复立变证加减法于后。如心火乘脾，乃血受火邪，而不升发，阳气伏于地中，地者人之脾也，必用当归和血，少
用黄柏以益真阴，如脾胃不足之证，须少用升麻，乃足阳明太阴引经之药也。使行阳道，自脾胃中左迁，少阳行春
令，生万物之根蒂也。更加柴胡，使诸经右迁，生发阴阳之气，以滋春之和气也。如脾虚缘心火亢盛，而乘其土也。其
次肺气受邪，为热所伤，必须黄 最多，甘草次之，人参又次之，三者皆甘温之阳药也，脾始虚，肺气先绝，故用黄
之甘温，以益皮毛之气，而闭腠理，不令自汗而损元气也，上喘气短懒言语，须用人参以补之，心火乘脾，须用炙甘
草以泻火热，而补脾胃中元气，甘草最少，恐滋满也。若脾胃之急痛，并脾胃大虚，腹中急缩，腹皮急缩者，却宜多用。
经曰∶急者缓之，若从权必加升麻以引之，恐左迁之邪坚盛，卒不肯退，反致项上及臀尻肉添而行阴道，故引之以行阳
道，使清气出地，右迁而上行，以和阴阳之气也。若中满者，去甘草，咳甚者，去人参，口干嗌干者，加甘葛，如脾胃
既
虚，不能升浮，为阴火伤其生发之气，荣血大亏，荣气伏于地中，阴火炽盛，日渐煎熬，血气亏少，且心包络与心主血，
血减则心无所养，致使心乱而烦，病名曰 者，心惑而烦闷不安也。是由清气不升，浊气不降，清浊相干，乱于胸中，
使周身血气逆行而乱。经云∶从下上者，引而去之，故当加辛温甘温之剂生阳，阳生而阴长也。故曰∶甘温何能生血？
又
非血药也？曰∶仲景之法。血虚以人参补之，阳旺则能生阴血也。更加当归和血，又宜少加黄柏以救肾水，盖甘寒泻热
火，火减则心气得平而安也。如烦乱犹不能止，少加黄连以去之。盖将补肾水，使肾水旺而心火自降，扶持地中阳气也。
如气浮心乱，则以朱砂安神丸镇固之，得烦减，勿再服，以防泻阳气之反陷也。如心下痞，亦少加黄连，气乱于胸，为
清
浊相干，故以陈皮理之，能助阳气之升，而散滞气，又助诸甘辛为用，故长夏湿土，客邪火旺，可从权加苍术、白术、
泽
泻，上下分消其湿热之气，湿气大盛，主食不消化，故食减不知谷味，加炒曲以消之，便加五味子、麦门冬、人参，泻
火
益肺气，助秋损也。此三伏中长夏正旺之时药也。
按∶此《证治准绳》中论暑证者，至精致密，立中含和王道之宗匠，不能具载，谨摘其要者，录于下，至加减清暑
益
气汤，尤东垣之知己。
随后制定了变证的加减法则如下。如果心火侵犯脾土，这是血液受到火邪侵害，导致阳气不能升发，阳气潜伏在地中（此处指人体脾土），必须使用当归来调和血液，少量使用黄柏以补益真阴。如果是脾胃不足的证候，需要少量使用升麻，因为它是足阳明胃经和足太阴脾经的引经药。它能使阳气运行于阳道，从脾胃中向左迁移（对应春生之气），少阳执行春季的生发令，如同万物生长的根基。再加上柴胡，使各条经脉向右迁移（对应秋收之气），生发阴阳二气，以滋养春季的和煦之气。如果是脾虚由于心火亢盛而乘袭脾土所致。其次是肺气受邪，被热邪所伤，必须重用黄芪，甘草次之，人参再次之，这三者都是甘温性质的阳药。脾气刚开始虚弱时，肺气往往先受损，所以用黄芪的甘温之性，来补益皮毛之气，并固密腠理，防止自汗而损伤元气。出现上气喘促、气短、懒言等症状，必须用人参来补益；心火侵犯脾土，必须使用炙甘草来清泻火热，并补益脾胃中的元气，但甘草用量要最少，恐怕会引起脘腹胀满。如果出现脾胃急痛，以及脾胃极度虚弱、腹中拘急收缩、腹部皮肤紧张收缩的情况，却应该多用甘草。《内经》说：拘急的症状要用缓急的方法治疗。如果是权宜之计，必须加入升麻来引导（清气上升），恐怕向左迁移的邪气坚固强盛，突然不肯消退，反而导致项部和臀部肌肉增生并向阴道运行（此处指病势下行或阴分受累），所以通过引导使其行于阳道，使清气出于地中，向右迁移而上行，以调和阴阳二气。如果有中焦胀满的，去掉甘草；咳嗽严重的，去掉人参；口干、咽喉干燥的，加葛根。如果脾胃已经虚弱，不能升浮，被阴火损伤了生发之气，营血严重亏损，营气潜伏在地中，阴火炽盛，日渐煎熬，导致气血亏少。而且心包络与心主血脉，血液减少则心脏失去滋养，致使心神紊乱而烦躁，这种病名叫“心惑”，是指心中困惑、烦闷不安。这是由于清气不升，浊气不降，清浊之气相互干扰，乱于胸中，使周身气血逆行而混乱。《内经》说：病势由下向上逆的，要用疏导的方法去除它，所以应当加入辛温、甘温的药物来生发阳气，阳气生发则阴血随之生长。所以说：甘温药物怎么能生血？又不是补血药吗？回答是：这是张仲景的法度。血虚用人参来补益，阳气旺盛就能化生阴血。再加上当归调和血液，又适宜少量加入黄柏来救补肾水，因为甘寒药物能清泻热火，火气减退则心气得以平和安宁。如果烦躁混乱仍然不能停止，少量加入黄连来清除它。这是因为将要补肾水，使肾水旺盛而心火自然下降，扶持地中的阳气。如果气浮、心神慌乱，就用朱砂安神丸来镇固，等到烦躁减轻后，不要再服用，以防过度泻火导致阳气反陷。如果心下痞塞，也少量加入黄连，气乱于胸中，是因为清浊之气相互干扰，所以用陈皮来调理，它能帮助阳气升发，并疏散滞气，又辅助各种甘味、辛味药物发挥作用，所以在长夏湿土当令、客邪火旺的时候，可以权宜加入苍术、白术、泽泻，上下分消湿热之气。湿气盛大时，主要影响食物消化，导致食欲减退、不知谷味，加入炒神曲来消食导滞。大便方面，加入五味子、麦门冬、人参，以泻火益肺气，帮助恢复秋季肺气的损耗。这是三伏天中长夏正气旺盛时所用的方药。
按语：这段内容出自《证治准绳》中关于暑证论述的部分，极其精致严密，确立了其中和王道（温和公正的治疗原则）的宗师地位，无法全部记载，谨摘录其要点记录如下。至于加减清暑益气汤，更是李东垣的知己之作。
Subsequently, methods for modifying the formula according to changed syndromes were established as follows. If Heart Fire invades the Spleen Earth, this indicates that the Blood has been harmed by Fire pathogen, preventing its ascending and dispersing nature; Yang Qi is latent within the "Earth" (referring to the human Spleen). In such cases, Danggui (Angelicae Sinensis Radix) must be used to harmonize the Blood, and a small amount of Huangbai (Phellodendri Cortex) should be employed to nourish True Yin. For syndromes of Spleen and Stomach deficiency, a small amount of Shengma (Cimicifugae Rhizoma) is required, as it serves as the guiding herb for