经义
气虚身热，得之伤暑。○后夏至日为病暑。暑当与汗皆出，勿止。○因于暑汗，烦则喘喝，静则多言。（《素问》）
哲言
太阳中 ，发热恶寒，身重疼痛，其脉弦细芤迟，小便已洒洒然毛耸，手足逆冷，小有劳身即热，口
开，前板齿燥。若发其汗则恶寒甚；加温针则发热甚；数下之则淋甚。○太阳中 者，热是也。汗出恶寒，身
热而渴，白虎加人参汤主之。○太阳中 ，身热疼重而脉微弱，此以夏月伤冷水，水行皮中所致也。一物瓜
蒂散主之。（《金匮》）
人知冬不藏精者致病，不知夏不藏精者更甚焉。尝见怯弱之人，而当酷暑，每云气欲闷绝。可知中
而死者，直因气之闷绝也。夫人值摇精，恒多气促，与当暑之气闷不甚相远。《经》曰热伤气，又曰壮火食气。
余故曰∶夏令之炎威，甚于冬令之寒，苟不藏精，壮者至秋发为伏暑，怯者即中 而死。（《吴医汇讲》）
伤暑与伤寒，身皆发热，不可不辨明施治。盖寒伤形，暑伤气。伤寒则恶寒而脉浮紧，伤暑则不恶寒而
脉虚。《经》曰∶脉盛身寒，得之伤寒；脉虚身热，得之伤暑。（《赤水玄珠》）
暑证变幻无常。彼暴中之激烈，扁鹊不及 指而投咀；久伏之毒深，长桑莫能隔肤而见脏。即寻常之
感，亦难于知觉，非若伤寒之有定期定证可据可疗者，不拘表里，不以渐次，不论脏腑。冒暑从口鼻入，直入
心包，先烦闷后身热；入肝则眩晕顽麻；入脾则昏睡不觉；入肺则喘咳痿 ；入肾则消渴。中暑归心，神昏
卒倒；暑伤肉分，周身烦躁，或如针刺，或有赤肿；暑入肠胃，腹痛霍乱吐泻；暑伏三焦，变出寒热不定，膨
胀中满，疟痢下血。治法，清内火为主，解表兼之。寒之中人乘其虚，暑则虚实并中，而实者更剧。盖强盛之
人，内有伏火，加之外火相合，故焦灼为甚。经虚处，寒栖之；经实处，暑栖之。寒凌其弱，暑亲其类也。
藜藿常被寒，膏粱独能御，暑则不问膏粱、藜藿，咸能侮之。虽广厦累冰，轻罗纨绮，一犯其烈焰，讵能却
之乎？是以知暑气之毒甚于寒。乃古人专以寒为杀厉之气，而不及暑者，何也？试观伤寒至七、八日方危，暑
病则有危在二、三日间，甚至朝发暮殆，尤有顷刻忽作，拯救不及者，如暑风、干霍乱之类是也。且暑证
多歧，中热、中 、中内、中外、为厥、为风、为颠痫，即发则泄泻霍乱，积久后发则疟痢疮疡。种种病名，
皆暑为厉，则杀厉之气，视寒岂少哉！（《温热暑疫全书》）
暑有八证∶脉虚、自汗、身热、背寒、面垢、烦渴、手足微冷、体重是也。○阳暑者，因暑受热也。在
仲景谓之中 。凡盛暑烈日之时，或于长途，或于田野，不辞劳苦，以致热邪伤阴，而病为头疼烦热、大渴大
汗、脉浮气喘，或无气以动等证。此以暑月受热，故名阳暑。治宜察气之虚实、火之微甚，或补或清，与阴
暑之治不同。○阴暑者，因暑受寒也。凡人之畏暑贪凉，或于深堂大厦，或于风地树阴，或乍热乍寒之时不
谨衣被，以致寒邪袭于肌表，而病为发热头痛、无汗恶寒、肢体酸痛等证。此名阴暑，即伤寒也。治宜温散。
又有不慎口腹，过食生冷，以致寒凉伤脏，而为呕吐、泻利、腹痛等证。此寒邪在内，亦阴暑之属。治宜温
中。○凡中暑热者，人皆知为阳证，而不知阳中有阴也。盖外中暑热，而内亦热者，方是阳证；若内本无热，
而因热伤气，但气虚于中者，便有伏阴之象。故凡治暑热之证，最当辨其阴阳虚实。若脉虚无力，证见恶寒、
呕恶、腹痛、泄泻、不喜凉饮、息短气促之类，皆阳中之阴证也。治当专顾元气，惟独参
汤最妙。若兼微呕恶寒者，宜加炮姜，甚者养中煎、理中汤、理阴煎随宜用之；若虚寒之甚，则舍时从证，
桂、附皆所必用，勿因暑热之名而执用寒凉，再伐阳气。○夏月盛暑之时，必令身有微汗，此养身之道也。若
必使快然无汗，则阴胜于阳，多致疾矣。观之《经》曰∶暑当与汗皆出，勿止。是言暑汗之勿宜止也。又
