诒按∶经云，凡病伤寒而成温者，先夏至日者为病温，后夏至日者为病暑；据此，则春之温，夏之暑，均
是伏气所发而为病也。惟春时另有风温之邪，暴感而病，与伏气所发者，名同而实异。夏时亦有暑热之邪，暴
感而病，与伏气所发者亦异。仲景恐与内经伏气之暑相浑，故伤寒论中，名曰 病。而王叔和伤寒例，根据难经
伤寒有五而别之，谓冬时伏寒，至春变为温病，至夏变为热病。后来诸书，遂以伏气所发者，名为热病；而以
暴感而病者，仍名曰暑病。以此暑病之名，既与伏邪之热病相浑，又与仲景之 病牵涉。后人谓 是阳邪，专
指热言；暑为阴邪，兼湿热而言。殊不知寒往暑来，暑与寒，显相对待。古人曰暑、曰 、曰热，皆属火气为
病，不兼湿也。若湿热并至之病，难经名曰湿温，不名为暑。若谓暑必兼湿，则当夏亢旱之
年，暑热偏盛，湿难必得。况湿之可兼者最多，诚以湿无定位，分旺四时，风湿寒湿，无不可兼；惟夏季之土
为独盛，故热湿多于寒湿。然暑字从日，日为天气；湿字从土，土为地气；霄壤不同∶虽可合而为病，究不可
谓暑中原有湿也。愚诚恐相习沿误；易于淆浑，因将仲景书中，伏气发为温热诸条，详注于前；复将暴感暑热
及湿温各条，分别附注于后；而另标之曰∶暴感暑热，兼感湿温。庶几眉目清楚，读者不至淆乱云。
太阳中热者， 是也，汗出恶寒，身热而渴，白虎加人参汤主之。
周禹载曰∶冬月寒能伤人，则名中寒；夏月热亦能伤人，则名中热。此是外来之热，故曰中，与伏寒发为
热病之热不同。而同用白虎者，则以所伤在气，则所主在金，所病在热，金病则母子俱病，故与伏气之在少阴
，发出而由阳明者无异，要皆并主一汤。不因冬月之伏，与夏月之中，为二义也。亦不因伏气之渴，与今病之
渴，为稍异也。方主人参白虎者，石膏功专清肺，退金中之火，是用为君；知母亦能就肺中泻火，滋水之源；
人参生津液，益所伤之气而为臣∶甘草、粳米补土以滋金，以为佐也。
徐洄溪曰∶凡汗出多之病，无不恶寒者。以其恶寒汗出，而误认为寒，妄用热剂，则立危矣。
伤寒脉浮滑，此表有热，里有寒，白虎汤主之。
方中行曰∶世本作表有热，里有寒，必系传写之误。夫白虎本治热病，暑病之药，其性大寒，安得里有寒
者可服之理。详本文脉浮滑，不但不紧而且见滑，乃阳气甚为郁蒸，此里有热也。里热甚，则格寒于外，多厥
逆身凉，而为亢害之证，此表有寒也。观厥阴篇中∶脉滑而厥者，里有热也。则知此表里二
字为错误可知，当上下更易之。
诒按∶此节经文，理不可通。三阳以寒字作邪字解；魏念庭以里字作经络之里解；沈尧封以寒字为 字之
误；王梦隐引徐亚枝说，谓寒字当作痰字解。以上诸家，均系曲为之说∶惟方氏之说，以表里二字互易，于义
略近。
伤寒脉滑而厥者，里有热也，白虎汤主之。
张路玉曰∶滑，阳脉也，故其厥为阳厥。里热郁炽，所以其外反恶寒厥逆，往往有唇面爪甲俱青者，故宜
白虎以清里而除热也。
伤寒无大热，口燥渴心烦，背微恶寒者，白虎加人参汤主之。
张兼善曰∶白虎治烦渴燥热之重剂，表证未罢者，不宜早用。此条背微恶寒，后条时时恶风，皆表证也；
特因其烦热已甚，非白虎不能退，故用之。
沈尧封曰∶背恶寒是阳虚证，但此乃营卫气血之阴阳，非肾命水火之阴阳。此条燥渴心烦， 热内炽，是
白虎证；惟 热伤耗胃气，致背微恶寒，故加人参补其卫。至若少阴病，口中和而背恶寒者；则卫阳与肾阳俱
虚，故人参与附子同用，而两补之也。
吴鹤皋曰∶背微恶寒者，其恶寒不甚也；既见燥渴；则白虎加人参，用无疑义。若恶寒而不燥渴者，则不
可用也。按合下条参之，必有汗乃可用也。
伤寒脉浮，发热无汗，其表不解者，不可与白虎汤；渴欲饮水，无表证者，白虎加人参汤主之。
沈尧封曰∶此承上节，言烦渴、背恶寒，固当用白虎加参
矣；但亦有 而外，复伤风寒，亦能令恶寒发热脉浮。更当于有汗无汗上，辨表证之解不解，以定此方之可用
否也。
伤寒病，若吐下后，七八日不解，热结在里，表里俱热，时时恶风，大渴，舌上干燥而烦，欲饮水数升者
，白虎加人参汤主之。
张路玉曰∶此条表证，比前较重，何以亦用白虎加参耶？盖惟热结在里，所以表热不除∶邪火内伏，所以
恶风大渴，舌燥而烦，饮水不止；如此安得不以生津解热为急也。
沈亮辰曰∶舌燥且干，谓视之无液也。然则温病之视审舌苔，以察津液，仲师已逗其倪矣。
太阳中 者，身热疼重，而脉微弱，此以夏月伤冷水，水行皮中所致也，一物瓜蒂汤主之。
皇甫士安曰，经云，脉盛身寒，得之伤寒；脉虚身热，得之伤暑。盖寒伤形而不伤气，故脉盛；热伤气而
不伤形，故脉虚。王梦隐按∶所云身寒者，虽发热而仍恶寒，不似暑热病之喜凉恶热也。
朱奉议曰∶夏月发热恶寒，头痛，身体肢节痛重，其脉洪盛者，热病也。夏月自汗恶寒，身热而渴，其脉
微弱者，中暑也。
