Library

Taiyang disease (Disease of the Taiyang channel) presents with a floating and tight pulse, absence of sweating, fever, and body pain. After eight or nine days, if the condition remains unresolved and the exterior syndrome persists, diaphoresis (inducing sweating to release the exterior) should be employed, primarily using Mahuang Tang (Ephedra Decoction). After taking the medicine, the symptoms may only slightly subside; the patient may feel irritable and experience blurred vision. In severe cases, epistaxis (nosebleed) will inevitably occur, and the disease will resolve through this bleeding. This occurs because the Yang Qi is excessively constrained.

Fever, absence of sweating, a floating and tight pulse, and body pain constitute the Mahuang Tang syndrome. If treatment is not administered promptly and the condition persists for eight or nine days without resolution, yet the exterior syndrome remains, diaphoresis is indicated, and Mahuang Tang is appropriate. If Wei Qi (Defensive Qi) is severely obstructed and the therapeutic effect cannot penetrate thoroughly, after taking the medicine, the illness may only slightly improve, and the patient may still feel restless and dizzy, failing to fully recover. In severe cases, due to the constraint of Wei Qi attempting to ascend but being blocked, epistaxis will inevitably occur, and the disease will only completely resolve through this bleeding. This happens because prolonged untreated illness leads to excessive constraint of Yang Qi.

A floating and tight pulse typically indicates body pain and should be treated by inducing sweating. However, if the pulse at the Chi position (cubital fossa/wrist area corresponding to Kidney/Yin) is slow, diaphoresis is contraindicated. How do we know this? Because Ying Qi (Nutritive Qi) is insufficient and Blood is scant. (Note: This refers to the pathway from Taiyang to Shaoyin). The Cun position (radial styloid process/wrist area corresponding to Lung/Yang) reflects Wei Qi, while the Chi position reflects Ying Qi. A slow pulse at the Chi position indicates insufficient Ying Qi, caused by deficiency of Liver and Spleen Yang leading to blood depletion. Sweating depletes the warming Qi within Ying Qi, potentially causing various complications such as collapse of Yang. Therefore, diaphoresis is contraindicated. The character "Ran" (Thus/Therefore) here carries the same meaning as in the *Nanjing* (Classic of Difficult Issues), serving to explain the reason.

In Taiyang disease, wind pathogen injury calls for Guizhi Tang (Cinnamon Twig Decoction), while cold pathogen injury calls for Mahuang Tang. For cases where both wind and cold are contracted simultaneously, the Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-Combined Decoction) was formulated to simultaneously harmonize Ying and Wei, expelling both wind and cold pathogens. Pulse diagnosis states: Wind injures Wei Qi, Cold injures Ying Qi. When both Ying and Wei are injured, diaphoresis is required; this is what is meant. If wind is predominant and cold is slight, a formula with two parts Guizhi Tang and one part Mahuang Tang is used. This still follows the principle of the half-combined method, merely adjusted slightly according to the specific pathology. Regarding cases with mild interior heat and light exterior cold, the Guizhi Mahuang Ge Ban Tang method is not suitable. Instead, two parts Guizhi Tang and one part Yuespi Tang (Yue Bi Decoction) should be used to gently diffuse exterior cold and lightly clear interior heat. This approach resembles the method of Da Qing Long Tang (Major Blue Dragon Decoction) but differs in principle, offering a more subtle efficacy. Thus, Guizhi Mahuang Ge Ban Tang succeeds the Guizhi and Mahuang formulas, while the combination of Guizhi Tang and Yuespi Tang precedes the Da Qing Long Tang formula.

Taiyang disease lasting eight or nine days may resemble malaria, with alternating fever and aversion to cold, where fever predominates over chills. The patient does not vomit, and bowel/bladder functions are relatively normal, with episodes occurring two or three times a day. If the pulse is floating and slow, it indicates the disease is about to heal. If the pulse is faint and there is aversion to cold, this indicates deficiency of both Yin and Yang, and diaphoresis, purgation, or emesis must not be used. If the face appears reddish, the disease has not resolved because the patient failed to produce even a slight sweat, leading to itching of the skin. Guizhi Mahuang Ge Ban Tang is indicated. ("Qing" 清 is interchangeable with "Qing" 圊, referring to defecation).

The description "resembling malaria" refers to the struggle between Ying Yin (Nutritive Yin) and Wei Yang (Defensive Yang). When Yang Qi is constrained internally, fever occurs; when Yin Qi is constrained centrally, aversion to cold occurs. Cold injuring Ying Qi causes Ying to desire release; wind injuring Wei Qi causes Wei to desire closure. Ying desires release but cannot achieve it, thus constricting Wei Qi and manifesting as cold; Wei desires closure but cannot achieve it, thus restraining Ying Blood and manifesting as heat. When Wei Qi declines and Ying Blood attempts to emerge externally, it constrains Wei Qi; when Ying Qi declines and Wei Qi attempts to retract internally, it restrains Ying Blood. This occurs because wind was contracted first, followed by cold; Ying desires release while Wei desires closure, resulting in mutual contention, hence the alternating chills and fever resembling malaria.

After eight or nine days of Taiyang disease, presenting like malaria with fever and chills, where fever exceeds chills, it indicates wind is greater than cold, with significant Wei injury and mild Ying injury. If the chills and fever do not occur frequently, it corresponds to the Guizhi-two-Mahuang-one syndrome described in the next chapter. If the patient neither vomits nor suffers constipation, the Middle Jiao Qi is unharmed. Episodes occurring two or three times a day indicate robust Zheng Qi (Upright Qi) frequently contending with pathogens. A faint and moderate pulse suggests pathogens are gradually receding, indicating impending recovery without need for treatment. If the pulse is faint and weak accompanied by aversion to cold, this indicates deficiency of both Wei Yang and Ying Yin. Ying deficiency leads to a faint pulse; Wei deficiency leads to aversion to cold (as explained by "This is Wu Yang Ye" - No Yang exists - in the next chapter). Due to deficiency, other methods like sweating, vomiting, or purging must not be used. If there is fever and a floating pulse, it corresponds to the Guizhi Yuespi syndrome in the next chapter. If there is no external aversion to cold but the face shows redness, it indicates Yang Qi is evaporating and attempting to resolve from the exterior, but is blocked by exterior cold constraint. If a slight sweat could be produced, Yang Qi would flow freely, and facial redness would disappear. Because Zheng Qi is deficient and unable to produce sweat, Yang Qi is constrained in the skin and pores, preventing free flow, thus causing itching. Guizhi Mahuang Ge Ban Tang is used to resolve this.

Ying and Wei are both injured. Across the preceding four chapters, there are three syndromes. The first chapter contains one syndrome with three variations, foreshadowing the content of the subsequent three chapters; the latter three chapters respectively follow up on and elaborate upon the first chapter.