温邪上受，首先犯肺，逆传心胞。肺主气，属卫；心主血，属营。辨营卫气血，虽与伤寒同，若论治法，则与伤寒
大异。盖伤寒之邪留恋在表，然后化热入里；温邪则化热最速。未传心胞，邪尚在肺，肺合皮毛而主气，故云在表。初
用辛凉轻剂。挟风，加薄荷、牛蒡之属；挟湿，加芦根、滑石之流。或透风于热外，或渗湿于热下，不与热相搏，势必
孤矣。不尔，风挟温热而燥生，清窍必干，谓水主之气不能上荣，两阳相劫也。湿与温合，蒸郁而蒙痹于上，清窍为之
壅塞，浊邪害清也，其病有类伤寒。验之之法，伤寒多有变症，温热虽久，总在一经为辨。
前言辛凉散风，甘淡驱湿，若病仍不解，是渐欲入营也。营分受热，则血液受劫，心神不安，夜甚无寐，或斑点隐
隐，即撤去气药。如从风热陷入者，用犀角、竹叶之属；如从湿热陷入者，用犀角、花露之品，参入凉血清热方中。若
加烦躁，大便不通，金汁亦可加入；老年及平素有寒者，以人中黄代之，急速透斑为要。若斑出热不解者，胃津亡也，
主以甘寒，重则如玉女煎，轻则如梨皮、蔗浆之类。或其人肾水素亏，病虽未及下焦，每多先自彷徨，此必验之于舌。
如甘寒之中加入咸寒，务在先安未受邪之地，恐其陷入耳。若其邪始终在气分流连者，可冀其战汗透邪，法宜益胃，令
邪与汗并，热达腠开，邪从汗出。解后胃气空虚，当肤冷一昼夜，待气还自温暖如常矣。盖战汗而解，邪退正虚，阳从
汗泄，故渐肤冷，未必即成脱症。此时宜安舒静卧，以养阳气来复，旁人切勿惊惶，频频呼唤，扰其元气。但诊其脉，
若虚软和缓，虽倦卧不语，汗出肤冷，却非脱症；若脉急疾，躁扰不卧，肤冷汗出，便为气脱之症矣。更有邪盛正虚，
不能一战而解，停一二日再战汗而愈者，不可不知。
再论气病有不传血分，而邪留三焦，犹之伤寒中少阳病也。彼则和解表里之半，此则分消上下之势。随症变法，如
近时杏、朴、苓等类；或如温胆汤之走泄。因其仍在气分，犹有战汗之门户，转疟之机括也。大凡看法，卫之后方言气，
营之后方言血。在卫汗之可也，到气才宜清气。乍入营分，犹可透热，仍转气分而解，如犀角、元参、羚羊等物是也。
至入于血，则恐耗血动血，直须凉血散血，如生地、丹皮、阿胶、赤芍等物是也。若不循缓急之法，虑其动手便错耳。
且吾吴湿邪害人最多，如面色白者，须要顾其阳气，湿胜则阳微也。如法应清凉，用到十分之六七，即不可过凉，盖恐
湿热一去，阳亦衰微也。面色苍者，须要顾其津液，清凉到十分之六七。往往热减身寒者，不可便云虚寒而投补剂，恐
炉烟虽熄，灰中有火也，须细察精详，方少少与之，慎不可漫然而进也。又有酒客，里湿素盛，外邪入里，与之相搏，
在阳旺之躯，胃湿恒多，在阴盛之体，脾湿亦不少，然其化热则一。热病救阴犹易，通阳最难。救阴不在补血，而在养
津与测汗；通阳不在温，而在利小便，较之杂症有不同也。
再论三焦不从外解，必致里结，里结于何？在阳明胃与肠也。亦须用下法，不可以气血之分，谓其不可下也。惟伤
寒热邪在里，劫烁津液，下之宜猛；此多湿邪内搏，下之宜轻。伤寒大便溏为邪已尽，不可再下；湿温病大便溏为邪未
尽，必大便硬，乃为无湿，始不可再攻也。再人之体，脘在腹上，其位居中，按之痛，或自痛，或痞胀，当用苦泄，以
其入腹近也。必验之于舌，或黄或浊，可与小陷胸汤或泻心汤随症治之。若白不燥，或黄白相兼，或灰白不渴，慎不可
乱投苦泄。其中有外邪未解，里先结者，或邪郁未伸，或素属中冷者，虽有脘中痞痛，宜从开泄，宣通气滞，以达归于
肺，如近世之杏、蔻、橘、桔等，轻苦微辛，具流动之品可耳。又有舌上白苔粘腻，吐出浊浓涎沫者，其口必甜，此为
脾瘅。乃湿热气聚，与谷气相搏，土有余也，盈满则上泛。当用佩兰叶，芳香辛散以逐之。若舌上苔如碱者，胃中宿滞，
挟浊秽郁伏，当急急开泄，否则闭结中焦，不能从募原达出矣。
再舌苔白浓而干燥者，此胃燥气伤也，滋润药中加甘草，令甘守津还之意。舌白而薄者，外感风寒也，当疏散之。
若薄白而干者，肺液伤也，加麦冬、花露、芦根汁等轻清之品，为上者上之也。若苔白而底绎者，湿遏热伏也，当先泄
湿透热，防其即干也；此可勿忧，再从里而透于外，则变润矣。初病舌即干，神不昏者，宜急养正，微加透邪之药；若
神已昏，此内溃，不可救药矣。
前云舌黄或浊，当用陷胸、泻心，须要有地之黄。若光滑者，乃无形湿热，已有中虚之象。大忌前法。其脐以上为
大腹，或满、或胀、或痛，此必邪已入里，表症必无，或存十之一二，亦须验之于舌。或黄甚，或如沉香色，或如灰黄
色，或老黄色，或中有断纹，皆当下之，如小承气汤，用槟榔、青皮、枳实、元明粉、生首乌等皆可。若未现此等舌，
不宜用此等药，恐其中有湿聚太阴为满，或寒湿错杂为痛，或气壅为胀，又当以别法治之矣。
再黄胎不甚浓而滑者，热未伤津，犹可清热透表。若虽薄而干者，邪虽去而津受伤也，苦重之药当禁，宜甘寒轻剂
养之。
再论其热传营，舌色必绛。绛，深红色也。初传绎色，中兼黄白色，此气分之邪未尽也，泄卫透营，两和可也。纯
绛鲜泽者，胞络受邪也，宜犀角、鲜生地、连翘、郁金、石菖蒲等清泄之。延之数日，或平素心虚有痰，外热一陷，里
络即闭，非菖蒲、郁金等所能开，须用牛黄丸、至宝丹之类，以开其闭，恐其昏厥为痉也。
再论舌绛而干燥者，火邪劫营，凉血清血为要。色绛而舌心干者，乃心胃火燔，劫烁津液，即黄连、石膏亦可加入。
其有舌心独绛而干者，亦胃热而心营受灼也，当于清胃方中加入清心之品，否则延及于尖，为津干火盛之候矣。舌尖独
绛而干，此心火上炎，用导赤散泻其腑。若烦渴、烦热，舌心干、四边色红、中心或黄或白者，此非血分也，乃上焦气
