（一名风温兼寒。俗称风寒包火。）
【因】伏气温病。感冷风搏引而发。或天时温暖。感风寒郁而暴发。一为伏气。一
为新感。病因不同。病势亦轻重迥异。
【证】冷风引发伏温者。初起必头疼身热。微恶风寒。继则灼热自汗。渴不恶
寒。咳嗽心烦。尺肤热甚。剧则鼻鼾多眠。语言难出。状如惊痫。手足螈 。面若火熏
。舌苔初则白薄。边尖红燥。继即舌赤苔黄。甚或深红无苔。风寒搏束温邪者。初
起头痛怕风。恶寒无汗。继即身热咳嗽。烦渴自汗。咽痛喉肿。舌苔白燥边红。甚则白
燥起刺或
由白而转黄。
【脉】右寸浮洪。左弦缓者。此新感引动伏气。仲景所谓发汗已。身灼热者。名曰
风温是也。甚则寸尺浮洪。且盛而躁。乃外风引动内热。仲景所谓伤寒七八日不解。时
时恶风。舌上干燥。大渴而烦。欲饮水数升者。热结在里。表里俱热是也。若右浮数。
左弦紧。乃外寒束搏内热。仲景所谓心烦口渴。背微恶寒者是也。发汗后。脉转浮洪有
力。仲景所谓服桂枝汤大汗出后。大烦渴不解。脉洪大者是也。
【治】冷风引发伏热。先与葱豉桔梗汤。轻清疏风以解表。继与新加白虎汤。辛
凉泄热以清里。里热大盛。已见风动螈 者。速与羚角钩藤汤。甘咸静镇以熄风。终与
人参白虎汤。加鲜石斛、梨汁、蔗浆等。甘寒救液以善后。若风寒搏束内热。先与
新加三拗汤。减轻麻黄。重加牛蒡。微散风寒以解表。继与连翘栀豉汤。加嫩桑芽鲜竹
叶。轻泄温邪以清里。其间痰多者。加淡竹沥（两瓢）、生姜汁（两滴、和匀、同冲）
。食滞者加生萝卜汁（两大瓢）、枳实汁（两小瓢、和匀、同冲）。见疹者加炒牛
蒡（三钱）、活水芦笋。（一两）。喉痛者。加金果榄（一钱）、安南子（三枚）、
制月石（五分）、吹加味冰硼散（冰片一分、硼砂一钱、风化硝、山豆根、青黛、胆矾
、牛黄各二分、吹喉最效、如痰涎壅塞、以鹅翎蘸桐油和皂荚末少许探吐、喉已成痈
者、以喉针刺患处流脓、脓净自愈）。总以整肃肺胃为要法。
【秀按】风温四时皆有。惟春为甚。新感从口鼻而内袭三焦。伏气多匿于膜原。或
内舍于营。二证属于肺胃者。照俞君按证施治。自能奏效。若邪伏膜原。初用微发其汗
后。风寒之表邪虽解。而膜原之伏邪。尚欲出而
不能遽出。证必寒热如疟。胸膈痞满。心中懊 。呕吐不食。速用柴胡达原饮。开达膜
原。使伏邪外溃。热从外透。此时辨其为燥热。则用新加白虎汤。辛凉甘寒以清泄之。
为湿热。则用增减黄连泻心汤。苦辛淡渗以清利之。如有下证。辨其轻重缓急。酌用诸
承气法引而竭之。若内舍于营。证较膜原伏邪为尤急。初用葱豉桔梗汤。辛凉发汗后。
表邪虽解。临时热退身凉。而胸腹之热不除。继即灼热自汗。烦躁不寐。神识时清时昏
。夜多谵语。脉数舌绛。甚则肢厥脉陷。急宜清透营热。使伏热转出气分。气宣卫泄。
或从疹 而解。或从狂汗而解。轻则玳瑁郁金汤。重则犀地清络饮。皆可选用。剧则紫
雪品行军散。历验如神。
【廉勘】伏温自内发。风寒从外搏。而为内热外寒之证者。予治甚多。重则麻杏石
甘汤。加连翘、牛蒡、桑叶、丹皮。轻则桑菊饮加麻黄。惟麻黄用量极轻。约二分至三
分为止。但取其轻扬之性。疏肺透表。效如桴鼓。奈吴鞠通。温病初起恶风寒者。主用
桂枝汤解肌。岂知桂枝辛热灼营。温病忌用。洄溪批叶案云。风温证服桂枝生姜。必吐
血。甚则失音。吴氏岂未之见耶。宜乎梦隐讥其诬圣误世也。鞠通又谓温病忌汗。最喜
解肌。予读《伤寒论》。病患脏无他病条。发汗则愈。病常自汗出条。须发其汗则愈。
并主桂枝汤。可见桂枝汤是风寒发汗之剂。非外寒搏内热之剂也。王大昌谓鞠通温病条
辨一书。以桂枝汤为治温首方。更属可议。洵不诬焉。
【荣斋按】张畹香温暑医旨说∶“风温分三焦治，葳蕤汤、苇茎汤、银翘散、白虎
汤上焦药也；黄芩汤提少阴邪并肺而祛之，亦上焦药也；至宝丹、紫雪、牛黄丸，芳香
开窍，心宫药，心肺同属上焦药也。凉膈散，由上焦至中下焦药也。舌黄滑浓，痰多，
用象贝，蒌仁，或葶苈大枣汤，皆肺分下药也。叶氏所云“忌下”者，不用承气耳。予
逢夹少阳邪者加柴胡，其头痛由于血虚者，用芎归无不效。风温有夹食者，予亦不用消
导，以风能消谷，即油腻浓味，不过多痰，祛其痰可也；若凑入消导，勉强成方，即属
