又四诊昨黄昏后，诊脉较诸早上，左手数疾顿减（脉象陡变，）惟尺中垂而仍动（阳邪内陷矣，）呓语不已，若有妄见（胃热蒸心益甚矣，）因思肾热乘心（胃热而非肾热，）膻中微闭，神明为蒙，自属（二字何解）昏乱（全不识阳明病，）随进周少川牛黄丸（领邪入心）一服，俾迷漫无质之热（热本无所为质，）暂可泄降（并未一用泄降之药，）服后颇安（并不能烦躁矣，）辰刻诊脉濡小（脉又变矣，）形质太衰（生熟地炭既立根蒂，何至形质大衰）舌边色淡，下利稀水（邪下陷矣，）夫救阴是要旨（撤热是要旨）读仲景少阴下利篇（太阳阳明亦有下利）上下交征（此句如何接得上，）关闸欲撤，必以堵塞阳明为治（昨日犀角，昨晚牛黄，尽开诸窍，一变而为堵塞，况阳明无堵塞之理，）以阳明司阖（阳明之合不如是讲，）有开无阖，下焦之阴，仍从走泄矣（生熟地炭之功何往，）议用桃花汤人参赤石脂炮姜白粳米（此方补涩而温，适与清泄苦降相反。）
又五诊晚服照方加茯苓（此时病已垂危，药之出入必不在一味茯苓）
又两诊脉左沉数，右小数（堵塞后脉又变矣，）暮热，微汗，时烦，辰刻神清（只有辰刻神清矣，）虚邪仍留阴分（实邪仍留阳分）议用清补（当用寒泻）人参茯苓川石斛炙甘草黑橹豆衣（何用）糯稻根须（何用）金匮麦门冬汤（全与温病无涉。）
温热门再有张姓一案，初仅形象畏冷，用复脉汤去参桂加甘蔗汁，及三诊，阴液尽涸，阴气欲绝（复脉汤有麦地，何以阴涸阴绝，）
再有顾姓一案，初尚能饮酒纳谷，用犀角生地，再诊目瞑舌缩，神昏如醉（心开窍于舌，犀角送邪入心，故舌缩。）
再有陈姓一案，初不过夜烦无寐，不嗜汤饮，亦用犀角生地，及三诊阳升风动（用生地阳当不升，用犀角风当风不动，何又升动若此·）
凡此所用药后种种变相，皆指南所自言，何以用其法者，皆不一问其药之效，固有如是者乎。
指南温热门共四十余案，其于席姓复诊者七，初诊左数右缓弱，为温热病应有之脉，邪在阳明，是为时气，非阴虚火炎骨蒸劳热之病，亦非上盛下虚，阳光飞越之病，与阳根未固，真阳不肯收纳，有何干涉，乃必曰久伏少阴，而欲育阴以立根柢，此在劳怯病中，尚为下乘，岂可以之论温热时邪哉，及复诊者再，而吸气喘促，心神蒙闭，非熟地生地炭腻隔留邪，犀角石菖蒲送邪入内之效耶，再予天冬地黄人参之三才，加以牛黄协犀角之力，脉之数疾顿减，一变而为濡小，或并外热之不见，病于是乎内陷矣，牛黄之服后颇安者，并烦躁之不能也，所以形质大衰，而即下利稀水，温病不撤阳邪，种种变相已露，尚曰救阴是要旨，而一任其阳邪之伤阴，以致关闸尽撤，有开无闺，即用桃花汤以堵塞之，此在痢疾门中，尚是末传之治，而始之仅为晡刻神烦者，至此而仅有辰刻神清矣，其人之终日昏沉，内风煽动，粒米不进，举室惊惶，已可想见，六诊，七诊只剩得稻根橹豆敷衍成方，而终之以一服麦门冬，嗟乎，此病之初，人迎数盛，气口濡弱，伤寒成温之的候也，此时一用仲景之葛根芩连汤，辛凉解散，病即外达，一汗而解，热退身凉，神清脉静矣，即不然而须专清里，则仲景之白虎汤栀子豉汤，辛寒泄热，里气一清，外邪不解，亦无不热退身凉，神清脉静矣，余为治三十年，凡遇温热病，无人不如此，无时不如此，无地不如此，无不以十日内贻之以安，惟尚未能起床出门，往往受人促迫耳，今观此案初诊之议，邈若山河，及四诊而一路之病随药变者，败坏至此，事已不可为矣，独有下利一证，或尚是热结旁流，为挟热之利，非燥屎即胶闭，若一投仲景之大小承气，尚能起死回生，乃华玉堂从未梦见，反谓见闻甚广，不肯胶柱鼓瑟，辄投石脂干姜温之涩之，病到如此不堪地步，一味人参聊以塞责，此外则橹豆之衣也，糯稻根之须也，一筹莫展，剩有麦门冬一方，如不欲战，于此而云此病尚有活理，谁其信之。(温热治法，从此失传，可恨哉。)。
今之抱一册为市医捷径者，名曰叶派，余初不解温病之十有九治者，何至于百无一生，及观此案之始终本末，而知编此一册者，正利其日后必然之状，已予定于始初立案之时，以为先见之明，言无不中，而病家即以其言无不中，果服其先见之明，孰能知其人之本非此病，而移病凑药，使之病随药变耶，此所以人愈死而名愈高也，则此一案之在病家，尚可安于不问哉。”(《世补斋医书》)
