Library

Qibo said: People nowadays treat wine as a beverage, regard reckless behavior as normal, and engage in sexual intercourse while intoxicated. This laments the decline of social morals compared to ancient times; people fail to avoid empty evils and thieving winds (pathogenic factors) in a timely manner like the ancients, nor do they keep their spirits inwardly guarded. How could diseases arise? From Qibo to the present, four or five thousand years have passed. Added to this are frequent interactions between China and foreign countries, dense populations, frequent wars, and successive famines. Would warm diseases (Wenbing) and epidemics not increase daily under these circumstances? Smallpox appeared in the Later Han Dynasty and became prevalent during the Tang and Song Dynasties. Sha syndrome (also known as dry Huoluan) was prevalent in the Song Dynasty but became even more severe after the Qing Dynasty. Diseases such as rotting throat dan sha (scarlet fever-like illness), diphtheria, and plague, although having different names in the past, only became prevalent after the Qing Dynasty. The reason for this is that in ancient times, the sky was clear and the earth peaceful, the people were simple and customs unadulterated, so empty evils and harsh toxins had no way to arise. Even if they did, they rarely manifested, so people did not notice them. As society declined, customs became more frivolous, and thus malignant diseases and dangerous syndromes increased.

Wu Youke lived in an era plagued by epidemics, so he stated: "Practitioners memorize and recite volumes upon volumes of texts on Shanghan (Cold Damage). Yet when treating patients clinically, they encounter nothing but epidemics. True Shanghan cases account for less than one or two out of a hundred." This is indeed not an empty statement. Although his theories served as the origin for the later confusion between warm diseases and epidemics, his elucidation that epidemic pathogens enter through the mouth and nose, lie latent in the membrane source (Moyuan), and undergo nine types of transmission, constitutes the golden needle (key method) for treating epidemics and should not be overlooked.

Yu Jiayan's three major examples of warm syndromes demonstrate a profound understanding of the pathology of latent qi transforming into disease. However, regarding a case in the *Yizong Jinjian* (Golden Mirror of Medicine), he labeled it as a miraculous verification of a fatal Shanghan syndrome but used forced reasoning, interpreting it as a spring warmth (Chunwen) dual-infection syndrome caused by winter cold injury combined with failure to store essence during winter. He prescribed Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) and Fuzi Xiexin Tang (Aconite and Rhubarb Decoction) to showcase its novelty. He claimed that in individuals who fail to store essence, kidney yang fails to stir, preventing essence fluids from ascending, resulting in external dryness. By using Fuzi to assist yang, yin qi ascends to the yang position, akin to adding fire to a pot, causing steam to rise and providing immediate moistening. Such arguments are extremely absurd. If it is labeled as Shanghan, how can it also be considered a warm disease? In those whose essence is depleted, essence fluids are exhausted and transform into fire. One should fear the lack of urgent cooling measures; how can acrid-warm herbs be used instead? Adding oil to fire, how could it not spread uncontrollably? His symptoms—high fever, delirium, dry and rough skin, curled tongue, scorched lips, and cold feet—correspond exactly to the "yin syndrome resembling yang" described in Wang Haizang's *Yinzheng Lueli*. It is actually a yin syndrome, not a warm disease.

Books such as *Linzheng Zhinan* (Clinical Guide), *Wenzheng Lunzhi* (Discussion on Treatment of Warm Syndromes), and *Jingyue Fahui* (Elucidation of Jingyue) are falsely attributed to Ye Tianshi. (Ye Tianshi never wrote any books himself. Most works circulating under his name are forgeries. *Wenzheng Lunzhi* and *Linzheng Zhinan*, revered as sacred talismans by the Ye school, were written by Gu Jingwen and compiled by Hua Xiuyun, respectively. Similarly, *Jingyue Fahui* was authored by Yao Qiu of Liangxi; booksellers altered the title to include Gui's name because sales were poor, leading to high demand. Cao Jian's *Yixue Dushu Zhi* details this extensively. Chen Xiuyuan also admitted in his *Yixue Sanzijing* to having used Ye Tianshi's name. These instances reveal the extent of forgery.) Both *Linzheng Zhinan* and *Jingyue Fahui* discuss latent qi extensively, not just new sensations (Xingan). Wu Jutong solely adopted the twelve characters from *Wenre Lun*: "Warm pathogens ascend from above, first attacking the Lung, and may reverse-transmit to the Pericardium." He discarded the concept of latent qi, basing his theory on new sensations. Furthermore, he rigidly adhered to the statement in *Linzheng Zhinan*: "Zhongjing's Shanghan is first divided into six channels; Hejian's warm diseases must be investigated through the Triple Burner." He delineated boundaries of the Triple Burner, drifting further from the truth. He represented neither the complete picture of the Ye school nor opened the door for blind following by later students; he is a sinner among warm disease practitioners. Lu Jiuzhi pointed out that Hejian's treatment methods were discussed exclusively in terms of the Six Channels, yet the term "Triple Burner" never appears in Hejian's *Six Books*. Initially puzzled by why *Zhinan* contained such remarks, Lu eventually realized that *Zhinan* mistook Xichang's discussion on plague for Hejian's discussion on warm diseases. Knowing that people generally regarded Hejian's work as differing from Zhongjing's, they felt free to attribute it to him. While this argument is solid, Ye Tianshi's intent might have been different. Hejian's specialization in Fire was well-known, and he wrote *Sanxiao Lun* (Treatise on Three Consumptions), treating Sanxiao via the Triple Burner. Sanxiao diseases involve dry-heat stagnation and exhaustion of essence and blood, requiring cooling treatments similar to warm diseases; perhaps Ye Tianshi deduced this from there. However, the "Triple Burner" in *Sanxiao Lun* refers to the anatomical locations of upper, middle, and lower pathologies, which is semantically similar but practically unrelated to Ye Tianshi's view that warm diseases necessarily start in the Upper Burner and end in the Lower Burner. Nevertheless, although Ye Tianshi knew of latent qi, he conflated new sensations with epidemics in his discussion of warm diseases. Thus, he adopted Youke's theory, taking "warm pathogens ascend from above, first attacking the Lung, and may reverse-transmit to the Pericardium" as the guideline. When the pathogen first attacks the Lung, acrid-cool herbs are used, representing new-sensation warm-heat, which Lu referred to as minor colds like minor wind-heat or minor wind-warmth. When it reverse-transmits to the Pericardium, herbs like Rhinoceros Horn, Gold Juice, and Human Midden Yellow are used, representing severe epidemic cases, which Lu described as entering the Pericardium within days, leading to a major illness and death.

