Library

Fa (Releasing the Exterior) refers to lifting, dispersing, and inducing sweating; Biao (Exterior) is defined in contrast to Li (Interior). The Three Yang meridians belong to the Exterior, while the Three Yin meridians belong to the Interior. Among them, the Taiyang (Greater Yang) meridian is the exterior of the exterior, the Yangming (Bright Yang) meridian is the interior of the exterior, and the Shaoyang (Lesser Yang) meridian is half-exterior and half-interior. Pathogenic factors damaging the human body first invade the exterior and gradually enter the interior, starting from the Taiyang meridian and then spreading to others.

(Zhang Zhongjing) treats Taiyang syndrome of Shanghan (Cold Damage), where pathogenic factors are in the exterior, presenting with fever, headache, body pain, lower back pain, joint pain, stiffness of the neck and back, aversion to cold and wind (if there is even a slight headache or aversion to cold, it indicates the pathogen is still in the exterior), absence of sweat, panting, and a floating and tight pulse (Cold pathogen binds the exterior, preventing Yang Qi from venting outward, thus causing stagnation and heat. The Classics state: When humans contract Cold, they develop febrile disease. Cold invading humans must first affect the exterior, specifically the Foot-Taiyang Bladder meridian of Water. The Taiyang meridian governs all Yang Qi and serves as the framework for the whole body. Its pulse originates at the inner canthus, ascends to the brain, descends to the nape, follows the shoulder, runs along the spine, reaches the waist, and travels along the posterior aspect of the body; therefore, no area it passes through is free from pain. Aversion to cold occurs even without wind; aversion to wind occurs only when exposed to wind, so aversion to cold always accompanies aversion to wind. Aversion to cold has Yin-Yang distinctions, but aversion to wind belongs exclusively to Yang meridians; thus, the Three Yin meridians do not present with aversion to wind. Wind is a Yang pathogen, while Cold is a Yin pathogen. *Yuan Bing Shi* states: Body heat with aversion to cold indicates Heat in the exterior. Since the Heat is superficial and the pathogen fears the healthy Qi, the patient feels hot yet paradoxically averse to cold. Some claim Cold is in the exterior, or that Heat is in the skin and Cold is in the marrow; these are errors. Generally, injuries by Wind, Summerheat, and Dampness involve sweating; only Shanghan uniquely lacks sweating because Cold congeals blood and represents an Excess condition of the exterior. Qi rebelling upward causes panting; pathogen in the exterior causes a floating pulse. In Shanghan, the pulse is tight; in Shangfeng (Wind Injury), it is slow, because Cold is rigid and urgent while Wind is slack and diffuse. Yu Jiayan says: Winter injury by Cold, Spring injury by Warmth, Summer/Autumn injury by Summerheat/Dampness are the regular diseases of the four seasons. However, Shanghan occurs in Summer/Autumn, and injury by Summerheat/Dampness occurs in Winter/Spring; these are irregular diseases of the four seasons, known as "different qi." For regular diseases in Winter/Spring, sweating indicates Wind Injury, lack of sweating indicates Shanghan; similarly, for regular diseases in Summer/Autumn, sweating indicates Summerheat/Dampness, while lack of sweating remains Shanghan... Highlighting the Taiyang meridian prevents the pathogen from sinking into the Yangming meridian, hence Ge Gen (Kudzu Root) is not used). It also treats Asthma (Asthma arises when Cold-Dampness lodges in the Back-Shu points and is aggravated by further Cold exposure... Mahuang (Ephedrae Herba, stem tips removed. 3 liang) Guizhi (Cinnamomi Ramulus, 2 liang) Xingren (Prunus Semen, peeled and cored, 70 seeds) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 1 liang). Boil Mahuang first for several boils, skim off the foam, then add other herbs and decoct. Take warm. Cover to induce slight sweating. Stop once the illness is addressed; do not necessarily finish the dose. If no sweat, take again (When using Mahuang, remove the nodes, briefly soak in vinegar water... Sweating leads to recovery. *Huo Ren Shu* states: Zang said: Exterior syndromes should be treated with sweating... The Three Yang meridians require prompt sweating... Prompt purgation, small doses, mild effects... This is a medicine for the Foot-Taiyang meridian. Mahuang is hollow, acrid-warm with thin aroma, a specific drug for the Lung organ, acting on the Taiyang meridian, capable of opening the Couli (skin pores) and dispelling Cold (The Couli are governed by the Lung; Cold enters here and exits here); Guizhi is acrid-warm, capable of drawing out pathogens from the Ying (Nutritive) level and reaching the muscle surface (Guizhi enters Ying-Blood, resolves the muscle layer; only when Ying and Wei harmonize can sweat be produced); Xingren is bitter-sweet, disperses Cold and directs Qi downward; Gancao is