我对于病证的理解，认为病是证的总称，证是病的表现，赦病包括证的大部表现在内，证则总是在病的范围内出现。但病有广义和狭义之分。如同一太阳病，而有中风、伤寒、温病、热病、湿病的名称。如《伤寒论》说：「太阳中风，啬啬恶寒，浙淅恶风，翕翕发热。」(12条)「或已发热，或未发热，必恶寒……名日伤寒。」(3条)「发热而渴，不恶寒者，为温病。」(6条)《金匮要略·痉湿喝病脉证治篇》说：「太阳中风者，喝是也，汗出恶寒，身热而渴。」湿家之为病，一身尽痛，发热，身色如熏黄也。」可见，所谓中风、伤寒、温病、热病、湿病，都有发热，这就要从其同异之间区另l了。如恶寒、中风、伤寒可见，热病也可见，湿家可能也见，惟温病则不恶寒。但中风的恶寒发热，伴有汗出，伤寒的恶寒发热，伴有无秆而喘}热病的恶寒发热，是汗出口渴；湿病的恶寒发热，是一身尽痛，或身色如熏黄。温病热病都渴，但热病是伴有身寒，温病是身不寒，还是可以区分一的。
又寒热虚实诸病，有但寒不热、但热不寒的；有表寒里热、表热里寒的有上寒下热、上热下寒的}有先寒后热、』先热后寒的；有寒多热少、热多寒少』的；有寒轻热重、热轻寒重的；有热寒往来、作止无．常的；有真寒假热、真热假寒的。都要作出适当分析。虚实也是这样，有形似虚而实实，形似实而实虚，所谓「大实如赢状，至虚有盛候。」即以真寒假热倒之，脉洪大是热，假热也有脉洪大，口渴是热，假热也有口渴。要在洪大中辨其有力是真，无力是假；无力中有时有力是真，有力中有时无力是假。口渴辨其饮多喜冷是真，饮多恶冷是假；喜热不多是假，喜冷不多也是假。
咳为肺病，一般病不及肺，是不会咳嗽的。故《素问·宣明五气篇》说「肺为咳」。如咳而无其它症状的，当然就是肺所为病；假如咳而胁痛，胁为肝位，即为肺病及肝，咳丽腰痛，腰为肾府，即为肺病及肾。反之，先胁痛而后咳的，为肝病传肺；先腰痛而后咳的，为肾病传肺。又肺病咳喘，肾病亦有喘咳。但先咳后喘，为肺病及肾，先喘后咳，为肾病及肺。
吐血与唾血有剐。唾血是唾中伴血属肺肾。吐_姐势如潮涌，胸满脉实的为热积肺胃；血色紫而面青脉．弦的为郁怒伤肝；血鲜而浓，喘咳烦热的为阴虚热扰；血鲜而淡，或如血丝，心烦准寐的为劳神伤心；血浊倦怠的为劳倦伤脾；血紫伴块，胸胁刺痛的为积瘀伤络；血淡无光，脉弱无力的为气虚失摄。
不寐病候，有所谓心肾不交的，一般伴有烦躁不安感。但烦不躁的，是心不下交于肾；但躁不烦的，是肾不上交于心。无烦躁感的，不属于心肾不交。
黄疸病候，大都是目黄、肤黄、尿黄、爪甲黄，同时或先后出现。单独目黄或肤黄及尿黄，不一定是黄疸}爪甲黄，是黄胆的独特症状。
胀满水肿，有先后轻重之别。胀比满为重，满比胀较轻，满是胀的初起，胀是满的加重；肿是胀的发展，胀满是肿的先河。
鼓胀非但与腹胀有别，即与其它胀病，也不一样。故如但胀不满，或但满不胀，即是胀病满病，不是鼓胀；既胀且满，亦是胀满病，不是鼓胀；胀满且_腹筋起的，乃是鼓胀病。
同病异治
《素问·异法方宜论》说：「一病而治各不同，皆愈，地势使然也……杂合以治，各得其所宜，故治所以异，而病皆愈者，得病之情，知治之大体也。」这是说，地有东西南北之殊，气有寒热温凉之异，人有老少强弱之分，生活环境不同，病邪感受当然刁：是一样，调治方法也宜有所区别，此即一般所谓因人、因时、因地三因说法，也就是所谓杂合以治，各得其宜的方法，是有其一定启示作用的。记得有一次一位老师问我；《素问·异法方宜论》一病而治各不同，是问同病异治的方法，而所答都是异病异治的方法，该如何理解?我说；以前在课堂讲授时是这样说的，此是古人「以宾形主，借宾定主」常用的章法。本篇首尾两段是主文，中间五小段是宾位。所以，但从文字的表面痈疡治宜砭石，挛痹治宜微针讲，是象异病异治。如由从字、来字、杂合字寻求，岂不是可以说。痈疡在砭石外，可以毒药，挛痹在微针外，可以灸燕及导引按牖多种方法。不然的话，从讲什么，来讲什么呢?从与来，即是为下文杂合而讲的，否则无所谓杂、无所谓合了。所以有些内科病累治不效，。而易以针灸，则很快显效，』就是这个道理。《素问》中类似此等文章，不是就此一篇。如「平人气象论」论平脉的文字少于病脉死脉，「刺志论」论虚实文字多于针刺等，同是这样的笔法。《金匮要略》百合病发汗吐下后与未经发汗吐下各异其治，亦是过个意思。再如「妇人妊娠病脉证并治」说：「妇人……假令腹中痛为胞阻，胶艾汤主之。「『妇人怀娠、腹中疗痛，当归芍药散主之。叫妇人杂病脉证治篇」说：「妇人腹中痛，小建中汤主之。●忆一九四一年，沈友三夫人妊娠腹中痛，调气和血，多方无效。枷投当归芍药散，痛不解,继以小建中汤，痛如故,后以胶艾汤，应手而愈。于此知妇人妊娠，腹中绞痛，或一般性的腹中痛，则宜当归芍药散或小建中汤，非胶艾汤可得而愈。如妇人妊娠腹中痛，为胞阻的，则宜胶艾汤主之，亦非当归芍药散或小建中汤所可得而愈的。古人成方，有其传统累验，是要学习再学习的。
异稿同治
异病同治之说，《伤寒论》有之，《金匮要略》亦有之。如《伤寒论》说：「病人藏无他病，时发热自汗出而不愈者，此卫气不和也，先其时发汗则愈，宜桂枝汤。」(54条)叉说；「吐利止而身痛不休者，当消息和解其外，宜桂枝汤小和之。」(386条)两条病证不同，而前则日；此卫气不和也}后则日：当消息和解其外。外即卫也，是同为卫气不和则一，故可同用桂枝汤和卫。此即所谓异途同归，二而一者也。再如《金硅要略》虚劳腰痛，痰饮短气，小便不利，消渴小便反多，以及转胞不得屎。不问小便剎与不利，或反多及不得尿，而其病因由于肾气不力、失约失化则一，亦同用肾气丸主之。《易系辞》说：「引而伸之，触类丽长之，则天下之能事毕矣。」忆曾治一女经闭，是为气血虚闭，采用十全太补汤，三剂而经潮。后治一女经水漏下，淋漓不断，是为气衄虚而失摄，证虽不同，虚则一也，亦以十全大补汤而愈。又治一女尿血，仿吐血衄血属热用泻心汤法，认为此女尿血亦属热伤，亦用泻心汤，很快得效。再治一臂痛，难以屈伸抬举，药后效果不显。我想《伤寒论》项背强几儿，《金匮要略》口噤不得语，都是用葛根汤，困为都是属于经输不利，葛根为治经输不利药。这个病人，臂难屈伸抬举，亦是经输不利，即于原方中重加葛根投之，果然效如影响。后来叉引伸到「时发热自汗出而不愈者」，「先其时发汗则愈」，在这两个「时」字、「愈」字上动脑筋，凡遇胃痛腹痛等属于有时间性的病证，亦告知其先时服药，同样效果很好。于此知《伤寒论》真是一部经验丰富，取之不尽，用之不竭的好书。
