Not Completely Gone
Lurking Summerheat Cases from WXG
It’s been a while since I posted here, and during that time I have had some new subscribers, so I wanted to welcome all the newcomers to the mulch. I have been a little more active on Substack Notes, where I post shorter items more frequently. I have a few different long posts in the works, but I thought I would string together a few of my Notes-style posts and publish it to the list in the interim.
Lurking Summerheat
It’s summer in the northern hemisphere, and the temperatures have been high across North America and Europe. I’ve been getting back to my ongoing project of translating what I can of the works of Qīng era physician Wáng Xùgāo (王旭高, 1798-1862). Longtime readers of Clinical mulch may remember many previous posts featuring Master Wáng. A few years back, I presented his discussion on treating summerheat.
I have been working through the e-text of Clinical Case Reports of Wáng Xùgāo [Wáng Xùgāo Línzhèng Yī’àn 王旭高臨證醫案], published in 1897. Here are a few short cases on the chapter concerning lurking summerheat [伏暑 fúshǔ]. Lurking pathogens was a subject I wrote a series about in the early years of the mulch; you can find an introduction here:
Anyway, here are three brief cases. Translation and commentary is by me, with properties and functions from Wiseman and Brand’s Comprehensive Chinese Materia Medica, 2020.
1. She lives on a boat
某 懷孕六月，感暑熱伏邪，噁心懊憹。炎天居舟，防其暈厥墮胎。
青蒿 大腹皮 半夏 赤苓 川樸 淡芩 焦六曲 蘇梗 陳皮 鮮佛手
Mǒu [Anonymous patient]
Six months pregnant, she contracted a summerheat-heat lurking pathogen. She is nauseous, vexed and irritable. The weather is hot and she lives on a boat. We must prevent her from fainting or miscarrying.
Qīnghāo, dàfùpí, bànxià, fúlíng, chìlíng, chuānpǔ, dànqín, jiāoliùqū, sūgěng, chénpí, xiān fóshǒu
Prescription analysis
Qīnghāo is sweet wormwood, Artemisiae Annuae Herba. It is bitter, acrid, and cold; it enters the liver, gallbladder, and kidney channels. It clears vacuity heat and resolves summerheat. It is used in lurking pathogen situations to vent [tòu 透] or outthrust the disease evil through the exterior.
Dàfùpí is the betel nut husk, Arecae Pericarpium. It is acrid and slightly warm; it enters the spleen, stomach, and large and small intestine channels. It moves qì and abducts stagnation. Its name, which can be rendered as “big belly husk”, attests to its ability to move qì in the abdomen. It also disinhibits water, and so is able to eliminate some dampness through the lower burner as well.
Bànxià is pinellia, Pinelliae Rhizoma. It is acrid and warm; it enters the spleen, stomach, and lung channels. It dries dampness and transforms phlegm, downbears counterflow and checks vomiting. It is a key phlegm-resolving herb in Chinese herbal medicine.
Fúlíng and chìlíng [or chìfúlíng] are layers of the poria fungus, Poria Alba and Poria Rubra. Poria is sweet and bland and enters the heart, spleen and kidney channels. It percolates dampness, fortifies the spleen, and quiets the spirit. The red layer, chìfúlíng, disinhibits damp-heat.
Chuānpǔ is magnolia bark from Sìchuān, Magnoliae Oficinalis Cortex Sichuanensis. It is bitter, acrid and warm; it enters the spleen, stomach, lung, and large intestine channels. It moves qì, dries dampness, and disperses accumulations. Magnolia bark is to be used with great caution in pregnancy; ordinarily it might prove too risky but in this case there was apparently a strong possibility of miscarriage if the pathogen went unresolved.
Dànqín is steam-processed scutellaria root, Scutellariae Radix. Raw scutellaria [huángqín] is bitter and cold; it enters the lung, stomach, gallbladder and large intestine channels. It clears heat and dries dampness, drains fire and resolves toxin. It is one of the fetal-calming herbs, given in cases of threatened miscarriage due to heat. The steaming lightens the yellow color and takes the edge off the cold, so it isn’t as hard on the spleen and stomach.
Jiāoliùqū is scorch-fried medicated leaven, Massa Medicata Fermentata Usta. It is acrid, sweet and warm; it enters the spleen and stomach channels. It disperses food and harmonizes the stomach. Scorch-frying the medicinal makes it better able to strengthen the spleen, remove accumulation, move qì and dispel phlegm.
