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(18) Shigao (Gypsum Fibrosum, 石膏) has the specific function of clearing lung heat and dissipating fire within the Metal element, thus serving as the Sovereign herb; Zhimu (Anemarrhenae Rhizoma, 知母) can also clear fire in the lungs and nourish the source of Kidney Water. Renshen (Ginseng Radix et Rhizoma, 人参) generates body fluids and benefits the damaged Qi, serving as the Minister herb; Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) and Jingmi (Oryza Sativa, 粳米) tonify Earth to nourish Metal, serving as the Assistant herbs.

Shen Yaofeng stated: This describes the evidence of Heat disease. The *Suwen* states that in Heaven it is Heat, and on Earth it is Fire. Heat is the Qi of Fire. Therefore, Heat is one of the Five Qi, and Heat disease is one of the five types of Cold Damage. In the *Shanghan Lun*, fearing that the character "Heat" from the *Nanjing* might be confused with the subsequent character "Warmth," it specifically points out "Shu" (Summerheat). Contracting the Qi of the scorching sun causes illness, which corresponds to the Summerheat among the Cold, Summerheat, Dryness, Dampness, and Wind in the *Suwen*. Some say: "Shu" is a Yang pathogen, while "Yue" (a specific term for severe summerheat) is a Yin pathogen; "humid and muggy summerheat" implies Heat combined with Dampness, seemingly different from "Shu." The response is: When Cold departs, Summerheat arrives; it stands in opposition to Cold. Is this not referring specifically to Heat? Ancients referred to Shu, Yue, and Re (Heat) as one and the same. If a disease involves both Dampness and Heat arriving together, the *Nanjing* calls it Shiwen (Damp-Warmth), not Shu. It was only after the Sui and Tang dynasties that people referred to Damp-Heat as Shu, causing the true name of Shu to be lost, and the name "Yue" became unknown.

Wang Mengying stated: Zhang Zhongjing named external Heat diseases in summer "Yue" to distinguish them from latent Heat diseases. The *Shuowen Jiezi* states: "Yue" means injury by Summerheat. The *Book of Han · Annals of Emperor Wu* states: "In a great summer drought, many people died of Yue." Thus, Shu, Re, and Yue are all names for the single Qi of the summer season. The *Book of Northern Qi · Annals of the Last Ruler* records: "In the sixth month, [the ruler] toured the South Park; sixty officials died of Yue." The *Qianjin Xuji* states: "Death from heat is called Yue." This indicates that even in the Tang dynasty, it was known that Shu and Yue referred to Heat. The *Neijing* states: "In Heaven it is Heat, on Earth it is Fire, its nature is Shu." It also states: "When the Year Fire is excessive, blazing Summerheat prevails." Generally, Shu is the Qi of the Sun; its character contains "Sun" (Ri). Terms like "blazing Summerheat" or "scorching heat" all refer to the Qi of the scorching sun. After the Summer Solstice come Minor Heat and Major Heat; after the Winter Solstice come Minor Cold and Major Cold. This shows that Shu is Heat, and Cold is Cold. Therefore, the character "Han" (Cold) relates to water vapor. Shu is Yang, and Cold is Yin; their opposition is a clear and easily understood matter between Heaven and Earth, without profound or unfathomable principles. Yet, divergent explanations have always been numerous, misleading people significantly. There are those who try to reconcile these views by forcibly distinguishing them by movement and stillness. Movement and stillness depend on humans; how can the atmospheric Summerheat in the sky be judged according to human distinctions? Moreover, the *Neijing* mentions seeking shade to avoid heat, and King Wu rested under tree shade. Others recklessly combine Dampness and Heat into Shu. In years of extreme drought, rivers and wells dry up, crops wither, and there is no Dampness at all; can this be called non-Shu? Furthermore, Dampness has no fixed location and prospers in all four seasons; Wind-Dampness and Cold-Dampness can all be combined. Only in the late summer (Earth phase) is it most abundant, so Heat-Dampness is more common than Cold-Dampness. However, the character "Shu" contains "Sun" (Heavenly Qi), while "Shi" (Dampness) contains "Earth" (Earthly Qi); they are as different as heaven and earth. Although they can combine to cause disease, one cannot ultimately claim that Shu originally contains Dampness.

(19) Taiyang Summerheat injury presents with fever, pain, and heaviness, with a faint pulse. This is caused by contracting cold water in summer, with water qi circulating in the skin. (*Jin Gui Yao Lue* advocates treating this with Yi Wu Gua Di Tang.) (From *Differentiating Taiyang Disease Pulse, Syndrome, and Treatment*).

Huang Baochen said: The previous clause discusses Summerheat without accompanying Dampness; this clause discusses Summerheat combined with Dampness pathogenic factors. In Taiyang Summerheat, Summerheat injures the form, resulting in fever, pain, and heaviness; Summerheat injures the Qi, resulting in a faint pulse. Based on this syndrome and pulse, we know it is caused by greed for coolness in summer, excessive drinking of cold water, injury by water-dampness, water qi circulating in the skin, being constrained by exterior pathogens, and inability to sweat out the pathogen.

