干霍乱用探吐，泄胃中有形之滞也。然泄邪而胃液不上升者，热邪愈炽。探吐而胃液不四布者，风邪更张，终成死候，
不可不知。
雄按∶此条自注，明以湿热二气分疏，章氏妄逞己见，谓湿热即暑也，强合二气为一气，且并《难经》湿温，
热病为一证矣。盖由未读越人之书耳。兹于原释中悉为订正，而附记于此，以质宗工。
五湿热证∶壮热口渴，舌黄或焦红，发痉神昏，谵语或笑，邪灼心包，营血已耗。宜犀角、羚羊角、连翘、生地、
元参、钩藤、银花露、鲜菖蒲、至宝丹等味。
雄按∶吴本无银花露。汪按∶宜从吴本。盖花露清灵芳润用治热病殊佳。
然中有蕴湿者，终觉非宜也。
上条言痉，此条言厥。温暑之邪，本伤阳气。
雄按∶此谓邪之初感，必先干阳分而伤气也。及至热极，逼入营阴。
雄按∶虽挟湿邪，日久已从热化，在气不能清解，必至逼营。则津液耗而阴亦病，心包受灼，神识昏乱，用药以清热救
阴，泄邪平肝为务。
雄按∶昏谵乃将厥之兆也。
六湿热证∶发痉，神昏笑妄，脉洪数有力，开泄不效者，湿热蕴结胸膈，宜仿凉膈散。若大便数日不通者，热邪闭
结肠胃，宜仿承气微下之例。章云∶曰宜仿、曰微下，教人细审详慎，不可孟浪攻泻。盖暑湿粘腻，须化气缓攻，不同
伤寒化热而燥结，须咸苦峻下以行之也。
雄按∶吴本无此条。
此条乃阳明实热，或上结胸膈。或下结肠胃。
清热泄邪，止能散络中流走之热，而不能除肠中蕴结之邪。故阳明之邪，仍假阳明为出路也。阳明实热，舌苔必老
黄色，或兼燥。若犹带白色而滑者，乃湿重为夹阴之邪。或胀满不得不下，须佐二术健脾燥湿，否则脾伤气陷，下利不
止，即变危证。盖湿重属太阴证，必当扶脾也。
雄按∶苔色白滑不渴，腹虽胀满，是太阴寒湿，岂可议下，但宜浓朴、
枳、术等温中化湿为治。若阳明之邪，假阳明为出路一言，真治温热病之金针也。盖阳明以下行为顺，邪既犯之，虽不
可孟浪攻泻，断不宜截其出路，故温热自利者，皆不可妄行提涩也。杨云∶注语极郑重，孟英辨驳尤精，二说皆宜参究。
汪按∶凡率投补涩者，皆不知邪必须有出路之义者也。
七湿热证∶壮热烦渴，舌焦红或缩，斑疹，胸痞自利，神昏痉厥，热邪充斥表里三焦。宜大剂犀角、羚羊角、生地、
元参、银花露、紫草、方诸水、金汁、鲜菖蒲等味。
雄按∶吴本无银花露、方诸水、金汁。有丹皮、连翘。
此条乃痉厥中之最重者，上为胸闷，下挟热利，斑疹痉厥，阴阳告困，独清阳明之热，救阳明之液为急务者，恐胃
液不存，其人自焚而死也。
雄按∶此治温热诸病之真诠也，医者宜切记之，方诸水俗以蚌水代之，腥浊已甚，宜用竹沥
为妙。此证紫雪、神犀丹皆可用也。
八湿热证∶寒热如疟。
雄按∶吴本下有“舌苔滑白，口不知味”八字。湿热阻遏膜原。宜柴胡、浓朴、槟榔、草果、
藿香、苍术、半夏、干菖蒲、六一散等味。
雄按∶吴本无柴胡、槟榔、藿香、菖蒲，有神曲。
疟由暑热内伏，秋凉外束而成。若夏月腠理大开，毛窍疏通，安得成疟？而寒热有定期，如疟证发作者，以膜原为
阳明之半表半里，热湿阻遏，则营卫气争，证虽如疟，不得与疟同治，故仿又可达原饮之例。盖一由外凉束，一由内湿
阻也。膜原在半表半里，如少阳之在阴阳交界处，而营卫之气，内出于脾胃，脾胃邪阻，则营卫不和，而发寒热似疟之
证矣。
九湿热证∶数日后，脘中微闷，知饥不食，湿邪蒙绕三。
雄按∶宜作“上”焦。宜藿香叶、薄荷叶、鲜荷叶、枇杷叶、
佩兰叶。
雄按∶《离骚》纫秋兰以为佩，故称秋兰为佩兰。若药肆中所售之佩兰，乃奶酣草之类，不可入药也。汪按∶兰
即省头草，《离骚》之兰，即本草之
兰，皆非今之兰花，前人辨之，已极明确，不必致疑矣。盖古
人所谓香草。皆取叶香非指花香，而今之兰花叶实不香，明非古之兰也。医者疑古药品之兰蕙正如儒者。疑古食品之
HT。皆不通古今之变者也。芦尖。
雄按∶即芦根也，用尖取其宣畅。冬瓜仁等味。
雄按∶吴本无此条。
此湿热已解，余邪蒙蔽清阳，胃气不舒，宜用极轻清之品，以宣上焦阳气。若投味重之剂，是与病情不相涉矣。雄
按∶章氏谓轻剂专为吴人体弱而设，是未察病情之言也。或问湿热盛时，疫气流行，当服何药？预为消弭。余谓叶讷人
《医案存真》载其高祖天士先生案云∶天气郁勃泛潮，常以枇杷叶拭去毛净锅炒香，泡汤饮之，取芳香不燥，不为秽浊
所侵，可免夏秋时令之病，余则建兰叶、竹叶、冬瓜、芦根，皆主清肃肺气，故为温热暑湿之要药，肺胃清降，邪自不
容矣。若别药恐滋流弊，方名虽美，不可试也，而薄滋味，远酒色，尤为要务。
此条须与第三十一条参看，彼初起之实邪，故宜涌泄，投此轻剂，不相合矣。又须与后条参看，治法有上中之分，
临证审之。解后余邪为虚，初发者为实，上焦近心，故有懊恼谵语，中焦离心远，故无。如其舌黄邪盛，亦有发谵语者。
十湿热证∶初起发热，汗出，胸痞，口渴，舌白，湿伏中焦。宜藿梗、蔻仁、杏仁、枳壳、桔梗、郁金、苍术、浓
朴、草果、半夏、干菖蒲、佩兰叶、六一散。
杨云∶俱可用，但须择一二味对证者用之，不必并用。等味。
雄按∶吴本胸痞下，曰∶“不知饥”，口渴下，曰∶“不
喜饮”，舌白作“舌苔滑白”，无杏仁、苍术、浓朴、草果、半夏。
浊邪上干则胸闷，胃液不升则口渴，病在中焦气分，故多开中焦气分之药。
雄按∶亦太多，颇不似薛氏手笔。此条
多有挟食者，其舌根见黄色，宜加栝蒌、楂肉、莱菔子。汪按∶此疑亦后人所附评语。
十一湿热证∶数日后。
雄按∶吴本下有“胸痞”二字。自利溺赤。
雄按∶吴本作“涩。口渴。
雄按∶吴本上有”身热二字。湿流下焦。宜滑石、猪苓、茯苓、泽泻、萆 、通草等味。
雄按∶吴本无泽泻、通草，有神曲、广皮。
下焦属阴，太阴所司，阴道虚故自利，化源滞则溺赤，脾不转津则口渴，总由太阴湿胜故也。湿滞下焦，故独以分
利为治。然兼证口渴胸痞，须佐入桔梗、杏仁、大豆黄卷，开泄中上。源清则流自洁，不可不知。
雄按∶据此则本条“胸
痞”二字，当从吴本增入为是。至源清流洁云云，则又非自注之文法，殊可疑也。汪按∶此篇多有后人评语传写羼入自
