Library

The pulse of malaria presents as slow, large, and deficient; it should be regulated with sweet medicines (Gan Yao). For all types of malaria where the pulse is imperceptible, pricking the ten fingertips to bleed will cure the disease once blood flows. Therefore, when the pulse does not emerge at the onset of illness, it is mostly caused by the stagnation and obstruction of Qi and Blood; there is no need for panic or to hastily administer warming and tonifying treatments, which would only lead to failure.

The human body feels cold not because of insufficient clothing, nor is there external cold in the middle jiao; why does cold generate from within? This is due to the presence of Bi Qi (obstructive pathogenic factors) in the person. The Kidney corresponds to Water and governs the bones; if the Kidney fails to function properly, Marrow cannot fill adequately, resulting in cold penetrating to the bones. Thus, both Qi Bi (Qi obstruction) and scant Essence can generate cold; one must not assume this is solely due to Yang deficiency.

For chronic diseases treated with acupuncture, needles should be inserted deeply and retained for a long time, with treatment repeated every other day. One must first regulate the Qi and Blood on the left and right sides, removing stasis from the vessels. I consider this the principle of acupuncture, which can be extended to the application of herbal medicine. Because the disease has penetrated deeply, deep insertion is necessary; because Yin Qi is difficult to mobilize, long retention is required. Treating every other day allows the Zheng Qi (Upright Qi) to rest and recover. Regulating the left and right, and removing vessel stasis, aims to treat areas not yet diseased, ensuring smooth circulation of Qi and Blood. Using pill-form drugs to attack the pathogen, and sweet medicines to nourish the upright Qi, alternating administration without seeking rapid results, aiming for balance, completes the principles of medication.

Wind is a Yang pathogen that moves upward; Wei Qi (Defensive Qi) is Yang Qi that governs the exterior. When a Yang pathogen follows Yang Qi, the Qi becomes floating; hence it is said, "When the Yang pulse floats, heat spontaneously arises." Yang becomes hyperactive due to wind, while Yin, lacking pathogenic interference, appears weak. Weakness following strength leads to Qi deficiency; hence it is said, "When the Yin pulse is weak, sweat spontaneously exits."

In Shanghan (Cold Damage), fever occurs because Yang Qi is depressed and cannot extend; in Fengzhong (Wind Strike), fever occurs because Yang Qi is drawn outward and floats. Depressed Yang must be dispersed; floating Yang requires more than just releasing the exterior. This is why Guizhi Tang (Cinnamon Twig Decoction) combines harmonizing Yin and Yang with opening and dispersing actions.

Zhang Zhongjing's theory of "Wei Strong and Ying Weak" merely elucidates the causes of fever and sweating. Later scholars failed to examine this carefully, leading to distinctions such as wind merging into Wei causing Wei Excess and Ying Deficiency, or cold entering Ying causing Ying Excess and Wei Deficiency. They did not realize that pathogens enter from the skin and hair into the muscles; whether Wind Strike or Cold Damage, none fail to affect Wei, and severe cases affect Ying as well. This aligns with Guo Baiyun's statement regarding pathogens moving from Wei to Ying. If Wei is diseased but Ying is harmonious, sweat occurs spontaneously; if both Ying and Wei are diseased, there is no sweat. No sweat requires diaphoresis; Mahuang Tang (Ephedra Decoction) removes exterior excess and expels pathogens. Sweat precludes further diaphoresis; Guizhi Tang assists exterior Qi and drives out pathogens. Students should distinguish between symptomatic sweating and non-sweating to strictly apply Mahuang Tang and Guizhi Tang, rather than obsessing over the deficiency or excess of Ying and Wei to differentiate Cold Damage from Wind Strike. Moreover, if no sweat indicates Exterior Excess, how can it be called Wei Deficiency? Does Mahuang Tang's removal of excess neglect Wei? Those who do not adhere to common misconceptions are truly outstanding scholars. Ying and Wei are originally harmonious; when Wei is attacked by pathogens and becomes hyperactive, while Ying lacks pathogens but appears weak, the disparity between pathogen and upright Qi, and the difference in strength levels, make harmony impossible; thus it is said, "When Ying Qi is harmonious internally, it is not harmonious externally."

Shanghan establishes three main categories: Guizhi Tang treats Wind injuring Wei; Mahuang Tang treats Cold injuring Ying; Da Qing Long Tang (Major Blue Green Dragon Decoction) treats Wind and Cold injuring both Ying and Wei. This theory began with Xu Shuwei and was completed by Fang Zhongxing and Yu Jiayan. In my view, Guizhi Tang treating Wind injuring Wei is correct, but Mahuang Tang treating Cold injuring Ying is incorrect. There are cases where Wei is diseased but Ying is not, but never cases where Ying is diseased but Wei is not. Regarding Da Qing Long Tang, its formulation intent adds Shi Gao (Gypsum Fibrosum) specifically due to irritability. As Wang Wenlu stated, this addresses heavy Wind-Cold closing heat in the meridians, adding Gypsum to dispersing herbs. If it were merely concurrent Wind-Cold, Mahuang and Guizhi would suffice; why add Gypsum?

Cold pathogens close the skin pores and depress Yang Qi, causing fever without sweat. Mahuang and Xingren (Apricot Seed) open Lung Qi and release the Cou Li (pores/cutaneous interstices). Guizhi and Gancao (Licorice Root) serve the purpose of acrid-sweet dispersion. Wind pathogens cannot externally close Yang Qi but instead internally disturb Yin Qi, causing spontaneous sweat. Shaoyao (Peony Root) is used to rescue Ying Qi. Books stating that Wind injures Wei while Ying remains unaffected, and thus Shaoyao is given to calm Ying, are still somewhat inaccurate.