若夏月伤暑，发热，汗大泄，无气力，脉虚细而迟。此暑伤元气也，服后方。
人参 黄 （蜜炙） 麦门冬（去心） 白芍药 陈皮 白茯苓（各一钱） 黄连（炒）
甘草（炙，各五分） 黄柏（三分） 白术（一钱五分） 香薷 知母（各七分）
上姜、水煎，食前温服。
愚按东垣先生曰∶暑热之时，无病之人，或避暑热，纳凉于深堂大厦得之者，名曰中暑，其病必头痛
恶寒，身形拘急，肢节疼痛，烦热无汗，为房室阴寒之气所遏，（名曰中 以大顺散）热药主之，
若行人或农夫于日中得之者，名曰劳役中热，其病必苦头痛，躁热，
恶热，肌热，大渴，汗泄，懒动，为天热外伤肺气，以苍术白虎汤凉剂主之。若人元气不足，
用前药不应，宜补中益气汤主之。大抵夏月阳气浮于外，阴气伏于内，若人饮食劳倦内伤中气，或
酷暑劳役外伤阳气者，多患之，法当调补元气为主，而佐以解暑。若中 者，乃阴寒之症，法当补
阳气为主，少佐以解暑。故先哲多用姜、桂、附子之类，此推《内经》舍时从症之良法也。今患暑
症殁，而手足指甲或肢体青黯，此皆不究其因，不温补其内，而泛用香薷饮之类所误也。夫香薷饮
乃散阳气导真阴之剂也，须审有是症而服，亦何患哉？若人元气素虚，或犯劳过度而饮之者，
适所以招暑患病也。（其暑热伤元气而类风症者，见第四卷首治验。）
若夏秋暑热，因过用冷物茶水伤其内，又过取凉风伤其外，以致恶寒发热，胸膈饱闷，或饮食不进，
或兼呕吐、泄泻，此内外俱伤寒冷也。
人参 干姜（炒紫色） 浓朴（姜水炒） 陈皮 羌活 枳实 白茯苓（各一钱） 白术（一钱五分）
甘草（炙，五分）
上姜、水煎，食前温服。
愚按前症如未应，宜用藿香正气散；若内外已解，寒热未退，或饮食未进，宜用六君子汤。《保命
集》云∶霍乱属阳明症，宜用和中、平胃、建中，或四君子汤辈。脉浮自汗，四君子加桂枝主之；脉浮无
汗，四君子加麻黄。吐利转筋，胁下痛，脉弦者，木
克土也。用平胃散加木瓜，或建中加柴胡、木瓜；吐利转筋，腹中痛，体重，脉沉而细者，四君子加
白芍药、良姜。吐利而四肢拘急，脉沉而迟，属少阴，四君子加姜、附、浓朴；吐利而四肢厥冷，脉
微缓，属厥阴，建中加归、附。吐利头痛而身热；多欲饮水者，五苓散；寒多不欲饮水者，理中丸
主之。元戎云∶太阴症霍乱者，理中加橘红；吐下腹痛，手足逆冷，理中加熟附；吐利后转筋者，理
中加火 石膏一两。
进士刘华甫，夏月食生冷果品患前症。余用附子理中汤，一服顿安。
上舍徐民则，夏月入房及食冰果面食而患腹痛。余曰∶此阴寒之症也，须用附子理中汤以回阳。不
信，别用二陈、枳实、黄连、香薷饮之类而死。
若夏暑在途中，常服以壮元气，清热驱暑，服之免中暑、霍乱、泄泻、痢疾等症。
人参（一钱二分） 白术（一钱五分） 五味子（十粒，杵碎） 麦门冬（去心） 白芍药（炒）
白茯苓（各一钱） 知母（炒） 陈皮 香薷（各七分） 黄芩（炒三分） 甘草（炙五分）
上姜、水煎，食前温服。
愚按前症若人元气虚弱，宜用补中益气去柴胡、升麻，加麦门、五味，或少加炒黑黄柏，人参养气汤
亦可用。
一儒者，季夏患泄泻，腹中作痛，饮食无味，肢
体倦怠。余用补中益气汤、八味地黄丸，月余而痊。后彼云∶每秋间必患痢，今则无恙何也？余曰∶此闭
藏之月，不远帏幕，妄泄真阳而然。前药善能补真火，火能生土，脾气生旺而免患也。
若遇劳倦辛苦用力过多，即服后方一、二服，免生内伤发热之病。此方主于补气。
