太阳中 者，发热恶寒，身重而头痛，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。若发汗则恶寒甚，加温针则发热甚，数下之则淋甚。
太阳中热 者，其人汗出恶寒，身热而渴，白虎加人参汤主之。（《活人》云∶夏月自汗恶寒，身热而
渴，面垢，手足冷，脉微无力者，中暑也，白虎汤主之。）
太阳中 者，身热疼重而脉微弱，此由夏月伤冷水，水行皮中所致也，一物瓜蒂汤主之。
一物瓜蒂汤 用瓜蒂二十七个，以水一升，煮取五合，去渣顿服。
上瓜蒂汤，后贤罕用，盖其剂缓故也。若果疼痛不退者，亦宜用之。
〔《活》〕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。盖寒伤形而不伤气，所以脉盛；热伤气而不伤形，所以脉虚。又有湿温与中暑
同，但身凉不渴为异耳。
〔丹〕暑热病，用黄连香薷饮。挟痰者，加半夏；挟虚者，加参、 。或用清暑益气汤。
〔《活》〕夏月发热恶寒，头疼，身体肢节痛重，其脉洪盛者，热病也。冬伤于寒，因暑气而发为热病，
治热病与伤寒同。有汗宜桂枝汤，无汗宜麻黄汤。如烦躁者，宜大青龙汤。然夏月药性须带凉，不可大温，桂
枝、麻黄、大青龙，须用加减。夏至前，桂枝加黄芩半两。夏至后，桂枝、麻黄、大青龙加知母一两，石膏二
两，或加升麻半两。盖桂枝、麻黄汤性热，及暖处非西北之比，夏月服之，必有发黄、斑出之失。热病三日外，
与前汤不瘥，脉势仍数，邪气犹在经络，未入脏腑者，桂枝石膏汤主之。此方夏至后，代桂枝证用。若加麻黄半
两，可代麻黄、青龙证用也。若三月至夏，为晚发伤寒，栀子升麻汤亦可选用之。
桂枝石膏汤 治法见前论。有汗脉缓为桂枝证，无汗脉紧为麻黄、青龙证。
桂枝（半两，去皮） 石膏（一两，碎） 黄芩（半两） 甘草（炙，一两） 栀子（三钱） 白芍药 升麻
干葛 生姜（以上各三分）
上 咀，每服五钱半，水一盏半，煮至八分，去渣，食顷再服。若得汗，即停后服。
栀子升麻汤 治晚发伤寒，三月至夏为晚发。
生地（半斤，切碎） 栀子（十个） 升麻（一两半） 柴胡 石膏（各二两半）
上 咀，每服五钱，水一盏半，煎至八分顿服。病不解，更作。
〔垣〕静而得之为中暑，中暑者阴证，当发散也。或避暑热，纳凉于深堂大厦，得之者曰中暑。其病必头
痛恶寒，身形俱急，肢节疼痛而烦心，肌肤大热无汗，为房室之阴寒所遏，使周身阳气不得伸越。世多以大顺
散主之是也。（海藏云∶静而伤暑，恶寒脉沉细，静而湿胜伤形者，白虎加苍术汤主之。大顺散，见《局方》，
甘草一钱半，干姜、杏仁、肉桂各一钱是也。）
动而得之为中热，中热者阳证，为热伤原气，非形体受病也。若行人或农夫，于日中劳役得之者，名曰中
热，其病必苦头疼，发躁热，恶热，扪之肌肤大热，必大渴引饮，汗大泄，无气以动，乃为天热，外伤肺气，
苍术白虎汤主之。（海藏云∶动而伤暑，身热、脉洪大，动而火胜伤气者，白虎加人参汤主之。）
〔《活》〕中暑背寒面垢，手足微冷，烦渴口燥，倦怠，四肢不痛重，其脉微弱，按之无力，白虎汤主
之。（方见发热。）
〔《本》〕有人头痛身热，心烦燥渴，诊其脉大而虚。予授以白虎汤，数服愈。仲景云∶脉虚身热，得之
伤暑。又云∶其脉弦细芤迟，何也。《素问》曰∶寒伤形，热伤气。盖伤气不伤形，则气消而脉虚弱，所谓弦细
芤迟者，皆虚脉也。仲景以弦为阴，朱、庞亦云中暑脉微弱，则虚可知。
〔海〕脉虚身热，自汗恶寒者，中暑也，白虎加桂汤主之。（方见疟。）
〔《活》〕酒蒸黄连丸 治暑毒深伏，累取不瘥，无药可治，伏暑发渴者。
黄连（四两，以无灰酒浸蒸，干）
上为末，糊丸，熟水下三十丸。胸膈凉、不渴为验。
橘皮汤 治中暑痰逆恶寒。
橘皮（二两，去白） 生姜（一两） 枣子（五枚，去核） 甘草（炙，半两） 人参（一钱）
竹茹（半升）
上分五服，每服水一盏二分，煮取八分，去渣热服。
竹叶石膏汤 治中暑不恶寒。（方见劳复。）
五苓散 治中暑，头痛，恶心，烦躁，心下不快。（方见渴。）
〔海〕若先饮冷，后伤暑者，五苓散主之。此必心下痞 ，生姜汤调服佳。或四君子汤调中，亦可。中
和后，或小便不利，或茎中痛，宜服下方。
蒲黄（三钱） 滑石（五钱） 生甘草（一钱）
中 ，脉弦细芤迟，黄 汤主之。
人参 黄 白术 甘草 茯苓 芍药（各等分）
上 咀，每服三钱，水一大盏，生姜三片，煎至六分，去渣温服。
〔丹〕徐三官，六月间发热，大汗恶寒，战栗不自禁持，且烦渴。予曰∶此暑病。脉之皆虚微细弱而数。
其人好赌，致劳而虚。遂以人参、竹叶作汤，调辰砂四苓散，八帖而安。
〔云〕口开前板齿干燥者，牙乃骨之精，今燥者骨热也，针药不能治，当灸大椎穴。
〔《活》〕湿温者，两胫逆冷，胸腹满，多汗，头痛妄言。其人常伤于湿，因而中暑，湿热相搏，则发湿
温。其脉阳濡而弱，阴小而急。治在太阳，不可发汗。汗出必不能言，耳聋，不知痛所在，身青面色变，名曰
重。如此死者，医杀之耳。白虎加苍术汤主之。
〔《本》癸丑年，故人王彦龙作毗陵仓官。季夏时病胸项多汗，两足逆冷，谵语。医者不晓，杂进药
已经旬日。予诊之，其脉关前濡，关后数。予曰∶当作湿温治之。盖先受暑，后受湿，暑湿相搏，是名湿温。
