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Section 56: Seven Prescriptions

The manifestations of Jueyin disease include excessive thirst, a sensation of Qi rushing upward to the chest and heart region, pain and burning heat in the heart, hunger without desire to eat. In severe cases, vomiting of roundworms may occur. If purgatives are mistakenly used, diarrhea will become intractable.

In Jueyin wind-stroke, if the pulse is slightly floating, recovery is imminent; if not floating, the disease has not yet resolved.

Jueyin disease tends to resolve during the period from Chou hour (1:00-3:00 AM) to Mao hour (5:00-7:00 AM).

If a patient with Jueyin disease desires water and drinks it, they will recover.

For all cases involving cold extremities (Sini), purgation is contraindicated, as is the case for patients with deficiency constitutions.

In Shanghan (Cold Damage), if cold extremities appear first, followed by fever and diarrhea, the diarrhea will cease. If cold extremities reappear, diarrhea will recur.

In Shanghan, if fever lasts for six days initially, but cold extremities last for nine days accompanied by diarrhea: typically, one cannot eat during cold extremities and diarrhea. The fact that the patient can now eat suggests "Chu Zhong" (a false sign of appetite indicating impending exhaustion of Stomach Qi). If, after feeding them millet cakes, there is no sudden fever, it indicates that Stomach Qi remains, and recovery is certain. However, one must beware of a sudden burst of heat that quickly fades. If, after a few days, the pulse shows sustained heat, recovery is expected at midnight on the following day. This prediction is based on the calculation: originally six days of fever, nine days of cold extremities, plus three more days of fever equals nine days total, matching the duration of cold extremities, thus predicting recovery at midnight. If the pulse remains rapid and heat persists for three more days, this indicates excess heat, which will likely lead to carbuncles and pus.

In Shanghan, if the pulse is slow after six or seven days, and the physician mistakenly uses Huangqin Tang (Scutellaria Decoction) to clear heat: a slow pulse indicates cold. Using Huangqin Tang further clears heat and causes abdominal coldness. Normally, one should not eat in this state. If the patient can now eat, it is "Chu Zhong," indicating inevitable death.

In Shanghan, if cold extremities and fever alternate, diarrhea usually stops spontaneously. However, if sweating occurs instead, accompanied by stiff and painful throat, this constitutes Hou Bi (throat obstruction). If there is fever without sweating, diarrhea usually stops; if pus and blood appear in the stool, Hou Bi will not occur.

In Shanghan, from the first to fourth or fifth day, if cold extremities appear, fever will follow. The deeper the cold extremities, the deeper the fever; the milder the cold extremities, the milder the fever. Cold extremities should be treated with purgation. If mistakenly treated with diaphoresis (sweating method), it will cause oral ulcers and redness.

Generally, Jue (cold extremities) occurs when Yin and Yang Qi fail to connect smoothly. Jue is characterized by cold hands and feet.

In Shanghan, if cold extremities last five days and fever lasts five days, and on the sixth day cold extremities do not return, the disease will heal itself. Since cold extremities did not exceed five days and matched the five days of fever, self-healing is predicted.

In Shanghan, if the pulse is faint and extremities are cold, and by the seventh or eighth day the skin is cold and the patient is restless without respite, this indicates internal organ coldness. Roundworms moving upward into the diaphragm cause "Hui Jue" (roundworm-induced Jue). The patient will vomit roundworms. When the patient is quiet, they may experience intermittent irritability due to internal cold and roundworms moving up. After a while, it stops. If eating induces vomiting and irritability, it is because roundworms are attracted by the smell of food. Patients often vomit roundworms naturally. For Hui Jue, Wumei Wan (Mume Pill) is the primary prescription.
Formula:
Wumei (Fructus Mume, 300 pieces), Xixin (Herba Asari, 6 liang), Ganjiang (Rhizoma Zingiberis Recens, 10 liang), Huanglian (Rhizoma Coptidis, 16 liang), Danggui (Radix Angelicae Sinensis, 4 liang), Shujiao (Pericarpium Zanthoxyli, 4 liang), Fuzi (Radix Aconiti Lateralis Preparata, 6 liang, processed), Guizhi (Caulis Cinnamomi, 6 liang), Renshen (Radix Ginseng, 6 liang), Huangbai (Cortex Phellodendri, 6 liang).
Process these ten herbs separately, then combine. Soak Wumei in vinegar overnight, remove pits, steam over rice, mash into paste, mix with other herbs, pound in a mortar with honey for 1,000 strikes, form pills the size of paulownia seeds. Take 10 pills before meals with warm water, three times daily, gradually increasing to 20 pills. Avoid raw, cold, slippery, and spoiled foods.

