Library

In the disease of cold damage (Shanghan), if a physician mistakenly employs purgation, followed by persistent diarrhea with undigested food in the stool and body pain, one must urgently treat the interior syndrome. After the interior is treated, if body pain persists but bowel movements are normal, one must urgently treat the exterior. To treat the interior, Si Ni Tang (Four Reversal Decoction) [see Taiyin Chapter 3] is appropriate; to treat the exterior, Guizhi Tang (Cinnamon Twig Decoction) [see Taiyang Chapter 5] is appropriate.

When exterior syndromes of cold damage are mistakenly purged, damaging the interior Yang, leading to persistent diarrhea with undigested food, this has evolved into spontaneous diarrhea characteristic of Taiyin syndrome, while the exterior symptom of body pain remains unresolved. This constitutes both exterior and interior involvement. However, urgent treatment of the interior is required, leaving no time for the exterior. After treating the interior, once diarrhea ceases and stools normalize, the exterior can then be treated. For persistent body pain, urgent treatment is necessary because unresolved exterior pathogens may cause interior Yin to stagnate again, generating cold. Therefore, urgent treatment of the interior with Si Ni Tang to warm the middle is indicated, and treatment of the exterior with Guizhi Tang to release the exterior is indicated.

Ma Huang Tang (Ephedra Decoction) is not used in treating cold damage when interior Yang is deficient, as excessive sweating is contraindicated. (This complements the chapter on Taiyin diarrhea with abdominal fullness: treating the exterior is equivalent to attacking the exterior, which is releasing the exterior.)

After sweating therapy, if body pain persists and the pulse is deep and slow, Gui Zhi Jia Shao Yao Sheng Jiang Ge Yi Ren Shen San Liang Xin Jia Tang (Guizhi Decoction with Added Peony, Ginger, One Person, Three Liang of Ginseng, New Formula) should be administered.

Sweating depletes the warming Qi within the blood, causing Yang deficiency and Liver Qi sinking, resulting in a deep and slow pulse. Stagnant meridians and suppressed Wind-Jade (Liver Wood) cause body pain. In Xin Jia Tang, Gan Cao (Licorice Root) tonifies Spleen essence; Gui Zhi (Cinnamon Twig) unblocks Liver Qi; Shao Yao (Peony Root) clears dryness of Wind-Jade; Sheng Jiang (Fresh Ginger) moves stasis in the meridians; and Ren Shen (Ginseng Root) tonifies Liver and Spleen Yang to warm Ying Blood and fill the meridians.

Ingredients: Gui Zhi (Three Liang), Gan Cao (Two Liang, honey-fried), Da Zao (Twelve Dates), Shao Yao (Four Liang), Sheng Jiang (Four Liang), Ren Shen (Three Liang).
This formula adds one Liang each of Shao Yao and Sheng Jiang, and three Liang of Ren Shen to Guizhi Tang, following the previous decoction method.

In Taiyang disease presenting as a Guizhi pattern, if a physician mistakenly uses purgation, causing persistent diarrhea and a rapid pulse indicating the exterior remains unresolved, and if wheezing and sweating occur, Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction) should be administered.

Taiyang Guizhi patterns have exterior pathogens without interior pathogens. Mistaken purgation damages Middle Qi, causing persistent diarrhea. Normally, warming the interior is indicated. However, if the pulse is rapid (Cu), it indicates the exterior is unresolved. Since the pathogen is in the meridians and unresolved, attacking the interior without releasing the exterior causes Exterior Yang to sink inward due to interior deficiency. Rejected by interior Yin and unable to descend, the binding pressure between exterior and interior results in a rapid pulse (characterized by frequent beats with occasional pauses). If wheezing and sweating occur, this is due to Stomach Qi rebelling upward obstructing Lung Qi (causing wheezing) and Lung stagnation generating heat that steams outward (causing sweating). Although there are interior signs resembling Si Ni patterns and exterior signs resembling Guizhi patterns, the heat is located in the chest and diaphragm, making both previous formulas unsuitable. Ge Gen Huang Lian Huang Qin Tang is indicated. Ge Gen (Kudzu Root) resolves Yangming stagnation; Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) clear Ministerial and Sovereign fire, restoring order to the chest and diaphragm. Only then can the cold in the middle and lower jiao be gradually addressed with warming. While Guizhi patterns typically use Guizhi to release the exterior, the presence of wheezing, sweating, and chest-diaphragmatic stagnation favors the acrid-cool nature of Ge Gen over the acrid-warm nature of Guizhi.