盖闻坤土主湿，湿土寄旺四季，而春夏为甚，季夏为尤甚。人知避风寒，不知避湿。能
避风寒，不能避湿者，以风寒伤人显而急，湿伤人隐而缓。隐则莫见，而受之也深；缓则不
觉，而发之也迟。湿生于土，本气属阴，阴为寒湿，后乃渐化为湿热。然阴气必得阳气而后
升，所以盛夏热甚湿生，万物皆润，溽暑蒸淫，自下而上，升于太虚，为云雾雨露，则湿之
化气，又为阴中之阳。阴中之阳，为湿热。为温病，湿热、温病，固同气异名者。湿热为病
，湿与热犹分为二；温病，湿与热直合为一，湿中有热，热中有湿，浊热粘腻，故谓之温。
治之者，须要分别为本气，为化气，为分邪，为合邪，为外感，为内伤；于外感中，又须分
别兼风、兼寒、兼暑之因；于外感、内伤中，又须分别湿多、热多、化燥、化火之变。
伤人身天气、地气之次第，入气分、血分之浅深。大抵湿之化气，多从上受，邪自口鼻
吸入，故先伤天气，次及地气。经曰∶伤于湿，首如裹。又曰∶湿上甚为热，是也。湿之本
气多从内受，总由脾肾阳虚，不能化水所致，故先伤地气，后及天气。经曰∶诸湿肿满，皆
属于脾。又曰∶肾主水，肾为胃关，关门不利，故聚水而从其类，是也。湿之本气，又或从
外受、下受，伤天气，并及地气。经曰∶风湿之伤人也，气血与邪，并客于分腠之间；寒湿
之伤人也，皮肤不收，肌肉坚固，营血涩，卫气去。又曰∶阴受湿气。又曰∶伤于湿者，下
先受之。又曰∶地之湿气，感则害人皮肉筋骨，是也。
夫皮肤、肌肉、经络、筋骨，虽有形质，属地，而其空窍之营运，实皆天气主之，此天
包乎地之说也。界乎人身天地之间者，则有膈膜。膈膜之下，肝、胆布焉，三焦（右肾旁三
焦腑。）之经脉行焉，相火寄于肝、胆。湿邪伤肺、脾、胃之表，（肺之表，皮肤也；脾之表，
四
里
下行，肝、胆、三焦适当其冲，上下为邪所阻，不得遂其条达之机，其所寄之相火，必与湿
热同升为病，而见寒热往来、耳聋、口苦、干呕、胁痛、停饮、膈痛等证。居乎人身前后之
间
盖湿土郁蒸之气，湿中有热，热中有湿，其秽浊粘腻之邪，由地而上，从口鼻传入，直趋中
道，流布三焦，故膜原为藏邪之渊薮，伏邪多发于此焉。（邪伤毛窍经络之表与脏腑之里，皆
随感随发，惟膜原空隙，如夹墙腹里一般，最易藏邪，超时乃发，名曰伏邪。温，伏邪也。
金之刘守真论温病主三焦，明吴又可又于三焦中揭出膜原。膜原本自《灵枢经》，二公之论
，皆独超千古。）伏邪往往因风寒而发，得药开通肺气，在经之邪，从汗而解，暂觉病退，
而半日一日之间，忽然转重。此无他，膜原湿热互酿之邪，从中而作。斯时也，必视其所传
而药之。传表则从汗解；邪气遏伏重者，则从斑疹解；传里则根据附胃肠糟粕，必从大便解。
湿为浊邪，以浊归浊，故传里者居多。药之邪退，迟一二日，复作复传，反复循环，往往经
屡下而邪始尽，吴氏又可所谓九传是也。其进锐者其退速，其进缓者其退迟；在春夏发者退
速，在秋冬发者俱迟。愈期速者，两候（五日为一候）三候，迟者五七候不等。凡温病及伏暑
晚发，暑湿疟、痢，多见如此，虚者尤甚。请析言之。湿之化气，为阴中之阳，氤氲浊腻，故兼证最多，变迁最幻，愈
期最缓。其见证也，面
色混浊如油腻，口气浊腻不知味，或生甜水，舌苔白腻，膜原邪重则舌苔满布，浓如积粉，
板贴不松，脉息模糊不清，或沉细似伏，断续不匀，（脉为邪遏，有似虚寒之象，误治为害非
轻。）神多沉困嗜睡。斯时也，邪在气分，即当分别湿多热多。湿多者，无烦渴热象，天气
为湿阻遏，不能外达下行，则必凛凛恶寒，甚而足冷，头目胀痛昏重，如裹如蒙，身痛不能
屈伸，身重不能转侧，肢节肌肉疼而且烦，腿足痛而且酸。胸痞者，湿闭清阳道路也；午后
寒热，状若阴虚者，申、酉、戌时，金气主令，又湿邪本旺于阴分也；小便短涩黄热者，肺
不能通调水道，下输膀胱，天气病地气因而不利也；大便溏而不爽，或濡泻者，肺与大肠相
表里，心与小肠相表里，天气病地气因而不调也。
治法总以轻开肺气为主，肺主一身之气，气化则湿自化，即有兼邪，亦与之俱化。湿气
弥漫，本无形质，宜用体轻而味辛淡者治之，辛如杏仁、蔻仁、半夏、浓朴、藿梗，淡如苡
仁、通草、茯苓、猪苓、泽泻之类。启上闸，开支河，导湿下行以为出路，湿去气通，布津
于外，自然汗解。经曰∶水郁折之。谓水上泛，折回而使之下也。贾真孙曰∶治湿不利小便
，非其治也。兼风者，汗出、恶风；兼寒者，恶寒、无汗。前法酌加苏梗、桔梗、豆豉、葱
白、生姜之类。邪在经络，一身掣痛，酌加桂枝、水炒防己、秦艽之类，以开毛窍经络之壅
。兼暑者，面赤、口渴、心烦，前法去蔻仁，酌加扁豆花、鲜荷叶清香辟秽，连翘、山栀、
滑石轻清微苦淡渗，以解暑湿热之结。热多者，及湿热合邪病温者，前论气色苔脉诸证毕见
，更加神烦、口渴，亦用前辛淡法，酌加芦根、淡竹叶、滑石轻淡辛凉之类，清金泄热。肺
得清肃之权，自能化湿热于无何有之乡。肺是人身天气，天气下降，浊邪焉有不降之理？或
