Library

Taiyang disease (disease of the Taiyang channel) presenting with fever and thirst, without aversion to cold, is termed Warm Disease (Wen Bing).

Zhou Yangjun's Commentary: Warm Disease arises from latent pathogenic factors emerging from within. Once they reach the exterior, both interior and exterior become hot. Since the heat intensity is vigorous, the stagnant pathogen consumes body fluids, hence thirst occurs immediately upon onset. The exterior originally has no pathogenic stagnation, and the interior actually prefers coolness, hence there is no aversion to cold. If delayed for three to five days, abdominal fullness or diarrhea may occur; this is such a syndrome. It differs greatly from Cold Damage (Shang Han), where exterior symptoms appear first followed by interior symptoms. However, it is solely attributed to the Taiyang channel because other channel syndromes have not yet manifested, clearly indicating that it originates from Shaoyin and presents as simultaneous interior-exterior involvement.

If after inducing sweating, the body becomes scorching hot, it is named Wind-Warmth (Feng Wen). In Wind-Warmth disease, the pulse is floating at all positions (Yin and Yang); there is spontaneous sweating; the body feels heavy; there is excessive sleepiness; nasal breathing is necessarily snoring; and speech is difficult to produce. If purgatives are mistakenly used, urinary difficulty, fixed staring, and incontinence will occur. If fire therapy is mistakenly applied, slight jaundice may appear; in severe cases, it resembles convulsive epilepsy with occasional spasms. If fumigated with fire, one error may prolong the illness, but a second error will hasten death.

Fang Youzhi's Commentary: "Scorching hot" means the heat intensifies significantly. "Wind-Warmth" means wind pathogen complicating Warm Disease. "Floating at Yin and Yang" refers to the Taiyang pulse naturally being floating, and since Wind-Warmth is entirely Yang, floating pulses are seen above and below. Spontaneous sweating indicates injury to the Defensive Qi (Wei Qi). Heavy body, excessive sleepiness, snoring, and difficulty speaking result from wind obstruction causing mental clouding and severe heat causing Qi stagnation. Urinary difficulty occurs because Taiyang governs the Bladder, and Wind-Warmth is Yang; purgation attacks downward, vainly depleting body fluids and injuring the Bladder's Qi transformation. Fixed staring occurs because Taiyang sinews branch to the upper eyelid; thus, the eyes do not rotate but stare upward. Incontinence means urine completely loses its normal regulation. "Fire" refers to moxibustion or warming therapies. "Slight" means mild intervention leads to mild complications. Jaundice appears because fire-heat dries the Earth element (Spleen/Stomach), causing yellow color to manifest externally. "Severe" means intense intervention leads to severe complications. Convulsions and spasms resemble epilepsy due to extreme heat generating wind. "Fumigation" is also a fire coercion method. "One error" refers to an initial mistake; "still prolongs days" means it can still linger temporarily. "Second error" refers to repeated mistakes; "hastens life period" means shortening natural lifespan. The warning intent here is profound.

Zhou Yangjun's Commentary: This clause follows the previous text closely: if after sweating, the body becomes scorching hot, it is named Wind-Warmth. This remains a Taiyang Warm Disease caused by mistaken sweating, which is distinct from contracting wind subsequently. Yet why is it called Wind-Warmth? Since it is Taiyang, it does not immediately show Shaoyin signs. Only through mistaken sweating does the original Warm Disease syndrome, combined with acrid-warm herbs for sweating, cause Yin fluids to escape outward, increasing heat in both interior and exterior. The pulse must become floating at both Cun and Chi positions. Precisely because wind and warmth mix, Kidney Water cannot sink alone, leading to spontaneous sweating and heavy body—these are root diseases of the Kidney. Excessive sleepiness, snoring, and difficulty speaking are also root diseases of the Kidney. Initially Taiyang, mistaken sweating causes Shaoyin manifestations to appear simultaneously, which is critical and dangerous. Ancient medical laws warn: "Wind-Warmth is treated in Shaoyin; do not induce sweating; those who sweat die." Does one not know that Taiyang should also not be sweated? Sweating Taiyang leads to the same Shaoyin involvement as Wind-Warmth. This happens because physicians mistakenly identify it as Cold Damage and use appropriate sweating drugs. If purged without sweating, Bladder Qi transformation is injured, causing urinary difficulty, massive fluid loss, fixed staring, and incontinence—one Fu organ and one Zang organ fail simultaneously. Regarding mistaken fire coercion: slight cases injure Ying and Wei Qi with heat, causing heat stasis and jaundice; severe cases generate wind from extreme heat, causing convulsions and spasms. This disrupts the Spirit (Shen) and disturbs sinews and vessels. Thus, among these three errors, one error awaits death; repeating the offense brings immediate peril. Yu Jiayan discusses the *Neijing* chapter on Acupuncture for Heat Diseases regarding Warm Disease, citing Taiyang pulse/color shining on cheekbones. If the luster has not crossed, it says "now sweat can be obtained, wait for the time." Those competing with Jueyin die within three days because heat disease connects internally to the Kidney. Shaoyang pulse/color shines on the front of cheeks. If luster has not crossed, "now sweat can be obtained, wait for the time." Those competing with Shaoyin die. These discuss obtaining sweat, not inducing sweat. Thus, the Sages specifically discuss Grain Qi; if Kidney essence prevails, sweating leads to survival; if Kidney deficiency is severe, further heat leads to death. The meaning is extremely thorough. Zhang Zhongjing complements the incomplete Zang theory, integrating the Bladder. Observing urinary difficulty indicates severe Bladder injury; fixed staring and incontinence indicate the Essence stored in the Gate of Vitality cannot illuminate objects, and Spirit/Marrow is exhausted. High pupils indicate Taiyang insufficiency; rolling back of eyes indicates Taiyang exhaustion. Exhausted limbs cannot flex or extend. Therefore, in stroke-like diseases, Bladder often fails. Failure to recognize people is the key point of Wind-Warmth: first observe the Bladder. There is no case where Bladder does not fail while Kidney Water fails first.

