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Mahuang (Ephedrae Herba, three liang, nodes removed, sweet flavor, warm nature) Shaoyao (Paeoniae Radix Alba, three liang, sour flavor, slightly cold nature) Wuweizi (Schisandrae Fructus, half sheng, sour flavor, warm nature) Ganjiang (Zingiberis Rhizoma, three liang, pungent flavor, hot nature) Gancao (Glycyrrhizae Radix et Rhizoma, three liang, processed with honey, sweet flavor, neutral nature) Guizhi (Cinnamomi Ramulus, three liang, bark removed, pungent flavor, hot nature) Banxia (Pinelliae Tuber, half sheng, washed in boiling water, pungent flavor, slightly warm nature) Xixin (Asari Radix et Rhizoma, three liang, pungent flavor, warm nature)
The above eight herbs. Use one dou of water. First decoct Mahuang, reduce the volume by two sheng, remove the foam on the surface. Add the remaining herbs. Decoct to obtain three sheng of liquid. Filter out the dregs. Take one sheng warm.
Cold pathogen is at the exterior; only sweet and pungent substances can disperse it. The sweet and pungent properties of Mahuang, Guizhi, and Gancao are used to disperse exterior pathogens. When fluid retention occurs below the heart and fails to circulate, the Kidney Qi becomes dry. The *Neijing* states: "The Kidney suffers from dryness; urgently consume pungent foods to moisten it." The pungency of Ganjiang, Xixin, and Banxia moves fluid qi and moistens the Kidney. Cough with counterflow and wheezing indicate rebellious Lung Qi. The *Neijing* states: "The Lung desires astringency; urgently consume sour foods to gather it." The sourness of Shaoyao and Wuweizi gathers rebellious qi and calms the Lung.
Modifications
If there is slight diarrhea, remove Mahuang and add Raohua (Edwardsia Radix). Size of a chicken egg, roasted until red. For those with diarrhea, attacking the exterior is contraindicated; sweating will inevitably cause abdominal fullness. Mahuang disperses Yang Qi; if water moisture enters the Stomach, diarrhea will occur. Raohua drains water from the twelve meridians; once water is gone, diarrhea stops.
If there is thirst, remove Banxia and add Gualougen (Trichosanthis Radix), three liang. Pungent and drying, yet bitter and moistening. Banxia is pungent and dries body fluids, unsuitable for those with thirst. Hence, remove it. Gualou is bitter and generates body fluids, hence add it.
If there is a sensation of choking (Ye), remove Mahuang and add one Fuzi (Aconiti Lateralis Radix Praeparata), processed. Classics state: "When water meets cold qi, cold must contend." The person will experience discomfort. Add Fuzi to warm and disperse cold-water. If the patient has cold and sweating is induced, the Stomach becomes cold, likely causing vomiting of roundworms. Remove Mahuang due to aversion to sweating.
If urination is difficult and the lower abdomen is full, remove Mahuang and add Fuling (Poria), four liang. Water accumulation in the Lower Jiao failing to circulate causes difficult urination and lower abdominal fullness. Mahuang directs body fluids outward, which is inappropriate here. Fuling drains accumulated water downward, making its addition appropriate.
If there is wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum), half sheng, skin and tips removed. The *Jingui Yaolue* states: "If the person has edema, do not add Mahuang. Add Xingzi (Almonds), because Mahuang disperses Yang Qi." Wheezing and edema indicate simultaneous root and branch pathology of water qi.
Zhang Qingzi said: This resembles Chaihu Tang syndrome. This formula treats the exterior, thus leaning towards warmth. That formula treats the half-exterior half-interior, thus leaning towards clearing heat.
In Shanghan, when water qi is present in the chest, coughing with slight wheezing, fever but no thirst: after taking the decoction, if thirst appears, this indicates cold has departed and resolution is imminent. Xiao Qinglong Tang is indicated.
Coughing with slight wheezing is caused by cold-water invading the Lung. Fever without thirst indicates the exterior syndrome has not resolved. Administer Xiao Qinglong Tang to release the exterior and scatter water. After taking the decoction, if thirst appears, it indicates interior warmth returning and water qi dissipating, signaling impending resolution.
In Taiyang disease, if exterior symptoms persist and the pulse is floating and weak, resolve via sweating. Guizhi Tang is suitable.
