之为病，稽之仲景，一则表里俱热，一则气伤液耗，其间虽有轻重，要不过此二途而已。如洁古所谓静
而得之者，王安道谓为伤寒之类，今皆不取。其他多歧之说，亦概从屏斥。其分剂者四，而隶以温中，所以备
其变焉。至道途卒倒证，则退置于篇末，亦遵经例也。
脉候 大抵中暑与热病，外证相似，但热病者脉盛，中暑者脉虚，以此别之。《甲乙经》云∶脉盛身
寒，得之伤寒，脉虚身热，得之伤暑。（按∶此《素问·刺志论》文。）盖寒伤形而不伤气，所以脉盛；热伤
气而不伤形，所以脉虚。（《活人书》）
脉虚而微弱，或浮大而散，或隐不见。（微弱隐伏，皆虚类也。）（《正传》）
脉浮自汗，或浮大而散，或洪大无力，或虚而迟，中得洪缓，皆为伤暑之脉也。（《医统》）
大抵脉来虚大无力，或小弱，皆本气虚而为暑所中，不足之证也。若得洪盛数疾之脉，皆热气燔灼，而为
时气所伤，为有余之邪。（《医通》）
暑耗气液精神，宜敛汗补虚。如汗后躁大，死期可必。如入里七八日，脉不躁大而涩小者，亦死。（《士
林余业》）
证治总例 病者身热恶寒头痛，状如伤寒，或往来寒热如疟，烦躁渴甚，眩晕呕吐，背寒面垢泄泻，
昏闷不清，其脉阴阳俱虚缓而微弱，皆由伤暑之所致也。（《三因》）
人有常言，伤暑做出百般病，其果浓诬哉。盖暑之入人，伏于三焦肠胃之间，至有兼旬累月而不可测识者。
如呕吐，如中满，如泄泻，如下利，如焦渴，如发疟，如腹痛，
如下血，以至诸热等证，苟因暑得之，其根未除，虽百药遍尝，难施其巧。夫人心胞络与胃口相应，胃气稍虚
，或因饥冒暑，故暑气自口鼻而入，凝之于牙颊，达之于心胞络，如附应声。遇暑以还，急漱口而勿咽可也。
若觉暑毒逼塞咽喉，尤当灌涤而吐之。伤暑脉虚，面垢自汗，身热背寒，烦闷大渴，倦怠少气，毛耸恶寒，或
头疼，或霍乱，或四肢厥冷，但身体无痛。经云∶热则诸毛孔开放，洒然恶寒。体认不精，妄以伤暑为伤寒，
误人不小。然而暑家何以脉虚？暑能消气，气消则血散，脉安得而不虚。其或六脉沉伏，冷汗自出，闷绝而昏
不知人，此则中暑证候，又加重耳。治法大要，虽贵于驱暑，尤贵于和中，二者并行，则其间杂证不战而自屈
。若汗，若下，若用药差冷，古人戒之。虽然，夏月伏阴在内，暑家气虚脉虚，或饮水过多，或冷药无度，伤
动其中，呕吐不食，自利不渴，此则外热里寒，无惑乎伤暑伏热之说，非理中汤不可也。又有冷药过度，胃寒
停水，潮热而呕，或身热微烦，此则阳浮外而不内，非小半夏茯苓汤不可也。抑犹有戒焉，暑家脉虚，面黧冷
汗，洒然毛耸，手足微寒，苟不明辨其里热之证，误以刚剂投之，抱薪救焚，不发黄则发斑，甚者蓄血闷乱而
毙矣，吁！可畏哉。（《直指》）
立夏以后，暑热盛行时，人有头疼恶心，身热恶寒，手足厥冷，肢节沉痛，不思饮食，或气高而喘，或气
短而促，甚者用手扪之，如火燎皮肤，或腹胀绞疼，或口鼻流血，病候与伤寒相似。不知者误认伤寒，用风热
发汗药，或加衣出汗，则元气益虚，终不知悟。盖此症乃夏属阴虚，元气不足，湿热蒸人，暴伤元气，人初感
之，即骨乏腿软，精神倦怠，昏睡懒语，其形如醉梦，间或无汗，或微汗不断，或大
汗不止，烦渴饮水，胸膈痞闷，小便黄而少，大便溏而频，或呕或泻或结，或霍乱不止。此等证与伤寒大异，
按时而施治，据症而急疗，无不应手者。语曰勿伐天和，正因时之道也。亦有不头痛身痛恶寒者，治法皆同。
治法∶轻者，宜五苓散以利小水，导火下泻而暑自解，或香薷饮辛散以驱暑毒，木瓜制暑之要药也，或藿香正
气散、十味香薷饮之类。重者，人参败毒散、桂苓甘露饮、竹叶石膏汤、白虎汤之类。弱者，用生脉散、清暑
益气汤、补中益气汤等。若不分内外，不论轻重强弱，一概以和解，百发百中，随试随应，则无如六和汤最良
矣。（《伤暑全书》）（按∶此云不分内外，不论轻重强弱，莫如六和汤者，极属概论。）
伤暑必自汗背寒面垢，或口热烦闷，或头疼发热，神思倦怠殊甚。所谓暑伤气而不伤形是也，但身体不痛
，与感风寒异，宜香薷饮、六和汤、香薷汤。呕而渴者，浸冷香薷汤，或五苓散兼吞消暑丸。泻而渴者，生
料平胃散和生料五苓散各半帖，名胃苓饮（《准绳》此下曰或理中汤加黄连，名连理汤），间进来复丹，此丹
本非治泻之药，唯施之暑泻则宜，然泻甚亦不可用。（消暑丸、来复丹并出《局方》中，宜考。）泻定仍渴，
春泽汤或缩脾饮。盛暑途中，仓卒无水，渴甚，急嚼葱头二寸许，抵饮水二升。暑气攻里，热不解，心烦口干
，辰砂五苓散，或香薷饮加黄连一钱。冒暑饮酒，引暑入肠内，酒热与暑气相并，发热大渴，小便不利，其色
如血，生料五苓散，去官桂，加黄连一钱。暑气久而不解，遂成伏暑，内外俱热，烦躁自汗，大渴喜冷，宜香
