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[Outline] Zhang Zhongjing said: The typical manifestation of Taiyang disease (Disease of the Taiyang/Bladder channel) is a floating pulse (Pulse that feels superficial and can be felt with light pressure), headache, stiffness and pain in the neck and occiput, and aversion to cold. In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind-strike syndrome (Zhongfeng, often referring to exterior deficiency pattern). In Taiyang disease, if there is headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) should be administered.

Shen Jin'ao's commentary: Throughout the book, whenever "Taiyang disease" is mentioned, or when there are exterior symptoms or the exterior pathogen has not yet resolved, they are all collectively categorized under exterior syndromes. These twenty clauses are listed here to detail the standard presentations. This does not imply that exterior syndromes are limited to these; other types also follow this example.

[Subsidiary] Zhu Gong said: Fever, aversion to cold, body pain, and a floating pulse belong to exterior syndromes. The hallmark of an exterior syndrome is aversion to cold. Aversion to cold belongs to the Taiyang channel. It is appropriate to treat it by inducing sweating.

Liu Wansu said: Exterior syndromes caused by wind injury present with headache, neck stiffness, painful and uncomfortable joints, or eye pain, muscle heat, dry retching, nasal congestion, warm hands and feet, spontaneous sweating, and aversion to wind and cold. The pulse is floating and slow at the cun position (yang) and floating and weak at the chi position (yin). This indicates pathogenic heat in the exterior, and Gui Zhi Tang is suitable for all such cases. If there is sweating, aversion to wind, accompanied by stiffness and pain in the neck and back, Gui Zhi Jia Ge Gen Tang (Guizhi Decoction plus Puerariae Radix) is suitable. For patients with wind injury and no sweating, if Gui Zhi Tang has been taken but vexation persists without interior symptoms, first puncture Fengchi (GB20) and Fengfu (GV16) acupoints, then administer Gui Zhi Jia Ge Gen Tang. Alternatively, Shuangjie San (Double-Release Powder) can be used universally to avoid errors from using Mahuang Tang or Guizhi Tang incorrectly.

Exterior syndromes caused by cold damage present with head and neck pain, stiff lower back and spine, bodily rigidity, fever and aversion to cold, no restlessness, no sweating, or head/face/eye pain, muscle heat, dry nose, chest fullness with wheezing, slight coldness in the fingertips, and a floating, rapid, and tight pulse. This indicates pathogenic heat in the exterior, and Mahuang Tang (Ephedra Decoction) or Tianshui San are suitable, yielding excellent results. One must ensure the medication matches the pathology to avoid causing further harm. When both wind and cold invade, presenting with head/neck pain, limb pain, and warm hands/feet, it is Wind-strike; however, if there is no sweating, aversion to wind, and a floating-tight pulse, it is Yin-cold. Or, if there is head/neck pain, stiff lower back/spine, bodily rigidity, slight coldness in the extremities, and no sweating, it is Cold Damage; however, if there is restlessness and a slow pulse, it is Wind Injury. Wind injures the Defensive Qi (Wei Qi), while Cold injures the Nutritive Blood (Ying Blood).

Chen Shiduo said: When pathogens enter the skin pores and interstices, approaching the Nutritive and Defensive levels, prompt dispersal is required. The prescription consists of Baizhu (Atractylodis Macrocephalae Rhizoma) 3 qian, and Chaihu (Bupleuri Radix), Jingjie (Schizonepetae Herba), Banxia (Pinelliae Rhizoma), Ziye (Perillae Folium), Gancao (Glycyrrhizae Radix et Rhizoma), Cangzhu (Atractylodis Rhizoma), and Danpi (Moutan Cortex) each 1 qian, decocted in water and taken orally. This formula contains profound principles within its mild nature. Since Liver Wood Qi stagnation is best treated by soothing and dispersing, and the herbs used here directly enter the Liver channel, they naturally unblock the Liver Wood, allowing the branches and leaves to grow smoothly.

