【纲】仲景曰。太阳中热者。 是也。其人汗出恶寒。身热而渴也。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。太阳中 者。身热疼重。而脉微弱。此
亦夏月伤于水。水行皮中所致也。
【目】张兼善曰。中 与伤寒相似而异。清邪中上。浊邪中下。风寒湿者。皆地之气。伤浊邪。
所以俱中足经。惟暑乃天之气。所以中手少阴心经也。其症多与伤寒相似。但脉不同耳。夫伤寒
虽恶寒发热。初病未至烦渴。惟暑初病即渴。所以异也。且伤寒之脉必浮盛。中暑之脉必虚弱。或
弦细。或芤迟。经曰。脉盛身寒。得之伤寒。脉虚身热。得之伤暑。此之谓也。至如太阳病。项背强
KTKT 。反汗出恶风。若当炎暑。岂不与中 相似。惟其不渴。故与桂枝加葛根汤。凡居夏秋之令。
炎暑之时。必当根据经详审。则无差失。
王好古曰。夏月发热恶寒。头疼。身体肢节痛。脉洪盛者。热病也。冬伤于寒。因暑气而发也。
治与伤寒同。然夏月药须带凉。如用麻桂青龙三方。须加减。夏至前。桂枝加黄芩。夏至后。三
方俱加知母、石膏。热病三日外。与前汤不瘥。脉仍数。邪气犹在经络。未入脏腑者。桂枝石膏汤
主之。此方夏至后代桂枝症用。若三月至夏。为晚发伤寒。栀子升麻汤可用。
鳌按。夏月热病。而王氏主用麻桂三方。殊非良法。当斟酌之。
庞安常曰。大抵热病。大热。须得脉洪大有力。或滑数有力。乃为脉病相应。为可治。若小弱
无力。难治。若人虚脉弱。宜以人参扶其元气。不可但攻其热。
暑风者。由大热制金。不能平木。搐搦不省人事。其脉虚浮。浮者风也。虚者暑也。俗名暑风。
乃相火甚而行令也。宜黄连香薷饮加羌活。或双解散加香薷。
暑脉必虚。外症头疼口干面垢。自汗倦怠。或背恶热。甚者迷闷不省。而为霍乱吐
利。痰滞呕逆。腹痛泄利。下血斑黄皆是。治以清心利小便为主。汗多者不利。宜白虎汤。次分表
里。如在表。头痛恶寒。双解散加香薷。或十味香薷饮。如在半表里。泄泻烦渴饮水吐逆。五苓散。
热甚烦渴。益元散。若表解里热。半夏解毒汤。下神芎丸。或老弱人冒暑。脉微下利。渴而喜温。
或厥冷不省人事。竹叶石膏汤。加熟附冷冻饮料。次以来复丹、五苓散治之。凡夏月暑症。不可服诸
热剂。致斑毒发黄。小便不利。闷乱而死。慎之。
戴原礼曰。暑病有冒伤中三者轻重之分。或腹痛水泄。胃与大肠受之。恶心者。胃口有痰饮。
此二者冒暑也。可与黄连香薷饮。或身热头疼。躁乱不宁。或身如针刺。此为热伤肉分。当解毒。
白虎汤加柴胡。虚加人参。或咳嗽发寒热。盗汗不止。脉数。热伤肺经。火乘金也。此为中暑。宜
清肺汤、柴胡天水散之类。
张从正曰。暑伤五脏。为症不同。如暑入心。则噎昏闷不知人。入肝。则眩晕顽痹。入脾。则
昏睡不觉。入肺。则嚏喘痿 。入肾。则消渴。
李杲曰。脾胃虚弱。遇六七月湿旺。汗泄身重。短气。四肢痿软。脚 眼花。此肾与膀胱俱竭
之状也。况汗大泄则亡津液。津者。庚大肠所主。三伏庚金受囚。木无可制。故风湿相搏。骨节
烦疼也。夫壬膀胱已绝于巳。癸肾水已绝于午。今更逢湿旺。助热为邪。西北方之寒清绝矣。圣人
立法。夏宜补者。为热伤元气。以人参、麦冬、五味、滋水之源。泻丙火。补庚金。益元气也。
长夏暑热蒸人。损伤元气。四肢困倦。精神短少。两脚痿软。早晚则发寒厥。日高之后。复热
如火。乃
阴阳气血俱不足也。或心胸痞满。肢节沉疼。或气高而喘。身热而烦。小便黄少。大便溏而频。或
利或渴。自汗身重。此血先病而气不病也。若湿气先搏。脉必洪缓而迟。病虽互换少瘥。其天暑湿
令则一。宜治以清燥。或远行大热而渴。则热舍于肾。故水不胜火。发为骨痿。此湿热成痿也。或
热厥而阴虚。或寒厥而气虚。四肢如火。为热厥。四肢冰冷。为寒厥。寒厥腹中有寒。热厥腹中有
热。脾主四肢也。
虞抟曰。暑 之症。变异不等。非止归五脏。盖人之形气有虚实。感有轻重。则后时而发。至
秋成疟痢是也。重则实时而发。如张氏所言诸症。至有轻变重。重变轻。亦自感有浅深。传有兼并。
况人之形志苦乐不一。岂为无变异乎。四时之症皆然。
杨士瀛曰。东垣论暑热症候则同。冬月伤寒传变为症之不一。彼为寒伤形。此为热伤气。若元
气虚甚受病。忽于一时不救者。与伤寒阴毒。顷刻害人实同。故东垣启是病例。大开后人之盲 也。
宜与痿门参看。
陶华曰。中暑脉虚而伏。身热面垢。自汗烦燥大渴。四肢微冷而不痛。用白虎汤。痰逆恶寒。
橘皮汤。热闷不恶寒。竹叶石膏汤。头痛恶心烦躁。五苓散。
凡中暑。小柴胡加香薷最良。脉迟。洒然毛耸。口齿燥。人参白虎汤。霍乱烦躁。大渴腹痛。
厥冷转筋。黄连香薷汤治之为要也。须冷服。热服反吐泻也。
龚信曰。伤寒与伤暑所以异者。以伤寒伤暑俱有热。若伤暑而误作伤寒治之则不可。盖暑伤形。
热伤气。伤寒则外恶寒而脉浮紧。伤暑则不恶寒而脉虚。此为异耳。治宜小柴胡加知母、石膏。
或人参白虎汤、天久淫雨。湿令大行。苍术白虎汤。若元气素弱而伤之重者。清暑益气汤。
