诒按∶伏邪之名，从前未经道及。自蒋问斋着医略十三
篇，煌煌然着伏邪之名，而伏温一病，始昭然大白于天下。惜乎其所撰伏邪篇，历引内经、仲景之文，既详且
备；而羼入吴又可募原之论，谓伏邪即与温疫同条共贯。殊不知温疫之邪，从口鼻吸受，所受者湿秽之邪，藏
于募原，则发为寒热、痞闷、呕恶等证。伏温之邪，从经络内袭，所袭者风寒之邪，伏于少阴，发为寒热、身
疼之候。病原见证，两者截然不同。蒋氏不能细加审别，而伏邪论中，每每将募原之说牵涉搀混，致学人转有
多歧之惑。爰亟取蒋氏伏邪篇原文，为之逐条辨正，俾读者豁目爽心，而于伏邪疫邪，不至更相牵混。诒非好
与前人辨难也，亦以病机所在，出入生死之间，不容稍有假借耳。
伏邪者，冬寒伏于募原之间，化热伤阴，表里分传，多为热证。以始得病，溲即混浊，或黄或赤为据。
原注兰亭曰∶小便乃州都气化，邪在表，无关于里，何至变色混浊；显是邪伏于中，化热伤阴之明验也。
诒按∶暑秽之邪，从口鼻吸受者，由肺胃而伏于募原，至秋令凉气外束，则发为伏暑。冬寒之邪，从皮毛
袭入者，由太阳而伏于少阴，至春令温气外达，则为伏温暑温两病。其病源见证，截然两途。吴又可所论温疫
病源，都属暑秽之邪。蒋氏乃谓冬寒伏于募原，是将温暑两邪，混为一病。其认题既误，则立论自不能中的矣
。
其见证，初起即溲赤而浑，神烦少寐，或洒洒振寒，蒸蒸发热，或但热不寒，或汗出热不退，或潮热往来
，或寒热如疟，或头疼身痛，或狂躁谵语，或渴或不渴，或反欲热饮，或有汗或无汗，或汗不达下。
诒按∶伏寒化热，由少阴而发，每有骨节烦疼，腰脊强痛之
证，以肾主骨髓，腰脊又为太阳经所辖之地也。内热上蒸，则头作痛，慎勿误认为表证，而强与发汗也。邪已
化热而反欲热饮者，中有痰浊弥漫，得热饮则开爽也。温病得汗，而热不达于下，甚或足冷不温，此由正虚而
气不流通，或因邪重而气被郁，以后病必见重，务宜留心。
舌苔或白或黄，或灰或黑，或滑或涩，或生芒刺，或反无苔而色紫赤。
诒按∶邪涉于胃，则舌上生苔。又可所论邪由募原而发，故始则苔如积粉。其邪化热，日渐加重，故苔亦
由白而黄而灰而黑，日渐增重也。若伏温化热，由少阴而出，间有不涉于胃者，则舌色如常。无论不见灰黑之
苔，即白黄之苔亦不甚浓。诚以热在阴经，其患不犯于胃，则胃中浊气无由上腾而结为苔也。此亦温暑两证之
分别处，学人当细心领会。
大便或秘或溏，或下利臭水，或如败酱，或带瘀血。
诒按∶伏温热养于里，必以大便通达，为热邪之出路。此与伤寒便溏为邪陷者，其论相反，而其理则一也
。
或遇湿土司令，酿成湿温，则身痛异常，溲更混浊，当与湿证门参治。然湿从土化，土无成位，湿无专证
，但治伏邪为主，辅以温通治湿之意可也。
诒按∶湿邪有外感时令之湿，亦有内伤久伏之湿，身痛亦有不因乎湿者，均当分别论治。至治法之或以湿
邪为主，或以伏温为主，当视湿邪温邪之轻重，其见证之缓急，方可着手，不容豫设成见也。
其解或战汗自汗，躁汗狂汗，发斑发疹。
诒按∶表气之郁，固由斑疹战汗而解。而欲求达表，必先里气畅行，则通腑一层，正伏温吃紧关头，不可
遗漏也。
其剧则或发痉，或神昏如醉，或苔黑起刺，唇齿焦枯，或鼻煤舌裂，或呃逆从少腹上冲，或摇头肢体振掉
，或气急痰壅。
诒按∶所叙诸剧证，皆热溃于阴。而燔及胃腑，或涉于手足厥阴之候，当分别施治，未可混列也。
其脉则忌紧涩细数，而喜和缓滑大。
诒按∶温邪之脉，弦滑数大，此其常也。间有邪热郁遏，而脉见细数不畅者，有正气不充，而脉见细弱不
数者，病必见重，医者宜留意焉。
其治或先用吴氏达原饮加减，从乎中治，然后或汗或下。如见三阳表证，则加羌葛柴胡之类；见三阴里证
，则加硝黄之类。或先汗而后下，或先下而后汗∶或汗而再汗，或下而再下；或但汗不下，或但下不汗；或养
阴化邪，补泻兼施。毋为夹阴所惑，误服桂附则死。当察其证脉，表里虚实，老少强弱，风土寒暄，膏粱藜藿
，参合为治。善后则宜和胃养阴。
原注兰亭曰∶夹阴二字，流俗相传，本无足据。若因房室致病，男子为夹阴，将女子为夹阳乎？真不值一
笑也。病在三阴为阴证，小儿亦有之，与房室何与焉？况阴证乃正伤寒家事，伏邪疫邪均无阴证；即或有之，
亦千百中之一耳。
诒按∶伏气化温，从阴而达，法当助阴托邪。达原饮乃燥烈伤阴之品，惟暑湿在募原，舌苔浊腻者宜之。
若施于伏温之病，则助热烁阴，岂堪尝试。盖由蒋氏误认又可所论之疫邪，谓即是伏温，而置内经、难经所论
于不问。
再按∶吴氏所列治法，于表证多用温燥劫阴之剂∶与伏气发温先伤阴分之病，甚不相宜。至所论里证治法
，都与伏温相合，可以取法不少。缘吴氏当日所见之证，仍属伏气居多；所论病情，亦多伏气之候。只以病源
未澈，识见不真，复有暑湿之邪夹杂而发者，淆乱其间。故论中每有病情确属伏温，治法亦合，而立论皆以疫
邪为名者，此则吴氏立说之卤莽也。
汗不出，九味羌活汤、活人败毒散、柴葛解肌汤、小柴胡汤、吴氏达原饮加三阳表药，医话柴胡白虎汤之
类。下则大小承气汤、调胃承气汤、桃仁承气汤、大柴胡汤、柴胡加芒硝汤、凉隔散、拔萃犀角地黄汤、吴氏
达原饮加大黄，医话中承气汤、蒌贝二陈汤之类。养阴化邪，则犀角地黄汤、医话柴胡生地汤之类。补养兼施
，则陶氏黄龙汤、医话大黄人参汤，或半夏泻心汤，或十味温胆汤之类。善后则医话归芍二陈汤加谷芽神曲之
类。此其大略，神而明之，存乎其人。
