伤暑热甚，舌焦神昏，谵语妄笑，寻衣摸床，撮空
理线，此邪盛正虚。宜用人参固本汤加牡蛎、白芍、
元参、鲜石斛、鲜菖蒲、羚角、钩藤等味，扶正透邪
也。
此言营血热炽，故舌黑昏谵，热极伤阴，真元失守，故
寻衣摸床，撮空理线，乃将危之兆。近世以寻衣摸床，撮空
理线，为心胞热极，不知此乃肾阳大伤，水不济火，阳化内
风，旋扰不息，有水火未济之象。宜用人参，二地、二冬、
甘草、牡蛎 白芍填阴济阳、羚角、钩藤清络熄风，庶几可
保万一焉。
伤暑日多，舌黄焦黑，大便闭结，少腹硬痛，转
矢气者，此有燥矢也。宜用小承气汤加元明粉、鲜石
斛、元参心、鲜菖蒲、生首乌等昧，化内结而保胃津
也。
舌赤苔黄，而兼焦黑，一如沉香色者，斯为有地之黑。
热烁既多，津枯邪滞，既难汗解，又难凉泄，且便闭腹硬，
时转矢气，此仲景所云：转矢气者有燥粪也。急以小承气合
元明粉，生首乌，仿仲景急下存津，既不伤胃，又能化结，
诚为至当。
伤暑曾经吐泻，舌黄而腻，胸膈不爽，此阳邪内
陷，将成痞结。宜用半夏泻心汤，苦降辛通，毌使成
结也。
按仲景《伤寒例》云(1)：痞气每因表邪未尽，遽行攻
下，以致阳邪乘虚内陷，结于胸下，既不能下泄，又不能上
散;上下久通，阴阳互结，心下有形，按之不痛，名曰痞
气。今暑湿之邪，初起虽与伤寒不同，然其吐泻邪陷而成痞
则一也。故用芩、连苦寒降热，姜、夏辛温通阳，俾热泄阳
(1)仲景《伤寒例》云：按今本《伤寒论，伤寒例》无此语。
通，使痞不攻自散矣。
暑热之邪致病且热势极盛，出现舌面焦黑、神志昏迷、胡言乱语、无故嬉笑，以及手在空中摸索衣物、抓握虚空、手指似在理线的动作，这是邪气亢盛而正气虚衰的表现。适宜使用人参固本汤，加入牡蛎、白芍、玄参、鲜石斛、鲜石菖蒲、羚羊角、钩藤等药物，以扶助正气、透达邪气。
这里论述的是营血分热势炽盛，所以舌色发黑、神志昏沉且胡言乱语；热势到了极点损伤阴液，真元失守，所以出现手摸衣床、撮空理线的症状，这是病情危重的征兆。近代医家认为手摸衣床、撮空理线是心包络热势达到极点所致，却不知道这其实是肾阳受到严重损伤，导致水不能制约火，阳气化为内风，旋转扰动不止，呈现出水火未能既济的现象。适宜使用人参、生地黄、熟地黄、天冬、麦冬、甘草、牡蛎、白芍来填补阴液以济助阳气，配合羚羊角、钩藤清泄络脉中的热邪并平息内风，或许还能保住一线生机。
患暑病日久，舌苔黄燥甚至焦黑，大便闭塞不通，小腹部坚硬疼痛，且频繁放屁（转矢气），这是体内有燥结粪便的表现。适宜使用小承气汤，加入玄明粉、鲜石斛、玄参心、鲜石菖蒲、制何首乌等药物，以化解内部的结滞并保护胃中津液。
舌质红赤，舌苔黄且兼有焦黑色，颜色如同沉香一般深沉，这才是真正由地气（肾阴）枯竭导致的黑苔。热邪灼烧已久，津液枯涸，邪气滞留，此时既难以通过发汗解除，也难以单纯通过寒凉药物泻下，加上大便闭塞、腹部坚硬，时常放屁，这正是张仲景所说的：“频繁放屁的，说明有燥结的粪便。”紧急情况下应使用小承气汤配合玄明粉、制何首乌，仿效张仲景“急下存津”的方法，这样既不损伤胃气，又能化解结滞，确实是非常恰当的做法。
患暑病期间曾经发生呕吐和腹泻，舌苔黄而腻滑，胸膈部感觉不舒畅，这是阳热邪气内陷，即将形成痞证（气机阻滞）。适宜使用半夏泻心汤，利用苦味药降泄、辛味药通散的作用，防止病情发展为痞结。
按张仲景《伤寒例》记载：痞气通常是因为表邪尚未完全清除，就急于使用攻下法，导致阳热邪气乘虚内陷，结聚于胸膈之下，既不能向下排泄，又不能向上消散；上下气机久不通畅，阴阳相互结聚，心下有形之物，按压时不痛，这种病症称为痞气。如今暑湿之邪，初起时虽然与伤寒不同，但其因吐泻导致邪气内陷而形成痞证的机理是一致的。因此使用黄芩、黄连苦寒以降泄热邪，生姜、半夏辛温以通阳，使热邪得泄、阳气通畅，痞证自然攻散。
When heat from summerheat is severe, presenting with a scorched tongue, coma, delirious speech, inappropriate laughter, picking at bedclothes, grasping at empty air, and finger movements resembling sorting threads, this indicates pathogenic excess and righteous deficiency. It is appropriate to use Renshen Guben Tang (Ginseng Root Decoction for Securing the Foundation) added with Muli (Oyster Shell), Baishao (White Peony Root), Xuanshen (Scrophulariae Radix), Xian Shihu (Fresh Dendrobii Caulis), Xian Changpu (Fresh Acori Tatarinowii Rhizome), Lingjiao (Antelopis Cornu), and Gouteng (Uncariae Ramulus cum Uncis) to support the righteous qi and expel the pathogen.
