论
《内经》曰∶因于暑汗，烦则喘喝，静则多言。洁古曰∶静而得之为中暑，动而得之为中热。中暑者阴证，中热者
阳证。东垣曰∶暑热之时，无病之人，或避暑于深堂大厦得之者，名曰中暑，其病必头痛恶寒，身形拘急，肢节疼痛而
烦心，肌肤大热无汗，为房室之阴寒所遏，使周身之阳气不得伸越，大顺散等热药主之。若行人或农夫，于日中劳役得
之者，名曰中热，其病必苦头痛，发躁热恶热，扪之肌肤大热，必大渴引饮，汗大泄，无气以动，乃为大热外伤肺气，
苍术白虎等凉剂主之。王安道曰∶暑热之气一也，皆夏月中伤其邪而为病焉，岂以一暑热分为阴阳二证而名之耶？其避
暑于深堂大厦，及恣食藏冰瓜果寒凉之物，正经所谓口得寒物、身犯寒气之病耳，自当同秋冬即病阴证伤寒处治，不可
名中暑也。此论固是，抑亦有未悉之旨也欤。
愚按∶仲景伤寒论中，一证曰中 ，即中暑也，虚而微弱，烦渴引饮，体热自汗，此盖得劳役体虚而暑邪干卫之候，
是宜东垣清暑益气汤等补益之剂治之而愈。一证曰热病，即中热也，脉洪而紧盛，头疼身热，口燥心烦，此盖得之于冬
感寒邪，郁积至夏而发，乃挟暑而成大热之候，是宜黄连、白虎、解毒等汤清凉之剂调之而愈。曰中暑者，阴证内伤之
为病也；曰中热者，阳证外感之为病也。曰阴曰阳，岂不于斯而明辨之乎，学人宜再思之。
脉法
经曰∶脉虚身热，得之伤暑。
脉弦细芤迟。（许学士云∶伤暑，其脉弦细芤迟，何也？《内经》曰∶寒伤形，热防气。盖伤气而不伤形，则气消而
脉虚，所谓弦细芤迟，皆虚脉也。仲景以弦为阴，朱肱亦曰中暑脉虚细弱，暑脉虚可知矣。）
脉虚而微弱，或浮大而散，或隐不见。（微弱隐伏，皆虚类也。）
方法
丹溪曰∶夏月阳气尽出于地，人之腹属地气，阳气于此时浮于肌表，腹中之阴虚矣。夏月伏阴在内，此阴字有虚之
义，若作阴冷看误矣。古人治暑，有用大顺散等剂，盖以凉亭水阁寒凉冰雪之伤，不用温剂，病何由安，非为伏阴而用
也。火令之时，流金烁石，何阴冷之有。孙真人制生脉散，令人夏月服之，非虚而何。
暑证，用黄连香薷饮、清暑益气汤、五苓散等药。有挟痰者，加南星、半夏之类。挟虚者，加入参、黄 之类。
（以上丹溪方法凡二条）
戴氏曰∶暑有冒、有伤、有中，三者有轻重之分。或腹痛水泻者，胃与大肠受之。恶心者，胃口有痰饮。此二者冒
暑也，可用黄连香薷饮，黄连退热，香薷消暑气。或身热头疼、躁乱不宁者，或身如针刺者，此为热伤在肉分也，当以
解毒、白虎等汤加柴胡，气虚加人参。或咳嗽发寒热、盗汗出不止、脉微者，热在肺经，火乘金也，此为中暑，宜用清
肺汤、柴胡天水散之类急治则可。
清暑益气汤 治长夏湿热大胜，人感之多四肢困倦，精神短少，懒于动作，胸满气促，肢节烦疼，或气高而喘，
身热而烦，心下痞满，小便黄而数，大便溏而频，或泄黄如糜，或如泔色，或渴或不渴，不思饮食，自汗体重。或汗少
者，血先病而气未病也。其脉中得洪缓，若湿热相搏，必加之以迟，病虽互换少差，其脉暑湿令则一也，宜以清燥之剂
治之。
黄 （汗少，一钱） 苍术（各一钱半） 升麻（一钱） 人参 白术 陈皮 神曲（炒） 泽泻（各五分） 甘
草（炙） 黄柏（酒浸炒） 川归 青皮 麦门冬（去心） 干葛（各三分） 五味子（九粒）
上细切，作一服，水二盏，煎至一盏，去渣温服。
白虎汤（仲景） 治暑热发渴。（方见伤寒门。）
益元散（河间，一名天水散，一名六一散。） 治中暑，身热烦渴，小便不利。此药能燥湿，分利水道，实大腑，
化热毒，行积滞，逐凝血，补脾胃，降火之要药也。（方见痢门。）
香薷饮（局方） 治一切暑热腹痛，霍乱吐利烦心等证。
香薷（三钱） 浓朴（姜制） 白扁豆（炒，各一钱五分）
上细切，作一服，水二盏，煎七分，去渣温服。
黄莲香薷饮（局方） 治证同前，以前方去扁豆，加黄连七分半也。
十味香薷饮
香薷（一钱） 人参 陈皮 白术 白茯苓 白扁豆（炒） 黄 木瓜 浓朴（各五分，姜汁制炒） 甘草（炙，
五分）
上细切，作一服，水二盏，煎至一盏，去渣温服。
桂苓甘露饮（河间） 治伏暑，发渴脉虚。
桂心 人参 黄 茯苓 白术 甘草 葛根 泽泻 石膏 寒水石（各一两） 滑石（二两，火 ，另研） 木
香（一钱）
上为细末，每服三钱，白汤调下。
五苓散（方见伤寒门。） 本方加茵 ，名茵 五苓散，治湿热发热黄证最捷。
大顺散（易老）
甘草 干姜 杏仁（汤煮，去皮尖，炒） 肉桂（各等分）
上先将甘草用白砂同炒，次入姜，却下杏仁炒过，筛去砂，同桂研为细末，每服二钱，白汤调下。王安道曰∶大顺
散，本为冒暑伏热、引饮过多、脾胃受湿、呕吐、水谷不分、脏腑不调所立，故甘草、干姜皆经火炒，又肉桂而非桂枝，
盖温中药也。内有杏仁，不过取其能下气耳。若以此药治静而得之之证，吾恐不能解表，反增内烦矣。
愚按∶《内经》必先岁气，无伐天和。其暑月，岂可用此热药。此方虽录于此，不可轻用。
生脉散
人参 五味子 麦门冬（泡去心，各等分）
上细切，水煎，夏月时时代熟水饮之。孙真人曰∶夏月必服五味子，以补五脏气。东垣曰∶夏月服生脉散加黄 、
甘草，令人气力涌出。
（祖传方）
凡人夏月冲斥道途，或于田野中务农作劳，或肥白气虚之人，不能抵当暑热，忽然昏闷运仆，其气将绝。如在日中，
即当移病者于阴处，徐徐以温汤水灌之。如未苏，急灸气海穴，以复其元气。醒后，以大剂滋补之药补之。切不可灌以
凉水，即死。
