Library

Spleen and stomach deficiency inevitably leads to insufficiency of Qi in the upper jiao. When encountering the excessive heat of summer, the primordial Qi is damaged, resulting in lethargy and drowsiness, inability to lift the limbs, lack of spirit, and flaccidity of both legs. If cold and reversal (Jue) are felt in the morning and evening, but after midday when Yang Qi is flourishing, fever returns like fire, this indicates a deficiency of both Yin and Yang, as well as Qi and Blood. Thus, some present with heat reversal due to Yin deficiency, while others present with cold reversal due to Qi deficiency. The mouth loses its sense of taste, eyes seem to have flowing fire causing blurred vision, urination is frequent, and defecation is difficult and constipated. Pain occurs in the epigastrium at the heart's location, with pain or spasmodic contraction in both hypochondria. The area around the umbilicus feels tight as if bound by a rope, severe cases feeling like knife stabbing, making it difficult to stretch the abdomen. The chest feels obstructed, with occasional vomiting and hiccups, phlegm cough, profuse white foam in the mouth, and a stiff tongue. Pain affects the waist, back, and scapulae, with intermittent headaches. Difficulty swallowing food, or feeling full immediately after eating, with no desire for food. Spontaneous sweating is particularly severe, as if Yin Qi covers the skin and hair. All these symptoms are assisted by the external heat weather, caused by Heat invading Geng Large Intestine and Xin Lung Metal. One should first assist the Primordial Qi and regulate the insufficiency of Geng and Xin metals; Huang Ren Shen Tang (Yellow Astragalus and Ginseng Decoction) is the primary formula.

Huangqi (Astragali Radix, 1 qian; add 1 qian if spontaneous sweating is excessive), Shengma (Cimicifugae Rhizoma, 6 fen), Renshen (Panacis Ginseng Radix et Rhizoma, remove rhizome), Jupi (Citri Reticulatae Pericarpium, keep albedo), Maidong (Ophiopogonis Radix, remove heart), Cangzhu (Atractylodis Rhizoma, add 5 fen if no sweat), Baizhu (Atractylodis Macrocephalae Rhizoma, each 5 fen above), Huangbai (Phellodendri Cortex, wine-washed to save the source of Water), Chaoqu (Fermented Medicinal Powder, stir-fried, 3 fen above), Dangguishen (Angelicae Sinensis Radix, wine-washed), Zhigancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 2 fen above), Wuweizi (Schisandrae Fructus, 9 berries).
All ingredients are coarsely crushed. Mix one dose, add two zhan of water, decoct to one zhan, strain, and take slightly warm, either far after meals or on an empty stomach. Avoid alcohol, damp noodles, strong spices, and excessive consumption of cold foods.
If there is stuffiness and oppression below the heart, add Huanglian (Coptidis Rhizoma) 2-3 fen; if there is pain in the epigastrium at the heart's location, reduce large cold medicines and add Caodoukou (Alpiniae Katsumadai Semen, 5 fen); if there is pain or spasm in the hypochondrium, add Chaihu (Bupleuri Radix) 2-3 fen; if there is headache and flowing fire in the eyes, add Huanglian 2-3 fen and Chuanxiong (Ligustici Chuanxiong Rhizoma) 3 fen; if there is headache, unclear vision, upper congestion and heat, add Manjingzi (Vittariae Spora) and Chuanxiong 3 fen each, Gaoben (Ligustici Jingwei Rhizoma) and Shengdihuang (Rehmanniae Radix) 2 fen each, Xixin (Asari Radix et Rhizoma) 1 fen; if there is shortness of breath, spirit wandering as if in dreams, fatigue and weakness, add Wuweizi 9 berries; if stool is astringent and stagnant, not passing for 1-2 days, leading to poor appetite and inability to eat, due to blood deficiency and latent fire in blood failing to moisten, add Dangguishen, Shengdihuang, and Maziren (Cannabis Fructus paste) 5 fen each, Taoren (Persicae Semen) 3 pieces (soaked in hot water, remove skin and tip, grind separately); if stool becomes smooth, stop adding these medicines.
