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[Section on Summerheat Pathogens]

Wenbing (Warm Disease): Summerheat pathogen combined with food stagnation, presenting with fever and abdominal pain. Initially use a method of dispersing and unblocking.
Elsholtzia Herba (Xiangru), Magnoliae Officinalis Cortex (Chuanpu), Areca Seed (Huabinglang), Amomum Fruit (Sharen), Agastache Stem (Huogeng), Perilla Stem (Sugeng), Poria Cocos with Red Coir (Chiling), Scorched Medicated Leaven (Jiaoliuqu), Tangerine Peel (Chenpi), Patrinia Herb (Tongcao).

Second visit: Abdominal pain with refusal to press, a mass at the umbilicus, high fever without sweating, yellow and greasy tongue coating, rebellious qi causing mental restlessness and vexation. Prevent potential jue syndrome (fainting/collapse). The method is to resolve both exterior and interior.
Bupleuri Radix (Chaihu), Scutellariae Radix (Danqin), Immature Bitter Orange (Zhishi), Poria Cocos with Red Coir (Chiling), Red Peony Root (Chishao), Pinellia Tuber (Banxia), Mirabilite (Yuanmingfen), Raw Rhubarb (Shengdahu).

Third visit: After administering the method of Da Chaihu Tang (Major Bupleurum Decoction), two stools of fragmented loose feces were passed. Abdominal pain remains unchanged, mental restlessness and discomfort persist, rebellious qi with vomiting, yellow and dry tongue coating. This indicates food stagnation blocking the Yangming channel, and summerheat pathogen moving inward to the Jueyin channel. Prevent potential coma and collapse. Propose draining Jueyin and unblocking Yangming.
Coptidis Rhizome (Chuanlian) (stir-fried with Evodiae Fructus), Charred Hawthorn Fruit (Zhatan), Fermented Soybean (Dandouchi), Gardenia Fruit (Heishanzhi), Trichosanthes Seed (Gualouren), Angelica Sinensis Radix (Danggui), Longdan Xiegan Wan (Gentian Liver-Draining Pill) (3 qian, decocted in silk bag), Immature Bitter Orange (Zhishi), Perilla Stem (Sugeng), Aucklandiae Radix (Muxiang) (the latter three ground into powder and taken with liquid).
External application formula:
Scallion (one handful), Salt (one cup), Clove (1 qian), Prepared Wheat Flour (Feimian) (3 qian).
Pounded into a paste, applied to the painful area. This combination integrates Simo Yin (Four-Marrow Drink), Xiaoxianxiong Tang (Minor Trap-in-the-Chest Decoction), Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), and Zuojin Wan (Left Metal Pill). It unblocks the qi level, drains the liver, and resolves stagnation. With the external application method, how could the qi not flow smoothly!
Yu's Commentary: Summerheat must be accompanied by dampness. Dampness is a yin pathogen that most easily obstructs yang qi. Therefore, summerheat-damp diseases often present with epigastric and abdominal fullness and pain. Internal obstruction by stagnation prevents the transformation of summerheat and dampness; this is fundamentally due to the blockage of qi mechanism. If pain persists after purgation, it is because acrid-unblocking herbs were not used, and the pi-stagnation in the middle jiao has not been removed.

Patient Ding: Summerheat is a heat pathogen of郁蒸 (stifling steaming); dampness is a sticky and stagnant pathogen. Summer rain and earthy dampness cause dampness to overflow and heat to郁结 (become constrained). Only those with deficiency are susceptible to this pathogen, as well as those who inherently possess damp-heat. For instance, in obese individuals prone to dampness, summerheat resides within the dampness; in those with heart labor and qi deficiency, heat lies latent within the qi. Consequently, qi rebels and fails to circulate, the Sanjiao (Triple Burner) loses its dissemination and descent functions, body heat is not prominent, urination is difficult, only the forehead is hot, chest and epigastrium feel full and stifled, tongue coating is yellow and greasy, tongue base is crimson and tip red. All these are signs of dampness constraining and heat lying latent. Pathogens are constrained in the center, unable to reach the exterior or descend downward, raising concern for internal closure complications. Propose using Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) to vent from above and below, Jisu San (Chicken Mint Powder) to distribute and eliminate from interior and exterior, Erchen Tang (Two-Aged Phlegm Resolving Decoction) to harmonize from the middle, and aromatic herbs to open orifices and penetrate pathogens, hoping for the smooth functioning of the Sanjiao. Whether this will succeed remains to be seen.
Fermented Soybean (Dandouchi), Gardenia Fruit (Heishanzhi), Patrinia Herb (Tongcao), Pinellia Tuber (Banxia), Acorus Rhizome (Changpu), Fresh Lotus Leaf (Xianheye), Liuyi San (Six-to-One Powder), Mint (Bohe), Poria Cocos with Red Coir (Chiling), Bamboo Shavings (Zhuru), Cardamom Seed (Kouren) (ground, added later during decoction).

