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(Also known as Summerheat-Dampness with Cold)

[Etiology] First, dampness is contracted; subsequently, summerheat is contracted; then, it is triggered by a sudden exposure to cold. There are also cases where the disease arises from external contraction of summerheat and dampness combined with internal injury caused by raw and cold food and drink. This occurs most frequently in summer and also in early autumn.

[Symptoms] In cases of summerheat-dampness with external cold, at the onset, there is headache, fever, aversion to cold, absence of sweating, heaviness and pain in the body, lassitude of the four limbs, and cold extremities. After urination, one feels chilly with gooseflesh. Only the anterior teeth appear dry, accompanied by coarse breathing, irritability, and in severe cases, panting with sighing. Subsequently, alternating chills and fever occur, resembling malaria. When dampness is predominant, chills exceed heat; when summerheat is predominant, heat exceeds chills. There is poor appetite, stuffiness and fullness in the chest and abdomen, loose stools or diarrhea, and short, yellow, hot urine. The tongue coating is initially white and turns yellow later, appearing greasy or rough.

In cases of summerheat-dampness with internal cold, at the onset, there is headache, bodily heaviness, distinct aversion to cold, mental restlessness and agitation, limb flaccidity, chest fullness, abdominal pain with vomiting and diarrhea. In severe cases, all four extremities are cold, or only the lower legs are cold. Urination is difficult, or scanty, astringent, and hot. The tongue coating is white and slippery, or gray and slippery; in severe cases, black and slippery, or pale white.

[Pulse] If the left pulse is wiry, fine, and tight, and the right pulse is slow and stagnant, this results from seeking coolness during summer, causing summerheat to be suppressed by cold and dampness, preventing the yang qi of the whole body from extending and rising. As Zhang Jiegu stated, this belongs to "acquired while resting," a disease caused by summerheat itself. If the pulse is deep and tight, or even deep, wiry, and fine, this results from excessive drinking and indulging in melons and raw/cold foods, injuring the spleen and stomach with cold and dampness. As Zhang Luyu stated, this is due to cold injury amidst heat, constituting an internal cold disease of summer.

[Treatment] For summerheat-dampness with external cold, the method should be to release the exterior with acrid-warm herbs and disperse the interior with aromatic and bland herbs. Use Huoxiang Zhengqi Tang (Agastache Powder for Regulating the Middle) as the main formula, added with Xiangru (Moslae Herba, 1.5 qian) and Xingren (Armeniacae Semen Amarum, 3 qian). Wait for slight sweating to resolve the external cold, then immediately switch to Dajupi Tang (Large Tangerine Peel Decoction) to warm and transform the dampness. Once the dampness is removed, the summerheat loses its basis and dissipates. If residual summerheat remains, remove Cangzhu (Atractylodis Rhizoma) and Guigui (Cinnamomi Ramulus) from the previous formula, and add Zhizi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), and Qinghao (Artemisiae Annuae Herba) to clear and regulate.

For summerheat-dampness with internal cold, the method should be to warm and transform raw/cold substances and use acrid-bland herbs to leach out dampness. Use Weiling Tang (Weiling Decoction) as the main formula, added with Dingxiang (Caryophylli Flos, 9 pieces) and Muxiang (Aucklandiae Radix, ground into juice, 2 chi mixed). Once the cold water is eliminated and vomiting/diarrhea stop, switch to Xiangsha Erchen Tang (Aucklandia and Amomum Two-Aged Peel Decoction) to warm and transport stomach yang. When yang qi harmonizes, summerheat and dampness gradually transform via fire; switch to Dajupi Tang, removing Guizhi (Cinnamomi Ramulus) and Baizhu (Atractylodis Macrocephalae Rhizoma), and adding Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Yinchen (Artemisiae Scopariae Herba), and Qinghaosuzi (Artemisiae Annuae Fructus) to clear and transform.

