此诸温不同之大关键也。温热等皆因于火，以火从火，阳明阳土，以阳从阳，故阳明病居多。湿
温则以湿从湿，太阴阴土，以阴从阴，则太阴病居多。暑兼湿热，故各半也。
三八、脉洪滑，面赤身热头晕，不恶寒，但恶热，舌上黄滑苔，渴欲凉饮，饮不解渴，得水则呕，
按之胸下痛，小便短，大便闭者，阳明暑温，水结在胸也，小陷胸汤加枳实主之。
脉洪面赤，不恶寒，病已不在上焦矣。暑兼温热，热甚则渴，引水求救。湿郁中焦，水不下行，反
来上逆，则呕。胃气不降，则大便闭。故以黄连、栝蒌清在里之热痰，半夏除水痰而强胃，加枳实
者，取其苦辛通降，开幽门而引水下行也。
小陷胸加枳实汤方（苦辛寒法）
黄连（二钱） 栝蒌（三钱） 枳实（二钱） 半夏（五钱）
急流水五杯，煮取二杯，分二次服。
三九、阳明暑温，脉滑数，不食不饥不便，浊痰凝聚，心下痞者，半夏泻心汤去人参、干姜、大
枣、甘草加枳实、杏仁主之。
不饥不便，而有浊痰，心下痞满，湿热互结而阻中焦气分。故以半夏、枳实开气分之湿结；黄连、
黄芩开气分之热结、杏仁开肺与大肠之气痹；暑中热甚，故去干姜；非伤寒误下之虚痞，故去人参、甘
草、大枣，且畏其助湿作满也。
半夏泻心汤去干姜甘草加枳实杏仁方（苦辛寒法）
半夏（一两） 黄连（二钱） 黄芩（三钱） 枳实（二钱） 杏仁（三钱）
水八杯，煮取三杯，分三次服。虚者复纳人参二钱，大枣三枚。
四十、阳明暑温，湿气已化，热结独存，口燥咽干，渴欲饮水，面目俱赤，舌燥黄，脉沉实者，小
承气汤各等分下之。
暑兼湿热，其有体瘦质燥之人，感受热重湿轻之证，湿先从热化尽，只余热结中焦，具诸下证，方可下之。
小承气汤（方义并见前。此处不必以大黄为君，三物各等分可也）
四一、暑温蔓延三焦，舌滑微黄，邪在气分者，三石汤主之；邪气久留，舌绛苔少，热搏血分
者，加味清宫汤主之；神识不清，热闭内窍者，先与紫雪丹，再与清宫汤。
蔓延三焦，则邪不在一经一脏矣，故以急清三焦为主。然虽云三焦，以手太阴一经为要领。盖
肺主一身之气，气化则暑湿俱化，且肺脏受生于阳明，肺之脏象属金色白，阳明之气运亦属金色白。
故肺经之药多兼走阳明，阳明之药多兼走肺也。再肺经通调水道，下达膀胱，肺痹开则膀胱亦开，
是虽以肺为要领，而胃与膀胱皆在治中，则三焦俱备矣，是邪在气分而主以三石汤之奥义也。若邪
气久羁，必归血络，心主血脉，故以加味清宫汤主之。内窍欲闭，则热邪盛矣，紫雪丹开内窍而清热
最速者也。
三石汤方
飞滑石（三钱） 生石膏（五钱） 寒水石（三钱） 杏仁（三钱） 竹茹（炒，二钱） 银花（三钱，
花露更妙） 金汁（一酒杯，冲） 白通草（二钱）
水五杯，煮成二杯，分二次温服。
〔方论〕此微苦辛寒兼芳香法也。盖肺病治法，微苦则降，过苦反过病所，辛凉所以清热，芳香
所以败毒而化浊也。按三石，紫雪丹中之君药，取其得庚金之气，清热退暑利窍，兼走肺胃者也；杏仁、通草为
宣气分之用，且通草直达膀胱，杏仁直达大肠；竹茹以竹之脉络，而通人之脉络；金汁、银花，败暑中之热毒。
加味清宫汤方
即于前清宫汤内加知母三钱、银花二钱、竹沥五茶匙冲入。
〔方论〕此苦辛寒法也。清宫汤前已论之矣，加此三味者；知母泻阳明独胜之热，而保肺清金；银
花败毒而清络；竹沥除胸中大热，止烦闷消渴；合清宫汤为暑延三焦血分之治也。
四二、暑温伏暑，三焦均受，舌灰白，胸痞闷，潮热呕恶，烦渴自利，汗出溺短者，杏仁滑石汤
主之。
舌白胸痞，自利呕恶，湿为之也。潮热烦渴，汗出溺短，热为之也。热处湿中，湿蕴生热，湿热
交混，非偏寒偏热可治，故以杏仁、滑石、通草、先宣肺气，由肺而达膀胱以利湿，浓朴苦温而泻湿
满，芩、连清里而止湿热之利，郁金芳香走窍而开闭结，桔、半强胃而宣湿化痰以止呕恶，俾三焦混
处之邪，各得分解矣。
杏仁滑石汤方（苦辛寒法）
杏仁（三钱） 滑石（三钱） 黄芩（二钱） 桔红（一钱五分） 黄连（一钱） 郁金（二钱） 通草（一钱）
浓朴（二钱） 半夏（三钱）
水八杯，煮取三杯，分三次服。
这是各种温病不同的关键所在。温热等病皆因于火，以火从火；阳明属阳土，以阳从阳，所以阳明病居多。湿温则以湿从湿，太阴属阴土，以阴从阴，所以太阴病居多。暑邪兼夹湿热，所以两者各占一半。
