伤寒发热，口中勃勃气出，头痛，目黄，衄不可制，阴阳俱虚，贪水者必呕，恶水者厥。若下之，则咽中生疮；假令手足温者，必下重便脓血。头痛目黄者，下之则目闭。贪水者，下之则脉厥，其声嘤嘤，咽喉塞，汗之则战栗；恶水者，下之则里冷，不嗜食，大便完谷出，汗之则口中伤，舌上白胎，烦躁，脉反数，不大便，六七日后必便血，小便不利也。
凡服下汤，得利便止，不必尽剂。此以前是汗吐下三法之大要也。若能于此例之外，更神而明之，斯道其庶几乎？
杂病例第五
问曰：上工治未病，何也？师曰：夫治未病者，见肝之病，知肝传脾，当先实脾，四季脾旺不受邪，即勿补之。中工不晓相传，见肝之病，不解实脾，惟治肝也。夫肝之病，补用酸，助用焦苦，益用甘味之药调之。酸入肝，焦苦入心，甘入脾。脾能伤肾，肾气微弱，则水不行；水不行，则心火气盛，心火气盛则伤肺；肺被伤，则金气不行；金气不行，则肝气盛，肝必自愈。此治肝补脾之要妙也。肝虚则用此法，实则不可用之。经曰：勿虚虚，勿实实，补不足，损有余，是其义也。余脏准此。
夫人禀五常，因风气而生长，风气虽能生万物，亦能害万物，如水能浮舟，亦能覆舟。若五脏元真通畅，人即安和。客气邪风，中人多死。千般疢难，不越三条；一者，经络受邪，入于脏腑，为内所因也；二者，四肢九窍，血脉相传，壅塞不通，为外皮肤所中也；三者，房室、金刃、虫兽所伤。以此详之，病由都尽。若人能养慎，不令邪风干杵经络，适中经络，未流传脏腑，即医治之，四肢才觉重滞，即导引、吐纳、针灸、膏摩，勿令九窍闭塞；更能无犯王法、禽兽灾伤，房室勿令竭乏，服食节其冷热苦酸辛甘，不遗形体有衰，病则无由入其腠理。腠者，是三焦通会元真之处，为血气所注；理者，是皮肤脏腑之纹理也。
问曰：病人有气色见于面部，愿闻其说。师曰：鼻头色青，腹中痛，苦冷者死。鼻头色微黑者，有水气；色黄者，胸上有寒；色白者，亡血也。设微赤非时者死。其目正圆者痉，不治。又色青为痛，色黑为劳，色赤为风，色黄者便难，色鲜明者有留饮。
师曰：语声寂寂然喜惊呼者，骨节间病；语声喑喑然不彻者，心膈间病；语声啾啾然细而长者，头中病。
师曰：息摇肩者，心中坚，息引胸中上气者，咳；息张口短气者，肺痿唾沫。
师曰：吸而微数者，其病在中焦，实也，当下之即愈，虚者不治。在上焦者，其吸促，在下焦者，其吸远，此皆难治。呼吸动摇振振者，不可治也。
师曰：寸口脉动者，因其旺时而动，假令肝旺色青，四时各随其色。肝色青而反白，非其时也，色脉非时，法皆当病。
问曰：有未至而至，有至而不至，有至而不去，有至而太过，何谓也？师曰：冬至之后，甲子夜半少阳起，少阳之时，阳始生，天得温和。以未得甲子，天因温和，此末至而至也；以得甲子，而天犹未温和，此为至而不至也；以得甲子，而天大寒不解，此为至而不去也；以得甲子，而天温如盛夏五六月时，此为至而太过也。
问曰：经云："厥阳独行"，何谓也？师曰：此为有阳无阴，故称厥阳。
问曰：寸脉沉大而滑，沉则为实，滑则为气，实气相搏，血气入脏即死，入腑即愈，此为卒厥，何谓也？师曰：唇口青，身冷，为入藏，即死；身和，自汗出，为入腑，即愈。
问曰：脉脱，入藏即死，入府即愈，何谓也？师曰：非为一病，百病皆然。譬如浸淫疮，从口流向四肢者可治，从四肢流来入口者不可治；病在外者可治，入里者即死。
问曰：阳病十八何谓也？师曰：头项痛腰脊臂脚掣痛。阴病十八，何谓也？师曰：咳上气喘哕咽痛肠鸣胀满心痛拘急。脏病三十六，腑病三十六，合为一百八病；此外五劳、七伤、六极、妇人三十六病，不在其中。清邪居上，浊邪居下，大邪中表，小邪中里，谷饪之邪，从口入者，宿食也。
问曰：病有急当救里救表者，何谓也？师曰：病，医下之，续得下利清谷不止，身体疼痛者，急当救里；后身疼痛，清便自调者，急当救表也。
师曰：五藏病各有所得者愈，五藏病各有所恶，各随其所不喜为病。如病者素不喜食，而反暴思之，必发热也。
夫病在诸脏，欲攻，当随其所得而攻之，如渴者，与猪苓汤。余仿此。
夫病者手足寒，上气脚缩，此六腑之气绝于外也。下利不禁，手足不仁者，此五脏之气绝于内也。内外气绝者，死不治。
师曰：热在上焦者，因咳为肺痿；热在中焦者，为腹坚；热在下焦者，则尿血，或为淋秘不通。大肠有寒者，多鹜溏；有热者，便肠垢。小肠有寒者，其人下重便脓血；有热者，必痔。
问曰：三焦竭，何谓也？师曰：上焦受中焦之气，中焦未和，不能消谷，故上焦竭者，必善噫；下焦承中焦之气，中气未和，谷气不行，故下焦竭者，必遗溺失便。
