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[Zhang Zihe] The onset of flaccidity syndrome (Wei Syndrome) occurs during the months of May, June, and July. The Wu month is the position where Shaoyin Junhuo (Ministerial Fire of Shaoyin) prevails. The Wei month is where damp earth and Geng Metal harbor latent fire. The Shen month is the domain of Shaoyang Xianghuo (Ministerial Fire of Shaoyang). Therefore, flaccidity syndrome occurring within these three months is caused by heat. Consequently, patients with flaccidity syndrome present with a floating and large pulse.

[Zhu Danxi] Zhu Xia (Summer Fatigue) belongs to Yin deficiency and insufficient Yuan Qi (Original Qi). In Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), remove Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma), and add fried Huang Bo (Phellodendri Cortex). If accompanied by phlegm, use Nan Xing (Arisaematis Rhizoma Praeparatum).

[Li Dongyuan] *Ci Zhi Lun* (Treatise on Acupuncture and Moxibustion regarding Qi) states: "Qi deficiency with body heat results from summerheat injury; heat damages Qi." *Fei Lun* (Treatise on Flaccidity) states: "If one travels far and labors, encountering intense heat and thirst, thirst causes Yang Qi to attack internally; internal attack allows heat to reside in the Kidney. The Kidney is the Water organ; now Water cannot overcome Fire, leading to dry bones and empty marrow, causing the legs to be unable to support the body, developing into Bone Flaccidity (*Gu Wei*). Thus, *Xia Jing* says: 'Bone Flaccidity arises from great heat.' This is flaccidity caused by damp-heat, making the bones weak and powerless; therefore, treatment of flaccidity focuses solely on the Yangming channel. During Changxia (Long Summer), damp-heat is overwhelming, steaming and blazing. People affected often experience heavy limbs, shortness of spirit, reluctance to move, chest fullness, shortness of breath, heaviness and pain in joints, or rebellious Qi with panting, body heat with vexation, epigastric distension and stuffiness, yellow and frequent urination, loose and frequent stools, or dysentery with yellow mushy discharge like rice water, thirst or no thirst, loss of appetite, spontaneous sweating with heaviness, or scanty sweating (indicating Blood disease preceding Qi disease). The pulse at the middle position is洪缓 (surging and slow). If dampness combats, a 迟 (slow) pulse is added. Although the disease may slightly improve, the heavenly heat and damp command remain the same; it should be treated with drying and clearing agents. *Neijing* states: 'Yang Qi guards the exterior and secures; heat causes Qi leakage.' Now summerheat pathogen attacks the Defensive Qi, causing body heat and spontaneous sweating. Huang Qi (Astragali Radix), sweet and warm, serves as the Sovereign herb for tonification; Ren Shen (Ginseng Radix), Chen Pi (Citri Reticulatae Pericarpium), Dang Gui (Angelicae Sinensis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma), sweet and slightly warm, serve as Ministers to tonify the Middle and augment Qi; Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Ze Xie (Alismatis Rhizoma) promote diuresis and drain dampness; Sheng Ma (Cimicifugae Rhizoma) and Ge Gen (Puerariae Lobatae Radix), bitter and sweet, flat in nature, excel at releasing muscle-layer heat and using wind herbs to overcome dampness. Dampness excess leads to indigestion and fullness/stuffiness, so fried Shen Qu (Massa Medicata Fermentata), sweet and pungent, and Qing Pi (Citri Reticulatae Pericarpium Viride), pungent and warm, digest food and move Qi. The Kidney dislikes dryness and urgently needs pungent flavors to moisten it; thus, Huang Bo (Phellodendri Cortex), bitter and cold, uses sweet flavor to drain heat and nourish water. For deficiency, nourish the source of transformation using Ren Shen (Ginseng Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), and Mai Men Dong (Ophiopogonis Tuber), sour, sweet, and slightly cold, to rescue Geng Metal injured by heavenly summerheat, serving as Assistant herbs. This is named Qingshu Yiqi Tang (Clear Summerheat and Augment Qi Decoction).

