云岐子∶伤寒汗下不愈,过经其证尚在而不除者,亦为温疫病也。如太阳证,
汗下过
经不愈,诊得尺寸俱浮者,太阳温病也。如身热目痛不眠,汗下过经不愈,诊得尺寸俱长
者,阳明温病也;如胸胁胀满,汗下过经不愈,诊
得尺寸俱弦者,少阳温病也;如腹满咽干,诊得尺寸俱沉细,过经不愈者,太阴温病也;如
口燥舌干而渴,诊得尺寸俱沉细,过经不愈者,少阴温病也;如烦满囊缩,诊得尺寸俱微缓
,过经不愈者,厥阴温病也。是故随其经而取之,随其证而治之,如发斑乃温毒也。
正误∶按∶伤寒叙一日太阳、二日阳明、三日少阳、四日太阴、五日少阴、六日厥阴,为传经尽,
七日后传太阳,为过经。云岐子所言伤寒过经不愈者,便指为温病,竟不知伤寒温病,自是
两途
注云∶愚谓温与热,有轻重之分。故仲景云∶若遇温气,则为温病(此叔和之言,非仲景
论)。更遇温热气,即为温毒,热比温尤重故也。但冬伤于寒,至春而发,不感异气,名
曰温病,此病之稍轻者也。温病未已,更遇温气,变为温病,此病之稍重者也。伤寒例以再
遇温气名曰温疫,又有不因冬伤于寒,至春而病温者,此特感春温之气,可名春温,如冬之
伤寒,秋之伤湿,夏之中暑相同也。(按∶《阴阳大论》四时正气之序∶春温、夏暑、秋凉
、冬寒。
今特感春温之气,可名春温,若感秋凉之气,可名秋凉病矣。春温可以为温病,秋凉独不可
为凉病乎?以凉病似觉难言,勉以湿证搪塞,既知秋凉病有碍,反而思之,则知春温病殊为
谬妄矣。)以此观之,是春之温病,有三种不同,有冬伤于寒,至春变为温病者,有温病未
已,再遇温气,而为温病者;有重感温气,相杂而为温病者;有不因冬伤于寒,不因更遇温
气,只于春时,感春温之气而病者。若此三者,皆可名为温病,不必各立名色,只要知其病
原之不同也。
正误∶凡病各有病因,如伤寒自觉触冒风寒,如伤食自觉饮食过度,各有所责。至于温病,乃伏邪
所发,多有安居静养,别无他故,倏焉而病。询其所以然之故,无处寻思,况求感受之际,
且自不觉。故立论者或言冬时非节之暖,或言春之温气,或言伤寒过经不解,或言冬时伏寒
,至春夏乃发(按∶冬伤于寒春必病温,出自《素问》,此汉人所撰,晋王叔和又以述《
伤寒例》,盖顺文之误也)。或指冬不藏精,春必病温(此亦汉人所撰,但言斫丧致病,不言
因邪致病,即使寓意邪气乘虚,实不言何气使然。夫邪气乘虚,最是切当,然又有童男室女,以无漏之体,富贵享逸,
以幽闲之志,在疫亦未能免,事有不可执滞)。又见冬时之温病,与春夏之温疫,脉证相同,治法无异。据云∶冬时即
病
为伤
寒,今发于冬时,应作正伤寒,且又实是温病,既是温病,当发于春夏而何又发于冬时?思之至此,不能无疑,乃觉前
人所论难凭,务求其所以然之故,既
不可言伤寒,又不可言伏寒,即得以冬时非节之暖,牵合而为病原。不思严寒酷暑,因其锋利
,人所易犯,故为病最重。至于温暖,乃天地中和之气,万物得之而发育,气血得之而融和
,当其肃杀之令,权施仁政,未有因其仁政而反蒙其害者。窃尝较之,冬时未尝温暖,
亦有
温病,或遇隆冬,临时温暖,虽有温病感温之由,亦无确据,此不过猜疑之说,乌足以为定
论
。或言感三春当令之温气为温病,夫春时自应温暖,责之尤其无谓;或言温病复感温气,而
为温病,正如头上安头;或言伤寒汗下过经不愈者为温病,则又指鹿为马。《活人》又以夏
应暑而寒气折之,责邪在心,为夏温;秋应凉而大热折之,责邪在肺,为秋温,转属支离。
陶氏又以秋感温气而为秋温,明是杂证,
叙温者络绎,议论者各别,言愈繁杂,而本源愈失,使学人反增亡羊之感,与医道何补。
《活人书》云∶夏月发热恶寒头疼,身体肢节痛重,其脉洪盛者,热也。冬伤于寒,因暑
气而发为热病,治热病与伤寒同,有汗宜桂枝汤,无汗宜麻黄汤,如烦躁宜大青龙汤,然夏
月药性须带凉,不可太温,桂枝麻黄大青龙须用加减,夏至前桂枝加黄芩,夏至后桂枝麻黄
大青龙加知母、石膏或加升麻,盖桂枝麻黄性热,地暖处,非西北之比,夏月服之,必有发
黄斑出之失。热病三日外,与前汤不瘥,脉势仍数、邪气犹在经络、未入脏腑者,桂枝石膏汤主
之,此方夏至后,代桂枝证用,若加麻黄,可代麻黄青龙汤证也。若三月至夏,为晚发伤寒
,栀子升麻汤,亦暂用之。(王宇泰述万历癸卯,李氏一婿,应举南下,时方盛暑,伤寒,一太
学生,新读仲景书,自谓知医,投以桂枝汤,入腹即毙,大抵麻黄桂枝二汤,隆冬正伤寒之
药,施之于温病不可,况于热病乎?)
正误∶按∶《活人》以温热病,用桂枝麻黄,虽加凉药,终未免发散之误,不危幸也,岂止三日
前汤不瘥、脉势仍数而已哉?至此尚然不悟为半里之证,且言邪气犹在经络,仍用桂枝石膏
汤,至死无悔。王宇泰及王履非之甚当,是以不用麻黄桂枝,贤于《活人书》远矣。究竟不识温热
之源,是以不知用药耳。
春温,《活人书》曰∶春应温而清气折之,责邪在肝,或身热头疼,目眩呕吐,长幼率相似
升麻葛根汤、解肌汤、四时通用败毒散。陶氏曰∶交春后至夏至前,不恶寒而渴者为温病,
用辛凉之药微解,不可大发汗,急证现者,用寒凉之药,急攻之,不可误汗误下,当须识
此,表证不与正伤寒同法,里证同。
夏温,《活人书》曰∶夏应暑而寒气折之,责邪在心,或身热头疼、腹满自利,长幼率相似
,理中汤、射干汤、半夏桂枝汤。陶氏曰∶交夏至,有头疼发热,不恶寒而渴,此名温病,愈加
热者为热病,止用辛凉之药解肌,不宜大汗,里证见者,急攻下,表证不与正伤寒同法,里
证治法同。