误事。又叶案中有风温劫伤阴津，用生地、阿胶、麦冬、白芍、炙甘草、蔗浆，又或用
沙参、麦冬、玉竹，其大旨总以甘药为主。若辛温表
散，或刚燥消导，未有不伤及阴液者；其骤变为痉厥，缓变为虚劳，皆未经顾及阴分之
过耳。按张氏为清代嘉、道、咸、同年间（1796─1870）人，世居绍兴洗马池头；曹炳章
先生称他为∶“古越治伤寒温暑之前辈，于医学富有经验。”（见张氏《温暑医旨》提
要）这篇学说，是张氏对风温治法的经验总结，当然是可靠的。
【病因】属于伏气温病。因感受冷风搏引而发作；或者是天时温暖，感受风寒导致郁热暴发。前者为伏气致病，后者为新感致病。病因不同，病势的轻重也截然不同。
【证候】由冷风引发伏温者，初起必然头痛、身体发热、轻微恶风恶寒。随后出现高热、自汗、口渴但不恶寒、咳嗽心烦、尺部皮肤灼热严重。病情剧烈时，出现鼻鼾、多睡、言语困难，症状类似惊痫抽搐，面色像被火熏过一样红赤。舌苔起初白薄，边缘和舌尖红燥，随后变为舌质红赤、苔黄，甚至深红无苔。由风寒束缚温邪者，初起头痛怕风、恶寒无汗，随后身体发热、咳嗽、烦躁口渴、自汗、咽喉疼痛肿胀。舌苔白燥且边缘红，严重时白燥起刺或由白转黄。
【脉象】右寸脉浮洪，左脉弦缓的，这是新感引动伏气。即张仲景所说的“发汗后，身体灼热的，名叫风温”。严重时寸部和尺部脉象都浮洪，且盛大躁动，这是外风引动内热。即张仲景所说的“伤寒七八日未解，时时恶风，舌上干燥，大渴心烦，想喝几升水的”，这是热结在里，表里俱热。如果右脉浮数，左脉弦紧，这是外寒束缚内热。即张仲景所说的“心烦口渴，背部轻微恶寒”的情况。发汗后，脉象转为浮洪有力，即张仲景所说的“服用桂枝汤大汗出后，大烦渴不解，脉象洪大”的情况。
【治法】冷风引发伏热，先用葱豉桔梗汤，轻清疏风以解表。接着用新加白虎汤，辛凉泄热以清里。如果里热极盛，已经出现风动抽搐的症状，迅速给予羚角钩藤汤，甘咸静镇以熄风。最后用人参白虎汤，加入鲜石斛、梨汁、蔗浆等，甘寒救阴液以善后调理。如果是风寒束缚内热，先用新加三拗汤，减轻麻黄的用量，重加牛蒡子，微散风寒以解表。接着用连翘栀豉汤，加入嫩桑芽、鲜竹叶，轻泄温邪以清里。期间痰多的，加淡竹沥（两瓢）、生姜汁（两滴，混合均匀，同冲服）。有食滞的，加生萝卜汁（两大瓢）、枳实汁（两小瓢，混合均匀，同冲服）。出疹子的，加炒牛蒡子（三钱）、活水芦笋（一两）。咽喉痛的，加金果榄（一钱）、安南子（三枚）、制月石（五分），吹喉用加味冰硼散（冰片一分、硼砂一钱、风化硝、山豆根、青黛、胆矾、牛黄各二分，吹喉效果极佳；如果痰涎壅塞，用鹅毛蘸桐油和少许皂荚末探吐；如果喉咙已成痈脓，用喉针刺患处排脓，脓净则自愈）。总以整肃肺胃功能为关键治法。
【秀按】风温四季都有，只有春季最严重。新感之邪从口鼻侵入，内袭三焦；伏气多隐匿于膜原，或者内舍于营分。这两种证候属于肺胃的，按照俞君辨证施治，自然能奏效。如果邪气潜伏在膜原，初用微发其汗后，虽然风寒表邪已解，但膜原的伏邪尚想外出而不能立即排出，症状必定寒热如疟疾，胸膈痞满，心中懊恼，呕吐不食。此时迅速使用柴胡达原饮，开达膜原，使伏邪向外溃散，热邪从外部透发。此时辨别其为燥热，则用新加白虎汤，辛凉甘寒以清泄；若为湿热，则用增减黄连泻心汤，苦辛淡渗以清利。如果有下证，辨别其轻重缓急，酌情使用各种承气法引导并竭除邪气。如果邪气内舍于营分，证候比膜原伏邪更为紧急。初用葱豉桔梗汤，辛凉发汗后，虽然表邪已解，暂时热退身凉，但胸腹的热邪未除。随后出现高热自汗、烦躁不寐、神识时清时昏、夜间多谵语、脉数舌绛，严重时四肢厥冷、脉象沉陷。急需清透营分热邪，使伏热转出到气分。气机宣通，卫气宣泄，或者通过出疹而解，或者通过狂汗而解。轻症用玳瑁郁金汤，重症用犀地清络饮，都可以选用。剧症用紫雪丹或行军散，历验如神。
