《此事难知》伤暑有二∶动而伤暑，心火大盛，肺气全亏，故身脉洪大。动而火
胜者，热伤气也，辛苦人多得之，白虎加人参汤。静而伤暑，火胜金位，肺气出表，
故恶寒脉沉疾。静而湿胜者，身体重也，安乐之人多受之，白虎加苍术汤。伤暑必
自汗背寒面垢，或口热烦闷，或头疼发热，神思倦怠殊甚，暑伤气而不伤形故也。
但身体不痛，与感风寒异。宜香薷饮、香薷汤、六和汤。呕而渴者，浸冷香薷汤，
或五苓散兼吞消暑丸。呕不止者，枇杷叶散去茅根，吞来复丹。呕而痰，却暑散吞
消暑丸，或小半夏茯苓汤，或消暑饮。泻而渴，生料平胃散和生料五苓散各半帖，
名胃苓散。或理中汤加黄连，名连理汤。泻定仍渴，春泽汤，或缩脾饮。泻而腹痛
有积者，生料五苓散、藿香正气散匀各半帖。若泻虽无积，其腹痛甚，生料五苓散
加木香七分，或六和汤加木香半钱。或不加木香，止与二药煎熟去滓，调下苏合香
丸。又有不泻而腹干痛者，六和汤煎熟调苏合香丸。泻而发热者，胃苓散。泻而发
渴者，胃苓散兼进缩脾饮。泻渴兼作未透者，汤化苏合香丸，吞来复丹。或研来复
丹作末，白汤调下。已透者，香薷饮。感冒外发热者，六和汤、香薷汤、香薷饮。
身热烦者，五苓散，或香薷汤加黄连一钱。热而汗多畏风甚者，生料五苓散。热而
渴者，五苓散兼进缩脾饮。暑气攻里，热不解，心烦口干，辰砂五苓散，或香薷饮加
黄连一钱。若大渴不止，辰砂五苓散吞酒煮黄连丸。暑气攻里，腹内刺痛，小便不
通，生料五苓散加木香七钱，或止用益元散。冒暑饮酒，引暑入肠内，酒热与暑气
相并，发热大渴，小便不利，其色如血，生料五苓散去桂加黄连一钱，或五苓散去
桂吞酒煮黄连丸。暑气入肠胃，而大便艰涩不通者，加味香薷饮，仍佐以三黄丸。
暑气入心，身烦热而肿者，辰砂五苓散，或香薷饮加黄连一钱。伤暑而伤食者，其
人头疼背寒，自汗发热，畏食恶心，噫酸臭气，胸膈痞满，六和汤倍砂仁。若因暑
渴，饮食冷物，致内伤生冷，外伤暑气，亦宜此药。暑先入心者，心属南方离火，
各从其类。小肠为心之腑，利心经暑毒使由小肠中出，五苓散利小便，为治暑上剂也。
有伤于暑，因而露卧，又为冷气所入，其人自汗怯风，身痛头痛，去衣则凛，
着衣则烦，或已发热，或未发热，并宜六和汤内加扁豆、砂仁。一方用薷香，一方
用紫苏，正治已感于暑，而复外感于风寒，或内伤生冷，以藿香、紫苏兼能解表，
砂仁、扁豆兼能温中。然感暑又感冷，亦有无汗者，只宜前药。若加以感风，则断
然多汗，审是此症，宜生料五苓散，内用桂枝为佳。市井中多有此病，往往日间冒
热经营，夜间开窗眠卧，欲取清凉，失盖不觉，用药所当详审。有此症而发潮热似
疟犹未成疟者，六和汤、养胃汤各半帖，相和煎。有此症而鼻流清涕，或鼻孔热气
时出者，六和汤加川芎半钱，羌活、黄芩各七分。有因伤暑，遂极饮以冷水，致暑
毒留结心胸，精神昏愦，语音不出者，煎香薷汤化苏合香丸。若先饮冷后伤暑者，
五苓散主之。此必心下痞 ，生姜汤调服佳。或四君子汤调中亦可。中和后，或小
便不利，或茎中痛，宜蒲黄三钱，滑石五钱，甘草一钱。有因伤暑，用水沃面，或
入水洗浴，暑湿相搏，自汗发热，身重，小便不利，宜五苓散。伤暑而大汗不止，
甚则真元耗散，宜急收其汗，生料五苓散倍桂，加黄 如术之数。伤暑自汗，手足
厥冷者，煎六和汤调苏合香丸。伤暑自汗，手足时自搐搦者，谓之暑风。缘已伤于
暑，毛孔开而又邪风乘之，宜香薷饮或香薷汤，并加羌活一钱。痰盛者，六和汤半
帖和星香散半帖。暑月身痒如针刺，间有赤肿处，亦名暑风。末子六和汤和消风散
酒调服。暑风而加以吐泻交作者，六和汤、藿香正气散各半帖，加全蝎三个。
有暑毒客于上焦，胸膈痞塞，汤药至口即出，不能过关，或上气喘急，六和汤
浸冷，调入麝香少许。伏暑烦渴而多热痰者，于消暑丸中每两入黄连末二钱，名黄
连消暑丸。或二陈汤，或小半夏茯苓汤，并可加黄连一钱。暑气久而不解，遂成伏
暑，内外俱热，烦躁自汗，大渴喜冷，宜香薷饮加黄连一钱，继进白虎汤。若服药
不愈者，暑毒深入，结热在里，谵语烦渴，不欲近衣，大便秘结，小便赤涩，当用
调胃承气汤，或三黄石膏汤。时当长夏，湿热大胜，蒸蒸而炽，人感之四肢困倦，
精神短少，懒于动作，胸满气促，肢节沉疼。或气高而喘，身热而烦，心下膨痞，
小便黄而数，大便溏而频，或利出黄如糜，或如泔色。或渴或不渴，不思饮食，自
汗体重或汗少者，血先病而气不病也。其脉中得洪缓。若湿气相搏，必加之以迟
迟，病虽互换少差，其天暑湿令则一也。宜以清燥之剂治之。《内经》曰∶阳气者，
卫外而为固也。热则气泄，今暑邪干卫，故身热自汗。以黄 甘温补之为君。人参、
陈皮、当归、甘草甘微温，补中益气为臣。苍术、白术、泽泻渗利而除湿，升麻、
葛根苦甘平，善解肌热，又以风胜湿也。湿热则食不消而作痞满，故以炒曲甘辛，
青皮辛温，消食快气。肾恶燥，急食辛以润之，故以黄柏辛苦寒，借其气味，泻热
补水。虚者滋其化源，以人参、五味子、麦门冬酸甘微寒，救天暑之伤于庚金为佐，
名曰清暑益气汤。此病皆由饮食劳倦，伤其脾胃，乘天暑而病作也。但药中犯泽泻、
猪苓、茯苓、灯心、通草、木通淡味渗利小便之类，皆从时令之旺气，以泄脾胃之
客邪，而补金水之不及也。此正方已是从权而立之。若于其时病湿热脾旺之证，或
小便已数，肾肝不受邪者，若误用之，必大泻真阴，竭绝肾水，先损其两目也。复
立变证加减法于后。如心火乘脾，乃血受火邪，而不能升发阳气，伏于地中，地者
人之脾也。必用当归和血，少用黄柏以益真阴。如脾胃不足之证，须少用升麻，乃
足阳明、太阴引经之药也。使行阳道，自脾胃中右迁，少阳行春令，生万物之根蒂
也。更少加柴胡，使诸经右迁，生发阴阳之气，以滋春之和气也。如脾虚缘心火亢
盛，而乘其土也，其次肺气受邪，为热所伤，必须用黄 最多，甘草次之，人参又
次之，三者皆甘温之阳药也。脾始虚肺气先绝，故用黄 之甘温，以益皮毛之气而
闭腠理，不令自汗而损元气也。上喘气短懒言语，须用人参以补之。心火乘脾，
须用炙甘草以泻火热，而补脾胃中元气。甘草最少，恐滋满也。若脾胃之急痛，并
脾胃大虚，腹中急缩，腹皮急缩者，却宜多用。经曰∶急者缓之。若从权、必加升
麻以引之，恐左迁之邪坚盛，卒不肯退，反致项上及臀尻肉添而行阴道，故引之以
行阳道，使清气出地，右迁而上行，以和阴阳之气也。若中满者去甘草，咳甚者去
人参，口干嗌干者加干葛。如脾胃既虚，不能升浮，为阴火伤其生发之气，荣血大
