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Taiyang syndrome (Syndrome of the Taiyang Channel) exterior patterns should be treated with sweating methods and must not be treated with purgation.
If purgation is wrongly used, heat will accumulate internally and form Jie Xiong (Chest Binding). Or it may result in Xu Pi (Deficiency-type Epigastric Fullness), Ao Nao (Mental Restlessness), Chuan Man (Wheezing and Chest Distension), Fu Tong (Abdominal Pain), Xia Li Bu Zhi (Unremitting Diarrhea), Huang Fan (Jaundice), Jing Kuang (Palpitations and Mania), Ban Chu (Eruption of Macules), and various other heat transformation syndromes, leading to critical illness and death.
Yangming syndrome (Syndrome of the Yangming Channel) interior patterns should be treated with purgation and must not be treated with sweating.
If sweating is wrongly used, heat becomes severe, causing Jaundice, Palpitations and Mania, Eruption of Macules, Dao Wang (Delirium) with Wheezing, Men Luan (Chest Oppression and Confusion), leading to extreme critical illness and death.
When the pathogen is half in the exterior and half in the interior, He Jie (Harmonizing) is appropriate.
This means harmonizing and resolving both the exterior and interior.
Sweating, vomiting, and purgation must not be used; wrongful treatment will result in the aforementioned syndromes.
For pathogens located in the upper part, Yong Fa (Emesis) should be used.
This refers to pathology above the diaphragm, such as chest fullness with vomiting or dizziness, where the pulse at the Guan position is extremely tight; Gua Di San (Melon Seed Powder) should be used for emesis.
For pathogens located in the lower part, Xie Fa (Purgation) should be used.
This refers to heat accumulation in the Lower Jiao (Lower Burner); Cheng Qi Tang (Gut-Regulating Decoction) and Di Dang Tang (Blood-Crushing Decoction) types should be used for purgation, attacking according to the location of the disease.
In Shang Han (Cold Damage) with no sweating, where the exterior is diseased but the interior is harmonious, Ma Huang Tang (Ephedra Decoction) should be used for sweating, or Tian Shui San (Water and Heaven Powder) is also good.
Symptoms include body heat, aversion to cold, no sweating, and a floating, tight, and rapid pulse.
If the exterior pattern is unresolved, with the pathogen half entering the interior and half remaining in the exterior, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be administered. Alternatively, one dose each of Tian Shui San and Liang Ge San (Cool the Chest Powder) taken together is even better. If heat in both the exterior and interior is severe, Da Chai Hu Tang (Major Bupleurum Decoction) should be used for mild purgation; if more severe, Da Cheng Qi Tang (Major Gut-Regulating Decoction) should be used for purgation.
Although the exterior pattern has not ceased, if the interior pattern is already severe, failing to purge will allow exterior heat to enter deeper into the interior, making interior heat critically dangerous. It is appropriate to use Da Chai Hu Tang and Da Cheng Qi Tang for purgation to simultaneously remove heat from both the exterior and interior, thereby avoiding the scenario where only interior heat is purged, allowing exterior heat to re-enter the interior through deficiency after purgation, resulting in Jie Xiong and Pi syndromes.
If exterior heat is predominant and interior heat is slight, use one part Tian Shui San and half part Liang Ge San for harmonization.
Decoct half portion of Liang Ge San and mix with one portion of Tian Shui San. The same method applies to upper and lower conditions.
If interior heat is predominant and exterior heat is slight, and purgation is not yet indicated, use one part Liang Ge San and half part Tian Shui San for regulation. If the condition worsens, Xiao Cheng Qi Tang (Minor Gut-Regulating Decoction) should be used for purgation. If the exterior pattern has ceased and only interior patterns remain, indicating heat transmission to the interior, Tiao Wei Cheng Qi Tang (Regulate the Stomach Gut-Regulating Decoction) should be used for purgation, solely to clear interior heat. For all these purgable cases (referring to Da Chai Hu Tang and the three Cheng Qi decoctions), San Yi Cheng Qi Tang (Three-in-One Gut-Regulating Decoction) is generally suitable; it effectively produces potent results and prevents exterior heat from entering the interior to cause Jie Xiong and Pi diseases.
