No Energy, No Appetite, Feeling Frazzled Every Summer? Li Dongyuan’s Famous Formula: Qing Shu Yi Qi Tang (Clear Summer-Heat and Tonify Qi Decoction)
When summer arrives, the weather turns stuffy and hot, and people feel as if all their strength has been drained away: no energy anywhere in the body, no appetite, restless vexation in the heart, and poor sleep at night — isn’t that the normal state of many people? If this feeling is troubling you, or someone around you is like this, then this article is a must-read. Li Dongyuan left behind an extremely famous formula that many renowned TCM doctors treat as their trump card — used extremely well, extremely precisely, and able to treat many illnesses. It is Qing Shu Yi Qi Tang (Clear Summer-Heat and Tonify Qi Decoction).
💬 Note from Doctor Luo: In the last lecture we analyzed the composition of Qing Shu Yi Qi Tang for everyone. But many friends were baffled after listening: this formula is too complicated! There’s middle qi insufficiency, insufficient upright qi, weak spleen and stomach, and then damp-heat — both dampness and heat present — plus dual injury of qi and yin. So many factors stirred together, symptoms mixed up in a mess — so when exactly can this formula be used? Today we’ll walk through the key points of pattern discrimination from beginning to end.
First, read the weather pattern: when does this illness appear?
To use this formula, you first need to be clear about what kind of weather pattern it fits. Li Dongyuan talked about chang xia (the ‘long summer’) — but let’s not be too literal; it means weather that is especially hot and damp. When it’s hot and stuffy outside and the dampness is heavy, people easily fall into this state.
But it doesn’t necessarily have to wait for hot-damp weather. Some people’s internal pattern is one of heavy damp-heat; even when the weather isn’t hot and damp, the same condition can appear. So we talk about the external environment first, so everyone has a mental picture.
💬 Note from Doctor Luo: Remember, the first layer of environment that Qing Shu Yi Qi Tang corresponds to is the two characters “damp-heat” — either the external long-summer hot-damp weather, or heavy damp-heat inside your own body. That’s the big premise. Next, look at the person: is the upright qi of a patient who can use this formula sufficient? Definitely not. And their spleen and stomach have certainly been injured.
How does the spleen and stomach get injured? Diet, overwork and emotion — none of them gets away
At this point, think it over: we have told so many medical cases of Li Dongyuan and his disciple Luo Tianyi in earlier lectures — how does spleen-and-stomach injury usually come about?
First, diet definitely goes wrong. “Diet and overwork” — diet comes first. Either rich, fatty, sweet foods eaten too greasily, or skipping meals, one meal full and the next empty — in short, not eating properly, and the spleen and stomach get hurt.
Second, overwork (lao juan). Being especially exhausted — hard work, physical strain, and also excessive sexual activity — all of these injure the spleen through overwork.
Third, emotion. Constrained liver qi (gan qi bu shu) — worries and anger held inside, feeling unhappy all day, unable to let things go, tangled up in all kinds of knots — the result is liver wood transversely invading and attacking spleen earth, affecting the spleen and stomach. The spleen and stomach are gradually injured, and only then does upright qi begin to be insufficient. This is a hidden detail: such patients are very likely in a bad emotional state.
💬 Note from Doctor Luo: After hearing so many medical cases of Li Dongyuan and Luo Tianyi, you should be very familiar with these three causes of spleen-and-stomach injury: diet, overwork and emotion. Patients who fit Qing Shu Yi Qi Tang usually have all three — and especially emotion, an easily overlooked hidden factor. Some patients even feel vexed, flare up in anger, feel sad, feel like crying, or are always on the verge of tears. Why is anger unlikely? Because they have already reached the “insufficient” state — all day long they are limp and listless, the fire can’t flare out, and it turns into sadness instead. So such patients tend to be pessimistic or tearful.
Sign one: vexation, sadness, insomnia — heart fire at work
The first important sign for using this formula is vexation (xin fan). Such patients feel vexed — why?
Li Dongyuan explained it very clearly: here heart fire is treated as a major pathogenic factor — heart fire bullies the spleen and stomach, the spleen and stomach get injured, and yuan qi (original qi) becomes insufficient. Doctor Luo adds that when Li Dongyuan speaks of heart fire, he really means what we call fire in the heart and liver — such people easily feel vexed. There are two reasons for the vexation:
One is the emotional factor — all kinds of worries that can’t be resolved were already there as a foundation. The second is that when long-summer hot-damp weather arrives, the heat and stuffiness make it worse — summer-heat easily injures heart yin. Sweating drains heart yin; once heart yin is deficient, vexation comes even more easily.
