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It is commonly said that heatstroke (Zhongshu) gives rise to myriad diseases; is this not a gross exaggeration? When pathogenic heat enters the human body, it lurks between the Sanjiao (Triple Burner) and the intestines and stomach. It may remain undetected for decades or months, manifesting as vomiting, epigastric fullness, diarrhea, dysentery, extreme thirst, malaria-like paroxysms, abdominal pain, hematochezia, and various other heat syndromes. If the disease originates from heatstroke, and the root cause remains uneliminated, even if hundreds of medicines are tried, their efficacy will be difficult to achieve. The Pericardium (Xinbao) corresponds to the stomach opening. If Stomach Qi is slightly deficient, or if one exposes oneself to heat while hungry, pathogenic heat enters through the mouth and nose, condenses in the teeth and cheeks, and reaches the Pericardium swiftly, like an echo responding to sound. Upon exposure to heat, one should rinse the mouth immediately without swallowing. If one feels pathogenic heat blocking the throat, it is imperative to induce vomiting to expel the toxin.

The pulse in heat injury is weak; the face appears grimy and dull; there is spontaneous sweating, body heat with coldness in the back, mental restlessness and extreme thirst, fatigue and shortness of breath, piloerection with aversion to cold, headache, cholera-like symptoms, or cold extremities, yet the body lacks pain. The Classics state: "Heat causes the pores to open, thus resulting in a chill." Failure to recognize this precisely and mistakenly treating heat injury as cold damage (Shanghan) causes significant harm. Why is the pulse weak in heatstroke? Heat consumes Qi; when Qi is consumed, Blood scatters, so how can the pulse not be weak? If all six pulse positions are deep and hidden, with spontaneous cold sweat, suffocation, coma, and unconsciousness, this indicates a severe exacerbation of the heatstroke syndrome.

The general principle of treatment values dispelling heat, but places even greater emphasis on harmonizing the Middle Jiao (Zhonghe). When both approaches are applied concurrently, complicated syndromes will subside without resistance. Methods such as diaphoresis (sweating), purgation, or using excessively cold medications are cautioned against by ancient masters. Nevertheless, in summer, Yin latent within the interior combined with Qi deficiency and a weak pulse in heatstroke patients, especially if they drink excessive water or consume cold medicines without restraint, can injure the Middle Jiao. This leads to vomiting, anorexia, spontaneous diarrhea without thirst, indicating exterior heat and interior cold. In such cases, the theory of heatstroke with latent heat applies, and Lizhong Tang (Regulate the Middle Decoction) is indispensable. Furthermore, excessive intake of cold medicines may cause Cold in the Stomach with retained fluids, leading to tidal fever with vomiting, or slight body heat with mild irritability. This represents Yang floating externally without returning inward, requiring Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction).

One must remain vigilant: heatstroke patients present with a weak pulse, sallow complexion, cold sweat, piloerection, and slightly cold hands and feet. If one fails to clearly distinguish the underlying heat syndrome and erroneously administers harsh, warm-tonifying agents, it is akin to carrying firewood to save a burning house. The result will be jaundice or maculopapular eruptions; in severe cases, blood stasis may accumulate, leading to confusion and death. Alas, how terrifying this is!