（按暑温伏暑，名虽异而病实同，治法须前后互参，故中下焦篇不另一门。）
三五、暑兼湿热，偏于暑之热者为暑温，多手
太阴证而宜清；偏于暑之湿者为湿温，多足太阴证而宜温；温热平等者两解之。各宜分晓，不可混也。
此承上起下之文。按暑温、湿温，古来方法最多精妙，不比前条温病毫无尺度，本论原可不必再
议，特以《内经》有先夏至为病温、后夏至为病暑之明文，是暑与温，流虽异而源则同，不得言温而遗
暑，言暑而遗湿。又以历代名家，悉有蒙混之弊，盖夏日三气杂感，本难条分缕晰。惟叶氏心灵手
巧，精思过人，案中治法，丝丝入扣，可谓汇众善以为长者，惜时人不能知其一、二；然其法散见于案
中，章程未定，浅学人读之，有望洋之叹，无怪乎后人之无阶而升也。故本论摭拾其大概，粗定规
模，俾学人有路可寻，精妙甚多，不及备录，学人仍当参考名家，细绎叶案，而后可以深造。再按∶张
洁古云∶“静而得之为中暑，动而得之为中热；中暑者阴证，中热者阳证”。呜呼！洁古笔下如是不
了了，后人奉以为规矩准绳，此医道之所以难言也。试思中暑，竟无动而得之者乎？中热，竟无静
而得之者乎？似难以动静二字分暑热。又云“中暑者阴证”，暑字从日，日岂阴物乎？暑中有火，火岂
阴邪乎？暑中有阴耳，湿是也，非纯阴邪也。“中热者阳证”，斯语诚然，要知热中亦兼秽浊，秽浊亦阴
类也，是中热非纯无阴也。盖洁古所指之中暑，即本论后文之湿温也；其所指之中热，即本论前条之
温热也。张景岳又细分阴暑，阳暑∶所谓阴暑者，即暑之偏于湿，而成足太阴之里证也；阳暑者，即
暑之偏于热，而成手太阴之表证也。学人非目无全牛，不能批隙中款。宋元以来之名医，多自以为
是，而不求之自然之法象，无怪乎道之常不明，而时人之随手杀人也，可胜慨哉！
三六、长夏受暑，过夏而发者，名曰伏暑。霜未降而发者少轻，霜既降而发者则重，冬日发者尤
重，子、午、丑、未之年为多也。
长夏盛暑，气壮者不受也；稍弱者但头晕片刻，或半日而已；次则即病；其不即病而内舍于骨
髓，外舍于分肉之间，气虚者也。盖气虚不能传送暑邪外出，必待秋凉金气相搏而后出也，金气本
所以退烦暑，金欲退之，而暑无所藏，故伏暑病发
也。其有气虚甚者，虽金风亦不能击之使出，必待深秋大凉、初冬微寒相逼而出，故尤为重也。子、
午、丑、未之年为独多者，子、午君火司天，暑本于火也；丑、未湿土司天，暑得湿则留也。
三七、头痛微恶寒，面赤烦渴，舌白，脉濡而数者，虽在冬月，犹为太阴伏暑也。
头痛恶寒，与伤寒无异；面赤烦渴，则非伤寒矣，然犹似伤寒阳明证；若脉濡而数，则断断非伤
寒矣。盖寒脉紧，风脉缓，暑脉弱，濡则弱之象，弱即濡之体也。濡即离中虚，火之象也；紧即坎中
满，水之象也。火之性热，水之性寒，象各不同，性则迥异，何世人悉以伏暑作伤寒治，而用足六经
羌、葛、柴、芩每每杀人哉！象各不同，性则迥异，故曰虽在冬月，定其非伤寒而为伏暑也。冬月犹为
伏暑，秋日可知。伏暑之与伤寒，犹男女之别，一则外实中虚，一则外虚中实，岂可混哉。
三八、太阴伏暑，舌白口渴，无汗者，银翘散去牛蒡、元参加杏仁、滑石主之。
此邪在气分而表实之证也。
三九、太阴伏暑，舌赤口渴，无汗者，银翘散加生地、丹皮、赤芍、麦冬主之。
此邪在血分而表实之证也。
四十、太阴伏暑、舌白口渴，有汗，或大汗不止者，银翘散去牛蒡子、元参、芥穗，加杏仁、石膏、
黄芩主之；脉洪大，渴甚汗多者，仍用白虎法；脉虚大而芤者，仍用人参白虎法。
此邪在气分而表虚之证也。
四一、太阴伏暑，舌赤口渴汗多，加减生脉散主之。
此邪在血分而表虚之证也。
银翘散去牛蒡子元参加杏仁滑石方
即于银翘散内，去牛蒡子、元参，加杏仁六钱，飞滑石一两。服如银翘散法。胸闷加郁金四钱，香豉四钱；呕而痰
多，加半夏六钱，茯苓六钱∶小便短，加薏仁八钱，白通草四钱。
银翘散加生地丹皮赤芍麦冬方