通常达变
病有寒热虚实，药有补泻凉温。寒者热之，热者寒之，虚者补之，实者泻之，劳者温之，逸者行之，内者内治，外者外治，此大法也。但人事万有不齐，所谓寒热虚实，又很少单纯出现，而有合并为病，错综复杂情况的。就是虚而宜补，也有形不足者，温之以气，精不足者，补之以味的不同，实而宜泻，复有攻表墩里、酸气破血、导痰涤饮、消坚逐水的各异。以药品言；人参、黄芪之补，一不等于阿胶、地黄之补；大黄、芒硝之泻，不等于甘遂、大戟之泻,附子、细辛之热，不等于干姜、肉桂之热；黄连、栀子之寒，不等于石膏、知母之寒。抑且人有老少强弱不同，生活条件悬殊，养尊处优之徒，不等于栉风洙雨之人，其间相去不可以道里计，不能干篇一律。故医必博采众方，灵活变通，而后可以左右逢源，各得其宜。还有一些病人，并非不治之症，不过比较略为复杂，往往跑遍各大医院，经过很多医者看过，寒热补泻，统通用过，就是病不能解。这类病人，为数不少，医者经常可以碰到。有一次，我碰到一个病人。处方刚完，病者即说：这些药品过去吃过。意思是说，不能治愈其病的。对这等病人，不做说服工作，就是方药对症，也是无有多大作用的。因之就说。医者处方是依据病的情况而定。这些药品，我也知道你是大部或全部吃过，同时也知道你是有这种看法的。但你只看到相同的一面，未有看到不同的一面，所以你的病证，迄今未有看好。现在我可这样说。某几种药你在某一方内吃过的；某几种药，又在同一方内，我可知你未有吃过。即使曾经吃过，药量一定不是一样的，如果一样，那就不是医师处方，而是医书的印抄方了。要之，此中同中之异，是同门异户，毫厘千里，这是方药的关键所在，也是方药有效无效的区别所在。此类例子很多，如《伤寒论》的桂枝去芍药加附子汤和桂枝附子汤、与桂枝麻黄各半汤和桂枝二麻黄一汤，就是因药同而份量不同，而治各异宜的。所以医者治病，当然要有责任心，而病人亦当具有信仰心。《素问·汤液醪醴论》说「病为本，工为标。标本不得，邪气不服。」《素问·移精变气论》说：「标本已得，邪气乃服。」就是这个道理。
以上肤浅体会，揭开天窗说亮话：「智者千虑，必有一失，愚者千虑，必有一得」。各人看法不同，大家取长补短，共同进步，更好地为四化建设出力。
(吴莲芳吴承玉整理)
精研潭思老而弥笃
上海中医学院教授张伯臾
【作者简介】张伯臾(1901～)，上海川沙县人。一九二三年毕业于上海中医专门学校，后又在丁甘仁先生门下学习一年，深受教益。一九二四年返乡行医，一九三七年又在沪悬壶。一九五六年应聘到上海第十一人民医院(后改为上海中医学院附属曙光医院)，从事中医内科和教学工作。中医临床前后凡六十年，长于内科杂病，辨证细致，分析精当，疗效卓著，深得病家信仰。撰有《张伯臾医案》，《中医中药治疗急性心肌梗塞的经验》等。
我幼年在农村中度过。当时农村哀鸿遍野，疫病流行，农民染病之后，常无力求医，倒毙者不可胜数。这对我童年的心灵触动很大。
记得当时孟河名医丁甘仁先生在上海创办了中医专门学校，名噪大江南北，它是许多有志于岐黄之术青年的响往之所，我也是其中一个。经过努力，终于在十八岁那年考入了该校，成为该校第三届学生中的一员。
入学后，同窗学友多有聪慧敏捷者，而我自知性较钝缓，故加倍努力，以勤补拙，终于获得较为优异的成绩，于一九二三年毕业。旋又师事丁甘仁先生，得蒙深造，获益良多。一年后，返乡梓行医。一九三七年「八·一三』抗日战争爆发，兵燹延及浦东，全家移居市区，设门诊所于当时的「中医疗养院」。解放后，应聘到上海第十一人民医院(后改为上海中医学院附属曙光医院)，从事中医内科临床及教学工作。十年内乱期间，虽身遭迫害，犹潜心医业。粉碎「四人帮」后，我虽已年届耄耋，但党和人民仍然绐了我「中医教授」及「上海市科学大会先进个人」的光荣称号，这对我来说是且感且愧的。在有生之年中，除了加倍努力，做好工作，以报答党和人民的恩情之外，其余一切皆无所萦怀。下面就自己在学习过程中的点滴体会，简要陈述于下，或与年青一代有所裨益。
治学尚实不拘门户
中医治学之道，以《内经》、《伤寒杂病论》为基础，但同时叉必须撷采众长，这样才能增进学识，提高医术。然而，中医书籍中有不少门户之见，故阅读医书，不能盲从，不能不加思索地兼收并蓄，重要的在于认真地进行临床验证，方能学得真谛。例如，徐灵胎弹注的《临}正指南医案》，是我一生爱凄的书。叶、徐两家均是一代名医，但在学术见解上，常有相佐之处。如《临汪指南医案》的吐血门中，叶氏常用麦冬、五昧子、玉竹、沙参等品。徐灵胎持不同意见，认为：「吐血咳嗽乃肺家痰火盘踞之病，岂宜峻补」；「今吐血之嗽，火邪入肺，痰凝血涌，惟恐其不散不降，乃反欲其痰火收住肺中，不放一毫出路，是何法吐王!」对此两说，在我始学之时，确有莫衷一是之感。为释疑团，我在临床中留心十余年，始有所悟，遂作批语如下：「徐叶两家之言，似乎背道，实乃相辅而不悖。吐血咳嗽而痰火恋肺者，麦冬、五味之属，当在禁用之列，以免助纣。然临证中，所遇肺阴已伤，舌红绛，脉细数而咳嵌吐血者不少。以阴虚为重，沙参、麦冬、玉竹等药，均属对症佳品，岂能废用?徒持苦寒，反伤胃气，非其治也。故徐、叶之说，未可偏废，须相机而用，取效临床。仲景有麦门冬汤，麦冬半夏同伍，补阴而不窒腻，遣方之妙，诚可取法。」可见，大凡治学，不能轻率随和一家之言，总应潜心研讨，方能融为已见。
贯通「寒」「温」论治热病
