（一名伏暑兼寒。通称伏暑晚发。）
【因】夏伤于暑。被湿所遏而蕴伏。至深秋霜降及立冬前后。为外寒搏动而触发。
邪伏膜原而在气分者。病浅而轻。邪舍于营而在血分者。病深而重。
【证】邪伏膜原。外寒搏束而发者。初起头痛身热。恶寒无汗。体痛肢懈。脘闷恶
心。口或渴或不渴。午后较
重。胃不欲食。大便或秘或溏。色如红酱。溺黄浊而热。继则状如疟疾。但寒热模糊。不
甚分明。或皮肤隐隐见疹。或红或白。甚或但热不寒。热甚于夜。夜多谵语。辗转反侧
。烦躁无奈。渴喜冷冻饮料。或呕或呃。天明得汗。身热虽退。而胸腹之热不除。日日如是
。速则三四候即解。缓则五七候始除。舌苔初则白腻而浓。或满布如积粉。继则由白转
黄。甚则转灰转黑。或糙或干。或焦而起刺。或燥而开裂。此为伏暑之实证。多吉少凶。若
邪舍于营。外寒激动而发者。一起即寒少热多。日轻夜重。头痛而晕。目赤唇红。面垢
齿燥。心烦恶热。躁扰不宁。口干不喜饮。饮即干呕。咽燥如故。肢虽厥冷。而胸腹灼
热如焚。脐间动气跃跃。按之震手。男则腰痛如折。先有梦遗。或临病泄精。女则少腹
酸痛。带下如注。或经水不应期而骤至。大便多秘。或解而不多。或溏而不爽。肛门如
灼。溺短赤涩。剧则手足螈 。昏厥不语。或烦则狂言乱语。静则郑声独语。舌色鲜红
起刺。别无苔垢。甚则深红起裂。或嫩红而干光。必俟其血分转出气分。苔始渐布薄黄
。及上罩薄苔粘腻。或红中起白点。或红中夹黑苔。或红中夹黄黑起刺。此为伏暑之虚
证。多凶少吉。其他变证。兼寒者暑邪内郁。则成 疟。或间一日而发。或间二日而发
。总多寒轻而热重。终则瘅疟而无寒。夹积者暑毒下陷。则成赤痢。或黄脓白涕。或
夹青汁黑垢。总多稠粘而无粪。终则下多而亡阴。
【脉】左弦紧。右沉滞。此《内经》所谓夏伤于暑。秋必 疟者是也。实则有正疟
类疟之殊。皆暑湿伏邪。至秋后被风寒新邪引动而发也。若左弦数。右弦软。此《内经
》所谓逆夏气则伤心。内舍于营。奉收者少。冬至重病是也。皆内经所论伏暑内发。
及伏暑晚发之明文也。
【治】邪伏膜原而在气分。先以新加木贼煎。辛凉微散以解外。外邪从微汗而解。
暂觉病退。而半日一日
之间。寒虽轻而热忽转重。此蕴伏膜原之暑湿。从中而作。固当辨其所传而药之。尤
必辨其暑与湿孰轻孰重。传胃而暑重湿轻者。则用新加白虎汤加连翘、牛蒡。辛凉透发
。从疹 而解。传二肠则伏邪根据附糟粕。即用枳实导滞汤。苦辛通降。从大便而解。
解后。暂用蒿芩清胆汤。清利三焦。使余邪从小便而解。然每有迟一二日。热复作。苔
复黄腻。伏邪层出不穷。往往经屡次缓下。再四清利。而伏邪始尽。邪虽尽。而气液两伤
。终以竹叶石膏汤去石膏。加西洋参、鲜石斛、鲜茅根、青蔗汁、甘凉清养以善后。传脾而湿重暑轻者。先用大橘
皮汤加茵陈、木通。温化清渗。使湿热从小便而泄。然脾与胃
以膜相连。湿在胃肠之外。热郁在胃肠之中。其湿热粘腻之伏邪。亦多与肠中糟粕相搏
。蒸作极粘腻臭秽之溏酱矢。前方酌加枳实导滞丸、更衣丸等缓下之。必俟宿垢下至
五六次或七八次。而伏邪始尽。邪既尽。而身犹暮热早凉者。阳陷入阴。阴分尚有伏热
也。可用清燥养营汤。加鳖血柴胡（八分）、生鳖甲（五钱）、青蒿脑（钱半）、地骨
皮（五钱）、清透阴分郁热。使转出阳分而解。解后。则以七鲜育阴汤。（鲜生地五钱、
鲜石斛四钱、鲜茅根五钱、鲜稻穗二支、鲜雅梨汁、鲜蔗汁各两瓢冲、鲜枇杷叶去毛、
炒香、三钱）。滋养阴液以善后。若邪舍于营而在血分。先与加减葳蕤汤。加青蒿脑、
粉丹皮。滋阴宣气。使津液外达。微微汗出以解表。继即凉血清营以透邪。轻则导赤
清心汤。重则犀地清络饮。二方随证加减。若已痉厥并发者。速与犀羚三汁饮。清火熄
风。开窍透络。定其痉以清神识。若神识虽清。而夜热间有谵语。舌红渐布黄腻。包络
痰热未净者宜清肃。玳瑁郁金汤去紫金片。加万氏牛黄丸（二颗、药汤调下）口燥咽干
。舌干绛而起裂。热劫液枯者宜清滋。清燥养营汤去新会皮。加鲜石斛、熟地露、甘蔗
汁。心动而悸。脉见结代。舌淡红而干光。血枯气怯者宜双补。复
脉汤加减。冲气上逆。或呃或厥。或顿咳气促。冲任脉搏。舌胖嫩圆大。阴竭阳厥者宜
滋潜。坎气潜龙汤主之。亦有凉泻太过。其人面白唇淡。肢厥便泄。气促自汗。脉沉细
或沉微。舌淡红而无苔。气脱阳亡者宜温补。附子理中汤。加原麦冬、五味子救之。
【廉勘】春夏间伏气温热。秋冬间伏暑晚发。其因虽有伤寒伤暑之不同。而其蒸
变为伏火则一。故其证候疗法。大致相同。要诀在先辨湿燥。次明虚实。辨得真方可下
手。俞公此论。颇有妙旨。耐人研究。后贤如王孟英。论伏气之治。亦语语精实。大旨
谓伏气温病。自里出表。乃先从血分而后达于气分。故起病之初。往往舌润而无苔垢。
但察其脉 。或弦或数。口未渴而心烦恶热。即宜投以清解营阴之药。迨邪从气分而化
。苔始渐布。然后再清其气分可也。伏邪重者。初起即舌绛咽干。甚有肢冷脉伏之假象
。亟宜大清阴分伏邪。继必浓腻黄浊之苔渐生。此伏邪与新邪先后不同处。更有邪伏深
沉。不能一齐外出者。纵治之得法。而苔退舌淡之后。逾一二日。舌复干绛。苔复黄燥
。正如抽蕉剥茧。层出不穷。不比外感温暑。由卫及气。自营而血也。秋冬伏暑。证势
轻浅者。邪伏膜原。深沉者亦多如此。苟阅历不多。未必知其曲折乃尔也。此真阅历有
得之言欤。然金针虽度。奈粗工只知新感伤寒。不知伏气温暑。羌苏荆防。随手乱投。
不知汗为心之液。恣用辛温燥烈药。强发其汗。则先伤其津液。涸其汗源。汗何能出。
汗不出。反益病。往往发 谵语。衄血喘满。昏迷闷乱。发痉发厥。变证百病。目击
心伤。石顽老人曰。世人只知辛温药能发汗。不知辛凉药亦能发汗。华岫云曰。辛凉开
