Library

Heat exuberance injures Qi, (Zhuang Huo [vigorous fire] consumes Qi. Furthermore, Qi is lost through sweat, leading to further depletion.) The pulse is large and empty, due to Qi deficiency causing the pulse to be empty. Symptoms include spontaneous sweating, a dirty complexion, aversion to cold on the back, (Qi loss through sweat leads to Yang deficiency; the back belongs to Yin, so slight Yang causes aversion to cold.) dry mouth, and dryness of the anterior incisors, (Heat qi exits through the mouth, hence the dryness of the anterior teeth.) irritability and oppression, or headache, (due to Fire attacking upwards.) fever, (due to Heat being exuberant on the exterior), and extreme mental fatigue and lassitude. Summerheat injures Qi but does not injure the Form, (Cold injures the Form, as blood vessels are stagnated by Cold.) thus the body does not ache, differing from Cold Damage (Shanghan). It is also similar to but distinct from Warm Disease (Wenre Bing); here the pulse is deficient, whereas in that condition it is excess. It is also similar to but distinct from Damp-Warmth (Shiwen); here there is fever and thirst, whereas in that condition there is no fever and no thirst. The primary aspect of this syndrome is to observe the amount of sweating. If sweating is scant, Heat is exuberant internally, injuring internal Qi. If Lung Qi is injured, panting and fatigue must occur; use Renshen Baihu Tang (Ginseng White Tiger Decoction). (See Fever.) If Spleen Qi is injured, there will be four limbs fatigue and anorexia; use Renshen Baihu Tang with increased Gancao (Licorice Root). If Kidney Qi is injured, fluids are depleted, and urine volume is low; use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) with Zhimu (Anemarrhena Rhizome) and Huangbai (Phellodendron Bark). (See Deficiency Injury.)

Furthermore, Summerheat first enters the Heart. The Heart belongs to Fire, following the principle of like attracting like and seeking dryness. (Observing that dry wood burns first while wet wood burns later illustrates this.) When Heart Qi is heated, it floats; when Heart Blood is heated, it becomes dry. Symptoms manifest as irritability and dry mouth; use Chen Sha Wuling San (Cinnabar Five-Ingredient Powder) (See Damp Injury), Zhusha Anshen Wan (Cinnabar Calming Spirit Pill) (See Irritability) added with Huanglian (Coptis Rhizome). The Small Intestine is the Fu organ of the Heart. Wuling San promotes urination to drain Summerheat toxins from the Heart meridian, allowing them to exit via urine; this is a superior treatment for Summerheat, and Yiyuan San is particularly excellent. If Summerheat Qi attacks inward, causing abdominal pain and urinary obstruction, use Shengliao Wuling San (Raw Material Five-Ingredient Powder) with Muxiang (Aucklandia Root) 7 fen, or Yiyuan San. For constipation, use Jia Wei Xiangru Yin (Modified Elsholtzia Decoction) (See Summerheat Stroke), assisted by Sanhuang Wan (Three-Yellow Pill) (See Fever). If Summerheat toxin lodges in the Upper Jiao, causing chest and diaphragm fullness and blockage, such that medicine vomits out immediately upon reaching the mouth, or if there is upper asthma and rapid breathing, use Liuhe Tang (Six-Harmony Decoction) cooled, mixed with a small amount of Shexiang (Musk). If Summerheat Qi lingers unresolved, it becomes Latent Summerheat (Fushi), with heat inside and out, irritability, spontaneous sweating, great thirst preferring cold drinks; use Xiangru Yin (Elsholtzia Decoction) with Huanglian 1 qian, followed by Baihu Tang (White Tiger Decoction) (See Fever). If unimproved, Summerheat toxin has penetrated deeply, with knotted heat inside, delirium, irritability and thirst, aversion to removing clothing, and constipation and urinary difficulty; use Tiaowei Chengqi Tang (Regulate the Stomach Mangosteen Decoction) (See Constipation), or Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction).