先以白虎加人参汤，次白虎加苍术汤，头痛渐退，足渐温，汗渐止，三日愈。此名贼邪，误用药，有死之理。
有人难曰∶何名贼邪？予曰∶《难经》云五邪，有实邪、虚邪、正邪、微邪、贼邪。从后来者为虚邪，从前来者
为实邪，从所不胜来者为贼邪，从所胜来者为微邪，自病者为正邪。又曰∶假令心病，中暑为正邪，中湿得之
为贼邪。今心先受暑，而湿邪胜之，水克火，从所不胜，斯谓之贼邪，五邪之中最逆也。《难经》曰∶湿温之脉，
阳濡而弱，阴小而急，濡弱见于阳部，湿气搏暑也；小急见于阴部，暑气蒸湿也。故经曰暑湿相搏，名曰湿温，
是谓贼邪也。不特此也，予素有停饮之疾，每至暑月两足汗 未尝干，每服此药二三盏即愈。
〔海〕湿温汗少者，白虎加苍术；汗多者，白虎加桂枝。（白虎加桂枝方见疟。）
〔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。
〔《保》〕立夏之后，至立秋、处暑之间伤寒者，身多微凉，自汗，四肢沉重，谓之湿温，苍术石膏汤主
之。（即白虎加苍术汤是也。）
苍术（半两） 石膏（三钱） 知母（二钱半） 甘草（一钱）
上 咀，水一盏，煎至一半，温服。谓内有湿也，多不欲饮水。如身热、脉洪、无汗、多渴者，热
在上焦，积于胸中，宜桔梗散。（此非湿温证，乃热病也。）
桔梗散
薄荷 黄芩 甘草 栀子（各一钱） 桔梗（三钱） 连翘（二钱）
上锉，每服五钱，水煮加竹叶。如大便涩，加大黄半两。
〔海〕消暑丹
半夏（一斤） 茯苓（半斤） 生甘草（半斤）
上以醋五升，煮半夏，尽醋熬干，姜汁作糊，无见生水为丸，每服五十丸，熟水咽下。精意修治，用之极
效。中暑为患，药下即苏。伤暑发热头痛，服之尤妙。夏月常服，止渴，利小便，虽饮水多，亦不为害。应是
暑药，皆不及此。若痰饮停节，并用生姜汤下。入夏之后，不可缺此。
又方，消暑丸 治头疼，恶心烦躁，消渴，霍乱。
绿豆粉（四两） 石膏（四两） 白矾（枯） 硫黄（各一两）
水浸蒸饼为丸弹子大，辰砂为衣。用姜汁醋点，新汲水化开服之。
〔丹〕暑风挟痰挟火实，可用吐法。
玉龙丸 治一切暑毒伏暑，腹胀疼痛，神效。
硫黄 硝石 滑石 明矾（各一两）
用无根水调丸。
太阳中暍，表现为发热、恶寒，身体沉重且头痛，脉象弦细、芤或迟。小便结束后，感到怕冷、毫毛竖起，手足逆冷；稍微劳作，身体即发热，张口时上前牙干燥。如果误用发汗法，则恶寒加重；误用温针，则发热加重；多次使用下法，则淋证加重。
太阳中热（即中暑），患者汗出、恶寒，身体发热且口渴，以白虎加人参汤主治。（《活人书》说：夏季自汗、恶寒，身体发热而口渴，面色垢浊，手足冰冷，脉微无力者，是中暑，用白虎汤主治。）
太阳中湿（此处指伤暑夹湿或特定暑病），身体发热、疼痛沉重而脉微弱，这是由于夏季贪凉饮冷，水气行于皮肤之间所致，以一物瓜蒂汤主治。
一物瓜蒂汤：用瓜蒂二十七个，加水一升，煮取五合，去渣一次性服用。
上述瓜蒂汤，后世医家很少使用，大概是因为药性缓和的缘故。如果确实疼痛不缓解，也应当使用。
〔《活人书》〕中暑与热病，外在症状相似。但热病患者脉象盛大，中暑患者脉象虚软，以此加以区别。《甲乙经》说：脉盛身寒，得之于伤寒；脉虚身热，得之于伤暑。大概是因为寒邪伤形体而不伤气，所以脉盛；热邪伤气而不伤形，所以脉虚。又有湿温病与中暑相同，只是身体凉爽且不口渴作为区别。
〔朱丹溪〕暑热病，用黄连香薷饮治疗。兼挟痰湿的，加半夏；兼挟虚损的，加人参、白术。或者使用清暑益气汤。
〔《活人书》〕夏季发热、恶寒，头痛，身体肢节疼痛沉重，脉象洪盛的，是热病。冬季感受寒邪，因暑气诱发而成为热病，治疗热病与伤寒相同。有汗的宜用桂枝汤，无汗的宜用麻黄汤。如果有烦躁的，宜用大青龙汤。然而夏季用药性质须带凉意，不可过于温热，桂枝汤、麻黄汤、大青龙汤必须加减使用。夏至前，桂枝汤加黄芩半两。夏至后，桂枝汤、麻黄汤、大青龙汤加知母一两，石膏二两，或者加升麻半两。因为桂枝汤、麻黄汤药性热，加上南方暖处不同于西北，夏季服用，必然导致发黄、发斑的失误。热病三天以后，与前服汤药无效，脉势仍然数急，邪气仍在经络，未入脏腑的，用桂枝石膏汤主治。此方在夏至后，代替桂枝证使用。如果加麻黄半两，可代替麻黄汤、大青龙汤证使用。若从三月到夏季发病，称为晚发伤寒，栀子升麻汤也可选用。
桂枝石膏汤：治法见前文论述。有汗脉缓为桂枝证，无汗脉紧为麻黄汤、大青龙汤证。
药物组成：桂枝（半两，去皮）、石膏（一两，捣碎）、黄芩（半两）、甘草（炙，一两）、栀子（三钱）、白芍药、升麻、干葛、生姜（以上各三分）。
上药切碎，每次服用五钱半，加水一盏半，煮至八分，去渣，过一会儿再服。如果出汗，就停止后续服药。
栀子升麻汤：治疗晚发伤寒，三月至夏季发病称为晚发。
药物组成：生地（半斤，切碎）、栀子（十个）、升麻（一两半）、柴胡、石膏（各二两半）。
上药切碎，每次服用五钱，加水一盏半，煎至八分一次性服用。病不解，再制作服用。
〔李东垣〕安静状态下得的是中暑，中暑属于阴证，应当发散。或者是避暑热，在深堂大厦纳凉，得病的叫做中暑。其病必定头痛、恶寒，身体拘急，肢节疼痛且心烦，肌肤大热无汗，这是因为房室之阴寒遏制了周身阳气，使其不能伸展越出。世人多用大顺散主治也是对的。（张元素海藏云：静而伤暑，恶寒脉沉细，静而湿胜伤形的，用白虎加苍术汤主治。大顺散，见《太平惠民和剂局方》，由甘草一钱半、干姜、杏仁、肉桂各一钱组成。）