Floating and weak pulse indicates weak Ying and strong Wei.
In Taiyang disease, if slight wheezing occurs after purgation, it is because the exterior has not resolved. Guizhi Jia Houpo Xingren Tang is indicated.
Severe wheezing after purgation indicates severe deficiency of interior Qi, transmission of pathogen to the interior, and impending collapse of righteous Qi. Slight wheezing after purgation indicates rebellious interior Qi, inability of pathogen to transmit to the interior, and persistence at the exterior. Give Guizhi Tang to resolve the exterior. Add Houpo and Xingren to direct rebellious Qi downward.
In Taiyang disease, if exterior symptoms have not resolved, purgation is contraindicated. Using purgation is contrary to treatment principles. To resolve the exterior, Guizhi Tang is indicated.
Classics state: "Originally should have sweated but instead purged is contrary treatment. If sweating is performed first, treatment is not contrary."
In Taiyang disease, if initial sweating fails to resolve the condition and purgation is subsequently used, and the pulse remains floating, the disease does not resolve. Floating indicates the pathogen is at the exterior; using purgation contrary to this prevents resolution.
Since the pulse is currently floating, we know the pathogen is at the exterior. Resolution of the exterior is required for cure. Guizhi Tang is indicated.
Classics state: "Chaihu Tang syndrome is present, but other medicines were used to purge. If Chaihu Tang syndrome persists, administer Chaihu Tang again. Although purgation was used, it is not considered contrary treatment, similar to this case."
In Taiyang disease, with floating-tight pulse, no sweat, fever, and body pain persisting for eight or nine days without resolution, the exterior syndrome remains. Sweating is indicated. After medication, symptoms may slightly alleviate. The patient may feel vexed and close their eyes. In severe cases, epistaxis (nosebleed) occurs, followed by resolution. This is because Yang Qi is heavy. Mahuang Tang is indicated.
Saying "Mahuang Tang is indicated" precisely refers to the need for sweating with this single decoction. After sweating, symptoms should slightly alleviate, or resolve via epistaxis. How could one deplete blood and sweat, then use Mahuang Tang again to sweat? The textual structure of the Han dynasty writings is intricate; this must be understood.
Floating-tight pulse, no sweat, fever, and body pain constitute Taiyang Cold Damage. Even if eight or nine days have passed, if the exterior syndrome remains, sweating is still indicated. Having taken warm, dispersing decoctions, although heavy sweating may not occur, there will be slight alleviation. Vexation refers to body heat. If the pathogen is not resolved by sweat, it stagnates and transforms into heat, steaming through meridians and manifesting on the muscle surface, generating heat and vexation. The Liver receives blood to enable vision. Initially, Qi injures Ying; as cold transforms to heat, blood is constrained by heat, Liver Qi fails to govern, resulting in closed eyes. Severe heat in meridians forces blood to move recklessly, causing epistaxis. Epistaxis allows heat to dissipate with blood, leading to resolution. "Heavy Yang Qi" refers to heavy heat. Mahuang Tang is given to resolve the preceding Taiyang Cold Damage pathogen.
Wang Wenlu said: View this alongside the next two clauses. The "heavy Yang Qi" mentioned above corresponds to "unable to vent" in the following clause. The "incomplete" mentioned below corresponds to "slight alleviation" above. Mahuang drains excess, hence it is indicated.
In Taiyang disease, with floating-tight pulse, fever, no body sweat, spontaneous epistaxis leads to recovery.
The previous clause describes epistaxis after taking diaphoretic medicine; this clause describes spontaneous epistaxis without such medicine. Both are signs of approaching recovery.
Wind-cold in the meridians cannot be resolved by sweating; stagnation transforms into heat. Epistaxis allows heat to dissipate with blood, hence "spontaneous epistaxis leads to recovery."
Two Yangs concurrent disease: When Taiyang disease is first acquired, sweating is induced. If the initial sweat is incomplete, the condition transfers to Yangming, continuing with slight spontaneous sweating and aversion to cold ceases.