【廉勘】伏温从内部发出，风寒从外部搏击，形成内热外寒的证候，我治疗过很多。重症用麻杏石甘汤，加连翘、牛蒡、桑叶、丹皮。轻症用桑菊饮加麻黄，只是麻黄用量极轻，大约二分至三分为止。只取其轻扬之性，疏肺透表，效果如敲鼓般迅速。无奈吴鞠通认为温病初起恶风寒者，主用桂枝汤解肌。哪里知道桂枝辛热会灼伤营阴，温病忌用。洄溪批注叶天士医案说：“风温证服用桂枝生姜，必然吐血，甚至失音。”吴氏难道没看过吗？难怪梦隐讥讽他诬蔑圣人、误导世人。鞠通又说温病忌汗，最喜欢解肌。我读《伤寒论》，看到“病患脏无他病”条，发汗则愈；“病常自汗出”条，须发其汗则愈，并且都主用桂枝汤。可见桂枝汤是治疗风寒发汗的方剂，不是治疗外寒搏内热的方剂。王大昌说鞠通的《温病条辨》一书，以桂枝汤作为治疗温病的首选方，更值得议论，确实没有冤枉他。
【荣斋按】张畹香在《温暑医旨》中说：“风温分三焦治疗，葳蕤汤、苇茎汤、银翘散、白虎汤是上焦药；黄芩汤提少阴邪并肺而祛之，也是上焦药；至宝丹、紫雪、牛黄丸，芳香开窍，是心宫药，心肺同属上焦药。凉膈散，是由上焦至中下焦的药。舌苔黄滑浓，痰多，用象贝母、瓜蒌仁，或者葶苈大枣汤，都是肺分下药。叶天士所说的‘忌下’，是指不用承气汤罢了。我遇到夹带少阳邪气的，加柴胡；头痛由于血虚的，用芎归汤无不有效。风温有夹食的，我也不使用消导药，因为风能消谷，即使是油腻浓味，不过是产生多痰，祛除痰即可；如果凑入消导药，勉强成方，就是误事。另外叶案中有关于风温劫伤阴津的，用地黄、阿胶、麦冬、白芍、炙甘草、蔗浆，或者用沙参、麦冬、玉竹，其大旨总以甘药为主。如果用辛温表散，或者刚燥消导，没有不伤及阴液的；其骤然变为痉厥，缓慢变为虚劳，都是未曾顾及阴分的过错。按张氏为清代嘉庆、道光、咸丰、同治年间（1796─1870）人，世居绍兴洗马池头；曹炳章先生称他为：‘古越治伤寒温暑之前辈，于医学富有经验。’（见张氏《温暑医旨》提要）这篇学说，是张氏对风温治法的经验总结，当然是可靠的。”
(Fengwen Shanghan, also known as Fengwen Jianhan. Commonly referred to as "Wind-Cold wrapping Fire.")
[Etiology] It belongs to latent heat diseases (Fuwen Bing). It is triggered by contracting cold wind; or it erupts suddenly due to warm weather where Wind-Cold causes internal heat to stagnate. The former is caused by latent pathogenic factors (Fuqi), and the latter by new contraction (Xingan). Since the etiologies differ, the severity of the disease conditions varies significantly.
[Symptoms] When triggered by cold wind acting on latent warmth: Initially, there must be headache, fever, slight aversion to wind and cold. Subsequently, high fever, spontaneous sweating, thirst without aversion to cold, cough, irritability, and intense heat in the skin of the forearm (Chifu) occur. In severe cases, snoring, excessive sleepiness, difficulty speaking, symptoms resembling convulsions (Jingxian), and a face reddened as if scorched by fire appear. The tongue coating is initially thin white with red and dry edges and tip, then