《伤寒论》师曰∶伏气之病，以意候之，今月之内，欲有伏气。假令旧有伏气，当须脉之。若脉微弱者，当喉中痛
似伤，非喉痹也。病患云∶实咽中痛，虽尔今复欲下利。
张路玉曰∶冬月感寒，伏藏于经，至春当发，故曰以意候之。今月之内言春分候也。若脉微弱者，其人真元素亏，
必不发于阳而发于阴，以少阴之脉循喉咙，伏邪始发，热必上升，故必喉中痛似伤。肾司开阖，经之热邪不能外发，势
必内攻，其后下利也。
章虚谷曰∶此条仲景教人辨冬伏寒邪，春发之温病，当以心意测候之也。如今月之内，欲有发伏气之病者，必无其
气而有其病，病与时气不合，即知其病因旧有伏气而发。假令旧有伏气者，须审其脉，知其邪从何处而出也。若脉微弱，
知其邪虽化热，未离少阴，循经脉而上灼，当喉中痛似伤者，却非外邪入内之喉痹，是内热欲出之喉痛也。何也？若春
时外感风邪，脉浮而弦数，先见发热恶寒之外证，今脉微弱，则非外感，而反喉痛，则确知为内发之伏热，是无其气而
有其病也。伏热上行，不得外散，势必又从下走，故曰实咽中痛。虽尔，今复欲下利也。然亦有兼外感者，即审其脉证，
皆可照此辨之也。观仲景标中风、伤寒、暑热等病之脉，与《难经》同。惟《难经》言温病之脉，行在诸经，不知何经
之动也。各随其经所在而取之。是言温病初由伏邪，随气血流行在诸经中，及其邪之发也。不知从何经而动，既发之后，
各随其邪所在之经而治之。其发无定处，故无一定之脉象可示也。今仲景又教人审脉以辨邪发之经，如脉微弱，即知其
邪未离少阴，必当有咽痛、下利等证，正与《难经》互相发明者也。故如下文云邪出三阳，热势大盛，其脉浮大上关上，
则是脉随证变，证随脉见。其发也，既无定处，则无定证，既无定证，则无定脉，故《难经》不标脉象也。由是观之，
其与外感之邪，而有定证、定脉者，迥不同矣，故仲景与《难经》无异也。
少阴病，脉微细，但欲寐也。二三日，咽痛者，可与甘草汤；不瘥者，与桔梗汤。
张路玉曰∶阴邪为病，其发必暴，所以伏气发于少阴，必咽痛，仲景遂以缓法治之。甘草味甘，其性最缓，因取以
治少阴伏气发温之最急者。盖甘先入脾，脾缓则阴火之势亦缓，且生用力能泻火，故不兼别味，独用以取专功也。设不
瘥，必是伏邪所发势盛，缓不足以济急，更加桔梗升载其邪，使发于阳分之阴邪，尽从阳分而散，不致仍复下陷入于阴
分也。倘治稍失宜，阴津为热邪所耗，即用祛热救阴之药，恐无及也。
叶香岩曰∶春夏温热之病，必自内而及外。汪按∶此专指伏气之病。
尤拙吾曰∶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。
章虚谷曰∶风寒外闭少阴而咽痛者，仲景用半夏散辛温开泄之法矣。此少阴伏热内发，循经上灼而咽痛，虽不合用
辛温开泄，亦不可用凉药以遏其外出之势。故用甘草甘平和中，导邪外达。如不瘥，更加桔梗上通其气。杨云∶据此则
桔梗分两宜轻。盖火郁不得外出故痛，通其气使火外达，则痛自止矣。伤寒之邪，自表入里，故先太阳，而后至少阴；
温病之邪，自里出表，故先少阴，而后出太阳。历来不辨源流，故各条次序亦紊，而伤寒、温病，搀混不清也。
淦按∶伏气为病，皆自内而之外，不止春温一病。盖四时之气，皆有伏久而发者，不可不知也。
少阴病，下利，咽痛，胸满，心烦者，猪肤汤主之。
张路玉曰∶下利咽痛，胸满心烦，少阴之伏邪，虽发阴经，实为热证，邪热充斥，上下中间，无所不到，寒下之药，
不可用矣。又立猪肤汤以润少阴之燥，与用黑驴皮之意颇同。阳微者，用附子温经；阴竭者，用猪肤润燥。同具散邪之
意，比而观之，思过半矣。
少阴病，得之二三日以上，心中烦，不得卧，黄连阿胶汤主之。
周禹载曰∶伏邪未发，津液先已暗耗。今得之二三日以上，虽阴火不升，未见咽痛等证，而心烦不得卧，已知阴液
消耗，故以芩、连祛热，胶、芍滋阴，两得之矣。
少阴病，下利六七日，咳而呕、渴，心烦不得眠者，猪苓汤主之。杨云∶此当兼有停饮，故方治如此。
章虚谷曰∶此不咽痛，其邪由肺直走肠胃而下利，六七日不止，因而热从下陷，不得外透，故逆于肺则咳而呕，乘
心则烦、渴、不得眠，以心肺皆通少阴之脉故也。主以猪苓汤，利小便而滋阴，滋其阴则热随利去，利其小便，则泻止
而烦渴亦解矣。
少阴病，得之二三日，口燥咽干者，急下之，宜大承气汤。
张路玉曰∶伏气之发于少阴，其势最急，与伤寒之传经热证不同。得病才二三日，即口燥咽干，延至五六日始下，
必枯槁难为矣。故宜急下以救肾水之燔灼也。○按少阴急下三证∶一属传经热邪亢极；一属热邪转入胃腑；一属温热发
自少阴。皆刻不容缓之证，故当急救欲绝之肾水，与阳明急下三法，同源异派。
章虚谷曰∶上五条皆邪不离少阴，其病之轻重变化，证之虚实不同，有如此者。况又传于他经，而其变证殆无穷尽，
观仲景随证设方，辨别施治，其义理精微，有难言喻矣。
太阳病，发热而渴，不恶寒者为温病。
郭白云曰∶冬伤于寒，至春发为温病；冬不伤寒，而春自感风温之气而病者，亦谓之温。
雄按∶自感温病，仲圣未论，详于叶氏列第三卷。
王安道曰∶温病如此，则知热病亦如此，是则不渴而恶寒者，非温热病矣。温热病而有恶风恶寒之证者，重有风寒
新中也。
周禹载曰∶温病由伏邪自内发出，一达于外，表里俱热，热势既壮，郁邪耗液，故发而即渴。其表本无邪郁，内方
喜寒，故不恶寒。延至三五日间，或腹满、或下利者，即此证也，与伤寒之先表后里者大异，然犹系太阳，以未显他经
之证，明自少阴发出为表里也。
叶香岩曰∶发热而渴者，温病热邪自内达外。若误汗之，祸不可言。
沈尧封曰∶此条虽不言脉，以后条参之，其尺部必浮也。
章虚谷曰∶温病之发而无定处，少阴之表为太阳，热邪从里出表，即有发热头痛之太阳病也。不恶寒，其非外感之
邪可知；渴者，热从内发之证也。仲景恐人错认为太阳伤风寒，故特标是伏热内发之温病也。其少阴温病反不标者，因
伏气条内已申明咽痛、下利为少阴初发之温病也。
雄按∶汪谢城孝廉云∶吴氏《温病条辨·上焦篇》首引《伤寒论》云∶太阳病，但恶热，不恶寒而渴者，名曰温病，
桂枝汤主之。今检《伤寒论》却未见此数语，使此语真出仲景耶？亦当辨其简误，若系吴氏误记，尤不可不为之辨正，
余谓非误记也。因喻氏尝云∶仲景治温证，凡用表药，皆以桂枝汤，以示微发于不发之意。尤在泾《读书记》云∶此喻
氏之臆说，非仲景之旧章。鞠通自问跳出伤寒圈子，而不觉已入嘉言套中，又不甘为人下，遂肆改原文，捏为圣训，以
窃附于宫墙，而不自知其诬圣误世之罪，亦可慨已。
汪按∶鞠通发愤着书，力辟升散温燥之弊，功已不细。然可议处尚多，梦隐此书，去其瑕而存其瑜，乃鞠通之诤友
也。
若发汗已，身灼热者，名曰风温。风温为病，脉阴阳俱浮，自汗出，身重，多眠睡，鼻息必鼾，语言难出。若被下
者，小便不利，直视失溲；若被火者，微发黄色，剧则如惊痫，时螈 ；若火熏之，一逆尚引日，再逆促命期。
张隐庵曰∶名曰温者，积寒成热而发也，宜辛凉发散，杨云∶此语误矣，非治此证之法。条内无“太阳病”三字，
是无表邪也，何必辛凉发散。微汗出而解。若误用辛温之药，发汗已，身反灼然热发者，名曰风温。盖发汗则阴液外泄，
风热之邪更甚，而身如烧灼也。脉阴阳俱浮者，风热之邪，自里出表，故浮也。风热伤气，故汗出而身重多眠也。杨云∶
此证最易出汗，故条中有自汗之文，不必以辛温误散而然也。肺气通于鼻而主皮毛，风热在表，而睡息必鼾也。夫心主
言，肺主声，肺热受伤，故语言难出，此因风热过甚，而阴气消沮，故为病如是焉。若被妄下，则愈亡阴液于后，而小
便不利于前矣，津液伤则州都之官失守，不能约束而失溲矣。足太阳之脉，入目系而出项，津液内亡，则目系不能转而
直视矣。若加以火攻，风火交炽，脾土转病，身必发黄。火攻之甚剧，则神志散越，如惊如痫，时 时 矣。是以一逆
尚可苟延时日，如再以火熏之，是再逆促命期矣。杨云∶注家皆以此条承上文而来，故所注如此。其实，上条乃温病提
纲，此条并不与上条连贯也。汪按∶杨评极精，然病名风温而脉浮，参以辛凉，未为过也。自汗固不必由于误表，然误
表致成此候者亦有之，后文白虎加人参汤，石膏亦辛甘之味。
沈尧封曰∶温热二病，古人往往互称，医者只须认定脉证，拟何方治，不必拘于名式。《难经》云∶热病之脉，阴阳
俱浮。本条云∶风温为病，脉阴阳俱浮。两证脉相同也。三阳合病，但欲眠睡，身重难以转侧。本条身重多眠，两证病
相似也。热病合病，俱主以白虎汤，则此条虽无主治，似可从白虎汤拟法。
章虚谷曰∶太阳外感之邪，若发汗已，必热退身凉矣。今热邪从少阴而发，既经外发，当清其热，乃误发其汗，反
伤津气，助其邪势，故身更灼热，因而勾起其肝风，鼓荡其温邪，故名曰风温。其为病也，虚阳外浮，热邪漫溢，故脉
阴阳俱浮。津液外泄，自汗不止，气乏神昏，则身重多眠睡。内风上鼓，而机窍窒塞，故鼻息必鼾，语言难出，其非外
受风邪之证可见矣。若被下者，谓未经误汗，非谓汗后又下也。盖邪伏少阴，热灼水枯，咽干口燥，法当急下，此热已
发出太阳，而少阴空虚，若下之伤阴，则小便不利，而直视失溲，则气亦脱矣。如被汗下而被火攻者，外火助内热，熏
蒸而发黄，剧则火邪扰心如惊痫，肝风炽盛而 ，皆败坏之象也。若止火熏之，一逆尚可引日苟延，若既汗又下而再
逆之，更促其命期也。
雄按∶彼冬温春温之先犯手太阴者，皆曰风温，乃吸受之温风也。此伏邪内发，误汗致逆者，亦曰风温，乃内动之
虚风也。然风温在肺，只宜清解。若误以辛热之药汗之，亦有自汗多眠，鼻鼾难语之变。
淦按∶鼻鼾是肺肾相关，子母同病，自汗出，乃阴不内守，心液外越也。未必尽是少阴一经之证。
服桂枝汤，大汗出后，大烦渴不解，脉洪大者，白虎加人参汤主之。
张路玉曰∶此本温热病，误认风伤卫，服桂枝汤也。若风伤卫，服汤后必微汗而解矣。不知此本温热，误服桂枝汤，
遂至脉洪大，大汗，烦渴不解。若误用麻黄，必变如上条之危殆。盖桂枝治自外入之风邪，石膏治自内发之热邪，故白
虎汤为热邪中 之的方，专解内蒸之热，非治在经之热也。大汗伤津，故加人参以救液，则烦渴自解矣。
尤拙吾曰∶温邪非发散可愈，即有表证，亦岂辛温可发，桂枝汤为伤寒表病而里和者设，温证邪从里发，而表且未
病，误用桂枝，适足以助邪而耗液。盖伏寒化热，少阴之精，已被劫夺，更用辛热，是绝其本而资之脱也。若曰少阴本
寒标热，邪入其界，非温不散，然温病之发，寒已变热，其欲出之势，有不待引之而自出者，其不能出者，必皆阴精已
涸者也，不然宁有不出者耶？
雄按∶先曾祖云∶风寒为病，可以桂枝汤发汗而愈。若发汗而热反灼者，乃风温病，温即热之谓也。后人不为详玩，
谓风温为汗后坏病，抑何固耶？夫病本热也，加以桂枝之辛热，故液为热迫而汗大出，液去则热愈灼，故大烦渴而脉洪
大，连上条似论一证，主以白虎加人参，正《内经》风淫热淫，治以甘寒之旨也。又《医林改错》谓∶发热有汗之证，
从未见桂枝汤治愈一人，是亦温病也。
太阳与少阳合病，自下利者，与黄芩汤；若呕者，黄芩加半夏生姜汤主之。
张路玉曰∶黄芩汤乃温病之主方，即桂枝汤以黄芩易桂枝而去生姜也。盖桂枝主在表风寒，黄芩主在里风热，不易
之定法也。其生姜辛散，非温热所宜，故去之。温病始发，即当用黄芩汤去热为主，伤寒传至少阳，热邪渐次入里，方
可用黄芩佐柴胡解之，此表里寒热之次第也。
周禹载曰∶明言太少二阳，何不用二经药？非伤寒也。伤寒由表入里，此则自内发外，无表何以知太少二阳？或胁
满，或头痛，或口苦引饮，或不恶寒而即热，故不得谓之表也。如伤寒合病，皆表病也，今不但无表，且有下利里证，
伤寒协热利，必自传经而入，不若此之即利也。温何以即利？外发未久，内郁已深，其人中气本虚，岂能一时尽泄于外，
势必下走作利矣。
雄按∶少阳胆木挟火披猖，呕是上冲，利由下迫，何必中虚始利，饮聚而呕乎？半夏、生姜专开饮结，如其热炽，
宜易连、茹。杨云∶此注精当，非前注所及。
三阳合病，脉浮大，上关上，但欲眠睡，目合则汗。
《伤寒论》老师说：伏气致病，需要通过推想来诊察，在这个月之内，可能有伏气发作。假如原本就有伏气，必须通过诊脉来判断。如果脉象微弱，应当出现咽喉疼痛，感觉像受伤一样，但这并不是喉痹（一种以咽喉肿痛、闭塞为主症的疾病）。病人说：确实是咽喉剧烈疼痛，虽然如此，现在又想发生腹泻。
张路玉说：冬季感受寒邪，潜伏在经脉中，到了春季应当发作，所以说要通过推想来诊察。“这个月之内”指的是春分前后的时节。如果脉象微弱，说明此人先天元气亏损，病邪一定不会发于阳经而发于阴经。因为少阴经脉循行经过喉咙，伏邪刚开始发作时，热势必然向上冲升，所以一定会出现咽喉疼痛似受伤的症状。肾主管开阖功能，经络中的热邪不能向外发散，势必向内攻伐，随后就会出现腹泻。
章虚谷说：这一条是仲景教导人们辨别冬季潜伏的寒邪，到春季发作的温病，应当用心意去推测诊察。就像在这个月之内，想要有发作伏气病的，一定是没有当时的时令气候之气，却出现了病症，病情与当时的气候不相符合，就能知道病因是旧有的伏气发作。假如旧有伏气的人，必须仔细审查其脉象，知道邪气从何处发出。如果脉象微弱，就知道邪气虽然已经化热，但尚未离开少阴经，顺着经脉向上灼烧，导致咽喉疼痛似受伤，这却不是外邪入内引起的喉痹，而是内热欲向外透发引起的喉痛。为什么呢？如果在春季感受风邪，脉象浮而弦数，先出现发热恶寒等表证；现在脉象微弱，就不是外感，反而出现喉痛，就可以确切知道这是内部发出的伏热，这就是没有时令之气却有病症。伏热上行，不能向外散发，势必又会向下走，所以说确实是咽喉疼痛。虽然这样，现在又想发生腹泻。然而也有兼夹外感的，只要仔细审查脉证，都可以参照此法进行辨别。看仲景标注的中风、伤寒、暑热等病的脉象，与《难经》相同。只有《难经》说温病的脉象，运行在诸经之中，不知道是哪一经发动。各随其所在的经脉部位来取脉。这是说温病起初由伏邪引起，随着气血流行在诸经中，等到邪气发作时，不知道从哪一经动起，既已发作之后，各随邪气所在的经脉来治疗。其发作没有固定位置，所以没有一定的脉象可以显示。现在仲景又教人审察脉象来辨别邪气发作的经脉，如脉象微弱，就知道邪气未离开少阴，必定会有咽痛、腹泻等症状，正与《难经》互相阐发。所以下文说邪气出于三阳，热势大盛，脉象浮大上至关上，那就是脉随证变化，证随脉显现。其发作既然没有固定位置，就没有固定的证候；既没有固定的证候，就没有固定的脉象，所以《难经》不标注脉象。由此看来，它与外感邪气而有固定证候、固定脉象的情况，截然不同，所以仲景的观点与《难经》没有差异。
少阴病，脉象微细，只想睡觉。发病二三天，出现咽喉痛的，可以给予甘草汤；如果不愈的，给予桔梗汤。
张路玉说：阴邪致病，其发作一定猛烈，所以伏气发于少阴，必定咽喉痛，仲景于是用缓和的方法治疗。甘草味甘，药性最缓，因此选取它来治疗少阴伏气发作温病中最急迫的情况。大概甘味先入脾，脾气缓和则阴火之势也缓和，而且生用甘草能泻火，所以不兼用其他药物，单独使用以取得专一的功效。假设不愈，必定是伏邪发作势头旺盛，缓和之法不足以救急，再加桔梗升提载引邪气，使发于阳分的阴邪，完全从阳分消散，不至于再次陷入阴分。倘若治疗稍失适宜，阴津被热邪耗伤，即使使用祛热救阴的药物，恐怕也来不及了。
叶香岩说：春夏季节的温热病，必定从内部波及外部。汪按：这专门指伏气致病。
尤拙吾说：少阴属阴，寒邪也属阴，以阴遇阴，所以能够隐藏而不发作。因此伤寒的邪气，从太阳依次传入三阴；温病的邪气，从少阴传出至三阳。
章虚谷说：风寒外闭少阴而导致咽痛的，仲景用了半夏散辛温开泄的方法了。这是少阴伏热内发，顺着经脉向上灼烧而咽痛，虽然不适合用辛温开泄，也不可用凉药来遏制其向外透发的趋势。所以用甘草甘平调和脾胃，引导邪气向外透达。如不愈，再加桔梗上通肺气。杨云：据此则桔梗的分量宜轻。大概火郁结不得外出故痛，通畅其气使火向外透达，则痛自然停止。伤寒的邪气，从表入里，所以先太阳，而后至少阴；温病的邪气，从里出表，所以先少阴，而后出太阳。历来不辨别源流，所以各条次序也混乱，而伤寒、温病混杂不清。
淦按：伏气致病，都是从内部向外部发展，不止春温这一种病。大概四时的气候，都有潜伏久而发作的，不可不知道。
张路玉说：腹泻、咽痛、胸满、心烦，是少阴的伏邪，虽然发于阴经，实为热证，邪热充斥，上下中间，无所不到，寒下之药，不可使用了。又立猪肤汤来滋润少阴的燥热，与用黑驴皮的意思颇为相同。阳气微弱的，用附子温经；阴液枯竭的，用猪肤润燥。同具有散邪的意思，比较起来观察，思过半矣。
周禹载说：伏邪未发，津液先前已经暗中耗伤。现在得病二三天以上，虽然阴火不升，未见咽痛等证，但心烦不能卧睡，已知阴液消耗，所以用黄芩、黄连祛除热邪，阿胶、芍药滋阴，两全其美。
少阴病，腹泻六七天，咳嗽且呕吐、口渴，心烦不能安眠的，猪苓汤主治。杨云：这应当兼有停饮，所以方剂治疗如此。
章虚谷说：这里不咽痛，邪气由肺直接走向肠胃而腹泻，六七天不止，因而热邪从下陷落，不能向外透发，所以逆犯于肺则咳嗽且呕吐，乘袭于心则烦、渴、不能安眠，因为心肺都通少阴的经脉。主治用猪苓汤，利小便而滋阴，滋养其阴则热随利而去，利其小便，则腹泻止而烦渴也解除了。
张路玉说：伏气发于少阴，其势头最急，与伤寒的传经热证不同。得病才二三天，就口干燥咽干，拖延到五六天才攻下，必定枯槁难治了。所以宜紧急攻下以挽救肾水的燔灼。○按少阴急下三证：一属于传经热邪亢极；一属于热邪转入胃腑；一属于温热发自少阴。都是刻不容缓的证候，所以应当急救将绝的肾水，与阳明急下三法，同源异派。
章虚谷说：上面五条都是邪气不离少阴，其病情的轻重变化，证候的虚实不同，有如此情况。况且又传于他经，而其变证几乎无穷无尽，看仲景随证设立方剂，辨别施治，其义理精微，难以言喻。
郭白云说：冬季受寒，到春季发为温病；冬季不伤于寒，而春季自己感受风温之气而生病的，也称为温。
王士雄按：自己感受的温病，仲景未论述，详细记载于叶氏列第三卷。
王安道说：温病如此，那么热病也是如此，是不口渴且恶寒的，就不是温热病了。温热病如果有恶风恶寒的证候，是重又感受了新的风寒。
周禹载说：温病由伏邪从内部发出，一旦达于外部，表里俱热，热势既壮盛，郁结的邪气耗伤津液，所以发作时就口渴。其体表本来没有邪气郁结，内部方才喜寒，所以不恶寒。拖延到三五日间，或者腹满、或者腹泻的，就是这种证候，与伤寒的先表后里的大不相同，然而仍然属于太阳，因为没有显现其他经的证候，明确是从少阴发出为表里关系。
叶香岩说：发热且口渴的，是温病热邪从内部达于外部。如果误用发汗法，祸患不可言说。
沈尧封说：这一条虽然不说脉，参考后一条，其尺部脉必浮。
章虚谷说：温病的发作没有固定位置，少阴的表是太阳，热邪从里出表，就有发热头痛的太阳病。不恶寒，可知其不是外感邪气；口渴，是热从内部发出的证候。仲景恐怕人们错认为太阳伤风寒，所以特别标出这是伏热内发的温病。其少阴温病反而不标出的原因，因为在伏气条内已申明咽痛、腹泻为少阴初发的温病。
王士雄按：汪谢城孝廉说：吴氏《温病条辨·上焦篇》首先引用《伤寒论》说：太阳病，只恶热，不恶寒而口渴的，名叫温病，桂枝汤主治。现在检查《伤寒论》却未见这几句话，假使这话真出自仲景耶？也应当辨别简略错误，如果是吴氏误记，尤其不可不为他辨正，我认为不是误记。因为喻氏曾说：仲景治疗温证，凡是用表药，都用桂枝汤，以示微微发汗而不大发汗的意思。尤在泾《读书记》说：这是喻氏的臆测之说，不是仲景的旧章。鞠通自问跳出伤寒圈子，却不觉已落入嘉言的套路中，又不甘心为人之下，于是肆意改动原文，捏造为圣人的训诫，以窃取依附于宫墙，而不知其诬蔑圣人误导世人的罪过，也可叹啊。
汪按：鞠通发愤著书，极力批判升散温燥的弊端，功劳已不小。然而可议之处还很多，梦隐此书，去除其瑕疵而保留其精华，乃是鞠通的诤友。
如果发汗后，身体灼热的，名叫风温。风温致病，脉象阴阳俱浮，自汗出，身体沉重，多睡，鼻息一定打鼾，语言难出。如果被误用攻下的，小便不利，直视失禁；如果被误用火疗的，轻微发黄，严重则像惊痫，时时抽搐；如果用火熏的，一次误治尚且拖延时日，再次误治加速死亡。
张隐庵说：名叫温的，是积寒成热而发作的，宜用辛凉发散，杨云：这话错了，不是治疗此证的方法。条文内没有“太阳病”三字，是没有表邪，何必辛凉发散。微微出汗而解。如果误用辛温的药，发汗后，身体反而灼热发作的，名叫风温。大概发汗则阴液外泄，风热之邪更甚，而身如烧灼。脉象阴阳俱浮的，是风热之邪，从里出表，所以浮。风热伤气，所以汗出而身重多睡。杨云：此证最容易出汗，所以条文中有自汗的文字，不必是因为误用辛温发散所致。肺气通于鼻而主皮毛，风热在表，而睡息一定打鼾。心主言语，肺主声音，肺热受伤，所以语言难出，这是因为风热过甚，而阴气消损，所以生病如此。如果被妄用攻下，则更加亡失阴液于后，而小便不利在前；津液损伤则州都之官失守，不能约束而失禁。足太阳的经脉，入目系而出项，津液内亡，则目系不能转动而直视。如果加上火攻，风火交炽，脾土转病，身体必发黄。火攻很剧烈，则神志散越，像惊像痫，时时抽搐。所以一次误治尚可苟延时日，如果再用火熏，是再次误治加速死亡。杨云：注家都认为此条承接上文而来，所以注释如此。其实，上条是温病提纲，此条并不与上条连贯。汪按：杨评极其精当，然而病名风温而脉浮，参以辛凉，不算过分。自汗固然不一定由于误用表药，然而误用表药导致形成此候的也有，后文白虎加人参汤，石膏也是辛甘之味。
沈尧封说：温热两种病，古人往往互称，医者只需认定脉证，拟定何方治疗，不必拘泥于名称格式。《难经》说：热病的脉，阴阳俱浮。本条说：风温致病，脉阴阳俱浮。两证脉象相同。三阳合病，只想睡觉，身体沉重难以转侧。本条身重多睡，两证病情相似。热病合病，都主治以白虎汤，则此条虽然没有主治，似乎可从白虎汤拟法。
章虚谷说：太阳外感邪气，如果发汗后，一定热退身凉。现在热邪从少阴而发，既已向外发，应当清其热，却误发其汗，反而伤津气，助长邪势，所以身体更灼热，因而勾起肝风，鼓荡温邪，所以名叫风温。其发病，虚阳外浮，热邪漫溢，所以脉象阴阳俱浮。津液外泄，自汗不止，气乏神昏，则身重多睡。内风上鼓，而机窍窒塞，所以鼻息一定打鼾，语言难出，其不是外受风邪的证候可见了。如果被误用攻下，谓未经误汗，非谓汗后又下。大概邪伏少阴，热灼水枯，咽干口燥，法当急下，此热已发出太阳，而少阴空虚，若下之伤阴，则小便不利，而直视失禁，则气也脱了。如被汗下而被火攻的，外火助内热，熏蒸而发黄，严重则火邪扰心如惊痫，肝风炽盛而抽搐，都是败坏之象。如果仅用火熏，一次误治尚可引日苟延，如果既汗又下而再误治，更促其命期。
王士雄按：那些冬温春温先犯手太阴的，都叫风温，乃吸受的温风。此伏邪内发，误汗致逆的，也叫风温，乃内动的虚风。然而风温在肺，只宜清解。如果误用辛热之药发汗，也有自汗多睡，鼻鼾难语的变证。
淦按：鼻鼾是肺肾相关，子母同病，自汗出，是阴不内守，心液外越。未必尽是少阴一经的证候。
服桂枝汤，大汗出后，大烦渴不解，脉洪大的，白虎加人参汤主治。
张路玉说：这本来是温热病，误认风伤卫，服用桂枝汤。如果风伤卫，服药后一定微汗而解。不知这本来是温热，误服桂枝汤，遂至脉洪大，大汗，烦渴不解。如果误用麻黄，必变如上条之危殆。大概桂枝治自外入的风邪，石膏治自内发的热邪，所以白虎汤为热邪中的的方，专解内蒸之热，不是治在经的热。大汗伤津，所以加人参以救液，则烦渴自解。
尤拙吾说：温邪非发散可愈，即有表证，岂是辛温可发，桂枝汤是为伤寒表病而里和者设，温证邪从里发，而表且未病，误用桂枝，适足以助邪而耗液。大概伏寒化热，少阴的精，已被劫夺，再用辛热，是断绝其根本而资助其脱失。如果说少阴本寒标热，邪入其界，非温不散，然而温病的发作，寒已变热，其欲出的趋势，有不待引导而自己出来的，其不能出来的，必定都是阴精已枯竭的，不然哪有不出来的呢？
王士雄按：先曾祖说：风寒致病，可以用桂枝汤发汗而愈。如果发汗而热反灼的，是风温病，温就是热的意思。后人不详细玩味，谓风温为汗后坏病，多么固执啊。夫病本是热，加上桂枝的辛热，所以液为热迫而汗大出，液去则热更灼，所以大烦渴而脉洪大，连上条似论一证，主治以白虎加人参，正是《内经》风淫热淫，治以甘寒的宗旨。又《医林改错》说：发热有汗的证，从未见桂枝汤治愈一人，这也是温病。
太阳与少阳合病，自腹泻的，给予黄芩汤；如果呕吐的，黄芩加半夏生姜汤主治。
张路玉说：黄芩汤是温病的主方，即桂枝汤以黄芩易桂枝而去生姜。大概桂枝主在表风寒，黄芩主在里风热，不易的定法。其生姜辛散，非温热所宜，所以去掉。温病始发，就当用黄芩汤去热为主，伤寒传至少阳，热邪渐次入里，方可用黄芩佐柴胡解之，此表里寒热的次第。
周禹载说：明言太少二阳，何不用二经药？不是伤寒。伤寒由表入里，此则自内发外，无表何以知太少二阳？或胁满，或头痛，或口苦引饮，或不恶寒而即热，所以不得谓之表。如伤寒合病，皆表病，今不但无表，且有下利里证，伤寒协热利，必自传经而入，不如此之即利。温何以即利？外发未久，内郁已深，其人中原气本虚，岂能一时尽泄于外，势必下走作利。
王士雄按：少阳胆木挟火披猖，呕是上冲，利由下迫，何必中虚始利，饮聚而呕？半夏、生姜专开饮结，如其热炽，宜易连、茹。杨云：此注精当，非前注所及。
The Master said in the *Treatise on Cold Damage*: For diseases caused by latent pathogenic factors (latent qi), one must use inference to diagnose them. Within this month, there may be an outbreak of latent qi. If one previously had latent qi, it is necessary to examine the pulse. If the pulse is weak and faint, there should be throat pain that feels like an injury, but this is not Hou Bi (a disease characterized by severe sore throat and obstruction). The patient says: "Indeed, there is severe throat pain." Although so, now there is also a desire for diarrhea.
Zhang Luyu stated: In winter, cold pathogenic factors are contracted and lie hidden in the meridians, to erupt in spring; hence it is said that one must use inference to diagnose. "Within this month" refers to the period around the Spring Equinox. If the pulse is weak and faint, it indicates that the person's primordial essence is deficient. The pathogen will certainly not erupt from the Yang meridians but from the Yin meridians. Since the Shaoyin meridian runs along the throat, when the latent pathogen begins to erupt, the heat must rise upward, thus causing throat pain resembling an injury. The Kidney governs opening and closing; since the heat pathogen in the meridians cannot vent outward, it will inevitably attack inward, leading to diarrhea subsequently.
Zhang Xugu stated: This clause teaches how Zhongjing distinguishes warm diseases caused by winter-lodged cold pathogens erupting in spring, which should be diagnosed through mental inference. Just as within this month, if one is about to suffer from a latent qi disease, there will be symptoms without the corresponding seasonal climate. When the illness does not match the seasonal qi, one can know that the cause is the eruption of old latent qi. If one has old latent qi, one must carefully examine the pulse to determine where the pathogen emerges. If the pulse is weak and faint, it indicates that although the pathogen has transformed into heat, it has not yet left the Shaoyin meridian. It follows the meridian upward and burns, causing throat pain resembling an injury. However, this is not Hou Bi caused by external pathogens entering internally, but rather throat pain caused by internal heat attempting to vent outward. Why? If one contracts wind pathogens in spring, the pulse will be floating and wiry-rapid, preceded by exterior signs such as fever and aversion to cold. Now, with a weak and faint pulse, it is not an external contraction. Instead, the presence of throat pain confirms it is internal latent heat erupting—symptoms present without the corresponding seasonal qi. As latent heat rises and cannot disperse outward, it will inevitably move downward. Hence, it is indeed throat pain. Although so, there is now also a tendency toward diarrhea. However, there are cases complicated by external contractions; by carefully examining the pulse and signs, one can distinguish them according to this method. Observing Zhongjing’s labeling of pulses for Wind Strike, Cold Damage, Summerheat, etc., they align with the *Classic of Difficult Issues* (*Nan Jing*). Only the *Nan Jing* states that the pulse of warm diseases moves through various meridians, without specifying which meridian is activated. One takes the pulse at the location of the affected meridian. This means that warm diseases initially arise from latent pathogens circulating with Qi and Blood through the meridians. When the pathogen erupts, it is unknown from which meridian it originates. After eruption, treatment follows the meridian where the pathogen resides. Since its eruption has no fixed location, there is no fixed pulse manifestation to indicate it. Now, Zhongjing further teaches examining the pulse to identify the meridian of eruption. For example, a weak and faint pulse indicates the pathogen has not left Shaoyin, and symptoms like throat pain and diarrhea must be present. This perfectly complements the *Nan Jing*. Thus, the text below states that when pathogens emerge from the Three Yang meridians, heat intensity is great, and the pulse is floating and large, reaching above the Guan position. This shows that the pulse changes with the syndrome, and the syndrome manifests with the pulse. Since eruption has no fixed location, there are no fixed syndromes; since there are no fixed syndromes, there are no fixed pulses. Hence, the *Nan Jing* does not label specific pulse manifestations. From this, we see that it is vastly different from external pathogens that have fixed syndromes and pulses. Therefore, Zhongjing’s view is consistent with the *Nan Jing*.
Shaoyin disease, characterized by a faint and fine pulse and a desire only to sleep. On the second or third day, if there is throat pain, Gancao Tang (Licorice Decoction) may be given; if it does not improve, Jiegeng Tang (Platycodon Decoction) is given.
Zhang Luyu stated: When Yin pathogens cause disease, their eruption is necessarily sudden. Thus, when latent qi erupts in Shaoyin, throat pain invariably occurs. Zhongjing therefore treats it with a mild method. Gancao (Licorice Root) is sweet in flavor and has the mildest nature. It is selected to treat the most acute cases of warm disease erupting from Shaoyin latent qi. Sweetness first enters the Spleen; when Spleen Qi is relaxed, the momentum of Yin Fire is also moderated. Moreover, raw Gancao can drain fire. Therefore, it is used alone without other herbs to achieve a focused effect. If it does not improve, it indicates that the latent pathogen’s eruption is vigorous, and the mild method is insufficient to address the urgency. Adding Jiegeng (Platycodon Root) lifts and carries the pathogen, allowing the Yin pathogen erupted into the Yang aspect to dissipate entirely through the Yang aspect, preventing it from sinking back into the Yin aspect. If treatment is slightly inappropriate, and Yin fluids are consumed by heat pathogens, even using drugs to clear heat and save Yin may come too late.
Ye Tianshi stated: Warm-heat diseases in spring and summer necessarily spread from the interior to the exterior. Wang’s Note: This specifically refers to diseases caused by latent qi.
You Zhuowu stated: Shaoyin belongs to Yin, and cold pathogens also belong to Yin. Yin encountering Yin allows for concealment without eruption. Therefore, pathogens of Cold Damage pass from Taiyang sequentially into the Three Yin meridians; whereas pathogens of Warm Diseases transmit from Shaoyin out to the Three Yang meridians.
Zhang Xugu stated: When Wind-Cold externally closes Shaoyin causing throat pain, Zhongjing used Banxia San (Pinellia Powder) with acrid-warm methods to open and drain. Here, Shaoyin latent heat erupts internally, burning upward along the meridian to cause throat pain. Although acrid-warm opening methods are unsuitable, cooling medicines should not be used to suppress its outward venting trend. Therefore, Gancao (Licorice Root) is used for its sweet and neutral nature to harmonize the Middle and guide the pathogen outward. If it does not improve, Jiegeng (Platycodon Root) is added to unblock Qi upwards. Yang’s Comment: Based on this, the dosage of Jiegeng should be light. Generally, pain arises because Fire is constrained and cannot vent outward. Unblocking Qi allows Fire to vent outward, and the pain stops naturally. Pathogens of Cold Damage enter from the exterior to the interior, starting at Taiyang and then reaching Shaoyin. Pathogens of Warm Diseases exit from the interior to the exterior, starting at Shaoyin and then emerging at Taiyang. Historically, failing to distinguish origins and flows has led to confused sequencing of clauses and mixed-up descriptions of Cold Damage and Warm Diseases.
Gan’s Note: Diseases caused by latent qi all develop from the interior outward, not limited to just Spring Warmth. Generally, the Qi of the four seasons all have instances of lying latent for a long time before erupting; this must be known.
Shaoyin disease, with diarrhea, throat pain, chest fullness, and vexation, is primarily treated with Zhufu Tang (Pig Skin Decoction).
Zhang Luyu stated: Diarrhea, throat pain, chest fullness, and vexation indicate that although the Shaoyin latent pathogen erupts in the Yin meridians, it is actually a Heat syndrome. The pathogenic heat fills the upper, lower, middle, and interior, leaving nowhere untouched. Cold purgative medicines must not be used. Zhufu Tang is established to moisten Shaoyin dryness, similar in intent to using black donkey skin. For slight Yang deficiency, Fuzi (Aconite Root) is used to warm the meridians; for Yin exhaustion, Zhufu (Pig Skin) is used to moisten dryness. Both share the intent of dispersing pathogens. Comparing them reveals much insight.
Shaoyin disease, persisting for two to three days or more, with vexation in the heart and inability to lie down, is primarily treated by Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).
Zhou Yuzai stated: Before the latent pathogen erupts, body fluids have already been secretly consumed. Now, after two or three days, although Yin Fire does not rise and symptoms like throat pain are absent, the presence of heart vexation and insomnia indicates Yin fluid consumption. Therefore, Huangqin (Scutellaria Root) and Lianzi (Coptis Rhizome) are used to remove heat, while Ejiao (Donkey-Hide Gelatin) and Shaoyao (Peony Root) nourish Yin, achieving both goals.
Shaoyin disease, with diarrhea for six or seven days, accompanied by cough, vomiting, thirst, vexation, and inability to sleep, is primarily treated by Zhuling Tang (Polyporus Decoction). Yang’s Comment: This case likely involves retained fluid retention, hence the prescription.
Zhang Xugu stated: Here, there is no throat pain. The pathogen travels directly from the Lung to the intestines and stomach, causing diarrhea. After six or seven days without stopping, heat sinks downward and cannot vent outward. Reversing into the Lung causes cough and vomiting; attacking the Heart causes vexation, thirst, and insomnia, because both the Heart and Lung connect to the Shaoyin meridians. Zhuling Tang is used to promote urination and nourish Yin. Nourishing Yin allows heat to leave with the urine; promoting urination stops diarrhea and resolves vexation and thirst.
Shaoyin disease, developing over two or three days, with dry mouth and throat, requires urgent purgation, preferably using Dachengqi Tang (Major Order the Qi Decoction).
Zhang Luyu stated: Eruption of latent qi in Shaoyin is the most urgent, differing from the transmittal heat syndromes of Cold Damage. Within just two or three days of onset, dry mouth and throat appear. Delaying purgation until the fifth or sixth day would result in withering and difficult treatment. Therefore, urgent purgation is needed to rescue the blazing Kidney Water. ○ Note on the Three Urgent Purgations of Shaoyin: One belongs to extreme hyperactivity of transmittal heat pathogens; one belongs to heat pathogens transferring to the Stomach Fu; one belongs to warm diseases originating in Shaoyin. All are critical conditions requiring immediate rescue of nearly exhausted Kidney Water, sharing the same source but different branches with the Three Urgent Purgations of Yangming.
Zhang Xugu stated: The previous five clauses all involve pathogens remaining in Shaoyin, with varying degrees of severity and虚实 (deficiency/excess). Furthermore, transmission to other meridians leads to endless variations. Observing Zhongjing’s formulation of prescriptions according to syndromes and his precise differentiation and treatment reveals profound principles beyond words.
