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"Summer injury by summerheat" refers to the condition where, during the periods of Late Summer, Minor Heat, and Major Heat, the body is injured by summerheat pathogen. At this time, the weather is hot and the earth's heat steams upward; people living in such an environment contract what are collectively called summerheat diseases. When summerheat pathogen invades the human body, it can be categorized into Shangshu (Injury by Summerheat), Maoshu (Encounter with Summerheat), and Zhongshu (Stroke of Summerheat). Furthermore, there are variations such as Shufeng (Summerheat Wind), Shuwen (Summerheat Warmth), Shuke (Summerheat Cough), and Shuzhai (Summerheat Consumption). Among these, Shangshu obtained while at rest is called Yinshangshu (Yin Injury by Summerheat), while that obtained during activity is called Yangshangshu (Yang Injury by Summerheat). Maoshu is milder than Shangshu, involving merely the encroachment of pathogen on the muscle-surface. Zhongshu, also known as Zhonghe (Stroke of Heat causing sudden collapse), involves sudden fainting or collapse, resembling stroke. Shufeng involves fainting within moments followed by convulsions of the hands and feet. Shuwen is slightly milder than Yangshangshu. Shuke results from summerheat invading the lungs, leading to cough and rebellious qi. Shuzhai results from summerheat damaging collaterals, leading to hematemesis. There is also Huoluan (Cholera-like syndrome characterized by sudden vomiting and diarrhea), caused by summerheat mixed with wind, cold, dampness, or food stagnation disturbing the middle jiao. Shaqi (Sha Qi disease) occurs due to weak constitutions in the south occasionally encountering sandy and turbid pathogens. Huihuo (Turbid Pathogen syndrome) arises when summerheat carries turbid pathogens to invade the body, commonly known as "Wochuo" (filthy disease). These are all conditions caused by summerheat during Late Summer. Additionally, Zhuxia (Sticking Summerheat) occurring in late spring and early summer, Rebing (Heat Disease) in Early Summer, and Meishi (Moldy Dampness) in Mid-Summer should also be discussed for treatment. Zhuxia is caused by the fire of the seasonal timing. Rebing is caused by latent qi hidden since winter. Meishi occurs after entering the plum rain season, where continuous rain allows one to contract dampness from the rainfall. These three conditions are appended here, thereby completing the discussion on summer diseases.

In Late Summer, injury by summerheat has distinctions between yin and yang. The pathology of Yinshangshu arises because, despite the scorching weather, one seeks coolness in deep halls and large buildings, using large fans or windmills; this is a yin syndrome obtained through stillness. The pulse is floating, wiry, and forceful, or floating and tight; symptoms include headache, aversion to cold, bodily stiffness and tension, pain in limbs and joints, vexation, high skin temperature but absence of sweating. This is caused by yin-cold forcing the body's yang qi to fail in its extension and dispersion. It is appropriate to use Acrid-Warm Exterior-Resolving Method, removing Fangfeng (Saposhnikovia Root) and adding Xiangru (Elsholtzia Herb) and Huoxiang (Patchouli Herb). If accompanied by retching, add Fuling (Poria) and Banxia (Pinellia Tuber); if accompanied by loose stools, add Houpo (Magnolia Bark) and Muxiang (Aucklandia Root). Conversely, Yangshangshu arises from long-distance travel or field labor under the scorching sun; this is a yang syndrome obtained through movement. The pulse is floating, surging, and forceful, or surging and rapid; symptoms include a greasy complexion, panting and cough, high fever, vexation, thirst with desire to drink, and steaming spontaneous sweating. This is caused by intense heat steaming the body, making both interior and exterior hot. It is appropriate to use Cool-Clearing and Summerheat-Scouring Method, removing BianDou (Faba Bean) and Tongcao (Tetrapanax Pith), and adding Shigao (Gypsum Fibrosum) and Yangshen (American Ginseng). If accompanied by retching, add Zhuru (Bamboo Shavings) and Huanglian (Coptis Rhizome); if accompanied by loose stools, add Gegen (Kudzu Root) and Heye (Lotus Leaf). One must further examine whether the constitution is excess or deficiency to prescribe medication appropriately, ensuring no errors.

Zhang Jiebin stated: Yinshangshu syndrome may manifest in the exterior or the interior, and is mostly seen in wealthy and leisurely people, generally resulting from indulgence and lack of caution against wind and cold. Yangshangshu syndrome is mostly seen in those who endure hard labor, resulting from unavoidable exposure to summer heat. However, when summer heat presses upon people, they fear it and can avoid it; thus, few fall ill. When yin cold attacks, it feels pleasant and goes unnoticed; thus, many fall ill. Therefore, among those suffering from summer diseases, Yangshangshu is rarely seen, whereas Yinshangshu accounts for eight or nine out of ten. Nowadays, when treating summer diseases, physicians see only symptoms like fever and headache and immediately diagnose it as Zhongshu (Stroke of Summerheat), prescribing nothing but cold-cooling herbs. This demonstrates a profound lack of understanding.

Jiang Cheng stated: Mr. Zhang Jiebin’s assertion that Yinshangshu is more common than Yangshangshu is most accurate. Today, physicians treat summerheat without distinguishing between yin and yang; upon seeing fever, they indiscriminately administer cooling medicines. Such reckless practice causes significant harm to patients.