曰∶夏暑汗不出者，秋成风疟。是言暑汗不出之为病也。此夏月之汗宜否，盖可知矣。（张景岳）
暑为阳邪，故蒸热；暑必兼湿，故自汗。暑邪干心则烦，干肺则渴，干脾则吐利，上蒸于头则重而痛，暑
伤气故倦怠。夏至日后病热为暑，暑者，相火行令也。人感之自口鼻而入，伤心包络之经，暑喜伤心故也；
其脉虚，或浮大而散，或弦细芤迟，盖热伤气，则气消而脉虚弱。治法宜清心、利小便、补真气为要，热渴者
并宜滋水。盖渴则阳气内伐，热舍于肾，令人骨乏无力，总由火盛则金病水衰，肾与膀胱俱竭。当急救之，补
肺气以滋水之上源，生脉散既扶元气，复保肺生津耳。（《冯氏锦囊》）
中暑中 ，脉虚脉沉，无汗有汗，发热不热，作渴不渴，或泻不泻，饮寒饮热，须辨其阴阳虚实，不
可泛投寒凉。盖夏月伏阴在内，古人用附子大顺散温补阳气，厥有旨哉！何今之老弱，夏月反服香薷饮，以为
解暑，复伤元气，无不招引暑邪，以致不起。至若清暑益气汤，内有泽泻、神曲、苍术、黄柏之类，必果
湿热壅滞，方可用之，否则反损其阴。用当审察。（薛立斋）
洁古云∶静而得之为中暑，动而得之为中热。中暑者阴证也，中热者阳证也。东垣云∶避暑于深堂大
厦得之者，名曰中暑。其病头痛恶寒，身形拘急，肢痛烦心，肤热无汗。此为房室之阴寒所遏，使周身阳气不
得伸越。大顺散主之。若行人农夫于日中劳役得之者，名曰中热。其病头痛恶热，肌肤大热，渴饮汗泄，
无气以动。此为天热，外伤肺气。苍术白虎汤主之窃谓暑热者，夏之令也。人或劳动，或饥饿，元气亏乏，
不足以御天令之亢极，
于是受伤而为病，名曰中暑，亦名中热，其实一也。今乃以动静所得分之，何哉？夫中暑热者，固多在劳役
之人。劳役则虚，虚则邪入，邪入则病；不虚则天令虽亢，亦无由以伤之。彼避暑于深堂大厦，所得头痛、恶
寒等证者，盖感冒风凉耳。其所以烦心与肌热者，非暑邪也，乃身中阳气被外邪所遏而作也。既非暑邪，其可
以中暑名乎？治则辛温发散可也。夫大顺散一方，本为冒暑引饮过多，脾胃受湿，呕吐水谷不分，脏腑不调所
立，盖温中药也。若以此药治静而得之之证，吾恐不能解表，反增内烦矣。世俗不明，类曰夏月阴气在内，大
顺散为必用之药。夫阴气，非寒气也。盖夏月阳气发泄于外，而阴气则在内耳。岂竟视阴气为寒气，而用温热
之药乎？阴果为寒，何以夏日则饮水乎？然则苍术白虎汤，岂可视为通行之药？必参之治暑诸方，随所见证而
用之。若夫所谓静而得之之证，虽当夏月，却非暑病，宜分出之，勿使后人有似同而异之惑。（王安道）
古称静而得之为中暑，动而得之为中热，暑阴而热阳也。不思暑字以日为首，正言热气之袭人耳。夏日
烈烈，为太阳之亢气，人触之则生暑病；至于静而得之者，乃纳凉于深堂水阁，大扇风车，嗜食瓜果，致生寒
疾。或头痛身痛，发热恶寒者，外感于寒也；或呕吐腹痛，四肢厥冷者，直中于寒也。与暑证有何干涉？大抵
辨暑证法，以自汗、口渴、烦心、溺赤、身热、脉虚为的。然有伤暑、中暑、闭暑之不同∶伤暑者，感之轻者
也。其证烦热口渴，益元散主之。中暑者，感之重者也。其证汗大出，昏闷不醒，或心烦喘喝。妄言昏闷之
际，先以消暑丸灌之；醒后验其暑气之轻重，轻者益元散，重者白虎汤。闭暑者，内伏暑气而外为风寒所闭。
其证头痛身痛，发热恶寒者，风寒也；口渴烦心者，暑也。四味香薷饮加荆芥、秦艽主之。（程钟龄）
天之暑热一动，地之湿浊自腾，人在蒸淫热迫之中，若正气设或有隙，则邪从口鼻吸入，气分先阻，上
焦清肃不行，输化之
机失其常度，水谷之精微亦蕴结而为湿也。故暑病必挟湿者，即此义耳。前人有因动因静之分，或伤或中
之候，以及入心入肝、为疟为痢、中瘀霍乱、暴厥、卒死，种种传变之原，各有精义可参。想大江以南，地
卑气薄，湿胜热蒸，当此时候，更须防患。昔李笠翁所谓使天只有三时而无夏，则人之病也必稀。此语最确。