问曰：病有积、有聚、有谷气，何谓也？师曰：积者，藏病也，终不移处；聚者，腑病也，发作有时，展转移痛，谷气者，胁下痛，按之则愈，愈而复发，为馨气。诸积之脉，沉细附骨在寸口，积在胸中；微出寸口，积在喉中；在关者，积在脐旁；上关上，积在心下；微出下关，积在少腹。在尺中，积在气冲；脉出左，积在左；脉出右，积在右；脉左右俱出，积在中央；各以其部处之。
温病有三：曰春温、曰秋温、曰冬温。此皆发于伏气，夏则病暑，而不病温。冬伤于寒，其气伏于少阴，至春乃发为温病，名曰春温。
气不当至而至，初冬乃大寒，燥以内收，其气伏于厥阴，冬至后，天应寒而反温，发为温病，名曰冬温。
春秋病温，此其常，冬时病温，此其变。冬时应寒而反大温，此非其时而蓄其气，及时不病，至春乃发，名曰大温。此由冬不藏精，气失其正，春时阳气外发，二气相搏为病则重，医又不晓病源为治，乃误尸气流传，遂以成疫。
病春温，其气在上，头痛，咽干，发热，目眩，甚则谵语，脉弦而急，小柴胡加黄连牡丹汤主之。
柴胡半斤 黄芩三两 人参三两 栝蒌根四两 黄连三两 牡丹皮四两 甘草三两（炙） 生姜三两 大枣十二枚（劈）
右九味，以水一斗二升，煮取三升，去滓，温服一升，日三服。
病秋温，其气在中，发热，口渴，腹中热痛，下利便脓血，脉大而短涩，地黄知母黄连阿胶汤主之；不便脓血者，白虎汤主之。
右四味，，以水一斗，煮米熟，汤成去滓，温服一升，日三服。
病冬温，其气在下，发热，腹痛引少腹，夜半咽中干痛，脉沉实，时而大数，石膏黄连黄芩甘草汤主之；不大便六七日者，大黄黄芩地黄牡丹汤主之。
右四味，以水一斗，煮取三升，温服一升，日三服。
右四味，以水一斗二升，煮取二升，去滓，分温二服，大便利，止后服。
病温，头痛，面赤，发热，手足拘急，脉浮弦而数，名曰风温，黄连黄芩栀子牡丹芍药汤主之。
右五味，以水六升，煮取三升，去滓，温服一升，日三服。
病温，其人素有湿，发热唇焦，下利，腹中热痛，脉大而数，名曰湿温，猪苓加黄连牡丹汤主之。
猪苓一两 茯苓一两 阿胶一两 泽泻一两 滑石一两 黄连一两 牡丹一两
右七味，以水四升，先煮六味，取二升，去滓，纳胶烊消，分温再服。
病温，舌赤，咽干，心中烦热，脉急数，上寸口者，温邪干心也，黄连黄芩阿胶甘草汤主之。
右四味，以水一斗，先煮三味，取四升，去滓，纳胶烊消，分温三服。
病温，口渴，咳嗽，衄不止，脉浮而数大，此温邪乘肺也，黄芩石膏杏子甘草汤主之。
黄芩三两 石膏半斤（碎） 杏仁十四枚（去皮尖） 甘草一两（炙）
右四味，以水五升，煮取三升，去滓，温服一升，日三服。，
病温，发热，腰以下有水气，甚煮取三升，少腹热痛，小便赤数，脉急而数下尺中者，此温邪移肾也，地黄黄柏秦皮茯苓泽泻汤主之。
右五味，以水八升，煮取三升，去滓，温服一升，日三服。
病大温，发热头晕，目眩，齿枯，唇焦，谵语，不省人事，面色乍青乍赤，脉急大而数者，大黄香蒲汤主之；若喉闭难下咽者，针少商令出血；若脉乍疏乍数，目内陷者，死。
右五味，，以水一斗，煮取六升，去滓，温服二升，日三服。
温病，下之大便他溏，当自愈；若下之利不止者，必腹满，宜茯苓白术甘草汤主之。
右三味，以水八升，煮取三升，去滓，温服一升，日三服。
风温者，因其人素有热，更伤于风，而为病也。脉浮弦而数，若头不痛者，桂枝去桂加黄芩牡丹汤主之。若伏气病温，误发其汗，则大热烦冤，唇焦，目赤，或衄，或吐，耳聋，脉大而数者，宜白虎汤；大实者，宜承气辈；若至十余日则入于里，宜黄连阿胶汤。何以知其入里？以脉沉而数，心烦不卧，故知也。
芍药三两 甘草二两（炙） 生姜三两（切） 大枣十二枚（劈） 黄芩三两 牡丹皮三两
右六味，以水八升，煮取三升，去滓，温服一升，日三服。
白虎汤方（见前）
大承气汤方
右四味，以水一斗，先煮二物，取五升，去滓，纳大黄更煮取二升，去滓，纳芒硝，更上微火，一两沸，分温再服，得下，余勿服。
小承气汤方
右三味，以水四升，煮取一升二合，去滓，分温二服，初服当更衣，不尔尽饮之，若更衣者，勿服之。
右三味，以水三升，煮二物至一升，去滓，纳芒硝，更上微火煮令沸，少少温服之。
右五味，以水六升，先煮三物，取二升，去滓，纳阿胶烊消，小冷，纳鸡子黄，搅令相得，温服七合，日三服。
病温，治不得法，留久移于三焦，其在上焦，则舌蹇，神昏，宜栀子汤；其在中焦，则腹痛而利，利后腹痛，唇口干燥，宜白虎加地黄汤；其在下焦，从腰以下热，齿黑，咽干，宜百合地黄牡丹皮半夏茯苓汤。
栀子汤方
右四味，以水四升，先煮栀子，取二升半，去滓，纳三味，煮取一升，分温再服。
知母六两 石膏一斤（碎） 甘草二两（炙） 粳米六合 地黄六两
右五味以水一斗，煮米熟，汤成去滓，温服一升，日三服。
