周禹载曰。仲景本内经病热之旨。申伏气之论。特叙夏月热病。白虎汤之治。可谓
精矣。乃复出 病于金匮中曰。太阳中热者。 是也。正恐人误认为热病。故又言
自外来而入。热由内伏而发。实为两途。然暑为夏火之令。伤人之气。脉虚身热。
遂令人大渴。齿燥汗出而喘。与伏发无异。并治以白虎汤。俱主甘寒去热。苦寒除
火。甘温益中。益中者。以暑伤气故益之。然津液耗甚者。必加人参。与辛散温散之
味。不相涉也。或谓伏发自内。白虎宜也。中 既由外而内。何为遽用里药。则以风
药略兼表散。似无不可。愚谓千古之误。正在于此。虽夏暑与冬寒对峙。而表里则
大不同也。冬月腠理密。即卫虚而受者。必以渐进何也。外阴而内阳也。若夏月。则
人身已阳外而阴内。外垣既撤。暑得直入。故风寒必显有余。有余者邪也。暑气必
显不足。不足者正也。今人以香薷一味。谓伤暑必用之药。不知乘凉饮冷。遏抑阳
气。或致霍乱者宜之。若强力作劳。内伤重者。清暑益气。庶几近之。苟用香薷。是重
虚其虚矣。况可以表散辛温之味。加于其间乎。计部张凤逵先生编辑诸书。特救
其谬。我北海林夫子。申明大义。并集名案。以表其后。不亦胜任而愉快耶。余小子
又复为之辨者。愿以白虎汤为主治。清暑益气辅之。亦必随证加减。至于天水散、
甘露饮诸方。皆可引用。如节庵之论。吾未见其可也。设有疑者。请观汗下温针之
禁。本于仲景圣人。至有夹食而吐利。夹气而胀闷。夹寒而厥逆。兼风而畏寒。要皆
本于脉以测识。而毋庸混淆。然后知圣人之论者常也。随其所遇者变也。明其常
则善于处经。通于变而靡不善于用权者。则有昔贤之案在。亦惟洞晓伤寒书者。可以神而明之也。
周禹载说：张仲景秉承《内经》关于热病的宗旨，阐发伏气温病的理论，特别论述夏季的热病，以及白虎汤的治疗方法，可以说是非常精辟了。然而他又在《金匮要略》中提出“中暍”（中暑）的病证，说：“太阳中热者，是谓中暍。”这大概是担心人们误将中暑当作普通的热病，所以又强调暑邪是从外侵入的，而热是由体内伏邪发作出来的，实际上这是两条不同的路径。
然而，暑气是夏季火气的时令主令，它损伤人的正气，导致脉象虚软、身体发热，使人极度口渴，牙齿干燥、出汗且气喘。这与伏气温病的发作没有两样，都用白虎汤来治疗。其原则都是主要用甘寒药清热，苦寒药除火，甘温药补益中气。之所以要补益中气，是因为暑邪容易耗伤元气，所以需要补益。但是，如果津液消耗非常严重，必须加入人参。这与使用辛散或温散的药味是没有关系的。
有人或许会说：伏气温病发自体内，用白虎汤是合适的；但中暍既然由外而入内，为什么突然使用治里的药物呢？这是因为方中略兼有风药可以稍微发散表邪，似乎没有什么不可以的。我认为，千古以来的误解，正在于此。虽然夏月的暑气和冬月的寒气相对立，但在表里关系上却大不相同。
冬季腠理致密，即使是卫气虚弱而受邪，也一定是逐渐侵入的，为什么呢？因为冬天是外阴内阳。到了夏季，人体则是阳气在外、阴气在内，体表的屏障已经松懈，暑邪得以直接深入。所以，感受风寒时，邪气往往表现为有余（实证）；有余的就是邪气。而感受暑气时，正气往往表现为不足（虚证）；不足的就是正气。
现在的人认为香薷一味药是治疗伤暑必用的药物，却不知道如果是乘凉饮冷，遏制了阳气，或者导致霍乱的情况，才适合使用香薷。如果是强力劳作，内伤严重的情况，采用清暑益气的治法，才比较接近正确。如果此时使用香薷，就是使原本就虚弱的正气更加虚弱了。更何况还能在其中加入辛温解表的药味呢？
计部的张凤逵先生编辑各种书籍，特意纠正这些谬误；我北海的林夫子，阐明大义，并收集著名医案，以作为后世的借鉴，这不也是胜任愉快的事吗？我这个晚辈又再次进行辨析，希望以白虎汤作为主治方法，以清暑益气汤辅助，但也必须根据症状进行加减。至于天水散、甘露饮等方剂，都可以引用。像节庵那样的议论，我没有看到它的可取之处。如果有怀疑的地方，请观察汗法、下法、温针的禁忌，这些都源于张仲景圣人的教导。至于有夹食而呕吐腹泻，夹气而胀闷，夹寒而四肢厥逆，兼风而畏寒等情况，都要依据脉象来推测识别，而不要混淆不清。然后才知道圣人的论述是常法，随着所遇到的具体情况而变化的是变法。明了常法就能善于处理常规病症，通晓变法就没有不善于运用权变之法的，这里有前贤的医案可供参考。也只有精通《伤寒论》的人，才能神妙地领悟其中的奥义。
Zhou Yuzai said: Zhang Zhongjing followed the principles of heat diseases in the *Neijing* (Inner Canon), expounded on the theory of latent pathogens, and specifically discussed summer-heat diseases and the treatment with Baihu Tang (White Tiger Decoction). This can be considered extremely precise. However, he further presented the disease of "Zhong Yue" (Heatstroke) in the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet), stating: "Taiyang heat-stroke is called Zhong Yue." He likely feared that people would mistakenly identify heatstroke as ordinary febrile diseases; thus, he emphasized that the pathogen enters from the exterior, while the heat erupts from internal latent factors, implying two distinct pathways.
