太阳中热者。 是也。其人汗出恶寒。身热而渴也。
者。盛夏暑热中之邪气也。 证三条。有本证变证之不同。盖示人以病无定情。证变不一。勉人当随
证立法。无一定不移之治也。此条先言本证之情形如此。而以中热二字通解 字之义。即内经热论
所谓病暑也。王肯堂云。中 中暑中热。名虽不同。实一病也。谓之 者。暑热当令之时。其气因暑为邪耳。
非即夏月暑热当令之正气也。夫冬月之寒邪。感之则为伤寒。而四时皆有不时之寒。感之亦为伤寒。春令之风邪。
感之则为中风。而四时皆有不时之风。感之亦为中风。春尽夏初。风邪未已。温热初行。感之则为风温。夏
令之夏至以前。热气未甚。其气尚温。其邪感之则为温病。即素问所谓先夏至日为病温者是也。然亦四时皆有
不时之温暖。故有春温冬温之病。即秋气肃爽之时。亦有感受非时之温暖。而成秋温者矣。惟中 一证。独于
盛暑中有之。其他时令。则绝无也。大凡四时游行于两间之邪气。即阴阳升降。气候变化中之太过不及。偏盛
偏虚之乖气也。但借四时寒暑温热之气。中人而为风寒温暑之病。然皆因人之虚而中之耳。故灵枢云。风雨寒
暑。不得虚邪。不能独伤人。必因虚邪之风。与身形两虚相得。乃客其形也。是以中 一症。非盛夏之热气。
乃暑热中之邪气也。即热论所谓后夏至日者为病暑是也。其气之中人
也。亦必由营卫而入。与风寒无异。故曰太阳。但较之中风。则同一发热汗出恶寒。而多一渴证。其所以渴者。非若风
寒本属寒因。至郁热之邪入里。胃中热燥。方见渴证。 乃暑热之邪。其气本热。不待入里。故中人即渴也。
若阳明证。虽亦发热汗出。然不恶寒而反恶热矣。若邪入阳明之里而渴欲饮水。则亦无恶寒者矣。此中风与中 。太阳
与阳明之辨也。然温病亦发热而渴。以不恶寒者。方为温病。 虽身热而渴。则又恶寒矣。此又中 与温病之殊也。温
病
与中 。皆夏令暑热之邪。 症恶寒而温病不恶寒者。以温邪为夏至以前之病。纯阳当令之时。其温热之邪。布于
皮肤。充于肌肉。渐至入里。则表里皆热。故不恶寒也。 证为夏至以后之病。阳极阴生之后。阴气已长。当暑汗大出
之时。腠理开张。卫阳空疏。表气已虚。不能胜受外气。故汗出恶寒也。前太阳中风。汗出恶风。为表邪未解。故以桂
枝
汤汗解之。太阳阳明中风。项背强。KT KT 汗出恶风者。亦以太阳表症未罢。故以桂枝加葛根汤汗解之。至于热邪入
胃。渴欲饮水。口干舌燥。或大汗出后。大烦渴不解。脉洪大者。方以白虎加人参汤主之。此条虽不立治法。而于金匮
要略中此条之下。以发热恶寒之证。似乎表邪未解。即以白虎加人参汤主之。何也。盖以风虽阳邪。尚非温暑可比。故
虽发
热汗出。仍当以汗解为治。暑属纯阳之气。本系热邪。况盛夏则暑汗大出。内经热论虽曰。暑当与汗皆出而勿止。然疟
论
又云。令人汗出空疏。腠理开。故暑邪得入。是热邪乘腠理之虚而为 证也。所以即用石膏以治时令暑热之邪。又加人
参
以补汗出之表虚。添津液而治燥渴也。此条虽未言脉。而下文之脉微弱。及弦细芤迟。皆虚脉也。以暑热之邪而脉不大。
汗出恶寒之症而脉不浮。其为虚邪无疑。证热脉虚。宁非人参白虎之治乎。故曰脉虚身热。得之伤暑也。世俗不知仲景
立法。
原以桂枝治中风。麻黄治伤寒。而以青龙治温。白虎治暑。先立四大柱。而后察
其证变。通其治法。以尽其变。寒热温凉补泻。随症设施。非独拘拘于大顺散。苍术白虎汤。香薷饮。治暑诸
方而已也。
辨误 暑病一门。从来议论繁多。纷纷莫定。刘氏云。洁古谓静而得之为中暑。动而得之为中热。东垣谓避
暑于深堂广厦。得之曰中暑。宜大顺散。劳役得之曰中热。宜苍术白虎汤。夫暑热一也。夏之令气也。静居堂厦
而病。乃夏月伤冷之病。何可以中暑而别求于中热邪。丹溪谓夏月阳气尽出于地。人之腹属地气。于此时浮于肌表。
腹中虚矣。夏月伏阴在内。此阴字有虚之义。若作阴冷看。误矣。前人治暑。有用大顺散温热药者。盖以凉亭
水阁。寒泉冰雪所伤也。非为伏阴而用。火令之时。烁石流金。有何阴冷。孙真人令人夏月服生脉散。非虚而何。
愚窃谓内经热论。以后夏至日者为暑病。则夏至以后。立秋以前。正酷暑炎蒸之际。凡受暑热中之邪气。皆是热邪。
即所谓中 者是也。盖暑即是热。热即是暑。但内经则谓之病暑。仲景则谓之太阳中热。而名之曰中 也。暑热既
非二证。动静岂可分属。东垣之深堂大厦。及劳役得之。亦即静动之谓也。岂可亦以中暑中热之名。分隶其下。而以
