黄芩滑石汤、半夏泻心等汤，量加栝蒌以通之。阴虚者，加以育阴。如舌苔黄浓，脉息沉数
，中脘按之微痛不硬，大便不解，此无形湿热与有形渣滓相搏，按之不硬，多似败酱色溏粪
，宜兼用酒煮大黄为丸，缓化而行，重者加熟大黄、元明粉磨荡而行。设使大剂攻下，走而
不守，则必宿垢不行，反行稀水，徒伤正气，变成坏证。若舌苔黄如沉香色，或黄黑而燥，
脉沉实而小，甚者沉微似伏，四肢发厥，或渴喜热饮，此皆里气不通之象，酌用三承气汤急
下之。中脘痞满按痛，邪在胃腑，宜小承气汤。当脐及小腹按痛，邪在小肠，胃脘下口及脐
两旁按痛，邪在大肠，热结旁流，按之硬痛，必有燥矢，均宜调胃承气汤咸苦下之。脘腹均
按痛，痞、满、燥、实、坚悉具，痞满为湿热气结，燥实坚为燥矢，甚则上蒸心包，下烁肝
、肾，烦躁、谵语、舌卷、囊缩，宜大承气汤急下之。阴伤者加鲜生地、元参、知母、芦根
之类足矣。盖速下其邪，即所以存津液也。少腹按痛，大便色黑如漆，反觉易行，其人喜笑
若狂，是肠胃蓄血，上干包络，小便色黑自利，是膀胱蓄血，均宜桃仁承气汤急下之，或合
犀角鲜地黄汤，以清包络。发黄、小便不利、腹满者，茵陈蒿汤下之。其有气虚甚而邪实者
，宜参黄汤；阴亏甚而邪实者，宜护胃承气汤去芒硝，或增液承气汤下之；即虚极不任下者
，宜用鲜生地汁、小生地汁、元参、知母、栝蒌、麻仁、蜂蜜、梨汁，稍加姜汁之类，滑以
去着，辛以润燥。慎勿当下不下，徒用滋腻，俾邪无出路，转致伤阴；亦勿迟回顾虑，致令
失下，虚人尤不可失，失则邪愈盛、正愈衰，后即欲下而不可得矣。更有邪热化燥，伤及肾
阴，旦慧夕剧，面少华色，或邪伤肝之经脉，发痉、发厥，审其有热无结，则又惟有酌用增
液、二甲复脉等汤，养阴托邪而已。又有发黄、小便不利而渴、腹不满者，及热入膀胱，小
便涩痛者，桂苓甘露饮最妙。其或病中遗滑，湿热袭入精窍，小便涩痛者，甘露饮加龟板、石
决明、芦根，一面养阴，一面化湿，两不相悖。湿热化气，病患之地气者又如此。
至于暑，即湿热合邪，酝酿为害，与前证无异。伏暑及伏暑晚发，较春夏温病来势稍缓
，而病实重。初起微寒发热，午后较重，状似疟疾，而不分明；继而但热不寒，热甚于夜，
天明得汗，身热稍退，而胸腹之热不除，日日如是，往往五七候始解。推此病之由，总缘阴
虚之质，夏月汗多伤液，内舍空虚，阳浮于外，暑湿合邪，深踞膜原，夏月伏阴在内，阳邪
处于阴所，相安无事，然虽暂无患，必有焦烦、少寐、饮食少纳，面少华色之象，秋来阳气
渐敛，邪与正争而病作矣。初起邪在气分，必须分别湿多热多，尤须知此病从阴虚而得，邪
热一传阴分，即当以育阴养液托邪为第一义。余前谓阴柔滋腻不可误用者，谓邪在肺经气分
，气为邪郁，不能敷布水精，而见烦渴、舌赤诸燥象，自当轻清开化，若用阴柔，则肺气愈
遏，金不生水，燥必转甚，邪近心宫。邪闭心宫，亦当轻虚开泄，若用阴柔，则心气愈遏，
邪无出路，闭必益甚；邪已传里，即当攻下，若但用阴柔，是扬汤止沸，非釜底抽薪。此皆
不当用而用之者也。余岂谓阴柔养液之不可用乎？况伏暑本由阴虚得乎！虽然，亦自有辨伏暑
有湿
辛淡法，忌用凉药；热多者，舌苔黄滑，或黄腻，脉息细数而遏，口干频饮而不能多，宜用
前辛凉淡法。邪在膈膜上下，乃由表传里之渐，舌苔黄腻而浓，胸痞、脘闷、干呕、心烦、口
渴，乃湿热与气相搏，虽近乎里，却仍在气分，宜用前辛苦通降法。邪传心包，用宁上丸开
法。若传及肝、肾，见有阴虚诸证，即宜加养液，如南北沙参、元参、细生地、麦冬、鲜石
斛、玉竹、龟板、阿胶之类。邪未传里时，寒已退、而热不解者，亦用此法。若邪已传里，
而
多，或虽多而仍觉不爽，宜于辛苦剂中，加熟大黄、栝蒌缓通之，或酒煮大黄为丸缓化之，
往往服一二钱，大解一次，再服再解，不服不解，如此服五七次，行五七次，而邪始尽。非
病者多食之过也，亦非宿滞之多也，乃膜原伏有暑湿，脾胃因散输不力，小肠亦变化机迟，
所进谷食，皆化糟粕，不化津液，所以屡解不尽。暑湿本属浊邪，以浊附浊，胶滞缠绵，焉
能脱然而解？若初起误用辛散，传里又误用峻下，必致亡阴，变成神昏、痉厥、脱厥不救。
其有里邪已尽，热仍不退者，审其舌无多苔，或苔薄而无质地，则一以育阴养液托邪为主，
如北沙参、大生地、玉竹、元参、麦冬、龟板之类。虚甚而神气消索，无热象者，甘凉犹不
中HT ，宜用甘平甘润之剂，如六味地黄汤、复脉汤之类，频进而垫托之，切勿见其不效
，中途易法，致令不救。往往上焦之邪，因中无砥柱，内舍空虚，乘虚内陷，得育阴垫托，
从中、下焦血分，复还气分，发白 而解。白 细小，色白有水，多发于胸腹、缺盆、肩
颈
为阴涸之象。亦有育阴垫托，由里还表，邪从汗解，将欲汗时，脉必浮缓，苔必宣松，汗解
后，舌苔有即退者，有迟一二日始退者，必得苔净、脉静、身凉，舌之两旁生薄白新苔，方
为邪尽。一切外邪、伏邪，均系如此。
更有妇女经水适断、适来，而病温者，热入血室，旦明夕昧，夜更神昏，低声呓语，如
见鬼状，甚有当面与言，若罔闻知，而户外之事，反能闻之见之者，人咸以为怪，而非怪也
。盖肝藏魂，肺藏魄，魄强者魂乃安。今热入血室，血液耗尽，肝为将军之官，最恶血燥，
肝血既燥，又加水竭金枯，肾水不足以涵濡，肺金不足以灌溉，肝遂不能自藏其魂，而飞扬
外越，名曰离魂。离魂则出入无时，故户外之事，皆能闻且见之也。又有病者自觉己身化作
两人并卧者，亦离魂所致。虚劳等证，往往如此。治法一以大剂甘润育阴为主。初病热入血
室，仲景尝用小柴胡汤领邪外出，余尝以青蒿易柴胡，加生地、当归、元参、麦冬养血养阴
，山栀、泽泻导血室之邪，下行膀胱，以为出路。有瘀少腹按痛者，加赤芍、桃仁、鳖甲、
龟板化瘀滋阴；暑未尽者，黄芩、半夏苦辛化邪。最忌攻下，即有实邪，亦必审其舌苔黄燥
而有质地，脘腹按痛，大便不解，或经水适来，邪搏瘀停，少腹板痛，或大便色黑如漆，实
有热结、停瘀见证，方可用桃仁承气汤下之，尤须加生地、当归、元参、麦冬养血滋阴，以
固其本。盖水浅者舟停，水足则舟自行也。妇人产后病温，亦当如此。其有产前病温者，见
有里证，当下则下。盖胎因邪不安，去邪即是安胎，但宜加养血药。
又有暑湿合邪病疟，或伏暑晚发，转为疟疾，此与寻常疟疾不同，脉苔见证，皆与伏暑
无异，但作止有期，病势较减，治法与伏暑无异，亦要分别湿多热多，酌用辛淡、辛凉、辛
苦等剂。按暑湿疟邪，伏于膜原半表半里，与少阳半表半里无涉。今时概用小柴胡汤，不独
不效，往往致肝胆相火与湿热同升为病，而见发呕、发痉、发惊等证。夫伤寒病邪在少阳，
寒热往来，是寒已而热，热已而寒，往来不断，而无止期，故曰“往来”，不曰“来往”。
