雄按∶江本吴本俱作湿温。
雄按∶此篇始见于舒松摩重刻《医师秘笈》，后云是薛作，章氏从而释之，而江白仙本以附陈作后，吴子音《温热赘
言》连前篇并为一人之书，并不标明何人所着，但曰寄瓢子述，且前篇之末，有“今补薛生白先生一法于后”云云，则
此篇亦非薛着矣。其江本所补一法，又无薛生白三字，且此篇张友樵所治酒客之案，但称曰余诊。言人人殊，无从核实，
姑存疑以质博雅。
一湿热证。
雄按∶既受湿又感暑也。即是湿温，亦有湿邪久伏而化热者。喻氏以为三气者，谓夏令地气已热，而又
加以天上之暑也。始恶寒，后但热不寒，汗出，胸痞，舌白（吴本下有“或黄”二字），口渴不引饮。
雄按∶甘露消毒丹
最妙。吴本虽出江本之后，无甚异同。所附酒客一案云，是其师治，似较江本为可信也。故引证但据吴本，而江本从略。
自注。此条乃湿热证之提纲也。湿热病，属阳明太阴经者居多。章虚谷云∶胃为戊土属阳，脾为己土属阴。湿土之
气，同类相召，故湿热之邪，始虽外受，终归脾胃也。中气实则病在阳明，中气虚则病在太阴。外邪伤人，必随人身之
气而变。如风寒在太阳则恶寒，传阳明即变为热而不恶寒。今以暑湿所合之邪，故人身阳气旺，即随火化而归阳明；阳
气虚，即随湿化而归太阴也。病在二经之表者，多兼少阳三焦。
雄按∶此二句从吴本补入。病在二经之里者，每兼厥阴
风木。以肝脾胃所居相近也。以少阳厥阴，同司相火。少阳之气，由肝胆而升，流行三焦，即名相火。阳明太阴，湿热
内郁，郁甚则少火皆成壮火，而表里上下，充斥肆逆。经曰∶少火生气，壮火食气。少火者，阳和之生气，即元气也；
壮火为亢阳之暴气，故反食其元气。食犹蚀也，外邪郁甚，使阳和之气悉变为亢暴之气，而充斥一身也。故是证最易耳
聋干呕，发痉发厥。暑湿之邪，蒙蔽清阳，则耳聋。内扰肝脾胃，则干呕而痉厥也。而提纲中不言及者，因以上诸证，
皆湿热病兼见之变局，而非湿热病必见之正局也。必见之证，标于提纲，使人识别，不至与他病混乱，其兼见之变证，
或有或无，皆不可定。若标之反使人迷惑也。始恶寒者，阳为湿遏而恶寒，终非若寒伤于表之恶寒。湿为阴邪，始遏其
阳而恶寒，即与暑合，则兼有阳邪，终非如寒邪之纯阴，而恶寒甚也。后但热不寒，则郁而成热，反恶热矣。
雄按∶后
则湿郁成热，故反恶热，所谓六气皆从火化也。况与暑合，则化热尤易也。热盛阳明，则汗出。章云∶热在湿中，蒸湿
为汗。湿蔽清阳，则胸痞。湿邪内盛，则舌白。湿热交蒸，则舌黄。
雄按∶观此句则提纲中舌白下应有“或黄”二字。热则液不升而口渴，湿则饮内留而不引饮。章云∶以上皆明提纲
所标，为必有之证也。然所云表者，乃太阴阳明之表，而非太阳之表。（湿热邪归脾胃，非同风寒之在太阳也）。
雄按∶
据此则前病在太阴下必有脱简，应从吴本补入。太阴之表，四肢也，阳明也；阳明之表，肌肉也，胸中也。四肢禀气于
脾胃，而肌肉脾胃所主，若以脾胃分之，则胃为脾之表，胸为胃之表也。故胸痞为湿热必有之证，四肢倦怠，肌肉烦疼，
亦必并见。此湿热在脾胃之表证也。其所以不干太阳者，以太阳为寒水之腑，主一身之表。
雄按∶肺为天，天包地外而处于上，膀胱为水，水环地极而处于下，故皆为一身之表，而风为阳邪，首及肺经，寒
为阴邪，先犯膀胱。惟湿为中土之气，胃为中土之腑，故胃受之。杨云∶此注奇情至理，所谓语必惊人，总近情也。风
寒必自表入，故属太阳。
雄按∶陈亮师云∶风邪上受，肺合皮毛，故桂枝证有鼻鸣干呕也。湿热之邪，从表伤者十之一
二，章云∶是湿随风寒而伤表，郁其阳气而变热，如仲景条内之麻黄赤小豆汤证是也，由口鼻入者十之八九。暑热熏蒸
之气，必由口鼻而入。阳明为水谷之海，太阴为湿土之脏，故多阳明太阴受病。湿轻暑重，则归阳明；暑少湿多，则归
太阴。膜原者，外通肌肉，内近胃腑，即三焦之门户，实一身之半表半里也。
雄按∶此与叶氏温热篇第三章之论合。邪
由上受，直趋中道，故病多归膜原。章云∶外经络，五内腑，膜原居其中，为内外交界之地。凡口鼻肌肉所受之邪，皆
归于此也，其为三焦之门户，而近胃口，故膜原之邪，必由三焦而入脾胃也。杨云∶细绎此言，则膜原乃人脂内之膜也。
然邪之由鼻入者，必先至肺，由口入者，必先至胃，何以云必归膜原？此不可解者也。若云在内之邪，必由膜原达外，
在外之邪，必由膜原入内，则似矣。要之湿热之病，不独与伤寒不同，且与温病大异，温病乃少阴太阳同病。此仲景所
论伏气之春温，若叶氏所论外感之风温，则又不同者矣。
雄按∶此注知有少阴太阳之温病，则与前篇风温条例力非伏气
之论者，断非一人之笔，即按文义亦彼逊于此。吴氏何以并为一家，江本必欲相合强为删改，岂非自呈伪妄耶。汪按∶
前篇自序自称其名曰祖恭未言又有此篇。此篇又无自序其非出一人手明甚。梦隐辩之是也。湿热乃阳明太阴同病也。始
受于膜原，终归于脾胃。而提纲中言不及脉者，以湿热之证，脉无定体，或洪或缓，或伏或细，各随证见，不拘一格，
故难以一定之脉，拘定后人眼目也。阳明热盛见阳脉，太阴湿盛见阴脉，故各随证见也。
