内经曰夏至日后病热为暑暑当与汗皆出勿止 因于暑汗烦则喘渴静则多言体若燔炭汗出
而散 脉虚身热得之伤暑
难经曰伤暑得之为正邪火自病也当恶臭其病身热而烦心痛其脉浮大而散
伤寒论曰太阳中热者 是也其人汗出恶寒身热而渴也太阳中 者身热疼重而脉微弱此亦
夏月
伤冷水水行皮中所致也 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
谨按许学士云伤暑其脉弦细芤迟何也内经曰寒伤形热伤气盖伤气而不伤形则气消而脉虚
弱所谓弦细芤迟皆虚脉也仲景以弦为阴而朱肱亦曰中暑脉细弱则皆虚脉也可知矣
洁古曰静而得之为中暑动而得之为中热中暑者阴证中热者阳证
东垣曰暑热之时无病之人或避暑热纳凉于深堂大厦得之者名曰中暑其病必头痛恶寒身形
拘急
肢节疼痛而烦心肌肤火热无汗为房室之阴寒所遏使周身阳气不得伸越多以大顺散热药主之是
也若行人或农夫于日中劳役得之者名曰中热其病必苦头痛发躁热恶热扪之肌肤大热必大渴引
饮汗大泄无气以动乃为天热外伤肺气苍术白虎汤凉剂主之
按此论中暑即仲景所谓 是也此只作暑热分之可见有阴阳二证受病不同然夏月受病有阴
寒所
遏使周身阳气不得伸越以大顺散主之者为中暑盖当暑月名之犹冬月发热为伤寒也但中热治例
虽云用苍术白虎汤而又处清暑益气之法况大顺散一方是仲景太阳例药然东垣施用谅不如此
必
有若盖气汤证例发挥HT HT 者惜乎无传故使后人不能无疑也详后所论矧中暑证亦有于劳役动而
得之中热证亦有于避暑静而得之大抵因人元气虚实不同故所受亦异为治岂得而无变法哉
《内经》说：夏至日后发生的发热病证称为暑病，暑邪应当随汗液排出，不可强行止汗。感受暑邪后出汗，若出现烦躁则气喘，口渴；若不烦躁则多言。身体像燃烧的炭火一样热，待汗出后热势自散。脉象虚而身体发热，这是因伤暑所致。
《难经》说：伤暑是由于正邪（六淫之邪）侵袭，火气自行发病，患者应当厌恶臭味。其病症为身体发热、心烦、心痛，脉象浮大而散。
《伤寒论》说：太阳经的中热病，就是所说的“中喝”（中暑）。其人表现为汗出、恶寒、身体发热且口渴。太阳经的“中暍”（阴暑），表现为身体发热、疼痛沉重，脉象微弱，这也是夏季受冷水刺激，水湿行于皮肤中所致。太阳经的另一种“中暍”，表现为发热、恶寒、身体沉重且疼痛，脉象弦细、芤或迟。小便结束后感觉寒冷战栗、毫毛竖起，手足逆冷，稍微活动身体即发热，张口呼吸，前板齿干燥。如果误用发汗法，则恶寒加重；如果误用温针法，则发热加剧；如果误用多次泻下法，则淋证加重。
谨按：许叔微学士说：伤暑的脉象为何是弦细、芤、迟呢？《内经》说：“寒邪伤形，热邪伤气。”既然只伤气而不伤形，那么气就会消损而导致脉虚弱。所谓弦细、芤、迟，都是虚脉的表现。张仲景认为弦脉属阴，朱肱也说中暑脉象细弱，这些都是虚脉，可以由此推知。
洁古（张元素）说：安静状态下得病的是中暑，运动状态下得病的是中热。中暑属于阴证，中热属于阳证。
东垣（李杲）说：在暑热之时，原本没有疾病的人，因为避暑热而在深堂大厦内纳凉而得病的，名叫中暑。其病症必定头痛、恶寒、身体拘急不舒、肢节疼痛、心烦，肌肤火热但无汗。这是因为被房室内的阴寒之气所遏制，导致周身阳气不能伸展发散，治疗多用大顺散热药为主，这是正确的。如果是行人或农夫在烈日下劳役而得病的，名叫中热。其病症必定痛苦地头痛、烦躁发热、厌恶炎热，触摸肌肤非常烫手，必定极度口渴引饮，大汗淋漓，气短无力。这是由于天热外伤肺气所致，治疗以苍术白虎汤等凉剂为主。
按语：此论述中的“中暑”，即张仲景所说的“中暍”（阴暑）。这里仅从暑热的角度区分，可见有阴阳两种证型，受病原因不同。然而夏季患病，若有阴寒遏制使周身阳气不得伸展发散，以大顺散主治的，称为中暑，这就像冬季发热称为伤寒一样。但是，中热的治法虽然说是用苍术白虎汤，却又制定了清暑益气的治法。况且大顺散一方本是张仲景太阳病的方药，但李东垣施用此方，想必不仅仅是这样，一定有关于“若盖气汤”等证例的发挥，可惜这些内容没有流传下来，致使后人不能不产生疑问。详见后文论述。况且中暑证也有因劳役运动而得的，中热证也有因避暑安静而得的。大体上是因为人的元气虚实不同，所以所受病邪也不同，治疗方法怎能没有变化之法呢？
The *Neijing* (Inner Canon) states: Febrile diseases occurring after the Summer Solstice are termed *Shu* (Summerheat). Summerheat pathogens should be expelled through sweating; do not forcibly stop perspiration. Upon contracting Summerheat and sweating, if restlessness occurs, there is panting and thirst; if calm, there is excessive talking. The body feels as hot as a burning charcoal, and the heat dissipates once sweat is released. A deficient pulse with febrile sensation indicates injury by Summerheat (*Shangshu*).