becomes red tongue body with yellow coating, or even deep red without coating. When bound by Wind-Cold acting on Warm-Heat: Initially, headache, fear of wind, aversion to cold, and anhidrosis occur. Subsequently, fever, cough, irritability, thirst, spontaneous sweating, sore throat, and swollen throat appear. The tongue coating is white, dry, and red at the edges; in severe cases, it becomes white, dry, and prickly, or turns from white to yellow.
[Pulse] If the right Cun pulse is floating and surging (Fuhong), and the left pulse is wiry and moderate (Xianhuan), this indicates that a new contraction has stirred up latent qi. This is what Zhang Zhongjing described as: "After sweating, if the body burns with heat, it is named Fengwen." In severe cases, both Cun and Chi pulses are floating and surging, vigorous and restless, indicating external wind stirring internal heat. This corresponds to Zhang Zhongjing's description: "Shanghan not resolving after seven or eight days, occasional aversion to wind, dryness on the tongue, great thirst and irritability, desiring to drink several liters of water," which signifies heat accumulation internally with heat in both exterior and interior. If the right pulse is floating and rapid (Fushu), and the left pulse is wiry and tight (Xianjin), this indicates external cold binding internal heat. This corresponds to Zhang Zhongjing's description: "Irritability, thirst, slight aversion to cold on the back." After sweating, if the pulse turns floating, surging, and forceful, this corresponds to Zhang Zhongjing's description: "After taking Guizhi Tang and sweating profusely, if great irritability and thirst remain unresolved, and the pulse is surging and large."
