温证论治，在华邵辈所编临证指南之外，乃顾景文者假托叶先生之语，而刻于唐笠三吴医会讲者也。唐刻有小引云，先生游于洞庭山，门人顾景文随之舟中，以当时所语，信笔记录，一时未经修饰，是以词多佶届，语亦稍乱，读者来免眩目，不揣冒昧，窃以语句稍为条达，前后少为移掇，惟使晦者明之，而先生立论之要旨，未敢稍更一字也。据此，则所刻云云，已经唐氏加以删润，尚且如此不堪，然则顾景文之原文，当更何如，不意托名大医，便能行世，贮春仙馆刻之，拜石山房刻之，种福堂又刻之，而其贻祸于病人者，直如此其大也。顾所记名曰温证论治，而章虚谷乐为之注，改其名为外感温热。王孟英又乐取之，谓仲景所论温热，是伏气，叶氏所论温热，是外感。故以温邪上受，首先犯肺，逆传心包十二字揭之篇首，以自别异，果如其说，则所称温热者，不过小小感冒，即俗称所谓小风热、小风温，如目赤、颐肿，喉梗、牙疼之类，却只须辛凉轻剂，其病立愈，然何以不出数日，遽入心包，为一场大病，以致于死，若不数日而病即入心，即可死者，则必非如其所说，只须轻剂之辛凉，且何以如其所言，不即愈于辛琼之轻剂耶。夫其所谓热入心包者，不可谓世无其病也，然总不在仅称外感，仅病及肺，仅用此无名轻剂之时，是故古之人不轻言热入心包也，而顾其信者，确凿言之若此，迹其所以有是作者，是欲以所用轻剂愈人之病也，似又欲以所用犀角愈人之病也，乃用其所谓轻剂，而病不解，渐欲入营，血液受劫，心神不安，斑点隐隐，即随其所用不言何物之轻剂次第而来，然则用轻剂而液受劫者，轻剂不可用矣，用其所谓犀角而斑出热不解，胃津告亡，肤冷至一昼夜，仅仅未成脱证，亦即随其视同花露之犀角次第而来，然则用犀角而津告亡者，犀角又不可用矣，此皆顾景文自己所说，皆顾景文自己所告人，夫医之教人以必用此药，教人以必不可用他药者，不过恐以他药使病增重，不过欲以此药使病速愈，不过期其此后之种种恶候，一用此药，尽消弭于无形，故必谆谆告诫，不惮烦言，饷遗来学，而人之生其后者，有心济世，乐为之反复引申，一刻再刻，使其愈病之法，昭然若发聋振聩，而惟恐其勿传，断无因其用此法则液受劫，用此法则津告亡，而谓此劫液亡津之法，有未可任其不传者，然而后之人，则必用其法矣，一用其法，则所说津劫津亡者，即于初用轻剂接用犀角时予言之而无不准，若有先见者然，并恐不用其法，则血液未定受劫，胃津未定告亡，而所谓先见者，便不十分稳作，何由取信于病家，此所以生其后者，万不肯不用其法也，人心愈幻，其法愈巧，后数十年而又有吴鞠通者，鞠通即本顾景文温邪上受，首先犯肺，逆传心包之十二字，而为温病条辨，自条自辨，可发一笑者也，开卷捏造温病以桂枝汤主之为仲景原文，继复承指南之讹，以西喻昌治瘟之法，谓是刘河间之所以治温，两失已不待言，乃以温病之本在中焦者，先移之于上焦，谓切不可用中焦药，痛戒中焦之芩连，而其下即云，热邪久羁，吸烁真阴，邪热久羁，肌肤甲错，皆鞠通所自言，皆鞠通自己所告人者，先是自制银翅、桑菊二方，即顾景文之辛凉轻剂不名一药，而鞠通为之引申者也，嗣是方名清宫，用犀角牛黄，方名增液，用元参麦冬，以及一甲二甲三甲之复脉汤，小定风珠、大定风珠，无非滋腻伤阴，引邪内陷，病至此，不可为矣，而因其中焦篇，亦或有偶用芩连膏黄时，凡温病之一用芩连膏黄，无不可祛邪撤热者，鞠通又若未尚不知；然苟非布置上焦，则邪热未必久羁，真阴即未定劫烁，苟非诃斥芩连，则邪热未必久羁，肌肤又未定甲错，顾景文延之数日，鞠通再加缓缓两字，何以必缓缓也，不可解而实可解也，此所以后乎鞠通者，亦万不肯不用其法也，以滋腻留邪之药，缓缓廷之，邪热方盛之时，阴无不伤，病无不死，陶节庵之一提金，杀车锤，截江网，书名之恶极者也，比之一甲、二甲，三甲、定风珠，方名之恶极者也，病何等事，医何等人，顾可儿戏若斯乎。(《世补斋医书》)
柴按；叶派认为温病初起，首先犯肺，治上焦如羽，非轻不举，所以开首用药，总是银翘、桑菊之类。陆九芝赞同柯琴“阳明为成温之薮"之说，认为温病病在阳明，而叶派治在太阴，隔靴搔痒，撤热不力，贻误病机，所以每致步步深入。考《临证指南》风温、温热诸门治案，其轻者为辨证属热之伤风，其重者为肺胀、肺痹之类。以银翘、桑菊治此类病，治亦未尝误。然学叶氏者，竟以此类药移治一切温病，其不愤事也几希矣！伤风、肺胀、肺痹、肺痈等病，原不称为温病，叶氏混称，从此就凭空阑入到温病范围。古之所谓温病，虽不局限于阳明一经，但以阳明为主，故陆氏主张从阳明论治。陆氏认为伤风、肺胀之类，只要稍用些能治病的药，就决不致遽入心包，为一场大病，以致于死。能遽入心包，为一场大病，以致于死的，决非伤风、肺胀之类，病非伤风，肺胀之类，治疗仍使用治伤风、肺胀之类的药物，自然无效。这些意见，显然是正确的。再论温邪上受首先犯肺逆传心包十二字此十二字者，温证论治之所以发凡而起例者也，初不言邪之何以独伤肺，肺之何以遽传心，但云若论治法，宜用辛凉轻剂，延之数日，夫人病之热，惟胃为甚，胃热之甚，神为之昏，从来神昏之病，悉届胃家，即使热果入心，亦必先病及胃，病苟仅在于肺，则断无神昏之事，即断无入心之理，乃于病之明明有神昏者，特将神昏二字，始终不提，又明知神昏不属于肺，即暗将神昏移入于心，其曰上受，曰先犯，曰逆传者，皆所以抹杀胃病之故，再加未入心包，邪专在肺二句，说成此时之病，不心则肺，一肺即心，若绝无与于阳明胃者，而不可用胃药之语，适在此种种胃病之时，欲成一家之言，翻尽千古之局，锻炼周内，病者不能呼冤也，其时病者或为太阳阳明两经递病，或为太阳阳明两经合病，太阳行身之后，由背贯胸，阳明行身之前，由胸彻背，肺为华盖，位在胸背之上，而胸为近，胃为五脏六腑之海，其清气上注于肺，注者射也，太阳之邪射肺，阳明之邪亦射肺，而阳明为近，故必阳明胃之热降，而在上之肺气始安，所病本只在胃，肺仅为病所累，于此而必曰肺病，势必徒用肺药，转将胃之支脉络于心，胃热之最易蒸心者，一任其逼近心包，日逼日近，而神昏益甚，又以为此即心病，此即肺病之传心，轻剂之后，即用犀角，将胃中之药，非特搁置勿道，并且禁绝勿用，遂令胃中射肺之邪，直攻心脏，是其所以逆传者，全赖此药以为之也，夫胃者腑也，肺与心脏也，本是腑病，而偏要说成脏病，遂乃舍腑治脏，夫岂有脏腑而可以不分者，人病腑为轻而脏为重，此时一治其腑，病无不除，亦何至领邪入脏，死于非命哉！独无如兔园册子，只有顾景文之温证论治吴鞠通之温病条辨等物，以为道在是矣，宜乎今日盛名之下，并脏腑之不言也。(《世补斋医书》)
