喻氏论春温，以冬伤于寒，春必病温，为一例；以冬不藏精，春必病温，为一例；以既
伤于
寒，又不藏精，为一例。愚按《金匮》云∶大邪中表，小邪中里。大邪漫风，虽大而力微；
小邪户牖隙风，虽小而气锐。以其锐也，故深入在里；以其小也，故藏而不觉。冬伤于寒者
，冬时所受之寒，本自小而不大，而又以不能蛰藏之故，邪气得以深伏于里；伏之既久，寒
变为热，至春人气升浮，邪气与之俱出，则发热而渴。是以冬伤于寒者，春月温病之由；而
冬不藏精者，又冬时受寒之源耳！嘉言所分三例，其实不过一端，而强为区画，辞愈烦而理
愈晦矣。
寒毒藏于肌肤，此叔和之谬说也。喻氏亦云冬伤于寒，藏于肌肤，感春月之温气而始发
。肌
肤，阳明胃之所主也。愚意肌肤非能藏之地，阳明亦无受寒不发之理，惟少阴为阴，寒邪亦
为
阴，以阴遇阴，故得藏而不发。是以伤寒之邪，自太阳递入三阴；温病之邪，自少阴传出三
阳。岂肌肤与胃之云乎哉？
喻氏云∶仲景治温症，凡用表药，皆以桂枝汤，以示微发于不发之意。又云∶温病二三
日间
，当用麻黄附子细辛汤、麻黄附子甘草汤，深入肾中，领出外邪，则重者愈矣。此喻氏之臆
说，非仲景之旧章也。盖温邪非发散可愈，即有表症，亦岂辛温可发？且桂枝汤为伤寒表病
而里和者设，温症邪从里发，而表且未病，若用桂枝，适足以助温邪而留病气。又温病伏寒
变热，少阴之精已被劫夺，更用辛、附，是绝其本而资之脱也。即曰少阴本寒标热，邪入其
界，非温不散，然而温病之发，寒已变热，其欲出之势，有不待引之而自甚者。其不能出者
，必皆阴精已涸者也，不然宁有不出者耶？喻氏强引经文，傅会己意，自误误人，不容不辨！
喻氏云∶冬伤于寒者，太阳膀胱主之；冬不藏精者，少阴肾经主之。与两感伤症中，一
日太
阳受之，即与少阴俱病，则头痛、口干、烦渴而满之例，纤毫不差。愚谓温病有新旧合邪，
而
无表里两感。盖温病是伏气所发，少阴有伏气，太阳而亦能伏气者，未必然也。不能伏，则
感而即发，乃是伤寒，而终非温病矣。
喻氏云∶少阴为阴脏而少血，所以强逼少阴汗者，重则血从耳、目、口、鼻出，而厥竭
可虞
；轻亦小便不利，而枯涸可待。余每用桂枝，必加生地，以匡芍药之不逮，功效历历可纪。
此论最善，可以稍补前言之失。盖温病之发，阴气先伤，设有当行解散者，必兼滋阴清热之
品参其间，昔贤于葱豉汤加童便，栀豉汤中加生地、麦冬，亦此意也。
又曰∶今人见热胜烦枯之症。而不敢用附子者，恶其以热助热也。孰知不藏精之人，肾
中阳
气不鼓，津液不得上升，故枯燥外见。才用附子助阳，则阴精上交于阳位，如釜底加薪，则
釜中之气水上腾，而润泽有立至者。数语亦有至理，惟于温病不能无弊。盖阴凝之枯燥，与
阴竭之枯燥，霄壤悬殊，万一误投，死生立判，不可不细审也！
喻嘉言论述春温病，将“冬季感受寒邪，春季必然发生温病”作为一例；将“冬季肾精不藏，春季必然发生温病”作为另一例；将“既感受寒邪，又肾精不藏”作为第三例。我认为《金匮要略》中说：大邪（风邪）侵犯体表，小邪（寒邪）侵犯体内。大邪如漫风，虽然气势大而力量微弱；小邪如门窗缝隙中的风，虽然微小但气机锐利。正因为其气机锐利，所以能深入体内；正因为其微小，所以潜伏其中而不易察觉。所谓“冬季感受寒邪”，是指冬季所受的寒邪，原本就细小而不盛大，再加上因不能潜藏封固的缘故，邪气得以深伏于体内；潜伏时间既久，寒邪转化为热邪，到了春季人体阳气升浮，邪气随之而出，就会出现发热且口渴的症状。因此，“冬季感受寒邪”是春季温病的成因；而“冬季肾精不藏”，又是冬季受寒的根源！喻嘉言所分的这三类情况，其实不过是同一回事，却强行划分界限，言辞越繁琐，道理反而越晦涩了。
王叔和说“寒毒潜伏在肌肤”，这是错误的说法。喻嘉言也说“冬季感受寒邪，潜伏在肌肤，感应到春季的温热之气才发作”。肌肤，是由阳明胃经所主。我认为肌肤并不是邪气潜伏的地方，阳明胃经也没有受寒而不发病的道理，只有少阴肾经属阴，寒邪也属阴，以阴遇阴，所以能够潜伏而不立即发病。因此，伤寒之邪，是从太阳经依次传入三阴经；温病之邪，是从少阴经传出至三阳经。怎么能说是潜伏在肌肤和胃呢？
喻嘉言说：张仲景治疗温症，凡是使用解表药，都用桂枝汤，以此表示微微发汗而不令大汗淋漓的意思。又说：温病两三天后，应当用麻黄附子细辛汤、麻黄附子甘草汤，深入肾中，引领出外邪，那么重症就能痊愈。这是喻嘉言的主观臆断，并非张仲景的原有法度。因为温邪不是通过发散就能治愈的，即使有表证，难道能用辛温药物发汗吗？况且桂枝汤是为伤寒表证而里气平和者设立的，温症的邪气从体内发出，而体表尚未受病，如果使用桂枝，恰好足以助长温邪而留住病气。另外，温病是伏寒变热，少阴的精气已被劫夺，再用辛温、附子，这是断绝根本而资助其脱亡。即便说少阴本寒标热，邪气进入其领域，非温不散，然而温病发作时，寒邪已经变为热邪，其向外透发的趋势，有不待引导而自然强烈的。那些不能透发的，必定都是阴精已经枯竭的人，否则哪有不能透发的呢？喻嘉言强行引用经文，牵强附会自己的意思，自己误人又误导他人，不容不辨析！