💬 Note from Doctor Luo: So remember: vexation, sadness with a desire to cry, constant worry, always feeling like crying, always unable to see a way out — these are often the first sign of this illness. Vexation is the most common — when the weather turns hot, or when damp-heat inside the body is especially heavy, the heart channel is disturbed (the qi mechanism already can’t move smoothly, the ascending-descending order is thrown off), and on top of that summer-heat scorches heart yin — the heart feels especially uncomfortable. In addition, vexation is usually accompanied by insomnia — most such patients sleep poorly, either unable to fall asleep at night or vexed and restless; in any case, sleep is never sound. Summer-heat disturbs the spirit, after all! Insomnia and vexation are on the same thread, mutually cause and effect. Very few such people lie down and sleep deeply and soundly — insufficient upright qi, heavy dampness, and dual qi-yin injury all acting together: sleep can’t possibly be good.
Sign two: heavy, limp limbs — the “Ge You slouch” patient
The second diagnostic sign is weakness: heavy, limp limbs, no strength, especially listless. The spirit is also short — always weary, always wanting to lie down — like the famous “Ge You slouch” meme.
The whole family of Li Dongyuan’s formulas regulates middle qi insufficiency, injured spleen and stomach, and injured yuan qi. The common foundation of all these formulas is no strength. So Li Dongyuan says this illness typically shows as heavy, limp, strengthless limbs and a short, depleted spirit.
💬 Note from Doctor Luo: Such patients are basically never the bouncing, lively type. They have been injured by summer-heat — summer-heat damages qi and yin — while their own yuan qi was already insufficient and their spleen and stomach weak to begin with. You can see they look wilted and droopy, always saying “why am I so drained,” languid and weary, just wanting to rest. The moment you see this, the Bu Zhong Yi Qi (Tonify the Middle and Augment Qi) line of thinking should come to mind. As for exactly how to tonify and how to adjust — that’s where the differences between individual formulas come in.
Sign three: changes in the digestive system — no appetite, “bitter summer,” diarrhea
This is an illness caused by spleen-and-stomach injury, so the digestive system reacts visibly.
First, poor appetite. When the weather is scorching hot and the heat is unbearable, is your appetite good? Certainly not. TCM has a term for this: zhu xia — written with the illness radical over the character “zhu” (host) — meaning summer weakness: limp limbs, deep weariness, no appetite at all, body heat, and so on. In plain speech people call it ku xia (“bitter summer”).
💬 Note from Doctor Luo: Many people use this formula to treat “bitter summer,” with excellent results — and if taken in advance, the “bitter summer” symptoms may not even appear. Why no appetite? Damp-heat trapping the spleen — the spleen and stomach were already weak, then the weather turns hot and the dampness heavy; damp-heat traps the spleen, and appetite disappears.
Second, diarrhea. Li Dongyuan was truly a clinician; he specifically describes the stool — loose, unformed stools, or discharging yellow, mushy, rotten material. Patients with heavy damp-heat usually have abnormal stools: either sticky, smearing the toilet bowl, or completely unformed; some have abdominal pain before the diarrhea. Diarrhea is an especially important manifestation of this formula — when damp-heat in the body is severe, the stool goes wrong.
Third, a tasteless mouth and a sticky feeling in the mouth. Spleen-deficient people have a tasteless mouth, always feeling there’s no flavor; tracing upward, the very top of the digestive tract is the mouth — such patients feel stickiness in the mouth, and when you look at the tongue, the coating is indeed thick and greasy, sometimes even yellow. This is an important sign of damp-heat at work, heavy dampness, and disordered spleen-stomach ascending and descending: turbid qi above, and this is what it looks like.
Dry mouth comes in two kinds: some don’t want water, some do — the shadow of yin deficiency
These people also get a dry mouth. Even though saliva in the mouth is abundant, they still feel dry. Here you must distinguish two situations:
One kind has a dry mouth but doesn’t want to drink water — that’s excessive dampness: the dampness is very heavy, the tongue coating is thick and watery-slick, and they can’t take any more water in.
The other kind has a dry mouth and does want to drink — such people’s tongue coating may be thinner, yin deficiency is relatively obvious, and the tongue body is red.
