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Xu Shuwei treated a patient who presented with headache, feverish body, mental restlessness, irritability, and thirst. Upon palpation, the pulse was large and deficient. He prescribed Baihu Tang (White Tiger Decoction) for several doses, after which the patient recovered. Zhang Zhongjing stated: "A deficient pulse accompanied by fever is caused by heatstroke." He also asked: "Why does the pulse appear wiry, fine, hollow, or slow?" The *Suwen* (Basic Questions) states: "Cold damages the form, while heat damages the qi." Since heat damages the qi without damaging the form, the qi becomes depleted, resulting in a weak pulse. Therefore, wiry, fine, hollow, and slow pulses are all types of deficient pulses. Zhang Zhongjing considered the wiry pulse to be yin, and Zhu Pang also stated that a faint and fine pulse indicates heatstroke, confirming it as a deficiency syndrome.

In the year Guichou, my old friend Wang Yanlong, serving as the granary official in Piling, experienced excessive sweating on the chest and neck during late summer, cold feet, and delirium. Physicians unfamiliar with this condition administered mixed medications for ten days. Upon examination, the pulse at the Guan position anteriorly was soggy (Ru), and posteriorly was rapid (Shu). I said: "This should be treated as Damp-Warmth disease." This occurs when one first contracts summerheat and then dampness; the interplay of summerheat and dampness is named Damp-Warmth. Initially, Baizhu Jia Renshen Tang (White Tiger Decoction plus Ginseng) was administered, followed by Baizhu Jia Cangzhu Tang (White Tiger Decoction plus Atractylodes Lancea Rhizome). The headache gradually subsided, the feet warmed, and sweating ceased, leading to recovery in three days. This is termed "Thief Pathogen" (Zeixie); if misdiagnosed and mistreated, death may result. Someone questioned: "What is meant by Thief Pathogen?" I replied: "The *Nanjing* (Classic of Difficult Issues) states there are five pathogenic factors: Excess, Deficiency, Direct, Minor, and Thief. Coming from the subsequent element is Deficiency; from the preceding element is Excess; from the element that overcomes me is Thief; from the element I overcome is Minor; and arising from one's own organ is Direct. For example, in Heart disease, summerheat is Direct; contracting dampness constitutes Thief Pathogen, which is the most adverse among the five. The *Nanjing* states: 'In Damp-Warmth, the Yang portion (Cun) is soggy and weak, while the Yin portion (Chi) is small and urgent.' Soggy and weak appearing in the Yang portion indicates dampness clashing with summerheat; small and urgent appearing in the Yin portion indicates summerheat steaming dampness. Thus, the classics say: 'Summerheat and dampness clashing is named Damp-Warmth,' which is the Thief Pathogen. Furthermore, I have a chronic condition of fluid retention. Often during summer months, my feet remain wet despite sweating. Taking two or three cups of this medication cures me."

Zhang Zihe treated Xiao Zheng, aged fifteen, who contracted heatstroke in the fields, suffering from headache, lethargy, and inability to rise. He was given Shuangjie San (Double Release Powder) to induce sweating, and rice wash water was administered, but symptoms persisted. In the evening, Sanhua Shenwan (Three-Flower Divine Pill) was used for strong purgation, after which he recovered.

Zhang Zihe treated an elderly man surnamed Zhang, aged seventy-one, who suffered from heatstroke due to hunger and exhaustion in the fields during summer. He had no appetite, frequent vomiting, constant salivation of phlegm-water, and abdominal and hypochondriac pain. Physicians indiscriminately used Pingwei San (Regulate the Stomach Powder), Lizhong Wan (Regulate the Middle Pill), and Daoqi Wan (Guide Qi Pill) without effect. Acupuncture was added, with diagnoses of Cold Stomach. When consulted, Zhang Zihe said: "Phlegm belongs to the Stomach; stomach heat fails to contain it, causing phlegm-water discharge. Given your advanced age, I dare not use emesis." Instead, he instructed using a chopstick to stimulate the throat, inducing the expectoration of one sheng (approx. 200ml) of phlegm-saliva without medicine. Subsequently, Huanglian Qingxin San (Coptis Clear Heart Powder), Daoyin Wan (Guide Fluid Pill), and Yulu San (Jade Dew Powder) were used to regulate him, improving his diet. Only constipation remained; a decoction of Weicheng Qi Tang (Regulate the Stomach and Purge Qi Decoction) with fresh ginger and jujube was administered to purge, leading to recovery.

