湿热病篇
1.（一）溼熱證始惡寒，後但熱不寒，汗出胸痞舌白，口渴不引飲。
自注，此條乃溼熱證之提綱也，溼熱病屬陽明太陰者居多，中氣實則病在陽明，中氣虛則病在太陰，病在二經之表者，多兼少陽三焦，病在二經之者，每兼厥陰風木，以少陽厥陰，同司相火，陽明太陰，溼熱內鬱，鬱甚則少火皆成壯火，而表上下，充斥肆逆，故是證最易耳聾乾嘔，發痙發厥，而提綱中不言及者，因以上諸證，皆溼熱病兼見之變局，而非溼熱病必見正局也，始惡寒者，陽為溼遏而惡寒，終非若寒傷於表之惡寒，後但熱不寒，則鬱而成熱，反惡熱矣，溼蔽清陽則胸痞，溼邪內甚舌白，溼熱交蒸則舌黃，熱則液不升而口渴溼則飲內留而不引飲，然所云表者，乃太陰陽明之表，而非太陽之表，太陰之表，四肢也，陽明也，陽明之表，肌肉也，胸中也，故胸痞為溼熱必有之證，四肢倦怠肌肉煩疼，亦必並見，其所以不幹太陽者，以太陽為寒水之腑，主一身之表，風寒必自表入，故屬太陽，溼熱之邪從表傷者，十之一二，由口鼻入者，十之八九，陽明為水穀之海，太陰為溼土之髒，故多陽明太陰受病，膜原者外通肌肉，內近胃腑，即三焦之門戶，實一身之半表半也，邪由上受，直趨中道，故病多歸膜原，要之溼熱之病，不獨與傷寒不同，且與溫病大異，溫病乃少陰太陽同病，溼熱乃陽明太陰同病也，而提綱中言不及脈者，以溼熱之證，脈無定體，或洪或緩，或伏或細各隨證見，不拘一格，故以一之脈，拘定後人眼目也。溼熱之證，陽明必兼太陰者，徒知臟腑相連，溼土同氣，而不知當與溫病之必兼少陰比例，少陰不藏，木火內燔，風邪外襲，表相應，故為溫病，太陰內傷溼飲停聚客邪再至，內外相引，故病溼熱，此皆先有內傷，再感客邪，非由腑及之謂，若溼熱之證，不挾內傷，中氣實者，其病必微，或有先因於溼，再因飢勞而病者，亦屬內傷挾溼，標本同病，然勞倦傷脾為不足，溼飲停聚為有餘，所以內傷外感孰多孰少，孰實孰虛又在臨證時權衡矣。
Self-commentary: This entry is the提纲 (guiding outline) of damp-heat patterns. Damp-heat diseases belong mostly to yangming and taiyin. If center qi is replete, the disease is in yangming; if center qi is deficient, the disease is in taiyin. When the disease is in the exterior of these two meridians, it often also involves lesser yang and the triple burner; when the disease is in these two meridians, it often also involves jueyin wind-wood, because lesser yang and jueyin together govern ministerial fire, and yangming and taiyin have damp-heat depressed internally; when depression is severe, lesser fire all becomes strong fire, and exterior and interior, upper and lower are filled and run rampant. Therefore, this pattern most easily causes deafness, dry vomiting, tetany and reversal; the outline does not mention them because the above patterns are all concurrent changed situations of damp-heat disease, not the necessary primary presentation of damp-heat disease. Initial aversion to cold is because yang is checked by damp and thus averse to cold; ultimately it is not like the aversion to cold of cold damaging the exterior. Later there is only heat and no cold, as depression forms heat, and then aversion to heat. Damp veils clear yang, so there is chest oppression; damp pathogen is severe internally, so the tongue is white; damp-heat steams each other, so the tongue is yellow; heat causes fluids not to rise and thus thirst; damp causes fluids to remain internally and thus no desire to drink. However, what is called exterior here is the exterior of taiyin and yangming, not the exterior of taiyang. The exterior of taiyin is the four limbs; the exterior of yangming is the muscles and the chest. Therefore, chest oppression is a necessary sign of damp-heat, and limb lassitude and vexing pain in the muscles will also surely appear together. The reason it does not involve taiyang is that taiyang is the fu-organ of cold water and governs the exterior of the whole body; wind-cold must enter from the exterior, so it belongs to taiyang. Damp-heat pathogens injuring from the exterior are one or two in ten; those entering from mouth and nose are eight or nine in ten. Yangming is the sea of water and grain; taiyin is the zang of damp earth; therefore, yangming and taiyin mostly receive the disease. The membrane source communicates externally with the muscles and internally is near the stomach fu; it is the gateway of the triple burner and truly the half-exterior of the whole body. When the pathogen is received from above, it goes straight to the middle way, so the disease mostly returns to the membrane source. In essence, damp-heat disease is not only different from cold damage, but also greatly different from warm disease. Warm disease is lesser yin and taiyang disease together; damp-heat is yangming and taiyin disease together. The outline does not mention the pulse because in damp-heat patterns the pulse has no fixed form: sometimes surging, sometimes moderate, sometimes hidden, sometimes fine, each appearing according to the pattern, not confined to one form; therefore, using one pulse to confine later generations' eyes is not done. In damp-heat patterns, yangming must be combined with taiyin; people only know that zang-fu are connected and damp earth shares the same qi, but do not know it should be compared with warm disease's necessary combination with lesser yin. When lesser yin does not store, wood-fire blazes internally, wind pathogen attacks externally, and exterior and interior respond to each other, thus warm disease occurs. When taiyin is internally injured, damp fluids stop and gather, and guest pathogens arrive again; internal and external draw each other, thus damp-heat disease occurs. These all are internal injury first, then contraction of guest pathogens, not what is meant by transmission from fu to zang. If damp-heat patterns are not complicated by internal injury and center qi is replete, the disease will surely be mild. Or there are those who first suffer from damp, then become ill from hunger and fatigue; this also belongs to internal injury complicated by damp, with root and branch diseased together. However, fatigue injures the spleen and is deficiency; damp fluids stopping and gathering is excess. Therefore, how much internal injury versus external contraction, and which is excess versus deficiency, must be weighed at the clinical encounter.