二二、形似伤寒，但右脉洪大而数，左脉反小于右，口渴甚，面赤，汗大出者，名曰暑温，在手太
阴，白虎汤主之；脉芤甚者，白虎加人参汤主之。
此标暑温之大纲也。按温者热之渐，热者温
之极也。温盛为热，木生火也。热极湿动，火生土也。上热下湿，人居其中而暑成矣。若纯热不兼
湿者，仍归前条温热例，不得混入暑也。形似伤寒者，谓头痛、身痛、发热恶寒也。水火极不同性，各
造其偏之极，反相同也。故经谓水极而似火也，火极而似水也。伤寒，伤于水气之寒，故先恶寒而后
发热，寒郁人身卫阳之气而为热也，故仲景《伤寒论》中，有已发热或未发热之文。若伤暑则先发
热，热极而后恶寒，盖火盛必克金，肺性本寒，而复恶寒也。然则伤暑之发热恶寒虽与伤寒相似，其
所以然之故实不同也，学人诚能究心于此，思过半矣。脉洪大而数，甚则芤，对伤寒之脉浮紧而言
也。独见于右手者，对伤寒之左脉大而言也，右手主上焦气分，且火克金也，暑从上而下，不比伤寒
从下而上，左手主下焦血分也，故伤暑之左脉反小于右。口渴甚面赤者，对伤寒太阳证面不赤，口不
渴而言也；火烁津液，故口渴，火甚未有不烦者，面赤者，烦也，烦字从火后页，谓火现于面也。汗大
出者，对伤寒汗不出而言也。首白虎例者，盖白虎乃秋金之气，所以退烦暑，白虎为暑温之正例也。
其源出自《金匮》，守先圣之成法也。
白虎汤、白虎加人参汤方（并见前）
二三、《金匮》谓太阳中 ，发热恶寒，身重而疼痛，其脉弦细芤迟，小便已，洒然毛耸，手足
逆冷，小有劳，身即热，口开前板齿燥，若发其汗，则恶寒甚，加温针，则发热甚，数下，则淋甚，可
与东垣清暑益气汤。
张石顽注∶谓太阳中 ，发热恶寒身重而疼痛，此因暑而伤风露之邪，手太阳标证也。手太阳
小肠属火，上应心包，二经皆能制金烁肺，肺受火刑，所以发热恶寒似足太阳证。其脉或见弦细，或
见芤迟，小便已，洒然毛耸，此热伤肺胃之气，阳明本证也（愚按∶小便已，洒然毛耸，似乎非阳明证，
乃足太阳膀胱证也。盖膀胱主水，火邪太甚而制金，则寒水来为金母复仇也。所谓五行之极，反兼
胜已之化）。发汗则恶寒甚者，气虚重夺（当作伤）其津（当作阳）也。温针则发热甚者，重伤经中之
液，转助时火。肄虐于外也。数下之则淋甚者，劫其在里之阴，热势乘机内陷也。此段经文，本无方
治，东垣特立清暑益气汤，足补仲景之未逮，愚按∶此言太过。仲景当日，必有不可立方之故，或
曾立方而后世脱简，皆未可知，岂东垣能立而仲景反不能立乎？但细按此证，恰可与清暑益气汤，曰
可者，仅可而有所未尽之词，尚望遇是证者，临时斟酌尽善。至沈目南《金匮要略注》，谓当用辛
凉甘寒，实于此证不合。盖身重疼痛，证兼寒湿也。即目南自注，谓发热恶寒身重疼痛，其脉弦细
芤迟，内暑而兼阴湿之变也。岂有阴湿而用甘寒柔以济柔之理？既曰阴湿，岂辛凉所能胜任！不待
辩而自明。
清暑益气汤方（辛甘化阳酸甘化阴复法）
黄 （一钱） 黄柏（一钱） 麦冬（一钱） 青皮（一钱） 白术（一钱五分） 升麻（三分） 当归（七
分） 炙草（一钱） 神曲（一钱） 人参（一钱） 泽泻（一钱） 五味子（八分） 陈皮（一钱） 苍
术（一钱五分） 葛根（三分） 生姜（二片） 大枣（二枚）
水五杯，煮取二杯，渣再煎一杯，分温三服。虚者得宜，实者禁用；汗不出而但热者禁用。
二四、手太阴暑温，如上条证，但汗不出者，新加香薷饮主之。
证如上条，指形似伤寒，右脉洪大，左手反小，面赤口渴而言。但以汗不能自出，表实为异，故用
香薷饮发暑邪之表也。按香薷辛温芳香，能由肺之经而达其络。鲜扁豆花，凡花皆散，取其芳香而
散，且保肺液，以花易豆者，恶其呆滞也，夏日所生之物，多能解暑，惟扁豆花为最，如无花时，用鲜扁
豆皮，若再无此，用生扁豆皮。浓朴苦温，能泄食满，浓朴皮也，虽走中焦，究竟肺主皮毛，以皮从
皮，不为治上犯中。若黄连甘草，纯然里药，暑病初起，且不必用，恐引邪深入，故易以连翘、银花，取
其辛凉达肺经之表，纯从外走，不必走中也。
温病最忌辛温，暑病不忌者，以暑必兼湿，湿为阴邪，非温不解，故此方香薷、浓朴用辛温，而余
则佐以辛凉云。下文湿温论中，不惟不忌辛温，且用辛热也。
新加香薷饮方（辛温复辛凉法）
香薷（二钱） 银花（三钱） 鲜扁豆花（三钱） 浓朴（二钱） 连翘（二钱）
水五杯，煮取二杯。先服一杯，得汗止后服；不汗再服；服尽不汗，再作服。
二五、手太阴暑温，服香薷饮，微得汗，不可再服香薷饮重伤其表，暑必伤气，最令表虚，虽有
余证，知在何经，以法治之。
按伤寒非汗不解，最喜发汗；伤风亦非汗不解，最忌发汗，只宜解肌，此麻桂之异其治，即异其
法也。温病亦喜汗解，最忌发汗，只许辛凉解肌，辛温又不可用，妙在导邪外出，俾营卫气血调和，
自然得汗，不必强责其汗也。若暑温、湿温则又不然，暑非汗不解，可用香薷发之，发汗之后，大汗不
止，仍归白虎法，固不比伤寒伤风之漏汗不止，而必欲桂附护阳实表，亦不可屡虚其表，致令厥脱
也，观古人暑门有生脉散法，其义自见。
二六、手太阴暑温，或已经发汗，或未发汗，而汗不止，烦渴而喘，脉洪大有力者，白虎汤主之；脉洪大而芤者，
白虎加人参汤主之；身重者，湿也，白虎加苍术汤主之；汗多脉散大，喘喝欲脱者，生脉散主之。
此条与上文少异者，只已经发汗一句。
白虎加苍术汤方
即于白虎汤内加苍术三钱。
汗多而脉散大，其为阳气发泄太甚，内虚不司留恋可知。生脉散酸甘化阴，守阴所以留阳，阳
留，汗自止也。以人参为君，所以补肺中元气也。
生脉散方（酸甘化阴法）
人参（三钱） 麦冬（不去心，二钱） 五味子（一钱）
水三杯，煮取八分二杯，分二次服，渣再煎服，脉不敛，再作服，以脉敛为度。
二七、手太阴暑温，发汗后，暑证悉减，但头微胀，目不了了，余邪不解者，清络饮主之，邪不
解而入中下焦者，以中下法治之。
既曰余邪，不可用重剂明矣，只以芳香轻药清肺络中余邪足矣。倘病深而入中下焦，又不可以浅药治深病也。
清络饮方（辛凉芳香法）