诒按∶所列诸方，粗浅散列。学人观其大略，原不能举以治病。其汗剂所列九味羌活及败毒解肌等方，燥
烈劫阴，于温病尤非所宜，学人勿为其所误也。
黄帝内经灵枢邪气脏腑病形篇曰∶正邪之中人也微，先见于色，不知于身；若有若无，若亡若存；有形无
形，莫知其情。
又五变篇曰∶百病之始期也，必先生于风雨寒暑，循毫毛而入腠理，或复还，或留止。
素问生气通天论曰∶冬伤于寒，春必病温。
八正神明论曰∶正邪者，身形若用力，汗出腠理开，逢虚风，其中人也微，故莫知其情，莫见其形。
热论篇曰∶今夫热病者，皆伤寒之类也。
此内经诸篇，分明以正邪内伏，而后发为温病也。
诒按∶以上内经各条，所论伏邪，亦既详且尽矣。何蒋氏尚牵涉募原之说，混而不分也。
六元正纪大论曰∶司天之气，气温草荣。民康之际，温厉大作，远近咸若，此其先有伏邪可知。
难经∶温病之脉，行在诸经，不知何经之动。此经中有伏邪可知。周礼四时皆有厉疫。盖邪伏之深，亦可
期年而发。
吕览∶礼记以非时之气为疫，即伏邪因感而发。
史记∶齐中御府长信，冬时堕水濡衣，至春病热。此伏邪化热可证。
诒按∶吕览一条，既以非时之气为疫，而又谓伏邪因感而发，是将疫邪伏邪牵合为一，蒋氏之病根在是矣
。
金匮要略，百合病，必待日数足而后解，是亦伏邪之类。
伤寒论平脉篇，直以伏邪为病名。
伤寒例以寒毒藏于肌肤，春变为温，夏变为暑。此以冬伤于寒，发为温病，本于经旨。
太阳篇∶太阳病发热而渴，不恶寒，为温病。既不恶寒，邪非在表，而渴属内热，其为伏气显然。
阳明篇诸下证，与伏邪入胃之意同。
少阴篇之自利，心下痛，厥阴篇之厥深热亦深，诸下证，亦与伏邪化热伤阴之意同。
诒按∶伤寒既经化热以后，其证治法，与伏温大略相同。其不同者，在即起自内达外之时，则恰与伤寒为
对待耳。
太平御览载曹植说，疫气致病，悉被褐茹藿之子，荆室蓬户之人；若夫殿处鼎食之家，若是者鲜矣。此亦
饥寒伤正，邪伏而后发也。巢元方以疫疠与时气温热相类，盖不知由于一气所伏，而有多寡轻重之分耳。通鉴
唐纪∶关中比岁饥馑，兵民率皆瘦黑。至麦始熟，市有醉人，当时以为嘉瑞。人乍饱食，死者五之一。此人饱
食，非受风寒，盖有伏邪内动也。刘河间宣明方，治疫疠，不宜热药。解表而用白虎汤、凉隔散，明其有伏热
在内也。
李东垣辩惑论载王辰改元，京师戒严，受敌半月。解围之后。都人之不病者万无一二，既病而死者接踵不
绝，将近百万。岂俱感风寒耶，盖伏邪所致耳。丹
溪心法附余，附伤寒直格心要论证治诸法，治伏邪甚善，当与吴氏温疫论互阅。
丹溪心法∶温疫，众人一般病者是。治有三法∶宜补，宜散，宜降。首用大黄、黄芩，先攻其里，亦因其
内有伏邪也。
方约之谓温热之病，因外感内伤，触动郁火，自内而发之于外也。此明言邪伏于中也。元史耶律楚材用大
黄治士卒病疫，亦足见其邪之伏于里也。
诒按∶以上各条所论，均系疫证；而蒋氏引之，每条牵入伏邪。其实疫证中有专病疫者，有兼伏邪者，当
随证审治。若将两证牵合立论，则不特伏邪之证治不清，并疫证亦茫无根据矣。
王履溯洄集∶温病热病，发于天令暄热之时，怫热自内而达之于外。又云∶世人治温热病，虽误攻其里，
亦无大害；误发其表，变不可言，足以明其热之自内达外矣。
张景岳以温疫本即伤寒，多发于春夏，必待日数足，然后得汗而解。此与金匮百合病之义同，皆有内伏之
邪故也。吴又可温疫论治伏邪最切，而反以冬伤于寒春必病温为非。是盖不知寒乃冬月之正邪，正邪之中人也
微，先见于色，不知于身；若有若无，若亡若存；及身形若用力，汗出腠理开，逢虚风；谓正邪可伏而后发也
。由是观之，伏邪所从来远矣。
诒按∶溯洄集所论，确系伏气所发，其论病情最为确当。蒋氏以伏邪与温疫牵合，已属误认。张景岳乃为温
疫本即伤寒，则误而又误。其谓必日数足而后能解，理亦不确。缘景岳于外感六淫病，其理路本未能清晰也。
吴又可专论温疫，遂将当时所见之病，无论其为伏温，为温疫，一概谓之疫邪。不责己之分辨不清，反疑内经
冬伤于寒之语为不确。其才识粗疏，横肆武断，亦未免不自量矣。蒋氏既知所伏者为正邪，则所见高出于吴氏
矣。何以篇中引用，仍以达原饮为主方。前后自相矛盾，吾所不解。
然人之强弱不同，攻补有异。大法有三∶攻邪为上策，扶正祛邪为中策，养阴固守为下策。盖邪扶于中，
犹祸起萧墙之内，邪正交争，势不两立。正气无亏，直攻其邪，邪退而正自复也。若正气有亏，不任攻邪，权
宜辅正，且战且守，胜负未可知也。若正气大亏，不能敌邪，惟有养阴一法，悉力固守，冀其邪分自解，不已
危乎。是以正气不虚，伏邪虽重，治得其宜，可奏全捷；惟正虚可畏。不知者，反以攻邪为太峻，乐用平稳之
方，致使邪氛日进，正气日亏，正不胜邪，则轻者重，重者危，卒至不起；乃引为天数，岂不谬哉。
诒按∶蒋氏此论，以攻邪为主，盖以邪退则正自复，去邪所以救阴也。吴鞠通温病条辨则专以养阴为主。
阴气既充，则在表者，液足自能致汗；在里者，增水乃可行舟。阴旺则热自解∶养阴即以泄热也。愚谓此两法
，亦当随人而施。如偏于阴虚者，则养阴以泄热，吴氏之论为宜。偏于邪重者，则泄热以
存阴，蒋氏之法为合。二者虽似相反，而实则相成也。
