按中 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
病治法有清热有解肌
太阳中热者 是也其人汗出恶寒身热而渴也（成 汗出恶寒身热而不渴者中风也汗出恶寒身热而渴者中 也白虎
汤）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（成 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
板齿燥者重有热也内经曰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○徐氏曰此条无治法东垣以清暑益气汤主
之所谓发千古之秘也）太阳中 者身热疼重而脉微弱此亦夏日伤于水水行皮中所致也（成 经曰脉虚身热得之伤暑身热
脉微弱者 也身体疼重者水也夏时暑热以水灌溉而得之○瓜蒂一物散或云五苓散）
中 与伤寒相似而异
张氏曰清邪中上浊邪中下其风寒湿者皆地之气系浊邪所以俱中足经惟暑乃天之气系清邪所
以中手少阴心经也其证多与伤寒相似但 与伤寒脉不同耳夫伤寒虽恶寒发热初病未至于烦渴惟暑则不然初病即渴所以
与伤寒为异也且伤寒之脉必浮盛中暑之脉必虚弱或弦细芤迟者有之经曰脉盛身寒得之伤寒脉虚身热得之伤暑此之谓也
假如太阳病项背强八八反汗出恶风若当炎暑之时岂不与中 相似惟其不渴故与桂枝加葛汤主之凡居夏秋之令炎暑之时
必当根据经详审则无差失之患矣
汪 以证言之伤寒恶寒伤热恶热以脉言之伤寒脉盛伤暑脉虚且暑脉虚细与湿痉之脉有相似
者而证则不同暑则自汗而渴湿则不渴痉则身疼也
脉洪身热恶寒为热病
活人云夏月发热恶寒头疼身体肢节痛重其脉洪盛者热病也冬伤于寒因暑气而发为热病治热
病与伤寒同有汗宜桂枝汤无汗宜麻黄汤如烦躁者宜大青龙汤然夏月药性须带凉不可太温桂枝麻黄大青龙须用加减夏至
前桂枝加黄芩半两夏至后桂枝麻黄大青龙加知母一两石膏二两或加升麻半两盖桂枝麻黄汤性热及暖处非西北之比夏月
服之必有发黄斑出之失热病三日外与前汤不瘥脉势仍数邪气犹在经络未入脏腑者桂枝石膏汤主之此方夏至后代桂枝证
用若加麻黄一两可代麻黄青龙证用也若三月至夏为晚发伤寒栀子升麻汤亦可选用之（万历癸卯兴化李氏一婿应举于南京
时方盛暑伤寒太学生新读仲景书自诧知医投以桂枝汤入腹即毙大抵麻桂二汤乃隆冬正伤寒之药施之温病尚不可况热病
乎）
桂枝石膏汤 治法见前论有汗脉缓为桂枝证无汗脉紧为麻黄青龙证
桂枝（去粗皮） 黄芩（各半两） 栀子（三钱） 白芍药 升麻 干葛 生姜（以上各七钱半） 石膏（碎） 甘
草（炙各一两）上 咀每服五钱半水一盏半煮至八分去滓食顷再服得汗即停后服
栀子升麻汤 治晚发伤寒三月至夏为晚发
生地黄（切碎半斤） 栀子（十枚劈） 升麻（一两半） 柴胡 石膏（各二两半）上 咀每服五钱水一盏半煎八
分顿服病不解更服
吴 自夏至以后时令炎暑有人壮热烦渴而不恶寒者乃热病也凡脉浮洪者发于太阳也洪而长者阳明也弦而数者少
阳
也然此发在三阳为可治若脉沉细微小足冷者发在三阴为难治也大抵热病大热须得脉洪大有力或滑数有力乃为脉病相应
为之可治若小弱无力为之难治若人虚脉弱者宜人参汤与之而扶其元气也不可以攻其热如脉洪身疼壮业无汗烦乱者宜六
神汤解散发汗则愈或人参羌活散加葛根淡豆豉生姜以汗之轻者只用十味芎苏散汗之亦佳如夹暑加香薷扁豆双解之若兼
有内伤生冷冻饮料食停滞或呕吐恶心中脘痞闷或恶风或增寒拘急者宜藿香正气散加香薷扁豆葛根以发汗名二香汤若发散热
不解者在太阳经宜用人参羌活散加黄芩在阳明经宜用升麻葛根汤加黄芩热甚燥渴脉大者白虎汤加人参主之在少阳宜用
小柴胡汤随证增损治之若夹暑者加黄连香薷主之若热而大便自利小便不利烦渴者五苓散去桂加葛根黄连香薷滑石之类
主之若表里俱热而自利脉浮数而小便不利者小柴胡汤合四苓散主之若其不解或传经变证或里实可下或阴寒可温或发斑
黄等证皆从正伤寒条内治之大抵热病一二日泄利腹满热甚者死三四日目昏谵语热盛而脉小者死四五日热盛脉小足冷者
死五六日汗不出呕吐谵语昏沉脉急促者死六七日舌本焦黑燥者死七八日衄血吐血燥热脉大者死九日发痉搐搦昏乱者死
凡热病脉促结代沉小者皆难治也热病不得汗而脉躁急者死以得汗而热反盛脉躁急者死也
脉虚身热恶寒为中暑
治法方论详杂病本门及后条
胫冷腹满头痛渴而无热者湿温
活人云湿温者两胫逆冷胸腹满多汗头痛妄言其人常伤于湿因而中暑湿热相搏则发
湿温其脉阳濡而弱阴小而急治在太阳不可发汗汗出必不能言耳聋不知痛所在身青面色变名曰重 如此死者医杀之耳白
虎加苍术汤主之
许 癸丑年故人王彦龙作毗陵仓官季夏时病胸项多汗两足逆冷谵语医者不晓杂进药已经旬日予诊之其脉关前濡
关
后数予曰当作湿温治之盖先受暑后受湿暑湿相搏是名湿温先以白虎加人参汤次白虎加苍术汤头痛渐退足渐温汗渐止三
日愈此名贼邪若误用药无不死有人难曰何名贼邪予曰难经云五邪有实邪虚邪正邪微邪贼邪从后来者为虚邪从前来者为
实邪从所不胜来者为贼邪从所胜来者为微邪自病者为正邪又曰假令心病中暑为正邪中湿得之为贼邪今心先受暑而湿邪
胜之水克火从所不胜斯谓之贼邪五邪之中最逆也难经曰湿温之脉阳濡而弱阴小而急濡弱见于阳部湿气搏暑也小急见于
阴部暑气蒸湿也故经曰暑湿相搏名曰湿温是谓贼邪也不特此也予素有停饮之疾每至暑月两足汗 未尝干每服此药二
三盏即愈
海 湿温汗少者白虎加苍术汗多者白虎加桂枝（白虎加桂枝方见）
孙 保庆门外有酒家姓姜者善歌唱孙爱之忽数日不见使人问之则曰病久将命绝孙诊之遍身皆润两足冷至膝下腹
