《活人》曰∶其人伤湿，又中于暑，名曰湿温。两胫逆冷，腹满头目痛，妄言多汗，其脉
阳浮而弱，阴小而急，茯苓白术汤、白虎加苍术汤。切勿发汗，汗之名中 ，必死。而吴氏引《活
人书》曰∶宜术附汤加人参、香薷、扁豆主之。《金鉴》曰∶温病复伤于湿，名曰湿温，其症两
胫逆冷，妄言多汗，头痛身重胸满，宜白虎加苍术、茯苓，温湿两治。若脉大有力，自汗烦渴者，
人参白虎汤加白术主之。轻者十味香薷饮、清暑益气汤增损用之。按古人治法不过如斯。但《金鉴》
曰∶温病复伤于湿曰湿温，而《活人》则曰伤湿而又中暑曰湿温。味其义意，当遵《金鉴》为是。
盖伤湿而又伤暑，只可谓之伤暑湿，而不可谓之湿温也。夫曰湿温者，是湿而兼瘟也。或先瘟而中
湿，或先湿而患瘟，与暑何涉焉。第瘟疫兼湿又最难辨。□□□□□□□□□□□□□□□□□□
□唯于一身尽痛，痛极且不能转侧，恶饮汤水，目中视物皆红黄，身目色微黄，而无谵妄等症者，
辨之始得。而湿症之中，又
有湿热、寒湿之分，总宜白术茯苓汤。湿热者，小便赤涩如马溺，混浊色白，且有烦热大便秘结诸
症，宜人参白虎汤加白术主之，或四苓散、大小厘清饮、茵陈饮之类，皆可择用。若天久阴雨，
湿气过胜，其人脏腑虚，大便滑，小便清，乃是寒湿，宜术附汤。但瘟疫发在热时，且兼湿热者多，
而兼寒湿者少，术附汤不可用。若服茯苓白术□□□□□□□□等汤不应，则用除湿达原饮，分治
瘟与湿，诚一举而两得也。北方风高土燥，患此者少，惟南方水乡卑湿，天气炎热，患者恒多。春
冬感者恒少，而夏秋患者恒多。所宜随其时地而变通之。至于前所引《活人》云∶湿温切勿发汗，而
《金匮要略》则云∶湿家身烦痛，可与麻黄加白术汤，发其汗为宜。《景岳全书》又曰∶凡湿从外
入者，汗散之，将谓止中湿者宜汗，而兼温者不宜汗。何以《准绳》湿温门中，既引《活人》云不
宜汗，又引《金匮》曰宜汗，更引成氏云湿家发汗则愈。是湿温一门，前后又自相矛盾，殊不可解。
愚意瘟疫始终不宜发汗，虽兼之中湿，而尚有瘟疫作祟，是又当以瘟疫为重，而中湿为轻，自
不宜发汗，当用和解疏利之法，先治其瘟，俟其自然汗出，则湿随其汗，而与瘟并解矣。或瘟解
而湿仍在者，当于湿证门中求之，故治湿诸方俱不开列。
除湿达原饮 （自定新方。）
槟榔（二钱） 草果仁（五分，研） 浓朴（一钱，姜汁炒） 白芍（一钱） 甘草（一钱）
栀子（五分，研） 黄柏（五分，酒炒） 茯苓（三钱）
如兼三阳经症，仍酌加柴、葛、羌活，瘟而兼湿，故去知母，而换黄柏，以燥湿且能救水而
利膀胱；去黄芩换栀子，泻三焦火而下行利水；加茯苓利小便而兼益脾胃。三者备而湿热除矣。再
加羌活等药，风药亦能胜湿，湿除温散，一举两得。（此方分两不过大概，临症加减用之。）
石草散 （治湿瘟多汗，妄言烦渴。）
石膏（ ） 炙草（等分）
共末，浆水调服二钱。
《活人书》说：人受了湿邪，又中暑热，称为湿温。症状表现为两小腿逆冷，腹部胀满，头目疼痛，胡言乱语，多汗，脉象阳部浮而弱，阴部小且急，可用茯苓白术汤、白虎加苍术汤治疗。千万不要发汗，如果误用发汗法，称为“中暍”（暑热伤气），必然致死。吴氏引用《活人书》说：适宜用术附汤加入人参、香薷、扁豆来主治。《医宗金鉴》说：温病再次受湿邪侵袭，称为湿温，其症状为两小腿逆冷，胡言乱语，多汗，头痛，身体沉重，胸脘痞满，适宜用白虎加苍术汤、茯苓白术汤，同时治疗温与湿。如果脉象大有力，自汗，烦躁口渴的，用人参白虎汤加白术主治。轻症的，用十味香薷饮、清暑益气汤加减使用。考察古人的治法不过如此。但《医宗金鉴》说：温病再受湿邪叫湿温，而《活人书》则说：受湿邪又中暑叫湿温。体味其中的义理，应当遵从《医宗金鉴》的说法是正确的。因为受湿邪又受暑邪，只能称之为伤暑湿，而不能称之为湿温。所谓湿温，是湿邪兼夹瘟疫（温热毒邪）。或者是先患瘟疫而后中湿邪，或者先中湿邪而后患瘟疫，这与暑邪有什么关系呢？只是瘟疫兼夹湿邪又最难辨别。□□□□□□□□□□□□□□□□□□□唯见全身尽痛，痛到极点甚至不能翻身转动，厌恶饮用汤水，眼中视物皆呈红黄色，身体和眼睛颜色微黄，而没有谵妄等症状的，才能辨别清楚。而在湿症之中，又有湿热、寒湿的区别，总宜用白术茯苓汤。湿热者，小便赤涩如马尿，混浊色白，且有烦热、大便秘结等症状，适宜用人参白虎汤加白术主治，或者四苓散、大小厘清饮、茵陈饮之类，都可以择用。如果天久阴雨，湿气过盛，其人脏腑虚弱，大便滑泄，小便清长，这是寒湿，适宜用术附汤。但是瘟疫发作在热时，且兼夹湿热的多，兼夹寒湿的少，术附汤不可用。如果服用茯苓白术□□□□□□□□等汤剂无效，则用除湿达原饮，分别治疗瘟与湿，这确实是一举两得的方法。北方风高土燥，患此病的人少，只有南方水乡低洼潮湿，天气炎热，患者往往很多。春夏季感邪的很少，而夏秋季患者很多。所宜随时间和地点的变化而变通运用。至于前面引用的《活人书》说：湿温切勿发汗，而《金匮要略》则说：湿家身体烦痛，可以用麻黄加白术汤，发其汗为宜。《景岳全书》又说：凡湿从外入的，用汗法发散之，将谓只中湿邪者适宜发汗，而兼温邪者不适宜发汗。为什么《准绳》湿温门中，既引用《活人书》说不宜发汗，又引用《金匮》说宜发汗，更引用成无己说湿家发汗则愈。这样湿温一门，前后又自相矛盾，实在难以理解。我的意见是瘟疫始终不适宜发汗，虽然兼夹中湿邪，但还有瘟疫作祟，这又应当以瘟疫为重，而中湿为轻，自然不适宜发汗，应当用和解疏利的方法，先治疗其瘟，等到其自然出汗，则湿邪随着汗液排出，而与瘟邪一并解除。或者瘟邪已解而湿邪仍在的，应当在湿证门中寻找治疗方法，所以治疗湿的各种方剂都不开列。
除湿达原饮 （自行制定的新方。）
槟榔（二钱） 草果仁（五分，研碎） 浓朴（一钱，姜汁炒） 白芍（一钱） 甘草（一钱）
栀子（五分，研碎） 黄柏（五分，酒炒） 茯苓（三钱）