活动状态下得的是中热，中热属于阳证，是热邪损伤元气，并非形体受病。如果是行人或农夫，在烈日下劳役得病的，名叫中热，其病必定苦于头痛，烦躁发热，厌恶热，触摸肌肤大热，必定大渴引饮，大汗淋漓，没有力气活动，这是天热外伤肺气，用苍术白虎汤主治。（张元素海藏云：动而伤暑，身热、脉洪大，动而火胜伤气的，用白虎加人参汤主治。）
〔《活人书》〕中暑背寒面垢，手足微冷，烦渴口燥，倦怠，四肢不痛重，脉微弱，按之无力，用白虎汤主治。（方剂见发热篇。）
〔王好古〕有人头痛身热，心烦燥渴，诊其脉大而虚。我给予白虎汤，服用数次痊愈。张仲景说：脉虚身热，得之于伤暑。又说：其脉弦细芤迟，为什么呢？《素问》说：寒伤形，热伤气。大概是伤气不伤形，则气消而脉虚弱，所谓弦细芤迟，都是虚脉。张仲景认为弦脉属阴，朱肱、庞安时也说过中暑脉微弱，那么脉虚就可以知道了。
〔张元素海藏〕脉虚身热，自汗恶寒的，是中暑，用白虎加桂汤主治。（方剂见疟疾篇。）
〔《活人书》〕酒蒸黄连丸：治疗暑毒深伏，屡次取效不愈，无药可治，伏暑发作口渴者。
药物组成：黄连（四两，用无灰酒浸蒸，晒干）。
研为末，糊丸，熟水送下三十丸。以胸膈凉、不渴为见效标准。
橘皮汤：治疗中暑痰逆恶寒。
药物组成：橘皮（二两，去白）、生姜（一两）、枣子（五枚，去核）、甘草（炙，半两）、人参（一钱）、竹茹（半升）。
分五服，每服加水一盏二分，煮取八分，去渣热服。
五苓散：治疗中暑，头痛，恶心，烦躁，心下不快。（方剂见渴篇。）
〔张元素海藏〕如果先喝冷饮，后伤暑的，用五苓散主治。这必定心下痞满，用生姜汤调服为佳。或者用四君子汤调理中焦，也可以。中焦调和后，如果小便不利，或者尿道疼痛，宜服下方。
药物组成：蒲黄（三钱）、滑石（五钱）、生甘草（一钱）。
中暍，脉弦细芤迟，用黄芪汤主治。
药物组成：人参、黄芪、白术、甘草、茯苓、芍药（各等分）。
上药切碎，每次服用三钱，加大盏水，生姜三片，煎至六分，去渣温服。
〔朱丹溪〕徐三官，六月间发热，大汗恶寒，战栗不自禁持，且烦渴。我说：这是暑病。诊其脉皆虚微细弱而数。其人喜好赌博，导致劳倦而虚。于是用人参、竹叶作汤，调辰砂四苓散，服用八帖而安宁。
〔某注〕张口上前牙干燥的，牙齿是骨之精，现在干燥说明骨热，针药不能治，应当灸大椎穴。
〔《活人书》〕湿温病，两小腿逆冷，胸腹满，多汗，头痛妄言。此人常伤于湿，因而中暑，湿热相搏，则发湿温。其脉阳部濡弱，阴部小而急。治疗在太阳经，不可发汗。发汗必定不能说话，耳聋，不知痛所在，身体青紫面色变，名叫重证。如此死者，是医生杀死的。用白虎加苍术汤主治。
〔王好古〕癸丑年，故人王彦龙任毗陵仓官。季夏时病胸项多汗，两足逆冷，谵语。医者不懂，杂进药已经十天。我诊之，其脉关前濡，关后数。我说：当作湿温治疗。盖先受暑，后受湿，暑湿相搏，是名湿温。先用白虎加人参汤，次用白虎加苍术汤，头痛渐退，足渐温，汗渐止，三日痊愈。这叫贼邪，误用药，有死理。有人问：什么叫贼邪？我说：《难经》说五邪，有实邪、虚邪、正邪、微邪、贼邪。从后来者为虚邪，从前来者为实邪，从所不胜来者为贼邪，从所胜来者为微邪，自病者为正邪。又说：假令心病，中暑为正邪，中湿得之为贼邪。今心先受暑，而湿邪胜之，水克火，从所不胜，斯谓之贼邪，五邪之中最逆也。《难经》说：湿温之脉，阳濡而弱，阴小而急，濡弱见于阳部，湿气搏暑也；小急见于阴部，暑气蒸湿也。故经曰暑湿相搏，名曰湿温，是谓贼邪也。不仅如此，我素有停饮之疾，每到暑月两足汗出未尝干，每服此药二三盏即愈。
〔张元素海藏〕湿温汗少的，用白虎加苍术；汗多的，用白虎加桂枝。（白虎加桂枝方见疟疾篇。）
〔孙思邈〕保庆门外有酒家姓姜的，善歌唱，孙思邈喜爱他。忽然数日不见，派人问之，则说病久，将命绝。孙思邈诊之，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。孙思邈说：这不是受病重，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，诣孙思邈谢，因请问曰：某得病剧，蒙尚药一治而苏，愿闻治法。孙思邈说：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。
〔《保命集》〕立夏之后，至立秋、处暑之间伤寒者，身多微凉，自汗，四肢沉重，谓之湿温，苍术石膏汤主治。（即白虎加苍术汤是也。）
药物组成：苍术（半两）、石膏（三钱）、知母（二钱半）、甘草（一钱）。
上药切碎，水一盏，煎至一半，温服。谓内有湿也，多不欲饮水。如身热、脉洪、无汗、多渴者，热在上焦，积于胸中，宜桔梗散。（此非湿温证，乃热病也。）
桔梗散
药物组成：薄荷、黄芩、甘草、栀子（各一钱）、桔梗（三钱）、连翘（二钱）。
上药锉碎，每服五钱，水煮加竹叶。如大便涩，加大黄半两。
〔张元素海藏〕消暑丹
药物组成：半夏（一斤）、茯苓（半斤）、生甘草（半斤）。