湿热之证，阳明必兼太阴者，徒知脏腑相连，湿土同气，而不知当与温病之必兼少阴比例，少阴不藏，水火内燔，
风邪外袭，表里相应，故为温病。此即经言冬不藏精，春发温病，先由内伤而后外感，膏粱中人多有之。其冬伤于寒，
曰少阴伏邪，至春发出于太阳之温病，藜藿中人多有之。皆必兼少阴者也。若外感风温，邪由上受者，又当别论矣。太
阴内伤，湿饮停聚，客邪再至，内外相引，故病湿热。脾主为胃行津液者也，脾伤而不健运，则湿饮停聚，故曰脾虚生
内湿也。
雄按∶此言内湿素盛者。暑邪入之，易于留着，而成湿温病也。此皆先有内伤，再感客邪，非由腑及脏之谓。
若湿热之证，不挟内伤，中气实者，其病必微。
雄按∶内湿不盛者，暑邪无所根据傍，虽患湿温，治之易愈。或有先因于
湿，再因饥劳而病者，亦属内伤挟湿，标本同病。然劳倦伤脾为不足，湿饮停聚为有余。
雄按∶脾伤湿聚，曷云有余？
盖太饱则脾困，过逸则脾滞，脾气困滞而少健运，则饮停湿聚矣。较之饥伤而脾馁，劳伤而脾乏者，则彼尤不足，而此
尚有余也。后人改饥饱劳逸，为饥饱劳役，不但辨证不明，于字义亦不协矣。所以内伤外感，孰多孰少，孰实孰虚，又
在临证时权衡矣。
二湿热证∶恶寒无汗，身重头痛。
雄按∶吴本下有“胸痞腰疼”四字。湿在表分。宜藿香、香薷、羌活、苍术皮、
薄荷、牛蒡子等味。头不痛者，去羌活。
雄按∶吴本无藿香、香薷、薄荷、牛蒡子，有葛根、神曲、广皮、枳壳。
自注。下仿此。身重恶寒，湿遏卫阳之表证，头痛必挟风邪，故加羌活，不独胜湿，且以祛风。
杨云∶湿宜淡渗，不宜专用燥药，头痛属热，不必牵涉及风。此条乃阴湿伤表之候。章云∶恶寒而不发热，故为阴
湿。
雄按∶阴湿故可用薷、术、羌活以发其表。设暑胜者，三味皆为禁药，章氏既知阴湿，因见其用香薷一味，遂以此
条为暑证之实据，总由误以湿热为暑也。故其论暑，连篇累牍，皆是影响之谈。夫七政营运，有形可据，尚难臆断，况
太极无形，空谈无谓，道迩求远，反误后人。兹概从删，免滋眩惑。
三湿热证∶
雄按∶吴本下有“汗出”二字。
恶寒发热，身重关节疼。
雄按∶吴本下有“胸痞腰”三字。痛，湿在肌肉，不为。
雄按∶吴本作“可”。汗解。宜滑石、
大豆黄卷、茯苓皮、苍术皮、藿香叶、鲜荷叶、白通草、桔梗等味。不恶寒者，去苍术皮。
雄按∶吴本此句作“汗少恶
寒者，加葛根。条内无荷叶、藿香、通草、桔梗。有神曲、广皮。”
此条外候与上条同，惟汗出独异，更加关节疼痛，乃湿邪初犯阳明之表，而即清胃脘之热者，不欲湿邪之郁热上蒸，
而欲湿邪之淡渗下走耳！此乃阳湿伤表之候。以其恶寒少而发热多，故为阳湿也。
雄按∶吴本下有“然药用渗利，其小
便之不利可知矣”二句。汪按∶此二句乃他人所附评语。
四湿热证∶三四日即口噤，四肢牵引拘急，甚则角弓反张，此湿热侵入经络脉隧中。宜鲜地龙、秦艽、威灵仙、滑
石、苍耳子、丝瓜藤、海风藤、酒炒黄连等味。
雄按∶吴本无此条。
此条乃湿邪挟风者。风为木之气，风动则木张，乘入阳明之络，则口噤。走窜太阴之经，则拘挛。故药不独胜湿，
重用息风。一则风药能胜湿，一则风药能疏肝也。选用地龙诸藤者，欲其宣通脉络耳。十二经络皆有筋相连系，邪由经
络伤及于筋，则螈 拘挛，角弓反张，筋由肝所主，故筋病必当舒肝。
雄按∶地龙殊可不必，加以羚羊、竹茹、桑枝等
亦可。 伯云∶地龙、灵仙、苍耳、海风藤，似嫌过于走窜，不如羚羊、竹茹、桑枝等较妥，或加钩藤可乎。
或问仲景治痉，原有桂枝加栝蒌根及葛根汤两方，岂宜于古而不宜于今耶？今之痉者，与厥相连，仲景不言及厥，
岂《金匮》有遗文耶？余曰∶非也。药因病用，病源既异，治法自殊。汪按∶不但此也，洄溪已云∶《金匮》治痉诸方，
见效绝少矣。伤寒之痉自外来，（谓由外风），证属太阳（口噤即属阳明，义详本论），治以散外邪为主；湿热之痉自内出
（谓由内风），波及太阳，治以息内风为主。盖三焦与肝胆同司相火（少阳生气，生于肝胆，流行三焦，名相火也），中
焦湿热不解，则热盛于里，而少火悉成壮火。火动则风生，而筋挛脉急；风煽则火炽，而识乱神迷。
雄按∶设再投桂、
葛以助其风，则燎原莫救矣。身中之气，随风火上炎，而有升无降。
雄按∶治温热诸病者，不可不知此理。常度尽失，
由是而形若尸厥，正《内经》所谓“血之与气，并走于上，则为大厥”者是也。外窜经脉，则成痉；内侵膻中，则为厥。
痉厥并见，正气犹存一线，则气复返而生。胃津不克支持，则厥不回而死矣。
雄按∶喻氏云∶人生天真之气，即胃中之
津液是也。故治温热诸病，首宜瞻顾及此。董废翁云∶胃中津液不竭，其人必不即死。皆见到之言也。奈世人既不知温
热为何病，更不知胃液为何物，温散燥烈之药，漫无顾忌，诚不知其何心也。所以痉之与厥，往往相连，伤寒之痉自外
来者，安有是哉。
雄按∶此痉即螈 也，吴鞠通辨之甚详确。
暑月痉证，与霍乱同出一源，风自火生，火随风转，乘入阳明则呕，贼及太阴则泻，是名霍乱。窜入筋中则挛急，
