受补者。皆难图治也。时疫变证多端。未能一一曲尽。谨陈大略数则。庶不负宪恩之泽及黎庶。
垂问刍荛也。
飞畴治郑月山女。寡居二十载。五月间忽壮热多汗。烦渴。耳聋胁痛。月山为女科名宿。谓
证属伤寒。委之他医。用柴、葛、桂枝等剂。其热弥甚。汗出不止。胸满昏沉。时时噫气。邀予
诊之。右脉数大。左脉少神。舌苔微黑。此伏气自内少阳发出。故耳聋胁痛。法当用白虎清解。
反行发表。升越其邪。是以热渴转甚。汗出多。故左脉无神。胃液耗。故昏沉胸满。其噫气者。
平素多郁之故。今元气已虚。伏邪未解。与凉膈去硝黄易栝蒌根、丹皮、竹叶。一服热减得睡。
但汗不止。倦难转侧。或时欲呕。此虚也。以生脉加枣仁、茯神、白芍。扶元敛阴。兼进粥饮以
扶胃气。渴止汗敛。而脉转虚微欲绝。此正气得补。而虚火潜息之真脉也。复与四君、归、地。
调补而痊。
素问云。因于暑。汗烦则喘喝。静则多言。
暑气内扰于营则汗。上迫于肺则烦喘。内干于心则多言。总不离乎热伤心胞。而蒸肺经之证也。
金匮云。太阳中 。发热恶寒。身重而疼痛。其脉弦细芤迟。小便已。洒洒然毛耸。手足逆
冷。小有劳。身即热。口开前板齿燥。若发其汗则恶寒甚。加温针则发热甚。数下之则淋甚。
太阳中 。发热恶寒。身重而疼痛。此因暑而伤风露之邪。手太阳标证也。太阳小肠属火。
上应心胞。二经皆能制金烁肺。肺受火刑。所以发热恶寒。似乎足太阳证。其脉或见弦细。或见
芤迟。小便已。洒洒然毛耸。此热伤肺胃之气。阳明本证也。发汗则恶寒甚者。气虚重夺其津也。
温针则发热甚者。重伤经中之液。转助时火肆虐于外也。数下之则淋甚者。劫其在里之阴。热势
乘机内陷也。此段经文。本无方治。东垣特立清暑益气汤。足补仲景之未逮。
太阳中热者。 是也。汗出恶寒。身热而渴。白虎加人参汤主之。
此无形之热。伤肺胃之气。所以多汗恶寒而渴。故用白虎以化热。人参以益气也。
太阳中 。身热疼重而脉微弱。此以夏月伤冷水。水行皮中所致也。一物瓜蒂汤主之。
此因冷水灌汗。有形之水。郁遏皮毛。闭其汗湿。所以身热疼重。故用一物瓜蒂汤涌吐。则
阳气发越。汗大泄而热愈矣。后人不敢效用。每以五苓散加葱豉。或栀子豉汤并用。探吐皆效。
王节斋曰。夫暑者。相火行令也。夏月人感之。自口齿而入。伤心胞络之经。其脉多虚。或浮大而
散。或弦细芤迟。盖热伤气。则气消而脉虚弱。其证身热汗出而喘。烦渴多言。倦怠少气。或下
血发黄生斑。甚者火热烁金。致金不能平木。搐搦不省人事。治暑之法。以去湿热清心利小便为
主。气伤宜补真气为要。又有恶寒。或四肢逆冷。甚者迷闷不省。而为霍乱吐利。痰滞呕逆。腹
满泻利。此非暑伤。乃因暑而自致之病也。若行人或农夫于日中劳役得之。此热伤阳证也。必苦
头痛发热汗泄。肌肤大热而渴。乃天热外伤元气也。宜益元散、白虎汤、竹叶石膏汤选用。若避
暑热于凉亭水阁得之。此暑伤阴证也。必头痛恶寒。身形拘急。肢节疼痛而烦心。肌肤大热无汗。
此为阴寒所遏。使周身阳气不得伸越。宜消暑十全散。或腹痛水泻者。胃与大肠受之。局方香薷
饮。恶心者。胃中有痰饮也。香薷饮下消暑丸。伏暑大热水泻脉数。可用黄连香薷饮。若外既受
寒。内复伤冰水生冷。腹痛泄泻。霍乱吐逆。藿香正气散、养胃汤选用。若饮食过多。吐泻腹痛。
脉沉微者。大顺散。若真阳虚人。房室不慎。复伤生冷。腹痛极泻利。脉沉弦者。冷香饮子。甚
则霍乱吐利。通身冷汗不止。脉伏或脱者。急用浆水散救之。庶可十全一二。暑气攻里。腹内刺
痛。小便不通。生料五苓散加木香。小便血者。导赤散加辰砂。伏暑霍乱。腹痛泄泻如水。身热
足冷者。五苓散下来复丹。伤气困倦。身有微热。头重吐利。小便赤涩。十味香薷饮。伤暑咳嗽
发寒热。盗汗不止。脉数者。热在肺经。清暑益气汤。冷水澡浴。致暑湿相搏。一身尽痛。自汗
发热。五苓加羌活。吐泻者。五苓与正气和服。冒暑纵饮。及饮冷酒。引暑入腹。大热而小便如
血。五苓减桂加黄连。日间冒暑经营。夜间露卧门窗。此先感暑而后感寒。去衣则凛。着衣则烦。
或鼻流清涕。或寒热如疟。六和汤加羌活。无汗。加紫苏。呕吐。加藿香。兼食。加草豆蔻、砂
仁。冒暑作劳。乘汗冷浴。身痹如针刺。间有赤肿处。或发
水泡者。六和汤加苍术、荆、防。甚则加桂。若身热头痛。躁乱不宁。或身如针刺。此热伤肉分
也。白虎汤加苍术。虚。加人参。或咳嗽发寒热。盗汗不止。脉数者热在肺经。清燥汤。秋暑泻
利。消暑丸。疰夏病。属阳虚元气不足。宜补中益气加半夏、茯苓。其人伤湿。因而中暑。名曰湿
温。两胫逆冷。胸满头目疼重。妄言多汗。脉阳濡而弱。阴小而急。及烦渴引饮者。切不可汗。
汗之必死。苍术白虎汤。
喻嘉言曰。体中多湿之人。外暑蒸动内湿。二气交通。最易中暑。所以
肥人湿多。夏月百计避暑。反为暑所中者。不能避身之湿。即不能避天之暑也。益元散驱湿从小
便出。夏月服之解暑。体盛湿多则宜之。清 无湿之人。津液为时火所耗。当用生脉散充其津液。
若用益元散妄利小水。竭其下泉。枯槁立至。故凡汗多之人。即不可利其小便也。小半夏茯苓汤。
治暑专治其湿也。少加甘草。即名消暑丸。是消暑在消其湿。理明辞正矣。又如益元散加辰砂。
则并去其热。五苓散加人参则益虚。加辰砂减桂则去热。白虎汤加人参则益虚。加苍术则胜湿也。
中暑必显躁烦热闷。东垣仿仲景竹叶石膏汤制方。名清燥汤。仍以去湿为首务。夫燥与湿。相反
者也。而清燥亦务除湿。非东垣具过人之识。不及此矣。古方治暑风。用苏合香丸。大非。今人
治暑。概用香薷饮。大谬。按香薷辛淡。辛能发散。淡能渗泄。乃夏月解表利水之剂。果身热烦
