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。
赵注。此证属阴阳俱虚。脉弦细者阳虚也。芤迟者阴虚也。所以温针复损其阴。
汗之复伤其阳。惟宜甘药补之。以解其热耳。即灵枢所谓阴阳俱不足。补阳则
阴竭。补阴则阳脱。可以甘药。因是知白虎汤中石膏之甘寒。粳米、甘草之辅正。人参之益元。
为的对之药矣。虽知母之苦寒。为除足阳明及手太阴气分之热。并可益肾。以除烦躁耳。舍此其谁与归。
太阳中热者。 是也。汗出恶寒。身热而渴。白虎加人参汤主之。（方见前）
周注。赵氏引成注一段。因表里不明。足以惑疑后人。故删之。赵云。此证为令火
之气酷其金。肺主气者也。肺伤则气虚。然太阳膀胱属水主表。肺金之子也。母
虚而子亦不足。卫虚表不足。由是汗出身热恶寒。内经曰。心移热于肺。传为膈
消。膈消则渴也。皆相火伤肺之所致。此可知其要在救肺也。石膏虽能除三焦
火热。然仲景名白虎者。为石膏功独多于清肺。退金中之火。是用为君。知母亦
就肺中泻火。滋水之源。人参生津液。益所伤之气而为臣。粳米、甘草补土以滋
金为佐也。愚按冬月有寒。则能伤人名中寒。夏月有热。亦能伤人名中热。此是
外来之热。故曰中。非即伏寒发出。夏必病热之热也。然而同用白虎者。总以所
伤在气。则所主在金。所病在热。生金者土。金生者水。金病则我母我子俱病。故
与伏气之在少阴发出之由阳明者无异。要皆并主一汤。全不因冬月之伏。与
夏月之中。为二义也。又全不以伏气之渴与今病之渴为稍异。而必主人参也。
呜呼。圣人于此。有意立方。无心表异。以千古之前。自有此理。万世之下。自有此
悟。不意今之学人。不知冬月伏气。与暑月中热。同治之旨。反当以此汤治伤寒。
每至投而辄毙。光与盏落。反疑圣人有未尽善者。何可胜悼。
太阳中 。身热疼重。而脉微弱。此以夏热伤冷水。水行皮中所致也。一物瓜蒂汤主之。
一物瓜蒂汤
瓜蒂（二七个）
上锉。以水一升。煮取五合。去渣顿服。
周注。脉虚身热。得之伤暑。今身热脉微弱者 也。身体疼痛者水也。夏因暑热。
以水灌洗而得。一物瓜蒂汤吐之。常观仲景。 病惟出三证。岂偶然哉。举其端
为万世准绳。一者明其表里俱虚。一者言其 中表之热。而此言水邪郁令火
而成中 也。若邪郁令火。比类而推。其因殆有不可胜言。如取风凉者。感雾露
者。食生冷者。素有积热者。阴血素虚。不胜大热者。宿邪感而动者。处阴地者。凡
此之类。皆足以郁其令火。为中 之由。或轻或重。或表或里。或虚或实。随证发
现。若论治邪退热。较量权衡。何可一言尽哉。诸集类方论。徒多其证。聚其方。未
有明言其脉证。属于何因。害于何经。用何药为君以主之。何药为臣以佐之。苟
不潜心仲景书者。吾未信其泛然方证。果切病情否也。瓜蒂本草谓其主胸腹
邪气。皆吐下之。此以夏月伤冷水。水行皮中。而皮中者岂非属表。何乃用是药
去胸中之水乎。盖形寒饮冷则伤肺。皮乃肺之合。胸中又肺之部。内外相应。且
瓜蒂又治四肢浮肿。下水而冷。水之在皮中者。不惟灌洗得散。而饮冷所伤者。
亦得散于皮中。故两者皆得而用之。
喻嘉言合论白虎加人参汤、瓜蒂汤二方云。金匮治 病。止出二方。一以白虎
加人参专治其热。以夏月之热淫。必僭而犯上。伤其肺金。耗其津液。用之以救
肺金。存津液也。孙思邈之生脉散。李东垣之清暑益气汤。亦既祖之矣。一以瓜
蒂汤专治其湿。以夏月之湿淫上甚为热。亦先伤其肺金。故外渍之水。得以聚