In Shanghan, if heat is slight with mild cold extremities, specifically cold fingertips, silence, anorexia, and irritability persist for several days, and urine is clear and copious, heat is cleared. Eating will lead to recovery. If cold extremities are accompanied by vomiting and fullness/irritability in the chest and hypochondrium, bloody stools will likely follow later.

If a patient has cold extremities, denies chest binding (Jie Xiong), but has lower abdominal fullness and tenderness upon pressure, this indicates cold binding at the Bladder Guan Yuan acupoint.

In Shanghan, if fever lasts four days, cold extremities three days, then fever four days again, the ratio of less cold to more heat suggests recovery. If from day four to six or seven the condition does not resolve, pus and blood in stool will occur.

In Shanghan, if cold extremities last four days, fever only three days, then cold extremities five days again, the disease progresses due to excess cold and deficient heat, indicating retreat of Yang Qi.

In Shanghan, after six or seven days, if the pulse is rapid, extremities are cold, and there is irritability, if Yin cold does not reverse (Yang does not return), it is a fatal prognosis.

In Shanghan, if diarrhea is accompanied by cold extremities and restlessness preventing lying down, it is fatal.

In Shanghan, if fever is accompanied by diarrhea progressing to irreversible cold extremities, it is fatal.

In Shanghan, if after six or seven days without diarrhea, sudden fever and diarrhea occur with unceasing sweating, it is fatal due to the presence of Yin without Yang.

In Shanghan, after five or six days, if there is no chest binding, abdomen is soft, pulse is deficient, and extremities are cold, purgation is contraindicated. Purgation will cause loss of blood and death. If Shanghan presents with fever and cold extremities, followed by diarrhea on the seventh day, it is difficult to treat.

In Shanghan, if the pulse is hurried and extremities are cold, moxibustion may be applied.

In Shanghan, if the pulse is slippery and extremities are cold, with exterior heat, Baihu Tang (White Tiger Decoction) is indicated.

For cold extremities with a fine or absent pulse, Danggui Sini Tang (Angelica Decoction for Reversal of Cold) is indicated.
Formula:
Danggui (Radix Angelicae Sinensis, 3 liang), Guixin (Cortex Cinnamomi, 3 liang), Xixin (Herba Asari, 3 liang), Shaoyao (Radix Paeoniae Alba, 3 liang), Gancao (Radix Glycyrrhizae Preparata, 2 liang, roasted), Tongcao (Medulla Tetrapanacis, 2 liang), Dazao (Fructus Jujubae, 25 pieces, split).
Boil these seven herbs in eight sheng of water to obtain three sheng. Strain and take one sheng warm, three times daily.

If the patient has underlying cold, Danggui Sini Tang plus Wuzhuyu and Shengjiang (Evodia and Fresh Ginger) is indicated.
Add Wuzhuyu (Fructus Evodiae, 2 liang) and Shengjiang (Rhizoma Zingiberis Recens, 8 liang, sliced) to the previous formula. Boil with four sheng of water and four sheng of clear wine to obtain three sheng. Strain and divide into four warm doses.

For massive sweating where heat persists, limb cramping and pain, or if diarrhea and cold extremities with aversion to cold occur, Sini Tang (Frigid Extremities Decoction) is indicated.

For massive sweating, especially if induced by fire therapy, leading to diarrhea and cold extremities, Sini Tang is indicated.

If a patient has cold extremities and a suddenly tight pulse, with fullness and irritability below the heart, hunger but inability to eat, the pathogen is bound in the chest. Emesis is indicated. Gouti San (Seeds of Melon Bitter Powder) is suitable.

In Shanghan, if cold extremities are accompanied by palpitations below the heart, treat the fluid retention first with Fuling Gancao Tang (Poria and Licorice Decoction), then treat the cold extremities. Otherwise, water entering the stomach will cause diarrhea. Fuling Gancao Tang is indicated.
Formula:
Fuling (Poria, 2 liang), Gancao (Radix Glycyrrhizae Preparata, 1 liang, roasted), Guizhi (Caulis Cinnamomi, 2 liang), Shengjiang (Rhizoma Zingiberis Recens, 3 liang).
Boil these four herbs in four sheng of water to obtain two sheng. Strain and divide into three warm doses.