Shen Hanqing said: This discusses contracting Summerheat first, then injuring oneself with cold water in summer. Heat enters from Taiyang to Yangming, hence the fever. Subsequent injury by cold water causes water qi to circulate in the skin, stagnating both Ying and Wei Qi. Obstruction of Ying Qi causes body pain; obstruction of Wei Qi causes body heaviness. In Taiyang Summerheat, the pulse should be rapid and large, not faint. Why is it faint? Because cold water in the skin moves with Ying and Wei Qi; their obstruction prevents reaching the vessels, causing the faint pulse. Hence, it is said to be caused by injuring cold water in summer, with water qi circulating in the skin. Gualou (Melon Pedicle, 瓜蒂) is bitter and cold, capable of inducing vomiting and purging, removing water qi from the body, face, and limbs. Once water qi is removed, heat resolves, hence it is used as the principal treatment.

Chen Xiuyuan said: This discusses Summerheat combining with Dampness to cause harm, where tangible Dampness obstructs Lung Qi. *Jin Gui Yao Lue* treats it with Yi Wu Gua Di Tang. Later scholars expanded its meaning, using Wu Ling San (Poria, Polyporus, Atractylodes Macrocephala, Alisma, Cinnamon Twig), Da Shun San (Licorice, Dried Ginger, Apricot Seed, Cinnamon Bark), Xiao Ban Xia Jia Fu Ling Tang (Pinellia, Poria, Fresh Ginger), Shi Wei Xiang Ru Yin (Mosla, Ginseng, Tangerine Peel, Atractylodes Macrocephala, Poria, Coix Seed, Coptis, Quince, Magnolia Bark, Licorice), and Bai Hu Jia Cang Zhu Tang (Gypsum, Anemarrhena, Licorice, Rice, Atractylodes Lancea), all treating Dampness simultaneously. In summer, when Yang is deficient and Yin hides, anyone fearing heat and seeking coolness can be analogized to injuring cold water. If the disease is in the Yin meridians, it becomes a Yin syndrome; how can Summerheat be treated solely with cooling methods?

(20) Taiyang Summerheat injury presents with fever, aversion to cold, body heaviness and pain, with a string-taut, fine, hollow, and slow pulse. After urination, one feels shivering with hair standing on end, and hands and feet are cold. Upon slight exertion, the body becomes hot, and upon opening the mouth, the front incisors become dry. If sweating is induced, aversion to cold worsens; if warm needles are applied, fever worsens; if purgatives are used repeatedly, strangury worsens. (From *Differentiating Taiyang Disease Pulse, Syndrome, and Treatment*)

Shen Yaofeng said: This discusses Summerheat injury in individuals with chronic deficiency of Essence and Qi.

Chen Xiuyuan said: This depicts the appearance of deficiency syndromes in Summerheat injury, illustrating involvement of both interior and exterior via meridians. The idea is: Cold injures the form, attributed to excess; Heat injures Qi, attributed to deficiency. Fever, aversion to cold, down to cold extremities, are all Yin-Cold pulses and syndromes. The three sentences regarding slight exertion are signs of deficiency with internal heat. Sweating, purging, and fire therapy are all contraindicated, revealing the treatment method.

Xu Zhongke said: This is what Jiegou referred to as "obtained Summerheat through stillness," which is a Yin syndrome. Essentially, Yue is Shu. In Taiyang Summerheat, the Taiyang pulse acts as the external defense of the body; all Six Qi infections enter through it, so Summerheat must also enter via Taiyang. Being in Taiyang causes fever and aversion to cold. In summer, Qi overflows into meridians, and at this time, Damp Earth rules; those injured by Summerheat must combine with Dampness, causing body heaviness and pain. Summerheat inevitably injures Qi, leading to string-taut, fine, hollow, and slow deficient pulses. However, Summerheat is not merely "Zhong Re" (Mid-Heat); with Summerheat internally received and Yin-Cold externally binding, similar to Li Dongyuan's description of cooling off in grand mansions, there is no sweating or thirst, but rather body heaviness and pain.

Cheng Wuji said: Diseases exist in the exterior, in the interior, or involving both. This case involves both. Fever, aversion to cold, body heaviness, and pain indicate Summerheat in the exterior; string-taut, fine, hollow, and slow pulses indicate deficient pulses from Summerheat; shivering with hair standing on end after urination and cold extremities indicate insufficiency of Taiyang Meridian Qi; slight exertion causing immediate fever indicates that labor disturbs Yang, triggering the Yue pathogen; opening the mouth and dry front incisors indicate Heat in the interior. The *Neijing* states: "Due to Summerheat, sweating occurs; if vexed, panting and drinking sounds arise." Opening the mouth refers to panting/drinking sounds; due to continuous panting, the front incisors become dry. If sweating is used to remove exterior pathogens, exterior Yang is depleted, worsening aversion to cold. If warm needles assist Yang, Fire-Heat attacks internally, worsening fever. If purgatives are used to remove interior Heat, interior deficiency leads to bladder dryness, worsening strangury.

