（一名暑湿兼寒）
【因】先受湿。继受暑。复感暴寒而触发。亦有外感暑湿。内伤生冷而得者。夏月
最多。初秋亦有。
【证】暑湿兼外寒者。初起即头痛发热。恶寒无汗。身重而痛。四肢倦怠。手足逆
冷。小便已。洒洒然毛耸。但
前板齿燥。气粗心烦。甚则喘而嘘气。继则寒热似疟。湿重则寒多热少。暑重则热多寒
少。胃不欲食。胸腹痞满。便溏或泄。溺短黄热。舌苔先白后黄。带腻或糙。暑湿兼内
寒者。一起即头痛身重。凛凛畏寒。神烦而躁。肢懈胸满。腹痛吐泻。甚则手足俱冷。
或两胫逆冷。小便不利。或短涩热。舌苔白滑。或灰滑。甚则黑滑。或淡白。
【脉】左弦细而紧。右迟而滞者。此由避暑纳凉。暑反为寒与湿所遏。周身阳气不
得伸越。张洁古所谓静而得之。因暑自致之病也。若脉沉紧。甚则沉弦而细者。此由引
饮过多。及恣食瓜果生冷。脾胃为寒湿所伤。张路玉所谓因热伤冷。而为夏月之内伤寒
病也。
【治】暑湿兼外寒。法当辛温解表。芳淡疏里。藿香正气汤加西香薷（钱半）、光
杏仁（三钱）为主。微汗出。外寒解。即以大橘皮汤。温化其湿。湿去则暑无所根据而
去矣。若犹余暑未净者。前方去苍术、官桂。加山栀、连翘、青蒿等整肃之。暑湿兼内
寒。法当温化生冷。辛淡渗湿。胃苓汤加公丁香（九支）、广木香（磨汁、两匙冲）、为
主。寒水去。吐泻止。即以香砂二陈汤。温运胃阳。阳和而暑湿渐从火化。改用大橘皮汤
。去桂术、加山栀、黄芩、茵陈、青蒿子等清化之。
【秀按】此夏月之杂感证也。外感多由于先受暑湿。后冒风雨之新寒。《内经》所谓生
于阳者。得之风雨寒暑是也。内伤多由于畏热却暑。浴冷卧风。及过啖冰瓜所致。《内
经》所谓生于阴者。得之饮食居处是也。乃暑湿病之兼证夹证。非伤暑湿之本证也。凡
暑为寒湿所遏。生冷所郁。俞氏方法。稳而惬当。与前哲所立香薷饮加减五方。及大顺
散。冷香饮子。浆水散等剂。意虽相同。而选药制方。尤鲜流弊。后学当遵用之。
【廉勘】夏月伤暑。最多兼挟之证。凡暑轻而寒湿重者。暑即寓于寒湿之中。为寒
湿吸收而同化。故散寒即
所以散暑。治湿即所以治暑。此惟阳虚多湿者为然。俞氏方法。固为正治。若其人阴虚
多火。暑即寓于火之中。纵感风寒。亦为客寒包火之证。初用益元散加葱豉薄荷。令其
微汗。以解外束之新寒。继用叶氏薷杏汤。（西香薷七分、光杏仁、飞滑石、丝瓜叶
各三钱、丝通草钱半、白蔻末五分冲。）轻宜凉淡以清利之。余邪不解者。则以吴氏清
络饮。（鲜银花、鲜扁豆花、鲜丝瓜皮、鲜竹叶心、鲜荷叶边、西瓜翠衣各二钱）。
辛凉芳香以整肃之。若其间暑湿并重者。酌用张氏苍术白虎汤加减。（杜苍术一钱拌研
石膏六钱、蔻末五分拌研滑石六钱、知母三钱、草果仁四分、荷叶包陈仓米三钱、卷心
竹叶二钱。）其他变证。可仿热证例治。至瓜果与油腻杂进。多用六和汤加减。亦不敢
率投姜附也。
【荣斋按】何廉臣先生说∶“暑为湿遏，初起邪在气分，即当分别湿多热多。湿多
者，治以轻开肺气为主，肺主一身之气，气化则湿自化，即有兼邪，亦与之俱化。湿气
弥漫，本无形质，宜用体轻而味辛淡者治之。辛如杏仁、蔻仁、半夏、浓朴、藿梗，
淡如苡仁、通草、茯苓、猪苓、泽泻之类；启上闸，开支河，导湿下行以为出路，湿去
气通，布津于外，自然汗解。若暑重于湿者，湿从火化，火必就燥，则生地、石斛，却
为善后之要药。”（录自《全国名医验案类编》）
（又名暑湿兼寒证）
【病因】先感受湿邪，继而感受暑邪，再因暴感寒邪而诱发。也有因外感暑湿，内伤生冷饮食而致病者。夏季最为多见，初秋时节亦有发生。
【症状】暑湿兼外感寒邪者，发病初期即出现头痛、发热、恶寒、无汗，身体沉重且疼痛，四肢倦怠无力，手足逆冷。小便排完后，感觉皮肤粟起发冷。仅见前板齿干燥，气粗心烦，严重时喘息并伴有嘘气声。随后出现寒热往来，状如疟疾。湿邪重则恶寒多而发热少；暑邪重则发热多而恶寒少。胃纳不佳，胸腹部痞闷胀满，大便溏薄或泄泻，小便短少、黄赤且有热感。舌苔先白后黄，带有腻象或粗糙。
暑湿兼内伤寒邪者，发病初期即头痛、身体沉重，凛凛畏寒，神志烦扰且躁动不安，肢体懈怠，胸部满闷，腹痛伴呕吐泄泻，严重时手足俱冷，或仅有两小腿逆冷。小便不利，或短涩有热感。舌苔白滑，或灰滑，严重时黑滑，或呈淡白色。