鲜荷叶边（二钱） 鲜银花（二钱） 西瓜翠衣（二钱） 鲜扁豆花（一枝） 丝瓜皮（二钱） 鲜竹叶心（二钱）
水二杯，煮取一杯，日二服。凡暑伤肺经气分之轻证皆可用之。
二八、手太阴暑温，但咳无痰，咳声清高者，清络饮加甘草、桔梗，甜杏仁、麦冬、知母主之。
咳而无痰，不嗽可知，咳声清高，金音清亮，久咳则哑，偏于火而不兼湿也。即用清络饮，清肺络
中无形之热，加甘、桔开提，甜杏仁利肺而不伤气，麦冬、知母保肺阴而制火也。
清络饮加甘桔甜杏仁麦冬汤知母方
即于清络饮内，加甘草一钱，枯梗二钱，甜杏仁二钱，麦冬三钱，知母三钱。
二九、两太阴暑温，咳而且嗽，咳声重浊，痰多不甚渴，渴不多饮者，小半夏加茯苓汤再加浓朴，杏仁主之。
既咳且嗽，痰涎复多，咳声重浊，重浊者土音也，其兼足太阴湿土可知。不甚渴，渴不多饮
，则其中之有水可知，此暑温而兼水饮者也。故以小半夏加茯苓汤，蠲饮和中；再加浓朴、杏仁，利肺
泻湿，预夺其喘满之路；水用甘澜，取其走而不守也。
此条应入湿温，却列于此处者，以与上条为对待之文，可以互证也。
小半夏加茯苓汤再加浓朴杏仁方（辛温淡法）
半夏（八钱） 茯苓块（六钱） 浓朴（三钱） 生姜（
五钱） 杏仁（三钱）
甘澜水八杯，煮取三杯，温服，日三。
三十、脉虚夜寐不安，烦渴舌赤，时有谵语，目常开不闭，或喜闭不开，暑入手厥阴也。手厥阴
暑温，清营汤主之；舌白滑者，不可与也。
夜寐不安，心神虚而阳不得入阴也。烦渴舌赤，心用恣而心体亏也。时有谵语，神明欲乱也。目常开不闭，目为火
户，火性急，常欲开以泄其火、且阳不下交于阴也；或喜闭不喜开者，阴为亢阳所损，阴损则恶见阳光也。故以清营汤
急清宫中之热，而保离中之虚也。若舌白滑，不惟热重，湿亦重矣，湿重忌柔润药，当于湿温例中求之，故曰不可与
清营汤也。
清营汤方（咸寒苦甘法）
犀角（三钱） 生地（五钱） 元参（三钱） 竹叶心（一钱） 麦
冬（三钱） 丹参（二钱） 黄连（一钱五分） 银花（三钱） 连翘（连心用，二钱）
水八杯，煮取三杯，日三服。
三一、手厥阴暑温，身热不恶寒，清神不了了时时谵语者，安宫牛黄丸主之，紫雪丹亦主之。
身热不恶寒，已无手太阴证，神气欲昏，而又时时谵语，不比上条时有谵语，谨防内闭，故以芳
香开窍、苦寒清热为急。
安宫牛黄丸、紫雪丹（方义并见前）
三二、暑温寒热，舌白不渴、吐血者，名曰暑瘵，为难治，清络饮加杏仁、薏仁、滑石汤主之。
寒热，热伤于表也；舌白不渴，湿伤于里也；皆在气分，而又吐血，是表里气血俱病，岂非暑瘵重
证乎？此证纯清则碍虚，纯补则碍邪，故以清络饮清血络中之热，而不犯手；加杏仁利气，气为血帅
故也；薏仁、滑石，利在里之湿，冀邪退气宁而血可止也。
清络饮加杏仁薏仁滑石汤方
即于清络饮内加杏仁二钱，滑石末三钱，薏仁三钱，服法如前。
三三、小儿暑温，身热，卒然痉厥，名曰暑痫，清营汤主之，亦可少与紫雪丹。
小儿之阴，更虚于大人，况暑月乎！一得暑温，不移时有过卫入营者，盖小儿之脏腑薄也。血络
受火邪逼迫，火极而内风生，俗名急惊，混与发散消导，死不旋踵，惟以清营汤清营分之热而保津
液，使液充阳和，自然汗出而解，断断不可发汗也。可少与紫雪者，清包络之热而开内窍也。
三四、大人暑痫，亦同上法。热初入营，肝风内动，手足螈 ，可于清营汤中，加勾藤、丹皮、羚羊角。
清营汤、紫雪丹（方法并见前）
二十二、症状类似伤寒，但右手脉象洪大且数，左手脉象反而比右手小，极度口渴，面色发红，大汗出，这称为暑温（夏季感受暑热病邪引起的急性外感热病），病位在手太阴肺经，用白虎汤主治；如果脉象出现芤脉（浮大中空，如按葱管）特别明显的，用白虎加人参汤主治。
这是概括暑温的大纲。据分析，“温”是“热”的渐进过程，“热”是“温”的极致。温热旺盛就变成热，如同木生火。热到了极点湿气就会动，如同火生土。上部热下部湿，人处于其中，暑气就形成了。如果是纯热不兼夹湿气的，仍归入前条温热的例子，不能混入暑病中。所谓“形似伤寒”，是指头痛、身体疼痛、发热恶寒。水和火的性质截然不同，各自发展到极端的偏颇时，反而显得相同。所以经典说水发展到极端像火，火发展到极端像水。伤寒，是伤于水气之寒，所以先恶寒而后发热，寒气郁遏人身卫阳之气而化为热，所以在张仲景《伤寒论》中有已经发热或尚未发热的记载。如果是伤暑，则先发热的，热极之后才恶寒，因为火盛必然克金，肺的本性属寒，所以又出现恶寒。既然这样，伤暑的发热恶寒虽然与伤寒相似，但其所以然的原因确实不同，学习者如果能深入研究这一点，理解就超过一半了。脉象洪大而数，甚至出现芤脉，是相对于伤寒的脉浮紧而言的。独见于右手，是相对于伤寒左脉大而言的，右手主上焦气分，且火克金，暑气从上而下侵袭，不像伤寒从下而上，左手主下焦血分，所以伤暑的左手脉反而小于右手。极度口渴、面色发红，是相对于伤寒太阳证面色不红、口不渴而言的；火热灼烧津液，所以口渴，火盛没有不烦躁的，面色发红就是烦躁的表现，“烦”字从火后页，意思是火现于面部。大汗出，是相对于伤寒不出汗而言的。首先列出白虎汤的例子，是因为白虎代表秋金之气，能够退除烦暑，白虎汤是治疗暑温的正法。其源头出自《金匮要略》，遵循先圣的成法。
二十三、《金匮要略》说太阳中喝（中暑），发热恶寒，身体沉重而疼痛，脉象弦细芤迟，小便结束后，感到洒淅恶寒、毫毛竖起，稍微劳作，身体立即发热，张口呼吸导致门齿干燥，如果发汗，则恶寒加重，如果用温针，则发热加重，多次攻下，则淋证加重，可以用东垣的清暑益气汤。