右五味，先以水洗百合，渍一宿，当白沫出，去其水，别以水二升，煮取一升，去滓，别以泉水四升，煮三味，取二升，去滓，纳地黄汁，与百合汁，更上火，令沸，温服一升，日三服。
伤暑肺先受之，肺为气府，暑伤元气，寸口脉弱，口渴，汗出，神昏，气短，竹叶石膏汤主之。
竹叶两把 粳米半升 半夏半升（洗） 石膏一斤 人参三两 麦门冬一升 甘草二两（炙）
右七味，以水一斗，先煮六味，取六升，去滓，纳粳米，煮取米熟，汤成，温服一升，日三服。
伤暑，发热，汗出，口渴，脉浮而大，名曰中暍，白虎加人参黄连阿胶汤主之。
白虎加黄连阿胶汤方
知母六两 石膏一斤碎（棉裹） 甘草二两（炙） 粳米六合 人参三两 黄连三两 阿胶二两
右七味，以水一斗，先煮六味，米熟汤成去滓，纳胶烊消，温服一升，日三服。
Shanghan (Cold Damage) presents with fever, a sensation of hot qi rushing out from the mouth, headache, yellowing of the eyes, and uncontrollable epistaxis. At this stage, both Yin and Yang are deficient. Those who crave water will inevitably vomit; those who repel water will experience cold extremities (Jue). If purgation is mistakenly applied, sores will form in the throat. If the hands and feet are warm, there will inevitably be tenesmus and pus and blood in the stool. For patients with headache and yellow eyes, purgation will cause the eyes to close. For those craving water, purgation will lead to a Jue pulse, a faint humming voice, and a sensation of blockage in the throat; diaphoresis will cause shivering. For those repelling water, purgation will result in internal cold, loss of appetite, and the passage of undigested food in the stool; diaphoresis will damage the oral cavity, resulting in a white tongue coating, irritability, a rapid pulse, constipation, and eventually bloody stools after six or seven days, accompanied by difficult urination.
When administering purgative decoctions, stop immediately once bowel movement occurs; it is not necessary to consume the entire dose. The above principles constitute the general guidelines for the three methods of sweating, vomiting, and purging. If one can understand and apply these principles divinely beyond the examples given, then the Way of medicine is nearly mastered.
Case Studies of Miscellaneous Diseases, Chapter 5
Q: What does "treating disease before it arises" mean for an expert physician?