我对病与证的理解是：病是证的总称，证是病的具体表现。因此，病包含了证的大部分表现，而证总是在病的范围内出现。但是，病有广义和狭义之分。例如同样是太阳病，却有中风、伤寒、温病、热病、湿病等不同名称。如《伤寒论》中说：“太阳中风，表现为怕冷瑟瑟，怕风淅淅，发热翕翕。”（第12条）“或者已经发热，或者尚未发热，必定恶寒……这叫作伤寒。”（第3条）“发热且口渴，不恶寒的，称为温病。”（第6条）《金匮要略·痉湿暍病脉证治篇》中说：“太阳中风，就是暍病，汗出恶寒，身热而渴。”湿病患者发病时，全身疼痛，发热，身体颜色像被烟熏过的黄色。”由此可见，所谓中风、伤寒、温病、热病、湿病，都有发热的症状，这就需要从它们的相同与不同之处加以区分。例如恶寒，在中风、伤寒中可见，热病也可能见到，湿病也可能见到，唯独温病不恶寒。但是中风的恶寒发热，伴有出汗；伤寒的恶寒发热，伴有无汗而喘；热病的恶寒发热，是出汗且口渴；湿病的恶寒发热，是全身疼痛，或者身体颜色像烟熏黄。温病和热病都会口渴，但热病伴有身体发冷，温病身体不发冷，这样还是可以区分的。
另外，寒热虚实各类疾病，有只寒不热、只热不寒的；有表寒里热、表热里寒的；有上寒下热、上热下寒的；有先寒后热、先热后寒的；有寒多热少、热多寒少的；有寒轻热重、热轻寒重的；有寒热往来、发作停止无常的；有真寒假热、真热假寒的。都需要做出适当的分析。虚实也是这样，有形似虚而实质实，形似实而实质虚的，所谓“大实如羸状，至虚有盛候”。以真寒假热为例，脉象洪大看似热证，假热证也有脉象洪大；口渴看似热证，假热证也有口渴。关键在于在洪大中辨别有力是真热，无力是假热；在无力中有时有力是真，有力中有时无力是假。对于口渴，辨别饮水多且喜冷饮为真热，饮水多且厌恶冷饮为假热；喜热饮但不多的是假热，喜冷饮但不多的也是假热。
咳嗽属于肺病，一般疾病如果不涉及肺，是不会引起咳嗽的。所以《素问·宣明五气篇》说“肺主咳”。如果只有咳嗽而没有其他症状，那当然是肺引起的病变；假如咳嗽伴随胁痛，胁部是肝的部位，这就是肺病波及肝；咳嗽伴随腰痛，腰部是肾的府邸，这就是肺病波及肾。反之，先胁痛而后咳嗽的，是肝病传肺；先腰痛而后咳嗽的，是肾病传肺。另外，肺病会引起咳喘，肾病也会有喘咳。但先咳嗽后气喘的，是肺病及肾；先气喘后咳嗽的，是肾病及肺。
吐血与唾血是有区别的。唾血是唾液中带血，属于肺肾范畴。吐血势如潮涌，胸满脉实的，是热邪积聚于肺胃；血色紫暗且面色青、脉弦的，是郁怒伤肝；血色鲜红而浓稠，伴喘咳烦热的，是阴虚热扰；血色鲜红而淡，或如血丝，心烦失眠的，是劳神伤心；血液浑浊倦怠的，是劳倦伤脾；血色紫暗伴血块，胸胁刺痛的，是积瘀伤络；血色淡而无光，脉弱无力的，是气虚失摄。
不寐（失眠）的病候中，有所谓心肾不交的，一般伴有烦躁不安的感觉。但如果只是心烦而不躁动，是心火不能下交于肾；如果只是躁动而不心烦，是肾水不能上交于心。如果没有烦躁感觉的，就不属于心肾不交。
黄疸病的病候，大多是目黄、肤黄、尿黄、爪甲黄，同时或先后出现。单独目黄或肤黄及尿黄，不一定是黄疸；爪甲黄，是黄疸的独特症状。
胀满和水肿，有先后轻重之别。胀比满严重，满比胀轻微，满是胀的初起阶段，胀是满的加重；肿是胀的发展，胀满是肿的先导。
鼓胀不仅与腹胀有别，与其他胀病也不一样。所以如果只胀不满，或只满不胀，即是胀病或满病，不是鼓胀；既胀且满，也是胀满病，不是鼓胀；胀满且腹部筋脉显露的，才是鼓胀病。
同病异治
《素问·异法方宜论》说：“一种病而治疗方法各不相同，都治愈了，这是地势造成的……综合各种方法治疗，各得其适宜，所以治疗方法不同，而病都能治愈，是因为掌握了病情，了解了治疗的总体原则。”这是说，地域有东西南北的差异，气候有寒热温凉的不同，人有老少强弱的区别，生活环境不同，感受的病邪自然不一样，调治方法也应当有所区别，这就是一般所说的因人、因时、因地制宜的三因说法，也就是所谓杂合以治、各得其宜的方法，这有一定的启示作用。记得有一次一位老师问我：《素问·异法方宜论》中提到的“一病而治各不同”，问的是同病异治的方法，而回答的都是异病异治的方法，该如何理解？我说：以前在课堂上讲授时是这样说的，这是古人常用的“以宾形主，借宾定主”的章法。本篇首尾两段是主文，中间五小段是宾位。所以，仅从文字表面看，痈疡治宜砭石，挛痹治宜微针，像是异病异治。但如果从字、来字、杂合字去寻求，难道不可以说吗？痈疡除了用砭石外，还可以用药毒（药物），挛痹除了用微针外，还可以用艾灸及导引按摩等多种方法。不然的话，从讲什么，来讲什么呢？“从”与“来”，即为下文“杂合”而讲的，否则无所谓杂、无所谓合了。所以有些内科病久治不效，改用针灸，则很快显效，就是这个道理。《素问》中类似这样的文章，不止这一篇。如“平人气象论”中论平脉的文字少于病脉死脉，“刺志论”中论虚实的文字多于针刺等，都是同样的笔法。《金匮要略》中百合病在发汗吐下后与未经发汗吐下治疗各异其治，也是这个意思。再如“妇人妊娠病脉证并治”说：“妇人……假如腹中痛为胞阻，用胶艾汤主治。”“妇人怀娠，腹中绞痛，用当归芍药散主治。”“妇人杂病脉证治篇”说：“妇人腹中痛，用小建中汤主治。”回忆一九四一年，沈友三夫人妊娠腹中痛，调和气血，多方无效。初次投予当归芍药散，痛不解，继以小建中汤，痛如故，后用胶艾汤，应手而愈。由此可知，妇人妊娠，腹中绞痛，或一般性的腹中痛，则宜用当归芍药散或小建中汤，非胶艾汤可得而愈。如妇人妊娠腹中痛，诊断为胞阻的，则宜用胶艾汤主治，亦非当归芍药散或小建中汤可得而愈的。古人的成方，有其传统经验，是要反复学习再学习的。
异病同治