柳宝诒按语：伏邪这一名称，过去未曾提及。自从蒋问斋撰写《医略》十三篇，赫然提出“伏邪”之名后，“伏温”这一疾病才开始在天下人面前清晰明了。可惜他所撰写的《伏邪篇》，虽然广泛引用《内经》和仲景的经文，详尽完备；但却掺杂了吴又可关于募原的论述，认为伏邪与温疫是同一条脉络、紧密相连的。殊不知温疫的病邪，是从口鼻吸入的，所感受的是湿秽之邪，潜伏在募原，从而引发寒热、痞闷、呕吐恶心等症状。而伏温的病邪，是从经络内袭的，所侵袭的是风寒之邪，潜伏在少阴经，引发寒热、身体疼痛等证候。病源和见证，两者截然不同。蒋氏不能仔细加以辨别，而在伏邪论中，常常将募原的说法牵强附会地混杂其中，致使学习者反而产生更多的疑惑。因此我急切地选取蒋氏《伏邪篇》的原文，逐条进行辨正，使读者豁然开朗，对于伏邪和疫邪，不至于再相互混淆。我并非喜欢与前人争辩，而是因为病机所在，关乎生死，不容许丝毫含糊。
所谓伏邪，是冬天的寒邪潜伏在募原之间，化热损伤阴液，表里同时传变，多表现为热证。以刚得病时，小便即混浊，或黄或赤作为依据。
原注兰亭说：小便乃州都之官气化功能的表现，邪气在表，与里无关，怎么会变色混浊？这显然是邪气潜伏在中焦，化热伤阴的明证。
柳宝诒按语：暑秽之邪，从口鼻吸入的，由肺胃潜伏于募原，到了秋季凉气外束，就发为伏暑。冬天的寒邪，从皮毛袭入的，由太阳经潜伏于少阴经，到了春季温气外达，就发为伏温和暑温两种病。它们的病源和见证，截然分为两条路。吴又可所论述的温疫病源，都属于暑秽之邪。蒋氏却说冬寒潜伏在募原，这是将温邪和暑邪混为一谈。既然对题目的认识错误，那么立论自然就不能切中要害了。
其见证，初起即小便赤色且浑浊，心神烦乱睡眠少，或怕冷发抖，或发热如蒸，或只发热不怕冷，或出汗后热不退，或潮热往来，或寒热像疟疾，或头痛身痛，或狂躁胡言乱语，或口渴或不渴，或反而想喝热饮，或有汗或无汗，或出汗但热度不达下肢。
柳宝诒按语：伏寒化热，从少阴经发出，常有骨节烦疼、腰脊强痛的证候，因为肾主骨髓，腰脊又是太阳经所辖的区域。内热上蒸，头部就会作痛，千万不要误认为是表证而强行发汗。邪气已经化热却反而想喝热饮，是因为中有痰浊弥漫，得到热饮则能开散清爽。温病得了汗，但热度不达于下肢，甚至脚冷不温暖，这是由于正气虚弱导致气机不流通，或者因为邪气太重导致气机被郁遏，此后病情必定加重，务必留心。
舌苔或白或黄，或灰或黑，或滑或涩，或生芒刺，或反而没有苔而舌色紫赤。
柳宝诒按语：邪气涉及胃，舌上就会生苔。吴又可论述邪气由募原发出，所以开始时舌苔像积粉一样。邪气化热，日渐加重，所以舌苔也由白变黄、变灰、变黑，日渐增重。如果伏温化热，从少阴经发出，间或有不涉及胃的情况，那么舌色如常。无论不见灰黑色的苔，即使有白黄色的苔也不甚浓重。诚然，热在阴经，其病患不侵犯胃，那么胃中的浊气就无法上腾结聚形成舌苔。这也是温病和暑温两种证候的区别之处，学习者应当细心领会。
柳宝诒按语：伏温热邪蕴养于体内，必须以大便通畅，作为热邪排出的出路。这与伤寒便溏是邪气内陷的观点相反，但其道理是一致的。
如果遇到湿土当令，酿成湿温，则身体疼痛异常，小便更加混浊，应当参考湿证门的方法治疗。然而湿从土化，土没有固定的位置，湿也没有专门的证候，只要以治疗伏邪为主，辅以温通治湿的意思就可以了。
柳宝诒按语：湿邪有外感时令的湿，也有内伤久伏的湿，身体疼痛也有不是因为湿引起的，都应当分别论治。至于治疗方法是以湿邪为主，还是以伏温为主，应当视湿邪和温邪的轻重，以及见证的缓急，才可以着手，不允许预先设定成见。
柳宝诒按语：表气的郁滞，固然可以通过斑疹、战汗来解除。但要寻求邪气达表，必须先让里气畅行，那么通腑这一层，正是伏温的关键关头，不可遗漏。
病情严重的，可能发痉，或神志昏迷像醉酒，或舌苔黑且有芒刺，嘴唇牙齿焦枯，或鼻孔如烟煤、舌头裂开，或呃逆从少腹向上冲，或摇头肢体颤抖，或气急痰壅。
柳宝诒按语：所叙述的这些危重证候，都是热邪溃败于阴分，燔灼波及胃腑，或涉及手足厥阴经的证候，应当分别施治，不可以混列在一起。
其脉象忌讳紧涩细数，而喜欢和缓滑大。
柳宝诒按语：温邪的脉象，弦滑数大，这是常态。间或有邪热郁遏，脉象出现细数不畅的；有正气不充，脉象出现细弱不数的，病情必定加重，医者应当留意。
其治疗方法，有的先用吴氏达原饮加减，从中焦治疗，然后或发汗或攻下。如果见到三阳表证，就加羌活、葛根、柴胡之类；见到三阴里证，就加芒硝、大黄之类。或先汗后下，或先下后汗；或汗后再汗，或下后再下；或只汗不下，或只下不汗；或养阴化邪，补泻兼施。不要被夹阴所迷惑，误服桂枝、附子就会死亡。应当观察其证候脉象，表里虚实，老少强弱，风土气候冷暖，饮食厚薄，综合参合进行治疗。善后调理则宜和胃养阴。
原注兰亭说：“夹阴”二字，流俗相传，本来就没有根据。如果因为房事致病，男子叫夹阴，难道女子就叫夹阳吗？真是不值得一笑。病在三阴属于阴证，小儿也有，与房事有什么关系呢？况且阴证乃是正伤寒的家事，伏邪和疫邪都没有阴证；即使有，也是千中无一。
柳宝诒按语：伏气化温，从阴分透出，治法应当助阴托邪。达原饮是燥烈伤阴的药物，只有暑湿在募原，舌苔浊腻的才适宜使用。如果用于伏温的病，就会助热烁阴，怎么经得起尝试呢？大概是因为蒋氏误认吴又可所论述的疫邪，认为就是伏温，而置《内经》、《难经》的论述于不顾。
再按：吴氏所列的治疗方法，对于表证多用温燥劫阴的药物，与伏气发温先伤阴分的病，非常不相宜。至于所论述的里证治法，都与伏温相合，可以取法的地方不少。因为吴氏当日所见到的证候，仍属伏气居多；所论述的病情，也多伏气的证候。只是因为病源未透彻，见识不真切，又有暑湿之邪夹杂发作，混淆在其中。所以论中每有病情确属伏温，治法也合适，但立论都以疫邪命名的，这是吴氏立说的粗疏之处。