A: Treating disease before it arises means that when observing liver disease, one knows that the liver transmits pathology to the spleen and should first strengthen the spleen. Since the spleen is prosperous in all four seasons and resists pathogenic factors, supplementation is unnecessary if the spleen is strong. An average physician, unaware of this transmission, sees liver disease but fails to strengthen the spleen, treating only the liver. In treating liver disease, sour herbs are used to tonify the liver, bitter-heat herbs to assist, and sweet herbs to harmonize. Sour enters the liver, bitter-heat enters the heart, and sweet enters the spleen. The spleen controls the kidney; if kidney Qi is weak, water metabolism fails. If water metabolism fails, Heart Fire becomes excessive. Excessive Heart Fire damages the Lung. If the Lung is damaged, Metal Qi fails. If Metal Qi fails, Liver Qi becomes excessive, and the liver heals itself. This is the subtlety of treating the liver by supplementing the spleen. This method applies to liver deficiency but not to excess. The Classics state: Do not make the deficient more deficient, nor the excessive more excessive; tonify insufficiency and reduce excess. This is the principle. The same applies to other organs.
Humans inherit the Five Constants and grow through Wind and Qi. Although Wind and Qi can generate all things, they can also harm them, just as water can float a boat but also capsize it. If the primal true Qi of the five zang organs flows smoothly, the person remains peaceful and healthy. External pathogenic wind and evil Qi often cause death when they strike humans. Among thousands of diseases and hardships, none exceed three categories: First, meridians receive pathogenic factors which enter the zang organs, constituting an internal cause; second, limbs and nine orifices transmit pathogens via blood vessels, causing blockages, constituting an external skin invasion; third, injuries from sexual excess, metal weapons, or insects/beasts. Analyzing thus, the origins of disease are exhausted. If one cultivates caution, preventing pathogenic wind from interfering with meridians, and treats promptly upon initial meridian involvement before it reaches zang organs, or uses Dao Yin, Tu Na, acupuncture, and herbal plaster massage at the first sign of limb heaviness to prevent orifice closure, avoids legal punishments and animal disasters, maintains sexual moderation, and regulates dietary temperature and flavors (cold, heat, bitter, sour, pungent, sweet) without allowing physical decline, pathogens cannot enter the Cou Li (interstices). Cou Li is where the San Jiao meets primal true Qi and where blood and Qi pour; Li refers to the texture of skin and zang-fu organs.
Q: Patients show complexion changes on the face; I wish to hear the explanation.
A: A bluish nose indicates abdominal pain; if accompanied by aversion to cold, it is fatal. A slightly black nose indicates fluid retention; a yellow nose indicates cold in the chest; a white nose indicates blood loss. Slight redness outside the appropriate season is fatal. Fixed staring eyes indicate Jing (spasm), which is difficult to treat. Blue complexion indicates pain; black indicates labor/exhaustion; red indicates wind; yellow indicates difficulty defecating; bright luster indicates retained fluid.
Speaking quietly but startingle with sudden shouts indicates joint disease; speaking indistinctly and unclearly indicates heart-diaphragm disease; speaking finely and long indicates head disease.
Breathing while shrugging shoulders indicates hardness in the heart/chest; breathing drawing Qi up from the chest indicates cough; open-mouthed shortness of breath indicates Fei Wei (lung atrophy) with saliva.
Slightly rapid inhalation indicates disease in the Middle Jiao, which is excess; purgation leads to cure. Deficiency cases are untreatable. Rapid inhalation indicates Upper Jiao disease; distant/deep inhalation indicates Lower Jiao disease; both are difficult to treat. Trembling during respiration is untreatable.
Pulse movements at Cun Kou vary with the prosperous season. For example, when the Liver is prosperous, the complexion is blue; each season follows its respective color. If the Liver color is blue but turns white, it is out of season. Mismatched color and pulse indicate disease according to the law.
Q: There is "arrival before time," "failure to arrive on time," "lingering past time," and "excess arrival." What do these mean?
A: After Winter Solstice, on the night of the Jia-Zi day, Shao Yang Qi begins. During Shao Yang time, Yang begins to grow, and the weather becomes mild. If the weather is mild before the Jia-Zi day, this is "arrival before time"; if the weather remains un-mild after the Jia-Zi day, this is "failure to arrive"; if severe cold persists after the Jia-Zi day, this is "lingering past time"; if the weather is as hot as midsummer after the Jia-Zhi day, this is "excess arrival."
Q: The Classics say "Jue Yang travels alone." What does this mean?
A: This refers to having Yang without Yin, hence called Jue Yang.
Q: The Cun pulse is deep, large, and slippery. Deep indicates excess, slippery indicates Qi. When excess and Qi contend, blood and Qi entering the Zang cause death, while entering the Fu causes recovery. This is called Cu Jue (sudden syncope). What does this mean?
A: Blue lips and cold body indicate entry into the Zang, leading to death; a harmonious body and spontaneous sweating indicate entry into the Fu, leading to recovery.
Q: Pulse disappearance, entering Zang causes death, entering Fu causes recovery. What does this mean?
A: This applies to all diseases, not just one. For instance, in impetigo-like sores, flow from mouth to limbs is treatable; flow from limbs to mouth is untreatable. Disease remaining external is treatable; entering interior is fatal.
