Too Worn Out to Move, Sweating All Day, Always Wanting to Sleep in the Summer Heat? Li Dongyuan’s Famous Formula: Huang Qi Ren Shen Tang (Astragalus and Ginseng Decoction)

Patient search terms: summer fatigue / heatstroke / qi deficiency / excessive sweating / always sleepy in summer / heat injuring qi Corresponding medical term: summer-heat damaging yuan qi · qi-yin deficiency pattern

When summer arrives, many people simply wilt: no strength anywhere, eyes too heavy to keep open, breaking into a sweat at the slightest movement, not even wanting to eat — have you noticed that summer actually tires you out more than winter? If you have this constitution, or someone around you suffers from “bitter summer” (ku xia) every year, you must read this article to the end. In the Pi Wei Lun (Treatise on the Spleen and Stomach), Doctor Li Dongyuan left behind a formula that looks simple but holds endless subtlety, aimed precisely at this situation. It is called Huang Qi Ren Shen Tang (Astragalus and Ginseng Decoction).

💬 Note from Doctor Luo: Today we continue with Doctor Li Dongyuan’s famous formulas — Huang Qi Ren Shen Tang. The formula has few ingredients and looks simple, but there is real subtlety inside. Doctor Li Dongyuan placed it in the Pi Wei Lun under the chapter “Pi Wei Xu Ruo, Sui Shi Wei Bing, Sui Bing Zhi Fang” (When the Spleen and Stomach Are Weak, Illness Appears with Each Season — Treat the Illness According to the Season). The chapter title alone is fascinating: spleen-stomach weakness is the foundation, but different seasons and solar terms give rise to different illnesses, so you treat each illness as it comes — you build the formula by following the changes.

一、Who Is This Formula For? — The People Who Suffer Most in Summer

Doctor Li Dongyuan states it very clearly: people with a weak spleen and stomach have insufficient upright qi, so the heart-lung qi of the upper burner is certainly insufficient as well. Such people run into big trouble in summer — because the weather is extremely hot, and heat injures yuan qi (original qi).

Every year, as each season comes around, people of different constitutions react differently. Who suffers most in summer? People with qi-yin deficiency suffer most — those with qi deficiency, those with yin deficiency, and those with both qi and yin deficiency all have a hard time. Why? When the weather turns hot, the qi and blood in your body start moving faster — not the kind of speed you choose by going for a run, but a forced, passive acceleration. Whether passive or active, your metabolism speeds up and your energy consumption rises. So do not assume hot weather burns little energy — hot weather actually burns a great deal of energy.

💬 Note from Doctor Luo: Let me give you a real example. Nowadays many northerners move to Hainan to live. A friend told me: ever since he moved to Sanya, why does he get hungry so fast? Before 11 a.m. he is already hungry, and he often feels dizzy. I looked at his tongue, took his pulse, and told him: you have qi deficiency! Why? Because Sanya is hot, your metabolism has sped up, and that itself is a form of consumption. Chinese medicine calls this heat injuring yuan qi — hot weather consumes qi.

There is a second reason heat injures yuan qi: qi escapes along with sweat (qi sui han tuo). In summer you sweat profusely; when you sweat too much, your body fluids (jin ye) are severely damaged. Chinese medicine holds that yin and yang are mutually rooted — qi and the “yin-type” substances like fluids depend on each other; qi attaches itself to liquid matter, and liquid is the vehicle that carries qi. When sweat pours out excessively, the fluids inside diminish, the source of blood is affected, and upright qi naturally weakens along with it. So sweating too much makes you even more qi deficient — this is what “qi sui han tuo” means.

二、When Heat Has Injured Your Yuan Qi, What Signals Does the Body Send?

