有病因，有病名，有病形；辨其因，正其名，察其形。三者俱当，始可以言治矣。一或未明，而曰不误于人，吾未
之信也。且如伤寒，此以病因而为病名者也。温病、热病，此以天时与病形而为病名者也。由三者皆起于感寒，或者通
以伤寒称之。夫通称伤寒者，原其因之同耳，至于用药则不可一例而施也。何也？夫伤寒盖感于霜降后春分前，然不即
发，郁热而发于春夏者也。伤寒即发于天令寒冷之时，而寒邪在表闭其腠理，故非辛甘温之剂，不足以散之，此仲景桂
枝、麻黄等汤，之所以必用也。温病、热病后发于天令暄热之时，怫热自内而达于外，郁其腠理，无寒在表，故非辛凉
或苦寒或酸苦之剂，不足以解之，此仲景桂枝、麻黄等汤独治外者，之所以不可用。而后人所处水解散（麻黄、大黄、
黄芩、桂心、甘草、白芍）、大黄汤（大黄、芒硝、芥子、丹皮、桃仁）、千金汤（麻黄、桑白皮、苏子、杏仁、白果、
黄芩、半夏、甘草、款冬花）、防风通圣散（防风、川芎、当归、芍药、大黄、薄荷、麻黄、连翘、芒硝、石膏、黄芩、
桔梗、滑石、甘草、芥穗、白术、栀子）之类，兼治内外者，之所以可用也。夫即病之伤寒，有恶风，恶寒之证者，风
寒在表，而表气受伤故也。后发之温病、热病，有恶风，恶寒之证者，重有风寒新中，而表气亦受伤故也。若无新中之
风寒，则无恶风，恶寒之证，故仲景曰∶太阳病，发热而渴，不恶寒者，为温病。温病如此，则知热病亦如此，是则不
渴而恶寒者，非温热病矣。然或有不因新中风寒，亦见恶风恶寒之证者。盖病患表气本虚，热达于表，又重伤表气，故
不禁风寒，非伤风，恶风，伤寒，恶寒也，但卫虚则恶风，营虚则恶寒耳。且温病、热病，亦有先见表证，而后传里者。
盖怫热自内达外，热郁腠理，不得外泄，遂复还里，而成可攻之证，非如伤寒，从表而始也。或者不悟此理，乃于春夏
温病热病而求浮紧之脉，不亦疏乎！殊不知紧为寒脉，有寒邪则见之，无寒邪则不见也。其温病、热病或见脉紧者，乃
重感不正之暴寒与内伤过度之冷食也，岂其本然哉。又或者不识脉形，但见弦便呼为紧，断为寒而妄治。盖脉之盛而有
力者，每每兼弦，岂可错认为紧而断为寒。夫温病、热病之脉，多在肌肉之分而不甚浮，且右手反盛于左手者，诚由怫
热在内故也。其或左手盛，或浮者，必有重感之风寒，否则非温病、热病，自是暴感风寒之病耳。凡温病、热病若无重
感，表证虽间见，而里病为多，故少有不渴者。斯时也，法当治里热为主，而解表兼之，亦有治里而表自解者。余每见
世人治温热病，虽误攻其里亦无大害，误发其表变不可言，此足以明其热之自内达外矣。其间有误攻里而致大害者，乃
春夏暴寒所中之疫证，邪纯在表，未入于里故也，不可与温病、热病同论。夫惟世以温病、热病混称伤寒，故每执寒字，
以求浮紧之脉，以用温热之药。若此者，因名乱实，而戕人之生，名其可不正乎。又方书多言四时伤寒，故以春夏之温
病、热病与秋冬之伤寒，一类视之，而无所别。夫秋冬之伤寒，真伤寒也；春夏之伤寒，寒疫也。与温病、热病自是两
途，岂可同治。吁！此弊之来，非一日矣，历考方书并无救弊之论，每每雷同，良可痛哉！虽然伤寒与温病、热病，其
攻里之法，若果是以寒除热，固不必求异，其发表之法，断不可不异也。况伤寒之直伤阴经，与太阳虽伤，不及郁热，
即传阴经为寒证，而当温者，又与温病、热病大不同，其可妄治乎！或者知一不知二，故谓仲景发表药今不可用，而攻
里之药乃可用。呜呼！其可用不可用之理，果何在哉？若能辨其因，正其名，察其形，治法其有不当者乎！彼时行不正
之气所作，乃重感异气而变者，则又当观其何时、何气，参酌伤寒、温热病之法，损益而治之，尤不可例以仲景即病伤
寒药通治也。（《伤寒温病热病说》）
有病因、有病名、有病状表现；辨别其病因，端正其病名，观察其病状。这三方面都弄清楚了，才可以谈论治疗。如果有一项不明白，却声称不会误人，我是不相信的。
再说如伤寒，这是以病因作为病名的。温病、热病，这是以天时气候和病状表现作为病名的。由于这三种病都起因于感受寒邪，有人便通称为伤寒。所谓通称伤寒，是因为追溯其起因相同罢了，至于用药则不能一概而论地施用。为什么呢？伤寒大概是在霜降之后、春分之前感受的，但当时不立即发病，而是郁积化热，到春夏季节才发作。伤寒是即时在天气寒冷之时发病，寒邪在体表闭塞腠理（皮肤毛孔），所以非用辛甘温性质的药剂，不足以发散它，这就是张仲景的桂枝汤、麻黄汤等方剂必须使用的缘故。
