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Zhang Zhongjing treated Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang meridian) presenting with body stiffness and a deep, slow pulse using Gualou Guizhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) to induce mild sweating. For Gang Jing (rigid spasm characterized by neck and back rigidity and lockjaw, accompanied by anhidrosis) without sweat, he used Gegen Tang. For cases presenting with chest fullness, lockjaw, inability to lie flat with the back touching the bed (opisthotonos), leg spasms, and clenched teeth, he used Dachengqi Tang (Major Order the Qi Decoction). These methods all belong to dispelling excess pathogens. Although such cases are rare, they do occur occasionally, so one must be aware of them.

Wang Haicang treated Gang Jing using Shenzhu Tang (Atractylodes Macrocephala Decoction) added with Qianghuo, Duhuo, and Mahuang. For Rou Jing (soft spasm characterized by neck and back rigidity and sweating), he used Baizhu Tang added with Guixin and Huangqin.

Daying Jian (New Supplement 14) Wufu Yin (New Supplement 6) Shen Gui Tang (Supplement 38) Shen Fu Tang (Supplement 37) Fuzi Tang (Supplement 43) Baizhu Tang (Harmonize 26) Yiyin Jian (New Supplement 8) Sanyin Jian (New Supplement 11) Baoyin Jian (New Cold 1) Wenwei Yin (New Heat 5) Weiguan Jian (New Heat 9) Qinghua Yin (New Cause 13) Yvnu Jian (New Cold 12) Dabu Yuanyuan Jian (New Supplement 1) Shiquan Dabu Tang (Supplement 20) Wuji San (Disperse 39) Dawenzhong Yin (New Disperse 8) Renshen Jianzhong Tang (Supplement 26) Qingge Jian (New Cold 9) Er Chaihu Yin (New Disperse 2) Danggui Liu Huang Tang (Cold 65) Shenzhu Tang (Harmonize 39) San Chaihu Yin (New Disperse 3) Buyin Yiqi Jian (New Supplement 16) Liu'an Jian (New Harmonize 2) Si Chaihu Yin (New Disperse 4) Jiajian Yiyin Jian (New Supplement 9) Gegen Tang (Disperse 29) Dachengqi Tang (Attack 1) Gualou Guizhi Tang (Disperse 12) Baolong Wan (Small 85)

Fangfeng Danggui Tang (Harmonize 241 - Spasm induced by excessive sweating)

The *Suwen: Yin-Ying Yingxiang Dalun* states: If cold is injured in winter, warm diseases will surely occur in spring.
The *Suwen: Jin Gui Zhenyan Lun* states: Essence (Jing) is the root of the body. Therefore, those who store essence well will not suffer from warm diseases in spring.
In the *Suwen: Relun Pian*, the Yellow Emperor asked: Now, heat diseases all belong to the category of cold damage. Some recover, some die; those who die usually do so between the sixth and seventh day, while those who recover usually do so after the tenth day. Why is this? Qibo replied: Juyang (Taiyang) is the leader of all Yang meridians. Its vessels connect to the Fengfu point, thus serving as the master qi for all Yang meridians. When humans are injured by cold, it manifests as a heat disease. Even if the heat is severe, it will not cause death. However, those who suffer from "double injury by cold" (simultaneous invasion of exterior and interior meridians) will inevitably die. The Yellow Emperor said: I wish to hear about its symptoms. Qibo said: On the first day of cold damage, Taiyang is affected, hence headache, stiff neck, and soreness/stiffness of the waist and spine. On the second day, Yangming is affected. Yangming governs flesh; its vessels run alongside the nose and connect to the eyes. Hence, there is fever, eye pain, dry nose, and inability to sleep. On the third day, Shaoyang is affected. Shaoyang governs the Gallbladder; its vessels follow the hypochondrium and connect to the ears. Hence, there is pain in the chest and hypochondrium, and deafness. If the diseases of the three Yang meridians have been received but have not entered the Zang organs, they can be cured by sweating. On the fourth day, Taiyin is affected. Taiyin vessels distribute in the stomach and connect to the throat. Hence, abdominal fullness and dry throat. On the fifth day, Shaoyin is affected. Shaoyin vessels penetrate the Kidney, connect to the Lung, and tie to the root of the tongue. Hence, dry mouth and tongue, and thirst. On the sixth day, Jueyin is affected. Jueyin vessels follow the genitalia and connect to the Liver. Hence, irritability, fullness, and retraction of the scrotum. When the three Yin and three Yang meridians, and the five Zang and six Fu organs are all diseased, and Ying and Wei qi cease to circulate, and the five Zang become blocked, death ensues. In cases not suffering from double injury by cold, on the seventh day, the disease in Taiyang declines, and headache improves slightly. On the eighth day, the disease in Yangming declines, and body heat subsides slightly. On the ninth day, the disease in Shaoyang declines, and hearing improves slightly. On the tenth day, the disease in Taiyin declines, abdominal distension reduces to normal, and appetite returns. On the eleventh day, the disease in Shaoyin declines, thirst stops, abdominal fullness ceases, tongue dryness resolves, and sneezing occurs. On the twelfth day, the disease in Jueyin declines, the scrotum relaxes, lower abdomen becomes slightly soft, pathogenic qi is expelled, and the illness heals day by day. The Yellow Emperor asked: How should it be treated? Qibo said: Treatment involves unblocking the meridians of each respective organ, so that the disease declines day by day. For those whose illness has lasted less than three days, sweating can cure it; for those whose illness has lasted more than three days, purging can cure it.
