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Zhongshu (Heatstroke) manifests as a dirty complexion, spontaneous sweating, dry mouth and tongue, chest stuffiness, fainting, coma with loss of consciousness, coldness of the back, and slightly cold hands and feet. It may also present with vomiting, diarrhea, wheezing, or abdominal fullness. At this time, one must absolutely not immediately give cold water, nor lie on cold ground. If a person dies from heatstroke while walking, they should be immediately placed in a hot place under the sun. Urine is poured onto the hot earth to create heated soil, which is then applied over the patient's umbilicus. Urgently, Erqi Dan (Two Qi Pill) combined with Suhexiang Wan (Styrax Pill) should be mixed with decoction and force-fed. If Erqi Dan is unavailable, grinding garlic and administering it with water is also acceptable. This is because Zhongshu injures the body with summer-heat toxicity, resulting in exterior Yang and interior Yin. Medicines for summer-heat mostly use warm agents, such as Ganjiang (Dried Ginger) and Rougui (Cinnamon Bark) in Dashun San (Great Harmony Powder), and Dingxiang (Clove) in Pipayeda San (Loquat Leaf Powder). Garlic is also a pungent-hot substance; its strong odor can open all orifices.

Li Dongyuan treated summer-heat by distinguishing between Yin and Yang patterns.
Those obtained through stillness belong to the Yin pattern. This occurs in deep halls or water pavilions, passing through cool rooms, where external cold damages the exterior; or from eating chilled melons and plums, consuming excessive raw and cold foods, damaging the interior. This is what is called "being injured by summer-heat." The illness must involve headache, aversion to cold, pain in the limbs and joints, irritability, high fever of the skin without sweat, abdominal pain, vomiting, and diarrhea. This is caused by the cold objects in rooms or Yin-cold factors suppressing the body's Yang Qi, preventing it from extending and diffusing. Dashun San (Great Harmony Powder) should be used as the primary formula.

Those obtained through movement belong to the Yang pattern. This occurs when pedestrians or farmers suffer from labor under the midday sun, where heat injures Yuan Qi (Primal Qi). The illness must involve severe headache, restlessness, dryness, aversion to heat, skin that feels very hot to the touch, extreme thirst with desire to drink, profuse sweating, dry teeth, and lack of energy to move. This is Summer-Heat injuring Qi, and Cangzhu Baihu Tang (Atractylodes White Tiger Decoction) should be used. If the patient has insufficient Yuan Qi and previous medicines are ineffective, only Qingshu Yiqi Tang (Clear Summer-Heat and Boost Qi Decoction) or Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) are appropriate. Generally, in summer, Yang Qi floats on the exterior, while Yin Qi hides within. If diet and fatigue injure the middle Qi internally, or if intense heat and labor damage Yang Qi externally, many will suffer from this. The method should focus on regulating and tonifying Yuan Qi, assisted by resolving summer-heat. For Yin-cold patterns, using Da Xinxin Re drugs like Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) in Dashun San is a good method of "abandoning the season to follow the syndrome" from the *Neijing*, which must be known. Nowadays, people who die from summer-heat syndromes often have blue-black fingernails or limbs. This is due to failing to investigate the cause, failing to warm the interior, and indiscriminately using formulas like Xiangru Yin (Mosla Decoction). Xiangru Yin is an agent that disperses Yang Qi and guides True Yin. It must be taken only after confirming the corresponding syndrome; otherwise, it is not targeted. Nowadays, people fear summer-heat disease and take this beforehand for prevention, which actually attracts summer-heat. If a person has deficient Yuan Qi or excessive sexual activity and drinks this, the disaster is particularly profound. If one wishes to prevent it, Sun Simiao's Shengmai San (Generate Pulse Powder) is most suitable for summer.

Summer-heat is one of the Six Qi, specifically the fire from heaven. Only this fire can be subdued by cold water, unlike the fire in a furnace or Dragon-Lei Fire. For those injured by summer-heat presenting with alternating abdominal pain, vomiting, and diarrhea, drinking cold well water mixed with Qinghao juice (Artemisia Annua Juice) cures it immediately, as the summer-heat toxin is excreted via urination. This is named Chouling Dan (Smelly Spirit Pill).

