热达于表又重伤表气故不禁风寒非伤风恶风伤寒恶寒也但卫虚则恶风荣虚则恶寒耳且温病热病亦有先见表证而后传里
者盖怫热自内达外热郁腠理不得外泄遂复还里而成可攻之证非如伤寒从表而始也或者不悟此理乃于春夏温病热病而求
浮紧之脉不亦疏乎殊不知紧为寒脉有寒邪则见之无寒邪则不见也其温病热病或见紧脉者乃重感不正之暴寒与内伤过度
之冷食也岂其本然哉又或者不识脉形但见弦便呼为紧断为寒而妄治盖脉之盛而有力者每每兼弦岂可错认为紧而断为寒
夫温病热病之脉多在肌肉之分而不甚浮且右手反盛于左手者诚由怫热在内故也其或左手盛或浮者必有重感之风寒否则
非温病热病自是暴感风寒之病耳凡温病热病若无重感表证虽间见而里病为多故少有不渴者斯时也法当治里热为主而解
表兼之亦有治里而表自解者余每见世人治温热病虽误攻其里亦无大害误发其表变不可言此足以明其热之自内达外矣其
间有误攻里而致大害者乃春夏暴寒所中之疫证邪纯在表未入于里故也不可与温病热病同论夫惟世以温病热病混称伤寒
故每执寒字以求浮紧之脉以用温热之药若此者因名乱实而戕人之生名其可不正乎又方书多言四时伤寒故以春夏之温病
热病与秋冬之伤寒一类视之而无所别夫秋冬之伤寒真伤寒也春夏之伤寒寒疫也与温病热病自是两涂岂可同治吁此弊之
来非一日矣虽然伤寒与温病热病其攻里之法若果是以寒除热固不必求异其发表之法断不可不异也况伤寒之直伤阴经与
太阳虽伤不及郁热即传阴经为寒证而当温者又与温病热病大不同其可妄治乎或者知一不知二故谓仲景发表药今不可用
而攻里之药乃可用呜呼其可用不可用之理果何在哉若能辨其因正其名察其形治法其有不当者乎彼时行不正之气所作及
重感异气而变者则又当观其何时何气参酌伤寒温热病之法损益而治之尤不可例以仲景即病伤寒药通治也
热邪到达体表，又严重损伤了表气，所以患者无法抵御风寒。这不同于伤风病的恶风（怕风吹）和伤寒病的恶寒（怕冷）。只是卫气虚弱就会恶风，营气虚弱就会恶寒罢了。况且温病、热病也有先出现表证，然后传入里证的。这是因为郁热从内部达于外部，热邪郁结在腠理（皮肤纹理及汗孔），不能向外宣泄，于是又返回体内，形成了可以使用攻下法的证候。这与伤寒从体表开始发病不同。
有些人不明白这个道理，竟然在春夏季节的温病、热病中寻求浮紧脉象，这不是太疏忽了吗？殊不知，“紧”是寒脉，有寒邪才会出现，没有寒邪就不会出现。那些温病、热病中出现紧脉的，是因为再次感受了不正之气的暴寒，或者因为内伤过度食用了冷食所致，难道这是它们的本来面目吗？
又或者有人不认识脉象形态，只要见到“弦”脉就称之为“紧”，断定为寒证而胡乱治疗。其实脉象盛大而有力量时，往往兼带弦象，怎么可以错认为是紧脉而断定为寒证呢？
温病、热病的脉象多在肌肉之分，而不甚浮起，且右手脉反而强于左手脉，这确实是因为郁热在内部的缘故。如果左手脉盛或浮起，那必定是再次感受了风寒，否则就不是温病、热病，而是突然感受风寒的疾病了。凡是温病、热病，如果没有再次感受表证，虽然偶尔见表证，但里证居多，所以很少有口渴不明显的情况。此时治法应当以清治里热为主，兼以解表。也有通过治疗里热而使表证自解的情况。
我常常见到世人治疗温热病，即使误用攻下法治疗里证，也没有大害；但如果误用发汗法治疗表证，变证就不可胜言了。这足以证明热邪是从内部达于外部的。
其中也有因误攻里而导致大害的，那是春夏季节被暴寒所中的疫证，邪气纯在体表，未进入体内，所以不可以与温病、热病混为一谈。
世人将温病、热病混称为伤寒，因此常常执着于“寒”字去寻求浮紧脉象，并使用温热性质的药物。像这样因为名称混乱而损害实质，从而残害人的性命，这个名称怎么能不纠正呢？
另外，医书中多讲四时伤寒，所以把春夏的温病、热病与秋冬的伤寒看作一类而没有区别。其实，秋冬的伤寒是真伤寒，春夏的伤寒是寒疫，它们与温病、热病本是两条不同的路径，怎么可以同样治疗呢？唉，这种弊病由来已久了。
虽然如此，伤寒与温病、热病在攻里的治法上，如果确实是用寒凉药来清除热邪，固然不必强求不同；但在发表的治法上，绝对不可以相同。况且伤寒直接损伤阴经，以及太阳经虽受邪但未致郁热即传入阴经成为寒证而需要用温法治疗的，又与温病、热病大不相同，怎么可以胡乱治疗呢？
有些人知其一不知其二，认为张仲景的发表药物现在不可使用，而攻里的药物才可使用。唉，这可用与不可用的道理究竟在哪里呢？
如果能辨别病因，端正名称，观察脉形，制定治法，难道还有不当的吗？至于那些由时行不正之气所作，以及再次感受异气而发生变化的病症，则应当观察是何时、何种气机，参照伤寒和温热病的治法进行增减调整来治疗，尤其不可以简单地用张仲景治疗即病伤寒的药物通治所有情况。
Heat reaches the exterior and severely damages the Wei Qi (Defensive Qi), thus failing to resist wind and cold. This is distinct from Shang Feng (Wind Strike) characterized by aversion to wind, and Shang Han (Cold Damage) characterized by aversion to cold. Merely, deficiency of Wei Qi leads to aversion to wind, while deficiency of Ying Qi (Nutritive Qi) leads to aversion to cold. Furthermore, Wen Bing (Warm Diseases) and Re Bing (Heat Diseases) may also initially present with exterior syndromes before transmitting inward. This occurs because constrained heat originates internally and reaches the exterior; heat stagnates in the Cou Li (skin pores and interstices) without being able to vent outward, subsequently returning inward to form a syndrome amenable to purgation. This differs from Shang Han, which begins at the exterior.