躁呕吐。小便不利者。合黄连以解暑。靡不应手获效。若气虚胃弱之人。食少体倦。自当多服参、
。岂能堪此发泄。苟误用之。是虚其虚也。至于奔走劳役而中热者。用此温散之剂复伤其气。
如火益热矣。今人不分虚实当否。夏月少有不快。一概用之。所谓习俗成讹也。
夏月无故卒例。昏不知人。面垢。冷汗自出。手足微冷搐搦。或吐泻。或喘渴。此君相二火内
外相煽。兼之素有痰郁。因
火鼓动窒碍心窍故也。宜先以热土熨脐中。或研蒜水灌鼻中。皆取其通窍也。石顽曰。按中寒卒
然倒仆如中风者。乃盛寒之气卒犯少阴。而厥逆无脉。此阳气大虚。不胜阴寒厉气也。必口鼻气
冷而无痰声。虽盛暑中亦有之。以其人真阳素虚之故。不可拘于时月也。中暑卒然晕倒如中风者。
乃酷暑之气鼓运其痰壅塞心胞。此肾水素亏。不胜时火燔灼也。必喘乏而无痰声。若中风卒倒。
则必手足搐引。痰声涌塞于喉中。甚则声如拽锯。为中风之真候。以此辨之。万无差误也。
或问。 暑用白虎、清暑、香薷等法。何以为辨。石顽曰。中 用白虎汤。热伤形之治也。
用人参白虎汤。兼伤无形之气也。中暑用生脉散。暑伤无形之气也。用清暑益气。暑伤于气兼挟
风热乘虚而伤其经也。伤暑用十味香藿。风热湿杂合而伤形气也。偏于表。则变香薷饮为消暑十
全。偏于里。则变香薷饮为六和汤。此夏月鼎峙三法也。其用消暑丸者。上盛之湿泛滥而为痞满
也。用益元散者。下盛之热阻滞而为溺涩也。用大顺散者。冰果内伤于脾也。用冷香饮者。冷食内伤
于肾也。用来复丹者。阴气固结于下也。用五苓散者。阳气遏绝于内也。近世医人。治夏月诸病。
不论虚实寒热。概用香薷饮。既开汗孔。复利水道。且克中气。况于方中必除去人参。增入枳壳、
槟榔辈重耗其气。而痞满发热烦躁愈剧。此际补之不可。泻之不可。惟栀子豉汤随证加入甘草、生
姜等味以和之。夜甚者。导赤散加丹皮、白芍以调之。次以生料六味调之。虚甚躁渴者。合生脉以
滋金水之源。此前贤未之及也。当知治暑 诸证。汗液大泄。中气先伤。虽有膈满潮热。最忌攻下。
以无形之热不能随药下散也。即有头额重痛。最忌发汗。凡表药皆能升举痰食浊气支撑膈上也。
而肥人湿热素盛。加以暑气相搏。则为湿温。证必自汗足冷漉漉如从水中出。脉虽沉细。而小
便必赤涩。不可误认阴寒而与温药。亦不可因其头重身疼而与发汗。误汗身青面色变者。大剂竹
叶石膏汤可救之。亦有因其痞满喘胀误与下药者。大剂桂苓丸可疗之。惟误用附子者。虽有合剂。
不能起矣。至于触热劳形。卒然倒仆。方书用道途中热土置当脐。更使聚溺其腹。并捣生蒜汁注
鼻孔。其立法最精。惜乎未经阐发。世都不解。殊不知此虽酷烈为患。良由其人真元素亏。加以
时火亢极。鼓激命门之虚阳。 然离根。非藉道途中之热土。往来人之热溺。不能护卫其阳使之
归源。用蒜汁注鼻孔者。取蒜以开窍。温散其郁闭之热。所谓热因热用。温能除大热也。若与冷
水灌之 之渍之。则气随焰息。而暴绝不返矣。间有元气不大虚人。真火原未离根。不胜亢 而
倒者。用水灌渍。亦有得苏者。因是愚夫一见热倒。便以水灌。既灌不苏。虽卢扁不能复图矣。
〔诊〕经去。脉虚身热。得之伤暑。此暑伤元气也。仲景以弦细芤迟为伤暑。以暑伤气而不伤
形。所以气消而脉虚弱也。大抵脉来虚大无力。或小弱。皆本气虚而为暑所中。不足之证也。若
得洪盛数疾之脉。皆热气燔灼而为时气所伤。为有余之邪。至若内伤寒冷。及中寒脉沉紧之类。
虽当夏月。却与暑证无预。
罗谦甫治一人。夏月胸项多汗。两足逆冷谵语。关前濡。关后急。当作湿温治。经曰。湿温
之脉。阳濡而弱。阴小而急。濡弱见于阳部。湿气搏暑也。小急见于阴部。暑气蒸湿也。盖先伤
湿而后伤暑。暑湿相搏。是名湿温。先与白虎加参。次换苍术。三日而愈。
又治一蒙古百户。因食酒肉 乳。得霍乱吐泻。从朝至午。精神愦乏。脉皆浮数无力。知所
伤之物已出。即于墙阴掘地约二尺。贮新汲水。搅动一时澄定。用清者一杯。调桂苓白术散。徐
徐服之。吐泻遂止。翌日微烦渴。遂与钱氏
白术散。时时服之而愈。
滑伯仁治一人。病自汗如雨。目赤身热。口燥心烦。盛暑中帷幕周密。以至亡阳。服术附数
剂。脉虚而洪数。舌上苔黄。曰。前药误矣。令撤幔开窗。以黄连解毒、人参白虎。三进而汗止。
渴。用冰水调益元散。七日而愈。
石顽治礼部员外申菽 。触热过梁溪。归而眩晕麻瞀。发热便闭。服黄连、香薷不应。用凉
膈散。便通。或时昏眩不省。或时四肢清冷。而晡时为甚。邀石顽诊之。脉得弦细而芤。此暑伤
心包。阳气郁伏。所以有似阴寒也。与生脉合保元。清理肺胃。则包络自宁矣。
凡是接受温补治疗的，都难以治愈。时行疫气的变证多种多样，无法一一详尽列举。谨陈述其中几个大略的法则，希望能不辜负宪恩惠及百姓的恩泽。
飞畴治疗郑月山的女儿。她寡居二十年。五月间突然高热多汗，烦躁口渴，耳聋胁痛。郑月山是妇科名医，认为病症属于伤寒，委托给其他医生治疗。使用了柴胡、葛根、桂枝等药剂，结果热势更加严重，汗出不止，胸闷昏沉，时常打嗝。邀请我诊治。右脉数而大，左脉少神气。舌苔微黑。这是伏气温病从体内少阳经发出，所以出现耳聋胁痛。治法应当用白虎汤清解里热。反而使用发表药物，升散邪气，因此热渴加重，出汗多，导致左脉无神。胃液耗损，所以出现昏沉胸闷。打嗝是因为平时多有郁结之气。如今元气已虚，伏邪未解。给予凉膈散去掉硝黄，改用瓜蒌根、丹皮、竹叶。服用一次后热减能睡。但汗仍不止，疲倦难以翻身，有时想呕吐，这是虚证的表现。用生脉散加枣仁、茯神、白芍，扶助元气收敛阴液。同时喝粥饮以扶持胃气。口渴停止，汗液收敛，但脉象转为虚微欲绝。这是正气得到补充，而虚火潜藏熄灭后的真脉表现。再给予四君子汤加当归、地黄，调理补益而痊愈。
