Library

To clear and disperse external fire entering from the exterior, such as Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Dahuang (Rhei Radix et Rhizoma), Xijiao (Rhinoceoris Cornu), Lingyangjiao (Saiga Tataricae Cornu), Chaihu (Bupleuri Radix), Chi Shaoyao (Paeoniae Radix Rubra) etc., select according to the syndrome.

To clear and resolve middle jiao stagnant fire, such as Shanzhi Geng (Gardeniae Caulis), Zhi Xiangfu (Cyperi Rhizoma Preparatum), Qingdai (Indigo Naturalis), Qinghao (Artemisiae Annuae Herba), Longdancao (Gentianae Radix), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Shegan (Belamcandae Rhizoma), Lugeng (Phragmitis Rhizoma), Shigao (Gypsum Fibrosum), Zhuru (Bambusae Caulis in Taedia), Zhuye (Bambusae Folium), Lanye (Magnoliae Flos - *Note: Context implies Magnolia or similar aromatic herb, literal translation used*), Gegen (Puerariae Lobatae Radix), Lianqiao (Forsythiae Fructus) etc., select according to the syndrome.

To nourish and descend deficiency fire rising from the lower jiao, such as Guijia (Testudinis Carapax et Plastrum), Biejia (Trionycis Carapax), Dihuang (Rehmanniae Radix), Danpi (Moutan Cortex), Xuanshen (Scrophulariae Radix), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Digupi (Lycii Cortex), Niuxi (Achyranthis Bidentatae Radix), Huangbai (Phellodendri Cortex), Qiushi (Urina Pueri Cocta - *Prepared urine of young boy*), Tongbian (Urina Pueri - *Urine of young boy*), Renzhongbai (Natrii Ureatis Depuratus) etc., select according to the syndrome.

To warm and extinguish the Dragon and Thunder fire of the Liver and Kidney (referring to floating Yang due to Kidney Yang deficiency), such as Heijiang (Zingiberis Rhizoma Carbonisatus), Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex), Shudi (Rehmanniae Radix Preparata), Shanzhuyu (Corni Fructus), Danpi (Moutan Cortex), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Zexie (Alismatis Rhizoma), Maidong (Ophiopogonis Radix), Niuxi (Achyranthis Bidentatae Radix), Wuweizi (Schisandrae Fructus) etc., select according to the syndrome.

To warm and nourish the furnace fire of the Spleen and Stomach (referring to Spleen/Stomach Yang), add Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Paojiang (Zingiberis Rhizoma Preparatum), Fuzi (Aconiti Lateralis Radix Praeparata), Buguzhi (Psoraleae Fructus), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), Wuweizi (Schisandrae Fructus) etc., select according to the syndrome.

Regarding Shanghan (Cold Damage), there are few formulas and theories in pediatrics, so this general discussion is combined for reference, hoping to make the profound accessible and easy to understand.