热烁津，急用凉膈散散其无形之热，再看其后转变可也；慎勿用血药，反致滋腻留邪。至舌绛望之若干，手扪之原有津
液，此津亏湿热薰蒸，将成浊痰蒙闭心胞也。舌色绛而上有粘腻，似苔非苔者，中挟秽浊之气，急加芳香逐之。舌绛而
抵齿难伸退场门者，痰阻舌根，有内风也。舌绛而光亮，胃阴亡也，急用甘凉濡润之品。舌绛而有碎点黄白者，将生疳也。
大红点者，热毒乘心也，用黄连、金汁。其有虽绛而不鲜，干枯而痿者，此肾阴涸也，急以阿胶、鸡子黄、地黄、天冬
等救之，缓则恐涸极而无救也。
再有热传营血，其人素有瘀伤宿血在胸膈中，舌色必紫而暗，扪之潮湿，当加散血之品，如琥珀、丹参、桃仁、丹
皮等，否则瘀血与热相搏，阻遏正气，遂变如狂发狂之症。若紫而肿大者，乃酒毒冲心。紫而干晦者，肾、肝色泛也，
难治。
舌若淡红无色，或干而色不荣者，乃是胃津伤而气无化液也，当用炙甘草汤，不可用寒凉药。
再有不拘何色，舌生芒刺者，皆是上焦热极也，当用青布拭冷薄荷水揩之，即去者轻，旋即生者险矣。
舌苔不燥，自觉闷极者，属脾湿盛也。或有伤痕血迹者，必问曾经搔挖否，不可以有血而便为枯症，仍从湿治可也。
再有神情清爽，舌胀大不能退场门者，此脾湿胃热郁极化风，而毒延于口也，用大黄磨入当用剂内，则舌胀自消矣。
舌无苔而有如烟煤隐隐者，慎不可忽视。如口渴烦热而燥者，平时胃燥也，不可攻之，宜甘寒益胃；若不渴、肢寒
而润者，乃挟阴病，宜甘温扶中，此何以故？外露而里无也。
舌黑而滑者，水来克火，为阴症，当温之。若见短缩，此肾气竭也，为难治，惟加入参、五味子，或救万一。舌黑
而干者，津枯火炽，急急泻南补北。若黑燥而中心浓者，土燥水竭，急以咸苦下之。
若舌白如粉而滑，四边色紫绛者，温疫病初入募原，未归胃腑，急急透解，莫待传入而为险恶之症。且见此舌者，
病必见凶，须要小心！凡斑疹初见，须用纸燃照看胸背两胁，点大而在皮肤之上者为斑，或云头隐隐，或琐碎小粒者为
疹，又宜见而不宜多见。按方书谓斑色红者属胃热，紫者热极，黑者胃烂，然亦必看外症所合，方可断之。春夏之间，
湿病俱发斑疹为甚，如淡红色，四肢清，口不甚渴，脉不洪数，此非虚斑，即属阴斑。或胸前微见数点，面赤足冷，或
下利清谷，此阴盛格阳于上，当温之。若斑色紫而点小者，心胞热也；点大而紫，胃中热也。斑黑而光亮者，热毒极炽，
虽属不治，然其人气血充者，根据法治之，或有可救。若黑而晦者，必死。黑而隐隐，四旁赤色者，乃火郁内伏，大用清
凉透发，间有转红而可救者。又有夹斑带疹，皆是邪之不一，各随其部而泄；然斑属血者恒多，疹属气者不少。斑疹皆
是邪气外露之象，发出之时，宜神情清爽，方为外解里和；如斑疹出而昏者，此正不胜邪而内陷，或胃津内涸之候矣。
再有一种白 ，小粒如水晶色者，此湿热伤肺，邪虽出而气液枯也，必得甘药补之。若未至久延，气液尚在未伤，
乃为湿郁卫分，汗出不彻之故，当理气分之邪。枯白如骨者多凶，气液竭也。
再温热之病，看舌之后，亦须验齿。齿为肾之余，龈为胃之络，热邪不燥胃津，必耗肾液，且二经之血走于此处。
病深动血，结瓣于上。阳血色紫，紫如干漆；阴血色黄，黄如酱瓣。阳血若见，安胃为主；阴血若见，救肾为要。然豆
瓣色者多险，惟症尚不逆者犹可治，否则难治矣，此何故耶？盖阴下竭，阳上厥也。
齿若光燥如石者，胃热甚也，证见无汗恶寒，卫偏胜也，辛凉泄卫透汗为要。若如枯骨色者，肾液枯也，为难治。
若上半截润，水不上承而心火上炎也。急急清心救水，俟枯处转润为妥。若切牙啮齿者，湿热化风，痉病。但切牙者，
胃热气走其络也。切牙而脉症皆衰者，胃虚无谷以内荣也，此何以故？虚则喜实也。舌本不缩而硬，牙关咬定难开者，
此非风痰阻络，即欲作痉症，用酸物擦之即开，酸走筋，木来泄土故也。
若齿垢如灰糕样者，胃气无权，津亡而湿浊用事，多死。初病齿缝流清血，痛者为胃火冲激，不痛者为龙火内燔。
齿焦无垢者死；齿焦有垢者，肾热胃劫也，当微下之，或玉女煎清胃救肾可也。
再妇人病温与男子同，但多胎前产后，以及经水适来适断。大凡胎前病，古人皆以四物加减用之，谓恐邪来害妊也。
如热极者，有用井底泥及蓝布浸冷覆盖腹上等，皆是护胎之意，然亦须看其邪之可解而用之。如血腻之药不灵，又当审
察，不可固执，仍宜步步保护胎元，恐正损邪陷也。至于产后，方书谓慎用苦寒，恐伤已亡之阴也，然亦要辨其邪能从
上中解者，稍从症用之，亦无妨也；不过，勿犯下焦，且属虚体，当如虚怯人病邪而治。况产后当血气沸腾之际，最多
空窦，邪必乘虚内陷，虚处受邪，为难治也。如经水适来适断，邪将陷于血室，少阳伤寒言之详悉，不必多赘，但数动
与正伤寒不同，仲景立小柴胡汤，提出所陷热邪，参、枣以扶胃气，因冲脉隶属阳明也，此惟虚者为合治。若热邪陷入，
与血相结者，当宗陶氏小柴胡汤，去参、枣，加生地、桃仁、查肉、丹皮，或犀角等。若本经血结自甚，必少腹满痛，
轻者刺期门，重者小柴胡汤去甘药，加延胡、归尾、桃仁，挟寒加肉桂心，气滞加香附、陈皮、枳壳等。然热陷血室之
症，多有谵语、如狂之象，与阳明胃热相似，此种病机，最须辨别。血结者，身体必重，非若阳明之轻便者，何以故耶？
阴主重浊，络脉被阻，身之侧旁气痹，连及胸背，皆为阻窒，故去邪通络，正合其病。往往延久，上逆心胞，胸中痹痛，
即陶氏所谓血结胸也，王海藏出一桂枝红花汤，加海蛤、桃仁，原欲表里上下一齐尽解之理，此方大有巧妙焉。
