Library

After suffering from internal cold damage (Nei Shang Han), accompanied by alternating chills and fever, slight bleeding from the nose, deep and choppy pulses in both hands, and no significant heat upon pressing the skin, with three to five macules appearing on the body, this is macular eruption due to internal cold damage. It is primarily treated with Tiaozhong Decoction. If complicated by summerheat, add Xiangru (Moslae Herba) and Biandou (Dolichoris Semen).

Tiaozhong Decoction
Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma Preparatum), Gancao (Glycyrrhizae Radix et Rhizoma), Jiegeng (Platycodonis Radix), Cangzhu (Atractylodis Rhizoma, soaked in rice water, stir-fried), Chuanxiong (Ligustici Chuanxiong Rhizoma, washed with wine), Baishao (Paeoniae Radix Alba, stir-fried with wine), Sharen (Amomi Fructus, stir-fried and crushed), Huoxiang (Agastaches Herba), Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Mahuang (Ephedrae Herba, or substitute with Ziye, Perillae Folium), Guizhi (Cinnamomi Ramulus), Zhike (Aurantii Fructus Immaturus).
Decoct with Shengjiang (Zingiberis Rhizoma Recens).

Those who develop jaundice due to internal cold damage typically have a constitutionally weak spleen and stomach, or have consumed cold and raw foods, leading to the binding and stagnation of cold pathogenic factors. This causes the middle jiao to become cold, resulting in yellow discoloration. If there is vomiting, abdominal fullness, spontaneous diarrhea, or scanty urination, Tiaozhong Decoction (see above) with Yinchen (Artemisiae Scopariae Herba) is appropriate. Alternatively, Lizhong Decoction with Yinchen, Zhishi (Aurantii Fructus), and Caoguo (Tsao-ko Fructus) may be used. If there is cold reversal in the four limbs and deep pulses, Fuzi (Aconiti Lateralis Radix Praeparata) should be added.
Note: Internal cold damage is originally a miscellaneous disease, but it is included in the plague section because after recovering from plague, patients often neglect dietary restrictions regarding cold and raw foods, frequently contracting this condition. They may experience mild fever and aversion to cold again. Ignorant practitioners, failing to examine carefully, often mistake it for a recurrence of the plague and treat it with plague protocols. The use of cold and cooling clearing agents harms people significantly; therefore, it is specifically highlighted for differentiation. Furthermore, those with recurrent plague cannot tolerate smoking, whereas those with internal cold damage can smoke throughout the illness; this serves as a distinguishing feature. Jin Zhi.

"Cishi Nan Zhi" states: "Do not sweat too early." This does not mean prematurely early, but rather early in the sense of morning versus evening. It means that before noon on a given day belongs to the yang phase, and sweating should be induced. After noon belongs to the yin phase, and sweating should not be induced. "Do not purge too late" does not mean waiting until very late, but refers to the time after Si hour (9–11 AM) on a given day, which is the yin phase. Purging should be done before Si hour, which is the yang phase.
When a person initially contracts cold pathogenic factors, feeling aversion to cold, headache, body pain, fever, and stiffness of the spine, one should immediately use warm dispersing agents to induce rapid sweating. There is no reason why it would not heal. Even in the elderly or those constitutionally weak and prone to difficulty sweating, if they take sweating agents as soon as they feel ill, the pathogenic factors will invariably be resolved at that moment. This is a method I have used repeatedly with success. Delay allows cold pathogens to linger and transform into various complications, such as macular eruption, jaundice, mania, and restlessness. Therefore, once cold contraction is felt, prompt treatment is advisable. If one strictly follows the saying in "Nan Zhi," and feels cold after noon, waiting until the next morning before noon to take sweating agents would indeed be too late! Suppose one contracts cold after noon; although this time belongs to the yin phase, one should still quickly take dispersing agents. Moreover, most people do not sweat immediately after taking them; one must wait until the next morning when the medicinal power has circulated and the yang phase arrives, making sweating easier. Thus, "do not sweat too early" clearly refers to premature early, not early in the sense of morning/evening. This applies to cold damage, and similarly to plague. When plague says sweating is inappropriate, it refers to Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), and Zisu (Perillae Folium). What about Yanshuang and Zixue pills? Are they not cooling dispersing agents? For plague onset, medication should be taken immediately, without being bound by specific times. As for the concept of "too late," it clearly refers to delayed purging, not morning or evening. However, this statement was made to excuse quacks who wrongly used purging when it was not indicated. Nevertheless, this saying □ inevitably has drawbacks. If encountering conditions requiring urgent purging, yet adhering strictly to "do not purge too late," the Yangming stomach fu organ will inevitably be scorched by pathogenic fire until dry and cracked, becoming incurable! If purging agents must be bound by timing, is this not absurd? The words "morning and evening" should be replaced with "delay and speed." "Do not sweat too fast, do not purge too slow," and the matter will be understood without further explanation.