四三、头痛恶寒，身重疼痛，舌白不渴，脉弦细而濡，面色淡黄，胸闷不饥，午后身热，状若阴虚，病难速已，
名
曰湿温。汗之则神昏耳聋，甚则目瞑不欲言，下之则洞泄，润之则病深不解，长夏深秋冬日同法，三仁汤主之。
头痛恶寒，身重疼痛，有似伤寒，脉弦濡，则非伤寒矣。舌白不渴，面色淡黄，则非伤暑之偏于火
者矣。胸闷不饥，湿闭清阳道路也。午后身热，状若阴虚者，湿为阴邪，阴邪自旺于阴分，故与阴虚
同一午后身热也。湿为阴邪，自长夏而来，其来有渐，且其性氤氲粘腻，非若寒邪之一汗而解，温热
之一凉则退，故难速已。世医不知其为湿温。见其头痛恶寒身重疼痛也，以为伤寒而汗之，汗伤心
阳，湿随辛温发表之药蒸腾上逆，内蒙心窍则神昏，上蒙清窍则耳聋目瞑不言。见其中满不饥，以
为停滞而大下之，误下伤阴，而重抑脾阳之升，脾气转陷，湿邪乘势内渍，故洞泄。见其午后身热，
以为阴虚而用柔药润之，湿为胶滞阴邪，再加柔润阴药，二阴相合，同气相求，遂有锢如而不可解之
势。惟以三仁汤轻开上焦肺气，盖肺主一身之气，气化则湿亦化也。湿气弥漫，本无形质，以重浊滋
味之药治之，愈治愈坏。伏暑湿温，吾乡俗名秋呆子，悉以陶氏《六书》法治之，不知从何处学来，医
者呆，反名病呆，不亦诬乎！再按∶湿温较诸温，病势虽缓而实重，上焦最少，病势不甚显张，中焦病
最多，详见中焦篇，以湿为阴邪故也，当于中焦求之。
三仁汤方
杏仁（五钱） 飞滑石（六钱） 白通草（二钱） 白蔻仁（二钱） 竹叶（二钱） 浓朴（二钱） 生
薏仁（六钱） 半夏（五钱）
甘澜水八碗，煮取三碗，每服一碗，日三服。
四四、湿温邪入心包，神昏肢逆，清宫汤去莲心、麦冬，加银花、赤小豆皮，煎送至宝丹，或紫雪丹亦可。
湿温着于经络，多身痛身热之候，医者误以为伤寒而汗之，遂成是证。仲景谓湿家忌发汗，发汗
则病痉。湿热相搏，循经入络，故以清宫汤清包中之热邪，加银花、赤豆以清湿中之热，而又能直入
手厥阴也。至宝丹去秽浊复神明，若无至宝，即以紫雪代之。
清宫汤去莲心麦冬加银花赤小豆皮方
犀角（一钱） 连翘心（三钱） 元参心（二钱） 竹叶心（二钱） 银花（二钱） 赤小豆皮（三钱）
至宝丹、紫雪丹方（并见前）
四五、湿温喉阻咽痛，银翘马勃散主之。
肺主气，湿温者，肺气不化，郁极而一阴一阳（谓心与胆也）之火俱结也。盖金病不能平木，木反挟心火来刑肺
金。喉即肺系，其闭在气分者即阻，闭在血分者即痛也，故以轻药开之。
银翘马勃散方（辛凉微苦法）
连翘（一两） 牛蒡子（六钱） 银花（五钱） 射干（三钱） 马勃（二钱）
上杵为散，服如银翘散法。不痛但阻甚者，加滑石六钱，桔梗五钱，苇根五钱。
四六、太阴湿温，气分痹郁而哕者（俗名为呃），宣痹汤主之。
上焦清阳 郁，亦能致哕，治法故以轻宣肺痹为主。
宣痹汤（苦辛通法）
枇杷叶（二钱） 郁金（一钱五分） 射干（一钱） 白通草（一钱） 香豆豉（一钱五分）
水五杯，煮取二杯，分二次服。
四七、太阴湿温喘促者，千金苇茎汤加杏仁、滑石主之。
《金匮》谓喘在上焦，其息促。太阴湿蒸为痰，喘息不宁，故以苇茎汤轻宣肺气，加杏仁、滑石利窍而逐热饮。若
寒饮喘咳者，治属饮家，不在此例。
千金苇茎汤加滑石杏仁汤（辛淡法）
苇茎（五钱） 薏苡仁（五钱） 桃仁（二钱） 冬瓜仁（二钱） 滑石（三钱） 杏仁（三钱）
水八杯，煮取三杯，分三次服。
四八、《金匮》谓太阳中 ，身热疼痛而脉微
弱，此以夏月伤冷水，水行皮中所致也，一物瓜蒂汤主之。
此热少湿多，阳郁致病之方法也。瓜蒂涌吐其邪，暑湿俱解，而清阳复辟矣。
一物瓜蒂汤方
瓜蒂（二十个）
上捣碎，以逆流水八杯，煮取三杯，先服一杯，不吐再服，吐停后服。虚者加参芦三钱。
四九、寒湿伤阳，形寒脉缓，舌淡，或白滑不渴，经络拘束，桂枝姜附汤主之。
载寒湿，所以互证湿温也。按寒湿伤表阳中
经络之证，《金匮》论之甚详，兹不备录。独采叶案一条，以见湿寒、湿温不可混也。形寒脉缓，舌白
不渴，而经络拘束，全系寒证，故以姜附温中，白术燥温，桂枝通行表阳也。
桂枝姜附汤（苦辛热法）
桂枝（六钱） 干姜（三钱） 白术（生，三钱） 熟附子（三钱）
水五杯，煮取二杯，渣再煮一杯服。