满
不省人事六脉皆小弱而急问其所服药取而视之皆阴病药也孙曰此非受病重药能重病耳遂用五苓散白虎汤十余帖病少苏
再服全愈姜氏既安诣孙谢因请问曰某得病剧蒙良药一治而苏愿闻治法孙曰汝病伤暑也始则阳微厥而脉小无力众医谓阴
病遂用阴药其病愈厥予用五苓散大利小便则腹减白虎解利邪热则病愈凡阴病胫冷两臂亦冷汝今胫冷臂不冷则非下厥上
行所以知是阳微厥也
保 立夏之后至立秋处暑之间伤寒者身多微凉自汗四肢沉重谓之湿温苍术石膏汤主之（即白虎加苍术汤）
苍术石膏汤方
苍术（半两） 石膏（三钱） 知母（二钱半） 甘草（一钱）上 咀水一盏煎至半盏温服谓内有湿也多不欲饮水
如身热脉洪无汗多渴者热在上焦积于胸中宜桔梗散（此非湿温病乃热病也）
桔梗散方
薄荷 黄芩 甘草 栀子（各一钱） 连翘（二钱） 桔梗（三钱）上锉每服五钱水煎加竹叶如大便涩加大黄半两
脉虚身热得之伤暑
刘纯曰按许学士云伤暑其脉弦细芤迟内经曰寒伤形热伤气盖伤气而不伤形则气消而脉虚弱所
谓弦细芤迟皆虚脉也仲景以弦为阴而朱肱亦曰中暑脉细弱则皆虚脉也可知矣
暑证有冒有伤有中
戴氏曰冒伤中三者轻重之分或腹痛水泄胃与大肠受之恶心者胃口有痰饮此二者冒暑也可用黄
连香薷饮（黄连退热香薷消暑）或身热头疼躁乱不宁者或身如针刺者此为热伤肉分当以解毒白虎汤加柴胡气虚加人参或
咳嗽发寒热盗汗不止脉数者热伤肺经火乘金也此为中暑宜用清肺汤柴胡天水散（之类）
夏月伏阴在内
丹溪曰夏月阳气尽出于地人之腹属地气于此时浮于肌表腹中虚矣夏月伏阴在内也阴字有虚之之义
若作阴冷看误矣前人治暑有用大顺散温热药者盖以凉亭水阁寒泉冰雪所伤也非为伏阴而用火令之时烁石流金有何阴冷
孙真人令人夏月服生脉散非虚而何刘氏曰洁古谓静而得之为中暑动而得之为中热东垣谓避暑于深堂大厦得之曰中暑宜
大顺散劳役得之曰中热宜苍术白虎汤夫暑热一也夏令之气也静居堂厦而病乃夏月伤冷之病何以中暑而别于中热耶王氏
曰窃谓暑热者夏之令也火行于天地间人或劳役或饥饿元气亏乏不足以御天令亢极于是受伤而为病名曰中暑亦名曰中热
其实一也今乃以动静所得分之何哉夫中暑者固多在劳役之人劳役则虚虚则邪入邪入则病苟或不虚天令虽亢亦无由伤之
彼避暑于深堂大厦得头疼恶热等证者盖亦伤寒之类耳不可以中暑名之其所以烦心与肌肤大热者非暑邪也身中阳气受阴
寒所遏而作也既非暑邪岂可以中暑名乎苟欲治之则辛温轻扬之剂发散可也夫大顺散一方甘草最多干姜杏仁肉桂次之除
肉桂外其三物皆炒其初意本为病者伏热引饮过多脾胃受湿呕吐水谷不分脏腑不调所立故甘草干姜皆火炒又肉桂而非桂
枝盖温中药也其杏仁不过取其能下气耳若以此药治静而得之之证吾恐不能解表反增内烦矣今世俗往往不明类曰夏月阴
气在内大顺散为必用之药夫阴气非寒气也盖夏月阳气发散在外而阴气则在内耳岂空视阴气为寒气而用温热之药乎阴果
为寒何以夏则饮水乎其苍术白虎汤虽宜用然亦岂可视为通行之药乎必参之治暑诸方随所见之证而用之然后合理夫所谓
静而得之证虽当暑月即非暑病宜分出之勿使后人有似同而异之惑
暑伤五脏为证不同
陈氏曰暑入心则噎闷昏不知人入肝则眩晕顽痹入脾则昏睡不觉入肺则喷满痿 入肾则消渴徐
氏曰暑 之证变异不等非止归五脏盖人之形气有虚实感有轻重轻则后时而发正秋成疟痢是也重则实时而发如以上证至
有轻变重重变轻亦自感有浅深传有兼并况人之形志苦药不一岂得无变异乎四时之证皆然
暑病宜补元气
东垣曰脾胃虚弱遇六七月湿旺汗泄身重短气四肢痿软脚欹眼黑此肾与膀胱俱竭之状也况汗大泄则
亡津液津者庚大肠所主三伏庚金受囚木无可制故风湿相搏骨节烦疼也夫壬膀胱已绝于已癸肾水已绝于午今更逢湿旺助
热为邪西北方之寒清绝矣圣人立法夏宜补者为热伤元气以人参麦门冬五味滋水之源泻内火补庚金益元气也
中暑发为痿厥诸证
东垣曰长夏湿热蒸人损伤元气四肢困倦精神短少两脚痿软遇早晚之际则发寒厥日高之后复热
如火乃阴阳气血俱不足也或心胸痞满肢节沉疼或气高而喘身热而烦小便黄而少大便溏而频或利或渴自汗体重此血先病
而气不病也若湿气先搏脉必洪缓而迟病虽互换少瘥其天暑湿令则一宜以清燥之剂治之或远行大热而渴则热舍于肾故水
不胜火发为骨痿此湿热成痿也或热厥而阴虚或寒厥而气虚四肢如火为热厥四肢寒冷为寒厥寒厥腹中有寒热厥腹中有热
为脾主四肢故也徐氏曰此论暑热证候则同冬月伤寒传变为证之不一彼为寒伤形此为热伤气若元气虚甚受病忽于一时不
救者与伤寒阴毒顷刻害人实同故东垣启是病例大开后人之盲 也宜与痿门互看
暑风
贾氏曰此由火热制金不能平木搐搦不省人事其脉虚浮者风也虚者暑也俗名暑风乃相火甚而行令也先以温水
化苏合香丸次以黄连香薷饮加羌活或双解散加香薷尤良
治暑大法
贾氏曰暑者相火行令也人感之其脉虚外证头疼口干面垢自汗倦怠或背恶热甚者迷闷不省而为霍乱吐利
痰滞呕逆腹痛泄利下血发黄生斑皆是其证治法清心利小便为上汗多者不可利宜白虎汤次分表里以治如在表头疼恶寒双
解加香薷及二香散十味香薷散如在半表半里泻泄烦渴饮水吐逆五苓散热甚烦渴益元散若表解里热宜半夏解毒汤下神芎
丸或老人及素弱人冒暑脉微下利渴而喜温或厥冷不省人事宜竹叶石膏汤加熟附半个冷冻饮料次以来复丹五苓散治之凡夏月
暑证不可服诸热燥剂致斑毒发黄小便不利闷乱而死矣徐氏曰此言治暑之法可谓详备然于暑风相火为病而用苏合香丸至
用双解皆当审谛脉证不可差失详苏合丸但可用于阴寒所遏或内伤生冷及气中或中恶者此等又不可谓暑风相火之证矣学
