综上所述，于温病学说之变迁，已略具梗概，此二十七家中，舍奇特不中于理，在温病学说思想上无甚影响者而外，其最可注意者，为王安道叶天士陆九芝三人。温病学说之剧变，王安道启其端，温病名实之淆乱，叶天士为祸首(虽不止天士一人，而天士之过最大)，处叶吴学说积威之下，作大举之驳击，则陆九芝殿其后。王安道以后之变革，约有三端，一为病因(伏气新感)，二为病理(由内达外)，三为治疗(注意清里热)。迹其用药之对象，大抵为胃，至叫‘天士始别创犯师之说，而温病之病所，遂有肺胃二系，此时胃系之温病，虽尚存在，然已处模糊之状态中，渐为医者所淡忘，厥后温热家以温邪上受首先犯肺逆传心包十二字，为温病之纲领，于是胃系温病之起病，不由于犯肺者(如湿温)，亦一律以此十二字兼统之，于是胃系温病初起之病因病理治疗诸学说，一律平空割去，另冠以肺系之证治，此真俗语之所谓张冠李戴，最后胃系温病之中期末期，亦皆以治怖之药治之，而治疗之成绩，遂不可问(陆九芝先生曰：夫人之所病者胃，而医之所言者肺，可以为证)，此种流弊，无形中蔚为风气，流行于时医之腕底，彼等所著之温热书，则兼收并蓄，仍以内难仲景，装点门面，以掩其用药轻淡之陋。其他各种流弊尚多，细考之皆有所从来，陆九芝先生目击其祸，因奋笔著世补斋医书，阐明胃系温病之证治，文词虽不免偏激，然切中肯綮，为救时之良药，惟陆氏一意阐发胃系之温病，置肺系于不顾，甚至谓胃病有神昏，肺病无神昏，此则失之武断，适贻主张犯肺者以口舌，彼必谓尔所说之温病，为胃系之温病，我所说之温病，为肺系之温病，尔阐发胃系温病，纵有若何妙义，排斥肺系温病，纵如何剧烈，皆与我无干，所谓尔亦一是非，我亦一是非，尔为尔，我为我，两不相涉，是则温病肺胃乏问题，仍未解决，而温病肺胃之争，亦将终古而无已。
进一步想，则九芝先生之阐发胃系温病，不可谓不力，批评肺胃温病，亦不可谓不尽，然卒未能荡平叶吴之壁垒，绝叶吴之根株者，盖未捣叶吴之巢穴，斫叶吴之根本耳。
凡批评一种学说，目光必笼罩此学说之全体，从大处落墨，若支支节节，攻其局部，则此剿彼窜，永无宁日，九芝先生之批评，尚为支支节节之铲除，一句一章之芟削，故仅成对抗之形势，无以扼叶吴之要吭，今当进而讨论肺系温病之根本问题。第一点当先问所谓肺系温病，本来是否称为温病。第二点当问所谓肺系温病，是否阑入温病之范围，有否阑入之必要。第三点正名责实，当问所谓肺系温病，应否冒温病之名，应否承认共为温病。第四点，叶氏治此肺系温病之疗法，有无价值。第五点，既不承认此种病为温病，应择何种病名以名之。根据温病学说思想变迁之经过情形，逐点解答如下：
一，温邪上受，首先犯肺之温病，考其症状，在叶天士以前，并未称为温病，人谓叶天士所发明，吾谓昨天士所杜撰，人谓叶天士所特创，吾谓叶天士所混称。
二、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，本已复杂(已行复杂，不足为可以阑入理由)，再阑入此漠不相关之温病，益令名实淆乱，故并无阑入之必要。
三、本非温病，中途阑入，不应冒温病之名，不应承认其为温病，当屏之于温病范围之外。
四、叶氏以冶肺之药，治犯肺之病，不误用消导攻伐，克削无辜，意见颇合，惟药力轻不及彀，致常有所谓逆传心包之变，叶氏之意见保留之，用药改革之(以治肺之药治胃，为叶氏以后之流弊，其过不在叶氏之本身，以此责叶氏，叶氏不任其咎)，叶氏治疗意见之合否，与叶氏对于此病之命名，不生关系。
五、此问题于后文详论之(见第五章清代温病书中所包含之疾病)。
要而言之，中医之病名，最为庞杂，所谓温病，非一病也，特以温病括之耳，在犯肺之病，未屏出以前，固极凌乱庞杂之致，已屏出以后，亦未入匣然有序之境，特以犯肺之病，本非温病，屏之温病范围之外，无损于犯肺之病之治疗，而有利于温病学说之整理，所以缩小温病之范围，核其名实之是否相孚，俾易于整理耳，非有所好恶于其问也。
章虚谷等，称叶氏犯肺之病，为外感温病，其实外感之病，不止犯肺一种(如暑病，俗医亦谓之外感温病，至伏暑则另是一种说法)，苟以为屏去犯肺之病，而外感温病即似被完全推翻，仿佛从此温病只有伏气之治法，而无外感温病之治法，以为温病之治疗，缺而不完，心中惶惶无所主者，皆谬见也，盖所谓外感温病者，既不止犯肺一种，则外感温病之大部分，依旧存在，似无所用其杞忧，以此为惧，何惧之有(伏气外感，当于后面批判之，见第三章)，一般心理，多误认叶氏犯肺之病，即温病之全体(此种误会之发生，大抵出于真以为温邪上受十二字，可为温病纲领之故)，以为推翻叶氏犯肺之病，即不啻推翻温病之全体，因之大起恐慌，此种见解，更为谬绝，吾前言叶氏之温病，仅为温病学说之一部分，不足为全体温病学说之代表，则推翻叶氏之温病，仅为推翻温病学说过程中之一部分，决非推翻温病之全体。进一步言，则犯肺之病，尤仅为所谓外感温病中之一部分，多之徒乱耳目，少之无关重要(叶氏胃之一系之温病，虽或背古旨，然尚可附带辨正，故废礼存羊，留而不削)，故吾所屏去之温病，匪特非温病之全体，抑且非叶氏外感温病之全体，芟此赘疣，则温病学说之整理，或将厘然而有序。(《温病论衡》)