【纲】张仲景说：太阳经受邪导致的中热病，就是暑病。患者表现为汗出、怕冷、身体发热且口渴。太阳经受邪导致的暑病（中暍），症状为发热、怕冷、身体沉重且疼痛，脉象弦细、芤大或迟滞。小便结束后，感到寒意战栗、毫毛竖起，手足逆冷。稍微活动，身体即发热；张口呼吸，门齿干燥。如果误用发汗法，则怕冷加重；如果误用温针疗法，则发热加剧；如果多次使用泻下法，则淋证加重。太阳经受邪导致的中暑病，表现为身体发热、疼痛沉重，脉象微弱，这也是夏季受水湿之邪侵袭，水气行于皮肤之间所致。
【目】张兼善说：中暑与伤寒相似但有所不同。清邪（如风暑）侵犯上部，浊邪（如寒湿）侵犯下部。风寒湿邪，都是地气所生，伤害的是浊邪，所以都侵犯足经。只有暑邪是天之气，所以侵犯手少阴心经。其症状多与伤寒相似，只是脉象不同。伤寒虽然也有恶寒发热，但初起时并未出现烦渴；而中暑在初起时就口渴，这就是区别所在。而且伤寒的脉象必然浮盛，中暑的脉象必然虚弱，或者弦细，或者芤迟。医经说：脉象盛大而身体寒冷，是得了伤寒；脉象虚弱而身体发热，是得了伤暑。说的就是这个道理。至于像太阳病，项背强直不舒，反而汗出怕风，如果在炎热的暑天，难道不与中暑相似吗？只是因为不口渴，所以用桂枝加葛根汤治疗。凡是处于夏秋季节，炎热酷暑之时，必须根据经络详细审察，才不会出差错。
王好古说：夏季出现发热、怕冷、头痛、身体及肢节疼痛，脉象洪大旺盛的，是热病。这是冬季感受寒邪，因暑气激发而发作的。治疗方法与伤寒相同。然而夏季用药须带凉性，如使用麻黄汤、桂枝汤、大青龙汤三方时，必须加减。夏至前，桂枝汤加黄芩；夏至后，三方均加知母、石膏。热病三天后，服用前述汤剂未愈，脉象仍然数急，邪气仍在经络，未入脏腑的，用桂枝石膏汤主治。此方在夏至后代替桂枝汤症使用。若从三月到夏季，属于晚发的伤寒，可用栀子升麻汤。
沈金鳌按语：夏季的热病，而王氏主张主要使用麻黄汤、桂枝汤、大青龙汤三方，这绝非良法，应当斟酌。
庞安常说：大体上热病，高热时，必须脉象洪大有力，或滑数有力，才是脉证相应，可以治疗。如果脉象小弱无力，难治。如果人体质虚弱、脉象微弱，宜用人参扶助元气，不可单纯攻伐热邪。
暑风病，是由大热克制肺金，不能平抑肝木，导致抽搐、昏迷不省人事。其脉象虚浮，浮代表风，虚代表暑。俗称暑风，是相火旺盛而行令所致。宜用黄连香薷饮加羌活，或双解散加香薷。
中暑的脉象必然虚，外症有头痛、口干、面部污垢、自汗、倦怠，或背部怕热，严重的出现昏迷不省人事，以及霍乱吐泻、痰滞呕逆、腹痛泄利、便血、斑疹发黄等。治疗以清心、利小便为主。汗多的不宜利小便，宜用白虎汤。其次分辨表里，如在表，头痛恶寒，用双解散加香薷，或十味香薷饮。如在半表半里，泄泻、烦渴饮水、呕吐逆气，用五苓散。热甚烦渴，用益元散。若表证已解而里热盛，用半夏解毒汤，或神芎丸。如果是老弱之人冒受暑邪，脉微细、下利，口渴喜温，或四肢厥冷、昏迷不省人事，用竹叶石膏汤，加熟附子，冷冻后服用。其次以来复丹、五苓散治疗。凡是夏季中暑病症，不可服用各种热性药剂，以免导致斑毒发黄、小便不利、闷乱而死。务必谨慎。
戴原礼说：暑病有冒暑、伤暑、中暑三者轻重之分。有的腹痛水样泄泻，是胃与大肠受邪，伴有恶心，是胃口有痰饮，这两者属于冒暑。可与黄连香薷饮。或者身热头痛、躁动不安，或身体如针刺感，这是热邪伤及肌肉分腠，应当解毒，用白虎汤加柴胡，体虚加人参。或者咳嗽、发寒热、盗汗不止、脉数，这是热邪伤肺经，火克金，属于中暑。宜用清肺汤、柴胡天水散之类。
张从正说：暑邪伤害五脏，症状各不相同。如暑邪入心，则噎塞昏闷不知人；入肝，则眩晕、肢体麻木；入脾，则昏睡不醒；入肺，则喷嚏、气喘、痿软；入肾，则消渴。
李杲说：脾胃虚弱，遇到六七月湿气旺盛时，汗出过多、身体沉重、短气、四肢痿软、脚膝无力、眼花，这是肾与膀胱俱竭的状态。况且大汗淋漓则亡失津液，津液由庚金（大肠）所主，三伏天庚金受囚禁，木气无制，所以风湿相搏，骨节烦疼。壬水（膀胱）已在巳月绝灭，癸水（肾）已在午月绝灭，如今更逢湿气旺盛，助热为邪，西北方的寒清气机断绝了。圣人立法，夏季适宜补益，是因为热邪损伤元气，用人参、麦冬、五味子滋补水之源，泻丙火（小肠/心包之火），补庚金（大肠），益元气。长夏暑热蒸腾，损伤元气，四肢困倦，精神不足，两脚痿软，早晚则发寒厥，日高之后，又发热如火，这是阴阳气血俱不足。或者心胸痞满，肢节沉痛，或者气逆而喘，身体发热而烦躁，小便黄少，大便溏薄而频数，或者泄利或者口渴，自汗身体沉重，这是血先病而气未病。如果湿气先搏结，脉象必洪缓而迟，病情虽互换稍有好转，但天暑湿令是一样的，宜用清燥法治之。或者远行大热而口渴，则热邪舍于肾，故水不胜火，发为骨痿，这是湿热成痿。或者热厥而阴虚，或寒厥而气虚，四肢如火，为热厥；四肢冰冷，为寒厥。寒厥腹中有寒，热厥腹中有热。脾主四肢。
虞抟说：中暑的症状，变异不等，不仅归于五脏。大概人的形气有虚实，感受有轻重，则后来发作，到了秋天形成疟疾痢疾等。重的则即时发作，如张氏所言诸症。甚至有轻变重、重变轻，也是由于感受有浅深，传变有兼并。何况人的形体意志苦乐不一，岂能没有变异呢？四季的疾病都是这样。
