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Original text of *Shanghan Lun*: When Taiyang disease and Yangming disease occur simultaneously, with symptoms of wheezing and chest fullness, purgation (downward draining) is contraindicated; it is appropriate to treat primarily with Mahuang Tang (Ephedra Decoction).

Simultaneous occurrence of Taiyang and Yangming diseases refers to the fact that the exterior syndrome of Taiyang has not yet resolved, while simultaneously accompanied by heat in Yangming. The wheezing is caused by wind-cold pathogens invading the Lung from the skin and hair. The chest fullness arises because the Great Qi in the chest cannot circulate freely due to the blockage of Ying (Nutritive) and Wei (Defensive) Qi, resulting in a sensation of distension. The statement "do not use purgation" exists because the Yangming channel is still connected to Taiyang; if purgation is mistakenly used, it will lead to Jie Xiong (Chest Binding/Clumping). Moreover, since the patient already suffers from chest fullness, developing Jie Xiong becomes even more likely. Furthermore, the heat in Yangming is merely located in the channels, so there is absolutely no rationale for using purgation. Therefore, repeated warnings are given against its use. Treating with Mahuang Tang again serves to open the Taiyang exterior, allowing the nascent heat of Yangming to dissipate through sweating.

Although the syndrome involves Yangming, Mahuang Tang is still used as the primary formula because ancient people had robust constitutions, lived simply, and had few desires, making them responsive to this prescription. Modern people, however, have weaker constitutions, increasing indulgences, and most suffer from Yin deficiency. In such cases, Bohe (Menthae Haplocalycis Herba, Mint) should be used to replace Guizhi (Cinnamomi Ramulus, Cinnamon Twig) in the formula. If the heat is slightly severe and the stool is dry, raw Shigao (Gypsum Fibrosum, Gypsum) should be added in doses of several qian to be effective.

Regarding Wenbing (Warm Diseases), in ancient times, they were collectively referred to as Shanghan (Cold Damage), which is why Qin Yueren's *Nanjing* (Classic of Difficult Issues) mentions that "Shanghan comprises five types." When Zhang Zhongjing wrote *Shanghan Lun*, he recognized that the treatment for early-stage Wenbing differed fundamentally from Fengzhong (Wind Strike) and Shanghan. Thus, at the beginning of the Taiyang chapter, he clearly divided them into three categories and discussed Wenbing in detail. This represents an advancement in Zhang Zhongjing’s medicine compared to ancient times.

Original text of *Shanghan Lun*: In Taiyang disease, if there is fever and thirst without aversion to cold, it is called Wenbing. If after sweating, the body feels burning hot, it is named Fengwen (Wind-Warmth). In Fengwen disease, the pulse is floating at both the Yin (Cun/Rencheng) and Yang (Chi/Yongquan) positions, there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring during respiration, and difficulty speaking.

The reason the opening of the discussion on Wenbing is headed with "Taiyang Disease" is that Wenbing must also originate from the Taiyang channel (specifically the Foot-Taiyang Bladder Channel; those who claim Wenbing enters only the Hand-Taiyang Small Intestine Channel and not the Foot channels—on what basis do they stand?). However, Wenbing transforms into heat extremely rapidly, invading the Yangming channel within hours, so one does not feel aversion to cold but directly experiences fever and thirst. If the practitioner fails to recognize this as Wenbing and mistakenly uses hot herbs to induce sweating, the illness will not resolve with sweat, and the burning heat will increase. Based solely on this rejection of hot exterior-releasing drugs, the name can be determined as Fengwen. The floating pulse at both Yin and Yang positions resembles the fluttering of wind; spontaneous sweating indicates heat penetrating outward along the floating pulse; body heaviness results from the body feeling sore and weak due to heat; excessive sleepiness reflects mental and neural dullness caused by heat; and difficulty speaking is due to swelling of the tongue caused by upper Jiao heat.

Besides Fengwen, there are Shiwen (Damp-Warmth) and Wenbing caused by latent pathogen transforming into heat. The outline discusses only Fengwen because the onset of Shiwen and latent-heat Wenbing is often triggered by wind pathogens, so they can all be categorized under Fengwen.