肺。便是汗剂。故余治伏暑内发。新凉外束。轻则用益元散加葱豉薄荷。重则用叶氏荷杏
石甘汤加葱豉。皆以辛凉泄卫法解外。外解已。而热不罢。伏暑即随汗而发。必先审其
上中下三焦。气营血三分随证用药。盖暑湿内留。多潜伏于三焦膜络之间。外与皮肉相
连。内与脏腑相关。伏暑传膜外溃。从皮肉而排泄者。气分病
多。入络内陷。从脏腑而中结者。营分血分病多。阴分病亦不少。凡病在上焦气分者。
酌与薛氏五叶芦根汤加味。（杜藿香叶。苏佩兰叶、苏薄荷叶、霜桑叶、炒香枇杷叶、鲜
卷心竹叶、青箬叶、活水芦笋、鲜冬瓜子、荷花露。）宣上焦以清肃肺气。若在上焦营
分者。酌与叶氏犀角地黄汤加味。（犀角尖、鲜生地、银花、连翘、广郁金、鲜石菖蒲
、鲜大青、粉丹皮、竹叶卷心、鲜茅根、野菰根。亦可重用生玳瑁代犀角）。清上焦以
凉透心营。若邪犯包络。舌色纯绛鲜泽者。前汤调下安宫牛黄丸。舌罩一层垢浊薄苔者
。调下《局方》至宝丹。芳香宣窍以清包络。病在中焦气分者。酌与王氏连朴饮加味。
（川连、川朴、焦栀、香豉、仙半夏、水节根、石菖蒲、枳实、条芩）。苦降辛通以清
胃气。若在中焦血分者。酌与吴氏养营承气汤加减。（鲜生地、生白芍、老紫草、白知
母、小枳实、真川朴、生锦纹酒浸汁、鲜茅根。）凉血泻火以保胃液。病在下焦气分者
。酌与桂苓甘露饮加减。（官桂、赤苓、猪苓、泽泻、滑石、石膏、寒水石、小青皮。
）辛淡降泄以清化肾气。若在下焦阴分血室者。酌与章氏青蒿鳖甲汤加减。（青蒿脑、
生鳖甲、归须、新绛、细生地、东白薇、银胡、地骨皮、鲜茅根、来复丹。虚谷治热入
血室、邪结血分、长热不退、夜多谵语、左关脉沉涩、服二三剂后、夜即安睡至晓、畅
解小便、色深碧、稠如胶浆、谵语止、热即退、历验、较吴氏青蒿鳖甲煎、效尤速。）
透络热以清镇血海。若在阴分精室者。酌与陶氏逍遥汤加减。（西洋参、知母、川柏、
韭白、 鼠矢、青竹皮、秋石水炒槐蕊、滑石、生甘细梢、 裆灰。肾茎及子宫痛甚者
、再加杜牛膝、当门子。）逐败精以整肃髓热。善后之法。则一以滋养阴液。整肃余热
为主。如叶氏加减复脉汤。（北沙参、龙牙燕、陈阿胶、吉林参、麦冬、大生地、生白
芍、清炙草、白毛石斛、鲜茅根。）及甘露饮加西参蔗浆汁。往往得育阴垫托。从中下
焦血分复还气分。阴分转出阳分。少腹部及两腰部。发白 黑疹而解。惟病在中下焦胃
肠。夹食积者最多。每用陆氏润字丸。磨荡而缓下之。或用枳实导滞丸。消化而轻逐之
。此皆治伏暑晚发。博采众长之疗法也。然素心谨慎。选药制
方。大旨以轻清灵稳为主。以近今膏粱体。柔脆居多。故于去病之时。不得不兼顾其虚
也。
【荣斋按】本节（伏暑伤寒）俞氏指出“邪伏膜原，外寒搏束而发为实证，邪舍于
营，外寒激动而发为虚证。”治疗方面∶把在膜原气分的伏邪，区分“传胃而暑重湿轻
，传脾而湿重暑轻。”的不同病型，订出不同的治法；把“邪舍于营而在血分“的病型
，另立一种治法。何氏则分析上中下三焦，气、营、血三分，随证用药，较俞氏治法更
灵活；他自己也承认是∶“博采众长之疗法。”然而，他晚年对伏暑的理解，更有宝贵
的实验。他说∶“伏暑解期，以候为期；每五日为一候，非若伤寒温邪之七日为期也。
如第九日有凉汗，则第十日热解；第十四日有凉汗，则第十五日解；如无凉汗，又须一
候矣。以热解之先一日，必有凉汗，此余所历验不爽者。”他对桂苓甘露饮的用法，也
另有一种经验。他说∶“古法所谓桂苓者，先用紫 桂钱半，泡浓汁，渗入茯苓片一两
五钱，晒干；然后对症酌用分量，配入煎剂为君。每剂如是，始有捷效。”（见全国名
医验案类编）这个经验虽创获于绍兴张畹香（见张氏《温暑医旨》），然经过何氏实验
有效而转载于《全国名医验案类编》中，帮助了这经验更具有可靠性。
【病因】夏季感受暑邪，被湿气遏制而蕴结潜伏。到了深秋霜降及立冬前后，被外来的寒气搏动而触发。
病机：邪气潜伏在膜原而在气分的，病情浅表且轻微；邪气舍于营分而在血分的，病情深重且严重。
【症状】邪气潜伏在膜原，被外寒束缚而发作的，初起时头痛、身体发热、恶寒无汗、身体疼痛四肢懈怠、胃脘部闷胀恶心、口或渴或不渴、午后症状加重、胃不想进食、大便或秘结或溏泄、颜色像红酱、小便黄浊且热。随后症状类似疟疾，但寒热模糊，不甚分明。或者皮肤隐隐出现皮疹，或红或白，甚至只有发热没有恶寒，夜间发热更重，夜间多胡言乱语，辗转反侧，烦躁无奈，口渴喜欢喝冷冻饮料，或呕吐或呃逆。天亮后出汗，虽然身体热度退去，但胸腹部的热度不除，日日如此。快的话三四个候（每候五日）即可解除，慢的话五七个候才能消除。舌苔起初白腻而浓，或满布如积粉，随后由白转黄，甚至转灰转黑，或粗糙或干燥，或焦枯而起刺，或干燥而开裂。这是伏暑的实证，大多预后良好少凶险。如果邪气舍于营分，被外寒激动而发作的，一起病就寒少热多，白天轻晚上重，头痛且头晕，眼睛红嘴唇红，面部污垢牙齿干燥，心烦怕热，躁扰不宁，口干但不想喝水，喝水即干呕，咽喉干燥依旧，四肢虽然厥冷，但胸腹部灼热如火烧，脐间跳动明显，按压震手。男性则腰痛如折断，先有梦遗，或临发病时泄精；女性则少腹酸痛，带下如注，或月经不按周期突然来潮，大便多秘结，或排便不多，或溏泄不爽，肛门如灼热，小便短赤涩痛，剧烈者手足抽搐，昏厥不语，或烦躁时狂言乱语，安静时郑声独语，舌色鲜红起刺，别无苔垢，甚至深红起裂，或嫩红而干光。必须等到血分邪气转出气分，舌苔才开始逐渐布满薄黄苔，以及上罩薄苔粘腻，或红中起白点，或红中夹黑苔，或红中夹黄黑起刺。这是伏暑的虚证，大多凶险少吉。其他变证：兼有寒邪的，暑邪内郁，则形成疟疾，或隔一日发作，或隔两日发作，总多寒轻热重，最终变成瘅疟而无寒。夹有积滞的，暑毒下陷，则形成赤痢，或黄脓白涕，或夹青汁黑垢，总多稠粘而无粪便，最终排泄过多而亡阴。
