蒋宝素曰：伤寒者，乃冬寒司令，从霜降以后，至春分节前，触冒霜露，体中寒邪即发之证，而为伏邪温热之原，正与夏暑司令，从谷雨后至秋分前，触冒太阳君火，炎蒸亢热之气，即发之中暑相对之证也。《素问·阴阳应象大论》曰：冬伤于寒，春必病温。又热论篇曰：今夫热病者，皆伤寒之类。此《内经》温热诸证，乃冬时伤寒内伏所致。余因立伏邪门，专论温热。张长沙伤寒论三百九十七法，一百一十三方，发尽伤寒奥旨，文多兹不选。言其要，一日太阳受病，太阳主气，其脉上连风府，循腰脊，故头项痛，腰脊强。二日阳明受病，阳明主肉，其脉挟鼻络于目，故身热目疼，鼻干不得卧。三日少阳受病，少阳主胆，其脉循胁络于耳，故胸胁病而耳聋。三阳经络皆受其病，未入于府者，可汗而已。四日太阴受病，太阴脉布胃中，络于嗌，故腹满而嗌干。五日少阴受病，少阴脉贯肾络于肺，系舌本，故口燥舌干而渴。六日厥阴受病，厥阴脉循阴器而络于肝，故烦满而囊缩。三阴经络皆受其病，已入府者可下而已。（伤寒化热在数日之后，伏邪温热化热在数月之后，乃用承气下之则一也。）六日为传经尽，则病当愈。不愈者，仍自太阳经来复。（七日来复、至十三日再复，俗以十四日非是。）此言传次之大体，非必如是也。有间经而传者，有越经而传者，有传至二三经而止者，有始终只在一经者，有自少阳阳明而入者，有初入太阳，不传阳明，遽入少阴，变成真阴证者。有直中三阴者，有二阳三阳合病者，有二阳并病者，有少阳倒入阳明胃府者。神而明之，存乎其人。然世转风移，近代正伤寒稀少。若大江以南，风气温和，正伤寒尤鲜，惟见伏邪温热诸证。然伏邪温热诸证，皆由冬时伏寒所致。或曰：人身营卫阴阳不失其常，虽微感风寒，病即随见，寒邪岂能伏于冬而发于春夏乎？曰：正邪可伏，贼邪不可伏，寒乃冬月之正邪也。《灵枢·邪气藏府病形篇》曰：正邪之中人也微，先见于色，不知于身，若有若无，若亡若存，有形无形，莫知其情。《素问·八正神明论》曰：正邪者，身形若用力，汗出腠理开，逢风寒，其中人也微。故莫知其情，莫见邪形。盖冬三月阳气闭藏于内，寒邪本不能伤。因逢肾气之亏，形体之劳，精摇于内，汗泄于外，寒氛得以乘之。同气相求，深入少阴之地，真阳复敛，进不能攻，腠理返密，退无归路，逡巡进退于其间，势必盘踞膜原之分。膜原者，藏府之外，形骸之内是也。有形积聚，尚且能容，而况无形寒气，因春之温气而发，故名温。因夏之暑热而发，故名暑热，即伏邪也。由是言之，其人肾气不虚，腠理又密，而触冒严寒杀厉之气，寒邪不能入肾，直袭足太阳膀胱寒水之经。膀胱为肾之府，此为正伤寒，当从仲景伤寒论治。所以正伤寒罕见者，以今世之人，肾气多亏，形体多劳，而知避严寒杀厉之气故也。若肾虚之人，不避严寒杀厉之气，则为直中三阴危证。今三冬所见感寒之证，不过恶寒发热，头疼身痛而已，如医案之用九味羌活汤，南阳败毒散，医话新制十味羌防散之类，一汗而解，甚者二三剂即愈。未闻循日以传经，依经以见证，究非真正伤寒。其辛苦之人，形劳汗泄，鼎食之家，肾虚难免，形劳伤肾，肾劳伤精，虽不触冒严寒杀厉之气，正邪由是潜伏于中，为伏邪诸病。今人但知严寒之可避，不觉正邪之潜侵，乐于以欲竭其精，不解奉闭藏之令，病患故多藏于隐微，而发于人之所忽。前哲以春夏诸病，总名伤寒者本此。此所以寒伏于冬，而蔓延于春夏及秋冬为病滋甚也。兹故略于伤寒，而详于伏邪温热诸证。
略曰：仲景因《内经》热论篇作《伤寒论》，后世因《伤寒论》化裁杂证。此《伤寒论》所以应万变于无穷。世多有其书，诸家多引其文，以故不录，而杂证门或援以为证云。
暑证第四
《椿田医话》曰：樾荫汤主治暑证。暑乃夏三月，从谷雨后至秋分前，触冒蒸热之气而即病者。正与冬三月之伤寒，从霜降后至春分前，触冒严寒之气而即病者，同归一体。与冬伤于寒，夏必病暑之暑不同。冬寒因暑而发之暑病，即伏邪温热，当求本门法治，不在此列。张洁古误以静而得之为中暑，盖静而得之之病，乃夏月违得凉气之感受，犹冬时非节之暖之冬温。冬温不可名伤寒，则静而得之之病不可名中暑。若以因暑贪凉，过食生冷，为静而得之之中暑，然则因寒就暖，多饮酒浆，为动而得之之伤寒乎？《伤寒论》云：君子固密，则不伤于寒。余推此意曰：君子静定则不伤于暑，又何静而得之之有。 云茯苓（三钱） 制半夏（钱半） 白扁豆（三钱） 老苏梗（一钱） 藿香梗（钱半） 新荷梗（八寸） 宣木瓜（一钱） 生甘草（五分） 热甚加黄连一钱。有表加香藿一钱。食滞加厚朴一钱。肥人多痰湿加滑石三钱。瘦人多火加黄柏一钱，或黄连亦可。虚人加入生脉散，甚则再加黄芪二钱。
《左传·昭元》曰：晋侯求医于秦伯，秦伯使医和视之。又曰：阳淫热疾。
京房易飞候曰：有云大如车盖十余，此阳渗之气，必暑有暍死也。
《淮南子》曰：暑气多夭。又曰：武王荟暍人于樾下，左拥而右扇之，而天下怀其德。
《九峰医案》曰：气虚脉虚，身热恶热，烦渴颠疼，神倦汗泄，火盛乘金，热伤元气，古名中暍，寒以取之。 人参（一钱） 生石膏（八钱） 知母（二钱） 生甘草（五分） 麦门冬（三钱） 五味子（八分） 粳米（一两） 淡竹叶（十四片）
暑必夹湿，气之熏蒸着而为病，湿寄旺于四季，随六气之变迁，因暑而为热，伤气伤阴，神倦脉软，身热自汗，恶风口渴，溲便自调，不思饮食，心脾肺三经互病，拟东垣清暑益气，略为加减。 人参（五分） 冬白术（五分） 陈橘皮（五分） 福泽泻（五分） 建神曲（五分） 炙甘草（五分） 川黄柏（三分） 当归身（三分） 麦门冬（三分） 蛀青皮（三分） 煨甘葛（三分） 五味子（五粒） 云茯苓（五分）
蒋宝素曰：暑证者，乃夏暑司令，从谷雨以后至秋分节前，触冒太阳君火，炎蒸亢热之气，即发之病，而为痎疟之原，非冬伤于寒，夏必病暑之暑病。正与冬寒司令，从霜降以后至春分节前，触冒严寒之气，即发之伤寒，相对之证也。冬寒因暑而发之暑病，即伏邪，当从伏邪门论治，不在此列。（余友徐香海曰：伏邪因暑而发，从内之外，溲色必浑赤。即发之暑病，从外之内，溲色必清澄。）《素问·生气通天论》曰：因于暑，汗，烦则喘喝，静则多言。又阴阳应象大论曰：夏热于暑，秋必痎疟。又刺志论曰：气虚身热，得之伤暑。又五运行大论曰：暑以蒸之。又气交变大论曰：岁火太过，炎暑流行。此《内经》诸篇，言因暑则汗出，伏暑为痎疟，气虚身热为伤暑。暑以蒸之，岁火太过，炎暑流行，暑为热证明矣。而张洁古谓静而得之为中暑，中暑者阴证，何耶。《难经》以中暑当身热而烦。《左传》言阳淫热疾。京房言暑有暍死者。《淮南子》言荫暍人于樾下，皆以暑暍为热证，与《内经》相合。盖以暑为夏月天令之当然，暑甚则人病为暍，暍甚则死，则暍为中暑之名，故《金匮要略》《伤寒论》巢元方、陈无择，俱以暑病名中暍。孙思邈以热死为暍，差矣。乃张洁古误以静而得之为中暑，中暑者阴证，李东垣宗之曰：或避暑热于深堂大厦，其病头痛身疼，恶寒发寒无汗，为房室之阴寒所遏，使周身阳气不得伸越，大顺散主之。盖不知此乃夏月有意违时之凉，犹冬时因寒就暖之温。（香海注曰：因寒就暖太过、亦能致病。）且夏月天令非时之凉致病，尚不得名中暑，犹冬时非节之暖之冬温，不得名伤寒，而况因暑贪凉之病乎。冬温不可名伤寒，则静而得之，避暑凉阴，有意违时之夏感，不可名中暑，王安道已辨其误，谓夏时阳气在外，阴气在内，岂可空视阴气为寒，而用温热之药，何以夏则饮水。所谓静而得之之证，虽当暑月，即非暑病，诚是也。然未及冬温，不可名伤寒，夏凉不可名中暑为证据，王节斋以夏至后病热为暑，此误以冬伤于寒，后夏至日为病暑之暑为中暑。戴元礼以中暑卒倒不识人名暑风。盖不知即中暍之甚，如死之状。巢元方、陈无择所谓不可得冷，以尿和土罨脐中，多有得生之证也。王肯堂谓市井之人，日间冒暑经营，夜间开窗露卧，先伤于暑，复感于凉，诚有之矣。然非静而得之可比，亦犹先伤于寒，复感冬温之意。张景岳承洁古、东垣之弊，而立阴暑之名，盖不知暑月感违时之凉，仍是感寒，犹冬时受有意之暖，即是受热。（香海注曰：若以因暑贪凉致病为阴暑，然则因寒就暖致病为阳寒乎。）喻嘉言是安道之论，以静而得之为中暑非是，又以避暑热反受阴湿风露，仍为暑证，盖亦不知避暑贪凉致病，不得名中暑也。由是言之，伤寒恶寒，伤暑恶热。伤寒无汗，伤暑有汗。寒乃冬月之正邪，暑乃夏月之正邪。冬寒内伏，为四时之伏邪。夏暑内伏，为四时之痎疟。是以伏邪或转为痎疟者，兼有夏暑内伏也。痎疟或转为伏邪者，兼有冬寒内伏也。寒暑互伏，如环无端，若冬之正伤寒，夏之中暑，俱是中而即发之病，无邪内伏，故无互转之证。（兰亭注曰：伏寒伏暑，互转伏邪痎疟，四时皆有。以转痎疟，即有伏暑。转伏邪，即有伏寒。伏寒因暑而发为伏邪，伏暑因寒而发为痎疟。惟内无所伏，方是伤寒中暑。故伤寒无转痎疟，中暑无转伏邪之理。