暑湿疟疾，先寒后热。卫气行于膜原，入于阴争，外无所卫，则恶寒；出与阴争，阴无所护
，则发热。热后汗出即退，是寒来热往，作止有时，与少阳之寒热往来无止期者，大相径庭
。又有一种伏暑疟疾，详载《内经》。经曰∶当暑汗不出者，秋成风疟。又曰∶ 疟皆生于
风。又曰∶夏伤于暑，秋成 疟。又曰∶夏伤于暑，热气盛，藏于皮肤之内，肠胃之外，此
营气之所舍也（此指暑热），令人汗空疏，腠理开，因得秋气，汗出遇风，及得之以浴，水气
舍于皮肤之内，与卫气并居，卫气日行于阳，夜行于阴，此气得阳而外出，得阴而内薄，内
外相薄，是以日作；其气之舍深，内薄于阴，阳气独发，阴邪内着，阴与阳争不得出，是以
间日作。其篇首论蓄作有时，先寒后热。曰∶阴阳上下交争，虚实更作，阴阳相移，阳并于
阴（卫气内行于营），则阴实（卫气在内）而阳虚（卫气内行于营，外无所卫，故虚），阳明虚则
寒栗鼓颔，巨阳（即太阳）虚则腰背头项痛，三阳俱虚则阴气胜，阴气胜则骨寒而痛，寒生于
内，故中外皆寒；阳盛（卫气复出于外）则外热，阴虚则内热，外内皆热，则喘而渴，故欲饮
冷。观暑热伤营、风湿伤卫之说，又与暑湿合邪，深伏膜原者不同。观营气之所舍一语，明
指
可知。古今来谓疟疾但属少阳经病者，一误解于寒热往来，再误解于半表半里。夫寒热往来
，即终而复始之意，已明辨之，再言半表半里。夫少阳经，乃人身两侧面之半表半里；营舍
属经脉，乃皮肤内肠胃外之半表半里；膜原乃人身前后间空隙处之半表半里。部位不同，病
邪亦异，是辨之不可不早辨也。或曰∶脉、苔、证、治当何如？曰∶暑湿合并为浊邪，脉必
模糊，苔必浊腻，寒热作止，不甚分明，治法与伏暑无异。其暑热伤营，风湿伤卫者，是营
分暑热本重，卫分又感风湿，卫气行营，并而后发，脉必浮弦而数，苔必淡白、滑白而不腻
，重者舌肉必深红，先寒后热，寒轻热重，后渐不寒而热。夫浮弦为风象，弦而数乃暑热在
营，为卫分风湿所搏，邪正交争，欲出而不得出之象。治宜桂枝白虎汤，疏卫清营；卫分邪
重者，用桂枝汤，疏卫护营。其当暑汗不出而成疟者，是夏月当风取凉，以水灌汗，逼令暑
邪深入，不复汗而伤于内，脉必浮弦，发时亦必弦数。《脉诀》谓弦为阴脉。弦数不尽属热
，乃营分之邪欲出而不得出之象，苔亦必淡白、滑白而不腻，但舌肉不深红，先寒后热，寒
重热轻，后方转为寒轻热重。治宜桂枝甘草汤疏卫为主，营热卫寒两重者，桂枝汤疏卫护营
，若风寒遏郁卫分，较甚者，用小柴胡汤，领邪出外也可，即用三阳表药，领邪外出亦可。
凡夏月风寒伏暑，秋成痢疾者，虽病各不同，而究其由来，同属暑为凉伏，因秋风而发
，皆从疟例治之，用小柴胡汤亦无不可。喻氏嘉言治痢用小柴胡仓廪汤，逆流挽舟，即此意
也。
又有湿郁成霍乱者，吐泻、腹痛、恶寒、头身均痛，此非寒也，乃湿胜耳！三阴 疟，
亦因湿胜而得，但 疟为湿郁脾经，其势缓；霍乱为湿闭气机，其势急。肺为湿闭，则各脏
腑之本气亦闭，气闭则不能行水，清气不得下行，浊气转而上干，清浊混淆，霍乱乃作；脉
必沉细而遏，甚则沉伏；苔必水白白腻，重者舌肉亦水白而不红活。此病最忌升散温燥以及
甘药，然间有服温药而愈者，乃湿未化热者耳！若屡进必误。夫温燥之品，助浊气上干一也
；六气皆从火化，霍乱泻多亡阴，化燥最速二也。法宜五苓散去苍术，化膀胱之气，以导下
流，尤须加辛通下达之品，以开气闭，气为水母，气开乃能行水。夫辛通下达，无过细辛
，
也
力居多。余屡验不爽，但不宜多用，其功大者，其力必猛，不可不知。
再以外感寒湿言之。寒湿为湿之本气，本气为阴邪。其见证也，恶寒战（身战）栗（心栗）
，周身疼痛，或外邪郁遏内热，疼而且烦，但舌苔白滑，不渴不饮，内无热象，故为寒湿。
必须分别伤表伤里，表虚里虚，化热化燥。表虽属毛窍经脉，而肺实统之；里虽指各脏腑，
而肾实主之。其湿兼风寒伤表也，虽当发汗，但忌发之太猛，犯湿家忌汗之戒。《金匮》云
∶风湿相搏，一身尽痛，法当汗出而解。值天阴雨不止，发其汗，汗大出者，风气去，湿气
在，亦不愈。治风湿者，发其汗，但微微似欲汗出者，风湿俱去也。盖风为阳邪，轻浮易去
；湿为阴邪，凝滞难驱。微微似欲汗出，即经所谓“渍形以为汗”是也。（妙在“渍”字，有
浸润透彻之义）。又曰∶病者一身尽痛，发热，日晡益剧，名风湿。此痛伤于寒，汗出当风
，或久伤取冷所致，可与麻杏苡甘汤。又曰∶湿家身烦疼，可与麻黄加术汤。麻黄加术，缓
中燥湿，一发一补，即微微似欲汗出，风湿俱去之意也。唐宋以后诸方，或不用麻黄，或用
麻黄，并杂用薄荷、苏叶、荆、防、羌、独升燥走窜之甚于麻黄者，皆由于未尝药辨性之故
。夫麻黄诚不可多用，若当用而用，止三四分，则较胜于杂用他药者多矣。即或不用，而以
杏仁、苏梗代之，原无不可，但勿杂用升燥走窜药，致湿邪内蒙包络，变为神昏，下伤肝胆
，变为痉厥，则善矣。书曰∶湿家忌汗，汗多则亡阳（汗为心液，汗多则心液受伤，太阳不
能外卫，故脱）。又曰∶湿家忌汗，发汗则病痉（汗多血耗，肝无所养，故痉）。洵不诬也。
其寒湿伤里也，以利小便为主，最忌误下。《金匮》云∶关节疼痛而烦，脉沉而细，此名湿
痹。小便不利，大便反快，但当利其小便。夫关节烦疼，虽属表湿，郁而生热，而脉沉细，
黄芩滑石汤、半夏泻心汤等方剂，酌情加入栝蒌以疏通气机。若属阴虚体质，则配合使用滋养阴液的药物。如果舌苔黄厚腻，脉象沉而数，中脘部按压时有轻微疼痛但质地不硬，大便不通畅，这是无形的湿热与有形的糟粕相互搏结所致。由于按之不硬，排出的粪便多呈类似败酱色的稀溏状，适宜兼用酒制大黄制成丸药，缓慢化解并推动排泄；病情较重者，可加用熟大黄和元明粉研磨后荡涤积滞。倘若使用大剂量峻猛攻下的药物，药力走而不守，必然导致宿垢无法排出，反而只排出稀水，白白损伤正气，进而演变为坏证（因误治而变生的危重证候）。
如果舌苔黄如沉香色，或者黄黑且干燥，脉象沉实而细小，严重时甚至沉微似伏，四肢发冷厥逆，或者口渴却喜欢喝热饮，这些都是里气不通的表现，应斟酌使用三承气汤急下攻逐。中脘部痞满且按压疼痛，病邪在胃腑，适宜用小承气汤。肚脐周围及小腹部按压疼痛，病邪在小肠；胃脘下口及脐旁两侧按压疼痛，病邪在大肠；若是热结旁流（燥屎内结，粪水从旁流出），按压时坚硬疼痛，必定有燥屎内结，均适宜用调胃承气汤，利用咸苦之性攻下泄热。若脘腹部都按压疼痛，痞、满、燥、实、坚五种症状俱全，其中痞满是湿热气机郁结，燥实坚是燥屎内结，严重时热邪上蒸扰乱心包，下灼肝肾，出现烦躁、说胡话（谵语）、舌头卷缩、阴囊收缩等症状，适宜用大承气汤急下攻逐。若有阴伤情况，加入鲜生地、玄参、知母、芦根等药物即可。因为迅速攻下邪气，就是保存津液的方法。
