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Whenever latent warm-heat disease (Fuwen Wenre) occurs due to contracting warm pathogens in spring or summer pathogens in summer, once it erupts, it presents with thirst and aversion to cold absent, but rather tidal fever, aversion to heat, mental restlessness, delirium, dry throat, dry tongue, faintly visible macules on the skin, and in severe cases, convulsions of the hands and feet resembling epilepsy. This corresponds to Zhang Zhongjing’s description of "heat accumulation in the interior, heat in both exterior and interior," which should be treated primarily with Baitu Jia Renshen Tang (Gypsum and Ginseng Decoction). However, one must differentiate based on bowel movements: if stools are unobstructed, the pathogen should be vented through the muscle layer and cleared from the internal organs; Xinjia Baitu Tang (Modified Gypsum Decoction) is the primary formula, while Chaiqin Qingge Jian (Bupleurum and Scutellaria Decoction to Clear the Diaphragm) may be used酌情 (as appropriate). If stools are obstructed, urgent purgation of the interior and draining of fire is paramount; Baitu Chengqi Tang (Gypsum and Rhubarb Decoction) and Xilian Chengqi Tang (Rhinoceros Horn and Coptis Decoction) are the main formulas. For cases complicated by phlegm, Xianxiong Chengqi Tang (Chest-Trapping Purgative Decoction) or Jiawei Liangge Jian (Modified Cooling Diaphragm Decoction) are selected. For food stagnation, Zhishi Daozhi Tang (Immature Bitter Orange Decoction to Guide Out Stagnation) is selected. For blood stasis, Tao Ren Chengqi Tang (Peach Kernel Purgative Decoction) is selected. For warm-toxin complications, Jiedu Chengqi Tang (Detoxifying Purgative Decoction) is selected. For blood deficiency, Yangrong Chengqi Tang (Nourishing Glory Purgative Decoction) is selected. For dual deficiency of qi and blood, Tao Shi Huanglong Tang (Mr. Tao’s Yellow Dragon Decoction) is selected.

When warm disease or latent summerheat is about to erupt but is simultaneously constrained by wind-cold, this is termed "external cold binding internal heat" (Ke Han Bao Huo). One must differentiate whether the exterior syndrome is urgent or the interior syndrome is urgent, and whether cold or heat is predominant. If external cold is heavy and exterior symptoms are urgent, release the exterior first using Congchi Jiegeng Tang (Scallion, Fermented Soybean, and Platycodon Decoction) with modifications. If latent heat is heavy and interior symptoms are urgent, clear the interior first using Chaiqin Qingge Jian with modifications.

For patients with a constitutionally deficient and cold body who inhale heat and contract summerheat, this is "superficial heat with root cold" (Biao Re Ben Han). Only light and clearing methods should be used to treat the superficial pathogen. Once the superficial pathogen is eliminated, transition to warming transformation and warming tonification formulas to avoid the risk of collapse.

Symptoms such as dry mouth and tongue, prickly tongue coating, swollen and painful throat, epigastric fullness and abdominal distension with severe pain upon pressure, craving for ice water, red and scanty urine causing severe pain even with drops, sticky constipation, or spontaneous passage of pure black watery stool with extremely foul odor, are all evidence of true heat in the interior (Li Zhen Re). However, the entire body surface feels like ice, nails are cyanotic or red and warm, and the six pulses are fine as silk, palpable lightly but vanishing under pressure. This is what Wu Keyi called "body jue and pulse jue" (Ti Jue Mai Jue). One must distinguish whether the extremities went from hot to warm, or from cold limbs to jue (coldness); upper limb coldness does not exceed the elbow, lower limb coldness does not exceed the knee. Pressing the chest and abdomen reveals burning heat after prolonged contact. This is the true manifestation of excess yang repelling yin (Yang Sheng Ge Yin). Blood stasis is certain, and Ying and Wei circulation is blocked, causing the pulse channels to close and skin to feel icy. Treatment should initially involve soaking scallion whites and perilla in liquor, extracting the juice, and wiping the chest, back, and limbs with soft cloth to warm and assist blood circulation. Internally, Tao Ren Chengqi Tang should be used urgently to purge, unblocking vessels to preserve yin fluids. However, given the critical nature of the condition, only one in ten might survive.

[Commentary by Xu Rongzhai]: True heat in the interior with false cold on the exterior is "yang syndrome resembling yin." Ge Cunju detailed this in Volume 1 of *Shanghan Butianshi* (Supplement to the Stone of Heaven for Cold Damage), which can serve as mutual verification. He stated: "Yang syndrome resembling yin is essentially extreme fire resembling water. In cold damage, when heat is excessive and sweating or purging was neglected, yang qi becomes hyperactive and depressed internally, manifesting externally as its controlling element (water); thus, the body feels cool, limbs are cold but occasionally warm, resembling yin syndrome. Generally, cracked lips, dry tongue, ability to drink fluids, red urine, and constipation are key. If loose watery stool flows out externally while dry feces accumulate internally, this is 'paradoxical diarrhea' (Pang Liu), not cold diarrhea. Also, check for extremely foul-smelling flatulence. Although the pulse may be deep, pressing reveals rapid, slippery, and forceful qualities. Signs of internal heat include aversion to covering, throwing hands and legs about, and forceful delirium—these indicate yang syndrome. Mild cases use Sini San combined with Xiaochaihu Tang; severe cases use Baitu Tang combined with Jiedu Chengqi Tang. With tidal fever and solid stool, use Da Chaihu Tang; with severe dryness, hardness, and fullness, use Da Chengqi Tang."