《温病条辨》认为：《伤寒论》只论狭议伤寒，此仅六气中之一气耳，其余五气，概未之及。这种观点，经陆九芝等痛斥，百余年来，无人再倡言，更未见有人出来反驳，直至最近，始又有人撰“伤寒正名”(以下简称“正名”)发表于《吉林中医药》1984年第6期，重新明确提出：仲景伤寒不是广义伤寒，是狭义伤寒。诚以此“是研究《伤寒论》的首要前提”，故不可以不辨。
一、不能根据具不具流行性下判断
耍判断仲景伤寒是广义的还是狭义的，至少应先弄明白何谓广义伤寒，何谓狭义伤寒。外感病固有具流行性与不具流行性的二种，但这原非区别伤寒广义狭义之依据。如所周知；在《难经》以前，伤寒并无广义狭义的讲法，自《五十八难》有“伤寒有五：有中风，有伤寒，有湿温，有热病，有温病”之明文，后世才有“其伤寒有五之伤寒字，属广义。有伤寒之伤寒字，属狭义”之说。这是伤寒产生广义狭义概念之来源。若此而不知，竟围绕具不具流行性质的问题去讨论仲景伤寒属不属广义，这样，根据天行非外感之全部，固可推论出“仲景伤寒不属广义”，然根据非天行不是外感之全部，不也是同样可以推论出“仲景伤寒不属广义”吗？显然，相反的前提，可以推出相同的结论，这在论证方法上有错误，是不言而喻的。
二、狭义伤寒不与中风相滥
六气伤人，虽常相兼为患，但中风毕竟是感受风邪而致，伤寒毕竟是感受寒邪而致。风与寒各属六气中之一气。中风、伤寒二证，其感邪有如此之不同，故《难经》将它们等列，与湿温、热病、温病三证，统隶于广义伤寒之下。《伤寒论》亦将其等列，并各出治方。由此可见，伤寒、中风二证，原来并不互混。因此，狭义伤寒的概念，本极清楚，它既不与中风相滥，更没有包括中风在内。但“正名”，由于将《伤寒论》之伤寒字，说成是狭义伤寒？故—方面说中风、伤寒为二证，一方面又通过泛论风寒之邪，将二证混为一谈，这是自相矛盾，无以自圆的。诚如《中医名词术语选释》所说：“狭义伤寒是属于太阳表证的一个证型”，它与太阳病的中风同是广义伤寒下面的一个分证。实际上我们只要明了狭义伤寒的概念，不使它与太阳中风相混淆，则仲景伤寒应属广义还是狭义，是非就已不准判断。
三、不能单凭太阳病来下判断
外感病初起，若谓必始于太阳，就值得商榷。我们从广义伤寒下面分证之一的温病来看，温病的发病，可始于太阳。但也可始于阳明，也可始于少阳或三阴。诚以其初发无定规，故《难经》说：“温病之脉，行在诸经，不知何经之动也。”就寒邪的伤人来说，也是同样。寒邪可以先伤太阳，可以直中阳明，也可先犯少阳或迳伤三阴。须知寒伤太阳仅仅只是寒邪伤人多种形式中的一种形式，而并非唯一的形式。外感病除了可以从太阳表证开始，也有一开始就是从里出外，或发自阳明，或发自少阳，或发自三阴的。阳明病有太阳阳明，有少阳阳明，有正阳阳明，正阳阳明是本经自病，即此已足说明；在出现阳明病变之前，不一定必有太阳病之前奏。认为阳明篇中的燥热证必从太阳伤寒传变而来，这种狭隘的认识，根本不符合临床实际，也解释不了伤寒原文。诚以外感病初起的临床表现不一定都必在太阳范畴，故只能依太阳病来判断仲景伤寒是否广义的观点，不能成立。
四、不能单凭中风伤寒二证下判断
六淫伤人，虽不一定从太阳始，但也可以从太阳始。因此，从太阳病初期的临床症状来分析：中风的病因是风邪，伤寒的病因是寒邪，中暍的病因是暑邪，湿痹的病因是湿邪，痉病的病因是燥邪，温病的病因是火邪。故仲景之论太阳病，下有六个证型，这说明仲景伤寒为广义，了无疑义。但“正名”不承认太阳温病这一明系与中风，伤寒相等列的证型，说这是作为鉴别才提出来的。若这种说法得以成立，痉、湿、暍固可置之不问，即中风，亦何尚不可剔出于太阳病之外，又何必要留此一证，与伤寒相滥，弄得连狭义伤寒的概念都被混淆呢！显然，用“是作为鉴别才提出来的”讲法，不承认温病为太阳病下面的一个证型，把中风、伤寒之外的其他证型全部剔除在太阳病之外，这是毫无理由的。将广义伤寒下面非狭义伤寒诸证型统统排斥在太阳病之外以证明仲景伤寒非广义，这样做到底有什么意义呢？按照这种做法，我们不也可以说伤寒是作为鉴别才提出来的吗？我们不也可以说仲景伤寒是温病而不包括伤寒吗？显然，这样做大谬。
五、不能否认伤寒论与内经难经的继承性
仲景在《伤寒论·自序》中明云：“勤求古训，博采众方，撰用《素问》、《九卷》、《八十一难》。”《内经》说热病离是伤寒，《难经》说伤寒有五，《伤寒论》之太阳病，下有中风，伤寒、温病、暍病、湿痹等证型。二二比观，其作论具有继承性，不言自明。说仲景伤寒与内经伤寒俱属广义，也是顺哩成章、浅显明白的。如因仲景未引《内经》、《难经》之文，就否定其论伤寒有继承性，这是十分错误的。“正名”似乎认为只要肯定仲景的伤寒是天行，就可证明其非广义。挽而，天行与非天行，寒疫与温疫，并非是天生就互相排斥的。东汉末年，即使有寒疫流行，也没有理由说仲景一生中没有碰到过温疫，更不能因此而否定仲景之世，还有许多“非天行”的外感病存在。《伤寒杂病论》本是一部连杂病都相提并论的书，所涉及的病种很广，怎么在外感方面，反会与《内经》、《难经》立异标新，竟置狭义伤寒之外众多的外感病不论，内容狭隘到仅仅只是谈属于天行范畴的狭义伤寒一种呢？我们认为：仲景作论，在继承内难的基础上，有所发展和创新，内、难、伤寒三书，虽同论广义伤寒，但内容伤寒论详而内、难简，故伤寒六经虽源于《内经·热论》，但已不全同于《内经·热论》，若因热论六经与伤寒六经的不同，竟得出“仲景伤寒为狭义伤寒无疑”的结论，这根本没有说服力。
结语；据《大司天三元甲子考》，“仲景所值气运为风为火”，而时医习用乌附辛热，力治多误，“故仲景以桂枝麻黄之温，治中风伤寒之病，即以葛根芩连白虎柏皮栀豉之清，治温热湿温之病”，这本已足说明，仲景伤寒为广义，然后世个别人，必欲把《伤寒论》说成是专论六气中一气，把仲景治温热病的许多方剂，说成是为狭义伤寒化热之后而设的，这种毫无意义的说法，实是叶吴学说中最大的瑕疵，“正名”拾前人糟粕而张大其言，说明谬论流传，遗误后世，迄今尚有余毒，余有见于此，故复作驳辩，如上。
葛根桑叶辨
或谓陆九芝之治温病，与叶派轻以去实，辛凉透邪的观点趋一致。是说也，因其小同，遂忽大异，有肺胃不分之弊焉。观陆氏书，有《葛根桂枝辨》，有《葛根麻黄辨》，乃仿之而撰葛根桑叶辨。
