迄李东垣(1180—1251)，又是一个兵荒马乱的年代，当时，患病者之多，死亡者之众，可谓前所未有，这是有大疫流行厂可以肯定，《内外伤辨惑论·辨阴证阳证篇》说；“向者壬辰改元，京师戒严，迨三月下旬，受乱者凡半月。解围之后，都人不受病者，万无一二，既病而死者，继踵而不绝。都门十有二所，每日各门所送，多者二千，少者不下一千，似此者几三月，此百万人，岂俱感风寒外伤者耶？大抵人在围城中，饮食不节；乃劳役所伤，不待言而知，由其朝饥暮饱，起居不时，寒温失所，动经三两月，胃气亏乏久矣。一旦饱食太过，感而伤人。”东垣对仲景以来，用六气归纳病原，认为病原是伤寒的说法提出了怀疑，但他忽视了王充以来的疫气相污说，他为了强调脾胃虚弱容易罹患疫疾，主张太过，竟把明明属于外感范畴的传染病，说成是内伤病，这在病原问题的认识上，实在是大错而特错。东汉末年及南宋时，战乱纷繁，民不聊生的历史条件和疫病流行情况，大体上差不多。如要说仲景、子和前后的疫病流行都是寒邪、疠气这一类外邪所致，唯东垣时的几百万人同时生病，都是内伤脾胃引起，这是无论如何也说不通的。何妨东垣自己也说“感而伤人”，既是“感而伤人”，病原当然仍是乖戾之气。饮食不节，胃气亏乏，劳役惊扰，起居不时，引起健康水平下降，免疫机制减弱，这不过是致病条件而已，所以，东垣对传染病病原的认识，实在不能与葛洪、王充等前人相比。但由于传染病病原繁多，针对病原寻找特效药，即使在现在，也不是易事。东垣在当时患者机体抗力普遍衰弱的情况下，采用补脾益气之法，以增强正气抗病能力，其治疗手段，却是十分可取的。这种治术，较之杀灭病原无专药而又轻施攻伐，反伤正气的治疗，合理得多，故就治法论，东垣的治疫病法，较之《伤寒论》的治法和刘河间，张子和等人的治法，显是又有了长足的进展。
明末天下大乱，又屡有传染病大流行，《温疫论》自序说：“崇祯辛巳(1641)，疫气流行，山东、浙江、南北二直患者尤多，至五六月益甚，或至阖门传染。”吴又可否定疫病与六气及四时不正之气有关，他认为疫病病原既不是伤寒，也不同于一般之温热，而是一种杂气，又称戾气或异气，他说：“夫瘟疫之为病，非风，非寒，非暑，非湿，乃天地问别有一种异气所感。”吴氏唯真理是尚，敢于非《内经》，疑仲景，斥叔和，在病原问题上，作了前所未有的详细讨论，他不但确认疫原是杂气，而且指出：“天地之杂气，种种不一"，“疫气亦杂气之一种，但有甚于他气，故为病颇重，因名之曰疠气。”(《杂气论》)他在区别戾气致病各有不同的基础上，还对疫病分为常疫与疠疫二种，所谓疠疫，就是诸如“瓜瓤瘟、疙瘩瘟”这一类来势凶猛，“缓者朝发夕死，急者顷刻而亡，此又诸疫之最重者”，“不可以与常疫并论也。”这是将一般传染病与烈性传染病进行区分的最早文献记载，这种分类方法，与我们现在将传染病分成甲类、乙类，大体相同。但杂气之所以造成流行，与五运六气和气候的异常变化关系极大，吴氏忽视了这一点，也是片面的。吴氏说：“草木有野葛巴豆”，“昆虫有毒蛇猛兽”，气变之中，“万物各有善恶不等，是知杂气之毒亦然。”“众人有触之者，各随其气而为病也，或时众人发颐，或时众人头面浮肿，俗称大头瘟是也。”这些议论，如与《论衡》中“天地之间，毒气流行，人当其冲，则面肿疾”等某些文字相比观，简直如出一辙。据此，我们有理由认为：吴氏作论，显然是受了王充等前人论疫思想之影响。
在清·乾隆年问(1792—1793)，云南发生肺鼠疫流行，洪稚存在《江边诗话》中写道：“时赵州(今云南大理附近的凤仪)有怪鼠，白日入家，即伏地而死。人染其气，亦无不殒者。”据此，鼠类在传播鼠疫中的作用，已为人们所认识，到道光年间(1820—1850)，汪期莲在《瘟疫汇编》中说：“忆昔年入夏，瘟疫大行，有红头青蝇千百为群，凡入人家，必有患瘟而亡者。”据此，苍蝇在传播疫病中的媒介作用，亦为人们所认识。
清·民以还，解放之前，仅上海在50年内，就发生了12次霍乱大流行；鼠疫在1910、1920、1947年三次在东北流行，死亡人数达10万人，此外，血吸虫病，天花、黑热病，伤寒、疟疾等传染病，亦均大肆泛滥。祝味菊(1885—1951)面对一国之内，六气偏胜甚大，而某些传染病，往往不旋踵即纵横南北，且病型相同之客观事实，认为用六气归纳外感病因，无法作出合理的解释，乃融会新知，参西说中，提出了“病原无寒邪温邪之分，但有无机有机之别"的新说法。视氏的病原论认为；传染病一般以“有形有机之邪为主因，无形无机之邪为诱因，彼二邪，每狼狈为奸，伺人于不察也”(《伤寒质难》)。祝氏不排除六气在传染病发生、流行过程中的影响，也把机体抗邪能力下降等因素考虑在内，其对疫病病因病理的解释，融贯中西，立论比较完善，它较之吴又可的杂气论和前人的各种论述，就沟通中西医来说，是更为接近了。惜发掘这份珍贵的遗产，尚未引起应有的重视，故甚连祝氏其人，就较为年轻的中医来说，迄今尚知之者不多。
综上所述，前人对传染病病原虽有毒气，疠气，伤寒、戾气，异气等种种称呼，但基本上都认为这是一种具有传染特性的外邪，故张锡纯说：“疫者，感岁运之戾气，因其岁运失和，中含毒气，人触之即病。”唯其如此，故就预防来说，增强体质与注意避邪，二不可废，就治疗来说，扶益正气与攻击病原，俱应重视。故李东垣健脾益气的治法，祝味菊匡扶正气的主张，在缺乏专病专药的情况下，是很为可取的。如忽视及此，而过于强调外感当攻，也就不无其片面性。从原则上来说，如治病救人则用药要猛要重，取其专而有力，截断逆转，要寻求针对性的特效药，如发觉专药，只要不会伤人，就应当机立断，予以大剂，直接杀灭驱逐病原。如无特效专药，采用治人却病法，则用药要稳要轻，协助自然疗能，务使正气得到扶持，要促使自调自控机能的恢复和加强，只要邪气有去路，体力能支持，不妨期待，使其自衰。如果不知从上述二方面权衡出入，但知按证下药，轻描淡写，就不免疲药塞职之诮。
参考文献
①、②林乾良，医学文字源流论(一)，(内部资料)2003-9-1422:24:59北海散人头衔：佛门弟子等级：管理员文章：3797积分：4270注册：2002-12-24
第3楼非湿黄疸论
时医咸谓“无湿不成疸”，而余独有燥疸非湿之论。有闻而诮之者曰：《内经》云：“湿热相交，民当病瘅。”《金匮》云：“黄家所得，从湿得之。”《丹溪心法》、《金匮钩玄》俱谓黄疸“病虽有五，皆湿热也。”此系秉之经旨。子责其非，竟作燥疽非湿之论，悖经违俗，请问何据？
