Library

Note: Zhongshu (heatstroke) and Zhongre (summerheat illness), although named differently, are essentially the same disease. If one is injured by cold in winter and it transforms into a heat disease that manifests in summer, this is a disease that manifests after the season has passed, originating from within and reaching the exterior, commonly known as "late onset" (Wanfa). This cannot be compared to acute new-onset Zhongshu or Zhongre. Some say: The pulse of newly contracted Zhongshu is deficient (Xu), while the pulse of late-onset fever is full/excess (Sheng). The treatment methods for these diseases include clearing heat (Qingre) and releasing the muscle layer (Jieji).

When Taiyang (Bladder channel) is affected by summerheat (Zhongye), the patient sweats, fears cold, has a fever, and feels thirsty. (Cheng Wuji notes: Sweating, fearing cold, and fever without thirst indicate Wind-stroke (Fengzhong); sweating, fearing cold, fever with thirst indicate Zhongye, treated with Baihu Tang [White Tiger Decoction].)

When Taiyang is affected by dampness (Zhongshi), symptoms include fever, aversion to cold, heaviness and pain in the body, a string-taut (Xuan) thin (Xi) or hollow (Kou) or slow (Chi) pulse, chills and piloerection after urination, cold extremities, fever upon slight exertion, open mouth, and dryness of the anterior teeth. If sweat-inducing methods are misused, aversion to cold worsens; if warm needle therapy is misused, fever intensifies; if purgative methods are misused, strangury (Lin) worsens. (Cheng Wuji notes: Diseases can be in the exterior, interior, or both. This case involves both. Fever, aversion to cold, body heaviness and pain indicate dampness in the exterior. String-taut, thin, hollow, or slow pulses indicate deficiency in summerheat. Chills/piloereaction/cold limbs indicate insufficiency of Taiyang channel Qi. Fever upon exertion indicates labor causing Yang to disperse and heat to arise. Open mouth and dry teeth indicate severe heat. *Neijing* states: "Affected by summerheat, sweating occurs; vexation leads to panting and drinking." The open mouth signifies panting/drinking. Due to persistent panting/drinking, the anterior teeth become dry. Sweating to remove exterior pathogens further depletes exterior Yang, worsening aversion to cold. Warm needles assist Yang but cause internal fire attack, worsening fever. Purgatives clear interior heat but deplete interior fluids, drying the Bladder and worsening strangury. ○ Xu Shi says: This clause lacks treatment; Li Dongyuan used Qingshu Yiqi Tang [Clear Summerheat and Boost Qi Decoction], revealing a secret of millennia.)

When Taiyang is affected by dampness (Zhongshi), symptoms include fever, painful heaviness, and a weak pulse. This results from water-dampness injuring the body in summer, circulating in the skin. (Cheng Wuji notes: *Neijing* states: "Deficient pulse and fever result from summerheat injury." Fever with weak pulse indicates summerheat injury; painful heaviness indicates water-dampness. In summer, when heat prevails, injury from water irrigation causes this. ○ Use Gouti Yiwu San [Melon Seed Single-Ingredient Powder] or Wuling San [Five-Ling Decoction].)

Zhongshi resembles Shanghan (Cold Damage) but differs.

Zhang Shi says: Clear pathogens (wind/summerheat) affect the upper part; turbid pathogens (cold/dampness) affect the lower part. Wind, cold, and dampness belong to Earth Qi (turbid) and thus affect the Foot channels. Only summerheat belongs to Heaven Qi (clear) and thus affects the Hand Shaoyin Heart channel. Symptoms resemble Shanghan, but the pulse differs. In Shanghan, there is aversion to cold and fever initially, without vexation/thirst. In summerheat, thirst appears immediately. Shanghan pulse is floating and full; summerheat pulse is deficient, or string-taut/thin/hollow/slow. *Neijing* states: "Full pulse with cold body indicates Shanghan; deficient pulse with hot body indicates summerheat injury." For example, Taiyang disease with stiff neck/back and sweating/fear of wind resembles Zhongshi in summer, but because there is no thirst, Guizhi Jia Gegen Tang [Cinnamon Twig plus Kudzu Root Decoction] is used. In summer/autumn heat, one must carefully examine according to classics to avoid error.