如果兼有三阳经的症状，仍酌情加入柴胡、葛根、羌活，因为瘟邪兼夹湿邪，所以去掉知母，换成黄柏，以燥湿且能救阴液而利膀胱；去掉黄芩换成栀子，泻三焦之火而下行利水；加入茯苓利小便而兼益脾胃。三者具备而湿热除去了。再加羌活等药，风药也能胜湿，湿除温散，一举两得。（此方的分量不过是大概，临症时加减使用。）
*Huoren Shu* states: When a person is injured by dampness and simultaneously struck by summerheat, it is called Damp-Warmth (Shi Wen). Symptoms include coldness reversing up from the lower legs, abdominal fullness, headache and eye pain, delirious speech, and profuse sweating. The pulse is floating and weak at the Yang position, and small and rapid at the Yin position. Treat with Ling Fu Bai Zhu Tang (Poria and Atractylodes Decoction) or Bai Hu Jia Cang Zhu Tang (White Tiger plus Coix Seed Decoction). Do not induce sweating; if mistakenly induced, it is termed Zhong Yue (Heatstroke injury to Qi), which leads to death. Wu cites *Huoren Shu*, stating that Shu Fu Tang (Aconite and Atractylodes Decoction) added with Ren Shen (Ginseng), Xiang Ru (Elsholtzia), and Bian Dou (Lablab Bean) should be used. *Yizong Jinjian* (Golden Mirror of Medical Tradition) states: When Warm Disease (Wen Bing) is re-injured by dampness, it is called Damp-Warmth. Symptoms include coldness reversing up from the lower legs, delirious speech, profuse sweating, headache, heavy body, and chest fullness. It is suitable to use Bai Hu Jia Cang Zhu Tang (White Tiger plus Coix Seed Decoction) and Fu Ling Bai Zhu Tang (Poria and Atractylodes Decoction) to treat both warmth and dampness simultaneously. If the pulse is large and forceful, with spontaneous sweating, irritability, and thirst, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) added with Bai Zhu (Atractylodes Macrocephala) should be used. For mild cases, Shi Wei Xiang Ru Yin (Ten-Ingredient Elsholtzia Decoction) or Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) can be used with modifications. Examining ancient treatment methods, they are no more than this. However, *Yizong Jinjian* states that Warm Disease re-injured by dampness is called Damp-Warmth, whereas *Huoren Shu* states that being injured by dampness and then struck by summerheat is called Damp-Warmth. Interpreting the meaning, one should follow *Yizong Jinjian* as correct. Because being injured by dampness and then by summerheat can only be termed Summerheat-Dampness Injury, not Damp-Warmth. What is called Damp-Warmth is dampness combined with Plague-Warmth (Epidemic Warmth). Whether one first contracts Plague-Warmth and then suffers dampness, or first suffers dampness and then contracts Plague-Warmth, what does this