余曰：尝览仲景之治疸，于脉证，有八纲之辨而燥湿未尝不分；于治法，有润利之殊而八法未曾偏废。若拘泥于论湿之文，而不知有燥淤诸疽之证治，是一叶障目，有昧仲师之活法。而内经民当病瘅之瘅，原指热病，非指黄疸，引瘅证疸，系后人之误解。至丹溪所云，仅言其常，景岳尝驳之矣！黄宫绣谓“如苗值于大早，则苗必燥而黄，是苗因燥而黄者也；太涝则苗必湿而黄，是苗因湿而黄者也”(《本草求真·茵陈条》)，此诫乃说明仲景学说之极好比喻，
有鉴于前人论燥淤诸黄者虽多，但迄无非湿黄疸之专文，故现以燥淤黄疸为主，专论非湿黄疸诸证，为谓“黄疸无湿不成”者之棒喝。
热燥黄疸
热病误治，热灼津伤，邪从燥化，因热燥而病黄疸者有之。如《伤寒论》114条，“太阳病中风，以火劫发汗，邪风被火热，血气流溢，失其常度，两阳相熏灼，其身发黄。阳盛则欲衄，阴虚小便难，阴阳俱虚竭，身体则枯燥，但头汗出，剂颈而还、腹满、微喘、口乾、咽烂，或不大便，……。”即是叙述了这一证型。因风为阳邪，火为阳热，两阳相熏灼，伤津劫液，病从燥化，故身黄之外，小便难，身枯燥，口咽干或不大便等燥的症状颇为突出。又205条：“阳明病，被火，额上微汗出，而小便不利者，必发黄。”笔者认为：这一条误用火攻，火热相合，两阳熏灼，消烁津液的情况，与上条完全相同，故亦作热燥黄疸看为妥，若概认为黄疸病小便难，或小便不利均为湿乏去路之表现，从而将上述条文俱作湿热解释，实谬。
热燥黄疸之症状表现，主要是热与燥二个方面。但上二条文只着重论述了病因病理及燥的表现，关于热的症状描述不很具体，但《金匮·黄疸篇》“师曰，病黄疸，发热，烦喘，胸满，口燥者，以病发时火劫其汗，两热所得。然黄家所得，从湿得之。一身尽发热而黄，肚热，热在里，当下之。”这一条也是论述热燥黄疸之文，且于热的症状描述较详，可以合参。其中“黄家所得，从湿得之"两句，是插笔。燥湿对举以为衡，是仲景作论常用之法。在论热燥黄疸之时而提及湿，目的在于既强调了黄疸毕竟以湿热为常，又告诫黄疸辨证，须就燥化湿化的不同病机，注意作鉴别诊断，有叫人对勘意。至于用下法治疗，是因热燥二面，处在因热而燥，尚以热为主的情况下，热邪入里，邪从燥化，必致里结，故治用釜底抽薪、急下以存阴。
刘完素深明仲景治疽以燥湿分论之旨，故《河间六书》云：“大抵凡诸黄者有二，一则湿热气郁而黄，万物皆然，义如麦秀而黔雨，湿热过极则黄疸也，及水涝而天气湿热，则草木将死而湿变黄者也；或病血液衰，则虚，燥热太甚，而身面痿黄者，犹亢旱而草木痿黄也，夫病燥热而黄者，当退热润燥而已。”黄宫绣之说，即基刘氏说而来。张石顽亦云“黄疸有干有湿”，惜片言只语，论述不详，为与临床相印证，现举前人治验一则，以备参究：
“朱天一年二十余，喜食糖及燥炙诸饼，忽病黄，面目如金，脉之两关数实有力尽滑，大便六七日不行，小便黄涩，此敦阜太过，加以素嗜炙火，其色必黄，非湿证也，与小承气汤加当归、白芍，一剂便行而瘥。"(《续名医类案，黄疸》)
按：此案明云非湿，诊者确有见识，其治方与仲景论热燥黄疸之文互参，实有互为补充，互为说明之妙，使人很受启迪。可见陈修园“黄疸皆由湿热成”(《医学实在易》)之说，乃为初学者说法，若医者止足于此而不入仲景之堂奥，以流于浅薄为自足，是固不足与语高深者。
燥淤黄疸
经云：“孙络水溢，则经有留血。”故津伤与血淤常可同时发生。若因发热而致伤津劫液，或热病后期，热邪虽退，阴津不足，因燥致淤，淤结发黄者亦有之。《金匮》：“腹满，舌痿黄，躁不得睡，属黄家”条，即是言此种证型。此条之舌痿是身痿，痿黄是形容黄色枯燥不润泽，与湿病篇的“熏黄”是形容黄晕如油正相反，亦宜对勘。腹满是胃肠燥结，肠中干粪不去之征。躁不得睡，则是热去阴伤之表现。黄疸篇“诸黄，猪膏发煎主之”条，即是为燥淤黄疸出治法。据前人治验，此方治燥淤黄疸效果很好。黄疸因多属湿热，油腻生湿助热，最为大忌，此其常也。惟燥淤黄疸，不但不忌，且可用猪油治疗。《肘后方·治卒发黄疸诸黄病第三十一》中曰：“伤寒频要疗男子妇人黄疸病医不愈，耳目悉黄，饮食不消，胃中胀热，生黄衣，在胃；中有干屎使病耳，用煎猪脂一小升，温热顿服之，日三，燥屎下乃愈。”《沈氏尊生》亦云：“有服对证药不效，耳目皆黄，食不消者，是胃中有干粪也。宜饮熬猪油，量人令禀，或一杯，或半杯，日二次，以燥粪下为度，即愈。”这是单用猪油治黄疸的记载，然唯燥甚淤微者为适宜，如淤甚，古人也有单用血余来治疗的，血余祛淤而兼能利水，对淤甚而兼湿者为适宜，若是燥淤黄疸，则总以猪膏发煎为妥贴。
燥淤黄疸用猪膏发煎取得显效之治验，可与下“《伤寒论》200条释疑"一文中之例案相互参。
淤血黄疸
直到李东垣（1180—1251）时期，又是一个战乱频仍的年代。当时患病者众多，死亡者极多，可谓前所未有，这显然是因为有大疫流行，可以肯定。《内外伤辨惑论·辨阴证阳证篇》中说：“此前壬辰年改元，京城戒严，等到三月下旬，遭受战乱长达半个月。解围之后，城里人没有生病的，万中无一二；既已生病而死的，接连不断。城门十二座，每天各门送出的尸体，多的两千，少的不下一千，像这样持续了将近三个月，这一百万人，难道都是感受风寒外邪所致吗？大抵人在围城中，饮食不节制，被劳役所伤，是不言而喻的，由于他们早晨饥饿晚上饱食，起居没有规律，寒暖失调，动则经过两三个月，胃气亏损已经很久了。一旦饱食过度，感邪伤人。”李东垣对自张仲景以来，用六气归纳病原，认为病原是伤寒的说法提出了怀疑，但他忽视了王充以来的疫气相互污染说。他为了强调脾胃虚弱容易罹患疫病，主张过于偏颇，竟把明明属于外感范畴的传染病，说成是内伤病，这在病原问题的认识上，实在是大错特错。东汉末年及南宋时，战乱纷繁、民不聊生的历史条件和疫病流行的情况，大体上差不多。如果说张仲景、刘完素前后的疫病流行都是寒邪、疠气这类外邪所致，唯独李东垣时期的几百万人同时生病，都是内伤脾胃引起，这是无论如何也说不通的。何况李东垣自己也说“感而伤人”，既然是“感而伤人”，病原当然仍是乖戾之气。饮食不节，胃气亏乏，劳役惊扰，起居不时，引起健康水平下降，免疫机制减弱，这不过是致病条件而已。所以，李东垣对传染病病原的认识，实在不能与葛洪、王充等前人相比。但由于传染病病原繁多，针对病原寻找特效药，即使在现在，也不是易事。李东垣在当时患者机体抗力普遍衰弱的情况下，采用补脾益气之法，以增强正气抗病能力，其治疗手段，却是十分可取的。这种治术，较之杀灭病原无专药而又轻施攻伐，反伤正气的治疗，合理得多。故就治法论，李东垣的治疫病法，较之《伤寒论》的治法和刘河间、张子和等人的治法，显是又有了长足的进展。
