《温热论》“又不拘何色，舌上生芒刺者，皆是上焦热极，当用青布拭冷薄荷水揩之”云云，这段文字，更不可盲目尊信。章虚谷说：“胃无大热，必无芒剌。”俞根初论六经舌苔，亦以芒刺属胃热。吴坤安认为：舌苔白面生燥刺，属肺经温邪；如厚黄燥刺，或边黄中心焦黑起剌，届阳明胃热；如鲜红起刺，为胆火炽，如舌苔焦紫起刺如杨梅状，是厥阴阡经阳邪热毒。秦皇士则认为：“凡渴不消水，脉滑不数，亦有舌苔生刺者，多是衷邪挟食，用保和丸加竹沥，莱菔汁，或栀豉加枳实并效。”从诸家经验来看，舌生芒刺，决非上焦热极端，叶氏不辨舌苔之色，不察形体脉证，一见舌生芒刺，概以为是上焦热极，这种认识，是极为片面的。温热病舌生芒刺，实际上以属中焦胃热居多，若以芒刺舌责之中焦热极，尚未大误，今谓皆属上焦，就大谬。吴鞠通撰《温病条辨》，在上焦篇不曾提到舌生芒刺，而中焦篇第一条就有“舌苔老黄，甚则黑有芒刺”之证，说明芒剌舌是以中焦胃热为多见。又中焦篇三五条云：“阳明温病，下后微热，舌苔不退者，薄荷末拭之。”吴氏以新汲凉水蘸薄荷末拭舌之法实是秉叶氏之教，但叶氏以芒刺舌皆届上焦，吴氏则以之属中焦，即此观之，遵《温热论》为最高指导原则而著《温病条辨》的吴鞠通，也早心识叶氏之误，只是讳言其失罢了。《温病学》对这一条能直率地指出；“临床辨证，必须结合证侯全面分析，而绝不可一见舌有芒刺，即认为是热盛所致”，这对指示后学，不力叶说所惑，是有积极意义的。而《中医原著选读》既说“本条是对黄苔的补充说明”，“温热病舌苔黄而又见芒剌的，是上焦邪热盛极。”又说“黄苔主里”，“黄厚焦燥起芒刺或中有裂纹者，为阳明府实。”就不免有随文曲释，自相矛盾之嫌了。
结语：叶氏的创新精神是可贵的，《温热论》有其一定的学术价值，这亦不可否定，但它毕竟不是没有瑕疵的天书。对古人著作，我们的原则是批判地继承，但历来注《温热论》之诸家，从来不言书中之失，这样，客观上成了全盘吸收，甚至可以说是囫囵吞枣了，又由于统一教材等原因，使扬稗之作，殊难得见，故略论其八失如上。
参考文献：
①南京中医学院主编，《温病学》(全国高等医药院校试用教材)
⑧同②
④金寿山，《温热论新编》，上海科技出版社，1960年。
⑤贝润浦等，上海中医药杂志，1983年1期，16页。
⑥转引自上海中医药杂志1981年，7期，19页。
再驳“温邪上受等十二字为温病提纲”说
《温热论》首文“温邪上受，首先犯肺，逆传心包”十二字，姜春华教授说“是指一病而言，叶氏在医案中并说邪从口鼻而入，后人竞以此十二字为—切温病提纲，错在后人。”①但作为全国高等医药院校统一教材的《温病学》，却认为“温邪外侵，必先犯肺而出现肺卫衷证”，“本条为论证温病证治的总纲。”二说相背，是非未定，若不深究，初学不知适从，后人见之眩目，不利于中医学术之发展，故本文拟再加剖析，以补上文论述之过简。
一，不是一切温病提纲
前人一般将温病分为新感、伏气两大类，近人亦多宗是说。叶氏对伏气说也不否定，如《临证指南》温热门杨案曰“伏邪发热”、马案曰“少阴伏邪”、黄案曰“体虚温邪内伏”，又暑门范案曰“伏暑阻其气分”，池案曰“伏暑至深秋而发”、又如《幼科·伏气篇》云：“春温一证，由冬令收藏未固，昔人以冬寒内伏，藏于少阴。”即此论，十二字决非指一切温病言，否则，叶氏何以云春温“以黄芩汤为主方，苦寒直清里热，热伏于阴，苦味坚阴，乃正治也，知温邪忌散，不与暴感门同法。"②伏气温病当苦寒直清里热，不与暴感同法，叶氏说的何等明白，不知后人何以竟以此为一切温病提纲？试观叶派中人，亦多不如此认识，如华岫云即说：“春温冬时伏寒藏于少阴，遇春时温气而发，非必上受之邪也。则此所论温邪，乃是风温湿温之由于外感者也。”他如章虚谷、王孟英以及近贤金寿山等，也都是这个看法，唯有吴鞠通始作此种谬解，《温病条辨·上焦篇》开宗明义就说，“温病者，有风温，有温热、有温疫、有温毒、有暑温、有湿温、有秋燥、有冬温，有温疟。”“凡病温者，始于上焦，在乎太阴。”后人不辨，踵其讹误，遂以之为一切温病提纲，吴氏作俑，流毒甚广。
叶派所说之温病，包括甚广，即吴氏所论，已有九种。其中风温、暑温，湿温等都是新感温病。叶氏说：“夏暑发自阳明”，即此一语，已足说明叶氏本人并不认为“温邪外侵，必先犯肺而出现肺卫表证”的。再如湿温，其初起的病变中心，就在脾胃，即使有表证，亦如薛生白所云，“所云表者，乃太阴(笔者按：指足太阴)阳明之表，而非太阳之表，太阴之表四肢也”，脾主四肢，故巳太阴表证有四肢倦怠证，它不同于手太阴之表，故湿温病亦不得以首先犯肺为提纲。但由于叶氏将温病、风温，湿温混在一起讲，故华岫云等人都误以为邪，从口鼻而入的温病，必定首先犯肺，实则风温等肺系疾病从鼻而犯肺，湿温等胃系疾病从口而犯胃，入肺入胃，分明二途。故叶氏“挟湿加芦根、滑石之流”云云，如指肺系疾病巾的温邪挟湿证言，则首文十二字尚属无误，无奈叶氏“湿温病大便溏为未尽”等文确是指湿温病言，故叶氏不得辞其咎。再从《临证指南》中“口鼻受寒暄不正之气，过募原，扰胃系”③“秽暑吸入，内结募原”④等这些活来看，说明叶氏奉不否定外邪从口鼻吸受，亦有不先犯肺，而走中道经募原直扰胃系，；或结于募原的，未悉何以在《温热论》起首又云“首先犯肺”？怪不得谢涌穆说：“所谓温热论者，……有自相矛盾者，有混杂不清者，凌乱支理，不可卒读。”⑤显然，时逸人关于温热病“不得以首先犯肺，以印定后人眼目，”⑧等论述，观点是正确的。吴鞠通“固执其说，致有理论与实际脱节的舛误”我们不应再踵其误。