sweet-neutral, disperses and harmonizes the Middle. The Classics state: When Cold invades internally, treat with sweet-hot, assisted by bitter-acrid. This is correct (Yu Jiayan says: Mahuang's sweating power is strongest, so Guizhi restrains it, Gancao harmonizes it, and Xingren moistens and descends to stop panting. It is like controlling a horse to prevent it from running wild. Li Shicai says: Ancient saying goes "Do not use Mahuang in Winter, do not use Guizhi in Summer," because Winter governs storage and should not promote dispersion, while Summer is hot and unsuitable for acrid-warm herbs. The Classics say one must first respect the annual Qi and not violate the Harmony of Heaven. Another saying is "Do not use Mahuang in Summer." Why are these two statements contradictory? One may abandon the season to follow the syndrome, or abandon the syndrome to follow the season; flexibility depends on the physician. Li Shizhen says: Zhang Zhongjing treated Shanghan, using Mahuang for no sweat and Guizhi for sweating, but few have explored its subtleties. Body fluids transform into sweat; sweat is blood. In Ying it is blood, in Wei it is sweat. Cold injures Ying, causing internal stagnation of Ying-blood, preventing external connection to Wei; Wei Qi becomes closed and solid, body fluids fail to circulate, resulting in no sweat, fever, and aversion to cold; Wind injures Wei, causing external leakage of Wei Qi, failing to protect Ying internally; Ying Qi becomes weak, body fluids become insecure, resulting in sweating, fever, and aversion to wind. However, both Wind and Cold enter via the skin and hair, which are the exterior correspondence of the Lung. Although the syndrome belongs to Taiyang, symptoms like red face, oppression, cough with phlegm, panting, and chest fullness indicate Lung disease. Basically, when the skin and hair close externally, pathogenic Heat attacks internally. Thus, Mahuang and Gancao, combined with Guizhi, draw out Ying-level pathogens and bring them to the muscle surface, assisted by Xingren to drain the Lung and benefit Qi. After sweating, if there is no high fever but panting persists, add Shigao (Gypsum Fibrosum). *Huo Ren Shu*: Add Shigao and Zhimu after Summer Solstice; these are drugs that drain Lung Fire. This shows that although Mahuang Tang is a heavy sweating agent for Taiyang, it is actually a drug that disperses Lung Fire stagnation. If Couli are not tight, body fluids leak externally, leading to Lung Qi deficiency. Deficiency requires tonifying the Mother, so Guizhi and Gancao are used to externally disperse Wind and save the Exterior, while internally attacking Liver Wood to protect the Spleen; assisted by Shaoyao (Paeoniae Radix Alba) to drain Wood and secure the Spleen; guided by Jiang (Zingiberis Rhizoma) and Zao (Jujubae Fructus) to move Spleen fluids and harmonize Ying and Wei. After purgation, if slight panting occurs, add Houpo (Magnoliae Officinalis Cortex) and Xingren to benefit Lung Qi; after sweating, if the pulse is deep and slow, add Renshen (Ginseng Radix et Rhizoma) to benefit Lung Qi. *Huo Ren Shu* adds Huangqin (Scutellariae Radix) to form Yangdan Tang to drain Lung Heat. This shows that although Guizhi Tang is a light muscle-resolving agent for Taiyang, it is essentially a drug regulating the Spleen and saving the Lung. Wang Lv says: Shanghan occurring immediately after contraction is called Shanghan; that not occurring immediately is called Wenshu (Warmth/Summerheat). Their origin is the same, so they are collectively called Shanghan, but their categories differ, and treatments must not be mixed. Zhang Zhongjing's book was designed specifically for immediate Shanghan, not for delayed Wenshu. Modern physicians sometimes use Shanghan methods for Wenshu, merely borrowing. In Three Yin Shanghan, Cold syndromes account for 70-80%. If Wenshu is purely Heat, later generations mistakenly thought they could be treated generally, leading to suspicion of using heat-promoting agents. This fails to realize that Zhang Zhongjing established Mahuang and Guizhi Tangs for specific indications and seasons. If one knows they are not for Wenshu, doubts will dissolve. He further says: Shanghan occurs in winter cold; Cold pathogen is in the exterior, closing Couli, requiring acrid-warm herbs to disperse it, hence Mahuang and Guizhi are essential. Wenshu and Rebing (Heat Disease) occur in hot weather; stagnant Heat reaches outward from within, with no Cold in the exterior, so acrid-cool, bitter-cold, or bitter-sour agents are required for resolution, making Guizhi and Mahuang unusable. Later prescriptions like Shuijie San, Dahuang Tang, Qianjin Tang, and Fangfeng Tongsheng San, which address both interior and exterior, are usable. Immediate Shanghan with aversion to wind/cold indicates Wind-Cold in the exterior damaging Exterior Qi. Delayed Wenshu/Rebing with aversion to wind/cold indicates secondary contraction of Wind-Cold damaging Exterior Qi. Without new Wind-Cold, there