Library

Summerheat pathogenic factors must be accompanied by dampness. They are inhaled through respiration and first damage the upper jiao (Upper Burner). Therefore, Zhang Zhongjing's treatment of Cold Damage (Shanghan) begins with distinguishing the Six Channels (Liu Jing), while Liu Hejian's treatment of Warm Diseases requires investigating the Three Jiaos (Three Burners). Generally speaking, summerheat damages Qi, and dampness obstructs the movement of Qi. The Lung governs the circulation of Qi throughout the body, is located high, and belongs to the Hand-Taiyin Lung Meridian. Based on the described symptoms—red face, cold feet, and epigastric fullness/stuffiness—it is evident that the disease originated in the Upper Jiao. This is because the patient habitually drinks alcohol, causing damp-heat to lie latent in the Stomach for a long time. Using acrid-warm and drying/cracking herbs not only fails to address the Lung pathology but also causes the damp-heat in the Stomach to be sealed off by the dry heat, leading to diarrhea with watery stools, known as "Xie Re Xia Li" (Diarrhea accompanying heat). Thus, Huanglian (Coptis Rhizome), being bitter and cold, inevitably worsens the diarrhea upon each administration; this is because the bitter-cold nature overcomes the acrid-warm heat, yet the medicinal flavor remains at the bottom of the Stomach, having no effect on the initial pathogen affecting the Lung. Shigao (Gypsum Fibrosum) is acrid and cold; the acrid flavor enters the Lung first. Zhimu (Anemarrhenae Rhizoma) has a cooling taste and represents the mother Qi of the Stomach (Metal generates Water, Lung is the mother of Kidney/Stomach contextually implies generating fluids). However, without understanding the Lung pathogen, merely claiming to generate fluids is not the ultimate principle. In the past, Sun Simiao asked questions before diagnosing, which was least likely to cause errors. Furthermore, according to the family, the illness began twenty days ago with no sweating or release. The Classic states: "In summerheat, one should sweat and not stop it." Due to obstruction in the Qi level for a long time, heat penetrates into the Blood level, resulting in hemoptysis (coughing up blood-stained sputum), red tongue, and little thirst. If the Upper Jiao is not resolved, it spreads to the Middle and Lower Jiaos. These are all indications for urgently clearing the Three Jiaos, which is the primary objective. Therefore, if stasis-heat from heat diseases remains in the collaterals, becoming residual toxins; or if it pours into the Fu organs and intestines causing severe diarrhea, then one would be helpless.

Furthermore, dampness is a heavy and turbid pathogen, while heat is a steaming and vaporizing qi. Heat situated within dampness creates steaming vapors that oppress the clear orifices from above, causing deafness. This differs from Shaoyang deafness. Qinghao (Artemisiae Annuae Herba) is one degree inferior to Chaihu (Bupleuri Radix) but is also a fundamental herb for Shaoyang. A major illness is like a great enemy; selecting herbs is like selecting generals. Without caution, success is rare. It is proposed to clarify the Three Jiaos, following Liu Hejian's method. Fei Huashi (Talcum), Sheng Shigao (Raw Gypsum Fibrosum), Hanshui Shi (Calcitum), Da Xingren (Semen Armeniacae Amarum), Chao Huang Zhu Ru (Fried Bamboo Shavings), Chuan Tongcao (Tetrapanacis Medulla), Ying Bai Jin Zhi (Clear White Human Excrement Juice), Yinjin Hua Lu (Honeysuckle Flower Dew).