异病同治的说法，《伤寒论》中有，《金匮要略》中也有。如《伤寒论》说：“病人脏腑没有其它病，时常发热自汗出而不愈的，这是卫气不和，在其发热之前发汗则愈，宜用桂枝汤。”（第54条）又说：“吐利止而身痛不休者，应当斟酌和解其表，宜用桂枝汤小和之。”（第386条）两条病证不同，而前则曰：这是卫气不和；后则曰：应当和解其表。表即卫也，同为卫气不和，所以可同用桂枝汤调和卫气。此即所谓异途同归，二而一者也。再如《金匮要略》中虚劳腰痛，痰饮短气，小便不利，消渴小便反多，以及转胞不得尿。不问小便通利与否，或反多及不得尿，而其病因由于肾气无力、失约失化则一，亦同用肾气丸主治。《易系辞》说：“引申它，触类旁通地推广它，那么天下的能事就完备了。”曾治一女经闭，是为气血虚闭，采用十全大补汤，三剂而月经来潮。后治一女经水漏下，淋漓不断，是为气虚而失摄，证虽不同，虚则一也，亦以十全大补汤而愈。又治一女尿血，仿照吐血衄血属热用泻心汤法，认为此女尿血亦属热伤，亦用泻心汤，很快得效。再治一臂痛，难以屈伸抬举，药后效果不显。我想《伤寒论》项背强几几，《金匮要略》口噤不得语，都是用葛根汤，因为都是属于经输不利，葛根为治经输不利的药。这个病人，臂难屈伸抬举，亦是经输不利，即在原方中重加葛根投之，果然效如桴鼓。后来又引申到“时发热自汗出而不愈者”，“先其时发汗则愈”，在这两个“时”字、“愈”字上动脑筋，凡遇胃痛腹痛等属于有时间性的病证，也告知其先时服药，同样效果很好。由此可知《伤寒论》真是一部经验丰富，取之不尽，用之不竭的好书。
通常达变
病有寒热虚实，药有补泻凉温。寒者热之，热者寒之，虚者补之，实者泻之，劳者温之，逸者行之，内者内治，外者外治，这是大法。但人事万有不齐，所谓寒热虚实，又很少单纯出现，而有合并为病，错综复杂情况的。就是虚而宜补，也有形不足者，温之以气，精不足者，补之以味的不同；实而宜泻，复有攻表攻里、破气破血、导痰涤饮、消坚逐水的各异。以药品言：人参、黄芪之补，不等于阿胶、地黄之补；大黄、芒硝之泻，不等于甘遂、大戟之泻；附子、细辛之热，不等于干姜、肉桂之热；黄连、栀子之寒，不等于石膏、知母之寒。况且人有老少强弱不同，生活条件悬殊，养尊处优之徒，不等于栉风沐雨之人，其间相去不可以道里计，不能千篇一律。故医者必须博采众方，灵活变通，而后可以左右逢源，各得其宜。还有一些病人，并非不治之症，不过比较略微复杂，往往跑遍各大医院，经过很多医者看过，寒热补泻，统统都用过，就是病不能解。这类病人，为数不少，医者经常可以碰到。有一次，我碰到一个病人。处方刚完，病者即说：这些药品过去吃过。意思是说，不能治愈其病的。对这等病人，不做说服工作，就是方药对症，也是无有多大作用的。因而就说：医者处方是依据病的情况而定。这些药品，我也知道你是大部或全部吃过，同时也知道你是有这种看法的。但你只看到相同的一面，未看到不同的一面，所以你的病证，迄今未有看好。现在我可这样说。某几种药你在某一方内吃过的；某几种药，又在同一方内，我可知你未有吃过。即使曾经吃过，药量一定不是一样的，如果一样，那就不是医师处方，而是医书的印抄方了。总之，此中同中之异，是同门异户，毫厘千里，这是方药的关键所在，也是方药有效无效的区别所在。此类例子很多，如《伤寒论》的桂枝去芍药加附子汤和桂枝附子汤、与桂枝麻黄各半汤和桂枝二麻黄一汤，就是因药同而份量不同，而治各异宜的。所以医者治病，当然要有责任心，而病人亦当具有信仰心。《素问·汤液醪醴论》说“病为本，工为标。标本不得，邪气不服。”《素问·移精变气论》说：“标本已得，邪气乃服。”就是这个道理。
以上肤浅体会，揭开天窗说亮话：“智者千虑，必有一失，愚者千虑，必有一得”。各人看法不同，大家取长补短，共同进步，更好地为四化建设出力。
(吴莲芳 吴承玉整理)
精研覃思老而弥笃
上海中医学院教授张伯臾
【作者简介】张伯臾(1901～)，上海川沙县人。一九二三年毕业于上海中医专门学校，后又在丁甘仁先生门下学习一年，深受教益。一九二四年返乡行医，一九三七年又在沪悬壶。一九五六年应聘到上海第十一人民医院(后改为上海中医学院附属曙光医院)，从事中医内科和教学工作。中医临床前后凡六十年，长于内科杂病，辨证细致，分析精当，疗效卓著，深得病家信仰。撰有《张伯臾医案》，《中医中药治疗急性心肌梗塞的经验》等。
我幼年在农村中度过。当时农村哀鸿遍野，疫病流行，农民染病之后，常无力求医，倒毙者不可胜数。这对我童年的心灵触动很大。
记得当时孟河名医丁甘仁先生在上海创办了中医专门学校，名噪大江南北，它是许多有志于岐黄之术青年的向往之所，我也是其中一个。经过努力，终于在十八岁那年考入了该校，成为该校第三届学生中的一员。
入学后，同窗学友多有聪慧敏捷者，而我自知性较钝缓，故加倍努力，以勤补拙，终于获得较为优异的成绩，于一九二三年毕业。旋又师事丁甘仁先生，得蒙深造，获益良多。一年后，返乡梓行医。一九三七年“八·一三”抗日战争爆发，兵燹延及浦东，全家移居市区，设门诊所于当时的“中医疗养院”。解放后，应聘到上海第十一人民医院(后改为上海中医学院附属曙光医院)，从事中医内科临床及教学工作。十年内乱期间，虽身遭迫害，犹潜心医业。粉碎“四人帮”后，我虽已年届耄耋，但党和人民仍然给了我“中医教授”及“上海市科学大会先进个人”的光荣称号，这对我来说是且感且愧的。在有生之年中，除了加倍努力，做好工作，以报答党和人民的恩情之外，其余一切皆无所萦怀。下面就自己在学习过程中的点滴体会，简要陈述于下，或与年青一代有所裨益。
治学尚实不拘门户
中医治学之道，以《内经》、《伤寒杂病论》为基础，但同时还必须撷采众长，这样才能增进学识，提高医术。然而，中医书籍中有不少门户之见，故阅读医书，不能盲从，不能不加思索地兼收并蓄，重要的在于认真地进行临床验证，方能学得真谛。例如，徐灵胎评注的《临证指南医案》，是我一生喜爱的书。叶、徐两家均是一代名医，但在学术见解上，常有相佐之处。如《临证指南医案》的吐血门中，叶氏常用麦冬、五味子、玉竹、沙参等品。徐灵胎持不同意见，认为：“吐血咳嗽乃肺家痰火盘踞之病，岂宜峻补”；“今吐血之嗽，火邪入肺，痰凝血涌，惟恐其不散不降，乃反欲其痰火收住肺中，不放一毫出路，是何法吐王！”对此两说，在我始学之时，确有莫衷一是之感。为释疑团，我在临床中留心十余年，始有所悟，遂作批语如下：“徐叶两家之言，似乎背道，实乃相辅而不悖。吐血咳嗽而痰火恋肺者，麦冬、五味之属，当在禁用之列，以免助纣。然临证中，所遇肺阴已伤，舌红绛，脉细数而咳逆吐血者不少。以阴虚为重，沙参、麦冬、玉竹等药，均属对症佳品，岂能废用？徒持苦寒，反伤胃气，非其治也。故徐、叶之说，未可偏废，须相机而用，取效临床。仲景有麦门冬汤，麦冬半夏同伍，补阴而不窒腻，遣方之妙，诚可取法。”可见，大凡治学，不能轻率随和一家之言，总应潜心研讨，方能融为己见。
