（春温冬温热病同治参叶案）
烦劳多欲之人。阴精久耗。适遇冬月非时之暖。感而即病者。冬温也。春时木火
司令。天道温暖。新邪引动。温从内发者。春温也。夏令炎热。感之即病。壮热烦渴。
而不恶寒者。热病也。大抵温热之症。阴精内耗。强阳无制。新邪一触。则燎原之
势。直从里发。故初起即见壮热烦渴。口干舌燥等症。而主治以存津液为要旨。
凡遇伤寒过经不解。或发汗不彻。反致昏剧者。皆温热误治之证也。前阳明少
阳条内。已见大意。而兹专以手三阴立言。治宜互参。
邵评∶冬不藏精。春必病温。阴亏是温病之原。故治温热病。以保阴存津为首务。
若春温夏热二症。亦俱有之。冬月受邪。伏藏不发。至春时天暖。外感时邪。引动
伏邪而发病者。名为伏气春温。若其人内无伏邪。春天感受温邪而即病者。此即发之春温也。夏令受热
而即病者。此即发之热病也。内有伏邪。春令不发。至夏至后壮热而病者。此伏气所发之热病也。如
此辨症。方可明晰。内经曰。冬伤于寒。春必病温。先夏至日为病温。后夏至日为病热。温病发出之
途自少阳。热病发出之病由阳明。温病主以黄芩汤。热病主以白虎汤。至于伤寒延久。邪已
化热。与温热治法相通。所谓伤寒与温热。始异而终同也。
又评∶伏气所发之温热病。与感而即发之温热病。见症稍异。伏气之病。其邪从里而达于外。表
上无邪。故初起即热。无一毫恶寒之象。即发之温病。邪由肺受。肺主皮毛。故初起微寒。继即纯热不已。
如此辨认。庶无错误。
手太阴气分 凡温邪入肺。症见头疼。恶寒发热。口燥舌干。脉数。胸满气喘。治宜
辛凉轻剂。栀豉、橘红、桑杏、连翘、薄荷、枳桔、黄芩之类。嗽加前胡、苏子、象贝、羚羊角之类。
邵评∶此受而即发之温热病。首先入肺。肺主皮毛而在表。故见表症。宜辛凉轻
清。以宣泄上焦肺卫之邪。
手少阴营分 温邪吸入。由卫及营者。其舌先白后绛也。或竟入营分。则舌必绛
赤。或红中兼微白。夜烦不寐。神呆谵语。宜犀角尖、鲜生地、淡竹叶、麦冬、连翘、石菖
蒲、川斛、丹皮之类。兼痰者。加川贝母、天竺黄之类。
邵评∶此承上条由卫而入营。亦受而即病之温症也。白苔邪在肺卫。绛苔邪入
心营。自卫入营。故舌先白后绛。绛。深红色也。红中兼微白。气分之邪未尽也。若热扰心营。则神
蒙不能自主。上条邪在肺卫。其病尚浅。此条由卫及营。邪气自外入内。其病较深。下条温邪传入心
包络中。痰潮内闭。其病尤深。此皆受而即病之温热症。宗心营肺卫主治。故以宣营清热达邪一法。
手厥阴内闭 如温邪传于膻中。即干心包络。痰潮内闭。则神昏谵语。舌苔纯红起刺。此重症也。
急宜清心开闭。用犀角、连翘、川贝、天竺黄、川郁金、石菖蒲、净银花、钩藤钩、西黄之类主之。
邵评∶膻中为心之宫城。邪入于此。干犯心包。热逼心中。挟痰浊互结。致神昏谵
语。而邪陷内闭。内闭则外脱。正不胜邪之候也。宜清心化痰。开闭达邪之法。再
加芳香宣窍之品。如紫雪、至宝丹之类尤妙。
以上三条。感而即发之温热。病邪由口鼻吸受。先入肺卫。由肺传入心营。甚至
逆传入心包。自外入内。一层递深一层。三条当合参之。
温邪劫液 如发热不退。烁干胃中津液。以致口糜气秽。当用甘露饮、玉女煎之类。
邵评∶热久阴伤。灼干胃液。不拘伏气温热。与受而即发之温热。俱有此候。口糜
气秽。阴虚火旺也。二方滋阴液以清胃火为治。
热久烦渴少气。竹叶石膏汤效。兼脘中痞闷不饥。加半夏。
邵评∶中虚胃热而作虚烦。用养正清胃除烦降火为治。
足厥阴液涸 若温邪误治。邪必深入厥阴。神昏音涩。舌绛裂纹。欲寐不寐。午间
烦躁。形象畏冷。心中如焚。此正气久虚。阴液已涸。宜复脉汤加减。如生地、麦冬、炙
草、白芍、阿胶、丹皮、梨汁之类。
邵评∶温热误治。邪入极深。陷于肝经。肝属木而有火。木火内燔。阴液枯涸。液涸
风动。故见症如此。故用滋阴以清肝火为治。
邪气血分 风温之邪。入于营分不解。以致舌赤音低。神呆潮热。脉数左甚。或发
丹疹。此邪过营。已及血分也。夫心主血。邪干血分。渐成内闭。风药燥血。固宜大禁。
即苦寒直走肠胃。亦非温邪逆入膻中心主所宜。须犀角、元参、鲜生地、川郁金、菖
蒲、丹皮、银花、西黄之类主之。