亏，荣气伏于地中，阴火炽盛，日渐煎熬，血气亏少，且心包与心主血，血减则心
无所养，致使心乱而烦，病名曰 。 者心惑而烦闷不安也。是由清气不升，浊气
不降，清浊相干，乱于胸中，使周身血气逆行而乱。经云∶从下上者，引而去之。
故当加辛温、甘温之剂生阳，阳生而阴长也。或曰甘温何能生血，又非血药也。曰∶
仲景之法，血虚以人参补之，阳旺则能生阴血也。更加当归和血，又宜少加黄柏以
救肾水，盖甘寒泻热火，火减则心气得平而安也。如烦乱犹不能止，少加黄连以去
之。盖将补肾水，使肾水旺而心火自降，扶持地中阳气也。如气浮心乱，则以朱砂
安神丸镇固之，得烦减、勿再服，以防泻阳气之反陷也。如心下痞，亦少加黄连。
气乱于胸，为清浊相干，故以陈皮理之，能助阳气之升而散滞气，又助诸甘辛为用。
故长夏湿土客邪火旺，可从权加苍术、白术、泽泻，上下分消其湿热之气。湿气大
胜，主食不消化，故食减不知谷味，加炒曲以消之。复加五味子、麦门冬、人参泻
火益肺气，助秋损也。此三伏中长夏正旺之时药也。
夫脾胃虚弱，必上焦之气不足。遇夏天气热甚，损伤元气，怠惰嗜卧，四肢不
收，精神不足，两脚痿软，遇早晚寒厥，日高之后，阳气将旺，复热如火，乃阴阳
气血俱不足，故或热厥而阴虚，或寒厥而气虚。口不知味，目中溜火，而视物KT KT
无所见，小便频数，大便难而秘结、胃脘当心而痛，两胁痛，或急缩，脐下周遭如
绳束之急，甚则如刀刺，腹难舒伸，胸中闭塞，时显呕哕，或有痰嗽，口沃白沫，
舌强腰背腹皆痛，头痛时作，食不下，或食入即饱，全不思食，自汗尤甚，若阴气
覆在皮毛之上。皆天气之热助本病也。乃庚大肠、辛肺金、为热所乘而作，当先助
元气，治庚辛之不足，黄 人参汤主之。
夫脾胃虚弱，至六七月间，河涨霖雨，诸物皆润，人汗 衣，身重短气，甚则
四肢痿软，行步不正，脚欹眼黑欲倒者，此肾水与膀胱俱竭之状也。当急救之，滋
肺气以补水之上源，又使庚大肠不受邪热，不令汗大泄也。汗泄甚则亡津液，亡津
液则七神无所根据。经云∶津液相成，神乃自生。津者、庚大肠所主，三伏之义，为
庚金受囚也。若亡津液汗大泄，湿今亢甚，则清肃之气亡，燥金受囚，风木无制，
故风湿相搏，骨节烦疼，一身尽痛，亢则害，承乃制也。孙思邈曰∶五月常服五味
子，是泻丙火，补庚金大肠，益五脏之元气。壬膀胱之寒已绝于巳，癸肾水已绝于
午，今更逢湿旺，助热为邪，西方、北方之寒清绝矣。圣人立法，夏月宜补者，补
天元之真气，非补热火也，今人夏食寒是也。为热伤元气，以人参、麦门冬、五味
子生脉，脉者，元气也。人参之甘，补元气泻热火也。麦门冬之苦寒，补水之源而
清肃燥金也。五味子之酸，以泻火补庚大肠与肺金也。当此之时，无病之人，亦或
有二症，况虚损、脾胃有宿疾之人，遇此天暑，将理失所，违时伐化，必困乏无力，
懒语气短，气弱气促，似喘非喘，骨乏无力，其形如梦寐，朦朦如烟雾中，不知身
所有也，必大汗泄。若风犯汗眼皮肤，必搐项筋，皮枯毛焦，身体皆重，肢节
时有烦疼，或一身尽疼或渴或不渴，或小便黄涩，此风湿相搏也。头痛或头重，
上热壅盛，口鼻气短气促，身心烦乱，有不乐生之意，情思惨凄，此阴胜阳之极也。
病甚则传肾肝为痿厥。厥者，四肢如在火中者为热厥，四肢寒冷者为寒厥。寒厥则
腹中有寒，热厥则腹中有热，为脾主四肢故也。若肌肉濡溃，痹而不仁，传为肉痿
证，证中皆有肺疾，用药之人，当以此调之。气上冲胸，皆厥证也。痿者，四肢痿
软而无力也，其心烦冤不止。厥者、气逆也，甚则大逆，故曰厥逆。其厥痿多相类
也。于前已立人参黄 五味子麦门冬汤中，每加白茯苓二分，泽泻四分，猪苓、白
术各一分。如小便快利不黄涩者，只加泽泻二分，与二术上下分消其湿。如行步不
正，脚膝痿弱，两足欹侧，已中痿邪者，加酒洗黄柏、知母三分或五分，令二足涌
出气力。如汗大泄者，津脱也，急止之，加五味子六粒，炒黄柏五分，炒知母三分，
不令妨其食，当以意斟酌。若妨食则止，候食进再服。取三里、气街以三棱针出血。
若汗不减不止者，于三里穴下三寸上廉穴出血。禁酒湿面。
六七月之间，湿令大行，子能令母实而热旺，湿热相合而刑庚大肠，故用寒凉
以救之。燥金受湿热之邪，绝寒水生化之源，源绝则肾亏，痿厥之病大作，腰以下
痿软，瘫痪不能动矣。步行不正，两足欹侧，以清燥汤主之。
《此事难知》指出，伤暑有两种情况：一是因活动而伤暑，此时心火旺盛，肺气严重亏损，所以脉象洪大。因活动导致火气胜邪的，属于热邪损伤元气，多见于辛苦劳作之人，治疗用白虎加人参汤。二是因静坐休息时伤暑，火气克制肺金，肺气外泄，所以出现怕冷、脉象沉而疾速。因静止状态导致湿气胜邪的，身体感到沉重，多见于生活安逸之人，治疗用白虎加苍术汤。
伤暑必然伴有自汗、背部发凉、面色污垢，或者口热烦闷，或者头痛发热，精神极度倦怠，这是因为暑邪损伤元气而不损伤形体所致。但身体不痛，这与感受风寒不同。适宜使用香薷饮、香薷汤、六和汤。如果呕吐且口渴，可用浸冷的香薷汤，或者五苓散配合吞服消暑丸。如果呕吐不止，可用枇杷叶散去茅根，配合吞服来复丹。如果呕吐且有痰，可用却暑散配合吞服消暑丸，或者小半夏茯苓汤，或者消暑饮。
如果腹泻且口渴，可用生料平胃散和生料五苓散各半帖混合，名为胃苓散。或者理中汤加黄连，名为连理汤。腹泻停止后仍然口渴，可用春泽汤，或者缩脾饮。如果腹泻且腹痛有积滞，可用生料五苓散、藿香正气散各半帖混合。如果腹泻虽然没有积滞，但腹痛剧烈，可用生料五苓散加木香七分，或者六和汤加木香半钱。也可以不加木香，仅将这两种药煎熟去渣，调服苏合香丸。又有不腹泻但腹部干痛的，用六和汤煎熟调服苏合香丸。腹泻且发热的，用胃苓散。腹泻且发渴的，用胃苓散兼进缩脾饮。腹泻和口渴同时发作但未透发的，用汤剂化开苏合香丸，吞服来复丹。或者研来复丹为末，用温水调服。已经透发的，用香薷饮。感冒外感发热的，用六和汤、香薷汤、香薷饮。
身体发热烦躁的，用五苓散，或者香薷汤加黄连一钱。发热且汗多、特别怕风的，用生料五苓散。发热且口渴的，用五苓散兼进缩脾饮。暑气攻入体内，发热不退，心烦口干，用辰砂五苓散，或者香薷饮加黄连一钱。如果大渴不止，用辰砂五苓散吞服酒煮黄连丸。暑气攻入体内，腹内刺痛，小便不通，用生料五苓散加木香七钱，或者只用益元散。
冒受暑气又饮酒，使暑气进入肠道，酒热与暑气相搏结，导致发热大渴，小便不利，颜色如血，用生料五苓散去桂枝加黄连一钱，或者五苓散去桂枝吞服酒煮黄连丸。暑气进入肠胃，大便艰涩不通，用加味香薷饮，并佐以三黄丸。暑气侵入心脏，身体烦躁发热且肿胀，用辰砂五苓散，或者香薷饮加黄连一钱。
