Formulas that clear Summerheat

  

Cara O. Frank, L.OM.

 

 

If you’ve been following me, you’ll notice a pattern in my writing: I’ve been preoccupied with iterations of heat clearing herbs and formulas for a decade. My attention has evolved this year towards restoration: Recently, I’ve written and taught a small formula that nourishes Yin- Zeng Ye Tang[1]. As we near August, this thread has evolved towards other formulas that replenish fluids and clear heat: the category of Formulas that Clear Summerheat

 

What is Summerheat? How does it differ from other heat patterns? In many ways, the category is nearly a throw-away. Within this family of formulas, none would be considered Major. Nevertheless, with the focus on damp-warm diseases because of all we’ve learned from treating COVID, I wanted to review these formulas. 

 

The overarching presentation of Summerheat is fully Yang: the external environment is hot and dispersing. As a result, the pores open, and there is excessive sweating. This results in thirst, fever, and irritability.

 

It’s not the heat- it’s the humidity: Dampness and Summerheat run in a pack. 

 

What distinguishes this pattern from other heat patterns is the layering of dampness into a pattern of heat. 

 

In contrast to herbs and formulas that clear heat and dry dampness, this can be thought of more as damp warmth. In the Su Wen, chapter 31, Qi Bo states (paraphrasing) that diseases in the early summer are warm diseases, and those of late summer are caused by Summerheat. The main therapeutic strategy is diaphoreses.

 

Within this category, there are five subcategories, which reflect the range of sub-patterns and treatment strategies. Summerheat is what we are experiencing now, in late July through early fall. However, the pattern is not season specific. Damage to body fluids and qi can occur in any season.

 

 

There’s 5 subsections within the chapter Formulas that clear Summerheat:

 

1.    Formulas that Clear heat and resolve Summerheat

2.    Formulas that Dispel Summerheat and resolve the exterior

3.  Formulas that Clear Summerheat and Drain Dampness 

4.    Formulas that Dispel Summerheat and augment the Qi

5.    Formulas that Dispel Summerheat and preserve body fluids

 

It is important to note that several formulas are not included in the “chapter” can also treat Summerheat: These include Sheng Mai San which is grouped with formulas that tonify qi; Gan Lu Xiao Du Dan, can be found with formulas that clear heat and expel dampness; Zhu Ye Shi Gao Tang and, of course, Bai Hu Jia Ren Shen Tang are both featured with formulas that clear Qi level heat.

 

 

Section 1:

 

Clear heat and resolve Summerheat

清热解暑 [qīnɡ rè jiě shǔ]

 

 Only one formula is discussed- Qīng Luò Yĭn 清络饮 Channel-Clearing Beverage.

 

The actions of the formula are to resolve Summerheat and clear the lungs. The symptom picture includes mild fever, thirst, and a vague or fuzzy feeling in the head—a basic picture of an overheated person.

 

It’s a kind of garden formula: it uses cooling, fresh medicinals. These include

Xian jin yin hua honeysuckle flowers, Xian Bian dou hua fresh hyacinth beans, xi gua watermelon, si gua luo luffa, Xian he ye lotus leaves, and zhu ye bamboo leaves.

 

Because the herbs are fresh and not dried, this formula in not commonly used in clinical practice.

 

Nevertheless, it’s easy to replicate this in different ways. For example, we can all enjoy watermelon in season. Fresh luffa is always in the produce aisle at Asian groceries and is delicious to eat. If that’s not available, you could opt for zucchini or summer squash and tomatoes because they are juicy and cooling.

 

Every year, I grow Bai Bian Dou for its beautiful flowers and bright purple bean pods. I can tell you with certainty that in Philadelphia, the beans are not ripe in the same season as honeysuckle. 

 

 

 

 

Section 2: 

Dispel Summerheat and Resolve the Exterior.

祛暑热解表 [qīnɡ shǔ rè jiě biǎo]

 

 

This pattern develops in the most common ways in the Western world: excessive cold and icy drinks, overly airconditioned spaces causes the contraction of Wind-Cold pathogen. If the cold closes the pores, then the yang is constrained. If it damages the spleen and stomach, then they lose their transportive action.

To resolve this, we need to dispel the exterior and at the same time dispel Summerheat from the interior.

 

The therapeutic focus for these cases should be the use of warm, acrid, and aromatic herbs, like Hou Po and Xiang Ru, or light fragrant exterior releasing herbs like Jin Yin Hua

 

Xiāng Rú Săn 香薷散 Mosla Powder starts off this section.

9-12 g Herba Moslae – Xiang Ru

6-9 g Semen Lablab Album- Bai Bian Dou

6-9 g Cortex Magnoliae Officinal– Hou Po

 

The actions of the formula are to release the exterior, scatter cold, transform dampness and harmonize the middle burner. As a result, this person feels heavy, has a headache, feels chilled but with warm skin, and lacks sweating.

