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Shu Ke (Summerheat Cough) is a disease that occurs exclusively during the summer months. This is primarily due to summer-heat and fire pathogens forcing downward, damaging the upper jiao first. Among the five zang organs, the Lung is positioned highest, serving as the "Canopy" (Huagai, 华盖) protecting all other organs. When summer-heat attacks it, it is inevitable that the Lung meridian becomes diseased first. Moreover, summer-heat contains fire; since the Lung belongs to Metal in the Five Elements, Fire inevitably overcomes Metal. The pulse is soggy, slippery, and rapid; the cun positions on both wrists are forceful and strong. There is coughing with rebellious qi and scanty sputum, or even no sputum at all. Symptoms may include fever, thirst, chest tightness, and hypochondriac pain. These are the pulse and symptom manifestations of summer-heat entering the Lung. It is appropriate to use Qing Xuan Jin Zang Fa (Clear and Disperse the Metal Organ Method) plus Hua Shi (Talcum, Talcum Glaucescens) and Gan Cao (Licorice Root, Glycyrrhizae Radix et Rhizoma) for treatment. If there is excessive sputum, it is not caused by summer-heat but by dampness; it should be named Sou (Phlegm-rheum cough) rather than Ke (Cough); the pathology lies in the Spleen rather than the Lung; and the treatment method should be warming rather than clearing. If the cough is indeed caused by phlegm, Jia Wei Er Chen Tang (Modified Two-Aged Powder) is appropriate. If one fails to distinguish carefully and mistakes summer-heat for dampness, mistakenly using warming herbs, it will disturb the collaterals, causing blood to boil within the collaterals, leading to hematemesis (vomiting blood). In such cases, Que Shu Diao Yuan Fa (Eliminate Summerheat and Regulate Primordial Qi Method) should be used, removing Dong Shen (Asiatic Solomon's Seal Rhizome, Glehniae Radix) and Ban Xia (Pinellia Tuber, Pinelliae Rhizoma), and adding Xing Ren (Apricot Seed, Armeniacae Semen Amarum), Hua Fen (Trichosanthes Root, Trichosanthis Radix), Han Lian Cao (Eclipta Herb, Ecliptae Herba), and Sheng Di Huang (Rehmannia Root, Rehmanniae Radix). Generally, it is best to clear summer-heat and protect the Lung metal, so as to prevent the condition from spreading into deficiency consumption.

Shu Zhai (Summerheat Tuberculosis-like Hemorrhage) presents with sudden hematemesis or epistaxis, cloudiness of the head and eyes, irritability, heat, thirst, cough, and wheezing. The pulse is surging when lightly palpated, empty when moderately palpated, and reappears when deeply palpated. This is caused by the ministerial fire being active during midsummer, scorching Lung metal and igniting the Yang collaterals, leading to the upward overflow of collateral blood. Ignorant practitioners mistake this for Lao Zhai (Tuberculosis/Consumption), not realizing that this is blood carried upward by fire, which is fundamentally different from true Yin deficiency consumptive diseases. One should clear summer-heat to protect the Lung and clear collateral heat to stop bleeding. For patients who are physically robust at the onset, Qing Xuan Jin Zang Fa (Clear and Disperse the Metal Organ Method) plus Ku Qin (Scutellaria Root, Scutellariae Radix) and Hei Zhi (Charred Gardenia Fruit, Gardeniae Fructus) is appropriate. For those with weak constitutions, Que Shu Diao Yuan Fa (Eliminate Summerheat and Regulate Primordial Qi Method) should be used, removing Shi Gao (Gypsum Fibrosum, Gypsum), Ban Xia (Pinellia Tuber, Pinelliae Rhizoma), and Jing Mi (Rice, Oryzae Fructus), and adding Xian Di Huang (Fresh Rehmannia Root, Fresh Rehmanniae Radix), Xian Hu (Fresh Dendrobium Stem, Dendrobii Caulis), and Xian Ou Jie (Fresh Lotus Rhizome Node, Nelumbinis Rhizomatis Nodus). If bleeding does not cease, add Mu Dan Pi (Moutan Cortex, Moutan Radicis Cortex) and Han Lian Cao (Eclipta Herb, Ecliptae Herba). Although this is not a tuberculous disease, after hemorrhage, symptoms such as tidal fever and cough may appear, and the fine, rapid pulse indicates that even if the Yin aspect was not previously deficient, it now is. At this stage, Gan Xian Yang Yin Fa (Sweet and Salty Nourishing Yin Method) should be employed. If treatment is delayed, damaging the True Yin, the condition will become difficult to cure.