the Foot-Yangming Stomach Meridian and Foot-Taiyin Spleen Meridian. It enables the movement of Yang Qi through the Yang pathways, migrating from the Spleen and Stomach towards the left (corresponding to Spring generation), where Shaoyang executes the command of Spring, generating the roots of all things. Additionally, Chaihu (Bupleuri Radix) is added to facilitate the migration of various meridians to the right (corresponding to Autumn harvest), generating and dispersing the Qi of Yin and Yang, thereby nourishing the harmonious Qi of Spring. If Spleen deficiency arises because Hyperactive Heart Fire attacks the Earth element. Secondly, if Lung Qi is affected by pathogens and injured by Heat, Huangqi (Astragali Radix) must be used in the largest dose, followed by Gancao (Glycyrrhizae Radix et Rhizoma), and then Renshen (Ginseng Radix). These three are all sweet-warm Yang herbs. When Spleen Qi begins to weaken, Lung Qi often fails first; therefore, the sweet-warm nature of Huangqi is used to benefit the Qi of the skin and hair, and to close the Couli (pores and interstices), preventing spontaneous sweating which would damage Yuan Qi. For symptoms such as upper body wheezing, shortness of breath, and reluctance to speak, Renshen must be used to tonify. To clear Heart Fire invading the Spleen, Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) is required to drain fire heat and tonify Yuan Qi in the Spleen and Stomach; however, the dosage of Gancao should be minimal to avoid causing fullness. If there is urgent pain in the Spleen and Stomach, or extreme deficiency of Spleen and Stomach manifesting as abdominal cramping and contraction, and tension of the abdominal skin, Gancao should be used in larger amounts. The Classic states: "For conditions of urgency, use soothing methods." If treating on an ad hoc basis, Shengma must be added to guide the Qi upward; otherwise, the pathogenic factor migrating left may become firm and strong, refusing to recede, potentially leading to flesh growth at the nape and buttocks moving along the Yin pathway. Thus, guidance is used to move Qi along the Yang pathway, allowing Clear Qi to emerge from the Earth, migrate rightward and ascend, thereby harmonizing the Qi of Yin and Yang. If there is fullness in the Middle Jiao, remove Gancao; if cough is severe, remove Renshen; if there is dryness of the mouth and throat, add Gegen (Puerariae Lobatae Radix). If Spleen and Stomach are already deficient and unable to ascend and float, and their generating Qi is damaged by Deficient Fire (Yin Fire), Ying Blood is severely depleted, and Ying Qi is latent within the Earth. With Intense Deficient Fire slowly simmering day by day, Blood and Qi become scarce. Since the Pericardium and the Heart govern Blood, a reduction in Blood means the Heart lacks nourishment, resulting in mental confusion and irritability. This disease is named "Xin Huo" (Heart Confusion), referring to a state