Library

Gancao (Zhi) (Prepared Glycyrrhizae Radix et Rhizoma) liang, Fuzi (Pao, Qu Pi, Po) pieces, Guizhi liang, Baizhu.
The above four ingredients are boiled with six sheng of water until three sheng remain. The dregs are removed, and one sheng is taken warm, three times a day. If mild sweating occurs after the first dose, the condition resolves, and appetite returns. If sweating stops but restlessness recurs, take five he. If one sheng is considered too much, it is advisable to take six or seven he instead.

[Formula Analysis]
For the treatment of Wind-Dampness, Gancao Fuzi Tang (Licorice and Aconite Decoction) is used. This formula is derived from Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) by removing Jiang (Ginger) and Zao (Jujube), and adding Baizhu (Atractylodis Macrocephalae Rhizoma). Ginger and Jujube are removed out of fear that they might assist in inducing excessive sweating. Baizhu is added to dry the dampness in the middle jiao. Taken three times a day, if the initial dose of one sheng does not induce sweating and resolve the condition, another full dose may be taken. If mild sweating occurs and the condition resolves, allowing for normal appetite, this indicates complete resolution, and further doses should be stopped. If sweating occurs followed by restlessness, it indicates incomplete resolution, and medication should continue; however, another full sheng should not be taken, as previous sweating has already occurred, and overdosing may lead to excessive sweating. Taking five he is appropriate. If the condition remains unresolved, taking six or seven he is optimal. This dosing method demonstrates the principle that one should not necessarily consume the entire prescribed amount. Students who do not fully understand the rationale can find the answer within the text itself.

Taiyang Zhongre (Heatstroke affecting the Taiyang channel) is referred to as Ye (Heatstroke). The patient presents with sweating, aversion to cold, fever, and thirst.

[Annotation]
Heatstroke also enters via the exterior of the Taiyang channel, hence it is stated: "Taiyang Zhongre is Ye." The symptoms of sweating, aversion to cold, fever, and thirst closely resemble Taiyang Warmth disease. However, Warmth disease lacks aversion to cold because the heat originates internally; thus, although sweating occurs, there is no aversion to cold. In Heatstroke, aversion to cold exists because summer-heat enters from the exterior, causing sweating accompanied by aversion to cold. Regarding the pulse, the floating pulse in Warmth disease must be floating and excess (solid); in Heatstroke, the floating pulse must be floating and deficient, because summer-heat damages Qi. Regarding thirst, in Warmth disease, early-stage illness involves only a desire to drink water; in Heatstroke, intense thirst requiring large amounts of drinking water appears immediately upon onset. Warmth disease transmits through the meridians with varied pathological changes, whereas Heatstroke does not transmit; if not cured, it leads to death. Although both are diseases of the Taiyang channel, their deficiency and excess nature require different treatments; Ren Shen Baihu Tang (Ginseng and White Tiger Decoction) should be primarily used.

[Collected Notes]
Fang Youzhi states: Steaming heat is called Shu (Summer-heat); injury by summer-heat is called Ye. Sweating with aversion to cold indicates instability of the Taiyang exterior. Fever indicates that Shu pathogen damages Yang. Thirst indicates loss of Jin-Ye (Body Fluids) leading to internal dryness.
Cheng Zhi states: This distinguishes the pulse and symptoms of Summer-heat. "Taiyang Zhongre" refers to a Taiyang exterior syndrome belonging to internal heat. Both are Taiyang exterior diseases: those with sweating, aversion to cold, fever, but no thirst are Wind-Strike; those with sweating, fever, thirst, but no aversion to cold are Warmth disease. Now, with sweating, aversion to cold, fever, and thirst, it is Heatstroke. Ye refers to the Qi of Summer-heat. It mentions "Re" (Heat) rather than "Ye" because Stomach heat is particularly severe. Internal heat causes fever and thirst; Summer-heat damages Qi, causing sweating and aversion to cold.
Wu Renju states: One should not use Acrid-Warm herbs due to aversion to cold, nor consolidate the exterior due to sweating; rather, Sweet-Cold herbs should be used to resolve Summer-heat.

@@@
Taiyang Zhongye (Heatstroke affecting the Taiyang channel) presents with fever, aversion to cold, heaviness of the body, and pain. The pulse is wiry, thin, knotted, and slow. After urination, there is a sensation of chills and goosebumps. The hands and feet are cold. Upon slight exertion, the body becomes hot. The mouth opens, and the anterior teeth become dry. If diaphoresis is induced, aversion to cold worsens. If warm needle therapy is applied, fever intensifies. If purgatives are frequently administered, strangury worsens.