Wang Shi says: From symptoms, Shanghan fears cold, summerheat fears heat. From pulse, Shanghan is full, summerheat is deficient. Summerheat's deficient/thin pulse resembles Dampness/Jing (spasm) pulses, but symptoms differ: summerheat has spontaneous sweating and thirst; dampness has no thirst; Jing has body pain.

Pulse flooding (Hong), fever, and aversion to cold indicate Rebing (Heat Disease).

*Liu Ren Shu* says: In summer, fever, aversion to cold, headache, heavy limb/joint pain, and flooding pulse indicate Heat Disease. This is Winter Cold transformed by Summerheat. Treatment is similar to Shanghan: sweating uses Guizhi Tang; non-sweating uses Mahuang Tang; with vexation uses Da Qinglong Tang. However, summer medicines should be cool, not too warm. Guizhi/Mahuang/Da Qinglong Tangs require modification: Before Summer Solstice, add Huangqin (Scutellaria Root) half liang to Guizhi Tang; After Summer Solstice, add Zhimu (Anemarrhena Rhizome) 1 liang, Shigao (Gypsum) 2 liang, or Shengma (Cimicifuga Rhizome) half liang to Guizhi/Mahuang/Da Qinglong Tangs. Guizhi/Mahuang are hot; southern warmth differs from northwest. Using them in summer causes jaundice/rashes. If Heat Disease persists beyond 3 days with rapid pulse and pathogen in meridians, use Guizhi Shigao Tang [Cinnamon Twig and Gypsum Decoction]. Add Mahuang 1 liang to replace Ma Huang Qing Long indications. For late-onset Shanghan (March to Summer), Zhizi Shengma Tang [Gardenia and Cimicifuga Decoction] is可选. (Case: Wanli Gui Mao year, Li's son-in-law took Guizhi Tang for summer Shanghan and died instantly. Mahuang/Guizhi are for deep winter Shanghan; using them on warm diseases is inadvisable, let alone heat diseases.)

Guizhi Shigao Tang: See previous discussion. Sweating/slow pulse = Guizhi indication; No sweating/tight pulse = Mahuang/Qing Long indication.
Ingredients: Guizhi (bark removed), Huangqin (0.5 liang each); Zhizi (3 qian); Baishao (White Peony Root), Shengma, Ge Gen (Kudzu Root), Sheng Jiang (Fresh Ginger) (7.5 qian each); Shigao (crushed), Gan Cao (Roasted Licorice Root) (1 liang each). Crushed, take 5.5 qian with 1.5 cups water, boil to 0.8 cup, strain, take after meal. Stop if sweating occurs.

Zhizi Shengma Tang: Treats late-onset Shanghan (March to Summer).
Ingredients: Sheng Di Huang (Rehmannia Root) (0.5 jin chopped); Zhizi (10 pods split); Shengma (1.5 liang); Chai Hu (Bupleurum Root), Shigao (2.5 liang each). Crushed, take 5 qian with 1.5 cups water, boil to 0.8 cup, take in one dose. Repeat if unresolved.

Wu Shi says: After Summer Solstice, intense heat causes high fever, vexation/thirst, no aversion to cold—this is Heat Disease. Floating/Hong pulse indicates Taiyang; Hong/Long pulse indicates Yangming; Xuan/Shu pulse indicates Shaoyang. These Three Yang cases are treatable. Deep/Thin/Xiao/Cold feet indicate Three Yin cases, difficult to treat. Generally, Heat Disease requires strong pulse (Hong/Big/Slippery/Rapid) for treatability. Weak/small pulse is difficult. For weak constitution, use Renshen Tang [Ginseng Decoction] to support Yuan Qi; do not attack heat. For Hong pulse/body pain/high fever/no sweating/vexation, use Liushen Tang [Six-God Decoction] to induce sweat. Or Renshen Qianghuo San [Ginseng and Notopterygium Powder] plus Ge Gen, Dou Chi, Sheng Jiang. Mild cases use Shiwei Xiong Su San [Ten-ingredient Cyperus and Perilla Powder]. If complicated by summerheat, add Xiang Ru (Elsholtzia Herb) and Bian Dou (Hyacinth Bean). If complicated by internal injury/cold food stagnation/vomiting/bloating/chills, use Huoxiang Zhengqi San [Patchouli Regulating Qi Powder] plus Xiang Ru, Bian Dou, Ge Gen (named Erxiang Tang). If heat remains unresolved in Taiyang, use Renshen Qianghuo San plus Huangqin; in Yangming, Shengma Ge Gen Tang plus Huangqin; for severe heat/thirst/big pulse, Baihu Tang plus Renshen; in Shaoyang, Xiaochaihu Tang [Minor Bupleurum Decoction] modified. If complicated by summerheat, add Huanglian (Coptis Rhizome) and Xiang Ru. If heat with diarrhea/strangury/thirst, use Wuling San minus Guizhi plus Ge Gen, Huanglian, Xiang Ru, Huashi (Talcum). If exterior/interior heat with diarrhea/floating rapid pulse/strangury, use Xiaochaihu Tang combined with Siling San [Four-Ling Powder]. If unresolved or transforming, follow Shanghan protocols. Prognosis: Death in 1-2 days with diarrhea/fullness/severe heat; 3-4 days with confusion/rapid pulse; 4-5 days with heat/small pulse/cold feet; 5-6 days with no sweat/vomiting/confusion/rapid pulse; 6-7 days with black tongue base; 7-8 days with bleeding/severe heat/big pulse; 9 days with spasms/confusion. Pulse Cu/Jie/Dai/Deep/Small are difficult. No sweat with rapid pulse is death; sweat with intensified heat/rapid pulse is death.