柴按：此案治法用药，是否合理，叶派医家，与陆氏有不同看法。原案俱在，后学自可研究，余亦不复赘言。但以生地、熟地炒成炭用，以麦冬炒用，以淡菜煎成胶用，叶氏诸此之类的药法，经徐、陆诸家提出批评之后，即叶派中人，亦罕见再用。生地炒炭，若果可养阴而不粘腻，何以不推广而发扬之耶。即此一瑞，陆氏之抨击，不可以一笔抹杀，亦明矣！
注此为章巨膺注2003-9-1422:25:58北海散人头衔：佛门弟子等级：管理员文章：3797积分：4270注册：2002-12-24
第6楼合论顾景文温证论治吴鞠通温病条辨
温证论治，在华邵辈所编临证指南之外，乃顾景文者假托叶先生之语，而刻于唐笠三吴医会讲者也。唐刻有小引云，先生游于洞庭山，门人顾景文随之舟中，以当时所语，信笔记录，一时未经修饰，是以词多佶届，语亦稍乱，读者来免眩目，不揣冒昧，窃以语句稍为条达，前后少为移掇，惟使晦者明之，而先生立论之要旨，未敢稍更一字也。据此，则所刻云云，已经唐氏加以删润，尚且如此不堪，然则顾景文之原文，当更何如，不意托名大医，便能行世，贮春仙馆刻之，拜石山房刻之，种福堂又刻之，而其贻祸于病人者，直如此其大也。顾所记名曰温证论治，而章虚谷乐为之注，改其名为外感温热。王孟英又乐取之，谓仲景所论温热，是伏气，叶氏所论温热，是外感。故以温邪上受，首先犯肺，逆传心包十二字揭之篇首，以自别异，果如其说，则所称温热者，不过小小感冒，即俗称所谓小风热、小风温，如目赤、颐肿，喉梗、牙疼之类，却只须辛凉轻剂，其病立愈，然何以不出数日，遽入心包，为一场大病，以致于死，若不数日而病即入心，即可死者，则必非如其所说，只须轻剂之辛凉，且何以如其所言，不即愈于辛琼之轻剂耶。夫其所谓热入心包者，不可谓世无其病也，然总不在仅称外感，仅病及肺，仅用此无名轻剂之时，是故古之人不轻言热入心包也，而顾其信者，确凿言之若此，迹其所以有是作者，是欲以所用轻剂愈人之病也，似又欲以所用犀角愈人之病也，乃用其所谓轻剂，而病不解，渐欲入营，血液受劫，心神不安，斑点隐隐，即随其所用不言何物之轻剂次第而来，然则用轻剂而液受劫者，轻剂不可用矣，用其所谓犀角而斑出热不解，胃津告亡，肤冷至一昼夜，仅仅未成脱证，亦即随其视同花露之犀角次第而来，然则用犀角而津告亡者，犀角又不可用矣，此皆顾景文自己所说，皆顾景文自己所告人，夫医之教人以必用此药，教人以必不可用他药者，不过恐以他药使病增重，不过欲以此药使病速愈，不过期其此后之种种恶候，一用此药，尽消弭于无形，故必谆谆告诫，不惮烦言，饷遗来学，而人之生其后者，有心济世，乐为之反复引申，一刻再刻，使其愈病之法，昭然若发聋振聩，而惟恐其勿传，断无因其用此法则液受劫，用此法则津告亡，而谓此劫液亡津之法，有未可任其不传者，然而后之人，则必用其法矣，一用其法，则所说津劫津亡者，即于初用轻剂接用犀角时予言之而无不准，若有先见者然，并恐不用其法，则血液未定受劫，胃津未定告亡，而所谓先见者，便不十分稳作，何由取信于病家，此所以生其后者，万不肯不用其法也，人心愈幻，其法愈巧，后数十年而又有吴鞠通者，鞠通即本顾景文温邪上受，首先犯肺，逆传心包之十二字，而为温病条辨，自条自辨，可发一笑者也，开卷捏造温病以桂枝汤主之为仲景原文，继复承指南之讹，以西喻昌治瘟之法，谓是刘河间之所以治温，两失已不待言，乃以温病之本在中焦者，先移之于上焦，谓切不可用中焦药，痛戒中焦之芩连，而其下即云，热邪久羁，吸烁真阴，邪热久羁，肌肤甲错，皆鞠通所自言，皆鞠通自己所告人者，先是自制银翅、桑菊二方，即顾景文之辛凉轻剂不名一药，而鞠通为之引申者也，嗣是方名清宫，用犀角牛黄，方名增液，用元参麦冬，以及一甲二甲三甲之复脉汤，小定风珠、大定风珠，无非滋腻伤阴，引邪内陷，病至此，不可为矣，而因其中焦篇，亦或有偶用芩连膏黄时，凡温病之一用芩连膏黄，无不可祛邪撤热者，鞠通又若未尚不知；然苟非布置上焦，则邪热未必久羁，真阴即未定劫烁，苟非诃斥芩连，则邪热未必久羁，肌肤又未定甲错，顾景文延之数日，鞠通再加缓缓两字，何以必缓缓也，不可解而实可解也，此所以后乎鞠通者，亦万不肯不用其法也，以滋腻留邪之药，缓缓廷之，邪热方盛之时，阴无不伤，病无不死，陶节庵之一提金，杀车锤，截江网，书名之恶极者也，比之一甲、二甲，三甲、定风珠，方名之恶极者也，病何等事，医何等人，顾可儿戏若斯乎。(《世补斋医书》)
