喻昌曰∶风也湿也，二气之无定体而随时变易者也。湿在冬为寒湿，在春为风湿，在夏为热湿，在秋为燥湿，以湿
土寄王于四季之末，其气每随四时之气而变迁。昌言之矣，惟风亦然。风在冬为 发之寒风，在春为调畅之温风，在夏
为南熏之热风，在秋为凄其之凉风。《内经》谓风者百病之长，其变无常者是也。其中人也，风则上先受之，湿则下先受
之，俱从太阳膀胱经而入。风伤其卫，湿流关节；风邪从阳而亲上，湿邪从阴而亲下；风邪无形而居外，湿邪有形而居
内；上下内外之间，邪相搏击，故显汗出恶风，短气发热，头痛，骨节烦疼，身重微肿等证。此固宜从汗解，第汗法不
与常法相同。用麻黄汤必加白术，或加薏苡仁以去其湿。用桂枝汤必去芍药加白术，甚者加附子以温其经。其取汗又贵
徐不贵骤，骤则风去湿存，徐则风湿俱去也。其有不可发汗者，缘风湿相搏，多夹阳虚，阳虚即不可汗，但可用辛热气
壮之药，扶阳以逐湿而已。凡见短气，虽为邪阻其正，当虑胸中阳虚。凡见汗出微喘，虽为肺气感邪，当虑真阳欲脱，
明眼辨之必早也。《伤寒论》中，风湿相搏，以冬寒而例三时。《金匮》痉湿 篇中，风湿相搏，以夏热而例三时。其日
病者一身尽痛，发热，日晡所剧者，名风湿。此病伤于汗出当风，或久伤取冷所致。岂非夏月当风，取凉过久，而闭其
汗乎？日晡所剧，其病在阳明。然与痉病之 齿，热甚入深，阳明可下之证不同，此但可汗而不可下也。何以言之？《内
经》谓太阴、阳明为表里，外合肌肉，故阳受风气，阴受湿气，所以风湿客于太阴、阳明，即为半表半里。而一身之肌
肉尽痛，即为在表之邪未除，故可汗而不可下也。况人身之气，昼日行阳二十五度，平旦属少阳，日中属太阳，日西属
阳明。日晡所剧，邪在阳明，而太阳、少阳之气，犹未尽退，故亦可汗不可下也。观《金匮》一则曰∶可与麻黄加术汤，
发其汗为宜，慎不可以火攻之。再则曰∶可与麻黄杏子薏苡甘草汤，虽未言及不可下，而其可汗不可下之意，比例具见
矣。若下之，则虚其胃气，而风邪下陷，湿邪上涌，其变不可胜言矣。其湿流关节之痛，脉见沉细者，则非有外风与之
相搏，只名湿痹。湿痹者，湿邪痹其身中之阳气也。利其小便，则阳气通行无碍，而关节之痹并解矣。设小便利已，而
关节之痹不解，必其人阳气为湿所持，而不得外泄，或但头间有汗，而身中无汗，反欲得被盖向火者，又当微汗以通其
阳也。因风湿相搏之文，错见不一，难于会通，故并及之。
者中暑之称，《左传》荫 人于樾下，其名久矣。后世以动而得之为中热，静而得之为中暑。然则道途中 之人，
可谓静而得之耶？动静二字，只可分外感内伤。动而得之，为外感天日之暑热。静而得之，因避天日之暑热，而反受阴
湿风露，瓜果生冷所伤，则有之矣。时令小寒、大寒，而人受之者为伤寒。时令小暑、大暑，而人受之者即为伤暑。劳
苦之人，凌寒触暑，故多病寒暑。安养之人，非有饮食房劳，为之招寒引暑，则寒暑无由入也。所以膏梁藜藿，东南西
北，治不同也。
体中多湿之人，最易中暑，两相感召故也。外暑蒸动内湿，二气交通，因而中暑。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，有自来矣。然体盛湿多则宜
之。清 无湿之人，津液为时令所耗，当用生脉散，充其津液。若用益元，妄利小水，竭其下泉，枯槁立至。况暑热蒸
动之湿，即肥人多有内夹虚寒，因至霍乱吐泻，冷汗四逆，动关性命者，徒恃益元解暑驱湿，反促其脏腑气绝者比比，
可不辨而轻用之欤？不特此也，凡见汗多之体，即不可利其小便。盖胃中只此津液，夫既外泄，又复下行，所谓立匮之
术也。仲景名曰无阳，其脉见短促结代，则去生远矣。
中暑卒倒无知，名曰暑风。大率有虚实两途，实者痰之实也，平素积痰。充满经络，一旦感召盛暑，痰阻其气，卒
倒流涎，此湿 合病之最剧者也。宜先吐其痰，后清其暑，犹易为也。虚者阳之虚也，平素阳气衰微不振，阴寒久
已用事，一旦感召盛暑，邪凑其虚，此湿 病之得自虚寒者也。宜回阳药中兼清其暑，最难为也。丹溪谓火令流金铄石，
何阴冷之有？立言未免偏执，十中不无二三之误也。夫峨眉积雪，终古未消，岂以他山不然，遂谓夏月旷刹皆热火乎？
人身之有积阴，乃至汤火不能温者，何以异此。《内经》谓无者求之，虚者责之，可见不但有者实者之当求责矣。管见
谓
大黄龙丸，有中 昏死，灌之立苏者，非一征乎？间亦有中气者，为七情所伤，气厥无痰，宜用苏合香丸灌之。许学士
云∶此气暴厥逆而然，气复即已。虽不药亦愈，然苏后暑则宜清也。
夏月人身之阳，以汗而外泄。人身之阴，以热而内耗。阴阳两俱不足，仲景于中 病，禁用汗下温针，汗则伤其阳，
下则伤其阴，温针则引火热内攻，故禁之也。而其用药，但取甘寒，生津保肺，固阳益阴为治。此等关系最巨，今特挈
出。《灵枢》有云∶阴阳俱不足，补阳则阴竭，泻阴则阳亡。盖谓阳以阴为宅，补阳须不伤其阴。阴以阳为根，泻阴须
不
动其阳。夫既阴阳俱不足，则补泻未可轻言，才有补泻，必造其偏。如重阴重阳之属，其初不过差之毫厘耳。所以过用
甘温，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。
合论《金匮》治 用白虎加人参汤瓜蒂汤二方 《金匮》治 病，止出二方。一者白虎加人参汤，颛治其热，
以夏月之热淫，必僭而犯上，伤其肺金，耗其津液，用之以救肺金存津液也。孙思邈之生脉散，李东垣之清暑益气汤，
亦既祖之矣。一者瓜蒂汤，颛治其湿，以夏月之湿淫上甚为热，亦先伤其肺金，故外渍之水，得以聚于皮间。皮者肺之
合也，用以搐其胸中之水，或吐或泻而出，则肺气得以不壅，而皮间之水，得以下趋也。何后人但宗仲景五苓散为例，
如河间之通苓散，子和之桂苓甘露饮，非不得导湿消暑之意，求其引伸瓜蒂汤之制，以治上焦湿热，而清夫肺金，则绝
无一方矣。故特举二方，合论其义。见无形之热，伤其肺金，则用白虎加人参汤救之。有形之湿，伤其肺金，则用瓜蒂
汤救之，各有所主也。二方《伤寒·痉湿 篇》中不载，《金匮·痉湿 篇》中复出之，金针暗度，宜识之矣。
白虎加人参汤 本文云∶太阳中热者， 是也。其人汗出恶寒，身热而渴，白虎加人参汤主之。本方之义，已见《尚
论》一百一十三方中，兹再详之。夏月汗出恶寒者，卫气虚也。身热而渴者，肺金受火克而燥渴也。《内经》曰∶心移热
于肺，传为膈消，消亦渴也。心火适王，肺金受制，证属太阳，然与冬月感寒之治不同，用此汤以救肺金，是为第一义
