胀为病 辨实虚 胀者，胀之于内也。虚胀误攻则坏，实胀误补则增。
气骤滞 七气疏 七气汤能疏通滞气。
满拒按 七物祛 腹满拒按，宜《金匮》浓朴七物汤，即桂枝汤小承气汤合用，以两
解表里之实邪也。
胀闭痛 三物锄 腹满而痛，若大便实者，宜《金匮》浓朴三物汤，行气中兼荡实法，
以锄其病根。
以上言实胀之治法。
若虚胀 且踌躇 仔细诊视，勿轻下药。
中央健 四旁如 喻嘉言云∶执中央以运四旁，千古格言。
参竺典 大地舆
单腹胀 实难除 四肢不肿而腹大如鼓。
山风卦 指南车
易中旨 费居诸
伤暑症 动静商 夏月伤暑分动静者，说本东垣。
动而得 热为殃 得于长途赤日，身热如焚，面垢，体倦，口渴，脉洪而弱。
六一散 白虎汤 六一散治一切暑症。白虎汤加人参者，以大汗不止，暑伤元气也，加
苍术者，治身热足冷，以暑必挟湿也。
静而得 起贪凉 处于高厦深室，畏热贪凉，受阴暑之气。
恶寒象 热逾常 恶寒与伤寒同，而发热较伤寒倍盛。
心烦辨 切莫忘 虽同伤寒，而心烦以别之；且伤寒脉盛，伤暑脉虚。
香薷饮 有专长 香薷发汗利水，为暑症之专药也。有谓夏月不可用香薷，则香薷将
用于何时也?
大顺散 从症方 此治暑天畏热贪凉成病，非治暑也。此舍时从症之方。
生脉散 久服康 此夏月常服之剂，非治病方也。
东坦法 防气伤 暑伤元气，药宜从补，东垣清暑益气汤颇超。
杂说起 道弗彰 以上皆诸家之臆说。而先圣之道，反为之晦，若行道人，不可不熟记
之，以资顾问。
若精蕴 祖仲师 仲景《伤寒论》《金匮要略·痉湿 篇》，字字皆精义奥蕴。
太阳病 旨在兹 仲师谓太阳中 ，太阳二字，大眼目也。因人俱认为热邪，故提
出太阳二字以喝醒之，寒暑皆为外邪。中于阳而阳气盛，则寒亦为热；中于阳而阳气虚，则
暑亦为寒。若中于阴，无分寒暑，皆为阴症。如酷暑炎热，并无寒邪，反多阴症。总之，邪
之中人，随人身之六气、阴阳、虚实而旋转变化，非必伤寒为阴，中暑为阳也。
经脉辨 标本歧 师云∶太阳中 发热者，病太阳而中标阳之气也。恶寒者，病太
阳而得本寒之气也。身重而疼痛者，病太阳通体之经也。脉弦细芤迟者，病太阳通体之脉也
。小便已洒洒然毛耸、手足逆冷者，病太阳本寒之气不得阳热之化也。小有劳身即热、口开
、前板齿燥者，病太阳标阳之化不得阴液之滋也。此太阳中 ，标本经脉皆病。治当助
其标本，益其经脉；若妄施汗下温针，则误矣。
临症辨 法外思 愚按∶借用麻杏石甘汤治中暑头痛、汗出、气喘、口渴之外症，黄连
阿胶鸡子黄汤治心烦不得卧之内症，至柴胡、栀子、承气等汤，俱可取用。师云∶渴者与猪
苓汤。又云∶瘀热在里，用麻连轺豆汤，育阴利湿，俱从小便而出。此法外之法，神而明之
，存乎其人焉。
方两出 大神奇 暑之中人，随人之阴阳、虚实为旋转变化。如阳脏多火，暑即寓于火
之中，为汗出而烦渴，师有白虎加人参之法。如阴脏多湿，暑即伏于湿之内，为身热、疼重
、脉微弱，师以夏月伤冷水，水行皮肤所致，指暑病以湿为病，治以一物瓜蒂汤，令水去而
湿无所根据，而亦解也。
胀病作为病症，需辨别是实证还是虚证。胀是指气机壅滞于体内。若是虚证引起的胀满，误用攻下法会导致病情恶化；若是实证引起的胀满，误用补益法则会使症状加重。
若腹部胀满且拒按（按压时疼痛加剧），宜使用《金匮要略》中的浓朴七物汤。该方即桂枝汤与小承气汤合用，旨在同时解除表里两方面的实邪。
若腹胀伴有大便闭结和疼痛，宜使用《金匮要略》中的浓朴三物汤。此方在行气的同时兼具荡涤实邪的作用，以铲除病根。
以上论述的是实证胀满的治疗方法。
如果是虚证胀满，诊治时需仔细斟酌，不要轻易使用泻下药。
脾胃功能强健（中央健），则四肢百骸正常运作（四旁如）。喻嘉言曾说：“把握中焦脾胃以运化四周”，这是千古流传的格言。
参考《参同契》与大地舆图之理（此处借喻人体与自然相应，强调中土的重要性）。
单腹胀（仅腹部肿大而四肢不肿）这种病症，实在难以根除。
引用《易经》山风蛊卦之意，如同指南车指引方向，揭示其中的深奥旨意，在于费直等易学家的阐释中。