王梦隐按∶此注之热病，乃夏至后所发之伏邪，内经亦谓之暑病。中暑者，夏月外感之热病，亦曰中 。
病有内外之殊，脉有洪微之别。是微弱本 脉，惟身重为湿候。后条虽亦身重，而口开齿燥，热炽已极，似当
急与甘寒救液矣。
张路玉曰∶此条是因热伤冷之病，乃中 之变证也。喻氏谓无形之热伤肺，则用白虎加人参汤以救之；有
形之湿伤肺，则用瓜蒂汤救之；各有所主也。
太阳中 者，发热恶寒，身重而疼痛，其脉弦细芤迟。小便已，洒洒然毛耸，手足逆冷，小有劳，身即热
，口开，前板齿燥。若发汗，则恶寒甚；加温针，则发热甚；数下之，则淋甚。
成聊摄曰∶病有在表者，有在里者，此则表里俱病者也。发热恶寒，身重疼痛者，表中 也。脉弦细芤迟
者，中暑脉象虚也。小便已洒洒然毛耸，手足逆冷者，太阳经气不足也。小有劳，身即热者，谓劳动其阳，而
即发也。口开，前板齿燥者，里有热也。内经云∶因于暑汗，烦则喘喝。口开，谓喘喝也。喘喝不止，故前
板齿燥。若发汗以去表邪，则阳气外虚，故恶寒甚。若以温针助阳，则火热内攻，故发热甚。若下之以除里热
，则内虚而膀胱燥，故淋甚。
王梦隐按∶即前齿燥一端，已为热炽津枯之候。虽身重恶寒，岂可再投清暑益气、五苓、藿香正气等辛温
燥烈以重劫其阴乎。东垣虚谷之言，误人不少。
又按∶观汗火下三禁，则虽未立方，而甘凉撤热存津之当用，已不言而喻矣。赵氏、方氏拟用白虎加人参
法，殆从三阳合病比例而出，似亦近理。
沈尧封曰∶此条言精气素亏而中 者。
柳宝诒按语：《内经》说，凡是患伤寒而转化为温病的，在夏至日之前发病的叫“病温”，在夏至日之后发病的叫“病暑”。据此而言，春季的温病、夏季的暑病，都是伏邪（潜伏体内的病邪）发作而致病。只是春季另有风温之邪，因突然感受外邪而发病，这与伏邪发作者，名称相同但实质不同。夏季也有暑热之邪，因突然感受外邪而发病，也与伏邪发作者不同。张仲景恐怕人们将《内经》中伏气所致的暑病混淆，所以在《伤寒论》中，将其命名为“中暍”（中暑）。而王叔和在《伤寒例》中，依据《难经》“伤寒有五”的说法加以区分，认为冬季潜伏的寒邪，到春天变为温病，到夏天变为热病。后来的医书，于是将伏邪发作的称为“热病”；而将突然感受外邪致病的，仍称为“暑病”。因为“暑病”这个名称，既与伏邪引起的“热病”相混淆，又与张仲景的“中暍”病相牵涉。后人认为“暍”是阳邪，专指热而言；“暑”是阴邪，兼有湿热而言。殊不知寒去暑来，暑与寒是相对立的。古人所说的“暑”、“暍”、“热”，都属于火气为病，不兼夹湿邪。如果是湿热并至的病，《难经》称之为“湿温”，不称为“暑”。如果说暑必兼湿，那么在夏季大旱之年，暑热偏盛，湿气未必能得到。况且可兼夹湿邪的情况很多，确实是因为湿气没有固定位置，分旺于四季，风湿、寒湿，无不皆可兼夹；只有夏季的土气独盛，所以热湿多于寒湿。然而，“暑”字从“日”，日为天气；“湿”字从“土”，土为地气；天地不同：虽然可以合而为病，终究不能说暑中原本就有湿。我实在担心这种习以为常的错误容易混淆视听，因此将张仲景书中伏邪发作导致温热的各条，详细注释在前面；又将暴感暑热及湿温的各条，分别附注在后面；并且另标题为：“暴感暑热，兼感湿温”。这样或许能条理清楚，使读者不至于混淆混乱。
太阳经受邪出现中暍症状的，就是中暍病，表现为汗出、恶寒、身热且口渴，用白虎加人参汤主治。
周禹载说：冬季寒冷能伤人，所以叫中寒；夏季炎热也能伤人，所以叫中热。这是外来的热邪，所以叫“中”，与伏寒发作成为热病的“热”不同。而两者都使用白虎汤，是因为所伤在气分，气分属金，所病在热，肺金受病则母子同病，所以与伏邪在少阴，发出而传至阳明的情况无异，都要以同一方剂为主。并不因为冬季的伏邪和夏季的中邪而分为两种含义，也不因为伏邪引起的口渴和当前病症的口渴而有细微差别。方中加入人参的白虎汤，石膏功效专于清肺，退除金中的火热，所以作为君药；知母也能在肺中泻火，滋补水之源；人参生津液，补益所伤之气，作为臣药；甘草、粳米补脾土以生肺金，作为佐药。
徐洄溪说：凡是出汗多的病，没有不恶寒的。如果因为恶寒汗出，误认为是寒证，妄用热性药剂，病人就会立刻陷入危险。
方中行说：世传本子上写的是“表有热，里有寒”，必定是传抄错误。白虎汤本是治疗热病、暑病的药物，其性质大寒，怎么会有里有寒的人可以服用的道理？详察本文脉象浮滑，不仅不紧，而且见滑，这是阳气非常郁蒸的表现，说明里有热。里热甚盛，则将寒气格拒于外，出现四肢厥逆、身体发凉，这是亢盛为害的症状，表现为表有寒。观察《厥阴篇》中说：“脉滑而厥的，是有里热。”由此可知这里的“表”、“里”二字是错误的，应当上下互换。