薷饮加黄连一钱，继进白虎汤。若服药不愈者，暑毒深入，结热在里，谵语烦渴，罔顾去近衣（《准绳》作不
欲近衣），大便秘结，小便赤涩，当作热病治，可于伤寒阳明证求药。
（《要诀》）
或身热头痛，躁乱不宁，身如针刺者，此为伤暑，即热伤分肉也，以黄连解毒汤、白虎汤加柴胡、气虚加
人参主之。或咳嗽发寒热，汗出不止脉数者，热在肺经，火乘金也，或脉虚身寒，即暑伤元气也，此为中暑，
宜清肺汤、柴胡天水散之类（原作宜以清肺汤，有热加柴胡，或天水散之类，今从统旨订正，清肺汤兹不取）。
有寒，宜冷香饮子及加桂附主之。若其人元气素虚，因于暑热，四肢困倦，不思饮食，此热伤脾胃也，以清暑
益气、补中益气汤之类主之。若脾胃不和，呕吐不食，宜以六和汤、缩脾饮之类调之。（《医方选要》）
泻而发渴，四苓加黄连、干葛。泻而发热，四苓加香薷、柴胡。（《统旨》）
治上吐下泻，乃湿热内甚，故阴阳乖错不和，治宜分利阴阳，散风行湿降火，用四苓散合六乙散，加姜汁
、木瓜，或黄连香薷散合五苓散，分消上下。治身热泄泻，宜用柴苓汤，以退热止泻。治冒暑身热小便涩，用
薷苓汤。（《士林余业》）
夏月多食冷物，及过饮茶汤水湿，致伤脾胃，吐泻霍乱，故治暑药多用温脾消食、渗湿利小便之药，医者
要识此意。（《医鉴》）
清热方法 孙保庆门外有酒家姓姜者，善歌唱，孙爱之，忽数日不见，使人问之，则曰病久将命绝。
孙诊之，遍身皆润，两足冷至膝下，腹满不省人事，六脉皆小弱而急。问其所服药，取而视之，皆阴病药也。
孙曰∶此非受病重，药能重病耳。遂用五苓散、白虎汤十余帖，病少苏，再服全愈。姜氏既安，诣孙谢，因请
问曰∶某得病剧，蒙尚药一治
而苏，愿闻治法。孙曰∶汝病伤暑也，始则阳微厥而脉小无力，众医谓阴病，遂用阴药，其病愈厥。予用五苓
散大利小便则腹减，白虎解利邪热则病愈。凡阴病胫冷则臂亦冷，汝今胫冷臂不冷，则非下厥上行，所以知是
阳微厥也。（《医学纲目》）
汪石山治一人，年三十余，形瘦弱，忽病上吐下泻，水浆不入口者七日，自分死矣。汪诊脉八至而数，曰∶
当夏而得是脉，暑邪深入也，吐泻不纳水谷，邪气自甚也，宜以暑治。遂以人参白虎汤进半杯，良久复进一杯
，觉稍安。三服后，减去石膏、知母，以人参渐次加作四五钱，黄柏、陈皮、麦冬等，随所兼病而佐使，一月
后平复。（《类按》）
中暑忽倒，口吐白沫，将欲发狂，身如火烧，紫斑烂然者，多不可救，而予谓有一线可救者，正以其紫斑
之发出也。倘不发出，则火毒内藏，必至攻心而亡。今嫌其斑虽发出，而其色纯紫，则毒瓦斯太盛，恐难化耳。
（《石室秘 》）（按∶此证当于白虎、黄连解毒二方，酌宜适用为佳，原处有救斑再苏汤，殊失冗漫，今不
取。）
竹叶石膏汤，治伏暑，内外热炽，烦躁大渴。（《直指》）
小柴胡汤，治伤暑外热内渴，于内更加生姜为妙。（同上）
柴胡天水散。
柴胡（三钱） 黄芩 人参（各二钱） 甘草（一钱） 滑石（二钱半）
水二钟，竹叶十片，煎八分，食远服。（《统旨》）
橘皮竹茹汤，治中暑痰退恶寒。（《得效方》）（按∶此本于活人书。）
天生白虎汤，治中暑。捣西瓜汁滤去滓，灌即醒。（《锦囊》）
和解诸方 神圣香薷散（出吴兢《五脏论》），治胃气（馆本有虚字），霍乱吐泻，转筋腹痛。
香薷穗（经霜者一两半） 新浓朴（二两取心） 川黄连（二两） 白扁豆（一两焙）
上先用姜汁四两，一处杵黄连、浓朴二味令细，炒成黑色，入香薷、扁豆二味，都为末，每服五钱，水一
盏，酒一盏，共煎至一盅，入瓷瓶内，蜡纸封，沉入井底，候极冷，一并服二服，濒死者亦生。京师有人卖此
药，一服三百钱，治胃气小腹切痛。（《苏沈》）
（《活人书》香薷散，去白扁豆。分两同。本方曰∶一方有白扁豆，尤良。）（按∶《活人书》全取《
传家秘宝》，彼曰∶一方更有白扁豆苗一两半。）上捣为粗末，每服三钱，水一盏，酒半盏，同煎至七分去滓
，用新汲水频频浸换，令极冷，顿服之，药冷则效速也。仍煎服时不得犯铁器，慢火煎之。《和剂》去黄连。
（服法稍与《苏沈》同。）（《易简方》曰∶今人往往读香薷饮之证，才见霍乱，遽尔投之。殊不知夏月伏阴
在内，食生冷以致霍乱，岂宜投以浸冷之药。故合先治中脘，方以香薷散解其烦躁，不可不知。）又香薷汤，
去黄连，加甘草、茯神，为细末，每服二钱，沸汤点服，入盐点服亦得，不拘时候。《杨氏》水沉散，治伏暑
伤冷，于香薷汤中加丁香（用茯苓），每服三钱，水一盏，入好酒半盏，同煎至一盏，水中沉冷服，不拘时候。
缩脾饮，解伏热，除烦渴，消暑毒，止吐利。
白扁豆（去皮炒） 干葛（锉各二两） 草果（煨去皮） 乌梅肉（净） 缩砂仁 甘草（炙各四两）