第四十三条：头痛、怕冷，身体沉重疼痛，舌苔白而不口渴，脉象弦细而濡缓，面色淡黄，胸闷不想进食，下午发热，症状像阴虚病，病情难以迅速痊愈，这种病叫做湿温。如果用发汗法治疗，会导致神志昏迷、耳聋，甚至眼睛闭合不想说话；如果用泻下法治疗，会导致腹泻不止；如果用滋润法治疗，会使病情加深而难以解除。长夏、深秋和冬季的治疗方法相同，主方用三仁汤。
头痛、怕冷，身体沉重疼痛，看起来像伤寒，但脉象弦而濡缓，就不是伤寒了。舌苔白而不口渴，面色淡黄，就不是偏于火邪的伤暑了。胸闷不想进食，是因为湿气闭塞了清阳上升的道路。下午发热，症状像阴虚，是因为湿属于阴邪，阴邪在阴分旺盛，所以与阴虚病的午后发热一样。湿属于阴邪，从长夏而来，逐渐形成，而且它的性质氤氲粘腻，不像寒邪那样一发汗就能解除，也不像温热病那样一用凉药就能退热，所以难以迅速痊愈。世间的医生不知道这是湿温病。看到患者头痛、怕冷、身体沉重疼痛，就认为是伤寒而使用发汗法，发汗损伤心阳，湿气随着辛温发表的药物蒸腾上逆，内扰心窍则神志昏迷，上蒙清窍则耳聋、眼睛闭合不想说话。看到患者胸中胀满不想进食，就认为是食积停滞而使用峻猛泻下法，误下损伤阴液，又重重压抑脾阳的升发，脾气转陷，湿邪趁机内侵浸渍，所以导致腹泻不止。看到患者下午发热，就认为是阴虚而使用柔润药物滋润，湿是胶滞的阴邪，再加上柔润的阴药，两种阴邪相合，同气相求，于是就有固结难解的趋势。只有用三仁汤轻轻开启上焦肺气，因为肺主一身之气，气机通畅则湿气也能化解。湿气弥漫，本来没有固定的形质，如果用重浊滋腻的药物去治疗，越治越坏。伏暑湿温，我们家乡俗称为“秋呆子”，都用陶华《六书》中的方法治疗，不知道是从哪里学来的，医生变得呆板，反而说病人呆滞，这不是冤枉吗？再按：湿温与其他温病相比，病势虽然缓慢但实际上严重，在上焦最少，病势不显著张扬，在中焦最多，详见中焦篇，这是因为湿属于阴邪的缘故，应当从中焦寻求治疗方法。
三仁汤方
杏仁（五钱） 飞滑石（六钱） 白通草（二钱） 白蔻仁（二钱） 竹叶（二钱） 浓朴（二钱） 生薏苡仁（六钱） 半夏（五钱）
用甘澜水八碗，煮取三碗，每次服用一碗，每天三次。
第四十四条：湿温邪气侵入心包，出现神志昏迷、四肢逆冷，用清宫汤去掉莲心、麦冬，加入银花、赤小豆皮，煎好后送服至宝丹，或者紫雪丹也可以。
湿温附着于经络，多有身体疼痛、身体发热的症状，医生误以为是伤寒而使用发汗法，于是造成这种证候。张仲景说患湿病的人忌用发汗法，发汗就会导致痉病。湿热相互搏结，沿着经络进入络脉，所以用清宫汤清除心包中的热邪，加入银花、赤小豆以清除湿气中的热邪，并且能直接入手厥阴经。至宝丹能去除秽浊、恢复神明，如果没有至宝丹，就用紫雪丹代替。
清宫汤去莲心麦冬加银花赤小豆皮方
犀角（一钱） 连翘心（三钱） 元参心（二钱） 竹叶心（二钱） 银花（二钱） 赤小豆皮（三钱）
至宝丹、紫雪丹方（均见前文）
肺主气，湿温病，肺气不能正常化生，郁结至极，导致心与胆的一阴一阳之火都结聚在一起。因为肺金有病不能平抑肝木，肝木反而挟带心火来克制肺金。喉咙就是肺系，气分闭阻就会感到阻塞，血分闭阻就会感到疼痛，所以用轻扬的药物来开泄。
银翘马勃散方（辛凉微苦法）
连翘（一两） 牛蒡子（六钱） 银花（五钱） 射干（三钱） 马勃（二钱）
以上药物捣碎成散剂，服用方法如同银翘散。如果不痛只是阻塞严重的，加滑石六钱，桔梗五钱，苇根五钱。
第四十六条：太阴湿温，气分痹阻郁滞而出现呃逆（俗名为打嗝），用宣痹汤主治。
宣痹汤（苦辛通法）
枇杷叶（二钱） 郁金（一钱五分） 射干（一钱） 白通草（一钱） 香豆豉（一钱五分）
用水五杯，煮取两杯，分两次服用。
第四十七条：太阴湿温出现气喘急促的，用千金苇茎汤加杏仁、滑石主治。
《金匮要略》说喘促在上焦，呼吸急促。太阴湿邪蒸腾化为痰，喘息不安，所以用苇茎汤轻轻宣发肺气，加入杏仁、滑石利窍并驱逐热饮。如果是寒饮导致的喘咳，治疗属于饮家范畴，不在此例。
千金苇茎汤加滑石杏仁汤（辛淡法）
苇茎（五钱） 薏苡仁（五钱） 桃仁（二钱） 冬瓜仁（二钱） 滑石（三钱） 杏仁（三钱）
用水八杯，煮取三杯，分三次服用。
第四十八条：《金匮要略》说太阳中暍（中暑），身体发热疼痛而脉微弱，这是因为夏天伤了冷水，水气行于皮肤中所致，用一物瓜蒂汤主治。
这是热少湿多，阳气郁滞致病的机理。瓜蒂涌吐邪气，暑湿都得以解除，清阳之气重新恢复。
一物瓜蒂汤方
瓜蒂（二十个）