明末天下大乱，又屡有传染病大流行，《温疫论》自序说：“崇祯辛巳年（1641），疫气流行，山东、浙江、南北二直辖区患者尤多，到五六月更加严重，甚至至全家传染。”吴又可否定疫病与六气及四时不正之气有关，他认为疫病病原既不是伤寒，也不同于一般之温热，而是一种杂气，又称戾气或异气。他说：“夫瘟疫之为病，非风，非寒，非暑，非湿，乃天地间别有一种异气所感。”吴氏唯真理是尚，敢于非议《内经》，怀疑张仲景，斥责王叔和，在病原问题上，作了前所未有的详细讨论。他不但确认疫原是杂气，而且指出：“天地之杂气，种种不一”，“疫气亦杂气之一种，但有甚于他气，故为病颇重，因名之曰疠气。”（《杂气论》）他在区别戾气致病各有不同的基础上，还对疫病分为常疫与疠疫二种。所谓疠疫，就是诸如“瓜瓤瘟、疙瘩瘟”这一类来势凶猛，“缓者朝发夕死，急者顷刻而亡，此又诸疫之最重者”，“不可以与常疫并论也。”这是将一般传染病与烈性传染病进行区分的最早文献记载，这种分类方法，与我们现在将传染病分成甲类、乙类，大体相同。但杂气之所以造成流行，与五运六气和气候的异常变化关系极大，吴氏忽视了这一点，也是片面的。吴氏说：“草木有野葛巴豆”，“昆虫有毒蛇猛兽”，气变之中，“万物各有善恶不等，是知杂气之毒亦然。”“众人有触之者，各随其气而为病也，或时众人发颐，或时众人头面浮肿，俗称大头瘟是也。”这些议论，如与《论衡》中“天地之间，毒气流行，人当其冲，则面肿疾”等某些文字相比观，简直如出一辙。据此，我们有理由认为：吴氏作论，显然是受了王充等前人论疫思想之影响。
在清乾隆年间（1792—1793），云南发生肺鼠疫流行，洪稚存在《江边诗话》中写道：“当时赵州（今云南大理附近的凤仪）有怪鼠，白日入家，即伏地而死。人染其气，亦无不殒者。”据此，鼠类在传播鼠疫中的作用，已为人们所认识。到道光年间（1820—1850），汪期莲在《瘟疫汇编》中说：“忆昔年入夏，瘟疫大行，有红头青蝇千百为群，凡入人家，必有患瘟而亡者。”据此，苍蝇在传播疫病中的媒介作用，亦为人们所认识。
清末民初至解放之前，仅上海在50年内，就发生了12次霍乱大流行；鼠疫在1910、1920、1947年三次在东北流行，死亡人数达10万人。此外，血吸虫病、天花、黑热病、伤寒、疟疾等传染病，亦均大肆泛滥。祝味菊（1885—1951）面对一国之内，六气偏胜甚大，而某些传染病，往往不旋踵即纵横南北，且病型相同之客观事实，认为用六气归纳外感病因，无法作出合理的解释，乃融会新知，参西说中，提出了“病原无寒邪温邪之分，但有无机有机之别”的新说法。祝氏的病原论认为：传染病一般以“有形有机之邪为主因，无形无机之邪为诱因，彼二邪，每狼狈为奸，伺人于不察也”（《伤寒质难》）。祝氏不排除六气在传染病发生、流行过程中的影响，也把机体抗邪能力下降等因素考虑在内，其对疫病病因病理的解释，融贯中西，立论比较完善。它较之吴又可的杂气论和前人的各种论述，就沟通中西医来说，是更为接近了。可惜发掘这份珍贵的遗产，尚未引起应有的重视，故甚至连祝氏其人，就较为年轻的中医来说，迄今尚知之者不多。
综上所述，前人对传染病病原虽有毒气、疠气、伤寒、戾气、异气等种种称呼，但基本上都认为这是一种具有传染特性的外邪。故张锡纯说：“疫者，感岁运之戾气，因其岁运失和，中含毒气，人触之即病。”唯其如此，故就预防来说，增强体质与注意避邪，二者不可废；就治疗来说，扶益正气与攻击病原，俱应重视。故李东垣健脾益气的治法，祝味菊匡扶正气的主张，在缺乏专病专药的情况下，是很为可取的。如忽视及此，而过于强调外感当攻，也就不无其片面性。从原则上来说，如治病救人则用药要猛要重，取其专而有力，截断逆转，要寻求针对性的特效药，如发觉专药，只要不会伤人，就应当机立断，予以大剂，直接杀灭驱逐病原。如无特效专药，采用治人却病法，则用药要稳要轻，协助自然疗能，务使正气得到扶持，要促使自调自控机能的恢复和加强，只要邪气有去路，体力能支持，不妨期待，使其自衰。如果不知从上述二方面权衡出入，但知按证下药，轻描淡写，就不免疲药塞职之诮。
参考文献
①、②林乾良，医学文字源流论(一)，(内部资料)2003-9-14 22:24:59北海散人头衔：佛门弟子等级：管理员文章：3797积分：4270注册：2002-12-24
第3楼非湿黄疸论
当代医生都称“无湿不成疸”，而我独有燥疸非湿之论。有听到后讥笑的人说：《内经》说：“湿热相交，民当病瘅。”《金匮要略》说：“黄家所得，从湿得之。”《丹溪心法》、《金匮钩玄》都谓黄疸“病虽有五，皆湿热也。”这是秉承经旨。你指责其非，竟作燥疽非湿之论，违背经典，违逆世俗，请问有何依据？
我说：曾阅览张仲景治疗黄疸，在脉证上，有八纲之辨而燥湿未曾不分；在治法上，有润利之殊而八法未曾偏废。若拘泥于论述湿之文，而不知道有燥瘀诸疸之证治，是一叶障目，昧于仲师之活法。而《内经》“民当病瘅”之瘅，原指热病，非指黄疸，引瘅证疸，系后人之误解。至于丹溪所言，仅言其常理，景岳曾驳斥过他！黄宫绣说“如苗值于大旱，则苗必燥而黄，是苗因燥而黄者也；太涝则苗必湿而黄，是苗因湿而黄者也”（《本草求真·茵陈条》），此诫乃是说明仲景学说之极好比喻。
鉴于前人论燥瘀诸黄者虽多，但迄无非湿黄疸之专文，故现以燥瘀黄疸为主，专论非湿黄疸诸证，为谓“黄疸无湿不成”者之棒喝。
热燥黄疸
热病误治，热灼津伤，邪从燥化，因热燥而病黄疸者有之。如《伤寒论》114条，“太阳病中风，以火劫发汗，邪风被火热，血气流溢，失其常度，两阳相熏灼，其身发黄。阳盛则欲衄，阴虚小便难，阴阳俱虚竭，身体则枯燥，但头汗出，剂颈而还、腹满、微喘、口乾、咽烂，或不大便，……。”即是叙述了这一证型。因风为阳邪，火为阳热，两阳相熏灼，伤津劫液，病从燥化，故身黄之外，小便难，身枯燥，口咽干或不大便等燥的症状颇为突出。又205条：“阳明病，被火，额上微汗出，而小便不利者，必发黄。”笔者认为：这一条误用火攻，火热相合，两阳熏灼，消烁津液的情况，与上条完全相同，故亦作热燥黄疸看为妥。若概认为黄疸病小便难，或小便不利均为湿乏去路之表现，从而将上述条文俱作湿热解释，实谬。
