夏月头疼妄言。自汗。身不甚热。两胫逆冷。四肢沉重。胸腹多汗而满。其人先伤于
湿。因而中暑。其脉阳涩或弱。阴小而急。不可发汗。汗之名重 。必死。汗多者。白虎
汤加桂枝。汗少者。白虎汤加苍术。或概用苍术白虎汤。（述古）
按湿温症。因长夏每多阴雨。得日气煦照。则潮湿上蒸。袭人肌表。着于经络。则发
热头胀。身痛。足胫痛。舌苔腻白等症。重者。兼感时邪不正之气。即为湿温疫症。
邪入气分 暑湿之邪。阻于肺。必咽痛、发热、身痛。舌苔黄浓粘腻。烦渴不解。当清
上焦。如连翘、桔梗、滑石、射干、米仁、马勃、通草、淡竹叶、银花、芦根之类。如见身发
疹。舌黄燥浓。当凉膈疏 。如连翘、薄荷、生栀、石膏、牛蒡、杏仁、枳实、黄芩之类。
邪乘包络 湿温之邪。乘于包络。则神识昏呆。发热身痛。四肢不暖。舌苔鲜红燥
刺者。宜解手厥阴之邪。如犀角尖、连翘、石菖蒲、川郁金、元参、赤小豆、西黄之属主之。
邪入营分 如湿温之邪。入于血络。舌苔中黄边赤。发为赤 丹疹。神昏谵语。宜
清疏血分以透 。佐芳香逐秽以开闭。犀角、连翘、赤芍、银花、牛蒡、菖蒲、郁金、元参、
薄荷、人中黄之类。
邪阻上焦 病起发热头胀。渐至耳聋。喉痛欲闭。鼻中衄血。此邪混气之象。邪在
上焦空虚之所。非苦寒直达胃中之药可以治。病不能即解。即有昏痉之变。宜轻清理上为治。如
连翘、马勃、牛蒡、银花、射干、白金汁。如见呃忒。加枇杷叶、竹茹。（以上参叶案）
夏季出现头痛、胡言乱语，自汗出，身体发热不明显，两小腿逆冷，四肢沉重，胸腹部多汗且胀满。此人先被湿邪所伤，进而感受暑邪。其脉象阳部涩或弱，阴部小而急。不可使用发汗法治疗，若误用发汗法称为“重”（指病情加重/误治），必然导致死亡。若汗出过多者，用白虎汤加桂枝；若汗出较少者，用白虎汤加苍术。或者一概使用苍术白虎汤。（引自述古）
按：湿温证，因长夏季节多阴雨，得到日光煦照，则潮湿之气上蒸，侵袭人体肌表，滞留于经络，从而出现发热、头胀、身痛、足胫痛、舌苔腻白等症状。重症者，兼感时行不正之气，即为湿温疫病。
邪入气分：暑湿之邪阻滞于肺，必然出现咽痛、发热、身痛，舌苔黄厚粘腻，烦躁口渴不解。应当清解上焦，如连翘、桔梗、滑石、射干、薏苡仁、马勃、通草、淡竹叶、金银花、芦根之类。如果见到身体发出疹子，舌苔黄燥厚浓，应当凉膈疏风，如连翘、薄荷、生栀子、石膏、牛蒡子、杏仁、枳实、黄芩之类。
邪乘包络：湿温之邪侵犯心包络，则神识昏呆，发热身痛，四肢不温暖，舌苔鲜红且有干燥刺状者，宜解手厥阴经之邪，如犀角尖、连翘、石菖蒲、川郁金、玄参、赤小豆、西黄（牛黄）之属主治。
邪入营分：如湿温之邪进入血络，舌苔中间黄边缘赤，发为赤斑丹疹，神志昏迷谵语，宜清疏血分以透邪外出，佐以芳香逐秽以开闭窍。药用犀角、连翘、赤芍、金银花、牛蒡子、菖蒲、郁金、玄参、薄荷、人中黄之类。
邪阻上焦：病起发热头胀，逐渐发展到耳聋，喉痛欲闭塞，鼻中衄血，这是邪气混杂在气分的现象。邪气在上焦空虚之处，不是苦寒直达胃中的药物可以治疗的。病不能立即解除，即使有昏痉的变证，宜轻清理上焦作为治疗原则，如连翘、马勃、牛蒡子、金银花、射干、白金汁。如果见到呃逆，加枇杷叶、竹茹。（以上参考叶天士医案）
In summer, headache and delirious speech occur. There is spontaneous sweating, the body is not significantly hot, the lower legs are cold in reverse, the four limbs feel heavy, and there is excessive sweating and fullness in the chest and abdomen. The person was first injured by dampness, and subsequently contracted summerheat. The pulse is coarse or weak at the yang position (cun), and small and rapid at the yin position (chi). Sweating methods must not be used; if sweating is induced, it is called "Zhong" (severe error/mismanagement), which will inevitably lead to death. If sweating is excessive, use Baihu Tang (White Tiger Decoction) with Guizhi (Cinnamon Twig). If sweating is slight, use Baihu Tang (White Tiger Decoction) with Cangzhu (Atractylodis Rhizoma). Alternatively, Cangzhu Baihu Tang (Atractylodes and White Tiger Decoction) may be used generally. (Quoted from Shugu)
Note: Shiwen syndrome (Damp-Heat Febrile Disease) often occurs during late summer due to frequent rainy days. When warmed by sunlight, dampness steams upward, attacking the muscle surface and lodging in the meridians, causing symptoms such as fever, head distension, body pain, leg pain, and a greasy white tongue coating. In severe cases, concurrent infection with pathogenic factors of the time results in Shiwen epidemic disease.