即于银翘散内，加生地六钱、丹皮四钱、赤芍四钱、麦冬六钱。服法如前。
银翘散去牛蒡子元参芥穗加杏仁石膏黄芩方
即于银翘散内，去牛蒡子、元参、芥穗，加杏仁（六钱），生石膏（二两），黄芩（五钱）。服法如前。
白虎法、白虎加人参法（俱见前）
加减生脉散方（酸甘化阴）
沙参（三钱） 麦冬（二钱） 五味子（一钱） 丹皮（二钱） 细生地（三钱）
水五杯，煮二杯，分温再服。
四二、伏暑、暑温、湿温，证本一源，前后互参，不可偏执。
（按语：暑温与伏暑，名称虽然不同，但病机实质相同，治疗方法需要前后相互参照，因此在中焦和下焦篇中不再单独设立一门。）
第三十五条：暑邪兼夹湿热，偏重于暑之热性的称为暑温，多表现为手太阴肺经的证候，适宜用清热法；偏重于暑之湿性的称为湿温，多表现为足太阴脾经的证候，适宜用温化法；若热与湿程度相等，则需表里两解。各种情况应当分辨清楚，不可混淆。
这是承上启下的文字。按：关于暑温和湿温，古来的治疗方法非常多且精妙，不像前一条所述的温病毫无尺度可言，本书原本可以不必再议。只是由于《内经》中有“夏至前发病的叫温病，夏至后发病的叫暑病”的明确记载，说明暑与温，流虽异而源则同，不能说治温就遗漏了暑，说治暑就遗漏了湿。又因为历代名医，都有模糊不清的弊病，大概是因为夏日三种邪气（暑、湿、风/寒）杂合感伤，本难条理分明。只有叶天士心灵手巧，思考精深过人，医案中的治法丝丝入扣，可以说是汇聚众家之长的人，可惜时人不能理解其一二；然而他的方法散见于医案中，章程未定，浅学之人读之，会有望洋兴叹之感，难怪后人没有阶梯可登。所以本书摘录其大概，粗略制定规模，使学习的人有路可循，其中精妙的内容很多，来不及全部记录，学习的人仍应当参考名家著作，细细推演叶氏医案，然后才可以深入深造。另外按：张洁古说：“静处所得的叫中暑，动处所得的叫中热；中暑属于阴证，中热属于阳证。”唉！张洁古笔下如此含糊不清，后人却奉为规矩准绳，这就是医道难以言说的原因啊。试着思考，中暑难道就没有动而得之的情况吗？中热难道就没有静而得之的情况吗？似乎难以用动静二字来区分暑和热。他又说“中暑属于阴证”，“暑”字从日，日难道是阴物吗？暑中有火，火难道是阴邪吗？暑中包含阴，那就是湿，并非纯阴邪。“中热属于阳证”，这话确实正确，但要知热中也兼夹秽浊之气，秽浊也属于阴类，所以中热并非完全没有阴。大概张洁古所指的中暑，就是本书后文所说的湿温；他所指的中热，就是本书前条所说的温热。张景岳又细分阴暑、阳暑：所谓阴暑，就是暑邪偏于湿，形成足太阴脾经的里证；阳暑，就是暑邪偏于热，形成手太阴肺经的表证。学习的人如果不是目无全牛（技艺纯熟），就不能剖析其中的关键。宋元以来的名医，大多自以为是，而不探求自然之法象，难怪医道常不明朗，而时人随手杀人，这怎能不令人感慨呢！
第三十六条：在长夏季节感受暑邪，过了夏天才发作的，叫做伏暑。霜降之前发作的较轻，霜降之后发作的则重，冬天发作的尤其重，在子年、午年、丑年、未年较多见。
长夏盛暑，体质强壮的人不会受邪；稍弱的人只是头晕片刻，或者半天而已；次之则会立即发病；那些不立即发病而邪气内舍于骨髓，外舍于分肉之间的，是气虚的人。大概因为气虚不能传送暑邪外出，必须等到秋凉金气与之相搏才能排出，金气本来是用来退除烦暑的，金气想要退除它，而暑邪无处藏身，所以伏暑病发作。如果有气虚特别严重的，即使是秋风也不能将其击出，必须等到深秋大凉、初冬微寒逼迫才能排出，所以尤为严重。子年、午年、丑年、未年之所以特别多，是因为子、午年由君火司天，暑本源于火；丑、未年由湿土司天，暑得到湿气就会停留。
第三十七条：头痛，轻微恶寒，面红，心烦口渴，舌苔白，脉象濡而数，即使在冬季，也是太阴伏暑。