矣。
瓜蒂汤 本文云∶太阳中 ，身疼重而脉微弱，此以夏月伤冷水，水行皮中所致，一物瓜蒂汤主之。
变散为汤，而去赤小豆、酸浆水，独用瓜蒂一味煎服。搐去胸中之水，则皮中之水，得以俱出也。搐中有宣泄之义，
汗如其故，不复水渍皮间矣。此即《内经》以水灌汗，乃至不复汗之证，仲景会其意，言中 者兼乎中湿，有所祖也。
然水行皮中，何以脉见微弱耶？盖中 脉本虚弱，而湿居皮肤，内合于肺，阻碍营卫之营运，其脉更见微弱也。 脉虚
弱，按之无力。湿脉微弱，举之不利。湿与 合之脉，则举按皆不利也。搐去其水，而营卫通，肺气行，举指流利，即
湿去之征。按之有力，即 解之征。一物之微，其功效之神且捷者，有如此矣。
水行皮中，乃夏月偶伤之水，或过饮冷水，或以冷水灌汗，因致水渍皮中，遏郁其外出之阳，以故身热疼重。用瓜
蒂一物驱逐其水，则阳气行而遏郁之病解矣。凡形寒饮冷则伤肺，乃积渐使然。此偶伤之水，不过伤肺所合之皮毛，故
一搐即通。并无借赤小豆、酸浆水之群力也。即是推之，久伤取冷，如风寒雨露，从天气而得之者，皆足遏郁其上焦之
阳，又与地气之湿，从足先受，宜利其小便者异治矣。可无辨欤？
夏月卒倒，不省人事，名曰暑风。乃心火暴甚，暑热乘之，令人噎闷，昏不知人。然亦有他藏素虚，暑得深中者，
但不似心藏之笃耳。入肝则眩晕顽痹；入脾则昏睡不觉；入肺则喘满痿 ；入肾则消渴。虽当补益与清解兼行，然必审
其属于何藏，用药乃得相当也。
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。
日中劳役，而触冒其暑者，此宜清凉解其暑毒，如白虎汤、益元散、黄连香薷饮、三黄石膏汤之类，皆可取用也。
深居广厦，袭风凉，餐生冷，遏抑其阳而病暑者，一切治暑清凉之方，即不得径情直施。如无汗仍须透表以宣其阳；
如吐利急须和解以安其中；甚者少用温药以从治之。故冒暑之霍乱吐泻，以治暑为主。避暑之霍乱吐泻，以和中温中为
主，不可不辨也。
元丰朝立和剂局，萃集医家经验之方，于中暑一门独详，以夏月暑证，五方历试，见闻广耳。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，名正言顺矣。其香薷饮，用香薷、扁豆、
浓朴为主方，热盛则去扁豆，加黄连为君，治其心火；湿盛则去黄连，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。医者于热湿虚
寒，浅深缓急间，酌而用之，其利溥矣。而后来诸贤，以益虚继之。河间之桂苓甘露饮，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、葛根、甘草、藿香、木香，益虚之中，又兼去浊。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。肥白内虚之人，勿论中暑与否，所宜频服者也。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。然尚有未备焉，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，管见从而赞之曰∶有中 昏死，灌之立苏，则其方亦可得治暑风之一斑矣。倘或其人阴血素亏，暑毒深入血分，进
以此丸，宁不立至危殆乎？良方复有地榆散，治中暑昏迷，不省人事而欲死者，但用平常凉血之药，清解深入血分之暑
风，良莫良于此矣！后有用之屡效，而美其名为泼火散者，知言哉！夫中天火运，流金烁石，而此能泼之。益见暑风为
心火暴甚，煎熬阴血，舍清心凉血之外，无可扑灭耳。综群方而论列之，以其详故益加详焉。（诸方俱汇本门后）
喻昌说：风和湿，是两种没有固定形态、随季节变化而改变的邪气。湿在冬季表现为寒湿，在春季表现为风湿，在夏季表现为热湿，在秋季表现为燥湿，这是因为湿土之气寄旺于四季之末，其性质往往随着四时的气候变迁而变化。我已经论述过这一点，风也是如此。风在冬季是凛冽的寒风，在春季是温和畅达的温风，在夏季是南来的热风，在秋季是凄清的凉风。《黄帝内经》说风是百病之长，指的就是它变化无常的特点。风邪侵袭人体，通常头部先受邪；湿邪侵袭人体，通常下肢先受邪；二者都从足太阳膀胱经进入体内。风邪损伤卫气，湿邪流注关节；风邪属阳而趋向身体上部，湿邪属阴而趋向身体下部；风邪无形而在体表，湿邪有形而在体内；上下内外之间，邪气相互搏击，所以出现出汗、怕风、气短、发热、头痛、骨节剧烈疼痛、身体沉重且轻微浮肿等症状。这种情况固然应当通过发汗来解除，但发汗的方法与常规不同。使用麻黄汤（Mahuang Decoction）必须加入白术，或者加入薏苡仁以祛除湿气。使用桂枝汤（Guizhi Tang）必须去掉芍药并加入白术，病情严重的还要加入附子以温通经脉。取汗贵在缓慢而不宜急促，如果发汗过急，则风邪虽去而湿邪留存；如果发汗缓慢，则风湿二邪都能去除。对于那些不能发汗的患者，是因为风湿相搏，多夹杂阳气虚弱，阳气虚弱则不可发汗，只能使用辛热壮阳的药物，扶助阳气以驱逐湿气罢了。凡是见到气短的症状，虽然是因为邪气阻滞正气，但也应当考虑到胸中阳气虚弱。凡是见到出汗且伴有轻微气喘的症状，虽然是因为肺气感受邪气，但也应当考虑到真阳即将脱失的危险，明眼医生一定能及早辨别。《伤寒论》中，将风湿相搏的情况，用冬季的寒邪来类比其他三个季节。《金匮要略·痉湿暍篇》中，将风湿相搏的情况，用夏季的热邪来类比其他三个季节。文中说：“患者全身疼痛，发热，且在日晡时（下午3-5点）加重，称为风湿。”这种病是由于出汗时当风，或长期贪凉受冷所致。难道不是夏天当风，贪凉太久，导致汗孔闭塞吗？日晡时加重，说明病位在阳明经。然而这与痉病中牙齿紧闭、热势深重、属于阳明可下证的病机不同，此病只可发汗，不可攻下。为什么这样说呢？《黄帝内经》说太阴和阳明互为表里，外合肌肉，所以阳经受风气，阴经受湿气，因此风湿客居于太阴、阳明经，就处于半表半里的位置。而全身肌肉尽痛，说明是在表的邪气未除，所以可以发汗而不可以攻下。况且人体的气，白天行于阳分二十五度，平旦时属于少阳，日中时属于太阳，日西时属于阳明。日晡时症状加重，邪气在阳明，但太阳、少阳的气机尚未完全消退，所以也可以发汗而不可以攻下。看《金匮要略》一则说：“可与麻黄加术汤（Mahuang Jia Zhu Tang），发汗为宜，千万不要用火攻法。”再则说：“可与麻黄杏仁薏苡甘草汤（Mahuang Xingren Yiyi Gancao Decoction），虽然没有明确说不可攻下，但其可汗不可下的意思，通过类比已经很明显了。”如果误用攻下法，就会使胃气虚弱，风邪内陷，湿邪上涌，产生的变证不可胜数。至于湿邪流注关节引起的疼痛，脉象沉细的，就不是有外风与之相搏，只称为湿痹（Shibi, Dampness Bi Syndrome）。湿痹，是指湿邪痹阻身体中的阳气。利小便，则阳气通行无碍，关节的痹阻也就解除了。如果小便利后，关节的痹阻仍未解除，一定是因为人的阳气被湿邪遏制，不能向外宣泄，或者只有头部出汗而身上无汗，反而想要盖被子靠近火源取暖，这时又应当微发汗以通达阳气。因为关于“风湿相搏”的条文，错见不一，难以融会贯通，所以一并加以论述。