上 咀，每服四钱，水一大碗，煎八分去滓，以水沉冷
服，以解烦，或欲热欲温，并任意服，代熟水饮之极妙。（《和剂》）（《医方考》曰∶夏月伏热，为酒食所
伤者，此方主之。）《易简》增损缩脾饮，用草果、乌梅、甘草三味，曰一方云云（与本方同），老人加附子
。《杨氏》于本方加生姜。《直指》香薷缩脾饮，于本方加香薷。
六和汤，治冒暑伏热烦闷，或成痢疾，中酒烦渴畏食。
缩砂仁 半夏（汤炮七次） 杏仁（去皮尖） 人参 甘草（炙各一两） 赤茯苓（去皮） 藿香叶（拂
去尘） 白扁豆（姜汁略炒） 木瓜（各二两） 香薷 浓朴（姜汁制各四两）
上锉，每服四钱，水一盏半，生姜三片，枣子一枚，煎至八分去滓，不拘时候服。（《和剂》）
枇杷叶散，治冒暑伏热，引饮过多，脾胃伤冷，饮食不化。
麦门冬（汤洗去心焙） 白茅根 干木瓜 甘草（炙各一两）
枇杷叶（去毛净炙） 陈橘皮（去白） 丁香（各半两） 香薷（三分） 浓朴（去粗皮涂姜汁炙四两）
上件药，捣罗为细末，每服二钱，水一盏，入生姜二片，煎至七分盏，去滓温服，温水调下亦得。（《和
剂》）《鸡峰》小枇杷叶散，于本方去浓朴。
渗利诸方 五苓散，治伤暑烦渴，引饮无度。（《三因》）小便赤涩，心下水气。（《直指》）盖夏
月伏阴在内，肠胃冷滑，易于伤动，暑毒一入，遍于五脏六腑，为病最急。夏月小有感冒，无问风寒暑湿，头
痛寒热，烦躁昏闷，霍乱疟痢，皆当先服五苓散，然后随证以他药主之。其实猪苓、茯苓利水道，白术、肉桂
有实表之功，若用以治病，无有不愈。（《简易》）大便水泻，小便不利，加车前子末煎服，不宜过多。（《
淡寮》）
辰砂五苓散，如中暑发渴，小便赤涩，用新汲水调下。（《和剂》）（此方系于五苓散加辰砂，既拈于《
伤寒广要》中，兹不赘。）
春泽汤，即五苓散加人参一钱。（《证治方》）
春泽汤，治伏暑发热，烦渴引饮，小便不利。
泽泻（三钱） 猪苓（二钱） 茯苓（二钱） 白术（二钱） 桂心（一钱）
人参（一钱半） 柴胡（一钱） 麦门冬（一钱半） 渴甚，去桂，加五味子、黄连各二钱。
上 咀，每服七钱，水一钟半，灯心二十茎，煎一钟，食远服。（《奇效》）
六味香薷汤，治卒中暑热，左脉虚弱，烦闷旋晕，欲呕不呕，怠情乏力，或发热自汗，小便赤涩，或腹胀
自利者。
香薷 干葛（各二两） 白术 赤茯苓 泽泻 桂心（各一两）
上件 咀，每服五钱，水一盏半，姜五片，乌梅一个，煎至一盏服。一方治尊年人胃气不和，因中暑吐利
旋晕，本方加草果。生附各□两，两倍生姜煎。一方吐痰厥逆，不省人事，本方加半夏三两，倍生姜煎服，仍
Zhongshu (Heatstroke) as a disease, when examined in Zhang Zhongjing's works, presents mainly in two ways: one is heat in both the exterior and interior, and the other is damage to Qi and depletion of fluids. Although there are variations in severity, it essentially falls into these two categories. For instance, Jiegu's concept of "acquiring it while at rest" (referring to contracting summerheat by resting in cool places), which Wang Andao considered similar to Shanghan (Cold Damage), is no longer accepted today. Other divergent theories are also generally discarded. The dosage forms are divided into four categories, with warming the middle method attached to prepare for variations. As for sudden collapse on the road, it is placed at the end of the chapter, following classical conventions.
