膏功专清肺，退金中之火，是用为君；知母亦能就肺中泻火滋水之源。人参生津液，益所伤之气而为臣；甘草、粳米补
土以滋金，为佐也。
沈尧封曰∶此是热病证据。《素问》在天为热，在地为火。热者，火之气也。故热为五气之一，而热病即伤寒有五
之一。《伤寒论》以《难经》热字恐与下文温字相混，故特指出曰 是也。感烈日之气而病，即《素问》寒、暑、燥、
湿、风之暑病。或曰 是阳邪，暑是阴邪，土润溽暑，热兼湿言也，似与 有异。曰寒往则暑来，与寒对待，非专言热
而何？古人称暑、 、热，一也。若湿热并至之病，《难经》名曰湿温，不名暑。迨至隋唐后，皆指湿热为暑，于是真
暑之名失，而 之名更不知为何病矣。
王孟英曰∶仲圣以夏月外感热病名曰 者，别于伏气之热病而言也。《说文》云∶ ，伤暑也。《汉书·武帝纪》云∶
夏大旱，民多 死。故暑也，热也， 也，皆夏令一气之名也。《北齐书·后主纪》∶六月游南苑，从官 死者六十人。
《千金须知》云∶热死曰 。是唐时尚知暑、 之为热也。《内经》云∶在天为热，在地为火，其性为暑。又云∶岁火
太过，炎暑流行。盖暑为日气，其字从日，曰炎暑，曰酷暑，皆指烈日之气而言也。夏至后有小暑、大暑，冬至后有小
寒、大寒，是暑即热也，寒即冷也。故寒字从“ ”，“ ”为水气。是暑为阳，寒为阴，阴阳对待，乃天地间显明易知
之事，并无深微难测之理。而从来歧说偏多，误人不浅。更有调停其说者，强以动静分之。夫动静惟人，岂能使天上之
暑气随人而判别乎？况《内经》有阴居避暑之文，武王有樾荫 人之事。又有妄合湿、热二气为暑者，则亢旱之年，河
井皆涸，禾苗枯槁，湿气全无，可以谓之非暑耶？况湿无定位，分旺四季，风湿、寒湿，无不可兼，惟季夏之土为独盛，
故热湿多于寒湿。然暑字从日，日为天气，湿字从土，土为地气，霄壤不同。虽可合而为病，究不可谓暑中原有湿也。
（十九）太阳中 者，身热疼重，而脉微弱，此以夏月伤冷水，水行皮中所致也。（《金匮》以一物瓜蒂汤主之。）（《辨
太阳病脉证并治》）。
黄宝臣曰∶上条言中暑而不兼湿之证，此条言暑合湿邪而为患也。太阳中 者，暑伤于形，则身热疼重；暑伤于气，
则脉微弱。以此证与脉揆之，知以夏月贪凉，过饮冷水，伤于水湿，水行皮中，为表邪所束，不得汗泄之所致也。
沈汉卿曰∶此论夏月先中 ，后伤冷水也。热由太阳入阳明，故身热。复伤冷水，水行皮中，则营卫俱滞。营气被
阻，则身疼；卫气被阻，则身重。太阳中 ，脉当数大，不当微弱，而脉微弱何也？此以冷水在皮中，随营卫气行，营
卫气被阻，不能达于脉，致令脉微弱，故曰此以夏月伤冷水，水行皮中所致也。瓜蒂苦寒，能吐能下，去身面四肢水气，
水气去，则热解，故主之。
陈修园曰∶此言暑合湿邪为患，有形之湿壅其肺气也。《金匮》治以一物瓜蒂汤，后人推展其义，用五苓散（茯苓、
猪苓、白术、泽泻、桂）、大顺散（甘草、干姜、杏仁、肉桂）、小半夏加茯苓汤（半夏、茯苓、生姜）、十味香薷饮（香
薷、人参、陈皮、白术、茯苓、扁豆、黄 、木瓜、浓朴、甘草）、白虎加苍术汤（石膏、知母、甘草、粳米、苍术），
皆兼治湿也。至夏月阳虚阴伏，凡畏热贪凉，皆可以伤冷水例之，病在阴经，即为阴证，岂可一以清凉治暑哉？
（二十）太阳中 者，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。若发汗则恶寒甚；加温针则发热甚；数下之则淋甚。（《辨太阳病脉证并治》）
沈尧封曰∶此言精气素亏而中 者。
陈修园曰∶此言中暑之证，从经脉表里俱病处绘出虚证模样。意者寒则伤形，责其实；热则伤气，责其虚。发热恶
寒至手足厥冷，皆阴寒之脉证。小有劳三句，是虚而有热之见证。汗下火皆为所戒，而治法从可知矣。
徐忠可曰∶此即洁古所谓静而得之为中暑，为阴证也。盖 即暑也。太阳中 者，太阳脉为一身之外卫，凡六气之
感，无不由之，故暑亦必由太阳入。惟太阳，故发热恶寒。夏月气溢经络，于时湿土司令，伤暑者必兼湿，故身重而疼
痛。暑热必伤气，故弦细芤迟虚脉也。然暑非中热之谓，暑热内受，阴寒外束，即东垣所谓广厦纳凉之类，故无汗不渴，