Huang Qi (1 qian, reduce by 0.5 qian if scanty sweat) Ren Shen (remove rhizome, 0.5 qian) Sheng Ma (1 qian) Ze Xie (0.5 qian) Gan Cao (roasted, 0.3 qian)
Cang Zhu (soaked in rice water, remove rhizome, 1 qian) Ge Gen (0.2 qian) Wu Wei Zi (9 grains) Bai Zhu (0.5 qian) Shen Qu (fried yellow, 0.5 qian)
Huang Bo (wine-soaked, peel removed, 0.3 qian) Mai Men Dong (remove heart, 0.3 qian) Gui Shen (Radix Angelicae Sinensis, 0.3 qian) Chen Pi (0.5 qian) Qing Pi (peel removed, 0.25 qian)

Grind all ingredients together, prepare as one dose. Add two large bowls of water, decoct to one bowl, remove dregs, take warm. Take after meals. Dosage should be adjusted according to circumstances.
This disease arises from dietary irregularities and overwork damaging the Spleen and Stomach, exacerbated by summerheat. Avoid herbs such as Ze Xie, Zhu Ling, Fu Ling, Deng Xin Cao, Tong Cao, and Mu Tong, which are bland and promote diuresis; these follow the prosperous qi of the season to drain pathogenic factors from the Spleen/Stomach and supplement the insufficiency of Metal and Water. This formula is established based on expediency. If symptoms of damp-heat and Spleen prosperity occur at this time, or if urination is already frequent and Kidney/Liver are not affected by pathogens, misuse will severely drain True Yin and exhaust Kidney Water, damaging the eyes first. The following modifications for changed syndromes are established:
If Heart Fire invades the Spleen, Blood is affected by Fire and cannot raise Yang Qi, which lies hidden in the Earth (Spleen). Use Dang Gui to harmonize Blood, and a small amount of Huang Bo to benefit True Yin.
For Spleen/Stomach insufficiency, use a small amount of Sheng Ma, an guiding herb for Foot Yangming and Taiyin, to facilitate movement along the Yang pathways, moving rightward from the Spleen/Stomach. Shaoyang governs Spring, generating roots. Add a little Chai Hu to guide meridians rightward, generating Yin and Yang Qi to nourish Spring harmony.
If Spleen deficiency stems from hyperactive Heart Fire invading Earth, followed by Lung Qi affected by heat, use the most Huang Qi, then Gan Cao, then Ren Shen. These are warm, sweet, Yang herbs. As Spleen becomes deficient, Lung Qi fails first. Thus, use sweet-warm Huang Qi to benefit Qi of skin/hair and close pores, preventing spontaneous sweating and damage to Yuan Qi. For panting, shortness of breath, and reluctance to speak, use Ren Shen. For Heart Fire invading Spleen, use roasted Gan Cao to drain heat and tonify Yuan Qi in the Middle. Use minimal Gan Cao to avoid exacerbating fullness. For acute Spleen/Stomach pain, severe deficiency, abdominal contraction, or tight abdominal skin, use more. *Jing* says: "For tension, use relaxation." If acting expediently, add Sheng Ma to guide, fearing leftward-moving pathogens are strong and stubborn, potentially causing wasting of neck/buttock muscles and entering Yin pathways. Guide them along Yang pathways so clear Qi rises rightward and upward to harmonize Yin/Yang. If central fullness exists, remove Gan Cao. If cough is severe, remove Ren Shen. If mouth/throat dry, add Ge Gen.
If Spleen/Stomach is deficient and cannot ascend/float, Yin Fire damages generating Qi, Ying Blood is greatly depleted, Ying Qi hides in Earth, Yin Fire blazes, day by day consuming, blood/Qi become scarce. Heart Protector and Heart master Blood; reduced blood means Heart lacks nourishment, causing Heart disorder and vexation, named [missing character]. Vexation implies mental confusion and unease. Clear Qi does not ascend, turbid Qi does not descend, clear/turbid interfere, chaos ensues in Chest, causing reverse flow of blood/Qi throughout body. *Jing* says: "For ascending disorders, guide them downward." Thus, add pungent-warm and sweet-warm agents to generate Yang; when Yang generates, Yin grows. Regarding the discussion of three sweet-warm herbs, some ask how sweet-warm can generate Blood, as they are not Blood herbs. Answer: Zhang Zhongjing's method uses Ren Shen to tonify Blood deficiency; vigorous Yang generates Yin Blood. Add Dang Gui to harmonize Blood, and a little Huang Bo to save Kidney Water, as sweet-cold drains Fire/Heat; reduced Fire calms Heart Qi. If vexation persists, add a little Huang Lian. Nourish Kidney Water so Water prospers and Heart Fire descends, supporting Earth's Yang Qi. If floating Qi and chaotic Heart, use Zhusha Anshen Wan to settle and secure. Stop taking once vexation reduces to prevent draining Yang Qi causing collapse. For epigastric stuffiness, add a little Huang Lian. Qi chaos in Chest due to clear/turbid interference is managed by Chen Pi to assist Yang Qi ascent and disperse stagnant Qi, aiding other sweet/pungent herbs.
During Long Summer, damp-earth pathogenic Fire is strong; expediently add Cang Zhu, Bai Zhu, Ze Xie to drain damp-heat up/down. Excess dampness prevents food digestion, reducing appetite; add fried Shen Qu to digest. Re-add Wu Wei Zi, Mai Men Dong, Ren Shen to drain Fire, benefit Lung Qi, and aid Autumn deficiency. This is medicine for the peak of Long Summer during Sanfu days.