【脉象】左手脉弦紧，右手脉沉滞，这就是《内经》所说的“夏伤于暑，秋必痎疟”的情况。实际上有正疟和类疟的区别，都是暑湿伏邪，到了秋天后被风寒新邪引动而发作。如果左手脉弦数，右手脉弦软，这就是《内经》所说的“逆夏气则伤心，内舍于营，奉收者少，冬至重病”的情况。这都是《内经》所论述的伏暑内发及伏暑晚发的明确记载。
【治疗】邪气潜伏在膜原而在气分的，先用新加木贼煎，辛凉微散以解表。外邪从微汗而解，暂时觉得病退，但在半天到一天之间，虽然寒轻但热忽转重，这是蕴伏在膜原的暑湿，从中而作。固然应当辨别其传变而用药，尤其必须辨别暑与湿哪个重哪个轻。传入胃腑而暑重湿轻的，则用新加白虎汤加连翘、牛蒡子，辛凉透发，从皮疹而解。传入大小肠则伏邪依附糟粕，即用枳实导滞汤，苦辛通降，从大便而解。解后，暂用蒿芩清胆汤，清利三焦，使余邪从小便而解。然而常有迟一两天，热又发作，苔复黄腻，伏邪层出不穷，往往经过屡次缓下，再四清利，伏邪才尽。邪虽尽，但气液两伤，最终用竹叶石膏汤去掉石膏，加西洋参、鲜石斛、鲜茅根、青蔗汁，甘凉清养以善后。传入脾脏而湿重暑轻的，先用大橘皮汤加茵陈、木通，温化清渗，使湿热从小便而泄。然而脾与胃以膜相连，湿在胃肠之外，热郁在胃肠之中，其湿热粘腻的伏邪，也多与肠中糟粕相搏，蒸作极粘腻臭秽的溏酱状矢气。前方酌情加枳实导滞丸、更衣丸等缓下之药。必须等到宿垢下行五六次或七八次，伏邪才尽。邪既尽，而身体仍有暮热早凉的现象，是阳陷入阴，阴分尚有伏热。可用清燥养营汤，加鳖血柴胡（八分）、生鳖甲（五钱）、青蒿脑（钱半）、地骨皮（五钱），清透阴分郁热，使其转出阳分而解。解后，则以七鲜育阴汤（鲜生地五钱、鲜石斛四钱、鲜茅根五钱、鲜稻穗二支、鲜雅梨汁、鲜蔗汁各两瓢冲、鲜枇杷叶去毛炒香三钱），滋养阴液以善后。若邪气舍于营分而在血分，先给予加减葳蕤汤，加青蒿脑、粉丹皮，滋阴宣气，使津液外达，微微汗出以解表。继即凉血清营以透邪，轻症用导赤清心汤，重症用犀地清络饮，两方随证加减。若已并发痉厥者，速与犀羚三汁饮，清火熄风，开窍透络，定其痉以清神识。若神识虽清，但夜间热时有谵语，舌红渐布黄腻，包络痰热未净者宜清肃，玳瑁郁金汤去掉紫金片，加万氏牛黄丸（两颗，药汤调下）。口燥咽干，舌干绛而起裂，热劫液枯者宜清滋，清燥养营汤去掉新会皮，加鲜石斛、熟地露、甘蔗汁。心动而悸，脉见结代，舌淡红而干光，血枯气怯者宜双补，复脉汤加减。冲气上逆，或呃或厥，或顿咳气促，冲任脉搏，舌胖嫩圆大，阴竭阳厥者宜滋潜，坎气潜龙汤主之。也有因凉泻太过，其人面白唇淡，肢厥便泄，气促自汗，脉沉细或沉微，舌淡红而无苔，气脱阳亡者宜温补，附子理中汤，加原麦冬、五味子救之。
【廉勘】春夏间的伏气温热，秋冬间的伏暑晚发，其病因虽有伤寒伤暑的不同，但其蒸变为伏火则是一样的。所以其证候疗法，大致相同。要诀在于先辨湿燥，次明虚实。辨得真切方可下手。俞公此论，颇有妙旨，耐人研究。后贤如王孟英，论伏气之治，也语语精实，大旨谓伏气温病，自里出表，乃先从血分而后达于气分。故起病之初，往往舌润而无苔垢，但察其脉，或弦或数，口未渴而心烦恶热，即宜投以清解营阴之药。待邪从气分而化，苔始渐布，然后再清其气分可也。伏邪重者，初起即舌绛咽干，甚有肢冷脉伏之假象，亟宜大清阴分伏邪，继必浓腻黄浊之苔渐生，此伏邪与新邪先后不同处。更有邪伏深沉，不能一齐外出者，纵治之得法，而苔退舌淡之后，逾一二日，舌复干绛，苔复黄燥，正如抽蕉剥茧，层出不穷，不比外感温暑，由卫及气，自营而血也。秋冬伏暑，证势轻浅者，邪伏膜原，深沉者亦多如此。苟阅历不多，未必知其曲折乃尔也。此真阅历有得之言欤。然金针虽度，奈粗工只知新感伤寒，不知伏气温暑，羌苏荆防，随手乱投，不知汗为心之液，恣用辛温燥烈药，强发其汗，则先伤其津液，涸其汗源，汗何能出。汗不出，反益病，往往发谵语，衄血喘满，昏迷闷乱，发痉发厥，变证百病，目击心伤。石顽老人曰，世人只知辛温药能发汗，不知辛凉药亦能发汗。华岫云曰，辛凉开肺，便是汗剂。故余治伏暑内发，新凉外束，轻则用益元散加葱豉薄荷，重则用叶氏荷杏石甘汤加葱豉，皆以辛凉泄卫法解外。外解已，而热不罢，伏暑即随汗而发，必先审其上中下三焦，气营血三分随证用药。盖暑湿内留，多潜伏于三焦膜络之间，外与皮肉相连，内与脏腑相关。伏暑传膜外溃，从皮肉而排泄者，气分病多；入络内陷，从脏腑而中结者，营分血分病多，阴分病亦不少。凡病在上焦气分者，酌与薛氏五叶芦根汤加味（杜藿香叶、苏佩兰叶、苏薄荷叶、霜桑叶、炒香枇杷叶、鲜卷心竹叶、青箬叶、活水芦笋、鲜冬瓜子、荷花露），宣上焦以清肃肺气。若在上焦营分者，酌与叶氏犀角地黄汤加味（犀角尖、鲜生地、银花、连翘、广郁金、鲜石菖蒲、鲜大青、粉丹皮、竹叶卷心、鲜茅根、野菰根。亦可重用生玳瑁代犀角），清上焦以凉透心营。若邪犯包络，舌色纯绛鲜泽者，前汤调下安宫牛黄丸。舌罩一层垢浊薄苔者，调下《局方》至宝丹，芳香宣窍以清包络。病在中焦气分者，酌与王氏连朴饮加味（川连、川朴、焦栀、香豉、仙半夏、水节根、石菖蒲、枳实、条芩），苦降辛通以清胃气。若在中焦血分者，酌与吴氏养营承气汤加减（鲜生地、生白芍、老紫草、白知母、小枳实、真川朴、生锦纹酒浸汁、鲜茅根），凉血泻火以保胃液。病在下焦气分者，酌与桂苓甘露饮加减（官桂、赤苓、猪苓、泽泻、滑石、石膏、寒水石、小青皮），辛淡降泄以清化肾气。若在下焦阴分血室者，酌与章氏青蒿鳖甲汤加减（青蒿脑、生鳖甲、归须、新绛、细生地、东白薇、银胡、地骨皮、鲜茅根、来复丹。