柳宝诒按语：这一节经文，道理讲不通。三阳病中以“寒”字作“邪”字解释；魏念庭以“里”字作经络的里解释；沈尧封以“寒”字为“暍”字之误；王梦隐引用徐亚枝的说法，认为“寒”字应当作“痰”字解释。以上各家，都是牵强附会的说法；只有方氏的说法，将“表”、“里”二字互换，在义理上略微接近。
张路玉说：滑脉是阳脉，所以他的厥逆属于阳厥。里热郁结炽盛，所以外表反而恶寒厥逆，往往有嘴唇、面部、指甲都发青的情况，所以适宜用白虎汤清里热而除热邪。
伤寒没有大热，口燥渴、心烦、背部微微恶寒的，用白虎加人参汤主治。
张兼善说：白虎汤是治疗烦渴燥热的重剂，表证未解除的，不宜过早使用。这一条提到的背部微微恶寒，后条提到的时时恶风，都是表证；只是因为烦热已经非常严重，非白虎汤不能退热，所以使用它。
沈尧封说：背恶寒是阳虚证，但这里指的是营卫气血的阴阳，不是肾命水火之阴阳。这一条燥渴心烦，暍热内炽，是白虎汤证；只是暍热耗伤胃气，导致背部微微恶寒，所以加入人参补益卫气。至于少阴病，口中平和而背恶寒的，则是卫阳与肾阳俱虚，所以人参和附子同用，两补之。
吴鹤皋说：背部微微恶寒，是指恶寒不严重；既然见到燥渴，那么白虎加人参汤的使用就没有疑问。如果恶寒而不燥渴的，则不可用。按：结合下条参看，必须有汗才可用此方。
伤寒脉象浮，发热无汗，表证未解的，不可给予白虎汤；口渴想喝水，没有表证的，用白虎加人参汤主治。
沈尧封说：这是承接上一节，说烦渴、背恶寒，固然应当用白虎加人参汤了；但也有在暍热之外，又伤风寒，也能导致恶寒、发热、脉浮。更应当在有汗无汗上，辨别表证是否解除，以确定此方是否可用。
伤寒病，如果在吐下之后，七八天仍未解除，热邪结聚在里，表里俱热，时时恶风，大渴，舌上干燥而烦躁，想要喝几升水的，用白虎加人参汤主治。
张路玉说：这一条的表证，比前一条较重，为什么也使用白虎加人参汤呢？盖因为只有热邪结聚在里，所以表热不能消除；邪火内伏，所以恶风、大渴、舌燥而烦躁，饮水不止；像这样怎么能不以生津解热为急务呢？
沈亮辰说：舌燥且干，是指看起来没有津液。那么温病通过观察审视舌苔，来察知津液存亡，张仲景已经开始揭示其端倪了。
太阳经受邪出现中暍症状，身体发热疼痛沉重，而脉象微弱，这是因为夏季损伤了冷水，水气行于皮肤中所导致的，用一物瓜蒂汤主治。
皇甫士安说：《内经》说，脉象盛大而身体寒冷的，得自伤寒；脉象虚弱而身体发热的，得自伤暑。大概寒邪伤形而不伤气，所以脉象盛大；热邪伤气而不伤形，所以脉象虚弱。王梦隐按：所说的“身寒”，虽然是发热但仍然恶寒，不像暑热病那样喜欢凉爽厌恶炎热。
朱奉议说：夏季发热恶寒，头痛，身体肢节疼痛沉重，脉象洪盛的，是热病。夏季自汗恶寒，身体发热而口渴，脉象微弱的，是中暑。
王梦隐按：这个注释中的“热病”，是夏至日后所发的伏邪，《内经》也称之为暑病。“中暑”是夏季外感的热病，也称为中暍。病有内外之分，脉象有洪大与微弱的区别。这微弱的脉象本是中暍的脉象，只有身体沉重是湿邪的征候。后条虽然也身体沉重，但口开、牙齿干燥，热势极盛，似乎应当紧急使用甘寒救阴液的方剂了。
张路玉说：这一条是因热伤冷的病，是中暍的变证。喻氏认为无形之热伤肺，就用白虎加人参汤来救治；有形之湿伤肺，就用瓜蒂汤来救治；各有主治。
太阳经受邪出现中暍症状，发热恶寒，身体沉重而疼痛，脉象弦细芤迟。小便结束后，感觉洒洒然毛发耸立，手足逆冷，稍微劳动，身体就发热，口开，上前牙板齿干燥。如果发汗，则恶寒更甚；加用温针，则发热更甚；多次攻下，则淋证更甚。
成聊摄说：病有的在表，有的在里，这则是表里都患病。发热恶寒，身体沉重疼痛的，是表中有暍邪。脉象弦细芤迟的，是中暑脉象虚弱的表现。小便结束后洒洒然毛发耸立，手足逆冷的，是太阳经气不足。稍微劳动，身体就发热的，是说劳动扰动阳气，随即发病。口开，上前牙板齿干燥的，是有里热。《内经》说：因于暑汗，烦躁则喘喝。口开，就是指喘喝。喘喝不止，所以上前牙板齿干燥。如果发汗以去除表邪，则阳气外虚，所以恶寒更甚。如果用温针助阳，则火热内攻，所以发热更甚。如果攻下以清除里热，则内虚而膀胱干燥，所以淋证更甚。
王梦隐按：仅从前牙板齿干燥一端来看，已经是热炽津枯的征候。虽然身体沉重恶寒，岂可以再投清暑益气、五苓散、藿香正气等辛温燥烈之剂，以进一步劫夺阴液呢？东垣、虚谷的话，误导了不少人。
又按：观察汗、火、下三种禁忌，那么即使尚未列出方剂，甘凉撤热存津的方法应当使用，已是不言而喻了。赵氏、方氏拟用白虎加人参法，大概是参照三阳合病的比例得出的，似乎也合乎情理。
