Library

Taiyang disease presenting with fever, which persists for six or seven days without resolution accompanied by irritability, exhibits both exterior and interior syndromes. The patient feels thirsty and desires to drink water, but vomits immediately after swallowing it. This condition is named "Water Reversal" (Shui Ni). It is primarily treated with Wuling San (Five-Ingredient Powder with Poria).

In Taiyang disease, after sweating therapy, profuse sweating occurs, leading to dryness in the Stomach. The patient experiences restlessness and insomnia. If they desire water, provide it in small amounts frequently. Recovery occurs when the Stomach Qi harmonizes. If the pulse is floating, urination is difficult, there is slight heat, and extreme thirst, Wuling Tang (Five-Ingredient Decoction with Poria) is indicated.

After sweating, if the pulse is floating and rapid, accompanied by irritability and thirst, Wuling San is indicated.

Originally, due to improper purgative treatment, epigastric fullness and stuffiness (Pi) occurred. After administering Xiexin Tang (Heart-Purging Decoction), the Pi did not resolve. If the patient is thirsty, has a dry and irritable mouth, and urination is difficult, Wuling Tang is indicated.

In Taiyang disease, the Cun (inch) position of the pulse is slow, the Guan (bar) position is floating, and the Chi (cubit) position is weak. The patient has fever and sweating, yet still fears cold, does not vomit, but only has epigastric stuffiness. This is caused by the physician's improper use of purgatives. If purgatives were not used, and the patient does not fear cold but is thirsty, the pathogen has transferred to the Yangming channel.

If urination is frequent, the stool must be hard. Even if no bowel movement occurs for ten days, the patient suffers no distress. If thirsty and desiring water, provide it in small amounts; treat according to proper principles. For those who are thirsty, Wuling San is suitable.

In Shanghan (Cold Damage) disease, if sweating is followed by thirst, Wuling San is indicated. If there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is indicated.

In Shanghan disease, if there is cold extremities (Jue) and palpitations in the epigastrium, water retention should be treated first with Fuling Gancao Tang.

In Taiyang disease, if mild wheezing occurs after purgative treatment, it is because the exterior syndrome has not resolved. Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) is indicated.

For patients with a chronic history of wheezing, using Guizhi Tang (Cinnamon Twig Decoction) plus Houpo (Magnolia Bark) and Xingren (Apricot Kernel) is beneficial.

Originally suffering from Taiyang disease, if the physician erroneously uses purgatives, resulting in abdominal fullness, severe solidness, and pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) is indicated.

In Shanghan, if the exterior syndrome is unresolved and there is fluid retention in the epigastrium, presenting with dry retching, fever, and cough, or alternatively thirst, diarrhea, belching, difficulty in urination with lower abdominal fullness, or wheezing, Xiao Qinglong Tang (Minor Blue Dragon Decoction) is indicated.

In Shanghan, if there is fluid retention in the epigastrium, presenting with cough and mild wheezing, fever, but no thirst, Xiao Qinglong Tang is indicated.

If thirst occurs after taking the decoction, it indicates that the cold pathogen has departed and the disease is about to resolve.

In Shanghan, if stagnant heat is trapped inside, the body will likely develop jaundice. Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction) is indicated.

In combined Taiyang and Yangming disease, if there is no diarrhea but vomiting occurs, Gegen Jia Banxia Tang (Kudzu Root plus Pinellia Decoction) is indicated.

In Shanghan, if fever persists despite sweating, with epigastric hardness, vomiting, and diarrhea, Da Chaihu Tang (Greater Bupleurum Decoction) is indicated.

In Taiyang disease, if the course extends beyond ten days and the physician erroneously uses purgatives two or three times, and after four or five days the Chaihu syndrome remains, administer Xiao Chaihu Tang (Lesser Bupleurum Decoction) first. If vomiting continues, there is urgency and tightness in the epigastrium, and slight depression/irritability, the disease is unresolved. Using Da Chaihu Tang to purge will lead to recovery.

In Shanghan lasting over ten days, if heat is consolidated internally while alternating chills and fever persist, Da Chaihu Tang is administered.

After Shanghan, if the pulse is deep and solid, indicating internal excess, purgation is required, and Da Chaihu Tang is suitable.