大顺散。苍术白虎汤主之邪。毋怪后人之议之也。丹溪以阴字作虚字解。恐未尽善。既云夏月伏阴在内。又曰火令
之时。烁石流金。有何阴冷。岂所谓伏阴之阴。全是虚邪。孙真人虽令人夏月服生脉散。其本意盖恐盛夏暑汗过泄。
故用人参五味以敛之。盛火克金。故以人参麦冬救之。乃未中暑时。预防调摄之方耳。非谓中暑之人。可概用生脉
散补敛之药也。不然。则素问热论所谓暑当与汗皆出。勿止之语。可竟弃而弗用邪。是以夏月之病。非必皆中暑也。
大顺散为饮冷寒中之药。人参白虎乃暑热袭虚之治。五苓散为温下焦。渗小便之法。益元散为清暑利小便之用。
香薷饮为解散和中渗利之剂。当因证而施。岂可泛用。其虽在夏月。若头痛恶寒。发热无汗者。亦是暑热中之寒邪
所中。仍当以治伤寒法
汗解之。盖因本是夏月之伤寒。原属麻黄汤证也。若兼有温暑之邪。则又大青龙证矣。第别其感受之风寒
暑湿。即当以仲景风寒暑湿之法治之。未可以天时之寒暖。遂变易其法也。何也。天地四时。有寒热温凉
之正气。各司其令。若有不时之温暖。即有春温冬温之厉病。又有非时之暴寒。故四时皆有伤寒。月令
所谓春行冬令。春行夏令。夏行春令。夏行冬令。及秋行冬令。冬行春令之类。皆足以致疾疫灾眚之变。
又岂可悉根据司令之正气而施治哉。是以四时之气。不偏则不病。病则治其偏胜之邪气可也。宁可胶于
前人之谬。谓寒凉必不可用之于三冬。汗剂必不可用之于盛夏乎。此从来俗习之弊也。溯洄集中。王履氏
亦谓中暑中热为一证。言暑热之令。大行于天地之间。劳役之人。或因饥饿令元气亏乏。不足以御天令之
亢热。因虚则邪入而病。若不虚则天令虽亢。亦无由伤之。至于避暑于深堂大厦。得头痛发热等症者。
亦伤寒之类。不可以中暑名之。乃身中阳气。受阴寒所遏而作也。苟欲治之。则辛温轻扬之剂发散可也。
若大顺散一方。甘草最多。姜桂杏仁次之。其初意本为病者伏热引饮过多。脾骨受湿。呕吐。水谷不分。
脏腑不调所立。故甘草干姜皆火炒。用肉桂而非桂枝。盖温中药也。若以此治静而得之之证。吾恐不能发
表。反增内烦矣。世俗往往不明。类曰夏月阴气在内。大顺散为必用之药。夫阴气。非寒气也。盖夏
月阳气发散在外。而阴则在内耳。岂可视阴气为寒气而用温热之药乎。其苍术白虎汤。虽或宜用。岂可
视为通行之药乎。必参之治暑诸方。随所见之证而治之。然后合理。夫所谓静而得之之证。虽当暑月。
即非暑病。宜分出之。勿使后人有似同而异之惑。王氏此论。伤寒暑病划然。颇足证前人之失。但治暑诸方。
大概皆出于后人之手。非活法也。不若参之仲景诸法。虽无方可据。而其治法。则于脉证。乃禁汗禁下中可推也。
所以不立方者。盖欲令人随证变通。非若后人之大
顺散。及苍术白虎汤。使人通行概用也。
太阳中 者。身热疼重而脉微弱。此夏月伤冷水。水行皮中所致也。
身热。太阳表证也。不言汗出恶寒者。邪气较轻于前也。疼重者。身体重而疼痛也。伤寒则有身疼腰痛。
骨节疼痛之证。而湿家亦有筋骨烦疼。一身尽疼。关节疼痛之证。此以中暑之阳邪。而亦有此寒湿之证。
是以知其为夏月伤冷水。水行皮肤中所致也。伤冷水者。或饮冷水。或以冷水盥濯。水寒留着。皆可渗入
皮中也。中暑之脉本虚。又以水寒所伤。故尤见微弱也。言太阳经为暑热之邪所中。其邪由营卫而入。故有
表证而发热也。前症本恶寒汗出而渴。此条不汗不渴而身疼重者。以既为暑邪所中。又为冷水所伤。水既行
于皮中。故无汗而不渴也。暑病之脉本虚。又为寒湿所伤。所以脉微弱也。然论中不立治法。而金匮要略。
于此条之下。有一物瓜蒂汤主之。王肯堂云。瓜蒂一物散。或曰五苓散。愚窃以理推之。若暑邪盛而表证甚者。
当以瓜蒂之苦寒。上涌下泄。使水去而表邪亦去。以因吐得汗。有发散之义故也。若身热微而表症少。但脉
微弱而疼重。水行皮中者。则水寒较胜。自当用五苓散。以助下焦蒸腾之气。使上焦肺气下行。通调水道。
下输膀胱。使从水道气化而出可也。但在临证者用之得宜耳。
太阳中 者。发热恶寒。身重而疼痛。其脉弦细芤迟。小便已。洒洒然毛耸。手足逆冷。小有劳。身即热。口
开前板齿燥。若发汗则恶寒甚。加温针则发热甚。数下之则淋甚。
首条以中热二字释 字之义。言其人汗出恶风。身热而渴。乃论太阳中 之本症也。其二条同是太阳中 。
身但热而不恶寒汗出。其暑邪较轻。又以不渴身疼重脉微弱。而知其为夏月伤冷水。
水行皮中所致。此中 之有兼症。
者也。此条亦是太阳中 而发热恶寒。不云汗出而又不渴。是以知其非阳邪独盛之 也。既非伤冷水。又