柴按：根据绍派经验，温热病之神昏詀语者，以“胃热蒸脑”一证为最多。叶派对此，但云“逆传心包”，对胃热蒸脑最多之证，反有所忽略，故陆氏有神昏詀语，悉属于胃之说。但热入心包，是否必有先病及胃这一中心环节，后世有不同意见。余谓陆氏之言，有矫枉过正之嫌，然叶派中人但指谪陆氏所见不广，而于其矫枉之旨亦一并抹杀之，则有失持平。温热病之神昏詀语，以属胃热者居多，此系不可否定之事实。柯琴“阳明为成温之薮”的论点，赞同者亦极多。章次公说，“后人欲评前哲之学说，最不可先有成见，成见横梗胸中，其流弊为武断。”通人之论，固名言可采。
世间原有一种肺病，其小者如咳呛、喷嚏、颐肿、喉梗之类，其大者如哮喘、咯血、肺痈、肺痿之类，皆不闻有神昏而至诂妄者，既曰肺病，断不能有神昏，既曰神昏，断不仅为肺病，既不神昏，断不病及心包，既不病心，断不需用犀角，是皆可以理断而不必尽通乎医道者也，鞠通所谓上焦病者，即景文所言之肺，鞠通所谓不可用中焦药者，即景文所不言之胃，乃于景文延之数日上，再加缓缓两字，胃不及待，酿成大热，或亦一用膏黄，似乎已胜顾说，而随即以清官增液者，使胃病仍归不治，夫人之所病者胃，而医之所言者肺，神之所以能昏者在胃，而医之所以治神昏者在心，类皆善用移字诀，而此之所移，又为移字诀中最大之祸，明明一部伤寒论，长留天地间，其于急祛邪热，阴始可保，如仲景之白虎承气汤，小之而一去其热，阴即不伤，如仲景之葛根芩连诸方，辛从甘以化阳，苦从甘以化阴，阴阳和而时雨降，顷刻间有嘘枯振槁之能者，概从摈弃，且若恶闻，岂无意乎，风寒温热寻常病耳，似此倘恍迷离，既令人于伤寒方视若畏途，并以一二肯用伤寒方者，目为怪物，登仁寿而免夭札，只看伤寒论之兴替何如，余既合论两家而并畅发此论，所望病家之曾受此害者，一权于肺胃之间，而恍然有悟也。(《世补斋医书》)
柴按：伤风感冒、气管炎、肺痈这一类病，在古人原不隶属温病范畴。此类病极少逆传心包，产生神昏诂语等种种危象，这在今医，已为常识。乙型脑炎等极易见神昏诂语者，又何尝首先犯肺，陆氏意见，明系可取，惜叶派医者只是挑剔，不肯虚心，则陆氏亦无可奈其何。缪希雍说；“凡作医师，宜先虚怀，灵知空洞，本无一物，苟执我见，便与物对，我见坚固，势必轻人，我是人非，与境角立，一灵空窍，动为所塞，虽日亲至人，终不获益，白首如故，良可悲已。”这话是值得我们深思的。
叶天士先生一代盛名，既为其门下华邵辈所毁，而顾景文之温证，又为章虚谷取而注之，改作外感温热，其所以改作外感者，想亦嫌其不类论温，故谓其与仲景伏气之温不同，是则天士之温，本非仲景之温，而虚谷之温，又非天士之温矣，然而换一衣冠，不能使其人之性情面貌因之而皆变也，况果如其外感之说，而意出于天士之意，则天士于临证指南既以小风寒抵作伤寒一大法门，天士于温证论治又以小风热抵作温热一大法门，所以伤寒一证，至天士而失传，温热一证，亦至天土而失传，而孰知皆非天士之书耶，此之般流直若傀儡登场，沐猴牵线，不使仲景圣道尽归澌灭不止，而王孟英温热经纬，尽罗而致之，皆不肯为病者计，呜呼，此中之劫运，其何日已耶。
坊间再有医效秘传，亦云是叶先生语，为吴子音所刻，秘传已极不堪，至于叶薛缪三家医案，非特用药之谬，彼此相似，即词句间亦多有雷同，明是一付笔墨，不问可知其伪，志称薛与叶积不相能，尝白署所居日扫叶山庄，则岂有薛而肯从叶派者乎，缪则我之自出不闻其有此方案，偏是此种讆言，最易动听，不托于两先生，置之可耳，乃假借大医，使人信从，以售其欺，害斯大矣，末附陆秋山温热赘言，则即王孟英所收陈乎伯祖恭语，及章虚谷所指薛氏湿热条辨者，一字不移，但改祖恭为余，自称拙著，不值一笑。(《世补斋医书》)
柴按：章巨膺读以上数篇后曾加按说：“以上数篇，最为精惊，席姓案评，就实指谬，昔孔子成春秋，而乱臣贼子惧，陆氏痛诋叶吴，而江湖庸伧曾不醒悟，所谓道高一尺魔高一丈，正道不克邪魔，致令流毒猖獗至于今日，观今日之域中，尽是邪魔当道，守南阳之宗派者，能有几人，医事败坏，行将渐灭，不亦宜者。”这一按语，措词激烈，在讨论学术中，实不可效法。但前人之愤愤，是环境所促成的，我们不必再为此而深责。叶派中人，若能落落大度，对此不加计较，平心静气地来分析陆九芝等人的学术观，在友好的学术争鸣中来共同研讨外感热病之治法，则于开创新局，振兴中医，必将大有裨益。余撰辑此作，即亦以此为希望。
【背景信息】
书名：热病衡正 章节：正文(43/49) 类别：伤寒
【待处理原文】
关于温病的论述与治疗，除了华岫云、邵新甫等人编纂的《临证指南医案》之外，还有顾景文假托叶天士先生之语，刻印在唐笠三主持的吴地医会讲习资料中的内容。唐氏刻本的小序中说：“先生游历于洞庭山，门人顾景文随船同行，将当时先生的言论信笔记录，一时未经修饰，因此言辞多有生涩难懂，语句也稍显杂乱，读者难免感到眼花缭乱。我不揣冒昧，私下对语句稍作梳理通达，前后略作移动调整，只使晦涩之处变得明白，而不敢更改先生立论的要旨哪怕一个字。”据此来看，唐氏已经加以删减润色，尚且如此不堪入目，那么顾景文的原文又该是什么样呢？没想到托名大医，便能流行于世。贮春仙馆刻印它，拜石山房刻印它，种福堂又刻印它，而其给病人带来的祸害，竟然如此巨大。顾氏所记名为《温证论治》，章虚谷乐于为之作注，将其名称改为《外感温热》。王孟英又乐于采纳其说，认为张仲景所论述的温热病是伏气致病，叶天士所论述的温热病是外感致病。因此以“温邪上受，首先犯肺，逆传心包”这十二个字揭示在篇首，以此标榜自己与众不同。果真像他说的那样，那么所称的温热病，不过是小小的感冒，即俗称所谓的小风热、小风温，如眼睛发红、腮部肿胀、咽喉梗塞、牙痛之类，却只需要辛凉轻剂，病立刻就会痊愈。然而为什么不出几天，就突然进入心包，变成一场大病，以至于死亡？如果不是几天而病立即进入心脏，就可以死亡的，那就必定不是像他说的那样，只需轻剂的辛凉药。而且为什么像他所说的，不立即在辛凉轻剂下痊愈呢？
