Library

Mr. Yiyang said: The notion that Taiyang (Cold Damage) disease transmits only through the Foot meridians and not the Hand meridians is not a statement derived from thorough investigation of principles. Mr. Liu of Caowang, referring to the Water, Earth, and Wood elements associated with the Foot meridians, argued that Water freezes and dries up when encountering cold, Earth cracks when encountering cold, and Wood withers and dies when encountering cold; therefore, Cold pathogens favor injuring them. In contrast, the Metal and Fire elements associated with the Hand meridals become harder when encountering cold. Generally, they are extremely hot, so Cold cannot invade them, and thus Cold cannot injure them. Ignorant people found this strange and actually severed the Ying (Nutrient) and Wei (Defensive) Qi and the meridians above and below the human body, disconnecting them from each other.

In fact, when a Cold pathogen invades the human body, it must first cause burning heat in the skin and hair, nasal congestion, and coarse breathing. Since the Lung governs the skin and hair, this indicates that the Xin Metal of the Hand Taiyin Lung Meridian is the first to be diseased. Therefore, the sages used decoctions such as Guizhi Tang (Cinnamon Twig Decoction) and Huanglian Tang (Coptis Decoction). However, if the sweating method does not start from the skin and hair, from where would the pathogen be resolved? When the Heat pathogen enters the interior and causes constipation, the Geng Metal of the Hand Yangming Large Intestine Meridian is diseased. Therefore, the sages used substances like Xiaoshi (Natrii Sulfas), Dahuang (Rhei Radix et Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Zhishi (Aurantii Fructus). However, if the purgative method does not act on the Large Intestine, from where would the fu-organs be unblocked? Can one believe Mr. Liu's statement that Metal becomes harder when encountering cold?

When Yang Qi is constrained, leading to abnormal tongue coating and delirious speech, the Xia Fire of the Hand Shaoyin Heart Meridian is diseased. This is why the sages employed several methods for Xiexin Tang (Drain the Epigastrium Decoction). When Fire reaches its extreme and causes bleeding, accompanied by vexation and steaming heat throughout the upper and lower body, the Huo Fire of the Hand Jueyin Pericardium Meridian and the Huo Fire of the Hand Shaoyang Sanjiao Meridian are diseased. Treatments include formulas containing Sanhuang (Three Yellows) or Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix). When there is strangury and urinary retention, the Neihuo (Internal Fire) of the Hand Taiyang Small Intestine Meridian is diseased. Treatments follow the examples of Wuling San (Five-Ingredient Powder with Poria) and Daochi San (Guide Out Redness Powder). Can one believe Mr. Liu's statement that great heat prevents Cold from causing injury?

The Classics state: "Taiyang disease transforms into Heat disease." If it is called a Heat disease, there should be no signs of Water freezing, Earth cracking, or Wood withering, but rather signs of Metal being scorched and Fire being hyperactive. Is Mr. Liu's statement not extremely absurd?

If Taiyang disease is treated with purgatives too early, the pathogen flows and accumulates, forming Jie Xiong (Chest Binding). If the epigastrium is distended and full, feels hard as stone upon pressure, is painful to touch, and is accompanied by dry thirst, delirium, solid constipation, and a deep, forceful pulse, it is named Da Jie Xiong (Major Chest Binding). However, if the pathogen stagnates in the chest and diaphragm, immediate purgation is not appropriate; one should use resolving and guiding methods and wait. Only when the pathogenic heat is abundant in the interior and the waste products are firmly accumulated in the lower part should one attack and remove them. Thus, the pathogenic heat is resolved without injuring the Yuan Qi (Primal Qi). This is what is meant by saying that purgative drugs should be used cautiously (late).

If pressing the area reveals no pain in the chest and heart, but only rapid and coarse breathing, it is named Xiao Jie Xiong (Minor Chest Binding). This indicates pathogenic qi filling the chest, not yet fully entering the fu-organs. One should only use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhike (Aurantii Fructus Immaturus) and Jiegeng (Platycodonis Radix); purgation is not indicated. If there is slight sweating on the head, the body is not very hot, there is frequent belching, and mild chest stagnation, it is named Shui Jie Xiong (Water Chest Binding). This is caused by excessive water-fluid accumulation stagnating in the epigastrium. Treatment should involve promoting urination. If after promoting urination, urine remains blocked and sweating occurs on the head, this is Yang collapse, which is untreatable.

If there is frequent mental restlessness (Ao Nu), oppression, dry tongue, very hot hands and feet, and a strong desire to drink cold liquids, this is Re Shi Jie Xiong (Heat-Excess Chest Binding). If there is no mania, but slightly cold hands and feet, with chest stuffiness and belching, this is Han Shi Jie Xiong (Cold-Excess Chest Binding). There is also Zang Jie (Zang Binding), which is similar to Jie Xiong but different. Jie Xiong is in the Yang aspect and involves loss of appetite, whereas Zang Jie is in the Yin aspect with normal appetite, and is always accompanied by frequent diarrhea.

Generally, in diseases lasting two to three days, if lying down causes epigastric vexation and fullness, but standing up brings slight relief, one must know that there is binding in the epigastrium. Lying down causes Qi to obstruct and rebel upward, leading to vexation; standing up allows Qi to descend and dissipate, bringing relief. However, this has not yet formed a solid excess pattern. If purged at this stage, the pathogen will bind more tightly due to deficiency, potentially leading to paralytic diarrhea.

There is also Yangming disease characterized by occasional delirium and tidal fever. If there is truly excess heat inside, digestion should be accelerated, and the patient should desire food. If instead there is no desire to eat, hardness and pain around the umbilicus in the lower abdomen, short and red urine, and thirst, this indicates Dry Stool (Zao Shi) in the stomach. Immediate purgation is indicated. If the patient frequently desires food but eats little, this indicates Deficient Heat in the stomach; although the abdomen may be hard, it is not Dry Stool, and purgation is contraindicated. If there is lower abdominal pain, black stool, free urination, jaundice, delirium, dry thirst, and a deep, forceful pulse, this is Xu Xue (Blood Accumulation/Stasis). Tao Ren Shun Qi Tang (Peach Kernel Regulate Qi Decoction) is indicated. Recovery occurs when black material is excreted. If pressing causes lower abdominal distension without hardness or pain, and urination is difficult, this is Niao Se (Urinary Difficulty). Promoting urination is indicated, but do not overdo it to avoid exhausting body fluids.

Generally, after purgation, if the spirit is clear, the body is cool, and the patient desires food, it indicates the pathogen has retreated and Zheng Qi (Upright Qi) has recovered. If conversely there is fever and irritability, it indicates Zheng Qi is scattered internally and the pathogen is rampant in the middle. The simultaneous appearance of purple-black spots indicates a fatal prognosis.

If the pulse beats and then stops, rarely recovering on its own, and when it returns again it is slightly rapid and small, it is named Jie Yin (Knotted Yin). Jie Yin indicates internal pathogenic qi acting recklessly and binding. If the pulse beats and does not recover, returning only with a weak beat, it is named Dai Yin (Intermittent Yin). Dai Yin indicates internal Zheng Qi is extremely deficient and about to cease. Therefore, it is said that a Jie (Knotted) pulse can survive, but a Dai (Intermittent) pulse implies death.