身重而疼痛。弦细芤迟。皆阴脉也。弦则阴邪劲急。细则元气已虚。芤则脉空。迟则为寒。中暑之脉虽虚。
未必若是之甚。是以知其为阴寒之证也。小便已。洒洒然毛耸者。小便虽通。其茎中艰涩可知。卫阳已虚。
恶寒之状可见。乃下焦无火。气化不快于流行也。四肢为诸阳之本。手足逆冷者。是阳虚而气不达于四肢也。
凡此。皆阴寒无火之脉症也。小有劳身即热者。病暑之人。非必勤动作劳。然后谓之劳也。即起居动静间。
小有劳动。即扰动其阳气。而虚邪伏暑。即因之而发热也。口开前板齿燥者。脉虽弦细芤迟。症虽手足逆冷。
以小劳而鼓动其阳邪。身热而枯燥其津液。虽不渴而板齿燥矣。成氏云。内经生气通天论云。因于暑汗。
烦则喘喝。盖因烦热则气不得息而喘喝。喘喝则口开而前板齿燥也。若发其汗。则卫阳愈虚。阳虚则生外
寒。故恶寒甚。若加温针。则火力内攻。必反助其暑热之阳邪。故发热甚。邪不在里而数下之。适足以败
坏真阳。使下焦愈冷。气化不行。小便艰涩而淋甚也。此条但叙脉证。而不言所以然之故。又无治法。但言
不可用火攻汗下。可见古人立法。道不轻传。欲令后之有知识者。自行推测。倘得悟彻精微。庶或知难而
不至于怠忽耳。故云。若能寻余所集。思过半矣。愚窃以理推之。当以五苓散助其下焦蒸腾之气。使气液上
腾而津回燥润。小便顺利。卫气强而邪自解矣。设阳回气复之后。暑邪未尽而身热反渴者。人参白虎汤。仍可
酌用也。
太阳中热，即所说的“暍”病。患者表现为汗出、恶寒、身体发热且口渴。
“暍”字，指的是盛夏时节暑热侵袭人体的邪气。“暍”证共有三条条文，包含本证与变证的不同情况，这是为了向人们展示病情没有固定的模式，证候变化不一，勉励医者应当根据具体证候确立治法，而不能拘泥于一种固定不变的治疗方案。这一条先描述了本证的情形，并用“中热”二字来解释“暍”字的含义，也就是《内经·热论》中所说的“病暑”。王肯堂说：“中暍、中暑、中热，名称虽然不同，实际上是一种病。”称之为“暍”，是因为在暑气当令的时候，其气因暑而成为邪气，并非指夏季暑气当令时的正气。冬季的寒邪，感受它就成了伤寒；但四季都有非时之寒，感受了也属于伤寒。春季的风邪，感受它就成了中风；但四季都有非时之风，感受了也属于中风。春末夏初，风邪未尽，温热之气刚开始流行，感受它就成了风温。夏季夏至之前，热气尚未极盛，气候尚属温和，感受这种邪气就成了温病，也就是《素问》所说的“夏至前为病温”。然而四季也有非时的温暖，所以有春温、冬温的病。即使是秋高气爽之时，若感受了非时的温暖，也会形成秋温。只有“暍”这一证，唯独在盛暑之中出现，其他季节则绝无可能。大凡四时游荡于天地之间的邪气，就是阴阳升降、气候变化中太过或不及、偏盛或偏虚的乖戾之气。只是借用了四时寒暑温热的天气，侵入人体而成为风寒温暑之病，但这都是因为人体虚弱才导致邪气入侵。所以《灵枢》说：“风雨寒暑，如果不是遇到虚邪，就不能单独伤人，必须虚邪之风与人体身形两虚相合，才能客居形体。”因此，“暍”这一症，不是盛夏的热气本身，而是暑热之中人的邪气，也就是《热论》所说的“夏至后为病暑”。这种邪气侵入人体，也必须由营卫而入，与风寒无异，所以说属于太阳经。但与中风相比，虽然同样有发热、汗出、恶寒，却多了一个口渴的症状。之所以口渴，不像风寒本来属于寒邪，等到郁积化热入里，胃中热燥，才出现口渴证；“暍”是暑热之邪，其气本身就是热的，不待入里，所以人刚受邪就会口渴。如果是阳明证，虽然也发热汗出，但不恶寒反而恶热。如果邪气入阳明之里而口渴想喝水，那也就没有恶寒症状了。这就是中风与中暍、太阳与阳明的区别。然而温病也发热而口渴，以不恶寒作为判断标准，才是温病。“暍”虽然身热而渴，却又伴有恶寒，这又是中暍与温病的不同之处。温病与中暍，都是夏令暑热之邪所致，“暍”证恶寒而温病不恶寒的原因，在于温邪是夏至以前的病，处于纯阳当令之时，其温热之邪布散于皮肤，充盈于肌肉，逐渐入里，导致表里皆热，所以不恶寒。“暍”证是夏至以后的病，阳极阴生之后，阴气已长，正值暑天大汗淋漓之时，腠理开张，卫阳空疏，表气已虚，不能承受外邪，所以汗出恶寒。之前的太阳中风，汗出恶风，是因为表邪未解，所以用桂枝汤发汗解表。太阳阳明中风，项背强几几，汗出恶风者，也是因为太阳表证未罢，所以用桂枝加葛根汤发汗解表。至于热邪入胃，口渴想喝水，口干舌燥，或者大汗出后，大烦渴不解，脉象洪大者，才用白虎加人参汤主治。