者审之陶氏曰中暑脉虚而伏身热背恶寒面垢自汗烦躁大渴毛耸恶寒昏冒倦怠而身不痛与伤寒诸证不同内外俱热口燥烦
渴四肢微冷而身不痛用白虎汤痰逆恶寒橘皮汤热闷不恶寒竹叶石膏汤头痛恶心烦躁心下不快小便不利五苓散下消暑丸
中暑用小柴胡汤（最良）
按语：中暑和中热，名称虽然不同，但实际上是同一种病。如果是冬天感受寒邪，到了夏天才转变为热病发作的，这是过了时令才发作、从体内发出并达于体表的疾病，俗称“晚发”。这又不能与突然发生的中暑中热新病相提并论。有人说：新近中暑的病脉象虚，晚发的发热病脉象盛。这两种病的治疗方法，有的用清热法，有的用解肌法。
太阳经受邪而中热（即中暍）的，其症状是病人汗出、怕冷、身体发热而且口渴。（成无己注：汗出、怕冷、身体发热但不口渴的，是中风证；汗出、怕冷、身体发热且口渴的，是中暍证，用白虎汤治疗。）
太阳经受邪而中湿（即中湿）的，症状是发热、怕冷、身体沉重且疼痛，脉象弦细、芤或迟，小便结束后感觉洒洒然恶寒、毫毛竖起，手足逆冷，稍微劳动身体就发热，张口呼吸，前板齿干燥。如果误用发汗法，则怕冷更严重；误用温针法，则发热更剧烈；误用攻下法，则淋证更严重。（成无己注：病有在表、在里、表里同病的，此条属于表里同病。发热、怕冷、身体沉重疼痛，是表受湿邪；脉象弦细、芤、迟，是中暑脉虚的表现；小便后洒洒恶寒、毫毛竖起、手足逆冷，是太阳经气不足；稍微劳动身体就发热，是说劳动导致阳气外越而热气随即发作；张口、前板齿干燥，是因为热重所致。《内经》说：“因于暑而汗出，烦闷则气喘喝。”张口即是气喘喝的表现。因为气喘喝不止，所以前板齿干燥。如果发汗以去除表邪，则体表阳气更虚，所以怕冷更严重；如果用温针助阳，则火热内攻，所以发热更剧烈；如果用攻下法以清除里热，则体内更虚而膀胱燥结，所以淋证更严重。○徐氏说：这一条没有给出治疗方法，李东垣用清暑益气汤主治，可以说是发掘了千古的秘密。）
太阳经受邪而中湿（即中湿）的，症状是身体发热、疼痛沉重而脉象微弱，这也是夏天伤于水湿，水湿行于皮肤之间所导致的。（成无己注：《内经》说：“脉虚身热，得之伤暑。”身体发热而脉象微弱的，是伤暑；身体疼痛沉重的，是水湿为患。夏天时暑热盛行，若用水灌溉而致病。○可用瓜蒂一物散，也有说是五苓散。）
中湿与伤寒相似但有所不同。
张氏说：清邪（风暑等）侵犯上部，浊邪（寒湿等）侵犯下部。风寒湿等邪气都属于地之气，系属浊邪，所以都侵犯足经；只有暑邪属于天之气，系属清邪，所以侵犯手少阴心经。其症状多与伤寒相似，但中湿与伤寒的脉象不同。大凡伤寒虽然怕冷发热，初起时尚未至于烦渴；只有暑病不然，初起即口渴，所以与伤寒不同。而且伤寒的脉象必定浮盛，中暑的脉象必定虚弱，或者出现弦细、芤、迟的脉象。《内经》说：“脉盛身寒，得之伤寒；脉虚身热，得之伤暑。”说的就是这种情况。假如太阳病出现项背强急，反见汗出恶风，如果在炎热酷暑之时，岂不与中湿相似？只因为不口渴，所以用桂枝加葛根汤主治。凡是处于夏秋季节，炎暑之时，必须根据经典仔细审察，才不会出差失的祸患。
汪氏说：从症状来说，伤寒怕冷，伤暑怕热；从脉象来说，伤寒脉盛，伤暑脉虚。而且暑脉的虚细与湿病、痉病的脉象有相似之处，但症状则不同：暑病自汗且口渴，湿病不口渴，痉病身体疼痛。
《活人书》说：夏季发热、怕冷、头痛、身体肢节疼痛沉重，脉象洪盛的，是热病。这是冬天伤了寒邪，因暑气激发而发作的热病。治疗热病与伤寒相同：有汗宜用桂枝汤，无汗宜用麻黄汤；如果有烦躁者，宜用大青龙汤。然而夏季用药性质须带凉性，不可太温。桂枝汤、麻黄汤、大青龙汤必须加减使用：夏至前，桂枝汤加黄芩半两；夏至后，桂枝汤、麻黄汤、大青龙汤加知母一两、石膏二两，或者加升麻半两。大概是因为桂枝、麻黄汤药性温热，以及南方暖处与西北寒冷地区不同，夏季服用必然会导致发黄、发斑的失误。热病三天以后，与前汤药无效，脉势仍然快数，邪气还在经络未入脏腑的，用桂枝石膏汤主治。此方在夏至后代替桂枝证使用；如果加麻黄一两，可代替麻黄青龙证使用。如果从三月到夏天发生的晚发伤寒，栀子升麻汤也可以选用。（万历癸卯年，兴化李氏的女婿去南京应试，当时正值盛夏，他得了伤寒。这位太学生刚读完仲景的书，自夸懂医，投服桂枝汤，入腹后立即死亡。大概麻黄、桂枝二汤是隆冬正伤寒的药物，施用于温病尚且不可，何况是热病呢？）
桂枝石膏汤：治法见前文论述。有汗脉缓为桂枝证，无汗脉紧为麻黄青龙证。
组成：桂枝（去粗皮）、黄芩（各半两）、栀子（三钱）、白芍药、升麻、干葛、生姜（以上各七钱半）、石膏（碎）、甘草（炙，各一两）。上药捣碎，每服五钱半，加水一盏半，煮至八分，去渣，进食片刻后再服，得汗即停服后药。
栀子升麻汤：治疗晚发伤寒，从三月到夏天称为晚发。
组成：生地黄（切碎半斤）、栀子（十枚劈开）、升麻（一两半）、柴胡、石膏（各二两半）。上药捣碎，每服五钱，加水一盏半，煎至八分，顿服。病不解再服。
