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Wang Jiezhai stated: Febrile diseases occurring after the Summer Solstice are termed Shu (Summerheat). Shu is the season when Ministerial Fire (Xianghuo) governs. When humans contract this pathogen in summer, it enters through the mouth and nose, damaging the Pericardium Collateral meridian (Pericardium Channel). The pulse is deficient, or floating and large and scattered, or wiry, thin, hollow, or slow; this is because heat damages Qi, leading to Qi consumption and a weak pulse. The manifestations include panting and thirst when restless, excessive talking when quiet, fever with irritability, heart pain, extreme thirst with desire to drink, headache with spontaneous sweating, fatigue with shortness of breath, or bleeding from the lower orifices, jaundice, and macules. In severe cases, Fire controls Metal (Lung), failing to restrain Wood (Liver), leading to spasms, convulsions, and loss of consciousness. The treatment for Shu is best achieved by clearing Heart fire and promoting urination. Since Shu damages Qi, tonifying Qi is essential. There are also cases of aversion to cold, cold limbs, severe confusion and loss of consciousness, Huoluan (cholera-like vomiting and diarrhea), phlegm obstruction with retching, abdominal pain, and diarrhea. These are not caused directly by Shu invading the body, but are self-induced illnesses due to summer conditions. Because they arise in summer, they are also called Shu diseases, but the treatment methods differ.

If walkers or farmers contract it while laboring under the sun, it is "obtained through movement," which is a Yang syndrome. Symptoms must include severe headache, restlessness and fever, aversion to heat, hot skin upon touch, extreme thirst with desire to drink, profuse sweating, and inability to move due to lack of Qi. This is external damage to Yuan Qi (Primal Qi) by heavenly heat. One should clear Summerheat and tonify Qi, using herbs such as Moslae Herba (Xiangru), Coptidis Rhizoma (Huanglian), Dolichoris Semen (Biandou), Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Schisandrae Fructus (Wuweizi), Anemarrhenae Rhizoma (Zhimu), and Gypsum Fibrosum (Shigao).

For Summerheat causing thirst and a deficient pulse, use Renshen Baihu Tang (Ginseng White Tiger Decoction) or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).

If healthy individuals, during the hot summer, seek coolness in deep halls, pavilions, or water towers, using large fans or wind machines, this is "obtained through stillness," which is a Yin syndrome. Such patients suffer from headache, aversion to cold, stiff and rigid body, painful joints with irritability, high fever on the skin but no sweat. This is caused by Yin-Cold restraining the body's Yang Qi, preventing its expansion and diffusion. One should use acrid-warm formulas to release the exterior and disperse cold, using herbs such as Magnoliae Officinalis Cortex (Houpo), Perillae Folium (Zisu), Puerariae Radix (Gegen), Agastachis Herba (Huoxiang), Notopterygii Rhizoma et Radix (Qianghuo), and Atractylodis Rhizoma (Cangzhu).

If there is external cold contraction combined with internal injury from raw/cold fruits and vegetables, add Dried Ginger (Ganjiang), Amomi Fructus (Sharen), and Medicated Leaven (Shenqu) to the previous formula. This does not treat Shu, but treats the illness caused by avoiding Shu improperly.

If there is no external cold, only internal injury from ice-cold drinks, causing abdominal pain and diarrhea, or Huoluan with vomiting and retching, use Suopi Yin (Spleen-Constricting Decoction) or Lizhong Tang (Regulate the Middle Decoction) added with Shenqu, Maltae Fructus (Maiya), Sharen, and Cangzhu, to warm the middle and digest food.

If vomiting and diarrhea present with a deep and faint pulse, cooling medicines must not be used. Instead, use Dashun San (Great Smooth Powder) added with equal parts of Prepared Aconite Root (Fuzi), or Fuzi Lizhong Tang added with stir-fried White Peony Root (Baishao).

If one is injured by both Summerheat and raw/cold foods, presenting with external heat and internal cold, one should first treat the interior by warming the middle and digesting food, then treat the exterior by clearing Summerheat and tonifying Qi, focusing primarily on regulating the Spleen. Li Dongyuan’s prescriptions already incorporate this idea. His use of Huangqi, Shengma, Renshen, Baizhu, Gancao, Maidong, Danggui, Wuweizi, Huangbai, and Gegen clears Summerheat and tonifies Qi; Cangzhu, Shenqu, Qingpi, Chenpi, and Zexie tonify the Spleen.

Zhu Danxi stated: Besides Shu disease, there is "Zhuxia" (Seasonal Weakness), belonging to Yin deficiency and insufficient Yuan Qi. In early summer and late spring, if one suffers from headache, weak legs, poor appetite, and low-grade fever, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) removing Shengma and Chaihu, adding stir-fried Huangbai and Baishao. If accompanied by phlegm, add Banxia and Juhong, or use Shengmai Tang (Generate the Pulse Decoction).

Yu Jiayan stated: For Shu symptoms contracted by laboring in the sun and being exposed to Summerheat, cooling methods should be used to resolve Summerheat toxicity. However, for those who live in deep mansions, enjoy cool breezes, eat raw/cold foods, and suppress their Yang Qi leading to illness, all cooling formulas should not be applied directly. If there is no sweat, one must still vent the exterior to diffuse Yang. If there is vomiting and diarrhea, one must urgently harmonize to calm the Middle Jiao; in severe cases, use small amounts of warming medicines to follow the disease trend (Congzhi). Therefore, for Huoluan vomiting and diarrhea caused by exposure to Summerheat, treating Shu is primary; for that caused by avoiding Summerheat, harmonizing and warming the Middle is primary. This distinction must not be overlooked.

