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Treats dysfunction of Qi ascending and descending, cholera with muscle spasms (Huo Luan Zhuan Jin), vomiting and diarrhea, and alternating chills and fever.
Sha Ren (Amomum Fruit), Ban Xia (Pinellia Rhizome), Xing Ren (Apricot Seed), Ren Shen (Ginseng Root), Zhi Gan Cao (Honey-fried Licorice Root), Chi Fu Ling (Red Poria), Huo Xiang Ye (Patchouli Leaf), Chao Bai Bian Dou (Fried White Hyacinth Bean with Ginger Juice), Mu Gua (Chaenomeles Fruit), Xiang Ru (Mosla Herb), Zhi Nong Po (Processed Magnolia Bark). Decoct with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube) and take orally.

Treats latent heat in children, vomiting with irritability and thirst, heat in the five centers (palms, soles, and chest), and scanty dark urine.
Xiang Ru (Mosla Herb, 3 qian), Dan Zhu Ye (Lophatherum Leaf), Ren Shen (Ginseng Root), Ban Xia Qu (Pinellia Fermented Dough), Tan Xiang (Sandalwood Wood, each 2 qian), Gan Cao (Licorice Root, 1 qian), Fu Ling (Poria, 3 qian), Geng Mi (Rice Grain, 5 qian). Decoct together with Sheng Jiang (Fresh Ginger) and Da Zao (Jujube), cool to room temperature, and take after meals.

(Also known as Yi Yuan San or Tian Shui San)
Treats injury by summerheat. One formula adds Chen Sha (Cinnabar) to be named Chen Sha Yi Yuan San; another adds Qing Dai (Indigo Naturalis) to be named Qing Dai Yi Yuan San.
Hua Shi (Talcum Powder, 6 liang, finely ground and processed by water flotation), Gan Cao (Licorice Root, 1 liang, sun-dried). Grind into powder, take with fresh well-water or cold Deng Xin Cao Tang (Juncus Decoction).

Treats heatstroke (Zhong Shu). Crush watermelon juice, filter out the dregs, and administer orally to restore consciousness immediately.

Treats thirst caused by latent summerheat in children.
Zhu Ling (Polyporus), Bai Zhu (Atractylodes Macrocephala Rhizome), Chi Fu Ling (Red Poria, each 5 qian), Ze Xie (Alisma Rhizome, 7.5 qian). Grind into powder, mix with decoction of Che Qian Zi (Plantago Seed) and Deng Xin Cao (Juncus Stamen) and take orally. If vomiting persists, add Sheng Jiang Zhi Ran Zhi (Fresh Ginger Juice).

Summerheat is a Yang pathogen. The Heart belongs to Li Fire, so summerheat enters the Heart first, following the principle of similarity. In the sixth lunar month, summerheat qi emanates entirely from the ground, representing floating qi. The *Classic* states: "Summer qi resides in the meridians, Changxia (late summer) qi resides in the muscles." When the exterior is excess, the interior must be deficient; when Qi is hot, it dissipates. Thus, the *Classic* says: "Pulse is empty, body is hot, acquired from injury by summerheat." However, when intense heat attacks the person, there are degrees of "covering" (Mao), "injuring" (Shang), and "smiting" (Zhong), distinguishing severity and deficiency/excess. If there is abdominal pain and watery diarrhea, the Stomach and Large Intestine are affected; if there is nausea, phlegm-fluid retention exists at the stomach opening. This is called "Mao Shu" (Covered Summerheat), treatable primarily with Huang Lian Xiang Ru Yin (Coptis and Mosla Decoction), modified according to symptoms. Huang Lian clears summerheat-heat, Xiang Ru resolves accumulated fluid. If there is body heat, headache, restlessness, or sensation like needle pricks, the heat has injured the flesh layer, termed "Shang Shu" (Injured Summerheat); treat with Bai Hu Tang (White Tiger Decoction) plus Chai Hu (Bupleurum Root). Add Ren Shen (Ginseng Root) for Qi deficiency. If there is cough, alternating chills and fever, night sweats, and rapid pulse, the heat is in the Lung Meridian, termed "Zhong Shu" (Smiting Summerheat). This is excessive fire overcoming Metal; urgent treatment is curative, delay is fatal. Use Tian Shui San (Sky Water Powder) to clear summerheat and moisten the Lung, or modify Sheng Mai Yin (Generate the Pulse Drink). Dong Yuan discussed summerheat syndromes as similar to winter Cold Damage, with varied transformations. There, Cold damages the form; here, Summerheat damages Qi. If Yuan Qi is severely deficient, death may occur instantly, similar to Yin Toxin in Cold Damage.

