伤气。湿着阻气。肺主一身周行之气。位高。为手太阴经。据述病样。面赤足冷。上脘痞塞。其为
上焦受病显著。缘平素善饮。胃中湿热久伏。辛温燥烈。不但肺病不合。而胃中湿热。得燥热
锢闭。下利稀水即协热下利。故黄连苦寒。每进必利甚者。苦寒以胜其辛热药味尚留于胃
底也。然与初受之肺邪无当。此石膏辛寒。辛先入肺。知母为味清凉。为肺之母气。然不明
肺邪。徒曰生津。焉是至理。昔孙真人未诊先问。最不误事。再据主家说及病起两旬。从无汗
泄。经云。暑当汗出勿止。气分窒塞日久。热侵入血中。咯痰带血。舌红赤。不甚渴饮。上焦不解。
漫延中下。此皆急清三焦。是第一章旨。故热病之瘀热。留络而为遗毒。注腑肠而为洞利。便
为束手无策。再论湿乃重浊之邪。热为熏蒸之气。热处湿中。蒸淫之气。上迫清窍。耳为失聪。
不与少阳耳聋同例。青蒿减柴胡一等。亦是少阳本药。且大病如大敌。选药若选将。苟非慎
重。鲜克有济。议三焦厘清治。从河间法。（初三日）
飞滑石 生石膏 寒水石 大杏仁 炒黄竹茹 川通草 莹白金汁 金银花露
又 暮诊。诊脉后。腹胸肌腠。发现瘾疹。气分湿热。原有暗泄之机。早间所谈。余邪遗热。必兼解
毒者为此。下午进药后。诊脉较大于早晨。神识亦如前。但舌赤中心甚干燥。身体扪之。热甚
于早间。此阴分亦被热气蒸伤。瘦人虑其液涸。然痰咯不清。养阴药无往而非腻滞。议得早
进清膈一剂。而三焦热秽之蓄。当用紫雪丹二三匙。藉其芳香宣窍逐秽斯锢热可解。浊痰
不粘。继此调理之方。清营分。滋胃汁。始可瞻顾。其宿垢欲去。犹在旬日之外。古人谓下不嫌
迟。非臆说也。紫雪丹一钱六分。
知母 竹叶心 连翘心 炒川贝 竹沥 犀角 元参 金汁 银花露
又 一剂后用。
竹叶心 知母 绿豆皮 元参 鲜生地 金银花
又 一剂后。去银花绿豆皮。加人参麦冬。
又 初十申刻诊。经月时邪。脉形小数。小为病退。数为余热。故皮腠麸蜕。气血有流行之义。思
食欲餐。胃中有醒豁之机。皆佳兆也。第舌赤而中心黄苔。热蒸既久。胃津阴液俱伤。致咽物
咽中若阻。溺溲尿管犹痛。咯痰浓浓。宿垢未下。若急遽攻夺。恐真阴更涸矣。此存阴为主。而
清腑兼之。故乱进食物。便是助热。惟清淡之味。与病不悖。自来热病。最怕食复劳复。举世共
闻。非臆说也。
细生地 元参心 知母 炒川贝 麦冬 地骨皮 银花露 竹沥
又 脉症如昨。仍议滋清阴分余热。佐清上脘热痰。
照昨日方去地骨皮银花露加盐水炒橘红。
某 脉虚。伤暑。头重脘闷。跗酸。
丝瓜叶（三钱） 大杏仁（三钱） 六一散（三钱） 茯苓皮（三钱） 汉防己（一钱半） 绵
茵陈（一钱） 细木通（一钱） 白蔻仁（五分）
某 中恶暑厥。（暑厥） 苍术白虎汤加滑石。
王 暑邪寒热。舌白不渴。吐血。此名暑瘵重症。（暑瘵）
西瓜翠衣 竹叶心 青荷叶汁 杏仁 飞滑石 苡仁
万 暑邪不解。陷入厥阴。舌灰消渴。心下板实。呕恶吐蛔。寒热。下利血水。最危之症。
（暑邪入厥阴）
川连 黄芩 干姜 生白芍 川椒 乌梅 人参 枳实
江 暑邪深入厥阴。舌缩。少腹坚满。声音不出。自利。上下格拒。危期至速。勉拟暑门酸苦泄热。
辅正驱邪一法。
黄连 淡干姜 乌梅 生白芍 半夏 人参 枳实
某（十八） 劳伤挟暑。肺气受戕。咳血口干。先清暑热（暑兼血症）
鲜荷叶 白扁豆 大沙参 茯神 苡仁
朱（三二） 三伏中。阴气不生。阳气不潜。其头胀身痛。是暑邪初受。暑湿热必先伤气分。故舌白口渴
身痛。早晨清爽。午夜烦蒸。状如温疟。沐浴绕动血络。宿病得时邪而来。仲景云。先治新病。后
理宿病。是亦阴气先伤。阳气独发也。
鲜生地 石膏 知母 元参 连翘 竹叶心 荷叶汁
王（三九） 虽是咳痰失血。然强能食。不知饥。目黄晡热。舌心黄。已现暑热客邪症象。此先宜清理肺
胃。莫因久恙而投腻补。
杏仁 象贝母 郁金 川通草 桑叶 石膏 橘红 苡仁
又 晚服枇杷叶膏 早六味加阿胶麦冬。
又 阿胶 鸡子黄 小生地 麦冬 桑叶 炒黑丹皮
徐（三六） 劳伤挟暑。咳血不饥。
鲜荷叶汁（冲） 大沙参 生苡仁 六一散 绿豆皮 杏仁 橘红 白蔻仁
天之暑热一动。地之湿浊自腾。人在蒸淫热迫之中。若正气设或有隙。则邪从口鼻吸入。
气分先阻。上焦清肃不行。输化之机。失于常度。水谷之精微。亦蕴结而为湿也。人身一小
天地。内外相应。故暑病必挟湿者。即此义耳。前人有因动因静之分。或伤或中之候。以及
入心入肝。为疟为痢。中痧霍乱。暴厥卒死。种种传变之原。各有精义可参。兹不重悉。想大
江以南。地卑气薄。湿胜热蒸。当此时候。更须防患于先。昔李笠翁记中所谓使天只有三
时而无夏。则人之病也必稀。此语最确。盖暑湿之伤。骤者在当时为患。缓者于秋后为伏
气之疾。其候也。脉色必滞。口舌必腻。或有微寒。或单发热。热时脘痞气窒。渴闷烦冤。每至
午后则甚。入暮更剧。热至天明。得汗则诸恙稍缓。日日如是。必要两三候外。日减一日。方
得全解。倘如元气不支。或调理非法。不治者甚多。然是病比之伤寒。其势觉缓。比之疟疾。
寒热又不分明。其变幻与伤寒无二。其愈期反觉缠绵。若表之汗不易彻。攻之便易溏泻。
过清则肢冷呕恶。过燥则唇齿燥裂。每遇秋来。最多是症。求之古训。不载者多。独己任编