中暑（Zhongshu, Heatstroke）的称呼，《左传》中记载有人在树荫下休息，其名由来已久。后世将活动状态下得病称为中热，静止状态下得病称为中暑。那么道路途中行走的人，可以说是静止得病的吗？动和静这两个字，只可以用来区分外感和内伤。活动状态下得病，是外感天日的暑热。静止状态下得病，是因为躲避天日的暑热，反而受到阴湿、风露、瓜果生冷所伤，这是有的。时令的小寒、大寒，人感受它叫伤寒。时令的小暑、大暑，人感受它就叫伤暑。劳苦之人，冒着寒冷接触暑热，所以容易患寒暑病。安养之人，如果没有饮食不节和房劳过度来招致寒暑，那么寒暑就没有途径侵入。所以富贵人家（膏梁）和平民百姓（藜藿），东南西北各地，治疗方法是不同的。
体内湿气重的人，最容易中暑，因为内外湿气相互感召。外部的暑热蒸动内部的湿气，二气交通，因而导致中暑。所以肥胖的人湿气多，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（Yiyuan San）能驱湿从小便排出，夏天服用它可以解暑，这是有来历的。然而体质壮实、湿气多的人才适宜使用。对于津液因时令消耗而无湿的人，应当使用生脉散（Shengmai San）来补充津液。如果使用益元散，妄自利小便，竭尽下焦源泉，枯槁之症立刻到来。况且暑热蒸动的湿气，即肥人多有内夹虚寒，导致霍乱吐泻，冷汗淋漓，四肢厥逆，危及生命的情况，如果单纯依赖益元散解暑驱湿，反而促使脏腑气绝的例子比比皆是，能不辨别而轻率使用吗？不仅如此，凡是见到汗多的人，就不可以利其小便。因为胃中只有这些津液，既然已经从外部泄出，又再从内部下行，这就是所谓的“立毙之术”。张仲景称之为“无阳”，如果脉象出现短促、结代，那就离死亡不远了。
中暑突然昏倒无知觉，称为暑风（Shufeng, Summerheat Wind）。大体上有虚实两条途径。实证是痰浊的实证，平时积痰充满经络，一旦感受盛暑，痰浊阻滞气机，突然昏倒流涎，这是湿暑合病中最剧烈的情况。应当先用吐法祛痰，后清暑热，还比较容易治疗。虚证是阳气的虚证，平时阳气衰微不振，阴寒久已占据主导，一旦感受盛暑，邪气凑其虚处，这是湿暑病中源于虚寒的情况。应当在回阳药物中兼清暑热，最难治疗。朱丹溪说火令时节流金烁石，怎么会有阴冷呢？他的言论未免偏执，十次中难免有二三次的失误。峨眉山的积雪，终年不消，难道因为他山没有，就说夏天的寺庙都是热火吗？人身上的积阴，甚至到了汤火都不能温暖的地步，与此有什么不同。《黄帝内经》说无者求之，虚者责之，可见不仅是有者实者应当追究。我的见解认为大黄龙丸（Dahuang Long Wan），有中暑昏死，灌服后立即苏醒的案例，这不就是证明吗？间或有中气（Qi Jue, Qi Collapse）的人，因七情所伤，气厥无痰，应当使用苏合香丸（Suhe Xiang Wan）灌服。许学士说：这是气暴厥逆所致，气复即愈。即使不吃药也会好，但苏醒后暑热应当清除。
夏季人身阳气，随汗液外泄。人身阴液，随热气内耗。阴阳两俱不足，张仲景在中暑病中，禁用汗法、下法和温针法，发汗则伤其阳，攻下则伤其阴，温针则引火热内攻，所以禁止使用。而其用药，只取甘寒之品，生津保肺，固阳益阴为治法。这关系重大，现在特别提出来。《灵枢》说：阴阳俱不足，补阳则阴竭，泻阴则阳亡。是说阳以阴为宅，补阳须不伤其阴。阴以阳为根，泻阴须不动其阳。既然阴阳俱不足，那么补泻不可轻言，只要有补泻，必然造成偏颇。如重阴重阳之类，起初不过是差之毫厘。所以过用甘温，恐怕犯补阳之戒。过用苦寒，恐怕犯泻阴之戒。只用一甘一寒，阴阳两无偏胜的药物，清解暑热而平治之，所以成为百代之宗。
综合讨论《金匮要略》治疗中暑用的白虎加人参汤（Baihu Jia Renshen Tang）和瓜蒂汤（Gua Di Tang）两方。《金匮要略》治疗中暑病，只出了这两个方子。一个是白虎加人参汤，专门治疗热邪，因为夏季的热淫，必定僭越而上犯，损伤肺金，耗伤津液，用它来救肺金、存津液。孙思邈的生脉散，李东垣的清暑益气汤，都已经效法于此。一个是瓜蒂汤，专门治疗湿邪，因为夏季的湿淫上甚化为热，也先伤肺金，所以外渍之水，得以聚于皮间。皮是肺之合，用它来搐去胸中之水，或通过呕吐或通过腹泻排出，则肺气得以不壅滞，而皮间的水，得以向下趋行。为何后人只尊奉张仲景的五苓散（Wuling San）为例，如刘河间的通苓散，张子和的桂苓甘露饮（Guiling Ganlu Yin），并非没有导湿消暑的意思，但寻求引申瓜蒂汤的制方原理，以治疗上焦湿热，而清肃肺金的，却绝无一方。所以特别举起这两方，合论其义。见到无形之热伤肺金，就用白虎加人参汤救治。有形之湿伤肺金，就用瓜蒂汤救治，各有所主。这两方在《伤寒论·痉湿暍篇》中不载，在《金匮要略·痉湿暍篇》中复出，这是金针暗渡的手法，应当识得。
白虎加人参汤：本文说：“太阳中热者，即中暑也。其人汗出恶寒，身热而渴，白虎加人参汤主之。”本方的意义，已在《尚论篇》一百一十三方中见过，这里再详细解释。夏季汗出恶寒，是卫气虚弱。身热而渴，是肺金受火克而燥渴。《黄帝内经》说：心移热于肺，传为膈消，消也是渴。心火正旺，肺金受制，证属太阳，但与冬季感寒的治疗不同，用此汤来救肺金，是第一要义。
