Library

[General Principle] Zhang Zhongjing stated: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang meridian), after three days, if sweating therapy has been administered, or if emesis, purgation, or warm needle therapy has been used, yet the condition remains unresolved, this is termed Huai Bing (deteriorated disease resulting from mismanagement). Guizhi Tang (Cinnamon Twig Decoction) is no longer indicated. One must observe the pulse and symptoms, determine the nature of the error committed, and treat according to the specific manifestations.

[Detailed Commentary] Li stated: If Shanghan disease (cold damage) does not resolve and is re-exposed to cold pathogens, it transforms into Wen Nue (warm malaria); if re-exposed to wind pathogens, it transforms into Feng Wen (wind-warmth); if re-exposed to damp-heat pathogens, it transforms into Wen Du (warm toxicity); if re-exposed to epidemic qi (epidemic pathogenic factors), it transforms into Wen Yi (warm epidemic). Furthermore, if Taiyang disease remains unresolved after sweating, emesis, purgation, or warm needle therapies, and persists beyond its normal course, all are named Huai Bing. Alternatively, if physicians fail to distinguish between Yin and Yang and erroneously apply sweating or purgation, causing the disease to persist, leading to chaotic meridians due to deteriorated symptoms that do not heal over time, one must examine the specific errors committed and treat accordingly. For cases with predominant exterior symptoms, Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction) is used; for half-exterior half-interior symptoms, Xiao Chaihu Tang (Minor Bupleurum Decoction) is used; for lingering residual heat, Shen Hu Shaoyao Tang (Ginseng, Bupleurum, and Peony Decoction) is used; in critical conditions, Duoming San (Life-Snatching Powder) is used; and if various medicines prove ineffective, Biejia San (Turtle Shell Powder) is employed for rescue.

Ke Qin stated: "Three days" is not a fixed time for administering emesis, purgation, or warm needles; improper treatment causes the disease to persist. Huai Bing refers to Bian Zheng (changed symptoms). If sweating is misapplied, symptoms such as continuous leakage of sweat, palpitations at the epigastrium, and palpitations below the umbilicus may occur. If emesis is misapplied, symptoms such as hunger without desire to eat, morning food vomited in the evening, and aversion to removing clothing may occur. If purgation is misapplied, symptoms such as Jie Xiong (chest binding), Pi Ying (fullness and hardness in the epigastrium), Xie Re Xia Li (diarrhea accompanied by fever), abdominal fullness, and undigested food in stool may occur. If fire therapy is misapplied (Huo Ni), symptoms such as jaundice, Wang Yang (collapse of Yang), hematochezia, and Ben Tun (rushing pig syndrome) may occur. Thus, the Guizhi Tang syndrome has ceased, so Guizhi Tang is no longer applicable.

[General Principle] Zhang Zhongjing stated: When original Taiyang disease does not resolve and transfers to Shaoyang (a syndrome caused by pathogenic factors affecting the Shaoyang meridian), presenting with hardness and fullness in the hypochondrium, dry retching, inability to eat, alternating chills and fever, and a string-taut and fine pulse, Xiao Chaihu Tang should be administered. If emesis, purgation, sweating, or warm needle therapies have already been used, resulting in Chan Yu (delirious speech), and the Chaihu syndrome has ceased, this constitutes Huai Bing. One must determine the nature of the error and treat according to the appropriate principles.

[Detailed Commentary] Zhao Sizhen stated: The Huai Bing mentioned in Zhang Zhongjing's discussions refers to symptoms such as deficiency-related vexation, chest binding, Qi stagnation, and internal vexation with abdominal fullness following emesis, which occur after erroneous sweating, emesis, or purgation of Taiyang disease. This precisely indicates that Guizhi Tang is no longer applicable and the Xiao Chaihu syndrome has ceased. How could it refer to diseases caused by "heterogeneous qi" as described in the *Huoren Shu*? Zhang Zhongjing also stated: "Re-exposure to heterogeneous qi transforms into other diseases," which corresponds to Sun Zhao's (courtesy name Suoju) concept of two or three types of qi mixing to cause disease. Since these cannot be definitively named, unlike the four specific warm diseases, they are termed Bian Bing (changed diseases). Moreover, regarding the four warm diseases, Zhang Zhongjing posits that winter cold damage transforms into Wen Bing (warm disease) in spring; if the warm disease persists and encounters further pathogens, it transforms into Wen Nue, Feng Wen, Wen Du, and Wen Yi. These diseases have not become Huai Bing, hence they are called Bian Bing. One is Huai Bing, the other is Bian Zheng; their names are inherently different. Thus, it is clear that heterogeneous qi does not constitute Huai Bing. If Wen Nue were truly Huai Bing, Zhang Zhongjing would not have stated that the Chaihu syndrome has ceased. Please reflect on this to understand naturally.

Wang Lü stated: When the exterior symptoms of Taiyang do not resolve, wind-cold pathogens enter the Shaoyang via the pivot mechanism. If the various Shaoyang symptoms appear, Chaihu formulas can still be used. However, if after erroneous treatment, half-exterior half-interior symptoms are absent but Chan Yu appears, the disease is transitioning to Yangming (a syndrome caused by pathogenic factors affecting the Yangming meridian) and no longer belongs to Shaoyang. Therefore, Chaihu Tang is no longer indicated. Nevertheless, one should not assume that Chan Yu alone indicates Wei Shi (excess in the stomach/intestines). One must carefully investigate what error was committed.