If stool is still not smooth, do not use other medicines. If unsmooth, it is not due to blood stasis or constipation, but heat generating wind, so the patient will manifest wind syndromes. Do not add blood-invigorating medicines alone; continue taking Huang Ren Shen Tang normally, using only Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) 5 qian each. Crush these two, add four zhan of water, decoct to two zhan, strain, and take on an empty stomach. Stool will likely pass freely; stop after one dose.
If there is Qi stagnation in the chest, add Qingpi (Citri Reticulatae Pericarpium Viride, choose fragrant ones) 1-2 fen, and double the amount of Jupi without albedo to dispel pathogenic factors. This disease fundamentally stems from Primordial Qi deficiency; one should tonify Qi, not purge it. If Qi stagnation is severe, or tonics are too strong, or the patient has emotional depression/stagnation, add Muxiang (Aucklandiae Radix) and Suozhren (Amomi Fructus Rotundus) 2-3 fen each, and Bairdoukou (Cardamomi Fructus) 2 fen, decoct together with the main medicine. If abdominal pain without aversion to cold, add Baishao (Paeoniae Radix Alba) 5 fen, Huangqin (Scutellariae Radix) 2 fen, and remove Wuweizi.

When Spleen and stomach are deficient, past the sixth or seventh month, rivers rise and rain persists, all things become moist, people sweat soaking clothes, body feels heavy and short of breath, even limbs become flaccid, walking is unsteady, feet tilt, vision blacks out and one feels like falling. This is a sign of exhaustion of Kidney Water and Bladder Qi, requiring urgent rescue. Nourish Lung Qi to supplement the upper source of Water, prevent Geng Large Intestine from being invaded by pathogenic heat, and prevent excessive sweating. Excessive sweating leads to loss of Jin-Ye (Body Fluids); loss of Jin-Ye leaves the Seven Spirits without foundation. The Classics state: "When Jin-Ye are complete, the Spirit arises naturally." Jin-Ye are governed by Geng Metal. The significance of the Sanfu (Three Fu) period is that Geng Metal is imprisoned.
If Jin-Ye are lost and sweat is excessive, Dampness becomes hyperactive, causing the clear and肃 (descending) Qi to be lost. Dry Metal is imprisoned, Wind-Wood has nothing to restrain it, so Wind-Dampness combats each other, causing joint pain and whole-body pain. This is the principle of "Hyperactivity brings disaster, control brings balance." Sun Simiao said: "Taking Wuweizi regularly in the fifth month purges Bing Fire, supplements Geng Large Intestine, and benefits the Primordial Qi of the Five Zang organs."
Ren Bladder Cold has already ceased in Si month, Gui Kidney Water has ceased in Wu month. Now encountering abundant Dampness assisting Heat as a pathogen, the cold and clarity of West and North have ceased. The Sages established laws: Summer supplementation should tonify Tian Yuan (Heavenly Origin) True Qi, not tonify Fire-Heat, hence eating cold foods in summer. Since Heat damages Primordial Qi, use Renshen, Maidong, and Wuweizi to generate Mai (Pulse/Vessel). Mai is Primordial Qi. Renshen's sweetness tonifies Primordial Qi and purges Fire-Heat; Maidong's bitterness and cold nourish the source of Water and clear Dry Metal; Wuweizi's sourness purges Fire and supplements Geng Large Intestine and Lung Metal.

