1. 1 Wen Bing 4 Class 5 – Jan 31, 2011

2. 2 Summer-Heat Warmth Summer Heat Warmth 暑温 is a acute febrile disease caused by invasion of summer heat evils. It has distinct season feature, summer time. It happens abrupt, with the early symptoms such as high fever,, extreme thirst, copious sweat, flooding pulse etc. it changes rapidly, easy impair body fluid and exhausts Qi, even causes unconsciousness and convulsion. Summer Heat Warmth 暑温 disease treatment can be a good reference for treating acute epidemic disease such as epidemic encephalitis B, leptospirosis, sunstroke, etc. Summer Heat/Warm – cont’d

3. 3 Summer-Heat Warmth Summer Acute exogenous Yangming ST warm disease at beginning High possibility develop into internal wind or qi and blood collapse syndrome Often combined with dampness

4. 4 Etiology and pathogenesis –Internal: after sweating or over work  qi damage, body fluid injury –External: summer heat pathogen  damage vital qi, transform into fire and disturb H Stimulate Liver wind

5. 5 Diagnosis –Summer (later summer) –Acute onset, seldom starts from Wei-stage. Acute with interior excess heat  Qi level syndrome –High fever, severe thirst, heavy sweating –Fast progression –With dampness syndrome

6. 6 1. Summer heat in Qi Level 1-1. Summer Heat invading Yangming – high fever, heavy sweating, thirst, restlessness, headache with dizzy, red complexion, heavy breathing, yellow dry tongue coating, flooding rapid pulse –Treatment Principle Clear summer heat, benefit Qi and body fluid –Prescription –Bai Hu Jia Ren Shen Tang Bai Hu Tang 人参 ren shen (Radix Ginseng)

7. 7 1-2. Summer Heat injures fluid and qi – fever,restlessness, yellow urine, thirst, heavy sweating, short of breath, fatigue, yellow dry tongue coating, weak pulse –Treatment Principle Clear summer heat, tonify Qi and benefit body fluid –Prescription –Qing Shu Yi Qi Tang 西洋参 xi yang shen (Radix Panacis Quinquefolii) 石斛 shi hu (Herba Dendrobii) 麦冬 mai dong (Tuber Ophiopogonis Japonici) 知母 zhi mu (Radix Anemarrhenae Asphodeloidis) 黄连 huang lian (Rhizoma Coptidis) 淡竹叶 dan zhu ye (Herba Lophatheri Gracilis) 荷叶 he ye (Folium Nelumbinis Nuciferae) 甘草 gan cao (Radix Glycyrrhizae Uralensis) 西瓜皮 xi gua pi (Pericarpium Citrulli Vulagris) 粳米 jing mi (Nonglutinous Rice)

8. 8 1-3. Body Fluid and qi collapse –Fever has gone, still sweating, heavy breath, Severe panting, Scattered and big pulse ( no root) –Treatment Principle Benefit Qi and astringe fluid, regenerate pulse –Prescription: Sheng Mai San 人参 ren shen (Radix Ginseng) 麦冬 mai dong (Tuber Ophiopogonis Japonici) 五味子 wu wei zi (Fructus Schisandrae Chinesis)

9. 9 1-4 summer damp heat obstruct middle Jiao –Symptom severe fever and thirst sweat with scanty urine abdominal distention with heavy sensation over the body flooding pulse –Treatment Principle Clear heat and resolve dampness –Prescription – 白虎加苍术汤 bai hu jia cang zhu tang White Tiger Decoction 白虎汤 bai hu tang p. 70 石膏 shi gao (Gypsum) 知母 zhi mu (Radix Anemarrhenae Asphodeloidis) 甘草 gan cao (Radix Glycyrrhizae Uralensis) 粳米 jing mi (Nonglutinous Rice) 苍术 cang zhu (Rhizoma Atractylodis)

