活人书云。先伤于湿。又中于暑。名曰湿温。许学士云。先受暑。后受湿。所言先后感
受不同。然湿病则缓。暑中则速。由斯以推。先湿后暑者为确也。其证两胫逆冷。
胸满颈目痛。妄言多汗。盖湿得暑邪。遏抑阳气。故胫冷而腹满。暑挟湿邪。郁蒸
为热。故头痛妄言多汗。其脉阳濡而弱。阴小而急。许学士以关前为阳。关后为
阴。纪氏以浮为阳。沉为阴。罗谦甫云。濡弱见于阳部。湿抟暑也。小急见于阴部。
暑抟湿也。然湿伤血。则必小急。暑伤气。则必濡弱。于此加浮为阳。沉为阴者当
矣。切不可发汗。汗之名重 死。治宜白虎加苍术汤。如有寒热外邪。加辛凉表药一二味。
若湿气胜。一身尽痛。小便不利。大便反快者。加茵陈、香薷。若有寒物停滞。及中寒
宜温。必小便清白。然后可。如赤涩而少。断不可用。通宜十味香薷饮。清暑益气。合天水散。
王宇泰云。昔人治湿温。通身皆润。足冷至膝下。腹满不省人事。六脉皆小弱而急。
问所服药。皆阴病药也。此非受病重。药能重病耳。以五苓合白虎十余剂少苏。
更与清燥汤调理而安。凡阴病厥冷。两臂皆冷。今胫冷臂不冷。则非下厥上行。
故知非阳微寒厥。而合用祛热药也。
阳邪亢极。遂成阳毒。亦有误以辛热与之而成者。金匮云。阳毒为病。面赤斑斑如
锦纹。咽喉痛。唾脓血。五日可治。七日不可治。升麻鳖甲汤主之。
虚热炽甚。毒不化者。阳毒升麻汤。大便结。去射干。加酒大黄。热甚去人参。加大青。
或吐下未当。陷邪内甚。其证壮热。头项强痛。躁闷不安。或狂言骂詈。妄见妄言。或
面生斑纹。口吐脓血。或舌卷焦黑。鼻如烟煤。或下利黄赤。六脉洪大而数。犀角
黑参汤。黄连解毒汤。慎不可用下药也。势甚者。以青布渍冷水。搭病患胸膛必喜。热即易之。须臾得睡。
The *Huoren Shu* (Book of Vitality) states: When one is first injured by dampness (Shi, 湿) and subsequently struck by summerheat (Shu, 暑), it is named Damp-Heat (Shiwen, 湿温). Scholar Xu stated: One first contracts summerheat and then dampness. The difference lies in the sequence of contraction. However, diseases caused by dampness develop slowly, whereas those caused by summerheat act rapidly. From this reasoning, the scenario of dampness preceding summerheat is considered accurate. The symptoms include coldness reversing up from the lower legs, chest fullness, pain in the neck and eyes, delirious speech, and profuse sweating. This occurs because dampness, combined with summerheat pathogen, suppresses the Yang Qi (Yang Energy, 阳气), resulting in cold lower legs and abdominal fullness; summerheat, carrying dampness, stagnates and steams into heat, causing headache, delirium, and excessive sweating. The pulse is superficial and soggy yet weak at the Yang position (Cun/Inch position, 阳部), and small and rapid at the Yin position (Chi/Cubit position, 阴部). Scholar Xu defined the area before the Guan (Bar) position as Yang and after as Yin; Ji defined floating pulse as Yang and sunken pulse as Yin. Luo Qianfu said: A soggy and weak pulse appearing in the Yang position indicates dampness clashing with summerheat; a small and rapid pulse appearing in the Yin position indicates summerheat clashing with dampness. Nevertheless, since dampness injures the Blood (Xue, 血), the pulse must be small and rapid; since summerheat injures the Qi (Qi, 气), the pulse must be soggy and weak. Adding the distinction of "floating is Yang, sunken is Yin" here is appropriate. Sweating therapy (Fa Han, 发汗) must absolutely not be used; misusing sweating can lead to severe consequences or death. Treatment should preferably employ Baihu Jia Cangzhu Tang (White Tiger plus Atractylodis Rhizoma Decoction, 白虎加苍术汤). If there are exterior pathogens of cold and heat, add one or two acrid-cool exterior-releasing herbs. If dampness is predominant, causing whole-body pain, difficulty in urination, and loose stools, add Yinchen (Artemisiae Scopariae Herba, 茵陈) and Xiangru (Elsholtziae Herba, 香薷). If there is stagnation of cold food or middle-jiao cold requiring warming, one must ensure the urine is clear and pale-colored before administering