柴按：上文为“温病学说思想之变迁”一章的结论。谢氏通过考察二十七家温病之本义后，明确将温病分成肺胃二系，认为叶氏“首先犯肺”云云，讲的是肺系温病，而这种温病，是叶氏杜撰的温病，实际上古人并不称为温病，这种所谓的温病，是温病学说中之赘瘤。而胃系温病，与“首先犯肺”说，可谓是风马牛不相及，谢氏之说若得以成立，叶派温病学说就基本上被推翻了。由于谢氏论证严密，故对叶派温病学说的批判，显得极有力量，因此，《温病论衡》无疑是抨击叶派学说中之一本最有学术价值的专著。谢氏提出的批判，迄今为止，亦未见有予以反驳者。谢氏在晚年曾著《温病要义》，对叶派的温热之学，“朴实地叙述了它的轮廓。”并云：“至于进一步的研究，那有待医界同志。”但从抨击叶派学说到介绍叶派学说，这是如恽铁樵所说，“不狂者非尤而效之亦佯狂不可”呢？还是如章巨膺所说：“乃致误入歧途”，知迷而返呢？细阅《温病要义》，并未见有一语涉及对《温病论衡》中之观点有所反省者，说明谢氏并不是象章巨膺那样，是先信某派之学而后来立场转变者。谢氏于十年动乱中，已被害致死，其因无法再起死人而问之，但《温病论衡》一书的学术价值，并不因谢氏复著《温病要义》而逊色。
叶派温病治术之批评
尝谓天士之学，出于喻西昌为多，而温病滋阴之法，尤与西昌默契而合符也。西昌之论温证曰：
“缘真阴为热邪久耗，无以制亢阳而燎原不熄也，以故温病之人，邪退而阴气犹存一线者，方可得生，然多骨瘦皮干，津枯肉烁，经年始复未病之体。”
以此杂天土鞠通书中，几不辨楮叶，何以神似之至于斯也，天士主张滋阴之说，指南中数见不鲜，剌取而条列之如下：
温邪逆传膻中……必兼滋清——温热门3
0高年热病……当滋清去邪——同上”
甘寒清气药中，必佐存阴——13
邪虽外达，阳气亦泄……当以育阴清热为主——47
阴中伏邪……与育阴清邪热法——53
温邪久伏少阴，古人立治，全以育阴祛热——53
肾阴不承……议以三才汤滋水制热——54
至其所以滋阴之理，则不外阴虚液涸，故云：
风温热灼之后，津液未复——风温门9
温邪发热津伤一—温热门6
邪入心包络中，深怕液涸神昏——19
阴液已涸，舌强音缩—-36
阳根求固，阴液渐涸——57
承叶氏之遗说而祖述之者，皆以滋阴为治温之要著。
吴鞠通曰：“热病未有不耗阴者，其耗之未尽则生，尽则阳无留恋，必脱而死也，真能体味斯言，思过半矣。”汪刃庵曰：“叶氏必以保津液为要。”
王孟英曰：“(阴)耗之而未尽者，尚有一线之生机可望，若耗尽而阴竭，如早苗之根已枯矣，沛然下雨，亦曷济耶。”
吴坤安曰：“大抵温病之证，阴精内耗，阳强无制，新邪一触，则燎原之势，直从里发，故初起即见壮热烦渴口千舌燥等证，而以存津液为要旨。”
叶氏子雨，对滋阴疗法有微词，陆九芝则深致不满，痛加惩创。
叶子雨曰：“治温暑保津液，固为第一义，知泻其阳之有余，即所以补其阴之不足，则进乎道矣。”
陆九芝曰：“急去邪热，阴始可保，一去其热，阴即不伤。”
又曰：“盖人之所病者寒也热也温也，只去其寒与温与热，其人而阴本不虚者，无伤也。即其人而本属阴虚者，亦无恙也。乃不防其阳盛伤阴，而独防阴虚邪恋，于是防其劫津，防其发疹，防其风动，防其热入心包，至末而防其脱，夫既曰劫曰发曰动臼入，则自有劫之发之动之入之之物，在不去其劫之发之动之入之之物，而药反留邪以劫津，引邪以发疹，助邪以动风，领邪以入心包，而同归于脱，防云何哉。阳之方盛，徒曰存阴，阴既不能以些微之药而存，而三五日间阳邪之足以伤阴者，方且势如奔马，涸液枯津，是其阴之伤于药后者，不更甚乎。总之，使病速去，阴始不伤，欲保其阴，必速去病，去病之药，十余味耳，亦甚平常，并非险峻，有历验者，非空言也。”
又曰：“然则生地石斛，将始终不可用乎，则又非也，当夫芩连石膏二三剂后，热退身凉，神清脉静，得此八字佳境，已出死关，而津亏液伤，元阴尚难遽复，稀粥烂饭，胃纳始得微开，即以生地养阴，石斛养胃，徐徐而作善后之图，亦为耍药，只是迟早先后间，则有确乎其有不可易者。”
临证指南中温热门席姓一案，叶氏谓古人立法，全以育阴清热，仿河间浊药轻投法，不为上焦热阻，下焦根柢自立，冀其烦躁热蒸自缓，用蓟则熟地之炭、远志之炭、淡苁蓉、川断。五味等补肾敛涩之药，腻隔留邪，卒至不救，以生地滋阴，取其甘寒多液，易为熟地，烧之成炭，则尤育阴之下乘矣。
滋阴之法，导源手朱丹溪，然丹溪之治温热病，无一滋阴方，支谓黄连、黄芩、栀子、黄柏降火，非阴中之火不可用，其说当否，姑置不论，然丹溪之意可知矣。故天士滋阴之法，非纯乎丹溪者也，袭古说而遗其半，以移治不可滋阴之病机，则其悖谬而偾事也固宜。
叶氏以辛凉轻剂冶犯肺之温病，寻常感冒，或足以了之，若肺胀(此处以肺胀代肺炎)则轻剂无能为力，故陆九芝曰：
“果如其说，则所称温热者，不过小小感冒，即俗所谓小风热小风温，如目赤颐肿喉梗牙痛之类，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，以至于死，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，不即愈于辛凉之轻剂耶。”
盖可以辛凉之轻剂愈之者，不过如九芝先生所说之小风热小风温，而辛凉轻剂所不能愈者，则肺胀之类也。以轻剂统治一切，此叶吴之所以流毒于无穷也。九芝先生以葛根芩连治温病，此但可以疗肠窒扶斯耳，肺胀则亦非其治也，故渊雷师曰：
“九芝先生痛斥吴瑭，诚非无的放矢，然以葛根芩连为温病主方，犹求得为定论，观温热风温之证候，舍麻杏石甘及白虎，殆无的当之方矣。”
渊雷师以此二方治仲景之谓温病风温，固坚卓不易，以麻杏石甘移治叶派温病中之肺胀，亦巧合无间。
金匮要略肺痿肺痈咳嗽上气病脉证治第七，有肺胀三条。
“上气，喘而躁者，属肺胀，欲作风水，发汗则愈。”
