Library

When the neck and back are stiff, use Guizhi Tang (Cinnamon Twig Decoction) with added Gegen (Kudzu Root).
(Bencao [Compendium of Materia Medica] states: Gegen treats wind-cold with dampness, opens orifices and releases the muscle layer. The term "Guizhi Tang with added Gegen" refers to adding Gegen to treat wind-stroke complicated by dampness, thereby dispelling wind-damp.)

For interior cold, use Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Aconite). (This is indicated when there is no desire for water.)
After any sweating therapy, if sweating does not stop, it is called "Lou Feng" (Leaking Wind), treated by Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). Abdominal fullness indicates a Taiyin syndrome; if the pulse is floating, Guizhi Tang may be administered.

[Text fragment missing: "Slight sweating... four... half tael. Use ancient formula."]

Question: How to distinguish between Shanghan (Cold Damage) and Shangfeng (Wind Injury)? In Shanghan, the pulse is tight and choppy; in Shangfeng, the pulse is floating and slow. Patients with Shanghan have no sweat.
[Text fragment missing: "Choppy pulse... Floating... Its symptoms... Shaoyang... Only... Fever and aversion to cold, irritability, warm hands and feet but pulse is surprisingly tight... Cold more than heat, no irritability, slightly cold hands and feet but pulse is surprisingly... Floating slow... More heat..."]

If a patient with Shanghan presents with a wind-type pulse, Da Qinglong Tang (Major Blue Dragon Decoction) is appropriate. Generally, the pulse of Da Qinglong Tang syndrome resembles that of Guizhi Tang but without sweat, and the condition resembles Mahuang Tang syndrome but with irritability. Weak pulse with sweat... [Text fragment missing: "Add... Add Gypsum inside. Hence it is tight. This treats both Ying and Wei levels. If the syndrome is not carefully examined and Da Qinglong Tang is mistakenly used, excessive sweating will damage the body. Because of the symptom of irritability, Da Qinglong Tang is necessary. Generally, contracting external wind is Shangfeng; contracting cold is Shanghan. Thus, wind damages Wei (Defensive Qi), and cold damages Ying (Nutritive Qi). Guizhi treats damage to Wei; Mahuang treats damage to Ying. Da Qinglong treats damage to both Ying and Wei. Wind damaging Wei means the disease is in the skin and hair layer. Since Wei circulates outside the vessels, belongs to Yang, and governs the exterior, the skin layer is the pathway of Wei Qi. The disease is shallow. Cold damaging Ying means cold qi penetrates the muscles. Since Ying circulates inside the vessels, belongs to Yin, and governs the interior, the muscle layer is the pathway of Ying Qi. The disease is deep. Therefore, the applications of Guizhi and Mahuang differ. Beware of misuse due to differences in depth and the distinction between wind and cold. Physicians must examine carefully. Da Qinglong Tang should be used with particular caution."]

Zhang Zhongjing said: If the pulse is faint and weak, with sweating and aversion to wind, Qinglong Tang must not be taken. Taking it will cause reversal of yang (cold limbs), damage to sinews, and contraction of flesh. This is an adverse reaction. Leicuan [Classified Compilation] says... [Text fragment missing: "To save... As combined..."]

In summer, fever, aversion to cold, headache, heaviness and pain in the body and joints, with a surging pulse, indicates Heat Disease caused by winter cold retained and triggered by summer heat. The treatment of Heat Disease is the same as Shanghan: use Guizhi Tang if there is sweat, Mahuang Tang if there is no sweat. If accompanied by irritability, use Da Qinglong Tang. However, medicines in summer must have a cooling nature and must not be too warming. Guizhi Tang, Mahuang Tang, and Da Qinglong Tang require modifications. Before Summer Solstice, add Huangqin (Scutellaria Root) half tael to Guizhi Tang. After Summer Solstice, add Zhi Mu (Anemarrhena Rhizome) one tael and Shigao (Gypsum Fibrosum) two taels, or Shengma (Cimicifugae Rhizome) half tael to Guizhi, Mahuang, and Da Qinglong Tangs. Since Guizhi and Mahuang Tangs are hot in nature, and southern regions are warm unlike the northwest, taking these hot formulas in summer inevitably leads to jaundice and macular eruptions. If after three days of Heat Disease the decoction fails to cure, and the pulse remains rapid with heat, indicating pathogenic factors still in the meridians and not yet in the zang-fu organs, Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) is indicated. This formula replaces Guizhi Tang indications after Summer Solstice. If Banxia (Pinelliae Rhizoma) half tael is added, it can replace Mahuang Tang and Da Qinglong Tang. Ancient formulas state that from March to summer, this is called Late-Onset Shanghan; Zhizi Shengma Tang (Gardenia and Cimicifuga Decoction) is also可选 (selectable). Question: Can Baihu Tang (White Tiger Decoction) be used after Summer Solstice? Baihu Tang treats Zhongshu (Heat Stroke) and post-sweating conditions... [Text fragment missing: "It is merely a surface-releasing drug. (Modern physicians, seeing illness in the sixth lunar month, often say it is Zhongshu, failing to distinguish Heat Disease, using drugs that are too cool. Moreover, in summer, Yin Qi resides internally, making regulation difficult.)"]