三、可以作呼吸器病提纲
《温热论》至少是包括了二种病(即风温和湿温)，如果不完全否定十二字有纲领性意义，则姜老“指一病而言”之说也不能成立。如果“指一病而言”之说成立，则十二宇就不存在任何纲领性意义。笔者认为：从《临证指南医案》来看，“上受，犯肺”说作为呼吸器病提纲，这样说是可以成立的，如温热门谢案曰：“温邪上受，内入乎肺”，丁案曰：以口鼻吸入热秽，肺先受邪"，王案曰：“吸入温邪，鼻通肺络，逆传心包络中，震动君主”，褚案曰：“温邪中自口鼻，始而入肺为咳喘，继传膻中则呛血”，又如风温门叶案曰：“风温入肺，肺气不通，热渐内郁”，郭案曰；“风温入肺，气不肯降”，某案曰：“风温从上而入，风属阳，温化热，上焦进肺，肺气不得舒转”，又如暑门姚案曰：“暑湿热气，始由肺受"，陈四五案曰：“暑湿伤气，肺先受病”，王案曰：“暑风热气入肺，”又如咳嗽门陆案曰；“秋暑燥气上受，先干于肺”，诸此类案，不胜枚举，详其症状，大都属呼吸器病，故彼十二字，不妨作呼吸器病提纲视之。然就病论，上述例案中，已有风温、温热、冬温、暑病、燥病等五六种之多(从中医辨病角度说，这都是些不同的病)，故彼十二字似不必以“单指一病言刀说来局限其范围。《温病条辨·上焦篇》第二条，如果作为呼吸器病的提纲提出，原也是可以的，但由于叶氏在《温热论》中，与湿温混在一起讲，吴氏不加辨正，反随意扩大，所以到后来竟产生了“温邪初起，必先犯肺”的误解。
四、究竟做不来温病提纲
呼吸器病，不一定就是温病。吴鞠通说：“太阴风温，但咳，身不甚热，微渴者，辛凉轻剂桑菊饮主之。”吴氏自辨说此“系小病”，这个小病，究其实，就是伤风。叶吴以前之医着，如《金匮钩玄》，《明医指掌》，《景岳全书》等之中，都载此病，陆九芝说伤风无传变。此病约定俗成，名为伤风，或称感冒，从不曾与温病相滥，但一到叶吴手中，此病之辨证属于风热者，竟一变而成了温病。章太炎曾对这种做法，提出过批评，章氏说：“夫病之治疗，古今或容有异，若以病状定病名，此不能违古而妄更，叶吴之所谓湿温，可谓悬牛头，卖马脯矣。”称伤风为风温，是更为明显的悬牛头，卖马脯，名不符实了。风温的症状，《伤寒论》中早有描述，但经叶吴一移，名实就混淆了。又如肺胀，仲景列于《金匮要略·肺痈肺痿咳嗽上气病篇》，原属杂病，但经叶氏之后，竟变成了理所当然的温病，其移亦始于叶氏，温热门“龚襁褓吸入温邪，酿成肺胀危证。芦根，桃仁、苡仁、冬瓜子”此案即是明证，惟仲景以苇茎汤治肺痈，叶氏以之治肺胀，这又是一移。后世将伤风感冒、肺痹、肺胀，肺痈等呼吸器病统隶于温病，作俑者即是叶氏。吴鞠通之后，更将治呼吸器病的一些药法，移作为一切温病初起之治法，这使中医对温病的处理，技术上退化不少。叶吴这样子的乱移，决不能看作是事物发展的必然，而实是人们认识事物必然规律过程中产生的一种混乱，否则，痉、湿、暍也罢，百合、狐惑，阴阳毒也罢，这一切原有别于温病的杂病，我们只要根据病从热化的证型，岂不统统可以冠以温病之名？如果认为不宜作这样的乱移，则伤风，肺胀这一些呼吸系病，俱不得棍称为温病，而这样一来，得出如下结论，顺理成章，十分自然，即：十二字虽不妨视为部分呼吸器病(因不能统风寒感冒、肺饮等在内)的提纲，而究竟做不来温病之提纲。细察叶氏所谓温邪犯肺的一些医案，虽命名有风温，冬温，温热，燥病等种种之不同，究其实大多是发于四时的伤风，肺胀，肺痈，肺痹之类。如细析源流，明察温病本义，不承认这些病为温病，则一部《温热论》，开首就已大谬不然。所以谢诵穆说：“温病名实之淆乱，叶天士为祸首。”谢氏认为：“从温病学说思想之变迁上考察，所谓温邪上受首先犯肺之温病，确是节外生枝，中途平空阑入，温病之涵义，本己复杂，再阑入此漠不相关之温病，益令名实混淆，故并无阑入之必要。”“本非温病，中途阑入，不应冒温病之名。”⑦近人将谢氏这些分析入理的议论，诋为复古之论，是极不妥当的。
五、提纲说副作用不小
薄荷、牛蒡、桑叶、菊花、桔梗，杏仁，豆豉、豆卷、象贝、芦根、银花，连翘等这一类药物，酌用于风热感冒，很是合适，银翘散，桑菊饮等这一类方剂，用于治疗伤风、喉蛾等病，也很可取。叶吴等人，用这样的药，治这样的病，无可非议。但按照提纲之说，“初用辛凉轻剂"，成了一切温病初起的治疗常规，故学叶派的人，肺胀(相当于肺炎)，肺痹(相当于大叶性肺炎)之类不必说，即湿温(相当于肠伤寒)，暑痉(相当于“脑炎”)以及稻热病(相当于“钩螺”)、疟疾等，亦每用这些治肺的方药来治疗，还美其名曰异病同治，有是证用是药，这样，与肺无关之病不必说，即肺胀、肺痹等病，辛凉轻淡，实亦属治术之下驷。章太炎认为仲景治肺胀用越婢加半夏汤，比叶派药法来的有力量。姜春华老说近人用鱼腥草、鸭跖草之类治大叶性肺炎比叶派用药合理，这些讲法都是合乎事实的。叶氏对伏气温病也懂得一开始就应该用苦寒直请里热为主(据何廉臣经验：温病伏气多，新感少)，而近人为提纲说所惑，却认为“极轻清极平淡者，取效更捷”。