名之曰秋时晚发。感症似疟。总当以感症之法治之。要知伏气为病。四时皆有。但不比风
寒之邪一汗而解。温热之气。投凉即安。夫暑与湿。为熏蒸粘腻之邪也。最难骤愈。若治不
中。暑热从阳上熏。而伤阴化燥。湿邪从阴下沉。而伤阳变浊。以致神昏耳聋。舌干龈血。
脘痞呕恶。洞泄肢冷。棘手之候丛生。竟至溃败莫救矣。参先生用意。宗刘河间三焦论立
法。认明暑湿二气。何者为重。再究其病。实在营气何分。大凡六气伤人。因人而化。阴虚者
火旺。邪归营分为多。阳虚者湿胜。邪伤气分为多。一则耐清。一则耐温。脏性之阴阳。从此
可知也。于是在上者以辛凉微苦。如竹叶连翘杏仁。薄荷之类。在中者以苦辛宣通。如半
夏泻心之类。在下者以温行寒性。质重开下。如桂苓甘露饮之类。此皆治三焦之大意也。
或有所夹。又须通变。至于治气分有寒温之别。寒者宗诸白虎法。及天水散意。温者从乎
二陈汤。及正气散法。理营分知清补之宜。清者如犀角地黄。加入心之品。补者有三才复
脉等方。又如湿热沉混之苍术石膏汤。气血两燔之玉女法。开闭逐秽。与牛黄及至宝紫
雪等剂。扶虚进参附。及两仪诸法。随其变幻。审其阴阳。运用之妙。存乎心也。附骥芜词。高
明教正。（邵新甫）
徐评 所列诸案。皆平素伏暑之症为多。其卒然受暑之病绝少。若卒受之症。则当以香茹饮
为主。不可不知也。
此老治暑邪。能用轻清凉润之品以和肺。是其所长。但暑邪深入。必有闷乱烦躁等症。近于霍
乱。此则更有治法。至于病重症危。属热邪横逆。不但人参不可轻用。而桂附干姜服之。无不立
毙。乃亦仿仲景伤寒坏症治法。轻于一试。当时不知有害与否。而耳食之徒。竟以为必用之药。
名本于此老。我见死者甚多。伤心惨目。不得不归咎于作俑之人也。
伤及气分。湿邪阻滞气机运行。肺主管全身周流运行的气。肺位居高。属于手太阴经。根据所述病情表现，面色发红而足部发冷，上脘部位痞闷堵塞。这明显是上焦受病。因为患者平素喜欢饮酒，胃中湿热久伏。使用辛温燥烈的药物，不仅对肺病不合适，而且胃中的湿热，被燥热之气锢闭在内，导致下利稀水，这就是协热下利。所以黄连苦寒，每次服用必定导致腹泻加重，这是因为苦寒药虽然能胜其辛热药味，但辛热药味尚残留于胃底。然而这与初受肺部的邪气没有直接关系。石膏辛寒，辛味先入肺；知母味道清凉，为肺之母气（金生水，土生金，此处指滋源以润肺）。如果不明白肺邪，只说生津，哪里是至理。从前孙思邈在诊察前先询问病史，最不会误事。再据主人家说，病起已经二十天，从无汗出宣泄。《内经》说：暑病应当让汗出，不要止住。气分窒塞日久，热气侵入血中，咯痰带血，舌红赤，不很渴饮。上焦不解，蔓延至中下焦。这都是急需清利三焦，这是第一章的宗旨。所以热病的瘀热，留滞络脉成为遗毒，注入腑肠成为洞泄下利，这就束手无策了。再论湿是重浊的邪气，热是熏蒸的气。热处在湿中，蒸淫之气，上迫清窍，耳朵失聪。这与少阳耳聋不同例。青蒿比柴胡低一等，也是少阳的本药。况且大病如大敌，选药如同选将，如果不慎重，很少能有成效。议定用三焦厘清治法，遵循河间法。（初三日）
飞滑石 生石膏 寒水石 大杏仁 炒黄竹茹 川通草 莹白金汁 金银花露
又一次晚间诊治。诊脉后，腹部胸部肌肤腠理，出现瘾疹。气分湿热，原本有暗泄的机理。早间所谈，余邪遗热，必须兼解毒者为此。下午进药后，诊脉比早晨大。神识也如前。只是舌赤中心非常干燥。身体触摸，热势比早间更甚。这说明阴分也被热气蒸伤。瘦人担心津液枯竭。然而痰咯不清，养阴药无处不是腻滞。议定得早进一剂清膈药，而三焦热秽之蓄积，当用紫雪丹二三匙，借其芳香宣窍逐秽，这样锢热可解，浊痰不粘。继此调理之方，清营分，滋胃汁，才可以瞻顾。其宿垢欲去，还在旬日之外。古人谓下法不嫌迟，不是臆说。紫雪丹一钱六分。
知母 竹叶心 连翘心 炒川贝 竹沥 犀角 元参 金汁 银花露
又初十申时诊。经过月时邪，脉形小数。小表示病退，数表示余热。所以皮肤腠理麸皮样蜕落，气血有流行之义。思食欲餐，胃中有醒豁之机，都是佳兆。只是舌赤而中心黄苔，热蒸既久，胃津阴液俱伤，导致咽物咽中若阻，溺溲尿管犹痛，咯痰浓浓，宿垢未下。如果急遽攻夺，恐怕真阴更枯竭了。此以存阴为主，而清腑兼之。所以乱进食物，便是助热。只有清淡之味，与病不悖。自来热病，最怕食复劳复，举世共闻，不是臆说。
细生地 元参心 知母 炒川贝 麦冬 地骨皮 银花露 竹沥
又脉症如昨。仍议滋清阴分余热。佐清上脘热痰。
照昨日方去地骨皮、银花露加盐水炒橘红。
某 脉虚。伤暑。头重脘闷。跗酸。
丝瓜叶（三钱） 大杏仁（三钱） 六一散（三钱） 茯苓皮（三钱） 汉防己（一钱半） 绵茵陈（一钱） 细木通（一钱） 白蔻仁（五分）
王 暑邪寒热。舌白不渴。吐血。此名暑瘵重症。（暑瘵）
西瓜翠衣 竹叶心 青荷叶汁 杏仁 飞滑石 苡仁
万 暑邪不解。陷入厥阴。舌灰消渴。心下板实。呕恶吐蛔。寒热。下利血水。最危之症。（暑邪入厥阴）
川连 黄芩 干姜 生白芍 川椒 乌梅 人参 枳实
江 暑邪深入厥阴。舌缩。少腹坚满。声音不出。自利。上下格拒。危期至速。勉拟暑门酸苦泄热。辅正驱邪一法。
黄连 淡干姜 乌梅 生白芍 半夏 人参 枳实