Doctor Li Dongyuan lists the symptoms in perfect order. The first group is the mild symptoms:

Dai duo shi wo (lethargy and constant desire to lie down) — no strength at all, extremely lazy, bone-tired, always wanting to lie down and sleep. Everyone has experienced this: on a summer afternoon without air conditioning, when the teacher is lecturing at the front of the classroom, your eyes simply will not stay open; and if you truly have nothing to do, you can sleep through the entire afternoon. This is the body’s instinct trying to slow down its own high-speed operation. People with qi deficiency — and those with even weaker yuan qi — slip into this state more easily.

Si zhi bu shou (weak limbs that will not obey) — arms and legs have no strength; you do not want to walk anywhere. Why? Because the spleen governs the four limbs, and the spleen and stomach have become even weaker.

Cold hands and feet in the morning and evening, yet burning hot like fire at noon — this is where Doctor Li Dongyuan observed most carefully: summer mornings and evenings are cool, so people with insufficient upright qi have cold hands and feet at those times; but when the sun rises high and beats down, the body instead begins to run hot — in severe cases a genuine fever, the body scorching like fire.

💬 Note from Doctor Luo: Speaking of this, I am deeply impressed — Doctor Li Dongyuan observed symptoms with extraordinary care. He wrote: “Gu re jue er yin xu, huo han jue er qi xu” (heat reversal belongs to yin deficiency; cold reversal belongs to qi deficiency). Heat reversal: yin-deficient people have unusually hot hands and feet. Cold reversal: qi-deficient people have ice-cold limbs. In our lectures we tend to cut everything with one stroke and say people with yin deficiency always have hot palms and soles — not necessarily! People with yin deficiency have insufficient qi and blood, which cannot circulate to the ends of the limbs. In summer heat their hands and feet are hot, but the moment they step into an air-conditioned room they go ice cold — it changes with the external environment, because with insufficient qi and blood, the body’s ability to regulate the temperature at its extremities is reduced. In winter, yin-deficient people have colder palms and soles than anyone else. What Doctor Li Dongyuan wrote is the true clinical picture — it looks “messy” on paper, but these are absolutely genuine symptoms.

Also: the mouth loses its taste — nothing tastes good anymore; the eyes blaze and the vision grows dim — you cannot see clearly.

💬 Note from Doctor Luo: When heat reaches a certain level, the eyes genuinely start to fail. Walk through a desert in extreme heat; work in the fields sweating so much that your fluids are badly damaged — your vision really does blur, and you can even faint on the spot. In even more severe cases, the eyes sink into their sockets. These things sound like scare tactics — until you meet a patient like that, you do not realize that everything Doctor Li Dongyuan wrote is the plain truth.

Frequent urination — always wanting to go, but with little urine, because the fluids are badly damaged and the body’s moisture is depleted; difficult, bound stool — with insufficient fluids inside, the stool dries out and constipation follows.

三、Two Stages: First Heat, Then Cold — Do Not Only Watch the First Half

Doctor Li Dongyuan specifically points out that heat injuring yuan qi unfolds in two stages, and you must know this:

Stage one is “heat” — at the beginning there is sweating, heavy sweating, fever. The body cannot control itself: the outside is hot, so the body follows and runs hot. This is a state of losing control.

Stage two is “cold” — when qi and yin are injured extremely severely and yuan qi is gravely damaged, the body begins to move toward a critical, life-threatening state, and then it turns cold instead. A few hours later, or after a night, the next day the whole body feels freezing, and a string of critical signals appears:

Stomach pain right over the heart (wei wan dang xin er tong) — the upright qi is severely deficient;
Pain in both flanks (liang xie tong) — the fluids are badly damaged and yang qi begins to scatter;
The navel area contracts as if bound by a rope (qi zhou shou suo ru sheng kun) — the area around the navel draws inward as if tied with rope, in severe cases as painful as a knife stab, the belly unable to relax — the body has entered a critical contracting state;
Chest oppression (xiong zhong bi se) — a stuffy, suffocating chest;
Retching and vomiting (shi ou hui) — “ou” is vomiting with sound and contents; “hui” is dry retching, straining with nothing coming out. The spleen and stomach begin to contract and cramp, which is what pushes the vomiting and phlegm outward;
White foam bubbling from the mouth (kou wo bai mo) — white froth wells up from the mouth;
A stiff tongue (she qiang) — the tongue goes hard, a sign that life has entered a dangerous state: the yin fluids are severely depleted and yang qi is about to slip away;
Pain in the lower back, shoulders and shoulder blades, intermittent headache, inability to eat (shi bu xia) — going from “full after a bite” to not wanting food at all;
Profuse spontaneous sweating (zi han you shen) — sweat pouring out — but at this point it is cold sweat.