Taiyang disease, with fever, thirst, and no aversion to cold, is classified as Warm Disease.
Guo Baiyun stated: Winter cold injury erupting as warm disease in spring; or contracting wind-warm Qi spontaneously in spring without winter cold injury, is also called Warm.
Wang Shixiong’s Note: Spontaneous contraction of warm diseases was not discussed by Zhongjing; details are found in Ye’s works, Volume 3.
Wang Andao stated: Since warm diseases are like this, heat diseases are also like this. Therefore, those without thirst and with aversion to cold are not warm-heat diseases. If warm-heat diseases present with aversion to wind or cold, it indicates a new contraction of Wind-Cold superimposed on the condition.
Zhou Yuzai stated: Warm diseases erupt from latent pathogens inside. Once they reach the exterior, both interior and exterior become hot. As heat intensity strengthens, constrained pathogens consume fluids, causing thirst upon eruption. The exterior originally has no pathogen constraint, and the interior prefers cold, hence no aversion to cold. By the third to fifth day, abdominal fullness or diarrhea may occur, representing this syndrome. This is greatly different from Cold Damage, which starts at the exterior and moves to the interior. However, it still relates to Taiyang because no other meridian symptoms are apparent, clarifying that it emanates from Shaoyin affecting both interior and exterior.
Ye Tianshi stated: Fever with thirst indicates warm-heat pathogens reaching the exterior from the interior. If mistaken for an exterior condition and treated with sweating, the disaster is incalculable.
Shen Yaofeng stated: Although this clause does not mention the pulse, referring to the next clause, the Chi position pulse must be floating.
Zhang Xugu stated: The eruption of warm diseases has no fixed location. The exterior of Shaoyin is Taiyang. When heat pathogens exit the interior to the exterior, Taiyang disease with fever and headache appears. No aversion to cold proves it is not an external pathogen. Thirst indicates heat erupting from the interior. Zhongjing specifically labels this as warm disease from internal latent heat to prevent misdiagnosis as Taiyang Wind-Cold. The reason Shaoyin Warm Disease is not separately labeled is that the latent qi clause already clarified throat pain and diarrhea as the initial presentation of Shaoyin warm disease.
Wang Shixiong’s Note: Xiaojuan Wang Xiecheng stated: Wu’s *Systematic Differentiation of Warm Diseases · Upper Jiao Chapter* first cites the *Treatise on Cold Damage*: "Taiyang disease, only aversion to heat, no aversion to cold, and thirst, is named Warm Disease, treated with Guizhi Tang." However, checking the *Treatise on Cold Damage*, these words are absent. If truly from Zhongjing, errors should be corrected. If Wu mistakenly recorded it, correction is essential. I believe it is not a mistake. Yu Shi once said: Zhongjing treated warm syndromes using Guizhi Tang for any exterior-releasing medication, indicating slight sweating rather than profuse sweating. You Zaijing’s *Reading Records* states: This is Yu Shi’s speculation, not Zhongjing’s original principle. Ju Tong claimed to escape the circle of Cold Damage but unknowingly fell into Jiayan’s trap. Not willing to be inferior, he arbitrarily altered the original text, fabricating sage teachings to attach himself to the orthodox lineage, unaware of his crime in slanderizing sages and misleading the world. It is lamentable.
Wang’s Note: Ju Tong wrote with determination to criticize the evils of ascending, dispersing, warming, and drying agents. His merit is significant. However, there are many points open to discussion. Mengyin’s book removes flaws and preserves virtues, making him a true friend who corrects Ju Tong.
If after sweating, the body becomes scorching hot, it is named Fengwen (Wind-Warm). Fengwen disease presents with floating pulses at both Yin and Yang positions, spontaneous sweating, heavy body, excessive sleepiness, snoring breath, and difficulty speaking. If wrongly treated with purgation, there will be difficulty urinating, staring gaze, and fecal/urinary incontinence. If wrongly treated with fire therapy, mild cases show yellowing of the skin; severe cases resemble convulsions or epilepsy with occasional spasms. If treated with fire moxibustion, one error may prolong life slightly, but a second error accelerates death.
Zhang Yinan stated: Named "Warm," it erupts from accumulated cold transforming into heat. Acrid-cool dispersal is suitable. Yang’s Comment: This statement is incorrect; it is not the treatment method for this syndrome. The clause lacks the words "Taiyang Disease," indicating no exterior pathogen. Why use acrid-cool dispersal? Mild sweating leads to resolution. If acrid-warm medicines are wrongly used, and after sweating the body becomes scorching hot, it is named Fengwen. Sweating leaks Yin fluids, making Wind-Heat pathogens stronger, causing the body to feel like burning. Pulses floating at both Yin and Yang positions indicate Wind-Heat pathogens exiting the interior to the exterior. Wind-Heat damages Qi, causing sweating, heaviness, and sleepiness. Yang’s Comment: This syndrome easily causes sweating; the mention of spontaneous sweating in the text need not result from erroneous acrid-warm dispersal. Lung Qi connects to the nose and governs skin/hair. With Wind-Heat at the exterior, breathing snores. The Heart governs speech, the Lung governs sound. Lung heat injury causes difficulty speaking. This results from excessive Wind-Heat consuming Yin Qi. Wrongful purgation further depletes Yin fluids posteriorly and causes urinary difficulty anteriorly. Fluid damage causes the Officer of the Cistern (Bladder) to lose control, leading to incontinence. The Foot-Taiyang meridian enters the eye system and exits the nape. Internal fluid loss prevents eye movement, causing staring gaze. Adding fire therapy creates intense Wind-Fire, disturbing Spleen Earth, causing jaundice. Severe fire therapy scatters spirit, resembling惊痫 (startle-epilepsy) with spasms. One error may delay death; a second error (fire moxibustion) accelerates it. Yang’s Comment: Commentators assume this clause follows the previous one. Actually, the previous clause is the outline of Warm Disease; this clause is not continuous with it. Wang’s Note: Yang’s critique is excellent. However, since the disease is named Fengwen and the pulse is floating, combining it with acrid-cool methods is not excessive. Spontaneous sweating does not necessarily stem from erroneous exterior treatment, though such cases exist. Later, Baibu Jia Renshen Tang uses Gypsum, which is also acrid and sweet.
Shen Yaofeng stated: Ancients often used "warm" and "heat" interchangeably. Physicians should focus on pulse and syndrome to prescribe, not rigidly adhere to names. The *Nan Jing* states: "The pulse of heat diseases is floating at both Yin and Yang." This clause states: "Fengwen disease, pulse floating at both Yin and Yang." The pulses are identical. Triple-Yang combined disease features desire to sleep and heavy body difficult to turn. This clause shares heavy body and sleepiness. Heat disease combined syndromes are primarily treated with Baihu Tang. Although this clause lacks a primary prescription, it seems appropriate to model treatment after Baihu Tang.
Zhang Xugu stated: Exterior pathogens of Taiyang, after sweating, should have fever subsiding and body cooling. Now, heat pathogens erupt from Shaoyin. Having emerged outward, heat should be cleared. Mistakenly inducing sweating damages fluids and Qi, aiding the pathogen, causing greater scorching heat. This stirs Liver Wind and agitates Warm pathogens, hence named Fengwen. The pathology involves floating Yang outward and overflowing heat, causing floating pulses at both Yin and Yang. Fluid leakage causes persistent spontaneous sweating. Qi deficiency and spirit confusion cause heaviness and sleepiness. Internal wind surges upward, blocking orifices, causing snoring and speech difficulty. This clearly shows it is not an externally contracted Wind pathogen. "Wrongly treated with purgation" refers to cases without prior erroneous sweating, not sweating followed by purgation. Generally, pathogens lie in Shaoyin, burning heat and drying water, causing dry throat/mouth, requiring urgent purgation. Here, heat has emerged to Taiyang, leaving Shaoyin empty. Purgation damages Yin, causing urinary difficulty, staring gaze, and incontinence, leading to Qi collapse. If subjected to sweating, purgation, and fire therapy, external fire aids internal heat, steaming jaundice. Severe cases involve heart disturbance resembling startle-epilepsy and intense Liver Wind spasms—all signs of deterioration. Mere fire moxibustion (one error) may prolong life; sweating, purgation, and further error accelerate death.
Wang Shixiong’s Note: Winter and Spring Warmths initially attacking Hand-Taiyin are called Fengwen, being inhaled warm wind. This latent internal eruption worsened by erroneous sweating is also called Fengwen, being internally moved deficient wind. However, Fengwen in the Lung should only be cleared and resolved. Mistaking it for an exterior condition and using acrid-hot medicines to sweat can also cause spontaneous sweating, sleepiness, snoring, and speech difficulty.
Gan’s Note: Snoring relates Lung and Kidney, mother and son organs suffering together. Spontaneous sweating indicates Yin failing to hold inward and Heart fluids escaping outward. It is not necessarily solely a Shaoyin meridian syndrome.
After taking Guizhi Tang, if profuse sweating occurs, followed by unresolved severe vexation and thirst, and a flooding pulse, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is primarily indicated.
Zhang Luyu stated: This was originally a warm-heat disease, mistaken for Wind damaging the Defensive layer, leading to the administration of Guizhi Tang. If Wind damaged the Defensive layer, sweating after medication would lead to mild resolution. Not knowing this was originally warm-heat, the mistaken use of Guizhi Tang resulted in a flooding pulse, profuse sweating, and unresolved vexation/thirst. If Ephedra were wrongly used, it would become as dangerous as the previous clause. Guizhi treats Wind entering from outside; Gypsum treats Heat erupting from inside. Thus, Baihu Tang is the specific formula for Heat pathogens, specifically clearing internal steaming heat, not treating heat in the meridians. Profuse sweating damages fluids; adding Ginseng rescues fluids, resolving vexation and thirst.
You Zhuowu stated: Warm pathogens cannot be cured by dispersal. Even with exterior signs, acrid-warm methods are inappropriate. Guizhi Tang is designed for Cold Damage exterior syndromes with interior harmony. Warm disease pathogens erupt from the interior, while the exterior is unaffected. Mistaken use of Guizhi only aids the pathogen and consumes fluids. Frozen cold transforming into heat has already robbed Shaoyin Essence. Using acrid-hot substances cuts off the root and promotes collapse. Some argue Shaoyin has Cold as root and Heat as branch, and pathogens entering require warmth to disperse. However, in warm disease eruption, Cold has transformed to Heat. Its tendency to exit does not require guidance to emerge spontaneously. Those that do not emerge must have exhausted Yin Essence. Otherwise, how could they fail to emerge?
Wang Shixiong’s Note: My great-great-grandfather said: Wind-Cold diseases can be cured by sweating with Guizhi Tang. If fever intensifies after sweating, it is Fengwen disease; "Warm" means Heat. Later generations failed to study this carefully, calling Fengwen a post-sweating deteriorated condition, how rigid! The disease is fundamentally Heat; adding Guizhi’s acrid-hot nature forces fluids out as sweat. Fluid loss makes heat more intense, causing severe vexation/thirst and flooding pulse. Linking with the previous clause, it discusses one syndrome. Treating with Baihu Jia Renshen Tang aligns with the *Inner Classic*’s principle: treating Wind and Heat excess with Sweet-Cool methods. Also, *Correcting Errors in Medical Forest* states: Never seen a single case of fever with sweating cured by Guizhi Tang; this is also a warm disease.
Combined disease of Taiyang and Shaoyang, with spontaneous diarrhea, is treated with Huangqin Tang (Scutellaria Decoction); if vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Scutellaria Plus Pinellia and Fresh Ginger Decoction) is primarily indicated.
Zhang Luyu stated: Huangqin Tang is the main formula for warm diseases, essentially Guizhi Tang with Guizhi replaced by Huangqin and Ginger removed. Guizhi treats exterior Wind-Cold; Huangqin treats interior Wind-Heat. This is an unchangeable rule. Ginger’s acrid dispersal is unsuitable for warm-heat, hence removed. At the onset of warm disease, Huangqin Tang should be used primarily to clear heat. In Cold Damage transmitting to Shaoyang, heat gradually enters the interior, allowing Huangqin to assist Chaihu in resolving it. This is the sequence of exterior-interior and cold-heat.
Zhou Yuzai stated: Explicitly mentioning Taiyang and Shaoyang, why not use medicines for both meridians? It is not Cold Damage. Cold Damage moves from exterior to interior; this erupts from interior to exterior. Without an exterior sign, how do we know it involves Taiyang and Shaoyang? Symptoms may include hypochondriac fullness, headache, bitter taste with desire to drink, or immediate heat without aversion to cold. Thus, it cannot be called exterior. Combined diseases in Cold Damage are all exterior diseases. Here, not only is there no exterior, but there are interior signs like diarrhea. Cold Damage’s coordinated heat diarrhea must result from transmittal, unlike this immediate diarrhea. Why does Warm Disease cause immediate diarrhea? External eruption is recent, internal constraint is deep. If the person’s Middle Qi is originally deficient, how can all pathogen vent outward at once? It must move downward causing diarrhea.
Wang Shixiong’s Note: Shaoyang Gallbladder Wood, carrying rampant Fire, causes vomiting (upward rushing) and diarrhea (downward pressing). Why must Middle deficiency cause diarrhea, and fluid accumulation cause vomiting? Banxia and Shengjiang specifically resolve fluid constraints. If heat is intense, substitute with Lianqin (Coptis) and Rudu (Skullcap). Yang’s Comment: This annotation is precise, surpassing the previous note.
Combined disease of the Three Yang meridians, with a floating and large pulse reaching above the Guan position, desire to sleep, and sweating when eyes are closed.