[Treatment] For cold wind triggering latent heat: First administer Congchi Jiegeng Tang to lightly clear and disperse wind to release the exterior. Then administer Xinjia Baihu Tang to use acrid-cool properties to drain heat and clear the interior. If interior heat is extremely abundant and signs of wind stirring and convulsions (Yongzhi) have appeared, quickly administer Lingjiao Gouteng Tang to use sweet-salty calming properties to extinguish wind. Finally, administer Renshen Baihu Tang added with fresh Shihu (Dendrobium), pear juice, and sugarcane juice to use sweet-cold properties to rescue fluids for follow-up care. For Wind-Cold binding internal heat: First administer Xinjia San'ao Tang, reducing the dosage of Mahuang and heavily adding Niubangzi to slightly disperse Wind-Cold to release the exterior. Then administer Lianqiao Zhichi Tang added with tender Sangya (Mulberry sprouts) and fresh Zhuye (Bamboo leaves) to lightly drain Warm-Heat pathogens to clear the interior. During this process, if there is much phlegm, add Danzhuli (Bamboo sap) (two ladles) and Shengjiangzhi (Ginger juice) (two drops, mixed evenly, taken together). If there is food stagnation, add Sheng Luobozhi (Radish juice) (two large ladles) and Zhishi Zhi (Immature Bitter Orange juice) (two small ladles, mixed evenly, taken together). If rashes appear, add Chao Niubangzi (Fried Arctii Fructus) (3 qian) and Huoshui Lusun (Living Reed Shoots) (1 liang). If there is a sore throat, add Jinguolan (Tinosporae Radix) (1 qian), Annanzi (Annamite Nut) (3 pieces), and Zhi Yueshi (Prepared Borax) (5 fen). For throat insufflation, use Jiawei Bingpeng San (Bingpian 1 fen, Pengsha 1 qian, Fenghua Xiao, Shandougen, Qingdai, Danfan, Niuhuang each 2 fen; most effective for throat insufflation; if phlegm and saliva obstruct, use a goose feather dipped in Tung oil and a little Saojiao powder to induce vomiting; if the throat has formed an abscess, puncture the affected area with a throat needle to drain pus, and it will heal naturally when the pus is clean). The general principle is to regulate the Lung and Stomach.
[Xiu's Commentary] Fengwen occurs in all four seasons but is most severe in spring. New contraction enters through the mouth and nose and invades the Triple Burner internally; latent qi often hides in the Membrane Source (Moyuan) or resides internally in the Ying level. For these two conditions belonging to the Lung and Stomach, following Dr. Yu's syndrome differentiation and treatment will naturally yield results. If pathogens hide in the Moyuan, after initial mild sweating, although the Wind-Cold exterior pathogens are resolved, the latent pathogens in the Moyuan still wish to exit but cannot do so immediately. Symptoms must include alternating chills and fever like malaria, chest and diaphragm fullness/stuffiness, mental restlessness (Aonao), vomiting, and loss of appetite. Quickly use Chaihu Dayuan Yin to open and reach the Moyuan, causing latent pathogens to溃散 externally and heat to penetrate outward. At this time, differentiate whether it is Dry-Heat, then use Xinjia Baihu Tang with acrid-cool and sweet-cold properties to clear and drain; if it is Damp-Heat, use Zengjian Huanglian Xiexin Tang with bitter-acrid and bland-draining properties to clear and promote urination. If there are indications for purgation, differentiate their severity and urgency, and酌情 use various Chengqi methods to guide and exhaust them. If pathogens reside internally in the Ying level, the condition is more urgent than latent pathogens in the Moyuan. Initially use Congchi Jiegeng Tang; after acrid-cool sweating, although exterior pathogens are resolved and temporarily heat subsides with coolness of the body, heat in the chest and abdomen remains. Subsequently, high fever with spontaneous sweating, irritability, insomnia, fluctuating clarity of consciousness, nighttime delirium, rapid pulse, and crimson tongue appear. In severe cases, limb coldness and sunken pulse occur. Urgently clear and penetrate Ying-level heat to transfer latent heat to the Qi level. Once Qi is unblocked and Wei Qi dissipates, resolution may occur via rashes or via violent sweating. Mild cases use Dai Mao Yujin Tang; severe cases use Xi Di Qingluo Yin; both can be selected. Critical cases use Zixue Dan or Xingjun San, which have proven efficacious like spirits.
