暑热之时。有遍身发泡。如碗如杯。如桃如李。晶莹脆薄。中含臭水。此湿热之水。泛
于肌表也。黄连、香薷及解毒汤。重者内实便秘。口疳臭秽。凉膈散、承气汤选用。外
以鲜莲花瓣贴疮上。周时平复。
膏粱富贵之人。暑月阳事痿顿。医以温热进之。误也。湿热交蒸。石金渗润。草木流
膏。精神亏乏之人。时令应之。金风一鼓。万类肃然。宜黄连解毒合生脉散。
夏月不头痛发热。但觉小腹疼痛。或心腹俱痛。胀痞不能屈伸。医疑生冷过多。执
为阴证。不知皆暑火流注脏腑。故先小腹痛。遍及心腹。宜六和汤清解之。或四苓
加香薷、木瓜、紫苏、半夏之类和散之。或正气散。或二陈加浓朴炒栀。或炒盐和滚
汤探吐痰涎。大抵此证以吐法为上。若用热药。去生远矣。
暑气入腹。恶心腹痛。上吐下泻。泻如水注。此暑火暴发。升降不利。清浊不分。所泻
者皆五脏之精液。宜速止之。用五苓散。或胃苓汤。利小便。清暑火。甚者桂苓甘露。
此证有夹食积者。医用下之误矣。不知精液暴涸。元气顿伤。当立止之为上。按云
止者。非通因塞用之谓也。分阴阳。去暑气。则吐利自止矣。
更有吐泻无物。亦有上下关闭。竟不吐泻者。为干霍乱。惟心腹绞痛。令人立毙。急
以炒盐汤或二陈汤探吐之。通则可救。即定后周时。勿进粒米。得食复发。慎之慎
之。集论曰。中暑一证。不过清心利小便。解暑毒。补真气而已。即脉来虚弱。重者伏
匿。喘促逆冷。卒然昏晕。不可用温。此热伤阴气。用温则助阳耗阴。且冬月脉浮紧
浮缓。分中风伤寒。夏月弦紧伤风。弦缓中暑。表疏自汗则脉缓。表致无汗则脉紧
耳。世俗不明。曰夏月阴气在内。大顺为必用之药。夫阴非寒也。阳外而阴内耳。丹
溪云。伏阴在内。阴字有虚之义。作阴冷则误矣。火令之时。烁石流金。何阴冷之有。
孙真人用生脉散。气虚可知也。古人用大顺。非谓伏阴。本治冰果所伤。冷香饮子。
治阳气大虚。多欲厥逆。浆水散治汗多亡阳。脉微欲绝。其余不过清暑益气汤。消
暑十全散。十味香薷饮之类足矣。
薛氏曰。若中 者。乃阴寒之证。法当补阳为主。先哲多用姜、桂、附子。或云 字当
作暑字看。然何不竟用暑字。而滋后人之惑耶。
周禹载曰，薛氏本东垣大顺散而有此说。其乖谬不可胜言。草菅人命。难逃作俑之罪。
暑热季节，有人全身起水泡，大小如碗、如杯，形状像桃、像李，晶莹剔透且脆薄，里面含有臭秽的水液。这是湿热之邪泛溢于肌表所致。可用黄连解毒汤（具有清热燥湿、泻火解毒功效的方剂）、香薷饮（祛暑解表、化湿和中功效的方剂）或解毒汤治疗。病情较重者，若伴有体内实热、大便秘结，以及口舌生疮、口气臭秽等症状，可选用凉膈散（清上泄下功效的方剂）或承气汤（攻下实热功效的方剂）。外用鲜莲花瓣贴敷在疮面上，一周左右即可平复痊愈。
生活优渥、饮食肥甘厚味之人，在暑月出现阳气痿弱不振的情况，医生却误用温热性质的药物进补，这是错误的。此时体内湿热交蒸，如同金石渗润、草木流膏。对于精神亏乏之人，顺应时令变化，宜使用黄连解毒汤合生脉散（益气养阴功效的方剂）治疗。
夏季如果不头痛、不发热，只感觉小腹疼痛，或者心腹俱痛，腹胀痞闷导致身体不能屈伸。医生怀疑是生冷食物吃多了，固执地认为是阴证。殊不知这都是暑火流注于脏腑所致，所以先从小腹疼痛开始，进而遍及心腹部。宜用六和汤（调和脾胃、祛暑化湿功效的方剂）进行清解。或者用四苓散（利水渗湿功效的方剂）加香薷、木瓜、紫苏、半夏等药物来调和疏散。也可以用正气散（祛暑解表、化湿和中功效的方剂），或者二陈汤（燥湿化痰、理气和功效的方剂）加浓朴、炒栀子。或者用炒盐和滚开水探吐痰涎。大体上这个病症以吐法为上策。如果使用热药，就会离康复越来越远。
暑气侵入腹部，导致恶心腹痛，上吐下泻，泻下如水注般急迫。这是暑火暴发，导致气机升降不利，清浊不分。所泻出的都是五脏的精微津液，应当迅速止住。可用五苓散（利水渗湿、温阳化气功效的方剂），或者胃苓汤（健脾燥湿、利水消肿功效的方剂），通过利小便来清除暑火。病情严重者用桂苓甘露散（清暑解热、化气利水功效的方剂）。这种病症有夹杂食积的情况，医生如果用攻下法就错了。不知道精液突然枯竭，元气顿时受损，应当立即止住吐泻为上策。所谓“止”，并不是指“通因塞用”（即用收敛固涩的方法治疗通泄的病证），而是分清阴阳，去除暑气，那么吐泻自然就会停止。