瓜蒂汤：本文说：“太阳中暑，身疼重而脉微弱，这是夏季伤冷水，水行皮中所致，一物瓜蒂汤主之。”变散为汤，去掉赤小豆、酸浆水，独用瓜蒂一味煎服。搐去胸中之水，则皮中之水，得以全部排出。搐法中有宣泄的意义，汗出如常，不再有水渍留于皮间。这就是《黄帝内经》中以水灌汗，导致不再出汗的证候，张仲景领会其意，说中暑者兼有中湿，是有师承的。然而水行皮中，为什么脉象见微弱呢？大概中暑脉本虚弱，而湿居皮肤，内合于肺，阻碍营卫的运行，其脉更见微弱。暑脉虚弱，按之无力。湿脉微弱，举之不利。湿与暑合之脉，则举按皆不利。搐去其水，而营卫通，肺气行，举指流利，即是湿去之征。按之有力，即是暑解之征。一味药的微小，其功效的神速，竟到如此地步。
水行皮中，乃夏季偶然受伤的水，或过饮冷水，或以冷水灌汗，导致水渍皮中，遏郁其外出之阳，所以身热疼重。用瓜蒂一味驱逐其水，则阳气行而遏郁之病解矣。凡形寒饮冷则伤肺，是积渐使然。此偶伤之水，不过伤肺所合之皮毛，所以一搐即通。并无借赤小豆、酸浆水之群力。由此推之，久伤取冷，如风寒雨露，从天气而得之者，皆足以遏郁其上焦之阳，又与地气之湿，从足先受，宜利其小便者异治矣。可不辨别吗？
夏季突然昏倒，不省人事，称为暑风。乃心火暴甚，暑热乘之，令人噎闷，昏不知人。但也有其他脏腑素虚，暑邪深入的情况，只是不像心脏那样严重。入肝则眩晕顽痹；入脾则昏睡不觉；入肺则喘满痿躄；入肾则消渴。虽然应当补益与清解兼行，但必须审察其属于何脏，用药才能相当。
伤暑的脉象，《黄帝内经》说：脉虚身热，得之伤暑。《甲乙经》说：热伤气而不伤形，所以脉虚是对的。若《难经》说：其脉浮大而散，殊有不对。夫浮大而散，乃心之本脉，非病脉也。张仲景不言，只补其偏说：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，考虑多么周全啊。
中午劳作，而触冒其暑者，此宜清凉解其暑毒，如白虎汤、益元散、黄连香薷饮、三黄石膏汤之类，皆可取用。深居广厦，袭风凉，餐生冷，遏抑其阳而病暑者，一切治暑清凉之方，即不得径情直施。如无汗仍须透表以宣其阳；如吐利急须和解以安其中；甚者少用温药以从治之。故冒暑之霍乱吐泻，以治暑为主。避暑之霍乱吐泻，以和中温中为主，不可不辨。
元丰朝设立和剂局，萃集医家经验之方，于中暑一门独详，因为夏季暑证，五方历试，见闻广耳。其取用小半夏茯苓汤，不治其暑，专治其湿。又以半夏、茯苓少加甘草，名消暑丸，见消暑在消其湿，名正言顺矣。其香薷饮，用香薷、扁豆、浓朴为主方，热盛则去扁豆，加黄连为君，治其心火；湿盛则去黄连，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。医者于热湿虚寒，浅深缓急间，酌而用之，其利溥矣。而后来诸贤，以益虚继之。河间之桂苓甘露饮，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、葛根、甘草、藿香、木香，益虚之中，又兼去浊。或用十味香薷饮，于《局方》五味中，增人参、黄芪、白术、陈皮、木瓜，益虚以去湿热，乃至东垣之清暑益气汤、人参黄芪汤，又补中实卫以去其湿热。肥白内虚之人，勿论中暑与否，所宜频服者也。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。然尚有未备焉，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，管见从而赞之曰：有中暑昏死，灌之立苏，则其方亦可得治暑风之一斑矣。倘或其人阴血素亏，暑毒深入血分，进以此丸，宁不立至危殆乎？良方复有地榆散，治中暑昏迷，不省人事而欲死者，但用平常凉血之药，清解深入血分之暑风，良莫良于此矣！后有用之屡效，而美其名为泼火散者，知言哉！夫中天火运，流金烁石，而此能泼之。益见暑风为心火暴甚，煎熬阴血，舍清心凉血之外，无可扑灭耳。综群方而论列之，以其详故益加详焉。（诸方俱汇本门后）
Yu Chang said: Wind and dampness are two pathogenic factors that have no fixed form and change with the seasons. Dampness manifests as cold-dampness in winter, wind-dampness in spring, heat-dampness in summer, and dry-dampness in autumn, because the qi of damp-earth is dominant at the end of each season, and its nature changes along with the four seasons. I have already discussed this; wind is the same. Wind is biting cold wind in winter, warm and smooth wind in spring, hot southern wind in summer, and desolate cool wind in autumn. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states that wind is the chief of a hundred diseases, referring to its unpredictable changes. When invading the human body, wind usually affects the upper part first, while dampness affects the lower part first; both enter through the Foot-Taiyang Bladder Meridian. Wind damages the Wei-Qi (Defensive Qi), and dampness flows into the joints; wind pathogen is yang and tends upward, damp pathogen is yin and tends downward; wind pathogen is formless and