邵评∶夏令暑天。热气湿浊。蒸成秽恶瘴毒。谓之痧秽。人中其邪。先从口鼻吸入。
适更受暑。留伏膜原。故有头疼寒热见症。邪阻气机。阳不宣运。则有肢冷脉伏呕泻痛闷见象
矣。治宜辛香逐秽。轻淡清暑。使其暑秽两分。则邪解散而愈。如食滞中宫。加消食化滞之品。
有触暑秽。腹痛。误饮姜糖汤而成霍乱。吐泻不得。六脉俱伏。绞肠痛欲死者。此内
闭也。外用放痧、提痧、刮痧、等法。内急以川郁金、石菖蒲、西黄（另冲）川连、草蔻、藿香、木
香、滑石、通草等投之。以开闭逐秽。
邵评∶姜与暑犯。糖与痧犯。误饮姜糖汤。则邪壅滞中宫。上下格拒。挥霍撩乱。欲
吐不吐。欲泻不泻。腹中绞痛。脉伏不起。邪内闭而为绞肠痧症。急用针刺提刮之法。以开泄其血络
机窍之气为外治。内服芳香辛散之剂。以开闭逐秽。而散邪通气也。如邪重不应。可服三物备
急丸温开之法。
暑挟食 凡头痛背寒。发热自汗。脉左虚右滑。畏食胸闷者。伤暑兼伤食也。宜藿
香、浓朴、青皮、香薷、神曲、楂肉、枳实、麦芽、紫苏、滑石之类。疏之清之。
邵评∶此清暑热而消食滞之正法。
邪结下焦 暑湿合邪。郁结下焦气分。以致小腹硬满。大便不下。舌苔白兼微黄。
此下焦气分结邪。勿以伤寒液涸便秘治之。宜猪苓、赤苓、滑石、通草、淡竹叶、晚蚕砂、皂荚子
之类。以解下焦气分之结。二便自通矣。
邵评∶暑湿合邪。暑轻湿重。注于下焦。而结在气分。则少腹硬满。气不宣运。故大
便不下。然小水亦未必流利。舌苔白而微兼黄色。湿多暑少之征也。湿阻气机。二便不利。与伤寒液涸
便结者大异。治以渗湿开气之法。下焦郁结之邪开化。则二便通行而邪自化矣。
动暑 行人农夫。于日中劳役得之。为中 。 即暑也。其证头痛发躁恶热。扪之
肌肤大热。大渴引饮。汗大泄。无气亦动。乃天热外伤元气。宜益气清暑为治。按仲景云。太阳中热。
是也。汗出恶寒。身热而渴。白虎汤加人参主之。夫元气为热邪所伤。以致大热大渴。汗出不已。故以人
参益气。石膏清暑。乃至精至当之法。何后人以东垣清暑益气汤代之。吾恐暑邪正盛。升葛之升。
术之闭。宁不助邪增病耶。惟生脉散加石膏。可以代之。然形气壮实者。只服六一散亦解。东垣此汤。
乃治暑月湿热伤气。脾胃受病之缓症也。若以之治中暑。则谬矣。
静暑 静处高堂大厦之中。虽无暑气。然偶或冒暑应接。亦能中暑。如迎宾送客。观荷曝书之类。
偶触暑邪是也。更有斗室低楼。热气外逼。即静处室中。亦能吸受暑邪。俱当以正暑治之。
阴暑 按方书以大顺散治阴暑。非暑也。乃暑月所受之阴寒也。然大顺散药经
炒熟。重用甘草。虽有杏仁下气。皆主甘温守中。并无散寒破结之能。即内伤生冷。
外受阴寒。亦非所宜。至若无病之人。避暑山房水阁。过于贪凉。感冒微风。以致寒
热无汗。或头疼恶寒发热。是周身阳气为寒所遏也。当从伤寒治。轻轻温散可也。
苏薄、藿朴之类。如恣食瓜果。内伤生冷。以致腹痛吐泻。脉沉迟。手足厥冷者。此即
太阴中寒也。理中加藿香、浓朴主之。
阳暑 此即动暑。见前。（以上合参治法汇叶案暑症全书）
暑风 暑月病患忽然手足搐挛者。暑风也。香薷饮加羌防。呕恶加藿香、陈皮、小便不利加二苓、
泽泻、滑石。有痰加半夏。渴易栝蒌。泻不止加苍术。转筋加木瓜。
势重者手足挛搐。角弓反张。如中恶状。亦有先病热。服表药后。渐成风者。谵语
狂呼浪走。气力百倍。亦暑气也。以寒凉攻劫之。兼解散化痰。
暑瘵 盛暑之月。火能烁金。不禁辛酒。脾火暴甚。劳热躁扰。火动心脾。令人咳嗽
气喘。骤然吐血、衄血。头目不清。膈中烦扰不宁。即童稚老夫。间有此病。昧者以为劳瘵。不知火载
血上。非真阴亏损而为虚劳者比也。宜清暑凉血。如荷叶汁、鲜生地、元参、知母、石膏、郁金、
连翘、杏仁、象贝之类。
暑疡 凡痈疽毒疮。发热有时。晡热旦止。若夏月间。有患头面外项赤肿。或腿足 肿。长至
数寸。不能步履。人皆疑为疮毒。但头痛内躁。昼夜发热不止。自与疮毒异。宜清暑解毒。如川连、
石膏之类。暑毒一解。其肿自消。亦无脓血也。
暑疮 盛暑之时。有遍身发泡。如碗如杯。如李如桃。晶莹脆薄。中含臭水。此湿热