张石顽注释：说太阳中喝，发热恶寒身体沉重而疼痛，这是因为暑气伤及风露之邪，是手太阳小肠经的标证。手太阳小肠属火，上应心包络，这两经都能克制金、灼烧肺脏，肺受火刑，所以发热恶寒类似于足太阳膀胱经的证候。其脉象有的见到弦细，有的见到芤迟，小便结束后洒淅恶寒、毫毛竖起，这是热伤肺胃之气，属于阳明本证（我按：小便结束洒淅恶寒，似乎不是阳明证，而是足太阳膀胱证。因为膀胱主水，火邪太甚而克制金，则寒水来为金母复仇。这就是所谓的五行之极，反兼胜己之化）。发汗则恶寒严重的，是气虚严重损伤了其津液（应当作阳气）。温针则发热严重的，是重伤经络中的津液，转而助长时令之火肆虐于外。多次攻下则淋证严重的，是劫夺其在里的阴液，热势乘机内陷。这段经文原本没有方治，东垣特意创立清暑益气汤，足以弥补张仲景的不足，我认为：这话太过分了。张仲景当时，一定有无法立方的原因，或许是曾经立方而后世脱简，都有可能，难道东垣能立而张仲景反而不能立吗？只是仔细推敲这个证候，恰好可以用清暑益气汤，说“可”，是仅仅可以而有所未尽的词，希望遇到这种证候的人，临时斟酌尽善。至于沈目南《金匮要略注》，说应当用辛凉甘寒，实际上与此证不合。因为身体沉重疼痛，证候兼有寒湿。即使沈目南自己注释，说发热恶寒身体沉重疼痛，脉象弦细芤迟，内暑而兼阴湿的变化。哪有阴湿而用甘寒柔以济柔的道理？既然说是阴湿，难道辛凉所能胜任！不用辩论自然明白。
清暑益气汤方（辛甘化阳酸甘化阴复法）
黄芪（一钱） 黄柏（一钱） 麦冬（一钱） 青皮（一钱） 白术（一钱五分） 升麻（三分） 当归（七分） 炙甘草（一钱） 神曲（一钱） 人参（一钱） 泽泻（一钱） 五味子（八分） 陈皮（一钱） 苍术（一钱五分） 葛根（三分） 生姜（二片） 大枣（二枚）
水五杯，煮取二杯，药渣再煎一杯，分三次温服。体虚者适宜，实证禁用；无汗而仅发热的禁用。
二十四、手太阴暑温，像上一条的证候，但是无汗的，用新加香薷饮主治。
证候像上一条，指形似伤寒，右脉洪大，左手反而小，面赤口渴而言。但因为汗不能自出，表实为异，所以用香薷饮发散暑邪在表。据分析，香薷辛温芳香，能从肺经到达其络脉。鲜扁豆花，凡是花都具有发散作用，取其芳香而散，且保护肺液，用花代替豆，是厌恶其呆滞。夏日所生的物，多能解暑，只有扁豆花最好，如果没有花，用鲜扁豆皮，如果还没有，用生扁豆皮。浓朴苦温，能泄食满，是浓朴皮，虽然走中焦，终究肺主皮毛，以皮从皮，不为治上犯中。如果黄连甘草，完全是里药，暑病初起，暂且不必用，恐怕引邪深入，所以换成连翘、银花，取其辛凉达肺经之表，纯从外走，不必走中焦。
温病最忌辛温，暑病不忌的，因为暑必兼湿，湿为阴邪，非温不解，所以此方香薷、浓朴用辛温，其余佐以辛凉。下文湿温论述中，不仅不忌辛温，而且用辛热。
新加香薷饮方（辛温复辛凉法）
香薷（二钱） 银花（三钱） 鲜扁豆花（三钱） 浓朴（二钱） 连翘（二钱）
水五杯，煮取二杯。先服一杯，得汗停止后服；不出汗再服；服完不出汗，再做一次服用。
二十五、手太阴暑温，服用香薷饮，微微出汗，不可再服用香薷饮重伤其表，暑必伤气，最令表虚，虽然有剩余证候，知道在哪一经，依法治疗。
据分析，伤寒非汗不解，最喜欢发汗；伤风也非汗不解，最忌讳发汗，只宜解肌，这是麻黄汤和桂枝汤的不同治法，即不同的方法。温病也喜欢汗解，最忌讳发汗，只允许辛凉解肌，辛温又不可用，妙在引导邪气外出，使营卫气血调和，自然得汗，不必强求其汗。如果是暑温、湿温则又不一样，暑非汗不解，可用香薷发散，发汗之后，大汗不止，仍归白虎法，固然不比伤寒伤风的漏汗不止，而必须用桂附护阳实表，也不可屡虚其表，致使厥脱，看古人暑门有生脉散法，其义自然可见。
二十六、手太阴暑温，或者已经发汗，或者未发汗，而汗不止，烦渴而喘，脉洪大有力者，白虎汤主治；脉洪大而芤者，白虎加人参汤主治；身体沉重者，是湿，白虎加苍术汤主治；汗多脉散大，喘喝欲脱者，生脉散主治。
这一条与上文稍有不同的地方，只有“已经发汗”一句。
汗多而脉散大，其为阳气发泄太甚，内虚不能留恋可知。生脉散酸甘化阴，守阴所以留阳，阳留，汗自然停止。以人参为君药，所以补肺中元气。
生脉散方（酸甘化阴法）
人参（三钱） 麦冬（不去心，二钱） 五味子（一钱）
水三杯，煮取八分之二杯，分两次服，药渣再煎服，脉不收敛，再做一次服用，以脉收敛为标准。
二十七、手太阴暑温，发汗后，暑证全部减轻，但头部微胀，眼睛看不清东西，余邪未解的，用清络饮主治，邪不解而入中下焦的，以中下法治之。
既然叫余邪，不可用重剂明了，只用芳香轻药清除肺络中余邪即可。如果病深而入中下焦，又不可以浅药治深病。
清络饮方（辛凉芳香法）
鲜荷叶边（二钱） 鲜银花（二钱） 西瓜翠衣（二钱） 鲜扁豆花（一枝） 丝瓜皮（二钱） 鲜竹叶心（二钱）
水二杯，煮取一杯，每日二次服。凡是暑伤肺经气分的轻证都可以用。
二十八、手太阴暑温，只咳嗽无痰，咳声清脆高扬的，清络饮加甘草、桔梗、甜杏仁、麦冬、知母主治。
咳嗽而无痰，可知不嗽，咳声清脆高扬，金音清亮，久咳则哑，偏于火而不兼湿。就用清络饮，清肺络中无形之热，加甘、桔开提，甜杏仁利肺而不伤气，麦冬、知母保肺阴而制火。
清络饮加甘桔甜杏仁麦冬知母汤方
即在清络饮内，加甘草一钱，桔梗二钱，甜杏仁二钱，麦冬三钱，知母三钱。
二十九、两太阴暑温，咳嗽且痰多，咳声重浊，痰多不甚渴，渴不多饮的，用小半夏加茯苓汤再加浓朴、杏仁主治。
既咳且嗽，痰涎又多，咳声重浊，重浊者是土音，其兼足太阴湿土可知。不甚渴，渴不多饮，则其中有水可知，这是暑温而兼水饮。所以用小半夏加茯苓汤，蠲饮和中；再加浓朴、杏仁，利肺泻湿，预先阻断其喘满之路；用水用甘澜水，取其走而不守。
这一条应入湿温，却列于此处的，是因为与上条为对待的文章，可以互相印证。
小半夏加茯苓汤再加浓朴杏仁方（辛温淡法）
半夏（八钱） 茯苓块（六钱） 浓朴（三钱） 生姜（五钱） 杏仁（三钱）
甘澜水八杯，煮取三杯，温服，每日三次。
三十、脉虚夜寐不安，烦渴舌赤，时有谵语，目常开不闭，或喜闭不开，暑入手厥阴心包经。手厥阴暑温，清营汤主治；舌白滑的，不可给予。
夜寐不安，心神虚而阳不得入阴。烦渴舌赤，心用恣而心体亏。时有谵语，神明欲乱。目常开不闭，目为火户，火性急，常欲开以泄其火，且阳不下交于阴；或喜闭不喜开的，阴为亢阳所损，阴损则恶见阳光。所以用清营汤急清宫中之热，而保离中之虚。如果舌白滑，不仅热重，湿也重了，湿重忌柔润药，应当在湿温例中求之，所以说不可与清营汤。