某（十八岁） 劳伤挟暑。肺气受戕。咳血口干。先清暑热（暑兼血症）
鲜荷叶 白扁豆 大沙参 茯神 苡仁
朱（三十二岁） 三伏中。阴气不生。阳气不潜。其头胀身痛。是暑邪初受。暑湿热必先伤气分。故舌白口渴身痛。早晨清爽。午夜烦蒸。状如温疟。沐浴绕动血络。宿病得时邪而来。仲景云。先治新病。后理宿病。是亦阴气先伤。阳气独发也。
鲜生地 石膏 知母 元参 连翘 竹叶心 荷叶汁
王（三十九岁） 虽是咳痰失血。然强能食。不知饥。目黄晡热。舌心黄。已现暑热客邪症象。此先宜清理肺胃。莫因久恙而投腻补。
杏仁 象贝母 郁金 川通草 桑叶 石膏 橘红 苡仁
徐（三十六岁） 劳伤挟暑。咳血不饥。
鲜荷叶汁（冲） 大沙参 生苡仁 六一散 绿豆皮 杏仁 橘红 白蔻仁
天之暑热一动。地之湿浊自腾。人在蒸淫热迫之中。若正气设或有隙。则邪从口鼻吸入。气分先阻。上焦清肃不行。输化之机。失于常度。水谷之精微。亦蕴结而为湿也。人身一小天地。内外相应。故暑病必挟湿者。即此义耳。前人有因动因静之分。或伤或中之候。以及入心入肝。为疟为痢。中痧霍乱。暴厥卒死。种种传变之原。各有精义可参。兹不重悉。想大江以南。地卑气薄。湿胜热蒸。当此时候。更须防患于先。昔李笠翁记中所谓使天只有三时而无夏。则人之病也必稀。此语最确。盖暑湿之伤。骤者在当时为患。缓者于秋后为伏气之疾。其候也。脉色必滞。口舌必腻。或有微寒。或单发热。热时脘痞气窒。渴闷烦冤。每至午后则甚。入暮更剧。热至天明。得汗则诸恙稍缓。日日如是。必要两三候外。日减一日。方得全解。倘如元气不支。或调理非法。不治者甚多。然是病比之伤寒。其势觉缓。比之疟疾。寒热又不分明。其变幻与伤寒无二。其愈期反觉缠绵。若表之汗不易彻。攻之便易溏泻。过清则肢冷呕恶。过燥则唇齿燥裂。每遇秋来。最多是症。求之古训。不载者多。独己任编名之曰秋时晚发。感症似疟。总当以感症之法治之。要知伏气为病。四时皆有。但不比风寒之邪一汗而解。温热之气。投凉即安。夫暑与湿。为熏蒸粘腻之邪也。最难骤愈。若治不中。暑热从阳上熏。而伤阴化燥。湿邪从阴下沉。而伤阳变浊。以致神昏耳聋。舌干龈血。脘痞呕恶。洞泄肢冷。棘手之候丛生。竟至溃败莫救矣。参先生用意。宗刘河间三焦论立法。认明暑湿二气。何者为重。再究其病。实在营气何分。大凡六气伤人。因人而化。阴虚者火旺。邪归营分为多。阳虚者湿胜。邪伤气分为多。一则耐清。一则耐温。脏性之阴阳。从此可知也。于是在上者以辛凉微苦。如竹叶连翘杏仁。薄荷之类。在中者以苦辛宣通。如半夏泻心之类。在下者以温行寒性。质重开下。如桂苓甘露饮之类。此皆治三焦之大意也。或有所夹。又须通变。至于治气分有寒温之别。寒者宗诸白虎法。及天水散意。温者从乎二陈汤。及正气散法。理营分知清补之宜。清者如犀角地黄。加入心之品。补者有三才复脉等方。又如湿热沉混之苍术石膏汤。气血两燔之玉女法。开闭逐秽。与牛黄及至宝紫雪等剂。扶虚进参附。及两仪诸法。随其变幻。审其阴阳。运用之妙。存乎心也。附骥芜词。高明教正。（邵新甫）
徐评 所列诸案。皆平素伏暑之症为多。其卒然受暑之病绝少。若卒受之症。则当以香茹饮为主。不可不知也。
此老治暑邪。能用轻清凉润之品以和肺。是其所长。但暑邪深入。必有闷乱烦躁等症。近于霍乱。此则更有治法。至于病重症危。属热邪横逆。不但人参不可轻用。而桂附干姜服之。无不立毙。乃亦仿仲景伤寒坏症治法。轻于一试。当时不知有害与否。而耳食之徒。竟以为必用之药。名本于此老。我见死者甚多。伤心惨目。不得不归咎于作俑之人也。
Qi injury. Dampness obstructs Qi mechanism. The Lung governs the circulating Qi of the whole body. Its position is high. It belongs to the Hand-Taiyin Meridian. According to the described symptoms, red face and cold feet, epigastric fullness and blockage. This is significantly a disease of the Upper Jiao (Upper Burner). Because the patient usually drinks alcohol, damp-heat has been潜伏 (latent) in the Stomach for a long time. Using acrid-warm and drying-hot drugs is not only unsuitable for Lung disease, but also the damp-heat in the Stomach, being confined by dry-heat, leads to diarrhea with watery stools, which is called "Xie Re Xia Li" (Diarrhea with