《素问》说：感受暑邪，出汗；心烦则气喘喝叫；安静则多言。
暑气内扰营分则出汗，上迫于肺则烦闷气喘，内干于心则多言。总离不开热伤心包络，以及蒸灼肺经的证候。
《金匮要略》说：太阳中暍（中暑），发热恶寒，身体沉重而疼痛，脉象弦细芤迟。小便后，感觉洒洒然毛发耸立，手足逆冷。稍微劳作，身体即发热，张口呼吸，前板齿干燥。如果发汗则恶寒更甚，加用温针则发热更甚，多次攻下则淋证更重。
太阳中暍，发热恶寒，身体沉重而疼痛。这是因为暑天受了风露之邪，是手太阳小肠经的标证。太阳小肠属火，上应心包络。这两经都能克制金（肺）烁伤肺。肺受火刑，所以发热恶寒，似乎像足太阳膀胱经的证候。其脉或见弦细，或见芤迟。小便后洒洒然毛发耸立，这是热伤了肺胃之气，是阳明本经的证候。发汗则恶寒甚者，是因为气虚再次夺去津液。温针则发热甚者，是因为重伤了经脉中的津液，转而助长时令之火肆虐于外。多次攻下则淋证甚者，是因为劫夺了在里的阴液，热势乘机内陷。这段经文原本没有方治，李东垣特意创立清暑益气汤，足以弥补张仲景的不足。
太阳中热者，就是中暍。汗出恶寒，身热而渴，用白虎加人参汤主治。
这是无形之热，伤了肺胃之气，所以多汗恶寒而渴。故用白虎汤来化热，用人参来益气。
太阳中暍，身热疼重而脉微弱。这是因为夏天受了冷水，水气行于皮肤中所致。用一物瓜蒂汤主治。
这是因为冷水灌入汗孔，有形之水，郁遏皮毛，闭塞汗湿，所以身热疼重。故用一物瓜蒂汤涌吐，则阳气发越，大汗泄出而热退。后人不敢效法使用，常用五苓散加葱豉，或栀子豉汤并用，探吐都有效。
王节斋说：暑，是相火当令。夏天人感之，自口齿而入，伤心包络之经。其脉多虚，或浮大而散，或弦细芤迟。因为热伤气，则气消而脉虚弱。其证身热汗出而喘，烦渴多言，倦怠少气，或下血发黄生斑，严重时火热烁金，导致金不能平木，出现抽搐痉挛不省人事。治暑的方法，以去湿热、清心、利小便为主。气伤宜补真气为要。又有恶寒，或四肢逆冷，严重时迷闷不省，而为霍乱吐利，痰滞呕逆，腹满泻利。这不是暑伤，而是因为暑天自己导致的病。如果是行路人或农夫在日中劳役得之，这是热伤阳证。必定苦于头痛发热汗泄，肌肤大热而渴，是天热外伤元气。宜选用益元散、白虎汤、竹叶石膏汤。如果在凉亭水阁避暑得之，这是暑伤阴证。必定头痛恶寒，身形拘急，肢节疼痛而心烦，肌肤大热无汗。此为阴寒所遏，使周身阳气不得伸越。宜用消暑十全散。如果腹痛水泻，是胃与大肠受病，用局方香薷饮。恶心，是胃中有痰饮，用香薷饮送服消暑丸。伏暑大热水泻脉数，可用黄连香薷饮。如果外既受寒，内复伤冰水生冷，腹痛泄泻，霍乱吐逆，选用藿香正气散、养胃汤。如果饮食过多，吐泻腹痛，脉沉微者，用大顺散。如果真阳虚人，房事不慎，又伤生冷，腹痛极泻利，脉沉弦者，用冷香饮子。甚至霍乱吐利，通身冷汗不止，脉伏或脱者，急用浆水散救之，或许能保全一二。暑气攻里，腹内刺痛，小便不通，用生料五苓散加木香。小便血者，用导赤散加辰砂。伏暑霍乱，腹痛泄泻如水，身热足冷者，用五苓散送下来复丹。伤气困倦，身有微热，头重吐利，小便赤涩，用十味香薷饮。伤暑咳嗽发寒热，盗汗不止，脉数者，热在肺经，用清暑益气汤。冷水澡浴，致暑湿相搏，一身尽痛，自汗发热，用五苓散加羌活。吐泻者，五苓散与正气和服。冒暑纵饮，及饮冷酒，引暑入腹，大热而小便如血，用五苓散减桂加黄连。日间冒暑经营，夜间露卧门窗，此先感暑而后感寒，去衣则凛冽，着衣则烦热，或鼻流清涕，或寒热如疟，用六和汤加羌活。无汗，加紫苏。呕吐，加藿香。兼食积，加草豆蔻、砂仁。冒暑作劳，乘汗冷浴，身痹如针刺，间有赤肿处，或发水泡者，用六和汤加苍术、荆芥、防风。甚则加桂枝。如果身热头痛，躁乱不宁，或身如针刺，这是热伤肉分，用白虎汤加苍术。虚，加人参。或咳嗽发寒热，盗汗不止，脉数者热在肺经，用清燥汤。秋暑泻利，用消暑丸。疰夏病，属阳虚元气不足，宜补中益气汤加半夏、茯苓。其人伤湿，因而中暑，名曰湿温。两胫逆冷，胸满头目疼重，妄言多汗，脉阳濡而弱，阴小而急，及烦渴引饮者，切不可发汗，发汗必死。用苍术白虎汤。
喻嘉言说：体中多湿之人，外暑蒸动内湿，二气交通，最容易中暑。所以肥人多湿，夏天百计避暑，反为暑所中者，是因为不能避身上的湿，也就不能避天上的暑。益元散驱湿从小便出，夏天服用可解暑，体质盛湿多的人适宜。清润无湿之人，津液为时火所耗，应当用生脉散充其津液。如果用益元散妄利小水，竭其下泉，枯槁立至。所以凡汗多之人，就不可利其小便。小半夏茯苓汤，治暑专治其湿。少加甘草，即名消暑丸。是消暑在消其湿，道理明确言辞正确。又如益元散加辰砂，则并去其热。五苓散加人参则益虚，加辰砂减桂则去热。白虎汤加人参则益虚，加苍术则胜湿。
中暑必定显现躁烦热闷。李东垣仿照张仲景竹叶石膏汤制方，名清燥汤。仍以去湿为首务。夫燥与湿，相反者也。而清燥亦务除湿，如果不是李东垣具有过人的见识，达不到这个境界。古方治暑风，用苏合香丸，大错。今人治暑，一概用香薷饮，大谬。按香薷辛淡，辛能发散，淡能渗泄，乃夏月解表利水之剂。果身热烦躁呕吐，小便不利者，合黄连以解暑，无不应手获效。如果气虚胃弱之人，食少体倦，自当多服参、芪。岂能忍受这种发泄。如果误用之，是虚其虚。至于奔走劳役而中热者，用此温散之剂又伤其气，如火益热。今人不分虚实当否，夏天稍有不快，一概用之。所谓习俗成讹。