Nevertheless, Summer-heat (Shu) is the ruling qi of fire in summer. It injures human Qi (Vital Energy), leading to a deficient pulse, feverish body, extreme thirst, dry teeth, sweating, and panting. This presentation is no different from the eruption of latent diseases. Both are treated with Baihu Tang (White Tiger Decoction), primarily using sweet-cold herbs to clear heat, bitter-cold herbs to eliminate fire, and sweet-warm herbs to tonify the Middle Jiao (Spleen and Stomach). The reason for tonifying the Middle is that Summer-heat easily damages Qi, necessitating supplementation. However, if Yin fluids are severely depleted, Ginseng must be added. This approach has nothing to do with using acrid-dispersing or warm-dispersing agents.
Some might argue: Since latent diseases originate internally, Baihu Tang is appropriate. But since Zhong Yue enters from the exterior into the interior, why suddenly use interior-resolving medications? They might claim that because the formula slightly includes wind-dispelling herbs to scatter the exterior, it seems acceptable. I believe the eternal misunderstanding lies precisely here. Although Summer-heat in summer and Cold in winter are opposing forces, their dynamics regarding the exterior and interior are vastly different.
In winter, the interstices (Cou Li) are tight. Even if one is affected due to defensive Qi deficiency, the invasion must be gradual. Why? Because winter is characterized by outer Yin and inner Yang. In summer, however, the human body has Yang Qi on the exterior and Yin Qi on the interior. With the external barrier relaxed, Summer-heat can enter directly. Therefore, when contracting Wind-Cold, the pathogenic factor often manifests as "excess" (repletion); excess indicates the pathogen. When contracting Summer-heat, the healthy Qi often manifests as "deficiency"; deficiency indicates the healthy Qi.
Currently, some consider Xiangru (Elsholtzia Herb) an indispensable herb for treating Summer-heat injury. They fail to realize that it is suitable only for cases where cooling off and drinking cold substances suppress Yang Qi, or for those resulting in cholera-like symptoms. For cases involving strenuous labor and severe internal injury, the method of clearing Summer-heat and tonifying Qi is much closer to the truth. Using Xiangru in such cases would doubly weaken an already deficient state. Moreover, how could one add acrid-warm exterior-dispersing herbs to the mix?
Mr. Zhang Fengkui of the Ministry of Works edited various books, specifically aiming to correct these errors. My teacher, Master Lin from Beihai, clarified the major principles and collected famous medical cases to serve as references for posterity. Is this not a task one can undertake with competence and joy? As a junior scholar, I have once again offered this clarification, hoping to establish Baihu Tang (White Tiger Decoction) as the primary treatment, assisted by Qingshu Yiqi Tang (Clear Summer-heat and Tonify Qi Decoction), while always adjusting according to specific symptoms. Formulas such as Tianshui San (Heavenly Water Powder) and Ganlu Yin (Sweet Dew Drink) may also be cited. Regarding the arguments of Jie'an, I see no merit in them. For any doubts, please observe the contraindications of sweating, purging, and moxibustion/needling warmth, which originate from the Sage Zhang Zhongjing. Conditions such as vomiting and diarrhea due to food retention, distension and fullness due to Qi stagnation, cold extremities due to Cold invasion, and aversion to cold due to Wind co-invasion, all require diagnosis through pulse analysis without confusion. Only then will one understand that the Sage's discussions represent the constant norms, while adaptations to specific encounters represent variable applications. Understanding the constants allows one to handle standard conditions well; mastering the variables ensures proficiency in applying flexible strategies. Precedent cases from former sages exist for reference. Only those who thoroughly comprehend the *Shanghan Lun* (Treatise on Cold Damage) can divine and illuminate its profound meanings.