One of the most fascinating aspects related to the environmental influence of disease pathology is the TCM concept of "spring warmth." First discussed in the Shang Han Bu Wang Lun (Supplement to What Has Been Lost From Discussion of Cold Damage), Guo Yong presents the concept of an external cold invasion during the winter in an individual with constitutional kidney yin deficiency.
When spring arrives, this lurking heat may be triggered by an external attack of wind-cold or wind-heat and/or irregularity of lifestyle. Fundamentally, this pattern results from an underlying yin deficiency and is triggered by patterns of heat from excess.
In the text Warm Pathogen Diseases: A Clinical Guide, by Guohui Liu, the author describes the treatment principles as: clear the interior heat directly, protect and enrich the yin, and provide an avenue for the interior heat to exit the body.
The fascinating issue of "spring warmth" is too complex to explore in this short column; however, I find this last clinical pearl offered by Guohui Liu to be extremely important, both metaphorically and clinically: "provide an avenue for the interior heat to exit the body." This idea has important implications for preparing patients for the hot summer months.
We can help our patients prepare by keeping three basic concepts in mind clinically:
- Heat damages yin
- Heat congeals blood
- Heat easily transforms into damp-heat
Heat Damages Yin
This concept is a common experience in the contemporary clinic. A large majority of patients suffer from underlying yin deficiency due to chronic stress, poor sleep and use of stimulants. While lifestyle adjustments and behavior change therapies are perhaps the most important aspect of treating yin deficiency, herbal medicine can play an important role in helping to bring the body back into balance.
Two formulas are important to consider: Liu Wei Di Huang Wan and Wu Zi Yan Zong Wan. I typically use these formulas in combination for patients who suffer from long-standing yin deficiency. The classic formula Liu Wei Di Huang Wan elegantly and gently drains as it supplements; and the unique formula Wu Zi Yan Zong Wan targets many important facets of treating yin, such as treating yin / yang in conjunction, supplanting blood and astringing / consolidating the jing.
If a patient presents with signs of deficiency heat along with yin deficiency, the combination of Zhi Bai Di Huang Wan and Wu Zi Yan Zong Wan can be used.
Heat Congeals Blood
Patients suffering from an underlying yin deficiency will in almost all cases show signs of blood deficiency. If this is not addressed prior to the summer months or if there are also inherent issues with concomitant heat, then blood stasis will subsequently manifest.
With patients suffering from yin deficiency presenting with blood deficiency / blood stasis, the following two formulas, used in combination, can be extremely effective: Ren Shen Yang Rong Tang and Tao Hong Si Wu Tang. This combination tonifies qi, nourishes and invigorates blood, nourishes yin, and assists yang.
I have also found it more clinically effective to improve blood deficiency signs before attempting to directly target yin deficiency signs, especially in patients who are not compliant with behavior change / lifestyle modifications to supplement yin deficiency.
Heat Transforms into Damp-Heat
In my experience, this is the most common issue encountered in the clinic. A combination of spleen qi deficiency and poor diet / lifestyle leads to accumulation of heat, easily transforming into the more recalcitrant condition of damp-heat. In these cases, Bao He Wan and Jian Pi Wan, along with lifestyle / dietary modifications, can provide significant relief and help slowly improve digestion.
In this scenario, consumption of organic apples and portion control can provide important support for the herbal medicines, helping gently and effectively clear heat without damaging the spleen.
The formula Kang Ning Wan (Curing Pills) can also be extremely helpful, and can be used as needed depending upon the severity of the digestive symptoms.
Clinical Takeaway
Regardless of the pattern presentation, clinicians should ponder and contemplate the concept of "providing an avenue for the heat to exit the body," and help patients cultivate behavior / lifestyle changes that support this concept. Herbal medicine alone is often not enough.
Does the patient need more work on diet? Does the patient need more work on cultivating important avenues for stress relief such as qi gong, tai chi, meditation, or walking in nature? All of these options help provide avenues for heat to exit the mind / body.
As the summer approaches keep it simple and consider the following when encountering patients: evaluate levels of yin, evaluate the potential for blood stasis, and evaluate if patients have avenues for heat and stress to "exit the body." Each of these concepts can be shifted with herbal medicine, nutrition and behavior / lifestyle changes.
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