虚谷治热入血室、邪结血分、长热不退、夜多谵语、左关脉沉涩、服二三剂后、夜即安睡至晓、畅解小便、色深碧、稠如胶浆、谵语止、热即退、历验、较吴氏青蒿鳖甲煎、效尤速），透络热以清镇血海。若在阴分精室者，酌与陶氏逍遥汤加减（西洋参、知母、川柏、韭白、鼠矢、青竹皮、秋石水炒槐蕊、滑石、生甘细梢、裆灰。肾茎及子宫痛甚者、再加杜牛膝、当门子），逐败精以整肃髓热。善后之法，则一以滋养阴液，整肃余热为主。如叶氏加减复脉汤（北沙参、龙牙燕、陈阿胶、吉林参、麦冬、大生地、生白芍、清炙草、白毛石斛、鲜茅根）及甘露饮加西参蔗浆汁，往往得育阴垫托，从中下焦血分复还气分，阴分转出阳分，少腹部及两腰部，发白黑疹而解。惟病在中下焦胃肠，夹食积者最多，每用陆氏润字丸，磨荡而缓下之。或用枳实导滞丸，消化而轻逐之。此皆治伏暑晚发，博采众长之疗法也。然素心谨慎，选药制方，大旨以轻清灵稳为主，以近今膏粱体，柔脆居多，故于去病之时，不得不兼顾其虚也。
【荣斋按】本节（伏暑伤寒）俞氏指出“邪伏膜原，外寒搏束而发为实证，邪舍于营，外寒激动而发为虚证。”治疗方面：把在膜原气分的伏邪，区分“传胃而暑重湿轻，传脾而湿重暑轻。”的不同病型，订出不同的治法；把“邪舍于营而在血分”的病型，另立一种治法。何氏则分析上中下三焦，气、营、血三分，随证用药，较俞氏治法更灵活；他自己也承认是：“博采众长之疗法。”然而，他晚年对伏暑的理解，更有宝贵的实验。他说：“伏暑解期，以候为期；每五日为一候，非若伤寒温邪之七日为期也。如第九日有凉汗，则第十日热解；第十四日有凉汗，则第十五日解；如无凉汗，又须一候矣。以热解之先一日，必有凉汗，此余所历验不爽者。”他对桂苓甘露饮的用法，也另有一种经验。他说：“古法所谓桂苓者，先用紫桂钱半，泡浓汁，渗入茯苓片一两五钱，晒干；然后对症酌用分量，配入煎剂为君。每剂如是，始有捷效。”（见全国名医验案类编）这个经验虽创获于绍兴张畹香（见张氏《温暑医旨》），然经过何氏实验有效而转载于《全国名医验案类编》中，帮助了这经验更具有可靠性。
(Fu Shu Shang Han, also known as Fu Shu Jian Han. Commonly referred to as late-onset Fu Shu.)
[Etiology] Summer-heat pathogen is contracted in summer, suppressed by dampness, and lies latent. In late autumn around Frost's Descent (Shuang Jiang) or around Start of Winter (Li Dong), it is triggered by the external cold pathogen interacting with the latent pathogen.
[Pathogenesis] When the pathogen lies in the Mo Yuan (Membrane Source) and affects the Qi level, the disease is superficial and mild. When the pathogen resides in the Ying (Nutritive) level and affects the Blood level, the disease is deep and severe.
[Symptoms] When the pathogen lies in the Mo Yuan and is constrained by external cold upon onset: Initially, there is headache, fever, aversion to cold, absence of sweating, body ache, and limb fatigue. There is epigastric fullness and nausea; thirst may or may not be present. Symptoms worsen in the afternoon. The stomach lacks appetite. Stool may be constipated or loose, resembling red paste. Urine is yellow, turbid, and hot. Subsequently, symptoms resemble malaria but with indistinct chills and fever. Alternatively, faint rashes may appear on the skin, either red or white. In severe cases, there is only fever without chills, with higher fever at night, frequent delirium at night, tossing and turning, unbearable restlessness, craving for cold drinks, vomiting, or hiccups. Upon dawn, sweating occurs; although body heat