At this time, even healthy people may have two types of syndromes. Those who avoid summer heat by staying in deep halls and buildings may contract Zhongshu (Summerheat Stroke). Symptoms include headache, aversion to cold, rigid body, joint pain, irritability, high skin temperature without sweat. This is caused by Yin-Cold of the house suppressing Whole-Body Yang Qi, preventing its extension. People often use Dashun San (Great Harmony Powder). Travelers or farmers working under the sun may contract Zhongre (Heat Stroke). Symptoms include severe headache, restlessness, heat sensation, aversion to heat, high skin temperature, extreme thirst with drinking, excessive sweating, lack of energy to move. This is Heavenly Heat injuring Lung Qi externally; Cangzhu Baitu Tang (Atractylodes and White Tiger Decoction) is used. Jiegu said: "Obtained through movement is Zhongre; obtained through stillness is Zhongshu." Zhongshu is a Yin syndrome, should be dispersed; Zhongre is a Yang syndrome, Heat damages Primordial Qi, not the physical form.
For those with Spleen-Stomach deficiency and chronic diseases, encountering summer heat with improper care, violating seasonal transformations, will result in fatigue, reluctance to speak, shortness of breath, weak and rapid Qi, panting-like breathing, bone weakness, dream-like state, confusion as if in smoke, unaware of self, and excessive sweating. If Wind invades sweat pores, skin may twitch, neck tendons dry, hair scorched, body heavy, intermittent joint pain or whole-body pain, thirst or no thirst, yellow and astringent urine. This is Wind-Damp combat.
Headache or heavy head, upper heat congestion, shortness of breath via nose and mouth, mental restlessness, despair of life, sorrowful mood. This is Extreme Yin overcoming Yang. Severe cases transmit to Kidney and Liver becoming Wei-Jue (Flaccidity-Reversal). Jue means limbs feel like in fire (Heat Reversal) or cold (Cold Reversal). Cold Reversal has cold in abdomen; Heat Reversal has heat in abdomen, because Spleen governs limbs. If muscles rot and ulcerate, numbness and bi syndrome, transmitting to Rouwei (Muscle Flaccidity). All syndromes involve Lung pathology; physicians should regulate accordingly. Qi rushing to chest are all Jue syndromes. Wei means limb flaccidity and weakness, with endless vexation. Jue means Qi rebellion, severe cases Great Rebellion, hence Jue-Ni. Jue and Wei often accompany each other. In the previously established Huang Ren Shen Wuweizi Maidong Tang, add Baifuling (Poria) 2 fen, Zexie (Alismatis Rhizoma) 4 fen, Zhuling (Polyporus) and Baizhu 1 fen each. If urination is smooth and not yellow/astringent, add only Zexie 2 fen, with Er Zhu (Two Atractylodes) to drain Dampness up and down.
If walking is unsteady, knee-ankle flaccidity, feet tilting, Wei pathogen has entered. Add Jiuhuangbai (Wine-processed Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) 3-5 fen to restore strength to legs.
If excessive sweating, this is Jin-Tuo (Fluid Collapse), stop urgently. Add Wuweizi 6 berries, Chao Huangbai 5 fen, Chao Zhimu 3 fen. Do not hinder digestion; adjust according to judgment. If worried about hindering digestion, stop; resume after eating. Bleed Sanli (ST36) and Qijie acupoints with three-edged needle; if sweat does not stop, bleed Shanglian (EX-LE7) 3 cun below Sanli. Avoid alcohol and damp noodles.
Wei syndrome is Damp-Heat attacking Kidney and Liver, must be removed urgently. Otherwise, Lower Jiao Primordial Qi exhausts, leading to soft paralysis, immobility below waist, endless vexation. If heaviness decreases, Qi is sufficient, urination normal, and Damp-Heat recedes, or added pathogenic Qi subsides, do not use Wuweizi, Zexie, Fuling, Zhuling, Huangbai, Zhimu, Cangzhu, Baizhu. Adjust only based on current syndrome. For maintenance, use Jiuhuangbai 2-3 fen. If seasons change and Clear-Dry Qi prevails, add Acrid-Warm medicines to purge. If Dampness is dominant, Wind syndromes persist, dizziness and numbness continue, Chu Fengshi Qianghuo Tang (Remove Wind-Dampness Notopterygium Decoction) is indicated.