杨士瀛说：东垣论述暑热症候是相同的。冬季伤寒传变为各种症状，那是寒邪伤形，这是热邪伤气。如果元气非常虚弱而受病，忽然一时无法救治的，与伤寒阴毒顷刻害人其实相同。所以东垣开启这类病例，大开后人之盲蔽。宜与痿证门参看。
陶华说：中暑脉象虚而伏匿，身热面垢，自汗烦躁大渴，四肢微冷而不痛，用白虎汤。痰逆恶寒，用橘皮汤。热闷不恶寒，用竹叶石膏汤。头痛恶心烦躁，用五苓散。
凡中暑，小柴胡汤加香薷最好。脉迟，洒然毛耸，口齿干燥，用人参白虎汤。霍乱烦躁，大渴腹痛，厥冷转筋，黄连香薷汤治疗是关键。必须冷服，热服反而引起吐泻。
龚信说：伤寒与伤暑之所以不同，是因为伤寒和伤暑都有热。如果伤暑而误作伤寒治疗则不可。盖暑邪伤形，热邪伤气。伤寒则外恶寒而脉浮紧，伤暑则不恶寒而脉虚，这就是区别。治疗宜用小柴胡汤加知母、石膏，或人参白虎汤。若天久淫雨，湿令大行，用苍术白虎汤。若元气素来虚弱而受伤重的，用清暑益气汤。
[General Principles] Zhang Zhongjing stated: Sun-heat disease affecting the Taiyang channel is known as heatstroke (Zhong Shu). The patient presents with sweating, aversion to cold, fever, and thirst. Heatstroke (Zhong Yue) affecting the Taiyang channel manifests as fever, aversion to cold, heaviness of the body, and pain. The pulse is wiry, thin, hollow (Kou), or slow. After urination, the patient feels chilly with shivering and piloerection, and experiences coldness in the hands and feet. Upon slight exertion, the body becomes hot; the mouth opens for breath, and the incisors become dry. If diaphoresis (sweating-inducing treatment) is incorrectly applied, aversion to cold worsens. If moxibustion or warming needle therapy is incorrectly applied, fever intensifies. If purgation is repeatedly applied, strangury (Lin syndrome) worsens. Heatstroke affecting the Taiyang channel presents with fever, painful heaviness, and a weak pulse. This is caused by water-dampness pathogen contracted in summer, where water qi circulates within the skin.
[Commentaries] Zhang Jianshan stated: Heatstroke resembles Cold Damage (Shang Han) but differs. Clear pathogens (such as wind-heat) attack the upper part, while turbid pathogens (such as cold-dampness) attack the lower part. Wind, cold, and dampness are Earth Qi; they injure the turbid pathogen and thus affect the Foot channels. Only Summer-Heat is Heaven Qi, so it affects the Hand-Shaoyin Heart channel. Its symptoms are mostly similar to Cold Damage, differing only in the pulse. Although Cold Damage presents with aversion to cold