若伏邪转疟，疟转伏邪，是冬寒夏暑两伏于中，先后互发之证。若冬之伤寒，夏之中暑，是内无所伏即发之证，故伤寒不转痎疟，中暑不转伏邪。盖有伏为伏邪痎疟，无伏为伤寒中暑。）治暑之法，《金匮》用白虎汤，清肃炎氛，加人参辅正气，可以类推矣。瓜蒂散，治饮冷水，水行皮中。大顺散，治违时凉气，皆非治暑。巢元方、陈无择治暍死谓不可得冷，用姜蒜及溺土罨脐等法，以热极则闭，寒不能入，必假温通之意，即同气相求，衰之以属，非治暑不可用冷也。刘河间宗《金匮》，用白虎不加人参，通治暑证，无问表里，盖未达白虎汤加人参之意，用补天真元气。且虚人中暑，岂可例用白虎，故东垣制清暑益气汤及生脉散，以治虚人中暑善矣。然不舍洁古静而得之为中暑，仍用大顺散，盖不知洁古所论，乃避暑贪凉，有意违时致病，不可名暑也。朱丹溪推《金匮》白虎加人参之意，用黄连香薷饮，清心发汗，随证加减。兼内伤，则宗东垣清暑益气汤固是。王节斋清心利小便亦好。王肯堂以市井之人，日间冒暑经营，夜间开窗露卧，先伤于暑，后感于寒，用六和汤、五苓散，此乃圆机。大要暑证，常人白虎加人参汤、黄连香薷饮。兼虚者，清暑益气汤、生脉散。非时之凉，有意避暑及饮冷，为夏感，犹冬温，非中暑，瓜蒂散、大顺散，或藿香正气散。先伤于暑，复感于凉，六和汤、正气散、五苓散。若医案用白虎合生脉，诚为活法。医话樾荫汤，乃中正和平之剂，可通用也。
略曰：经言寒极生热，热极生寒。此一寒字，即虚字之义。寒伤血，化为热，暑伤气，化为虚。如冬至春，万物茂，寒化热也。夏至秋，万物凋，热化虚也。故伤寒伏邪，宜攻邪为主，中暑痎疟，宜扶正为先，则暑化虚而非寒明矣。，宜攻邪为主，中暑痎疟，宜扶正为先，则暑化虚而非寒明矣。
暑证论列方
白虎加人参汤（九） 一物瓜蒂散（十） 大顺散（十一） 清暑益气汤（十二） 生脉散（十三） 黄连香薷饮（十四） 六和汤（十五） 五苓散（十六） 藿香正气散（十七）
湿证第五
《椿田医话》曰：化湿汤，主治湿证。湿从土化，寄旺四季，在天则云雨，在地则泥沙，在人则脾胃，在时则长夏，在西北则多化为寒，在东南则多化为热，与燥相反，畏风克制，地气上为云，天气下为雨，虽有上受下受之分，其实皆中土之所化也。从化而来，亦从化而去，故以化湿名之。内受酒浆茶水，外受汗衣等湿，亦同此义。酿而为湿温，著而为痿痹，及或为之证，难以悉举，然当从而化之，以意加减，不可执一。 云茯苓（五钱） 炙甘草（五分） 制半夏（二钱） 焦白术（二钱） 薏苡仁（三钱） 煨木香（五分） 苦参（二钱） 在上在表，宜汗散，加羌活、独活、防风、川芎、藁本之类。 在下在里，宜分利，加猪苓、泽泻、车前子、木通、飞滑石之类。 热多加茵陈、川黄连、黄芩之类。寒多加苍术、制附子、油肉桂之类。气虚加人参，血虚加生地，实则加制大黄。
《左传·昭元》曰：晋侯求医于秦伯，秦伯使医和视之。又曰：雨淫腹疾。
《九峰医案》曰：脉来滑数无力，证本湿热伤阴，五液日耗，形神慵倦，竟若骨痿不能起于床，法宜补阴化湿，苦寒虽效，究非常服之方，拟甘露饮加减。 钗石斛（三钱） 天花粉（三钱） 淡天冬（二钱） 大麦门（三钱） 玄参（钱半） 地骨皮（三钱） 白知母（二钱） 川黄柏（一钱） 黄芩（钱半）
蒋宝素说：伤寒，是指冬季寒气当令，从霜降以后到春分节前这段时间，人体触冒霜露，体内寒邪随即发作的病证，这也是伏邪温热病的根源。这与夏季暑气当令，从谷雨后至秋分前，人体触冒太阳君火、炎热亢盛之气而随即发作的中暑，是相对立的病证。《素问·阴阳应象大论》说：“冬伤于寒，春必病温。”又《热论篇》说：“现在的热病，都属于伤寒一类。”这些《内经》中关于温热的各种病证，都是冬季伤寒之邪内伏所致。因此我设立“伏邪”一门，专门论述温热病。张仲景的《伤寒论》有三百九十七法，一百一十三方，阐发了伤寒的深奥旨意，文字太多，此处不选录。概括其要点：第一天太阳经受病，太阳主司体表之气，其经脉上连风府，沿腰脊下行，所以出现头项痛、腰脊强直。第二天阳明经受病，阳明主肌肉，其经脉挟鼻络于目，所以出现身热、目痛、鼻干、不能安卧。第三天少阳经受病，少阳主胆，其经脉循行胁肋络于耳，所以出现胸胁病和耳聋。三阳经络都受病，但邪气未入腑的，可以通过发汗治愈。第四天太阴经受病，太阴经脉布散于胃中，络于咽喉，所以出现腹满和咽喉干燥。第五天少阴经受病，少阴经脉贯穿肾脏络于肺，系于舌根，所以出现口燥、舌干而渴。第六天厥阴经受病，厥阴经脉循行阴器络于肝，所以出现烦闷和阴囊收缩。三阴经络都受病，且邪气已入腑的，可以通过泻下治愈。（伤寒化热在数日之后，伏邪温热化热在数月之后，此时用承气汤类攻下，道理是一样的。）第六天传经完毕，病应当痊愈。若不愈，仍会从太阳经再来复传。（所谓“七日周期”或至十三日再复，世俗认为十四日是错误的。）这是阐述传经的大体规律，并非一定如此。有的隔一经而传，有的越一经而传，有的传至二、三经而止，有的始终只在一经；有的从少阳、阳明而入；有的初入太阳，不传阳明，突然传入少阴，变成真阴证；有的直中三阴；有的二阳、三阳合病；有的二阳并病；有的少阳邪气转入阳明胃腑。神妙之处在于灵活运用，关键在于医生本人。然而世风转变，近代患正伤寒的人很少。若在大江以南，风气温和，正伤寒尤其少见，只见伏邪温热等病证。然而伏邪温热诸证，都是由冬季伏寒所致。有人问：人身营卫阴阳不失常态，即使轻微感受风寒，病即随见，寒邪岂能潜伏于冬季而在春夏发作呢？回答说：正邪可伏，贼邪不可伏，寒是冬季的正邪。《灵枢·邪气藏府病形篇》说：“正邪伤人很轻微，先见于面色，身体无感觉，若有若无，若亡若存，有形无形，不知其情状。”《素问·八正神明论》说：“正邪者，身形劳累用力，汗出腠理开泄时，逢遇风寒，其中人也微。”所以不知其情状，不见邪形。大概冬季三个月阳气闭藏于内，寒邪本不能伤。如果遇到肾气亏虚，形体劳倦，精摇于内，汗泄于外，寒氛得以乘虚而入。同气相求，深入少阴之地，真阳复敛，进不能攻，腠理反密，退无归路，徘徊进退于其间，势必盘踞于膜原之分。膜原者，在脏腑之外，形骸之内。有形积聚尚且能容纳，何况无形寒气，因春季温气而发，故名温；因夏季暑热而发，故名暑热，这就是伏邪。由此而言，如果其人肾气不虚，腠理又密，而触冒严寒杀厉之气，寒邪不能入肾，直袭足太阳膀胱寒水之经。膀胱为肾之府，此为“正伤寒”，应当遵循张仲景《伤寒论》治疗。之所以正伤寒罕见，是因为今世人肾气多亏，形体多劳，且知道躲避严寒杀厉之气。若肾虚之人，不避严寒杀厉之气，则为直中三阴的危重证候。如今三冬所见感寒之证，不过是恶寒发热、头疼身痛而已，如医案中用九味羌活汤、南阳败毒散、医话新制十味羌防散之类，一汗而解，严重的二三剂即愈。未曾听说循日以传经，依经以见证，究非真正的伤寒。那些辛苦之人，形体劳累汗泄；富贵之家，肾虚难免，形体劳伤肾，肾劳伤精，即使不触冒严寒杀厉之气，正邪由此潜伏于中，成为伏邪诸病。今人只知道躲避严寒，不觉察正邪的潜侵，乐于纵欲竭精，不懂顺应闭藏之令，病患故多藏于隐微之处，而发作于人们疏忽之时。前哲将春夏诸病总名为伤寒，根本原因在此。这就是寒伏于冬，而蔓延于春夏及秋冬，致病更甚的原因。因此此处略述伤寒，而详述伏邪温热诸证。
简略地说：张仲景依据《内经》热论篇作《伤寒论》，后世依据《伤寒论》化裁杂证。这就是《伤寒论》所以能应对无穷万变的原因。世上多有此书，各家多引用其文，因此不录，而在杂证门中或许援引作为证明罢了。
暑证第四
《椿田医话》说：樾荫汤主治暑证。暑是夏季三个月，从谷雨后至秋分前，触冒蒸热之气而立即发病的。与冬季三个月的伤寒，从霜降后至春分前，触冒严寒之气而立即发病的，同属一体。不同于“冬伤于寒，夏必病暑”的那种暑。冬季寒邪因暑气而发的暑病，即伏邪温热，应当寻求伏邪门的治法，不在此列。张洁古错误地将静而得之的称为中暑，其实静而得之的病，是夏季违背常理获得凉气的感受，犹如冬季非节气的暖之冬温。冬温不可名为伤寒，则静而得之的病不可名为中暑。如果把因暑贪凉，过食生冷，视为静而得之的中暑，那么因寒就暖，多饮酒浆，难道算是动而得之的伤寒吗？《伤寒论》说：“君子固密，则不伤于寒。”我推演此意说：君子静定则不伤于暑，又何来静而得之的说法。茯苓（三钱） 制半夏（钱半） 白扁豆（三钱） 老苏梗（一钱） 藿香梗（钱半） 新荷梗（八寸） 宣木瓜（一钱） 生甘草（五分）。热甚加黄连一钱。有表证加香薷一钱。食滞加厚朴一钱。肥人多痰湿加滑石三钱。瘦人多火加黄柏一钱，或黄连亦可。虚人加入生脉散，甚则再加黄芪二钱。
《左传·昭公元年》说：晋侯向秦伯求医，秦伯派医和诊治。又说：阳淫导致热疾。