💬 Note from Doctor Luo: Note that the pattern of Qing Shu Yi Qi Tang does include yin deficiency — yin deficiency often lurks underneath, trapped by the dampness, with yin deficiency at the base. So some patients have a dry mouth without wanting water (heavy dampness), and some have a dry mouth and want water (obvious yin deficiency). How do you spot the yin deficiency? Look at the lips — yin-deficient people’s lips are often bright red, and the tongue is sometimes red too, without coating. Some elderly people being rescued in hospital beds have red tongues without coating and bright red lips — would you say this formula can’t be used? No! They have damp-heat, but their yin deficiency is also obvious — this formula should still be used. Also, some yin-deficient patients have hot palms and soles, so when damp-heat coexists with yin deficiency, the palms and soles may be hot — remember that too.
Sign four: chest fullness and shortness of breath
Tracing downward from the mouth, there is chest fullness and shortness of breath (xiong man qi cu): the whole chest feels stuffy, breathing feels short and oppressed. Li Dongyuan’s original words are exactly “chest fullness and shortness of breath.”
Why? The spleen-stomach ascending-descending mechanism is disordered: turbid qi above, chaotic qi in the chest; clear yang below, and the heart-lung function is affected, so the chest feels stuffy. There was already heart fire, and upright qi is insufficient; both middle qi and the great qi (da qi, the qi of the chest) sink, so the chest feels full and the person weary.
💬 Note from Doctor Luo: Remember: if a patient has no strength, digestive problems with diarrhea, and then chest stuffiness — especially worse in hot-damp weather, so that even breathing feels like effort — then think about whether this is the pattern for Qing Shu Yi Qi Tang.
Sign five: water metabolism and the body surface — profuse sweating, fear of wind, body heat, red rashes
With heavy damp-heat and insufficient upright qi, water metabolism goes wrong.
Profuse sweating (spontaneous sweating, zi han). Always sweating; a head of sweat just from eating a meal. First, upright qi is insufficient and can’t secure and hold the body fluids; second, the dampness really is heavy. In the same hot, damp weather, different people behave differently — some are fine, while others pour sweat.
Occasional edema. When dampness inside the body is especially heavy — heavy damp-heat — some individuals feel swollen.
Body heat. The body-surface defense system reacts: in the hottest, most humid part of summer, the body feels hot; some people really do run a fever, like a cold. Some people’s faces turn red; others develop red rashes on the skin — this is heavy damp-heat inside pushing outward, reaching the surface.
Fear of wind and cold. Because upright qi is insufficient, qi deficiency makes people easily fear wind and cold. Especially some postpartum women who were caught in a draft after giving birth are always afraid of wind and cold — whenever someone fears wind and cold, it shows their upright qi is insufficient.
Tongue, pulse and urine: swollen tongue with teeth marks, empty-large-wiry pulse
Tongue. Most patients’ tongues are swollen and large with teeth marks on the edges — mainly qi deficiency and heavy dampness; the coating is usually thick and greasy. A minority are mainly yin-deficient — red tongue body, very thin coating or no coating at all — this is an extreme case, but if you meet it you must know how to handle it: the patient has qi deficiency and yin deficiency, dual qi-yin deficiency. When you see yin deficiency, the qi deficiency is actually hidden underneath; you must rescue the yin quickly while also tonifying qi, and only then can the patient recover.
Pulse. This formula’s pulse patterns are extremely varied. One especially famous senior expert, Zhu Jinzhong, was exceptionally skilled with Qing Shu Yi Qi Tang — it was his trump card too. He said the pulse is xu da er xian — empty, large and wiry: very large, but empty on pressure; wiriness is a sign of yin injury. This is mainly dual qi-yin deficiency — the person’s ascending and descending have lost control, turbid yin above and clear yang below. Others describe the pulse as floating, wiry, forceful and rapid. Li Dongyuan said the pulse is slow, but from our current perspective, with damp-heat predominating, most patients’ pulses beat fast; there are also those with especially heavy dampness whose pulses beat slowly — that exists too, but it’s not common.
Urine. Such patients’ urine is generally scanty and yellow, not clear and copious; some urinate frequently; some feel a burning sensation when urinating — if urination feels especially hot, that means the damp-heat is very heavy. Heavy damp-heat with some yin injury — that’s why the urine is yellow and burning.
Summary: who is this formula really for?
Putting all the diagnostic signs together, they come down to a few areas:
First, the emotional side — vexation, insomnia, sadness, low spirits; some women sink into a poor emotional state. Emotion is the foundation on which the spleen and stomach get injured.