叶派之轻以去实，辛凉透邪，如桑叶者，治肺也，陆氏之轻以去实，辛凉透邪，如葛根者，治胃也。轻以去实虽同，治肺治胃大别。叶氏治温病，独重肺系，故谓“温邪上受，首先犯肺”；陆氏治温病，独重胃系，故谓；“温病即阳明病”。故叶氏之治温病，初起必用桑叶、薄荷，桔梗、牛蒡之属，肺药也，陆氏之治温病，初起必用葛根，黄芩，黄连、山栀之类，胃药也。唯叶氏亦知伏气温病不与暴感门同法，故曰：春温一证，冬寒内伏，藏于少阴，以黄芩汤为主方，苦寒直清里热，乃正治也，陆氏亦知温病之邪，在肺胃者，不得独用胃经药，故《不谢方》之治春温、风温者，亦用桑，薄、翘，桔之类也。温病初起，有在肺者，有在胃者，有肺胃二及者，有竟在三阴者。或伏邪从内而出外，或新感由表而入里，或新感引动伏邪，或伏邪又兼新感，或始终但病一经，或发即数经同病，故《难经》云：“温病之脉，行在诸经，不知何经之动，各随其经所在而取之。”温病初起之治，原不可以一经印定眼目，然吴鞠通固执叶氏之说，以为温病初起，必先犯肺，竟谓凡病温者，均始于上焦，在手太阴。后世盲从，踵其讹误，遂以轻清平淡为一切温病初起之治规，盖惑于“温邪上受，首先犯肺”，“治上焦如羽，非轻不举”等说也。叶氏以肺药治肺经病，未误。后人以肺药治胃经病，大谬。治肺宜辛淡轻宣，不可卑用芩、连苦寒者，盖恐胃本无热，而早投苦寒凉中，中寒气馁，则转失托邪外出之力，反招冰伏之弊也。治胃宜积极撤热，不可但用桑叶、薄荷者，盖恶病属中焦，而反治上焦，射不中的，坐使热灼阴伤，用药轻淡如儿戏，终至步步深入也。惟邪机概以从更出表为顺，故病之在肺者，初起必以辛散为宗，宜桑叶之类以轻举之；病之在胃者，初起亦以达邪为旨，宜葛根之类以透解之。然若因此小同，竟忽彼大异，则陆氏斥叶吴学派似肺药治胃之旨，固不得大白于世矣！“麻黄之轻扬，可去伤寒之实，葛根之轻扬，可去温病之实。”其去实亦同，然寒温相异也。斯陆氏已辨之矣。葛根之轻扬，可去手阳明之实，桑叶之轻扬，可去手太阴之实。此陆氏所未言，然亦正其砭斥时弊之宗旨，何后人反于此昧昧耶。须知只须辛凉轻剂，如桑叶配薄、桔之类，其病即可立愈者，无非伤风、肺胀之属也。而必须旱投苦泄，如葛根合芩、连之类，尚恐热盛蒸脑者，乃是暑痉，湿温之属也。病之轻重悬绝，用药肺胃有异，未可同日语也。总之，能“遽入心包，为一场大病，以致于死者。”必非肺经温病，如伤风、肺胀之属，故陆氏重阳明之治，有轻则芩连葛根，重则硝黄石膏之主张。用轻剂病不解，入营入血，动风发痉，而仍曰：病属上焦，初用辛凉宣其肺，终用芳香开心窍，有是证，用是药，治未尝误。此正犯病中治上，撤热被动之误。乃后人既不解叶氏慎苦寒，是为邪热在肺，故主用桑叶、薄，桔之类宣散之以解郁热；又不解陆氏之激言，是为砭时医肺胃不分，初起概用肺药之弊而发，故力倡用葛根、芩、连之类清透以祛胃热，乃终至从陆氏之抨击叶吴学说中，得出益可证叶派这一治疗学思想科学性之认识，则诚非陆氏生前之所能料！
《吴鞠通医案》伏暑门周姓案析评
周姓案前后共十四诊，病程较长，记录完整。通过此案，我们可以看到银翘散，桑菊饮，三仁汤，化斑汤、复脉汤、增液承气汤等方在温病治疗中的具体运用。就反映吴鞠通的温病之学来说，这是一个很有代表性的例案，故特详加析评，以与伺仁共研究。
壬戌八月十六日周十四岁伏暑内发，新凉外加，脉右大左弦，身热如烙，无汗，吐胶痰，舌苔满黄，不宜再见泄泻，不渴，腹胀，少腹痛。是谓阴阳并病，两太阴互争，难；台之症，议先清上焦湿热，盖气化湿热亦化也。
飞滑石三钱连翘二钱象贝母一钱杏仁泥三钱银(：二钱白通草一钱老厚朴二钱鲜梨皮二钱生苡仁一钱五分竹叶一钱今晚一帖，明早一帖。析：鞠通根据“暑温伏暑，名虽异而病实同”，“暑兼湿热，偏于暑之湿者为湿温”等认识，初诊选方，采用三仁汤加减。因发热很高，故去蔻仁、半夏之温燥；加银花、连翘以清热；并加芦根、梨皮以护津，而象贝一味，是为咳吐胶痰设。
评：此案热自内发，寒从外束，证见高热无汗，苔黄痰帖，脉证合参，的系手太阴温病，但与足太阴脾实无涉。值此口不渴，津液尚未大伤之际，若能不受“温病忌用麻黄”等观念之束缚，投以大剂麻杏石甘汤(但《温病条辨》之麻杏石甘汤麻黄石膏等分，则不可用)，积极撤热，津即可保，若能汗出热解，肺气自然清肃。倘若是处理，力挫病势，原可指望。但吴氏计不及此，不但于撤热一项轻描淡写，且以淡渗芳化为重点，此所以后来有阴津大伤之变。
十七日案仍前。
飞滑石三钱连翘二钱鲜梨皮一钱-五分杏仁泥一钱五分冬桑叶一钱银花二钱老厚朴一钱五分薄荷八分扁豆皮二钱苦桔梗一钱五分芦根二钱荷叶边一钱五分炒知母一钱五分午一帖，晚一帖，明早一帖。
析：前方服后未效，故二诊更弦易辙，改用银翘散加减。《温病条辨》治太阴伏暑，不论表虚表实，不论气分血分，概以此为基本方。鞠通说：“太阴伏暑，舌白口渴，无汗者，银翘散去牛蒡、玄参加杏仁，滑石主之。”其自注说这是邪在气分而表实的治法。今观此诊，药法正是属此。因高热未退，故去性温之荆芥、豆豉，代之以凉散之桑叶；并加知母之苦寒，与芦根、梨皮之甘寒，合化阴气，以治热淫所胜。为病属伏暑，故复加扁豆衣、厚朴、荷叶边偕滑石等以清暑化湿。
比较前两诊之用药，有异有同。初诊虽亦用银、翘等清热，但重点在化湿；二诊虽亦用滑、朴等化湿，但重点在散热，故主方各异。但治疗上注重调畅气机，目的都在冀暑湿分解、肺得清肃，此则相同。这种药法，与“冶上焦如羽，非轻不举”的理论相一致。
《温病条辨》认为：《伤寒论》只论述了狭义的伤寒，这仅仅是六气中的一种气而已，其余五种气，一概没有涉及。这种观点，曾被陆九芝等人严厉斥责，百余年来，无人再提出此说，更未见有人出来反驳，直到最近，才又有人撰写了题为“伤寒正名”（以下简称“正名”）的文章，发表于《吉林中医药》1984年第6期，重新明确提出：张仲景所说的伤寒不是广义伤寒，而是狭义伤寒。既然这是“研究《伤寒论》的首要前提”，所以不能不进行辨析。
一、不能根据是否具有流行性来下判断
要判断张仲景的伤寒是广义的还是狭义的，至少应先弄明白什么是广义伤寒，什么是狭义伤寒。外感病固然有具有流行性和不具有流行性的两种，但这原本不是区别伤寒广义与狭义的依据。如众所周知：在《难经》以前，伤寒并没有广义和狭义的讲法，自从《难经·五十八难》有“伤寒有五：有中风，有伤寒，有湿温，有热病，有温病”的明文规定后，后世才有了“其‘伤寒有五’中的‘伤寒’字，属于广义；‘有伤寒’中的‘伤寒’字，属于狭义”的说法。这是伤寒产生广义和狭义概念的来源。如果对此不了解，竟围绕是否具有流行性质的问题去讨论张仲景的伤寒是否属于广义，这样，根据“天行（时行疫病）并非外感病的全部”，固可以推论出“张仲景的伤寒不属于广义”，然而根据“非天行（非时行疫病）也不是外感病的全部”，不也是同样可以推论出“张仲景的伤寒不属于广义”吗？显然，相反的前提，可以推出相同的结论，这在论证方法上有错误，是不言而喻的。
二、狭义伤寒不与中风相混淆
六气伤人，虽然常常相互兼夹致病，但中风毕竟是感受风邪所致，伤寒毕竟是感受寒邪所致。风和寒各属六气中的一种气。中风和伤寒这两个证候，它们感受的病邪有如此的不同，所以《难经》将它们并列，与湿温、热病、温病三个证候一起，统归于广义伤寒之下。《伤寒论》也将它们并列，并分别给出治疗方剂。由此可见，伤寒和中风这两个证候，原来并不互相混杂。因此，狭义伤寒的概念，本来非常清楚，它既不与中风相混淆，更没有包括中风在内。但“正名”文章，由于将《伤寒论》中的“伤寒”二字，说成是狭义伤寒，所以一方面说中风和伤寒是两个证候，另一方面又通过泛论风寒之邪，将两个证候混为一谈，这是自相矛盾，无法自圆其说的。诚如《中医名词术语选释》所说：“狭义伤寒是属于太阳表证的一个证型”，它与太阳病的中风同是广义伤寒下面的一个分证。实际上我们只要明了狭义伤寒的概念，不使它与太阳中风相混淆，那么张仲景的伤寒应属广义还是狭义，是非就已经不难判断。