Deficient pulse, fever, aversion to cold indicate Zhongshu (Summerheat Injury).
Treatment formulas see Miscellaneous Diseases section.

Cold calves, abdominal fullness, headache, thirst without fever indicate Shiwen (Damp-Warmth).

*Liu Ren Shu* says: Shiwen presents with cold calves, chest/abdominal fullness, sweating, headache, delirium. Caused by prior dampness injury followed by summerheat, combining damp and heat. Pulse: Exterior (Yang) Ru/Ruo (Soft/Weak), Interior (Yin) Xiao/Ji (Small/Urgent). Treat in Taiyang, do not induce sweat. Sweating causes mutism, deafness, loss of pain sensation, cyanosis, color change, called "Chong Ye" (Heavy Summerheat). Such deaths are physician-induced. Use Baihu Jia Cangzhu Tang [White Tiger plus Atractylodes Macrocephala Decoction].

Xu Xueshi says: Gui Chou year, Wang Yanlong suffered chest/neck sweating, cold calves, delirium in late summer. Pulse: Guan front Ru, Guan back Shu. Diagnosed as Shiwen (Summerheat then Dampness). Treated with Baihu Jia Renshen Tang then Baihu Jia Cangzhu Tang. Headache resolved, feet warmed, sweat stopped, cured in 3 days. Called "Zeixie" (Thief Pathogen). Question: What is Zeixie? *Nanjing* defines Five Pathogens: Real, Deficient, Correct, Minor, Thief. Thief comes from the "Non-Overcoming" source. Heart summerheat is Correct; Heart dampness is Thief (Water overcomes Fire). Most adverse. *Nanjing*: Yang Ru/Ruo is damp attacking summerheat; Yin Xiao/Ji is summerheat steaming damp. I have retained fluid retention; summer months bring sweaty calves. This medicine cures me.

Haizang says: Shiwen with little sweat uses Baihu Jia Cangzhu Tang; with much sweat uses Baihu Jia Guizhi Tang [White Tiger plus Cinnamon Twig Decoction].

Sun Taizhen says: Jiang, a wine merchant, had moist body, cold calves to knees, abdominal fullness, unconsciousness, small/weak/urgent pulses. Previous doctors used Yin-disease medicines, worsening condition. Sun used Wuling San and Baihu Tang for 10+ doses. Jiang recovered and asked for explanation. Sun said: It was summerheat injury. Initially Yang-deficient cold limbs with small pulse, mistaken for Yin disease. Wuling San drained dampness/reduced abdomen; Baihu Tang cleared heat. Yin disease causes cold calves AND arms; you only had cold calves, indicating Yang-deficient cold (not Yin-Jue ascending).

Bao Shi says: Between Start of Summer and End of Heat, Shanghan with slight chill, sweating, heavy limbs is Shiwen, treated with Cangzhu Shigao Tang [Atractylodes and Gypsum Decoction] (i.e., Baihu Jia Cangzhu Tang).