吴氏说：自夏至以后，时令炎热，有人壮热、烦渴而不怕冷的，乃是热病。凡是脉象浮洪的，发于太阳经；洪大而长的，发于阳明经；弦而数的，发于少阳经。然而这三阳经发病尚可治疗；如果脉象沉细微小、足冷的，发于三阴经，为难治。大抵热病大热，必须得到脉象洪大有力，或者滑数有力，才是脉病相应，可以治疗；如果脉小弱无力，为难治。如果人体质虚弱、脉弱者，宜用人参汤与之以扶持元气，不可以攻伐其热。如脉洪、身疼、壮热、无汗、烦乱的，宜用六神汤解散发汗，汗出则愈；或者用人参羌活散加葛根、淡豆豉、生姜以发汗；轻症只用十味芎苏散发汗也很好。如果夹暑，加香薷、扁豆双解。如果兼有内伤，生冷饮食停滞，或者呕吐恶心、中脘痞闷，或者恶风或增寒拘急的，宜用藿香正气散加香薷、扁豆、葛根以发汗，名为二香汤。如果发散热邪不解，在太阳经宜用人参羌活散加黄芩；在阳明经宜用升麻葛根汤加黄芩；热甚、燥渴、脉大的，用白虎汤加人参主治；在少阳经宜用小柴胡汤随证增减治疗。如果夹暑，加黄连、香薷主治。如果热而大便自利、小便不利、烦渴的，用五苓散去桂枝加葛根、黄连、香薷、滑石之类主治。如果表里俱热而自利、脉浮数而小便不利的，用小柴胡汤合四苓散主治。如果病不解，或者传经变证，或者里实可下，或者阴寒可温，或者发斑发黄等证，都按照正伤寒条文内治疗。大抵热病一二日泄利腹满、热甚的，死；三四日目昏谵语、热盛而脉小的，死；四五日热盛、脉小、足冷的，死；五六日汗不出、呕吐、谵语、昏沉、脉急促的，死；六七日舌本焦黑干燥的，死；七八日衄血吐血、燥热、脉大的，死；九日发痉搐搦、昏乱的，死。凡热病脉促、结代、沉小的，皆难治。热病不得汗而脉躁急的，死；得汗而热反而盛、脉躁急的，死。
脉虚、身体发热、怕冷的，是中暑。
治法方论详见杂病本门及后条。
《活人书》说：湿温病，两小腿逆冷，胸腹满闷，多汗，头痛，妄言。其人常伤于湿，因而中暑，湿热相搏则发为湿温。其脉象阳部濡弱，阴部小而急。治疗在太阳经，不可发汗，发汗必不能言语，耳聋，不知痛在哪里，身体发青，面色改变，名叫重暍。如此死亡的，是医生杀死的。应用白虎加苍术汤主治。
许学士说：癸丑年，老朋友王彦龙任毗陵仓官，季夏时患病，胸项多汗，两足逆冷，谵语。医者不懂，杂进药物，已经十天。我诊察他的脉象，关前濡，关后数。我说应当作湿温治疗。盖先受暑，后受湿，暑湿相搏，名叫湿温。先用白虎加人参汤，次用白虎加苍术汤，头痛渐退，足渐温，汗渐止，三日痊愈。这名叫贼邪。如果有人问：什么叫贼邪？我说：《难经》说五邪有实邪、虚邪、正邪、微邪、贼邪。从后来者为虚邪，从前来者为实邪，从所不胜来者为贼邪，从所胜来者为微邪，自病者为正邪。又说：假令心病，中暑为正邪，中湿得之为贼邪。今心先受暑而湿邪胜，水克火，从所不胜而来，斯谓之贼邪。在五邪之中最为逆乱。《难经》说：湿温之脉，阳濡而弱，阴小而急。濡弱见于阳部，是湿气搏暑也；小急见于阴部，是暑气蒸湿也。所以经上说：暑湿相搏，名叫湿温，是谓贼邪。不仅如此，我素有停饮之疾，每到暑月，两足出汗未尝干燥，每次服此药二三盏即愈。
海藏说：湿温汗少的，用白虎加苍术汤；汗多的，用白虎加桂枝汤（白虎加桂枝方见前）。
孙真人说：保庆门外有个姓姜的酒家，善于歌唱，孙真人喜爱他。忽然几天不见，派人去问，他说病久将命绝。孙真人诊察，遍身皆润，两足冷至膝下，腹满，不省人事，六脉皆小弱而急。问他所服药物，取来一看，都是治阴病的药。孙真人说：这不是病重，是药能重病罢了。于是用五苓散、白虎汤十余帖，病稍苏醒，再服全愈。姜氏既安，诣孙谢，因请问曰：“我病重蒙良药一治而苏，愿闻治法。”孙真人说：“你病是伤暑。开始则是阳微厥而脉小无力，众医认为是阴病，遂用阴药，其病愈厥（加重）。我用五苓散大利小便则腹减，白虎汤解利邪热则病愈。凡阴病，胫冷两臂亦冷；你今胫冷臂不冷，则非下厥上行，所以知道是阳微厥也。”
保氏说：立夏之后至立秋处暑之间，伤寒者身体多微凉，自汗，四肢沉重，谓之湿温，苍术石膏汤主治（即白虎加苍术汤）。
苍术石膏汤方：
苍术（半两）、石膏（三钱）、知母（二钱半）、甘草（一钱）。上药捣碎，水一盏，煎至半盏，温服。谓内有湿，也多不欲饮水。如身热脉洪、无汗、多渴者，热在上焦积于胸中，宜桔梗散（此非湿温病，乃热病也）。
桔梗散方：
薄荷、黄芩、甘草、栀子（各一钱）、连翘（二钱）、桔梗（三钱）。上锉，每服五钱，水煎，加竹叶。如大便涩，加大黄半两。
刘纯说：按许学士说，伤暑其脉弦细、芤、迟。《内经》说：“寒伤形，热伤气。”盖伤气而不伤形，则气消而脉虚弱。所谓弦细、芤、迟，皆虚脉也。仲景以弦为阴，而朱肱也说中暑脉细弱，则皆虚脉，可以知道了。
暑证有冒、伤、中三种。
戴氏说：冒、伤、中三者是轻重之分。或者腹痛水泄，胃与大肠受之，恶心者，胃口有痰饮，此二者是冒暑，可用黄连香薷饮（黄连退热，香薷消暑）。或者身热头疼、躁乱不宁者，或者身如针刺者，此为热伤肉分，当以解毒白虎汤加柴胡，气虚加人参。或者咳嗽、发寒热、盗汗不止、脉数者，热伤肺经，火乘金也，此为中暑，宜用清肺汤、柴胡天水散（之类）。
夏月伏阴在内。
丹溪说：夏月阳气尽出于地表，人之腹部属地气，于此时浮于肌表，腹中虚矣，夏月伏阴在内也。“阴”字有虚的意思。如果看作阴冷看就错了。前人治暑有用大顺散温热药的，大概是因为凉亭水阁、寒泉冰雪所伤也，并非为伏阴而用火令之时，烁石流金，有何阴冷？孙真人令人夏月服生脉散，非虚而何？刘氏说：洁古谓静而得之为中暑，动而得之为中热；东垣谓避暑于深堂大厦得之曰中暑，宜大顺散；劳役得之曰中热，宜苍术白虎汤。夫暑热一也，夏令之气也。静居堂厦而病，乃夏月伤冷之病，何以中暑而别于中热耶？王氏说：窃谓暑热者，夏之令也，火行于天地间。人或劳役，或饥饿，元气亏乏，不足以御天令亢极，于是受伤而为病，名曰中暑，亦名曰中热，其实一也。今乃以动静所得分之，何哉？夫中暑者固多在劳役之人，劳役则虚，虚则邪入，邪入则病。苟或不虚，天令虽亢，亦无由伤之。彼避暑于深堂大厦得头疼恶热等证者，盖亦伤寒之类耳，不可以中暑名之。其所以烦心与肌肤大热者，非暑邪也，身中阳气受阴寒所遏而作也。既非暑邪，岂可以中暑名乎？苟欲治之，则辛温轻扬之剂发散可也。夫大顺散一方，甘草最多，干姜、杏仁、肉桂次之。除肉桂外，其三物皆炒，其初意本为病者伏热引饮过多，脾胃受湿，呕吐水谷不分，脏腑不调所立，故甘草、干姜皆火炒，又肉桂而非桂枝，盖温中药也。其杏仁不过取其能下气耳。若以此药治静而得之之证，吾恐不能解表，反增内烦矣。今世俗往往不明类，曰夏月阴气在内，大顺散为必用之药。夫阴气非寒气也，盖夏月阳气发散在外，而阴气则在内耳，岂空视阴气为寒气而用温热之药乎？阴果为寒，何以夏则饮水乎？其苍术白虎汤虽宜用，然亦岂可视为通行之药乎？必参之治暑诸方，随所见之证而用之，然后合理。夫所谓静而得之证，虽当暑月，即非暑病，宜分出之，勿使后人有似同而异之惑。
