This summer, a somewhat new clinical presentation was commonplace in my clinic and I received many questions from patients concerning this “new” disorder: summer SAD. Summer seasonal affective disorder was in the daily news this past summer, as numerous areas of the country experienced oppressive heatwaves.
This was interesting because seasonal affective disorder is most commonly associated with the winter months, manifesting symptoms such as sadness, reduced feelings of pleasure, oversleeping, overeating, and overall sluggishness.
Summer SAD has some unique features compared with winter SAD. While both conditions share the symptoms of sadness and overall malaise, summer SAD presents with the symptoms of lowered appetite and insomnia – the opposite of winter SAD.
Living most of my life in the hot and humid climates of Louisiana and Texas, I am very familiar with extended periods of heat and how this environment can affect mood and overall health. This is not a mysterious phenomenon. Traditional Chinese medicine has always acknowledged the importance of the seasons and adapting behavior, diet and medicine in harmony with the seasons. In this article, let’s focus on the unique symptoms of lowered appetite and insomnia in summer SAD cases I treated; and discuss options for targeting these presentations with herbal medicine.
Summer SAD Symptom: Sadness & Reduced Appetite
In the majority of cases of sadness and depression with reduced appetite I saw during the hot summer months, the underlying patterns of liver depression qi stagnation and spleen qi deficiency played a significant role. I rarely saw cases of strictly liver depression or strictly spleen qi deficiency. In most cases, these two patterns cross-pollinated and created a negative feedback loop – a cloudy clinical atmosphere wherein it can be hard to tell which pattern came first or is more predominant.
Patients often described how they felt “imprisoned” during the summer months and stayed inside, often avoiding social situations, which created significant frustration and anger. If the spleen is not strong in its activity, the liver depression will eventually damage the spleen, resulting in poor appetite and potentially blood deficiency / blood stasis.
Herbal Formulas That Help
Xiao Yao San: This classic formula soothes the liver qi, moves the liver blood, harmonizes the liver and spleen, tonifies the spleen qi, and tonifies blood. I have used this formula extensively in patients who dread the summer months and suffer from anger or frustration at being limited in what they can experience.
I tend to use the modified formula Jia Wei Xiao Yao San, which adds the herbs zhi zi and mu dan pi to clear heat, which may accumulate due to qi stagnation or is present prior to the liver / spleen disharmony. The pulse is typically rapid and wiry, and the tongue is typically red with a swollen body, particularly swollen sides in the liver area.
Shu Gan Wan: This formula soothes the liver qi, moves liver blood, cools liver heat, harmonizes the liver and spleen, descends the stomach qi, and relieves pain. This is a phenomenally effective modern patent medicine that strongly targets both liver and stomach qi, making it particularly effective in summer SAD cases characterized by sadness and reduced appetite.
I tend to use this modern patent medicine in cases in which the patient describes vague stomach discomfort along with the reduced appetite and other symptoms connected to liver depression qi stagnation, such as anger, frustration and depression. The pulse is typically fast and wiry, and the tongue can be red and swollen with engorged sublingual veins; however, it can also present as normal.
Summer SAD Symptom: Sadness With Insomnia
This unique aspect of summer SAD is not that strange, in my opinion. It is well-known that quality of sleep declines in hot / humid temperatures. During the hot summer months, patients perspire more and according to TCM, “Sweat is the fluid of the heart.” Excessive sweating can easily lead to qi deficiency patterns, as well as blood deficiency patterns.
Most often these two patterns occur in conjunction, much like the aforementioned liver / spleen disharmony pattern. Therefore, it is extremely common to see liver depression qi stagnation linked to spleen qi deficiency and heart blood deficiency. These three patterns are deeply intertwined in the majority of cases of summer SAD I have treated.
Gui Pi Wan: This is a classic formula that calms the shen, tonifies spleen and heart qi, and nourishes heart blood.
One key underlying cause of spleen qi deficiency with heart blood deficiency is traditionally considered to be obsessive thinking and overuse of the mind. I find that patients who dread the summer months tend to obsess on the inevitable arrival of the summer. This can cause obsessive brooding, leading to sadness and the pattern complex Gui Pi Wan is designed to treat.
The pulse is typically weak or thready and the tongue is typically pale and swollen, but can often be regular.
Herbal Formulas That Help
Suan Zao Ren Tang: This formula calms shen, nourishes heart and liver blood, nourishes yin, clears deficiency heat, and invigorates blood. I use this formula extensively for insomnia that occurs during the summer months. It tends to clear heat which may be accumulating during the summer season, and also protects the yin, which may be damaged by excessive heat exposure.
Combining Suan Zao Ren Tang with Jia Wei Xiao Yao Wan is extremely effective for cases of summer SAD with the underlying mechanisms of liver / spleen disharmony with heart blood deficiency with heat (which may be excess or deficient).
A Few Final Words...
It is also important for clinicians to remember to counsel patients on harmonizing the diet for the summer season, including easy-to-digest, cooling foods; as well as appropriate hydration strategies The summer season does not have to be a time of dread; it can and should be a time of vibrant celebrations with the help of traditional Chinese medicine.
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