若小腹部按压疼痛，大便颜色黑如漆，反而觉得容易排出，病人喜笑如狂，这是肠胃蓄血，瘀血上扰心包络；若小便颜色黑且自利（自行通畅），这是膀胱蓄血，均适宜用桃仁承气汤急下攻逐，或者合用犀角地黄汤，以清解心包络的热毒。出现发黄、小便不利、腹部胀满的，用茵陈蒿汤攻下泄热。对于气虚严重而邪气实盛的，适宜用参黄汤；阴亏严重而邪气实盛的，适宜用护胃承气汤去掉芒硝，或者用增液承气汤攻下；即使极度虚弱不能耐受攻下治疗的，适宜用鲜生地汁、小生地汁、玄参、知母、栝蒌、火麻仁、蜂蜜、梨汁，稍加姜汁等药物，利用滑利之品去除粘着，辛润之品滋润燥结。千万不要该攻下时不攻下，徒然使用滋腻药物，使邪气没有出路，反而导致伤阴；也不要迟疑顾虑，导致错失攻下时机，虚人尤其不可错过，一旦错过，邪气更盛、正气更衰，之后想攻下也不可能了。
更有邪热化燥，损伤肾阴，表现为早晨清醒傍晚加重，面色缺乏光泽；或者邪气损伤肝经经脉，出现痉挛、厥逆，仔细辨证确认为有热无结滞，那么只有斟酌使用增液汤、二甲复脉汤等方剂，通过滋养阴液来托举驱散邪气。又有出现发黄、小便不利且口渴、腹部不胀满的，以及热邪侵入膀胱、小便涩痛的，用桂苓甘露饮最为巧妙。若病中出现遗精滑泄，湿热侵袭精窍，导致小便涩痛的，用甘露饮加入龟板、石决明、芦根，一方面滋养阴液，一方面化除湿热，两者并不矛盾。湿热转化为气机阻滞，病患体内的地气受影响，情况就是这样。
至于暑邪，就是湿热合邪，酝酿为害，与前文所述证候无异。伏暑及伏暑晚发，比起春夏季的温病来势稍缓，但病情实际上更重。初起时微恶寒发热，午后加重，症状类似疟疾，但不分明；继而变成但热不寒，夜间热势更甚，天亮出汗后，身体热度稍退，但胸腹部的热度不退，日日如此，往往经过五七个候（约35天）才解除。推究此病的成因，总归是因为阴虚体质，夏季汗出过多损伤津液，体内空虚，阳气浮越于外，暑湿合邪，深伏于膜原。夏季体内伏阴，阳邪处于阴分之中，暂时相安无事，虽然暂无大患，但必有焦躁烦闷、睡眠少、饮食减少、面色缺乏光泽等现象。到了秋季阳气渐敛，邪气与正气相争而发病。
初起时邪气在气分，必须分别湿多还是热多，尤其要知道此病源于阴虚，邪热一旦传入阴分，就应当以滋养阴液、托举邪气为第一要义。我之前说阴柔滋腻之品不可误用，是指邪气在肺经气分，气被邪气郁遏，不能敷布水精，而出现烦渴、舌红等各种燥象，自然应当用轻清宣化之法，如果使用阴柔滋腻，则肺气更加遏制，金不生水，燥邪必然转甚，邪气靠近心宫。邪气闭阻心宫，也应当用轻虚开泄之法，如果使用阴柔滋腻，则心气更加遏制，邪气没有出路，闭阻必然更甚；邪气已经传入里，就应当攻下，如果只用阴柔滋腻，这是扬汤止沸，而非釜底抽薪。这些都是不当用而误用的情况。我难道是说滋阴养液的方法不可用吗？况且伏暑本来就是因为阴虚引起的！
虽然如此，也有辨别方法：伏暑有湿重的，用辛淡法，忌用凉药；热多的，舌苔黄滑或黄腻，脉象细数而受遏抑，口干频繁饮水但不能多喝，适宜用前文的辛凉淡法。邪气在膈膜上下，是由表传里的渐进过程，舌苔黄腻而浓，胸中痞塞、胃脘闷胀、干呕、心烦、口渴，这是湿热与气机相互搏结，虽然接近里证，却仍在气分，适宜用前文的辛苦通降法。邪气传入心包，用宁上丸开窍。如果传及肝肾，见到阴虚诸证，就应当加入养液药物，如南沙参、北沙参、玄参、细生地、麦冬、鲜石斛、玉竹、龟板、阿胶等。邪气未传入里时，寒已退而热不解的，也用此法。若邪气已传入里，大便次数多，或者虽多但仍觉排便不爽，适宜在辛苦剂中加入熟大黄、栝蒌缓慢疏通，或者用酒煮大黄为丸缓慢化解，往往服用一两钱，大便通一次，再服再通，不服不通，这样服用五七次，排便五七次，邪气才能尽除。这不是病人多吃造成的过错，也不是宿食停滞过多，而是膜原伏有暑湿，脾胃因输布无力，小肠变化机能迟缓，所进食物的谷物，都化为糟粕，不能化为津液，所以屡次排便仍不尽。暑湿本属浊邪，以浊附浊，胶滞缠绵，怎么能轻易解脱呢？如果初起误用辛散，传入里后又误用峻下，必然导致亡阴，变成神昏、痉厥、脱厥而不救。
若里邪已尽，热仍不退的，仔细查看舌苔不多，或者苔薄而无质地，则一概以育阴养液托邪为主，如北沙参、大生地、玉竹、玄参、麦冬、龟板等。虚损严重而神气消索，没有热象的，甘凉之药尚且不合适，适宜用甘平甘润的剂型，如六味地黄汤、复脉汤等，频频进服以垫托正气，千万不要见其无效，中途更换疗法，导致不救。往往是上焦的邪气，因为中焦无砥柱支撑，内舍空虚，乘虚内陷，得到育阴垫托后，从中、下焦血分，复还到气分，发出白㾦（白色小水泡）而解。白㾦细小，色白有水，多发于胸腹、缺盆、肩颈部位，这是阴液枯竭的现象。也有通过育阴垫托，由里还表，邪气从汗而解的情况，将要出汗时，脉必浮缓，舌苔必宣松，汗解后，舌苔有的立即消退，有的迟一二日才消退，必须等到舌苔净、脉静、身凉，舌两旁生出薄白新苔，才算邪气尽除。一切外邪、伏邪，都是如此。
更有妇女月经刚断或刚来，而患温病的，热入血室，表现为早晨清醒傍晚迷糊，夜间更加神昏，低声呓语，如同见鬼一般，甚至有当面与人说话，好像没听见没看见，但户外的事情，反而能听到看到的人，大家都觉得很奇怪，其实并不奇怪。因为肝藏魂，肺藏魄，魄强则魂安。现在热入血室，血液耗尽，肝为将军之官，最厌恶血燥，肝血既已燥，又加上水竭金枯，肾水不足以涵养濡润，肺金不足以灌溉，肝遂不能自藏其魂，而飞扬外越，名叫离魂。离魂则出入无定时，所以户外的事情，都能听到且看到。又有病人自觉自己化作两人并卧的，也是离魂所致。虚劳等证，往往如此。治疗方法一律以大剂量的甘润育阴为主。初病热入血室，张仲景曾用小柴胡汤领邪外出，我曾以青蒿代替柴胡，加入生地、当归、玄参、麦冬养血养阴，山栀、泽泻引导血室之邪下行至膀胱，作为出路。如果有瘀血在小腹按压疼痛的，加赤芍、桃仁、鳖甲、龟板化瘀滋阴；暑邪未尽的，用黄芩、半夏苦辛化邪。最忌讳攻下，即使有实邪，也必须审察舌苔黄燥而有质地，脘腹按压疼痛，大便不通，或者月经刚来，邪气搏结瘀血停留，少腹板硬疼痛，或者大便色黑如漆，确实有热结、停瘀的见证，方可用桃仁承气汤攻下，尤其须加生地、当归、玄参、麦冬养血滋阴，以固其根本。因为水浅则舟停，水足则舟自行。妇人产后患温病，也应当如此。有产前患温病的，见到里证，该攻下就攻下。因为胎元因邪气而不安，去除邪气就是安胎，但适宜加入养血药。