and fever, there is no irritability or thirst in the initial stage. In contrast, heatstroke presents with thirst from the onset; this is the difference. Furthermore, the pulse in Cold Damage must be floating and vigorous, whereas in heatstroke, the pulse must be deficient, or wiry and thin, or hollow and slow. The Classics state: A vigorous pulse with cold body indicates Cold Damage; a deficient pulse with hot body indicates Summer-Heat injury. This refers to such cases. Regarding Taiyang disease, stiffness of the neck and back with spontaneous sweating and aversion to wind, if occurring during intense summer heat, might seem similar to heatstroke. However, because there is no thirst, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root) is used. Whenever one resides in the seasons of Summer and Autumn, during times of intense heat, one must carefully examine according to the channels to avoid errors.
Wang Haogu stated: Fever, aversion to cold, headache, body and joint pain, with a surging and vigorous pulse in summer constitute Heat Disease. This is Cold contracted in winter, triggered by summer heat. The treatment is the same as for Cold Damage. However, medicines in summer must have cooling properties. When using Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), or Da Qing Long Tang (Great Blue Green Dragon Decoction), modifications are necessary. Before the Summer Solstice, add Huangqin (Scutellaria Root) to Guizhi Tang. After the Summer Solstice, add Zhimu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum) to all three formulas. If after three days of Heat Disease, the aforementioned decoctions fail to cure, and the pulse remains rapid, indicating the pathogen is still in the channels and has not entered the Zang-Fu organs, Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) should be used. This formula replaces Guizhi Tang indications after the Summer Solstice. From March to summer, constituting late-onset Cold Damage, Zhizi Shengma Tang (Gardenia and Cimicifuga Decoction) can be used.