Pulse Diagnosis Generally, Zhongshu (Heatstroke) and Rebing (Heat Disease) have similar external symptoms, but in Rebing (Heat Disease), the pulse is vigorous, whereas in Zhongshu (Heatstroke), the pulse is deficient; this distinguishes them. The *Jiayi Jing* states: A vigorous pulse with cold body indicates Shanghan (Cold Damage); a deficient pulse with hot body indicates Shangshu (Summerheat Injury). (Note: This text is from *Suwen · Cizhi Lun*.) Cold damages the form but not Qi, hence the pulse is vigorous; heat damages Qi but not the form, hence the pulse is deficient. (*Huanren Shu*)
The pulse may be deficient and weak, or floating and large and scattered, or hidden and invisible. (Weakness and hiding both belong to deficiency types.) (*Zhengzhuan*)
A floating pulse with spontaneous sweating, or floating and large and scattered, or surging and large without strength, or deficient and slow, with a surging and moderate quality within, are all pulses of Shangshu (Summerheat Injury). (*Yitong*)
Generally, a pulse that is deficient, large, and without strength, or small and weak, indicates that the original Qi is deficient and has been struck by summerheat, representing a deficiency syndrome. If a surging, vigorous, rapid, and frequent pulse is obtained, it indicates blazing heat and injury by seasonal pathogens, representing an excess pathogen. (*Yitong*)
Summerheat consumes Qi, fluids, and spirit; one should astringe sweat and tonify deficiency. If restlessness and a large pulse appear after sweating, death is certain. If, after seven or eight days of entering the interior, the pulse is not restless and large but rather choppy and small, death will also occur. (*Shilin Yuye*)
General Principles of Syndrome Differentiation and Treatment Patients present with fever, aversion to cold, headache, resembling Shanghan (Cold Damage), or alternating chills and fever like malaria, severe irritability and thirst, dizziness and vomiting, cold back, greasy face, diarrhea, confusion and lack of clarity. Their pulses are Yin and Yang both deficient, slow, and weak, all caused by Shangshu (Summerheat Injury). (*Sanyin*)
People often say that Shangshu (Summerheat Injury) causes hundreds of diseases; is this really not exaggeration? Summerheat invading the body hides between the Sanjiao (Triple Burner) and intestines/stomach, sometimes remaining undetectable for decades or months. Symptoms such as vomiting, abdominal fullness, diarrhea, dysentery, extreme thirst, malaria-like episodes, abdominal pain, lower bleeding, and various heat syndromes, if caused by summerheat, will remain incurable despite trying hundred herbs if the root is not removed. The Pericardium meridian corresponds to the stomach opening. If Stomach Qi is slightly deficient, or if one exposes oneself to summerheat while hungry, summerheat enters through the mouth and nose, condenses in the teeth and cheeks, and reaches the Pericardium meridian like an echo. Upon exposure to summerheat, rinse the mouth urgently without swallowing. If summerheat toxin feels blocked in the throat, induce vomiting. Shangshu (Summerheat Injury) presents with a deficient pulse, greasy face, spontaneous sweating, fever with cold back, severe irritability and thirst, fatigue and shortness of breath, piloerection and aversion to cold, headache, cholera-like symptoms, or cold limbs, but without body pain. The Classics state: Heat causes pores to open, leading to a chill. Imprecise understanding leads to mistaking Shangshu (Summerheat Injury) for Shanghan (Cold Damage), causing significant harm. Why is the pulse deficient in summerheat cases? Summerheat dissipates Qi; when Qi dissipates, blood scatters, so how can the pulse not be deficient? If all six pulses are deep and hidden, with cold sweat and unconsciousness due to oppression, this is a severe case of Zhongshu (Heatstroke). The main treatment principle values expelling summerheat but especially values harmonizing the middle; practicing both simultaneously makes mixed syndromes submit naturally. Sweating, purging, and using excessively cold medicines are warned against by ancients. Nevertheless, in summer, Yin hides inside. Summerheat patients have deficient Qi and pulse; excessive water intake or uncontrolled use of cold medicines damages the middle, causing vomiting, anorexia, spontaneous diarrhea without thirst. This is exterior heat and interior cold; there is no doubt about the theory of trapped summerheat and latent heat, requiring Lizhong Tang (Licorice and Ginger Decoction). Excessive cold medicines cause Stomach cold and retained water, tidal fever and vomiting, or slight fever and irritability; this is Yang floating externally and not internally, requiring Xiao Banxia Fuling Tang (Small Pinellia and Poria Decoction). Another warning: Summerheat patients have a deficient pulse, dark complexion, cold sweat, piloerection, and slightly cold hands and feet. If one fails to clearly distinguish interior heat syndromes and mistakenly uses harsh/warm-tonifying agents, it is like adding firewood to a fire; jaundice or macules will develop, or severe blood stasis and confusion leading to death. Alas! How terrifying! (*Zhizhi*)
After Lixia (Start of Summer), when summerheat prevails, people may experience headache, nausea, fever, aversion to cold, cold extremities, heavy joint pain, anorexia, high-pitched breathing with asthma, or shortness of breath. Severe cases feel burning skin upon touch, abdominal distension with colic, or bleeding from mouth/nose. These symptoms resemble Shanghan (Cold Damage). Unaware individuals mistake it for Shanghan (Cold Damage), using wind-heat diaphoretics or covering up to sweat, further depleting Yuan Qi (Original Qi) without realization. This syndrome belongs to Yin deficiency in summer, with insufficient Yuan Qi (Original Qi), steaming damp-heat violently damaging Yuan Qi (Original Qi). Initial sensation brings bone weakness, leg softness, mental fatigue, lethargy, drowsiness, reluctance to speak, resembling drunkenness or dreaming. Sometimes no sweat, sometimes slight continuous sweat, or profuse unstoppable sweat, irritability and thirst for water, chest/epigastric stuffiness, yellow scanty urine, loose frequent stools, vomiting, diarrhea, constipation, or persistent cholera-like symptoms. These differ greatly from Shanghan (Cold Damage). Timely treatment based on symptoms yields immediate results. The saying "do not violate Tianhe (Heavenly Harmony)" emphasizes treating according to seasons. Some do not have headache, body pain, or aversion to cold; their treatment is the same.