黄 （二钱半，蜜炙） 人参 麦门冬（去心） 陈皮（各一钱） 白术 炙草 五味（各五分）
上姜、枣、水煎，食前温服。劳倦甚，加熟附子四、五分。
愚按前论开世俗之蒙 ，济无穷之夭枉。内附子若素畏寒饮食者，尤宜用；若素喜寒饮食者，以肉桂
或炮姜代之亦可，但世所鲜用耳！
一妇人因劳役，发热，倦怠，唾痰，欲呕，或以为火症，用清热化痰等药，反大便不实，无气以动。
余以寒凉复伤中气，形病俱虚，用前方加附子治之而痊。后复劳，经水数日不止，众以为附子之热所致，
用四物、芩、连、槐花之类，凉而止之，前症愈甚，更加胸膈痞满，饮食日少。余仍用前方，去门冬，更加
茯苓、半夏、炮姜，数剂渐愈，又用当归芍药汤而经止。但四肢逆冷，饮食难化，不时大热，此命门真火
衰，脾土虚寒之假热也。用八味丸半载而痊，又服六味丸三载而生子。
如果夏季感受暑邪，出现发热、大汗淋漓、四肢无力、脉象虚细而迟缓的症状。这是暑热损伤了元气，服用后面的方剂。
人参 黄（蜜炙） 麦门冬（去心） 白芍药 陈皮 白茯苓（各一钱） 黄连（炒）
甘草（炙，各五分） 黄柏（三分） 白术（一钱五分） 香薷 知母（各七分）
以上药物加生姜、水煎煮，饭前温服。
我按：李东垣先生说：在暑热季节，没有生病的人，或者为了避暑热，在深堂大厦中纳凉而得病的，名叫“中暑”，其病症必定是头痛、恶寒、身体拘急不舒、肢节疼痛、烦热无汗，这是因为被房屋内的阴寒之气所遏制，（名叫中阴），用大顺散这类热性药物来主治。如果是行路的人或农夫在烈日下得病的，名叫“劳役中热”，其病症必定是剧烈头痛、烦躁发热、怕热、肌肤发热、极度口渴、大汗淋漓、懒于活动，这是因为天热外伤肺气，用苍术白虎汤这类凉性药物来主治。如果人元气不足，使用前面的药物无效，适宜用补中益气汤来主治。大体上夏季阳气浮越于体表，阴气潜伏于体内，如果人因饮食劳倦内伤中气，或因酷暑劳役外伤阳气者，多患此病，治法应当以调补元气为主，辅以解暑。若是“中阴”之症，乃是阴寒性质的病症，治法应当以补阳气为主，少量辅以解暑。所以先哲多用干姜、肉桂、附子之类的药物，这是推演《内经》中“舍时从症”的良好法则。如今患暑症死亡，而手足指甲或肢体呈现青黑色，这都是不探究病因，不温补内脏，而滥用香薷饮之类药物造成的误治。香薷饮是发散阳气、引导真阴的方剂，必须审察有相应的症状才服用，又有什么可担忧的呢？如果人元气本来虚弱，或者因过度劳累而饮用它，恰好就是招致暑邪患病的原因。（那些暑热损伤元气而类似风症的病例，见第四卷首部的治疗验案。）
如果在夏秋季节，因为过食生冷食物茶水损伤内部，又过度贪凉受风损伤外部，导致恶寒发热、胸膈饱闷，或者饮食不进，或者兼有呕吐、泄泻，这是内外都受到寒冷伤害。
人参 干姜（炒至紫色） 浓朴（姜水炒） 陈皮 羌活 枳实 白茯苓（各一钱） 白术（一钱五分）
甘草（炙，五分）
以上药物加生姜、水煎煮，饭前温服。
我按：前面的病症如果用药未见效，适宜用藿香正气散；如果表里症状已解除，但寒热未退，或者饮食未进，适宜用六君子汤。《保命集》说：霍乱属于阳明症，适宜用和中、平胃、建中，或者四君子汤之类的方剂。脉象浮、自汗出的，用四君子汤加桂枝主治；脉象浮、无汗出的，用四君子汤加麻黄。吐利伴有转筋、胁下痛、脉弦的，是木克土的表现。用平胃散加木瓜，或者建中汤加柴胡、木瓜；吐利伴有转筋、腹中痛、身体沉重、脉沉而细的，用四君子汤加白芍药、良姜。吐利且四肢拘急、脉沉而迟缓的，属于少阴症，用四君子汤加干姜、附子、浓朴；吐利且四肢厥冷、脉微缓的，属于厥阴症，用建中汤加当归、附子。吐利、头痛且身热、想喝水的，用五苓散；寒多不想喝水的，用理中丸主治。元戎说：太阴症霍乱的，理中汤加橘红；吐下腹痛、手足逆冷的，理中汤加熟附子；吐利后出现转筋的，理中汤加火硝石膏一两。