resides externally, damp pathogen has form and resides internally; between the upper and lower, inside and outside, the pathogens fight each other, thus manifesting symptoms such as sweating, aversion to wind, shortness of breath, fever, headache, severe pain in bone joints, heaviness of the body, and slight swelling. This condition should indeed be resolved through sweating, but the method differs from the usual approach. When using Mahuang Decoction (Mahuang Tang), Baizhu must be added, or Yiyiren can be added to remove dampness. When using Guizhi Tang, Shaoyao must be removed and Baizhu added; in severe cases, Fuzi should be added to warm the meridians. Inducing sweat should be done slowly rather than rapidly; if rapid, wind will leave but dampness will remain; if slow, both wind and dampness will be expelled. For those who cannot undergo sweating therapy, it is because wind-dampness intermingling often involves Yang deficiency; when Yang is deficient, sweating is contraindicated, and one should only use pungent-hot herbs to strengthen Yang and expel dampness. Whenever shortness of breath is seen, although it is due to pathogen obstructing Zheng-Qi (Upright Qi), one should consider deficiency of Yang in the chest. Whenever sweating accompanied by slight panting is seen, although it is due to Lung Qi being affected by pathogen, one should consider the impending collapse of True Yang; an astute physician will identify this early. In the *Shanghan Lun* (Treatise on Cold Damage), the case of wind-dampness intermingling uses winter cold to analogize the other three seasons. In the "Jing Shi Yue" chapter of the *Jingui Yaolue*, the case of wind-dampness intermingling uses summer heat to analogize the other three seasons. It says: "The patient suffers from whole-body pain, fever, which worsens at dusk (Ribu), named Wind-Damp." This disease is caused by sweating while exposed to wind, or long-term exposure to cold. Is it not because in summer, exposing oneself to wind and staying in the cold too long closes the sweat pores? Worsening at dusk indicates the disease is in the Yangming channel. However, this is different from the Jing disease where teeth are clenched, heat is deep and severe, and Yangming purgation is indicated; this condition can only be treated with sweating, not purgation. Why? The *Neijing* states that Taiyin and Yangming are exterior-interior pairs, externally combining with muscles; thus, Yang channels receive wind, and Yin channels receive dampness. Therefore, when wind-dampness attacks Taiyin and Yangming, it is in a semi-exterior semi-interior state. Whole-body