京房易飞候说：有大如车盖十余的云，这是阳渗之气，必定有中暑死亡的情况。
《淮南子》说：暑气使人夭折。又说：武王在树荫下聚集中暑的人，左手拥抱着，右手扇风，天下人都感念他的恩德。
《九峰医案》说：气虚脉虚，身热恶热，烦渴颠疼，神倦汗泄，火盛乘金，热伤元气，古名中暍，用寒法取之。人参（一钱） 生石膏（八钱） 知母（二钱） 生甘草（五分） 麦门冬（三钱） 五味子（八分） 粳米（一两） 淡竹叶（十四片）。
暑必夹湿，气之熏蒸着而为病，湿寄旺于四季，随六气之变迁，因暑而为热，伤气伤阴，神倦脉软，身热自汗，恶风口渴，小便大便正常，不思饮食，心脾肺三经互病，拟定东垣清暑益气汤，略为加减。人参（五分） 冬白术（五分） 陈橘皮（五分） 福泽泻（五分） 建神曲（五分） 炙甘草（五分） 川黄柏（三分） 当归身（三分） 麦门冬（三分） 蛀青皮（三分） 煨甘葛（三分） 五味子（五粒） 云茯苓（五分）。
蒋宝素说：暑证，是指夏季暑气当令，从谷雨以后至春分节前，触冒太阳君火、炎蒸亢热之气，随即发作的病，也是痎疟的根源，不同于“冬伤于寒，夏必病暑”的暑病。正与冬季寒气当令，从霜降以后至春分节前，触冒严寒之气，随即发作的伤寒，是相对立的病证。冬季寒邪因暑气而发的暑病，即伏邪，应当从伏邪门论治，不在此列。（我的朋友徐香海说：伏邪因暑而发，由内向外，小便颜色必浑赤。随即发作的暑病，由外向内，小便颜色必清澄。）《素问·生气通天论》说：“因于暑，汗，烦则喘喝，静则多言。”又《阴阳应象大论》说：“夏热于暑，秋必痎疟。”又《刺志论》说：“气虚身热，得之伤暑。”又《五运行大论》说：“暑以蒸之。”又《气交变大论》说：“岁火太过，炎暑流行。”这些《内经》各篇，讲因暑则汗出，伏暑为痎疟，气虚身热为伤暑。暑以蒸之，岁火太过，炎暑流行，暑为热证明显了。而张洁古说静而得之为中暑，中暑者是阴证，为什么呢？《难经》认为中暑应当身热而烦。《左传》说阳淫热疾。京房说暑有暍死。《淮南子》说荫庇中暑的人在树荫下，都是以暑暍为热证，与《内经》相合。大概因为暑是夏季天令的当然，暑甚则人病为暍，暍甚则死，则暍是中暑之名，所以《金匮要略》《伤寒论》巢元方、陈无择，都以暑病名为中暍。孙思邈认为热死为暍，错了。乃至于张洁古错误地将静而得之称为中暑，中暑者是阴证，李东垣遵从他说：或者避暑热于深堂大厦，其病头痛身疼，恶寒发寒无汗，为房室之阴寒所遏，使周身阳气不得伸越，用大顺散主治。大概不知道这是夏季有意违背时令的凉，犹如冬季因寒就暖之温。（香海注曰：因寒就暖太过，也能致病。）况且夏季天令非时的凉致病，尚且不能名为中暑，犹如冬季非节气的暖之冬温，不能名为伤寒，更何况因暑贪凉的病呢。冬温不可名为伤寒，则静而得之，避暑凉阴，有意违背时令的夏感，不可名为中暑，王安道已经辨明其误，说夏季时阳气在外，阴气在内，岂可空视阴气为寒，而用温热之药，何以夏季要饮水。所谓静而得之的证，虽当暑月，即非暑病，诚然正确。然而未提及冬温不可名为伤寒，夏凉不可名为中暑作为证据，王节斋以夏至后病热为暑，这是错误地将“冬伤于寒，后夏至日为病暑”的暑当作中暑。戴元礼以中暑卒倒不识人名暑风。大概不知道这是中暍之甚，如死之状。巢元方、陈无择所谓不可得冷，用尿和土罨脐中，多有得生之证也。王肯堂说市井之人，日间冒暑经营，夜间开窗露卧，先伤于暑，复感于凉，确实有这种情况。然而不能与静而得之相比，也犹如先伤于寒，复感冬温的意思。张景岳继承洁古、东垣的弊端，而立阴暑之名，大概不知道暑月感违时之凉，仍是感寒，犹如冬季受有意之暖，即是受热。（香海注曰：若以因暑贪凉致病为阴暑，然则因寒就暖致病为阳寒乎？）喻嘉言赞同安道之论，认为静而得之为中暑是不对的，又以避暑热反受阴湿风露，仍为暑证，大概也不知道避暑贪凉致病，不得名为中暑。由此而言，伤寒恶寒，伤暑恶热。伤寒无汗，伤暑有汗。寒是冬季的正邪，暑是夏季的正邪。冬寒内伏，为四时之伏邪。夏暑内伏，为四时之痎疟。是以伏邪或转为痎疟者，兼有夏暑内伏也。痎疟或转为伏邪者，兼有冬寒内伏也。寒暑互伏，如环无端，若冬季的正伤寒，夏季之中暑，俱是中而即发之病，无邪内伏，故无互转之证。（兰亭注曰：伏寒伏暑，互转伏邪痎疟，四时皆有。以转痎疟，即有伏暑。转伏邪，即有伏寒。伏寒因暑而发为伏邪，伏暑因寒而发为痎疟。惟内无所伏，方是伤寒中暑。故伤寒无转痎疟，中暑无转伏邪之理。若伏邪转疟，疟转伏邪，是冬寒夏暑两伏于中，先后互发之证。若冬之伤寒，夏之中暑，是内无所伏即发之证，故伤寒不转痎疟，中暑不转伏邪。盖有伏为伏邪痎疟，无伏为伤寒中暑。）治暑之法，《金匮》用白虎汤，清肃炎氛，加人参辅正气，可以类推矣。瓜蒂散，治饮冷水，水行皮中。大顺散，治违时凉气，皆非治暑。巢元方、陈无择治暍死谓不可得冷，用姜蒜及溺土罨脐等法，以热极则闭，寒不能入，必假温通之意，即同气相求，衰之以属，非治暑不可用冷也。刘河间宗《金匮》，用白虎不加人参，通治暑证，无问表里，盖未达白虎汤加人参之意，用补天真元气。且虚人中暑，岂可例用白虎，故东垣制清暑益气汤及生脉散，以治虚人中暑善矣。然不舍洁古静而得之为中暑，仍用大顺散，盖不知洁古所论，乃避暑贪凉，有意违时致病，不可名暑也。朱丹溪推《金匮》白虎加人参之意，用黄连香薷饮，清心发汗，随证加减。兼内伤，则宗东垣清暑益气汤固是。王节斋清心利小便亦好。王肯堂以市井之人，日间冒暑经营，夜间开窗露卧，先伤于暑，后感于寒，用六和汤、五苓散，此乃圆机。大要暑证，常人白虎加人参汤、黄连香薷饮。兼虚者，清暑益气汤、生脉散。非时之凉，有意避暑及饮冷，为夏感，犹冬温，非中暑，瓜蒂散、大顺散，或藿香正气散。先伤于暑，复感于凉，六和汤、正气散、五苓散。若医案用白虎合生脉，诚为活法。医话樾荫汤，乃中正和平之剂，可通用也。
简略地说：经言寒极生热，热极生寒。此一寒字，即虚字之义。寒伤血，化为热，暑伤气，化为虚。如冬至春，万物茂，寒化热也。夏至秋，万物凋，热化虚也。故伤寒伏邪，宜攻邪为主，中暑痎疟，宜扶正为先，则暑化虚而非寒明矣。
暑证论列方
白虎加人参汤（九） 一物瓜蒂散（十） 大顺散（十一） 清暑益气汤（十二） 生脉散（十三） 黄连香薷饮（十四） 六和汤（十五） 五苓散（十六） 藿香正气散（十七）
湿证第五
《椿田医话》说：化湿汤，主治湿证。湿从土化，寄旺四季，在天则云雨，在地则泥沙，在人则脾胃，在时则长夏，在西北则多化为寒，在东南则多化为热，与燥相反，畏风克制，地气上为云，天气下为雨，虽有上受下受之分，其实皆中土之所化也。从化而来，亦从化而去，故以化湿名之。内受酒浆茶水，外受汗衣等湿，亦同此义。酿而为湿温，著而为痿痹，及或为之证，难以悉举，然当从而化之，以意加减，不可执一。茯苓（五钱） 炙甘草（五分） 制半夏（二钱） 焦白术（二钱） 薏苡仁（三钱） 煨木香（五分） 苦参（二钱）。在上在表，宜汗散，加羌活、独活、防风、川芎、藁本之类。在下在里，宜分利，加猪苓、泽泻、车前子、木通、飞滑石之类。热多加茵陈、川黄连、黄芩之类。寒多加苍术、制附子、油肉桂之类。气虚加人参，血虚加生地，实则加制大黄。
《左传·昭公元年》说：晋侯向秦伯求医，秦伯派医和诊治。又说：雨淫导致腹疾。
《九峰医案》说：脉来滑数无力，证本湿热伤阴，五液日耗，形神慵倦，竟若骨痿不能起于床，法宜补阴化湿，苦寒虽效，究非常服之方，拟甘露饮加减。钗石斛（三钱） 天花粉（三钱） 淡天冬（二钱） 大麦门（三钱） 玄参（钱半） 地骨皮（三钱） 白知母（二钱） 川黄柏（一钱） 黄芩（钱半）。
Jiang Baosu said: Shanghan (Cold Damage) refers to the condition where, during winter when cold qi governs, from after Shuangjiang (Frost's Descent) until before Chunfen (Spring Equinox), one is exposed to frost and dew, causing cold pathogenic factors to manifest in the body. This is the origin of latent heat diseases (Fu Xie Wen Re). It stands in contrast to Zhongshu (Heat Stroke), which occurs during summer when summer heat qi governs, from after Guyu (Grain Rain) until before Qiufen (Autumn Equinox), when one is exposed to the scorching heat of the Sovereign Fire of the Heart (Taiyang Jun Huo).
