雍曰。医家论温病多误者。盖以温为别一种病。不思冬伤于寒。
至春发者。谓之温病。冬不伤寒。而春自感风寒温气而病者。亦谓之
温。及春有非节之气。中人为疫者。亦谓之温。三者之温。自不同也。
素问曰。冬伤于寒。春必病温。
又曰。凡病伤寒而成温者。先夏至日
为病温。此皆谓伤寒而成温者。比之伤寒热病为轻。而比之春温之
疾为重也。其治法与伤寒皆不同。或有冬不伤寒。至春自伤风寒而
病者。初无寒毒为之根源。不得谓之伤寒。第可名曰温病也。又或有
春天行非节之气中人。长幼病状相似者。此则温气成疫也。故谓之
瘟疫。瘟疫之病。多不传经。故不拘日数。治之发汗吐下。随症可施
行。其不伤寒。至春触冒自感之温。治与疫同。又轻于疫也。或曰。春
时触冒自感之温。古无其名。何也。曰。假令春时有触冒自感风寒而
病。发热恶寒。头疼身体痛者。既非伤寒。又非疫气。不因春时温气
而名温病。当何名也。如夏月之疾。由冬感者为热病。不由冬感者为
暑为 。春时亦如此也。活人书葳蕤汤方云。治风温。兼疗冬温。及
春月中风伤寒。即其药也。曰。何以辨其冬感春感之异。曰。但传经。
皆冬感也。皆以伤寒治。不传经者。皆春感也。皆以温气治之。今于
诸家方论下别而言之。庶几易明。然春温之病。古无专治之法。温疫
之法兼之也。
活人书曰。春月伤寒。谓之温病。冬伤于寒。轻者夏至以前发
者。为温病。盖由春温暖之气而发也。雍曰。此谓伤寒之温也。即素
问所谓凡病伤寒而成温病者是也。其治与伤寒同。故朱氏自注曰。
非徒温疫也。
又曰。治温病。与冬月伤寒夏月热病不同。盖热轻故也。雍曰。
此谓春温非伤寒者。若伤寒成温。则其热轻于热病。而重于冬月伤
寒也。盖冬月伤寒。为轻。至春发为温病。为重。夏月热病。为尤重
也。朱氏注曰。春秋初末。阳气在里。其病稍轻。纵不用药治之。五六
日亦自安。即此推之。则此春温之病。乃谓非伤寒成温者。
又曰。升麻汤解肌汤最良。热多者。小柴胡汤主之。不渴。外有
微热者。小柴胡加桂枝也。嗽者。小柴胡加五味也。烦躁发渴。脉实。
大便闭塞者。大柴胡微利也。虚烦者。竹叶汤。次第服之。此治春温
之法。其伤寒成温者。并根据伤寒治之。治温疫之法。并同春温。而加
疫药也。
又曰。一岁之中。长幼疾多相似。此温疫也。四时皆有不正之
气。春夏亦有寒凉时。秋冬亦有暄暑时。人感疫疠之气。故一岁之
中。病无长幼。悉相似者。此则时行之气。俗谓之天行是也。老君神
明散、务成子萤火丸、圣散子、败毒散主之。雍曰。此谓春温成疫之
治法也。若夏暑成疫。秋瘟成疫。冬寒成疫。皆不得同治。各因其时
而治之。况一岁之中。长幼疾状相似者。即谓之疫。如疟利相似。咽
喉病相似。赤目相似。皆即疫也。皆谓非触冒自取之。因时行之气而
得也。
又曰。春应暖而凉气折之。则责邪在肝。升麻解肌汤主之。夏应
暑而寒气折之。则责邪在心。射干汤、半夏桂枝甘草汤选用之。秋应
凉而反大热抑之。则责邪在肺。温热相搏。民多病疟。宜白虎加苍术
汤。煎茵陈汤调五苓散。冬应寒而反大温抑之。则伏寒变为温。宜葳
蕤汤。土无正名。因火而名。当随其经而取之。此又治四时温气之
法。温疫皆同治也。
郭雍说：医家论述温病时，大多出现错误。原因在于将“温”视为一种独立的疾病，而没有考虑到冬季感受寒邪，到了春季发作的，称为温病；冬季没有感受寒邪，但在春季自然感受风寒或温气而发病的，也称为温；以及春季遇到非时令之气，中人致病为疫的，也称为温。这三种情况的“温”，本质上是不同的。
《素问》说：“冬季感受寒邪，春季必定发生温病。”又说：“凡是患伤寒而转化为温病的，在夏至日之前发病的，称为温病。”这些说法都是指由伤寒转化而来的温病，其病情比一般的伤寒热病要轻，但比春季自感风寒所致的春温疾病要重。其治疗方法与伤寒都不同。有的情况是冬季未感寒邪，到了春季因自感风寒而发病，起初并没有寒毒作为根源，不能称为伤寒，只能命名为温病。又有一种情况是春天流行非时令之气伤人，无论老少症状相似的，这是温气形成了疫病，所以称为瘟疫。瘟疫这类疾病，大多不传经，因此不拘泥于日数，治疗时发汗、催吐、泻下等法，可根据症状灵活施用。那种冬季未感寒邪，到春季触冒自感的温病，治疗方法与瘟疫相同，但比瘟疫更轻。
有人问：春季触冒自感的温病，古代没有专门的名字，为什么呢？回答说：假如春季有触冒自感风寒而发病，出现发热、恶寒、头痛、身体疼痛等症状，既然不是伤寒，也不是疫气，如果不因为春季的温气而命名为温病，那该叫什么名字呢？就像夏季的疾病，由冬季感受引起的叫热病，不由冬季感受引起的叫暑病（注：原文此处可能有缺字，通常指暑湿或单纯暑病）。春季的情况也是如此。《活人书》葳蕤汤方记载：治疗风温，兼治冬温，以及春月中风伤寒，用的就是这种药。
问：如何辨别是冬季感受还是春季感受的不同？答：凡是传经的，都是冬季感受的，都用治疗伤寒的方法；不传经的，都是春季感受的，都用治疗温气的方法。现在我在各家方论之下分别阐述，以便更容易明白。然而，春温这类疾病，古代没有专门的治疗法则，温疫的治疗法则可以兼用。
《活人书》说：春季的伤寒，称为温病。冬季感受寒邪，病情较轻的，在夏至以前发作的，为温病。这是因为由春季温暖的气候引发的。郭雍说：这指的是由伤寒转化而来的温病，即《素问》所说的“凡是患伤寒而转化为温病”的情况。其治疗方法与伤寒相同，所以朱氏（朱肱）自己注释说：“不仅仅是温疫。”
又说：治疗温病，与冬季的伤寒、夏季的热病不同，因为热势较轻的缘故。郭雍说：这指的是春季自感风寒而非伤寒转化的情况。如果是伤寒转化为温病，那么其热势比热病轻，但比冬季的伤寒重。因为冬季的伤寒较轻，到了春季发作成为温病，则较重；夏季的热病，则更为严重。朱氏注释说：春秋初末时节，阳气在体内，病情稍轻，即使不用药物治疗，五六天也能自愈。由此推断，这里的春温病，是指非伤寒转化而来的温病。
又说：升麻解肌汤是最好的。热势重的，用小柴胡汤主治；口不渴，体表有微热的，用小柴胡汤加桂枝；咳嗽的，用小柴胡汤加五味子；烦躁且口渴，脉实，大便闭塞的，用大柴胡汤轻微通利；虚烦的，用竹叶汤，依次服用。这是治疗春温的方法。那些由伤寒转化而来的温病，都依据治疗伤寒的方法进行。治疗瘟疫的方法，都与春温相同，只是加入治疗疫病的药物。