伤暑症，需根据患者发病时的动静状态来商榷辨证。夏季伤暑分动、静两类，这一说法源自李东垣。
“动而得”：指在烈日长途行走后患病，表现为身体发热如火烧，面色污垢，身体疲倦，口渴，脉象洪大但重按无力。
治疗可用六一散治疗各种暑症。白虎汤加人参，适用于大汗不止、暑热损伤元气者；若加入苍术，则用于治疗身热足冷者，因为暑邪常挟带湿气。
“静而得”：指居住在高大深邃的房屋内，因怕热而贪凉，感受了阴暑之气。
表现为恶寒，这与伤寒相似，但发热程度比伤寒更严重。
需用心烦来加以辨别，切勿忘记：虽然症状类似伤寒，但通过心烦可以区分；且伤寒脉象盛实，伤暑脉象虚弱。
香薷饮具有专长，香薷能发汗利水，是治疗暑症的专用药物。有人说夏季不可用香薷，那香薷又该何时使用呢？
大顺散则是从症状出发的方剂，此方治疗因暑天畏热贪凉而导致的疾病，并非直接治疗暑邪本身，这是“舍时从症”的方子。
生脉散适合长期服用以恢复健康，它不是用来治病的方子。
李东垣的方法重在防止元气受损，暑邪损伤元气，用药宜偏向补益，李东垣的清暑益气汤颇为高超。
关于暑症的杂说很多，导致先圣的道理反而变得晦涩不明。行医之人不可不熟记这些内容，以备咨询参考。
若能探究其精微蕴奥，应尊仲景为先祖。张仲景的《伤寒论》及《金匮要略·痉湿暍篇》，字字都蕴含精义奥理。
太阳病的论述，关键在于此。仲景提到“太阳中暍”，“太阳”二字是关键眼目。因为人们通常认为中暑就是热邪，所以特意提出“太阳”二字以警醒世人，寒邪和暑邪都属于外邪。如果邪气侵犯阳分且阳气旺盛，那么寒邪也会转化为热邪；如果邪气侵犯阳分但阳气虚弱，那么暑邪也会表现为寒象。如果邪气侵犯阴分，无论寒暑，都表现为阴证。例如酷暑炎热之时，并没有寒邪，反而多出现阴证。总之，邪气侵入人体，会随着人体六气、阴阳、虚实的变化而旋转转化，并不一定是伤寒为阴证，中暑为阳证。
经脉辨证显示标本有别。老师说：太阳中暍出现发热，是因为病在太阳经而标阳之气受病；出现恶寒，是因为病在太阳经而本寒之气受病；身体沉重且疼痛，是因为病在太阳经贯通全身的经脉；脉象弦细芤迟，是因为病在太阳经贯通全身的脉道；小便后感到洒洒然毛耸、手足逆冷，是因为病在太阳本寒之气得不到阳热的温化；稍微劳作身体就发热、张口呼吸、前板齿干燥，是因为病在太阳标阳之化得不到阴液的滋润。这就是太阳中暍，标本经脉皆受病。治疗应当助益其标本，补益其经脉；如果妄用发汗、攻下或温针疗法，那就是错误的。
临症辨证需要法外思考。我按语：借用麻杏石甘汤治疗中暑引起头痛、出汗、气喘、口渴的外在症状；用黄连阿胶鸡子黄汤治疗心烦不得卧的内在症状；至于柴胡汤、栀子汤、承气汤等，都可以取用。老师说：口渴者给予猪苓汤。又说：瘀热在里，用麻黄连翘赤小豆汤，滋养阴液并利湿，使邪气从小便排出。这些是法外的方法，神妙之处在于灵活运用，取决于医者本人。
同一个方子有两种用法，非常神奇。暑邪侵入人体，会随人的阴阳、虚实而发生旋转变化。如阳脏人多火，暑邪就寓于火之中，表现为出汗、烦躁、口渴，仲景有白虎加人参汤的法度。如阴脏人多湿，暑邪就潜伏在湿之内，表现为身热、疼痛沉重、脉微弱，仲景指出这是夏季饮用冷水，水气行于皮肤所致，将暑病归结为湿邪致病，治疗用一物瓜蒂汤，令水去而湿无所依附，从而得以解散。
Distention as a disease requires differentiation between excess and deficiency. Distention refers to the stagnation of qi within the body. If distention is due to deficiency, mistaken use of purgative methods will worsen the condition; if distention is due to excess, mistaken use of tonifying methods will aggravate it.
