Library

When the three yang meridians are simultaneously affected, presenting with abdominal fullness, heaviness of the body, difficulty in turning over, and sweating, Baihu Tang (White Tiger Decoction) is used (see "Heaviness of Body" for discussion). After purgation, if chest fullness, irritability, palpitations, dysuria, delirium, heaviness of the body, and inability to turn over occur, Chaihu Muli Tang (Bupleurum and Oyster Shell Decoction) is used (see "Palpitations" for discussion). When wind-dampness pathogens contend with each other, causing severe body pain and inability to turn over independently, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) is used (see "Body Pain" for detailed discussion).

(Face covered with greasy dirt-like coating Red eyes Blue-green face color)
In Taiyang disease, if the face appears reddish instead of pale, it indicates that exterior pathogens have not been resolved. It must be cured by dispersing exterior pathogens and releasing muscle-layer stagnation. In Bingbing (simultaneous involvement) of two yang meridians (Taiyang and Yangming), if the face shows a continuous bright red color, it is also due to exterior pathogens and requires resolving the muscle layer and releasing the exterior to heal. If Shaoyang disease presents with red eyes, it should be stabilized by harmonizing the Shaoyang. If Shaoyin disease presents with a red face accompanied by cold limbs; or Jueyin disease presents with a slightly red face, if not treated promptly, it will inevitably develop into Si Ni syndrome (cold limbs) within two days, at which point warming interior and restoring yang methods may be considered. Although facial redness is often caused by yang heat, there are no indications for purgation in any of these meridian patterns. In Shaoyin and Jueyin diseases, if the red face is associated with true yin-cold severity, symptoms such as diarrhea, cold limbs, and a faint pulse will appear, indicating a yin-cold pathology. Even if the red face resembles yang heat, it is merely a concurrent transformational heat.

If Taiyang disease presents like malaria (alternating chills and fever), with a weak pulse, aversion to cold, a reddish face, and body itching, Guizhi Mahuang Ge Ban Tang (Half-Size Decoction of Cinnamon Twig and Ephedra) should be used for mild diaphoresis (see "Fever" for formula discussion). If the pulse is floating and slow, the face is hot and red, and the patient trembles with fear, resolution through sweating usually occurs on the sixth or seventh day. If fever persists instead, recovery is delayed because yang qi is deficient and cannot produce sweat, leading to body itching.

In Bingbing of two yang meridians: When Taiyang disease first occurs, if sweating is initiated but not thorough, the pathogen may transfer to Yangming, continuing with slight sweating and no aversion to cold. If Taiyang symptoms have not ceased, purgation is contraindicated as it constitutes an error. Mild diaphoresis can be attempted here. If the face shows a continuous bright red color, it indicates yang qi stagnation in the exterior; it should be resolved via external methods such as fumigation. If sweating does not occur, or is insufficient, causing yang qi stagnation and inability to vent, and if sweating was indicated but not performed, the patient will become irritable, unable to locate specific pain points (sometimes in the abdomen, sometimes in the limbs, unresponsive to pressure), short of breath, and able only to lie still. This is due to incomplete sweating. Re-initiating sweating will lead to recovery. How do we know sweating was incomplete? By observing a choppy pulse. (Facial redness, irritability, and shortness of breath due to incomplete sweating are not due to yang qi stagnation, but simply failure to sweat when indicated; thus, re-sweating leads to recovery.)

In Yangming disease, if the face is bright red, purgation is contraindicated (Ge Gen Tang may be used). In Shaoyin disease, if there is diarrhea with undigested food, internal cold with external heat, cold limbs, a faint pulse nearly imperceptible, absence of aversion to cold, and a red face, or accompanied by abdominal pain, dry retching, sore throat, or cessation of diarrhea with an absent pulse, Tongmai Sini Tang (Pulse-Restoring Four Reversals Decoction) with added Congbai (Scallion White) is used (see "Diarrhea" for details). In Jueyin disease, if there is diarrhea with undigested food, a deep and slow pulse, a slightly red face, and mild body heat, the patient will likely experience dizziness and sweating as signs of resolution. The patient will likely have mild cold limbs. This occurs because of "Dai Yang" (floating false yang) on the face due to lower jiao deficiency and cold (see "Diarrhea" for details).

If the face is red, the body is hot, the feet are cold, the mouth is locked (trismus), and the back is arched backward (opisthotonos), it is Jing disease (Spasm disease) (see Miscellaneous Diseases - Spasm section). If the face is red with mottled patterns like brocade, accompanied by sore throat and expectoration of pus and blood, it is Yang Du (Yang Toxin) (see Yang Toxin section).

Face covered with greasy dirt-like coating
In simultaneous involvement of the three yang meridians, with abdominal fullness, body heaviness, difficulty turning over, insensitivity in the mouth (Kou Bu Ren), delirium, a dirty-looking face, and enuresis, neither diaphoresis nor purgation is permitted.

Blue-green face color
After sweating in Taiyang disease, if fever and aversion to cold persist, and moxibustion/cauterization needles are applied, leading to chest oppression, a blue-green face, and moist skin, the condition is difficult to treat. If the face is slightly yellow and the hands and feet are warm, it is easy to cure.

Red eyes
In Shaoyang Wind-Stroke, if both ears lose hearing, eyes are red, and there is chest fullness and irritability, emesis and purgation are contraindicated (Xiao Chai Hu Tang may be used).

Appendix
Yellow face: Sun Zhao's manual records that Zheng Nongzhong, Vice Director of the Ministry of Works, suffered from Shanghan (Cold Damage). His chest, abdomen, and face turned yellow, resembling gold color. The Hanlin physicians discussed the case but could not decide, deferring to one another, saying, "Chest fullness suggests purgation, but the pulse might be floating and deficient." They summoned Sun Zhao. Sun Zhao said, "Although you gentlemen doubt and do not use purgatives, this is Mr. Zheng's fortune. Purgation would certainly cause death. I have one or two prescriptions that will surely cure him." He prescribed Xiao Xian Xiong Tang (Minor Trap the Chest Decoction). Following bowel movement, the illness was cured. The next day, his complexion returned to white, and people in the capital praised the treatment.