贯通“寒”“温”论治热病
My understanding of disease and syndrome is that "disease" (Bing) is the general term for syndromes, while "syndrome" (Zheng) is the manifestation of the disease. Therefore, a disease encompasses most manifestations of its syndromes, and a syndrome always appears within the scope of a disease. However, diseases can be classified into broad and narrow senses. For instance, the same Taiyang Disease (Taiyang Jing Shou Xie Suo Zhi De Bing Zheng, a disease pattern caused by pathogenic factors affecting the Taiyang meridian) may have different names such as Wind Strike (Feng Zhong), Cold Damage (Shang Han), Warm Disease (Wen Bing), Heat Disease (Re Bing), or Dampness Disease (Shi Bing). As stated in *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): "In Taiyang Wind Strike, there is aversion to cold with shivering, aversion to wind with chilliness, and fever with heat." (Clause 12) "Whether fever has already occurred or not, there must be aversion to cold... this is called Cold Damage." (Clause 3) "Fever accompanied by thirst and without aversion to cold is called Warm Disease." (Clause 6) In the chapter "Pulse, Syndrome, and Treatment of Spasm, Dampness, and Sunstroke Diseases" from *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), it is said: "Taiyang Wind Strike refers to Sunstroke (Ye), characterized by sweating, aversion to cold, body heat, and thirst." For patients with dampness, the disease manifests as whole-body pain, fever, and a body color resembling smoked yellow. Thus, Wind Strike, Cold Damage, Warm Disease, Heat Disease, and Dampness Disease all involve fever; differentiation must be made based on their similarities and differences. For example, aversion to cold is seen in Wind Strike and Cold Damage, possibly in Heat Disease and Dampness Disease, but not in Warm Disease. However, Wind Strike's aversion to cold and fever are accompanied by sweating; Cold Damage's aversion to cold and fever are accompanied by anhidrosis and wheezing; Heat Disease's aversion to cold and fever involve sweating and thirst; Dampness Disease's aversion to cold and fever involve whole-body pain or a body color like smoked yellow. Both Warm Disease and Heat Disease involve thirst, but Heat Disease is accompanied by cold limbs, whereas Warm Disease is not, allowing for distinction.