温病、热病是在天气温暖炎热之时发作，郁热从体内向外透达，郁滞腠理，体表没有寒邪，所以非用辛凉或苦寒或酸苦性质的药剂，不足以解除它，这就是张仲景的桂枝汤、麻黄汤等仅能治疗外感表证的方剂不可使用的原因。而后来医生所开的水解散（由麻黄、大黄、黄芩、桂心、甘草、白芍组成）、大黄汤（由大黄、芒硝、芥子、丹皮、桃仁组成）、千金汤（由麻黄、桑白皮、苏子、杏仁、白果、黄芩、半夏、甘草、款冬花组成）、防风通圣散（由防风、川芎、当归、芍药、大黄、薄荷、麻黄、连翘、芒硝、石膏、黄芩、桔梗、滑石、甘草、芥穗、白术、栀子组成）这类兼治内外的方剂，之所以可以使用。
那些即时发病的伤寒，有怕风、怕冷的症状，这是因为风寒在体表，导致体表之气受伤的缘故。后发之温病、热病，也有怕风、怕冷的症状，这是因为再次新受了风寒，导致体表之气也受伤的缘故。如果没有新近感受的风寒，就不会有怕风、怕冷的症状，所以张仲景说：“太阳病（太阳经受邪所致的病证），发热且口渴，不怕冷的，叫做温病。”温病是这样，那么热病也是这样，如果不渴且怕冷，那就不是温热病了。
然而，有的患者并不因新近感受风寒，也出现怕风、怕冷的症状。这是因为患者体表之气本来虚弱，热邪到达体表，又重伤了体表之气，所以禁受不住风寒，这并不是伤风导致的怕风、伤寒导致的怕冷，只是卫气虚则怕风，营气虚则怕冷罢了。况且温病、热病，也有先出现表证，而后传入里证的。这是因为郁热从体内向外透达，热邪郁滞腠理，不能向外宣泄，于是又返回体内，形成可以攻下的证候，不像伤寒那样从体表开始。
有人不明白这个道理，竟然在春夏季的温病、热病中寻求浮紧脉象，这不是太疏漏了吗！殊不知紧脉是寒脉，有寒邪才会出现，没有寒邪就不会出现。那些温病、热病如果出现紧脉，乃是再次感受不正的暴寒以及内伤过度食用冷食所致，难道是其本来的脉象吗？又或者有人不认识脉象形态，只要见到弦脉就称之为紧脉，断定为寒邪而胡乱治疗。脉象盛大而有力量者，常常兼带弦象，岂可错认为紧脉而断定为寒邪。
夫温病、热病的脉象，多在肌肉层次而不甚浮取即得，且右手脉反而盛于左手脉，这确实是因为郁热在体内的缘故。如果左手脉盛，或者脉浮，必定有再次感受的风寒，否则就不是温病、热病，而是突然感受风寒的疾病罢了。凡是温病、热病如果没有再次感受风寒，虽然间或见到表证，但里证居多，所以很少有不觉口渴的。这个时候，治法应当以治疗里热为主，兼以解表，也有只治疗里证而表证自然解除的情况。
我常见世人治疗温热病，即使错误地攻下里证也没有大害，但如果错误地发汗解表，变证就不可言说了，这足以证明热邪是从内部透达至外部的。其中有误攻里证而导致大害的，那是春夏季暴寒所中的疫病，邪气纯在体表，未进入体内，所以不可与温病、热病混为一谈。
正因为世人将温病、热病混称为伤寒，所以每每执着于“寒”字，以求寻浮紧脉象，使用温热性质的药物。像这样，因为名称混乱了实质，从而残害人的生命，病名怎么可以不端正呢？另外医书中多讲四时伤寒，所以将春夏季的温病、热病与秋冬季的伤寒，视为一类而没有区别。夫秋冬季的伤寒，是真伤寒；春夏季的伤寒，是寒疫。这与温病、热病自然是两条不同的路径，岂可同样治疗。唉！这种弊端的由来，不是一天了，遍考医书并没有纠正弊端的论述，每每雷同，实在令人痛心啊！
虽然如此，伤寒与温病、热病，其攻里的治法，如果确实是以寒除热，固然不必强求不同，但其发表的治法，绝对不可以不相同。况且伤寒直接损伤阴经，以及虽伤太阳经但未及郁热，随即传入阴经成为寒证，而应当用温法治疗的，又与温病、热病大不相同，岂可胡乱治疗！有人知其一不知其二，所以说张仲景的发表药现在不可用，而攻里的药才可用。唉！那可用与不可用的道理，究竟在哪里呢？如果能辨别其病因，端正其病名，观察其病状，治疗方法难道会有不当的吗？如果是时行不正之气所作，乃是再次感受异气而变化的，则又应当观察是何时、何种气机，参照伤寒、温热病的治法，增减损益来治疗，尤其不可一概用张仲景即时发病的伤寒药通治。（《伤寒温病热病说》）
There are etiology, disease names, and clinical manifestations; one must distinguish the etiology, rectify the disease name, and observe the clinical manifestations. Only when all three aspects are clarified can treatment be discussed. If any one of them is unclear, yet claiming not to harm patients, I do not believe it.