清营汤方（咸寒苦甘法）
犀角（三钱） 生地（五钱） 元参（三钱） 竹叶心（一钱） 麦冬（三钱） 丹参（二钱） 黄连（一钱五分） 银花（三钱） 连翘（连心用，二钱）
水八杯，煮取三杯，每日三次服。
三一、手厥阴暑温，身热不恶寒，神志不清时时谵语的，安宫牛黄丸主治，紫雪丹也主治。
身热不恶寒，已无手太阴证，神气欲昏，而又时时谵语，不比上条时有谵语，谨防内闭，所以用芳香开窍、苦寒清热为急。
三二、暑温寒热，舌白不渴、吐血的，名叫暑瘵，为难治，清络饮加杏仁、薏仁、滑石汤主治。
寒热，热伤于表；舌白不渴，湿伤于里；都在气分，而又吐血，是表里气血俱病，岂非暑瘵重证？此证纯清则碍虚，纯补则碍邪，所以用清络饮清血络中之热，而不犯手；加杏仁利气，气为血帅的缘故；薏仁、滑石，利在里之湿，希望邪退气宁而血可止。
清络饮加杏仁薏仁滑石汤方
即在清络饮内加杏仁二钱，滑石末三钱，薏仁三钱，服法如前。
三三、小儿暑温，身热，突然痉厥，名叫暑痫，清营汤主治，也可少量给予紫雪丹。
小儿的阴，更虚于大人，何况暑月！一得暑温，不久就有过卫入营的，因为小儿脏腑薄。血络受火邪逼迫，火极而内风生，俗名急惊，胡乱用发散消导，死得快，只用清营汤清营分之热而保津液，使液充阳和，自然汗出而解，绝对不可发汗。可少与紫雪的，清包络之热而开内窍。
22. When the presentation resembles Shaoyang disease (Taiyang disease), but the pulse at the right hand is surging and rapid, while the pulse at the left hand is surprisingly smaller than that at the right; accompanied by extreme thirst, redness of the face, and profuse sweating, this condition is named Summerheat-Warmth (Shu Wen, an acute febrile disease caused by summerheat pathogenic factors in summer). The pathology is located in the Hand-Taiyin Lung Meridian. It should be treated with Baihu Tang (White Tiger Decoction). If the Kou pulse (floating, large, and empty, felt like pressing on a scallion stalk) is particularly prominent, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng Decoction) should be used.
This outlines the general principles of Summerheat-Warmth. Analysis shows that "Warmth" is the gradual onset of "Heat," and "Heat" is the extreme of "Warmth." When Warmth becomes excessive, it transforms into Heat, analogous to Wood generating Fire. When Heat reaches its extreme, Dampness moves, analogous to Fire generating Earth. With Heat above and Dampness below, and humans residing in between, Summerheat is formed. If there is pure Heat without concurrent Dampness, it still falls under the category of Warmth discussed in previous articles and should not be confused with Summerheat. "Resembling Taiyang disease" refers to headache, body pain, fever, and aversion to cold. Water and Fire have fundamentally different natures; when each develops to its extreme bias, they appear similar. Thus, classics state that Water at its extreme resembles Fire, and Fire at its extreme resembles Water. Taiyang disease results from injury by the cold of Water Qi, so aversion to cold precedes fever; cold stagnates the Wei-Yang Qi of the body, transforming into heat. Therefore, Zhang Zhongjing's *Treatise on Cold Damage* mentions