热燥黄疸之症状表现，主要是热与燥二个方面。但上二条文只着重论述了病因病理及燥的表现，关于热的症状描述不很具体，但《金匮·黄疸篇》“师曰，病黄疸，发热，烦喘，胸满，口燥者，以病发时火劫其汗，两热所得。然黄家所得，从湿得之。一身尽发热而黄，肚热，热在里，当下之。”这一条也是论述热燥黄疸之文，且于热的症状描述较详，可以合参。其中“黄家所得，从湿得之"两句，是插笔。燥湿对举以为衡，是仲景作论常用之法。在论热燥黄疸之时而提及湿，目的在于既强调了黄疸毕竟以湿热为常，又告诫黄疸辨证，须就燥化湿化的不同病机，注意作鉴别诊断，有叫人对勘意。至于用下法治疗，是因热燥二面，处在因热而燥，尚以热为主的情况下，热邪入里，邪从燥化，必致里结，故治用釜底抽薪、急下以存阴。
刘完素深明张仲景治疸以燥湿分论之旨，故《河间六书》云：“大抵凡诸黄者有二，一则湿热气郁而黄，万物皆然，义如麦秀而黔雨，湿热过极则黄疸也，及水涝而天气湿热，则草木将死而湿变黄者也；或病血液衰，则虚，燥热太甚，而身面痿黄者，犹亢旱而草木痿黄也，夫病燥热而黄者，当退热润燥而已。”黄宫绣之说，即基刘氏说而来。张石顽亦云“黄疸有干有湿”，惜片言只语，论述不详。为与临床相印证，现举前人治验一则，以备参究：
“朱天一年二十余，喜食糖及燥炙诸饼，忽病黄，面目如金，脉之两关数实有力尽滑，大便六七日不行，小便黄涩，此敦阜太过，加以素嗜炙火，其色必黄，非湿证也，与小承气汤加当归、白芍，一剂便行而瘥。”（《续名医类案，黄疸》）
按：此案明云非湿，诊者确有见识，其治方与仲景论热燥黄疸之文互参，实有互为补充，互为说明之妙，使人很受启迪。可见陈修园“黄疸皆由湿热成”（《医学实在易》）之说，乃为初学者说法，若医者止足于此而不入仲景之堂奥，以流于浅薄为自足，是固不足与语高深者。
燥淤黄疸
经云：“孙络水溢，则经有留血。”故津伤与血淤常可同时发生。若因发热而致伤津劫液，或热病后期，热邪虽退，阴津不足，因燥致淤，淤结发黄者亦有之。《金匮》：“腹满，舌痿黄，躁不得睡，属黄家”条，即是言此种证型。此条之舌痿是身痿，痿黄是形容黄色枯燥不润泽，与湿病篇的“熏黄”是形容黄晕如油正相反，亦宜对勘。腹满是胃肠燥结，肠中干粪不去之征。躁不得睡，则是热去阴伤之表现。黄疸篇“诸黄，猪膏发煎主之”条，即是为燥淤黄疸出治法。据前人治验，此方治燥淤黄疸效果很好。黄疸因多属湿热，油腻生湿助热，最为大忌，此其常也。惟燥淤黄疸，不但不忌，且可用猪油治疗。《肘后方·治卒发黄疸诸黄病第三十一》中曰：“伤寒频要疗男子妇人黄疸病医不愈，耳目悉黄，饮食不消，胃中胀热，生黄衣，在胃；中有干屎使病耳，用煎猪脂一小升，温热顿服之，日三，燥屎下乃愈。”《沈氏尊生》亦云：“有服对证药不效，耳目皆黄，食不消者，是胃中有干粪也。宜饮熬猪油，量人令禀，或一杯，或半杯，日二次，以燥粪下为度，即愈。”这是单用猪油治黄疸的记载，然唯燥甚淤微者为适宜，如淤甚，古人也有单用血余来治疗的，血余祛淤而兼能利水，对淤甚而兼湿者为适宜，若是燥淤黄疸，则总以猪膏发煎为妥贴。
燥淤黄疸用猪膏发煎取得显效之治验，可与下“《伤寒论》200条释疑"一文中之例案相互参。
淤血黄疸
Until the time of Li Dongyuan (1180–1251), it was another era of war and chaos. At that time, the number of patients was huge, and the number of deaths was immense, unprecedented in history. This was undoubtedly due to the prevalence of a great epidemic. *Nei Wai Shang Bian Huo Lun* (Treatise on Differentiating Internal Injury from External Contraction) · "Chapter on Differentiating Yin and Yang Syndromes" states: "Previously, when the reign title changed in the Renchen year, the capital city was under siege. By late March, the turmoil had lasted half a month. After the siege was lifted, not one or two out of ten thousand citizens remained unill; those who fell ill and died followed each other without ceasing. There were twelve gates to the city, and each day, the corpses sent through each gate numbered between one thousand and two thousand. This situation persisted for nearly three months. Could these million people all have been affected by external contraction of wind and cold? Generally speaking, people within the besieged city suffered from irregular diet and injury caused by overwork, which goes without saying. Due to their irregular eating habits (starving in the morning and overeating in the evening), erratic daily