结语：治燥大法，诚如前人云：“上燥治气，下燥治血。”气谓津气，补津气可用北沙参、麦冬、五味子之类；血谓精血，滋精血可用当归、地黄、苁蓉之属。而“燥者润之”一语，总不失为治燥之大法。今鞠通冶燥，于此略之，于苦热刚燥峻下诸法独详之，则索隐行怪，流入异端矣！故余谓中燥门诸案及《补秋燥胜气论》后诸条，实不足为后人法。
卷四抨叶医论选辑
叶先生临证指南卷五，以风寒分门，而寒门所有者六方，并非伤寒大证，即在太阳一经，亦仅言其至小，此书行后，遂不闻以伤寒论治病，今之置寒水六气于不讲者，大抵即由于此，而伤寒论中之细微曲折，亦更无能道其片语者矣。乃有门人华玉堂者，于此一门后，大放厥词，谓人但拘仲景之法，皆为见闻不广，胶柱鼓瑟，不知变通，以明仲景之不足法，而以此六方为治伤寒之一大宗。徐灵胎曰：此即俗名着寒之病，偶尔小恙，不入经络者也，何必牵引伤寒大证，发诸议论，及细阅此篇，竟无伤寒之门，即此为伤寒之法，不禁失笑，夫医者之学问，全在明伤寒之理，则万病皆通，故伤寒为病中第一证，而学医者之第一功夫也，此编独阙此一门，则平日所习何书，所治何病，此非此老之过，抑编此书者，胸中茫无定见矣。灵胎说如此，尚不知此案与此药，亦未必定出自先生也，昔梁苣林中丞浪迹丛谈，载叶先生轶事一则，为龙虎山张真人在吴，于万年桥停舆，让桥下天医星过去，而是日是的，不先不后，天士小舟适从桥下摇橹行来，中丞于此，不溢一词，而其下即引纪文达语，谓天士不事著述，今所有医案十卷，为门人取其治验，附以论断，非天士本意也，石琢堂殿撰，亦谓先生少所著作，指南一编，冗杂不足以传，乃先生弃世后，门下学者，荟萃而成，其方不尽出先生之手，然则此书，明是及门假托，为一时渔利之物，奇在所作医案，每以不了语气，及上下文不联属，又每以也字易矣字，谓是其师汉魏文章，然号无害于病者，若此伤寒一门，则俗医正怕读伤寒书，正谓伤寒方难用，遂若照此六方，法已大备，更不必问途于仲景，而又因此作江南无伤寒之说，非皆不辨真赝而徒震其名之害耶，呜呼！自有李士材医宗必读，而世不知有血证，白有此临证指南，而世不知有伤寒，叶先生为吾苏大医，享盛名于雍乾时，必不至此，彼华玉堂邵新甫辈，造此大孽，且坏先生生后名，安得不为先生一雪此愤哉！(《世补斋医书》)
柴按：考《临证指南》寒门治案，是普通感冒类病之辨证属寒者，叶氏用辛温解表、宣肺化痰类药治疗，治未尝误。感冒又称伤风，乃轻浅小病，陆九芝谓不传经。汪琥认为与《伤寒论》中之伤寒、中风不同。然华岫云辈“牵引伤寒大证，大发议论”，又无的放矢，曰“拘仲景之法而施治，此乃见闻不广。”这在医界竟谓学《伤寒论》是学屠龙之技的历史条件下，极易使人误以为“照此六方，法已大备，更不必问途于仲景”，故陆氏特作此论以针砭时弊，这对发扬仲景学说，是具有积极意义的。
论临证指南温热门席姓七案
席姓脉左数，右缓弱（此为温热病脉）阳根未固（温热与阳根无涉，）阴液渐涸（阳邪之甚，）舌赤微渴（亦阳邪也）喘促，自利溲数（三焦大热）晡刻自热，神烦呓语（日哺所阳明王时也，初诊只有晡刻神烦，）夫温邪久伏少阴（此沿喻氏之说，其误即始于此，）古人立法，全以育阴祛热（古人治温，决不育阴，全以下语气未了，）但今见证，阴分固有伏邪（阳伏于胃，病在阳分，）真阳亦不肯收纳（乃阳邪之充斥，非真阳之不纳，）议仿刘河间浊药轻投（河间从无此法，）不为上焦热阻（独此用未一药，）下焦根柢自立（与下焦根蒂无关，）冀其烦躁热蒸渐缓（不去其热何由缓，）熟地炭茯苓淡苁蓉远志炭川石斛五味（方谬。）
又再诊晚诊阴中伏邪（阳伏于胃，）晡时而升（的是阳明，）目赤羞明（睛不和也，）舌绛而渴（渴为温病，）与育阴清邪法（以阳邪而育阴，阴愈育阳邪念固，而云法乎）生地炭（生熟地之所贵在滋膏，而炒为炭则无用，亦断无先熟后生之理，）元参心川石斛炒麦冬（麦冬无炒用者）犀角石菖蒲（二味并开心窍，送邪入心）
又三诊脉左数右软（此时脉尚未变，）舌干苔白，小溲淋沥（腻滋之效，）吸气喘促（呼气促是脱，吸气促，乃是闭，）烦汗（的是阳明，）肾阴不承（非也，）心神热灼蒙闭（一去胃热蒙闭即开，）议以三才汤滋水制热（岂阴虚而火炎耶，此时之邪热，非滋水所能制）三才加茯神黄柏金箔（邪必益锢）晚进周少川牛黄清心丸一服（助犀角送邪入内·）