又有暑湿合邪患疟疾，或伏暑晚发转为疟疾，这与寻常疟疾不同，脉象、舌苔、见证，都与伏暑无异，只是发作停止有定期，病势较轻，治疗方法与伏暑无异，也要分别湿多热多，斟酌使用辛淡、辛凉、辛苦等剂型。按暑湿疟邪，伏于膜原半表半里，与少阳半表半里无关。现今一概用小柴胡汤，不仅无效，往往导致肝胆相火与湿热同升为病，而出现发呕、发痉、发惊等证。伤寒病邪在少阳，寒热往来，是寒去热来，热去寒来，往来不断，而没有休止期，所以叫“往来”，不叫“来往”。暑湿疟疾，先寒后热。卫气行于膜原，进入阴分相争，外无所卫，则恶寒；出来与阴分相争，阴无所护，则发热。热后出汗即退，是寒来热往，发作停止有时，与少阳的寒热往来无止期的情况，大相径庭。
又有一种伏暑疟疾，详细记载于《内经》。经文说：当暑天出汗不出，秋天形成风疟。又说：疟疾都生于风。又说：夏天伤于暑，秋天形成疟疾。又说：夏天伤于暑，热气盛，藏在皮肤之内，肠胃之外，这是营气所居之处（此指暑热），使人汗孔疏阔，腠理开泄，因而遇到秋气，出汗遇风，以及洗澡，水气留在皮肤之内，与卫气并居，卫气白天行于阳分，夜晚行于阴分，此气得阳而出外，得阴而内迫，内外相迫，所以每天发作；此气潜伏较深，内迫于阴，阳气独发，阴邪内着，阴与阳争不得出，所以隔天发作。该篇首论发作有时，先寒后热。说：阴阳上下交争，虚实更作，阴阳相移，阳并入阴（卫气内行于营），则阴实（卫气在内）而阳虚（卫气内行于营，外无所卫，故虚），阳明虚则寒栗鼓颔，巨阳（即太阳）虚则腰背头项痛，三阳俱虚则阴气胜，阴气胜则骨寒而痛，寒生于内，故中外皆寒；阳盛（卫气复出于外）则外热，阴虚则内热，外内皆热，则喘而渴，故欲饮冷。观察暑热伤营、风湿伤卫的说法，又与暑湿合邪，深伏膜原的不同。观察“营气之所舍”一语，明确指向可知。古至今谓疟疾只属于少阳经病的，一是误解于寒热往来，二是误解于半表半里。夫寒热往来，即终而复始之意，已经明辨，再言半表半里。少阳经，乃人身两侧面的半表半里；营舍属经脉，乃皮肤内肠胃外的半表半里；膜原乃人身前后间空隙处的半表半里。部位不同，病邪亦异，这是辨证不可不早辨别的。有人问：脉、苔、证、治应当如何？答：暑湿合并为浊邪，脉必模糊，苔必浊腻，寒热发作停止，不甚分明，治疗方法与伏暑无异。其暑热伤营，风湿伤卫的，是营分暑热本重，卫分又感风湿，卫气行于营，并而后发，脉必浮弦而数，苔必淡白、滑白而不腻，重者舌肉必深红，先寒后热，寒轻热重，后来逐渐不寒而热。夫浮弦为风象，弦而数乃暑热在营，为卫分风湿所搏，邪正交争，欲出而不得出之象。治疗适宜用桂枝白虎汤，疏卫清营；卫分邪重者，用桂枝汤，疏卫护营。其当暑天汗不出而成疟的，是夏月当风取凉，用水灌汗，逼迫暑邪深入，不再出汗而伤于内，脉必浮弦，发作时也必弦数。《脉诀》谓弦为阴脉。弦数不尽属热，乃营分之邪欲出而不得出之象，苔亦必淡白、滑白而不腻，但舌肉不深红，先寒后热，寒重热轻，后来转为寒轻热重。治疗适宜用桂枝甘草汤疏卫为主，营热卫寒两重的，桂枝汤疏卫护营，若风寒遏郁卫分，较严重的，用小柴胡汤，领邪出外也可以，即用三阳表药，领邪外出也可以。
凡夏月风寒伏暑，秋天成痢疾的，虽然病各不同，但究其由来，同属暑为凉伏，因秋风而发，皆从疟例治疗，用小柴胡汤也没有不可以。喻氏嘉言治痢用小柴胡仓廪汤，逆流挽舟，就是这个意思。
又有湿郁成霍乱的，吐泻、腹痛、恶寒、头身均痛，这不是寒证，乃是湿胜罢了！三阴疟，也因湿胜而得，但疟疾为湿郁脾经，其势缓；霍乱为湿闭气机，其势急。肺为湿闭，则各脏腑之本气亦闭，气闭则不能行水，清气不得下行，浊气转而上干，清浊混淆，霍乱乃作；脉必沉细而遏抑，甚则沉伏；苔必水白白腻，重者舌肉亦水白而不红活。此病最忌升散温燥以及甘药，然而间有服温药而愈的，乃是湿未化热的缘故！若屡进必误。夫温燥之品，助浊气上干是一；六气皆从火化，霍乱泻多亡阴，化燥最快是二。治法适宜用五苓散去苍术，化膀胱之气，以导引下行，尤其须加辛通下达之品，以开气闭，气为水母，气开乃能行水。夫辛通下达，无过于细辛，其功居多。我屡次验证无误，但不宜多用，其功效大的，其力量必猛，不可不知。
再从外感寒湿而言。寒湿为湿之本气，本气为阴邪。其见证为，恶寒战栗（身战栗、心战栗），周身疼痛，或者外邪郁遏内热，疼而且烦，但舌苔白滑，不渴不饮，内无热象，故为寒湿。必须分别伤表伤里，表虚里虚，化热化燥。表虽属毛窍经脉，而肺实统之；里虽指各脏腑，而肾实主之。其湿兼风寒伤表的，虽当发汗，但忌发之太猛，犯湿家忌汗之戒。《金匮》云：风湿相搏，一身尽痛，法当汗出而解。值天阴雨不止，发其汗，汗大出的，风气去，湿气在，亦不愈。治风湿者，发其汗，但微微似欲汗出的，风湿俱去也。盖风为阳邪，轻浮易去；湿为阴邪，凝滞难驱。微微似欲汗出，即经所谓“渍形以为汗”是也。（妙在“渍”字，有浸润透彻之义）。又说：病人一身尽痛，发热，日晡益剧，名风湿。此痛伤于寒，汗出当风，或久伤取冷所致，可与麻杏苡甘汤。又说：湿家身烦疼，可与麻黄加术汤。麻黄加术，缓中燥湿，一发一补，即微微似欲汗出，风湿俱去之意也。唐宋以后诸方，或不用麻黄，或用麻黄，并杂用薄荷、苏叶、荆芥、防风、羌活、独活升燥走窜之甚于麻黄的，皆由于未尝药辨性之故。夫麻黄诚不可多用，若当用而用，止三四分，则较胜于杂用他药者多矣。即或不用，而以杏仁、苏梗代之，原无不可，但勿杂用升燥走窜药，致湿邪内蒙包络，变为神昏，下伤肝胆，变为痉厥，则善矣。书曰：湿家忌汗，汗多则亡阳（汗为心液，汗多则心液受伤，太阳不能外卫，故脱）。又说：湿家忌汗，发汗则病痉（汗多血耗，肝无所养，故痉）。确是不诬也。
其寒湿伤里的，以利小便为主，最忌误下。《金匮》云：关节疼痛而烦，脉沉而细，此名湿痹。小便不利，大便反快，但当利其小便。夫关节烦疼，虽属表湿，郁而生热，而脉沉细，