Q: What are the Eighteen Yang Diseases?
A: Head/neck pain, back/spine pain, arm/leg pulling pain. What are the Eighteen Yin Diseases?
A: Cough, hyperpnea, wheezing, hiccups, sore throat, borborygmus, distension, heart pain, spasm/tightness. Thirty-six Zang diseases and thirty-six Fu diseases total one hundred and eight diseases. Additionally, Five Exhaustions, Seven Injuries, Six Extremes, and Thirty-Six Women's Diseases are not included. Clear pathogens reside above, turbid pathogens below; major pathogens attack the exterior, minor pathogens attack the interior; pathogens from food/drink enter via the mouth, constituting retained food.
Q: When should one urgently rescue the Interior or the Exterior?
A: If a patient was wrongly purged, leading to continuous diarrhea with undigested food and body pain, urgently rescue the Interior. Later, if body pain persists but stool normalizes, urgently rescue the Exterior.
When a chronic disease is compounded by an acute disease, treat the acute disease first, then the chronic disease.
Diseases of the five Zang heal when conditions are favorable and worsen when conditions are unfavorable. For example, if a patient usually dislikes certain foods but suddenly craves them, fever will likely ensue.
To attack diseases in the Zang, follow the condition they have acquired. For thirst, administer Zhu Ling Tang. Follow this pattern for others.
Cold hands and feet with upper Qi rebellion and leg retraction indicate exhaustion of Fu Qi externally. Uncontrollable diarrhea and numbness of hands and feet indicate exhaustion of Zang Qi internally. Exhaustion of both internal and external Qi is fatal and untreatable.
Heat in the Upper Jiao causes cough and Fei Wei; heat in the Middle Jiao causes abdominal hardness; heat in the Lower Jiao causes hematuria or strangury/retention. Cold in the Large Intestine causes watery diarrhea; heat causes intestinal mucus. Cold in the Small Intestine causes tenesmus and pus/blood in stool; heat causes hemorrhoids.
What is meant by the exhaustion of the San Jiao? The Upper Jiao receives Qi from the Middle Jiao. If the Middle Jiao is disharmonious and cannot digest grain, the Upper Jiao exhausts, leading to frequent belching. The Lower Jiao receives Qi from the Middle Jiao. If Middle Qi is disharmonious and grain Qi does not move, the Lower Jiao exhausts, leading to urinary incontinence and fecal incontinence.
What are Ji (accumulation), Ju (gathering), and Gu Qi? Ji is a Zang disease, fixed in location. Ju is a Fu disease, occurring intermittently with shifting pain. Gu Qi causes hypochondriac pain relieved by pressure but recurring, known as Xin Qi. Pulses for various accumulations are deep and fine, adhering to the bone at Cun Kou. Accumulation in the chest corresponds to Cun Kou; slightly beyond Cun Kou indicates accumulation in the throat; at Guan indicates accumulation near the navel; above Guan indicates accumulation below the heart; slightly below Guan indicates accumulation in the lower abdomen. At Chi indicates accumulation at Qi Chong. Left pulse indicates left-sided accumulation; right pulse indicates right-sided accumulation; bilateral pulses indicate central accumulation. Treat according to the pulse location.
Shang Han Za Bing Lun Volume 4
Treatment of Warm Diseases with Pulse and Symptom Differentiation, Chapter 6
There are three types of Warm Diseases: Chun Wen (Spring Warmth), Qiu Wen (Autumn Warmth), and Dong Wen (Winter Warmth). These arise from latent pathogens. Summer brings Heat (Shu) disease, not Warm disease. Winter cold injury, with Qi latent in Shao Yin, manifests as Warm disease in Spring, named Chun Wen.
Summer dampness injury, with Qi latent in Tai Yin, manifests as Warm disease in Autumn when dryness prevails, named Qiu Wen.
Abnormal early warmth followed by severe cold in early winter, with dryness contracting inward, allows Qi to lie latent in Jue Yin. After Winter Solstice, despite the need for cold, warmth returns, manifesting as Warm disease named Dong Wen.
Warmth in Spring/Autumn is normal; warmth in Winter is abnormal. Abnormal warmth in Winter, storing Qi out of season, may not manifest until Spring, named Da Wen (Great Warmth). This results from failing to store Essence in Winter, losing proper Qi regulation. Spring Yang expansion combined with stored abnormal Qi creates severe disease. Misdiagnosis and treatment errors spread epidemic Qi, causing plagues.
Chun Wen affects the Upper Jiao: headache, dry throat, fever, vertigo, delirium, wiry/tense pulse. Treat with Xiao Chai Hu Tang plus Huang Lian and Mu Dan Pi Decoction.
