恐犯补阳之戒；过用苦寒，恐犯泻阴之戒。但用一甘一寒，阴阳两无偏胜之药，清解暑热而平治之，所以为
百代之宗也。○暑伤气，才中人即 短气，有似乎虚，故清暑益气兼而行之。不知者，妄行温补，致
令暑邪深入血分而成衄、痢，其害无穷。○伤寒夹阴，误用阳旦汤，得之便厥；伤暑夹阴，误用香薷饮，入
喉便喑。后贤于香薷饮中加参、 、白术、陈皮、木瓜，兼治内伤，诚有见也。○体中多湿之人，外暑蒸动内
湿，二气交通，最易中暑。所以肥人湿多，夏月百计避暑，反为暑所中者，不能避身之湿，即不能避天之暑也。
益元散，驱湿从小便出，夏月服之解暑。然体盛湿多则宜之；清 无湿之人，津液为时火所耗，当用生脉散充
其津液。若妄利小水，竭其下泉，枯槁立至。○元丰朝萃集经验医方，于中暑一门独详。其取用小半夏茯苓汤，
不治其暑，颛治其湿；又
以半夏、茯苓少加甘草名消暑丸，见消暑在消其湿耳。其香薷饮，用香薷、扁豆、浓朴为主方，热盛则去扁豆
加黄连，治其心火；湿甚则去黄连加茯苓、甘草，治其脾湿。其缩脾饮，则以脾为湿所浸淫而重滞，于扁豆、
葛根、甘草队中佐以乌梅、砂仁、草果，以快脾而去脾所恶之湿；甚则用大顺散、来复丹以治暑证之多泻利者，
又即缩脾之意而推之也。其枇杷叶散，则以胃为湿所窃据而浊秽，故用香薷、枇杷叶、丁香、白茅香之辛香以
安胃而去胃所恶之臭；甚则用冷香饮子以治暑证之多呕吐者，又即枇杷叶散而推之也。后来诸贤以益虚继之，
河间之桂苓甘露饮，用五苓、三石，意在生津液以益胃之虚。子和之桂苓甘露饮，用人参、甘草、葛根、藿香、
木香，意在益虚之中又兼去湿；或用十味香薷饮，于局方五味中增人参、黄 、白术、陈皮、木瓜，益虚以去
湿热。乃至东垣之清暑益气汤、人参黄 汤，又补中实卫以去其湿热也。中暑必显躁烦热闷。东垣仿仲景竹叶
石膏汤之制，方名清燥汤，仍以去湿为首务。夫燥与湿相反者也，而清燥亦务除湿，非东垣具过人之识，不及
此矣。又如益元散之去湿，而加辰砂则并去其热；五苓散之去湿，而加人参则益虚，加辰砂减桂则去热；白
虎汤加人参则益虚，加苍术则胜湿。合之局方则大备矣。然尚有未备者，昌观暑风一证，其卒倒类乎中风，而
不可从风门索治。《百一选方》虽有大黄龙丸，初不为暑风立法，然有中 昏死，灌之立苏，则其方亦可得
治暑风之一斑矣。傥其人阴血素亏，暑毒深入血分者，《良方》复有地榆散治中暑昏迷，不省人事，但用平常
凉血之药，清解深入血分之暑风。而美其名为泼火散者，益见暑风为心火暴甚，煎熬真阴，舍清心凉血之外，
无可泼灭耳。○凡治中暑病，不辨内伤外感、动静劳逸，一概袭用成方者，医之罪也。○凡治中暑病，不兼治
其湿者，医
之过也。○凡治中暑病，遇无汗者，必以得汗为正。若但清其内，不解其外，医之罪也。（《医门法律》）
脉候
伤暑之脉，《内经》曰脉虚身热，得之伤暑。《甲乙经》曰热伤气而不伤形，所以脉虚者是也。若
《难经》曰其脉浮大而散，殊有未然。夫浮大而散，乃心之本脉，非病脉也。仲景不言，但补其偏，曰弦、
细、芤、迟，芤即虚豁也；弦、细、迟，即热伤气之应也。其水行皮中之脉，则曰微弱，见脉为水湿所持，阳
气不行也。统而言之曰虚，分而言之曰弦、细、芤、迟、微弱。其不以浮大之脉混入虚脉之中，称为病暑之脉，
虑何周耶？（喻嘉言）
选案
一儿患吐泻，烦躁，搐搦。或以为惊，或以为风。余见其口燥，手指茶壶，腹中雷鸣。曰∶易治也。借
笼中三味药足矣。乃用黄连五分，甘草三分，人参五分，水煎冷服。下咽顷刻即睡而安。或曰∶黄连、甘草解
毒善矣，又加人参谓何？余曰∶若不用参，此儿当病气弱数日，得参明日复如无病患。次日果然。（《赵氏医贯》）
恐怕触犯补阳的禁忌；过度使用苦寒药物，恐怕触犯泻阴的禁忌。只使用一味甘寒、一味寒凉的药，即阴阳两无偏胜的药物，来清解暑热并平和地治疗它，所以这成为百代遵循的准则。○暑邪伤气，刚被暑邪中人就会短气，看起来像虚证，所以清暑与益气要同时进行。不懂的人，胡乱进行温补，导致暑邪深入血分而变成鼻衄、痢疾，其危害无穷无尽。○伤寒夹阴，误用阳旦汤，服药后立刻出现四肢厥冷；伤暑夹阴，误用香薷饮，药入喉立刻失音。后世贤者在香薷饮中加入人参、[缺字]、白术、陈皮、木瓜，兼治内伤，确实是有见识的做法。○体内湿气多的人，外部的暑热蒸动内部的湿气，二气交通，最容易中暑。所以肥胖之人湿气多，夏天千方百计避暑，反而被暑邪所中，是因为不能避开身上的湿气，也就不能避开天上的暑气。益元散，让湿气从小便排出，夏天服用可以解暑。然而身体壮实湿气多的人适合用它；对于津液清稀没有湿气的人，津液被时令火热耗伤，应当用生脉散补充他的津液。如果胡乱利小便，枯竭下焦泉源，枯槁之象立刻到来。○元丰年间汇集经验医方，在中暑一门特别详细。其中取用小半夏茯苓汤，不治疗暑邪，专门治疗湿气；又用半夏、茯苓少加甘草名叫消暑丸，可见消暑在于消除湿气罢了。其中的香薷饮，以香薷、扁豆、浓朴为主方，热盛则去掉扁豆加入黄连，治疗心火；湿甚则去掉黄连加入茯苓、甘草，治疗脾湿。其中的缩脾饮，则是认为脾被湿气浸淫而沉重滞涩，在扁豆、葛根、甘草的队伍中佐以乌梅、砂仁、草果，以使脾气畅快并去除脾所厌恶的湿气；严重时用大顺散、来复丹来治疗暑证中多腹泻痢疾的情况，又是从缩脾饮的意思推演而来的。其中的枇杷叶散，则是认为胃被湿气窃据而浊秽，所以用香薷、枇杷叶、丁香、白茅香的辛香来安胃并去除胃所厌恶的臭秽；严重时用冷香饮子来治疗暑证中多呕吐的情况，又是从枇杷叶散推演而来的。后来的各位贤者以补益虚损接着论述，河间氏的桂苓甘露饮，用五苓散和三石（滑石、石膏、寒水石），意在生津液以补益胃的虚损。子和氏的桂苓甘露饮，用人参、甘草、葛根、藿香、木香，意在补益虚损之中又兼去湿气；或者用十味香薷饮，在局方五味的基础上增加人参、黄芪、白术、陈皮、木瓜，补益虚损以去除湿热。乃至东垣氏的清暑益气汤、人参黄芪汤，又是补中气实卫气以去除湿热。中暑必定显现烦躁热闷。东垣氏仿照仲景竹叶石膏汤的体制，方名清燥汤，仍然以去湿为首要任务。