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(Attachment: Treatment methods for weak pulse, sweating, aversion to wind, and muscle twitching/trembling)
When the pulse of Taiyang Wind Strike (Taiyang Zhong Feng) is present, accompanied by the pulse characteristics of Taiyang Cold Damage (Taiyang Shang Han), this constitutes the syndrome primarily treated by Da Qing Long Tang (Great Blue Dragon Decoction).
The original text of *Shanghan Lun* states: In Taiyang Wind Strike, if the pulse is floating and tight, with fever, aversion to cold, body pain, absence of sweating, and restlessness, Da Qing Long Tang should be administered. However, if the pulse is weak and faint, with sweating and aversion to wind, it must not be taken; taking it will result in cold extremities (Jue Ni) and muscle twitching/trembling (Jin Ti Rou Gu), which constitutes a therapeutic error (Ni).
[Formula for Da Qing Long Tang] Mahuang (Ephedrae Herba) 6 liang, stripped of nodes; Guizhi (Cinnamomi Ramulus) 2 liang, stripped of bark; Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang, honey-fried; Xingren (Armeniacae Semen Amarum) 50 pieces, stripped of skin and tips; Shengjiang (Zingiberis Rhizoma Recens) 3 liang, sliced; Dazao (Ziziphi Jujubae Fructus) 12 pieces, torn open. Shi Gao (Gypsum Fibrosum) the size of a chicken egg, crushed (a piece of gypsum the size of a chicken egg corresponds approximately to 3 liang in modern measurement).
Take the above seven ingredients, add nine sheng of water, first decoct Mahuang until two sheng are reduced, skim off the foam on the surface, then add the remaining herbs. Decoct until three sheng remain, strain the dregs, and take one sheng warm. Aim for a slight sweat. If sweating is excessive, apply Wen Fen (warm powder) to the body to stop sweating. If sweating occurs after the first dose, discontinue subsequent doses. Excessive sweating leading to Yang collapse and deficiency may cause aversion to wind, restlessness, and insomnia.
This syndrome indicated by Da Qing Long Tang originally involves latent heat accumulating in the chest, bound by wind-cold on the exterior, causing the internal heat to accumulate to an extreme degree and seek to escape outward. Regarding the binding wind-cold, there was concern that the bitter-descending and sour-astringent nature of Shaoyao (Paeoniae Radix Alba/Rubra) might hinder sweating. Therefore, Shi Gao (Gypsum Fibrosum) is used instead, in larger quantities to enhance efficacy. The pungent-dispersing and cool-moistening nature of Shi Gao can both assist Mahuang and Guizhi in reaching the exterior and effectively transform the accumulated heat in the chest into sweat, which exits with the penetrating action of Mahuang and Guizhi. This resembles clouds rising to produce rain, hence the name "Great Blue Dragon." As for cases with weak pulse, sweating, and aversion to wind, these originally stem from deficiency and damage of the Great Qi (Da Qi) in the chest, failing to secure the Wei Qi (Defensive Qi). Even if heat is present, it is floating Deficient Yang. Misadministration of Da Qing Long Tang will exacerbate the deficiency, causing Yuan Yang (Primal Yang) to collapse due to extreme Qi deficiency, thereby stirring Liver Wind and resulting in muscle twitching/trembling. Since Da Qing Long Tang is contraindicated, a different treatment method is required for such cases. I propose using Sheng Huangqi (Astragali Radix) and Sheng Baishao (Paeoniae Radix Alba) each at 5 qian, and Mahuang (Ephedrae Herba) at 1.5 qian, decocted and taken once. Here, Mahuang expels external pathogens, Huangqi tonifies Qi deficiency, and Baishao clears deficient heat. Because Huangqi supplements the Qi aspect, Mahuang can still be used in small amounts. If a patient has already mistakenly taken Da Qing Long Tang, resulting in profuse sweating, Yang collapse, and muscle twitching/trembling, remove Mahuang from the formula and add Jing Yurou (Corni Fructus) at 1 liang.
The original text of *Shanghan Lun* states: In Shanghan (Cold Damage), if the pulse is floating and slow, the body does not ache but feels heavy, occasionally feeling lighter, and there are no Shaoyin syndrome signs, Da Qing Long Tang can be used to induce sweating.