Wan Mizhai treated Li Tianquan, a county deputy magistrate, who suffered from abdominal pain due to heatstroke in June. His maid, coming from another household, suggested the doctor diagnosed cold and prescribed Lizhong Tang (Regulate the Middle Decoction). After one dose, pain stopped, but fever ensued, along with generalized joint pain. Shishen Tang (Ten Spirits Decoction) was then given to induce sweating; fever subsided, and pain ceased. Wan Mizhai examined the patient; Li claimed recovery, but his complexion showed redness, indicating unresolved pathology. The pulse was surging, slippery, and rapid. (Color and pulse correspond.) The classics state: "Large pulse indicates advancing disease." Now, post-sweating, the pulse remains surging and rapid, meaning the disease is progressing, yet he claims cure. Before Wan left, the illness recurred. Severe abdominal pain resembling Ben Tun (Rushing Bull) syndrome occurred, with rubbing of the abdomen. Wan was urgently summoned. Li said: "You diagnosed my pulse earlier but left silently, knowing my condition. Please save me urgently." Wan said: "No harm." He prescribed Jianzhong Tang (Establish the Middle Decoction). One dose stabilized the pain. The next day, Wan Pu, a provincial examiner and skilled physician, visited. Upon palpation, Wan Pu was startled and looked around; Li was suspicious and fearful. Wan Mizhai told Wan Pu: "Are you surprised by the intermittent pulse? This is due to palpitations in the epigastrium." Li immediately confirmed: "My heart feels chaotic and restless." Medicine was prepared containing Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), Gancao (Licorice Root), Baishao (White Peony Root), Shengdi (Rehmannia Root), and Wuweizi (Schisandra Fruit), decocted with pig heart soup. One dose stopped the palpitations and regularized the pulse. Since the Heart dislikes heat, using hot medicines to treat heat violated contraindications, causing recurrence.

Li Shaohua, knowledgeable in medicine, contracted summerheat in June. After one dose of Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), sweating occurred but the disease did not resolve. Believing the dosage was insufficient for effective sweating, he took a larger dose, resulting in profuse sweating and intensified fever. Three consecutive doses worsened the condition. He became delirious like a madman, with a stiff tongue, slurred speech, limb twitching, difficulty urinating, and penile pain (only one or two drops upon pressure). He ate nothing, drinking only water. Wan Mizhai found the pulse weak, minute, and slow. Asked if curable, Wan replied: "This is a ruined disease, the fault of the physician. The Heart dislikes heat; vigorous fire consumes qi. In midsummer, fire qi is strong; excessive sweating damages the Heart. The Heart houses the Spirit; delirium indicates spirit disorder (not blood stasis). The tongue corresponds to the Heart; excessive sweating causes blood deficiency failing to nourish the tongue, hence stiffness and inability to speak. Limb twitching results from excessive sweating causing muscle tremors (not wind-stroke). Thirst for water indicates fluid depletion from sweating (not Yangming thirst). Difficulty urinating stems from Heart heat transferring to the Small Intestine, then to the Bladder; fluid scarcity and failed qi transformation cause penile pain. Five doses cured him." (The specific formula was not recorded, which is a omission.)