In Shanghan unresolved for thirteen days, with chest and hypochondriac fullness and vomiting, tidal fever occurring at dusk, followed by mild diarrhea: this was originally a Chaihu syndrome. Purging should not have caused diarrhea. The fact that diarrhea now occurs indicates the physician used pill-based purgatives, which was incorrect. Tidal fever indicates excess. First, use Da Chaihu Tang to resolve the exterior, then use Chaihu Jia Mangxiao Tang (Bupleurum plus Mirabilite Decoction).

According to the above syndromes, all belong to unresolved exterior syndromes, while the interior may have accumulated water, retained phlegm, stored food, or accumulated heat. The exterior is excess, and the interior is also excess; thus, they are collectively categorized as "Exterior and Interior Excess Syndromes."

**Wuling San (Five-Ingredient Powder with Poria)**
Zhenling (Polyporus), 18 Zhu; Zexie (Alisma), 1 Liang 6 Qian; Baizhu (Atractylodes Macrocephala), 18 Zhu; Guizhi (Cinnamon Twig), half Liang; Fuling (Poria), 18 Zhu.
(Note: 1 Liang equals 24 Zhu; 18 Zhu equals 7.5 Qian.)
Grind into powder. Mix with rice water and take 3 Qian per dose, three times daily. Drink plenty of warm water afterwards until sweating occurs for recovery.
Commentary: Since the exterior pathogen is unresolved and water qi is stagnant internally, Guizhi is used to circulate the channels and release the exterior; Baizhu dries dampness and generates fluids; Zhenling, Fuling, and Zexie promote urination and drain dampness.

**Fuling Gancao Tang (Poria and Licorice Decoction)**
Fuling (Poria), 2 Qian; Guizhi (Cinnamon Twig), 2 Qian; Gancao (Licorice), 2 Qian; Shengjiang (Fresh Ginger), 3 Qian.
Decoct in water and take.
Commentary: Absence of thirst indicates lighter dampness. Thus, Fuling, Guizhi, Shengjiang, and Gancao are used to drain water and soothe the Liver (Wood), harmonize the Middle and strengthen the Spleen (Earth), preventing dampness from moving and causing water stagnation.

**Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel)**
Guizhi (Cinnamon Twig), 3 Qian; Gancao (Licorice), 2 Qian; Shaoyao (Peony), 3 Qian; Dazao (Jujube), 4 pieces; Xingren (Apricot Kernel), 14 pieces; Houpo (Magnolia Bark), 1.5 Qian; Shengjiang (Fresh Ginger), 3 Qian.
Decoct in water. Aim for a slight sweat.
Commentary: Since the exterior pathogen is unresolved and interior Qi is obstructed, Guizhi releases the exterior, while adding Houpo and Xingren descends rebellious Qi and breaks congestion.

**Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb)**
Guizhi (Cinnamon Twig), 3 Qian; Shaoyao (Peony), 6 Qian; Gancao (Licorice), 2 Qian; Shengjiang (Fresh Ginger), 3 Qian; Dazao (Jujube), 4 pieces; Dahuang (Rhubarb), 0.7 Qian.
Decoct in water and take.
Commentary: The exterior syndrome is unresolved, and erroneous purgation led to abdominal fullness, severe solidness, and pain. Guizhi releases the exterior; doubling Shaoyao clears/dries the Liver Wood; adding Dahuang drains Spleen Earth stagnation.

**Xiao Qinglong Tang (Minor Blue Dragon Decoction)**
Mahuang (Ephedra), 2 Qian; Shaoyao (Peony), 2 Qian; Xixin (Asarum), 1 Qian; Ganjiang (Dried Ginger), 2 Qian; Guizhi (Cinnamon Twig), 2 Qian; Gancao (Licorice), 2 Qian; Wuweizi (Schisandra), 1 Qian; Banxia (Pinellia), 1.5 Qian.
Boil Mahuang first, remove foam, then add other herbs and decoct.
Modifications: If mild diarrhea, remove Mahuang, add Raohua (now replaced by Fuling for stability); if thirsty, remove Banxia, add Gualougen (Trichosanthes Root) 2 Qian; if choking sensation, remove Mahuang, add Paofuzi (Prepared Aconite) 1 Qian; if difficulty urinating with lower abdominal fullness, add Fuling 3 Qian; if wheezing, remove Mahuang, add Xingren (Apricot Kernel) 13 pieces.
Commentary: Exterior syndrome unresolved, water qi stagnant and obstructive. Gancao nourishes Middle Qi; Mahuang and Guizhi disperse Ying and Wei; Shaoyao clears Wind-Wood; Banxia descends rebellious Qi and stops vomiting; Wuweizi, Xixin, and Ganjiang descend rebellious Qi and stop coughing.