accompanying heat). Therefore, Huang Lian (Coptis Rhizome), being bitter-cold, causes worsening diarrhea every time it is taken, because although bitter-cold drugs overcome acrid-hot drug flavors, the acrid-hot residues remain at the bottom of the Stomach. However, this has no direct relation to the initial pathogenic factor in the Lung. Shi Gao (Gypsum Fibrosum) is acrid-cold; acrid flavor enters the Lung first; Zhi Mu (Anemarrhenae Rhizoma) has a cool taste and is the mother Qi of the Lung (Metal generates Water, Earth generates Metal, here referring to nourishing the source to moisten the Lung). If one does not understand the Lung pathogen and merely speaks of generating fluids, how can that be the ultimate principle? In the past, Sun Simiao asked about medical history before diagnosis, which was least likely to cause errors. Furthermore, according to the family, the illness began twenty days ago, with no sweating to vent the pathogen. The *Classic* says: For Summerheat diseases, sweat should be allowed to come out, do not stop it. When Qi obstruction lasts for a long time, heat invades the Blood level, causing coughing up of phlegm with blood, red tongue, and little thirst. If the Upper Jiao is not resolved, it spreads to the Middle and Lower Jiao. All these require urgent clearing of the Three Jiao, which is the main theme of the first chapter. Thus, the stasis-heat of heat diseases, remaining in the collaterals as residual toxins, or entering the Fu organs and intestines as profuse diarrhea, becomes a situation where one is helpless. Again, dampness is a heavy and turbid pathogen, heat is a steaming Qi. Heat residing in dampness, the steaming and excessive Qi presses upward upon the clear orifices, causing deafness. This is different from Shaoyang deafness. Qing Hao (Artemisiae Annuae Herba) is one grade lower than Chai Hu (Bupleuri Radix), yet it is also a primary herb for Shaoyang. Moreover, treating a major illness is like fighting a great enemy; selecting herbs is like selecting generals. If not cautious, success is rare. It is proposed to use the method of clarifying the Three Jiao, following He Jian's method. (3rd day)
