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After taking Guizhi Tang (Cinnamon Twig Decoction), after a short while, one should drink a small bowl of hot thin porridge to assist the medicinal power. Then lie in bed and cover with warm blankets. After about one shichen (two hours), there will be a slight, continuous sweat all over the body ("si" here means continuous, not "as if"). The disease will then be completely eliminated. This sweat should be called "medicinal sweat," distinct from the previous "disease sweat." Disease sweat usually carries a cool sensation, whereas medicinal sweat carries a warm sensation. Although disease sweat may persist for a long time, it is insufficient to eliminate the disease; medicinal sweat, though instantaneous, achieves significant efficacy. This is the distinction between them. When a patient presenting with Guizhi Tang syndrome comes for consultation and is prescribed Guizhi Tang, and is told: "Sweating after taking this medicine will cure your illness," they will inevitably say: "Sir, I already have sweating." It is not blameworthy that ordinary people do not understand the difference between disease sweat and medicinal sweat. What is surprising is that some physicians still debate whether Guizhi Tang induces sweating or stops sweating, arguing endlessly without resolution. They fail to realize that for a Wind-Strike syndrome taking Guizhi Tang, obtaining medicinal sweat first constitutes inducing sweating, which subsequently clears the disease sweat, thereby also stopping sweating. Therefore, both the theories of inducing sweating and stopping sweating are either both incorrect or both correct, depending on perspective. Unfortunately, they fail to grasp the holistic connection, falling short by one step! Guizhi (Cinnamon Twig) is a Yang herb containing volatile oils, thus capable of dispersing. Shaoyao (Peony Root) is a Yin herb containing paeonic acid, thus capable of astringing. After astringency follows dispersion, and upon extreme dispersion, it turns back to astringency. The two interact as beginning and end, like a circle without start or finish, operating according to the Dao, cycling continuously. Thus, astringency does not imply stagnation; dispersion does not mean non-recovery. The reason for separate naming is merely to indicate different directions of operation. From this, we can see that the division of labor between Guizhi and Shaoyao is essentially cooperation. Moreover, capillaries are distributed throughout the body, reaching everywhere, intermingling with muscles, nerves, and sweat glands. Therefore, after accelerated arterial and venous blood circulation, heat must be generated, more intense than previous fever. Heat steams the sweat glands, inevitably causing sweating. This is exactly the same principle as when humans engage in vigorous exercise: heart beat accelerates, pulse quickens, blood circulation speeds up, the whole body heats up, and consequently sweating occurs.

However, sweat produced by such exercise need not contain toxins. In contrast, sweat obtained after illness followed by medication undoubtedly contains toxins. The decoction and administration instructions of this formula state: "Slight, continuous sweating all over the body is best... If no sweat, administer again... If still no sweat, shorten the interval between doses... If still no sweat, continue until two or three doses..." Master Zhongjing earnestly teaches and repeatedly advises, seeking only one instance of sweating before stopping, why is this? The answer is: Only through this medicinal sweat can all toxins be expelled! On hot summer days, when sweating profusely down the back, drinking ice-cold beverages can stop sweating. This is because ice cools the Stomach. Since cooling the Stomach can stop sweating, how can warming the Stomach not be necessary when inducing sweating via medication? Thus, Shengjiang (Fresh Ginger), a fine herb for warming the Stomach and stopping vomiting, becomes essential. Fearing that excessive sweating might damage Stomach fluids, Dazao (Jujube Fruit) is used to preserve them.

Furthermore, fearing that since the Intestines reside below the Stomach, Stomach disharmony might transmit pathology to the Intestines, Gancao (Licorice Root) is preemptively used to pacify them. In summary, Jiang (Ginger), Zao (Jujube), and Cao (Licorice) are all sacred herbs for harmonizing the Stomach and Intestines. The Stomach and Intestines prefer mild warmth; warmth brings harmony, hence the saying. Once the Stomach and Intestines are protected and harmonized by these three herbs, and blood circulation is accelerated by the stimulation of Guizhi and Shaoyao, the interior and exterior combine, resulting in slight, continuous sweating all over the body.