Lu Jiuzhi treated warm diseases by focusing strictly on the Yangming channel, viewing Yangming as the reservoir where warm diseases form. He believed all internal and external pathogens must pass through this vital gateway, much like rivers flowing into the sea, which serves as a comprehensive outline. However, he only elucidated warm diseases located in the Yangming, failing to distinguish between latent qi and new sensations, and treating light/heavy and slow/urgent cases uniformly. While this may serve as a standard method, it lacks flexibility. His intention was to clear obstacles and open new paths, but he arguably went too far in correcting errors.

Wang Mengying was an outstanding figure among warm disease practitioners. He criticized Jutong: "Does Jutong's fixed pathway of the Triple Burner imply that warm-heat diseases must follow this route? Is there any logic in this?" Investigating the Triple Burner in warm-heat diseases does not mean the disease always starts in the Upper Burner and gradually spreads to the Middle and Lower. Latent qi emerging from within can cause diseases starting in the Lower Burner. The stomach, being a place of accumulation, can be the site of wet-warmth and epidemic toxins starting in the Middle Burner. Summer-heat pathogens carrying dampness also invade the Middle Burner. Moreover, summer-heat belongs to Fire, and the Heart is the Fire organ; due to sympathetic resonance, pathogens easily invade. Even if starting in the Upper Burner, it cannot be assumed to be confined to the Hand-Taiyin Lung channel. Regarding the distinction between latent qi and new sensations, he stated: "Latent qi warm diseases emerge from the interior to the exterior, moving from the Blood level to the Qi level first. Some pathogens lie deep and cannot exit simultaneously, like peeling a banana or cocoon, endlessly emerging, unlike external warm pathogens that move from Wei (Defensive) to Qi, and from Ying (Nutritive) to Blood." These discussions contain profound truths and are worthy of emulation. His clinical cases are numerous and worth studying.

Zhang Xugu and Wu Jutong were contemporaries who both worshipped Ye Tianshi. Although Zhang made no new discoveries regarding warm-heat diseases, he corrected errors in Jutong's *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases), performing slightly better than Jutong.

The disease of latent evil is discussed in detail in the *Neijing* (*Inner Canon*), though the specific name is absent. Although *Shanghan Lun* (*Treatise on Cold Damage*) mentions latent qi, it does not use the term "new sensation," leading to constant confusion among those discussing warm diseases. Jiang Baosu's *Fuxie Pian* (Chapter on Latent Evil) in his *Yilue Gao* (*Draft of Medical Notes*) elucidated latent warm diseases clearly. Unfortunately, he borrowed the concepts of traveling and latent pathogens from Wu's *Wenyi Lun* (*Treatise on Epidemic Pestilence*), still failing to distinguish between plague and warm diseases, making it unsuitable as a model. Liu Baoyi followed up, distinguishing the differences between plague and warm diseases, and between new sensations and latent qi. He corrected previous errors and expounded on points previously unmentioned, making his work the most comprehensive discussion on latent qi warm diseases.