从汗解，或从小便解。湿热内郁时，溺赤而清；湿热下注，则溺赤而浑。湿热治肺，千古定
论也。余氏春山曰∶阳为湿郁，不能外达下行，每见恶寒、足冷，若拘伤寒恶寒之说，投以
温散，其寒反甚，但用芦根、灯草甘淡通阳利窍，滚煎热服，下咽即觉热从外达，津津汗出
而解。屡验不爽，此其证也。其有初起神烦而昏者，此湿热郁蒸过极，内蒙清窍，前辛凉淡
法去蔻仁、浓朴，加细辛二三分、白芥子钱许，辛润行水开闭，合之芦根、滑石等味，轻清
甘淡，泄热导湿，蒙蔽即开，亦屡验不爽。若初起神智模糊，不能言语，舌苔白腻，无热象
者，此寒燥之气搏遏水湿，内蒙清窍。急用辛开淡渗法，如杏仁、牛蒡、桔梗、芥子、细辛
、通草、茯苓、泽泻之类。其辛香辛燥升散诸品，切勿沾唇，即生姜辛润不燥，亦不可用，
以其性升故也。红糖甘缓填中，糜粥浓浓腻邪，均在禁例。愈后亦须忌一二日。此病与痧麻、
霍乱，治法、宜忌皆同。其大便不利者，用蒌皮、薤白辛滑流利气机，气机一开，大便自解
，即汗亦自出，随证均可加入。假使不知湿家忌汗、忌升，汗则亡阳，升则上蔽；闭证忌燥
、忌升，燥则闭而且结，升则蒙而益蒙。误以头身疼痛、恶寒、无汗、隐疹而用升散，如薄
荷、苏叶、荆芥、防风、羌、独活等味；误以湿蒙清窍，痧麻、霍乱诸闭证，而用藿香叶、
香薷
蔽，而药复升之、燥之，必致未闭者闭，已闭者益闭，轻则多言谵语，重则神昏、烦躁，内
窍闭极，则目瞑不言，目睛频转；亦必致肝、胆、三焦少火化为壮火，耳聋、干呕，甚则痉
厥；又必致邪走皮肤肌肉，发疹发斑。兹不具论，论其化热。其化热也，气分邪热，郁遏灼
津，尚未传入血分，面色红黄黑混，口气秽浊，舌苔黄腻，舌之边尖红紫欠津，或底白罩黄
，混浊不清，重者浓而且满，板贴不松，脉息数滞不调，神烦口渴。湿邪化热，多见此象；
湿热合邪病温，初起时亦见此象。宜用前辛凉淡法，加以微苦，如连翘、山栀之类，或加姜
水炒木通之苦辛，内通外达，表里两彻，以冀汗解。湿热交合，加半夏、姜水炒黄芩，重者
加姜水炒黄连三四分，苦辛通降；渐欲化燥，加知母清滋肺金。肺气为湿热郁蒸，不能敷布
水精外达下行，必见烦渴、多汗、斑疹、停饮等证。如热汗时出，大渴引饮，轻者用前辛凉
微苦法，加花粉、银花之类；重者用白虎汤，辛凉重剂，清肺泄热，虚者加南沙参。盖湿热
清肺，如溽暑炎蒸，金风骤起，顷刻湿收热退，如登清凉界中。其邪走皮肤发疹，邪走肌肉
发斑，隐隐不见者，用杏仁、牛蒡、桔梗、蒌皮、大贝、银花、连翘、淡竹叶、通草之类，
辛凉开达；最忌多用辛燥，如苏叶、薄荷、荆芥、柴胡之类。斑疹已出，热重者，用白虎汤
酌加元参、银花、芦根以化之。其饮停胸膈者，必见胸膈闷痛、心烦、干呕、渴欲饮水、水
入则吐等证。斯时须辨舌苔，如舌苔白腻，则属饮重，热因饮郁而生，宜辛淡化饮。辛能行水
，辛润
，或用五苓散；清淡如滑石、淡竹叶、芦根之类。如饮热并重，湿热与气互结，舌苔黄腻，
宜苦辛通降，佐以淡渗，如小陷胸汤、半夏泻心汤，去参、草、大枣，以姜汁炒芩、连代干
姜，加通草、茯苓、栝蒌皮、薤白等味；黄芩滑石汤、杏仁滑石汤、黄连温胆汤，均可选用
。湿热遏郁肝、胆、三焦经脉，耳聋、干呕者，亦宜用上法苦辛开化。胁痛及欲痉者，加鳖
甲、石决明、牡蛎以咸降之，既能柔肝，又能化湿，两不相悖。邪传心包，神昏谵烦，亦须
辨舌苔，如舌苔黄腻，仍属气分湿热，内蒙包络，与前同一病因，宜用半夏泻心、陷胸等汤
，或用杏仁、芥子、姜水炒木通、盐水炒黄连、连翘、滑石、芦根、淡竹叶、栝蒌皮之类，
辛润以通之，咸苦以降之，清淡以泄之，其湿热浊邪自化，其闭自开。凉膈散亦可间用（妙
在用散），宁上丸、普济丹亦效。更有邪传包络，化燥伤阴，神昏谵妄，舌赤无苔，此证与
前证同一神昏，而虚实相反。前系舌苔黄腻，湿热明征；此系舌赤无苔，伤阴确据。斯时用
药，最要空灵。神昏为内闭之象，闭则宜开，心宫乃虚灵之所，虚则忌实。宜犀角、鲜地黄
、连翘、银花、郁金、鲜石菖蒲、芦根、梨汁、竹沥，和姜汁少许，滚煎热服。再用宁上丸
或普济丹，开闭养阴，较牛黄至宝尤胜。地黄用鲜者，取其滑利。少加姜汁，凉药热饮，取
其流通，此即阴阳开阖之理。芦根尤宜多用，轻清甘淡，两清金水，又能泄热化湿，从膀胱
而解。如此治法，断无不效之理。心宫之邪，本属郁蒸之气，无质无形，最忌一派苦寒冰伏
，阴柔浊腻，如三黄解毒、三黄地冬、犀角地黄、清营、清宫等汤，集而用之，有阖无开，
毫无方义。今时习俗，尤误于温病伤阴之说，不知气分热郁灼津之理，每见舌绛，便用大剂
阴柔，是浊热已遏上焦气分，又用浊药，两浊相合，逼令邪气深入膏肓，深入骨髓，遂成锢
结不解之势。又或舌苔黄腻，明系气分湿热熏蒸，法宜苦辛开化，乃不用开化，而用大剂凉
药，如三黄、白虎、三石、玉女煎之类，有阖无开，亦足逼令邪气深伏，邪伏则胃气不得
上升，舌苔因之亦伏，转成舌绛无苔；见其舌绛无苔，又用犀角地黄、清宫、增液诸汤，更