柴按；叶派认为温病初起，首先犯肺，治上焦如羽，非轻不举，所以开首用药，总是银翘、桑菊之类。陆九芝赞同柯琴“阳明为成温之薮"之说，认为温病病在阳明，而叶派治在太阴，隔靴搔痒，撤热不力，贻误病机，所以每致步步深入。考《临证指南》风温、温热诸门治案，其轻者为辨证属热之伤风，其重者为肺胀、肺痹之类。以银翘、桑菊治此类病，治亦未尝误。然学叶氏者，竟以此类药移治一切温病，其不愤事也几希矣！伤风、肺胀、肺痹、肺痈等病，原不称为温病，叶氏混称，从此就凭空阑入到温病范围。古之所谓温病，虽不局限于阳明一经，但以阳明为主，故陆氏主张从阳明论治。陆氏认为伤风、肺胀之类，只要稍用些能治病的药，就决不致遽入心包，为一场大病，以致于死。能遽入心包，为一场大病，以致于死的，决非伤风、肺胀之类，病非伤风，肺胀之类，治疗仍使用治伤风、肺胀之类的药物，自然无效。这些意见，显然是正确的。再论温邪上受首先犯肺逆传心包十二字此十二字者，温证论治之所以发凡而起例者也，初不言邪之何以独伤肺，肺之何以遽传心，但云若论治法，宜用辛凉轻剂，延之数日，夫人病之热，惟胃为甚，胃热之甚，神为之昏，从来神昏之病，悉届胃家，即使热果入心，亦必先病及胃，病苟仅在于肺，则断无神昏之事，即断无入心之理，乃于病之明明有神昏者，特将神昏二字，始终不提，又明知神昏不属于肺，即暗将神昏移入于心，其曰上受，曰先犯，曰逆传者，皆所以抹杀胃病之故，再加未入心包，邪专在肺二句，说成此时之病，不心则肺，一肺即心，若绝无与于阳明胃者，而不可用胃药之语，适在此种种胃病之时，欲成一家之言，翻尽千古之局，锻炼周内，病者不能呼冤也，其时病者或为太阳阳明两经递病，或为太阳阳明两经合病，太阳行身之后，由背贯胸，阳明行身之前，由胸彻背，肺为华盖，位在胸背之上，而胸为近，胃为五脏六腑之海，其清气上注于肺，注者射也，太阳之邪射肺，阳明之邪亦射肺，而阳明为近，故必阳明胃之热降，而在上之肺气始安，所病本只在胃，肺仅为病所累，于此而必曰肺病，势必徒用肺药，转将胃之支脉络于心，胃热之最易蒸心者，一任其逼近心包，日逼日近，而神昏益甚，又以为此即心病，此即肺病之传心，轻剂之后，即用犀角，将胃中之药，非特搁置勿道，并且禁绝勿用，遂令胃中射肺之邪，直攻心脏，是其所以逆传者，全赖此药以为之也，夫胃者腑也，肺与心脏也，本是腑病，而偏要说成脏病，遂乃舍腑治脏，夫岂有脏腑而可以不分者，人病腑为轻而脏为重，此时一治其腑，病无不除，亦何至领邪入脏，死于非命哉！独无如兔园册子，只有顾景文之温证论治吴鞠通之温病条辨等物，以为道在是矣，宜乎今日盛名之下，并脏腑之不言也。(《世补斋医书》)
柴按：根据绍派经验，温热病之神昏詀语者，以“胃热蒸脑”一证为最多。叶派对此，但云“逆传心包”，对胃热蒸脑最多之证，反有所忽略，故陆氏有神昏詀语，悉属于胃之说。但热入心包，是否必有先病及胃这一中心环节，后世有不同意见。余谓陆氏之言，有矫枉过正之嫌，然叶派中人但指谪陆氏所见不广，而于其矫枉之旨亦一并抹杀之，则有失持平。温热病之神昏詀语，以属胃热者居多，此系不可否定之事实。柯琴“阳明为成温之薮”的论点，赞同者亦极多。章次公说，“后人欲评前哲之学说，最不可先有成见，成见横梗胸中，其流弊为武断。”通人之论，固名言可采。
再论胃病有神昏肺病无神昏之理
Furthermore, the fourth consultation took place after dusk yesterday. Compared to the morning, the pulse at the left hand showed a sudden decrease in rapidity and frequency (the pulse changed abruptly), while only the Chi position remained deep yet active (indicating that Yang pathogenic factors have sunk inward). The patient continued to speak incoherently and seemed to have hallucinations (this indicates that Stomach heat steaming the