Zhang Zhongjing said: In winter, when the cold is severe, all things hide deep. The gentleman keeps himself secure and does not injure himself with cold; those who are exposed and touched by it are named having Shanghan. However, children's Shanghan is no different from adults', except that treatment must consider accompanying fright. But children under eight years old do not have true Shanghan; they only suffer from common colds or wind injury. Therefore, methods of dispersing, draining, and detoxifying are particularly unsuitable for young children. Any cold contracted in winter that erupts in spring when Yin and Yang qi contend is called Bingwen (Warm Disease) if before Summer Solstice, and Bingshu (Summer Heat Disease) if after Summer Solstice. Only when cold pathogenic factors and killing qi are contracted between Frost Descent and Spring Equinox, immediately causing high fever and headache, is it True Shanghan. There is also Winter Warmth, contracted during an unusually warm winter. If sudden cold occurs in March-April when Yang qi is still weak, the resulting heat is mild. If in May-June when Yang qi is abundant, the resulting heat is heavy. If in July-August when Yang qi is declining, the resulting heat is slight. These are all seasonal epidemics belonging to Lei Shanghan (Shanghan-like diseases). Thus, gentlemen nourish Yang in spring and summer, and nourish Yin in autumn and winter, following the rigidity and softness of heaven and earth. Those who are exposed will have latent disease. The Classic says: Wind injuring in spring leads to lingering pathogenic qi, resulting in diarrhea. (Wind qi connects to the Liver, which prospers in spring; Wood overcomes Earth, hence diarrhea arises.) Summer heat injuring in summer leads to malaria in autumn. (Summer heat is extreme, autumn Yang contracts; Yang heat attacks each other, forming malaria. 'Nue' means old, also refers to emaciation.) Dampness injuring in autumn leads to upward reversal and cough. (Autumn dampness prevails, winter Water qi rises; Water overcomes Lung, hence cough and reversal arise.) This develops into flaccidity and cold limbs. (Internal dampness causes cough/reversal; external dispersion causes flaccidity.) Cold injuring in winter leads to Warm Disease in spring. (Winter cold condenses; spring Yang qi emerges. Cold is not released; Yang is blocked inside. Cold and blocked Yang contend, hence Warm Disease arises.) Those who develop illness immediately are called Shanghan, referring to the origin of the disease. The Neijing calls it Bingre (Disease Heat), referring to the symptoms. Generally, Wind injures Wei (Defensive) qi, Cold injures Ying (Nutritive) blood. Ying blood with Cold causes pain; Wei qi with Wind causes heat. Once Wind and Cold injure, hair stands erect, skin pores close, causing heat, named Shanghan. In the first three days, the disease transmits to the Three Yang meridians. On day one or two, Taiyang meridian is affected; its collaterals connect to Fengfu, so there is necessarily body heat, headache, sudden stiffness of waist and spine, and pulse floating at both cun and chi positions. On day two or three, Yangming meridian is affected; its pulse starts at the nose and connects to the eyes, so there is necessarily dry nose, eye pain, body heat, and restless sleep. The Classic says: When the Stomach is disharmonious, sleep is uneasy. Pulse is long at both cun and chi. On day three or four, Shaoyang meridian is affected; its pulse runs through the hypochondrium and reaches the ears, so there is hypochondriac pain and deafness, pulse string-like at both cun and chi. If the pulse is not deep/thin but rapid, and there is still aversion to wind/cold, hiding from people, pulling clothes tightly, this is a Exterior Syndrome, not yet entered the Fu organs, only sweating can resolve it. If on day four or five, pulse is deep and thin at both cun and chi, this is Taiyin meridian affected. Its pulse spreads in the Stomach and connects to the throat, so there is abdominal fullness and dry throat, Spleen meridian congestion generating heat. On day five or six, Shaoyin meridian is affected, pulse deep at both cun and chi. Its pulse penetrates the Kidney and connects to the Lung, so there is dry mouth/tongue and thirst; here heat gradually deepens. On day six or seven, Jueyin meridian is affected, pulse slow at both cun and chi. Its pulse circles the genitalia and connects to the Liver, so there is irritability and fullness, curled tongue, retracted scrotum, and