For Latent Summerheat with irritability and thirst, accompanied by much Phlegm-Heat, use Xiaoshu Wan (Summerheat-Relieving Pill). Add 2 qian of Huanglian powder per liang of the pill, named Huanglian Xiaoshu Wan. Alternatively, Erchen Tang (Two-Aged Decoction) (See Phlegm) or Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction) (See Phlegm) can be used with Huanglian 1 qian added. For spontaneous sweating with cold hands and feet, use Liuhe Tang and Suhexiang Wan (Styrax Pill) (See Various Midstrokes). For spontaneous sweating with intermittent spasms of hands and feet, it is called Summerwind (Shufeng). This occurs because pores open with sweating, allowing Wind to invade; Fire, fanned by Wind, becomes more fierce, causing tendons and vessels to become dry and tense. Use Xiangru Yin or Xiangru Tang (both See Summerheat Stroke) with Qianghuo (Notopterygium Rhizome) 1 qian added. For excessive Phlegm, (Wind and Fire stirring together cause Phlegm to surge,) use half a dose of Liuhe Tang and half a dose of Xingxiang San (Star Aucklandia Powder) (See Stroke). In summer months, body itching like needle pricks, occasionally with red swelling, is also named Summerwind. (Wind pathogen remains in the skin, Heat cannot vent, causing itching and pain.) Use Liuhe Tang powder mixed with Xiaofeng San (Wind-Expelling Powder) (See Headache), taken with wine.

Excessive sweating allows Heat to dissipate externally, leading to Yang decline internally and dispersion of True Qi; one should urgently consolidate sweat using Renshen (Ginseng), Huangqi (Astragalus Root), Baizhu (Atractylodes Macrocephala Rhizome), and Wuweizi (Schisandra Fruit). A warming interior and consolidating exterior approach is appropriate. Furthermore, unremitting massive sweating leads to collapse of Yang, exhausting Kidney Water and drying internal fluids, termed collapse of Yin; one must urgently nourish the source of Water above (the Lungs). The meaning of the Three Fu days is that Geng Metal is imprisoned. (Metal meets Bing-Ding Fire, losing its clear and肃 [purifying] nature, hence Sun Simiao said: In summer, one should often take Wuweizi, to drain Bing Fire and tonify Geng Metal. (Feared that Metal Qi is severely scattered by Heat, so astringe it. Astringing is tonifying.) Ren Water ends at Ji day, Gui Water ends at Wu hour; the cold and clear Qi of the northwest is exhausted. Hence, ancient practitioners established that summer requires tonification, which is tonifying the Primal Qi of Heaven and Earth, not tonifying Hot-Fire, hence people eat cold foods in summer. Shengmai San (Generate Pulse Powder) (See Summerheat Stroke) governs this.

If the two legs are tilted, knees and feet are flaccid and weak, and walking is unsteady, this is Flaccidity Syndrome (Wei), add Jiuhuang Huangbai (Alcohol-washed Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to generate strength in the legs. Li Dongyuan stated: Heat injures Yuan Qi, causing the four limbs to be unresponsive, legs flaccid, with cold reversal in the morning and evening. After sunrise, when Yang Qi is about to flourish, heat returns like fire; this indicates insufficiency of both Yin and Yang and Qi and Blood, hence Yin deficiency causes hot reversal, and Yang deficiency causes cold reversal. (Excessive Heat leads to Yin deficiency; Qi injury leads to Yang deficiency too.) Loss of taste in the mouth, (Liver Heat causes sour taste, Heart Heat bitter, Lung Heat pungent, Kidney Heat salty, Spleen Heat sweet or bland; this is mouth disharmony causing loss of taste. Also, Qi deficiency leads to indigestion, and those with food stagnation lose taste.) Eyes leaking fire, (Liver Fire ascending.) Blurred vision, (mental confusion.) Frequent urination, constipation, (Heat in the Lower Jiao.) Epigastric pain, (Qi deficiency fails to transport, or food, phlegm, or dead blood stagnates in the epigastrium causing pain.) Chest blockage, occasional vomiting and hiccups, (all due to failure of transportation.) Possibly cough with phlegm, (Metal punished by Fire.) Foaming at the mouth, (Kidney Water flooding upward.) Pain in waist, back, and abdomen, severe cases feeling like knife-stabbing in the abdomen, (all due to Qi and Blood stagnation.) Occasional headache, (Fire attacking upwards.) Hypochondriac pain (Liver Qi stagnation), or acute contraction, tightness around the umbilicus like a rope binding, (Dai Mai [Girdle Vessel] blood dryness and tendon contraction.) Inability to eat, or feeling full immediately after eating, total lack of appetite, (Fire Qi causing distension and oppression.) Severe spontaneous sweating, as if Yin Qi covers the skin and hair. (Qi is weak, Yang cannot extend outward, compounded by sweat soaking the body.) All these are caused by Heat injuring Yuan Qi, governed by Huangren Shen Tang (Yellow Ginseng Decoction).