Cangzhu Shigao Tang Formula:
Cangzhu (0.5 liang), Shigao (3 qian), Zhimu (2.5 qian), Gan Cao (1 qian). Boil 1 cup water to 0.5 cup, warm drink. Indicates internal dampness, usually no thirst. If fever/flooding pulse/no sweating/thirst, heat accumulates in Upper Jiao/Chest, use Jiegeng San [Platycodon Powder] (This is Heat Disease, not Shiwen).

Jiegeng San Formula:
Bohe (Mint), Huangqin, Gan Cao, Zhizi (1 qian each); Lianqiao (2 qian); Jiegeng (3 qian). Chop, take 5 qian boiled with water and Zhu Ye (Bamboo Leaf). If constipation, add Dahuang (Rhubarb) 0.5 liang.

Deficient pulse, fever indicates Shangshu (Summerheat Injury).

Liu Chun says: Xu Xueshi states Shangshu pulse is Xuan/Xi/Kou/Chi. *Neijing*: "Cold injures Form, Heat injures Qi." Heat injures Qi, causing Qi depletion and deficient pulse. Xuan/Xi/Kou/Chi are all deficient pulses. Zhongjing considers Xuan as Yin; Zhu Gong says summerheat pulse is thin/weak. All confirm deficiency.

Summerheat syndromes include Mao (Enveloping), Shang (Injuring), and Zhong (Striking).

Dai Shi says: Severity varies. Abdominal pain/water diarrhea/stomach/intestine injury/nausea/phlegm-fluid at stomach opening = Mao Shu (Enveloping Summerheat). Use Huanglian Xiangru Yin [Coptis and Elsholtzia Drink]. Fever/headache/restlessness/prickling sensation = Heat injuring flesh layers. Use Jiedu Baihu Tang [Detoxifying White Tiger Decoction] plus Chai Hu; add Renshen if Qi deficient. Cough/chills/fever/night sweats/rapid pulse = Heat injuring Lung channel (Fire insulting Metal). This is Zhong Shu (Striking Summerheat). Use Qingfei Tang [Clear Lung Decoction], Chai Hu Tianshui San [Bupleurum and Heavenly Water Powder].

Summer: Hidden Yin Inside.

Danxi says: In summer, Yang Qi emerges to the surface; abdomen becomes empty. "Hidden Yin inside" means emptiness/deficiency, not cold. Predecessors used Dashun San [Great Smooth Powder] (warm/hot) for cooling pavilions/snow injuries, not for hidden Yin. In blazing heat, where is the cold? Sun Taizhen recommended Shengmai San [Generate Pulse Powder] in summer for deficiency. Liu Shi says: Jiegu says quiet acquisition is Zhongshu, active acquisition is Zhongre; Dongyuan says seeking coolness in halls is Zhongshu (use Dashun San), labor is Zhongre (use Cangzhu Baihu Tang). Summerheat is one Qi. Why distinguish? Wang Shi says: Summerheat is Heaven's command. Labor/hunger depletes Yuan Qi, failing to resist extreme heat, causing injury. Named Zhongshu or Zhongre, they are the same. Distinguishing by motion/rest is flawed. Zhongshu often affects laborers (deficiency allows invasion). Those seeking coolness in halls suffer cold damage (Shanghan), not summerheat. Vexation/heat is due to Yang blocked by Yin-cold, not summerheat pathogen. Treat with acrid-warm dispersants. Dashun San contains mostly Gan Cao, Gan Jiang, Xing Ren, Rou Gui (all roasted/warming). It was designed for internal heat leading to excessive drinking, spleen/stomach dampness, vomiting. Using it for "quiet" cases may fail to release exterior and increase internal vexation. Common people mistake "Yin inside" for cold and use Dashun San. Yin is not cold; it is relative emptiness. If Yin were cold, why drink water in summer? Cangzhu Baihu Tang is suitable but not universal. Modify based on syndrome. "Quiet" cases in summer are not true summerheat; distinguish them to avoid confusion.

Summerheat injuring Five Zang organs presents differently.

Chen Shi says: Summerheat entering Heart causes choking/coma; Liver causes dizziness/numbness; Spleen causes lethargy; Lung causes distension/atrophy; Kidney causes wasting-thirst. Xu Shi says: Variations are numerous, not limited to Five Zang. Constitution and severity vary. Mild cases manifest later (autumn malaria/dysentery); severe cases manifest immediately. Light can become heavy, heavy light. Depth and transmission vary. Life conditions vary. Four-season diseases are alike.