**Spleen/Stomach Weakness Causes Variable Diseases; Formulas Adjusted Accordingly**
Spleen/Stomach weakness inevitably leads to insufficient Upper Jiao Qi. Encountering intense summer heat damages Yuan Qi, causing lethargy, desire to lie down, limbs unreceptive, insufficient spirit, weak legs. Morning/evening cold reversal; after midday, Yang Qi rises, heat returns like fire. This indicates insufficiency of Yin/Yang and Qi/Blood. Thus, either Heat Reversal with Yin deficiency, or Cold Reversal with Qi deficiency. Tasteless mouth, fire flashing in eyes, blurred vision, frequent urination, difficult constipation, epigastric pain below heart. Hypochondriac pain or contraction, umbilical constriction like rope binding, stabbing pain, inability to stretch abdomen, chest oppression, occasional vomiting/wheezing, phlegm cough, white foam in mouth, stiff tongue, back/abdominal pain, intermittent headache, inability to eat or early satiety, total loss of appetite, severe spontaneous sweating. If Yin Qi covers skin/hair, it is heavenly heat assisting the disease. Geng Large Intestine and Xin Lung Metal are attacked by heat. First assist Yuan Qi, treat Geng/Xin insufficiency. Main formula: Huang Qi Ren Shen Tang.

Huang Qi (1 qian, add 1 qian if excessive spontaneous sweating) Ren Shen (remove rhizome, 0.5 qian) Gan Cao (roasted, 0.2 qian) Bai Zhu (0.5 qian)
Cang Zhu (0.5 qian, 1 qian if no sweat) Ju Pi (0.2 qian, keep white pith) Huang Bo (wine-washed, 0.2 qian, to save Kidney Water source)
Shen Qu (fried, 0.3 qian) Wu Wei Zi (9 grains) Mai Men Dong (remove heart, 0.2 qian) Gui Shen (wine-washed, 0.2 qian) Sheng Ma (0.6 qian)