令邪气深伏，药愈清滋，舌肉愈燥、愈赤、愈黑，甚至音哑，神昏窍闭。斯时若邪在心包，
势
稍缓。二者均属难救。于难救之中而求救法，其邪闭心包者，酌用连翘、银花、芦根、梨汁
、竹沥、姜汁、鲜石菖蒲之类，和宁上、普济丹丸以开之。邪入肝肾，神智尚清者，用复脉
汤之类，屡进而垫托之，阴液托足，传送邪气，由里还表，从战汗而解（邪盛正虚，故汗必
先战）。又有神昏、谵烦，舌苔黄燥、黑燥，而有质地，此胃肠实邪，地气壅闭，天气因之
亦闭，宜承气汤急下其邪，以决壅闭。阴虚者，加鲜生地、元参、芦根清轻滑利之品，滋燥
养阴足矣。若阴柔滋腻药多，虽用大黄，亦恐不解，是滋阴转致伤阴也。湿热化气，病患之
天气及膈膜、肝、胆、三焦者如此。
湿热病天气，若脾肾不虚，即从天气而化，不致内传；若脾肾素虚，或误于药，或膜原
之邪本重，皆令内传。邪既内传，不能还表，即从里治；从里治，最要辨其人之体质阴阳、
湿多热多，即可知虚实之分。若其人色白而肥，肌肉柔脆，素有寒湿，此金水之质，其体属
阴，湿邪不易化热，多病太阴脾土。病脾土，则舌苔腐白，或底白灰滑，见证多胸痞脘闷、
不饥、不食、不便，或大便溏滑；或湿郁为热，走入肌肉，发为阴黄，黄而昏暗，如熏黄色
，而无烦渴热象，或渐次化热，舌苔黄滑，口干而不多饮。其未化热者，宜苦辛淡温法，如
除湿汤、吴氏加减正气散之类；已化热者，宜苦辛淡清法，如加减正气散加清药、温胆汤
、清热渗湿汤之类。发黄，酌加茵陈、黄柏、栀子之类。斯病也，若误以脘闷等证为食滞，
而消之、下之，则脾阳下陷，湿邪内渍，转成洞泄、胀满诸病，如是则又当急救脾肾之阳，
用寒湿门方法治之。若其人苍赤而瘦，肌肉坚实，素有湿热、肝热，此木火之质，其体属阳
，湿邪最易化热，多病阳明胃土。病胃土，又要分别有形质与无形质，若无形湿热，与气相
搏，舌苔黄滑而无质地，或有质地而黄腻，见证多呕逆、心烦、口渴、间有谵语、胸脘痞闷
，按之不痛；或湿热瘀遏，走入肌肉，发为阳黄，黄而鲜明，如橘皮色。法宜苦辛通降，如
听说坤土主司湿气，湿土之气寄旺于四季之中，而在春夏两季尤为显著，在长夏（季夏）时最为严重。人们只知道躲避风寒，却不知道躲避湿气。能够躲避风寒，却难以躲避湿气的原因在于：风寒伤人表现得明显而急骤，湿气伤人则隐蔽而缓慢。因为隐蔽所以看不见，但侵入人体后病位较深；因为缓慢所以没有感觉，但发病时间较迟。湿气生于土，其本气属于阴，阴气表现为寒湿，随后逐渐转化为湿热。然而阴气必须得到阳气的推动才能上升，所以在盛夏炎热之时湿气滋生，万物滋润，闷热潮湿，湿气自下而上，升腾于高空，形成云雾雨露，这时湿气的变化之气，又成为了“阴中之阳”。所谓“阴中之阳”，就是湿热。湿热与温病，本质上是同一种气机，只是名称不同。在湿热为病时，湿与热还可以分为两部分；而在温病中，湿与热直接合二为一，湿中有热，热中有湿，浊热粘腻，所以称为“温”。治疗时，必须分别辨别它是本气还是化气，是单独的邪气还是复合的邪气，是外感还是内伤；在外感中，又须分别是否兼有风、寒、暑的因素；在外感和内伤中，又须分别湿多还是热多，以及是否化燥或化火的变化。
这涉及伤害人身天气和地气的先后次序，以及进入气分和血分的深浅程度。大抵湿气的变化之气，多从上部受邪，邪气通过口鼻吸入，所以先伤害天气，其次波及地气。《内经》说：“伤于湿，头部像被包裹一样沉重。”又说：“湿气在上部严重会导致发热”，说的就是这个道理。湿气的本气多从内部受邪，总归是由于脾肾阳气虚弱，不能运化水液所致，所以先伤害地气，后波及天气。《内经》说：“各种湿证引起的肿胀痞满，都归属于脾。”又说：“肾主水，肾是胃的关口，如果关门不利，就会聚水并伴随同类邪气聚集”，说的就是这个道理。湿气的本气，有时也从外部、下部受邪，既伤害天气，也波及地气。《内经》说：“风湿伤人，气血与邪气共同客居在分肉腠理之间；寒湿伤人，皮肤松弛不收，肌肉坚实，营血涩滞，卫气离去。”又说：“阴经受湿气侵袭。”又说：“伤于湿的人，下部先受邪。”又说：“地的湿气，感应到就会伤害人的皮肉筋骨”，说的就是这个道理。
皮肤、肌肉、经络、筋骨，虽然是有形质的物质，属于地，但它们空窍的气机运行，实际上都由天气所主宰，这就是“天包乎地”的说法。介于人身天地之间的，是膈膜。膈膜之下，分布着肝和胆，三焦（位于右肾旁的三焦腑）的经脉行走其中，相火寄居于肝和胆。当湿邪伤害肺、脾、胃的体表时，（肺的体表是皮肤；脾的体表是肌肉），邪气向下行，肝、胆、三焦正处在邪气冲击的要冲位置，上下被邪气阻滞，无法实现条达舒展的气机，其所寄居的相火，必然与湿热一同上升致病，从而出现寒热往来、耳聋、口苦、干呕、胁痛、停饮、膈痛等症状。