于皮间。皮者肺之合也。用以搐其胸中之水。或吐或泻而出。则肺气得以不壅。
而皮间之水。得以下趋也。何后人但宗仲景五苓散为例。如河间之通苓散。子
和之桂苓甘露饮。非不得导湿消暑之意。求其引伸瓜蒂汤之制。以治上焦湿
热而清肺金。则绝无一方矣。抑知无形之热伤其肺金。则用白虎加人参汤救之。有形之湿伤于肺金。则用瓜蒂汤救之。
各有所主也。
太阳中暍（中暑）。出现发热、恶寒的症状，身体沉重且疼痛。脉象表现为弦细、芤迟。小便结束后，感到洒洒然怕冷、毫毛竖起，手足逆冷。
稍微活动一下，身体就会发热，张口呼吸时前侧门齿干燥。如果误用发汗法治疗，则恶寒症状加重；如果误用温针疗法，则发热症状加重；如果多次使用泻下法治疗，则淋证（小便频数短涩）症状加重。
赵氏注解：此证属于阴阳俱虚。脉象弦细，是阳气虚弱；脉象芤迟，是阴液亏虚。因此，温针会进一步损伤阴液，发汗会进一步耗伤阳气。只适宜用甘味药物来补益，以解除热邪罢了。这正是《灵枢》所说的“阴阳俱不足”，若补阳则阴液枯竭，若补阴则阳气脱失，应当用甘药调理。由此可知，白虎汤中的石膏，其性甘寒，粳米和甘草辅助正气，人参补益元气，是对证的良药。虽然知母性苦寒，能清除足阳明经及手太阴经气分的火热，并能益肾以消除烦躁。除此之外，还能用什么药呢？
太阳中热者，就是中暍（中暑）。表现为汗出、恶寒、身热且口渴，主方为白虎加人参汤。（方剂见前文）
周氏注解：赵氏引用成无己的一段注释，因为表里辨证不明，足以迷惑后人，所以我将其删去。赵氏说：此证是因为时令火气酷烈克制肺金所致。肺主气，肺受伤则气虚。然而太阳膀胱属水而主表，肺金是膀胱水的子脏。母脏虚弱，子脏也不足。卫气虚弱，体表不固，因此出现汗出、身热、恶寒。《内经》说：“心将热邪移于肺，传变为膈消。”膈消就会导致口渴。这都是相火伤肺所导致的。由此可知，治疗的要害在于救肺。石膏虽然能清除三焦的火热，但张仲景称其为“白虎”，是因为石膏的功效独重于清肺，退除肺金中的火热，所以作为君药。知母也是在肺中泻火，滋补水之源。人参生津液，补益受损之气，作为臣药。粳米、甘草补益脾胃（土）以滋养肺（金），作为佐药。我按语：冬季有寒气，能伤人称为“中寒”；夏季有热气，也能伤人称为“中热”。这是外来的热邪，所以称为“中”，并非即伏寒发出、夏季必然发病的那种热邪。然而同样使用白虎汤的原因，总是因为所伤在气分，病位主要在肺金，病性在热。生金者为土，金生水。肺金有病，则我的母脏（脾土）和我的子脏（肾水）都受牵连。所以这与伏气温病从少阴发出、由阳明经病变的情况没有不同。关键在于都主治同一张汤方，完全不因冬季的伏气与夏季的中暑而分为两种义理。也完全不因伏气温病的口渴与当前病症的口渴稍有差异而改变用人参的原则。唉！圣人在这里，是有意识地创立方剂，无心标新立异。在千古之前，自有此理；在万世之后，自有此悟。没想到现在的学人，不知道冬季伏气与暑月中热同治的宗旨，反而用这张汤方治疗伤寒，每次投药往往导致死亡，如同光与盏落，反而怀疑圣人有所未尽善之处，这怎么不令人痛惜呢？
太阳中暍，身体发热且疼痛沉重，脉象微弱。这是因为夏季受热后饮用冷水，水气行于皮肤中所致。主方为一物瓜蒂汤。
一物瓜蒂汤
瓜蒂（二十七个）
以上锉碎，用水一升，煮取五合，去渣，一次性服用。