三、不能单凭太阳病来下判断
外感病初起，如果说一定始于太阳经，就值得商榷。我们从广义伤寒下面分证之一的温病来看，温病的发病，可以始于太阳经。但也可以始于阳明经，也可以始于少阳经或三阴经。正因为其初发没有定规，所以《难经》说：“温病的脉象，运行在诸经之中，不知道是哪一经发动。”就寒邪伤人来说，也是同样的道理。寒邪可以先伤太阳经，可以直中阳明经，也可以先犯少阳经或直接伤害三阴经。须知寒邪伤太阳仅仅只是寒邪伤人多种形式中的一种形式，而并非唯一的形式。外感病除了可以从太阳表证开始，也有一开始就是从里出外，或发自阳明经，或发自少阳经，或发自三阴经的。阳明病有太阳阳明，有少阳阳明，有正阳阳明，正阳阳明是本经自病，仅以此一点已足以说明：在出现阳明病变之前，不一定必有太阳病作为前奏。认为阳明篇中的燥热证必定从太阳伤寒传变而来，这种狭隘的认识，根本不符合临床实际，也解释不了伤寒原文。正因为外感病初起的临床表现不一定都必须在太阳经范畴内，所以只能依太阳病来判断张仲景的伤寒是否属于广义的观点，不能成立。
四、不能单凭中风、伤寒两个证候来下判断
六淫伤人，虽然不一定从太阳经开始，但也可以从太阳经开始。因此，从太阳病初期的临床症状来分析：中风的病因是风邪，伤寒的病因是寒邪，中暍（中暑）的病因是暑邪，湿痹的病因是湿邪，痉病的病因是燥邪，温病的病因是火邪。所以张仲景论述太阳病，下面有六个证型，这说明张仲景的伤寒为广义伤寒，毫无疑问。但“正名”不承认太阳温病这一明显与中风、伤寒相等列的证型，说这是作为鉴别诊断才提出来的。如果这种说法得以成立，那么痉病、湿病、中暍固然可以置之不问，即中风，又何尚不可以剔除出太阳病之外，又何必保留这一个证候，与伤寒相混淆，弄得连狭义伤寒的概念都被混淆呢！显然，用“是作为鉴别才提出来的”这种说法，不承认温病为太阳病下面的一个证型，把中风、伤寒之外的其他证型全部剔除在太阳病之外，这是毫无理由的。将广义伤寒下面非狭义伤寒的诸证型统统排斥在太阳病之外以证明张仲景的伤寒非广义，这样做到底有什么意义呢？按照这种做法，我们不也可以说伤寒是作为鉴别才提出来的吗？我们不也可以说张仲景的伤寒是温病而不包括伤寒吗？显然，这样做是大错特错的。
五、不能否认《伤寒论》与《内经》、《难经》的继承性
张仲景在《伤寒论·自序》中明确写道：“勤求古训，博采众方，撰用《素问》、《九卷》、《八十一难》。”《内经》说热病就是伤寒，《难经》说伤寒有五，《伤寒论》的太阳病下面，有中风、伤寒、温病、中暍病、湿痹等证型。二者比较观看，其著作具有继承性，不言自明。说张仲景的伤寒与《内经》的伤寒都属于广义伤寒，也是顺理成章、浅显明白的。如果因为张仲景未引用《内经》、《难经》的文字，就否定其论伤寒有继承性，这是十分错误的。“正名”似乎认为只要肯定张仲景的伤寒是天行（时行疫病），就可证明其非广义。然而，天行与非天行，寒疫与温疫，并非是天生就互相排斥的。东汉末年，即使有寒疫流行，也没有理由说张仲景一生中没有碰到过温疫，更不能因此而否定张仲景的时代，还有许多“非天行”的外感病存在。《伤寒杂病论》本是一部连杂病都相提并论的书，所涉及的病种很广，怎么在外感方面，反会与《内经》、《难经》立异标新，竟然置狭义伤寒之外众多的外感病于不论，内容狭隘到仅仅只是谈属于天行范畴的狭义伤寒一种呢？我们认为：张仲景作论，在继承《内经》、《难经》的基础上，有所发展和创新，《内经》、《难经》、《伤寒论》三书，虽然同论广义伤寒，但内容上《伤寒论》详细而《内经》、《难经》简略，所以伤寒六经虽然源于《内经·热论》，但已不全同于《内经·热论》，如果因为热论六经与伤寒六经的不同，竟然得出“张仲景的伤寒为狭义伤寒无疑”的结论，这根本没有说服力。
结语：据《大司天三元甲子考》，“张仲景所处的运气为风为火”，而后世医生习用乌头、附子等大辛大热之药，治疗多有误治，“所以张仲景用桂枝、麻黄的温性，治疗中风、伤寒之病，即用葛根、黄芩、黄连、白虎汤、柏皮汤、栀子豉汤的清性，治疗温热、湿温之病”，这本已足以说明，张仲景的伤寒为广义，然后世个别人，必欲把《伤寒论》说成是专论六气中一气，把张仲景治疗温热病的许多方剂，说成是为狭义伤寒化热之后而设的，这种毫无意义的说法，实在是叶天士、吴鞠通学说中最大的瑕疵，“正名”拾取前人的糟粕而夸大其词，说明谬论流传，遗误后世，迄今尚有余毒，我鉴于此，所以再次进行驳辩，如上所述。
葛根桑叶辨
有人说陆九芝治疗温病，与叶天士学派“轻以去实，辛凉透邪”的观点趋于一致。这种说法，因其小同，遂忽大异，有肺胃不分之弊焉。观陆氏书，有《葛根桂枝辨》，有《葛根麻黄辨》，乃仿之而撰葛根桑叶辨。
叶派之轻以去实，辛凉透邪，如桑叶者，治肺也，陆氏之轻以去实，辛凉透邪，如葛根者，治胃也。轻以去实虽同，治肺治胃大别。叶氏治温病，独重肺系，故谓“温邪上受，首先犯肺”；陆氏治温病，独重胃系，故谓：“温病即阳明病”。故叶氏之治温病，初起必用桑叶、薄荷，桔梗、牛蒡之属，肺药也，陆氏之治温病，初起必用葛根，黄芩，黄连、山栀之类，胃药也。唯叶氏亦知伏气温病不与暴感门同法，故曰：春温一证，冬寒内伏，藏于少阴，以黄芩汤为主方，苦寒直清里热，乃正治也，陆氏亦知温病之邪，在肺胃者，不得独用胃经药，故《不谢方》之治春温、风温者，亦用桑，薄、翘，桔之类也。温病初起，有在肺者，有在胃者，有肺胃二及者，有竟在三阴者。或伏邪从内而出外，或新感由表而入里，或新感引动伏邪，或伏邪又兼新感，或始终但病一经，或发即数经同病，故《难经》云：“温病之脉，行在诸经，不知何经之动，各随其经所在而取之。”温病初起之治，原不可以一经印定眼目，然吴鞠通固执叶氏之说，以为温病初起，必先犯肺，竟谓凡病温者，均始于上焦，在手太阴。后世盲从，踵其讹误，遂以轻清平淡为一切温病初起之治规，盖惑于“温邪上受，首先犯肺”，“治上焦如羽，非轻不举”等说也。叶氏以肺药治肺经病，未误。后人以肺药治胃经病，大谬。治肺宜辛淡轻宣，不可卑用芩、连苦寒者，盖恐胃本无热，而早投苦寒凉中，中寒气馁，则转失托邪外出之力，反招冰伏之弊也。治胃宜积极撤热，不可但用桑叶、薄荷者，盖恶病属中焦，而反治上焦，射不中的，坐使热灼阴伤，用药轻淡如儿戏，终至步步深入也。惟邪机概以从更出表为顺，故病之在肺者，初起必以辛散为宗，宜桑叶之类以轻举之；病之在胃者，初起亦以达邪为旨，宜葛根之类以透解之。然若因此小同，竟忽彼大异，则陆氏斥叶吴学派似肺药治胃之旨，固不得大白于世矣！“麻黄之轻扬，可去伤寒之实，葛根之轻扬，可去温病之实。”