such treatment. If the urine is red, scanty, and difficult to pass, these treatments are absolutely contraindicated. Generally, Shiwei Xiangru Yin (Ten-Ingredient Elsholtzia Decoction, 十味香薷饮) is suitable to clear summerheat and benefit Qi, combined with Tianshui San (Heavenly Water Powder, 天水散). Wang Yutai said: In the past, when treating Damp-Heat, patients had moist skin all over, cold feet extending below the knees, abdominal fullness, and unconsciousness. All six pulses were small, weak, and rapid. Upon inquiry, the administered medicines were all for Yin-pattern diseases. This was not due to the severity of the disease, but rather the medicine exacerbating the condition. After taking Wuling San (Five-Ingredient Poria Decoction, 五苓散) combined with Baihu Tang (White Tiger Decoction, 白虎汤) for more than ten doses, the patient slightly regained consciousness. Subsequently, Qingzao Tang (Clear-Dryness Decoction, 清燥汤) was given for regulation, leading to recovery. In cases of Yin-pattern disease causing cold extremities, both arms are typically cold. Here, only the lower legs are cold while the arms are not, indicating this is not lower-jiao Jue (Reversal Cold, 厥) ascending. Therefore, it is known not to be a cold Jue caused by deficient Yang, but rather requires the use of heat-clearing medications.
When Yang pathogens reach extreme hyperactivity, Yang Du (Yang Toxin, 阳毒) forms. It can also result from the erroneous administration of acrid-hot substances. The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet, 《金匮要略》) states: For Yang Du disease, the face is red with mottled patterns like brocade, accompanied by sore throat and expectoration of pus and blood. It is treatable within five days, but untreatable after seven days. The primary formula is Shengma Biejia Tang (Anemarrhenae and Softshell Turtle Shell Decoction, 升麻鳖甲汤).
For deficiency-heat blazing severely with unresolving toxin, Yang Du Shengma Tang (Yang Toxin Anemarrhena Decoction, 阳毒升麻汤) is used. If stool is constipated, remove Shegan (Belamcandae Rhizoma, 射干) and add Jiu Dahuang (Wine-processed Rheum Radix et Rhizoma, 酒大黄). If heat is severe, remove Renshen (Ginseng Radix, 人参) and add Daqingye (Isatidis Folium, 大青叶). Or, if vomiting and purging were improperly applied, causing pathogens to sink deeply inward, symptoms include high fever, stiffness and pain in the head and neck, restlessness and anxiety, or delirious cursing, hallucinations, and nonsensical speech. There may be facial macules, expectoration of pus and blood, curled and scorched-black tongue, or nose resembling soot. Diarrhea of yellow-red stool may occur. The six pulses are surging and rapid. Use Xijiao Heishen Tang (Rhinoceros Horn and Black Ginseng Decoction, 犀角黑参汤) and Huanglian Jiedu Tang (Coptis Detoxification Decoction, 黄连解毒汤). Purging drugs must absolutely not be used. For severe cases, soak blue cloth in cold water and place it on the patient's chest; the patient will likely find relief. Replace it when it warms up. Sleep will follow shortly.