Decoctions such as Huangqin Huashi Tang (Scutellaria and Coix Seed Decoction) and Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) should be modified by adding Gualou (Trichosanthes Fruit) to promote unblocking. In cases of Yin deficiency, nourishing Yin herbs should be added. If the tongue coating is thick and yellow, the pulse is deep and rapid, there is slight tenderness upon palpation of the epigastrium without hardness, and defecation is obstructed, this indicates a struggle between formless damp-heat and有形 (formable) fecal matter. Since it is not hard upon palpation, the loose stool often resembles the color of fermented bean paste. It is appropriate to concurrently use Rhubarb (Da Huang) wine-processed into pills for slow resolution and propulsion. For severe cases, cooked Rhubarb (Shu Da Huang) and Mirabilite (Yuanming Fen) ground for purgation can be added. If large doses of harsh purgatives are used, their action will be swift and uncontrolled, leading to the failure to expel accumulated waste while only passing watery stool, thereby vainly damaging healthy Qi and transforming into a complicated disease (Huai Zheng).
If the tongue coating is yellow like agarwood, or yellow-black and dry, the pulse is deep, solid, and small, or in severe cases, deep, faint, and seemingly hidden; if the limbs are cold and厥逆 (rebellious), or if there is thirst but a preference for hot drinks, these are all signs of obstruction of interior Qi. One should酌情 (discretionarily) use one of the Three Chengqi Decoctions for urgent purgation. If the epigastrium is full and tender upon pressure, the pathogen is in the Stomach Fu organ, and Xiao Chengqi Tang (Minor Order the Qi Decoction) is suitable. If tenderness upon pressure is around the umbilicus and in the lower abdomen, the pathogen is in the Small Intestine; if tenderness is at the lower opening of the stomach and on both sides of the umbilicus, the pathogen is in the Large Intestine. In cases of heat binding with side-flow (Re Jie Pang Liu - dry stool bound internally with liquid stool flowing out), where pressure reveals hardness and pain, indicating dry fecal pellets, Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) should be used to purge using salty and bitter properties. If both the epigastrium and abdomen are tender upon pressure, and the symptoms of stagnation (Pi), fullness (Man), dryness (Zao), excess (Shi), and hardness (Jian) are all present—where Pi-Man results from damp-heat qi stagnation, and Zao-Shi-Jian results from dry fecal pellets—if severe, heat steams upward to disturb the Pericardium and scorches downward the Liver and Kidneys, causing irritability, delirium, tongue curling, and testicular retraction, Da Chengqi Tang (Major Order the Qi Decoction) should be used for urgent purgation. If Yin injury exists, add fresh Shengdi Huang (Rehmannia Root), Xuanshen (Scrophularia Root), Zhimu (Anemarrhena Rhizome), and Lugen (Reed Rhizome). Rapidly purging the pathogen is the method to preserve body fluids.