上用醋五升，煮半夏，尽醋熬干，姜汁作糊，无见生水为丸，每服五十丸，熟水咽下。精意修治，用之极效。中暑为患，药下即苏。伤暑发热头痛，服之尤妙。夏月常服，止渴，利小便，虽饮水多，亦不为害。应是暑药，皆不及此。若痰饮停节，并用生姜汤下。入夏之后，不可缺此。
又方，消暑丸：治疗头疼，恶心烦躁，消渴，霍乱。
药物组成：绿豆粉（四两）、石膏（四两）、白矾（枯）、硫黄（各一两）。
水浸蒸饼为丸弹子大，辰砂为衣。用姜汁醋点，新汲水化开服之。
Taiyang Zhongyue (Heatstroke in the Taiyang Channel) presents with fever, aversion to cold, heaviness of the body, and headache. The pulse is wiry, fine, hollow (Kou), or slow. After urination, there is a sensation of chills and piloerection; the hands and feet are cold. Slight exertion causes immediate fever, and opening the mouth reveals dryness of the anterior teeth. If sweating-inducing methods are used, aversion to cold worsens; if warm needle therapy is applied, fever worsens; if purgative methods are frequently used, strangury worsens.
Taiyang Zhongre (Summerheat-Stroke in the Taiyang Channel) presents with sweating, aversion to cold, body heat, and thirst. Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is the primary treatment. (The *Ren Jian Huo Ren Shu* states: In summer, spontaneous sweating, aversion to cold, body heat, thirst, greasy complexion, cold hands and feet, and a faint, powerless pulse indicate Summerheat-Stroke, treated with Baihu Tang.)
Taiyang Zhongshi (Summerheat-Dampness in the Taiyang Channel) presents with body heat, painful heaviness, and a weak or faint pulse. This is caused by consuming cold water in summer, leading to water qi circulating within the skin. Yiwu Gudi Tang (Single-Herb Melon Peduncle Decoction) is the primary treatment.
Yiwu Gudi Tang: Use 27 Gudi (Melon Peduncle). Boil in one sheng of water until five ge remain. Strain and take in one dose.
The aforementioned Gudi Tang is rarely used by later physicians, likely because its action is mild. However, if pain persists, it should be used.
[From *Huo Ren Shu*] Summerheat-Stroke and Heat Disease have similar external manifestations. However, in Heat Disease, the pulse is vigorous; in Summerheat-Stroke, the pulse is deficient. This distinguishes them. The *Jia Yi Jing* states: Vigorous pulse with cold body indicates Cold Damage; deficient pulse with hot body indicates Summerheat Injury. Generally, cold damages the form but not the Qi, hence the vigorous pulse; heat damages the Qi but not the form, hence the deficient pulse. Wet-Warmth is similar to Summerheat-Stroke, distinguished only by cool body and absence of thirst.
