活人书云。先伤于湿。又中于暑。名曰湿温。许学士云。先受暑。后受湿。所言先后感
受不同。然湿病则缓。暑中则速。由斯以推。先湿后暑者为确也。其证两胫逆冷。
胸满颈目痛。妄言多汗。盖湿得暑邪。遏抑阳气。故胫冷而腹满。暑挟湿邪。郁蒸
为热。故头痛妄言多汗。其脉阳濡而弱。阴小而急。许学士以关前为阳。关后为
阴。纪氏以浮为阳。沉为阴。罗谦甫云。濡弱见于阳部。湿抟暑也。小急见于阴部。
暑抟湿也。然湿伤血。则必小急。暑伤气。则必濡弱。于此加浮为阳。沉为阴者当
矣。切不可发汗。汗之名重 死。治宜白虎加苍术汤。如有寒热外邪。加辛凉表药一二味。
若湿气胜。一身尽痛。小便不利。大便反快者。加茵陈、香薷。若有寒物停滞。及中寒
宜温。必小便清白。然后可。如赤涩而少。断不可用。通宜十味香薷饮。清暑益气。合天水散。
王宇泰云。昔人治湿温。通身皆润。足冷至膝下。腹满不省人事。六脉皆小弱而急。
问所服药。皆阴病药也。此非受病重。药能重病耳。以五苓合白虎十余剂少苏。
更与清燥汤调理而安。凡阴病厥冷。两臂皆冷。今胫冷臂不冷。则非下厥上行。
故知非阳微寒厥。而合用祛热药也。
阳邪亢极。遂成阳毒。亦有误以辛热与之而成者。金匮云。阳毒为病。面赤斑斑如
锦纹。咽喉痛。唾脓血。五日可治。七日不可治。升麻鳖甲汤主之。
虚热炽甚。毒不化者。阳毒升麻汤。大便结。去射干。加酒大黄。热甚去人参。加大青。
或吐下未当。陷邪内甚。其证壮热。头项强痛。躁闷不安。或狂言骂詈。妄见妄言。或
面生斑纹。口吐脓血。或舌卷焦黑。鼻如烟煤。或下利黄赤。六脉洪大而数。犀角
黑参汤。黄连解毒汤。慎不可用下药也。势甚者。以青布渍冷水。搭病患胸膛必喜。热即易之。须臾得睡。
《活人书》说：先被湿邪所伤，又感受暑邪，称为湿温。许学士说：先感受暑邪，后感受湿邪。这里所说的先后感受不同。然而，湿病发病较缓，暑邪致病则迅速。由此推断，先受湿后受暑的情况是确切的。其症状表现为两小腿逆冷，胸部胀满，颈部和眼部疼痛，胡言乱语且多汗。这是因为湿邪得到暑邪的侵袭，遏制了阳气的运行，所以小腿发冷而腹部胀满；暑邪挟带湿邪，郁结蒸腾化为热邪，所以头痛、胡言乱语且多汗。其脉象表现为寸部（阳）濡软而弱，尺部（阴）细小而急。许学士以关前为阳，关后为阴；纪氏以浮脉为阳，沉脉为阴。罗谦甫说：濡弱脉出现在阳部，是湿邪搏结暑邪的表现；细小紧急脉出现在阴部，是暑邪搏结湿邪的表现。然而，湿邪损伤血分，则脉必细小紧急；暑邪损伤气分，则脉必濡弱。在此处加上“浮为阳，沉为阴”的判断也是恰当的。切不可使用发汗法，误用发汗法后果严重，甚至导致死亡。治疗适宜用白虎加苍术汤。如果有寒热外邪侵袭，加入一两味辛凉解表药。如果湿气偏盛，全身疼痛，小便不利，大便反而通畅者，加入茵陈、香薷。如果有寒性食物停滞，以及中焦虚寒需要温补的情况，必须小便清亮颜色淡，然后才可以用药。如果小便赤涩量少，绝对不可使用。通常适宜用十味香薷饮，以清解暑热、益气生津，配合天水散。王宇泰说：过去有人治疗湿温病，患者全身皮肤湿润，脚冷直到膝盖以下，腹部胀满，神志不清人事不知。六脉都细小虚弱而急。询问服用的药物，都是治疗阴病的药物。这不是因为病情重，而是药物加重了病情。用五苓散合白虎汤服用十余剂后稍微清醒。再给予清燥汤调理而痊愈。凡是阴病导致的四肢厥冷，双臂都冷。现在只是小腿冷而手臂不冷，这就不是下焦厥逆上行。因此知道这不是阳气微弱导致的寒厥，而是应当配合使用清热祛热的药物。
阳邪亢盛到了极点，就形成阳毒。也有因为误用辛热药物而导致形成的。《金匮要略》说：阳毒这种病，面部红赤，斑纹像锦缎花纹一样，咽喉疼痛，吐脓血。五天还可以治疗，七天就不能治疗了。主方用升麻鳖甲汤。
如果是虚热炽盛，毒邪不能化解的，用阳毒升麻汤。如果大便干结，去掉射干，加入酒制大黄。热势很重的，去掉人参，加入大青叶。或者是因为吐下法使用不当，导致邪气内陷严重的，其症状表现为高热，头项强直疼痛，烦躁闷乱不安，或者胡言乱语、骂人，看见或听到不存在的东西，胡乱说话。或者面部生出斑纹，口吐脓血。或者舌头卷缩焦黑，鼻孔像烟煤一样黑。或者腹泻排出黄红色粪便。六脉洪大而数。用犀角黑参汤，黄连解毒汤。千万不要使用泻下药。病情严重的，用青布浸泡冷水，搭在病患胸膛上，病人一定会感到舒适。热了就更换。一会儿就能睡着。
The *Huoren Shu* (Book of Vitality) states: When one is first injured by dampness (Shi, 湿) and subsequently struck by summerheat (Shu, 暑), it is named Damp-Heat (Shiwen, 湿温). Scholar Xu stated: One first contracts summerheat and then dampness. The difference lies in the sequence of contraction. However, diseases caused by dampness develop slowly, whereas those caused by summerheat act rapidly. From this reasoning, the scenario of dampness preceding summerheat is considered accurate. The symptoms include coldness reversing up from the lower legs, chest fullness, pain in the neck and eyes, delirious speech, and profuse sweating. This occurs because dampness, combined with summerheat pathogen, suppresses the Yang Qi (Yang Energy, 阳气), resulting in cold lower legs and abdominal fullness; summerheat, carrying dampness, stagnates and steams into heat, causing headache, delirium, and excessive sweating. The pulse is superficial and soggy yet weak at the Yang position (Cun/Inch position, 阳部), and small and rapid at the Yin position (Chi/Cubit position, 阴部). Scholar Xu defined the area before the Guan (Bar) position as Yang and after as Yin; Ji defined floating pulse as Yang and sunken pulse as Yin. Luo Qianfu said: A soggy and weak pulse appearing in the Yang position indicates dampness clashing with summerheat; a small and rapid pulse appearing in the Yin position indicates summerheat clashing with dampness. Nevertheless, since dampness injures the Blood (Xue, 血), the pulse must be small and rapid; since summerheat injures the Qi (Qi, 气), the pulse must be soggy and weak. Adding the distinction of "floating is Yang, sunken is Yin" here is appropriate. Sweating therapy (Fa Han, 发汗) must absolutely not be used; misusing sweating can lead to severe consequences or death. Treatment