Library

Pang stated: There are no combined diseases (He Bing) involving only the three Yin meridians. There are fourteen types of combined diseases involving the three Yang meridians. When the three Yin and three Yang meridians are simultaneously affected, it is called Liang Gan (Double Contraction). Guo Yong stated: The fourteen types of combined diseases have already been listed in the chapters on the three Yang meridians. They are re-listed below for convenience of reference and easier understanding through cross-referencing, thereby avoiding errors.

Zhang Zhongjing stated: In cases where the Taiyang (Greater Yang) and Yangming (Yang Brightness) meridians present with a combined disease, spontaneous diarrhea will inevitably occur. Gegen Tang (Kudzu Decoction) is the primary treatment.

He further stated: In cases where the Taiyang and Yangming meridians present with a combined disease, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang (Kudzu Decoction with Pinellia) is the primary treatment.

He further stated: In cases where the Taiyang and Yangming meridians present with a combined disease, characterized by wheezing and chest fullness, purgation (Xia Fa) is contraindicated. Mahuang Tang (Ephedra Decoction) is appropriate.

Zhang Zhongjing asked: What is the cause of acquiring a Yangming disease? The answer is: If a patient suffering from a Taiyang disease undergoes sweating therapy, purgation, or diuresis, their body fluids (Jin Ye) are depleted. This leads to dryness in the Stomach, causing the condition to transform into a Yangming disease. If the patient fails to defecate and experiences difficulty in bowel movements, this constitutes a Yangming disease. Guo Yong stated: If there are no symptoms of the Taiyang meridian, Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) is appropriate. The method of transformation (Zhuan Shu) differs slightly from that of combined disease. For instance, in a Taiyang-Yangming combined disease, one must resolve the pathogenic factors of both meridians; therefore, Zhang Zhongjing did not discard Gegen Tang and Mahuang Tang. However, if the condition has transformed into a Yangming disease, one may wait briefly for the Taiyang symptoms to subside, then use Tiaowei Chengqi Tang to specifically attack the Yangming pathology, achieving two goals with one action. This is because the Taiyang aspect represents past pathology, which wanes on that day, while the Yangming aspect represents emerging pathology, which peaks on that day.

He further stated: In Er Yang Bing Bing (Concurrent Disease of Two Yangs), when the Taiyang symptoms have ceased, but tidal fever (Chao Re), sweating of the hands and feet, difficulty in bowel movements, and delirium (Chan Yu) are present, purgation will lead to recovery. Dachengqi Tang (Major Order the Qi Decoction) is appropriate. Zhu stated: If Taiyang symptoms have not ceased, purgation is contraindicated. Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) should be used to induce slight sweating. Guo Yong stated: If Taiyang symptoms have not ceased, it is appropriate to wait another day. If they still persist, follow Zhu's method.

He further stated: In Er Yang Bing Bing, when the Taiyang disease was first contracted, sweating therapy was administered, but the sweat was not thorough. Consequently, the pathology transferred to the Yangming meridian. Subsequently, the patient exhibits slight spontaneous sweating and aversion to cold has ceased. If Taiyang symptoms have not yet ceased, purgation is contraindicated; using it would be an adverse reaction. In such cases, slight sweating should be induced. If the patient's face is persistently red, this indicates Yang Qi stagnation at the exterior. It should be treated with resolution and fumigation (or steaming). If sweating was not thorough, mere insufficiency does not suffice. Yang Qi stagnates and cannot vent. Although sweating should occur, it does not. The patient becomes restless and irritable, unable to pinpoint the pain location, which shifts between the abdomen and limbs, and cannot be elicited by pressure. The patient suffers from shortness of breath and can only sit upright. This is due to incomplete sweating. Re-inducing sweating will lead to recovery. How do we know the sweating was incomplete? We know it from the choppy pulse (Se Mai). Guo Yong stated: Guizhi Mahuang Ge Ban Tang is appropriate.

Question: How to distinguish between Taiyang-Yangming He Bing (Combined Disease) and Bing Bing (Concurrent Disease)? Zhu stated: A pulse that is floating, large, and long, accompanied by headache, lower back pain, muscle heat, dry nose, and eye pain, indicates He Bing. If, upon initial contraction of Taiyang disease, sweating therapy was administered but was not thorough, leading to transfer to Yangming, followed by slight spontaneous sweating and absence of aversion to cold, this indicates Bing Bing. Guo Yong stated: In He Bing, a floating, large, and long pulse does not necessarily imply aversion to cold. If the pulse is floating, tight, and long, with no sweating, aversion to cold should be present. Both conditions are appropriate for Guizhi Mahuang Ge Ban Tang. If there are indications for purgation, the previous methods should be used.