cases where fever has already appeared or has not yet appeared. In contrast, Summerheat injury causes fever first, and only after heat reaches its extreme does aversion to cold appear, because excessive Fire inevitably overacts on Metal; since the Lung nature is inherently cold, aversion to cold occurs. Thus, although the fever and aversion to cold in Summerheat injury resemble those in Taiyang disease, the underlying mechanisms are truly different. If students can focus their study on this point, they will have understood more than half of the subject. A surging and rapid pulse, or even a Kou pulse, is stated in contrast to the floating-tight pulse of Taiyang disease. Being found exclusively in the right hand contrasts with the large pulse at the left hand in Taiyang disease. The right hand governs the Upper Jiao Qi level, and Fire overacts on Metal; Summerheat descends from above, unlike Taiyang disease which ascends from below. The left hand governs the Lower Jiao Blood level; therefore, in Summerheat injury, the left pulse is surprisingly smaller than the right. Extreme thirst and facial redness contrast with the non-red face and lack of thirst in Taiyang syndrome. Fire scorches body fluids, causing thirst; excessive Fire invariably causes irritability; facial redness is a manifestation of irritability. The character "Fan" (irritability) contains "Fire" and "Ye" (back/page), meaning Fire manifests on the face. Profuse sweating contrasts with the absence of sweating in Taiyang disease. Baihu Tang is listed first because Baihu represents the Qi of Autumn Metal, which can retreat vexing Summerheat; thus, Baihu Tang is the standard treatment for Summerheat-Warmth. Its origin lies in the *Jin Gui Yao Lue*, adhering to the established methods of the Sages.
Baihu Tang and Baihu Jia Renshen Tang formulas (see previous sections).
23. The *Jin Gui Yao Lue* states: In Taiyang Zhong (Sunstroke), there is fever and aversion to cold, heaviness of the body with pain, and a pulse that is wiry-thin, Kou, or slow. After urination, one feels chilly with gooseflesh. Upon slight exertion, the body immediately becomes hot, and opening the mouth leads to dryness of the front teeth. If diaphoresis is induced, aversion to cold worsens; if warm needles are applied, fever worsens; if purgatives are used repeatedly, strangury worsens. Dong Yuan's Qingshu Yiqi Tang (Clear Summerheat and Benefit Qi Decoction) may be given.