Fei Hua Shi (Talcum), Sheng Shi Gao (Raw Gypsum Fibrosum), Han Shui Shi (Calcitum), Da Xing Ren (Semen Armeniacae Amarum), Chao Huang Zhu Ru (Fried Bamboo Shavings), Chuan Tong Cao (Tetrapanacis Medulla), Ying Bai Jin Zhi (Pure White Gold Juice), Jin Yin Hua Lu (Honeysuckle Dew).
Another visit in the evening. After pulse diagnosis, urticaria appeared on the abdominal and chest skin and pores. Damp-heat in the Qi level originally had a mechanism for hidden discharge. As discussed in the morning, residual pathogens and lingering heat must be accompanied by detoxification for this purpose. After taking medicine in the afternoon, the pulse was larger than in the morning. Consciousness remained the same. Only the tongue was red, especially dry in the center. Touching the body, the heat was more severe than in the morning. This indicates the Yin level is also injured by steaming heat. For thin people, worry about fluid depletion arises. However, since phlegm cannot be expectorated clearly, Yin-nourishing drugs are invariably cloying and stagnating. It is proposed to take one dose of Qing Ge (Clear Diaphragm) early, and for the accumulation of heat and filth in the Three Jiao, use Zi Xue Dan (Purple Snow Pill) two or three spoons, borrowing its aromatic opening of orifices and expelling of filth, so that confined heat can be resolved and turbid phlegm will not stick. Subsequent conditioning formulas should clear the Ying (Nutritive) level and nourish Stomach juices, only then can care be taken. The removal of accumulated fecal matter will still take ten days. The ancients said that purgation is not too late; this is not an arbitrary statement. Zi Xue Dan 1 qian 6 fen.
Zhi Mu (Anemarrhenae Rhizoma), Zhu Ye Xin (Bamboo Leaf Heart), Lian Qiao Xin (Forsythiae Fruit Heart), Chao Chuan Bei (Fried Fritillariae Bulbus), Zhu Li (Bamboo Sap), Xi Jiao (Rhinocerotis Cornu - note: substitute with water buffalo horn in modern practice), Yuan Shen (Scrophulariae Radix), Jin Zhi (Gold Juice), Yin Hua Lu (Honeysuckle Dew).
After taking one dose.
