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Huangqi (Astragali Radix) - reduce by 0.5 fen if sweating is scanty; Cangzhu (Atractylodis Rhizoma) - soaked in rice water, skin removed; Shengma (Cimicifugae Rhizoma) - each of the above 1 qian; Renshen (Ginseng Radix) - radix tip removed; Zexie (Alismatis Rhizoma); Shenqu (Massa Medicata Fermentata) - stir-fried until yellow; Chenpi (Citri Reticulatae Pericarpium); Baizhu (Atractylodis Macrocephalae Rhizoma) - each of the above 0.5 fen; Maidong (Ophiopogonis Radix) - heart removed; Danggui (Angelicae Sinensis Radix), Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparata with honey) - each of the above 0.3 fen; Qingpi (Citri Reticulatae Pericarpium Viride) - white pith removed, 0.25 fen; Huangbai (Phellodendri Cortex) - washed with wine, skin removed, 0.2 or 0.3 fen; Gegen (Puerariae Lobatae Radix) - 0.2 fen; Wuweizi (Schisandrae Chinensis Fructus) - nine pieces.

All ingredients are coarsely crushed together. Prepare as a single dose, add two large cups of water, decoct until one cup remains, strain, and take warm when very hot, long after meals. The dosage should be adjusted according to the condition.

This disease arises from dietary irregularities and overwork damaging the Spleen and Stomach, compounded by summer heat pathogen. However, using herbs such as Zexie, Zhuling (Polypori Umbellati), Fuling (Poria), Dengxincao (Junci Medulla), Tongcao (Tetrapanacis Medulla), Mutong (Akebiae Caulis), which are bland and promote urination, follows the vigorous qi of the season to drain guest pathogens from the Spleen and supplement the deficiency of Metal (Lung) and Water (Kidney). This main formula is established as an expedient measure. If used mistakenly in cases without seasonal damp-heat or Spleen excess, or where urination is already frequent and Kidney/Liver are not affected by pathogens, it will severely drain True Yin, exhaust Kidney Water, and first damage the eyesight. Variations for altered syndromes are listed below.

When Heart Fire invades the Spleen, blood is affected by fire and cannot ascend; Yang Qi lies dormant underground. "Underground" refers to the human Spleen. One must use Danggui to harmonize blood and a small amount of Huangbai to nourish True Yin.

For Spleen and Stomach insufficiency, a small amount of Shengma should be used, as it is the guiding herb for the Foot-Yangming and Foot-Taiyin meridians. It guides Qi to move along the Yang pathways, migrating rightward from the Spleen and Stomach. Shaoyang executes the Spring command, generating the root of all transformations. Adding a little Chaihu (Bupleuri Radix) allows the meridians to migrate rightward, generating Yin and Yang Qi to nourish the harmonious Qi of Spring.

Spleen deficiency occurs because Heart Fire is hyperactive and attacks Earth (Spleen); secondarily, Lung Qi is affected by pathogens and injured by heat. One must use Huangqi (Astragali Radix) in the largest quantity, followed by Gancao (Glycyrrhizae Radix et Rhizoma), then Renshen (Ginseng Radix). These three are sweet-warm Yang herbs. When the Spleen is initially deficient, Lung Qi is often the first to fail. Therefore, the sweet-warm nature of Huangqi is used to benefit the Qi of the skin and hair, closing the Couli (pores) to prevent spontaneous sweating and loss of Yuan Qi. For upper asthma, shortness of breath, and reluctance to speak, Renshen is necessary to tonify. When Heart Fire attacks the Spleen, Zhi Gancao is used to drain fire and tonify Yuan Qi in the Spleen and Stomach; however, Gancao should be used sparingly to avoid causing fullness. In cases of urgent Spleen/Stomach pain, severe Spleen/Stomach deficiency, abdominal cramping, or tight abdominal wall, Gancao should be used in larger amounts. As the Classic says: "Urgency requires soothing." If using this expedient method, Shengma must be added to guide the Qi. Otherwise, left-migrating pathogens may become entrenched, leading to wasting of muscles in the neck and lower back, and causing Qi to descend improperly. Thus, Shengma guides Qi to ascend along the Yang pathway, bringing clear Qi upward to harmonize Yin and Yang. If there is chest fullness, remove Gancao; if cough is severe, remove Renshen. If there is dry mouth and throat, add Gegen (Puerariae Lobatae Radix).

Since the Spleen and Stomach are deficient, they cannot ascend and float, and their generating Qi is damaged by Yin Fire. Ying Blood is greatly depleted, and Ying Qi lies dormant underground. Yin Fire blazes, gradually simmering and depleting Qi and Blood. Since the Pericardium and Heart govern Blood, reduced blood means the Heart lacks nourishment, resulting in mental confusion and vexation, termed "Xin Fan" (Heart Vexation). "Fan" denotes mental confusion and restlessness. This is due to Clear Qi failing to ascend and Turbid Qi failing to descend, causing them to interfere with each other and chaos in the chest, leading to reversed and chaotic blood flow throughout the body. The Neijing states: "For conditions rising from below, use methods to draw them out." Therefore, acrid-warm and sweet-warm agents should be added to generate Yang. When Yang generates, Yin grows. The discussion on the three sweet-warm herbs has already been presented. Some ask: "How can sweet-warm herbs generate blood? They are not blood-tonifying herbs?" Zhang Zhongjing's method states that for blood deficiency, Renshen is used to tonify; when Yang is vigorous, it can generate Yin Blood. Add Danggui to harmonize blood. A small amount of Huangbai should also be added to rescue Kidney Water. Bitter-cold herbs drain fire and heat; when fire decreases, Heart Qi becomes calm and peaceful. If vexation persists, add a small amount of Huanglian (Coptidis Rhizoma) to eliminate it, aiming to tonify Kidney Water so that abundant Kidney Water naturally descends Heart Fire, supporting the Yang Qi underground.

If Qi floats and the Heart is chaotic, use Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) to stabilize it. Once vexation decreases, discontinue use to prevent draining Yang Qi and causing sinking. If there is epigastric stuffiness, add a small amount of Huanglian. Qi chaos in the chest is due to interference between Clear and Turbid Qi; thus, Chenpi is used to regulate it, assisting Yang Qi ascent and dispersing stagnant Qi, while aiding the action of various sweet and acrid herbs.

During late summer, when damp-earth guest pathogens are vigorous, Cangzhu, Baizhu, and Zexie may be added expediently to distribute and eliminate damp-heat from above and below. When dampness prevails significantly, digestion of food is impaired, leading to poor appetite and loss of taste for grains; add stir-fried Shenqu to digest food. Further add Wuweizi, Maidong, and Renshen to drain fire, benefit Lung Qi, and assist the Autumn deficiency. This is the prescription for the period of Sanfu (Dog Days) when late summer earth qi is at its peak.