盖暑湿之伤，骤者在当时为患，缓者于秋后为伏气之疾。其候也，脉色必滞，口舌必腻，或有微寒，或单发
热，热时脘痞气窒，渴闷烦冤，每至午后则甚，入暮更剧，热至天明得汗，则诸恙稍缓，日日如是，必要两三
候外，日减一日，方得全解。倘元气不支，或调理非法，不治者甚多。然是病比之伤寒，其势觉缓；比之疟
疾，寒热又不分明。变幻与伤寒无二，愈期反觉淹缠。若表之，汗不易彻；攻之，便易溏泻；过清，则肢冷呕
恶；过温，则唇齿燥裂。每遇秋来，最多是证，求之古训，不载者多，独《己任编》名之曰秋时晚发。感证似
疟，当以感证之法治之。要知伏气为病，四时皆有，但不比风寒之邪一汗而解，温热之气投凉即安。夫暑与湿，
为熏蒸粘腻之邪也，最难骤愈。若治不中 ，暑热从阳上熏而伤阴化燥，湿邪从阴下沉而伤阳变浊，以致神昏
耳聋、舌干龈血、脘痞呕恶、洞泄肢冷，棘手之候丛生，竟至溃败莫救。先生宗刘河间《三焦论》立法，认明
暑湿二气何者为重？再究其病实在营气何分？大凡六气伤人，因人而化，阴虚者火旺，邪归营分为多；阳虚
者湿胜，邪伤气分为多。一则耐清，一则耐温，脏性之阴阳，从此可知也。于是在上者，以辛凉微苦，如竹叶、
连翘、杏仁、薄荷之类；在中者，以苦辛宣通，如半夏泻心之类；在下者，以温行寒，性质重开下，如桂苓甘
露饮之类。此皆治三焦之大意也。或有所夹，又须通变。至于治气分，有寒温之别，寒者宗诸白虎法及天水散
意；温者从乎二陈汤及正气散法。理营分，知清补之宜，清者如犀角地黄加入心之品；补者有三才、复脉等方。
又如湿热沉混之苍术石膏汤，气血两燔之玉女法，开闭
逐秽与牛黄、至宝、紫雪等剂，扶虚进参附、两仪诸法，随其变幻，审其阴阳，运用之妙，存乎一心也。
（《临证指南》）
风者，阳也。暑者，热也。《经》曰∶诸暴强直，皆属于风；诸风眩掉，皆属于肝。又曰∶暑胜则地热；
风胜则动。陈无择曰∶暑喜归心，心中之使人噎闷，昏不知人；入肝则眩晕顽痹。戴氏曰∶夏月卒倒，不省人
事，名曰暑风。王节斋曰∶治暑之法，清心、利小便最好。由此观之，则治暑风之法，惟以清暑驱风为第
一要着，虽见搐搦等证，不可作世俗惊风治之。风暑除，搐搦自定。（方星岩）
暑厥即 病，兼手足厥冷，与伤寒发厥义同。（《医学入门》）
大概兼恶寒发热而渐厥者，为心脾中暑证也；不恶寒但恶热而渐厥者，为膀胱中 证也。若但恶寒不发
热而渐厥者，为夏月感寒阴证也，不与暑、 证同类。○中暑宜解暑和中，中 宜泻火益元，伤暑宜补元气，
冒暑宜清利二便。（《证治汇补》）
暑证临死必抽掣。虽云暑伤气，然久必亡阴耗液，筋无所养，则搐搦矣。○暑证死后身青与阴证之身青
不同，阴证身青，乃血凝；暑证则口鼻必流血。（《见闻录》）
人知清暑，我知益气，以暑伤气也。益气不独金能敌火，凡气之上腾为津为液者，回下即肾中之水，水
足，火淫自却矣。（程郊倩）
暑热伤气，益气而暑自消；暑热伤阴，益阴而暑自退。（《会心录》）
中 ，用白虎汤，热伤形也；用人参白虎汤，兼伤无形之气也。中暑，用生脉散，暑伤无形之气也；
用清暑益气汤，暑伤于气，兼挟风热，乘虚而伤其经也。伤暑，用十味香薷饮，风热湿杂合，而伤形气也。偏
于表则变香薷饮为消暑十全；偏于里则变香薷饮为六和汤。此夏月鼎峙三法也。其用消暑丸者，上盛之湿泛滥
而为痞满也；用益元散者，下盛之热阻滞而为溺涩也；用大顺散者，水果内伤于脾也；用冷香饮者，冷食内
伤于胃也；用来复
丹者，阴气固结于下也；用五苓散者，阳气遏绝于内也。○触热劳形，卒然倒仆，方书用热土置当脐，聚溺其
腹，捣蒜汁注鼻，立法最精。然未经阐发，世都不解。殊不知此虽酷烈为患，良由其人真元素亏，加以时火亢
