Compiled by Xiao Zhi Yi, practical skills and knowledge points that must be learned 
Section Two: Damp-Heat Syndrome
Key Point One: “Damp-Heat Syndrome, initial aversion to cold… white tongue, thirst without desire to drink.”
【Original Text】Damp-Heat Syndrome, initial aversion to cold, later only heat without cold, sweating with chest oppression, white tongue, thirst without desire to drink. (1)
【Explanation of Original Text】
This clause outlines the diagnostic criteria for Damp-Heat Syndrome, listing typical symptoms at the onset of the condition. At the onset of Damp-Heat Syndrome, the dampness injures the exterior, as dampness is a yin pathogen that obstructs the defensive yang, hence the aversion to cold; as dampness gradually transforms into heat internally, the damp-heat accumulates and steams, resulting in fever without aversion to cold; with heat prevailing in the Yangming, sweating occurs; dampness, being a turbid yin pathogen, easily obstructs the flow of qi, hence the symptom of chest oppression; with dampness internally, the tongue coating appears white; the internal heat consumes body fluids, leading to thirst; and with water dampness stagnating internally, one may feel thirsty yet not desire to drink.
【Interpretation of Classic Texts】
Xue Shengbai believes that the exterior syndrome of Damp-Heat is related to the Taiyin and Yangming, with the pathological nature being the obstruction of qi by dampness, leading to symptoms such as fatigue in the limbs, muscle soreness, and chest oppression, indicative of spleen and stomach disorders. In contrast, the exterior syndrome of cold damage is a Taiyang cold syndrome, which may also present with aversion to cold and fever, but the pathological nature is the binding of cold pathogens at the exterior, leading to stagnation of qi and closure of the pores, hence symptoms like headache, body aches, absence of sweating, and a floating tight pulse are more pronounced.
Key Point Two: “Damp-Heat Syndrome, aversion to cold without sweating… if there is no headache, omit Qianghuo.”
【Original Text】Damp-Heat Syndrome, aversion to cold without sweating, heavy body and headache, dampness at the exterior. Should use herbs like Huo Xiang (Agastache), Xiang Ru (Elsholtzia), Qiang Huo (Notopterygium), Cang Zhu (Atractylodes), Bo He (Mint), and Niu Bang Zi (Burdock Seed). If there is no headache, omit Qiang Huo. (2)
【Explanation of Original Text】
This clause mainly discusses the treatment of symptoms caused by “yin dampness” injuring the exterior. Dampness is a yin pathogen that injures the exterior, hence the aversion to cold without sweating; the heavy nature of dampness obstructs the qi, clouding the clear yang, resulting in heavy body and headache. Since the dampness has not yet transformed into heat, the disease is located at the exterior, and treatment should focus on aromatic and pungent herbs to disperse and transform dampness. Herbs like Huo Xiang, Xiang Ru, and Cang Zhu are used to aromatically transform dampness, combined with Bo He and Niu Bang Zi to disperse and penetrate the exterior. Headaches often accompany wind pathogens, and Qiang Huo can dispel wind and overcome dampness; if there is no headache, it indicates that the wind component is not prominent, hence Qiang Huo is omitted.
【Interpretation of Classic Texts】
Xue Shengbai notes that this syndrome is characterized as “the exterior injury from yin dampness,” where the dampness is at the exterior and has not yet transformed into heat, thus the internal dampness is not significant, and treatment should employ aromatic and pungent herbs to disperse and transform dampness.
Key Point Three: “Damp-Heat Syndrome, aversion to cold with fever… if there is no aversion to cold, omit Cang Zhu.”