Summer-heat likes to injure the Heart. The Heart belongs to South Fire, following its category. The Small Intestine is the Fu organ of the Heart. To clear summer-heat toxin from the Heart Meridian so it exits via the Small Intestine, Qinghao (Artemisia Annua) and Xiangru (Mosla) are essential.

Some, due to summer-heat injury, drink large amounts of cold water, or doctors administer excessive cold agents, causing continuous vomiting and diarrhea, exterior heat and interior cold, irritability, excessive thirst, and even a desire to strip naked, resembling Taiyang Cold Damage (Shanghan). This is Yin excess repelling cold; warm medicines are suitable. Add Fuzi (Prepared Aconite Root) to Xiangru Yin, soak it, and take it cold.

Others, due to exposure to summer-heat, vomit excessively, leading to Stomach deficiency, where hundreds of medicines cannot enter, no rice goes down, and anything ingested is vomited immediately. The condition is critical. Urgently use Renshen (Ginseng Root) 1 qian, Huanglian (Coptis Rhizome) 5 fen, stir-fried with ginger juice until charred, and a pinch of Nuomi (Glutinous Rice). Add 1 zhong of water, decoct to a small wine cup amount. Wait until cool, and slowly moisten/swallow with a tea spoon. After a short while, add another spoonful. If several spoonfuls are swallowed without vomiting, finish the small cup, then medication and food can be administered.

Summer-heat disease resembles Heat disease; the distinction lies in the pulse: Heat disease presents with a surging pulse, while Summer-heat disease presents with a deficient pulse.

Erqi Dan: Treats latent summer-heat and cold injury, where two qi interact, causing epigastric blockage, vomiting, or diarrhea.
Xiaoshi (Niter) and Liuhuang (Sulfur) (equal parts): Grind into fine powder, stir-fry in a stone mortar until yellow, then grind again. Make pills the size of paulownia seeds using glutinous rice paste. Take 40 pills per dose.

Dashun San: Treats exposure to summer-heat and latent heat, excessive drinking, spleen and stomach dampness, indistinguishable water and grain, cholera-like vomiting, and disharmony of the zang-fu organs.
Gancao (Licorice Root) (3 liang), Ganjiang (Dried Ginger), Xingren (Apricot Seed), Rougui (Cinnamon Bark) (4 liang): First stir-fry Gancao until 80% yellow. Then add Ganjiang and stir-fry until the ginger cracks. Then add Xingren and stir-fry until the seeds no longer make noise. Sieve cleanly, mix together, and pound/sift. Take 2 qian per dose with 1 zhong of water, decoct to 70%, and take warm. If irritable, take with well water at any time.

Xiangru Yin: Treats latent summer-heat with excessive drinking, dry mouth and throat, vomiting, or diarrhea.
Xiangru (Mosla Herb) (8 liang), Baibian Dou (Fava Bean) (stir-fried 4 liang), Houpo (Magnolia Bark) (stir-fried with ginger juice 4 liang), Huanglian (Coptis Rhizome) (stir-fried with ginger juice 2 liang): Cut into pieces. Take 3 qian per dose with 1 zhong of water, add a little wine, decoct to 70%, and take warm.

Shiwei Xiangru Yin: Resolves summer-heat, harmonizes spleen and stomach.
Xiangru (Mosla Herb) (1 liang), Renshen (Ginseng Root), Chenpi (Tangerine Peel), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Huangqi (Astragalus Root), Baibian Dou (Fava Bean), Mugua (Chaenomeles Fruit), Houpo (Magnolia Bark) (stir-fried with ginger juice), Gancao (Licorice Root) (roasted): All equal to half liang. Grind into fine powder. Take 3 qian per dose, mixed with cold water.

Qingshu Yiqi Tang:
Huangqi (Astragalus Root) (1 qian), Cangzhu (Atractylodes Lancea Rhizome) (1.5 qian), Shengma (Cimicifuga Rhizome) (1 qian), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel), Shenqu (Medicated Leaven), Zexie (Alisma Rhizome) (each 5 fen), Gancao (Licorice Root), Huangbai (Phellodendron Bark), Gegen (Kudzu Root), Qingpi (Green Tangerine Peel), Danggui (Angelica Sinensis Root), Maidong (Ophiopogon Tuber) (each 3 fen), Wuweizi (Schisandra Berry) (9 grains). Add 2 zhongs of water, decoct to 1 zhong.