The *Suwen* (Basic Questions) states in the "Yin Yang Ying Xiang Da Lun" chapter: "If injured by cold in winter, one will suffer from warm diseases in spring." In the "Re Lun" (Treatise on Heat) chapter, it says: "All current heat diseases belong to the category of Shanghan." These various warm disease syndromes described in the *Neijing* are caused by cold pathogens lying latent within since winter. Therefore, I established a section on "Latent Pathogens" (Fu Xie) to specifically discuss warm diseases. Zhang Zhongjing's *Shanghan Lun* contains 397 methods and 113 prescriptions, fully elucidating the profound principles of Shanghan. Due to the extensive text, they are not selected here. Summarizing the essentials: On the first day, the Taiyang meridian is affected. Taiyang governs the exterior qi; its pulse connects to Fengfu (GV16) and runs along the waist and spine, thus causing headache, stiff neck, and stiffness in the lower back and spine. On the second day, the Yangming meridian is affected. Yangming governs the flesh; its pulse runs alongside the nose and connects to the eyes, thus causing fever, eye pain, dry nose, and inability to sleep. On the third day, the Shaoyang meridian is affected. Shaoyang governs the Gallbladder; its pulse runs along the flanks and connects to the ears, thus causing chest and hypochondriac pathology and deafness. If the three Yang meridians are affected but the pathogen has not entered the Fu organs, it can be cured by sweating. On the fourth day, the Taiyin meridian is affected. The Taiyin pulse spreads in the stomach and connects to the throat, thus causing abdominal fullness and dry throat. On the fifth day, the Shaoyin meridian is affected. The Shaoyin pulse passes through the Kidney, connects to the Lung, and ties to the root of the tongue, thus causing dry mouth, dry tongue, and thirst. On the sixth day, the Jueyin meridian is affected. The Jueyin pulse runs along the genitalia and connects to the Liver, thus causing irritability, fullness, and retraction of the scrotum. If the three Yin meridians are affected and the pathogen has entered the Fu organs, it can be cured by purging. (Shanghan transforming into heat occurs after several days, whereas latent pathogenic warm diseases transform into heat after several months; using Chengqi Decoction for purging at that stage follows the same principle.) The sixth day marks the completion of the transmission through the meridians, and the disease should heal. If it does not heal, it will return from the Taiyang meridian. (The concept of "return on the seventh day" or recurrence on the thirteenth day exists; the common belief in the fourteenth day is incorrect.) This describes the general pattern of transmission, but it is not absolute. Some transmit skipping a meridian, some skip over a meridian, some stop after transmitting to two or three meridians, and some remain in one meridian throughout. Some enter via Shaoyang and Yangming; some initially affect Taiyang, do not transmit to Yangming, but suddenly enter Shaoyin, transforming into a true Yin syndrome. Some directly attack the three Yin meridians. There are combined diseases of two Yang or three Yang meridians, concurrent diseases of two Yang meridians, and cases where Shaoyang pathogen pours into the Yangming Stomach Fu organ. Divine wisdom lies in flexible application, depending