又四诊昨黄昏后，诊脉较诸早上，左手数疾顿减（脉象陡变，）惟尺中垂而仍动（阳邪内陷矣，）呓语不已，若有妄见（胃热蒸心益甚矣，）因思肾热乘心（胃热而非肾热，）膻中微闭，神明为蒙，自属（二字何解）昏乱（全不识阳明病，）随进周少川牛黄丸（领邪入心）一服，俾迷漫无质之热（热本无所为质，）暂可泄降（并未一用泄降之药，）服后颇安（并不能烦躁矣，）辰刻诊脉濡小（脉又变矣，）形质太衰（生熟地炭既立根蒂，何至形质大衰）舌边色淡，下利稀水（邪下陷矣，）夫救阴是要旨（撤热是要旨）读仲景少阴下利篇（太阳阳明亦有下利）上下交征（此句如何接得上，）关闸欲撤，必以堵塞阳明为治（昨日犀角，昨晚牛黄，尽开诸窍，一变而为堵塞，况阳明无堵塞之理，）以阳明司阖（阳明之合不如是讲，）有开无阖，下焦之阴，仍从走泄矣（生熟地炭之功何往，）议用桃花汤人参赤石脂炮姜白粳米（此方补涩而温，适与清泄苦降相反。）
又五诊晚服照方加茯苓（此时病已垂危，药之出入必不在一味茯苓）
又两诊脉左沉数，右小数（堵塞后脉又变矣，）暮热，微汗，时烦，辰刻神清（只有辰刻神清矣，）虚邪仍留阴分（实邪仍留阳分）议用清补（当用寒泻）人参茯苓川石斛炙甘草黑橹豆衣（何用）糯稻根须（何用）金匮麦门冬汤（全与温病无涉。）
温热门再有张姓一案，初仅形象畏冷，用复脉汤去参桂加甘蔗汁，及三诊，阴液尽涸，阴气欲绝（复脉汤有麦地，何以阴涸阴绝，）
再有顾姓一案，初尚能饮酒纳谷，用犀角生地，再诊目瞑舌缩，神昏如醉（心开窍于舌，犀角送邪入心，故舌缩。）
再有陈姓一案，初不过夜烦无寐，不嗜汤饮，亦用犀角生地，及三诊阳升风动（用生地阳当不升，用犀角风当风不动，何又升动若此·）
凡此所用药后种种变相，皆指南所自言，何以用其法者，皆不一问其药之效，固有如是者乎。
指南温热门共四十余案，其于席姓复诊者七，初诊左数右缓弱，为温热病应有之脉，邪在阳明，是为时气，非阴虚火炎骨蒸劳热之病，亦非上盛下虚，阳光飞越之病，与阳根未固，真阳不肯收纳，有何干涉，乃必曰久伏少阴，而欲育阴以立根柢，此在劳怯病中，尚为下乘，岂可以之论温热时邪哉，及复诊者再，而吸气喘促，心神蒙闭，非熟地生地炭腻隔留邪，犀角石菖蒲送邪入内之效耶，再予天冬地黄人参之三才，加以牛黄协犀角之力，脉之数疾顿减，一变而为濡小，或并外热之不见，病于是乎内陷矣，牛黄之服后颇安者，并烦躁之不能也，所以形质大衰，而即下利稀水，温病不撤阳邪，种种变相已露，尚曰救阴是要旨，而一任其阳邪之伤阴，以致关闸尽撤，有开无闺，即用桃花汤以堵塞之，此在痢疾门中，尚是末传之治，而始之仅为晡刻神烦者，至此而仅有辰刻神清矣，其人之终日昏沉，内风煽动，粒米不进，举室惊惶，已可想见，六诊，七诊只剩得稻根橹豆敷衍成方，而终之以一服麦门冬，嗟乎，此病之初，人迎数盛，气口濡弱，伤寒成温之的候也，此时一用仲景之葛根芩连汤，辛凉解散，病即外达，一汗而解，热退身凉，神清脉静矣，即不然而须专清里，则仲景之白虎汤栀子豉汤，辛寒泄热，里气一清，外邪不解，亦无不热退身凉，神清脉静矣，余为治三十年，凡遇温热病，无人不如此，无时不如此，无地不如此，无不以十日内贻之以安，惟尚未能起床出门，往往受人促迫耳，今观此案初诊之议，邈若山河，及四诊而一路之病随药变者，败坏至此，事已不可为矣，独有下利一证，或尚是热结旁流，为挟热之利，非燥屎即胶闭，若一投仲景之大小承气，尚能起死回生，乃华玉堂从未梦见，反谓见闻甚广，不肯胶柱鼓瑟，辄投石脂干姜温之涩之，病到如此不堪地步，一味人参聊以塞责，此外则橹豆之衣也，糯稻根之须也，一筹莫展，剩有麦门冬一方，如不欲战，于此而云此病尚有活理，谁其信之。(温热治法，从此失传，可恨哉。)。
今之抱一册为市医捷径者，名曰叶派，余初不解温病之十有九治者，何至于百无一生，及观此案之始终本末，而知编此一册者，正利其日后必然之状，已予定于始初立案之时，以为先见之明，言无不中，而病家即以其言无不中，果服其先见之明，孰能知其人之本非此病，而移病凑药，使之病随药变耶，此所以人愈死而名愈高也，则此一案之在病家，尚可安于不问哉。”(《世补斋医书》)
柴按：此案治法用药，是否合理，叶派医家，与陆氏有不同看法。原案俱在，后学自可研究，余亦不复赘言。但以生地、熟地炒成炭用，以麦冬炒用，以淡菜煎成胶用，叶氏诸此之类的药法，经徐、陆诸家提出批评之后，即叶派中人，亦罕见再用。生地炒炭，若果可养阴而不粘腻，何以不推广而发扬之耶。即此一瑞，陆氏之抨击，不可以一笔抹杀，亦明矣！
注此为章巨膺注2003-9-1422:25:58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6楼合论顾景文温证论治吴鞠通温病条辨