Zhu Ye Xin (Bamboo Leaf Heart), Zhi Mu (Anemarrhenae Rhizoma), Lv Dou Pi (Mung Bean Peel), Yuan Shen (Scrophulariae Radix), Xian Sheng Di (Fresh Rehmanniae Radix), Jin Yin Hua (Lonicerae Japonicae Flos).
After another dose. Remove Jin Yin Hua and Lv Dou Pi. Add Ren Shen (Ginseng Radix) and Mai Dong (Ophiopogonis Tuber).
Another visit at Shen hour on the 10th day. After a month of seasonal pathogens, the pulse form is small and rapid. Small indicates disease retreat, rapid indicates residual heat. Therefore, skin desquamation like bran indicates the meaning of Qi and Blood circulation. Desire for food and appetite indicates the Stomach has a mechanism of awakening and clarity; all are good omens. Only the tongue is red with yellow coating in the center. Long-standing heat steaming injures both Stomach fluids and Yin liquids, causing difficulty swallowing as if obstructed, pain in the urethra during urination, thick phlegm expectoration, and unpassed accumulated feces. If aggressive purging is used hastily, true Yin may be further depleted. This case prioritizes preserving Yin, while simultaneously clearing the Fu organs. Therefore, indiscriminate eating aids heat. Only light and bland flavors are compatible with the disease. Since ancient times, heat diseases fear relapse due to diet and fatigue, known to all, not an arbitrary statement.
Xi Sheng Di (Rehmanniae Radix Preparata), Yuan Shen Xin (Scrophulariae Radix Heart), Zhi Mu (Anemarrhenae Rhizoma), Chao Chuan Bei (Fried Fritillariae Bulbus), Mai Dong (Ophiopogonis Tuber), Di Gu Pi (Lycii Cortex), Jin Yin Hua Lu (Honeysuckle Dew), Zhu Li (Bamboo Sap).
Pulse and symptoms as yesterday. Still propose nourishing and clearing residual heat in the Yin level, assisting in clearing heat-phlegm in the upper epigastrium.
Follow yesterday's formula, remove Di Gu Pi and Jin Yin Hua Lu, add Yan Shui Chao Ju Hong (Salt-water fried Tangerine Peel).
Certain Patient: Pulse deficient. Summerheat injury. Heavy head, epigastric stuffiness, soreness in the dorsum of foot.
Si Gua Ye (Loofah Leaf, 3 qian), Da Xing Ren (Semen Armeniacae Amarum, 3 qian), Liu Yi San (Six-to-One Powder, 3 qian), Fu Ling Pi (Poria Cocos Peel, 3 qian), Han Fang Ji (Stephaniae Tetrandrae Radix, 1.5 qian), Mian Yin Chen (Artemisiae Scopariae Herba, 1 qian), Xi Mu Tong (Akebiae Caulis, 1 qian), Bai Kou Ren (Amomi Fructus Rotundus, 0.5 qian).
Certain Patient: Zhong E (Sudden Evil) Summerheat Jue (Summerheat Collapse). Cang Zhu Bai Hu Tang (Atractylodis Rhizoma White Tiger Decoction) plus Hua Shi (Talcum).
Wang: Summerheat pathogen with alternating chills and fever. White tongue, no thirst. Hematemesis. This is named Shu Zhai (Summerheat Consumption), a severe condition.
Xi Gua Cui Yi (Watermelon Rind Green Layer), Zhu Ye Xin (Bamboo Leaf Heart), Qing He Ye Zhi (Green Lotus Leaf Juice), Xing Ren (Semen Armeniacae Amarum), Fei Hua Shi (Talcum), Yi Yi Ren (Coicis Semen).
Wan: Summerheat pathogen unresolved, sinking into Jueyin. Grey tongue, excessive thirst. Hardness below the heart. Vomiting and nausea, vomiting roundworms. Chills and fever. Diarrhea with bloody water. A most critical condition. (Summerheat invading Jueyin)
Chuan Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Gan Jiang (Zingiberis Rhizoma), Sheng Bai Shao (Paeoniae Radix Alba), Chuan Jiao (Zanthoxyli Pericarpium), Wu Mei (Mume Fructus), Ren Shen (Ginseng Radix), Zhi Shi (Aurantii Fructus Immaturus).
Jiang: Summerheat pathogen deeply invading Jueyin. Retracted tongue. Fullness and hardness in the lower abdomen. Loss of voice. Spontaneous diarrhea. Obstruction between upper and lower. Critical period arrives quickly. Tentatively propose Sour-Bitter Heat-Draining method for Summerheat, assisting Righteousness to drive out Pathogens.
