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If a patient with Taiyang disease (Cold Damage) presents with a knotted (Jie) or intermittent (Dai) pulse and palpitations, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) is the primary treatment.
Cold pathogen damages the Heart Master (Heart), causing the Shen (Spirit) to be unsettled, resulting in palpitations; the Heart fails to govern the vessels, losing its normal rhythm, resulting in knotted or intermittent pulses. Both Jie and Dai are Yin pulses. The appearance of such pulses in Taiyang disease constitutes "Yang syndrome presenting with Yin pulse," which indicates a fatal prognosis. Unwilling to stand by idly, I have tentatively formulated Zhi Gan Cao Tang to attempt to salvage the condition from its advanced stage. This is akin to gathering remaining embers and making a last stand behind the city walls; it is still better than waiting passively for death?

Zhi Gan Cao Tang (Honey-Fried Licorice Decoction):
Gancao (Licoriza Radix et Rhizoma Praeparatum cum Melle, four liang, honey-fried) Guizhi (Cinnamomi Ramulus) Shengjiang (Zingiberis Rhizoma Recens, each three liang) Maidong (Ophiopogonis Radix, half sheng) Suanzaoren (Ziziphi Spinosae Semen, half sheng; the old editions using Mahuang Ren/Cannabis Seed are erroneous) Renshen (Ginseng Radix) Ejiao (Asini Corii Colla, each two liang) Dazao (Jujubae Fructus, thirty pieces) Shengdihuang (Rehmanniae Radix, one jin).

Take the above nine herbs. Add seven sheng of wine and eight sheng of water. First decoct the first eight herbs until three sheng remain. Remove the dregs, add Ejiao, warm the mixture, and take one sheng per dose, three times daily.

Among the 113 formulas, none use Dihuang (Rehmanniae Radix) or Maidong (Ophiopogonis Radix); these may have been appended by Wang Shuhe. However, since these two herbs are recorded in *Shennong Bencao Jing* as premier Yin-nourishing agents, they were likely excluded from this specific text due to the focus on Cold Damage. Perhaps this addresses cases of Yang hyperactivity and Yin exhaustion, proposing a method of nourishing Yin to restrain Yang, thereby opening a pathway for future scholars to utilize Yin-nourishing techniques. Dihuang, Maidong, and Ejiao nourish Yin; Renshen, Guizhi, and Qingjiu (Clear Wine) unblock the vessels; Gancao, Shengjiang, and Dazao harmonize Ying and Wei; Suanzaoren calms the Spirit. Thus, the knotted/intermittent pulse can be harmonized, and palpitations stopped. Is this not what is meant by tonifying Heart Yang, allowing even cold to circulate freely?

A pulse that arrives slowly and occasionally stops before resuming is called Jie (Knotted) pulse; a pulse that arrives rapidly and occasionally stops before resuming is called Cu (Surging) pulse. Yang excess leads to Cu pulse, Yin excess leads to Jie pulse; both are pathological pulses.
If the pulse at the Cun Kou (Radial Artery) beats fifty times without interruption, it indicates that all five Zang organs receive Qi. With normal respiration, five beats per breath cycle indicate balance. Excess or deficiency indicates Yin-Yang imbalance and loss of normal rhythm.
When an imbalanced pulse is further obstructed by pathogenic factors, it stops and does not advance. Yang pathogen excess appearing as a rapid pulse with interruptions is named Cu (Surging), resembling a sudden fall while rushing forward. Yin pathogen excess appearing as a slow pulse with interruptions is named Jie (Knotted), resembling the continuous dripping of lacquer. Yang excess indicates a pathological pulse of Yin deficiency; Yin excess indicates a pathological pulse of Yang deficiency.

Furthermore, if the pulse stops during beating, resumes slightly faster, shows a return tendency but then rebounds, it is named Jie (Knotted), belonging to Yin. If the pulse stops during beating, cannot recover spontaneously, and only resumes subsequently, it is named Dai (Intermittent), belonging to Yin. Obtaining such a pulse indicates a difficult-to-treat condition.
When Yin and Yang contend, causing pulsation, and this appears in Cold Damage, it signifies that the physical form is cold and aversion to cold exists, indicating injury to the San Jiao (Triple Burner). Moreover, if there are interruptions in the beat, followed by a slight acceleration and rebound, resembling the pecking of a sparrow, it is not named Cu but Jie, because it is a True Zang Yin pulse of the Heart. If the beat stops, cannot recover, and resumes resembling the swimming of a shrimp, it cannot be named Jie but is named Dai, because it is a Yin pulse indicating the impending extinction of the Spleen.

A pulse floating lightly like fat oil on soup indicates declining Yang Qi; a pulse winding like a spider's thread indicates declining Yin Qi. A pulse that is floating and vacuously large indicates Yang has lost its root; a pulse that is deep and vacuously fine indicates Yin has lost its root.

A floating pulse accompanied by sweat droplets like pearls indicates decline of Wei Qi (Defensive Qi); a pulse that is continuous yet fading like the end of pouring lacquer indicates loss of Blood.

A floating pulse typically suggests Yang excess, where sweating should be absent. However, if sweat flows like pearls, it indicates Yang deficiency failing to secure the exterior, resulting in "Absolute Sweat" (Jue Han). Yin deficiency failing to store Essence and govern Blood results in a pulse that fades continuously, like lacquer being poured out.

In Cold Damage, if there is coughing and rebellious Qi ascending, and the pulse is scattered (San), death is indicated, due to the damage of the physical form.
External cold damages the form, internal heat damages Qi. Persistent coughing with upward-rushing Qi that does not descend, and a scattered pulse that does not converge, indicates the exhaustion of Lung and Heart Qi. The cause of coughing and rebellious Qi lies in cold damaging the form, leading to a lack of mutual support between Form and Qi.

A floating and surging pulse, combined with sweat like oil, incessant panting, inability to ingest fluids, numbness of the body, and alternating states of quietness and agitation, indicates the exhaustion of Life (Ming Jue).
A floating and surging pulse is not inherently fatal. However, sweat like oil indicates the complete depletion of Heart Fluids, with Yang remaining alone. The failure of regulatory functions, inability of the Granary Storehouse (Stomach/Spleen) to accept food, and the loss of mastery over Form and Spirit indicate no hope for life.

It is unknown which Zang organ suffers first. If sweat wets the hair and panting is incessant, this is the premature exhaustion of the Lung (Yang remains alone, body color like smoke, staring eyes, shaking head = Heart exhaustion; lips/mouth turning blue, twitching limbs = Liver exhaustion; black ring around mouth, soft yellow sweat = Spleen exhaustion; incontinence, delirium, eyes rolling back = Kidney exhaustion).

It is also unknown whether Yin or Yang exhausts first. If Yang exhausts first and Yin follows, the corpse will be green. If Yin exhausts first and Yang follows, the corpse will be red, with warmth in the axillae and heat in the epigastrium.

The Five Zang generate each other; if one suffers disaster, the other four cannot be saved. Yin and Yang depend on each other; if one Qi exhausts first, the other cannot survive. Those responsible for healing should not regulate health before disaster and exhaustion occur?