Zhao Yi-de said: I have pondered this; this syndrome belongs to simultaneous deficiency of Yin and Yang. String-taut and fine pulses indicate Yang deficiency; hollow and slow pulses indicate Yin deficiency. Thus, warm needles further damage Yin, and sweating further damages Yang. This syndrome requires sweet medicines to tonify Zheng Qi and resolve Heat, as stated in the *Ling Shu*: when both Yin and Yang are insufficient, tonifying Yang depletes Yin, and tonifying Yin causes Yang to escape. Sweet medicines may be used, but harsh agents should not be drunk.

Wang Yutai said: Zhong Yue, Zhong Shu, and Zhong Re differ in name but are essentially the same disease. If Cold is contracted in winter and transforms into Heat disease in summer, this is a delayed onset, spreading from interior to exterior, commonly called "late-onset," which differs from acute new Summerheat diseases. Some say new Summerheat diseases present with deficient pulses, while late-onset Heat diseases present with vigorous pulses.

(21) The Master said: Latent Qi diseases require intuitive observation. Within this month, one should anticipate latent Qi. If latent Qi exists previously, the pulse must be examined. If the pulse is faint, there should be throat pain resembling injury, but it is not Hou Bi (Sore Throat/Pharyngitis). The patient says: "Indeed, the throat hurts." Even so, diarrhea is now impending. (From *Methods for Examining Pulses*)

Zhang Xiju said: This clause discusses Latent Qi disease emerging from the interior, unlike epidemic sudden diseases that arrive from the exterior.

Zhang Yin'an said: This section discusses the onset of Latent Qi disease, initially moving from Yin to Yang, and subsequently from Yang to Yin. Latent Qi disease refers to Spring Wind, Summer Summerheat, Autumn Dampness, and Winter Cold; upon contraction, they hide in the membrane sources and muscle interstices, not manifesting in the pulse, hence requiring intuitive observation. "Anticipating latent Qi within this month" relies on intuition, such as strong winds in the third month or intense heat in the ninth month. Physicians should know that excessive seasonal conditions within the month lead to latent Qi, which hides in the body upon contraction. If latent Qi existed previously and now manifests, the pulse must be checked. A faint pulse indicates deficiency of Central Earth, with Wind Wood pathogen overcoming it, causing throat pain resembling injury. The throat governs Heavenly Qi; pain resembling injury indicates Fire Qi. This is latent pathogen moving from Yin to Yang. "Not Hou Bi" means it is not the Yin-Cold internal closure type of sore throat. The patient stating "real throat pain" distinguishes the throat (Yang/Heaven) from the pharynx (Yin/Earth). Prior throat pain followed by pharyngeal pain indicates prior Yang then Yin disease. "Even so, diarrhea is now impending" clarifies that despite throat pain, diarrhea follows, emphasizing the pharynx's connection to Earthly Qi. Latent Qi begins moving from Yin to Yang; once diseased, it moves from Yang to Yin.

Ye Ziyu said: This section discusses Latent Qi disease hiding internally, not immediately showing symptoms or pulse changes, hence requiring observation of which Qi is latent. Latent within the current month, it will manifest in the current month, hence "anticipating latent Qi within this month" is intuitive observation. If latent Qi existed previously and now manifests, it appears in both symptoms and pulse, requiring pulse examination. A faint pulse indicates spring wind injury, where Wind Wood pathogen harms Central Earth, causing a faint pulse. Wind pathogen ascends from above, causing throat pain resembling injury; this is Latent Qi disease, not epidemic sore throat. Not only throat pain but also pharyngeal pain occurs because Wind Qi connects to Liver, and Earthly Qi connects to Pharynx; Spleen governs Earth, and Wood overcomes Earth. Pathogen lingers, ascends to the extreme, then descends to cause profuse diarrhea, hence "even so, diarrhea is now impending." This is communication between upper and lower, resonance of one Qi. Zhang Zhongjing's discussion of Spring Wind allows inference of Summerheat, Dampness, and Cold in the other three seasons. Commentators often mistake faint/fine pulses, throat pain, and diarrhea as Shaoyin indications, not knowing Shaoyin pulses are faint/fine, whereas here it is faint/weak. Weak differs from fine, and faint exceeds weak; it does not exclusively discuss faint pulses. Weak indicates deficiency of True Yang and great deficiency of Stomach Qi, distinct from Shaoyin fine pulses, and certainly not excess Heat. Due to Earth deficiency, Wood pathogen insults the unconquerable. Those discussing Latent Qi extensively fail to understand it so clearly!