Huang Lian (Coptidis Rhizoma), Dan Gan Jiang (Mild Dried Ginger), Wu Mei (Mume Fructus), Sheng Bai Shao (Paeoniae Radix Alba), Ban Xia (Pinelliae Rhizoma), Ren Shen (Ginseng Radix), Zhi Shi (Aurantii Fructus Immaturus).
Certain Patient (18 years old): Labor injury combined with Summerheat. Lung Qi damaged. Hemoptysis and dry mouth. First clear Summerheat-heat (Summerheat combined with Blood Disease).
Xian He Ye (Fresh Lotus Leaf), Bai Bian Dou (Dolichos Lablab Seed), Da Sha Shen (Glehniae Radix), Fu Shen (Poria Cocos with Hostwood), Yi Yi Ren (Coicis Semen).
Zhu (32 years old): During the Three Fu periods, Yin Qi does not generate, Yang Qi does not submerge. Head distension and body pain indicate initial Summerheat invasion. Summerheat-Dampness-Heat must first injure the Qi level. Hence white tongue, thirst, and body pain. Refreshing in the morning, vexatious steaming at midnight. Resembles Warm Malaria. Bathing agitates blood collaterals. Old illness acquired through seasonal pathogen. Zhang Zhongjing said: Treat new illness first, then manage old illness. This is also Yin Qi injured first, Yang Qi acting alone.
Xian Sheng Di (Fresh Rehmanniae Radix), Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Yuan Shen (Scrophulariae Radix), Lian Qiao (Forsythiae Fructum), Zhu Ye Xin (Bamboo Leaf Heart), He Ye Zhi (Lotus Leaf Juice).
Wang (39 years old): Although coughing phlegm and blood loss, strong appetite, unaware of hunger. Yellow eyes, afternoon fever. Yellow coating on tongue center. Already showing signs of Summerheat-heat guest pathogen. This should first clear and regulate Lung and Stomach. Do not use cloying tonics due to chronic illness.
Xing Ren (Semen Armeniacae Amarum), Xiang Bei Mu (Fritillariae Cirrhosae Bulbus), Yu Jin (Curcumae Radix), Chuan Tong Cao (Tetrapanacis Medulla), Sang Ye (Mori Folium), Shi Gao (Gypsum Fibrosum), Ju Hong (Citri Reticulatae Pericarpium), Yi Yi Ren (Coicis Semen).
Again: Evening take Pi Pa Ye Gao (Loquat Leaf Paste). Morning six ingredients plus E Jiao (Asini Corii Colla) and Mai Dong (Ophiopogonis Tuber).
Again: E Jiao (Asini Corii Colla), Ji Zi Huang (Egg Yolk), Xiao Sheng Di (Rehmanniae Radix Preparata), Mai Dong (Ophiopogonis Tuber), Sang Ye (Mori Folium), Chao Hei Dan Pi (Moutan Cortex Stir-fried Black).
Xu (36 years old): Labor injury combined with Summerheat. Hemoptysis and lack of appetite.
Xian He Ye Zhi (Fresh Lotus Leaf Juice, mixed in), Da Sha Shen (Glehniae Radix), Sheng Yi Yi Ren (Coicis Semen), Liu Yi San (Six-to-One Powder), Lv Dou Pi (Mung Bean Peel), Xing Ren (Semen Armeniacae Amarum), Ju Hong (Citri Reticulatae Pericarpium), Bai Kou Ren (Amomi Fructus Rotundus).