muscle pain indicates that exterior pathogens remain, so sweating is permissible but purgation is not. Moreover, the Qi of the human body circulates in the Yang aspect twenty-five times during the day: at dawn it belongs to Shaoyang, at noon to Taiyang, and at sunset to Yangming. Worsening at dusk means the pathogen is in Yangming, but the Qi of Taiyang and Shaoyang has not yet fully receded, so sweating is permissible but purgation is not. Looking at the *Jingui Yaolue*, one passage says: "Mahuang Jia Zhu Tang may be given; inducing sweat is appropriate, strictly avoid fire therapy." Another passage says: "Mahuang Xingren Yiyi Gancao Decoction may be given." Although it does not explicitly say purgation is forbidden, the meaning that sweating is allowed but purgation is not is evident by analogy. If purgation is used, Stomach Qi will be weakened, wind pathogen will sink inward, and damp pathogen will surge upward, leading to untold complications. Regarding pain from dampness flowing into joints with a sinking-thin pulse, this is not due to external wind fighting with it, but is called Shibi (Dampness Bi Syndrome). Shibi refers to dampness blocking the Yang Qi within the body. Promoting urination allows Yang Qi to flow freely, resolving the joint blockage. If urination becomes normal but joint blockage persists, it must be that Yang Qi is held by dampness and cannot vent outward, or perhaps only the head sweats while the body does not, and the patient desires covering and warmth near fire; in this case, mild sweating should be induced to unblock Yang. Due to the varied and confusing texts on "wind-dampness intermingling," which are hard to reconcile, I discuss them together.
Zhongshu (Heatstroke) is a term known since the *Zuo Zhuan*, which records resting under tree shade. Later generations distinguished between "Zhongre" (Heatstroke from activity) and "Zhongshu" (Heatstroke from rest). Can people walking on roads be considered resting? The terms "activity" and "rest" only distinguish between external contraction and internal injury. Activity-induced illness is external contraction of solar heat. Rest-induced illness occurs when avoiding solar heat leads to exposure to yin-dampness, wind-dew, melons, and raw/cold foods. Seasonal Minor Cold and Major Cold cause Shanghan (Cold Damage). Seasonal Minor Heat and Major Heat cause Shangshu (Summerheat Injury). Laborers exposed to cold and heat often suffer from cold/heat diseases. Those living in comfort do not contract these unless invited by improper diet or sexual excess. Thus, treatments differ for the rich and poor, and across regions.