routines, and failure to regulate warmth and coldness, their stomach qi had been deficient for months. Once they ate too much, they contracted pathogens and were injured." Li Dongyuan questioned the theory, prevalent since Zhang Zhongjing, that pathogens are categorized by the Six Qi (Six Excesses: Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and that the pathogen is primarily Cold Damage (Shanghan). However, he ignored the theory of epidemic qi contaminating each other, proposed since Wang Chong. To emphasize that spleen and stomach deficiency makes one susceptible to epidemics, his argument was overly biased; he mistakenly classified infectious diseases, which clearly belong to the category of external contraction, as internal injuries. This was a significant error in understanding the etiology of pathogens. The historical conditions of frequent wars and widespread suffering among the people during the late Eastern Han Dynasty and the Southern Song Dynasty, along with the prevalence of epidemics, were largely similar. If one argues that the epidemics before and after Zhang Zhongjing and Liu Wan-su were caused by external pathogens such as Cold Evil and Pestilential Qi, it is unreasonable to claim that only the millions of people sick simultaneously during Li Dongyuan's time were caused by internal injury to the spleen and stomach. Moreover, Li Dongyuan himself said "contracted pathogens and injured," implying that if it is "contracted and injuring," the pathogen must still be aberrant qi. Irregular diet, deficiency of stomach qi, injury from labor and shock, and erratic routines lead to decreased health levels and weakened immune mechanisms; these are merely predisposing factors. Therefore, Li Dongyuan's understanding of the pathogen of infectious diseases cannot compare with predecessors like Ge Hong and Wang Chong. However, given the diversity of infectious disease pathogens, finding specific effective drugs targeting these pathogens is difficult even today. Under the circumstances where patients' resistance was generally weak at that time, Li Dongyuan adopted the method of tonifying the spleen and benefiting qi to enhance the body's righteous qi and resistance capacity. His therapeutic approach was highly commendable. This treatment method is more reasonable than therapies that attack pathogens without specific drugs and inadvertently damage righteous qi. Thus, in terms of therapeutic methods, Li Dongyuan's approach to treating epidemics showed significant progress compared to the methods in *Shanghan Lun* (Treatise on Cold Damage) and those of Liu Hejian and Zhang Zihe.