have to do with summerheat? Only plague-warmth combined with dampness is hardest to distinguish. □□□□□□□□□□□□□□□□□□□ Only when there is pain throughout the entire body, so severe that turning over is impossible, aversion to drinking soups/waters, vision appearing red and yellow, slight yellowing of the body and eyes, without delirium and other symptoms, can it be distinguished. Among damp syndromes, there is a distinction between Damp-Heat and Cold-Damp. Generally, Bai Zhu Fu Ling Tang (Atractylodes and Poria Decoction) is suitable. For Damp-Heat, urine is red and scanty like horse urine, turbid and white-colored, accompanied by irritability, heat sensation, and constipation. Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) added with Bai Zhu (Atractylodes Macrocephala) is suitable, or Si Ling San (Four Poria Powder), Da Xiao Li Qing Yin (Large and Small Clearing Decoctions), Yin Chen Yin (Artemisia Capillaris Decoction), etc., can be selected. If it rains continuously for a long time, dampness is excessive, the person's internal organs are deficient, stool is loose, and urine is clear, this is Cold-Damp. Shu Fu Tang (Aconite and Atractylodes Decoction) is suitable. However, plague-warmth occurs in hot seasons, and combined with Damp-Heat is common, while combined with Cold-Damp is rare; thus, Shu Fu Tang should not be used. If Fu Ling Bai Zhu □□□□□□□□ and other decoctions are ineffective, then Chu Shi Da Yuan Yin (Damp-Removing Da Yuan Decoction) should be used to treat plague and damp separately, truly achieving two benefits with one move. In the North, wind is high and soil is dry, so few suffer from this. Only in the South, water towns are low and damp, weather is hot, and patients are numerous. Spring and winter infections are rare, while summer and autumn patients are many. Treatment should be adapted according to time and place. As previously cited, *Huoren Shu* says: Damp-Warmth must not induce sweating, while *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) says: For those with dampness suffering bodily irritability and pain, Ma Huang Jia Bai Zhu Tang (Ephedra plus Atractylodes Decoction) to induce sweating is appropriate. *Jing Yue Quan Shu* (Complete Works of Jingyue) also states: For damp entering from outside, disperse with sweating; implying that only those struck by dampness should sweat, but those combined with warmth should not. Why does *Zhun Sheng* in the Damp-Warmth section