湿热病篇
清·薛生白
（一）湿热证始恶寒，後但热不寒，汗出胸痞舌白，口渴不引饮。
自注，此条乃湿热证之提纲也，湿热病属阳明太阴者居多，中气实则病在阳明，中气虚则病在太阴，病在二经之表者，多兼少阳三焦，病在二经之 者，每兼厥阴风木，以少阳厥阴，同司相火，阳明太阴，湿热内郁，郁甚则少火皆成壮火，而表 上下，充斥肆逆，故是证最易耳聋乾呕，发痉发厥，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 正局也，始恶寒者，阳为湿遏而恶寒，终非若寒伤於表之恶寒，後但热不寒，则郁而成热，反恶热矣，湿蔽清阳则胸痞，湿邪内甚舌白，湿热交蒸则舌黄，热则液不升而口渴湿则饮内留而不引饮，然所云表者，乃太阴阳明之表，而非太阳之表，太阴之表，四肢也，阳明也，阳明之表，肌肉也，胸中也，故胸痞为湿热必有之证，四肢倦怠肌肉烦疼，亦必并见，其所以不干太阳者，以太阳为寒水之腑，主一身之表，风寒必自表入，故属太阳，湿热之邪从表伤者，十之一二，由口鼻入者，十之八九，阳明为水谷之海，太阴为湿土之脏，故多阳明太阴受病，膜原者外通肌肉，内近胃腑，即三焦之门户，实一身之半表半 也，邪由上受，直趋中道，故病多归膜原，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，湿热乃阳明太阴同病也，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，故以一之脉，拘定後人眼目也。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，木火内燔，风邪外袭，表 相应，故为温病，太阴内伤湿饮停聚客邪再至，内外相引，故病湿热，此皆先有内伤，再感客邪，非由腑及之谓，若湿热之证，不挟内伤，中气实者，其病必微，或有先因於湿，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，湿饮停聚为有馀，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，湿在表分，宜藿香香薷羌活苍求皮薄荷牛蒡子等味，头不痛者去羌活。
自注，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，此条乃阴湿伤表之候。
（三）湿热证恶寒发热，身重关节疼痛，汪在肌肉，不为汗解，宜滑石大豆黄卷茯苓皮苍术皮藿香叶鲜荷叶鲜荷叶白白通草桔梗等味，不恶寒者去苍术皮。
此条外候与上条同，惟汗山独异，更加关节疼痛，乃湿邪初犯阳明之表，而即清胃 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。
（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。
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，欲其宣过脉络耳。或问仲景治痉，原有桂枝加栝娄根及葛根汤两，方岂宜於古而不宜於今耶，今之痉者，与厥相连，仲景不信及厥，岂金匮有遗文耶，予曰，非也，药因病用，病源既，异，治法自殊，伤寒之痉自外来，治以散外邪为主，湿热之痉自内出，波及太阳，治以息内风为主，盖三焦与肝胆同司相火，中焦湿热不解，则热盛於 ，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，身中之气，随风火上炎，而有升无降，常度尽失，由是而形若尸厥，正内经所谓血之与气，并走於上，则为暴厥者是也，外窜经脉，则成痉，内侵 中，则为厥，痉 并见，正气犹存一线，则气复反而生，胃津不克支持，则厥不回而矣，所以痉之与厥，往往相连，伤寒之痉自外来者，安有是哉，暑月痉证，与霍乱同出一源，风自火出，出火随风转，乘入阳明则呕，贼及太阴则泻，是名霍乱，窜入筋中者挛急，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 乱神明，故多厥，霍乱风火外泄，泄则邪势外解，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 入 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，痉之挛急，乃湿热生风，霍目之转筋，乃风来胜湿，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，热多湿少，则风乘三焦而痉厥，厥而不返者死，胃液乾枯，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，所关顾不巨哉，厥证用辛开，泄胸中无形之邪也，乾霍乱用探吐，泄胃中有形之滞也，然泄邪而胃液不上升者，热邪益炽，探吐而胃液不四布者，风邪更张，终成死候，不可不知。