is no aversion to wind/cold. Hence Zhang Zhongjing said: "Taiyang syndrome, fever with thirst and no aversion to cold, is Wenshu." Knowing this for Wenshu implies Rebing is similar; those without thirst and aversion to cold are not Wenshu. Some may show aversion to wind/cold without new Wind-Cold due to Exterior deficiency allowing Heat to reach the exterior and damage Exterior Qi, i.e., Wei deficiency causes aversion to wind, Ying deficiency causes aversion to cold, distinct from Wind Injury or Shanghan. Wenshu/Rebing may start with exterior signs and transmit inward; stagnant Heat reaches outward, cannot vent, returns inward, forming attackable syndromes, unlike Shanghan which starts from the exterior. Seeing people treat Wenshu by wrongly purging the interior causes little harm, but wrongly releasing the exterior leads to unpredictable changes, proving Heat comes from within. Rare cases of harm from purging are epidemic syndromes caused by sudden Cold in Spring/Summer, where pathogen is purely in the exterior and has not entered the interior; these cannot be discussed with Wenshu/Rebing. Winter/Autumn Shanghan is true Shanghan; Spring/Summer Shanghan is Cold Epidemic, distinct from Wenshu/Rebing. Moreover, Shanghan directly invading Yin meridians, or transmitting to Yin as Cold syndromes requiring warming, differs greatly from Wenshu/Rebing; how can they be mixed? Yi Yangzi said: "Shanghan transmits to Foot meridians but not Hand meridians" is not a reasoned statement. Caochuang Liu Zi pointed out that Foot meridians correspond to Water, Earth, Wood; Water freezes in Cold, Earth cracks in Cold, Wood withers in Cold, so Cold harms them. Hand meridians correspond to Metal and Fire; Metal hardens in Cold, Fire is extremely hot and Cold cannot attack, so Cold does not harm them. Ignorant people find this strange, severing Ying-Wei and meridians above and below, losing the principle of continuous Qi circulation. Cold invading humans first causes burning skin, nasal congestion, coarse breathing. Lung governs skin/hair; thus Hand-Taiyin Lung Metal is affected first. Haizang said Shanghan enters via skin/hair. Ancestors prescribed Guizhi, Mahuang, Qianghuo, Xionggu. Although these are exterior-releasing agents for Taiyang, how else can sweating resolve the pathogen except via skin/hair? Abnormal bowel movements, constipation or loose stools indicate Hand-Yangming Large Intestine Geng Metal disease. Ancestors used Xiaoshi (Mirabilitum), Dahuang (Rhei Radix et Rhizoma), Houpo, Rushi. Although these are interior-purging agents for Yangming and Three Yin, how else can purgation open the Large Intestine? Liu Zi claims Metal hardens in Cold; is this true? Yang Qi stagnation, tongue coating, delirious speech indicate Hand-Shaoyin Heart Ding Fire disease; ancestors had multiple methods for Xiexin Tang. Hyperactivity moving Blood, upper/lower vexation and steaming indicate Hand-Jueyin Pericardium Fire and Hand-Shaoyang Sanjiao Fire disease; treatments include Sanhuang San and Chaiqin Tang. Oliguria/retention indicates Hand-Taiyang Small Intestice Bing Fire disease; treatments include Wuling San and Daochi San. Liu Zi claims Fire/Cold cannot harm; is this true? The Classics also say: Humans contracting Cold develop febrile disease. If it is febrile disease, there is no concept of freezing water or cracking earth/withering wood, but rather signs of scorching Metal and hyperactive Fire. Who is Liu Zi to rely on limited insight to confuse the world? *Jiyao* states: Jueyin meridian unceasing diarrhea, deep/slow pulse, cold limbs, spitting saliva/pus/blood is difficult to treat; use Mahuang Tang or Xiao Xuming Tang to sweat. This indicates pathogen contracted inward from the exterior; resolving the exterior heals it. Zhang Zihe said: Sundry diarrhea (Sunxie) has Wind as its root; Wind cannot exit without sweating. Patients have borborygmus, undigested food in stool, dysuria. Astringent and warm medicines failed. Moxibustion on Zhongwan and below umbilicus intensified dryness/heat and depleted fluids. Upon examination, pulse was floating, large, long; slight exterior fever. Used Guizhi Mahuang Tang with Jiang/Zao, three doses, sweating all day, recovered by dawn. Then used Weifeng Tang to harmonize organs; appetite returned. Classics say: Wind injury in Spring leads to Sunxie in Summer; thus it can be cured by sweating. Wind corresponds to Wood, Spleen to Earth; Wood overacts on Earth, causing diarrhea. Appendix: Dahuang Tang: Dahuang 1.5 liang, Mangxiao (Natrii Sulfas), Dafupi (Citri Grandis Pericarpium), Mutong (Akebiae Caulis), Gancao each 1 liang, Guixin (Cinnamomi Cortex) 7.5 qian, Taoren (Persicae Semen) 21 seeds. Treats unresolved Yangdu Shanghan, Heat inside, delirium resembling mania. Pogu Qianjin Tang: Kushen (Sophorae Flavescentis Radix) 1 liang. Decoct in wine, induce vomiting. Treats Tianxing (Epidemic) Heat-Toxin near death. Shuijie San, Fangfeng Tongsheng San, see Section on Exterior-Interior.)