Furthermore, among diseases of Cold, Heat, Deficiency, and Excess, some present with only cold without heat, or only heat without cold; some have exterior cold and interior heat, or exterior heat and interior cold; some have upper cold and lower heat, or upper heat and lower cold; some progress from cold to heat, or from heat to cold; some have more cold than heat, or more heat than cold; some have mild cold and severe heat, or mild heat and severe cold; some feature alternating cold and heat with irregular onset and cessation; some exhibit true cold with false heat, or true heat with false cold. All require appropriate analysis. The same applies to Deficiency and Excess: there are cases that appear deficient but are actually excess, or appear excess but are actually deficient, as described: "Great excess resembles emaciation, extreme deficiency presents with vigorous symptoms." Taking true cold with false heat as an example, a surging pulse suggests heat, but false heat also presents with a surging pulse; thirst suggests heat, but false heat also involves thirst. The key lies in distinguishing strength: a surging pulse that is forceful indicates true heat, while one that is weak indicates false heat; weakness that occasionally becomes forceful indicates truth, while forcefulness that occasionally becomes weak indicates falsehood. Regarding thirst, drinking much and preferring cold drinks indicates true heat, while drinking much and disliking cold drinks indicates false heat; preferring hot drinks but drinking little is false, and preferring cold drinks but drinking little is also false.
Cough belongs to Lung diseases; generally, if a disease does not affect the Lung, cough will not occur. Thus, *Suwen: Xuanming Wuqi Pian* states, "The Lung governs cough." If cough occurs without other symptoms, it is naturally due to the Lung. If cough is accompanied by hypochondriac pain, since the hypochondrium is the domain of the Liver, this indicates Lung disease affecting the Liver. If cough is accompanied by lower back pain, since the lower back is the mansion of the Kidney, this indicates Lung disease affecting the Kidney. Conversely, hypochondriac pain preceding cough indicates Liver disease transmitting to the Lung; lower back pain preceding cough indicates Kidney disease transmitting to the Lung. Additionally, Lung disease causes cough and wheezing, and Kidney disease also causes wheezing and cough. However, cough preceding wheezing indicates Lung disease affecting the Kidney, while wheezing preceding cough indicates Kidney disease affecting the Lung.
Hematemesis (vomiting blood) differs from hemoptysis in saliva (spitting blood). Spitting blood mixed with saliva belongs to the Lung and Kidney. Hematemesis gushing like a tide, with chest fullness and a forceful pulse, indicates heat accumulation in the Lung and Stomach; purple blood with a cyan face and wiry pulse indicates liver qi stagnation due to anger; bright red and thick blood with wheezing, cough, irritability, and heat indicates yin deficiency with heat disturbance; bright red but pale blood or thread-like streaks with irritability and insomnia indicate heart spirit damage from overwork; turbid blood with fatigue indicates spleen damage from laborious toil; purple blood with clots and stabbing pain in the chest and hypochondrium indicates stasis damaging collaterals; pale, lusterless blood with a weak and forceless pulse indicates qi deficiency failing to contain blood.
Insomnia (Bu Mei) patterns include Heart-Kidney Non-Interaction, generally accompanied by irritability and restlessness. If there is irritability without restlessness, it is because Heart fire fails to descend to the Kidney; if there is restlessness without irritability, it is because Kidney water fails to ascend to the Heart. Without irritability or restlessness, it does not belong to Heart-Kidney Non-Interaction.
Jaundice patterns typically present with yellow eyes, yellow skin, yellow urine, and yellow nails, appearing simultaneously or sequentially. Isolated yellow eyes, skin, or urine do not necessarily indicate jaundice; yellow nails are a unique symptom of jaundice.
Distension and fullness, and edema, differ in sequence and severity. Distension is more severe than fullness, and fullness is milder than distension; fullness is the initial stage of distension, and distension is the aggravation of fullness; edema is the development of distension, and distension/fullness is the precursor to edema.
Drum distension (Gu Zhang) differs not only from abdominal distension but also from other distension diseases. Therefore, if there is distension without fullness, or fullness without distension, it is a distension or fullness disease, not drum distension; if both distension and fullness are present, it is still a distension/fullness disease, not drum distension; only when distension and fullness are accompanied by visible abdominal veins is it drum distension.
Treating the Same Disease Differently
*Suwen: Yifang Fangyi Lun* states: "One disease treated differently, yet all cured, is due to geographical terrain... Combining various treatments, each suited to its appropriateness, thus treatments differ but diseases are cured, because the condition of the disease is understood, and the general principles of treatment are known." This means that regions vary east to west, north to south; climates differ in cold, heat, warmth, and coolness; people vary in age, constitution, and strength. Different living environments lead to different pathogenic influences, necessitating differentiated treatment methods. This is the general principle of treating according to the person, time, and place (San Yin), also known as combining treatments appropriately, which offers certain inspiration. I recall a teacher asking me: In *Suwen: Yifang Fangyi Lun*, "treating one disease differently" asks about treating the same disease differently, but the answers describe treating different diseases differently. How should this be understood? I replied: In previous lectures, this was explained using the ancient rhetorical device of "using the accessory to shape the principal, borrowing the accessory to define the principal." The first and last paragraphs are the main text, while the five middle paragraphs are the accessory. Thus, superficially, treating carbuncles with stone knives and spasms with fine needles seems like treating different diseases differently. However, seeking meaning in words like "from," "come," and "combine," could we not say that for carbuncles, besides stone knives, drugs can be used; for spasms, besides fine needles, moxibustion, qigong, and massage can be used? Otherwise, what is being discussed? "From" and "come" prepare for the subsequent discussion of "combining"; otherwise, there is no combination. Hence, some internal medicine cases unresponsive to prolonged treatment respond quickly to acupuncture and moxibustion, which is the reason. Similar articles in *Suwen* are not limited to this one. For example, in "Pingren Qixiang Lun," descriptions of normal pulses are fewer than pathological or fatal pulses; in "Cizhi Lun," discussions on deficiency and excess exceed those on needle insertion. These employ the same writing style. *Jingui Yaolue* states that Baihe Disease is treated differently after sweating, vomiting, purging, or downward-draining compared to before these interventions, conveying the same meaning. Furthermore, "Furen Renbing Maizheng Bingzhi" states: "Women... if abdominal pain is due to Baozu (womb obstruction), Jiao Ai Tang (Collodion and Mume Decoction) is the primary formula." "If a pregnant woman suffers from colicky abdominal pain, Danggui Shaoyao San (Angelica Sinensis and Peony Powder) is the primary formula." The chapter "Furen Zabing Maizheng Zhi" states: "For women with abdominal pain, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is the primary formula." Recalling 1941, Mrs. Shen Yousan suffered from abdominal pain during pregnancy. After multiple ineffective attempts at harmonizing qi and nourishing blood, Danggui Shaoyao San was administered first, but pain persisted. Then Xiaojianzhong Tang was given, with no relief. Finally, Jiao Ai Tang was used, resulting in immediate cure. From this, we learn that for pregnant women with colicky or general abdominal pain, Danggui Shaoyao San or Xiaojianzhong Tang is appropriate, and Jiao Ai Tang would not suffice. However, if the diagnosis is Baozu, Jiao Ai Tang is indicated, and neither Danggui Shaoyao San nor Xiaojianzhong Tang would be effective. Ancient established formulas possess traditional efficacy and require repeated study.
