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(Note: Shuwen [Summerheat-Warmth] and Fushe [Retained Summerheat], although named differently, share the same pathological essence. Their treatment methods must be referenced mutually; therefore, no separate section is established in the Middle Jiao and Lower Jiao chapters.)

Article 35: When Summerheat combines with Dampness-Heat, if it leans towards the heat aspect of Summerheat, it is called Shuwen (Summerheat-Warmth), which mostly presents as Hand-Taiyin [Lung] patterns and should be treated with clearing methods. If it leans towards the damp aspect of Summerheat, it is called Shiwen [Damp-Warmth], which mostly presents as Foot-Taiyin [Spleen] patterns and should be treated with warming/drying methods. If heat and dampness are equal, both exterior and interior should be resolved simultaneously. Each condition must be distinguished clearly and not confused.

This text serves to connect the preceding and following sections. Note: Regarding Shuwen and Shiwen, ancient methods are numerous and exquisite, unlike the previous article on Warmth diseases which lacked standards. This treatise could theoretically have omitted further discussion. However, since *Neijing* explicitly states "diseases occurring before the Summer Solstice are called Warmth, and those after are called Summerheat," Summerheat and Warmth, though divergent in flow, share the same source. One cannot discuss treating Warmth while omitting Summerheat, nor treat Summerheat while omitting Dampness. Furthermore, past famous physicians often suffered from ambiguity because the three pathogens of summer (Summerheat, Dampness, Wind/Cold) are complex and hard to distinguish meticulously. Only Ye Tianshi possessed exceptional insight and skill; his treatment methods in medical cases were precise and coherent, gathering the strengths of many. Regrettably, contemporaries failed to understand even a fraction of this. His methods were scattered across cases without fixed protocols, causing beginners to feel overwhelmed, hence the lack of a ladder for later generations. Thus, this treatise extracts the general principles and establishes a rough framework to guide learners. Many subtleties are not fully recorded; learners should still consult famous masters and carefully analyze Ye’s cases to achieve mastery. Additionally, Zhang Jiegu stated: "Obtained in stillness is Zhongshu [Heatstroke]; obtained in motion is Zhonger [Heatstroke]. Zhongshu is a Yin pattern, Zhonger is a Yang pattern." Alas! Zhang Jiegu’s writing was so ambiguous that later generations took it as a standard, making the Dao of medicine difficult to articulate. Consider: Is there really no case of Zhongshu obtained through motion? Or no case of Zhonger obtained through stillness? It seems difficult to distinguish Summerheat and Heat merely by motion and stillness. He also claimed "Zhongshu is a Yin pattern." The character "Shu" contains "Sun"; is the Sun not a Yin object? Summerheat contains Fire; is Fire not a Yin pathogen? Summerheat contains Yin, which is Dampness, not purely Yin pathogenic factors. "Zhonger is a Yang pattern" is indeed true, but one must know that Heat also incorporates turbid qi, which belongs to the Yin category; thus, Zhonger is not devoid of Yin. Essentially, Zhang Jiegu’s "Zhongshu" refers to what this treatise calls Shiwen later on; his "Zhonger" refers to the Wenre [Warmth-Heat] mentioned earlier. Zhang Jingyue further subdivided Yin Summerheat and Yang Summerheat: Yin Summerheat refers to Summerheat leaning towards Dampness, forming Foot-Taiyin interior patterns; Yang Summerheat refers to Summerheat leaning towards Heat, forming Hand-Taiyin exterior patterns. Learners who are not proficient enough to dissect the cow (idiom for mastering technique) cannot grasp the key points. Since the Song and Yuan dynasties, many famous physicians have been self-righteous, failing to seek natural laws, explaining why the Dao remains obscure and why contemporaries kill people casually. How lamentable!

Article 36: When Summerheat is contracted during Changxia [Late Summer] and manifests after the summer season has passed, it is called Fushe [Retained Summerheat]. Manifestation before frost fall is mild; manifestation after frost fall is severe; manifestation in winter is particularly severe. It occurs most frequently in Zi, Wu, Chou, and Wei years.

In the intense heat of Changxia, those with strong Qi do not contract the disease. Those slightly weaker may only experience dizziness for a moment or half a day. Others will fall ill immediately. Those who do not fall ill immediately but have the pathogen lodging internally in the bone marrow and externally between the muscle layers possess deficient Qi. Because deficient Qi cannot transmit the Summerheat pathogen outward, it must wait for the cooling Metal Qi of autumn to clash with it before expulsion. Metal Qi naturally retards Summerheat; when Metal Qi attempts to retreat it, the Summerheat has nowhere to hide, leading to the onset of Fushe. In cases of severe Qi deficiency, even the autumn wind cannot expel it; it must wait for the deep cold of late autumn and slight cold of early winter to force it out, making it even more severe. The prevalence in Zi, Wu, Chou, and Wei years is due to the fact that in Zi and Wu years, Junhuo [Ministerial Fire] governs the Heaven, and Summerheat originates from Fire; in Chou and Wei years, Shitu [Wet Earth] governs the Heaven, and Summerheat lingers when combined with Dampness.

Article 37: Headache, slight aversion to cold, red face, irritability, thirst, white tongue coating, and a soggy (Ru) yet rapid pulse indicate Taiyin Fushe, even in winter.