 

Only three herbs comprise this formula, xiang ru, bai bian dou, and hou po. There’s a large dosage of xiang ru- twice as much as the other 2 herbs. 

 

I don’t think that most practitioners use Xiang Ru often. It is warm and acrid, and fragrant. It enters the Lung and Stomach Channels, targeting all the main therapeutic points for this pattern. 

Summerheat is divided into two sub presentations: Yin Summerheat and Yang Summerheat. 

Yin Summerheat refers to Cold Damage in the summer. Yang Summerheat refers to Heat Damage. Both Xiang Ru as a stand-alone herb and the entire formula Xiang Ru San only treats Yin Summerheat. 

What this means, in this context is that the herb doesn’t resolve Summerheat. It is specific for the contraction of Cold pathogen in the summertime. 

 

In Xiāng Rú Săn, it’s paired with Bai Bian Dou to strengthen the spleen and resolve Summerheat, and Hou Po to fragrantly expel dampness and reduce abdominal bloating and distention.

 

Like many formulas from the Shang Han Lun, it addresses a center pivot: correcting the qi dynamic of the spleen and stomach. But this is not a Shang Han Formula: it was recorded in the Song Dynasty in Beneficial Formulas from the Taiping Imperial Pharmacy (Tài Píng Huì Mín Hé Jì Jú Fāng, 太平惠民和剂局方)

 

 

Use this formula judiciously: it’s warming and drying, so take care not to further injure fluids. Like Ma Huang, once the patient has sweat, then the herb is discontinued

 

Later in the Qing dynasty, the Wen Bing revised the formulas forming Xīn Jiā Xiāng Rú Yĭn新加 香薷 饮 Newly Supplemented Mosla Beverage. 

 

Jin Yin Hua and Lian Qiao were added to promote sweating to release Summerheat pathogen. This version of the formula treats and higher fever and greater irritability. Furthermore, the dosage of xiang ru is lower than bai bian dou and hou po. 

Combined with Jin Yin Hua and Lian Qiao to emphasize a lighter, floating, surface relieving action

 

 

 

Section 3:    

Formulas that Clear Summerheat and Drain Dampness 

清暑 利湿 [qīnɡ shǔ lì shī]

 

In this group, dampness predominates. The symptoms picture includes a stifling sensation in the chest, a feeling of heaviness and lethargy and poor urine output. 

The clinical focus is to free the Triple Warmer’s qi transforming qualities by transforming and draining dampness. 

Treatment strategies need to straddle the fine line between clearing heat, promoting urination, while not injuring fluids. Many of the medicinals are bland and slippery. Some are acrid They are predominantly white herbs: Shi gao, Hua Shi, Ze Xie, Fu Ling. Secondarily, sweet herbs that protect yin fluids and relax and harmonize are included. Think of gui zhi and gan cao.

 

The primary formula in this category is a dui yao: Liù Yī Săn     六一散Six-to-One Powder. 

 

This is Jin Dynasty Physician Liu Wan Su’s formula from the Huáng Dì Sù Wèn Xuán Míng Lùn Fāng (Formulas from the Discussion Illuminating the Yellow Emperor’s Basic Questions). As a reminder, Liu founded the cooling school of medicine. He had a specific focus on how the environment influenced the impact of external pathogens on people. 

It contains Hua Shi- Talcum and Zhi Gan Cao– Radix et Rhizoma Glycyrrhizae Praeparata cum Melle, in a 6:1 ration. The actions are to clear Summerheat, resolve damp, and augment the qi. Symptoms include fever, thirst, irritability, difficulty urinating. A thin yellow coating on the tongue and a slippery or soggy pulse. It’s often added to other formulas. The range of clinical application includes lin syndrome (painful urination) and damp heat skin lesions. 

 

Hua shi– talc, literally translates to Slippery Rock. It’s cooling, soothing, slippery heavy nature creates an outlet to discharge Summerheat. Given that the internal heat can also disturb the heart spirit, it also helps drain heart heat to calm the spirit. 

 

In contrast to the first section, this formula treats Yang Summerheat. 

 

 

 

Section 4: 

Formulas that clear Summerheat and Boost Qi 清暑益气 [qīnɡ shǔ yì qì].

 

There are 2 formulas in this section with the same name, but widely differing strategies 

 

Qīng Shŭ Yì Qì Tāng

清暑益气汤 Summerheat-Clearing Qi-Boosting Decoction

 

The first formula was recorded in the Qing Dynasty text “Warp and Woof of Warm-Heat Diseases (Wēn Rè Jīng Wĕi, 温热经纬)” by Wang Shi-xiong. 

