温病之于风寒。在太阳病初起时。已自不同。仲景于伤寒中风而外。明揭出太阳病发热
而渴
。不恶寒者为温病。太阳中风。啬啬恶寒。翕翕发热。太阳伤寒。或已发热。或未发热。必
恶
寒。太阳温病。但发热。不恶寒。而其辨证最要之诀。又全在渴之一字。盖风寒之邪。由外
而入。必待传变后里热炽盛。方始口渴。若温病初起便渴。此在太阳病时。早与里热相合。
消烁津液。不即善治。真阴之亡。可立而待。且风寒之病。或微汗。或大汗。或战汗。病随
汗解。温病虽汗不解。若汗出热不退而脉反躁盛者。内经即决为死证。阴精亡故也。故凡治
温病者。当以阴精为至宝。此自轩岐以来一脉相传之宗旨。仲景既揭明温病。苦无专方。
后人以意造方。思补仲景之缺。究未可为典要。以予度之。仲景于中风病。以风为阳邪卫气
易泄。尚不取大发其汗。则温病之不宜发汗。此理断然莫易。内经云。温者清之。意者当
以清里为主。而微
兼解肌可乎。
仲景既言太阳病发热而渴不恶寒为温病。更剔出风温之为病。而特申发汗之禁。是有二
说焉。
温邪内发。误责其汗。卫气既疏。风邪又袭。两阳相合。身反灼热。此一说也。温邪内伏。
少阴既病。肾精不藏。内风易动由里出表。汗出之后。身乃灼热。此又一说也。二说可以并
存
。而其不宜发汗则一也。余按温之为病。本有新邪伏邪之不同。新邪者。内热本郁。适与时
令之温邪相感召。身乃灼热。此病之兼内外因者。伏邪者。阴分自病。风自内生。虽见表热
。其
病全属内因。而绝不关外因。若发汗后而身反灼热者。不惟阳脉本浮。即阴津与汗俱泄。阴
脉亦浮。故脉阴阳俱浮。若自汗出。身重。多眠睡。息必鼾。语言难出。何一非津伤之象。
更逆之以误下。则阴虚重泄其阴。逆之以误火。则阳亢益扰其阳。一误再误。不至促命期不
止。仲景禁例。如此森严。能知其所禁而治法可微会矣。然则治温病者。亦当于未发汗之前
。详审病因。慎勿误治焉可矣。
Wenbing (Warm Diseases) differ from Fenghan (Wind-Cold diseases) right from the initial stage of Taiyang disease (disease pattern of the Bladder meridian). Zhang Zhongjing, besides discussing Shanghan (Cold Damage) and Zhongfeng (Wind Strike), explicitly points out that when Taiyang disease presents with fever, thirst, and aversion to cold is absent, it is classified as Wenbing.
In Taiyang Zhongfeng, symptoms include mild aversion to cold (se-se e han) and moderate fever (xi xi fa re). In Taiyang Shanghan, fever may or may not be present initially, but aversion to cold is always definite. In contrast, Taiyang Wenbing presents only with fever and no aversion to cold. The most crucial key for differentiation lies entirely in the character "thirst". This is because pathogens of Wind-Cold enter from the exterior and must undergo transmission to the interior, where heat becomes intense, before thirst occurs. If thirst appears at the very onset of Wenbing, it indicates that even during the Taiyang stage, the pathogen has already combined with internal heat, consuming body fluids. Without immediate proper treatment, the depletion of True Yin can happen instantly.
Furthermore, in Wind-Cold diseases, whether through slight sweating, profuse sweating, or chills followed by sweating, the illness resolves with the sweat. However, in Wenbing, sweating does not resolve the condition. If fever persists despite sweating and the pulse becomes restless and vigorous, the *Neijing* (Classic of Internal Medicine) declares this a fatal syndrome due to the loss of Yin essence. Therefore, anyone treating Wenbing should regard the preservation of Yin essence as the utmost treasure. This principle has been passed down continuously since Huangdi (Yellow Emperor) and Qibo. Although Zhang Zhongjing clarified the concept of Wenbing, he lacked specific formulas. Later practitioners created formulas based on their own ideas to fill this gap, yet these could not serve as standard guidelines. In my estimation, Zhang Zhongjing, regarding wind as a Yang pathogen that easily disperses Wei Qi (Defensive Qi), did not employ drastic diaphoresis even for Zhongfeng. Thus, it is logically certain that Wenbing should not be treated with diaphoresis. The *Neijing* states: "For warmth, use cooling." I suggest that treatment should primarily focus on clearing internal heat, possibly accompanied by a mild release of the muscle layer.
After stating that Taiyang disease with fever, thirst, and no aversion to cold constitutes Wenbing, Zhang Zhongjing further isolated the pathology of Fengwen (Wind-Warmth) and specifically emphasized the prohibition of diaphoresis. There are two explanations for this:
The first explanation is: When Warm pathogens originate internally, erroneous use of diaphoresis causes Wei Qi to become more dispersed, allowing Wind pathogens to invade again. The combination of two Yangs results in intense burning heat in the body.
The second explanation is: Warm pathogens lie dormant internally. When Shaoyin (Kidney channel) is affected, Kidney Essence fails to store properly, leading to easy movement of internal wind emerging from the interior to the exterior. After sweating, the body becomes intensely hot.
These two explanations can coexist, but both agree that diaphoresis is contraindicated. Upon examination, Wenbing differs between newly acquired pathogens and latent pathogens. Newly acquired pathogens involve pre-existing internal heat郁 (stagnation) that resonates with seasonal warm pathogens, causing burning heat; this involves both internal and external factors. Latent pathogens arise from disease within the Yin aspect, with wind generated internally. Although surface heat is visible, the pathology belongs entirely to internal factors and has nothing to do with external factors.
If the body becomes intensely hot after diaphoresis, not only are the Yang pulses floating, but Yin fluids are also lost along with sweat, causing the Yin pulses to float as well, resulting in floating pulses in both Yin and Yang positions. Symptoms such as spontaneous sweating, heavy body, excessive sleepiness, snoring respiration, and difficulty speaking are all signs of fluid injury. If one further violates the correct treatment by using purgatives incorrectly, it will severely deplete Yin and leak more Yin fluids. If one uses fire therapy incorrectly, it will exacerbate Yang hyperactivity and disturb Yang further. One error after another will inevitably lead to premature death. Zhang Zhongjing’s prohibitions are so strict. Understanding what is prohibited allows one to grasp the therapeutic methods. Therefore, those treating Wenbing must carefully examine the etiology before administering diaphoresis and must avoid erroneous treatment.