这一条虽然没有立治法，但在《金匮要略》此条之下，针对发热恶寒之证，似乎表邪未解，却直接用白虎加人参汤主治，为什么呢？大概因为风虽为阳邪，尚不如温暑可比，所以虽然发热汗出，仍应当用发汗法治疗。暑属于纯阳之气，本来就是热邪，何况盛夏时节暑汗大出，《内经·热论》虽然说“暑邪应当随汗而出，不要止住”，但《疟论》又说：“使人汗出空疏，腠理开，所以暑邪得以侵入。”这是热邪乘腠理之虚而造成的“暍”证。所以即用石膏来治疗时令暑热之邪，又加人参来补益汗出导致的表虚，添生津液以治疗燥渴。这一条虽然没有提及脉象，但下文的脉微弱，以及弦细芤迟，都是虚脉。以暑热之邪而脉不大，汗出恶寒之症而脉不浮，其为虚邪无疑。证见热而脉见虚，难道不是人参白虎汤的适应证吗？所以说“脉虚身热，得之伤暑”。世俗之人不懂张仲景立法原意，原本是用桂枝治中风，麻黄治伤寒，用青龙治温，用白虎治暑，先确立四大支柱，然后观察证候变化，通晓治法，以穷尽各种变化，寒热温凉补泻，随证施设，并不是仅仅拘泥于大顺散、苍术白虎汤、香薷饮等治暑诸方而已。
【辨误】
暑病一门，历来议论繁多，纷乱不定。刘完素说：洁古认为静而得之为中暑，动而得之为中热；东垣认为避暑于深堂广厦所得的叫中暑，宜用大顺散；劳役所得的叫中热，宜用苍术白虎汤。其实暑热是一回事，是夏季的令气。静居堂厦而病，乃是夏月伤冷的病，怎么能用中暑来区别于中热呢？丹溪认为夏月阳气尽出于地表，人的腹部属地气，此时阳气浮于肌表，腹中虚矣。夏月伏阴在内，这个“阴”字有虚的含义，如果看作阴冷就错了。前人治暑，有用大顺散这类温热药的，那是因为在凉亭水阁、寒泉冰雪所伤的情况下使用的，并非为了治疗伏阴。火令之时，烁石流金，哪里有阴冷？孙真人让人在夏月服生脉散，难道不是因为虚吗？我私下认为，《内经·热论》说“夏至后为暑病”，那么夏至以后、立秋以前，正是酷暑炎蒸之际，凡是感受暑热中之邪气的，都是热邪，也就是所谓的中暍。大概暑即是热，热即是暑，只是《内经》称之为病暑，仲景称之为太阳中热，并命名为中暍。既然暑热不是两种证，动静怎么可以分别归属？东垣所说的深堂大厦及劳役所得，也就是静和动的意思，怎么可以用中暑、中热的名字分列其下，而用大顺散、苍术白虎汤主治呢？难怪后人对此议论纷纷。丹溪把“阴”字作“虚”字解，恐怕不尽善。既然说夏月伏阴在内，又说火令之时烁石流金，哪里有阴冷？难道所谓的伏阴之阴，全是虚邪吗？孙真人虽然让人在夏月服生脉散，其本意大概是担心盛夏暑汗过泄，所以用人参、五味子来收敛它；盛火克金，所以用人参、麦冬来救之，这是在中暑之前预防调摄的方子罢了，并不是说中暑的人就可以一概用生脉散这样的补敛药。否则，《素问·热论》所说的“暑当与汗皆出，勿止”的话，岂能完全抛弃不用？因此夏月的病，不一定都是中暑。大顺散是治疗饮冷寒中的药物，人参白虎是治疗暑热袭虚的方法，五苓散是温下焦、渗小便的法度，益元散是清暑利小便的用途，香薷饮是解散和中、渗利的剂型，应当根据证候施用，怎么能泛用呢？如果在夏月，头痛恶寒，发热无汗者，也是暑热中之寒邪所中，仍应当用治伤寒的方法发汗解表，因为这本是夏月的伤寒，原属麻黄汤证。如果兼有温暑之邪，那就是大青龙汤证了。只要辨别其感受的是风寒还是暑湿，就应当用仲景的风寒暑湿法治之，不可以因为天时寒暖的变化，就改变治法。为什么呢？天地四时有寒热温凉的正气，各自司掌时令，如果有非时的温暖，就有春温、冬温的厉病；又有非时的暴寒，所以四季都有伤寒。《月令》所谓春行冬令、春行夏令、夏行春令、夏行冬令，以及秋行冬令、冬行春令之类，都足以导致疾病疫灾的变化，又怎么能完全根据司令的正气来施治呢？因此四时之气，不偏就不会生病，生病了就要治疗其偏胜的邪气，宁可固执于前人的谬误，说寒凉必不可用于三冬，汗剂必不可用于盛夏吗？这是历来俗习的弊病。《溯洄集》中，王履氏也说中暑中热为一证，言暑热之令大行于天地之间，劳役之人，或因饥饿令元气亏乏，不足以御天令之亢热，因虚则邪入而病，如果不虚，天令虽亢，也无从伤害他。至于避暑于深堂大厦，得头痛发热等症状的，也是伤寒之类，不可以称为中暑，乃身中阳气受阴寒所遏而发作。如果要治疗，辛温轻扬之剂发散即可。至于大顺散一方，甘草最多，姜、桂、杏仁次之，其初意本是为病人伏热引饮过多，脾胃受湿，呕吐，水谷不分，脏腑不调所立的，所以甘草、干姜都火炒，用肉桂而非桂枝，算是温中药。