Second, the spleen-stomach / digestive system — sticky, uncomfortable mouth; dry mouth (some want water, some don’t); poor appetite; abdominal distension after eating; then diarrhea — the whole digestive system is in disorder.
Third, water metabolism — easy, profuse sweating; easy fear of wind and cold; some people easily run a fever.
Fourth, body-surface sensations — chest stuffiness, easy fatigue, and joint pain — Li Dongyuan said the four limbs will have problems.
Fifth, urine — scanty, yellow, with a burning sensation.
💬 Note from Doctor Luo: Overall, all these symptoms tell us: first, upright qi is insufficient — injured spleen and stomach, insufficient yuan qi, dual qi-yin deficiency; the person is always in a state of insufficiency, exhausted, no strength all day; second, damp-heat is especially heavy — both dampness and heat severe, water metabolism disturbed, gastrointestinal system disturbed, all kinds of heat signs, always a restless, fiery side, always a yin-injuring side. If a person: has no strength, weak limbs, always in a deficient state; the body runs a bit hot, face flushed, vexed, profuse sweating; the head sometimes feels dizzy (dampness above); no appetite; the lower system is off — diarrhea, unformed stools, stools that smear the toilet bowl — with these symptoms, you can judge insufficient upright qi, heavy damp-heat inside, plus yin injury, and use this formula. No illness arrives by the textbook — saying “this is qi deficiency, that is yin deficiency” is far too simple. Most cases are complex, with each factor combined together.
Why do modern people get the chance to use this formula so often?
Think about it: are there many modern people with insufficient upright qi? More than the hairs on an ox. Are there many with insufficient upright qi, injured spleen and stomach, dual qi-yin deficiency? Far too many — busy every day, overwork injuring the spleen. Is the outside dampness heavy? Extremely heavy — especially in most regions of China. And when the weather is hot, and you also have damp-heat inside — so the rate at which this formula applies is especially high.
The treatment territory is even wider:
- Meniere’s disease (vertigo): you see a person with digestive problems, sticky stools, no strength all day, poor sleep, lots of sweating, a bit of dampness and damp-heat signs, insufficient upright qi, dual qi-yin injury — use this formula and it resolves immediately, the vertigo disappears;
- Trigeminal neuralgia: Senior Doctor Zhu Jinzhong had a trigeminal neuralgia case — he took the pulse and said “this is empty-large-wiry, dual qi-yin deficiency,” prescribed this formula, and once used, the trigeminal neuralgia was cured;
- And diarrhea, diabetes, low potassium and more — the treatment range is extremely wide.
💬 Note from Doctor Luo: The qi-tonifying formulas we discussed before generally develop in the “cold” direction — yang qi insufficiency, which is easy to adjust; once adjusted, it turns around, with Bu Zhong Yi Qi and the like. But Qing Shu Yi Qi Tang is another pattern entirely, not so simple: after a person is injured by summer-heat, qi and yin inside the body are both damaged, yet dampness is heavy and damp-heat is heavy — this is more complex. And this complex state is precisely the state of imbalance in most people. None of our bodies falls ill according to textbook or teaching-material categories — illness is usually long-term, built up from many factors stacking together. Everyone’s illness looks messy, with a pile of clues; normally we have to discriminate the pattern one item at a time. But Li Dongyuan’s formula recognizes it up front and adjusts everything at once. That’s why it’s a famous formula — the targeting is especially precise: once you identify this problem, a few doses usually turn things around.
Why a famous formula is a famous formula
One last word. A famous formula is a famous formula because its theory is especially clear and its effects especially good. With a formula like this, we must grit our teeth and learn it — especially friends practicing TCM, you must grit your teeth and learn it. Once such a formula is applied, the adjustment effect for patients is excellent; no long struggle needed — put down a few doses directly, and the problem is solved.
💬 Note from Doctor Luo: Earlier I explained the composition features of this formula, and today I’ve walked you through its key points of pattern discrimination — the core being: how to recognize damp-heat inside the body, and how insufficient upright qi allows damp-heat to remain, and how we adjust it. As you gradually master this set of symptoms, when you meet similar formulas and similar problems, you’ll have that feeling of “I’ve studied this, I can match it up.” Qing Shu Yi Qi Tang is one of the famous formulas Li Dongyuan left behind, well worth studying carefully.
(Compiled from Doctor Luo Dalun’s explanation of Doctor Li Dongyuan’s formulas; Qing Shu Yi Qi Tang comes from Pi Wei Lun (Treatise on the Spleen and Stomach).)