温热病邪从口鼻侵入，首先侵犯肺脏，若病情恶化，可逆传至心包。肺主气，归属于卫分；心主血，归属于营分。辨别营分和卫分、气分和血分的病变，虽然与伤寒病有相同之处，但若论及治疗方法，则与伤寒大不相同。因为伤寒的病邪留恋在体表，然后才化热传入体内；而温病邪气化热的速度最快。当病邪尚未传入心包时，邪气仍在肺经，肺合于皮毛且主司气，所以说病邪在表。初期使用辛凉轻剂治疗。如果兼夹风邪，加入薄荷、牛蒡子等药物；如果兼夹湿邪，加入芦根、滑石等药物。或者将风邪透散于热邪之外，或者将湿邪渗利于热邪之下，使邪气不与热邪相互搏结，邪气势必孤立无援。如果不这样处理，风邪挟带温热之邪会导致燥热内生，清窍必然干燥，这是因为水精之气不能上荣滋润所致，这是风火两阳之邪相互劫夺的结果。湿邪与温邪结合，蒸腾郁滞而蒙蔽清窍，导致清窍壅塞不通，这是浊邪伤害清阳的表现，其病症表现类似伤寒。验证区分的方法是：伤寒病多有变化复杂的症状，而温热病即使病程较长，总归是在一经（如肺卫）为特征来进行辨别。
前面提到用辛凉药疏散风邪，用甘淡药驱除湿邪，如果病仍不愈，说明病邪逐渐进入营分。营分受热，血液受到劫耗，心神不安，夜间发热加重且无法入睡，或者皮肤出现隐隐约约的斑点，此时应立即撤去气分药物。如果是从风热陷入营分的，使用犀角、竹叶等药物；如果是从湿热陷入营分的，使用犀角、花露等药物，配合入凉血清热方剂中。如果出现烦躁、大便不通的情况，也可以加入金汁；对于老年人以及平时体质偏寒的人，用人中黄代替，迅速透发斑疹是关键。如果斑疹发出后热势仍不退，说明胃津已亡，治疗以甘寒生津为主，重症如玉女煎，轻症如梨皮、甘蔗浆之类。如果患者肾水素来亏虚，病邪虽未波及下焦，但往往先出现彷徨不安的症状，这必须通过观察舌象来验证。如果在甘寒药中加入咸寒药，务必在于预先安护尚未受邪的部位，防止病邪进一步深入。如果病邪始终在气分流连，可以期望通过战汗的方式透达邪气，治法宜益胃，使邪气随汗并出，热势达到腠理开泄，邪气随汗而出。战汗解后，胃气空虚，可能会出现皮肤发冷持续一昼夜的情况，等待正气回复，身体自然会恢复温暖。因为战汗而解，邪退正虚，阳气随汗外泄，所以皮肤渐渐发冷，这不一定会形成脱证。此时宜安静舒适地卧床休息，以养护阳气回复，旁人切勿惊慌，频繁呼唤，扰乱患者的元气。只需诊察脉象，如果脉象虚软和缓，虽然疲倦卧倒不语，出汗且皮肤发冷，但这并非脱证；如果脉象急疾，躁动不安无法躺卧，皮肤冷汗出，这才是气脱的病症。更有甚者，邪盛正虚，不能一次战汗而解，停留一二日再次战汗而痊愈的，这种情况不可不知。
再论述气分病有不传入血分，而邪气留滞在三焦的，这就如同伤寒中的少阳病一样。伤寒少阳病是和解表里半表半里的邪气，此病则是分消上下之势。根据症状变化治法，如近期常用的杏仁、厚朴、茯苓等类药物；或者像温胆汤那样走泄痰热。因为邪气仍在气分，仍有通过战汗透邪的机会，也有转化为疟疾样发作的机制。大凡诊治看法，卫分之后才讲气分，营分之后才讲血分。在卫分可以用发汗法，到了气分才适宜用清气法。刚入营分，还可以透热转气，仍然转为气分而解，如使用犀角、玄参、羚羊角等药物。至于进入血分，则恐怕耗血动血，必须直接用凉血散血的方法，如生地黄、牡丹皮、阿胶、赤芍等药物。如果不遵循这种缓急次序，担心动手就会出错。
况且我们吴地湿邪害人最多，如面色白的人，必须要顾护他的阳气，湿胜则阳气微弱。如果按理应使用清凉药，用到十分之六七的程度，就不可过于寒凉，因为恐怕湿热一去，阳气也随之衰微。面色青黑的人，必须要顾护他的津液，清凉药用到十分之六七。往往热减身寒的，不可立即说是虚寒而投用补剂，恐怕炉烟虽熄，灰中有火，必须仔细考察详审，才能少量给予，千万不要贸然进补。又有嗜酒之人，体内湿气素来旺盛，外邪入里，与之相搏，在阳气旺盛的躯体，胃湿通常较多，在阴气盛的体质，脾湿也不少，然而它们化热的情况是一样的。热病救阴相对容易，通阳最难。救阴不在于补血，而在于养津液和控制汗出；通阳不在于温补，而在于利小便，这与杂症的治疗有所不同。
再论述三焦病不从外部解除，必定导致内部结滞，内部结滞在何处？在阳明胃与大肠。也必须用下法，不可以因为是气血之分，就说它不可用下法。只有伤寒热邪在里，劫烁津液，用下法应当猛烈；此病多湿邪内搏，用下法应当轻缓。伤寒病大便溏薄表示邪气已尽，不可再下；湿温病大便溏薄表示邪气未尽，必须到大便变硬，才是没有湿邪了，这才不可再用攻下法。再人的身体，脘部在腹部之上，位置居中，按压疼痛，或自痛，或痞胀，应当用苦泄法，因为病位接近腹部。必须验之于舌，如果舌苔黄或浊，可以与小陷胸汤或泻心汤随症治疗。如果舌苔白而不燥，或黄白相兼，或灰白且不渴，千万不可乱投苦泄药。其中有外邪未解，里先结滞的，或邪气郁结未伸张的，或素来中焦虚冷的，虽然有脘中痞痛，宜从开泄法，宣通气滞，以达归于肺，如近世常用的杏仁、豆蔻、橘皮、桔梗等，轻苦微辛，具有流动性的药物即可。又有舌上白苔粘腻，吐出浊浓涎沫的，口中必甜，这是脾瘅。乃湿热气聚，与谷气相搏，土气有余，盈满则上泛。应当用佩兰叶，芳香辛散以驱逐之。如果舌上苔如碱样的，胃中宿滞，挟浊秽郁伏，应当急急开泄，否则闭结中焦，不能从募原达出了。
再舌苔白厚而干燥的，这是胃燥气伤，在滋润药中加入甘草，令甘守津还的意思。舌苔白而薄的，是外感风寒，应当疏散。如果薄白而干的，是肺液受伤，加麦冬、花露、芦根汁等轻清之品，这是“上者上之”的治疗方法。如果苔白而底绎（指舌苔剥落处显露红色舌质）的，是湿遏热伏，应当先泄湿透热，防止其即干；这可以不必担忧，再从里而透于外，则会变润。初病舌即干，神志不昏乱的，宜急养正气，微加透邪之药；如果神志已昏乱，这是内脏溃败，不可救药了。