The *Suwen: Relun Pian* states: In cases of double injury by cold, on the first day, Taiyang and Shaoyin are both diseased, resulting in headache, dry mouth, and irritability/fullness. On the second day, Yangming and Taiyang are both diseased, resulting in abdominal fullness, fever, aversion to food, and delirious speech. On the third day, Shaoyang and Jueyin are both diseased, resulting in deafness, scrotal retraction, and cold limbs; inability to take fluids or food, and unconsciousness lead to death on the sixth day. The Yellow Emperor asked: The five Zang are damaged, the six Fu are blocked, and Ying and Wei qi do not circulate. After this, why does death occur three days later? Qibo said: Yangming is the head of the twelve meridians, and its blood and qi are abundant. Hence, unconsciousness occurs; after three days, its qi is exhausted, leading to death.
The *Suwen: Relun Pian* states: Any disease originating from cold damage that transforms into warmth: if it occurs before the Summer Solstice, it is called Warm Disease (Wen Bing); if it occurs after the Summer Solstice, it is called Summerheat Disease (Shu Bing). Summerheat should exit with sweat; do not stop sweating.
In the *Suwen: Relun Pian*, the Yellow Emperor asked: Heat diseases have healed, yet sometimes residual heat remains. Why? Qibo said: Residual heat occurs because food is forced upon the patient when heat is intense. In such cases, the disease has declined but heat is hidden; the qi of grain interacts with the residual heat, combining two heats, causing residual symptoms. The Yellow Emperor asked: How to treat residual heat? Qibo said: Observe deficiency and excess, regulate reversal and順 (shun), and the disease can certainly be cured. The Yellow Emperor asked: What should be prohibited during heat disease? Qibo said: When heat disease shows slight improvement, eating meat causes relapse; overeating causes residual heat. This is the prohibition.
