凡人三四月，天气乍暑，腠理乍开，内气不胜其散，而为神昏、发热、体倦、不思食之
症，谓
之注夏，世医论之多矣。至于七八月间，暑气初收，新凉乍来，腠理乍闭，而内气久经夏汗
外泄，其力孱弱，不能自充，多见肺气下陷，呼吸短促不足之象，继则连暑气、凉气、湿气
一齐吸受皮腠之内，发为 热、恶寒、体重肢倦、饮食无味、口渴不欲饮诸症。此与注夏之
病，正相对待∶一为阴虚，天气乍开，而力不足于开也；一为阳虚，天气乍合，而力不足于
合也。世医论之者少，惟张石顽《医通》劳倦门有之。吾名之以“注秋”，而录其文曰∶脾
胃虚，则怠惰嗜卧，四肢不收，时值秋燥令行，湿热少退，体重节痛，口干舌燥，饮食无味
，不欲食，食不消，大便不调，小便频数，兼肺病洒淅恶寒，惨惨不乐，而色槁不和，乃阳
气不伸故也，升阳益胃汤。又曰∶劳役辛苦，肾中阴火沸腾，后因脱衣，或沐浴，歇息阴凉
处所，其阴火不行，还归皮肤，腠理极虚无阳，被风阴凉所遏，以此表虚，不任风寒，与外
感恶寒相似，其症少气短促，懒于言语，困弱无力，不可同外感治，补中益气加柴、苏、羌
活，甚者加桂枝，最当。此条虽不言秋令，而风与阴凉，非秋气乎?故乍凉见证，每多如此
。后条较前条尤重者，为凉气乍至，尤觉有猝不及防之势也。
又按∶注夏一病，前人有指为三四月乍暑之时，即见此证者；有指为长夏六月暑湿交蒸
之时
，而见此证者。窃谓二者当并有之。如乍暑见此证，盛夏未有不加甚者也；盛暑见此证，初
夏未有不先兆者也。且病名注夏，本统夏令三月而言。其病由于阴虚，不任疏散，自是夏令
之月，无日不然，而其机总发动于初夏，与初秋为一开一合之对待，故以初夏见证为当也。
但时有初盛，即病有微甚耳!亦有初夏见证，至盛夏转精神清爽者，此阳气不足，经络伏有
寒湿，初时阳力不能伸达，非如阴虚者内气先已不固，不胜天气之再散也。其证多见烦 躁
扰，不似注夏之怠惰少气也，是又注夏之别一证矣。戴元礼以七月初凉见证为注夏，殊觉名
义未协，吾故创“注秋”之说也。
凡是到了三四月间，天气突然变热，腠理（皮肤毛孔）骤然张开，体内的正气难以承受这种耗散，从而出现神志昏沉、发热、身体疲倦、不想吃东西等症状，这被称为“注夏”，世间的医生对此论述很多。至于七八月间，暑气开始收敛，新的凉意突然袭来，腠理骤然闭合，而体内的正气经过整个夏天的汗出外泄，力量已经孱弱，无法自我充盈，常常表现为肺气下陷，呼吸短促不足的现象。随后，暑气、凉气、湿气一齐侵入皮腠之内，引发身热、恶寒、身体沉重四肢倦怠、饮食无味、口渴但不想喝水等各种症状。这与“注夏”的病机正好相对待：一个是阴虚，天气骤然开放，而体力不足以应对这种开放；一个是阳虚，天气骤然闭合，而体力不足以应对这种闭合。世间医生对此论述较少，只有张石顽在《医通》的劳倦门中有记载。我将此病命名为“注秋”，并摘录其原文如下：“脾胃虚弱，就会怠惰嗜睡，四肢无力收持，正值秋季燥气当令，湿热稍退，身体沉重关节疼痛，口干舌燥，饮食无味，不想进食，食物不消化，大便不调，小便频数，兼有肺病引起的洒淅恶寒，心情凄惨不乐，面色枯槁不和，这是阳气不能伸展的缘故，用升阳益胃汤。”又说：“因劳役辛苦，肾中阴火沸腾，后来脱衣，或沐浴，在阴凉处休息，那阴火不得运行，返还归于皮肤，腠理极度空虚而无阳气，被风凉之气所遏制，因此表虚，不能耐受风寒，与外感引起的恶寒相似，其症状是少气短促，懒于言语，困弱无力，不可当作外感来治疗，可用补中益气汤加柴胡、紫苏、羌活，严重的加桂枝，最为恰当。”这一条虽然没提秋季，但风和凉气，不就是秋气吗？所以乍凉时出现的证候，大多如此。后一条比前一条更重的原因，在于凉气突然到来，尤其觉得有猝不及防的态势。
另外按语：关于“注夏”这一病，前人有的指为在三四月突然炎热之时就出现此证；有的指为在长夏六月暑湿交蒸之时出现此证。我认为这两种情况应当都存在。如果在突然炎热时就见此证，盛夏时节没有不加重的；如果在盛夏见此证，初夏时节没有不先兆现的。而且病名“注夏”，本来统括夏令三个月而言。此病由于阴虚，不能耐受疏散，自然是在夏令月份，天天如此，但其发病机制总发动于初夏，与初秋构成一开一合的对待关系，所以以初夏出现证候为恰当。只是时令有初起和旺盛之分，即病情有轻微和严重之别！也有在初夏出现证候，到了盛夏反而精神清爽的，这是因为阳气不足，经络中潜伏有寒湿，起初阳气之力不能伸展到达，不像阴虚者体内正气先已不固，不能承受天气再次发散那样。其证多见烦躁扰攘，不像注夏那样怠惰少气，这又是注夏的另一类证候了。戴元礼将七月初凉时出现的证候称为注夏，我觉得名义上不太协调，所以我创立了“注秋”的说法。
In the third and fourth months, when the weather suddenly becomes hot, the *Couli* (pores of the skin) suddenly open. The internal Qi cannot withstand this dispersion, leading to symptoms such as mental confusion, fever, body fatigue, and loss of appetite. This is called "Zhu Xia" (Summer-Attending Disease). Many physicians in the world have discussed it. However, during the seventh and eighth months, when the summer heat begins to recede and a new coolness suddenly arrives, the *Couli* suddenly close. The internal Qi, having been leaked out through sweating throughout the summer, is weak and unable to replenish itself. It often manifests as sinking of Lung Qi, with shortness of breath and insufficiency. Subsequently, summer heat, coolness, and dampness are all absorbed into the *Couli*, causing symptoms such as fever, aversion to cold, heavy body, limb fatigue, tastelessness in food, thirst without desire to drink. This stands in exact opposition to the disease of "Zhu Xia": one is Yin deficiency, where the weather suddenly opens but the strength is insufficient for opening; the other is Yang deficiency, where the weather suddenly closes but the strength is insufficient for closing. Few physicians discuss this. Only Zhang Shiweng mentions it in the section on Labor Fatigue in his *Yi Tong* (General Treatise on Medicine). I name it "Zhu Qiu" (Autumn-Attending Disease) and record its