观仲景论伤寒，则知中暑中 中热，同一夏令之病，但其脉证有虚实耳。何洁古强以动
静分
暑热，而与夏日伤冷之病并称乎？此亦名不正矣。大约暑之伤也，劳苦多得之。闱要云∶暑
邪中太阳，开腠理，夺正气，若随汗大泄，邪不入里，所谓精气夺则虚。而发热者，虚火是
也。脉当迟细，宜扶正气为主，带祛暑邪，清暑益气汤之类是也。东垣又有血虚发热，证类
白虎，惟脉不长为辨，此又似中暑而非中暑，类伤寒又有类中暑，辨不可不明，治岂可不慎
哉。
湿者，天地间阴阳蒸润之气也。所感之由，或因雾露之侵，或因阴雨所客，或因汗出沾
衣，
为风所阏。或因涉水行泥，为寒所郁。或因引饮过多，或以卑湿之地，有伤于皮肉筋骨。或
感头面四肢，尤多患于腰脚者，盖伤湿则下先受之也。更喜侵于脾胃者，以其同气相感也。
大抵湿之为病，感于寒则为寒湿，兼于风则为风湿，动于火则为湿热，逆于气则为湿气，郁
聚于中则为痰。流注于下则为水，入皮肤则为顽痹，入气血则为倦怠。入肺则为喘满，入脾
则为湿痰肿胀，面目萎黄，入肝则胁满而四节不利，入肾则腰痛胯痛，身如板夹，胁如沙坠
。入腑则麻木不仁，入脏则肢体强直。注于关节，或肿或疼；流于经络，难伸难屈；滞于经
脉，则为香港脚等疾。若内素有寒湿，或初患浮肿等证，又重感外湿，以致内外交攻，正气衰
竭，卒倒无知，似乎中风，其脉沉涩细迟者，即中湿也。凡治者，宜分其属寒属热以施之。
湿热者，脉必洪数沉实，证必溺赤口渴，如水之潴蓄而无从得出之，故宜利小便为主。即开
沟渠以泄水之义也。寒湿者，脉必沉细缓弱，证必倦怠濡泄，如地雨泥而不能生物之象，故
用燥脾土为主，犹用干灰以收泥湿之义也。外如中湿者，乃寒湿之甚，阳气衰微，非参、芍
、桂附等甘温辛热之剂，不能治之。又如积冻凝阴，雨雪相继，而求开霁回春于和气杲日之
义也。是以湿之为病，所在皆有，而人不知治者众矣。医者宜审之。
观察张仲景对伤寒的论述，就可以知道中暑和中热，都是夏季常见的疾病，只是它们的脉象和症状有虚证和实证的区别。何洁古强行用“动”与“静”来区分暑热，并将其与夏日受寒的疾病并列，这也是名不副实。大抵暑邪伤人，多因劳苦所致。《闱要》说：暑邪侵犯太阳经，使腠理开泄，耗夺正气，如果随着汗液大量流失，邪气就不入里，这就是所谓的“精气被夺则表现为虚证”。而出现的发热，是虚火所致。脉象应当迟细，治疗应以扶助正气为主，兼以祛除暑邪，清暑益气汤之类的方剂就是如此。李东垣又有血虚发热的说法，其症状类似白虎汤证（阳明经热盛），只有脉象不长作为鉴别，这又像是中暑又不是中暑，类伤寒又有类似中暑的情况，辨证不可不明确，治疗岂可不谨慎呢？
湿，是天地间阴阳蒸腾滋润的气。感受湿邪的原因，有的因为雾露侵袭，有的因为阴雨停留，有的因为出汗沾衣，被风邪郁遏。有的因为涉水行泥，被寒气郁结。有的因为饮水过多，或者处于低洼潮湿之地，损伤了皮肉筋骨。湿气或侵犯头面四肢，尤其多患于腰脚，这是因为伤湿则下部先受邪。更喜好侵犯脾胃，是因为同气相感。大抵湿邪致病，感受寒邪则为寒湿，兼夹风邪则为风湿，触动火邪则为湿热，逆乱气机则为湿气，郁结聚积在中焦则为痰。流注于下焦则为水饮，侵入皮肤则为顽痹，侵入气血则为倦怠。进入肺则为喘满，进入脾则为湿痰肿胀，面目萎黄，进入肝则胁肋胀满且四肢关节不利，进入肾则腰痛胯痛，身体像木板夹住一样僵硬，胁部感觉像沙子坠着沉重。进入腑则麻木不仁，进入脏则肢体强直。注于关节，或肿或疼；流于经络，难以伸展弯曲；滞于经脉，则形成香港脚等病。如果体内素来有寒湿，或者初患浮肿等症状，又再次感受外湿，导致内外交攻，正气衰竭，突然昏倒无知，似乎中风，但脉象沉涩细迟的，就是中湿。凡是治疗，应该分辨属于寒还是属于热来施治。湿热者，脉象必定洪数沉实，症状必定小便赤黄口渴，就像水积聚而无法排出，所以宜以利小便为主，这就是开沟渠以泄水的道理。寒湿者，脉象必定沉细缓弱，症状必定倦怠濡泄，就像地雨泥泞不能生养万物的景象，所以用燥脾土为主，犹如有干灰吸收泥土湿气的道理。另外如中湿者，乃是寒湿之极甚，阳气衰微，非人参、芍药、桂枝、附子等甘温辛热的药剂，不能治愈。这就像积雪冰冻阴冷，雨雪相继，而要寻求在和气杲日之下开霁回春的道理一样。因此湿邪致病，到处都有，而人们不知道治疗的很多。医者应当审慎考察。
Observing Zhang Zhongjing’s (Zhang Jingyue) discussion on Shanghan (Cold Damage), one can understand that Shuzhong (Heatstroke due to summer heat) and Zhongre (Heatstroke due to excessive heat) are both diseases occurring in the summer season, differing only in their pulse manifestations and symptoms, which may be of deficiency or excess. He Jiegu (He Xuan) forcibly distinguished summer heat by "movement" and "stillness," grouping it with diseases caused by cold in summer; this is an improper naming convention. Generally, summer heat injures those who engage in hard labor. The *Wei Yao* states: Summer-heat pathogen invades the Taiyang channel (Taiyang meridian syndrome), opening the cou-li (pores), and depleting healthy qi. If sweat flows profusely, the pathogen does not penetrate inward, which is referred to as "depletion of essence and qi leads to deficiency." The resulting fever is due to deficient fire. The pulse should be slow and fine; treatment should primarily support healthy qi while dispelling summer-heat pathogens, such as with Qing Shu Yi Qi Tang (Clear Heat and Benefit Qi Decoction). Li Dongyuan also described fever due to blood deficiency, where symptoms resemble Baihu Tang syndrome (Yangming Channel Excess Heat), distinguishable only by a pulse that is not long. This resembles summer heat but is not summer heat; Lei Shanghan (Shanghan-like syndromes) includes cases resembling summer heat. Differentiation must be clear, and treatment must be cautious.