之水。泛于肌表也。黄连香薷解毒汤之类。若口疳臭秽。凉膈散效。外用鲜莲花辨
贴疮上。一周时平复。（以上四条出暑症全书）
邵评：夏季暑天，热气与湿浊之气蒸腾，形成秽恶的瘴毒，称为痧秽。人体一旦感受这种邪气，首先从口鼻吸入。如果此时又受到暑邪侵袭，邪气就会留伏在膜原（半表半里的部位），因此出现头痛、寒热往来等症状。邪气阻滞气机运行，阳气不能宣通运化，就会出现四肢发冷、脉象沉伏、呕吐腹泻、腹痛闷胀等表现。治疗应当使用辛香药物驱除秽浊，用轻淡之品清解暑热，使暑邪与秽浊分离，那么邪气解散而病愈。如果有食积停滞在中焦脾胃，加入消食化滞的药物。
若因触冒暑秽，导致腹痛，误饮姜糖汤从而引发霍乱，出现呕吐腹泻不止、六脉全部沉伏、腹部绞痛欲死的情况。这是邪气内闭所致。外治法可采用放痧、提痧、刮痧等方法；内服急需用川郁金、石菖蒲、西黄（另冲服）、黄连、草豆蔻、藿香、木香、滑石、通草等药物投喂，以开闭逐秽。
邵评：姜性温，易与暑邪相犯；糖性腻，易与痧秽相犯。误饮姜糖汤，会导致邪气壅滞于中焦脾胃，造成上下格拒，气机挥霍撩乱，想吐吐不出，想拉拉不出，腹中绞痛，脉象沉伏不起。这是邪气内闭形成的绞肠痧症。急需采用针刺、提刮等外治法，以开泄血络和机窍的气机；内服芳香辛散的药剂，以开闭逐秽，疏散邪气并通畅气机。如果病情严重服药无效，可以服用三物备急丸，采用温通开窍的方法。
暑挟食：凡是出现头痛、背部怕冷、发热自汗、左脉虚右脉滑、畏食且胸闷的患者，是伤暑兼有伤食。适宜使用藿香、厚朴、青皮、香薷、神曲、山楂肉、枳实、麦芽、紫苏、滑石等药物，疏解表邪并清解里热。
邪结下焦：暑湿合邪，郁结在下焦气分，导致小腹硬满、大便不通、舌苔白兼微黄。这是下焦气分的结邪，不要当作伤寒津液枯竭导致的便秘来治疗。适宜使用猪苓、赤茯苓、滑石、通草、淡竹叶、晚蚕砂、皂荚子等药物，以解开下焦气分的郁结，大小便自然通畅。
邵评：暑湿合邪，暑邪轻而湿邪重，注于下焦并在气分郁结，导致少腹硬满，气机不宣通运化，所以大便不下。然而小便也未必流利。舌苔白而微兼黄色，是湿多暑少的征象。湿邪阻滞气机，导致二便不利，这与伤寒津液枯竭导致的大便干结大不相同。治疗采用渗湿开气的法则，当下焦郁结的邪气得以开散化解，二便通行，邪气自然化解。
动暑：行路之人或农夫，在烈日下劳作得此病，属于中暍（即中暑）。症状表现为头痛、烦躁、怕热，触摸肌肤感觉大热，极度口渴想喝水，大汗淋漓，气息微弱甚至无法动弹。这是天气炎热外伤元气所致，治疗宜益气清暑。按张仲景所说：“太阳中热”，就是这种情况。表现为汗出、恶寒、身热而渴，主方用白虎汤加人参。因为元气被热邪所伤，导致大热大渴、汗出不止，所以用人参益气，石膏清解暑热，这是非常精当的方法。为何后人用李东垣的清暑益气汤替代？我担心暑邪正盛时，升麻、葛根的升提，白术的固守，岂不是助长邪气加重病情吗？只有生脉散加石膏，可以替代它。然而形体气力壮实的人，只服用六一散也能解暑。李东垣的这个方子，是治疗暑月湿热伤气、脾胃受病的缓症。如果用这个方子治疗中暑，那就错了。
静暑：安静地待在高大房屋之中，虽然外面没有暑气，但偶尔接触暑气应接人事，也能中暑。比如迎宾送客、观赏荷花、曝晒书籍等情况，偶然触冒暑邪。更有狭小低矮的房间，热气从外部逼迫，即使静处室内，也能吸受暑邪。这些都应当按正暑来治疗。
阴暑：按医书用大顺散治疗阴暑，其实这不是暑病，而是暑月感受的阴寒之邪。但大顺散中的药物经过炒熟，重用甘草，虽然有杏仁降气，但主要都是甘温守中的药物，并没有散寒破结的能力。即使是内伤生冷、外受阴寒，也不适宜。至于没有生病的人，避暑于山房水阁，过于贪凉，感冒微风，导致寒热无汗，或者头痛、恶寒发热，这是周身阳气被寒邪遏制所致。应当从伤寒论治，轻轻温散即可。可用苏叶、薄荷、藿香、厚朴之类。如果恣意食用瓜果，内伤生冷，导致腹痛吐泻、脉象沉迟、手足厥冷，这就是太阴中寒证。用理中汤加藿香、厚朴主治。
