仲景论湿病。未尝明言湿温。然湿温之病状。可即仲景论中。比类得之。王叔和于仲景
伤寒
论。剔出痉湿 三种以为宜应别论。其于湿病首列湿痹。即从太阳辨证。曰太阳病关节疼痛
而烦。脉沉而细者。此名湿痹。则是湿证中同有头项强痛恶寒之太阳病。其类于伤寒者以此
。
然湿痹之病其人小便不利。大便反快。故当利小便。使湿邪从太阳之腑而解。是湿也。而不
必其兼温也。又云。湿家之为病。一身尽疼。发热。身色如似熏黄。此又示人以谛实湿病之
法。然湿病多端。亦不必尽属兼温。因思仲景已分明揭出太阳病发热而渴不恶寒者为温病。
以所言种种湿证。与此条之温病互勘。则湿温之病状。可得而言矣。湿温初起。所见之太阳
病。头痛。腰痛。骨节烦痛。与太阳伤寒同。以湿病本主身疼也。发热。汗出。恶风。与太
阳中风同。以温邪本易汗出也。但风寒之邪。由表入里。湿温之邪。由里出表。故当太阳病
初起时。其蒸郁之气。即已弥布三焦。故或往来寒热。胸膈痞满。呕吐。不欲食。或腹中痛
。
不大便。或下利稀臭水。表里之病。往往一时并见。以上各证。不必悉具。必兼口渴舌上
胎
者。此属湿温之定证。又湿病脉多沉细。湿既兼温。脉不尽沉。温病脉浮。温复挟湿。其脉
又不尽浮。不浮不沉之间。其中候必数。以数之甚与不甚。别邪之轻重。病之缓急。合此脉
证互参。始知仲景不言湿温。而湿温之脉证在其中。湿温之治法。即在其中矣。读仲景书。
当知比类。不知比类。即风寒之显然者,尚且目眩。奚况湿温哉。
Zhang Zhongjing, in his discussion of dampness diseases, never explicitly mentioned "damp-warmth" (Shiwen). However, the clinical manifestations of damp-warmth can be deduced by analogy from Zhang Zhongjing's discussions. Wang Shuhe, when compiling the *Shanghan Lun* (Treatise on Cold Damage), extracted three categories—spasm (Jing), dampness (Shi), and heatstroke (He)—arguing they should be treated as separate treatises. In his discussion of dampness diseases, he first listed "damp-bi" (Shibi) and differentiated it according to the Taiyang (Greater Yang) pattern, stating: "In a Taiyang disease, if there is pain and vexation in the joints, and the pulse is deep and thin, this is called damp-bi." This indicates that among dampness patterns, there are simultaneously Taiyang disease symptoms such as stiffness of the head and nape, and aversion to cold; this similarity to cold damage is the key point.
However, in the disease of damp-bi, the patient experiences difficulty in urination, while the stool is loose or frequent. Therefore, one should employ methods to promote diuresis, allowing the damp pathogen to resolve through the bladder fu-organ of the Taiyang channel. This represents pure dampness, which does not necessarily involve concurrent warmth. He also stated: "For those suffering from dampness diseases, the entire body aches, there is fever, and the complexion resembles the yellow hue of smoke curing." This illustrates the definitive treatment approach for confirmed dampness diseases. Nevertheless, dampness diseases manifest in various ways and do not necessarily always involve concurrent warmth. I recall that Zhang Zhongjing clearly pointed out: "In a Taiyang disease, if there is fever accompanied by thirst and no aversion to cold, this is called a warm disease." By cross-referencing the aforementioned various dampness patterns with this specific description of warm disease, the clinical picture of damp-warmth can be elucidated.
At the onset of damp-warmth, the Taiyang disease symptoms observed—such as headache, lower back pain, and painful soreness of the bone joints—are identical to those of Taiyang cold-damage, because dampness inherently causes body ache. Fever, sweating, and aversion to wind are identical to Taiyang wind-strike, because warmth pathogens inherently tend to cause sweating. However, wind-cold pathogens move from the exterior to the interior, whereas damp-warmth pathogens move from the interior to the exterior. Thus, at the initial stage of the Taiyang disease, the steaming and stagnant qi has already permeated the Sanjiao (Triple Burner). Consequently, one may observe alternating chills and fever, fullness and obstruction in the chest and epigastrium, vomiting, loss of appetite, abdominal pain, constipation, or diarrhea with foul-smelling watery stools. Exterior and interior pathological changes often appear simultaneously. Not all the above-mentioned symptoms need to be present. However, the presence of thirst and a coated tongue are essential criteria; only then can it be classified as a definitive damp-warmth pattern.
Furthermore, the pulse in dampness diseases is typically deep and thin. Since dampness is combined with warmth, the pulse is not entirely deep. The pulse in warm diseases is floating; since warmth is complicated by dampness, the pulse is not entirely floating. Between floating and deep, the middle position (Zhonghou) must be rapid (Shu). The degree of rapidity helps distinguish the severity of the pathogen and the urgency of the disease. By correlating these pulse characteristics with the clinical signs, one realizes that although Zhang Zhongjing did not explicitly name damp-warmth, its pulse and symptomatology are implicitly contained within his text. Similarly, the therapeutic principles for damp-warmth are inherent therein. When studying Zhang Zhongjing's works, one must understand the method of analogical reasoning. Without this skill, even obvious wind-cold patterns may cause confusion; how much more so would damp-warmth?