Liu Baozhi's Commentary: The *Classic of Internal Medicine* (*Huangdi Neijing*) states, "Regarding all diseases that transform from cold damage into warm diseases, those occurring before the Summer Solstice are called 'Wen Bing' (Warm Disease), and those occurring after the Summer Solstice are called 'Shu Bing' (Summerheat Disease). Based on this, both the warmth of spring and the summerheat of summer are diseases caused by the eruption of latent pathogens (Fu Qi, pathogenic factors lying dormant in the body). However, in spring, there is additionally a wind-warmth pathogen; when contracted suddenly, it causes disease. This differs in essence, though not in name, from diseases caused by latent pathogens. In summer, there is also a summerheat-hot pathogen; when contracted suddenly, it causes disease, which also differs from diseases caused by latent pathogens. Zhang Zhongjing feared confusion with the summerheat of latent qi described in the *Neijing*, so in the *Treatise on Cold Damage* (*Shanghan Lun*), he named it 'Zhong Ye' (Heatstroke/Summerheat Stroke). Wang Shuhe, in the *Example of Cold Damage* (*Shanghan Li*), based his differentiation on the *Classic of Difficult Issues* (*Nan Jing*) stating that 'cold damage has five types,' claiming that latent cold from winter transforms into warm disease in spring and into hot disease in summer. Later medical texts thus named diseases caused by latent qi as 'Hot Disease' (Re Bing); while those caused by sudden contraction remained named 'Summerheat Disease' (Shu Bing). Because the name 'Summerheat Disease' was confused with the 'Hot Disease' of latent pathogens, and implicated Zhang Zhongjing's 'Zhong Ye' disease. Later scholars claimed that 'Ye' is a yang pathogen, referring specifically to heat; whereas 'Shu' is a yin pathogen, involving both dampness and heat. Little do they know that as cold departs and summerheat arrives, summerheat and cold are opposites. What the ancients called 'Shu', 'Ye', or 'Re' all belong to diseases caused by fire-qi, without involving dampness. If a disease involves