流入脉络则反张，是名痉。但痉证多厥，霍乱少厥。盖痉证风火闭郁，郁则邪势愈甚，不免逼乱神明，故多厥。霍乱风
火外泄，泄则邪势外解。
雄按∶宜作“越”，不至循经而走，故少厥，此痉与霍乱之分别也。然痉证邪滞三焦，三焦乃火
化，风得火而愈煽，则逼入膻中而暴厥。霍乱邪走脾胃，脾胃乃湿化，邪由湿而停留，则淫及诸经而拘挛。火郁则厥，
火窜则挛，又痉与厥之遗祸也。痉之挛结，乃湿热生风，霍乱之转筋，乃风来胜湿。
雄按∶木克土也。痉则由经及脏而
厥，霍乱则由脏及经而挛，总由湿热与风，淆乱清浊，升降失常之故。夫湿多热少，则风入土中而霍乱。
雄按∶霍乱湿
多热少，道其常也。余自髫年，即见此证流行，死亡接踵，然闻诸父老云，向来此证甚稀，而近则常有，因于道光戊戌
辑一专论问世，嗣后此证屡行，然必在夏热亢旱酷暑之年，则其证乃剧，自夏末秋初而起，直至立冬后始息。夫彤彤徂
暑，湿自何来？贝缘今人蕴湿者多，暑邪易于深伏，迨一朝猝发，遂至阖户沿村，风行似疫。医皆未知原委，理中、四
逆随手乱投，殊可叹也！余每治愈此证，必问其人曰，病未猝发之先，岂竟毫无所苦耶？或曰∶病前数日，手足心先觉
热。或曰∶未病前睹物皆红如火。噫！岂非暑热内伏欲发，而先露其机耶？咸丰纪元，此证盛行，经余治者，无一不活，
而世人不察，辄以姜、附杀之，不已 乎杨云∶道光元年，直省此证大作，一觉转筋即死，京师至棺木买尽，以席裹身
而葬，卒未有识为何证者，俗传食西瓜者即死，故西瓜贱甚，余时年十一，辄与同学人日日饱啖之，卒无恙。今读此论，
则医学之陋，不独今日为然也。热多湿少则风乘三焦而痉厥。厥而不返者死。胃液干枯，火邪盘踞也。转筋入腹者死。
胃液内涸，风邪独劲也。然则胃中之津液，所关顾不钜哉。
雄按∶此理喻氏发之，叶氏畅之，实诸病之生死关键也，在
温热等病尤为扼要。然明明言之，而鞠通、虚谷之论霍乱也，犹未知之，况他人乎。厥证用辛开，泄胸中无形之邪也。
Wang Shixiong's commentary: Both the Jiang edition and the Wu edition write "Shi Wen" (Damp-Warmth).
Wang Shixiong's commentary: This chapter first appeared in the reprinted *Yishi Miji* (Secret Records of Physicians) by Shu Songmo, with a later note claiming it was written by Xue Shengbai. Zhang Xugu subsequently interpreted it based on this claim. However, the Jiang Baixian edition attached it after Chen's work. Wu Ziyin's *Wenre Zhuoyan* (Supplementary Remarks on Warm Diseases) combined the preceding and following chapters as works of a single author, without specifying who wrote them, merely stating they were narrated by Jipiaozi. Moreover, at the end of the preceding chapter, there is a phrase like "Now adding one method from Mr. Xue Shengbai below," which indicates that this chapter was not authored by Xue Shengbai either. The method supplemented in the Jiang edition lacks the name "Xue Shengbai." Furthermore, in the case of the wine-drinker treated by Zhang Youqiao in this chapter, he only refers to himself as "my diagnosis." Since accounts vary, verification is impossible; I hereby preserve the doubt for scholars to judge.
Article 1: Damp-Warmth Syndrome.