（五）湿热证壮热口渴，舌黄或焦红，发痉神昏，谵语或笑，邪灼心包，荣血已乾，官犀黄羚羊角连翘生地元叁钩藤银花露鲜菖蒲至宝丹等味。
上条言痉，此条言厥，温暑之邪，本伤阳气，及至热极， 入营阴，则津液耗而阴亦病，心包受灼，神识昏乱，用药以清热救阴，泄邪平肝为务。
（六）湿热证发痉神昏笑妄，脉洪数有力，开泄不效者，湿热蕴结胸膈，宜仿凉膈散，若大便数日不通者，热邪闭结肠胃，宜仿承气微下之例。
此条乃阳明实热，或上结，或下结，清热泄邪，止能散络中流走之热，而不能除膈中蕴结之邪，故阳明之邪，仍假阳明为山路也。
（七）湿热证壮热烦渴，舌焦红或缩，斑疹胸痞，自利神昏，痉厥，热邪充斥表 三焦，宜大剂犀角羚羊角生地元叁银花露紫草方诸水金汁鲜菖蒲等味。
此条乃痉厥中之最重者，上为胸闷，下挟热利，斑疹痉厥，阴阳告困，独清阳明之热，阳明之液为急务者，恐胃液不存，其人自焚而死。
（八）湿热证寒热如疟，湿热阻遏膜原，宜柴胡厚朴槟榔草果藿香苍术半夏乾菖蒲六一散等味。
疟由暑热内伏，秋凉外束而成，若月腠理大开，毛窍疏通，安得成疟，而寒热有定期，如疟证发作者，以膜原为阳明之半表半 ，湿热阻遏，则营卫气争，证虽如疟，不得与疟同治，故仿又可达原饮之例，盖一由外凉束，一由内湿阻也。
（九）湿热证数日後， 中湿闷，知饥不食，湿邪蒙绕三焦，宜藿香叶薄荷叶鲜荷叶枇杷叶佩兰叶芦尖冬瓜仁等味。
此湿热已解，馀邪蒙蔽清阳，胃气不舒，宜用极轻清之品，以宣上焦阳气，若投味重之剂，则与病情不相涉矣。
此条须与第三十一条叁看，彼初起之实邪，故宜涌泄，投此轻剂，不相合矣，又须与後条叁看，治法有上中之分临证审之。
（十）湿熬证初起发热汗出，胸痞口渴舌白，湿伏中焦，宜藿梗蔻仁杏仁枳壳桔梗郁金苍术厚朴草果半夏乾菖蒲佩兰叶六一散等味。
浊邪上干则胸闷，胃液不升则口渴，病在中焦气分，故多开中焦气分之药，此条多有挟食者，其舌根见黄色，宜加瓜娄查肉莱菔子。
（十一）湿热证数日後自利溺赤，口渴，湿流下焦，宜滑石猪苓泽泻 通草等味。
下焦属阴，太阴所司，阴道虚故自利，化源滞则溺赤，脾不转津则口渴，总由太阴湿胜故也，湿滞下焦，故独以分利为治，然兼证口渴胸痞，须佐入桔梗杏仁大豆黄卷。开泄中上，源清则流自洁，不可不知，以上三条，俱湿重於热之候。
湿热之邪，不自表而入，故无表 可分，而未尝无三焦可辨，犹之河间治消渴以分三焦者是也，夫热为天之气，湿为地之气，热得湿而愈炽，湿得热而愈横，湿热两分，其病轻而缓，湿热两合，其病重而速，湿多热少，则蒙上流下，当三焦分治，湿热俱多，则上闭下壅，而三焦俱困矣，犹之伤寒门二阳合病，三阳合病也，盖太阴湿化，三焦火化，有湿无热，止能蒙蔽清阳，或阻於上，或阻於中，或阻於下，若湿热一合则身中少火悉化为壮火，而三焦相火，有不皆起而为虐者哉，所以上下充斥，内外煎熬，最为酷烈，兼之木火同气，表 分同，再引肝风，痉厥立至，胃中津液几何，其能供此交征乎，至其所以必属阳明者，以阳明为水谷之海，鼻食气，口食味，悉归阳明，邪从口鼻而入，则阳明必由之路，其始也邪入阳明，早己伤残其胃液，其继也邪盛三焦，更欲取资於胃液，司命者可不为阳明顾虑哉，或问木火同气，热盛生风以致痉厥，理固然矣，然有湿热之证，表 极热，不痉不厥者何也，余曰，风木为火热引动者，原因木气素旺，肝阴先亏，内外相引，两阳相煽，因而动张，若肝肾素优，并无 热者，火热安能招引肝风也，试观产妇及小儿，一经壮热，便成 者，以失血之後，与纯阳之体，阴气未充，故肝风易动也，或问曰，亦有阴气素亏之人，病患湿热，甚至斑疹外现，入暮? y昏迷，而不痉不厥者何也，答曰，病邪自甚於阳明之营分，故由上 而薰胸中，则入暮? k，邪不在三焦气分，则金不受囚，木有所畏，未敢起而用事，至於斑属阳明，疹属太阴，亦二经营分热极，不与三焦相干，即不与风木相引也，此而痉厥，必胃中津液尽涸，耗及心营，则肝风亦起，而其人已早无生理矣。