[Zhu Danxi] For Summerheat-Heat Disease, use Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction). If complicated by phlegm, add Banxia (Pinellia Rhizome); if complicated by deficiency, add Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome). Alternatively, use Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction).
[From *Huo Ren Shu*] In summer, fever, aversion to cold, headache, heavy painful limbs and joints, and a surging pulse indicate Heat Disease. Winter Cold Damage, triggered by summer heat, becomes Heat Disease. Treatment is the same as for Cold Damage. With sweating, Guizhi Tang (Cinnamon Twig Decoction) is indicated; without sweating, Mahuang Tang (Ephedra Decoction) is indicated. With irritability, Da Qinglong Tang (Great Blue Green Dragon Decoction) is indicated. However, summer medicines must have a cooling nature and should not be overly warming. Guizhi Tang, Mahuang Tang, and Da Qinglong Tang require modifications. Before the Summer Solstice, add half liang of Huangqin (Scutellaria Root) to Guizhi Tang. After the Summer Solstice, add one liang of Zhimu (Anemarrhena Rhizome) and two liang of Shigao (Gypsum Fibrosum) to Guizhi Tang, Mahuang Tang, or Da Qinglong Tang, or add half liang of Shengma (Cimicifugae Rhizome). Since Guizhi Tang and Mahuang Tang are heating, and the warm south differs from the northwest, summer use may cause jaundice or macular eruptions. If after three days of Heat Disease the previous decoctions fail, the pulse remains rapid, and the pathogen is still in the channels and meridians without entering the zang-fu organs, Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) is indicated. This formula replaces Guizhi Tang indications after the Summer Solstice. Adding half liang of Mahuang allows it to replace Mahuang Tang or Da Qinglong Tang indications. If illness occurs from March to summer, termed Late-Onset Cold Damage, Zhizi Shengma Tang (Gardenia and Cimicifuga Decoction) may also be selected.