进士刘华甫，夏季食用生冷果品患上上述病症。我用附子理中汤，服用一次立刻痊愈。
上舍徐民则，夏季进入房事并食用冰镇水果面食而患上腹痛。我说：这是阴寒性质的病症，必须用附子理中汤来回阳救逆。他不相信，另外使用二陈汤、枳实、黄连、香薷饮之类的药物而死。
如果在夏季暑热天气在途中行走，常服用此方以壮元气、清热驱暑，服用后可避免中暑、霍乱、泄泻、痢疾等病症。
人参（一钱二分） 白术（一钱五分） 五味子（十粒，捣碎） 麦门冬（去心） 白芍药（炒）
白茯苓（各一钱） 知母（炒） 陈皮 香薷（各七分） 黄芩（炒三分） 甘草（炙五分）
以上药物加生姜、水煎煮，饭前温服。
我按：前面的病症如果人元气虚弱，适宜用补中益气汤去掉柴胡、升麻，加麦门冬、五味子，或者少量加入炒黑的黄柏，人参养气汤也可以使用。
一位儒生，在季夏时节患泄泻，腹中作痛，饮食无味，肢体倦怠。我用补中益气汤、八味地黄丸，一个月多月后痊愈。后来他说：每年秋天必定患痢疾，现在却安然无恙，为什么呢？我说：这是闭藏之月，远离帷幔（指节制房事），妄泄真阳而导致的。前面的药物善于补益真火，火能生土，脾气生旺从而免于患病。
如果遇到劳倦辛苦用力过多，就服用后面的一两个方剂，可以避免产生内伤发热的疾病。这个方剂主要在于补气。
黄（二钱半，蜜炙） 人参 麦门冬（去心） 陈皮（各一钱） 白术 炙草 五味（各五分）
以上药物加生姜、大枣、水煎煮，饭前温服。如果劳倦严重，加熟附子四、五分。
我按：前面的论述开启了世俗人的蒙昧，救济了无数早夭之人。方中附子如果平时畏寒喜热饮食的人，尤其适宜使用；如果平时喜欢寒凉饮食的人，用肉桂或炮姜代替也可以，只是世间很少这样使用罢了！
一位妇人因为劳役，发热，倦怠，唾痰，想呕吐，有人认为是火症，使用清热化痰等药物，反而导致大便不成形，没有力气活动。我认为她是因寒凉药物再次损伤中气，形体和病症都虚弱，用前面的方剂加附子治疗而痊愈。后来再次劳累，月经数日不止，众人认为是附子的热性所致，使用四物汤、黄芩、黄连、槐花之类的药物，试图用凉血止血的方法止住经血，前面的病症更加严重，加上胸膈痞满，饮食日渐减少。我仍然用前面的方剂，去掉麦门冬，再加茯苓、半夏、炮姜，几剂后逐渐好转，又用当归芍药汤使经血停止。但是四肢逆冷，饮食难以消化，不时出现大热，这是命门真火衰微，脾土虚寒产生的假热。用八味丸半年后痊愈，又服用六味丸三年后生下孩子。
If one contracts summerheat in the summer months, presenting with fever, profuse sweating, lack of strength, and a deficient, fine, and slow pulse. This is summerheat damaging the Yuan Qi (Original Energy). Take the following prescription.
Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix, honey-fried), Mai Men Dong (Ophiopogonis Radix, heart removed), Bai Shao Yao (Paeoniae Radix Alba), Chen Pi (Citri Reticulatae Pericarpium), Bai Fu Ling (Poria), each 1 qian; Huang Lian (Coptidis Rhizoma, stir-fried), Gan Cao (Licorice Radix, roasted), each 5 fen; Huang Bo (Phellodendri Cortex), 3 fen; Bai Zhu (Atractylodis Macrocephalae Rhizoma), 1.5 qian; Xiang Ru (Moslae Herba), Zhi Mu (Anemarrhenae Rhizoma), each 7 fen.
Add fresh ginger and water, decoct, and take warm before meals.
My commentary: Mr. Li Dongyuan stated: During hot summer weather, healthy individuals who seek coolness in deep halls and large buildings may contract what is called "Zhong Shu" (Summerstroke). Their symptoms must include headache, aversion to cold, stiffness and tension of the body, pain in limbs and joints, irritability, heat sensation, and absence of sweat. This occurs because they are constrained by the yin-cold qi within the rooms. (This condition is also referred to as "Zhong Yin" [Mid-Yin], treated primarily with warming herbs such as Da Shun San). If travelers or farmers contract it under the midday sun, it is called "Lao Yi Zhong Re" (Heatstroke due to Labor). Symptoms must include severe headache, restlessness and heat, aversion to heat, skin heat, extreme thirst, profuse sweating, and lethargy. This results from heavenly heat injuring Lung Qi externally, and should be treated primarily with cooling agents like Cang Zhu Bai Hu Tang. If the patient's Yuan Qi is insufficient and previous remedies fail, Bu Zhong Yi Qi Tang is appropriate. Generally, in summer, Yang Qi floats outward while Yin Qi hides inward. If internal injury to Middle Qi occurs due to diet and overwork, or if external injury to Yang Qi occurs due to intense heat and labor, these conditions are common. The treatment principle should focus on regulating and tonifying Yuan Qi, assisted by resolving summerheat. In cases of "Zhong Yin," which is a yin-cold syndrome, the method should prioritize tonifying Yang Qi, with minor assistance from resolving summerheat. Thus, ancient physicians often used ginger, cinnamon, and aconite. This deduces the excellent method from the *Nei Jing* of "abandoning the season to follow the symptoms." Today, patients dying of summerheat syndromes often have cyanotic fingernails or dark limbs. This is all due to failing to investigate the cause and failing to warm and tonify the interior, instead indiscriminately using formulas like Xiang Ru Yin. Xiang Ru Yin is a formula that disperses Yang Qi and guides True Yin. It must only be taken when specific indications are present; otherwise, why worry? If a person has constitutionally weak Yuan Qi or drinks this after excessive labor, it precisely invites summerheat disease. (Cases where summerheat damages Yuan Qi resembling wind syndromes are seen at the beginning of Volume 4.)
In summer and autumn, if excessive consumption of cold foods and teas injures the interior, and excessive exposure to cool winds injures the exterior, leading to aversion to cold and fever, chest and diaphragmatic fullness, anorexia, or accompanied by vomiting and diarrhea, this indicates both interior and exterior injuries from cold.