“咳而上气，此为肺胀，其人目如脱状，脉浮大者，越婢加半夏汤。"(渊雷师曰：“此条证候，是毛细支气管炎及肺炎，其咯痰呼吸，非常困难，又易成水肿，此因呼吸困难肺循环郁血，弓(起全身急性郁血故也。”越婢汤为麻黄石膏半夏生姜大枣甘草)
“肺胀，咳而上气，烦躁而喘，脉浮者，心下有水，小青龙加石膏汤主之。”
“上气，面浮肿，肩息，其脉浮大，不治，下利又加甚。”(按：此节注家亦释为肺胀，丹波元坚云，肺胀一证，诸家未有云后世某证者，考下文云，肺胀咳而上气，又云，咳而上气，此为肺胀，由此观之，即后世所谓呷嗽哮嗽之届，巢源云：痰气相击，随嗽动息，呼呷有声，谓之呷嗽。本事续方云，哮嗽如拽锯是也。渊雷按：呷嗽哮嗽之证候，即支气管性气喘，支气管性气管炎及支气管性肺炎也。)
以旧说考之，则肺胀之所包含，不止肺炎一病，以肺炎属肺胀，则事理俱惬，以肺胀为肺炎，则不合逻辑，故吾以肺胀名肺炎，亦假定之辞耳。
肺胀之治，着重于麻黄石膏，金匮治肺胀两方，皆以麻黄石膏为主药，章太炎先生有论肺炎病治法一文，殊精绝，节录如下：
In summary, the evolution of the theory of warm diseases (Wenbing, 温病) has been roughly outlined. Among these twenty-seven physicians, excluding those with eccentric views that are unreasonable and have little impact on warm disease thought, the most noteworthy are Wang Andao, Ye Tianshi, and Lu Jiuzhi. The drastic transformation of warm disease theory began with Wang Andao; Ye Tianshi was the primary culprit in the confusion of the name and reality of warm diseases (although not the only one, his responsibility was the greatest); and it was Lu Jiuzhi who followed later to launch a major rebuttal under the long-standing dominance of the theories of Ye Tianshi and Wu Jutong.
Reforms since Wang Andao can be summarized in three aspects: etiology (latent qi vs. new contraction), pathology (from interior to exterior), and treatment (focus on clearing interior heat). Examining the primary targets of their medication, they generally focused on the Stomach. It was not until Ye Tianshi created the theory of "warm pathogenic factors enter from above and first attack the Lungs" that the sites of warm diseases were divided into two systems: Lung and Stomach. At this time, although warm diseases of the Stomach system still existed, they were in a vague state and gradually forgotten by physicians. Later, the warm-heat school took the twelve characters "warm pathogenic factors enter from above, first attack the Lungs, and reverse transmit to the Pericardium" as the guideline for warm diseases. Consequently, even the initial stage of warm diseases of the Stomach system (such as damp-warmth), if not originating from the Lungs, was uniformly governed by these twelve characters. This led to the arbitrary severing of the etiology, pathology, and treatment theories of the initial stage of warm diseases of the Stomach system, which were then labeled as syndromes