Heart has become even more severe). I considered it to be Kidney heat encroaching upon the Heart (actually, it is Stomach heat, not Kidney heat), with slight closure of the Shanzhong (Chest center), causing the Shen (Spirit/Mind) to be obscured; thus, it naturally belongs to confusion/disorder (completely failing to recognize this as a Yangming disease). Consequently, I administered one dose of Zhou Shaochuan's Niuhuang Wan (Calculus Bovis Pill) (which leads pathogenic factors into the Heart), allowing the diffuse, formless heat (heat inherently has no substantial form) to temporarily drain and descend (yet no draining or descending herbs were actually used). After taking the medicine, the condition seemed quite peaceful (although it could not eliminate irritability). At Chen hour (7-9 AM), the pulse was soft and small (the pulse changed again), and the physical constitution appeared too deficient (after using prepared Rehmanniae Radix Carbonis and Rehmanniae Radix Praeparata Carbonis to establish a root, how could the physical constitution deteriorate so severely?). The edges of the tongue were pale, and there was diarrhea with watery stool (pathogenic factors sank downward). Preserving Yin is the key principle (removing heat is the key principle). Reading Zhang Zhongjing's chapter on diarrhea in Shaoyin disease (Taiyang and Yangming diseases also present with diarrhea)... [The text contains rhetorical questions regarding the logic of the original case]. I proposed using Taohua Tang (Peach Kernel Decoction) with Renshen (Ginseng), Chishizhi (Halloysitum Rubrum), Paojiang (Prepared Ginger), and Baijingmi (White Rice) (this formula is tonifying, astringent, and warming, which is contrary to clearing, draining, bitter, and descending methods).
