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After sweating pervades the whole body, the pathogenic factor is resolved through sweat. This sweat is generated from grain (nutritive essence), and its function is precisely to harmonize Ying and Wei (Nutritive and Defensive levels), moisten the Cou Li (interstitial spaces between skin and muscle), fill the muscles, and nourish the skin and hair. If sweating is excessive like flowing water, it prevents Yin from storing essence; when essence is insufficient, it cannot overcome the pathogen, thus the disease remains unresolved. Physicians of the world only know how to induce heavy sweating, and dare not even use Shaoyao (Paeoniae Radix Alba); inducing sweat after sweat—would this not harm people?
If there is no sweating, administer again according to the previous method. If still no sweating, shorten the interval between subsequent doses. Within about half a day, ensure all three doses are consumed.
The previous spontaneous sweating was sweat of the pathogen in the Wei level. After taking the decoction, if there is suddenly no sweating, it means the pathogenic sweat in the Wei level has been exhausted, but the Qi from grain is not yet full, and the Essence Qi has not yet spread to the Ying level. Following the previous method will lead to Essence Qi prevailing and pathogen retreating; accelerating the drug's action will resolve the disease.
For severe cases, administer medicine over one day and one night, observing for twenty-four hours. If symptoms persist after finishing one dose, prepare another dose. If sweating does not occur, continue administering until two or three doses are finished.
When stating that the case is severe, the dosage must be doubled. One day and one night should be divided into two administrations; if the disease is urgent, hasten the subsequent doses without interruption. It is permissible to take up to three doses. This is because Guizhi Tang (Cinnamon Twig Decoction) harmonizes Ying and Wei, which differs from Mahuang Tang (Ephedra Decoction) that specializes in releasing the exterior. Therefore, it can be repeatedly decocted and stacked in doses to induce sweating, without worrying about Yang collapse. Using it for other formulas would be an error.
Contraindications include cold/raw foods, sticky/slippery foods, meat, noodles, Five Pungent Spices (Wu Xin: garlic, chives, leeks, scallions, asafoetida), wine/cheese, and foul/rotten substances.
These contraindications apply to all patients taking the medicine. Because Guizhi Tang is the primary formula, these notes are recorded afterwards. I often see families forbidding their patients from eating grains but instead giving them wheat drink; is this not a great deviation?
Guizhi (Cinnamon Twig) is originally used to resolve the muscle layer. If the pulse is floating and tight, with fever and no sweating, it should not be given. One must recognize this to avoid errors.
"Resolving the muscle layer" refers to resolving pathogens at the muscle level. Since sweat naturally occurs within the inner skin/flesh, Mahuang (Ephedra) is not used. A floating and tight pulse is the pulse pattern for Mahuang Tang; absence of sweating is the symptom pattern for Mahuang Tang. Guizhi Tang lacks Mahuang to open the Cou Li and vent the skin, but contains Shaoyao to astringe Yin fluids and restrain pungent-heat properties. There is fear that pathogenic factors will coagulate and fail to resolve externally, inevitably attacking internally, causing significant harm. Hence, such earnest warnings are given.
Removing the bark of Guizhi refers to removing its rough outer bark, which aligns with the meaning of "resolving the muscle layer." Ignorant people have made the ridiculous claim of "removing the muscle to take the bone."
Patients who are habitual drinkers (Jiu Ke) should not be given Guizhi Tang; taking it will cause vomiting because drinkers dislike sweet flavors.
Those who habitually drink alcohol have damp-heat accumulating in the Middle Jiao; therefore, encountering sweet flavors inevitably causes vomiting. Zhang Zhongjing was so cautious in prescribing formulas; implicitly, one should understand the method of using Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction) to resolve the muscle layer.
Anyone who vomits after taking Guizhi Tang will subsequently vomit pus and blood.
Guizhi Tang is not only contraindicated for drinkers; for anyone with excessive heat blazing internally, using sweet-warm and pungent-hot drugs to assist Yang will not resolve the muscle layer but will instead surge the heat, damaging the Yang collaterals along its path. Thus, vomiting pus and blood is certain. This is what is meant by "Once Guizhi enters the throat, if Yang is excessive, death ensues."
The above sixteen discussions on Guizhi Tang thoroughly explain distinguishing symptoms via pulses. The post-formula section details compound prescriptions and administration methods, showing people how to use it correctly; it details drug contraindications and formulas, showing people how not to use it. Zhang Zhongjing’s painstaking effort is evident; readers must understand that he established formulas based on pulse and symptom patterns, not merely for Shanghan (Cold Damage) or Fengzhong (Wind Strike). It is not restricted to a single meridian, hence terms like "Guizhi Syndrome" and "Chaihu Syndrome" appear.