Summer Rains and Damp Earth
Wáng Xùgāo’s Treatment of Summerheat
It is a hot July here in South Florida. A patient commented yesterday that it was the tenth straight day of heat warnings for the area. I can believe that, just by listening to the recent symptoms of many of the people who come into the clinic. Whatever we had been previously working on, add summerheat to the mix. I sometimes tell my students that I never truly understood why summerheat was considered a separate pathogenic factor until I moved to Florida. With nine months of hot muggy weather, there is plenty of time to contemplate its qualities. But July and August here can be a whole other level of swampy.
Wáng Xùgāo: Summerheat treatment methods
These days I am spending a lot of my free time working on reading and translating the texts and cases of Wáng Xùgāo (1798-1862), so I dove back in to get a better understanding of treating summerheat. First is a discussion from Yī Xué Chú Yán (Medical Ruminations, 1862).
暑病治法 暑屬火，暑必夾濕。有因貪涼閉汗，外則無汗惡寒（暑兼外寒），內則熱甚煩悶者，宜香薷飲（香薷飲：扁豆、厚朴各半斤，香薷一斤。為粗末，每服三錢，酒水煎服。功能祛暑解表，化濕和中。《和劑局方》方。）為主。有因食瓜果冷水，內變寒濕者（暑兼內冷），腹痛吐瀉，輕者霍香正氣散；重者脈伏肢冷，此即所謂陰暑也，寒多宜理中湯；欲飲水者宜五苓散。
暑熱治法 暑熱甚，煩躁多汗，脈洪大，宜白虎湯。但熱不寒，背微惡寒者，白虎加桂枝湯。
暑濕治法 暑濕胸痞嘔惡，消暑丸為主，醋炒半夏、茯苓、甘草是也。仿此則二陳湯，藿香正氣散等，皆所宜用。他如濕溫，舌白膩，噁心，身疼足冷，口渴不多飲，而又煩躁者，蒼朮白虎湯可選。
Summerheat disease treatment method: Summerheat belongs to fire, and summerheat is always mixed with dampness. This causes an insatiable desire for cold [drinks], and blocked sweating; on the exterior it results in lack of sweating and aversion to cold (summerheat compounded with exterior cold), on the interior it results in vexation and oppression aggravated by heat. Xiāng Rú Yǐn (Elsholtzia Beverage) is appropriate: Biǎn Dòu (Sm Lablab), Hòu Pò (Cx Magnoliae), half a catty (jīn) each, one catty of Xiāng Rú (Hb Elsholtziae). Grind to a coarse powder. Each dose is three qián, take decocted in wine and water. The function is to dispel summerheat, resolve the exterior, transform dampness and harmonize the center. It is a formula from the Hé Jì Jú Fāng (Imperial Grace Formulary). This is the main prescription. For those with interior transformation to cold-damp caused by eating melons and fruits and drinking cold water, (summerheat compounded by interior cold), there is abdominal pain, vomiting and diarrhea. In mild cases use Huò Xiāng Zhèng Qì Sàn (Agastache Qi-Righting Powder); in severe cases, the pulse is hidden and the limbs are cold, this is what is called yīn summerheat. For more cold it is appropriate to use for Lǐ Zhōng Tāng (Center-Rectifying Decoction). Those who desire to drink water should get Wǔ Líng Sàn (Poria Five Powder).
Summerheat-heat treatment method: For extreme summerheat-heat, with vexation, agitation, copious sweating, and a flooding large pulse, Bái Hǔ Tāng (White Tiger Decoction) is appropriate. For fever without chills, with slight aversion to cold on the back, use Bái Hǔ Jiā Guì Zhī Tāng (White Tiger Decoction with Cinnamon Twig).
Summerheat-damp treatment method: For summerheat-damp, with thoracic glomus, nausea and vomiting, Xiāo Shǔ Wán (Summerheat-Dispersing Pill) is mainly used; this is cù chǎo Bàn Xià (Rz Pinelliae, vinegar-fried), Fú Líng (Poria), and Gān Cǎo (Rx Glycyrrhizae). Similar to this, Èr Chén Tāng (Two Aged Decoction), Huò Xiāng Zhèng Qì Sàn, and the like are all appropriate for use. For those who have damp-warmth with a white slimy tongue coating, nausea, body aches, cold feet, are thirsty but do not drink much, with vexation and agitation, Cāng Zhú Bái Hǔ Tāng (White Tiger Decoction with Atractylodes) can be chosen.