Patient Wu: Individuals engaged in hard labor inevitably have deficient Middle Qi. Summerheat, dampness, heat, and turbid miasma enter through the mouth and nose into the airways, filling the Sanjiao. Although the tongue coating is fully covered, there is no epigastric fullness, distinguishing it from pathogens latent in the Membrane Source (Mo Yuan). Heavy and turbid medicines would merely injure Middle Qi, offering no benefit against diffusely spreading damp-heat. Now five days have passed; although spirit seems clear, it is turbid. One must fear subsequent changes such as deafness, mental confusion, and hiccups. The treatment method should temporarily employ aromatic herbs to regulate qi and expel turbidity, then re-evaluate.
Canarium Seed (Daodouzi), Curcuma Root (Yujin), Alisma Rhizome (Zexie), Acorus Rhizome (Shichangpu), Apricot Seed (Xingren), Trichosanthes Seed (Gualouren), Tangerine Peel (Chenpi), Talcum (Huashi), Elsholtzia Herba (Xiangru), Platycodon Root (Jiegeng), Glehnia Root (Beishashen), Poria Cocos with Red Coir (Chiling), Patchouli Leaf (Huoxiang), Bergamot Fruit (Foshou), Fresh Lotus Leaf (Xianheye), Fresh Eupatorium Leaf (Xianpeilan).

Patient Gu: Having lived in the South for a long time, yang qi leaks out, internal organs are often cold, and warm-tonifying medicines are habitually taken. Currently suffering from Wen Nue (Warm Malaria) for ten days. The tongue tip is already red, the root coating is fully white, stool is watery diarrhea, accompanied by roundworms, thirst but no desire to drink, sweet and greasy taste in the mouth. These are all manifestations of dampness constraining and heat lying latent. Referring to the treatment methods of Xi Yi, Gegen Qinlian Tang (Kudzu and Scutellaria Decoction) is the main formula. Considering the constitution, it seems appropriate to warm the middle and drain downward, clear the upper and release the muscle layer. Propose using Guiling Ganlu San (Cassia and Poria Sweet Dew Powder) for a trial to observe efficacy.
Raw Gypsum (Sheng Shigao) (3 qian), Polyporus (Zhuling) (3 qian), Alisma Rhizome (Zexie) (1.5 qian), Cinnamon Bark (Rougui) (0.3 qian), Talcum (Huashi) (3 qian), Raw Atractylodes Macrocephala Rhizome (Sheng Maoshu) (1 qian), Poria Cocos (Fuling) (3 qian), Patchouli Leaf (Huoxiang) (1 qian), Patrinia Herb (Tongcao) (0.8 fen), Aucklandiae Radix (Muxiang) (0.4 fen).
Second visit: Add Glehnia Root (Beishashen) 5 qian to the previous prescription.

Patient Ding: Chronic cough. Recently, after a seasonal warm disease, original qi has not recovered, and summerwind was contracted again, closing the sweat pores, leading to recurrent fever. The method should first address summerwind, using light agents to ventilate the upper jiao.
Mulberry Root Bark (Sangpi), Perilla Stem (Sugeng), Apricot Seed (Xingren), Fritillaria Bulb (Chuanbei), Tangerine Peel (Juhong), Poria Cocos (Fuling), Winter Melon Seed (Dongguazi), Bamboo Shavings (Zhuru).
This is deficiency with accompanying pathogens. Temporarily use light and ascending exterior-resolving methods; heavy-handed approaches are inappropriate.

Patient Jiang: Chronic malaria lasting several months, contracted summerwind again, coughing with wheezing and blood in sputum, chaotic heat intensity. Temporarily focus on resolving summerheat and clearing/descending Lung and Stomach.
Elsholtzia Herba (Xiangru) (1 qian), Glehnia Root (Beishashen) (5 qian), Winter Melon Peel (Dongguapi) (3 qian), Liuyi San (Six-to-One Powder) (4 qian), Medicated Leaven (Shenqu) (3 qian), Artemisia Annua Herb (Qinghao) (1.5 qian), Apricot Seed (Xingren) (3 qian), Moutan Cortex (Danpi) (1.5 qian), Mulberry Leaf (Sangye) (1.5 qian), White Hyacinth Bean (Baibian Dou) (3 qian), Loquat Leaf (Pipaye) (2 slices).
Yu's Commentary: Coughing with wheezing and blood in sputum indicates injury to Lung yin and Lung qi. Although there is an exterior pathogen, the use of Elsholtzia Herba requires careful consideration.