During the Yuanfeng era, the Heji Bureau was established, compiling experienced formulas from physicians, with particular detail on Zhongshu (Heatstroke). Summer Shu symptoms were tested widely across regions. They utilized Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction), not to treat Shu directly, but specifically to treat Dampness. By adding Banxia and Fuling with a little Gancao, named Xiaoshu Wan (Summerheat-Relieving Pill), it shows that relieving Summerheat lies in eliminating Dampness, making the name appropriate. Their Xiangru Yin uses Xiangru, Biandou, and Houpo as the main formula. If Heat is prevalent, remove Biandou and add Huanglian as the sovereign herb to treat Heart Fire. If Dampness is prevalent, remove Huanglian and add Fuling and Gancao to treat Spleen Dampness. Their Suopi Yin addresses the Spleen being soaked by Dampness and becoming heavy and stagnant; it adds Wumei, Sharen, and Caoguo to Bian Dou, Gegen, and Gancao to invigorate the Spleen and eliminate the Dampness the Spleen dislikes. In severe cases, Dashun San and Laifu Dan are used to treat Shu symptoms with frequent diarrhea, extending the logic of Suopi Yin. Physicians should weigh Heat, Dampness, Deficiency, and Cold, considering depth and urgency, to maximize benefit.

Later sages added methods to tonify deficiency. Liu Hejian’s Guiling Ganlu Yin (Cassia Twig, Poria, and Dew-Dripping Decoction) and Wuling San plus Three Stones (Huashi, Hanshuishi, Chishishi) aim to generate fluids to tonify Stomach deficiency. Zhang Hezi’s Guiling Ganlu Yin uses Renshen, Gegen, Gancao, Huoxiang, and Muxiang to tonify deficiency while clearing turbidity. Alternatively, Shiwei Xiangru Yin (Ten-Ingredient Mosla Decoction) adds Renshen, Huangqi, Baizhu, Chenpi, and Chaomugua to the Bureau’s Five-Ingredient Xiangru Yin to tonify deficiency while clearing Damp-Heat.

Li Dongyuan’s Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction) and Renshen Huangqi Tang further tonify the Middle and solidify the Defensive Qi to remove Damp-Heat. For obese, pale individuals with internal deficiency, these are suitable for frequent use regardless of whether Zhongshu is present. Zhongshu typically manifests as restlessness, irritability, heat, and stifling sensation. Li Dongyuan, imitating Zhang Zhongjing’s Zhuye Shigao Tang, created Qingzao Tang (Clear Dryness Decoction), prioritizing dampness removal. Although Dryness and Dampness are opposites, clearing dryness also involves removing dampness; this profound insight belongs uniquely to Li Dongyuan.

Furthermore, Yi Yuan San (Benefit Primordial Powder) removes dampness and adds Chen Sha (Cinnabar) to also clear Heat; Wuling San removes dampness and adds Renshen to tonify deficiency, or adds Chen Sha and reduces Guizhi to clear Heat; Baihu Tang adds Renshen to tonify deficiency and Cangzhu to overcome dampness. Combined with the Bureau’s formulas, they are comprehensive, yet some aspects remain incomplete.

Shu Feng (Summerwind) is a condition where Heart Fire becomes violently excessive, scorching Yin Blood. Sudden collapse resembles Stroke (Zhongfeng), but it should not be treated via the Wind channel. Although *Baiyi Xuanfang* contains Da Huanglong Wan (Great Yellow Dragon Pill), it was not originally legislated for Shu Feng. However, for sudden death from Shu coma, administering this pill can restore consciousness immediately. But caution is needed: if the patient has chronic Yin Blood deficiency and Summerheat toxin has deeply entered the Blood level, this formula must not be used. *Liangfang* offers Duyu San (Sanguisorba Powder) to treat Shu coma and near-death states; using ordinary blood-cooling herbs to clear Summerheat wind deeply entrenched in the Blood level, nothing is better than this.

Sudden collapse and unconsciousness from Zhongshu is named Shu Feng. Generally, there are two pathways: Excess and Deficiency. Excess is Phlegm Excess. Normally accumulating phlegm fills the collaterals; once contracting intense Summerheat, phlegm obstructs Qi, causing sudden collapse and salivation. This is the most severe combination of Dampness and Phlegm. One should first induce vomiting to expel phlegm, then clear Summerheat; this is relatively easy. Deficiency is Yang Deficiency. Normally, Yang Qi is weak and Yin-Cold dominates. Once contracting intense Summerheat, pathogens attack the deficiency. This is a Damp disease originating from Cold-Deficiency. One must combine Yang-restoring drugs with Summerheat-clearing agents; this is the most difficult to treat.

Li Dongyuan stated: When Spleen and Stomach are weak, around June and July, people sweat soaking clothes, feel heavy and short of breath, and even suffer flaccid paralysis of limbs, unsteady gait, tilted feet, blurred vision, and dark complexion suggesting imminent collapse. This indicates exhaustion of Kidney and Bladder. Immediate rescue is required by nourishing Lung Qi to supplement the upper source of Water. Furthermore, excessive sweating injures Body Fluids; if tendons and bones lose nourishment, pain or thirst occurs. This should not be treated as Summerheat.