所谓的热入心包，不能说世上没有这种病。然而总不在仅仅称为外感、仅仅病及肺部、仅仅使用这种无名轻剂的时候。所以古人不轻易谈论热入心包。而相信顾氏说法的人，确实如此确凿地言说。追溯其所以有这种著作的原因，是想用他所用的轻剂治好人的病，似乎又想用他所用的犀角治好人的病。乃至于使用他所谓的轻剂，而病不解，逐渐进入营分，血液被劫夺，心神不安，斑点隐隐出现，随即随着他所用的不知是什么成分的轻剂次第而来。那么，使用轻剂而导致津液被劫夺的，轻剂是不可用的了。使用他所谓的犀角而斑出热不退，胃中津液告罄，皮肤冰冷长达一昼夜，仅仅未形成脱证，也随即随着他视同花露一般的犀角次第而来。那么，使用犀角而导致津液告罄的，犀角又是不可用的了。这些都是顾景文自己所说，都是顾景文自己所告诉别人的。医生教导人们必须用此药，教导人们绝不可用他药，不过是因为恐怕用其他药会使病情加重，不过是想以此药使病速愈，不过期望此后种种恶候，一用此药，全部消弭于无形。所以必定谆谆告诫，不怕烦琐言语，馈赠给后学者。而后来的医者，有心济世，乐于为此反复引申，刻印再刻印，使其治病的方法，昭然若揭如同唤醒聋子振聋发聩，并且惟恐其不流传。断无因为使用此法则津液被劫、使用此法则津液亡失，而认为这种劫津亡津的方法有不可以任其不流传的道理。然而后之人，则必定会使用这种方法。一旦使用这种方法，那么所说的津液被劫、津液亡失的情况，就在初用轻剂接着使用犀角时预言而没有不准的，好像有先见之明一样。并担心如果不使用这种方法，那么血液未必一定被劫夺，胃津未必一定告罄，而所谓先见之明，便不会十分稳妥，如何能取信于病家？这就是后来的医者，万万不肯不使用这种方法的原因。人心越虚幻，方法越巧妙。几十年后又有吴鞠通者，吴鞠通就是依据顾景文“温邪上受，首先犯肺，逆传心包”这十二字，而编写了《温病条辨》，自条自辨，可笑至极。
翻开书卷捏造温病以桂枝汤主治为张仲景原文，接着又承袭《指南》的错误，以西昌喻嘉言治疗瘟疫的方法，说是刘河间治疗温病的方法，两方面的失误已不必多说。乃至于把温病的根本在中焦的病，先移到上焦，说切不可使用中焦的药，严厉戒止使用中焦的黄芩、黄连，而其下面紧接着又说：“热邪久留不去，吸烁真阴；邪热久留不去，肌肤甲错”，这都是吴鞠通自己说的，都是吴鞠通自己所告诉别人的。先是自制银翘散、桑菊饮两个方子，即顾景文的辛凉轻剂，但不指名具体药物，而由吴鞠通加以引申。嗣后方名清宫汤，使用犀角、牛黄；方名增液汤，使用玄参、麦冬；以及一甲复脉汤、二甲复脉汤、三甲复脉汤，小定风珠、大定风珠，无非是滋腻伤阴，引邪内陷，病到了这种地步，就无法救治了。而在其中焦篇中，也或许有偶尔使用黄芩、黄连、石膏、黄柏的时候，凡是温病中使用黄芩、黄连、石膏、黄柏，无不具有祛除邪气撤除热势的作用，吴鞠通又像不知道似的。然而如果不是布置在上焦，那么邪热未必久留不去，真阴未必一定被劫夺烧灼；如果不是诃斥黄芩、黄连，那么邪热未必久留不去，肌肤未必一定甲错。顾景文拖延了几天，吴鞠通再加“缓缓”两个字，为什么一定要缓缓呢？不可解而又实在可解。这就是后来的人，也万万不肯不使用这种方法的原因。用滋腻留邪的药物，缓缓地拖延，邪热正盛之时，阴无不伤，病无不死。陶节庵的一提金、杀车锤、截江网，书名极其恶劣。比起一甲、二甲、三甲、定风珠，方名也是极其恶劣的。病是何等大事，医是何等人物，怎么可以儿戏到这种地步呢。（出自《世补斋医书》）
柴达木按：叶派认为温病初起，首先犯肺，治疗上焦如羽毛般轻清，非轻不能举扬，所以开头用药，总是银翘散、桑菊饮之类。陆九芝赞同柯琴“阳明为成温之薮”的说法，认为温病病在阳明，而叶派治在太阴，隔靴搔痒，撤热不力，贻误病机，所以每致步步深入。考证《临证指南医案》中风温、温热各门的治案，其轻者为辨证属热之伤风，其重者为肺胀、肺痹之类。用银翘散、桑菊饮治疗这类病，治疗也未尝错误。然而学习叶氏的人，竟然用这类药移治一切温病，不把事情搞坏是很少见的！伤风、肺胀、肺痹、肺痈等疾病，原本不称为温病，叶氏混称，从此就凭空阑入到温病范围。古之所谓温病，虽然不局限于阳明一经，但以阳明为主，所以陆氏主张从阳明论治。陆氏认为伤风、肺胀之类，只要稍用些能治病的药，就决不致突然进入心包，变成一场大病，以至于死亡。能突然进入心包，变成一场大病，以至于死亡的，决非伤风、肺胀之类。病非伤风、肺胀之类，治疗仍使用治伤风、肺胀之类的药物，自然无效。这些意见，显然是正确的。
再论“温邪上受，首先犯肺，逆传心包”十二字，这十二字是《温证论治》之所以发凡起例的关键。起初并不说邪气为何独伤肺，肺为何突然传心，只说如果论治法，宜用辛凉轻剂。拖延数日，人之病热，以胃为甚。胃热之甚，神志为之昏蒙。从来神昏之病，都属于胃家。即使热果真正进入心脏，也必先病及胃。病如果仅在于肺，则断无神昏之事，也断无入心的道理。乃至于对于明明有神昏的病人，特意将神昏二字始终不提，又明知神昏不属于肺，就暗中将神昏移入于心。其所谓“上受”、“先犯”、“逆传”，都是为了抹杀胃病的原因。再加上“未入心包，邪专在肺”两句，说成此时之病，不是心就是肺，一肺即心，仿佛绝无与阳明胃有关的事情，而“不可用胃药”的话，恰好在此种种胃病之时说出。想要成就一家之言，翻尽千古之局，锻炼周内（罗织罪名），病者不能呼冤。其时病人或为太阳阳明两经递病，或为太阳阳明两经合病。太阳行身之后，由背贯胸；阳明行身之前，由胸彻背。肺为华盖，位在胸背之上，而胸为近处。胃为五脏六腑之海，其清气上注于肺。注者射也，太阳之邪射肺，阳明之邪亦射肺，而阳明为近。所以必须阳明胃之热降，而在上之肺气始安。所病本只在胃，肺仅为病所累。于此而必曰肺病，势必徒用肺药，转将胃之支脉络于心。胃热之最易蒸心者，一任其逼近心包，日逼日近，而神昏益甚。又以为此即心病，此即肺病之传心。轻剂之后，即用犀角，将胃中之药，非特搁置勿道，并且禁绝勿用。遂令胃中射肺之邪，直攻心脏。是其所以逆传者，全赖此药以为之也。夫胃者腑也，肺与心皆脏也。本是腑病，而偏要说成脏病，遂乃舍腑治脏。夫岂有脏腑而可以不分者？人病腑为轻而脏为重。此时一治其腑，病无不除，亦何至领邪入脏，死于非命哉！独无如兔园册子（指浅陋之书），只有顾景文之《温证论治》、吴鞠通之《温病条辨》等物，以为道在是矣。宜乎今日盛名之下，并脏腑之不言也。（出自《世补斋医书》）