夏天无故突然晕倒，昏不知人，面垢，冷汗自出，手足微冷抽搐，或吐泻，或喘渴。这是君相二火内外相煽，兼之素有痰郁，因火鼓动窒碍心窍所致。宜先用热土熨脐中，或研蒜水灌鼻中，都是取其通窍。石顽说：按中寒突然倒仆如中风者，是盛寒之气突然侵犯少阴，而厥逆无脉，这是阳气大虚，不胜阴寒厉气。必定口鼻气冷而无痰声，即使在盛夏也有，因为其人真阳素虚的缘故，不可拘泥于时节。中暑突然晕倒如中风者，是酷暑之气鼓运其痰壅塞心包，这是肾水素亏，不胜时火燔灼。必定喘乏而无痰声。如果中风卒倒，则必手足搐引，痰声涌塞于喉中，甚至声如拽锯，为中风之真候。以此辨别，万无差误。
有人问：治暑用白虎、清暑、香薷等法，如何辨别？石顽说：中暍用白虎汤，是热伤形体的治法。用人参白虎汤，是兼伤无形之气。中暑用生脉散，是暑伤无形之气。用清暑益气汤，是暑伤于气兼挟风热乘虚而伤其经。伤暑用十味香薷饮，是风热湿杂合而伤形气。偏于表，则变香薷饮为消暑十全散。偏于里，则变香薷饮为六和汤。这是夏天鼎峙三法。其用消暑丸者，是上盛之湿泛滥而为痞满。用益元散者，是下盛之热阻滞而为溺涩。用大顺散者，是冰果内伤于脾。用冷香饮子者，是冷食内伤于肾。用来复丹者，是阴气固结于下。用五苓散者，是阳气遏绝于内。近世医人，治夏天诸病，不论虚实寒热，一概用香薷饮。既开汗孔，复利水道，且克伐中气。况且方中必除去人参，增入枳壳、槟榔辈重耗其气，而痞满发热烦躁愈剧。此时补之不可，泻之不可，惟栀子豉汤随证加入甘草、生姜等味以和之。夜甚者，用导赤散加丹皮、白芍以调之。次以生料六味地黄丸调之。虚甚躁渴者，合生脉散以滋金水之源。这是前贤未曾涉及的。应当知道治暑暍诸证，汗液大泄，中气先伤，虽有膈满潮热，最忌攻下，因为无形之热不能随药下散。即有头额重痛，最忌发汗，凡表药皆能升举痰食浊气支撑膈上也。而肥人湿热素盛，加以暑气相搏，则为湿温。证必自汗足冷漉漉如从水中出，脉虽沉细，而小便必赤涩，不可误认阴寒而与温药，亦不可因其头重身疼而与发汗。误汗身青面色变者，大剂竹叶石膏汤可救之。亦有因其痞满喘胀误与下药者，大剂桂苓丸可疗之。惟误用附子者，虽有合剂，不能起矣。至于触热劳形，突然倒仆，方书用道途中热土置当脐，更使聚溺其腹，并捣生蒜汁注鼻孔，其立法最精，可惜未经阐发，世人都不理解。殊不知这虽然酷烈为患，良由其人真元素亏，加上时火亢极，鼓激命门之虚阳，飘然离根，非藉道途中之热土，往来人之热溺，不能护卫其阳使之归源。用蒜汁注鼻孔者，取蒜以开窍，温散其郁闭之热，所谓热因热用，温能除大热也。若与冷水灌之渍之，则气随焰息，而暴绝不返矣。间有元气不大虚人，真火原未离根，不胜亢阳而倒者，用水灌渍，亦有得苏者。因是愚夫一见热倒，便以水灌，既灌不苏，虽卢扁也不能复图了。
〔诊〕经云：脉虚身热，得之伤暑。这是暑伤元气。张仲景以弦细芤迟为伤暑，因为暑伤气而不伤形，所以气消而脉虚弱。大抵脉来虚大无力，或小弱，皆本气虚而为暑所中，是不足之证。若得洪盛数疾之脉，皆热气燔灼而为时气所伤，为有余之邪。至若内伤寒冷，及中寒脉沉紧之类，虽当夏月，却与暑证无关。
罗谦甫治疗一人。夏天胸项多汗，两足逆冷谵语，关前濡，关后急，当作湿温治。经曰：湿温之脉，阳濡而弱，阴小而急。濡弱见于阳部，湿气搏暑也。小急见于阴部，暑气蒸湿也。盖先伤湿而后伤暑，暑湿相搏，是名湿温。先与白虎加人参汤，次换苍术，三日而愈。
又治疗一蒙古百户。因食酒肉酪乳，得霍乱吐泻。从早晨到中午，精神疲惫，脉皆浮数无力。知所伤之物已出，即在墙阴掘地约二尺，贮新汲水，搅动一时澄定，用清者一杯，调桂苓白术散，徐徐服之。吐泻遂止。第二天微烦渴，遂与钱氏白术散，时时服之而愈。
滑伯仁治疗一人。病自汗如雨，目赤身热，口燥心烦。盛暑中帷幕周密，以至亡阳。服术附数剂，脉虚而洪数，舌上苔黄。说：前药误矣。令撤幔开窗，以黄连解毒汤、人参白虎汤，三进而汗止。渴，用冰水调益元散，七日而愈。
石顽治疗礼部员外申菽。触热过梁溪，归而眩晕麻瞀，发热便闭。服黄连、香薷不应。用凉膈散，便通。或时昏眩不省，或时四肢清冷，而晡时为甚。邀石顽诊之。脉得弦细而芤，这是暑伤心包，阳气郁伏，所以有似阴寒。与生脉散合保元汤，清理肺胃，则包络自宁矣。
Those who have received tonic treatment are difficult to cure. The variable manifestations of epidemic pathogens are numerous and cannot be exhaustively listed here. I briefly state a few general principles, hoping not to fail the benevolent grace that extends to the common people.
