die of plague." This indicated the recognition of flies as vectors for epidemic transmission.
From the late Qing to pre-liberation periods, Shanghai alone experienced 12 cholera pandemics in 50 years. Plague erupted three times in Northeast China (1910, 1920, 1947), killing 100,000. Additionally, schistosomiasis, smallpox, kala-azar, typhoid, and malaria proliferated. Zhu Weiju (1885–1951), facing the fact that within one country, Six Qi imbalances were severe, yet certain infectious diseases spread rapidly north and south with identical clinical patterns, argued that categorizing external pathogenic causes via Six Qi could not provide a reasonable explanation. Integrating new knowledge and Western theories, he proposed a new view: "Pathogens have no distinction between Cold and Warm evils, only inorganic and organic differences." Zhu's pathogen theory held: "Infectious diseases generally take 'tangible organic pathogens' as the primary cause and 'intangible inorganic pathogens' as inducing factors; these two evils collude, waiting for human negligence" (*Shanghan Zhinan*). Zhu did not exclude the influence of Six Qi in the occurrence and spread of infectious diseases, nor did he ignore factors like decreased host resistance. His explanation of epidemic etiology and pathology integrated Chinese and Western medicine, offering a more complete theoretical stance. Compared to Wu Youke's Za Qi theory and previous discussions, it was closer to bridging Chinese and Western medicine. Regrettably, this precious heritage has not received due attention; even Zhu's name is unknown to many younger TCM practitioners.
In summary, although predecessors used various terms for infectious disease pathogens such as Toxic Qi, Li Qi, Shanghan, Li Qi, and Yi Qi, they essentially regarded them as external pathogens with contagious characteristics. Thus, Zhang Xichun said: "Epidemics result from contracting aberrant Qi of the annual cycle; due to the disharmony of the annual cycle containing toxic Qi, touching it causes immediate illness." Therefore, in prevention, strengthening constitution and avoiding pathogens are indispensable. In treatment, supporting Zheng Qi and attacking pathogens should both be valued. Thus, Li Dongyuan's Spleen-tonifying and Qi-supplementing methods and Zhu Weiju's advocacy of supporting Zheng Qi are highly commendable in the absence of specific anti-epidemic drugs. Ignoring this and overly emphasizing attack for external contractions is one-sided. In principle, for saving lives, medication should be potent and heavy, targeting specificity and strength to intercept and reverse the disease process, seeking targeted specific drugs. If a specific drug is found, provided it does not harm the patient, decisive large doses should be administered directly to kill and expel the pathogen. Without specific drugs, adopting a "treating the person to cure the disease" approach requires steady and mild medication, assisting natural healing powers, supporting Zheng Qi, and promoting the recovery of self-regulatory mechanisms. As long as the pathogen has an exit route and physical strength supports it, one may wait for spontaneous decline. Failing to weigh these two aspects and merely prescribing lightly based on symptoms leads to criticism of ineffective treatment.
References
①, ② Lin Qianliang, *Medical Textual Origins Study (Part 1)*, (Internal Material) 2003-9-14 22:24:59 Beihai Sanren Title: Buddhist Disciple Rank: Administrator Articles: 3797 Points: 4270 Registered: 2002-12-24
Post 3: Non-Dampness Jaundice Theory
Contemporary physicians all assert "no dampness, no jaundice," whereas I alone propose the theory of Dry Jaundice unrelated to dampness. Some mocked me, saying: *Neijing* states, "When dampness and heat interact, the people will suffer from Dan [fever/jaundice]." *Jinkui Yaolue* states, "Jaundice arises from dampness." *Danxi Xinfa* and *Jinkui Gouxuan* both state that although jaundice has five types, all are due to damp-heat. This follows the canonical principles. You criticize this, proposing Dry Jaundice is not dampness, contradicting classics and customs. What is your evidence?
I say: I have reviewed Zhang Zhongjing's treatment of jaundice. Regarding pulse and signs, there is differentiation by Eight Principles, separating dry and damp; regarding treatment methods, there are moistening and draining distinctions, yet the Eight Methods are never abandoned. If one sticks rigidly to texts discussing dampness and ignores the diagnosis and treatment of dry stasis jaundices, it is like being blinded by a leaf, missing the flexible methods of Master Zhongjing. The "Dan" in *Neijing*'s "people will suffer from Dan" originally referred to febrile diseases, not jaundice; linking Dan to Jaundice is a later misunderstanding. Danxi's statement only describes the norm; Jingyue has refuted this! Huang Gongxiu stated, "Like seedlings in drought, they become dry and yellow, meaning seedlings turn yellow due to dryness; in floods, they become wet and yellow, meaning seedlings turn yellow due to dampness" (*Bencao Qiuyi · Yinchen Section*). This is an excellent metaphor illustrating Zhongjing's theory.
Given that while many predecessors discussed dry stasis jaundices, none wrote specifically on non-dampness jaundice, I now focus on dry stasis jaundice, specifically discussing non-dampness jaundice syndromes, to deliver a wake-up call to those claiming "jaundice cannot exist without dampness."
Heat-Dry Jaundice