极，鼓激命门，虚阳 然离根，非藉热土、热溺不能护卫其阳；用蒜汁注鼻者，取蒜以开窍，温散其郁闭之热
也。若与冷水灌之，则气随焰息而绝矣。（《张氏医通》）
夏月人身之阳以汗而外泄，人身之阴以热而内耗，阴阳两俱不足。仲师于中 病禁用汗、下、温针者，
盖汗则伤其阳，下则伤其阴，温针则引火热内攻故也。而其用药，但取甘寒生津保肺、固阳益阴为治。《灵
枢》有云∶阴阳俱不足，补阳则阴竭，泻阴则阳亡。盖谓阳以阴为宅，补阳须不伤其阴；阴以阳为根，泻阴
须不动其阳。夫既阴阳俱不足，则补泻未可轻言，才有补泻，必造其偏，如重阴、重阳之属。所以过用甘温，
[Classic Discourse]
Qi deficiency with body heat results from summerheat injury. ○ Diseases occurring after the Summer Solstice are termed summerheat diseases. Summerheat should be expelled along with sweat; do not forcibly stop sweating. ○ Due to summerheat, sweating occurs; when irritable, there is panting and loud shouting; when quiet, there is excessive talking. (Suwen)
[Philosophical Remarks]
Taiyang Zhong-Yue (Sunstroke), characterized by fever, aversion to cold, heaviness and pain in the body, with a pulse that is wiry, thin, hollow (Kou), or slow. After urination, one feels chilly with gooseflesh, cold hands and feet, and slight exertion causes fever, open-mouth breathing, and dryness of the anterior teeth. If sweating is induced, aversion to cold worsens; if moxibustion is applied, fever intensifies; if purgatives are used repeatedly, strangury worsens. ○ Taiyang Zhong-Yue refers to heat pathogen. If sweating, aversion to cold, fever, and thirst are present, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. ○ In Taiyang Zhong-Yue, if there is fever, heavy painful body, and a weak pulse, this is caused by injuring cold water in summer, with water qi circulating in the skin. Yiwu Gaudi San (Single-Ingredient Melon Pedicel Powder) is indicated.