both dampness and heat, the *Nan Jing* calls it 'Damp-Warmth' (Shi Wen), not 'Summerheat'. If one claims summerheat must involve dampness, then in years of severe drought in summer, when summerheat is predominant, dampness is not necessarily present. Moreover, conditions where dampness can be combined are numerous; indeed, because dampness has no fixed location and prospers through the four seasons, wind-damp, cold-damp, etc., can all be combined; only in summer does earth-qi prevail alone, so heat-damp is more common than cold-damp. However, the character 'Shu' contains 'Sun' (Day), representing heavenly qi; the character 'Shi' (Damp) contains 'Earth', representing earthly qi; heaven and earth are different. Although they can combine to cause disease, one cannot say that dampness originally exists within summerheat. I truly fear that these habitual errors will easily cause confusion. Therefore, I have detailed annotations for the sections in Zhang Zhongjing's book regarding latent qi erupting into warm and heat diseases at the front; and separately attached annotations for the sections on sudden summerheat-hot contraction and damp-warmth at the back; and labeled them distinctly as: 'Sudden Summerheat-Hot, Combined with Damp-Warmth.' Hopefully, this will clarify the structure, preventing readers from becoming confused.
When the Taiyang channel is affected by summerheat, it is called Zhong Ye. Symptoms include sweating, aversion to cold, fever, and thirst. It is treated with Baihu Tang plus Renshen (Ginseng Decoction).
Zhou Yuzai said: In winter, cold injures the body, hence called 'Zhong Han' (Cold Strike); in summer, heat injures the body, hence called 'Zhong Re' (Heat Strike). This is external heat, hence the term 'Zhong' (Strike), differing from the 'heat' of latent cold erupting into hot disease. Both use Baihu Tang because the injury is in the Qi level, which corresponds to Metal (Lung). The disease is heat; when Metal