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Treatment for warm diseases (Wenbing, febrile diseases caused by warm pathogens), where the patient feels heat in both the exterior and interior, with a pulse that is surging (Hong) and floating (Fu).
Bohe Ye (Menthae Haplocalycis Herba, 3 qian) Chantui (Cicadae Periostracum, 2 qian, remove feet and soil) Sheng Shigao (Gypsum Fibrosum, 1 liang, crushed to fine powder) Gancao (Glycyrrhizae Radix et Rhizoma, 1.5 qian)

Spring warm diseases often present with heat in both the exterior and interior from the onset; this is even more severe in summer-heat warm diseases, as detailed in previous discussions. Wind-warm diseases (Fengwen) also frequently exhibit these pulse and symptom patterns within two to three days. This decoction can treat all such cases; recovery occurs upon sweating.

Western physicians commonly use aspirin for exogenous diseases. One grain of aspirin is taken mixed with lactose (or white sucrose as a substitute); recovery follows sweating. I have tested this repeatedly: its diaphoretic power is very strong. For exogenous conditions solvable by sweating, it induces sweat and cures. The Liangjie Tang (Cooling and Resolving Decoction) and the preceding Qingjie Tang (Clearing and Resolving Decoction) can be substituted with this drug because it is cooling and dispersing. However, the subsequent Hanjie Tang (Cold-Resolving Decoction) cannot be substituted, as aspirin has excessive diaphoretic power but insufficient heat-clearing capacity.

For treatment of high fever throughout the body, heat and thirst in the heart/mind, white tongue coating turning yellow, and a surging-slippery pulse. Or, when there is still headache and a sensation of stiffness/constriction throughout the body.
Sheng Shigao (Gypsum Fibrosum, 1 liang, crushed to fine powder) Zhi Mu (Anemarrhenae Rhizoma, 8 qian) Lianqiao (Forsythiae Fructus, 1.5 qian) Chantui (Cicadae Periostracum, 1.5 qian, remove feet and soil)

Question: This formula is an exterior-releasing agent, yet it heavily uses Shigao and Zhi Mu while lightly using Lianqiao and Chantui. How does it induce sweating? Answer: The concern lies only in the possibility of inaccurate pulse diagnosis or imprecise syndrome differentiation. If the pulse and symptoms match those noted under the formula, sweating will occur shortly after ingestion; there is no need to worry about inefficacy. A surging-slippery pulse with thirst indicates excess heat in the Yangming Fu organs, which originally constitutes a Baihu Tang (White Tiger Decoction) pattern. However, due to occasional slight headache and residual exterior constriction, a portion of Taiyang pathogen remains. Therefore, heavy doses of Shigao and Zhi Mu are used to clear stomach/fu heat, while small amounts of Lianqiao and Chantui, which excel at reaching the exterior, guide the transforming heat from the stomach back to the Taiyang channel to resolve via sweating. This harmonizes yin and yang, allowing natural sweating rather than forcing it. Moreover, Shigao is cool (Shennong Bencao Jing states "slightly cold" equals cool) and slightly pungent; can patients with excess heat sweat merely by taking it alone?

I once treated a young man who contracted a warm disease after strenuous labor in early summer. Treatment failed for half a month. Upon my examination, his eyes were clear but blind, his hands wandered touching clothes and beds, he moved restlessly, spoke nonsense, and was unconscious. He previously had loose stools, which stopped, but he still passed soft stools one or twice daily. The pulse was floating and rapid, especially so in the right Cun position, while the Chi pulses disappeared upon pressure. Blindness indicated impending exhaustion of Kidney Yin. Hand wandering indicated stirring of Liver Wind. The condition was critical. Fortunately, the floating pulse indicated the pathogen remained in the Taiyang channel. The pronounced floating in the right Cun indicated an impending sweat. The reason for impending but absent sweating is that human sweating resembles heavenly rain: heaven and earth produce rain only when yin and yang harmonize; humans sweat only when yin and yang harmonize. Here, the weak Chi pulse meant rising yang could not be matched by yin, so how could sweat form? I prescribed a large dose of moistening tonics to severely supplement True Yin, aiding yin to respond to yang, expecting natural sweating. I used Shudi (Rehmanniae Radix Preparata), Xuanshen (Scrophulariae Radix), Ejiao (Asini Corii Colla), Gouqi (Lycii Fructus), totaling approximately 6–7 liang, decocted in a large bowl of water, administered slowly warm. Two doses were given in one day, resulting in profuse sweating and recovery on the same day. Thus, there is no fixed method for inducing sweating. One must tonify and regulate based on yin-yang deficiency, or guide according to pathogenesis; all can induce sweating without necessarily using diaphoretics. Note: In Shanghan (Cold Damage) and Wenbing, sticky yin-nourishing and sweet-cold heat-clearing herbs are generally contraindicated as they may trap pathogens. However, used as aids for sweating, they expel pathogens. It depends on application.