至于处于人身前后之间的部位，即膜原。盖因湿土郁蒸之气，湿中有热，热中有湿，这种秽浊粘腻的邪气，由地而上，从口鼻传入，直趋中道，流布于三焦，所以膜原是藏匿邪气的渊薮，伏邪多发于此。（邪气伤害毛窍经络之表与脏腑之里，都是随感随发，只有膜原空隙，如同夹墙腹里一般，最容易藏邪，超过一定时间才发作，称为伏邪。温病，就是伏邪。金代刘守真论温病主张从三焦论治，明代吴又可又在三焦中提出膜原。膜原本出自《灵枢经》，这两位先生的论述，都超越千古。）伏邪往往因风寒诱发，服用药物开通肺气后，在经的邪气随汗而解，暂时觉得病退，但在半天或一天之间，忽然病情加重。这没有别的原因，是因为膜原中湿热互结酿生的邪气，从中作祟。这个时候，必须视邪气传变的情况用药。邪气传向表，则从汗解；邪气遏伏严重的，则从斑疹解；邪气传向里，则依附胃肠糟粕，必须从大便解。湿是浊邪，以浊归浊，所以传里的情况居多。药力使邪气退去，过一两天，病情复发并再次传变，反复循环，往往经过多次攻下邪气才能除尽，这就是吴又可所说的“九传”。其进展迅猛的，消退也快；进展缓慢的，消退也慢；在春夏季发作的，消退快；在秋冬季发作的，消退都慢。痊愈期快的，经过两候（五日为一候）或三候，慢的则需要五七候不等。凡是温病及伏暑晚发，暑湿疟疾、痢疾，多见这种情况，体虚者尤其严重。请详细分析。湿气的变化之气，属于阴中之阳，氤氲浊腻，所以兼证最多，变化最幻莫测，痊愈期最慢。其见证表现，面色浑浊如油腻，口气浊腻不知味，或者口中生甜水，舌苔白腻，膜原邪重则舌苔满布，浓厚如积粉，板贴不松，脉象模糊不清，或沉细似伏，断续不匀，（脉象因邪气遏制，有类似虚寒的现象，误治危害非轻。）神志多沉困嗜睡。这个时候，邪在气分，就应当分别湿多还是热多。湿多的，没有烦渴热象，天气被湿阻遏，不能外达下行，则必定凛凛恶寒，甚至足冷，头目胀痛昏重，像被包裹蒙蔽一样，身体疼痛不能屈伸，身体沉重不能转侧，肢节肌肉疼痛且烦躁，腿足疼痛且酸楚。胸脘痞闷的，是湿邪闭塞了清阳上升的道路；午后寒热，状若阴虚的，是因为申、酉、戌时，金气主令，且湿邪本旺于阴分；小便短涩黄热的，是肺不能通调水道，下输膀胱，天气病导致地气因而不利；大便溏而不爽，或濡泻的，是肺与大肠相表里，心与小肠相表里，天气病导致地气因而不调。
治疗方法总以轻开肺气为主，肺主一身之气，气化则湿自化，即使有兼邪，也会随之化解。湿气弥漫，本来无形质，宜用体轻而味辛淡的药物治之，辛味的如杏仁、蔻仁、半夏、厚朴、藿梗，淡味的如苡仁、通草、茯苓、猪苓、泽泻之类。开启上闸，开支河，引导湿邪下行作为出路，湿去气通，布津于外，自然汗解。《内经》说：“水郁折之。”意思是水上泛，折回使其下行。贾真孙说：“治湿不利小便，不是正确的治法。”兼风的，汗出、恶风；兼寒的，恶寒、无汗。在前法基础上酌加苏梗、桔梗、豆豉、葱白、生姜之类。邪在经络，全身掣痛，酌加桂枝、水炒防己、秦艽之类，以开通毛窍经络的壅滞。兼暑的，面赤、口渴、心烦，前法去掉蔻仁，酌加扁豆花、鲜荷叶清香辟秽，连翘、山栀、滑石轻清微苦淡渗，以解暑湿热之结。热多的，以及湿热合邪病温的，前述气色苔脉诸证毕现，更加神烦、口渴，也用前辛淡法，酌加芦根、淡竹叶、滑石轻淡辛凉之类，清金泄热。肺得到清肃的权能，自然能在无何有之乡化除湿热。肺是人身天气，天气下降，浊邪焉有不降的道理？或从汗解，或从小便解。湿热内郁时，尿赤而清；湿热下注，则尿赤而浑。湿热治肺，是千古定论。余氏春山说：阳气被湿郁遏，不能外达下行，每见恶寒、足冷，如果拘泥于伤寒恶寒的说法，投以温散药，其寒反而更甚，只用芦根、灯草甘淡通阳利窍，滚煎热服，下咽即觉热从外达，津津汗出而解。屡验不爽，这就是该证。初起神烦而昏的，这是湿热郁蒸过极，内蒙清窍，前辛凉淡法去掉蔻仁、厚朴，加细辛二三分、白芥子钱许，辛润行水开闭，合之芦根、滑石等味，轻清甘淡，泄热导湿，蒙蔽即开，也屡验不爽。若初起神智模糊，不能言语，舌苔白腻，无热象的，这是寒燥之气搏遏水湿，内蒙清窍。急用辛开淡渗法，如杏仁、牛蒡、桔梗、芥子、细辛、通草、茯苓、泽泻之类。那些辛香辛燥升散的诸品，切勿沾唇，即使是生姜辛润不燥，也不可用，因为其性升的缘故。红糖甘缓填中，糜粥浓浓腻邪，均在禁忌之列。愈后也须忌口一二日。此病与痧麻、霍乱，治法、宜忌皆同。大便不利的，用瓜蒌皮、薤白辛滑流利气机，气机一开，大便自解，即汗亦自出，随证均可加入。假使不知道湿家忌汗、忌升，汗则亡阳，升则上蔽；闭证忌燥、忌升，燥则闭而且结，升则蒙而益蒙。误以头身疼痛、恶寒、无汗、隐疹而用升散药，如薄荷、苏叶、荆芥、防风、羌活、独活等味；误以湿蒙清窍，痧麻、霍乱诸闭证，而用藿香叶、香薷等药，不仅不能开闭，反而升之、燥之，必致未闭者闭，已闭者益闭，轻则多言谵语，重则神昏、烦躁，内窍闭极，则目瞑不言，目睛频转；也必致肝胆、三焦少火化为壮火，耳聋、干呕，甚则痉厥；又必致邪走皮肤肌肉，发疹发斑。这里不详论，只论其化热。其化热时，气分邪热，郁遏灼津，尚未传入血分，面色红黄黑混杂，口气秽浊，舌苔黄腻，舌之边尖红紫欠津，或底白罩黄，混浊不清，重的浓而且满，板贴不松，脉象数滞不调，神烦口渴。