is diseased, mother and child organs are both affected. Thus, it is no different from latent qi originating in Shaoyin, erupting, and transmitting to Yangming; both are primarily treated with the same decoction. It is not divided into two meanings due to winter latent qi versus summer strike, nor are the thirsts slightly different between latent qi cases and current cases. In the formula Baihu Tang plus Renshen, Shigao (Gypsum) specializes in clearing the Lung and reducing fire in Metal, serving as the Sovereign herb; Zhimu (Anemarrhena Rhizome) also clears fire in the Lung and nourishes the source of Water; Renshen generates fluids and benefits the injured Qi, serving as the Minister herbs; Gancao (Licorice Root) and Jingmi (Rice) tonify Earth to generate Metal, serving as the Assistant herbs.
Xu Huixi said: Any disease with profuse sweating invariably involves aversion to cold. If, due to aversion to cold and sweating, it is mistaken for a cold pattern and hot agents are wrongly administered, the patient will immediately face danger.
In cold damage, if the pulse is floating and slippery, indicating exterior heat and interior cold, Baihu Tang is indicated.
Fang Xingzhong said: The transmitted text reads 'exterior heat and interior cold,' which must be a transcription error. Baihu Tang is originally for treating hot and summerheat diseases; its nature is greatly cold. How could someone with interior cold take it? Examining the text, the pulse is floating and slippery, not tight but slippery, indicating severe stagnation of yang qi, meaning there is interior heat. Severe interior heat repels cold to the exterior, causing limb厥逆 (reversal cold) and cool body, presenting as extreme pathological manifestations, appearing as exterior cold. Observing the Jueyin chapter: 'Pulse slippery with厥逆 indicates interior heat.' Thus, it is evident that the characters 'exterior' and 'interior' here are erroneous and should be swapped.
