热达于表又重伤表气故不禁风寒非伤风恶风伤寒恶寒也但卫虚则恶风荣虚则恶寒耳且温病热病亦有先见表证而后传里
者盖怫热自内达外热郁腠理不得外泄遂复还里而成可攻之证非如伤寒从表而始也或者不悟此理乃于春夏温病热病而求
浮紧之脉不亦疏乎殊不知紧为寒脉有寒邪则见之无寒邪则不见也其温病热病或见紧脉者乃重感不正之暴寒与内伤过度
之冷食也岂其本然哉又或者不识脉形但见弦便呼为紧断为寒而妄治盖脉之盛而有力者每每兼弦岂可错认为紧而断为寒
夫温病热病之脉多在肌肉之分而不甚浮且右手反盛于左手者诚由怫热在内故也其或左手盛或浮者必有重感之风寒否则
非温病热病自是暴感风寒之病耳凡温病热病若无重感表证虽间见而里病为多故少有不渴者斯时也法当治里热为主而解
表兼之亦有治里而表自解者余每见世人治温热病虽误攻其里亦无大害误发其表变不可言此足以明其热之自内达外矣其
间有误攻里而致大害者乃春夏暴寒所中之疫证邪纯在表未入于里故也不可与温病热病同论夫惟世以温病热病混称伤寒
故每执寒字以求浮紧之脉以用温热之药若此者因名乱实而戕人之生名其可不正乎又方书多言四时伤寒故以春夏之温病
热病与秋冬之伤寒一类视之而无所别夫秋冬之伤寒真伤寒也春夏之伤寒寒疫也与温病热病自是两涂岂可同治吁此弊之
来非一日矣虽然伤寒与温病热病其攻里之法若果是以寒除热固不必求异其发表之法断不可不异也况伤寒之直伤阴经与
太阳虽伤不及郁热即传阴经为寒证而当温者又与温病热病大不同其可妄治乎或者知一不知二故谓仲景发表药今不可用
而攻里之药乃可用呜呼其可用不可用之理果何在哉若能辨其因正其名察其形治法其有不当者乎彼时行不正之气所作及
重感异气而变者则又当观其何时何气参酌伤寒温热病之法损益而治之尤不可例以仲景即病伤寒药通治也
热邪到达体表，又严重损伤了卫表之气，所以患者不能抵御风寒。这不同于伤风病的恶风或伤寒病的恶寒，只是卫气虚弱则表现为恶风，营气虚弱则表现为恶寒罢了。况且温病和热病也有先出现表证，然后传入里证的。这是因为郁热从内部达于外部，热邪郁结在腠理（皮肤纹理及汗孔），不能向外宣泄，于是又返回体内，形成了可以攻下的证候。这与伤寒从体表开始发病是不同的。
有些人不明白这个道理，却在春夏季节的温病、热病中寻求浮紧脉象，这不也太疏忽了吗？殊不知，“紧”是寒脉，有寒邪才会出现，没有寒邪就不会出现。那些温病、热病中出现紧脉的，是因为再次感受了不正之气的暴寒，或者因为内伤过度食用了冷食所致，难道这是它们的本来面目吗？
又或者有人不认识脉象形态，只要见到“弦”脉就称之为“紧”，断定为寒证而胡乱治疗。其实脉象盛大而有力量时，常常兼带弦象，怎么能错认为是紧脉并断定为寒证呢？
温病、热病的脉象多在肌肉之分，而不甚浮起，且右手脉往往比左手脉盛，确实是因为郁热在内部的缘故。如果左手脉盛或浮起，那一定是再次感受了风寒，否则就不是温病、热病，而是突然感受风寒的疾病了。凡是温病、热病，如果没有再次感受表证，虽然偶尔可见表证，但里证居多，所以很少有口渴不明显的情况。此时治法应当以清治里热为主，兼以解表。也有通过治疗里热而使表证自解的情况。
我常常见到世人治疗温热病，即使误用攻下法治疗里证，也不会有大害；但如果误用发汗法治疗表证，变证就不可胜言了。这足以证明热邪是从内部达于外部的。
其中有的因误攻里而导致大害的，那是春夏季节被暴寒所中的疫证，邪气纯在体表，未进入体内，所以不能与温病、热病混为一谈。
世人将温病、热病混称为伤寒，因此总是执着于“寒”字去求索浮紧脉象，并使用温热性质的药物。像这样因为名称混乱而损害实质，从而残害人的性命，这个名称怎么可以不纠正呢？
另外，医方书籍多谈论四时伤寒，所以把春夏的温病、热病与秋冬的伤寒看作一类而没有区别。其实，秋冬的伤寒是真伤寒，春夏的伤寒是寒疫，它们与温病、热病本来就是两条不同的路径，怎么可以同样治疗呢？唉，这种弊病由来已久了。
虽然如此，伤寒与温病、热病在攻里的治法上，如果确实是用寒凉药来清除热邪，固然不必强求不同；但在发表的治法上，绝对不可以相同。况且伤寒直接损伤阴经，以及太阳经虽受邪但未郁积化热即传入阴经成为寒证而需要用温法治疗的，又与温病、热病大不相同，怎么可以胡乱治疗呢？
有的人知其一不知其二，认为张仲景的发表药现在不可用，而攻里的药才可用。唉，这可用与不可用的道理究竟在哪里呢？
如果能辨别病因，端正名称，察看病形，制定治法，还有不当的吗？至于那些由时行不正之气所作，以及再次感受异气而发生变化的病症，则应当观察是何时、何种气机，参照伤寒和温热病的治法进行增减调整来治疗，尤其不可简单地用张仲景治疗即病伤寒的药物通治所有情况。
Heat reaches the exterior and severely damages the Wei (Defensive) Qi, thus failing to resist wind-cold. This is distinct from the aversion to wind in Wind-Strike or the aversion to cold in Cold Damage; it merely indicates that deficiency of Wei Qi manifests as aversion to wind, while deficiency of Ying (Nutritive) Qi manifests as aversion to cold. Furthermore, Warm Disease (Wen Bing) and Heat Disease (Re Bing) may also initially present with Exterior Syndrome before transmitting to the Interior. This occurs because stagnant heat rises from the interior to the exterior, becoming trapped in the Cou Li (pores and interstices), unable to vent outward, and subsequently returning inward to form a syndrome amenable to purgation. This differs from Shang Han (Cold Damage), which originates at the exterior.
