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Jiang suffered from fever, thirst, headache, and body pain during the summer. The physician diagnosed it as heatstroke (Shangshu). Initially, Xiangru Yin (Elsholtzia Decoction) was used but proved ineffective. Due to the intense heat, Qinghao (Artemisiae Annuae Herba) and Lianqiao (Forsythiae Fructus) were added. After taking the medicine, the condition worsened. Pulse diagnosis revealed a deep and fine pulse. Observation showed a white tongue coating and bluish complexion. Although the body was hot, the patient preferred to wrap up in clothes; although thirsty, he preferred hot drinks. I said, "This is Yin Heatstroke (Yin Shu), which can only be treated with Aconite (Fuzi) and Ginger (Ganjiang)." His family members said, "The patient has had high fever for days. Continuous use of cooling medicines has been ineffective. Moreover, given the scorching weather, it seems inappropriate to use hot medicines like Aconite and Ginger." I replied, "In summer, yin cold lurks inside the body. People often fear heat and crave coolness, making them susceptible to cold pathogens. If one argues that hot medicines cannot be taken in summer, then cold medicines should not be taken in winter either. Why did Zhang Zhongjing frequently use Gypsum (Shigao), Scutellaria (Huangqin), and Coptis (Huanglian) when treating Winter Cold Damage (Shanghan)? Discarding the season to follow the syndrome is a practice established since ancient times." Therefore, Fuzi Lizhong Tang (Aconite Pill to Regulate the Middle) was administered. After one dose, the fever subsided; after another dose, the illness resolved.

Wang, a carpenter in his early twenties, contracted an exogenous pathogenic condition in summer. Initially, he experienced aversion to cold alternating with fever, vomiting, diarrhea, spontaneous sweating, and headache. Other physicians prescribed formulas to disperse wind and harmonize the exterior. Although vomiting and diarrhea ceased, the fever persisted. He had profuse sweating, thirst, fatigue, and reluctance to speak. His complexion was bluish-white and lusterless. The tongue coating was blackish-yellow and moist. The pulse was deficient and fine. The Classic states: "Deficient pulse with body heat indicates injury by summerheat." Thus, Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) was prescribed with modifications. After one dose, the night fever intensified, accompanied by delirium and restlessness. On the next morning's re-examination, the pulse became even finer, indicating a Yang syndrome presenting with Yin pulse characteristics. The tongue coating differed significantly from the previous day: it was purplish, the tongue flesh was fragmented, and blood traces were coagulated. He was thirsty and craved frozen beverages. I reasoned that there must be internal heat pathogens lurking and failing to penetrate. One should discard the pulse signs and follow the symptoms, switching to Baihu Tang (White Tiger Decoction) supplemented with Shengdi Huang (Rehmanniae Radix), Mudan Pi (Moutan Cortex), Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taenia), and Dengxincao (Junci Medulla). In the afternoon, someone came requesting my presence, stating that after taking the first decoction, the whole body sweated. Although delirium stabilized, the spirit was dull, and limbs were cold. Upon examination, his hands and feet were abnormally ice-cold. The pulse could not be felt even at the bone level. Eyes closed, he was unconscious. This was identified as Heat Jue (Heat Reversal). I ordered the medication to continue. Bystanders argued that given the constitution and pulse, it might be a Yin syndrome, suggesting the previous prescription was unsuitable. I said, "This is not a Yin syndrome, but extreme Yang mimicking Yin. If hot medicines are mistakenly administered, danger ensues; otherwise, let us withhold medication tonight and reassess tomorrow." They agreed. The next day, mental dullness slightly improved, but the physical state and pulse remained unchanged. The tongue coating had changed again: it was short and thick, covered with purple blisters as large as grapes, mixed with green, yellow, black, and colors, overlaid with a greasy coating. I was greatly astonished and declined treatment. His mother pleaded for help. Pitying him, I deliberated extensively, instructed applying Zixue San (Purple Snow Powder) mixed with honey to the tongue, and modified the formula by adding Xijiao (Rhinocerotis Cornu - *Note: Substitute with Buffalo Horn in modern practice*), Huanglian (Coptidis Rhizoma), Xuanshen (Scrophulariae Radix) to clear heat; Jinzhi (Gold Juice), Renzhonghuang (Human Waste Precipitate), Yinhua (Lonicerae Japonicae Flos), and Ludou (Phaseoli Semen) to detoxify. Additionally, snow water was used to decoct the herbs. On the second day's re-examination, the reversal reversed, and the pulse returned. The tongue blisters subsided, leaving only dry, purplish coating. After two more doses, the fever cleared, consciousness returned, and the tongue color normalized. In this case, although I correctly identified the Yang syndrome mimicking Yin later, I failed to detect the excess syndrome resembling deficiency earlier. I blame my insufficient scholarly attainment. Throughout my career treating Shanghan and Plague conditions, I have never seen such anomalous tongue coatings. Over five days of consultation, the changes seemed to come from five different patients. Such phenomena are rarely mentioned in ancient texts, truly beyond imagination. As the proverb says, "Reading all of Wang Shuhe's works is inferior to gaining clinical experience." Indeed, this is no empty talk.