Some individuals fail to comprehend this principle and seek a Floating-Tight pulse (Fu Jin Mai) in the warm and heat diseases of spring and summer, which is indeed negligent. It must be understood that "Tight" is a pulse indicating cold; it appears only when cold pathogenic factors are present and does not appear otherwise. The occurrence of a Tight pulse in Wen Bing or Re Bing is due to secondary exposure to sudden cold from abnormal climatic factors, or excessive internal injury caused by consuming cold food. Is this their inherent nature?
Alternatively, some lack knowledge of pulse morphology; upon perceiving a Wiry pulse (Xian Mai), they mislabel it as Tight and diagnose it as Cold, administering inappropriate treatment. Often, pulses that are vigorous and forceful also exhibit a Wiry quality; how can one mistake them for Tight and diagnose Cold?
The pulses of Wen Bing and Re Bing are typically located at the level of the muscles rather than being superficially floating, and the Right Hand pulse is often stronger than the Left Hand pulse. This is indeed due to constrained heat residing internally. If the Left Hand pulse is strong or floating, it indicates secondary exposure to wind and cold; otherwise, it is not Wen Bing or Re Bing, but a disease caused by sudden exposure to wind and cold. In cases of Wen Bing or Re Bing without secondary exterior exposure, although exterior signs may occasionally appear, interior syndromes predominate; thus, thirst is rarely absent. At this stage, the treatment method should primarily focus on clearing interior heat, accompanied by resolving the exterior. There are also instances where treating the interior resolves the exterior spontaneously.
I frequently observe that when physicians treat warm-heat diseases, even if they mistakenly use purgation for the interior, there is usually no severe harm. However, if they mistakenly use diaphoresis (sweating methods) for the exterior, the resulting complications are incalculable. This sufficiently demonstrates that the heat originates from within and extends outward.
Among these, those who suffer severe harm from mistaken purgation are suffering from Yi Zheng (Epidemic Patterns) struck by sudden cold in spring and summer, where the pathogen resides purely in the exterior and has not entered the interior. Therefore, they cannot be discussed together with Wen Bing or Re Bing.
Since the world conflates Wen Bing and Re Bing under the term Shang Han, people often cling to the character "Cold" to seek a Floating-Tight pulse and employ warm-hot medications. Such practices confuse names with reality and endanger lives; how can such nomenclature not be corrected?
Furthermore, medical texts often discuss Four Seasons Shang Han, categorizing the warm and heat diseases of spring and summer alongside the cold damage of autumn and winter without distinction. However, the cold damage of autumn and winter is True Shang Han, whereas the cold damage of spring and summer is Han Yi (Cold Epidemic). These are distinct from Wen Bing and Re Bing and should not be treated identically. Alas, this malpractice has existed for a long time.
Nevertheless, regarding the method of purging the interior for Shang Han versus Wen Bing/Re Bing, if the goal is indeed to eliminate heat with cold herbs, there is no need to seek difference. However, the method of releasing the exterior must absolutely differ. Moreover, Shang Han directly injuring the Yin Channels, or Tai Yang (Greater Yang) channel involvement where heat does not constrain but transmits to Yin channels becoming a Cold Syndrome requiring warming, is vastly different from Wen Bing and Re Bing. How can such conditions be treated recklessly?
Some know one aspect but not the other, claiming that Zhang Zhongjing's exterior-releasing formulas are now unusable, while purgatory formulas are usable. Oh, what is the rationale behind what is usable and what is not?
If one can discern the etiology, correct the nomenclature, examine the pulse morphology, and formulate appropriate treatments, would there be any impropriety? As for diseases caused by epidemic abnormal qi, or those transformed by secondary exposure to different pathogens, one must observe the timing and specific pathogenic factors, referring to the methods of Shang Han and Warm-Heat Diseases for modification and treatment. One must especially avoid indiscriminately using Zhang Zhongjing's formulas for immediate-onset Shang Han to treat all cases.