【结语】：治疗燥证的大法，确实像前人所说：“上焦燥治气，下焦燥治血。”所谓“气”，指的是津液与正气，补益津气可以使用北沙参、麦冬、五味子这类药物；所谓“血”，指的是精血，滋养精血可以使用当归、地黄、肉苁蓉这一类药材。而“燥者润之”这句话，始终不失为治疗燥证的根本大法。如今吴鞠通（吴瑭）治疗燥证，对此却略而不谈，唯独详细论述苦热、刚燥、峻下等方法，这简直是探寻隐秘、行径怪异，流入了异端邪说！所以我称《温病条辨》中燥证门的各种医案以及《补秋燥胜气论》后的各种条文，实在不足以成为后人的典范。
卷四 抨击叶天士医学理论的选辑
叶天士先生的《临证指南医案》卷五，以风寒分门，其中寒门所收录的六个方剂，并非伤寒的重症，即便是在太阳经这一经病中，也只是提及了最轻微的情况。此书流行之后，便不再听说有人用《伤寒论》来治病了。现在那些置六气中的寒水之气于不讲的人，大抵就是由于这个原因，导致《伤寒论》中细微曲折的道理，也没有人能说出只言片语了。然而有他的门人华岫云（字玉堂），在这一门之后大放厥词，认为人们如果拘泥于张仲景的方法，都是见闻不广、胶柱鼓瑟、不知变通，以此说明张仲景的方法不值得效法，而将这六个方剂作为治疗伤寒的一大流派。徐灵胎评论道：这就是俗称的着寒之病，偶尔的小毛病，病邪未入经络，何必牵扯到伤寒重症，发表议论？等到仔细查阅这篇内容，竟然没有真正的伤寒门类，仅凭这六个方剂就说是治疗伤寒的方法，不禁让人失笑。医生的学问，全在于明白伤寒的原理，那么万病都能通晓，所以伤寒是疾病中的第一证候，也是学医者第一功夫所在。这部书唯独缺少这一门，那么他平日所学的是什么书，所治的是什么病？这不是这位老先生的过错，而是编纂这本书的人心中茫然、没有定见啊。徐灵胎这样说，但尚且不知道这些医案和药方是否一定出自叶先生之手。以前梁廷枏（字苣林）在《浪迹丛谈》中记载一则叶先生的轶事：龙虎山张真人在苏州时，在万年桥停下马车，让桥下的“天医星”过去，那天正是如此，不早不晚，叶天士的小船恰好从桥下摇橹经过。梁中丞对此一言不发，随即引用纪昀（字文达）的话，说叶天士不从事著述，现在流传的十卷医案，是门人选取他的治疗验案，附上论断，并非叶天士的本意。石韫玉（字琢堂）殿撰也说，先生著作很少，《指南》这一编，冗杂不足以传世，是先生去世后，门下学者汇集而成的，其中的方剂不尽出自先生之手。既然如此，这本书明显是门人假托名义，为了当时谋取利益的东西。奇怪的是，所作的医案中，每多用未尽的语气，以及上下文不连贯，又常用“也”字代替“矣”字，声称这是效法汉魏文章的风格。然而号称无害于病的，像这种伤寒一门，正是俗医害怕读《伤寒论》的地方，正谓伤寒方难用，于是就像照着这六个方剂，方法已经完备，更不必向张仲请示教，又因此作出“江南无伤寒”的说法，这不都是不辨别真伪而徒然震惊其名号的害处吗？唉！自从李中梓（字士材）编写《医宗必读》，世人便不知道有血证；自从有了这本《临证指南》，世人便不知道有伤寒。叶先生是我们苏州的大医家，在雍正、乾隆年间享有盛名，必定不至于此。那是华岫云、邵新甫等人造下了这个大孽，并且败坏了先生死后的名声，怎么能不为先生洗雪此愤慨呢！（出自《世补斋医书》）
柴松岩按：考证《临证指南》寒门治案，是普通感冒类疾病的辨证属于寒证的，叶氏使用辛温解表、宣肺化痰类药物进行治疗，治疗未曾有误。感冒又称伤风，乃是轻浅小病，陆九芝认为不传经。汪琥认为与《伤寒论》中的伤寒、中风不同。然而华岫云等人“牵引伤寒大证，大发议论”，又无的放矢，说“拘泥张仲景之法而施治，这是见闻不广。”这在医界竟认为学习《伤寒论》是学屠龙之技的历史条件下，极易使人误以为“照着这六个方剂，方法已经完备，更不必向张仲请示教”，所以陆氏特意作此论以针砭时弊，这对发扬张仲景学说，是具有积极意义的。
论《临证指南医案·温热门》席姓七案
席姓患者脉象左部数疾，右部缓弱（此为温热病的脉象）。阳根未固（温热病与阳根无涉），阴液逐渐枯竭（阳邪炽盛所致）。舌质红赤微渴（也是阳邪的表现）。喘促，自利，小便频数（三焦大热）。傍晚时分自觉发热，神志烦躁，胡言乱语（日晡时即下午3-5点，是阳明经旺盛的时候，初诊只有傍晚神志烦躁）。夫温邪久伏少阴（这是沿袭喻嘉言的说法，其错误即始于此）。古人立法，全以育阴祛热（古人治疗温病，绝不单纯育阴，此处语气未完）。但现今见证，阴分固有伏邪（阳邪伏于胃，病在阳分）。真阳亦不肯收纳（乃阳邪充斥，并非真阳不纳）。议仿刘河间浊药轻投（刘河间从未有此法）。不为上焦热阻（此处用药未一，意指杂乱）。下焦根柢自立（与下焦根基无关）。冀其烦躁热蒸渐缓（不去其热，如何能缓？）。熟地炭、茯苓、淡苁蓉、远志炭、川石斛、五味子（方剂谬误）。