Second visit: After pulse diagnosis, urticaria suddenly appeared on the abdomen, chest, muscles, and skin pores. This indicates that damp-heat in the Qi level has an opportunity for hidden discharge. The residual pathogens and lingering heat discussed in the morning must involve detoxification for this reason. After taking medicine in the afternoon, the pulse was larger than in the morning, and mental clarity remained unchanged, except for the red tongue, especially dry in the center. Palpating the body revealed higher heat than in the morning. This indicates the Yin level is also damaged by steaming heat. For thin individuals, one worries about fluid depletion. However, since phlegm is difficult to expectorate, yin-nourishing herbs tend to be cloying and stagnating. It is proposed to administer a dose of Qing Ge Tang (Clear Diaphragm Decoction) early on. For the accumulation of heat and turbidity in the Three Jiaos, Zi Xue Dan (Purple Snow Pill) 2-3 spoons should be used. Relying on its aromatic properties to open orifices and expel turbidity will resolve the depleted heat and prevent turbid phlegm from sticking. Subsequent conditioning formulas should clear the Ying (Nutritive) level and nourish Stomach fluids to ensure recovery. The expulsion of accumulated fecal matter may take ten days. Ancients said purgation is not too late; this is not speculation. Zhimu (Anemarrhenae Rhizoma), Zhuye Xin (Bamboo Leaf Heart), Lianqiao Xin (Forsythiae Fruit Heart), Chao Chuan Bei Mu (Fried Fritillariae Bulbus), Xijiao (Rhinocerotis Cornu - *Note: Substitute with Buffalo Horn in modern practice*), Yuanshen (Scrophulariae Radix), Jin Zhi (Human Excrement Juice), Yinhua Lu (Honeysuckle Dew), Zi Xue Dan (Purple Snow Pill).

Third visit: After a month of seasonal pathogens, the pulse is small and rapid. Small indicates disease retreat; rapid indicates residual heat. Therefore, peeling skin suggests the free flow of Qi and Blood; appetite returning suggests the Stomach is awakening. These are good omens. However, the red tongue with yellow coating in the center indicates that prolonged heat steaming has damaged both Stomach fluids and Yin fluids, causing difficulty swallowing and pain in the urethral tip. Phlegm is thick, and accumulated waste has not passed. If attacked hastily, true Yin may be further depleted. The main strategy here is preserving Yin, supplemented by clearing the Fu organs. Therefore, consuming milk/food aids heat; only bland flavors harmonize with the disease. Since ancient times, heat diseases fear relapse due to dietary indiscretion after illness, a universally known fact, not speculation. Xi Shengdi (Rehmanniae Radix Preparata), Yuanshen Xin (Scrophulariae Radix Heart), Zhimu (Anemarrhenae Rhizoma), Chao Chuan Bei Mu (Fried Fritillariae Bulbus), Maidong (Ophiopogonis Tuber), Digupi (Lycii Cortex), Yinhua Lu (Honeysuckle Dew), Zhuli (Bamboo Juice).

Summerheat must carry dampness; both injure the Qi level. They enter via the nose and first attack the Lung, constituting a disease of the Upper Jiao. Treatment methods use acrid-cool and slightly bitter herbs; once the Qi level of the Upper Jiao is cleared, the disease resolves. Regrettably, physicians specialized in Tao Hua's Six Classics viewed the disease through the Six Channels, using herbs for exterior-release followed by interior-clearing typical of Wind-Cold. This caused the pathogen located in the upper part to spread and remain bound for over forty days. Since it was not initially a Six Channel disease, there is no need to debate its fallacy. The Classic says: "Diseases entering from above should be treated from above." Citing classic principles to discuss treatment is not heretical. Following Liu Hejian's method: Xingren (Semen Armeniacae Amarum), Gualou Pi (Trichosanthis Pericarpium), Banxia (Pinelliae Rhizoma), Jiang Zhi (Ginger Juice), Baiko Ren (Amomi Fructus Rotundus), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Zhuli (Bamboo Juice).

Fourth visit: Pulse spirit is quite calm. Rash appeared yesterday noon, preceded by chills. Since this illness originated from damp-heat, and there was no sweat, Qi obstruction in muscle and skin pores prevented complete expulsion of the pathogen despite skin peeling like bran. The recurrence of wind-rash indicates dampness resolving through shivering. For a month, the disease has ravaged the body, leaving muscles without lubrication, emaciated and withered. Ancients said for thin patients, worry about Yin depletion. If Yin fluids are insufficient, tonify with flavor, but fishy/fatty/turbid flavors only aid Upper Jiao heat-phlegm and do not benefit Yin nourishment. Moreover, since accumulated stagnation remains and intestinal Qi is still obstructed/dull, bland conditioning is necessary to keep Upper Qi fresh so heat-phlegm does not re-aggregate. Seasonal heat diseases fear post-illness relapse. At this critical stage ("nine ren"), careful attention is urged. Yuanshen Xin (Scrophulariae Radix Heart), Xi Shengdi (Rehmanniae Radix Preparata), Yinhua (Honeysuckle), Zhimu (Anemarrhenae Rhizoma), Sheng Gancao (Raw Licorice Root), Chuan Bei (Fritillariae Bulbus), Danpi (Moutan Cortex), Juhong (Citri Reticulatae Pericarpium Rubrum), Zhuli (Bamboo Juice).