而身反重痛也。
成无己曰∶病有在表，有在里者，有表里俱病者，此则表里俱病者也。发热恶寒、身重疼痛者，表中 也；脉弦细
芤迟者，中暑脉虚也；小便已，洒洒然毛耸，手足逆冷者，太阳经气不足也；小有劳，身即热者，谓劳动其阳，而 即
发也；口开前板齿燥者，里有热也。《内经》云∶因于暑，汗，烦则喘喝。口开谓喘喝也，以喘喝不止，故前板齿干燥。
若发汗以去表邪，则外虚阳气，故恶寒甚；若以温针助阳，则火热内攻，故发热甚；若下之以除里热，则内虚而膀胱燥，
故淋甚。
赵以德曰∶予尝思之，此症属阴阳俱虚。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，
此症惟宜甘药补正，以解其热尔，即《灵枢》所谓阴阳俱不足，补阳则阴竭，补阴则阳脱。可将以甘药，不可饮以刚剂。
王宇泰曰∶中 、中暑、中热，名虽不同，实一病也。若冬伤于寒，至夏而变为热病者，此则过时而发，自内达表
之病，俗谓晚发是也，又非暴中暑热新病之可比。或曰新中暑病脉虚，晚发热病脉盛。
（二十一）师曰∶伏气之病，以意候之。今月之内，欲有（一作知）伏气。假令旧有伏气，当须脉之。若脉微弱者，
当喉中痛似伤，非喉痹也。病患云∶实咽中痛。虽尔，今复欲下利。（《平脉法》）
张锡驹曰∶此条言伏气之病，由内而出，非若时行卒病，由外而至也。
张隐庵曰∶此一节言伏气发病，始则从阴出阳，既则从阳入阴也。伏气之病者，春之风气，夏之暑气，秋之湿气，
冬之寒气，感之则潜匿于膜原肌腠之中，不形于脉，故当以意候之。今月之内欲有伏气者，是以意候也，如三春风盛，
九夏暑盛。医者当知今月之内，时今太过，欲有伏气，感之则潜匿于形身，而为伏气之病矣。假令旧有伏气，今时乃发，
当须脉之。若脉微弱者，中土内虚，风木之邪相克也，故当喉中痛似伤。喉者，天气也；痛似伤者，火气也。此伏邪从
阴出阳也。非喉痹者，言非阴寒内闭之喉痹也。病患云∶实咽中痛者，喉主天气为阳，咽主地气为阴，先病喉痛，后病
喉痛，是先病阳后病阴也。虽尔今复欲下利者，言虽咽痛，当复下利，所以申明咽主地气之意。伏气始病，则从阴出阳；
既病，则从阳入阴者如此。
叶子雨曰∶此节言伏气之病，伏藏于内，不即见于病，亦不见于脉，故当候其何气之伏藏。伏于今月之内，当发于
今月之中，故曰∶今月之内，欲有伏气，是谓以意候之也。假令旧有伏者，今时乃发，既见于病，亦必见于脉，故当须
脉之。若脉微弱者，此春伤于风，风木之邪，贼于中土，故脉微弱也。风邪上受，当喉痛似伤，此伏气之病，非时行之
喉痹也。不特喉痛而且咽痛，以风气通于肝，地气通于咽，脾主地，木克土也。邪气留连，上行极乃下而为洞泄，故曰∶
虽尔今复欲下利。此上下之交通，一气之相感也。仲景论一春之风气，而三时之暑、湿、寒气，亦可类推矣。注家多以
脉微细喉痛下利，乃少阴应有之脉证，不知少阴之脉是微细，此云微弱，但弱与细有间，而微则加于弱细之上，非专论
微脉也。弱乃真阳不足，胃气大虚之候，固非少阴之细脉，亦断无实热之理，因其土虚，故木邪侮所不胜也。侈谈伏气
者，何伏气不明若是耶！
（十八）石膏功效专于清泻肺热，退除肺金中的火热，因此作为君药；知母也能在肺中泻火并滋补肾水之源。人参能生津液，补益受损之气，作为臣药；甘草、粳米补益脾胃（土）以滋养肺（金），作为佐药。
沈尧封说：这是热病的证候依据。《素问》中说，在天为热，在地为火。热，是火的气化表现。所以热是五气之一，而热病就是伤寒五种类型之一。《伤寒论》因为《难经》中的“热”字恐怕与下文的“温”字相混淆，所以特别指出说是“暑”。感受烈日之气而发病，就是《素问》中寒、暑、燥、湿、风五气中的暑病。有人说：“暑”是阳邪，“暑”是阴邪，潮湿闷热的天气，是热兼有湿气的说法，似乎与“暑”有所不同。（回答者说：）寒冷过去则暑热到来，它与寒冷相对待，难道不是专门指热吗？古人称暑、暍、热，其实是一回事。如果是湿热同时到来的疾病，《难经》称之为湿温，不称为暑。等到隋唐以后，都指湿热为暑，于是真正的暑之名就失传了，而“暍”这个名字更不知道是指什么病了。