前面说舌黄或浊，当用陷胸汤、泻心汤，须要有根基的黄苔（指苔厚）。如果光滑的，是无形的湿热，已有中虚之象。大忌前法。脐以上为大腹，或满、或胀、或痛，这必定是邪已入里，表证必无，或存十之一二，也须验之于舌。如果苔黄甚，或如沉香色，或如灰黄色，或老黄色，或中有断纹，都当下之，如小承气汤，用槟榔、青皮、枳实、元明粉、生首乌等皆可。如果没有出现这些舌象，不宜用这些药，恐怕其中有湿聚太阴为满，或寒湿错杂为痛，或气壅为胀，又当以别法治之。
再黄苔不甚浓而滑的，热未伤津，犹可清热透表。如果虽薄而干的，邪虽去而津受伤，苦重之药当禁，宜甘寒轻剂养之。
再论述热传营分，舌色必绛。绛，是深红色。初传绛色，中间兼黄白色，这是气分之邪未尽，泄卫透营，两和可也。纯绛鲜泽的，是心包络受邪，宜犀角、鲜生地、连翘、郁金、石菖蒲等清泄之。拖延数日，或平素心虚有痰，外热一陷，里络即闭，非菖蒲、郁金等所能开，须用牛黄丸、至宝丹之类，以开其闭，恐其昏厥成痉。
再论述舌绛而干燥的，是火邪劫营，凉血清血为要。色绛而舌心干的，是心胃火燔，劫烁津液，即黄连、石膏亦可加入。有舌心独绛而干的，也是胃热而心营受灼，应当在清胃方中加入清心之品，否则延及于尖，成为津干火盛之候。舌尖独绛而干，这是心火上炎，用导赤散泻其腑。如果烦渴、烦热，舌心干、四边色红、中心或黄或白的，这不是血分病，而是上焦气热烁津，急用凉膈散散其无形之热，再看其后转变如何；慎勿用血药，反致滋腻留邪。到舌绛望之若干，手扪之原有津液的，这是津亏湿热薰蒸，将成浊痰蒙闭心包。舌色绛而上有粘腻，似苔非苔的，中挟秽浊之气，急加芳香逐之。舌绛而抵齿难伸退的，是痰阻舌根，有内风。舌绛而光亮的，是胃阴亡，急用甘凉濡润之品。舌绛而有碎点黄白者的，将生疳疮。大红点的，是热毒乘心，用黄连、金汁。有虽绛而不鲜，干枯而痿的，这是肾阴涸，急以阿胶、鸡子黄、地黄、天冬等救之，缓则恐涸极而无救。
再有热传营血，其人素有瘀伤宿血在胸膈中，舌色必紫而暗，扪之潮湿，当加散血之品，如琥珀、丹参、桃仁、丹皮等，否则瘀血与热相搏，阻遏正气，遂变如狂发狂之症。如果紫而肿大者，是酒毒冲心。紫而干晦的，是肾、肝色泛，难治。
舌若淡红无色，或干而色不荣的，乃是胃津伤而气无化液，当用炙甘草汤，不可用寒凉药。
再有不拘何色，舌生芒刺的，皆是上焦热极，当用青布拭冷薄荷水揩之，即去的轻，旋即生的险。
舌苔不燥，自觉闷极的，属脾湿盛。或有伤痕血迹的，必问曾经搔挖否，不可以有血而便为枯症，仍从湿治可也。
再有神情清爽，舌胀大不能退出的，这是脾湿胃热郁极化风，而毒延于口，用大黄磨入当用剂内，则舌胀自消。
舌无苔而有如烟煤隐隐的，慎不可忽视。如果口渴烦热而燥的，平时胃燥，不可攻之，宜甘寒益胃；如果不渴、肢寒而润的，是挟阴病，宜甘温扶中，此何以故？外露而里无也。
舌黑而滑的，是水来克火，为阴症，当温之。如果见短缩，这是肾气竭，为难治，惟加入参、五味子，或救万一。舌黑而干的，是津枯火炽，急急泻南补北。如果黑燥而中心浓的，是土燥水竭，急以咸苦下之。
如果舌白如粉而滑，四边色紫绛的，是温疫病初入募原，未归胃腑，急急透解，莫待传入而为险恶之症。且见此舌者，病必见凶，须要小心！凡斑疹初见，须用纸燃照看胸背两胁，点大而在皮肤之上者为斑，或云头隐隐，或琐碎小粒者为疹，又宜见而不宜多见。按方书谓斑色红者属胃热，紫者热极，黑者胃烂，然亦必看外症所合，方可断之。春夏之间，湿病俱发斑疹为甚，如淡红色，四肢清，口不甚渴，脉不洪数，此非虚斑，即属阴斑。或胸前微见数点，面赤足冷，或下利清谷，此阴盛格阳于上，当温之。如果斑色紫而点小者，是心胞热；点大而紫，是胃中热。斑黑而光亮者，是热毒极炽，虽属不治，然其人气血充者，根据法治之，或有可救。如果黑而晦的，必死。黑而隐隐，四旁赤色的，是火郁内伏，大用清凉透发，间有转红而可救者。又有夹斑带疹，皆是邪之不一，各随其部而泄；然斑属血者恒多，疹属气者不少。斑疹皆是邪气外露之象，发出之时，宜神情清爽，方为外解里和；如果斑疹出而昏的，这是正不胜邪而内陷，或胃津内涸之候。
再有一种白痦，小粒如水晶色者，这是湿热伤肺，邪虽出而气液枯，必得甘药补之。如果未至久延，气液尚在未伤，是为湿郁卫分，汗出不彻之故，当理气分之邪。枯白如骨的多数凶险，气液竭也。
再温热之病，看舌之后，也须验齿。齿为肾之余，龈为胃之络，热邪不燥胃津，必耗肾液，且二经之血走于此处。病深动血，结瓣于上。阳血色紫，紫如干漆；阴血色黄，黄如酱瓣。阳血若见，安胃为主；阴血若见，救肾为要。然而豆瓣色者多险，惟症尚不逆者犹可治，否则难治矣，此何故耶？盖阴下竭，阳上厥也。
齿若光燥如石的，是胃热甚，证见无汗恶寒，卫偏胜，辛凉泄卫透汗为要。如果如枯骨色的，是肾液枯，为难治。如果上半截润，是水不上承而心火上炎。急急清心救水，俟枯处转润为妥。如果切牙啮齿的，是湿热化风，痉病。但切牙的，是胃热气走其络。切牙而脉症皆衰的，是胃虚无谷以内荣，此何以故？虚则喜实。舌本不缩而硬，牙关咬定难开的，这不是风痰阻络，就是欲作痉症，用酸物擦之即开，酸走筋，木来泄土故也。
如果齿垢如灰糕样的，是胃气无权，津亡而湿浊用事，多死。初病齿缝流清血，痛的是胃火冲激，不痛的是龙火内燔。齿焦无垢的死；齿焦有垢的，是肾热胃劫，当微下之，或玉女煎清胃救肾可也。