When Heaven's Summerheat moves, Earth's damp-turbidity naturally rises. Humans, amidst steaming and oppressive heat, if Righteous Qi has any gap, pathogens enter from mouth and nose. Qi level obstructed first. Upper Jiao's clearing and descending function fails. Transport and transformation mechanism loses normal degree. Essence and micro-nutrients of water and grain also accumulate and become dampness. The human body is a small heaven and earth; internal and external correspond. Thus Summerheat diseases must carry dampness, which is the meaning here. Ancients distinguished between movement and stillness, injury or penetration, entering Heart or Liver, becoming Malaria or Dysentery, Zhong Sha (Miasma) Huo Luan (Cholera-like syndrome), sudden collapse and death. Various origins of transmission each have profound meanings to reference. Here not repeated in detail. Thinking of south of the Yangtze River, low land and thin Qi, dampness wins and heat steams. At this time, prevention must be prior. As Li Ki Weng recorded in his notes: "If heaven had only three seasons without Summer, human illness would surely be rare." This statement is most accurate. The injury of Summer-dampness, acute cases suffer at the time, chronic cases become latent Qi disease after Autumn. Its manifestations: pulse and color must be stagnant, mouth and tongue must be greasy. Or slight chills, or single fever. During fever, epigastric fullness and Qi obstruction, thirst, oppression, vexation. Worse in afternoon, more severe at dusk. Heat until dawn, sweating alleviates symptoms slightly. Day after day like this, necessary beyond two or three pulses, decreasing day by day, only then fully resolved. If Yuan Qi cannot support, or conditioning is illegal, many are untreatable. However, this disease compared to Shang Han (Cold Damage), its momentum feels slower; compared to Malaria, chills and fever are not distinct. Its changes are no different from Shang Han, but recovery period feels lingering. If exteriorized, sweat is not easy to penetrate thoroughly; if attacked internally, loose stool easily occurs. Over-clearing leads to cold limbs and vomiting; over-drying leads to dry lips and cracked teeth. Every autumn comes, this symptom is most common. Seeking ancient teachings, many are not recorded. Only Ji Ren compiled and named it "Autumn Late Onset," feeling symptoms resembling Malaria. Generally treat with methods for feeling pathogens. Know that latent Qi disease exists in four seasons, but unlike Wind-Cold pathogen solved by one sweat, Warm-Thermal Qi relieved by cooling. Summer and Dampness are steaming and sticky pathogens, hardest to cure suddenly. If treatment is not appropriate, Summer-heat steams upward from Yang, injuring Yin and transforming into dryness; Damp-pathogen sinks downward from Yin, injuring Yang and transforming into turbidity. Leading to confusion, deafness, dry tongue, gingival bleeding, epigastric fullness, vomiting, profuse diarrhea, cold limbs. Thorny symptoms arise, eventually collapsing beyond rescue. Referencing Mr.'s intent, base legislation on Liu Hejian's Theory of Three Jiao. Clearly recognize which of Summer-damp two Qi is heavier. Then investigate the disease, actually in Ying-Qi what division. Generally, Six Qi injuring humans transform according to person. Yin deficiency leads to Fire hyperactivity, pathogens return mostly to Ying-Blood levels. Yang deficiency leads to Dampness winning, pathogens injure Qi level mostly. One tolerates clearing, one tolerates warming. Yin-Yang of organ nature can be known from this. Thus, those above use Acrid-Cool Slight-Bitter, such as Zhu Ye, Lian Qiao, Xing Ren, Bo He (Mint). Those in middle use Bitter-Acid Dredging, such as Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction). Those below use Warm-moving Cold-nature, heavy quality opening downward, such as Gui Ling Gan Lu Yin (Cinnamon, Poria, Sweet Dew Drink). These are the general ideas of treating Three Jiao. Or if there is夹杂 (intermingling), must adapt. Regarding treating Qi level, there is difference between Cold and Warm. Cold follows various Bai Hu (White Tiger) methods and Tian Shui San (Heavenly Water Powder) intent. Warm follows Er Chen Tang (Two Aged Decoction) and Zheng Qi San (Upright Qi Powder) methods. Managing Ying level, know suitability of Clearing and Tonifying. Clearing like Xi Jiao Di Huang Tang (Rhino Horn Rehmannia Decoction), adding Heart-entering products. Tonifying like San Cai Fu Mai Tang (Three Talents Reviving Pulse Decoction). Also like Cang Zhu Shi Gao Tang (Atractylodes Gypsum Decoction) for deep-mixed damp-heat, Yu Nu Fa (Jade Maiden Method) for Qi and Blood simultaneous flaming. Opening closure and expelling filth, with Niu Huang (Calculus Bovis) and Zhi Bao Zi Xue (Treasure Purple Snow) agents. Supporting deficiency advancing Ren Shen and Fu Zi (Aconite), and Liang Yi (Two Powers) methods. Following changes, examining Yin-Yang, the subtlety of application lies in the mind. Attaching to the tail with humble words, taught by the wise. (Shao Xin Fu)
Xu's Commentary: The listed cases are mostly chronic latent Summerheat symptoms. Cases of sudden Summerheat invasion are extremely rare. If sudden invasion, must use Xiang Ru Yin (Agastache Drink) as main treatment. Must not be unknown.
This elder treats Summerheat pathogen, able to use light-cool moistening products to harmonize Lung, which is his strength. But when Summerheat pathogen goes deep, there must be stifled chaos and irritability symptoms, close to Cholera-like syndrome. This then has other treatment methods. As for severe and critical illness, belonging to Heat pathogen horizontal reversal, not only is Ren Shen not to be used lightly, but Gui (Cinnamon Bark), Fu Zi (Aconite), Gan Jiang (Dried Ginger) taken, all die immediately. Yet he imitated Zhang Zhongjing's treatment method for damaged Shang Han conditions, lightly trying once. At that time, unknown whether harmful or not, but gossips actually thought it was a necessary drug, name originating from this elder. I have seen many deaths, heartbreaking, must blame the instigator.