中暑发热，心下似烦，漾漾欲呕，此暑侵上焦，
肺胃不和。宜用苏叶、藿香叶、白寇壳、人中白等
味，宜通肺气也。
古称有声无物谓之呕，有物无声谓之吐。然呕则在脾，
吐则在胃。更有轧轧连声似噫气而短促者，谓哕，病亦在
胃，即呃逆是也，乃胃败之象，《内经》所谓土败则其声哕
也。又轧轧连声似呃逆而缓长者则谓噫，病在肝，即噫气是
也。今邪犯上焦，未尽传胃，而漾漾欲呕，乃肺气不和。故
用苏叶、藿香叶、白芷、蔻壳辛香轻薄，恰到肺位，兼用人
中白者，因暑本浊邪，以浊攻浊也。
中暑吐泻并作，吐既止而泻不止者，宜胃芩汤泄
之;若泻止而吐不止者，宜黄连温胆汤和之。
既吐且泻，邪已分布，今吐止而泻不止，为上焦既清，
而邪趋于下，用五芩以分泄，合平胃以驱湿;若泻止而吐犹
未止，乃邪在中焦，用黄连温胆汤，苦降辛通，勿使邪结中
焦，而成痞胀为要。
中暑吐泻不止，渐致肢厥汗冷，甚而转筋麻木，
初起宜六和汤，甚则四逆汤加吴萸、木瓜，姜汁炒川
连等味，温胃制肝也。
凡暑中在脾，秋发则为疟痢，骤发则为霍乱。今吐泻不
止，而致四肢厥逆，汗冷气衰，阳津阴液俱凅，气血营卫皆
伤，霎时形肉取瘪，转筋麻痹，皆气血不能运达四末，急宜
大剂竣补中阳，仍兼和荣益气 以冀吐泻止而肢温汗敛，即
是回阳之兆，若再疏泄，则投石下井矣。至于呕吐频频，药
难下咽，阴盛于内，阳药拒格，故用四逆汤，加吴萸，木瓜
平肝敛液，更用姜汁炒川连三四分，另煎取汁一杯，滴入药
内饮之，俾以类相招，不致呕出，此即仲景白通汤中，加入
尿、猪胆汁之意也。再按转筋霍乱，年来屡见，甚至如疫一
般，同时并染，虽系人间病象，究亦天时所侵。盖大江以
南，地卑气湿，其沿江濒海，雾露潮湿，甚于别处，故湿邪
为患，四时多有，山岚瘴气，夏秋益倍。茍其人正气素虚，
暑秽湿浊乘虚犯之，必由口鼻直趋中道，忽然胸腹闷痛，烦
乱不安，且不得吐泻，此属闭症，宜与探吐。更有胸腹沟
闷，实时吐泻，甚至频频，而肢冷汗多，形肉顿瘪，且转筋
麻木，此属脱症，宜用温补，盖既吐且泻，水谷倾囊，冷汗
不止，气液外泄，致身中阳津阴液俱凅，气血营卫皆损，无
以荣养筋脉，自然肢节拘攀，麻痹不仁并至矣。此时急宜大
补，以附子理中汤温理中阳，合吴萸、木爪舒筋泄肝;或以
乌梅安胃丸去黄柏，倍用参、附，亦对症之良方。余遇是
症，每用此汤，屡获奇效，较之四逆、理中汤更为合宜。
中暑导致发热，心中感觉烦闷不适，恶心欲吐，这是暑邪侵犯上焦，导致肺胃功能失调。应当使用苏叶、藿香叶、白蔻壳、人中白等药物，以宣通肺气。
古人称有声音但没有呕吐物称为“呕”，有呕吐物但没有声音称为“吐”。然而，“呕”的病位主要在脾，“吐”的病位主要在胃。还有那种连续发出轧轧声，类似打嗝但短促的情况，称为“哕”，即呃逆，病位也在胃，这是胃气衰败的表现，《内经》所说的“土败则其声哕”就是这个意思。又有那种连续发出轧轧声，类似呃逆但声音缓慢悠长的，称为“噫”，即嗳气，病位在肝。现在邪气侵犯上焦，尚未完全传入胃中，而表现为恶心欲吐，这是由于肺气不和所致。因此使用苏叶、藿香叶、白芷、蔻壳等辛香轻清之品，药力恰好到达肺部；同时加入人中白，是因为暑邪本质上是浊邪，用浊性药物来攻逐浊邪（以浊攻浊）。
中暑引起呕吐和腹泻同时发作，如果呕吐停止而腹泻不止，应当使用胃芩汤来清泄；如果腹泻停止而呕吐不止，应当使用黄连温胆汤来调和。
既呕吐又腹泻，说明邪气已经分布全身。现在呕吐停止而腹泻不止，是因为上焦邪热已清，而邪气趋向于下焦，使用五苓散来分利渗泄，配合平胃散来驱除湿邪；如果腹泻停止而呕吐仍未停止，说明邪气滞留中焦，使用黄连温胆汤，利用苦味降逆、辛味通阳的作用，防止邪气结聚在中焦，从而形成痞满胀气的症状，这是治疗的关键。
中暑引起的呕吐腹泻不止，逐渐导致四肢厥冷、出汗发凉，甚至出现肌肉痉挛（转筋）和麻木，初起时宜用六和汤，病情严重时则用四逆汤加吴茱萸、木瓜，以及姜汁炒黄连等药物，以温补胃气、制约肝风。
凡是暑邪伤及脾脏，若在秋季发作则成为疟疾或痢疾，若突然发作则成为霍乱。现在呕吐腹泻不止，导致四肢厥逆、冷汗出、气息衰弱，体内的阳津和阴液都枯竭了，气血营卫都受到了损伤，短时间内形体肌肉变得干瘪，肌肉痉挛麻痹，都是因为气血不能运达四肢末端。此时急需大剂量峻补中焦阳气，同时兼顾调和营血、益气，希望能使呕吐腹泻停止，四肢温暖，汗液收敛，这就是回阳的征兆。如果再使用疏泄之法，那就是投石下井（加重病情）了。至于呕吐频繁，药物难以咽下，这是因为阴寒盛于内，温热性质的药物被格拒不受，所以使用四逆汤，加入吴茱萸、木瓜以平抑肝气、收敛津液，更用姜汁炒黄连三四分，单独煎取一杯汁液，滴入药液中服用，借此同类相引，避免药物被吐出，这正是张仲景在《白通汤中加入人尿、猪胆汁的意思。再考察转筋霍乱，近年来屡见不鲜，甚至像瘟疫一样，同时多人感染，虽然属于人间疾病现象，究其根源也是受到天时气候的侵袭。