convulsions. Here heat has gathered entirely internally, extremely deep and severe. Extreme Yang heat causes Yin qi to perish, so the patient exposes head/face, throws hands/feet, lifts clothes, breathes roughly, is thirsty and irritable, appearing to have constipation awaiting passage. Da Chengqi Tang should be used to purge, to inherit/lead the remaining thread of Yin qi, preventing Yin from being robbed by Yang, allowing survival. Although there is a major warning against excessive purging leading to Yin loss, there is also the active method of urgent purging to save Yin. Thus, days 1-2 allow exterior release; day 3 allows harmonization and recovery; day 5-6 with solid stool allows consideration of purging; day 7-8 without resolution indicates further transmission. If transmission does not follow days, or in Lianggan (Dual Invasion) cases, rules cannot be applied uniformly. If not Lianggan and no mixed pathogens, on day 7 Taiyang disease declines, headache lessens; day 8 Yangming declines, body heat rests; day 9 Shaoyang declines, hearing slightly returns; day 10 Taiyin declines, abdomen reduces to normal, appetite returns; day 11 Shaoyin declines, thirst stops, fluids generate, sneezing occurs; day 12 Jueyin declines, scrotal retraction heals, lower abdomen flattens, pathogens leave, spirit refreshes. If headache worsens by day 6-7, it transmits from Taiyang to Jueyin, called Second Stage (Er Hou); if still present on day 13, called Third Stage (San Hou). First stage: illness; second stage: worsening; third stage: critical. Internal righteous qi is deficient, pathogenic qi dominates, so heat persists. Pulse deep/sunken at both cun/chi indicates Yang collapse, a death sign. However, Shanghan has Hebing (Combined Disease) and Bingbing (Concurrent Disease), with vomiting or dysentery. Why? Hebing: Three Yang meridians simultaneously affected, pulses manifest, diagnosed together, non-transmitting. Bingbing: e.g., Taiyang unresolved, merging with Yangming, Two Yangs concurrent. Excessive Yang qi disturbs interior, causing upward vomiting or downward dysentery. Pulse surging/full/tight/choppy indicates unresolved heat. Re-exposure to cold causes cold-heat contention, transforming into Wen Nue (Warm Malaria). Yang pulse surging/rapid, Yin pulse solid/large indicates internal/external heat. Further exposure to warm qi transforms into Wendu (Warm Toxin). Wendu is severe, with internal/external heat. Subsequent stages have Yang Jie (Yang Knot) and Yin Jie (Yin Knot). Yang Jie: constipation but able to eat, pulse floating/rapid. Yin Jie: constipation unable to eat, pulse deep/slow. Yang Jie resolves on day 17; Yin Jie on day 14. Why? Day 17 transmits to Shaoyin Kidney. Kidney is Water, Yang is Fire; Water controls Fire, knot resolves. Day 14 transmits to Yangming Stomach. Stomach is Earth, Yin is Water; Earth controls Water, knot resolves. Ultimately, Yang meets Yin to resolve, Yin meets Yang to resolve. Treatment should prioritize harmonization. Harmonize if suitable, sweat if suitable, purge if suitable. Yang excess/Yin deficiency: pathogen enters interior via deficiency. Purging removes internal pathogen; sweating exhausts fluids and causes death. Yin excess/Yang deficiency: pathogen stays in couli (skin/muscle interstices), cannot enter. Sweating disperses pathogen; purging drives pathogen inward, causing disaster. Some resolve with shivering and profuse sweating (Righteous Qi defeats Pathogen). Some resolve without sweating/shivering due to lack of fluids, causing slight itching. If resolving but body becomes very hot, pathogen is distant from surface. Prolonged heat indicates fluid loss, Yin deficiency failing to control Yang. Stomach deficiency: tonify Earth to store Yang. Yin deficiency: nourish Yin to retreat fire, residual heat clears. If early stage (1-2 days) without fluid depletion, and three doses of diaphoretics fail to induce sweat, pathogen is overwhelming, Yang cannot overcome it, leading to fatal illness. Delirium and mania indicate Yang syndrome. Floating/large pulse: survival; deep/thin pulse: death. Sweat on forehead with panting, difficult/frequent urination indicates Yang reversing upward, Yin flowing downward, Yin-Yang separation. Numbness with trembling aversion to cold indicates Ying-Wei collapse and Yang loss. Inability to swallow liquids indicates Stomach Qi collapse. Persistent fever, oily sweat, continuous panting indicates Righteous Qi exhaustion and Pathogen dominance. All these are death signs.