and treatments of the Lung system. This is truly what the vernacular calls "putting Zhang's hat on Li's head." In the middle and late stages of warm diseases of the Stomach system, medications used for treating the Lung system were applied, resulting in unpredictable treatment outcomes (Mr. Lu Jiuzhi stated: "The patient suffers from stomach disease, but the physician speaks of lung disease; this serves as evidence"). These drawbacks inadvertently became a trend, prevalent among contemporary physicians. Their books on warm diseases absorbed everything indiscriminately, using the *Neijing*, *Nanjing*, and the works of Zhang Zhongjing as a facade to cover up their habit of using light and weak medications. There are many other drawbacks, all traceable to specific origins. Witnessing these disasters, Mr. Lu Jiuzhi wrote vigorously in *Shibu Zhai Yishu* to elucidate the syndrome differentiation and treatment of warm diseases of the Stomach system. Although his language was somewhat extreme, it hit the nail on the head and served as a good medicine for saving the times. However, Mr. Lu focused solely on elucidating warm diseases of the Stomach system, completely ignoring warm diseases of the Lung system, even stating that stomach diseases present with clouded consciousness while lung diseases do not. This was arbitrary and provided ammunition for those advocating "attacking the Lungs." They would surely say, "What you speak of is warm disease of the Stomach system, what I speak of is warm disease of the Lung system. Your elaboration on the Stomach system, no matter how profound, has nothing to do with me; my rejection of the Lung system, no matter how intense, has nothing to do with you." This is the so-called "you have your truth, I have mine," where the two are unrelated. Thus, the issue of the Lung-Stomach debate in warm diseases remains unresolved, and this debate will likely continue indefinitely.
Thinking further, Mr. Jiuzhi's effort to elucidate warm diseases of the Stomach system was considerable, and his criticism of Lung-Stomach warm diseases was thorough. Yet, he ultimately failed to dismantle the fortifications of Ye Tianshi and Wu Jutong or eradicate their roots because he did not destroy their nest or cut off their foundation.