再妇人病温与男子同，但多胎前产后，以及经水适来适断。大凡胎前病，古人皆以四物汤加减用之，谓恐邪来害妊。如热极的，有用井底泥及蓝布浸冷覆盖腹上等，皆是护胎之意，然亦须看其邪之可解而用之。如果血腻之药不灵，又当审察，不可固执，仍宜步步保护胎元，恐正损邪陷。至于产后，方书谓慎用苦寒，恐伤已亡之阴，然亦要辨其邪能从上中解的，稍从症用之，亦无妨；不过，勿犯下焦，且属虚体，当如虚怯人病邪而治。况产后当血气沸腾之际，最多空窦，邪必乘虚内陷，虚处受邪，为难治。如经水适来适断，邪将陷于血室，少阳伤寒言之详悉，不必多赘，但数动与正伤寒不同，仲景立小柴胡汤，提出所陷热邪，参、枣以扶胃气，因冲脉隶属阳明，此惟虚者为合治。如果热邪陷入，与血相结的，当宗陶氏小柴胡汤，去参、枣，加生地、桃仁、查肉、丹皮，或犀角等。如果本经血结自甚，必少腹满痛，轻者刺期门，重者小柴胡汤去甘药，加延胡、归尾、桃仁，挟寒加肉桂心，气滞加香附、陈皮、枳壳等。然而热陷血室之症，多有谵语、如狂之象，与阳明胃热相似，此种病机，最须辨别。血结者，身体必重，非若阳明之轻便者，何以故耶？阴主重浊，络脉被阻，身之侧旁气痹，连及胸背，皆为阻窒，故去邪通络，正合其病。往往延久，上逆心胞，胸中痹痛，即陶氏所谓血结胸也，王海藏出一桂枝红花汤，加海蛤、桃仁，原欲表里上下一齐尽解之理，此方大有巧妙焉。
Warm-pathogen enters from above, first attacking the Lung; if it reverses, it transmits to the Pericardium. The Lung governs Qi and belongs to the Wei (Defensive) level; the Heart governs Blood and belongs to the Ying (Nutritive) level. Differentiating between Ying/Wei and Qi/Blood levels is similar to that in Cold Damage (Shanghan), but regarding treatment methods, they are vastly different. This is because the pathogen of Cold Damage lingers at the exterior before transforming into heat and entering the interior; whereas warm pathogens transform into heat most rapidly. Before transmitting to the Pericardium, the pathogen remains in the Lung. Since the Lung combines with the skin and hair and governs Qi, it is said to be at the exterior. Initially, use mild acrid-cool formulas. If accompanied by Wind, add herbs such as Bohe (Menthae Haplocalycis Herba) and Niuxibang (Arctii Fructus); if accompanied by Dampness, add substances such as Lugeng (Phragmitis Rhizoma) and Huashi (Talcum). Alternatively, vent the Wind outside the Heat, or drain the Dampness below the Heat, so that the pathogen does not contend with the Heat, and will inevitably become isolated. Otherwise, Wind carrying Warmth generates Dryness, and the clear orifices will certainly become dry. This is called "the water's governing qi cannot ascend to nourish," which is the result of two Yang pathogens劫 (robbing) each other. Dampness combining with Warmth steams and obstructs, clouding the upper orifices, causing obstruction and blockage of the clear orifices due to turbid pathogens harming the clear. The disease presents similarly to Cold Damage. To verify and distinguish: Cold Damage often has changing symptoms, while Warm diseases, even if prolonged, generally remain within one meridian/level for differentiation.