汗不出，用九味羌活汤、活人败毒散、柴葛解肌汤、小柴胡汤、吴氏达原饮加三阳表药，医话中提到的柴胡白虎汤之类。攻下则用大小承气汤、调胃承气汤、桃仁承气汤、大柴胡汤、柴胡加芒硝汤、凉隔散、拔萃犀角地黄汤、吴氏达原饮加大黄，医话中提到的中承气汤、蒌贝二陈汤之类。养阴化邪，则用犀角地黄汤、医话中提到的柴胡生地汤之类。补养兼施，则用陶氏黄龙汤、医话中提到的大黄人参汤，或半夏泻心汤，或十味温胆汤之类。善后调理则用医话中提到的归芍二陈汤加谷芽神曲之类。这只是大致情况，神妙运用，在于个人。
柳宝诒按语：所列诸方，粗略散列。学习者看其大意，原本不能拿来直接治病。其所列的发汗剂中的九味羌活及败毒解肌等方，燥烈劫阴，对于温病尤其不适宜，学习者不要为其所误。
《黄帝内经灵枢·邪气脏腑病形篇》说：正邪中人很轻微，先见于面色，身体感觉不到；若有若无，若亡若存；有形无形，不知道它的实情。
又《五变篇》说：百病开始的时候，一定先生于风雨寒暑，顺着毫毛进入腠理，有的返回，有的停留。
《素问·生气通天论》说：冬天伤害于寒，春天必定发生温病。
《八正神明论》说：正邪者，身形如果用力的时候，汗出腠理开，逢遇虚风，它中人很轻微，所以不知道它的实情，看不见它的形状。
《热论篇》说：现在的热病，都是伤寒一类。
柳宝诒按语：以上《内经》各条，所论述的伏邪，也已经详尽完备了。为什么蒋氏还要牵涉募原的说法，混淆而不区分呢？
《六元正纪大论》说：司天的之气，气温草荣。民众安康之际，温厉大作，远近都一样，这说明先前有伏邪可知。
《难经》说：温病的脉象，行走在各经，不知道哪一经动。这说明经中有伏邪可知。《周礼》四时都有厉疫。大概邪气伏藏很深，也可以过一年才发作。
《吕览》说：《礼记》以非时之气为疫，即伏邪因感而发。
《史记》说：齐国中御府长信，冬天落水弄湿衣服，到春天病热。这是伏邪化热的证明。
柳宝诒按语：《吕览》这一条，既然以非时之气为疫，又说伏邪因感而发，是将疫邪和伏邪牵合为一，这是蒋氏的病因所在。
《伤寒例》以寒毒藏于肌肤，春变为温，夏变为暑。这是以冬伤于寒，发为温病，本于经旨。
《太阳篇》：太阳病发热而渴，不恶寒，为温病。既然不恶寒，邪不在表，而渴属内热，其为伏气显然。
《少阴篇》之自利，心下痛，《厥阴篇》之厥深热亦深，诸下证，也与伏邪化热伤阴的意思相同。
柳宝诒按语：伤寒既经化热以后，其证治法，与伏温大致相同。不同的地方在于，即起自内达外之时，则恰好与伤寒相对待。
《太平御览》载曹植说，疫气致病，全是被穿粗布吃野菜的儿子，住在荆棘蓬户的人；如果是殿处鼎食之家，像这样的人很少。这也是饥寒伤正，邪伏而后发。巢元方以疫疠与时气温热相类，大概不知道由于一气所伏，而有多寡轻重之分罢了。《通鉴·唐纪》：关中连年饥荒，兵民大都瘦黑。到麦子刚熟，市场上有醉人，当时以为是嘉瑞。人突然饱食，死者五分之一。这些人饱食，不是受风寒，大概是伏邪内动。刘河间《宣明方》，治疫疠，不宜热药。解表而用白虎汤、凉隔散，明其有伏热在内。
李东垣《辩惑论》载王辰改元，京师戒严，受敌半月。解围之后，都城中不生病的人万无一二，既病而死者接踵不绝，将近百万。难道是都感风寒吗？大概是伏邪所致。《丹溪心法附余》，附《伤寒直格心要》论证治诸法，治伏邪很好，应当与吴氏《温疫论》互阅。
《丹溪心法》：温疫，众人一般病者是。治有三法：宜补，宜散，宜降。首用大黄、黄芩，先攻其里，也是因其内有伏邪。
方约之说温热之病，因外感内伤，触动郁火，自内而发之于外。这明确说明邪伏于中。《元史》耶律楚材用大黄治士卒病疫，也足以见其邪之伏于里。
柳宝诒按语：以上各条所论，均系疫证；而蒋氏引之，每条牵入伏邪。其实疫证中有专病疫者，有兼伏邪者，应当随证审治。若将两证牵合立论，则不仅伏邪之证治不清，并疫证亦茫无根据。
王履《溯洄集》：温病热病，发于天令暄热之时，怫热自内而达之于外。又说：世人治温热病，虽误攻其里，亦无大害；误发其表，变不可言，足以明其热之自内达外。
张景岳认为温疫本即伤寒，多发于春夏，必待日数足，然后得汗而解。这与《金匮》百合病的意义相同，都有内伏之邪的缘故。吴又可《温疫论》治伏邪最切，反而以“冬伤于寒春必病温”为非。这是不知道寒乃冬月之正邪，正邪之中人也微，先见于色，不知于身；若有若无，若亡若存；及身形若用力，汗出腠理开，逢虚风；谓正邪可伏而后发。由此观之，伏邪所从来远矣。
柳宝诒按语：《溯洄集》所论，确系伏气所发，其论病情最为确当。蒋氏以伏邪与温疫牵合，已属误认。张景岳乃为温疫本即伤寒，则误而又误。其谓必日数足而后能解，理亦不确。缘景岳于外感六淫病，其理路本未能清晰。
吴又可专论温疫，遂将当时所见之病，无论其为伏温，为温疫，一概谓之疫邪。不责己之分辨不清，反疑《内经》“冬伤于寒”之语为不确。其才识粗疏，横肆武断，亦未免不自量。蒋氏既知所伏者为正邪，则所见高出于吴氏矣。何以篇中引用，仍以达原饮为主方。前后自相矛盾，吾所不解。
然而人的强弱不同，攻补有异。大法有三：攻邪为上策，扶正祛邪为中策，养阴固守为下策。盖邪扶于中，犹祸起萧墙之内，邪正交争，势不两立。正气无亏，直攻其邪，邪退而正自复。若正气有亏，不任攻邪，权宜辅正，且战且守，胜负未可知。若正气大亏，不能敌邪，惟有养阴一法，悉力固守，冀其邪分自解，不已危乎。是以正气不虚，伏邪虽重，治得其宜，可奏全捷；惟正虚可畏。不知者，反以攻邪为太峻，乐用平稳之方，致使邪氛日进，正气日亏，正不胜邪，则轻者重，重者危，卒至不起；乃引为天数，岂不谬哉。