Although the outline details the symptoms of Fengwen, it lacks treatment methods afterward, which later generations regretted. Upon careful re-examination, it becomes clear that *Shanghan Lun* originally contained formulas for treating Wenbing, but due to the loss and subsequent disordered compilation by Wang Shuhe, these sections were misplaced. I once observed Article 62 of *Shanghan Lun*: "After sweating, Guizhi Tang should not be administered again. If there is sweating and wheezing without significant internal heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be given." Comparing this article with the Wenbing outline: "After sweating" corresponds to "if sweating"; "wheezing" corresponds to "snoring"; mouth breathing leading to wheezing equates to nose breathing leading to snoring; "no significant heat" corresponds to "burning body heat," implying the heat remains superficial while the interior remains relatively cool. A one-to-one comparison confirms their perfect alignment.

Fengzhong, Shanghan, and Wenbing are established as three major outlines at the beginning of the chapter. Later, when discussing treatments for Fengzhong and Shanghan, the outlines are reiterated. By analogy, it is certain that this section originally belonged to the treatment of Wenbing, and Mahuang Xingren Gancao Shigao Tang is undoubtedly the primary formula for Wenbing. During Zhang Zhongjing's time, practitioners often confused Wenbing with Fengzhong and Shanghan. At the onset, failing to distinguish fever without aversion to cold, they used warm herbs to induce sweating, leading to unresolved illness post-sweating. Alternatively, mistaking fever without aversion to cold for interior transmission, they used purgatives, as noted in Article 163 regarding post-purgation contraindications. The distinction lies in whether the error occurred post-sweating or post-purgation. Zhang Zhongjing warned against misdiagnosing post-sweating sweating as a Guizhi Tang syndrome, strictly advising Mahuang Xingren Gancao Shigao Tang instead. According to the standard protocol of Shanghan, if the original syndrome persists after erroneous medication, the correct original formula should be used (e.g., Article 103 advises Xiao Chaihu Tang if Chaihu syndrome persists after purgation). By analogy, Mahuang Xingren Gancao Shigao Tang is the rescue formula for mistreated Wenbing and effectively the primary formula for early-stage Wenbing. To use this formula today, dosages must be adjusted.

[Original Formula: Mahuang Xingren Gancao Shigao Tang]
Mahuang (Ephedrae Herba, Ephedra) 4 liang (removed joints), Xingren (Prunus Armeniaca Semen, Apricot Seed) 50 pieces (skin and tips removed), Gancao (Glycyrrhizae Radix et Rhizoma, Licorice Root) 2 liang, Shigao (Gypsum Fibrosum, Gypsum) 8 liang (crushed, wrapped in cloth).
Take the above four ingredients, add 7 sheng of water, first boil Mahuang until reduced by 2 sheng, remove the foam on top, then add the remaining herbs. Boil to obtain 2 sheng, strain, and take 1 sheng warm.

The rationale of the formula: Mahuang combined with Xingren stabilizes wheezing; paired with Shigao to reduce heat; once heat subsides, sweating stops naturally. Gancao is added for its sweet and緩 (moderating) nature to harmonize Mahuang and Shigao, blending their cooling and warming properties seamlessly to enhance efficacy, resulting in rapid action.

This formula originally treated Wenbing with sweating and no significant internal heat. If the case involves no sweating and heavier heat, dosage adjustments are necessary. In my practice, the dosage of Shigao is usually ten times that of Mahuang, e.g., Mahuang 1 qian with Shigao 1 liang, or Mahuang 1.5 qian with Shigao 1.5 liang. For patients without sweating, fearing insufficient Mahuang dosage may fail to induce sweat, Aspirin may be taken after administration to assist sweating. For severe heat, Shigao dosage can be increased. I once treated Baihou (Diphtheria) and Lanhou Sha (Scarlet Fever-like throat condition) [Lanhou Sha invariably involves Wenbing; Baihou often involves slight exterior contraction]. Using Mahuang 1 qian and Shigao up to 2 liang, although throat conditions generally contraindicate Mahuang, the copious use of Shigao counteracts its heat, allowing Mahuang to exert miraculous effects.

