二陈（去甘草） 豆卷 青蒿 秦艽 焦六曲 谷芽 生姜 红枣
仁渊曰∶暑邪与温邪异，伏暑亦然。当暑感而即发者，为暑邪。暑天受暑湿之邪，不即发，秋后复感凉风，闭其
汗孔，欲发不能速发，外则形寒，内则发热，寒热起伏无已，有类乎疟，为伏
暑。古人谓往来寒热属少阳。余谓暑湿伏邪，往来寒热，全由脾胃为病。少阳胆甲，因脾胃失化波及之耳。盖脾为阴
土，恶湿喜燥，澡则升化，湿郁之而不得升；胃为阳土，恶热喜凉，凉则顺
降，热阻之而不得降。升降窒滞，故多胸腹痞闷。木寄土居，土失温凉，木不条畅，必然之势。湿重者多寒，热甚者
多热。热则消水而口渴。湿郁于中，又渴不多饮。湿热互蒸，胃浊不化，舌
苔每布白腻。底绛者，热为湿遏也；淡白者，湿胜也。化黄、化燥、化灰，热胜于湿。湿亦化燥，化火也。胸腹痞
满，板硬拒按，或挟痰挟食，视其人之本体及所感之轻重而为变迁。论治∶
初病以苦辛芳淡为正轨，徒为发汗无益。盖苦能泄热，辛能通气，芳可解郁，淡可利水，使中宫郁遏通解，不汗自
汗，不便自便，为邪在气分治法。入营则不然，若初入营分，犹可透营就
气，仍从气分而解。已陷营分，昏蒙狂呓，犀地、牛黄、至宝之类，亦所必需。劫津化燥，痞结硬满，邪实阳明，
救阴通腑与温邪同治。但温邪从温化火，火退而病解；伏暑从湿化燥，燥去而
湿或再来。所以然者，湿虽化燥，终属阴邪，且湿最伤中，中虚而阴湿易生。故清到六、七，须为审顾。下法亦有
不同。温邪可下宜速，伏暑可下宜缓。温邪下之邪清，伏暑下之邪未必清。温
属火，为阳，性速，暑夹湿，多阴，性迟。温邪阳明兼少阴者多，伏暑兼太阴者多也。甚有大便半月不通，胸腹痞
满，仍属无形湿热而不可下者。总宜验舌，若浓白而未化黄燥者，虽满亦不
可下。下之不但邪势不服，中气大伤，更为难治。须识气通病解四字，其于治伏暑，思过半矣。再者热虽灼而汗少，
苔虽燥而灰黄，若渴饮不多，或多而胸痞，凉苦可用，须佐芳香。若龟板、
鳖甲、鲜石斛、鲜生地等，清滋沉降宜慎，每见愈投愈燥者矣。其故由暑必夹湿，中气不升化，清滋抑遏而邪愈不化也。
二陈汤（去除甘草）、大豆卷、青蒿、秦艽、焦六曲、谷芽、生姜、红枣。
仁渊评论说：暑邪与温邪不同，伏暑也是如此。在感受暑邪后立即发病的，称为暑邪。在暑天感受了暑湿之邪，没有立即发病，到了秋天后又感受凉风，闭塞了汗孔，导致病邪想要发散但不能迅速发散，外部表现为形寒，内部表现为发热，寒热起伏没有休止，症状类似疟疾，这叫做伏暑。古人认为往来寒热属于少阳病证。我认为暑湿伏邪引起的往来寒热，完全是由脾胃病变导致的。少阳胆甲（指少阳经气），是因为脾胃运化失常而波及到的。脾属阴土，厌恶湿气喜欢燥气，燥则气机升发转化，湿气郁结则气机不得升发；胃属阳土，厌恶热气喜欢凉气，凉则气机顺降，热气阻滞则气机不得下降。升降之气窒塞停滞，所以多出现胸腹部痞闷胀满。肝木寄居在脾土之中，脾土失去了温凉的平衡，肝木必然不能条达舒畅，这是必然的趋势。湿气重的患者多表现为寒象，热气重的患者多表现为热象。热气盛会消耗津液而导致口渴。湿气郁结在中焦，虽然口渴但饮水不多。湿热互相蒸腾，胃中浊气不化，舌苔往往布满白腻苔。舌底颜色深红的，是热气被湿气遏制所致；舌色淡白的，是湿气偏胜所致。病邪转化为黄、转化为燥、转化为灰黑，说明热气胜于湿气。湿气也会转化为燥，转化为火。胸腹部痞满，按之板硬且抗拒按压，或者夹杂痰饮或食积，根据患者的体质本源以及所感邪气的轻重而发生变迁。