燥与湿是相反的，但清燥也致力于除湿，如果不是东垣氏具有过人的见识，达不到这个地步。又如益元散去湿，加上辰砂就同时去除热邪；五苓散去湿，加上人参就补益虚损，加上辰砂减去桂枝就去热邪；白虎汤加上人参就补益虚损，加上苍术就胜湿。合起来局方的方剂就完备了。然而还有不完备的地方，我观察暑风这一证候，其突然昏倒类似中风，但不能从风门索取治疗方法。《百一选方》虽然有大黄龙丸，起初并不是为暑风立法，但是有中暑昏迷死亡的，灌服后立刻苏醒，那么它的方剂也可以窥见治疗暑风的一斑了。假如那人阴血素来亏虚，暑毒深入血分的，《良方》又有地榆散治疗中暑昏迷，不省人事，只用平常凉血的药物，清解深入血分的暑风。并且美其名曰泼火散，更可见暑风是心火暴甚，煎熬真阴，除了清心凉血之外，没有别的办法可以泼灭火焰。○凡是治疗中暑病，不辨别内伤外感、动静劳逸，一概袭用成方的，是医生的罪过。○凡是治疗中暑病，不兼治湿气的，是医生的过错。○凡是治疗中暑病，遇到无汗的，必须以得汗为正治。如果只清解内部，不解表，是医生的罪过。（出自《医门法律》）
脉候
伤暑的脉象，《内经》说脉虚身热，这是得之于伤暑。《甲乙经》说热伤气而不伤形，所以脉虚就是这种情况。如果《难经》说脉浮大而散，实在是不对的。夫浮大而散，是心的本脉，不是病脉。仲景不言，只是补充其偏颇，说弦、细、芤、迟，芤即虚豁之意；弦、细、迟，就是热伤气的应验。其水行皮中的脉，则说微弱，见到脉为水湿所持，阳气不行也。统而言之叫虚，分而言之叫弦、细、芤、迟、微弱。他不把浮大的脉混入虚脉之中，称为病暑的脉，考虑多么周全啊？（喻嘉言）
选案
一个小孩患吐泻，烦躁，抽搐。有人认为是惊风，有人认为是风邪。我看见他口燥，手指茶壶，腹中雷鸣。说：容易治。借笼中的三味药就够了。于是用黄连五分，甘草三分，人参五分，水煎冷服。咽下顷刻就睡着而安定。有人说：黄连、甘草解毒很好，又加人参为什么？我说：如果不用人参，这孩子应当病气弱几天，用了人参明天恢复如没生病一样。第二天果然如此。（出自《赵氏医贯》）
Afraid of violating the taboo against tonifying Yang; overusing bitter-cold herbs, afraid of violating the taboo against draining Yin. Only using one sweet-cold and one cold herb, i.e., herbs that do not favor either Yin or Yang excessively, to clear and resolve summerheat-heat and treat it in a balanced manner, thus becoming the standard followed for generations. ○ Summerheat injures Qi; immediately after being affected by summerheat, there is shortness of breath, which appears like deficiency, so clearing summerheat and tonifying Qi should be done simultaneously. Those who do not understand this recklessly apply warm-tonifying methods, causing summerheat pathogen to penetrate deeply into the Blood level, resulting in epistaxis (nosebleed) and dysentery, with infinite harm. ○ Cold damage with Yin involvement, mistakenly using Yangdan Tang, results in immediate limb coldness (Jue); summerheat injury with Yin involvement, mistakenly using Xiangru Yin, results in immediate aphonia upon swallowing. Later sages added Ren Shen (Ginseng Root), [missing character], Bai Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), and Mu Gua (Chaenomelis Fructus) to Xiangru Yin to concurrently treat internal injury, which is indeed insightful. ○ Individuals with abundant dampness internally, when external summerheat steams and moves internal dampness, allowing the two energies to interact, are most prone to summerheat stroke. Therefore, obese people have much dampness; even if they try every means to avoid summerheat in summer, they still suffer from summerheat stroke because they cannot avoid their own body's dampness, and thus cannot avoid