以上捣碎，用逆流清水八杯，煮取三杯，先服用一杯，不呕吐再服用，呕吐停止后停服。体虚者加参芦三钱。
第四十九条：寒湿损伤阳气，形体畏寒，脉象缓，舌色淡，或舌苔白滑而不渴，经络拘紧束缚，用桂枝姜附汤主治。
记载寒湿，是为了与湿温互相印证。按寒湿损伤表阳及经络的证候，《金匮要略》论述得很详细，这里不再全部收录。只选取叶天士医案中的一条，以说明湿寒和湿温不可混淆。形体畏寒，脉象缓，舌苔白而不渴，且经络拘紧束缚，完全是寒证，所以用姜、附温中，白术燥湿，桂枝通行表阳。
桂枝姜附汤（苦辛热法）
桂枝（六钱） 干姜（三钱） 白术（生，三钱） 熟附子（三钱）
用水五杯，煮取两杯，药渣再煮一杯服用。
Article 43: Headache, aversion to cold, heaviness and pain in the body, white tongue coating without thirst, wiry, fine and soggy pulse, pale yellow complexion, chest fullness with loss of appetite, afternoon fever resembling Yin deficiency, a condition difficult to cure quickly, is named Damp-Warmth (Shi Wen). Sweating will lead to coma and deafness, or even closed eyes and unwillingness to speak; purging will lead to severe diarrhea; moistening will deepen the disease and make it unresolved. The method applies equally to late summer, deep autumn, and winter days. San Ren Tang (Three Kernel Decoction) is the principal formula.
Headache, aversion to cold, heaviness and pain in the body resemble Taiyang Cold Damage (Taiyang Shang Han), but a wiry and soggy pulse indicates it is not Taiyang Cold Damage. White tongue coating without thirst and pale yellow complexion indicate it is not Summerheat with Fire bias. Chest fullness and loss of appetite are due to Dampness obstructing the pathway of Clear Yang ascending. Afternoon fever resembling Yin deficiency occurs because Dampness is a Yin pathogen, which flourishes in the Yin aspect, thus sharing the characteristic of afternoon fever with Yin deficiency. Dampness is a Yin pathogen originating from late summer, accumulating gradually. Its nature is misty and sticky, unlike Cold pathogens that resolve with one sweating, or Warm-Heat pathogens that recede with one cooling, hence it is difficult to cure quickly. Physicians of the world do not