Zhang Zhongjing stated: In Taiyang-Shaoyang Bing Bing (Concurrent Disease of Taiyang and Shaoyang), presenting with stiffness and pain in the head and neck, dizziness or vertigo, occasional sensation similar to Jie Xiong (Chest Binding), and epigastric hardness and fullness, acupuncture at the first interspace of the Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) points is indicated. Sweating therapy must be strictly avoided. Inducing sweating will lead to delirium and a wiry pulse (Xian Mai). If delirium persists after five to six days, Qimen (LR14) should be needled. Guo Yong stated: Zhang Zhongjing stated that Shaoyang should not be treated with sweating; thus, concurrent disease also prohibits sweating.

He further stated: In Taiyang-Shaoyang Bing Bing, presenting with epigastric hardness, stiff neck, and dizziness, acupuncture at Dazhui, Feishu, and Ganshu is indicated. Purgation must strictly be avoided. Guo Yong stated: Zhang Zhongjing said: If Taiyang disease transfers to Shaoyang and the pulse is deep and slow, Xiaochaihu Tang (Minor Bupleurum Decoction) is given. Pang stated: If the pulse is tight, Xiaochaihu Tang with added Oyster Shell (Muli) is used. Generally, Shaoyang diseases are best treated with harmonization, making Xiaochaihu Tang appropriate. Harmonizing Taiyang disease also suits its use.

He further stated: In Taiyang-Shaoyang Bing Bing, if Taiyang disease remains unresolved and transfers to Shaoyang, presenting with hardness and fullness in the hypochondrium, dry retching, inability to eat, and alternating chills and fever, emesis and purgation are not yet applicable. If the pulse is deep and tight, Xiaochaihu Tang is given. Pang stated: If the pulse is tight, Xiaochaihu Tang with added Cinnamon Twig (Guizhi) is used. For hardness and fullness in the hypochondrium, add Oyster Shell (Muli).

He further stated: In Yangming-Shaoyang He Bing, diarrhea will inevitably occur. If the pulse is "not negative" (Fu), it is a favorable prognosis. If "negative," it is unfavorable. Mutual overcoming and attacking is termed "Fu." Guo Yong stated: Lizhong Tang (Center Regulating Decoction) is appropriate. If diarrhea is accompanied by cold extremities (Jue), Sini Tang (Four Reversal Decoction) is appropriate. A pulse that is not wiry indicates favorability. A wiry pulse indicates that Yangming Earth is being overcome (by Shaoyang Wood). Urgent drainage of Qiuxu (GB40) and Yanglingquan (GB34) is needed to drain Shaoyang Wood. Urgent moxibustion of Zusanli (ST36) is needed to tonify Yangming Earth.

Zhang Zhongjing stated: In San Yang He Bing (Combined Disease of Three Yangs), presenting with abdominal fullness, heaviness of the body, difficulty in turning over, numbness of the mouth (Kou Bu Ren), facial grease, and delirium. If purgation is used, sweating on the forehead and cold extremities will result. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is the primary treatment.

He further stated: In San Yang He Bing, the pulse is floating and large, prominent at the Guan position above. The patient desires sleep and sweats when closing the eyes. Pang stated: The absence of a wiry description implies it is hidden within the large and long qualities. Chang stated: Guizhi Chaihu Ge Ban Tang (Guizhi and Bupleurum Half-Dose Decoction) can be used. Guo Yong stated: This is Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).

Question: Zhang Zhongjing stated that originally suffering from Taiyang disease, due to physician-induced purgation, resulting in abdominal fullness and intermittent pain, transferring to Taiyin. Is this Liang Gan (Double Contraction) or He Bing (Combined Disease)? Guo Yong stated: No. Although He Bing may involve transformation, it fundamentally involves simultaneous onset of two Yang meridians. Liang Gan involves simultaneous disease of both interior and exterior, Yin and Yang. The Nan Jing states: The Chi pulse of a person is like the root of a tree. Even if branches and leaves wither, the root will regenerate. In Liang Gan, both root and leaves wither, and regeneration is impossible. He Bing involving Taiyang and Taiyin, though named one Yin and one Yang, does not actually involve meridians that are exterior-interior pairs, but rather mutually generating and rescuing relationships. For example, if Taiyang is diseased, Shaoyin is not; if Taiyin is diseased, Yangming is not. This resembles withered branches and leaves while the root remains alive. Thus, it is not considered Liang Gan. Moreover, it is not due to pathogenic transmission, but physician error in purgation, moving Taiyang pathology into Taiyin. It is clearly not a simultaneous disease of two meridians. Therefore, Zhang Zhongjing uses Guizhi Jia Shaoyao Tang (Guizhi Decoction with Added Peony Root) and Guizhi Jia Dahuang Tang (Guizhi Decoction with Added Rhubarb).