按暑与 。皆日气也。不必分属。动而得之为中 。静而得之为中暑。其说出自洁古。后人因之。
未可据为确论也。盖动静不过劳逸之分。既均受暑治法不甚相远。至于阴暑。尤宜速辨。夫当盛暑之时。
炎火若炙。静处深堂大厦。正以避暑。不近烈日。炎暑何来。即膏粱深处。亦有中暑之症者。盖不能无
冒暑应接。正在动中得之耳。此静中之动。即洁古所称静得之暑也。若乃纳凉于水阁山房。或感冒微
风。或静夜着凉。此外受阴寒。遏其周身阳气。以致头痛恶寒。肤热无汗等症者。当以辛温之
剂微微表散。至若浮瓜沉李。冷水寒冰。以伤胃中之阳。又当温中散寒。此乃暑月感寒之症。不得以阴
暑名之。然以辛温治阴暑。其弊在命名。若薛氏以温热之品治中 。则贻害不浅矣。窃假为辨正。以免
后学之惑。
邵评∶暑与 二者。皆炎天热日之气也。夏月火土当令。天之热气下。地之湿气上。湿与热蒸。
或成暑气。暑者。热之兼湿者也。故曰暑必挟湿。至于 。单是炎天火热之气。不夹湿气在内。乃夏天令
火之邪为 。故奔走于赤日之中而中 也。治 只用白虎黄连。清其火热。与治暑之兼用浓朴、滑石。
辛香渗泄之法不同。如此分别。未知是否。若阴暑二字。尤属不通。夏天炎火之令。烁石流金。何阴
之有。即使阳气素虚之人。每处夏月。阳气尽浮于肌表。其人中阳虚弱。或外受凉风。内伤生冷而病者。
此暑天受寒。因暑而自致之病。非阴暑为病也。暑为阳邪。从无阴暑之名。故特辨之。至暑 同是
热气。岂可以动得静得而分属耶。推其意。岂以 为阳而暑为阴。故以动静之阴阳而分属之耶。阴暑
之名一立。贻误后人。实非浅鲜。惟纳凉而外受风邪。夜间着凉。此是夏月之风寒。人感受之。
着于肌表。遏其表之阳气。以致恶寒头痛。身热无汗之表症发现。此是夏月感冒风寒。非暑症也。乃因
暑而自致之病。故用辛温散邪之药。以疏通其表间之阳气。与治暑无涉也。多食生冷寒物。内伤脾胃中
阳。以致吐泻霍乱肢冷汗泄等见症。因夏月阳气外浮。中阳虚弱。寒冷伤中。亦非暑病。是因暑而自致
之病。故用温中散寒。以扶脾胃之阳。与治暑亦无涉也。古人大顺散等方。是治夏月着寒之症。非治阴
暑之方。至于以温热治中 。真是抱薪救火也。
暑伤气分 凡吸入致病。上焦气分先受。舌白边红。呕恶烦渴。咳嗽喘急。二便不爽。脉右大者。此
暑邪阻于上焦气分也。宜杏仁、石膏、半夏、浓朴、栀皮、豆豉、郁金、竹
茹之类。如热邪内迫。肺气郁闭。而致胸中胀闷者。宜栀子豉汤。加枳实、川郁金、杏
仁、半夏、白蔻、滑石、连翘、蒌皮、黄芩之类。
邵评∶暑热由口鼻吸受。先伤上焦气分。邪留肺胃。邪在肺则舌白边红者。热也。
胃热则呕恶心烦。肺火盛则咳。气不降则喘急。大小便不利也。
暑袭肺卫 如身热头胀脘闷。咳呛不已者。此暑邪外袭。干肺卫也。宜清上焦。甜
杏仁、滑石粉各三钱。香薷七分。白蔻五分。通草一钱五分。丝瓜叶三钱。如暑风外
袭肺卫。气阻发热。畏风头胀咳呛。防作肺疟。宜香薷、杏仁、桔梗、连翘、六一散、丝瓜叶。
邵评∶邪郁上焦。肺不宣降。则头胀咳呛。身热脘闷。此邪在卫分也。卫分不解。则
入气分。气分不解。则邪传中焦。而入营分。营分不解。则邪传下焦。而入血分矣。
三焦俱受。营卫均病。甚至逆传包络。邪入膻中。而邪闭正脱之症见矣。故邪初
在卫。先用辛香以开泄上焦为主。如暑邪挟风。袭入于肺。肺主皮毛。故亦为之
表。邪在于卫。表气不宣。暑风郁蒸发热。卫气被邪抑遏。则微恶寒。寒热似疟。而
畏风咳呛。此是暑疟。与少阳足经之疟大异。当从手经施治。宣泄肺卫之暑邪。
肺伤痰喘 暑风热气伤肺。身热痰嗽而喘。宜桑杏、连翘、石膏、淡竹叶、橘红、栝蒌
皮、苡仁、芦根之类。喉痛。加射干、牛蒡。小水不利。加六一散。头胀。加鲜荷叶。
邵评∶此条暑风入肺。肺有痰浊。痰热伤肺。肺升不降而喘嗽。治宜宣泄上焦。清化痰热。
如暑湿伤气。午后痰喘更加者。肺先受病也。亦宜清理上焦。为无形气分之治。如
芦根杏仁、蒌霜、苡仁、橘红、川贝、西瓜、翠衣、通草、茯苓皮之类。
邵评∶暑必挟湿。暑先入上焦。与痰热先伤肺气。故痰喘加于午。而化痰渗湿。用
轻药以开泄上焦无形之肺气也。
暑湿伤胃 凡身热。中焦痞满。不饥不纳。二便不爽。此暑热伤于中焦气分。热痰
聚胃所致。宜苦辛泄降。半夏泻心。去甘草、干姜。加杏仁、枳实。
邵评∶邪自上焦而至中焦。由卫分而入气分。上焦主肺。中焦主胃。病则痞满。不
饥不纳。是暑热湿痰伏于中焦气分。胃气不得宣行也。宜苦辛开痞。宣泄中焦气分治之。
暑入营分 凡身热。心烦面赤。舌绛神呆。夜寐不安。此暑邪入心也。辰砂、六一散、
加川郁金、川连之类。或犀角尖、鲜生地、石菖蒲、川郁金、连翘、银花之类。
邵评∶邪由肺卫而入心营。邪入渐深矣。心主血而藏神。营热则伤神。神呆而寐
不安也。当清热以开泄其邪。使邪从肺达为妥。否则热灼阴伤。邪入下焦血分。有阴涸邪陷之危。亦有逆传
心包。邪热内闭。为内闭外脱之症耳。
暑入膻中 如暑邪初伤气分。发热口渴。失治则邪传膻中。舌形绛缩。小便赤涩。鼻煤裂血。耳聋
神昏。此邪由气分蔓延及血分。最怕内闭外脱。急用犀角尖、石菖蒲、川郁金、鲜生地、银花、连翘、
元参、西黄之类。
邵评∶暑邪由口鼻吸入。先伤上焦肺卫。肺内膜与心包络膜相连。心在肺下。其道最近。故极易
传入心包。且心为君火。心包为相火。暑为相火行令之邪。同气相求。其入心包尤易。即陈无择所谓暑
喜归心是也。邪入营分。而至逆传心包。则元神伤耗。阴血涸竭。邪热深入宫城。每多内闭外脱。急用
清心达邪芳香开闭一法。如用牛黄清心丸、至宝丹、紫雪丹等。然亦十不救一矣。
暑入阳明 凡大热大渴。干呕唇燥。舌苔黄浓。六脉洪数。此暑邪入于阳明也。黄
连香薷饮及益元散。大热大渴大汗者。白虎汤。
邵评∶暑邪在上焦肺卫。不传心营。而传入阳明之经。见症热渴干呕。脉洪数而
舌苔黄浓。此邪在中焦阳明胃经症也。汗少者。用黄连香薷饮。热渴而大汗者。白虎汤。盖邪入阳明。
无所复传。以阳明为中土万物所归也。然邪入阳明。有在经在腑之分。在经宜清。在腑当下。皆以救液