其去实亦同，然寒温相异也。斯陆氏已辨之矣。葛根之轻扬，可去手阳明之实，桑叶之轻扬，可去手太阴之实。此陆氏所未言，然亦正其砭斥时弊之宗旨，何后人反于此昧昧耶。须知只须辛凉轻剂，如桑叶配薄、桔之类，其病即可立愈者，无非伤风、肺胀之属也。而必须旱投苦泄，如葛根合芩、连之类，尚恐热盛蒸脑者，乃是暑痉，湿温之属也。病之轻重悬绝，用药肺胃有异，未可同日语也。总之，能“遽入心包，为一场大病，以致于死者。”必非肺经温病，如伤风、肺胀之属，故陆氏重阳明之治，有轻则芩连葛根，重则硝黄石膏之主张。用轻剂病不解，入营入血，动风发痉，而仍曰：病属上焦，初用辛凉宣其肺，终用芳香开心窍，有是证，用是药，治未尝误。此正犯病中治上，撤热被动之误。乃后人既不解叶氏慎苦寒，是为邪热在肺，故主用桑叶、薄，桔之类宣散之以解郁热；又不解陆氏之激言，是为砭时医肺胃不分，初起概用肺药之弊而发，故力倡用葛根、芩、连之类清透以祛胃热，乃终至从陆氏之抨击叶吴学说中，得出益可证叶派这一治疗学思想科学性之认识，则诚非陆氏生前之所能料！
《吴鞠通医案》伏暑门周姓案析评
周姓案前后共十四诊，病程较长，记录完整。通过此案，我们可以看到银翘散，桑菊饮，三仁汤，化斑汤、复脉汤、增液承气汤等方在温病治疗中的具体运用。就反映吴鞠通的温病之学来说，这是一个很有代表性的例案，故特详加析评，以与伺仁共研究。
壬戌八月十六日周十四岁伏暑内发，新凉外加，脉右大左弦，身热如烙，无汗，吐胶痰，舌苔满黄，不宜再见泄泻，不渴，腹胀，少腹痛。是谓阴阳并病，两太阴互争，难；台之症，议先清上焦湿热，盖气化湿热亦化也。
飞滑石三钱连翘二钱象贝母一钱杏仁泥三钱银(：二钱白通草一钱老厚朴二钱鲜梨皮二钱生苡仁一钱五分竹叶一钱今晚一帖，明早一帖。析：鞠通根据“暑温伏暑，名虽异而病实同”，“暑兼湿热，偏于暑之湿者为湿温”等认识，初诊选方，采用三仁汤加减。因发热很高，故去蔻仁、半夏之温燥；加银花、连翘以清热；并加芦根、梨皮以护津，而象贝一味，是为咳吐胶痰设。
评：此案热自内发，寒从外束，证见高热无汗，苔黄痰帖，脉证合参，的系手太阴温病，但与足太阴脾实无涉。值此口不渴，津液尚未大伤之际，若能不受“温病忌用麻黄”等观念之束缚，投以大剂麻杏石甘汤(但《温病条辨》之麻杏石甘汤麻黄石膏等分，则不可用)，积极撤热，津即可保，若能汗出热解，肺气自然清肃。倘若是处理，力挫病势，原可指望。但吴氏计不及此，不但于撤热一项轻描淡写，且以淡渗芳化为重点，此所以后来有阴津大伤之变。
十七日案仍前。
飞滑石三钱连翘二钱鲜梨皮一钱-五分杏仁泥一钱五分冬桑叶一钱银花二钱老厚朴一钱五分薄荷八分扁豆皮二钱苦桔梗一钱五分芦根二钱荷叶边一钱五分炒知母一钱五分午一帖，晚一帖，明早一帖。
析：前方服后未效，故二诊更弦易辙，改用银翘散加减。《温病条辨》治太阴伏暑，不论表虚表实，不论气分血分，概以此为基本方。鞠通说：“太阴伏暑，舌白口渴，无汗者，银翘散去牛蒡、玄参加杏仁，滑石主之。”其自注说这是邪在气分而表实的治法。今观此诊，药法正是属此。因高热未退，故去性温之荆芥、豆豉，代之以凉散之桑叶；并加知母之苦寒，与芦根、梨皮之甘寒，合化阴气，以治热淫所胜。为病属伏暑，故复加扁豆衣、厚朴、荷叶边偕滑石等以清暑化湿。
比较前两诊之用药，有异有同。初诊虽亦用银、翘等清热，但重点在化湿；二诊虽亦用滑、朴等化湿，但重点在散热，故主方各异。但治疗上注重调畅气机，目的都在冀暑湿分解、肺得清肃，此则相同。这种药法，与“冶上焦如羽，非轻不举”的理论相一致。
The *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) holds that the *Shanghan Lun* (Treatise on Cold Damage) only discusses narrow-sense Shanghan (Cold Damage), which is merely one of the Six Qi (Six climatic factors: wind, cold, summer heat, dampness, dryness, fire). The remaining five Qi are not covered at all. This viewpoint was severely criticized by Lu Jiuzhi and others over a hundred years ago; no one has advocated it since, nor has anyone refuted it, until recently when someone published an article titled "Zhengming" (Correcting the Name of Shanghan) (hereinafter referred to as "Zhengming") in Issue 6, Volume 1984 of *Jilin Journal of Traditional Chinese Medicine*, re-emphasizing that Zhang Zhongjing's Shanghan is not broad-sense Shanghan, but narrow-sense Shanghan. Since this is considered the "primary prerequisite for studying the *Shanghan Lun*," it cannot go without clarification.
I. Judgment Cannot Be Based Solely on the Presence or Absence of Epidemic Nature