注之处。此数语亦后人所附评语也。以上三条，俱湿重于热之候。湿热之邪，不自表而入，故无表里可分，谓由膜原中
道而入也，虽无表里之分，亦有浅深当别。而未尝无三焦可辨，犹之河间治消渴亦分三焦者是也。夫热为天之气。
雄按∶
此明热即暑之谓也，章氏何以曲为改释。湿为地之气，热得湿而愈炽，湿得热而愈横。
雄按∶热得湿则郁遏而不宣，故
愈炽；湿得热则蒸腾而上熏，故愈横。两邪相合，为病最多。丹溪有云∶湿热为病，十居八九。故病之繁且苛者，莫如
夏月为最。以无形之热，蒸动有形之湿，素有湿热之人，易患湿温，误发其汗，则湿热混合为一，而成死证，名曰重
也。湿热两分，其病轻而缓，湿热两合，其病重而速。章云∶故当开泄以分其热，若误作虚而用补法，则闭塞气道而死
矣。湿多热少，则蒙上流下，当三焦分治。调三焦之气，分利其湿也。湿热俱多，则下闭上壅，而三焦俱困矣。当开泄
清热，两法兼用。犹之伤寒门二阳合病、三阳合病也。盖太阴湿化，三焦火化，有湿无热，止能蒙蔽清阳，或阻于上，
或阻于中，或阻于下，若湿热一合，则身中少火悉化为壮火，而三焦相火，有不起而为虐者哉。
雄按∶湿热一合，业已
阴从阳化，如此披猖，况热多湿少乎？故不言热多湿少者，非阙文也。盖急宜清热，有不待言矣。所以上下充斥，内外
煎熬，最为酷烈。
雄按∶曰酷曰烈，皆暑之威名。兼之木火同气，表里分司，再引肝风，痉厥立至。
雄按∶津虚之体，
夏月每有肝风陡动煎厥一证，言其不耐暑气煎熬，可谓形容逼肖。胃中津液几何？其能供此交征乎？
雄按∶不辨暑证之
挟湿与否，而辄投温燥以劫津者，宜鉴斯言。至其所以必属阳明者，以阳明为水谷之海，鼻食气，口食味，悉归阳明，
邪从口鼻而入，则阳明为必由之路。
雄按∶肺胃大肠，一气相通，温热究三焦，以此一脏二腑为最要，肺开窍于鼻，吸
入之邪，先犯于肺，肺经不解，则传于胃，谓之顺传，不但脏病传腑为顺，而自上及中，顺流而下，其顺也有不待言者，
故温热以大便不闭者易治，为邪有出路也。若不下传于胃，而内陷于心包络，不但以脏传脏，其邪由气分入营，更进一
层矣，故曰逆传也。因叶氏未曾明说顺传之经，世多误解逆传之理，余已僭注于本条之后，读此可证管窥之非妄。汪按∶
鼻为肺窍所受之气，必先入肺，此云悉归阳明，不免语病梦隐。以肺经不解，乃传入胃，释之意始圆惬。其始也邪入阳
明，早已先伤其胃液，其继邪盛三焦，更欲资取于胃液，司命者可不为阳明顾虑哉。
雄按∶此不独为湿热病说法也，风
寒化热之后，亦须顾此，况温热乎。
或问木火同气，热盛生风，以致痉厥，理固然矣。然有湿热之证，表里极热，不痉不厥者何也？余曰∶风木为火热
引动者，原因木气素旺，木旺由于水亏，故得引火生风，反焚其木，以致痉厥。若水旺足以制火而生木，即无痉厥者也。
肝阴先亏，内外相引，两阳相煽，因而动。
雄按∶吴本作“劲”张。若肝肾素优，并无里热者，火热安能招引肝风也。
雄按∶喻氏云∶遇暄热而不觉其热者，乃为平人。盖阴不虚者，不畏暑而暑不易侵，虽侵之亦不致剧，犹之乎水田
不惧
旱也。阴虚者见日即畏，虽处深宫之内，而无形之暑气，偏易侵之，更有不待暑侵，而自成为厥者矣。杨云∶虚损之原，
一语揭出。试观产妇及小儿一经壮热，便成 者，以失血之后，与纯阳之体，阴气未充，故肝风易动也。
雄按∶原本
未及产妇，今从吴本与小儿并论，尤为周密，然妇科不知血脱易痉，往往称为产后惊风，喻氏辟之违矣。幼科一见发热，
即以柴葛解肌为家常便饭，初不究其因何而发热也，表热不清，柴葛不撤，虽肝风已动，螈 已形，犹以风药助虐，不
亦乎，此叶氏所以有劫肝阴，竭胃汁之切戒也。杨云∶痉厥之证，举世不知其因，今经此详明剖析，昭如白日矣。
或问曰∶亦有阴气素亏之人，病患湿热，甚至斑疹外见，入暮谵语昏迷，而不痉不厥者何也？答曰∶病邪自盛于阳
明之营分，故由上脘而熏胸中，则入暮谵妄，邪不在三焦气分，则金不受囚，木有所畏，未敢起而用事。至于斑属阳明，
疹属太阴，亦二经营分热极，不与三焦相干，即不与风木相引也，此而痉厥，必胃中津液尽涸，耗及心营，则肝风亦起，
而其人已早无生理矣。
雄按∶此从吴本采补，观此则粗工之治温热，妄用柴葛竭力以耗胃汁而鼓其肝风者，真杀人不以
刃也。惟稍佐于凉润方中，或不致为大害。
十二湿热证∶舌遍体白，口渴，湿滞阳明。宜用辛开，如浓朴、草果、半夏、干菖蒲等味。舌白者言其苔，若苔滑
而口不渴者，即属太阴证，宜温之。
雄按∶苔白不渴，须询其便溺，不热者，始为宜温之的证也。又按∶此与第十条证
相似，吴本无此条。杨云∶湿盛热微之证，初起原可暂用此等药开之，一见湿开化热，便即转手清热。若执此为常用之
法则误矣。注内补出审便溺一层，尤为周到。
此湿邪极盛之候，口渴乃液不上升，非有热也。辛泄太过，即可变而为热，以其属阳明湿邪，开泄则阳气升而热透，
而此时湿邪尚未蕴热，故重用辛开，使上焦得通，津液得下也。阳气升则津液化，而得上输下布也。
十三湿热证∶舌根白，舌尖红，湿渐化热，余湿犹滞。宜辛泄佐清热。如∶蔻仁、半夏、干菖蒲、大豆黄卷、连翘、
绿豆衣、六一散等味。
雄按∶吴本无此条。
此湿热参半之证，而燥湿之中，即佐清热者，亦所以存阳明之液也。上二条凭验舌以投剂，为临证时要诀。盖舌为
心之外候，浊邪上熏心肺，舌苔因而转移。叶氏《温热论》辨舌最精详，宜合观之。
雄按∶更宜参之《准绳》。
十四湿热证，初起，即胸闷、不知人、瞀乱大叫痛，湿热阻闭中上二焦。宜草果、槟榔、鲜菖蒲、芫荽、六一散，
各重用。或加皂角，地浆水煎。
雄按∶吴本无此条。淦按∶此条颇似痧证，宜用灵验痧丸为妙。六一散有甘草，须慎用。
此条乃湿热俱盛之候，而去湿药多，清热药少者，以病邪初起即闭，不得不以辛通开闭为急务，不欲以寒凉凝滞气
机也。
雄按∶芫荽不如用薤白，或可配栝蒌、栀、豉者则配之。
干霍乱采用探吐法，是为了排泄胃中有形的积滞。然而，如果通过泄邪后胃液不能上升，热邪会更加炽盛；如果通过探吐后胃液不能布散全身，风邪更加猖獗，最终会形成死证，这一点不可不知道。
王士雄按语：这一条的自注，明确将湿热二气分别论述，章氏却妄加己见，认为湿热就是暑气，强行将二气合为一气，并且把《难经》中的湿温和热病也混为一谈了。这大概是因为没有读过越人（扁鹊）的书的缘故。现在我在原解释中全部进行了订正，并附记在这里，以请教精通中医的专家。
五、湿热证：高热口渴，舌苔黄或焦红，发生痉挛、神志昏迷，胡言乱语或嬉笑，这是热邪灼伤心包，营血已经耗伤。适宜使用犀角、羚羊角、连翘、生地黄、玄参、钩藤、金银花露、鲜石菖蒲、至宝丹等药物。
王士雄按语：吴本没有金银花露。汪按语：应当遵从吴本。因为花露性质清灵芳香滋润，用来治疗热病非常适宜。但是体内有蕴结湿气的人，终究觉得不太合适。
上一条讲的是痉挛，这一条讲的是厥逆。温病和暑病的邪气，本来就会损伤阳气。
王士雄按语：这里说的是邪气初感时，必定先侵犯阳分而伤气。等到热势极盛时，逼迫进入营阴。
王士雄按语：虽然夹杂湿邪，但日久已经从热化，在气分阶段不能清解，必定会逼迫入营。这样津液耗损，阴分也受病，心包受到灼烧，神识昏乱，用药应以清热救阴、泄邪平肝为要务。
王士雄按语：神志昏乱、胡言乱语是即将发生厥逆的先兆。
六、湿热证：发生痉挛，神志昏迷，胡言乱语嬉笑，脉象洪数有力，使用开泄法无效的，是湿热蕴结在胸膈，适宜仿照凉膈散的方法治疗。如果大便几天不通，是热邪闭结在肠胃，适宜仿照承气汤轻微攻下的例子。章云说：所谓“宜仿”、“微下”，是教导人们仔细审察、详细谨慎，不可鲁莽地攻下泻利。因为暑湿粘腻，必须化气缓攻，不同于伤寒化热后的燥结，需要用咸苦峻猛的药物攻下。
这一条属于阳明实热，或者是上结胸膈，或者是下结肠胃。
清热泄邪，只能疏散经络中流动的热邪，而不能清除肠道中蕴结的邪气。所以阳明的邪气，仍然需要借助阳明作为出路。阳明实热，舌苔一定是老黄色，或者兼有干燥。如果还带有白色且滑润，那是湿重夹带阴寒之邪。如果出现胀满不得不攻下的情况，必须佐用白术、苍术来健脾燥湿，否则脾脏受伤、气机下陷，会导致腹泻不止，这就变成了危重证候。因为湿重属于太阴证，必须扶助脾气。
王士雄按语：舌苔白滑且不口渴，腹部虽然胀满，这是太阴寒湿，怎么能讨论攻下呢？只适宜用厚朴、枳实、白术等药温中化湿来治疗。至于“阳明的邪气，假借阳明作为出路”这句话，真是治疗温热病的金针秘诀啊。因为阳明以向下运行顺，邪气既然侵犯它，虽然不可以鲁莽攻下，但绝对不应该截断它的出路，所以温热病出现自然腹泻的，都不可以妄用固涩药。杨云说：注释非常郑重，孟英（王士雄字）的辨驳尤其精妙，两种说法都值得参考研究。汪按语：凡是贸然投用补益固涩药的，都是不懂得邪气必须有出路这个道理的人。
七、湿热证：高热烦躁口渴，舌苔焦红或舌体收缩，出现斑疹，胸部痞闷，自发性腹泻，神志昏迷、痉挛厥逆，这是热邪充斥表里三焦。适宜大剂量使用犀角、羚羊角、生地黄、玄参、金银花露、紫草、方诸水、金汁、鲜石菖蒲等药物。
王士雄按语：吴本没有金银花露、方诸水、金汁。有牡丹皮、连翘。
这一条是痉厥中最严重的，上部表现为胸闷，下部夹杂热性腹泻，出现斑疹、痉挛、厥逆，阴阳都陷入困境。此时单独清阳明之热、救阳明之津液是当务之急，恐怕胃液枯竭，病人会像自焚一样死去。
王士雄按语：这是治疗温热各类疾病的真正精髓，医生应该牢记。方诸水民间常用蚌水代替，腥味浑浊得很严重，适宜用竹沥代替为好。此证紫雪丹、神犀丹都可以使用。
王士雄按语：吴本下面有“舌苔滑白，口不知味”八个字。这是湿热阻遏膜原。适宜使用柴胡、厚朴、槟榔、草果、藿香、苍术、半夏、干石菖蒲、六一散等药物。
疟疾是由暑热内伏，被秋凉外束而成的。如果在夏天腠理大开，毛孔疏通，怎么会形成疟疾？而那些寒热发作有定期，像疟疾一样发作的，是因为膜原是阳明的半表半里，热湿阻遏，导致营卫之气相争，症状虽然像疟疾，但不能与疟疾同治，所以仿照达原饮的例子治疗。这是因为一个是外凉束缚，一个是内湿阻遏。膜原在半表半里，就像少阳经在阴阳交界处，而营卫之气内出于脾胃，脾胃邪气阻遏，导致营卫不和，从而发出寒热似疟的症状。
九、湿热证：几天后，胃脘部微微发闷，知道饥饿但不想吃东西，这是湿邪蒙绕上焦。
王士雄按语：应当作“上”焦。适宜使用藿香叶、薄荷叶、鲜荷叶、枇杷叶、佩兰叶。
王士雄按语：《离骚》中说“纫秋兰以为佩”，所以称秋兰为佩兰。如果药店出售的佩兰，乃是奶酣草之类，不可入药。汪按语：兰即省头草，《离骚》中的兰，即本草中的兰，都不是现在的兰花，前人辨析得非常明确，不必怀疑。因为古人所说的香草，都是取叶子的香味，而不是指花香，而现在的兰花叶子其实不香，明显不是古代的兰。医生对古代药品中兰蕙的疑惑，正如儒者对古代食品中HT的疑惑一样，都是不通晓古今变化的人。芦尖。
这是湿热已解，余邪蒙蔽清阳，胃气不舒展，适宜使用极轻清的药物，来宣通上焦阳气。如果投用味道厚重的药剂，就与病情不相符合了。王士雄按语：章氏说轻剂专门是为吴人体质虚弱而设的，这是没有考察病情的话。有人问：湿热盛行时，疫气流行，应当服用什么药？预先消除它。我说：叶讷人在《医案存真》中记载他的先祖天士先生的医案说：天气郁勃泛潮，常用枇杷叶刷去毛，在干净的锅里炒香，泡汤饮用，取其芳香不燥，不被秽浊之气侵袭，可以避免夏秋时令的病。我则推荐建兰叶、竹叶、冬瓜、芦根，都主司清肃肺气，所以是温热暑湿的重要药物，肺胃清降，邪气自然不容存在。如果用别的药恐怕滋生流弊，方名虽然好听，不可尝试。而且饮食清淡，远离酒色，更是重要事务。
这一条须与第三十一条参看，那条是初起的实邪，所以适宜涌吐泄下，投用这种轻剂，就不相合了。又须与后面的条目参看，治疗方法有上焦和中焦的区别，临证时要审察清楚。解邪后的余邪属于虚，初发的属于实。上焦靠近心脏，所以会有懊恼、胡言乱语；中焦离心脏远，所以没有。如果舌苔黄、邪气盛，也有发生胡言乱语的。
十、湿热证：初起发热，出汗，胸部痞闷，口渴，舌苔白，这是湿伏在中焦。适宜使用藿梗、蔻仁、杏仁、枳壳、桔梗、郁金、苍术、厚朴、草果、半夏、干石菖蒲、佩兰叶、六一散。
杨云说：都可以使用，但须选择一两个对症的药物使用，不必全部并用。等药物。
王士雄按语：吴本在“胸痞”下说：“不知饥”，在“口渴”下说：“不喜饮”，“舌白”作“舌苔滑白”，没有杏仁、苍术、厚朴、草果、半夏。
浊邪上犯则胸闷，胃液不能上升则口渴，病在中焦气分，所以多用开通中焦气分的药物。
王士雄按语：药味也太多了，颇不像薛氏的手笔。这一条多有挟带食积的，其舌根见黄色，适宜加瓜蒌、山楂肉、莱菔子。汪按语：这怀疑也是后人附上的评语。
十一、湿热证：几天后。
王士雄按语：吴本上有“身热”二字。这是湿流注在下焦。适宜使用滑石、猪苓、茯苓、泽泻、萆薢、通草等药物。
下焦属阴，由太阴所主管，阴道虚故自发性腹泻，化源阻滞则小便赤涩，脾不转输津液则口渴，总归是由于太阴湿胜的缘故。湿滞留在下焦，所以只用分利的方法治疗。但是如果兼有口渴、胸痞的症状，必须佐入桔梗、杏仁、大豆黄卷，以开通泄中上焦。源头清澈则水流自然洁净，不可不知道。
王士雄按语：根据这点，那么本条的“胸痞”二字，应当从吴本增入才是正确的。至于“源清流洁”这样的话，又不是自注的文章写法，很可疑。汪按语：这一篇有很多后人评语传写混杂在自注里的地方。这几句话也是后人附上的评语。以上三条，都是湿重于热的证候。湿热之邪，不从体表而入，所以没有表里可分，说是从膜原中道而入的。虽然没有表里之分，也有浅深应当区别。但未尝没有三焦可以辨别，就像河间治疗消渴也分三焦是一样的。热是天之气。
王士雄按语：这里说明热就是暑的意思，章氏为什么曲解改释。湿是地之气，热得到湿就更加炽盛，湿得到热就更加横暴。
王士雄按语：热得到湿则郁遏而不宣散，所以更加炽盛；湿得到热则蒸腾而上熏，所以更加横暴。两邪相结合，造成的病症最多。丹溪说过：湿热为病，十居八九。所以病症繁杂苛刻的，莫过于夏季最甚。以无形之热，蒸动有形之湿，素有湿热的人，容易患湿温，误用发汗法，则湿热混合为一，而成死证，名叫重暍。湿热两分，病轻而缓；湿热两合，病重而速。章云说：所以应当开泄以分其热，如果误作虚证而用补法，则会闭塞气道而死。湿多热少，则蒙蔽上部、流注下部，应当三焦分治，调三焦之气，分利其湿。湿热俱多，则下闭上壅，而三焦都困顿了。应当开泄清热，两法兼用。就像伤寒门中的二阳合病、三阳合病一样。因为太阴主湿化，三焦主火化，有湿无热，只能蒙蔽清阳，或者阻于上，或者阻于中，或者阻于下，如果湿热一结合，则体内的少火全都化为壮火，而三焦相火，有不起来肆虐的吗？
王士雄按语：湿热一旦结合，业已阴从阳化，如此猖狂，何况热多湿少呢？所以不说热多湿少的情况，不是缺文。因为急需清热，是不言而喻的了。所以上下充斥，内外煎熬，最为酷烈。
王士雄按语：说“酷”说“烈”，都是暑气的威名。再加上木火同气，表里分司，再引动肝风，痉挛厥逆立刻到来。
王士雄按语：津液亏虚的体质，夏天常有肝风陡动煎厥一证，说它不耐暑气煎熬，可谓形容得逼真贴切。胃中的津液有多少？能供此交征吗？
王士雄按语：不辨别暑证是否挟湿，就贸然投用温燥药来劫夺津液的，应当以此为鉴。至于之所以必定属于阳明，是因为阳明是水谷之海，鼻吸入气，口摄入味，都归于阳明，邪气从口鼻而入，则阳明是必经之路。
王士雄按语：肺、胃、大肠，一气相通，温热病究其根本在三焦，以此一脏二腑最为重要。肺开窍于鼻，吸入的邪气，先侵犯肺，肺经不解，则传于胃，叫做顺传。不但脏病传腑为顺，而且自上及中，顺流而下，其顺是有不言而喻的道理的，所以温热病大便不闭的容易治，是因为邪气有出路。如果不向下传于胃，而内陷于心包络，不但以脏传脏，邪气由气分入营，更进一层了，所以叫逆传。因为叶氏未曾明说顺传的经脉，世人多误解逆传的道理，我已经僭越注释在本条之后，读这个可以证明我的管窥之见并非狂妄。汪按语：鼻为肺窍，所受之气，必先入肺，这里说都归阳明，不免有语病。梦隐以肺经不解，乃传入胃，解释才圆满惬意。起初邪入阳明，早已先伤其胃液，接着邪盛三焦，更想索取于胃液，作为医生怎能不为阳明顾虑呢？
王士雄按语：这不只是为湿热病说法，风寒化热之后，也必须顾护这个，何况温热病呢。
有人问：木火同气，热盛生风，以致痉挛厥逆，道理固然如此。但是有湿热证，表里极热，却不痉挛、不厥逆的，为什么呢？我说：风木被火热引动，原因是木气素来旺盛，木旺由于水亏，所以得引火生风，反焚其木，以致痉挛厥逆。如果水旺足以制火而生木，就没有痉挛厥逆了。肝阴先亏，内外相引，两阳相煽，因而动。
王士雄按语：吴本作“劲”张。如果肝肾素来优厚，并无里热，火热怎么能招引肝风呢？
王士雄按语：喻氏说：遇到温暖炎热而不觉得热的，才是平常人。因为阴不虚的人，不畏暑且暑不易侵入，即使侵入了也不致严重，就像水田不惧旱一样。阴虚的人见到太阳就害怕，即使身处深宫之内，无形的暑气也偏易侵入他，更有不待暑气侵入，而自己成为厥逆的了。杨云说：虚损的根本原因，一句话揭出。试看产妇及小儿一经高热，便成痉挛的，是因为失血之后，以及纯阳之体，阴气未充，所以肝风易动。
王士雄按语：原本未提及产妇，现在从吴本与小儿并论，尤为周密。然而妇科不知道血脱易痉，往往称为产后惊风，喻氏对此辟斥是对的。幼科一见发热，就以柴葛解肌为家常便饭，根本不探究因何而发热，表热不清，柴葛不解，即使肝风已动，抽搐已现，还用风药助虐，不也很荒谬吗？这就是叶氏所以有“劫肝阴，竭胃汁”的深切告诫。杨云说：痉挛厥逆的证候，举世不知其原因，今天经过这样详细的剖析，昭如白日了。
有人问：也有阴气素亏的人，患病湿热，甚至斑疹外见，入暮胡言乱语昏迷，却不痉挛、不厥逆的，为什么呢？答曰：病邪自盛于阳明之营分，所以由上脘而熏胸中，则入暮谵妄，邪不在三焦气分，则金不受囚，木有所畏，未敢起而用事。至于斑属阳明，疹属太阴，也是二经营分热极，不与三焦相干，即不与风木相引也，这种情况下发生痉挛厥逆，必然是胃中津液尽涸，耗及心营，则肝风亦起，而其人已经没有生机了。
王士雄按语：这是从吴本采补的，看这个则粗工治疗温热病，妄用柴胡、葛根竭力以耗胃汁而鼓动肝风的，真是不用刀杀人啊。只有稍微佐于凉润方中，或许不至于造成大害。
十二、湿热证：舌遍体白，口渴，湿滞阳明。适宜用辛开的方法，如厚朴、草果、半夏、干石菖蒲等药物。舌白是指舌苔，如果苔滑而口不渴的，就属于太阴证，适宜温之。
王士雄按语：苔白不渴，必须询问其二便，不热的，始是适宜温的确证。又按：这与第十条证相似，吴本没有这一条。杨云说：湿盛热微的证候，初起原可暂用这些药开之，一见湿开化热，便立即转手清热。如果执此为常用法则就错了。注内补出审二便一层，尤为周到。
这是湿邪极盛的证候，口渴乃津液不上升，并非有热。辛泄太过，即可变为热，因为其属阳明湿邪，开泄则阳气升而热透，而此时湿邪尚未蕴热，故重用辛开，使上焦得通，津液得下。阳气升则津液化，而得上输下布。
十三、湿热证：舌根白，舌尖红，湿渐化热，余湿犹滞。适宜辛泄佐清热。如：蔻仁、半夏、干石菖蒲、大豆黄卷、连翘、绿豆衣、六一散等药物。
这是湿热参半的证候，而在燥湿之中，即佐清热者，也是为了保存阳明之津液。上两条凭验舌以投剂，为临证时的要诀。因为舌为心之外候，浊邪上熏心肺，舌苔因而转移。叶氏《温热论》辨舌最精详，宜合观之。
王士雄按语：更宜参之《准绳》。
十四、湿热证，初起，即胸闷、不知人、瞀乱大叫痛，湿热阻闭中上二焦。适宜草果、槟榔、鲜石菖蒲、芫荽、六一散，各重用。或加皂角，地浆水煎。
王士雄按语：吴本没有这一条。淦按：这一条颇似痧证，适宜用灵验痧丸为好。六一散有甘草，须慎用。
Gan Huoluan (Dry Cholera) is treated with induced vomiting to expel tangible stagnation in the stomach. However, if after expelling the pathogen, Stomach fluids fail to ascend, the heat pathogen will become even more fierce. If after induced vomiting, Stomach fluids fail to distribute throughout the body, the wind pathogen will become more rampant, ultimately resulting in a fatal condition. This must be known.
Wang Shixiong's Note: The self-note of this clause clearly distinguishes between dampness and heat as two separate qi. Zhang blindly imposed his own views, claiming that damp-heat is simply summerheat, forcing the two qi into one, and further conflating Wet-Warmth (Shi Wen) and Heat Disease from the *Nan Jing* into a single syndrome. This is likely due to not having read the works of Yue Ren (Bian Que). I have corrected all explanations in the original text here and attached them for discussion with experts.
5. Damp-Heat Syndrome: High fever, thirst, yellow or scorched-red tongue coating, spasms, coma, delirium, or laughter. This indicates heat burning the Pericardium and depletion of Ying-Blood. Suitable herbs include Rhinoceros Horn (Xijiao), Antelope Horn (Lingyangjiao), Forsythia (Lianqiao), Rehmannia Root (Shengdi), Scrophularia Root (Yuanshen), Uncaria (Gouteng), Honeysuckle Dew (Yinhualu), Fresh Acorus (Xianchangpu), and Zhibao Dan.
Wang Shiong's Note: Wu's edition lacks Honeysuckle Dew. Wang's annotation: One should follow Wu's edition. Flower dew is clear, light, aromatic, and moistening, making it excellent for treating heat diseases. However, for those with internal dampness accumulation, it is ultimately unsuitable.
The previous clause discusses spasms; this clause discusses Jue (reversal cold/convulsion). Warm and Summerheat pathogens inherently damage Yang Qi.
Wang Shixiong's Note: This refers to the initial invasion, where the pathogen first affects the Yang aspect and damages Qi. When heat reaches its extreme, it forces entry into Ying-Yin.
Wang Shixiong's Note: Although accompanied by dampness, after a long time it transforms into heat. If it cannot be resolved at the Qi level, it must force its way into Ying. Thus, fluids are depleted and Yin is diseased; the Pericardium is scorched, causing mental confusion. Medication should focus on clearing heat, saving Yin, draining pathogens, and calming the Liver.
Wang Shixiong's Note: Coma and delirium are precursors to impending Jue.
6. Damp-Heat Syndrome: Spasms, coma, delirious speech and laughter, pulse that is surging, rapid, and forceful. If opening and draining methods fail, it indicates damp-heat accumulating in the chest and diaphragm. It is suitable to imitate Liangge San (Cooling the Chest Powder). If stool has been blocked for several days, it indicates heat pathogen closing and knotting in the intestines and stomach. It is suitable to imitate the mild purgative example of Chengqi Tang. Zhang Yun says: Terms like "suitable to imitate" and "mild purgation" teach people to examine carefully and cautiously, avoiding rash purging. Because summer-dampness is sticky and greasy, it requires transforming Qi and slow attacking, unlike the dry accumulation caused by Cold transforming into heat, which requires harsh saline-bitter purgatives.
Wang Shixiong's Note: Wu's edition does not contain this clause.
This clause belongs to Yangming Excess-Heat, either knotting above in the chest/diaphragm or below in the intestines/stomach.
Clearing heat and draining pathogens can only disperse heat flowing in the collaterals but cannot remove pathogens accumulated in the intestines. Therefore, Yangming pathogens still require Yangming as an exit route. In Yangming Excess-Heat, the tongue coating must be old yellow or dry. If it remains white and slippery, it indicates heavy dampness with yin-cold pathogens. If distension necessitates purgation, one must assist with Atractylodes Macrocephala (Baizhu) and Atractylodes Lancea (Cangzhu) to strengthen the Spleen and dry dampness; otherwise, Spleen injury and Qi sinking will cause unceasing diarrhea, becoming a critical condition. Since heavy dampness belongs to Taiyin syndrome, supporting the Spleen is mandatory.
Wang Shixiong's Note: A white, slippery tongue coating without thirst, despite abdominal distension, indicates Taiyin Cold-Dampness. How can one discuss purgation? One should only use Pinellia (Houpo), Zedoary/Arisaema (Zhishi), and Atractylodes (Zhu) to warm the middle and transform dampness. The statement "Yangming pathogens borrow Yangming as an exit route" is truly the golden needle for treating Warmth diseases. Because Yangming favors downward movement, once invaded, although rash purging is inadvisable, cutting off the exit route is absolutely prohibited. Therefore, spontaneous diarrhea in Warmth diseases should never be treated with astringents. Yang Yun says: The note is very solemn, and Mengying's refutation is particularly exquisite; both sayings deserve study. Wang's annotation: Those who rashly administer tonics and astringents do not understand the principle that pathogens must have an exit.
7. Damp-Heat Syndrome: High fever, irritability, and thirst, scorched-red or contracted tongue, macules and papules, chest fullness, spontaneous diarrhea, coma, spasms, and Jue. This indicates heat pathogens filling the interior and exterior of the Three Burners. Large doses of Rhinoceros Horn (Xijiao), Antelope Horn (Lingyangjiao), Rehmannia Root (Shengdi), Scrophularia Root (Yuanshen), Honeysuckle Dew (Yinhualu), Arnebia/Lithospermum (Zicao), Fangzhu Water (Fangzhushui), Jinzhi (Gold Juice), and Fresh Acorus (Xianchangpu) are suitable.
Wang Shixiong's Note: Wu's edition lacks Honeysuckle Dew, Fangzhu Water, and Jinzhi. It contains Moutan Bark (Danpi) and Forsythia (Lianqiao).
This clause represents the most severe form of spasms and Jue. Upper symptoms include chest tightness; lower symptoms involve heat diarrhea. With macules, papules, spasms, and Jue, both Yin and Yang are exhausted. Urgently clearing Yangming heat and saving Yangming fluids is critical, fearing that if Stomach fluids are depleted, the patient will die as if self-immolated.
Wang Shixiong's Note: This is the true essence of treating various Warmth diseases; physicians must remember it. Fangzhu Water is commonly replaced by clam water, which is extremely fishy and turbid; Bamboo Sap (Zhuli) is a better alternative. Zixue San (Purple Snow Powder) and Shenxi Dan (Divine Rhinoceros Pill) are also applicable to this syndrome.
8. Damp-Heat Syndrome: Alternating chills and fever resembling malaria.
Wang Shixiong's Note: Wu's edition adds "slippery white tongue coating, loss of taste" below. This indicates damp-heat obstructing the Mo Yuan (Membrane Source). Suitable herbs include Bupleurum (Chaihu), Pinellia (Houpo), Areca Seed (Binglang), Tsaoko (Caoguo), Agastache (Huoxiang), Atractylodes (Cangzhu), Pinellia (Banxia), Dry Acorus (Ganchangpu), and Liuyi San.
Wang Shixiong's Note: Wu's edition lacks Chaihu, Binglang, Huoxiang, and Changpu, but contains Medicated Leaven (Shenqu).
Malaria is formed by summerheat lying internally and autumn coolness binding externally. If pores are open in summer, how can malaria form? Cases with periodic chills and fever resembling malaria occur because the Mo Yuan is the half-exterior/half-interior of Yangming. Heat and dampness obstruct, causing Ying and Wei Qi to contend. Although symptoms resemble malaria, it must not be treated as such. Thus, we imitate Daoyin Yin. One case is external coolness binding; the other is internal dampness obstructing. The Mo Yuan is half-exterior/half-interior, similar to Shaoyang at the junction of Yin and Yang. Ying and Wei Qi originate from the Spleen and Stomach; when pathogens obstruct the Spleen and Stomach, Ying and Wei become disharmonious, causing chills and fever resembling malaria.
9. Damp-Heat Syndrome: After several days, slight stuffiness in the epigastrium, awareness of hunger but inability to eat, indicating dampness enveloping the Upper Jiao.
Wang Shixiong's Note: Should be read as "Upper" Jiao. Suitable herbs include Agastache Leaf (Huoxiangye), Mint Leaf (Bohewo), Fresh Lotus Leaf (Xianheye), Loquat Leaf (Pipaye), and Eupatorium Leaf (Peilan ye).
Wang Shixiong's Note: The *Li Sao* states "threading autumn orchids," hence autumn orchid is called Peilan. The Peilan sold in pharmacies is often akin to milk-sweet grass and is unsuitable for medicine. Wang's annotation: Lan refers to Shengtou Cao. The Lan in *Li Sao* is the Lan in Materia Medica, neither being modern orchids. Predecessors clarified this explicitly. Ancient fragrant herbs referred to leaf fragrance, not flower fragrance; modern orchid leaves are not fragrant, proving they are not ancient Lan. Physicians doubting ancient Lan/Hui are like Confucians doubting ancient foods—failing to understand changes between eras. Lu Jian (Reed Tip).
Wang Shixiong's Note: This is Reed Rhizome (Lugen); using the tip promotes free flow. Winter Melon Seed (Dongguaren) and other herbs.
Wang Shixiong's Note: Wu's edition lacks this clause.
This indicates resolved damp-heat with residual pathogens clouding Clear Yang and stagnating Stomach Qi. Extremely light and clear herbs should be used to ventilate Upper Jiao Yang Qi. Heavy-tasted formulas would mismatch the condition. Wang Shixiong's Note: Zhang claimed light formulas were specifically for Wu's weak constitution, showing a lack of clinical observation. Question: What medicine should be taken during peak damp-heat and epidemic spread to prevent illness? Answer: Ye Naren's *Medical Cases* records his ancestor Tianshi's case: On humid, oppressive days, roast Loquat leaves (brushed clean) until fragrant, brew as tea. Its aroma is non-drying, preventing invasion by turbid pathogens, avoiding seasonal illnesses. I recommend Jianlan Leaf, Bamboo Leaf, Winter Melon, and Reed Rhizome, all clearing Lung Qi, making them key drugs for Warmth, Summerheat, and Damp-Heat. Clearing Lung and Stomach prevents pathogens. Other medicines may cause side effects; beautiful names should not be tested. Light diet and avoiding alcohol/sex are crucial.
Compare this with Clause 31: That involves initial excess pathogens requiring emesis/purgation; light formulas are inappropriate. Compare with subsequent clauses: Treatment differs for Upper vs. Middle Jiao. Residual pathogens post-resolution are deficient; initial pathogens are excess. Upper Jiao is near the Heart, causing restlessness/delirium; Middle Jiao is distant, so no delirium. Unless tongue is yellow with strong pathogens, causing delirium.
10. Damp-Heat Syndrome: Initial fever, sweating, chest fullness, thirst, white tongue coating, indicating dampness latent in the Middle Jiao. Suitable herbs include Luo Bu Gen (Huo geng), Cardamom (Kou ren), Apricot Seed (Xing ren), Aurantium (Zhi ke), Platycodon (Jie geng), Curcuma (Yujin), Atractylodes (Cangzhu), Pinellia (Houpo), Tsaoko (Caoguo), Pinellia (Banxia), Dry Acorus (Ganchangpu), Eupatorium Leaf (Peilan ye), and Liuyi San.
Yang Yun says: All can be used, but select one or two symptomatic herbs; do not use all together. And other herbs.
Wang Shixiong's Note: Wu's edition adds "no hunger" under "chest fullness" and "dislikes drinking" under "thirst." "White tongue" is "slippery white coating." It lacks Xingren, Cangzhu, Houpo, Caoguo, Banxia.
Turbid pathogens affecting upward cause chest tightness; failure of Stomach fluids to ascend causes thirst. The disease is in Middle Jiao Qi, hence herbs opening Middle Jiao Qi are used.
Wang Shixiong's Note: Too many herbs; unlike Xue's style. Many cases involve food retention; yellow root tongue suggests adding Trichosanthes Fruit (Gualou), Hawthorn Flesh (Shazhou), and Radish Seed (Laifuzi). Wang's annotation: Suspected later commentary.
11. Damp-Heat Syndrome: After several days.
Wang Shixiong's Note: Wu's edition adds "chest fullness." Spontaneous diarrhea and red urine.
Wang Shixiong's Note: Wu's edition reads "scanty." Thirst.
Wang Shixiong's Note: Wu's edition adds "body heat." Dampness flowing to Lower Jiao. Suitable herbs include Poria (Shizhu), Polyporus (Zhuling), Alisma (Fuling), Alisma (Zexie), Dioscorea Hypoglauca (Bixie), and Tongcao.
Wang Shixiong's Note: Wu's edition lacks Zexie, Tongcao, but has Shenqu and Chenpi.
Lower Jiao is Yin, governed by Taiyin. Deficiency in Yin pathway causes spontaneous diarrhea; stagnant transformation source causes red urine; Spleen failing to transport fluids causes thirst. All stem from Taiyin Dampness excess. Dampness stagnating in Lower Jiao requires diuresis alone. However, if accompanied by thirst and chest fullness, assist with Platycodon (Jie geng), Apricot Seed (Xing ren), and Soybean (Dadou Huangjuan) to open/draining Middle/Upper Jiao. Clear source ensures clean flow; this must be known.
Wang Shixiong's Note: Thus, "chest fullness" should be added from Wu's edition. "Clear source/clean flow" phrasing seems unlike self-notes, raising suspicion. Wang's annotation: Later commentaries mixed into self-notes. These sentences are later additions. The above three clauses show dampness heavier than heat. Damp-heat enters via Mo Yuan/Middle Path, not exterior, so no exterior/interior distinction, yet depth varies. Differentiation by Three Burners applies, like Hejian's diabetes treatment. Heat is Heaven's Qi.
Wang Shixiong's Note: Clarifying heat equals summerheat; why did Zhang distort this? Dampness is Earth's Qi. Heat intensifies with dampness; dampness becomes rampant with heat.
Wang Shixiong's Note: Heat trapped by dampness cannot vent, thus intensifying; dampness steamed by heat rises, thus becoming rampant. Their combination causes many diseases. Danxi said: Damp-heat accounts for 80-90% of cases. Summer is worst due to formless heat蒸动 (steaming/moving) tangible dampness. Those prone to damp-heat easily get Wet-Warmth; mistaken sweating merges damp-heat into a fatal condition called Chong Re. Separated damp-heat is mild/slow; merged is severe/fast. Zhang says: Open/draining separates heat; mistaking for deficiency and tonifying closes Qi pathways to death. More damp/less heat clouds upper/flows lower; treat Three Burners separately, regulate Qi, drain damp. Equal damp-heat blocks upper/lower, distressing Three Burners; combine opening/draining with clearing heat, like Shaoyang/Yangming combined diseases. Taiyin transforms damp, Three Burners transform fire. Damp without heat clouds Clear Yang (upper/middle/lower). Damp-heat merger turns Shao Fire into Zhuang Fire, triggering Three Burner Ministerial Fire.
Wang Shixiong's Note: Once merged, Yin follows Yang transformation, becoming rampant. Hence, "more heat/less damp" is omitted—not missing text, but urgent heat-clearing is implied. Thus, upper/lower filling and internal/external roasting are most severe.
Wang Shixiong's Note: "Ku" and "Lie" describe summerheat's power. Wood and Fire share Qi, governing exterior/interior; drawing Liver Wind causes immediate spasms/Jue.
Wang Shixiong's Note: Fluid-deficient constitutions in summer often experience sudden Liver Wind/Jue Roasting, intolerant of summerheat. Accurate description. How much Stomach fluid exists to supply this?
Wang Shixiong's Note: Those not distinguishing damp-heat in summerheat, rashly using warm-dry drugs to rob fluids, should heed this. Why strictly Yangming? Yangming is Sea of Grain/Water; nose breathes air, mouth tastes food, all return to Yangming. Pathogens enter mouth/nose, making Yangming the必经 (necessary) path.
Wang Shixiong's Note: Lung, Stomach, Large Intestine connect via Qi. Warmth focuses on Three Burners, prioritizing this Zang-Fu pair. Lung opens to nose; inhaled pathogens hit Lung first. Unresolved Lung transmission to Stomach is "Shun Chuan" (Smooth Transmission). Not just Zang-to-Zang smoothness, but top-to-middle downward flow is naturally smooth. Hence, unblocked bowels in Warmth are easier to treat (pathogen exit). Failure to transmit to Stomach, sinking into Pericardium, is Zang-to-Zang, Qi-to-Ying progression, called "Ni Chuan" (Reverse Transmission). Ye failed to specify Shun Chuan meridians, causing misunderstanding of Ni Chuan. My notes clarify. Wang's annotation: Nose is Lung orifice; Qi enters Lung first. Saying "all return to Yangming" is flawed. Explaining Lung unresolved transmission to Stomach makes sense. Initially, Yangming invasion damages Stomach fluids; subsequently, Three Burner excess draws more fluids. Physicians must guard Yangming.
Wang Shixiong's Note: Applies not just to damp-heat, but Cold-Heat transformation and Warmth too.
Question: Wood/Fire share Qi; heat generates wind causing spasms/Jue, logically sound. But some damp-heat cases have extreme interior/exterior heat without spasms/Jue? Answer: Wind-Wood drawn by fire implies inherent Wood excess due to Water deficiency, allowing fire to generate wind and burn Wood. If Water controls Fire and nourishes Wood, no spasms/Jue occur. Liver Yin deficiency invites internal/external factors, two Yangs fan flames, causing movement.
Wang Shixiong's Note: Wu's edition reads "Jin Zhang" (Stiff/Tense). If Liver/Kidney are robust without interior heat, how can fire attract Liver Wind?
Wang Shixiong's Note: Yu Shi said: Those unaffected by warmth/heat are normal. Non-Yin-deficient resist summerheat; invasion is mild, like paddy fields resisting drought. Yin-deficient fear sun; even indoors, formless summerheat invades easily, potentially causing Jue without invasion. Yang Yun: One sentence reveals deficiency origin. Postpartum women and children with high fever quickly develop spasms due to blood loss and pure-Yang constitution with insufficient Yin, making Liver Wind prone.
Wang Shixiong's Note: Original missed postpartum; Wu's addition with children is thorough. Gynecology misidentifying blood-loss spasms as "Postpartum Convulsions" is wrong per Yu Shi. Pediatrics routinely use Bupleurum/Pueraria for fever without investigating cause. Unresolved exterior heat, continued use of these drugs, plus wind-drugs for active Liver Wind/spasms is absurd. Hence Ye's warning against "Robbing Liver Yin, Exhausting Stomach Juice." Yang Yun: World ignores spasms/Jue etiology; this analysis clarifies it.
Question: Yin-deficient patients with damp-heat, macules/papules, evening delirium/coma, but no spasms/Jue? Answer: Pathogen盛 (abundant) in Yangming Ying level, steaming from Upper Epigastrium to Chest, causing evening delirium. Pathogen not in Three Burner Qi level means Metal is not imprisoned, Wood fears Metal,不敢 (dares not) act. Macules belong to Yangming, Papules to Taiyin; both are Ying-level heat extremes, unrelated to Three Burners/Wind-Wood. Spasms/Jue here imply complete Stomach fluid depletion, consuming Heart Ying, triggering Liver Wind; patient is already dead.
Wang Shixiong's Note: Borrowed from Wu's edition. Crude practitioners using Bupleurum/Pueraria excessively deplete Stomach juice and stir Liver Wind—true murder without weapons. Adding slightly to cooling-moist formulas avoids major harm.
12. Damp-Heat Syndrome: Whole tongue white, thirst, dampness stagnating in Yangming. Use acrid-opening methods: Pinellia (Houpo), Tsaoko (Caoguo), Pinellia (Banxia), Dry Acorus (Ganchangpu). "White tongue" refers to coating. Slippery coating without thirst indicates Taiyin syndrome; use warming methods.
Wang Shixiong's Note: White coating/no thirst requires checking urination/stool; absence of heat confirms indication for warming. Also similar to Clause 10; Wu's edition lacks this. Yang Yun: For damp-excess/heat-deficiency, initial acrid-opening is okay; switch to clearing heat once damp transforms to heat. Treating as standard rule is error. Checking urination/stool in notes is thorough.
This is extreme dampness. Thirst is fluid failure to ascend, not heat. Excessive acrid-draining converts to heat. As Yangming dampness, opening allows Yang Qi to rise and heat to penetrate. Since damp hasn't accumulated heat yet, heavy acrid-opening vents Upper Jiao, allowing fluids to descend. Rising Yang transforms fluids for distribution.
13. Damp-Heat Syndrome: White tongue root, red tongue tip, damp transforming to heat, residual damp stagnation. Acrid-draining assisted by heat-clearing: Cardamom (Kou ren), Pinellia (Banxia), Dry Acorus (Ganchangpu), Soybean (Dadou Huangjuan), Forsythia (Lianqiao), Mung Bean Coat (Lvdou yi), Liuyi San.
Wang Shixiong's Note: Wu's edition lacks this.
This is equal damp-heat. Moisture-drying assisted by heat-clearing preserves Yangming fluids. Previous two clauses rely on tongue diagnosis, a key clinical skill. Tongue reflects Heart status; turbid pathogens steam Heart/Lung, changing coating. Ye's *Wen Re Lun* tongue diagnosis is detailed; consult together.
Wang Shixiong's Note: Also consult *Zhun Sheng*.
14. Damp-Heat Syndrome: Initial chest fullness, unconsciousness, chaotic pain/crying, damp-heat blocking Middle/Upper Jiao. Heavy doses of Tsaoko (Caoguo), Areca Seed (Binglang), Fresh Acorus (Xianchangpu), Coriander (Yansui), Liuyi San. Or add Soap Pod (Zaojiao), decocted in Earth Slurry Water.
Wang Shixiong's Note: Wu's edition lacks this. Gan's note: Resembles Sha disease; Lingyan Sha Wan is suitable. Liuyi San contains Licorice; use cautiously.
This is severe damp-heat, but more damp-resolving than heat-clearing herbs. Initial blockage requires urgent acrid-unblocking; cold herbs would stagnate Qi mechanism.
Wang Shixiong's Note: Coriander is inferior to Allium Chinese Rhubarb (Xiebai); or combine with Trichosanthes (Gualou), Gardenia (Zhi), Soybean (Chi Dou).