十五湿热证∶四五日，口大渴，胸闷欲绝，干呕不止，脉细数，舌光如镜，胃液受劫，胆火上冲。宜西瓜汁、金汁、
鲜生地汁、甘蔗汁、磨服郁金、木香、香附、乌药等味。
雄按∶吴本作西瓜白汁，谓不取瓤中汁，而以瓜肉捣汁也。并
无金汁、蔗汁。
此营阴素亏，木火素旺者，木乘阳明，耗其津液，幸无饮邪，故一清阳明之热，一散少阳之邪，不用煎者，取其气
全耳。舌光无苔，津枯而非浊壅，反胸闷欲绝者，肝胆气上逆也，故以诸汁滋胃液，辛香散逆气。
雄按∶凡治阴虚气滞
者，可以仿此用药。杨云∶此例精当，能如此旁通，方为善读书人。雄又按∶有治饮痛一案宜参。俞惺庵云∶嘉善一人，
胸胀脘闷，诸治不效，一瓢用续随子煎汤，磨沉香、木香、檀香、降香、丁香，服一月，泻尽水饮而痊。汪按∶续随子
去油务尽，否则误人。去油法∶木床用椹榨后，更宜纸隔重压，换纸多次，方能去净。
十六湿热证∶
雄按∶吴本下有“身热口苦”四字。呕吐清水，或痰多，湿热内留，木火上逆。宜温胆汤加栝蒌、雄
按∶吴本作“黄连”。碧玉散等味。
此素有痰饮，而阳明少阳同病，故一以涤饮，一以降逆，与上条呕同而治异，正当合参。碧玉散即六一加青黛以清
肝胆之热。上条液枯以动肝胆之火，故干呕。此条痰饮郁其肝胆之火，故呕水。
十七湿热证∶呕恶不止，昼夜不瘥欲死者，肺胃不和，胃热移肺，肺不受邪也。宜用川连三四分、苏叶二三分，两
味煎汤，呷下即止。
肺胃不和，最易致呕。盖胃热移肺，肺不受邪，还归于胃，必用川连以清湿热，苏叶以通肺胃，投之立愈者，以肺
胃之气非苏叶不能通也。分数轻者，以轻剂恰治上焦之病耳。
雄按∶此方药止二味，分不及钱，不但治上焦宜小剂，而
轻药竟可以愈重病，所谓轻可去实也。合后条观之，盖气贵流通，而邪气挠之。则周行窒滞，失其清虚灵动之机，反觉
实矣。惟剂以轻清，则正气宣布，邪气潜消，而窒滞者自通，设投重药，不但已过病所，病不能去，而无病之地，反先
遭其克伐，章氏谓轻剂为吴人质薄而设，殆未明治病之理也。川连不但治湿热，乃苦以降胃火之上冲。苏叶味甘辛，而
气芳香，通降顺气，独擅其长，然性温散，故虽与黄连并驾，尚减用分许而节制之，可谓方成知约矣。世人不知诸逆冲
上，皆属于火之理，治呕，辄以姜、萸、丁、桂从事者，皆粗工也。余用以治胎前恶阻，甚妙。
十八湿热证∶咳嗽，昼夜不安，甚至喘不得眠者，暑邪入于肺络。宜葶苈、枇杷叶、六一散等味。
雄按∶吴本咳嗽
下有“喘逆、面赤、气粗”六字，而无“甚至”句。
人但知暑伤肺气则肺虚，而不知暑滞肺络则肺实，葶苈引滑石，直泻肺邪，则病自除。吴子音曰∶业师张友樵治一
酒客，夏月痰咳气喘，夜不得卧，服凉药及开气药不效，有议用人参、麦冬等药者，师诊其脉，右寸数实，此肺实非肺
虚也，投以人参则立毙矣。遂与此方煎服立愈。明年复感客邪，壅遏肺气，喘咳复作，医有以葶苈进者，服之不效，反
烦闷汗泄，师脉其右寸浮数，口渴恶热，冷汗自出，喘急烦闷，曰热邪内壅，肺气郁极，是以逼汗外出，非气虚自汗也。
服葶苈而反烦闷者，肺热极盛，与苦寒相格拒也。夫肺苦气上逆，本宜苦以泄之。而肺欲散，又当兼食辛以散之，与麻
杏甘膏汤一剂，肺气得通而喘止汗敛，诸证悉平矣。杨云∶余曾治一酒客，大喘，用《金鉴》苏葶丸而愈。亦与此同，
此盖湿热上壅之证也，至案内所云，服此益甚，则外感束其肺热，用此降之，则外感反内陷而病益甚，麻杏甘石正祛外
感而清内热之方，故速愈。张君用药则是，而立论高而不切，非垂教后学之法也。
十九湿热证∶十余日，大势已退，惟口渴汗出，骨节。
雄按∶吴本有“隐”字。痛。
雄按∶吴本下有“不舒，小便赤
涩不利”八字。余邪留滞经络。宜元米（即糯米）汤泡于术，隔一宿去术煎饮。
病后湿邪未尽，阴液先伤，故口渴身痛，此时救液则助湿，治湿则劫阴，宗仲景麻沸汤之法，取气不取味，走阳不
走阴，佐以元米汤养阴逐湿，两擅其长。杨云∶煎法精妙，注亦明析。汪按∶此身痛一证，乃湿滞之的验。则口渴未必
非湿淫于内，而引饮也。然津液亦必须顾虑。以木治湿不用煎而用泡。既巧妙亦周致。
雄按∶用沙参、麦冬、石斛、枇
杷叶等味，冬瓜汤煎服亦可。汪按∶用冬瓜灵妙。宜加丝瓜络。
二十湿热证∶数日后，汗出热不除，或痉，忽头痛不止者，营液大亏，厥阴风火上升。宜羚羊角、蔓荆子、钩藤、
元参、生地、女贞子等味。
雄按∶吴本无女贞，有白芍。杨云∶白芍不如女贞。
湿热伤营，肝风上逆，血不荣筋而痉，上升巅顶则头痛，热气已退，木气独张，故痉而不厥。投剂以息风为标，养
阴为本。
雄按∶蔓荆不若以菊花、桑叶易之。杨云∶蔓荆最无谓，所易甚佳。汪按∶枸杞子亦可用，不嫌其腻。
二十一湿热证∶胸痞发热、肌肉微疼、始终无汗者，腠理暑邪内闭。
雄按∶吴本无此四字，作“气机拂郁，湿热不能达外”。杨云∶吴本胜于原本。宜六一散一两、薄荷叶三四分。
雄按∶
吴本作“三、四十片”。泡汤调下，即汗解。
湿病发汗，昔贤有禁，此不微汗之，病必不除。盖既有不可汗之大戒，复有得汗始解之治法。临证者当知所变通矣。
吴云∶此湿热蕴遏，气郁不宣，故宜辛凉解散。汗出灌浴之辈，最多此患。若加头痛恶寒，便宜用香薷温散矣。章云∶
湿病固非一概禁汗者，故仲景有麻黄加术汤等法。但寒湿在表，法当汗解；湿热在里，必当清利。今以暑湿闭于腠理，
故以滑石利毛窍。若闭于经者，又当通其经络可知矣。汪按∶吴本薄荷较多。则非微汗矣。
二十二湿热证∶按法治之，数日后，或吐下，一时并至者，中气亏损，升降悖逆。宜∶生谷芽、莲心。
雄按∶当是
莲子。扁豆、米仁、半夏、甘草、茯苓等味，甚者用理中法。
雄按∶吴本无此条。若可用理中法者，必是过服寒凉所致。
升降悖逆，法当和中，犹之霍乱之用六和汤也。若太阴惫甚，中气不支，非理中不可。忽然吐下，更当细审脉证，
有无重感别邪，或伤饮食。
雄按∶亦有因忿怒而致者，须和肝胃。
二十三湿热证∶十余日后左关弦数，腹时痛，时圊血，肛门热痛，血液内燥，热邪传入厥阴之证。宜仿白头翁法。
热入厥阴而下利，即不圊血，亦当宗仲景治热利法。若竟逼入营阴，安得不用白头翁汤凉血而散邪乎？设热入阳明
而下利，即不圊血，又宜师仲景下利谵语，用小承气汤之法矣。
雄按∶章氏谓小承气汤乃治厥阴热利，若热入阳明而下
利，当用黄芩汤，此不知《伤寒论》有简误之文也。本文云∶下利谵语者，有燥矢也，宜小承气汤。既有燥矢，则为太
阴转入阳明之证，与厥阴无涉矣。湿热入阳明而下利，原宜宗黄芩汤为法，其有燥矢而谵语者，未尝无其候也，则小承
气亦可援例引用焉。
二十四湿热证∶十余日后，尺脉数，下利或咽痛，口渴心烦，下泉不足，热邪直犯少阴之证。宜仿猪肤汤凉润法。
同一下利，有厥少之分，则药有寒凉之异。谓厥阴宜寒，少阴宜凉也。
然少阴有便脓之候，不可不细审也。
二十五湿热证∶身冷脉细，汗泄胸痞，口渴，舌白，湿中少阴之阳。宜人参、白术、附子、茯苓、益智等味。
雄按∶
吴本无此条。杨云∶此等证固有之，然本论湿热，却夹入寒湿，又不提明药误，岂不自乱其例。
此条湿邪伤阳，理合扶阳逐湿，口渴为少阴证，乌得妄用寒凉耶？津液出于舌下少阴经之廉泉穴，故凡少阴受邪，
津液不升则渴也，然胸痞舌白，当加浓朴，半夏或干姜，恐参、术太壅气也。渴者湿遏阳气，不化津液以上升，非热也。
雄按∶此湿热病之类证，乃寒湿也。故伤人之阳气。或湿热证治不如法，但与清热，失于化湿，亦有此变，但口渴