头痛恶寒，与伤寒无异；面红心烦口渴，就不是伤寒了，但仍然类似伤寒阳明证；如果脉象濡而数，那就绝对不是伤寒了。大概寒邪脉紧，风邪脉缓，暑邪脉弱，濡脉是弱脉的表现，弱脉即濡脉的本质。濡脉即离卦中虚，是火的象；紧脉即坎卦中满，是水的象。火的性质热，水的性质寒，象各不同，性则迥异，为什么世人全都把伏暑当作伤寒治疗，而使用羌活、葛根、柴胡、黄芩等足六经药物每每导致杀人呢！象各不同，性则迥异，所以说即使在冬季，确定其非伤寒而是伏暑。冬季尚且是伏暑，秋季的情况就可以推知了。伏暑与伤寒，就像男女的区别，一个外实中虚，一个外虚中实，怎么可以混淆呢。
第三十八条：太阴伏暑，舌苔白，口渴，无汗的，用银翘散去牛蒡子、玄参，加杏仁、滑石主治。
第三十九条：太阴伏暑，舌质红，口渴，无汗的，用银翘散加生地、丹皮、赤芍、麦冬主治。
第四十条：太阴伏暑，舌苔白，口渴，有汗，或大汗不止的，用银翘散去牛蒡子、玄参、荆芥穗，加杏仁、石膏、黄芩主治；脉象洪大，口渴严重，出汗多的，仍用白虎汤法；脉象虚大而芤的，仍用人参白虎汤法。
第四十一条：太阴伏暑，舌质红，口渴，出汗多，用加减生脉散主治。
银翘散去牛蒡子玄参加杏仁滑石方
即在银翘散内，去掉牛蒡子、玄参，加入杏仁六钱，飞滑石一两。服用方法如银翘散法。胸闷加郁金四钱，香豉四钱；呕吐且痰多，加半夏六钱，茯苓六钱；小便短少，加薏仁八钱，白通草四钱。
银翘散加生地丹皮赤芍麦冬方
即在银翘散内，加入生地六钱、丹皮四钱、赤芍四钱、麦冬六钱。服用方法如前。
银翘散去牛蒡子玄参荆芥穗加杏仁石膏黄芩方
即在银翘散内，去掉牛蒡子、玄参、荆芥穗，加入杏仁（六钱），生石膏（二两），黄芩（五钱）。服用方法如前。
白虎法、白虎加人参法（均见前文）
加减生脉散方（酸甘化阴）
沙参（三钱） 麦冬（二钱） 五味子（一钱） 丹皮（二钱） 细生地（三钱）
用水五杯，煮取两杯，分两次温服。
(Note: Shuwen [Summerheat-Warmth] and Fushe [Retained Summerheat], although named differently, share the same pathological essence. Their treatment methods must be referenced mutually; therefore, no separate section is established in the Middle Jiao and Lower Jiao chapters.)
Article 35: When Summerheat combines with Dampness-Heat, if it leans towards the heat aspect of Summerheat, it is called Shuwen (Summerheat-Warmth), which mostly presents as Hand-Taiyin [Lung] patterns and should be treated with clearing methods. If it leans towards the damp aspect of Summerheat, it is called Shiwen [Damp-Warmth], which mostly presents as Foot-Taiyin [Spleen] patterns and should be treated with warming/drying methods. If heat and dampness are equal, both exterior and interior should be resolved simultaneously. Each condition must be distinguished clearly and not confused.