实际上，“乙脑”、“流脑”，“钩螺”、“肠伤寒”、“出血热”等真正的温热病，如立法轻淡，用上述方药去治疗，而欲冀截断逆转，即不算椽木以求鱼，亦无异杯水而车薪。温病原非指伤风、肺胀之类，其发病大都热度较高，故陆九芝赞同“阳明为成温之薮”之说，陆氏等之所以激烈抨击叶吴之学，关键就在学叶氏的人竟每以治肺之药治与肺无关之病。陆氏以葛根芩连汤等治胃之药治胃系之温病，当然比用治肺方药治胃系温病为合理。“只须辛凉轻剂，其病立愈”的，只不过是伤风感冒，轻证肺胀之类，原非胃系温病。而辛凉散风、甘淡驱湿，病仍不解，“遽入心包，为一场大病，以致于死”的，则决非伤风感冒，轻证肺胀等此类病。病非此类病，药用此类药，实际上等于不治，当然防入营而即入营，防入血而即动血，逆传心包，动风发痉，心识其变，所料皆中，但疾病按其规律，仍步步深入发展，所以陆九芝说：“然则用轻剂，而液受劫者，轻剂不可用矣。”这些批评意见，显然是正确的，但近人从陆氏对叶派药法的这些批评中，反而引伸出这样的结论——“说明了叶派这一治疗学思想的科学性和生命力。”⑧这实在令人愕然。
In *Wen Re Lun* (Treatise on Warm-Heat), it is written: "Regardless of the color of the tongue coating, if prickles (sharp, pointed projections) appear on the tongue surface, it indicates extreme heat in the Upper Jiao (Upper Burner). One should wipe the tongue with cold mint water using a blue cloth." Such statements should not be blindly accepted. Zhang Xugu said: "Without significant heat in the Stomach, there will certainly be no prickles." Yu Genchu, in his discussion of tongue coatings for the Six Channels, also attributed prickles to Stomach heat. Wu Kun'an believed: "White tongue coating with dryness and prickles belongs to warm pathogenic factors in the Lung Meridian; thick yellow dry coating with prickles, or yellow edges with a scorched black center and prickles, belongs to Yangming Stomach heat; bright red color with prickles indicates blazing Gallbladder fire; scorched purple coating with prickles resembling a mulberry fruit indicates yang pathogenic heat-toxin in the Jueyin Meridian." Qin Huangshi argued: "For cases where there is thirst but no desire to drink, and the pulse is slippery but not rapid, tongue prickles may also occur. These are mostly damp-pathogen combined with food retention. Using Baohe Wan (Preserve Harmony Pill) added with bamboo sap and radish juice, or Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) added with Zhi Shi (Immature Bitter Orange), can all be effective." From the experiences of various physicians, tongue prickles are by no means caused by extreme heat in the Upper Jiao. Ye Tianshi did not distinguish the color of the tongue coating, nor did he observe the physical condition and pulse symptoms. Upon seeing tongue prickles, he universally considered them to be due to extreme