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Da Huang (Rhei Radix et Rhizoma, washed with wine) 4 liang Hou Po (Magnoliae Officinalis Cortex, roasted, skin removed) 8 liang Zhi Shi (Immature Bitter Orange, roasted) 5 pieces Mang Xiao (Natrii Sulfas) 3 he
The above four ingredients are decocted in one dou of water. First, boil Hou Po and Zhi Shi to obtain five sheng of liquid, then strain out the dregs. Add Da Huang and continue boiling until two sheng of liquid remain. Strain out the dregs again, add Mang Xiao, and heat over a fire until it boils slightly for one or two rolls. Divide into two doses and take warm. Stop taking if bowel movement is achieved.
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Taiyang disease (disease caused by pathogenic factors invading the Taiyang channel) with complete symptoms, stiffness of the body, and a stiff, awkward sensation in the neck and back making flexion and extension difficult, accompanied by a pulse that is unexpectedly deep and slow, is termed Jing disease (a disease characterized by stiffness of the neck and back, spasms of the limbs, and even opisthotonos). It should be treated with Gualou Guizhi Tang.
[Annotation]
"Complete symptoms of Taiyang disease" refers to the presence of headache, stiffness of the neck, fever, aversion to wind and cold. The additional symptom of body stiffness with an awkward inability to move freely characterizes Jing disease. However, the pulse is unexpectedly deep and slow, which corresponds to the spleen-deficiency pulse of the Taiyin channel, differing from the floating-tight, anhidrotic rigid Jing syndrome of Taiyang. Therefore, Gegen Tang is not used; instead, Gualou Guizhi Tang is prescribed to harmonize the exterior of Taiyang and clear the interior of Taiyin.

Gualou Gen (Trichosanthis Radix) 2 liang Guizhi (Cinnamomi Ramulus) 3 liang Shaoyao (Paeoniae Radix Alba) 3 liang Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang Shengjiang (Zingiberis Rhizoma Recens) 3 liang Dazao (Jujubae Fructus) 12 pieces
The above six ingredients are decocted in nine sheng of water until three sheng remain. Divide into three warm doses. Aim for a slight sweat. If no sweat occurs, after a short while, drink hot porridge to promote sweating.
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In Taiyang disease, if there is fever and the pulse is deep and fine, it is named Jing disease, which is difficult to treat.
[Annotation]
Fever is a manifestation of Taiyang disease. A deep and fine pulse indicates Shaoyin kidney involvement. The designation as Jing disease implies the presence of either rigid or flaccid Jing symptoms. The appearance of a Shaoyin pulse in Taiyang Jing disease signifies concurrent exterior and interior pathology. Pathogenic factors of Taiyang stagnating on the exterior cause fever; pathogenic factors of Shaoyin condensing on the interior cause the deep and fine pulse. Typically, a wiry-tight pulse is the proper pulse for Jing disease; even a deep-slow pulse may still be treatable. However, a deep and fine pulse indicates that pathogens have entered the Shaoyin and yang qi has declined, making treatment difficult. Hence, it is said to be hard to treat.
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If Wind disease is treated with purgatives, it leads to Jing disease; if sweating is subsequently induced, it will inevitably result in limb contracture.
[Annotation]
The Jing diseases discussed above are all caused by external contraction of wind, cold, and dampness. There are also cases where Wind disease is improperly treated with purgatives, damaging body fluids, or improperly treated with diaphoresis, damaging blood and fluids. This leads to dryness of body fluids and loss of nourishment to the sinews, resulting in Jing disease. Thus, it is stated: "Purgation in Wind disease causes Jing; subsequent sweating causes contracture." Such cases should not be treated as external-contracted Jing disease but rather with a focus on specifically nourishing body fluids.
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Taiyang disease, when excessive sweating is induced, can lead to Jing disease.
[Annotation]
This section elaborates on the mechanism of Jing disease caused by excessive sweating. Taiyang disease requires diaphoresis, but if done excessively, pores open widely, exterior qi becomes insecure, and pathogenic wind enters due to deficiency, causing Jing disease. This is invasion due to internal deficiency. It should be treated with Guizhi Jia Fuzi Tang to secure the exterior and warm the channels. By analogy, any condition involving excessive sweating, postpartum state, or severe bleeding from trauma leading to this syndrome belongs to this category.
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Sudden abdominal distension indicates impending resolution. If the pulse remains unchanged but becomes hidden and wiry, it is Jing disease.
[Commentary]
The six sentences "If sweating is induced..." under the first item of Jing disease in this chapter should be moved to the beginning of this item for logical coherence. The phrase "Sudden abdominal distension" in this item is likely a textual error and should be deleted.