【Original Text】Damp-Heat Syndrome, aversion to cold with fever, heavy body, joint pain, dampness in the muscles, not relieved by sweating. Should use herbs like Hua Shi (Talc), Da Dou Huang Juan (Soybean Yellow Roll), Fu Ling Pi (Poria Skin), Cang Zhu (Atractylodes), Huo Xiang Ye (Huo Xiang Leaf), Fresh He Ye (Lotus Leaf), Bai Tong Cao (Plantago), and Jie Geng (Platycodon). If there is no aversion to cold, omit Cang Zhu. (3)
【Explanation of Original Text】
This clause mainly discusses the treatment of “yang dampness” injuring the exterior. Dampness at the exterior obstructs the defensive yang, hence the aversion to cold; dampness has already transformed into heat, and the damp-heat stagnates at the muscle layer, hence the presence of fever, with heat symptoms being more pronounced; the heavy nature of dampness causes stagnation in the muscles and joints, leading to heavy body and joint pain; the sticky nature of dampness makes it difficult to be relieved by sweating. Treatment should focus on dispersing dampness while also clearing heat. Herbs like Hua Shi, Da Dou Huang Juan, Fu Ling Pi, Cang Zhu, Huo Xiang Ye, Fresh He Ye, Bai Tong Cao, and Jie Geng can be used. Since Cang Zhu is warm in nature, it should be omitted if there is no aversion to cold.
【Interpretation of Classic Texts】
Xue Shengbai notes that this syndrome is characterized as “yang dampness injuring the exterior,” which is in contrast to the previous clause regarding “yin dampness injuring the exterior.” At this time, dampness injures the exterior, and dampness has transformed into heat, thus treatment should focus on draining dampness and clearing heat, using aromatic herbs to disperse and transform dampness. Xue also notes that the presence or absence of sweating is key to distinguishing between yin dampness and yang dampness. Generally, it is believed that yin dampness does not produce sweating, while yang dampness does.
Key Point Four: “Damp-Heat Syndrome, alternating chills and fever… use Gan Cao (Licorice), Liu Yi San (Six One Powder) and other herbs.”
【Original Text】Damp-Heat Syndrome, alternating chills and fever, damp-heat obstructing the membrane source. Should use herbs like Chai Hu (Bupleurum), Hou Po (Magnolia Bark), Bing Lang (Areca), Cao Guo (Tsaoko Fruit), Huo Xiang, Cang Zhu, Ban Xia (Pinellia), Gan Chang Pu (Acorus), Liu Yi San (Six One Powder) and others. (8)
【Explanation of Original Text】
This clause mainly discusses the treatment of “damp-heat obstructing the membrane source.” The membrane source is the gateway of the San Jiao, being half exterior and half interior; when damp-heat obstructs the membrane source, the qi of the Ying and Wei is in conflict, leading to alternating chills and fever resembling malaria. Treatment should focus on dispersing the membrane source and eliminating turbid pathogens, hence Chai Hu is used to penetrate the membrane source, while Hou Po, Ban Xia, Bing Lang, Cao Guo, and Cang Zhu are used to regulate the spleen, dry dampness, and open the membrane source. Huo Xiang and Gan Chang Pu are used to aromatically transform turbidity, and Liu Yi San is used to clear and drain damp-heat.
【Interpretation of Classic Texts】
Xue Shengbai notes that the membrane source is half exterior and half interior of the Yangming, indicating that this syndrome is neither a Yangming interior syndrome nor a half exterior syndrome of cold damage. This syndrome is located in the foot Shaoyang, with damp-heat obstructing the spleen and stomach, but not in the Yangming, presenting as alternating chills and fever, but unlike malaria, which has a fixed timing, this condition presents with fluctuating chills and fever, and may show a white greasy tongue coating or a thick greasy coating, with symptoms of fullness and oppression in the abdomen indicative of internal dampness.
Key Point Five: “Damp-Heat Syndrome, after several days, slight oppression in the epigastrium… use Lu Jian (Reed Tip), Dong Gua Ren (Winter Melon Seed) and other herbs.”
