Library

Zhang Zhongjing stated that Taiyang disease (disease of the Taiyang channel) presenting with fever, absence of sweating, and aversion to cold is named Gang Jing (Spasm characterized by rigidity and trismus). This occurs when Wind-Heat is heavy due to Wind pathogen invasion, compounded by Cold. This aligns with the *Neijing*’s description of "Hexi Zhi Ji" (a period dominated by excessive Fire Qi), where Earth Qi manifests as Dryness; the principle is identical. If Wind-Dampness invades, the Heat associated with Fire movement differs little in its thermal nature from pure Heat. However, secondary contraction of Cold is similar to the Cold associated with excessive Earth/Dryness: both involve external constraint. The Heat becomes more severe due to this constraint. When extreme, the Heat combines with Dryness transformation, resulting in anhidrosis. Qi and Blood fail to circulate freely, causing both large and small tendons to suffer heat damage and become rigid. Hence, it is called Gang Jing.

Conversely, Taiyang disease presenting with fever, sweating, and no aversion to cold is named Rou Jing (Spasm characterized by sweating and neck stiffness). This results from heavy Taiyang Heat combined with Dampness invasion. This corresponds to the *Neijing* statement: "All spasms and neck stiffness belong to Dampness." It also states: "Due to Dampness, the head feels wrapped [heavy]." If Damp-Heat is not resolved, the large tendons become short and contracted, while the small tendons become lax and elongated. Contraction leads to spasm/cramping; laxity leads to flaccidity/paralysis. Liver Heat transferring to the Kidney transforms into Rou Jing. Annotations explain: "Rou" refers to tendons that are soft and weak; "Qiang" refers to bones that are stiff and unyielding. Do these three meanings not align with Zhang Zhongjing’s assertion that secondary Dampness invasion causes Rou Jing? Is it not true that small tendons affected by Dampness become flaccid and weak? Are symptoms such as head shaking, fever, neck stiffness, opisthotonos (backward arching of the back), convulsions, and trismus not identical in presentation to Gang Jing? Are they not caused by large tendons becoming spasmodic and rigid due to Heat? Later generations erroneously classified absence of sweating as Exterior Excess and presence of sweating as Exterior Deficiency. Failing to consider that excessive Dampness often causes sweating, they treated sweating as Exterior Deficiency, employing warming agents like Ginger and Aconite. Would this not exacerbate the Heat in the large tendons!

The prescription incorporates three therapeutic methods: Renzhonghuang (Human Middle Yellow) serves as the chief herb to treat epidemic heat-toxin; Cangzhu (Atractylodis Rhizoma) and Xiangfu (Cyperi Rhizoma) act as deputy herbs to dissipate nodules and resolve stagnation; Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) descend fire; Renshen (Ginseng Radix) tonifies deficiency; Jiegeng (Platycodonis Radix) and Fangfeng (Saposhnikoviae Radix) promote Qi flow and unblock meridians as assistant herbs. When heat-toxin stagnates, internal and external Qi and fluids fail to communicate, leading to dryness. Dahuang (Rhei Radix et Rhizoma), bitter and cold, purges dryness-heat. Huashi (Talcum), slippery and bland, opens orifices, resolves stagnation, promotes Qi/fluid circulation, and moistens dryness. These two herbs, one Yin and one Yang, serve as envoy herbs. These three methods are not merely universal for all warm diseases. The *Neijing* states that winter Cold injury leads to spring Warmth, and winter failure to store Essence leads to Warmth; these differ in Deficiency vs. Excess. Some arise from郁 (stagnation) of abnormal seasonal Qi; others from the imposition of Ministerial or Sovereign Fire. Even distinguishing between Sovereign and Guest Qi, when Five Movements and Six Qi undergo transition, if the controlling Qi suppresses them preventing ascent/descent, one must differentiate the specific Qi manifesting to treat it. How can one rigidly apply only these three methods to all Warm diseases? The Master said: Whenever excessive Yang overflows abnormally, or unusual phenomena like violent winds and hail occur, one must record the timing of their manifestation to identify the source for treatment.