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In summer, sudden collapse with stiffness and unconsciousness is termed Shu Jue (Heat Stroke Collapse). It should be differentiated into Yin and Yang syndromes.

Yang syndrome presents with a flooding, rapid yet forceless pulse, body heat, and sweating, known as Yang Jue. This is caused by Summerheat and food damaging the Spleen and Stomach. The more food ingested, the greater the heat generated. One should use Lian Shao Tiao Zhong Tang (Coptis and Peony Decoction to Regulate the Middle) or Chen Sha Liu Yi San (Vermilion Cinnabar Six-to-One Powder) first to treat the heat. Wait until the patient regains clarity of mind, then adjust treatment based on the amount of food retention. Ancient texts state: "Summerstroke cannot be treated with cold [medicines]; using cold leads to death." This statement applies to those suffering from true Summerstroke, not those suffering from Heat Strike. Nowadays, people encountering any heat syndrome immediately cite this saying, primarily due to a lack of understanding of the principles distinguishing Summerstroke from Heat Strike.

Regarding cases where the pulse is deep, fine, and forceless, the skin is not hot, and there is a history of consuming raw, cold fruits and vegetables, this is termed Cold Jue. In summer, the body's Yuan Qi (Original Qi) disperses outward, leaving the abdomen empty. If one consumes raw and cold foods that damage the Spleen, the cold acts like ice, trapping the food qi and causing blockage. One should use Nong Po Wen Zhong Tang (Aucklandia and Magnolia Bark Decoction to Warm the Middle). Do not administer tonics hastily. Only if there is excessive sweating and a cold body should Xiang Sha Li Zhong Tang (Amomum and Aucklandia Decoction to Regulate the Middle) be used. Many medical books discuss this condition without distinguishing between Yin and Yang presentations, confusingly attributing harm to the misuse of ascending and dispersing agents for Wind and Summerheat, which causes significant harm.

Additionally, elderly or deficient individuals in summer may suffer from Phlegm Strike (Zhong Tan), which often resembles Shu Jue. However, patients with Phlegm Strike have warm bodies rather than cold ones, do not exhibit high fever, and have drooling at the corners of the mouth; these features serve as differentiators. (Note: Differentiating Jue into Cold and Heat types is an insight not previously expounded by predecessors. Students must study this carefully to avoid hasty errors that endanger lives. The key lies in precise symptom differentiation before prescribing, thereby avoiding therapeutic confusion.)

Zhong Re (Heat Strike) is characterized by thirst and a desire to drink. The patient experiences chilliness and mild fever, closely resembling Taiyang Cold Damage (Shang Han). However, while Cold Damage presents with a flooding pulse, Zhong Re presents with a fine and rapid pulse, allowing for differentiation. Zhong Re can also present with a flooding pulse; however, the key distinction is that thirst appears immediately at onset, unlike Cold Damage where thirst occurs only after prolonged illness. For obese individuals, Liu Yi San (Six-to-One Powder) can be used to clear heat, allowing it to exit via urination, thus preventing damage to Jin Ye (Body Fluids). For thin, dark-skinned individuals, whose Jing Blood (Essence and Blood) has been depleted by seasonal heat, promoting diuresis is contraindicated. Instead, Chai Hu Shao Yao Tang (Bupleurum and Peony Decoction) should be used to generate fluids and relieve thirst, yielding miraculous results. (Note: When both Zhong Re and Cold Damage present with a flooding pulse, the subtle difference—fine and rapid for Zhong Re versus other characteristics for Cold Damage—is critical and leaves no room for error. It requires careful discussion and personal comprehension.)