Guizhi Shigao Tang: See treatment principles in the preceding discussion. Sweating with a slow pulse indicates Guizhi Tang indication; no sweating with a tight pulse indicates Mahuang Tang or Da Qinglong Tang indication.
Ingredients: Guizhi (Cinnamon Twig, half liang, bark removed), Shigao (Gypsum Fibrosum, one liang, crushed), Huangqin (Scutellaria Root, half liang), Gancao (Licorice Root, roasted, one liang), Zhizi (Gardenia Fruit, three qian), Shaoyao (Peony Root), Shengma (Cimicifugae Rhizome), Gegen (Puerariae Radix), Shengjiang (Fresh Ginger, each three fen).
Crush the herbs. Take five qian and half per dose. Add one and a half sheng of water, boil to eight parts, strain, and take again after a short interval. If sweating occurs, stop subsequent doses.
Zhizi Shengma Tang: Treats Late-Onset Cold Damage, occurring from March to summer.
Ingredients: Shengdi (Rehmanniae Radix Preparata, half jin, chopped), Zhizi (Gardenia Fruit, ten), Shengma (Cimicifugae Rhizome, one and a half liang), Chaihu (Bupleuri Radix), Shigao (Gypsum Fibrosum, each two and a half liang).
Crush the herbs. Take five qian per dose. Add one and a half sheng of water, boil to eight parts, and take in one dose. If the disease does not resolve, prepare another dose.
[Li Dongyuan] Obtained while at rest is Summerheat-Stroke (Zhongshu), which is a Yin syndrome and requires dispersing. It results from seeking coolness in deep halls or large buildings to avoid summer heat. Symptoms include headache, aversion to cold, bodily stiffness, painful limbs, irritability, intense skin heat without sweating. This is due to the inhibition of whole-body Yang Qi by the yin-cold of dwellings. The world often uses Dashun San (Great Harmony Powder), which is correct. (Zhang Yuansu [Hai Zang] states: Summerheat injury from rest, with aversion to cold and deep, fine pulse, or dampness excess damaging the form, is treated with Baihu Jia Cangzhu Tang (White Tiger Plus Atractylodes Macrocephala Decoction). Dashun San is found in the *Ju Fang*, consisting of one and a half qian of Gancao, one qian each of Ganjiang (Dried Ginger), Xingren (Apricot Seed), and Rougui (Cinnamon Bark).)
Obtained through activity is Summerheat-Heat (Zhongre), which is a Yang syndrome. It involves heat damaging the original Qi, not the physical form. It occurs to travelers or farmers laboring under the sun. Symptoms include severe headache, irritability, heat, aversion to heat, intense skin heat upon touch, extreme thirst with desire to drink, profuse sweating, and lack of energy to move. This is heavenly heat externally injuring Lung Qi. Cangzhu Baihu Tang (Atractylodes Macrocephala White Tiger Decoction) is indicated. (Zhang Yuansu [Hai Zang] states: Summerheat injury from activity, with body heat and surging-large pulse, or fire excess damaging Qi, is treated with Baihu Jia Renshen Tang.)
[From *Huo Ren Shu*] Summerheat-Stroke with cold back, greasy face, slightly cold hands and feet, irritability, thirst, dry mouth, fatigue, non-painful/heavy limbs, weak pulse that is powerless on pressure, is treated with Baihu Tang. (Formula see Fever section.)
[Wang Haogu] A patient had headache, body heat, irritability, and extreme thirst. The pulse was large and deficient. I administered Baihu Tang, cured after several doses. Zhang Zhongjing says: Deficient pulse with hot body indicates Summerheat Injury. He also asks: Why the wiry, fine, hollow, slow pulse? The *Su Wen* states: Cold damages the form, heat damages the Qi. Damaging Qi without damaging the form leads to Qi consumption and deficient pulse. Wiry, fine, hollow, and slow are all deficient pulses. Zhang Zhongjing considers wiry as Yin. Zhu Gong and Pang Anshi also stated Summerheat-Stroke has a weak pulse, thus deficiency is known.
[Zhang Yuansu / Hai Zang] Deficient pulse, hot body, spontaneous sweating, and aversion to cold indicate Summerheat-Stroke. Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction) is indicated. (Formula see Malaria section.)
[From *Huo Ren Shu*] Jiuzheng Huanglian Wan (Wine-Steamed Coptis Pill): Treats deep-seated Summerheat toxin, unresponsive to repeated treatments, no other medicine works, latent Summerheat causing thirst.