周氏注解：脉虚身热，得之于伤暑。如今身热而脉微弱，是中暍之象。身体疼痛，是水邪所致。夏季因暑热，用冷水灌洗而致病。一物瓜蒂汤通过涌吐法治疗。常观察张仲景，关于中暍的病证只列出三种，难道是偶然的吗？列举其端绪作为万世的准则。一是明确其表里俱虚，二是言明其中表之热，而此处言明水邪郁遏时令之火而成中暍。如果邪气郁遏时令之火，类比推演，其成因大概有不可胜言的情况。如贪取风凉者，感受雾露者，食用生冷者，素有积热者，阴血素虚不能耐受大热者，宿邪感而动者，居住在阴湿之地者。凡此之类，都足以郁遏时令之火，成为中暍的缘由。或轻或重，或表或里，或虚或实，随证显现。如果论治邪退热，较量权衡，怎么能一言尽述呢？各类集方论著，徒增其证候，聚集其方剂，没有明确说明其脉证属于何种病因，损害哪条经络，用什么药为君以主之，什么药为臣以佐之。如果不潜心研读张仲景著作的人，我不相信他们那些泛泛的方证对应，果真切合病情与否。瓜蒂在《本草》中说它能主治胸腹邪气，都是采用吐下法。此处是因为夏季伤于冷水，水气行于皮中，而皮中难道不属于表吗？为何用这种药去去除胸中之水呢？大概形体受寒、饮食生冷会伤肺，皮肤是肺的外合，胸中又是肺的部位，内外相应。而且瓜蒂又能治疗四肢浮肿，下行水气而性冷。水在皮中的情况，不仅灌洗所得之水可以消散，而且饮冷所伤的水气，也能消散于皮中。所以两者都可以使用它。
喻嘉言合论白虎加人参汤、瓜蒂汤二方说：《金匮要略》治疗中暍病，只给出两个方子。一个是用白虎加人参汤专门治疗其热，因为夏季的热邪淫盛，必定僭越而上犯，损伤肺金，耗伤津液，用它来救肺金，保存津液。孙思邈的生脉散，李东垣的清暑益气汤，也已经以此为祖源了。另一个是用瓜蒂汤专门治疗其湿，因为夏季的湿邪淫盛上甚而为热，也先损伤肺金，所以外渍之水，得以聚于皮间。皮肤是肺的外合，用它来搐引胸中之水，或通过吐或通过泻而出，则肺气得以不壅滞，而皮间的水气，得以向下趋行。为什么后人只宗法张仲景的五苓散为例，如刘河间的通苓散，张子和的桂苓甘露饮，并非没有导湿消暑的意思，寻求其引申瓜蒂汤的制方原理，来治疗上焦湿热而清肺金，却绝无一方。岂不知无形之热损伤肺金，就用白虎加人参汤救治它；有形之湿损伤肺金，就用瓜蒂汤救治它。各有所主也。
Taiyang Zhongxie (Heatstroke in the Taiyang stage). Fever and aversion to cold occur. The body feels heavy and painful. The pulse is wiry, fine, hollow, and slow. After urination, there is a sensation of shivering chills and piloerection, with cold extremities.
Slight exertion causes immediate bodily heat; opening the mouth reveals dryness on the anterior lateral teeth. If diaphoresis (sweating-inducing treatment) is applied, aversion to cold becomes severe. If warm needle therapy is used, fever becomes severe. If purgation is repeatedly applied, strangury (dysuria) becomes severe.