People with abundant internal dampness are most prone to Zhongshu due to mutual resonance. External summer heat steams internal dampness, allowing the two to interact, causing Zhongshu. Hence, obese people have much dampness; despite trying to avoid summer heat, they still get struck because they cannot avoid their own dampness, and thus cannot avoid heavenly summer heat. Yiyuan San expels dampness via urine and is effective for summer heat relief. However, it suits those with robust constitutions and high dampness. For those with fluid depletion but no dampness, Shengmai San should be used to replenish fluids. Using Yiyuan San would recklessly promote urination, exhausting the lower source and causing immediate withering. Furthermore, summer heat steaming dampness often accompanies internal deficiency-cold in obese people, leading to Huoluan (Cholera-like syndrome) with vomiting, diarrhea, cold sweat, and cold limbs, endangering life. Relying solely on Yiyuan San to resolve heat and dampness often accelerates organ failure. Moreover, for those with profuse sweating, promoting urination is contraindicated. Since Stomach fluids are limited, losing them externally and then internally is a recipe for death. Zhang Zhongjing calls this "Yanglessness"; if the pulse is short, rapid, knotted, or intermittent, death is imminent.
Sudden collapse with loss of consciousness in Zhongshu is called Shufeng (Summerheat Wind). It generally has excess and deficiency types. Excess is phlegm-excess: chronic phlegm accumulation in collaterals, suddenly triggered by intense summer heat, blocking Qi, causing sudden collapse and salivation. This is the most severe form of damp-summerheat combined disease. Phlegm should be vomited out first, then summerheat cleared. Deficiency is Yang-deficiency: chronic Yang weakness and Yin-cold dominance, suddenly triggered by intense summer heat, allowing pathogen to exploit deficiency. This is damp-summerheat disease originating from deficiency-cold. Yang-restoring herbs combined with summerheat-clearing herbs are needed, making it difficult to treat. Zhu Danxi argued that in fire seasons, metals melt and stones crack, so how can there be Yin-cold? His view was biased, leading to errors. Snow on Mount Emei never melts; does this mean all temples in summer are fires? Internal accumulated Yin can be so cold that soup and fire cannot warm it. The *Neijing* says "seek what is absent, blame what is deficient," implying we must address deficiency, not just excess. My view holds that Dahuang Long Wan has cured sudden Zhongshu coma upon administration. Occasionally, Qi Jue (Qi Collapse) from emotional injury causes collapse without phlegm; Suhe Xiang Wan is indicated. Xu Xueshi stated this is sudden Qi reversal, resolving spontaneously, but clearing summerheat after recovery is necessary.
In summer, Yang Qi escapes via sweat, and Yin fluids deplete via heat. Both Yin and Yang are insufficient. Zhang Zhongjing forbids sweating, purging, and moxibustion for Zhongshu: sweating injures Yang, purging injures Yin, and moxibustion draws fire inward. Treatment relies on sweet-cold herbs to generate fluids, protect the Lung, secure Yang, and benefit Yin. This is crucial. The *Lingshu* states: "If Yin and Yang are both deficient, tonifying Yang exhausts Yin, draining Yin destroys Yang." Yang resides in Yin, so tonifying Yang must not injure Yin. Yin roots in Yang, so draining Yin must not disturb Yang. With both deficient, tonification and drainage are risky, easily causing imbalance. Overusing sweet-warm risks tonifying Yang excessively; overusing bitter-cold risks draining Yin excessively. Using one sweet and one cold herb balances Yin and Yang, clearing summerheat gently, becoming the model for generations.
Regarding the *Jingui Yaolue*'s treatment of Zhongshu using Baihu Jia Renshen Tang and Gua Di Tang: The text offers only these two formulas. Baihu Jia Renshen Tang specifically treats heat. Summer heat rebels upward, damaging Lung Metal and consuming fluids; this formula saves Lung Metal and preserves fluids. Sun Simiao's Shengmai San and Li Dongyuan's Qingshu Yiqi Tang derive from this. Gua Di Tang specifically treats dampness. Summer dampness rising transforms into heat, also damaging Lung Metal first, causing water to accumulate in the skin. Skin is the exterior of the Lung; this formula extracts water from the chest, inducing vomiting or diarrhea, unblocking Lung Qi, and directing skin water downward. Later physicians only followed Zhang Zhongjing's Wuling San. Liu Wansu's Tongling San and Zhang Zihé's Guiling Ganlu Yin guide dampness and relieve heat but lack the derivation from Gua Di Tang to clear Upper Jiao damp-heat and soothe Lung Metal. Thus, I highlight these two: for formless heat damaging Lung Metal, use Baihu Jia Renshen Tang; for formed dampness damaging Lung Metal, use Gua Di Tang. These are not in the *Shanghan Lun* but reappear in the *Jingui Yaolue*, a subtle technique to be recognized.
Baihu Jia Renshen Tang: The text says: "Taiyang Zhongre is Zhongshu. Patient has sweating, aversion to cold, body heat, and thirst; Baihu Jia Renshen Tang governs." Sweating with aversion to cold in summer indicates Wei-Qi deficiency. Body heat and thirst indicate Lung Metal oppressed by Fire, causing dryness and thirst. The *Neijing* says: "Heart transfers heat to Lung, transmitting as Ge Xiao (Diabetes); Xiao implies thirst." Heart Fire is strong, oppressing Lung Metal. Though presenting as Taiyang, it differs from winter cold damage. This formula saves Lung Metal, the primary principle.