on the physician. However, customs change, and recently, patients with proper Shanghan are rare. In the regions south of the Yangtze River, where the wind and qi are mild, proper Shanghan is even scarcer; instead, latent pathogenic warm diseases are seen. Yet, all latent pathogenic warm diseases are caused by latent cold from winter. One might ask: If the body's Ying and Wei, Yin and Yang are normal, even slight exposure to wind-cold causes immediate illness; how can cold pathogenic factors lie latent in winter and manifest in spring and summer? The answer is: Proper pathogens (Zheng Xie) can lie latent, but thief pathogens (Ze Xie) cannot. Cold is the proper pathogen of winter. The *Lingshu* chapter "Xie Qi Zang Fu Bing Xing" states: "Proper pathogens injure people subtly; they first appear in the complexion, are not felt in the body, seeming to exist and not exist, seeming to perish and remain, having form and no form, making their nature unknown." The *Suwen* chapter "Ba Zheng Shen Ming Lun" states: "Regarding proper pathogens, if the body is tired from exertion, sweat flows, and pores open, encountering wind-cold, the injury is subtle." Thus, their nature is unknown, and their form is unseen. Generally, during the three winter months, Yang qi is stored internally, and cold pathogens cannot injure. However, if Kidney qi is deficient, the body is fatigued, essence is shaken internally, and sweat leaks externally, cold vapors can take advantage. Seeking like with like, they penetrate deeply into the Shaoyin region. True Yang retreats and consolidates; unable to advance to attack, and pores becoming tight, unable to retreat, they linger and hesitate, inevitably occupying the Mo Yuan (Membrane Source). Mo Yuan is located outside the Zang-Fu organs but inside the physical body. Even tangible accumulations can accommodate it, let alone intangible cold qi. Manifesting due to spring warmth, it is named Warm Disease; manifesting due to summer heat, it is named Summer-Heat Disease; this is the latent pathogen. Therefore, if a person has robust Kidney qi and tight pores, yet encounters severe killing cold, the cold pathogen cannot enter the Kidney but attacks directly the Foot-Taiyang Bladder Water Meridian. Since the Bladder is the Fu organ of the Kidney, this is "Proper Shanghan," which should be treated according to Zhang Zhongjing's *Shanghan Lun*. Proper Shanghan is rare because modern people often have deficient Kidney qi, are physically laborious, and know to avoid severe killing cold. If a person with Kidney deficiency does not avoid severe killing cold, it becomes a critical condition of direct attack on the three Yin meridians. Currently, cold injuries seen in the three winter months are merely aversion to cold, fever, headache, and body pain. Formulas such as Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), Nanyang Baidu San (Nanyang Detoxification Powder), and Xin Zhi Shiwei Qiangfang San (Newly Formulated Ten-Ingredient Notopterygium and Saposhnikovia Powder) used in medical records resolve the condition with one dose of sweating, or severe cases with two or three doses. It is unheard of for them to transmit day by day or present symptoms strictly according to meridians; thus, they are not true Shanghan. For hardworking people whose bodies are fatigued and sweating, and for wealthy families where Kidney deficiency is inevitable, fatigue injures the Kidney, and Kidney exhaustion injures essence. Even without exposing oneself to severe killing cold, proper