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Shangshu (Summerheat Injury) presents with no significant high fever, profuse sweating, mental fatigue, lethargy, and anorexia. The tongue coating is yellow, and urination is reddish. This indicates that summer-dampness has injured the Yang Qi. Qingxu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) is appropriate to boost Qi and promote diuresis to resolve dampness.

The preceding clause discusses deficiency complicated by summerheat, characterized by fever and profuse sweating; thus, among methods of regulating ascending and descending, dispersing, and tonifying, a slight addition of bitter-cold herbs is used to clear internal heat. This clause discusses summer-dampness injuring Yang Qi, characterized by absence of fever but profuse sweating; therefore, cooling agents are not added to avoid further damaging Middle Jiao Yang Qi.

When Shangshu persists for many days without resolution, presenting with coolness in the morning and fever in the evening, yellow tongue coating with a red tip, thirst, profuse sweating, and occasional nocturnal delirium or coma, this indicates that heat has injured the Yin aspect, and pathogenic factors are lingering in the Ying (Nutritive) level. Yu Nu Jian (Jade Woman Decoction) added with Renshen (Ginseng Radix et Rhizoma), Xuanshen (Scrophulariae Radix), Gupi (Cortex Dictamni), Chaihu (Bupleuri Radix), Heye (Nelumbinis Folium), Qinghao (Artemisiae Annuae Herba), and Xian Changpu (Acori Tatarinowii Rhizoma Fresh) is appropriate to nourish Yin and clear the Ying level.

Unresolved summerheat leading to coolness in the morning and fever in the evening is termed Chaore (Tidal Fever). Although the presentation resembles malaria, there is no chills stage. It is named so because it occurs like the tide without missing its schedule. In severe cases, the tongue tip is red, and nocturnal delirium or coma occurs due to heat injuring Yin fluids and pathogens lingering in the Ying level. Afternoon is when Wei (Defensive) Qi enters the Yin; Yin pathogens dominate, and latent residual heat moves opportunistically. Therefore, Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma) from Yu Nu Jian are used to clear the Qi level; Shengdi (Rehmanniae Radix) and Xuanshen (Scrophulariae Radix) nourish the Blood level; and Qinghao (Artemisiae Annuae Herba), Heye (Nelumbinis Folium), and Chaihu (Bupleuri Radix) are used to vent interior pathogens.

Zhongshu (Heatstroke) presents with head distension, aversion to cold with body fever, chest and abdominal fullness and oppression, desire to vomit but inability to do so, desire to defecate but inability to do so, and unbearable restlessness. This indicates summer-turbidity obstructing the Stomach. A pinch of Yanpan (Sal) mixed with Tongbian (Uterine Urine) should be taken, followed by finger-induced emesis to unblock the Upper Jiao.

Whenever summerheat turbidity invades, it first enters the Stomach. Stomach Qi is obstructed, disrupting ascending and descending functions, leading to inability to vomit or defecate, resulting in restlessness. This is a Bi Syndrome (Closed Syndrome) which cannot be resolved without emesis. Therefore, a pinch of Yan (Sal) heated red-hot on a spatula is mixed with a cup of Tongbian (Uterine Urine) and taken, followed by finger-induced emesis, as emesis contains the intent of dispersion. Moreover, both Yan (Sal) and Tongbian (Uterine Urine) have salty-cold and descending properties. By inducing emesis immediately after swallowing, pathogens are dispersed from above. After symptoms subside slightly, Zhichi Tang (Gardeniae and Fermented Soybean Decoction) added with Xingren (Pruni Semen), Houpo (Magnoliae Officinalis Cortex), and Bidou (Dolichoris Semen) is used to harmonize. If vomiting and diarrhea persist indefinitely, Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) is used immediately to dispel turbidity and transform pathogens.