heat in the Upper Jiao. This understanding is extremely one-sided. In warm-heat diseases, tongue prickles actually mostly belong to Stomach heat in the Middle Jiao. If tongue prickles are attributed to extreme heat in the Middle Jiao, it is not a major error. However, stating that they all belong to the Upper Jiao is a gross mistake. Wu Jutong, in writing *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases), did not mention tongue prickles in the Upper Jiao Chapter. However, Article 1 of the Middle Jiao Chapter states: "Tongue coating is old yellow, even turning black with prickles." This illustrates that tongue prickles are predominantly seen in Stomach heat of the Middle Jiao. Furthermore, Article 35 of the Middle Jiao Chapter says: "In Yangming warm disease, after purgation, if slight fever persists and the tongue coating does not recede, wipe it with mint powder." Wu's method of dipping mint powder in fresh cool water to wipe the tongue was actually derived from Ye Tianshi's teachings. However, while Ye considered tongue prickles to belong to the Upper Jiao, Wu attributed them to the Middle Jiao. From this, it can be seen that Wu Jutong, who revered *Wen Re Lun* as the highest guiding principle for writing *Wen Bing Tiao Bian*, had long recognized Ye's errors but avoided discussing them. *Wen Bing Xue* (Warm Disease Theory) frankly points out regarding this passage: "Clinical differentiation must combine comprehensive analysis of syndromes; one must absolutely not assume heat excess merely upon seeing tongue prickles." This has positive significance in guiding later learners not to be confused by Ye's theories. However, *Selected Readings of Traditional Chinese Medicine Classics* states both "This passage supplements the description of yellow coating" and "In warm-heat diseases, a yellow tongue coating accompanied by prickles indicates extreme upper jiao pathogenic heat," while also stating "Yellow coating governs interior conditions" and "Thick, scorched, dry yellow coating with prickles or cracks in the center indicates Yangming Fu organ excess." This inevitably leads to charges of arbitrary interpretation and self-contradiction.