[Annotation]
This elaborates on the previous clause, detailing the symptoms and pulse, and warns against indiscriminate use of diaphoresis, purgation, or warm needle therapy. Taiyang Zhongye without sweat, with body heaviness and pain, resembles Cold Damage; however, the wiry, thin, knotted, and slow pulse is not characteristic of Cold Damage. Furthermore, the symptom of chills and goosebumps after urination indicates that the exterior Qi of the Taiyang Bladder is damaged by Summer-heat. Cold hands and feet occur because Summer-heat damages Qi, preventing it from reaching the limbs, resulting in coldness. Slight exertion causing fever, opening the mouth, and drying of the anterior teeth indicates that exertion generates heat, exacerbating Summer-heat and damaging Yin fluids. These are all critical signs of Heatstroke. If fever without sweat, aversion to cold, and body pain are mistaken for the exterior syndrome of Cold Damage and diaphoresis is wrongly induced, the exterior Qi becomes more deficient, and aversion to cold worsens. If cold hands and feet are mistaken for Yang deficiency and warm needles are wrongly applied, the Summer-heat pathogen becomes more vigorous, and fever intensifies. If high fever and dry teeth are mistaken for Stomach fire and purgatives are frequently administered, the source of water becomes depleted and obstructed, leading to severe strangury. All these conditions result from improper use of diaphoresis, purgation, or warm needles in Heatstroke cases. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be primarily used. Alternatively, Ren Shen Tang (Ginseng Decoction) mixed with Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) may also be used.

[Collected Notes]
Cheng Wuji states: The Classic says: "Due to Summer-heat sweating,烦躁 leads to panting and loud breathing." Opening the mouth refers to panting and loud breathing. Continuous panting leads to dryness of the anterior teeth.
Cheng Zhi states: Human Yang escapes outward through sweat; human Yin is exhausted internally by heat. Therefore, diaphoresis, purgation, and warm needles are contraindicated in Ye syndromes, as sweating damages Yang, purgation damages Yin, and warm needles draw fire inward.
Zhang Xiju states: "Sasa" describes the appearance of aversion to cold. "Mao song" means the hair stands erect.

@@@
Taiyang Zhongye presents with fever, heaviness, and pain, with a weak and faint pulse. This is also caused by injuring oneself with cold water in summer, where water qi circulates within the skin.

[Annotation]
In Taiyang Zhongye, fever, heaviness, and pain indicate that Summer-heat damages the形体 (physical form); a weak and faint pulse indicates that Summer-heat damages Qi. Based on these symptoms and pulse, it is likely that during the height of summer, the person enjoyed cool breezes and drank excessive cold water. Water qi circulated within the skin, the exterior was constrained by pathogens, and sweat could not be excreted. At this time, Xiangru Yin (Elsholtzia Decoction) or Da Shun San (Great Smooth Powder) should be used to induce sweating, leading to immediate recovery. If left untreated, water qi cannot be excreted from the exterior, leading to edema, and inevitably attacks the interior, causing wheezing and distension. In such cases, Tingli Dazao Tang (Lepidii Fructus and Jujube Decoction) or Goudi Yiwu San (Momordica Seed Single-Ingredient Powder) should be used to purge. The previous clause warned against diaphoresis and purgation; this clause indicates when diaphoresis and purgation are appropriate. Zhang Zhongjing's methods often follow this pattern, fearing that practitioners might adhere rigidly and act inappropriately.

[Collected Notes]
Fang Youzhi states: Fever, heaviness, and pain, attributed to summer cold water injury and water circulating in the skin, occur because Earth governs muscles and dislikes dampness; water seeps into Earth and evaporates. A weak and faint pulse indicates that heat dries blood and consumes Qi. Drinking water in summer is common, so why is it called injury? Indeed, due to Summer-heat pressure, excessive drinking occurs, or bathing in cold water causes Summer-heat to enter internally.
Zhang Lu states: According to the three discussions on Ye: The first discusses illness obtained through movement, called Zhongye, belonging to external causes; the second discusses illness obtained through stillness, also called Zhongye but actually Shu Bing (Summer-heat disease), belonging to internal causes; the third discusses illness caused by heat injuring cold, which is a variant of Zhongye, belonging to neither internal nor external causes. These three should not be conflated.
Cheng Yingmao states: It can be seen that in Zhongye, Yang Qi is mostly at the exterior, while the Stomach is deficient and cold, causing fever, heaviness, pain, and a weak pulse. Drinking cold water in summer causes interior Yin to stagnate and block exterior Yang, preventing water qi from being excreted and causing it to circulate in the skin. This case involves resolving stagnation and promoting Yang, adding another aspect to the understanding of Ye syndromes.

Phonetic Guide
Ji sounds like Shu
Bo sounds like Tuan
Che sounds like Che
Ye sounds like Ye
Sa pronounced as Suo Xia Qie