秋温,《活人书》曰∶秋应凉而大热折之,责邪在肺,湿热相搏,民病咳嗽,金沸草散、白
苍术汤;病疸发黄,茵陈五苓散。陶氏曰∶交秋至霜降前,有头疼发热、不恶寒、身体痛
小便短者,名湿病,亦用辛凉之药,加疏利以解肌,亦不宜汗,里证见者,宜攻下,表证不
冬温,《活人书》曰∶冬应寒而反大温折之,责邪在肾,宜葳蕤汤。丹溪曰∶冬温为病,非
其时有其气者,冬时严寒,君子当闭藏而反发泄于外,专用补药带表药。
正误∶按∶西北高浓之地,风高气燥,湿证希有,南方卑湿之地,更遇久雨淋漓,时有感湿者,在天
或时久雨,或时亢旱,盖非时令所拘,故伤湿之证,随时有之,不待交秋而后能也。推节庵
之意,以至春为温病、至夏为热病,至秋似不可复言温热,然至秋冬,又未免温病,只得勉
以湿证抵搪,且湿热杂证,更不得借此混淆。惟其不知温病四时皆有,故说到冬时,遂付之
不言,宇泰因见陶氏不言,乃引丹溪述非其时有其气,以补冬温之缺,然则冬时交错之
气,又不可以为冬温也。
《活人书》但言四时之温,盖不知温之源,故春责清气,夏责寒气,
气,冬责温气,殊不知清、温、寒、热,总非温病之源。复以四时专令之脏而受伤,不但胶
柱鼓瑟,且又罪及无辜矣。
Yun Qizi stated: When Taiyang disease (disease of the Taiyang channel) caused by Shanghan (Cold Damage) fails to resolve after sweating or purging therapies, and symptoms persist beyond the transmission of channels, it is also classified as a Wenyi epidemic. For instance, if Taiyang syndrome persists after sweating/purging and channel transmission, and the pulse at the cun, guan, and chi positions on both wrists is floating in all three positions, it is Taiyang Wenbing (Spring Warmth Disease). If there is fever, eye pain, and insomnia persisting after these therapies, with a long pulse in all three positions, it is Yangming Wenbing. If there is chest and hypochondriac fullness persisting after these therapies, with a wiry pulse in all three positions, it is Shaoyang Wenbing. If there is abdominal fullness and dry throat persisting after these therapies, with a deep and fine pulse in all three positions, it is Taiyin Wenbing. If there is dry mouth and tongue with thirst persisting after these therapies, with a deep and fine pulse in all three positions, it is Shaoyin Wenbing. If there is irritability, abdominal fullness, and retraction of the scrotum persisting after these therapies, with a faint and moderate pulse in all three positions, it is Jueyin Wenbing. Therefore, treatment should be selected according to the affected channel and administered according to the specific syndrome. If macules appear, it is considered Wendu (Warm Toxin).
Correction: The commentary notes that the *Shanghan Lun* describes the progression as Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang, Day 4 Taiyin, Day 5 Shaoyin, Day 6 Jueyin, which constitutes the completion of channel transmission. Transmission back to Taiyang after seven days is termed "passing the channel" (Guojing). Yun Qizi’s assertion that Shanghan failing to resolve after passing the channel is immediately identified as Wenbing demonstrates a failure to recognize that Shanghan and Wenbing follow distinct pathological pathways.