If sweating fails to resolve the disease, and subsequent purgable signs appear without other differing symptoms, Liang Ge San should generally be used for regulation to reduce heat, preventing critical danger from excessive heat. Apart from this, it far surpasses Xiao Chai Hu Tang; treat Liang Gan (Simultaneous Invasion of Exterior and Interior) similarly.
Regulate based on the severity of exterior and interior conditions. "Liang Gan" refers to simultaneous involvement of channels: Day 1 involves Taiyang and Shaoyin; Day 2 involves Yangming and Taiyin; Day 3 involves Shaoyang and Jueyin. These are the patterns of the first six channels.
For Shang Feng (Wind Strike) with spontaneous sweating, where the exterior is diseased but the interior is harmonious, Gui Zhi Tang (Cinnamon Twig Decoction) should be used to release the muscle layer.
No sweating indicates Shang Han; Gui Zhi Tang must not be administered.
Spontaneous sweating indicates Shang Feng; Ma Huang Tang must not be administered.
When the pathogen is half in the exterior and half in the interior (pulse felt in the muscle layer, half entering the interior), Bai Hu Tang (White Tiger Decoction) should be used for harmonization. If the disease is in the interior, the pulse should be deep; Da Cheng Qi Tang should be used for purgation.
Another method: Regardless of wind-cold or wind-heat/dampness, with or without sweating, if there are any purgable signs, or if neither exterior nor interior signs are obvious but the disease progresses daily, presenting only with Ling Long Liao Liao (Blurred Vision/Dull Eyes), or abdominal fullness and solid pain, or irritability and thirst, or delirium, or mania, or wheezing and distension, or extreme heat accumulation nearing death, Da Cheng Qi Tang should generally be used for purgation, or San Yi Cheng Qi Tang is even better.
In Shang Han, after heavy sweating, if sweating occurs but the disease does not resolve, and instead there is no sweating with a still floating pulse, Cang Zhu Bai Hu Tang (Atractylodes and White Tiger Decoction) should be used again to resolve the exterior.
Or in Summerheat stroke with spontaneous profuse sweating, weak pulse, headache, dry mouth, fatigue, irritability, occasional aversion to cold, or fear of sunlight, regardless of exterior or interior, Bai Hu Tang should generally be used; or if interior heat is severe, abdominal fullness, and a deep pulse indicating purgation is possible, Da Cheng Qi Tang or San Yi Cheng Qi Tang is especially excellent.
In Shang Han with extreme exterior heat, body pain, unbearable headache, dizziness, or vomiting, with slight interior heat, sweating, vomiting, and purgation are contraindicated. One might intend to use Xiao Chai Hu Tang, Tian Shui San, or Liang Ge San for harmonization, fearing they cannot reduce severe heat.
If exterior heat is severe and interior heat already exists, and releasing the exterior fails to open, Yang heat becomes violently severe, so sweating is unsuitable. If exterior heat is severe and vomiting or purgation is used, exterior heat will deeply invade due to deficiency, forming Jie Xiong and other syndromes, leading to extreme danger.
After major purgation, or repeated purgations, if heat remains severe and unsubsided, and the root qi is damaged and weak with a pulse that cannot fill out, intending to purge again risks immediate death from collapse; failing to purge risks death from extreme heat. Cold and warm herbs cannot reduce severe heat; or if damp-heat lingers internally causing unremitting diarrhea with unsubsided heat; or if post-purgation damp-heat causes unremitting diarrhea with unsubsided heat, weak pulse, and deficient qi, precluding further purgation; or if various damp-heat accumulations cause red, scanty, painful urination, loose stools, frequent urgent defecation, inevitably developing into Dysentery, Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) should generally be used to resolve it.
