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Chen Wuzhe stated: Summer-heat and dryness (Shu-Re) tend to affect the Heart, causing chest oppression, mental confusion, and unconsciousness. If it enters the Liver, it causes dizziness, vertigo, and numbness with pain. If it enters the Spleen, it leads to lethargy and sleepiness without awareness. If it enters the Lung, it results in panting, chest fullness, and flaccidity. If it enters the Kidney, it causes Xiao Ke (Wasting and Thirsting Syndrome). In cases of fatal heatstroke, treatment must absolutely avoid cold medicines; only warm nourishing methods are suitable. Using cold medicine will lead to death. If no hot water is available on the road, one should apply hot earth to the umbilicus or allow urine to be poured over the umbilicus; these methods have proven effective. Whenever one feels heatstroke, immediately chew a large piece of fresh ginger and swallow it with water. If already comatose, chew a large clove of garlic and swallow it with water. If unable to chew, grind it in water and force-feed it; the patient will awaken immediately.

In review: The manifestations of heatstroke vary greatly and are not limited merely to affecting the five Zang organs. One must rely on pulse and symptom patterns to determine whether to use cold or hot treatments. This is because individuals differ in their physical constitution and Qi deficiency/excess, and the pathogenic factors vary in severity. Mild cases may manifest later, developing into malaria or dysentery in autumn. Severe cases manifest immediately, as described above. There are also instances where mild conditions become severe or severe conditions become mild, depending on the depth of infection and the complexity of transmission. Moreover, since people's physical and mental states of suffering and joy are diverse, variations are inevitable. Generally, this applies to diseases in all four seasons.

Li Dongyuan stated: When the Spleen and Stomach are weak, the Qi of the Upper Jiao is inevitably insufficient. During the summer heat, Yuan Qi (Original Qi) is damaged, leading to lassitude, preference for lying down, flaccidity of the four limbs, lack of spirit, and weakness in the legs. Encountering cold in the morning and evening may cause cold extremities (Jue); after sunrise, when Yang Qi rises, the body may feel hot like fire, indicating insufficiency of both Yin-Yang and Qi-Blood. Some present with limb fatigue, shortness of spirit, reluctance to move, chest fullness, rapid breathing, heavy and painful joints. Others exhibit rapid breathing with panting, fever with vexation, epigastric distension and palpitations, yellow and scanty urination, loose and frequent stools, or diarrhea with yellow, mushy discharge resembling rice water. Some are thirsty, others are not; some have loss of appetite, spontaneous sweating, heaviness of the body, or scanty sweating (indicating blood disease preceding Qi disease). The pulse at mid-depth is Hong (Surging) and Huan (Moderate). If combined with Dampness, a Chi (Slow) pulse may appear. Although symptoms may interchange and slightly improve, the climatic condition of summer heat and dampness remains constant. Treatment should employ formulas that clear dryness and heat.

If one travels far, becomes fatigued, encounters intense heat and thirst, the thirst causes internal consumption of Yang Qi. Internal consumption allows heat to lodge in the Kidney. The Kidney is the Water organ; now Water cannot overcome Fire, leading to withered bones and empty marrow, inability of the feet to support the body, resulting in Gu Wei (Bone Flaccidity), which is primarily attributed to Fire-Heat. This is Wei syndrome caused by Damp-Heat, making the bones weak and powerless. It may also present as Re Jue (Heat Jue) due to Yin deficiency, or Han Jue (Cold Jue) due to Qi deficiency. Jue refers to extremities feeling like they are in fire (Re Jue) or being cold (Han Jue). Cold Jue implies cold in the abdomen; Heat Jue implies heat in the abdomen. This is because the Spleen governs the four limbs.

Commentary: This discussion on summer-heat syndromes is similar to how Winter-heat (Shang Han) transforms into various syndromes upon transmission. Shang Han involves Cold Evil damaging the Form, whereas summer-heat damages Qi. If True Qi and Yuan Qi are severely deficient, sudden illness may prove untreatable in time, just as Yin Du (Yin Toxin) in Shang Han can be fatal instantly. Thus, Li Dongyuan opened this case study, enlightening later generations who were previously blind to such mechanisms. Students should carefully investigate its principles and indications, integrating them with the Wei (Flaccidity) category.