The *Suwen: Ci Re Pian* states: In Liver Heat disease, urine turns yellow first, accompanied by abdominal pain, tendency to lie down, and fever. When heat contends, there is delirium and惊 (startle/fright), hypochondriac fullness and pain, restlessness of hands and feet, and inability to sleep peacefully. Symptoms worsen on Geng/Xin days, and profuse sweating occurs on Jia/Yi days. If qi rebels, death occurs on Geng/Xin days. Needle the Foot Jueyin and Foot Shaoyang meridians. If qi rebels, there is dizziness and headache, with pulse qi rushing to the head. In Heart Heat disease, there is initial displeasure, followed by fever after several days. When heat contends, sudden heart pain, irritability, frequent vomiting, headache, red face, and anhidrosis occur. Symptoms worsen on Ren/Gui days, and profuse sweating occurs on Bing/Ding days. If qi rebels, death occurs on Ren/Gui days. Needle the Hand Shaoyin and Hand Taiyang meridians. In Spleen Heat disease, there is initial heavy head and cheek pain, irritability, bluish complexion, desire to vomit, and fever. When heat contends, lower back pain prevents bending and stretching, abdominal fullness, diarrhea, and pain in both mandibles occur. Symptoms worsen on Jia/Yi days, and profuse sweating occurs on Wu/Ji days. If qi rebels, death occurs on Jia/Yi days. Needle the Foot Taiyin and Foot Yangming meridians. In Lung Heat disease, there is initial chills, goosebumps, aversion to wind and cold, yellow coating on the tongue, and fever. When heat contends, wheezing and coughing occur, pain radiates to the chest, epigastrium, and back, difficulty in deep breathing, unbearable headache, sweating, and chills occur. Symptoms worsen on Bing/Ding days, and profuse sweating occurs on Geng/Xin days. If qi rebels, death occurs on Bing/Ding days. Needle the Hand Taiyin and Hand Yangming meridians; bleeding like a soybean size leads to immediate recovery. In Kidney Heat disease, there is initial lower back pain and soreness, bitter thirst with frequent drinking, and fever. When heat contends, neck pain and stiffness, aversion to cold with soreness, heat in the soles of the feet, and reluctance to speak occur. If qi rebels, there is neck pain and dizziness. Symptoms worsen on Wu/Ji days, and profuse sweating occurs on Ren/Gui days. If qi rebels, death occurs on Wu/Ji days. Needle the Foot Shaoyin and Foot Taiyang meridians. Sweating occurs on the day that controls the diseased organ. In Liver Heat disease, the left cheek reddens first. In Heart Heat disease, the forehead reddens first. In Spleen Heat disease, the nose reddens first. In Lung Heat disease, the right cheek reddens first. In Kidney Heat disease, the chin reddens first. Even if the disease has not manifested, seeing redness indicates the need for acupuncture, known as treating disease before it arises. If Taiyang vessel color reflects on the zygomatic bone, it is a heat disease. If the color has not mixed, it is said that if sweat is obtained now, waiting for the appropriate time will suffice. If it competes with Jueyin vessel color, death will not exceed three days. If heat disease internally connects to the Kidney, it is indicated by Shaoyang vessel color. If Shaoyang vessel color reflects on the front of the cheek, it is a heat disease. If the color has not mixed, it is said that if sweat is obtained now, waiting for the appropriate time will suffice. If it competes with Shaoyin vessel color, death will not exceed three days. (This section discusses double injury by cold; detailed notes are recorded in *Lei Jing · Disease Category* 44).
The *Suwen: Re Bing Pian* states: On the third day of heat disease, if the Qi Kou pulse is quiet and the Ren Ying pulse is agitated, needle the Yang meridians. Use the fifty-nine needles to drain heat and induce sweat, solidifying Yin to supplement insufficiency. If body heat is very high and both Yin and Yang pulses are quiet, do not needle. For those who can be needled, act quickly; if sweat does not occur, use purging. Those who should not be needled show signs of death. On the seventh or eighth day of heat disease, if the pulse mouth moves, pants, and is wiry, needle urgently; sweat will self-occur. Needle shallowly at the space between the thumb and index finger. On the seventh or eighth day, if the pulse is minute and small, and the patient urinates blood, has a dry mouth, death occurs in one and a half days. If the pulse is intermittent (Dai), death occurs in one day. If heat disease has produced sweat, but the pulse remains agitated, panting occurs, and fever returns, do not needle the skin; severe panting leads to death. On the seventh or eighth day, if the pulse is not agitated, and agitation is not scattered and rapid, sweat may occur within three days; if no sweat occurs in three days, death occurs on the fourth day. For those who have never sweated, do not needle the couli (pores). If heat disease presents with unknown pain location, deafness, inability to control limbs, dry mouth, extreme Yang heat, and significant Yin cold, the heat is in the marrow; this is incurable and fatal. If heat disease is about to sweat, and the pulse allows for sweating, needle Yuji, Taiyuan, Dadu, and Taibai. Draining removes heat; tonifying induces sweat. If sweating is excessive, needle the transverse vessel above the medial malleolus to stop it. If heat disease has produced sweat but the pulse remains agitated and full, this is the extreme of Yin pulses, indicating death. If sweat occurs and the pulse becomes quiet, life is preserved. If heat disease patients have agitated and full pulses but no sweat, this is the extreme of Yang pulses, indicating death. If pulses are full and agitated but become quiet after sweating, life is preserved. There are nine conditions in heat disease where needling is contraindicated: 1. Anhidrosis, redness of the zygomatic bones, and hiccups indicate death. 2. Diarrhea with severe abdominal fullness indicates death. 3. Unclear vision with persistent heat indicates death. 4. Elderly people and infants with heat and abdominal fullness indicate death. 5. Anhidrosis with vomiting and hematochezia/hematemesis indicate death. 6. Ulceration of the tongue root with persistent heat indicates death. 7. Coughing with epistaxis, anhidrosis, or sweat failing to reach the feet indicate death. 8. Marrow heat indicates death. 9. Heat with convulsions (spasticity, opisthotonos, lockjaw) indicates death. All nine conditions are contraindications for needling. If Taiyang vessel color reflects on the zygomatic bone, it is a heat disease. Competition with Jueyin vessel color indicates death within three days. If Shaoyang vessel color reflects on the front of the cheek, it is a heat disease. Competition with Shaoyin vessel color indicates death within three days. (Needling methods in this chapter are not fully recorded; see *Lei Jing · Needling Category* 40).
