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Heat (Shu) corresponds to the late summer (the last month of summer). Late summer is governed by damp-earth. If the Sovereign Fire (Heart Fire) holds authority and does not yield to its offspring (damp-earth), the climate characteristics of heat-dampness will not manifest. When the dampness mandate does not appear, the Earth Qi becomes deficient.

At this time, the Wood Qi, which Earth normally controls, acts recklessly, manifesting as excessive Wood Qi and prosperity of Shaoyang Ministerial Fire. The element generated by Earth, namely Lung Metal, suffers disease and becomes insufficient. Due to Lung Metal's insufficiency, the Water Qi, which normally controls Metal, rebels against it (reverse overcoming), allowing Water Qi to invade the Earth sector.

Earth corresponds to the Kun trigram. In the twelve Earthly Branches, Shen month corresponds to the position of Kun Earth, and Shen is also associated with Ministerial Fire. If Water Qi enters the Earth position, Water and Fire interfere with each other, leading to a struggle between Yin and Yang.

Therefore, alternating chills and fever occur. The terminal manifestation of combined Wood Qi can be seen in the Sanjiao (Triple Burner), which represents the combination of the two Shaoyangs (Hand Shaoyang and Foot Shaoyang). Since Shaoyang resides in the domain of damp-earth, it presents as alternating chills and fever. The chills and fever with a shivering sensation caused by Lung Metal insufficiency are all signs of unsettled, fluctuating Qi. Thus, it is diagnosed as Malaria.

If malaria does not manifest in summer but appears in autumn, it is because the Heat-Dampness Qi gains dominance in You month (the second month of autumn). Therefore, it manifests after the Great Heat solar term.

Autumn Qi is clear, crisp, and肃 (solemn/clear), possessing the nature of convergence and downward movement. If injured by dampness, it means the Qi of Long Summer (late summer) interferes with the Autumn mandate. When the Autumn mandate is insufficient, the Wood Qi, which Metal normally controls, acts recklessly (Note: The text implies a complex interaction where Autumn Metal fails to control Wood, or previous Wood excess continues). Consequently, Fire Qi flares upward and overcomes Metal. Once Heart Fire forms pathogenic influence in the Lung, Lung Qi rebels upward causing cough.

The Wood Qi, which overcomes Metal, also moves upward, acting together with Fire Qi, gaining momentum and ceasing not. The element generated by Metal, Kidney Water, suffers disease and becomes deficient. The Qi of Long Summer has already become hyperactive, and the Qi of the Sanjiao is vigorous. Mingmen (Gate of Life) is the residence of the Sanjiao; therefore, it forces Kidney Water to move upward, combining with the Damp-Heat of Spleen Earth to form Phlegm obstruction, disturbing the Dampness within the Spleen.

Thus, cough produces sound and phlegm. If cough does not manifest in autumn but appears in winter, it is because winter is the extreme of the Six Yin phases, and the Killing Qi (Cold/Autumnal energy) just begins to gain its dominant air. Therefore, the Lung does not cough in autumn but coughs in winter.

Cough is the rebellion of Qi moving upward. As Qi moves upward and rebels, the face and eyes may swell slightly; in severe cases, the whole body swells, transforming into Edema (Water Qi). Hence it is said, "Turbid Qi remaining above causes distension." It is also said, "All Qi stagnation and oppression belong to Lung Metal," which refers to this phenomenon.

"Spring injury by Wind, Summer injury by Heat, Winter injury by Cold" have smooth logic because the usage of "Time" and "Injuring Mandate" characters is consistent. Only "Autumn injury by Dampness" treats "Dampness" as the "Mandate" (of Long Summer) and "Autumn" as the "Time". Readers do not doubt this. These four conditions involve no extreme exuberance of the pathogen itself, but rather harm the "offspring" organ that it generates (or is related to via generation). The pathogen manifests from the subsequent season, indicating that the annual governing Qi has specific divisions for causing disease, which is a fixed law. If one interprets "Autumn injury by Dampness" as having the same textual structure as the preceding three sentences, the literary connection exists, but the medical theory and method do not align. Generally, theory and method must connect, without being bound by literal text. Therefore, when interpreting poetry, one should not let words obscure phrases, nor phrases obscure meaning, but seek the intent behind the words to truly understand. Thus, saying "Spring injury by Wind" simply means being injured by wind as a person is incorrect. If so, there would only be headache, aversion to wind, and spontaneous sweating; how could one speak of diarrhea (sun-xie) occurring in summer? Now, stating "Spring injury by Wind" clearly means injuring the mandate at the appropriate time. The Classic states: "Wind coming from the East is called Infant Wind; when it injures people, externally it affects tendons, internally it abides in the Liver." It also says: "Injury on Jia and Yi days in Spring is called Liver Wind." Using these two sentences to compare with the preceding text, the logic and rhetoric naturally become coherent.