Regarding lung diseases originating from Wind-Warmth invasion, where wind pathogens linger in the Lung, transform into heat, and scorch the Lung tissue, sometimes causing itching in the Lung leading to continuous coughing and wheezing, this decoction should also be administered to clear long-standing wind pathogens. After several doses, when Lung itching ceases, coughing and wheezing will naturally subside, followed by moistening-Lung, clearing-fire, and resolving-phlegm therapies to cure the disease. Mahuang Xingren Gancao Shigao Tang has broad applications: it is suitable for new exterior contractions causing cough/wheeze, headache, toothache, or bilateral cheek swelling due to exterior wind-heat, provided dosages are adjusted according to the syndrome.

[Appendix] Patient Lin XX, nearly fifty years old, suffered from Wind-Warmth. Although cured by previous doctors, residual heat remained in the Lung, consuming Lung Yin and resulting in chronic Lung disease unresponsive to multiple treatments. Pulse was 5 beats per breath, forceful at both superficial and deep levels. He reported that itching extending from the throat to the Lung interface triggered immediate coughing fits, lasting dozens of bouts with profuse sweating and expectoration of thick phlegm before relief. He felt constant internal heat and severe constipation (bowel movement every 4-5 days). I deduced that the Lung itching triggering cough indicated residual wind pathogens from the initial exterior invasion that had entered the Lung via skin/hair and remained uncleared. Since wind-heat in the Lung were exacerbating each other, I prescribed Mahuang Xingren Gancao Shigao Tang: Mahuang 1.5 qian, Raw Shigao 1.5 liang, Xingren 3 qian, Gancao 2 qian. One dose resulted in immediate cessation of coughing. The pulse remained forceful, so I prescribed a follow-up formula: Shanyao (Dioscoreae Rhizoma, Yam) 1 liang, Beishashen (Glehniae Radix, Glehnia Root), Tianhuafen (Trichosanthis Radix, Trichosanthes Root), Tiandong (Asparagi Radix, Asparagus Root) each 5 qian, Chuanbei (Fritillariae Cirrhosae Bulbus, Fritillaria Bulb), Shegan (Belamcandae Rhizoma, Belamcanda Rhizome), Suzi (Perillae Fructus, Perilla Fruit), Gancao each 2 qian. He was advised to take several doses to eradicate the disease. Ten days later, he returned, stating that after taking the follow-up formula, Lung itching and coughing recurred. Resuming the first formula for ten doses, internal heat subsided, no cold sensation was felt from the medicine, and Lung itching/coughing resolved. Appetite increased, and bowel movements normalized. This outcome surprised me. Re-pulse diagnosis showed a non-rapid but still forceful pulse. I adjusted the formula: Mahuang 1 qian, Shigao 1 liang, Xingren 2 qian, plus Raw Huai Shanyao 6 qian. He was instructed to continue drinking the decoction and stop immediately if it felt too cold. After 7-8 doses, a slight cold sensation prompted cessation, and the Lung disease was finally cured.

Commentary: Treating Feilao (Lung Consumption/TB) with Mahuang Xingren Gancao Shigao Tang for over twenty doses and achieving a cure may seem doubtful to readers, but there are precise reasons. Lung disease is difficult to cure because practitioners often treat only current symptoms without investigating the root cause. This case originated from exterior wind contracting into Feilao. The persistent Lung itching indicates lingering wind pathogens, now entrenched due to duration. Only Mahuang can penetrate this deep entrapment, but its hot nature is unsuitable for Lung excess-heat. Heavy use of Raw Shigao counters Mahuang's heat and clears long-standing Lung heat, making it the correct treatment for wind-heat Feilao cough, hence the immediate effect. Long-term use is required to eradicate the root. The safety of long-term Mahuang and Shigao use lies in the following: entrenched wind pathogens require repeated dispersal to exit; Shigao acts as a counter-agent (fan zuo), confining Mahuang's action to the Lung rather than forcing it to the surface as sweat, preventing adverse effects from prolonged Mahuang use. Although Shigao is cold, its heavy texture and light aroma mean it contains no viscous fluid ("no fluid implies no substance"). Its light, cool qi exits with Mahuang's exterior-releasing power, avoiding retention in the Middle Jiao to damage the Spleen/Stomach, explaining the safety of prolonged Shigao use. Such cases require this specific method and medication.