三八、脉象洪大滑利，面色红赤，身体发热，头晕，不恶寒，只恶热，舌上覆盖黄滑苔，口渴想喝凉饮，但饮水不能解渴，得水则呕吐，按压胸下疼痛，小便短少，大便闭塞的，属于阳明暑温，是水邪结聚在胸膈，用小陷胸汤加枳实主治。
脉洪大、面赤、不恶寒，说明病位已不在上焦。暑邪兼夹温热，热盛则口渴，引水自救。湿邪郁阻中焦，水液不能下行，反而上逆，导致呕吐。胃气不降，则大便闭塞。因此用黄连、栝蒌清除体内的热痰，半夏祛除水痰并强健胃气，加入枳实，是取其苦辛通降之性，开通幽门引导水液下行。
小陷胸加枳实汤方（苦辛寒法）
黄连（二钱） 栝蒌（三钱） 枳实（二钱） 半夏（五钱）
急流水五杯，煮取两杯，分两次服用。
三九、阳明暑温，脉象滑数，不想进食也不觉得饥饿，大便不通，浊痰凝聚，心下部痞满的，用半夏泻心汤去掉人参、干姜、大枣、甘草，加入枳实、杏仁主治。
不饥不便，且有浊痰，心下痞满，这是湿热互结阻碍了中焦气机。因此用半夏、枳实开通气分的湿结；黄连、黄芩开通气分的热结；杏仁开通肺与大肠的气机痹阻。暑病中热势甚重，所以去掉干姜；这不是伤寒误下导致的虚痞，所以去掉人参、甘草、大枣，并且担心它们助湿导致胀满。
半夏泻心汤去干姜甘草加枳实杏仁方（苦辛寒法）
半夏（一两） 黄连（二钱） 黄芩（三钱） 枳实（二钱） 杏仁（三钱）
水八杯，煮取三杯，分三次服用。体虚者再纳入人参二钱，大枣三枚。
四十、阳明暑温，湿气已经化尽，只有热邪结聚留存，口燥咽干，口渴想喝水，面目都红赤，舌燥黄，脉象沉实的，用小承气汤各等分量攻下。
暑邪兼夹湿热，对于形体消瘦、体质干燥的人，感受热重湿轻的病证，湿气先随热邪完全化尽，只剩下热结在中焦，具备诸种可下的证候，才可以攻下。
小承气汤（方义见前文。此处不必以大黃为君药，三味药各等分即可）
四一、暑温蔓延三焦，舌苔滑微黄，邪气在气分的，用三石汤主治；邪气久留不去，舌质绛红苔少，热邪搏结于血分的，用加味清宫汤主治；神识不清，热邪闭阻内窍的，先用紫雪丹，再用清宫汤。
邪气蔓延三焦，则邪气不再局限于一经或一脏，所以以急清三焦为主。虽然说是三焦，但以手太阴肺经为要领。因为肺主一身之气，气化则暑湿俱化，且肺脏受生于阳明，肺的脏象属性属金白色，阳明的气运也属金白色。所以肺经的药物多兼走阳明，阳明的药物多兼走肺。另外肺经通调水道，下达膀胱，肺痹开通则膀胱亦开，是以肺为要领，而胃与膀胱都在治疗范围内，这样三焦就都照顾到了，这就是邪在气分而以三石汤为主的奥妙所在。如果邪气久留，必然归于血络，心主血脉，所以用加味清宫汤主治。内窍欲闭，说明热邪盛极，紫雪丹是开通内窍且清热最快的药物。
三石汤方
飞滑石（三钱） 生石膏（五钱） 寒水石（三钱） 杏仁（三钱） 竹茹（炒，二钱） 银花（三钱，用花露更佳） 金汁（一酒杯，冲服） 白通草（二钱）
水五杯，煮成两杯，分两次温服。
〔方论〕这是微苦辛寒兼芳香的方法。大概肺病的治疗法则，微苦则能降，过苦反而超过病所，辛凉用来清热，芳香用来败毒化浊。按：三石是紫雪丹中的君药，取其得庚金之气，清热退暑利窍，兼走肺胃；杏仁、通草用于宣通气分，且通草直达膀胱，杏仁直达大肠；竹茹利用竹子的脉络，来通人的脉络；金汁、银花，败除暑中的热毒。
加味清宫汤方
即在前方清宫汤内加知母三钱、银花二钱、竹沥五茶匙冲入。
〔方论〕这是苦辛寒法。清宫汤前面已经论述过了，加这三味药的原因是：知母泻阳明独胜之热，而保肺清金；银花败毒而清络；竹沥除胸中大热，止烦闷消渴；合清宫汤成为治疗暑邪延及三焦血分的方剂。
四二、暑温伏暑，三焦均受邪，舌苔灰白，胸脘痞闷，潮热呕恶，烦渴自利，汗出尿短的，用杏仁滑石汤主治。
舌白胸痞，自利呕恶，是湿邪造成的。潮热烦渴，汗出尿短，是热邪造成的。热处湿中，湿蕴生热，湿热交混，不是偏寒或偏热可以治疗的，所以用杏仁、滑石、通草，先宣发肺气，由肺而达膀胱以利湿，厚朴苦温而泻湿满，黄芩、黄连清里而止湿热之利，郁金芳香走窍而开闭结，桔梗、半夏强胃而宣湿化痰以止呕恶，使三焦混杂的邪气，各自分解。
杏仁滑石汤方（苦辛寒法）
杏仁（三钱） 滑石（三钱） 黄芩（二钱） 桔红（一钱五分） 黄连（一钱） 郁金（二钱） 通草（一钱）
厚朴（二钱） 半夏（三钱）
水八杯，煮取三杯，分三次服用。
This is the key distinction among the various types of warm diseases. Warm-heat and similar conditions all originate from Fire; with Fire following Fire, and Yangming belonging to Yang Earth, Yang follows Yang; thus, Yangming diseases are predominant. Damp-warmth, however, involves Dampness following Dampness; Taiyin belongs to Yin Earth, and Yin follows Yin; thus, Taiyin diseases are predominant. Summerheat combines with Damp-Heat, so both aspects are present in equal measure.
38. When the pulse is surging and slippery, the face is red, the body is hot, there is dizziness, no aversion to cold, but only aversion to heat, the tongue has a yellow and slippery coating, thirst desires cool drinks but drinking does not quench it, drinking water induces vomiting, pressing on the hypochondrium causes pain, urine is scanty, and stool is closed, this is Yangming Summerheat-Warmth, where Water is knotted in the chest. It should be treated with Xiaoxianzhong Decoction plus Zhishi (Immature Bitter Orange).
A surging pulse, red face, and absence of aversion to cold indicate that the disease is no longer in the Upper Jiao. Summerheat combines with Warmth; when Heat is severe, thirst arises, and the patient draws water for relief. Dampness stagnates in the Middle Jiao, preventing water from descending, causing it to rebel upward, leading to vomiting. If Stomach Qi fails to descend, stool becomes closed. Therefore, Huanglian (Coptis Rhizome) and Gualou (Trichosanthes Fruit) are used to clear internal Heat-Phlegm; Banxia (Pinellia Tuber) removes watery Phlegm and strengthens the Stomach; Zhishi (Immature Bitter Orange) is added for its bitter-pungent property to promote descending flow, opening the pylorus to guide water downward.
Xiaoxianzhong Plus Zhishi Decoction Formula (Bitter-Pungent-Cold Method)
Huanglian (2 qian) Gualou (3 qian) Zhishi (2 qian) Banxia (5 qian)
Boil five cups of fast-flowing water until two cups remain. Divide into two doses.
39. In Yangming Summerheat-Warmth, if the pulse is slippery and rapid, there is anorexia without hunger, constipation, accumulation of turbid Phlegm, and epigastric fullness/stuffiness, Banxia Xiexin Decoction minus Renshen (Ginseng), Ganjiang (Dried Ginger), Dazao (Jujube), and Gancao (Licorice Root), plus Zhishi (Immature Bitter Orange) and Xingren (Apricot Seed) should be used.
Anorexia without hunger and constipation, accompanied by turbid Phlegm and epigastric fullness, indicate that Damp-Heat are interknotted, obstructing the Qi mechanism of the Middle Jiao. Therefore, Banxia (Pinellia Tuber) and Zhishi (Immature Bitter Orange) are used to open the Damp-knot in the Qi level; Huanglian (Coptis Rhizome) and Huangqin (Scutellaria Root) open the Heat-knot in the Qi level; Xingren (Apricot Seed) opens the Qi obstruction in the Lung and Large Intestine. Since Heat is severe in Summerheat diseases, Ganjiang (Dried Ginger) is removed. This is not a deficiency-type fullness caused by erroneous purgation in Cold Damage, so Renshen (Ginseng), Gancao (Licorice Root), and Dazao (Jujube) are removed to avoid aiding Dampness and causing distension.
Banxia Xiexin Decoction Minus Ganjiang, Gancao Plus Zhishi and Xingren Formula (Bitter-Pungent-Cold Method)
Banxia (1 liang) Huanglian (2 qian) Huangqin (3 qian) Zhishi (2 qian) Xingren (3 qian)
Boil eight cups of water until three cups remain. Divide into three doses. For deficient patients, add Renshen (2 qian) and Dazao (3 pieces).
40. In Yangming Summerheat-Warmth, if Dampness has transformed completely, leaving only Heat knotting alone, with dry mouth and throat, thirst desiring water, redness of face and eyes, dry yellow tongue coating, and a deep, solid pulse, Xiao Chengqi Decoction in equal parts should be used to purge.
Summerheat combines with Damp-Heat. In individuals who are thin and dry in constitution, contracting a condition where Heat is heavy and Dampness is light, the Dampness transforms completely with the Heat first, leaving only Heat knotting in the Middle Jiao. Only when symptoms indicating purgation are present can purgation be employed.
Xiao Chengqi Decoction (See previous text for formula rationale. Here, Dahuang (Rhubarb Root) need not be the sovereign herb; equal parts of the three herbs suffice.)
41. If Summerheat-Warmth spreads through the Three Jiao, with a slippery, slightly yellow tongue coating, and the pathogen is at the Qi level, Sanshi Decoction should be used. If the pathogen lingers for a long time, the tongue is crimson with little coating, and Heat combats the Blood level, Jiawei Qinggong Decoction should be used. If consciousness is unclear due to Heat closing the inner orifices, Zixue Dan (Purple Snow Pill) should be given first, followed by Qinggong Decoction.
Spreading through the Three Jiao means the pathogen is no longer confined to one meridian or zang-fu organ, so urgent clearing of the Three Jiao is prioritized. Although it concerns the Three Jiao, the Hand-Taiyin Lung meridian is the key. The Lung governs the Qi of the whole body; when Qi transforms, Summerheat and Dampness transform together. Moreover, the Lung receives its generation from Yangming; the Lung's zang image belongs to Metal and White, and Yangming's Qi movement also belongs to Metal and White. Thus, drugs acting on the Lung meridian often affect Yangming, and drugs acting on Yangming often affect the Lung. Furthermore, the Lung meridian regulates water passages, directing them down to the Bladder. When Lung obstruction opens, the Bladder also opens. Thus, although the Lung is the key, the Stomach and Bladder are included in the treatment, covering the Three Jiao. This is the profound meaning behind using Sanshi Decoction for pathogens at the Qi level. If the pathogen lingers, it must enter the blood collaterals. The Heart governs the blood vessels, so Jiawei Qinggong Decoction is used. If inner orifices are about to close, Heat is excessive; Zixue Dan (Purple Snow Pill) is the fastest method to open inner orifices and clear Heat.
Sanshi Decoction Formula
Fei Huashi (Flourished Talcum, 3 qian) Sheng Shigao (Raw Gypsum Fibrosum, 5 qian) Hanshui Shi (Cold Water Stone, 3 qian) Xingren (Apricot Seed, 3 qian) Zhuru (Bamboo Shavings, fried, 2 qian) Yinhua (Honeysuckle Flower, 3 qian; flower dew is better) Jinzhi (Golden Juice, 1 wine cup, mixed in) Baotongcao (White Tetrapanax Herb, 2 qian)
Boil five cups of water until two cups remain. Divide into two doses, taken warm.
[Formula Commentary] This is a slightly bitter-pungent-cold method combined with aromatic properties. Generally, the treatment principle for Lung diseases is that slight bitterness promotes descending; excessive bitterness exceeds the disease site. Pungent-cool clears Heat, and aromatic herbs defeat toxins and resolve turbidity. Note: The "Three Stones" are the sovereign herbs in Zixue Dan (Purple Snow Pill), utilizing the Qi of Geng Metal to clear Heat, dispel Summerheat, benefit orifices, and act on both Lung and Stomach. Xingren (Apricot Seed) and Tongcao (Tetrapanax Herb) are used to disseminate Qi-level pathogens; Tongcao reaches the Bladder directly, and Xingren reaches the Large Intestine directly. Zhuru (Bamboo Shavings) uses the bamboo's vascular bundles to unblock human meridians. Jinzhi (Golden Juice) and Yinhua (Honeysuckle Flower) defeat Summerheat toxins.
Jiawei Qinggong Decoction Formula
Take the preceding Qinggong Decoction and add Zhimu (Anemarrhena Rhizome, 3 qian), Yinhua (Honeysuckle Flower, 2 qian), and Zhuli (Bamboo Sap, 5 tea spoons, mixed in).
[Formula Commentary] This is a bitter-pungent-cold method. Qinggong Decoction was discussed previously. These three additions are added because: Zhimu (Anemarrhena Rhizome) drains the exclusive excess Heat of Yangming, preserving the Lung and clearing Metal; Yinhua (Honeysuckle Flower) defeats toxins and clears collaterals; Zhuli (Bamboo Sap) eliminates great Heat in the chest, stops irritability and thirst. Combined with Qinggong Decoction, it treats Summerheat extending to the Blood level of the Three Jiao.
42. In Summerheat-Warmth or Hidden Summerheat, where the Three Jiao are equally affected, with grayish-white tongue coating, epigastric stuffiness, tidal fever, nausea/vomiting, irritability/thirst, spontaneous diarrhea, sweating, and short urination, Xingren Huashi Decoction should be used.
Grayish-white tongue and epigastric stuffiness, spontaneous diarrhea, and nausea/vomiting are caused by Dampness. Tidal fever, irritability/thirst, sweating, and short urination are caused by Heat. Heat resides within Dampness, and Dampness generates Heat; they mix intricately. They cannot be treated by merely using cold or hot herbs. Therefore, Xingren (Apricot Seed), Huashi (Talcum), and Tongcao (Tetrapanax Herb) are used to first disseminate Lung Qi, reaching the Bladder via the Lung to promote diuresis. Houpo (Magnolia Bark), being bitter and warm, drains Damp-fullness. Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) clear the interior and stop Damp-Heat diarrhea. Yujin (Curcuma Aromatica Rhizome), aromatic and penetrating orifices, opens closure. Jiegeng (Platycodon Root) and Banxia (Pinellia Tuber) strengthen the Stomach, disseminate Dampness, resolve Phlegm, and stop nausea/vomiting. This allows the pathogens mixed in the Three Jiao to be resolved separately.
Xingren Huashi Decoction Formula (Bitter-Pungent-Cold Method)
Xingren (Apricot Seed, 3 qian) Huashi (Talcum, 3 qian) Huangqin (Scutellaria Root, 2 qian) Juhong (Ponkan Peel, 1.5 qian) Huanglian (Coptis Rhizome, 1 qian) Yujin (Curcuma Aromatica Rhizome, 2 qian) Tongcao (Tetrapanax Herb, 1 qian)
Houpo (Magnolia Bark, 2 qian) Banxia (Pinellia Tuber, 3 qian)
Boil eight cups of water until three cups remain. Divide into three doses.