柴达木按：根据绍派经验，温热病之神昏谵语者，以“胃热蒸脑”一证为最多。叶派对此，但云“逆传心包”，对胃热蒸脑最多之证，反有所忽略，故陆氏有神昏谵语，悉属于胃之说。但热入心包，是否必有先病及胃这一中心环节，后世有不同意见。余谓陆氏之言，有矫枉过正之嫌，然叶派中人但指责陆氏所见不广，而于其矫枉之旨亦一并抹杀之，则有失持平。温热病之神昏谵语，以属胃热者居多，此系不可否定之事实。柯琴“阳明为成温之薮”的论点，赞同者亦极多。章次公说：“后人欲评前哲之学说，最不可先有成见，成见横梗胸中，其流弊为武断。”通人之论，固名言可采。
世间原有一种肺病，其小者如咳呛、喷嚏、颐肿、喉梗之类，其大者如哮喘、咯血、肺痈、肺痿之类，皆不闻有神昏而至谵妄者。既曰肺病，断不能有神昏；既曰神昏，断不仅为肺病；既不神昏，断不病及心包；既不病心，断不需用犀角。是皆可以理断而不必尽通乎医道者也。鞠通所谓上焦病者，即景文所言之肺；鞠通所谓不可用中焦药者，即景文所不言之胃。乃于景文延之数日上，再加“缓缓”两字。胃不及待，酿成大热。或亦一用膏黄，似乎已胜顾说，而随即以清宫、增液者，使胃病仍归不治。夫人之所病者胃，而医之所言者肺；神之所以能昏者在胃，而医之所以治神昏者在心。类皆善用移字诀，而此之所移，又为移字诀中最大之祸。明明一部《伤寒论》，长留天地间，其于急祛邪热，阴始可保，如仲景之白虎承气汤，小之而一去其热，阴即不伤，如仲景之葛根芩连诸方，辛从甘以化阳，苦从甘以化阴，阴阳和而时雨降，顷刻间有嘘枯振槁之能者，概从摈弃，且若恶闻，岂无意乎？风寒温热寻常病耳，似此恍恍迷离，既令人于伤寒方视若畏途，并以一二肯用伤寒方者，目为怪物。登仁寿而免夭札，只看《伤寒论》之兴替何如。余既合论两家而并畅发此论，所望病家之曾受此害者，一权于肺胃之间，而恍然有悟也。（出自《世补斋医书》）
柴达木按：伤风感冒、气管炎、肺痈这一类病，在古人原不隶属温病范畴。此类病极少逆传心包，产生神昏谵语等种种危象，这在今医，已为常识。乙型脑炎等极易见神昏谵语者，又何尝首先犯肺？陆氏意见，明系可取，惜叶派医者只是挑剔，不肯虚心，则陆氏亦无可奈其何。缪希雍说：“凡作医师，宜先虚怀，灵知空洞，本无一物，苟执我见，便与物对，我见坚固，势必轻人，我是人非，与境角立，一灵空窍，动为所塞，虽日亲至人，终不获益，白首如故，良可悲已。”这话是值得我们深思的。
叶天士先生一代盛名，既为其门下华岫云、邵新甫等人所毁，而顾景文之《温证》，又为章虚谷取而注之，改作《外感温热》。其所以改作外感者，想亦嫌其不类论温，故谓其与仲景伏气之温不同。是则天士之温，本非仲景之温，而虚谷之温，又非天士之温矣。然而换一衣冠，不能使其人之性情面貌因之而皆变也。况果如其外感之说，而意出于天士之意，则天士于《临证指南》既以小风寒抵作伤寒一大法门，天士于《温证论治》又以小风热抵作温热一大法门。所以伤寒一证，至天士而失传；温热一证，亦至天士而失传。而孰知皆非天士之书耶？此之般流直若傀儡登场，沐猴牵线，不使仲景圣道尽归澌灭不止。而王孟英《温热经纬》，尽罗而致之，皆不肯为病者计。呜呼，此中之劫运，其何日已耶。
坊间再有《医效秘传》，亦云是叶先生语，为吴子音所刻。《秘传》已极不堪。至于叶、薛、缪三家医案，非特用药之谬，彼此相似，即词句间亦多有雷同，明是一付笔墨，不问可知其伪。志称薛与叶积不相能，尝自署所居曰扫叶山庄，则岂有薛而肯从叶派者乎？缪则我之自出不闻其有此方案，偏是此种讆言，最易动听，不托于两先生，置之可耳，乃假借大医，使人信从，以售其欺，害斯大矣。末附陆秋山《温热赘言》，则即王孟英所收陈乎伯祖恭语，及章虚谷所指薛氏《湿热条辨》者，一字不移，但改祖恭为余，自称拙著，不值一笑。（出自《世补斋医书》）
柴达木按：章巨膺读以上数篇后曾加按说：“以上数篇，最为精惊，席姓案评，就实指谬。昔孔子成春秋，而乱臣贼子惧。陆氏痛诋叶吴，而江湖庸伧曾不醒悟。所谓道高一尺魔高一丈，正道不克邪魔，致令流毒猖獗至于今日。观今日之域中，尽是邪魔当道，守南阳之宗派者，能有几人？医事败坏，行将渐灭，不亦宜者。”这一按语，措词激烈，在讨论学术中，实不可效法。但前人之愤愤，是环境所促成的，我们不必再为此而深责。叶派中人，若能落落大度，对此不加计较，平心静气地来分析陆九芝等人的学术观，在友好的学术争鸣中来共同研讨外感热病之治法，则于开创新局，振兴中医，必将大有裨益。余撰辑此作，即亦以此为希望。
[Background Information]
Book Title: Re Bing Heng Zheng (Balanced Correction on Febrile Diseases)
Chapter: Main Text (43/49)
Category: Shang Han (Cold Damage)
[Original Text Translation]