If the lower abdomen is tender upon pressure, stool is black like lacquer but surprisingly easy to pass, and the patient laughs maniacally, this indicates blood stasis in the intestines and stomach affecting the Pericardium. If urine is black but flows freely, this indicates blood stasis in the Bladder. Both conditions warrant urgent purgation with Tao Ren Chengqi Tang (Peach Kernel and Cinnamon Twig Order the Qi Decoction), or combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) to clear the Pericardium. For jaundice, difficulty in urination, and abdominal fullness, Yinchen Hao Tang (Artemisia Capillaris and Yellow Dock Decoction) should be used to purge. For those with severe Qi deficiency but excess pathogen, Shenhuang Tang (Ginseng and Rhubarb Decoction) is suitable. For those with severe Yin deficiency but excess pathogen, Hugwei Chengqi Tang (Stomach-Protecting Order the Qi Decoction) with Mangxiao (Mirabilite) removed, or Zengye Chengqi Tang (Increase Fluids Order the Qi Decoction) should be used. Even for those extremely deficient and unable to tolerate purgation, fresh Shengdi juice, small Shengdi juice, Xuanshen, Zhimu, Gualou, Huma Ren (Hemp Seed), honey, and pear juice, with a little ginger juice, should be used. Slippery agents remove adherence, and pungent agents moisten dryness. One must avoid failing to purge when indicated, relying solely on cloying tonics that block the pathogen's exit and further injure Yin. Nor should one hesitate, missing the opportunity to purge; deficient patients especially must not miss this chance, as delay allows the pathogen to flourish and healthy Qi to decline, eventually making purgation impossible.
Furthermore, if pathogenic heat transforms into dryness and injures Kidney Yin, symptoms may include clarity in the morning and worsening in the evening, and lackluster complexion. If the pathogen damages the Liver meridians, causing spasms or厥逆, and upon examination shows heat without binding, one should discretionarily use Zengye Tang (Increase Fluids Decoction) or Erjia Fumai Tang (Two Shells Pulse-Recovering Decoction) to nourish Yin and support the expulsion of pathogens. For jaundice, difficulty in urination, thirst, but no abdominal fullness, or for heat entering the Bladder causing painful, difficult urination, Guiling Ganlu Yin (Cassia Seed and Polyporus Sweet Dew Drink) is most effective. For seminal emission during illness due to damp-heat invading the essence orifices, causing painful urination, Ganlu Yin (Sweet Dew Decoction) with Guiban (Turtle Shell), Shijueming (Concha Arcae), and Lugen is suitable, nourishing Yin while resolving dampness simultaneously. This illustrates how damp-heat transforms Qi and affects the patient's internal environment.