如果用此治疗静而得之的证，我恐怕不能发表，反而增加内烦。世俗往往不明白，常说夏月阴气在内，大顺散是必用之药。夫阴气，不是寒气。盖夏月阳气发散在外，而阴在内耳，岂可视阴气为寒气而用温热之药呢？苍术白虎汤，虽然有时适宜使用，岂可视为通行之药呢？必须参考治暑诸方，随所见之证而治，然后合理。所谓静而得之的证，虽然在暑月，即非暑病，应当分出，不要让后人产生似同而异的困惑。王氏这一论述，将伤寒与暑病划然分开，颇足以证明前人的失误。但治暑诸方，大概都出于后人之手，不是活法，不如参考仲景诸法，虽然无方可依，但其治法，则在禁汗禁下中可以推知。所以不立方，大概是希望人们随证变通，不像后人的大顺散及苍术白虎汤，使人通行概用。
太阳中暍，身体发热疼痛沉重而脉微弱，这是夏月伤冷水，水行皮中所致。
身热，是太阳表证。不说汗出恶寒，是因为邪气比前条轻。疼重，是指身体重而疼痛。伤寒则有身疼腰痛、骨节疼痛的证候，而湿家也有筋骨烦疼、一身尽疼、关节疼痛的证候。这里是因为中暑的阳邪，却也有这种寒湿的证候，所以知道它是夏月伤冷水，水行皮肤中所致。伤冷水，或者是喝冷水，或者用冷水洗涤，水寒留着，都可以渗入皮中。中暑的脉本虚，又因水寒所伤，所以更加见到微弱。说太阳经被暑热之邪所中，邪气由营卫而入，所以有表证而发热。前症本来恶寒汗出而渴，这一条不汗不渴而身疼重，是因为既为暑邪所中，又为冷水所伤，水既行于皮中，所以无汗而不渴。暑病的脉本虚，又为寒湿所伤，所以脉微弱。然而论中没有立治法，而《金匮要略》在此条之下，有一物瓜蒂汤主治。王肯堂说：一物瓜蒂散，或者说五苓散。我私下以理推测，如果暑邪盛而表证甚者，应当用瓜蒂之苦寒，上涌下泄，使水去而表邪亦去，因为因吐得汗，有发散的意义。如果身热微而表症少，仅脉微弱而疼重，水行皮中者，则水寒较胜，自然应当用五苓散，以助下焦蒸腾之气，使上焦肺气下行，通调水道，下输膀胱，使从水道气化而出。但在临证时应用得当即可。
太阳中暍，发热恶寒，身体重而疼痛，脉弦细芤迟，小便后，洒洒然毛耸（如寒战），手足逆冷，稍微劳作，身体即发热，口开前板齿干燥。如果发汗则恶寒更甚，加温针则发热更甚，多次攻下则淋证更严重。
首条用中热二字解释暍字的含义，说其人汗出恶风，身热而渴，是论述太阳中暍的本证。第二条同样是太阳中暍，身体但热而不恶寒汗出，其暑邪较轻，又以不渴、身疼重、脉微弱，而知其为夏月伤冷水，水行皮中所致，这是中暍的兼证。这一条也是太阳中暍而发热恶寒，不说汗出且不渴，所以知道它不是阳邪独盛的暍证。既然不是伤冷水，又身重而疼痛，弦细芤迟，都是阴脉。弦则阴邪劲急，细则元气已虚，芤则脉空，迟则为寒。中暑的脉虽虚，未必如此严重，所以知道它是阴寒之证。小便后，洒洒然毛耸，意思是小便虽通，但尿道艰涩可知，卫阳已虚，恶寒之状可见，乃下焦无火，气化不快于流行。四肢为诸阳之本，手足逆冷，是阳虚而气不达于四肢。凡此，都是阴寒无火的脉症。小有劳身即热，患暑病的人，不一定是勤动作劳才叫劳，即在起居动静间，小有劳动，即扰动其阳气，而虚邪伏暑，便因此发热。口开前板齿燥，脉虽弦细芤迟，症虽手足逆冷，但因小劳而鼓动其阳邪，身热而枯燥其津液，虽不渴但板齿燥。成无己说：《内经·生气通天论》说“因于暑汗，烦则喘喝”，大概因为烦热则气不得息而喘喝，喘喝则口开而前板齿燥。如果发其汗，则卫阳愈虚，阳虚则生外寒，故恶寒甚。如果加温针，则火力内攻，必反助其暑热之阳邪，故发热甚。邪不在里而数下之，适足以败坏真阳，使下焦愈冷，气化不行，小便艰涩而淋甚。这一条只叙述脉证，而不说所以然的原因，又没有治法，只说不可以用火攻汗下，可见古人立法，道不轻传，欲让后世有知识的人自行推测，如果能悟彻精微，或许知难而不至于怠忽。所以说：“若能寻余所集，思过半矣。”我私下以理推测，应当用五苓散助其下焦蒸腾之气，使气液上腾而津回燥润，小便顺利，卫气强而邪自解。假设阳回气复之后，暑邪未尽而身热反渴者，人参白虎汤仍可酌情使用。
Taiyang Zhongre (Heatstroke in the Taiyang Channel), also known as "Ye" (Heatstroke), manifests with sweating, aversion to cold, body fever, and thirst.