If Taiyang symptoms have not ceased, purgation is contraindicated. Using purgation is contrary treatment. In such cases, mild sweating may be induced. If the face is uniformly red, it indicates cold qi stagnating at the exterior. Resolve and fumigate. If sweating is incomplete, it is insufficient to describe as Yang Qi stagnation unable to vent. When sweating should occur but does not, the person becomes restless and vexed, unaware of pain location, shifting between abdomen and limbs, unpressable. Shortness of breath, sitting only, is due to incomplete sweating. Re-sweating leads to recovery. How do we know sweating was incomplete? By the choppy pulse.
Taiyang disease unresolved, transmitting into Yangming, while Taiyang symptoms persist, is called concurrent disease. Continued slight spontaneous sweating and absence of aversion to cold indicate Taiyang symptoms have ceased and Yangming symptoms are complete. According to method, purgation is indicated. However, if Taiyang symptoms persist, the exterior is unresolved, so purgation is contraindicated. Mild sweating should be induced to resolve the exterior first. The Yangming meridian traverses the face; uniform redness indicates Yang Qi stagnating at the exterior. Resolve and fumigate to induce sweat. If sweating is incomplete, it is insufficient to call Yang Qi stagnation. It simply means failure to sweat when indicated, preventing Yang Qi from venting. Pathogen has no exit, accumulating heavily in meridians, causing restlessness. Pathogen follows meridians, so pain is irregular. In abdomen or limbs, unpressable. Shortness of breath is solely blamed on incomplete sweating; re-sweating leads to recovery. *Neijing* states: "Palpate all abnormalities. Choppy indicates excess Yang, body heat, and no sweat." Thus, choppy pulse indicates Yang Qi stagnation and incomplete sweating.
Floating-numerous pulse indicates sweating should lead to recovery. If purgation is used, resulting in heaviness of body and palpitations, sweating is contraindicated. Spontaneous sweating will lead to resolution. This is because the pulse at the cun-knee position (Chi) is faint, indicating interior deficiency. Interior and exterior must become solid; when body fluids harmonize, spontaneous sweating occurs and recovery follows.
Classics state: "All floating-numerous pulses indicate fever and chills, signifying pathogen at the exterior." Recovery via sweating is expected. If purgation is used, causing body heaviness and palpitations, body fluids are damaged and Stomach Qi is weakened. If body heaviness and palpitations accompany a solid Chi pulse, it indicates interior deficiency post-purgation with pathogen transmitting inward due to deficiency.
Now, with a faint Chi pulse, body heaviness, and palpitations, we know interior deficiency and insufficient body fluids post-purgation, with pathogen remaining at the exterior. However, due to insufficient body fluids, sweating is contraindicated. Interior Qi must strengthen and body fluids replenish before spontaneous sweating and recovery can occur.
Floating-tight pulse indicates body pain; sweating is indicated. If the Chi pulse is slow, sweating is contraindicated. Why? Because Ying Qi is deficient and blood is scant.
*Zhenjing* states: "Those who lose blood have no sweat." Slow Chi pulse indicates deficiency of Ying blood, hence sweating is contraindicated.
Floating pulse indicates disease at the exterior; sweating is possible. Mahuang Tang is suitable.
Floating is felt lightly, assessing Qi at the skin. *Neijing* states: "Where pathogen is in the skin, release via sweating."
Floating-numerous pulse allows sweating. Mahuang Tang is suitable.
Floating injures Wei; Numerous injures Ying. When Ying and Wei receive pathogen, disease is at the exterior, requiring dispersal via sweating.
Patients with constant spontaneous sweating have harmonious Ying Qi. Harmonious Ying Qi implies disharmony externally, because Wei Qi does not harmonize with Ying Qi. Ying circulates within vessels; Wei circulates outside. Inducing sweating restores harmony between Ying and Wei, leading to recovery. Guizhi Tang is suitable.
Wind injures Wei; Cold injures Ying. If Wei receives wind pathogen but Ying is unaffected, Ying Qi is harmonious. Once Wei hosts pathogen, it cannot harmonize with Ying nor protect the skin and pores, causing constant spontaneous sweating. Guizhi Tang disperses wind pathogen and harmonizes Ying and Wei, leading to recovery.
Patients with no internal organ pathology, experiencing intermittent fever and spontaneous sweating without recovery, suffer from disharmonious Wei Qi. Sweating prior to symptom onset leads to recovery. Guizhi Tang is indicated.