Regarding the discussion and treatment of warm diseases, apart from Hua Xiuyun and Shao Xinpu's compilation *Lin Zheng Zhi Nan Yi An* (Clinical Guide to Medical Cases), there is also content by Gu Jingwen, who falsely attributed it to Master Ye Tianshi, which was printed in materials from the Wu Medical Society lectures hosted by Tang Lisan. The preface of Tang's printed edition states: "The Master traveled to Dongting Mountain, and his disciple Gu Jingwen accompanied him on the boat. He recorded the Master's words at that time freely without editing. Consequently, the language was often obscure and difficult to understand, and the sentences were somewhat chaotic, causing readers to feel dazzled. I dared not presume, but privately smoothed out the sentences for clarity and made slight adjustments to the order, only making the obscure clear, and did not dare change even a single word of the Master's main arguments." Based on this, although Tang had already edited and polished it, it remains so unacceptable. Then what must Gu Jingwen's original text have been like? Unexpectedly, by claiming the name of a great physician, it could circulate in the world. It was printed by Zhuchun Xianguan, by Baishi Shanfang, and again by Zhongfutang. Yet the harm it caused to patients was so immense. Gu's record was titled *Wen Zheng Lun Zhi* (Discussion on the Treatment of Warm Disorders). Zhang Xugu was pleased to annotate it, changing its title to *Wai Gan Wen Re* (Exogenous Warmth-Heat). Wang Mengying was also pleased to adopt its theory, believing that Zhang Zhongjing discussed warmth-heat as latent qi disease, while Ye Tianshi discussed warmth-heat as exogenous disease. Therefore, he highlighted the twelve characters "Warm pathogenic factors enter from above, first attacking the Lung, and reversely transmitting to the Pericardium" at the beginning of the chapter to distinguish himself. If this were true, then the so-called warmth-heat disease would merely be a minor cold, commonly known as minor wind-heat or minor wind-warmth, such as red eyes, swollen cheeks, throat obstruction, or toothache. Such conditions would heal immediately with mild acrid-cool formulas. However, why do they suddenly enter the Pericardium within a few days, becoming a severe illness leading to death? If the disease enters the Heart and causes death immediately without waiting several days, it certainly cannot be as he said, requiring only mild acrid-cool agents. Moreover, why does it not heal immediately under these mild acrid-cool agents as he claims?