If the patient presents with the exterior syndrome of Type 1 or 2 of this formula's indications, they will heal accordingly. Even if they present with vomiting (Type 3) or diarrhea (Type 4), they will also heal. If one can further discern the severity and weigh the symptoms, the outcome would be even better.

Guizhi Tang Syndrome Case 5 (Including Student's Clinical Record)

Master Yu Shunchen once said: Before the January 28th Incident, an old woman in Zhabei had a son working at the post office. She suffered from a carbuncle on the head (Naoju), spreading around with a diameter of nearly one chi. Upon removing her plaster, steam rose intensely. Her head and neck could not turn. Mr. Yu Hongsun and I consulted together. After three days, there was little effect. On the fourth day, late in the evening, we saw the patient lying buried under blankets, unwilling to emerge. Asking the reason, the attendant said she experienced chills, fever, and sweating at this time every day. I realized this was the Guizhi Tang syndrome characterized by "se se" (mild aversion to cold) and "xi xi" (mild fever). I immediately prescribed a light dose: Guizhi 5 fen, Shaoyao 1 qian, plus light doses of Jiang, Cao, and Zao. The next day, the condition greatly improved. I gradually increased the dosage daily until Guizhi reached 3 qian and Shaoyao 5 qian, adjusting the other three herbs accordingly, without adding any other medicines. After several days, she was completely cured.

[Commentary] Naoju (Carbuncle on Head) is a disease. Masters Yu and Yu initially treated it using methods for carbuncles, with little effect for three days. Upon recognizing the Guizhi Tang syndrome, they tried Guizhi Tang. Using no more than 5 fen of Guizhi and 1 qian of Shaoyao, along with mild Jiang, Cao, and Zao, one might expect only modest effects. Yet the result exceeded expectations, justifying Master Yu's surprise. That a single formula achieved complete cure further demonstrates that only those who can identify syndromes can treat diseases. Moreover, the flexible application of Zhongjing's formulas is not limited to Guizhi Tang alone. Zhongjing detailed the modifications of Guizhi Tang specifically to set an example for later generations. If one can apply various formulas flexibly, the benefits would be even greater. Through careful study, one realizes the true value of Zhongjing's pulse-syndrome-treatment methods.

Cao Yingfu said: Mr. Ding Garen stated, "Naoju belongs to the Taiyang channel; Fabei (carbuncle on back) belongs to Taiyang combined with Shaoyin. Misusing cold medicines for these two conditions will surely cause death." Profound words! I recall my youth in Hou Cheng, East Township, Jiangyin. A TCM practitioner named Jiang Kuntian suffered from Naoju, staying home for three days. My father met him in the market, asked about his condition, and he replied, "I am healed." Asked about the treatment, he said, "Guizhi Tang." Asked about the dosage of Guizhi, he said, "Only 4 fen." If 4 fen of Guizhi could cure Naoju, it explains why Yu Sheng's use of 5 fen was highly effective. However, Jiang's condition was mild, so 4 fen sufficed. The old woman's condition was severe, requiring an increase to 3 qian. If one rigidly adhered to Jiang's 4 fen as a precedent, it would be dangerous for severe cases requiring 3-4 qian.

Guizhi Tang Syndrome Case 6 (Including Student's Clinical Record)

Ms. Wang presented with no exterior syndrome, a slow pulse, delayed menstruation with scant flow, occasional mild aversion to cold (especially on the back), and reduced appetite. This is due to sluggish blood circulation and weak Stomach and Intestines. Guizhi Tang is suitable to harmonize.

Chuan Guizhi 3 qian, Da Bai Shao 3 qian, Jiu Chao Zhi Gancao 3 qian, Shengjiang 3 slices, Dazao 12 pieces.

