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(That is, Diyu San) Treats heatstroke leading to coma, loss of consciousness, and a condition nearing death. It also treats discomfort from summerheat causing irritability, bitter taste in the mouth, dry tongue, headache, nausea, loss of appetite, as well as bloody dysentery.
Diyu (Sanguisorbae Radix), Chishao Yao (Paeoniae Radix Rubra), Huanglian (Coptidis Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride - removed white pith, equal parts). Take three qian per dose, mixed with Jiangshui (fermented rice water). If it is bloody dysentery, decoct in water and take orally.

Yu Jiayan said: During the Yuanfeng era, the Heji Bureau was established to compile experienced prescriptions from various physicians, with particular detail on the category of heatstroke. Because summer prescriptions have been widely tested, the knowledge gained is extensive. Among them, Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) is taken not to treat summerheat directly, but specifically to treat dampness. Furthermore, Banxia Fuling is named Xiaoshu Wan (Summerheat-Relieving Pill), indicating that relieving summerheat lies in eliminating dampness; thus the name is appropriate and logical. Regarding Xiangru Yin (Elsholtzia Drink), Elshua, Bideng (Coicis Semen), and Houpo (Magnoliae Officinalis Cortex) form the main prescription. Adding Huanglian (Coptidis Rhizoma) as the sovereign herb treats Heart Fire. If dampness is prevalent, Huanglian is removed and Fuling (Poria) and Gancao (Glycyrrhizae Radix et Rhizoma) are added to treat Spleen dampness. Summerheat soaked by dampness becomes heavy and stagnant; therefore, within the formula of Bideng, Gegen (Puerariae Lobatae Radix), and Gancao, Wumei (Mume Fructus), Sharen (Amomi Fructus), and Caoguo (Tsaoko Fructus) are assisted to invigorate the Spleen. Meanwhile, Dashun San (Great Harmony Powder) and Laifu Dan (Reviving Pill) are excluded, which is applied to treat cases of summerheat complicated by frequent diarrhea; this extends the principle of Suopi San (Spleen-Constricting Powder). Pipaye San (Loquat Leaf Powder) addresses turbid and foul pathogens caused by summerheat; thus, Xiangru (Elsholtziae Herba), Pipaye (Folium Eriobotryae), Dingxiang (Flos Caryophylli), and Baimaogen (Imperatae Rhizoma) are used for their pungent and aromatic properties to calm the Stomach and remove the foul odors detested by the Stomach. This is derived from Pipaye San to treat cases of summerheat complicated by frequent vomiting. Physicians benefit greatly from understanding the depth, severity, and urgency of heat, dampness, deficiency, and cold. Later sages supplemented this by addressing deficiency. Liu Wanhe’s Guiling Ganlu Yin (Cassia Twig, Polyporus, and Sweet Dew Drink), along with Wu Ling San (Five-Ingredient Powder with Poria) plus Three Stones, aims to tonify deficiency. Zhang Ziheng’s Guiling Ganlu Yin uses Ren Shen (Ginseng Radix et Rhizoma), Gegen, Gancao, Huoxiang (Agastaches Herba), and Muxiang (Aucklandiae Radix) to tonify deficiency while simultaneously clearing turbidity. The Ju Fang (Bureau Formula) Wu Wei Zi San is modified by adding Ren Shen, Huang Qin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Mugua (Chaenomelis Fructus) to clear damp-heat through tonifying deficiency. Even Dongyuan Li Gao’s [Formula] further tonifies the Middle and strengthens the Defensive Qi to clear damp-heat; this is suitable for obese individuals with internal deficiency. Heatstroke must be accompanied by restlessness. Zhongjing’s Zhuye Shigao Tang (Leaf of Bamboo and Gypsum Decoction), named Qingzao Tang (Dryness-Clearing Decoction), still prioritizes dispelling dampness. Dryness and dampness are opposing factors. Without Dongyuan’s exceptional insight, such understanding would not have been reached. For instance, Yiyuan San (Benefit Origin Powder) dispels dampness; adding Chensha (Cinnabar) clears heat; adding Ren Shen tonifies deficiency; adding Chensha and reducing Guizhi (Cinnamon Twig) clears heat. Baihu Tang (White Tiger Decoction) with Ren Shen tonifies deficiency; with Cangzhu (Atractylodis Rhizoma)... [text implies completion of formula variations], making it comprehensive, yet still incomplete. I have observed the syndrome of Summerwind (Heatstroke-induced wind-stroke); its sudden collapse resembles Wind Stroke (Zhong Feng), but cannot be treated as such. Although Dayanglong Wan (Great Yang Dragon Pill) exists, it was not originally legislated for Summerwind. My humble opinion supports this: in cases of heatstroke coma, administering this pill reveals a glimpse of Summerwind treatment. However, if a person has inherent Yin-blood deficiency and summer-toxin penetrates deeply into the Blood level, administering this pill could lead to immediate death. Diyu San, treating heatstroke coma where one loses consciousness and nears death, uses only common blood-cooling herbs to clear and resolve summer-toxin that has penetrated deep into the Blood level; this is correct. Later, many found it effective and praised its name as Pohuo San (Extinguish Fire Powder), showing true understanding. When heavenly luck favors Fire transport, it becomes evident that Summerwind arises from violent excess of Heart Fire, scorching Yin-blood; apart from clearing Heart and cooling Blood, there is no other way to extinguish it. Summarizing these points, I elaborate further.