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。
（二六）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。
暑月为阳气外泄，阴气内耗之时，故热邪伤阴，阳明消烁，宜清宜滋，太阴告困，湿浊弥漫，宜温宜散，古法最详，医者鉴诸。
（二七）湿热证按法治之，诸证皆退，惟目瞑则惊悸梦惕，馀邪内留，胆气未舒，宜酒浸郁李仁姜汁炒枣仁猪胆皮等味。
滑可去着，郁李仁性最滑脱，古人治惊後肝系滞而不下，始终目不瞑者，用之以治肝系而去滞，此证借用，良由湿热之邪，留於胆中，胆为清净之府，藏而不写，是以病去而内留之邪不去，寐则阳气行於阴，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。
（二八）湿热证曾开泄下夺，恶候皆平，独神思不清，倦语不思食，溺数唇齿乾，胃气不输，肺气不布，元神大亏，宜人叁麦冬石斛木瓜生甘草生谷芽莲子等味。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。
（二九）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 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。
此条脉证，全是亡阳之候，独於举动神气，得其真情，噫此医之所以贵识见也。
（三十）湿热证发痉神昏，足冷阴缩，下体外受客寒，仍宜从湿热治，只用辛温之品，煎汤 洗。
阴缩为厥因之外候，合之足冷，全似虚寒，乃谛观本证，无一大虚，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，又何以耶。
（三一）湿热证初起状热口渴， 闷懊恼，眼欲闭，时? y，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。
此与第九条宜叁看，彼属馀邪，法当轻散，此则浊邪蒙闭上焦，故懊恼 闷，眼欲闭者，肺气不舒也，时? y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 之阳，而开心胸之表，邪从吐散。
（三二）湿热证经水适来，壮热口渴，? y神昏，胸腹痛，或舌无苔，脉滑数，邪陷营分，宜大剂犀角紫草茜根贯众连翘鲜菖蒲银花露等味。
（三三）热证上下失血或汗血，毒邪深入营分，走窜欲泄，宜大剂犀角生地赤芍丹皮连翘紫草茜根银花等味。
热 而上下，失血汗血，势即危而犹不即坏者，以毒从血出，生机在是，大进凉血解毒之剂，以救阴而泄邪，邪解而血自止矣，血止後须进叁 善後乃得。
汗血即张氏所谓肌衄也，内经谓热淫於内，治以咸寒，方中当增入咸寒之味。
（三四）湿热证七八日，口不渴，声不出，与饮食亦不却，默默不语，神识昏迷，进辛香凉泄，芳香逐秽，俱不效，此邪入厥阴，主客浑受，宜仿吴又可三甲散，醉地鳖虫醋炒鳖甲土炒穿山甲生僵蚕柴胡桃仁泥等味，
暑湿先伤阳分，然病久不解，必及於阴，阴阳两困，气钝血滞而暑湿不得外泄。遂深入厥阴络脉凝瘀使一阳不能萌动，生气有降无升，心主阻遏，灵气不通，所以神不清而昏迷默默也，破滞通瘀，斯络脉通而邪得解矣。
海昌许益斋云，此条即伤寒门百合病之类，赵以德张路玉陶厚堂以为心病，徐忠可以为肺病，本论又出厥阴治法，良以百脉一宗，悉致其病，元神不布，邪气淹留，乃祖仲景法，用异类灵动之物鳖甲入厥阴，用柴胡引之，俾阴中之邪，尽达於表，? J血，用桃仁引之，俾血分之邪，尽泄於下，山甲入络，用僵蚕引之，俾络中之邪，亦从风化而散，缘病久气钝血滞，非拘拘於恒法所能愈也。
（三五）湿热证口渴，苔黄起刺，脉弦缓，囊缩舌鞭，谵语昏不知人，两手搐搦，津枯邪滞，宜鲜芦根生首乌鲜稻根等味，若脉有力，大便不通者，大黄亦可加入。
胃津劫夺，热邪内据，非润下以泄邪则不能，故仿承气之例，以甘凉易苦寒，正恐胃气受伤胃津不复也。
（三六）湿热证发痉撮空，神昏笑妄，舌苔乾黄起刺，或转黑色，大便不通者，热邪闭结胃腑，宜用承气汤下之。
撮空一证，昔贤谓非大实即大虚，虚则神明涣散，将有脱绝之虞，实则神明被 ，故多撩乱之象，今舌苔黄刺乾涩，大便闭而不通，其为热邪内结，阳明腑热显然矣，徒事清热泄邪，止能散络中流走之热，不能除胃中蕴结之邪，假承气以通地道，然舌不乾黄起刺，不可投也。
（三七）热证壮热口渴自汗，身重胸痞，脉洪大而长者，此太阴之湿与阳明之热相合，宜白虎加苍术汤。
热渴之汗，阳明之热也，胸痞身重，太阴之湿见矣，脉洪大而长，知湿热滞於阳明之经，故用苍术白虎汤，以清热散湿，然乃热多湿少之候。
白虎汤，仲景用以清阳明无形之燥热也，胃汁枯 者，加人叁以生津，曰白虎加人叁汤，身中素有 气者，加桂枝以通络，名曰桂枝白虎汤，而其实在清胃热也，是以後人治暑热伤气，身热而渴者，亦用白虎加人叁汤，热渴汗泄，肢节烦疼者，亦用白虎加桂枝汤，胸痞身重兼见，则於白虎汤中加入苍术以理太阴之湿，寒热往来兼集，则於白虎汤中加入柴胡以散半表半 之邪。凡此皆热盛阳明，他证兼见，故用白虎汤清热，而复各随证以加减， 非热渴汗泄，脉洪大者，白虎便不可投，辨证察脉，最宜详审也。
（三八）湿热说湿热伤气，四肢困倦，精神减少，身热气高，心烦溺黄，口渴自汗，脉虚者，东垣用清暑益气汤主治。
同一热渴自汗，而脉虚神倦，便是中气受伤，而非阳明郁热，清暑益气汤，黄口渴自汗，乃东垣所制，方中药味颇多，学者当於临证时斟酌去取也。
（三九）暑月热伤元气，气短倦怠，口渴多汗，肺虚而骇者，宜人叁麦冬五味子等味。
此即千金生脉散也，与第十八条同一肺病，而气粗与气短有分，则肺实与肺虚各异实则泻而虚则补一定之理也，然生名生脉，则热伤气之脉虚欲绝可知矣，雄按徐洄溪云，此伤暑之後，存其津液之方也，观方下治证，无一字治暑邪者，庸医以治暑病，误以甚矣，其命中之意，即於复脉汤内，取用叁麦二味，因止汗故加五味子，近人不论何病，每用此方收住邪气，杀人无算，用此方者须详审其邪之有无，不可徇俗而视为治暑之剂也。
（四十）暑月乘凉饮冷，阳气为阴寒所 ，皮肤蒸热凛凛畏寒，头痛头重自汗烦渴，或腹痛吐泻者宜香薷厚朴扁豆等味。
此由避暑而感受寒湿之邪，虽病於暑月而实非暑病，昔人不曰暑月伤寒湿，而曰阴暑，以致後人淆惑，贻误匪轻，今特正之，其用香薷之辛温，以散阴邪而发越阳气，厚朴之苦温，除湿邪而通行滞气，扁豆甘淡，行水和中，倘无恶寒头痛之外证，即无取香薷之辛香走窜矣，无腹痛吐利之 证，亦无取厚朴扁豆之疏滞和中矣，故热渴甚者，加黄连以清暑，名四味香薷，饮减去扁豆名黄连香薷饮，湿甚於 ，腹膨泄泻者，去黄连加茯苓甘草名五物香薷饮，若中虚气怯，汗出多者，加人叁 白术橘皮木瓜名十味香薷饮，然香薷之用，总为寒湿外 而设，不可用以治不挟寒湿之暑热也。
（四一）湿热内滞太阴，郁久而为滞下，其证胸痞腹痛，下坠窘迫，脓血稠黏， 结後重，脉软数者，宜厚朴、黄芩、神曲、广皮、木香、槟榔、柴胡、煨葛根、银花、炭荆芥、炭等味、古之所谓滞下，即今所云痢疾也，由湿热之邪，内伏太阴，阻遏气机以致太阴矢健运，少阳失疏连热郁湿蒸，传导失其常度，蒸为败浊，脓血下注肛门，故後重气壅不化，仍数至圊而不能便，伤气则下白，伤血则下赤，气血并伤，赤白兼下，湿热盛极痢成五色，故用厚朴除湿而行滞气，槟 下逆而破结气，黄芩斗清庚金之热，木香神曲疏中气之滞，葛根升下陷之胃气，柴胡升土中之木气，热侵血分而便血，以银花荆芥入营清热，若热甚於 当用黄连以清热，大实而痛，宜增大黄以逐邪，昔张洁古制芍药汤治以治血痢，方用归芍、芩连、大黄、木香、槟榔、甘草、桂心等味，而以芍药名汤者，盖谓下血必调藏血之脏，故用之为君不特欲其土中泻木，抑亦赖以敛肝和阴也，然芍药味酸性敛，终非湿热内蕴者所宜服，倘遇痢久中虚，而宜用芍药甘草之化土者，恐难任芩连大黄之苦寒，木香槟榔之破气，其下痢初作，湿热正盛者，白芍酸敛滞邪，断不可投，此虽昔人已试之成方，不敢引为後学之楷式也。
雄按呕恶者忌木香，无表证者忌柴葛，盖胃以下行为顺，滞下者垢浊欲下而气滞也杂以升药，浊气反上冲而为呕恶矣，至洁古芍药汤之桂心，极宜审用， 热邪内盛者，虽有芩连大黄之监制，亦恐其有跋扈之患也，若芍药之酸，不过苦中兼有酸昧，考本经原主除血， 破坚积，寒热疝瘕，为敛肝气破血中气结之药，仲圣於腹中满痛之证多用之，故太阴病脉弱其人续自便利，设当行大黄芍糜者宜减之，以胃气弱易动故也，盖大黄开阳结，芍换开阴结，自便利者宜减，则欲下而窒滞不行之痢，正宜用矣。
（四二）痢久伤阳，脉虚滑脱者，真人养脏汤，加甘草、当归、白芍，脾阳虚者当补而兼温，然方中用木香，必其腹痛未止，故兼疏滞气，用归芍必其阴分亏残，故兼和营阴，但痢虽脾疾，又必传肾，以肾为胃关，司下焦而开窍於二阴也，况火为土母，欲温土中之阳，必补命门之火，若虚寒甚而滑脱者，当加附子以补阳，不得杂入阴药矣。
雄按观此条似非一瓢手笔，而注则断非本人自注，叶香岩云，夏月炎热，其气皆浮於外，故为蕃秀之月，过食寒冷，郁其暑热，不得外达，食物厚味，为内伏之火，煅炼成积，伤於血分则为红，伤於气分则为白，气滞不行，火气 迫於肛门，则为後重，滞於人肠，则为腹痛，故仲景用下药通之，河间丹溪用调血和气而愈，此时令不得发越，至秋收敛於内而为痢世，此埋甚明，何得误认为寒，而用温热之药，余历证四十馀年，治痢惟姒疏理推荡清火，而愈者不计其数，观其服热药而死者甚多，同志之士，慎勿为景岳之书所误以杀人也，聂久吾云，痢疾投补太早，锢塞邪燕在内，久而正气已虚，邪气犹盛，欲补而涩之则助邪，欲清而疏之则愈滑，多致不救，徐洄溪云，夏秋之间，总由湿热积滞，与伤寒传入三阴之利不同，後人竟用温补，杀人无算，触目伤怀，尤拙吾云，痢与泄泻，其病不同，其冶亦异泄泻多由寒湿，寒则宜温，湿则宜燥也，痢多成於湿热，热则宜清，湿则宜利也，虽泄泻有热证毕竟寒多於热，痢病亦有寒证，毕竟热多於寒，是以泄泻经久，必伤於阳而肿胀喘满之变生，痢病经久必损，於阴而虚烦痿废之疾起，痢病兜涩太早，湿热流注多成痛 ，泄泻疏利过当，中虚不复，多怍脾劳，此余所亲历，非臆说也或问热则清而寒则温是矣，均是湿也或从利，或从燥何欤，曰寒湿者寒从湿生，故宜苦温燥其中，湿热者湿从热化，故宜甘淡，利其下，盖燥性多热，利药多寒，便利则热亦自去，中温则寒兴俱消，寒湿必本中虚，不可更行清利，湿热郁多成毒，不宜益以温燥也，合诸论而观之，可见痢久伤阳之证，乃绝无而仅有者，然则真人养脏之汤，须慎重而审用矣，犹谓其杂用阴药，岂未闻下多亡阴之语乎须知阳脱者亦由阴先亡而阳无依，如盏中之油，乾则火灭也。
（四三）痢久伤阴，虚坐努责者，宜用熟地炭炒当归，炒白芍，灸甘草，广皮之属， 结欲便，坐久而仍不得便者，谓之虚坐努责，凡 结属火居多，火性传送至速，郁於於大肠，窘迫欲便仍不舒，故痢疾门中，每用黄芩清火，肾者用大黄逐热，若痢久血虚，血不足则生热，亦急迫欲便，但坐久而不得便耳，此热由血虚所生，故治以补血为主， 结与後重不同， 结者急迫欲便，後重者肛门重 ， 结有虚实之分，实为火邪有馀，虚为阴营不足，後重有虚实之异，实为邪实下壅，虚由气虚下陷，是以治 结者，有清热养阴之异，治後重者有行气升补之殊，虚实之辨，不可不明。
（四四）暑湿内袭，腹痛吐利，胸痞脉缓者，湿浊内阻太阴，宜缩聪饮，此暑湿浊邪，伤太阴之气，以致土用不宣，太阴告困，故以芳香涤秽，辛燥化湿为剂也。
（四五）暑月饮冷过多，寒湿内留，水谷不分，上吐下泻，肢冷脉浮者，宜大顺散。
暑月过多於贪凉，寒湿外袭者，有香薷饮，寒湿内侵者，有大顺散，夫吐泻肢冷脉浮，是脾胃之阳，为寒湿所蒙，不得升越，故宜温热之剂，调脾胃利气散寒，然广皮茯苓似不可少，此即仲景治阴邪内侵之霍乱，而用理中汤之旨乎。
（四六）腹痛下利，胸痞烦燥口渴，脉数大，按之豁然空者，宜冷香饮子。
此不特湿邪伤伤脾，抑且寒邪伤肾，烦燥热渴，极似阳邪为病，惟数大之脉，按之豁然而空，知其躁渴等证，为虚阳外越，而非热邪内扰，故以此方冷服，俾下咽之後，冷气既消，热性乃发，庶药气与病气，无擀格之虞也。
这一条论述湿邪损伤阳气，理当扶助阳气、驱逐湿邪。口渴是少阴病的证候，怎么能胡乱使用寒凉药物呢？
（二十六）暑天发病初起，只怕冷，面色发黄，口不渴，精神疲倦，四肢乏力，脉象沉弱，腹痛腹泻，这是湿气困阻太阴脾阳，应当仿照缩脾饮，或者大顺散、来复丹等方剂的方法治疗。
暑天是阳气向外发泄、阴气在内消耗的时候，所以热邪伤阴，导致阳明经燥热消烁，适宜清热滋阴；太阴脾土受困，湿浊弥漫，适宜温阳发散。古人的治法非常详细，医生们应当以此为鉴。
（二十七）湿热证按照正确方法治疗后，各种症状都消退了，唯独闭眼时惊悸、梦中惊恐，这是因为余邪内留，胆气未舒，适宜用酒浸郁李仁、姜汁炒枣仁、猪胆汁皮等药味。
滑利可以去除附着之邪，郁李仁性质最滑利，古人治疗惊悸后肝系滞涩不通、始终不能安睡的病症，用它来疏通肝系、去除滞涩，此证借用此法，确实是因为湿热之邪留在胆中，胆为清净之府，主藏而不泻，所以病去而内留的邪气不去，睡眠时阳气行于阴分，胆热内扰，肝魂不安，用郁李仁来泄除邪气并用酒引导，酒气独归于胆；枣仁的酸味入肝安神，并用姜汁炮制，既安神又兼散邪。
（二十八）湿热证经过开泄或攻下治疗后，危重症状都已平复，唯独神志不清，倦怠懒言，不思饮食，小便频数，嘴唇牙齿干燥，这是胃气不能输布，肺气不能宣发，元神大亏，适宜用人参、麦冬、石斛、木瓜、生甘草、生谷芽、莲子等药味。
开泄和攻下之后，恶候虽平，但正气也大大受损，所以见到的症状多呈气虚之象，理当清补元气，如果使用滋腻停滞的阴药，就会离康复越来越远。
（二十九）湿热证四五天后，突然大汗出，手脚冰冷，脉细如丝或摸不到，口渴，阴茎疼痛，但起居自如，神志清醒，说话洪亮，这是因为出汗过多，卫外之阳暂时亡失，湿热之邪仍然结聚，一时之间表气不通，所以脉伏，并非真阳外脱，适宜用五苓散去白术加滑石、酒炒黄连、生地、地骨皮等药味。
这一条的脉证，全是亡阳的表现，唯独从举动神气上，能看出真情实意，唉！这就是医生之所以珍贵在于见识啊。
（三十）湿热证出现抽搐、神志昏迷，脚冷、阴囊收缩，这是由于下体外受客寒侵袭，仍然应该从湿热论治，只用辛温的药物煎汤熏洗。
阴囊收缩是厥证的伴随症状，加上脚冷，完全像是虚寒证，但仔细审视本证，没有一处是大虚的表现，才知道是寒邪客居下体，一时营气不能通达，不仅不是虚寒证，也不是上热下寒证可以比拟的，为什么仍然从湿热论治呢？
（三十一）湿热证初起，像发热口渴，心中烦闷懊恼，眼睛想闭，不时呻吟，语声浑浊，这是浊邪蒙闭上焦，适宜用涌吐泄邪法，用枳壳、桔梗、淡豆豉、生山栀，无汗者加葛根。
这一条应与第九条一起参考，第九条属于余邪，治法应当轻散，这则是浊邪蒙闭上焦，所以心中烦闷懊恼，眼睛想闭，是肺气不舒；不时呻吟，是邪气郁在心包。如果投以轻剂，病必定不能除去。《内经》说：“高者越之”，用栀豉汤这种涌吐泄邪的方剂，引胃中之阳，开通心胸之表，邪气随呕吐而消散。
（三十二）湿热证女子月经适来，壮热口渴，呻吟神昏，胸腹痛，或者舌面无苔，脉滑数，这是邪气陷入营分，适宜用大剂量的犀角、紫草、茜根、贯众、连翘、鲜菖蒲、银花露等药味。
（三十三）热证上下失血或汗血，毒邪深入营分，走窜欲泄，适宜用大剂量的犀角、生地、赤芍、丹皮、连翘、紫草、茜根、银花等药味。
热邪炽盛而上下出血，汗血，病情虽然危险但还没有立即败坏，是因为毒邪从血外出，生机在此，大量进服凉血解毒的药剂，以救阴液并泄除邪气，邪气解除而血自然停止。血止后须进服人参等药善后，才能痊愈。
汗血就是张氏所说的肌衄，《内经》说：“热淫于内，治以咸寒”，方中应当增加咸寒的药味。
（三十四）湿热证七八天后，口不渴，声音不出，给饮食也不拒绝，默默不语，神识昏迷，服用辛香凉泄、芳香逐秽的药物，都没有效果，这是邪气进入厥阴，主客浑受，适宜仿照吴又可的三甲散，用醉地鳖虫、醋炒鳖甲、土炒穿山甲、生僵蚕、柴胡、胡桃仁泥等药味。
暑湿先伤阳分，但病久不解，必然波及阴分，阴阳两困，气钝血滞，而暑湿不得外泄，遂深入厥阴络脉凝瘀，使一阳之气不能萌动，生气有降无升，心主被阻遏，灵气不通，所以神志不清而昏迷、默默不语。破除滞涩、通利瘀血，这样络脉通畅而邪气得解。
海昌许益斋说，这一条就是伤寒门百合病之类，赵以德、张路玉、陶厚堂认为是心病，徐忠可认为是肺病，本论又提出厥阴治法，实在是因为百脉同宗，都受到病邪影响，元神不能布散，邪气淹留，于是效法仲景之法，用异类灵动之物，鳖甲入厥阴，用柴胡引导它，使阴分之邪尽达于表；桃仁破血，用桃仁引导它，使血分之邪尽泄于下；穿山甲入络，用僵蚕引导它，使络中之邪也从风化而散。因为病久气钝血滞，不是拘泥于常规方法所能治愈的。
（三十五）湿热证口渴，苔黄起刺，脉弦缓，阴囊收缩，舌体僵硬，谵语昏不知人，两手抽搐，这是津枯邪滞，适宜用鲜芦根、生首乌、鲜稻根等药味，如果脉有力，大便不通的，大黄也可以加入。
胃津被劫夺，热邪内据，如果不润下以泄除邪气就不能治愈，所以仿照承气汤的例子，用甘凉代替苦寒，正是担心胃气受伤、胃津不复原。
（三十六）湿热证出现抽搐、撮空理线，神昏笑妄，舌苔干黄起刺，或者转为黑色，大便不通的，这是热邪闭结胃腑，适宜用承气汤攻下。
撮空一症，以前的贤者认为非大实即大虚，虚则神明涣散，将有脱绝的危险，实则神明被扰乱，所以多有撩乱之象。现在舌苔黄刺干涩，大便闭而不通，其为热邪内结，阳明腑热显然了。徒然从事清热泄邪，只能疏散络中流走的邪热，不能清除胃中蕴结的邪气，假借承气汤来通利地道，但如果舌不干黄起刺，不可投用。
（三十七）热证壮热口渴自汗，身重胸痞，脉洪大而长的，这是太阴之湿与阳明之热相合，适宜用白虎加苍术汤。
热渴之汗，是阳明之热；胸痞身重，是太阴之湿显现。脉洪大而长，知道湿热滞于阳明之经，所以用苍术白虎汤，以清热散湿，但这属于热多湿少的证候。
白虎汤，是仲景用来清阳明无形之燥热的。胃汁干枯者，加人参以生津，叫白虎加人参汤；身体素有风气者，加桂枝以通络，名叫桂枝白虎汤，而其实际在于清胃热。所以后人治疗暑热伤气，身热而渴的，也用白虎加人参汤；热渴汗泄，肢节烦疼的，也用白虎加桂枝汤；胸痞身重兼见，则在白虎汤中加入苍术以调理太阴之湿；寒热往来兼集，则在白虎汤中加入柴胡以散半表半里之邪。凡此皆是热盛阳明，他证兼见，所以用白虎汤清热，而又各随证加减。如果不是热渴汗泄、脉洪大的，白虎汤便不可投用，辨证察脉，最宜详审。
（三十八）湿热说湿热伤气，四肢困倦，精神减少，身热气高，心烦溺黄，口渴自汗，脉虚的，东垣用清暑益气汤主治。
同样是热渴自汗，但脉虚神倦，便是中气受伤，而非阳明郁热。清暑益气汤，是东垣所制，方中药味颇多，学者应当在临证时斟酌去取。
（三十九）暑月热伤元气，气短倦怠，口渴多汗，肺虚而惊骇的，适宜用人参、麦冬、五味子等药味。
这就是千金生脉散，与第十八条同属肺病，但气粗与气短有分别，则肺实与肺虚各异，实则泻而虚则补是定理。然而名为生脉，则可知热伤气之脉虚欲绝了。雄按：徐洄溪说，这是伤暑之后，保存津液的方子。看方下的治证，没有一个字治暑邪的，庸医用来治暑病，误得很厉害。其命中之意，即在复脉汤内，取用人参、麦冬二味，因为止汗故加五味子。近人不论何病，每用此方收住邪气，杀人无数，用此方的人必须详审邪之有无，不可徇俗而视为治暑之剂。
（四十）暑月乘凉饮冷，阳气为阴寒所束，皮肤蒸热凛凛畏寒，头痛头重自汗烦渴，或腹痛吐泻的，适宜用香薷、厚朴、扁豆等药味。
这是由于避暑而感受寒湿之邪，虽然在暑月发病，但实际上不是暑病，古人不说暑月伤寒湿，而叫阴暑，以致后人混淆迷惑，贻误不轻，现在特别纠正它。用香薷的辛温，以散阴邪而发越阳气；厚朴的苦温，除湿邪而通行滞气；扁豆甘淡，行水和中。如果没有恶寒头痛之外证，就不需要香薷的辛香走窜了；没有腹痛吐利的内证，也不需要厚朴扁豆的疏滞和中了。所以热渴甚的，加黄连以清暑，名四味香薷饮；减去扁豆名黄连香薷饮；湿甚于内，腹膨泄泻的，去黄连加茯苓甘草名五物香薷饮；如果中虚气怯，汗出多的，加人参、白术、橘皮、木瓜名十味香薷饮。然而香薷之用，总为寒湿外束而设，不可用来治不挟寒湿的暑热。
（四十一）湿热内滞太阴，郁久而为滞下（痢疾），其证胸痞腹痛，下坠窘迫，脓血稠黏，里急后重，脉软数的，适宜用厚朴、黄芩、神曲、广皮、木香、槟榔、柴胡、煨葛根、银花、炭荆芥、炭等药味。古之所谓滞下，即今所云痢疾也。由湿热之邪，内伏太阴，阻遏气机，以致太阴失职，少阳失疏，热郁湿蒸，传导失其常度，蒸为败浊，脓血下注肛门，故里急后重，气壅不化，仍数至圊而不能便。伤气则下白，伤血则下赤，气血并伤，赤白兼下，湿热盛极痢成五色。故用厚朴除湿而行滞气，槟榔下逆而破结气，黄芩清庚金之热，木香神曲疏中气之滞，葛根升下陷之胃气，柴胡升土中之木气。热侵血分而便血，以银花荆芥入营清热；若热甚于内，当用黄连以清热；大实而痛，宜增大黄以逐邪。昔张洁古制芍药汤治血痢，方用归芍、芩连、大黄、木香、槟榔、甘草、桂心等味，而以芍药名汤者，盖谓下血必调藏血之脏，故用之为君，不特欲其土中泻木，抑亦赖以敛肝和阴也。然芍药味酸性敛，终非湿热内蕴者所宜服。倘遇痢久中虚，而宜用芍药甘草之化土者，恐难任芩连大黄之苦寒，木香槟榔之破气。其下痢初作，湿热正盛者，白芍酸敛滞邪，断不可投。此虽昔人已试之成方，不敢引为后学之楷式也。
雄按：呕恶者忌木香，无表证者忌柴葛。盖胃以下行为顺，滞下者垢浊欲下而气滞也，杂以升药，浊气反上冲而为呕恶矣。至洁古芍药汤之桂心，极宜审用，热邪内盛者，虽有芩连大黄之监制，亦恐其有跋扈之患也。若芍药之酸，不过苦中兼有酸味，考本经原主除血，破坚积，寒热疝瘕，为敛肝气破血中气结之药。仲圣于腹中满痛之证多用之，故太阴病脉弱其人续自便利，设当行大黄芍药者宜减之，以胃气弱易动故也。盖大黄开阳结，芍药开阴结，自便利者宜减，则欲下而窒滞不行之痢，正宜用矣。
（四十二）痢久伤阳，脉虚滑脱的，用真人养脏汤，加甘草、当归、白芍。脾阳虚者当补而兼温，然方中用木香，必其腹痛未止，故兼疏滞气；用归芍必其阴分亏残，故兼和营阴。但痢虽脾疾，又必传肾，以肾为胃关，司下焦而开窍于二阴也。况火为土母，欲温土中之阳，必补命门之火。若虚寒甚而滑脱者，当加附子以补阳，不得杂入阴药矣。
雄按：观此条似非一瓢手笔，而注则断非本人自注。叶香岩云：夏月炎热，其气皆浮于外，故为蕃秀之月，过食寒冷，郁其暑热，不得外达，食物厚味，为内伏之火，锻炼成积，伤于血分则为红，伤于气分则为白，气滞不行，火气逼迫于肛门，则为后重，滞于人肠，则为腹痛。故仲景用下药通之，河间丹溪用调血和气而愈，此时令不得发越，至秋收敛于内而为痢，此理甚明，何得误认为寒，而用温热之药？余历证四十余年，治痢惟以疏理推荡清火，而愈者不计其数，观其服热药而死者甚多，同志之士，慎勿为景岳之书所误以杀人也。聂久吾云：痢疾投补太早，锢塞邪气在内，久而正气已虚，邪气犹盛，欲补而涩之则助邪，欲清而疏之则愈滑，多致不救。徐洄溪云：夏秋之间，总由湿热积滞，与伤寒传入三阴之利不同，后人竟用温补，杀人无算，触目伤怀。尤拙吾云：痢与泄泻，其病不同，其治亦异。泄泻多由寒湿，寒则宜温，湿则宜燥也；痢多成于湿热，热则宜清，湿则宜利也。虽泄泻有热证毕竟寒多于热，痢病亦有寒证毕竟热多于寒。是以泄泻经久，必伤于阳而肿胀喘满之变生；痢病经久必损于阴而虚烦痿废之疾起。痢病兜涩太早，湿热流注多成痈疽；泄泻疏利过当，中虚不复，多作脾劳。此余所亲历，非臆说也。或问：热则清而寒则温是矣，均是湿也，或从利，或从燥何欤？曰：寒湿者寒从湿生，故宜苦温燥其中；湿热者湿从热化，故宜甘淡利其下。盖燥性多热，利药多寒，便利则热亦自去，中温则寒湿俱消。寒湿必本中虚，不可更行清利；湿热郁多成毒，不宜益以温燥也。合诸论而观之，可见痢久伤阳之证，乃绝无而仅有者，然则真人养脏之汤，须慎重而审用矣。犹谓其杂用阴药，岂未闻下多亡阴之语乎？须知阳脱者亦由阴先亡而阳无依，如盏中之油，干则火灭也。
（四十三）痢久伤阴，虚坐努责的，适宜用熟地炭、炒当归、炒白芍、灸甘草、广皮之属。里急欲便，坐久而仍不得便的，谓之虚坐努责。凡里急属火居多，火性传送至速，郁于大肠，窘迫欲便仍不舒，故痢疾门中，每用黄芩清火，甚者用大黄逐热。若痢久血虚，血不足则生热，亦急迫欲便，但坐久而不得便耳。此热由血虚所生，故治以补血为主。里急与后重不同，里急者急迫欲便，后重者肛门重坠。里急有虚实之分，实为火邪有余，虚为阴营不足；后重有虚实之异，实为邪实下壅，虚由气虚下陷。是以治里急者，有清热养阴之异；治后重者，有行气升补之殊。虚实之辨，不可不明。
（四十四）暑湿内袭，腹痛吐利，胸痞脉缓的，湿浊内阻太阴，适宜用缩脾饮。此暑湿浊邪，伤太阴之气，以致土用不宣，太阴告困，故以芳香涤秽，辛燥化湿为剂也。
（四十五）暑月饮冷过多，寒湿内留，水谷不分，上吐下泻，肢冷脉浮的，适宜用大顺散。
暑月过于贪凉，寒湿外袭的，有香薷饮；寒湿内侵的，有大顺散。夫吐泻肢冷脉浮，是脾胃之阳，为寒湿所蒙，不得升越，故宜温热之剂，调脾胃利气散寒。然广皮茯苓似不可少，此即仲景治阴邪内侵之霍乱，而用理中汤之旨乎。
（四十六）腹痛下利，胸痞烦躁口渴，脉数大，按之豁然空的，适宜用冷香饮子。
这不仅是湿邪伤脾，而且寒邪伤肾。烦躁热渴，极似阳邪为病，惟数大之脉，按之豁然而空，知其躁渴等证，为虚阳外越，而非热邪内扰，故以此方冷服，俾下咽之后，冷气既消，热性乃发，庶药气与病气，无格拒之虞也。
This clause discusses dampness pathogen damaging Yang Qi. The principle is to support Yang Qi and expel dampness. Thirst is a syndrome of the Shaoyin (Lesser Yin) channel; how can cold-natured drugs be used recklessly?
(26) In the early stage of disease in summer, there is only aversion to cold, yellowish complexion, no thirst, mental fatigue, lethargy of the four limbs, deep and weak pulse, abdominal pain, and diarrhea. This is dampness confining the Yang of the Taiyin (Greater Yin) Spleen. One should imitate the methods of Suopi Yin (Spleen-Confining Decoction), or Dashun San (Great Smooth Powder) and Laifudans (Reviving Pill).
Summer months are times when Yang Qi dissipates outward and Yin Qi consumes inward. Therefore, when heat pathogen damages Yin causing Mingyang (Yangming) consumption and withering, clearing and nourishing are appropriate. When Taiyin is distressed by pervasive damp-turbidity, warming and dispersing are appropriate. Ancient methods are most detailed; physicians should take this as a warning.
(27) After treating damp-heat syndrome according to correct methods, all symptoms recede, except for palpitations and fright upon closing eyes, and dream-disturbed terrors. This is due to residual pathogen remaining internally and Gallbladder Qi not yet舒展 (expanding/soothing). It is appropriate to use alcohol-soaked Prunus mume seed (Yuli Ren), Ziziphus jujube seed (Zao Ren) stir-fried with ginger juice, and pig gallbladder skin.
Slippery substances remove adherent pathogens. Prunus mume seed is the slipperiest. Ancients used it to treat liver system stagnation after fright, where the patient could not sleep with eyes closed, to unblock the liver system and remove stagnation. Borrowing this method here is because damp-heat pathogen remains in the Gallbladder. The Gallbladder is a pure and clear organ, storing but not excreting. Thus, although the disease subsides, the internal residual pathogen remains. During sleep, Yang Qi moves into Yin; Gallbladder heat disturbs internally, disturbing the Liver Soul. Prunus mume seed is used to drain pathogen, guided by wine, as wine qi uniquely enters the Gallbladder. Ziziphus jujube seed's sour flavor enters the Liver to calm the Spirit, processed with ginger juice to calm the Spirit while dispersing pathogen.
(28) After open-draining or purgative treatment of damp-heat syndrome, severe symptoms have subsided, but mental clarity is lacking, fatigue and reluctance to speak prevail, appetite is absent, urination is frequent, lips and teeth are dry. This is Stomach Qi failing to distribute and Lung Qi failing to disseminate, with great depletion of Yuan Shen (Original Spirit). It is appropriate to use Ginseng Radix et Rhizoma (Renshen), Ophiopogon Tuber (Maidong), Dendrobium Caulis (Shihu), Chaenomelis Fructus (Mugua), raw Licorice Root (Sheng Gancao), raw Coix Seed Sprout (Sheng Guya), and Lotus Seed (Lianzi).
After open-draining and purging, severe symptoms subside, but Righteous Qi is greatly damaged; hence, signs of Qi deficiency appear. The principle is to clear-tonify Yuan Qi. Using cloying and stagnant Yin-nourishing drugs would distance one from recovery.
(29) On the fourth or fifth day of damp-heat syndrome, sudden profuse sweating occurs, hands and feet are cold, pulse is fine as a thread or imperceptible, thirst is present, penis hurts, yet movement and sitting are normal, spirit is clear, voice is loud. This is due to excessive sweating causing temporary loss of Wei (Defensive) Yang externally, while damp-heat pathogen remains knotted. For a moment, exterior circulation is blocked, so the pulse is hidden; this is not true Yang collapse. It is appropriate to use Wuling San (Five-Ingredient Powder with Poria) removing Atractylodis Rhizoma (Bai Zhu), adding Polyporus (Fuling - *Note: Text says Huashi/Pumex, usually added in variations*), Pumex (Huashi), Coptis Rhizoma (Chuan Lian) wine-fried, Rehmanniae Radix (Sheng Dihuang), and Cortex Lycii (Di Gu Pi).
The pulse and symptoms of this clause are entirely signs of Yang collapse. Only by observing movement and spirit can one discern the true nature. Alas! This is why physicians value insight.
(30) Damp-heat syndrome presenting with spasms and coma, cold feet, and retracted genitals, caused by external cold invading the lower body, should still be treated as damp-heat. Use only acrid-warm substances decocted for washing.
Genital retraction is an external sign of Jue syndrome. Combined with cold feet, it resembles deficiency-cold. However, careful observation of the primary syndrome reveals no significant deficiency. Thus, we know cold has invaded the lower body, temporarily blocking Ying (Nutritive) Qi circulation. It is not only not deficiency-cold, nor can it be compared to upper-heat/lower-cold. Why treat it as damp-heat?
(31) Early damp-heat syndrome presents like fever and thirst, mental restlessness and distress, desire to close eyes, occasional groaning, turbid speech. This is turbid pathogen clouding the Upper Jiao. It is appropriate to use vomiting/draining methods with Bitter Orange Pericarp (Zhi Ke), Platycodon Root (Jie Geng), Fermented Soybean (Dan Dou Chi), and Gardenia Fruit (Shan Zhi). Add Kudzu Root (Ge Gen) if there is no sweat.
Refer to Clause 9. That case involves residual pathogen, requiring light dispersion. This case involves turbid pathogen clouding the Upper Jiao, causing mental distress, desire to close eyes (Lung Qi not soothing), and groaning (pathogen郁 in Pericardium). Light agents will not cure it. The Classic says: "What is high, vent it." Use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), a vomiting/draining agent, to guide Stomach Yang upward, open the chest surface, and scatter pathogen via vomiting.
(32) Damp-heat syndrome in a woman during menstruation, with high fever, thirst, groaning, coma, chest/abdominal pain, or tongue without coating, slippery rapid pulse. Pathogen has fallen into the Ying (Nutritive) level. Use large doses of Rhinoceros Horn (Xijiao - *substitute typically Buffalo Horn*), Arnebiae Radix seu Lithospermi Radix (Zicao), Rubiae Radix et Rhizoma (Qianggen), Agastache Herba (Guanzhong), Forsythiae Fructus (Lianqiao), fresh Acori Tatarinowii Rhizoma (Changpu), and Honeysuckle Inflorescence Dew (Yinhua Lu).
(33) Heat syndrome with bleeding from above and below, or sweating blood. Toxic pathogen has deeply entered the Ying level, wandering and seeking exit. Use large doses of Rhinoceros Horn (Xijiao), Rehmanniae Radix (Sheng Dihuang), Red Peony Root (Chishao), Moutan Cortex (Danpi), Forsythiae Fructus (Lianqiao), Arnebiae Radix seu Lithospermi Radix (Zicao), Rubiae Radix et Rhizoma (Qianggen), and Honeysuckle Inflorescence (Yinhua).
Heat blazing and bleeding above/below, sweating blood: the condition is critical but not immediately fatal because toxins exit via blood, preserving vitality. Administer large doses of cooling-blood and detoxifying herbs to save Yin and drain pathogen. Once pathogen resolves, bleeding stops. After bleeding stops, tonify with Ginseng etc. for convalescence.
Sweating blood is what Zhang referred to as "skin petechiae" (Jinu). The Inner Classic states: "Heat rampant within, treat with salty-cold." Increase salty-cold herbs in the formula.
(34) Damp-heat syndrome after seven or eight days: no thirst, voicelessness, refusal of food/drink is absent, silent muteness, coma. Acrid-aromatic, cool-draining, and aromatic-purging methods fail. Pathogen has entered Jueyin, affecting both host and guest chaotically. Imitate Wu Youke's Sanjia San (Three Shells Powder): Earthworm (Dibie Chong) drunk-braised, Turtle Shell (Biejia) vinegar-fried, Pangolin Scale (Chuanshanjia) earth-fried, Silkworm (Jiangcan), Bupleurum Root (Chaihu), Walnut Kernel (Taoren) mashed.
Summer-dampness first damages Yang levels. If unresolved long-term, it reaches Yin. Both Yin and Yang are distressed, Qi becomes dull, Blood stagnates, and summer-dampness cannot vent. It sinks deep into Jueyin collaterals, coagulating stasis, preventing the sprouting of One Yang. Vital Qi descends but does not ascend. Heart Master is obstructed, spiritual energy blocked. Hence, unclear spirit, coma, and muteness. Break stagnation, unblock stasis, then collaterals clear and pathogen resolves.
Xu Yizhai of Haichang said: This clause resembles Baihe Bing (Lily Disease) in Shanghan. Zhao Yi-de, Zhang Lu-yu, and Tao Hou-tang consider it Heart disease; Xu Zhong-ke considers it Lung disease. This theory proposes Jueyin treatment because all vessels share one source and are affected. Original Spirit fails to distribute, pathogen lingers. Following Jingue's method: Turtle Shell enters Jueyin, guided by Bupleurum, bringing Yin-level pathogen to the surface. Peach Kernel breaks blood, guiding blood-level pathogen downward. Pangolin scale enters collaterals, guided by Silkworm, scattering collateral pathogen via wind transformation. Since illness is chronic with dull Qi and stagnant Blood, standard methods cannot cure it.
(35) Damp-heat syndrome with thirst, yellow coating with prickles, string-taut slow pulse, genital retraction, stiff tongue, delirium, unconsciousness, hand/twitching. Fluids are depleted, pathogen is stuck. Use fresh Reed Rhizome (Luxgen), Raw Polygonum Multiflorum (Shouwu), fresh Rice Root (Daogen). If pulse is forceful and stool is constipated, Rhubarb (Dahuang) may be added.
Stomach fluids are seized, heat pathogen occupies internally. Without moistening purgation to drain pathogen, it cannot be cured. Imitate Chengqi Tang example, using sweet-cool instead of bitter-cold, fearing damage to Stomach Qi and failure to restore Stomach fluids.
(36) Damp-heat syndrome with spasms, picking at empty air, coma, laughing delirium, dry yellow coating with prickles, or turning black, constipation. Heat pathogen closes and knots the Stomach Fu. Use Chengqi Tang to purge.
Picking at empty air indicates either extreme excess or extreme deficiency. Deficiency scatters Spirit, risking collapse. Excess disturbs Spirit, causing chaotic movements. Here, dry yellow prickly coating and constipation indicate obvious Heat knotting in Yangming Fu. Merely clearing heat drains superficial collateral heat but cannot remove Stomach accumulation. Borrow Chengqi Tang to open the pathway. Do not use if coating is not dry/yellow/prickly.
(37) Heat syndrome with high fever, thirst, spontaneous sweating, heavy body, chest oppression, surging long pulse. Taiyin Damp combines with Yangming Heat. Use Baihu Jia Cangzhu Tang (White Tiger plus Atractylodes Macrocephala Decoction).
Thirst/sweat is Yangming Heat. Chest heaviness/body weight is Taiyin Damp. Surging long pulse indicates damp-heat stagnating in Yangming channels. Cangzhu Baihu Tang clears heat and disperses damp. This is Heat-dominant, Damp-minor.
Baihu Tang clears formless dry-heat in Yangming. Add Ginseng for dry fluids (Baihu Jia Renshen Tang). Add Cinnamon Twig for wind/channels (Guizhi Baihu Tang). Core action is clearing Stomach heat. Later doctors use Baihu Jia Renshen Tang for summer-heat damaging Qi (fever/thirst). Use Guizhi Baihu Tang for fever/thirst/sweat with joint pain. Add Cangzhu for chest heaviness/heavy body (Taiyin damp). Add Chaihu for alternating chills/fever (half-exterior/half-interior). These are Yangming Heat dominant with concurrent syndromes. Baihu Tang clears heat, modified per syndrome. If not fever/thirst/sweat with surging pulse, do not use Baihu Tang. Differentiation and pulse diagnosis must be meticulous.
(38) Damp-heat damaging Qi: limb fatigue, reduced spirit, body heat/high temperature, vexation, yellow urine, thirst, spontaneous sweating, deficient pulse. Dongyuan uses Qingshu Yiqi Tang (Clear Summer-heat Tonify Qi Decoction).
Same fever/thirst/sweat, but deficient pulse/fatigue indicates Middle Qi injury, not Yangming constraint heat. Qingshu Yiqi Tang is Dongyuan's formula. Many ingredients; physicians must select based on presentation.
(39) Summer-heat damaging Yuan Qi: shortness of breath, fatigue, thirst, profuse sweating, Lung deficiency with fright. Use Ginseng, Ophiopogon, Schisandra.
This is Qianjin Shengmai San (Generate Pulse Powder). Same Lung disease as Clause 18, but coarse vs. short breathing distinguishes Lung Excess vs. Deficiency. Excess drains, Deficiency tonifies. Name "Generate Pulse" implies heat damaged Qi, pulse near collapse. Xiong notes: Xu Huixi says this preserves fluids after summer-heat. No words address summer-heat pathogen directly. Quacks misuse it for summer-heat, causing death. Its essence derives from Fumai Tang (Restore Pulse Decoction), taking Ginseng/Ophiopogon, adding Schisandra for sweating. Moderns use it indiscriminately to trap pathogen, killing many. Verify presence of pathogen before use; do not blindly follow custom as a summer-heat remedy.
(40) Summer-heat: seeking coolness, drinking cold. Yang constrained by Yin-Cold. Skin steaming heat, shivering aversion to cold, headache/heaviness, spontaneous sweating, vexation/thirst, or abdominal pain/vomiting/diarrhea. Use Euphrasia Herb (Xiangru), Magnolia Bark (Houpo), Lablab Bean (BianDou).
Avoiding heat causes Cold-Damp invasion. Though in summer, it is not Summer-heat but "Yin Summer-heat," confusing later generations. Correct this now. Xiangru (acrid-warm) disperses Yin-Cold, vents Yang. Houpo (bitter-warm) dries damp, moves Qi. BianDou (sweet-bland) harmonizes middle. If no aversion to cold/headache, Xiangru is unnecessary. If no abdominal pain/diarrhea, Houpo/BianDou are unnecessary. Severe thirst/heat: add Coptis (Huanglian), name Siwei Xiangru Yin. Remove BianDou: Huanglian Xiangru Yin. Severe internal damp/bloating/diarrhea: remove Huanglian, add Poria/Glycyrrhiza, name Wuwu Xiangru Yin. Middle deficiency/cowardly Qi/profuse sweat: add Ginseng/Atractylodes/Citrus/Medlar, name Shiwei Xiangru Yin. Xiangru is for external Cold-Damp constriction. Do not use for summer-heat without Cold-Damp.
(41) Damp-heat stagnating in Taiyin,郁久 becoming Dysentery (Zhixia). Symptoms: chest oppression, abdominal pain, tenesmus, thick sticky pus/blood, heavy sensation after defecation, soft rapid pulse. Use Atractylodes Bark (Houpo), Scutellaria Root (Huangqin), Medicated Leaven (Shenqu), Tangerine Peel (Guangpi), Aucklandia Root (Muxiang), Areca Seed (Binglang), Bupleurum Root (Chaihu), Roasted Kudzu Root (Weige Gen), Honeysuckle (Yinhua), Charred Schizonepeta (Tan Jingjie), Charred [missing herb likely Fangfeng or similar], etc. Ancient "Zhixia" is modern Dysentery. Damp-heat hides in Taiyin, blocking Qi mechanism. Taiyin fails transport, Shaoyang fails free flow. Heat/Damp ferment, transmission失常. Rot turns to turbid pus/blood, descending to anus. Tenesmus, Qi stagnation, frequent trips to toilet with inability to pass. Qi injury -> white discharge. Blood injury -> red discharge. Both injured -> mixed red/white. Extreme damp-heat -> five-color dysentery. Houpo dries damp/moves Qi. Binglang directs rebellious Qi/breaks knots. Huangqin clears Metal heat. Muxiang/Shenqu soothes Middle Qi stagnation. Ge Gen raises sinking Stomach Qi. Chaihu raises Wood Qi in Earth. Blood heat/bleeding: Yinhua/Jingjie enter Ying to clear heat. Severe internal heat: add Huanglian. Extreme excess/pain: add Dahuang. Zhang Jiegu's Shaoyao Tang treats bloody dysentery: Danggui, Shaoyao, Huangqin, Huanglian, Dahuang, Muxiang, Binglang, Gancao, Rougui. Named Shaoyao Tang because blood disorders require regulating Blood-storage organ (Liver). Shaoyao is Chief. Not just draining Wood from Earth, but also astringing Liver/nourishing Yin. However, Shaoyao is sour/astringent, unsuitable for internal damp-heat. If chronic dysentery with Middle deficiency requires Shaoyao/Gancao to transform Earth, fear Huanglian/Dahuang bitterness/cold and Muxiang/Binglang Qi-breaking. Early dysentery with strong damp-heat: White Peony root astringes/stagnates pathogen; absolutely contraindicated. Though tested ancient prescription, do not set as model for students.
Xiong notes: Vomiting/Nausea contraindicates Muxiang. No exterior syndrome contraindicates Chaihu/Ge Gen. Stomach prefers descending. Dysentery wants turbid matter down but Qi is stuck. Adding ascending herbs reverses turbid Qi upward, causing vomiting. Zhang Jiegu's Rougui in Shaoyao Tang requires caution. With intense internal heat, even with Huanglian/Dahuang restraint, Rougui may cause rebellion. Shaoyao's sourness is slightly acidic among bitter. Benjing treats blood removal, breaking hard accumulations, cold/heat hernia masses. It astringes Liver Qi, breaks Blood Qi knots. Jingue uses it for abdominal fullness/pain. Taiyin disease, weak pulse, continuous loose stool: if Dahuang/Shaoyao needed, reduce dose because weak Stomach Qi moves easily. Dahuang opens Yang knots; Shaoyao opens Yin knots. Continuous loose stool needs reduction; thus, dysentery with blockage needing passage is exactly where Shaoyao fits.
(42) Chronic dysentery damaging Yang, deficient slipping pulse. Use Zhenren Yangzang Tang (True Man Nourishing Viscera Decoction), add Glycyrrhiza, Danggui, Baishao. Spleen Yang deficiency: tonify and warm. Formula uses Muxiang because abdominal pain persists (disperses Qi); uses Danggui/Baishao because Yin deficiency remains (harmonizes Ying/Yin). Dysentery is Spleen disease but transmits to Kidney. Kidney is Stomach gate, governs Lower Jiao, opens to two yin openings. Fire is Mother of Earth. To warm Earth Yang, must supplement Mingmen Fire. If severe deficiency-cold with slipping, add Aconite to tonify Yang; do not mix Yin drugs.
Xiong notes: This clause seems not by Yipiao; commentary definitely not self-written. Ye Tianshi said: Summer heat floats outward (lush month). Overeating cold suppresses summer-heat, preventing outward release. Rich food creates internal fire, forging accumulation. Blood injury -> red; Qi injury -> white. Qi stagnation, fire forces anus -> tenesmus. Stagnates intestines -> abdominal pain. Jingue used purgatives; Hejian/Danxi regulated blood/Qi. Seasonal Qi cannot vent, autumn contraction leads to dysentery. Logic is clear; why mistake for cold and use warm drugs? I treated dysentery 40+ years, using regulation/pushing/clearing fire, cured countless. Many died from warm drugs. Colleagues, beware of Jingue's book misleading you to kill. Nie Jiawu said: Too early tonification traps pathogen. Long term, Righteous Qi weak, Pathogen strong. Tonify/astringe aids pathogen; clear/drain increases slipping. Often fatal. Xu Huixi said: Summer/Autumn is always damp-heat accumulation, different from Shanghan Three-Yin diarrhea. Later doctors use warm tonification, killing many. You Zhuowu said: Dysentery and Diarrhea differ in pathology and treatment. Diarrhea mostly Cold-Damp (warm/dry). Dysentery mostly Damp-Heat (clear/drain). Diarrhea may have heat but Cold > Heat. Dysentery may have cold but Heat > Cold. Chronic diarrhea damages Yang -> swelling/wheezing. Chronic dysentery damages Yin -> vexation/atrophy. Early astringency in dysentery -> damp-heat flows into abscesses. Over-draining diarrhea -> Middle deficiency -> Spleen劳. This is my experience, not speculation. Question: Heat clear, Cold warm. Both damp, why drain vs. dry? Answer: Cold-Damp: Cold generates from Damp, use bitter-warm to dry Middle. Damp-Heat: Damp transforms from Heat, use sweet-bland to drain Lower. Dryness is hot; draining herbs are cold. Draining removes heat; warming eliminates cold. Cold-Damp roots in Middle deficiency, cannot use cold-draining. Damp-Heat郁 becomes toxin, cannot add warm-dry. Synthesizing theories: Yang-damaging chronic dysentery is rare. Zhenren Yangzang Tang must be used cautiously. Claiming it mixes Yin drugs ignores "profuse lower loss damages Yin." Know that Yang collapse stems from prior Yin loss leaving Yang unsupported, like oil drying out extinguishing flame.
(43) Chronic dysentery damaging Yin, false tenesmus (Xu Zuo Nu Ze). Use Charred Rehmannia (Shudi Tan), Stir-fried Danggui, Stir-fried Baishao, Moxa Glycyrrhiza (Jiu Gancao), Tangerine Peel (Guangpi). Urgency to defecate, sitting long but unable to pass is "False Tenesmus." Urgency is mostly Fire. Fire moves fast,郁 in Large Intestine, urgent discomfort. Usually Huangqin clears fire, severe cases Dahuang drains heat. If chronic dysentery blood deficiency, lack of blood generates heat, urgency exists but sitting yields nothing. Heat generated by blood deficiency; treat by tonifying blood. Urgency differs from Tenesmus (Hou Zhong). Urgency = urgent need to pass. Tenesmus = heavy anus. Urgency has Excess/Deficiency: Excess=Fire surplus; Deficiency=Yin/Blood insufficiency. Tenesmus has Excess/Deficiency: Excess=Pathogen obstruction; Deficiency=Qi sinking. Treat Urgency: Clear heat/nourish Yin. Treat Tenesmus: Move Qi/raise tonify. Differentiate Excess/Deficiency clearly.
(44) Summer-dampness invading internally: abdominal pain, vomiting/diarrhea, chest oppression, slow pulse. Turbid damp blocks Taiyin. Use Suopi Yin. Summer-damp-turbid pathogen damages Taiyin Qi, Earth function fails, Taiyin distressed. Use aromatic purification, acrid-dry damp resolution.
(45) Summer-heat: excessive cold drink, internal Cold-Damp retention, water/grain undifferentiated, vomiting/diarrhea, cold limbs, floating pulse. Use Dashun San.
Summer-heat greed for coolness: External Cold-Damp uses Xiangru Yin. Internal Cold-Damp uses Dashun San. Vomiting/diarrhea/cold limbs/floating pulse: Spleen/Stomach Yang covered by Cold-Damp, cannot ascend. Use warm agents to regulate Spleen/Stomach, move Qi, disperse cold. Citrus/Poria seem essential. This aligns with Jingue's Lizhong Tang for Yin-Cold invasion Cholera.
(46) Abdominal pain, diarrhea, chest oppression, vexation/thirst, rapid large pulse, hollow on pressure. Use Lengxiang Yin Zi (Cold Fragrant Decoction).
Not only Damp damaging Spleen, but Cold damaging Kidney. Vexation/thirst resembles Yang pathogen. But rapid large pulse hollow on pressure indicates Rebellious Yang externally, not internal Heat disturbance. Take formula cold. Cold neutralizes initially, then warmth activates. Prevents drug-pathogen rejection.