[Commentary] Traditional Chinese women often lack exercise, leading to indigestion. In winter, limited facilities prevent frequent bathing. Complex family structures, often involving disharmony among sisters-in-law, lead to internal depression affecting Qi and Blood. Initially, this manifests as Qi rebellion and epigastric pain, poor appetite, self-diagnosed as Liver-Stomach Qi stagnation, or described in texts as Wood insulting Earth. Despite differences in terminology, the essence is the same. Eventually, it develops into dizziness, palpitations, and irregular menstruation, commonly known as anemia. The pulse is typically slow and weak. In severe anemia, it may become fine, rapid, and weak. Without wind-cold invasion, patients often feel chilly, especially in winter. I frequently prescribe the original Guizhi Tang for such cases. Patients report sudden warmth throughout the body and smooth meridians, akin to basking in winter sun or after bathing. This is due to the blood-invigorating properties of Guizhi and Shaoyao. Previously difficult bowel movements now pass smoothly because Gancao pacifies the Intestines and has a mild laxative effect. If stools remain hard, adding 1 qian of Dahuang (Rhubarb Root) per dose can gently promote evacuation. Raw Dahuang is preferred, but processed is acceptable. After 2-3 doses, bowels move freely, and appetite improves. This usage is subtle and best understood by experience. If Dahuang is considered too harsh, Huren (Hemp Seed) 4-5 qian can be used for gradual effect. Additionally, Jiang and Zao stimulate gastric function, transforming food into essence. Once the source opens, blood nourishes gradually. My teacher summarized the formula's function concisely: "Guizhi Tang soothes the Liver and tonifies the Spleen." Since the Liver stores blood, smooth blood flow nourishes nerves, preventing irritability, hence "soothing the Liver" or "calming the Liver." The Spleen encompasses the digestive system; healthy intestines and stomach mean "tonifying the Spleen." Excellent words!

A key point to note is whether Ms. Wang sweated after taking Guizhi Tang. Answer: No sweating, only feeling warm. Does this mean Guizhi Tang cannot induce sweating? The presence or absence of sweating is a post-medication phenomenon.

The post-medication phenomenon equals the combination of the formula and the syndrome; it is not determined solely by the formula. Specifically, Guizhi Tang induces sweating only when combined with a Wind-Strike syndrome. If combined with an interior syndrome (like in this case, distinguished from Taiyang Wind-Strike exterior syndrome), sweating will likely not occur, or will be minimal and imperceptible. Understanding this allows generalization to other formulas. For example, profuse sweating after Mahuang Tang indicates the patient originally had a Mahuang Tang syndrome; profound purgation after Chengqi Tang indicates an original Chengqi Tang syndrome. Conversely, applying Mahuang Tang to a Chengqi syndrome, or Chengqi Tang to a Mahuang syndrome, will not necessarily cause profuse sweating or purgation, respectively. However, confusing the disease pattern leads to complicated illnesses.

Question: Guizhi Tang treats both exterior and interior syndromes, yet the formula remains the same despite differing locations. Is there evidence from Zhongjing? Answer: The Master said: "In women, if the pulse is level, the Yin pulse is slightly weak, the patient feels thirsty and cannot eat, without chills or fever, this is named Pregnancy, and Guizhi Tang governs it." Saying "no chills or fever" implies no exterior syndrome. Saying "cannot eat and thirsty" implies Stomach-Intestine deficiency-cold, inability to transform food into essence. Saying "named Pregnancy" implies no disease and certainly no exterior syndrome. Another question: By this logic, Guizhi Tang is purely a tonic formula; even perfectly healthy people could take it? Answer: Indeed. However, strictly speaking, those with chronic Stomach-Intestine excess-heat or hypertension should avoid it. For elderly or female patients with constitutional deficiency-cold, it yields unexpected results. Thus, Zhongjing regards this formula as a primary warming-tonic base. Adding Guizhi treats rebellious Qi rushing to the heart; adding Fuzi treats persistent leakage; adding Longgu and Muli treats night sweats and seminal emission; adding Shaoyao and Yitang treats abdominal pain; adding Renshen, Shengjiang, and Shaoyao treats body ache after sweating; adding Huangqi and Danggui treats general deficiency-wasting; removing Shaoyao and adding Shengdi, Maidong, Ejiao, Renshen, and Huren treats knotted pulse and palpitations. None are not major tonic formulas.