text as follows: "When Spleen and Stomach are deficient, there is lethargy and a desire to lie down, limbs are not held firm. When the autumn dryness command prevails and damp-heat slightly retreats, the body feels heavy and joints painful, mouth and tongue are dry, food tastes bland, there is no desire to eat, food does not digest, bowel movements are irregular, urination is frequent. Accompanied by Lung disease manifesting as shivering aversion to cold, miserable unhappiness, and sallow, discordant complexion, this is due to Yang Qi not extending. Use Sheng Yang Yi Wei Tang (Spleen-Boosting Decoction)." It also says: "Due to labor and hardship, Yin fire in the Kidneys boils. Later, after removing clothes, bathing, or resting in a cool place, that Yin fire fails to circulate and returns to the skin. The *Couli* are extremely empty lacking Yang, obstructed by wind and coolness. Thus, the exterior is deficient and cannot bear wind-cold, resembling aversion to cold from external contraction. Symptoms include shortness of breath, reluctance to speak, weakness and lack of strength. It must not be treated as an external contraction. Use Bu Zhong Yi Qi Tang (Middle-Boosting Qi-Supplementing Decoction) plus Chai Hu (Bupleuri Radix), Zi Su (Perillae Folium), Qiang Huo (Notopterygii Rhizoma et Radix). In severe cases, add Guizhi (Cinnamomi Ramulus), which is most appropriate." Although this passage does not mention the autumn season, are wind and coolness not autumnal Qi? Therefore, manifestations appearing with sudden coolness are often like this. The latter case is more severe than the former because the sudden arrival of coolness feels particularly unanticipated.
Furthermore: Regarding "Zhu Xia," some predecessors refer to the time of sudden heat in the third and fourth months when these symptoms appear; others refer to the time of humid-heat steaming in the sixth month of Long Summer (Central Summer). I believe both should exist. If these symptoms appear during sudden heat, they will inevitably worsen in midsummer; if they appear in midsummer, there will inevitably be precursors in early summer. Moreover, the name "Zhu Xia" generally refers to the three months of the summer season. Since the disease stems from Yin deficiency and inability to tolerate dispersal, it naturally occurs daily during the summer months, but its mechanism always activates in early summer, forming an opposition of opening and closing with early autumn. Therefore, it is appropriate to consider early summer manifestations as the standard. However, timing varies between initial onset and peak, meaning the illness varies in severity. There are also cases where symptoms appear in early summer but the patient feels refreshed and clear-headed in midsummer. This is due to Yang insufficiency and latent cold-dampness in the meridians; initially, Yang power cannot extend and reach, unlike Yin deficiency where internal Qi is already insecure and cannot withstand the weather's repeated dispersion. Such cases often show irritability and disturbance, unlike the lethargy and shortness of breath seen in Zhu Xia. This is another variant of Zhu Xia. Dai Yuanli referred to manifestations in early July coolness as Zhu Xia, which seems semantically inconsistent. Hence, I created the theory of "Zhu Qiu."