秦子曰∶热与寒，相反也。冬有寒，夏有热。仲景于冬则有直中阴经之寒症，有寒伤三
阳之热症，总其名曰《伤寒论》。其夏秋寒热病，则无垂训也。洁古、东垣，虽有动而得之
之中热，静而得之之中暑，然其治法，似乎未纯。夫中热中暑，均是热症，但得之有动静
之分，则治之不无差别。盖动而得者，行役气扰，外引时令之热，直中阳经，并无寒邪外束
，即俗云热病也。静而得者，里有热邪，伏于身中，又因纳凉太过，束其内热，不得外越，
郁而发热，此即俗云寒热病也。古人因其均是热病，以动而得，明其无表邪，故曰中热；以
静而得，明其有表邪，故曰中暑。后人不解其义，概用寒凉，不知治热病，原有两条分别，
无表邪者，不必用发表，即可寒凉；若有表邪者，先散外束之寒邪，后用寒凉可也。此症与
仲景冬月伤寒相似，但冬月伤寒，内无暑热，故初起无口燥舌干内热之象；直待日久，寒郁
成热，然后口燥咽干，今夏秋寒热病，内有暑热，外冒风寒，初起即见外寒里热之症，故不
同冬月伤寒治法，妄用辛温，但宜辛凉散表以治之。今有重视表症者，误用仲景麻桂发表，
碍其暑热，重视暑热者，误用寒凉清里，抑遏表邪，良以不明夏秋之热病，不同冬月伤寒治
（即无表邪之热病）
【中热之症】发热昏沉，闷乱口噤，烦躁大渴，神识不清，遗
尿便赤，外无表症，此即古名动而得之为中热症也。
【中热之因】时值夏令，天之热气下降，地之热气上升，人在气交之中，日中劳役扰
动其阳，热邪直中阳经，则有中热之症矣。
【中热之脉】脉息洪数，六经皆热。或见洪长，阳明之热。或见沉数，时有结热。身
【中热之治】忽然倒仆，闷绝不知，切勿置极热极冷之处，宜以鲜藿香煎汤，调六一
服，得汗乃佳；若治之太热，恐增其热，治之太冷，则遏其热，直待手足自汗，热邪外出，
人事少知，然后以黄连香薷饮、三黄石膏汤治之；渴者，人参白虎汤加干葛；若肺家多热
赤各半汤；心肺俱热，神志不清，凉膈散；湿热甚，苍术白虎汤；燥热甚，竹叶石膏汤。
黄连香薷饮 通治暑热。
黄连 香薷 白扁豆 浓朴
加鲜藿香同煎。身痛，加羌活；转筋挛缩，加木瓜；小便赤涩，加六一散；呕，加广皮
三黄石膏汤 治无表邪，多汗口渴，里热甚者。
黄连 黄柏 黄芩 石膏 山栀 玄参 知母 甘草
人参白虎汤 治阳明经里热之症。
人参 石膏 知母 粳米 甘草 葛根
桔梗汤 治肺素有热，烦热喘咳，口燥咽干。
薄荷 桔梗 黄芩 山栀 连翘 甘草 竹叶
导赤各半汤 利去小肠之热，则心火自退，故曰导赤；泻去心火，则小肠自利，
黄连 生地 木通 犀角 山栀 黄芩 麦冬 灯心 甘草
凉膈散 治上焦热甚，表解里热，宜清未宜下之症。
黄芩 山栀 桔梗 连翘 天花粉 黄连 薄荷
苍术白虎汤 治阳明湿热。
苍术 石膏 知母 甘草
竹叶石膏汤 治阳明燥热。
石膏 知母 麦冬 甘草 竹叶 人参
中热，即暴发热病之重者，以其昏沉卒倒，故曰中热；以其无恶寒表热之表症，故不曰
寒热病、温病。热令之温热病，但热不恶寒，而无卒倒昏沉之候。按中热与热病，同纯阳之
症，而热病可用寒凉直折；若中热恐痰饮食滞，迷塞中焦，昏沉不省，胃阳抑遏，手足反冷
，故凡治神昏之症，反不得用寒凉，重在胃阳凝结、填塞痰迷者多耳，治中热昏沉，宜先用
利中焦，待其胃气宣通，胃阳敷布，手足温热有汗，方可用以上诸方，以清上焦之热。如热
结下焦，大便闭结，有下症者，用三化汤、承气汤；若大小便俱闭者，八正散。
大凡去邪去病，止寻三条出路，身热上焦热，寻毛窍发汗而出；下焦热在小肠、膀胱，
当从小便而出；热在大肠，当从大便而出；此三者人人知之，不曾认得的耳。
秦子说：热与寒，是性质相反的。冬天有寒气，夏天有热气。张仲景在冬季论述了直中阴经的寒证，以及寒邪伤及三阳经的热证，总称为《伤寒论》。但对于夏秋季的寒热病，却没有留下明确的教导。洁古（张元素）、东垣（李杲），虽然提出了动而得之的中热和静而得之的中暑，但他们的治疗方法似乎还不够纯正。中热和中暑，都是热证，但因为发病原因有动静之分，所以治疗上不能没有差别。大概而言，动而得病的，是因为劳作奔波使气机扰动，外引时令之热，直接中伤阳经，并没有寒邪在体表束缚，这就是俗称的热病。静而得病的，是因为体内有热邪潜伏于身体之中，又因为贪凉太过，束住了内热，使其不能向外发散，郁结而发热，这就是俗称的寒热病。古人因为两者都是热病，对于动而得者，明确其没有表邪，所以叫中热；对于静而得者，明确其有表邪，所以叫中暑。后人不懂其中的含义，一概使用寒凉药物，不知道治疗热病原本就有两条分别的路径：没有表邪的，不必用发表药，可以直接用寒凉药；如果有表邪的，先疏散外束的寒邪，然后再用寒凉药。这种病症与张仲景冬季的伤寒相似，但冬季伤寒，体内没有暑热，所以初起时没有口燥舌干、内热的现象；必须等到日久，寒邪郁结化热，然后才出现口燥咽干的症状。而现在的夏秋季寒热病，体内有暑热，外受风寒侵袭，初起就见到外寒里热的症状，所以不同于冬季伤寒的治疗方法，误用辛温药物，只应当用辛凉药物疏散表邪来治疗。现在有的人重视表症，误用张仲景的麻黄汤、桂枝汤来发汗，这会妨碍暑热的清除；有的人重视暑热，误用寒凉药清里热，这会压抑遏阻表邪，这都是因为不明白夏秋季的热病，不同于冬季伤寒的治疗方法。
【中热的症状】发热、昏沉、闷乱、口噤（牙关紧闭）、烦躁、大渴、神识不清、遗尿、小便赤红，体表没有表症，这就是古名所说的“动而得之”的中热症。
【中热的原因】正值夏令，天上的热气下降，地上的热气上升，人处在天地气交之中，白天劳作役使扰动阳气，热邪直接中伤阳经，就会发生中热症。
【中热的脉象】脉搏洪大而数，六经都有热象。或者见洪长脉，是阳明经的热；或者见沉数脉，时有结聚之热。
【中热的治疗】突然跌倒昏迷，闷绝不知人事，千万不要放置在极热或极冷的地方，适宜用鲜藿香煎汤，调服六一散，出汗后情况会好转；如果治疗时环境太热，恐怕会增加体内的热；治疗时环境太冷，则会遏阻热邪的外出。必须等到手足自然出汗，热邪外出，人事稍微清醒，然后用黄连香薷饮、三黄石膏汤治疗；口渴的，用人参白虎汤加干葛；若肺家多热，用桔梗汤；心肺俱热，神志不清，用凉膈散；湿热甚，用苍术白虎汤；燥热甚，用竹叶石膏汤。
黄连香薷饮：通治暑热。
组成：黄连、香薷、白扁豆、浓朴。加鲜藿香同煎。身痛，加羌活；转筋挛缩，加木瓜；小便赤涩，加六一散；呕吐，加广皮。
三黄石膏汤：治疗无表邪，多汗口渴，里热严重的病症。
组成：黄连、黄柏、黄芩、石膏、山栀、玄参、知母、甘草。
人参白虎汤：治疗阳明经里热的病症。
组成：人参、石膏、知母、粳米、甘草、葛根。
桔梗汤：治疗肺素有热，烦热喘咳，口燥咽干。
组成：薄荷、桔梗、黄芩、山栀、连翘、甘草、竹叶。