The term "Ye" refers to the pathogenic factor of summer-heat invading the human body during the height of summer. There are three clauses regarding the Ye syndrome, distinguishing between primary syndromes and transformed syndromes. This illustrates that diseases do not have fixed patterns and symptoms vary, urging physicians to establish treatment principles based on specific manifestations rather than adhering to a rigid, unchanging method. This clause first describes the primary syndrome and uses the phrase "Zhongre" (being struck by heat) to explain the meaning of "Ye," which corresponds to "Bing Shu" (disease of summer-heat) mentioned in the *Neijing: Re Lun* (Treatise on Heat). Wang Kentang stated: "Zhongye, Zhongshu, and Zhongre differ in name but are essentially the same disease." It is called "Ye" because during the time when summer-heat is dominant, the qi becomes pathogenic due to the summer-heat; it does not refer to the righteous qi of the summer season itself. The cold pathogen of winter, when contracted, causes Shanghan (Cold Damage); however, non-seasonal cold exists in all four seasons, and contracting it also results in Shanghan. The wind pathogen of spring, when contracted, causes Fengzhong (Wind Strike); similarly, non-seasonal wind exists in all seasons, and contracting it results in Fengzhong. At the end of spring and beginning of summer, if wind pathogens persist and warm-heat begins to circulate, contracting them causes Fengwen (Wind-Warmth). Before the Summer Solstice in summer, when heat is not yet extreme and the climate remains mild, contracting such pathogens causes Wenbing (Warm Disease), as described in the *Suwen*: "Diseases occurring before the Summer Solstice are Warm Diseases." Nevertheless, non-seasonal warmth occurs in all seasons, leading to diseases like Chunwen (Spring Warmth) and Dongwen (Winter Warmth). Even during the crisp autumn air, contracting non-seasonal warmth can result in Qiuwen (Autumn Warmth). Only the "Ye" syndrome occurs exclusively during peak summer heat and is absent in other seasons. Generally, pathogenic factors roaming between heaven and earth in the four seasons are aberrant qi resulting from excess or deficiency in the ascent and descent of yin and yang, and climatic changes. These factors utilize the seasonal qi of cold, heat, warmth, and coolness to invade humans, causing diseases of wind, cold, warmth, and summer-heat, but they only invade when the human body is deficient. Thus, the *Lingshu* states: "Wind, rain, cold, and heat cannot injure people alone unless they encounter empty pathogens; they must combine with the dual deficiency of the pathogen and the body's constitution to invade the form." Therefore, the "Ye" syndrome is not caused by the summer heat itself, but by the pathogenic qi of summer-heat invading the body, corresponding to "Bing Shu" (disease of summer-heat) after the Summer Solstice as stated in the *Re Lun*. This pathogenic qi enters through the Ying and Wei (Nutritive and Defensive levels), similar to wind and cold, hence it is associated with the Taiyang channel. However, compared to Fengzhong (Wind Strike), although both present with fever, sweating, and aversion to cold, Ye presents additionally with thirst. The reason for thirst in Ye differs from Shanghan: in Shanghan, which originates as cold, thirst arises only after the cold transforms into heat and enters the interior, drying the stomach; in contrast, Ye is caused by summer-heat, which is inherently hot, so thirst appears immediately upon invasion without needing to enter the interior. In Yangming syndrome, although there is fever and sweating, there is aversion to heat rather than cold. If the pathogen enters the interior of Yangming causing thirst for water, aversion to cold would be absent. This distinguishes Fengzhong from Ye, and Taiyang from Yangming. Wenbing also presents with fever and thirst, but the absence of aversion to cold defines it as Wenbing. Ye presents with fever, thirst, and aversion to cold, distinguishing it from Wenbing. Both Wenbing and Ye are caused by summer-heat pathogens in summer. Ye presents with aversion to cold, while Wenbing does not, because Wenbing occurs before the Summer Solstice during the pure yang season; its warm-heat pathogen spreads on the skin and fills the muscles, gradually entering the interior, causing heat in both exterior and interior, thus no aversion to cold. Ye occurs after the Summer Solstice, when yang reaches its peak and yin begins to grow. During this time, heavy sweating opens the pores, leaving the Wei yang sparse and the exterior qi deficient, unable to resist external pathogens, resulting in sweating and aversion to cold. In previous Taiyang Fengzhong, sweating and aversion to wind indicated unresolved exterior pathogens, treated with Guizhi Tang (Cinnamon Twig Decoction) to induce sweating. In Taiyang-Yangming Fengzhong with stiffness of the neck and back, sweating, and aversion to wind, the exterior Taiyang syndrome was unresolved, treated with Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Pueraria Root Decoction). When heat pathogens enter the stomach, causing thirst, dry mouth and tongue, or severe restlessness and unquenchable thirst with a surging pulse after profuse sweating, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. Although this clause does not specify a treatment, the *Jingui Yaolue* applies Baihu Jenshen Tang to the fever and aversion to cold presented here, seemingly indicating an unresolved exterior. Why? Wind, though a yang pathogen, is less intense than warm-heat or summer-heat; thus, despite fever and sweating, sweating therapy is appropriate. Summer-heat is pure yang qi and inherently hot. Given the profuse sweating in midsummer, although the *Re Lun* states "summer-heat should exit with sweat and not be suppressed," the *Nue Lun* notes that sweating leaves pores open, allowing