Wang Huaijiang suffered from heatstroke complicated by food stagnation. A physician used Wujii San (Five Accumulations Powder) and other drying-hot agents, dispersing yang qi externally and depleting yin fluids internally, resulting in hyperactive yang and deficient yin, dry skin, and anhidrosis. The treatment should first nourish yin, then restrain yang, allowing sweat to emerge and harmonize the exterior. Liangge San (Cool the Chest Powder) was modified by removing Dahuang (Rhubarb Root) and Mangxiao (Mirabilite), adding Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), Danshi (Fermented Soybean), and Zhuye (Bamboo Leaf). One dose produced slight sweating and moistened the body. Just as downward purgation was planned, another physician arrived, diagnosing yin deficiency with fire hyperactivity, advising against purgation. Siwu Tang (Four Substance Decoction) with fried Ganjiang (Dried Ginger) was used, stirring up Yangming fire, causing gingival bleeding and cold feet (Yang reversal). Liangge San was then reused, resulting in three bowel movements and recovery.

Gong Zicai treated a woman who, in summer, exited a hot kitchen to cool off in the wind, removing clothes. She immediately developed headache, fever, aversion to cold, and body pain. Misdiagnosed as Cold Damage (Shanghan), Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) was given. Immediately after swallowing, she fell silent, breathless, with blue-purple lips, though the heart area remained warm. The six pulses were large, rapid, and forceful, indicating heat syndrome mistreated with hot medicine. Burnt wine was sprayed on her chest, and a mirror was waved to cool her. Fresh well water mixed with honey was applied to her mouth with a chicken feather several times. Soon, she extended her tongue seeking water. Yi Yuan Tang (Benefit Origin Decoction) was poured down, reviving her.

Li Shicai treated the son of Prefect Zhang, who fainted and lost consciousness in June between 3-5 PM, remaining unconscious until midnight. This was caused by excessive consumption of raw/cold foods. Soapberry powder blown into the nose failed to induce sneezing, causing family panic. He was taught to use soapberry ash (preserved nature) mixed with fresh well water, and burning Chenxiang (Agarwood) and Tanxiang (Sandalwood) to fill the room with fragrance to open the orifices. He revived at midnight and was settled with Shiwei Xiangru Yin (Ten-Ingredient Elsholtzia Decoction).

Wu Fuxian treated a man who, running under the scorching sun, suddenly developed headache, fever, occasional irritability, profuse sweating, extreme thirst with desire to drink, panting, and fatigue. Symptoms worsened with Xiangru Yin (Elsholtzia Decoction), indicating Summerheat Syndrome. Summerheat contraction has Yin and Yang types. Laborers on roads contract intense heat, named Shangshu (Injury by Summerheat). Those in pavilions contracting ease suffer Zhongshu (Midst Summerheat). Xiangru Yin is suitable only for Yin Summerheat; using it for Yang Summerheat causes harm. Ren Shen Baihu Tang (Ginseng White Tiger Decoction) cured him.

Dong Renzhong, cooling off and drinking cold beverages in summer, suddenly developed headache, fever, cholera-like vomiting and diarrhea, irritability, thirst, and white-slippery tongue coating. This is Yin Summerheat, caused by excessive cold inhibiting whole-body yang qi. Xiangru’s pungent-warm nature should be used to vent yang qi, disperse water, and harmonize the spleen. Four doses cured him. (Li notes: This is cold contraction in summer, termed Yin Summerheat, while Shangshu is Yang Summerheat. Treatment was correct, but nomenclature is erroneous. Same applies to the previous case.)

A grass-cutting woman, indulging in cold drinks in summer, felt a ball of fire in her chest. Cold tea flowed down from this fire ball. Her eyes feared light and fire, and fire seemed to emanate from her mouth and nose. The six pulses were all yin-type (deep/slow), and the tongue coating was purple-green and slippery. Wu said: "This is cold rejection manifesting as false heat." Ganjiang (Dried Ginger) and Rougui (Cinnamon Bark) were used for warming dispersion, with a little Huanglian (Coptis Rhizome) as a guide. After a while, the chest fire turned cool, and she recovered.