For the fifth consultation, Fu Ling (Poria) was added to the prescription taken at night (at this stage, the illness was critical; adding a single herb like Poria would not significantly alter the outcome).
For the sixth consultation, the pulse was deep and rapid on the left, and slightly rapid and small on the right (the pulse changed again after obstruction). There was evening fever, slight sweating, occasional irritability, but clear consciousness at Chen hour (only clear consciousness at Chen hour). Deficient pathogenic factors remained in the Yin aspect (excess pathogenic factors remained in the Yang aspect). I proposed a clearing and tonifying method, using Renshen (Ginseng), Fu Ling (Poria), Chuan Shihu (Dendrobii Officinalis Herba), Zhi Gancao (Prepared Licorice Root), Hei Ludouyi (Black Soybean Integument), Nuodaogenxu (Sacchari Spicae), and Jin Gui Maidong Tang (Maidong Decoction from the Golden Cabinet). [Critique: This is entirely unrelated to warm diseases.]
In the Warm Disease section, there is another case of a surnamed Zhang. Initially, he merely exhibited aversion to cold. We used Fumai Tang (Restore the Pulse Decoction) without Renshen (Ginseng) and Guizhi (Cinnamon Twig), adding Sugarcane Juice. By the third consultation, Yin fluids were exhausted, and Yin Qi was about to perish... [Critique follows].
There is also a case of a surnamed Gu. Initially, he could still drink alcohol and eat grain. We used Xijiao (Rhinoceros Horn - now substituted with Water Buffalo Horn) and Shengdi Huang (Rehmanniae Radix). By the second consultation, his eyes closed, tongue retracted, and he was comatose as if drunk... [Critique follows].
There is also a case of a surnamed Chen. Initially, he merely had nighttime irritability and insomnia, and did not desire hot drinks. We also used Xijiao (Rhinoceros Horn) and Shengdi Huang (Rehmanniae Radix). By the third consultation, Yang rose and wind stirred... [Critique follows].
All these various changes after medication are stated by Ye Tianshi himself. Why do those who follow his methods never ask about the efficacy of the drugs? Is it really so?
Ye Tianshi's Warm Disease section contains over forty cases. In the case of Xi, there were seven consultations. The initial pulse was rapid on the left and slow/weak on the right, which is the expected pulse for warm diseases. The pathogen was in Yangming, constituting a seasonal qi disease, not a Yin deficiency with fire flaring up or bone-steaming consumption disease, nor an upper excess and lower deficiency with solar energy flying outward. What does it have to do with the Yang root being unestablished and True Yang refusing to receive? Yet, he insisted it had been lurking in Shaoyin for a long time and wanted to nourish Yin to establish a foundation. Even in consumption diseases, this is considered inferior treatment; how can it be applied to warm seasonal pathogens? Upon subsequent consultations, gasping and panting upon inhalation occurred, and the Shen (Spirit) was obscured. Was this not the effect of Shudi (Prepared Rehmannia) and Shengdi Carbonis being cloying and retaining pathogens, and Xijiao (Rhinoceros Horn) and Shichangpu (Acori Tatarinowii Rhizoma) leading pathogens inward? Subsequently, Santian Dan (Three Immortals Pill) with Tiandong (Asparagi Radix), Dihuang (Rehmanniae Radix), and Renshen (Ginseng) was given, along with Niuhuang (Calculus Bovis) to assist Xijiao. The pulse's rapidity decreased suddenly, changing to soft and small, or even external heat disappeared. The disease sank inward. The peace after taking Niuhuang was merely the absence of irritability. Thus, the physical constitution declined severely, followed by watery diarrhea. Since warm diseases did not remove Yang pathogens, various abnormalities emerged. Yet, he still claimed preserving Yin was the key, allowing Yang pathogens to damage Yin until all gates were open, with opening but no closing. Then, Taohua Tang was used to block/clog. In the Dysentery section, this is a late-stage treatment. The patient initially only had evening