导赤各半汤：利去小肠之热，则心火自退，所以叫导赤；泻去心火，则小肠自利。
组成：黄连、生地、木通、犀角、山栀、黄芩、麦冬、灯心、甘草。
凉膈散：治疗上焦热甚，表解里热，宜清不宜下的病症。
组成：黄芩、山栀、桔梗、连翘、天花粉、黄连、薄荷。
竹叶石膏汤：治疗阳明燥热。
组成：石膏、知母、麦冬、甘草、竹叶、人参。
中热，就是暴发的热病中的重症，因为它昏沉卒然倒仆，所以叫中热；因为它没有恶寒、表热等表症，所以不叫寒热病、温病。热令的温热病，只是发热而不恶寒，而没有卒然倒仆、昏沉的症状。按中热与热病，同属于纯阳的病症，而热病可以用寒凉药直接折服；若是中热，恐怕有痰饮食滞，迷塞中焦，导致昏沉不省人事，胃阳被抑遏，手足反而发冷，所以凡是治疗神昏的病症，反而不得用寒凉药，大多是因为胃阳凝结、填塞痰迷所致。治疗中热昏沉，适宜先用利中焦的方法，等待其胃气宣通，胃阳敷布，手足温热且有汗，才可以用上方的诸方，以清上焦之热。如果热结下焦，大便闭结，有下症者，用三化汤、承气汤；如果大小便都闭结者，用八正散。
大凡祛除邪气疾病，只有三条出路：身热、上焦热，从毛窍发汗而出；下焦热在小肠、膀胱，应当从小便而出；热在大肠，应当从大便而出；这三点人人皆知，只是不曾真正认清罢了。
Qin Zi said: Heat and cold are opposite in nature. Winter has cold, summer has heat. Zhang Zhongjing discussed the cold syndromes directly invading the Yin meridians and the heat syndromes where cold injures the Three Yang meridians in winter, collectively naming it *Shanghan Lun* (Treatise on Cold Damage). However, he left no explicit teachings for the cold-heat diseases of summer and autumn. Jiegu (Zhang Yuansu) and Dongyuan (Li Gao), although they distinguished between *Zhongre* (Heatstroke/Summerheat Strike) obtained through movement and *Zhongshu* (Summerheat Stroke) obtained through stillness, their treatment methods seemed not entirely pure. Both *Zhongre* and *Zhongshu* are heat syndromes, but due to the distinction in etiology involving movement or stillness, their treatments must differ. Generally speaking, those obtained through movement suffer from laborious exertion that disturbs Qi, externally attracting seasonal heat which directly invades the Yang meridians, without any external cold pathogen binding the exterior; this is commonly known as a heat disease. Those obtained through stillness have latent heat pathogens inside the body, and due to excessive cooling (e.g., seeking cold air), the internal heat is constrained and cannot vent outward, leading to stagnation and fever; this is commonly known as a cold-heat disease. The ancients, recognizing both as heat diseases, named the one obtained through movement as *Zhongre* to clarify the absence of exterior pathogens, and the one obtained through stillness as *Zhongshu* to clarify the presence of exterior pathogens. Later generations failed to understand this meaning and uniformly used cold-cooling herbs, unaware that treating heat diseases originally had two distinct paths: for those without exterior pathogens, dispersing the exterior is unnecessary, and cold-cooling herbs can be used directly; for those with exterior pathogens, one must first disperse the binding external cold, and then use cold-cooling herbs. This condition resembles Zhang Zhongjing's winter cold damage, but winter cold damage lacks internal summerheat, so initially there are no signs of dry mouth, parched tongue, or internal heat; only after prolonged time does cold