伤暑又伤食的人，会出现头痛背寒、自汗发热、畏食恶心、打嗝有酸臭气、胸膈痞满，用六和汤倍加砂仁。如果因为暑天口渴，饮食生冷之物，导致内伤生冷、外感暑气，也适宜用此药。暑气先入心的，因为心属南方离火，同类相应。小肠是心的腑，利导心经的暑毒使其从小肠排出，五苓散利小便，是治疗暑病的上剂。
有被暑邪所伤，因而露天睡觉，又被冷气侵入，其人自汗怯风，身体疼痛头痛，脱衣则凛冽，穿衣则烦热，或者已经发热，或者尚未发热，都适宜在六和汤内加扁豆、砂仁。一方用藿香，一方用紫苏，这是正治法，针对已感于暑，又外感风寒，或内伤生冷，因为藿香、紫苏兼能解表，砂仁、扁豆兼能温中。然而感暑又感冷，也有无汗的，只适宜用前面的药。如果加上感风，则肯定多汗，仔细辨证若是此症，宜用生料五苓散，其中用桂枝为佳。市井中多有此病，往往白天冒着热气经营事务，晚上开窗睡觉，想要取清凉，忘记盖被子，用药应当详细审慎。
有此症而发潮热像疟疾但尚未成疟的，用六和汤、养胃汤各半帖，混合煎服。有此症而鼻流清涕，或者鼻孔热气不时出来的，用六和汤加川芎半钱，羌活、黄芩各七分。有因伤暑，随即大量饮用冷水，导致暑毒留结心胸，精神昏愦，语音不能发出的，煎香薷汤化开苏合香丸。如果先饮冷后伤暑的，用五苓散主治。这必定有心下痞塞，用生姜汤调服较好。或者四君子汤调中也行。中和之后，如果小便不利，或者尿道疼痛，宜用蒲黄三钱，滑石五钱，甘草一钱。
有因伤暑，用水浇脸，或者入水洗浴，暑湿相搏结，自汗发热，身体沉重，小便不利，宜用五苓散。伤暑而大汗不止，甚至真元耗散，宜急收其汗，用生料五苓散倍加桂枝，加黄芪如白术的数量。伤暑自汗，手足厥冷的，煎六和汤调服苏合香丸。伤暑自汗，手足时常抽搐的，称为暑风。因为已经伤于暑，毛孔张开而又邪风乘虚而入，宜用香薷饮或香薷汤，并加羌活一钱。痰盛的，用六和汤半帖和星香散半帖。暑月身体痒如针刺，间有红肿处，也称为暑风。末子六和汤和消风散用酒调服。暑风而加上吐泻交作的，用六和汤、藿香正气散各半帖，加全蝎三个。
有暑毒客居在上焦，胸膈痞塞，汤药到口即吐出，不能过关，或者上气喘急，用六和汤浸冷，调入麝香少许。伏暑烦渴且多热痰的，在消暑丸中每两加入黄连末二钱，名为黄连消暑丸。或者二陈汤，或小半夏茯苓汤，都可以加黄连一钱。暑气久留不解，遂成伏暑，内外俱热，烦躁自汗，大渴喜冷，宜用香薷饮加黄连一钱，继进白虎汤。如果服药不愈者，暑毒深入，结热在里，谵语烦渴，不想靠近衣物，大便秘结，小便赤涩，当用调胃承气汤，或者三黄石膏汤。
时值长夏，湿热大胜，热气蒸腾炽盛，人感受它则四肢困倦，精神短少，懒于动作，胸满气促，肢节沉疼。或者气高而喘，身热而烦，心下膨痞，小便黄而频数，大便溏而频繁，或者拉出黄色如糜状，或者像米泔水色。或者渴或不渴，不思饮食，自汗体重或者汗少的，是血先病而气未病。其脉象中得洪缓。如果湿气相搏结，必加上迟脉，病虽然互换稍有差异，但天暑湿令是一样的。宜以清燥之剂治疗。《内经》说：阳气者，卫护体表而固密。热则气泄，现在暑邪干扰卫气，所以身热自汗。以黄芪甘温补之为君药。人参、陈皮、当归、甘草甘微温，补中益气为臣药。苍术、白术、泽泻渗利而除湿，升麻、葛根苦甘平，善于解肌热，又以风能胜湿。湿热则食物不消化而作痞满，故以炒曲甘辛，青皮辛温，消食快气。肾恶燥，急食辛以润之，故以黄柏辛苦寒，借其气味，泻热补水。虚者滋其化源，以人参、五味子、麦门冬酸甘微寒，救天暑对庚金的伤害为佐药，名为清暑益气汤。此病皆由饮食劳倦，损伤脾胃，乘天暑而发病。但药中犯泽泻、猪苓、茯苓、灯心、通草、木通淡味渗利小便之类，都是顺从时令的旺气，以泄脾胃的客邪，而补金水的不足。此正方已是权变而立之法。如果在当时病湿热脾旺的证，或者小便已频数，肾肝不受邪的，如果误用之，必大泻真阴，竭绝肾水，先损其两目。
随后立变证加减法如下。如心火乘脾，乃血受火邪，而不能升发阳气，伏于地中，地者人之脾也。必用当归和血，少用黄柏以益真阴。如脾胃不足之证，须少用升麻，乃是足阳明、太阴引经之药也。使行阳道，自脾胃中右迁，少阳行春令，生万物之根蒂也。更少加柴胡，使诸经右迁，生发阴阳之气，以滋春之和气也。如脾虚缘心火亢盛，而乘其土也，其次肺气受邪，为热所伤，必须用黄芪最多，甘草次之，人参又次之，三者皆甘温之阳药也。脾始虚肺气先绝，故用黄芪之甘温，以益皮毛之气而闭腠理，不令自汗而损元气也。上喘气短懒言语，须用人参以补之。心火乘脾，须用炙甘草以泻火热，而补脾胃中元气。甘草最少，恐滋满也。若脾胃之急痛，并脾胃大虚，腹中急缩，腹皮急缩者，却宜多用。经曰：急者缓之。若从权、必加升麻以引之，恐左迁之邪坚盛，卒不肯退，反致项上及臀尻肉添而行阴道，故引之以行阳道，使清气出地，右迁而上行，以和阴阳之气也。若中满者去甘草，咳甚者去人参，口干嗌干者加干葛。
如脾胃既虚，不能升浮，为阴火伤其生发之气，荣血大亏，荣气伏于地中，阴火炽盛，日渐煎熬，血气亏少，且心包与心主血，血减则心无所养，致使心乱而烦，病名曰“心惑”。心惑者心惑而烦闷不安也。是由清气不升，浊气不降，清浊相干，乱于胸中，使周身血气逆行而乱。经云：从下上者，引而去之。故当加辛温、甘温之剂生阳，阳生而阴长也。或曰甘温何能生血，又非血药也。曰：仲景之法，血虚以人参补之，阳旺则能生阴血也。更加当归和血，又宜少加黄柏以救肾水，盖甘寒泻热火，火减则心气得平而安也。如烦乱犹不能止，少加黄连以去之。盖将补肾水，使肾水旺而心火自降，扶持地中阳气也。如气浮心乱，则以朱砂安神丸镇固之，得烦减、勿再服，以防泻阳气之反陷也。如心下痞，亦少加黄连。气乱于胸，为清浊相干，故以陈皮理之，能助阳气之升而散滞气，又助诸甘辛为用。故长夏湿土客邪火旺，可从权加苍术、白术、泽泻，上下分消其湿热之气。湿气大胜，主食不消化，故食减不知谷味，加炒曲以消之。复加五味子、麦门冬、人参泻火益肺气，助秋损也。此三伏中长夏正旺之时药也。