When criticizing a theory, one's vision must encompass the entire theory, focusing on the big picture. If one attacks only fragments locally, it results in a situation where "what is suppressed here escapes there," leading to endless conflict. Mr. Jiuzhi's criticism was still a fragmented elimination, deleting sentence by sentence and chapter by chapter, thus forming only an antagonistic stance without choking the vital throat of Ye and Wu. Now, we should proceed to discuss the fundamental issue of warm diseases of the Lung system. First, we must ask whether the so-called "Lung system warm disease" was originally called warm disease. Second, we must ask whether the so-called "Lung system warm disease" intruded into the scope of warm diseases and whether such intrusion was necessary. Third, to rectify names and demand reality, we must ask whether the so-called "Lung system warm disease" should assume the name of warm disease and whether it should be acknowledged as warm disease. Fourth, does Ye Tianshi's therapy for this Lung system warm disease have value? Fifth, if we do not acknowledge this disease as warm disease, what name should we choose for it? Based on the historical evolution of warm disease theory, the answers are as follows:
One. Regarding the warm disease of "warm pathogenic factors entering from above and first attacking the Lungs," examining its symptoms reveals that before Ye Tianshi, it was not called warm disease. People claim Ye invented it; I claim Ye fabricated it. People claim Ye specially created it; I claim Ye confusedly named it.
Two. Examining the ideological evolution of warm disease theory, the so-called "warm pathogenic factors entering from above and first attacking the Lungs" warm disease is indeed an extraneous branch, intruding arbitrarily midway. The meaning of warm disease was already complex (the fact that it is complex is not a reason for further intrusion). Intruding this irrelevant warm disease further confuses names and realities, so there was no necessity for such intrusion.
Three. Since it was not originally warm disease and intruded midway, it should not assume the name of warm disease nor be acknowledged as such. It should be excluded from the scope of warm diseases.
Four. Ye Tianshi used medications for treating the Lungs to treat diseases attacking the Lungs, avoiding the misuse of digestive and purgative methods to harm the innocent. This opinion was quite reasonable. However, the medicinal power was too light and insufficient, often leading to the so-called "reverse transmission to the Pericardium." Ye Tianshi's therapeutic opinion can be retained, but the medication needs reform (The subsequent deviation of using lung-treating drugs for stomach diseases after Ye Tianshi is not Ye's fault personally; blaming Ye for this is unjustified). Whether Ye's therapeutic opinion is correct is unrelated to his naming of this disease.
Five. This issue will be discussed in detail later (see Chapter 5, Diseases Contained in Qing Dynasty Warm Disease Books).
In short, Traditional Chinese Medicine disease names are extremely diverse. "Warm disease" is not a single disease but a generalization. Before removing diseases attacking the Lungs, the situation was indeed chaotic; even after removal, it has not reached a perfectly orderly state. However, since diseases attacking the Lungs are not inherently warm diseases, excluding them from the scope of warm diseases does not harm the treatment of these diseases but aids in organizing warm disease theory. Therefore, narrowing the scope of warm diseases and verifying the correspondence between names and realities facilitates organization, rather than stemming from any personal preference.