愚按∶《内经》有曰∶阳气者，烦劳则张，精绝辟积，于夏使人煎厥，目盲不可以视，耳闭不可以听，愦愦乎若坏都，
乎不可止。是则中暑运厥之候也。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Affected by summerheat, one sweats; when vexed, there is panting and loud breathing; when quiet, there is excessive talking." Jiegu (Zhang Yuansu) stated: "Obtained while at rest, it is called Zhongshu (Summerheat Stroke); obtained during exertion, it is called Zhongre (Heat Stroke). Zhongshu belongs to Yin syndromes, while Zhongre belongs to Yang syndromes." Dongyuan (Li Gao) stated: "During the time of summerheat, healthy individuals who seek refuge in deep halls and large buildings and contract the disease are named as having Zhongshu. The illness must present with headache, aversion to cold, stiffness and constraint of the body, pain in the limbs and joints, and vexation. The skin and flesh are very hot but without sweat. This is because the yin-cold of the rooms suppresses the yang qi of the whole body, preventing it from extending and rising. Treatment should be primarily with hot medicines such as Dashun San (Great Harmony Powder). If pedestrians or farmers contract the disease while laboring under the midday sun, they are named as having Zhongre. The illness must involve painful headache, irritability, fever, aversion to heat, burning hot skin upon touch, extreme thirst with a desire to drink, profuse sweating, and lack of energy to move. This is due to great heat externally injuring Lung Qi. Treatment should be primarily with cool formulas such as Cangzhu Baizhu Tang (Atractylodes and White Tiger Decoction)." Wang Andao stated: "The qi of summerheat is the same; all are illnesses contracted by pathogenic factors in summer. How can one type of summerheat be divided into two syndromes of Yin and Yang and named differently? Those who avoid summerheat in deep halls and large buildings, or those who indulge in eating cold things like stored ice and melons, are suffering from what the Classic calls 'getting cold food in the mouth and cold qi on the body.' Naturally, they should be treated just like Yin syndrome Cold Damage occurring in autumn and winter, and should not be named Zhongshu." This argument is indeed correct, yet there may be principles not fully understood.