湿邪化热，多见此象；湿热合邪病温，初起时也见此象。宜用前辛凉淡法，加以微苦，如连翘、山栀之类，或加姜水炒木通之苦辛，内通外达，表里两彻，以冀汗解。湿热交合，加半夏、姜水炒黄芩，重的加姜水炒黄连三四分，苦辛通降；渐欲化燥，加知母清滋肺金。肺气为湿热郁蒸，不能敷布水精外达下行，必见烦渴、多汗、斑疹、停饮等证。如热汗时出，大渴引饮，轻的用前辛凉微苦法，加花粉、银花之类；重的用白虎汤，辛凉重剂，清肺泄热，虚者加南沙参。盖湿热清肺，如溽暑炎蒸，金风骤起，顷刻湿收热退，如登清凉界中。其邪走皮肤发疹，邪走肌肉发斑，隐隐不见的，用杏仁、牛蒡、桔梗、瓜蒌皮、大贝、银花、连翘、淡竹叶、通草之类，辛凉开达；最忌多用辛燥，如苏叶、薄荷、荆芥、柴胡之类。斑疹已出，热重的，用白虎汤酌加元参、银花、芦根以化之。其饮停胸膈的，必见胸膈闷痛、心烦、干呕、渴欲饮水、水入则吐等证。此时须辨舌苔，如舌苔白腻，则属饮重，热因饮郁而生，宜辛淡化饮。辛能行水，辛润，或用五苓散；清淡如滑石、淡竹叶、芦根之类。如饮热并重，湿热与气互结，舌苔黄腻，宜苦辛通降，佐以淡渗，如小陷胸汤、半夏泻心汤，去参、草、大枣，以姜汁炒芩、连代干姜，加通草、茯苓、瓜蒌皮、薤白等味；黄芩滑石汤、杏仁滑石汤、黄连温胆汤，均可选用。湿热遏郁肝胆、三焦经脉，耳聋、干呕的，也宜用上法苦辛开化。胁痛及欲痉的，加鳖甲、石决明、牡蛎以咸降之，既能柔肝，又能化湿，两不相悖。邪传心包，神昏谵烦，也须辨舌苔，如舌苔黄腻，仍属气分湿热，内蒙包络，与前同一病因，宜用半夏泻心、陷胸等汤，或用杏仁、芥子、姜水炒木通、盐水炒黄连、连翘、滑石、芦根、淡竹叶、瓜蒌皮之类，辛润以通之，咸苦以降之，清淡以泄之，其湿热浊邪自化，其闭自开。凉膈散亦可间用（妙在用散），宁上丸、普济丹亦效。更有邪传包络，化燥伤阴，神昏谵妄，舌赤无苔，此证与前证同一神昏，而虚实相反。前系舌苔黄腻，湿热明征；此系舌赤无苔，伤阴确据。此时用药，最要空灵。神昏为内闭之象，闭则宜开，心宫乃虚灵之所，虚则忌实。宜犀角、鲜地黄、连翘、银花、郁金、鲜石菖蒲、芦根、梨汁、竹沥，和姜汁少许，滚煎热服。再用宁上丸或普济丹，开闭养阴，较牛黄至宝尤胜。地黄用鲜者，取其滑利。少加姜汁，凉药热饮，取其流通，此即阴阳开阖之理。芦根尤宜多用，轻清甘淡，两清金水，又能泄热化湿，从膀胱而解。如此治法，断无不效之理。心宫之邪，本属郁蒸之气，无质无形，最忌一派苦寒冰伏，阴柔浊腻，如三黄解毒、三黄地冬、犀角地黄、清营、清宫等汤，集而用之，有阖无开，毫无方义。今时习俗，尤误于温病伤阴之说，不知气分热郁灼津之理，每见舌绛，便用大剂阴柔，是浊热已遏上焦气分，又用浊药，两浊相合，逼令邪气深入膏肓，深入骨髓，遂成锢结不解之势。又或舌苔黄腻，明系气分湿热熏蒸，法宜苦辛开化，乃不用开化，而用大剂凉药，如三黄、白虎、三石、玉女煎之类，有阖无开，亦足逼令邪气深伏，邪伏则胃气不得上升，舌苔因之亦伏，转成舌绛无苔；见其舌绛无苔，又用犀角地黄、清宫、增液诸汤，更令邪气深伏，药愈清滋，舌肉愈燥、愈赤、愈黑，甚至音哑，神昏窍闭。此时若邪在心包，势稍缓。二者均属难救。于难救之中而求救法，其邪闭心包的，酌用连翘、银花、芦根、梨汁、竹沥、姜汁、鲜石菖蒲之类，和宁上、普济丹丸以开之。邪入肝肾，神智尚清的，用复脉汤之类，屡进而垫托之，阴液托足，传送邪气，由里还表，从战汗而解（邪盛正虚，故汗必先战）。又有神昏、谵烦，舌苔黄燥、黑燥，而有质地，这是胃肠实邪，地气壅闭，天气因之亦闭，宜承气汤急下其邪，以决壅闭。阴虚的，加鲜生地、元参、芦根清轻滑利之品，滋燥养阴足矣。若阴柔滋腻药多，虽用大黄，亦恐不解，是滋阴转致伤阴也。湿热化气，病患的天气及膈膜、肝、胆、三焦的情况如此。
湿热病的天气，若脾肾不虚，即从天气而化，不致内传；若脾肾素虚，或误于药，或膜原之邪本重，皆令内传。邪既内传，不能还表，即从里治；从里治，最要辨其人之体质阴阳、湿多热多，即可知虚实之分。若其人色白而肥，肌肉柔脆，素有寒湿，此金水之质，其体属阴，湿邪不易化热，多病太阴脾土。病脾土，则舌苔腐白，或底白灰滑，见证多胸痞脘闷、不饥、不食、不便，或大便溏滑；或湿郁为热，走入肌肉，发为阴黄，黄而昏暗，如熏黄色，而无烦渴热象，或渐次化热，舌苔黄滑，口干而不多饮。其未化热的，宜苦辛淡温法，如除湿汤、吴氏加减正气散之类；已化热的，宜苦辛淡清法，如加减正气散加清药、温胆汤、清热渗湿汤之类。发黄，酌加茵陈、黄柏、栀子之类。斯病也，若误以脘闷等证为食滞，而消之、下之，则脾阳下陷，湿邪内渍，转成洞泄、胀满诸病，如是则又当急救脾肾之阳，用寒湿门方法治之。若其人苍赤而瘦，肌肉坚实，素有湿热、肝热，此木火之质，其体属阳，湿邪最易化热，多病阳明胃土。病胃土，又要分别有形质与无形质，若无形湿热，与气相搏，舌苔黄滑而无质地，或有质地而黄腻，见证多呕逆、心烦、口渴、间有谵语、胸脘痞闷，按之不痛；或湿热瘀遏，走入肌肉，发为阳黄，黄而鲜明，如橘皮色。法宜苦辛通降，如……
