Library

Dried Ginger (Ganjiang, 干姜) one tael, Aconite Root (Fuzi, 附子) (peeled, used raw, broken into eight pieces) one piece.
These two ingredients, with three sheng of water, are boiled to obtain one sheng of decoction. The dregs are removed, and the liquid is taken in a single dose.

@@@
If sweating or purgation has been applied but the disease remains unresolved, and irritability (Fan Zao, 烦躁) occurs, it should be treated with Poria Four-Inverse Decoction (Fuling Sini Tang, 茯苓四逆汤).
[Annotation]
This statement follows the previous one. Applying sweating first and purgation subsequently does not violate therapeutic principles; the disease should resolve but fails to do so, instead presenting with irritability. This distinction clarifies the treatment approach. Excessive sweating and purgation have led to deficiency in both exterior and interior, with excess Yin repelling Yang. Consequently, this chaotic state manifests day and night. One should employ Four-Inverse Decoction (Sini Tang, 四逆汤) to strengthen Yang and overcome Yin, add Poria (Fuling, 茯苓) to suppress Yin pathogens, and use Ginseng (Renshen, 人参) as an assistant to support healthy Qi. Thus, Yang grows while Yin diminishes, healthy Qi returns, pathogens recede, the disease resolves, and irritability subsides. In the syndrome of Major Ephedra Decoction (Da Qinglong Tang, 大青龙汤), irritability without sweating belongs to excess, occurring before any sweating or purgation. In this case, irritability following unresolved disease after sweating and purgation belongs to deficiency. However, superficial-tight pulse versus deep-micro pulse naturally require differentiation to prevent misdiagnosis, hence the earnest explanation.
[Collected Annotations]
Wang Hu stated: In cold damage, sweating or purgation should stop irritability and resolve the disease. If irritability stems from excess Yin, forcing sweat leads to loss of Yang at the exterior; subsequent purgation leads to loss of Yin at the interior. With Wei-Yang unprotected and Ying-Yin empty inside, pathogens remain unresolved, generating new irritability. This is false heat manifesting as deficiency irritability. Only warming and tonification are suitable; dispersing pathogens is inappropriate. Hence, Poria Four-Inverse Decoction is used.

Poria (Fuling, 茯苓) six taels, Ginseng (Renshen, 人参) one tael, Licorice Root (Gancao, 甘草) (roasted) two taels, Dried Ginger (Ganjiang, 干姜) one and a half taels, Aconite Root (Fuzi, 附子) (used raw, peeled, broken into eight pieces) one piece.
These five ingredients, with five sheng of water, are boiled to obtain three sheng of decoction. The dregs are removed, and seven ge of the warm decoction are taken per dose, three times daily.
[Formula Analysis]
When diseases of the exterior and interior are treated improperly—excessive sweating followed by excessive purgation, or purgation followed by sweating—errors compound, resulting in complicated diseases (Huai Bing, 坏病). If the patient's Yang is abundant and transforms into heat, the disease shifts to the Three Yang meridians; if Yang is deficient and transforms into cold, it involves the Three Yin meridians. The irritability described in these two clauses belongs to complicated diseases. Irritability can occur in all Six Meridians but is most common in Taiyang and Shaoyin, as Taiyang is the branch of True Yin and Shaoyin is the root of True Yang. Irritability before sweating/purgation usually indicates Yang excess (pulse solid-large, symptoms of heat/thirst); here, "fan" (vexation) is Yang excess, and "zao" (restlessness) is Yin deficiency. Irritability after sweating/purgation usually indicates Yin excess (pulse deep-micro, symptoms of sweating/cold limbs); here, "fan" is Yang deficiency, and "zao" is Yin excess. Purging then sweating is therapeutically adverse. Without significant external heat or internal vomiting/thirst, it seems Yin and Yang harmonize, but actually reflects Yang deficiency and Yin excess. Deficient Yang disturbs the Yang aspect, causing daytime irritability and insomnia; Excess Yin dominates the Yin aspect, causing nighttime quietness. A deep-micro pulse indicates impending collapse of True Yang. Dried Ginger and Aconite strengthen Yang to match Yin. Ginger and Aconite are "Yang within Yang"; using them first sharpens their force, and omitting Licorice makes their action more fierce than Four-Inverse Decoction, which is necessary for urgent rescue of separated Yin and Yang. Sweating then purging is therapeutically smooth. Unresolved disease with sudden increase in day-and-night irritability also reflects Yin excess repelling Yang. Poria Four-Inverse Decoction suppresses Yin to restore Yang. Poria absorbs the Qi of Great Harmony, draining Water pathogens without damaging Yang, serving as the Sovereign herb. Ginseng generates Qi from non-existence and unblocks blood vessels at the verge of collapse, serving as an Assistant. Ginseng combined with Ginger/Aconite tonifies Qi and benefits Fire; Ginger/Aconite combined with Poria tonifies Yang and drains Yin. Harmonized with Licorice, it is milder than Four-Inverse Decoction, suitable for gradual resolution of mutual repulsion. Removing Licorice and adding Ginseng/Poria distinguishes urgency from slowness. Such is the subtlety of Zhang Zhongjing's formula usage.