Wang Shixiong's commentary: This involves both dampness and summerheat contraction. It is essentially Shi Wen (Damp-Warmth), though there are cases where damp pathogen lies latent for a long time and transforms into heat. Yu Jiayan considered the three qi (referring to combinations of wind, cold, summerheat, dampness, dryness, and fire) to mean that in midsummer, the earth qi is already hot, compounded by the heavenly summerheat. Initially, there is aversion to cold, followed by fever without aversion to cold, sweating, chest stuffiness, white tongue coating (the Wu edition adds "or yellow" after "white"), thirst but no desire to drink.
Wang Shixiong's commentary: Ganlu Xiaodu Dan (Sweet Dew Detoxifying Powder) is most excellent. Although the Wu edition follows the Jiang edition, there are few differences. The attached case of the wine-drinker states it was treated by his teacher, making it seemingly more credible than the Jiang edition. Therefore, citations rely solely on the Wu edition, omitting the Jiang edition.
Self-note: This article serves as the outline for Damp-Warmth syndrome. Most Damp-Warmth diseases involve the Yangming and Taiyin meridians. Zhang Xugu stated: The Stomach belongs to Wu Earth and is Yang; the Spleen belongs to Ji Earth and is Yin. Damp Earth qi attracts similar qi; thus, although Damp-Heat pathogen initially enters from outside, it ultimately returns to the Spleen and Stomach. If Middle Qi is solid, the disease is in Yangming; if Middle Qi is deficient, it is in Taiyin. External pathogens affect people according to their own Qi transformation. For instance, Wind-Cold in the Taiyang meridian causes aversion to cold; upon transmitting to Yangming, it becomes heat without aversion to cold. Now, with the combined pathogen of Summerheat and Dampness, if the body's Yang Qi is vigorous, it transforms with Fire and returns to Yangming; if Yang Qi is weak, it transforms with Dampness and returns to Taiyin. When the disease is in the exterior of these two meridians, it often involves Shaoyang Sanjiao.
