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Observing Zhang Zhongjing’s (Zhang Jingyue) discussion on Shanghan (Cold Damage), one can understand that Shuzhong (Heatstroke due to summer heat) and Zhongre (Heatstroke due to excessive heat) are both diseases occurring in the summer season, differing only in their pulse manifestations and symptoms, which may be of deficiency or excess. He Jiegu (He Xuan) forcibly distinguished summer heat by "movement" and "stillness," grouping it with diseases caused by cold in summer; this is an improper naming convention. Generally, summer heat injures those who engage in hard labor. The *Wei Yao* states: Summer-heat pathogen invades the Taiyang channel (Taiyang meridian syndrome), opening the cou-li (pores), and depleting healthy qi. If sweat flows profusely, the pathogen does not penetrate inward, which is referred to as "depletion of essence and qi leads to deficiency." The resulting fever is due to deficient fire. The pulse should be slow and fine; treatment should primarily support healthy qi while dispelling summer-heat pathogens, such as with Qing Shu Yi Qi Tang (Clear Heat and Benefit Qi Decoction). Li Dongyuan also described fever due to blood deficiency, where symptoms resemble Baihu Tang syndrome (Yangming Channel Excess Heat), distinguishable only by a pulse that is not long. This resembles summer heat but is not summer heat; Lei Shanghan (Shanghan-like syndromes) includes cases resembling summer heat. Differentiation must be clear, and treatment must be cautious.

Shi (Dampness) is the moistening vapor generated by the interaction of yin and yang in heaven and earth. Causes of contracting dampness include invasion by fog and dew, lingering rainy weather, sweat-soaked clothing obstructed by wind, wading through water or mud causing cold stagnation, excessive drinking, or residing in low, damp places injuring skin, flesh, sinews, and bones. Dampness often affects the head, face, and limbs, particularly the waist and legs, because dampness injury first affects the lower body. It has a special affinity for the Spleen and Stomach due to similar energetic qualities. Generally, when dampness combines with cold, it becomes Cold-Dampness; with wind, Wind-Dampness; with fire, Damp-Heat; disrupting qi mechanism, it becomes Damp-Qi; stagnating in the middle jiao, it transforms into Tan (Phlegm); flowing downward, it becomes Shui (Water retention); entering the skin, it causes stubborn Bi syndrome (obstruction); entering qi and blood, it causes fatigue. Entering the Lung, it causes panting and fullness; entering the Spleen, it causes Damp-Phlegm swelling, sallow complexion; entering the Liver, it causes hypochondriac fullness and limb stiffness; entering the Kidney, it causes lower back and hip pain, a sensation of the body being clamped like wood, and heaviness in the flanks. Entering the Fu organs, it causes numbness and insensitivity; entering the Zang organs, it causes limb rigidity. Accumulating in joints, it causes swelling or pain; flowing through collaterals, it limits extension and flexion; stagnating in meridians, it causes conditions such as Hongxiangjiao (Gout/Charcot foot). If there is pre-existing internal Cold-Dampness or initial edema, compounded by external dampness, leading to internal and external attack, depletion of healthy qi, sudden collapse and unconsciousness resembling Zhongfeng (Wind Stroke), but with a deep, choppy, fine, and slow pulse, this is Zhongshi (Dampness Stroke). Treatment must differentiate between cold and heat. For Damp-Heat, the pulse is typically surging, rapid, deep, and solid, with symptoms of dark urine and thirst, resembling stagnant water unable to drain; thus, promoting urination is primary, akin to dredging channels to release water. For Cold-Dampness, the pulse is deep, fine, slow, and weak, with symptoms of fatigue and loose stools, resembling muddy ground unable to nourish life; thus, drying Spleen Earth is primary, akin using dry ash to absorb mud moisture. Regarding Zhongshi, it is extreme Cold-Dampness with depleted yang qi, requiring sweet-warm and pungent-hot formulas containing Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Lateralis Radix Preparata). This is like seeking spring warmth after continuous freezing snow and ice. Therefore, dampness diseases are ubiquitous, yet few know how to treat them. Physicians must examine this carefully.