（十二）湿热证舌遍体白，口渴，湿滞阳明，宜用辛开，如厚朴草果半夏乾菖蒲等味。
此湿邪极盛之候，口渴乃液不上升，非有热也，辛泄太过，即可变，而为热，而此时湿邪尚未蕴热，故重用辛开，使上焦得通，津液得下也。
（十三）湿热证舌根白，舌尖红，湿渐化热，馀湿犹滞，宜辛泄佐清热，如蔻仁半夏乾菖蒲大豆黄卷连翘绿豆衣六一散等味。
此湿热叁半之证，而燥湿之中，即佐清热者，亦所以存阳明之液也，上二条凭验舌以投剂，为临证时要诀，盖舌为心之外候，浊邪上薰心肺，舌苔因而转移。
（十四）湿热证初起，即胸闷不知人，瞀乱大叫痛，湿热阻闭中上二焦，宜草果槟榔鲜菖蒲芫荽六一散各重用，或加皂角，地浆水煎。
此条乃湿热俱盛之候，而去湿药多，清热药少者，以病邪初起即闭，不得不以辛通开闭为急务，不欲以寒凉凝滞气机也。
（十五）湿热证四五日，口大渴胸闷欲绝，乾呕不止，脉细数，舌光如镜，胃液受劫，胆火上冲，宜西瓜汁金汁鲜生地汁甘蔗汁磨服郁金木香香附乌药等味。
此营阴素亏，木火素旺者，木乘阳明，耗其津液，幸无饮邪，故一清阳明之热，一散少阳之邪，不用煎者，取其气全耳。
（十六）湿热证呕吐清水，或痰多，湿热内留，木火上逆，宜温胆汤加栝娄碧玉散等味。
此素有痰饮，而阳明少阳同病，故一以涤饮，一以降逆，与上条呕同而治异，正当合叁。
（十七）湿热证呕恶不止，昼夜不差欲死者，肺胃不和，胃热移肺，肺不受邪也，宜用川连三四分，苏叶二三分，两味煎汤呷下即止。
肺胃不和最易致呕，盖胃热移肺，肺不受邪，还归於胃，必用川连以清湿热，苏叶以通肺胃，投之立愈者，以肺胃之气非苏叶不能通也，分数轻者，以轻剂恰治上焦之病耳。
（十八）湿热证 嗽，昼夜不安，甚至喘不得眠者，暑邪入於肺络，宜葶苈枇杷叶六一散等味。
人但佑暑伤肺气则肺虚，而不佑暑滞肺络肺实，葶苈引滑石直泻肺邪，则病自除。
（十九）湿热证十馀日，大势已退，惟口渴汗出，骨节痛，馀邪留滞经络，宜元米汤泡於术，隔一宿去术煎饮。
病後湿邪未尽，阴液先伤，故口渴身痛，此时救液则助湿，治湿则劫阴，宗仲景麻沸汤之法，取气不取味，走阳不走阴，佐以元米汤，养阴逐湿，两擅其长。
（二十）湿热证数日後，汗出热不除，或痉忽头痛不止者，营液大亏，厥阳风火上升，宜羚羊角蔓荆子钩藤元叁生地女贞子等味。
湿热伤营，肝风上逆，血不荣筋而痉，上升巅顶则头痛，热气已退，木气独张，故痉而不厥，投剂以息风为标，养阴为本。
（二一）湿热证胸痞发热，肌肉微疼，始终无汗者，腠理暑邪内闭，宜六一散一两，薄荷叶三四分，泡汤调下即汗解。
湿病发汗，昔贤有禁，此不微汗之，病必不除，盖既有不可汗之大戒，有得汗始解之治法，临证者当知所变通矣。
（二二）湿热证按法治之，数日後忽吐下一时并至者，中气亏损，升降悖逆，宜生谷芽莲心扁豆米仁半夏甘草茯苓等味，甚者用理中法。
升降悖逆，法当和中，犹之霍乱之用六和汤也，若太阴惫甚，中气不支，非理中不可。
（二三）湿热证十馀日後，左关弦数，腹时痛，时圊血，肛门热痛，血液内燥，热邪传入厥阴之证，宜仿白头翁法。
热入厥阴而下利即不圊血，亦当宗仲景治热利法，若竟 入营阴，安得不用白头翁汤凉血而散邪乎，设热入阳明而下利，即不圊血，又宜师仲景下利谵语，用小承气汤之法矣。
（二四）湿热证十馀日後，尺脉数，下利或咽痛，口渴心烦，下泉不足，热邪直犯少阴之阴，宜仿猪肤汤凉润法。
同一下利，有厥少之分，则药有寒凉之异，然少阴有便脓之候，不可不细审也。
（二五）湿热证身冷脉细，汗泄胸痞，口渴舌白，湿中少阴之阳，宜人叁白术附子茯苓益智等味。
Chapter on Damp-Heat Pathology
Qing Dynasty · Xue Shengbai
(1) In the initial stage of damp-heat syndrome (Damp-Heat Syndrome), there is aversion to cold, followed by fever without aversion to cold. There is sweating, chest stuffiness, a white tongue coating, thirst, but no desire to drink.
