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Article 36: When the summerheat pathogen penetrates deeply into the Shaoyin channel and manifests as excessive thirst (xiaoke), Lianmei Tang (Coptis and Mume Decoction) is indicated. If it invades the Jueyin channel and manifests as paralysis, Lianmei Tang is also indicated. In cases of severe heart heat with irritability and profound mental confusion, Zixue Dan (Purple Snow Pill) should be administered first, followed by Lianmei Tang.

The Kidney governs the five fluids and detests dryness. Summerheat enters the Heart first, exacerbating the solitary hyperactivity of Heart Fire above, preventing Kidney fluids from ascending to nourish, thus causing excessive thirst. Furthermore, both the Heart and Kidney belong to the Shaoyin channel and govern Fire. Since summerheat is a Fire pathogen, Fire interacting with Fire creates a struggle where Water cannot provide relief; hence, excessive thirst occurs. Coptis Rhizoma (Huanglian) clears vigorous Fire to prevent it from scorching body fluids. Mume Fructus (Wumei) generates fluids via its sour taste. Combined, Sour and Bitter transform into Yin. Donkey-hide Gelatin (Ejiao), being black and heavy-settling, rescues Kidney Water. Ophiopogon Tuber (Maidong) and Rehmannia Root (Shengdihuang) combined with Mume Fructus use Sour and Sweet to transform into Yin, thereby stopping excessive thirst.

The Liver governs the sinews and receives fluid nourishment from the Kidney. Heat pathogens damage Yin, leaving the sinew channels without sustenance, resulting in paralysis. Additionally, the Pericardium and Liver both belong to the Jueyin channel and govern Wind-Wood. Summerheat enters the Heart first, and the Pericardium bears the impact on behalf of the Heart. Wind and Fire struggle against each other, leading to paralysis. Coptis Rhizoma (Huanglian) clears the Fire that overacts on Water. Mume Fructus (Wumei) captures the Qi of Wood early, supplementing the Liver's upright Qi. Donkey-hide Gelatin (Ejiao) increases fluids to extinguish Liver Wind. Ophiopogon Tuber (Maidong) and Rehmannia Root (Shengdihuang) nourish Water to soften Wood, thereby stopping paralysis. For severe heart heat, irritability, and mental confusion, Zixue Dan is used first to open an exit for the summerheat pathogen, allowing Lianmei Tang to enter effectively.

Lianmei Tang Formula (Sour-Sweet Transforming Yin, Sour-Bitter Draining Heat Method)
Coptis Rhizoma (Yunlian) - 2 qian
Mume Fructus (Wumei), pitted - 3 qian
Ophiopogon Tuber (Maidong), with heart - 3 qian
Rehmannia Root (Shengdihuang) - 3 qian
Donkey-hide Gelatin (Ejiao) - 2 qian
Boil five cups of water until reduced to two cups. Divide into two doses. If the pulse is deficient, large, and hollow (kou), add Ginseng Radix et Rhizoma (Renshen).

Article 37: When the summerheat pathogen penetrates deeply into the Jueyin channel, presenting with gray tongue coating, excessive thirst, epigastric fullness and hardness, vomiting or nausea with expulsion of roundworms, alternating chills and fever, bloody diarrhea, inability to speak, and upper-lower obstruction, Jiaomei Tang (Zanthoxylum and Mume Decoction) is indicated.

This represents the failure of Earth (Spleen/Stomach) and the overacting of Wood (Liver/Gallbladder), with deficiency of righteous Qi and excess of pathogenic factors. It is a critical condition. Therefore, the method of Sour-Bitter draining heat and supporting righteous Qi to expel pathogens is adopted. The formula is constructed based on theory, hoping for a turning point in the disease.

Jiaomei Tang Formula (Sour-Bitter Restoring Pungent-Sweet Method, i.e., Zhang Zhongjing's Wumei Wan Method; see Middle Jiao Chapter for rationale)
Coptis Rhizoma (Huanglian) - 2 qian
Scutellaria Root (Huangqin) - 2 qian
Dried Ginger (Ganjiang) - 2 qian
White Peony Root (Baishao), raw - 3 qian
Zanthoxylum Pericarpium (Chuanjiao), stir-fried until black - 3 qian
Mume Fructus (Wumei), pitted - 3 qian
Ginseng Radix et Rhizoma (Renshen) - 2 qian
Immature Bitter Orange (Zhishi) - 1.5 qian
Pinellia Tuber (Banxia) - 2 qian
Boil eight cups of water until reduced to three cups. Divide into three doses.