recognize this as Damp-Warmth. Seeing headache, aversion to cold, heaviness and pain, they mistake it for Taiyang Cold Damage and use sweating. Sweating damages Heart Yang; Dampness steams upward along with acrid-warm releasing drugs, internally confusing the Heart Orifices leading to coma, and externally clouding the Clear Orifices leading to deafness, closed eyes, and silence. Seeing chest fullness and loss of appetite, they mistake it for food stagnation and use harsh purging. Mistaken purging damages Yin and further suppresses the ascending of Spleen Yang. Spleen Qi sinks, and Dampness takes advantage to infiltrate internally, causing severe diarrhea. Seeing afternoon fever, they mistake it for Yin deficiency and use soft/moistening drugs. Dampness is a sticky Yin pathogen; adding soft Yin drugs combines two Yins, seeking similar energies, creating an entrenched and unresolved state. Only by using San Ren Tang to gently open the Lung Qi of the Upper Jiao can this be addressed, as the Lung governs the Qi of the whole body; when Qi transforms, Dampness also transforms. Dampness pervades without fixed form; treating it with heavy, turbid, and cloying drugs makes the condition worse with each treatment. For latent Summerheat-Dampness, locally known as "Autumn Stupidity," people invariably use methods from Tao Hua's *Liu Shu*,不知 where learned. The physician becomes rigid, wrongly blaming the patient for being "stupid." Is this not unjust? Furthermore: Compared to other Warm diseases, Damp-Warmth has a slower but actually more serious course. It appears least in the Upper Jiao, with mild manifestations; most frequently in the Middle Jiao, detailed in the Middle Jiao chapter, because Dampness is a Yin pathogen. One should seek the pathology in the Middle Jiao.