再次复诊，晚间诊察，阴中伏邪（阳邪伏于胃）。傍晚时升高（确实是阳明病）。目赤羞明（眼睛不和）。舌绛而渴（渴是温病的表现）。与育阴清邪法（以阳邪而育阴，阴愈育则阳邪愈固，岂能称为法？）。生地炭（生熟地之所以珍贵在于滋膏，炒成炭则无用，也绝无先熟后生的道理）。元参心、川石斛、炒麦冬（麦冬无炒用的）。犀角、石菖蒲（两味药并开心窍，送邪入心）。
第三次复诊，脉象左数右软（此时脉象尚未变化）。舌干苔白，小便淋沥（腻滞药物的效果）。吸气喘促（呼气急促是脱证，吸气急促，乃是闭证）。烦汗（确实是阳明病）。肾阴不承（不对）。心神热灼蒙闭（一旦去除胃热蒙闭即可开通）。议以三才汤滋水制热（难道是阴虚而火炎吗？此时的邪热，非滋水所能制约）。三才汤加茯神、黄柏、金箔（邪气必更加固结）。晚上服用周少川牛黄清心丸一服（助犀角之力送邪入内）。
第四次复诊，昨天黄昏后，诊脉较早上相比，左手数疾顿减（脉象突然变化）。惟尺中脉垂而仍动（阳邪内陷了）。胡言乱语不止，若有妄见（胃热蒸腾于心更加严重了）。因思肾热乘心（是胃热而非肾热）。膻中微闭，神明被蒙蔽，自属昏乱（完全不懂阳明病）。随即进服周少川牛黄丸一服，领邪入心。俾迷漫无质之热（热本无实质）。暂可泄降（并未使用任何泄降的药物）。服后颇安（并不能消除烦躁了）。辰时诊脉濡小（脉象又变了）。形质太衰（生熟地炭既立根蒂，何至于形质大衰）。舌边色淡，下利稀水（邪气下陷了）。夫救阴是要旨（撤热才是关键）。读仲景少阴下利篇（太阳阳明也有下利）。上下交征（这句如何衔接得上）。关闸欲撤，必以堵塞阳明为治（昨日犀角，昨晚牛黄，尽开诸窍，一变而为堵塞，况且阳明无堵塞之理）。以阳明司阖（阳明之合不是这样讲的）。有开无阖，下焦之阴，仍从走泄矣（生熟地炭的功效去哪了？）。议用桃花汤、人参、赤石脂、炮姜、白粳米（此方补涩而温，恰与清泄苦降相反）。
第五次复诊，晚上服药照原方加茯苓（此时病已垂危，药的出入必然不在一味茯苓上）。
第六次复诊，脉象左沉数，右小数（堵塞后脉象又变了）。暮热，微汗，时烦，辰刻神清（只有辰刻神志清醒了）。虚邪仍留阴分（实邪仍留阳分）。议用清补。人参、茯苓、川石斛、炙甘草、黑橹豆衣（何用？）。糯稻根须（何用？）。金匮麦门冬汤（全与温病无涉）。
温热门再有张姓一案，起初仅形象畏冷，用复脉汤去人参、桂枝加甘蔗汁，及至第三诊，阴液尽涸，阴气欲绝（复脉汤中有麦冬、地黄，为何阴涸阴绝？）。
再有顾姓一案，起初尚能饮酒纳谷，用犀角、生地，再诊时目瞑舌缩，神昏如醉（心开窍于舌，犀角送邪入心，故舌缩）。
再有陈姓一案，起初不过夜烦无寐，不嗜汤饮，亦用犀角、生地，及至第三诊阳升风动（用生地阳气当不升，用犀角风当不动，为何又升动如此？）。
凡此所用药后种种变相，皆是《指南》中所自述，何以用其法者，皆不一问其药之效，固有如是者乎。
《指南》温热门共四十余案，其中席姓复诊者七次。初诊左数右缓弱，为温热病应有之脉，邪在阳明，是为时气，非阴虚火炎骨蒸劳热之病，亦非上盛下虚、阳光飞越之病，与阳根未固、真阳不肯收纳有何干涉？乃必曰久伏少阴，而欲育阴以立根柢，此在劳怯病中，尚为下乘，岂可以之论温热时邪哉？及复诊者再，而吸气喘促，心神蒙闭，非熟地、生地炭腻隔留邪，犀角、石菖蒲送邪入内之效耶？再予天冬、地黄、人参之三才，加以牛黄协犀角之力，脉之数疾顿减，一变而为濡小，或并外热之不见，病于是乎内陷矣。牛黄之服后颇安者，并烦躁之不能也，所以形质大衰，而即下利稀水。温病不撤阳邪，种种变相已露，尚曰救阴是要旨，而一任其阳邪之伤阴，以致关闸尽撤，有开无阖，即用桃花汤以堵塞之，此在痢疾门中，尚是末传之治，而始之仅为晡刻神烦者，至此而仅有辰刻神清矣。其人之终日昏沉，内风煽动，粒米不进，举室惊惶，已可想见。六诊、七诊只剩得稻根、橹豆敷衍成方，而终之以一服麦门冬。嗟乎，此病之初，人迎数盛，气口濡弱，伤寒成温之的候也。此时一用仲景之葛根芩连汤，辛凉解散，病即外达，一汗而解，热退身凉，神清脉静矣。即不然而须专清里，则仲景之白虎汤、栀子豉汤，辛寒泄热，里气一清，外邪不解，亦无不热退身凉，神清脉静矣。余为治三十年，凡遇温热病，无人不如此，无时不如此，无地不如此，无不以十日内贻之以安，惟尚未能起床出门，往往受人促迫耳。今观此案初诊之议，邈若山河，及四诊而一路之病随药变者，败坏至此，事已不可为矣。独有下利一证，或尚是热结旁流，为挟热之利，非燥屎即胶闭，若一投仲景之大小承气，尚能起死回生，乃华玉堂从未梦见，反谓见闻甚广，不肯胶柱鼓瑟，辄投石脂、干姜温之涩之，病到如此不堪地步，一味人参聊以塞责，此外则橹豆之衣也，糯稻根之须也，一筹莫展，剩有麦门冬一方。如不欲战，于此而云此病尚有活理，谁其信之。（温热治法，从此失传，可恨哉。）