Ke Qin said: All six channels have exterior syndromes, but only Taiyang governs the exterior. Therefore, only Taiyang fully embodies the characteristics of exterior syndromes and pulses. For instance, a floating pulse indicates the disease is in the exterior. As the first Yang channel, Taiyang's pulse qi is floating and forceful, which differs significantly from the Chang-da (large and long) pulse combined with Yangming, the Xuan-xi (string-like and fine) pulse combined with Shaoyang, and the slightly floating pulse of the Three Yin channels. The head and neck govern the exterior of the whole body. The Taiyang meridians circulate around the head and converge at the neck, hence the stiffness connecting the head and neck. This differs from the frontal headache of Yangming and the temporal headache of Shaoyang. Aversion to cold indicates the disease is in the exterior. Although all six channels may exhibit aversion to cold, Taiyang corresponds to the transformation of Cold Water, so its aversion to cold is particularly severe. This stands in stark contrast to Yangming (which stops on its own after two days), Shaoyang (alternating chills and fever), and the internal aversion to cold of the Three Yin channels. Taiyang focuses primarily on exterior symptoms and pulses, rather than on the specific diseases governed by its meridians.

[Outline] Zhang Zhongjing said: A floating pulse indicates the disease is in the exterior; sweating may be induced using Mahuang Tang. A floating and rapid pulse allows for sweating, preferably with Mahuang Tang.

After inducing sweating for cold damage, if vexation recurs after about half a day and the pulse is floating and rapid, sweating may be induced again, suitably with Guizhi Tang. If Taiyang disease has persisted for ten days or more, and the pulse is floating and fine with a desire to sleep, the exterior has resolved. If there is chest fullness and hypochondriac pain, Xiao Chaihu Tang (Minor Bupleurum Decoction) should be given. If the pulse is merely floating, administer Mahuang Tang.

[Subsidiary] Zhu Gong said: A floating pulse belongs to Exterior-Yang. The *Suwen* states: "If the Cun-kou pulse is floating and vigorous, the disease is external." Thus, a floating pulse indicates an exterior syndrome.

Zhang Yuansu said: The method for treating cold damage begins by distinguishing between exterior and interior, as well as urgency and slackness. Exterior conditions of the Three Yang channels should be treated urgently, while interior conditions should be treated slowly. Exterior conditions of the Three Yin channels should be treated slowly, while interior conditions should be treated urgently. He further stated: Floating pulses require sweating; sinking pulses require purging. A rapid sweating method and slow purging method refer to the exterior of the Three Yang channels. A rapid purging method and slow sweating method refer to the interior of the Three Yin channels. Mahuang Tang is called an urgent sweating method, while Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is called a slow sweating method. The *Neijing* mentions inducing sweat by soaking the body, referring to the slow sweating method for the exterior of the interior. It also says, "For diseases in the skin, induce sweat to disperse them," referring to the urgent sweating method for the exterior of the exterior. Urgent sweating targets the Taiyang channel, while slow sweating targets the Shaoyin channel, reflecting the correspondence of organ and channel transmissions. For example, Mahuang Fuzi Xixin Tang is for early Shaoyin disease with fever, sinking pulse, harmonious interior, and no sweat, thus using soaking to induce sweat without excessive diaphoresis. Current Mahuang Tang treats Taiyang syndrome with head/neck pain, stiff back, floating pulse, no sweat, and harmonious interior; since the pathogen is in the skin, inducing sweat to disperse it is appropriate. The classics state: "Treat the principal condition with a gentle method, treat the guest condition with an urgent method." This is what is meant.

Li Dongyuan said: Exterior diseases belong to the Taiyang channel. Whenever headache, fever, aversion to cold, normal urination and defecation, stiff waist/neck/back, and a floating-tight pulse are seen, it is an exterior syndrome. Regardless of the number of days ill, one should promptly resolve the exterior and avoid purgative or draining methods. Sweating indicates Exterior Deficiency, suitable for resolving the muscle layer (Jieji, a mild method). No sweating indicates Exterior Excess, suitable for inducing sweating (Fahan, a heavy method).

However, inducing sweating varies in intensity. Ancients said sweating is suitable in spring and summer, borrowing seasonal timing to illustrate yang pathogens outside. Actually, in spring, yang qi is still weak; in autumn, yang qi is gathering; neither should undergo heavy sweating. In summer, weather is hot, pores open, so heavy sweating is unnecessary. In winter, yang qi is hidden; for mild colds, sweating is especially inappropriate. Only in severe cold damage, with strict seasonal climates and tight skin/pores, is heavy sweating necessary to disperse the pathogen, which is a temporary measure of necessity. For Yin syndromes, if there is only cold limbs and no sweating, reckless sweating will disturb the meridians and cause death. If there is exterior pathogen, use pungent-warm herbs to induce slight sweating to disperse it.