【脉象】左手脉弦细而紧，右手脉迟而滞涩的，这是由于避暑纳凉，导致暑邪反被寒湿所遏制，周身阳气不得舒展升发。正如张洁古所说，属于“静而得之”，是因暑自致的病证。若脉象沉紧，甚至沉弦而细的，这是由于饮水过多，以及恣意食用瓜果生冷食物，导致脾胃受到寒湿损伤。正如张路玉所说，属于因热伤冷，而为夏季之内伤寒病。
【治法】暑湿兼外感寒邪，治法应当用辛温药解表，用芳香淡味药疏理里气。以藿香正气汤加西香薷（一钱半）、光杏仁（三钱）为主方。待微微出汗，外寒解除后，随即改用大橘皮汤，温化体内湿邪。湿邪去除，则暑邪无所依附而随之而去。如果仍有残余暑热未清，前方去掉苍术、官桂，加入山栀、连翘、青蒿等药物进行清理整顿。
暑湿兼内伤寒邪，治法应当温化生冷，用辛淡药渗湿。以胃苓汤加公丁香（九枚）、广木香（磨汁，两匙冲服）为主方。寒水去，吐泻止，随即改用香砂二陈汤，温运胃阳。阳气调和，则暑湿逐渐从火化，改用大橘皮汤，去掉桂枝、白术，加入山栀、黄芩、茵陈、青蒿子等药物清热化湿。
【秀按语】这是夏季的杂感证候。外感多由于先受暑湿，后又冒犯风雨新寒。《内经》所谓“生于阳者，得之风雨寒暑”即是此理。内伤多由于畏惧炎热躲避暑气，洗冷水澡卧于风中，以及过食冰镇瓜果所致。《内经》所谓“生于阴者，得之饮食居处”即是此理。这乃是暑湿病的兼证和夹证，并非伤暑湿的本证。凡是暑为寒湿所遏，或被生冷所郁，俞氏的方法稳妥恰当。与前哲所立的香薷饮加减五方，及大顺散、冷香饮子、浆水散等方剂，立意虽相同，但在选药制方上，尤其少有流弊。后学者应当遵用。
【廉勘语】夏季伤暑，最多兼挟其他证候。凡是暑邪轻而寒湿重的，暑邪就寓于寒湿之中，与寒湿吸收而同化。所以散寒就是散暑，治湿就是治暑。这只有对于阳虚多湿体质的人才是这样。俞氏的方法是正治法。如果是阴虚多火体质，暑邪就寓于火之中，即使感受风寒，也是客寒包火的证候。初期用益元散加葱豉薄荷，令其微微出汗，以解除外束的新寒。继用叶氏薷杏汤（西香薷七分、光杏仁、飞滑石、丝瓜叶各三钱、丝通草一钱半、白蔻末五分冲服），宜用轻清凉淡之品以清利之。余邪不解者，则用吴氏清络饮（鲜银花、鲜扁豆花、鲜丝瓜皮、鲜竹叶心、鲜荷叶边、西瓜翠衣各二钱），用辛凉芳香之品以清理整顿。如果其间暑湿并重者，酌情使用张氏苍术白虎汤加减（杜苍术一钱拌研石膏六钱、蔻末五分拌研滑石六钱、知母三钱、草果仁四分、荷叶包陈仓米三钱、卷心竹叶二钱）。其他变证，可仿照热证例治疗。至于瓜果与油腻食物混杂进食，多用六和汤加减，也不敢贸然投用姜、附等大热之药。
【荣斋按语】何廉臣先生说：“暑为湿遏，初起邪在气分，即当分别湿多还是热多。湿多者，治以轻开肺气为主，肺主一身之气，气化则湿自化，即使有兼夹邪气，也与之俱化。湿气弥漫，本无形质，宜用体轻而味辛淡的药物治之。辛味如杏仁、蔻仁、半夏、浓朴、藿梗，淡味如苡仁、通草、茯苓、猪苓、泽泻之类；启上闸，开支河，导湿下行以为出路，湿去气通，布津于外，自然汗解。若暑重于湿者，湿从火化，火必就燥，则生地、石斛，却为善后之要药。”（录自《全国名医验案类编》）
(Also known as Summerheat-Dampness with Cold)
[Etiology] First, dampness is contracted; subsequently, summerheat is contracted; then, it is triggered by a sudden exposure to cold. There are also cases where the disease arises from external contraction of summerheat and dampness combined with internal injury caused by raw and cold food and drink. This occurs most frequently in summer and also in early autumn.