柳宝诒按语：蒋氏此论，以攻邪为主，盖以邪退则正自复，去邪所以救阴。吴鞠通《温病条辨》则专以养阴为主。阴气既充，则在表者，液足自能致汗；在里者，增水乃可行舟。阴旺则热自解：养阴即以泄热。愚谓此两法，亦当随人而施。如偏于阴虚者，则养阴以泄热，吴氏之论为宜。偏于邪重者，则泄热以存阴，蒋氏之法为合。二者虽似相反，而实则相成。
Liu Baozhi's commentary: The term "Fu Xie" (latent pathogenic factor) was not mentioned before. Since Jiang Wenzhai wrote the *Yi Lue* (Medical Strategy), thirteen chapters, prominently proposing the name "Fu Xie", the disease of "Fu Wen" (latent warm disease) has finally become clear to the world. Unfortunately, in his chapter on "Fu Xie", although he extensively cited texts from the *Neijing* (Inner Canon) and Zhang Zhongjing, being detailed and complete; he intermingled Wu Keyou's theory about the "Mu Yuan" (seminary/moat origin), claiming that Fu Xie is identical to and closely linked with Wen Yi (warm epidemic). Little did he know that the pathogen of Wen Yi enters through the mouth and nose, absorbing damp-turbid pathogens, which hide in the Mu Yuan, thereby causing symptoms such as alternating chills and fever, chest fullness and stuffiness, nausea, and vomiting. On the other hand, the pathogen of Fu Wen invades internally via the meridians, attacking with wind-cold pathogens, hiding in the Shaoyin (Lesser Yin) meridian, causing symptoms like alternating chills and fever, and body pain. The etiology and manifestations are completely different. Jiang failed to carefully distinguish them, often forcing the theory of Mu Yuan into his discussion of Fu Xie, causing confusion among learners. Therefore, I urgently selected the original text of Jiang's "Fu Xie" chapter to refute it item by item, so that readers may have a clear mind and not confuse Fu Xie with epidemic pathogens. I do not enjoy debating with predecessors; rather, because the mechanism of disease involves life and death, no ambiguity is tolerated.
What is called Fu Xie is winter cold pathogens hiding between the Mu Yuan, transforming into heat and damaging Yin fluids, transmitting simultaneously to the exterior and interior, mostly manifesting as heat syndromes. The basis for this is that upon onset, urine becomes turbid, either yellow or red.