heaven's summerheat. Yiyuan San drives dampness out through urination; taking it in summer resolves summerheat. However, it suits those with robust constitutions and abundant dampness; for those with clear fluids but no dampness, whose fluids are consumed by seasonal fire, Shengmai San should be used to replenish their fluids. If one recklessly promotes diuresis, exhausting the lower source, desiccation will occur immediately. ○ During the Yuanfeng era, experienced medical formulas were collected, with special detail on summerheat stroke. Among them, Xiaobanxia Fuling Tang was selected; it does not treat summerheat directly but specifically treats dampness; furthermore, Banxia (Pinelliae Rhizoma) and Fuling (Poria) with a small amount of Gancao (Licorice Root) named Xiaoshu Wan, showing that resolving summerheat lies in eliminating dampness. The Xiangru Yin uses Xiangru (Moslae Herba), Bian Dou (Vigna Semen), and Hou Po (Magnoliae Officinalis Cortex) as the main formula; if heat is severe, remove Bian Dou and add Huanglian (Coptidis Rhizoma) to treat Heart Fire; if dampness is severe, remove Huanglian and add Fuling (Poria) and Gancao (Licorice Root) to treat Spleen Dampness. The Suopi Yin assumes the Spleen is immersed by dampness and becomes heavy and sluggish; among Bian Dou (Vigna Semen), Gegen (Puerariae Lobatae Radix), and Gancao (Licorice Root), it adds Wumei (Mume Fructus), Sharen (Amomi Fructus), and Caoguo (Tsaoko Fructus) to invigorate the Spleen and eliminate the dampness the Spleen dislikes; in severe cases, Dashun San (Great Harmony Powder) and Laifu Dan (Reviving Life Pill) are used to treat summerheat syndromes with frequent diarrhea and dysentery, further extending the principle of Suopi Yin. The Pipaye San assumes the Stomach is occupied by dampness and becomes turbid and foul; thus, it uses the pungent-aromatic properties of Xiangru (Moslae Herba), Pipaye (Loquat Leaf), Dingxiang (Caryophylli Flos), and Baimaoxiang (Costi Rhizoma) to calm the Stomach and eliminate the foulness the Stomach dislikes; in severe cases, Lengxiang Yin (Cold Fragrant Decoction) is used to treat summerheat syndromes with frequent vomiting, further extending the principle of Pipaye San. Later sages continued with tonifying deficiency. Hejian Shi's Guiling Ganlu Yin uses Wu Ling San (Five-Ingredient Powder with Poria) and Three Stones (Hua Shi, Shigao, Hanshuishi), intending to generate fluids to tonify Stomach deficiency. Hezi Shi's Guiling Ganlu