【Original Text】Damp-Heat Syndrome, after several days slight oppression in the epigastrium, knowing hunger but not eating, dampness obstructing the San Jiao. Should use herbs like Huo Xiang Ye, Bo He Ye, Fresh He Ye, Pi Pa Ye (Loquat Leaf), Pei Lan Ye (Eupatorium), Lu Jian, Dong Gua Ren and others. (9)
【Explanation of Original Text】
This clause mainly discusses the treatment of residual dampness after Damp-Heat Syndrome, where the stomach qi has not awakened. In the later stages of Damp-Heat Syndrome, the major damp-heat has been resolved, but residual pathogens remain, and residual dampness obstructs the spleen, preventing the stomach qi from awakening, leading to slight oppression in the epigastrium, where one may feel hunger but not desire to eat. Herbs like Huo Xiang Ye, Bo He Ye, Fresh He Ye, Pi Pa Ye, and Pei Lan Ye (the five leaves) are used to lightly clear and transform, combined with Lu Jian and Dong Gua Ren to promote light drainage and drain dampness, allowing the qi to flow smoothly, eliminating residual dampness, and leading to the resolution of symptoms.
【Interpretation of Classic Texts】
This clause emphasizes that “dampness obstructs the San Jiao,” focusing on the middle and upper Jiao, and thus light and clear herbs should be used to promote the flow of qi. At this time, it is not advisable to use aggressive or tonifying methods, as excessive use of aggressive herbs may damage the righteous qi, while indiscriminate use of tonifying herbs may lead to lingering pathogens.
Key Point Six: “Damp-Heat Syndrome, initial fever… use Pei Lan Ye, Liu Yi San and other herbs.”
【Original Text】Damp-Heat Syndrome, initial fever, sweating with chest oppression, thirst with white tongue, dampness lurking in the middle Jiao. Should use herbs like Huo Geng (Huo Geng), Cardamom Seed, Apricot Kernel, Zhi Ke (Bitter Orange), Jie Geng, Yu Jin (Curcuma), Cang Zhu, Hou Po, Cao Guo, Ban Xia, Gan Chang Pu, Pei Lan Ye, Liu Yi San and others. (10)
【Explanation of Original Text】
This clause mainly discusses the treatment of dampness obstructing the middle Jiao, where dampness is heavier than heat. Although there is fever and sweating, there is no aversion to cold, indicating that the dampness is no longer at the exterior but has internally lurked in the middle Jiao. Damp-heat obstructs the flow of qi, causing the lung qi to fail to disperse, resulting in chest oppression; with internal dampness obstructing, body fluids cannot rise, leading to thirst, often characterized by thirst without desire to drink; dampness is heavier than heat, hence the tongue coating appears white. Herbs like Cang Zhu, Hou Po, and Cao Guo are used to dry dampness; Huo Xiang, Pei Lan, Cardamom Seed, Yu Jin, and Gan Chang Pu are used to aromatically transform dampness; Apricot Kernel, Jie Geng, and Zhi Ke are used to open and disperse lung qi, promoting qi flow and transforming dampness; Liu Yi San is used to clear heat and promote light drainage of dampness.
【Interpretation of Classic Texts】
This syndrome is characterized by dampness lurking in the middle Jiao, with initial signs of heat, where dampness is heavier than heat, thus treatment should focus on drying and transforming dampness, supplemented with heat-clearing methods. The thirst in this syndrome is due to internal obstruction of dampness preventing the upward movement of body fluids, leading to thirst without desire to drink, which is not due to insufficient gastric fluids. Therefore, treatment should focus on transforming dampness; once dampness is transformed, body fluids will rise, and thirst will resolve. The prescriptions mentioned here concentrate on four methods: drying dampness, transforming dampness, dispersing dampness, and draining dampness, reflecting Xue’s fundamental principles for treating dampness.
Key Point Seven: “Damp-Heat Syndrome, white at the root of the tongue… use Green Bean Skin, Liu Yi San and other herbs.”