💬 Note from Doctor Luo: Remember the difference between the sweating in these two stages. At the beginning you sweat while the body is hot, following the hot weather outside — hot sweat, still fairly normal. Later, when upright qi is scattering, qi is escaping with the sweat, and death is near, you also sweat in torrents — but the sweat is cold. Doctor Li Dongyuan described it in one phrase: “Ruo yin qi fu zai pi mao zhi shang” — as if a layer of cold qi clung to the surface of the skin while sweat poured out. At this point the body can no longer hold onto the last remnants of its fluids and lets them go. Heat first, cold later — but the root cause is the same in both stages: people whose spleen-stomach qi is insufficient in summer have their upright qi injured by the heat pathogen; qi and yin are gravely damaged, yuan qi is gravely damaged. Doctor Li Dongyuan’s summary: “Ci jie tian qi zhi re zhu ben bing” — all of this is the heat of the weather “helping” the underlying disease. When the spleen and stomach are already weak and upright qi insufficient, the weather’s heat comes along to lend a hand; the Geng channel (the Large Intestine channel), the Heart channel and the Lung channel are attacked — mainly the Lung channel.

四、What To Do? — No Matter How Mild or Severe, First Tonify Yuan Qi

What should you do at this point? You must tonify yuan qi — when yuan qi is restored, the person can be saved. So regardless of severity, for someone with spleen-stomach qi deficiency whose upright qi has been injured by the heat pathogen in summer, the following formula works — and this is Huang Qi Ren Shen Tang (Astragalus and Ginseng Decoction).

💬 Note from Doctor Luo: Huang Qi Ren Shen Tang is not well known; not many people talk about it, because it looks too simple. But let me tell you: among all of Doctor Li Dongyuan’s formulas, the one with the most appended modifications and additions is this one. It is thoroughly worth studying as a model. Look at its weight — the two great qi tonics, huang qi and ren shen, are both on board. Why? Because the situation calls for urgently tonifying qi to save the patient!

五、Formula Breakdown: Huang Qi With Ren Shen, Cang Zhu With Bai Zhu, and the Touch of Genius — Huang Bai

Huang qi (astragalus, one qian) — Doctor Li Dongyuan actually did not use huang qi heavily; if the spontaneous sweating was too severe he added one more qian, six grams in total. His doses were small, but his method had a rule: in his day the herbs were ground into fine powder, and the powder was boiled in water, so far more of the effective ingredients dissolved out; today we boil sliced herbs, which wastes a great deal.

💬 Note from Doctor Luo: Huang qi is the elder of the qi tonics — ranked number one for tonifying qi. Its greatest trait is tonifying qi and securing the exterior: when the qi at the body surface is deficient and the pores gape open so external pathogens can slip in, huang qi secures the exterior; it also lifts upright qi. A whole series of Doctor Li Dongyuan’s formulas lead with huang qi. Later Doctor Zhang Xichun learned this and transformed it into Sheng Xian Tang and the rest — he was exceptionally skilled with huang qi. A Doctor He Jian who came out of the Mayo Clinic once told me: Americans say you Chinese do not know how to use huang qi — when you boil it in a decoction, most of the active ingredients are wasted; only Americans know how to process and extract it so all the effective components come out. So Doctor Li Dongyuan’s method of grinding to powder and boiling was actually ahead of its time.