Headache and aversion to cold are identical to Shanghan [Cold Damage]; however, a red face, irritability, and thirst rule out Shanghan, though it may resemble Yangming patterns of Shanghan. If the pulse is soggy and rapid, it is definitely not Shanghan. Generally, Cold pulses are tight, Wind pulses are slow, and Summerheat pulses are weak. A soggy pulse is a manifestation of weakness; weakness is the substance of sogginess. A soggy pulse corresponds to the empty center of the Li trigram, representing Fire; a tight pulse corresponds to the full center of the Kan trigram, representing Water. Fire’s nature is hot, Water’s nature is cold; their images differ, and their natures are distinct. Why do people universally treat Fushe as Shanghan, using herbs like Qianghuo, Gegen, Chaihu, and Huangqin targeting the Foot Six Channels, often resulting in death? Since images differ and natures are distinct, even in winter, one must determine it is not Shanghan but Fushe. If it is Fushe in winter, one can infer the situation in autumn. Fushe and Shanghan are as different as male and female: one is exterior excess and interior deficiency, the other is exterior deficiency and interior excess. How can they be confused?

Article 38: For Taiyin Fushe presenting with white tongue coating, thirst, and absence of sweating, Yinqiao San (Honeysuckle and Forsythia Decoction) modified by removing Niubangzi (Arctii Fructus) and Yuanshen (Scrophulariae Radix), and adding Xingren (Armeniacae Semen Amarum) and Huashi (Talcum) is the primary prescription.

This indicates the pathogen is in the Qi level with an exterior excess pattern.

Article 39: For Taiyin Fushe presenting with red tongue, thirst, and absence of sweating, Yinqiao San (Honeysuckle and Forsythia Decoction) modified by adding Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Chishao (Paeoniae Radix Rubra), and Maidong (Ophiopogonis Radix) is the primary prescription.

This indicates the pathogen is in the Blood level with an exterior excess pattern.

Article 40: For Taiyin Fushe presenting with white tongue coating, thirst, sweating, or profuse continuous sweating, Yinqiao San (Honeysuckle and Forsythia Decoction) modified by removing Niubangzi (Arctii Fructus), Yuanshen (Scrophulariae Radix), and Jiejui (Schizonepetae Spica), and adding Xingren (Armeniacae Semen Amarum), Shigao (Gypsum Fibrosum), and Huangqin (Scutellariae Radix) is the primary prescription. If the pulse is flooding (Hongda), thirst is severe, and sweating is profuse, Baihu Tang (White Tiger Decoction) method should still be used. If the pulse is deficient, large, and hollow (Kou), Ren Shen Baihu Tang (Ginseng White Tiger Decoction) method should still be used.

This indicates the pathogen is in the Qi level with an exterior deficiency pattern.

Article 41: For Taiyin Fushe presenting with red tongue, thirst, and profuse sweating, Jiasheng Mai San (Modified Shengmai San) is the primary prescription.

This indicates the pathogen is in the Blood level with an exterior deficiency pattern.

Yinqiao San Modified Formula (Removing Niubangzi and Yuanshen, Adding Xingren and Huashi):
Take Yinqiao San, remove Niubangzi (Arctii Fructus) and Yuanshen (Scrophulariae Radix), add Xingren (Armeniacae Semen Amarum) 6 qian and Fei Huashi (Prepared Talcum) 1 liang. Administer according to the Yinqiao San method. Add Yujin (Curcumae Radix) 4 qian and Xiangchi (Perillae Folium Fermentatum) 4 qian for chest oppression; add Banxia (Pinelliae Rhizoma) 6 qian and Fuling (Poria) 6 qian for vomiting with excessive phlegm; add Yiren (Coicis Semen) 8 qian and Baotongcao (Akebiae Caulis) 4 qian for scanty urination.

Yinqiao San Modified Formula (Adding Shengdi, Danpi, Chishao, and Maidong):
Take Yinqiao San, add Shengdi (Rehmanniae Radix) 6 qian, Danpi (Moutan Cortex) 4 qian, Chishao (Paeoniae Radix Rubra) 4 qian, and Maidong (Ophiopogonis Radix) 6 qian. Administer as previously described.

Yinqiao San Modified Formula (Removing Niubangzi, Yuanshen, and Jiejui, Adding Xingren, Shigao, and Huangqin):
Take Yinqiao San, remove Niubangzi (Arctii Fructus), Yuanshen (Scrophulariae Radix), and Jiejui (Schizonepetae Spica), add Xingren (Armeniacae Semen Amarum) 6 qian, Sheng Shigao (Raw Gypsum Fibrosum) 2 liang, and Huangqin (Scutellariae Radix) 5 qian. Administer as previously described.

Baihu Method and Baibu Jia Renshen Method (See previous sections).

Jiasheng Mai San Formula (Sour and Sweet Transform into Yin):
Shashen (Glehniae Radix) 3 qian, Maidong (Ophiopogonis Radix) 2 qian, Wuweizi (Schisandrae Fructus) 1 qian, Danpi (Moutan Cortex) 2 qian, Xi Shengdi (Young Rehmanniae Radix) 3 qian.
Boil five cups of water down to two cups. Divide into two doses, taken warm.

Article 42: Fushe [Retained Summerheat], Shuwen [Summerheat-Warmth], and Shiwen [Damp-Warmth] originate from the same source. Their treatments must be referenced mutually; one must not adhere rigidly to one aspect.