Dr. Greg Zimmerman, L.Ac.

Summer heat afflictions happen during the summer season, especially following the summer solstice, when the temperature is at its highest and very humid. These are the pathogenic factors fire and dampness which can become pathogenic and cause illness. There are various types of summer heat afflictions that can occur due to differing circumstances. These include summer heat complicated with an exterior pathogen, summer heat where dampness is prominent, summer heat that has disturbed the qi mechanisms, qi deficiency cause by summer heat induced sweating, and fluid damage caused by summer heat induced sweating. There are various formulas and treatment strategies that can used to treat summer heat afflictions, and many of them will be structured to address the various aspects of summer heat pathology.

Since summer heat disorders are primarily caused by heat and dampness, summer heat clearing formulas always include herbs that address dampness. It is not uncommon to experience exterior cold symptoms simultaneously with summer heat symptoms, surface releasing herbs are often used as well. Summer heat will cause excessive sweating which can damage the qi, body fluids and yin, so herbs that tonify the qi, nourish body fluids and tonify yin are also often used according the pattern differentiation.

The lungs generate fluids by directing qi down, and water follows the qi into the kidneys. For this reason, the lungs are referred to as the “upper source of water”. The lungs are delicate and easily injured, and therefore care must be taken at the onset of a summer heat affliction. When the lungs are damaged and unable to guide fluids downwards, the fluids with then exit as sweat which will be detrimental to the qi, body fluid and yin.

Common formulas used to clear summer heat include

o   Astragalus and Atractylodes Combination, Qing Shu Yi Qi Tang 清暑益氣湯

o   American Ginseng and Ophiopogon Combination, Qing Shu Yi Qi Tang 清暑益氣湯

o   Elsholtzia Combination, Xiang Ru Yin 香薷飲

o   Elsholtzia Plus Combination, Xin Jia Xiang Ru Yin 新加香薷飲

o   Elsholtzia Ten Combination, Shi Wei Xiang Ru Yin 十味香薷飲

 

Astragalus and Atractylodes Combination, Qing Shu Yi QI Tang 清暑益氣湯

Astragalus	Huang Qi	黃耆
Ginseng	Ren Shen	人參
Atractylodes (white)	Bai Zhu	白朮
Atractylodes	Cang Zhu	蒼朮
Citrus Peel	Chen Pi	陳皮
Alisma	Ze Xie	澤瀉
Tang-kuei	Dang Gui	當歸
Citrus Peel (immature)	Qing Pi	青皮
Shen-chu	Shen Qu	神麴
Ophiopogon	Mai Men Dong	麥門冬
Schizandra	Wu Wei Zi	五味子
Phellodendron	Huang Bo	黃柏
Licorice	Gan Cao	甘草
Cimicifuga	Sheng Ma	升麻
Pueraria	Ge Gen	葛根

This formula is recorded in the Treatise on the Spleen and Stomach, Pi Wei Lun by Li, Dong-yuan and is prescribed for those who have over time exhausted their spleen and stomach by irregular eating or exhaustion, are assailed by the heat of summertime, and become ill.

To treat this condition Li, Dong-yuan modified Ginseng and Astragalus Combination, Bu Zhong Yi Qi Tang 補中益氣湯 to create a clearing and drying formula by adding herbs that transform and leach out dampness, move qi, and generate body fluids.

Astragalus and Atractylodes Combination, Qing Shu Yi Qi Tang 清暑益氣湯tonifies the qi, clears summer heat, strengthens the spleen, and dries dampness. The symptoms that this formula addresses include fever, headache, thirst, spontaneous sweating, fatigue, weakness of the arms and legs, fullness and discomfort in the chest, heavy sensation, poor appetite, loose stools, scanty dark urine, greasy tongue coating, weak pulse.

o   Mai Men Dong and Wu Wei Zi generate body fluids

o   Huang Bo and Ze Xie clear damp heat

o   Ge Gen clears heat from the muscle layer and promotes the generation of body fluids

o   Shen Qu promotes digestion and removes stagnant food

o   Qing Pi regulates the flow of qi

 

Modifications:

o   Severe sweating: wu wei zi, huang bai, zhi mu

o   Damp-heat affecting the liver and kidneys: huang bai, zhi mu

o   Constipation: dang gui, sheng di huang, tao ren, huo ma ren

 

American Ginseng and Ophiopogon Combination, Qing Shu Yi Qi Tang 清暑益氣湯

American Ginseng	Xi Yang Shen	西洋參
Watermelon Peel	Xi Gua Pi	西瓜皮
Lotus Stem	Lian Geng	蓮梗
Dendrobium	Shi Hu	石斛
Ophiopogon	Mai Men Dong	麥門冬
Lopatherum	Dan Zhu Ye	淡竹葉
Anemarrhena	Zhi Mu	知母
Coptis	Huang Lian	黃連
Licorice	Gan Cao	甘草
Oryza	Jing Mi	精米

 

While this formula shares the same name as the formula above, they are indeed different formulas written by different people who have differing backgrounds, in different periods of time.

This version of Qing Shu Yi Qi Tang was composed by Wang Shi-Xiong in the Wen Re Jing Wei, The Essentials of Warmth and Heat. It treats damaged qi and body fluids injured by summer heat. When summer heat attacks and penetrates into the interior, the interior heat pushes the interstices and pores open to cause excessive sweating. When there is profuse sweating, there will also be qi deficiency as the qi exits with the sweat.