Article 38: If summerheat is treated incorrectly, damaging the Stomach, extending to the Middle and Lower Jiao, causing Qi blockage filling the chest, restlessness, thirst, pathogenic accumulation internally, and mixing of Clear and Turbid Qi, Laifu Dan (Restoration Pill) is indicated.

This is a critical condition where Righteous Qi is mistakenly injured by medication, allowing Pathogenic Factors to occupy the Middle Jiao firmly, making it difficult to resolve. Both attacking pathogens and tonifying deficiency are challenging. This formula attempts to rotate the Clear and Turbid Qi.

Laifu Dan Formula (Sour-Warm Method)
Taiyuan Yuanjing Stone (Yuanshi) - 1 liang
Bo Shang Sulfur (Shuhuang) - 1 liang
Niter (Xiaoshaoshi) - 1 liang (ground together with sulfur, stir-fried over low heat until granular)
Tangerine Peel (Juhong) - 2 qian
Green Tangerine Peel (Qingpi), white pith removed - 2 qian
Trogopterus Feces (Wulingzhi), clarified and sand removed, stir-fried until smoke ceases - 2 qian

[Formula Commentary] Wang Yingxiong (Jinsan) stated: The *I Ching* speaks of "One Yang returning below," which in humans corresponds to the organ where Shaoyang Sheng Qi originates. In conditions of excess above and deficiency below, Yang Qi departs and Sheng Qi exhausts. This pill restores Yang at the bottom, hence named "Laifu" (Returning to Rebirth). Yuanjing Stone is the essence of salt brine, extreme Yin. Sulfur is the essence of pure Yang stone fire. Cold and Heat paired, Yin and Yang mutually assisting, they have the merit of rescuing critical conditions. Niter transforms sulfur into water, assisting Yuanjing Stone and Sulfur in descending rebellious Qi. Trogopterus Feces enters the Liver channel rapidly, guiding the stone properties inward to Jueyin and outward to Shaoyang, serving as the pivot for interacting Yin and Yang. Tangerine Peel and Green Tangerine Peel are used as envoys because gathering Qi requires moving Qi first; they act as guides for the Liver and Gallbladder.

Article 39: When summerheat causes prolonged fever, restless sleep, lack of taste in food, unclear consciousness, and injury to both Yin fluids and Yuan Qi, Santang Tang (Three Powers Decoction) is indicated.

For long-standing heat diseases penetrating the Lower Jiao, which consume True Yin, restoring Yin must be the primary focus. If Yuan Qi is also injured, protecting Yang must be concurrent. Santang Tang restores both Yin and Yang, but leans more towards restoring Yin. It is also useful when warm-heat or warm-epidemic pathogens have not yet transmitted, and the pathogen has receded by 80-90%. For summerheat-warmth that has not transmitted, formulas such as Fumai Tang, Sanjia San, and Huanglian Ejiao Tang may also be used. Compare these mutually; do not adhere rigidly to one view. Summerheat-warmth is not listed among other warm diseases but stands alone because diseases occurring after the Summer Solstice are termed "Shu" (Summerheat). With significant dampness movement, if it does not combine with Dampness, it cannot be named Summerheat-Warmth, and would remain in the Warm-Heat category. Since it combines with Dampness, the initial stage cannot follow the same methods as other warm diseases. However, if the disease has not transmitted and the Dampness has transformed, during the phase of residual heat injuring Yin, the general approach is similar to other warm diseases. The differences were established in previous articles.

Santang Tang Formula (Sweet-Cool Method)
Ginseng Radix et Rhizoma (Renshen) - 3 qian
Asparagus Tuber (Tiandong) - 2 qian
Prepared Rehmannia Root (Ganedihuang) - 5 qian
Boil five cups of water, decoct strongly to two cups. Divide into two warm doses. To restore Yin, add Ophiopogon Tuber (Maidong) and Schisandra Berry (Wuweizi). To restore Yang, add Poria (Fuling) and Honey-fried Licorice Root (Zhigancao).