Zhang Shiwang annotates: The symptoms of Taiyang Zhong, fever, aversion to cold, body heaviness, and pain, arise because Summerheat injures Wind-Dew pathogens, representing the manifest signs of the Hand-Taiyin Small Intestine Meridian. The Hand-Taiyin Small Intestine belongs to Fire and corresponds internally to the Pericardium. Both meridians can restrain Metal and scorch the Lung. When the Lung suffers from Fire punishment, fever and aversion to cold occur, resembling the Foot-Taiyang Bladder meridian syndrome. The pulse may appear wiry-thin or Kou-slow. Chills and gooseflesh after urination indicate Heat injuring the Qi of the Lung and Stomach, which is a Yangming root syndrome (Note: Chills and gooseflesh after urination seem not to be a Yangming syndrome, but rather a Foot-Taiyang Bladder syndrome. Since the Bladder governs Water, excessive Fire restraining Metal causes Cold Water to seek revenge for its mother Metal. This is what is meant by the extremity of the Five Elements reversing to assume the transformation of the element that conquers it). Severe aversion to cold after sweating indicates severe Qi deficiency damaging Yin fluids (should be Yang). Severe fever after warm needle therapy indicates severe injury to fluids within the channels, further assisting seasonal Fire to rampage externally. Frequent purgation worsening strangury indicates robbing internal Yin, allowing Heat to sink inward opportunistically. This passage originally lacked a formula; Dong Yuan specifically created Qingshu Yiqi Tang, sufficiently supplementing Zhang Zhongjing's omissions. I argue: This statement is too strong. There must have been reasons why Zhang Zhongjing could not prescribe a formula at the time, or perhaps a formula existed but was lost in later transmission; both are possible. How could Dong Yuan create it while Zhang Zhongjing could not? However, carefully analyzing this syndrome, it indeed fits Qingshu Yiqi Tang. The word "Ke" (may/can) implies "barely acceptable with reservations." Those encountering this syndrome should exercise discretion. Shen Munan's commentary on *Jin Gui Yao Lue* suggests using Acrid-Cool and Sweet-Cold methods, which actually do not fit this syndrome. Body heaviness and pain indicate concurrent Cold-Damp. Even Shen's own note admits that fever, aversion to cold, body heaviness, pain, and wiry-thin/Kou-slow pulses indicate internal Summerheat combined with Yin-Damp variation. How can Sweet-Cold and softening-to-nourish-softness be used for Yin-Damp? If it is Yin-Damp, how can Acrid-Cold suffice? This is self-evident without debate.
Qingshu Yiqi Tang Formula (Acrid-Sweet to generate Yang, Sour-Sweet to generate Yin, compound method):
Huangqi (Astragali Radix, 1 qian), Huangbai (Phellodendri Cortex, 1 qian), Maidong (Ophiopogonis Radix, 1 qian), Qingpi (Citri Reticulatae Pericarpium Viride, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Shengma (Cimicifugae Rhizoma, 0.3 qian), Danggui (Angelicae Sinensis Radix, 0.7 qian), Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma, 1 qian), Shenqu (Massae Fermentatae Medicatae, 1 qian), Renshen (Ginseng Radix, 1 qian), Zexie (Alismatis Rhizoma, 1 qian), Wuweizi (Schisandrae Fructus, 0.8 fen), Chenpi (Citri Reticulatae Pericarpium, 1 qian), Cangzhu (Atractylodis Rhizoma, 1.5 qian), Gegen (Puerariae Lobatae Radix, 0.3 qian), Shengjiang (Zingiberis Rhizoma Recens, 2 slices), Dazao (Jujubae Fructus, 2 pieces).
Boil five cups of water until two cups remain. Decoct the dregs again to obtain one cup. Divide into three warm doses. Suitable for deficiency patterns; contraindicated in excess patterns. Contraindicated if there is no sweat but only fever.
24. For Hand-Taiyin Summerheat-Warmth, presenting as in the previous article but with an absence of sweating, Xinjia Xiangru Yin (Newly Modified Euphrasia Decoction) should be used.
The syndrome refers to resembling Taiyang disease, surging right pulse, surprisingly small left pulse, red face, and thirst. However, the inability to sweat spontaneously indicates exterior excess, hence the use of Xiangru Yin to release Summerheat pathogens from the exterior. Analysis: Xiangru is Acrid-Warm and aromatic, capable of reaching the collaterals via the Lung meridian. Fresh Bidouhua (Flos Dolichotis Lablab) is used because flowers generally disperse; its aroma disperses while protecting Lung fluids. Using flower instead of bean avoids stagnation. Plants born in summer often resolve Summerheat, with Flos Dolichotis Lablab being the best. If flowers are unavailable, fresh skin of Dolichos labio beans may be used; if not, raw bean skin. Houpo (Magnoliae Officinalis Cortex) is Bitter-Warm and can drain food stagnation. Although it acts on the Middle Jiao, since the Lung governs skin and hair, using bark treats the exterior without invading the middle.黄连 (Coptidis Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) are purely interior herbs. In early Summerheat, they should be avoided to prevent drawing pathogens deeper. Instead, Lianqiao (Forsythiae Fructus) and Yinhua (Lonicerae Japonicae Flos) are substituted for their Acrid-Cool properties to reach the Lung exterior, acting purely outwardly without entering the middle.
Warm diseases most strictly forbid Acrid-Warm herbs, but Summerheat diseases do not, because Summerheat must combine with Dampness. Dampness is a Yin pathogen, which cannot be resolved without Warmth. Therefore, this formula uses Acrid-Warm Xiangru and Houpo, assisted by Acrid-Cool herbs. In the subsequent discussion on Damp-Warmth, Acrid-Warm is not forbidden, and Acrid-Hot is even used.
Xinjia Xiangru Yin Formula (Acrid-Warm combined with Acrid-Cool method):
Xiangru (Herba Elsholtziae, 2 qian), Yinhua (Lonicerae Japonicae Flos, 3 qian), Xian Biandouhua (Flos Dolichotis Lablab, 3 qian), Houpo (Magnoliae Officinalis Cortex, 2 qian), Lianqiao (Forsythiae Fructus, 2 qian).
Boil five cups of water until two cups remain. Take one cup first; stop if sweating occurs. If no sweat, take another cup. If no sweat after finishing, prepare another dose.