No internal organ pathology indicates interior harmony. Disharmonious Wei Qi indicates exterior disease. *Waitai Mi Yao* states: "Interior harmonious, exterior diseased; sweating leads to recovery." "Prior to onset" means sweating before the fever and sweating episode begins.
Shanghan with floating-tight pulse, if not sweated, leading to epistaxis, Mahuang Tang is indicated.
Previous clause: Taiyang disease unresolved after eight-nine days, give Mahuang Tang to sweat, resolving via spontaneous epistaxis. This clause: Not sweating leads to epistaxis. Mahuang Tang is indicated. Why? Previous clause: Sweating leads to spontaneous epistaxis; epistaxis acts as sweating, hence "epistaxis resolves." This clause: Not sweating leads to epistaxis; pathogen stagnates in meridians. Thus, Mahuang induces sweating to resolve both aspects.
Shanghan with floating-tight pulse indicates pathogen at the exterior. Mahuang Tang should be given to sweat. If not sweated, pathogen has no exit, accumulates heavily in meridians, forces blood recklessly, causing epistaxis.
Wang Sanyang said: Blood loss precludes sweat. Since epistaxis has occurred, Mahuang Tang should not be used lightly. Scrutinize carefully. Only use if bleeding is minimal.
Shanghan with constipation for six-seven days, headache with fever: Give Chengqi Tang. If urine is clear, know pathogen is not in the interior but remains at the exterior.
Sweating is indicated. If headache persists, epistaxis will likely occur. Guizhi Tang is suitable.
Constipation for six-seven days with headache and fever suggests purgation is appropriate. If urine is clear, interior heat is absent, so purgation is contraindicated. Classics state: "Frequent urination leads to hard stool. Ten days without bowel movement without discomfort is acceptable." Especially with six-seven days of constipation and clear urine, do not blame pathogen in the interior; it remains at the exterior. Guizhi Tang resolves the exterior. If headache persists, exterior has not resolved, stagnation in meridians forces blood recklessly upward, causing epistaxis.
Wang Sanyang said: Headache with fever requires resolving the exterior. Even with six-seven days of constipation, Da Chaihu Tang is appropriate. Chengqi Tang is not. Suspect a textual error ("cured"). Even ten days without bowel movement, why fear?
Shanghan, after sweating, resolves. Half a day later, vexation returns, pulse floating-numerous: Can re-sweat. Guizhi Tang is indicated.
Vexation indicates heat. Body cooling after sweating indicates resolution. Half a day later, body heats up again, pulse floating-numerous indicates pathogen not fully expelled. Re-sweating is possible. Guizhi Tang is given.
For any disease, whether treated with sweating, vomiting, purgation, or loss of body fluids, if Yin and Yang self-harmonize, recovery is inevitable.
Severe loss of body fluids prevents sweating. Must wait for Yin-Yang self-harmony for recovery.
After severe purgation and subsequent sweating, if urination is difficult, it is due to loss of body fluids. Do not treat directly. When urination normalizes, recovery will follow spontaneously.
Urinary difficulty due to body fluid loss should not be treated with diuretics. Wait for body fluids to replenish and urination to normalize; recovery will follow.
After purgation and subsequent sweating, chills and faint-thin pulse occur. This is because both interior and exterior are deficient.
Sweating causes exterior deficiency and loss of Yang. Purgation causes interior deficiency and loss of blood. Chills indicate微弱 Yang Qi. Faint-thin pulse indicates weak Yin blood.
After purgation and subsequent sweating, daytime irritability and insomnia, nighttime quietness, no vomiting or thirst, no exterior syndrome, sinking-faint pulse, and no significant heat: Ganjiang Fuzi Tang is indicated.
Purgation weakens the interior; sweating weakens the exterior. Both purgation and sweating result in dual interior-exterior deficiency. Yang dominates daytime; Yang attempts to recover but deficiency cannot overcome pathogen. Righteous and pathogenic Qi contend, causing daytime irritability and insomnia. Nighttime, Yin dominates; Yang deficiency cannot contend, hence nighttime quietness. No vomiting/thirst indicates no interior heat. No significant heat indicates no exterior heat. With no exterior syndrome and sinking-faint pulse, we know severe Yang deficiency and prevailing Yin-cold. Ganjiang Fuzi Tang retreats Yin and restores Yang.