【Original Text】Damp-Heat Syndrome, white at the root of the tongue, red at the tip, dampness gradually transforming into heat, residual dampness still stagnating. Should use herbs that release and clear heat, such as Cardamom Seed, Ban Xia, Gan Chang Pu, Da Dou Huang Juan, Lian Qiao (Forsythia), Green Bean Skin, Liu Yi San and others. (13)
【Explanation of Original Text】
This clause mainly discusses the treatment of “dampness gradually transforming into heat, with residual dampness still stagnating.” A white coating at the root of the tongue indicates the presence of dampness; a red tip indicates that dampness is gradually transforming into heat. Although dampness is transforming into heat, residual dampness remains, thus treatment should focus on both transforming dampness and clearing heat, using Cardamom Seed, Ban Xia, and Gan Chang Pu to disperse and dry dampness, while Da Dou Huang Juan, Lian Qiao, Green Bean Skin, and Liu Yi San are used to clear heat and drain dampness, resolving both dampness and heat.
【Interpretation of Classic Texts】
Although Xue Shengbai notes this as “a syndrome of half dampness and half heat,” the heat is not yet severe, and it is actually still a syndrome of heavier dampness and lighter heat. In addition to the white coating at the root of the tongue and the red tip, symptoms may include chest oppression, nausea, vomiting, body heat with sweating that does not resolve, and a slippery and rapid pulse. The gradual transformation of dampness into heat can easily injure body fluids; if one carelessly uses moistening herbs, it may exacerbate dampness, hence drying dampness should be combined with heat-clearing methods to preserve body fluids.
Section Three: Differentiation of Warm Diseases
Key Point One: “Warm diseases: Wind-Warm, Warm-Heat… Winter-Warm, Warm-Malaria.” (Upper Jiao 1)
【Original Text】 Warm diseases: Wind-Warm, Warm-Heat, Warm-Epidemic, Warm-Toxin, Summer-Warm, Damp-Warm, Autumn-Dry, Winter-Warm, Warm-Malaria. (Upper Jiao 1)
【Explanation of Original Text】
This clause lists nine types of warm diseases, explaining the concept and scope of warm diseases. This clause clearly states that warm diseases are a general term for various externally contracted heat diseases. Wu Ju Tong classifies them into nine types based on climatic characteristics, pathogenic characteristics, or clinical manifestations: Wind-Warm, Warm-Heat, Warm-Epidemic, Warm-Toxin, Summer-Warm, Damp-Warm, Autumn-Dry, Winter-Warm, and Warm-Malaria, providing a basis for differentiation, classification, and treatment of warm diseases.
【Interpretation of Classic Texts】
Among the nine warm diseases, Wind-Warm, Summer-Warm, Autumn-Dry, and Winter-Warm are named according to the seasons and predominant qi. Wind-Warm is a warm disease that occurs in early spring due to the invasion of wind-heat pathogens; Summer-Warm occurs in midsummer due to the invasion of summer heat pathogens; Autumn-Dry occurs in autumn due to the invasion of dry-heat pathogens; and Winter-Warm occurs in winter due to the invasion of abnormal warm qi. Additionally, there are names based on different pathogens or clinical characteristics, such as Warm-Toxin, which is caused by the invasion of warm-heat toxins, presenting common symptoms of heat diseases along with local swelling and toxic manifestations; Warm-Heat is primarily characterized by interior heat symptoms; Damp-Warm occurs in late summer and early autumn due to the invasion of damp-heat pathogens; Warm-Malaria occurs when there is internal yin deficiency followed by invasion of summer heat, leading to excess yang heat; Warm-Epidemic is caused by the invasion of pestilential qi, characterized by high infectivity and epidemic nature.