Take *Shanghan* (Cold Damage) as an example: this is a disease named after its etiology. *Wenbing* (Warm Disease) and *Rebing* (Heat Disease) are named after the seasonal climate and clinical manifestations. Since these three diseases all originate from contracting cold pathogens, some people generally refer to them all as *Shanghan*. The reason for this general term is that their etiological origins are the same; however, medication cannot be applied uniformly. Why? *Shanghan* is typically contracted between the Frost Descent (Shuangjiang) and the Spring Equinox (Chunfen), but does not manifest immediately. Instead, heat stagnates and manifests during spring and summer. *Shanghan* manifests immediately during cold weather, with cold pathogens closing the *Couli* (pores/skin interstices) at the exterior. Therefore, only acrid-sweet-warm formulas are sufficient to disperse it. This is why Zhang Zhongjing’s *Guizhi Tang* (Cinnamon Twig Decoction) and *Mahuang Tang* (Ephedra Decoction) must be used.
In contrast, *Wenbing* and *Rebing* manifest during warm and hot weather. Stagnant heat reaches from the interior to the exterior, obstructing the *Couli*, without cold pathogens at the exterior. Therefore, only acrid-cool, bitter-cold, or sour-bitter formulas are sufficient to resolve it. This is why Zhang Zhongjing’s *Guizhi Tang* and *Mahuang Tang*, which treat only exterior conditions, cannot be used. Later physicians’ prescriptions such as *Shuijie San* (Water-Dispersing Powder [containing Ephedrae Herba, Rhubarb Radix et Rhizoma, Scutellariae Radix, Cinnamomi Cortex, Glycyrrhizae Radix, Paeoniae Radix Alba], *Dahuang Tang* (Rhubarb Decoction [containing Rhubarb Radix et Rhizoma, Natrii Sulfas, Mustard Seed, Moutan Cortex, Persicae Semen], *Qianjin Tang* (Thousand-Gold Decoction [containing Ephedrae Herba, Morus Albae Cortex, Perillae Fructus, Armeniacae Semen Amarum, Ginkgo Semen, Scutellariae Radix, Pinelliae Rhizoma, Glycyrrhizae Radix, Farfarae Flos]), and *Fangfeng Tongsheng San* (Wind-Protecting Universal-Pass Powder [containing Saposhnikoviae Radix, Chuanxiong Rhizome, Angelicae Sinensis Radix, Paeoniae Radix, Rhubarb Radix et Rhizoma, Menthae Haplocalycis Herba, Ephedrae Herba, Forsythiae Fructus, Natrii Sulfas, Gypsum Fibrosum, Scutellariae Radix, Platycodonis Radix, Talcum, Glycyrrhizae Radix, Schizonepetae Spica, Atractylodis Macrocephalae Rhizoma, Gardeniae Fructus])—those treating both interior and exterior—are therefore applicable.
For immediate-onset *Shanghan*, symptoms of aversion to wind and aversion to cold occur because wind-cold is at the exterior, injuring the exterior Qi. For delayed-onset *Wenbing* and *Rebing*, symptoms of aversion to wind and aversion to cold also occur because there is a new contraction of wind-cold, which also injures the exterior Qi. Without new wind-cold contraction, there would be no aversion to wind or cold. Thus, Zhang Zhongjing stated: “In *Taiyang Bing* (Disease of the Taiyang Channel), if there is fever, thirst, and no aversion to cold, it is called *Wenbing*.” Knowing this for *Wenbing*, we know it is the same for *Rebing*. Therefore, if there is no thirst but aversion to cold, it is not a warm-heat disease.