Ingredient: Huanglian (Coptis Rhizome, four liang, soaked and steamed in pure wine, dried).
Grind into powder, make pills with paste, swallow thirty pills with cooked water. Effectiveness is confirmed by coolness in the chest/diaphragm and cessation of thirst.
Jupi Tang (Tangerine Peel Decoction): Treats Summerheat-Stroke with phlegm reversal and aversion to cold.
Ingredients: Jupi (Tangerine Peel, two liang, white pith removed), Shengjiang (Fresh Ginger, one liang), Zaozi (Jujube, five pieces, pits removed), Gancao (Licorice Root, roasted, half liang), Renshen (Ginseng Root, one qian), Zhuru (Bambusae Caulis in Taeniam, half sheng).
Divide into five doses. Each dose: add one and a quarter sheng of water, boil to eight parts, strain, and take hot.
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction): Treats Summerheat-Stroke without aversion to cold. (Formula see Relapse after Labor section.)
Wuling San (Five-Ingredient Powder with Poria): Treats Summerheat-Stroke with headache, nausea, irritability, and discomfort below the heart. (Formula see Thirst section.)
[Zhang Yuansu / Hai Zang] If cold drinks were taken first, followed by Summerheat injury, Wuling San is indicated. This likely involves epigastric fullness/stuffiness; taking it with Shengjiang Tang (Fresh Ginger Decoction) is good. Or use Sijunzi Tang (Four Gentlemen Decoction) to regulate the middle. After regulation, if urination is difficult or urethral pain occurs, use the following formula:
Puhuang (Typhae Pollen, three qian), Huashi (Talcum, five qian), Sheng Gancao (Raw Licorice Root, one qian).
Zhongyue (Heatstroke) with wiry, fine, hollow, slow pulse is treated with Huangqi Tang (Astragalus Decoction).
Ingredients: Renshen (Ginseng Root), Huangqi (Astragali Radix), Baizhu (Atractylodes Macrocephala Rhizome), Gancao (Licorice Root), Fuling (Poria), Shaoyao (Peony Root) (equal parts).
Crush the herbs. Take three qian per dose. Add one large sheng of water and three slices of fresh ginger. Boil to six parts, strain, and take warm.
[Zhu Danxi] Xu Sangguan had fever in June, profuse sweating, aversion to cold, uncontrollable shivering, irritability, and thirst. I said: This is Summerheat Disease. The pulse was deficient, minute, fine, weak, and rapid. His gambling habit led to exhaustion and deficiency. I used Renshen (Ginseng Root) and Zhuye (Bamboo Leaf) as a decoction, mixed with Chen Sha Siling San (Cinnabar Five-Ingredient Powder with Poria). Eight doses brought peace.
[Note] Dryness of the anterior teeth when opening the mouth indicates bone heat (teeth are the essence of bone). Acupuncture and medicine cannot treat this; moxibustion on Dazhui (GV14) is indicated.
[From *Huo Ren Shu*] Wet-Warmth presents with cold reverse in both calves, chest/abdominal fullness, excessive sweating, headache, and delirious speech. The person is usually injured by dampness, then contracts Summerheat. Dampness and heat contend, causing Wet-Warmth. The pulse is damp-weak in the Yang position and small-rapid in the Yin position. Treatment is in the Taiyang channel; sweating is contraindicated. Sweating will cause inability to speak, deafness, unawareness of pain location, bluish body, and changed complexion, named "Heavy" syndrome. Death in such cases is due to medical error. Baihu Jia Cangzhu Tang (White Tiger Plus Atractylodes Macrocephala Decoction) is indicated.
[Wang Haogu] In the Gui Chou year, my old friend Wang Yanlong, official of Bilicang, suffered in late summer from excessive sweating in the chest and neck, cold reverse in both feet, and delirium. Physicians did not understand and gave mixed medicines for ten days. I diagnosed: pulse damp before the guan position, rapid after. I said: Treat as Wet-Warmth. First Summerheat, then dampness, contending is Wet-Warmth. First use Baihu Jia Renshen Tang, then Baihu Jia Cangzhu Tang. Headache receded, feet warmed, sweating stopped, cured in three days. This is called "Thief Evil" (Ze Xie). Wrong medication leads to death. Someone asked: What is Thief Evil? I said: The *Nan Jing* discusses five evils: Excess, Deficiency, Correct, Minor, and Thief. From behind is Deficiency Evil; from front is Excess Evil; from the unconquered is Thief Evil; from the conquered is Minor Evil; self-disease is Correct Evil. Also: Assuming Heart disease, Summerheat is Correct Evil, dampness is Thief Evil. Now the Heart first receives Summerheat, then dampness conquers it. Water overcomes Fire, from the unconquered, thus Thief Evil, the most adverse of the five evils. The *Nan Jing* states: Wet-Warmth pulse, damp-weak in Yang, small-rapid in Yin. Damp-weak in Yang shows dampness contending with Summerheat; small-rapid in Yin shows Summerheat steaming dampness. Thus, Summerheat and dampness contending is Wet-Warmth, called Thief Evil. Furthermore, I have chronic fluid retention. Every summer, my feet sweat and never dry. Taking this medicine two or three cups cures me.