I observe: In Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage), one syndrome is called Zhongye (Summerheat Stroke), which is Zhongshu. It presents as deficiency with weak pulse, vexation and thirst with a desire to drink, body heat and spontaneous sweating. This is likely due to labor causing body deficiency, allowing summerheat pathogens to invade the Wei (Defensive) level. It is suitable to treat with tonifying agents such as Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) from Dongyuan for recovery. Another syndrome is called Re Bing (Heat Disease), which is Zhongre. The pulse is surging and tight/full, with headache and body heat, dry mouth and vexation. This is likely caused by cold pathogens contracted in winter, accumulating until summer to erupt, forming a great heat syndrome accompanied by summerheat. It is suitable to regulate with cooling agents such as Huanglian Tang (Coptis Decoction), Baizhu Tang (White Tiger Decoction), and Jiedu Tang (Detoxification Decoction) for recovery. Zhongshu refers to diseases caused by internal injury of Yin syndromes; Zhongre refers to diseases caused by external contraction of Yang syndromes. Regarding Yin and Yang, is it not clearly distinguishable here? Students should ponder this further.
Pulse Methods
The Classics state: "Weak pulse and body heat result from injury by summerheat."
Pulse is wiry, fine, hollow, and slow. (Scholar Xu said: Why is the pulse for summerheat injury wiry, fine, hollow, and slow? The *Neijing* says: Cold injures the form, heat damages the qi. Since qi is damaged but not the form, qi diminishes leading to a weak pulse. The so-called wiry, fine, hollow, and slow are all deficiency pulses. Zhang Zhongjing considers wiry as Yin, and Zhu Gong also said the pulse for summerheat stroke is weak and fine. Thus, the summerheat pulse is known to be deficient.)
Pulse is weak and faint, or floating, large, and scattered, or hidden and invisible. (Faint and hidden both belong to deficiency categories.)
Methods
Danxi (Zhu Zhenheng) stated: "In summer, yang qi emerges entirely from the earth. The human abdomen belongs to earth qi. At this time, yang qi floats on the muscle surface, making the yin inside the abdomen deficient. Summer has latent yin within; this 'yin' character implies deficiency. Viewing it as cold would be a mistake." Ancient people treating summerheat used agents like Dashun San (Great Harmony Powder), presumably because injuries from cool pavilions, water towers, cold snow, and ice require warm agents to heal; it was not used for 'latent yin'. During the fire season, when metal melts and stones scorch, where is there cold? Sun Taizhen (Sun Simiao) formulated Shengmai San (Generate Pulse Powder) for summer use; if not for deficiency, why use it?
For summerheat syndromes, use Huanglian Xiangru Yin (Coptis and Mosla Drink), Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction), Wuling San (Five-Ingredient Powder with Poria), etc. For cases complicated by phlegm, add Tian Nan Xing (Arisaema Rhizome) and Ban Xia (Pinellia Tuber). For cases complicated by deficiency, add Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root).