In the *Suwen: Ping Re Bing Lun*, the Yellow Emperor asked: In warm disease patients, sweat is produced but heat immediately returns, the pulse is rapid and agitated, does not subside with sweat, and there is delirium and inability to eat. What is the name of this disease? Qibo said: It is named Yin-Yang Jiao (Yin-Yang Intersection). Jiao means death. Humans produce sweat from grain qi, which originates from essence. When pathogenic qi contends in muscle and bone and sweat is produced, it means pathogen is retreating and essence is victorious. If essence is victorious, the patient should be able to eat and not have recurrent fever. Recurrent fever indicates pathogenic victory. Sweat is essence. If sweat is produced but heat immediately returns, it indicates pathogenic victory. Inability to eat means essence has no support. If the disease lingers, life is instantly imperiled. Furthermore, the *Re Lun* states: Sweat produced with agitated and full pulse indicates death. Now, the pulse does not correspond with sweat, meaning the body cannot overcome the disease; death is evident. Delirium indicates loss of Zhi (Will/Shen). Loss of Zhi indicates death. Seeing three signs of death and no sign of life, even if temporary improvement occurs, death is certain.
The *Suwen: Ci Zhi Lun* states: Abundant qi with cold body results from cold damage; deficient qi with hot body results from summerheat injury.
The *Suwen: Lun Ji Zhen Chi Pian* states: Hot skin on the chi region with agitated and full pulse indicates warm disease. If the pulse is full and slippery, the disease is about to exit.
In the *Suwen: Ci Fa Lun*, the Yellow Emperor asked: I have heard that the five plagues arrive and infect each other, regardless of age, with similar symptoms. Without treatment, how can one avoid infection? Qibo said: Those who do not get infected have righteous qi stored within, preventing pathogenic interference. Avoid toxic vapors; they enter through the nose (Tianping) and should be expelled back out. Qi emerges from the brain, thus not interfering with pathogens. To emerge qi from the brain, one must visualize the heart like the sun. Before entering an epidemic room, visualize green qi emerging from the Liver, moving left to the East, transforming into forests and trees. Next, visualize white qi emerging from the Lungs, moving right to the West, transforming into weapons and armor. Next, visualize red qi emerging from the Heart, moving south upwards, transforming into bright flames. Next, visualize black qi emerging from the Kidneys, moving north downwards, transforming into water. Next, visualize yellow qi emerging from the Spleen, residing in the Center, transforming into earth. After completing the protection of the five qi, visualize the head shining like the Big Dipper, then one can enter the epidemic room.
In the *Suwen: Shui Re Xue Lun*, the Yellow Emperor asked: Master spoke of fifty-nine acupoints for treating heat disease. I wish to know their locations and meanings. Qibo said: The five rows of five points on the head disperse rebellious heat from all Yang meridians. Dazhu, Ying Shu, Quepen, and Bei Shu (eight points) drain heat from the chest. Qijie, Zusanli, Shangjuxu, and Xiaguxu (eight points) drain heat from the stomach. Yunmen, Guyuan (or similar bone point), Weizhong, and Suikong (eight points) drain heat from the four limbs. Five points beside the Back-Shu points of the five Zang (ten points) drain heat from the five Zang. All these fifty-nine points are lateral counterparts for treating heat. The Yellow Emperor asked: Why does cold injury transmit into heat? The answer is: Extreme cold generates heat.