irritability, but here only had clear consciousness at Chen hour. One can imagine the person's constant drowsiness, internal wind stirring, inability to eat, and the family's panic. By the sixth and seventh consultations, only Nuodaogenxu (Sacchari Spicae) and Ludou (Soybean) were used perfunctorily, ending with a single dose of Maidong Tang. Alas! At the beginning of this illness, the Renying (Human Welcoming) pulse was rapid and full, and the Qikou (Qi Opening) pulse was soft and weak. This is the definitive sign of Cold Damage transforming into Warm Disease. At this time, if Zhang Zhongjing's Gegen Qinlian Tang (Kudzu and Scutellaria Decoction) had been used for acrid-cool dispersal, the disease would have reached the exterior, resolved with sweat, and the patient would have cooled down, regained clarity, and had a calm pulse. Even if not, if focusing on clearing the interior, Zhang Zhongjing's Baihu Tang (White Tiger Decoction) or Zhizi Chidui Tang (Gardenia and Fermented Soybean Decoction) for acrid-cold heat-draining would have cleared the interior Qi, and even if external pathogens remained, the patient would surely have cooled down, regained clarity, and had a calm pulse. In my thirty years of treating illnesses, whenever I encountered warm diseases, I treated everyone, everywhere, at all times this way, ensuring peace within ten days, though they might not yet be able to get out of bed, often facing pressure from others. Now, looking at the proposal in the first consultation of this case, it is as distant as mountains and rivers. By the fourth consultation, the disease had changed with every drug, ruined to this extent. The matter was beyond redemption. Only the diarrhea might have been "heat-binding with peripheral flow," a diarrhea with heat, not dry feces or sticky obstruction. If Zhang Zhongjing's Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction) had been used, life could have been restored. But Hua Yutang (referring to Ye Tianshi) never dreamed of this. Instead, claiming broad experience, he refused to stick to rigid rules, instead using Chizhi (Halloysitum Rubrum) and Ganjiang (Dried Ginger) to warm and astringe. With the illness in such a wretched state, he relied solely on Renshen (Ginseng) to cover his responsibility, besides Ludou skin and Nuodaogenxu (Sacchari Spicae), having no other plans, leaving only Maidong Tang. If one does not wish to fight, saying this illness still has a chance of survival, who would believe it? (Warm disease treatment methods are lost because of this, hateful!)
Nowadays, those holding a booklet as a shortcut for city doctors call themselves the "Ye School." I initially did not understand why nineteen out of ten warm disease treatments failed, resulting in zero survivors. Until I observed the beginning and end of this case, I realized that the compiler of this booklet precisely benefited from the inevitable outcome that would occur later, predetermining it at the initial registration to appear prescient. His words always hit the mark, and the patients' families believed his prescience. Who could know that the doctor was not treating the actual disease but forcing the disease to fit the medicine, causing the disease to change with the drugs? This is why people die more, and fame grows higher. Can the patient's family then remain indifferent to this case?" (Shibu Zhai Yishu)
Chai An: Whether the treatment and medication in this case were reasonable, the Ye School physicians and Lu Jiuzhi held different views. The original cases are available for later scholars to study; I will not add further comments. However, the methods of charring Shengdi and Shudi, frying Maidong, and decocting Dancai into glue—Ye's medicinal methods of this kind—have rarely been used even by Ye School followers after criticism by Xu Lingtai, Lu Jiuzhi, and others. If charring Shengdi truly nourishes Yin without being cloying, why is it not promoted? From this single instance, it is clear that Lu's criticism cannot be dismissed outright.
Note: This is a note by Zhang Juying.