Key Point Two: “Taiyin Wind-Warm, Warm-Heat… Damp-Warm, Warm-Malaria, not included in this example.” (Upper Jiao 4)
【Original Text】Taiyin Wind-Warm, Warm-Heat, Warm-Epidemic, Winter-Warm, if there is significant aversion to wind-cold, Gui Zhi Tang (Cinnamon Twig Decoction) is the main treatment; if there is heat without aversion to cold and thirst, then the mild cooling formula Yin Qiao San (Yin Qiao Powder) is the main treatment. Warm-Toxin, Summer-Warm, Damp-Warm, Warm-Malaria, are not included in this example. (Upper Jiao 4)
【Explanation of Original Text】
This clause discusses the treatment of warm pathogens initially invading the Wei level and the treatment contraindications. For Wind-Warm, Warm-Heat, Warm-Epidemic, and Winter-Warm at the initial stage, if there is a significant aversion to wind-cold, it indicates that the exterior pathogen is predominant, and treatment should use warming methods to resolve the exterior, with Gui Zhi Tang as the representative formula. However, caution should be exercised with pungent warming herbs to avoid exacerbating heat and dryness. If the heat symptoms are more pronounced, without aversion to cold and with thirst, then a cooling method should be used, with Yin Qiao San as the representative formula. Warm-Toxin, Summer-Warm, Damp-Warm, and Warm-Malaria have different initial locations, thus the treatment methods differ, hence they are “not included in this example.” However, it should not be generalized.
【Interpretation of Classic Texts】
In this clause, Wu Ju Tong uses “aversion to wind-cold” and “no aversion to cold” as important criteria for selecting warming or cooling methods, but in clinical practice, other clinical manifestations should also be considered. Yin Qiao San is the primary formula for treating warm diseases at the upper jiao, derived from the “Neijing” principle that “wind invades internally, treated with cooling, supplemented with bitter and sweet,” using primarily cooling herbs, slightly supplemented with warming and aromatic herbs, with a balanced and neutral nature, creating a method for cooling and dispersing pathogens at the exterior, distinct from the treatment methods for exterior syndromes in the “Shang Han Lun,” representing a significant contribution from Wu.
Key Point Three: “Taiyin Warm Disease, blood overflowing from above… can use methods to clear the collaterals and nourish yin.” (Upper Jiao 11)
【Original Text】Taiyin Warm Disease, blood overflowing from above, can use Xie Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) combined with Yin Qiao San. If there is a middle Jiao disease, treat it according to the middle Jiao method. If there is vomiting of pink blood, it is fatal and cannot be treated; if blood overflows from above, pulse is seven or eight beats or more, and the face is dark, it is fatal and cannot be treated; can use methods to clear the collaterals and nourish yin. (Upper Jiao 11)
【Explanation of Original Text】
This clause discusses the treatment of blood-related symptoms in Taiyin Warm Disease and the manifestations of critical conditions. The warm pathogen transmits from the Taiyin to the blood level, injuring the blood vessels, leading to blood overflowing from the mouth and nose. If the disease belongs to the upper jiao, the lung collaterals are injured, hence the treatment for warm disease at the upper jiao should use Yin Qiao San to disperse lung heat; if the disease belongs to the blood level, heat forces the blood to flow, hence the treatment should combine with Xie Jiao Di Huang Tang to cool the blood and stop the bleeding. If the warm pathogen transmits to the middle jiao, then treat it according to the middle jiao methods, such as Bai Hu Tang (White Tiger Decoction), Cheng Qi Tang (Purgative Decoction), etc. If there is vomiting of pink blood or blood overflowing from above, with pulse seven or eight beats or more, and the face is dark and lacking luster, these are critical conditions that are fatal and cannot be treated. At this time, methods to cool the blood, clear the collaterals, and nourish yin should be used.
【Interpretation of Classic Texts】
If the following two critical conditions occur, they are both fatal and cannot be treated: one is vomiting pink blood, which Wu notes in his commentary is “pink water is neither blood nor liquid, but rather blood and liquid forced out together, with a tendency to spread rapidly, leading to a rapid end;” the second is blood overflowing from above, with mouth and nose bleeding, pulse seven or eight beats or more, and the face appearing dark and lacking luster, which Wu refers to as “fire extreme and resembling water,” indicating that the yin fluids of the lower jiao are severely deficient, unable to nourish the heart fire, leading to a dangerous condition where heart fire combines with the warm pathogen, creating a rapid spread, severely injuring lung yin. Wu suggests using methods to cool the blood, clear the collaterals, and nourish yin, which may include Xie Jiao Di Huang Tang combined with Huang Lian and E Jiao Decoction with modifications.