Sūgěng is the perilla stem, Perillae Caulis. It is sweet, acrid and slightly warm; it enters the lung, spleen and stomach channels. It loosens the chest, disinhibits the diaphragm, normalizes qì and quiets the fetus.
Chénpí is the aged tangerine peel, Citri Reticulatae Pericarpium. It is acrid, butter and warm; it enters the lung and spleen channels. It moves qì and fortifies the spleen, dries dampness and transforms phlegm. With bànxià and fúlíng, it makes a core three-herb combination that can be found in many of the most commonly used phlegm-transforming formulas.
Xiān fóshǒu is the finger citron or “Buddha’s Hand”, Sacrodactylis Fructus. It is acrid, bitter, and warm; it enters the liver, lung, spleen and stomach channels. It courses the liver, rectifies qì and harmonizes the center, dries dampness and transforms phlegm. It has a relatively mild action which enhances the qì-moving and aromatic damp-drying herbs in the prescription.
2. Not completely gone
某 暑濕熱阻滯陽明，積垢雖下，尚未盡淨。夜間熱甚，神識沉迷。所慮津傷化燥等變。今以生津、泄熱、化濁佐之。
鮮石斛 赤苓 連翹 香豉 栝蔞仁 大竺黃 淡芩 山梔 菖蒲 竹茹
Mǒu [Anonymous patient]
Summerheat, dampness and heat obstruct the yángmíng. The accumulated filth, even after purgation, has not completely gone. At night [the patient is] extremely hot, with profound mental confusion. I’m concerned about a damage-to-liquid-transforming-into-dryness type of change. Presently, using [herbs to] engender liquid, drain heat, and transform turbidity is helping.
Xiān shíhú, chìlíng, liánqiáo], xiāngchǐ, guālóurén, dàzhúhuáng], dànqín, shānzhī, chāngpú, zhúrú
Prescription analysis
Xiān shíhú is fresh dendrobium orchid, Dendrobii Herba Recens. It is sweet and cold, and enters the stomach and kidney channels. It treats damage to liquid with heart vexation and mild heat effusion.
Chìlíng is the red part of the poria fungus, Poria Rubra, introduced in the first case, above. It is sweet, bland, and balanced, and enters the heart, spleen, and bladder channels. It moves water and disinhibits damp heat to treat turbid strangury.
Liánqiáo is the forsythia fruit, Forsythiae Fructus. It is bitter and slightly cold, and enters the lung, heart, and gallbladder channels. It clears heat from the pericardium in warm disease.
Xiāngchǐ is the fermented soybean, Sojae Semen Fermentatum, acrid sweet and slightly bitter, entering lung and stomach channels. It resolves the exterior and eliminates vexation from heat lingering in the chest.
Guālóurén is the trichosanthis seed, Trichosanthis Semen. It is sweet and cold, and enters the lung, stomach, and large intestine channels. It moistens the lung and transforms phlegm-heat.
Dàzhúhuáng is, I believe, a miscopied entry for tiānzhúhuáng or bamboo sugar, Bambusae Concretio Silicea. It is sweet and cold, and enters the heart and liver channels. Clears heat, transforms phlegm, clears the heart and treats clouded spirit in febrile diseases.
Dànqín, Scutellariae Baicalensis Radix, is discussed in the first case, above.
Shānzhī is the gardenia fruit, Gardeniae Fructus. It is bitter and cold, and enters the heart, lung, stomach, and triple burner channels. It drains fire and eliminates vexation [with fermented soybean it eliminates vexation and heat from the chest] and clears damp-heat from the three burners.
Chāngpú is the acorus rhizome, Acori Rhizoma, which is bitter, acrid and warm, and enters the heart and stomach channels. It opens the orifices, quiets the spirit, and sweeps turbidity with spirit clouding and confusion.
Zhúrú is bamboo shavings, Bambusae Caulis in Taenia. It is sweet, cool, and enters the lung, stomach, and gallbladder channels. It clears heat, transforms phlegm, and eliminates vexation.
An important feature of this prescription is the interplay of bitter cold medicinals to clear heat and dry dampness with the sweet cold ingredients to engender fluids and guard against dryness.