逐邪为务。盖阳明主津液所生病。病在阳明。津液涸竭。则邪陷气脱而死。或可迁延二候四候。非若邪
入心包。直犯宫城。元神无所归束。外散而亡。每在一候二候。邪内闭而正外脱也。
暑入膜原 暑秽从口鼻吸入。结于膜原。则必脘闷寒热。治宜清疏募原。如广藿梗、川郁金、
槟榔、浓朴、草蔻、青皮、滑石、连翘、紫苏、黄芩之类。
邵评∶暑湿秽邪从口鼻吸受。直行中道。流布三焦。结于膜原。膜原附近于胃。为半表半里之界。
故见症寒热如疟。实非疟也。与少阳之半表半里大为不同。故仿达原饮意。用辛香温化之药。以达
膜原暑秽之邪。
暑入厥阴 凡四肢不热。中心如焚。舌灰黑。消渴。心下板实。呕恶吐蛔。寒热似疟者。此暑邪
陷于厥阴也。病势最危。治宜酸苦泄热。扶正祛邪。须人参、枳实、川连、干姜、黄芩、白芍、椒梅。
邵评∶此暑热乘虚而陷入于足厥阴肝经也。厥者。尽也。阴尽则阳生。木中有相
火。故外不热而内如焚。火灼津伤。故渴而且消。虫为风木所化。热盛生风。木邪犯胃。则呕而吐蛔
也。邪结不开。则心下板实。肝与胆为表里。故寒热如疟。邪陷至阴。症势危险。厥阴见症。多寒
热错杂之邪。故药亦须寒热并用耳。
暑毒入肠 如冒暑饮酒。引暑毒入于肠内。酒与暑并。大热大渴。小便不利。其色
如血。五苓去桂。加川连、银花、滑石。
邵评∶暑为阳热之邪。酒性大热而有湿。冒暑饮酒。两热相并。入于小肠。火府不
宣。故大热大渴。而小便赤如血也。此热结下焦。而小水不利。用利水清热之剂以治之。
伏暑内发 凡潮热。汗出不解。烦渴呕恶。胸痞。舌苔白。带灰黑。小溺赤涩。或自利。此伏暑内发。
三焦并受。治宜清理上中为要。如滑石、杏仁、通草、橘红、半夏、浓朴、川连、郁金、黄芩之类。
邵评∶人受暑热。栖伏三焦肠胃之间。久久而发者。为伏暑。夏不即发。有至秋而发者。亦有至
霜降后发者。其发愈迟。则邪伏愈深。而病愈重也。惟伏暑见症。三
焦俱有。或吐泻霍乱。似疟非疟。或竟成疟利等症。盖暑必挟湿。为粘腻之邪。留
伏于里。最为淹牵。治宜宣泄肺胃。清暑渗湿。理分三焦为主。
暑邪成疟 头痛脘闷。舌白而干。四肢麻痹。脉左劲右濡。寒热不止。此暑邪入里。
蒙闭清窍而疟作也。治宜清理上焦。如连翘、滑石、杏仁、川郁金、淡竹叶、半夏、蒌皮、贝母之类。
邵评∶暑从口鼻吸受。先入于肺。挟内有之痰湿。而成疟疾。虽有头痛寒热见症。
左脉见劲。此非表邪发疟。乃是邪蕴于肺胃。痰热上蒸。蒙闭清气而作疟也。与少阳之风寒发疟者
不同。治宜清理肺胃暑热。化痰渗湿之剂。
伤暑兼感寒 小暑后。先触暑邪。复感寒邪。而病身热头痛。恶寒烦渴。无汗。或自
汗。脉虚数。舌苔白者。此属伤暑后复感寒。邪在肺胃间也。宜紫苏、薄荷、香薷、青蒿、
滑石、浓朴、通草之类。腹胀加枳实、腹皮。挟食加楂肉、青皮。舌黄干呕。加姜制川连。
邵评∶先受暑邪。后感秋寒。抑遏肌表。其症身热烦渴自汗。暑邪也。头痛恶寒无
汗。表寒也。是肺胃先受暑热。表复外感寒邪。表里俱病。当内清暑邪。外散表寒为治。
劳役辛苦之人。日间冒暑。夜间乘凉。而病头痛寒热如疟者。六和汤加减和之。
邵评∶中气虚弱。内暑热而外寒凉。表里均病。故有寒热头痛等见症。体虚挟邪。以扶正清暑散寒为治。
冒暑兼停饮 有因暑热而饮凉水太多。以致水停心下。遏伏暑邪。证见大热烦渴。胸膈痞闷。
或兼喘急。小水不利。或身重疼痛。右脉微弱。仲景用一物瓜蒂散吐之。如用五苓去术。加紫苏、浓朴、
通草、散而利之。亦解。舌黄燥者。加入制川连。
邵评∶此水邪郁令火。而为中 之症。由夏令火热。以水灌洗而伤冷水。水行皮中所致。仲景用
一物瓜蒂散。以去上焦之水。饮水太多。停于心下。遏伏暑邪。则热渴烦痞。火气上逆于肺。则喘急而小
水不利也。冷水闭汗湿而滞阳气。故身重疼痛。暑伤元气。则右脉微弱。以饮冷水灌冷水。俱郁遏阳气。
所谓形寒饮冷则伤肺也。用瓜蒂以去上焦水饮。则肺气通行而水自散矣。后人用五苓散加
减。亦通阳利水之治耳。舌黄燥。其邪已入中焦。阳明胃热。故加川连。
冒暑兼伤冷 有因伤暑口渴。恣食生冷瓜果。以致寒包暑邪。宜六和汤。去人参、扁豆。加楂肉。
凡胸腹闷痛。舌苔中白边红。气口脉微弱。而身大热者。此即寒包暑之暴症也。若缓发。非疟即痢矣。
邵评∶暑为阳邪。热灼津亏。则多口渴。渴则饮冷。恣食瓜果生冷。伤脾胃中阳。郁遏阳气。
以致暑不能外出。此因暑而自致之病。非暑伤也。盖冷物滞于中宫。阳气不得伸越。故胸腹闷痛。舌
苔中白边红者。寒抑热邪也。中虚邪滞。则脉微弱。身大热者。暑也。寒郁暑邪。用六和汤和中消
邪。加楂肉以化冷物之积。
暑挟湿 凡暑必挟湿。湿为重浊之邪。暑乃熏蒸之气。热处湿中。湿热相蒸。阻于气分。当治在
手太阴。若治不中 。其邪无处发泄。则渐走营分。侵入血中。其症神昏谵语。舌色绛赤。
或咯痰带血。若上蒙清窍。则耳聋无闻。上焦不解。蔓延中下。则胸腹板闷。二便不利。即为湿温重症。
治当急清三焦。如滑石、石膏、寒水石、杏仁、银花、竹茹、枳实、通草、金汁之类。嗣用犀角、连翘、
银花、鲜地、元参、川贝、知母、淡竹叶、绿豆皮之类。清营分以养胃阴。
邵评∶天之热气下降。地之湿气上腾。则蒸而成暑。故暑必挟湿。郁蒸化热。先入
上焦。肺卫。故治在手太阴肺经为先。治不合法。卫分之邪不解。则入于气分。气分暑邪不解。则渐入
营分。营分不解。则入下焦血分。所谓卫之后方言气。营之后方言血也。若邪入营不解。亦有逆传
包络。神昏耳聋。机窍被蒙。而内闭外脱
者。治宜清营达邪。芳香开闭为主。总之暑湿温热。先由上焦而递传中下焦。首在肺卫上焦。病属气
分及营分。若传中下焦。则入血分。而灼耗阴精。则为重症。故温暑宗三焦立法主治。
暑挟痧 暑兼秽气。从口鼻吸入。亦头疼。恶寒。发热。或手足指冷。脉沉伏。饱闷呕
恶。或腹痛泄泻。治宜清暑兼逐秽。如广藿梗、川郁金、紫苏、青蒿、浓朴、茯苓皮、滑石
粉、连翘、草蔻、通草之类清之。有食加青皮、楂肉、枳实。