Feichou treated the daughter of Zheng Yueshan. She had been a widow for twenty years. In May, she suddenly developed high fever with profuse sweating, irritability, thirst, deafness, and hypochondriac pain. Zheng Yueshan, a renowned expert in gynecology, believed the condition belonged to Cold Damage (Shanghan) and entrusted it to other physicians. They used formulas containing Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), and Gui Zhi (Cinnamomi Ramulus). Consequently, the heat intensified, sweating continued unceasingly, chest fullness and mental clouding occurred, and frequent belching was present. He invited me to diagnose. The right pulse was rapid and large; the left pulse lacked spirit (vitality). The tongue coating was slightly black. This indicates latent heat emerging from the interior Shaoyang (Lesser Yang) channel, hence the deafness and hypochondriac pain. The method should employ Baihu Tang (White Tiger Decoction) to clear and resolve internal heat. Instead, releasing exterior drugs were used, ascending and dispersing the pathogen, thereby worsening the heat and thirst. Profuse sweating depleted the left pulse's vitality. Consumption of stomach fluids caused mental clouding and chest fullness. The belching resulted from chronic Qi stagnation. Now, Yuan Qi (Original Qi) is deficient, and latent pathogens remain unresolved. I prescribed Liangge San (Cool the Epigastrium Powder) without Mang Xiao (Natrii Sulfas) and Huang Lian (Coptidis Rhizoma), substituting Gua Lou Gen (Trichosanthis Radix) and Dan Pi (Moutan Cortex), along with Zhu Ye (Bambusae Folium). After one dose, heat decreased and sleep was achieved. However, sweating persisted, fatigue made turning over difficult, and occasional nausea appeared, indicating deficiency. I administered Shengmai San (Generate the Pulse Powder) added with Suan Zao Ren (Ziziphi Spinosae Semen), Fu Shen (Poria Cum Radix), and Bai Shao (Paeoniae Radix Alba) to support Yuan Qi and astringe Yin. Concurrently, rice gruel was given to support Stomach Qi. Thirst ceased, and sweating stopped, but the pulse became extremely weak and nearly imperceptible. This is the true pulse manifestation where righteous Qi has been replenished and deficient fire has subsided. Subsequently, Sijunzi Tang (Four Gentlemen Decoction) combined with Dang Gui (Angelicae Sinensis Radix) and Di Huang (Rehmanniae Radix) was used for regulation and tonification, leading to recovery.
