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[Background Information]
Book: *Yifang Jiyi* (Collection of Beneficial Medical Prescriptions)
Author: Ding Yi
Dynasty: Ming
Chapter: Shaoyang Madness Caused by Cold Damage
Category: Formulas

[Translation]

The *Neijing* states: "Excess Yang leads to madness." In cold damage, heat pathogens reside in the stomach and merge into the heart, causing the spirit (*Shen*) to be unsettled and will (*Zhi*) to be unstable, thus resulting in madness. Initially, it manifests as little sleep, loss of appetite, delirious speech, and manic laughter; severely, it presents as climbing high and singing, discarding clothes and running, or climbing over walls and roofs. This is due to extreme hyperactivity of solitary Yang and excessive heat, which cannot be stopped without drastic purgation. There are also cases where sweating should have been induced but was not, leading to blood stasis and heat in the interior, with blood accumulation in the lower *Jiao*, presenting as a state resembling madness, with difficult urination, sometimes appearing like madness but not fully reaching that state. As for those who speak deliriously, stare fixedly, and lose control of urination and defecation, or those who exhibit severe heat after profuse sweating, these are all critical conditions.

○ Dyspnea Caused by Cold Damage

In *Taiyang* disease, if there is headache, fever, absence of sweating, and dyspnea, *Mahuang Tang* (Ephedra Decoction) is indicated; if sweating is present, *Guizhi Jia Houpo Zixi Tang* (Cinnamon Twig Decoction with Magnolia Bark and Apricot Seed) is indicated.
In *Yangming* disease, if there is sweating, aversion to cold is absent, tidal fever occurs, abdominal fullness is present, and dyspnea exists, *Xiao Chengqi Tang* (Minor Order the Qi Decoction) is indicated.
For dyspnea caused by water retention, accompanied by edema and cough, *Xiao Qinglong Tang* (Minor Blue Dragon Decoction) is indicated.
In *Yin* syndrome with *Jue* (cold extremities/reversal), if the pulse is deep and dyspnea is present, *Wuweizi Tang* (Schisandra Decoction) is indicated.

○ Thirst Caused by Cold Damage

If there is fever, aversion to cold, and normal urination, this indicates the exterior pattern has not resolved; *Wuling San* (Five-Ling Powder) with *Tianhuafen* (Trichosanthes Root) is indicated.
If there is no aversion to cold, fever, irritability, and thirst, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Tianhuafen* (Trichosanthes Root) and *Mendong* (Ophiopogon Tuber) is indicated.
In *Yangming* disease, if there is profuse sweating and thirst, *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) is indicated.

○ Delirium Caused by Cold Damage

In combined diseases of two *Yang* meridians, if there is tidal fever, delirium, and difficulty in defecation, *Da Chengqi Tang* (Major Order the Qi Decoction) is indicated.
In combined diseases of three *Yang* meridians, if there is headache, dryness and heat, spontaneous sweating, and delirium, *Baitu Tang* (White Tiger Decoction) is indicated.
In *Yangming* disease, if there is aversion to heat, delirious speech, and thirst, *Huanglian Jiedu San* (Coptis Detoxification Powder) is indicated.
If blood stasis is bound internally, causing delirium, irritability, and hard stool, *Taoren Chengqi San* (Peach Kernel Order the Qi Powder) is indicated.

○ Diarrhea Caused by Cold Damage

In combined diseases of *Taiyang* and *Yangming*, if there is diarrhea and vomiting, *Gegen Banxia Tang* (Kudzu and Pinellia Decoction) is indicated.
In *Yangming* disease, if there is diarrhea with heat, and pus and blood in the stool, *Huanglian Jiedu Tang* (Coptis Detoxification Decoction) with *Xijiao* (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) and *Shengdihuang* (Rehmannia Root) is indicated.
In *Shaoyin* disease, if there is diarrhea with undigested food, faint pulse, and cold extremities, *Tongmai Sini Tang* (Pulse-Recovering Counterflow Cold Decoction) or *Baitong Tang* (White Through Decoction) is indicated.
In *Shaoyin* disease, if there is diarrhea with pus and blood, cold pain in the abdomen, and deep, faint pulse, *Taohua Tang* (Peach Blossom Decoction) is indicated.
In *Shaoyin* disease, if there is diarrhea with cold characteristics resembling duck droppings, indicating a cold pattern, *Lizhong Tang* (Middle-Warming Decoction) or *Lizhong Wan* (Middle-Warming Pill) is indicated.