To determine whether Zhang Zhongjing's Shanghan is broad-sense or narrow-sense, one must first clarify what broad-sense Shanghan and narrow-sense Shanghan mean. Exogenous diseases indeed have two types: those with epidemic nature and those without. However, this is originally not the basis for distinguishing between broad-sense and narrow-sense Shanghan. As is well known, before the *Nanjing* (Classic of Difficult Issues), there was no discussion of broad-sense versus narrow-sense Shanghan. Only after the explicit statement in Chapter 58 of the *Nanjing*: "Shanghan encompasses five conditions: Wind Strike, Shanghan, Damp-Warmth, Heat Disease, and Warm Disease," did later generations develop the saying: "The term 'Shanghan' in 'Shanghan encompasses five' refers to broad-sense, while the term 'Shanghan' in 'there is Shanghan' refers to narrow-sense." This is the origin of the concepts of broad-sense and narrow-sense Shanghan. If one ignores this and instead discusses whether Zhang Zhongjing's Shanghan belongs to broad-sense based solely on its epidemic nature, then, based on the premise that "epidemic diseases do not constitute the entirety of exogenous diseases," one could deduce that "Zhang Zhongjing's Shanghan does not belong to broad-sense." Conversely, based on the premise that "non-epidemic diseases also do not constitute the entirety of exogenous diseases," one could equally deduce that "Zhang Zhongjing's Shanghan does not belong to broad-sense." Obviously, opposite premises leading to the same conclusion indicates a logical error in argumentation, which is self-evident.
II. Narrow-Sense Shanghan Should Not Be Confused with Wind Strike
Although the Six Qi often cause disease in combination, Wind Strike is essentially caused by contracting Wind Pathogen, while Shanghan is essentially caused by contracting Cold Pathogen. Wind and Cold each belong to one of the Six Qi. Given such distinct differences in the pathogens contracted for Wind Strike and Shanghan, the *Nanjing* lists them side by side, grouping them under broad-sense Shanghan along with Damp-Warmth, Heat Disease, and Warm Disease. The *Shanghan Lun* also lists them side by side and provides separate treatment formulas for each. Thus, it is evident that Shanghan and Wind Strike were originally distinct and not mixed. Therefore, the concept of narrow-sense Shanghan is inherently clear: it does not overlap with Wind Strike, nor does it include Wind Strike. However, "Zhengming," by interpreting the term "Shanghan" in the *Shanghan Lun* as narrow-sense Shanghan, simultaneously states that Wind Strike and Shanghan are two distinct conditions while conflating them through a general discussion of Wind-Cold pathogens. This is contradictory and untenable. As stated in *Selected Explanations of Traditional Chinese Medicine Terminology*: "Narrow-sense Shanghan is a syndrome type within Taiyang Exterior Syndrome." It shares the status of a sub-syndrome under broad-sense Shanghan with Wind Strike in Taiyang Disease. In fact, once the concept of narrow-sense Shanghan is understood and distinguished from Taiyang Wind Strike, determining whether Zhang Zhongjing's Shanghan is broad-sense or narrow-sense becomes straightforward.
