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Chapter 7 of 29
伤寒杂病论
When summerheat pathogen injures the human body, the Lung bears the brunt of the attack. The Lung serves as the general manager of Qi (the mansion of qi) throughout the entire body. Summerheat-heat pathogen most readily consumes the body's Original Qi (the fundamental driving force of life activities). Therefore, those injured by summerheat commonly present with a Cun-kou pulse (at the radial artery of the wrist) that is weak and feeble, thirst, sweating, mental confusion/absent-mindedness, and shortness of breath. At this point, Bamboo Leaf and Gypsum Decoction (Zhuye Shigao Tang) should be used for treatment.
Bamboo Leaf and Gypsum Decoction consists of Bamboo Leaf, Japonica Rice, Pinellia Rhizome, Gypsum, Ginseng, Dwarf Lilyturf Root, and Honey-Fried Licorice. The formulation strategy is: Gypsum and Bamboo Leaf clear and resolve summerheat-heat; Ginseng, Dwarf Lilyturf Root, Japonica Rice, and Licorice supplement qi and nourish yin, tonifying the spleen and stomach; Pinellia Rhizome directs counterflow downward and harmonizes the stomach. This achieves the goal of clearing heat without damaging the righteous qi, and supplementing qi without retaining pathogens.
If after summerheat injury there is fever, sweating, thirst, and a pulse that is floating and large (readily palpable upon light touch with a broad pulse body), this pattern is called Zhong Ye (heatstroke/sunstroke). Treatment should employ White Tiger Plus Ginseng, Coptis, and Donkey-Hide Gelatin Decoction (Baihu Jia Renshen Huanglian Ejiao Tang). This formula, based on White Tiger Decoction's heat-clearing and fluid-generating effects, adds Ginseng to supplement qi, Coptis to clear heart-fire, and Donkey-Hide Gelatin to nourish yin and enrich the blood. It is suited to the pattern of exuberant summerheat-heat with dual injury to qi and yin, and hyperactivity of heart-fire.
If after summerheat injury there is persistent fever following sweating, restlessness and agitation, hoarse voice, and a pulse that is nonetheless floating and rapid (palpable upon light touch with rapid skipping), this indicates damage to the Lung Fluids (the fluid essence governed by the Lung). Treatment should use Lily and Rehmannia Plus Oyster Shell Decoction (Baihe Dihuang Jia Muli Tang). This formula uses Lily and Rehmannia to nourish the yin of the Lung and Kidney, and Oyster Shell to anchor and settle the spirit. It targets the pathogenesis of summerheat damaging yin with vacuity yang floating upward.
If after summerheat injury there is retention of fluid-rheum below the heart region (in the stomach duct area), manifested as sweating, coughing, thirst with desire to drink but vomiting upon drinking, and a pulse that is weak yet slippery (insufficient in force but flowing smoothly like pearls), this is a pattern of summerheat-heat complicated by internal water-qi retention. Treatment should use Trichosanthis and Poria Decoction (Gualou Fuling Tang). This formula uses Trichosanthis Fruit to broaden the chest and transform phlegm, Poria to percolate dampness and promote urination, Pinellia Rhizome to direct counterflow downward and arrest vomiting, Coptis to clear heat and dry dampness, and Licorice to harmonize the various medicinals. Together they achieve the effect of clearing heat, resolving fluid-retention, harmonizing the stomach, and directing counterflow downward.
If after summerheat injury there is fever without sweating, this is because water-dampness has become lodged between the skin and the interstices (cou li). The pulse will necessarily be floating and slippery. Treatment should first use hot water bathing to open the sweat pores and allow the pathogen to be expelled through sweating, after which Bamboo Shavings and Pinellia Decoction (Zhuru Banxia Tang) is administered. This formula uses Bamboo Shavings to clear heat and arrest vomiting, Trichosanthis Root (Tian Hua Fen) to generate fluids and relieve thirst, Poria to promote urination and percolate dampness, and Pinellia Rhizome to dry dampness and transform phlegm. It is suited to the pattern of summerheat-dampness constraining the exterior with unmetabolized water-qi.