should preferably employ Baihu Jia Cangzhu Tang (White Tiger plus Atractylodis Rhizoma Decoction, 白虎加苍术汤). If there are exterior pathogens of cold and heat, add one or two acrid-cool exterior-releasing herbs. If dampness is predominant, causing whole-body pain, difficulty in urination, and loose stools, add Yinchen (Artemisiae Scopariae Herba, 茵陈) and Xiangru (Elsholtziae Herba, 香薷). If there is stagnation of cold food or middle-jiao cold requiring warming, one must ensure the urine is clear and pale-colored before administering such treatment. If the urine is red, scanty, and difficult to pass, these treatments are absolutely contraindicated. Generally, Shiwei Xiangru Yin (Ten-Ingredient Elsholtzia Decoction, 十味香薷饮) is suitable to clear summerheat and benefit Qi, combined with Tianshui San (Heavenly Water Powder, 天水散). Wang Yutai said: In the past, when treating Damp-Heat, patients had moist skin all over, cold feet extending below the knees, abdominal fullness, and unconsciousness. All six pulses were small, weak, and rapid. Upon inquiry, the administered medicines were all for Yin-pattern diseases. This was not due to the severity of the disease, but rather the medicine exacerbating the condition. After taking Wuling San (Five-Ingredient Poria Decoction, 五苓散) combined with Baihu Tang (White Tiger Decoction, 白虎汤) for more than ten doses, the patient slightly regained consciousness. Subsequently, Qingzao Tang (Clear-Dryness Decoction, 清燥汤) was given for regulation, leading to recovery. In cases of Yin-pattern disease causing cold extremities, both arms are typically cold. Here, only the lower legs are cold while the arms are not, indicating this is not lower-jiao Jue (Reversal Cold, 厥) ascending. Therefore, it is known not to be a cold Jue caused by deficient Yang, but rather requires the use of heat-clearing medications.
When Yang pathogens reach extreme hyperactivity, Yang Du (Yang Toxin, 阳毒) forms. It can also result from the erroneous administration of acrid-hot substances. The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet, 《金匮要略》) states: For Yang Du disease, the face is red with mottled patterns like brocade, accompanied by sore throat and expectoration of pus and blood. It is treatable within five days, but untreatable after seven days. The primary formula is Shengma Biejia Tang (Anemarrhenae and Softshell Turtle Shell Decoction, 升麻鳖甲汤).
For deficiency-heat blazing severely with unresolving toxin, Yang Du Shengma Tang (Yang Toxin Anemarrhena Decoction, 阳毒升麻汤) is used. If stool is constipated, remove Shegan (Belamcandae Rhizoma, 射干) and add Jiu Dahuang (Wine-processed Rheum Radix et Rhizoma, 酒大黄). If heat is severe, remove Renshen (Ginseng Radix, 人参) and add Daqingye (Isatidis Folium, 大青叶). Or, if vomiting and purging were improperly applied, causing pathogens to sink deeply inward, symptoms include high fever, stiffness and pain in the head and neck, restlessness and anxiety, or delirious cursing, hallucinations, and nonsensical speech. There may be facial macules, expectoration of pus and blood, curled and scorched-black tongue, or nose resembling soot. Diarrhea of yellow-red stool may occur. The six pulses are surging and rapid. Use Xijiao Heishen Tang (Rhinoceros Horn and Black Ginseng Decoction, 犀角黑参汤) and Huanglian Jiedu Tang (Coptis Detoxification Decoction, 黄连解毒汤). Purging drugs must absolutely not be used. For severe cases, soak blue cloth in cold water and place it on the patient's chest; the patient will likely find relief. Replace it when it warms up. Sleep will follow shortly.