Or if interior heat is extremely severe, fearing Cheng Qi Tang cannot reduce it; or if heat persists after purgation; or if heat accumulates deeply internally, causing extreme Yang Jue (Reversal Cold), leading to Yang Qi stagnation and failure to circulate to the body surface and limbs, resulting in whole-body coldness (or blueness), unbearable pain, neck and back stiffness, red eyes and eye pain, dizziness and confusion, dry or painful throat, thirst with empty sweating, vomiting and diarrhea, abdominal fullness and solid pain, mental distress and oppression, rapid breathing, and Zheng Sheng (Confused Speech).
Yu refers to stagnation and blockage. Zheng refers to speech; the voice is turbid, evil, and unclear, indicating heat is excessively severe, causing speech disorder and lack of clarity. Folklore wrongly transmits this as extreme cold and Yin toxicity, which is a serious error.
The pulse should be rapid and frequent because extreme heat accumulation impedes the pulse vessels, potentially causing a deep, fine pulse near extinction. Laypeople do not understand the principles of creation and wrongly claim it is transmission to extreme cold and Yin toxicity; or initially suffering from violent Yang heat but presenting with these signs.
To distinguish Yin and Yang syndromes in Shang Han: Pathogenic heat in the exterior and Fu organ disease is Yang; pathogenic heat in the interior and Zang organ disease is Yin. Folklore wrongly discusses differences between cold/heat and Yin/Yang syndromes, having been mistaken for a long time. Moreover, *Su Wen* (Basic Questions) directly calls Shang Han "Re Bing" (Heat Disease), certainly not cold. The three chapters are named *Re Lun* (Discussion on Heat), *Ci Re Pian* (Chapter on Acupuncture for Heat), and *Ping Re Bing Pian* (Chapter on Evaluating Heat Diseases), explicitly stating heat throughout, with no mention of cold logic. Combining *Su Wen* and *Ling Shu* (Spiritual Pivot) theories on Yun Qi (Six Qi) and creation clearly shows it is Heat Disease, not cold. Cold diseases exist, but they are not referred to as sweating diseases. Creation’s generation of sweat is the work of Yang heat Qi, not Yin cold. Observing that all things produce fluid when heat reaches its peak makes this clear. The Classics state: "All heat diseases belong to the category of Shang Han." Also: "When humans are injured by cold, it becomes a heat disease." However, internal Yin cold belongs only to miscellaneous diseases and never becomes a sweating disease. Furthermore, disease laws state: Body heat indicates heat in the exterior; desire to drink water indicates heat in the interior. In Shang Han sweating diseases, it is unheard of to have a cool body throughout, no thirst, yellow-free urine, and non-rapid pulse. Although Zhang Zhongjing used hot medicines like Si Ni Tang (Frigid Extremities Decoction), Ginger, and Aconite, these were to treat the root. If the interior was harmonious but cold medicine was used for purgation too early; or if exterior heat had not entered the interior but cold purgation caused unremitting diarrhea; or if there was exterior heat and interior cold with spontaneous diarrhea, urgently use Si Ni Tang to attack the interior. Once diarrhea stops and the interior harmonizes, urgently resolve the exterior. Thus, after Si Ni Tang patterns in Zhang Zhongjing’s work, there is discussion of using Cheng Qi to purge heat. Therefore, Shang Han sweating diseases are directly called Heat Disease in the Classics, with no doubt about cold. The Three Yin patterns mentioned in the Classics refer to pathogenic heat in the Zang organs and interior, which are Yin, requiring heat purgation. The distinction between Yin and Yang in Shang Han is: If not exterior heat requiring sweating, purging leads to death; if interior heat requiring purging, sweating leads to death. Thus Zhang Zhongjing said: "Gui Zhi Tang swallowed, Yang excess leads to death; Cheng Qi enters the stomach, Yin solidity leads to