伤湿舌白肢冷，腕痛欲呕，脉弦而小，此冷湿
伤脾。宜用理中汤去术，加半夏、益智、吴萸、附
子等味，扶阳泄湿也。
(1)肢：原作"腕"，又不妥，据注义改。
上条脾阳内虚，湿自外侵;此条脾阳不足，湿自内壅。
故并无寒热身疼，但见腕痛肢冷，舌白脉缓。若非辛温健
脾，湿何由解，故用理中汤以运中阳，去术恐其壅滞，加
半夏、益智则通阳，吴萸则泄浊，寒甚者再加附子温之。
伤湿发热微寒，舌黄溺赤，口渴不食，身倦脉
大，汗多气泛，此阳湿伤胃。宜用鲜佩兰、鲜藿香、
鲜石斛、鲜荷叶、六一散、芦根、淡竹叶等味，理
湿清热也。
前条阴湿伤脾，例宜温散。此条阳湿伤胃，必由多食煎
炙，恣情酒色，致阴虚胃热，值暑湿之令，内外燔蒸。故
外无头痛身疼，内无呕恶胸闷，但见发热，而略似恶寒。直
至舌黄溺赤，口渴不食，势已燎原，兼之身倦脉大，汗多气
泛，皆阴虚阳亢之候。故用佩兰、荷叶、藿香、石斛，俱取
鲜者，得气轻力薄以却热邪，犹恐拘留不解，再兼六一，芦
根、竹叶清之利之。此法既不伤正，又能祛邪，舍此而技滋
腻，恐反增剧矣。
伤湿肢体倦怠，嗜卧不食，舌腻便溏，脉虚无
力，此气虚挟湿。宜用东垣清暑益气汤，升清降浊
凡人中气素馁，湿邪易蕴，至夏则大气开泄，不克支
持，忽而肢体倦怠，嗜卧不食。经云：伤于湿，则身重不
举。又云，脾病则脸(1)涩、嗜卧。且舌腻便溏，脉虚无力，
皆脾衰湿盛之症。故用参、祗，术、甘补中州，葛根，升麻
升清阳，茯苓、泽泻降浊阴，神曲、麦芽疏脾气，兼之麦冬
清心，五味敛肺，合升降疏补俱备，而并力补土，又能清热
敛液者也。此东垣先师化裁制方之妙，岂流俗所能测哉。
伤湿证见舌苔白、四肢发冷，腕部疼痛且想呕吐，脉象弦而细弱，这是寒湿损伤了脾脏。适宜使用理中汤去掉白术，加入半夏、益智仁、吴茱萸、附子等药物，以扶助阳气、渗泄湿气。
(1)“肢”：原文作“腕”，又不恰当，根据注释含义改为“肢”。
上一条讲的是脾阳内部虚弱，湿气从外部侵入；这一条讲的是脾阳不足，湿气从内部壅滞。
所以并没有恶寒发热和身体疼痛的症状，只见到腕痛、四肢发冷、舌苔白、脉象缓。如果不是用辛温的药物健运脾胃，湿气怎么能解除呢？所以用理中汤来运转中焦阳气，去掉白术是担心它导致气机壅滞，加入半夏、益智仁可以通阳，吴茱萸可以泄除浊气，如果寒气特别重，再加附子来温煦。
伤湿证见发热、轻微恶寒，舌苔黄、小便赤红，口渴不想进食，身体疲倦、脉象大，汗多、气息浮泛，这是阳湿损伤了胃腑。适宜使用鲜佩兰、鲜藿香、鲜石斛、鲜荷叶、六一散、芦根、淡竹叶等药物，以调理湿气、清除热邪。
前一条是阴湿损伤脾脏，按照例法适宜用温散的方法。这一条是阳湿损伤胃腑，必定是因为多吃煎炸烤炙的食物，放纵酒色，导致阴虚胃热，正值暑湿当令之时，内外火热蒸腾。所以外部没有头痛身疼，内部没有呕吐恶心胸闷，只见到发热，略微有点像恶寒。直到出现舌苔黄、小便赤红、口渴不食，病势已经像燎原大火一样猛烈，加上身体疲倦、脉象大、汗多气息浮泛，都是阴虚阳亢的表现。所以用佩兰、荷叶、藿香、石斛，都选用鲜品，取其气味轻清、药力薄淡以驱除热邪，还担心热邪拘留不解，再加上六一散、芦根、淡竹叶来清热利湿。这种方法既不损伤正气，又能祛除邪气，如果舍弃此法而改用滋腻的药物，恐怕反而会使病情加重。
伤湿证见肢体倦怠、嗜睡懒动、不想进食，舌苔腻、大便稀溏，脉象虚而无力，这是气虚夹杂湿气。适宜使用东垣清暑益气汤，提升清气、降下浊气。
大凡人平素中气亏虚，湿气容易蕴结，到了夏季，大气开泄，身体不能支撑，忽然出现肢体倦怠、嗜睡不想进食。《内经》说：受湿气伤害，身体沉重难以抬举。又说，脾有病则面色晦涩、嗜睡。而且舌苔腻、大便稀溏、脉虚无力，都是脾衰湿盛的病症。所以用人参、黄芪、白术、甘草补益中焦脾胃，葛根、升麻提升清阳之气，茯苓、泽泻降下浊阴之气，神曲、麦芽疏理脾气，兼用麦冬清心火，五味子收敛肺气，合起来升降疏补俱备，并全力补益脾土，又能清热敛液。这是东垣先师化裁制方的精妙之处，难道是世俗之人所能揣测的吗？
Cold-dampness injury presents with a white tongue coating and cold limbs, pain in the wrists, desire to vomit, and a wiry yet thin pulse. This indicates that cold-dampness is injuring the Spleen (Spleen). It is appropriate to use Lizhong Tang (Cinnamon Twig and Dried Ginger Decoction), removing Atractylodis Rhizoma (Baizhu), and adding Pinelliae Tuber (Banxia), Alpiniae Oxyphyllae Fructus (Yizhi), Evodiae Fructus (Wuyu), and Aconiti Lateralis Radix Praeparata (Fuzi), etc., to support Yang Qi and drain dampness.
(1) "Limbs": The original text reads "wrists," which is inappropriate; it is corrected to "limbs" based on the annotation's meaning.
The preceding paragraph discusses internal deficiency of Spleen Yang with external invasion of dampness; this paragraph discusses insufficiency of Spleen Yang with internal stagnation of dampness.
Therefore, there are no symptoms of aversion to cold, fever, or body ache, but only wrist pain, cold limbs, white tongue coating, and a moderate pulse. If one does not use acrid-warm herbs to strengthen the Spleen and transport fluids, how can the dampness be resolved? Thus, Lizhong Tang is used to move Middle Jiao Yang Qi. Removing Atractylodis Rhizoma (Baizhu) avoids potential stagnation; adding Pinelliae Tuber (Banxia) and Alpiniae Oxyphyllae Fructus (Yizhi) unblocks Yang Qi; Evodiae Fructus (Wuyu) drains turbidity. If the cold is severe, Aconiti Lateralis Radix Praeparata (Fuzi) is added for warming.
Damp-heat injury presents with fever, slight aversion to cold, yellow tongue coating, red urine, thirst, anorexia, fatigue, large pulse, profuse sweating, and floating Qi. This indicates that Yang-dampness is injuring the Stomach (Stomach). It is appropriate to use fresh Eupatorii Herba (Peilan), fresh Agastaches Herba (Huoxiang), fresh Dendrobii Caulis (Shihu), fresh Nelumbinis Folium (Heye), Liuyi San (Six-to-One Powder), Phragmitis Rhizoma (Lugen), and Lophatheri Herba (Zhuye), etc., to regulate dampness and clear heat.
The previous case involved Yin-dampness injuring the Spleen, appropriately treated with warming and dispersing methods. This case involves Yang-dampness injuring the Stomach, likely caused by excessive consumption of fried and roasted foods, indulgence in alcohol and sexual activity, leading to Yin deficiency and Stomach heat. During the season of summer-dampness, internal and external heat steams together. Therefore, there is no headache or body ache externally, nor vomiting, nausea, or chest fullness internally. Only fever is seen, slightly resembling aversion to cold. Until yellow tongue coating, red urine, thirst, and anorexia appear, the condition becomes fierce like a prairie fire. Coupled with fatigue, large pulse, profuse sweating, and floating Qi, these are all signs of Yin deficiency and Yang hyperactivity. Therefore, Peilan, Heye, Huoxiang, and Shihu are used in their fresh forms, taking advantage of their light aroma and mild potency to dispel heat pathogens. Fearing the heat may remain trapped, Liuyi San, Phragmitis Rhizoma (Lugen), and Lophatheri Herba (Zhuye) are added to clear and promote urination. This method neither damages healthy Qi nor fails to eliminate pathogenic factors; abandoning this approach for cloying and greasy herbs would likely exacerbate the condition.
Dampness injury presents with limb fatigue, lethargy, anorexia, greasy tongue coating, loose stools, and a weak, powerless pulse. This indicates Qi deficiency complicated by dampness. It is appropriate to use Dongyuan Qingshu Yiqi Tang (Dongyuan's Clear Summerheat and Boost Qi Decoction) to ascend clear Yang and descend turbid Yin.
Generally, individuals with chronic deficiency of Middle Qi are prone to dampness accumulation. In summer, when atmospheric Qi opens and dissipates, the body cannot sustain itself, suddenly presenting with limb fatigue, lethargy, and anorexia. The Classic states: "Injury by dampness results in heaviness of the body and inability to lift." It also states: "When the Spleen is diseased, the complexion becomes dull, and there is lethargy." Furthermore, greasy tongue coating, loose stools, and a weak, powerless pulse are all symptoms of Spleen decline and abundant dampness. Therefore, Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), and Glycyrrhizae Radix et Rhizoma (Gancao) tonify the Middle Jiao; Puerariae Lobatae Radix (Gegen) and Cimicifugae Rhizoma (Shengma) ascend clear Yang; Poria (Fuling) and Alismatis Rhizoma (Zexie) descend turbid Yin; Massae Fermentatae Medicinalis (Shenqu) and Hordeum Germinatum (Maiya) soothe Spleen Qi; Ophiopogonis Tuber (Maidong) clears Heart Fire; Schisandrae Fructus (Wuweizi) astringes Lung Qi. Together, they provide ascending, descending, soothing, and tonifying effects, focusing on strengthening Earth (Spleen/Stomach), while also clearing heat and preserving fluids. This demonstrates the exquisite art of formula modification by Master Dongyuan, which is hardly conceivable by common practitioners.