Others such as Zhou Yucai, You Zaijing, Shu Chiyuan, and Chen Pingbo also made contributions to warm disease theory. Zhou Yucai's *Wenre Shuyi Quan shu* (*Complete Book on Warm, Heat, Summer-heat, and Epidemic Diseases*) elucidates warm diseases originating in the Shaoyang channel. He stated: "What warm diseases injure is Cold; what they manifest as is Warmth; what lies latent is Shaoyin; what erupts is Shaoyang." The reason is that Shaoyin is inherently deficient and injured by Cold. In spring, Wood flourishes while Water is depleted, causing Fire to blaze. The disease will have Yang without Yin, requiring cold herbs and avoiding warm ones. Huangqin Tang (Scutellaria Decoction) is the primary treatment. You Zaijing's *Shanghan Guan Zhu Ji* (*Pearl String Collection on Cold Damage*) elucidates clearing methods for Shaoyin and Jueyin. He stated: "Heat in Shaoyin may transmit from Yang channels or arise from Cold pathogens lingering and transforming into heat over time. When Cold in Yang channels transforms, heat returns to the Qi level or enters the Blood level. When Cold in Yin channels transforms, heat enters the Blood level without returning to the Qi level." Jueyin disease involves polydipsia and internal heat, resulting from transmitted pathogens affecting Jueyin. Shu Chiyuan's *Shanghan Liujing Dingfa* (*Fixed Methods for the Six Channels of Cold Damage*) elucidates fire syndromes in the Taiyin channel. He stated: "The two syndromes of Bi obstruction (fixed and migrating) in the Taiyin channel result from excessive fire and yin deficiency, with heat binding in the meridians, causing redness, heat, swelling, and pain that cannot be touched. The treatment should clear heat and moisten dryness." Chen Pingbo's *Wenre Bing Zhinan* (*Guide to Warm Disease Treatment*) elucidates that the Lung and Stomach are the sites inevitably attacked by warm pathogens. He stated: "Wind-warmth is a dry-heat pathogen. Dryness follows Metal transformation, and dry-heat returns to Yangming. Thus, the Lung and Stomach are the inevitable targets. Since wind-warmth is a dry-heat disease, dryness injures Yin and heat injures fluids. Clearing heat and harmonizing Yin is the definitive treatment for wind-warmth."

The statements of these masters all contain profound truths, but each highlights only one aspect. Students should absorb broadly and integrate them to form a comprehensive treatment principle for warm diseases. Adhering rigidly to one school's views is highly inadvisable. The Six Channel manifestations in *Shanghan Lun* are the outline for all diseases, not just for Shanghan. Liu Songfeng proposed Six Channel treatments for epidemics, and Zhu Lantai's *Yizheng Zhili* (*Examples of Treating Epidemics*) also divides them into Six Channels. If even epidemics are treated based on Six Channel manifestations, how much more so for warm diseases! "Manifestations" means treating based on which channel the symptoms appear in. Interpreting this as the sequential transmission of Shanghan—from Taiyang to Yangming, ending in Jueyin—is erroneous. The *Nanjing* states: "The pulse of warm diseases travels through the various channels; it is unknown which channel is active." Therefore, those discussing warm diseases cannot be dogmatic.

Regarding treatment methods, the *Neijing* says: "Treat cold with heat, treat heat with cold." It also states: "For conditions originating internally and manifesting externally, regulate the interior; for conditions originating externally and penetrating internally, treat the exterior. If internal-originating conditions become severe externally, regulate the interior first, then treat the exterior; if external-originating conditions become severe internally, treat the exterior first, then regulate the interior. If interior and exterior are unrelated, treat the primary disease." It further states: "Treat heat with cold, administer warmly; treat cold with heat, administer coolly; treat warmth with clarity, administer coldly; treat clarity with warmth, administer hotly." Thus, reducing, cutting, vomiting, purging, tonifying, and draining are applied similarly regardless of whether the disease is chronic or acute. These are general principles of treatment, applicable to warm-heat diseases as well.

Lu Jiuzhi said: "In *Linzheng Zhinan*, Ye Tianshi treated minor wind-cold as a major category of Shanghan; in *Wenzheng Lunzhi*, he treated minor wind-heat as a major category of warm diseases. Consequently, the knowledge of Shanghan was lost at Ye Tianshi's time, and the knowledge of warm diseases was also lost at his time." This laments the forgeries by Jingwen and Xiuyun. Who would have thought that without Ye Tianshi's errors, there would be no later disputes between Shanghan and warm diseases, and neither would have been elucidated? The "Shanghan has five types" mentioned in the *Nanjing* refers to the general term for external contraction. *Shanghan Lun* is the comprehensive book on the Six Excesses. However, among the five types of Shanghan, there is a specific type called "Shanghan." Thus, Shanghan has both broad and narrow meanings. With a narrow meaning, Shanghan and warm diseases cannot be conflated. Today's warm disease practitioners do not speak solely of warm diseases but encompass summer-heat, dampness, dryness, and fire. This does not contradict canonical principles and further develops them. Why cannot they shine alongside *Shanghan Lun*, complementing each other? Although this book was written to clarify the name of warm diseases, it also serves to provide further interpretation for *Shanghan Lun*.