subsides, heat in the chest and abdomen persists day after day. Recovery takes 3-4 "hou" (periods of five days) if rapid, or 5-7 "hou" if slow. Tongue coating is initially thick, white, and greasy, or covered like accumulated powder. It then turns yellow, even grey or black, becoming rough, dry, scorched with prickles, or cracked. This constitutes the Excess pattern of Fu Shu, generally favorable with few critical cases. If the pathogen resides in the Ying level and is agitated by external cold upon onset: Chills are few and fever is abundant; symptoms are lighter during the day and heavier at night. Headache with dizziness, red eyes, red lips, facial grime, and dry teeth occur. There is mental restlessness, aversion to heat, irritability, dry mouth without desire to drink (or dry heaving upon drinking). Throat remains dry. Limbs are cold, but chest and abdomen are burning hot. Pulsation at the umbilicus is prominent and palpable. Males may experience low back pain as if broken, prior nocturnal emissions, or seminal emission before illness onset. Females may have lower abdominal soreness and pain, profuse leukorrhea, or premature menstruation. Stool is often constipated, scanty, or loose and unsatisfactory, with a burning sensation at the anus. Urine is short, red, and dysuric. In severe cases, convulsions, coma, and aphasia occur. Delirious speech may occur when restless, or monotonous muttering when quiet. The tongue is bright red with prickles, lacking coating, or deeply red with cracks, or tender red and dry/glossy. Only when the pathogen exits the Blood level to the Qi level does the tongue coating gradually become thin and yellow, or show a thin greasy coating, white spots on red, or black/yellow prickles on red. This constitutes the Deficiency pattern of Fu Shu, generally critical with few favorable cases. Other variations: With concurrent cold, internal stagnation of summer-heat leads to malaria (Jie Nue), occurring every one or two days, typically with mild chills and heavy fever, eventually becoming Dan Nue (febrile malaria) without chills. With food stagnation, summer-toxin sinking downward leads to bloody dysentery (Chi Li), with yellow pus, white mucus, or green/black sludge, typically sticky without feces, eventually leading to Yin depletion from excessive discharge.