Wang Shixiong's commentary: These two sentences were added from the Wu edition. When the disease is in the interior of these two meridians, it often involves Jueyin Wind-Wood, because the Liver, Spleen, and Stomach are located near each other. Shaoyang and Jueyin jointly govern Ministerial Fire. Shaoyang Qi rises from the Liver and Gallbladder, circulates through the Sanjiao, and is named Ministerial Fire. In Yangming and Taiyin, Damp-Heat stagnates internally; when severe, mild Fire (Shao Huo) all becomes excessive Fire (Zhuang Huo), filling and disrupting the interior and exterior, upper and lower. The Classics state: Mild Fire generates Qi; Excessive Fire consumes Qi. Mild Fire is the vital generating Qi of Yang harmony, i.e., Yuan Qi; Excessive Fire is the violent Qi of hyperactive Yang, thus consuming Yuan Qi. "Consume" here means "corrode." Severe external pathogen stagnation transforms all harmonious Yang Qi into violent Qi, filling the whole body. Therefore, this syndrome easily presents with deafness, dry retching, spasms, and syncope. Summerheat-Dampness clouding clear Yang causes deafness. Internal disturbance of Liver, Spleen, and Stomach causes dry retching and spasm/syncope. These are not mentioned in the outline because they are variable patterns accompanying Damp-Warmth, not the essential pattern. Essential signs are marked in the outline for identification to avoid confusion with other diseases. Variable signs may or may not appear and cannot be fixed. Marking them would cause confusion. Initial aversion to cold is due to Yang being constrained by Dampness; it is fundamentally different from aversion to cold caused by Cold damaging the exterior. Dampness is Yin pathogen; initially constraining Yang causes aversion to cold. Even when combining with Summerheat (Yang pathogen), it is not purely Yin like Cold, so aversion to cold is not severe. Later, fever without aversion to cold occurs because stagnation generates Heat, leading to aversion to heat.
Wang Shixiong's commentary: Later, Dampness stagnates into Heat, hence aversion to heat, as stated: "All six qi transform into Fire." Especially when combining with Summerheat, transformation into Heat is easier. Heat excess in Yangming causes sweating. Zhang said: Heat within Dampness steams Dampness into sweat. Dampness obscuring clear Yang causes chest stuffiness. Dampness excess internally leads to white tongue coating. Damp-Heat steaming together leads to yellow tongue coating.
Wang Shixiong's commentary: Observing this sentence, "or yellow" should be present under "white tongue coating" in the outline. Heat prevents fluid ascent causing thirst; Dampness retains fluids internally causing no desire to drink. Zhang said: Above clarifies that the signs marked in the outline are necessary. However, the "exterior" mentioned here refers to the exterior of Taiyin and Yangming, not Taiyang. (Damp-Heat pathogen returns to Spleen/Stomach, unlike Wind-Cold in Taiyang).
Wang Shixiong's commentary: Based on this, there must be missing text after "disease in Taiyin" previously, which should be supplemented from the Wu edition. The exterior of Taiyin is the limbs and muscles; the exterior of Yangming is muscles and chest. Limbs receive Qi from Spleen and Stomach, and muscles are governed by Spleen and Stomach. Differentiating by Spleen/Stomach, Stomach is the exterior of Spleen, and Chest is the exterior of Stomach. Thus, chest stuffiness is a necessary sign of Damp-Heat; limb fatigue and muscle pain also necessarily appear. This is the exterior syndrome of Damp-Heat in Spleen and Stomach. It does not involve Taiyang because Taiyang is the organ of Cold Water, governing the exterior of the whole body.
Wang Shixiong's commentary: Lung is Heaven, enveloping Earth from above; Bladder is Water, surrounding Earth from below; thus both are the exterior of the body. Wind is Yang pathogen, affecting Lung meridian first; Cold is Yin pathogen, attacking Bladder first. Only Dampness is Qi of Central Earth, and Stomach is the organ of Central Earth, so Stomach receives it. Yang noted: This annotation is profound and reasonable, striking yet plausible. Wind-Cold must enter from the exterior, thus belonging to Taiyang.
Wang Shixiong's commentary: Chen Liangshi said: Wind pathogen enters from above; Lung combines with skin/hair, hence Guizhi Tang syndrome has nasal congestion and dry retching. Damp-Heat pathogen damaging the exterior accounts for 10-20%; Zhang said: This is Dampness following Wind-Cold damaging the exterior, constraining Yang Qi transforming into Heat, such as the Mahuang Chixiaodou Tang syndrome in Zhang Zhongjing's clauses. 80-90% enter via mouth and nose. Summerheat steaming Qi must enter via mouth and nose. Yangming is the Sea of Water and Grain; Taiyin is the Organ of Damp Earth; thus Yangming and Taiyin are mostly affected. Light Dampness and heavy Summerheat return to Yangming; less Summerheat and more Dampness return to Taiyin. Momoyuan (Diaphragm Origin) connects externally to muscles and internally to the Stomach; it is the gateway of Sanjiao and truly the half-exterior half-interior of the body.
