Library

Restlessness occurs after sweating or purging therapies. Examining the syndromes of these two formulas, both present with exterior heat accompanied by diarrhea; therefore, although the pulse is faint, Ginseng Radix et Rhizoma (Renshen) is not added. In Si Ni Jia Ren Shen Tang (Four Reversals plus Ginseng Decoction), the patient presents with aversion to cold and a faint pulse but no body heat, hence Ginseng is added. Regarding the addition of Ginseng when diarrhea stops but the pulse does not emerge, Zhang Zhongjing indeed stated this clearly. This indicates that his addition of Ginseng was due to the faint pulse, not because of blood loss following the cessation of diarrhea. As for Fu Ling Si Ni Tang (Poria Four Reversals Decoction), it arises from Shaoyin Yang deficiency, where deficient Yang disturbs the Heart, causing restlessness. Si Ni Tang supports Yang to calm restlessness; Poria (Fuling) enters the Kidney to suppress Yin; Ginseng enters the Heart to remove vexation. Each herb has a specific purpose; how can one dismiss it vaguely? The discussions on formulas and herbs by these two scholars are generally like this. It is not just these two scholars who do so. As the saying goes, "A Confucian scholar learning medicine is like treating vegetables as meat" (implying a superficial understanding). Alas, how difficult it is to speak of! (In the original collection, Ginseng's ability to treat vexation was not mentioned, hence this supplementary discussion.)

Zou stated: Gypsum Fibrosum (Shigao) is extremely heavy in texture, bright and lustrous. When struck, it shatters instantly, scattering in fragments with fibers arranged longitudinally, without any transverse strands. Thus, its nature primarily resolves heat pathogens overflowing horizontally. This is precisely why Gypsum can "release the muscle layer." Its acrid and sweet flavor also contributes to releasing the muscle layer; however, its heavy texture and extreme coldness make it insufficient for inducing sweating. Yet, *Ben Cao Jing Ji Zhu* (Supplement to the Materia Medica) states under Almond Seed (Xingren) that it "releases the muscle layer," and under Giant Knotweed Root (Daji) that it "induces sweating," while linking "releasing the muscle layer" and "inducing sweating" together for Gypsum. Is it because Zhang Zhongjing once used it to induce sweating? One should know that Gypsum treats spontaneous sweating in Yangming disease of Shanghan, not absence of sweating in Taiyang disease. If there is Taiyang exterior excess combined with Yangming heat stagnation, Ephedra Herb (Mahuang) is used to induce sweating, and Gypsum to clear heat; there is no case of discarding Mahuang to use only Shigao. Bai Hu Tang (White Tiger Decoction) treats spontaneous sweating without exterior syndrome, and explicitly warns against using it when there is no sweating. Even later empirical formulas for releasing the exterior never use Gypsum, which aligns with the principle that "releasing the exterior does not distance itself from hot-natured drugs." Then, does Gypsum not release the muscle layer? In Bai Hu syndrome, heat exists in both interior and exterior. Although it has not yet entered the Blood level to form Fu-organ excess, the heat in the Qi level of the Yangming channel has formed a balanced force. It requires Acrid-Sweet-Cold herbs to release the muscle layer, not to induce sweating. Other formulas like Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) and Bai Hu Jia Gui Zhi Tang (White Tiger plus Cinnamon Twig Decoction) are not unused for absence of sweating, but their syndromes are not those requiring exterior release. Students should not overly adhere to *Ben Cao Jing Ji Zhu*.