American Ginseng and Ophiopogon Combination, Qing Shu Yi Qi Tang 清暑益氣湯 clears summer heat, tonifies qi, nourishes yin, and promotes the generation of body fluids. It treats fever, profuse sweating, irritability, thirst, scanty dark urine, fatigued limbs, shortness of breath, apathy, deficient rapid pulse.

• Xi Yang Shen, Shi Hu, and Mai Men Dong nourish yin and clear heat
• Xi Gua Pi and Lian Geng clear summer heat
• Zhi Mu, Dan Zhu Ye, and Huang Lian clear heat and relieve irritability
• Jing Mi and Gan Cao nourish the stomach and tonify qi

While this formula clears heat and benefits the qi, its purpose is to salvage body fluid. From this perspective, it can be compared to Ginseng and Gypsum Combination, Bai Hu Jia Ren Shen Tang 白虎加人參湯 and Bamboo Leaf and Gypsum Combination, Zhu Ye Shi Gao Tang 竹葉石膏湯.

 

Elsholtzia Combination, Xiang Ru Yin 香薷飲

This formula addresses both the exterior and the interior simultaneously to treat exterior cold and interior dampness contracted during the summer. The contraction of exterior cold combined with interior dampness dampers the yang qi and inhibits the middle burner.

Elshotzia	Xiang Ru	香薷
Magnolia Bark	Hou Po	厚朴
Dolichos	Bai Bian Dou	白扁豆

Elsholtzia Combination, Xiang Ru Yin香薷飲 dispels cold, releases the exterior, transforms dampness, and harmonizes the middle warmer. It addresses the symptoms of fever without sweating, aversion to cold, heavy sensation in the head, headache, chest stiffness, nausea, general heaviness, abdominal pain, vomiting, diarrhea, white greasy tongue coating, floating pulse.

• Xiang Ru releases the exterior and induces sweating, transforms dampness, and harmonizes the middle burner.
• Hou Po regulates the flow of qi and transforms dampness.
• Bai Bian Dou strengthens the spleen and transforms dampness.

 

Elsholtzia Plus Combination, Xin Jia Xiang Ru Yin 新加香薷飲

Elsholtzia	Xiang Ru	香薷
Dolichos Flower	Bian Dou Hua	扁豆花
Magnolia Bark	Hou Po	厚朴
Lonicera	Jin Yin Hua	金銀花
Forsythia	Lian Qiao	連翹

This is a variation of Xiang Ru Yin where Jin Yin Hua and Lian Qiao, light cooling acrid herbs, are being used instead of bitter downward draining Huang Lian in order to prevent the summer heat pathogen located in the lungs, which sit in the upper burner, from penetrating deep into the body.

This formula addresses severe summer heat in an early stage that is affecting the lung complicated by concurrent cold or wind-cold. This can happen during the summer when the season’s heat and humidity, damp heat, becomes trapped by an acutely contracted cold or wind-cold pathogen and the cold disperses yang at the surface which obstructs the pores. The damp-heat in the interior disturbs the triple burner. In this pattern, both the lungs and the triple burner become obstructed and fluids are not able to pass downward.

Elsholtzia Plus Combination, Xin Jia Xiang Ru Yin 新加香薷飲 dispels summer heat, releases the exterior, clears heat, and transforms dampness. It treats fever and chills without sweating, headache, thirst, flushes face, stifling sensation in the chest, heavy aching body, dark rough urination, red tongue with a greasy white coating, flooding pulse on the right and small pulse on the left.

• Xiang Ru, Hou Po, and Xian Bian Dou Hua induce sweating and release the exterior, transform dampness, and harmonize the middle burner.
• JIn Yin Hua and Lian Qiao clear summer heat.

Modifications

o   Severe fever: add Qing Hao and Hua Shi

o   Interior heat: Da Huang

o   Pronounced dampness: Huo Xiang

 

Elsholtzia Ten Combination, Shi Wei Xiang Ru Yin 十味香薷飲

Elsholtzia	Xiang Ru	香薷
Astragalus	Huang Qi	黃耆
Ginseng	Ren Shen	人參
Atractylodes	Bai Zhu	白朮
Citrus Peel	Chen Pi	陳皮
Hoelen	Fu Ling	茯苓
Chaenomeles	Mu Gua	木瓜
Magnolia Bark	Hou Po	厚朴
Dolichos	Bai Bian Dou	白扁豆
Licorice	Zhi Gan Cao	炙甘草

This formula treats the middle burner that has been inhibited by summer heat and dampness.

Elsholtzia Ten Combination, Shi Wei Xiang Ru Yin 十味香薷飲 eliminates summer dampness, releases the exterior, augments qi, and harmonizes the middle burner. Symptoms that it treats are lassitude, heaviness in the head, general heaviness, and fullness and discomfort in the chest

• Xiang Ru, Hou Po, Bai Bian Dou release the exterior and transform dampness.
• Ren Shen, Bai Zhu, Fu Ling, Gan Cao and Chen Pi augment qi, strengthen the spleen, and harmonize the stomach.
• Huang Qi augments the qi and strengthens the exterior.
• Mu Gua transforms dampness and harmonizes the stomach.