Regarding Summerheat, it is the combination of damp-heat fermenting to cause harm, similar to previous syndromes. Latent Summerheat (Fushu) and late-onset latent summerheat progress more slowly than spring-summer warm diseases but are actually more severe. Initially, there is slight aversion to cold and fever, worse in the afternoon, resembling malaria but indistinct; subsequently, there is fever without chills, worse at night, with slight relief after sweating at dawn, but heat remains in the chest and abdomen daily. This often resolves after five to seven "hou" (periods). The etiology stems from a Yin-deficient constitution, excessive sweating in summer injuring fluids, leaving the interior empty, with Yang floating externally. Summer-damp combines with the pathogen, deeply lodged in the Membranous Source (Moyuan). In summer, Yin is latent within, and Yang pathogens reside in the Yin domain, coexisting peacefully but causing irritability, insomnia, poor appetite, and lackluster complexion. In autumn, as Yang Qi收敛 (converges), the pathogen struggles with healthy Qi, triggering the disease.
Initially, when the pathogen is in the Qi level, one must distinguish whether dampness or heat predominates. Crucially, knowing this disease arises from Yin deficiency, once the pathogenic heat transmits to the Yin level, nourishing Yin and fluids to support pathogen expulsion becomes the primary principle. Previously, I stated that Yin-nourishing and cloying herbs should not be misused; this refers to when the pathogen is in the Lung Qi level, where Qi is constrained, failing to distribute fluids, causing thirst and red tongue. Light, clear, and transforming methods are appropriate. Using Yin-nourishing herbs would further constrain Lung Qi, preventing Metal from generating Water, worsening dryness, and allowing the pathogen to approach the Heart Palace. If the pathogen blocks the Heart Palace, light and void-opening methods are needed; cloying herbs would constrain Heart Qi, blocking the pathogen's exit. Once the pathogen enters the interior, purgation is required; using only Yin-nourishing herbs is like stirring boiling water to stop it, rather than removing firewood from under the pot. These are examples of inappropriate usage. Do I deny the utility of Yin-nourishing? Latent summerheat originates from Yin deficiency!
However, differentiation is key: For latent summerheat with predominant dampness, use Pungent-Light methods, avoiding cooling drugs. For predominant heat, with yellow-slippery or yellow-greasy tongue coating, fine-rapid-restricted pulse, frequent dry mouth drinking but inability to drink much, use Pungent-Cool-Light methods. When the pathogen is above and below the diaphragm, transitioning from exterior to interior, with thick yellow-greasy coating, chest oppression, epigastric stuffiness, dry retching, irritability, and thirst, damp-heat struggles with Qi. Though near the interior, it remains in the Qi level; use Pungent-Bitter descending methods. If the pathogen transmits to the Pericardium, use Ning Shang Wan for opening. If it reaches the Liver and Kidneys with Yin deficiency signs, add fluid-nourishing herbs like Nan Sha Shen, Bei Sha Shen, Xuanshen, Xi Sheng Di, Maidong, Fresh Shihu, Yuzhu, Guiban, and Ejiao. If the pathogen has not entered the interior, and cold has subsided but heat persists, this method also applies. If the pathogen has entered the interior, and bowel movements are frequent or incomplete despite frequency, add cooked Rhubarb and Gualou to the Pungent-Bitter formula for slow unblocking, or wine-processed Rhubarb pills. Often, one or two qian causes one bowel movement; repeated dosing leads to repeated movements. After five to seven times, the pathogen is exhausted. This is not due to overeating or excessive retained food, but because latent summer-damp in the Membranous Source, combined with weak Spleen-Stomach transport and slow Small Intestine transformation, turns grain into waste rather than fluids. Damp-heat is turbid; turbidity adhering to turbidity is sticky and lingering.
If initially mistaken for exterior syndrome and treated with pungent dispersants, or later treated with harsh purgatives, Yin collapse, coma, spasms, and厥逆 may result. If interior pathogens are cleared but heat persists, and the tongue coating is thin or lacks substance, focus entirely on nourishing Yin and fluids to expel pathogens (e.g., Bei Sha Shen, Da Sheng Di, Yuzhu, Xuanshen, Maidong, Guiban). If severely deficient with depleted spirit and no heat signs, even sweet-cool herbs are unsuitable; use sweet-neutral and sweet-moist formulas like Liuwei Dihuang Tang or Fumai Tang frequently to support the body. Do not change methods midway due to perceived ineffectiveness. Sometimes, upper-jiao pathogens sink into the empty interior due to lack of central support; nourishing Yin and supporting from the Middle/Lower Jiao Blood level can return them to the Qi level, manifesting as Bai Bi (white miliary rash) for resolution. Bai Bi are small, white, fluid-filled vesicles on the chest, abdomen, clavicle, and neck, indicating Yin exhaustion. Alternatively, pathogens may return from interior to exterior via sweat after Yin nourishment. Before sweating, the pulse becomes floating and relaxed, and the coating loosens. After sweating, the coating may disappear immediately or take days; resolution is confirmed when the coating is clean, pulse is calm, body temperature normalizes, and new thin white coating appears on the tongue sides. This applies to all external and latent pathogens.
