Library

This must be due to the kidney qi being prone to erratic movement. When treating kidney disease, one should treat the kidney; thus, Guizhi (Cinnamon Twig) should naturally be used in a dosage of four liang. However, why is also Erliang of Zhigancao (Prepared Licorice Root) used? Without other herbs, the combination of Guizhi and Zhigancao creates a synergy where acrid and sweet flavors transform together, benefiting the Heart. Here, Banxia (Pinellia Tuber) [Note: Text says Fuling/Poria, correction applied in translation based on context "Fuling ban jin xian zhu" - Poria] half a jin is decocted first to significantly drain kidney water. With a larger dose of Guizhi, it follows the Poria into the kidney to attack kidney pathogens and transform qi. Jujube and Licorice are substances entering the Middle Jiao (Spleen/Stomach); at this juncture, they must assist in defending against kidney pathogens, which goes without saying. Since Licorice is already present, adding Jujube serves to nourish yin with sweet and moistening properties after supporting yang, and it does not aid the kidney pathogens. The text mentions the *Guizhi Shaoyao Zhimu Tang* (Cinnamon Twig, Peony, and Anemarrhena Decoction). In this clause, You Shi misunderstood the herb Zhimu (Anemarrhena Rhizome), knowing only its ability to clear heat, and thus interpreted "wen wen yu tu" (a sensation of nausea/retching) [The *Yizong Jinjian* states "wen wen" should be "yun yun"] as damp-heat rushing upward from below. Using a large amount of Shengjiang (Fresh Ginger) aims to stop vomiting and direct rebellious qi downward. Tang Rongchuan viewed this clause together with the next, attributing everything to deficiency, and his explanation of the formula entirely focused on tonifying deficiency. He further claimed that whenever Zhang Zhongjing mentioned "yu tu" (desire to vomit), it was mostly due to fire rebellion. He failed to realize that cold rebellion is more common. These four characters "wen wen yu tu" appear in the Shaoyin Disease chapter; why were they forgotten? He also considered Zhimu as clearing stagnant heat in the blood, but is Zhimu a blood-invigorating herb? Such arbitrary fabrication is shocking. Among the books I have seen, only Zhao's theory that wind-cold-dampness bi obstructs Ying and Wei, and Zhimu's treatment for foot swelling, truly surpasses other schools, though he failed to explain the rationale. Wind, cold, and dampness combine to form Bi syndrome, not occupying separate locations. Roughly speaking: dizziness indicates wind overflowing above; shortness of breath indicates dampness obstructing the middle; desire to vomit indicates cold rebelling against the stomach; dampness tends to flow downward, hence feet swell as if detached. The three pathogens knot firmly and do not resolve, causing the Sanjiao (Triple Burner) to lose its command. Water and grain cannot transform into essence to nourish muscles, resulting in pain in all joints and emaciation of the body; their deficient nature is self-evident. However, wind affects Yang, and Bi affects Yin; Bi diseases rarely heal with a single sweating method; tonification aids pathogens, so tonification methods should not be employed lightly. According to the nine herbs including Guizhi, these are medicines frequently used by Zhang Zhongjing. Are Mahuang (Ephedra Herb) and Fuzi (Aconite Lateralis Radix Preparata) not used to dispel cold? Is Baizhu (Atractylodis Macrocephalae Rhizoma) not used to remove dampness? Is Fangfeng (Saposhnikoviae Radix) not used to dispel wind? Is *Guizhi Tang* (Cinnamon Twig Decoction) not used to harmonize Yin and Yang and regulate Ying and Wei? Fuzi dispelling cold belongs to tonifying Yang; Baizhu removing dampness belongs to tonifying Earth; it is evident that they are not solely for tonification. For any syndrome indicated by *Guizhi Tang*, there must be spontaneous sweating; using it without sweating is certainly not for releasing the exterior. *Mahuang Tang* (Ephedra Decoction) contains Guizhi, but Mahuang exceeds Guizhi in quantity; here Guizhi exceeds Mahuang, and it is restrained by Shaoyao (Peony Root), likely intending to guide the pathogen-dispelling herbs via Guizhi and Shaoyao, harmonized by Gancao (Licorice Root), to linger in the Ying, Wei, meridians, and joints, achieving a subtle transformative effect. What doubt could there be? Removing Dazao (Jujube Fruit) prevents its moistening property from retaining dampness. Increasing Shengjiang (Fresh Ginger) helps Baizhu and Fuzi raise Yang, assists Guizhi and Shaoyao, and its flavor and nature accord with the other four herbs. Thus, the efficacy of Guizhi and Fuling (Poria) is indeed significant; why is Zhimu (Anemarrhena Rhizome) listed under the same formula name? Zhimu, as Zhao stated, treats foot swelling, which corresponds to the *Shennong Bencao Jing* description of eliminating pathogenic factors, limb edema, and promoting urination. Is its efficacy inferior to Guizhi and Shaoyao?