Discussion on Gu Jingwen's Lunzhi Wen Zheng and Wu Jutong's Wendong Tiaobian
Regarding the treatment of Warm Diseases, outside of the Linzheng Zhinan (Guide to Clinical Practice) compiled by Hua and Shao, there is Gu Jingwen's work, falsely attributed to Master Ye, printed in Tang Lisan's Wu Yi Hui Jiang. Tang's preface states that while visiting Dongting Mountain, his disciple Gu Jingwen recorded their conversations on the boat without editing, resulting in awkward phrasing. Tang smoothed the language but kept the essence. Yet, even edited, it is poor. Imagine the original. It is surprising that a work named after a great physician could circulate so widely, printed by multiple publishers, causing such great harm to patients. Gu called it Lunzhi Wen Zheng, but Zhang Xugu annotated it as Waigan Wenre. Wang Mengying adopted it, claiming Zhang Zhongjing discussed latent warmth, while Ye discussed exogenous warmth. Thus, he highlighted the twelve characters: "Warm pathogen enters from above, first attacks the Lung, and reversely transmits to the Pericardium" to distinguish his theory. If true, "warmth" would just be minor colds (minor wind-heat/wind-warmth) like red eyes, swollen cheeks, sore throat, or toothache, requiring only mild acrid-cool formulas for immediate cure. Why would it enter the Pericardium in a few days, becoming a major fatal illness? If it entered the Heart quickly and caused death, it wouldn't require only mild acrid-cool agents. Nor would it fail to cure with them. Those who claim "heat entering the Pericardium" exist, but certainly not when merely labeled exogenous, affecting only the Lung, and treated with unnamed mild agents. Hence, ancients did not lightly speak of heat entering the Pericardium. Yet, believers cite Gu Jingwen authoritatively. Examining his motive, he likely wanted to validate his mild agents and his use of Xijiao (Rhinoceros Horn). When the mild agent failed, the pathogen moved to the Ying level, blood was damaged, Shen was unsettled, and spots appeared. This followed the mysterious mild agent. Thus, mild agents damaging fluids should not be used. When Xijiao was used, spots appeared but heat didn't resolve, Stomach fluids were depleted, skin became cold for a day, nearly reaching collapse. This followed the view of Xijiao as mere flower dew. Thus, Xijiao depleting fluids should not be used. These are Gu Jingwen's own words and warnings. Doctors usually insist on specific drugs to avoid worsening the condition or to speed recovery, hoping to prevent future adverse events. They teach rigorously. But later generations, eager to spread the method, ignore that these methods damage fluids. They insist on using them. Why? Because if they don't use them, the predicted fluid depletion might not happen, ruining their "prescience." To maintain credibility with patients, they must use the method. Human hearts become illusory, methods become clever. Decades later, Wu Jutong wrote Wendong Tiaobian based on Gu's twelve characters. He fabricated that Zhang Zhongjing used Guizhi Tang for warm diseases, and wrongly attributed Yu Chang's plague treatment to Liu Wansu. He moved the root of warm diseases from the Middle Jiao to the Upper Jiao, forbidding Middle Jiao herbs like Huangqin and Huanglian. Yet, he admitted that prolonged heat consumes True Yin and causes crusty skin. He created Yinwei and Sangju formulas (extensions of Gu's mild agents), then Qinggong, Zengye, and Dingfeng Zhu formulas, which are cloying, damage Yin, and lead pathogens inward. By the time the disease is incurable, he occasionally uses Huangqin/Huanglian in the Middle Jiao chapter, acknowledging their value. But if he hadn't focused on the Upper Jiao, heat wouldn't linger, and Yin wouldn't be consumed. If he hadn't condemned Huangqin/Huanglian, heat wouldn't linger, and skin wouldn't crust. Gu delayed for days; Wu added "slowly." Why slowly? Unsolvable but solvable. This is why later generations won't abandon his method. Using cloying herbs to delay heat ensures Yin damage and death during peak heat. Tao Jian'an's harsh methods are evil; Wu's formula names are equally evil. How can medicine be played with so frivolously? (Shibu Zhai Yishu)
Chai An: The Ye School believes warm diseases begin in the Lung, treating the Upper Jiao like feathers, requiring light action. Thus, initial treatment uses Yinqing or Sangju. Lu Jiuzhi agrees with Ke Qin that "Yangming is the source of warm diseases," believing the disease is in Yangming, while Ye treats the Taiyin, scratching an itch from outside the boot, failing to remove heat effectively, delaying the mechanism, and causing progressive deterioration. Examining Linzheng Zhinan cases, mild ones are heat-type common colds, severe ones are Feizhang or Feibi. Treating these with Yinqing/Sangju is not necessarily wrong. However, students of Ye applied these to all warm diseases, leading to failure. Common colds, Feizhang, etc., are not originally called warm diseases. Ye conflated them, expanding the scope of warm diseases. Ancient warm diseases, while not limited to Yangming, focused on it. Lu advocated treating from Yangming. Lu believed that treating common colds/Feizhang appropriately prevents entry into the Pericardium. Entering the Pericardium fatally implies a disease different from common colds. Using cold-treatment drugs for such diseases is ineffective. These opinions are correct.