Annotation states: I believe there is a distinction in severity between "Wen" (Warmth) and "Re" (Heat). Thus, Zhang Zhongjing stated: "If one encounters Warm Qi, it becomes Wenbing" (This statement is attributed to Wang Shuhe, not Zhang Zhongjing himself). If one further encounters Warm-Heat Qi, it becomes Wendu, as Heat is more severe than Warmth. However, Cold damage sustained in winter manifesting in spring without exposure to other pathogenic factors is called Wenbing, representing a milder form. If Wenbing persists and is compounded by Warm Qi, becoming a more severe Wenbing, this represents a slightly heavier condition. The *Shanghan Li* defines contracting Warm Qi twice as Wenyi. There are also cases where Wenbing arises in spring not due to winter cold but from specifically contracting Spring Warmth Qi, which can be named Chunwen (Spring Warmth), analogous to Winter Shanghan, Autumn Shanshi (Dampness Injury), or Summer Zhongshu (Summerheat Stroke). (Commentary: The *Yinyang Dalun* outlines the sequence of seasonal correct qi: Spring Warmth, Summer Summerheat, Autumn Coolness, Winter Cold. If one specifically contracts Spring Warmth Qi, it may be named Chunwen; similarly, contracting Autumn Coolness Qi could be named Qiuliang illness. If Chunwen qualifies as Wenbing, why cannot Qiuliang qualify as Coolness illness? Since naming it Coolness illness seems difficult, it was tentatively covered by Dampness syndromes. Reflecting on the obstruction regarding Autumn Coolness reveals that attributing Spring Warmth to Wenbing is fundamentally flawed.) Thus, Spring Wenbing presents in three variations: those transforming from winter cold into spring Wenbing; those where unresolved Wenbing is compounded by Warm Qi; those where repeated contraction of Warm Qi mixes to form Wenbing; and those contracting Spring Warmth Qi directly in spring without prior winter cold or subsequent Warm Qi. All three may be termed Wenbing, distinguished only by their differing etiologies.