Wang Shixiong's commentary: This aligns with Ye Tianshi's discussion in Chapter 3 of *Wenre Lun*. Pathogen entering from above trends directly to the middle pathway, so diseases often localize at Momoyuan. Zhang said: Outside are meridins and internal organs; Momoyuan resides in between, the boundary of interior and exterior. All pathogen received by mouth, nose, and muscles gathers here. As the gateway of Sanjiao near the stomach opening, pathogen at Momoyuan must enter Spleen/Stomach via Sanjiao. Yang noted: Careful analysis reveals Momoyuan is the membrane within fat. However, pathogen entering via nose must reach Lung first; via mouth, Stomach first. Why say it must return to Momoyuan? This is inexplicable. If internal pathogen reaches exterior via Momoyuan, and external pathogen enters interior via Momoyuan, it seems plausible. In short, Damp-Heat disease differs not only from Shanghan but significantly from Wenbing. Wenbing involves simultaneous Shaoyin and Taiyang. This is Zhang Zhongjing's discussion of latent Qi Spring-Warmth. If Ye Tianshi's exogenous Wind-Warmth, it is different again.
Wang Shixiong's commentary: This annotation acknowledges Shaoyin-Taiyang Wenbing, differing from the previous chapter's Wind-Warmth clauses which strongly opposed latent Qi theory. They are certainly not by the same hand; even stylistically, the latter is inferior. Why did Wu combine them? Jiang edition forced combination and deletion, presenting forgery. Wang noted: The preface of the previous chapter names himself Zugong, mentioning no other chapter. This chapter has no preface, clearly not by one person. Mengyin's refutation is correct. Damp-Heat is simultaneous Yangming and Taiyin disease. Initially receiving at Momoyuan, ultimately returning to Spleen/Stomach. The outline omits pulse because Damp-Heat pulses have no fixed form; they may be洪 (Surging), 缓 (Moderate), 伏 (Hidden), or 细 (Fine), varying with symptoms,不拘一格 (not confined to one style). Thus, difficult to fix posterior eyes with a fixed pulse. Yangming heat excess shows Yang pulse; Taiyin dampness excess shows Yin pulse, varying with symptoms.
In Damp-Heat, Yangming must accompany Taiyin. Knowing only viscera connection and shared Damp-Earth nature is insufficient; one must compare it to Wenbing necessarily involving Shaoyin. Shaoyin failing to store, Water/Fire burning internally, Wind pathogen attacking externally, interior/exterior responding, thus becoming Wenbing. This is the Classic saying: Winter failure to store essence, Spring develops Wenbing; first internal injury then external contraction, common among those eating rich foods. Winter Cold damage, called Shaoyin latent pathogen, emerging in Spring as Taiyang Wenbing, common among those eating coarse food. Both necessarily involve Shaoyin. If exogenous Wind-Warmth, pathogen entering from above, is another matter. Taiyin internal injury, Damp/Fluid retention, guest pathogen arriving again, interior/exterior attracting, thus Damp-Heat disease. Spleen governs transporting fluids for Stomach; Spleen injury impairs transportation, Damp/Fluid retain, hence "Spleen deficiency generates internal Dampness."
Wang Shixiong's commentary: This refers to those with abundant internal Dampness. Summerheat entering easily lingers, forming Damp-Warmth. These are cases of prior internal injury plus guest pathogen, not disease transferring from Fu to Zang. If Damp-Heat does not carry internal injury, and Middle Qi is solid, the disease will be mild.
Wang Shixiong's commentary: Those with scant internal Dampness have no basis for Summerheat; though suffering Damp-Warmth, treatment is easy. Some first suffer Dampness, then illness due to hunger/fatigue, also internal injury carrying Dampness, root and branch diseased simultaneously. However, fatigue injuring Spleen is deficiency; Damp/Fluid retention is excess.
Wang Shixiong's commentary: Spleen injured, Dampness gathers, how can it be excess? Generally, overeating confuses Spleen; excessive leisure stagnates Spleen. Spleen Qi confused/stagnant lacks transportation, Fluid retains/Dampness gathers. Compared to hunger injuring Spleen (weakness) or labor injuring Spleen (exhaustion), the former is more deficient, while this still has excess. Later generations changed "hunger/fullness/leisure/labor" to "hunger/fullness/labor/service," confusing differentiation and misaligning semantics. Whether internal/external, much/little, excess/deficiency requires clinical weighing.
Article 2: Damp-Warmth: Aversion to cold, no sweat, heavy body, headache.
Wang Shixiong's commentary: Wu edition adds "chest stuffiness, waist/back pain." Dampness in the exterior branch. Suitable herbs: Huoxiang, Xiangru, Qianghuo, Cangzhu Pi, Bohe, Niubangzi. If no headache, remove Qianghuo.