Zhang Xugu and others referred to Ye Tianshi's disease attacking the Lungs as "exogenous warm disease." In fact, exogenous diseases are not limited to those attacking the Lungs (for example, summerheat disease is also commonly called exogenous warm disease by folk physicians, while latent summerheat is a different concept). Those who believe that removing the disease attacking the Lungs completely overturns exogenous warm disease, implying that warm diseases now only have treatments for latent qi and lack treatments for exogenous warm disease, feeling that warm disease treatment is incomplete and causing anxiety, hold erroneous views. Since exogenous warm disease includes more than just diseases attacking the Lungs, the majority of exogenous warm diseases still exist, making such worry unnecessary. What is there to fear? (The issues of latent qi and exogenous contraction will be critiqued later, see Chapter 3). Generally, people mistakenly believe that Ye Tianshi's disease attacking the Lungs constitutes the entirety of warm diseases (this misunderstanding largely arises from genuinely believing the twelve characters "warm pathogenic factors enter from above" serve as the guideline for warm diseases). They think that overturning Ye Tianshi's disease attacking the Lungs is equivalent to overturning the entirety of warm diseases, causing panic. This view is even more absurd. As stated earlier, Ye Tianshi's warm disease is only a part of warm disease theory and does not represent the whole. Therefore, overturning Ye Tianshi's warm disease is only overturning a part of the process of warm disease theory, not the entirety of warm diseases. Furthermore, the disease attacking the Lungs is merely a part of the so-called exogenous warm disease. Having too much confuses the senses, having too little is unimportant (Ye Tianshi's warm disease of the stomach system, although possibly contradicting ancient principles, can still be corrected incidentally; thus, adopting the attitude of "discarding the ritual to preserve the sheep," it is kept and not deleted). Therefore, the warm diseases I exclude are not only not the entirety of warm diseases but also not even the entirety of Ye Tianshi's exogenous warm diseases. Removing these excrescences may bring clarity and order to the organization of warm disease theory. (*Wenbing Lunheng*)
Chai Haoran notes: The above text is the conclusion of the chapter "Evolution of Warm Disease Theory Thought." After examining the original meanings of warm diseases from twenty-seven schools, Xie clearly divided warm diseases into Lung and Stomach systems. He believed that Ye Tianshi's statement "first attacking the Lungs" refers to warm diseases of the Lung system, which Ye fabricated. In reality, ancients did not call this warm disease. This so-called warm disease is an excrescence in warm disease theory. Warm diseases of the Stomach system have nothing to do with the "first attacking the Lungs" theory. If Xie's viewpoint holds, the Ye-school warm disease theory would be basically overturned. Due to Xie's rigorous argumentation, his critique of the Ye-school warm disease theory appears very powerful. Therefore, *Wenbing Lunheng* is undoubtedly one of the most academically valuable monographs attacking the Ye-school theory. To date, no one has refuted Xie's critiques. In his later years, Xie wrote *Wenbing Yaoyi*, which "simply narrated the outline" of the Ye-school warm-heat studies. He said, "Further research awaits colleagues in the medical field." But shifting from attacking the Ye-school theory to introducing it—is this, as Yun Tieqiao said, "a sane person imitating madness is also considered madness"? Or is it, as Zhang Juying said, "leading astray," realizing the mistake and returning? Reading *Wenbing Yaoyi* carefully, there is not a single word reflecting on the viewpoints in *Wenbing Lunheng*. This shows that Xie was not like Zhang Juying, who initially believed in a certain school and later changed his stance. Xie died during the Ten-Year Turmoil, so we cannot ask him again. However, the academic value of *Wenbing Lunheng* is not diminished by Xie's later work *Wenbing Yaoyi*.
Critique of Ye-School Warm Disease Therapeutics
I have said that Ye Tianshi's learning derived largely from Yu Chang (courtesy name Xichang), and the method of nourishing yin for warm diseases aligns closely with Xichang's views. Xichang discussed warm syndromes saying:
"Because true yin is long consumed by heat pathogens, unable to control hyperactive yang, causing the fire to spread uncontrollably. Therefore, among warm disease patients, only those whose pathogens recede but retain a thread of yin energy can survive, yet they mostly remain emaciated with dry skin, withered fluids and flesh, taking a year to recover their pre-illness physique."
Mixing this quote with texts by Ye Tianshi and Wu Jutong makes it hard to distinguish between them; why is the similarity so striking? Ye Tianshi's advocacy of nourishing yin is frequently seen in *Lin Zheng Zhi Nan Yi An* (Clinical Guide to Medical Cases). Extracting and listing them as follows:
Warm pathogens reverse transmitting to the Danzhong... must combine nourishing and clearing—Warm Disease Section 3
Elderly high-age heat diseases... should use nourishing clearing to expel pathogens—Same source
In sweet-cold clearing qi medicines, must assist with preserving yin—13
Although pathogens reach the exterior, yang energy also leaks... should focus on nurturing yin and clearing heat—47
Latent pathogens within yin... adopt methods of nurturing yin and clearing pathogenic heat—53
Warm pathogens lingering in Shaoyin for a long time, ancient methods established treatment entirely based on nurturing yin and dispelling heat—53
Kidney yin fails to ascend... propose Sancai Tang to nourish water and control heat—54
As for the rationale behind his nourishing yin, it is simply yin deficiency and fluid depletion, hence he stated:
After wind-warmth burns, fluids have not recovered—Wind-Warmth Section 9
Warm pathogens cause fever and fluid injury—Warm Disease Section 6
Pathogens enter the Heart Pericardium collaterals, deeply fearing fluid depletion and clouded consciousness—19
Yin fluids exhausted, tongue stiff and voice constricted--36
Yang root seeks consolidation, yin fluids gradually deplete—57
Those inheriting Ye Tianshi's legacy and following his teachings all regard nourishing yin as a crucial method for treating warm diseases.