Ren shen (ginseng) — paired with huang qi to tonify qi. The two differ: ginseng is forceful and acts immediately, tonifying qi and generating fluids; in the Shang Han Lun (Treatise on Cold Damage), when Zhang Zhongjing rescued patients in emergencies and exterior-contraction illness, he mostly used ginseng and hardly any huang qi; but in the Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet), which treats chronic illness through slow regulation, huang qi appears constantly. Ginseng is swift and fierce; huang qi is gentle and steady. Putting the two most important qi-tonifying herbs together is a match made in heaven.

Bai zhu (atractylodes) — strengthens the spleen. It is precisely because the spleen and stomach are weak that upright qi becomes deficient, so when tonifying qi you must tonify the root — add bai zhu to strengthen the spleen.

Cang zhu (black atractylodes) — dispels dampness. Cang zhu moves without staying put; its dampness-dispelling power is strong, its spleen-strengthening power weaker; bai zhu excels at strengthening the spleen and also dispels dampness. Bai zhu paired with cang zhu is like huang qi paired with ren shen — the classic combination for strengthening the spleen and dispelling dampness. Old Chinese medicine doctors pair them all the time.

Honey-fried gan cao (licorice) — harmonizes; regulates the spleen and stomach.

Sheng ma (cimicifuga, six fen) — raises the yang qi of the yangming, lifting the stomach qi upward. When qi is deficient, the clear yang qi cannot rise; sheng ma lifts the clear yang, and suddenly the formula becomes alive — qi rises and falls, flowing like water.

Ju pi (aged tangerine peel, the white pith not removed) — that is chen pi; it moves qi, circulates qi, and also resolves phlegm. Tonifying qi fears stagnation above all; you must open the qi pathways while you tonify, or nothing can be absorbed. That is why a qi-tonifying formula is always matched with herbs that move and disperse the qi.

Mai men dong (ophiopogon) — nourishes yin and supplements body fluids. When both qi and yin are injured, you must supplement fluids while tonifying qi — tonify both qi and yin together.

Dang gui (Chinese angelica, two fen) — nourishes blood, in a small amount. When fluids are depleted, blood is depleted too; tonifying qi while regulating qi and blood, adding a little fluid and a little blood, makes the tonification well-rounded.

Shen qu (medicated leaven) — aids digestion, removes stagnation and harmonizes the spleen and stomach. Like chen pi, its purpose is “pushing out the old to bring in the new” — restoring the appetite. When you can eat, upright qi grows stronger.

Wu wei zi (schisandra) — Doctor Li Dongyuan remembered that Sun Simiao said “in the fifth month, always take wu wei zi.” Wu wei zi can tonify the qi of all five viscera, and it astringes as well.

💬 Note from Doctor Luo: Everyone knows Sheng Mai San (Pulse-Engendering Powder) — ren shen, mai dong and wu wei zi: ginseng tonifies qi, ophiopogon nourishes yin, schisandra astringes — the perfect trio for tonifying both qi and yin. Today’s formula contains ren shen, mai dong and wu wei zi — the shadow of Sheng Mai San is right inside it. In summer, when qi and yin are injured, for mild cases you can take some wu wei zi; for severe cases, take Huang Qi Ren Shen Tang. There is another intention behind the wu wei zi here: in summer heat, fire overcomes metal — the lung metal is imprisoned. When lung metal is imprisoned, liver wind easily stirs and bursts; wu wei zi is sour and astringent, and it can help restrain liver wind. See how broad the thinking of these masters is — with every single herb, they saw ten connections at once.

Huang bai (phellodendron, three fen, washed in wine) — clears heat. Washing it in wine sends its action upward, to clear the heat of the upper burner — the lung has been injured by heat, so huang bai clears the fire. Just a touch is needed — it is matched with extraordinary subtlety.