San Ren Tang Formula
Xing Ren (Apricot Seed, five qian) Fei Hua Shi (Calcined Talcum, six qian) Bai Tong Cao (Akebia Caulis, two qian) Bai Kou Ren (Amomi Fructus Rotundus, two qian) Zhu Ye (Bambusa Leaves, two qian) Hou Po (Magnolia Bark, two qian) Sheng Yi Yi Ren (Coix Seed, six qian) Ban Xia (Pinellia Rhizome, five qian)
Boil in eight bowls of Gan Lan Shui (Gentle Wave Water) to obtain three bowls. Take one bowl per dose, three times daily.
Article 44: When Damp-Warmth pathogen enters the Pericardium, causing coma and cold limbs, use Qing Gong Tang (Clear the Palace Decoction) removing Lian Xin (Nelumbinis Plumula) and Mai Dong (Ophiopogonis Radix), adding Yin Hua (Lonicerae Flos) and Chi Xiao Dou Pi (Vigna Semen Cutis), decocted to administer Zhi Bao Dan (Treasure of Supreme Clarity Pill) or Zi Xue Dan (Purple Snow Pill).
Damp-Warmth adhering to meridians often presents with body pain and fever. Physicians mistakenly treat it as Taiyang Cold Damage and use sweating, resulting in this syndrome. Zhang Zhongjing stated that patients with Dampness must avoid sweating; sweating leads to Jing Disease (spasms). Damp-Heat combats and travels through meridians into collaterals. Therefore, Qing Gong Tang clears Heat in the Pericardium, while Yin Hua and Chi Xiao Dou clear Heat within Dampness and directly enter the Hand-Jueyin meridian. Zhi Bao Dan removes turbidity and restores consciousness; if unavailable, substitute with Zi Xue Dan.
Qing Gong Tang Modified (Removing Lian Xin and Mai Dong, Adding Yin Hua and Chi Xiao Dou Pi)
Xi Jiao (Rhinoceros Horn, one qian) - *Note: Substitute with water buffalo horn in modern practice* Qiao Xin (Lonicerae Calyx/Heart, three qian) Yuan Shen Xin (Scrophulariae Radix Heart, two qian) Zhu Ye Xin (Bambusa Leaf Heart, two qian) Yin Hua (Lonicerae Flos, two qian) Chi Xiao Dou Pi (Vigna Semen Cutis, three qian)
Zhi Bao Dan and Zi Xue Dan formulas (see previous articles).
Article 45: Damp-Warmth causing throat obstruction and sore throat is treated with Yin Qiao Ma Bo San (Honeysuckle and Wood Ear Powder).
The Lung governs Qi. In Damp-Warmth, Lung Qi fails to transform. Extreme stagnation causes the Fire of Heart and Gallbladder (Yin and Yang) to knot together. Since Metal disease cannot control Wood, Wood counterattacks the Lung Metal carrying Heart Fire. The throat is the Lung system; obstruction in the Qi level causes blockage, while obstruction in the Blood level causes pain. Thus, light herbs are used to open it.
Yin Qiao Ma Bo San Formula (Acrid-Cool Slightly Bitter Method)
Qiao (Forsythiae Fructum, one liang) Niu Bang Zi (Arctii Fructum, six qian) Yin Hua (Lonicerae Flos, five qian) She Ye (Belamcandae Rhizoma, three qian) Ma Bo (Eupolyphaga/Steleophaga, two qian)
Grind into powder. Administer according to Yin Qiao San method. If there is obstruction without pain, add Hua Shi (Talcum, six qian), Jie Geng (Platycodon Root, five qian), and Wei Gen (Phragmitis Rhizoma, five qian).
Article 46: Taiyin Damp-Warmth causing hiccups due to Qi-level bi-obstruction and stagnation is treated with Xuan Bi Tang (Unblock Obstruction Decoction).