At the end of the Ming Dynasty, amidst national turmoil, there were repeated major epidemics. The preface to *Wen Yi Lun* (Treatise on Pestilential Diseases) states: "In the Xinsi year of Chongzhen (1641), pestilential qi prevailed. Patients were particularly numerous in Shandong, Zhejiang, and the Two Directly Governed Areas. It worsened in May and June, sometimes spreading to entire families." Wu Youke denied the connection between epidemics and the Six Qi or abnormal qi of the four seasons. He believed that the pathogen of epidemics was neither Cold Damage nor general Warmth diseases, but a type of miscellaneous qi, also called Li Qi (Pestilential Qi) or Yi Qi (Abnormal Qi). He stated: "The disease of plague is not caused by Wind, Cold, Summer-heat, or Dampness, but by a distinct kind of abnormal qi in heaven and earth." Wu Youke upheld truth, daring to criticize the *Neijing*, doubt Zhang Zhongjing, and rebuke Wang Shuhe. He made unprecedented detailed discussions on the issue of pathogens. He not only confirmed that the epidemic origin is miscellaneous qi but also pointed out: "The miscellaneous qi of heaven and earth is diverse," "Epidemic qi is also a type of miscellaneous qi, but it is more severe than other qi, thus causing serious illness, hence named Pestilential Qi." (*Za Qi Lun*). Based on the differentiation that different Li Qi cause different diseases, he further divided epidemics into Common Epidemics and Pestilential Epidemics. The so-called Pestilential Epidemic refers to fierce outbreaks like "Melon Rind Plague" and "Glandular Plague," where "those with slow onset die by evening after morning appearance, and those with rapid onset die in an instant; these are the most severe of all epidemics" and "cannot be discussed alongside common epidemics." This is the earliest documentary record distinguishing general infectious diseases from lethal infectious diseases. This classification method is roughly similar to our current classification of Class A and Class B infectious diseases. However, the reason why miscellaneous qi causes pandemics is greatly related to anomalies in the Five Movements and Six Qi and climate changes. Wu Youke's neglect of this point was also one-sided. Wu Youke said: "Plants include wild gelsemium and croton," "Insects include venomous snakes and fierce beasts." Amidst atmospheric changes, "all things have varying degrees of good and evil, so we know the toxicity of miscellaneous qi is also so." "When many people come into contact with it, they fall ill according to the specific qi, sometimes causing everyone to develop mumps, or sometimes causing facial swelling, commonly known as Big Head Plague." These discussions, when compared with certain texts in *Lunheng* such as "Between heaven and earth, toxic qi prevails; when people are struck by it, their faces swell and they suffer quickly," are virtually identical. Based on this, we have reason to believe: Wu Youke's arguments were obviously influenced by the epidemic theories of predecessors like Wang Chong.
During the Qianlong reign of the Qing Dynasty (1792–1793), a pneumonic plague epidemic occurred in Yunnan. Hong Zhicun wrote in *Jiangbian Shihua*: "At that time, in Zhaozhou (Fengyi near Dali, Yunnan), there were strange rats that entered homes during the day and died lying on the ground. People infected by their qi invariably perished." Based on this, the role of rodents in transmitting plague was recognized by people. By the Daoguang reign (1820–1850), Wang Qilian wrote in *Wenyi Huibian*: "I recall entering summer in previous years, when a plague was rampant. Red-headed houseflies gathered in thousands. Whenever they entered houses, someone would inevitably contract the plague and die." Based on this, the vector role of flies in spreading epidemics was also recognized by people.
From the late Qing Dynasty to the Republic of China period, before liberation, Shanghai alone experienced 12 cholera pandemics within 50 years. Plague erupted three times in Northeast China in 1910, 1920, and 1947, resulting in 100,000 deaths. Additionally, schistosomiasis, smallpox, kala-azar, typhoid fever, malaria, and other infectious diseases raged widely. Facing the objective fact that within the country, the Six Qi were severely imbalanced, yet certain infectious diseases spread rapidly across north and south with identical clinical presentations, Zhu Weiju (1885–1951) believed that categorizing external contraction etiologies using the Six Qi could not provide a reasonable explanation. Integrating new knowledge and incorporating Western theories into Chinese medicine, he proposed a new theory: "There is no distinction between Cold and Warm pathogens in etiology, only a difference between inorganic and organic." Zhu's theory of pathogens holds: "Infectious diseases are generally mainly caused by 'tangible organic pathogens,' while intangible inorganic pathogens act as inducing factors; these two pathogens often collude, waiting for people to be unaware." (*Shanghan Zhinan*). Zhu did not exclude the influence of the Six Qi in the occurrence and spread of infectious diseases, nor did he ignore factors such as decreased resistance of the organism. His explanation of the etiology and pathology of epidemics integrated Chinese and Western medicine and was relatively well-founded. Compared to Wu Youke's theory of miscellaneous qi and various previous discussions, it was closer to bridging Chinese and Western medicine. Unfortunately, the excavation of this precious heritage has not attracted due attention; thus, even Zhu himself is not well-known among younger TCM practitioners to this day.