Original note by Lanting states: Urination is governed by the Qi transformation of the Zhou Du (bladder). If the pathogen is at the exterior, it should not affect the interior, so why would the color change and become turbid? This is clearly evidence of pathogens hiding in the middle, transforming into heat and damaging Yin.
Liu Baozhi's commentary: Damp-turbid pathogens absorbed through the mouth and nose hide in the Mu Yuan via the Lung and Stomach. When autumn cool air binds the exterior, it manifests as Fu Shu (latent summerheat). Winter cold pathogens entering through the skin and hair hide in the Shaoyin via the Taiyang (Greater Yang) meridian. When spring warmth reaches the exterior, it manifests as two diseases: Fu Wen (latent warm disease) and Shu Wen (summerheat-warm disease). Their etiologies and manifestations are strictly separate paths. Wu Keyou's discussion on the etiology of warm epidemics belongs entirely to damp-turbid pathogens. Jiang claimed that winter cold hides in the Mu Yuan, mixing Wen (warm) and Shu (summerheat) pathogens into one disease. Since his understanding of the topic is wrong, his theoretical arguments naturally miss the mark.
Manifestations include: At onset, urine is red and turbid; mental restlessness and insomnia; or aversion to cold with shivering; or steaming fever; or only fever without aversion to cold; or fever persisting after sweating; or tidal fever with alternation; or chills and fever resembling malaria; or headache and body pain; or mania and delirium; or thirst or no thirst; or preference for hot drinks despite heat; or sweating or no sweating; or sweating but heat not reaching the lower limbs.
Liu Baozhi's commentary: When latent cold transforms into heat and emerges from the Shaoyin, there are often painful joints and stiffness/pain in the waist and spine, because the Kidney governs bone marrow, and the waist/spine is the territory of the Taiyang meridian. Internal heat steaming upward causes headache. Do not mistake this for an exterior syndrome and force sweating. If the pathogen has transformed into heat but the patient still desires hot drinks, it is due to turbid phlegm obstructing the interior; hot drinks help disperse it. In warm diseases, if sweat occurs but heat does not reach the lower limbs, or feet are cold, this is due to deficiency of healthy Qi leading to stagnant Qi flow, or severe pathogen causing Qi depression. The condition will likely worsen subsequently, requiring careful attention.
Tongue coating may be white, yellow, gray, or black; slippery or rough; with prickles; or conversely, no coating with purple-red tongue body.
Liu Baozhi's commentary: When pathogens involve the Stomach, coating appears on the tongue. Wu Keyou discussed pathogens emerging from the Mu Yuan, hence initially the coating resembles accumulated powder. As pathogens transform into heat and worsen day by day, the coating changes from white to yellow, then gray, then black, worsening progressively. However, if Fu Wen transforms into heat and emerges from the Shaoyin, sometimes it does not involve the Stomach, resulting in a normal tongue color. Whether gray/black coating is absent, even white/yellow coating is not thick. Indeed, heat in the Yin meridians does not invade the Stomach, so turbid Qi in the Stomach cannot ascend to form coating. This is also the distinction between warm and summerheat syndromes; learners should comprehend this carefully.
Stool may be constipated or loose; or discharge foul-smelling water; or resemble spoiled sauce; or contain blood stasis.
Liu Baozhi's commentary: Latent warm-heat pathogens nourish themselves within the interior. Unobstructed bowel movement serves as the exit route for heat pathogens. This contrasts with Shanghan (cold damage) where loose stool indicates pathogen sinking inward, yet the underlying principle is consistent.
If wet-earth season commands,酿成湿温 (brewing damp-warmth), body pain is extreme, urine more turbid. Treat referencing the Dampness chapter. However, dampness transforms from earth, earth has no fixed position, dampness has no specific syndrome. Focus primarily on treating Fu Xie, assisted by warming and unblocking methods for dampness.
Liu Baozhi's commentary: Damp pathogens include external seasonal dampness and internal long-term latent dampness. Body pain may also occur unrelated to dampness. All must be treated separately. Regarding treatment strategy—whether prioritizing dampness or latent warmth—depends on the severity of damp vs. warm pathogens and the urgency of symptoms. One must not hold preconceived notions.
Resolution may occur via battle-sweat, spontaneous sweat, restless sweat, manic sweat, macules, or papules.
Liu Baozhi's commentary: Exterior Qi stagnation can indeed resolve via macules/papules or battle-sweat. But to seek resolution at the exterior, Interior Qi must first flow freely. Thus, purging the bowels is a critical juncture in treating Fu Wen and cannot be overlooked.
Severe cases may present with convulsions, coma resembling drunkenness, black tongue coating with prickles, scorched lips/teeth, soot-like nostrils, cracked tongue, hiccups rushing up from the lower abdomen, head shaking, limb tremors, or急促 breathing with phlegm obstruction.
Liu Baozhi's commentary: These severe symptoms indicate heat溃败 (溃败:溃烂/breakdown) in the Yin levels, blazing to the Stomach organ, or involving the Hand-Foot Jueyin meridians. They must be treated distinctly, not mixed together.
Pulse should avoid tight, choppy, fine, and rapid qualities; instead, prefer harmonious, slippery, and large pulses.
Liu Baozhi's commentary: Warm pathogen pulses are typically string-taut, slippery, rapid, and large. Occasionally, heat constraint causes fine/rapid/unsmooth pulses; healthy Qi deficiency causes weak/fine/non-rapid pulses. Both indicate serious illness; physicians must pay attention.
Treatment methods vary: Some start with modified Wu's Da Yuan Yin (Reach the Origin Decoction), treating from the Middle Jiao, followed by sweating or purging. If Taiyang/Yangming/Jueyin exterior signs appear, add Qiang Huo (Notopterygium Rhizome), Ge Gen (Kudzu Root), Chai Hu (Bupleurum Root). If Yin interior signs appear, add Mang Xiao (Mirabilite), Da Huang (Rhubarb Root). Order may be sweat then purge, or purge then sweat; repeat sweating or purging; or only sweat, or only purge; or nourish Yin to resolve pathogens, combining tonification and draining. Do not be confused by "Jia Yin" (clamped Yin); mistakenly using Gui Zhi Tang (Cinnamon Twig Decoction) or Fu Zi (Aconite Root) will cause death. Observe syndrome and pulse, exterior/interior, deficiency/excess, age/strength, local climate, diet richness/coarseness, and treat comprehensively. Post-illness care should harmonize the Stomach and nourish Yin.