大概长江以南地区，地势低洼，湿气重，沿江沿海一带，雾露潮湿比别处更甚，所以湿邪为患，四季都有，山岚瘴气在夏秋季节加倍严重。假如一个人正气素来虚弱，暑秽湿浊之气乘虚而入，必定由口鼻直趋中道，突然胸腹闷痛，烦躁不安，且无法通过呕吐或腹泻排出，这属于闭症，应当采用探吐法。另有胸腹闷堵，随即发生呕吐腹泻，甚至频繁发作，并且四肢冷汗多，形体肌肉顿时干瘪，且出现肌肉痉挛麻木，这属于脱症，应当使用温补法。因为既呕吐又腹泻，水谷精华倾囊而出，冷汗不止，气与津液外泄，导致体内阳津阴液全部枯竭，气血营卫都受损，无法荣养筋脉，自然会出现肢体关节拘挛攀急、麻痹不仁等症状。此时急需大补，使用附子理中汤温补调理中焦阳气，配合吴茱萸、木瓜舒缓筋脉、疏泄肝气；或者使用乌梅安胃丸去掉黄柏，倍用人参、附子，这也是对症的良方。我遇到这类病症，经常使用此方，屡获奇效，比起单纯使用四逆汤或理中汤更为适宜。
Heatstroke causing fever, a sensation of vexation in the epigastrium, and nausea with a desire to vomit, indicates that summer-heat pathogen has invaded the Upper Jiao (Upper Burner), leading to disharmony between the Lung and Stomach. It is appropriate to use herbs such as Perilla Leaf (Ziye), Agastache Leaf (Huoxiang Ye), White Cardamom Shell (Baikou Qiao), and Humanoid Ash (Renzhongbai) to unblock Lung Qi.
Ancient texts define "Ou" (vomiting with sound but no substance) as having sound without substance, and "Tu" (vomiting without sound but with substance) as having substance without sound. However, "Ou" is associated with the Spleen, while "Tu" is associated with the Stomach. Furthermore, there is a condition characterized by continuous "yaya" sounds, resembling belching but short and abrupt, called "Yue" (hiccups or dry heaves), which also resides in the Stomach; this is essentially hiccups (E'ni), representing a sign of Stomach Qi failure, as stated in the *Neijing*: "When Earth fails, its sound is Yue." Another condition involves continuous "yaya" sounds similar to hiccups but slow and prolonged, called "Yi" (belching), which is associated with the Liver. Currently, the pathogen invades the Upper Jiao and has not yet fully transmitted to the Stomach, manifesting as nausea due to Lung Qi disharmony. Therefore, Ziye, Huoxiang Ye, Bai Zhi, and Kouqiao are used for their acrid, aromatic, light, and thin properties, reaching precisely the Lung level. Renzhongbai is added because summer-heat is inherently a turbid pathogen, employing a turbid agent to attack turbidity (using turbidity to combat turbidity).