III. Judgment Cannot Be Based Solely on Taiyang Disease
It is debatable to claim that exogenous diseases always begin in the Taiyang channel. Looking at Warm Disease, which is one of the syndromes under broad-sense Shanghan, its onset can begin in Taiyang. However, it can also begin in Yangming, Shaoyang, or the Three Yin channels. Because its initial presentation lacks fixed rules, the *Nanjing* states: "The pulse of Warm Disease travels through various channels; it is unknown which channel is activated." The same applies to Cold Pathogen injuring the body. Cold Pathogen may first injure Taiyang, directly strike Yangming, initially affect Shaoyang, or directly damage the Three Yin channels. It must be noted that Cold injuring Taiyang is merely one form among many ways Cold Pathogen injures the body, not the only form. Exogenous diseases can start from Taiyang Exterior Syndrome, but some begin from the interior moving outward, originate in Yangming, originate in Shaoyang, or originate in the Three Yin. Yangming Disease includes Taiyang-Yangming, Shaoyang-Yangming, and Zhengyang-Ming (Direct Yangming). Zhengyang-Ming is a disease originating in its own channel; this alone suffices to show that prior to the appearance of Yangming pathology, Taiyang disease is not necessarily a prerequisite. The belief that the dry-heat syndromes in the Yangming chapter must evolve from Taiyang Shanghan transmission is a narrow view that fundamentally contradicts clinical reality and fails to explain the original text of Shanghan. Since the clinical manifestations at the onset of exogenous diseases are not confined to the Taiyang category, the viewpoint that judges whether Zhang Zhongjing's Shanghan is broad-sense solely based on Taiyang disease is untenable.
IV. Judgment Cannot Be Based Solely on Wind Strike and Shanghan Syndromes
Although the Six Excesses (Wind, Cold, Summer Heat, Dampness, Dryness, Fire) do not necessarily attack starting from Taiyang, they can. Therefore, analyzing the early clinical symptoms of Taiyang Disease: the etiology of Wind Strike is Wind Pathogen, Shanghan is Cold Pathogen, Zhong Yue (Heat Stroke) is Summer Heat Pathogen, Shi Bi (Dampness Bi) is Dampness Pathogen, Jing Bing (Spasm Disease) is Dryness Pathogen, and Wen Bing (Warm Disease) is Fire Pathogen. Thus, Zhang Zhongjing’s discussion of Taiyang Disease includes six syndrome types below it. This clearly indicates that Zhang Zhongjing's Shanghan is broad-sense, beyond doubt. However, "Zhengming" denies the existence of Taiyang Warm Disease, a syndrome explicitly listed alongside Wind Strike and Shanghan, claiming it was proposed merely for differential diagnosis. If this claim were valid, then Jing, Shi, and Yue could be disregarded entirely. Why not exclude Wind Strike from Taiyang Disease as well? Why retain it to confuse matters with Shanghan, thereby blurring the concept of narrow-sense Shanghan! Obviously, using the excuse "proposed merely for differential diagnosis" to deny Warm Disease as a sub-syndrome of Taiyang and excluding all other syndromes besides Wind Strike and Shanghan from Taiyang Disease is baseless. What is the point of excluding all non-narrow-sense Shanghan syndromes under broad-sense Shanghan from Taiyang Disease just to prove that Zhang Zhongjing's Shanghan is not broad-sense? By this logic, could we not also say Shanghan was proposed merely for differential diagnosis? Could we not say Zhang Zhongjing's Shanghan is Warm Disease and excludes Shanghan? Obviously, this approach is grossly erroneous.
V. One Cannot Deny the Inheritance of the *Shanghan Lun* from the *Neijing* and *Nanjing*
In the preface to the *Shanghan Lun*, Zhang Zhongjing explicitly states: "Diligently seeking ancient teachings, extensively collecting various prescriptions, I compiled this work using the *Suwen* (Basic Questions), *Jiuan* (Nine Canons/Huangdi Neijing Lingshu), and *Bayishiyi Nan* (Eighty-One Difficult Issues)." The *Neijing* states that Heat Diseases are Shanghan; the *Nanjing* states Shanghan encompasses five; and the Taiyang Disease section of the *Shanghan Lun* includes syndromes such as Wind Strike, Shanghan, Warm Disease, Zhong Yue, and Shi Bi. Comparing these, the inheritability of his theoretical framework is self-evident. Asserting that both Zhang Zhongjing's Shanghan and the *Neijing*'s Shanghan belong to broad-sense Shanghan is logical and obvious. Denying the inheritability of his discourse on Shanghan simply because he did not quote the *Neijing* or *Nanjing* texts is highly erroneous. "Zhengming" seems to imply that affirming Zhang Zhongjing's Shanghan as epidemic (Tianxing) proves it is not broad-sense. However, epidemic vs. non-epidemic, Cold Epidemic vs. Warm Epidemic are not mutually exclusive by nature. Even if Cold Epidemics were prevalent in the late Eastern Han Dynasty, there is no reason to assume Zhang Zhongjing never encountered Warm Epidemics, nor can this negate the existence of many "non-epidemic" exogenous diseases during his time. The *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases) is a book that discusses miscellaneous diseases alongside exogenous diseases, covering a wide range of pathologies. How could it, regarding exogenous diseases, deviate from the *Neijing* and *Nanjing*, ignoring the numerous exogenous diseases outside narrow-sense Shanghan, and restrict its content narrowly to only discussing narrow-sense Shanghan within the scope of epidemics? We believe: Zhang Zhongjing developed and innovated upon the foundation of the *Neijing* and *Nanjing*. Although all three texts discuss broad-sense Shanghan, the *Shanghan Lun* is detailed while the *Neijing* and *Nanjing* are concise. Although the Six Channels of Shanghan originate from the *Re Lun* (Thermal Treatise) in the *Neijing*, they are not identical to the *Re Lun*. Drawing the conclusion that "Zhang Zhongjing's Shanghan is undoubtedly narrow-sense" solely due to differences between the Six Channels in the *Re Lun* and the *Shanghan Lun* lacks persuasiveness.