Conclusion: Ye Tianshi's spirit of innovation is valuable, and *Wen Re Lun* possesses certain academic value, which cannot be denied. However, it is by no means an flawless divine text. Our principle regarding ancient works is critical inheritance. Yet, commentators on *Wen Re Lun* have never pointed out its errors, objectively resulting in wholesale absorption, or even swallowing whole without chewing. Due to reasons such as unified textbooks, works correcting biases are rarely seen. Thus, I briefly discuss eight major errors as follows.
References:
① Nanjing College of Traditional Chinese Medicine, ed., *Wen Bing Xue* (Trial Textbook for National Higher Medical Institutions).
② Shi Yiren, *Zhong Yi Shang Han Yu Wen Bing* (TCM Cold Damage and Warm Diseases), Shanghai Science and Technology Press, 1958.
③ Ibid.
④ Jin Shoushan, *Wen Re Lun Xin Bian* (New Compilation of Treatise on Warm-Heat), Shanghai Science and Technology Press, 1960.
⑤ Bei Runpu et al., *Shanghai Journal of Traditional Chinese Medicine*, 1983, Issue 1, p. 16.
⑥ Cited from *Shanghai Journal of Traditional Chinese Medicine*, 1981, Issue 7, p. 19.
Refutation of the Claim that "Warm Pathogen Enters from Above..." Twelve Characters Serve as the Outline for Warm Diseases
The opening twelve characters of *Wen Re Lun*: "Warm pathogen enters from above, first attacks the Lung, and reversely transmits to the Pericardium," Professor Jiang Chunhua stated: "This refers to a single disease. Ye Tianshi also said in medical cases that pathogens enter via the mouth and nose. Later generations mistakenly took these twelve characters as the outline for all warm diseases; the error lies with later generations."① However, *Wen Bing Xue*, the unified textbook for national higher medical institutions, claims: "When warm pathogen invades externally, it must first attack the Lung, presenting Wei syndrome of the Lung." It further states: "This passage serves as the general outline for demonstrating the syndrome differentiation and treatment of warm diseases." The two views contradict each other. Without deep investigation, beginners will not know whom to follow, and later readers will be bewildered, hindering the development of TCM academia. Therefore, this article proposes further analysis to supplement the overly brief previous discussion.
I. Not the Outline for All Warm Diseases
Predecessors generally divided warm diseases into two categories: New Sensation (Xin Gan) and Hidden Qi (Fu Qi). Modern scholars also largely adhere to this view. Ye Tianshi did not deny the Hidden Qi theory. For example, in the Warm Category of *Lin Zheng Zhi Nan Yi An* (Guidelines for Clinical Practice), Case Yang states "Hidden pathogen causing fever," Case Ma states "Hidden pathogen in Shaoyin," and Case Huang states "Body deficiency with warm pathogen hidden internally." In the Summer Heat Category, Case Fan states "Hidden summer heat obstructing the Qi level," and Case Chi states "Hidden summer heat manifesting in late autumn." Additionally, *You Ke · Fu Qi Pian* (Pediatrics · Hidden Qi Chapter) states: "Spring warmth is a condition caused by failure of storage during winter, where ancients believed winter cold hides internally within Shaoyin." Based on this argument alone, these twelve characters certainly do not refer to all warm diseases. Otherwise, why would Ye Tianshi say that Spring warmth uses Huang Qin Tang (Scutellaria Decoction) as the main formula, using bitter-cold herbs to directly clear interior heat? Since heat hides in Yin, bitter flavors solidify Yin, which is the correct treatment. He knew that warm pathogen contraindicates dispersal and does not follow the same methods as acute external contraction.② Hidden qi warm diseases require bitter-cold herbs to directly clear interior heat, differing from acute external contraction. Ye Tianshi was very clear about this. Why did later generations take it as the outline for all warm diseases? Even among Ye's followers, few held this view. Hua Xiuyun stated: "Spring warmth is winter cold hidden in Shaoyin, triggered by spring warmth; it is not necessarily a pathogen entering from above. Thus, the warm pathogen discussed here refers to Wind-Warmth and Damp-Warmth caused by external contraction." Others like Zhang Xugu, Wang Mengying, and modern scholar Jin Shoushan shared this view. Only Wu Jutong began this erroneous interpretation. In the Opening Statement of *Wen Bing Tiao Bian · Upper Jiao Chapter*, he wrote: "Warm diseases include Wind-Warmth, Warm-Thermal, Warm Epidemic, Warm-Toxic, Summer-Warmth, Damp-Warmth, Autumn Dryness, Winter-Warmth, and Warm Malaria." "All warm diseases begin in the Upper Jiao, affecting Taiyin." Later generations failed to discriminate, following this error, and thus adopted it as the outline for all warm diseases. Wu initiated this trend, spreading widespread harm.