王孟英说：张仲景将夏季外感热病命名为“暍”，是为了区别于伏气温病而言的。《说文解字》说：暍，是伤暑。《汉书·武帝纪》说：夏天大旱，百姓多因暍而死。所以暑、热、暍，都是夏令一气（夏季气候）的名称。《北齐书·后主纪》记载：六月在南苑游玩，随行官员因暍死去的有六十人。《千金须知》说：热死叫做暍。这说明唐代时还知道暑、暍就是热。《内经》说：在天为热，在地为火，其性质为暑。又说：岁火太过，炎暑流行。大概暑是日气，它的字从“日”，叫炎暑、叫酷暑，都是指烈日之气而言。夏至后有小暑、大暑，冬至后有小寒、大寒，这说明暑就是热，寒就是冷。所以“寒”字从“宀”下从“井”（注：此处原文字形解析可能有误，通常寒从宀从井从人从冰，意指屋下有冰），代表水气。暑属于阳，寒属于阴，阴阳相对待，这是天地间明显容易知晓的事情，并没有深奥难测的道理。然而历来歧说偏多，误导人不浅。更有调和折衷其说的人，强行用动和静来区分。动静只在于人，难道能使天上的暑气随着人的判断而改变吗？况且《内经》有阴居避暑的文字，周武王有在树荫下休息的事例。又有胡乱将湿、热二气合为暑的说法，那么在亢旱之年，河井都干涸，禾苗枯槁，完全没有湿气，可以说不叫暑吗？况且湿气没有固定位置，分旺于四季，风湿、寒湿，没有什么不可以兼夹的，只有季夏（长夏）的土气最为旺盛，所以热湿多于寒湿。然而“暑”字从“日”，日是天气；“湿”字从“土”，土是地气，天地不同。虽然可以合并致病，终究不能说暑中原本就有湿。
（十九）太阳中暍（中暑）的病证，身体发热且疼痛沉重，脉象微弱，这是因为夏天受了冷水，水气运行于皮肤中所导致的。（《金匮要略》主张用一物瓜蒂汤治疗。）（出自《辨太阳病脉证并治》）。
黄宝臣说：上一条条文讲的是中暑而不兼夹湿邪的证候，这一条讲的是暑邪结合湿邪为患的情况。太阳中暍，暑邪伤害形体，所以身体发热、疼痛沉重；暑邪伤害气机，所以脉象微弱。根据这个证候和脉象推测，是因为夏天贪凉，过量饮用冷水，损伤了水湿，水气运行于皮中，被表邪束缚，不能通过汗液排出所致。
沈汉卿说：这条论述的是夏天先中暍，后受冷水伤害。热气由太阳传入阳明，所以身体发热。又受了冷水，水气运行于皮中，导致营卫之气都阻滞。营气被阻碍，所以身体疼痛；卫气被阻碍，所以身体沉重。太阳中暍，脉象应当数大，不应当微弱，为什么脉象微弱呢？这是因为冷水在皮中，随着营卫之气运行，营卫之气被阻，不能通达于脉，导致脉象微弱，所以说这是因为夏天伤了冷水，水气运行于皮中所致。瓜蒂味苦性寒，能催吐也能导下，能去除身面四肢的水气，水气去除，则热邪自解，所以用它为主药。
陈修园说：这条讲的是暑邪结合湿邪为患，有形之湿壅塞肺气。《金匮要略》用一物瓜蒂汤治疗，后人推展其义，使用五苓散（茯苓、猪苓、白术、泽泻、桂枝）、大顺散（甘草、干姜、杏仁、肉桂）、小半夏加茯苓汤（半夏、茯苓、生姜）、十味香薷饮（香薷、人参、陈皮、白术、茯苓、扁豆、黄连、木瓜、厚朴、甘草）、白虎加苍术汤（石膏、知母、甘草、粳米、苍术），都是兼治湿邪的方法。到了夏天阳气虚衰、阴寒内伏的时候，凡是怕热贪凉，都可以用伤冷水的例子类推，病在阴经，就是阴证，怎么能一概用清凉法治疗暑病呢？
（二十）太阳中暍，发热恶寒，身体沉重且疼痛，脉象弦细芤迟，小便结束后，感觉洒洒然毛发耸立，手足逆冷，稍微劳动，身体就发热，张口呼吸且前板齿干燥。如果发汗，则恶寒加重；如果用温针，则发热加重；如果多次攻下，则淋证加重。（出自《辨太阳病脉证并治》）
陈修园说：这条讲的是中暑的证候，从经脉表里俱病的地方描绘出虚证的模样。大意是：寒邪伤害形体，责之于实证；热邪伤害气机，责之于虚证。发热恶寒直到手足厥冷，都是阴寒的脉证。稍微劳动三句，是虚而有热的见证。汗法、下法、火法都被禁忌，治疗方法就可以知道了。