Original note by Lanting says: The term "Jia Yin" is folk tradition without basis. If sexual activity causes disease in men as "Jia Yin", does it mean women have "Jia Yang"? It is laughable. Yin syndromes in the Three Yin meridians occur in children too, unrelated to sexual activity. Moreover, Yin syndromes belong to Zheng Shanghan (True Cold Damage); Fu Xie and Yi Xie (epidemic pathogens) generally do not have Yin syndromes; if any, they are rare.
Liu Baozhi's commentary: When latent cold transforms into warmth and emerges from Yin, the method should assist Yin to push out pathogens. Da Yuan Yin is drying and damaging to Yin; it is suitable only for damp-heat in the Mu Yuan with turbid/greasy tongue coating. Using it for Fu Wen would aggravate heat and consume Yin. Jiang mistakenly identified Wu Keyou's epidemic pathogens as Fu Wen, ignoring the *Neijing* and *Nanjing*.
Further commentary: Wu's listed treatments for exterior syndromes use many drying/harsh agents that injure Yin, unsuitable for latent Qi warming which first damages the Yin level. However, his interior treatments align well with Fu Wen and offer much to learn. Wu observed mostly latent Qi cases; his discussions reflect latent Qi patterns. Due to unclear etiology and imprecise insight, compounded by mixed damp-heat pathogens, he labeled everything as epidemic pathogens even when describing Fu Wen accurately. This shows Wu's rash theorizing.
For no sweat: Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction), Huo Ren Bai Du San (Life-Saving Toxin-Expelling Powder), Chai Ge Jie Ji Tang (Bupleurum and Kudzu Muscle-Releasing Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), Wu's Da Yuan Yin plus Taiyang/Yangming/Jueyin exterior herbs, or Chai Hu Bai Hu Tang (Bupleurum and White Tiger Decoction) from medical anecdotes. For purging: Da Cheng Qi Tang (Major Order the Qi Decoction), Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction), Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), Chai Hu Jia Mang Xiao Tang (Bupleurum Plus Mirabilite Decoction), Liang Ge San (Cool the Grid Powder), Ba Cui Xi Jiao Di Huang Tang (Excellence Collection Rhino Horn Rehmannia Decoction), Wu's Da Yuan Yin plus Da Huang, or Zhong Cheng Qi Tang/Lou Bei Er Chen Tang from anecdotes. For nourishing Yin/resolving pathogens: Xi Jiao Di Huang Tang (Rhino Horn Rehmannia Decoction), Chai Hu Sheng Di Tang (Bupleurum and Rehmannia Decoction) from anecdotes. For combined tonification/draining: Tao Shi Huang Long Tang (Tao's Yellow Dragon Decoction), Da Huang Ren Shen Tang (Rhubarb and Ginseng Decoction) from anecdotes, or Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction), Shi Wei Wen Dan Tang (Ten-Ingredient Warming Gallbladder Decoction). Post-care: Gui Shao Er Chen Tang plus Gu Ya (Grain Sprout) and Shen Qu (Medicated Leaven) from anecdotes. This is the general outline; divine application depends on the individual.
Liu Baozhi's commentary: Listed formulas are roughly scattered. Learners seeing the gist cannot directly use them for treatment. The sweating agents listed, such as Jiu Wei Qiang Huo and Bai Du/Jie Ji formulas, are harsh and injure Yin, especially unsuitable for warm diseases. Learners must not be misled.
The *Huangdi Neijing Lingshu: Xieqi Zangfu Bingxing Pian* states: When Zheng Xie (regular pathogens) attack humans, it is subtle; first seen in complexion, unnoticed by the body; seeming present yet absent, existing yet vanishing; shapeless, its nature unknown.
The *Wubian Pian* states: At the beginning of all diseases, they must arise from wind, rain, cold, and heat, entering through hair follicles and couli (pores); some return, some remain.
The *Suwen: Shengqi Tongtian Lun* states: Injury by cold in winter leads to warm disease in spring.
The *Bazheng Shenming Lun* states: Zheng Xie attacks subtly when the body exerts effort, pores open from sweat, encountering deficient winds; its nature is unknown, its form unseen.
The *Relun Pian* states: Current heat diseases are all categories of Shanghan (cold damage).
These *Neijing* chapters clearly state that Zheng Xie hides internally, later manifesting as warm disease.
Liu Baozhi's commentary: The above *Neijing* passages discuss Fu Xie in detail. Why does Jiang still mix in the Mu Yuan theory, confusing them?
The *Liuyuan Zhengji Dalun* states: When Si Tian (ruling) Qi brings warmth, grass flourishes. Amidst public health, warm plagues erupt widely; this indicates prior latent pathogens.
The *Nanjing* states: Pulses of warm diseases travel through various meridians, making it hard to identify the active meridian. This implies latent pathogens in the meridians. The *Zhouli* mentions plagues in all four seasons. Deeply hidden pathogens can take a year to manifest.
The *Lüshi Chunqiu* states: The *Liji* defines non-seasonal Qi as plague, i.e., Fu Xie manifesting upon stimulation.
The *Shiji* records: Changxin of Qi's Imperial Guard fell into water in winter, soaking clothes; in spring, he developed fever. This proves latent pathogens transform into heat.
Liu Baozhi's commentary: The *Lüshi Chunqiu* passage conflates plague and Fu Xie, which is Jiang's fundamental error.
The *Jingui Yaolüe* notes: Baihe Bing (Lily Disease) resolves only after sufficient days pass, indicating it is a type of Fu Xie.
The *Shanghan Lun: Pingmai Pian* explicitly names Fu Xie as a disease category.