论治法：
初起发病以苦辛芳淡作为正治法则，单纯使用发汗法是没有益处的。因为苦味能泄热，辛味能通气，芳香可以解郁，淡味可以利水，使中焦脾胃的郁遏得以通解，不需要发汗自然出汗，不需要通便自然排便，这是针对邪气在气分的治法。如果邪气进入营分则不然，如果是初入营分，还可以透转营分之邪回到气分，仍然从气分而解。如果已经陷入营分，出现神志昏蒙、胡言乱语，犀角地黄汤、安宫牛黄丸、至宝丹之类的药物，也是必需的。劫伤津液转化为燥证，痞结硬满，邪气实于阳明腑，救阴通腑的方法与温邪的治疗相同。但是温邪是从温化为火，火退则病愈；伏暑是从湿化为燥，燥去则湿气或许会再来。之所以这样，是因为湿气虽然化为燥，终究属于阴邪，而且湿气最易损伤中焦，中气虚弱则阴湿容易滋生。所以在清热治疗到六七天时，必须审慎顾护中气。下法也有不同。温邪可下宜速，伏暑可下宜缓。温邪用下法后邪气可清，伏暑用下法后邪气未必能清。温属火，为阳，性质急速；暑夹湿，多属阴，性质迟缓。温邪兼夹少阴证的较多，伏暑兼夹太阴证的较多。甚至有半个月大便不通，胸腹部痞满，仍然属于无形的湿热而不能使用下法的。总之应当查验舌象，如果舌苔浓白而没有转化为黄燥的，即使痞满也不可下法。使用下法不但邪气势头不服，中气大伤，更加难以治疗。必须认识“气通病解”这四个字，对于治疗伏暑，就已经思虑过半了。再者，热度虽然炽盛但汗少，舌苔虽然干燥呈灰黄色，如果口渴饮水不多，或者饮水多但胸中痞闷，可以使用凉苦药物，但必须佐以芳香类药物。如果使用龟板、鳖甲、鲜石斛、鲜生地等药物，清滋沉降的药物需要谨慎，常常见到越用这些药病情越燥热的情况。其原因在于暑必夹湿，中气不升发转化，清滋药物抑制遏制气机，导致邪气更加不能化解。
Erchen Tang (Two-Aged Decoction, without Gancao/Radix Glycyrrhizae), Sojae Seminis Germinatum (Doudouan), Artemisiae Annuae Herba (Qinghao), Gentianae Macrophyllae Radix (Qinjiao), Jiao Liuqu (Scorched Six-Ingredient Fermented Dough), Setariae Italicae Fructus Germinatus (Guya), Zingiberis Rhizoma Recens (Shengjiang), Jujubae Fructus (Hongzao).