 

xī yáng shēn Radix Panacis Quinquefolii

xī guā Fructus Citrulli

lián gĕng Petiolus Nelumbinis

shí hú Caulis Dendrobii

Mai Men Dong Ophiopogonis Radix

dàn zhú yè   Herba Lophatheri

zhī mŭ        Rhizoma Anemarrhenae

huáng lián   Rhizoma Coptidis

Gan Cao Glycyrrhizae Radix

Jīng Mĭ       Oryza Sativa L.

 

 

The formula features Xi Yang Shen– rarely seen as a monarch in Chinese herbal medicine. In fact, it’s the only formula that specifically used it. For the most part, it’s an option that one chooses to use instead of Ren Shen. The formula then moves to Xi Gua, watermelon, so again, right from the start, it’s apparent that the formula. Shi hu and mai dong act as deputies to support this action. Zhi mu, dan zhu ye and huang lian clear heat and irritbalitiy. Jing mi, gan cao and to a certain extent, huang lian protect the spleen qi from the formulas cloying nature. 

 

 

In contrast, Li Dong-yuan’s version nods to his iconic Bu Zhong Yi Qi Tang- Center-Supplementing and Qi-Boosting Decoction

 

Li’’s Summerheat-Clearing Qi-Boosting Decoction

 

Huang Qi Astragali Radix

Cang Zhu Atractylodis Rhizoma

Mai Men Dong Ophiopogonis Radix

Ge Gen Radix Puerariae Lobatae

Dang Gui Radix Angelicae Sinensis

Ze Xie Rhizoma Alismatis

Huang Bai Cortex Phellodendri Chinensis

Bai Zhu Atractylodis Macrocephalae Rhizoma

Ren Shen Ginseng Radix

Shen Qu Massa Medicata Fermentata

Wu Wei Zi Schisandrae Fructus

Chen Pi Citri Reticulatae Pericarpium

Qing Pi Citri Reticulatae Viride Pericarpium

Sheng Ma Cimicifugae Rhizoma

Zhi Gan Cao Glycyrrhizae Praeparata cum Melle Radix

 

The actions of the formula are to clear Summerheat, supplement the qi, strengthens the spleen, and dry dampness. The symptoms include fever, headaches, thirst, sweating, a sensation of heaviness, and loose stools. The actions of the formula clear Summerheat, supplement the qi, strengthens the spleen, and dry dampness. The symptoms include fever, headaches, thirst, sweating, a sensation of heaviness, and loose stools.

 

The herb selection is complex and, I think, brilliant: Li weaves together drying herbs, moistening herbs, qi regulating, qi boosting herbs and it all comes together. It’s a practical and versatile formula whose realm of actions extends beyond Summerheat patterns. Recently, I’ve used it for Long-Covid patients. In the past, I’ve used it for menopausal women and even asthma

 

Section 5: 

Formulas that Dispel Summer Heat and Preserve Fluids.

 

祛暑保津 [qīnɡ shǔ bǎo jīn]

 

The final section of this chapter is recorded in Wu Ju-tong’s Wēn Bìng Tiáo Biàn.

 

Wú Shì Lián Méi Tāng (Master Wu’s Coptis and Mume Decoction) 吳氏連梅湯

 

huáng lián Rhizoma Coptidis

wū méi Fructus Mume
mài mén dōng Radix Ophiopogonis

shēng dì Radix Rehmanniae

ē jiāo Colla Corii Asini

 

 

The formula treats Summerheat that enters the shao yin and jue yin warps. The pattern describes an end stage disease with wasting and thirsting, heart heat, irritability and clouding of conciousness. Thus: we see a symptom picture that includes the heart and kidneys as well as the liver and pericardium.

Imagine nearly dying of dehydration but being rescued in time. 

Throughout history to the present day, many doctors of Chinese medicine and  have groups of herbs that form the backbone of their practice. Wu had an understanding and was able to apply the complex and opposite natures of Huang Lian and Wu Mei, which are also used in Wu Mei Wan.

Wu mei generates fluids, helps restore the stomach and protects it from the drying quality of huang lian, which is necessary to clear heart heat. It’s important to understand a key dynamic: All students are taught to avoid astringent herbs while a pathogen is still retained. Here, the wu mei and huang lian dance together to restore fluids, while simultaneously clearing heat. 

 

Sheng Di and Mai Dong reference Zeng Ye Tang- Fluid Engendering Decoction to nourish the yin and generate fluids. To support the recovery of the Ye Fluids- the thick yin, E jiao stands in for Xuan Shen. The black color of the sheng di and e jiao resonates with the kidneys. Huang Lian’s yellow with the Stomach.