In summary, although predecessors used various terms for the pathogens of infectious diseases, such as Toxic Qi, Pestilential Qi, Cold Damage, Li Qi, and Abnormal Qi, they basically considered them to be external pathogens with contagious characteristics. Thus, Zhang Xichun said: "Epidemics are contracted from the aberrant qi of the annual cycle; because the annual cycle is out of harmony, containing toxic qi, people fall ill upon contact." Precisely for this reason, regarding prevention, enhancing physical constitution and avoiding pathogens are both indispensable; regarding treatment, supporting righteous qi and attacking pathogens should both be emphasized. Therefore, Li Dongyuan's method of invigorating the spleen and benefiting qi, and Zhu Weiju's advocacy of supporting righteous qi, are highly commendable in the absence of specific drugs for specific diseases. Ignoring this and overly emphasizing that external contractions require attack is somewhat one-sided. In principle, if the goal is to treat disease and save lives, medications should be potent and heavy, aiming for specificity and strength, to intercept and reverse the disease process, seeking targeted specific effective drugs. If a specific drug is found, provided it does not harm the patient, one should make a prompt decision to administer large doses to directly kill and expel the pathogen. If no specific effective drug exists, adopting the method of treating the person to cure the disease requires stable and mild medication, assisting natural healing capabilities, ensuring righteous qi is supported, and promoting the recovery and strengthening of self-regulatory mechanisms. As long as there is an exit for the pathogenic factor and physical strength can support it, one may wait and expect spontaneous decline. If one fails to weigh these two aspects and merely prescribes herbs based on symptoms superficially, one risks criticism for ineffective treatment.
References
①, ② Lin Qianliang, *Medical Text Origins (Part I)*, (Internal Material) 2003-9-14 22:24:59 Beihai Sanren Title: Buddhist Disciple Rank: Administrator Articles: 3797 Points: 4270 Registered: 2002-12-24
Floor 3: Non-Dampness Jaundice Theory
Contemporary physicians all assert "No dampness, no jaundice," whereas I alone hold the theory of Dry Jaundice not being dampness-related. Some laughed and asked: The *Neijing* says: "When dampness and heat intersect, the people will suffer from Dan [fever/jaundice]." The *Jingui Yaolue* says: "Jaundice arises from dampness." Both *Danxi Xinfa* and *Jingui Gouxuan* state that although jaundice has five types, they are all related to damp-heat. This follows the canonical teachings. You criticize this view and propose the theory of Dry Jaundice not being dampness-related, contradicting classics and custom. On what basis do you ask?
I say: Having studied Zhang Zhongjing's treatment of jaundice, in pulse and syndrome differentiation, the Eight Principles distinguish dryness and dampness; in treatment methods, moistening and purging differ, but the Eight Methods are never abandoned. If one sticks rigidly to texts discussing dampness and ignores the syndromes and treatments of Dry-Stasis Jaundices, it is like a leaf blocking the eye, ignorant of Master Zhong's flexible methods. The "Dan" in *Neijing*'s "people will suffer from Dan" originally referred to febrile diseases, not jaundice; citing Dan to prove jaundice is a misunderstanding by later generations. As for Danxi's statement, it only describes the norm; Jingyue refuted it! Huang Gongxiu said, "If seedlings face severe drought, they become dry and yellow, meaning seedlings turn yellow due to dryness; if flooded, they become wet and yellow, meaning seedlings turn yellow due to dampness" (*Bencao Qiuyi · Yinchen Section*). This analogy perfectly illustrates Zhongjing's theory.
Given that although many predecessors discussed Dry-Stasis Jaundices, there was no dedicated text on Non-Dampness Jaundice until now, I now focus on Dry-Stasis Jaundice to specifically discuss Non-Dampness Jaundice syndromes, serving as a wake-up call for those who claim "No dampness, no jaundice."
If hot diseases are treated incorrectly, heat burns fluids, and pathogens transform towards dryness, jaundice caused by hot-dryness exists. For example, Article 114 of *Shanghan Lun*: "Taiyang disease with Wind Strike, coerced sweating by fire therapy. Pathogenic wind combined with fire heat, blood and qi flow excessively, losing their normal rhythm. Two Yangs scorch each other, causing yellowing of the body. Excess Yang leads to epistaxis, Yin deficiency leads to difficult urination. Both Yin and Yang are depleted, the body becomes dry and rough, sweat only appears on the head up to the neck, abdominal fullness, slight wheezing, dry mouth, rotten throat, or constipation..." This narrates this syndrome type. Since Wind is a Yang pathogen and Fire is Yang heat, the two Yangs scorch each other, damaging fluids and transforming the disease towards dryness. Thus, besides yellowing, symptoms like difficult urination, dry body, dry mouth/throat, or constipation are prominent. Also Article 205: "Yangming disease, subjected to fire, slight sweat on forehead, and difficult urination, will certainly develop jaundice." I believe: This article involves incorrect use of fire therapy, combining fire and heat, two Yangs scorching, consuming fluids. This situation is identical to the previous article, so it should also be viewed as Hot-Dry Jaundice. If one generally assumes that difficult or obstructed urination in jaundice is always a manifestation of dampness lacking an exit, and interprets all above articles as damp-heat, it is truly erroneous.