当今抱着这一册书作为市井医生捷径的人，名叫“叶派”。我起初不解温病十分之九治愈者，何至于百无一生？及观此案之始终本末，而知编此一册者，正利其日后必然之状，已予定于始初立案之时，以为先见之明，言无不中，而病家即以其言无不中，果服其先见之明，孰能知其人之本非此病，而移病凑药，使之病随药变耶？此所以人愈死而名愈高也，则此一案之在病家，尚可安于不问哉？”（出自《世补斋医书》）
柴松岩按：此案治法用药，是否合理，叶派医家与陆氏有不同看法。原案俱在，后学自可研究，余亦不复赘言。但以生地、熟地炒成炭用，以麦冬炒用，以淡菜煎成胶用，叶氏诸此之类的药法，经徐、陆诸家提出批评之后，即叶派中人，亦罕见再用。生地炒炭，若果可养阴而不粘腻，何以不推广而发扬之耶？即此一瑞，陆氏之抨击，不可以一笔抹杀，亦明矣！
注：此为章巨膺注 2003-9-14 22:25:58 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6楼 合论顾景文温证论治吴鞠通温病条辨
[Conclusion]: The general principle for treating dryness (Zao) is indeed as the predecessors said: "Treat Qi for upper jiao dryness, treat Blood for lower jiao dryness." By "Qi," it refers to body fluids and righteous Qi; tonifying body fluids and Qi can use herbs such as Bei Shashen (Glehniae Radix), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). By "Blood," it refers to essence and blood; nourishing essence and blood can use herbs such as Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), and Rongrong (Cynomorii Herba). The phrase "Dryness should be moistened" (Zao zhe run zhi) remains the fundamental principle for treating dryness. However, Wu Jutong (Wu Tang) in his treatment of dryness omits this, detailing only methods involving bitter heat, rigid dryness, and severe purgation. This is akin to seeking hidden secrets and acting strangely, falling into heterodox paths! Therefore, I state that the various medical cases in the Dryness Section of *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) and the articles following *Bu Qiuzuo Shengqi Lun* (Supplementing Autumn Dryness to Overcome Dominant Qi) are truly not worthy of being models for future generations.