Illness nearly a month, still deaf, mental confusion, severe cough with sticky phlegm, audible breathing sounds in throat. This is not acute Cold Damage, but rather summer-damp-heat internal depression during Summer/Autumn, triggered by new coolness activating latent pathogens. Light agents should clear and resolve the Three Jiaos. Alas, physicians do not understand latent Qi disease, focusing only on dispersing, digesting, cooling, and fire-clearing. This consumes Stomach juices and burns true Yin. Red tongue edges, dry/cracked gums indicate pathogen remaining in Ying (Nutritive) level, risking internal closure, convulsions, and reversal cold. Right pulse small/rapid, left pulse choppy/weak. Heat is firmly internal. With daily Yin injury, prolonged neglect risks Yin collapse. Head and face are clear orifices; when obscured by pathogen, essence/Qi/Blood do not circulate freely, losing sensory function. Light clearing and resolving is decisive. Propose clearing congestion of Qi and Blood in Upper Jiao first, avoiding heavy bitter-cold herbs, imitating ancients' caution against damaging Yang in obese patients. Lianqiao Xin (Forsythiae Fruit Heart), Yuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Yujin (Curcumae Radix), Juhong (Citri Reticulatae Pericarpium Rubrum), Hei Zhipi (Gardeniae Cortex), Chuan Bei (Fritillariae Bulbus), Xian Changpu Gen (Fresh Acori Tatarinowii Rhizoma), Zhuli (Bamboo Juice).

Fifth visit: Pulse right slow/large, left weak. Facial dirtiness reduced, phlegm-cough unsmooth. Likely due to Stomach fluids damaged by acrid-dispersing/warm-drying herbs. Heart Ying and Lung Wei are all steamed by heat flames, causing mental dullness, panting, deafness, obstruction of Clear Yang, and dysfunction of nine orifices. First formula: disperse/resolve Qi and Blood. Second formula: aromatic orifice-opening. Let the formless transform and rotate; Three Jiaos have their specific functions, unlike vulgar doctors who only know attacking stagnation. Now effective, proceed to clear/nourish Stomach Yin and Lung Qi. Constitution is robust, Yang weak, intolerant of deep cold. However, in late Autumn/Winter transition, Heaven's Qi descends, affecting Upper Jiao first. Observe frost/dew falling, plants changing color; humans in Qi intersection follow Heaven and Earth, combining constitution with treatment. Pipa Ye (Loquat Leaf), Chao Huang Chuan Bei (Fried Yellow Fritillariae Bulbus), Juhong (Citri Reticulatae Pericarpium Rubrum), Yujin (Curcumae Radix), Fuling (Poria), Yiren (Coicis Semen).

San Nüe (Tri-periodic Malaria) pathogen is in Yin, not yet healed. Spring severe diarrhea/anorexia suggests spring rain external dampness and internal water/grain dampness aggregation, i.e., "dampness becomes five types of diarrhea". Skin lesions only drained collateral dampness, not internal dampness. Long Summer inhaled summerheat, obscuring clear orifices, causing cough/deafness. This is clearly a new pathogen, not comparable to chronic disease. Lianqiao (Forsythiae Fructum), Fei Huashi (Talcum), Nen Zhuye (Young Bamboo Leaf), Hetu Bian Zhi (Lotus Leaf Margin Juice), Sangye (Mori Folium), Xingren (Semen Armeniacae Amarum), Xiang Bei (Fritillariae Thunbergii Bulbus), Hei Shanzhi (Gardeniae Fructum).