更有呕吐腹泻无物排出，也有上下窍道闭塞，竟然完全不吐不泻的，这叫做干霍乱。只有心腹剧烈绞痛，让人立刻死亡。急需用炒盐汤或二陈汤探吐。如果能通畅则可得救。即使症状缓解后的一周内，也不要进食一粒米，吃了食物就会复发，务必谨慎再谨慎。《集论》说：中暑这一证候，不过是清心、利小便、解暑毒、补真气罢了。即使脉象虚弱，重者脉伏匿不出，气喘急促、四肢逆冷，突然昏晕，也不可用温性药物。这是因为热邪伤了阴气，用温药则会助长阳气、耗伤阴液。而且冬季脉象浮紧或浮缓，用来区分中风和伤寒；夏季脉象弦紧为伤风，弦缓为中暑，表虚自汗则脉缓，表闭无汗则脉紧罢了。世俗之人不明白这个道理，说夏季阴气在内，认为大顺散（温中散寒功效的方剂）是必用的药。其实“阴”并非“寒”，只是阳气在外而阴气在内而已。朱丹溪说：伏阴在内，“阴”字包含“虚”的含义，如果理解为阴冷就错了。火令之时，石头被烧得滚烫，金属熔化，哪里有什么阴冷？孙思邈使用生脉散，说明气虚可知。古人使用大顺散，并非针对伏阴，原本是用来治疗冰果所伤的。冷香饮子（温中散寒功效的方剂）用于治疗阳气大虚、多欲导致的厥逆。浆水散（敛汗固脱功效的方剂）用于治疗汗多亡阳、脉微欲绝的情况。其余不过是用清暑益气汤（清暑益气、养阴生津功效的方剂）、消暑十全散、十味香薷饮（祛暑解表、化湿和中功效的方剂）之类的方子就足够了。
薛氏说：如果是中寒证，乃是阴寒之证，治法应当以补阳为主。先哲多用生姜、肉桂、附子。或者说“中”字应当看作“暑”字，然而为什么不直接用“暑”字，反而滋长了后人的疑惑呢？
During the hot and sultry season, some people develop blisters all over their bodies, varying in size like bowls or cups, resembling peaches or plums. They are crystal clear, crisp, and thin, containing foul-smelling fluid. This is caused by damp-heat pathogenic factors overflowing onto the muscle surface (肌表). Treatment may involve Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity), Xiangru Yin (Elsholtzia Drink), or Jiedu Tang (Detoxifying Decoction). In severe cases with internal excess and constipation, accompanied by mouth ulcers and foul breath, Liangge San (Cooling the Diaphragm Powder) or Chengqi Tang (Descending the Qi Decoction) may be selected. Externally, fresh lotus petals applied to the sores can lead to recovery within a week.
Individuals of wealthy status accustomed to rich foods may experience flaccidity and weakness of yang energy during the summer months. If physicians mistakenly administer warming and heating herbs, it is an error. When dampness and heat steam together, akin to moisture seeping into metal and stone or sap flowing from plants, those with depleted spirit and qi should follow the seasonal changes. The appropriate treatment is Huanglian Jiedu Tang combined with Shengmai San (Generate the Pulse Powder).