而兼
身冷，脉细汗泄，舌白诸证者，固属阴证宜温，还须察其二便，如溲赤且短，便热极臭者，仍是湿热蕴伏之阳证，虽露
虚寒之假象，不可轻投温补也。章氏所云，湿遏阳气不化津液之渴，又为太阴证而非少阴证矣。
二十六暑月病∶初起，但恶寒，面黄，口不渴，神倦，四肢懒，脉沉弱，腹痛下利，湿困太阴之阳。宜仿缩脾饮，
甚则大顺散、来复丹等法。
雄按∶吴本无此条。
暑月为阳气外泄，阴气内耗之时，故热邪伤阴，阳明消烁，宜清宜凉。
雄按∶此治暑之正法眼藏。太阴告困，湿浊弥漫，宜温宜散。
雄按∶凡寒湿为病，虽在暑月，忌用凉药，宜舍时从
证也。昔贤虽知分别论治，惜不能界画清厘，而创阴暑等名，贻误后学不少。徐洄溪云∶天有阴暑，人间有阴热矣。一
语破的。汪按∶如夏日有阴暑，冬日当有阳寒乎？倘冬日感病，而医者云∶此为阳寒，治宜凉药，未有不嗤其妄者，而
阴暑之名，乃相沿数百年积非胜是不可解也。古法最详，医者鉴诸。仲景谓自利不渴者属太阴，以其脏有寒故也，今湿
重恶寒不发热，即为太阴证之寒湿也。如或肢冷脉细，必须姜附理中法。
二十七湿热证∶按法治之，诸证皆退。惟目瞑则惊悸、梦惕，余邪内留，胆气未舒。宜酒浸郁李仁、姜汁炒枣仁、
猪胆皮等味。
雄按∶吴本无此条。
滑可志着，郁李仁性最滑脱，古人治惊后肝系滞而不下，始终目不瞑者，用之以下肝系而去滞，此证借用，良由湿
热之邪，留于胆中，胆为清虚之府，藏而不泻，是以病去，而内留之邪不去，寐则阳气行于阴，胆热内扰，肝魂不安。
用郁李仁以泄邪而以酒行之，酒气独归胆也。枣仁之酸，入肝安神，而以姜汁制，安神而又兼散邪也。肝性喜凉散，枣
仁、姜汁太温，似宜酌加凉品。
雄按∶此释甚是。如黄连、山栀、竹茹、桑叶，皆可佐也。
二十八湿热证∶曾开泄下夺，恶候皆平，独神思不清，倦语不思食，溺数，唇齿干，胃气不输，肺气不布，元神大
亏。宜人参、麦冬、石斛、木瓜、生甘草、生谷芽、鲜莲子等味。
雄按∶吴本无此条。汪按∶百合似亦可用。
开泄下夺，恶候皆平，正亦大伤，故见证多气虚之象，理合清补元气。若用腻滞阴药，去生便远。
雄按∶此肺胃气
液两虚之证，故宜清补，不但阴腻不可用，且与脾虚之宜于守补温运者亦异。杨云∶分别极清。
二十九湿热证∶四五日，忽大汗出，手足冷，脉细如丝或绝，口渴，茎痛，而起坐自如，神清语亮，乃汗出过多，
卫外之阳暂亡，湿热之邪仍结，一时表里不通，脉故伏，非真阳外脱也。宜五苓散去术，加滑石、酒炒川连、生地、
皮等味。
雄按∶吴本无川连、生地。
此条脉证，全似亡阳之候，独于举动神气，得其真情，噫！此医之所以贵识见也。
以口渴、茎痛，知其邪结。以神清语亮，知非脱证。
雄按∶此条原注，全似评赞，章氏以为自注，究可疑也。至卫
阳暂亡，必由误表所致，湿热仍结，阴液已伤，故以四苓加滑石导湿下行，川连、生地清火救阴， 皮固其卫气，用法
颇极周密。杨云∶发明方意精当。汪按。此注当亦后人所附评语。且此证世所罕见，况亡阳脱证。起坐自如。神清语亮
者。亦不少。据以辨证似不甚明确。惟口渴茎痛为亡阳所无耳。
三十湿热证∶发痉神昏，独足冷阴缩，下体外受客寒，仍宜从湿热治，只用辛温之品，煎汤熏洗。杨云∶仍从湿热
治是矣。辛温熏洗，不愈益其湿乎，不惟治下而遗上也。汪按∶熏洗似无大碍，但未必有益。
阴缩为厥阴之外候，合之足冷，全似虚寒，乃谛观本证，无一属虚，始知寒客下体，一时营气不达，不但证非虚寒，
并非上热下寒之可拟也。仍从湿热治之，又何疑耶？发痉神昏，邪犯肝心。若邪重内闭，厥阴将绝，必囊缩足冷而舌亦
卷，是邪深垂死之证。本非虚寒，今云由外受客寒，临证更当详细察问为要。
雄按∶此条本文，颇有语病，恐非生白手
笔。
三十一湿热证初起∶壮热，口渴，脘闷，懊 ，眼欲闭，时谵语，浊邪蒙闭上焦，宜涌泄。用枳壳、桔梗、淡豆豉、
生山栀。无汗者加葛根。
此与第九条宜参看，彼属余邪，法当轻散，余邪不净者，自无壮热谵语等证，必与初起邪势重者，形状不同。此则
浊邪蒙闭上焦，故懊 脘闷。眼欲闭者，肺气不舒也；时谵语者，邪郁心包也。若投轻剂，病必不除。经曰∶高者越之，
用栀豉汤涌泄之剂，引胃脘之阳，而开心胸之表，邪从吐散。若舌苔薄而清者，邪未胶结，可吐散，如舌苔浓而有根，
浊邪瘀结，须重用辛开苦降，如吐之邪结不得出，反使气逆而变他证矣。
雄按∶此释甚是。病在上焦，浊邪未结，故可
越之，若已结在中焦，岂可引吐，不但湿热证，吐法宜慎也，即痰饮证之宜于取吐者，亦有辨别要诀。赵恕轩《串雅》
第十五条 湿热证：发病四五天后，出现大口口渴、胸闷几乎要窒息、干呕不止、脉象细而数、舌面光滑如镜。这是胃中津液被劫夺，胆火向上冲逆所致。适宜用西瓜汁、金汁、鲜生地汁、甘蔗汁，以及磨碎服用的郁金、木香、香附、乌药等药物。
王士雄按语：吴氏原本写作“西瓜白汁”，意思是不要取瓜瓤中的汁液，而是将瓜肉捣烂取汁。并且没有提到金汁和蔗汁。
这是因为患者素来营阴不足，肝木之火旺盛，导致肝木乘袭阳明胃土，耗伤津液。幸好体内没有水饮邪气停留，所以治疗既要清泄阳明之热，又要疏散少阳之邪。不使用煎煮法，是为了保留药物的全气。舌光无苔，说明津液枯竭而非痰浊壅塞；反而出现胸闷欲绝的症状，是肝胆之气上逆所致。因此用各种汁液滋养胃液，用辛香药物疏散上逆之气。
王士雄按语：凡是治疗阴虚兼有气滞的患者，可以仿照此法用药。杨云评论说：这个案例精当，能如此触类旁通，才是善于读书的人。我又按语：有一个治疗饮邪致痛医案可供参考。俞惺庵说：嘉善有一人，胸部胀满、胃脘闷堵，多种治疗方法无效，一瓢医生用续随子煎汤，磨入沉香、木香、檀香、降香、丁香服用一个月，泻尽体内水饮后痊愈。汪氏按语：续随子必须去尽油分，否则误人。去油方法：在木床上用椹榨压榨后，再用纸隔开重重压住，多次更换纸张，才能去净。
第十六条 湿热证：
王士雄按语：吴氏原本在此下有“身热口苦”四字。呕吐清水，或痰多，这是湿热内留，肝木之火上逆所致。适宜用温胆汤加栝蒌（注：此处原文似缺字，通常指栝蒌皮或栝蒌仁，依上下文及方义推测为栝蒌相关），王士雄按语：吴本作“黄连”。碧玉散等药物。
这是因为患者素来有痰饮，且阳明与少阳同病，所以一方面涤除痰饮，一方面降逆止呕。这与上一条虽然都是呕吐但治法不同，应当结合参看。碧玉散即六一散加青黛，以清肝胆之热。上一条因津液枯竭而动肝胆之火，所以是干呕；这一条因痰饮郁遏肝胆之火，所以呕吐清水。
第十七条 湿热证：呕吐恶心不止，昼夜不停，痛苦欲死，这是肺胃不和，胃热移于肺，肺不接受邪气所致。适宜用川黄连三四分、苏叶二三分，两味药煎汤，小口呷下即可停止。
肺胃不和，最容易导致呕吐。因为胃热移于肺，肺不接受邪气，邪气又回归于胃，必须用川黄连清泄湿热，用苏叶疏通肺胃之气。投药后立即见效，是因为肺胃之气非苏叶不能疏通。剂量轻，是因为用轻剂恰好治疗上焦的疾病。