又说：一年之中，老少疾病多相似，这是温疫。四季都有不正之气，春夏也有寒凉的时候，秋冬也有温暖暑热的时候。人感染了疫疠之气，所以一年之中，无论老少，生病症状都相似，这就是时行之气，俗称天行。可用老君神明散、务成子萤火丸、圣散子、败毒散来主治。郭雍说：这是指春温转化为疫病的治疗方法。如果是夏季暑热转化为疫病，秋季瘟气转化为疫病，冬季寒邪转化为疫病，都不能用同样的方法治疗，应当根据时节分别治疗。况且一年之中，老少症状相似的，就称为疫，如疟疾相似、痢疾相似、咽喉病相似、赤眼相似，都属于疫。这些都称为非因个人触冒感染，而是因时行之气所致。
又说：春季本该温暖却被凉气抑制，则病责在于肝，用升麻解肌汤主治。夏季本该暑热却被寒气抑制，则病责在于心，选用射干汤、半夏桂枝甘草汤。秋季本该凉爽却反而大热抑制，则病责在于肺，温热相搏，百姓多患疟疾，宜用白虎加苍术汤，煎茵陈汤调服五苓散。冬季本该寒冷却反而大温抑制，则伏藏的寒邪变为温病，宜用葳蕤汤。土没有固定的名称，因火而得名，应当随其所在的经络来选取治疗。这又是治疗四时温气的方法，温疫的治疗也都相同。
Guo Yong stated: Physicians often make errors when discussing warm diseases (Wenbing). This is because they treat "warmth" as a distinct disease entity, failing to consider that cases where cold pathogenic factors were contracted in winter and manifested in spring are called warm diseases. Additionally, cases where no cold was contracted in winter, but the individual naturally contracted wind-cold or warm qi in spring, are also termed warm; furthermore, instances where non-seasonal qi in spring infects people causing epidemic diseases are also referred to as warm. These three types of "warm" conditions are fundamentally different.
The *Suwen* states: "If cold is injured in winter, warm disease will inevitably occur in spring." It further states: "For all cases of Shaoyang disease transforming into warmth, those manifesting before the Summer Solstice are called warm disease." These statements refer specifically to warm diseases resulting from the transformation of Cold Damage (Shanghan). Their severity is lighter than typical Cold Damage heat diseases but heavier than spring warm diseases caused by natural contraction in spring. Their treatment methods differ entirely from those for Cold Damage. In some cases, there was no cold injury in winter, but illness occurred in spring due to self-contracted wind-cold; initially, there is no cold toxin as the root cause, so it cannot be called Cold Damage, but rather named warm disease. Another scenario involves the prevalence of non-seasonal qi in spring affecting people, where symptoms among young and old are similar; this constitutes an epidemic formed by warm qi, hence termed plague/epidemic (Wenyi). Plague diseases generally do not transmit through meridians, so the number of days is not rigidly adhered to; treatments such as inducing sweating, vomiting, or purging can be applied flexibly according to symptoms. The warm disease contracted spontaneously in spring after no winter cold injury is treated similarly to plague but is milder.