Some individuals fail to comprehend this principle and seek a Tight Pulse (Jin Mai) in cases of Warm or Heat diseases occurring in spring and summer, which is indeed negligent. It must be understood that a Tight Pulse is indicative of Cold; it appears only when Cold Pathogens are present and disappears when they are absent. If a Tight Pulse appears in Warm or Heat diseases, it is due to a secondary exposure to sudden, pathogenic cold, or excessive consumption of cold food causing internal injury—not its inherent nature.
Others, unfamiliar with pulse morphology, mistake a Wiry Pulse (Xian Mai) for a Tight Pulse, diagnose it as Cold, and treat recklessly. A pulse that is vigorous and forceful often accompanies a wiry quality; how can it be mistaken for a tight pulse and diagnosed as cold?
The pulses of Warm and Heat diseases typically manifest at the muscle level rather than being superficial, and the Right Hand pulse is often stronger than the Left Hand pulse, truly reflecting stagnant heat within. If the Left Hand pulse is strong or superficial, it indicates a secondary exposure to wind-cold; otherwise, it is not a Warm or Heat disease but an acute contraction of wind-cold. In Warm and Heat diseases, if there is no secondary exterior syndrome, although exterior signs may occasionally appear, interior syndromes predominate; thus, thirst is rarely absent. The treatment method should primarily focus on clearing interior heat, accompanied by resolving the exterior. There are also cases where treating the interior resolves the exterior spontaneously.
I frequently observe that when physicians treat Warm-Heat diseases, even if they mistakenly use purgation for the interior, serious harm is rarely caused. However, if they mistakenly use diaphoresis (sweating methods) for the exterior, the complications are incalculable. This sufficiently demonstrates that the heat originates from the interior and moves outward.
Cases where mistaken purgation leads to severe harm usually involve epidemic conditions contracted by sudden cold in spring and summer, where the pathogen remains purely in the exterior without entering the interior. These cannot be discussed together with Warm or Heat diseases.
Because the general public conflates Warm and Heat diseases with Shang Han, they cling to the character "Cold" to seek a Floating-Tight pulse and employ warming herbs. Such practices, confusing name with reality and harming life, necessitate the correction of terminology.
Moreover, medical texts often discuss "Four Seasons Shang Han," grouping spring/summer Warm-Heat diseases with autumn/winter Shang Han without distinction. Autumn/winter Shang Han constitutes True Shang Han, whereas spring/summer Shang Han refers to Cold Epidemics. These are fundamentally different from Warm and Heat diseases and should not be treated identically. Alas, this error has persisted for a long time.
Nevertheless, regarding the method of purging the interior, if the goal is indeed to remove heat with cold properties, there is no need to insist on differences. However, the method of releasing the exterior must absolutely differ. Furthermore, Shang Han directly injuring the Yin meridians, or Tai Yang syndrome failing to stagnate into heat and transmitting to Yin meridians to become a Cold syndrome requiring warming, is vastly different from Warm and Heat diseases; reckless treatment is impermissible.
Some who know one aspect but not the other claim that Zhang Zhongjing’s exterior-releasing formulas are now unusable, while interior-purging formulas are usable. Alas, what is the rationale for their usability or non-usability?
If one can distinguish the etiology, correct the nomenclature, examine the clinical presentation, and formulate appropriate treatments, are there still errors? For conditions caused by seasonal pathogenic qi or those altered by secondary exposure to different pathogens, one must consider the timing and specific pathogenic factors, referencing and modifying the methods of both Shang Han and Warm-Heat diseases. One must certainly not indiscriminately apply Zhang Zhongjing’s formulas for immediate-onset Shang Han to all such cases.