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In the third and fourth months, when the weather suddenly becomes hot, the *Couli* (pores of the skin) suddenly open. The internal Qi cannot withstand this dispersion, leading to symptoms such as mental confusion, fever, body fatigue, and loss of appetite. This is called "Zhu Xia" (Summer-Attending Disease). Many physicians in the world have discussed it. However, during the seventh and eighth months, when the summer heat begins to recede and a new coolness suddenly arrives, the *Couli* suddenly close. The internal Qi, having been leaked out through sweating throughout the summer, is weak and unable to replenish itself. It often manifests as sinking of Lung Qi, with shortness of breath and insufficiency. Subsequently, summer heat, coolness, and dampness are all absorbed into the *Couli*, causing symptoms such as fever, aversion to cold, heavy body, limb fatigue, tastelessness in food, thirst without desire to drink. This stands in exact opposition to the disease of "Zhu Xia": one is Yin deficiency, where the weather suddenly opens but the strength is insufficient for opening; the other is Yang deficiency, where the weather suddenly closes but the strength is insufficient for closing. Few physicians discuss this. Only Zhang Shiweng mentions it in the section on Labor Fatigue in his *Yi Tong* (General Treatise on Medicine). I name it "Zhu Qiu" (Autumn-Attending Disease) and record its text as follows: "When Spleen and Stomach are deficient, there is lethargy and a desire to lie down, limbs are not held firm. When the autumn dryness command prevails and damp-heat slightly retreats, the body feels heavy and joints painful, mouth and tongue are dry, food tastes bland, there is no desire to eat, food does not digest, bowel movements are irregular, urination is frequent. Accompanied by Lung disease manifesting as shivering aversion to cold, miserable unhappiness, and sallow, discordant complexion, this is due to Yang Qi not extending. Use Sheng Yang Yi Wei Tang (Spleen-Boosting Decoction)." It also says: "Due to labor and hardship, Yin fire in the Kidneys boils. Later, after removing clothes, bathing, or resting in a cool place, that Yin fire fails to circulate and returns to the skin. The *Couli* are extremely empty lacking Yang, obstructed by wind and coolness. Thus, the exterior is deficient and cannot bear wind-cold, resembling aversion to cold from external contraction. Symptoms include shortness of breath, reluctance to speak, weakness and lack of strength. It must not be treated as an external contraction. Use Bu Zhong Yi Qi Tang (Middle-Boosting Qi-Supplementing Decoction) plus Chai Hu (Bupleuri Radix), Zi Su (Perillae Folium), Qiang Huo (Notopterygii Rhizoma et Radix). In severe cases, add Guizhi (Cinnamomi Ramulus), which is most appropriate." Although this passage does not mention the autumn season, are wind and coolness not autumnal Qi? Therefore, manifestations appearing with sudden coolness are often like this. The latter case is more severe than the former because the sudden arrival of coolness feels particularly unanticipated.

Furthermore: Regarding "Zhu Xia," some predecessors refer to the time of sudden heat in the third and fourth months when these symptoms appear; others refer to the time of humid-heat steaming in the sixth month of Long Summer (Central Summer). I believe both should exist. If these symptoms appear during sudden heat, they will inevitably worsen in midsummer; if they appear in midsummer, there will inevitably be precursors in early summer. Moreover, the name "Zhu Xia" generally refers to the three months of the summer season. Since the disease stems from Yin deficiency and inability to tolerate dispersal, it naturally occurs daily during the summer months, but its mechanism always activates in early summer, forming an opposition of opening and closing with early autumn. Therefore, it is appropriate to consider early summer manifestations as the standard. However, timing varies between initial onset and peak, meaning the illness varies in severity. There are also cases where symptoms appear in early summer but the patient feels refreshed and clear-headed in midsummer. This is due to Yang insufficiency and latent cold-dampness in the meridians; initially, Yang power cannot extend and reach, unlike Yin deficiency where internal Qi is already insecure and cannot withstand the weather's repeated dispersion. Such cases often show irritability and disturbance, unlike the lethargy and shortness of breath seen in Zhu Xia. This is another variant of Zhu Xia. Dai Yuanli referred to manifestations in early July coolness as Zhu Xia, which seems semantically inconsistent. Hence, I created the theory of "Zhu Qiu."