暑伤五脏为证不同。
陈氏说：暑入心则噎闷昏不知人；入肝则眩晕顽痹；入脾则昏睡不觉；入肺则喷满痿躄；入肾则消渴。徐氏说：暑中之证变异不等，非止归五脏。盖人之形气有虚实，感有轻重。轻则后时而发，正秋成疟痢是也；重则实时而发，如以上证。至有轻变重，重变轻，亦自感有浅深，传有兼并。况人之形志苦乐不一，岂得无变异乎？四时之证皆然。
暑病宜补元气。
东垣说：脾胃虚弱，遇六七月湿旺，汗泄身重，短气，四肢痿软，脚欹眼黑，此肾与膀胱俱竭之状也。况汗大泄则亡津液，津者庚大肠所主，三伏庚金受囚，木无可制，故风湿相搏，骨节烦疼也。夫壬膀胱已绝于巳，癸肾水已绝于午，今更逢湿旺助热为邪，西北方之寒清绝矣。圣人立法，夏宜补者，为热伤元气，以人参、麦门冬、五味子滋水之源，泻内火，补庚金，益元气也。
东垣说：长夏湿热蒸人，损伤元气，四肢困倦，精神短少，两脚痿软，遇早晚之际则发寒厥，日高之后复热如火，乃阴阳气血俱不足也。或心胸痞满，肢节沉疼，或气高而喘，身热而烦，小便黄而少，大便溏而频，或利或渴，自汗体重，此血先病而气不病也。若湿气先搏，脉必洪缓而迟，病虽互换少瘥，其天暑湿令则一，宜以清燥之剂治之。或远行大热而渴，则热舍于肾，故水不胜火，发为骨痿，此湿热成痿也。或热厥而阴虚，或寒厥而气虚。四肢如火为热厥，四肢寒冷为寒厥。寒厥腹中有寒，热厥腹中有热，为脾主四肢故也。徐氏说：此论暑热证候则同，冬月伤寒传变为证之不一，彼为寒伤形，此为热伤气。若元气虚甚，受病忽于一时，不救者与伤寒阴毒顷刻害人实同，故东垣启是病例，大开后人之盲瞽也。宜与痿门互看。
暑风。
贾氏说：此由火热制金，不能平木，搐搦不省人事。其脉虚浮者，风也；虚者，暑也。俗名暑风，乃相火甚而行令也。先以温水化苏合香丸，次以黄连香薷饮加羌活，或双解散加香薷尤良。
治暑大法。
贾氏说：暑者，相火行令也。人感之，其脉虚，外证头疼，口干，面垢，自汗，倦怠，或背恶热，甚者迷闷不省，而为霍乱吐利，痰滞呕逆，腹痛泄利下血，发黄生斑，皆是其证。治法清心利小便为上。汗多者不可利，宜白虎汤。次分表里以治：如在表，头疼恶寒，双解加香薷及二香散、十味香薷散；如在半表半里，泻泄烦渴，饮水吐逆，五苓散；热甚烦渴，益元散。若表解里热，宜半夏解毒汤下神芎丸。或老人及素弱人冒暑，脉微下利，渴而喜温，或厥冷不省人事，宜竹叶石膏汤加熟附半个，冷冻饮料，次以来复丹、五苓散治之。凡夏月暑证，不可服诸热燥剂，致斑毒发黄，小便不利，闷乱而死矣。徐氏说：此言治暑之法，可谓详备。然于暑风相火为病而用苏合香丸，至用双解，皆当审谛脉证，不可差失。详苏合丸但可用于阴寒所遏，或内伤生冷及气中，或中恶者，此等又不可谓暑风相火之证矣。学者审之。陶氏说：中暑脉虚而伏，身热，背恶寒，面垢，自汗，烦躁，大渴，毛耸，恶寒，昏冒，倦怠而身不痛，与伤寒诸证不同。内外俱热，口燥烦渴，四肢微冷而身不痛，用白虎汤；痰逆恶寒，橘皮汤；热闷不恶寒，竹叶石膏汤；头痛恶心，烦躁，心下不快，小便不利，五苓散；下消暑丸；中暑用小柴胡汤（最良）。
Note: Zhongshu (heatstroke) and Zhongre (summerheat illness), although named differently, are essentially the same disease. If one is injured by cold in winter and it transforms into a heat disease that manifests in summer, this is a disease that manifests after the season has passed, originating from within and reaching the exterior, commonly known as "late onset" (Wanfa). This cannot be compared to acute new-onset Zhongshu or Zhongre. Some say: The pulse of newly contracted Zhongshu is deficient (Xu), while the pulse of late-onset fever is full/excess (Sheng). The treatment methods for these diseases include clearing heat (Qingre) and releasing the muscle layer (Jieji).