The *Nanjing* (Classic of Difficult Issues) states: Injury by Summerheat results from direct pathogenic invasion, where Fire acts as the disease itself. Patients may exhibit an aversion to foul odors. Symptoms include febrile sensation, restlessness, heart pain, and a floating, large, and scattered pulse.
The *Shanghan Lun* (Treatise on Cold Damage) states: *Taiyang Zhongre* (Summerheat in the Taiyang channel), also referred to as *Zhonghe*, manifests with sweating, aversion to cold, febrile sensation, and thirst. *Taiyang Zhongye* (Yin-summerheat/Cold-summerheat in the Taiyang channel) presents with febrile sensation, painful heaviness, and a weak pulse; this is caused by exposure to cold water in summer, leading to water-dampness residing in the skin. Another presentation of *Taiyang Zhongye* includes fever, aversion to cold, bodily heaviness, and pain, with a wiry-thin, knotted-empty, or slow pulse. After urination, one feels chilly with shivering and piloerection; the hands and feet are cold. Slight exertion causes immediate heat; the mouth opens, and the anterior teeth appear dry. If diaphoresis (sweating-inducing treatment) is applied, aversion to cold worsens; if warm needle therapy is used, fever intensifies; if purgation is repeatedly applied, strangury (dysuria) worsens.
Commentary: Xu Xueshi (Xu Shuni) asks: Why is the pulse in injury by Summerheat wiry-thin, knotted-empty, or slow? The *Neijing* states: "Cold damages the form; Heat damages the Qi." Since only Qi is damaged and not the form, Qi becomes depleted, resulting in a weak pulse. Therefore, wiry-thin, knotted-empty, and slow pulses are all deficient pulses. Zhang Zhongjing considers the wiry pulse as Yin, and Zhu Gong also states that the pulse in Summerheat is fine and weak; thus, these are all deficient pulses, which can be deduced.
Jiegou (Zhang Yuansu) states: Contracting illness while at rest is termed *Zhongshu* (Summerstroke/Yin-summerheat); contracting illness during activity is termed *Zhonger* (Heatstroke/Yang-summerheat). *Zhongshu* is a Yin syndrome; *Zhonger* is a Yang syndrome.
Dongyuan (Li Dongyuan) states: During the season of Summerheat, healthy individuals who seek coolness in deep halls and large buildings to avoid the heat contract what is named *Zhongshu*. Their symptoms necessarily include headache, aversion to cold, stiff and rigid body, joint pain, and restlessness. The skin and muscles feel hot, but there is no sweat. This is because the yin-cold of the rooms suppresses the body's Yang Qi, preventing it from extending and dispersing. Treatment primarily uses *Dashun San* (Great Harmony Powder) to disperse heat, which is correct. However, for porters or farmers who labor under the sun and contract the disease, it is named *Zhonger*. Their symptoms necessarily include severe headache, irritability, heat sensation, aversion to heat, scorching-hot skin upon touch, extreme thirst with desire to drink, profuse sweating, and lethargy due to lack of Qi. This is caused by heavenly heat externally injuring Lung Qi. Treatment uses cooling agents such as *Cangzhu Baihu Tang* (Atractylodes White Tiger Decoction).
Annotation: The *Zhongshu* discussed here corresponds to Zhang Zhongjing’s *Zhongye* (Yin-summerheat). Here, the distinction is made solely based on Summerheat, revealing two syndromes of Yin and Yang with different etiologies. However, in summer illnesses, those suppressed by yin-cold preventing the extension of whole-body Yang Qi, treated with *Dashun San*, are called *Zhongshu*, analogous to how febrile diseases in winter are called *Shanghan* (Cold Damage). Yet, although the treatment for *Zhonger* mentions using *Cangzhu Baihu Tang*, methods for clearing Summerheat and benefiting Qi are also prescribed. Furthermore, *Dashun San* is originally a formula from Zhang Zhongjing’s Taiyang chapter. Li Dongyuan’s application of this formula likely involved more than just this; there must have been elaborations on cases similar to *Ruogaiqi Tang*, but unfortunately, these were not transmitted, causing doubt among later generations. See further discussions below. Moreover, *Zhongshu* can also result from labor and activity, while *Zhonger* can result from seeking coolness and rest. Generally, because individuals’ Yuan Qi (Original Qi) varies in deficiency or excess, the contracted pathology differs accordingly. How can the treatment methods remain without variation?