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The two formulas discussed above are both used to treat the combined disease of Taiyang (Greater Yang) and Yangming (Yang Brightness). However, there is a condition where the pathogen originally belonged to Taiyang, but after mismanagement, it becomes purely a Yangming condition. This is the condition governed by Gegen Qinlian Tang (Kudzu, Scutellaria, and Coptis Decoction).

Original text from *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): In a Taiyang disease presenting with Guizhi Tang syndrome, if the physician erroneously applies purgation, diarrhea persists incessantly. If the pulse is Cu (Rapid and Interrupted), it indicates that the exterior pathogen has not yet resolved. If accompanied by wheezing and sweating, Gegen Qinlian Tang should be primarily administered.

[Formula: Gegen Qinlian Tang] Gegen Radix Puerariae (48g), Gancao Radix Glycyrrhizae Preparata (12g, honey-fried), Huangqin Cortex Scutellariae (18g), Huanglian Rhizoma Coptidis (18g).
Take the above four ingredients, add eight sheng of water. First decoct Gegen until the volume reduces by two sheng, then add the remaining herbs. Decoct until two sheng remain, strain off the dregs, and divide into two warm doses for administration.

The Cu (Rapid and Interrupted) pulse differs from the Jie (Knotted) and Dai (Intermittent) pulses. Most commentators define the Cu pulse as a rapid pulse with occasional pauses. Although the Cu pulse often appears in rapid pulses, it does not actually involve a pause. Consider this analogy: when a person walks, stopping occasionally before continuing, this represents the Jie or Dai pulse. Conversely, when a person runs hurriedly, encountering an uneven spot on the road causes a slight stumble or change in rhythm, yet the running continues without cessation; this represents the Cu pulse. Thus, the Cu pulse is frequently seen in rapid pulses. Such pulses usually result from exogenous heat sinking inward, accelerating the heartbeat and causing congestion in the pulse vessels, creating this image as if urged by someone. Therefore, the formula heavily employs Huangqin and Huanglian to transform the sunken heat. Simultaneously, using Gegen's clear and light properties to penetrate the exterior guides the transformed heat, which desires to dissipate, completely outwards, thereby clearing both interior and exterior heat. Furthermore, wheezing is a lung pathology, and sweat is the fluid of the heart. The sunken heat accelerates the pulse beyond its normal rhythm and forces the Yang qi of the heart and lungs to float outward, resulting in wheezing and sweating. From this, we know that Huangqin and Huanglian not only clear the exogenous heat that has sunk inward but also effectively clear heat from the heart and lungs, allowing wheezing and sweating to resolve spontaneously.

Moreover, Huanglian possesses the property of thickening the intestines and is a crucial herb for treating diarrhea. If, after taking the medicine, residual heat remains and diarrhea persists, one should treat it with my self-formulated Ziyin Xuanjie Tang (Nourish Yin and Vent Outward Decoction).

Lu Jiuzhi stated: The difference between Warm-Heat diseases and Cold Damage lies in the fact that Cold Damage patients experience aversion to cold, whereas Warm-Heat patients do not. Aversion to cold is the primary symptom of Taiyang; absence of aversion to cold is the primary symptom of Yangming. Zhang Zhongjing distinguished these most strictly. For aversion to cold without sweat, use Mahuang Tang; for aversion to cold with sweat, use Guizhi Tang; for no aversion to cold with sweat and aversion to heat, use Gegen Tang. Gegen in Yangming disease corresponds to Guizhi in Taiyang disease, both serving to release the exterior. Huangqin and Huanglian in Gegen Qinlian Tang correspond to Shaoyao in Guizhi Tang, both serving to stabilize the interior. Guizhi assists Mahuang to treat Cold Damage with aversion to cold; Gegen assists Huangqin and Huanglian to treat Warm-Heat without aversion to cold. These formulas represent the divergent paths for treating Cold Damage and Warm-Heat, allowing later generations to choose based on whether the disease is cold or heat. Crucially, the bitterness of Huangqin and Huanglian not only descends and purges but also adheres to the principle of "bitterness to consolidate." Consolidating the hair follicles stops sweating; consolidating the intestines and stomach stops diarrhea. Thus, Gegen Qinlian Tang treats persistent diarrhea. One formula clears both exterior and interior. This utilizes the drug according to the disease's nature, not specifically designed solely for diarrhea. Why do later generations view this formula as having uses other than treating diarrhea?

Using this formula as an exterior-releasing agent for Yangming Warm-Heat disease demonstrates unique insight. However, Gegen's power to release the exterior is very weak. In cases without sweat, one should add three qian of Bohe Ye (Menthae Haplocalycis Folium) to effectively vent the exterior and induce sweating. Observe that Gegen Tang treats stiffness of the neck and back with aversion to wind and no sweat, requiring assistance from Mahuang and Guizhi. During Zhang Zhongjing's time, Bohe was not yet used in medicine, as previously discussed. Fundamentally, herbs that are clear, light, and resolve the muscle layer are most suitable for releasing the exterior in Yangming meridian diseases. In early-stage Warm diseases, not only Bohe, but also Lianqiao Fructus Forsythiae and Chantui Periostracum Cicadae have properties similar to Bohe. However, in Zhang Zhongjing's time, Lianqiao root (Lianyao) was known only for promoting urination in Chixiaodou Tang, and its use for releasing the exterior was unknown. Regarding cicadas, ancients used the whole body of the cicada (Zhechan) but did not know the efficacy of its shed skin (Chantui) in reaching the skin. Generally, if Lianqiao is used alone at one liang, it can induce continuous mild sweating over twelve hours. If only two or three qian are used with Bohe, it can prolong the diaphoretic effect of Bohe. Chantui, if used alone at three qian, shows no apparent exterior-releasing power, yet can induce mild sweating throughout the body. Both Lianqiao and Chantui are excellent products for clearing the exterior and treating warm rashes, assisting Bohe in achieving its effect. Thus, discussing Bohe leads to mentioning them.

[Appendix: Dosages of Gegen Qinlian Tang in Later Generations]
Gegen Radix Puerariae (4 qian), Gancao Radix Glycyrrhizae Preparata (1 liang, honey-fried), Huangqin Cortex Scutellariae (1.5 qian), Huanglian Rhizoma Coptidis (1.5 qian).
If there is no diarrhea, remove Huanglian and add Zhimu Rhizoma Dioscoreae Bungeanae (3 qian). If there is no sweat, add Bohe Ye Menthae Haplocalycis Folium and Chantui Periostracum Cicadae (1.5 qian each).