邵评∶邪初入肺则在卫。不解。则入气分。气分不解。则传心营。营不解。则入下焦
血分矣。邪在血分。入里极深。中焦俱病。阴液受戕。每多液涸内闭之候。宜救阴
达邪清营凉血治之。至于膻中。是包络所居。在于上焦。用药宜清轻而忌重浊。
此种药味。治邪入心包之剂。若入血分。当用地黄、阿胶、复脉汤。方是血分治法。
气血两伤 若感温邪。治不中 。热毒内燔。必至气血两伤。如脉左数右大。烦渴
口糜。舌赤唇焦。是也。宜玉女煎。
邵评∶温邪误治。热入阳明。灼伤少阴阴液。此少阴不足。阳明有余。病在中下二
焦也。宜滋肾阴。以清胃火。
邪结上焦 温邪从口鼻吸入。则上焦先受。气血与热邪混处胶固。必致清窍不
利。凡寒热后。颐颔肿胀。咽喉疼痛。牙关紧闭。脉左小右搏指者。皆邪结上焦所致
也。当照疫症施治。宜连翘、牛蒡、射干、马勃、滑石、银花、赤芍、薄荷、夏枯草、人中黄之类选用。
邵评∶温热疫毒。口鼻吸受。蕴结上焦。不得宣散。发为大头风毒、颐肿、咽痛等症。
此温邪兼风毒而成。治宜清热解毒之法。
胃中不和 若热退后。不饥不纳者。此胃气不和也。宜香豉、山栀、半夏、枳实、陈皮等和之。
邵评∶热退而余邪不净。胃气不和。故不饥不纳。当清化余邪。以和胃气为治。
(Spring-warmth and winter-warmth febrile diseases are treated similarly; refer to Ye Tianshi's medical cases.)
Individuals who overexert themselves and have excessive desires suffer from long-term depletion of Yin essence. If they encounter unseasonably warm weather in winter and contract pathogens immediately upon exposure, it is called Winter-Warmth (Dongwen). In spring, Wood and Fire govern the season, and the heavenly climate is warm. When new pathogens trigger latent warmth to erupt from within, it is called Spring-Warmth (Chunwen). In summer, when the weather is hot, contracting pathogens leads to immediate illness characterized by high fever, irritability, thirst, and absence of aversion to cold; this is called Heat Disease (Rebing). Generally, warmth-febrile diseases involve internal depletion of Yin essence and unrestrained Yang fire. Once triggered by new pathogens, the condition spreads like a prairie fire, originating directly from the interior. Therefore, at the onset, symptoms such as high fever, irritability, thirst, dry mouth, and dry tongue appear. Consequently, the main treatment principle is to preserve body fluids (Jinye).