徐忠可说：这就是洁古所说的“静而得之为中暑”，属于阴证。大概暍就是暑。太阳中暍，太阳脉是全身的外卫，凡六气之感，没有不由太阳传入的，所以暑邪也必然由太阳传入。因为是太阳经受邪，所以发热恶寒。夏天经络之气充溢，此时湿土当令，伤暑的人必然兼夹湿邪，所以身体沉重且疼痛。暑热必然伤气，所以出现弦细芤迟等虚脉。然而暑不是中热的意思，暑热内受，阴寒外束，就像李东垣所说的在大厦中纳凉之类情况，所以无汗不渴，反而身体沉重疼痛。
成无己说：病有的在表，有的在里，有的表里同病，这则是表里同病的。发热恶寒、身体沉重疼痛，是表中有暍；脉弦细芤迟，是中暑脉虚的表现；小便结束，洒洒然毛发耸立，手足逆冷，是太阳经气不足；稍微劳动，身体就发热，是说劳动扰动阳气，而暍邪就发作；张口呼吸且前板齿干燥，是里有热。《内经》说：因于暑，出汗，心烦则喘喝。张口就是指喘喝，因为喘喝不止，所以前板齿干燥。如果用发汗法去表邪，则外虚阳气，所以恶寒加重；如果用温针助阳，则火热内攻，所以发热加重；如果用攻下法除里热，则内虚而膀胱燥，所以淋证加重。
赵以德说：我曾经思考过，此症属于阴阳俱虚。脉弦细，是阳虚；脉芤迟，是阴虚。所以温针会进一步损伤阴液，发汗会进一步损伤阳气，此症只宜用甘药补益正气，以解除热邪，也就是《灵枢》所说的阴阳俱不足，补阳则阴竭，补阴则阳脱。可以用甘药，不可用刚猛之剂。
王宇泰说：中暍、中暑、中热，名称虽然不同，实际上是同一种病。如果是冬天伤了寒邪，到夏天变为热病，这是过时发作，从内部达于外部的病，俗称为晚发，这就不同于突然中暑的新病。有人说新中暑病脉虚，晚发热病脉盛。
（二十一）老师说：伏气之病，要靠医者的心意去揣度观察。在这个月之内，想要知道是否有伏气。假如旧有伏气，必须诊察脉象。如果脉象微弱，应当喉咙痛像受伤一样，但不是喉痹。病人说：确实是咽喉痛。即使这样，现在又想腹泻。（出自《平脉法》）
张锡驹说：这条讲伏气之病，是从内部发出的，不像时行卒病那样从外部侵入。
张隐庵说：这一节讲伏气发病，开始是从阴出阳，随后是从阳入阴。所谓伏气之病，春之风气、夏之暑气、秋之湿气、冬之寒气，感受之后潜伏在膜原肌腠之中，不显现于脉象，所以应当靠心意去揣度。说“今月之内欲有伏气”，是靠心意揣度，比如三月春风盛，九月夏暑盛。医者应当知道在这个月之内，时令太过，会有伏气，感受之后潜伏在身形之中，成为伏气之病。假如旧有伏气，此时才发作，必须诊察脉象。如果脉象微弱，是中土内虚，风木之邪相克，所以应当喉咙痛像受伤。喉，主天气；痛像受伤，是火气。这是伏邪从阴出阳。说“非喉痹”，是指不是阴寒内闭的喉痹。病人说“实咽中痛”，喉主天气为阳，咽主地气为阴，先病喉痛，后病咽痛，是先病阳后病阴。说“虽尔今复欲下利”，是说虽然咽痛，应当又会腹泻，以此来申明咽主地气的意思。伏气始病，从阴出阳；既病，从阳入阴，就是这样。
叶子雨说：这一节讲伏气之病，潜伏在内，不立即表现为病状，也不见于脉象，所以应当候察是何种气机伏藏。伏藏在当月之内，应当发作于当月之中，所以说“今月之内，欲有伏气”，这叫靠心意揣度。假如旧有伏气，此时才发作，既然见于病状，也必见于脉象，所以必须诊察脉象。如果脉象微弱，这是春天伤了风，风木之邪贼害中土，所以脉象微弱。风邪从上受，应当喉咙痛像受伤，这是伏气之病，不是时行的喉痹。不仅喉痛而且咽痛，因为风气通于肝，地气通于咽，脾主地，木克土。邪气留连，上行至极乃下行而为洞泄，所以说“虽尔今复欲下利”。这是上下交通，一气相感。仲景论述春天的风气，那么三时的暑、湿、寒气，也可以类推了。注家多以脉微细、喉痛、下利，认为是少阴应有的脉证，不知道少阴的脉是微细，这里说的是微弱，但弱与细有区别，而微则强于弱细之上，并非专门论述微脉。弱是真阳不足、胃气大虚的征候，固然是少阴的细脉，也断无实热的道理，因为土虚，所以木邪侮其所不胜。大肆谈论伏气的人，为什么对伏气的认识如此不明呢！
