Library

In cases of Shanghan (Cold Damage) or plague, when the exterior syndrome is initially contracted, sweating therapy should be employed promptly; delay is inadvisable. Thus, Zhang Zhongjing stated: "When administering herbal decoctions for sweating, although the prescription instructions specify three doses per day, if the condition is severe and unresolved, all three doses should be consumed within half a day." If, after one dose, the symptoms persist, the original decoction should be administered again. In some instances where sweating does not occur, three doses may be required to resolve the pathogen. If sweating remains impossible despite treatment, it indicates a fatal prognosis. This illustrates the principle that sweating therapy should not be delayed. However, the method of inducing sweating must assess the deficiency or excess of both the patient's Yuan Qi (Original Qi) and the pathogenic factor. In sudden acute illnesses where the exterior syndrome is fully manifested but Yuan Qi is intact, mild acrid-pungent agents can be used directly to disperse the pathogen. If complicated by other syndromes, one must evaluate the cold, heat, warmth, or coolness patterns and treat accordingly, rather than relying solely on dispersing methods. Furthermore, even if the body presents with high fever and complete exterior symptoms, if the pulse is weak, sweating will likely not occur easily; in such cases, detailed assessment and treatment focusing on tonifying deficiency are necessary. Ignoring the root and branch relationship and indiscriminately forcing dispersion can lead to exhaustion of Ying Blood (Nutritive Blood), resulting in death.

1. For Shanghan requiring mild dispersal, this applies when there are only exterior signs without internal cold-heat imbalance and with intact Yuan Qi. Zheng Chaihu Yin (Regular Bupleurum Decoction) is indicated as the primary formula. Additionally, Shishen Tang (Ten Spirits Decoction) and Shen Su Yin (Ginseng Perilla Decoction) may be used酌情ly. If the disease involves the Yangming channel, Shengma Gegen Tang (Cimicifuga and Pueraria Decoction) is appropriate. For infections from seasonal plagues presenting with body pain, fever, or exposure to miasmic vapors, Baidu San (Poison-Resolving Powder) or Jingfang Baidu San (Schizonepeta and Saposhnikovia Poison-Resolving Powder) are suitable. If the disease affects the Three Yang channels, presenting with headache, nasal congestion, stiffness of the neck and back, body pain, and cough, Shenzhu San (Divine Efficacy Powder) is indicated. For wind-cold invasion with fever and cough, Chaichen Jian (Bupleurum and Tangerine Peel Decoction) or Jinfeicao San (Boil-down Grass Powder) are appropriate. In severe cases, Xiao Qinglong Tang (Minor Green Dragon Decoction) is used.

2. For Shanghan requiring warm dispersal, this applies when external cold pathogens are strong, there are no internal heat signs, Yuan Qi is intact, and the constitution is clear/cold susceptible to cold. Er Chaihu Yin (Secondary Bupleurum Decoction) is most appropriate. In cases of severe cold with exterior excess, Magui Yin (Cinnamon Twig and Ephedra Decoction) is optimal, without hesitation. Additionally, Wuji San (Five Accumulations Powder), Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), Xiao Qinglong Tang (Minor Green Dragon Decoction), Gegen Tang (Pueraria Decoction), and Shengsanzi (Holy Seed Powder) may be used酌情ly.

3. For Shanghan requiring cool dispersal, this applies when there is heat externally and internally, with yang-type pulses and symptoms, restlessness, thirst preferring cold drinks, and robust Yuan Qi. In such cases, cooling and dispersing methods can be combined, starting with Yi Chaihu Yin (Primary Bupleurum Decoction). Alternatively, Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) or Chaige Jiexu Tang (Bupleurum and Pueraria Muscle-Releasing Decoction) may be used. In severe cases, Liutong Shengjie San (Six-Penetration Unblocking Powder) is suitable. If there is heat inside and out accompanied by hot diarrhea, Chaixin Jian (Bupleurum and Scutellaria Decoction) is indicated. If exterior and interior heat coexist with macules and rashes, Chaige Jian (Bupleurum and Pueraria Decoction) is appropriate.

4. For Shanghan requiring simultaneous tonification and dispersal, this is due to insufficiency of Ying and Wei (Defensive) Qi and lack of blood and qi. Using medicine is like using troops; if troops advance without supply, they perish; if attacking pathogens without supporting Yuan Qi, the patient suffers collapse. Therefore, treating deficiency with pathogenic factors requiring dispersal requires prioritizing the root before addressing the branch, which is crucial. If cold pathogens reside in the Ying level with liver-spleen blood deficiency and persistent pathogenic heat, San Chaihu Yin (Tertiary Bupleurum Decoction) or Guichai Yin (Angelica and Bupleurum Decoction) are indicated. If cold pathogens reside in the Wei level with spleen-lung qi deficiency and unresolved exterior pathogens, Si Chaihu Yin (Quaternary Bupleurum Decoction) is appropriate. If spleen-stomach qi and blood are insufficient with unresolved pathogenic heat, Wu Chaihu Yin (Quinary Bupleurum Decoction) is indicated. If pathogens are at the half-exterior half-interior level, presenting with alternating chills and fever and slight qi deficiency, Xiao Chaihu Tang (Minor Bupleurum Decoction) is suitable. For warm summer-heat with high fever, extreme thirst, dried-up fluids, and yin deficiency preventing sweating, Guige Yin (Angelica and Pueraria Decoction) is indicated. If cold pathogens penetrate deeply with insufficient yang qi within yin, or aversion to cold on the back, dispersion is difficult; Liyin Jian (Nourishing Yin Decoction) is essential. If middle jiao qi is severely deficient and cold, presenting with fever, aversion to cold, loose stools, and unresolved exterior pathogens, Dawenzhong Yin (Great Warming Middle Decoction) is indispensable.