Xiao Chai Hu Tang Plus Huang Lian and Mu Dan Pi Decoction Formula:
Chai Hu (Bupleuri Radix) 8 liang, Huang Qin (Scutellariae Radix) 3 liang, Ren Shen (Ginseng Radix) 3 liang, Gua Lou Gen (Trichosanthis Radix) 4 liang, Huang Lian (Coptidis Rhizoma) 3 liang, Mu Dan Pi (Moutan Cortex) 4 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 3 liang, Sheng Jiang (Zingiberis Rhizoma Recens) 3 liang, Da Zao (Jujubae Fructus) 12 pieces [split].
Nine ingredients. Boil in 12 sheng water, reduce to 3 sheng, strain, take 1 sheng warm, three times daily.
Qiu Wen affects the Middle Jiao: fever, thirst, abdominal heat/pain, dysentery with pus/blood, large/short/slipping pulse. Treat with Di Huang Zhi Mu Huang Lian E Jiao Tang; if no pus/blood, use Bai Hu Tang.
Di Huang Zhi Mu Huang Lian E Jiao Tang Formula:
Di Huang (Rehmanniae Radix) 8 liang, Zhi Mu (Anemarrhenae Rhizoma) 4 liang, Huang Lian (Coptidis Rhizoma) 3 liang, E Jiao (Colla Corii Asini) 1 liang.
Four ingredients. Boil in 10 sheng water until rice is cooked, strain, take 1 sheng warm, three times daily.
Dong Wen affects the Lower Jiao: fever, abdominal pain radiating to lower abdomen, dry/sore throat at midnight, deep/solid pulse, occasionally large/rapid. Treat with Shi Gao Huang Lian Huang Qin Gan Cao Tang; if constipated for 6-7 days, use Da Huang Huang Qin Di Huang Mu Dan Pi Tang.
Shi Gao Huang Lian Huang Qin Gan Cao Tang Formula:
Shi Gao (Gypsum Fibrosum) [crushed, wrapped in cotton] 8 liang, Huang Lian (Coptidis Rhizoma) 3 liang, Huang Qin (Scutellariae Radix) 4 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 liang.
Four ingredients. Boil in 10 sheng water, reduce to 3 sheng, take 1 sheng warm, three times daily.
Da Huang Huang Qin Di Huang Mu Dan Pi Tang Formula:
Da Huang (Rhei Radix et Rhizoma) 4 liang, Huang Qin (Scutellariae Radix) 3 liang, Di Huang (Rehmanniae Radix) 4 liang, Mu Dan Pi (Moutan Cortex) 3 liang.
Four ingredients. Boil in 12 sheng water, reduce to 2 sheng, strain, divide into two warm doses. Stop subsequent doses after bowel movement.
Wind Wen: headache, red face, fever, limb spasms, floating/wiry/rapid pulse. Treat with Huang Lian Huang Qin Zhi Zi Mu Dan Pi Shao Yao Tang.
Huang Lian Huang Qin Zhi Zi Mu Dan Pi Shao Yao Tang Formula:
Huang Lian (Coptidis Rhizoma) 3 liang, Huang Qin (Scutellariae Radix) 3 liang, Zhi Zi (Gardeniae Fructus) 14 pieces [split], Mu Dan Pi (Moutan Cortex) 3 liang, Shao Yao (Paeoniae Radix Alba) 3 liang.
Five ingredients. Boil in 6 sheng water, reduce to 3 sheng, strain, take 1 sheng warm, three times daily.
Shi Wen (Damp Warmth): patient has prior dampness, fever, cracked lips, diarrhea, abdominal heat/pain, large/rapid pulse. Treat with Zhu Ling Tang plus Huang Lian and Mu Dan Pi Decoction.
Zhu Ling Tang Plus Huang Lian and Mu Dan Pi Decoction Formula:
Zhu Ling (Polypori Parodia) 1 liang, Fu Ling (Poria) 1 liang, E Jiao (Colla Corii Asini) 1 liang, Ze Xie (Alismatis Rhizoma) 1 liang, Hua Shi (Talcum) 1 liang, Huang Lian (Coptidis Rhizoma) 1 liang, Mu Dan Pi (Moutan Cortex) 1 liang.
Seven ingredients. Boil first six in 4 sheng water, reduce to 2 sheng, strain, dissolve E Jiao, divide into two warm doses.
Wen affecting Heart: red tongue, dry throat, mental restlessness, urgent/rapid pulse reaching Cun Kou. Treated with Huang Lian Huang Qin E Jiao Gan Cao Tang.
Huang Lian Huang Qin E Jiao Gan Cao Tang Formula:
Huang Lian (Coptidis Rhizoma) 1 liang, Huang Qin (Scutellariae Radix) 1 liang, E Jiao (Colla Corii Asini) 1 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 1 liang.
Four ingredients. Boil first three in 10 sheng water, reduce to 4 sheng, strain, dissolve E Jiao, divide into three warm doses.