When sudden stagnation of Qi causes distention, Qi Ji Tang (Seven Qi Decoction) can be used to unblock the stagnant Qi.
If abdominal fullness is present with refusal to pressure (pain increases upon palpation), Nongpu Qiwu Tang (Magnolia Bark Seven-Ingredient Decoction) from *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) is indicated. This formula combines Guizhi Tang (Cinnamon Twig Decoction) and Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) to simultaneously resolve excess pathogens in both the exterior and interior.
If abdominal distension is accompanied by constipation and pain, Nongpu Sangu Tang (Magnolia Bark Three-Ingredient Decoction) from *Jingui Yaolue* is indicated. This method promotes Qi movement while simultaneously purging excess accumulation, thereby eradicating the root of the disease.
The above discusses the treatment methods for excess-type distention.
If it is deficiency-type distention, one must deliberate carefully during diagnosis and avoid lightly administering laxatives.
When the Central Earth (Spleen/Stomach) is robust, the Four Peripheries (Limbs/Organs) function normally. Yu Jiayan stated: "Grasping the Center to govern the Periphery" is an eternal maxim.
Referencing the principles of *Shentong Qi* (Resonance of Heaven and Man) and the geography of the earth (metaphorically illustrating the correspondence between human physiology and nature).
Monostatic abdominal distension (abdominal swelling without edema in the limbs) is truly difficult to eradicate.
Drawing on the hexagram Mountain Wind Gu (蛊) from the *I Ching* (Book of Changes), like a south-pointing chariot guiding the way, revealing its profound meaning lies in the interpretations of Fei Zhu and others.
Summerheat injury symptoms require discussion based on whether the onset was associated with activity or rest. The distinction between active and passive summerheat injury originates from Li Dongyuan.
"Acquired through Activity": Refers to illness contracted after walking long distances under the scorching sun. Symptoms include body heat burning like fire, dirty complexion, physical fatigue, thirst, and a pulse that is large (Hong) but weak upon deep pressure.
Liuyi San (Six-to-One Powder) treats all types of summerheat conditions. Baihu Tang (White Tiger Decoction) with added Ginseng is used when profuse sweating persists and summerheat damages Yuan Qi (Original Qi); adding Atractylodis Rhizoma (Cangzhu) treats cases of body heat with cold feet, as summerheat often carries dampness.
"Acquired through Rest": Refers to illness contracted by staying in high, deep rooms, fearing heat and craving coolness, thereby inhaling Yin Summerheat (coolness-induced summerheat).
Symptoms include aversion to cold, similar to Cold Damage (Shanghan), but fever is more severe than in Cold Damage.
One must differentiate using mental irritability (Xin Fan); do not forget this: although symptoms resemble Cold Damage, mental irritability distinguishes them; furthermore, the pulse in Cold Damage is vigorous, whereas in summerheat injury, the pulse is deficient.
Xiangru Yin (Mosla Decoction) has specific expertise; Mosla (Xiangru) induces sweating and promotes urination, serving as a specialized medicine for summerheat conditions. Some claim Mosla should not be used in summer; then when should it be used?
Dashun San (Great Harmony Powder) is a formula tailored to symptoms rather than the season. It treats illness caused by craving coolness in summer, not summerheat itself; this is a formula that "abandons the season to follow the symptoms."