Shi (Dampness) is the moistening vapor generated by the interaction of yin and yang in heaven and earth. Causes of contracting dampness include invasion by fog and dew, lingering rainy weather, sweat-soaked clothing obstructed by wind, wading through water or mud causing cold stagnation, excessive drinking, or residing in low, damp places injuring skin, flesh, sinews, and bones. Dampness often affects the head, face, and limbs, particularly the waist and legs, because dampness injury first affects the lower body. It has a special affinity for the Spleen and Stomach due to similar energetic qualities. Generally, when dampness combines with cold, it becomes Cold-Dampness; with wind, Wind-Dampness; with fire, Damp-Heat; disrupting qi mechanism, it becomes Damp-Qi; stagnating in the middle jiao, it transforms into Tan (Phlegm); flowing downward, it becomes Shui (Water retention); entering the skin, it causes stubborn Bi syndrome (obstruction); entering qi and blood, it causes fatigue. Entering the Lung, it causes panting and fullness; entering the Spleen, it causes Damp-Phlegm swelling, sallow complexion; entering the Liver, it causes hypochondriac fullness and limb stiffness; entering the Kidney, it causes lower back and hip pain, a sensation of the body being clamped like wood, and heaviness in the flanks. Entering the Fu organs, it causes numbness and insensitivity; entering the Zang organs, it causes limb rigidity. Accumulating in joints, it causes swelling or pain; flowing through collaterals, it limits extension and flexion; stagnating in meridians, it causes conditions such as Hongxiangjiao (Gout/Charcot foot). If there is pre-existing internal Cold-Dampness or initial edema, compounded by external dampness, leading to internal and external attack, depletion of healthy qi, sudden collapse and unconsciousness resembling Zhongfeng (Wind Stroke), but with a deep, choppy, fine, and slow pulse, this is Zhongshi (Dampness Stroke). Treatment must differentiate between cold and heat. For Damp-Heat, the pulse is typically surging, rapid, deep, and solid, with symptoms of dark urine and thirst, resembling stagnant water unable to drain; thus, promoting urination is primary, akin to dredging channels to release water. For Cold-Dampness, the pulse is deep, fine, slow, and weak, with symptoms of fatigue and loose stools, resembling muddy ground unable to nourish life; thus, drying Spleen Earth is primary, akin using dry ash to absorb mud moisture. Regarding Zhongshi, it is extreme Cold-Dampness with depleted yang qi, requiring sweet-warm and pungent-hot formulas containing Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Lateralis Radix Preparata). This is like seeking spring warmth after continuous freezing snow and ice. Therefore, dampness diseases are ubiquitous, yet few know how to treat them. Physicians must examine this carefully.