阳暑：这就是前面的动暑，见前文。（以上综合参考叶天士医案及《暑症全书》）
暑风：暑月病患突然手足抽搐者，称为暑风。用香薷饮加羌活、防风；呕吐恶心加藿香、陈皮；小便不利加猪苓、茯苓、泽泻、滑石；有痰加半夏；口渴将瓜蒌替换原有药物；腹泻不止加苍术；转筋加木瓜。
病情严重者，手足挛缩抽搐，角弓反张，像中恶的样子。也有先患热病，服用解表药后，逐渐发展成风的，出现谵语、狂呼浪走，气力百倍，这也是暑气所致。用寒凉攻劫之法，兼以解散化痰。
暑瘵：盛暑月份，火能烁金（肺），如果不禁辛辣酒类，脾火暴甚，劳热躁扰，火动心脾，令人咳嗽气喘，骤然吐血、衄血，头目不清爽，膈中烦扰不宁。即使是儿童或老人，间或有此病。不明医理的人以为是劳瘵（肺结核等慢性消耗性疾病），不知道这是火载血上，并非真阴亏损导致的虚劳相比拟。适宜清暑凉血，如荷叶汁、鲜生地、玄参、知母、石膏、郁金、连翘、杏仁、象贝母等药物。
暑疡：凡是痈疽毒疮，发热有时，傍晚发热早晨停止。如果在夏季，有人患头面颈部红肿，或者腿足肿胀，长达数寸，不能行走。人们都怀疑是疮毒，但如果伴有头痛内躁，昼夜发热不止，这就与疮毒不同。适宜清暑解毒，如黄连、石膏等药物。暑毒一解，肿胀自然消退，也没有脓血。
暑疮：盛暑之时，全身发泡，如碗如杯，如李如桃，晶莹脆薄，里面含有臭水。这是湿热之水泛溢于肌表所致。用黄连香薷解毒汤之类。如果口疳口臭秽浊，凉膈散有效。外用鲜莲花瓣贴敷疮上，一周时间平复。（以上四条出自《暑症全书》）
Shao's Commentary: During the summer months, heat qi and damp turbidity evaporate and mix to form foul miasmic toxins, known as "Sha Hui" (sand-miasma). When the human body is invaded by this pathogen, it first enters through the mouth and nose. If one is subsequently exposed to summerheat, the pathogen remains latent in the *Mo Yuan* (Membrane Source, a location between the exterior and interior), resulting in symptoms such as headache and alternating chills and fever. The pathogen obstructs the mechanism of Qi movement, preventing the Yang from being disseminated and transported; thus, manifestations such as cold limbs, deep/fine pulse, vomiting, diarrhea, abdominal pain, and oppression occur. Treatment should employ acrid-aromatic herbs to expel filth and light-bland herbs to clear summerheat, separating the summerheat from the filth so that the pathogen dissipates and the disease resolves. If there is food stagnation in the Middle Jiao (Spleen and Stomach), add herbs that promote digestion and resolve stagnation.