Shengmai San (Generate the Pulse Powder) is suitable for long-term consumption to restore health, not primarily as a therapeutic formula for acute disease.
Li Dongyuan's method focuses on preventing damage to Qi. Since summerheat damages Yuan Qi, medication should lean towards tonification; Li Dongyuan's Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) is quite superior.
Miscellaneous theories abound, causing the Way of the Sages to become obscured. Practitioners must memorize these contents thoroughly to assist in consultation.
To explore the profound essence, one should revere Zhang Zhongjing as the ancestor. Every word in Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), specifically the chapter on Spasm, Dampness, and Heatstroke, contains profound meanings.
The focus of Taiyang Disease lies here. Zhongjing mentions "Taiyang Zhongshu" (Heatstroke affecting the Taiyang channel); the term "Taiyang" is the key eye. Because people generally assume heatstroke is merely a heat pathogen, he specifically highlights "Taiyang" to awaken them. Both Cold and Summerheat are external pathogens. If the pathogen attacks the Yang aspect and Yang Qi is strong, Cold transforms into Heat; if the pathogen attacks the Yang aspect but Yang Qi is deficient, Summerheat manifests as Cold. If the pathogen attacks the Yin aspect, regardless of Cold or Summerheat, it presents as a Yin syndrome. For example, during intense summer heat without actual Cold pathogens, Yin syndromes often occur. In summary, pathogens invading the body rotate and change according to the body's Six Qi, Yin-Yang, and excess-deficiency states; it is not necessarily true that Cold Damage is Yin and Heatstroke is Yang.
Meridian differentiation reveals differences in Root and Branch. The Master said: Fever in Taiyang Zhongshu indicates the disease affects the Taiyang channel and its Branch Yang Qi; aversion to cold indicates the disease affects the Taiyang channel and its Root Cold Qi; heaviness and pain in the body indicate the disease affects the meridians running through the whole body of Taiyang; a pulse that is string-taut (Xian), fine (Xi), hollow (Kou), and slow (Chi) indicates the disease affects the vessels running through the whole body of Taiyang; feeling chilly and hair standing on end after urination, with cold extremities, indicates the Root Cold Qi of Taiyang fails to receive warming transformation from Yang Heat; slight exertion causing immediate heat, open mouth breathing, and dry anterior teeth indicate the Branch Yang transformation of Taiyang fails to receive nourishment from Yin fluids. This constitutes Taiyang Zhongshu where both Root and Branch, and meridians, are diseased. Treatment should assist the Root and Branch, and benefit the meridians; reckless use of sweating, purging, or warm needle therapy would be erroneous.
Clinical differentiation requires thinking beyond standard methods. My commentary: Borrow Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) to treat external symptoms of heatstroke such as headache, sweating, asthma, and thirst; use Huanglian Ejiao Jizihuang Tang (Coptis, Donkey-Hide Gelatin, and Egg Yolk Decoction) to treat internal symptoms such as mental irritability and inability to sleep; formulas such as Chaihu Tang (Bupleurum Decoction), Zhizi Tang (Gardenia Decoction), and Chengqi Tang (Order the Dragon Decoctions) can also be utilized. The Master said: For those with thirst, administer Zhuling Tang (Polyporus Decoction). He also said: For stasis-heat in the interior, use Mahelianqiao Dou Tang (Ephedra, Forsythia, and Soybean Decoction) to nourish Yin and promote dampness drainage, allowing pathogens to exit via urination. These are methods beyond the standard rules; their divine application depends on the practitioner.
The same formula yields great miracles through dual applications. Summerheat invading the body rotates and changes according to the individual's Yin-Yang and excess-deficiency status. For individuals with Yang constitutions prone to Fire, summerheat resides within Fire, manifesting as sweating, irritability, and thirst; Zhongjing provides the method of Baihu Tang plus Ren Shen (Ginseng). For individuals with Yin constitutions prone to Dampness, summerheat hides within Dampness, manifesting as body heat, heavy pain, and a weak pulse; Zhongjing points out this results from drinking cold water in summer, with water qi moving in the skin, categorizing the heatstroke disease as dampness pathology, treating it with Yiwu Guiti Tang (Single-Ingredient Melon Pedicle Decoction) to remove water so dampness loses its basis, thereby resolving the condition.