Zhao's Commentary: This syndrome belongs to deficiency of both Yin and Yang. A wiry and fine pulse indicates Yang deficiency; a hollow and slow pulse indicates Yin deficiency. Therefore, warm needles further damage Yin, and sweating further injures Yang. It is only appropriate to use sweet-natured herbs to tonify, thereby resolving the heat. This corresponds to what is stated in the *Ling Shu*: "When both Yin and Yang are insufficient," tonifying Yang leads to exhaustion of Yin, and tonifying Yin leads to loss of Yang; thus, sweet herbs should be used. From this, we know that in Baihu Tang (White Tiger Decoction), Shi Gao (Gypsum Fibrosum) is sweet and cold; Jing Mi (Oryzae Semen, Rice) and Gan Cao (Glycyrrhizae Radix et Rhizoma) assist righteous Qi; and Ren Shen (Ginseng Radix) benefits Yuan Qi. These are precisely the correct medicines. Although Zhi Mu (Anemarrhenae Rhizoma) is bitter and cold, clearing heat from the Qi level of the Foot-Yangming and Hand-Taiyin meridians, and benefiting the Kidney to remove irritability, it serves a specific role. Apart from these, what else could be used?
Taiyang Zhongre (Heatstroke in the Taiyang stage) refers to Zhongxie (Heatstroke). Symptoms include sweating, aversion to cold, bodily heat, and thirst. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is the primary formula. (Formula seen previously.)
Zhou's Commentary: Zhao cited a passage from Cheng Wuji's commentary. Because the differentiation of exterior and interior was unclear, it was sufficient to confuse later generations, so I deleted it. Zhao said: This syndrome occurs because the seasonal Fire Qi severely restricts Lung Metal. The Lung governs Qi; when injured, Qi becomes deficient. However, the Taiyang Bladder belongs to Water and governs the exterior; Lung Metal is the child organ of Bladder Water. When the mother organ is deficient, the child organ is also insufficient. Defensive Qi is weak, and the exterior is inadequate; consequently, sweating, bodily heat, and aversion to cold occur. The *Nei Jing* states: "Heart transfers heat to the Lung, transmitting as Ge Xiao (Diaphragmatic Thirst)." Ge Xiao leads to thirst. All of this is caused by Ministerial Fire injuring the Lung. Thus, we can see that the key to treatment lies in saving the Lung. Although Shi Gao (Gypsum Fibrosum) can clear heat and fire from the Triple Burner, Zhang Zhongjing named it "Baihu" (White Tiger) because its efficacy is uniquely focused on clearing the Lung and retreating fire within Metal. Therefore, it is used as the Sovereign herb. Zhi Mu (Anemarrhenae Rhizoma) also clears fire in the Lung and nourishes the source of Water. Ren Shen (Ginseng Radix) generates fluids and benefits damaged Qi, serving as the Minister herb. Jing Mi (Oryzae Semen, Rice) and Gan Cao (Glycyrrhizae Radix et Rhizoma) tonify Earth to nourish Metal, serving as Assistant herbs. My analysis: In winter, Cold can injure people, termed "Zhonghan" (Cold Strike); in summer, Heat can also injure people, termed "Zhongre" (Heat Strike). This is exogenous Heat, hence called "Zhong" (Strike), not the heat that emerges from latent Cold or the heat inevitable in summer diseases. However, the reason for using Baihu Tang is generally because the injury is to the Qi level, the location is primarily Lung Metal, and the pathology is Heat. Earth generates Metal, and Metal generates Water. When Lung Metal is diseased, both its mother (Spleen/Earth) and its child (Kidney/Water) are affected. Thus, this is no different from latent Qi disease emerging from Shaoyin and manifesting in Yangming. The essential point is that they all treat with the same decoction, completely不因 (not due to) whether it is latent Qi in winter or Heat Strike in summer being treated as two different principles. Nor does it differentiate between the thirst of latent Qi disease and the current disease's thirst slightly differently, insisting on the use of Ren Shen (Ginseng Radix). Alas! The Sage here intentionally established the formula, without intent to stand out. Before millennia past, this principle existed; after millennia future, this understanding will exist. Unexpectedly, modern scholars do not understand the principle of treating latent Qi in winter and Heat Strike in summer similarly. Instead, they use this decoction to treat Shanghan (Cold Damage), often resulting in death upon administration, like light extinguishing and lamp falling, and then suspect the Sage was not fully perfect. How lamentable.
Taiyang Zhongxie (Heatstroke in the Taiyang stage): Bodily heat and painful heaviness, with a faint pulse. This is caused by Summer Heat injuring the person who drank cold water, causing water qi to circulate in the skin. Yi Wu Gua Di Tang (One-Ingredient Trichosanthes Fruit Decoction) is the primary formula.