Pulse is full and body is hot: termed "Zhong Re" (Middle Heat), an Excess syndrome. Symptoms include severe headache, high fever, and extreme thirst with desire to drink. Use cooling agents. Pulse is empty and body is hot: termed "Zhong Shu" (Smiting Summerheat), a Deficiency syndrome. Symptoms include headache, aversion to cold, stiff posture, and dull complexion. Use warming dispersants. In cases of extreme Yin-Cold, the method should prioritize tonifying Yang Qi. Ancients used large doses of Sheng Jiang (Fresh Ginger) and Fu Zi (Prepared Aconite Root); this follows the *Nei Jing* principle of "abandoning the season to follow the syndrome." Regarding Xiang Ru Yin, it is a formula that disperses Yang Qi and guides True Yin. Shizhen said: "Xiang Ru is the exterior-releasing herb for summer, just as Ma Huang (Ephedra) is for winter." Using it for those with Qi deficiency or post-coital depletion causes great harm.

During Changxia (late summer), heat steams and Damp Earth governs, so summerheat always combines with dampness. For children with constipation, irritability, thirst, vomiting, or diarrhea, it is because excessive dampness prevents Qi transformation. Therefore, treatment should support the Spleen and harmonize the Stomach to aid transformation, causing dampness to disperse naturally.

"Shu Feng" (Summerwind) refers to sudden collapse and loss of consciousness in summer. It can be due to Fire or Phlegm. Fire refers to Ministerial Fire and Sovereign Fire; Summerheat refers to Heavenly Fire and Earthly Fire. Internal and external fires combine to scorch, causing sudden collapse. Phlegm is body fluids agitated by summerheat qi, obstructing the heart's orifices, leading to immobility and sudden collapse. For robust patients, both conditions can be treated with emesis. The *Classic* says: "For stagnated fire, vent it." Emesis is a form of venting. After waking, use clearing agents. Do not drink cold water or lie on damp ground, as this blocks the flow of Qi in the Triple Burner, causing significant harm.

"Zhu Xia" (Staying in Summer) belongs to Yin syndromes with insufficient Yuan Qi. Symptoms in early summer/late spring include headache, weak legs, poor appetite, and low-grade fever. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), remove Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root), add Chao Bai Shao (Fried White Peony Root) and Chao Huang Bo (Fried Phellodendron Bark).

When heaven reaches summer, the Way moves south, belonging to Fire and heat, corresponding to the Heart in humans. Cold damages form; heat damages Qi. Humans and heaven-earth function like a bellows. In summer, heavenly Yang Qi floats on the surface; human Yang Qi floats on the skin/muscle layers. Affected by intense summerheat, pores open, Qi and fluids escape as sweat externally, leaving both interior and exterior Qi deficient. Those who do not preserve health suffer external summerheat and internal damage from raw/cold foods, hindering transformation. Thus, food and water stagnate into Damp-Heat, causing vomiting and diarrhea, or both simultaneously ("Huo Zhuo Luan"). If not immediate, Damp-Heat stagnates internally, later becoming Malaria or Dysentery. People speak of "latent Yin inside"; "Yin" implies deficiency. Interpreting it as literal cold is a grave error.

Summerheat is Yang, thus steaming heat; it combines with Damp, thus spontaneous sweating; affecting the Heart causes irritability, affecting the pulse causes thirst, affecting the Spleen causes vomiting/diarrhea, rising to the head causes heaviness and pain. Summerheat damages Qi, causing fatigue. Fever after Summer Solstice is Summerheat, governed by Ministerial Fire. Entering via mouth/teeth, it injures the Pericardium Meridian, as Summerheat favors injuring the Heart. Pulses may be empty, floating-large-scattered, wiry-thin-hollow-slow. Heat damages Qi, depleting Qi and weakening the pulse. Treatment generally prioritizes clearing the Heart, promoting urination, and tonifying True Qi. For heat/thirst, nourish Water. Thirst indicates internal attack by Yang Qi, heat stored in Kidney, causing bone weakness. Ultimately, excessive Fire damages Metal, Water declines, Kidney and Bladder exhaust. Urgently rescue by nourishing Lung Qi to supplement the upper source of Water. Hence, Sheng Mai San (Generate the Pulse Powder) supports Yuan Qi and preserves Lung to generate fluids.

One type: Pedestrians or farmers working under the sun acquire "Zhong Yue" (Heatstroke), obtained through movement, a Yang syndrome. Symptoms: severe headache, dry heat, aversion to heat, burning skin, profuse sweating, lethargy, extreme thirst. Caused by heavenly heat damaging Yuan Qi externally. Clear summerheat and tonify Qi using Xiang Ru (Mosla), Huang Lian (Coptis), Bian Dou (Hyacinth Bean), Ren Shen (Ginseng), Huang Qi (Astragalus), Wu Wei Zi (Schisandra), Zhi Mu (Anemarrhena), Shi Gao (Gypsum). If vomiting/diarrhea with deep/faint pulse, avoid cooling drugs.

Another type: Healthy people seeking coolness in deep halls, pavilions, using fans/wind machines acquire illness through stillness, a Yin syndrome. Symptoms: headache, aversion to cold, stiff body, joint pain, irritability, hot skin without sweat. Blocked by Yin-Cold, preventing Yang Qi extension. Use acrid-warm agents to release exterior and cold, raise Yang Qi, scatter water and harmonize Spleen. Use Hou Po (Magnolia Bark), Zi Su (Perilla Leaf), Ge Gen (Kudzu Root), Huo Xiang (Patchouli), Qiang Huo (Notopterygium Rhizome), Cang Zhu (Atractylodes Rhizome). Named "Zhong Shu," but essentially Cold Damage. If external cold and internal cold-cold injury, add Gan Jiang (Dried Ginger), Suo Sha (Amomum), Shen Qu (Medicated Leaven). This treats illness caused by summerheat, not summerheat itself.