People know that failing to store essence in winter leads to disease, but do not realize that failing to store essence in summer is even more severe. I have seen frail individuals during intense summer heat often complaining of suffocating breathlessness. It can be known that those who die from Zhong-Yue (Sunstroke) die directly due to Qi suffocation. When people deplete their essence, they often experience shortness of breath, which is not far different from the Qi suffocation in summerheat stroke. The Classics state: "Heat injures Qi," and also "Blazing fire consumes Qi." Therefore, I say: The fierce heat of summer is more severe than the cold of winter. If essence is not stored, robust individuals may develop latent summerheat in autumn, while frail individuals may die immediately from Zhong-Yue. (Wu Yi Hui Jiang)
Shang-Shu (Summerheat Injury) and Shang-Han (Cold Injury) both present with body heat, so differentiation is essential for treatment. Generally, cold injures the form, while summerheat injures Qi. Cold injury presents with aversion to cold and a floating-tight pulse; summerheat injury presents without aversion to cold but with a deficient pulse. The Classics state: "Pulse full with body cold comes from cold injury; pulse deficient with body heat comes from summerheat injury." (Chishui Xuanzhu)
Summerheat patterns change unpredictably. In acute, violent attacks, even Bian Que would not have time to identify and prepare herbs; for deep-seated, long-latent toxins, even Chang Sang Jun could not see the organs through the skin. Even ordinary infections are hard to perceive, unlike cold injury which has fixed timing and symptoms for treatment. Summerheat does not adhere to exterior/interior distinctions, does not progress gradually, and affects any zang-fu. Contracting summerheat via mouth and nose, it enters the Pericardium directly, causing irritability followed by fever; entering the Liver causes dizziness and numbness; entering the Spleen causes lethargy and unconsciousness; entering the Lungs causes panting, cough, and flaccidity; entering the Kidneys causes Xiao Ke (Wasting-Thirst). Zhong-Shu (Severe Sunstroke) affects the Heart, causing coma and sudden collapse; summerheat affecting muscle layers causes whole-body irritability, needle-like pain, or red swelling; summerheat entering the Stomach and Intestines causes abdominal pain, Huoluan (Cholera-like vomiting and diarrhea); summerheat latent in the Sanjiao (Triple Burner) causes alternating chills and fever, distension, malaria, dysentery, and bloody stool. Treatment focuses on clearing internal fire, supplemented by releasing the exterior. Cold pathogens attack when deficiency exists; summerheat attacks both excess and deficiency, with excess cases being more severe. Robust individuals have latent fire internally, combined with external fire, leading to severe scorching. Cold resides where meridians are deficient; summerheat resides where meridians are excess. Cold bullies weakness; summerheat attracts similarity. Those eating coarse food are often injured by cold; those eating rich food resist cold, but summerheat invades both. Despite cool mansions and ice, light silks cannot withstand its blazing flame. Thus, summerheat toxicity is greater than cold. Why did ancients consider only cold as a lethal pathogen, ignoring summerheat? Observe that cold injury becomes critical on days 7-8, while summerheat can be critical in 2-3 days, or even morning onset evening death, or sudden instantaneous onset like Shu Feng (Summerwind) or Gan Huoluan (Dry Cholera). Moreover, summerheat patterns are diverse: Zhong-Re (Heat Stroke), Zhong-Yue (Sunstroke), Zhong-Nei (Internal), Zhong-Wai (External), Jue (Collapse), Feng (Wind), Dian-Xian (Epilepsy); immediate onset causes diarrhea and cholera; long-term latency causes malaria, dysentery, sores, and ulcers. All these names are caused by summerheat as a lethal pathogen; is its lethality less than cold?! (Wen Re Shu Yi Quan Shu)
There are eight summerheat signs: deficient pulse, spontaneous sweating, body heat, cold back, greasy face, irritability and thirst, slightly cold hands and feet, and heavy body. ○ Yang-Shu (Yang Summerheat) results from heating up in summer. Zhang Zhongjing called this Zhong-Yue. During intense sun, whether traveling long distances or working in fields, enduring hardship leads to heat injuring Yin, causing headache, irritability, fever, extreme thirst, profuse sweating, floating rapid pulse, panting, or lack of energy to move. This is named Yang-Shu because it results from heating in summer months. Treatment requires assessing Qi deficiency/excess and fire mild/severe, using tonification or clearing, differing from Yin-Shu treatment. ○ Yin-Shu (Yin Summerheat) results from catching