(18) Shigao (Gypsum Fibrosum, 石膏) has the specific function of clearing lung heat and dissipating fire within the Metal element, thus serving as the Sovereign herb; Zhimu (Anemarrhenae Rhizoma, 知母) can also clear fire in the lungs and nourish the source of Kidney Water. Renshen (Ginseng Radix et Rhizoma, 人参) generates body fluids and benefits the damaged Qi, serving as the Minister herb; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) and Jingmi (Oryza Sativa, 粳米) tonify Earth to nourish Metal, serving as the Assistant herbs.
Shen Yaofeng stated: This describes the evidence of Heat disease. The *Suwen* states that in Heaven it is Heat, and on Earth it is Fire. Heat is the Qi of Fire. Therefore, Heat is one of the Five Qi, and Heat disease is one of the five types of Cold Damage. In the *Shanghan Lun*, fearing that the character "Heat" from the *Nanjing* might be confused with the subsequent character "Warmth," it specifically points out "Shu" (Summerheat). Contracting the Qi of the scorching sun causes illness, which corresponds to the Summerheat among the Cold, Summerheat, Dryness, Dampness, and Wind in the *Suwen*. Some say: "Shu" is a Yang pathogen, while "Yue" (a specific term for severe summerheat) is a Yin pathogen; "humid and muggy summerheat" implies Heat combined with Dampness, seemingly different from "Shu." The response is: When Cold departs, Summerheat arrives; it stands in opposition to Cold. Is this not referring specifically to Heat? Ancients referred to Shu, Yue, and Re (Heat) as one and the same. If a disease involves both Dampness and Heat arriving together, the *Nanjing* calls it Shiwen (Damp-Warmth), not Shu. It was only after the Sui and Tang dynasties that people referred to Damp-Heat as Shu, causing the true name of Shu to be lost, and the name "Yue" became unknown.
