Library

The syndrome of heatstroke manifests as fever, headache, coldness in the back, a greasy facial complexion, spontaneous sweating, irritability, extreme thirst with dry mouth, fatigue without body pain, occasional aversion to cold, or fear of sunlight and hot air, with a pulse that is deficient and weak. Regardless of whether the pathogen is in the exterior or interior, Baihu Tang (White Tiger Decoction) is generally appropriate. For fever, irritability, and thirst caused by common cold, Wuling San (Five-Ingredient Powder with Poria), Guizhi Fuling Ganlu Yin (Cinnamon Twig, Poria, and Sweet Dew Decoction), Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction), or Shuangjie San (Double-Release Powder) may be used. If internal heat is severe, accompanied by abdominal fullness and a deep pulse indicating constipation suitable for purgation, Dachengqi Tang (Major Order the Qi Decoction) should be used to purge, or Sanyi Chengqi Tang (Three-One Order the Qi Decoction) is even better. For half-exterior half-interior conditions, Xiaochaihu Tang (Minor Bupleurum Decoction), Liangge San (Cool the Diaphragm Powder), or Tianshui San (Heaven and Water Powder) are indicated.

Commentary: Liu Hejian's discussion on heatstroke syndromes is very detailed, and his analysis of various physicians' medication strategies is precise and accurate, truly grasping the essence. However, regarding heatstroke, distinguishing between exterior and interior is unnecessary; one should solely clear internal heat, resolving the condition with cold-cooling herbs and astringing with bitter-sour ones, without needing purgatives. Dachengqi Tang acts swiftly like a galloping horse to purge feces; it should be rejected.

The *Cistao Lun* (Treatise on Acupuncture Points) states: "Qi deficiency with body heat results from injury by summerheat, as heat injures Qi." The *Weilun* (Treatise on Flaccidity Syndromes) states: "If one travels far and becomes fatigued, encountering intense heat and thirst, Yang Qi is internally attacked by heat, causing heat to lodge in the Kidney. The Kidney is the Water Organ. Now, if Water cannot overcome Fire, bones become withered and marrow empty, feet cannot support the body, developing into bone flaccidity (Gu Wei). Thus, the *Xia Jing* says: 'Bone flaccidity arises from great heat.' This refers to damp-heat causing flaccidity, leading to skeletal weakness and lack of strength. Therefore, treating flaccidity focuses exclusively on the Yangming channel. During late summer, damp-heat prevails, steaming and blazing intensely. People often contract it, resulting in limb fatigue, diminished spirit, reluctance to move, rapid breathing, heaviness and pain in joints, or qi rebellion with panting, body heat with irritability, epigastric distension and stuffiness, yellow and scanty urine, loose and frequent stools, or dysentery discharging yellow mushy matter or rice-water colored fluid, thirst or no thirst, loss of appetite, spontaneous sweating with heavy body, or scanty sweating, which indicates blood disease preceding qi disease. From this time until late summer, already incorporated into the main text, avoiding bias, we restate that the pulse is洪缓 (surging and slow); if dampness combats, it adds a 迟 (slow) quality. Although diseases vary slightly, the heavenly heat and damp command remain the same. It is appropriate to treat with drying and clearing agents, named Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction).

Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction):
Huangqi (Astragali Radix) [reduce by 5 fen if sweating is scant]
Cangzhu (Atractylodis Rhizoma) [soaked in rice water, skin removed, 1.5 qian each]
Shengma (Cimicifugae Rhizoma) [1 qian]
Renshen (Ginseng Radix) [remove rhizome]
Baizhu (Atractylodis Macrocephalae Rhizoma)
Chenpi (Citri Reticulatae Pericarpium)
Shenqu (Massa Medicata Fermentata) [stir-fried]
Zexie (Alismatis Rhizoma) [0.5 qian each]
Gancao (Glycyrrhizae Radix et Rhizoma)
Huangbai (Phellodendri Cortex) [wine-soaked]
Dangguishen (Angelicae Sinensis Radix)
Maimendong (Ophiopogonis Radix) [remove heart]
Qingpi (Citri Reticulatae Pericarpium Viride) [remove white pith]
Gegen (Puerariae Lobatae Radix) [0.3 qian each]
Wuweizi (Schisandrae Chinensis Fructus) [9 berries]

The *Neijing* states: "Yang Qi guards the exterior and maintains solidity. Heat causes Qi to leak. Now, summerheat pathogen invades the Defensive Qi, causing body heat and spontaneous sweating. Huangqi, Renshen, and Gancao tonify Middle Qi and boost energy, serving as Sovereign herbs. Chenpi and Dangguishen, being sweet, pungent, and slightly warm, nourish Stomach Qi and harmonize Blood vessels, serving as Minister herbs. Cangzhu, Baizhu, and Zexie promote diuresis and drain dampness. Shengma and Gegen, bitter, sweet, and neutral, effectively release muscle-layer heat, utilizing wind herbs to overcome dampness. If dampness prevails, it fails to dissipate and causes distension and fullness; thus, stir-fried Shenqu is sweet and pungent, Qingpi is pungent and warm, digesting food and moving Qi. The Kidney dislikes dryness; urgently eat pungent substances to moisten it. Huangbai, bitter, pungent, and cold, borrows the sweet flavor to clear heat and replenish fluids for deficiency, nourishing the source of transformation. Wuweizi and Maimendong, sour, sweet, and slightly cold, rescue Lung Metal injured by summerheat, serving as Assistant herbs.

Grind these into coarse pieces for one dose. Add two cups of water, decoct to one cup, remove dregs, and take when slightly warm, long after meals.

Commentary: Dong Yuan's intentions are precise. His formula formulation is balanced. Qing Shu Yi Qi Tang has been widely followed in recent times. However, it is most suitable for individuals with Qi and Blood deficiency. For robust individuals, it may not be effective and could exacerbate internal heat; therefore, careful consideration is necessary.