In summer, if there is no headache or fever, but only pain in the lower abdomen, or pain in both the heart and abdomen, with bloating and fullness preventing flexion and extension, physicians might suspect excessive consumption of cold and raw foods and stubbornly diagnose it as a yin syndrome. However, this is actually due to summer-heat fire flowing into the zang-fu organs. Thus, pain starts in the lower abdomen and spreads to the heart and abdomen. Liuhe Tang (Six Harmonies Decoction) should be used to clear and resolve. Alternatively, Siling San (Four苓 Powder) added with Xiangru, Mugua, Zisu, and Banxia can be used to harmonize and disperse. Zhengqi San (Righteous Qi Powder), or Erchen Tang (Two Aged Things Decoction) added with Houpo and Chao Zhizi, may also be used. One may also induce vomiting of phlegm and saliva using roasted salt mixed with boiling water. Generally, for this condition, the vomiting method is superior. Using warming medicines would distance the patient from health.
When summer-heat qi enters the abdomen, causing nausea, abdominal pain, vomiting, and diarrhea with watery stools, this is a sudden outbreak of summer-heat fire leading to dysfunctional ascending and descending movements, failing to separate the clear from the turbid. The discharged fluids are essentially the essence and fluids of the five zang organs, which must be stopped quickly. Wuling San (Five苓 Powder) or Weiling Tang (Stomach Five苓 Decoction) can be used to promote urination and clear summer-heat fire. In severe cases, Guiling Ganlu San (Cassia and Poria Dew Sweetening Powder) is indicated. Some cases involve food stagnation; if physicians use purgatives, it is a mistake. Since the essence and fluids have suddenly dried up and primordial qi is instantly damaged, stopping the symptoms immediately is paramount. "Stopping" here does not mean treating flow with obstruction (using astringents for discharge syndromes), but rather distinguishing yin and yang and removing summer-heat, after which vomiting and diarrhea will cease naturally.
There are cases where there is nothing to vomit or pass, with closure of both upper and lower orifices, resulting in no vomiting or diarrhea at all. This is called Dry Huoluan (Dry Cholera). It presents with severe cramping pain in the heart and abdomen, leading to immediate death. Emergency treatment involves inducing vomiting with roasted salt water or Erchen Tang. If the orifices open, rescue is possible. Even after stabilization, for one week, no grain should be consumed; eating will cause relapse. Exercise extreme caution. *Ji Lun* states that summer-heat stroke involves merely clearing the heart, promoting urination, resolving summer-heat toxicity, and supplementing true qi. Even if the pulse is weak, deep-hidden, with panting, cold extremities, and sudden fainting, warming agents must not be used. This is because heat injures yin qi; using warming agents aids yang and consumes yin. Furthermore, in winter, floating-tight or floating-slow pulses distinguish wind-strike from cold damage; in summer, string-tight indicates wind injury, string-slow indicates summer-heat stroke. Surface deficiency with spontaneous sweating yields a slow pulse, while surface constraint with no sweating yields a tight pulse. Laypeople misunderstand, claiming that since yin qi resides inside during summer, Dashun San (Great Harmony Powder) is essential. However, "yin" does not mean "cold"; it simply means yang is outside and yin is inside. Zhu Danxi stated that "hidden yin inside" implies deficiency, not coldness. Interpreting it as coldness is erroneous. During the fire season, stones melt and metals flow; where is the cold? Sun Simiao used Shengmai San, indicating qi deficiency. The ancients used Dashun San not for hidden yin, but originally for injuries caused by ice-cold fruits. Lengxiang Yin (Cold Fragrance Drink) treats severe yang deficiency and厥逆 (reversal cold) from excessive desire. Jiangshui San (Fermented Grain Water Powder) treats collapse of yang from profuse sweating with a faint, nearly imperceptible pulse. Other suitable formulas include Qingshu Yiqi Tang (Clear Summer-Heat and Benefit Qi Decoction), Xiaoshu Shiquan San (Eliminate Summer-Heat Perfect Ten Powder), and Shiwei Xiangru Yin (Ten Ingredients Elsholtzia Drink).
Xue notes: If it is a case of cold strike, it is a yin-cold syndrome, and the method should primarily tonify yang. Ancients often used Shengjiang (Fresh Ginger), Rongui (Cinnamon Twig), and Fuzi (Aconite Root). Some argue that the character "Zhong" (strike) should be read as "Shu" (summer-heat). However, why not simply use the character "Shu," thereby avoiding confusion for later generations?
Zhou Yu-zai comments: Xue's statement originates from Li Dongyuan's Dashun San. Its absurdity is incalculable; it disregards human life and deserves the blame for initiating such harmful practices.