Wang Mengying stated: Zhang Zhongjing named external Heat diseases in summer "Yue" to distinguish them from latent Heat diseases. The *Shuowen Jiezi* states: "Yue" means injury by Summerheat. The *Book of Han · Annals of Emperor Wu* states: "In a great summer drought, many people died of Yue." Thus, Shu, Re, and Yue are all names for the single Qi of the summer season. The *Book of Northern Qi · Annals of the Last Ruler* records: "In the sixth month, [the ruler] toured the South Park; sixty officials died of Yue." The *Qianjin Xuji* states: "Death from heat is called Yue." This indicates that even in the Tang dynasty, it was known that Shu and Yue referred to Heat. The *Neijing* states: "In Heaven it is Heat, on Earth it is Fire, its nature is Shu." It also states: "When the Year Fire is excessive, blazing Summerheat prevails." Generally, Shu is the Qi of the Sun; its character contains "Sun" (Ri). Terms like "blazing Summerheat" or "scorching heat" all refer to the Qi of the scorching sun. After the Summer Solstice come Minor Heat and Major Heat; after the Winter Solstice come Minor Cold and Major Cold. This shows that Shu is Heat, and Cold is Cold. Therefore, the character "Han" (Cold) relates to water vapor. Shu is Yang, and Cold is Yin; their opposition is a clear and easily understood matter between Heaven and Earth, without profound or unfathomable principles. Yet, divergent explanations have always been numerous, misleading people significantly. There are those who try to reconcile these views by forcibly distinguishing them by movement and stillness. Movement and stillness depend on humans; how can the atmospheric Summerheat in the sky be judged according to human distinctions? Moreover, the *Neijing* mentions seeking shade to avoid heat, and King Wu rested under tree shade. Others recklessly combine Dampness and Heat into Shu. In years of extreme drought, rivers and wells dry up, crops wither, and there is no Dampness at all; can this be called non-Shu? Furthermore, Dampness has no fixed location and prospers in all four seasons; Wind-Dampness and Cold-Dampness can all be combined. Only in the late summer (Earth phase) is it most abundant, so Heat-Dampness is more common than Cold-Dampness. However, the character "Shu" contains "Sun" (Heavenly Qi), while "Shi" (Dampness) contains "Earth" (Earthly Qi); they are as different as heaven and earth. Although they can combine to cause disease, one cannot ultimately claim that Shu originally contains Dampness.
(19) Taiyang Summerheat injury presents with fever, pain, and heaviness, with a faint pulse. This is caused by contracting cold water in summer, with water qi circulating in the skin. (*Jin Gui Yao Lue* advocates treating this with Yi Wu Gua Di Tang.) (From *Differentiating Taiyang Disease Pulse, Syndrome, and Treatment*).
Huang Baochen said: The previous clause discusses Summerheat without accompanying Dampness; this clause discusses Summerheat combined with Dampness pathogenic factors. In Taiyang Summerheat, Summerheat injures the form, resulting in fever, pain, and heaviness; Summerheat injures the Qi, resulting in a faint pulse. Based on this syndrome and pulse, we know it is caused by greed for coolness in summer, excessive drinking of cold water, injury by water-dampness, water qi circulating in the skin, being constrained by exterior pathogens, and inability to sweat out the pathogen.
Shen Hanqing said: This discusses contracting Summerheat first, then injuring oneself with cold water in summer. Heat enters from Taiyang to Yangming, hence the fever. Subsequent injury by cold water causes water qi to circulate in the skin, stagnating both Ying and Wei Qi. Obstruction of Ying Qi causes body pain; obstruction of Wei Qi causes body heaviness. In Taiyang Summerheat, the pulse should be rapid and large, not faint. Why is it faint? Because cold water in the skin moves with Ying and Wei Qi; their obstruction prevents reaching the vessels, causing the faint pulse. Hence, it is said to be caused by injuring cold water in summer, with water qi circulating in the skin. Gualou (Melon Pedicle, 瓜蒂) is bitter and cold, capable of inducing vomiting and purging, removing water qi from the body, face, and limbs. Once water qi is removed, heat resolves, hence it is used as the principal treatment.
