溯源集云。 者盛夏暑热中之邪气也。此条先言本证之情形如此。而以中热二字。通解 字之义。即内经热论所谓
病暑也。王肯堂云。中 中暑中热。名虽不同。实一病也。谓之 者。暑热当令之时。其气因暑为邪耳。非即夏月暑热
当令之正气也。即热论所谓。后夏至日者。为病暑。是也。 乃暑热之邪。其气本热。不待入里。故中人即渴也。 为
夏至以后之病。阳极阴生之后。阴气已长。当暑汗大出之时。腠理开张。卫阳空疏。表气已虚。不能胜受外气。故汗出
恶寒也。是热邪乘腠理之虚。而为 证也。故以白虎加人参汤主之。即用石膏。以治时令暑热之邪。又加人参。以补汗
出之表虚。添津液而治燥渴也。（案钱氏辨洁古东垣中暑中热之误。甚详。然非本条之所干。且文词繁冗。故不载此。）
案淮南人间训云。夫病温而强之食。病 而饮之寒。此众人之所以为养也。可见古温 对言也。而说文。 伤暑也。
玉篇。中热也。以此推之。中 之中字似赘。然而先贤立命。必有令人不可思议者。宜置而不论焉。
白虎加人参汤方
知母（六两） 石膏（一斤碎○太阳上编有绵裹二字诸本同） 甘草（二两○太阳上
篇有炙字诸本同） 粳米（六合） 人参（三两）
上五味。以水一斗。煮米熟汤成。去滓温服一升。日三服。
〔程〕白虎。西方神名也。其令为秋。其政清肃。凉风至白露降。则溽暑潜消。以此汤有彻暑热之功。行清肃之政。
故以白虎名之。表有热者。散以石膏之辛寒。里有热者。降以知母之甘苦。热则气伤。人参用以生津而益气。石膏过
于寒凉。甘草粳米之甘。用以和胃补中。共除中热。而解表里。
案直指方。竹叶石膏汤。治伏暑内外热炽。烦躁大渴。正是与本条用白虎之证同。
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。一物瓜蒂汤主之。（伤寒论。玉函。脉经。无
一物瓜蒂汤主之七字。）
〔程〕脉虚身热。得之伤暑。此证先中于热。再伤冷水。水气留于腠理皮肤之中。则身热疼重也。与
瓜蒂汤。以散水气。
〔鉴〕李 曰。中 邪在表。故身热。伤冷水。故身疼重。暑伤气。气虚故脉微弱也。
溯源集云。 症三条。有本证变证之不同。此条言其变证。身热太阳之证也。不言汗出恶寒者。邪气
较轻于前也。疼重者。身体重而疼痛也。伤寒则有身疼腰痛。骨节疼痛之证。而湿家亦有筋骨烦疼。一身尽
疼。关节疼痛之证。此以中暑之阳邪。而亦有此寒湿之证。是或饮冷水。或以冷水盥濯。水寒留着。渗入
皮中所致也。中暑之脉本虚。又以水寒所伤。故尤见微弱也。论中不立治法。而金匮要略。有一物
瓜蒂汤主之。王肯堂云。瓜蒂一物散。或曰。五苓散。愚窃以理推之。若暑邪盛。而表证甚者。当以瓜蒂之
苦寒。上涌下泄。使水去而表邪亦去。以因吐得汗。有发散之义故也。若身热微而表证少。但脉微弱。而
疼重。水行皮中者。则水寒较胜。自当用五苓散。使从水道气化而出可也。
一物瓜蒂汤方
瓜蒂（二七个○赵本七作十）
上锉。以水一升。煮取五合。去滓顿服。
〔程〕本草云。瓜蒂味苦寒。主大水身面四肢浮肿。用之以散皮肤水气苦寒又可胜热也。
案此方与证不对。恐是错出。伤寒论。玉函。脉经。并不载。可以为佐证矣。
According to *Su Yuan Ji*, "Zhong Ye" (Heatstroke) refers to the pathogenic factor of summer-heat invading the body during the height of summer. This clause first describes the presentation of the primary syndrome (Heatstroke) and uses the term "Zhong Re" (Middle Heat) to interpret the meaning of "Zhong Ye". This corresponds to what is stated in the *Nei Jing: Re Lun* as "Bing Shu" (Disease of Summer-Heat). Wang Kentang stated that Zhong Ye, Zhong Shu (Summer-Heat Stroke), and Zhong Re are different names for the same disease. It is called "Zhong Ye" because during the time when summer-heat is prevalent, its qi becomes a pathogen due to the heat; it is not the righteous qi of summer-heat itself. This aligns with the *Re Lun*: "Diseases occurring after the Summer Solstice are called Bing Shu." "Ye" is the pathogen of summer-heat, whose nature is inherently hot. Therefore, thirst occurs immediately upon invasion, without needing the pathogen to enter the interior. "Ye" is a disease occurring after the Summer Solstice, a time when yang reaches its peak and yin begins to grow, and yin qi is already increasing. During this period of heavy sweating in summer, the couli (pores) are open, and the defensive yang is empty and sparse. The exterior qi is deficient and unable to resist external pathogens, leading to sweating and aversion to cold. This is the "Zhong Ye" syndrome caused by heat pathogens taking advantage of the deficiency in the couli. Therefore, it is treated with Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction). Shi Gao (Gypsum Fibrosum) is used to treat the seasonal summer-heat pathogen, while Ren Shen (Ginseng Radix et Rhizoma) is added to tonify the exterior deficiency caused by sweating, replenish fluids, and treat dryness-thirst. (Note: Qian's differentiation of the errors regarding Zhong Shu and Zhong Re by Jiegu and Dongyuan is very detailed, but it is irrelevant to this clause and too verbose, so it is not included here.)