Self-note: This clause serves as the outline for damp-heat syndrome. Damp-heat diseases mostly belong to the Yangming and Taiyin meridians. If the middle qi is substantial, the disease is in Yangming; if the middle qi is deficient, the disease is in Taiyin. When the disease is at the exterior level of these two meridians, it often involves Shaoyang and the Sanjiao (Triple Burner); when the disease is at the interior level, it often involves Jueyin wind-wood. Since Shaoyang and Jueyin jointly govern ministerial fire, damp-heat stagnation in Yangming and Taiyin, when severe, transforms normal mild fire into excessive blazing fire. This causes rampant disturbance throughout the interior and exterior, upper and lower. Therefore, this syndrome easily presents with deafness, dry retching, spasms (Spasms), and syncope (Syncope). The outline does not mention these because they are variable presentations accompanying damp-heat, not the essential manifestations. Initial aversion to cold occurs because yang qi is obstructed by dampness, which differs from aversion to cold caused by cold pathogen invading the exterior. Subsequent fever without aversion to cold results from stagnation transforming into heat, leading to aversion to heat. Dampness obscuring clear yang causes chest stuffiness; severe internal dampness leads to a white tongue coating; damp-heat steaming together leads to a yellow tongue coating. Heat prevents fluid ascent causing thirst, while dampness retains fluids internally causing lack of desire to drink. The "exterior" mentioned here refers to the exterior of Taiyin and Yangming, not Taiyang. The exterior of Taiyin refers to the limbs and muscles; the exterior of Yangming refers to the muscles and chest center. Thus, chest stuffiness is a necessary symptom of damp-heat, accompanied by limb fatigue and muscle soreness. It does not involve Taiyang because Taiyang is the organ of cold water, governing the body's exterior, where wind-cold enters from the surface. Only one or two percent of damp-heat pathogens enter from the exterior, while eight or nine percent enter via the mouth and nose. Yangming is the sea of water and grain, and Taiyin is the viscera of wet earth, so they are most commonly affected. The Mo Yuan (Membrane Source) connects externally to muscles and internally to the stomach, serving as the gateway of the Sanjiao and the half-exterior half-interior of the body. Pathogens entering from above go directly to the central pathway, so the disease often settles in the Mo Yuan. In summary, damp-heat pathology differs not only from Cold Damage (Shanghan) but also significantly from Warm Diseases (Wenbing). Warm diseases involve simultaneous pathology of Shaoyin and Taiyang, whereas damp-heat involves simultaneous pathology of Yangming and Taiyin. The outline omits pulse diagnosis because damp-heat pulses vary—may be surging, moderate, deep, or fine—depending on the syndrome, making it impossible to fixate on a single pulse type. The reason Yangming must accompany Taiyin in damp-heat is not just due to zang-fu connection and shared earth nature, but should be compared to warm diseases involving Shaoyin. Shaoyin failing to store leads to internal flaming of wood and fire, combined with external wind invasion, resulting in warm disease. Internal injury to Taiyin with stagnant damp-fluids attracting external pathogens results in damp-heat. These cases involve prior internal injury followed by external pathogen invasion, not transmission from fu to zang organs. If damp-heat does not involve internal injury and middle qi is strong, the disease will be mild. Alternatively, disease caused initially by dampness and subsequently by hunger/fatigue belongs to internal injury with dampness, affecting both root and branch. However, fatigue injuring spleen is deficiency, while stagnant damp-fluids are excess; determining the balance requires clinical judgment.