Shen Jin'ao commented: For Heat Disease in summer, Wang's proposal to primarily use the three formulas (Mahuang, Guizhi, Da Qing Long) is certainly not a good method and requires deliberation.
Pang Anchang stated: Generally, for Heat Disease, high fever must correspond with a surging, large, forceful pulse, or a slippery, rapid, forceful pulse, indicating pulse-symptom correspondence, which is treatable. If the pulse is small, weak, and forceless, it is difficult to treat. If the person is deficient and the pulse is weak, Renshen (Ginseng Radix et Rhizoma) should be used to support Yuan Qi (Original Qi); one should not merely attack the heat.
Summer-Heat Wind Syndrome arises from excessive heat suppressing Metal (Lung), failing to control Wood (Liver), leading to spasms and unconsciousness. The pulse is deficient and floating; floating indicates Wind, deficient indicates Summer-Heat. Commonly known as Summer-Heat Wind, it is due to vigorous Ministerial Fire acting. It should be treated with Huanglian Xiangru Yin (Scutellaria and Elsholtzia Decoction) plus Qianghuo (Notopterygium Rhizome), or Shuangjie San (Double Release Powder) plus Xiangru (Elsholtzia Herb).
The pulse in heatstroke must be deficient. External symptoms include headache, dry mouth, greasy face, spontaneous sweating, fatigue, or aversion to heat on the back. Severe cases present with coma, Huoluan (Colic with vomiting and diarrhea), phlegm obstruction, vomiting, abdominal pain, diarrhea, bloody stool, macules, and jaundice. Treatment focuses on clearing the Heart and promoting urination. If sweating is profuse, promoting urination is contraindicated; Baihu Tang (White Tiger Decoction) is suitable. Next, differentiate between exterior and interior. If in the exterior, with headache and aversion to cold, use Shuangjie San plus Xiangru, or Shiwei Xiangru Yin (Ten-Ingredient Elsholtzia Decoction). If in half-exterior/half-interior, with diarrhea, irritability, thirst for water, and vomiting, use Wuling San (Five-Ingredient Powder). With severe heat and thirst, use Yiyuan San (Origin-Sustaining Powder). If the exterior is resolved and interior heat prevails, use Banxia Jiedu Tang (Pinellia Detoxification Decoction) or Shenxiong Wan (Shenxiong Pill). For elderly or weak persons exposed to summer heat, presenting with a faint pulse, diarrhea, thirst preferring warmth, or cold limbs and unconsciousness, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) plus Shu Fuzi (Prepared Aconite Lateral Root), served chilled. Subsequently, treat with Laifu Dan (Reviving Pill) and Wuling San. In summer heatstroke syndromes, one must not administer any hot-natured agents, lest it cause macular toxins, jaundice, difficulty in urination, and death from oppression and confusion. Be cautious.
Dai Yuanli stated: Summer-Heat diseases have three levels of severity: Mao Shu (Covering Heat), Shang Shu (Injuring Heat), and Zhong Shu (Midst Heat). Abdominal pain with watery diarrhea indicates Stomach and Large Intestine involvement; nausea indicates phlegm-fluid in the stomach region. These two are Mao Shu (Covering Heat), treatable with Huanglian Xiangru Yin. Or, fever, headache, restlessness, or body sensation like needle pricks indicate Heat injuring the muscle layer; detoxification is needed, using Baihu Tang plus Chaihu (Bupleurum Root), adding Renshen if deficient. Or, cough with chills and fever, continuous night sweats, and rapid pulse indicate Heat injuring the Lung channel, with Fire overcoming Metal; this is Zhong Shu (Midst Heat). Use Qingfei Tang (Clear Lung Decoction) or Chaihu Tianshui San (Bupleurum and Heavenly Water Powder).
Zhang Congzheng stated: Summer-Heat injuring the Five Zang organs presents differently. If entering the Heart, there is choking, coma, and obtundation. If entering the Liver, there is vertigo and numbness/stiffness. If entering the Spleen, there is drowsiness and unawareness. If entering the Lung, there is sneezing, panting, and flaccidity. If entering the Kidney, there is Xiao Ke (Wasting-Thirst).