Wu Jutong said: "Heat diseases invariably consume yin. If consumption is incomplete, life is possible; if complete, yang has no attachment and will collapse and die. Truly understanding this statement covers half the problem." Wang Ren'an said: "Ye Tianshi definitely regarded preserving body fluids as essential."
Wang Mengying said: "(Yin) consumed but not exhausted leaves a ray of hope for survival. If exhausted and yin depleted, like the roots of early seedlings withering, even heavy rain cannot help."
Wu Kun'an said: "Generally, warm disease syndromes involve internal consumption of yin essence and unchecked yang strength. When touched by new pathogens, the momentum spreads like prairie fire from the interior. Thus, initial stages show severe fever, irritability, thirst, dry mouth, and dry tongue, with preserving body fluids as the key principle."
Ye Tianshi's son, Ye Yu, had reservations about the nourishing yin therapy, and Lu Jiuzhi expressed deep dissatisfaction, criticizing it severely.
Ye Yu said: "Treating warm and summerheat by preserving body fluids is indeed the primary principle. Knowing that reducing excess yang is equivalent to supplementing insufficient yin advances one to the Dao."
Lu Jiuzhi said: "Urgently remove pathogenic heat, and yin can be preserved; once heat is removed, yin is not injured."
He also said: "Generally, what people suffer from is cold, heat, or warmth. Only by removing cold, warmth, and heat is there no injury, provided the person's yin was not deficient originally. Even if the person was originally yin-deficient, they would be fine. Instead of preventing yang excess from injuring yin, they exclusively prevent yin deficiency from harboring pathogens. Thus, they guard against fluid劫 (plunder), rashes, wind stirring, and heat entering the pericardium, finally guarding against collapse. Since terms like plunder, erupt, stir, and enter imply agents doing these actions, if one does not remove the agent causing plunder, eruption, stirring, and entry, but instead uses drugs that linger pathogens to plunder fluids, draw pathogens to cause rashes, aid pathogens to stir wind, and lead pathogens into the pericardium, all leading to collapse, what is there to guard against? When yang is flourishing, merely speaking of preserving yin, yin cannot be preserved by trivial medicines. Within three to five days, the damage to yin by yang pathogens is like a galloping horse, drying fluids and withering juices. Is the injury to yin caused by drugs afterwards not even greater? In short, if the disease is removed quickly, yin is not injured. To preserve yin, one must quickly remove the disease. Medicines to remove the disease are merely ten-plus ingredients, very common, not harsh, and proven effective, not empty talk."
He also said: "Then, should Shengdi (Rehmanniae Radix) and Shihu (Dendrobii Caulis) never be used? That is also incorrect. After two or three doses of Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Shigao (Gypsum Fibrosum), when heat recedes, body cools, spirit clears, and pulse calms, achieving this excellent state of eight characters, one has passed the death gate. Although fluid deficit and yin injury make immediate recovery of primal yin difficult, consuming thin porridge and soft rice allows stomach appetite to slightly open. At this point, using Shengdi to nourish yin and Shihu to benefit the stomach, slowly planning for convalescence, is also important medicine. The only difference lies in the timing and sequence, which has definite unchangeable rules."
In the case of Patient Xi in the Warm Disease Section of *Lin Zheng Zhi Nan*, Ye Tianshi stated that ancient legislation relied entirely on nurturing yin and clearing heat, imitating He Jian's method of "light dosage of heavy medicines," ensuring the lower jiao root stands firm despite upper jiao heat obstruction, hoping irritability and heat steaming would subside. The prescription included Charred Shudi (Rehmanniae Radix Preparata), Charred Yuanzhi (Polygalae Radix), Dan Congrong (Cynomorii Herba), Chuanduan (Drynariae Rhizoma), and Wuweizi (Schisandrae Fructus)—medicines for tonifying kidneys and astringing. These cloyingly block and retain pathogens, ultimately leading to untreatable conditions. Switching to Shengdi for nourishing yin, utilizing its sweet-cold nature and abundant fluids, replacing Shudi, charring it, results in an inferior method of nurturing yin.
The method of nourishing yin originates from Zhu Danxi. However, Danxi had no nourishing-yin prescriptions for treating warm-heat diseases, only stating that Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex) descend fire, usable only for fire within yin. Whether this view is correct is debatable, but Danxi's intent is clear. Thus, Ye Tianshi's method of nourishing yin was not purely Danxi's; it appropriated ancient theories while omitting half, applying them to pathological mechanisms unsuitable for nourishing yin. Its contradiction and failure were inevitable.