Shen Jin'ao's commentary: The first clause mentions only a floating pulse, not slow or weak, indicating the pulse is floating and forceful. However, one must verify that the heat is truly in the exterior before using Mahuang Tang. The Zhongjing discussions cited in this chapter are not those belonging to no specific channel; specifically, because cold damage requires first distinguishing exterior and interior, this clause is placed at the beginning.

[Outline] Zhang Zhongjing said: In Taiyang disease, if there is stiffness and discomfort in the neck and back, no sweating, and aversion to wind, Gegen Tang (Kudzu Root Decoction) is the primary treatment.

In Taiyang disease, if there is stiffness and discomfort in the neck and back, but with sweating and aversion to wind, Guizhi Jia Gegen Tang (Guizhi Decoction plus Kudzu Root) is the primary treatment.

[Subsidiary] Wang Haogu said: Treating cold damage requires distinguishing between exterior and interior. If not distinguished, errors in sweating and purging methods will occur, preventing one from being a superior physician. For example, regarding fever: body heat without thirst indicates heat in the exterior; Xiaochaihu Tang plus Guizhi is used. Cold limbs with a slippery pulse indicate heat in the interior; Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is used. Regarding fluid retention: dry retching with slight diarrhea, fever, and cough indicate fluid in the exterior; Xiao Qinglong Tang plus Yuanhua is used. Cool body, resolved exterior symptoms, cough with hypochondriac pain indicate fluid in the interior; Shizao Tang (Ten Jujube Decoction) is used. Regarding aversion to cold: aversion to cold with heat indicates onset in Yang channels; Mahuang Tang, Guizhi Tang, or Xiaochaihu Tang are used. Aversion to cold without heat indicates onset in Yin channels; Fuzi Sini Tang (Aconite Reverse Cold Decoction) is used. Regarding body pain: floating pulse, fever, headache, and body pain indicate unresolved exterior; Mahuang Tang is used. Sinking pulse, spontaneous diarrhea, and body pain indicate interior disharmony; Sini Tang is used. From this, we see Zhongjing's methods for distinguishing exterior and interior are very detailed; students should study them carefully.

[Outline] Zhang Zhongjing said: In JieXiong syndrome (Chest Binding Syndrome), if the pulse is floating and large, purging is contraindicated; purging will lead to death.

[Subsidiary] Zhu Zhenheng said: The *Ju Fang Xin Shu* states that mixed pathogens should be treated with mixed methods. For instance, aversion to cold and fever caused by a common cold clearly indicate external pathogens. With a floating-rapid pulse, but a tight and vigorous Qi-kou pulse, it is clearly food injury. The patient is also fatigued, and deep palpation reveals an empty pulse quality, with chest/diaphragm fullness sometimes radiating to the hypochondrium, and the pulse feeling string-like on light palpation. This is due to Liver pathogen from frequent anger. Careful palpation of the left Chi pulse shows it large, deep, and weak, indicating past sexual excess. The treatment should postpone addressing the cold. First, observe the patient's complexion, strength, and constitution. Use methods to tonify the middle, transform food, move stagnation, clear stomach fire, and guide with ginger and pepper. This will restore middle qi, move stagnation, harmonize fluids, induce whole-body sweating, and naturally resolve the external pathogen. Physicians who do not investigate details, only focusing on dispersing external pathogens, failing to analyze concurrent pulses or inquire thoroughly into causes (such as personality traits), and cleverly applying mixed treatments, will see righteous qi become deficient daily and pathogens become entrenched daily. This is the fault of incompetent physicians.

Shen Jin'ao's commentary: Mixed diseases also involve exterior syndromes, so this is attached here.

Lou Quanshan said: External wind-cold invasion always occurs because continuous physical exertion leads to internal injury and deficiency, allowing external pathogens to enter. Thus, in one family, some get sick while others do not; deficiency allows pathogen entry, while non-deficiency leaves no gap for pathogens. Therefore, most (80-90%) of cold damage diseases are related to internal injury. Later generations, adhering strictly to the phrase "cold damage has no tonification method," see only chills and fever without distinguishing deficiency or excess, and uniformly apply sweating and purging, leading to many premature deaths and injuries.