[Commentary] Summerheat (Shu) and Yin-summerheat (Yin Shu, a condition caused by cold exposure while avoiding heat) are both manifestations of the hot qi of summer. It is unnecessary to rigidly distinguish their categories. Contracting it during activity leads to Zhong-Yue (Zhong Ye, severe heatstroke), while contracting it during rest leads to Shu-Bing (Shu Bing, common heatstroke). This theory originated from Zhang Jiegu, and later generations followed it, but it cannot be taken as an absolute truth. Activity and rest merely distinguish between labor and leisure; since both involve exposure to summerheat, the treatment methods are not significantly different. Regarding Yin-summerheat, it requires rapid differentiation. During the peak of summer, when the sun scorches like fire, people retreat to deep halls and large buildings to avoid the heat, staying away from direct sunlight. Where does the summerheat come from? Even in wealthy households rich in food, there are cases of heatstroke symptoms. This is because they cannot avoid going out for social engagements, contracting the pathogen during movement. This is "movement within stillness," which is what Zhang Jiegu referred to as "contracted during stillness." If one cools off in water pavilions or mountain houses, catches a slight breeze, or gets chilled on quiet nights, this is external contraction of yin-cold, which obstructs the yang qi of the whole body, leading to symptoms such as headache, aversion to cold, skin fever without sweat. In such cases, mild diaphoretic agents with acrid-warm properties should be used to gently release the exterior. As for consuming floating melons, sunken plums, cold water, or ice, which damage the yang qi of the stomach, warm-middle dispel-cold methods should be employed. These are conditions of cold contraction during the summer months and should not be named Yin-summerheat. However, treating Yin-summerheat with acrid-warm agents has the drawback of improper naming. If, like Xue Ji, one uses warm-hot substances to treat Zhong-Yue, it would cause significant harm. I offer this clarification privately to prevent confusion among future students.