It is heard that Kun Earth governs dampness, and the damp earth qi thrives in all four seasons, being particularly prominent in spring and summer, and most severe in late summer. People know to avoid wind and cold, but do not know to avoid dampness. The reason one can avoid wind and cold but not dampness is that wind and cold injure the body manifestly and urgently, whereas dampness injures the body insidiously and slowly. Because it is insidious, it is unseen, yet its invasion is deep; because it is slow, it is unnoticed, yet its onset is delayed. Dampness arises from Earth; its original qi belongs to Yin. Yin manifests as cold-dampness, which later gradually transforms into damp-heat. However, Yin qi must obtain Yang qi to ascend. Therefore, in midsummer when heat is intense, dampness is generated, moistening all things. The muggy, steaming dampness rises from below upwards into the great void, forming clouds, mist, rain, and dew. Thus, the transformed qi of dampness becomes "Yin within Yang." This "Yin within Yang" is damp-heat. Damp-heat and warm diseases (Wen Bing) are essentially the same qi with different names. In diseases caused by damp-heat, dampness and heat can still be distinguished as two entities; in warm diseases, dampness and heat merge directly into one. There is heat within dampness, and dampness within heat; this turbid, hot, sticky, and greasy nature is why it is called "warm." Treatment requires distinguishing whether it is the original qi or transformed qi, a separate pathogen or combined pathogen, an external contraction or internal injury. Among external contractions, one must further distinguish whether there are concurrent factors of wind, cold, or summerheat. Among both external contractions and internal injuries, one must distinguish whether dampness predominates or heat predominates, and whether transformation into dryness or fire has occurred.
This involves the sequence of injuring the heavenly qi and earthly qi in the human body, and the depth of entry into the Qi level and Blood level. Generally, the transformed qi of dampness is mostly contracted from above; the pathogen is inhaled through the mouth and nose, thus first injuring the heavenly qi, then affecting the earthly qi. The Classics state: "Injured by dampness, the head feels as if wrapped." It also states: "When dampness is excessive in the upper part, it leads to heat," which refers to this phenomenon. The original qi of dampness is mostly contracted internally, generally due to deficiency of Spleen and Kidney Yang, failing to transform water. Thus, it first injures the earthly qi, then affects the heavenly qi. The Classics state: "All dampness causing swelling and fullness belongs to the Spleen." It also states: "The Kidney governs water; the Kidney is the gate of the Stomach. If the gate is not functioning properly, water accumulates and follows its kind," which refers to this mechanism. The original qi of dampness may also be contracted externally and from below, injuring both heavenly and earthly qi. The Classics state: "When wind-dampness injures humans, Qi and Blood, along with the pathogen, reside together between the muscle intervals and interstices; when cold-dampness injures humans, the skin fails to contract, muscles become firm, Ying Blood becomes stagnant, and Wei Qi departs." It also states: "Yin meridians receive dampness." It further states: "Those injured by dampness receive it first in the lower parts." And again: "Earthly dampness, when encountered, harms the skin, flesh, sinews, and bones," referring to this reality.
Although skin, muscle, meridians, sinews, and bones have form and substance and belong to Earth, their hollow orifices' operation is actually governed by Heavenly Qi. This is the theory of "Heaven enveloping Earth." Between the heaven and earth of the human body lies the diaphragm membrane (Ge Mo). Below the diaphragm, the Liver and Gallbladder are distributed, and the meridians of the San Jiao (Triple Burner, located beside the right kidney) run through. Ministerial Fire (Xiang Huo) resides in the Liver and Gallbladder. When damp pathogens injure the exterior of the Lung, Spleen, and Stomach (the exterior of the Lung is the skin; the exterior of the Spleen is the muscle), the pathogen moves downward. The Liver, Gallbladder, and San Jiao are situated at the critical impact point, blocked above and below by the pathogen, preventing the free flow and spreading of Qi. Consequently, the resident ministerial fire must rise together with damp-heat to cause disease, presenting symptoms such as alternating chills and fever, deafness, bitter taste in the mouth, dry retching, hypochondriac pain, fluid retention, and diaphragmatic pain.
Regarding the area between the front and back of the human body, known as the Membrane Source (Mo Yuan): Due to the stagnating and steaming qi of damp-earth, where dampness contains heat and heat contains dampness, this foul, turbid, sticky, and greasy pathogen rises from the earth, enters via the mouth and nose, heads straight for the central pathway, and spreads throughout the San Jiao. Thus, the Membrane Source is the abyss where pathogens hide, and latent pathogens (Fu Xie) often originate here. (Pathogens injuring the exterior of hair follicles, meridians, and the interior of zang-fu organs usually manifest immediately upon contraction. Only the empty spaces of the Membrane Source, like the cavity within a wall or the abdomen, easily harbor pathogens, manifesting only after a period of time, termed latent pathogens. Warm diseases are latent pathogens. Liu Shouzhen of the Jin Dynasty discussed warm diseases focusing on the San Jiao; Wu Youke of the Ming Dynasty further identified the Membrane Source within the San Jiao. The Membrane Source originates from the *Ling Shu*, and both scholars' theories surpass antiquity.) Latent pathogens often erupt due to wind-cold. After taking medicine to open Lung Qi, the pathogen in the meridians resolves via sweating, giving temporary relief. However, within half a day to a day, the condition suddenly worsens. This is due to the pathogen fermented by the mutual interaction of dampness and heat in the Membrane Source arising from within. At this time, treatment must be guided by the transmission of the pathogen. If transmitting to the exterior, resolve via sweating; if the pathogen is heavily suppressed, resolve via macules and petechiae; if transmitting to the interior, rely on gastrointestinal waste and resolve via defecation. Dampness is a turbid pathogen; returning turbidity to turbidity means transmission to the interior is common. After medicinal action reduces the pathogen, it may recur and transmit after one or two days, cycling repeatedly. Often, multiple purgations are required before the pathogen is fully eliminated, what Wu Youke called the "Nine Transmissions." Rapid progression leads to rapid regression; slow progression leads to slow regression. Those erupting in spring and summer regress quickly; those in autumn and winter regress slowly. Recovery periods vary from two to three pentads (a pentad is five days) for fast cases, to five to seven pentads for slow ones. Such patterns are common in warm diseases, late-onset summerheat-dampness, summerheat-damp malaria, and dysentery, especially in deficient individuals. Let us analyze this in detail. The transformed qi of dampness is Yin within Yang, misty, turbid, and greasy, resulting in the most numerous accompanying syndromes, the most illusory changes, and the slowest recovery. Manifestations include a turbid complexion resembling oil, foul and greasy breath with loss of taste, or sweet saliva in the mouth. The tongue coating is white and greasy; if the pathogen in the Membrane Source is heavy, the coating covers the entire tongue, thick like accumulated powder, tightly adhered and loose. The pulse is vague and unclear, or deep and fine resembling hidden, intermittent and uneven. (The pulse appears similar to deficiency-cold due to pathogen suppression; misdiagnosis causes grave harm.) Spirit is often lethargic and sleepy. At this stage, with the pathogen in the Qi level, one must distinguish whether dampness or heat predominates. In cases of predominant dampness, there are no signs of vexation, thirst, or heat. Heavenly Qi is obstructed by dampness and cannot reach the exterior or descend, leading to distinct aversion to cold, even cold feet, distending and painful heaviness in the head and eyes as if wrapped or covered, body pain preventing flexion and extension, body heaviness preventing turning over, painful and vexing limb joints and muscles, and painful and sore legs and feet. Chest stuffiness indicates dampness blocking the pathway of clear Yang. Afternoon chills and fever resembling Yin deficiency occur because during the Shen, You, and Xu hours, Metal Qi governs, and dampness naturally thrives in the Yin aspect. Short, scanty, yellow, and hot urination occurs because the Lung fails to regulate water passages and transport them down to the Bladder; heavenly Qi pathology causes earthly Qi dysfunction. Loose, unsatisfactory stools or watery diarrhea occur because the Lung and Large Intestine are exterior-interior pairs, and the Heart and Small Intestine are exterior-interior pairs; heavenly Qi pathology causes earthly Qi disharmony.
The general treatment method focuses on lightly opening Lung Qi. The Lung governs the Qi of the whole body; when Qi transforms, dampness transforms itself. Even with concurrent pathogens, they transform together. Dampness is pervasive and originally formless; thus, drugs that are light in texture and pungent-bland in flavor should be used. Pungent herbs include Apricot Seed (Xing Ren), Cardamom Seed (Kou Ren), Pinellia Tuber (Ban Xia), Magnolia Bark (Hou Po), and Agastache Stem (Huo Geng). Bland herbs include Coix Seed (Yi Yi Ren), Tongcao, Poria (Fu Ling), Polyporus (Zhu Ling), and Alisma Rhizome (Ze Xie). Open the upper sluice, branch out rivers, guide dampness downward as an exit route. When dampness leaves and Qi flows, fluids are distributed outward, resolving naturally via sweat. The Classics state: "Obstruction of Water is treated by restraining it." This means water surging upward is restrained and directed downward. Jia Zhen Sun said: "Treating dampness without promoting urination is not correct treatment." For concurrent wind: sweating, aversion to wind. For concurrent cold: aversion to cold, no sweating. Add Perilla Stem (Su Geng), Platycodon Root (Jie Geng), Fermented Soybean (Dou Chi), Scallion White (Cong Bai), and Ginger (Sheng Jiang) to the previous method. For pathogen in meridians causing whole-body pulling pain, add Cinnamon Twig (Gui Zhi), Stephania Root (Fang Ji) stir-fried with water, and Gentian Root (Qin Jiao) to open the congestion of hair follicles and meridians. For concurrent summerheat: red face, thirst, mental restlessness. Remove Cardamom Seed from the previous method; add Dolichos Flower (Bian Dou Hua) and Fresh Lotus Leaf (Xian He Ye) for fragrance and dispelling foulness; Forsythia Fruit (Lian Qiao), Gardenia Fruit (Shan Zhi), and Talcum (Hua Shi) for light, clear, slightly bitter, and bland leaching to resolve summerheat-damp-heat knots. For predominant heat, or damp-heat combining to cause warm disease, where all previous Qi, complexion, coating, and pulse signs are present, plus mental restlessness and thirst, use the previous pungent-bland method. Add Reede Rhizome (Lu Gen), Bamboo Leaf (Dan Zhu Ye), and Talcum (Hua Shi) for light, bland, pungent-cooling effects to clear Metal and drain heat. Once the Lung gains the power of clearing and descending, it naturally transforms damp-heat in the realm of nothingness. The Lung is the heavenly Qi of the human body; as heavenly Qi descends, how can turbid pathogen not descend? It may resolve via sweat or urine. When damp-heat is internally depressed, urine is red and clear; when damp-heat pours downward, urine is red and turbid. Treating damp-heat via the Lung is a timeless principle. Yu Chunshan said: When Yang is depressed by dampness and cannot reach the exterior or descend, aversion to cold and cold feet are often seen. If one rigidly adheres to the concept of aversion to cold in cold damage and uses warming-dispersing drugs, the cold worsens. Instead, use Reede Rhizome (Lu Gen) and Juncus Effusus (Deng Cao) for sweet-bland effects to unblock Yang and open orifices. Boil vigorously and take hot; upon swallowing, heat is felt reaching the exterior, followed by profuse sweating and resolution. This has been verified repeatedly. For initial mental restlessness and confusion, this is extreme damp-heat stagnation internally confusing the clear orifices. Remove Cardamom Seed and Magnolia Bark from the previous pungent-cool-bland method; add Asarum (Xi Xin) 2-3 fen and White Mustard Seed (Bai Jie Zi) 1 qian. Use pungent-moist properties to move water and open blockage, combined with Reede Rhizome and Talcum for light, clear, sweet-bland heat-draining and damp-guiding effects, opening the confusion. This is also verified. If initially confused spirit and inability to speak occur with white-greasy tongue coating and no heat signs, this is cold-dry qi constraining water-dampness, internally confusing the clear orifices. Urgently use pungent-opening and bland-leaching methods, such as Apricot Seed (Xing Ren), Bullace Seed (Niu Bang), Platycodon Root (Jie Geng), Mustard Seed (Jie Zi), Asarum (Xi Xin), Tongcao, Poria (Fu Ling), and Alisma Rhizome (Ze Xie). Do not touch pungent-aromatic, pungent-dry, or ascending-dispersing herbs. Even Ginger (Sheng Jiang), though pungent-moist and not dry, is forbidden due to its ascending nature. Brown sugar is sweet-slow and fills the middle; thick porridge is greasy and cloying; both are prohibited. Avoidance is necessary for one or two days after recovery. This disease shares treatment methods and prohibitions with sand-rash and cholera. For constipation, use Trichosanthes Peel (Lou Pi) and Allium Macrostem (Xie Bai) for pungent-slippery Qi-moving effects. Once Qi moves, stool resolves spontaneously, and sweat may also appear; these can be added according to syndrome. If one does not know that dampness patients prohibit sweating and ascending, sweating leads to Yang collapse, and ascending leads to upper obstruction; closed syndromes prohibit drying and ascending, as drying causes closure and knotting, and ascending increases confusion. Mistaking head/body pain, aversion to cold, no sweat, and hidden rash for indications to use ascending-dispersing herbs like Mint (Bo He), Perilla Leaf (Su Ye), Schizonepeta (Jing Jie), Saposhnikovia Root (Fang Feng), Notopterygium Root (Qiang Huo), and Cyathula Root (Du Huo); or mistaking damp-confused clear orifices and closed syndromes of sand-rash/cholera for indications to use Patchouli Leaf (Huo Xiang Ye) and Mosla Herb (Xiang Ru)... [Text cuts off]