夫脾胃虚弱，必上焦之气不足。遇夏天气热甚，损伤元气，怠惰嗜卧，四肢不收，精神不足，两脚痿软，遇早晚寒厥，日高之后，阳气将旺，复热如火，乃阴阳气血俱不足，故或热厥而阴虚，或寒厥而气虚。口不知味，目中溜火，而视物KT KT无所见，小便频数，大便难而秘结、胃脘当心而痛，两胁痛，或急缩，脐下周遭如绳束之急，甚则如刀刺，腹难舒伸，胸中闭塞，时显呕哕，或有痰嗽，口沃白沫，舌强腰背腹皆痛，头痛时作，食不下，或食入即饱，全不思食，自汗尤甚，若阴气覆在皮毛之上。皆天气之热助本病也。乃庚大肠、辛肺金、为热所乘而作，当先助元气，治庚辛之不足，黄芪人参汤主之。
夫脾胃虚弱，至六七月间，河涨霖雨，诸物皆润，人汗浃衣，身重短气，甚则四肢痿软，行步不正，脚欹眼黑欲倒者，此肾水与膀胱俱竭之状也。当急救之，滋肺气以补水之上源，又使庚大肠不受邪热，不令汗大泄也。汗泄甚则亡津液，亡津液则七神无所根据。经云：津液相成，神乃自生。津者、庚大肠所主，三伏之义，为庚金受囚也。若亡津液汗大泄，湿今亢甚，则清肃之气亡，燥金受囚，风木无制，故风湿相搏，骨节烦疼，一身尽痛，亢则害，承乃制也。孙思邈曰：五月常服五味子，是泻丙火，补庚金大肠，益五脏之元气。壬膀胱之寒已绝于巳，癸肾水已绝于午，今更逢湿旺，助热为邪，西方、北方之寒清绝矣。圣人立法，夏月宜补者，补天元之真气，非补热火也，今人夏食寒是也。为热伤元气，以人参、麦门冬、五味子生脉，脉者，元气也。人参之甘，补元气泻热火也。麦门冬之苦寒，补水之源而清肃燥金也。五味子之酸，以泻火补庚大肠与肺金也。当此之时，无病之人，亦或有之二症，况虚损、脾胃有宿疾之人，遇此天暑，将理失所，违时伐化，必困乏无力，懒语气短，气弱气促，似喘非喘，骨乏无力，其形如梦寐，朦朦如烟雾中，不知身所有也，必大汗泄。若风犯汗眼皮肤，必搐项筋，皮枯毛焦，身体皆重，肢节时有烦疼，或一身尽疼或渴或不渴，或小便黄涩，此风湿相搏也。头痛或头重，上热壅盛，口鼻气短气促，身心烦乱，有不乐生之意，情思惨凄，此阴胜阳之极也。病甚则传肾肝为痿厥。厥者，四肢如在火中者为热厥，四肢寒冷者为寒厥。寒厥则腹中有寒，热厥则腹中有热，为脾主四肢故也。若肌肉濡溃，痹而不仁，传为肉痿证，证中皆有肺疾，用药之人，当以此调之。气上冲胸，皆厥证也。痿者，四肢痿软而无力也，其心烦冤不止。厥者、气逆也，甚则大逆，故曰厥逆。其厥痿多相类也。于前已立人参黄芪五味子麦门冬汤中，每加白茯苓二分，泽泻四分，猪苓、白术各一分。如小便快利不黄涩者，只加泽泻二分，与二术上下分消其湿。如行步不正，脚膝痿弱，两足欹侧，已中痿邪者，加酒洗黄柏、知母三分或五分，令二足涌出气力。如汗大泄者，津脱也，急止之，加五味子六粒，炒黄柏五分，炒知母三分，不令妨其食，当以意斟酌。若妨食则止，候食进再服。取三里、气街以三棱针出血。若汗不减不止者，于三里穴下三寸上廉穴出血。禁酒湿面。
六七月之间，湿令大行，子能令母实而热旺，湿热相合而刑庚大肠，故用寒凉以救之。燥金受湿热之邪，绝寒水生化之源，源绝则肾亏，痿厥之病大作，腰以下痿软，瘫痪不能动矣。步行不正，两足欹侧，以清燥汤主之。
*Cishi Nan Zhi* (Difficulties in This Matter) states that heatstroke (Shang Shu, injury by summer-heat) has two types: one is injury by summer-heat due to activity, where Heart Fire is excessive and Lung Qi is severely deficient, resulting in a洪大 (Hong Da, large and surging) pulse. When activity causes Fire to prevail, it is Heat damaging Qi, commonly seen in hardworking laborers; treat with Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). The other is injury by summer-heat during rest, where Fire overcomes Metal (Lung), causing Lung Qi to escape outward, leading to aversion to cold and a 沉疾 (Chen Ji, deep and rapid) pulse. When stillness causes Dampness to prevail, the body feels heavy, commonly seen in those living in comfort; treat with Baihu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodis Rhizoma).
Injury by summer-heat inevitably presents with spontaneous sweating, coldness of the back, and a grimy complexion, or oral heat with vexation and stuffiness, or headache with fever, and extreme mental fatigue. This is because Summer-heat damages Qi but not Form. However, the body does not ache, which differs from contracting Wind-Cold. Suitable formulas include Xiangru Yin (Elsholtzia Decoction), Xiangru Tang (Elsholtia Decoction), and Liuhe Tang (Six Harmonies Decoction). If there is vomiting with thirst, use Xiangru Tang cooled in ice water, or Wuling San (Five-Ingredient Powder with Poria) taken together with Xiaoshu Wan (Summer-Heat Relieving Pill). If vomiting persists, use Pipaye San (Loquat Leaf Powder) minus Maogen (Imperatae Rhizoma), taken with Laifu Dan (Reviving Return Pellet). If vomiting occurs with phlegm, use Queshu San (Summer-Heat Repelling Powder) taken with Xiaoshu Wan, or Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction), or Xiaoshu Yin (Summer-Heat Relieving Drink).