Upon careful reflection of this passage, it is evident that the described syndrome is originally Wenyi (Warm Disease). The prefix "Shanghan" is used because, according to the conventions of this book, both Zhongfeng (Wind Strike) and Wenyi can be termed Shanghan. Most external contraction pulses are floating because they often involve Wind Strike. The previous section mentioned Shanghan with a floating-tight pulse, indicating the pathogen was biting cold wind, constituting Wind Strike combined with Cold Damage. The latter section mentions Shanghan with a floating-slow pulse, indicating the pathogen was not biting cold wind but gentle warm wind. Contracting gentle warm wind leads to Fengwen (Wind-Warmth). Thus, for a disease classified as Shanghan, Shi Gao (Gypsum Fibrosum) is used only if there is chest restlessness. For Wenyi, even without chest restlessness, Shi Gao can often be used. Furthermore, the symptom of body heaviness without pain aligns with the description in the sixth section's outline of Wenyi in *Shanghan Lun*, providing clear evidence. Moreover, since the symptoms occasionally lighten, if it were Shanghan, Shi Gao would not be heavily used; however, in Wenyi, even with occasional relief, heavy use of Shi Gao is permissible. Additionally, if early-stage Shanghan presents with Shaoyin signs, Wenyi never presents with Shaoyin signs throughout (Shaoyin syndromes include both cold and heat; here, "no Shaoyin signs" refers specifically to Shaoyin Cold Syndrome. Shaoyin Cold Syndrome absolutely contraindicates Da Qing Long Tang. However, Shaoyin Heat Syndrome, arising from latent heat transforming and invading Shaoyin, can be treated with Da Qing Long Tang even in early stages; this distinction must be known). This further confirms it is Wenyi rather than Shanghan. From this perspective, this section provides guidance for treating Wenyi, emphasizing the urgent need to clear dry-heat to preserve True Yin. When I use this formula to treat Wenyi, I often substitute Bohe (Menthae Haplocalycis Herba) for Guizhi (Cinnamomi Ramulus), which is particularly safe.
For all drugs used to induce sweating, whether cooling or heating, suitability to the disease is paramount. For initial cold diseases, hot drugs should be used to induce sweating; for initial heat diseases, cooling drugs should be used. In the case of Da Qing Long Tang syndrome, if Mahuang Tang (Ephedra Decoction) were administered, it would be adding heat to heat, often failing to induce sweat. Even if sweat occurs, the disease will not resolve but restlessness will increase. Only by removing Shaoyao from Mahuang Tang/Guizhi Tang and heavily increasing Shi Gao (several times the amount of Mahuang and Guizhi) can its cooling, moistening, and light-dispersing nature combine with chest restlessness to naturally produce sweat. Assisted by Mahuang's ability to penetrate the exterior, sweat can be achieved throughout the body shortly after ingestion.
I once treated a patient who contracted Shanghan in winter, presenting with extreme chest restlessness. The physician failed to recognize this as a Da Qing Long Tang syndrome and administered Mahuang Tang. After ingestion, no sweat occurred, and chest restlessness intensified; the patient felt the room was too small to contain them. The pulse was洪滑 (surging, slippery, and floating). I treated with Da Qing Long Tang, adding Huafen (Trichosanthis Radix) at 8 qian. Five minutes after ingestion, the patient sweated profusely as if washed, and the illness seemed to vanish.
Someone asked: For those taking Guizhi Tang, slight perspiration is appropriate; sweating like flowing water must be avoided, otherwise the disease will not be cured. For those taking Mahuang Tang, slight perspiration is also sought, implying sweating like flowing water is also prohibited. Now, with Huafen added to Da Qing Long Tang, why does the patient sweat profusely yet recover completely? I reply: Excellent question. There is profound logic herein, revealed only by this inquiry. Both Shanghan and Wenyi must avoid damaging the Yin aspect. Guizhi Tang and Mahuang Tang prohibit excessive sweating to prevent Yin damage. However, in Da Qing Long Tang syndrome, dry-heat accumulates in the chest. Combined with large amounts of Shi Gao, this transforms into sweat. The deeper the dry-heat, the more sweat is produced. Unless thoroughly vented outward, the dry-heat cannot be completely cleared. Therefore, such sweat, once it starts, pours down like heavy rain, unstoppable. Generally, formulas like Mahuang Tang and Guizhi Tang use drugs to dispel disease; once slight sweat occurs, the drug's power suffices to overcome the disease, so excessive sweating to damage Yin is unnecessary. Da Qing Long Tang combines Mahuang and Guizhi, removes the astringent nature of Shaoyao, and adds the pungent-cool nature of Shi Gao. Its combination with the dry-heat in the chest is like pouring water on red-hot iron; the heat naturally expands vigorously. This harmonizes and regulates Yin and Yang, allowing spontaneous sweating. The subtle principle here differs vastly from the prohibition against excessive sweating in Guizhi and Mahuang Tangs.
Someone asked: Why does Da Qing Long Tang syndrome present with such intense heat in the chest right from the onset of the disease? I reply: This is a syndrome of latent heat transforming within Shanghan (Wenyi also features latent heat transformation; Shanghan does as well). Previously contracted external cold was mild, insufficient to cause immediate illness, but it lurked within the Sanjiao (Triple Burner) fatty membranes, obstructing the ascending and descending Qi dynamics. Over time, it transformed into heat. Later, triggered by a mild new external contraction, the heat suddenly erupted,窜入 (invading) the empty cavity of the chest, causing absence of sweating and restlessness. The chest is originally the domain of the Taiyang channel. Since the pathogen remains in Taiyang, despite the intensity of the heat, it can still be resolved through sweating.