This text serves to connect the preceding and following sections. Note: Regarding Shuwen and Shiwen, ancient methods are numerous and exquisite, unlike the previous article on Warmth diseases which lacked standards. This treatise could theoretically have omitted further discussion. However, since *Neijing* explicitly states "diseases occurring before the Summer Solstice are called Warmth, and those after are called Summerheat," Summerheat and Warmth, though divergent in flow, share the same source. One cannot discuss treating Warmth while omitting Summerheat, nor treat Summerheat while omitting Dampness. Furthermore, past famous physicians often suffered from ambiguity because the three pathogens of summer (Summerheat, Dampness, Wind/Cold) are complex and hard to distinguish meticulously. Only Ye Tianshi possessed exceptional insight and skill; his treatment methods in medical cases were precise and coherent, gathering the strengths of many. Regrettably, contemporaries failed to understand even a fraction of this. His methods were scattered across cases without fixed protocols, causing beginners to feel overwhelmed, hence the lack of a ladder for later generations. Thus, this treatise extracts the general principles and establishes a rough framework to guide learners. Many subtleties are not fully recorded; learners should still consult famous masters and carefully analyze Ye’s cases to achieve mastery. Additionally, Zhang Jiegu stated: "Obtained in stillness is Zhongshu [Heatstroke]; obtained in motion is Zhonger [Heatstroke]. Zhongshu is a Yin pattern, Zhonger is a Yang pattern." Alas! Zhang Jiegu’s writing was so ambiguous that later generations took it as a standard, making the Dao of medicine difficult to articulate. Consider: Is there really no case of Zhongshu obtained through motion? Or no case of Zhonger obtained through stillness? It seems difficult to distinguish Summerheat and Heat merely by motion and stillness. He also claimed "Zhongshu is a Yin pattern." The character "Shu" contains "Sun"; is the Sun not a Yin object? Summerheat contains Fire; is Fire not a Yin pathogen? Summerheat contains Yin, which is Dampness, not purely Yin pathogenic factors. "Zhonger is a Yang pattern" is indeed true, but one must know that Heat also incorporates turbid qi, which belongs to the Yin category; thus, Zhonger is not devoid of Yin. Essentially, Zhang Jiegu’s "Zhongshu" refers to what this treatise calls Shiwen later on; his "Zhonger" refers to the Wenre [Warmth-Heat] mentioned earlier. Zhang Jingyue further subdivided Yin Summerheat and Yang Summerheat: Yin Summerheat refers to Summerheat leaning towards Dampness, forming Foot-Taiyin interior patterns; Yang Summerheat refers to Summerheat leaning towards Heat, forming Hand-Taiyin exterior patterns. Learners who are not proficient enough to dissect the cow (idiom for mastering technique) cannot grasp the key points. Since the Song and Yuan dynasties, many famous physicians have been self-righteous, failing to seek natural laws, explaining why the Dao remains obscure and why contemporaries kill people casually. How lamentable!
Article 36: When Summerheat is contracted during Changxia [Late Summer] and manifests after the summer season has passed, it is called Fushe [Retained Summerheat]. Manifestation before frost fall is mild; manifestation after frost fall is severe; manifestation in winter is particularly severe. It occurs most frequently in Zi, Wu, Chou, and Wei years.
In the intense heat of Changxia, those with strong Qi do not contract the disease. Those slightly weaker may only experience dizziness for a moment or half a day. Others will fall ill immediately. Those who do not fall ill immediately but have the pathogen lodging internally in the bone marrow and externally between the muscle layers possess deficient Qi. Because deficient Qi cannot transmit the Summerheat pathogen outward, it must wait for the cooling Metal Qi of autumn to clash with it before expulsion. Metal Qi naturally retards Summerheat; when Metal Qi attempts to retreat it, the Summerheat has nowhere to hide, leading to the onset of Fushe. In cases of severe Qi deficiency, even the autumn wind cannot expel it; it must wait for the deep cold of late autumn and slight cold of early winter to force it out, making it even more severe. The prevalence in Zi, Wu, Chou, and Wei years is due to the fact that in Zi and Wu years, Junhuo [Ministerial Fire] governs the Heaven, and Summerheat originates from Fire; in Chou and Wei years, Shitu [Wet Earth] governs the Heaven, and Summerheat lingers when combined with Dampness.
Article 37: Headache, slight aversion to cold, red face, irritability, thirst, white tongue coating, and a soggy (Ru) yet rapid pulse indicate Taiyin Fushe, even in winter.
Headache and aversion to cold are identical to Shanghan [Cold Damage]; however, a red face, irritability, and thirst rule out Shanghan, though it may resemble Yangming patterns of Shanghan. If the pulse is soggy and rapid, it is definitely not Shanghan. Generally, Cold pulses are tight, Wind pulses are slow, and Summerheat pulses are weak. A soggy pulse is a manifestation of weakness; weakness is the substance of sogginess. A soggy pulse corresponds to the empty center of the Li trigram, representing Fire; a tight pulse corresponds to the full center of the Kan trigram, representing Water. Fire’s nature is hot, Water’s nature is cold; their images differ, and their natures are distinct. Why do people universally treat Fushe as Shanghan, using herbs like Qianghuo, Gegen, Chaihu, and Huangqin targeting the Foot Six Channels, often resulting in death? Since images differ and natures are distinct, even in winter, one must determine it is not Shanghan but Fushe. If it is Fushe in winter, one can infer the situation in autumn. Fushe and Shanghan are as different as male and female: one is exterior excess and interior deficiency, the other is exterior deficiency and interior excess. How can they be confused?
