中暑之证，身热头痛，背寒面垢，自汗烦燥，大渴口干，倦怠而身不痛，或时恶寒，或畏日气，脉虚而弱。无问
表里，通宜白虎汤，并感冒发热烦渴，五苓散、桂枝茯苓甘露饮、黄连香薷饮，或双解散，或里热甚，腹满而脉沉可
下者，大承气汤下之，或三一承气汤尤妙。半表半里者，小柴胡汤、凉膈散、天水散。
按∶刘河间论暑证甚详，独明于诸家用药，头头中款，可谓得其解者。但暑证不分表里，一味清内，得寒凉而解，
苦酸而收，不必用下，承气汤走马之粪也。却之却之。
刺志论云∶气虚身热，得之伤暑，热伤气故也。痿论云∶有所远行劳倦，逢大热而渴，则阳气内伐，则热舍于肾，
肾者水脏也。今水不能胜火，则骨枯而髓虚，足不任身，发为骨痿，故下经曰∶骨痿者，生于大热也。此湿热成痿，
令人骨乏无力，故治痿独取阳明，时当长夏，湿热大胜，蒸蒸而炽，人感之多，四肢困倦，精神短少，懒于动作，脑气
促，肢节沉痛，或气高而喘，身热而烦，心下膨痞，小便黄而少，大便
溏而频，或痢出黄糜，或如泔色，或渴或不渴，不思饮食，自汗体重，或汗少者，血先病而气不病也。自时当长夏
至此，已采入正款，不敢摆刖，故重出其脉中得洪缓，若湿气相搏，必加以迟，病虽互换少差，其天暑湿令则一也。
宜以清燥之剂治之，名曰清暑益气汤主之。
清暑益气汤
黄 （汗少者减五分） 苍术（泔浸，去皮，各一钱五分） 升麻（一钱） 人参（去芦） 白术 橘皮 神曲
（炒） 泽泻（各五分） 甘草 黄柏（酒浸） 当归身 麦门冬（去心） 青皮（去白） 葛根（各三分） 五味
（九个）
《内经》云∶阳气者卫外而为固也，炅则气泄，今暑邪干卫，故身热自汗。以黄 、人参、甘草、补中益气为君，
橘皮、当归身、甘辛微温，养胃气，和血脉为臣，苍术、白术、泽泻、渗利除湿，升麻、葛根、苦甘平，善解肌热，
又以风胜湿也，湿胜则湿不消而作痞满，故炒曲甘辛，青皮辛温，消食快气，肾恶燥，急食辛以润之，以黄柏苦辛寒，
借甘味泻热补水虚者，滋其化源，以五味子、麦门冬、酸甘微寒，救天暑之伤庚金为佐也。
上 咀作一服，水二盏，煎至一盏，去粗稍热，食远服。
按∶东垣意见精密。立方中和，清暑益气汤一剂近世多宗之。然气血虚弱之人，用之最宜，如遇强壮者，不能取效，
且助温火，不可不斟酌也。
中暑的病症，表现为身体发热、头痛，背部怕冷、面色污垢，自汗、烦躁，极度口渴且口干，疲倦乏力但身体不疼痛，有时恶寒，或畏惧日光热气，脉象虚而弱。不论病在表还是在里，都适宜使用白虎汤；如果是感冒引起的发热、烦躁和口渴，可用五苓散、桂枝茯苓甘露饮、黄连香薷饮，或者双解散；如果体内热邪严重，腹部胀满且脉象沉实可以攻下的，用大承气汤泻下，或者三一承气汤效果更佳。病在半表半里的，用小柴胡汤、凉膈散、天水散。
按语：刘河间论述暑证非常详细，唯独对各家用药分析得头头是道，可谓深得其中奥妙。但是暑证不分表里，一味清解内热，依靠寒凉药物使病邪解除，利用苦酸药物收敛，不必使用攻下法，承气汤如同走马般峻猛攻逐粪便。排斥它，排斥它。
《刺志论》说：气虚而身体发热，是由于伤暑所致，因为热邪损伤了气。《痿论》说：如果有远行劳倦，遇到大热而口渴，那么阳气在内被热邪侵伐，热邪就会留舍于肾，肾是水脏。现在水不能胜过火，就会导致骨骼枯槁而骨髓空虚，双脚无法支撑身体，发展为骨痿，所以《下经》说：骨痿，是由于大热引起的。这是湿热导致痿证，使人骨骼乏力无力，所以治疗痿证独取阳明经。时值长夏季节，湿热盛行，热气蒸腾炽盛，人们感受较多，四肢困倦，精神不足，懒得活动，呼吸急促，肢体关节沉重疼痛，或者气逆喘息，身体发热而烦躁，心下部胀满痞塞，小便黄而量少，大便稀溏而次数多，或者痢疾排出黄色糜烂物，或者像米泔水颜色，或者口渴或者不渴，不想饮食，自汗且身体沉重，或者汗少的，这是血先受病而气未受病。从这时到长夏，已经采入正题，不敢偏颇，所以重新列出脉象中得洪缓，如果湿气相搏，必然加上迟脉，病情虽然稍有差异，但天暑湿令是一致的。适宜用清燥的药剂治疗，名为清暑益气汤主治。
清暑益气汤
黄芪（汗少者减去五分） 苍术（用米泔水浸泡，去皮，各一钱五分） 升麻（一钱） 人参（去芦头） 白术 陈皮 神曲（炒） 泽泻（各五分） 甘草 黄柏（酒浸） 当归身 麦门冬（去心） 青皮（去白） 葛根（各三分） 五味子（九个）
《内经》说：阳气护卫体表而固密，受热则气泄，现在暑邪侵犯卫气，所以身体发热自汗。以黄芪、人参、甘草，补益中气为君药；陈皮、当归身，甘辛微温，养胃气，调和血脉为臣药；苍术、白术、泽泻，渗利除湿；升麻、葛根，苦甘平，善于解肌热，又借风药胜湿。湿胜则湿气不消而产生痞满，所以炒神曲甘辛，青皮辛温，消食快气。肾恶燥，急食辛以润之，用黄柏苦辛寒，借甘味泻热补水虚者，滋养化源；用五味子、麦门冬，酸甘微寒，救治暑热伤害肺金为佐药。