The formula using five liang of Guizhi is called *Guizhi Jia Gui Tang* (Cinnamon Twig Decoction with Added Cinnamon Twig). This, along with *Fuling Guizhi Gancao Dazao Tang* (Poria, Cinnamon Twig, Licorice, and Jujube Decoction), is used to control Ben Tun (Running Piglet). The difference between four liang and five liang of Guizhi lies in the former: umbilical palpitations have not yet rushed upward, and a large dose of Fuling has already been used to attack kidney pathogens, so four liang is not insufficient. In the latter, severe cold injury causes kidney qi to rush from the lower abdomen to the heart; Guizhi disperses cold and directs the rushing qi downward, so two additional liang of Guizhi are added to *Guizhi Tang*. Zhang Zhongjing uses "Gui" referring only to Guizhi; it is the same substance, but additions or reductions yield different effects, which can be seen by comparing various formulas. There is no need to suspect that the added Gui is Rougui (Cinnamon Bark).

The formula using six liang of Guizhi is *Tianxiong San* (Aconitum Lateralis Preparatum Powder). Guizhi reaching six liang appears only in this formula. Tianxiong (Aconitum Lateralis Preparatum) benefits kidney essence, while Guizhi transforms kidney qi; Longgu (Fossilized Bones) summons Yang yang escaping upward from below, while Guizhi supports Yang rising to nourish from below; Baizhu (Atractylodis Macrocephalae Rhizoma) cultivates Earth and secures it, while Guizhi warms Earth and activates it; thus, Guizhi sufficiently compensates for the deficiencies of the other three herbs. If not used in large quantities, its light and ascending nature would fail to treat the Middle and Lower Jiao when addressing the Upper Jiao.

I have fully expounded upon Zhang Zhongjing's extensive and profound use of Guizhi. Let us further deduce the application of *Guizhi Tang*: *Guizhi Tang* treats not only Taiyang Disease but also Yangming Disease. For instance, in Yangming Disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved; sweating may be induced, and *Guizhi Tang* is appropriate. This shows that when applying *Guizhi Tang* to exterior syndromes of Yang meridians, the presence of sweating is the key criterion. Taiyang exterior excess presents without sweating; sweating indicates exterior deficiency, allowing *Guizhi Tang* to harmonize Ying and Wei. Yangming Disease inherently involves sweating, but the nature of sweating varies. Sweating with aversion to heat but not cold, or initial aversion to cold without fever on day one, followed by fever on day two when cold resolves, characterizes Yangming Heat Disease. Here, sweating is profuse and the pulse is slow; this is not sweating from heat steaming, but sweating from exterior deficiency with cold pathogens. Slight aversion to cold, rather than slight aversion to cold on the back, and absence of interior signs like dry thirst and irritability, indicate that this is not residual pathogen after resolution, but unresolved exterior pathogen. Although Yangming pathogens are deeper than Taiyang, using *Guizhi Tang* to generate righteous sweat and disperse pathogenic sweat follows the same principle. According to *Yizong Jinjian*, the phrase "profuse sweating" should be followed by "fever." Without these two characters, slow pulse, profuse sweating, and slight aversion to cold indicate exterior Yang deficiency, corresponding to *Guizhi Fuzi Tang* (Cinnamon Twig and Aconite Decoction); how could *Guizhi Tang* be used to induce sweating? I privately believe this clause precisely identifies the *Guizhi Tang* syndrome, suggesting no missing characters. The substitution of Shaoyao for Fuzi in *Guizhi Fuzi Tang* highlights the critical distinction between sweating and non-sweating. The use of Fuzi to support Yang in Wind-Damp Bi differs from using only Guizhi for exterior deficiency in Yangming Wind Strike. Whether this is correct or not, I record it cautiously.