Counting the 113 formulas in Shanghan Lun, over 20 are modifications of Guizhi Tang. Thus, Zhongjing indeed favored tonic formulas. Who says Shanghan formulas are only for attacking pathogens? Cao Yingfu said: This Guizhi Tang Syndrome Case 6 also belongs to Taiyin. Guizhi Tang treats Taiyang exterior syndromes and Taiyin interior syndromes. Zhongjing dedicated sections to both. It is well-known for treating Taiyang, but less believed for treating Taiyin-related Taiyang diseases. This clinical record proves Zhongjing's words were not empty. Did Zhongjing not say Taiyin disease involves abdominal fullness, vomiting, inability to eat, spontaneous diarrhea, and abdominal pain? If Taiyin disease presents with a floating-slow Taiyang pulse, it becomes a Guizhi Tang syndrome.

Mahuang Tang Syndrome Case 1

Fan Zuo contracted Cold Damage (Shanghan). After six or seven days, he exhibited aversion to cold, fever, anhidrosis, wheezing, stiffness and pain in the head, neck, waist, and spine. Both pulses were floating and tight. The pathogen had not transmitted. Mahuang Tang governs.

Mahuang 1 qian, Guizhi 1 qian, Zhi Cao 8 fen, Xingren 3 qian.

[Commentary] This is my teacher's early prescription; the light dosage is evident. Recently, his dosages of Mahuang and Guizhi are often 3-5 qian, curing the disease in one dose. He often admonished us: "My use of large doses resulted from gradual increases; I dare not treat human life as a game." Light doses cure slowly; heavy doses cure rapidly. Doctors aim to cure disease; thus, my use of heavy doses is necessary. He Gongdu wrote in "Eulogy for Mr. Yun Tieqiao": "...A year later, his second and third sons died of Shanghan. Grief-stricken, he studied Shanghan Lun intensively... Years later, his fourth son fell ill with Shanghan. Fever, anhidrosis, wheezing. Physicians prescribed Dou Chi, Shan Zhi, Dou Juan, Sang Ye, Ju Hua, Bo He, Lian Qiao, Xingren, Xiang Bei, etc. Fever persisted, wheezing worsened. He paced all night. At dawn, he declared: 'This is not just any illness; it matches Shanghan Lun Taiyang disease: headache, fever, body ache, waist/back pain, joint pain, aversion to wind, anhidrosis, wheezing—Mahuang Tang governs.' He wrote: Mahuang 7 fen, Guizhi 7 fen, Xingren 3 qian, Zhi Cao 5 fen. He gave the prescription to his wife: 'My three sons died from this; now my fourth is sick, and doctors refuse. Rather than waiting to die, let us try medicine!' His wife agreed. He continued working at Commercial Press. Returning home, he saw the boy's breathing stabilized and skin moist. He administered more medicine, resulting in sweating, cessation of wheezing, and recovery.

Having saved his fourth son, Mr. Yun firmly believed in Shanghan formulas.... (Excerpt from Modern TCM Monthly, Vol 2, Issue 9). These few lines contain profound meaning. Contemporary physicians can treat mild Wind-Heat with Sang Ju Zhi Qiao, but fail to use Mahuang Tang for severe Shanghan. Victims include not only the Yun family. This is the first lesson. Mr. Yun studied Shanghan Lun for years yet hesitated even with a light Mahuang Tang dose, proving the difficulty of medicine. This is the second lesson. However, these are not my focus; I seek to clarify the full syndrome of Mahuang Tang.

The complete pulse-syndrome of Mahuang Tang includes wheezing (severe cases show nasal flaring), floating-tight pulses beating strongly against the finger, headache, aversion to cold, anhidrosis, fever (present or absent), vomiting/reversal, body ache, waist/back pain, and joint soreness. Its brief pathology is external Cold invading the skin/hair and internally affecting the Lung. The Lung closes due to Cold, obstructing respiration, causing upward reversal and wheezing. With Lung dysfunction, the nose compensates, causing flaring. Skin contracts due to Cold, losing excretion control, causing chilliness and aversion to cold. Circulation compensates, causing fever. Blood flow tension causes tight pulses. Stomach is affected, causing vomiting. Nerves are uncomfortable, causing pain. Detailing this fully would require volumes. But treating based on pulse and syndrome is sufficient for immediate effect, which is why Zhongjing's teachings are eternal models!