(Above are two rules of treatment from Danxi.)
Dai stated: Summerheat has Mao (Encounter), Shang (Injury), and Zhong (Stroke), with three degrees of severity. Abdominal pain with watery diarrhea indicates involvement of the Stomach and Large Intestine. Nausea indicates phlegm-fluid in the stomach opening. These two are Mao Summerheat, treatable with Huanglian Xiangru Yin; Huanglian clears heat, Xiangru dissipates summerheat qi. Body heat, headache, restlessness, or sensation like needle pricks indicate heat injuring the muscle layer; treat with Jiedu Tang (Detoxification Decoction) or Baizhu Tang (White Tiger Decoction) plus Chai Hu (Bupleurum Root); add Ren Shen (Ginseng Root) for qi deficiency. Cough with alternating chills and fever, endless night sweats, and faint pulse indicate heat in the Lung Meridian, with Fire overcoming Metal; this is Zhong Summerheat, treat urgently with Qingfei Tang (Clear Lung Decoction) or Chai Hu Tianshui San (Bupleurum and Heavenly Water Powder).
Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) treats long summer seasons with excessive damp-heat. Patients often suffer from four-limb fatigue, shortness of spirit, reluctance to move, chest fullness and shortness of breath, painful limbs and joints, high-pitched breathing and panting, body heat and vexation, epigastric fullness, yellow and frequent urination, loose and frequent stools, or yellow diarrhea like millet gruel or rice water, thirst or no thirst, loss of appetite, spontaneous sweating, and heavy body. If sweat is scant, blood is diseased first while qi is not. The pulse is surging and moderate; if damp-heat struggles, it adds slowness. Though symptoms vary slightly, the pulse remains consistent under the influence of summer-dampness. Treat with drying and clearing agents.
Huang Qi (Astragali Radix, 1 qian if scant sweat), Cang Zhu (Atractylodis Rhizoma, 1.5 qian each), Sheng Ma (Cimicifugae Rhizoma, 1 qian), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Shen Qu (Massa Medicata Fermentata, stir-fried), Ze Xie (Alismatis Rhizoma, 0.5 qian each), Gan Cao (Liquorice Radix, honey-fried), Huang Bo (Phellodendri Cortex, wine-soaked and stir-fried), Chuan Gui (Angelicae Sinensis Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Mai Men Dong (Ophiopogonis Tuber, heart removed), Ge Gen (Puerariae Lobatae Radix, 0.3 qian each), Wu Wei Zi (Schisandrae Fructus, 9 grains).
Finely cut, take one dose. Add two cups of water, decoct to one cup, remove dregs, and take warm.
Baizhu Tang (White Tiger Decoction) (Zhang Zhongjing) treats thirst caused by summerheat. (Formula see Shanghan Section.)
Yiyuan San (Heavenly Element Powder) (Liu Hejian, also known as Tianshui San or Liuyi San) treats summerheat stroke with body heat, vexation, thirst, and difficult urination. This medicine dries dampness, separates and benefits the water passages, solidifies the Large Intestine, transforms heat toxins, moves stagnation, expels stagnant blood, tonifies Spleen and Stomach, and is a key herb for descending fire. (Formula see Dysentery Section.)
Xiangru Yin (Mosla Drink) (Jufang) treats all summerheat abdominal pain, cholera-like vomiting and diarrhea with vexation.
Xiang Ru (Moslae Herba, 3 qian), Hou Po (Magnoliae Officinalis Cortex, ginger-processed), Bian Dou (Vigna Radiata Semen, stir-fried, 1.5 qian each).
Finely cut, take one dose. Add two cups of water, decoct to 0.7 cup, remove dregs, and take warm.
Huanglian Xiangru Yin (Coptis and Mosla Drink) (Jufang) treats the same syndromes as above, removing Bian Dou from the previous formula and adding Huang Lian (Coptidis Rhizoma, 0.75 qian).