Ye Tianshi used mild acrid-cool preparations to treat warm diseases attacking the Lungs. For ordinary colds, this might suffice. However, for Feizhang (here referring to pneumonia), mild preparations are powerless. Thus, Lu Jiuzhi said:
"If indeed as he says, then the so-called warm-heat diseases are merely minor colds, commonly known as minor wind-heat or minor wind-warmth, such as red eyes, swollen cheeks, sore throat, or toothache. These require only mild acrid-cool preparations, and the illness resolves immediately. However, why does it suddenly enter the pericardium after a few days, becoming a major illness leading to death? If diseases entering the heart within a few days are fatal, they certainly do not fit the description of requiring only mild acrid-cool preparations. Moreover, why, as he claims, do they not heal immediately with mild acrid-cool preparations?"
Diseases curable by mild acrid-cool preparations are merely, as Mr. Jiuzhi described, minor wind-heat and minor wind-warmth. Diseases not curable by mild acrid-cool preparations include Feizhang (pneumonia). Using mild preparations to govern all cases is why Ye and Wu's influence has infinite toxicity. Mr. Jiuzhi used Gegen Qinlian Decoction to treat warm diseases, which can only treat Enteric Fever (Typhoid). It is not the treatment for Feizhang (pneumonia). Thus, Master Yuanlei said:
"Mr. Jiuzhi's harsh criticism of Wu Tang is certainly not baseless. However, taking Gegen Qinlian Decoction as the main formula for warm diseases still requires definitive proof. Observing the syndromes of Warm Heat and Wind Warmth, abandoning Maxing Shigan Decoction and Baihu Decoction, there are hardly appropriate formulas."
Master Yuanlei used these two formulas to treat the Warm Disease and Wind Warmth mentioned by Zhang Zhongjing, which was indeed firm and unique. Using Maxing Shigan Decoction to treat Feizhang (pneumonia) in Ye-school warm diseases also coincided perfectly.
Chapter 7 of *Jin Gui Yao Lue* ("Pulse, Syndrome, and Treatment of Lung萎, Lung Abscess, Cough, and Asthma") contains three entries regarding Feizhang (Lung Distension):
"Asthma with agitation belongs to Lung Distension, intending to develop into Water Swelling. Sweating promotes recovery."
"Cough with asthma indicates Lung Distension. If the patient's eyes bulge and the pulse is floating and large, Yuebi Jia Banxia Decoction is indicated." (Master Yuanlei noted: "This syndrome corresponds to bronchiolitis and pneumonia. Expectoration and breathing are very difficult, and edema easily forms due to respiratory difficulty causing pulmonary circulatory congestion, leading to systemic acute congestion." Yuebi Decoction consists of Ephedrae Herba, Gypsum Fibrosum, Pinelliae Rhizoma Preparatum, Zingiberis Rhizoma Recens, Zizyphi Fructus, and Glycyrrhizae Radix et Rhizoma.)
"Lung Distension with cough, asthma, irritability, panting, and a floating pulse indicates water retention below the heart. Xiao Qinglong Jia Shigao Decoction is indicated."
"Asthma with facial swelling, shoulder breathing, and a floating-large pulse is untreatable. If accompanied by diarrhea worsening the condition..." (Note: Commentators also interpret this section as Lung Distension. Danbo Yuanjian stated that no previous school defined Lung Distension as a later syndrome. Examining the following text, "Lung Distension with cough and asthma," and "Cough and asthma indicate Lung Distension," it is evident that this refers to the later concepts of Xia Sou (wheezing cough) and Xiao Sou (asthmatic cough). Chaoyuan states: Phlegm and qi strike each other, moving with cough and breath, producing whistling sounds, called Xia Sou. Ben Shi Xu Fang states: Asthmatic cough sounds like sawing wood. Yuanlei notes: The syndromes of Xia Sou and Xiao Sou correspond to bronchial asthma, bronchitis, and bronchopneumonia.)
According to old theories, Lung Distension encompasses more than just pneumonia. Classifying pneumonia under Lung Distension fits logic and facts. Equating Lung Distension with pneumonia is illogical. Therefore, my use of "Lung Distension" to name "pneumonia" is also a hypothetical term.
The treatment of Lung Distension focuses on Ephedrae Herba and Gypsum Fibrosum. Both formulas in *Jin Gui* for treating Lung Distension use Ephedrae Herba and Gypsum Fibrosum as principal herbs. Mr. Zhang Taiyan wrote an article on the treatment of pneumonia, which is exceptionally brilliant. An excerpt follows: