伏温之邪，冬时之寒邪也。其伤人也，本因肾气之虚，始得入而据之。其乘春阳之气而外达也，亦以肾气
暗动，始能鼓邪化热而出。设其人肾阳虚馁，则邪机冰伏，每有半化半伏、欲达不达之症。如外面热象炽盛，
或已见昏谵、痉厥之候，而少阴之伏邪尚有未经化热，仍留滞于阴分者。此时就热象论，已有热扰厥阴之险，
清泄之药不容缓。而内伏之邪，又以肾气内馁，不能化达。设专用凉泄，则邪机愈滞∶设用温化，又属抱薪救
火。展转之间，内则阴液干涸，外则邪热蒙闭。迟之一二日，即不可挽救矣。此等症情，在温病中，为最险重
之候。即使竭力挽回，亦属冒险图功。治病者，必须豫为道破，庶免疑谤。此证邪伏少阴，喻氏仿仲景少阴病
治例，用麻黄附子细辛汤及麻黄附子甘草汤两方以透邪，增入生地以育阴扶正，其用意颇为切当。惟温邪既动
，必有热象外现；其甚者邪热蒙陷，已有痉厥之象。此时麻附细辛，断难遽进。然非此大力之药，则少阴之沉
寒，安能鼓动。治当师其意而变其制，如用麻黄汁制豆豉，附子汁制生地，至凉肝熄风治标之药，仍宜随症参
入。似此面面周到，庶可收功。
附案∶及门生金石如，戊戌三月初旬，患时感。初起恶寒发热，服疏
散药一剂，未得汗解，而热势转淡，神情呆钝，倦卧耳聋，时或烦燥，足冷及膝，指尖耳也鼻准亦冷，两便不
利，腰俞板硬，不能转侧，脉迟细而弱，呕恶不能纳水饮，惟嚼酱姜稍止，舌苔浓燥微灰。此由新感引动伏邪
，而肾阳先馁，不能托邪化热，故邪机冰伏不出∶其已化之热，内陷厥阴，欲作痉厥∶证情极为险重。赵生静
宜先往，用栀、豉、桂枝、羚羊角，合左金法，小便得通，足温呕止；余则证情如故，邪仍不动。议用麻、附
，合洋参、生地等扶正托邪，而余适至，遂令赶紧煎服。两进之后，尺脉始弦，而神情之呆钝，腰脊之板痛仍
尔也。拟用麻黄制豆豉，附子制大生地，桂枝制白芍，合人参、牛膝、元参、淡芩、羚羊、生牡蛎等味出入。
三剂后，以舌苔灰浓而干，又加大黄。服后忽作寒栗战汗，而腰脊顿松，随得大解，而里热亦泄，神情爽朗，
调理一月而愈。此证就邪之深伏而未化热者论之，则只宜温托，大忌寒凉∶然痉厥神糊，舌苔灰燥，若再助其
热，势必内陷厥阴，而为昏狂蒙闭之证，无可挽也。就邪之已动而化热者论之，则只宜清泄，何堪温燥∶然脉
情迟细，神呆形寒，经腑俱窒，若专用凉化，则少阴之伏邪不出，迁延数日，势必内溃，而为厥脱之证，其去
生愈远矣。再四筹审，决无偏师制胜之理。不得已，取喻氏法以治其本，合清泄法以治其标，一面托邪，一面
化热。幸赖少阴之气，得扶助而伸。凡经邪腑邪，已化未化之邪，乘肾气之动，一齐外达。故战汗一作，大便
一行，而表里诸病若失也。
黄村桥范养逵令郎，于戊戌夏间患三疟，至八月初服截药而止。至二十外，忽然遗泄数次，遂发寒热，如
日作之疟。先寒后热，迨外热已甚，而下体骨节仍寒，须再作寒栗一次，随啜热粥一碗，然后得汗而解。延至
九月初，已十余发矣。一日当啜粥助汗之时，忽然头晕目暗，冷汗肢厥，如欲脱之状，超时始定。此后遂卧床
不起，惟胃纳尚不大坏，缠绵不愈。予往诊时，十月中矣。予谓从前三疟，是暑湿之邪。迨愈而复作，是引动
少阴伏邪，乘少阳新病之虚而出；而肾阳先馁，不能托邪，故寒栗日甚，而热势反不重也。此当用温经托邪之
法，用桂枝汤加人参、当归、生地、附子汁制牛膝，仍用柴胡、豆豉、黄芩等味出入，十余剂。中间迭见惊悸
痉惕诸证，又加龙骨、牡蛎、羚羊角等味，随证治之而愈。此证当疟疾再发之时，诸医仍用暑湿门套方，服二
三十剂，而病情毫无增
减。病者自言不起，每夜分辄有谵语。病家疑神疑鬼，医家莫测其病原所在。其故皆由近日医家，不囿于吴又
可募原之说，即泥于吴鞠通三焦之论，而绝不知有少阴伏邪随经发病之理。故遇此等证，便觉毫无把握，轻者
迁延致重，重者无法挽救，近年所见不少矣，哀哉！
伏气温病之邪，实质是冬季感受的寒邪。人体之所以受其侵害，根本原因在于肾气虚弱，寒邪才得以侵入并潜伏体内。当春季阳气升发时，若肾气暗中萌动，才能鼓动邪气化为热邪而外达。假如患者肾阳虚衰，则邪气会像冰一样深伏凝滞，常出现半化半伏、欲出而不能出的症状。例如体表热象炽盛，甚至已经出现神昏谵语、抽搐厥逆等危候，但少阴经中的伏邪仍有未完全化热的部分，继续滞留于阴分。此时仅从体表的熱象来看，已有热邪扰乱厥阴心的险恶局面，清热泄火的药物不容迟缓使用。然而体内的伏邪，又因肾气内虚，无法自行化散外达。如果单纯使用寒凉清泄药，会使邪气更加凝滞；如果使用温通化散药，又如同抱薪救火，助长热势。在这样进退两难之间，体内阴液将干涸枯竭，体外邪热蒙蔽心窍。拖延一两天，就难以挽救了。这类病情，在温病中属于最危险严重的证候。即使竭尽全力抢救，也属于冒险求功。医生必须预先向家属说明病情的凶险，以免产生怀疑和责难。此证邪气潜伏于少阴，喻嘉言（喻氏）模仿张仲景治疗少阴病的先例，使用麻黄附子细辛汤及麻黄附子甘草汤两方来透达邪气，加入生地黄以滋养阴液扶助正气，其用意颇为恰当。只是温邪既然已经发动，必然有热象外现；严重者邪热蒙蔽陷入，已有抽搐厥逆之象。此时麻黄、附子、细辛等大辛大热之药，断然不能立即使用。然而若非此类大力温通之药，少阴经的沉寒痼冷，怎能被鼓动？治疗应当效法其意而改变其制法，如用麻黄汁炮制的豆豉，附子汁炮制的生地黄，至于平肝熄风治标的药物，仍应根据症状酌情加入。如此面面俱到，才可能取得疗效。
附医案：我的学生金石如，戊戌年三月初旬，患时行感冒。初起时恶寒发热，服用发散药一剂，未能出汗解表，反而热势减退，神情呆滞迟钝，疲倦嗜卧，耳聋，时而烦躁，足冷至膝盖，指尖、耳朵、鼻准均冷，大小便不通利，腰脊僵硬板硬，不能翻身转动，脉象迟细而弱，呕吐恶心不能进食水饮，只有咀嚼酱姜稍能缓解，舌苔浓燥微呈灰色。这是由新感引动伏邪，而肾阳先已虚衰，不能托举邪气化热外出，故邪气冰伏不出；其已化的热邪，内陷厥阴，即将发生抽搐厥逆；病情极为险重。赵静宜先生先去诊治，用了栀子、豆豉、桂枝、羚羊角，配合左金丸的方法，小便得以通畅，足温呕止；但我到达后，其余证情依旧，邪气仍未变动。商议使用麻黄、附子，配合西洋参、生地黄等扶正托邪，而我恰好赶到，于是命令赶紧煎服。服药两次后，尺脉始见弦象，但神情呆滞、腰脊板痛依然如故。拟定用麻黄制的豆豉，附子制的生地黄，桂枝制的白芍，配合人参、牛膝、玄参、淡黄芩、羚羊角、生牡蛎等药物加减。服用三剂后，因舌苔灰浓且干燥，又加入了大黄。服药后忽然出现寒战栗动继而汗出（战汗），腰脊顿时松弛，随即大便通畅，里热随之宣泄，神情变得清爽，调理一个月后痊愈。此证就邪气深伏而未化热的一面来看，只宜温补托毒，大忌寒凉；但既然出现抽搐厥逆、神志模糊、舌苔灰燥，若再助其热势，势必内陷厥阴，导致昏迷狂乱蒙闭的证候，就无法挽回了。就邪气已动而化热的一面来看，只宜清热泄火，岂能承受温燥；然而脉象迟细，神志呆滞，形体畏寒，经络脏腑皆闭塞，若专用凉润化热之法，则少阴的伏邪不能外出，拖延数日，势必内部溃败，导致厥脱证候，离死亡就更远了。反复斟酌审察，决没有偏执一方就能制胜的道理。不得已，采用喻嘉言的方法以治其本，结合清热泄火的方法以治其标，一面托举邪气，一面化解热邪。幸赖少阴之气得到扶助而伸展。凡是经络之邪、脏腑之邪，已化或未化的邪气，乘着肾气的发动，一齐向外透达。所以一旦战汗发生，大便通行，表里各种病症仿佛消失一般。
黄村桥范养逵先生的儿子，在戊戌年夏季患三日疟，到八月初服用截疟药而停止。到了二十多天后，忽然遗精泄泻数次，随即发作寒热，像每日发作的疟疾。先恶寒后发热，等到体表热势很盛时，下肢骨节仍然寒冷，必须再次出现寒战栗动，随后喝下一碗热粥，然后出汗而解。延续到九月初，已经发作十多次了。有一天正当要喝粥助汗的时候，忽然头晕目暗，冷汗淋漓，四肢厥冷，呈现欲脱之状，过了很久才安定。此后便卧床不起，只有胃纳尚好，缠绵不愈。我去诊视时，已是十月份了。我说从前三日疟，是暑湿之邪。等到痊愈后又复发，是引动了少阴伏邪，趁着少阳新病的虚弱而发出；而肾阳先已虚衰，不能托举邪气，所以寒战日益严重，而热势反而不重。这应当用温经托邪的方法，用桂枝汤加人参、当归、生地黄、附子汁制的牛膝，仍用柴胡、豆豉、黄芩等药物加减，十余剂。中间屡次出现惊悸、抽搐惊恐等各种证候，又加入龙骨、牡蛎、羚羊角等药物，随证治疗而痊愈。此证在疟疾复发之时，各位医生仍沿用暑湿门的成方，服用二三十剂，而病情毫无增减。病人自己说快要死了，每夜分时就有谵语。家属疑神疑鬼，医生也摸不清病原所在。其原因都是由于近来的医生，不拘泥于吴又可的募原学说，就是死守吴鞠通的三焦理论，而完全不知道有少阴伏邪随经络发病的道理。所以遇到这种证候，就觉得毫无把握，轻者拖延变重，重者无法挽救，近年所见不少，真是可悲啊！
The pathogenic factor of latent warm disease is essentially the cold pathogen contracted in winter. The reason why the human body is injured by it lies fundamentally in the deficiency of Kidney Qi, which allows the cold pathogen to enter and take residence. When it reaches outward driven by the ascending Yang Qi of spring, it is also because the Kidney Qi stirs secretly that it can drum up the pathogen to transform into heat and emerge. If a person's Kidney Yang is deficient and weak, the pathogenic mechanism becomes frozen like ice, often presenting symptoms of being half-transformed and half-latent, desiring to reach outward but unable to do so. For instance, external heat manifestations may be blazing intense, or even signs of coma with delirium and convulsions with cold limbs may have appeared, yet there are still latent pathogens in the Shaoyin meridian that have not fully transformed into heat, remaining stagnant in the Yin aspect. At this time, judging from the external heat signs, there is already the danger of heat disturbing the Jueyin (Liver/Pericardium), and drugs for clearing and purging heat cannot be delayed. However, the internally latent pathogen, due to the internal weakness of Kidney Qi, cannot transform and reach outward. If only cooling and purging drugs are used, the pathogenic mechanism will become even more stagnant; if warming and transforming drugs are used, it would be like carrying firewood to save a fire. In this dilemma, internally the Yin fluids will dry up, and externally the pathogenic heat will cover and close [the mind]. Delaying for one or two days makes it irretrievable. Such conditions are the most dangerous and severe presentations among warm diseases. Even with utmost efforts to rescue, it remains a risky attempt at success. Physicians must explain the situation clearly in advance to avoid suspicion and blame. In this condition, the pathogen is latent in Shaoyin. Yu Jiayan (Yu Shi) imitated Zhang Zhongjing's treatment principles for Shaoyin disease, using Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) and Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) to vent the pathogen, adding Shengdi Huang (Rehmanniae Radix) to nourish Yin and support healthy Qi, an intention that was quite appropriate. However, since the warm pathogen has moved, there must be external heat signs; in severe cases, pathogenic heat covers and sinks, showing signs of convulsions and cold limbs. At this time, Mahuang, Fuzi, and Xixin—powerful hot drugs—cannot be administered abruptly. Yet without such powerful warming drugs, how can the deep-seated cold of Shaoyin be stirred? Treatment should follow their intent but alter the formulation, such as using Douchi (Fermented Soybean) processed with Mahuang juice, and Shengdi Huang processed with Fuzi juice. Meanwhile, drugs for calming the Liver and extinguishing wind to treat the branch symptoms should still be included according to the specific presentation. Only in this comprehensive manner can success be achieved.
Attached Case: My student Jin Shiru, in early March of the Wuxu year, suffered from a seasonal epidemic cold. Initially, he had aversion to cold and fever. After taking one dose of diaphoretic drugs, he did not sweat to resolve the exterior, but the heat intensity decreased, his expression became dull and sluggish, he lay tiredly wanting to sleep, was deaf, occasionally irritable, his feet were cold up to the knees, fingertips, ears, and nose tip were all cold, urination and defecation were obstructed, the lower back and spine were stiff and hard, unable to turn over, the pulse was slow, fine, and weak, he vomited and felt nauseous unable to take water or food, only chewing pickled ginger provided slight relief, and the tongue coating was thick, dry, and slightly gray. This was caused by a new contraction triggering latent pathogens, while Kidney Yang was first depleted and unable to push the pathogen out by transforming it into heat, thus the pathogenic mechanism remained frozen and unexposed; the heat that had already transformed sank inward into Jueyin, threatening convulsions and cold limbs; the condition was extremely critical. Zhao Jingyi went first and used Zhizi (Gardeniae Fructus), Chidouchi (Red Fermented Soybean), Guizhi (Cinnamomi Ramulus), Lingyangjiao (Saigae Tataricae Cornu), combined with the Zuojin method, resulting in free urination, warm feet, and cessation of vomiting; however, upon my arrival, other symptoms remained unchanged, and the pathogen still did not move. We discussed using Mahuang and Fuzi combined with Yangshen (American Ginseng) and Shengdi Huang to support healthy Qi and push out the pathogen, and I happened to arrive, ordering immediate decoction and administration. After two doses, the Chi position of the pulse began to appear wiry, but the dullness of spirit and stiffness/pain of the waist and spine remained the same. I proposed using Mahuang-processed Douchi, Fuzi-processed Da Shengdi Huang, Guizhi-processed Baishao (Paeoniae Radix Alba), combined with Renshen (Ginseng Radix), Niuxi (Achyranthis Bidentatae Radix), Xuanshen (Scrophulariae Radix), Danhuangqin (Scutellariae Radix), Lingyangjiao, and Shengmuli (Ostreae Concha), modifying as needed. After three doses, because the tongue coating was thick gray and dry, Dahuang (Rhei Radix et Rhizoma) was added. After taking it, he suddenly experienced chills and shivering followed by profuse sweating (Zhanhan), the waist and spine instantly relaxed, followed by large bowel movement, releasing interior heat, and his spirit became clear. He recovered after one month of conditioning. Regarding this case, looking at the aspect of the pathogen deeply latent and not yet transformed into heat, only warming and supporting methods are suitable, strictly avoiding cold and cool herbs; however, given the convulsions, coma, and dry gray tongue coating, if heat is further assisted, it will inevitably sink into Jueyin, leading to coma, mania, and closure, which would be incurable. Looking at the aspect where the pathogen has moved and transformed into heat, only clearing and purging are suitable, enduring no warmth and dryness; yet with a slow, fine pulse, dull spirit, cold form, and obstruction of meridians and fu-organs, if only cooling and transforming methods are used exclusively, the latent Shaoyin pathogen will not exit, dragging on for days, inevitably leading to internal collapse and Jue-Tuo syndrome, moving further away from life. After repeated deliberation, there is no principle of winning with a unilateral approach. Reluctantly, adopting Yu Shi's method to treat the root, combined with clearing and purging methods to treat the branch, pushing out the pathogen while resolving heat. Fortunately, thanks to the Shaoyin Qi being assisted and extending, all pathogens in meridians and organs, whether transformed or not, took advantage of the stirring of Kidney Qi to reach outward together. Thus, once Zhanhan occurred and stool passed, all exterior and interior ailments seemed to vanish.
