Library

On the following day, during the follow-up consultation, the pulse had slightly risen, and symptoms were slightly reduced during sleep. Modifications should be made to the original prescription. By the fifth day, the scarlet fever rash appeared, accompanied by slight sweating. The rash was densely distributed over the entire body, thicker than that of other children with similar conditions. Although the rash persisted for five days, chest tightness remained unrelieved, and high fever did not subside. At this point, a heavy dose of Mahuang Xinggan Shigao Tang (Ephedra, Apricot Kernel, Glycyrrhiza, and Gypsum Decoction) was administered, leading to recovery. One month later, Mr. Gao contracted a mild wind-cold invasion, causing a recurrence of lethargy. His pulse became faint and fine, resembling the previous episode. At this time, I was confident in my diagnosis and did not fear complications. I prescribed a light dose of Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction), and he recovered after four days.

[Commentary] Mahuang (Ephedrae Herba) can open Lung Qi; Fuzi (Aconiti Lateralis Radix Praeparata) can strengthen the heart; Gancao (Glycyrrhizae Radix et Rhizoma) can stabilize the stomach and intestines. When combined, they form Mahuang Fuzi Gancao Tang, which treats deficiency-type patients who have contracted pathogenic factors but lack sufficient righteous Qi to expel them. If Gancao is replaced by Xixin (Asari Radix et Rhizoma) in this formula, it becomes Mahuang Fuzi Xixin Tang, which has greater potency. This is because Xixin has an aromatic nature capable of dispelling phlegm-fluids and eliminating turbid pathogens. As mentioned in this case, "faint and fine pulse with desire to sleep" is indeed a Shaoyin disease. If further complicated by fever, aversion to cold, and curling up while lying down, it also belongs to Shaoyin disease, differing only in severity and urgency.

However, the Japanese scholar Yamada insisted on adding "aversion to cold" to define it as "Shaoyin disease: faint and fine pulse, merely aversion to cold and desire to sleep." Is this approach acceptable? Cao Yingfu stated: "In my treatment of patients with faint and fine pulses and desire to sleep, I often achieve results using Sini Tang (Frigid Extremities Decoction). However, the child surnamed Gao treated by Jiang Sheng actually suffered from Taiyang exterior syndrome internalized into Shaoyin. Therefore, only Mahuang could be effective; Sini Tang alone would certainly not work. Sini Tang can only guide pathogenic factors from Shaoyin outward to the muscle layer; Dried Ginger (Shengjiang) and Roasted Licorice (Zhi Gancao) warm the Spleen and Stomach, which govern the muscles. If Dried Ginger is replaced by Mahuang, it can reach the Lungs directly from Shaoyin, opening the skin and hair, because the Lungs govern the skin and hair. Observing the three changes in his syndrome and treatment, yet always retaining Mahuang, his meticulousness is unparalleled. Moreover, although there was fever without aversion to cold, seemingly making Mahuang unnecessary, he resolutely used it, showing insight beyond reach. Since he wakes when called but sleeps naturally, indicating a state of obscuration, we can conclude this is not a Shaoyin disease but a Taiyang syndrome internalized. Furthermore, given the child's pure Yang constitution, such a Shaoyin disease should not occur."

Xiao Qing Long Tang Syndrome (Including Case Records of Disciples)

Zhang Zhiming, residing at Wuzhou Pharmacy, first consultation on October 18th. Due to frequent swimming baths during the hot summer, he developed coughing. Various medications proved ineffective, and symptoms worsened upon exposure to cold. This indicates fluid retention in the epigastrium (Heart region); Xiao Qing Long Tang is indicated.

Purified Mahuang (Ephedrae Herba) 1.5 qian, Chuan Guizhi (Cinnamomi Ramulus) 1.5 qian, Da Baishao (Paeoniae Radix Alba) 2 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian, Bei Xixin (Asari Radix et Rhizoma) 1.5 qian, Wuweizi (Schisandrae Fructus) 1.5 qian, Ganjiang (Zingiberis Rhizoma) 1.5 qian, Jiang Banxia (Pinelliae Tuber Preparatum) 3 qian.