(2) Damp-heat syndrome with aversion to cold, no sweating, heavy body, and headache indicates dampness at the exterior level. Use Huoxiang (Patchouli Herb), Xiangru (Elsholtzia Herb), Qianghuo (Notopterygium Rhizome), Cangzhu Pi (Atractylodis Rhizoma Perioecium), Bohe (Menthae Haplocalycis Herba), and Niuxiazi (Arctii Fructus). Remove Qianghuo if there is no headache.
Self-note: Heavy body and aversion to cold are exterior signs of dampness restraining Wei-yang (Defensive Yang). Headache implies wind pathogen involvement, hence Qianghuo is added to dispel dampness and wind. This clause describes Yin-damp injuring the exterior.
(3) Damp-heat syndrome with aversion to cold, fever, heavy body, and joint pain, where dampness is in the muscles and does not resolve with sweating, use Shihui (Talcum), Dadouhuangjuan (Sojae Semen Praeparatum), Fuling Pi (Poria Cum Mycelium Perioecium), Cangzhu Pi, Huoxiang Ye (Patchouli Leaf), Xian He Ye (Lotus Leaf), Tongcao (Tetrapanacis Medulla), and Jiegeng (Platycodonis Radix). Remove Cangzhu Pi if there is no aversion to cold.
The external signs are similar to the previous clause, except for sweating differences and additional joint pain. This indicates dampness initially attacking the exterior of Yangming, followed by clearing stomach heat to prevent upward steaming of damp-heat and promote downward leaching of dampness. This describes Yang-damp injuring the exterior.
(4) Damp-heat syndrome presenting with trismus (lockjaw), limb traction and spasm, or even opisthotonos (arched back) after three to four days, indicates damp-heat invading meridians and collaterals. Use Xian Dilong (Pheretima), Qinjiao (Gentianae Macrophyllae Radix), Weilingxian (Syneilesidis Rhizoma), Shihui, Can'er Zi (Xanthii Fructus), Siguateng (Luffae Caulis), Haifengteng (Akebiae Caulis), and Jiuchao Huanglian (Coptidis Rhizoma stir-fried with wine).
This clause involves dampness complicated by wind. Wind is the qi of wood; wind movement expands wood, invading Yangming collaterals causing trismus, and moving through Taiyin meridians causing spasms. Medications must not only dispel dampness but heavily calm wind, as wind herbs dispel dampness and soothe the liver. Earthworms and vines are selected to unblock meridians. Regarding Zhang Zhongjing’s treatments for spasms using Guizhi Jia Gualougen Tang (Cinnamon Twig Decoction plus Trichosanthis Radix) and Gegen Tang (Kudzu Decoction): modern spasms often link with syncope. Zhang did not discuss syncope in this context? No, medicines suit diseases; different etiologies require different treatments. Cold damage spasms come from outside, treated by dispersing external pathogens. Damp-heat spasms arise internally, affecting Taiyang, treated by calming internal wind. Sanjiao and Liver/Gallbladder govern ministerial fire; unresolved middle jiao damp-heat turns mild fire into blazing fire, generating wind and spasms. Wind fanning fire causes confusion. Qi rises with wind-fire, losing regulation, resembling corpse-like syncope ("Blood and Qi rushing upward causes sudden syncope"). External wandering causes spasms; internal invasion of Pericardium causes syncope. If Zheng Qi remains, recovery is possible; if Stomach fluids fail, death ensues. Spasms and syncope often connect. Summer heat spasms share origin with Cholera-like disorder (Huoluan). Wind arises from fire; invading Yangming causes vomiting, invading Taiyin causes diarrhea (Cholera-like). Invading sinews causes spasms. Spasms often involve syncope due to closed wind-fire disturbing spirit; Cholera-like disorders release wind-fire externally, rarely involving syncope. Spasms involve Sanjiao (fire transformation), Cholera-like involves Spleen/Stomach (damp transformation). Damp-heat generates wind in spasms; wind overcomes dampness in Cholera-like turning tendons. Total imbalance of clear/turbid and ascending/descending. More damp/less heat leads to Cholera-like; more heat/less damp leads to spasms/syncope. Syncope returning means death (Stomach fluid exhaustion); tendon contraction entering abdomen means death (Wind dominance). Treating syncope with acrid-opening clears formless evil; treating Dry Cholera-like with emesis clears有形 (formable) stagnation. Failure to restore fluids leads to death.