○ Jaundice Caused by Cold Damage

In *Yangming* disease, if heat is bound internally, urination is difficult, thirst is present, and jaundice develops, *Yinchen Tang* (Artemisia Capillaris Decoction), *Yinchen Wuling San* (Artemisia Capillaris Five-Ling Powder), or *Zhizi San* (Gardenia Powder) is indicated.
In *Yangming* disease, if blood is accumulated internally, causing jaundice and a manic state, with frequent urination and black stool, *Taoren Chengqi Tang* (Peach Kernel Order the Qi Decoction) is indicated.

○ Eruption (Macules/Papules) Caused by Cold Damage

Red eruptions indicate one survivor out of ten deaths; black eruptions indicate one survivor out of ten deaths. This occurs because purgation was performed too early, leaving heat in the stomach, with Yang toxicity binding heat in the interior, lingering and not dispersing. *Huanglian Hua Tang* (Coptis Transformation Decoction), *Huanglian Jupi Tang* (Coptis and Tangerine Peel Decoction), *Xuanshen Shengma Tang* (Scrophularia and Cimicifuga Decoction), *Huaban Tang* (Eruption Resolution Decoction), or *Zixue Huadu Tang* (Purple Snow Detoxification Decoction) are indicated.
Warm toxicity causing eruptions results from cold contracted in winter manifesting in spring, unresolved after sweating and purgation; *Heigao Fang* (Black Ointment Formula) is indicated.
Eruptions result from deficiency of the exterior and excess in the interior; excessive use of exterior-releasing drugs should be avoided to prevent worsening the erosion of the skin.

○ Stagnant Qi (Plugged Sensation) Caused by Cold Damage

If the patient experiences a plugged sensation in the epigastrium without pain, *Jiegeng Zhike Tang* (Platycodon and Aurantium Decoction) is indicated.
If there is plugged sensation, vomiting, and fever, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) can be used; if ineffective, *Banxia Xiexin Tang* (Pinellia Heart-Draining Decoction) can be used.

○ Chest Binding (Jie Xiong) Caused by Cold Damage, with Five Types: Major, Minor, Cold-Excess, Heat-Excess, and Water Binding

If purgation was performed too early, causing the chest and heart region to bulge upward, painful even without pressure, and intolerant to touch, it is named Major Chest Binding; *Da Xianxiong Tang* (Major Trap the Chest Decoction) is indicated.
If there is fever, chest fullness, and pain upon pressure, it is named Minor Chest Binding; *Xiao Xianxiong Tang* (Minor Trap the Chest Decoction) is indicated.
If there is heat-excess, irritability, frequent delirium, and chest pain, it is named Heat-Binding; *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Zhishi* (Aurantium Fruit) and *Huanglian* (Coptis Rhizome) is indicated.
If there is cold-excess, cold body without fever, chest fullness, and pain, it is named Cold-Binding (Cold-Excess Chest Binding); *Lizhong Tang* (Middle-Warming Decoction) with *Zhishi* (Aurantium Fruit) and *Banxia* (Pinellia Tuber) is indicated.
If excessive water intake remains stagnant, causing chest fullness and slight sweating on the head, it is named Water-Binding; *Da Xianxiong Wan* (Major Trap the Chest Pill) is indicated.
For Blood-Binding in women, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Zhike* (Aurantium Fruit), *Shengdihuang* (Rehmannia Root), and *Chishao* (Red Peony Root) is indicated.

○ Vomiting Caused by Cold Damage, with Yin and Yang Syndromes

In Yang syndrome vomiting, if there is fever, irritability, thirst, red urine, constipation, and hot palms, this is Stomach Heat; *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Zhuru* (Bamboo Shavings) or *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) is indicated.
In Yin syndrome vomiting, if there is cold body, no thirst, free defecation, and no fever, *Lizhong Tang* (Middle-Warming Decoction) with *Huoxiang* (Patchouli), *Jupi* (Tangerine Peel), *Banxia* (Pinellia Tuber), and *Fuling* (Poria) is indicated; for severe cold, *Jiangfu Tang* (Ginger and Aconite Decoction) with *Dingxiang* (Clove) is indicated.

○ Head Sweating Caused by Cold Damage

In *Yangming* disease, if there is fever and only head sweating, this indicates heat venting outward, potentially leading to jaundice; *Yinchen Tang* (Artemisia Capillaris Decoction) is indicated.
In *Yangming* disease, if there is delirium, head sweating, and difficulty in defecation, *Chengqi Tang* (Order the Qi Decoction) is indicated.
In *Shaoyang* disease, on the fifth or sixth day, if there is head sweating, slight aversion to cold, and epigastric fullness, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) is indicated.