Simultaneous disease of Taiyang and Shaoyang with spontaneous diarrhea is treated with Huangqin Decoction. If vomiting occurs, Huangqin Jia Banxia Shengjiang Tang (Huangqin Decoction plus Pinellia and Fresh Ginger Decoction) is the primary treatment.

Zhou Yangjun's Commentary: Huangqin Decoction is the fundamental medicine for treating Warm Disease. Why mention Taiyang and Shaoyang two channels but not use medicines for these two channels? This is not Cold Damage. Cold Damage moves from exterior to interior; this disease emerges from interior to exterior. Without exterior signs, how do we know it involves Taiyang and Shaoyang? Symptoms may include hypochondriac fullness, headache, or bitter taste with desire to drink. Because there is no aversion to cold but immediate heat, it cannot be called an exterior syndrome. In Cold Damage simultaneous disease, all are exterior diseases. Now there is not only no exterior syndrome but also interior diarrhea. Cold Damage concurrent heat diarrhea must result from transmission through channels, unlike this immediate diarrhea. Why does Warm Disease cause immediate diarrhea? Because external emergence is recent, internal stagnation is deep. The patient's Middle Qi is originally deficient; how can it all be discharged outward at once? It must flow downward causing diarrhea.

Huangqin Decoction
Huangqin (3 liang), Gancao (2 liang, honey-fried), Shaoyao (2 liang), Dazao (12 pieces, split).
These four ingredients are boiled in 10 sheng of water to yield 3 sheng. Strain and take 1 sheng warm, twice daily and once at night. If vomiting occurs, add Banxia (0.5 sheng) and Shengjiang (3 liang).

Huangqin Jia Banxia Shengjiang Tang
Huangqin (3 liang), Gancao (2 liang), Shaoyao (2 liang), Dazao (12 pieces, split), Banxia (0.5 sheng), Shengjiang (3 liang).
These six ingredients are boiled in 10 sheng of water to yield 3 sheng. Strain and take 1 sheng warm, twice daily and once at night.

Zhou Yangjun's Commentary: Huangqin clears heat, making it the main drug for Warm Disease diarrhea because it drains heat. However, Shaoyao is used because its sour-cold nature penetrates deeply into the Yin level. One drains, one astringes; when heat leaves, diarrhea stops. Gancao and Dazao are taken to harmonize the Middle. Since the Bladder and Gallbladder (two Fu organs) are diseased, the Stomach cannot remain safe alone. Vomiting indicates phlegm-fluid retention; only Ginger and Pinellia can remove it. Although Ginger and Pinellia are acrid-dry and unsuitable for latent Qi, they excel at stopping vomiting. Moreover, with Huangqin as the sovereign herb, what is there to fear?

Simultaneous disease of the Three Yang channels: pulse is floating and large, located above the Guan position; the patient desires sleep; sweating occurs when closing the eyes.

Fang Youzhi's Commentary: Taiyang pulse is floating, Yangming pulse is large. The Guan position belongs to Shaoyang, hence "Three Yang simultaneous disease." Desire to sleep results from heat gathering in the Gallbladder. Sweating upon closing eyes occurs because Shaoyang has little blood; deficiency prevents harmony with Yang. Sleep belongs to Yin, hence nocturnal sweating occurs.