Grind all, prepare as one dose. Add two bowls of water, decoct to one bowl, remove dregs, take slightly warm after meals or on empty stomach. Avoid alcohol, damp wheat, strong spices, and excessive cold foods.
If epigastric stuffiness, add Huang Lian (0.2-0.3 qian). If epigastric pain, reduce cold herbs, add Caodoukou Ren (0.5 qian). If hypochondriac pain/contraction, add Chai Hu (0.2-0.3 qian). If headache/fire in eyes, add Huang Lian (0.2-0.3 qian), Chuan Xiong (0.3 qian). If head/eyes unclear, upper congestion/heat, add Man Jing Zi (0.3 qian), Gao Ben (0.2 qian), Xi Xin (0.1 qian), Chuan Xiong (0.3 qian), Sheng Di Huang (0.2 qian). If shortness of breath, low spirit, dream-like fatigue, add Wu Wei Zi (9 grains). If stool sticky/obstructed, absent for 1-2 days, leading to poor intake, blood deficiency, latent fire in blood preventing lubrication, add Dang Gui Shen, Sheng Di Huang (each 0.5 qian), Tao Ren (3 kernels, peeled/seeded, ground separately), Ma Zi Ren (ground paste, 0.5 qian). If stool passes, stop added herbs. If stool still not smooth, do not use other drugs, add a little Da Huang (baked, 0.5 qian). If not unblocking, it is not blood stagnation/constipation; heat generates wind, showing wind symptoms. Do not re-add single blood herbs. Continue Huang Qi Ren Shen Tang. Use only Qiang Huo (0.5 liang), Fang Feng (0.5 liang), grind, add four bowls water, decoct to one bowl, remove dregs, take on empty stomach. Stool will pass significantly; stop after one dose. If chest Qi stagnation, add Qing Pi, double Chen Pi (white removed) to expel pathogen. Disease root is Yuan Qi insufficiency; must tonify, not drain. If Qi stagnation too severe, or tonics too much, or emotional depression, add Mu Xiang (0.2-0.3 qian), Sha Ren (0.2-0.3 qian), Ba Dou Kou Ren (0.2 qian) to decoct with main herbs. If abdominal pain without aversion to cold, add Bai Shao Yao (0.5 qian), Huang Qin (0.2 qian), reduce Wu Wei Zi.