When Taiyang (Bladder channel) is affected by summerheat (Zhongye), the patient sweats, fears cold, has a fever, and feels thirsty. (Cheng Wuji notes: Sweating, fearing cold, and fever without thirst indicate Wind-stroke (Fengzhong); sweating, fearing cold, fever with thirst indicate Zhongye, treated with Baihu Tang [White Tiger Decoction].)
When Taiyang is affected by dampness (Zhongshi), symptoms include fever, aversion to cold, heaviness and pain in the body, a string-taut (Xuan) thin (Xi) or hollow (Kou) or slow (Chi) pulse, chills and piloerection after urination, cold extremities, fever upon slight exertion, open mouth, and dryness of the anterior teeth. If sweat-inducing methods are misused, aversion to cold worsens; if warm needle therapy is misused, fever intensifies; if purgative methods are misused, strangury (Lin) worsens. (Cheng Wuji notes: Diseases can be in the exterior, interior, or both. This case involves both. Fever, aversion to cold, body heaviness and pain indicate dampness in the exterior. String-taut, thin, hollow, or slow pulses indicate deficiency in summerheat. Chills/piloereaction/cold limbs indicate insufficiency of Taiyang channel Qi. Fever upon exertion indicates labor causing Yang to disperse and heat to arise. Open mouth and dry teeth indicate severe heat. *Neijing* states: "Affected by summerheat, sweating occurs; vexation leads to panting and drinking." The open mouth signifies panting/drinking. Due to persistent panting/drinking, the anterior teeth become dry. Sweating to remove exterior pathogens further depletes exterior Yang, worsening aversion to cold. Warm needles assist Yang but cause internal fire attack, worsening fever. Purgatives clear interior heat but deplete interior fluids, drying the Bladder and worsening strangury. ○ Xu Shi says: This clause lacks treatment; Li Dongyuan used Qingshu Yiqi Tang [Clear Summerheat and Boost Qi Decoction], revealing a secret of millennia.)
When Taiyang is affected by dampness (Zhongshi), symptoms include fever, painful heaviness, and a weak pulse. This results from water-dampness injuring the body in summer, circulating in the skin. (Cheng Wuji notes: *Neijing* states: "Deficient pulse and fever result from summerheat injury." Fever with weak pulse indicates summerheat injury; painful heaviness indicates water-dampness. In summer, when heat prevails, injury from water irrigation causes this. ○ Use Gouti Yiwu San [Melon Seed Single-Ingredient Powder] or Wuling San [Five-Ling Decoction].)
Zhongshi resembles Shanghan (Cold Damage) but differs.
Zhang Shi says: Clear pathogens (wind/summerheat) affect the upper part; turbid pathogens (cold/dampness) affect the lower part. Wind, cold, and dampness belong to Earth Qi (turbid) and thus affect the Foot channels. Only summerheat belongs to Heaven Qi (clear) and thus affects the Hand Shaoyin Heart channel. Symptoms resemble Shanghan, but the pulse differs. In Shanghan, there is aversion to cold and fever initially, without vexation/thirst. In summerheat, thirst appears immediately. Shanghan pulse is floating and full; summerheat pulse is deficient, or string-taut/thin/hollow/slow. *Neijing* states: "Full pulse with cold body indicates Shanghan; deficient pulse with hot body indicates summerheat injury." For example, Taiyang disease with stiff neck/back and sweating/fear of wind resembles Zhongshi in summer, but because there is no thirst, Guizhi Jia Gegen Tang [Cinnamon Twig plus Kudzu Root Decoction] is used. In summer/autumn heat, one must carefully examine according to classics to avoid error.
Wang Shi says: From symptoms, Shanghan fears cold, summerheat fears heat. From pulse, Shanghan is full, summerheat is deficient. Summerheat's deficient/thin pulse resembles Dampness/Jing (spasm) pulses, but symptoms differ: summerheat has spontaneous sweating and thirst; dampness has no thirst; Jing has body pain.
Pulse flooding (Hong), fever, and aversion to cold indicate Rebing (Heat Disease).
*Liu Ren Shu* says: In summer, fever, aversion to cold, headache, heavy limb/joint pain, and flooding pulse indicate Heat Disease. This is Winter Cold transformed by Summerheat. Treatment is similar to Shanghan: sweating uses Guizhi Tang; non-sweating uses Mahuang Tang; with vexation uses Da Qinglong Tang. However, summer medicines should be cool, not too warm. Guizhi/Mahuang/Da Qinglong Tangs require modification: Before Summer Solstice, add Huangqin (Scutellaria Root) half liang to Guizhi Tang; After Summer Solstice, add Zhimu (Anemarrhena Rhizome) 1 liang, Shigao (Gypsum) 2 liang, or Shengma (Cimicifuga Rhizome) half liang to Guizhi/Mahuang/Da Qinglong Tangs. Guizhi/Mahuang are hot; southern warmth differs from northwest. Using them in summer causes jaundice/rashes. If Heat Disease persists beyond 3 days with rapid pulse and pathogen in meridians, use Guizhi Shigao Tang [Cinnamon Twig and Gypsum Decoction]. Add Mahuang 1 liang to replace Ma Huang Qing Long indications. For late-onset Shanghan (March to Summer), Zhizi Shengma Tang [Gardenia and Cimicifuga Decoction] is可选. (Case: Wanli Gui Mao year, Li's son-in-law took Guizhi Tang for summer Shanghan and died instantly. Mahuang/Guizhi are for deep winter Shanghan; using them on warm diseases is inadvisable, let alone heat diseases.)
Guizhi Shigao Tang: See previous discussion. Sweating/slow pulse = Guizhi indication; No sweating/tight pulse = Mahuang/Qing Long indication.
Ingredients: Guizhi (bark removed), Huangqin (0.5 liang each); Zhizi (3 qian); Baishao (White Peony Root), Shengma, Ge Gen (Kudzu Root), Sheng Jiang (Fresh Ginger) (7.5 qian each); Shigao (crushed), Gan Cao (Roasted Licorice Root) (1 liang each). Crushed, take 5.5 qian with 1.5 cups water, boil to 0.8 cup, strain, take after meal. Stop if sweating occurs.
Zhizi Shengma Tang: Treats late-onset Shanghan (March to Summer).
Ingredients: Sheng Di Huang (Rehmannia Root) (0.5 jin chopped); Zhizi (10 pods split); Shengma (1.5 liang); Chai Hu (Bupleurum Root), Shigao (2.5 liang each). Crushed, take 5 qian with 1.5 cups water, boil to 0.8 cup, take in one dose. Repeat if unresolved.