Conclusion: According to the *Da Si Tian San Yuan Jia Zi Kao*, "the climate Qi during Zhang Zhongjing's time was Wind and Fire." Later physicians habitually used Aconite (*Fuzi*) and Asarum (*Xixin*), which are acrid-hot, leading to frequent mis-treatments. "Therefore, Zhang Zhongjing used the warming properties of Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) to treat Wind Strike and Shanghan, and used the clearing properties of Gegen Qinlian Tang (Kudzu and Coptis Decoction), Baihu Tang (White Tiger Decoction), Bopi Tang (Phellodendron Bark Decoction), and Zhichi Chi Tang (Gardenia and Soybean Decoction) to treat Warmth and Damp-Warmth diseases." This sufficiently demonstrates that Zhang Zhongjing's Shanghan is broad-sense. Yet, some individuals insist on portraying the *Shanghan Lun* as exclusively discussing one of the Six Qi, and interpret Zhang Zhongjing's many formulas for treating Warmth diseases as being designed only for narrow-sense Shanghan transforming into heat. This meaningless assertion is the greatest flaw in the theories of Ye Tianshi and Wu Jutong. "Zhengming" picks up this dross and exaggerates it, showing how fallacies persist and mislead future generations, leaving residual toxicity even today. Seeing this, I have composed this rebuttal as above.
Differentiation of Gegen and Sangye
Some argue that Lu Jiuzhi's treatment of Warm Disease aligns with the Ye School's view of "using light agents to remove excess and acrid-cool agents to vent pathogens." This view focuses on their similarities while ignoring significant differences, exhibiting a failure to distinguish between Lung and Stomach. Examining Lu's works, which include *Ge Gen Gui Zhi Bian* (Differentiation of Gegen and Guizhi) and *Ge Gen Ma Huang Bian* (Differentiation of Gegen and Mahuang), I wrote this *Ge Gen Sang Ye Bian* (Differentiation of Gegen and Sangye) in imitation.
The Ye School uses light agents to remove excess and acrid-cool agents to vent pathogens; for example, Sangye (Mulberry Leaf) treats the Lung. Lu's school uses light agents to remove excess and acrid-cool agents to vent pathogens; for example, Gegen (Kudzu Root) treats the Stomach. While the method of "light agents removing excess" is similar, the targets—Lung versus Stomach—are vastly different. Ye's treatment of Warm Disease focuses exclusively on the Lung system, hence stating "Warm pathogens enter from above and first invade the Lung." Lu's treatment focuses exclusively on the Stomach system, hence stating "Warm Disease is Yangming Disease." Therefore, Ye's initial treatment of Warm Disease must use Sangye, Bohe (Mint), Jiegeng (Platycodon), and Niubangzi (Arctium Seed)—Lung herbs. Lu's initial treatment must use Gegen, Huangqin (Scutellaria), Huanglian (Coptis), and Shanzhi (Gardenia)—Stomach herbs. However, Ye also knew that latent Warm Disease differs from acute contraction; thus, he stated: "For Spring Warmth, winter Cold lies latent inside, hidden in Shaoyin, treated primarily with Huangqin Tang (Scutellaria Decoction), using bitter-cold to directly clear interior heat, which is the correct treatment." Lu also knew that pathogens in the Lung and Stomach cannot be treated solely with Stomach channel herbs; thus, in *Bu Xie Fang*, his treatments for Spring Warmth and Wind Warmth also use Sangye, Bohe, Jinqiao (Forsythia), and Jiegeng. At the onset of Warm Disease, pathogens may be in the Lung, in the Stomach, in both Lung and Stomach, or even in the Three Yin. Latent pathogens may emerge from the interior to the exterior; new pathogens may enter from the exterior to the interior; new pathogens may trigger latent pathogens; latent pathogens may coexist with new pathogens; or the disease may remain in one channel throughout, or multiple channels may be affected simultaneously upon onset. Hence, the *Nanjing* says: "The pulse of Warm Disease travels through various channels; it is unknown which channel is activated. Treatment should follow the location of the affected channel." The treatment of Warm Disease at onset should not be rigidly defined by a single channel. However, Wu Jutong stubbornly adhered to Ye's theory, believing Warm Disease always begins by invading the Lung, asserting that all Warm diseases start in the Upper Jiao, specifically the Hand-Taiyin Lung channel. Later generations blindly followed, perpetuating this error, and established light, clear, and bland methods as the standard for all Warm diseases at onset, misled by statements like "Warm pathogens enter from above and first invade the Lung" and "Treating the Upper Jiao is like feathers; only light agents can lift it." Ye's use of Lung herbs for Lung channel disease was not erroneous. Later generations using Lung herbs for Stomach channel disease is a gross error. Treating the Lung requires acrid-bland and light dispersal; one should not inferiorly use bitter-cold agents like Huangqin and Huanglian. This is because if the Stomach originally has no heat, administering bitter-cold coolants early will chill the Middle Jiao, causing Qi deficiency, losing the power to expel pathogens outward, and instead inviting the pathology of "ice-stagnation." Treating the Stomach requires active heat clearance; one should not merely use Sangye and Bohe. If a severe disease belongs to the Middle Jiao but is treated in the Upper Jiao, it is like shooting and missing the target, allowing heat to scorch and yin to deplete. Using light and bland medicines frivolously leads to the condition worsening step by step. Generally, it is favorable for pathogens to exit via the exterior. Therefore, for diseases in the Lung, initial treatment should prioritize acrid dispersal, suitable for light lifting agents like Sangye. For diseases in the Stomach, initial treatment aims to reach and resolve pathogens, suitable for penetrating agents like Gegen. However, focusing on these minor similarities while ignoring major differences means Lu's criticism of the Ye-Wu school's tendency to use Lung herbs for Stomach diseases would never be clarified. "Mahuang's light ascending nature can remove the excess of Shanghan; Gegen's light ascending nature can remove the excess of Warm Disease." Both remove excess, yet Cold and Warm differ. Lu has already differentiated this. Gegen's light ascending nature removes excess in the Hand-Yangming Large Intestine; Sangye's light ascending nature removes excess in the Hand-Taiyin Lung. Lu did not explicitly state this, but it aligns with his purpose of criticizing contemporary medical flaws. Why do later generations remain ignorant here? It must be understood that illnesses curable immediately with light acrid-cool agents, such as Sangye combined with Bohe and Jiegeng, are nothing more than Wind Injury or Lung Distension. Illnesses requiring early administration of bitter-draining agents, such as Gegen combined with Huangqin and Huanglian, where heat is so intense it steams the brain, belong to Summer Heat Spasm or Damp-Warmth. The severity of these diseases is vastly different, and the choice of Lung versus Stomach herbs varies; they cannot be discussed on the same level. In short, cases that "rapidly enter the Pericardium, causing severe illness and death," are definitely not Lung-channel Warm Diseases like Wind Injury or Lung Distension. Therefore, Lu emphasizes treating Yangming: mild cases use Huangqin, Huanglian, and Gegen; severe cases use Xiaoshi (Mirabilite), Dahuang (Rhubarb), and Shigao (Gypsum). If light agents fail to resolve the disease, and it enters the Ying and Blood levels, stirring wind and causing spasms, yet one still claims: "The disease belongs to the Upper Jiao; initially use acrid-cool to ventilate the Lung, finally use aromatic agents to open the orifices of the Heart," applying medicine according to symptoms is not mistaken. This, however, falls into the error of treating the Upper Jiao when the disease is central, passively clearing heat. Later generations, failing to understand that Ye's caution against bitter-cold was because pathogens were in the Lung, thus advocating Sangye, Bohe, and Jiegeng to disperse and resolve stagnant heat; and failing to understand that Lu's passionate remarks were aimed at criticizing contemporary physicians for confusing Lung and Stomach and indiscriminately using Lung herbs at onset, instead vigorously advocating Gegen, Huangqin, and Huanglian to clear and penetrate Stomach heat. Ultimately, deriving from Lu's critique of the Ye-Wu school the recognition that validates the scientific nature of the Ye School's therapeutic thought is truly something Lu could not have anticipated in his lifetime!