Article 38: For Taiyin Fushe presenting with white tongue coating, thirst, and absence of sweating, Yinqiao San (Honeysuckle and Forsythia Decoction) modified by removing Niubangzi (Arctii Fructus) and Yuanshen (Scrophulariae Radix), and adding Xingren (Armeniacae Semen Amarum) and Huashi (Talcum) is the primary prescription.
This indicates the pathogen is in the Qi level with an exterior excess pattern.
Article 39: For Taiyin Fushe presenting with red tongue, thirst, and absence of sweating, Yinqiao San (Honeysuckle and Forsythia Decoction) modified by adding Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Chishao (Paeoniae Radix Rubra), and Maidong (Ophiopogonis Radix) is the primary prescription.
This indicates the pathogen is in the Blood level with an exterior excess pattern.
Article 40: For Taiyin Fushe presenting with white tongue coating, thirst, sweating, or profuse continuous sweating, Yinqiao San (Honeysuckle and Forsythia Decoction) modified by removing Niubangzi (Arctii Fructus), Yuanshen (Scrophulariae Radix), and Jiejui (Schizonepetae Spica), and adding Xingren (Armeniacae Semen Amarum), Shigao (Gypsum Fibrosum), and Huangqin (Scutellariae Radix) is the primary prescription. If the pulse is flooding (Hongda), thirst is severe, and sweating is profuse, Baihu Tang (White Tiger Decoction) method should still be used. If the pulse is deficient, large, and hollow (Kou), Ren Shen Baihu Tang (Ginseng White Tiger Decoction) method should still be used.
This indicates the pathogen is in the Qi level with an exterior deficiency pattern.
Article 41: For Taiyin Fushe presenting with red tongue, thirst, and profuse sweating, Jiasheng Mai San (Modified Shengmai San) is the primary prescription.
This indicates the pathogen is in the Blood level with an exterior deficiency pattern.
Yinqiao San Modified Formula (Removing Niubangzi and Yuanshen, Adding Xingren and Huashi):
Take Yinqiao San, remove Niubangzi (Arctii Fructus) and Yuanshen (Scrophulariae Radix), add Xingren (Armeniacae Semen Amarum) 6 qian and Fei Huashi (Prepared Talcum) 1 liang. Administer according to the Yinqiao San method. Add Yujin (Curcumae Radix) 4 qian and Xiangchi (Perillae Folium Fermentatum) 4 qian for chest oppression; add Banxia (Pinelliae Rhizoma) 6 qian and Fuling (Poria) 6 qian for vomiting with excessive phlegm; add Yiren (Coicis Semen) 8 qian and Baotongcao (Akebiae Caulis) 4 qian for scanty urination.
Yinqiao San Modified Formula (Adding Shengdi, Danpi, Chishao, and Maidong):
Take Yinqiao San, add Shengdi (Rehmanniae Radix) 6 qian, Danpi (Moutan Cortex) 4 qian, Chishao (Paeoniae Radix Rubra) 4 qian, and Maidong (Ophiopogonis Radix) 6 qian. Administer as previously described.
Yinqiao San Modified Formula (Removing Niubangzi, Yuanshen, and Jiejui, Adding Xingren, Shigao, and Huangqin):
Take Yinqiao San, remove Niubangzi (Arctii Fructus), Yuanshen (Scrophulariae Radix), and Jiejui (Schizonepetae Spica), add Xingren (Armeniacae Semen Amarum) 6 qian, Sheng Shigao (Raw Gypsum Fibrosum) 2 liang, and Huangqin (Scutellariae Radix) 5 qian. Administer as previously described.
Baihu Method and Baibu Jia Renshen Method (See previous sections).
Jiasheng Mai San Formula (Sour and Sweet Transform into Yin):
Shashen (Glehniae Radix) 3 qian, Maidong (Ophiopogonis Radix) 2 qian, Wuweizi (Schisandrae Fructus) 1 qian, Danpi (Moutan Cortex) 2 qian, Xi Shengdi (Young Rehmanniae Radix) 3 qian.
Boil five cups of water down to two cups. Divide into two doses, taken warm.
Article 42: Fushe [Retained Summerheat], Shuwen [Summerheat-Warmth], and Shiwen [Damp-Warmth] originate from the same source. Their treatments must be referenced mutually; one must not adhere rigidly to one aspect.