When the Greater Yang channel (the body's outermost defensive line) is affected by summerheat-heat pathogen, this is called Ye. The patient manifests sweating, chills, generalized fever, and thirst. Treatment should use White Tiger Plus Ginseng Decoction (Baihu Jia Renshen Tang). This formula employs White Tiger Decoction (Anemarrhena, Gypsum, Licorice, Japonica Rice) to greatly clear heat pathogen at the qi level, with the addition of Ginseng to supplement qi and generate fluids. It is the classic formula for treating summerheat injuring fluids and consuming qi.
Greater Yang summerheat stroke (zhong ye) manifests as generalized fever, heavy and painful limbs, and a faint and weak pulse. This results from excessive indulgence in cold foods and drinks or cold water exposure during summer, causing water-dampness to become lodged within the skin. Treatment should use Pig's Kelp (Polyporus) Plus Ginseng Decoction (Zhuling Jia Renshen Tang), alternatively using Single-Ingredient Muskmelon Pedicel Decoction (Yiwu Guadi Tang). Pig's Kelp Plus Ginseng Decoction uses Polyporus, Poria, Alisma, and Talc to promote urination and percolate dampness, Donkey-Hide Gelatin to nourish yin, and Ginseng to supplement qi. It is suited to the pattern of summerheat-dampness damaging qi with fluid stasis and failure of transformation. The Single-Ingredient Muskmelon Pedicel Decoction uses only Muskmelon Pedicel, taking advantage of its emetic action, with the intention of guiding the pathogen outward in accordance with its tendency, allowing water-dampness to be expelled from above.
The general principle for summerheat disease is: summerheat disease should naturally cause sweating. If there is no sweating, fever will inevitably develop; those with fever will certainly not sweat easily. Under no circumstances should sweating therapy be forcibly induced, as this will lead to aggravated fever, restlessness, and loss of voice. This is because sweating further consumes the Lung Fluids. If manifestations of shallow and rapid breathing (xi gao - short, rapid respiration with difficult inhalation) or qi surging upward (qi ben) appear, this indicates that lung qi is about to expire. The ancients considered this an incurable pattern.
After summerheat injury, if there is restless sleep at night, restlessness, delirious speech, a red tongue body, and a rapid pulse (rapid skipping), this is the manifestation of summerheat pathogen affecting the heart (summerheat-heat pathogen invading the cardiac system). Treatment should use Coptis, Pinellia, Gypsum, and Licorice Decoction (Huanglian Banxia Shigao Gancao Tang). This formula uses Coptis to clear heart-fire, Gypsum to clear heat and relieve vexation, Pinellia Rhizome to transform phlegm and direct counterflow downward, and Licorice to harmonize the middle. It targets the pattern of summerheat-heat entering the heart with mental disturbance.
Greater Yang summerheat stroke manifests with fever, chills, heavy and painful body, and a pulse that is stringlike, thin, hollow, and slow (stringlike indicates constrained qi movement, thin indicates insufficiency of fluids and blood, hollow indicates severe injury to yin blood, slow indicates insufficiency of yang qi). After urination there are episodes of chills involving the entire body with goosebumps, and cold extremities of the hands and feet. Slight exertion triggers fever. The patient breathes through an open mouth, and the anterior front teeth (front incisors) are dry. If sweating therapy is mistakenly applied at this point, the chills will become even more severe. If warm needling (moxa burner needle insertion) is mistakenly used, the fever will become more severe. If purging is repeatedly used, this leads to dribbling, painful urination. This complex pattern should be treated with White Tiger Plus Cassia Twig, Ginseng, and Peony Decoction (Baihu Jia Guizhi Renshen Shaoyao Tang). This formula uses White Tiger Decoction to clear heat, adding Cassia Twig to harmonize the nutritive and defensive layers and free the yang, Ginseng to supplement qi, and Peony to nourish yin and harmonize the nutritive. It is suited to the severe pattern of unrelieved summerheat-heat with dual injury to qi and yin and disharmony between the nutritive and defensive layers.
After summerheat injury, with a weak pulse, thirst, profuse sweating, and dizziness, treatment should use Ginseng and Gypsum Decoction (Renshen Shihao Tang). This formula uses Ginseng to greatly supplement original qi, Gypsum to clear and resolve summerheat-heat, Bamboo Leaf to clear heat and relieve vexation, Coptis to clear heart-fire, and Pinellia to harmonize the stomach and direct counterflow downward. It is used for the pattern of summerheat-heat consuming qi and injuring fluids while the heat pathogen is still exuberant.