If diarrhea occurs with thirst, mix half a portion of Shengliao Pingwei San (Raw Material Pingwei Powder) and half a portion of Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria), named Weiling San (Stomach-Limit Powder). Or use Lizhong Tang (Regulate the Middle Decoction) added with Huanglian (Coptidis Rhizoma), named Lianli Tang (Coptis and Licorice Decoction). If diarrhea stops but thirst remains, use Chunze Tang (Spring Spring Decoction) or Suopi Yin (Spleet-Spleen Drink). If diarrhea occurs with abdominal pain and accumulation, mix half a portion of Shengliao Wuling San and half a portion of Huoxiang Zhengqi San (Patchouli Qi-Regulating Powder). If diarrhea occurs without accumulation but with severe abdominal pain, use Shengliao Wuling San added with Muxiang (Aucklandiae Radix) 7 qian, or Liuhe Tang added with Muxiang 0.5 qian. Alternatively, do not add Muxiang; simply boil the two medicines, strain, and take with Suhexiang Wan (Styrax Pill). In cases of no diarrhea but dry abdominal pain, use Liuhe Tang boiled and taken with Suhexiang Wan. For diarrhea with fever, use Weiling San. For diarrhea with thirst, use Weiling San combined with Suopi Yin. For simultaneous diarrhea and thirst that has not yet fully manifested, dissolve Suhexiang Wan in decoction and swallow Laifu Dan. Or grind Laifu Dan into powder and take with warm water. If it has fully manifested, use Xiangru Yin. For external contraction with fever, use Liuhe Tang, Xiangru Tang, or Xiangru Yin.
For body heat with vexation, use Wuling San, or Xiangru Tang added with Huanglian 1 qian. For heat with profuse sweating and severe aversion to wind, use Shengliao Wuling San. For heat with thirst, use Wuling San combined with Suopi Yin. When Summer-heat attacks the interior, heat does not resolve, accompanied by mental vexation and dry mouth, use Chencha Wuling San (Cinnabar Five-Ingredient Powder with Poria) or Xiangru Tang added with Huanglian 1 qian. If extreme thirst persists, use Chencha Wuling San swallowed with Jiuzhu Huanglian Wan (Wine-Boiled Coptis Pill). When Summer-heat attacks the interior causing stabbing abdominal pain and urinary obstruction, use Shengliao Wuling San added with Muxiang 7 qian, or solely Yiyuan San (Benefit Origin Powder).