Sun Wen yuan treated his brother Sun Shunan with forehead pain, generalized body pain, dry mouth, thick yellow tongue coating, floating-large left pulse, and rapid pulses in all positions. It was early autumn. Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Baihu Tang plus Qianghuo (Notopterygium Rhizome) failed to reduce fever. In the afternoon, Liutong Shenjie San (Six-Awakening Unblocking Powder) taken with green onion soup slightly reduced fever. After midnight, fever returned, forehead pain worsened (especially vertex), tongue root became yellow and scorched-black, urine was red and painful, irritability prevented sleep, and body pain recurred. This is Summerheat syndrome with simultaneous involvement of the Three Yang channels. The next day, Xiaochaihu Tang was used with Gypsum as the sovereign herb, plus Chuanxiong (Szechwan Lovage Rhizome), Baizhi (Angelica Dahurica Root), Zhuye (Bamboo Leaf), Jingmi (Rice), Shengjiang (Fresh Ginger), and Dazao (Jujube). Sweating reached the feet (true sweating), and fever completely subsided. Irritability persisted, so Xiaochaihu Tang was continued with Guizhi (Cinnamon Twig), Zhizi (Gardenia Fruit), Zhuru (Bamboo Shavings), and Zhuye. Drinking this cured her.

Zhang Luyu treated his sister-in-law Gu Jiuyu, who suffered from chest oppression and head distension during peak summer. The pulse was deficient, large, and soggy; the Qi Kou (Radial Artery at Cunkou) alone showed a slippery image, indicating damp-heat flooding above the diaphragm. Qing Shu Yi Qi Tang (Clear Summerheat Benefit Qi Decoction) for two doses stopped head distension but not chest oppression. Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction) was used, reducing Paojiang (Fried Ginger), removing Dazao, and adding Zhishi (Immature Bitter Orange). One dose cured her.

Fan Wenxue treated Sun Zhenlin, who suffered from cold limbs and spontaneous diarrhea during peak summer. The six pulses were wiry, fine, hollow, and slow, nearly imperceptible upon pressure. The tongue was pale white with a black-moist center and no coating. Breath from mouth and nose was slightly cold, genitals retracted into the abdomen, and seminal emission was watery. The cause was lying on the ground for a nap in cold, followed by two nocturnal emissions that night. Suddenly, severe head distension like a mountain occurred, leading to fainting upon sitting up, cold limbs, abdominal pain, diarrhea, nausea, and muttering delirium, resembling Damp-Warmth. Physicians misdiagnosed food stagnation and cold damage, prescribing dispersing and digesting agents. Post-medication, sweating flowed from chest/head/neck, back chill increased, lower body felt like cold water, and confusion occurred multiple times daily. This is Yin-Cold夹 (accompanied by) Summerheat entering the Foot-Shaoyin and Hand-Shaoyin channels. Kidney true yang is extremely deficient, preventing fever. Sini Jia Renshen Tang (Four Reversal plus Ginseng Decoction) was prescribed: Renshen 1 liang, Shufu 3 qian, Paojiang 2 qian, Zhigancao 2 qian. Administered day and night, six doses over three days. Recovery of yang was expected on the fourth day at Yin hour. That day, Jiang and Fu were discarded; Baoyuan Tang (Protect Origin Decoction) was used: Renshen 5 qian, Huangqi (Astragalus Root) 3 qian, Zhigancao 2 qian, Maidong 2 qian, Wuweizi 1 qian, to clear deficient yang above the diaphragm. After four doses, eating improved; Shengli Liuwei Wan (Raw Six-Ingredient Pill) with Maidong and Wuweizi was used. Each dose contained Shudi (Prepared Rehmannia Root) 8 qian to rescue exhausted lower jiao yin, achieving yin-yang balance and spiritual health.