summer-heat to invade. This indicates the summer-heat pathogen exploits the deficiency of the pores to cause Ye. Therefore, Shigao (Gypsum Fibrosum) is used to clear seasonal summer-heat, and Renshen (Ginseng Radix et Rhizoma) is added to tonify the exterior deficiency caused by sweating and generate fluids to treat dryness and thirst. Although this clause omits the pulse, subsequent mentions of weak, fine, hollow, and slow pulses indicate deficiency. A large pulse with summer-heat or a floating pulse with sweating and aversion to cold would suggest excess; their absence confirms deficiency. Fever with a deficient pulse indicates the indication for Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). Hence, "deficient pulse and body heat result from summer-heat injury." Laypeople misunderstand Zhang Zhongjing's legislative intent: he originally used Guizhi Tang for Fengzhong, Mahuang Tang (Ephedra Decoction) for Shanghan, Qinglong Tang (Green Dragon Decoction) for warmth, and Baihu Tang (White Tiger Decoction) for summer-heat, establishing four main pillars, then observing transformations and adapting treatments accordingly, utilizing cold, heat, warmth, coolness, tonification, and purgation as needed, rather than rigidly adhering to formulas like Dashun San (Great Perfection Powder), Cangzhu Baizhu Tang (Atractylodes Macrocephala and White Tiger Decoction), or Xiangru Yin (Elsholtzia Decoction).
[Correction of Errors]
Discussions on summer-heat diseases have been numerous and confusing. Liu Wansu reported that Zhang Congzheng (Jiegu) distinguished static acquisition as Zhongshu (Heatstroke) and dynamic acquisition as Zhongre (Heatstroke), while Li Dongyuan distinguished resting in deep halls as Zhongshu, treated with Dashun San, and labor-induced cases as Zhongre, treated with Cangzhu Baizhu Tang. However, summer-heat is a single entity, the qi of summer. Illness from resting in halls is actually cold injury in summer, not distinct from Zhongre. Danxi argued that in summer, yang qi floats to the surface, leaving the abdomen deficient ("hidden yin" implies deficiency, not cold). Predecessors used warming medicines like Dashun San for summer-heat, but this was for injuries from cold environments (pavilions, ice), not for "hidden yin." In the fire season, with temperatures melting stone and flowing metal, where is the cold? Sun Simiao recommended Shengmai San (Generate Pulse Powder) in summer due to deficiency. I argue that according to the *Re Lun*, diseases after the Summer Solstice are summer-heat. From post-Solstice to pre-Autumn Equinox, during intense heat, any contraction of summer-heat pathogenic qi is heat pathology, i.e., Ye. Summer-heat and heat are synonymous; *Neijing* calls it Bing Shu, Zhongjing calls it Taiyang Zhongre, named Ye. Since summer-heat and heat are one, static vs. dynamic distinction is invalid. Li Dongyuan's distinction of environment vs. labor is merely static vs. dynamic. Using names like Zhongshu/Zhongre to categorize under different formulas is erroneous. Danxi's interpretation of "yin" as "deficiency" is incomplete; if "hidden yin" meant true cold, it would contradict the intense heat of summer. Sun Simiao's use of Shengmai San was preventive, using Renshen and Wuweizi to retain fluids lost through excessive sweating, and Renshen and Maidong to protect metal (lungs) from fire, not as a general cure for those already suffering from summer-heat. Otherwise, the *Suwen* instruction "summer-heat should exit with sweat" would be ignored. Thus, not all summer illnesses are summer-heat. Dashun San treats cold from drinking cold liquids; Ren Shen Bai Hu Tang treats summer-heat attacking deficiency; Wuling San warms the lower jiao and promotes urination; Yiyuan San clears summer-heat and promotes urination; Xiangru Yin disperses, harmonizes, and drains dampness. Treatments must match the syndrome. If in summer, headache, aversion to cold, fever, and absence of sweating occur, it is cold pathogen mixed with summer-heat, treated as Shanghan with Ma Huang Tang. If combined with warm-heat, Da Qing Long Tang is indicated. Differentiate wind, cold, summer-heat, and dampness, and apply Zhongjing's methods. Do not change methods based solely on weather. Heaven and earth have correct qi of cold, heat, warmth, and coolness governing seasons. Non-seasonal warmth causes Chunwen/Dongwen; non-seasonal cold causes Shanghan in all seasons. As stated in *Yueling*, improper seasonal movements cause epidemics. One cannot treat solely based on correct seasonal qi. Illness arises from deviation; treat the deviant pathogen. Is it reasonable to stubbornly claim cooling herbs are forbidden in winter and diaphoretics forbidden in summer? This is a vulgar error. Wang Lv in *Suhui Ji* agreed that Zhongshu and Zhongre are one syndrome. He stated that laborers with deficient yuan qi cannot resist extreme heavenly heat, leading to invasion; those avoiding heat in halls suffer from cold obstructing yang, resembling Shanghan, treatable with acrid-warm dispersants. Dashun San, rich in Gancao (Licorice Root), ginger, cinnamon, and apricot kernel, was originally for spleen-dampness from overdrinking due to hidden heat, causing vomiting and indigestion. Using it for static cases may fail to disperse and increase internal irritability. Laypeople mistakenly believe "yin inside" means cold, necessitating warming drugs. Summer "yin" refers to relative interior state, not cold. Cangzhu Baizhu Tang is occasionally suitable but not universal. Treatments must follow observed syndromes. Wang's distinction clarifies Shanghan vs. summer-heat, proving predecessors' errors. However, later summer-heat formulas are not flexible enough; Zhongjing's methods, though lacking specific formulas, offer diagnostic principles (contraindications for sweating/purging) that allow adaptation. Formulas were omitted to encourage flexibility, unlike rigid later formulas.