For pediatric Shanghan, dispersing within 2-3 days is ideal, as Yuan Qi is insufficient to withstand disease. Prolonged entry into meridians consumes Qi/Blood, causing Slow Convulsion. Unresolved pathogen leaves residual heat. Disordered movement causes Labor Recurrence. Spleen deficiency with undigested food causes Food Recurrence. Unresolved heat re-exposed to cold causes Malaria. Evening fever/morning coolness indicates Yin deficiency. Afternoon tidal fever indicates Stomach Excess. Dawn belongs to Shaoyang, noon to Taiyang, afternoon to Yangming. In Shanghan, afternoon tidal fever is Stomach Excess, never Deficiency.

Shanghan follows Zhang Zhongjing exclusively. Reading his works requires separating Shanghan and Zhonghan (Direct Cold Injury) into two categories to avoid confusion. Mastering the principles, distinguishing pathogen/righteousness, excess/deficiency, true/false cold/heat makes treatment easy. Seeking too many variations leads to fragmentation. Speaking of Yang syndromes: Cold pathogen enters from exterior to interior. Depth varies: skin -> muscle -> bone/joint -> gut. Wind-Cold first affects Taiyang (Cold-Water meridian), causing aversion to wind/cold, headache, spine pain. Cold stagnating in skin is Exterior Syndrome. Floating/tight pulse without sweat is Shanghan, treated with Mahuang Tang to induce sweat. Pathogens have no fixed location; one need not wait for Six Meridians transmission to complete. Zhongjing's laws: Exterior-dispersing, Middle-harmonizing, Interior-purging, depending on pathogen location, to retreat heat and restore righteousness. Floating/relaxed pulse with sweat is Wind Injury, treated with Guizhi Tang. No headache/aversion to cold, pulse not floating, indicates Exterior resolved, pathogen in Middle (between exterior/interior, Yangming/Shaoyang division). Pulse neither floating nor sunken, in muscles/skin depth. Two types: Mildly surging/long is Yangming pulse. External signs: dry nose, insomnia, treat with Gegen Tang to resolve muscle layer. String-like/rapid is Shaoyang pulse. Signs: hypochondriac pain, deafness, alternating chills/fever, bitter taste, treat with Xiaochaihu Tang to harmonize. Yangming/Shaoyang do not follow standard root/branch, but middle treatment. Any aversion to cold remains in Exterior. Even in Middle, combine dispersing. Beyond this, pathogen enters Interior as Excess Heat. Deep/solid/surging/rapid forceful pulse, no aversion to cold/wind but aversion to heat, delirium, extreme thirst, lifting clothes, rough breathing, throwing limbs, hot extremities, ease of movement, constipation >6-7 days. Heat entered interior, intestines/stomach dry/excess. Mild: Dachaihu Tang. Severe: Er Chengqi Tang. Bowel movement clears heat. Speaking of Yin syndromes: Immediate fear of cold, cold limbs, shivering, quiet/breathless, blurred vision, inability to swallow, incontinence, preference for lying facing wall, closing eyes, red lips absent, curled posture, no thirst, abdominal pain/fullness, vomiting/diarrhea, salivation, pale face, cold breath, hiding, heavy body, no fever, deep/slow or thin/weak pulse. Direct Cold Injury to Yin meridians, True Yin Syndrome. Not transmitted from Yang/Heat. Assess external signs. Mild: Lizhong Tang. Severe: Jiangfu Tang, Sini Tang to warm. Do not delay. Classic: Fever with aversion to cold originates in Yang. No fever with aversion to cold originates in Yin. People know this, but fever/red face/irritability/lifting blankets/large weak pulse is often mistaken for Yang syndrome, treated with cold herbs, causing death. One must not distinguish Yin syndrome by heat presence or pulse size/floating, but by weakness under finger, especially deep pressure indicating hidden Yin. Urgently use Wuji San to resolve exterior/interior cold. Deep cold requires Ginger/Aconite warming. Treating as heat with cooling herbs increases thirst/agitation, leading to death. This prioritizes pulse over symptoms.