The symptom presentation of Hot-Dry Jaundice mainly involves Heat and Dryness. However, the above two articles focus on etiology/pathology and dryness manifestations, with less specific description of heat symptoms. But in *Jingui · Jaundice Chapter*: "The Master said, in jaundice disease, fever, irritability, wheezing, chest fullness, dry mouth... When the disease started, sweat was coerced by fire, two heats combined. However, jaundice arises from dampness. Whole body fever and yellowing, abdominal heat, heat in the interior, should be purged." This article also discusses Hot-Dry Jaundice, with more detailed heat symptoms, and can be referenced together. The sentences "However, jaundice arises from dampness" are inserted remarks. Contrasting dryness and dampness for balance is a common method in Zhongjing's writings. Mentioning dampness when discussing Hot-Dry Jaundice aims to emphasize that jaundice is usually damp-heat, while warning that jaundice differentiation must note the different pathogenesis of dryness transformation vs. dampness transformation for differential diagnosis. Regarding the use of purgation therapy, it is because in the aspect of heat and dryness, where dryness results from heat and heat is still dominant, heat pathogens enter the interior, transform towards dryness, leading to interior accumulation. Thus, treatment uses "pulling firewood from under the cauldron" (clearing heat from below) and urgent purgation to preserve Yin.
Liu Wansu deeply understood Zhongjing's principle of differentiating jaundice by dryness and dampness. Thus, *Hejian Liushu* states: "Generally, all yellows are of two types. One is damp-heat qi stagnation causing yellow, as seen in all things, like wheat growing and then rain; excessive damp-heat causes jaundice, similar to waterlogging and humid weather causing plants to die and turn wet-yellow; or if blood and yin are deficient, becoming empty, extreme dry-heat causes withered yellow skin and face, like drought causing plants to wither and turn yellow. For diseases turning yellow due to dry-heat, one should clear heat and moisten dryness." Huang Gongxiu's theory is based on Liu's. Zhang Shiwan also said "Jaundice has dry and wet types," unfortunately, his words were brief and discussion unclear. To verify with clinical practice, here is a past case for reference:
"Zhu Tiannian, over twenty years old, liked eating sugar and dry-roasted pastries. Suddenly developed jaundice, face and eyes like gold. Pulse at both Guan positions was rapid, excess, strong, and slippery. Bowels had not moved for six or seven days, urine was yellow and astringent. This is excessive accumulation, compounded by habitual preference for roasted/fire foods, color must be yellow, not a damp syndrome. Given Xiao Chengqi Tang plus Dang Gui and Bai Shao. One dose led to bowel movement and recovery." (*Xu Mingyi Leian, Jaundice*)
Commentary: This case explicitly states it is not dampness; the diagnosing physician indeed had insight. Comparing this prescription with Zhongjing's text on Hot-Dry Jaundice reveals mutual supplementation and explanation, providing great inspiration. It shows that Chen Xiuyuan's statement "All jaundice is formed by damp-heat" (*Yixue Shizaiyi*) is for beginners. If physicians stop here and do not enter the depths of Zhongjing's teachings, satisfying themselves with superficiality, they are certainly not worthy of discussing profound matters.
The Classics state: "When fluid overflows in Sun Luo vessels, stagnant blood remains in Jing vessels." Thus, fluid injury and blood stasis often occur simultaneously. If fever causes fluid damage, or in the late stage of hot diseases, although heat pathogens recede, Yin fluids are insufficient, leading to stasis due to dryness, and jaundice due to stasis accumulation, this also exists. *Jingui*: "Abdominal fullness, tongue withered yellow, restlessness unable to sleep, belongs to the Jaundice family" article, speaks of this syndrome type. The "withered tongue" here refers to whole-body withering; "withered yellow" describes a dry, non-lustrous yellow color, opposite to the "smoky yellow" in Dampness Disease Chapter which describes a greasy oil-like yellow hue; they should be compared. Abdominal fullness is a sign of gastrointestinal dry accumulation, dry feces remaining in the intestines. Restlessness unable to sleep is a manifestation of heat receding and Yin injury. The article "For all yellows, Zhugao Fa Jian (Pig Fat and Hair Decoction) is primary" in the Jaundice Chapter provides the treatment method for Dry-Stasis Jaundice. According to past cases, this formula works well for Dry-Stasis Jaundice. Jaundice mostly belongs to damp-heat; greasy foods generate dampness and assist heat, which is the greatest taboo, this is the norm. However, for Dry-Stasis Jaundice, not only is it not taboo, but pig fat can be used for treatment. *Zhouhou Fang · Treating Sudden Onset Jaundice Various Yellows Chapter 31* states: "Cold damage frequently requires treating men and women with jaundice that doctors have not cured, eyes and ears completely yellow, food not digesting, stomach bloated and hot, yellow coating in stomach; dry feces in stomach cause the illness. Use one sheng of boiled pig fat, take warm in one dose, three times a day. When dry feces pass, the illness cures." *Shenshi Zunsheng* also says: "Those who take correct medicines with no effect, eyes and ears all yellow, food not digesting, have dry feces in stomach. Should drink boiled pig oil, according to person's capacity, one cup or half cup, twice a day, until dry feces pass, then cured." This is a record of using only pig oil to treat jaundice, suitable only for cases with severe dryness and mild stasis. If stasis is severe, ancients also used single Xueyu (Human Hair Charcoal) for treatment; Xueyu removes stasis and promotes diuresis, suitable for severe stasis with dampness. For Dry-Stasis Jaundice, Zhugao Fa Jian is always appropriate.
Cases of significant efficacy using Zhugao Fa Jian for Dry-Stasis Jaundice can be cross-referenced with the case in the article "Clarification of Article 200 of Shanghan Lun."