Treatment: Mild cases: Wuling San (Five-Ingredient Powder with Poria) to promote urination, guiding fire downward to resolve summerheat; or Xiangru Yin (Elsholtzia Decoction) to disperse summerheat toxin with acrid-warm properties; Mugua (Chaenomeles Fruit) is a key herb for controlling summerheat; or Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) or Shiwei Xiangru Yin (Ten-Ingredient Elsholtzia Decoction). Severe cases: Renshen Baidu San (Ginseng Powder to Overcome Toxins), Guiling Ganlu Yin (Cassia Twig, Poria, and Talcum Drink), Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), or Baihu Tang (White Tiger Decoction). Weak cases: Shengmai San (Generate the Pulse Powder), Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If not distinguishing exterior/interior or mild/severe/weak, and uniformly applying harmonization with 100% success, Liuhe Tang (Six-Harmony Decoction) is best. (*Shangshu Quan Shu*) (Note: This general statement regarding Liuhe Tang applies broadly.)
Shangshu (Summerheat Injury) inevitably presents with spontaneous sweating, cold back, greasy face, oral heat and irritability, headache, fever, and extreme mental fatigue. This illustrates "summerheat damages Qi but not the form"; the body does not hurt, differing from Wind-Cold invasion. Use Xiangru Yin (Elsholtzia Decoction), Liuhe Tang (Six-Harmony Decoction), or Xiangru Tang (Elsholtzia Decoction). Vomiting with thirst: Soaked cold Xiangru Tang (Elsholtzia Decoction) or Wuling San (Five-Ingredient Powder with Poria) taken with Xiaoshu Wan (Summerheat-Relieving Pill). Diarrhea with thirst: Shengliao Pingwei San (Raw Material Pingwei Powder) and Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria) half dose each, named Weiping Yin (Stomach-Poria Drink) (Zhuanshu mentions Lizhong Tang plus Huanglian, named Lianli Tang); intermittently administer Laifu Dan (Reviving Pill). This pill is not primarily for diarrhea but suits summerheat diarrhea; however, avoid if diarrhea is severe. (Xiaoshu Wan and Laifu Dan are from Ju Fang; verify.) If thirsty after diarrhea stops: Chunze Tang (Spring Spring Decoction) or Suopi Yin (Splese-Restraining Drink). In intense summer heat on the road without water, chew ~2 cun of green onion head urgently, equivalent to drinking 2 sheng of water. Summerheat attacking the interior with unresolved heat, heart vexation, dry mouth: Chen Sha Wuling San (Cinnabar Five-Ingredient Powder with Poria) or Xiangru Yin (Elsholtzia Decoction) plus 1 qian Huanglian (Scutellaria Root). Drinking alcohol while exposed to summerheat draws summerheat into intestines; wine heat combines with summerheat causing fever, extreme thirst, difficult urination with bloody color: Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria), remove Guan Gui (Cinnamon Bark), add 1 qian Huanglian (Scutellaria Root). Persistent summerheat becomes Fushe (Latent Summerheat), with internal/external heat, irritability, spontaneous sweating, extreme thirst preferring cold: Xiangru Yin (Elsholtzia Decoction) plus 1 qian Huanglian (Scutellaria Root), followed by Baihu Tang (White Tiger Decoction). If medication fails, summerheat toxin penetrates deeply, heat knots in the interior, delirium, irritability, thirst, ignoring removing clothes (Zhuanshu says "does not desire closeness to clothes"), constipation, red/scanty urine: Treat as Rebing (Heat Disease); seek remedies in Yangming syndrome of Shanghan (Cold Damage). (*Yaojue*)
Fever, headache, restlessness, body feeling like needle pricks: Shangshu (Summerheat Injury), heat damaging muscle layers. Use Huanglian Jiedu Tang (Scutellaria, Phellodendron, Gardenia, and Coptis Decoction), Baihu Tang (White Tiger Decoction) plus Chaihu (Bupleurum Root); add Renshen (Ginseng Root) if Qi deficient. Cough with chills/fever, incessant sweating, rapid pulse: Heat in Lung Meridian, Fire insulting Metal. Or deficient pulse with cold body: Summerheat damaging Original Qi, this is Zhongshu (Heatstroke). Use Qingfei Tang (Clear Lung Decoction) or Chaihu Tianshui San (Bupleurum and Heavenly Water Powder) (Original text suggests Qingfei Tang plus Chaihu if heat, or Tianshui San; corrected here per Tongzhi, Qingfei Tang omitted). With cold: Lengxiang Yinzi (Cold Fragrance Drink) plus Guizhi (Cinnamon Twig) and Fuzi (Aconite Root). If Original Qi is chronically deficient, affected by summerheat, with limb fatigue and anorexia: Heat damaging Spleen/Stomach. Use Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Spleen/Stomach disharmony with vomiting/anorexia: Harmonize with Liuhe Tang (Six-Harmony Decoction) or Suopi Yin (Splese-Restraining Drink). (*Yifang Xuanya*)