王士雄按语：此方只有两味药，分量不到一钱，不仅治疗上焦宜用小剂，而且轻药竟然可以治愈重病，这就是所谓的“轻可去实”。结合后一条来看，气贵在流通，若被邪气扰乱，则周身运行窒滞，失去清虚灵动的机能，反而感觉像实证一样。只有用轻清之剂，正气得以宣发布散，邪气自然潜消，窒滞之处自然通畅。如果投用重药，不但超过了病所，病不能去除，而无病的地方反而先遭受攻伐。章氏说轻剂是为体质瘦弱的吴地人设立的，这大概是不明白治病原理吧。川黄连不仅能治湿热，更是用其苦味以降胃火之上冲。苏叶味甘辛，气味芳香，能通降顺气，独擅其长，但其性温散，所以虽然与黄连并列使用，仍减少用量几分加以节制，可谓方成而知简约。世人不知道诸逆冲上皆属于火的道理，治疗呕吐，动辄用生姜、吴茱萸、丁香、肉桂等药，都是粗劣的医生。我用此方治疗妊娠恶阻，非常巧妙。
第十八条 湿热证：咳嗽，昼夜不安，甚至气喘无法入睡，这是暑邪侵入肺络所致。适宜用葶苈子、枇杷叶、六一散等药物。
王士雄按语：吴本在咳嗽下有“喘逆、面赤、气粗”六字，而没有“甚至”一句。
人们只知道暑邪损伤肺气会导致肺虚，却不知道暑邪阻滞肺络会导致肺实。葶苈子引导滑石，直接泻除肺中邪气，病自然消除。吴子音说：我的老师张友樵治疗一个酒客，夏季痰咳气喘，夜间不能卧床，服用凉药及开气药无效，有人建议用人参、麦冬等药。老师诊察其脉象，右寸脉数而实，这是肺实而非肺虚，若投用人参则会立即致死。于是给予此方煎服，立即痊愈。第二年再次感受外邪，壅遏肺气，喘咳复发，医生有用葶苈子进服的，服用后无效，反而烦闷汗出。老师诊其右寸脉浮数，口渴恶热，冷汗自出，喘急烦闷，说这是热邪内壅，肺气郁极，所以逼迫汗液外出，并非气虚自汗。服用葶苈子反而烦闷，是因为肺热极盛，与苦寒药发生格拒。肺苦气上逆，本应用苦味泄之。但肺欲散，又应当兼用食辛以散之。给予麻杏甘膏汤一剂，肺气得以通畅，喘止汗敛，诸证悉平。杨云评论说：我曾治疗一个酒客，大喘，用《医宗金鉴》中的苏葶丸而愈。也与这种情况相同，这是湿热上壅的证候。至于案内所说，服用此方病情加重，是因为外感束闭了肺热，用此方降之，则外感反而内陷而病情加重。麻杏甘石汤正是祛除外感并清解内热的方子，所以迅速痊愈。张君用药是正确的，但立论高而不切实际，不是教导后学的方法。
第十九条 湿热证：十余日后，大势已退，仅剩下口渴、出汗、骨节隐痛。
王士雄按语：吴本有“隐”字。
王士雄按语：吴本下有“不舒，小便赤涩不利”八字。这是余邪留滞经络。适宜用元米（即糯米）汤浸泡于术，隔一夜后去掉于术，煎汤饮用。
病后湿邪未尽，阴液先伤，所以口渴身痛。此时救阴液则会助湿，治湿则会劫伤阴液。遵循仲景麻沸汤之法，取气不取味，走阳不走阴，佐以元米汤养阴逐湿，两全其美。杨云评论说：煎法精妙，注解也明析。汪氏按语：这种身痛一证，是湿滞的确验。那么口渴未必不是湿淫于内，从而引水自救。然而津液也必须顾护。用木治湿不用煎而用泡，既巧妙又周全。
王士雄按语：用沙参、麦冬、石斛、枇杷叶等药物，用冬瓜汤煎服也可以。汪氏按语：用冬瓜很灵妙。宜加丝瓜络。
第二十条 湿热证：数日后，出汗而热不退，或者发生痉病，忽然头痛不止，这是营液大亏，厥阴风火上冲所致。适宜用羚羊角、蔓荆子、钩藤、玄参、生地、女贞子等药物。
王士雄按语：吴本没有女贞子，有白芍。杨云评论说：白芍不如女贞子。
湿热损伤营血，肝风上逆，血液不能荣养筋脉而发生痉病，热气上升巅顶则头痛。热气已退，唯独肝木之气嚣张，所以发生痉病但不发生厥逆。投药以息风为标，养阴为本。
王士雄按语：蔓荆子不如用菊花、桑叶代替。杨云评论说：蔓荆子最无谓，所换的很好。汪氏按语：枸杞子也可以用，不嫌其腻。
第二十一条 湿热证：胸痞发热、肌肉微疼、始终无汗，这是腠理间暑邪内闭。
王士雄按语：吴本没有这四字，作“气机拂郁，湿热不能达外”。杨云评论说：吴本胜于原本。适宜用六一散一两、薄荷叶三四分。
王士雄按语：吴本作“三、四十片”。泡汤调服，即可出汗而解。
湿病发汗，前贤有禁忌，此处若不微微发汗，病必不能除。既然有不可大汗的大戒，又有得汗始解的治疗方法。临证者应当知道变通。吴云评论说：这是湿热蕴遏，气郁不宣，所以宜用辛凉解散。汗出灌浴之辈，最多患此病。若加上头痛恶寒，就便宜用香薷温散了。章云评论说：湿病固非一概禁汗，所以仲景有麻黄加术汤等方法。但寒湿在表，法当汗解；湿热在里，必当清利。如今暑湿闭于腠理，所以用滑石利毛窍。若闭于经络，又应当通其经络可知矣。汪氏按语：吴本薄荷较多，那就不是微汗了。
第二十二条 湿热证：按法治之，数日后，或者呕吐腹泻，一时并至，这是中气亏损，升降悖逆。适宜用：生谷芽、莲心。
王士雄按语：应当是莲子。扁豆、米仁、半夏、甘草、茯苓等药物，严重的用理中法。
王士雄按语：吴本没有此条。若可用理中法者，必定是过服寒凉所致。
升降悖逆，法当和中，犹如霍乱之用六和汤。若太阴疲惫严重，中气不支，非理中不可。忽然吐下，更应当仔细审察脉证，有无重感别邪，或伤饮食。
第二十三条 湿热证：十余日后左关脉弦数，腹部时时疼痛，时而便血，肛门热痛，这是血液内燥，热邪传入厥阴的证候。适宜仿照白头翁法。
热入厥阴而下利，即使不便血，也应当遵循仲景治热利的方法。若竟逼入营阴，怎能不用白头翁汤凉血而散邪呢？假设热入阳明而下利，即使不便血，又应当师法仲景下利谵语，用小承气汤的方法。
王士雄按语：章氏说小承气汤是治厥阴热利的，若热入阳明而下利，当用黄芩汤，这是不知道《伤寒论》有简误之文。本文说：下利谵语者，有燥矢也，宜小承气汤。既有燥矢，则为太阴转入阳明的证候，与厥阴无关了。湿热入阳明而下利，原宜宗黄芩汤为法，其有燥矢而谵语者，未尝无其候也，则小承气亦可援例引用焉。
第二十四条 湿热证：十余日后，尺脉数，下利或咽痛，口渴心烦，这是下泉不足，热邪直犯少阴的证候。适宜仿照猪肤汤凉润法。
同一下利，有厥阴、少阴之分，则药有寒凉之异。谓厥阴宜寒，少阴宜凉。
然而少阴有便脓血的证候，不可不仔细审察。
第二十五条 湿热证：身冷脉细，汗泄胸痞，口渴，舌白，这是湿邪损伤少阴之阳。适宜用人参、白术、附子、茯苓、益智等药物。
王士雄按语：吴本没有此条。杨云评论说：此类证候固然有，但本论讲湿热，却夹入寒湿，又不提明药误，岂不是自乱其例。
此条湿邪伤阳，理应扶阳逐湿。口渴为少阴证，怎能妄用寒凉呢？津液出于舌下少阴经的廉泉穴，所以凡少阴受邪，津液不升则渴。然而胸痞舌白，应当加浓朴、半夏或干姜，恐怕参、术太壅气。口渴是湿遏阳气，不化津液以上升，并非热证。
王士雄按语：此湿热病之类证，乃是寒湿。所以伤人之阳气。或是湿热证治不如法，只与清热，失于化湿，亦有此变，但口渴而兼身冷，脉细汗泄，舌白诸证者，固属阴证宜温，还须察其二便，如溲赤且短，便热极臭者，仍是湿热蕴伏之阳证，虽露虚寒之假象，不可轻投温补也。章氏所云，湿遏阳气不化津液之渴，又为太阴证而非少阴证矣。
第二十六条 暑月病：初起，但恶寒，面黄，口不渴，神倦，四肢懒，脉沉弱，腹痛下利，这是湿困太阴之阳。适宜仿照缩脾饮，严重的用大顺散、来复丹等方法。
王士雄按语：吴本没有此条。
暑月为阳气外泄，阴气内耗之时，故热邪伤阴，阳明消烁，宜清宜凉。
王士雄按语：这是治暑的正法眼藏。太阴告困，湿浊弥漫，宜温宜散。
王士雄按语：凡寒湿为病，虽在暑月，忌用凉药，宜舍时从证也。昔贤虽知分别论治，惜不能界画清厘，而创阴暑等名，贻误后学不少。徐洄溪云：天有阴暑，人间有阴热矣。一语破的。汪氏按语：如夏日有阴暑，冬日当有阳寒乎？倘冬日感病，而医者云：此为阳寒，治宜凉药，未有不嗤其妄者，而阴暑之名，乃相沿数百年积非胜是不可解也。古法最详，医者鉴诸。仲景谓自利不渴者属太阴，以其脏有寒故也，今湿重恶寒不发热，即为太阴证之寒湿也。如或肢冷脉细，必须姜附理中法。