以上锉成粗末，作一服，用水两盏，煎至一盏，去掉粗渣，稍热服用，在饭后远时服用。
按语：东垣的意见精密。立方中和，清暑益气汤这一方剂近世大多推崇它。然而对于气血虚弱的人，使用最为适宜，如果遇到强壮的人，不能取得疗效，且会助长温火，不可不斟酌考虑。
The syndrome of heatstroke manifests as fever, headache, coldness in the back, a greasy facial complexion, spontaneous sweating, irritability, extreme thirst with dry mouth, fatigue without body pain, occasional aversion to cold, or fear of sunlight and hot air, with a pulse that is deficient and weak. Regardless of whether the pathogen is in the exterior or interior, Baihu Tang (White Tiger Decoction) is generally appropriate. For fever, irritability, and thirst caused by common cold, Wuling San (Five-Ingredient Powder with Poria), Guizhi Fuling Ganlu Yin (Cinnamon Twig, Poria, and Sweet Dew Decoction), Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction), or Shuangjie San (Double-Release Powder) may be used. If internal heat is severe, accompanied by abdominal fullness and a deep pulse indicating constipation suitable for purgation, Dachengqi Tang (Major Order the Qi Decoction) should be used to purge, or Sanyi Chengqi Tang (Three-One Order the Qi Decoction) is even better. For half-exterior half-interior conditions, Xiaochaihu Tang (Minor Bupleurum Decoction), Liangge San (Cool the Diaphragm Powder), or Tianshui San (Heaven and Water Powder) are indicated.
Commentary: Liu Hejian's discussion on heatstroke syndromes is very detailed, and his analysis of various physicians' medication strategies is precise and accurate, truly grasping the essence. However, regarding heatstroke, distinguishing between exterior and interior is unnecessary; one should solely clear internal heat, resolving the condition with cold-cooling herbs and astringing with bitter-sour ones, without needing purgatives. Dachengqi Tang acts swiftly like a galloping horse to purge feces; it should be rejected.