Diarrhea with thirst: Siling San (Four-Ingredient Powder) plus Huanglian (Scutellaria Root) and Gegen (Kudzu Root). Diarrhea with fever: Siling San (Four-Ingredient Powder) plus Xiangru (Elsholtzia Herb) and Chaihu (Bupleurum Root). (*Tongzhi*)
Upper vomiting and lower diarrhea due to severe internal damp-heat causing Yin/Yang disharmony: Treat by separating Yin/Yang, dispersing wind, drying dampness, descending fire. Use Siling San (Four-Ingredient Powder) combined with Liuyi San (Six-to-One Powder) plus Jiangzhi (Ginger Juice) and Mugua (Chaenomeles Fruit); or Huanglian Xiangru San (Scutellaria and Elsholtzia Powder) combined with Wuling San (Five-Ingredient Powder with Poria) to drain upper/lower. Fever with diarrhea: Chai Ling Tang (Bupleurum and Poria Decoction) to reduce fever and stop diarrhea. Summerheat exposure with fever and difficult urination: Ru Ling Tang (Elsholtzia and Poria Decoction). (*Shilin Yuye*)
Summer consumption of cold foods and excessive tea/water damages Spleen/Stomach, causing vomiting, diarrhea, cholera. Thus, summerheat remedies often use herbs to warm Spleen, digest food, leach dampness, and promote urination; physicians must understand this. (*Yijian*)
Clearing Heat Method Sun Baoqing had a tavern owner surnamed Jiang outside his gate, skilled in singing. Sun liked him. After several days of absence, inquiry revealed he was dying of long illness. Sun diagnosed him: body moist, legs cold to knees, abdominal fullness, unconsciousness, six pulses small/weak/rapid. Examining prescribed meds, they were all for Yin diseases. Sun said: "Not severe disease, but medicine worsened it." Prescribed Wuling San (Five-Ingredient Powder with Poria) and Baihu Tang (White Tiger Decoction) over ten doses; patient revived, cured after more. Jiang recovered, thanked Sun, asked for explanation. Sun said: "You suffered Shangshu (Summerheat Injury). Initially Yang was weak with cold limbs and small/weak pulse. Doctors called it Yin disease, used Yin-cold meds, worsening cold limbs. I used Wuling San (Five-Ingredient Powder with Poria) to strongly promote urination reducing abdomen, and Baihu Tang (White Tiger Decoction) to clear evil heat curing you. In Yin diseases, calf coldness implies arm coldness. Your calves are cold but arms are not, indicating non-inversion of cold from below upwards, thus knowing it is Yang-weak cold limbs." (*Yixue Gangmu*)
Wang Shishan treated a man, 30s, thin/weak, sudden vomiting/diarrhea, unable to keep fluids down for 7 days, expecting death. Wang felt pulse: 8 beats per respiration, rapid. Said: "In summer, this pulse indicates deep summerheat pathogen. Vomiting/diarrhea preventing food/fluid intake means pathogen is strong. Treat as summerheat." Gave Renshen Baihu Tang (Ginseng and White Tiger Decoction) half cup, then another cup later; patient felt better. After three doses, reduced Shigao (Gypsum) and Zhimu (Anemarrhena Rhizome), gradually increased Renshen (Ginseng Root) to 4-5 qian, added Huangbai (Phellodendron Bark), Chenpi (Tangerine Peel), Maidong (Ophiopogon Tuber), etc., assisting based on accompanying diseases. Recovered after one month. (*Lei An*)
Sudden Zhongshu (Heatstroke) collapse, foaming at mouth, impending madness, body burning like fire, bright purple macules: Usually incurable. I believe there is a sliver of hope precisely because the purple macules erupted. If they do not erupt, fire-toxin hides inside, attacking Heart leading to death. Now, if macules erupt but are pure purple, toxin is too strong, likely hard to resolve. (*Shishi Milu*) (Note: For this syndrome, Baihu Tang (White Tiger Decoction) and Huanglian Jiedu Tang (Scutellaria, Phellodendron, Gardenia, and Coptis Decoction) are suitable; original Jiu Ban Zai Su Tang is redundant and omitted.)
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction): Treats Fushe (Latent Summerheat), blazing internal/external heat, irritability, extreme thirst. (*Zhizhi*)
Xiao Chaihu Tang (Minor Bupleurum Decoction): Treats Shangshu (Summerheat Injury) with exterior heat and interior thirst; adding fresh ginger is excellent. (Same source)
Chaihu Tianshui San (Bupleurum and Heavenly Water Powder).
Chaihu (Bupleurum Root) (3 qian), Huangqin (Scutellaria Root), Renshen (Ginseng Root) (each 2 qian), Gancao (Licorice Root) (1 qian), Huashi (Talcum) (2.5 qian).