pathogens lie latent within, causing various latent pathogenic diseases. People today only know to avoid severe cold but fail to perceive the insidious invasion of proper pathogens. They indulge in desires, exhausting their essence, and ignore the command of storage. Patients' conditions therefore hide in obscurity and manifest when people are negligent. Ancient sages named all spring and summer diseases "Shanghan" based on this. This is why cold lies latent in winter and spreads in spring, summer, autumn, and winter, causing more severe illness. Hence, this text briefly discusses Shanghan and details latent pathogenic warm diseases.
Briefly: Zhang Zhongjing wrote the *Shanghan Lun* based on the "Re Lun" chapter of the *Neijing*, and later generations modified miscellaneous diseases based on the *Shanghan Lun*. This is why the *Shanghan Lun* can respond to infinite changes. Many possess this book, and many schools cite its text; therefore, it is not reproduced here, though miscellaneous disease sections may cite it as evidence.
Summer-Heat Syndrome Chapter 4
*Chuntian Yihua* states: Yueyin Tang treats Summer-Heat Syndrome. Summer-heat occurs during the three summer months, from after Guyu until before Qiufen, when one is exposed to steaming hot qi and falls ill immediately. This belongs to the same category as Winter-Cold, which occurs during the three winter months, from after Shuangjiang until before Chunfen, when one is exposed to severe cold qi and falls ill immediately. It differs from the summer-heat resulting from "winter injury by cold leading to summer summer-heat." Summer-heat caused by winter cold manifesting due to summer heat is a latent pathogenic warm disease and should be treated according to the Latent Pathogen section, not listed here. Zhang Jiegu mistakenly called the condition acquired while resting "Zhongshu" (Severe Summer-Heat). The condition acquired while resting is actually an exposure to cool air contrary to summer norms, similar to Dongwen (Winter Warmth) caused by unseasonal warmth in winter. Just as Dongwen cannot be named Shanghan, the condition acquired while resting cannot be named Zhongshu. If acquiring summer-heat due to greed for coolness and excessive consumption of raw/cold foods is considered "acquired while resting," then seeking warmth due to cold and drinking excessively would be "acquired while moving" Shanghan? The *Shanghan Lun* says: "If the gentleman maintains firmness and secrecy, he will not be injured by cold." I deduce from this: If the gentleman maintains stillness and stability, he will not be injured by summer-heat; thus, what is there of "acquired while resting"?
Prescription: Poria (Sanqian), Prepared Pinellia (Qianban), White Lablab Bean (Sanqian), Old Perilla Stem (Yiqian), Patchouli Stem (Qianban), New Lotus Stem (Cunba),宣木瓜 (Yiqian), Raw Licorice (Wufen). If heat is severe, add Coptis (Yiqian). If exterior signs exist, add Schizonepeta (Yiqian). If food stagnation, add Magnolia Bark (Yiqian). For phlegm-dampness in obese individuals, add Talc (Sanqian). For fire in thin individuals, add Phellodendron (Yiqian) or Coptis. For deficient persons, add Shengmai San; if severe, add Astragalus (Erqian).
*Zuo Zhuan* (Duke Zhao Year 1) states: The Marquis of Jin sought medical help from the Earl of Qin, who sent Yi He to examine him. It also states: Excess Yang leads to heat diseases.
Jing Fang's Yi Fei Hou states: Clouds large as cart covers, more than ten in number, indicate seeping Yang qi; there must be deaths from heat stroke.