A man in his forties was bound by wind-cold, unable to sweat, with chest irritability and wheezing. Treated with Suzi Jiangqi Tang (Perillae Fructus Descending Qi Decoction) plus wind-dispersing and fire-clearing herbs, the condition worsened after several doses. Pulse was surging, slippery, and floating. Hanjie Tang was administered; upper body sweated within moments. Then, lower jiao and legs sweated, and the illness vanished.

A man around thirty contracted a warm disease. Treatment failed for over ten days. Pulse was surging and forceful, yet still floating. Headache confirmed. Thirst for cold water was occasional, not extreme. Although prolonged, Yangming heat was not fully established, and Taiyang exterior was not fully resolved. Hanjie Tang was given; sweating occurred shortly, and he recovered.

A man in his thirties contracted wind-cold in winter. Whole-body aversion to cold, no sweat, chest irritability. Originally a Daqinglong Tang (Great Green Dragon Decoction) pattern, but treated with Mahuang Tang (Ephedra Decoction). No sweat resulted, irritability worsened to near madness. Pulse was extremely surging and slippery, both Cun positions floating, right Cun particularly so. Hanjie Tang was administered; profuse sweating occurred immediately, and he recovered. Thus, Hanjie Tang is suitable not only for warm diseases but also for Shanghan presenting this pulse.

An elderly man, seventy years old, suffered from chronic劳疾 (consumptive disease). Mild external contraction triggered wheezing/inversion, cured by Xiao Qinglong Tang (Minor Green Dragon Decoction) minus Mahuang, adding Xingren (Prunus Armeniacus Semen) and Sheng Shigao. After Lantern Festival, severe external contraction relapsed the old disease. Within five to six days, heat entered the Yangming Fu. Pulse was string-taut, long, floating, and rapid, forceful upon pressure, lacking surging-slippery quality (pulse of external contraction combined with internal injury). Hanjie Tang plus Lushen (Codonopsis Radix, 3 qian) was given; one dose induced sweating and cured wheezing. Re-examination showed lingering heat. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) modified with Shanyao (Dioscoreae Rhizoma) replacing Jingmi (Oryza Sativa Germ) was administered in one large dose, divided into three warm intakes; full course cured him.

A pregnant woman, two to three days into Shanghan. Pulse extremely surging and slippery, mental confusion, intermittent delirium, thick white tongue coating. Prescribed Hanjie Tang. A physician present asked the rationale. I said: To resolve via sweating. He asked if it works. I said: For this pattern, it naturally induces sweat; generic diaphoretics would fail. Shortly after ingestion, sweating occurred, and she recovered.

A woman in her twenties contracted a warm disease. Sore throat, stiff tongue, nearly unable to speak, heart heat and thirst, frequent drinking, yet pulse was extremely deep and fine, skin not hot. Abandoning pulse for symptoms, Hanjie Tang was given. Slight sweating followed, condition improved slightly. Next morning, recurrence with worse tongue stiffness. Medication was correct but too weak. Hanjie Tang was repeated with doubled Shigao, decocted into two bowls, taken warm in two doses. Slight sweating ensued, and she recovered.

