天之热气下，地之湿气上，人在气交之中，无隙可避，虚而受者，即名曰暑。暑之为
言，有湿有热，不言而喻矣。夫暑先入心，暑必伤气，气分之湿不为之先除，则所蓄之热必不
能外出。所以暑湿热三气交蒸之初，务须消去其湿，正合古人消暑在消其湿之旨也。然湿邪
一去，热气即从外达，又名暑热，不名暑湿。一气而有两名，前后之用药有异。盖以热则阴
伤，气亦更弱。无怪乎鼻衄旧恙上从清道而出，身体困惫，饮食渐减，脉转弦数，阳分更
热，口内知干，种种见虚中有实之象。但暑邪一证，河间每论三焦。现下头额昏蒙，邪热偏
于中上，惟衄去过多，虚在下焦阴液。如此细诊，断在少阴不足阳明有余，有何疑惑哉。拟
张景岳玉女煎法，俾得中下焦热气上熏于肺者，悉从暗化，而下焦之阴气亦不再伤，仍不
出乎刘氏三焦治例。未知是否？候西耕先生政之。
细生地 煨石膏 怀牛膝 麦冬 知母
九牛二虎丸 左虎掌（十二两，酥炙） 茯苓（五两，人乳拌蒸，晒） 牛肋骨（九根，要用第三根者佳，
酥炙） 牛膝（五两，盐水炒） 大力子（二十两，生晒） 白蒺藜（二十两，去刺） 小川芎（一两，生晒）
归身（五两，酒炒） 黄 （五两，蜜炙） 沙参（五两，盐水炒） 雄乌骨鸡（一只，将鸡干去毛杂，煮烂
连骨重打如泥，酥炙）
共为细末，炼蜜和丸，桐子大。每服四钱，朝以开水送下。
天气之热气下降，地气之湿气上升，人处于天地之气交汇的空间中，无处可以躲避。若人体正气虚弱而受邪，便称为“暑”。所谓“暑”，包含湿与热两种性质，这是不言自明的道理。暑邪首先侵犯心脏，且必定损伤元气。如果气分中的湿邪不先行祛除，那么体内蓄积的热邪就无法向外透发。因此，在暑、湿、热三气交蒸的初期，务必先消除湿邪，这正符合古人“消暑必先消湿”的宗旨。然而，一旦湿邪去除，热气便会从体表外达，此时病证名称变为“暑热”，而不再称为“暑湿”。同一种病因前后有两个名称，是因为前后的用药方法不同。因为热邪会损伤阴液，元气也会更加虚弱。难怪患者鼻衄（鼻出血）这一旧疾复发，血液从上部的清窍流出，身体感到困倦疲惫，饮食逐渐减少，脉象转为弦数，阳分的热势更盛，口中感觉干燥，种种表现呈现出虚证中夹杂实证的现象。但是，关于暑邪这一病证，刘河间（刘完素）常从三焦理论进行论述。目前患者头额昏蒙，说明邪热偏重于中上二焦；唯独因鼻衄失血过多，导致下焦阴液亏虚。如此细致诊察，判断为少阴不足而阳明有余，还有什么可疑惑的呢？拟采用张景岳的玉女煎法，使得中下焦热气上熏于肺的情况，能够暗中化解，同时下焦的阴气也不再受到损伤，这依然没有超出刘氏三焦治疗的范例。不知是否妥当？请西耕先生指正。
九牛二虎丸：左虎掌（十二两，用酥油炙烤）、茯苓（五两，用人乳拌蒸后晒干）、牛肋骨（九根，最好选用第三根，用酥油炙烤）、牛膝（五两，用盐水炒制）、大力子（二十两，生晒）、白蒺藜（二十两，去刺）、小川芎（一两，生晒）、归身（五两，用酒炒制）、黄芪（五两，用蜜炙）、沙参（五两，用盐水炒制）、雄乌骨鸡（一只，将鸡毛和杂质清理干净，煮烂连骨捣成泥状，用酥油炙烤）。
以上药材共研为细末，用炼蜜调和制成丸药，大小如梧桐子。每次服用四钱，早晨用开水送服。
The hot qi of heaven descends, and the damp qi of earth ascends. Humans exist within the intersection of these two qis, with no place to avoid them. When the body is deficient and susceptible to pathogenic factors, it is named "Shu" (Summerheat). The term "Shu" implies the presence of both dampness and heat, which goes without saying. Shu pathogen first enters the Heart and inevitably injures Qi. If the dampness in the Qi level is not removed first, the accumulated heat cannot be expelled outward. Therefore, at the initial stage where Shu, Dampness, and Heat interact and steam together, it is imperative to eliminate the dampness, which aligns with the ancient principle that "to dispel summerheat, one must first dispel dampness." However, once the damp pathogen is eliminated, the hot qi reaches outward from the exterior; this condition is then named "Shu-Re" (Summerheat-Heat) rather than "Shu-Shi" (Summerheat-Dampness). Although originating from a single pathogenic factor, the preceding and subsequent conditions have different names because the medication strategies differ. This is because heat injures Yin, and Qi becomes even weaker. No wonder the old ailment of epistaxis (nosebleed) recurs, bleeding out from the upper clear orifices; the body feels heavy and exhausted; food intake gradually decreases; the pulse turns wiry and rapid; the Yang level becomes hotter; the mouth feels dry; all these manifestations present an image of deficiency mixed with excess. Regarding the syndrome of Shu pathogen, Hejian (Liu Wansu) often discusses it via the Sanjiao (Triple Burner). Currently, the patient's head and forehead feel heavy and confused, indicating that the evil heat is biased toward the Middle and Upper Jiao. Only due to excessive blood loss from epistaxis is there a deficiency of Yin fluids in the Lower Jiao. With such detailed diagnosis, the judgment lies in "Insufficiency of Shaoyin and Excess of Yangming," leaving no room for doubt. I propose adopting Zhang Jingyue's Yungnü Decoction method, so that the hot qi steaming upward from the Middle and Lower Jiao to the Lung can be resolved covertly, and the Yin qi of the Lower Jiao will no longer be injured. This still falls within the framework of Liu's Sanjiao treatment examples. I wonder if this is correct? I await Mr. Xigeng's correction.
Raw Rehmanniae Radix (prepared), Calcined Gypsum Fibrosum, Huai Achyranthis Bidentatae Radix, Ophiopogonis Radix, Anemarrhenae Rhizoma.
Jiuniu Erhu Wan (Nine Oxen and Two Tigers Pill): Zuo Huzhang (12 liang, roasted with butter), Poria (5 liang, steamed with human milk and sun-dried), Cow Rib Bone (9 pieces, preferably the third rib, roasted with butter), Achyranthis Bidentatae Radix (5 liang, stir-fried with salt water), Arctii Fructus (20 liang, sun-dried raw), Tribuli Fructus (20 liang, thorns removed), Chuanxiong Rhizoma (1 liang, sun-dried raw), Angelicae Sinensis Radix (5 liang, stir-fried with wine), Astragali Membranacei Radix (5 liang, honey-roasted), Glehniae Radix (5 liang, stir-fried with salt water), Male Black-bone Chicken (1 whole chicken, feathers and impurities cleaned, boiled until tender, pounded into paste with bones, roasted with butter).
Grind all ingredients into fine powder. Mix with refined honey to form pills, sized like paulownia seeds. Take 4 qian per dose, swallowed with warm water in the morning.