Zhou Yangjun's Commentary: Warm Qi emerging affects all Three Yang channels; the pathogenic heat is mixed and solid, evident without saying. Hence the pulse is floating and large. Recalling when pathogen was latent in Shaoyin, the Chi pulse was already large. Now, emerging from interior to exterior and rising from lower to upper, floating and large pulses appear above Guan, hence "above Guan." Although pathogen appears in Yang positions, the source in Shaoyin is unsettled, so desire to sleep shows the root syndrome, and sweating upon eye closure shows nocturnal sweating, revealing Shaoyang root syndrome. Why only Shaoyang? Because Mother (Water/Kidney) deficiency causes Son (Wood/Liver/Gallbladder) deficiency; Shaoyin pathogenic fire and Shaoyang ministerial fire rise together burning fiercely. The difference from general heat disease is that only sweating upon eye closure occurs, unlike the continuous profuse sweating of heat disease. Why not mention Taiyang and Yangming channel signs? Because floating represents Taiyang channel pulse, and large represents Yangming channel pulse. Treatment should focus on Xiaochaihu Tang (Minor Bupleurum Decoction) minus Renshen, Shengjiang, and Banxia, plus Shaoyao.

The Master said: Latent Qi disease is diagnosed by intuition. Within this month, latent Qi is anticipated. If latent Qi exists previously, the pulse must be examined. If the pulse is faint and weak, throat pain resembling injury should occur, but it is not Hou Bi (throat bi). The patient reports actual throat pain. Even so, diarrhea is expected now.

Zhou Yangjun's Commentary: During latent Qi, observing latent Qi disease with a faint and weak pulse indicates Shaoyin pulse. In persons with Kidney Qi deficiency, Yang does not reach, and Yin manifests immediately. Since Shaoyin pulse traverses the throat, throat pain must precede eruption. After eruption, pain becomes extreme, resembling injury. How can it be mistaken for Bi syndrome and mistreated? Although throat pain erupts upward, one must realize the Kidney controls opening and closing. Yin-heat rises; how can it all discharge downward? Thus, diarrhea rushing to the posterior orifice is predictable.

Shaoyin disease lasting two to three days with throat pain may be treated with Gancao Tang (Licorice Decoction). If ineffective, Jiegeng Tang (Platycodon Decoction) is given.

Zhou Yangjun's Commentary: When latent Qi emerges from Shaoyin channel, throat pain is inevitable. First giving Gancao Tang slows its upward momentum. Then giving Jiegeng Tang opens the stagnant pathogen. This needs no explanation. However, latent Qi is a severe syndrome, and Shaoyin is extremely deficient. Zhang Zhongjing gently tests first, not using Huangqin Ben Tang, for good reason. Since Shaoyin just emerged, only throat pain is seen, without chest fullness, irritability, etc., nor diarrhea, vomiting, or thirst. To use other drugs, where to start? Thus, in two to three days, focusing on throat pain, two decoctions are presented. If pain stops after taking them, more than half of Shaoyin pathogen is removed. Subsequent symptoms guide further medication. This is the Sage's clear instruction against reckless treatment.

Gancao Tang
Gancao (2 liang).
This single ingredient is boiled in 3 sheng of water to yield 1.5 sheng. Strain and take 0.7 sheng warm, twice daily.

Zhou Yangjun's Commentary: Shaoyin pulse traverses the throat; how can pathogenic heat lodging there not cause pain? It precisely carries Shaoyin fire upward. Gancao is used because sweet flavor treats hot-fire.

Jiegeng Tang
Jiegeng (1 liang), Gancao (2 liang).
These two ingredients are boiled in 3 sheng of water to yield 1.5 sheng. Strain, divide into two warm doses.

Zhou Yangjun's Commentary: If the previous decoction fails to resolve symptoms, it is not because the medicine is insufficient for the disease. Precisely because Shaoyin fire carries pathogen attacking upward, affecting its mother (Earth/Spleen-Stomach), adding Jiegeng opens the blockage, ensuring recovery.

Shaoyin disease persisting for two to three days or more, with vexation in the heart and inability to lie down, is primarily treated with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).

Zhou Yangjun's Commentary: Before latent pathogen emerges, body fluids are secretly consumed. Now, after two to three days, although Yin fire does not rise and throat pain etc. are absent, heart vexation and insomnia indicate Yin-blood consumption. Thus, Huangqin and Huanglian dispel heat, while Ejiao and Shaoyao nourish Yin, achieving both goals.

Huanglian Ejiao Tang
Huanglian (4 liang), Huangqin (2 liang), Shaoyao (2 liang), Ji Zi Huang (2 yolks), Ejiao (3 liang).
These five ingredients are boiled in 5 sheng of water. First boil the three herbs to yield 2 sheng, strain, add Ejiao until melted, cool slightly, add chicken egg yolks, stir well. Take 0.7 sheng warm, three times daily.

Zhou Yangjun's Commentary: Interior heat must be dispelled; internal dryness must be moistened. Moistening provides lubrication; dispelling cleanses heat. Only the Sage achieves this appropriateness. Heart vexation makes Huanglian the sovereign, assisted by Huangqin, clearing Lung and Stomach pathogens. However, severe heat consumes Shaoyin Water; once the water source is dry, how can fluids not be scarce? Chicken egg yolk and Ejiao deeply benefit Blood-level substances to nourish Yin. With this support, Huanglian and Huangqin achieve great merit. Furthermore, adding Shaoyao astringes the consuming Heart Qi and enters the Liver, making the vexed calm and the insomniac sleep.