(5) Damp-heat syndrome with high fever, thirst, yellow or scorched-red tongue, spasms, coma, delirium, or laughter, indicates pathogen burning Pericardium and drying Ying-blood. Use Shuiniujiao (Rhinocerotis Cornu - substitute Water Buffalo Horn), Xiyangjiao (Capri Cornu), Lianqiao (Forsythiae Fructus), Shengdi (Rehmanniae Radix), Xuanshen (Scrophulariae Radix), Gouteng (Uncariae Ramulus cum Uncis), Yinhualu (Jasmine Dew), Xian Changpu (Acori Tatarinowii Rhizoma), and Zhibao Dan (Treasure Pill).
Previous clause discussed spasms; this discusses syncope. Warm-heat pathogens injure Yang qi; extreme heat enters Ying-Yin, consuming fluids. Pericardium burns, consciousness disorders. Treatment focuses on clearing heat, saving Yin, draining pathogen, and calming liver.
(6) Damp-heat syndrome with spasms, coma, manic laughter, surging-rapid-forceful pulse, unresponsive to opening-draining methods, indicates damp-heat knotting in chest/diaphragm. Imitate Liangge San (Cool the Diaphragm Powder). If constipated for several days, heat knots intestines/stomach; imitate Chengqi Tang (Order the Qi Decoction) for mild purgation.
This is Yangming excess-heat, knotting upper or lower. Clearing heat drains pathogen but cannot remove diaphragmatic knotting. Yangming pathogen uses Yangming as the pathway.
(7) Damp-heat syndrome with high fever, irritability/thirst, scorched-red/shrunken tongue, macules/rash, chest stuffiness, spontaneous diarrhea, coma, spasms/syncope, indicates heat pathogen filling interior/exterior and Sanjiao. Use large doses of Shuiniujiao, Xiyangjiao, Shengdi, Xuanshen, Yinhualu, Zicao (Arnebiae Radix), Fangzhushui, Jinzhi (Golden Juice), Xian Changpu.
This is the heaviest form of spasms/syncope. Upper chest oppression, lower hot diarrhea. Macules/rashes/spasms/syncope indicate Yin/Yang distress. Urgently clearing Yangming heat preserves Stomach fluids to prevent self-burning death.
(8) Damp-heat syndrome with chills and fever like malaria, damp-heat obstructing Mo Yuan, use Chaihu (Bupleuri Radix), Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), Caoguo (Tsaoko Fructus), Huoxiang, Cangzhu, Banxia (Pinelliae Rhizoma), Gan Changpu (Acori Tatarinowii Rhizoma), Liuyi San (Six-to-One Powder).
Malaria forms from summer-heat hiding internally and autumn-cool binding externally. With open pores, malaria shouldn't form. Periodic chills/fever resemble malaria due to Mo Yuan obstruction (half-exterior/half-interior of Yangming), disrupting Ying/Wei qi. Treat differently from malaria, imitating Daoyin Yin (Reach the Origin Decoction). One is bound by external cool, the other blocked by internal damp.
(9) Damp-heat syndrome after several days, chest fullness/stuffiness, knowing hunger but not eating, dampness enveloping Sanjiao, use Huoxiang Ye, Bohe Ye, Xian He Ye, Pipa Ye (Loquat Leaf), Peilan (Eupatorii Herba), Luxian (Reed Shoot), Dongguaren (Benincasae Semen).
Damp-heat resolved, residual pathogen obscures clear yang, Stomach qi unsmooth. Use very light/clear herbs to ventilate Upper Jiao yang. Heavy herbs mismatch the condition. Compare with Clause 31 (initial excess requires vomiting/draining) and subsequent clauses (upper/middle treatment distinctions).
(10) Damp-heat syndrome initial fever/sweating, chest stuffiness/thirst, white tongue, dampness hidden in Middle Jiao, use Huogeng (Patchouli Stem), Keren (Amomi Fructus), Xingren (Prunus Armeniaca Seed), Zhike (Aurantii Fructus), Jiegeng, Yujin (Curcumae Radix), Cangzhu, Houpo, Caoguo, Banxia, Gan Changpu, Peilan Ye, Liuyi San.
Turbid evil rising causes chest oppression; fluid not ascending causes thirst. Disease in Middle Jiao Qi level, so use herbs opening Middle Jiao Qi. Often food retention; yellow root tongue adds Gualou (Trichosanthes Fruit), Shanzha (Crataegi Fructus), Laifuzi (Radish Seed).
(11) Damp-heat syndrome after several days, spontaneous diarrhea, dark urine, thirst, dampness flowing to Lower Jiao, use Shihui, Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Tongcao.