Analysis and Commentary on Case of Surname Zhou in the Latent Summerheat Section of *Wu Jutong's Medical Cases*
The case of Surname Zhou comprises fourteen consultations with a long course and complete records. Through this case, we can observe the specific application of formulas such as Yinqiao San (Honeysuckle and Forsythia Powder), Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction), Sanren Tang (Three Seeds Decoction), Huaban Tang (Spot Resolving Decoction), Fumai Tang (Pulse Reviving Decoction), and Zengye Chengqi Tang (Increasing Fluids and Descending Hardness Decoction) in the treatment of Warm Diseases. Reflecting Wu Jutong's study of Warm Diseases, this is a highly representative case; therefore, it is analyzed and commented on in detail for research with colleagues.
Renxu Year, August 16th: Zhou, aged 14, latent Summerheat erupted internally, compounded by external fresh coolness. Pulse: Right large, Left wiry. Body heat like branding iron, no sweat, coughing up sticky phlegm, tongue coating fully yellow. Diarrhea should not occur again. No thirst, abdominal distension, lower abdominal pain. This is termed Yin-Yang concurrent disease, with two Taiyin channels contending, difficult to treat. Proposed strategy: First clear damp-heat in the Upper Jiao, as Qi transformation can also transform damp-heat.
Fei Huashi (Prepared Talcum) 3 qian, Lianqiao (Forsythia Fruit) 2 qian, Xiang Beimu (Fritillaria Thunbergii Bulb) 1 qian, Xingren Ni (Apricot Seed Paste) 3 qian, Yinhua (Honeysuckle Flower) 2 qian, Baitongcao (White Tetrapanax Pith) 1 qian, Lao Houpo (Magnolia Bark) 2 qian, Xian Lipi (Fresh Pear Peel) 2 qian, Sheng Yiren (Raw Coix Seed) 1.5 qian, Zhuye (Bamboo Leaf) 1 qian. Take one decoction tonight, one tomorrow morning.
Analysis: Jutong, based on the understanding that "Shuwen and Fushe share the same pathology despite different names," and "Summerheat combines with damp-heat; when dampness predominates in Summerheat, it is called Damp-Warmth," selected a modified Sanren Tang for the first consultation. Due to high fever, he removed the warm-drying Kou Ren (Cardamom Seed) and Banxia (Pinellia Tuber); added Yinhua and Lianqiao to clear heat; and added Lugeng (Reed Rhizome) and Lipi to protect fluids. Xiangbei was included specifically for coughing up sticky phlegm.
Commentary: In this case, heat originates internally, constrained by external cold. Symptoms include high fever, no sweat, yellow coating, and sticky phlegm. Pulse and symptoms combined indicate Hand-Taiyin Warm Disease, unrelated to Foot-Taiyin Spleen excess. At this stage, with no thirst and fluids not yet significantly damaged, if one were not bound by concepts like "Warm Disease contraindicates Mahuang," administering a large dose of Maxing Shigan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction)—note: the version in *Wenbing Tiaobian* with equal parts Mahuang and Shigao should not be used—would actively clear heat, preserving fluids. If sweat occurs and heat resolves, Lung Qi would naturally become clear and descending. With such handling, overcoming the disease momentum was feasible. However, Wu's plan fell short of this. He not only downplayed heat clearance but focused on mild diuresis and aromatic transformation, leading to subsequent severe damage of Yin fluids.
17th Day Case: Same as before.
Fei Huashi 3 qian, Lianqiao 2 qian, Xian Lipi 1.5 qian, Xingren Ni 1.5 qian, Dong Sangye (Winter Mulberry Leaf) 1 qian, Yinhua 2 qian, Lao Houpo 1.5 qian, Bohe (Mint) 0.8 fen, Biandou Pi (Coix Seed Husk) 2 qian, Ku Jiegeng (Platycodon Root) 1.5 qian, Lugeng 2 qian, Hetabian (Lotus Leaf Edge) 1.5 qian, Chao Zhimu (Processed Anemarrhena Rhizome) 1.5 qian. Take one decoction at noon, one at night, one tomorrow morning.
Analysis: The previous prescription was ineffective, so the second consultation changed the approach, switching to a modified Yinqiao San. The *Wenbing Tiaobian* treats Taiyin Fushe regardless of exterior deficiency/excess or Qi/Blood level, using this as the basic formula. Jutong stated: "For Taiyin Fushe, with white tongue coating, thirst, and no sweat, use Yinqiao San removing Niu Bang Zi (Arctium Seed) and Xuanshen (Scrophularia Root), adding Xingren and Huashi as chief ingredients." His self-note explains this is the treatment for pathogens in the Qi level with exterior excess. Observing this consultation, the herbal method fits this description. Due to unrelenting high fever, he removed the warm-natured Jingjie (Schizonepeta) and Douchi (Fermented Soybean), replacing them with the cool-dispersing Sangye; and added bitter-cold Zhimu, combined with sweet-cold Lugeng and Lipi, to harmonize Yin Qi and treat excessive heat. Since the disease is Fushe, he additionally added Biandou Yi (Coix Seed Coat), Houpo, Hetabian, and Huashi to clear Summerheat and transform dampness.
Comparing the medication of the first two consultations, there are similarities and differences. The first consultation used Yinhua and Lianqiao to clear heat, but the focus was on transforming dampness. The second consultation used Huashi and Houpo to transform dampness, but the focus was on dissipating heat; thus, the main formulas differed. However, both treatments emphasized regulating Qi mechanism, aiming for the separation of Summerheat and dampness and the clearing of Lung Qi, which is consistent. This herbal method aligns with the theory "Treating the Upper Jiao is like feathers; only light agents can lift it."