第二十七条 湿热证：按法治之，诸证皆退。惟目瞑则惊悸、梦惕，余邪内留，胆气未舒。适宜用酒浸郁李仁、姜汁炒枣仁、猪胆皮等药物。
王士雄按语：吴本没有此条。
滑可志着，郁李仁性最滑脱，古人治惊后肝系滞而不下，始终目不瞑者，用之以下肝系而去滞，此证借用，良由湿热之邪，留于胆中，胆为清虚之府，藏而不泻，是以病去，而内留之邪不去，寐则阳气行于阴，胆热内扰，肝魂不安。用郁李仁以泄邪而以酒行之，酒气独归胆也。枣仁之酸，入肝安神，而以姜汁制，安神而又兼散邪也。肝性喜凉散，枣仁、姜汁太温，似宜酌加凉品。
第二十八条 湿热证：曾开泄下夺，恶候皆平，独神思不清，倦语不思食，溺数，唇齿干，胃气不输，肺气不布，元神大亏。适宜用人参、麦冬、石斛、木瓜、生甘草、生谷芽、鲜莲子等药物。
开泄下夺，恶候皆平，正亦大伤，故见证多气虚之象，理合清补元气。若用腻滞阴药，去生便远。
王士雄按语：此肺胃气液两虚之证，故宜清补，不但阴腻不可用，且与脾虚之宜于守补温运者亦异。杨云评论说：分别极清。
第二十九条 湿热证：四五日，忽大汗出，手足冷，脉细如丝或绝，口渴，茎痛，而起坐自如，神清语亮，这是汗出过多，卫外之阳暂亡，湿热之邪仍结，一时表里不通，脉故伏，非真阳外脱也。适宜用五苓散去术，加滑石、酒炒川连、生地、陈皮等药物。
王士雄按语：吴本无川连、生地。
此条脉证，全似亡阳之候，独于举动神气，得其真情，噫！此医之所以贵识见也。
王士雄按语：此条原注，全似评赞，章氏以为自注，究可疑也。至卫阳暂亡，必由误表所致，湿热仍结，阴液已伤，故以四苓加滑石导湿下行，川连、生地清火救阴，陈皮固其卫气，用法颇极周密。杨云评论说：发明方意精当。汪氏按语：此注当亦后人所附评语。且此证世所罕见，况亡阳脱证。起坐自如。神清语亮者。亦不少。据以辨证似不甚明确。惟口渴茎痛为亡阳所无耳。
第三十条 湿热证：发痉神昏，独足冷阴缩，下体外受客寒，仍宜从湿热治，只用辛温之品，煎汤熏洗。杨云评论说：仍从湿热治是矣。辛温熏洗，不愈益其湿乎，不惟治下而遗上也。汪氏按语：熏洗似无大碍，但未必有益。
阴缩为厥阴之外候，合之足冷，全似虚寒，乃谛观本证，无一属虚，始知寒客下体，一时营气不达，不但证非虚寒，并非上热下寒之可拟也。仍从湿热治之，又何疑耶？发痉神昏，邪犯肝心。若邪重内闭，厥阴将绝，必囊缩足冷而舌亦卷，是邪深垂死之证。本非虚寒，今云由外受客寒，临证更当详细察问为要。
王士雄按语：此条本文，颇有语病，恐非生白手笔。
第三十一条 湿热证初起：壮热，口渴，脘闷，懊憹，眼欲闭，时谵语，这是浊邪蒙闭上焦，适宜涌泄。用枳壳、桔梗、淡豆豉、生山栀。无汗者加葛根。
此与第九条宜参看，彼属余邪，法当轻散，余邪不净者，自无壮热谵语等证，必与初起邪势重者，形状不同。此则浊邪蒙闭上焦，故懊憹脘闷。眼欲闭者，肺气不舒也；时谵语者，邪郁心包也。若投轻剂，病必不除。经曰：高者越之，用栀豉汤涌泄之剂，引胃脘之阳，而开心胸之表，邪从吐散。若舌苔薄而清者，邪未胶结，可吐散，如舌苔浓而有根，浊邪瘀结，须重用辛开苦降，如吐之邪结不得出，反使气逆而变他证矣。
王士雄按语：此释甚是。病在上焦，浊邪未结，故可越之，若已结在中焦，岂可引吐，不但湿热证，吐法宜慎也，即痰饮证之宜于取吐者，亦有辨别要诀。赵恕轩《串雅》
Article 15 Damp-heat syndrome: After four or five days, severe thirst with large gulps of water, extreme chest tightness as if suffocating, incessant dry retching, fine and rapid pulse, and a tongue surface smooth like a mirror. This indicates that the stomach fluids have been depleted and the Gallbladder fire is rushing upward. It is suitable to use watermelon juice, Jinzhi (Gold Juice), fresh Rehmanniae Radix juice, sugarcane juice, and drugs such as Curcumae Radix (Yujin), Aucklandiae Radix (Muxiang), Cyperi Rhizoma (Xiangfu), and Linderae Cortex (Wuyao) ground and taken orally.
Wang Shixiong's note: The Wu edition writes "white juice of watermelon," meaning not taking the juice from the pulp, but crushing the melon flesh to extract the juice. It also does not mention Jinzhi or sugarcane juice.
This occurs in patients who are constitutionally deficient in Ying-Yin and have a naturally vigorous Liver-Fire. The Wood overacts on the Yangming Stomach, consuming the body fluids. Fortunately, there is no fluid retention pathogen, so the treatment must both clear the heat of Yangming and dissipate the pathogen of Shaoyang. Decoction is not used to preserve the complete Qi of the herbs. A smooth tongue without coating indicates fluid exhaustion rather than turbid obstruction; the extreme chest tightness is due to the rebellious ascent of Liver-Gallbladder Qi. Therefore, various juices are used to nourish stomach fluids, and acrid-aromatic drugs are used to dissipate the rebellious Qi.
Wang Shixiong's note: For treating Yin deficiency with Qi stagnation, one can imitate this medication strategy. Yang commented: This case is precise; being able to draw analogies like this makes one a good reader. I further note: There is a medical case regarding the treatment of pain caused by fluid retention worth referencing. Yu Xing'an said: A person from Jiashan suffered from chest distension and epigastric stuffiness, unresponsive to various treatments. Doctor Yipiao used a decoction of Euphorbia lathyris (Xuisui Zi), ground with Aquilariae Lignum Resinatum (Chenxiang), Aucklandiae Radix (Muxiang), Santali Albi Lignum (Tánxiāng), Aquilariae Lignum Resinatum (Jiangxiang), and Caryophylli Flos (Dīngxiāng). After one month of consumption, all water retention was purged through stool, and he recovered. Wang's note: Euphorbia lathyris must have its oil completely removed, otherwise it will harm people. Method for removing oil: Press on a wooden bed using a mulberry press, then press heavily between papers, changing the paper multiple times until clean.
Article 16 Damp-heat syndrome:
Wang Shixiong's note: The Wu edition adds "fever and bitter taste in the mouth" below this line. Vomiting clear water or excessive phlegm indicates damp-heat retained internally with Liver-Fire rebelling upward. It is suitable to use Wendan Tang (Warm the Gallbladder Decoction) plus Trichosanthis Fructus (Guālóu). Wang Shixiong's note: The Wu edition writes "Coptidis Rhizoma (Huánglián)". Biyu San (Jade Green Powder) and other substances.
This patient has had phlegm-fluid retention since before, and now both Yangming and Shaoyang are diseased. Thus, one aspect clears the fluid retention, and another descends the rebellion. Although vomiting is present as in the previous article, the treatment differs, so they should be studied together. Biyu San consists of Liuyi San (Six-to-One Powder) added with Indigo Naturalis (Qīndài) to clear Liver-Gallbladder heat. In the previous article, fluid exhaustion moved the Liver-Gallbladder fire, causing dry retching. In this article, phlegm-fluid retention depresses the Liver-Gallbladder fire, causing vomiting of water.
Article 17 Damp-heat syndrome: Incessant vomiting and nausea, day and night without relief, suffering to the point of death. This is disharmony between Lung and Stomach, where Stomach heat transfers to the Lung, but the Lung rejects the pathogen. It is suitable to use Coptidis Rhizoma (Chuānlián) 3-4 fen and Perillae Folium (Sūyè) 2-3 fen. Decoct these two ingredients and sip the soup slowly to stop the symptoms.
Disharmony between Lung and Stomach easily leads to vomiting. Because Stomach heat transfers to the Lung, and the Lung rejects the pathogen, it returns to the Stomach. One must use Coptidis Rhizoma to clear damp-heat and Perillae Folium to unblock Lung and Stomach Qi. Immediate effect occurs because only Perillae Folium can unblock Lung and Stomach Qi. The light dosage is because light agents precisely treat diseases of the Upper Jiao.
Wang Shixiong's note: This formula contains only two ingredients, totaling less than one qian. Not only is small dosage appropriate for Upper Jiao diseases, but light medicines can indeed cure serious illnesses. This is what is meant by "lightness can remove excess." Observing the next article together, Qi values free flow. When disturbed by pathogens, circulation becomes obstructed, losing its clear, empty, and agile nature, falsely appearing as excess. Only with light and pure agents can Zheng Qi be distributed, pathogens subside, and obstruction resolve. If heavy medicines are used, they pass beyond the disease site, failing to remove the illness, while healthy areas suffer attack first. Zhang claimed light agents were designed for frail people from Wu region; this likely misunderstands the principles of treatment. Coptidis Rhizoma not only treats damp-heat but uses its bitterness to descend rebellious Stomach fire. Perillae Folium is sweet and acrid, aromatic in odor, excels in unblocking and descending Qi, but its nature is warm and dispersing. Thus, although paired with Coptidis Rhizoma, its dose is reduced slightly for restraint, showing wisdom in formula composition. People do not understand that all rebellious upward movements belong to Fire. Treating vomiting with Ginger, Evodiae Fructus, Clove, and Cinnamon Twig is the work of crude physicians. I use this formula to treat morning sickness during pregnancy with excellent results.
Article 18 Damp-heat syndrome: Cough, restlessness day and night, even to the point of panting and inability to sleep. This is Summer-heat pathogen entering the Lung collaterals. It is suitable to use Lepidii Semen (Tínglì), Loquat Leaf (Pípá Yè), and Liuyi San (Liùyīsàn).
Wang Shixiong's note: The Wu edition adds "panting, red face, coarse breathing" after cough, and lacks the phrase "even to the point of".
People only know that Summer-heat damages Lung Qi leading to Lung deficiency, but do not know that Summer-heat stagnating in Lung collaterals leads to Lung excess. Lepidii Semen guides Talcum (Huáshí) to directly drain Lung pathogens, curing the disease. Wu Ziyin said: My teacher Zhang Youqiao treated a wine drinker in summer with phlegm-cough, panting, and insomnia. Cool medicines and Qi-opening medicines failed. Some suggested Ginseng and Ophiopogonis Radix. The teacher palpated the pulse: Right Cun was rapid and excess. This is Lung excess, not deficiency. Administering Ginseng would cause immediate death. He gave this formula, and recovery was immediate. The following year, re-infected by external pathogens, obstructing Lung Qi, panting and cough recurred. A doctor used Lepidii Semen, which failed, causing irritability and sweating. The teacher palpated Right Cun floating and rapid, thirst, aversion to heat, spontaneous cold sweat, urgent panting, and irritability. He said: Heat pathogen is internally obstructed, Lung Qi is extremely depressed, forcing sweat out. This is not Qi-deficiency spontaneous sweating. Irritability after taking Lepidii Semen is due to extreme Lung heat rejecting bitter-cold drugs. Lung dislikes Qi rebellion and should be drained with bitter. But Lung desires dispersion, so one should add food-based acrids to disperse. One dose of Mahuang Xingren Gancao Gypsum Decoction (Máxìng Gānzǐ Tāng) allowed Lung Qi to flow, stopping panting and sweating, resolving all symptoms. Yang commented: I once treated a wine drinker with severe panting, cured by Su Ting Wan (Su-Ting Pill) from *Medical Center of the Golden Mirror*. This is similar, representing damp-heat congestion upward. Regarding the case note saying condition worsened after taking this, it was because external contraction bound Lung heat; using descending herbs caused external pathogens to sink inward, worsening the disease. Mahuang Xingren Gancao Gypsum Decoction expels external pathogens and clears internal heat, hence rapid recovery. Dr. Zhang's medication was correct, but his theory was high-minded yet impractical, not a method for teaching students.
Article 19 Damp-heat syndrome: After more than ten days, major symptoms have subsided, leaving only thirst, sweating, and hidden pain in bone joints.
Wang Shixiong's note: The Wu edition has the character "hidden" (yǐn).
Wang Shixiong's note: The Wu edition adds "discomfort, red and scanty urine with difficult urination" below. This is residual pathogens lingering in the collaterals. It is suitable to soak Atractylodis Rhizoma (Yúzhú) in Yuanmi (glutinous rice) soup overnight, remove the Atractylodis Rhizoma, and decoct the liquid for drinking.
After illness, damp pathogen remains incomplete, and Yin fluids are injured first, causing thirst and body pain. At this time, saving fluids aids dampness, and treating dampness injures Yin. Following Zhongjing's Mafei Tang method, extracting Qi rather than Flavor, acting on Yang rather than Yin, supplemented by Yuanmi soup to nourish Yin and drive out dampness, achieving both benefits. Yang commented: The decoction method is exquisite, and the annotation is clear. Wang's note: This body pain is a definitive sign of damp stagnation. Thirst may not necessarily be due to internal dampness inducing drinking. However, body fluids must be considered. Using wood to treat dampness by soaking rather than decocting is both clever and thorough.
Wang Shixiong's note: Using Glehniae Radix (Shāshēn), Ophiopogonis Radix (Màidōng), Dendrobii Caulis (Shíhú), and Loquat Leaf (Pípá Yè) decocted in Winter Melon (Dōngguā) soup is also acceptable. Wang's note: Using winter melon is ingenious. Add Luffae Fructus Retinervus (Sīguā Luò).
Article 20 Damp-heat syndrome: After several days, sweating does not relieve heat, or spasms occur, suddenly accompanied by unceasing headache. This is severe depletion of Ying fluids, with Jueyin Wind-Fire rising. It is suitable to use Antelope Horn (Língyáng Jiǎo), Vitex Fruit (Mànjīngzǐ), Uncaria Ramulus cum Uncis (Gōuténg), Scrophulariae Radix (Xuánshēn), Rehmanniae Radix (Shēngdì), and Ligustri Lucidi Fructus (Nǚzhēnzǐ).
Wang Shixiong's note: The Wu edition lacks Ligustri Lucidi Fructus but includes Paeoniae Radix Alba (Báisháo). Yang commented: Paeoniae Radix Alba is inferior to Ligustri Lucidi Fructus.
Damp-heat injures Ying, Liver wind rebels upward, blood fails to nourish sinews causing spasms, heat rises to the vertex causing headache. Heat has retreated, but Wood energy dominates alone, causing spasms without cold limbs. Treatment addresses wind-calming as branch and Yin-nourishing as root.
Wang Shixiong's note: Vitex Fruit is inferior to substituting Chrysanthemi Flos (Júhuā) and Mori Folium (Sāngyè). Yang commented: Vitex Fruit is useless; the substitution is excellent. Wang's note: Lycii Fructus (Gǒuqǐzǐ) can also be used; stickiness is not a concern.
Article 21 Damp-heat syndrome: Chest stuffiness, fever, slight muscle pain, and persistent absence of sweating. This is Summer-heat pathogen internally closed in the Cou-li (pores/skin interstices).
Wang Shixiong's note: The Wu edition lacks these four characters, writing instead "Qi mechanism frustrated and depressed, damp-heat unable to reach exterior". Yang commented: The Wu edition is superior to the original. It is suitable to use Liuyi San (Liùyīsàn) 1 liang and Menthae Haplocalycis Herba (Bòhè Yè) 3-4 fen.
Wang Shixiong's note: The Wu edition writes "30-40 leaves". Soak in soup and take orally to induce sweating and resolution.
Ancient sages prohibited sweating for damp diseases, but here mild sweating is necessary; otherwise, the disease will not resolve. Having both the great taboo against sweating and the treatment method requiring sweat to resolve creates a paradox. Clinicians must know how to adapt. Wu commented: This is damp-heat accumulation, Qi depression not venting, so acrid-cool dispersal is suitable. Those who bathe profusely often suffer this. If headache and aversion to cold are added, Elsholtziae Herba (Xiāngrú) warm dispersal is appropriate. Zhang commented: Damp diseases are not universally prohibited from sweating; thus Zhongjing had methods like Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction). But cold-damp on the exterior requires sweating; damp-heat in the interior requires clearing and draining. Now Summer-damp closes the Cou-li, so Talcum opens the pores. If closed in the meridians, one must unblock the meridians. Wang's note: The Wu edition has more Mint, so it is not mild sweating.
Article 22 Damp-heat syndrome: After following proper treatment, several days later, vomiting and diarrhea occur simultaneously. This is damage to Middle Qi, with reversal of ascending and descending functions. It is suitable to use: Germinatio Setariae Milaceae (Shēnggǔyá), Nelumbinis Plumula (Liánxīn).
Wang Shixiong's note: It should be Nelumbinis Semen (Liánzǐ). Coicis Semen (Mǐrén), Pinelliae Rhizoma Preparatum (Bànxià), Glycyrrhizae Radix et Rhizoma (Gāncǎo), Poria (Fúlíng), etc. Severe cases use Lizhong Fa (Regulate the Middle Method).
Wang Shixiong's note: The Wu edition lacks this article. If Lizhong Fa is applicable, it must be due to excessive intake of cold medicines.
Reversal of ascending and descending functions requires harmonizing the Middle, similar to using Liuhe Tang (Six-Harmonies Decoction) for Huoluan. If Taiyin is severely exhausted and Middle Qi cannot support, Lizhong is indispensable. Sudden vomiting and diarrhea require careful examination of pulse and symptoms to rule out secondary infections or dietary injury.
Wang Shixiong's note: It can also be caused by anger, requiring harmonization of Liver and Stomach.
Article 23 Damp-heat syndrome: After more than ten days, Left Guan pulse is wiry and rapid, abdominal pain occurs intermittently, occasional bloody stools, hot and painful anus. This is internal drying of Blood, a syndrome where heat pathogen enters Jueyin. It is suitable to imitate the Baitouweng Fa (White-Head-Poppy Method).
When heat enters Jueyin causing dysentery, even without bloody stools, one should follow Zhongjing's method for treating heat dysentery. If it forces entry into Ying-Yin, why not use Baitouweng Tang (White-Head-Poppy Decoction) to cool blood and scatter pathogens? If heat enters Yangming causing dysentery, even without bloody stools, one should follow Zhongjing's method for dysentery with delirium, using Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction).
Wang Shixiong's note: Zhang claimed Xiaochengqi Tang treats Jueyin heat dysentery, and if heat enters Yangming causing dysentery, Huangqin Tang (Scutellaria Decoction) should be used. This shows ignorance of textual errors in *Shanghan Lun*. The text says: Dysentery with delirium indicates dry feces; Xiaochengqi Tang is suitable. With dry feces, it is a Taiyin transforming into Yangming syndrome, unrelated to Jueyin. Damp-heat entering Yangming causing dysentery originally follows Huangqin Tang. Cases with dry feces and delirium exist, so Xiaochengqi Tang can be cited by analogy.
Article 24 Damp-heat syndrome: After more than ten days, Chi pulse is rapid, dysentery or sore throat, thirst, irritability. This is insufficiency of Lower Springs (Kidney Water), a syndrome where heat pathogen directly attacks Shaoyin. It is suitable to imitate the Zhufu Tang (Pig Skin Decoction) cooling-moistening method.
The same dysentery differs between Jueyin and Shaoyin, leading to different cold/cool medications. Jueyin prefers cold, Shaoyin prefers cool.
However, Shaoyin can present with pus and blood in stool; this must be carefully examined.
Article 25 Damp-heat syndrome: Cold body, fine pulse, sweating, chest stuffiness, thirst, white tongue coating. This is damp injuring Shaoyin Yang. It is suitable to use Ginseng Radix (Rénshēn), Atractodis Rhizoma (Baizhú), Aconiti Lateralis Radix Praeparata (Fùzǐ), Poria (Fúlíng), and Alpiniae Oxyphyllae Fructus (Yìzhì).
Wang Shixiong's note: The Wu edition lacks this article. Yang commented: Such syndromes exist, but this treatise discusses damp-heat yet introduces cold-damp without clarifying medicinal error, confusing its own examples.
This article involves damp injuring Yang, requiring supporting Yang and driving out damp. Thirst is a Shaoyin symptom; how can cold medicines be used recklessly? Fluids emerge from the Lianquan acupoint of the Shaoyin meridian under the tongue. Thus, when Shaoyin is attacked and fluids fail to rise, thirst occurs. However, with chest stuffiness and white coating, one should add Magnoliae Officinalis Cortex (Hòupò), Pinelliae Rhizoma (Bànxià), or Zingiberis Rhizoma (Gānjiāng), fearing Ginseng and Atractylodes are too cloying. Thirst is due to damp restraining Yang, failing to transform fluids upward, not heat.
Wang Shixiong's note: This is a differential of damp-heat, namely cold-damp. Thus it injures human Yang Qi. Or, if damp-heat treatment is improper, focusing only on clearing heat while neglecting to transform damp, this variation can occur. But if thirst is accompanied by cold body, fine pulse, sweating, and white coating, it belongs to Yin syndrome requiring warmth. One must still examine urination and defecation. If urine is red and scanty, and stool is hot and foul-smelling, it is still Yang syndrome with damp-heat accumulation, showing false signs of deficiency-cold; warm tonics should not be lightly administered. Zhang's statement that thirst from damp restraining Yang failing to transform fluids is a Taiyin syndrome, not Shaoyin.
Article 26 Summerheat disease: Initially, only aversion to cold, yellow face, no thirst, mental fatigue, lazy limbs, deep and weak pulse, abdominal pain, and dysentery. This is damp confining Taiyin Yang. It is suitable to imvoke Suopi Yin (Spleen-Constricting Drink); severe cases use Dashun San (Great Smooth Powder) or Laifu Dan (Returning Renewal Pill).
Wang Shixiong's note: The Wu edition lacks this article.
Summer months are when Yang Qi escapes outward and Yin Qi consumes inward. Thus heat pathogen injures Yin, Yangming burns away, requiring clearing and cooling.
Wang Shixiong's note: This is the orthodox method for treating summerheat. Taiyin is distressed, damp-turbidity pervades, requiring warming and dispersing.
Wang Shixiong's note: For cold-damp diseases, even in summer, cool medicines are contraindicated; one should abandon the season and follow the syndrome. Ancient sages knew to differentiate and treat, but failed to clearly define boundaries, creating names like "Yin Summerheat," misleading students greatly. Xu Huixi said: Heaven has Yin Summerheat, the world has Yin Heat. This pierces the truth. Wang's note: If there is Yin Summerheat in summer, should there be Yang Cold in winter? If one catches disease in winter and the doctor says: This is Yang Cold, treat with cool medicines, everyone would laugh at the absurdity. Yet the name Yin Summerheat has persisted for centuries, accumulating falsehoods. Ancient methods are most detailed; doctors should learn from them. Zhongjing said: Spontaneous diarrhea without thirst belongs to Taiyin, because the zang organ has cold. Now, heavy damp, aversion to cold, no fever constitutes Taiyin cold-damp. If limbs are cold and pulse is fine, Ginger and Aconite Lizhong method is mandatory.
Article 27 Damp-heat syndrome: After proper treatment, all symptoms retreat. Only upon closing eyes does palpitation and startle occur, dream disturbance. Residual pathogens remain internally, Gallbladder Qi is not relaxed. It is suitable to use Prunus mume seed (Yúlǐ Rén) soaked in wine, Ziziphus Spinosa Seed (Zǎorén) stir-fried with Ginger Juice, and Porcine Gallbladder Membrane (Zhūdǎnpí).
Wang Shixiong's note: The Wu edition lacks this article.
Slippery substances anchor the spirit. Prunus mume seed is very slippery. Ancients used it for post-startle Liver system stagnation preventing downward movement, causing insomnia, to descend the Liver system and remove stagnation. Borrowed for this case, it is because damp-heat pathogen remains in the Gallbladder. Gallbladder is a clear-empty fu, storing but not excreting. Thus, after illness resolves, internal residual pathogens remain. During sleep, Yang Qi moves into Yin, Gallbladder heat disturbs internally, Liver Hun is unsettled. Use Prunus mume seed to drain pathogens and wine to guide it; wine Qi uniquely enters the Gallbladder. Sour Ziziphus Spinosa Seed enters Liver to calm spirit, processed with Ginger Juice to calm spirit and scatter pathogens. Liver likes cool dispersal; Ziziphus Spinosa Seed and Ginger Juice are too warm, so cool items should be酌情 added.
Wang Shixiong's note: This explanation is correct. Coptidis Rhizoma (Huánglián), Gardeniae Fructus (Shānzhī), Bamboo Sap (Zhúrú), and Mori Folium (Sāngyè) can all be assistants.
Article 28 Damp-heat syndrome: After opening-draining and purging-down, evil manifestations have平息ed, but mental clarity is absent, speech is fatigued, appetite is lost, frequent urination, dry lips and teeth, Stomach Qi fails to transport, Lung Qi fails to distribute, Yuan Shen is severely depleted. It is suitable to use Ginseng Radix (Rénshēn), Ophiopogonis Radix (Màidōng), Dendrobii Caulis (Shíhú), Chaenomelis Fructus (Mùguā), Raw Glycyrrhizae Radix et Rhizoma (ShēngGāncǎo), Germinatio Setariae Milaceae (Shēnggǔyá), and Fresh Nelumbinis Semen (Xiānliánzǐ).
Wang Shixiong's note: The Wu edition lacks this article. Wang's note: Polygonati Rhizoma (Bǎihé) might also be usable.
Opening-draining and purging-down平息ed evil manifestations, but Zheng Qi is severely damaged, hence many Qi-deficiency signs appear. Clear-tonification of Yuan Qi is appropriate. Using cloying Yin medicines drives life away.
Wang Shixiong's note: This is Qi and fluid deficiency of Lung and Stomach, requiring clear-tonification. Not only are cloying Yin medicines unusable, but it differs from Spleen deficiency requiring steady-tonification and warm-moving. Yang commented: Distinction is very clear.
Article 29 Damp-heat syndrome: Four or five days in, sudden profuse sweating, cold hands and feet, pulse fine as silk or imperceptible, thirst, penile pain, yet sitting and moving freely, spirit clear, voice bright. This is excessive sweating causing temporary loss of Wei-Yang protecting the exterior, while damp-heat pathogen remains knotted. Temporary blockage of interior-exterior communication causes hidden pulse, not true Yang collapse. It is suitable to use Wuling San (Five-Ingredient Powder with Lingzhi) minus Atractylodis Rhizoma, adding Talcum (Huáshí), Wine-fried Coptidis Rhizoma (Chuānlián), Rehmanniae Radix (Shēngdì), and Citri Reticulatae Pericarpium (Chénpí).
Wang Shixiong's note: The Wu edition lacks Coptidis Rhizoma and Rehmanniae Radix.
Pulse and symptoms of this article resemble Yang collapse, but movement and spirit reveal the true nature. Ah! This is why physicians value insight.
Thirst and penile pain indicate pathogen knotting. Clear spirit and bright voice indicate non-collapse syndrome.
Wang Shixiong's note: The original note reads like praise; Zhang considered it self-commentary, which is suspicious. Temporary loss of Wei-Yang must result from incorrect sweating treatment. Damp-heat remains knotted, Yin fluids injured. Thus Si Ling San plus Talcum guides damp downward, Coptidis Rhizoma and Rehmanniae Radix clear fire and save Yin, Citri Reticulatae Pericarpium secures Wei Qi. Usage is very thorough. Yang commented: Explanation of formula intent is precise. Wang's note: This note is likely appended commentary by later generations. This syndrome is rare in the world, let alone Yang collapse. Cases with free movement and clear spirit are not uncommon. Differentiation based on this seems unclear. Only thirst and penile pain are absent in Yang collapse.
Article 30 Damp-heat syndrome: Spasms and coma, but only cold feet and genital retraction. Lower body externally exposed to guest cold. Still treat according to damp-heat, using only acrid-warm substances decocted for fumigation and washing. Yang commented: Treating according to damp-heat is correct. Acrid-warm fumigation/washing, doesn't it increase dampness? It treats lower body while neglecting upper. Wang's note: Fumigation/washing seems harmless but not necessarily beneficial.
Genital retraction is an external manifestation of Jueyin. Combined with cold feet, it fully resembles deficiency-cold. But observing the main syndrome, nothing belongs to deficiency. Knowing cold guests the lower body temporarily blocks Ying Qi. Not only is the syndrome not deficiency-cold, nor is it upper-heat/lower-cold. Still treating according to damp-heat, what doubt remains? Spasms and coma indicate pathogen attacking Liver and Heart. If pathogen is heavy and internally closed, Jueyin is about to perish,必然 with scrotal retraction, cold feet, and curled tongue. This is a critical dying syndrome. Originally not deficiency-cold, now stated as external guest cold. Clinical observation must be detailed.
Wang Shixiong's note: This article text has grammatical errors, likely not written by Shengbai himself.
Article 31 Early stage of Damp-heat syndrome: High fever, thirst, epigastric stuffiness, anguish, eyes wanting to close, occasional delirium. Turbid pathogen confuses and blocks Upper Jiao. Suitable for inducing vomiting (Yǒngxiè). Use Aurantii Fructus (Zhǐké), Platycodonis Radix (JiéGěng), Fermented Soybean (DànDòuchǐ), and Raw Gardeniae Fructus (ShēngShānzhī). Add Puerariae Radix (Gégēn) if no sweat.
Compare with Article 9. That belongs to residual pathogens, requiring light dispersal. Those with incomplete residual pathogens naturally lack high fever and delirium. They differ in appearance from those with heavy pathogenic force at onset. Here, turbid pathogen confuses Upper Jiao, causing anguish and epigastric stuffiness. Eyes wanting to close indicates Lung Qi not relaxing; occasional delirium indicates pathogen depressing Heart Protector. If light agents are used, disease will not resolve. Classic says: "High things are vented." Use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) as a vomiting agent to guide Epigastric Yang and open Chest exterior, scattering pathogen via vomiting. If tongue coating is thin and clear, pathogen is not sticky, vomiting/scattering is possible. If coating is thick with roots, turbid pathogen is knotted, requiring heavy acrid-opening and bitter-descending. If vomiting fails to expel knotted pathogen, it reverses Qi and causes other syndromes.
Wang Shixiong's note: This explanation is correct. Disease in Upper Jiao, turbid pathogen not knotted, so it can be vented. If knotted in Middle Jiao, how can vomiting be induced? Not only in damp-heat, vomiting method should be cautious. Even for phlegm-fluid cases suitable for vomiting, there are key differentiation points. Zhao Shuxuan's *Chuan Ya*...