Water 2 zhong, Zhu Ye (Bamboo Leaf) 10 pieces, decoct to 0.8 zhong, take far from meals. (*Tongzhi*)
Jupi Zhuru Tang (Citrus Peel and Bamboo Shavings Decoction): Treats Zhongshu (Heatstroke) with phlegm reduction and aversion to cold. (*Defang Fang*) (Note: Based on Huanren Shu.)
Tiansheng Baihu Tang (Naturally Occurring White Tiger Decoction): Treats Zhongshu (Heatstroke). Crush watermelon juice, filter pulp, administer to wake patient. (*Jinnang*)
Harmonizing Formulas Shensheng Xiangru San (Divine and Sacred Elsholtzia Powder) (from Wu Jing's *Wuzang Lun*): Treats Wei Qi (Stomach Qi) [edition has 'deficient'], cholera vomiting/diarrhea, tendon contraction abdominal pain.
Xiangru Sui (Elsholtzia Spike) (frost-exposed, 1.5 liang), Xin Houpo (Fresh Magnolia Bark) (2 liang, take heart), Chuan Huanglian (Sichuan Scutellaria Root) (2 liang), Baibian Dou (White Hyacinth Bean) (1 liang, roasted).
First mix 4 liang Ginger Juice, pound Huanglian (Scutellaria Root) and Houpo (Magnolia Bark) finely, stir-fry until black. Add Xiangru (Elsholtzia Herb) and Baibian Dou (White Hyacinth Bean), grind to powder. Take 5 qian each time, with 1 zhan water and 1 zhan wine, decoct to 1 zhong, store in porcelain bottle sealed with wax paper, sink to bottom of well until extremely cold. Take together, two doses; even near-death patients survive. Someone in Beijing sells this for 300 coins per dose, treating Stomach Qi and sharp lower abdominal pain. (*Su Shen*)
(*Huanren Shu* Xiangru San removes Baibian Dou (White Hyacinth Bean). Dosages same. Note: One version has Baibian Dou (White Hyacinth Bean), especially good.) (Note: *Huanren Shu* fully takes from *Chuanjia Mibao*, which says: One version adds 1.5 liang Baibian Dou Miao (White Hyacinth Bean Sprouts).) Grind to coarse powder. Take 3 qian each time, with 1 zhan water and 0.5 zhan wine, decoct to 0.7, strain. Use newly drawn water frequently to soak/change until extremely cold. Take in one gulp; cold medicine acts faster. Do not use iron vessels during decoction; use slow fire. *Heji* removes Huanglian (Scutellaria Root). (Administration slightly differs from *Su Shen*.) (*Yijian Fang*) says: People often read Xiangru Yin (Elsholtzia Decoction) indications, seeing cholera immediately administering it. Little do they know that in summer, Yin hides inside; eating cold/raw causing cholera, how can one administer soaked cold medicine? Thus, first treat Zhongwan (CV12), then use Xiangru San (Elsholtzia Powder) to relieve irritability. Do not ignore this. Also Xiangru Tang (Elsholtzia Decoction), remove Huanglian (Scutellaria Root), add Gancao (Licorice Root) and Fushen (Poria with Hostwood), grind to fine powder. Take 2 qian each time, steep in boiling water. Adding salt is also acceptable. No specific time. *Yangshi* Shuichen San (Water-Sinking Powder) treats Fushe (Latent Summerheat) and cold injury. Add Dingxiang (Clove) (using Fuling (Poria)) to Xiangru Tang (Elsholtzia Decoction). Take 3 qian each time, with 1 zhan water and 0.5 zhan good wine, decoct to 1 zhan, sink in water to cool, take. No specific time.
Suopi Yin (Splese-Restraining Drink): Resolves latent heat, relieves irritability/thirst, clears summerheat toxin, stops vomiting/diarrhea.
Baibian Dou (White Hyacinth Bean) (peeled, roasted), Gegen (Kudzu Root) (cut, each 2 liang), Caoguo (Black Cardamom) (roasted, peeled), Wumei Rou (Dark Plum Flesh) (clean), Suozharen (Amomum Fructus), Gancao (Licorice Root) (roasted, each 4 liang).
Cut. Take 4 qian each time, with 1 large bowl water, decoct to 0.8, strain. Cool by sinking in water to relieve irritability. Can be taken hot or warm as desired, replacing boiled water is excellent. (*Heji*) (*Yifang Kao*) says: Summer latent heat injured by wine/food, this formula governs. *Yijian* modified Suopi Yin (Suopi Yin) uses Caoguo (Black Cardamom), Wumei (Dark Plum), Gancao (Licorice Root) three ingredients (same as main formula), add Fuzi (Aconite Root) for elderly. *Yangshi* adds Shengjiang (Fresh Ginger) to main formula. *Zhizhi* Xiangru Suopi Yin (Elsholtzia Splese-Restraining Drink) adds Xiangru (Elsholtzia Herb) to main formula.
Liuhe Tang (Six-Harmony Decoction): Treats summerheat exposure, latent heat irritability, or dysentery formation, wine intoxication irritability/thirst/anorexia.