Shao's Commentary: Both Shu and Yin-Shu are the hot qi of the blazing summer sun. In summer, Fire and Earth reign supreme. The hot qi of heaven descends, and the damp qi of earth ascends. Dampness and heat steam together, forming summerheat. Shu is heat combined with dampness. Therefore, it is said that "Summerheat must carry dampness." Yin-Shu, however, is solely the fiery heat of summer, without internal dampness. It is the evil of Fire commanding in summer causing harm, so running under the red sun leads to Zhong-Yue. Treatment for Zhong-Yue uses only Baihu Tang (White Tiger Decoction) and Huanglian (Coptis Rhizome) to clear the fire-heat. This differs from treating Shu with acrid-aromatic draining agents like Houpo (Magnolia Bark) and Huashi (Talcum). Whether such distinctions are accurate is questionable. The term "Yin-summerheat" is particularly illogical. In summer, when fire commands and stones melt, gold flows, where is the "Yin"? Even if a person has inherently deficient yang qi, during summer, all yang qi floats to the muscle surface. If their middle yang is weak, or they are externally exposed to cool winds and internally injured by raw/cold foods, this is cold contracted in summer due to summerheat, a disease self-induced by summer, not Yin-summerheat disease. Shu is a yang evil; there is no concept of "Yin-shu." Hence, I specifically clarify this. Since Shu and Zhong-Yue are both hot qi, how can they be categorized by activity or rest? Perhaps the implication is that Zhong-Yue is yang and Shu is yin, thus categorizing them by the yin-yang of activity and rest? Once the name "Yin-summerheat" was established, it misled later generations, causing considerable error. Only when cooling off, one is externally exposed to wind evil, or chilled at night, is this winter-cold of summer. When humans contract it, it attaches to the muscle surface, obstructing superficial yang qi, leading to aversion to cold, headache, body heat, and no sweat—superficial symptoms. This is catching wind-cold in summer, not a summerheat syndrome. It is a disease self-induced by summer. Thus, acrid-warm dispersing drugs are used to unblock superficial yang qi, unrelated to treating summerheat. Eating too much raw/cold food injures middle yang of spleen and stomach, leading to vomiting, diarrhea, cholera, cold limbs, and sweating. Due to summer yang floating outward and middle yang weakness, cold injuring the center is also not a summerheat disease, but self-induced by summer. Thus, warming the middle and dispelling cold supports spleen-stomach yang, unrelated to treating summerheat. Ancient formulas like Dashun San treat cold contraction in summer, not Yin-summerheat. Using warm-hot drugs to treat Zhong-Yue is indeed adding fuel to the fire.