Furthermore, Wang Haicang stated that Gypsum induces sweating, and Zhu Danxi stated that Gypsum causes sweating. Both merely echoed empty texts without substantiating their meaning. I ponder that in medical formularies, Gypsum's indications include epidemic febrile diseases with high fever in muscles, vexation and thirst, wheezing and counterflow, wind-stroke, vertigo, Yang toxicity with macules, etc. None of these conditions can be cured by inducing sweating. The disease most reliant on Gypsum is heat plague. Yu Shiyu's Qing Wen Bai Du San (Clear Plague and Resolve Toxin Powder) uses up to six or eight taels per dose, yet in his work *Yi Zheng Yi De*, he earnestly warns against exterior-releasing therapies. Gu Songyuan treated Wang Zuangong's Yangming heat syndrome with Bai Hu Tang, using three taels of Gypsum per dose. After two doses, the fever subsided suddenly, but the patient broke out in cold sweat all over, with cold limbs and hiccups. The physicians clamored, stopping further administration. Gu cited Zhang Zhongjing's "deep heat leads to deep cold extremities" and Yu Jia Yan's "one in ten thousand cases where Yang syndrome suddenly changes to Yin cold extremities" to argue. They did not listen. When they administered Shen Fu Hui Yang agents (Ginseng and Aconite to restore Yang), the sweating increased, and the body became colder. They sought Gu again. Gu continued the previous method, using three taels of Gypsum. After two doses, the sweating stopped, and the body warmed. (See Lu Dingpu's *Leng Lu Yi Hua*). This is even more definitive proof that Gypsum releases the muscle layer and does not induce sweating.

In summary, the terms "wind-stroke, cold, heat" in *Shen Nong Ben Cao Jing* were viewed by Liu Qianjiang and Zou Run'an as two separate categories, which is very correct. Only Zou forcibly linked the subsequent text: "adverse Qi in the epigastrium, frightful panting, dry mouth, scorched tongue, inability to breathe" as symptoms of wind-stroke and cold/heat, which is inappropriate. Liu said: "When Yang is insufficient and Yin is excessive, it is deficiency-wind; when Yin is insufficient and Yang is excessive, it is excess-wind." The excessive Yin nature of this herb [Gypsum] precisely counters the syndrome of excessive Yang, thereby treating wind-excess. Discussing Gypsum for wind-stroke is very accurate; discussing it for cold/heat, one might explain it via the alternating chills and fever of the Triple Burner in Wu Zheng Tang (Five Steaming Decoction), using Gypsum to interpret it. However, Wu Zheng Tang does not rely solely on Gypsum to remove cold/heat. I believe that for wind-stroke, Gypsum is used in Feng Yin Tang (Wind Pulling Decoction) from *Jin Gui Yao Lue* and Xu Ming Tang (Continuing Life Decoction) from *Gu Jin Lu Yan*; for cold/heat, Gypsum should be used as described in *Wai Tai Mi Yao*: single herb Gypsum treating Yang pathogen entering the interior, transforming into bone-steaming consumption, causing initial chills followed by fever, gradually leading to emaciation, with sweating and a long pulse. Additionally, Bai Hu Jia Ren Shen Tang treats Taiyang heatstroke with sweating, aversion to cold, body heat, and thirst, which can serve as evidence for Gypsum treating cold/heat. However, these two syndromes are completely different from Yang-deficiency cold, Yin-deficiency heat, and the aversion to cold seen in Shanghan with exterior syndrome. They must not be treated indiscriminately without careful differentiation.

Gypsum is sweet and bland, entering the Stomach; acrid, entering the Lung. It is heavy, brittle, rising and descending, thus entering the Triple Burner. With its clearing and肃 (solemn/clearing) coldness, it washes away steaming and stagnant heat. It acts only on the Qi level of the three channels and does not enter the Blood level. Being a Stomach herb rather than a Spleen herb stems from this. Therefore, for hardness and pain in the abdomen, bitter-cold herbs entering the Blood level, such as Rhubarb (Dahuang), are required to be effective. Even Magnolia Bark (Zhipohuang) and Immature Bitter Orange (Zhishi) or Peony Root (Shaoyao) can only serve as assistant or guide herbs. Gypsum absolutely cannot attack hardness or relieve pain. The four characters "hardness and pain in the abdomen" in *Ben Cao Jing* must be a later addition.