3. Not easy to outthrust
童 伏邪晚發，朝涼暮熱，頭痛胸悶，舌白無汗，似宜疏達。至於腰痛眼花，其陰內虧，邪不易達，恐致淹纏，宜小心為是。
秦艽 赤苓 青蒿 蘇梗 杏仁 甘菊花 枳實 杜仲（薑汁炒） 豆豉 桑葉
Tóng
Lurking pathogen effuses late, in the morning [the patient is] cool but in the evening [they are] hot. There is headache and chest oppression, the tongue is white and there is no sweating. It seems appropriate to course and outthrust. As for the back pain and flowery vision, this is interior yīn depletion. The pathogen is not easy to outthrust and I fear causing the illness to linger, so it is appropriate to be cautious.
Qínjiāo, chìlíng, qīnghāo, sūgěng, xìngrén, gānjúhuā, zhǐshí, dùzhōng (fry in ginger juice), dòuchǐ, sāngyè.
Prescription analysis
Qínjiāo is the large-leaf gentian, Gentianae Macrophyllae Radix. It is bitter, acrid, and slightly cold; it enters the stomach, liver, and gallbladder channels. It dispels wind-damp and relieves pain from impediment [bì 痹], abates deep-lying vacuity heat [”steaming bone”] and clears damp heat. It can both help outthrust the pathogen and treat the pain.
Chìlíng is described in the first case, above.
Qīnghāo is described above.
Sūgěng is described above.
Xìngrén if the apricot kernel, Armeniacae Semen. It is bitter, slightly warm and slightly toxic; it enters the lung and large intestine channels. It downbears qì, moves phlegm and scatters nodulation.
Gānjúhuā is the chrysanthemum flower, Chrysanthemi Flos. It is acrid sweet, bitter, and slightly cold; it enters the liver and lung channels. It disperses externally-contracted heat, clears the liver and brightens the eyes, and calms liver yáng. It treats headache and flowery vision while helping to vent the pathogen outward.
Zhǐshí is the unripe bitter orange, Aurantii Fructus Immaturus. It is bitter, acrid, and slightly cold; it enters the spleen and stomach channels. It breaks qì and eliminates glomus [pǐ 痞, a subjective feeling of fullness and blockage], transforms phlegm and disperses accumulation.
Dùzhōng is the eucommia bark, Eucommiae Cortex. It is sweet and warm; it enters the liver and kidney channels. It supplements the liver and kidney and strengthens sinew and bone. Stir frying in ginger helps its ability to treat back pain (Bao et al, 2024).
Dòuchǐ is the fermented soybean, see xiāngchǐ above. The salted fermented soybean is known as xiāngchǐ, and the unsalted variety is dàndouchǐ.
Sāngyè is the mulberry leaf, Mori Folium. It is acrid, sweet and cold; it enters the lung and liver channels. It disperses externally-contracted heat, clears the liver and brightens the eyes. It is frequently paired in early stage warm disease with gānjúhuā.
When a pathogen is deep-lying and lodged on the interior, a key strategy is to dislodge it and bring it to one or more of the body’s natural exits so it can be pushed out. Outthrusting or venting is requires bringing the pathogen from the interior to the surface, and if, as in this case, the interior is depleted, it can be difficult to accomplish. Strengthening the liver and kidney is thus an important principle here, and it mostly relies on dùzhōng. The bulk of the prescription is focused on rectifying the qì mechanism to open the chest and restore upbearing and downbearing [xìngrén, zhǐshí, sūgěng] to dislodge the disease evil, and then bringing it to the surface to vent or outthrust [qínjiāo, qīnghāo, gānjúhuā, sāngyè, dòuchǐ] or down to the lower burner to be expelled in the urine [chìlíng].
Okay, that’s all from the mulch pile for now. Until next time, thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Bao, L., Sun, Y.L., Wang, J.M., Li, W.B., Liu, J., Li, T.Y., & Liu, Z.Q. (2024). A review of “plant gold” Eucommia ulmoides Oliv.: A medicinal and food homologous plant with economic value and prospect. Heliyon, 10(2). doi: 10.1016/j.heliyon.2024.e24851
Wang, X.G., & Fang, R.Y. (1897). Wang Xugao linzheng yi’an. https://jicheng.tw/tcm/book/%E7%8E%8B%E6%97%AD%E9%AB%98%E8%87%A8%E8%AD%89%E9%86%AB%E6%A1%88/index.html Retrieved April 15, 2023.
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.