When Spleen/Stomach is weak, in June/July, rivers rise, continuous rain, things moisten, sweat soaks clothes, body heavy, shortness of breath, even limb flaccidity, unsteady gait, tilted feet, blackened eyes, near falling. This is exhaustion of Kidney Water and Bladder. Urgently rescue: nourish Lung Qi to supplement upper source of Water, prevent Geng Large Intestine from receiving pathogenic heat, prevent excessive sweating. Severe sweating loses Jin Ye (Body Fluids); loss of fluids leaves Seven Spirits without basis. *Jing* says: "Fluids and Qi form each other, Spirit arises naturally." Fluids are governed by Geng Large Intestine. Sanfu meaning is Geng Metal imprisoned. If fluids lost, sweat profuse, damp command excessive, clear/descending Qi perishes, Dry Metal imprisoned, Wind/Wood unchecked. Thus Wind-Damp combat, joint pain, whole body pain. "Excess causes harm, control follows." Sun Simiao said: "Take Wu Wei Zi regularly in May to drain Bing Fire, tonify Geng Metal Large Intestine, benefit Five Zang Yuan Qi." Ren Bladder cold ends at Si, Gui Kidney Water ends at Wu. Now meeting damp prosperity assisting heat as pathogen, Western/Northern cold/clarity perishes. Sages' law: Summer tonification supplements Heavenly Primal True Qi, not hot/fire. Let people eat cold in summer. Heat damages Yuan Qi; use Ren Shen, Mai Men Dong, Wu Wei Zi to generate Pulse. Pulse is Yuan Qi. Ren Shen sweet tonifies Yuan Qi, drains hot fire. Mai Men Dong bitter/cold supplements Water source, clears/descends Dry Metal. Wu Wei Zi sour drains fire, tonifies Geng Large Intestine and Lung Metal. At this time, even healthy people may have two symptoms, let alone those with Spleen/Stomach deficiency and chronic illness. Encountering heat, mismanagement, violating seasonal transformation, leads to fatigue, weakness, reluctance to speak, shortness of breath, weak/rebellious Qi, panting-like but not true panting, bone weakness, dream-like state, misty confusion, unawareness of body, massive sweating. If wind strikes sweat-pores/skin, neck tendons spasm, skin dry, hair brittle, body heavy, joint pain, or whole body pain, thirst/no thirst, yellow/scanty urine, this is Wind-Damp combat. Headache/heavy head, upper heat congestion, mouth/nose shortness of breath, mind/body vexation, dislike for life, sad mood, this is extreme Yin overcoming Yang. Severe disease transmits to Kidney/Liver, becoming Fei Jue (Flaccidity-Reversal). Jue: limbs feeling like in fire is Heat Reversal; limbs cold is Cold Reversal. Cold Reversal has cold in abdomen; Heat Reversal has heat in abdomen, because Spleen governs limbs. If muscles soaked, numbness/anesthesia, transmits to Flesh Flaccidity. All syndromes involve Lung pathology; users should adjust accordingly. Qi rushing to chest are all Jue syndromes. Fei: limbs flaccid/powerless, endless Heart vexation (Heart spirit chaotic). Jue: Qi rebellion, severe Great Rebellion. Hence Jue Ni. Jue and Fei often accompany each other. In previous Huang Qi Ren Shen Wu Wei Zi Mai Men Dong Tang, add Bai Fu Ling (0.2 qian), Ze Xie (0.4 qian), Zhu Ling, Bai Zhu (each 0.1 qian). If urination smooth/not yellow/scanty, add only Ze Xie (0.2 qian) with Er Zhu to drain damp up/down. If unsteady gait, weak knees/feet, tilted feet, already infected by Fei pathogen, add wine-washed Huang Bo, Zhi Mu (0.3-0.5 qian) to generate strength in feet. If massive sweating, fluid escape, stop urgently: add Wu Wei Zi (6 grains), fried Huang Bo (0.5 qian), fried Zhi Mu (0.3 qian). Do not hinder eating; judge by intent. If hinders eating, stop, resume after meal. Puncture Sanli, Qijie with three-edged needle to bleed. If sweat does not decrease/stop, bleed Shanglian point (3 cun below Sanli), forbid alcohol/damp wheat. Fei is damp-heat attacking Kidney/Liver, urgent removal required. Otherwise, Lower Jiao Yuan Qi exhausts, becoming soft paralysis, waist down immobile, endless Heart vexation. If body heaviness reduces, no shortness of breath, normal urination, and damp-heat command recedes, or increased pathogenic Qi recedes, do not use Wu Wei Zi, Ze Xie, Zhu Ling, Fu Ling, Huang Bo, Zhi Mu, Cang Zhu, Bai Zhu. Only adjust regular medicine based on primary syndrome. Must also use wine Huang Bo (0.2-0.3 qian). In June/July, damp command prevails, Son makes Mother solid, heat prospers. Damp-heat combines to punish Geng Large Intestine, use cold/cool to rescue. Dry Metal receives damp-heat pathogen, cuts off source of Cold Water generation. Source cut, Kidney deficiency, Fei Jue disease erupts, waist down flaccid/paralyzed, immobile, unsteady gait, tilted feet. Main formula: Qing Zao Tang.

Huang Qi (1.5 qian) Huang Lian (1 qian, remove stamens) Cang Zhu (1 qian) Bai Zhu (1 qian) Chen Pi (0.5 qian) Wu Wei Zi (9 grains)
Ren Shen Bai Fu Ling Sheng Ma (each 0.3 qian) Dang Gui (1.2 qian) Ze Xie (0.5 qian) Chai Hu Mai Men Dong Sheng Di Shen Qu (fried)
Zhu Ling Huang Bo (wine processed) Gan Cao (roasted. each 0.2 qian)

Cut like hemp seeds. Each dose 0.5 liang. Add two bowls water, decoct to one bowl, remove dregs, take slightly warm on empty stomach.

[Zhu Danxi] Song Mou, labor injury with fever, treat as Zhu Xia.
Huang Bo (fried) Sheng Ma (each 0.3 qian) Huang Qi Ren Shen Mu Tong Bai Shao Yao (each 0.5 qian) Bai Zhu (1.5 qian) Chen Pi
Gan Cao (roasted. each 0.2 qian)

Woman suffering Zhu Xia, sour/weak hands/feet with heat.
Bai Zhu (1 qian) Huang Bo (fried) Bai Shao Yao Chen Pi Dang Gui (1 qian) Cang Zhu (0.5 qian) Gan Cao (raw) Jiang (2 slices)