Volume Four: Selected Critiques of Ye Tianshi's Medical Theory
On the Formulas in the Cold Section of Ye Tianshi's *Linzheng Zhinan Yian* (Guide to Clinical Practice)
In Volume Five of Mr. Ye Tianshi's *Linzheng Zhinan Yian*, diseases are categorized by Wind-Cold. The Cold section contains only six formulas, none of which represent major Cold Damage (Shanghan) syndromes. Even within the Taiyang channel, they only address the mildest conditions. After this book became popular, people stopped using the *Shanghan Lun* (Treatise on Cold Damage) for treatment. Most who now neglect the Cold-Water aspect of the Six Qi likely do so because of this, leading to an inability to explain even a fragment of the subtle details in the *Shanghan Lun*. Yet, his disciple Hua Xiyun (courtesy name Yutang) went further, claiming that those who adhere strictly to Zhang Zhongjing's methods lack broad experience and are rigid like a fixed tuning peg, failing to adapt. He argued that Zhang Zhongjing's methods were not worth emulating and promoted these six formulas as a major school for treating Shanghan. Xu Lingtai commented: This is merely the common cold caused by chilling, a minor ailment where pathogens have not entered the meridians. Why drag in major Shanghan syndromes and make grand theories? Upon careful reading, there is no actual Shanghan category here; relying solely on these six formulas as the method for treating Shanghan is laughable. A physician's learning lies entirely in understanding the principles of Shanghan, through which all diseases can be comprehended. Thus, Shanghan is the primary disease category and the first skill for students of medicine. This book uniquely lacks this section, revealing what books he studied and what diseases he treated. This is not the old master's fault, but rather the compiler's lack of clear vision. Although Xu Lingtai noted that these cases and prescriptions might not necessarily be from Mr. Ye himself, Liang Tingnan recorded in *Langji Congtan* an anecdote: When the Daoist Master Zhang from Longhu Mountain was in Suzhou, he stopped at Wannian Bridge to let the "Star of Heavenly Doctors" pass underneath. Coincidentally, Ye Tianshi's boat passed under the bridge at that exact moment. Liang remained silent but cited Ji Yun (Wenda), stating that Ye Tianshi did not engage in writing; the ten volumes of medical cases currently circulating were compiled by his disciples from his clinical experiences with added commentary, not Ye's original intent. Shi Yunchuan also stated that Mr. Ye wrote little, and the *Zhinan* compilation is cluttered and unworthy of transmission, assembled by disciples after his death, with prescriptions not all originating from him. Thus, this book is clearly a forgery by disciples for profit. Strangely, the cases often use incomplete sentences and disjointed contexts, replacing "yi" (矣) with "ye" (也), claiming this mimics Han-Wei prose style. However, regarding the Cold Damage section, which ordinary physicians fear due to the difficulty of Shanghan formulas, it suggests that following these six formulas is sufficient, eliminating the need to consult Zhang Zhongjing, thereby fostering the false notion that "there is no Shanghan in Jiangnan." Is this not the harm of confusing truth with falsehood while being awed by reputation? Alas! Since Li Shicai's *Yizong Bidu*, people forgot about Blood Syndromes; since the *Linzheng Zhinan*, people forgot about Shanghan. Mr. Ye, a great physician of our region renowned during the Yongzheng and Qianlong eras, would not have intended this. It was Hua Xiyun, Shao Xinpu, and others who created this disaster, tarnishing Mr. Ye's posthumous reputation. We must clear this grievance for him! (From *Shibuzhai Yishu*)
Chai Songyan notes: Examining the Cold section cases in *Linzheng Zhinan*, they refer to common colds classified as Cold patterns. Ye used acrid-warm exterior-releasing and lung-promoting phlegm-resolving herbs, which was not erroneous. Common colds (Shangfeng) are mild ailments; Lu Jiuzhi believed they do not transmit channels. Wang Hu distinguished them from Shanghan and Fengzhong in the *Shanghan Lun*. However, Hua Xiyun et al.'s "dragging in major Shanghan syndromes" was baseless, claiming adherence to Zhang Zhongjing indicated narrow views. In an era where studying *Shanghan Lun* was dismissed as impractical, this easily misled people into thinking "these six formulas are sufficient, no need to consult Zhang Zhongjing." Thus, Lu's critique was significant for promoting Zhang Zhongjing's theory.