The *Shanghan Li* states: Cold toxins hide in skin/flesh, becoming warm in spring, summerheat in summer. This bases "winter cold injury leading to spring warm disease" on canonical principles.
The *Taiyang Pian* states: Taiyang disease with fever, thirst, and no aversion to cold is warm disease. No aversion to cold means pathogen is not at the exterior; thirst indicates internal heat, clearly showing latent Qi.
The *Yangming Pian*'s purgative syndromes align with the concept of Fu Xie entering the Stomach.
The *Shaoyin Pian*'s spontaneous diarrhea and epigastric pain, and the *Jueyin Pian*'s "deeper cold, deeper heat," along with purgative syndromes, align with the concept of Fu Xie transforming into heat and damaging Yin.
Liu Baozhi's commentary: After Shanghan transforms into heat, its treatment is largely similar to Fu Wen. The difference lies in the onset: Fu Wen emerges from interior to exterior, opposite to typical Shanghan progression.
The *Taiping Yulan* cites Cao Zhi: Plague afflicts those wearing coarse cloth and eating vegetables, living in thorn-huts; rarely affects palace dwellers and noble families. This shows malnutrition/cold damaging healthy Qi, with pathogens hiding then manifesting. Chao Yuanfang compared plague to seasonal warm-heat, failing to recognize variations in severity based on the same hidden pathogen. The *Tongjian Tang Ji* records: Guanzhong suffered famine; soldiers/civilians were emaciated. When wheat ripened, drunkards appeared in markets, hailed as auspicious. Sudden overeating killed one-fifth. This wasn't wind-cold, but internal activation of latent pathogens. Liu Hejian's *Xuanming Fang* advised against hot drugs for plague; using Bai Hu Tang and Liang Ge San for exterior release confirms internal latent heat.
Li Dongyuan's *Bianhuo Lun* records: During Wang Chen's reign change, Beijing was besieged for half a month. After relief, almost everyone got sick, nearly a million died. Was it all wind-cold? No, it was caused by latent pathogens. The *Danxi Xinfa Fuyu* includes methods for treating Fu Xie excellently; compare with Wu's *Wenyi Lun*.
The *Danxi Xinfa* states: Plague affects everyone similarly. Treatment has three methods: tonify, disperse, descend. Start with Da Huang and Huang Qin to purge the interior, acknowledging internal latent pathogens.
Fang Yuezhi stated: Warm-heat diseases arise from external/internal injuries triggering stagnant fire, emerging from interior to exterior. This explicitly states pathogens hide within. The *Yuan Shi* records Yelu Chucai using Da Huang to treat soldiers' plague, proving pathogens hide in the interior.
Liu Baozhi's commentary: The above passages discuss plague syndromes; Jiang forces them into Fu Xie discussions. Plague syndromes include pure plague cases and those combined with Fu Xie; treat according to symptoms. Conflating them confuses both Fu Xie and plague treatments.
Wang Lv's *Suhui Ji* states: Warm/heat diseases emerge during hot weather, with stifling heat rising from interior to exterior. He noted that mistakenly purging the interior in warm-heat treatment causes little harm, but mistakenly sweating the exterior causes unpredictable changes, proving heat rises from interior to exterior.
Zhang Jingyue considered plague essentially Shanghan, occurring in spring/summer, resolving only after sufficient days with sweat. This aligns with *Jingui*'s Baihe Bing, implying internal latent pathogens. Wu Keyou's *Wenyi Lun* addressed Fu Xie effectively but denied "winter cold leads to spring warm disease." He failed to understand that winter cold is the regular pathogen of winter; its attack is subtle, appearing in complexion, seemingly present/absent, activating upon exertion/sweat/open pores. Thus, regular pathogens can hide and manifest later. This shows the ancient origins of Fu Xie theory.
Liu Baozhi's commentary: *Suhui Ji* correctly discusses latent Qi emergence. Jiang's conflation of Fu Xie and plague is erroneous. Zhang Jingyue's claim that plague is Shanghan is doubly wrong. His insistence on waiting for days to resolve is also inaccurate, as Zhang lacked clarity on Six Exogenous Pathogens.
Wu Keyou focused solely on plague, labeling all contemporary diseases as epidemic pathogens regardless of whether they were Fu Wen or plague. Blaming others for his lack of distinction, he doubted the *Neijing*'s "winter cold" statement. His reasoning was crude and dogmatic. Although Jiang recognized the hidden pathogen as Zheng Xie, surpassing Wu, he still used Da Yuan Yin as the main formula in his chapter, contradicting himself.
Human strength varies; attack and tonification differ. There are three major principles: Attacking pathogens is the best strategy; supporting healthy Qi while expelling pathogens is medium; nourishing Yin and holding fast is the worst. Pathogens hiding within are like internal rebellion; healthy Qi and pathogens clash irreconcilably. If healthy Qi is intact, directly attack pathogens; once pathogens retreat, healthy Qi recovers. If healthy Qi is deficient and cannot withstand attack, temporarily support healthy Qi, fighting and defending simultaneously, outcome uncertain. If healthy Qi is severely depleted, only nourishing Yin remains; hold fast hoping pathogens self-resolve, though this is dangerous. Therefore, if healthy Qi is not deficient, even heavy Fu Xie can be cured properly; only healthy Qi deficiency is feared. Ignorant people consider attacking pathogens too harsh, preferring mild formulas, allowing pathogens to advance daily, healthy Qi to decline, leading to light cases becoming heavy, heavy cases becoming critical, and death. They blame fate, which is absurd.
Liu Baozhi's commentary: Jiang's argument prioritizes attacking pathogens, believing that removing pathogens saves Yin. Wu Juztong's *Wenbing Tiaobian* prioritizes nourishing Yin. Once Yin is replenished, exterior fluid suffices for sweat; interior fluid allows navigation (bowel movement). Abundant Yin resolves heat; nourishing Yin drains heat. I believe these two methods should be applied based on the patient. For Yin deficiency, nourishing Yin to drain heat suits Wu's approach. For severe pathogens, draining heat to preserve Yin suits Jiang's approach. Though seemingly opposite, they complement each other.