Running around disrupts Qi, compounded by drinking liquor. Liquor qi is acrid-hot, ascending without descending, causing Lung Qi depression, upper-lower blockage. White tongue, thirst, Qi knot from chest to abdomen, foul-smelling loose stools, body ache, profuse sweating without relief. All stem from summer-damp-heat starting in Lung, spreading through Three Jiaos. Doctors used digestive/bitter drugs attacking only intestines/stomach, leaving upper blockage unresolved. Propose light leaching aided by slight acridity, conforming to Xuanti's "treat upper disease from above" formula. Xigua Cuiyi (Watermelon Rind), Chuan Bai Tongcao (Tetrapanacis Medulla), Dadou Huangjuan (Sojae Semen Praeparatum), Madouling (Aristolochiae Radix), Shegan (Belamcandae Rhizoma), Yiren (Coicis Semen).

During Sanfu (Dog Days), Yin Qi does not generate, Yang Qi does not hide. Head distension/body pain indicates initial summerheat reception. Summerheat-damp-heat first injures Qi level, hence white tongue, thirst, body pain, refreshing mornings, stifling afternoons, resembling warm malaria. Bathing agitates blood collaterals; chronic disease meets seasonal pathogen. Zhongjing said: "Treat new disease first, then manage chronic disease." This is also Yin Qi injured first, Yang Qi flaring alone. Xian Shengdi (Fresh Rehmanniae Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Yuanshen (Scrophulariae Radix), Lianqiao (Forsythiae Fructum), Zhuye Xin (Bamboo Leaf Heart), Hetu Zhi (Lotus Juice).

Initial latent summerheat injures Qi level, mild fever/thirst, pathogen attacks Lung. Mismanagement allows pathogen to expand, reverse to Danzhong (Conception Vessel area), causing crimson/shrunken tongue, sudden urinary retention, blackened nose/cracked bleeding, mouth ulcers/deafness, mental dullness. Qi-level heat spreads to Blood level. Lung governs Wei (Defensive), Heart governs Ying (Nutritive). Ying-Wei Qi circulates meridians day/night, meeting pathogen, alternating cool/hot. Now entering collaterals, fluids robbed, leading to gradual coma/sleepiness, termed "internal closure, external collapse". Xian Shengdi (Fresh Rehmanniae Radix), Lianqiao (Forsythiae Fructum), Yuanshen (Scrophulariae Radix), Xijiao (Rhinocerotis Cornu), Shichangpu Bo (Acori Tatarinowii Rhizoma Peel), Yinhua (Honeysuckle).

Right pulse empty/large, left pulse small/hollow. Alternating chills/fever, numbness/palsy, lower back pain, cold sweat. Chronic internal deficiency from labor, autumn summerheat guest pathogen invades Zang Yin, causing mental confusion, heart heat, irritability. Scraping provides slight relief, but disease persists. Not a meridian disease, but worry about deep heat robbing Yin leading to spasms/reversal. Zhang Sinong collected theories on summerheat: entering Liver causes numbness/palsy, entering Kidney causes thirst, clear evidence. Propose clearing Yin-level pathogen, supplementing with righteousness/nourishment. Ejiao (Asini Corii Colla), Xiao Shengdi (Small Fresh Rehmanniae Radix), Maidong (Ophiopogonis Tuber), Renshen (Ginseng Radix), Xiao Chuanlian (Small Coptidis Rhizoma), Wumei Rou (Mume Fructus Seed Flesh).

Summerheat enters from above, first into Lung collaterals. Days pass, Qi-level heat reversely transmits to Ying, forcing into Pericardium collaterals, causing coma/restlessness, short tongue, limb traction. Deep summerheat invasion is called Fa Jing (Spasm). Heat closed internally, limbs反而 not hot. Heat closed internally leads to external collapse, profound truth. Ancient methods: clearing collateral heat must combine aromatics to open inner orifices and clear consciousness. Heavy drugs attacking pathogen go straight to intestines/stomach, irrelevant to Pericardium closure. Xijiao (Rhinocerotis Cornu), Xian Shengdi (Fresh Rehmanniae Radix), Lianqiao (Forsythiae Fructum), Xian Changpu (Fresh Acori Tatarinowii Rhizoma), Yinhua (Honeysuckle), Hua Zhibao Dan (Transformed Ultimate Treasure Pill) 4 pills.