On the Seven Cases of Patient Xi in the Warm Heat Section of *Linzheng Zhinan*
Patient Xi's pulse was rapid on the left and slow/weak on the right (typical of warm diseases). The root of Yang is unstable (irrelevant to warm diseases); Yin fluids are gradually drying up (due to intense Yang pathogen). Tongue is red with slight thirst (also Yang pathogen). Panting, spontaneous diarrhea, frequent urination (intense heat in the Three Jiao). Fever in the late afternoon, mental restlessness, and muttering (Bing time corresponds to the peak of Yangming). The author claims warm pathogens lie dormant in Shaoyin (following Yu Jiazuo's error). Ancient methods focused on nourishing Yin to dispel heat (ancient texts did not solely nourish Yin; the sentence is incomplete). But current signs show latent pathogens in the Yin aspect (Yang pathogen latent in Stomach, disease in Yang aspect). True Yang refuses to receive (it is Yang pathogen filling the space, not True Yang refusing). Proposed to imitate Liu Hejian's "light administration of turbid drugs" (Liu never used this method). To avoid upper Jiao heat blockage (medication is chaotic). Establishing the lower Jiao foundation (irrelevant to lower Jiao roots). Hoping for gradual relief of restlessness and steaming heat (how can it relieve without removing heat?). Prescription: Shudi Tan (Charred Rehmanniae Radix), Fuling (Poria), Dan Congrong (Cynomorium), Yuanzhi Tan (Charred Polygalae Radix), Chuan Shihu (Dendrobii Caulis), Wuwei Zi (Schisandrae Fructus). (Prescription is erroneous.)
Second consultation (evening): Latent pathogens in Yin (Yang latent in Stomach). Rising in the evening (definitely Yangming). Red eyes, aversion to light (eyes unharmonious). Crimson tongue with thirst (thirst indicates warm disease). Prescribed nourishing Yin and clearing pathogens (Nourishing Yin when Yang pathogen exists solidifies the pathogen; how is this a method?). Prescription: Shengdi Tan (Charred Raw Rehmanniae Radix) [Raw/Cooked Rehmanniae are valued for their fluid content; charring destroys this utility; sequence is illogical]. Yuanshen Xin (Scrophulariae Radix), Chuan Shihu, Chao Maidong (Fried Ophiopogonis Radix) [Maidong is not fried]. Xijiao (Rhinocerotis Cornu - prohibited/substitute), Shichangpu (Acori Tatarinowii Rhizoma). [These two open orifices, sending pathogen into Heart.]
Third consultation: Pulse rapid left, soft right (pulse unchanged). Dry tongue, white coating, scanty dribbling urine (effect of cloying/nourishing herbs). Inspiratory dyspnea (expiratory difficulty indicates collapse; inspiratory difficulty indicates closure). Restlessness and sweating (definitely Yangming). Kidney Yin fails to ascend (incorrect). Heart spirit scorched and blocked by heat (removing Stomach heat clears blockage). Proposed Sancai Tang to nourish Water to control Heat (Is it Yin deficiency with flaming fire? Current heat cannot be controlled by nourishing water). Sancai Tang plus Fushen (Poria with Hostwood), Huangbai (Phellodendri Cortex), Jinpo (Gold Leaf). Evening dose: Zhou Shaochuan Niuhuang Qingxin Wan (Assists Xijiao in sending pathogen inward).
Fourth consultation: Yesterday evening, pulse rapidness decreased significantly on the left (sudden change). Chi position hangs but still moves (Yang pathogen has sunk inward). Continuous muttering, hallucinations (Stomach heat steaming Heart severely). Thought: Kidney heat attacking Heart (It is Stomach heat, not Kidney heat). Pericardium slightly closed, Spirit蒙蔽 (confused). Belongs to confusion (Complete ignorance of Yangming disease). Administered Zhou Shaochuan Niuhuang Wan to lead pathogen into Heart. Let diffuse, formless heat temporarily descend (No descending herbs used). Patient felt better after taking it (Restlessness not resolved). Chen hour pulse: soggy and small (pulse changed again). Physical constitution too depleted (How can charred Rehmanniae cause depletion?). Pale tongue edges, loose watery stool (Pathogen sunk downward). Saving Yin is key (Removing heat is key). Reading Zhang Zhongjing's Shaoyin diarrhea chapter (Taiyang/Yangming also have diarrhea). Upper and lower both affected (Sentence connection unclear). Closing gates requires blocking Yangming (Yesterday Xijiao, last night Niuhuang opened orifices; now switching to blocking? Yangming does not block). Yangming governs closing (Incorrect interpretation). Opening without closing, lower Jiao Yin leaks away (Where is the effect of charred Rehmanniae?). Proposed Taohua Tang, Renshen (Ginseng Radix), Chishizhi (Halloysit Rubrum), Paojiang (Prepared Zingiberis Rhizoma), Baijingmi (Oryza Sativa Var. Glutinosa). [This formula is warming/astringent, opposite to clearing/descending.]