Whenever a Taiyang disease persists beyond its expected duration or incomplete sweating therapy results in worsened confusion and severity, these are signs of misdiagnosis and mistreatment of warmth-febrile diseases. The general principles were already discussed in the Yangming and Shaoyang sections. Here, the discussion focuses specifically on the Hand Three Yin meridians, and treatments should be cross-referenced.
Shao’s Commentary: Failure to store essence in winter leads to warmth diseases in spring. Yin deficiency is the root of warmth diseases; thus, preserving Yin and body fluids is the primary task in treating warmth-febrile diseases. This applies to both Spring-Warmth and Summer-Heat diseases. If pathogens are contracted in winter but lie dormant until spring warmth triggers them via external seasonal pathogens, it is named Latent-Qi Spring-Warmth (Fuqi Chunwen). If there is no latent pathogen internally, and illness occurs immediately upon contracting warmth pathogens in spring, it is Immediate-Onset Spring-Warmth. If illness occurs immediately upon contracting summer heat, it is Immediate-Onset Heat Disease. If latent pathogens remain dormant in spring but manifest with high fever after the Summer Solstice, it is Latent-Qi induced Heat Disease. Such differentiation clarifies the diagnosis. The *Neijing* states: "Injury by cold in winter leads to warmth disease in spring." Illness occurring before the Summer Solstice is termed Warmth Disease; after the Summer Solstice, it is termed Heat Disease. Warmth diseases originate from the Shaoyang channel, while Heat diseases originate from the Yangming channel. Warmth diseases are primarily treated with Huangqin Tang, and Heat diseases with Baihu Tang. As for prolonged Taiyang disease where pathogens transform into heat, the treatment aligns with that of warmth diseases. Thus, Taiyang disease and warmth diseases differ initially but converge ultimately.
Another Commentary: Latent-Qi induced warmth diseases and immediate-onset warmth diseases present slightly different symptoms. In Latent-Qi disease, pathogens emerge from the interior to the exterior, with no exterior pathogens present; thus, fever appears immediately without any aversion to cold. In immediate-onset warmth diseases, pathogens enter via the Lung, which governs skin and hair; hence, mild aversion to cold appears initially, followed by persistent pure heat. Accurate identification prevents errors.
Hand-Taiyin Qi Level: When warmth pathogens enter the Lung, symptoms include headache, aversion to cold and fever, dry mouth and tongue, rapid pulse, chest fullness, and wheezing. Treatment requires light acrid-cool agents, such as Zhichi (Gardeniae Fructus cum Faba), Juhong (Citri Reticulatae Pericarpium), Sangxing (Mori Bombycis Folium cum Fructu), Lianqiao (Forsythiae Fructus), Bohe (Menthae Haplocalycis Herba), Zhijie (Aurantii Fructus Immaturus cum Calyce), and Huangqin (Scutellariae Radix). For cough, add Qianhu (Peucedani Radix), Suzi (Perillae Fructus), Xiangbei (Fritillariae Thunbergii Bulbus), and Lingyangjiao (Rhinocerotis Cornu).
Shao’s Commentary: This refers to immediate-onset warmth diseases entering the Lung first. Since the Lung governs skin and hair and resides in the exterior, exterior symptoms appear. Acrid-cool and light-clearing methods should be used to vent pathogens from the Upper Jiao Lung-Wei defense system.
Hand-Shaoying Ying Level: When inhaled warmth pathogens move from Wei (Defensive) to Ying (Nutritive) levels, the tongue coating turns white then crimson. If pathogens enter Ying directly, the tongue becomes crimson-red or red with slight whiteness. Symptoms include nighttime irritability, insomnia, mental dullness, and delirious speech. Treatment involves Xijiaojian (Rhinocerotis Cornu), Xianshengdi (Rehmanniae Radix Recens), Danzhuye (Lophatheri Herba), Maidong (Ophiopogonis Radix), Lianqiao (Forsythiae Fructus), Shichangpu (Acori Tatarinowii Rhizoma), Chuanhu (Dendrobii Caulis), and Danpi (Moutan Cortex). If phlegm is present, add Chuanbeimu (Fritillariae Cirrhosae Bulbus) and Tianzhuhuang (Calami Tuber).