Lower Jiao is Yin, governed by Taiyin. Deficient Yin channel causes diarrhea; stagnant source causes dark urine; Spleen failing to transport fluids causes thirst. Total Taiyin damp excess. Treat by separating/drainling dampness. For accompanying thirst/chest stuffiness, add Jiegeng, Xingren, Dadouhuangjuan to open Upper/Middle. Clear source cleans flow. Above three clauses are damp-heavy/heat-light.
Damp-heat doesn't enter from exterior, so no exterior/interior distinction, but Sanjiao differentiation applies. Heat is Heaven Qi, Damp is Earth Qi. Heat+Damp=stronger disease; separated=lighter/slower. Damp>Heat=mists upper/flows lower (treat Sanjiao separately); Equal=upper closure/lower blockage (Sanjiao distressed). Like Yangming/Taiyang combination in Cold Damage. Taiyin damp/Sanjiao fire. Damp alone obscures clear yang. Damp+Heat transforms mild fire to blazing fire, stirring Sanjiao ministerial fire. Upper/lower filling, internal/external roasting is severe. Wood/Fire share nature, exterior/interior same, drawing Liver wind causing immediate spasms/syncope. Stomach fluids insufficient. Must involve Yangming (Sea of Water/Grain, entry via mouth/nose). Initial invasion injures Stomach fluids; later Sanjiao excess consumes them. Doctor must worry about Yangming. Why some have heat but no spasms/syncope? Wind-moved by fire requires pre-existing strong Wood/deficient Liver Yin. Healthy Liver/Kidney resists. Postpartum/children prone due to blood loss/pure-yang constitution. Some Yin-deficient patients have rash/coma at night but no spasms/syncope? Pathogen deep in Yangming Ying level, steaming chest, night worsening. Not in Sanjiao Qi level, so Metal not imprisoned, Wood restrained. Macules=Yangming, Rash=Taiyin (Ying level heat, not Sanjiao/Wood linked). Spasms/syncope only occur if Stomach fluids exhausted, Heart Ying consumed, Liver wind rises (death inevitable).
(12) Damp-heat syndrome white tongue coating all over, thirst, dampness stagnating in Yangming, use Acrid-Opening: Houpo, Caoguo, Banxia, Gan Changpu.
Extreme dampness. Thirst is fluid not ascending, not heat. Excessive acrid-draining creates heat; currently no heat, so heavy acrid-opening vents Upper Jiao, allows fluid descent.
(13) Damp-heat syndrome white root/red tip tongue, damp transforming to heat, residual damp stagnating, use Acrid-Draining assisting Heat-Clearing: Keren, Banxia, Gan Changpu, Dadouhuangjuan, Lianqiao, Lv Dou Yi (Mung Bean Coat), Liuyi San.
Half-damp half-heat. Drying damp while clearing heat preserves Yangming fluids. Tongue diagnosis is key. Tongue reflects Heart; turbid evil steams Heart/Lungs, changing coating.
(14) Damp-heat syndrome initial chest stuffiness, unconsciousness, chaotic screaming/pain, damp-heat blocking Upper/Middle Jiao, use heavy Caoguo, Binglang, Xian Changpu, Yuanshi (Coriandrum Fructus), Liuyi San, or add Zaogiao (Gleditsiae Spina), decoct in Dip Soil Water.
Damp-heat both abundant. More damp-dispelling than heat-clearing because early blockage requires urgent acrid-unblocking, avoiding cold-stagnation.
(15) Damp-heat syndrome day 4-5, severe thirst, unbearable chest stuffiness, continuous dry retching, fine-rapid pulse, mirror-like smooth tongue, Stomach fluid劫 (robbed), Gallbladder fire rushing up, use Watermelon Juice, Jinzhi, Fresh Shengdi Juice, Sugarcane Juice, ground with Yujin, Muxiang (Aucklandiae Radix), Xiangfu (Cyperi Rhizoma), Wuyao (Linderae Radix).
Pre-existing Ying-Yin deficiency, Wood-Fire abundance. Wood attacks Yangming, consuming fluids. No fluid retention. Clear Yangming heat, disperse Shaoyang pathogen. Not decocted to preserve qi.
(16) Damp-heat syndrome vomiting clear water or phlegm, damp-heat internal retention, Wood-Fire rebellious, use Wendan Tang (Warm the Gallbladder Decoction) + Gualou (Trichosanthes Fruit), Biyu San (Jade Green Powder).