demise." The key to life and death lies in an instant; caring for the patient leaves no time to count days. This is the interlacing of Yin/Yang and Deficiency/Excess; signs are subtle; opposing treatments like sweating/vomiting/purging bring rapid disaster. Physicians with shallow knowledge, ignorant of the disease source, err from the start, causing patient death. Merely saying "heat in exterior -> sweat; heat in interior -> purge; heat in upper -> vomit; heat in lower -> drain; heat half-exterior/half-interior -> harmonize" does not distinguish the deficiency/excess of cold/heat/Yin/Yang or the signs of Yin/Yang sweating diseases. Moreover, Zhu Fengyi stated that Yin Du (Yin Toxicity) pulse is rapid, reaching seven or eight beats per breath, too fast to count, indicating deep Yin Du. A pulse faster than eight beats per breath, too rapid to count, is precisely the pulse of extreme deep Yang heat, not Yin cold. All folk所称 Yin Du syndromes, verified by *Su Wen*’s creation theory, are actually syndromes of extreme Yang heat亢盛 (Hyperactivity), with heat accumulating deeply inside while the body surface appears similar to Yin cold. The Classic says: "Excess causes harm, succession brings control." This refers to the Way of the Five Elements: when things exceed extremes, they seemingly counteract themselves, known as Jian Hua (Combined Transformation). For example, extreme heat produces fluids; heating metal until extreme seems like water. This is Fire transforming to resemble Water; the same applies to all Five Elements. Thus, Liver heat excess tears; Heart heat excess sweat; Spleen heat excess saliva; Lung heat excess mucus; Kidney heat excess spit. Now, the pathogenic Qi causing sweating in Shang Han is Yang extremity stagnation turning to recovery, i.e., steaming heat producing sweat. Like weather: extreme Yang heat drought turns to rain after negation reaches extreme. To rain requires郁热 (Stagnant Heat); sunny weather feels cool. Human coolness means disease resolves; heat presence means disease persists. So cold diseases are cold diseases, not this sweating Qi. Although cold belongs to Yin Water, the principle of mutual generation of Yin/Yang Qi and Fluids in heaven and earth dictates that Cold’s transformation cannot regenerate Yin Water. Thus ancient sages said: "Yin is born from Yang, Yang is born from Yin; Fluid is born from Qi, Qi is born from Fluid." Also: "Accumulated Fluid generates Qi, accumulated Qi generates Fluid." Also: "Harmonious Qi generates like Fluid." Since Qi is Yang, all human fluids are born from Yang heat Qi. When heavenly Yang heat is extreme, all things are moist; in winter cold, all things are dry. Thus, since it is the pathogenic Qi of sweating, it is fundamentally heat, not cold, clearly. The Classic also says: "All Shang Han becoming Wen Bing (Warm Diseases) are Wen Bing before Summer Solstice, and Shu Bing (Summerheat Diseases) after Summer Solstice." Shu and sweat both originate here. It says pathogenic heat exits completely with sweat and the disease heals. Also: "Overeating, sweat comes from Stomach. Fright stealing essence, sweat comes from Heart. Carrying heavy loads walking far, sweat comes from Kidney. Running fast and fearing, sweat comes from Liver. Shaking body working hard, sweat comes from Spleen." All these are agitation and labor causing Yang heat to produce sweat; how can one wrongly say the sweating disease is Yin cold? Current folk doctors, not understanding Yin/Yang transformation, wrongly take "Yang governs life, Yin governs death" to mean nurturing Yang heat, not knowing this refers to post-birth manifestation as Yang, Yang births Yin, so life is the path to death. After death, hidden as Yin, Yin births Yang, so death is the path to life. This is the ancients' discussion on the Yin/Yang of life/death, existence/non-existence, movement/stillness, hidden/appearance, not cold/heat Yin/Yang. Folklore also wrongly claims Immortal Scriptures say "Pure Yang ascends to become