Illness over ten days, body still restless/heat, sticky tongue coating, mental dullness/fixed eyes, rigid/rapid pulse, irritability/confabulation. Long-latent summer-damp combined with seasonal turbid pathogen, brewing sticky phlegm, blocking clear mansion, confusing spirit. Stomach turbid fluids steamed/oppressed, cannot vent. Sweet meds/herbs cause ascariasis reversal/vomiting. Classic says: below damp position, dry qi attacks, thus follow it. Damp turns to dry. Without damp-phlegm moisture steaming up, tongue coating would already be dry/cracked. Now first nourish fluids to clear raging fire. Xian Shengdi (Fresh Rehmanniae Radix), Maidong (Ophiopogonis Tuber), Wumei (Mume Fructus), Zhe Jiang (Sugarcane Juice), Yinhua Lu (Honeysuckle Dew), Lingyang Jiao (Saiga Antelope Horn), Bang Shui (Clam Water).

Sixth visit: Dirty face, white tongue, thirst, short breath like panting, spontaneous diarrhea. Turbid qi entered nose/mouth, mixed with food/grain qi, dampness blocked, steaming internally, Three Jiaos affected. Dark spots on chest/back/limbs, turbidity stuck with Qi/Blood, Heart collaterals scorched by pathogen, coma/confabulation. Hand meridians spread epidemic pathogen, different from Cold Damage. Method: aromatic repulsion of pathogen, assisted by detoxification, preventing damp-turbid obscuration, avoiding spasms/reversal. Shichangpu Zhi (Acori Tatarinowii Rhizoma Juice), Baiko Ren (Amomi Fructus Rotundus), Xijian (Rhinocerotis Cornu Tip), Xiao Qingpi (Small Citri Reticulatae Pericarpium Viride), Lianqiao Xin (Forsythiae Fruit Heart), Yinhua (Honeysuckle), Liuyi San (Six-to-One Powder), Jin Zhi (Human Excrement Juice), Zhibao Dan (Ultimate Treasure Pill).

Seventh visit: Pathogen sank, diarrhea returned, injuring Jueyin. Symptoms: Qi rushing to heart, hunger but no appetite, dry heaving/abdominal pain, all signs of Liver disease. Liver is storage of extreme Yin, housing Minister Fire. Zhang Zhongjing's method avoids purely rigid/hot agents because Liver is a rigid organ. Now intersecting Earth prosperous time, Wood/Fire are enemies. Five days not stable, caution advised. Renshen (Ginseng Radix), Dan Wuyu (Light Evodiae Fructus), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Qinpi (Fraxini Cortex), Chao Wumei (Fried Mume Fructus).

This July, autumn summerheat not removed. Initial headache/body heat, summerheat from upper orifices injuring Clear Yang. Medicine should use acrid-cool to capture Qi, same qi seeks same, middle-upper light pathogens disperse naturally. Instead, acrid-warm, bitter-cold, clearing/nourishing mixed together, food/grain internal steaming, turbidity unresolved. Symptoms still above waist, between shell, not major Zang-Fu disease. Ten days of vegetable diet can resolve Upper Jiao depression. Chuanxiong (Ligustici Chuanxiong Rhizoma), Bohe (Menthae Haplocalycis Herba), Jingjie Tan (Schizonepetae Spica Carbonized), Chao Baizhi (White Peucedani Radix), Manjingzi (Vernoniae Semen), Juhua Di (Chrysanthemi Flos Calyx), Green Tea decocted as water.

Middle Qi exhausted, craving cold drinks/drinks, suppressing summer-damp fire, accumulating in Danzhong, robbing fluids/consuming liquids, all transforming to dryness. Lung Qi cannot descend, intestines/stomach dry/full/blockage. Purging forces blood downward. Once blood is lost, it is exhausted. Yin cannot match Yang, sweat does not escape, becoming Upper Reversal. Upper reversal, lower exhaustion, Lung meridian alone suffers dryness. Urgently administer Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction) to restore Yin fluids. Pipa Ye (Loquat Leaf), Renshen (Ginseng Radix), Maidong (Ophiopogonis Tuber), Sangye (Mori Folium), Ejiao (Asini Corii Colla), Xingren (Semen Armeniacae Amarum), Sheng Shigao (Raw Gypsum Fibrosum), Zhuye (Bamboo Leaf).