**Mahuang Lianqiao Chixiaodou Tang (Ephedra, Forsythia, and Red Bean Decoction)**
Mahuang (Ephedra), 2 Qian; Lianyao (Forsythia Fruit/Stem), 2 Qian; Gancao (Licorice), 2 Qian; Chixiaodou (Red Bean), 3 Qian; Shengzibapi (Catalpa Bark), 2 Qian; Xingren (Apricot Kernel), 3 Qian; Dazao (Jujube), 3 pieces; Shengjiang (Fresh Ginger), 2 Qian.
Use rainwater (Liaoshui). Boil Mahuang in 2.5 cups until reduced to 2 cups, remove dregs, add other herbs, decoct to 0.8 cup, take warm.
Commentary: In Shanghan exterior disease, dampness stagnates generating interior heat. Without sweat or urine to vent, jaundice develops. Mahuang vents skin/lung congestion; Xingren descends Lung Qi; Shengzibapi clears Ministerial Fire and soothes Liver Wood; Lianqiao and Chixiaodou drain damp-heat and promote urination; Jiang, Gan, and Dazao harmonize Stomach Qi and tonify Spleen Essence. Sweating and promoting urination eliminate jaundice.

**Gegen Jia Banxia Tang (Kudzu Root plus Pinellia Decoction)**
Gegen (Kudzu Root), 4 Qian; Mahuang (Ephedra), 3 Qian; Shaoyao (Peony), 2 Qian; Shengjiang (Fresh Ginger), 2 Qian; Gancao (Licorice), 2 Qian; Guizhi (Cinnamon Twig), 2 Qian; Dazao (Jujube), 4 pieces; Banxia (Pinellia), 2 Qian.
Boil Mahuang and Gegen first, remove foam, add other herbs, decoct and take.
Commentary: Combined Taiyang and Yangming disease causes channel pressure and Fu organ stagnation, unable to accommodate undigested food, leading to forced vomiting. Gegen and Mahuang vent Wei stagnation in both Yang channels; Banxia descends Stomach rebellious Qi and stops vomiting.

**Da Chaihu Tang (Greater Bupleurum Decoction)**
Chaihu (Bupleurum), 4 Qian; Banxia (Pinellia), 1.5 Qian; Shaoyao (Peony), 1.5 Qian; Huangqin (Scutellaria), 1.5 Qian; Shengjiang (Fresh Ginger), 2.5 Qian; Zhishi (Immature Bitter Orange), 1.5 Qian; Dahuang (Rhubarb), 2 Qian; Dazao (Jujube), 2 pieces.
Decoct in 2 cups of water to 1.5 cups, remove dregs, re-decoct to 0.8 cup, take warm.
Commentary: Exterior unresolved, interior heat erupts. Chaihu, Huangqin, and Shaoyao clear Shaoyang fire; Zhishi and Dahuang drain Yangming heat; Shengjiang and Banxia descend Stomach Qi and stop vomiting.

**Chaihu Jia Mangxiao Tang (Bupleurum plus Mirabilite Decoction)**
Chaihu (Bupleurum), 1.2 Qian; Banxia (Pinellia), 0.7 Qian; Huangqin (Scutellaria), 1 Qian; Gancao (Licorice), 1 Qian; Shengjiang (Fresh Ginger), 1 Qian; Renshen (Ginseng), 1 Qian; Dazao (Jujube), 1 piece; Mangxiao (Mirabilite), 1 Qian.
Decoct in water, add Mangxiao last. Boil briefly, then take.
Commentary: Pathogen constrains the channels, Fu heat increases daily. Chaihu resolves the exterior and clears surface heat; Mangxiao specifically clears Fu organ heat.