If one is touched by summerheat-filth, causing abdominal pain, and mistakenly drinks Ginger-Sugar Decoction, leading to Cholera (*Huo Luan*), with symptoms of intractable vomiting and diarrhea, all six pulses becoming deep/fine, and severe intestinal colic resembling death, this is due to internal closure. External treatments include bloodletting for Sha (*Fang Sha*), lifting Sha (*Ti Sha*), and scraping (*Gua Sha*). Internally, urgently administer Chuan Yu Jin (Curcuma Aromatica Rhizome), Shi Chang Pu (Acori Tatarinowii Rhizoma), Xi Huang (Calculus Bovis, administered separately), Chuan Lian (Coptidis Rhizoma), Cao Dou Kou (Cardamomi Fructus), Huo Xiang (Agastaches Herba), Mu Xiang (Aucklandiae Radix), Hua Shi (Talcum), and Tong Cao (Tetrapanacis Medulla) to open the closure and expel filth.
Shao's Commentary: Ginger's warmth conflicts with summerheat; sugar's cloying nature conflicts with Sha-miasma. Mistakenly drinking Ginger-Sugar Decoction causes pathogenic factors to stagnate in the Middle Jiao, creating rejection between the upper and lower, leading to chaotic Qi movement, inability to vomit or defecate, severe abdominal cramping, and non-rising deep pulses. This is the "Jiao Chang Sha" (Intestinal Colic Sha) syndrome caused by internal pathogenic closure. Urgently use acupuncture, lifting, and scraping external therapies to open and drain the Qi in the blood collaterals and physiological apertures. Internally, administer acrid-aromatic dispersing agents to open closure, expel filth, disperse pathogens, and unblock Qi. If the condition is severe and does not respond, San Wu Bei Ji Wan may be taken using the method of warm opening.
Summerheat Accompanied by Food Stagnation: Patients presenting with headache, aversion to cold on the back, fever with spontaneous sweating, left pulse deficient and right pulse slippery, aversion to eating, and chest fullness are suffering from Summerheat injury combined with Food Injury. Suitable herbs include Huo Xiang (Agastaches Herba), Hou Po (Magnoliae Officinalis Cortex), Qing Pi (Citri Reticulatae Pericarpium Viride), Xiang Ru (Moslae Herba), Shen Qu (Massa Medicata Fermentata), Zha Rou (Crataegi Fructus), Zhi Shi (Aurantii Fructus Immaturus), Mai Ya (Hordei Fructus Germinatus), Zi Su (Perillae Folium), and Hua Shi (Talcum), to disperse and clear.
Shao's Commentary: This is the standard method for clearing summerheat and eliminating food stagnation.