[Pulse] Left pulse is wiry and tight; right pulse is deep and sluggish. This corresponds to the *Nei Jing* saying: "Summer injury by summer-heat leads to Jie Nue in autumn." In reality, there are distinctions between regular malaria and malaria-like syndromes, all caused by latent summer-dampness pathogen triggered by new wind-cold in autumn. If left pulse is wiry and rapid, right pulse is wiry and soft, this corresponds to the *Nei Jing* saying: "Reversing summer qi injures the heart, lodging in the Ying level, receiving less support for autumn gathering, leading to severe illness at Winter Solstice." These are explicit discussions in the *Nei Jing* regarding internal onset and late onset of Fu Shu.
[Treatment] For pathogen lying in the Mo Yuan affecting the Qi level: First use Xin Jia Mu Zei Decoction (Newly Modified Wood-Eel Decoction), pungent-cool and slightly dispersing to release the exterior. The exterior pathogen resolves via slight sweating. Temporarily feeling better, within half a day to one day, chills become mild but fever suddenly intensifies. This indicates summer-dampness latent in the Mo Yuan arising from within. One must distinguish its transmission and treat accordingly, especially distinguishing whether summer-heat or dampness is heavier. If transmitting to the Stomach with heavy summer-heat and light dampness: Use Xin Jia Bai Hu Tang (Newly Modified White Tiger Decoction) plus Lian Qiao (Forsythiae Fructum) and Niu Bang Zi (Arctii Fructus), pungent-cool to vent and release via rashes. If transmitting to the Large and Small Intestines, where latent pathogen adheres to fecal matter: Use Zhi Shi Dao Zhi Tang (Immature Bitter Orange and Guide Out Decoction), bitter-pungent and descending to resolve via stool. After resolution, temporarily use Hao Qin Qing Dan Tang (Artemisiae Scabrae and Scutellariae Gallbladder-Clearing Decoction) to clear and drain the San Jiao (Triple Burner), allowing residual pathogen to exit via urine. However, fever may recur after one or two days with return of yellow-greasy coating, as latent pathogen emerges endlessly. Often requires repeated gentle purgation and clearing-draining until latent pathogen is exhausted. Once exhausted, Qi and fluids are damaged; finally use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) minus Shi Gao (Gypsum), adding Xi Yang Shen (American Ginseng), Xian Shi Hu (Dendrobii Herba), Xian Mao Gen (Imperatae Rhizoma), and Qing Zhe Zhi (Green Sugarcane Juice), sweet-cool and nourishing for recovery. If transmitting to the Spleen with heavy dampness and light summer-heat: First use Da Ju Pi Tang (Large Tangerine Peel Decoction) plus Yin Chen (Artemisiae Scopariae Herba) and Mu Tong (Akebiae Caulis), warm-transforming and clear-draining to excrete damp-heat via urine. Since Spleen and Stomach are connected by membranes, dampness is outside the GI tract while heat is inside. Sticky damp-heat latent pathogen often binds with intestinal feces, steaming into sticky, foul-smelling loose stools. Modify previous formulas with Zhi Shi Dao Zhi Wan (Immature Bitter Orange and Guide Out Pill) or Geng Yi Wan (Clothing Change Pill) for gentle purgation. Must wait for 5-7 bowel movements of old filth to exhaust latent pathogen. After exhaustion, if evening fever and morning coolness persist, Yang has sunk into Yin, with latent heat in Yin level. Use Qing Zao Yang Ying Tang (Clear Dryness and Nourish Nutritive Level Decoction) plus Die Xue Chai Hu (Chai Hu processed with blood of turtle shell), Sheng Bie Jia (Uncooked Turtle Shell), Qing Hao Nao (Artemisiae Annuae Cortex Brain), and Di Gu Pi (Lycii Cortex), to clear and vent stagnant heat in Yin level, transferring it to Yang level for resolution. After resolution, use Qi Xian Yu Yin Tang (Seven Fresh Fluid-Nourishing Decoction: Xian Sheng Di Huang, Xian Shi Hu, Xian Mao Gen, Xian Dao Sui, Xian Ya Li Zhi, Xian Zhe Zhi, Xian Pi Pa Ye) to nourish Yin fluids for recovery. If pathogen resides in Ying/Blood level: First give Jia Jian Wei Rui Tang (Modified Polygonati Rostati Decoction) plus Qing Hao Nao and Fen Dan Pi (Moutan Cortex), to nourish Yin and ventilate Qi, allowing fluids to reach exterior for slight sweating. Then cool blood and clear Ying level to vent pathogen. Mild cases: Dao Chi Qing Xin Tang (Guide Out Redness and Clear Heart Decoction). Severe cases: Xi Di Qing Luo Yin (Rhino Horn and Rehmannia Clear Collateral Decoction), modified per syndrome. If convulsions and coma occur simultaneously: Quickly give Xi Ling San Zhi Yin (Rhino Horn and Antelope Horn Three-Juice Decoction) to clear fire, extinguish wind, open orifices, and calm convulsions to restore consciousness. If consciousness clears but night fever with occasional delirium persists, tongue red with spreading yellow-greasy coating, indicating phlegm-heat in Pericardium not fully cleared: Use Dai Mao Yu Jin Tang (Acanthospanx and Curcuma Decoction) minus Zi Jin Pian, add Wan Shi Niu Huang Wan (Wan's Calculus Bovis Pill) taken with decoction. If mouth/throat dry, tongue dry/crimson with cracks, heat consuming fluids: Use Qing Zao Yang Ying Tang minus Xin Hui Pi, add Xian Shi Hu, Shu Di Lu (Rehmanniae Radix Preparata Dew), and Sugarcane Juice. If palpitations, knotted/intermittent pulse, pale-red dry/glossy tongue, indicating blood deficiency and Qi timidity: Use double tonification with Mai Mai Dong Jing Tang (Pulse-Nourishing Decoction) modified. If Chong Qi rebels upward causing hiccups, cold limbs, or sudden cough/shortness of breath, with pulsating Ren/Mai vessels, fat/tender large tongue, indicating Yin exhaustion and Yang collapse: Use Zi Qian method with Kan Qi Qian Long Tang (Kidney Qi Subduing Dragon Decoction). If over-treated with cooling/purgatives leading to pale face/lips, cold limbs/diarrhea, shortness of breath/sweating, deep/fine or micro pulse, pale-red tongue without coating, indicating Qi collapse and Yang loss: Use Wen Bu (Warm Tonification) with Fu Zi Li Zhong Tang (Aconite and Poria Regulate Middle Decoction) plus Yuan Mai Dong and Wu Wei Zi.