○ Administration of Water in Cold Damage

When a patient with cold damage is extremely thirsty, water may be given. However, do not force drinking if not extremely thirsty; give small amounts frequently and do not allow them to drink their fill. Forcing water causes harm, leading to water-binding, palpitations with dyspnea, coughing and choking, vomiting and hiccups, and swelling/fullness. These are all Water-Qi diseases.

○ Rinsing Mouth Without Swallowing in Cold Damage

In *Yangming* disease, rinsing the mouth without swallowing indicates heat in the channels and no heat in the interior; epistaxis (nosebleed) is likely; *Xijiao Dihuang Tang* (Rhinoceros Horn and Rehmannia Decoction) is indicated.
In blood disorders with mania, rinsing the mouth without swallowing indicates heat accumulation and blood stasis in the lower burner; *Taoren Chengqi Tang* (Peach Kernel Order the Qi Decoction) is indicated.

○ Aversion to Cold on the Back Caused by Cold Damage, with Yin and Yang Syndromes

In *Yangming* disease, if there is aversion to cold on the back and dry lips/mouth, *Baitu Tang* (White Tiger Decoction) is indicated.
In *Shaoyin* disease, if there is aversion to cold on the back and a neutral sensation in the mouth, *Fuzi Tang* (Aconite Decoction) is indicated.

○ Hematemesis (Vomiting Blood) Caused by Cold Damage

If evil heat enters the three *Yang* meridians and heat toxin lodges in the five Zang organs, and hematemesis occurs due to missed sweating, *Xijiao Dihuang Tang* (Rhinoceros Horn and Rehmannia Decoction) with fried *Zhizi* (Gardenia Fruit) is indicated.
In Yang syndrome, if there is fever, hematemesis, and hard stool, *Sanhuang Xiexin Tang* (Three-Yellow Heart-Draining Decoction) is indicated.

○ Epistaxis (Nosebleed) Caused by Cold Damage

In *Taiyang* disease, if the course has passed without sweating and the pulse is tight and full, do not induce sweating again; doing so will cause epistaxis. *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) with *Baimaogen* (Imperata Rhizome) is indicated; additionally, charred *Zhizi* (Gardenia Fruit) mixed with *Longgu* (Fossilized Bone) as powder can be insufflated into the nostrils.
For epistaxis, acrid-warm herbs must not be used, as blood flows when heated. First, cool the blood and stop bleeding, then regulate. *Baipi Shengdihuang Tang* (Phellodendron and Rehmannia Decoction) or *Mendong Yin* (Ophiopogon Drink) is indicated; alternatively, decocting *Yuanhua* (Genkwa Flower) in water for oral administration is also effective.

○ Tidal Fever Caused by Cold Damage (Fever occurring at regular times, like the tide, typically in Wei and Shen hours [1 PM - 7 PM])

In *Yangming* disease, if tidal fever occurs at dusk (You hour, 5-7 PM), accompanied by delirium and solid stool, *Da Chengqi Tang* (Major Order the Qi Decoction) is indicated.
In *Yangming* disease, if there is solid stool and abdominal fullness, *Da Chengqi Tang* (Major Order the Qi Decoction), *Da Chaihu Tang* (Major Bupleurum Decoction), or *Xiao Chengqi Tang* (Minor Order the Qi Decoction) is indicated.

○ Fever Caused by Cold Damage

In *Taiyang* fever with aversion to cold and body pain, sweating (diaphoresis) is indicated.
In *Yangming* fever with dry mouth and eye pain, *Gegen Jiemo Tang* (Kudzu Muscle-Relieving Decoction) is indicated; if stool is solid, *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
In *Shaoyang* fever with bitter taste, dry throat, retching, and hypochondriac pain, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) is indicated.

○ Abdominal Pain Caused by Cold Damage, with Yin and Yang Syndromes

In Yang syndrome abdominal pain, if there is constipation, pain below the umbilicus, alternating chills and fever, irritability, and thirst, this indicates dry feces in the intestines; *Da Chaihu Tang* (Major Bupleurum Decoction) or *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Shaoyao* (Peony Root) and *Zhike* (Aurantium Fruit) is indicated.
In Yin syndrome abdominal pain, if there is no fever, no thirst, cold extremities, and free defecation, *Wuji San* (Five-Accumulations Powder) or *Fuzi Lizhong Tang* (Aconite Middle-Warming Decoction) is indicated.