Fifth consultation: Added Fuling to evening prescription (Condition critical; adding one herb is irrelevant).
Sixth consultation: Pulse deep-rapid left, small-rapid right (changed after blocking). Evening fever, slight sweat, occasional restlessness, clear mind at Chen hour (Only clear at Chen hour). Deficient pathogen remains in Yin aspect (Excess pathogen remains in Yang aspect). Proposed clearing and tonifying. Renshen, Fuling, Chuan Shihu, Zhi Gancao (Honey-fried Glycyrrhizae Radix), He Ludou Yi (Black Vigna Umbellata Seed Coat) [Useless?]. Nuodaogen Xu (Pennisetum Setaceum) [Useless?]. Jingui Maimendong Tang (Completely unrelated to warm diseases).
Another case in Warm Heat section: Patient Zhang initially feared cold. Used Fumai Tang minus Renshen/Guizhi, adding Sugarcane juice. By third consultation, Yin fluids exhausted, Yin Qi dying (Fumai Tang contains Maidong/Dihuang; why exhaustion?).
Patient Gu initially drank alcohol and ate well. Used Xijiao/Shengdi. Second consultation: Eyes closed, tongue retracted, coma-like intoxication (Heart opens to tongue; Xijiao sent pathogen to Heart, causing tongue retraction).
Patient Chen initially had night restlessness, insomnia, dislike for hot drinks. Also used Xijiao/Shengdi. Third consultation: Yang rising, wind stirring (Shengdi should prevent Yang rising; Xijiao should stop wind; why rising/stirring?).
All these variations after medication are self-admitted in *Zhinan*. Why do followers not question the efficacy? Are such outcomes inherent?
The Warm Heat section has over 40 cases. Patient Xi had seven consultations. Initial pulse (rapid left/slow right) fits warm disease, pathogen in Yangming (seasonal qi), not Yin deficiency bone-steaming or upper excess/lower deficiency. Claiming "latent in Shaoyin" to nourish Yin for foundation is inferior even for consumption diseases, let alone seasonal warm pathogens. Subsequent consultations showed inspiratory dyspnea and spirit blockage, effects of cloying charred Rehmanniae retaining pathogen and Xijiao/Shichangpu sending pathogen inward. Adding Sancai and Niuhuang accelerated pulse changes to soggy/small, loss of external heat, and internal sinking. Feeling "better" after Niuhuang meant loss of restlessness, leading to physical depletion and watery diarrhea. Failure to remove Yang pathogen revealed all these signs, yet still claimed "saving Yin is key," allowing Yang pathogen to damage Yin until gates collapsed. Using Taohua Tang to block is a late-stage treatment for dysentery, inappropriate here. The patient progressed from evening restlessness to only morning clarity, constant coma, internal wind, anorexia, and family panic. Final consultations used rice roots and bean coats perfunctorily, ending with Maimendong. Initially, Renying pulse was rapid, Qikou was soggy/weak, indicating transformation from Cold Damage to Warm Disease. Early use of Ge Gen Qin Lian Tang (acrid-cool release) would have resolved it externally. Or Bai Hu Tang/Zhi Zi Chi Tang (acrid-cold clearing) would have cleared interior heat. In thirty years of practice, I always resolve warm diseases within ten days, leaving patients bedridden but safe. Here, the initial proposal was distant from reality, and by the fourth consultation, the condition deteriorated irreversibly due to medication errors. Only the diarrhea might have been heat-binding with free-flowing liquid; if treated with Da/Xiao Cheng Qi Tang, recovery might have been possible. Hua Xiyun, claiming broad knowledge and rejecting rigidity, instead used astringent/warming herbs (Chishizhi/Ganjiang), worsening the condition, using only Renshen to cover up, followed by useless bean coats and rice roots, ending with Maimendong. Who would believe this disease could be saved? (Warm disease treatment lost here, hateful!)
Modern "Ye School" practitioners use this book as a shortcut. I wondered why 90% cure rates led to near-total mortality. Seeing this case's progression, the compiler anticipated the inevitable outcome to claim prescience. Patients trusted this "prescience," unaware the doctor forced symptoms to fit the prescription ("moving disease to match medicine"). Hence, higher fame with more deaths. Can families ignore this case? (From *Shibuzhai Yishu*)
Chai Songyan notes: Disagreement exists between Ye School and Lu regarding the rationality of this case's treatment. Original cases are available for study. However, Ye's methods of charring Shengdi/Shudi, frying Maidong, and boiling Concha Meretricis (Dancai) into gel were criticized by Xu and Lu. Even Ye School disciples rarely use them now. If charred Shengdi nourishes Yin without cloying, why not promote it? Lu's criticism cannot be dismissed.
Note: Annotation by Zhang Juying.