Article 40: Blood stasis (Xuxue) and Heat entering the Blood Chamber (Xueshi) are treated using the same methods as warm-heat diseases.

Article 41: For hypochondriac pain caused by latent summerheat or damp-warmth, with or without cough, without chills but with tidal fever, or even chills and fever resembling malaria, do not mistake this for a Chaihu pattern. Xiangfu Xuanfuhua Tang (Cyperus and Inula Flower Decoction) is indicated. If unresolved for a long time, Kongyan Dan (Phlegm-Fluid Expelling Pill) may be used intermittently.

Note: Latent summerheat and damp-warmth often retain branch-fluids hanging under the hypochondrium, causing hypochondriac pain. This resembles the *Jin Gui Yao Lue* case of "Water in the Liver" treated with Shizao Tang. That condition involves long-standing internal water accumulation requiring harsh purgation. This condition involves seasonal pathogens newly combining with internal water, with unstable roots, so harsh drugs like Shizao Tang are unnecessary. Instead, Cyperus Rhizome (Xiangfu) and Inula Flower (Xuanfuhua) unblock Liver collaterals and drive out fluid under the hypochondrium. Perilla Seed (Suzi) and Apricot Seed (Xingren) descend Lung Qi to transform fluid ("Establish Metal to calm Wood"). Tangerine Peel (Guangpi) and Pinellia Tuber (Banxia) eliminate phlegm-fluid directly. Poria (Fuling) and Coix Seed (Yiren) open the Taiyang and close the Yangming ("To treat water, one must solidify Earth"; opening side channels when the main stream floods). Used correctly, self-healing occurs within 3-5 days. If previous physicians misidentified the cause and treatment, allowing fluid to stagnate in the hypochondrium, it may become "Xuan Yin" (hanging fluid) causing internal pain. Although harsh Shizao Tang is not needed, Kongyan Dan by Chen Wuyue is used to gently purge the fluid.

Xiangfu Xuanfuhua Tang Formula (Bitter-Pungent-Diffuse Combining with Aromatic Unblocking Collaterals Method)
Raw Cyperus Rhizome (Xiangfu) - 3 qian
Inula Flower (Xuanfuhua), wrapped in silk - 3 qian
Perilla Seed Paste (Suzishuang) - 3 qian
Tangerine Peel (Guangpi) - 2 qian
Pinellia Tuber (Banxia) - 5 qian
Poria Block (Fulingkuai) - 3 qian
Coix Seed (Yiren) - 5 qian
Boil eight cups of water until reduced to three cups. Divide into three warm doses. For abdominal fullness, add Magnolia Bark (Houpo). For severe pain, add Powdered Costus Root (Jiangxiang).

Kongyan Dan Formula (Bitter-Cold Following Treatment Method)
Phlegm-fluid is a Yin disease. Treating Yin disease with Bitter-Cold herbs follows the principle of "seeking the root to reduce it." Regarding the Kidney Channel: from the Zang perspective, it belongs to Water, tastes Salty, and is Cold in nature. From the Jing (Channel) perspective, it belongs to Shaoyin, governs Fire, tastes Bitter, and transforms into Dry-Heat. The Kidney governs Water, so Bitter-Cold belongs to Water, not just Salty-Cold. True Yang resides in the Kidney; thus, Kidney and Heart are both called Shaoyin and govern Fire. Understanding this explains the use of Bitter-Cold and Salty-Cold methods. To drain excess Fire, Bitter-Cold is used; Cold controls Fire, Bitter transforms from Fire. Within direct treatment, there is following treatment. To drain excess Water, Bitter-Cold is also used; Cold follows Water Qi, Bitter follows Fire Taste. Within following treatment, there is direct treatment. When Water and Fire reach extremes of deviation, they appear similar. Using Bitter-Salty-Cold for excess Fire and insufficient Water is direct treatment. For excess Water and insufficient Fire, such as shell medicines or Mirabilite (Mangxiao) moving Water, where moving Water restores Fire, this is following treatment.

Kansui Root (Gansui), heart removed and processed -
Bighead Knawel Root (Daji), skin removed and processed -
Mustard Seed (Baijiezi)
Grind equal parts into fine powder. Make pills with Qu paste, size of wutong seeds. Take 9 pills per dose with Ginger Decoction. Increase dose for strong constitutions, decrease for weak ones. Stop when effective.