Mahuang Tang Syndrome Case 2

Huang Handong walked in wind and snow at night, exposed to Cold, resulting in aversion to cold, occasional nausea, and floating-tight pulse. Mahuang Tang is suitable.

Sheng Mahuang 3 qian, Chuan Guizhi 3 qian, Guang Xingren 3 qian, Sheng Gancao 1.5 qian.

Zhuochao Note: After taking this, Handong sweated. He then drank a decoction of Jiegeng 5 qian and Sheng Cao 3 qian, and recovered.

[Commentary] While the full syndrome of Mahuang Tang is as described above, it is not required that all symptoms be present to use this formula. Missing one symptom does not preclude its use. Conversely, if the internal pathology matches Mahuang Tang, even with slight variations in presentation, it can be effective. Patient constitutions vary, pathogenic factors differ in severity, and seasons vary in cold/heat. Thus, even within the same syndrome, presentations differ. For instance, the previous case had wheezing but no vomiting; this case has vomiting but no wheezing. The Great Treatise states: "Taiyang disease, whether fever is present or not, must involve aversion to cold, body pain, vomiting/reversal, and Yin-Yang pulses both tight; this is named Cold Damage." I interpret "must" as "often," not "always." Weak Stomach Qi or damp-phlegm may trigger vomiting. Wheezing, however, is the primary symptom of Mahuang Tang, far more important than vomiting. This must be clear in our minds.

Mahuang Tang Syndrome Case 3

My friend Shen Jingfu's tenant contracted Shanghan starting in December. Due to poverty, he delayed medical care for a month. Sympathizing with his plight, Shen invited me to consult free of charge. His pulse was floating-tight, with headache and aversion to cold; fever was mild, consistent with initial onset. I prescribed: Mahuang 2 qian, Guizhi 2 qian, Xingren 3 qian, Gancao 1 qian. Given his prolonged illness weakened Stomach Qi, I advised adding Shengjiang 3 slices and Hong Zao 2 pieces, decocting quickly and drinking hot, then covering with blankets to sleep. Indeed, after one quarter-hour, the illness vanished. In winter's coldest days, many contract Shanghan; I routinely cure them with one dose of Mahuang Tang. Who says there is no true Shanghan in Jiangnan?

[Commentary] The Neijing theory of "Day 1 Taiyang, Day 2 Yangming, Day 3 Shaoyang..." is insufficient as a rule.

As shown in this case, the patient maintained Mahuang Tang syndrome for a month without medication. Upon administering Mahuang Tang, he recovered in one dose, effectively echoing the diagnosis. This is because his righteous Qi was strong, allowing prolonged resistance against the pathogen.

While consulting at Guangyi Hospital, I treated a child with convulsions. Eyes glazed, constipation, critical condition. Multiple doses of Chengqi formulas to purge, and Baihu to clear, took days to stabilize. Subsequently, it transformed into Shaoyin alternating chills and fever, treated with Xiaochaihu Tang modified. After several days, slight improvement suggested recovery. One day, visiting a nearby charity clinic, I was shocked to see the child receiving care again. Examining closely, he had recurrent chills and fever multiple times daily, indicating Mahuang-Guizhi Half-Dose Tang syndrome. Counting from onset, nearly a month had passed. Observing the complex progression, seemingly deviating from standard patterns, how could it be limited by the "one or two days" theory?

Mahuang Tang Syndrome Case 4

Yu Right Residing at No. 1 Weide Li, Gaochang Temple, contracted Shanghan. Symptoms: stiffness and pain in head/neck, aversion to cold, occasional nausea, tight pulse. Mahuang Tang is suitable.

Mahuang 5 qian, Guizhi 5 qian, Xingren 3 qian, Sheng Cao 3 qian.