Ren Shen (Ginseng Radix), Gan Jiang (Zingiberis Rhizoma, stir-fried until purple), Hou Po (Magnoliae Officinalis Cortex, stir-fried with ginger juice), Chen Pi (Citri Reticulatae Pericarpium), Qiang Huo (Notopterygii Rhizoma et Radix), Zhi Shi (Aurantii Fructus Immaturus), Bai Fu Ling (Poria), each 1 qian; Bai Zhu (Atractylodis Macrocephalae Rhizoma), 1.5 qian; Gan Cao (Licorice Radix, roasted), 5 fen.
Add fresh ginger and water, decoct, and take warm before meals.
My commentary: If the aforementioned symptoms do not respond, Huo Xiang Zheng Qi San is appropriate. If exterior and interior pathogens are resolved but chills and fever persist, or appetite has not returned, Liu Jun Zi Tang is appropriate. *Bao Ming Ji* states: Huoluan (Cholera) belongs to the Yangming syndrome. He Zhong (Harmonizing the Middle), Ping Wei (Calming the Stomach), Jian Zhong (Establishing the Center), or Si Jun Zi Tang (Four Gentlemen Decoction) are suitable. With a floating pulse and spontaneous sweating, Si Jun Zi Tang plus Gui Zhi (Cinnamon Twig) is indicated; with a floating pulse and no sweating, Si Jun Zi Tang plus Ma Huang (Ephedrae Herba) is indicated. Vomiting and diarrhea with muscle cramps, hypochondriac pain, and a wiry pulse indicate Wood overcoming Earth. Use Ping Wei San plus Mu Gua (Chaenomeles Fruit), or Jian Zhong Tang plus Chai Hu (Bupleuri Radix) and Mu Gua. Vomiting and diarrhea with cramps, abdominal pain, heavy body, and a deep, fine pulse require Si Jun Zi Tang plus Bai Shao Yao (Paeoniae Radix Alba) and Liang Jiang (Alpiniae Katsumadai Rhizoma). Vomiting and diarrhea with limb stiffness, deep and slow pulse belong to Shaoyin syndrome; treat with Si Jun Zi Tang plus Gan Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata), and Hou Po. Vomiting and diarrhea with cold extremities and faint, slow pulse belong to Jueyin syndrome; treat with Jian Zhong Tang plus Dang Gui (Angelicae Sinensis Radix) and Fu Zi. Vomiting and diarrhea with headache and fever, with desire for water, indicate Wu Ling San (Five-Ingredient Powder with Poria); with much cold and no desire for water, Li Zhong Wan (Regulate the Middle Pill) is indicated. Yuan Rong stated: For Taiyin syndrome Huoluan, add Ju Hong (Tangerine Peel) to Li Zhong Tang; for vomiting, downward discharge, abdominal pain, and cold extremities, add Shu Fu Zi (Prepared Aconite Root) to Li Zhong Tang; for cramps after vomiting and diarrhea, add Huo Xiao Shi Gao (Fire-mined Gypsum Fibrosum) to Li Zhong Tang.
Jinshi Liu Huafu consumed raw and cold fruits in summer and contracted the aforementioned syndrome. I used Fu Zi Li Zhong Tang (Aconite Regulate-the-Middle Decoction), and he recovered immediately after one dose.
Shangshe Xu Minze engaged in sexual activity and ate ice-cooled fruits and wheat noodles in summer, contracting abdominal pain. I said: This is a yin-cold syndrome; you must use Fu Zi Li Zhong Tang to restore Yang. He did not believe me, used Er Chen Tang (Two-Aged Decoction), Zhi Shi (Aurantii Fructus Immaturus), Huang Lian (Coptidis Rhizoma), and Xiang Ru Yin (Moslae Decoction), and died.
If traveling during summer heat, taking this formula regularly strengthens Yuan Qi, clears heat, and expels summerheat, preventing summerstroke, Huoluan, diarrhea, and dysentery.