Shu Damages Qi Level: Whenever inhalation causes disease, the upper jiao qi level is affected first. Symptoms include white tongue coating with red edges, vomiting/nausea, irritability/thirst, cough/wheezing, and difficulty with urination/defecation. A large pulse on the right indicates summerheat evil obstructing the upper jiao qi level. Use Almond (Xingren), Gypsum (Shigao), Pinellia (Banxia), Magnolia Bark (Houpo), Gardenia Skin (Zhi Pi), Fermented Soybean (Dou Chi), Curcuma (Yujin), and Bamboo Shavings (Zhuru). If heat forces inward, lung qi is stagnant causing chest fullness/stuffiness, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) plus Zhi Shi (Immature Bitter Orange), Chuan Yujin (Curcuma), Xingren (Almond), Banxia (Pinellia), Baokou (White Cardamom), Huashi (Talc), Lianqiao (Forsythia), Loupi (Trichosanthes Peel), and Huangqin (Scutellaria).
Shao's Commentary: Summerheat enters via nose/mouth, first damaging upper jiao qi level. Evil stays in Lung/Stomach. Evil in Lung causes white tongue coating with red edges (heat sign). Stomach heat causes vomiting, nausea, irritability. Lung fire excess causes cough; failing qi descent causes wheezing and bowel/bladder obstruction.
Shu Attacks Lung-Wei: If body heat, head distension, epigastric stuffiness, and incessant cough occur, this is summerheat attacking externally, interfering with Lung-Wei. Clear upper jiao using Sweet Almond (Tian Xingren) 3 qian, Talc Powder (Huashi Fen) 3 qian, Mosla Herb (Xiangru) 7 fen, White Cardamom (Baikou) 5 fen, Tongcao 1.5 qian, and Loofah Leaf (Siguye) 3 qian. If summerwind attacks Lung-Wei, qi obstruction causes fever, fear of wind/head distension/cough, preventing Lung Malaria, use Xiangru, Xingren, Platycodon (Jiegeng), Lianqiao (Forsythia), Liuyi San (Six-One Powder), and Siguye.
Shao's Commentary: Evil stagnates in upper jiao, Lung fails to diffuse/descend, causing head distension/cough, body heat/epigastric stuffiness. This is evil in Wei level. If Wei level unresolved, it enters Qi level; if Qi level unresolved, evil transmits to Middle Jiao, then Ying level; if Ying level unresolved, it transmits to Lower Jiao and Blood level. All three jiaos affected, Ying-Wei diseased, even reverse transmission to Pericardium, evil entering Danzhong, showing signs of evil closure and righteous collapse. Thus, initially when evil is in Wei, use acrid-aromatics primarily to open/drain upper jiao. If summerheat carries wind invading Lung, Lung governs skin/hair, so it also acts as exterior release. Evil in Wei, exterior qi not diffused, summerwind stagnates and generates heat, Wei qi suppressed by evil, causing slight aversion to cold, chills/fever resembling malaria, fear of wind/cough. This is Summer Malaria, vastly different from Shaoyang Foot Meridian malaria. Treat via Hand Meridians, venting Lung-Wei summerheat.
Lung Damaged by Phlegm-Wheeze: Summerwind/heat damages Lung, causing body heat, phlegm-cough, and wheezing. Use Mulberry Leaf (Sangye), Almond (Xingren), Forsythia (Lianqiao), Gypsum (Shigao), Light Bamboo Leaf (Dan Zhuye), Tangerina Peel (Juhong), Trichosanthes Peel (Gualou Pi), Coix Seed (Yiren), and Reed Rhizome (Lugen). For sore throat, add Belamcanda (Shegan) and Bullace Seed (Niuxiang). For difficult urination, add Liuyi San. For head distension, add Fresh Lotus Leaf (Xian Heye).
Shao's Commentary: This section describes summerwind entering Lung, Lung having turbid phlegm, phlegm-heat damaging Lung, Lung ascending not descending causing wheeze/cough. Treatment should vent upper jiao, clear/transform phlegm-heat. If summer-damp damages qi, afternoon phlegm-wheeze worsens, Lung is primarily diseased. Also clear upper jiao, treating formless qi level, using Lugen, Xingren, Guashuang (Trichosanthes Frost), Yiren, Juhong, Chuan Bei (Fritillaria), Watermelon (Xigua), Cuiyi (Watermelon Rind), Tongcao, Fuling Pi (Poria Peel).
Shao's Commentary: Summerheat must carry dampness; summerheat enters upper jiao first. Combined with phlegm-heat damaging Lung qi, phlegm-wheeze worsens at noon. Transform phlegm and drain dampness using light drugs to open/drain formless Lung qi in upper jiao.
Summer-Damp Damages Stomach: Body heat, middle jiao fullness/oppression, lack of appetite/refusal to eat, difficulty with urination/defecation. This is summer-heat damaging middle jiao qi level, caused by heat-phlegm gathering in Stomach. Use bitter-acrid draining/descending method. Banxia Xiexin Tang remove Gancao (Licorice) and Ganjiang (Dried Ginger), add Xingren (Almond) and Zhishi (Immature Bitter Orange).
Shao's Commentary: Evil moves from upper jiao to middle jiao, from Wei level to Qi level. Upper jiao governs Lung, middle jiao governs Stomach. Disease causes fullness/oppression, lack of appetite. Summer-heat-damp-phlegm hides in middle jiao qi level, Stomach qi cannot diffuse. Use bitter-acrid to open fullness, vent middle jiao qi level.