of mental perplexity, vexation, and unease. This occurs because Clear Qi does not ascend, Turbid Qi does not descend, and Clear and Turbid interfere with each other, causing chaos in the Chest. This leads to reverse flow and disorder of Blood and Qi throughout the body. The Classic states: "For disorders rising from below, use draining and dispersing methods." Therefore, acrid-warm and sweet-warm agents should be added to generate Yang; when Yang generates, Yin grows. One might ask: "How can sweet-warm herbs generate Blood? Are they not blood-tonifying herbs?" The answer lies in the method of Zhang Zhongjing: For Blood deficiency, Renshen is used to tonify; when Yang Qi is vigorous, it can generate Yin Blood. Additionally, Danggui is added to harmonize Blood, and a small amount of Huangbai is suitable to rescue Kidney Water. Sweet-cold herbs drain fire heat; once fire decreases, Heart Qi becomes peaceful and calm. If vexation and chaos persist despite this, a small amount of Huanglian (Coptidis Rhizoma) is added to eliminate it. This is done to tonify Kidney Water, making Kidney Water abundant so that Heart Fire naturally descends, supporting the Yang Qi within the Earth. If Qi floats and the Heart is chaotic, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) is used to stabilize and secure it. Once vexation subsides, do not continue taking it to prevent excessive draining of Yang Qi leading to sinking. If there is epigastric stuffiness, a small amount of Huanglian is also added. Qi chaos in the chest is due to interference between Clear and Turbid Qi, so Chenpi (Citri Reticulatae Pericarpium) is used to regulate it, assisting the ascent of Yang Qi and dispersing stagnant Qi, while further aiding the action of various sweet and acrid herbs. Therefore, during the late summer when Damp-Earth is dominant and external Fire pathogens are strong, Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Zexie (Alismatis Rhizoma) can be added on an ad hoc basis to distribute and eliminate Damp-Heat from above and below. When Dampness is excessive, digestion of food is impaired, leading to reduced appetite and loss of taste for grains; Chao Qu (Fermented Wheat Mass) is added to digest food. Regarding bowel movements, Wuweizi (Schisandrae Chinensis Fructus), Maidong (Ophiopogonis Radix), and Renshen are added to drain fire, benefit Lung Qi, and assist in recovering the depletion associated with Autumn. This is the prescription used during the Sanfu days when Late Summer Qi is at its peak.
Note: This discussion on Summerheat syndromes from *Zhengzhi Zhunsheng* (Mirror of Medicine) is extremely refined and meticulous, establishing a paradigm of the King's Way (gentle and balanced treatment). It cannot be fully recorded here; only the essential points are excerpted below. The Modified Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) is particularly considered a masterpiece attuned to Li Dongyuan's theories.