Gua Di Tang: The text says: "Taiyang Zhongshu, body pain and heaviness with weak pulse, caused by summer cold water injuring the skin; Yi Wu Gua Di Tang governs." Changing powder to decoction, removing Chixiaodou and Suanjiangshui, using only Gua Di. Extracting chest water allows skin water to exit. Extraction implies venting; normal sweating resumes, no water remains in skin. This aligns with the *Neijing* case where pouring water on sweat stops sweating. Zhang Zhongjing understood this, noting Zhongshu includes Zhongshi. Why is the pulse weak? Zhongshu pulse is inherently weak; dampness in skin combines with Lung, hindering Ying-Wei circulation, making the pulse weaker. Summer pulse is weak on pressure; damp pulse is weak on light touch; combined, it is weak on both. Extracting water restores Ying-Wei and Lung Qi; smooth pulse indicates damp removal; strong pressure indicates summerheat resolution. One herb achieves such swift results.
Water in skin comes from accidental summer cold exposure, excessive cold drink, or cold water on sweat, blocking outgoing Yang, causing heat and pain. Gua Di expels water, restoring Yang. Chronic cold/drink injures Lung gradually; this acute injury only affects skin-Lung connection, resolved quickly without Chixiaodou or Suanjiangshui. Extending this, long-term cold exposure blocks Upper Jiao Yang, differing from ground dampness entering feet, which requires diuretics. Distinction is vital.
Sudden collapse in summer is Shufeng. Heart Fire surges, summerheat exploits it, causing choking, coma. Other organs may be deficient, allowing deep summerheat invasion, though less severe than Heart involvement. Entering Liver causes dizziness/stiffness; Spleen causes lethargy; Lung causes wheezing/weakness; Kidney causes wasting-thirst. Tonification and clearing must be combined, targeting the specific organ.
Pulse of Shangshu: *Neijing* says: "Weak pulse, body heat, from Shangshu." *Jiayi Jing* says: "Heat injures Qi, not Form, hence weak pulse." *Nan Jing* says: "Floating-large-scattered," which is incorrect; this is the normal Heart pulse, not pathological. Zhang Zhongjing supplements this with "String-Thin-Hollow-Slow." Hollow implies void; String-Thin-Slow reflects heat injuring Qi. Water-in-skin pulse is weak, showing dampness holding Qi. Generally called Weak; specifically String-Thin-Hollow-Slow-Weak. Not mixing Floating-Large with Weak shows thoroughness.
Midday labor with summerheat exposure requires cooling detoxification: Baihu Tang, Yiyuan San, Huanglian Xiangru Yin, Sanhuang Shigao Tang. Living in cool houses, eating raw/cold food, suppressing Yang to cause Zhongshu requires caution. Cooling formulas are not directly applicable. If no sweat, release exterior to vent Yang; if vomiting/diarrhea, harmonize Middle; if severe, use mild warming herbs to guide treatment. Cholera from summerheat exposure focuses on clearing heat; cholera from avoiding heat focuses on harmonizing/warming Middle. Distinction is key.
Yuanfeng era Heji Ju compiled medical formulas, detailing Zhongshu due to widespread observation. Xiaobanxia Fuling Tang treats dampness, not heat. Adding Gancao creates Xiaoshu Wan, correctly naming heat relief as dampness elimination. Xiangru Yin uses Xiangru, BianDou, Houpo. High heat: remove BianDou, add Huanglian to treat Heart Fire. High damp: remove Huanglian, add Fuling, Gancao to treat Spleen Damp. Suopi Yin addresses Spleen heavy from damp, adding Wumei, Sharen, Caoguo to invigorate Spleen and remove damp. Severe cases use Dashun San, Laifu Dan for diarrhea, extending Suopi Yin logic. Pipaye San addresses Stomach turbid from damp, using Xiangru, Pipaye, Dingxiang, Baimaoxiang to calm Stomach. Severe vomiting uses Lengxiang Yin, extending Pipaye San logic. Physicians should adjust for heat, damp, deficiency, cold, depth, and urgency. Later scholars added deficiency-tonifying methods. Liu Wansu's Guiling Ganlu Yin and Wuling Sanshi aim to generate fluids for Stomach deficiency. Zhang Zihé's Guiling Ganlu Yin adds Renshen, Gegen, Gancao, Huoxiang, Muxiang to tonify and clear turbidity. Shiwei Xiangru Yin adds Renshen, Huangqi, Baizhu, Chenpi, Mugua to tonify and clear damp-heat. Li Dongyuan's Qingshu Yiqi Tang and Renshen Huangqi Tang tonify Middle and solidify Wei to clear damp-heat. Obese, deficient people should take these frequently. Zhongshu shows irritability/heat; Li Dongyuan's Qingzao Tang follows Zhuyeshigu Tang logic, prioritizing damp removal. Dryness opposes dampness, yet clearing dryness removes damp, showing Li's insight. Yiyuan San removes damp; adding Chenasha clears heat. Wuling San removes damp; adding Renshen tonifies deficiency; adding Chenasha reducing Guizhi clears heat. Baihu Tang adding Renshen tonifies deficiency; adding Cangzhu overcomes dampness. Combined with Heji Ju formulas, it is complete. However, Shufeng resembles stroke but is not wind-pathology. Baiyi Xuanfang's Dahuang Long Wan cures Zhongshu coma, suggesting utility for Shufeng. But if Yin-blood is deficient and summerheat toxin enters Blood level, this pill could be fatal. Diyü San treats Zhongshu coma with blood-cooling herbs, effectively clearing deep blood-level Shufeng. Later called Pohuo San, aptly named. Heavenly fire melts metal; this "sprinkles fire." Shufeng is Heart Fire scorching Yin-blood; only clearing Heart and cooling Blood can extinguish it. Summarizing these formulas, detailed analysis is provided. (All formulas collected at the end of this section.)