The *Suwen* states: "Affected by summerheat, there is sweating; if irritated, there is panting and loud breathing; if quiet, there is excessive talking."
Summerheat disturbing the Ying (Nutritive) level internally causes sweating; pressing upward on the Lung causes irritability and panting; interfering internally with the Heart causes excessive talking. All these relate to heat damaging the Pericardium and steaming the Lung meridian.
The *Jingui Yaolue* states: "Taiyang Zhongshu (Heatstroke in Taiyang), characterized by fever and aversion to cold, heaviness and pain in the body, with a pulse that is string-taut, fine, hollow, or slow. After urination, one feels chilly with gooseflesh rising, and cold extremities. Slight exertion immediately causes fever, open-mouth breathing, and dryness of the anterior teeth. If sweating is induced, aversion to cold worsens; if moxibustion/needling with heat is applied, fever worsens; if purgatives are frequently used, strangury worsens."
Taiyang Zhongshu, with fever, aversion to cold, heaviness, and pain, results from wind and dew pathogens contracted during summer. This is the manifest symptom of the Hand-Taiyang Small Intestine channel. The Small Intestine belongs to Fire and corresponds to the Pericardium. Both channels can restrain Metal (Lung) and scorch the Lungs. When the Lung suffers from Fire punishment, fever and aversion to cold occur, resembling Foot-Taiyang Bladder symptoms. The pulse may appear string-taut and fine, or hollow and slow. Chilly sensations after urination indicate heat damaging Lung and Stomach Qi, representing the root syndrome of Yangming. Worsening aversion to cold after sweating occurs because Qi deficiency leads to further loss of fluids. Worsening fever after heat therapy occurs because deep injury to fluid in the channels aids seasonal Fire to rage externally. Frequent purging worsens strangury because Yin within is robbed, allowing heat to sink inward. This passage originally lacked a formula. Li Dongyuan specifically created Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction), supplementing Zhang Zhongjing's omission.
Taiyang Zhongre (Summerheat-Heat in Taiyang) is Zhongshu. With sweating, aversion to cold, fever, and thirst, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated.
This is formless heat damaging Lung and Stomach Qi, causing profuse sweating, aversion to cold, and thirst. Thus, Baihu Tang transforms heat, and Renshen (Ginseng Radix et Rhizoma) boosts Qi.
Taiyang Zhongshu, with fever, painful heaviness, and a weak pulse, results from exposure to cold water in summer, where water qi circulates in the skin. Yiwu Gudi Tang (One-Herb Melon Pedicle Decoction) is indicated.
This is due to cold water entering sweat pores, where tangible water obstructs the skin and closes sweat dampness, causing fever and painful heaviness. Yiwu Gudi Tang induces vomiting, allowing Yang Qi to expand, profuse sweating to occur, and heat to subside. Later generations dared not use this, often employing Wuling San (Five-Ingredient Powder with Poria) plus Cong Bai (Allii Fistulosi Bulbus) and Chi Qiao (Perillae Folium), or Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) for induced vomiting, all of which are effective.
Wuzhai said: "Summerheat is the command of Ministerial Fire. In summer, humans contract it through the mouth and teeth, damaging the Pericardium channel. The pulse is mostly deficient, either floating-large and scattered, or string-taut, fine, hollow, and slow. Heat damages Qi, causing Qi consumption and a weak pulse. Symptoms include fever, sweating, panting, irritability, thirst, excessive talking, fatigue, and shortness of breath. Severe cases involve bleeding, jaundice, macules, or heat scorching Metal so that Metal cannot control Wood, leading to convulsions and unconsciousness. Treatment of summerheat focuses on removing damp-heat, clearing the Heart, and promoting urination. For Qi damage, tonifying True Qi is essential. There are also cases of aversion to cold or cold extremities, severe confusion, and Huoluan (Cholera-like disorder) with vomiting/diarrhea, phlegm obstruction, abdominal fullness, and diarrhea. These are not direct summerheat damage but diseases self-induced due to summer conditions. If contracted by laborers under the sun, this is Heat damaging Yang. It involves headache, fever, sweating, intense skin heat, and thirst, representing external damage to Yuan Qi by heavenly heat. Yi Yuan San (Benefit Origin Powder), Baihu Tang, or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be selected. If contracted while avoiding heat in cool pavilions, this is Summerheat damaging Yin. It involves headache, aversion to cold, stiffness, joint pain, irritability, intense skin heat without sweating. This is Yin-cold obstruction preventing Yang Qi expansion. Xiaotu Shiquan San (Eliminate Summerheat Ten-Gentleman Powder) is suitable. For abdominal pain and watery diarrhea affecting Stomach and Large Intestine, Ju Fang Xiangru Yin (Agastache Decoction from the Bureau Formulary) is used. For nausea due to Phlegm-fluid in the Stomach, Xiangru Yin with Xiaotu Wan (Eliminate Summerheat Pill) is given. For latent summerheat with high fever, watery diarrhea, and rapid pulse, Huanglian Xiangru Yin (Coptis Agastache Decoction) is used. If externally exposed to cold and internally injured by ice/cold food, causing abdominal pain, diarrhea, Huoluan, vomiting, Huoxiang Zhengqi San (Patchouli Harmonizing Qi Powder) or Yangwei Tang (Nourish Stomach Decoction) are selected. For excessive eating with vomiting, diarrhea, abdominal pain, and deep-micro pulse, Dashun San (Great Smooth Powder) is used. For individuals with deficient True Yang who engaged in intercourse and consumed cold/raw food, causing severe abdominal pain, diarrhea, and deep-stringy pulse, Lengxiang Yinzi (Cold Fragrant Decoction) is used. In severe Huoluan with cold sweat, hidden or collapsed pulse, Jiangshui San (Fermented Rice Water Powder) must be urgently used to save life. If summerheat attacks the interior