Shao’s Commentary: Following the previous section, this describes progression from Wei to Ying, also an immediate-onset warmth syndrome. White coating indicates pathogens in Lung-Wei; crimson coating indicates entry into Heart-Ying. Progression from Wei to Ying causes the tongue to change from white to crimson. Crimson denotes deep red color. Red with slight whiteness indicates residual Qi-level pathogens. If heat disturbs Heart-Ying, consciousness is clouded. The previous section involved Lung-Wei pathogens (shallow); this section involves Wei-to-Ying progression (deeper). The next section involves pathogens entering the Pericardium with phlegm closure (deepest). These are all immediate-onset warmth syndromes. Adhering to the treatment principles of Ying and Lung-Wei, the method is to ventilate Ying, clear heat, and expel pathogens.
Hand-Jueyin Internal Closure: If warmth pathogens transmit to Danzhong (Chest Center), interfering with the Pericardium, and phlegm turbidity causes internal closure, symptoms include coma, delirium, and a pure red tongue with prickles. This is a severe condition. Urgent treatment requires clearing the Heart and opening closure, using Xijiao (Rhinocerotis Cornu), Lianqiao (Forsythiae Fructus), Chuanbei (Fritillariae Cirrhosae Bulbus), Tianzhuhuang (Calami Tuber), Chuan Yujin (Curcumae Radix), Shichangpu (Acori Tatarinowii Rhizoma), Jingyinhua (Lonicerae Japonicae Flos), Goutenggou (Uncariae Ramulus cum Uncis), and Xihuang (Bovis Calculus).
Shao’s Commentary: Danzhong is the palace city of the Heart. Pathogens entering here interfere with the Pericardium, forcing heat into the Heart, combining with phlegm turbidity to cause coma and delirium. Pathogen sinking into internal closure leads to external collapse if closure persists, indicating righteous Qi failing to overcome pathogens. Treatment requires clearing the Heart, resolving phlegm, opening closure, and expelling pathogens, supplemented by aromatic orifice-opening agents like Zixue (Purple Snow Powder) and Zhibao Dan (Treasure of Life Pill).
The above three sections describe immediate-onset warmth diseases. Pathogens enter via nose and mouth, first affecting Lung-Wei, then transmitting to Heart-Ying, and even reversely to the Pericardium. Moving from exterior to interior, depth increases layer by layer. These three sections should be studied together.
Warmth Pathogens Depriving Fluids: If fever persists, scorching stomach fluids, leading to oral ulcers and foul breath, use Ganlu Yin (Sweet Dew Decoction) or Yunnv Jian (Lady Yu’s Decoction).
Shao’s Commentary: Prolonged heat injures Yin, scorching stomach fluids. This occurs in both latent and immediate-onset warmth diseases. Oral ulcers and foul breath indicate Yin deficiency with hyperactive fire. Both decoctions nourish Yin and clear stomach fire.
For prolonged heat with irritability, thirst, and shortness of breath, Zhuyegashitang (Bamboo Leaf and Ginseng Decoction) is effective. Add Banxia (Pinelliae Rhizoma) for epigastric fullness and lack of appetite.
Shao’s Commentary: Middle Jiao deficiency with stomach heat causes empty irritability. Treatment involves nourishing righteousness, clearing stomach heat, relieving irritability, and descending fire.
Foot-Jueyin Fluid Depletion: If warmth diseases are mistreated, pathogens deepen into Jueyin, causing coma, hoarse voice, crimson cracked tongue, desire to sleep but inability, midday irritability, aversion to cold despite feeling, and burning sensation in the chest. This indicates long-standing righteous Qi deficiency and exhausted Yin fluids. Use Maixue Tang (Pulse-Replenishing Decoction) modified, including Shengdi (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Zhigancao (Prepared Licorice Root), Baishao (Paeoniae Radix Alba), Ejiao (Asini Corii Colla), Danpi (Moutan Cortex), and Lizhi (Pear Juice).