Summer spontaneous sweating, aversion to cold, body heat with thirst, and a faint pulse is named Zhongshu (Heat Stroke). Generally, the exterior symptoms of Zhongshu resemble Heat Disease, but Heat Disease patients... [Text fragment missing: "Cover... Prosperous (Their faces look like coated with oil. Leicuan says: A greasy face is a Yang syndrome, also called Mian Chen [Face Dust], like dust adhering to the face.)"]

Slightly cold hands and feet, irritability, thirst, dry mouth, feeling only fatigue, but limbs are not painful or heavy, pulse is faint and powerless upon pressure, treated by Baihu Tang.
[Text fragment missing: "Phlegm rebellion... Most excellent... Skin... Heat Disease... Body... Disease. Cover (Early spring and late autumn, Yang Qi is internal. The disease is slightly mild. Even without medication, it heals itself in five to six days.)"]

Shengma Tang, Jiemi Tang (Release Muscle Decoction), Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) are best. For greater heat, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. For no thirst with slight exterior heat, Xiaochaihu... [Text fragment missing: "Next... Only in winter and early spring can the standard formulas be used. From late spring to before Summer Solstice, modifications are needed within Guizhi, Mahuang, and Da Qinglong Tangs."]

If a patient has fever first followed by chills, and the Cun, Guan, and Chi pulses are all vigorous, it is named Wen Nue (Warm Malaria). Fever first then chills is Warm Malaria. Vigorous pulses at Cun and Chi, re-contracted by cold, transforming into Warm Malaria, treated by Xiaochaihu Tang. For malaria with equal chills and fever, or fever first then chills, Xiaochaihu Tang is suitable. For chills first then fever, use Chaihu Jia Guizhi Tang. For more heat, use Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction). For more chills, use cold-natured herbs alone. For only chills, use Chaihu Guijiang Tang (Bupleurum, Cinnamon, and Ginger Decoction). For profuse sweating, irritability, thirst, astringent red urine, chronic miasma, acclimatization issues, or severe vomiting, Wuling San (Five-Ling Powder) may be taken. For small-tight pulse, chills/fever, vomiting, irregular paroxysms, and constipation, Daxiehu Tang (Major Bupleurum Decoction) for purgation is suitable. For floating-large pulse with alternating chills and fever, Quxie Wan (Evil-Expelling Pill) for emesis is suitable. For chronic cases, Nuomu Jianwan (Malaria Mass Decoction Pills) should bring self-healing. No method surpasses this for treating malaria. Generally, the malaria pulse is Xian (Wiry); wiry-rapid indicates more heat; wiry-slow indicates more cold; wiry-small-tight indicates purgation cures; wiry-slow indicates warming; wiry-tight indicates sweating; floating-large indicates emesis. Summer injury by summer heat leads to autumn malaria. This is not referring to Shanghan, but because Warm Malaria exists within Shanghan, it is mentioned here.

Pulses at Cun and Chi are both floating, with headache, body heat, constant spontaneous sweating, body heaviness,必喘 (inevitable panting), inability to control limbs, silence, and desire to sleep, is named Fengwen (Wind-Warmth). The person was previously injured by wind, then again by heat. Wind and heat clash, triggering Fengwen. Main symptoms: inability to control limbs, constant headache and body heat, unremitting sweat. Treatment focuses on Shaoyin and Jueyin channels. Sweating must not be induced. If induced, it causes delirious speech, internal irritability, restlessness, inability to lie down, resembling convulsions, with chaotic eyes and lack of spirit. Such deaths are caused by the physician. Fengwen cannot be treated by sweating; Weirui Tang (Jade Bud Decoction) is suitable. For burning heat in Fengwen, Zimu Gan Ge Tang (Anemarrhena and Kudzu Root Decoction) is used. For severe thirst in Fengwen, Gualou Gen Tang (Trichosanthes Root Decoction) is used. For floating pulse, body heaviness, and sweating in Fengwen, Han Fangji Tang (Stephania Tetrandra Decoction) is used.