However, some patients exhibit aversion to wind and cold without new wind-cold contraction. This is because the patient’s exterior Qi was originally deficient; when heat reaches the exterior, it further injures the exterior Qi, making it unable to withstand wind-cold. This is not the aversion to wind caused by wind-strike or the aversion to cold caused by cold-damage, but rather aversion to wind due to defensive Qi deficiency and aversion to cold due to nutritive Qi deficiency. Furthermore, *Wenbing* and *Rebing* may initially present exterior syndromes before transmitting to the interior. This is because stagnant heat reaches from the interior to the exterior, obstructing the *Couli*, preventing external release, and thus returning inward to form syndromes suitable for purgation. This differs from *Shanghan*, which begins at the exterior.
Those who do not understand this principle seek floating-tight pulses in spring and summer *Wenbing* and *Rebing*, which is indeed negligent! One must know that a tight pulse is a cold pulse; it appears only when cold pathogens are present and disappears when they are absent. If *Wenbing* or *Rebing* presents a tight pulse, it is due to secondary contraction of sudden cold or internal injury from excessive consumption of cold food, not its natural state. Others, failing to recognize pulse morphology, mistake a wiry pulse for a tight pulse, diagnose cold, and treat recklessly. Pulses that are vigorous and forceful often accompany a wiry quality; how can they be mistaken for tight and diagnosed as cold?
The pulses of *Wenbing* and *Rebing* are mostly located at the muscle level and are not very superficial. Moreover, the right hand pulse is often stronger than the left, truly due to stagnant heat within. If the left hand pulse is strong or superficial, there must be secondary wind-cold contraction; otherwise, it is not *Wenbing* or *Rebing*, but a sudden wind-cold disease. In *Wenbing* and *Rebing* without secondary contraction, although exterior signs may occasionally appear, interior signs predominate; thus, thirst is rarely absent. At this time, the method should prioritize treating interior heat while simultaneously resolving the exterior; sometimes, treating the interior alone resolves the exterior naturally.
I often see people treating warm-heat diseases; even if they erroneously purge the interior, there is little major harm. However, if they erroneously induce sweating to resolve the exterior, the complications are indescribable. This sufficiently demonstrates that the heat originates from the interior and reaches the exterior. Cases where erroneous purging causes major harm belong to epidemics contracted from sudden cold in spring and summer, where pathogens are purely exterior and have not entered the interior; these cannot be discussed together with *Wenbing* and *Rebing*.
Because the world confuses *Wenbing* and *Rebing* with *Shanghan*, people cling to the character "cold," seeking floating-tight pulses and using warm-hot medicines. Such practices confuse names with reality, harming lives; how can disease names not be rectified? Additionally, medical texts often speak of "Four Seasons Shanghan," viewing spring/summer *Wenbing* and *Rebing* identically to autumn/winter *Shanghan* without distinction. Autumn/winter *Shanghan* is true *Shanghan*; spring/summer *Shanghan* is cold epidemic (*Han Yi*). These are distinct paths from *Wenbing* and *Rebing* and cannot be treated alike. Alas! This malpractice has existed for days; examining medical texts reveals no corrective arguments, merely repetition, which is truly lamentable!
Nevertheless, regarding the purgative methods for *Shanghan* versus *Wenbing* and *Rebing*: if the goal is indeed to remove heat with cold, differences need not be sought. However, the releasing-exterior methods must absolutely differ. Moreover, *Shanghan* directly damaging the Yin channels, or injuring the Taiyang channel without causing heat stagnation, subsequently transmitting to Yin channels as cold syndromes requiring warming treatment, is vastly different from *Wenbing* and *Rebing*. How can they be treated recklessly? Some know one aspect but not the other, claiming Zhang Zhongjing’s exterior-releasing medicines are now unusable, while purgatives are usable. Alas! Where exactly lies the logic of usability and non-usability? If one can distinguish the etiology, rectify the disease name, and observe the clinical manifestations, can the treatment methods be inappropriate?
If the disease arises from erratic seasonal Qi, changing due to secondary contraction of abnormal Qi, one must observe the timing and specific Qi, referencing the methods of *Shanghan* and warm-heat diseases, adjusting and modifying the treatment accordingly. It is especially inadvisable to universally apply Zhang Zhongjing’s immediate-onset *Shanghan* medicines. (From *Shanghan Wenbing Rebing Shuo*)