The *Neijing* states: Yang Qi guards the exterior and stabilizes it. Heat causes Qi to leak. Now, summer-heat pathogen invades the Wei Qi, hence fever and spontaneous sweating. Huangqi (Astragalus Root) with sweet-warm properties tonifies as the Sovereign herb. Renshen (Ginseng Root), Chenpi (Tangerine Peel), Danggui (Angelica Sinensis Root), and Gancao (Licorice Root), mildly warm, tonify the middle and augment Qi as the Minister herbs. Cangzhu (Atractylodes Lancea Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), and Zexie (Alisma Rhizome) promote diuresis and remove dampness. Shengma (Cimicifuga Rhizome) and Gegen (Kudzu Root) are bitter-sweet and neutral, excellent for releasing muscle-layer heat, using wind to overcome dampness. Heat impairs digestion, causing fullness; thus, stir-fried Shenqu (Medicated Leaven) is sweet-pungent, and Qingpi (Green Tangerine Peel) is pungent-warm to digest food and move Qi. The Kidney dislikes dryness; urgently eat pungent to moisten it. Thus, Huangbai (Phellodendron Bark) is bitter-cold, borrowing its aroma to drain heat and nourish water. For deficiency, nourish the source of transformation; thus, Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry) are sour-sweet and slightly cold, rescuing Geng Metal (Lungs) injured by heavenly summer-heat as the Assistant herbs. These diseases arise from diet and fatigue injuring Yuan Qi, triggered by heavenly summer-heat. If Yuan Qi is not deficient, where would summer-heat pathogen enter?

A child suffered vomiting and diarrhea, irritability, and convulsions. Some attributed it to fright, others to wind. I observed his dry mouth, his finger pointing to the teapot, and abdominal borborygmi. I told the other physicians: "Easy to treat. Three herbs from the medicine cabinet suffice." Use Huanglian (Coptis Rhizome) 5 fen, Gancao (Licorice Root) 3 fen, Renshen (Ginseng Root) 5 fen. Decoct in water and take cold. Within moments of swallowing, he slept and was calm. Someone asked: "Huanglian and Gancao detoxify well, but why add 5 fen of Renshen?" I said: "If Renshen is not used, this child will remain weak for several days. With Renshen, he will return to normal the next day." The next day, it was indeed so.

Baihu Tang:
Shigao (Gypsum Fibrosum), Zhimu (Anemarrhena Rhizome), Gancao (Licorice Root), Renshen (Ginseng Root), Nuomi (Glutinous Rice).
This formula is the correct prescription for fever in Heat disease during summer. Named Baihu (White Tiger), it represents the Metal Spirit of the West. What comes forward advances; what succeeds retreats. When the command of Autumn Metal prevails, the Fire command recedes. Shigao (Gypsum Fibrosum) is a cold-in-the-middle drug, bland and pungent, capable of inducing sweating and promoting urination. One must verify that the patient has profuse sweating, thirst, dry teeth, and a surging, long pulse, applicable in summer. If there is no sweating, no thirst, a deficient pulse that is not surging/long, or empty upon heavy pressure, even with high fever and thirst resembling Baihu Tang syndrome, this is Spleen-Stomach Qi deficiency and insufficiency of Primal Yang. Misusing Baihu will cause death. Also, those who have suffered massive blood loss, or postpartum women, presenting with high fever, panting, red face, desire to drink, and deficient pulse, are named Blood Deficiency Fever. Baihu is strictly contraindicated; Danggui Buxue Tang (Angelica Tonify Blood Decoction) must be used to stabilize.

*Yijian Jiazhi* records: Formerly, Chancellor Yu was summoned from Quchuan. On the way, he was exposed to summer-heat and suffered from dysentery for months. There was a rhyme on the wall: "Summer-heat toxin in the Spleen, dampness connects to the feet; if not diarrhea, then dysentery; if not dysentery, then malaria. Smelt realgar alone, mix with steamed dough pills, decoct licorice soup, take it and find peace." Other treatments were major errors by physicians. Following this prescription, the illness healed immediately. Citing this as an example, the rest can be inferred.