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Heat. Here it refers to external pathogens stagnating and transforming into fire within the Middle Jiao (middle burner). If pathogens stagnate and transform into fire, by analogy and deduction of their causes, there are countless situations that cannot be fully enumerated. For instance, those who seek wind and coolness, those exposed to mist and dampness, those who consume raw and cold foods, those with pre-existing accumulated heat, those whose Yin blood is inherently deficient and unable to withstand heat, those whose latent pathogens are stirred, and those dwelling in yin-cold places. All these factors are sufficient to cause the stagnation of "ling-fire" (regulatory fire), leading to Jing disease (a condition characterized by stiffness of the neck and back, trismus, and opisthotonos). The severity may vary from mild to severe; the location may be exterior or interior; the nature may be deficiency or excess, manifesting according to the specific syndrome. Regarding treatment, to eliminate pathogens and clear heat, weighing all factors, can this be summarized in a single statement? Various collections of formulas and discussions merely add more symptoms and gather more prescriptions, without clearly stating which etiology the pulse and symptoms belong to, which meridians are harmed, or what herb should serve as the Jun (Emperor) drug for treatment. Unless one has deeply studied Zhang Zhongjing's works, I do not believe that those who casually follow formula discussions truly grasp the clinical condition. Bencao states that Geng Ti (Thunberg Fritillary Bulb) treats evil qi in the chest and abdomen, eliminating it through vomiting and purging. This applies when cold water is injured in summer, and water flows within the skin. Since the skin belongs to the Exterior, why use such a drug to remove water from the chest? The Neijing states that exposure to cold and consumption of cold drinks injure the Lung. Moreover, the skin is the exterior correspondence of the Lung, with internal-external resonance. Furthermore, Geng Ti also treats edema of the four limbs and promotes the downward flow of water. Thus, cold water retained in the skin can be dispersed not only by washing but also by drinking cold water causing stagnation, which can disperse within the skin. Therefore, both conditions can utilize this remedy. Jiayan, in his comprehensive discussion on treatment, employs two formulas: Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) and Geng Ti Tang (Thunberg Fritillary Bulb Decoction).

[Supplementary Note] The Jin Gui Yao Lue treats Jing disease with only two formulas. One is Baihu Jia Renshen Tang, specifically treating heat. In summer, excessive heat tends to rebel upward, injuring Lung Metal and consuming body fluids; this formula is used to rescue Lung Metal and preserve fluids. Sun Simiao's Shengmai San (Generate Pulse Powder) and Li Dongyuan's Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) are derived from this principle. The other is Geng Ti San (Thunberg Fritillary Bulb Powder), specifically treating dampness. In summer, excessive dampness, particularly severe in the upper Jiao, first injures Lung Metal. Consequently, externally infiltrated water accumulates between the skin layers. As the skin is the exterior correspondence of the Lung, this formula is used to induce expulsion of water from the chest via vomiting or purging, thereby preventing Lung Qi obstruction and allowing water in the skin layers to drain downward. Why do later practitioners solely revere Zhang Zhongjing's Wuling San (Five-Ingredient Poria Pill) as the model? While Liu Hejian's Tongling San and Zhang Ziheng's Guiling Ganlu Tang (Cinnamon Twig, Poria, and Dew Sweetener) aim to guide out dampness and dissipate summerheat, none extend the formulation logic of Geng Ti Tang to treat Upper Jiao damp-heat and clear Lung Metal. It must be understood that when formless heat injures Lung Metal, Baihu Jia Renshen Tang is used for rescue; when formed dampness injures Lung Metal, Geng Ti Tang is used. Each has its specific indication.