Treating Different Diseases Similarly
The concept of treating different diseases similarly exists in *Shanghan Lun* and *Jingui Yaolue*. For instance, *Shanghan Lun* states: "When a patient has no internal organ pathology but experiences recurrent fever and spontaneous sweating without resolution, this is disharmony of Wei Qi. Sweating before the fever occurs will resolve it; Guizhi Tang (Cinnamon Twig Decoction) is suitable." (Clause 54) It also states: "After vomiting and diarrhea cease, if body pain persists, one should cautiously harmonize the exterior; Guizhi Tang (Cinnamon Twig Decoction) in a small dose is suitable." (Clause 386) Although the two conditions differ, the former attributes it to Wei Qi disharmony, and the latter advises harmonizing the exterior (which is Wei Qi). Since both involve Wei Qi disharmony, Guizhi Tang (Cinnamon Twig Decoction) can be used to harmonize Wei Qi in both cases. This is the so-called "different paths leading to the same destination, two aspects of one reality." Similarly, in *Jingui Yaolue*, Xu Lao (Deficiency Consumption) lower back pain, Tan Yin (Phlegm-Fluid) shortness of breath, difficult urination, Xiao Ke (Wasting-Thirst) with excessive urination, and Zhuan Bao (Displaced Bladder) inability to urinate—regardless of whether urination is obstructed, excessive, or absent—the etiology is consistently Kidney Qi insufficiency and failure of regulation and transformation. Thus, Shengji Wan (Kidney Qi Pill) is used for all. *Yijing Xi Ci* states: "Extend it, categorize and expand upon it, then the affairs of the world are complete." I once treated a female patient with amenorrhea due to qi and blood deficiency using Shiquan Dabu Tang (Ten Great Tonifying Decoction), resulting in menstruation after three doses. Later, I treated another female patient with metrorrhagia (irregular uterine bleeding) due to qi deficiency failing to control blood. Although the syndromes differed, the underlying deficiency was the same, and she was cured with Shiquan Dabu Tang (Ten Great Tonifying Decoction). I also treated a female patient with hematuria, imitating the method for hematemesis and epistaxis attributed to heat using Xixin Tang (Gentian Decoction), believing her hematuria was also due to heat injury, and she responded quickly. Another case involved arm pain with difficulty in flexion, extension, and elevation, showing poor response to medication. Considering that *Shanghan Lun* describes stiff neck and back treated with Gegen Tang (Kudzu Decoction), and *Jingui Yaolue* describes trismus treated with Gegen Tang (Kudzu Decoction), both due to channel and collateral dysfunction, where Gegen (Kudzu Root) treats such dysfunction, I reasoned this patient's arm limitation was also channel/collateral dysfunction. I heavily increased the dosage of Gegen (Kudzu Root) in the original formula, resulting in immediate efficacy. I later extended this reasoning to "recurrent fever and spontaneous sweating" and "sweating before fever resolves," focusing on the characters "time" and "resolve." For gastric or abdominal pains with specific timing, advising medication prior to onset yielded good results. This confirms *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) as a book of inexhaustible experience.
Adapting General Principles to Specific Changes
Diseases involve cold, heat, deficiency, and excess; medicines involve tonification, purgation, cooling, and warming. Cold is treated with heat, heat with cold, deficiency with tonification, excess with purgation, exhaustion with warming, lethargy with movement, internal diseases with internal treatment, external diseases with external treatment—these are general principles. However, human circumstances vary greatly. Cold, heat, deficiency, and excess rarely appear purely; they often combine, creating complex situations. Even tonification for deficiency varies: for form insufficiency, warm with qi; for essence insufficiency, tonify with flavor. Purgation for excess varies: attacking exterior/interior, breaking qi/blood, guiding phlegm/fluids, eliminating hardness/draining water. Medicinally, the tonification of Renshen (Ginseng Radix) and Huangqi (Astragali Radix) does not equal Ejiao (Donkey-Hide Gelatin) and Dihuang (Rehmanniae Radix); the purgation of Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) does not equal Gansui (Kansui Radix) and Daji (Euphorbiae Pekinensis Radix); the heat of Fuzi (Aconiti Lateralis Radix Praeparata) and Xixin (Asari Radix et Rhizoma) does not equal Ganjiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex); the cold of Huanglian (Coptidis Rhizoma) and Zhizi (Gardeniae Fructus) does not equal Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma). Moreover, people vary in age, strength, and living conditions. Those living in luxury differ vastly from those exposed to wind and rain; the difference is immeasurable. One cannot apply uniform methods. Thus, physicians must collect diverse prescriptions and adapt flexibly to achieve versatility and appropriateness. Some patients, though not incurable, have complex conditions, having visited major hospitals and seen many doctors, tried all cold, heat, tonifying, and purgative treatments, yet remain uncured. Such cases are common. Once, a patient told me immediately after receiving my prescription: "I have taken these medicines before," implying they were ineffective. For such patients, without persuasion, even a symptomatic prescription lacks efficacy. I explained: Prescriptions are based on the specific condition. I know you have likely taken most or all of these medicines, and I understand your skepticism. But you only see the similarity, not the difference. Now, let me clarify: certain herbs you took in a specific formula; others in the same formula you may not have taken. Even if taken, dosages likely differed. Identical dosages would imply copying medical books rather than prescribing. The difference within similarity is crucial—"same door, different house," differing by millimeters but yielding miles of result. This is the key to efficacy. Examples abound, such as Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Prepared Aconite Root) vs. Guizhi Fuzi Tang (Cinnamon Twig and Aconite Twig Decoction), and Guizhi Mahuang Ban Tang (Half Cinnamon Twig and Ephedra Decoction) vs. Guizhi Er Mahuang Yi Tang (Twice Cinnamon Twig and Once Ephedra Decoction) in *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), where identical herbs with different dosages yield different indications. Physicians must be responsible, and patients must have faith. *Suwen: Tangye Laoli Lun* states: "The disease is the root, the physician is the branch. If root and branch do not match, pathogenic qi cannot be subdued." *Suwen: Yijing Bianqi Lun* states: "When root and branch are aligned, pathogenic qi submits." This is the principle.