As previously mentioned, using acrid-cool to scatter Wind and sweet-bland to drive out Dampness: if the disease still does not resolve, it indicates the pathogen is gradually entering the Ying level. When the Ying level is heated, Blood is robbed, the Shen (Spirit) becomes unsettled, night fever worsens with insomnia, or spots appear faintly. At this point, remove Qi-level medicines immediately. If it entered from Wind-Heat, use substances like Xijiao (Rhinocerotis Cornu) and Zhuye (Bambusae Folium); if it entered from Damp-Heat, use substances like Xijiao and Hualu (Floral Dew), incorporated into blood-cooling and heat-clearing formulas. If restlessness and constipation occur, Jinzhi (Human Excrement Juice) may also be added; for the elderly and those with habitual cold constitutions, Renzhonghuang (Refined Human Excrement) substitutes it. Rapidly venting the spots is essential. If spots erupt but heat does not resolve, it indicates the loss of Stomach Yin. The primary treatment is sweet-cold to nourish Yin; severe cases use Yunnv Jian (Jade Woman Decoction), mild cases use Pear Skin and Sugarcane Juice. If the person’s Kidney Water is chronically deficient, even if the disease has not reached the Lower Jiao, they often experience hesitation and anxiety beforehand; this must be verified by the tongue. Adding salty-cold herbs to sweet-cold ones aims to secure areas not yet affected by the pathogen, preventing further invasion. If the pathogen lingers in the Qi level throughout, one may hope for a battle-sweat (Zhanhan) to vent the pathogen. The method should benefit the Stomach, allowing the pathogen to exit with sweat, heat reaches the interstices, opening them, and the pathogen exits via sweat. After resolution, Stomach Qi is empty, leading to cool skin for one day and night; wait for Qi to return, and warmth will normalize. Because battle-sweat resolves the disease, pathogen retreats and Zheng Qi is deficient; Yang escapes with sweat, hence gradual skin coolness. This does not necessarily constitute Collapse Syndrome. At this time, rest comfortably to nourish Yang recovery; attendants must not panic or call frequently, disturbing Yuan Qi. Only examine the pulse: if weak, soft, and slow, despite fatigue, silence, sweating, and cool skin, it is not Collapse; if rapid, restless, unable to lie down, with cold sweat, it is Qi Collapse. Furthermore, when Pathogen is excess and Zheng Qi is deficient, one battle-sweat may not resolve it; waiting one or two days for another battle-sweat to heal is possible, which must be known.
Again discussing Qi-level diseases that do not transmit to the Blood level but linger in the Three Jiao, similar to Shaoyang disease in Cold Damage. That involves harmonizing half-exterior/half-interior; this involves dispersing upper and lower tendencies. Vary methods according to symptoms, such as recent uses of Xingren (Armeniacae Semen Amarum), Houpo (Magnoliae Officinalis Cortex), Lingzhi (Poria), etc.; or Wen Dan Tang (Warm Gallbladder Decoction) for draining turbidity. Because it remains in the Qi level, there is still a portal for battle-sweat and a mechanism for malaria-like transformations. Generally, after Wei comes Qi, after Ying comes Blood. In Wei, sweating is appropriate; only upon reaching Qi is clearing Qi appropriate. Just entering Ying, one can still vent heat back to Qi for resolution, using Xijiao, Xuanshen (Scrophulariae Radix), Lingyangjiao (Saigae Tataricae Cornu), etc. Upon entering Blood, fearing consumption and movement of blood, direct cooling of Blood and dispersal of Blood stasis are required, using Shengdi Huang (Rehmanniae Radix), Mudan Pi (Moutan Cortex), Ejiao (Colla Corii Asini), Chishao (Paeoniae Radix Rubra), etc. Not following this order of urgency risks error.
Moreover, in our Wu region, Damp-pathogen harms people most. For those with white complexions, Yang Qi must be protected; excessive Damp leads to weak Yang. If cooling is indicated, use it to 60-70% strength, then stop, lest removing Damp-Heat also destroys Yang. For those with dark complexions, protect Body Fluids; use cooling to 60-70%. Often, heat decreases and body feels cold; do not immediately diagnose deficiency-cold and administer tonics, for fear that although the stove smoke is out, embers still hold fire. Observe carefully before giving small amounts; do not advance rashly. Alcohol drinkers have abundant internal Damp; external pathogen entering contends with it. In Yang-excess constitutions, Stomach Damp is abundant; in Yin-excess constitutions, Spleen Damp is considerable, yet transformation into Heat is uniform. Saving Yin in heat diseases is relatively easy; unblocking Yang is hardest. Saving Yin lies not in tonifying Blood but in nourishing Fluids and controlling sweat; unblocking Yang lies not in warming but in promoting urination, differing from miscellaneous diseases.
Again, if Three Jiao disease does not resolve externally, it leads to internal binding. Where? In the Yangming Stomach and Intestines. Purging is necessary; do not say it cannot be purged due to Blood/Qi distinction. In Cold Damage, heat in the interior consumes fluids, so purging should be fierce; here, Damp contends internally, so purging should be mild. In Cold Damage, loose stool means pathogen is exhausted, no more purging; in Wet-Warm disease, loose stool means pathogen is not exhausted; only hard stool indicates no Damp, then stop attacking. Again, the Wan (epigastrium) is above the abdomen, centrally located. Tenderness on pressure or spontaneous pain/distension requires bitter-draining, as it is near the abdomen. Verify with tongue: yellow or turbid coating allows Xiaoxianxiong Tang (Minor Chest-Harmonizing Decoction) or Xiexin Tang (Drain the Epigastrium Decoction). If white and not dry, or yellow-white mixed, or gray-white without thirst, absolutely do not use bitter-draining. Cases include unresolved exterior with prior interior binding, depressed pathogen not extending, or chronic middle-cold. Even with epigastric fullness/pain, use opening/draining to circulate Qi stagnation towards the Lung, using Xingren, Doukou (Amomi Fructus Rotundus), Juqpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix)—light bitter, slightly acrid, mobile substances suffice. White sticky coating with thick turbid saliva and sweet taste indicates Pi Dan (Spleen Heat). Damp-Heat gathering contends with Grain Qi, Earth excess overflows upward. Use Peilan Ye (Eupatorii Herba), aromatic and acrid-dispersing to drive it out. Coating like alkali indicates old stagnation in Stomach with turbid depression; urgently open and drain, otherwise Middle Jiao closes, unable to reach Mu Yuan (Source of Malaria).