In Shanghan, after six or seven days, if the patient has undergone severe purgation, resulting in a deep and slow pulse, cold extremities, absent lower pulses, dysphagia, spitting of pus and blood, and intractable diarrhea, it is difficult to treat. Mahuang Shengma Tang (Ephedra and Cimicifuga Decoction) is indicated.
Formula:
Mahuang (Herba Ephedrae, de-segmented, 2.5 liang), Zhimu (Rhizoma Anemarrhenae, 18 zhu), Weirui (Rhizoma Polygonati Odorati, 18 zhu), Huangqin (Radix Scutellariae, 18 zhu), Shengma (Rhizoma Cimicifugae, 1 liang 6 zhu)... [Text implies 14 ingredients total]. Boil Mahuang first, skim foam, add remaining herbs, boil to three sheng. Strain and take three warm doses. Sweating within the time of one meal indicates recovery.

In Shanghan, after four or five days, if abdominal pain occurs with gas moving toward the lower abdomen, spontaneous diarrhea is impending.

In Shanghan, if the patient originally had cold-type diarrhea, and the physician mistakenly induced vomiting, causing cold rejection and worsening vomiting (food immediately expelled), Ganjiang Huangqin Huanglian Renshen Tang (Ginger, Scutellaria, Coptis, and Ginseng Decoction) is indicated.
Formula:
Ganjiang (Rhizoma Zingiberis Recens), Huangqin (Radix Scutellariae), Huanglian (Rhizoma Coptidis), Renshen (Radix Ginseng) (each 3 liang).
Boil in six sheng of water to obtain two sheng. Strain and take twice warm.

For diarrhea with slight fever, thirst, and a weak pulse, the disease will heal spontaneously.

For diarrhea with a rapid pulse, if there is slight fever and sweating, the disease will heal spontaneously. If the pulse becomes tight again, the disease is unresolved.

For diarrhea with cold extremities and absent pulse, if moxibustion fails to warm the limbs and shortness of breath occurs, it is fatal. If the Shaoyin pulse is weaker than the Duyang pulse, it is a favorable sign.

For diarrhea, if the pulse is surprisingly floating and rapid, and the Chi position is choppy, pus and blood in stool will occur.

For diarrhea with undigested food, exterior attack is contraindicated. Sweating will cause abdominal fullness.

For diarrhea, if the pulse is deep and string-taut, there is a sense of heaviness in the anus. If the pulse is large, the disease continues. If the pulse is weak, fine, and rapid, the disease will stop spontaneously; even with fever, it is not fatal.

For diarrhea, if the pulse is deep and slow, with a slightly red face and mild body heat, and undigested food in stool, the patient will likely experience vertigo/dizziness, sweat, and recover. Mild cold extremities may occur. If the pulse is surprisingly rapid and there is thirst, the disease will heal spontaneously. If not, pus and blood in stool will occur due to heat.

After diarrhea, if the pulse disappears and extremities are cold, but the pulse returns and extremities warm, survival is possible. If the pulse does not return, it is fatal.

In Shanghan diarrhea, if the patient defecates more than ten times a day and the pulse is surprisingly strong/excess, it is fatal.

For diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tongmai Sini Tang (Pulse-Recovering Frigid Extremities Decoction) is indicated.

For hot diarrhea with rectal tenesmus (feeling of incomplete evacuation), Baitouweng Tang (Pulsatilla Decoction) is indicated.

For diarrhea with desire to drink water, indicating internal heat, Baitouweng Tang is indicated.
Formula:
Baitouweng (Radix Pulsatellae, 2 liang), Huangbai (Cortex Phellodendri, 3 liang), Huanglian (Rhizoma Coptidis, 3 liang), Qinpi (Cortex Fraxini, 3 liang).
Boil in seven sheng of water to obtain two sheng. Strain and take one sheng warm. Repeat if necessary.

For diarrhea with abdominal fullness and body pain, first warm the interior, then attack the exterior. Warm the interior with Sini Tang; attack the exterior with Guizhi Tang (Cinnamon Twig Decoction).

For diarrhea accompanied by delirium, indicating dry feces, Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated.

For increased irritability after diarrhea, with a soft epigastrium upon palpation, this is empty irritability. Zhizi Tang (Gardenia Decoction) is indicated.

For vomiting due to abscess pus, do not treat the vomiting; it will resolve spontaneously when the pus is exhausted.

For vomiting with fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.

For vomiting with a weak pulse, free urination, mild body heat, and cold extremities (difficult to treat), Sini Tang is indicated.

For dry heaving, salivation, and headache, Wuzhuyu Tang (Evodia Decoction) is indicated.

In Shanghan, after severe vomiting and purgation leading to extreme deficiency, followed by excessive sweating, if the physician gives water to induce sweating, hiccups (Yue) may result due to cold in the Stomach.

In Shanghan, if hiccups are accompanied by fullness, examine the anterior and posterior orifices to determine which is obstructed. Relieving the obstruction will cure the condition.