Pre-existing phlegm-fluid, Yangming/Shaoyang simultaneous disease. Purge fluid, descend rebellion. Different treatment for same vomiting vs previous clause.
(17) Damp-heat syndrome continuous vomiting/nausea day/night, Lung-Stomach disharmony, Stomach heat transferring to Lung, Lung rejecting evil, return to Stomach. Use Chuanlian (Coptidis Rhizoma) 3-4 fen, Suzhou (Perilla Leaf) 2-3 fen, decoct sip. Stops immediately.
Lung-Stomach disharmony causes vomiting. Stomach heat moves to Lung, Lung rejects, returns to Stomach. Chuanlian clears damp-heat, Suzhou unblocks Lung-Stomach qi. Light dosage suits Upper Jiao.
(18) Damp-heat syndrome cough, restless day/night, asthma unable to sleep, summer-heat entering Lung collaterals, use Tingli (Descurainiae Semen/Lepidii Semen), Pipa Ye, Liuyi San.
People know summer-heat injures Lung Qi (deficiency), not that it stagnates Lung collaterals (excess). Tingli guides Shihui to drain Lung evil.
(19) Damp-heat syndrome >10 days, major symptoms receded, only thirst/sweating, joint pain, residual pathogen in meridians. Soak Baizhu (Atractylodis Macrocephalae Rhizoma) in Yuanmi Tang (Rice Soup), leave overnight, remove Baizhu, decoct and drink.
Post-illness dampness remaining, Yin fluid injured first. Thirst/body pain. Saving fluid aids dampness; treating dampness injures Yin. Follow Zhang Zhongjing's Ma Fei Tang method: take qi not flavor, move Yang not Yin. Rice soup nourishes Yin/drains damp.
(20) Damp-heat syndrome several days later, sweating/fever persists, or spasms/sudden persistent headache, Ying fluid greatly deficient, Jue-Yang wind-fire rising, use Xiyangjiao, Man Jing Zi (Vittariae Spora), Gouteng, Xuanshen, Shengdi, Nvzhen Zi (Ligustri Lucidi Fructus).
Damp-heat injures Ying, Liver wind rebels, blood fails to nourish sinews (spasms), rises to vertex (headache). Heat receded, Wood qi dominates (spasms no syncope). Calm wind (branch), nourish Yin (root).
(21) Damp-heat syndrome chest stuffiness/fever, slight muscle pain, no sweating always, pore-heat pathogen internal closure. Use Liuyi San 1 liang, Bohe Ye 3-4 fen, soak in water, mix, sweat resolves.
Ancients forbade sweating for dampness. Here, mild sweating is needed. Learn flexibility between prohibition and resolution methods.
(22) Damp-heat syndrome treated correctly, suddenly vomiting/diarrhea simultaneously after days, Middle Qi deficient, ascending/descending reversal. Use Sheng Guya (Germinatus Milii), Lianxin (Nelumbinis Plumula), Bidou (Phaseoli Semen), Yiren (Coicis Semen), Banxia, Gancao (Glycyrrhizae Radix), Fuling. Severe cases use Lizhong Fa (Regulate Middle Method).
Reversal requires harmonizing Middle, like Liuhé Tang (Harmonize Six Decoction) for Cholera-like. If Taiyin exhausted, Lizhong is necessary.
(23) Damp-heat syndrome >10 days, Left Guan string-rapid pulse, abdominal pain, bloody stool, anal heat/pain, Blood dryness internally, Heat entering Jueyin. Imitate Baitouweng San (Peony Root Powder).
Heat entering Jueyin with diarrhea/blood needs cooling blood/draining pathogen (Baitouweng Tang). If Heat enters Yangming with diarrhea/delirium, use Xiao Chengqi Tang (Minor Order the Qi Decoction).
(24) Damp-heat syndrome >10 days, Chi pulse rapid, diarrhea or sore throat, thirst/irritability, Lower Spring insufficient, Heat directly attacking Shaoyin Yin. Imitate Zhufu Tang (Swine Skin Decoction) cooling-moistening method.
Same diarrhea, different Jue/Shaoyin, different cold/heat meds. Shaoyin may have pus/blood, examine carefully.
(25) Damp-heat syndrome cold body, fine pulse, sweating/chest stuffiness, thirst/white tongue, damp injuring Shaoyin Yang. Use Renshen (Ginseng Radix), Baizhu, Fuzi (Aconiti Lateralis Radix Preparata), Fuling, Yizhi (Alpiniae Oxyphyllae Fructus).