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During the hot and sultry season, some people develop blisters all over their bodies, varying in size like bowls or cups, resembling peaches or plums. They are crystal clear, crisp, and thin, containing foul-smelling fluid. This is caused by damp-heat pathogenic factors overflowing onto the muscle surface (肌表). Treatment may involve Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity), Xiangru Yin (Elsholtzia Drink), or Jiedu Tang (Detoxifying Decoction). In severe cases with internal excess and constipation, accompanied by mouth ulcers and foul breath, Liangge San (Cooling the Diaphragm Powder) or Chengqi Tang (Descending the Qi Decoction) may be selected. Externally, fresh lotus petals applied to the sores can lead to recovery within a week.

Individuals of wealthy status accustomed to rich foods may experience flaccidity and weakness of yang energy during the summer months. If physicians mistakenly administer warming and heating herbs, it is an error. When dampness and heat steam together, akin to moisture seeping into metal and stone or sap flowing from plants, those with depleted spirit and qi should follow the seasonal changes. The appropriate treatment is Huanglian Jiedu Tang combined with Shengmai San (Generate the Pulse Powder).

In summer, if there is no headache or fever, but only pain in the lower abdomen, or pain in both the heart and abdomen, with bloating and fullness preventing flexion and extension, physicians might suspect excessive consumption of cold and raw foods and stubbornly diagnose it as a yin syndrome. However, this is actually due to summer-heat fire flowing into the zang-fu organs. Thus, pain starts in the lower abdomen and spreads to the heart and abdomen. Liuhe Tang (Six Harmonies Decoction) should be used to clear and resolve. Alternatively, Siling San (Four苓 Powder) added with Xiangru, Mugua, Zisu, and Banxia can be used to harmonize and disperse. Zhengqi San (Righteous Qi Powder), or Erchen Tang (Two Aged Things Decoction) added with Houpo and Chao Zhizi, may also be used. One may also induce vomiting of phlegm and saliva using roasted salt mixed with boiling water. Generally, for this condition, the vomiting method is superior. Using warming medicines would distance the patient from health.

When summer-heat qi enters the abdomen, causing nausea, abdominal pain, vomiting, and diarrhea with watery stools, this is a sudden outbreak of summer-heat fire leading to dysfunctional ascending and descending movements, failing to separate the clear from the turbid. The discharged fluids are essentially the essence and fluids of the five zang organs, which must be stopped quickly. Wuling San (Five苓 Powder) or Weiling Tang (Stomach Five苓 Decoction) can be used to promote urination and clear summer-heat fire. In severe cases, Guiling Ganlu San (Cassia and Poria Dew Sweetening Powder) is indicated. Some cases involve food stagnation; if physicians use purgatives, it is a mistake. Since the essence and fluids have suddenly dried up and primordial qi is instantly damaged, stopping the symptoms immediately is paramount. "Stopping" here does not mean treating flow with obstruction (using astringents for discharge syndromes), but rather distinguishing yin and yang and removing summer-heat, after which vomiting and diarrhea will cease naturally.

There are cases where there is nothing to vomit or pass, with closure of both upper and lower orifices, resulting in no vomiting or diarrhea at all. This is called Dry Huoluan (Dry Cholera). It presents with severe cramping pain in the heart and abdomen, leading to immediate death. Emergency treatment involves inducing vomiting with roasted salt water or Erchen Tang. If the orifices open, rescue is possible. Even after stabilization, for one week, no grain should be consumed; eating will cause relapse. Exercise extreme caution. *Ji Lun* states that summer-heat stroke involves merely clearing the heart, promoting urination, resolving summer-heat toxicity, and supplementing true qi. Even if the pulse is weak, deep-hidden, with panting, cold extremities, and sudden fainting, warming agents must not be used. This is because heat injures yin qi; using warming agents aids yang and consumes yin. Furthermore, in winter, floating-tight or floating-slow pulses distinguish wind-strike from cold damage; in summer, string-tight indicates wind injury, string-slow indicates summer-heat stroke. Surface deficiency with spontaneous sweating yields a slow pulse, while surface constraint with no sweating yields a tight pulse. Laypeople misunderstand, claiming that since yin qi resides inside during summer, Dashun San (Great Harmony Powder) is essential. However, "yin" does not mean "cold"; it simply means yang is outside and yin is inside. Zhu Danxi stated that "hidden yin inside" implies deficiency, not coldness. Interpreting it as coldness is erroneous. During the fire season, stones melt and metals flow; where is the cold? Sun Simiao used Shengmai San, indicating qi deficiency. The ancients used Dashun San not for hidden yin, but originally for injuries caused by ice-cold fruits. Lengxiang Yin (Cold Fragrance Drink) treats severe yang deficiency and厥逆 (reversal cold) from excessive desire. Jiangshui San (Fermented Grain Water Powder) treats collapse of yang from profuse sweating with a faint, nearly imperceptible pulse. Other suitable formulas include Qingshu Yiqi Tang (Clear Summer-Heat and Benefit Qi Decoction), Xiaoshu Shiquan San (Eliminate Summer-Heat Perfect Ten Powder), and Shiwei Xiangru Yin (Ten Ingredients Elsholtzia Drink).

Xue notes: If it is a case of cold strike, it is a yin-cold syndrome, and the method should primarily tonify yang. Ancients often used Shengjiang (Fresh Ginger), Rongui (Cinnamon Twig), and Fuzi (Aconite Root). Some argue that the character "Zhong" (strike) should be read as "Shu" (summer-heat). However, why not simply use the character "Shu," thereby avoiding confusion for later generations?

Zhou Yu-zai comments: Xue's statement originates from Li Dongyuan's Dashun San. Its absurdity is incalculable; it disregards human life and deserves the blame for initiating such harmful practices.