Pathogen entering Qi Level: Summerheat-dampness pathogens obstructing the Lung will necessarily cause sore throat, fever, body pain, a thick yellow sticky tongue coating, restlessness, and unquenchable thirst. One should clear the Upper Jiao, using herbs such as Qiaofeng (Forsythiae Flos), Jiegeng (Platycodonis Radix), Huashi (Talcum), Shegan (Belamcandae Rhizoma), Yiyiren (Coicis Semen), Mabo (Bletillae Rhizoma), Tongcao (Tetrapanacis Medulla), Danzhuye (Lophatheri Herba), Yinhua (Lonicerae Japonicae Flos), and Lugen (Phragmitis Rhizoma). If rashes appear on the body and the tongue coating is yellow, dry, and thick, one should cool the Diaphragm and disperse wind, using herbs such as Qiaofeng (Forsythiae Flos), Bohe (Menthae Haplocalycis Herba), Shengzhi (Gardeniae Fructus), Shigao (Gypsum Fibrosum), Niubang (Arctii Fructus), Xingren (Armeniacae Semen Amarum), Zhishi (Aurantii Fructus Immaturus), and Huangqin (Scutellariae Radix).
Pathogen affecting Pericardium: When damp-heat pathogens affect the Pericardium, mental confusion and dullness occur, accompanied by fever, body pain, and cold extremities. If the tongue coating is bright red, dry, and prickly, one should resolve pathogens of the Hand-Jueyin Meridian, primarily using herbs such as Xijiao (Rhinocerotis Cornu - note: substitute with water buffalo horn in practice), Qiaofeng (Forsythiae Flos), Shichangpu (Acori Tatarinowii Rhizoma), Chuan Yujin (Curcumae Radix), Xuanshen (Scrophulariae Radix), Chixiaodou (Vigna Semen Rubrum), and Xi Huang (Moschus).
Pathogen entering Ying Level: When damp-heat pathogens enter the blood collaterals, the tongue coating is yellow in the center and red at the edges, manifesting as red macules and papules. With coma and delirious speech, one should clear and disperse the Blood level to vent pathogens, assisted by aromatic herbs to dispel turbidity and open the orifices. Herbs include Xijiao (Rhinocerotis Cornu), Qiaofeng (Forsythiae Flos), Chishao (Paeoniae Radix Rubra), Yinhua (Lonicerae Japonicae Flos), Niubang (Arctii Fructus), Changpu (Acori Tatarinowii Rhizoma), Yujin (Curcumae Radix), Xuanshen (Scrophulariae Radix), Bohe (Menthae Haplocalycis Herba), and Renzhonghuang (Hominis Excrementum Treatum).
Pathogen obstructing Upper Jiao: The disease begins with fever and head distension, gradually progressing to deafness, sore throat threatening closure, and epistaxis. This indicates pathogens mixed within the Qi. The pathogen resides in the empty spaces of the Upper Jiao; bitter-cold herbs that directly reach the Stomach cannot treat this. The illness will not resolve immediately, and complications such as coma and convulsions may arise. Treatment should involve light clearing and resolving of the Upper Jiao, using herbs such as Qiaofeng (Forsythiae Flos), Mabo (Bletillae Rhizoma), Niubang (Arctii Fructus), Yinhua (Lonicerae Japonicae Flos), Shegan (Belamcandae Rhizoma), and Baijin Zhi (Platinum Water Juice). If hiccups are present, add Pipaye (Eriobotryae Folium) and Zhuru (Bambusae Caulis in Taenia). (Referencing Ye Tianshi's medical cases above)