Summerheat injury by itself does not cause headache. If headache appears, it indicates concurrent wind pathogen; if the head feels heavy as if wrapped, it indicates concurrent dampness pathogen. These are the key distinguishing points for combined presentations in summerheat injury.
This chapter systematically elaborates on the etiology, pathogenesis, pattern classification, treatment principles, and contraindications of summerheat injury (heatstroke). The core concepts can be summarized as follows:
I. Summerheat is a yang pathogen that most severely damages qi and yin. The nature of summerheat-heat is to rise, disperse, open, and drain. It very readily consumes the body's qi and fluids (jin ye). The Lung governs qi, dominates the skin and body hair, and controls respiration; therefore the summerheat pathogen first attacks the Lung when injuring the body. The symptoms of weak pulse, thirst, sweating, shortness of breath, and mental confusion that recur throughout the chapter are, in essence, external manifestations of dual injury to qi and yin. This is the fundamental pathological thread running through the entire text.
II. The core of treating summerheat injury lies in combining "clearing summerheat" with "supplementing qi and nourishing yin." Pure heat-clearing can more readily damage righteous qi; pure qi supplementation risks locking the pathogen within. Therefore, almost all formulas in this chapter combine heat-clearing medicinals with qi-supplementing and yin-nourishing ones: Gypsum, Bamboo Leaf, Anemarrhena, and Coptis clear heat and eliminate summerheat; Ginseng, Dwarf Lilyturf Root, Japonica Rice, Licorice, Donkey-Hide Gelatin, Lily, and Rehmannia supplement qi and nourish yin. This is the concrete application of the Chinese medical principle of "simultaneously attacking and supplementing" in summerheat disease.
III. Summerheat is often complicated by dampness; one must distinguish the location of water-qi stasis. The Trichosanthis and Poria Decoction pattern (fluid stasis below the heart), the Bamboo Shavings and Pinellia Decoction pattern (water moving through the skin), and the Pig's Kelp Plus Ginseng Decoction pattern (water-dampness constraining the exterior) correspond respectively to water-qi located in the stomach duct, in the skin, and in the body surface. The treatment methods correspondingly differ—or resolve fluid, or promote urination, or percolate dampness—demonstrating the Chinese medical dialectical thinking of "treating the same disease with different methods."
IV. There are "three prohibitions" in treating summerheat injury—no sweating therapy, no warm needling, and no repeated purging. These are the ancients' profound conclusions on the consequences of therapeutic errors: sweating damages lung fluids, warm needling intensifies heat pathogen, and purging injures fluids. Summerheat disease already involves dual injury to qi and yin; using these attacking methods on top of this is equivalent to adding injury to insult. This explicit warning about treatment contraindications embodies the ancients' treatment philosophy of "regarding righteous qi as fundamental."
V. Differential diagnosis runs throughout. The chapter closes with the concise distinction that "no headache indicates simple summerheat, headache indicates wind, and heavy head indicates dampness," which succinctly summarizes the key differential points in identifying the three pathogens of summerheat, wind, and dampness. The various clauses throughout the chapter also form a complete diagnostic network: among those with the same sweating and thirst, a weak pulse indicates qi deficiency while a floating-large pulse indicates heat exuberance; among those with the same fever without sweating, water moving through the skin or summerheat-heat constraining the exterior require different treatments—the former with Bamboo Shavings and Pinellia Decoction, the latter with hot water bathing first.
From a modern medical viewpoint, the "summerheat injury" and "summerheat stroke" described in this chapter broadly correspond to heat illness, including different types such as heat exhaustion and heat stroke. The symptoms the ancients observed—fever, sweating, thirst, mental confusion, and weak pulse—highly align with modern medical understanding of dehydration and heat injury in heat illness.
Aspects with scientific rationality:
Historical limitations to note:
From the perspective of daily living, this chapter provides universally applicable summer health maintenance principles:
Related Concepts
Further Reading
This content is based on classic ancient Chinese medical texts and is provided for traditional cultural study and research purposes only. It does not constitute medical diagnosis, medication prescriptions, or treatment recommendations. Please consult a qualified healthcare provider promptly if you experience any symptoms.