Library

San Liao (3 qian), Gancao (Zhi) (2 qian), Fuzi (Pao, qu pi, po ba pian) (1 piece).
The above three herbs are boiled in five sheng of water until one sheng and five he remain. The dregs are removed, and the decoction is divided into two doses to be taken warm.

[Ji Jie]
Cheng Yingmao said: The method of inducing sweating for Shanghan was originally established to dispel cold. If the exterior syndrome has resolved but the patient feels more aversion to cold than before, it is evident that this is no longer an exterior pathogen. Since sweat leakage leads to deficiency of the defensive exterior, the main treatment is Shaoyao Gancao Fuzi Tang. When Shaoyao is combined with Guizhi, it releases the exterior; when combined with Fuzi, it tonifies the exterior. Gancao harmonizes the middle jiao and draws from the yin aspect to restrain yang. Once yang returns and deficiency is filled, the state of deficiency ceases to exist.
Aversion to cold after inducing sweating indicates deficiency; absence of aversion to cold but presence of heat indicates excess. One should harmonize the stomach qi and administer Tiaowei Chengqi Tang.

[Zhu]
In Shanghan, if sweating occurs and the disease resolves, there will be neither aversion to cold nor aversion to heat, which signifies recovery. If aversion to cold persists after sweating, it indicates yang deficiency, and Shaoyao Gancao Fuzi Tang is appropriate as the primary treatment. Now, if after sweating there is no aversion to cold but only aversion to heat, this indicates stomach excess. Therefore, Tiaowei Chengqi Tang is given to purge heat and harmonize the stomach.

[Ji Zhu]
Fang Youzhi said: Absence of aversion to cold after sweating indicates strong exterior qi. Heat alone, accompanied by loss of body fluids and dryness in the stomach, constitutes excess. One should harmonize the stomach qi because the pathology lies in the stomach and is excess in nature. Thus, giving Tiaowei Chengqi Tang purges excess, while Gancao within it has the meaning of purging the middle and harmonizing.
Cheng Zhi said: Aversion to cold after sweating implies deficiency of both ying and wei; absence of aversion to cold but presence of fever after sweating implies dried fluids and stomach excess. Hence, there is a method of harmonizing the stomach and unblocking fluids. However, the use of terms like "should" (dang) and "give" (yu) suggests careful deliberation rather than reckless administration, so as not to further deplete fluids.
Tiaowei Chengqi Tang formula is found in the Yangming chapter.

When the pulse is floating and tight, body pain is expected according to the law, and sweating should be used to resolve it. If, however, the chi position pulse is slow, sweating must not be induced. How do we know this? Because it is due to insufficiency of ying qi and blood deficiency.

[Zhu]
A floating and tight pulse is the pulse pattern of cold injuring ying; body pain is the symptom of cold injuring ying. Both pulse and symptoms indicate exterior excess pathogens, so sweating is indicated, and Mahuang Tang is suitable. If the cun and guan pulses are floating and tight, but only the chi pulse is slow, then sweating is contraindicated. Why? Because the person inherently suffers from ying qi insufficiency and blood deficiency. From this, we can see that if the yin and yang aspects of the pulse are not both tight, one should not lightly induce sweating.

[Ji Zhu]
Fang Youzhi said: The chi position reflects yin; slow indicates insufficiency. Ying governs blood, and sweat is the fluid of blood. A slow chi pulse makes sweating inadvisable, lest blood be depleted.
Zhang Lu said: A slow pulse at the chi position contraindicates the use of Mahuang for sweating. Instead, Xiaojianzhong Tang should be frequently administered to harmonize. If harmonization resolves the pathogen, no sweating is needed; if unresolved, repeated administration followed by covering to induce sweating is permissible.

After inducing sweating, if body pain persists and the pulse is deep and slow, Guizhi Jia Shaoyao Shengjiang Ge Yi Liang, Renshen Er Liang Xinjia Tang should be used as the main treatment.

[Zhu]
After inducing sweating, if body pain is accompanied by a floating and tight or floating and rapid pulse, it means sweating was incomplete and exterior pathogens remain; sweating should still be performed, and Guizhi Tang is suitable. Now, if after sweating body pain persists but the pulse is deep and slow, this indicates deficiency and cold of ying and wei. Therefore, Guizhi Xinjia Tang is suitable to warm and tonify ying and wei.

[Ji Zhu]
Cheng Wuji said: Exuberant exterior pathogens cause body pain; blood deficiency also causes body pain. A floating and tight pulse indicates pathogen exuberance; a deep and slow pulse indicates blood deficiency. Exuberance is settled by reducing (dispelling); deficiency is healed by tonifying.
Yu Chang said: A deep and slow pulse applies to all six positions, which is vastly different from a slow chi pulse. A slow chi pulse indicates inherent deficiency; here, deficiency results from sweating. Therefore, in the Guizhi Tang formula, Shaoyao and Shengjiang are each doubled by one liang to expel pathogens, and Renshen three liang is added to tonify healthy qi. It is named Xinjia Tang (Newly Added Decoction) to clarify that this is not the old method within Guizhi Tang.
Wang Hu said: Body pain with a deep and slow pulse—how do we know it is not a Zhonghan (cold strike) syndrome? One must understand that this syndrome involves persistent body pain after sweating for Taiyang Shanghan, with the pulse changing to deep and slow; it cannot be compared to Zhonghan.