Wen affecting Lung: thirst, cough, persistent epistaxis, floating/large/rapid pulse. Treated with Huang Qin Shi Gao Xing Zi Gan Cao Tang.
Huang Qin Shi Gao Xing Zi Gan Cao Tang Formula:
Huang Qin (Scutellariae Radix) 3 liang, Shi Gao (Gypsum Fibrosum) [crushed] 8 liang, Xing Ren (Armeniacae Semen Amarum) [skin/kernel removed] 14 pieces, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 1 liang.
Four ingredients. Boil in 5 sheng water, reduce to 3 sheng, strain, take 1 sheng warm, three times daily.
Wen affecting Kidney: fever, edema below waist, lower abdominal heat/pain, red/frequent urination, urgent/rapid pulse at Chi. Treated with Di Huang Huang Bai Qin Pi Fu Ling Ze Xie Tang.
Di Huang Huang Bai Qin Pi Fu Ling Ze Xie Tang Formula:
Di Huang (Rehmanniae Radix) 6 liang, Huang Bai (Phellodendri Cortex) 3 liang, Qin Pi (Fraxini Cortex) 2 liang, Fu Ling (Poria) 3 liang, Ze Xie (Alismatis Rhizoma) 1 liang.
Five ingredients. Boil in 8 sheng water, reduce to 3 sheng, strain, take 1 sheng warm, three times daily.
Da Wen (Great Warmth): fever, dizziness, vertigo, dry teeth, cracked lips, delirium, unconsciousness, alternating blue/red face, urgent/large/rapid pulse. Treated with Da Huang Xiang Pu Tang. If throat closure prevents swallowing, needle Shao Shang to bleed. If pulse alternates sparse/rapid and eyes sink, death is imminent.
Da Huang Xiang Pu Tang Formula:
Da Huang (Rhei Radix et Rhizoma) 4 liang, Xiang Pu (Typhae Pollen) 1 liang, Huang Lian (Coptidis Rhizoma) 3 liang, Di Huang (Rehmanniae Radix) 8 liang, Mu Dan Pi (Moutan Cortex) 6 liang.
Five ingredients. Boil in 10 sheng water, reduce to 6 sheng, strain, take 2 sheng warm, three times daily.
If purgation for Warmth results in loose stool, self-healing is expected. If purgation causes persistent diarrhea and abdominal fullness, use Fu Ling Bai Zhu Gan Cao Tang.
Fu Ling Bai Zhu Gan Cao Tang Formula:
Fu Ling (Poria) 4 liang, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 3 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 1 liang.
Three ingredients. Boil in 8 sheng water, reduce to 3 sheng, strain, take 1 sheng warm, three times daily.
Feng Wen: caused by prior internal heat plus wind injury. Floating/wiry/rapid pulse. If no headache, use Gui Zhi Qu Gui Jia Huang Qin Mu Dan Pi Tang. If latent Warmth is wrongly sweated, causing high fever, irritability, cracked lips, red eyes, epistaxis/vomiting, deafness, large/rapid pulse, use Bai Hu Tang. For excess, use Cheng Qi Tang variants. After 10+ days entering interior, use Huang Lian E Jiao Tang (indicated by deep/rapid pulse, irritability, insomnia).
Gui Zhi Qu Gui Jia Huang Qin Mu Dan Pi Tang Formula:
Shao Yao (Paeoniae Radix Alba) 3 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 2 liang, Sheng Jiang (Zingiberis Rhizoma Recens) [sliced] 3 liang, Da Zao (Jujubae Fructus) 12 pieces [split], Huang Qin (Scutellariae Radix) 3 liang, Mu Dan Pi (Moutan Cortex) 3 liang.
Six ingredients. Boil in 8 sheng water, reduce to 3 sheng, strain, take 1 sheng warm, three times daily.
Bai Hu Tang Formula (see previous section).
Da Cheng Qi Tang Formula:
Da Huang (Rhei Radix et Rhizoma) [wine-washed] 4 liang, Hou Po (Magnoliae Officinalis Cortex) [processed] 8 liang, Zhi Shi (Aurantii Fructus Immaturus) [roasted] 5 pieces, Mang Xiao (Natrii Sulfas) 3 he.
Four ingredients. Boil Hou Po and Zhi Shi in 10 sheng water, reduce to 5 sheng, strain, add Da Huang, boil to 2 sheng, strain, add Mang Xiao, boil briefly, divide into two warm doses. Stop if bowel movement occurs.
Xiao Cheng Qi Tang Formula:
Da Huang (Rhei Radix et Rhizoma) [wine-washed] 4 liang, Hou Po (Magnoliae Officinalis Cortex) [processed] 2 liang, Zhi Shi (Aurantii Fructus Immaturus) [roasted, large] 3 pieces.
Three ingredients. Boil in 4 sheng water, reduce to 1.2 sheng, strain, divide into two warm doses. Take first dose expecting bowel movement; if none, finish dose. If movement occurs, stop.