II. Cannot Serve as the Outline for New Sensation Warm Diseases
The warm diseases discussed by Ye's school are broad, including nine types mentioned by Wu. Among them, Wind-Warmth, Summer-Warmth, and Damp-Warmth are all New Sensation warm diseases. Ye Tianshi said: "Summer heat originates from Yangming." This single statement suffices to show that Ye himself did not believe that "warm pathogen invading externally must first attack the Lung, presenting Wei syndrome of the Lung." Take Damp-Warmth as an example: its initial pathological center is in the Spleen and Stomach. Even if there are exterior symptoms, as Xue Shengbai stated, "The so-called exterior refers to the exterior of Foot Taiyin and Foot Yangming, not Taiyang. The exterior of Taiyin is the limbs." Since Spleen governs the limbs, Foot Taiyin exterior syndrome presents with limb fatigue. It differs from Hand Taiyin exterior, so Damp-Warmth cannot use "first attacking the Lung" as its outline. However, because Ye Tianshi mixed warm diseases, Wind-Warmth, and Damp-Warmth together, Hua Xiuyun and others mistakenly believed that warm pathogens entering via mouth and nose must first attack the Lung. In reality, Wind-Warmth and other Lung-system diseases enter via the nose to attack the Lung, while Damp-Warmth and other Stomach-system diseases enter via the mouth to attack the Stomach. Entering Lung vs. Entering Stomach are clearly two different paths. Therefore, when Ye Tianshi said "add Radix Angelicae Pubescentis (Lugen) and Semen Polypori (Huashi) for cases with dampness," if referring to warm pathogen with dampness in Lung-system diseases, the opening twelve characters might be acceptable. Unfortunately, Ye's statements like "Damp-warmth with loose stool indicates incomplete resolution" clearly refer to Damp-Warmth. Thus, Ye cannot evade responsibility. From passages in *Lin Zheng Zhi Nan Yi An* such as "Cold and warm irregular qi received via mouth and nose, passing through Mu Yuan, disturbing the Stomach system"③ and "Fetid summer heat inhaled, internally binding at Mu Yuan"④, it shows Ye did not deny external pathogens entering via mouth and nose. There are cases where pathogens do not first attack the Lung but travel via the central path through Mu Yuan to directly disturb the Stomach system, or bind at Mu Yuan. Why then does *Wen Re Lun* begin with "First attacks the Lung"? No wonder Xie Songmu said: "The so-called *Wen Re Lun*... contains self-contradictions, mixtures, confusion, fragmentation, making it unreadable."⑤ Clearly, Shi Yiren's assertion that warm diseases "should not use 'first attacks the Lung' to dictate future perspectives"⑧ is correct. Wu Jutong's "stubborn adherence to this theory led to discrepancies between theory and practice." We should not follow his error.
III. Can Serve as the Outline for Respiratory System Diseases
*Wen Re Lun* includes at least two diseases (Wind-Warmth and Damp-Warmth). If we do not completely deny the纲领性 (programmatic/guiding) significance of the twelve characters, then Old Jiang's claim of "referring to a single disease" cannot stand. If "referring to a single disease" is established, then the twelve characters lack any programmatic significance. I believe: Based on *Lin Zheng Zhi Nan Yi An*, viewing "Enters from above, attacks Lung" as the outline for respiratory system diseases is valid. For instance, in the Warm Category, Case Xie states: "Warm pathogen enters from above, internally entering the Lung"; Case Ding states: "Inhaling hot filth via mouth and nose, Lung suffers pathogen first"; Case Wang states: "Inhaling warm pathogen, nose connects to Lung collaterals, reversely transmitting to Pericardium collaterals, shaking the Sovereign"; Case Chu states: "Warm pathogen enters via mouth and nose, initially entering Lung causing cough and asthma, subsequently transmitting to Danzhong causing hemoptysis." In the Wind-Warmth Category, Case Ye states: "Wind-Warmth enters Lung, Lung Qi unblocked, heat gradually stagnates internally"; Case Guo states: "Wind-Warmth enters Lung, Qi refuses to descend"; Case Unknown states: "Wind-Warmth enters from above, Wind is Yang, Warm transforms to Heat, Upper Jiao enters Lung, Lung Qi cannot circulate freely." In the Summer Heat Category, Case Yao states: "Summer-damp-hot qi initially received by Lung"; Case Chen Siwu states: "Summer-damp damages Qi, Lung suffers disease first"; Case Wang states: "Summer-wind-hot qi enters Lung." In the Cough Category, Case Lu states: "Autumn-summer-dry qi enters from above, first affecting Lung." Such cases are numerous. Detailed symptom analysis shows they mostly belong to respiratory system diseases. Therefore, those twelve characters can be viewed as the outline for respiratory system diseases. However, regarding pathology, the aforementioned cases include Wind-Warmth, Warm-Thermal, Winter-Warmth, Summer diseases, and Dryness diseases—five or six types (from the perspective of TCM disease differentiation, these are distinct diseases). Thus, limiting the twelve characters to "referring to a single disease" restricts their scope unnecessarily. Article 2 of *Wen Bing Tiao Bian · Upper Jiao Chapter* could originally serve as an outline for respiratory diseases. However, because Ye mixed it with Damp-Warmth, and Wu failed to clarify, instead expanding arbitrarily, it later generated the misunderstanding that "warm pathogen initially must first attack the Lung."