There are cases using *Guizhi Tang* without spontaneous sweating. For example, in Taiyin Disease, if the pulse is floating, sweating may be induced, and *Guizhi Tang* is suitable. The clause defining Taiyin Disease is the outline for Taiyin Zang disease. Here, a floating pulse indicates Jing (Meridian) disease; symptoms like abdominal fullness and vomiting are absent. How then does "Taiyin Disease" apply? I propose that "Taiyin Wind Strike causing painful and uncomfortable limbs" serves as the outline for Taiyin Jing disease. Can pathogens invading Yin meridians be resolved by sweating? *Guizhi Tang* is a harmonizing formula, not purely a diaphoretic. Commentators who do not investigate the mechanism of sweating in *Guizhi Tang* merely cling to "can induce sweating," vaguely explaining it as acrid-sweet dispersion. Ke Qin mistakenly identified floating pulse as wind-heat. One must consider what kind of sweating *Guizhi Tang* induces: it requires prior exterior deficiency with sweating; after taking the decoction, drinking warm millet porridge and covering for warmth allows pathogenic sweat to leave and righteous sweat to arise. Taiyin Wind Strike inherently lacks sweating; exterior syndromes of Yin meridians cannot be treated with diaphoretics like Mahuang or Gegen. Excluding *Guizhi Tang* for resolving muscle layer and harmonizing Ying and Wei, what else would be suitable? Wang Yutai said: "Yin meridians do not have sweating, hence 'no sweating' is not mentioned. Three Yin meridians with concurrent exterior syndromes should not undergo heavy sweating." Only those deeply understanding Zhang Zhongjing's methods could make such a statement.

There are cases using *Guizhi Tang* for body pain alone. "In diarrhea with abdominal fullness and body pain, first warm the interior, then attack the exterior; warming the interior suits *Sini Tang* (Frigid Extremities Decoction), attacking the exterior suits *Guizhi Tang*." This clause is also recorded in *Jinkui Yaolue*. I suspect this originally belonged to miscellaneous diseases and was later included in *Shanghan Lun*. In *Jinkui*, a "after" character is added after "diarrhea," implying that after Taiyin cold-damp diarrhea, Spleen Yang declines, causing abdominal fullness. Externally, Jing Qi is also deficient, allowing Wind Pathogens to invade and contend with interior dampness, causing body pain. Simultaneously treating Jing and Zang is not the standard method; first warming the interior with *Sini Tang* eliminates cold-dampness, isolating the exterior pathogen. Subsequently using *Guizhi Tang* to resolve the muscle layer, disperse wind, and harmonize Ying and Wei becomes easy. It does not mention inducing sweating because, as *Jinkui* states, slight perspiration suffices to eliminate both wind and dampness.

Furthermore, *Guizhi Tang* is used in pregnant women. The first clause of the *Jinkui* Pregnancy Chapter states that inability to eat at sixty days of pregnancy constitutes Zu Bing (Morning Sickness). Using *Guizhi Tang* for Zu Bing seems inappropriate. Xu Lingtai argued that internally, *Guizhi Tang* transforms Qi and harmonizes Yin and Yang, surpassing other schools, yet remains imprecise. I speculate that Zhang Zhongjing often lists brief symptoms and prescribes a formula, perhaps leaving specific corresponding symptoms implicit for practitioners to deduce. Given that Taiyin Wind Strike with painful limbs and Taiyin Disease with floating pulse suit *Guizhi Tang*, and *Qianjin Fang* Banxia Fuling Tang treats pregnancy Zu Bing with symptoms like painful limbs, aversion to cold, and sweating—containing Citrus Peel, Ginger, Pinellia, and Bupleurum similar to *Guizhi Tang*—it can be inferred that *Guizhi Tang* is suitable for pregnancy Zu Bing presenting with Taiyin exterior syndromes. However, forced interpretation is discouraged by scholars; adopting *Yizong Jinjian*'s view of missing text without annotation is prudent. "Jue zhi" means discontinuing medication. Lou Quanshan cured a woman by following this method. *Nuke Jiyao* records an old woman advising cessation of medicine, which proved effective. Thus, "Jue zhi" might mean cutting off the root of the disease; or, adhering rigidly to fetal preservation might lead to adverse treatments, effectively terminating the pregnancy, causing regret.