喻嘉言说：“冬季感受寒邪”，由太阳膀胱经主管；“冬季肾精不藏”，由少阴肾经主管。这与两感伤寒中，一日太阳经受邪，随即与少阴经同时发病，出现头痛、口干、烦渴、腹满等症状的例子，丝毫不差。我认为温病有新旧合邪的情况，而没有表里两感的情况。因为温病是伏气发作，少阴经有伏气，太阳经也能伏气的说法，未必确实。如果不能伏气，则是感邪即发，那是伤寒，终究不是温病了。
喻嘉言说：少阴是阴脏而血少，所以强行逼迫少阴出汗的话，重的会导致血液从耳、目、口、鼻流出，厥逆衰竭令人担忧；轻的也会导致小便不利，枯涸可待。我每次使用桂枝，必定加入生地，来弥补芍药的不足，功效历历在目。这一论点最好，可以稍微弥补前面言论的缺失。因为温病发作，阴气先受伤，如果有需要行解散治疗的，必须兼用滋阴清热的药物参杂其中，以前的贤人在葱豉汤中加入童便，栀豉汤中加入生地、麦冬，也是这个意思。
又说：现在的人见到热盛导致烦躁干枯的症状，不敢使用附子，是厌恶它用热助热。殊不知肾精不藏的人，肾中阳气不鼓动，津液不得上升，所以外表呈现枯燥。刚用附子助阳，则阴精上交于阳位，如同锅底添加柴火，锅中的水汽就会上腾，润泽立刻就能到达。这几句话也有至理，只是在温病治疗中不能有弊端。因为阴凝导致的枯燥，与阴竭导致的枯燥，相差悬殊，万一误投，生死立判，不可不仔细审察啊！
Yu Jiayan’s discussion on Spring-Warmth (Chunwen) disease presents three cases: one where “winter injury by cold leads to warmth disease in spring”; another where “failure to store essence in winter leads to warmth disease in spring”; and a third where “both cold injury and failure to store essence occur.” In my view, the *Jingui Yaolue* states: Major pathogens (wind) strike the exterior, while minor pathogens (cold) strike the interior. Major pathogens are like widespread wind; though vast in scope, their force is weak. Minor pathogens are like wind through cracks in doors and windows; though small, their qi is sharp. Because they are sharp, they penetrate deeply into the interior; because they are small, they remain hidden without being perceived. The phrase “winter injury by cold” refers to cold received in winter, which is originally subtle rather than severe. Due to the inability to hibernate and store (zhe cang), the pathogen lies deep within. After lying latent for a long time, the cold transforms into heat. When spring arrives and human qi ascends and floats, the pathogen emerges with it, resulting in fever and thirst. Thus, “winter injury by cold” is the cause of spring warmth diseases; whereas “failure to store essence in winter” is the source of winter cold exposure! Yu Jiayan’s division into three examples actually describes only one phenomenon but forces artificial distinctions, making the discourse verbose and the logic obscure.