Wang Shixiong's commentary: Wu edition lacks Huoxiang, Xiangru, Bohe, Niubangzi; includes Gegen, Shenqu, Guangpi, Zhiqiao.
Self-note: Following this pattern. Heavy body and aversion to cold are exterior signs of Damp constraining Wei Yang. Headache implies Wind pathogen, hence adding Qianghuo, not only overcoming Dampness but dispelling Wind.
Yang noted: Dampness should be leached lightly, not solely using drying drugs. Headache belongs to Heat, no need to involve Wind. This article describes Yin-Dampness damaging the exterior. Zhang said: Aversion to cold without fever indicates Yin-Dampness.
Wang Shixiong's commentary: Yin-Dampness allows use of Xiangru, Cangzhu, Qianghuo to vent the exterior. If Summerheat dominates, these three are contraindicated. Zhang knowing Yin-Dampness saw only Xiangru used, thus taking this article as evidence for Summerheat syndrome, mistakenly equating Damp-Heat with Summerheat. His discussions on Summerheat are verbose and irrelevant. Celestial movements have tangible evidence, hard to guess; how much more so formless Taiji? Empty talk is meaningless, seeking far from near misleads later generations. Here deleted generally to avoid confusion.
Article 3: Damp-Warmth:
Wang Shixiong's commentary: Wu edition adds "sweating."
Aversion to cold and fever, heavy body, joint pain.
Wang Shixiong's commentary: Wu edition adds "chest stuffiness, waist..." Pain. Dampness in muscles, not [avoidable?] (Wu edition makes it "possible"). Sweating resolves. Suitable herbs: Shisui, Daye Huangjuan, Fuling Pi, Cangzhu Pi, Huoxiang Ye, Xian He Ye, Bai Tongcao, Jiegeng. If no aversion to cold, remove Cangzhu Pi.
Wang Shixiong's commentary: Wu edition reads: "If little sweating and aversion to cold, add Gegen." The clause lacks He Ye, Huoxiang, Tongcao, Jiegeng. Includes Shenqu, Guangpi.
This article's external signs match the previous one, except for sweating and additional joint pain. This is Dampness initially attacking the exterior of Yangming, clearing Stomach Heat immediately, preventing Damp-Heat from steaming upward, preferring Dampness to drain downward. This is Yang-Dampness damaging the exterior. Because aversion to cold is slight and fever prominent, it is Yang-Dampness.
Wang Shixiong's commentary: Wu edition adds: "However, using leaching drugs implies urinary difficulty is known." Wang noted: These two sentences are appended comments by others.
Article 4: Damp-Warmth: Within three to four days, jaw lock, limb traction/spasm, even opisthotonos. This is Damp-Heat invading meridians and collaterals. Suitable herbs: Xian Dilong, Qinjiao, Weilingxian, Shisui, Can'er Zi, Siguateng, Haifengteng, Jiuhuang Lian.
Wang Shixiong's commentary: Wu edition lacks this article.
This article involves Dampness carrying Wind. Wind is Wood Qi; Wind movement expands Wood, invading Yangming collaterals causing jaw lock. Moving through Taiyin meridians causing spasm. Thus, drugs not only overcome Dampness but heavily use Wind-extinguishing agents. First, Wind drugs overcome Dampness; second, Wind drugs soothe Liver. Selecting Dilong and vines aims to unblock meridians. Twelve meridians connect via sinews; pathogen damaging sinews via meridians causes twitching/spasm/opisthotonos. Sinews are governed by Liver, so sinew disease requires soothing Liver.
Wang Shixiong's commentary: Dilong is unnecessary; Lingyang, Zhuru, Sangzhi could be added. Boyun: Dilong, Lingxian, Can'er, Haifengteng seem too dispersing; Lingyang, Zhuru, Sangzhi are better; perhaps add Gouteng?
Questioner: Zhang Zhongjing treated spasms with Guizhi Jia Gualougen Tang and Gegen Tang. Are they suitable for ancient times but not now? I say: No. Drugs suit diseases; different origins require different treatments. Wang noted: Not just this; Huixi already said: Methods in *Jinkui* for spasms rarely work. Shanghan spasms come from outside (external Wind), syndrome belongs to Taiyang (jaw lock belongs to Yangming, see main text), treated by dispersing external pathogen; Damp-Heat spasms emerge from inside (internal Wind), affecting Taiyang, treated by extinguishing internal Wind. Sanjiao and Liver/Gallbladder jointly govern Ministerial Fire (Shaoyang Vital Qi born in Liver/Gallbladder, circulating Sanjiao, named Ministerial Fire). Unresolved Damp-Heat in Middle Jiao causes Heat excess internally, turning mild Fire into excessive Fire. Fire moving generates Wind, causing sinew spasm/pulse urgency; Wind fanning ignites Fire, causing confusion/coma.