[Annotation]
Not only does excessive sweating in Wind disease cause Jing, but excessive sweating in diseases of combined Cold and Dampness also causes Jing. Excessive sweating further weakens the exterior; exterior weakness leads to severe aversion to cold. After sweating in Cold-Damp disease, if the pulse is not straight and tight but relaxed like a curved snake, it indicates pathogen retreat and resolution. If the pulse remains straight and tight, or becomes hidden, firm, and wiry-tense, it indicates pathogen retention and development of Jing disease.
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Patients with sores/ulcers, despite body pain, should not undergo diaphoresis; inducing sweat will lead to Jing disease.
[Annotation]
At the initial stage of sores, when toxic heat has not fully formed, diaphoresis is indicated to disperse pathogens. After ulceration, qi and blood are damaged. Even if there are exterior symptoms like body pain, diaphoresis should be avoided. Sweating may exhaust blood further, depriving sinews of nourishment and causing Jing disease, or allow pathogenic wind to invade, also causing Jing.
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Jing disease with moxibustion sores is difficult to treat.
[Annotation]
Moxibustion is suitable for Jing disease. If moxa sores are present and do not suppurate, it indicates exhaustion of Ying and Wei qi, hence it is difficult to treat.
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Patients with Dampness disease suffer from whole-body pain, fever, and a yellowish discoloration of the body resembling smoked yellow.
[Annotation]
"Dampness patients" refer to those suffering from Dampness pathology. Dampness disease may arise from external exposure to Dampness, causing whole-body pain, or from internal generation of Dampness, causing fever and jaundice. When both internal and external factors are involved, there is whole-body pain, fever, and a smoked-yellow discoloration. The body pain and jaundice in Dampness disease differ from that in Cold Damage because it lacks the typical manifestations of the Six Channels.
[Collected Annotations]
Xu Bin states: This describes pure Dampness stagnating for a long time and transforming into Heat. If Dampness combines with Wind, Wind moves through orifices, so pain is localized in joints; here, pure Dampness permeates the body, causing widespread pain beyond just joints. Long-standing Dampness stagnates and generates Heat, causing fever. Prolonged Heat steams Qi onto the skin and hair, so where pain exists, Dampness exists, and where Dampness exists, Heat exists. The smoked-yellow color results from the smoky heat; Dampness smoldered by heat produces a dull, blackish-yellow hue.
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Dampness patients presenting with body pain, fever, yellow face, wheezing, headache, nasal congestion, and irritability, with a large pulse, normal appetite, and a harmonious abdomen without internal disease, have Cold-Damp in the head causing nasal congestion. Treatment involves inserting medication into the nose for cure.
[Annotation]
This clarifies the previous item, detailing the pulse and differentiating treatment. Body pain, fever, yellow face, and wheezing indicate combined internal and external Dampness. External treatment uses Qianghuo Shengshi Tang; internal treatment uses Yinchen Wuling San. For severe wheezing, Da Xianxiong Wan is used. If accompanied by headache, nasal congestion, and irritability with a large pulse, resembling Cold Damage, but with a harmonious interior and ability to eat, it is not Cold Damage and should not be treated with diaphoresis. It is Cold-Damp in the head causing nasal congestion. Only inserting medication into the nose is appropriate, allowing yellow fluid to drain with mucus, expelling Cold-Damp and curing the disease. Medications such as Gouti San may be used.
[Collected Annotations]
Wei Litong states: The head is the summit of all Yang channels and not a place easily invaded by Cold-Damp. The presence of Cold-Damp in the head implies Heat rising with it, driven by internal Damp-Heat. Heat attracts Dampness upward to disturb the clear orifices, causing nasal congestion. Nasal insertion of medication ventilates and unblocks clear Qi, leading to recovery.
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Dampness patients with vexatious body pain may use Mahuang Jia Zhu Tang to induce sweating, which is appropriate. Fire therapy must be strictly avoided.
[Annotation]
For Dampness patients with severe external body pain, Qianghuo Shengshi Tang is used; for severe internal jaundice, Yinchen Wuling San is used. If there is only vexatious body pain without jaundice, it is external Cold-Damp, treated with Mahuang Jia Zhu Tang to induce sweating, resolving both Cold and Damp. Fire therapy must be avoided because forcing heavy sweating via heat can cause adverse transformations.
[Collected Annotations]
Zhao Liang states: Combination of Dampness and Cold causes body pain. Generally, if exterior excess transforms into Heat, sweating is indicated. Without Heat, Yang Qi is weak, and sweating may further weaken the exterior. Although this case mentions no Heat but Vexation, Vexation arises from Heat, so heavy sweating after medication is contraindicated. Dampness can be dispersed by mild sweating. Mahuang Tang treats Cold, adding Zhu removes Dampness, aiming for mild sweating. Fire therapy increases Heat and causes other complications, hence caution is advised.
Yu Chang states: Mahuang Jia Zhu induces sweating without excessive perspiration, and Zhu combined with Mahuang can resolve Dampness in both exterior and interior. Fire therapy should be avoided as it exacerbates Fever.