The so-called heat entering the Pericardium should not be said to not exist in the world. However, it generally does not occur when one merely labels it as exogenous, when the pathology is limited only to the Lung, or when using such nameless mild agents. Thus, ancients did not lightly speak of heat entering the Pericardium. Those who believe Gu's statements assert them with such certainty. Tracing the reason for such works, it seems they wished to cure people with the mild agents they used, and seemingly also wished to cure people with the rhinoceros horn they used. When using his so-called mild agents, the disease does not resolve; gradually, it enters the Ying (Nutritive) level, blood is depleted, the Spirit becomes unsettled, and rashes appear faintly. These symptoms follow sequentially according to the unknown ingredients of his mild agents. Therefore, if mild agents deplete fluids, mild agents are unusable. If using his so-called rhinoceros horn results in rashes appearing but heat persisting, and stomach fluids are exhausted, with skin becoming cold for up to twenty-four hours, narrowly avoiding collapse, these outcomes also follow sequentially according to his rhinoceros horn, which he treats like flower dew. Therefore, if rhinoceros horn exhausts fluids, rhinoceros horn is unusable. All these are what Gu Jingwen himself said and told others. Physicians teach people to use specific medicines and forbid others because they fear other medicines will worsen the condition, hoping this medicine will cure quickly, expecting all subsequent adverse signs to vanish instantly upon using this medicine. Hence, they earnestly warn, not sparing verbose advice, to instruct future learners. Later physicians, intending to benefit the world, are happy to elaborate repeatedly, printing and reprinting, making their curing methods clear as if awakening the deaf and startling the dull, fearing they will not spread. There is absolutely no reason to think that methods causing fluid depletion and exhaustion should be withheld from transmission. Yet later practitioners inevitably use these methods. Once used, the predicted fluid depletion and exhaustion occur precisely when initially using mild agents followed by rhinoceros horn, proving accurate as if having foresight. They fear that if these methods are not used, blood might not necessarily be depleted, and stomach fluids might not necessarily be exhausted, making their supposed foresight less reliable, thus failing to gain the trust of patients. This is why later physicians are unwilling to abandon these methods. As human minds become more illusory, methods become more ingenious. Decades later, Wu Jutong appeared. Wu based his *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases) on Gu Jingwen's twelve characters "Warm pathogenic factors enter from above, first attacking the Lung, and reversely transmitting to the Pericardium," creating self-referential distinctions, which is laughable.
Opening the book, he fabricates that Zhang Zhongjing originally stated warm diseases should be treated with Guizhi Tang (Cinnamon Twig Decoction). He then continues the error of the *Guide*, attributing Yu Chang's method for treating plague to Liu Wansu's method for treating warmth. Both errors need not be elaborated. He moves the root of warm diseases, which lies in the Middle Jiao, to the Upper Jiao, stating strictly that Middle Jiao medicines must not be used, severely warning against Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome). Yet immediately below, he says: "If pathogenic heat lingers for a long time, it consumes True Yin; if pathogenic heat lingers for a long time, the skin becomes scaly." These are words spoken by Wu Jutong himself to others. First, he created two formulas, Yinqing San (Honeysuckle and Forsythia Powder) and Sangju Yin (Mulberry Leaf and Chrysanthemum Drink), which correspond to Gu Jingwen's mild acrid-cool agents but do not name specific herbs, extending Gu's ideas. Subsequently, he named formulas Qinggong Tang (Clear the Palace Decoction) using Xijiao (Rhinoceros Horn) and Niuhuang (Calculus Bovis); Zengye Tang (Increase Fluids Decoction) using Xuanshen (Scrophularia Root) and Maidong (Ophiopogon Tuber); as well as Yijia Fumai Tang, Erjia Fumai Tang, Sanjia Fumai Tang, Xiaodingfeng Zhu, and Dadingsheng Zhu. These are nothing but cloying and yin-damaging, drawing pathogens inward. At this stage, the disease is incurable. Although in his Middle Jiao section, he occasionally uses Huang Qin, Huang Lian, Shigao (Gypsum), and Huangbo (Phellodendron Bark), whenever these are used in warm diseases, they effectively dispel pathogens and remove heat. Wu Jutong acts as if unaware of this. However, if the strategy is not deployed in the Upper Jiao, pathogenic heat may not linger long, and True Yin may not necessarily be consumed. If he did not condemn Huang Qin and Huang Lian, pathogenic heat might not linger, and skin scaling might not occur. Gu Jingwen delayed for several days; Wu Jutong added the word "slowly." Why must it be slow? It is inexplicable yet truly explicable. This is why those after Wu Jutong are also unwilling to abandon these methods. Using cloying medicines that retain pathogens to slowly delay the process, when pathogenic heat is flourishing, Yin is invariably damaged, and the disease invariably leads to death. Tao Jianan's titles *Yi Ti Jin*, *Sha Che Chui*, and *Jie Jiang Wang* are extremely malicious. Compared to Yijia, Erjia, Sanjia, and Dingfeng Zhu, their names are equally malicious. Disease is a serious matter; physicians are important figures. How can they treat it so frivolously? (From *Shi Bu Zhai Yi Shu*)
Chai Da Mu notes: The Ye school believes that at the onset of warm diseases, the pathogen first attacks the Lung. Treating the Upper Jiao requires lightness, like feathers; only light substances can lift. Therefore, initial medications are always Yinqing San (Honeysuckle and Forsythia Powder) or Sangju Yin (Mulberry Leaf and Chrysanthemum Drink). Lu Jiuzhi agrees with Ke Qin's view that "the Yangming channel is the breeding ground for warm diseases." He believes warm diseases reside in the Yangming, whereas the Ye school treats the Taiyin. This is scratching an itch through a boot—ineffective in removing heat—and missing the opportunity for treatment, leading to progressive deterioration. Examining cases of Wind-Warmth and Warmth in *Lin Zheng Zhi Nan Yi An*, mild cases are diagnosed as wind-cold with heat, while severe cases involve Lung Distension or Lung Bi. Using Yinqing San or Sangju Yin for these conditions is not necessarily erroneous. However, students of Ye Tianshi apply these drugs to all warm diseases, which almost inevitably leads to failure. Wind-cold, Lung Distension, Lung Bi, and Lung Abscess were originally not classified as warm diseases. Ye Tianshi conflated them, thereby arbitrarily expanding the scope of warm diseases. Ancient definitions of warm diseases, though not limited to the Yangming channel, primarily focused on it. Thus, Lu advocated treating from the Yangming perspective. Lu believed that for wind-cold or Lung Distension, using appropriate medication would prevent sudden entry into the Pericardium, severe illness, and death. Conditions leading to sudden Pericardium involvement, severe illness, and death are definitely not simple wind-cold or Lung Distension. Treating non-wind-cold/Lung Distension conditions with wind-cold/Lung Distension medications is naturally ineffective. These opinions are clearly correct.