Summerheat Enters Ying Level: Body heat, irritability, red face, crimson tongue, dull spirit, restless sleep at night. This is summerheat entering Heart. Use Chen Sha (Cinnabar), Liuyi San (Six-One Powder), plus Chuan Yujin (Curcuma) and Chuan Lian (Coptis). Or use Xijiao (Rhinoceros Horn - substitute with Buffalo Horn), Xianshengdi (Fresh Rehmannia), Shichangpu (Acorus), Chuan Yujin (Curcuma), Lianqiao (Forsythia), Yinhua (Honeysuckle).
Shao's Commentary: Evil enters Heart-Ying from Lung-Wei, progressing deeper. Heart governs blood and stores spirit. Ying-heat damages spirit, causing dullness and restless sleep. Clear heat to vent evil, allowing exit via Lung is appropriate. Otherwise, heat burns yin, evil enters Lower Jiao Blood level, risking yin exhaustion and evil sinking, or reverse transmission to Pericardium, internal closure and external collapse.
Summerheat Enters Danzhong: If summerheat initially damages qi level, causing fever/thirst, and mistreatment leads to evil transmitting to Danzhong, tongue becomes crimson and shrunk, urine is red/astringent, nasal coal/cracking/bleeding, deafness/coma. This is evil spreading from qi level to blood level. Fear internal closure and external collapse most. Urgently use Xijiao (Rhinoceros Horn), Shichangpu (Acorus), Chuan Yujin (Curcuma), Xianshengdi (Fresh Rehmannia), Yinhua (Honeysuckle), Lianqiao (Forsythia), Xuanshen (Scrophularia), and Xihuang (Musk).
Shao's Commentary: Summerheat enters via nose/mouth, first damaging upper jiao Lung-Wei. Lung inner membrane connects to Pericardium membrane. Heart is below Lung, path is closest, easily transmitting to Pericardium. Heart is Minister Fire, Pericardium is Minister Fire. Summerheat is Minister Fire commanding evil, same qi seeks same, entering Pericardium is easy. As Chen Wuzhe said, "Summerheat likes returning to Heart." Evil enters Ying level, reverse transmits to Pericardium, Yuan Shen damaged, yin blood exhausted, evil heat deeply enters palace city, often causing internal closure and external collapse. Urgently use clearing Heart, venting evil, aromatic opening closure method, e.g., Niuhuang Qingxin Wan, Zhibao Dan, Zixue Dan. Yet, ten out of ten may not survive.
Summerheat Enters Yangming: High fever, great thirst, dry retching, dry lips, thick yellow tongue coating, surging-rapid six pulses. This is summerheat entering Yangming. Use Huanglian Xiangru Yin (Coptis and Mosla Decoction) and Yiyuan San. For high fever, great thirst, great sweating, use Baihu Tang (White Tiger Decoction).
Shao's Commentary: Summerheat in upper jiao Lung-Wei, not transmitting to Heart-Ying, but entering Yangming Meridian. Symptoms: fever, thirst, dry retching, surging-rapid pulse, thick yellow coating. This is evil in Middle Jiao Yangming Stomach Meridian. Less sweat: Huanglian Xiangru Yin. Fever/thirst/great sweating: Baihu Tang. Evil entering Yangming has nowhere else to transmit, as Yangming is central earth, destination of all things. However, evil in Yangming has Meridian vs. Fu organ distinction. Meridian: clear; Fu: purge. Priority is saving fluids and driving out evil. Yangming governs diseases of fluids/jin-ye. If fluids exhausted in Yangming, evil sinks, qi collapses, death ensues. May linger two/four pentads, unlike Pericardium invasion directly striking palace city, Yuan Shen scattering, dying in one/two pentads with internal closure and external collapse.
Summerheat Enters Mo Yuan: Summer-turbidity enters via nose/mouth, knotting at Mo Yuan, causing epigastric stuffiness, chills/fever. Treat by clearing/dredging Mu Yuan. Use Guang Huojing (Patchouli Stem), Chuan Yujin (Curcuma), Binglang (Areca Nut), Houpo (Magnolia Bark), Cao Kou (Grass Cardamom), Qingpi (Green Tangerina Peel), Huashi (Talc), Lianqiao (Forsythia), Zisu (Perilla Leaf), Huangqin (Scutellaria).
Shao's Commentary: Summer-damp-turbid evil enters via nose/mouth, travels mid-way, spreads through three jiaos, knots at Mo Yuan. Mo Yuan is near Stomach, boundary of half-exterior/half-interior. Symptoms: chills/fever like malaria, actually not malaria. Vastly different from Shaoyang half-exterior/half-interior. Mimic Da Yuan Yin intent, use acrid-aromatic warming-transforming drugs to reach Mo Yuan summer-turbid evil.
Summerheat Enters Jueyin: Limbs not hot, heart feels like burning, grey-black tongue, excessive thirst, board-like hardness below heart, vomiting/nausea/vomiting roundworms, chills/fever like malaria. This is summerheat sinking into Jueyin. Condition is critical. Treat with sour-bitter draining heat, supporting righteousness, expelling evil. Use Renshen (Ginseng), Zhishi (Immature Bitter Orange), Chuan Lian (Coptis), Ganjiang (Dried Ginger), Huangqin (Scutellaria), Baishao (White Peony), Jiaomei (Pepper and Sour Plum).