Cold in Exterior requires sweating; Cold in Interior requires warming. Yang Qi is master of the body. Classic: Yang Qi is like Heaven and Sun; losing it shortens life. Cold is Yin desolate/killing qi. Yin excess causes Yang decline; Yang exhaustion/Yin termination leads to death. Zhongjing started with Shanghan to establish cold disease as the guideline. For Three Yang, use Xinwen (Acrid-Warm) herbs like Guizhi, Mahuang, Chaihu, Gegen to disperse. For Three Yin, require Xinre (Acrid-Hot) herbs like Jiang, Fuzi, Rougui, Yuzhu, and Ganwen (Sweet-Warm) herbs like Renshen, Baizhu, Zhigancao to dispel Yin-cold and restore Yang. Dampness cases follow this logic. Later generations misunderstood, creating rigid categories, increasing confusion. Headache/fever is often wrongly diagnosed as Shanghan/Taiyang, causing unnecessary deaths. Feng Chu-zhan deeply pities this, offering "Commentary on Shanghan Lun" to expose flaws.

Six Fu organs are Yang; Cold affecting Yang meridians starts in Taiyang. Five Zang organs are Yin; Cold affecting Yin meridians starts in Taiyin. Yang meridian disease: clear exterior/heat first, resolves in 6-7 days. Yin meridian disease: requires warming/supporting righteousness, resolves in 14 days. Shanghan enters from skin to Zang-Fu, initially cold/fever, ultimately heat, patient usually has prior internal heat. Zhonghan enters directly to Zang-Fu, persistent cold, no fever, patient lacks internal heat. One releases exterior/purges interior; one warms middle/scatters cold. They are distinct. Seven-day transmission theory: Five Zangs transmit via Twelve Hours, completing cycle in seven days. Heaven/Earth Qi recurs every seven days; Stomach Qi also recurs.

Taiyang is outermost exterior, runs back. Yangming is inner exterior, runs front. Shaoyang is half-exterior/half-interior, runs sides. Beyond this, Shaoyin, Taiyin, Jueyin enter Zang (Interior). Early Shanghan/Wenbing, pathogen in exterior, headache/fever, Three Yang. Disperse immediately. Winter: Acrid-Warm/Hot to sweat. Spring/Summer: Acrid-Cool/Cold/Sweet-Cold to sweat. Post-sweat cool/pulse calm = cure. Delayed/heavy disease/light medicine causes interior binding, Three Yin disease, requires purging. Interior deficiency cannot tolerate purging, leads to danger. All difficult cases stem from late dispersal.

Zhonghan signs: stiff body, locked jaw, dizziness, no sweat or spontaneous sweat, due to deficient couli and weak Yang. Shanghan has fever; Zhonghan has none. Yang moves, Yin stills. Yin cold stagnating generates heat, transmitting variably. Non-heat indicates stable Yin pathogen. External cold exposure is same; difference lies in internal Fire presence.

Yiguan states: Induo (Yin Toxin) disease: Kidney originally deficient/cold, cold food/pathogen, or post-sweat Yang loss. Blue fingernails, abdominal cramping, cold limbs, sweating/confusion, muttering/vomiting, fatigue/body pain, deep/weak pulse, or weak chi/strong cun, or deep/thin/urgent. Treat with Sini Tang, Lizhong Tang. No pulse: Tongmai Sini Tang. Induo: Gancao Tang. Moxibustion on Qihai/Guanyuan with green onion. Use mild Qi-tonifying herbs to restore Yang. If unresponsive, death. Treatable within 5 days, not after 6-7. Yin signs are known, but atypical signs (fever/red face/irritability/lifting blankets/drinking cold/large pulse) are mistaken for Yang, causing death. Must rely on pulse. Weak/deep pressure indicates hidden Yin forcing Yang outward (false heat). Do not use cooling herbs. Failure to read Dongyuan leads to misunderstanding internal injury. Failure to read Danxi/Xue leads to misunderstanding True Yin/Yang. Dongyuan: Where pathogen gathers, Qi is deficient. Internal injuries are common, external rare. Dongyuan's Piwei Lun clarifies hunger/fullness/fatigue fever as internal injury, resembling Shanghan, forbidding sweating/purging. Tonify warmth, do not disperse. Righteous Qi pushes out cold. For external predominant, add slight dispersal to tonification. Main formula: Buzhong Yiqi Tang. Modifications: Internal injury with Shanghan, add Ma...