○ Cold Extremities Caused by Cold Damage, with Yin and Yang Syndromes

In Yang syndrome *Jue* (reversal/cold extremities), if there is fever, headache, red urine, constipation, delirium, irritability, and hands/feet that are occasionally warm, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) with *Shanzhi* (Gardenia Fruit) is indicated; if stool is blocked, *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
In Yin syndrome *Jue*, if the body is warm, hands/feet are constantly cold, there is no irritability or thirst, the mind is calm, or there is vomiting/diarrhea, *Lizhong Tang* (Middle-Warming Decoction) with *Fuzi* (Aconite Root), or *Sini Tang* (Counterflow Cold Decoction) or *Jiangfu Tang* (Ginger and Aconite Decoction) is indicated.

○ Four Conditions Resembling Cold Damage (Phlegm Disorder, Food Retention, Deficiency Irritability, Hong Kong Foot/Jiaqi)

Phlegm Disorder: Characterized by aversion to cold with fever, aversion to wind, spontaneous sweating, epigastric plugged sensation, no headache, and floating pulse at the Cun position. *Shensu Yin* (Ginseng and Perilla Drink), *Jiegeng Banxia Tang* (Platycodon and Pinellia Decoction), or *Wendan Tang* (Gallbladder-Warming Decoction) are indicated.
Phlegm-Fluid Accumulation: Characterized by vomiting, nausea, back pain, and shortness of breath. *Erchen Tang* (Two-Aged Decoction) or *Daotan Tang* (Great Phlegm Decoction) is indicated.
Food Retention: Characterized by headache, fever, aversion to cold, epigastric plugged sensation, vomiting with food odor, and no body pain. If cold exceeds heat, *Wuji San* (Five-Accumulations Powder) or *Zhizhong Tang* (Middle-Sustaining Decoction) with digestive herbs is indicated; if heat exceeds cold, with abdominal distension and difficult defecation, *Da Chaihu Tang* (Major Bupleurum Decoction) or *Guizhi Jia Dahuang Tang* (Cinnamon Twig with Rhubarb Decoction) is indicated.
Deficiency Irritability: Characterized by slight aversion to cold and fever, irritability, insomnia, rebellious Qi with urge to vomit, and no headache/body pain. This is deficiency irritability; *Zhuye Shigao Tang* (Bamboo Leaf and Gypsum Decoction) or *Wendan Tang* (Gallbladder-Warming Decoction) with *Zhimu* (Anemarrhena Rhizome) and *Mendong* (Ophiopogon Tuber) is indicated.
Hong Kong Foot (Jiaqi): Characterized by aversion to cold with fever, spontaneous sweating, aversion to wind, heavy waist/legs, hard stool, swollen calves, sore/spasmodic feet, and no headache. *Xiangsu Binglang San* (Perilla and Areca Nut Powder) or *Baidu San* (Detoxify Hundred Powders) with *Mugua* (Chaenomeles Fruit) is indicated.

○ Tongue Coating in Cold Damage

"The tongue is the sprout of the heart; its color should be red and lustrous, not yellow or black."
After four or five days of cold damage, if there is a white, slippery coating, aversion to cold, and vomiting, *Xiao Chaihu Tang* (Minor Bupleurum Decoction) is indicated.
In *Yangming* disease, if there is abdominal fullness, thirst, and a yellow coating, purgation is appropriate; *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
If the coating is white and slippery, the pathogen is in the exterior, and purgation may be considered (Note: Context implies resolving exterior via specific methods).
If the coating is dry and rough, purgation is appropriate.
The *Jingyao* states: If the tongue is yellow and purgation has not been used, purgation will make the yellow coating recede. A black coating indicates extreme heat. In heat diseases, cracked lips and black tongue indicate death.
For any tongue coating (white, yellow, or black), rinse the tongue with water using a wet blue cloth, then scrape gently with soaked ginger slices until the coating recedes.

○ Recurrence Due to Overexertion After Cold Damage

If residual heat persists after recovery from a major illness, modify and use *Xiao Chaihu Tang* (Minor Bupleurum Decoction).
If fever persists after illness, with a solid pulse and hard stool, *Da Chaihu Tang* (Major Bupleurum Decoction) is indicated.
If fever recurs due to labor/exertion after illness, *Zhike Zhizi Tang* (Aurantium and Gardenia Decoction) is indicated.
If fever recurs due to dietary injury after illness, with epigastric fullness, *Zhishi Zhizi Dahuang Tang* (Aurantium, Gardenia, and Rhubarb Decoction) is indicated.
If recurrence occurs due to sexual intercourse (Yin-Yang connection) after illness, *Shufen Tang* (Mouse Feces Decoction) or *Shushi Chi Tang* (Mouse Feces and Fermented Soybean Decoction) is indicated.