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Treatment for Taiyang disease (Taiyang syndrome) with sweating.

Guizhi Jian (Cinnamon Twig Tip, 3 qian), Sheng Hangshao (Raw Paeoniae Radix Alba, 3 qian), Gancao (Licorice Root, 1.5 qian), Shengjiang (Fresh Ginger, 3 qian), Dazao (Jujube Fruit, 3 pieces, split open), Sheng Huangqi (Raw Astragali Radix, 3 qian), Zhimu (Anemarrhenae Rhizoma, 3 qian), Fangfeng (Saposhnikoviae Radix, 2 qian).

Decoct in water to obtain one teacupful of decoction. Take warm and cover with blankets. After about one hour, slight general sweating is ideal. Do not allow profuse sweating like flowing water, otherwise the pathogenic factor will certainly not be eliminated. Avoid raw/cold foods, sticky/slippery foods, meat/noodles, five pungent spices, wine/dairy products, and foul-smelling substances.

Guizhi Tang (Cinnamon Twig Decoction) is a formula for treating Shangfeng (Wind-stroke) with sweating. Commentators state that when Wind damages Ying (Nutrient level), sweating occurs; others suggest that deficiency in Ying allows it to resonate with external pathogens. I have always doubted this theory.

Ying (Nutrient level) and Wei (Defensive level) constitute the outer barriers of the body. Wei is like the outer wall, while Ying is like the inner city. With Wei protecting Ying from the outside, how can external pathogens bypass Wei to damage Ying?

The Daqi (Pivotal Qi) in the chest is intimately related to Wei at every breath. When Daqi fills the chest, it possesses suction power, drawing Wei tightly to protect the body densely, defending against external pathogens, preventing them from attaching to the body. Even if they attach, they only affect Wei, not Ying. This principle is obvious. However, when Daqi in the chest is deficient and cannot hold Wei, Wei becomes scattered and unable to defend against external pathogens. Consequently, external pathogens can penetrate Wei directly into Ying. In my clinical experience, patients with deficient or sinking Daqi often suffer from profuse sweating. Several cases are recorded under Shengxian Tang (Ascending the Sinking Decoction) for reference. Thus, all Guizhi Tang patterns result from Daqi deficiency. The sweating indicates a tendency for fluids to escape outward, and the external pathogen, taking advantage of Wei's weakness, penetrates Ying, disturbing Ying fluids which then leak out as sweat. Fundamentally, Wind and Cold are inseparable; even in Wind-strike, Cold is present. If only Wei were affected, it could close the pores and prevent sweating. Therefore, Guizhi Tang not only dispels Wind but also scatters Cold.

Chen Guyu stated: "Guizhi is acrid and warm, Yang. Shaoyao is bitter and neutral, Yin. Guizhi combined with the acridity of Shengjiang seeks its kind, regulating Yang Qi throughout the body. Shaoyao combined with the sweet/bitter nature of Dazao and Gancao nourishes Yin fluids throughout the body. By using herbs that greatly tonify Yin and Yang to nourish the source of sweat, serving as the foundation for overcoming pathogens, and drinking hot congee to assist, utilizing Jingwei (Essence and Wei) fluids to form sweat without damaging the body, one stands on unassailable ground for perfection." While this explanation is profound, it fails to fully elaborate on the essence of drinking congee. If consuming grain fluids forms sweat without injury, why do other diaphoretic formulas not require congee? The pattern treated by Guizhi Tang is an exterior excess with interior deficiency. What is deficient? The Daqi in the chest. The *Neijing* states: "When food enters the stomach, its refined essence first emerges from the two Jiao of the stomach to irrigate the Zang-fu organs, separating into two pathways for Ying and Wei. The Daqi that gathers and does not circulate accumulates in the chest, named Qi Hai (Sea of Qi)." Thus, although Daqi originates from congenital essence, it relies on postnatal Qi from food and drink for cultivation. In Guizhi Tang patterns, Daqi deficiency causes Wei to scatter, allowing pathogens to bypass Wei and invade Ying. Drinking hot congee after medication supplements Daqi to overcome pathogens and aids Jiang/Gui in dispersing pathogens. This is indeed a winning formula. Later physicians neglected this, often omitting congee, leading to treatment failure and deepening illness. Wang Qingren criticized Guizhi Tang as useless in *Yilin Gaicuo*, but it is not useless; it is ineffective due to the omission of congee. Therefore, I add Huangqi to ascend and tonify Daqi, replacing the tonic effect of congee, and Fangfeng to circulate Ying and Wei, replacing the dispersing effect of congee. Drinking congee is beneficial, but effective even without it. To prevent heat generation from Huangqi's warming nature, I add Zhimu as a precaution.

Note: For the original Guizhi Tang to induce sweating, drinking congee is essential. Zhao Qingchu reported: His nephew Botang, aged 21, caught wind while sleeping after drinking alcohol. His skin was numb and insensitive to pain/itch, though appetite was normal. Wu Jutong, staying nearby, prescribed Guizhi Tang: Guizhi 5 qian, Baishao 4 qian, Gancao 3 qian, Shengjiang 3 slices, Dazao 2 pieces. Water 3 cups, decocted to 2 cups. Drink one cup; stop if sweating occurs, continue if not. Advised against dinner; take medicine when hungry before sleep, followed immediately by a bowl of hot thin congee, then cover to induce sweat. Botang followed this method. After one dose, he sweated slightly from head to toe. Wherever he sweated, scratching induced sensation. The next day, the illness vanished. This case confirms that to use Guizhi Tang for sweating, congee is mandatory. Without it, even if sweating occurs, the efficacy is lacking.

Question: Since Guizhi Tang patterns stem from Daqi deficiency, shouldn't the Yang pulse appear weak? Why is it floating on the Yang position (Cun) and weak on the Yin position (Chi)? Answer: The entire body is supported by Qi. This Qi is Yuanqi (Original Qi) in the Lower Jiao, Zhongqi (Middle Qi) in the Middle Jiao, and Daqi in the Upper Jiao. Though regions differ, Qi is continuous. Thus, Qi deficiency anywhere manifests as weakness in all three pulse positions (Cun, Guan, Chi). Here, the Cun pulse floats due to Wind, masking the weakness, while the Chi pulse remains weak, hence "Yang floating and Yin weak." If Yin weakness indicated Lower Jiao Yin deficiency, the pulse would likely be rapid. However, such cases typically present with slow pulses (less than four beats per breath), indicating Qi deficiency rather than Yin deficiency. Symptoms like aversion to cold (se se), aversion to wind (xi xi), and fever (xi xi) are manifestations of Qi deficiency and timidity.