Stagnation of Clear Yang in the Upper Jiao can also cause hiccups. The treatment principle focuses on gently dispersing Lung Bi.
Xuan Bi Tang Formula (Bitter-Acid Unblocking Method)
Pi Pa Ye (Loquat Leaf, two qian) Yu Jin (Curcumae Radix, one qian five fen) She Ye (Belamcandae Rhizoma, one qian) Bai Tong Cao (Akebia Caulis, one qian) Xiang Dou Chi (Fermented Soybean, one qian five fen)
Boil in five cups of water to obtain two cups. Divide into two doses.
Article 47: Taiyin Damp-Warmth causing panting and urgency is treated with Qian Jin Wei Jing Tang (Thousand Gold Reed Shoot Decoction) added with Xing Ren (Apricot Seed) and Hua Shi (Talcum).
The *Jin Gui Yao Lue* states that panting in the Upper Jiao involves urgent breathing. Taiyin Dampness steams into Phlegm, causing restless panting. Therefore, Wei Jing Tang gently disperses Lung Qi, while Xing Ren and Hua Shi unblock orifices and expel Heat-Fluid. If panting/cough is caused by Cold Fluid, it belongs to the category of Fluid Retention diseases and is not covered here.
Qian Jin Wei Jing Tang Added with Hua Shi and Xing Ren Formula (Acrid-Light Method)
Wei Jing (Phragmitis Rhizoma, five qian) Yi Yi Ren (Coix Seed, five qian) Tao Ren (Prunus Persica Seed, two qian) Dong Gua Ren (Benincasae Semen, two qian) Hua Shi (Talcum, three qian) Xing Ren (Apricot Seed, three qian)
Boil in eight cups of water to obtain three cups. Divide into three doses.
Article 48: The *Jin Gui Yao Lue* states that Sunstroke (Zhong Shu) presents with body heat, pain, and a faint/weak pulse. This is caused by injuring cold water in summer, with water qi circulating in the skin. Yi Wu Gua Di Tang (Single Herb Melon Thistle Decoction) is the principal formula.
This represents a pattern of less Heat and more Dampness, where Yang is depressed causing disease. Gua Di induces vomiting to expel the pathogen, resolving both Summerheat and Dampness, restoring Clear Yang.
Yi Wu Gua Di Tang Formula
Gua Di (Melonis Fructus Pedicellus, twenty pieces)
Crush. Boil in eight cups of reverse-flowing water to obtain three cups. Take one cup first; if no vomiting, take another. Stop after vomiting ceases. For deficiency cases, add Shen Lu (Ginseng Stem, three qian).
Article 49: Cold-Dampness damaging Yang presents with aversion to cold, slow pulse, pale tongue, or white-slippery coating without thirst, and tight/constricted meridians. Gui Zhi Jiang Fu Tang (Cinnamon Twig, Ginger, and Aconite Decoction) is the principal formula.
Recording Cold-Dampness serves to cross-reference with Damp-Warmth. Regarding Cold-Dampness damaging Exterior Yang and meridians, the *Jin Gui Yao Lue* discusses it in detail, so it is not fully recorded here. Only one case from Ye Tianshi is selected to show that Cold-Dampness and Damp-Warmness must not be confused. Aversion to cold, slow pulse, white non-thirsty tongue, and constricted meridians are entirely Cold patterns. Therefore, Jiang (Ginger) and Fu (Aconite) warm the interior, Bai Zhu (Atractylodes Macrocephala Rhizoma) dries dampness, and Gui Zhi (Cinnamon Twig) circulates Exterior Yang.
Gui Zhi Jiang Fu Tang Formula (Bitter-Acid-Hot Method)
Gui Zhi (Cinnamomi Ramulus, six qian) Gan Jiang (Zingiberis Rhizoma, three qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, raw, three qian) Shu Fu Zi (Aconiti Lateralis Radix Praeparata, three qian)
Boil in five cups of water to obtain two cups. Re-boil the dregs to obtain one cup for administration.