Yin uses Ren Shen (Ginseng Root), Gancao (Licorice Root), Gegen (Puerariae Lobatae Radix), Huoxiang (Agastaches Herba), and Muxiang (Aucklandiae Radix), intending to tonify deficiency while also removing dampness; or using Shiwei Xiangru Yin (Ten-Ingredient Mosla Decoction), adding Ren Shen (Ginseng Root), Huangqi (Astragali Radix), Bai Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), and Mu Gua (Chaenomelis Fructus) to the Bureau Formula's Five-Ingredient base, tonifying deficiency to remove damp-heat. Even Dongyuan Shi's Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction) and Renshen Huangqi Tang (Ginseng and Astragalus Decoction) tonify Middle Jiao and solidify Wei Qi to remove damp-heat. Summerheat stroke must manifest as restlessness, irritability, heat, and oppression. Dongyuan Shi imitated Zhongjing's Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) structure, naming the formula Qingzao Tang (Clear Dryness Decoction), still prioritizing dampness removal. Although Dryness and Dampness are opposites, clearing dryness also strives to remove dampness; without Dongyuan Shi's exceptional insight, this would not have been achieved. For example, Yiyuan San removes dampness, but adding Chensha (Cinnabar) also clears heat; Wu Ling San removes dampness, but adding Ren Shen (Ginseng Root) tonifies deficiency, adding Chensha (Cinnabar) and reducing Guizhi (Cinnamon Twig) clears heat; Baihu Tang (White Tiger Decoction) adding Ren Shen (Ginseng Root) tonifies deficiency, adding Cangzhu (Atractylodis Rhizoma) overcomes dampness. Combined with Bureau Formulas, they are comprehensive. However, there are still incompletenesses. I observe the syndrome of Summerwind (Summerheat Wind); its sudden collapse resembles Stroke (Zhong Feng), but treatment should not be sought from the Wind category. Although "Baiyi Xuanfang" has Da Hulong Wan (Great Yellow Dragon Pill), it was not originally legislated for Summerwind, yet there are cases of summerheat coma death where administering it leads to immediate revival, so its formula can reveal a glimpse of treating Summerwind. If the person has chronic Yin-Blood deficiency and summerheat toxin penetrates deeply into the Blood level, "Liangfang" has Diyu San (Sanguisorba Powder) to treat summerheat coma and unconsciousness, using ordinary blood-cooling herbs to clear and resolve summerheat wind penetrating deeply into the Blood level. And beautifying its name as Pohuo San (Extinguish Fire Powder) further