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This is the key distinction among the various types of warm diseases. Warm-heat and similar conditions all originate from Fire; with Fire following Fire, and Yangming belonging to Yang Earth, Yang follows Yang; thus, Yangming diseases are predominant. Damp-warmth, however, involves Dampness following Dampness; Taiyin belongs to Yin Earth, and Yin follows Yin; thus, Taiyin diseases are predominant. Summerheat combines with Damp-Heat, so both aspects are present in equal measure.

38. When the pulse is surging and slippery, the face is red, the body is hot, there is dizziness, no aversion to cold, but only aversion to heat, the tongue has a yellow and slippery coating, thirst desires cool drinks but drinking does not quench it, drinking water induces vomiting, pressing on the hypochondrium causes pain, urine is scanty, and stool is closed, this is Yangming Summerheat-Warmth, where Water is knotted in the chest. It should be treated with Xiaoxianzhong Decoction plus Zhishi (Immature Bitter Orange).
A surging pulse, red face, and absence of aversion to cold indicate that the disease is no longer in the Upper Jiao. Summerheat combines with Warmth; when Heat is severe, thirst arises, and the patient draws water for relief. Dampness stagnates in the Middle Jiao, preventing water from descending, causing it to rebel upward, leading to vomiting. If Stomach Qi fails to descend, stool becomes closed. Therefore, Huanglian (Coptis Rhizome) and Gualou (Trichosanthes Fruit) are used to clear internal Heat-Phlegm; Banxia (Pinellia Tuber) removes watery Phlegm and strengthens the Stomach; Zhishi (Immature Bitter Orange) is added for its bitter-pungent property to promote descending flow, opening the pylorus to guide water downward.
Xiaoxianzhong Plus Zhishi Decoction Formula (Bitter-Pungent-Cold Method)
Huanglian (2 qian) Gualou (3 qian) Zhishi (2 qian) Banxia (5 qian)
Boil five cups of fast-flowing water until two cups remain. Divide into two doses.

39. In Yangming Summerheat-Warmth, if the pulse is slippery and rapid, there is anorexia without hunger, constipation, accumulation of turbid Phlegm, and epigastric fullness/stuffiness, Banxia Xiexin Decoction minus Renshen (Ginseng), Ganjiang (Dried Ginger), Dazao (Jujube), and Gancao (Licorice Root), plus Zhishi (Immature Bitter Orange) and Xingren (Apricot Seed) should be used.
Anorexia without hunger and constipation, accompanied by turbid Phlegm and epigastric fullness, indicate that Damp-Heat are interknotted, obstructing the Qi mechanism of the Middle Jiao. Therefore, Banxia (Pinellia Tuber) and Zhishi (Immature Bitter Orange) are used to open the Damp-knot in the Qi level; Huanglian (Coptis Rhizome) and Huangqin (Scutellaria Root) open the Heat-knot in the Qi level; Xingren (Apricot Seed) opens the Qi obstruction in the Lung and Large Intestine. Since Heat is severe in Summerheat diseases, Ganjiang (Dried Ginger) is removed. This is not a deficiency-type fullness caused by erroneous purgation in Cold Damage, so Renshen (Ginseng), Gancao (Licorice Root), and Dazao (Jujube) are removed to avoid aiding Dampness and causing distension.
Banxia Xiexin Decoction Minus Ganjiang, Gancao Plus Zhishi and Xingren Formula (Bitter-Pungent-Cold Method)
Banxia (1 liang) Huanglian (2 qian) Huangqin (3 qian) Zhishi (2 qian) Xingren (3 qian)
Boil eight cups of water until three cups remain. Divide into three doses. For deficient patients, add Renshen (2 qian) and Dazao (3 pieces).

40. In Yangming Summerheat-Warmth, if Dampness has transformed completely, leaving only Heat knotting alone, with dry mouth and throat, thirst desiring water, redness of face and eyes, dry yellow tongue coating, and a deep, solid pulse, Xiao Chengqi Decoction in equal parts should be used to purge.
Summerheat combines with Damp-Heat. In individuals who are thin and dry in constitution, contracting a condition where Heat is heavy and Dampness is light, the Dampness transforms completely with the Heat first, leaving only Heat knotting in the Middle Jiao. Only when symptoms indicating purgation are present can purgation be employed.
Xiao Chengqi Decoction (See previous text for formula rationale. Here, Dahuang (Rhubarb Root) need not be the sovereign herb; equal parts of the three herbs suffice.)