Correction: Every disease has its specific etiology; for example, Shanghan results from exposure to Wind-Cold, while food injury results from overeating. In contrast, Wenbing arises from latent pathogens (Fuxie). Patients often fall ill suddenly while living quietly without obvious cause, unable to identify the onset or the moment of infection. Consequently, theorists propose various causes: non-seasonal warmth in winter, Spring Warmth Qi, unresolved Shanghan after channel transmission, or latent winter cold manifesting in spring/summer. (Note: "Winter cold damage leads to spring Wenbing" originates from the *Suwen*, written by Han dynasty scholars; Wang Shuhe included it in the *Shanghan Li*, likely due to textual continuity errors.) Others cite "failure to store essence in winter leads to spring Wenbing" (also Han dynasty writing, focusing on depletion rather than pathogenic invasion; while pathogenic invasion via deficiency is plausible, it fails to specify the pathogen. Even virgins or wealthy individuals living secluded lives are not immune to epidemics, indicating rigid adherence is inappropriate.). Observing that winter Wenbing and summer/autumn Wenyi share identical pulses and syndromes, yet treating them identically to Shanghan, raises contradictions: if winter onset is Shanghan, why does Wenbing manifest in winter rather than spring/summer? This uncertainty renders previous theories unreliable. Seeking the root cause, neither Shanghan nor latent cold fits perfectly. Attributing it to non-seasonal winter warmth is speculative and lacks evidence. Severe cold and heat are sharp and easily contracted, causing serious illness. Warmth, however, is the harmonious qi of heaven and earth, promoting growth and blood/qi harmony. It is illogical to blame benevolent weather for harm. Comparatively, Wenbing occurs even in cold winters, and temporary warmth in deep winter lacks definitive proof for causation. Claiming Spring's proper warmth causes Wenbing is redundant; claiming Wenbing compounded by Warm Qi is superfluous ("adding head to head"); and equating unresolved Shanghan with Wenbing is erroneous (*Baren Shu*'s attribution of Summer Cold to Heart and Autumn Heat to Lung is fragmented). Tao's attribution of Autumn Warmth to mixed syndromes adds confusion. The proliferation of theories obscures the source, confusing students and aiding no medical practice.
The *Baren Shu* states: In summer, fever, aversion to cold, headache, heavy body/joint pain, and surging pulse indicate Rebing (Heat Disease). Caused by winter cold triggered by summer heat, it is treated like Shanghan: Guizhi Tang (Cinnamon Twig Decoction) for sweating, Mahuang Tang (Ephedra Decoction) for no sweating, Da Qinglong Tang (Major Green Dragon Decoction) for irritability. However, summer prescriptions must include cooling herbs. Guizhi Tang, Mahuang Tang, and Da Qinglong Tang require modifications: add Huangqin (Scutellaria Root) before the Summer Solstice; add Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), or Shengma (Cimicifugae Rhizoma) after the solstice. Since Cinnamon Twig and Ephedra are hot-natured, using them in warm southern regions during summer risks inducing jaundice and macules. If Rebing persists beyond three days with rapid pulse and pathogen still in channels (not organs), Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) is indicated. After the solstice, this replaces Guizhi Tang indications; adding Mahuang covers Mahuang/Da Qinglong indications. For late-onset Shanghan from March to summer, Zhizi Shengma Tang (Gardenia and Cimicifuga Decoction) may be used temporarily. (Wang Yutai recorded a case in the Gui Mao year of Wanli: A scholar traveling south in peak summer contracted Shanghan. A student physician, newly versed in Zhang Zhongjing’s works, prescribed Guizhi Tang, resulting in immediate death. Mahuang and Guizhi are for deep winter Shanghan; they are contraindicated for Wenbing and certainly for Rebing.)