causing stabbing abdominal pain and urinary retention, Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria) plus Muxiang (Aucklandiae Radix) is used. For hematuria, Daochi San (Guide Red Powder) plus Chen Sha (Cinnabar) is used. For latent summerheat Huoluan with watery diarrhea, fever, and cold feet, Wuling San followed by Laifu Dan (Revive Nature Pellet) is used. For Qi damage with fatigue, slight fever, heavy head, vomiting/diarrhea, and red/scanty urine, Shiwei Xiangru Yin (Ten-Ingredient Agastache Decoction) is used. For summerheat cough with chills/fever, night sweats, and rapid pulse (heat in Lung), Qingshu Yiqi Tang is used. For cold bathing causing summer-damp interaction with whole-body pain, spontaneous sweating, and fever, Wuling San plus Qianghuo (Notopterygii Rhizoma et Radix) is used. For vomiting/diarrhea, Wuling San is taken with Huozheng Qi San. For indulging in drinks and cold wine after summer exposure, causing intense heat and bloody urine, Wuling San minus Gui Zhi plus Huanglian is used. For daytime summer exposure and nighttime sleeping near windows causing initial summerheat then cold contraction (chills when undressed, irritability when dressed), with runny nose or malaria-like chills/fever, Liuhe Tang (Six-Harmonies Decoction) plus Qianghuo is used. Add Zisu (Perillae Folium) for no sweat; add Huoxiang (Patchouli Herb) for vomiting; add Caodoukou (Amomi Fructus Rotundus) and Sharen (Amomi Fructus) for food stagnation. For summerheat exertion followed by cold bathing causing numbness like needle pricks, red swelling, or blisters, Liuhe Tang plus Cangzhu (Atractylodis Rhizoma), Jingjie (Schizonepetae Herba), and Fangfeng (Saposhnikoviae Radix) is used; add Guizhi (Cinnamon Twig) if severe. For fever, headache, restlessness, or prickling sensation (heat damaging flesh), Baihu Tang plus Cangzhu is used; add Renshen for deficiency. For cough with chills/fever, night sweats, rapid pulse (heat in Lung), Qingzao Tang (Clear Dryness Decoction) is used. For autumn summerheat diarrhea, Xiaotu Wan is used. For Zhuxia disease (summer malaise) due to Yang deficiency and insufficient Yuan Qi, Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction) plus Banxia (Pinelliae Rhizoma) and Fuling (Poria) is used. If dampness injury precedes summerheat, it is called Shiwen (Damp-Warmth). Symptoms include cold lower legs, chest/head heaviness, delirium, profuse sweating, floating-weak yang pulse and small-rapid yin pulse, and thirst. Sweating is strictly contraindicated; inducing sweat will cause death. Cangzhu Baihu Tang is indicated.
Yu Jiayan said: "Individuals with abundant dampness in the body, when external summerheat steams internal dampness, the two energies interact, making them prone to summerheat. Fat people have much dampness; even if they try hard to avoid summerheat, they still suffer from it because they cannot avoid their own internal dampness, and thus cannot avoid heavenly summerheat. Yi Yuan San expels dampness via urination and resolves summerheat in summer; it suits those with excess dampness. Individuals without dampness have their fluids consumed by seasonal fire; Shengmai San should be used to replenish fluids. Using Yi Yuan San to induce urination would deplete the lower source, leading to immediate withering. Therefore, those with profuse sweating must not have their urination promoted. Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) treats summerheat by focusing on dampness. Adding Gancao (Licorice Root) makes Xiaotu Wan. Resolving summerheat involves resolving dampness; the principle is clear. Yi Yuan San plus Chen Sha clears heat. Wuling San plus Renshen tonifies deficiency; plus Chen Sha minus Guizhi clears heat. Baihu Tang plus Renshen tonifies deficiency; plus Cangzhu overcomes dampness.
Summerheat strike manifests as irritability and heat oppression. Li Dongyuan modeled his Qingzao Tang on Zhang Zhongjing’s Zhuye Shigao Tang, prioritizing dampness removal. Dryness and dampness are opposites, yet clearing dryness also aims to remove dampness. Only Li Dongyuan’s superior insight could achieve this. Ancient formulas used Suhexiang Wan (Styrax Pill) for summerwind, which is incorrect. Modern practitioners indiscriminately use Xiangru Yin, which is a major error. Xiangru is acrid and bland; acrid disperses, bland drains. It is an exterior-releasing and diuretic agent for summer. If there is fever, irritability, vomiting, and dysuria, combining it with Huanglian resolves summerheat effectively. However, for Qi-deficient or Stomach-weak individuals with poor appetite and fatigue, they cannot tolerate such dispersing/draining actions; tonifying with Renshen and Huangqi (Astragali Radix) is appropriate. Misusing it harms the deficient. For those overheated by labor, using warm-dispersing agents further damages Qi, adding fire to heat. Indiscriminate use in summer is a customary error.
Sudden fainting in summer without obvious cause, with facial dirtiness, cold sweat, cold/convulsive extremities, vomiting/diarrhea, or panting/thirst, results from Ministerial and Sovereign Fire fanning each other internally and externally, combined with pre-existing phlegm stagnation agitated by fire blocking the Heart orifice. Apply hot earth to the umbilicus or garlic water to the nose to open the orifice. Shiwan stated: "Sudden collapse resembling stroke due to Cold Damage is sudden invasion of Shaoyin by severe cold, causing cold reversal and absent pulse due to extreme Yang deficiency and inability to withstand Yin-cold. Breath at mouth/nose is cold without phlegm sounds. This occurs even in midsummer due to inherent True Yang deficiency, regardless of season. Summerheat strike sudden collapse resembles stroke due to summerheat agitating phlegm blocking the Pericardium, caused by inherent Kidney Water deficiency unable to withstand seasonal fire. Panting is present without phlegm sounds. Stroke collapse involves limb convulsions and loud phlegm rattling in the throat, sounding like sawing wood. This distinguishes them accurately."