One might ask: Why is there no ancient specific name for the warm disease contracted spontaneously in spring? The answer is: Suppose one contracts wind-cold spontaneously in spring and develops fever, aversion to cold, headache, and body pain. Since it is neither Cold Damage nor epidemic qi, if it is not named warm disease due to the spring warm qi, what should it be called? Just as summer diseases caused by winter contraction are called heat diseases, while those not caused by winter contraction are called summerheat, the situation in spring is analogous. The *Huoren Shu* (Book of Vitality) under the formula Weirui Tang states: "Treats wind-warmth, also treats winter-warmth, and mid-spring wind-strike with Cold Damage," indicating this is the appropriate medication.
Question: How to distinguish between winter contraction and spring contraction? Answer: Cases involving meridian transmission are due to winter contraction and are treated using Cold Damage protocols. Cases without meridian transmission are due to spring contraction and are treated using warm qi protocols. I will elaborate separately below various physicians' formulas and discussions to clarify. However, ancient texts lack specific treatment laws for spring warm diseases; the laws for plague/epidemic can be applied concurrently.
The *Huoren Shu* states: "Cold damage in spring is called warm disease. Those who contracted cold in winter, with mild severity, manifesting before the Summer Solstice, are diagnosed with warm disease, arising from the warming qi of spring." Guo Yong commented: This refers to warmth derived from Cold Damage, i.e., what the *Suwen* calls "all cases of Shanghan transforming into warm disease." Its treatment is the same as for Cold Damage. Hence, Zhu Shi (Zhu Gong) annotated: "It is not merely plague/epidemic."
He further stated: "Treating warm disease differs from winter Cold Damage and summer heat disease because the heat is lighter." Guo Yong commented: This refers to spring warm disease not derived from Cold Damage. If Cold Damage transforms into warmth, its heat is lighter than summer heat disease but heavier than winter Cold Damage. Winter Cold Damage is mild; when it manifests in spring as warm disease, it becomes heavier; summer heat disease is even more severe. Zhu Shi annotated: "In early and late spring and autumn, yang qi resides within, making the condition slightly milder; even without medication, it may resolve spontaneously in five to six days." From this inference, the spring warm disease mentioned here refers to warmth not derived from Cold Damage.
He further stated: "Shengma Jieji Tang is excellent. For heavy heat, Xiaochaihu Tang is primary. For no thirst with slight external heat, use Xiaochaihu Tang plus Guizhi. For cough, use Xiaochaihu Tang plus Wuweizi. For irritability, thirst, solid pulse, and constipation, use Dachaihu Tang to mildly relieve stagnation. For deficiency irritability, use Zhuye Tang, administered sequentially." This is the method for treating spring warm disease. Cases where Cold Damage transforms into warmth follow Cold Damage treatment protocols. Treatment for plague/epidemic is identical to spring warm disease, merely adding anti-epidemic herbs.
He further stated: "When symptoms among young and old in a year are similar, this is plague/epidemic. All four seasons have irregular qi; spring and summer may have cold spells, autumn and winter may have warm spells. When people contract epidemic pestilence qi, illnesses across all ages appear similar. This is the qi of the season, commonly known as 'heavenly travel' (Tianxing). Treatments include Laojun Shenming San, Wuchengzi Yinghuo Wan, Shengsanzi, and Baidu San." Guo Yong commented: This describes the treatment for spring warm disease transforming into epidemic. If summer summerheat transforms into epidemic, autumn pestilence transforms into epidemic, or winter cold transforms into epidemic, they cannot be treated identically; each must be treated according to its season. Moreover, similarity in symptoms among all ages defines an epidemic; whether malaria-like, dysentery-like, throat disease-like, or red eye-like, these are all epidemics. They are defined as not caused by personal exposure but by seasonal epidemic qi.
He further stated: "If spring should be warm but is suppressed by cool qi, the pathology is attributed to the Liver; treat with Shengma Jieji Tang. If summer should be hot but is suppressed by cold qi, the pathology is attributed to the Heart; select Shegan Tang or Banxia Guizhi Gancao Tang. If autumn should be cool but is suppressed by excessive heat, the pathology is attributed to the Lung; heat and warmth contend, leading many to suffer malaria; use Baihu Jia Cangzhu Tang, decoct Yinchen Tang to regulate Wuling San. If winter should be cold but is suppressed by excessive warmth, latent cold transforms into warmth; use Weirui Tang. Earth has no fixed name, being named due to fire; treatment should be selected according to the affected meridian." This outlines the treatment for warm qi in the four seasons; plague/epidemic treatments are consistent with this.