💬 Note from Doctor Luo: Have you noticed that almost every one of Doctor Li Dongyuan’s formulas shares one structure: a large base of qi-tonifying and spleen-tonifying herbs, always matched with a small touch of heat-clearing herbs like huang bai or huang lian. Sometimes I explain this with the gut-microbiome idea, half in jest: one crowd of herbs feeds the beneficial bacteria, and a small amount of dampness-heat-clearing herbs controls the harmful ones — improving the proportion of the gut flora. The prescription structure is often exactly this: tonics as the main force, a touch of heat-clearing as the finishing stroke. This formula would not work without that little bit of heat-clearing. It is a classic combination — once you know how to use it, it can genuinely snatch patients back from the brink of death.

六、When To Use It? — Injured by Summer Heat, and After Major Illness

Doctor Luo Dalun emphasizes two categories of application:

First: people injured by summer heat — those who are genuinely qi deficient in summer: after hot weather, weak limbs, blurred vision, wanting to sleep all day, no energy at all, and a sharp decline in health. For this kind of “summer-heat injury,” the formula works immediately. It can even save lives in critical situations: working in the fields under scorching heat, a person collapses, sweat pouring out, finally ice-cold all over, near the last breath — to simply call that “heatstroke” is too easy; it is actually heat injuring yuan qi to a critical degree. In extreme environments like a great desert, when heat injures the body into a critical state, this formula also works extremely well — it truly can bring someone back, and the person gradually recovers.

Second: people with qi-yin deficiency — those with severe qi deficiency and scattered upright qi, for example those recovering after surgery or after various major illnesses. As long as they are in the state Doctor Li Dongyuan describes, using this formula to regulate and tonify works very well.

💬 Note from Doctor Luo: Most people have never paid attention to this formula of Doctor Li Dongyuan’s. I want to draw your attention to it — it tonifies qi, and it is especially effective for the insufficiency of upright qi that follows injury by the heat pathogen, with all the various symptoms that result. In addition, I suggest that students of Chinese medicine — and students in TCM colleges — carefully study the modifications Doctor Li Dongyuan appended to every one of his formulas. Take Bu Zhong Yi Qi Tang (Center-Supplementing Qi-Boosting Decoction): we use it every day, yet Doctor Li Dongyuan wrote so many modifications for different symptoms. That is an extraordinarily precious treasure; study it thoroughly, and it will absolutely benefit your clinical practice.

What to Take Away

Hot weather really does consume qi. The metabolism speeds up and burns energy, and heavy sweating drags qi out with the fluids (qi sui han tuo). If summer exhausts you every year — no strength, constant sleepiness, breaking into sweat easily — the foundation is often spleen-stomach weakness with qi-yin deficiency.
Doctor Li Dongyuan’s two stages: first heat (sweating, fever — a loss of control), then cold (the critical stage: stomach pain, rope-bound navel contraction, chest oppression, white foam at the mouth, stiff tongue, and above all profuse COLD sweat). Hot sweat early, cold sweat late — the root cause is the same: heat injuring yuan qi.
No matter how mild or severe, first tonify yuan qi. Huang Qi Ren Shen Tang is the formula: huang qi + ren shen as the heavy qi tonics, bai zhu + cang zhu to strengthen the spleen and dispel dampness, sheng ma to raise the clear yang, mai dong + dang gui to supplement fluids and blood, wu wei zi to astringe, and a touch of wine-washed huang bai to clear the upper burner — tonics as the main force, heat-clearing as the finishing stroke.
How to use it: boil the herbs as fine powder rather than slices — far more of the effective ingredients dissolve out, exactly as Doctor Li Dongyuan did in his own day.
Two main applications: genuine summer-heat injury (including critical heatstroke collapse), and qi-yin deficiency during recovery from surgery or major illness.

(Compiled from Doctor Luo Dalun’s lecture series on Doctor Li Dongyuan’s formulas. Huang Qi Ren Shen Tang comes from the Pi Wei Lun, the Treatise on the Spleen and Stomach.)