Note: Deep-fine pulses in Shanghan usually indicate Yin patterns. In warm diseases, deep-fine pulses often indicate Yang patterns. Warm diseases are often acquired in winter and manifest in spring, with pathogenesis moving from interior to exterior. Sometimes pathogenic qi stagnates and cannot reach the exterior, presenting a deep-fine pulse. Mistaking this for cold leads to error. Also, although Hanjie Tang worked, next morning tongue stiffness worsened. Doubling Shigao to 2 liang, divided into two doses, cured the illness. This shows that for treating heat in cold/warm diseases, decocting a large dose and dividing it into multiple intakes mimics the ancient method of one dose taken three times.

My disciple Gao XX treated an elderly woman, nearly seventy. Early spring, Shanghan pattern, extreme irritability/heat within three to four days. Accompanied by white dysentery, frequent diarrhea day and night. Pulse surging, slippery, and floating. Gao XX administered Hanjie Tang plus Sheng Hangshao (Paeoniae Radix Alba, 3 qian). One dose brought slight sweating, heat resolved, and dysentery cured.

Furthermore: Wu Youke stated: "After purgation for interior patterns, if the pulse is floating and slightly rapid, with slight body heat and unclear spirit, this indicates pathogenic heat floating on the muscle surface with no interior obstruction. Even without sweat, Baihu Tang is appropriate; the pathogen can resolve via sweating. If after purgation the pulse is empty and rapid, feeling hollow upon pressure, Baihu Jia Renshen Tang is appropriate; sweating occurs rapidly." Note: Neither Baihu Tang nor Baihu Jia Renshen Tang are exterior-resolving agents. Yet, when used correctly, even after purgation, sweating can occur quickly, let alone before purgation. Not only this; Chengqi Tang (Harmonizing Harmony Decoctions) can also serve as diaphoretics depending on usage.

Furthermore: Hong Jiren stated: "I once treated heat disease for eight or nine days. Using Chai Ge Jie Biao Tang (Bupleurum and Pueraria Exterior-Resolving Decoction), Qin Lian Qing Re Tang (Scutellaria and Coptis Heat-Clearing Decoction), and Xiao Huang Xia Zhi Tang (Sodium Nitrate and Rhubarb Purging Decoction), none induced sweat. Mental confusion, agitation, grasping at air, touching beds, critical condition. I prescribed a large dose of Dihuang Tang (Rehmannia Decoction, definitely minus Guizhi and Fuzi), heavily supplemented with Renshen and Maidong. Soon, profuse whole-body sweating occurred, evil signs retreated, and spirit cleared."

Note: This resembles my use of yin-tonifying herbs to induce sweating, differing only by adding Renshen to boost Qi. The above discusses the principles of sweating. Integrating these views exhausts the theory of diaphoresis.

Appendix:
Letter from Li XX of Yanshan, Zhili:
Patient XX in Tianjin contracted a warm disease. Previous clearing/resolving formulas failed. Pulse was forceful in both floating and sunken positions; exterior and interior blazing heat with no sweat. Original Hanjie Tang formula was given; whole-body sweating occurred, and he recovered. From this, I learned that heavy use of Sheng Shigao and Zhi Mu clears heat, while small amounts of Lianqiao and Chantui guide heat out through the exterior. The formulation is far superior to Yinqiao San (Honeysuckle and Forsythia Powder) and Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction). Furthermore, raw Shigao is indeed a miraculous drug. Since curing this case, for all solid-heat patterns in cold/warm diseases, I strictly follow the book's theory, using heavy raw Shigao. For heat-solid with pulse-deficiency, I use Baihu Jia Renshen Tang or Baihu Jia Renshen Tang with Shanyao replacing Jingmi, achieving immediate results.

Letter from Sun XX of Yanshan, Zhili:
Early winter this year, a Ms. Guo contracted Shanghan. Within three to four days, Yangming heat was severe: red face, coarse breathing, six pulses surging and rapid, occasional delirium. Prescribed Hanjie Tang. Due to chest stuffiness, added Gualou Ren (Trichosanthis Semen, 1 liang). One dose cured the illness.