Case: *Huainanzi: Renjian Xun* states, "For those suffering from Wen diseases, forcing food intake; for those suffering from 'Ye', drinking cold water—this is what the masses consider to be health-preserving." This shows that "Wen" and "Ye" were discussed in opposition in ancient times. *Shuo Wen Jie Zi* defines "Ye" as "injury by summer-heat," and *Yu Pian* defines it as "middle heat." Based on this, the character "Zhong" (middle/struck by) in "Zhong Ye" seems redundant. However, the establishment of terms by sages must have profound reasons beyond ordinary comprehension, so it should be left aside for discussion.
**Baihu Jia Renshen Tang Formula**
Mu Ye (Motherwort Herba) (6 liang)
Shi Gao (Gypsum Fibrosum) (1 jin, crushed [Some editions include 'wrapped in silk', consistent across versions])
Zhi Gan Cao (Prepared Licorice Root) (2 liang [Some editions include 'prepared', consistent across versions])
Jing Mi (Oryza Sativa Var. Glutinosa Semen) (6 he)
Ren Shen (Ginseng Radix et Rhizoma) (3 liang)
Take the above five ingredients, boil in 10 dou of water until the rice is cooked and the decoction is ready. Strain and take 1 sheng warm, three times a day.
[Cheng] Baihu (White Tiger) is the deity of the West. Its season is Autumn, and its governance is clear and肃 (solemn/clear). When cool winds arrive and white dew falls, humid summer-heat dissipates. This formula is named Baihu because it has the function of eliminating summer-heat and implementing the clear and solemn governance of autumn. For heat in the exterior, Shi Gao's acrid-cool nature disperses it; for heat in the interior, Zhi Mu's sweet-bitter nature descends it. Heat damages qi, so Ren Shen is used to generate fluids and benefit qi. Since Shi Gao is overly cold, the sweetness of Gan Cao and Jing Mi is used to harmonize the stomach and tonify the middle, jointly clearing middle heat and resolving both exterior and interior pathogens.
Case: Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) in *Zhi Fang* treats internal and external blazing heat due to latent summer-heat, with irritability and severe thirst. This is precisely the same syndrome as using Baihu Tang in this clause.
Taiyang Zhong Ye (Summer-Heat Strike in Taiyang): The body feels hot, painful, and heavy, with a faint and weak pulse. This is caused by being injured by cold water in summer, with water qi circulating in the skin. It is treated with Yi Wu Gua Di Tang (Single-Ingredient Melon Pedicle Decoction). ([The *Shang Han Lun*, *Yu Han*, and *Mai Jing* do not contain the seven characters "Yi Wu Gua Di Tang zhu zhi" (treated with Single-Ingredient Melon Pedicle Decoction).])
[Cheng] A faint pulse and body heat result from injury by summer-heat. This syndrome first involves heat strike, followed by injury from cold water. Water qi remains in the couli and skin, causing body heat, pain, and heaviness. Gua Di Tang is given to disperse the water qi.
[Jian] Li said: The pathogen of Zhong Ye is in the exterior, hence the body heat; injury from cold water causes pain and heaviness. Summer-heat injures qi, and qi deficiency leads to a faint and weak pulse.
*Su Yuan Ji* states: There are three clauses on Zhong Ye, distinguishing between primary syndromes and modified syndromes. This clause discusses a modified syndrome. Body heat is a Taiyang syndrome. The absence of sweating and aversion to cold indicates the pathogen is milder than in the previous case. "Pain and heaviness" refers to bodily heaviness and pain. Shang Han (Cold Damage) presents with body ache, waist pain, and joint pain; Shi Jia (Dampness Patients) present with bone and joint irritability/pain and full-body pain. Here, despite the Yang pathogen of summer-heat, there is a syndrome resembling cold-dampness, likely caused by drinking cold water or washing with cold water, allowing cold water to remain and penetrate the skin. The pulse in summer-heat is originally deficient; further injured by cold water, it appears even more faint and weak. The *Lun* does not establish a treatment method, but *Jin Gui Yao Lue* prescribes Yi Wu Gua Di Tang. Wang Kentang suggested either Yi Wu Gua Di San (Melon Pedicle Powder) or Wu Ling San (Five-Ingredient Powder with Poria). I reason that if summer-heat pathogen is strong and exterior symptoms are severe, one should use the bitter-cold nature of Gua Di to induce vomiting and purging, expelling water and thus the exterior pathogen, as vomiting can lead to sweating, which has a dispersing effect. If body heat is mild, exterior symptoms are few, and only faint pulse and heaviness/pain exist with water in the skin, then cold-water dominance prevails, and Wu Ling San should be used to allow water to exit via the urinary pathway through qi transformation.
**Yi Wu Gua Di Tang Formula**
Gua Di (Melonis Fructus Exsiccatus) (27 seeds [Zhao edition reads 10])
Cut into pieces, boil in 1 sheng of water to obtain 5 he. Strain and take in one dose.
[Cheng] *Ben Cao* states: Gua Di is bitter and cold, primarily treating massive edema of the body, face, and limbs. It disperses water qi in the skin, and its bitter-cold nature overcomes heat.
Case: This formula does not match the syndrome well and is likely a textual error. It is not recorded in *Shang Han Lun*, *Yu Han*, or *Mai Jing*, which serves as corroborating evidence.