@@@
In Taiyang disease, if purgation is applied first without cure, followed by sweating, the exterior and interior become deficient. The patient may experience "Mao" (dizziness/mental clouding). If the patient sweats, they will heal spontaneously. This is because sweating harmonizes the exterior. If the interior remains unharmonized, purgation may be applied subsequently.
[Annotation]
Taiyang exterior disease requires sweating. If purgation is used first and cures the disease, followed by sweating, the exterior and interior become deficient, leading to mental clouding due to deficiency. "Mao" refers to any condition causing mental cloudiness due to illness. Some cases of Mao resolve with spontaneous sweating because pathogens and healthy Qi both decline, allowing natural harmony of exterior and interior. Resolution via sweating harmonizes the exterior; resolution via diarrhea harmonizes the interior. If the interior is unharmonized, purgation is appropriate, specifically Stomach-Regulating Chengqi Decoction (Tiaowei Chengqi Tang, 调胃承气汤). By inference, if the exterior is unharmonized, sweating is appropriate, likely using Cinnamon Twig Decoction (Guizhi Tang, 桂枝汤), implied but not stated.
[Collected Annotations]
Cheng Zhi stated: Mao implies unclear consciousness, as if covered by an object. Sweating harmonizes the exterior and resolves pathogens. If the exterior is harmonized but the interior is not, purgation follows. One must not mistake Mao for interior pathogens and purge blindly, nor assume unresolved exterior and sweat blindly.
Wang Hu noted: The term "interior" in "interior unharmonized" refers to bowel movements. Since the text says "purge," it specifically refers to stool, not urine. The meaning is self-evident.

@@@
For any disease, whether treated by sweating, vomiting, purgation, or involving blood/fluid loss, if Yin and Yang naturally harmonize, the disease will surely heal itself.
[Annotation]
"All diseases" includes wind-strike and cold damage. If treatments like sweating, vomiting, purgation, or conditions like blood/fluid loss are managed appropriately, healing occurs naturally. Even if treatment is suboptimal and no immediate cure is seen, complications are avoided as pathogens and healthy Qi decline. No further treatment is needed; one waits quietly. If diagnosis shows natural Yin-Yang harmony, self-healing is certain.
[Collected Annotations]
Fang Youzhi stated: Yin and Yang refer to pulses, including bowel/bladder function. Harmony between them ensures balanced Qi and Blood, guaranteeing self-healing.
Cheng Zhi stated: A pulse with even left/right sections indicates health. After sweating/vomiting/purgation, if Yin and Yang harmonize, self-healing occurs without over-treatment.

@@@
Question: Why does a patient shiver then sweat, leading to resolution? Answer: A floating-tight pulse that feels hollow upon pressure indicates underlying deficiency. Therefore, shivering and sweating occur for resolution. The patient's underlying deficiency causes shivering; the floating pulse indicates sweating will lead to resolution. If the pulse is floating-numerous and not hollow upon pressure, the patient is not deficient. Resolution will occur via sweating alone, without shivering. Question: Why does a patient resolve without shivering but with sweating? Answer: A large, floating, numerous pulse indicates resolution without shivering. Question: Why does a patient resolve without shivering or sweating? Answer: A faint pulse indicates prior sweating, vomiting, purgation, or blood loss, leading to internal fluid depletion. Natural Yin-Yang harmony ensures self-resolution without shivering or sweating.
[Annotation]
Floating-tight pulse indicates pathogen excess; hollow pressure indicates healthy Qi deficiency. Deficiency of Zheng and excess of Xie cause conflict, leading to shivering and sweating for resolution. Floating-numerous pulse without hollow pressure indicates neither pathogen excess nor Zheng deficiency; thus, no conflict, resolving via sweating without shivering. Faint pulse indicates prior treatment or fluid loss. Internal fluid depletion leads to decline of both Xie and Zheng, allowing Yin-Yang harmony and resolution without shivering or sweating.