*Huainanzi* states: Summer-heat causes premature death. It also states: King Wu gathered heat-stroke victims under tree shade, embracing them with his left hand and fanning them with his right, so the world cherished his virtue.
*Jiufeng Yian* states: Pulse is slippery, rapid, and weak. The syndrome is damp-heat injuring Yin, daily depletion of the five fluids, lethargy of form and spirit, resembling bone-withering inability to rise from bed. The method should tonify Yin and transform dampness. Although bitter-cold herbs are effective, they are not for long-term use. Prescribe Ganlu Yin with modifications: Dendrobium (Sanqian), Trichosanthes Root (Sanqian), Light Anemarrhena (Erqian), Large Ophiopogon (Sanqian), Scrophularia (Qianban), Ground Tree Bark (Sanqian), White Anemarrhena (Erqian), Phellodendron (Yiqian), Scutellaria (Qianban).
Summer-heat must be accompanied by dampness. Qi steaming and attaching causes disease. Dampness thrives in the four seasons, changing with the six qi, becoming heat due to summer-heat, injuring Qi and Yin. Symptoms include lethargy, soft pulse, fever, spontaneous sweating, aversion to wind, thirst, normal urination and defecation, loss of appetite, and mutual pathology of the Heart, Spleen, and Lung meridians. Prescribe Dongyuan's Qing Shu Yi Qi Tang with slight modifications. Ginseng (Wufen), Winter Atractylodes (Wufen), Tangerine Peel (Wufen), Zeaxia (Wufen), Medicated Leaven (Wufen), Roasted Licorice (Wufen), Phellodendron (Sifen), Angelica Sinensis Body (Sifen), Ophiopogon (Sifen), Green Citrus Peel (Sifen), Gingered Kudzu Root (Sifen), Schisandra (Wuli), Poria (Wufen).
Jiang Baosu states: Summer-Heat Syndrome occurs when summer heat qi governs, from after Guyu until before Chunfen, when one is exposed to the scorching heat of the Sovereign Fire and falls ill immediately. It is the origin of intermittent fevers (Jiemai), distinct from the summer-heat resulting from "winter injury by cold leading to summer summer-heat." It stands in contrast to Winter-Cold, which occurs when winter cold qi governs, from after Shuangjiang until before Chunfen, when one is exposed to severe cold qi and falls ill immediately (Proper Shanghan). Summer-heat caused by winter cold manifesting due to summer heat is a latent pathogen and should be discussed in the Latent Pathogen section, not here. (My friend Xu Xianghai said: Latent pathogens manifesting due to summer heat move from inside out, with turbid red urine. Immediate summer-heat moves from outside in, with clear urine.) The *Suwen* "Sheng Qi Tian Tong Lun" states: "Due to summer-heat, sweating; if irritable, panting and shouting; if quiet, speaking much." The "Yin Yang Ying Xiang Da Lun" states: "Summer heat leads to summer-heat, autumn leads to intermittent fevers." The "Ci Zhi Lun" states: "Qi deficiency with body heat results from injuring summer-heat." The "Wu Yun Xing Da Lun" states: "Summer-heat steams." The "Qi Jiao Bian Da Lun" states: "Excessive annual fire leads to widespread hot summer-heat." These chapters explain that summer-heat causes sweating, latent summer-heat causes intermittent fevers, and Qi deficiency with body heat is injuring summer-heat. Summer-heat steams, excessive annual fire leads to widespread hot summer-heat; summer-heat is clearly a heat syndrome. Why did Zhang Jiegu say "acquired while resting is Zhongshu," and that Zhongshu is a Yin syndrome? The *Nanjing* states Zhongshu involves body heat and irritability. *Zuo Zhuan* mentions Yang excess heat disease. Jing Fang mentions heat-stroke deaths. *Huainanzi* mentions shading heat-stroke victims. All treat summer-heat/stroke as heat syndromes, consistent with the *Neijing*. Generally, summer-heat is the natural decree of summer; severe summer-heat causes illness called "Ye"; severe Ye causes death. Thus, Ye is the name for Zhongshu. Therefore, *Jingui Yaolue*, *Shanghan Lun*, Chao Yuanfang, and Chen Wuyue all named summer-heat disease "Zhong Ye". Sun Simiao considered heat-death as Ye, which was wrong. Zhang Jiegu mistakenly called "acquired while resting" Zhongshu, a Yin syndrome. Li Dongyan followed him: Avoiding summer heat in deep halls causes headache, body ache, aversion to cold, chills, no sweat, suppressed by the Yin-cold of rooms, preventing Yang qi extension. Treat with Dashun San. They failed to realize this is intentional cooling contrary to seasonal norms, similar to seeking warmth in winter (Dongwen). (Xianghai note: Excessive seeking of warmth also causes disease.) Moreover, illness from unseasonal summer cooling cannot be named Zhongshu, just as unseasonal winter warmth cannot be named Shanghan, let alone illness from greed for coolness in summer. Wang Andao already refuted this, stating that in summer, Yang qi is outside and Yin qi is inside; one cannot view Yin qi as cold and use warming herbs, hence the need for drinking water in summer. The so-called "acquired while resting" syndrome, though in summer months, is not a summer-heat disease, which is correct. However, lacking evidence that "winter warmth cannot be named Shanghan" and "summer cooling cannot be named Zhongshu," Wang Jiezhai defined heat illness after Summer Solstice as summer-heat, mistakenly equating "winter injury by cold leading to summer summer-heat" with Zhongshu. Dai Yanli named sudden collapse and unconsciousness in Zhongshu as "Shu Feng" (Summer Wind). He likely did not know this was extreme Zhong Ye, resembling death. Chao Yuanfang and Chen Wuyue stated that for those unable to tolerate cold, applying urine-mixed earth to the umbilicus often saves lives. Wang Kentang noted that market people, working in summer heat by day and sleeping with windows open by night, first injure summer-heat, then catch cold. This is true. But it is not comparable to "acquired while resting," similar to first injuring cold then catching Dongwen. Zhang Jingyue inherited the errors of Jiegu and Dongyan, establishing the name "Yin Shu" (Yin Summer-Heat). He did not realize that contracting unseasonal coolness in summer is still contracting cold, just as receiving intentional warmth in winter is receiving heat. (Xianghai note: If illness from greed for coolness in summer is Yin Shu, then illness from seeking warmth in winter is Yang Han?) Yu Jiayan supported Andao's view that "acquired while resting" is not Zhongshu, but argued that avoiding heat and suffering Yin-damp/wind/dew remains a summer-heat syndrome, failing to realize that illness from avoiding heat and greed for coolness cannot be named Zhongshu. Thus, Shanghan involves aversion to cold; Shushu involves aversion to heat. Shanghan has no sweat; Shushu has sweat. Cold is the proper pathogen of winter; summer-heat is the proper pathogen of summer. Winter cold lying latent is the latent pathogen of the four seasons. Summer heat lying latent is the intermittent fever of the four seasons. Therefore, latent pathogens turning into intermittent fevers involve latent summer heat. Intermittent fevers turning