Chen Xiuyuan said: This discusses Summerheat combining with Dampness to cause harm, where tangible Dampness obstructs Lung Qi. *Jin Gui Yao Lue* treats it with Yi Wu Gua Di Tang. Later scholars expanded its meaning, using Wu Ling San (Poria, Polyporus, Atractylodes Macrocephala, Alisma, Cinnamon Twig), Da Shun San (Licorice, Dried Ginger, Apricot Seed, Cinnamon Bark), Xiao Ban Xia Jia Fu Ling Tang (Pinellia, Poria, Fresh Ginger), Shi Wei Xiang Ru Yin (Mosla, Ginseng, Tangerine Peel, Atractylodes Macrocephala, Poria, Coix Seed, Coptis, Quince, Magnolia Bark, Licorice), and Bai Hu Jia Cang Zhu Tang (Gypsum, Anemarrhena, Licorice, Rice, Atractylodes Lancea), all treating Dampness simultaneously. In summer, when Yang is deficient and Yin hides, anyone fearing heat and seeking coolness can be analogized to injuring cold water. If the disease is in the Yin meridians, it becomes a Yin syndrome; how can Summerheat be treated solely with cooling methods?
(20) Taiyang Summerheat injury presents with fever, aversion to cold, body heaviness and pain, with a string-taut, fine, hollow, and slow pulse. After urination, one feels shivering with hair standing on end, and hands and feet are cold. Upon slight exertion, the body becomes hot, and upon opening the mouth, the front incisors become dry. If sweating is induced, aversion to cold worsens; if warm needles are applied, fever worsens; if purgatives are used repeatedly, strangury worsens. (From *Differentiating Taiyang Disease Pulse, Syndrome, and Treatment*)
Shen Yaofeng said: This discusses Summerheat injury in individuals with chronic deficiency of Essence and Qi.
Chen Xiuyuan said: This depicts the appearance of deficiency syndromes in Summerheat injury, illustrating involvement of both interior and exterior via meridians. The idea is: Cold injures the form, attributed to excess; Heat injures Qi, attributed to deficiency. Fever, aversion to cold, down to cold extremities, are all Yin-Cold pulses and syndromes. The three sentences regarding slight exertion are signs of deficiency with internal heat. Sweating, purging, and fire therapy are all contraindicated, revealing the treatment method.
Xu Zhongke said: This is what Jiegou referred to as "obtained Summerheat through stillness," which is a Yin syndrome. Essentially, Yue is Shu. In Taiyang Summerheat, the Taiyang pulse acts as the external defense of the body; all Six Qi infections enter through it, so Summerheat must also enter via Taiyang. Being in Taiyang causes fever and aversion to cold. In summer, Qi overflows into meridians, and at this time, Damp Earth rules; those injured by Summerheat must combine with Dampness, causing body heaviness and pain. Summerheat inevitably injures Qi, leading to string-taut, fine, hollow, and slow deficient pulses. However, Summerheat is not merely "Zhong Re" (Mid-Heat); with Summerheat internally received and Yin-Cold externally binding, similar to Li Dongyuan's description of cooling off in grand mansions, there is no sweating or thirst, but rather body heaviness and pain.
Cheng Wuji said: Diseases exist in the exterior, in the interior, or involving both. This case involves both. Fever, aversion to cold, body heaviness, and pain indicate Summerheat in the exterior; string-taut, fine, hollow, and slow pulses indicate deficient pulses from Summerheat; shivering with hair standing on end after urination and cold extremities indicate insufficiency of Taiyang Meridian Qi; slight exertion causing immediate fever indicates that labor disturbs Yang, triggering the Yue pathogen; opening the mouth and dry front incisors indicate Heat in the interior. The *Neijing* states: "Due to Summerheat, sweating occurs; if vexed, panting and drinking sounds arise." Opening the mouth refers to panting/drinking sounds; due to continuous panting, the front incisors become dry. If sweating is used to remove exterior pathogens, exterior Yang is depleted, worsening aversion to cold. If warm needles assist Yang, Fire-Heat attacks internally, worsening fever. If purgatives are used to remove interior Heat, interior deficiency leads to bladder dryness, worsening strangury.