[Lian's Review] Latent warmth originates from within, while Wind-Cold attacks from without, forming a pattern of internal heat and external cold. I have treated many such cases. Severe cases use Maxing Shigan Tang added with Lianqiao, Niubangzi, Sangye, and Danpi. Mild cases use Sangju Yin added with Mahuang, but the dosage of Mahuang is extremely light, approximately 2 to 3 fen only. Only its light and ascending nature is utilized to vent the Lung and penetrate the exterior, with efficacy as immediate as striking a drum. Regrettably, Wu Jutong advocates using Guizhi Tang to resolve the muscle layer for Wind-Cold aversion at the onset of Warm diseases. Does he not know that Guizhi is acrid and hot, scorching the Ying level, and thus contraindicated in Warm diseases? Huixi's commentary on Ye Tianshi's medical cases states: "For Fengwen patterns, taking Guizhi and Shengjiang will inevitably cause hematemesis, and even aphonia." Had Wu seen this? No wonder Mengyin ridiculed him for falsifying the sages and misleading the world. Jutong also claims that sweating is contraindicated in Warm diseases, and resolving the muscle layer is preferred. Reading the *Shanghan Lun*, in the clause "If the patient's viscera have no other disease," it says "sweating leads to cure"; in the clause "The patient often sweats spontaneously," it says "must induce sweating to lead to cure," and both primarily use Guizhi Tang. This shows Guizhi Tang is a formula for inducing sweating in Wind-Cold, not for treating external cold binding internal heat. Wang Dachang stated that Jutong's *Wenbing Tiaobian* uses Guizhi Tang as the primary formula for treating Warm diseases, which is highly debatable. Indeed, this is not unjustified.
[Rongzhai's Commentary] Zhang Wanxiang in *Wenshu Yizhi* said: "Treating Fengwen by Triple Burner: Weiru Tang, Weijing Tang, Yinqiao San, and Baihu Tang are Upper Burner formulas; Huangqin Tang extracts Shaoyin pathogens and expels them along with the Lung, also an Upper Burner formula; Zhibao Dan, Zixue, and Niuhuang Wan, aromatic orifices-opening agents, are Heart Palace formulas, and since Heart and Lung belong to the Upper Burner, they are Upper Burner formulas. Liangge San acts from Upper Burner to Middle and Lower Burners. For yellow, slippery, thick tongue coating with much phlegm, use Xiangbei (Fritillariae Thunbergii Bulbus), Louren (Trichosanthis Fructus), or Tingli Dazao Tang, all are Lower Lung formulas. What Ye Tianshi meant by 'contraindicated for purgation' refers to not using Chengqi Tang. When encountering patterns with concurrent Shaoyin pathogens, I add Chaihu; for headaches due to Blood deficiency, Xiong Gui Tang is invariably effective. For Fengwen with food stagnation, I also do not use digestive-promoting herbs, because Wind can digest grain; even greasy and rich flavors merely produce excess phlegm, so removing phlegm suffices; forcing digestive herbs into the prescription constitutes an error. Furthermore, in Ye's cases regarding Fengwen damaging Yin fluids, Shengdi, Ejiao, Maidong, Baishao, Zhigancao, and sugarcane juice are used, or sometimes Shashen, Maidong, and Yuzhu; the main gist always relies on Sweet herbs. If Acrid-Warm exterior-releasing or rigid-dry digestive herbs are used, they inevitably damage Yin fluids; sudden transformation into spasms and convulsions, or slow transformation into consumptive diseases, are all due to neglecting the Yin aspect. Dr. Zhang was a person during the Jiaqing, Daoguang, Xianfeng, and Tongzhi reigns of the Qing Dynasty (1796–1870), residing in Ximachi Tou, Shaoxing; Mr. Cao Bingzhang called him: 'A senior predecessor in Shaoxing for treating Shanghan and Wenshu, rich in medical experience.' (See Summary of Zhang's *Wenshu Yizhi*). This theory is Dr. Zhang's summary of experience in treating Fengwen and is certainly reliable."