Suozharen (Amomum Fructus), Banxia (Pinellia Tuber) (boiled 7 times), Xingren (Apricot Seed) (peeled/cored), Renshen (Ginseng Root), Gancao (Licorice Root) (roasted, each 1 liang), Chi Fuling (Red Poria) (peeled), Huoxiang Ye (Patchouli Leaf) (dust brushed off), Baibian Dou (White Hyacinth Bean) (lightly roasted with Ginger Juice), Mugua (Chaenomeles Fruit) (each 2 liang), Xiangru (Elsholtzia Herb), Houpo (Magnolia Bark) (processed with Ginger Juice, each 4 liang).
Cut. Take 4 qian each time, with 1.5 zhan water, 3 slices Shengjiang (Fresh Ginger), 1 date, decoct to 0.8, strain. Take anytime. (*Heji*)
Pipaye San (Loquat Leaf Powder): Treats summerheat exposure, latent heat, excessive drinking, Spleen/Stomach cold injury, undigested food.
Maidong (Ophiopogon Tuber) (washed, core removed, roasted), Baimaogen (Imperata Rhizome), Gan Mugua (Dried Chaenomeles Fruit), Gancao (Licorice Root) (roasted, each 1 liang).
Pipaye (Loquat Leaf) (de-hair, clean, roasted), Chenjupi (Aged Tangerine Peel) (white removed), Dingxiang (Clove) (each 0.5 liang), Xiangru (Elsholtzia Herb) (0.3 fen), Houpo (Magnolia Bark) (rough bark removed, coated with Ginger Juice, roasted, 4 liang).
Grind/sieve to fine powder. Take 2 qian each time, with 1 zhan water, 2 slices Shengjiang (Fresh Ginger), decoct to 0.7 zhan, strain, take warm. Mixing with warm water is also acceptable. (*Heji*) *Jifeng* Xiao Pipaye San (Small Loquat Leaf Powder) removes Houpo (Magnolia Bark) from this formula.
Draining/Diffusing Formulas Wuling San (Five-Ingredient Powder with Poria): Treats Shangshu (Summerheat Injury) irritability/thirst, unlimited drinking. (*Sanyin*) Red/scanty urine, water qi under heart. (*Zhizhi*) Summer Yin hides inside, intestines/stomach cold/slipping, easily damaged. Once summerheat toxin enters, it spreads through Zang-Fu organs, causing urgent disease. Minor summer colds, regardless of wind/cold/summerheat/dampness, headache/chills-fever, irritability/confusion, cholera/malaria/dysentery, should first take Wuling San (Five-Ingredient Powder with Poria), then treat according to syndrome with other meds. Actually, Zhu Ling (Polyporus), Fuling (Poria) drain water pathways; Baizhu (Atractylodes Rhizome), Rougui (Cinnamon Bark) solidify exterior. Used to treat disease, none fail. (*Jianyi*) Watery diarrhea, difficult urination: Add Cheqian Zi (Plantago Seed) powder, decoct and take; do not overdose. (*Danliao*)
Chen Sha Wuling San (Cinnabar Five-Ingredient Powder with Poria): For Zhongshu (Heatstroke) thirst, red/scanty urine, take with newly drawn water. (*Heji*) (This formula is Wuling San (Five-Ingredient Powder with Poria) plus Chen Sha (Cinnabar); already mentioned in *Shanghan Guangyao*, omitted here.)
Chunze Tang (Spring Spring Decoction): Is Wuling San (Five-Ingredient Powder with Poria) plus 1 qian Renshen (Ginseng Root). (*Zhengzhi Fang*)
Chunze Tang (Spring Spring Decoction): Treats Fushe (Latent Summerheat) fever, irritability/thirst for drinking, difficult urination.
Zexie (Alisma Rhizome) (3 qian), Zhuling (Polyporus) (2 qian), Fuling (Poria) (2 qian), Baizhu (Atractylodes Rhizome) (2 qian), Guixin (Cinnamon Heart) (1 qian).
Renshen (Ginseng Root) (1.5 qian), Chaihu (Bupleurum Root) (1 qian), Maidong (Ophiopogon Tuber) (1.5 qian). Extreme thirst: Remove Guixin (Cinnamon Heart), add Wuweizi (Schisandra Berry) and Huanglian (Scutellaria Root) each 2 qian.
Cut. Take 7 qian each time, with 1.5 zhong water, 20 stems Dengxin (Juncus Medullary), decoct to 1 zhong, take far from meals. (*Qixiao*)
Liawei Xiangru Tang (Six-Ingredient Elsholtzia Decoction): Treats sudden summerheat, left pulse weak, irritability/dizziness, urge to vomit but cannot, lethargy/fatigue, or fever/spontaneous sweating, red/scanty urine, or abdominal distension/spontaneous diarrhea.
Xiangru (Elsholtzia Herb), Gegen (Kudzu Root) (each 2 liang), Baizhu (Atractylodes Rhizome), Chi Fuling (Red Poria), Zexie (Alisma Rhizome), Guixin (Cinnamon Heart) (each 1 liang).
Cut. Take 5 qian each time, with 1.5 zhan water, 5 slices Shengjiang (Fresh Ginger), 1 Wumei (Dark Plum), decoct to 1 zhan, take. One version treats elderly with Stomach Qi disharmony, vomiting/diarrhea/dizziness due to summerheat: Add Caoguo (Black Cardamom) to main formula. Raw Fuzi (Aconite Root) [missing character] liang, double Shengjiang (Fresh Ginger) decoction. One version vomiting phlegm/cold limbs/unconsciousness: Add Banxia (Pinellia Tuber) 3 liang to main formula, double Shengjiang (Fresh Ginger) decoct and take. Still