IV. Ultimately Cannot Serve as the Outline for Warm Diseases
Respiratory system diseases are not necessarily warm diseases. Wu Jutong said: "Taiyin Wind-Warmth, presenting only with cough, slight body heat, and mild thirst, should be treated with the mild acrid-cool agent Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction)." Wu himself clarified this as a "minor illness." In essence, this minor illness is Common Cold (Shang Feng). Pre-Ye/Wu medical texts like *Jin Gui Gou Xuan*, *Ming Yi Zhi Zhang*, and *Jing Yue Quan Shu* all record this disease. Lu Jiuzhi stated that Common Cold has no transmission. This disease, by convention, is named Common Cold or Gan Mao, and has never been confused with warm diseases. However, under Ye and Wu, cases differentiated as Wind-Heat transformed into warm diseases. Zhang Taiyan criticized this practice, stating: "Treatment of diseases may differ古今 (ancient and modern), but defining disease names based on symptoms cannot violate antiquity and change recklessly. What Ye and Wu called Damp-Warmth can be described as hanging a cow's head but selling horse meat." Calling Common Cold Wind-Warmth is an even more obvious mismatch, lacking factual basis. Symptoms of Wind-Warmth were described early in *Shang Han Lun*. However, after Ye and Wu's manipulation, name and reality became confused. For example, Fei Zhang (Lung Distension) was listed by Zhang Zhongjing in *Jin Gui Yao Lue · Fei Yong Fei Wei Ke Sou Shang Qi Bing Pian* (Chapter on Lung Abscess, Lung Withering, Cough, and Asthma in Essential Prescriptions of the Golden Cabinet) as a miscellaneous disease. After Ye, it became理所当然 (taken for granted) as a warm disease. This shift started with Ye. In the Warm Category, "Infant Gong inhaled warm pathogen, brewing into critical Lung Distension. Radix Angelicae Pubescentis (Lugen), Semen Pruni Armeniacae (Taoren), Semen Coicis (Yiren), Fructus Benincasae (Dongguazi)" is a clear case. While Zhang Zhongjing used Wei Jing Tang (Reed Rhizome Decoction) for Lung Abscess, Ye used it for Lung Distension—another shift. Later generations subsumed Common Cold, Fei Bi (Lung Obstruction), Fei Zhang, and Fei Yong under warm diseases, with Ye as the initiator. After Wu, methods for treating respiratory diseases were shifted to become treatments for the initial stage of all warm diseases, causing technical regression in TCM management of warm diseases. Such reckless shifting by Ye and Wu cannot be seen as inevitable development but rather as confusion arising in the process of human understanding of natural laws. Otherwise, Spasm, Dampness, Sunstroke, Lily Disease, Fox-Disease, and Yin-Yang Toxin—all miscellaneous diseases distinct from warm diseases—could all be labeled warm diseases simply based on heat-transforming syndromes? If such reckless shifting is deemed inappropriate, then Common Cold and Lung Distension, as respiratory diseases, should not be mixed into warm diseases. Consequently, the conclusion follows logically and naturally: Although the twelve characters can be viewed as the outline for *some* respiratory diseases (excluding Common Cold and Lung Fluid Retention), they ultimately cannot serve as the outline for warm diseases. Careful examination of Ye's medical cases regarding warm pathogen attacking the Lung reveals that although named differently (Wind-Warmth, Winter-Warmth, Warm-Thermal, Dryness Disease), they are essentially Common Cold, Lung Distension, Lung Abscess, and Lung Obstruction occurring in the four seasons. Tracing sources and clarifying the original meaning of warm diseases, if we do not recognize these as warm diseases, then *Wen Re Lun* is fundamentally flawed from the start. Thus, Xie Songmu said: "Confusion of name and reality in warm diseases, Ye Tianshi is the chief culprit." Xie believed: "Examining the evolution of warm disease theory, the so-called warm disease of 'warm pathogen entering from above, first attacking the Lung' is indeed adding branches to the trunk, intruding randomly midway. The connotation of warm disease was already complex; adding this unrelated warm disease further confuses name and reality, so there is no need for intrusion." "Originally not warm disease, intruding midway, should not assume the name of warm disease."⑦ Modern scholars dismissing Xie's rational analysis as "restorationism" is highly inappropriate.