For women whose menstruation has just ceased or begun while suffering from warm disease, heat enters the Blood Chamber (Xueshi). Symptoms include clarity in the morning and confusion in the evening, worsening nocturnal coma, whispering, hallucinations, and apparent deafness to direct speech while perceiving external events. This is not strange. The Liver stores the Hun (Ethereal Soul); the Lung stores the Po (Corporeal Soul). A strong Po stabilizes the Hun. Heat entering the Blood Chamber depletes blood. As the General, the Liver hates blood dryness. With dry Liver blood, depleted Kidney Water, and dry Lung Metal, the Liver cannot store its Hun, which flies outward, called "Li Hun" (Departing Soul). This causes perception of external events. Similarly, feeling oneself as two people lying together is Li Hun. Consumption diseases often present thus. Treatment requires large doses of sweet-moist Yin-nourishing herbs. Zhang Zhongjing used Xiaochaihu Tang (Minor Bupleurum Decoction) to lead pathogens out; I substitute Qinghao (Artemisia Annua) for Chaihu, adding Shengdi, Danggui, Xuanshen, and Maidong to nourish blood and Yin, and Zhizi and Zexie to guide pathogens from the Blood Chamber to the Bladder. For lower abdominal stasis pain, add Chishao, Taoren, Biejia, and Guiban to resolve stasis and nourish Yin. For residual summerheat, use Huangqin and Banxia. Purging is contraindicated unless there is clear evidence of heat-binding and stasis (yellow-dry coating, epigastric/abdominal tenderness, constipation, or dark stool), in which case Tao Ren Chengqi Tang with blood-nourishing herbs is appropriate. "Shallow water stops the boat; sufficient water lets it float." Postpartum warm disease should be treated similarly. For antenatal warm disease with interior signs, purge if indicated; eliminating the pathogen calms the fetus, supplemented by blood-nourishing herbs.
Summer-damp malaria or latent summerheat turning into malaria differs from common malaria. Pulse, coating, and symptoms resemble latent summerheat, but with periodic attacks and milder severity. Treatment follows latent summerheat principles, distinguishing damp vs. heat. Summer-damp malaria pathogens lodge in the Membranous Source (half-exterior/half-interior), unrelated to Shaoyang. Using Xiaochaihu Tang indiscriminately is ineffective and may raise Gallbladder Fire with damp-heat, causing vomiting, spasms, and fright. Shaoyang cold damage features alternating chills and fever without fixed timing ("wanglai"). Summer-damp malaria features chills first, then fever, with fixed timing. Wei Qi circulates in the Membranous Source; entering Yin causes chills (no exterior defense), emerging causes fever (no Yin protection). Sweat resolves the heat. This differs significantly from Shaoyang alternation.
The *Neijing* describes latent summerheat malaria: "Sweat withheld in summer leads to wind-malaria in autumn." Malaria arises from wind. Summer heat lodges in skin/intestines (Nourishing Qi residence), opening pores. Autumn wind/water enters, residing with Wei Qi. Wei Qi moves Yang by day, Yin by night. Pathogen moves with Wei Qi, causing daily or every-other-day attacks based on depth. Initial chills involve Yang deficiency (Yang merges into Yin); subsequent fever involves Yang excess. This differs from summer-heat injuring Nourishing Qi and wind-damp injuring Defensive Qi. The "Nourishing Qi residence" indicates the location. Misinterpreting malaria as solely Shaoyang disease stems from misunderstanding alternating chills/fever and half-exterior/half-interior. Shaoyang is lateral half-exterior/half-interior; Nourishing Qi is intra-skin/intra-intestine half-exterior/half-interior; Membranous Source is inter-anterior-posterior half-exterior/half-interior. Locations and pathogens differ.
For summer-damp turbid pathogens, the pulse is blurred, coating is greasy, and chills/fever are indistinct; treat as latent summerheat. For summer-heat injuring Nourishing Qi and wind-damp injuring Defensive Qi, the pulse is floating-wiry-rapid, coating pale-white/slippery (not greasy), tongue flesh deep red, chills mild/fever severe. Floating-wiry indicates wind; wiry-rapid indicates summer-heat in Nourishing Qi struggling against wind-damp. Use Guizhi Baitao Tang (Cinnamon Twig and White Tiger Decoction) to release Wei and clear Nourishing Qi; if Wei pathogen is heavy, use Guizhi Tang. For summer heat withheld by wind/cold/water, pulse is floating-wiry,发作时 wiry-rapid. Use Guizhi Gancao Tang to release Wei; if Nourishing heat and Wei cold are both heavy, use Guizhi Tang. If wind-cold heavily constrains Wei, Xiaochaihu Tang or three-Yang exterior herbs can lead pathogens out.
Summer wind-cold and latent summerheat causing autumn dysentery are treated as malaria using Xiaochaihu Tang. Yu Jia Yan's Canglin Tang for dysentery uses "rowing upstream" logic.
Dampness stagnating into Cholera (Huoluan) presents with vomiting, diarrhea, abdominal pain, aversion to cold, and body ache. This is not cold, but damp excess. San Yin Malaria is also due to damp excess but is slower (Spleen constraint) compared to Huoluan's acute Qi closure. Lung damp-closure affects all organs; Qi closure prevents water metabolism, causing clear Qi to fail descending and turbid Qi to rise, mixing clear and turbid, causing Huoluan. Pulse is deep-fine-restricted or hidden; coating is white-water-greasy, tongue flesh pale. Avoid ascending/dispersing/warm-dry and sweet herbs. Warm-dry herbs aid turbid rising; six Qi transform to fire, and Huoluan diarrhea rapidly consumes Yin causing dryness. Use Wuling San minus Cang Zhu to transform Bladder Qi and guide downward, plus pungent-descending herbs (like Xixin) to open Qi closure. Qi is the mother of water; opening Qi allows water flow. Xixin is potent; use sparingly.
External Cold-Damp is the root of dampness, a Yin pathogen. Signs include aversion to cold, tremors, body ache, or internal heat with irritability. Tongue is white-slippery, no thirst, no internal heat. Differentiate exterior/interior, deficiency/excess, heat/dryness transformation. Exterior is governed by Lung; interior by Kidney. For damp-cold-wind exterior, sweating is indicated but must be gentle ("soaking form into sweat") to avoid harming the Dampness patient. *Jin Gui* states wind-damp pain requires mild sweating; profuse sweating expels wind but leaves damp. Mild sweating expels both. Wind is Yang/easy to remove; damp is Yin/stubborn. Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Macrocephala Decoction) or Ma Xing Yi Gan Tang are appropriate. Later formulas using pungent-dry herbs (Bohe, Zi Su Ye, Jing Jie, Fang Feng, Qiang Huo, Du Huo) are incorrect due to lack of herb nature understanding. Ma Huang should be used sparingly (3-4 fen) if indicated, or substituted with Xing Ren/Su Geng, avoiding pungent-dry herbs that could trap damp in the Pericardium (coma) or Liver/Gallbladder (spasms). Sweating excessively harms Yang (Heart fluid) and causes spasms (Liver blood depletion).
Interior Cold-Damp focuses on promoting urination, avoiding purging. *Jin Gui* states joint pain with deep-fine pulse is Wet Bi. Urinary difficulty with loose stool requires promoting urination. Joint pain with heat from damp constraint still requires urinary promotion if pulse is deep-fine.