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The classics state: "Affected by summerheat, sweating occurs; those who are restless exhibit panting and chest fullness, while those who are quiet speak excessively. The body feels like burning charcoal, but the pathogen is dispersed through sweating." It also states: "When qi is abundant but the body feels cold, it is contracted as Cold Damage (Shanghan); when qi is deficient but the body feels hot, it is contracted as Summerheat Injury (Shangshu)." Chen Feixia stated: "Infants' illnesses are more severe in summer and autumn. This is because Fire and Earth qi flourish during late summer, at which time Metal and Water organs are injured. With tender yang and weak yin, harmony of heaven and humanity is already lost. Added to this is the heat of summer, causing yang qi to float on the exterior, while raw and cold foods damage the middle jiao. If summer fails to nourish properly, Metal cannot be generated, leading to summerheat disease. However, there are cases of direct summerheat stroke and cases caused by the summer environment. Although the manifestations differ, all stem from summerheat." (These two meanings are repetitive, essentially one and the same.) Therefore, its diseases are divided into two categories: Yin Summerheat and Yang Summerheat. Their treatments are as different as ice and charcoal, and must be distinguished carefully.

Yin Summerheat refers to contracting cold due to summer conditions. It often affects infants from affluent families who fear the heat and seek coolness, failing to avoid cold air; or those living in deep halls and large mansions, or those who fail to dress warmly during fluctuating temperatures, allowing cold pathogens to invade the muscle layer. Symptoms include headache, absence of sweating, aversion to cold, and bodily stiffness. Because cold was contracted during the summer month, although named Yin Summerheat, it is essentially Cold Damage (Shanghan). Treatment should employ warm dispersal methods, using Wuji San (Five Accumulations Powder) or Qingshu Yiqi Tang (Clear Summerheat and Benefit Qi Decoction). If there is no aversion to cold but rather fever, Renshen Baihu Tang (Ginseng White Tiger Decoction) is used; after the fever subsides, Diaoyuan Shengmai San (Regulate Origin and Generate Pulse Powder) is used for tonification. Another type arises from dietary negligence, overconsumption of raw fruits, vegetables, cold tea, or water, damaging the internal organs with cold. This leads to vomiting, diarrhea/dysentery, and abdominal pain. This is also cold invading due to summer conditions, with cold pathogens inside. Treatment focuses on warming the middle, using Jiawei Wuling San (Modified Five-Ingredient Powder with Poria) as the primary formula; if ineffective, Lizhong Tang (Regulate the Middle Decoction) is used.

Yang Summerheat typically affects children from commoner families. They stay under the scorching sun, sit on hot ground, or bathe in cold mountain streams. Symptoms include fever, headache, restlessness, extreme thirst, profuse sweating, a flooding-slippery-large pulse, constipation, and dark red urine. For these, Baihu Tang (White Tiger Decoction) is indicated. If the pulse is deficient with restlessness, thirst, and shortness of breath, Renshen Baihu Tang (Ginseng White Tiger Decoction) is used. If dizziness occurs, Shengmai San (Generate Pulse Powder) is used. For summerheat combined with dampness, Ruling Tang (Artemisia and Poria Decoction) is used.

In treating summerheat diseases, distinguishing between yin/yang and deficiency/excess is paramount. If external heat pathogens affect the interior, causing internal restlessness and heat, this is excess heat in both exterior and interior, constituting a Yang Syndrome. Treatment should involve clearing heat and tonifying, as described above. If the pulse is weak and powerless, or if there is aversion to cold/back cold, vomiting/nausea, abdominal pain/diarrhea, slight coldness in limbs/nose tip, dislike for cold drinks, rapid breathing/shortness of breath, or inability to move due to weakness, these belong to Yin Syndromes within Yang contexts. In such cases, one must focus solely on protecting Yuan Qi (Original Qi), using Sijunzi Tang (Four Gentlemen Decoction) as the main treatment, or Lizhong Tang (Regulate the Middle Decoction) with Shaoyao (Peony Root). If deficiency-cold is severe, one should abandon seasonal considerations and treat based on symptoms; Fuzi (Aconite Root) and Rougui (Cinnamon Bark) are essential. One must not stubbornly use cold-cooling herbs just because of the name "summerheat," or the consequences will be dire.