Mr. Fan Yangkui's son from Huangcun Bridge, in the summer of the Wuxu year, suffered from San-Nue (every-third-day malaria). By early August, he took antimalarial drugs to stop it. Beyond the 20th day, he suddenly had seminal emission and diarrhea several times, then developed chills and fever resembling daily Nue. First chills, then fever; when external heat became intense, the bones and joints of the lower body remained cold, requiring another episode of chills and shivering, followed by drinking a bowl of hot porridge, before sweating could resolve the condition. By early September, it had recurred more than ten times. One day, just as he was about to drink porridge to assist sweating, he suddenly suffered dizziness and dim vision, cold sweat, and cold limbs, appearing as if collapsing, stabilizing only after a long time. Thereafter, he remained bedridden, though stomach appetite was not too bad, lingering without recovery. When I visited to diagnose, it was mid-October. I said that previously, San-Nue was due to Summerheat-Dampness pathogen. Its recurrence after cure indicated the triggering of latent Shaoyin pathogens, emerging due to the deficiency of a new Shaoyang illness; and because Kidney Yang was first depleted and unable to push out the pathogen, chills worsened daily while heat intensity did not increase significantly. This required warming the meridians and pushing out the pathogen method, using Guizhi Tang (Cinnamon Twig Decoction) plus Renshen, Danggui (Angelicae Sinensis Radix), Shengdi Huang, and Niuxi processed with Fuzi juice, still modifying with Chaihu (Bupleuri Radix), Douchi, and Huangqin (Scutellariae Radix) for over ten doses. During this period, various symptoms of palpitations, fright, and convulsive tremors appeared repeatedly, so Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) plus Lingyangjiao were added, treating according to symptoms until recovery. At the time of the malaria recurrence, other physicians still used standard formulas for Summerheat-Dampness, taking twenty to thirty doses, with no change in condition. The patient himself said he would not recover, having delirious speech every night. The family suspected spirits, and doctors could not fathom the source of the disease. The reason was that recent physicians, while not bound by Wu Youke's Muyuan theory, were stuck in Wu Jutong's Sanjiao theory, completely unaware of the principle of latent Shaoyin pathogens manifesting along meridians. Thus, encountering such cases, they felt uncertain, light cases dragged into severity, severe cases had no remedy, seen frequently in recent years. Alas!