into latent pathogens involve latent winter cold. Cold and heat lie latent in each other, like a circle without end. Proper Shanghan in winter and Zhongshu in summer are diseases manifesting immediately upon injury, with no latent pathogen, hence no mutual transformation. (Lanting note: Latent cold and latent summer heat mutually transform into latent pathogens and intermittent fevers in all seasons. Transforming into intermittent fever implies latent summer heat; transforming into latent pathogen implies latent cold. Latent cold manifesting due to summer heat becomes latent pathogen; latent summer heat manifesting due to cold becomes intermittent fever. Only when there is no internal latency is it Shanghan or Zhongshu. Thus, Shanghan does not transform into intermittent fever, and Zhongshu does not transform into latent pathogen. If latent pathogen transforms to malaria, and malaria to latent pathogen, it means both winter cold and summer heat are latent within, manifesting sequentially. Winter Shanghan and summer Zhongshu are immediate manifestations with no internal latency; thus, Shanghan does not transform into intermittent fever, and Zhongshu does not transform into latent pathogen. Having latency makes it latent pathogen/intermittent fever; having no latency makes it Shanghan/Zhongshu.) Treatment of summer-heat: *Jingui* uses Baihu Tang to clear scorching vapors, adding Ginseng to support righteous Qi; this can be extrapolated. Gouti San treats drinking cold water, where water moves in the skin. Dashun San treats unseasonal cool air; neither treats summer-heat. Chao Yuanfang and Chen Wuyue, treating heat-stroke death, stated one cannot seek cold. Using ginger, garlic, and urine-earth applied to the umbilicus relies on the principle that extreme heat closes pores, preventing cold entry, requiring warm-unblocking methods (seeking like with like, reducing by affinity). It is not that summer-heat treatment cannot use cold. Liu Hejian followed *Jingui*, using Baihu Tang without Ginseng to treat all summer-heat, regardless of interior/exterior, failing to understand the meaning of adding Ginseng to tonify innate Qi. Moreover, can deficient persons with summer-heat routinely use Baihu Tang? Therefore, Dongyuan created Qing Shu Yi Qi Tang and Shengmai San to treat deficient persons with summer-heat, which is excellent. However, retaining Jiegu's "acquired while resting is Zhongshu" and still using Dashun San shows ignorance that Jiegu's discussion referred to intentional avoidance of heat and greed for coolness, causing illness contrary to season, which cannot be named summer-heat. Zhu Danxi deduced the meaning of *Jingui*'s Baihu Tang plus Ginseng, using Huanglian Xiangru Yin to clear the Heart and induce sweating, modifying according to syndrome. For concomitant internal injury, following Dongyuan's Qing Shu Yi Qi Tang is correct. Wang Jiezhai's clearing the Heart and promoting urination is also good. Wang Kentang used Liuhe Tang and Wuling San for market people who first injure summer-heat then catch cold, showing flexibility. Generally, for ordinary people with summer-heat, use Baihu Jia Renshen Tang or Huanglian Xiangru Yin. For concomitant deficiency, use Qing Shu Yi Qi Tang or Shengmai San. For unseasonal coolness, intentional heat avoidance, and drinking cold (Summer Sensation, like Dongwen, not Zhongshu), use Gouti San, Dashun San, or Huoxiang Zhengqi San. For first injuring summer-heat then catching cold, use Liuhe Tang, Zhengqi San, or Wuling San. Using Baihu combined with Shengmai in medical records is indeed a flexible method. Yueyin Tang in medical conversations is a balanced and harmonious formula, suitable for general use.
Briefly: The Classics state: Extreme cold generates heat; extreme heat generates cold. This character "cold" implies "deficiency." Cold injures Blood, transforming into heat; summer-heat injures Qi, transforming into deficiency. Like winter turning to spring, all things flourish; cold transforms to heat. Like summer turning to autumn, all things wither; heat transforms to deficiency. Thus, for Shanghan and latent pathogens, attacking the pathogen should be primary; for Zhongshu and intermittent fevers, supporting righteousness should come first. Then it is clear that summer-heat transforms to deficiency, not cold.
Formulas Listed for Summer-Heat Syndrome
Baihu Jia Renshen Tang (9) Yiwu Gouti San (10) Dashun San (11) Qing Shu Yi Qi Tang (12) Shengmai San (13) Huanglian Xiangru Yin (14) Liuhe Tang (15) Wuling San (16) Huoxiang Zhengqi San (17)
Dampness Syndrome Chapter 5
*Chuntian Yihua* states: Huashi Tang treats Dampness Syndrome. Dampness transforms from Earth, thriving in the four seasons. In heaven, it is clouds and rain; in earth, mud and sand; in humans, Spleen and Stomach; in time, Late Summer. In the northwest, it mostly transforms to cold; in the southeast, mostly to heat. It opposes Dryness, fears Wind control. Earth qi rises to become clouds; heaven qi descends to become rain. Although there is distinction between upper and lower reception, essentially all transform from Central Earth. Coming from transformation, going by transformation, hence named Huashi. Internally receiving wine/tea, externally receiving sweat-damp clothes, shares this meaning. Brewing into Damp-Warmth, attaching causing Flaccidity and Bi, and other syndromes are too numerous to list. However, one should follow transformation to resolve it, modifying by intent, not adhering rigidly. Poria (Wuqian), Roasted Licorice (Wufen), Prepared Pinellia (Erqian), Scorched Atractylodes (Erqian), Coix Seed (Sanqian), Gingered Aucklandonia (Wufen), Sophora Root (Erqian). If in the upper/exterior, use sweating/dispersing, adding Notopterygium, Saposhnikovia, Saposhnikovia, Ligusticum, Lithospermum, etc. If in the lower/interior, use separating/draining, adding Polyporus, Alisma, Plantago Seed, Akebia Stem, Precipitated Talc, etc. If heat increases, add Artemisia Capillaris, Coptis, Scutellaria. If cold increases, add Atractylodes Lancea, Prepared Aconite, Cassia Twig. If Qi deficiency, add Ginseng; if Blood deficiency, add Rehmannia; if excess, add Prepared Rhubarb.
*Zuo Zhuan* (Duke Zhao Year 1) states: The Marquis of Jin sought medical help from the Earl of Qin, who sent Yi He to examine him. It also states: Excess Rain leads to abdominal diseases.
*Jiufeng Yian* states: Pulse is slippery, rapid, and powerless. The syndrome is fundamentally damp-heat injuring Yin, daily depletion of the five fluids, lethargy of form and spirit, resembling bone-withering inability to rise from bed. The method should tonify Yin and transform dampness. Although bitter-cold herbs are effective, they are not for long-term use. Prescribe Ganlu Yin with modifications: Dendrobium (Sanqian), Trichosanthes Root (Sanqian), Light Anemarrhena (Erqian), Large Ophiopogon (Sanqian), Scrophularia (Qianban), Ground Tree Bark (Sanqian), White Anemarrhena (Erqian), Phellodendron (Yiqian), Scutellaria (Qianban).