@@@
Question: In cold damage on the third day, why does a patient with floating-numerous-faint pulse and cool body indicate impending resolution? Answer: This signifies impending resolution. Resolution occurs at midnight. Floating pulse resolution presents as continuous sweating; numerous pulse resolution indicates ability to eat; faint pulse resolution presents as heavy sweating.
[Annotation]
Floating-numerous pulse with weak pressure requires shivering/sweating due to underlying deficiency. Strong pressure indicates no shivering, only sweating, due to lack of deficiency. Faint pulse indicates prior treatment or fluid loss, resolving without shivering/sweating due to Yin-Yang harmony. On the third day of cold damage, without prior sweating/vomiting/purgation or blood loss, a floating-numerous-faint pulse with reduced heat and harmonious body indicates impending resolution. Midnight resolution occurs because Yang diseases harmonize during Yin hours. While floating, numerous, and faint pulses all suggest resolution, the signs differ. Floating pulse with continuous sweating indicates pathogens returning to the exterior. Numerous pulse with appetite indicates stomach harmony. Faint pulse with heavy sweating indicates sufficient fluids and lack of deficiency, allowing robust resolution.
[Collected Annotations]
Fang Youzhi stated: "Three days" covers the Three Yang meridians. Floating-numerous indicates no transmission to Yin. Faint indicates declining pathogens. Midnight is when Yin ends and Yang begins. "Continuous sweating" describes harmonious perspiration. "Ability to eat" indicates return of Stomach Qi.

@@@
In unresolved Taiyang disease, if both Yin and Yang pulses cease (stop), the patient will first tremble and shake, then sweat to resolve. If only the Yang pulse is faint, sweating resolves it. If only the Yin pulse is faint, purgation resolves it. For purgation, Stomach-Regulating Chengqi Decoction (Tiaowei Chengqi Tang, 调胃承气汤) is appropriate.
[Annotation]
Unresolved Taiyang disease should show specific pulses. Absence of these, with Yin/Yang pulses ceasing (deep/faint/unfelt), suggests a critical state. However, absence of death signs indicates impending resolution. Resolution requires trembling/shaking followed by sweating, caused by Xie-Zheng conflict. The resolving pulse cannot stay ceased; its emergence has precursors. If the Yang pulse (Cun position) emerges faintly, the pathogen moves outward, resolving via sweating. If the Yin pulse (Chi position) emerges faintly, the pathogen moves inward, resolving via diarrhea. If diarrhea does not occur spontaneously, purgation with Tiaowei Chengqi Tang harmonizes the interior. By inference, if sweating does not occur spontaneously, sweating with Mahuang Guizhi Half-Decoction (Mahuang Guizhi Ban Tang, 麻黄桂枝半汤) harmonizes the exterior. The phrasing "if purgation is desired" implies mild intervention, not drastic purgation.
[Collected Annotations]
Cheng Yingmao stated: Trembling/sweating resolution applies only to ceased pulses. The subsequent resolutions apply to gradually emerging pulses, not necessarily involving shivering.

@@@
In cold damage, abdominal fullness and delirium with a floating-tight Cun Kou pulse indicate Liver attacking Spleen, named "Zong" (Vertical). Acupuncture Qimen (LR14).
[Annotation]
Floating-tight pulse in cold damage is Taiyang exterior cold. Abdominal fullness and delirium are Taiyin/Yangming interior heat. Sweating (for Taiyang) conflicts with interior presence; purging (for Taiyin/Yangming) conflicts with exterior presence. Treatment is difficult, hence acupuncture is used instead of herbs. Although Guizhi Plus Rhubarb Decoction (Guizhi Jia Dahuang Tang, 桂枝加大黄汤) treats Taiyang exterior with Taiyin abdominal pain, this case of Liver attacking Spleen ("Zong") at Qimen seems disconnected from the preceding context, possibly a textual error.

@@@
In cold damage, fever, aversion to cold, extreme thirst with desire to drink, abdominal fullness, spontaneous sweating, and free urination indicate impending resolution. This is Liver attacking Lung, named "Heng" (Horizontal). Acupuncture Qimen (LR14).
[Annotation]
Fever and aversion to cold without sweating is exterior. Extreme thirst and abdominal fullness indicate retained fluid. Spontaneous sweating resolves the exterior; free urination removes fullness. Thus, the disease resolves. If no sweating and closed urination, Xiao Qinglong Decoction (Xiao Qinglong Tang, 小青龙汤) resolves the exterior first; if fullness persists, Shizao Decoction (Shizao Tang, 十枣汤) purges. This Liver attacking Lung ("Heng") at Qimen also seems disconnected, possibly a textual error.

@@@
Taiyang disease tends to resolve from Si hour to Wei hour.
[Annotation]
Diseases resolve when their meridian Qi is prosperous. Taiyang is盛 Yang. Yang Qi is abundant at noon; thus, resolution occurs during the prosperous hours of Si, Wu, and Wei.

Phonetics
Ti sounds like Ti □ Ri Lun Qie Pi Pang Ji Qie Li sounds like Li Sou Suo Liu Qie □ Zhi Lian Qie Ye Yi Jie Qie Rao Yin Rao
Kou Ku Hou Qie Ji Zu Li Qie