White thick dry coating indicates Stomach Dryness and Qi injury; add Gancao (Glycyrrhizae Radix et Rhizoma) to moistening meds for "Sweet guards, Fluid returns." Thin white coating indicates Exterior Wind-Cold, disperse it. Thin white dry indicates Lung Fluid injury; add Maidong (Ophiopogonis Radix), Hualu, Lugeng Zhi (Rhizoma Phragmitis Juice)—light clear substances for "Upper treats Upper." White coating with red edges indicates Damp suppressing Heat; first drain Damp and vent Heat to prevent drying; this is not worrying, venting from inside to outside makes it moist. Dry tongue at onset with clear Shen requires urgent Righteous Qi nourishment with slight pathogen-venting drugs; if Shen is confused, internal collapse occurs, incurable.
Previous mention of yellow/turbous coating requiring Xianxiong/Xiexing requires grounded yellow. Smooth coating indicates formless Damp-Heat and Middle Deficiency; previous methods are taboo. Above navel is Da Fu (Great Abdomen); fullness/bloating/pain indicates interior pathogen, no exterior signs (or 10-20%), verify with tongue. Deep yellow, sandalwood color, gray-yellow, old yellow, or cracked lines require purging, e.g., Xiao Chengqi Tang, Binglang (Arecae Semen), Qingpi (Citri Reticulatae Pericarpium Viride), Zhishi (Aurantii Fructus), Yuanmingfen (Natrii Sulfas), Sheng Shouwu (Polygoni Multiflori Radix), etc. Without these tongues, do not use these meds; fear Taiyin Damp accumulation, Cold-Damp pain, or Qi congestion bloating, requiring other treatments.
Yellow coating not dense but slippery: Heat hasn't injured Fluids, can clear Heat and vent exterior. Thin but dry: Pathogen gone, Fluids injured; forbid heavy bitter meds, use sweet-cold light agents to nourish.
Heat transmitting to Ying: Tongue must be crimson (Jiang). Jiang is deep red. Initial Jiang with yellow/white center: Qi pathogen not exhausted; vent Wei and Ying, harmonize both. Pure bright Jiang: Pericardium Collateral pathogen; use Xijiao, Xian Shengdi, Lianqiao (Forsythiae Fructus), Yujin (Curcumae Radix), Shichangpu (Acori Tatarinowii Rhizoma) to clear/drain. Delayed days or chronic Heart deficiency with Phlegm: External heat sinks, interior collaterals close; Shichangpu/Yujin insufficient; use Niuhuang Wan (Calculus Bovis Pill) or Zhibao Dan (Precious Treasure Pill) to open closure, fearing syncope/spasm.
Crimson dry tongue: Fire pathogen robs Ying, cool Blood and clear Blood is key. Crimson with dry center: Heart/Stomach Fire blazing, consuming Fluids; add Huanglian (Coptidis Rhizoma), Shigao (Gypsum Fibrosum). Crimson dry center only: Stomach Heat burning Ying; add Heart-clearing to Stomach-clearing formula, else spreads to tip, indicating Fluid dryness/Fire excess. Crimson dry tip only: Heart Fire flaming up; use Daochi San (Guide Out Redness Powder) to drain its Fu. Restlessness/thirst/heat, dry center, red sides, yellow/white center: Not Blood level, Upper Jiao Qi Heat scorching Fluids; urgently use Liangge San (Cool the Diaphragm Powder) to scatter formless Heat; observe changes later; avoid Blood meds to prevent cloying/stagnation. Crimson looking dry but moist to touch: Fluid deficiency with Damp-Heat steaming, forming turbid Phlegm clouding Pericardium. Crimson with sticky coating like moss: Turbid Qi in Middle; urgently add aromatic dispersants. Crimson tongue hard to extend/retract: Phlegm blocking root, Internal Wind. Crimson bright: Stomach Yin exhausted; urgently use sweet-cool moistening. Crimson with yellow/white dots: Impending ulceration. Large red dots: Heat-Toxin attacking Heart; use Huanglian, Jinzhi. Crimson not bright, dry/withered: Kidney Yin exhausted; urgently save with Ejiao, Jizihuang (Gallicolum Ovum), Dihuang (Rehmanniae Radix), Tiandong (Asparagi Radix); delay risks irretrievable exhaustion.
Heat transmitting Ying/Blood with chronic Bruise-Blood in chest/diaphragm: Tongue purple-dark, moist to touch; add Blood-dispersing like Hupo (Succinum), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Taoren (Persicae Semen), Mudan Pi; otherwise Blood-Stasis contends with Heat, obstructing Zheng Qi, leading to mania. Purple swollen: Wine-Toxin rushing Heart. Purple dry/dull: Liver/Kidney colors surfacing, difficult to treat.
Pale red colorless or dry/unlustrous: Stomach Fluid injury, Qi fails to generate Fluid; use Zhigancao Tang (Honey-Fried Licorice Decoction), avoid cold-cool meds.
Any color with prickles: Upper Jiao Heat extreme; wipe with blue cloth dipped in cold Mint Water. Disappearing quickly is mild; regrowing quickly is dangerous.
Non-dry coating with extreme stuffiness: Spleen Damp excess. Scratches/blood: Ask if scratched; do not diagnose dryness due to blood, treat as Damp.
Clear Shen with swollen tongue unable to retract: Spleen Damp/Stomach Heat郁极化风 (extreme depression transforms to Wind), toxin extends to mouth; grind Dahuang (Rhei Radix et Rhizoma) into formula, swelling subsides.
No coating, coal-smoke shadow: Do not ignore. Thirsty/restless/dry: Chronic Stomach Dryness, do not purge, use sweet-cold benefit Stomach; Non-thirsty/cold limbs/moist: Yin-complicated disease, use sweet-warm support Middle. Why? Exterior exposed, Interior absent.