shows that Summerwind is caused by violent Heart Fire scorching True Yin; apart from clearing Heart and cooling Blood, there is no other way to extinguish the fire. ○ Anyone treating summerheat stroke without distinguishing between internal injury and external contraction, or movement/stillness and labor/rest, and blindly applying established formulas commits the doctor's sin. ○ Anyone treating summerheat stroke without concurrently treating dampness commits the doctor's fault. ○ Anyone treating summerheat stroke encountering anhidrosis (no sweat) must take sweating as the correct outcome. If only clearing the interior without releasing the exterior, it is the doctor's sin. (From *Yimen Falü*)
Pulse Signs
The pulse of summerheat injury: *Neijing* states "pulse is deficient, body is hot," caused by summerheat injury. *Jia Yi Jing* states "Heat injures Qi but not Form," hence the deficient pulse is correct. If *Nanjing* states "the pulse is floating, large, and scattered," this is indeed incorrect. Floating, large, and scattered is the normal pulse of the Heart, not a pathological pulse. Zhongjing did not mention it, but supplemented its bias by stating wiry (Xian), fine (Xi), knotted/empty (Kou), and slow (Chi). Kou implies emptiness; wiry, fine, and slow are responses to Heat injuring Qi. Regarding pulses where water moves under the skin, it states "weak and faint," indicating the pulse is held by water-dampness, and Yang Qi does not circulate. Generally speaking, it is called deficient; specifically, it is wiry, fine, kou, slow, weak, and faint. By not mixing floating-large pulses into deficient pulses, calling it the pulse of pathological summerheat, how thorough is the consideration? (Yu Jiayan)
Selected Cases
A child suffered from vomiting and diarrhea, restlessness, and convulsions. Some considered it fright, others wind. I saw his dry mouth, him pointing to the teapot, and rumbling in the abdomen. I said: "Easy to treat. Borrow three ingredients from the cage." So I used Huanglian (Coptidis Rhizoma) 5 fen, Gancao (Licorice Root) 3 fen, Ren Shen (Ginseng Root) 5 fen, decocted in water and served cold. Within moments of swallowing, he slept and became calm. Someone asked: "Huanglian and Gancao detoxify well, why add Ren Shen?" I said: "If Ren Shen is not used, this child will suffer from Qi weakness for several days; with Ren Shen, he will recover tomorrow as if never ill." The next day, it was indeed so. (From *Zhao Shi Yi Guan*)