Re-discussing the twelve characters "Warm pathogenic factors enter from above, first attacking the Lung, and reversely transmitting to the Pericardium": These twelve characters form the premise of *Wen Zheng Lun Zhi*. Initially, it does not explain why the pathogen uniquely injures the Lung or why the Lung rapidly transmits to the Heart. It only states that for treatment, mild acrid-cool agents should be used. After several days, human fever is most severe in the Stomach. Extreme Stomach heat causes spiritual confusion. Historically, spiritual confusion belongs to the Stomach organ system. Even if heat truly enters the Heart, it must first affect the Stomach. If the disease is solely in the Lung, there is absolutely no spiritual confusion, nor any logic for entering the Heart. Yet, for patients clearly exhibiting spiritual confusion, the term "spiritual confusion" is never mentioned. Knowing spiritual confusion does not belong to the Lung, they secretly attribute it to the Heart. Terms like "entering from above," "first attacking," and "reversely transmitting" serve to erase the cause of Stomach disease. Adding "not yet entered the Pericardium, pathogen exclusively in the Lung" creates the illusion that the disease is either Heart or Lung, equating Lung with Heart, implying no relation to the Yangming Stomach. Statements forbidding Stomach medicines appear precisely during these Stomach-related conditions. To establish a unique doctrine and overturn millennia of precedent, manipulating facts makes patients unable to appeal. At that time, patients might have sequential diseases involving both Taiyang and Yangming channels, or combined diseases of both. The Taiyang channel runs along the back, passing through the chest; the Yangming channel runs along the front, passing through the chest and back. The Lung, as the Canopy, sits above the chest and back, closer to the chest. The Stomach is the Sea of the Five Zang and Six Fu organs; its clear Qi ascends to the Lung. "Ascending" implies shooting/projecting. Taiyang pathogens project to the Lung, and Yangming pathogens also project to the Lung, with Yangming being closer. Therefore, Yangming Stomach heat must descend for Upper Lung Qi to settle. The disease fundamentally resides in the Stomach, with the Lung merely affected. Insisting on Lung disease leads to using only Lung medicines, transferring Stomach collateral pathways to the Heart. Stomach heat easily steams the Heart. Allowing it to approach the Pericardium day by day increases spiritual confusion. Claiming this is Heart disease or Lung disease transmitting to the Heart, after using mild agents, they immediately use rhinoceros horn. Stomach medicines are not only ignored but banned. This allows pathogens projecting from the Stomach to the Lung to attack the Heart directly. This "reverse transmission" relies entirely on these medicines. The Stomach is a Fu organ; the Lung and Heart are Zang organs. It is fundamentally a Fu disease but claimed as a Zang disease. Abandoning Fu to treat Zang ignores the distinction between Zang and Fu. Diseases in Fu are lighter; diseases in Zang are heavier. Treating the Fu at this stage would eliminate the disease, preventing pathogens from entering the Zang and causing untimely death. Unfortunately, shallow texts like Gu Jingwen's *Wen Zheng Lun Zhi* and Wu Jutong's *Wen Bing Tiao Bian* dominate, ignoring the Dao. Under today's fame, even the distinction between Zang and Fu is ignored. (From *Shi Bu Zhai Yi Shu*)
Chai Da Mu notes: According to Shao school experience, spiritual confusion and delirious speech in warm diseases are most frequently caused by "Stomach heat steaming the Brain." The Ye school only mentions "reverse transmission to the Pericardium," neglecting the prevalent "Stomach heat steaming the Brain." Thus, Lu's assertion that all spiritual confusion and delirium belong to the Stomach. Whether heat entering the Pericardium necessarily involves prior Stomach disease as a central link is debated. I believe Lu's statement risks overcorrection. However, Ye school members criticizing Lu for narrow vision while dismissing his corrective intent lacks balance. It is an undeniable fact that most cases of spiritual confusion and delirium in warm diseases belong to Stomach heat. Many agree with Ke Qin's point that "the Yangming channel is the breeding ground for warm diseases." Zhang Cigong said, "When evaluating predecessors' theories, one must not hold preconceptions. Preconceptions lead to dogmatism." This wise remark is worthy of adoption.