Also observe for other pathogens. For example, contracting Summerheat while drinking alcohol, where alcohol Heat and Summerheat Qi are exuberant internally, causing fever, great thirst, and difficult urination with urine color like blood; use Shengliao Wuling San (See Wind Damaging Dampness) without Guizhi (Cinnamon Twig) plus Huanglian 1 qian. Or use Wuling San without Guizhi, swallowing Jiuzhu Huanglian Wan (Alcohol-boiled Coptis Pill). For food stagnation, the person has headache and back cold, (Qi is depressed by food, failing to reach the back.) aversion to eating, nausea, belching with sour foul odor, chest and diaphragm fullness; use Liuli Tang (Six-Benefiting Decoction) with doubled Sharen (Amomum Fruit). If due to thirst from Summerheat drinking cold water, causing Summerheat toxin to knot in the heart and chest, with mental confusion and inability to speak, (Cold closes Heat in the lung tube, hence voice is absent); use Xiangru Tang (See Summerheat Stroke) and dissolve Suhexiang Wan (See Various Midstrokes). If cold water was drunk first then Summerheat contracted, this must be epigastric fullness; use Wuling San, preferably taken with Ginger Decoction. Or Junzi Tang (Gentleman Decoction) (See Qi) to harmonize the middle is also acceptable. After harmonizing, if urination is difficult or glans pain occurs, use Puhuang (Lygodium Spore) 3 qian, Huashi (Talcum) 5 qian, Gancao 1 qian.

Furthermore, Summerheat often combines with Dampness. During late summer, Damp-Heat prevails, steaming and blazing. Contracting it causes limb fatigue, shortness of spirit, and reluctance to move. Yellow-red urine indicates Heat. Joint pain, loose stools, and heavy body indicate Dampness. Pulse is Hongda (large and forceful, indicating Heat) and Rou (soft) or Chi (slow, indicating Dampness). One must treat with formulas that clear Heat and dry Dampness. Li Dongyuan's Qing Shu Yi Qi Tang (Clear Summerheat Tonify Qi Decoction) posits that Heat injures Qi, so Huangqi (Astragalus) is the sovereign herb to tonify Qi and consolidate the exterior. Renshen and Gancao are ministers. Cangzhu (Atractylodes Lancea Rhizome), Baizhu, and Zexie (Alisma Rhizome) promote urination to drain Dampness; Shengma (Cimicifuga Rhizome) and Gegen (Pueraria Root) release exterior Heat and overcome Dampness; (Wind herbs, thus they overcome Dampness.) Damp-Heat stagnation prevents digestion causing fullness; Chaoqu (Fried Medicated Leaven) and Qingpi (Aurantium Peel) digest food and move Qi; Chenpi (Tangerine Peel) regulates Qi chaos in the chest where clear and turbid interfere; Huangbai clears Heat to save the Kidney; Renshen, Wuweizi, and Maidong (Ophiopogon Tuber) rescue Lung Metal to nourish the source of Water above as assistants. Add Danggui (Angelica Sinensis Root) for Blood deficiency; add Shengma and Chaihu (Bupleurum Root) for Qi stagnation; remove Gancao for middle fullness; remove Renshen for cough; add Gegen for dry throat; add Renshen and Danggui for reduced Blood and irritability (Yang generates Yin), with slight Huangbai to drain Fire; if irritability persists, add Huanglian. However, if Dampness is not combined, these diuretic agents will instead deplete Kidney Water and damage the eyes; be cautious.