Zhang Zhongjing's formulas combining Gypsum and Ephedra are similar to combining Rhubarb and Aconite to alter their nature into warm herbs. Setting up various methods to increase or decrease them creates confusion. However, if one recognizes that Ephedra disperses cold and induces sweating, while Gypsum clears heat and stops sweating, and that they mutually constrain and utilize each other, then any formula can be understood and mastered. Da Qing Long Tang (Major Blue Dragon Decoction) is widely considered a potent sweating agent. I believe the most potent sweating agent is Ma Huang Tang (Ephedra Decoction), not Da Qing Long Tang. In Ma Huang Tang, Cinnamon Twig (Guizhi) and Almond Seed (Xingren) enhance Ephedra's sweating efficacy, without Gypsum to restrain it. In Da Qing Long Tang, Ephedra is restrained... [text implies restraint by Gypsum], hence the pulse is floating and slow, the body does not ache, but feels heavy. Wind-stroke is naturally milder than cold damage. Body heaviness without pain indicates it is not merely for releasing the exterior. Ke Yunbo stated: The post-formula instructions of Da Qing Long Tang—"If sweating is profuse, apply warm powder; if one dose induces sweating, stop the next dose; profuse sweating leads to Yang collapse, resulting in deficiency, aversion to wind, restlessness, and insomnia"—should be moved to after Ma Huang Tang. This insight likely came from observing warm intake of 8 liang and distinguishing between post-sweating vexation and pre-sweating vexation. Scholars, awed by the name "Blue Dragon" and mindful of the warning against profuse sweating causing Yang collapse, liken Ephedra with Gypsum to a dragon raising clouds and rain. This explanation fails to account for why Bai Hu Tang is not a wind-dispelling formula, why Xiao Qing Long Tang bears the name "Dragon" despite lacking Gypsum, and why Yue Bi Tang uses large amounts of Ephedra and Gypsum without mentioning sweating induction. These are oversights.