Wu Shi says: After Summer Solstice, intense heat causes high fever, vexation/thirst, no aversion to cold—this is Heat Disease. Floating/Hong pulse indicates Taiyang; Hong/Long pulse indicates Yangming; Xuan/Shu pulse indicates Shaoyang. These Three Yang cases are treatable. Deep/Thin/Xiao/Cold feet indicate Three Yin cases, difficult to treat. Generally, Heat Disease requires strong pulse (Hong/Big/Slippery/Rapid) for treatability. Weak/small pulse is difficult. For weak constitution, use Renshen Tang [Ginseng Decoction] to support Yuan Qi; do not attack heat. For Hong pulse/body pain/high fever/no sweating/vexation, use Liushen Tang [Six-God Decoction] to induce sweat. Or Renshen Qianghuo San [Ginseng and Notopterygium Powder] plus Ge Gen, Dou Chi, Sheng Jiang. Mild cases use Shiwei Xiong Su San [Ten-ingredient Cyperus and Perilla Powder]. If complicated by summerheat, add Xiang Ru (Elsholtzia Herb) and Bian Dou (Hyacinth Bean). If complicated by internal injury/cold food stagnation/vomiting/bloating/chills, use Huoxiang Zhengqi San [Patchouli Regulating Qi Powder] plus Xiang Ru, Bian Dou, Ge Gen (named Erxiang Tang). If heat remains unresolved in Taiyang, use Renshen Qianghuo San plus Huangqin; in Yangming, Shengma Ge Gen Tang plus Huangqin; for severe heat/thirst/big pulse, Baihu Tang plus Renshen; in Shaoyang, Xiaochaihu Tang [Minor Bupleurum Decoction] modified. If complicated by summerheat, add Huanglian (Coptis Rhizome) and Xiang Ru. If heat with diarrhea/strangury/thirst, use Wuling San minus Guizhi plus Ge Gen, Huanglian, Xiang Ru, Huashi (Talcum). If exterior/interior heat with diarrhea/floating rapid pulse/strangury, use Xiaochaihu Tang combined with Siling San [Four-Ling Powder]. If unresolved or transforming, follow Shanghan protocols. Prognosis: Death in 1-2 days with diarrhea/fullness/severe heat; 3-4 days with confusion/rapid pulse; 4-5 days with heat/small pulse/cold feet; 5-6 days with no sweat/vomiting/confusion/rapid pulse; 6-7 days with black tongue base; 7-8 days with bleeding/severe heat/big pulse; 9 days with spasms/confusion. Pulse Cu/Jie/Dai/Deep/Small are difficult. No sweat with rapid pulse is death; sweat with intensified heat/rapid pulse is death.
Deficient pulse, fever, aversion to cold indicate Zhongshu (Summerheat Injury).
Treatment formulas see Miscellaneous Diseases section.
Cold calves, abdominal fullness, headache, thirst without fever indicate Shiwen (Damp-Warmth).
*Liu Ren Shu* says: Shiwen presents with cold calves, chest/abdominal fullness, sweating, headache, delirium. Caused by prior dampness injury followed by summerheat, combining damp and heat. Pulse: Exterior (Yang) Ru/Ruo (Soft/Weak), Interior (Yin) Xiao/Ji (Small/Urgent). Treat in Taiyang, do not induce sweat. Sweating causes mutism, deafness, loss of pain sensation, cyanosis, color change, called "Chong Ye" (Heavy Summerheat). Such deaths are physician-induced. Use Baihu Jia Cangzhu Tang [White Tiger plus Atractylodes Macrocephala Decoction].
Xu Xueshi says: Gui Chou year, Wang Yanlong suffered chest/neck sweating, cold calves, delirium in late summer. Pulse: Guan front Ru, Guan back Shu. Diagnosed as Shiwen (Summerheat then Dampness). Treated with Baihu Jia Renshen Tang then Baihu Jia Cangzhu Tang. Headache resolved, feet warmed, sweat stopped, cured in 3 days. Called "Zeixie" (Thief Pathogen). Question: What is Zeixie? *Nanjing* defines Five Pathogens: Real, Deficient, Correct, Minor, Thief. Thief comes from the "Non-Overcoming" source. Heart summerheat is Correct; Heart dampness is Thief (Water overcomes Fire). Most adverse. *Nanjing*: Yang Ru/Ruo is damp attacking summerheat; Yin Xiao/Ji is summerheat steaming damp. I have retained fluid retention; summer months bring sweaty calves. This medicine cures me.
Haizang says: Shiwen with little sweat uses Baihu Jia Cangzhu Tang; with much sweat uses Baihu Jia Guizhi Tang [White Tiger plus Cinnamon Twig Decoction].
Sun Taizhen says: Jiang, a wine merchant, had moist body, cold calves to knees, abdominal fullness, unconsciousness, small/weak/urgent pulses. Previous doctors used Yin-disease medicines, worsening condition. Sun used Wuling San and Baihu Tang for 10+ doses. Jiang recovered and asked for explanation. Sun said: It was summerheat injury. Initially Yang-deficient cold limbs with small pulse, mistaken for Yin disease. Wuling San drained dampness/reduced abdomen; Baihu Tang cleared heat. Yin disease causes cold calves AND arms; you only had cold calves, indicating Yang-deficient cold (not Yin-Jue ascending).
Bao Shi says: Between Start of Summer and End of Heat, Shanghan with slight chill, sweating, heavy limbs is Shiwen, treated with Cangzhu Shigao Tang [Atractylodes and Gypsum Decoction] (i.e., Baihu Jia Cangzhu Tang).
Cangzhu Shigao Tang Formula:
Cangzhu (0.5 liang), Shigao (3 qian), Zhimu (2.5 qian), Gan Cao (1 qian). Boil 1 cup water to 0.5 cup, warm drink. Indicates internal dampness, usually no thirst. If fever/flooding pulse/no sweating/thirst, heat accumulates in Upper Jiao/Chest, use Jiegeng San [Platycodon Powder] (This is Heat Disease, not Shiwen).
Jiegeng San Formula:
Bohe (Mint), Huangqin, Gan Cao, Zhizi (1 qian each); Lianqiao (2 qian); Jiegeng (3 qian). Chop, take 5 qian boiled with water and Zhu Ye (Bamboo Leaf). If constipation, add Dahuang (Rhubarb) 0.5 liang.
Deficient pulse, fever indicates Shangshu (Summerheat Injury).
Liu Chun says: Xu Xueshi states Shangshu pulse is Xuan/Xi/Kou/Chi. *Neijing*: "Cold injures Form, Heat injures Qi." Heat injures Qi, causing Qi depletion and deficient pulse. Xuan/Xi/Kou/Chi are all deficient pulses. Zhongjing considers Xuan as Yin; Zhu Gong says summerheat pulse is thin/weak. All confirm deficiency.
Summerheat syndromes include Mao (Enveloping), Shang (Injuring), and Zhong (Striking).