10. 10 1-5 summer damp heat diffuse all over three Jiao –Symptom fever red face, deaf fullness sensation in the chest and abdomen diarrhea with mucus dark scanty urine cough with blood in the sputum not very noticeable thirst red tongue with yellow greasy coating –Treatment Principle Clear heat, drain dampness, regulating San Jiao –Prescription – 三石汤 san shi tang 滑石 hua shi (Talcum) 石膏 shi gao (Gypsum) 寒水石 han shui shi (Calcitum) 杏仁 xing ren (Semen Pruni Armeniacae) 竹茹 zhu ru (Caulis Bambusae in Taeniis) 金银花 jin yin hua (Flos Lonicerae Japonicae) 通草 tong cao (Medulla Tetrapanacis Papyriferi) 金汁 jin zhi

11. 11 2. Summer heat enters Ying-stage –Fever, restlessness, insomnia, delirium, deep red tongue body, thin rapid pulse –Treatment Principle Cooling Ying and clear heat, clear heart and open the orifice –Prescription –Qing Ying Tang + An Gong Niu Huang Wan

12. 12 3. Wind stirring by Summer heat –Fever, convulsion, opisthotonos, unconsciousness, wiry rapid or wiry slippery pulse –Treatment Principle Clear heat, calm the convulsion –Prescription –Ling Jiao Gou Teng Tang 羚羊角 ling yang jiao (Cornu Antelopis) 钩藤 gou teng (Ramulus cum Uncis Uncariae) 桑叶 sang ye (Folium Mori Albae) 菊花 ju hua (Flos Chrysanthemi Morifolii) 白芍 bai shao (Radix Paeoniae Lactiflorae) 生地黄 sheng di huang (Radix Rehmanniae Glutinosae) 川贝母 chuan bei mu (Bulbus Fritillariae Cirrhoses) 竹茹 zhu ru (Caulis Bambusae in Taeniis) 茯神 fu shen (Sclerotium Poriae Cocos Pararadicis) 甘草 gan cao (Radix Glycyrrhizae Uralensis)

13. 13 4. Summer heat entering Blood-stage –Fever, restlessness, delirium, large area of dark purplish macula, various bleeding, convulsion, opisthotonos, deep red tongue with burnt coating –Treatment Principle Cooling blood, relieves toxin, clear heart and open orifice –Prescription –Shen Xi Dan 犀角 xi jiao (Cornu Rhinoceri) 石菖蒲 shi chang pu (Rhizoma Acori Graminei) 黄芩 huang qin (Radix Scutellariae Baicalensis) 连翘 lian qiao (Fructus Forsythiae Suspensae) 生地黄 sheng di huang (Radix Rehmanniae Glutinosae) 金银花 jin yin hua (Flos Lonicerae Japonicae) 板兰根 ban lan gen (Radix Isatidis seu Baphicacanthi) 豆豉 dou chi (Semen Sojae Praeparatum) 玄参 xuan shen (Radix Scrophulariae Ningpoenisis) 天花粉 tian hua fen (Radix Trichosanthis Kirilowii) 紫草 zi cao (Radix Arnebiae seu Lithospermi) 粪清 fen qing –Calm the Palace Pill with Cattle Gallstone 安宫牛黄丸 an gong niu huang wan P 416

14. 14 5. Excessive H fire with Liver & Kidney deficiency –Later stage of Summer heat warmth, insomnia, restlessness, thirst, deep red tongue body with yellow dry tongue coating, thin rapid pulse –Treatment Principle Clear heart fire, nourish kidney Yin –Prescription –Lian Mei Tang 黄连 huang lian (Rhizoma Coptidis) 乌梅 wu mei (Fructus Pruni Mume) 麦冬 mai dong (Tuber Ophiopogonis Japonici) 生地黄 sheng di huang (Radix Rehmanniae Glutinosae) 阿胶 e jiao (Gelatinum Corii Asini)

15. 15 Damp-Warmth Exogenous warm disease Middle Jiao Mainly stay in Qi-stage Slow progression and long duration Late Summer (abundant rain)

16. 16 Etiology and pathogenesis –Late summer ( hot, plenty of rain)  Damp- heat attack –Improper diet, overstrain  damages Middle Jiao  Dampness accumulation

17. 17 Diagnosis –Summer onset, lingering fever – slow developing: 1st step: aversion to cold and fever at beginning, hiding fever, slow pulse. 2nd step: fever ascending and lasted for long time, accompany with heaviness sensation in head and body, oppressed chest, fullness in abdomen, nausea, vomiting, thick greasy tongue coating –Long duration: blood in stools at later period.