Wang Shuhe’s claim that “cold poison hides in the skin and muscles” is erroneous. Yu Jiayan also stated that “winter cold injury hides in the skin and muscles, manifesting only upon sensing the warmth of spring.” Skin and muscles are governed by the Yangming Stomach meridian. I believe the skin and muscles are not places where pathogens hide, nor does the Yangming stomach suffer from cold without manifesting disease. Only the Shaoyin Kidney, being Yin, encounters Cold Pathogen, which is also Yin; Yin meeting Yin allows for hiding without immediate manifestation. Therefore, the pathogen of Cold Damage (Shanghan) transmits sequentially from Taiyang to the Three Yin meridians; the pathogen of Warmth disease transmits from Shaoyin to the Three Yang meridians. How can it be said to hide in the skin, muscles, and stomach?
Yu Jiayan claimed: Zhang Zhongjing treated warmth syndromes using Guizhi Tang (Cinnamon Twig Decoction) whenever releasing exterior agents were used, indicating an intention to induce slight sweating rather than profuse sweating. He further stated: For warmth disease lasting two or three days, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) or Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) should be used to reach deep into the Kidney, leading out the external pathogen, thereby curing severe cases. This is Yu Jiayan’s subjective speculation, not Zhang Zhongjing’s original principles. Warmth pathogens cannot be cured by dispersal alone; even if exterior symptoms exist, can they be released with acrid-warm herbs? Moreover, Guizhi Tang is designed for Cold Damage exterior syndromes where the interior is harmonious. Warmth pathogens originate from the interior, and the exterior is not yet diseased; using Guizhi would merely assist the warmth pathogen and retain the disease qi. Furthermore, since warmth disease involves latent cold transforming into heat, and Shaoyin essence has already been depleted, using acrid-warm herbs and Aconite (Fuzi) severs the root and aids collapse. Even if one argues that Shaoyin has cold as its substance and heat as its manifestation, and that non-warm methods cannot disperse pathogens entering this domain, when warmth disease erupts, the cold has already turned to heat, and its tendency to emerge is naturally strong without needing guidance. Those who fail to emerge must have exhausted Yin essence; otherwise, how could there be those who do not emerge? Yu Jiayan forcibly cites scriptures to fit his own ideas, misleading himself and others, requiring clarification!
Yu Jiayan stated: “Winter injury by cold” is governed by the Taiyang Bladder meridian; “failure to store essence in winter” is governed by the Shaoyin Kidney meridian. This matches the case of Lianggan Cold Damage (Two-Fold Contraction of Cold), where Taiyang is affected on the first day and simultaneously involves Shaoyin, presenting with headache, dry mouth, irritability, thirst, and fullness, with no discrepancy. I hold that warmth disease involves the combination of old and new pathogens, but does not involve simultaneous exterior and interior contraction. Warmth disease arises from latent Qi; while Shaoyin possesses latent Qi, it is uncertain whether Taiyang can harbor latent Qi. If it cannot lie latent, the pathogen manifests immediately upon infection, constituting Cold Damage, not Warmth disease.
Yu Jiayan said: Shaoyin is a Yin organ with scant blood; thus, forcing sweat from Shaoyin may cause blood to flow from the ears, eyes, mouth, and nose in severe cases, leading to alarming collapse; in mild cases, it causes difficult urination and impending desiccation. Whenever I use Guizhi Tang, I always add Shengdi Huang (Rehmanniae Radix) to compensate for the insufficiency of Baishao (White Peony Root), and the efficacy is evident. This argument is excellent and slightly corrects previous errors. Since warmth disease onset injures Yin Qi first, if exterior resolution is required, it must be combined with herbs that nourish Yin and clear heat. Former sages added Tongbian (Child’s Urine) to Congchi Tang (Scallion and Fermented Soybean Decoction), and added Shengdi Huang and Maidong (Ophiopogonis Radix) to Zhichi Tang (Gardenia and Fermented Soybean Decoction), following this same principle.
He also said: Nowadays, people see symptoms of excessive heat causing irritability and dryness and dare not use Fuzi (Prepared Aconite Lateral Root), fearing it will aid heat with heat. Little do they know that in individuals failing to store essence, Kidney Yang fails to stir, preventing Jin Ye (Body Fluids) from ascending, resulting in external dryness. Upon using Fuzi to assist Yang, Yin Essence ascends to the Yang positions, like adding fire to the bottom of a pot, causing steam to rise and moisture to return instantly. These words contain profound truth, but applying them to warmth disease has drawbacks. Dryness caused by Yin stagnation differs vastly from dryness caused by Yin exhaustion; a misprescription leads to immediate death or life, so careful examination is essential!