门人问曰。夫子本仲景法而言湿温之为病。既可比类以通其义矣。然仲景言湿病曰风湿
。曰
寒湿。此显然可稽者。不识治法可与湿温相通否。答曰。此同一湿病而治法判然不同。今且
与子先论风湿。仲景言风湿相搏。一身尽疼痛。其稍轻者。身体烦疼。不能自转侧。重则骨
节烦疼。掣痛不得屈伸。近则痛剧。或身微肿。甚至汗出短气。小便不利。恶风不欲去衣。
此其证虽有轻重不同。总由风湿中入关节。浸淫于皮肤筋骨之间。并无里邪。故仲景于风湿
相搏证。特着出不呕不渴四字。以明与湿温有别。风湿相搏之证。法当汗出而愈。但大发其
汗。风气去。湿气在。只取微微似欲汗出者。此为风湿俱去。阅仲景方。主用术以理脾胜湿
。更藉附子之大力。迅走卫外。追风逐湿。绝不杂一毫风药。自得微汗而解。此与中风病之
主用桂枝。必赖芍药甘枣。和营分以托出卫邪者同义。设以此等剂而误施之既渴且呕之湿温
病。不立速其毙者几希。又湿家之为病。身色如似熏黄。发黄之证。不惟湿热已也。寒湿在
里。亦能发黄。仲景有不可下之戒。以其别于湿温病也。而曰当从寒湿中求之。则当以温药祛寒
胜湿不言可知矣。子欲知湿温。当知湿证中又各有表里寒温之不同。能辨于其似。则湿温之
真面目始见。欲知湿温之别于风湿寒湿。当先审其口之渴与不渴。在他证皆可或有或无。断
未有温邪内伏。而口不渴者。此要诀也。
弟子问道：“老师依据张仲景的法则来论述湿温病，既然可以类比推演以通晓其义理。然而张仲景在论述湿病时，提到‘风湿’和‘寒湿’，这是明显可以查考的。不知治疗这些病的方法是否与湿温病相通？”
老师回答说：“这虽然同属湿病，但治疗方法截然不同。现在我先与你讨论风湿病。张仲景说，风湿邪气相互搏结，导致全身疼痛；病情较轻的，身体烦扰疼痛，不能自行翻身转动；病情较重的，关节烦痛剧烈，牵引性疼痛导致无法屈伸，靠近患处则疼痛加剧，或者身体轻微肿胀，甚至出现出汗、气短、小便不利、怕风不想脱衣等症状。这些证候虽然有轻重不同，但总归是风湿邪气侵入关节，浸淫于皮肤筋骨之间，并没有里证（脏腑内部的病变）。所以张仲景在论述风湿相搏的证候时，特别强调‘不呕不渴’这四个字，以此来明确它与湿温病的区别。
对于风湿相搏的证候，治法应当通过发汗而痊愈。但不能大发其汗，如果大汗出，风气虽去，湿气仍在；只有取微微似欲出汗的状态，这样才能使风湿之邪一同去除。查阅张仲景的方剂，主要使用白术来调理脾胃、胜除湿气，更借助附子的大力，迅速运行于卫分之外，追逐风邪与湿气，绝不混杂任何一般的祛风药。这样自然能得到微汗而病解。这与治疗中风病主要使用桂枝汤，必须依赖芍药、甘草、大枣调和营分，从而将卫分之邪托出的道理是相同的。假如将这些方剂误用于已经出现口渴且呕吐的湿温病，病人几乎立刻就会死亡。
另外，患湿病的患者，面色像熏黄一样。发黄这种证候，不仅仅是湿热所致，寒湿在里也能导致发黄。张仲景有不可用下法的戒律，以此区别于湿温病。并且说应当在寒湿中寻求治法，那么应当用温药来祛除寒邪、胜除湿气，这是不言而喻的。
你想知道湿温病，应当知道在湿证中又有表里、寒温的不同。能在相似之处加以辨别，湿温病的真面目才能显现。想要知道湿温病与风湿、寒湿的区别，应当先审视其口是否口渴。在其他证候中，口渴与否都可能有或没有，但绝不会有温邪内伏而口不渴的情况。这是关键的诀窍。”
The disciple asked, "Master, you discuss the disease of Damp-Warmth (Shi Wen) based on the methods of Zhang Zhongjing. Since principles can be inferred by analogy to understand its meaning, when Zhang Zhongjing discusses Dampness diseases, he mentions 'Wind-Damp' (Feng Shi) and 'Cold-Damp' (Han Shi), which are clearly verifiable. I wonder if the treatment methods for these can be applied interchangeably with Damp-Warmth?"
The Master replied, "Although these all belong to Dampness diseases, their treatment methods are distinctly different. Let me first discuss Wind-Damp with you. Zhang Zhongjing stated that when Wind and Dampness pathogens struggle against each other, the whole body suffers from pain. In milder cases, the body feels restless and painful, making it difficult to turn over or shift position independently. In severe cases, there is intense joint pain, pulling pain preventing flexion and extension, and pain worsens upon touching the area. There may also be slight swelling of the body, shortness of breath, difficulty in urination, aversion to wind, and a reluctance to remove clothing. Although these symptoms vary in severity, they generally result from Wind and Dampness pathogens entering the joints and infiltrating between the skin, sinews, and bones, without any interior pathogenic factors (Li Xie). Therefore, in discussing the syndrome of Wind-Damp struggle, Zhang Zhongjing specifically emphasized the four characters 'no vomiting and no thirst' to clarify the distinction from Damp-Warmth.
For the syndrome of Wind-Damp struggle, the treatment method should achieve recovery through sweating. However, one must not induce profuse sweating; if sweat is excessive, the Wind pathogen leaves, but the Dampness remains. Only by inducing a slight, continuous perspiration ('wei wei si yu han chu') can both Wind and Dampness be expelled. Reviewing Zhang Zhongjing's formulas, the primary use of Atractylodis Rhizoma (Baizhu, 白术) regulates the Spleen to overcome Dampness, assisted by the powerful action of Aconiti Lateralis Radix Praeparata (Fuzi, 附子) to swiftly move in the Exterior Wei level, pursuing Wind and expelling Dampness, without mixing any ordinary Wind-dispelling herbs. This naturally leads to resolution via slight sweating. This principle is similar to treating Wind-Strike (Zhong Feng) primarily using Guizhi Tang (Cinnamon Twig Decoction), relying on Paeoniae Radix Alba (Shaoyao, 芍药), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), and Jujubae Fructus (Dazao, 大枣) to harmonize the Ying (Nutritive) level and push out the Wei (Defensive) pathogen. If such formulas were mistakenly applied to a Damp-Warmth patient who is already thirsty and vomiting, death would likely ensue almost immediately.
Furthermore, patients suffering from Dampness diseases often have a complexion resembling smoky yellow. The syndrome of jaundice is not caused solely by Damp-Heat; Cold-Damp in the Interior can also cause jaundice. Zhang Zhongjing issued a warning against using purgation methods, distinguishing this from Damp-Warmth. He stated that one should seek the treatment within the context of Cold-Damp. Thus, it is self-evident that warm herbs should be used to dispel Cold and overcome Dampness.
To understand Damp-Warmth, you must know that within Dampness syndromes, there are differences regarding Exterior/Interior and Cold/Warmth. Only by distinguishing them where they appear similar can the true nature of Damp-Warmth be revealed. To distinguish Damp-Warmth from Wind-Damp and Cold-Damp, one must first examine whether the mouth is thirsty or not. In other syndromes, thirst may or may not be present, but it is absolutely impossible for Warmth pathogens to be latent inside while the patient has no thirst. This is the key principle."