V. Significant Negative Side Effects of the Outline Theory
Herbs like Bo He (Mint), Niu Bang Zi (Arctii Fructus), Sang Ye (Mulberry Leaf), Ju Hua (Chrysanthemum), Jie Geng (Platycodon Root), Xing Ren (Apricot Seed), Dou Chi (Fermented Soybean), Dou Juan (Soybean Sprout), Xiang Bei (Fritillaria Thunbergii Bulb), Lu Gen (Imperata Rhizome), Yin Hua (Lonicera Flower), and Lian Qiao (Forsythia Fruit) are appropriate for Wind-Heat Common Cold. Formulas like Yin Qiao San (Honeysuckle and Forsythia Powder) and Sang Ju Yin are suitable for treating Common Cold and tonsillitis. Ye and Wu using these drugs for these diseases is impeccable. However, according to the outline theory, "Initially use mild acrid-cool agents" became the standard treatment for the initial stage of all warm diseases. Thus, students of Ye's school used lung-treating formulas for Lung Distension (equivalent to pneumonia), Lung Obstruction (equivalent to lobar pneumonia), and even for Damp-Warmth (equivalent to typhoid fever), Summer Spasm (equivalent to encephalitis), Rice Fever (equivalent to leptospirosis), and Malaria. They justified this as "treating different diseases with the same method" or "using medicine matching the syndrome." For diseases unrelated to the Lung, this is problematic. Even for Lung Distension and Lung Obstruction, mild acrid-cool and light/dry herbs are inferior therapeutic strategies. Zhang Taiyan argued that Zhang Zhongjing's use of Yue Bi Jia Ban Xia Tang (Magnolia Bark and Pinellia Decoction) for Lung Distension is more potent than Ye's methods. Elder Jiang Chunhua stated that modern use of Huaxin Cao (Houttuynia) and Yazhu Cao (Commelina) for lobar pneumonia is more reasonable than Ye's prescriptions. These views align with facts. Ye Tianshi understood that for hidden qi warm diseases, one should initially use bitter-cold herbs to directly clear interior heat (based on He Lianchen's experience: hidden qi warm diseases are common, new sensation ones are rare). However, misled by the outline theory, modern practitioners believe "extremely light, clear, bland, and plain agents yield faster results." In reality, for true warm diseases like Japanese Encephalitis, Epidemic Encephalitis B, Leptospirosis, Typhoid Fever, and Hemorrhagic Fever with Renal Syndrome, adopting light/plain legislation and using the aforementioned formulas to hope for intercepting and reversing the disease is akin to climbing a tree to catch fish or pouring a cup of water on a cartload of burning firewood. Warm diseases were originally not meant to include Common Cold or Lung Distension; their onset usually involves high fever. Thus, Lu Jiuzhi agreed with the saying "Yangming is the source of mature warm diseases." The key reason Lu and others fiercely attacked Ye and Wu's learning is that students of Ye often used lung-treating medicines for diseases unrelated to the Lung. Lu's use of Gegen Qinlian Tang (Kudzu and Scutellaria-Coptis Decoction) and other stomach-treating medicines for Stomach-system warm diseases is obviously more reasonable than using lung formulas for Stomach-system warm diseases. Cases where "only mild acrid-cool agents are needed for immediate recovery" are merely Common Cold or mild Lung Distension, originally not Stomach-system warm diseases. Cases where acrid-cool disperses wind and sweet-bland drives out dampness, yet the disease persists, "suddenly entering the Pericardium, becoming a severe illness leading to death," are definitely not Common Cold or mild Lung Distension. Treating non-such diseases with such medicines is effectively no treatment. Naturally, preventing entry into Ying level leads to immediate Ying invasion, preventing blood disturbance leads to immediate blood movement, reverse transmission to Pericardium, stirring wind and causing spasms. Recognizing these changes, predictions come true, but the disease still progresses step-by-step according to its laws. Thus, Lu Jiuzhi said: "Therefore, if using mild agents causes fluid depletion, mild agents should not be used." These criticisms are obviously correct. However, modern scholars, drawing from Lu's criticism of Ye's pharmacological methods, instead concluded: "This demonstrates the scientific nature and vitality of Ye's school of therapeutics."⑧ This is truly astonishing.