Shiwei Xiangru Yin (Ten-Ingredient Mosla Drink)
Xiang Ru (Moslae Herba, 1 qian), Ren Shen (Ginseng Radix), Chen Pi (Citri Reticulatae Pericarpium), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Bian Dou (Vigna Radiata Semen, stir-fried), Huang Qi (Astragali Radix), Mu Gua (Chaenomelis Fructus), Hou Po (Magnoliae Officinalis Cortex, 0.5 qian each, ginger juice processed and stir-fried), Gan Cao (Liquorice Radix, honey-fried, 0.5 qian).
Finely cut, take one dose. Add two cups of water, decoct to one cup, remove dregs, and take warm.
Guiling Ganlu Yin (Cinnamon, Poria, and Sweet Dew Drink) (Liu Hejian) treats latent summerheat with thirst and weak pulse.
Gui Xin (Cinnamomi Cortex), Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Liquorice Radix), Ge Gen (Puerariae Lobatae Radix), Ze Xie (Alismatis Rhizoma), Shi Gao (Gypsum Fibrosum), Hanshui Shi (Halloysit Rubrum, 1 liang each), Hua Shi (Talcum, 2 liang, calcined and ground separately), Mu Xiang (Aucklandiae Radix, 1 qian).
Grind into fine powder. Take 3 qian per dose, mixed with plain boiled water.
Wuling San (Five-Ingredient Powder with Poria) (See Shanghan Section.) Adding Yin Chen (Artemisiae Scopariae Herba) to this formula creates Yinchen Wuling San, which is most effective for damp-heat fever with jaundice.
Dashun San (Great Harmony Powder) (Yang Yilao)
Gan Cao (Liquorice Radix), Gan Jiang (Zingiberis Rhizoma), Xing Ren (Armeniacae Semen Amarum, boiled in water, skin and tip removed, stir-fried), Rou Gui (Cinnamomi Cortex, equal parts).
First stir-fry Gan Cao with white sand. Then add Gan Jiang, followed by Xing Ren. Stir-fry, sieve out the sand, and grind together with Rou Gui into a fine powder. Take 2 qian per dose, mixed with plain boiled water. Wang Andao said: Dashun San was established for encountering summerheat with latent heat, excessive drinking, Spleen-Stomach dampness, vomiting, indistinguishable food and water, and disharmony of zang-fu. Hence, Gan Cao and Gan Jiang are fire-roasted, and Rou Gui (not Guizhi/Cinnamon Twig) is used, as it is a warming medicine. Xing Ren is included merely for its ability to direct qi downward. Using this medicine for syndromes obtained while at rest, I fear it cannot release the exterior and will instead increase internal vexation.
I observe: The *Neijing* states: "One must first consider the seasonal qi and not violate the harmony of Heaven." In the summer month, how can such hot medicines be used? Although recorded here, this formula should not be used lightly.
Shengmai San (Generate Pulse Powder)
Ren Shen (Ginseng Radix), Wu Wei Zi (Schisandrae Fructus), Mai Men Dong (Ophiopogonis Tuber, soaked and heart removed, equal parts).
Finely cut, decoct in water. Drink frequently in summer instead of boiled water. Sun Taizhen said: "In summer, one must consume Wu Wei Zi to tonify the qi of the five zang organs." Dongyuan said: "Consuming Shengmai San with added Huang Qi and Gan Cao in summer causes qi and strength to surge forth."
(Ancestral Formula)
When ordinary people travel on roads or farm in fields during summer, or when obese and qi-deficient individuals cannot withstand summerheat, they may suddenly become faint, dizzy, and collapse, with breath nearly failing. If in the sun, immediately move the patient to a shady place and slowly pour warm water into their mouth. If not revived, urgently moxa Qihai (CV6) to restore yuan qi. After waking, tonify with large doses of nourishing medicines. Do not pour cold water, or death will ensue.
I observe: The *Neijing* says: "When yang qi is subjected to excessive labor, it expands excessively; essence is exhausted and accumulates, causing Jianjue (Frying Syncope) in summer. Eyes become blind and cannot see, ears closed and cannot hear, mind confused like a broken dam, unstoppable. This is the presentation of summerheat syncope."