Liu Baozhi's commentary: The logic of this passage is untenable. Some interpret 'cold' in the Three Yang channels as 'pathogen'; Wei Nianting interprets 'interior' as the interior of meridians; Shen Yaofeng considers 'cold' a typo for 'Ye'; Wang Mengyin cites Xu Yazhi, suggesting 'cold' should be interpreted as 'phlegm'. All previous scholars offer forced explanations; only Fang's theory, swapping 'exterior' and 'interior', is closer to the correct meaning.
In cold damage, if the pulse is slippery with limb厥逆, it indicates interior heat, treated with Baihu Tang.
Zhang Luyu said: Slippery pulse is a yang pulse, so the厥逆 is yang厥逆. Interior heat is stagnant and blazing, so externally there is aversion to cold and limb reversal. Often, lips, face, and nails turn blue. Thus, Baihu Tang is suitable to clear interior heat.
If cold damage presents with no high fever, dry mouth/thirst, irritability, and slight aversion to cold on the back, Baihu Tang plus Renshen is indicated.
Zhang Jianshan said: Baihu Tang is a heavy agent for treating severe irritability, thirst, and dry heat. It should not be used early if exterior syndrome persists. The slight aversion to cold on the back mentioned here, and the frequent aversion to wind in the next section, are both exterior signs; however, because the irritability and heat are extremely severe, only Baihu Tang can resolve them, hence its use.
Shen Yaofeng said: Aversion to cold on the back is a yang deficiency pattern, but here it refers to the yin-yang of Ying and Wei Qi and Blood, not the water-fire of Kidney and Mingmen. This case features dry thirst and irritability, with intense Ye-heat inside, constituting a Baihu Tang pattern; only because Ye-heat consumes Stomach Qi, causing slight aversion to cold on the back, is Renshen added to tonify Wei Qi. In contrast, in Shaoyin disease, if the mouth is normal/pale and there is aversion to cold on the back, both Wei Yang and Kidney Yang are deficient, so Renshen and Fuzi (Aconite Root) are used together to tonify both.
Wu Hegao said: Slight aversion to cold on the back means the aversion is not severe; since dry thirst is present, the use of Baihu Tang plus Renshen is unquestionable. If there is aversion to cold without dry thirst, it cannot be used. Note: Comparing with the next section, sweat must be present for this formula to be applicable.
In cold damage, if the pulse is floating, with fever and no sweating, and the exterior is unresolved, Baihu Tang must not be given. If there is thirst for water and no exterior syndrome, Baihu Tang plus Renshen is indicated.
Shen Yaofeng said: This follows the previous section, stating that while irritability, thirst, and back aversion to cold warrant Baihu Tang plus Renshen, there are cases where, besides Ye-heat, wind-cold is also contracted, leading to aversion to cold, fever, and floating pulse. One must distinguish whether the exterior syndrome is resolved based on the presence or absence of sweat to determine if this formula is applicable.
In cold damage, if after vomiting or purging, the condition remains unresolved after seven to eight days, with heat結聚 (accumulating) in the interior, presenting with exterior-interior heat, frequent aversion to wind, severe thirst, dry tongue with irritability, and desire to drink several liters of water, Baihu Tang plus Renshen is indicated.
Zhang Luyu said: The exterior syndrome here is heavier than before; why use Baihu Tang plus Renshen? Only because heat accumulates in the interior does exterior heat persist; evil fire lurking inside causes aversion to wind, severe thirst, dry tongue, irritability, and incessant drinking. Under such circumstances, generating fluids and resolving heat must be urgent.
Shen Liangchen said: 'Dry and parched tongue' means visually lacking fluid. Thus, examining tongue coating to assess fluid status in warm diseases was already hinted at by Master Zhang.