Li Gao stated: When Spleen-Stomach Qi is deficient, encountering the abundant dampness of the sixth and seventh lunar months, excessive sweating leads to heaviness, shortness of breath, limb flaccidity, weak knees, and blurred vision. This is a sign of exhaustion of the Kidney and Bladder. Moreover, profuse sweating loses Jin Ye (Body Fluids). Jin Ye is governed by Geng Metal (Large Intestine). In the Three Fu periods, Geng Metal is imprisoned, Wood is uncontrolled, so Wind-Dampness combats, causing bone and joint pain. Ren Bladder Qi is exhausted in Si month, Gui Kidney Water is exhausted in Wu month. Now, encountering abundant dampness assisting Heat as a pathogen, the cold-clear Qi of the Northwest is severed. The Sages legislated that Summer requires tonification because Heat injures Yuan Qi. Using Renshen, Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Fruit) to nourish the source of Water, purge Bing Fire (Small Intestine/Pericardium Fire), tonify Geng Metal, and benefit Yuan Qi. In Late Summer, steaming summer-heat damages Yuan Qi, causing limb fatigue, lack of spirit, leg flaccidity, chills in morning/evening, and intense heat after noon. This is deficiency of both Yin-Yang and Qi-Blood. Or, chest fullness, heavy joint pain, asthma, fever, irritability, yellow scanty urine, loose frequent stools, or diarrhea/thirst, spontaneous sweating, and heaviness indicate Blood disease preceding Qi disease. If Dampness attacks first, the pulse is surging, slow, and delayed. Although symptoms may interchange slightly, the heavenly heat and damp command remain the same; treat with clearing and drying. Or, traveling in great heat with thirst implies Heat residing in the Kidney, so Water cannot overcome Fire, leading to bone flaccidity; this is Damp-Heat forming flaccidity. Or, Heat Jue (Cold Limbs) with Yin deficiency, or Cold Jue with Qi deficiency. Limbs like fire indicate Heat Jue; cold limbs indicate Cold Jue. Cold Jue has cold in the abdomen; Heat Jue has heat in the abdomen. The Spleen governs the four limbs.
Yu Tun stated: Heatstroke symptoms vary greatly, not limited to the Five Zang organs. Human constitution and Qi have deficiency and excess; pathogenic influence has light and heavy degrees, leading to delayed onset, becoming malaria or dysentery in autumn. Heavy cases occur immediately, as described by Zhang. Light may become heavy, heavy may become light, depending on depth of infection and transmission combinations. Moreover, human physical and mental states differ; variations are inevitable. This applies to diseases of all four seasons.
Yang Shayun stated: Dongyuan's discussion on summer-heat symptoms is consistent. Winter Cold Damage transforming into various symptoms is Cold injuring the Form; here, Heat injures Qi. If Yuan Qi is extremely deficient upon illness, sudden untreatable cases are identical to Yin Toxin in Cold Damage, harming people instantly. Thus, Dongyuan opened these cases to enlighten later generations. Refer to the Flaccidity Syndrome chapter.
Tao Hua stated: Heatstroke presents with deficient and hidden pulse, fever, greasy face, spontaneous sweating, irritability, and extreme thirst. Limbs are slightly cold but not painful; use Baihu Tang. Phlegm obstruction with aversion to cold uses Jupi Tang (Tangerine Peel Decoction). Heat oppression without aversion to cold uses Zhuye Shigao Tang. Headache, nausea, irritability uses Wuling San.
For all heatstroke, Xiaochaihu Tang (Minor Bupleurum Decoction) plus Xiangru is best. Slow pulse, shivering, dry teeth/mouth uses Renshen Baihu Tang. Huoluan with irritability, extreme thirst, abdominal pain, cold limbs, and convulsions: Huanglian Xiangru Tang is essential. Must be taken cold; hot administration causes vomiting/diarrhea.
Gong Xin stated: The difference between Cold Damage and Summer-Heat Injury is that both involve heat. Treating Summer-Heat as Cold Damage is incorrect. Summer-Heat injures the Form; Heat injures Qi. Cold Damage presents with external aversion to cold and floating-tight pulse; Summer-Heat presents with no aversion to cold and deficient pulse. This is the distinction. Treatment should use Xiaochaihu Tang plus Zhimu and Shigao, or Renshen Baihu Tang. If prolonged rain causes abundant dampness, use Cangzhu Baihu Tang (Atractylodes and White Tiger Decoction). If Yuan Qi is inherently weak and injury is severe, use Qingshu Yiqi Tang (Clear Summer-Heat and Benefit Qi Decoction).