*Jicheng* Warm Dispersal Wuji San (Five Accumulations Powder):
Baizhi (Angelicae Dahuricae Radix, 1 qian), Chenpi (Citri Reticulatae Pericarpium, 5 fen), Chuanpu (Magnoliae Officinalis Cortex, 7 fen), Jiegeng (Platycodonis Radix, 1 qian), Zhike (Aurantii Fructus Immaturus, 7 fen), Chuanxiong (Ligustici Chuanxiong Rhizoma, 5 fen), Baishao (Paeoniae Radix Alba, 1 qian), Fuling (Poria, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Danggui (Angelicae Sinensis Radix, 1 qian), Banxia (Pinelliae Rhizoma, 6 fen), Guizhi (Cinnamomi Ramulus, 5 fen), Paojiang (Zingiberis Rhizoma Preparatum, 5 fen), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparatum, 1 qian), Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Dazao (Jujubae Fructus, 1 piece).

Renshen Baihu Tang (Ginseng White Tiger Decoction) - See previous Wenbing formulas.

*Jicheng* Diaoyuan Shengmai San (Regulate Origin and Generate Pulse Powder):
Lushen (Codonopsis Pilosula, 1 qian), Zhi Huangqi (Astragali Radix Preparatum, 1 qian), Cundong (Ophiopogonis Radix, 1 qian), Wuweizi (Schisandrae Chinensis Fructus, 1 qian), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparatum, 1 qian), Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Dazao (Jujubae Fructus, 1 piece).

*Jicheng* Jiawei Wuling San (Modified Five-Ingredient Powder with Poria):
Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Fuling (Poria, 1 qian), Zhuling (Polyporus, 1 qian), Zexie (Alismatis Rhizoma, 1 qian), Guizhi (Cinnamomi Ramulus, 7 fen), Huoxiang Geng (Agastaches Herba Stem, 1 qian), Xuan Mugua (Chaenomelis Fructus, 1 qian), Sharen (Amomi Fructus Rotundus, 5 fen), Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Dazao (Jujubae Fructus, 1 piece). Use ten stems of Dengxincao (Junci Medulla) as a guide, decoct in water, and take hot.

Baihu Tang (White Tiger Decoction) - See Vomiting formulas.

Shengmai San (Generate Pulse Powder):
Renshen (Panacis Ginseng Radix, 1 qian), Cundong (Ophiopogonis Radix, 1 qian), Wuweizi (Schisandrae Chinensis Fructus, 1 qian).

*Jicheng* Ruling Tang (Artemisia and Poria Decoction):
Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian), Xiangru (Elsholtziae Herba, 1 qian), Fuling (Poria, 1 qian), Zhuling (Polyporus, 1 qian), Zexie (Alismatis Rhizoma, 1 qian), Guizhi (Cinnamomi Ramulus, 5 fen), Bian Dou (Dolichoris Semen, 1 qian), Chuanpu (Magnoliae Officinalis Cortex, 5 fen), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparatum, 1 qian), Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Dazao (Jujubae Fructus, 1 piece), Dengxincao (Junci Medulla, 1 qian).

Tu Weisheng stated: The six exogenous pathogens of heaven and earth are Wind, Cold, Summerheat, Dampness, Dryness, and Fire. Regarding Wind, I know it as Wind; regarding Cold, I know it as Cold; regarding Summerheat, Dampness, Dryness, and Fire, I know them as such. But if we probe further to ask what constitutes Summerheat? What is Summerheat like? People invariably say: Summerheat is a hot and fiery qi in heaven and earth, extremely vigorous and fierce. When humans contract it, they suffer from fever, spontaneous sweating, red face, dry mouth, restlessness, excessive thirst, dark urine, and constipation. There has never been a case where neck and back stiffness, fever, and aversion to cold were named Summerheat Injury. Nor has there ever been a case where abdominal pain from cold invasion, borborygmus, and diarrhea were named Summerheat Stroke. Summerheat is naturally generated hot qi from heaven and earth. Humans follow the natural way of heaven and earth, hence naming it Summerheat, without any artificial manipulation. However, symptoms like neck/back stiffness, fever, aversion to cold, abdominal pain from cold, borborygmus, and diarrhea often occur in late summer. Why? Just as heaven and earth cannot lack even a moment of cool air during midsummer, they cannot lack warmth during midwinter. Falling ill with neck/back stiffness in midsummer is akin to falling ill with fever/aversion to cold/tongue coating yellow/restlessness/constipation in midwinter. One cannot claim that heaven and earth lack this qi at this time, nor can one claim that humans lack this disease at this time. One cannot limit heaven and earth to having only specific air at specific times/places, nor can one limit humans to having only specific diseases at specific times/places. However, one also cannot say that humans should not have other diseases besides these at this time. If one insists that all cold and heat diseases in summer must be categorized under "Summerheat" and forcibly divided into Yin Summerheat and Yang Summerheat, then how should we name winter's fever/aversion to cold versus fever/aversion to heat? Call the former Yang Cold Damage? But in freezing weather with cold pathogens, there is no "Yang" to add. Call the latter Yin Cold Damage? But with fire/pathogens and heat prevailing, there is no "Yin" to add. This puts us in a dilemma. Moreover, summerheat is fierce, making people prone to seeking coolness, wearing thin clothes, and eating raw/cold foods. Contracting back pain/aversion to cold or cold-induced diarrhea in this season is inevitable due to circumstances and human behavior. Yet ancient sages were too rigid about seasons, believing that in such hot weather, cold syndromes should not exist. Since these cold syndromes do occur, they insisted on linking them all to "Summerheat," refusing to allow other disease names outside of "Summerheat." How pedantic is this!