One type: Injury by summerheat combined with raw/cold injury during times of external Yang/internal Yin. Prioritize treating the interior: warm middle, digest food; then treat exterior: clear summerheat, tonify Qi, focusing on Spleen. Combine previous Yin/Yang approaches. Summer Yang floats outside, Yin hides inside. Diet/labor damage middle Qi; extreme heat/labor damages exterior Yang. Regulate and tonify Yuan Qi, assist with summerheat resolution. For Yin-Cold syndromes, use Da Shun San (Great Smooth Powder) with Gui (Cinnamon) and Fu Zi (Aconite), large acrid-hot drugs. This is the *Nei Jing* method of abandoning season for syndrome. Death from summerheat with cyanotic nails results from failing to investigate cause, failing to warm interior, and indiscriminately using Xiang Ru Yin. Xiang Ru Yin disperses Yang and drains True Yin; use only if indicated. Preventive use invites summerheat. Especially dangerous for those with inherent Qi deficiency or sexual exhaustion. For prevention, Sheng Mai San is best for summer.

Wind, Cold, Damp are Earth Qi, turbid pathogens, affecting Foot meridians. Summerheat is Heaven Qi, clear pathogen, Fire element, mostly affecting Hand-Shaoyin Heart Meridian. Symptoms resemble Cold Damage, but initial Cold Damage lacks irritability/thirst, while Summerheat has immediate thirst. Cold Damage pulse is floating-full; Summerheat pulse is empty-weak. Different.

Summerheat is one of Six Qi, Heavenly Fire. Only Cold Water can counteract it, unlike furnace fire or Dragon Thunder fire. Summerheat injures Heart (South Fire), following similarity. Small Intestine is Heart's paired organ; draining Heart summerheat toxin via Small Intestine makes Qing Hao (Artemisia Annua) and Xiang Ru (Mosla) key herbs. Summerheat diseases should not induce sweating, as heat damages Qi, sweat is Heart fluid, excessive sweating loses Yang.

Some, after summerheat injury, drink excessive cold water or receive too many cold medicines, causing persistent vomiting/diarrhea, external heat/internal cold, irritability, thirst, desire to undress, resembling Cold Damage. This is Yin excess repelling Yang. Use warm Xiang Ru Yin with Fu Zi (Aconite), or Wu Ling San (Five-Ingredient Powder with Poria), adding Rou Gui (Cinnamon Bark) is excellent. Take cold. During Dog Days, Cold Damage fever and Summerheat fever look similar but treatments differ vastly. Misidentification causes disaster. *Classic*: "Full pulse, cold body = Cold Damage; Empty pulse, hot body = Summerheat." Cold damages form, not Qi, hence full pulse. Heat damages Qi, not form, hence empty pulse. Heart governs pulse; Lung directs all pulses. Lung prosperity strengthens four organs; Lung deficiency leads to pulse absence and shortness of breath. Cold Damage fever: Cold damages Wei, pathogen in exterior, no sweat, Excess, treat exterior. Summerheat fever: Heat damages Ying, Yuan Qi damaged, profuse sweat, Deficiency, treat interior. Summerheat easily damages Yuan Qi. With internal Yang deficiency and hidden Yin, sages legislate prioritizing Heavenly True Qi.

Some, after covering summerheat, vomit excessively, Stomach becomes deficient, rejecting all medicine/food, critical condition. Urgently use Ren Shen (Ginseng, 1 qian), Huang Lian (Coptis, 0.5 qian), stir-fried with ginger juice until charred, Nuomi (Glutinous Rice, a pinch). Decoct in small cup of water, cool, slowly moisten mouth with tea spoon, repeat until several spoons tolerated without vomiting, finish cup, then administer other medicines/food. If pulse is deep/slow/fine/thin, limbs cold, use warming tonification. Use hot medicine taken cold method; Huang Lian is contraindicated.

Fourth month Si, Fifth month Wu, Fire too strong damages Metal. Sixth month Wei Earth, too strong damages Water. In summer, nourish Metal and Water organs. Kidney Water relies on Lung Metal to supplement deficiency. Now both Metal and Water decline, mother and child distressed. Ancients lived simply and ate bland in summer for this reason. Tenth month Hai, Eleventh month Zi, Fire Qi hides. Must nourish root and truth to aid Spring growth. Late Spring/Early Summer lack headache/weak leg diseases. *Classic*: "Those who store Essence in Winter do not get Warm diseases in Spring."

In extreme heat, human Yang follows heaven, floating on surface, hard to hide. Yin of hundred vessels feels season, sap flows in trees, cannot gather. Middle Qi leaks and dissipates. One Yin returns and begins to grow. Fire too strong damages Metal/Water. Yang deficient, Heart/Spleen distressed. Health-conscious gentlemen must be cautious.