cite *Huoren Shu* saying sweating is inappropriate, yet cite *Jin Gui* saying it is appropriate, and further cite Cheng Shi saying dampness sufferers recover after sweating? Thus, the Damp-Warmth section contradicts itself前后, which is hard to understand. My opinion is that plague-warmth should never induce sweating throughout its course. Although combined with dampness strike, the plague-warmth remains the primary pathogen. Therefore, plague-warmth takes precedence, and dampness strike is secondary; inducing sweating is inappropriate. One should use harmonizing and draining methods, treating the plague-warmth first. Wait for natural sweating to occur; then dampness will exit with the sweat, resolving together with the plague-warmth. Or if plague-warmth resolves but dampness remains, seek treatment within the Damp Syndrome section; therefore, various formulas for treating dampness are not listed.
Chu Shi Da Yuan Yin (Self-formulated New Formula.)
Bing Lang (Areca Seed, 2 qian) Cao Guo Ren (Tsaoko Cardamom Fruit Kernel, 5 fen, crushed) Nong Po (Magnolia Bark, 1 qian, stir-fried with ginger juice) Bai Shao (White Peony Root, 1 qian) Gan Cao (Licorice Root, 1 qian)
Zhi Zi (Gardenia Fruit, 5 fen, crushed) Huang Bo (Phellodendron Bark, 5 fen, wine-fried) Fu Ling (Poria, 3 qian)
If symptoms of the Three Yang meridians are present, still add Chai Hu (Bupleurum), Ge Gen (Kudzu Root), Qiang Huo (Notopterygium Rhizome) as appropriate. Because plague-warmth combines with dampness, Zhi Mu (Anemarrhena) is removed and replaced with Huang Bo (Phellodendron) to dry dampness and preserve fluids while benefiting the bladder; Huang Qin (Scutellaria) is removed and replaced with Zhi Zi (Gardenia) to drain Triple Burner fire and promote downward urination; Fu Ling (Poria) is added to benefit urination and strengthen the Spleen and Stomach. With these three prepared, damp-heat is eliminated. Adding Qiang Huo (Notopterygium Rhizome) and other drugs, wind-drugs can also overcome dampness. Dampness removed, warmth dispersed, achieving two benefits with one move. (The dosages in this formula are approximate; adjust according to clinical presentation.)
Shi Cao San (Stone-Caoli Powder) (Treats Damp-Warmth with profuse sweating, delirious speech, irritability, and thirst.)
Shi Gao (Gypsum Fibrosum, ) Zhi Cao (Honey-fried Licorice Root, equal parts)
Grind into powder, mix with Jiang Shui (Fermented Rice Water), take 2 qian orally.