[Commentary] Mr. Zhang Zhiming is a close friend of mine. He once suffered from carbuncles. After self-treatment with Western medicine exacerbated his condition, he sought my Traditional Chinese Medicine treatment and was cured. He then marveled at the efficacy of TCM. Since then, regardless of illness severity, he always consulted me. However, due to my busy schedule and frequent absences, we often missed each other. One morning, he visited again, saying, "Coughing is a minor ailment; why has TCM failed to cure it for so long?" He showed me his prescription, which included Qingshui Doujuan (Vigna angularis var. nipponensis), Dong Sangye (Mori Folium), Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Chi Ling (Poria cum Ligno), Zhiqiao (Aurantii Fructus), Jiegeng (Platycodonis Radix), Zhuru (Bambusae Caulis in Taeniam), Niubangzi (Arctii Fructus), Beimu (Fritillariae Bulbus), Gualoupi (Trichosanthis Pericarpium), Dongguazi (Trichosanthis Semen), and Pipaye (Loquafolium). I asked him, "Did you practice swimming in the summer?" He replied, "Yes." "Does your cough worsen with cold?" He replied, "Yes." I comforted him, saying, "This syndrome is very easy to treat; one dose will suffice. Do not worry." I wrote the above prescription for him. Two days later, he reported, "My cough has healed." I then provided the following prescription for conditioning.

Second consultation on October 20th. The cough has completely resolved, but slight wheezing remains, indicating residual pathogens. A light dose of San'ao Tang (Three Unblocking Decoction) is appropriate. Medicinal ingredients should be kept minimal.

Purified Mahuang 6 fen, Guang Xingren (Armeniacae Semen Amarum) 3 qian, Gancao 8 fen.

I have frequently used this formula to treat coughing with remarkable effects. However, one must carefully verify that the cough is caused by fluid retention before using it; it is not a universal remedy for all coughs. What is "fluid retention"? It refers to pathogenic factors associated with water. For example, Mr. Zhang acquired fluid retention through swimming (Case 1). Another example is consuming excessive fruits and cold drinks (Case 2). Another is traveling long distances exposed to rain and dew (Case 3). Another is having chronic phlegm-fluids aggravated by wind-cold (Case 4). For all such coughs caused by fluid retention, this decoction is highly effective. However, dosages vary based on severity. If fever is severe, with significant headache and aversion to cold, heavy doses of Mahuang and Guizhi are needed. If fever and aversion to cold are mild, reduce the dosage of Mahuang and Guizhi; even substituting Mahuang with Douchi (Sojae Semen Preparatum) and Guizhi with Zi Su Ye (Perillae Folium) is possible. If phlegm-fluid retention is severe, increase the dosage of Ganjiang, Xixin, Banxia, and Wuweizi, as these four herbs work synergistically like a single agent. My teacher often used up to 3 qian of Wuweizi; do not fear its sour astringent properties. If prolonged coughing leads to abdominal wall spasms and pain, increase Baishao and Gancao to soothe the area. Otherwise, use lightly or omit them, achieving similar efficacy. In summary, Xiao Qing Long Tang syndrome involves fluid retention internally and cough externally (often preceded by throat itching). Initially, the severity of exterior symptoms need not be strictly adhered to, nor must the tongue coating be limited to white and greasy. Other symptoms like wheezing, thirst, diarrhea, or choking are secondary. These are empirical observations and should not be rigidly bound by textbooks. This summer, many friends practiced swimming relentlessly, even in the rain. Within a month, nearly twenty developed coughs, all cured by modifications of this decoction.

Cao Yingfu stated: "Recently, I treated a Mrs. Ding suffering from ten-year-old chronic phlegm-fluids. Symptoms worsened with cold, featuring evening aversion to cold and wheezing. I used this formula: Mahuang 3 qian, Xixin 2 qian, Ganjiang 3 qian, Baizhu 3 qian, Banxia 2 qian, Guizhi 4 qian. After two doses, cough and wheezing slightly improved, but anhidrosis and aversion to cold persisted. I increased Mahuang by 2 qian (total 5 qian) and Xixin by 1 qian (total 3 qian), added Xingren 4 qian and Paofuzi 4 qian. Effectiveness awaited confirmation. However, Jiang Sheng’s success with light doses for Mr. Zhang was due to the acute nature of the new illness, unlike chronic conditions which are harder to resolve quickly."

Shegan Mahuang Tang Syndrome

Feng Shijue, July 21st. