凡伏气温热，皆是伏火，虽其初感受之气有伤寒、伤暑之不同，而潜伏既久，蕴酿蒸变，超时而发，无一
不同归火化。中医所谓伏火症，即西医所谓内炎症也。王秉衡曰∶风寒暑湿，悉能化火，血气郁蒸，无不生火，
所以人之火症独多焉。朱心农曰∶东南方天气多热，地气多湿，最多湿温、湿热之症，正伤寒症极少，即云冬
月多正伤寒症，亦不尽然。历症以来，恒见大江以南，每逢冬令太温，一遇感冒，表分虽有外
寒，内则竟多伏火，悉以伏火治之，丝毫不爽。故魏柳州曰∶壮火为万病之贼。嘉约翰曰∶炎症为百病之源。
中医西医，其揆一也。虽然，同一伏火，而湿火与燥火，判然不同。以治燥火之法治湿火，则湿愈遏，而热愈
伏；势必为痞满，为呕呃，为形寒热不扬，为肠鸣泄泻，甚则蒙闭清窍、谵语神昏、自汗肢厥，或口噤不语，
或手足拘挛。以治湿火之法治燥火，则以燥济燥，犹拨火使扬，势必为灼热、为消渴、为热盛昏狂、为风动痉
厥，甚则鼻煽音哑，舌卷囊缩，阴竭阳越，内闭外脱。是以对症发药，必据湿火、燥火之现症为凭，分际自清，
误治自少。
试先论湿火之症治。凡湿火症，发于夏至以前者为湿温，夏至以后者，为湿热，发于霜降立冬后者为伏暑
挟湿；其邪必伏于膜原，内经所谓横连膜原是也。（拯华注∶膜原，即统腹膜空隙之处，外通肌肤，内近胃肠，
上连胸膈，下包内肾膀胱，中有夹缝，最易藏邪。邪伏于此，症必胸腹热甚，按之灼手，小便黄赤浊热者，职
是之故，故凡湿热内伏之邪，必由膜原达外。）其人中气实，而热重于湿者，则发于阳明胃肠；中气虚，而湿
重于热者，则发于太阴肺脾。初起邪在气分，当分别湿多热多。
湿多者，湿重于热也。其病多发于太阴肺脾，其舌苔必白腻，或白滑而浓，或白苔带灰，兼粘腻浮滑，或
白带黑点而粘腻，或兼黑纹而粘腻，甚或舌苔满布，浓如积粉，板贴不松。脉息模糊不清，或沉细似伏，断续不
匀。神多沉困嗜睡，症必凛凛恶寒。甚而足冷，头目胀痛昏重，如裹如蒙；身痛不能屈伸，身重不能转侧，肢
节肌肉疼而且烦，腿足痛而且酸；胸膈痞满，渴不引饮，或竟不渴；午后寒热，状若阴虚；小便短涩黄热，大便
溏而不爽，甚或水泻。治法以轻开肺气为主。肺主一身
之气，肺气化，则脾湿自化，即有兼邪，亦与之俱化。宜用藿朴夏苓汤，体轻而味辛淡者治之，启上闸，开支
河，导湿下行，以为出路；湿去气通，布津于外，自然汗解。
若兼神烦而昏者，此由湿热郁蒸过极，内蒙清窍；前辛淡法，去蔻仁、浓朴，加细辛二三分，白芥子钱许，
辛润行水开闭∶再加芦根一二两，滑石四五钱，轻清甘淡，泄热导湿，蒙闭即开，屡验不爽。
若兼大便不利者，此由湿阻气滞，或夹痰涎，前辛淡法，去藿朴、豆豉，重用栝蒌仁、薤白、小枳实等味，
或重用紫菀、苏子（捣）、郁李仁等品。此皆味辛质滑，流利气机，气机一开，大便自解，即汗亦自出，随症均
可加入。
其有湿遏热伏，走入肌肉，发为阴黄，黄而昏暗，如熏黄色，而无烦渴热象；或渐次化热，舌苔黄滑，口干
而不多饮。其未化火者，宜苦辛淡温法，如茵陈胃苓汤、茵陈五苓散，加除疸丸之类；已化火者，宜苦辛淡清法，
如清热渗湿汤、黄连温胆汤、藿香左金汤，重加茵陈及栀柏、绛矾丸之类。若误以脘痞等症为食滞，而消之、
下之，则脾阳下陷，湿浊内渍，转成洞泄、胀满诸病矣。
其有腹痛痞满，呕吐不纳，舌白或黄，手扪之糙，渴不引饮，大便泄泻，小溲不利，或赤而短，此湿热内
结于脾，而成湿霍乱也。如舌苔白腻者，宜辛开温化法，如蚕矢汤、燃照汤之类；舌苔黄滑者，宜辛开清解法，
如藿香左金汤、连朴饮之类；夹食加楂、曲、青皮之类。总之，湿遏热伏，其热从湿中来，只要宣通气分，气分
湿走，热自止矣。全在初起一二日，藿、朴、豆豉，疏中解表，使湿邪从皮腠而排泄；白蔻、四苓，芳淡渗湿，
使湿邪从内肾膀胱而排泄。汗利兼行，自然湿开热透，表里双解，而伏邪自去矣。虽然，湿热自内而出，恒结于
中焦，而成痞满，必有痰食错杂其间，前辛淡法中，痰郁加星香导痰丸，食滞加沉香百消曲，又生莱菔汁最妙，既开湿
火之郁闭，亦消痰食之停留，随症均可加入。
热多者，热重于湿也。其病多发于阳明胃肠，热结在里，由中蒸上。此时气分邪热，郁遏灼津，尚未郁结
血分。其舌苔必黄腻，舌之边尖红紫欠津，或底白罩黄、混浊不清，或纯黄少白，或黄色燥刺，或苔白底绛，
或黄中带黑、浮滑粘腻，或白苔渐黄而灰黑。伏邪重者，苔亦浓而且满，板贴不松，脉息数滞不调；症必神烦
口渴，渴不引饮，甚则耳聋干呕，面色红黄黑混，口气秽浊。余则前论诸症，或现或不现，但必胸腹热满，按
之灼手，甚或按之作痛。宜用枳实、栀、豉合小陷胸汤，加连翘、茵陈之清芬，青子芩（姜水炒）、木通之苦
辛，内通外达，表里两彻，使伏邪从汗利而双解。渐欲化燥，渴甚脉大，气粗而逆者，重加石膏、知母，清肺
气而滋化源；惟芦根、灯心尤宜多用（先煎代水），轻清甘淡，泄热化湿，下行从膀胱而解，外达从白 而解，
或斑疹齐发而解。
至于传变，凡胃家湿热，郁蒸肺气，致肺气不能敷布水精，外达下行，必见烦渴、多汗、斑疹、停饮、发
黄等症。
如热汗时出，大渴引饮，轻者用芦根饮子，加花粉、知母之类；重者用白虎汤，加鲜竹叶、鲜枇杷叶之类，
清肺气，泄胃热，虚者加西洋参，或珠几参。盖湿热一症，肃肺清胃，如溽暑炎蒸，凉风骤起，顷刻湿收热退，
如登清凉界中矣。
其有邪走皮肤发疹，邪走肌肉发斑，隐隐不现者，用杏仁、牛蒡、木贼草、栝蒌皮、川贝、银花、连翘、
鲜竹叶、通草、紫草、丹皮之类，辛凉开达，轻清透络。最忌辛燥升散，如藿香、浓朴、半夏、升麻、柴胡、
川芎、葛根、苏叶、荆芥之类。斑疹已出，热重者，用白虎汤，酌加元参、银花、
芦根、紫花地丁，以解毒而宣化之。
其饮停胸膈者，必见胸膈满痛、心烦干呕、渴欲饮水、水入则吐等症。斯时须辨舌苔，如舌苔白腻，则属
饮重，热因饮郁而陷，宜辛淡化饮；辛能行水，辛润又不烁津，二陈加芥子最妙。重者加细辛二三分尤妙，
再加淡渗如滑石、通草、茯苓、猪苓、泽泻、苡仁之类，或用五苓散，加清淡如滑石、淡竹叶、芦根之类。如
饮热并重，湿热与气液互结，舌苔黄腻，宜苦辛通降，佐以淡渗，如小陷胸汤，加枳实、浓朴、浙苓、广皮之
类，半夏泻心汤去参、草、大枣，以姜汁炒芩、连代干姜，均加滑石、通草、竹沥、姜汁等味，清化湿热、以
通利之。便闭者，必有粘涎浊饮，互结胃肠，再加控涎丹四五分，以洗涤之。
其有湿热瘀遏肌肉，发为阳黄，黄而鲜明，如橘皮色，宜苦辛佐淡渗，茵陈五苓散加栀柏伐木丸，以通泄
之。
如湿热郁遏肝胆经脉，耳聋干呕者，宜用连茹橘半汤，加条芩、胆草、石菖蒲等，苦辛开泄；胁痛及欲痉
者，重加羚角、石决明、海蛤壳、童便等，以咸降之，既能泄肝，又能化湿，两不相悖。
即邪传心经，神昏 烦，亦须辨舌苔。如舌苔黄腻，仍属气分湿热、内蒙包络清窍，与前同一病因，宜用
小陷胸汤，合半夏泻心汤，去干姜、大枣、参、草，加竹沥、姜汁；或用昌阳泻心汤，辛润以达之，苦寒以降
之，清淡以泄之，使湿热浊邪无地自容，其闭自开。极重者，再加太乙紫金丹。如昏蒙而厥者，可加厥症返魂
丹。
又有神昏 烦，舌苔黄燥黑燥而有质地，此胃肠实邪，浊气壅闭。清气因之亦闭，宜小承气汤合小陷胸汤
急下其邪，以决壅闭。阴虚者，加鲜生地、元参、芦根、鲜冬瓜子等轻利滑利之品，滋燥养阴足矣；若阴柔滋
腻药多，虽用大黄，
亦恐不解，是滋阴转致伤阴也。如舌苔黄浓而滑，脉息沉数，中脘按之微痛不硬，大便不解，此粘腻湿热与有
形渣滓相搏，按之不硬，多败酱色溏粪，宜用小陷胸汤合朴黄丸，或枳实导滞丸等，缓化而行；重者合神芎导
水丸或陆氏润字丸等，磨荡而行。设使大剂攻下，走而不守，则必宿垢不行，反行稀水，徒伤正气，变成坏症。
若舌苔黄如沉香色，或黄黑而燥，脉沉实而小，甚者沉微似伏，四肢发厥，或渴喜热饮，此皆湿热食滞，
互结胃肠，里气不通之象，酌用三承气汤。当脐及小腹按痛，邪在小肠∶胃脘下口及脐两旁按痛，邪在大肠；
热结旁流，按之硬痛，必有燥矢；均宜调胃承气汤，咸苦下之。脘腹均按痛，痞满燥实坚悉具──痞满为湿热
气结，燥实坚为燥矢，甚则上蒸心包，下烁肝肾，烦躁谵语，舌卷囊缩，宜大承气汤加犀、连急下之。阴伤者，
加鲜生地、元参、知母、川柏之类足矣。盖速下其邪，即所以存津液也。
少腹按痛，大便色黑如漆，反觉易行，若其人喜笑若狂，是肠胃蓄血，上干包络；小便色黑自利，是膀胱
蓄血；均宜桃仁承气汤急下之，或合犀角鲜地黄汤以清包络。发黄、小便不利、腹满者，茵陈蒿汤缓下之。
其间有气虚甚而邪实者，宜参黄汤，阴亏甚而邪实者，宜千金生地黄汤去芒硝，或养荣承气汤缓下之。即虚极
不任下者，宜用雪羹加鲜生地汁、鲜冬瓜汁、元参、栝蒌仁、蜂蜜、梨汁、稍加姜汁之类，咸滑以去着，辛润
以清燥。慎勿当下不下，徒用滋腻，俾邪无出路，转致伤阴；亦勿迟回顾虑，致令失下。虚人尤不可失，失则
邪愈盛，正愈衰，后即欲下，而不可得矣。
更有湿热化燥，伤及肾阴，旦慧夕剧，面少华色，或邪伤肝之经脉，发痉发厥，审其有热无结，则又惟有
酌用阿胶
鸡子黄汤，养阴熄风而已。
其或病中遗滑，湿热袭入精窍，小便涩痛者，导赤散合加味虎杖散，一面养阴通窍，一面化湿泄热，其症
自愈，或用猪苓汤合 鼠矢散亦效，切忌用止涩药以强止之。
至于伏暑，由夏令吸收之暑气，与湿气蕴伏膜原，至秋后而发者是也。内经曰∶夏伤于暑，秋必 疟。又
曰∶逆夏气则伤心，秋为 疟，奉收者少，冬至重病。此即经论伏暑晚发之明文也。就余所验，发于处暑以后
者，名曰伏暑，病尚易治；发于霜降后冬至前者，名曰伏暑晚发，病最重而难治。其伏邪往往因新邪而发，如
叶氏云∶伏暑内发，新凉外束。确多是症。初起恶寒发热，午后较重，状似疟疾而不分明；继而但热不寒，
热甚于夜，恶心胸闷，口干不喜饮，至晨得汗，身热稍退，而胸腹之热不除，日日如是，往往五七候始解，治法
须辨其舌。
舌苔白腻而浓，或中虽黄黑，而边仍白滑，膜原湿遏热伏也。宜用新定达原饮，加藿香、青蒿，达膜原而
解外邪。外邪解，而热不罢，汗自出，不恶寒反恶热，即伏邪发现矣。苔必转黄而糙，或黄浓而腻。症必胸腹
痞满，按之软而作痛；大便或秘或溏，或虽解不多，或虽多而仍觉不爽；小便必赤涩，或黄浊。此由浊热粘腻之
伏邪与肠中糟粕相搏，必积有溏酱粪。宜用加味小陷胸汤加陆氏润字丸缓通之，或加枳实导滞丸缓下之，往往
服二三钱大解一次，再服再解，不服不解。如此服五六次，行五六次，而伏邪始尽。若里邪已尽，而热仍不退
者，审其舌无多苔，或苔薄而无质地，即邪少虚多，阴虚火旺矣，则一以育阴养液、整肃余热为主，如甘露饮
去熟地，加西洋参、蔗浆、梨汁之类。若虚甚而神气消索，一无实热现象者，甘凉犹不中的，宜用甘平温润之
剂，如参麦六味、加减复脉之类，频进而垫
托之；切勿见其无速效，而中途易法，致今不救。余每见伏邪因中无砥柱，内含空虚，乘虚内陷，得育阴垫托，
从中下焦血分复还气分，于胸腹、缺盆、肩、颈、肘、臂等部位，发白 而解；若枯白无水，则又为阴涸之象，
症多不治。
舌绛干光，或鲜红起刺，症若闷瞀厥逆，日轻夜重，烦躁不宁，左脉弦数者，必邪伏血分，深入阴经也，
病多凶变。挽救之法，须审其火重而便通者宜清，石氏犀角地黄汤主之。兼神昏蒙闭者，重加瓜霜紫雪丹，
以宣心脑之络热。火重而便闭者宜下，拔萃犀角地黄汤主之。兼风动痉厥者，重加羚羊角、龙胆草、清童便，
以熄肝胆之风火。大势瘥后，一以育阴潜阳为主，三甲复脉汤加减，或以叶氏加减复脉汤育阴垫托，往往有从
里达表，舌起白苔，伏邪由汗而解。将欲汗时，脉必浮缓，苔必宣松。汗解后，白舌苔有即退者，有迟一二日
始退者，必得苔净、脉静、身凉，舌之两旁再生薄白新苔，方为邪尽。
如伏暑初起，有因秋燥及冬温时气，触引而发者，舌多燥白，或望之似润，扪之仍糙，症兼咳吐粘痰，胸
部串痛，唇干齿燥，或咽干喉痛，当先以邵氏热郁汤，辛凉轻润，以宣解上焦之新邪，余可仍仿前法酌用之。
凡伏气温热病，都是伏火所致。虽然最初感受的病邪有伤寒、伤暑的不同，但潜伏时间既久，蕴酿蒸变，过时发作，无一不归结为火化。中医所说的伏火证，即西医所说的内炎症。王秉衡说：风寒暑湿，都能化火，血气郁蒸，无不生火，所以人的火症特别多。朱心农说：东南方天气多热，地气多湿，最多见湿温、湿热之症，正伤寒症极少；即使说冬季多有正伤寒症，也不尽然。根据历年病症来看，常常见到大江以南地区，每逢冬季气候过于温暖，一旦感冒，表分虽有外寒，内里却多伏火，全部用治伏火的方法治疗，丝毫不差。所以魏柳州说：壮火（亢盛的阳气）是万病的贼寇。嘉约翰说：炎症是百病的根源。中医和西医，其道理是一致的。虽然如此，同样是伏火，但湿火与燥火，截然不同。用治燥火的方法来治湿火，则湿气更加郁遏，而热邪更加潜伏；势必导致痞满、呕吐呃逆、形寒而发热不明显、肠鸣泄泻，甚至蒙蔽清窍、谵语神昏、自汗肢冷，或牙关紧闭不语，或手足拘挛抽搐。用治湿火的方法来治燥火，则是以燥助燥，如同拨动火使其扬起，势必导致灼热、消渴、热盛昏狂、风动痉厥，甚至鼻翼煽动、声音嘶哑、舌卷囊缩、阴竭阳越、内闭外脱。因此对症用药，必须依据湿火、燥火的现症作为凭据，分寸自然清晰，误治自然减少。
试先论述湿火证的治法。凡是湿火证，发于夏至以前的是湿温，发于夏至以后的是湿热，发于霜降立冬之后的是伏暑挟湿；其邪气必定潜伏在膜原，就是《内经》所说的“横连膜原”。（拯华注：膜原，即统腹膜空隙之处，外通肌肤，内近胃肠，上连胸膈，下包内肾膀胱，中有夹缝，最易藏邪。邪气潜伏于此，症状必定胸腹热甚，按之灼手，小便黄赤浊热者，就是这个缘故，所以凡是湿热内伏的邪气，必定由膜原达外。）其中人气实，而热重于湿的，则发于阳明胃肠；中气虚，而湿重于热的，则发于太阴肺脾。初起邪在气分，应当分别湿多还是热多。
湿多的，是湿重于热。其病多发生于太阴肺脾，舌苔必定白腻，或白滑而厚，或白苔带灰，兼粘腻浮滑，或白带黑点而粘腻，或兼黑纹而粘腻，甚至舌苔满布，厚如积粉，板贴不松。脉象模糊不清，或沉细似伏，断续不均。神志多沉困嗜睡，症状必定凛凛恶寒。甚至足冷，头目胀痛昏重，如裹如蒙；身痛不能屈伸，身重不能转侧，肢节肌肉疼而且烦，腿足痛而且酸；胸膈痞满，口渴但不想饮水，或者竟然不渴；午后寒热，状若阴虚；小便短涩黄热，大便溏而不爽，甚至水泻。治法以轻开肺气为主。肺主一身之气，肺气化，则脾湿自化，即使有兼邪，也随之一同化解。宜用藿朴夏苓汤，药性体轻而味辛淡，以启上闸，开支河，导湿下行，以为出路；湿去气通，布津于外，自然汗解。
如果兼有神烦而昏的，这是由于湿热郁蒸过极，内蒙清窍；前面的辛淡法，去掉蔻仁、浓朴，加细辛二三分，白芥子一钱左右，辛润行水开闭；再加芦根一二两，滑石四五钱，轻清甘淡，泄热导湿，蒙闭即开，屡验不爽。
如果兼有大便不利的，这是由于湿阻气滞，或夹痰涎，前面的辛淡法，去掉藿香、浓朴、豆豉，重用栝蒌仁、薤白、小枳实等味，或重用紫菀、苏子（捣）、郁李仁等品。这些都是味辛质滑，流利气机，气机一开，大便自解，汗也自然出，随症均可加入。
有的湿遏热伏，走入肌肉，发为阴黄，黄色昏暗，如熏黄色，而没有烦渴热象；或者渐次化热，舌苔黄滑，口干而不多饮。其未化火的，宜用苦辛淡温法，如茵陈胃苓汤、茵陈五苓散，加除疸丸之类；已化火的，宜用苦辛淡清法，如清热渗湿汤、黄连温胆汤、藿香左金汤，重加茵陈及栀柏、绛矾丸之类。如果误将脘痞等症状当作食滞，而用消导、攻下之法，则脾阳下陷，湿浊内渍，转成洞泄、胀满诸病。
有的腹痛痞满，呕吐不纳，舌白或黄，手摸之粗糙，口渴但不想饮水，大便泄泻，小便不利，或赤而短，这是湿热内结于脾，而成湿霍乱。如舌苔白腻的，宜用辛开温化法，如蚕矢汤、燃照汤之类；舌苔黄滑的，宜用辛开清解法，如藿香左金汤、连朴饮之类；夹食的加山楂、神曲、青皮之类。总之，湿遏热伏，其热从湿中来，只要宣通气分，气分湿走，热自止矣。全在初起一二日，用藿香、浓朴、豆豉，疏中解表，使湿邪从皮腠排泄；白蔻、四苓，芳淡渗湿，使湿邪从内肾膀胱排泄。汗利兼行，自然湿开热透，表里双解，而伏邪自去矣。虽然，湿热自内而出，常结于中焦，而成痞满，必有痰食错杂其间，前面的辛淡法中，痰郁加星香导痰丸，食滞加沉香百消曲，又生莱菔汁最妙，既开湿火之郁闭，亦消痰食之停留，随症均可加入。
热多的，是热重于湿。其病多发生于阳明胃肠，热结在里，由中蒸上。此时气分邪热，郁遏灼津，尚未郁结血分。其舌苔必定黄腻，舌之边尖红紫欠津，或底白罩黄、混浊不清，或纯黄少白，或黄色燥刺，或苔白底绛，或黄中带黑、浮滑粘腻，或白苔渐黄而灰黑。伏邪重的，苔也厚而且满，板贴不松，脉象数滞不调；症状必定神烦口渴，渴但不想饮水，甚至耳聋干呕，面色红黄黑混杂，口气秽浊。其余前面论述的各种症状，或现或不现，但必定胸腹热满，按之灼手，甚至按之作痛。宜用枳实、栀、豉合小陷胸汤，加连翘、茵陈的清芬，黄芩（姜水炒）、木通的苦辛，内通外达，表里两彻，使伏邪从汗利而双解。逐渐欲化燥，渴甚脉大，气粗而逆的，重加石膏、知母，清肺气而滋化源；惟芦根、灯心尤宜多用（先煎代水），轻清甘淡，泄热化湿，下行从膀胱而解，外达从白㾦而解，或斑疹齐发而解。
至于传变，凡是胃家湿热，郁蒸肺气，致肺气不能敷布水精，外达下行，必见烦渴、多汗、斑疹、停饮、发黄等症状。
如热汗时出，大渴引饮，轻的用芦根饮子，加花粉、知母之类；重的用白虎汤，加鲜竹叶、鲜枇杷叶之类，清肺气，泄胃热，虚者加西洋参，或珠儿参。盖湿热一症，肃肺清胃，如溽暑炎蒸，凉风骤起，顷刻湿收热退，如登清凉界中矣。
有的邪走皮肤发疹，邪走肌肉发斑，隐隐不现的，用杏仁、牛蒡、木贼草、栝蒌皮、川贝、银花、连翘、鲜竹叶、通草、紫草、丹皮之类，辛凉开达，轻清透络。最忌辛燥升散，如藿香、浓朴、半夏、升麻、柴胡、川芎、葛根、苏叶、荆芥之类。斑疹已出，热重的，用白虎汤，酌加元参、银花、芦根、紫花地丁，以解毒而宣化之。
有的饮停胸膈的，必见胸膈满痛、心烦干呕、渴欲饮水、水入则吐等症状。这时须辨舌苔，如舌苔白腻，则属饮重，热因饮郁而陷，宜辛淡化饮；辛能行水，辛润又不烁津，二陈加芥子最妙。重的加细辛二三分尤妙，再加淡渗如滑石、通草、茯苓、猪苓、泽泻、苡仁之类，或用五苓散，加清淡如滑石、淡竹叶、芦根之类。如饮热并重，湿热与气液互结，舌苔黄腻，宜苦辛通降，佐以淡渗，如小陷胸汤，加枳实、浓朴、浙苓、广皮之类，半夏泻心汤去参、草、大枣，以姜汁炒芩、连代干姜，均加滑石、通草、竹沥、姜汁等味，清化湿热、以通利之。便闭的，必有粘涎浊饮，互结胃肠，再加控涎丹四五分，以洗涤之。
有的湿热瘀遏肌肉，发为阳黄，黄色鲜明，如橘皮色，宜苦辛佐淡渗，茵陈五苓散加栀柏伐木丸，以通泄之。
如湿热郁遏肝胆经脉，耳聋干呕的，宜用连茹橘半汤，加条芩、胆草、石菖蒲等，苦辛开泄；胁痛及欲痉的，重加羚角、石决明、海蛤壳、童便等，以咸降之，既能泄肝，又能化湿，两不相悖。
即使邪传心经，神昏烦扰，也须辨舌苔。如舌苔黄腻，仍属气分湿热、内蒙包络清窍，与前同一病因，宜用小陷胸汤，合半夏泻心汤，去干姜、大枣、参、草，加竹沥、姜汁；或用昌阳泻心汤，辛润以达之，苦寒以降之，清淡以泄之，使湿热浊邪无地自容，其闭自开。极重的，再加太乙紫金丹。如昏蒙而厥的，可加厥症返魂丹。
又有神昏烦扰，舌苔黄燥黑燥而有质地，这是胃肠实邪，浊气壅闭。清气因之亦闭，宜小承气汤合小陷胸汤急下其邪，以决壅闭。阴虚的，加鲜生地、元参、芦根、鲜冬瓜子等轻利滑利之品，滋燥养阴足矣；若阴柔滋腻药多，虽用大黄，亦恐不解，是滋阴转致伤阴也。如舌苔黄浓而滑，脉象沉数，中脘按之微痛不硬，大便不解，这是粘腻湿热与有形渣滓相搏，按之不硬，多败酱色溏粪，宜用小陷胸汤合朴黄丸，或枳实导滞丸等，缓化而行；重的合神芎导水丸或陆氏润字丸等，磨荡而行。设使大剂攻下，走而不守，则必宿垢不行，反行稀水，徒伤正气，变成坏症。
若舌苔黄如沉香色，或黄黑而燥，脉沉实而小，甚者沉微似伏，四肢发厥，或渴喜热饮，这都是湿热食滞，互结胃肠，里气不通之象，酌用三承气汤。当脐及小腹按痛，邪在小肠；胃脘下口及脐两旁按痛，邪在大肠；热结旁流，按之硬痛，必有燥屎；均宜调胃承气汤，咸苦下之。脘腹均按痛，痞满燥实坚悉具——痞满是湿热气结，燥实坚为燥屎，甚则上蒸心包，下烁肝肾，烦躁谵语，舌卷囊缩，宜大承气汤加犀角、黄连急下之。阴伤的，加鲜生地、元参、知母、川柏之类足矣。盖速下其邪，即所以存津液也。
少腹按痛，大便色黑如漆，反觉易行，若其人喜笑若狂，是肠胃蓄血，上干包络；小便色黑自利，是膀胱蓄血；均宜桃仁承气汤急下之，或合犀角鲜地黄汤以清包络。发黄、小便不利、腹满的，茵陈蒿汤缓下之。
其间有气虚甚而邪实的，宜参黄汤，阴亏甚而邪实的，宜千金生地黄汤去芒硝，或养荣承气汤缓下之。即虚极不任下的，宜用雪羹加鲜生地汁、鲜冬瓜汁、元参、栝蒌仁、蜂蜜、梨汁、稍加姜汁之类，咸滑以去着，辛润以清燥。慎勿当下不下，徒用滋腻，俾邪无出路，转致伤阴；亦勿迟回顾虑，致令失下。虚人尤不可失，失则邪愈盛，正愈衰，后即欲下，而不可得矣。
更有湿热化燥，伤及肾阴，旦慧夕剧，面少华色，或邪伤肝之经脉，发痉发厥，审其有热无结，则又惟有酌用阿胶鸡子黄汤，养阴熄风而已。
有的病中遗滑，湿热袭入精窍，小便涩痛的，导赤散合加味虎杖散，一面养阴通窍，一面化湿泄热，其症自愈，或用猪苓汤合鼠矢散亦效，切忌用止涩药以强止之。
至于伏暑，由夏令吸收之暑气，与湿气蕴伏膜原，至秋后而发的是。《内经》说：夏伤于暑，秋必疟疾。又说：逆夏气则伤心，秋为疟疾，奉收者少，冬至重病。这就是经论伏暑晚发的明文。就我所验证的，发于处暑以后的，名叫伏暑，病尚易治；发于霜降后冬至前的，名叫伏暑晚发，病最重而难治。其伏邪往往因新邪而发，如叶天士所说：伏暑内发，新凉外束。确多是此症。初起恶寒发热，午后较重，状似疟疾而不分明；继而但热不寒，热甚于夜，恶心胸闷，口干不喜饮，至晨得汗，身热稍退，而胸腹之热不除，日日如是，往往五七候始解，治法须辨其舌。
舌苔白腻而浓，或中虽黄黑，而边仍白滑，是膜原湿遏热伏。宜用新定达原饮，加藿香、青蒿，达膜原而解外邪。外邪解，而热不罢，汗自出，不恶寒反恶热，即伏邪发现矣。苔必转黄而糙，或黄浓而腻。症状必定胸腹痞满，按之软而作痛；大便或秘或溏，或虽解不多，或虽多而仍觉不爽；小便必赤涩，或黄浊。这是由浊热粘腻之伏邪与肠中糟粕相搏，必积有溏酱粪。宜用加味小陷胸汤加陆氏润字丸缓通之，或加枳实导滞丸缓下之，往往服二三钱大解一次，再服再解，不服不解。如此服五六次，行五六次，而伏邪始尽。若里邪已尽，而热仍不退的，审其舌无多苔，或苔薄而无质地，即邪少虚多，阴虚火旺矣，则一以育阴养液、整肃余热为主，如甘露饮去熟地，加西洋参、蔗浆、梨汁之类。若虚甚而神气消索，一无实热现象的，甘凉犹不中的，宜用甘平温润之剂，如参麦六味、加减复脉之类，频进而垫托之；切勿见其无速效，而中途易法，致今不救。我每见伏邪因中无砥柱，内含空虚，乘虚内陷，得育阴垫托，从中下焦血分复还气分，于胸腹、缺盆、肩、颈、肘、臂等部位，发白㾦而解；若枯白无水，则又为阴涸之象，症多不治。
舌绛干光，或鲜红起刺，症若闷瞀厥逆，日轻夜重，烦躁不宁，左脉弦数的，必邪伏血分，深入阴经也，病多凶变。挽救之法，须审其火重而便通的宜清，石氏犀角地黄汤主之。兼神昏蒙闭的，重加瓜霜紫雪丹，以宣心脑之络热。火重而便闭的宜下，拔萃犀角地黄汤主之。兼风动痉厥的，重加羚羊角、龙胆草、清童便，以熄肝胆之风火。大势瘥后，一以育阴潜阳为主，三甲复脉汤加减，或以叶氏加减复脉汤育阴垫托，往往有从里达表，舌起白苔，伏邪由汗而解。将欲汗时，脉必浮缓，苔必宣松。汗解后，白舌苔有即退的，有迟一二日始退的，必得苔净、脉静、身凉，舌之两旁再生薄白新苔，方为邪尽。
如伏暑初起，有因秋燥及冬温时气，触引而发的，舌多燥白，或望之似润，扪之仍糙，症兼咳吐粘痰，胸部串痛，唇干齿燥，或咽干喉痛，当先以邵氏热郁汤，辛凉轻润，以宣解上焦之新邪，余可仍仿前法酌用之。
Any latent-heat warm disease is caused by latent fire. Although the initial pathogenic qi contracted may differ between cold damage (Shanghan) and summerheat injury, once it has been latent for a long time, fermenting and steaming, and erupts after a delay, none fails to transform into fire. The "latent fire syndrome" in Traditional Chinese Medicine corresponds to "internal inflammation" in Western medicine. Wang Bingheng stated: Wind, cold, summerheat, and dampness can all transform into fire; blood and qi stagnation and steaming inevitably generate fire, which is why people suffer from so many fire syndromes. Zhu Xinnong stated: In the southeast, the heavenly qi is mostly hot, and the earthly qi is mostly damp, making damp-warmth and damp-heat syndromes most common, while true cold damage syndromes are extremely rare. Even if one claims that winter sees many true cold damage syndromes, this is not entirely accurate. Based on years of clinical observation, it is frequently seen that south of the Yangtze River, whenever the winter climate is excessively warm, upon contracting a cold, although there is external cold at the exterior level, internally there is predominantly latent fire. Treating all such cases with methods for latent fire yields precise results without error. Thus, Wei Liuzhou said: Vigorous fire is the thief of ten thousand diseases. John Chalmers said: Inflammation is the source of a hundred diseases. The principles of TCM and Western medicine are identical. Nevertheless, although both are latent fire, damp-fire and dry-fire are distinctly different. Using methods for dry-fire to treat damp-fire will cause dampness to be further constrained and heat to be more deeply hidden; inevitably leading to fullness and obstruction, vomiting and hiccups, aversion to cold with low-grade fever, borborygmus and diarrhea, or even clouding of the clear orifices, delirium and coma, spontaneous sweating with cold limbs, jaw stiffness and inability to speak, or limb spasms and convulsions. Using methods for damp-fire to treat dry-fire is like adding dryness to dryness, akin to fanning flames; inevitably leading to burning heat, wasting-thirst, severe heat with confusion and mania, wind stirring with spasms and syncope, or even nasal flaring and hoarseness, curled tongue and retracted scrotum, exhaustion of yin with floating of yang, internal closure with external collapse. Therefore, prescribing medication according to symptoms must rely on the presenting signs of damp-fire or dry-fire; distinctions will naturally become clear, and mis-treatment will naturally decrease.
Let us first discuss the treatment of damp-fire syndromes. Damp-fire syndromes occurring before the Summer Solstice are called damp-warmth; those occurring after the Summer Solstice are called damp-heat; and those occurring after Frost's Descent or Start of Winter are called latent summerheat with dampness. The pathogen invariably lies hidden in the membrane source (Moyuan), as described in the *Neijing* as "horizontally connecting to the membrane source." (Zhenghua's note: The membrane source refers to the spaces within the peritoneum, communicating externally with the skin and muscles, internally near the stomach and intestines, superiorly connected to the chest and diaphragm, inferiorly enveloping the kidneys and bladder, with clefts in between where pathogens easily hide. When pathogens lie hidden here, symptoms must include intense heat in the chest and abdomen, burning to the touch, and yellow, turbid, hot urine; this is the reason. Thus, any pathogen of damp-heat lying hidden internally must emerge from the membrane source.) In individuals with strong middle-jiao qi, where heat outweighs dampness, the disease manifests in the Yangming Stomach and Intestines; in those with deficient middle-jiao qi, where dampness outweighs heat, it manifests in the Taiyin Lung and Spleen. At the onset, when the pathogen is in the qi level, one must distinguish whether dampness or heat predominates.
When dampness predominates, dampness outweighs heat. The disease often occurs in the Taiyin Lung and Spleen. The tongue coating must be white and greasy, or white, slippery, and thick, or white with grey tones, accompanied by sticky, slippery texture, or white with black spots and sticky, or with black cracks and sticky, or even fully covered, thick like accumulated powder, stiff and adherent. The pulse is vague and unclear, or deep and fine resembling hidden, irregular and uneven. Spirit is often heavy, drowsy, and sleepy; symptoms definitely include aversion to cold with shivering. Severe cases involve cold feet, distending pain and heaviness in the head and eyes, feeling wrapped or covered; body pain preventing flexion and extension, body heaviness preventing turning over, joint and muscle pain with irritability, leg and foot pain with soreness; chest and diaphragm fullness and obstruction, thirst without desire to drink, or no thirst at all; afternoon chills and fever resembling yin deficiency; short, scanty, yellow, and hot urine; loose stools that are unsatisfying to pass, or even watery diarrhea. The treatment method focuses on lightly opening Lung qi. The Lung governs the qi of the whole body; when Lung qi transforms, Spleen dampness naturally transforms. Even if there are concurrent pathogens, they transform together. Huo Po Xia Ling Decoction should be used, consisting of light-bodied and pungent-bland herbs to open the upper gate, branch out the waterways, guide dampness downward as an exit route; once dampness leaves and qi flows freely, fluids distribute outward, resulting in natural resolution through sweating.
If accompanied by mental restlessness and confusion, this is due to extreme damp-heat stagnation steaming inwardly clouding the clear orifices; in the previous pungent-bland method, remove Cardamom Seed and Magnolia Bark, add 2-3 fen of Asarum and about 1 qian of White Mustard Seed, using pungent-moistening properties to move water and open blockage; additionally add 1-2 liang of Reed Rhizome and 4-5 qian of Talc, which are light, clear, sweet, and bland to drain heat and guide dampness, opening the clouding instantly with consistent efficacy.
If accompanied by difficulty in passing stool, this is due to dampness obstructing qi stagnation, or夹杂着 phlegm-saliva; in the previous pungent-bland method, remove Agastache, Magnolia Bark, and Fermented Soybean, heavily use Trichosanthes Seed, Allii Macrostemonis Bulbus, and small Zhi Shi, or heavily use Aster Root, Perilla Fruit (crushed), and Prunus Seed. These are all pungent in flavor and smooth in substance, facilitating qi mechanism; once qi mechanism opens, stool passes naturally, and sweat also emerges spontaneously. They can be added according to symptoms.
In cases where dampness constrains and heat hides, entering the muscles and manifesting as Yin Jaundice, dark and dim yellow like smoked color, without irritability, thirst, or heat signs; or gradually transforming into heat, with yellow-slippery tongue coating, dry mouth but little desire to drink. For those not yet transformed into fire, use bitter-pungent-bland-warm methods, such as Yinchen Weiling Decoction, Yinchen Wuling Powder, plus Du Dan Wan. For those already transformed into fire, use bitter-pungent-bland-clearing methods, such as Qingre Shenshi Decoction, Huanglian Wendan Decoction, Huoxiang Zuojin Decoction, heavily adding Yinchen, Gardenia and Phellodendron, and Jiangfan Wan. If mistakenly treating epigastric fullness as food stagnation and using digestion-promoting or purgative methods, Spleen Yang sinks downward, damp-turbidity infiltrates internally, transforming into flooding diarrhea, distension, and other diseases.
In cases of abdominal pain, fullness, vomiting, inability to eat, white or yellow tongue, rough to touch, thirst without desire to drink, loose stools, difficult urination, or red and scanty urine, this is damp-heat knotting internally in the Spleen, forming damp-type cholera. If the tongue coating is white and greasy, use pungent-opening and warm-transforming methods, such as Can Shi Tang, Ran Zhao Tang. If the tongue coating is yellow and slippery, use pungent-opening and clearing-resolving methods, such as Huoxiang Zuojin Decoction, Lian Po Yin. Add Hawthorn, Medicated Leaven, and Green Tangerine Peel for food retention. In summary, damp-constrained heat-hidden, the heat comes from dampness; simply ventilate the qi level, and as dampness moves in the qi level, heat stops. It depends entirely on the first one or two days of onset: using Agastache, Magnolia Bark, and Fermented Soybean to vent the middle and resolve the exterior, allowing damp pathogen to excrete through skin pores; White Cardamom and Si Ling (Four Substances) to aromatic-dry and leach dampness, allowing damp pathogen to excrete through Kidney and Bladder. Sweating and diuresis performed simultaneously naturally open dampness and penetrate heat, resolving both interior and exterior, eliminating the latent pathogen. However, damp-heat emerging from within often knots in the Middle Jiao, forming fullness, necessarily mixed with phlegm and food retention. In the previous pungent-bland method, for phlegm stagnation add Xingxiang Daotan Pill, for food retention add Chenxiang Baixiao Qu; raw Radish Juice is best, opening damp-fire depression and eliminating phlegm-food retention, addable according to symptoms.
When heat predominates, heat outweighs dampness. The disease often occurs in the Yangming Stomach and Intestines, heat knotting internally, steaming upward from the center. At this time, qi-level pathogenic heat stagnates and scorches fluids, but has not yet knotted in the blood level. Tongue coating must be yellow and greasy, edges and tip red-purple lacking moisture, or white base covered with yellow, turbid and unclear, or pure yellow with little white, or yellow with dry prickles, or white coating with crimson base, or yellow with black, floating, slippery, and sticky, or white coating gradually turning yellow then grey-black. With heavy latent pathogen, coating is thick and full, stiff and adherent; pulse is rapid, stagnant, and irregular; symptoms definitely include mental restlessness and thirst, thirst without desire to drink, even deafness and dry retching, complexion mixing red, yellow, and black, foul breath. Other previously discussed symptoms may or may not appear, but chest and abdomen must be hot and full, burning to touch, even painful to press. Use Zhishi, Zhi, Chi combined with Xiao Xianxiong Tang, add Forsythia and Yinchen for clear fragrance, Scutellaria (stir-fried with ginger juice) and Akebia for bitter-pungency, penetrating internally and reaching externally, thoroughly resolving interior and exterior, allowing latent pathogen to resolve via sweat and urine. Gradually desiring transformation into dryness, with severe thirst, large pulse, coarse and rebellious qi, heavily add Gypsum and Anemarrhena to clear Lung qi and nourish the source of transformation; Reed Rhizome and Bamboo Leaf are especially suitable for heavy use (decocted first as water substitute), light, clear, sweet, and bland to drain heat and transform dampness, descending to resolve via Bladder, ascending to resolve via white miliary rash, or erupting with macules and papules.
Regarding transmission, when Stomach damp-heat steams Lung qi, causing Lung qi to fail to distribute water essence outward and downward, symptoms of irritability-thirst, profuse sweating, macules/papules, fluid retention, and jaundice must appear.
If hot sweat occurs intermittently with great thirst and desire to drink, use Lu Gen Yin Zi for mild cases, adding Trichosanthes Root and Anemarrhena; use Baihu Tang for severe cases, adding Fresh Bamboo Leaf and Fresh Loquat Leaf, clearing Lung qi and draining Stomach heat; for deficiency add American Ginseng or Pearl Ginseng. For damp-heat syndrome,肃肺清胃 (clearing Lung and Stomach) is like cool breeze suddenly rising in humid summer heat, instantly retracting dampness and retreating heat, entering a realm of coolness.
For pathogens moving to skin causing rashes, or moving to muscles causing macules, faintly appearing, use Apricot Kernel, Burdock Fruit, Equisetum, Trichosanthes Peel, Fritillaria, Honeysuckle, Forsythia, Fresh Bamboo Leaf, Tongcao, Arnebia, and Moutan Cortex, using pungent-cool opening-reaching and light-clear penetrating collaterals. Most taboo are pungent-dry ascending-dispersing herbs like Agastache, Magnolia Bark, Pinellia, Bupleurum, Cimicifuga, Ligusticum, Kudzu Root, Perilla Leaf, and Schizonepeta. Once macules and papules have erupted, for severe heat use Baihu Tang,酌情 adding Ophiopogon, Honeysuckle, Reed Rhizome, and Viola Yedoensis to detoxify and diffuse.
For fluid retention in chest and diaphragm, symptoms of chest-diaphragm fullness-pain, mental restlessness, dry retching, thirst for drinking, and vomiting immediately after drinking must appear. At this time, distinguish tongue coating: if white and greasy, it belongs to heavy fluid retention, heat trapped by fluid depression, requiring pungent-bland fluid-resolving; pungency moves water, pungent-moist does not scorch fluids, Er Chen Tang plus Mustard Seed is best. For severe cases, adding 2-3 fen of Asarum is excellent, plus bland-leaching herbs like Talc, Tongcao, Poria, Polyporus, Alisma, and Coix Seed, or Wuling San, adding light-clear herbs like Talc, Light Bamboo Leaf, and Reed Rhizome. If fluid and heat are equally heavy, damp-heat knotting with qi-fluid, with yellow-greasy coating, use bitter-pungent descending-regulating assisted by bland-leaching, such as Xiao Xianxiong Tang, adding Zhishi, Magnolia Bark, Zhejiang Poria, and Broadleaf Kelp Peel; Banxia Xiexin Tang removing Ginseng, Licorice, and Jujube, replacing Ginger with Scutellaria and Coptis stir-fried with ginger juice, all adding Talc, Tongcao, Bamboo Sap, and Ginger Juice to clear-transform damp-heat and promote unblocking. For constipation, there must be sticky saliva and turbid fluid knotting in stomach-intestines, add Kongyan Dan 4-5 fen to wash them out.
For damp-heat瘀遏 (stagnating) in muscles causing Yang Jaundice, bright yellow like orange peel, use bitter-pungent assisted by bland-leaching, Yinchen Wuling San plus Zhibai Famu Wan to unblock-drain.
For damp-heat depressing Liver-Gallbladder meridians, causing deafness and dry retching, use Lianru Juban Tang, adding Scutellaria, Gentian, and Acorus, bitter-pungent opening-draining; for hypochondriac pain and impending spasms, heavily add Antelope Horn, Abalone Shell, Clam Shell, and Child's Urine to descend with saltiness, both draining Liver and transforming dampness, mutually non-contradictory.
Even if pathogen transmits to Heart Meridian, causing confusion and restlessness, one must still distinguish tongue coating. If yellow-greasy, it still belongs to qi-level damp-heat, inwardly clouding Pericardium clear orifices, same etiology as before, use Xiao Xianxiong Tang combined with Banxia Xiexin Tang, removing Dried Ginger, Jujube, Ginseng, and Licorice, adding Bamboo Sap and Ginger Juice; or Changyang Xiexin Tang, pungent-moist to reach, bitter-cold to descend, light-clear to drain, leaving no place for damp-heat turbid pathogen to exist, its closure self-opens. For extreme severity, add Taiyi Zijin Dan. For confusion with syncope, add Juesheng Fanhun Dan.
Again, for confusion and restlessness, with yellow-dry or black-dry tongue coating having substance, this is excess pathogen in stomach-intestines, turbid qi blocking. Clear qi is thereby blocked too; use Xiao Chengqi Tang combined with Xiao Xianxiong Tang to urgently purge the pathogen to resolve blockage. For yin deficiency, add Fresh Rehmannia, Ophiopogon, Reed Rhizome, and Fresh Winter Melon Seed, light-draining and slippery products sufficient to nourish dryness and yin; if too many yin-nourishing cloying herbs are used, even with Rhubarb, it may not resolve, as nourishing yin turns to injuring yin. If tongue coating is yellow-thick and slippery, pulse deep-rapid, epigastrium slightly painful but not hard on pressure, stool not passed, this is sticky-damp-heat battling with tangible residue, not hard on pressure, mostly败酱色 (Baijiang-colored) loose stool, use Xiao Xianxiong Tang combined with Puhuang Wan, or Zhishi Daozhi Wan, slowly transforming and moving; for severe cases combine Shenxiong Daoshui Wan or Lu Shi Runzi Wan, grinding and washing away. If large doses of purgatives are used, moving without staying,宿垢 (retained filth) will not move, instead thin water runs, vainly injuring healthy qi, transforming into ruined syndrome.
If tongue coating is yellow like agarwood color, or yellow-black and dry, pulse deep-solid and small, even deep-microscopic resembling hidden, limbs cold, or thirst preferring hot drinks, this is damp-heat and food stagnation knotting in stomach-intestines, image of interior qi不通 (unblocked). Use Three Chengqi Decoctions酌情. Pain at umbilicus and lower abdomen indicates pathogen in Small Intestine; pain below stomach outlet and sides of umbilicus indicates pathogen in Large Intestine; heat-knotting with side-flow, hard and painful on pressure indicates dry feces; all suit Tiaowei Chengqi Tang, salty-bitter purging. Pain in epigastrium and abdomen, fullness, dryness, excess, and hardness all present—fullness is damp-heat qi knot, dry-excess-hard is dry feces, even steaming upward to Pericardium, scorching downward Liver-Kidney, irritability, delirium, curled tongue, retracted scrotum, suit Dachengqi Tang adding Rhinoceros Horn (substitute) and Coptis to urgently purge. For yin injury, add Fresh Rehmannia, Ophiopogon, Anemarrhena, and Phellodendron sufficient. Urgently purging the pathogen is precisely how to preserve fluids.
Pain in lower abdomen, stool black like lacquer, surprisingly easy to pass, if person laughs wildly, this is blood stasis in stomach-intestines, affecting Pericardium; urine black and free-flowing, this is blood stasis in Bladder; both suit Taoren Chengqi Tang to urgently purge, or combine Xijiao Sheng Dihuang Tang to clear Pericardium. Jaundice, difficult urination, abdominal fullness, suit Yinchen Hao Tang to slowly purge.
Among these, for extreme qi deficiency with excess pathogen, use Shenhuang Tang; for extreme yin deficiency with excess pathogen, use Qianjin Shengdihuang Tang removing Mangxiao, or Yangrong Chengqi Tang to slowly purge. For extreme deficiency unable to tolerate purging, use Xue Geng adding Fresh Rehmannia Juice, Fresh Winter Melon Juice, Ophiopogon, Trichosanthes Seed, Honey, Pear Juice, slightly adding Ginger Juice, salty-smooth to remove adherence, pungent-moist to clear dryness. Carefully do not fail to purge when indicated, vainly using cloying herbs, giving pathogen no exit, turning to injure yin; nor hesitate and worry, causing missed opportunity to purge. Deficient persons especially must not miss this; missing it means pathogen grows stronger, healthy qi weaker, later desiring to purge becomes impossible.
Furthermore, damp-heat transforming into dryness, injuring Kidney yin, improving in morning worsening in evening, face lacking luster, or pathogen injuring Liver meridians, causing spasms and syncope, examining heat without knotting, only appropriately use Ejiao Jizihuang Tang to nourish yin and extinguish wind.
If during illness seminal emission/slippage, damp-heat invading essence orifice, causing涩痛 (astringent-painful) urination, use Daochi San combined with Jiawei Huzhang San, nourishing yin and opening orifices while transforming dampness and draining heat, syndrome heals itself; or Zhuling Tang combined with Shushi San is also effective. Strongly avoid using astringent drugs to forcibly stop.
As for latent summerheat, it is summerheat qi absorbed in summer, knotting with dampness in membrane source, erupting after autumn. *Neijing* says: Summer injury by summerheat, autumn must have malaria. Also says: Reversing summer qi injures Heart, autumn malaria,奉收 (assisting gathering) is less, serious illness at Winter Solstice. This is explicit text in classics regarding late-emerging latent summerheat. From my verification, erupting after End of Heat is named latent summerheat, disease still easy to treat; erupting after Frost's Descent before Winter Solstice is named late-emerging latent summerheat, disease heaviest and hardest to treat. Its latent pathogen often erupts due to new pathogen, as Ye Tianshi said: Latent summerheat erupts internally, new coolness binds externally. Indeed mostly this syndrome. Onset chills and fever, heavier in afternoon, resembling malaria but indistinct; subsequently only heat no chills, heat severe at night, nausea chest fullness, dry mouth no desire to drink, morning sweating, body heat slightly retreats, but chest-abdomen heat remains, day after day like this, often resolves after five-seven pentads. Treatment method must distinguish tongue.
Tongue coating white-greasy and thick, or middle yellow-black but edges still white-slippery, is membrane-source damp-constraining heat-hiding. Use Xinding Dayin Decoction, adding Agastache and Artemisia Annua, reaching membrane source and resolving exterior pathogen. Exterior pathogen resolved, heat does not cease, spontaneous sweating, no aversion to cold but aversion to heat, latent pathogen discovered. Coating must turn yellow-rough, or yellow-thick-greasy. Symptoms definitely chest-abdomen fullness-obstruction, soft and painful on press; stool either constipated or loose, or passed but not much, or much but still unsatisfying; urine definitely red-astringent, or yellow-turbid. This is turbid-heat-sticky latent pathogen battling with intestinal waste, accumulating loose paste-like stool. Use Jiawei Xiao Xianxiong Tang plus Lu Shi Runzi Wan to slowly unblock, or Zhishi Daozhi Wan to slowly purge, often taking 2-3 qian results in one major bowel movement, taking again results in another, not taking no movement. Taking 5-6 times, moving 5-6 times, latent pathogen finally exhausted. If interior pathogen exhausted but heat still不退 (does not retreat), examine tongue no much coating, or coating thin without substance, meaning pathogen few yin-many, yin deficiency fire hyperactivity, then solely focus on nourishing yin and fluids, rectifying residual heat, such as Ganlu Yin removing Shudi, adding American Ginseng, Sugarcane Juice, Pear Juice. If deficiency severe and spirit-energy exhausted, no excess heat signs, sweet-cool still misses target, use sweet-flat-warm-moist agents, such as Shenmai Liuwei, Jiawei Fumai, frequent administration to pad-support; never see no quick effect and change method midway, causing untreatable condition. I often see latent pathogen because middle lacks pillar, containing emptiness, taking advantage of deficiency sinking inward, obtaining yin-nourishing padding-support, returning from middle-lower jiao blood level to qi level, erupting white miliary rash at chest-abdomen, supraclavicular fossa, shoulder, neck, elbow, arm etc., resolving; if withered-white without water, this is yin-exhaustion image, syndrome mostly untreatable.
Tongue crimson dry-shiny, or fresh-red with prickles, symptoms like oppression-confusion syncope, lighter day heavier night, restless irritability, left pulse string-rapid, must be pathogen hiding in blood level, deeply entering yin meridians, disease mostly ominous changes. Rescue method must examine fire-heavy and stool-passing suits clearing, Shi-style Xijiao Dihuang Tang governs. Accompanied by confusion-clouding, heavily add Guashuang Zixue Dan to ventilate Heart-brain collateral heat. Fire-heavy and stool-closed suits purging, Bacui Xijiao Dihuang Tang governs. Accompanied by wind-stirring spasms-syncope, heavily add Antelope Horn, Gentian, Clear Child's Urine to extinguish Liver-Gallbladder wind-fire. After major trend recovers, solely focus on nourishing yin subduing yang, Sanjia Fumai Tang modified, or Ye-style Jiawei Fumai Tang nourishing yin padding-support, often from interior reaching exterior, tongue growing white coating, latent pathogen resolving via sweat. About to sweat, pulse must float-slow, coating must loosen. After sweat resolution, white tongue coating some retreat immediately, some delay one-two days, must get coating clean, pulse quiet, body cool, sides of tongue regrow thin white new coating, only then pathogen exhausted.
If latent summerheat onset, triggered by autumn dryness and winter-warmth seasonal qi, tongue mostly dry-white, or looks moist but feels rough, symptoms accompany coughing sticky phlegm, chest piercing pain, dry lips teeth dry, or dry throat sore throat, first use Shao's Reyu Tang, pungent-cool light-moist, to ventilate-resolve Upper Jiao new pathogen, rest can still follow previous methods酌情 use.