When Taiyang is affected by Zhong Ye, the body feels hot, painful, and heavy, with a weak pulse. This is caused by injuring cold water in summer, with water circulating in the skin. It is treated with Yi Wu Gua Di Tang (Single Melon Spicule Decoction).
Huangfu Mi said: The *Neijing* states, 'Pulse surging with body cold comes from cold damage; pulse deficient with body heat comes from summerheat injury.' Generally, cold damages the form but not the Qi, hence the surging pulse; heat damages the Qi but not the form, hence the deficient pulse. Wang Mengyin notes: 'Body cold' here means although feverish, there is still aversion to cold, unlike summerheat diseases which prefer coolness and dislike heat.
Zhu Fengyi said: In summer, fever with aversion to cold, headache, and heavy pain in limbs/joints with a surging pulse is Hot Disease. In summer, spontaneous sweating with aversion to cold, body heat, and thirst with a weak pulse is Zhong Shu (Summerheat Stroke).
Wang Mengyin notes: The 'Hot Disease' in this note refers to latent pathogens erupting after the Summer Solstice, also called Summerheat Disease in the *Neijing*. 'Zhong Shu' is an external heat contraction in summer, also called Zhong Ye. Diseases differ internally and externally; pulses differ between surging and weak. The weak pulse is naturally a Zhong Ye pulse; only body heaviness is a sign of dampness. In the following section, although there is body heaviness, with open mouth and dry teeth, the heat is extremely intense, suggesting immediate use of sweet-cold fluids-nourishing formulas.
Zhang Luyu said: This section describes a disease caused by heat injuring cold, a variant of Zhong Ye. Yu Xi stated that if formless heat injures the Lung, use Baihu Tang plus Renshen to save it; if formed dampness injures the Lung, use Gua Di Tang to save it; each has its specific indication.
When Taiyang is affected by Zhong Ye, there is fever, aversion to cold, body heaviness, and pain. The pulse is string-taut, fine, knotted, and slow. After urination, one feels chilly with hair standing on end, and hands/feet are cold. Upon slight exertion, the body heats up, the mouth opens, and the anterior teeth become dry. If sweating is induced, aversion to cold becomes severe; if moxibustion/warming needles are applied, fever becomes severe; if purged repeatedly, strangury becomes severe.
Cheng Liaoshe said: Diseases can be in the exterior or interior; this case involves both. Fever, aversion to cold, body heaviness, and pain indicate Ye-pathogen in the exterior. String-taut, fine, knotted, and slow pulses indicate the deficient pulse of summerheat. Chilly sensation with hair standing on end after urination, and cold limbs, indicate insufficiency of Taiyang channel Qi. Heating up upon slight exertion means disturbing Yang leads to immediate manifestation. Mouth opening and dry anterior teeth indicate interior heat. The *Neijing* says: 'Due to summerheat sweating, irritability leads to panting and gasping.' Mouth opening refers to panting/gasping. Continuous panting causes dry anterior teeth. Sweating to remove exterior pathogen causes external Yang deficiency, worsening aversion to cold. Warming needles assisting Yang causes internal attack of fire-heat, worsening fever. Purging to remove interior heat causes internal deficiency and bladder dryness, worsening strangury.
Wang Mengyin notes: The single sign of dry anterior teeth already indicates blazing heat and depleted fluids. Although there is body heaviness and aversion to cold, how can one administer acrid-warm, drying, and fierce agents like Qingshu Yiqi Tang, Wuling San, or Huoxiang Zhengqi San to further rob Yin? Dongyuan and Xugu's words have misled many.
Furthermore, observing the three prohibitions (sweating, fire, purging), even without a prescribed formula, the necessity of using sweet-cool methods to withdraw heat and preserve fluids is self-evident. Zhao Shi and Fang Shi proposed using Baihu Tang plus Renshen, likely derived by analogy from Triple Yang combination disease, which seems reasonable.
Shen Yaofeng said: This section describes cases of Zhong Ye in individuals with inherent essence and Qi deficiency.