immortal, Pure Yang dies to become ghost," thus wanting to nurture Yang heat, not knowing this uses Yang to govern emptiness/spirit as Yang, Yin to govern form as form. It says good cultivators harmonize Yin/Yang, refine Yang Spirit to ascend, discard Yin body, so Pure Yang Spirit becomes immortal; those不懂道 (not understanding the Way) fail to harmonize cold/heat, causing Yin/Yang conflict, exhausting Yang Spirit, leaving only Yin shell, wandering souls become ghosts. This is the cultivation school's Yin/Yang of Form/Spirit, not the medical school's Yin/Yang of Cold/Heat. Folklore also wrongly claims *I Ching* (Book of Changes) honors Yang as noble, beautiful, good, strong, clear, correct, and Yin opposes this, thus wanting only to nurture Yang heat, not knowing *I Ching* images discuss Yin/Yang substance/function as teaching, not one-body cold/heat Yin/Yang. Thus Yang moves and commands, Yin follows and harmonizes; Yin harmonizing leads to Yin/Yang peace and return to goodness, not specifically defining Yang as heat. Moreover, Confucius said: Qian is Heaven, Circle, Ruler, Father, Jade, Metal, Cold, Ice. Then Qian is Pure Yang. Does this mean heat? This is not specifically taking ice/cold as Yang, but taking the vigor, order, clarity, and strength of ice/cold as the image of Qian’s vigor. Regarding Cold/Heat trigrams: Kan is Middle Son, Lesser Yang trigram, i.e., Ice/Cold; Li is Middle Daughter, Lesser Yin trigram, i.e., Fire/Heat. Kan/Li Water/Fire are husband/wife; *I Ching* takes Yang-strong Kan Water Cold as Husband, and Yin-soft Li Fire Heat as Wife, not taking heat as Yang-strong and cold as Yin-soft. Thus *I Ching* discussing Yin/Yang merely clarifies object images, not *Su Wen*’s discussion of disease cold/heat Yin/Yang Qi. If one says Qian is cold, it is not taking Qian Yang as cold, but taking the chilling, clear, and orderly nature of cold to resemble Qian’s Way. Folklore also wrongly claims humans are warm when alive and cold when dead, and although sick people with heat haven't died, those dying must turn from heat to cold before death. Thus claiming Yang is life, Yin is death. Using this to exclusively nurture Yang heat, not knowing within the body, Cold, Heat, Dryness, Dampness, Wind, Fire (Six Qi) are unified. Rain stopping brings peace; rise and fall cause disease. The constant of peace is appropriate warmth and coolness, its Yang-harmonious Qi, as folk say human body is warm. Winter cold closes pores, body should be warm; Summer heat opens pores, much sweat, body should be slightly cool. Opposition is disease, excess and deficit are also disease. Internal Zang-Fu Yin division serves as root,固守 (firmly guarding) Yang-harmonious Qi, only being warm constitutes peace. Only Zang-Fu Qi, following Five Elements resting/imprisoned/prosperous/strong/dead times and positions, has slight deficiency/excess variation; this natural deficiency/excess is the Way of Nature, not disease. Winter Kidney Water Yin arrives and is cold; combined with heavenly cold closing pores, Yang Qi stores and guards internally, achieving balance, handling internal/external cold. Summer Heart Fire Yang prospers and is hot; combined with heavenly heat opening pores, Yang heat scatters externally, achieving balance, handling internal/external heat. All things are like this. This is the great principle of Yin/Yang obstruction/recovery creation, nothing greater than this. Although Autumn/Winter obstruction occurs because Lung/Kidney Yin dominates and finds its place, so health prevails and illness is light; Spring/Summer recovery occurs because Liver/Heart Yang dominates, so weakness and illness prevail, and if heat stagnates, Yang scatters, so illness is severe with many deaths. Also geography elevation, four seasons cold/heat/warm/cool, safety/lifespan illness are same. Thus Classic says: "Where Yin Essence is offered, people live long; where Yang Essence is offered, people die young." Also *Immortal Scripture · West Mountain Record* says: "Healthy people sigh four seasons, meaning Triple Burner Ministerial Fire is never insufficient; Eight Festivals must not blow, meaning Kidney Yin rarely achieves fullness." Thus how can one not understand Yin/Yang deficiency/excess and only want to nurture Yang heat? All diseases leading to death, if Yang-harmonious Qi is absent, remain only Yin-damp form, not cold what else? Laypeople do not know extreme heat accumulates internally, Yang heat cannot circulate to limbs/body surface, causing limb reversal cold, leading to body cold, fine/micro pulse, then death; extreme heat accumulation, Qi/Blood blocked, face/body blue, this is deep heat accumulation. Thus Zhang Zhongjing said Shang Han extreme heat failing to purge leads to Jue (Reversal); deep Jue means deep heat; slight Jue means slight heat. Thus extreme heat death involves body cold, micro pulse, leading to extinction. Laypeople don't understand this, wrongly saying "Yang present = life, Yang gone = death," or "Yang heat transforms to Yin cold = death," thus wanting to nurture Yang heat,反而 (instead) causing residual Yin sudden extinction, Yang Qi later exhaustion and death is not few. Lay doctors not deeply understanding creation wrongly think Shang Han bad momentum, Yang momentum violently severe causing deep heat accumulation, body cold reversal cold, limbs no longer warm, directly as extreme cold Yin Jue, contrasting Yang Jue; and exterior/interior heat both severe without internal heat accumulation as Yang Du (Yang Toxicity), pairing Yin Du, dividing into cold/heat Yin/Yang different syndromes. Not knowing Shang Han sweating disease is Heat Disease, truly having no Yin Du or Yin Jue. Alas! Disease root is extreme heat, heat蕴藏 (accumulates) in interior, Yang Qi sinks, causing reversal cold, body cold or blue, micro pulse, wrongly treating as extreme cold and urgently rescuing Yang inside/outside,反而招致 (instead inviting) violence, thus wrongly declaring inevitable death. Occasionally strong people, originally not weak, with heat stagnation, or weak people, accidentally hit by acrid-sweet-hot dispersing meds, pores/Qi open, stagnant heat releases with sweat and heals,遂以为 (thus considering) inevitable death disease saved to life,反而恨 (instead regretting) past deaths,救助 (rescuing) Yang insufficient, thus arguing mutually. Seeing only heat accumulation internal binding reversal cold, or non-reversal, early warming, no cold-cool meds, fearing Yin Du/Yin Syndrome death. Lay doctors treating Shang Han, misleading many, none exceeds this. Students, just use *Su Wen* Yun Qi natural creation principles, trace root/source, then clearly visible. And follow methods to save people, do not be confused by public words. Thus Classic says: "Carefully master Yin/Yang, do not consult masses." Also: "Know reversal and compliance, act correctly without asking, this is the Way."
If Liang Gan severity is high, generally use Jie Du plus Da Cheng Qi Tang for purgation. If heat doesn't recede, purge again. Although ancients all said, three purges with heat not receding means death. There are also cases following method purging four or five times, stool one or two movements, heat finally receding and surviving, avoiding death from not purging heat. After purging, heat slightly recedes but not healed, Huang Lian Jie Du Tang regulates. Or slight heat not removed, Liang Ge San regulates. Or missed purging extreme heat, causing body cold, micro pulse, coma nearing death, urgent purging causes residual Yin sudden extinction death, as Yang Qi later exhausts; not purging also death, use Liang Ge San or Huang Lian Jie Du Tang to nourish Yin and retreat Yang, heat gradually dissipates, chest/heart warms, pulse gradually returns. Until pulse returns and is forceful, then San Yi Cheng Qi Tang can be used for purgation, or Jie Du plus Da Cheng Qi Tang is especially good. After purging, slight heat unresolved, Liang Ge San regulates. After recovery, usually take anti-heat meds, avoid pro-heat foods.