25. For Hand-Taiyin Summerheat-Warmth, after taking Xiangru Yin and obtaining slight sweating, do not take Xiangru Yin again to avoid severely injuring the exterior. Summerheat inevitably injures Qi, making the exterior particularly deficient. Even if residual symptoms exist, identify the affected meridian and treat accordingly.
Analysis: Taiyang disease requires sweating to resolve and favors diaphoresis. Wind-strike also requires sweating but forbids aggressive diaphoresis, preferring muscle-releasing methods. This distinguishes the treatments of Mahuang Tang and Guizhi Tang. Warm diseases also favor resolution through sweating but forbid aggressive diaphoresis, permitting only Acrid-Cool muscle-releasing methods; Acrid-Warm is prohibited. The subtlety lies in guiding pathogens out, harmonizing Ying, Wei, Qi, and Blood, leading to natural sweating without forcing it. However, Summerheat and Damp-Warmth are different. Summerheat requires sweating to resolve and can be treated with Xiangru to induce sweating. After sweating, if profuse sweating continues, return to the Baihu method. This differs from the unceasing leakage of sweat in Taiyang or Wind-strike, which requires Guizhi and Fuzi to protect Yang and secure the exterior. One must not repeatedly weaken the exterior, leading to collapse. The ancient use of Shengmai San in Summerheat chapters reveals this principle.
26. For Hand-Taiyin Summerheat-Warmth, whether already sweated or not, if sweating persists, accompanied by vexation, thirst, panting, and a surging-strong pulse, Baihu Tang (White Tiger Decoction) should be used. If the pulse is surging and Kou, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng Decoction) should be used. If the body feels heavy, it indicates Dampness; Baizhu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodes Macrocephala Decoction) should be used. If there is profuse sweating, a scattered-large pulse, and panting with gasping suggesting collapse, Shengmai San (Generate Pulse Powder) should be used.
The difference from the previous article is only the phrase "already sweated."
Baizhu Jia Cangzhu Tang Formula:
Add Cangzhu (Atractylodis Rhizoma, 3 qian) to Baihu Tang.
Profuse sweating with a scattered-large pulse indicates excessive emission of Yang Qi and internal deficiency unable to retain it. Shengmai San uses Sour-Sweet to generate Yin; preserving Yin retains Yang. Once Yang is retained, sweating stops naturally. Renshen (Ginseng Radix) is the sovereign herb to tonify Yuan Qi in the Lung.
Shengmai San Formula (Sour-Sweet to generate Yin method):
Renshen (Ginseng Radix, 3 qian), Maidong (Ophiopogonis Radix, peeled heart removed, 2 qian), Wuweizi (Schisandrae Fructus, 1 qian).
Boil three cups of water until eight-tenths of two cups remain. Divide into two doses. Decoct dregs again. If the pulse does not converge, prepare another dose. Stop when the pulse converges.
27. For Hand-Taiyin Summerheat-Warmth, after sweating, if Summerheat symptoms largely subside, but mild head distension, blurred vision, and unresolved residual pathogens remain, Qingluo Yin (Clear Collaterals Decoction) should be used. If pathogens fail to resolve and enter the Middle or Lower Jiao, treat according to Middle/Lower Jiao methods.
Since it is called "residual pathogen," heavy agents are obviously inappropriate. Only light aromatic herbs are needed to clear residual pathogens in the Lung collaterals. If the disease is deep and enters the Middle/Lower Jiao, shallow herbs cannot treat deep disease.
Qingluo Yin Formula (Acrid-Cool Aromatic method):
Xian He Ye Bian (Fresh Lotus Leaf Margin, 2 qian), Xian Yinhua (Fresh Lonicerae Japonicae Flos, 2 qian), Xigua Cuiyi (Watermelon Rind, 2 qian), Xian Biandouhua (Fresh Flos Dolichotis Lablab, 1 branch), Sigua Pi (Luffae Pericarpium, 2 qian), Xian Zhuye Xin (Fresh Bamboo Leaf Heart, 2 qian).
Boil two cups of water until one cup remains. Take twice daily. Applicable to all mild cases of Summerheat injuring Lung Qi level.
28. For Hand-Taiyin Summerheat-Warmth, if there is only cough without phlegm, and the cough sounds clear and high-pitched, add Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), Tian Xingren (Prunus Armeniacae Semen Dulce), Maidong (Ophiopogonis Radix), and Zhimu (Anemarrhenae Rhizoma) to Qingluo Yin (Clear Collaterals Decoction).
Cough without phlegm indicates no expectoration. Clear, high-pitched cough indicates bright Metal sound; chronic cough leads to hoarseness. This leans toward Fire without Dampness. Use Qingluo Yin to clear formless Heat in Lung collaterals. Add Gancao and Jiegeng to lift and open; Tian Xingren benefits the Lung without injuring Qi; Maidong and Zhimu preserve Lung Yin and control Fire.
Qingluo Yin Plus Gancao, Jiegeng, Tian Xingren, Maidong, Zhimu Formula:
Add Gancao (1 qian), Jiegeng (2 qian), Tian Xingren (2 qian), Maidong (3 qian), Zhimu (3 qian) to Qingluo Yin.
29. For Liang Taiyin (Both Hand and Foot Taiyin) Summerheat-Warmth, if there is cough and phlegm production, heavy cough sound, abundant phlegm, little thirst, or thirst with little desire to drink, Xiao Banxia Jia Fuling Tang (Minor Pinellia Decoction plus Poria Decoction) plus Houpo (Magnoliae Officinalis Cortex) and Xingren (Prunus Armeniacae Semen) should be used.
Cough with phlegm production and abundant saliva, with heavy cough sound (earth tone), indicates concurrent Foot-Taiyin Spleen Dampness. Little thirst or desire to drink indicates water retention inside. This is Summerheat-Warmth combined with Fluid retention. Thus, Xiao Banxia Jia Fuling Tang is used to eliminate fluid and harmonize the middle. Houpo and Xingren are added to benefit the Lung and drain Dampness, preemptively blocking the path to panting and fullness. Use Ganlan Shui (Agitated Water) for its moving, non-retaining nature.