Shao’s Commentary: Mistreatment drives pathogens deeply into the Liver meridian. Liver belongs to Wood and harbors Fire; internal blazing of Wood-Fire exhausts Yin fluids. Fluid depletion leads to wind stirring, causing these symptoms. Treatment involves nourishing Yin to clear Liver fire.
Pathogens in Qi and Blood Levels: Wind-warmth pathogens remaining in Ying level fail to resolve, leading to red tongue, low voice, mental dullness, tidal fever, rapid pulse (stronger on left), or erysipelas rash. This indicates pathogens have passed Ying and entered Blood level. The Heart governs Blood; pathogens invading Blood lead to internal closure. Acrid-warm drugs that dry blood are strictly prohibited. Even bitter-cold drugs acting directly on intestines and stomach are unsuitable for warmth pathogens reversing into Danzhong/Heart. Use Xijiao (Rhinocerotis Cornu), Xuanshen (Scrophulariae Radix), Xianshengdi (Rehmanniae Radix Recens), Chuan Yujin (Curcumae Radix), Changpu (Acori Tatarinowii Rhizoma), Danpi (Moutan Cortex), Yinhua (Lonicerae Japonicae Flos), and Xihuang (Bovis Calculus).
Shao’s Commentary: Pathogens start in Wei (Lung), move to Qi, then Ying, and finally Lower Jiao Blood level if unresolved. Blood-level pathogens penetrate deeply, affecting Middle Jiao and damaging Yin fluids, often leading to fluid depletion and internal closure. Treatment requires rescuing Yin, expelling pathogens, clearing Ying, and cooling Blood. Danzhong, residence of Pericardium in Upper Jiao, requires light-clearing drugs, avoiding heavy/turbid ones. The previously mentioned drugs treat Pericardium invasion. For Blood level, use Dihuang (Rehmanniae Radix), Ejiao (Asini Corii Colla), and Maixue Tang, which constitute Blood-level treatment.
Qi and Blood Both Injured: If warmth pathogens are mistreated, heat toxins blaze internally, injuring both Qi and Blood. Signs include rapid left pulse and large right pulse, irritability, thirst, oral ulcers, red tongue, and scorched lips. Use Yunnv Jian (Lady Yu’s Decoction).
Shao’s Commentary: Mistreatment sends heat into Yangming, scorching Shaoyin Yin fluids. This represents Shaoyin insufficiency and Yangming excess, affecting Middle and Lower Jiao. Treatment involves nourishing Kidney Yin to clear Stomach fire.
Pathogens Congesting Upper Jiao: Inhaled warmth pathogens affect Upper Jiao first. Qi, Blood, and heat pathogens mix and adhere, obstructing clear orifices. After fever/chills, swelling of cheeks/jaw, sore throat, locked jaw, small left pulse, and forceful right pulse indicate Upper Jiao congestion. Treat as epidemic disease. Select Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Shegan (Belamcandae Rhizoma), Mabo (Cordyceps Militaris or similar throat herbs), Huashi (Talcum), Yinhua (Lonicerae Japonicae Flos), Chishao (Paeoniae Radix Rubra), Bohe (Menthae Haplocalycis Herba), Xiakucao (Prunellae Spica), and Renzhonghuang (Human Waste Charcoal).
Shao’s Commentary: Warmth-epidemic toxins inhaled accumulate in Upper Jiao, unable to disperse, causing大头风毒 (Big Head Plague), cheek swelling, and sore throat. This is warmth combined with wind-toxin. Treatment requires clearing heat and detoxifying.
Stomach Disharmony: After fever subsides, lack of appetite and inability to eat indicate Stomach Qi disharmony. Use Xiangchi (Fermented Soybeans), Shanzhi (Gardeniae Fructus), Banxia (Pinelliae Rhizoma), Zhishi (Aurantii Fructus Immaturus), and Chenpi (Citri Reticulatae Pericarpium) to harmonize.
Shao’s Commentary: Residual pathogens remain after fever subsides, causing Stomach Qi disharmony and lack of appetite. Clear residual pathogens and harmonize Stomach Qi.