stagnate and transform into heat, resulting in dry mouth and throat. In contrast, current summer-autumn cold-heat diseases have internal summerheat and external wind-cold invasion, presenting with exterior cold and interior heat symptoms from the onset. Therefore, the treatment differs from winter cold damage; mistakenly using acrid-warm herbs is wrong, and one should only use acrid-cool herbs to disperse the exterior. Some who overemphasize exterior symptoms mistakenly use Zhang Zhongjing's *Mahuang Tang* (Ephedra Decoction) or *Guizhi Tang* (Cinnamon Twig Decoction) to induce sweat, which hinders the clearance of summerheat; others who overemphasize summerheat mistakenly use cold-cooling herbs to clear the interior, which suppresses and obstructs the exterior pathogens. This is because they do not understand that summer-autumn heat diseases differ in treatment from winter cold damage.
[Symptoms of Zhongre] Fever, lethargy, mental restlessness, trismus (lockjaw), irritability, severe thirst, unclear consciousness, urinary incontinence, red urine, with no exterior symptoms. This is what the ancients called *Zhongre* obtained through movement.
[Etiology of Zhongre] During the summer season, heavenly heat descends and earthly heat rises. Humans exist within the intersection of these qi. Daytime labor disturbs Yang Qi, allowing heat pathogens to directly invade the Yang meridians, resulting in *Zhongre*.
[Pulse of Zhongre] The pulse is surging (Hong) and rapid (Shu), indicating heat in all six meridians. It may appear surging and long, indicating heat in the Yangming Meridian; or deep and rapid, indicating occasional stagnant heat.
[Treatment of Zhongre] If the patient suddenly collapses into unconsciousness and coma, do not place them in extremely hot or cold environments. It is appropriate to decoct fresh Huoxiang (Agastache Herba) and administer Liuyi San (Six-to-One Powder) mixed in the soup; sweating indicates improvement. If treated in an environment too hot, it may exacerbate the heat; if too cold, it may obstruct the exit of heat. One must wait until the hands and feet sweat naturally, allowing heat pathogens to exit, and consciousness slightly returns, before administering Huanglian Xiangru Yin (Coptis and Mosla Decoction) or Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction). For thirst, use Renshen Baibu Tang (Ginseng and White Tiger Decoction) plus Gegen (Kudzu Root); for heat in the Lung, use Jiegeng Tang (Platycodon Decoction); for heat in both Heart and Lung with unclear consciousness, use Liangge San (Cool the Diaphragm Powder); for severe damp-heat, use Cangzhu Baibu Tang (Atractylodes and White Tiger Decoction); for severe dry-heat, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).