Q: How to differentiate between Baihu, Qingshu, and Xiangru methods for summerheat?
A: Zhongshu (Heatstroke) uses Baihu Tang to treat heat damaging form (body fluids/tissues). Ren Shen Baihu Tang treats concurrent damage to formless Qi. Zhongshu (Summerheat Strike) uses Shengmai San for damage to formless Qi. Qingshu Yiqi Tang treats Qi damage with Wind-Heat invading channels due to deficiency. Shangshu (Injured by Summerheat) uses Shiwei Xiangru Yin for mixed Wind-Heat-Damp damaging form and Qi. Exterior bias changes Xiangru Yin to Xiaotu Shiquan San; interior bias changes it to Liuhe Tang. These are the three major summer methods. Xiaotu Wan treats upper excess dampness causing fullness. Yi Yuan San treats lower excess heat causing urinary difficulty. Dashun San treats spleen injury from ice fruit. Lengxiang Yinzi treats kidney injury from cold food. Laifu Dan treats Yin Qi knotting below. Wuling San treats Yang Qi blockage inside. Modern doctors indiscriminately use Xiangru Yin for summer ailments, opening pores, draining waterways, and attacking Middle Qi. Removing Renshen and adding Zhiqiao (Aurantii Fructus) and Binglang (Arecae Semen) further depletes Qi, worsening fullness/fever/irritability. At this stage, tonification or purgation is impossible; Zhizi Chi Tang with Gancao/Shengjiang harmonizes. Night exacerbation uses Daochi San plus Danshen/Mudanpi. Follow with Shengliu Weidi (Six-Ingredient Rehmannia). Extreme deficiency/thirst combines with Shengmai San. Prior experts missed this. Note: Summerheat treatments cause massive sweating, injuring Middle Qi first. Even with epigastric fullness/tidal fever, purgation is forbidden as formless heat cannot be purged. Even with heavy forehead pain, sweating is forbidden as exterior drugs raise turbid Qi. Fat people with inherent damp-heat contracting summerheat develop Shiwen. Symptoms include spontaneous sweating, cold feet wet as if from water, deep-fine pulse, but red/scanty urine. Do not mistake for Yin-cold and use warming drugs. Do not induce sweat for heavy head/body ache. Mistaken sweating turns skin blue; Da Ji Zhuye Shigao Tang saves. Mistaken purgation for fullness/bloating uses Da Ji Guiling Wan. Mistaken Aconite use is incurable.
For sudden collapse from heat/labor, ancient texts suggest hot earth on umbilicus, urine on abdomen, and garlic juice in nose. This precise method explains that although heat is fierce, it stems from inherent Yuan deficiency aggravated by extreme seasonal fire, driving Minming (Gate of Life) deficient Yang away. Hot earth and warm urine protect Yang and guide it home. Garlic opens orifices and warms dispersed heat ("treat heat with heat," "warmth removes great heat"). Pouring cold water extinguishes Qi and causes sudden death. Those with sufficient Yuan Qi may recover with cold water, but laypeople mistakenly use it on all collapses, leading to death despite Lu Binhu’s skill.
[Diagnosis] Classics state: "Deficient pulse with fever indicates summerheat injury." This is Qi damage by summerheat. Zhang Zhongjing considers string-taut/fine/hollow/slow pulses as summerheat injury because summerheat damages Qi, not form, causing Qi consumption and weak pulse. Generally, floating-large/weak or small-weak pulses indicate underlying Qi deficiency attacked by summerheat (deficiency syndrome). Hong-sheng/rapid pulses indicate heat blazing from seasonal pathogens (excess syndrome). Internal cold injury or Cold Damage with deep-tight pulses, even in summer, are unrelated to summerheat.
Luo Qianfu treated a man in summer with chest/neck sweating, cold feet, and delirium. Guan position: anterior soft, posterior urgent. Diagnosed as Shiwen. Classics: "Shiwen pulse: Yang soft-weak, Yin small-urgent." Soft-weak at Yang position indicates dampness battling summerheat; small-urgent at Yin position indicates summerheat steaming dampness. Damp injury precedes summerheat; their interaction is Shiwen. Treated initially with Baihu Jia Renshen Tang, then switched to Cangzhu, cured in three days.
Treated a Mongol officer who ate meat/cheese, developing Huoluan vomiting/diarrhea. From morning to noon, spirit was exhausted, pulse floating-numerous-weak. Knowing damaged food was expelled, he dug two chi deep in shade, stored fresh water, stirred and settled. One cup of clear water mixed with Guiling Baizhu San was slowly drunk. Vomiting/diarrhea stopped. Next day, slight irritability/thirst; Qian’s Baizhu San was given intermittently until cured.
Hua Borren treated a man with profuse sweating like rain, red eyes, fever, dry mouth, irritability. In deep summer, curtains were closed tightly, causing Yang collapse. Several doses of Zhufu (Atractylodes-Aconite) failed; pulse was deficient-huge-numerous, tongue yellow coating. Hua said previous meds were wrong. Opened windows/curtains, gave Huanglian Jiedu Tang and Renshen Baihu Tang. After three doses, sweating stopped. Thirst treated with Yi Yuan San mixed with ice water; cured in seven days.
Shiwan treated Ministry of Rites official Shen Shu. Traveling in heat across Liangxi, returned with dizziness, numbness, fever, constipation. Huanglian/Xiangru failed. Liangge San cleared bowels. Occasional fainting or cold limbs worse in afternoon. Pulse string-taut/fine/hollow. Diagnosed as summerheat damaging Pericardium, Yang Qi depressed, mimicking Yin-cold. Combined Shengmai San with Baoyuan Tang to clear Lung/Stomach, calming Pericardium.