Black slippery: Water controls Fire, Yin syndrome, warm it. Shortened tongue: Kidney Qi exhausted, difficult; add Renshen (Ginseng Radix), Wuzizi (Schisandrae Fructus) for chance. Black dry: Fluid exhausted/Fire blazing, urgently drain South (Fire) supplement North (Water). Black dry thick center: Earth dry/Water exhausted, urgently purge with salty-bitter.
White like powder slippery, purple-red edges: Warm Epidemic just entered Mu Yuan, not yet Stomach Fu; urgently vent/solve, do not wait for dangerous transmission. Seeing this tongue means ominous disease, be careful! For initial macules/rash, use paper flame to check chest/back/flanks. Large spots on skin are Ban (Macules); cloud-like faint or tiny grains are Zhen (Papules). Better to see some than many. Formulas say: Red Ban = Stomach Heat; Purple = Extreme Heat; Black = Stomach rot. But must combine with external symptoms. Spring/Summer, Damp diseases often have severe macules/rashes. Pale red, cold limbs, not very thirsty, non-rapid pulse: Not deficiency macule, but Yin macule. Few points on chest, red face/cold feet, or diarrhea undigested: Yin excess repelling Yang upward, warm it. Purple small spots: Pericardium Heat; large purple spots: Stomach Heat. Black bright: Heat-Toxin extreme, usually untreatable, but if Qi/Blood sufficient, follow method, maybe save. Black dull: Death. Black faint with red surroundings: Fire depression internal, large dose cool-clear venting, occasionally turns red and saves. Mixed Ban/Zhen: Pathogens differ, drain according to location; Ban mostly Blood, Zhen mostly Qi. Both are pathogen exteriorization; during eruption, Shen should be clear for exterior resolution/internal harmony; if confusion upon eruption, Zheng cannot overcome Pathogen sinking inward, or Stomach Fluid exhaustion.
White Qipin (prickly heat), crystal-like small grains: Damp-Heat injuring Lung, pathogen out but Qi/Fluid exhausted; must tonify with sweet meds. If not prolonged, Qi/Fluid intact, it is Damp depressing Wei, incomplete sweating; regulate Qi level pathogen. Bone-white dry: Mostly ominous, Qi/Fluid exhausted.
For Warm diseases, after tongue, check teeth. Teeth are remainder of Kidney; gums are network of Stomach. Heat not drying Stomach Fluids must consume Kidney Fluids; blood of both meridians flows here. Deep disease moves Blood, forming clots above. Yang-blood purple like dried lacquer; Yin-blood yellow like soybean paste. Yang-blood seen: Stabilize Stomach; Yin-blood seen: Save Kidney. Bean-paste color: Dangerous, but if symptoms not adverse, treatable; otherwise difficult. Why? Yin exhausted below, Yang rebellious above.
Teeth shiny/dry like stone: Stomach Heat extreme, no sweat/chill, Wei excess; acrid-cool vent Wei/sweat is key. Like dead bone: Kidney Fluid exhausted, difficult. Upper part moist: Water not ascending, Heart Fire flaming; urgently clear Heart/save Water, wait for dry part to moisten. Grinding teeth: Damp-Heat transforming to Wind, Spasm. Only grinding: Stomach Heat moving through collaterals. Grinding with weak pulse/symptoms: Stomach deficiency lacking Grain to nourish; why? Deficiency prefers excess. Tongue base stiff/not shortened, jaw locked: Not Wind-Phlegm blocking collateral, but impending Spasm; rub with sour substance to open, sour enters sinews, Wood drains Earth.
Teeth tartar like gray cake: Stomach Qi powerless, Fluid lost, Damp-Turbid dominates, mostly death. Initial bleeding from gum crevice: Painful = Stomach Fire rushing; Painless = Dragon Fire internal blazing. Teeth scorched no tartar: Death; scorched with tartar: Kidney Heat/Stomach robbery, slight purge or Yunnv Jian clear Stomach/save Kidney.
Women's Warm disease same as men, but often pre/post-natal or menstrual irregularities. Pre-natal disease, ancients used Siwu Tang modifications, fearing pathogen harms fetus. Extreme heat: Well-bottom mud or cold blue cloth on abdomen to protect fetus, but must judge if pathogen resolvable. If blood-cloying meds fail, examine carefully, do not stick rigidly; still protect Fetal Source step-by-step, fear Zheng damage/pathogen sinking. Post-natal, formulas advise caution with bitter-cold to protect lost Yin, but differentiate if pathogen resolves from Upper/Middle; slight symptomatic use is fine; just avoid Lower Jiao, treat as deficiency-cold person with pathogen. Post-natal blood/Qi boiling, many empty spaces, pathogen invades deficiency, treating deficiency-receiving pathogen is difficult. Menstruation just started/stopped, pathogen sinking into Blood Chamber (Xueshi), detailed in Shaoyang Cold Damage, no need repeat. Frequent movement differs from regular Cold Damage. Zhang Zhongjing established Xiao Chaihu Tang (Minor Bupleurum Decoction) to extract sunk heat, Ginseng/Jujube to support Stomach Qi, as Chong Mai belongs to Yangming; this fits only deficiency. If Heat sinks contending with Blood, follow Tao's Xiao Chaihu Tang, remove Ginseng/Jujube, add Shengdi, Taoren, Shanrou (Crataegi Fructus), Mudan Pi, or Xijiao. If Blood Stasis severe, lower abdomen full/painful: Light puncture Qimen; Heavy Xiao Chaihu Tang remove sweet meds, add Yanzhu (Cyperi Rhizoma), Guiwei (Angelicae Sinensis Radix), Taoren, plus Rouguixin (Cinnamomi Cortex) for Cold, Xiangfu (Cyperi Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus Immaturus) for Qi stagnation. Heat sinking Blood Chamber often has delirium/mania, similar to Yangming Stomach Heat; this mechanism must be distinguished. Blood Stasis: Body heavy, unlike Yangming lightness. Why? Yin governs heaviness/turbidity, collaterals blocked, side Qi bi, connecting chest/back, all obstructed; thus removing pathogen/unblocking collaterals fits disease. Prolonged, rises to Pericardium, chest Bi-pain, Tao's Blood Stasis Chest. Wang Haicang proposed Guizhi Honghua Tang (Cinnamon Twig and Safflower Decoction) + Haige (Concha Meretricis), Taoren, originally intending simultaneous resolution of exterior/interior/up/down; this formula is ingenious.