This article should belong to Damp-Warmth but is placed here to contrast with the previous article for mutual verification.
Xiao Banxia Jia Fuling Tang Plus Houpo and Xingren Formula (Acrid-Warm Bland method):
Banxia (Pinelliae Rhizoma, 8 qian), Fuling Kuai (Poria, 6 qian), Houpo (Magnoliae Officinalis Cortex, 3 qian), Shengjiang (Zingiberis Rhizoma Recens, 5 qian), Xingren (Prunus Armeniacae Semen, 3 qian).
Boil eight cups of Agitated Water until three cups remain. Take warm, three times daily.
30. If the pulse is deficient, sleep is restless at night, there is vexation and thirst, red tongue, occasional delirious speech, eyes often stay open or prefer closing, Summerheat has entered the Hand-Jueyin Pericardium. For Hand-Jueyin Summerheat-Warmth, Qingying Tang (Clear Nutrient Decoction) should be used. If the tongue coating is white and slippery, do not give it.
Restless sleep indicates deficient Shen-Mind and Yang unable to enter Yin. Vexation, thirst, and red tongue indicate excessive Heart function and deficient Heart substance. Occasional delirium indicates impending confusion of Shen-Mind. Eyes staying open: Eyes are the portal of Fire; Fire nature is urgent, seeking to open to vent Fire, and Yang fails to descend to interact with Yin. Preferring closed eyes: Yin is damaged by hyperactive Yang; damaged Yin dislikes sunlight. Thus, Qingying Tang is used urgently to clear Heat in the Palace of the Heart and protect the emptiness in the Li (Fire) center. If the tongue coating is white and slippery, both Heat and Dampness are heavy. Heavy Dampness forbids moistening herbs; seek treatment in Damp-Warmth protocols. Hence, Qingying Tang is contraindicated.
Qingying Tang Formula (Salty-Cold Bitter-Sweet method):
Xijiao (Rhino Ceratios Cornu - substitute with Niujia or other alternatives in modern practice, 3 qian), Shengdi (Rehmanniae Radix, 5 qian), Yuanshen (Scrophulariae Radix, 3 qian), Zhuye Xin (Bamboo Leaf Heart, 1 qian), Maidong (Ophiopogonis Radix, 3 qian), Danshen (Salviae Miltiorrhizae Radix, 2 qian), Huanglian (Coptidis Rhizoma, 1.5 qian), Yinhua (Lonicerae Japonicae Flos, 3 qian), Lianqiao (Forsythiae Fructus, use with heart, 2 qian).
Boil eight cups of water until three cups remain. Take three times daily.
31. For Hand-Jueyin Summerheat-Warmth, if there is fever without aversion to cold, unclear spirit, and frequent delirious speech, Angong Niuhuang Wan (Angong Niuhuang Pill) should be used; Zaixue Dan (Purple Snow Elixir) is also applicable.
Fever without aversion to cold indicates no longer Hand-Taiyin syndrome. Impending coma and frequent delirium differ from occasional delirium in the previous article. To prevent internal closure, aromatic orifice-opening and bitter-cold heat-clearing are urgent.
Angong Niuhuang Wan, Zaixue Dan (Formulas and meanings see previous sections).
32. Summerheat-Warmth with alternating chills and fever, white tongue coating, no thirst, and hemoptysis is named Shu Zhai (Summerheat Consumption), which is difficult to treat. Qingluo Yin (Clear Collaterals Decoction) plus Xingren (Prunus Armeniacae Semen), Yiren (Coicis Semen), and Huashi (Talcum) should be used.
Chills and fever indicate Heat injuring the exterior. White tongue coating without thirst indicates Dampness injuring the interior. Both are in the Qi level, yet hemoptysis indicates simultaneous injury to Exterior/Interior and Qi/Blood. Is this not a severe case of Shu Zhai? Pure clearing hinders deficiency; pure tonification hinders pathogens. Thus, Qingluo Yin clears Heat in blood collaterals without harming the surface. Xingren benefits Qi, as Qi is the commander of Blood. Yiren and Huashi drain internal Dampness, hoping that as pathogens retreat and Qi calms, bleeding stops.
Qingluo Yin Plus Xingren, Yiren, Huashi Formula:
Add Xingren (2 qian), Huashi powder (3 qian), Yiren (3 qian) to Qingluo Yin. Administration as before.
33. Pediatric Summerheat-Warmth, with fever and sudden spasms and convulsions, is named Shu Xian (Summerheat Epilepsy). Qingying Tang (Clear Nutrient Decoction) should be used; a small amount of Zaixue Dan (Purple Snow Elixir) may also be given.
Children's Yin is more deficient than adults', especially in summer. Upon contracting Summerheat-Warmth, progression from Wei to Ying levels occurs quickly due to thin organs and collaterals. Blood collaterals pressured by Fire pathogenic factors generate internal wind when Fire reaches its extreme (commonly known as Acute Convulsion). Indiscriminate use of dispersing or digesting agents leads to rapid death. Only Qingying Tang should be used to clear Heat in the Ying level and preserve fluids. When fluids are sufficient and Yang is harmonized, natural sweating leads to resolution. Diaphoresis is absolutely contraindicated. A small amount of Zaixue Dan clears Heat in the Pericardium and opens internal orifices.
34. Adult Summerheat Epilepsy follows the same method. If Heat initially enters Ying, stirring internal Liver Wind with twitching of hands and feet, add Gouteng (Uncariae Ramulus cum Uncis), Danpi (Moutan Cortex), and Lingyangjiao (Saigae Tataricae Cornu) to Qingying Tang.
Qingying Tang, Zaixue Dan (Methods see previous sections).