🌿 Folk Prescriptions

In Traditional Chinese Medicine, heatstroke is caused by exposure to summer heat pathogen externally, with insufficient vital energy (zheng qi) as the internal predisposing factor. During summer, high temperatures and humidity prevail. If vital energy is deficient or excessive fatigue depletes body fluids and qi, the summer heat pathogen invades the body, causing illness—thus, heatstroke has a distinct seasonal pattern. Elderly people, long-term bedridden patients, postpartum women, newborns, and outdoor workers are particularly susceptible. Dr. Zhang Ping believes the basic treatment principle is rapid clearing of summer-heat and cooling, emphasizing speed.
TCM Treatment
Based on syndrome differentiation and individualized treatment, excellent results can be achieved.
Summer-Heat Invading Yangming: Sudden high fever, headache, dizziness, profuse sweating, thirst, yellow dry tongue coating, and forceful rapid pulse. This syndrome results from summer-heat injuring qi and excess heat in Yangming. Treatment focuses on clearing summer-heat and reducing fire. Modified Baihu Decoction: Raw gypsum 30g, Anemarrhena 10g, licorice 10g, reed root 30g, watermelon green rind 30g, rice 10g.
Summer-Heat Damaging Qi and Body Fluids: Fever, irritability, spontaneous sweating, thirst, fatigue, scanty tongue coating, and weak pulse. This syndrome results from summer-heat damaging both qi and body fluids. Treatment focuses on clearing summer-heat, generating body fluids, and replenishing qi. Modified Qingshu Yiqi Decoction: American ginseng 10g, dendrobium 10g, ophiopogon 10g, Coptis 6g, bamboo leaf 10g, lotus stem 10g, Anemarrhena 10g, licorice 10g, rice 10g, watermelon green rind 30g.
Body Fluids and Qi Depletion: Sudden drop in fever, uncontrollable sweating, restlessness, thirst, fatigue, and weak pulse. This syndrome results from severe depletion of qi and body fluids. Treatment focuses on replenishing qi, generating body fluids, and consolidating the essence. Modified Shengmai Decoction: Ginseng 10g, Ophiopogon 30g, Schisandra 10g, Dendrobium 10g, rice 10g, watermelon green rind 30g.
Summer-Heat Inducing Liver Wind: Fever, limb convulsions, clenched jaw, unconsciousness, and taut rapid pulse. This syndrome results from intense summer-heat stirring liver wind. Treatment focuses on clearing summer-heat, reducing fire, calming the liver, and extinguishing wind. Modified Lingjiao Gouteng Decoction: Antelope horn powder 1.5g (taken separately), Uncaria 10g, mulberry leaf 10g, Fritillaria 6g, fresh rehmannia 30g, chrysanthemum 10g, white peony 10g, licorice 10g.
In emergencies, Zixue Powder, Zhibao Pill, or An Gong Niu Huang Wan may be administered via nasogastric tube. Acupuncture with strong stimulation at points such as Renzhong and Neiguan may also be used.
Western Medicine Treatment
1. Prodromal and Mild Heatstroke: Patients should immediately leave the hot environment and rest in a cool, quiet place. Replenish cool, salt-containing beverages, and recovery usually occurs gradually. For mild heatstroke with signs of respiratory or circulatory failure, intravenous infusion of glucose saline is given. Central nervous system and circulatory stimulants may be used if necessary.
2. Severe Heatstroke: Immediate emergency intervention is required. The treatment principle is rapid reduction of elevated body temperature. Correct fluid, electrolyte, and acid-base imbalances, and actively prevent shock and cerebral edema.
Cooling Methods:
Physical Cooling: Place the patient in a room maintained at normal temperature (25°C). Apply ice packs to the head, armpits, and groin. Use cold water, ice water, or alcohol to wipe the body, and blow air with fans. In severe cases, submerge the patient’s entire body except the head in a 4°C water bath to cool the limbs and prevent peripheral circulatory stagnation. During initial physical cooling, cold stimulation may cause cutaneous vasoconstriction and muscle tremors, paradoxically impairing heat dissipation or even increasing heat production, raising body temperature. Thus, current practice favors combined drug and physical cooling.
Drug Cooling: The primary cooling agent currently used is chlorpromazine, which works through several mechanisms: controlling the hypothalamic thermoregulatory center; dilating peripheral blood vessels to accelerate heat loss; relaxing muscles, reducing tremors, and preventing excessive heat production; lowering cellular oxygen consumption, improving tolerance to hypoxia; and counteracting histamine effects to prevent shock.
Aspirin and similar drugs can be used synergistically with chlorpromazine.
During all cooling procedures, close monitoring of temperature, blood pressure, and cardiac status is essential. Once rectal temperature drops to around 38°C, cooling should be stopped immediately to avoid the risk of hypothermic collapse.
3. Prevention and Management of Complications: In elderly patients and those with cardiovascular disease, intravenous fluid replacement should not be too rapid. Patients with heart failure tendency should receive fast-acting digitalis agents early. Those with acute renal insufficiency must strictly limit intake of water and sodium, especially monitoring serum potassium levels. Patients with jaundice should receive large doses of vitamins B and C. Comatose patients are prone to aspiration pneumonia or secondary infections and may require prophylactic antibiotics.
In summary, heatstroke is preventable. By taking proper precautions, harm can be avoided.