[Commentary] Fu Wen Re (Latent Warm-Thermal) in Spring/Summer and Fu Shu Wan Fa (Late Onset Fu Shu) in Autumn/Winter differ in etiology (Cold vs. Summer-heat) but share the same transformation into latent fire. Thus, symptoms and treatments are largely similar. Key is first distinguishing Dampness/Dryness, then Deficiency/Excess. Accurate differentiation allows proper treatment. Mr. Yu's theory is profound. Later experts like Wang Mengying also discussed latent Qi treatment precisely, stating latent warm diseases emerge from interior to exterior, starting from Blood level to Qi level. Initially, tongue is moist without coating; pulse wiry/rapid, no thirst but mental restlessness/aversion to heat; treat with herbs clearing/nourishing Ying Yin. Once pathogen transforms in Qi level, coating appears, then clear Qi level. Heavy latent pathogen shows crimson tongue/dry throat initially, possibly fake signs of cold limbs/deep pulse; urgently clear Yin latent pathogen, followed by thick yellow-turbid coating appearing. This differs from new pathogens. Deeply latent pathogen cannot exit all at once; even with correct treatment, after coating recedes and tongue becomes pale, it may revert to dry/crimson tongue and yellow-dry coating after 1-2 days, like peeling a banana, endless. Unlike external warm-summer diseases moving from Wei to Qi, Ying to Blood. Autumn/Winter Fu Shu, mild cases lie in Mo Yuan, deep cases similarly. Without experience, such complexities are unknown. This is true wisdom from experience. However, skilled needles passed down, yet crude practitioners only know new-onset Shang Han, not latent warm-summer. They indiscriminately use Qiang Huo, Zi Su, Jing Jie, Fang Feng. Knowing sweat is fluid of the Heart, using pungent-warm acrid-hot drugs forcibly induces sweating, damaging fluids and exhausting sweat source. Sweat cannot come out, worsening disease. Leads to delirium, epistaxis, wheezing/fullness, coma/confusion, convulsions/coma, and myriad complications. Witnessing these causes heartbreak. Shi Wen Lao Ren said: People only know pungent-warm drugs induce sweating, not knowing pungent-cool drugs can too. Hua Xiu Yun said: Pungent-cool opening of Lung is a sweating agent. Thus, I treat internal Fu Shu with external cool constraint: Mild cases use Yi Yuan San plus Cong Chi Bo He; severe cases use Ye Shi He Xing Shi Gan Tang plus Cong Chi. All use pungent-cool releasing Wei method to resolve exterior. Once exterior resolved but fever persists, Fu Shu follows sweat. Must examine San Jiao and Qi/Ying/Blood levels to medicate. Summer-dampness stays internally, mostly latent in San Jiao membrane collaterals, connected externally to skin/flesh, internally to Zang-Fu. Fu Shu transmitting outward through membranes/excreting via skin/flesh tends to affect Qi level. Entering collaterals/sinking inward/knotting in Zang-Fu tends to affect Ying/Blood levels, and Yin level diseases are also common. For Upper Jiao Qi level: Use Xue Shi Wu Ye Lu Gen Tang (Mr. Xue's Five-Leaf Reed Root Decoction) modified (Du Huo Xiang Ye, Su Pei Lan Ye, Su Bo He Ye, Shuang Sang Ye, Chao Xiang Pi Pa Ye, Xian Juan Xin Zhu Ye, Qing Ruo Ye, Huo Shui Lu Sun, Xian Dong Gua Zi, He Hua Lu) to vent Upper Jiao and clear Lung Qi. For Upper Jiao Ying level: Use Ye Shi Xi Jiao Di Huang Tang (Mr. Ye's Rhino Horn and Rehmannia Decoction) modified (Xi Jiao Jian, Xian Sheng Di, Yin Hua, Lian Qiao, Guang Yu Jin, Xian Shi Chang Pu, Xian Da Qing, Fen Dan Pi, Zhu Ye Juan Xin, Xian Mao Gen, Ye Gu Gen. Can heavily use Sheng Dai Mao replacing Xi Jiao) to clear Upper Jiao and cool-vent Heart Ying. If pathogen invades Pericardium, tongue pure crimson bright: Take An Gong Niu Huang Wan with previous decoction. Tongue coated with thin turbid coating: Take Ju Fang Zhi Bao Dan, aromatic opening orifices to clear Pericardium. For Middle Jiao Qi level: Use Wang Shi Lian Po Yin (Mr. Wang's Coptis and Magnolia Decoction) modified (Chuan Lian, Chuan Hou, Jiao Zhi, Xiang Chi, Xian Ban Xia, Shui Jie Gen, Shi Chang Pu, Zhi Shi, Tiao Qin) to bitter-descend and pungent-unblock to clear Stomach Qi. For Middle Jiao Blood level: Use Wu Shi Yang Ying Cheng