Wáng Xùgāo: A summerheat case report
Then I went looking in Wáng Xùgāo Lín Zhèng Yī Àn (Wang Xugao's Clinical Records), a compilation by one of Wáng’s students from 1897. Here is a representative case:
丁 暑乃鬱蒸之熱，濕為濡滯之邪。暑雨地濕，濕淫熱鬱，惟虛者受其邪，亦維素有濕熱者感其氣。如體肥多濕之人，暑即寓於濕之內；勞心氣虛之體，熱即伏於氣之中。於是氣逆不達，三焦失宣，身熱不揚，小溲不利，頭額獨熱，心胸痞悶，舌苔黃膩，底絳尖紅，種種皆為濕遏熱伏之徵。邪蘊於中，不能外達，亦不下行，頗慮內閉之變。擬以梔豉上下宣泄之，雞蘇表裡分消之，二陳從中以和之，芳香宣竅以達之，冀其三焦宣暢，未識能奏功否。
淡豆豉 黑山梔 通草 半夏 菖蒲 鮮荷葉 六一散 薄荷 赤苓 竹茹 蔻仁（研，後下）
Dīng [name of patient]
Summerheat is a depressive steaming heat, and dampness is a lingering evil. With the summer rains and the damp earth, dampness drenches and heat stagnates, but only those with vacuity [of right qì] suffer from this evil, and also those who inherently have dampness and heat will contract this qì. For instance, in a fat-bodied person with lots of dampness, the summerheat will promptly lodge in the interior dampness; if the body is exhausted with heart qì vacuity, summerheat will promptly hide in the qì. As a result, the qì turns counterflow and will not outthrust, and the sān jiāo will not diffuse. There is unsurfaced fever, inhibited urination, heat only [felt at] the forehead, glomus and oppression of the heart and chest, a yellow slimy tongue coating, with a crimson underside and a red tip, all of which are evidence of dampness trapping deep-lying heat. The evil is contained inside, and cannot be outthrust to the exterior, and also will not descend, and I’m quite worried about tranformation into interior blockage. The plan is to to use Zhī Chǐ [Zhī Zĭ Chǐ Tāng/ Gardenia and Prepared Soybean Decoction] to diffuse and discharge the upper and lower, Jī Sū (Hb Stachydis) to separate and disperse interior and exterior, and Èr Chén [Tāng, Two Aged Decoction] to harmonize the center. Use aromatics to perfuse the orifices in order to outthrust in hopes that the sān jiāo will begin to diffuse umimpeded, but I do not know if this will be effective.
Dàn Dòu Chǐ (Sm Sojae Preparata), Hēi Shān Zhī (Fr Gardeniae Carbonisatus), Tōng Cǎo (Medulla Tetrapanacis), Bàn Xià (Rz Pinelliae), Chāng Pú (Rz Acori), Xiān Hé Yè (Fm Nelumbinis Recens), Liù Yī Sàn (Six-To-One Powder, i.e. Huā Shi /Talcum and Gān Cӑo /Rx Glycyrrhizae), Bò Hé (Hb Menthae), Chì Líng (Poria Rubra), Zhú Rú (Caulis Bambusae In Taenis), Kòu Rén (Fr Amomi Rotundus) (grind and decoct last).
Takeaway
In terms of patient complaints, I’ve seen mostly sudden gastrointestinal disruptions from the summerheat-damp, but I suspect that there may be some summerheat-heat showing up at some point. I’ve already stocked up on Huò Xiāng Zhèng Qì Sàn (which I always keep on hand since it disappeared from the supply chain during the early pandemic), and Èr Chén (though frankly I find more use for Wēn Dǎn Tāng/Warm Gallbladder Decoction). I think at this point it would be good to have some Bái Hǔ Tāng and Zhī Zĭ Chǐ Tāng around por si acaso.
Stay cool, folks, and thanks for reading.
Note: this newsletter 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
Wáng, X. (1862). Yī xué chú yán. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%8A%BB%E8%A8%80/index.html
Wáng, X.G., & Fāng, R.Y. (1897). Wáng Xùgāo lín zhèng yī àn. 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