Summer-heat causing simultaneous vomiting and diarrhea: if vomiting stops but diarrhea persists, Wei Qin Tang should be used to drain it; if diarrhea stops but vomiting persists, Huanglian Wendan Tang should be used to harmonize it.
When both vomiting and diarrhea occur, the pathogen has distributed itself. Now, if vomiting stops but diarrhea continues, it indicates that the Upper Jiao has been cleared, and the pathogen has shifted downward. Wuling San is used to separate and drain fluids, combined with Pingwei San to drive out dampness. If diarrhea stops but vomiting continues, it indicates the pathogen is in the Middle Jiao. Huanglian Wendan Tang is used, employing bitter descent and acrid unblocking to prevent pathogen stagnation in the Middle Jiao, thereby avoiding the formation of fullness and distension (Pi Zhang), which is crucial.
For summer-heat-induced persistent vomiting and diarrhea, gradually leading to cold extremities (Jue) and cold sweating, and even muscle cramps (Zhuanjin) and numbness, Liuhe Tang is suitable for early stages. In severe cases, Sini Tang is used with additions of Evodia Fruit (Wuyu), Chaenomelum Fructus (Mugua), and Coptis Rhizome (Chuanlian) stir-fried with ginger juice, to warm the Stomach and subdue the Liver.
Whenever summer-heat affects the Spleen, if it manifests in autumn, it becomes Malaria or Dysentery; if it strikes suddenly, it becomes Cholera-like syndrome (Huo Luan). Now, persistent vomiting and diarrhea lead to cold extremities, cold sweat, and weak qi, causing exhaustion of Yang Jin (Yang fluids) and Yin fluids, and damage to Blood, Qi, Ying, and Wei. The body and muscles become sunken rapidly, and muscle cramps and paralysis occur because Blood and Qi cannot reach the four extremities. Urgent large-dose strong tonification of Middle Yang is required, combined with harmonizing Ying and benefiting Qi, hoping to stop vomiting and diarrhea, warm the limbs, and consolidate sweat, which signifies the return of Yang. If dispersing methods are used again, it would be like throwing a stone down a well (exacerbating the condition). Regarding frequent vomiting where medicine is difficult to swallow, due to Yin excess internally rejecting Yang-tonifying drugs, Sini Tang is used with Evodia Fruit and Chaenomelum Fructus to calm the Liver and consolidate fluids. Additionally, 3-4 fen of Coptis Rhizome stir-fried with ginger juice is decocted separately to obtain one cup of liquid, which is dripped into the medicine for drinking. This utilizes similarity to attract, preventing expulsion via vomiting, following the principle of adding human urine and pig bile in Zhang Zhongjing's Baitong Tang. Further observing muscle-cramp Cholera-like syndrome, seen frequently in recent years, even spreading like an epidemic among many simultaneously, although it is a common disease phenomenon, it ultimately results from climatic invasion. Generally, south of the Yangtze River, the terrain is low and air is humid; areas along rivers and coasts have heavier fog, dew, and dampness than elsewhere. Thus, Dampness pathogen causes illness throughout the year, with mountain miasma doubling in summer and autumn. If a person has inherent deficiency of Zheng Qi (Upright Qi), summer-heat, foulness, and damp-turbidity invade through deficiency, entering directly via mouth and nose to the central pathway. Suddenly, chest and abdomen become stuffy and painful, with vexation and restlessness, and inability to vomit or defecate; this belongs to Bi Syndrome (Closed Syndrome) and requires induced vomiting. Conversely, chest and abdominal stuffiness followed immediately by vomiting and diarrhea, even frequent episodes, with cold limbs, profuse sweat, sudden emaciation, muscle cramps, and numbness, belongs to Tuo Syndrome (Collapsing Syndrome) and requires warming and tonification. Because simultaneous vomiting and diarrhea pour out food and water, continuous cold sweat leaks Qi and fluids, exhausting Yang Jin and Yin fluids, damaging Blood, Qi, Ying, and Wei, failing to nourish sinews and vessels, naturally leading to limb joint spasms, numbness, and insensitivity. At this time, urgent large-scale tonification is needed: Fuzi Lizhong Tang to warm and regulate Middle Yang, combined with Evodia Fruit and Chaenomelum Fructus to relax sinews and vent the Liver; or Wu Mei Anwei Wan removing Phellodendron Cortex (Huangbai), doubling Ginseng Radix (Renshen) and Aconite Lateral Root Preparata (Fuzi), which is also an excellent prescription for this indication. I encounter these symptoms often and use this decoction, achieving remarkable effects repeatedly, making it more suitable than using Sini Tang or Lizhong Tang alone.