[Zhang Yuansu / Hai Zang] Wet-Warmth with little sweat: Baihu Jia Cangzhu Tang. With much sweat: Baihu Jia Guizhi Tang. (Baihu Jia Guizhi Tang formula see Malaria section.)
[Sun Simiao] Outside Baoqing Gate, a wine merchant surnamed Jiang, skilled in singing, was loved by Sun Simiao. He disappeared for several days. Inquiry revealed he was critically ill. Sun diagnosed: body moist, feet cold to knees, abdominal fullness, unconsciousness, all six pulses small-weak and rapid. Medicines taken were all for Yin diseases. Sun said: The disease is not severe; the medicine aggravated it. Used Wuling San and Baihu Tang for over ten doses. Condition improved, cured after further doses. Jiang thanked Sun and asked for the method. Sun said: Your disease is Summerheat injury. Initially Yang was weak, leading to cold extremities and small, powerless pulse. Physicians thought it was Yin disease and used Yin medicines, worsening the cold extremities. I used Wuling San to strongly promote urination, reducing abdominal fullness; Baihu clears evil heat, curing the disease. In Yin diseases, calf cold implies arm cold. Your calves are cold but arms are not, so it is not lower cold ascending, but Yang weakness cold extremities.
[From *Bao Ming Ji*] Cold damage between Start of Summer and Start of Autumn/End of Heat presents with slight body coolness, spontaneous sweating, heavy limbs, called Wet-Warmth. Cangzhu Shigao Tang (Atractylodes Macrocephala and Gypsum Decoction) is indicated. (This is Baihu Jia Cangzhu Tang.)
Ingredients: Cangzhu (Atractylodes Macrocephala Rhizome, half liang), Shigao (Gypsum Fibrosum, three qian), Zhimu (Anemarrhena Rhizome, two and a half qian), Gancao (Licorice Root, one qian).
Crush, add one sheng of water, boil to half, take warm. Internal dampness means little desire to drink. If body heat, surging pulse, no sweating, and extreme thirst occur, heat is in the Upper Jiao, accumulated in the chest. Jiegeng San (Platycodon Powder) is indicated. (This is not Wet-Warmth, but Heat Disease.)
Jiegeng San
Ingredients: Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Gancao (Licorice Root), Zhizi (Gardeniae Fructus) (each one qian), Jiegeng (Platycodonis Radix, three qian), Lianqiao (Forsythiae Fructus, two qian).
Cut coarse. Take five qian per dose. Boil in water with Zhuye (Bamboo Leaf). If stool is hard, add Dahuang (Rhei Radix et Rhizoma) half liang.
[Zhang Yuansu / Hai Zang] Xiaoshu Dan (Summerheat-Relieving Pill)
Ingredients: Banxia (Pinelliae Rhizoma Preparatum, one jin), Fuling (Poria, half jin), Sheng Gancao (Raw Licorice Root, half jin).
Boil Banxia in five sheng of vinegar until vinegar is dry. Make paste with Shengjiang juice. Form pills avoiding raw water. Take fifty pills per dose with cooked water. Carefully prepared, extremely effective. Summerheat-Stroke patients revive immediately after taking. Summerheat fever/headache responds especially well. Regular summer use stops thirst, promotes urination; even with high water intake, it is harmless. No summer medicine surpasses this. If phlegm-fluid retention exists, take with Shengjiang Tang. Indispensable after entering summer.
Another Formula, Xiaoshu Wan (Summerheat-Relieving Pill): Treats headache, nausea, irritability, wasting-thirst, cholera.
Ingredients: Lvdou Fen (Mung Bean Flour, four liang), Shigao (Gypsum Fibrosum, four liang), Baifan (Alumen Exsiccatum), Liuhuang (Sulfur) (each one liang).
Make pills the size of bullet seeds using steamed bread dough soaked in water. Coat with Chen Sha (Cinnabar). Take with ginger juice and vinegar, dissolved in fresh drawn water.
[Zhu Danxi] Summerwind with phlegm and fire excess can use emetic methods.
Yulong Wan (Jade Dragon Pill): Treats all summer toxins and latent Summerheat, abdominal distension and pain. Divine efficacy.
Ingredients: Liuhuang (Sulfur), Xiaoshi (Natrii Nitratis Crystalloides), Huashi (Talcum), Mingfan (Alumen) (each one liang).
Form pills using Wu Gen Shui (Water from Unrooted Plants/Rainwater).