Re-discussing the principle that Stomach disease causes spiritual confusion while Lung disease does not:
There are indeed Lung diseases in the world. Minor ones include coughing, sneezing, cheek swelling, and throat obstruction. Major ones include asthma, hemoptysis, Lung abscess, and Lung atrophy. None are heard of causing spiritual confusion leading to delirium. If it is Lung disease, it definitely cannot cause spiritual confusion. If there is spiritual confusion, it is definitely not just Lung disease. If there is no spiritual confusion, it definitely does not involve the Pericardium. If it does not involve the Heart, rhinoceros horn is definitely unnecessary. These can be judged by reason without needing full medical expertise. Wu Jutong's "Upper Jiao disease" refers to Gu Jingwen's Lung. His "forbidden Middle Jiao medicines" refer to Gu's unmentioned Stomach. Building on Gu's delay of several days, Wu adds "slowly." The Stomach cannot wait, brewing severe heat. Perhaps using Gypsum and Coptis seems to surpass Gu's claim, but immediately following with Qinggong and Zengye leaves Stomach disease untreated. The patient suffers from Stomach disease, but the physician speaks of Lung disease. Spiritual confusion originates in the Stomach, but the physician treats it via the Heart. All employ the trick of shifting terminology, and this shift causes the greatest disaster. The *Shang Han Lun* remains in the world. Urgently dispelling pathogenic heat preserves Yin. For example, Zhang Zhongjing's Baihu Tang and Chengqi Tang, or smaller doses where removing heat protects Yin, such as Gegen Qinlian Tang. Acrid transforms Yang via Sweet; Bitter transforms Yin via Sweet. When Yin and Yang harmonize, timely rain falls, achieving miraculous recovery instantly. These are discarded and despised. Is this intentional? Wind-cold and warmth-heat are common diseases. Such ambiguity makes Shang Han formulas seem like a fearful path, labeling those who use them as monsters. Achieving longevity and avoiding premature death depends on the rise and fall of the *Shang Han Lun*. Having discussed both schools and voiced this argument, I hope patients who suffered from this harm will weigh between Lung and Stomach and have an epiphany. (From *Shi Bu Zhai Yi Shu*)
Chai Da Mu notes: Diseases like wind-cold, bronchitis, and lung abscess were not originally categorized under warm diseases in ancient times. Such diseases rarely reverse-transmit to the Pericardium, producing critical signs like spiritual confusion and delirium, which is common knowledge among modern physicians. Epidemic encephalitis B, which easily presents with spiritual confusion and delirium, hardly starts by attacking the Lung first. Lu's opinion is clearly acceptable. It is a pity that Ye school physicians are merely critical and unwilling to be humble, leaving Lu helpless. Miao Xiyong said: "Physicians should be humble, empty and clear, possessing nothing. If holding onto personal views, one opposes external things. Firm personal views lead to despising others, asserting self-righteousness, blocking the spirit. Even daily visiting sages brings no benefit, remaining unchanged until old age, truly pitiable." This warrants deep reflection.
On Zhang Xugu's *Wai Gan Wen Re*:
Master Ye Tianshi's generation-defining reputation was ruined by his disciples Hua Xiuyun and Shao Xinpu. Gu Jingwen's *Wen Zheng* was annotated by Zhang Xugu and retitled *Wai Gan Wen Re*. The reason for changing it to "exogenous" was likely dissatisfaction with its resemblance to discussing warmth, claiming it differs from Zhang Zhongjing's latent qi warmth. Thus, Tianshi's warmth was not Zhongjing's warmth, and Xugu's warmth was not Tianshi's warmth. Changing clothes does not change a person's nature or appearance. If his exogenous theory aligns with Tianshi's intent, then Tianshi treated minor wind-cold as major Cold Damage in *Lin Zheng Zhi Nan*, and minor wind-heat as major Warmth in *Wen Zheng Lun Zhi*. Thus, Cold Damage was lost under Tianshi, and Warmth was also lost under Tianshi. Who knows these are not Tianshi's books? Such flow resembles puppets on stage, monkeys pulling strings, ensuring Zhongjing's sacred way is completely extinguished. Wang Mengying's *Wen Re Jing Wei* collects all this, disregarding patients' interests. Alas, when will this calamity end?
Another book, *Yi Xiao Mi Chuan*, also claims to be Master Ye's words, printed by Wu Ziyin. *Mi Chuan* is extremely unacceptable. Regarding the medical cases of Ye, Xue, and Miao, not only are their medication errors similar, but their wording is also largely identical, clearly using the same penmanship, revealing their falsity. Records state Xue and Ye were incompatible, with Xue naming his residence "Sao Ye Shan Zhuang." Would Xue ever join the Ye school? Miao's origin is unknown, and there is no record of such cases. Yet these rumors are pleasing to hear. Not attributing them to the two masters would suffice, but borrowing great physicians' names deceives people and sells fraud, causing great harm. The appendix Lu Qiushan's *Wen Re Zhui Yan* copies Chen Hugong's words collected by Wang Mengying and Zhang Xugu's references to Xue's *Shi Re Tiao Bian*, word for word, changing Hugong to "I" and calling it my clumsy work, unworthy of a smile. (From *Shi Bu Zhai Yi Shu*)
Chai Da Mu notes: After reading the above articles, Zhang Juying added a note: "The above articles are most profound. Mr. Xi's commentary points out errors realistically. Confucius wrote the *Spring and Autumn Annals*, making treacherous ministers afraid. Lu fiercely criticized Ye and Wu, but mediocre doctors in the jianghu remain unawakened. As the saying goes, 'The Way rises one foot, the demon rises ten feet.' Righteousness fails to overcome demons, allowing poison to rage to this day. Looking at the world today, demons rule everywhere. How many guard the lineage of Zhang Zhongjing? Medical affairs are ruined, heading towards extinction, is this not fitting?" This note is harsh and should not be emulated in academic discussion. However, previous indignation was driven by circumstances, and we need not blame them deeply. If Ye school members were magnanimous,不计较 this, calmly analyzing Lu Jiuzhi's academic views, and jointly discussing exogenous febrile disease treatments in friendly academic debate, it would greatly benefit opening new situations and revitalizing Traditional Chinese Medicine. I compile this work with this hope.
Refutation of Wu Jutong's Fallacious Three Jiao Theory