When exposed to summer-heat and drinking alcohol, summer-heat enters the intestines; wine heat combines with summer-heat, causing fever, extreme thirst, and difficult urination with urine colored like blood. Use Shengliao Wuling San minus Guizhi (Cinnamon Twig) added with Huanglian 1 qian, or Wuling San minus Guizhi swallowed with Jiuzhu Huanglian Wan. When summer-heat enters the stomach and intestines causing difficult and obstructed defecation, use Jiawei Xiangru Yin (Modified Elsholtia Drink) assisted by Sanhuang Wan (Three-Yellow Pill). When summer-heat enters the Heart, causing body vexation, heat, and swelling, use Chencha Wuling San or Xiangru Tang added with Huanglian 1 qian.
For injury by summer-heat combined with food stagnation, symptoms include headache and back coldness, spontaneous sweating and fever, aversion to eating and nausea, belching with sour foul odor, and chest/epigastric fullness. Treat with Liuhe Tang doubled with Sharen (Amomi Fructus). If caused by drinking cold items due to summer-heat thirst, leading to internal injury from cold/raw food and external injury from summer-heat, this medicine is also suitable. Since summer-heat first enters the Heart, and the Heart belongs to South Li Fire, it follows its own kind. The Small Intestine is the Fu organ of the Heart; promoting urination helps expel Heart channel summer-heat toxins via the Small Intestine. Wuling San promotes urination and is a superior treatment for summer-heat.
If injured by summer-heat and sleeping outdoors, further invaded by cold air, the patient has spontaneous sweating, fear of wind, body pain, and headache. Removing clothes causes shivering, while wearing them causes vexation. Whether fever has appeared or not, all should use Liuhe Tang added with Bidou (Dolichos Lablab) and Sharen. One formula uses Huoxiang (Pogostemonis Herba), another uses Zisu (Perillae Folium). This is the standard treatment for having contracted summer-heat and then externally contracting Wind-Cold, or internally injuring with cold/raw food, as Huoxiang and Zisu can release the exterior, while Sharen and Bidou can warm the middle. However, contracting summer-heat and cold may also result in no sweating; only the previous medicines are suitable. If Wind is added, there will definitely be profuse sweating. Carefully verifying this syndrome, use Shengliao Wuling San, preferably with Guizhi. This disease is common among townspeople, who often work in the heat during the day and sleep with windows open at night seeking coolness, forgetting to cover themselves. Medication must be carefully considered.
For this syndrome presenting with tidal fever resembling malaria but not yet formed malaria, mix half a portion of Liuhe Tang and half a portion of Yangwei Tang (Nourish Stomach Decoction) and decoct together. For this syndrome with clear nasal discharge or hot air occasionally coming from the nostrils, use Liuhe Tang added with Chuanxiong (Ligustici Chuanxiong Rhizoma) 0.5 qian, Qianghuo (Notopterygii Rhizoma et Radix) and Huangqin (Scutellariae Radix) each 7 fen. If caused by drinking cold water excessively after summer-heat injury, causing summer-heat toxin to knot in the chest and heart, leading to mental confusion and inability to speak, decoct Xiangru Tang to dissolve Suhexiang Wan. If cold drink preceded summer-heat injury, use Wuling San as the main treatment. This likely involves epigastric stuffiness; taking it with Shengjiang Tang (Fresh Ginger Decoction) is good. Or Sijunzi Tang (Four Gentlemen Decoction) to regulate the middle is also acceptable. After regulation, if urination is difficult or urethral pain occurs, use Puhuang (Typhae Pollen) 3 qian, Huashi (Talcum) 5 qian, and Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian.
If facial washing or bathing in water after summer-heat injury causes summer-heat and dampness to struggle, resulting in spontaneous sweating, fever, heaviness, and difficult urination, use Wuling San. For summer-heat injury with continuous profuse sweating, even depleting True Yuan, urgently stop the sweating using Shengliao Wuling San doubled with Guizhi, adding Huangqi (Astragali Radix) in the same amount as Baizhu (Atractylodis Macrocephalae Rhizoma). For summer-heat injury with spontaneous sweating and cold extremities, decoct Liuhe Tang to take with Suhexiang Wan. For summer-heat injury with spontaneous sweating and occasional convulsions of hands and feet, it is called Shufeng (Summer-Wind). Because the summer-heat has injured the pores, opening them, and evil wind takes advantage. Use Xiangru Yin or Xiangru Tang, adding Qianghuo 1 qian. For abundant phlegm, mix half a portion of Liuhe Tang and half a portion of Xingxiang San (Star Fragrance Powder). During summer months, body itching like needle pricks with intermittent red swelling is also named Shufeng. Take Mozi Liuhe Tang (Powdered Six Harmonies Decoction) mixed with Xiaofeng San (Wind-Expelling Powder) with wine. For Shufeng with alternating vomiting and diarrhea, mix half a portion of Liuhe Tang and half a portion of Huoxiang Zhengqi San, adding three Quanxie (Scorpio).
When summer-heat toxin lodges in the Upper Jiao, causing chest/sternum stuffiness where medicine vomits immediately upon reaching the mouth, or upper asthma and急促 (rapid breathing), use Liuhe Tang cooled, mixing in a small amount of Shexiang (Moschus). For latent summer-heat with vexation, thirst, and much heat-phlegm, add 2 qian of Huanglian powder to every liang of Xiaoshu Wan, named Huanglian Xiaoshu Wan. Or Erchen Tang (Two-Aged Decoction), or Xiao Banxia Fuling Tang, all can add Huanglian 1 qian. If summer-heat lingers unresolved, becoming latent summer-heat, with internal and external heat, vexation, spontaneous sweating, extreme thirst preferring cold, use Xiangru Tang added with Huanglian 1 qian, followed by Baihu Tang (White Tiger Decoction). If medication fails, summer-heat toxin has penetrated deeply, knotting heat in the interior, with delirium, vexation, thirst, aversion to clothing, constipation, and dark scanty urine. Use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) or Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction).