Huanglian Xiangru Yin: Universally treats summerheat-heat.
Ingredients: Huanglian (Coptidis Rhizoma), Xiangru (Moslae Herba), Bai Biandou (Vigna Semen), Houpo (Magnoliae Officinalis Cortex). Add fresh Huoxiang (Agastache Herba) for decoction. For body pain, add Qianghuo (Notopterygii Rhizoma et Radix); for muscle spasms/cramps, add Mugua (Chaenomelis Fructus); for red and scanty urination, add Liuyi San; for vomiting, add Guangpi (Citri Reticulatae Pericarpium).
Sanhuang Shigao Tang: Treats conditions without exterior pathogens, characterized by profuse sweating, thirst, and severe interior heat.
Ingredients: Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), Shigao (Gypsi Fibrum), Shanzhi (Gardeniae Fructus), Xuanshen (Scrophulariae Radix), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Renshen Baibu Tang: Treats interior heat of the Yangming Meridian.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Shigao (Gypsi Fibrum), Zhimu (Anemarrhenae Rhizoma), Jingmi (Oryza Sativa Germen), Gancao (Glycyrrhizae Radix et Rhizoma), Gegen (Puerariae Lobatae Radix).
Jiegeng Tang: Treats pre-existing lung heat, manifesting as irritability, fever, wheezing, cough, dry mouth, and parched throat.
Ingredients: Bohe (Menthae Haplocalycis Herba), Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuye (Bambusae Folium).
Daochi Gehan Tang: Drains heat from the Small Intestine, causing Heart Fire to subside naturally, hence named "Guiding Red"; purges Heart Fire, allowing the Small Intestine to function freely.
Ingredients: Huanglian (Coptidis Rhizoma), Shengdi (Rehmanniae Radix), Mutong (Akebiae Caulis), Xijiao (Rhinoceoris Cornu - note: substitute with water buffalo horn in modern practice), Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Tuber), Dengxin (Sparganiatis Stamen), Gancao (Glycyrrhizae Radix et Rhizoma).
Liangge San: Treats severe heat in the Upper Jiao, where the exterior is resolved but interior heat remains, suitable for clearing rather than purging.
Ingredients: Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Jiegeng (Platycodonis Radix), Lianqiao (Forsythiae Fructus), Tianhuafen (Trichosanthis Radix), Huanglian (Coptidis Rhizoma), Bohe (Menthae Haplocalycis Herba).
Cangzhu Baibu Tang: Treats Yangming damp-heat.
Ingredients: Cangzhu (Atractylodis Rhizoma), Shigao (Gypsi Fibrum), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Zhuye Shigao Tang: Treats Yangming dry-heat.
Ingredients: Shigao (Gypsi Fibrum), Zhimu (Anemarrhenae Rhizoma), Maidong (Ophiopogonis Tuber), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuye (Bambusae Folium), Renshen (Ginseng Radix et Rhizoma).
*Zhongre* refers to severe cases of acute heat diseases. It is called *Zhongre* because of sudden collapse and lethargy; it is not called *Hanre Bing* (Cold-Heat Disease) or *Wenbing* (Warm Disease) because it lacks exterior symptoms such as aversion to cold or exterior heat. Summer heat warm diseases involve heat without aversion to cold, but lack the sudden collapse and lethargy seen in *Zhongre*. Although both *Zhongre* and heat diseases belong to pure Yang syndromes, and heat diseases can be treated directly with cold-cooling herbs, *Zhongre* may involve phlegm, food stagnation, and obstruction of the Middle Jiao, leading to coma, suppression of Stomach Yang, and cold extremities. Therefore, for comatose conditions, cold-cooling herbs should generally be avoided, as the root cause is often Stomach Yang stagnation and phlegm obstruction. When treating *Zhongre* with lethargy, one should first use methods to unblock the Middle Jiao. Wait until Stomach Qi circulates, Stomach Yang spreads, and hands/feet become warm and sweaty, before using the aforementioned formulas to clear Upper Jiao heat. If heat binds the Lower Jiao with constipation and indications for purgation, use Sanhua Tang or Chengqi Tang; if both urine and stool are blocked, use Bazheng San.
Generally, to eliminate pathogens and disease, there are only three pathways: heat in the body and Upper Jiao exits via pores through sweating; heat in the Lower Jiao (Small Intestine, Bladder) exits via urination; heat in the Large Intestine exits via defecation. These three principles are known to everyone, yet few truly comprehend them.