Shen Shu contracted heat while crossing Liangxi. Returning home, he suffered dizziness, numbness, blurred vision, fever, and constipation. Huanglian Xiangru Yin was ineffective. Liangge San cleared bowels. Sometimes he fainted or had cold limbs, worse in the afternoon. Pulse was wiry, fine, and hollow. This indicated Summerheat damaging the Pericardium, with yang qi depressed, mimicking yin-cold. Shengmai San (Generate Pulse Powder) combined with Baoyuan Tang cleared Lung/Stomach, calming the Pericardium.

Chai Yuqing treated Chen Renzhi, whose physician used warming-dispersing drugs, causing insomnia and hallucinations, with deep-hidden pulses. Diagnosed as summerheat, Jiajian Qing Shu Yi Qi Tang (Modified Clear Summerheat Benefit Qi Decoction) without Renshen/Fuling was given. One dose reduced fever; six pulses became surging-large. Liuyi San (Six-to-One Powder) cured the fever. Insomnia persisted, resolved by tonifying and calming spirits.

In summer of Renxu, Zhu Zaichang vomited and fainted with incontinence in his carriage. Treated as wind-stroke with Fuzi Lizhong Tang plus Jiangcan (Silkworm). Later, pulsing vessels indicated critical condition; more Ginseng/Aconite needed. Chai said: "This is Summerwind; no death signs. I will ensure safety." Qian Zhuyan, lodging with him, disagreed, preparing the previous medicine. Fortunately, Zhu Runeng gave Liuyi San, stabilizing spirit. Qian knew Liuyi San contradicted Lizhong Tang, stopping the previous meds. Next day, Huanglian Xiangru Yin plus Qianghuo cured him after days of regulation.

Lu Zuyu treated Chen Yuanfu, who in July, after litigation and fasting, ate cold porridge, vomiting shortly after. All tea/water vomited. Headache, fever, sore throat, dizziness, salivation. Diagnosed as summerheat, Leng Xiangru Yin (Cold Elsholtzia Decoction) caused immediate vomiting. Well water mixed with Yi Yuan San also caused vomiting, worsening coma. Pulse: Yang portion surging-rapid, Yin portion deep-weak. Pathogen in Upper Jiao. "Those above should be expelled upwards." Emesis was indicated. Hunger emptied the stomach; summerheat entered. Extreme stomach heat met cold water, causing rejection and salivation. Boiled water with salt and vinegar was drunk hot. After 2-3 bowls, massive vomiting occurred (water/phlegm ~1 basin). Shengmai San restored clarity and reduced symptoms. Siwu Tang regulated recovery.

Zhang Shaofu treated a person with summerheat headache, fever, somnolence, and extreme thirst. Treated as cold damage unsuccessfully. Pulse large-deficient. Diagnosed as summerheat. Curtains removed, windows opened, cool water placed around. Patient felt refreshed. Fed watermelon by servants. Drinking 4-5 cups cured him. (Exquisite method.)

When Zhang was a student, in summer of Wuzi (Wanli era), he suffered severe summerheat, gasping, and fainting. Quacks diagnosed internal injury or fatigue. Physician Wang Yunyu nearby frowned: "Mental restlessness and dirty face indicate summerheat." Zhang, partially conscious, took Yi Yuan San, recovering in two doses. Su Rui Yin regulated recovery. (Zhang Shaofu, name Fengkui, authored *Shu Re Quan Shu*, published Tianqi era.)

Li Gou treated Lady Feng, wife of Zhu Zhu, with seven days of fever without sweating, then another seven days without sweating, exceeding twenty days. Physicians declared untreatable cold damage, preparing funeral items. Zhu invited Li to climb the tower for diagnosis. Li laughed: "Your lady's tower is surrounded by wood; wood generates fire, triggering summerheat, hiding the pulse. Organs are healthy. Quickly give melon well water; she will recover without medicine." Following advice, she ate gruel overnight and resumed housekeeping. (*Pashu Ting Ji*.)