Wang Shixiong's commentary: If Guizhi/Gegen are given to aid Wind, the prairie fire cannot be saved. Body Qi rises with Wind/Fire, ascending without descending.
Wang Shixiong's commentary: Those treating Warm diseases must know this principle. Normal limits lost, appearing like corpse syncope, exactly as *Neijing* says: "Blood and Qi rushing upward together causes Great Syncope." Exteriorally spreading to meridians causes spasm; internally invading Pericardium causes syncope. Spasm and syncope together, if a thread of Righteous Qi remains, Qi returns and life is saved. If Stomach Fluid cannot support, syncope does not reverse and death ensues.
Wang Shixiong's commentary: Yu Jiayan said: Human innate True Qi is Stomach Fluid. Thus, treating Warm diseases must prioritize protecting this. Dong Feiweng said: If Stomach Fluid is not exhausted, the person will not die immediately. Both are insightful remarks. Alas, people do not know what Warm diseases are, nor what Stomach Fluid is. Using warming/dispersing/drying/acrid drugs recklessly, truly unknown intent. Hence spasm and syncope often link; Shanghan spasms from outside never do this.
Wang Shixiong's commentary: This spasm is twitching, clarified accurately by Wu Jutong.
Summer month spasm syndrome shares origin with Huoluan (Cholera-like disorder). Wind born from Fire, Fire turns with Wind. Invading Yangming causes vomiting; harming Taiyin causes diarrhea, named Huoluan. Entering sinews causes cramping; flowing into meridians causes opisthotonos, named Spasm. But Spasm often has syncope; Huoluan rarely has syncope. Spasm: Wind/Fire closed/stagnant, stagnation increases pathogen force, disturbing Spirit, hence frequent syncope. Huoluan: Wind/Fire vented outward, venting releases pathogen force.
Wang Shixiong's commentary: Should read "vent," not following meridians, hence rare syncope; this distinguishes Spasm and Huoluan. However, Spasm pathogen stagnates in Sanjiao; Sanjiao is Fire transformation. Wind gets Fire to fan more, forcing entry into Pericardium causing sudden syncope. Huoluan pathogen moves in Spleen/Stomach; Spleen/Stomach is Damp transformation. Pathogen stays with Damp, flooding meridians causing cramping. Fire stagnant causes syncope; Fire scattering causes cramping; these are sequelae of Spasm/Syncope. Spasm cramping is Damp-Heat generating Wind; Huoluan tendon cramping is Wind overcoming Dampness.
Wang Shixiong's commentary: Wood conquers Earth. Spasm goes from Meridian to Zang causing syncope; Huoluan goes from Zang to Meridian causing cramping. Total result of Damp-Heat and Wind confusing Clear/Turbid, ascending/descending dysfunction. If Damp > Heat, Wind enters Earth causing Huoluan.
Wang Shixiong's commentary: Huoluan Damp > Heat is normal. Since childhood, I saw this disease流行 (epidemic), deaths following. Elders said it was rare before, common now since publishing a monograph in Wuxu year of Daoguang. Subsequently recurring, but severe only in years of extreme Summer heat/drought. Starts late Summer/early Autumn, ends after Lidong. How comes Dampness with scorching heat? Probably modern people accumulate Dampness; Summerheat hides deep, suddenly erupting, household/village epidemic. Doctors ignorant of cause, randomly using Lizhong/Sini Tang, lamentable! I always ask cured patients: Before sudden onset, any discomfort? Some say: Days before, palms/soles felt hot. Some say: Before illness, seeing things red like fire. Ah! Is this not Summerheat latent internally about to erupt, revealing its mechanism? Xianfeng era, this disease prevalent, all I treated survived. People unaware, killed with Ginger/Aconite, tragic! Yang noted: Daoguang Year 1, province-wide outbreak, death upon tendon cramp. Capital ran out of coffins, bodies wrapped in mats. No one knew the disease. Folk legend: Eating watermelon kills, so watermelon cheap. I was eleven, ate it daily with classmates, remained healthy. Reading this, medical ignorance is not just today's issue. Heat > Dampness, Wind attacks Sanjiao causing Spasm/Syncope. Syncope not reversing is death. Stomach Fluid dried up, Fire pathogen entrenched. Tendon cramp entering abdomen is death. Stomach Fluid internally exhausted, Wind pathogen alone strong. Thus, importance of Stomach Fluid is huge.
Wang Shixiong's commentary: This theory initiated by Yu, elaborated by Ye, is key to life/death in all diseases, crucial in Warm diseases. Yet explicitly stated, Jutong and Xugu discussing Huoluan still ignore it, let alone others. Syncope uses Acrid-Opening to drain formless Evil in Chest.