Pathogen Knotting in the Lower Jiao: Summerheat and Dampness combine as pathogens, knotting in the Qi level of the Lower Jiao, resulting in hardness and fullness of the lower abdomen, constipation, and a white tongue coating with slight yellow. This indicates pathogenic knotting in the Qi level of the Lower Jiao. Do not treat it as constipation due to fluid depletion in Cold Damage (*Shang Han*). Suitable herbs include Zhu Ling (Polypori Sclerotium), Chi Ling (Poria Cum Radio), Hua Shi (Talcum), Tong Cao (Tetrapanacis Medulla), Dan Zhu Ye (Lophatheri Herba), Wan Can Sha (Bombyx Batryticatus), and Zhao Jia Zi (Gleditsiae Sinensis Spina), to resolve the knotting in the Qi level of the Lower Jiao, allowing urination and defecation to flow freely.
Shao's Commentary: In combined Summerheat-Dampness pathogens, Summerheat is mild while Dampness is heavy, pouring into the Lower Jiao and knotting in the Qi level, causing lower abdominal hardness and fullness. Since Qi is not disseminated and transported, defecation does not occur. However, urination may also not be smooth. A white tongue coating with slight yellow indicates more Dampness than Summerheat. Dampness obstructing Qi mechanism leads to difficulty in both urination and defecation, which is vastly different from constipation due to fluid depletion in Cold Damage. Treatment employs the method of leaching out Dampness and opening Qi. Once the knotted pathogen in the Lower Jiao is opened and transformed, urination and defecation will proceed, and the pathogen will naturally transform.
Active Summerheat (*Dong Shu*): Laborers and farmers who work under the midday sun contract this disease, known as *Zhong Yue* (Heat Stroke/Summerheat Strike). Symptoms include headache, restlessness, aversion to heat, skin feeling very hot to the touch, extreme thirst with desire to drink, profuse sweating, and Qi deficiency so severe that even movement is difficult. This is Heavenly Heat injuring Yuan Qi externally. Treatment should tonify Qi and clear Summerheat. According to Zhang Zhongjing: "Taiyang Summerheat Heat" refers to this condition. Symptoms include sweating, aversion to cold, fever, and thirst. The main formula is Bai Hu Tang (White Tiger Decoction) plus Ren Shen (Ginseng Radix et Rhizoma). Because Yuan Qi is injured by heat pathogens, causing high fever, extreme thirst, and incessant sweating, Ren Shen is used to tonify Qi, and Shi Gao (Gypsum Fibrosum) to clear Summerheat. This is an exquisite and appropriate method. Why did later generations replace it with Li Dongyuan's Qing Shu Yi Qi Tang? I fear that when Summerheat pathogens are vigorous, the ascending properties of Sheng Ma and Ge Gen, and the binding nature of Bai Zhu, might assist the pathogen and worsen the disease. Only Sheng Mai San (Generate the Pulse Powder) plus Shi Gao can serve as a substitute. However, those with strong constitution and Qi need only take Liu Yi San (Six-to-One Powder) to resolve the heat. Li Dongyuan's decoction is intended for chronic cases where Summerheat-Dampness injures Qi and affects the Spleen and Stomach. Using it to treat acute Summerheat strike would be erroneous.
Quiet Summerheat (*Jing Shu*): One staying quietly in tall buildings may not feel external heat, but occasional exposure to Summerheat during social interactions can still cause Summerheat strike. Examples include greeting guests, viewing lotuses, or airing books—accidental contact with Summerheat pathogens. Furthermore, in small, low rooms where external heat presses in, even staying quietly indoors allows inhalation of Summerheat pathogens. All these should be treated as typical Summerheat.
Yin Summerheat (*Yin Shu*): Medical texts prescribe Da Shun San (Great Harmony Powder) for Yin Summerheat, but this is not actually Summerheat; it is Yin-Cold contracted during the Summer months. However, the herbs in Da Shun San are roasted and contain heavy doses of Gan Cao (Licorice Root), and although Xing Ren (Armeniacae Semen) directs Qi downward, they are primarily sweet-warm and middle-stabilizing, lacking the ability to disperse Cold and break knots. Thus, it is unsuitable even for internal Cold damage and external Yin-Cold contraction. For healthy individuals avoiding heat in mountain pavilions or water towers, excessive indulgence in coolness leading to wind-cold contraction, resulting in chills, fever, no sweat, headache, aversion to cold, and fever, is due to whole-body Yang Qi being suppressed by Cold. This should be treated according to Cold Damage principles, using gentle warming and dispersing methods. Herbs such as Zi Su (Perillae Folium), Bo He (Menthae Haplocalycis Herba), Huo Xiang (Agastaches Herba), and Hou Po (Magnoliae Officinalis Cortex) are suitable. If one indulges in melons and fruits, causing internal Cold damage leading to abdominal pain, vomiting, diarrhea, deep-slow pulse, and cold extremities, this is Taiyin Cold Damage. It is treated with Li Zhong Tang (Regulate the Middle Decoction) plus Huo Xiang (Agastaches Herba) and Hou Po (Magnoliae Officinalis Cortex).