[Symptoms] In cases of summerheat-dampness with external cold, at the onset, there is headache, fever, aversion to cold, absence of sweating, heaviness and pain in the body, lassitude of the four limbs, and cold extremities. After urination, one feels chilly with gooseflesh. Only the anterior teeth appear dry, accompanied by coarse breathing, irritability, and in severe cases, panting with sighing. Subsequently, alternating chills and fever occur, resembling malaria. When dampness is predominant, chills exceed heat; when summerheat is predominant, heat exceeds chills. There is poor appetite, stuffiness and fullness in the chest and abdomen, loose stools or diarrhea, and short, yellow, hot urine. The tongue coating is initially white and turns yellow later, appearing greasy or rough.
In cases of summerheat-dampness with internal cold, at the onset, there is headache, bodily heaviness, distinct aversion to cold, mental restlessness and agitation, limb flaccidity, chest fullness, abdominal pain with vomiting and diarrhea. In severe cases, all four extremities are cold, or only the lower legs are cold. Urination is difficult, or scanty, astringent, and hot. The tongue coating is white and slippery, or gray and slippery; in severe cases, black and slippery, or pale white.
[Pulse] If the left pulse is wiry, fine, and tight, and the right pulse is slow and stagnant, this results from seeking coolness during summer, causing summerheat to be suppressed by cold and dampness, preventing the yang qi of the whole body from extending and rising. As Zhang Jiegu stated, this belongs to "acquired while resting," a disease caused by summerheat itself. If the pulse is deep and tight, or even deep, wiry, and fine, this results from excessive drinking and indulging in melons and raw/cold foods, injuring the spleen and stomach with cold and dampness. As Zhang Luyu stated, this is due to cold injury amidst heat, constituting an internal cold disease of summer.
[Treatment] For summerheat-dampness with external cold, the method should be to release the exterior with acrid-warm herbs and disperse the interior with aromatic and bland herbs. Use Huoxiang Zhengqi Tang (Agastache Powder for Regulating the Middle) as the main formula, added with Xiangru (Moslae Herba, 1.5 qian) and Xingren (Armeniacae Semen Amarum, 3 qian). Wait for slight sweating to resolve the external cold, then immediately switch to Dajupi Tang (Large Tangerine Peel Decoction) to warm and transform the dampness. Once the dampness is removed, the summerheat loses its basis and dissipates. If residual summerheat remains, remove Cangzhu (Atractylodis Rhizoma) and Guigui (Cinnamomi Ramulus) from the previous formula, and add Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), and Qinghao (Artemisiae Annuae Herba) to clear and regulate.
For summerheat-dampness with internal cold, the method should be to warm and transform raw/cold substances and use acrid-bland herbs to leach out dampness. Use Weiling Tang (Weiling Decoction) as the main formula, added with Dingxiang (Caryophylli Flos, 9 pieces) and Muxiang (Aucklandiae Radix, ground into juice, 2 chi mixed). Once the cold water is eliminated and vomiting/diarrhea stop, switch to Xiangsha Erchen Tang (Aucklandia and Amomum Two-Aged Peel Decoction) to warm and transport stomach yang. When yang qi harmonizes, summerheat and dampness gradually transform via fire; switch to Dajupi Tang, removing Guizhi (Cinnamomi Ramulus) and Baizhu (Atractylodis Macrocephalae Rhizoma), and adding Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Yinchen (Artemisiae Scopariae Herba), and Qinghaosuzi (Artemisiae Annuae Fructus) to clear and transform.