Tiao Wei Cheng Qi Tang Formula:
Da Huang (Rhei Radix et Rhizoma) [wine-washed] 4 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 2 liang, Mang Xiao (Natrii Sulfas) 8 liang.
Three ingredients. Boil Da Huang and Gan Cao in 3 sheng water to 1 sheng, strain, add Mang Xiao, boil briefly, take small amounts warm.
Huang Lian E Jiao Tang Formula:
Huang Lian (Coptidis Rhizoma) 4 liang, Shao Yao (Paeoniae Radix Alba) 2 liang, Huang Qin (Scutellariae Radix) 2 liang, E Jiao (Colla Corii Asini) 3 liang, Ji Zi Huang (Ovi Galli Albumen) 3 pieces.
Five ingredients. Boil first three in 6 sheng water, reduce to 2 sheng, strain, dissolve E Jiao, cool slightly, add egg yolk, mix well, take 0.7 sheng warm, three times daily.
Untreated Warmth lingering in San Jiao: Upper Jiao causes stiff tongue/confusion, use Zhi Zi Tang. Middle Jiao causes abdominal pain/diarrhea/dry mouth, use Bai Hu Jia Di Huang Tang. Lower Jiao causes lower body heat/black teeth/dry throat, use Bai He Di Huang Mu Dan Pi Ban Xia Fu Ling Tang.
Zhi Zi Tang Formula:
Zhi Zi (Gardeniae Fructus) [split] 16 pieces, Huang Qin (Scutellariae Radix) 3 liang, Ban Xia (Pinelliae Rhizoma) 8 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 liang.
Four ingredients. Boil Zhi Zi in 4 sheng water to 2.5 sheng, strain, add remaining three, boil to 1 sheng, divide into two warm doses.
Bai Hu Jia Di Huang Tang Formula:
Zhi Mu (Anemarrhenae Rhizoma) 6 liang, Shi Gao (Gypsum Fibrosum) [crushed] 1 jin, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 2 liang, Geng Mi (Oryza Sativa) 6 he, Di Huang (Rehmanniae Radix) 6 liang.
Five ingredients. Boil in 10 sheng water until rice is cooked, strain, take 1 sheng warm, three times daily.
Bai He Di Huang Mu Dan Pi Ban Xia Fu Ling Tang Formula:
Bai He (Lilii Bulbus) [split] 7 pieces, Di Huang Zhi (Rehmanniae Juice) 1 sheng, Mu Dan Pi (Moutan Cortex) 6 liang, Ban Xia (Pinelliae Rhizoma) 1 sheng, Fu Ling (Poria) 4 liang.
Five ingredients. Wash Bai He, soak overnight until white foam appears, discard water. Boil in 2 sheng water to 1 sheng, strain. Boil remaining three in 4 sheng spring water to 2 sheng, strain. Add Di Huang Zhi and Bai He juice, boil, take 1 sheng warm, three times daily.
Shang Han Za Bing Lun Volume 5
Treatment of Summerheat Injury with Pulse and Symptom Differentiation, Chapter 7
Summerheat injures the Lung first. Lung is the house of Qi; summerheat damages Yuan Qi. Cun Kou pulse is weak, with thirst, sweating, confusion, and shortness of breath. Treat with Zhu Ye Shi Gao Tang.
Zhu Ye Shi Gao Tang Formula:
Zhu Ye (Bambusae Folium) 2 bunches, Geng Mi (Oryza Sativa) 0.5 sheng, Ban Xia (Pinelliae Rhizoma) [washed] 0.5 sheng, Shi Gao (Gypsum Fibrosum) 1 jin, Ren Shen (Ginseng Radix) 3 liang, Mai Men Dong (Ophiopogonis Radix) 1 sheng, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 2 liang.
Seven ingredients. Boil first six in 10 sheng water to 6 sheng, strain, add Geng Mi, cook until rice is done, strain, take 1 sheng warm, three times daily.
Summerheat with fever, sweating, thirst, floating/large pulse is named Zhong Ye (Heat Stroke). Treat with Bai Hu Jia Ren Shen Huang Lian E Jiao Tang.
Bai Hu Jia Ren Shen Huang Lian E Jiao Tang Formula:
Zhi Mu (Anemarrhenae Rhizoma) 6 liang, Shi Gao (Gypsum Fibrosum) [crushed, wrapped] 1 jin, Gan Cao (Glycyrrhizae Radix et Rhizoma) [roasted] 2 liang, Geng Mi (Oryza Sativa) 6 he, Ren Shen (Ginseng Radix) 3 liang, Huang Lian (Coptidis Rhizoma) 3 liang, E Jiao (Colla Corii Asini) 2 liang.
Seven ingredients. Boil first six in 10 sheng water until rice is done, strain, dissolve E Jiao, take 1 sheng warm, three times daily.