cold in summer. People fearing heat seeking coolness, staying in deep halls, under trees, or neglecting clothing during temperature changes, allow cold pathogens to invade the muscle surface, causing fever, headache, no sweating, aversion to cold, and limb soreness. This is Yin-Shu, equivalent to Cold Injury. Treatment requires warming and dispersing. Also, careless diet, overeating raw/cold foods, damages internal organs with cold, causing vomiting, diarrhea, and abdominal pain. This is internal cold, belonging to Yin-Shu. Treatment requires warming the Middle. ○ Regarding summerheat, people know it is a Yang pattern, but fail to see Yin within Yang. If external summerheat combines with internal heat, it is a Yang pattern; if there is no internal heat initially, but heat injures Qi causing central Qi deficiency, there are signs of latent Yin. Therefore, treating summerheat requires distinguishing Yin/Yang and Deficiency/Excess. If pulse is weak, signs include aversion to cold, nausea/vomiting, abdominal pain, diarrhea, dislike of cold drinks, shortness of breath—these are Yin within Yang patterns. Treatment must focus on protecting Yuan Qi; Dushen Tang (Single Ginseng Decoction) is best. If accompanied by mild nausea/aversion to cold, add Pao Jiang (Prepared Ginger); for severe cases, use Yangzhong Jian, Lizhong Tang, or Liyin Jian as appropriate. For extreme deficiency-cold, ignore season and follow pattern; Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) are necessary. Do not stick to cold/cool herbs due to the name "summerheat," further damaging Yang Qi. ○ In midsummer, slight sweating is essential for health. Forcing no sweat makes Yin overcome Yang, leading to disease. The Classic says: "Summerheat should exit with sweat; do not stop it." And: "If summer sweat does not occur, wind-malaria forms in autumn." This explains the pathology of no summer sweat. Thus, the appropriateness of summer sweating is clear. (Zhang Jingyue)
Summerheat is a Yang pathogen, hence steaming heat; summerheat always combines with dampness, hence spontaneous sweating. Summerheat disturbing the Heart causes irritability; disturbing the Lungs causes thirst; disturbing the Spleen causes vomiting/diarrhea; rising to the head causes heaviness and pain; summerheat injures Qi, causing fatigue. Heat after Summer Solstice is termed summerheat; summerheat is the command of Minister Fire. Humans contract it via mouth/nose, injuring the Pericardium meridian, because summerheat favors the Heart. Pulse is deficient, or floating-large-scattered, or wiry-thin-hollow-slow, because heat injures Qi, consuming Qi and weakening the pulse. Treatment prioritizes clearing the Heart, promoting urination, and tonifying True Qi. For heat/thirst, nourishing Water is also needed. Thirst implies internal attacking Yang, heat lodging in Kidney, causing bone weakness; ultimately due to Fire excess damaging Metal and Water decline, exhausting Kidney and Bladder. Emergency rescue is needed: tonify Lung Qi to nourish the source of Water. Shengmai San (Generate the Pulse Powder) supports Yuan Qi and protects Lungs to generate fluids. (Feng Shi Jin Nang)
Zhong-Shu (Severe Sunstroke) and Zhong-Yue (Sunstroke) present with deficient/deep pulses, with/without sweat, fever/no fever, thirst/no thirst, diarrhea/no diarrhea, preference for cold/hot drinks. One must distinguish Yin/Yang and Deficiency/Excess; do not indiscriminately use cold/cool herbs. Summer has latent Yin inside. Ancients used Fuzi Dashun San (Aconite Greatly Smooth Powder) to warm/tonify Yang, which is profound. Why do modern frail/elderly take Xiangru Yin (Elsholtzia Decoction) in summer for cooling, damaging Yuan Qi, inviting summerheat, and dying? Qing Shu Yi Qi Tang contains Zexie, Shenqu, Cangzhu, Huangbai, etc., suitable only for damp-heat stagnation; otherwise, it damages Yin. Use with caution. (Xue Lizhai)
Jiegu said: Quiet acquisition is Zhong-Shu (Summerheat Stroke); active acquisition is Zhong-Re (Heat Stroke). Zhong-Shu is Yin pattern; Zhong-Re is Yang pattern. Dongyuan said: Acquired by avoiding heat in deep halls is Zhong-Shu. Symptoms: headache, aversion to cold, stiff body, limb pain, irritability, hot skin, no sweat. This is suppressed by indoor cold, preventing Yang Qi extension. Dashun San is indicated. Acquired by laborers/farmers in sun is Zhong-Re. Symptoms: headache, aversion to heat, very hot skin, thirst, sweating, lack of energy. This is heavenly heat injuring Lung Qi. Cangzhu Baizhu Tang (Atractylodes White Tiger Decoction) is indicated. I believe summerheat is the summer command. Labor or hunger depletes Yuan Qi, insufficient to resist extreme heavenly heat, causing illness named Zhong-Shu or Zhong-Re, essentially the same. Why distinguish by movement/quietness? Zhong-Shu/Re