[Commentary by Xiu] This is a miscellaneous contraction syndrome of summer. External contractions mostly result from first contracting summerheat-dampness, then being exposed to new cold from wind and rain. This corresponds to the *Neijing* saying: "Those born from Yang are acquired from wind, rain, cold, and summerheat." Internal injuries mostly result from fearing heat and avoiding summerheat, bathing in cold water, lying in the wind, and overeating ice-cold melons. This corresponds to the *Neijing* saying: "Those born from Yin are acquired from diet and dwelling." These are concurrent and complicated syndromes of summerheat-dampness diseases, not the primary syndromes of summerheat-dampness injury. Whenever summerheat is suppressed by cold-dampness or depressed by raw/cold foods, Yu's methods are stable and appropriate. Although the intent is similar to the five formulas modified from Xiangru Yin (Mosla Decoction) established by earlier sages, as well as Dashun San (Dashun Powder), Lengxiang Yin (Cold Fragrant Decoction), and Jiangshui San (Grain Water Powder), the selection of herbs and formulation design has fewer adverse effects. Later students should follow these methods.

[Commentary by Lian] Summerheat injury in summer most often involves complicated syndromes. When summerheat is light and cold-dampness is heavy, summerheat resides within cold-dampness and assimilates with it. Therefore, dispersing cold is equivalent to dispersing summerheat, and treating dampness is equivalent to treating summerheat. This applies only to those with yang deficiency and abundant dampness. Yu's methods are indeed the correct treatment. However, if the person has yin deficiency and abundant fire, summerheat resides within fire. Even if wind-cold is contracted, it constitutes a syndrome of "guest cold wrapping fire." Initially, use Yiyuan San (Yiyuan Powder) plus Congchi Bohe (Scallion, Fermented Soybean, and Mentha) to induce slight sweating and resolve the newly constrained external cold. Subsequently, use Ye's Xiangru-Xingren Tang (Xiangru-Armeniacae Decoction) [Xiangru (0.7 qian), Xingren, Feihushi (Talcum), Siguye (Luffae Folium) each 3 qian, Sitongcao (Tetrapanacis Medulla) 1.5 qian, Baokoufen (Amomi Fructus Rotundus Powder) 0.5 qian mixed]. Use light, cool, and bland herbs to clear and promote diuresis. If residual pathogens remain unresolved, use Wu's Qingluo Yin (Clear Collaterals Decoction) [Xianyinhuaj (Lonicerae Japonicae Flos), Xianbiandouhua (Dolichoris Flos), Xiansigua pi (Luffae Pericarpium), Xianzhuyexin (Bambusae Folium Heart), Xianheyebian (Nelumbinis Folium Margin), Xiguancuiyi (Citrullae Exocarpium) each 2 qian]. Use acrid-cool and aromatic herbs to regulate and clear. If summerheat and dampness are both heavy, use Zhang's Cangzhu Baihu Tang (Atractylis-Baihu Decoction) modified [Du Cangzhu (1 qian) mixed with Yan Shigao (6 qian), Koufen (0.5 qian) mixed with Yan Feihushi (6 qian), Zhimu (3 qian), Caoguoren (0.4 qian), Chen Cangmi (3 qian) wrapped in Lotus Leaf, Juanxin Zhuye (2 qian)]. Other transformed syndromes can be treated according to heat syndrome examples. Regarding the mixed intake of melons and greasy foods, Liuhe Tang (Six-Harmony Decoction) modified is mostly used; one dare not rashly administer Jiang (Zingiberis Rhizoma) and Fu (Aconiti Lateralis Preparata Root).

[Commentary by Rongzhai] Mr. He Lianchen stated: "When summerheat is constrained by dampness, and the pathogen is in the Qi level at the onset, one must distinguish whether dampness or heat is predominant. If dampness is predominant, treatment focuses on lightly opening Lung Qi. Since the Lung governs the Qi of the whole body, when Qi transforms, dampness naturally transforms; even if there are concurrent pathogens, they transform together. Dampness pervades without form or substance; thus, herbs that are light in nature and acrid-bland in flavor should be used. Acrid herbs such as Xingren (Armeniacae Semen Amarum), Kourén (Amomi Fructus Rotundus), Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Huogeng (Pogostemonis Herba); bland herbs such as Yiren (Coicis Semen), Tongcao (Tetrapanacis Medulla), Fuling (Poria), Zhuling (Polyporus), and Zexie (Alismatis Rhizoma); open the upper sluice, branch off rivers, guide dampness downward as an exit route. When dampness leaves and Qi flows freely, fluids are distributed externally, and sweating resolves naturally. If summerheat is heavier than dampness, dampness transforms via fire, and fire tends toward dryness; thus, Shengdi (Rehmanniae Radix) and Shihu (Dendrobii Caulis) become essential herbs for subsequent care." (Recorded from *Compilation of Verified Cases of Famous Physicians Nationwide*)