18. 18 Damp or Heat –More Damp: hidden fever, milder in the morning and worsen in the evening, heaviness pain in the body, loose stools, turbid urine, thirst without desire for water or just W/O thirst, tastelessness, slightly red tongue with white greasy tongue coating –More Heat: higher fever but not reduced after sweating, constipation, foul stools, concentrated urine, thirst but drinks little water,bitter taste, red tongue with thick yellow greasy tongue coating

19. 19 Treatment principles –Upper Jiao- disperse –Middle Jiao- warm to resolve –Lower Jiao- diuresis

20. 20 1. Damp-heat obstruct Wei qi –Aversion to cold, little sweating, hiding fever and worsen in the afternoon, bandage head, heaviness sensation all over body, oppressed chest, no hunger, yellow complexion, no thirst, white greasy tongue coating, slow pulse –Obvious exterior damp: Huo Po Xia Ling Tang Huo Xiang Hou Po Jiang Ban Xia Chi Fu Ling Xing Ren Yi Yi Ren Bai Dou Kou Zhu Ling Dan Dou Chi Ze Xie –Obvious interior damp: San Ren Tang

21. 21 2. Pathogen obstructed in Mo Yuan –Alternated fever and chills, body pain, sweating, heavy limbs, vomiting, abdominal distention, thick greasy white tongue coating, slow pulse –Da Yuan Yin Bing Lang Hou Po Cao Guo Zhi Mu Shao Yao Huang Qin Gan Cao –Lei Shi Xuan Tou Mo Yuan Fa Hou Po Bing Lang Cao Guo Huang Qin Huo Xiang Ban Xia Gan Cao Sheng Jiang

22. 22 3. Damp-heat obstructed in Middle Jiao –Fever stays after sweating, thirst but drinks little water, distention in epigastria, nausea, vomiting, restlessness, yellow loose stools, concentrated urine, yellow greasy tongue coating, slippery rapid pulse –Wang Shi Lian Po Yin modification Huang Lian Hou Po Shi Chang Pu Ban Xia Dan Dou Chi Zhi Zi

23. 23 4 Damp-heat with toxin –Fever, thirst, oppressed chest and abdominal distention, sore throat, concentrated urine, yellow greasy tongue coating, slippery rapid pulse –Gan Lu Xiao Du Dan modification Hua Shi Yin Chen Hao Huang Qin Shi Chang Pu Chuan Bei Mu Mu Tong Huo Xiang She Gan Lian Qiao Bo He Bai Dou Kou

24. 24 5. Damp-heat transform to phlegm and covers PC –Long last fever, milder in the morning, worsen in the evening, sometime sobriety, sometimes unconsciousness, sometimes delirium, yellow greasy tongue coating, slippery rapid pulse –Chang Pu Yu Jin Tang Shi Chang Pu Yu Jin Zhi Zi Lian Qiao Mu Tong Zhu Ye Mu Dan Pi Zhu Li Deng Xin Cao Zi Jin Pian Su He Xiang Wan Zhi Bao Dan

25. 25 6. Heat in Yangming, Damp in Taiyin –High fever, sweating, thirst with desire to drink, red complexion, heavy breathing, heaviness sensation in body, yellow greasy tongue coating, slippery rapid pulse –Bai Hu Jia Cang Zhu Tang Bai Hu Tang Cang Zhu

26. 26 7. Dampness generate cold –Fullness distention in abdomen, unfinished sensation after defecation, loose stools, poor apatite, white greasy tongue coating, slow pulse –Si Jia Jian Zheng Qi San Huo Xiang Chen Pi Fu Ling Hou Po Cao Guo Shan Zha Shen Qu –Wu Jia Jian Zheng Qi San Huo Xiang Chen Pi Fu Ling Hou Po Da Fu Pi Gu Ya Cang Zhu