usually affects laborers. Labor causes deficiency, deficiency allows pathogen entry, entry causes disease; no deficiency means heavenly heat cannot injure. Those in deep halls getting headache/aversion to cold likely caught wind-cold. Their irritability/hot skin is not summerheat, but Yang Qi suppressed by external pathogen. Since not summerheat, why call it Zhong-Shu? Treatment should be acrid-warm dispersal. Dashun San was originally for drinking too much while exposed to summerheat, causing Spleen/Stomach dampness, vomiting undigested food, organ disharmony—a warming herb formula. Using it for quiet-acquired cases may fail to release exterior and increase internal irritability. Laypeople mistakenly think summer Yin equals cold, making Dashun San essential. But summer Yin is not cold; Yang vents outward, Yin stays inward. Is Yin really cold? Why drink water in summer? Cangzhu Baizhu Tang cannot be a universal remedy. Reference various summerheat formulas and use according to pattern. Quiet-acquired cases in summer are not summerheat; distinguish them to avoid confusion. (Wang Andao)
Ancient saying: Quiet acquisition is Zhong-Shu, active is Zhong-Re; summerheat is Yin, heat is Yang. Consider the character "Shu" (暑) starts with "Sun" (日), indicating heat invading. Summer sun is extreme Solar Qi; contact causes summerheat disease. Quiet acquisition involves cooling in deep halls/pavilions, using fans, eating fruits, causing cold diseases. Headache/body pain, fever/aversion to cold indicates external cold; vomiting/abdominal pain, cold limbs indicates direct cold invasion. What does this have to do with summerheat? Differentiating summerheat relies on: spontaneous sweating, thirst, irritability, dark urine, body heat, deficient pulse. However, differences exist between Shang-Shu (Injury), Zhong-Shu (Stroke), and Bi-Shu (Closed). Shang-Shu is mild infection: irritability, fever, thirst; Yi Yuan San is indicated. Zhong-Shu is severe infection: profuse sweating, coma/unconsciousness, irritability, panting/shouting. During coma, administer Xiaoshu Wan (Cool Summer Pill); upon waking, assess severity: mild uses Yi Yuan San, severe uses Baihu Tang. Bi-Shu is internal latent summerheat closed by external wind-cold. Headache/body pain, fever/aversion to cold is wind-cold; thirst/irritability is summerheat. Siwei Xiangru Yin (Four-Ingredient Elsholtzia Decoction) plus Jingjie, Qinjiao is indicated. (Cheng Zhongling)
When heavenly summerheat moves, earthly damp turbidity rises. In steaming heat, if Righteous Qi has gaps, pathogens enter via mouth/nose, blocking Qi division first. Upper Jiao clearing descends poorly, transformation mechanism loses normal rhythm, essence of food/water accumulates into dampness. Thus, summerheat always carries dampness. Ancients discussed movement/quietness, injury/stroke, entry into Heart/Liver, malaria/dysentery, blood stasis/cholera, sudden collapse/death, each with profound meaning. South of the Yangtze, low land, thin Qi, damp excess/heat steaming requires prevention. Li Likeng said: If heaven had three seasons without summer, human disease would be rare. This is accurate. Summer-damp injury: acute causes harm then; chronic becomes latent Qi disease in autumn. Signs: stagnant pulse/color, greasy tongue/mouth, slight chills or single fever, chest stuffiness/breath block during fever, thirst/irritation, worse afternoon/evening, slight relief with dawn sweat, daily recurrence, taking 2-3 decads to resolve day by day. If Yuan Qi fails or treatment is wrong, many die. Compared to cold injury, progression is slower; compared to malaria, chills/fever are indistinct. Changes resemble cold injury, but recovery is prolonged. Releasing exterior: sweat difficult to achieve; purging: easy loose stools; over-clearing: cold limbs/nausea; over-warming: dry lips/teeth. Most common in autumn, rarely recorded in classics, except Ji Ren Bian calls it "Late Autumn Onset." Pattern resembles malaria, treat as infection. Latent Qi disease exists in all seasons, but unlike wind-cold (sweat resolves) or warm heat (cooling soothes), summer-damp are steaming/sticky pathogens, hardest to cure quickly. If treatment misses mark: summerheat rises via Yang, injuring Yin turning dry; damp sinks via Yin, injuring Yang turning turbid, causing coma/deafness, dry tongue/gum bleeding, chest stuffiness/nausea, watery diarrhea/cold limbs—difficult cases arise, leading to collapse. Master Liu Hejian's Sanjiao Theory guides legislation: identify if summerheat or damp is heavier; investigate if disease is in Ying/Blood or Qi level. Six Qi affect humans differently based on constitution: Yin deficiency leads to Fire excess, pathogen enters Ying/Blood; Yang deficiency leads to Damp excess, pathogen enters Qi