Yang Summerheat (*Yang Shu*): This is the Active Summerheat mentioned above. (The above treatment methods are compiled from Ye Tianshi's medical cases and *Shu Zheng Quan Shu*).
Summerheat Wind (*Shu Feng*): Patients in the Summer months suddenly experiencing hand and foot spasms suffer from Summerheat Wind. Use Xiang Ru Yin (Mosla Decoction) plus Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix). For vomiting and nausea, add Huo Xiang (Agastaches Herba) and Chen Pi (Citri Reticulatae Pericarpium). For difficult urination, add Zhu Ling (Polypori Sclerotium), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), and Hua Shi (Talcum). For phlegm, add Ban Xia (Pinelliae Rhizoma). For thirst, replace existing herbs with Gua Lou (Trichosanthis Fructus). For persistent diarrhea, add Cang Zhu (Atractylodis Rhizoma). For muscle twitching/cramps, add Mu Gua (Chaenomelis Fructus).
In severe cases, hands and feet spasm and convulse, with opisthotonos, resembling Evil Invasion. Some patients initially had heat illness, and after taking exterior-releasing medicines, gradually developed wind patterns, manifesting as delirious speech, wild shouting and running, and superhuman strength; this is also due to Summerheat Qi. Treat with cold-cooling purgative methods, combined with dispersing and resolving phlegm.
Summerheat Consumption Disease (*Shu Zhai*): In peak Summer months, Fire can melt Metal (Lung). If one does not abstain from spicy foods and alcohol, Spleen Fire becomes violent, causing labor-heat and restlessness. Fire agitates the Heart and Spleen, leading to coughing, wheezing, sudden hematemesis (vomiting blood), epistaxis (nosebleed), unclear head and eyes, and restless oppression in the diaphragm. Even children and the elderly occasionally suffer from this. Ignorant practitioners mistake it for Lao Zhai (Consumption/Tuberculosis), not realizing that this is fire carrying blood upward, which is not comparable to deficiency-consumption caused by True Yin depletion. Treatment should clear Summerheat and cool blood, using herbs such as He Ye Zhi (Nelumbinis Folium Juice), Xian Di Huang (Rehmanniae Radix Recens), Yuan Shen (Scrophulariae Radix), Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), Yu Jin (Curcumae Radix), Lian Qiao (Forsythiae Fructus), Xing Ren (Armeniacae Semen), and Xiang Bei Mu (Fritillariae Thunbergii Bulbus).
Summerheat Ulcer (*Shu Yang*): Generally, carbuncles and toxic sores have periodic fever, with evening fever subsiding by morning. In summer, if someone suffers from red swelling of the head, face, neck, or legs and feet extending several inches, making walking impossible, people often suspect toxic sores. However, if accompanied by headache and internal restlessness, with ceaseless day-and-night fever, it differs from toxic sores. Treatment should clear Summerheat and detoxify, using herbs like Chuan Lian (Coptidis Rhizoma) and Shi Gao (Gypsum Fibrosum). Once the Summerheat toxin is resolved, the swelling subsides naturally, without pus or blood.
Summerheat Rash (*Shu Chuang*): During peak Summer, blisters appear all over the body, like bowls or cups, like plums or peaches, crystal clear, thin, and brittle, containing foul-smelling fluid. This is Damp-Heat water flooding the muscle surface. Use Huang Lian Xiang Ru Jie Du Tang (Coptis and Mosla Detoxifying Decoction). If there is oral ulceration with foul odor, Liang Ge San (Cool the Diaphragm Powder) is effective. Externally, apply fresh Lotus petals to the rash; it heals within a week. (The above four items are from *Shu Zheng Quan Shu*).