Ren Yuan commented: Shu-Xie (Summerheat Pathogen) differs from Wen-Xie (Warm Pathogen), and Fu-Shu (Latent Summerheat) is no exception. When summerheat is contracted and manifests immediately, it is called Shu-Xie (Summerheat Pathogen). When one contracts Shu-Shi (Summerheat-Dampness) during the summer months but does not manifest immediately, and later in autumn contracts cool wind which closes the sweat pores, preventing the pathogen from expelling rapidly, the exterior presents with aversion to cold while the interior presents with fever. The alternating chills and fever persist without cessation, resembling Malaria (Nue-Ji), which is termed Fu-Shu (Latent Summerheat). Ancients stated that alternating chills and fever belong to Shaoyang disease. I assert that the alternating chills and fever caused by latent Shu-Shi pathogens are entirely due to Spleen and Stomach pathology. The Shaoyang Gallbladder Qi (Shaoyang Danjia) is affected secondarily due to the failure of Spleen and Stomach transformation. The Spleen is Yin Earth; it dislikes dampness and prefers dryness. Dryness promotes ascending transformation, whereas dampness stagnates and prevents ascending. The Stomach is Yang Earth; it dislikes heat and prefers coolness. Coolness promotes descending flow, whereas heat obstructs and prevents descending. When ascending and descending mechanisms are blocked and stagnant, chest and abdominal fullness and oppression frequently occur. Wood resides within Earth; when Earth loses its balance of warmth and coolness, Wood inevitably fails to flourish smoothly—this is an inevitable trend. When dampness is heavy, chills predominate; when heat is severe, fever predominates. Heat consumes fluids leading to thirst. Dampness stagnating in the middle jiao causes thirst but little desire to drink. When dampness and heat steam each other, stomach turbidity fails to transform, and the tongue coating often presents as white and greasy. A crimson tongue base indicates heat suppressed by dampness; a pale tongue indicates excess dampness. Transformation to yellow, dry, or grey/black states indicates heat exceeding dampness. Dampness can also transform into dryness and fire. Chest and abdominal fullness, hardness upon palpation with resistance, or accompaniment by phlegm or food retention, vary according to the patient's constitutional root and the severity of the contracted pathogen.
Regarding treatment:
In the initial stage, bitter, acrid, aromatic, and bland methods constitute the correct approach. Merely using diaphoresis (sweating method) is of no benefit. Bitter flavors drain heat, acrid flavors circulate qi, aromatics resolve depression, and bland flavors promote urination/drainage. This allows the stagnation in the Middle Jiao to be resolved; sweating occurs naturally without forcing it, and bowel movements normalize without purgatives. This is the method for treating pathogens in the Qi level. If the pathogen enters the Ying (Nutritive) level, the approach differs. If it has just entered the Ying level, one may still vent the Ying pathogen back to the Qi level and resolve it from the Qi level. If it has already sunk into the Ying level, presenting with mental confusion and delirious speech, formulas such as Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), Niuhuang Wan (Calculus Bovis Pill), or Zhibao Dan (Precious Treasure Pill) are necessary. When fluid depletion leads to dryness, resulting in stubborn fullness and hardness, with pathogenic excess in the Yangming Fu organs, the method of nourishing yin and unblocking the bowels is the same as for Warm Pathogens. However, Warm Pathogens transform into fire; when the fire subsides, the disease resolves. Latent Summerheat transforms from dampness into dryness; when dryness is removed, dampness may return. This is because although dampness transforms into dryness, it ultimately remains a Yin pathogen, and dampness most injures the Middle Jiao. When Middle Qi is deficient, Yin-dampness easily arises. Therefore, when clearing heat for six or seven days, one must carefully protect the Middle Qi. Purging methods also differ. For Warm Pathogens, purging should be rapid; for Latent Summerheat, purging should be slow. Purging clears pathogens in Warm Pathogens, but may not clear them in Latent Summerheat. Warmth belongs to Fire, is Yang, and acts swiftly; Summerheat combined with Dampness is largely Yin and acts slowly. Warm Pathogens often involve Shaoyin, whereas Latent Summerheat often involves Taiyin. There are cases where constipation persists for half a month with chest and abdominal fullness, yet it still belongs to formless damp-heat and cannot be purged. One must always examine the tongue. If the coating is thick and white without transforming to yellow and dry, purging is contraindicated even if there is fullness. Purging will not subdue the pathogenic force, will severely damage Middle Qi, and make treatment more difficult. One must understand the four characters "Qi circulation leads to disease resolution"; regarding the treatment of Latent Summerheat, this covers more than half the understanding. Furthermore, if heat is scorching but sweating is scant, and the tongue coating is dry and grey-yellow, yet thirst is slight or drinking leads to chest oppression, cool and bitter herbs may be used but must be assisted with aromatic herbs. One must be cautious with cooling and moistening, sinking and heavy substances like Guiban (Tartarich Nux), Biejia (Carapax Trionycis), Xianshidu (Fresh Dendrobii Caulis), and Xianshengdi (Fresh Rehmanniae Radix). It is often seen that these increase dryness. The reason is that Summerheat invariably combines with Dampness; if Middle Qi fails to ascend and transform, cooling and moistening agents suppress and inhibit qi mechanism, causing the pathogen to become even more entrenched.