Li Dongyuan also stated: Wind invades sweat pores, sweat closure leads to Dampness, causing heavy body and pain, thirst or no thirst, difficult urination; this is Wind-Dampness combing. Headache, or upper Heat congestion, irritability, despondency, feeling life is not worth living, (this is the state of Yin-Dampness, known as Yang comfort and Yin misery), this is Yin overcoming Yang to the extreme. Severe disease transmits to Wei-Jue (Flaccidity-Reversal). Jue is Qi reversing upward. Wei is flaccidity and weakness of the four limbs. Due to Dampness郁 (depressing) into Heat, extreme Heat reverses upward causing Jue, and tendon-vessel injury causes Wei; draining Dampness and clearing Heat is appropriate. (Qingzao Tang may be used.) Additionally, for those who contract Summerheat then catch Wind-Cold: body pain, headache, fever; removing clothes causes shivering, wearing clothes causes vexation; catching Wind causes sweating; use Wuling San (See Damp Injury) with Guizhi. Catching Cold causes no sweating; use Liuhe Tang with Huoxiang (Patchouli Herb) and Zisu (Perilla Leaf). This is common among laborers, often caused by working under Summerheat during the day and sleeping with windows open at night. For this syndrome with tidal fever resembling malaria but not quite: use half a dose of Liuhe Tang and half a dose of Yangwei Tang (Nourish Stomach Decoction) (See Malaria). If clear nasal discharge or hot air from nostrils occurs, also use Liuhe Tang with Chuanxiong (Ligusticum Rhizome) 5 fen, Qianghuo and Huangqin (Scutellaria Root) 7 fen each. All the above are Summerheat pathogens contracted in summer. (What ancients called "obtained through movement is Yang syndrome.") There are those obtained without movement, contracting heat Qi directly, using Yiyuan San. There are also those who, avoiding Summerheat by seeking coolness, are injured by cold-coolness instead; either wind-cool injures the exterior, or melons/fruits injure the interior, causing headache, fever, aversion to wind, and no sweating. (Ancients named this Summerheat Stroke or Zhong Han [Midstuck Cold], names were confused, so we delete the name and keep the syndrome.) The syndrome resembles Cold Damage, but this is suppressed by Yin-Cold, preventing Zhou Shen Yang Qi from extending. Treatment should be acrid-cool dispersing and acrid-warm guiding out. (This is completely un-injured by Summerheat but caught Wind-Cold, different from the aforementioned Summerheat then Wind-Cold; what ancients called "obtained through stillness is Yin syndrome.")

In summer, eating much raw/cold food then suddenly contracting Summerheat, Heat enters internally, Yin and Yang are mixed, Cold and Heat combat, Middle Qi is disturbed, rising causes vomiting, descending causes diarrhea, hence much vomiting and diarrhea. For Huoluan (Chaos Reversal) with unremitting vomiting, use Pipaye San (Loquat Leaf Powder) (See Summerheat Stroke), remove Maogen (Imperata Rhizome), swallow Laifu Dan (Reviving Elixir) (See Summerheat Stroke). Vomiting with Phlegm, use Queshu San (Summerheat-Repelling Powder) (See Summerheat Stroke) swallowing Xiaoshu Wan or Xiao Banxia Fuling Tang (See Phlegm-Fluids). Vomiting with thirst, use chilled Xiangru Tang (See Summerheat Stroke) or Wuling San (See Damp Injury), swallowing Xiaoshu Wan concurrently. Diarrhea with thirst, use Shengliao Pingwei San (Raw Material Level the Stomach Powder) (See Food Injury) and Shengliao Wuling San half doses each, named Weiping San, or Lianli Tang. (That is Lizhong Tang added with Huanglian and Baifuling. Lizhong Tang See Cold Damage Middle.) If diarrhea stops but thirst remains, use Chunze Tang, (that is Wuling added with Renshen.) or Suopi Yin (Spleet-Spleen Drink) (See Summerheat Stroke). Diarrhea with abdominal pain and accumulation, use Shengliao Wuling San and Huoxiang Zhengqi San (Patchouli Regulating Qi Powder) (See Summerheat Stroke) half doses each. Even without accumulation, severe abdominal pain is Qi stagnation; use Shengliao Wuling San with Muxiang 7 fen, or Liuhe Tang with Muxiang 5 fen, or use these two decoctions to tune Suhexiang Wan. (See Various Midstrokes) Diarrhea with fever, use Weiping San. If vomiting and diarrhea do not stop, external Heat and internal Cold, irritability wanting to strip naked, this is Yin Excess repelling Yang; use Xiangru Tang with Fuzi (Aconite Lateral Root), or Dashun San (Great Smooth Powder) with Renshen and Fuzi, taken chilled. For extreme vomiting with Stomach deficiency, unable to eat even a grain, critically ill: use Renshen 1 qian, Huanglian 5 fen (fried in Ginger Juice until charred), Nuomi (Glutinous Rice) a pinch, water one tea cup, decoct to one wine cup, wait for cool, give one tea spoonful gradually, once finished, administer medicine/food. Many take Xiangru Yin in summer for prevention; if Yuan Qi is originally deficient or sexual exertion is excessive, taking it causes harm. For dietary prevention, only Shengmai San is suitable. Summer diseases are mostly Yin syndromes, evidenced by death with green-black limbs and nails, hence Summerheat treatments often use warm-hot agents.