Summerheat diseases require boosting Yuan Qi.

Dongyuan says: Spleen/Stomach weakness in 6th/7th lunar months with dampness, sweating, heaviness, shortness of breath, flaccidity, dizziness indicates Kidney/Bladder exhaustion. Profuse sweating loses Jin-Ye (fluids). Third Dog Days: Geng Metal is imprisoned, Wood uncontrollable, Wind-Damp attacks joints. Ren Bladder ends at Si, Gui Kidney ends at Wu. Dampness aids heat. Sage's law: Summer requires tonification because heat damages Yuan Qi. Use Renshen, Maidong, Wuweizi to nourish Water source, drain internal fire, tonify Geng Metal, boost Yuan Qi.

Summerheat causing Wei-Jue (Flaccidity-Cold Limbs) syndromes.

Dongyuan says: Late Summer damp-heat steams, damaging Yuan Qi. Limb fatigue, spirit shortage, leg flaccidity, cold limbs morning/evening, heat afternoon. Yin/Yang/Qi/Blood deficiency. Chest fullness, joint pain, asthma, fever, vexation, yellow urine, loose stool, sweating, heaviness. Blood diseased first, Qi secondary. Dampness pulse is Hong/Huan/Chi. Treat with drying agents. Traveling in heat causes heat in Kidney, Water fails to control Fire, bone flaccidity (damp-heat Wei). Heat-Jue is Yin deficiency; Cold-Jue is Qi deficiency. Limbs hot = Heat-Jue; Limbs cold = Cold-Jue. Spleen governs limbs. Xu Shi says: This discusses summerheat patterns like Shanghan transformation. Cold injures Form; Heat injures Qi. Severe Qi deficiency leads to sudden collapse, similar to Shanghan Yin-Du toxicity. Cross-reference with Wei (Flaccidity) chapter.

Summerwind (Shufeng).

Jia Shi says: Fire controls Metal, failing to calm Wood. Spasms/unconsciousness. Floating/deficient pulse indicates Wind/Summerheat. Popularly "Summerwind," caused by Minister Fire acting. First dissolve Suhexiang Wan [Suhexiang Pill] in warm water; then Huanglian Xiangru Yin plus Qiang Huo, or Shuangjie San plus Xiang Ru.

General Principles of Treating Summerheat.

Jia Shi says: Summerheat is Minister Fire. Deficient pulse, headache, dry mouth, greasy face, sweating, fatigue, fear of back heat, coma, cholera-like vomiting/diarrhea, phlegm, abdominal pain, bloody diarrhea, jaundice, rashes. Best method: Clear Heart, promote urination. Do not promote urination if sweating heavily; use Baihu Tang. Differentiate exterior/interior: Exterior (headache/aversion to cold) use Shuangjie San plus Xiang Ru, Erxiang San, Shiwei Xiangru San; Half-exterior/half-interior (diarrhea/thirst/vomiting) use Wuling San; Severe heat/vexation use Yiyuan San. Exterior resolved/Interior heat: Banxia Jiedu Tang Shenxiong Wan. Elderly/weak with faint pulse/diarrhea/thirst/warm preference/cold limbs/unconsciousness: Zhuyeshigao Tang plus Shu Fu Zi, frozen drinks, Laifu Dan, Wuling San. Never use hot/dry drugs in summer to avoid rash/jaundice/death. Xu Shi comments: Detailed, but Suhexiang Wan for Summerwind/Minister Fire needs caution. Suhexiang Wan is for Yin-cold blockage, cold food injury, Qi stagnation, or evil invasion, not Summerwind/Minister Fire. Scholars must verify. Tao Shi says: Summerheat pulse deficient/hidden, fever, back aversion to cold, greasy face, sweating, vexation, thirst, piloerection, coma, fatigue, no body pain (differs from Shanghan). Internal/external heat, dry mouth, cold limbs, no pain: Baihu Tang. Phlegm/aversion to cold: Jupi Tang. Heat/stuffiness/no aversion to cold: Zhuyeshigao Tang. Headache/nausea/vexation/substernal discomfort/strangury: Wuling San. Downward: Xiaoshao Wan. Summerheat: Xiaochaihu Tang (Best).