Shao's Commentary: Summer-heat takes advantage of deficiency to sink into Foot Jueyin Liver Meridian. Jue means end; yin ends, yang generates. Wood contains Minister Fire, hence exterior not hot but interior burning. Fire burns fluids, causing thirst/consumption. Worms transform from Wind-Wood; heat excess generates wind, Wood evil invades Stomach, causing vomiting/worm expulsion. Evil knots unresolved, causing board-like hardness below heart. Liver/Gallbladder are exterior-interior, hence chills/fever like malaria. Evil sinks to extreme yin, condition dangerous. Jueyin symptoms often mixed cold-heat evils, so medicines must mix cold-heat.
Summer-Toxin Enters Intestines: Exposing to summerheat while drinking alcohol draws summer-toxin into intestines. Alcohol combines with summerheat, causing high fever, great thirst, difficult urination, urine color like blood. Wuling San remove Guizhi (Cinnamon Twig), add Chuan Lian (Coptis), Yinhua (Honeysuckle), Huashi (Talc).
Shao's Commentary: Summerheat is yang-hot evil, wine is hot-damp. Exposing to summerheat while drinking combines two heats, entering Small Intestine, Fire Mansion not diffusing, causing high fever, great thirst, urine red like blood. Heat knots in lower jiao, difficult urination. Use diuretic-clearing heat agents.
Latent Summerheat Internal Onset: Tidal fever, sweating without relief, irritability/thirst/vomiting/nausea, chest oppression, white tongue coating with grey-black tinge, red-astringent urine, or spontaneous diarrhea. This is latent summerheat internal onset, affecting all three jiaos. Prioritize clearing upper/middle. Use Huashi (Talc), Xingren (Almond), Tongcao, Juhong (Tangerina Peel), Banxia (Pinellia), Houpo (Magnolia Bark), Chuan Lian (Coptis), Yujin (Curcuma), Huangqin (Scutellaria).
Shao's Commentary: Humans contract summerheat, which lingers in three jiaos/intestines-stomach, erupting after time. Not erupting in summer, erupting in autumn or after Frost Descent. Later eruption means deeper hiding, heavier disease. Latent summerheat symptoms affect all three jiaos: vomiting/diarrhea/cholera, malaria-like but not malaria, or becoming malaria-dysentery. Summerheat must carry dampness, sticky evil, lingering inside, dragging on. Treat by venting Lung/Stomach, clearing summerheat/draining dampness, regulating three jiaos.
Summerheat Becomes Malaria: Headache, epigastric stuffiness, white-dry tongue, limb numbness, left pulse wiry/right pulse soggy, incessant chills/fever. This is summerheat entering interior, clouding clear orifices causing malaria. Clear upper jiao. Use Lianqiao (Forsythia), Huashi (Talc), Xingren (Almond), Chuan Yujin (Curcuma), Dan Zhuye (Light Bamboo Leaf), Banxia (Pinellia), Loupi (Trichosanthes Peel), Beimu (Fritillaria).
Shao's Commentary: Summerheat enters via nose/mouth, first into Lung, carrying internal phlegm-damp, becoming malaria. Though headache/chills/fever present, left pulse wiry indicates not exterior malaria, but evil hidden in Lung/Stomach, phlegm-heat steaming upward, clouding clear qi causing malaria. Different from Shaoyang wind-cold malaria. Clear Lung/Stomach summerheat, transform phlegm/drain damp.
Summer-Injury Complicated by Cold Contraction: After Minor Heat, first touching summerheat evil, then contracting cold evil, causing body heat/headache, aversion to cold/irritability/thirst, no sweat or spontaneous sweat, deficient-rapid pulse, white tongue coating. This is summer-injury followed by cold contraction, evil between Lung/Stomach. Use Zisu (Perilla), Bohe (Mint), Xiangru (Mosla), Qinghao (Artemisia), Huashi (Talc), Houpo (Magnolia Bark), Tongcao. Abdominal distension add Zhishi (Immature Bitter Orange), Fupi (Mandarin Orange Peel). Food retention add Zharon (Hawthorn), Qingpi (Green Tangerina Peel). Yellow-dry tongue/dry retching add Jiangzhi Chuanlian (Ginger-processed Coptis).
Shao's Commentary: First summerheat, then autumn cold, suppressing muscle surface. Symptoms: body heat/irritability/thirst/sweat are summerheat. Headache/aversion to cold/no sweat are exterior cold. Lung/Stomach first receive summer-heat, exterior contracts cold evil, exterior-interior both diseased. Internally clear summerheat, externally disperse exterior cold. Laborers working hard, exposing to summerheat by day, cooling off by night, causing headache/chills/fever like malaria. Liuhe Tang modified harmonizes.
Shao's Commentary: Middle qi weak, internal summer-heat, external cold-cool, exterior-interior both diseased, causing chills/fever/headache. Weak constitution carrying evil, support righteousness, clear summerheat, disperse cold.
Exposing to Summerheat Complicated by Fluid Retention: Due to summerheat, drinking too much cold water, causing water stopping below heart, suppressing summerheat. Symptoms: high fever/irritability/thirst, chest/diaphragm oppression, or wheezing urgency, difficult urination, or heavy body/pain, weak-moderate right pulse. Zhang Zhongjing uses Yi Wu Guiti San (Single-Ingredient Melon Spurge Powder) to induce vomiting. Or use Wuling San remove Baizhu (Atractylodes), add Zisu (Perilla), Houpo (Magnolia Bark), Tongcao, disperse and drain. Also resolves. Yellow-dry tongue add Jiangzhi Chuanlian (Ginger-processed Coptis).