These superficial reflections, spoken openly: "The wise may err in a thousand deliberations; the foolish may gain in a thousand deliberations." Views differ; let us complement each other, progress together, and contribute better to modernization.
(Compiled by Wu Lianfang and Wu Chengyu)
Refining Research and Deep Thinking, Firming with Age
Professor Zhang Boyu, Shanghai College of Traditional Chinese Medicine
[Author Profile] Zhang Boyu (1901–), born in Chuansha, Shanghai. Graduated from Shanghai TCM Specialized School in 1923, studied under Mr. Ding Ganren for one year, gaining significant benefit. Practiced in his hometown in 1924, and in Shanghai in 1937. Hired by Shanghai No. 11 People's Hospital (later Shanghai TCM College Affiliated Shuguang Hospital) in 1956, engaging in TCM internal medicine and teaching. Sixty years of clinical practice, specializing in internal miscellaneous diseases, with meticulous differentiation, precise analysis, and outstanding efficacy, earning deep trust from patients. Authored *Zhang Boyu Medical Cases* and *Experience in TCM and Chinese Materia Medica for Treating Acute Myocardial Infarction*.
I spent my childhood in rural areas. At that time, rural areas were devastated, epidemics raged, and farmers infected with disease often lacked the means to seek medical help, dying in droves. This deeply touched my young mind.
I remember Mr. Ding Ganren, a famous physician from Menghe, founded the TCM Specialized School in Shanghai, renowned throughout the region, attracting many youths aspiring to the art of Qi and Huang. I was one of them. Through effort, I entered the school at eighteen, becoming a member of the third cohort.
Upon enrollment, many classmates were intelligent and agile, but knowing my own slower nature, I worked doubly hard to make up for my lack of talent, eventually achieving excellent grades and graduating in 1923. I then studied under Mr. Ding Ganren, receiving advanced training and benefiting greatly. A year later, I returned home to practice. In 1937, with the outbreak of the Anti-Japanese War ("August 13"), war reached Pudong, and my family moved to the city, setting up a clinic at the then "TCM Sanatorium." After liberation, I was hired by Shanghai No. 11 People's Hospital (later Shanghai TCM College Affiliated Shuguang Hospital) for clinical and teaching work in TCM internal medicine. During the Ten-Year Turmoil, despite persecution, I remained devoted to medicine. After the fall of the "Gang of Four," although elderly, the Party and people awarded me the titles of "TCM Professor" and "Advanced Individual in Shanghai Science Conference," which filled me with gratitude and humility. In my remaining years, apart from working harder to repay the Party and people, I care for nothing else. Below, I briefly state my insights from learning, hoping to benefit the younger generation.
Scholarship Values Reality, Not Sectarianism
The path of TCM scholarship is based on *Neijing* (Inner Canon) and *Shanghan Zabing Lun* (Treatise on Cold Pathogenic and Miscellaneous Diseases), but must also absorb strengths from various sources to enhance knowledge and skill. However, TCM literature contains sectarian views. Thus, reading medical books requires blind obedience avoidance and thoughtful integration, with clinical verification being crucial to grasp the truth. For example, Xu Lingtai's annotated *Linzheng Zhinan Yi'an* (Guide to Clinical Practice Medical Cases) is a lifelong favorite. Ye and Xu were both renowned masters, yet their academic views often conflicted. In the hematemesis section of *Linzheng Zhinan Yi'an*, Ye frequently used Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Yuzhu (Polygonati Odorati Rhizoma), and Shashen (Glehniae Radix). Xu Lingtai disagreed, stating: "Hematemesis and cough are diseases of phlegm-fire entrenched in the Lung; how can strong tonification be appropriate?" "Now, cough with hematemesis involves fire evil entering the Lung, congealed phlegm, and surging blood; fearing dispersion and descent, why desire to retain phlegm-fire in the Lung without letting it escape? What kind of method is this!" Initially, I felt confused by these two views. To resolve doubts, I observed clinically for over ten years, gaining insight, and wrote annotations: "Xu and Ye's words seem contradictory but are actually complementary. For hematemesis and cough with phlegm-fire lingering in the Lung, Maidong and Wuweizi should be banned to avoid aiding the villain. However, clinically, many cases present with injured Lung yin, crimson tongue, fine-rapid pulse, cough, and hematemesis. With yin deficiency as the priority, Shashen, Maidong, and Yuzhu are excellent对症 herbs; how can they be discarded? Solely relying on bitter-cold damages stomach qi, which is not the correct treatment. Thus, neither Xu nor Ye should be ignored; they must be used opportunistically for clinical efficacy. Zhang Zhongjing's Maimendong Tang (Lily Bulb and Pinellia Decoction) combines Maidong and Banxia, tonifying yin without cloying; the elegance of this prescription is worthy of emulation." Thus, scholarship requires not rashly following one school, but deep study to form independent views.
Integrating "Cold" and "Warm" Theories to Treat Heat Diseases