Patient Li: Summerheat pathogen internally closed, aversion to cold and fever, pulse not palpable, inability to speak, preceded by cough. This is Lung qi closure. Propose opening and penetrating.
Belamcanda Rhizome (Shegan), Platycodon Root (Jiegeng), Forsythia Fruit (Lianqiao), Fermented Soybean (Douchi), Apricot Seed (Xingren), Fritillaria Thunbergii Bulb (Xiangbei), Elsholtzia Herba (Xiangru), Tangerine Peel (Juhong), Acorus Rhizome (Changpu), Bamboo Shavings (Zhuru), Arnebia Root/Buddleja Flower (Niubangzi), Yushu Dan (Jade Pivot Pill) (0.4 fen, ground and taken with liquid).

Patient An: Days of mental fatigue and deep worry, summerheat injuring qi easily returns to the Heart. Mental confusion, rapid, fine, and deep pulse, critical condition! Pathogens stifling the Pericardium, like fire burning. Dry yellow tongue color, dry lips and teeth, deafness, diarrhea, depleted fluids! Diseases of all three jiaos must be distinguished. Regarding treatment, reference He Jian's "Re Lun" (Treatise on Heat).
Fresh Dendrobium Stem (Xianshihu), Bhutanese Fritillary Bulb (Zhuhuang), Forsythia Fruit (Lianqiao), Acorus Rhizome (Changpu), Poria Cocos with Red Coir (Chiling), Glehnia Root (Beishashen), Patrinia Herb (Tongcao), Yiyuan San (Benefit Origin Powder), Jasmine Flower (Molihua), Bamboo Shavings (Zhuru), Mint Leaf (Bohoye), Reed Rhizome (Lugen), Fresh Lotus Leaf (Xianheye).
Zixue Dan (Purple Snow Pill), taken separately mixed with water.

Patient Li: Summer-damp qi of the yin level enters through the mouth, nose, and skin surface, causing alternating chills and fever, diarrhea, head distension. Propose fragrant herbs to expel turbidity and methods to distribute and eliminate damp-heat.
Patchouli Leaf (Huoxiang), Magnoliae Officinalis Cortex (Chuanpu), Scorched Medicated Leaven (Jiaoliuqu), Pinellia Tuber (Banxia), Poria Cocos (Fuling), Tangerine Peel (Chenpi), Alisma Rhizome (Zexie), Greater Betel Nut (Dafupi), Amomum Fruit (Sharen), Patrinia Herb (Tongcao).

Ren Yuan said: Two days combined form the character "Summerheat" (Shu). Summerheat is a yang pathogen. Those traveling or working in fields, enduring the scorching sun, contracting the hot qi of heaven and earth, are named as suffering from Shang Shu (Injury by Summerheat). Others, seeking coolness by drinking cold things or sleeping in dew/wind, contract cold wind and cold dampness due to avoiding summerheat. Although occurring in summer, this is named Shu Shi (Summerheat-Dampness), which differs from injury by intense heat, and cannot be called Summerheat Pathogen. Predecessors' discussions on Yin Summerheat and Yang Summerheat are superfluous. However, why are there many yin-cold diseases during peak summer? Because the transformation of heaven and earth, when reaching extremity, reverses; six yangs exhaust, one yin appears early within them. On earth it is hot, underground it is already cold. The human body is a small universe, is it not so? Moreover, when Damp Earth rules, damp turbidity prevails. Heat steams and dampness rises; heat and dampness combine, making illness easy to contract. Thus, among diseases of the four seasons, midsummer is the most miscellaneous: cold-damp, heat-damp, cholera, dysentery, sha miasma, summerwind, with various names, changing according to the contracted pathogen and individual constitution. They are all syndromes concurrent with summer, not the primary disease of Summerheat Injury. However, although syndromes are mixed, they do not depart from the Taiyin and Yangming Spleen and Stomach meridians. Consider summer medications: they are essentially aromatic, acrid-light, and bitter-draining. Whether treating Heart, Lung, Liver/Gallbladder, Bladder, using cold or hot herbs differently, all aim to relieve the Middle Jiao Spleen and Stomach. This is not only because Damp Earth ruling governs qi, but also because Spleen and Stomach belong to Earth, preferring dryness and disliking dampness. Summer diseases invariably involve dampness.