level. One tolerates clearing, one tolerates warming, revealing Zang nature Yin/Yang. Upper Jiao: acrid-cool/slightly bitter (Zhuye, Lianqiao, Xingren, Bohe); Middle Jiao: bitter-acrid unblocking (Banxia Xiexin Tang style); Lower Jiao: warm-moving/cold, heavy opening descending (Guiling Ganlu Yin style). These are general Sanjiao treatments. With complications, adapt. For Qi level: cold follows Baizhu methods/Tianshui San intent; warm follows Erchen Tang/Zhengqi San methods. For Ying level: know clearing/tonifying suitability. Clearing: Xijiao Dihuang Tang adding Heart herbs; Tonifying: Sancai, Fumai formulas. Also Cangzhu Shigao Tang for damp-heat sinking, Yuniu Fa for Qi/Blood simultaneous burning, Kaibi Zhuhui with Niuhuang, Zhibao, Zixue for opening/clearing turbidity, Fuxu advancing Renshen/Fuzi, Liangyi methods for supporting deficiency. Adapt to changes, judge Yin/Yang, subtlety lies in mind. (Lin Zheng Zhi Nan)
Wind is Yang. Summerheat is Heat. Classics: "All sudden stiffness belongs to Wind; all wind dizziness/trembling belongs to Liver." Also: "Summerheat excess causes earth heat; Wind excess causes movement." Chen Wuyue said: Summerheat favors Heart, causing chest oppression, coma. Entering Liver causes dizziness/numbness. Dai Shi said: Summer sudden collapse, unconsciousness, named Shu Feng (Summerwind). Wang Jiezhai said: Treating summerheat, clearing Heart and promoting urination is best. Thus, treating Shu Feng, clearing summerheat and expelling Wind is primary. Even with convulsions, do not treat as secular惊风 (Convulsive Disease). Removing wind/summerheat stops convulsions. (Fang Xingyan)
Shu Jue (Summerheat Collapse) is Zhong-Yue disease, with cold hands/feet, same meaning as Cold Injury Jue. (Yi Xue Ru Men)
Generally, aversion to cold/fever progressing to Jue is Heart/Spleen Summerheat; no aversion to cold, only aversion to heat progressing to Jue is Bladder Zhong-Yue. Only aversion to cold, no fever progressing to Jue is Summer Cold Yin pattern, not similar to Summerheat/Zhong-Yue. ○ Zhong-Shu: resolve summerheat, harmonize middle; Zhong-Yue: purge fire, benefit Yuan; Shang-Shu: tonify Yuan Qi; Mao-Shu: clear/drain two bowels. (Zheng Hui Bu)
Summerheat near death causes spasms. Though summerheat injures Qi, long-term consumes Yin/fluids, tendons lose nourishment, causing convulsions. ○ Post-mortem blue body in summerheat differs from Yin pattern blue body; Yin pattern is blood coagulation; summerheat has bleeding from mouth/nose. (Jian Wen Lu)
People know clearing summerheat; I know tonifying Qi, because summerheat injures Qi. Tonifying Qi not only Metal controls Fire; Qi rising as fluid/juice returning to Kidney Water, sufficient Water, Fire excess retreats. (Cheng Jiaoqian)
Summerheat injuring Qi: tonify Qi, summerheat dissipates; Summerheat injuring Yin: tonify Yin, summerheat recedes. (Hui Xin Lu)
Zhong-Yue: Baihu Tang if heat injures Form; Renshen Baihu Tang if无形 (Formless) Qi also injured. Zhong-Shu: Shengmai San if summerheat injures Formless Qi; Qing Shu Yi Qi Tang if summerheat injures Qi, combining wind-heat, invading meridians via deficiency. Shang-Shu: Shiwei Xiangru Yin if wind-heat-damp combine, injuring Form/Qi. Exterior bias: transform Xiangru Yin to Xiaoshu Shiquan; Interior bias: transform to Liuhe Tang. These are the three tripod methods of summer. Xiaoshu Wan for upper excess damp flooding causing stuffiness; Yi Yuan San for lower excess heat blocking causing urinary difficulty; Dashun San for fruit injuring Spleen; Lengxiang Yin for cold food injuring Stomach; Laifu Dan for Yin solidifying below; Wuling San for Yang blocked inside. ○ Touching heat, laboring, sudden collapse: texts use hot earth on navel, urine on abdomen, garlic juice in nose. Principle is precise but unexplained. Unknown to world: though severe, it is due to original Qi deficiency plus extreme seasonal fire stirring Mingmen, floating Yang leaving root. Hot earth/urine protect Yang; garlic opens orifices, warms/disperses trapped heat. Pouring cold water extinguishes Qi with flame, causing death. (Zhang Shi Yi Tong)
Summer: Body Yang exits via sweat; Body Yin consumed internally by heat. Both Yin/Yang insufficient. Master Zhong forbade sweating/purgation/moxibustion for Zhong-Yue: sweating injures Yang; purging injures Yin; moxibustion draws fire inward. Medications use sweet-cold generating fluids/protecting Lungs, securing Yang/nourishing Yin. Ling Shu states: "Both Yin/Yang insufficient; tonifying Yang exhausts Yin; draining Yin kills Yang." Yang resides in Yin; tonifying Yang must not injure Yin. Yin roots in Yang; draining Yin must not move Yang. Since both insufficient, do not lightly speak of tonifying/draining; any action creates bias, like Heavy Yin/Heavy Yang. Thus, overusing sweet-warm...