Removing Guizhi from this formula and adding Shigao creates Mahuang Xingren Gancao Shigao Tang (Zhang Zhongjing): Treats cases where Guizhi Tang is contraindicated after sweating/purgation, presenting with sweating, panting, and no significant heat. (Question: After sweating, Guizhi Tang is contraindicated; if Guizhi is unusable, is Mahuang usable? With no significant heat, is Shigao usable? Yu Jiayan says: Treating Shanghan requires distinguishing Ying and Wei; Guizhi and Mahuang Tangs should never be mixed. In this case, Taiyang pathogen resolved by sweating, but Lung Heat remains. Thus, although fever subsides slightly, panting persists. Use Mahuang to release Lung pathogen, Xingren to direct Lung Qi down, Gancao to relieve Lung urgency, Shigao to clear Lung Heat. Using Taiyang medicines to treat Hand-Taiyin meridian. Mistakenly using Guizhi would obstruct Lung Qi and cause lung abscess with pus.) It also treats Wenmei (Warm Malaria) with heat preceding cold. Adding Baizhu (Atractylodis Macrocephalae Rhizoma) creates Mahuang Jia Zhu Tang (*Jinkui Yaolue*): Treats patients with Dampness experiencing bodily restlessness and pain, suitable for sweating. Removing Guizhi and Xingren, adding Fuzi (Aconiti Lateralis Radix Praeparata) creates Mahuang Fuzi Tang (*Jinkui Yaolue*): Treats deep, deficient, distended pulse, indicating Qi-Water retention belonging to Shaoyin; inducing sweating stops it. Removing Guizhi and Xingren creates Gancao Mahuang Tang (*Jinkui Yaolue*): Treats Li Shui (Interior Water) characterized by generalized edema of face/body, deep pulse, difficulty urinating, requiring covered sweating. Removing Guizhi, using Mahuang (nodes intact), Xingren (skin/intact tips), raw Gancao creates San'ao Tang (*Ju Fang*): Treats common cold by Wind-Cold, cough, nasal congestion (Mahuang retaining nodes allows release with restraint; Xingren retaining tips utilizes its releasing nature; skin retained for astringency; raw Gancao tonifies Middle... Contraindicated in sweating syndromes. Zhang Zhongjing said: Yang excess/Yin deficiency, purgation heals, sweating kills; Yin excess/Yang deficiency, sweating heals, purgation kills. Floating pulse... Sweat... Diarrhea though... Body fluids... Depletion of sweat... Guizhi... Sweat then... In interior... Exhaustion... Empty interior... Moving Qi...)

Differentiation of Shanghan and Shangfeng (Shanghan develops fever after stagnation; Shangfeng develops fever immediately; Shanghan has no sweat, Shangfeng has sweat; Shanghan has no runny nose, Shangfeng has runny nose...)

Yin-Yang Exterior-Interior (Differentiating Exterior of Yang Syndrome: Fever, aversion to cold, headache, stiff spine, clear urine, no thirst, warm hands/feet. Exterior of Yin Syndrome: No fever, aversion to cold, pale face, cold breath, cold limbs. Interior of Yang Syndrome: Dry lips/tongue, vexation/thirst, kicking clothes, throwing hands/feet, constipation, dark/scanty urine, red nail beds, easy movement, floating/huge/rapid pulse. Interior of Yin Syndrome: No thirst, curled up posture, covering self, purple lips/rolled tongue, loose stool, clear/abundant urine, black/blue nail beds, heavy body/difficult movement, deep/fine/rapid pulse. Only abdominal pain and vomiting appear in both Yin and Yang Interior syndromes. The Three Yang meridians also have Yin-Yang Exterior-Interior distinctions. Taiyang: Heat in skin, headache/stiff neck, in Meridian is Exterior, treated with Mahuang Tang, Guizhi Tang, Jiwei Qianghuo Tang; thirst/red urine, Heat entering Bladder, in Organ is Interior, treated with Wuling San. Yangming: Heat in Muscle, eye pain/insomnia, in Meridian... for... Qin... Dampness... Eight...)