[Commentary by Xiu] This is a miscellaneous contraction syndrome of summer. External contractions mostly result from first contracting summerheat-dampness, then being exposed to new cold from wind and rain. This corresponds to the *Neijing* saying: "Those born from Yang are acquired from wind, rain, cold, and summerheat." Internal injuries mostly result from fearing heat and avoiding summerheat, bathing in cold water, lying in the wind, and overeating ice-cold melons. This corresponds to the *Neijing* saying: "Those born from Yin are acquired from diet and dwelling." These are concurrent and complicated syndromes of summerheat-dampness diseases, not the primary syndromes of summerheat-dampness injury. Whenever summerheat is suppressed by cold-dampness or depressed by raw/cold foods, Yu's methods are stable and appropriate. Although the intent is similar to the five formulas modified from Xiangru Yin (Mosla Decoction) established by earlier sages, as well as Dashun San (Dashun Powder), Lengxiang Yin (Cold Fragrant Decoction), and Jiangshui San (Grain Water Powder), the selection of herbs and formulation design has fewer adverse effects. Later students should follow these methods.
[Commentary by Lian] Summerheat injury in summer most often involves complicated syndromes. When summerheat is light and cold-dampness is heavy, summerheat resides within cold-dampness and assimilates with it. Therefore, dispersing cold is equivalent to dispersing summerheat, and treating dampness is equivalent to treating summerheat. This applies only to those with yang deficiency and abundant dampness. Yu's methods are indeed the correct treatment. However, if the person has yin deficiency and abundant fire, summerheat resides within fire. Even if wind-cold is contracted, it constitutes a syndrome of "guest cold wrapping fire." Initially, use Yiyuan San (Yiyuan Powder) plus Congchi Bohe (Scallion, Fermented Soybean, and Mentha) to induce slight sweating and resolve the newly constrained external cold. Subsequently, use Ye's Xiangru-Xingren Tang (Xiangru-Armeniacae Decoction) [Xiangru (0.7 qian), Xingren, Feihushi (Talcum), Siguye (Luffae Folium) each 3 qian, Sitongcao (Tetrapanacis Medulla) 1.5 qian, Baokoufen (Amomi Fructus Rotundus Powder) 0.5 qian mixed]. Use light, cool, and bland herbs to clear and promote diuresis. If residual pathogens remain unresolved, use Wu's Qingluo Yin (Clear Collaterals Decoction) [Xianyinhuaj (Lonicerae Japonicae Flos), Xianbiandouhua (Dolichoris Flos), Xiansigua pi (Luffae Pericarpium), Xianzhuyexin (Bambusae Folium Heart), Xianheyebian (Nelumbinis Folium Margin), Xiguancuiyi (Citrullae Exocarpium) each 2 qian]. Use acrid-cool and aromatic herbs to regulate and clear. If summerheat and dampness are both heavy, use Zhang's Cangzhu Baihu Tang (Atractylis-Baihu Decoction) modified [Du Cangzhu (1 qian) mixed with Yan Shigao (6 qian), Koufen (0.5 qian) mixed with Yan Feihushi (6 qian), Zhimu (3 qian), Caoguoren (0.4 qian), Chen Cangmi (3 qian) wrapped in Lotus Leaf, Juanxin Zhuye (2 qian)]. Other transformed syndromes can be treated according to heat syndrome examples. Regarding the mixed intake of melons and greasy foods, Liuhe Tang (Six-Harmony Decoction) modified is mostly used; one dare not rashly administer Jiang (Zingiberis Rhizoma) and Fu (Aconiti Lateralis Preparata Root).
[Commentary by Rongzhai] Mr. He Lianchen stated: "When summerheat is constrained by dampness, and the pathogen is in the Qi level at the onset, one must distinguish whether dampness or heat is predominant. If dampness is predominant, treatment focuses on lightly opening Lung Qi. Since the Lung governs the Qi of the whole body, when Qi transforms, dampness naturally transforms; even if there are concurrent pathogens, they transform together. Dampness pervades without form or substance; thus, herbs that are light in nature and acrid-bland in flavor should be used. Acrid herbs such as Xingren (Armeniacae Semen Amarum), Kourén (Amomi Fructus Rotundus), Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Huogeng (Pogostemonis Herba); bland herbs such as Yiren (Coicis Semen), Tongcao (Tetrapanacis Medulla), Fuling (Poria), Zhuling (Polyporus), and Zexie (Alismatis Rhizoma); open the upper sluice, branch off rivers, guide dampness downward as an exit route. When dampness leaves and Qi flows freely, fluids are distributed externally, and sweating resolves naturally. If summerheat is heavier than dampness, dampness transforms via fire, and fire tends toward dryness; thus, Shengdi (Rehmanniae Radix) and Shihu (Dendrobii Caulis) become essential herbs for subsequent care." (Recorded from *Compilation of Verified Cases of Famous Physicians Nationwide*)