During late summer, Damp-Heat prevails, steaming and blazing. People contracting it suffer from limb fatigue, shortness of spirit, laziness in movement, chest fullness and shortness of breath, and heavy joint pain. Or high Qi with panting, body heat with vexation, epigastric distension, yellow frequent urination, loose frequent stools, or passage of yellow mush-like stool or rice-water color. Thirst may or may not be present; appetite is lost; spontaneous sweating with heaviness or little sweating indicates Blood is diseased first while Qi is not. The pulse is Hong (large) and Huan (moderate). If Dampness struggles, a Chi (slow) pulse is added. Although the disease varies slightly, the heavenly heat and damp command are the same. Treat with clearing-drying agents. *Neijing* states: "Yang Qi guards the exterior and secures." Heat causes Qi to leak; now Summer-heat evil disturbs Wei Qi, hence body heat and spontaneous sweating. Use Huangqi (Astragali Radix) sweet and warm as Sovereign to tonify. Renshen (Ginseng Radix), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) are sweet and slightly warm, tonifying the middle and benefiting Qi as Ministers. Cangzhu (Atractylodis Rhizoma), Baizhu, and Zexie (Alismatis Rhizoma) are penetrating and draining to remove dampness; Shengma (Cimicifugae Rhizoma) and Gegen (Puerariae Lobatae Radix) are bitter and sweet, neutral, excellent at resolving muscle heat, using Wind to overcome Dampness. Damp-Heat prevents digestion causing fullness, so use Chaoqu (Fried Mass Medicated with Yeast) sweet and pungent, Qingpi (Citri Reticulatae Pericarpium Viride) pungent and warm to digest food and move Qi. The Kidney dislikes dryness; eat pungent urgently to moisten it. Thus, use Huangbai (Phellodendri Cortex) bitter, pungent, and cold, borrowing its aroma to drain heat and nourish Water. For deficiency, nourish the source of transformation using Renshen, Wuweizi (Schisandrae Fructus), and Maidong (Ophiopogonis Radix) sour, sweet, and slightly cold to rescue Geng Metal from heavenly summer-heat injury as Assistants. Named Qingshu Yiqi Tang (Clear Summer-heat Benefit Qi Decoction). This disease arises from diet and overwork injuring the Spleen and Stomach, acting on heavenly summer-heat. Ingredients like Zexie, Zhuling (Polyporus), Fuling (Poria), Dengxincao (Junci Medulla), Tongcao (Tetrapanacis Medulla), Mutong (Akebiae Caulis) are bland and draining for urination, following the prosperous qi of the season to drain guest pathogens from the Spleen/Stomach and supplement the insufficiency of Metal and Water. This main formula is established as a temporary measure. If in that season the disease is Damp-Heat with Spleen prosperity, or urination is already frequent, and Kidney/Liver are not affected by evil, misuse will greatly drain True Yin and exhaust Kidney Water, damaging the eyes first.
Subsequently, modification methods for changed syndromes are established. If Heart Fire attacks the Spleen, Blood receives Fire evil and cannot ascend Yang Qi, which lies buried in the Earth (the Human Spleen). Must use Danggui to harmonize Blood, and use a little Huangbai to benefit True Yin. For Spleen/Stomach insufficiency, use a little Shengma, which is the guiding herb for Foot Yangming and Taiyin. It moves along the Yang pathway, migrating right from the Spleen/Stomach; Shaoyang performs the Spring command, generating the roots of all things. Add a little Chaihu (Bupleuri Radix) to make all meridians migrate right, generating Yin and Yang Qi to nourish the harmony of Spring. If Spleen deficiency is due to Hyperactive Heart Fire attacking Earth, and subsequently Lung Qi is affected by Heat, Huangqi must be used most, Gancao next, Renshen least. All three are sweet and warm Yang herbs. As Spleen becomes deficient, Lung Qi is cut off first; thus, use Huangqi's sweet warmth to benefit Qi of skin/hair and close Couli (pores), preventing spontaneous sweating from damaging Original Qi. For upper asthma, shortness of breath, and reluctance to speak, must use Renshen to tonify. For Heart Fire attacking Spleen, use Zhi Gancao (Honey-fried Licorice) to drain Fire heat and tonify Original Qi in the Spleen/Stomach. Gancao should be minimal to avoid causing fullness. For urgent Spleen/Stomach pain and great Spleen/Stomach deficiency with abdominal cramping and skin retraction, use more. Classic says: "For urgency, use relaxation." If acting temporarily, must add Shengma to guide it, fearing left-migrating evil is strong and stubborn, causing flesh on neck and buttocks to increase and follow the Yin pathway; thus guide it to follow the Yang pathway, making Clear Qi emerge from earth, migrate right and ascend, to harmonize Yin and Yang Qi. If middle fullness, remove Gancao; if severe cough, remove Renshen; if dry mouth/throat, add Gan Ge (Puerariae Radix).
If Spleen/Stomach is deficient and cannot ascend/floating, Yin Fire damages its generating Qi, Ying Blood is greatly deficient, Ying Qi lies buried in the earth, Yin Fire blazes, daily simmering, Blood and Qi become scarce. Since Pericardium and Heart govern Blood, reduced Blood means Heart lacks nourishment, causing Heart chaos and vexation, named "Xin Huo" (Heart Confusion). Xin Huo means mental confusion and restless unease. This is because Clear Qi does not ascend, Turbid Qi does not descend, Clear and Turbid interfere, chaotic in the chest, causing whole-body Blood and Qi to reverse and chaotically flow. Classic says: "From below ascending, guide and remove it." Thus, add acrid-warm and sweet-warm agents to generate Yang; when Yang generates, Yin grows. Someone asks: How can sweet-warm generate Blood? It is not a Blood herb. Answer: Zhang Zhongjing's method: for Blood deficiency, use Renshen to tonify; when Yang is vigorous, it can generate Yin Blood. Add Danggui to harmonize Blood, and appropriately add a little Huangbai to save Kidney Water, as sweet-cold drains Fire heat; when Fire reduces, Heart Qi calms and settles. If vexation/chaos still cannot stop, add a little Huanglian to remove it. This aims to tonify Kidney Water, making Kidney Water vigorous so Heart Fire naturally descends, supporting Earth's Yang Qi. If Qi floats and Heart is chaotic, use Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) to stabilize it; once vexation reduces, do not take again, to prevent draining Yang Qi from sinking. If epigastric stuffiness, also add a little Huanglian. Qi chaotic in chest due to Clear/Turbid interference, so use Chenpi to regulate it, assisting Yang Qi ascent and dispersing stagnant Qi, aiding various sweet/pungent herbs. Thus, in late summer Damp Earth with guest pathogen and Fire prosperity, temporarily add Cangzhu, Baizhu, Zexie to distribute Damp-Heat up and down. When Dampness greatly prevails, food is not digested, appetite decreases and grain taste is unknown; add fried Qu to digest. Further add Wuweizi, Maidong, Renshen to drain Fire and benefit Lung Qi, assisting Autumn damage. This is medicine for the peak time of Late Summer during the Three Fu days.