Taiyang Ye, characterized by fever, heaviness, pain, and a weak pulse, results from injuring cold water in summer, causing water to remain in the skin.
Fever indicates a Taiyang exterior syndrome. The absence of mention of sweating and aversion to cold suggests a milder pathogen than in the previous clause. "Heaviness and pain" refers to bodily heaviness and pain. Shanghan presents with body ache, waist pain, and joint pain; Shi Jia (Dampness patients) present with bone/joint discomfort and generalized pain. Here, the yang pathogen of summer-heat presents with cold-damp symptoms, indicating injury from cold water in summer, with water lingering in the skin. Injury from cold water includes drinking cold water or washing with it; cold water lingers and penetrates the skin. The pulse in summer-heat is naturally deficient; combined with cold-water injury, it becomes particularly weak. The Taiyang channel is invaded by summer-heat, entering via Ying and Wei, causing exterior fever. Previous symptoms included aversion to cold, sweating, and thirst; this clause lacks sweating and thirst but has body heaviness and pain because, in addition to summer-heat, cold water has entered the skin, preventing sweating and thirst. The pulse is weak due to summer-heat deficiency and cold-damp injury. Although the text lacks a treatment, the *Jingui Yaolue* prescribes Yi Wu Gua Di Tang (Single Melon Citron Decoction). Wang Kentang suggested Yi Wu Gua Di San or Wuling San. Reasoning logically: if summer-heat is severe with strong exterior symptoms, Yi Wu Gua Di Tang's bitter-cold properties can induce vomiting and purging, expelling water and exterior pathogens, as vomiting induces sweating (dispersing action). If fever is mild, exterior symptoms few, but pulse is weak and heaviness/pain prominent with water in the skin, cold-water dominance prevails; Wuling San is appropriate to assist lower jiao steaming qi, directing upper jiao lung qi downward to regulate water passages and excrete via bladder qi transformation. Clinical application requires appropriateness.
Taiyang Ye, presenting with fever, aversion to cold, body heaviness, pain, and a string-tight, fine, hollow, or slow pulse. After urination, the patient feels chilly with goosebumps; hands and feet are cold. Slight exertion causes immediate fever; opening the mouth reveals dry front teeth. Sweating exacerbates aversion to cold; moxibustion exacerbates fever; repeated purgation worsens strangury.
The first clause explained "Ye" as Zhongre, describing sweating, aversion to wind, fever, and thirst as the primary syndrome. The second clause described milder summer-heat without aversion to cold/sweating, identified as cold-water injury due to lack of thirst, heaviness, pain, and weak pulse. This clause represents a complex Ye syndrome. It presents with fever, aversion to cold, heaviness, pain, but no sweating or thirst, ruling out pure yang-pathogen dominance. It is not cold-water injury either. String-tight, fine, hollow, and slow pulses are yin pulses: string-tight indicates yin pathogen tension, fine indicates qi deficiency, hollow indicates emptiness, slow indicates cold. While summer-heat pulse is deficient, it is rarely this severe, indicating a yin-cold syndrome. Chills and goosebumps after urination indicate difficult urination and deficient Wei yang, reflecting lack of fire in the lower jiao and sluggish qi transformation. Hands and feet are cold because limbs are the root of yang, and yang deficiency prevents qi reaching them. All these are yin-cold signs. Slight exertion causing fever disturbs yang, activating latent summer-heat. Dry front teeth despite cold limbs result from slight exertion stirring yang, causing fever and fluid dryness. Cheng Wuji cited *Shengqi Tongtian Lun*: "Summer-heat sweating leads to panting when annoyed; panting opens the mouth and dries front teeth." Sweating depletes Wei yang, increasing exterior cold (worsening aversion to cold). Moxibustion adds fire, aggravating summer-heat (worsening fever). Purging damages true yang, chilling the lower jiao, stopping qi transformation, and worsening strangury. This clause lists pulses and symptoms without explaining mechanisms or providing treatment, only warning against fire therapy, sweating, and purging. Ancient legislation was profound, encouraging later scholars to deduce principles. "If you can explore my collected works, you will understand more than half." I reason that Wuling San should be used to assist lower jiao qi transformation, restoring fluids, facilitating urination, strengthening Wei qi, and resolving pathogens. If yang recovers but summer-heat persists with fever and thirst, Ren Shen Bai Hu Tang may be considered.