Jiegu said: "Obtained while resting is Summerheat Stroke (Zhongshu); obtained while moving is Heat Stroke (Zhongre). Summerheat Stroke is a Yin syndrome; Heat Stroke is a Yang syndrome." He sought to divide Summerheat and Heat. I argue that we should distinguish the depth of Summerheat Stroke based on human activity levels (rest vs. exertion), rather than dividing the heat of Summerheat into cold and warm. Preferring ease and avoiding labor is human nature; seeking coolness in summer is especially common. Sometimes, however, ability is constrained, or economy pressured, forcing one to work. Consider a mountain woodcutter or field farmer, exhausted, lying stiffly under mulberry or plum trees, resting on slopes. Suddenly, slanting sunlight penetrates the skin, turning their desire for coolness into injury by summerheat. This is "obtained while resting," fitting the meaning of Summerheat Stroke. Conversely, wielding a hoe to weed or harvest millet, with no escape from intense heat, transforming a healthy body into one injured by summerheat, is "obtained while moving," fitting the meaning of Heat Stroke. Otherwise, consider those in high halls, lying on electric beds/chairs, served by servants, with fans blowing, who occasionally get abdominal pain from excessive cooling. Can this be called Summerheat Stroke? The fierce heat cannot enter them.

It is strange that enlightened scholars like Mengjue still cling to this view. They claim Summerheat is Yin pathogen, Heat is Yang pathogen. They say Summerheat Stroke involves feeling "earth-stirring qi," Yin meeting Yin, causing headache, fever, greasy face, sweating, differing from Heat Stroke, with clear urine, loose stools, vomiting, shortness of breath, quietness, sleepiness, and a weak pulse—vastly different from Heat Stroke. They also say: Summerheat always damages Qi; only Huangqi (Astragalus) can tonify Qi; Summerheat always combines with Dampness; only charred Baizhu (Atractylodes) can dry Dampness; Summerheat always accumulates Cold; only Fuzi (Aconite) can warm Cold. Yet their empirical formulas use Baizhu, Jiang (Ginger), Fuzi, Fuling, Gancao, Bidou, Yiren—standard summer cold-mid warming methods. They say Heat Stroke involves feeling "heaven-burning qi," Yang meeting Yang, causing headache, fever, greasy face, sweating, differing from Summerheat Stroke, with dark/scanty urine, hard stools, chest fullness, panting, restlessness, insomnia, and flooding-rapid pulse—separated by a world from Summerheat Stroke. They also say: Severe heat causes dryness; only Maidong (Ophiopogon) clears dryness; Severe heat becomes toxin; only Huanglian (Coptis) resolves toxin; Severe heat depletes fluids; only Zhuling (Polyporus) promotes urination. Yet their empirical formulas use Fuling, Baizhu, Huanglian, Gancao, Qianhu, Xingren, Maidong, Zhuling, Zexie—standard summer heat-clearing methods.

In my view, when they describe Yin meeting Yin causing headache, fever, loose stools, it is actually due to human greed for coolness and thin clothing. When they describe Yang meeting Yang causing headache, fever, dark/hard stools, it fits human hardship and heavenly summer heat. Otherwise, how to explain "Summerheat" vs. "Heat"? How to distinguish Summerheat Stroke from Cold Damage? I assert: Winter cannot lack Fire/Heat diseases, so Summer cannot lack Cold Damage diseases. Winter Fire/Heat diseases are named Fire/Heat; Summer Cold Damage diseases should be named Cold Damage. Why rigidly adhere to seasons, dividing Summerheat into Yin/Yang, and shunning the term Cold Damage? Why divide Summerheat as Yin pathogen and Heat as Yang pathogen, misunderstanding the Sage's intent?