Dai Shi says: Severity varies. Abdominal pain/water diarrhea/stomach/intestine injury/nausea/phlegm-fluid at stomach opening = Mao Shu (Enveloping Summerheat). Use Huanglian Xiangru Yin [Coptis and Elsholtzia Drink]. Fever/headache/restlessness/prickling sensation = Heat injuring flesh layers. Use Jiedu Baihu Tang [Detoxifying White Tiger Decoction] plus Chai Hu; add Renshen if Qi deficient. Cough/chills/fever/night sweats/rapid pulse = Heat injuring Lung channel (Fire insulting Metal). This is Zhong Shu (Striking Summerheat). Use Qingfei Tang [Clear Lung Decoction], Chai Hu Tianshui San [Bupleurum and Heavenly Water Powder].
Summer: Hidden Yin Inside.
Danxi says: In summer, Yang Qi emerges to the surface; abdomen becomes empty. "Hidden Yin inside" means emptiness/deficiency, not cold. Predecessors used Dashun San [Great Smooth Powder] (warm/hot) for cooling pavilions/snow injuries, not for hidden Yin. In blazing heat, where is the cold? Sun Taizhen recommended Shengmai San [Generate Pulse Powder] in summer for deficiency. Liu Shi says: Jiegu says quiet acquisition is Zhongshu, active acquisition is Zhongre; Dongyuan says seeking coolness in halls is Zhongshu (use Dashun San), labor is Zhongre (use Cangzhu Baihu Tang). Summerheat is one Qi. Why distinguish? Wang Shi says: Summerheat is Heaven's command. Labor/hunger depletes Yuan Qi, failing to resist extreme heat, causing injury. Named Zhongshu or Zhongre, they are the same. Distinguishing by motion/rest is flawed. Zhongshu often affects laborers (deficiency allows invasion). Those seeking coolness in halls suffer cold damage (Shanghan), not summerheat. Vexation/heat is due to Yang blocked by Yin-cold, not summerheat pathogen. Treat with acrid-warm dispersants. Dashun San contains mostly Gan Cao, Gan Jiang, Xing Ren, Rou Gui (all roasted/warming). It was designed for internal heat leading to excessive drinking, spleen/stomach dampness, vomiting. Using it for "quiet" cases may fail to release exterior and increase internal vexation. Common people mistake "Yin inside" for cold and use Dashun San. Yin is not cold; it is relative emptiness. If Yin were cold, why drink water in summer? Cangzhu Baihu Tang is suitable but not universal. Modify based on syndrome. "Quiet" cases in summer are not true summerheat; distinguish them to avoid confusion.
Summerheat injuring Five Zang organs presents differently.
Chen Shi says: Summerheat entering Heart causes choking/coma; Liver causes dizziness/numbness; Spleen causes lethargy; Lung causes distension/atrophy; Kidney causes wasting-thirst. Xu Shi says: Variations are numerous, not limited to Five Zang. Constitution and severity vary. Mild cases manifest later (autumn malaria/dysentery); severe cases manifest immediately. Light can become heavy, heavy light. Depth and transmission vary. Life conditions vary. Four-season diseases are alike.
Summerheat diseases require boosting Yuan Qi.
Dongyuan says: Spleen/Stomach weakness in 6th/7th lunar months with dampness, sweating, heaviness, shortness of breath, flaccidity, dizziness indicates Kidney/Bladder exhaustion. Profuse sweating loses Jin-Ye (fluids). Third Dog Days: Geng Metal is imprisoned, Wood uncontrollable, Wind-Damp attacks joints. Ren Bladder ends at Si, Gui Kidney ends at Wu. Dampness aids heat. Sage's law: Summer requires tonification because heat damages Yuan Qi. Use Renshen, Maidong, Wuweizi to nourish Water source, drain internal fire, tonify Geng Metal, boost Yuan Qi.
Summerheat causing Wei-Jue (Flaccidity-Cold Limbs) syndromes.
Dongyuan says: Late Summer damp-heat steams, damaging Yuan Qi. Limb fatigue, spirit shortage, leg flaccidity, cold limbs morning/evening, heat afternoon. Yin/Yang/Qi/Blood deficiency. Chest fullness, joint pain, asthma, fever, vexation, yellow urine, loose stool, sweating, heaviness. Blood diseased first, Qi secondary. Dampness pulse is Hong/Huan/Chi. Treat with drying agents. Traveling in heat causes heat in Kidney, Water fails to control Fire, bone flaccidity (damp-heat Wei). Heat-Jue is Yin deficiency; Cold-Jue is Qi deficiency. Limbs hot = Heat-Jue; Limbs cold = Cold-Jue. Spleen governs limbs. Xu Shi says: This discusses summerheat patterns like Shanghan transformation. Cold injures Form; Heat injures Qi. Severe Qi deficiency leads to sudden collapse, similar to Shanghan Yin-Du toxicity. Cross-reference with Wei (Flaccidity) chapter.
Summerwind (Shufeng).
Jia Shi says: Fire controls Metal, failing to calm Wood. Spasms/unconsciousness. Floating/deficient pulse indicates Wind/Summerheat. Popularly "Summerwind," caused by Minister Fire acting. First dissolve Suhexiang Wan [Suhexiang Pill] in warm water; then Huanglian Xiangru Yin plus Qiang Huo, or Shuangjie San plus Xiang Ru.
General Principles of Treating Summerheat.
Jia Shi says: Summerheat is Minister Fire. Deficient pulse, headache, dry mouth, greasy face, sweating, fatigue, fear of back heat, coma, cholera-like vomiting/diarrhea, phlegm, abdominal pain, bloody diarrhea, jaundice, rashes. Best method: Clear Heart, promote urination. Do not promote urination if sweating heavily; use Baihu Tang. Differentiate exterior/interior: Exterior (headache/aversion to cold) use Shuangjie San plus Xiang Ru, Erxiang San, Shiwei Xiangru San; Half-exterior/half-interior (diarrhea/thirst/vomiting) use Wuling San; Severe heat/vexation use Yiyuan San. Exterior resolved/Interior heat: Banxia Jiedu Tang Shenxiong Wan. Elderly/weak with faint pulse/diarrhea/thirst/warm preference/cold limbs/unconsciousness: Zhuyeshigao Tang plus Shu Fu Zi, frozen drinks, Laifu Dan, Wuling San. Never use hot/dry drugs in summer to avoid rash/jaundice/death. Xu Shi comments: Detailed, but Suhexiang Wan for Summerwind/Minister Fire needs caution. Suhexiang Wan is for Yin-cold blockage, cold food injury, Qi stagnation, or evil invasion, not Summerwind/Minister Fire. Scholars must verify. Tao Shi says: Summerheat pulse deficient/hidden, fever, back aversion to cold, greasy face, sweating, vexation, thirst, piloerection, coma, fatigue, no body pain (differs from Shanghan). Internal/external heat, dry mouth, cold limbs, no pain: Baihu Tang. Phlegm/aversion to cold: Jupi Tang. Heat/stuffiness/no aversion to cold: Zhuyeshigao Tang. Headache/nausea/vexation/substernal discomfort/strangury: Wuling San. Downward: Xiaoshao Wan. Summerheat: Xiaochaihu Tang (Best).