Yi Wu Gua Di Tang
Gua Di (Trichosanthis Fructus, 27 units)
Cinch the material. Boil in one sheng of water until five ge remains. Remove dregs and take in one dose.
Zhou's Commentary: Faint pulse and bodily heat result from Summer Heat injury. Now, bodily heat with a faint pulse indicates Zhongxie (Heatstroke). Body pain indicates Water pathogen. In summer, due to Summer Heat, bathing with cold water causes this disease. Yi Wu Gua Di Tang treats it by inducing vomiting. Observing Zhang Zhongjing, he only listed three syndromes for Zhongxie (Heatstroke). Is this accidental? He set the precedent as a standard for ten thousand generations. One clarifies that both exterior and interior are deficient; another speaks of the heat in the exterior and interior; here, it speaks of Water pathogen郁 (stagnating) seasonal Fire to form Zhongxie (Heatstroke). If pathogen stagnates seasonal Fire, by analogy, the causes are countless. Such as those seeking wind coolness, contracting fog and dew, eating raw/cold foods, having chronic accumulated heat, having constitutionally deficient Yin blood unable to withstand great heat, having old pathogens activated by infection, dwelling in yin/damp places. All such cases can stagnate seasonal Fire, becoming the cause of Zhongxie (Heatstroke). Whether mild or severe, exterior or interior, deficient or excess, appearing according to syndrome. If discussing eliminating pathogen and reducing heat, weighing and balancing, how can it be summarized in one word? Various collected formulas and discussions merely add more syndromes and gather more formulas, without clearly stating which etiology the pulse and syndrome belong to, which meridian is harmed, which herb is Sovereign to lead, and which herb is Minister to assist. Without deeply studying Zhang Zhongjing's books, I do not believe their generic syndrome-formula correlations truly fit the patient's condition. *Ben Cao* states Gua Di (Trichosanthis Fructus) treats evil qi in the chest and abdomen, using vomiting and purging. Here, it is because Summer Heat injury from cold water causes water qi in the skin. Is the skin not the exterior? Why use this medicine to remove water from the chest? Generally, cold shape and cold drinks injure the Lung; skin is the Lung's exterior correspondence; the chest is the Lung's region. Interior and exterior correspond. Moreover, Gua Di (Trichosanthis Fructus) treats edema of the four limbs, descending water and being cold. Water in the skin, whether obtained from bathing or injured by drinking cold, can dissipate in the skin. Thus, both situations allow its use.
Yu Jiayan jointly discussed Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) and Gua Di Tang (Trichosanthes Fruit Decoction): The *Jin Gui Yao Lue* treats Zhongxie (Heatstroke) with only two formulas. One uses Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) specifically for heat. Summer Heat excess must overstep and attack upward, damaging Lung Metal and consuming fluids; it is used to save Lung Metal and preserve fluids. Sun Simiao's Sheng Mai San (Generate Pulse Powder) and Li Dongyuan's Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) have already taken this as their ancestor. The other uses Gua Di Tang (Trichosanthes Fruit Decoction) specifically for dampness. Summer Dampness excess rising severely creates heat, also first damaging Lung Metal; thus, externally soaked water gathers between the skin. Skin is Lung's exterior correspondence; it is used to draw out water from the chest, exiting via vomiting or purging, so Lung Qi is not obstructed, and water between the skin flows downward. Why do later generations only follow Zhang Zhongjing's Wu Ling San (Five-Ingredient Powder with Poria) as an example? Like Liu Hejian's Tong Ling San (Unblocking Poria Powder) and Zhang Zihe's Gui Ling Gan Lu Yin (Cinnamon Twig, Poria, and Sweet Dew Drink), while possessing the meaning of guiding dampness and dispelling summerheat, seeking to extend the formulation principle of Gua Di Tang (Trichosanthes Fruit Decoction) to treat Upper Jiao damp-heat and clear Lung Metal, there is absolutely not one formula. Should we not know that formless Heat damaging Lung Metal requires Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) to save it; and formed Dampness damaging Lung Metal requires Gua Di Tang (Trichosanthes Fruit Decoction) to save it? Each has its specific dominion.