Correction: The *Baren Shu*’s use of Guizhi/Mahuang for Warm-Heat diseases, even with cooling additions, inevitably errs in dispersing, leading to danger beyond mere persistent rapid pulse. Failing to recognize half-interior syndromes and continuing to use Guizhi Shigao Tang for exterior-channel pathogens is fatal. Wang Yutai and Wang Lv correctly criticized this, favoring avoidance of Mahuang/Guizhi, far superior to the *Baren Shu*. Ultimately, ignorance of Warm-Heat origins leads to incorrect prescribing.
Regarding Chunwen, the *Baren Shu* attributes it to Clear Qi obstructing warmth, affecting the Liver, causing fever, headache, dizziness, vomiting, similar across ages, treated with Shengma Gegen Tang (Cimicifuga and Pueraria Decoction), Jiemi Tang (Muscle-Releasing Decoction), or Baidu San (Hundred-Toxin Powder) for all seasons. Tao states: From start of Spring to pre-Summer Solstice, non-aversion-to-cold with thirst indicates Wenbing, treated with mild Acrid-Cool herbs to release the exterior; avoid vigorous sweating. For urgent syndromes, use Cold-Cool herbs to attack urgently; avoid erroneous sweating/purging. Exterior syndromes differ from standard Shanghan; interior syndromes are the same.
Regarding Xiawen, the *Baren Shu* attributes it to Cold obstructing Summerheat, affecting the Heart, causing fever, headache, abdominal fullness, spontaneous diarrhea, similar across ages, treated with Lizhong Tang (Regulate the Middle Decoction), Shegan Tang (Belamcanda Decoction), or Banxia Guizhi Tang (Pinellia and Cinnamon Twig Decoction). Tao states: From Summer Solstice onward, headache/fever, non-aversion-to-cold with thirst is Wenbing; increased heat is Rebing. Use Acrid-Cool herbs to release muscle layer; avoid profuse sweating. For interior syndromes, attack urgently with purgatives. Exterior treatment differs from Shanghan; interior treatment is the same.
Regarding Qiuwen, the *Baren Shu* attributes it to Heat obstructing Autumn Coolness, affecting the Lung, with Damp-Heat clashing causing cough, treated with Jinfeicao San (Boiling Grass Powder) or Baicangzhu Tang (White Atractylodes Macrocephala Decoction); for jaundice/yellowing, use Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction). Tao states: From start of Autumn to pre-Frost Descent, headache/fever, non-aversion-to-cold, body pain, short urine is Shibing (Dampness Disease), treated with Acrid-Cool herbs plus draining/dispersing to release muscle layer; avoid sweating. For interior syndromes, use purgatives. Exterior treatment differs from Shanghan.
Regarding Dongwen, the *Baren Shu* attributes it to excessive Warmth obstructing Winter Cold, affecting the Kidney, recommending Zhenyu Tang (Polygonatum Decoction). Danxi stated: Dongwen arises when seasonal Qi is absent; in harsh winter, when one should conserve, outward leakage occurs. Use tonifying herbs combined with exterior-releasing herbs.
Correction: In high, dry Northwest regions, Dampness is rare; in low, wet Southern regions, prolonged rain causes frequent Dampness injuries. Weather varies independently of seasons, so Dampness syndromes occur anytime, not just post-Autumn equinox. Analyzing Jie’an’s view: Spring is Wenbing, Summer is Rebing; Autumn should not be termed Warm-Heat, yet Winter/Autumn still see Wenbing. He resorts to Dampness explanations, conflating Damp-Heat mixed syndromes. Ignorance that Warmth exists in all four seasons led to omitting Winter. Yutai filled this gap citing Danxi’s "non-seasonal Qi," yet interstitial Qi in winter cannot simply be Dongwen.
The *Baren Shu* discusses Four Seasons' Warmth but misunderstands its origin, blaming Clear Qi in Spring, Cold in Summer, Dryness in Autumn, and Warmth in Winter. These are not the source of Wenbing. Blaming specific organ injuries based on seasonal rulership is rigid and unjust.