Qi Tang (Mr. Wu's Nourish Ying and Purge Decoction) modified (Xian Sheng Di, Sheng Bai Shao, Lao Zi Cao, Bai Zhi Mu, Xiao Zhi Shi, Zhen Chuan Hou, Sheng Jin Wen Jiu Jin Zhi, Xian Mao Gen) to cool-blood purge-fire to protect Stomach fluids. For Lower Jiao Qi level: Use Gui Ling Gan Lu Yin (Cinnamon and Poria Sweet Dew Decoction) modified (Guan Gui, Chi Ling, Zhu Ling, Ze Xie, Hua Shi, Shi Gao, Han Shui Shi, Xiao Qing Pi) to pungent-light descend-excrete to clear Kidney Qi. For Lower Jiao Yin/Blood Chamber: Use Zhang Shi Qing Hao Bie Jia Tang (Mr. Zhang's Artemisia and Turtle Shell Decoction) modified (Qing Hao Nao, Sheng Bie Jia, Gui Xu, Xin Jiang, Xi Sheng Di, Dong Bai Wei, Yin Hu, Di Gu Pi, Xian Mao Gen, Lai Fu Dan. Xu Gu treated Heat entering Blood Chamber, pathogen knotting in Blood level, long-lasting fever, night delirium, left Guan pulse deep/sluggish; after 2-3 doses, sleeps soundly till dawn, urinate freely dark-green thick like glue, delirium stops, fever retreats; verified effective, faster than Wu Shi Qing Hao Bie Jia Jian) to vent collateral heat and calm Blood Sea. For Yin/Essence Chamber: Use Tao Shi Xiao Yao Tang (Mr. Tao's Sojourning Free Decoction) modified (Xi Yang Shen, Zhi Mu, Chuan Bai, Jiu Bai, Shu Shi, Qing Zhu Pi, Qiu Shi Shui Chao Huai Rui, Hua Shi, Sheng Gan Xi Shao, Dang Hui Ash. Add Du Niu Xi, Dang Men Zi for severe kidney/genital/uterus pain) to expel stale essence and regulate Marrow Heat. Recovery method focuses on nourishing Yin fluids and regulating residual heat. Like Ye Shi Jia Jian Mai Mai Dong Jing Tang (Bei Sha Shen, Long Ya Yan, Chen E Jiao, Ji Lin Shen, Mai Dong, Da Sheng Di, Sheng Bai Shao, Qing Zhi Cao, Bai Mao Shi Hu, Xian Mao Gen) and Gan Lu Yin plus Xi Shen Zhe Jiang Zhi. Often achieve Yin-nourishing support, returning from Middle/Lower Jiao Blood level to Qi level, Yin to Yang, resolving via white/black rashes on lower abdomen and waist. Most cases in Middle/Lower Jiao GI tract involve food stagnation. Often use Lu Shi Run Zi Wan to grind and gently purge, or Zhi Shi Dao Zhi Wan to digest and lightly drive out. These are therapies for late-onset Fu Shu, collecting strengths from many sources. However, cautious selection of herbs and formulas emphasizes light, clear, agile, and stable methods, as modern constitutions are often delicate due to rich diets. Thus, while removing disease, one must consider deficiency.
[Editor's Note] In this section (Fu Shu Shang Han), Mr. Yu points out: "Pathogen lying in Mo Yuan, constrained by external cold, manifests as Excess pattern; pathogen residing in Ying, agitated by external cold, manifests as Deficiency pattern." In treatment: For latent pathogen in Mo Yuan Qi level, differentiate "transmitting to Stomach with heavy summer-heat/light dampness" vs "transmitting to Spleen with heavy dampness/light summer-heat," establishing different methods. For "pathogen residing in Ying/Blood level," establish a separate method. Mr. He analyzes Upper/Middle/Lower San Jiao and Qi/Ying/Blood levels, medicating per syndrome, offering more flexibility than Mr. Yu's methods; he admits this as "collecting strengths from many sources." However, his late-life understanding of Fu Shu offers valuable experimental insights. He stated: "Resolution period of Fu Shu is based on 'hou' (5 days); unlike Shang Han/Warm pathogens which take 7 days. If cool sweat occurs on Day 9, fever resolves on Day 10; if on Day 14, resolves on Day 15; if no cool sweat, another 'hou' is needed. One day before fever resolves, cool sweat must occur; this is my verified experience." His usage of Gui Ling Gan Lu Yin also has unique experience: "Ancient method for Gui Ling: First soak Zi Gui (Purple Cinnamon) 1 qian in strong juice, permeate Fu Ling slices 1 liang 5 qian, dry; then use appropriate dosage according to syndrome as chief ingredient in decoction. Doing so per dose yields quick effect." (See National Famous Doctors' Verified Cases Compilation). Although originated by Zhang Wanxiang of Shaoxing (see Zhang's *Wen Shu Yi Zhi*), Mr. He's verification and reprinting in *National Famous Doctors' Verified Cases Compilation* enhances its reliability.