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The pulse of heat disease is also examined according to the affected meridian. When it originates in the Taiyang (Greater Yang) meridian, the pulse is floating and tight; when it originates in the Yangming (Yang Brightness) meridian, the pulse is floating and long; when it originates in Shaoyang (Lesser Yang) meridian, the pulse is wiry and rapid. Generally speaking, cases originating in the three Yang meridians are more common, while those originating in the three Yin meridians are fewer, which is due to specific causes. (Treatment follows the regulations for warm diseases. If exterior pathogens transmit into the three Yin meridians, the treatment method is the same as the purgative indications in Shanghan Treatise. If the pulse is deep and small with cold feet, it indicates origin in the Yin, which is difficult to treat.)

Generally, heat disease is more severe than warm disease. A pulse that is surging, large, and forceful, or slippery and rapid and forceful, indicates correspondence between the pathological pulse and the condition, termed "treatable"; if the pulse is fine, small, and weak, it is termed "difficult to cure." (For patients with deficiency and weak pulses, the primary approach is to support Yuan Qi (Original Qi) while simultaneously resolving pathogenic heat; harsh attacking methods should not be used.) For cases where exterior syndromes exist, the treatment principles are the same as those for warm diseases. If complicated by summerheat, internal injury from raw/cold food, or food stagnation, treatment is administered according to the specific syndrome. Summerheat stroke resembles heat disease in external symptoms, but in heat disease the pulse is vigorous, whereas in summerheat stroke the pulse is deficient; this distinguishes them. The *Jia Yi Jing* states: "A vigorous pulse with cold body results from Cold Damage (Shanghan); a deficient pulse with hot body results from Summerheat Injury (Shangshu)." This is because cold damages the form (body structure) but not the Qi, hence the vigorous pulse; heat damages the Qi but not the form, hence the deficient pulse. (This distinguishes summerheat and heat, noting differences between sudden acquisition and latent qi, resulting in different pulse characteristics of fullness and deficiency.) Both summerheat and wind strike result in a deficient pulse, with greasy facial complexion, spontaneous sweating, irritability, and thirst. When static, heat damaging the Heart and Spleen constitutes summerheat stroke, which resembles summer heat disease; however, heat disease presents with a surging and tight pulse, while summerheat stroke presents with a fine, rapid, and deep pulse. When active, heat damaging the Taiyang meridian constitutes Zhong Yue (a type of summerheat stroke), with a floating pulse resembling summer wind strike; however, sweating and aversion to wind with fever but no thirst indicate wind strike, whereas fever with thirst indicates Zhong Yue. (What later generations call summerheat stroke often refers to Yin syndromes in summer.) There are four syndromes in summer: Cold Damage and Wind Strike, where pulses and symptoms intermingle; summerheat stroke and heat disease, which are similar and hard to distinguish. If the pulse is tight with aversion to cold, it is Cold Damage; if the pulse is slow with aversion to wind, it is Wind Strike; if the pulse is vigorous with high fever, it is heat disease; if the pulse is deficient with body heat, it is summerheat injury. These distinctions apply.

In the first or second day of heat disease, diarrhea, abdominal fullness, and severe heat indicate death.
In the third or fourth day, blurred vision, delirium, severe heat, and a small pulse indicate death.
In the fifth or sixth day, a scorched black tongue root and dry thirst indicate death.
In the seventh or eighth day, epistaxis, hematemesis, hematochezia, dry heat, and a large pulse indicate death.
In the ninth or tenth day, spasms accompanied by coma indicate death.

Regarding heat disease pulses, Cu (Hasty), Jie (Knotted), Fu (Deep/Hidden), Chen (Deep), and Xiao (Small) pulses are all difficult to treat. Heat disease without sweating and with a restless pulse is also difficult to treat. If sweating occurs but the heat intensifies and the pulse becomes restless, it indicates death.