Yao Haishan, a civil servant, suffered summerheat headache, fever, panting, fatigue, and hand numbness. Stomach heat damaged original qi. Ren Shen Yi Qi Tang brought instant relief. Buzhong Yiqi Tang plus Maidong/Wuweizi completed cure.

Once, someone hid indoors in summer. Guest arrived; sitting by window, he felt fatigued, took Buzhong Tang himself, worsening condition. Doctor asked cause, gave Xiangru Yin twice, curing him. (*Wan Mizhai Yangsheng Siyao*.)

Ma Yuanyi treated Lu Taishi during autumn summerheat with occasional fever/headache. Pulse large-deficient. Said middle qi was greatly deficient, requiring tonification. Patient argued: "Minor summerheat injury, diet/rest normal, why deficient? Just clear summerheat and regulate middle, remove pathogen, why tonify?" Reluctantly given Qing Shu Yi Qi Tang. Next morning, pulse changed from large to weak-minute, fever persisted. Ma said: "Today, not only tonify, but warm. Take immediately, or complications arise." Lizhong Tang given. Shortly after, sweating like a spring. Afternoon: pulses very weak-minute, sweat like pearls. Continued with 4 liang Renshen and approx. 1 liang Fuzi. Daily total: 10 liang Renshen, 4 liang Fuzi. Sweat stopped, essence stored, gradual recovery.

Pei Zaijian from Renqiu abandoned family for Zen, vegetarian, traveled widely. Lodged in Jintan West Chan Temple, sat/slept in cool tower in extreme heat, chanting 3000 Zhunti mantras and 30,000 Buddha names daily. Suddenly severe headache like axe-chop, fever, irritability, dry mouth, drinking >1 dou cold water daily without relief, expecting death. Zhuang Lianzhi pitied him, visited often. One day, Pei summoned Lianzhi for farewell, giving paintings/artifacts, saying: "After my death, bury me simply in two jars, 3 chi deep." Lianzhi wept, helpless, urged Miao Zhongchun to diagnose. Miao was traveling; sent servant Keqin to catch up. Returned, diagnosed summerheat, prescribed Zhuye Shigao Tang (Bamboo Leaf Gypsum Decoction). Two doses stopped fever/thirst. Dozens of doses reduced illness. Added spleen-strengthening herbs for stability. (*Guang Biji*.)

Lai Tianpei treated Ms. Cai, ill 6-7 days. Early July, fever, headache, chest fullness, abdominal pain, irritability, thirst, closed eyes, coma, muttering. Pulse floating-fine-rapid, vague on pressure. Asked about convulsions: Yes. Lai said: "Commonly called Summerwind Cold Damage." Prescribed Xiangru, Qinghao, Qianghuo, Fangfeng, Zhishi, Jiegeng, Qinjiao, Gouteng, Shichangpu, Banxiaqu, Huoxiang, Chaihu, Huanglian. One dose reduced symptoms, clarified spirit, harmonized pulse. Removed Qianghuo, Shichangpu, Zhishi, Jiegeng, Xiangru; added Guangpi, Houpo, Huafen, Danpi. One dose stable, fever lingering due to fluid non-generation. Changed to Shengdi, Maidong, Fuling, Huafen, Huangqin, Shihu, Guangpi, Guya, Banxiaqu. Two doses fully cured.

Shen Mingsheng treated Wang Mingfu, comatose and mute in long summer, bedridden two nights. Visited noon: "Deficient pulse, feverish body, this is summerheat, not wind. Why not use Ginseng?" Elder brother said: "Friend used Ginseng this morning, worsened agitation." Asked amount: 5 fen. Shen said: "Expected worsening. Should quadruple dose to work." Brother skeptical. Shen explained: "Small doses of Ginseng cause stagnation. Dongyuan advised resting in cool halls for summerheat (yin type). Ancients used..."