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The summer-heat pathogen contracted during the Sanfu period (the hottest days of summer), if strong, manifests immediately; if weak, it erupts in late autumn. Contemporary physicians refer to this late-onset condition in autumn as "Fu Shu" (Latent Summer-heat Disease). At this time, cool breezes invade the skin and muscles; new external pathogens attempt to enter while latent qi attempts to exit, resulting in alternating chills and fever resembling malaria. The symptoms may present with slight chills or slight fever, lacking the clear demarcation seen in typical malaria. The pulse is necessarily sluggish, and the tongue coating is necessarily greasy. There is epigastric fullness and Qi obstruction, thirst, and a sense of stifling vexation. Symptoms worsen after noon and become more severe at night, only alleviating slightly after sweating occurs at dawn. This pattern persists daily for two to three pentads (each pentad being five days) before complete resolution. If management is improper, many cases remain untreatable. Unlike Wind-Cold pathogens, which resolve with a single sweat, or Warm-Thermal pathogens, which settle with cooling agents, this condition requires specific handling.

It is proposed to use the method of Clearing, Disseminating, Warming, and Transforming (Qing Xuan Wen Hua Fa) to separate the new pathogen from the latent qi, thereby resolving the new pathogen first, followed by the latent qi. However, this syndrome involves numerous variations. Initially resembling malaria, one should first administer the Clearing, Disseminating, Warming, and Transforming method. If chills have resolved but fever lingers persistently, add Reeds Rhizome (Lugen, 芦根), Bamboo Rhus (Zhuru, 竹茹), and Forsythia Fruit (Lianqiao, 连翘). Banxia (Pinelliae Rhizoma, 半夏) and Chenpi (Citri Reticulatae Pericarpium, 陈皮) within the original formula may be removed, lest their warming and drying properties damage Body Fluids (Jin Ye, 津液). If the initially greasy tongue coating gradually turns yellow, dry, black, and scorched, it indicates that the heat of Latent Summer-heat has injured Yin. In this case, add American Ginseng (Yangshen, 洋参), Ophiopogon Tuber (Maidong, 麦冬), Scrophularia Root (Xuanshen, 元参), and Rehmannia Root prepared with wine (Shengdihuang, 细地) to treat the condition. If mental confusion and clouding of consciousness occur, it signifies the pathogen approaching the Pericardium (Xin Bao, 心包). Yi Yuan San (Benefit Origin Powder) and Zi Xue Dan (Purple Snow Pill) should be used according to the severity of the syndrome. If high fever, scorched tongue, delirium, and a full yet not deficient pulse are present, the pathogenic heat has merged into the Yangming channel. One should employ the Moistening Purging and Saving Fluids method (Run Xia Jiu Jin Fa). For robust individuals, raw Rhubarb (Sheng Dahuang, 生军) may replace processed Rhubarb (Shu Dahuang, 熟军) for greater efficacy. Regarding these various transformed syndromes, one must carefully examine the duration of the disease and the deficiency or excess of the constitution during clinical practice, applying methods accordingly to avoid errors.

A questioner asked: "In Yu Zai's writings on Latent Summer-heat, it was stated that during the Sanfu period, books were exposed to the scorching sun and then stored in chests while still hot. Upon opening the chest in winter, contact with the residual heat caused illness. This current discussion does not mention this at all. Is it an omission?" The reply was: "You are indeed carving a mark on the boat to find the sword (acting dogmatically without regard to changing circumstances). This is merely an occasional occurrence. If your theory held, Latent Summer-heat would only affect those who dry books, and never those who do not; it would only occur in winter, never in autumn. Such reasoning is laughable."