When Spleen/Stomach is weak, Upper Jiao Qi is insufficient. Encountering intense summer heat damages Original Qi, leading to lethargy and desire to lie down, limbs not gathering, insufficient spirit, weak legs. Encountering cold厥 (Jue, reversal/cold extremities) in morning/evening, after midday when Yang Qi is about to prosper, heat returns like fire. This is insufficiency of Yin/Yang and Blood/Qi, hence either Heat Jue with Yin deficiency, or Cold Jue with Qi deficiency. Mouth loses taste, eyes see sparks, vision is blurry ("KT KT" likely refers to blurred/vague vision), frequent urination, difficult constipated stool, epigastric pain at the pit of stomach, hypochondriac pain or sudden retraction, umbilical area tight like rope binding, severe stabbing pain, abdomen difficult to stretch, chest closed, occasional retching, phlegm cough, white foam in mouth, stiff tongue, back/waist/abdomen pain, intermittent headache, inability to eat or feeling full immediately after eating, total loss of appetite, severe spontaneous sweating as if Yin Qi covers skin/hair. All are heavenly heat assisting the root disease. It is Geng Large Intestine and Xin Lung Metal attacked by heat. First assist Original Qi, treat Geng/Xin insufficiency; Huangqi Renshen Tang (Astragalus and Ginseng Decoction) is main.
When Spleen/Stomach is weak, in June/July, rivers flood and rain falls, all things are moist, people sweat soaking clothes, body heavy and short of breath, even limbs flaccid, walking unsteady, feet tilting, eyes black wanting to fall. This is exhaustion of Kidney Water and Bladder. Urgently rescue it, nourish Lung Qi to supplement Water's upper source, and prevent Geng Large Intestine from receiving evil heat, preventing profuse sweating. Profuse sweating loses Jin Ye (Body Fluids); losing Jin Ye leaves Seven Spirits without basis. Classic says: "Jin Ye form each other, Shen (Spirit) naturally arises." Jin is governed by Geng Large Intestine. The meaning of Three Fu is Geng Metal being imprisoned. If Jin Ye is lost and sweat profuses, Dampness becomes hyperactive, Clear/Pure Qi is lost, Dry Metal is imprisoned, Wind/Wood has no control, hence Wind-Damp struggles, bone/joint vexation/pain, whole body pain. Hyperactivity causes harm, succession brings control. Sun Simiao said: "Take Wuweizi regularly in May; this drains Bing Fire, supplements Geng Metal Large Intestine, benefits Five Zang Original Qi." Ren Bladder cold is extinct at Si hour, Gui Kidney Water is extinct at Wu hour. Now encountering prosperous Dampness, assisting Heat as evil, Western/Northern cold clarity is extinct. Sages legislate: Summer month supplementation should supplement Tian Yuan (Heavenly Origin) True Qi, not supplement Hot Fire; today people eating cold in summer is wrong. Heat damages Original Qi; use Renshen, Maidong, Wuweizi to generate Mai (Pulse/Vessel), which is Original Qi. Renshen's sweetness tonifies Original Qi and drains hot fire. Maidong's bitterness/cold supplements Water source and clears/dries Dry Metal. Wuweizi's acidity drains fire and supplements Geng Large Intestine and Lung Metal. At this time, even healthy people may have these two syndromes, let alone those with deficiency damage or chronic Spleen/Stomach disease. Encountering this heavenly heat, mismanagement violates seasonal transformation, surely leading to fatigue, weakness, reluctance to speak, shortness of breath, weak/rapid Qi, panting-like-but-not-panting, bone fatigue, form like dreaming, hazy like in smoke, unaware of body, surely profuse sweating. If Wind invades sweaty skin, neck tendons convulse, skin dries, hair burns, body heavy, joints occasionally vexation/pain, or whole body pain, thirst or no thirst, yellow/scanty urine, this is Wind-Damp struggle. Headache or head heaviness, upper heat congestion, mouth/nose shortness of breath, mind/body vexation, unwillingness to live, sad mood, this is Yin overcoming Yang extreme. Severe disease transmits to Kidney/Liver as Wei Jue (Flaccidity-Reversal). Jue means limbs in fire is Heat Jue, limbs cold is Cold Jue. Cold Jue has cold in abdomen, Heat Jue has heat in abdomen, because Spleen governs limbs. If muscles rot/ulcerate, numbness and insensitivity, transmitting to Rou Wei (Muscle Flaccidity) syndrome, all syndromes involve Lung disease; medicators should adjust accordingly. Qi rushing to chest is all Jue syndromes. Wei means limbs flaccid and weak, heart vexation/unbearable continues. Jue means Qi rebellion, severe is Great Rebellion, hence Jue Ni (Reversal Counterflow). Jue and Wei are often similar. In the previously established Renshen Huangqi Wuweizi Maidong Tang, add Baifuling (White Poria) 2 fen, Zexie 4 fen, Zhuling and Baizhu each 1 fen. If urination is smooth and not yellow/scanty, only add Zexie 2 fen, with Two Zhu (Atractylodes) to distribute Dampness up/down. If walking unsteady, knee/leg flaccid, feet tilting, already infected with Wei evil, add Jiu Xi Huangbai (Wine-washed Phellodendron) and Zhimu (Anemarrhenae Rhizoma) 3 or 5 fen, to make two feet surge with strength. If sweat profuses, it is Jin Tu (Fluid Collapse), urgently stop it, add six Wuweizi grains, fried Huangbai 5 fen, fried Zhimu 3 fen, do not hinder food intake, decide by intent. If hindering food, stop, wait for food intake then resume. Bleed Sanli (ST36) and Qijie (ST29) with three-edged needle. If sweat does not reduce/stop, bleed Shanglian (ST34) 3 cun below Sanli. Prohibit alcohol, dampness, and wheat/noodles.
In June/July, Damp command greatly acts, Son makes Mother solid and Heat prospers, Damp-Heat combines and punishes Geng Large Intestine, thus use cold/cool to rescue it. Dry Metal receives Damp-Heat evil, cutting off Han Water generation source; source cut leads to Kidney deficiency, Wei Jue disease greatly erupts, lower waist flaccid, paralyzed unable to move. Walking unsteady, feet tilting, treat with Qingzao Tang (Clear Dryness Decoction).