Ren Shen (Ginseng Radix), 1.2 qian; Bai Zhu (Atractylodis Macrocephalae Rhizoma), 1.5 qian; Wu Wei Zi (Schisandrae Chinensis Fructus), 10 grains (crushed); Mai Men Dong (Ophiopogonis Radix, heart removed); Bai Shao Yao (Paeoniae Radix Alba, stir-fried); Bai Fu Ling (Poria), each 1 qian; Zhi Mu (Anemarrhenae Rhizoma, stir-fried); Chen Pi (Citri Reticulatae Pericarpium); Xiang Ru (Moslae Herba), each 7 fen; Huang Qin (Scutellariae Radix, stir-fried), 3 fen; Gan Cao (Licorice Radix, roasted), 5 fen.
Add fresh ginger and water, decoct, and take warm before meals.
My commentary: For the aforementioned syndrome, if the patient has weak Yuan Qi, use Bu Zhong Yi Qi Tang removing Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma), adding Mai Men Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Chinensis Fructus), or a small amount of stir-fried black Huang Bo (Phellodendri Cortex). Ren Shen Yang Qi Tang (Ginseng Tonifying-Qi Decoction) is also usable.
A scholar suffered from diarrhea, abdominal pain, loss of taste for food, and limb fatigue in late summer. I used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). He recovered after more than a month. Later he asked: Why am I free of illness now, whereas I always suffered from dysentery every autumn? I said: This is due to wasting True Yang during the month of closure (winter/late autumn) by not avoiding sexual activity. The previous medicines effectively tonify True Fire. Fire generates Earth; when Spleen Qi becomes robust, the disease is avoided.
If one encounters excessive labor, fatigue, or strenuous effort, taking one or two doses of the following prescriptions prevents internal injury fever. This formula primarily tonifies Qi.
Huang Qi (Astragali Radix, honey-fried), 2.5 qian; Ren Shen (Ginseng Radix); Mai Men Dong (Ophiopogonis Radix, heart removed); Chen Pi (Citri Reticulatae Pericarpium), each 1 qian; Bai Zhu (Atractylodis Macrocephalae Rhizoma); Zhi Cao (Roasted Licorice); Wu Wei Zi (Schisandrae Chinensis Fructus), each 5 fen.
Add fresh ginger, jujube, and water, decoct, and take warm before meals. If labor is severe, add Shu Fu Zi (Prepared Aconite Root), 4-5 fen.
My commentary: The preceding discussion dispels worldly ignorance and saves countless premature deaths. If the patient constitutionally fears cold and prefers hot drinks, Fu Zi (Aconiti Lateralis Radix Praeparata) is especially suitable. If the patient prefers cold drinks, Rou Gui (Cinnamomi Cortex) or Pao Jiang (Zingiberis Rhizoma Preparatum) can substitute, though this is rarely done in practice!
A woman suffered from fever, fatigue, expectoration of phlegm, and nausea due to labor. Others diagnosed it as a Fire syndrome and used clearing-heat and resolving-phlegm drugs, resulting in loose stools and lack of energy to move. I determined that cold-natured drugs had further injured Middle Qi, leaving both form and pathology deficient. I treated her with the previous formula plus Fu Zi (Aconiti Lateralis Radix Praeparata), and she recovered. Later, upon re-exertion, her menstruation lasted several days. Others attributed this to the heat of Fu Zi and used Si Wu Tang (Four Substances Decoction), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Huai Hua (Sophorae Flos) to stop bleeding with cold properties. Her previous symptoms worsened, accompanied by chest and diaphragmatic stuffiness and decreasing appetite. I again used the previous formula, removing Mai Men Dong (Ophiopogonis Radix), adding Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma), and Pao Jiang (Zingiberis Rhizoma Preparatum). After several doses, she gradually improved, then used Dang Gui Shao Yao San (Angelica and Peony Powder) to stop menstruation. However, she had cold extremities, difficulty digesting food, and intermittent high fever. This was false heat caused by decline of True Fire in the Gate of Vitality and deficiency-cold of Spleen Earth. She recovered after half a year of taking Ba Wei Wan (Eight-Ingredient Pill), and bore a child after three years of taking Liu Wei Wan (Six-Ingredient Pill with Rehmannia).