41. If Summerheat-Warmth spreads through the Three Jiao, with a slippery, slightly yellow tongue coating, and the pathogen is at the Qi level, Sanshi Decoction should be used. If the pathogen lingers for a long time, the tongue is crimson with little coating, and Heat combats the Blood level, Jiawei Qinggong Decoction should be used. If consciousness is unclear due to Heat closing the inner orifices, Zixue Dan (Purple Snow Pill) should be given first, followed by Qinggong Decoction.
Spreading through the Three Jiao means the pathogen is no longer confined to one meridian or zang-fu organ, so urgent clearing of the Three Jiao is prioritized. Although it concerns the Three Jiao, the Hand-Taiyin Lung meridian is the key. The Lung governs the Qi of the whole body; when Qi transforms, Summerheat and Dampness transform together. Moreover, the Lung receives its generation from Yangming; the Lung's zang image belongs to Metal and White, and Yangming's Qi movement also belongs to Metal and White. Thus, drugs acting on the Lung meridian often affect Yangming, and drugs acting on Yangming often affect the Lung. Furthermore, the Lung meridian regulates water passages, directing them down to the Bladder. When Lung obstruction opens, the Bladder also opens. Thus, although the Lung is the key, the Stomach and Bladder are included in the treatment, covering the Three Jiao. This is the profound meaning behind using Sanshi Decoction for pathogens at the Qi level. If the pathogen lingers, it must enter the blood collaterals. The Heart governs the blood vessels, so Jiawei Qinggong Decoction is used. If inner orifices are about to close, Heat is excessive; Zixue Dan (Purple Snow Pill) is the fastest method to open inner orifices and clear Heat.
Sanshi Decoction Formula
Fei Huashi (Flourished Talcum, 3 qian) Sheng Shigao (Raw Gypsum Fibrosum, 5 qian) Hanshui Shi (Cold Water Stone, 3 qian) Xingren (Apricot Seed, 3 qian) Zhuru (Bamboo Shavings, fried, 2 qian) Yinhua (Honeysuckle Flower, 3 qian; flower dew is better) Jinzhi (Golden Juice, 1 wine cup, mixed in) Baotongcao (White Tetrapanax Herb, 2 qian)
Boil five cups of water until two cups remain. Divide into two doses, taken warm.
[Formula Commentary] This is a slightly bitter-pungent-cold method combined with aromatic properties. Generally, the treatment principle for Lung diseases is that slight bitterness promotes descending; excessive bitterness exceeds the disease site. Pungent-cool clears Heat, and aromatic herbs defeat toxins and resolve turbidity. Note: The "Three Stones" are the sovereign herbs in Zixue Dan (Purple Snow Pill), utilizing the Qi of Geng Metal to clear Heat, dispel Summerheat, benefit orifices, and act on both Lung and Stomach. Xingren (Apricot Seed) and Tongcao (Tetrapanax Herb) are used to disseminate Qi-level pathogens; Tongcao reaches the Bladder directly, and Xingren reaches the Large Intestine directly. Zhuru (Bamboo Shavings) uses the bamboo's vascular bundles to unblock human meridians. Jinzhi (Golden Juice) and Yinhua (Honeysuckle Flower) defeat Summerheat toxins.
Jiawei Qinggong Decoction Formula
Take the preceding Qinggong Decoction and add Zhimu (Anemarrhena Rhizome, 3 qian), Yinhua (Honeysuckle Flower, 2 qian), and Zhuli (Bamboo Sap, 5 tea spoons, mixed in).
[Formula Commentary] This is a bitter-pungent-cold method. Qinggong Decoction was discussed previously. These three additions are added because: Zhimu (Anemarrhena Rhizome) drains the exclusive excess Heat of Yangming, preserving the Lung and clearing Metal; Yinhua (Honeysuckle Flower) defeats toxins and clears collaterals; Zhuli (Bamboo Sap) eliminates great Heat in the chest, stops irritability and thirst. Combined with Qinggong Decoction, it treats Summerheat extending to the Blood level of the Three Jiao.

42. In Summerheat-Warmth or Hidden Summerheat, where the Three Jiao are equally affected, with grayish-white tongue coating, epigastric stuffiness, tidal fever, nausea/vomiting, irritability/thirst, spontaneous diarrhea, sweating, and short urination, Xingren Huashi Decoction should be used.
Grayish-white tongue and epigastric stuffiness, spontaneous diarrhea, and nausea/vomiting are caused by Dampness. Tidal fever, irritability/thirst, sweating, and short urination are caused by Heat. Heat resides within Dampness, and Dampness generates Heat; they mix intricately. They cannot be treated by merely using cold or hot herbs. Therefore, Xingren (Apricot Seed), Huashi (Talcum), and Tongcao (Tetrapanax Herb) are used to first disseminate Lung Qi, reaching the Bladder via the Lung to promote diuresis. Houpo (Magnolia Bark), being bitter and warm, drains Damp-fullness. Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) clear the interior and stop Damp-Heat diarrhea. Yujin (Curcuma Aromatica Rhizome), aromatic and penetrating orifices, opens closure. Jiegeng (Platycodon Root) and Banxia (Pinellia Tuber) strengthen the Stomach, disseminate Dampness, resolve Phlegm, and stop nausea/vomiting. This allows the pathogens mixed in the Three Jiao to be resolved separately.
Xingren Huashi Decoction Formula (Bitter-Pungent-Cold Method)
Xingren (Apricot Seed, 3 qian) Huashi (Talcum, 3 qian) Huangqin (Scutellaria Root, 2 qian) Juhong (Ponkan Peel, 1.5 qian) Huanglian (Coptis Rhizome, 1 qian) Yujin (Curcuma Aromatica Rhizome, 2 qian) Tongcao (Tetrapanax Herb, 1 qian)
Houpo (Magnolia Bark, 2 qian) Banxia (Pinellia Tuber, 3 qian)
Boil eight cups of water until three cups remain. Divide into three doses.