Zhao Yi-de said: I have pondered this; this syndrome belongs to simultaneous deficiency of Yin and Yang. String-taut and fine pulses indicate Yang deficiency; hollow and slow pulses indicate Yin deficiency. Thus, warm needles further damage Yin, and sweating further damages Yang. This syndrome requires sweet medicines to tonify Zheng Qi and resolve Heat, as stated in the *Ling Shu*: when both Yin and Yang are insufficient, tonifying Yang depletes Yin, and tonifying Yin causes Yang to escape. Sweet medicines may be used, but harsh agents should not be drunk.
Wang Yutai said: Zhong Yue, Zhong Shu, and Zhong Re differ in name but are essentially the same disease. If Cold is contracted in winter and transforms into Heat disease in summer, this is a delayed onset, spreading from interior to exterior, commonly called "late-onset," which differs from acute new Summerheat diseases. Some say new Summerheat diseases present with deficient pulses, while late-onset Heat diseases present with vigorous pulses.
(21) The Master said: Latent Qi diseases require intuitive observation. Within this month, one should anticipate latent Qi. If latent Qi exists previously, the pulse must be examined. If the pulse is faint, there should be throat pain resembling injury, but it is not Hou Bi (Sore Throat/Pharyngitis). The patient says: "Indeed, the throat hurts." Even so, diarrhea is now impending. (From *Methods for Examining Pulses*)
Zhang Xiju said: This clause discusses Latent Qi disease emerging from the interior, unlike epidemic sudden diseases that arrive from the exterior.
Zhang Yin'an said: This section discusses the onset of Latent Qi disease, initially moving from Yin to Yang, and subsequently from Yang to Yin. Latent Qi disease refers to Spring Wind, Summer Summerheat, Autumn Dampness, and Winter Cold; upon contraction, they hide in the membrane sources and muscle interstices, not manifesting in the pulse, hence requiring intuitive observation. "Anticipating latent Qi within this month" relies on intuition, such as strong winds in the third month or intense heat in the ninth month. Physicians should know that excessive seasonal conditions within the month lead to latent Qi, which hides in the body upon contraction. If latent Qi existed previously and now manifests, the pulse must be checked. A faint pulse indicates deficiency of Central Earth, with Wind Wood pathogen overcoming it, causing throat pain resembling injury. The throat governs Heavenly Qi; pain resembling injury indicates Fire Qi. This is latent pathogen moving from Yin to Yang. "Not Hou Bi" means it is not the Yin-Cold internal closure type of sore throat. The patient stating "real throat pain" distinguishes the throat (Yang/Heaven) from the pharynx (Yin/Earth). Prior throat pain followed by pharyngeal pain indicates prior Yang then Yin disease. "Even so, diarrhea is now impending" clarifies that despite throat pain, diarrhea follows, emphasizing the pharynx's connection to Earthly Qi. Latent Qi begins moving from Yin to Yang; once diseased, it moves from Yang to Yin.
Ye Ziyu said: This section discusses Latent Qi disease hiding internally, not immediately showing symptoms or pulse changes, hence requiring observation of which Qi is latent. Latent within the current month, it will manifest in the current month, hence "anticipating latent Qi within this month" is intuitive observation. If latent Qi existed previously and now manifests, it appears in both symptoms and pulse, requiring pulse examination. A faint pulse indicates spring wind injury, where Wind Wood pathogen harms Central Earth, causing a faint pulse. Wind pathogen ascends from above, causing throat pain resembling injury; this is Latent Qi disease, not epidemic sore throat. Not only throat pain but also pharyngeal pain occurs because Wind Qi connects to Liver, and Earthly Qi connects to Pharynx; Spleen governs Earth, and Wood overcomes Earth. Pathogen lingers, ascends to the extreme, then descends to cause profuse diarrhea, hence "even so, diarrhea is now impending." This is communication between upper and lower, resonance of one Qi. Zhang Zhongjing's discussion of Spring Wind allows inference of Summerheat, Dampness, and Cold in the other three seasons. Commentators often mistake faint/fine pulses, throat pain, and diarrhea as Shaoyin indications, not knowing Shaoyin pulses are faint/fine, whereas here it is faint/weak. Weak differs from fine, and faint exceeds weak; it does not exclusively discuss faint pulses. Weak indicates deficiency of True Yang and great deficiency of Stomach Qi, distinct from Shaoyin fine pulses, and certainly not excess Heat. Due to Earth deficiency, Wood pathogen insults the unconquerable. Those discussing Latent Qi extensively fail to understand it so clearly!