Regarding the twelve characters "Warm pathogen enters from above, first attacks the Lung, reversely transmits to the Pericardium": These initiate Lunzhi Wen Zheng. It doesn't explain why the Lung is attacked or why it transmits to the Heart. It only suggests mild acrid-cool agents. Heat resides most strongly in the Stomach. Severe Stomach heat obscures the Shen. Shen confusion always relates to the Stomach. Even if heat enters the Heart, it must affect the Stomach first. If only the Lung is affected, there is no Shen confusion or transmission to the Heart. Yet, in cases with obvious Shen confusion, the term is omitted. Knowing Shen confusion isn't Lung-related, it's shifted to the Heart. "Entering from above," "first attacking," "reversely transmitting" all serve to erase the role of the Stomach. Adding "not yet entered Pericardium, pathogen solely in Lung" creates a dichotomy: either Heart or Lung, equating Lung with Heart, denying any relation to Yangming/Stomach, and forbidding Stomach herbs. This occurs amidst Stomach pathology, aiming to establish a new school, overturning history, trapping patients. Patients might have Taiyang-Yangming transmitted or combined diseases. Taiyang runs behind, back to chest; Yangming runs front, chest to back. Lung is the canopy, above chest/back. Chest is closer. Stomach is the sea of organs, sending clear Qi to the Lung. Pathogens from Taiyang/Yangming shoot to the Lung, especially Yangming due to proximity. Thus, Yangming Stomach heat must descend for Lung Qi to settle. The disease is fundamentally in the Stomach; the Lung is merely involved. Insisting on Lung disease leads to using only Lung herbs, allowing Stomach heat (which easily steams the Heart) to approach the Pericardium, worsening Shen confusion. Claiming this is Heart/Lung disease, after mild agents, Xijiao is used. Stomach herbs are abandoned and forbidden. Pathogens shooting from Stomach to Lung attack the Heart directly. This "reverse transmission" relies on these drugs. The Stomach is a Fu organ; Lung/Heart are Zang organs. It's a Fu disease disguised as Zang. Abandoning Fu to treat Zang ignores the distinction. Treating Fu cures the disease; leading pathogens to Zang causes death. Unfortunately, textbooks only contain Gu's Lunzhi and Wu's Tiaobian. Under their fame, the distinction between Zang and Fu is ignored. (Shibu Zhai Yishu)
Chai An: According to Shao School experience, Shen confusion and delirium in warm diseases are mostly due to "Stomach heat steaming the Brain." The Ye School only mentions "reverse transmission to the Pericardium," ignoring the prevalent Stomach heat steaming the Brain. Thus, Lu claims all Shen confusion belongs to the Stomach. Whether heat entering the Pericardium must involve the Stomach first is debated. I believe Lu's view is somewhat overcorrecting. However, Ye School followers criticizing Lu's narrow vision while dismissing his corrective intent is unfair. Shen confusion/delirium in warm diseases is predominantly Stomach heat-related, an undeniable fact. Ke Qin's "Yangming is the source of warm diseases" has many supporters. Zhang Cigong said, "When evaluating predecessors' theories, one must not have preconceptions. Preconceptions lead to dogmatism." This is wise advice.
Further discussion on the principle that Stomach disease causes Shen confusion while Lung disease does not.