This passage discusses blazing heat in the Ying (Nutritive) and Xue (Blood) levels, hence the black tongue, coma, and delirium. Extreme heat injures Yin, causing the loss of True Yuan (Original Qi), leading to picking at bedclothes and grasping at empty air, which are signs of critical danger. Recent practitioners attribute these symptoms to extreme heat in the Pericardium, failing to realize that this is actually severe injury to Kidney Yang, where Water fails to control Fire, generating internal Wind through Yang transformation, causing continuous turmoil, reflecting a state of Failure of Water and Fire to Interact. It is appropriate to use Renshen (Ginseng), Dihuang (Rehmanniae Radix - both Sheng and Shu), Donggu (Asparagi Radix and Ophiopogonis Radix), Gancao (Licorice Root), Muli (Oyster Shell), and Baishao (White Peony Root) to tonify Yin and assist Yang, combined with Lingjiao (Antelopis Cornu) and Gouteng (Uncariae Ramulus cum Uncis) to clear the collaterals and extinguish wind, thereby preserving life by a narrow margin.
After many days of summerheat illness, with a yellow, scorched, or black tongue, constipation, hardness and pain in the lower abdomen, and frequent passing of gas (Zhuan Shi Qi), this indicates dry fecal impaction. It is appropriate to use Xiao Chengqi Tang (Minor Order the Qi Decoction) added with Yuanmingfen (Mirabilite), Xian Shihu (Fresh Dendrobii Caulis), Xuanshen Xin (Center of Scrophulariae Radix), Xian Changpu (Fresh Acori Tatarinowii Rhizome), and Sheng Shouwu (Prepared Polygoni Multiflori Radix) to resolve internal accumulation and preserve Stomach fluids.
A red tongue body with yellow coating turning scorched black, resembling the color of agarwood, indicates true blackness due to Kidney Yin depletion. After prolonged heat scorching, fluids are exhausted and pathogens stagnate; it is difficult to resolve via sweating or cooling purgation. With constipation and abdominal hardness, accompanied by frequent passing of gas, this corresponds to Zhang Zhongjing's statement: "Frequent passing of gas indicates dry feces." Urgently use Xiao Chengqi Tang combined with Yuanmingfen (Mirabilite) and Sheng Shouwu (Prepared Polygoni Multiflori Radix), imitating Zhang Zhongjing's method of "urgent purgation to preserve fluids," which neither damages the Stomach nor fails to resolve accumulation, making it highly appropriate.
Following vomiting and diarrhea during summerheat illness, with a yellow and greasy tongue coating and discomfort in the chest and diaphragm, this indicates Yang pathogens sinking inward, predisposing to Pi Syndrome (Stagnation). It is appropriate to use Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium), using bitter drugs to descend and acrid drugs to unblock, preventing the formation of stagnation.
According to Zhang Zhongjing's *Shanghan Li* (Treatise on Cold Damage Examples): Pi Syndrome often arises because exterior pathogens remain unresolved, and premature purgation allows Yang pathogens to sink inward due to deficiency, knotting below the chest. Unable to descend or ascend, long-term obstruction leads to mutual knotting of Yin and Yang, creating a palpable mass in the epigastrium that is non-tender upon pressure, termed Pi Syndrome. Although summer-damp pathogens differ from cold damage initially, the mechanism of sinking into Pi syndrome due to vomiting and diarrhea is the same. Therefore, Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) are used for their bitter-cold nature to descend heat, while Jiang (Zingiberis Rhizoma Recens) and Banxia (Pinelliae Rhizoma) are used for their acrid-warm nature to unblock Yang, allowing heat to drain and Yang to flow freely, causing the Pi Syndrome to dissipate spontaneously.