Shao's Commentary: Water evil suppresses fire, causing Zhong-Yue symptoms. Summer heat, washing with cold water injures cold water, water moves in skin. Zhang Zhongjing uses Yi Wu Guiti San to remove upper jiao water. Drinking too much, stopping below heart, suppressing summerheat, causes heat/thirst/irritability/oppression. Fire qi rebels to Lung, causing wheezing/difficult urination. Cold water closes sweat/damp, stagnates yang qi, causing heavy body/pain. Summerheat damages yuan qi, right pulse weak. Drinking cold water suppresses yang qi, "form cold, drink cold damages Lung." Use Guiti to remove upper jiao fluid retention, Lung qi flows, water scatters. Later generations use Wuling San modified, also promoting yang/diuresis. Yellow-dry tongue, evil entered middle jiao, Yangming Stomach heat, add Chuanlian.
Exposing to Summerheat Complicated by Cold Injury: Due to summer-injury thirst, indulging in raw/cold fruits, causing cold wrapping summerheat. Use Liuhe Tang remove Renshen (Ginseng), Bian Dou (Broad Bean), add Zharon (Hawthorn). Chest/abdomen stuffiness/pain, white tongue coating middle/red edges, weak Qi Kou pulse, high body heat. This is acute cold-wrapping-summerheat. If slow onset, becomes malaria or dysentery.
Shao's Commentary: Summerheat is yang evil, heat burns fluids, causing thirst. Thirst drinks cold, indulges raw/cold fruits, injures spleen-stomach middle yang, suppresses yang qi, preventing summerheat from exiting. Self-induced by summer, not summer injury. Cold matter stagnates in middle palace, yang qi cannot extend, causing chest/abdomen stuffiness/pain. White middle/red edge tongue coating, cold suppresses heat evil. Middle deficiency/evil stagnation, weak pulse. High body heat is summerheat. Cold suppresses summerheat, use Liuhe Tang harmonize middle/disperse evil, add Hawthorn to resolve cold accumulation.
Summerheat Carries Dampness: Summerheat must carry dampness. Dampness is heavy-turbid evil, summerheat is steaming qi. Heat in dampness, damp-heat steaming, obstructing qi level. Treat in Hand Taiyin. If treatment misses the mark, evil has no outlet, gradually moves to Ying level, invades blood. Symptoms: coma/delirium, crimson tongue, or hemoptysis/phlegm. If clouding clear orifices, deafness/unhearing. Upper jiao unresolved, spreading middle/lower, board-like chest/abdomen fullness, difficult urination/defecation, becomes severe Wet-Warmth. Urgently clear three jiaos. Use Huashi (Talc), Shigao (Gypsum), Hanshuishi (Cold Water Stone), Xingren (Almond), Yinhua (Honeysuckle), Zhuru (Bamboo Shavings), Zhishi (Immature Bitter Orange), Tongcao, Jinzhi (Gold Juice). Subsequently use Xijiao (Rhinoceros Horn), Lianqiao (Forsythia), Yinhua (Honeysuckle), Xianshengdi (Fresh Rehmannia), Xuanshen (Scrophularia), Chuanbei (Fritillaria), Zhimu (Anemarrhena), Dan Zhuye (Light Bamboo Leaf), Ludoupi (Mung Bean Skin), clear Ying level to nourish stomach yin.
Shao's Commentary: Heaven heat descends, earth moisture ascends, steaming forms summerheat, thus summerheat carries dampness. Stagnating/steaming generates heat, entering upper jiao Lung-Wei first. Treat Hand Taiyin Lung Meridian first. Improper treatment, Wei evil unresolved, enters Qi level. Qi level summerheat unresolved, gradually enters Ying level. Ying level unresolved, enters Lower Jiao Blood level. "After Wei speaks Qi, after Ying speaks Blood." If Ying evil unresolved, reverse transmission to Pericardium, coma/deafness, orifices clouded, internal closure/external collapse. Treat clearing Ying/venting evil, aromatic opening closure primarily. Summer-damp-warmth first transmits upper jiao to middle/lower, starting Lung-Wei upper jiao, disease belongs to Qi/Ying levels. Transmitting middle/lower enters Blood level, burning/yin essence consumed, becomes severe. Thus Warm-summer follows three jiaos legislation for treatment.
Summerheat Carries Sha (Sand/Toxin): Summerheat combines with turbid qi, enters via nose/mouth, headache, aversion to cold, fever, or cold fingers/toes, deep-hidden pulse, fullness/oppression/vomiting/nausea, or abdominal pain/diarrhea. Treat clearing summerheat and expelling turbidity. Use Guang Huojing (Patchouli Stem), Chuan Yujin (Curcuma), Zisu (Perilla), Qinghao (Artemisia), Houpo (Magnolia Bark), Fuling Pi (Poria Peel), Huashi Fen (Talc Powder), Lianqiao (Forsythia), Cao Kou (Grass Cardamom), Tongcao. Add Qingpi (Green Tangerina Peel), Zharon (Hawthorn), Zhishi (Immature Bitter Orange) for food retention.