The *Cistao Lun* (Treatise on Acupuncture Points) states: "Qi deficiency with body heat results from injury by summerheat, as heat injures Qi." The *Weilun* (Treatise on Flaccidity Syndromes) states: "If one travels far and becomes fatigued, encountering intense heat and thirst, Yang Qi is internally attacked by heat, causing heat to lodge in the Kidney. The Kidney is the Water Organ. Now, if Water cannot overcome Fire, bones become withered and marrow empty, feet cannot support the body, developing into bone flaccidity (Gu Wei). Thus, the *Xia Jing* says: 'Bone flaccidity arises from great heat.' This refers to damp-heat causing flaccidity, leading to skeletal weakness and lack of strength. Therefore, treating flaccidity focuses exclusively on the Yangming channel. During late summer, damp-heat prevails, steaming and blazing intensely. People often contract it, resulting in limb fatigue, diminished spirit, reluctance to move, rapid breathing, heaviness and pain in joints, or qi rebellion with panting, body heat with irritability, epigastric distension and stuffiness, yellow and scanty urine, loose and frequent stools, or dysentery discharging yellow mushy matter or rice-water colored fluid, thirst or no thirst, loss of appetite, spontaneous sweating with heavy body, or scanty sweating, which indicates blood disease preceding qi disease. From this time until late summer, already incorporated into the main text, avoiding bias, we restate that the pulse is洪缓 (surging and slow); if dampness combats, it adds a 迟 (slow) quality. Although diseases vary slightly, the heavenly heat and damp command remain the same. It is appropriate to treat with drying and clearing agents, named Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction).
Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction):
Huangqi (Astragali Radix) [reduce by 5 fen if sweating is scant]
Cangzhu (Atractylodis Rhizoma) [soaked in rice water, skin removed, 1.5 qian each]
Shengma (Cimicifugae Rhizoma) [1 qian]
Renshen (Ginseng Radix) [remove rhizome]
Baizhu (Atractylodis Macrocephalae Rhizoma)
Chenpi (Citri Reticulatae Pericarpium)
Shenqu (Massa Medicata Fermentata) [stir-fried]
Zexie (Alismatis Rhizoma) [0.5 qian each]
Gancao (Glycyrrhizae Radix et Rhizoma)
Huangbai (Phellodendri Cortex) [wine-soaked]
Dangguishen (Angelicae Sinensis Radix)
Maimendong (Ophiopogonis Radix) [remove heart]
Qingpi (Citri Reticulatae Pericarpium Viride) [remove white pith]
Gegen (Puerariae Lobatae Radix) [0.3 qian each]
Wuweizi (Schisandrae Chinensis Fructus) [9 berries]
The *Neijing* states: "Yang Qi guards the exterior and maintains solidity. Heat causes Qi to leak. Now, summerheat pathogen invades the Defensive Qi, causing body heat and spontaneous sweating. Huangqi, Renshen, and Gancao tonify Middle Qi and boost energy, serving as Sovereign herbs. Chenpi and Dangguishen, being sweet, pungent, and slightly warm, nourish Stomach Qi and harmonize Blood vessels, serving as Minister herbs. Cangzhu, Baizhu, and Zexie promote diuresis and drain dampness. Shengma and Gegen, bitter, sweet, and neutral, effectively release muscle-layer heat, utilizing wind herbs to overcome dampness. If dampness prevails, it fails to dissipate and causes distension and fullness; thus, stir-fried Shenqu is sweet and pungent, Qingpi is pungent and warm, digesting food and moving Qi. The Kidney dislikes dryness; urgently eat pungent substances to moisten it. Huangbai, bitter, pungent, and cold, borrows the sweet flavor to clear heat and replenish fluids for deficiency, nourishing the source of transformation. Wuweizi and Maimendong, sour, sweet, and slightly cold, rescue Lung Metal injured by summerheat, serving as Assistant herbs.
Grind these into coarse pieces for one dose. Add two cups of water, decoct to one cup, remove dregs, and take when slightly warm, long after meals.
Commentary: Dong Yuan's intentions are precise. His formula formulation is balanced. Qing Shu Yi Qi Tang has been widely followed in recent times. However, it is most suitable for individuals with Qi and Blood deficiency. For robust individuals, it may not be effective and could exacerbate internal heat; therefore, careful consideration is necessary.