So why name them Major and Minor Blue Dragons? The dragon symbolizes unclassifiable flexibility, rising, sinking, flying, and hiding, capable of summoning Yang to transform Yin. Ephedra can reach extreme Yang from extreme Yin, but its nature is light and ascending. With Gypsum and Peony, it bends inward; with Cinnamon Twig and Almond, it extends outward. Gypsum, being heavy and cold, yet possessing acrid-sweet moisture to release the muscle layer, can support Ephedra, hence named Major Blue Dragon. Xiao Qing Long Tang involves Water Qi in the epigastrium. Gypsum's heavy coldness dispels it, allowing Ephedra to induce sweating. However, with equal amounts of Ephedra and Peony (3 liang each), Ephedra's action is checked. The acrid and warm herbs promote water metabolism downward. Like a hidden dragon, it is named Minor Blue Dragon. In Yue Bi Tang, Ephedra is also restrained by Gypsum, but deliberately restrained yet heavily dosed due to the syndrome. Wind-water syndrome features aversion to wind, generalized edema, floating pulse, and no thirst—all Ephedra indications. However, continuous spontaneous sweating due to interior heat necessitates Gypsum. Because of Gypsum, Ephedra is used up to 6 liang; because of Ephedra, Gypsum is used up to half a jin even without severe heat. Gypsum is not doubled relative to Ephedra because transforming Yin is more critical than reducing Yang. Someone asked: Yue Bi Tang uses Gypsum for sweating; Da Qing Long Tang uses it for vexation. Without Yangming heat, it shouldn't be used. Yet, for Shanghan with floating-slow pulse, body heaviness without pain, and intermittent lightness, Da Qing Long Tang is used to "release" it. Xu Huixi claimed this clause must be erroneous. Is it true? I say: This perfectly fits the meaning of the dragon's flexing and hiding. You Saijing said: The classic states slow pulses often indicate heat. When Shanghan pathogen is in the exterior, the body aches; when it enters the interior, the body feels heavy. Cold transforming to heat results in a slow pulse, meridians are not cramped, so no pain, only heaviness. The pulse remains floating, indicating the pathogen is advancing or retreating, causing intermittent heaviness/lightness. It says "release" instead of "treat" because the pathogen desires to enter the interior, and the medicine releases it to exit via the exterior. His interpretation is superior to others. Releasing a pathogen desiring to enter the interior requires Ephedra aided by Gypsum's heavy coldness, like a dragon exiting and re-entering. If Gypsum were viewed as a sweating drug, and Ephedra not increased due to Gypsum (a common error), this clause would indeed be suspicious. In Yue Bi Tang, Gypsum exceeds Ephedra by only 2 liang, and it is not named Dragon, nor does it forbid sweating. Da Qing Long Tang's Gypsum certainly does not amount to a piece the size of a chicken egg. Moreover, excessive Gypsum prevents sweating, proven by Ma Xing Gan Shi Tang where Gypsum doubles Ephedra. Ephedra is 4 liang, less than Da Qing Long Tang's 6 liang but more than Ma Huang Tang's 3 liang. Almonds are fewer than in Ma Huang Tang by 20 pieces, but 1 liang of Ephedra is not comparable to 20 almonds. Why is this formula used for sweating syndromes instead of non-sweating ones? Because Gypsum restrains Ephedra even more strongly than in Yue Bi Tang. Gypsum stops sweating caused by Yangming heat blazing and wheezing caused by Lung heat congestion. With Ephedra, Almond might seem unnecessary, but since Ephedra's power is weakened by restraint, Almond assists in resolving residual exterior pathogens. Using half a jin of Gypsum without significant heat shares the same logic as Yue Bi Tang. Ke failed to observe this, changing "sweating, wheezing, no great heat" to "no sweating, wheezing, great heat," accusing predecessors of blind adherence. Not knowing that Gypsum is used precisely for sweating; if there were no sweating and wheezing, it would be a Ma Huang Tang syndrome, completely different. Further evidence comes from Gui Zhi Er Yue Bi Yi Tang. Da Qing Long Tang warns against use in patients with faint pulse, sweating, and aversion to wind. Here, faint pulse means "no Yang," and sweating is forbidden. How can one still use Ephedra to release and Gypsum to cool? Forbidding further sweating implies prior sweating or spontaneous sweating. The use of full Gui Zhi Tang without removing Peony confirms this. Adding Ephedra and Gypsum requires comparison with Gui Zhi Ma Huang Ge Ban Tang (Gui Zhi and Ephedra Half-Dose Decoction). That decoction presents fever, aversion to cold, more heat than cold, similar to this. But that one resembles malaria with a faint-slow pulse, showing pathogen retreat and recovery. If the pulse is faint but not slow, with aversion to cold and facial heat color, Gui Zhi Ma Huang Ge Ban Tang induces slight sweating. Here, faint pulse with aversion to cold indicates Yang deficiency, with no likelihood of self-recovery. Gui Zhi Tang harmonizes Yang; combined with Ephedra, it disperses residual cold and releases exterior pathogens. The method is complete. Why add Gypsum? For heat? Heat is only slightly greater than cold. If the pulse were not faint, it would recover like the Half-Dose Decoction, leaving little heat to worry about. Thus, Gypsum is added specifically because Yang deficiency cannot withstand Ephedra's releasing power; Gypsum restrains it, turning harshness into peace. The seven herbs are selected from severe Shanghan cases, but doses are greatly reduced, making it an excellent method for treating residual pathogens. Using Gypsum not to clear heat, but like Rhubarb used to drain the Heart or promote urination, is equally skillful. Ginger is used in larger quantities than other herbs to assist Cinnamon and Licorice in generating Yang, and to prevent adverse effects of Gypsum.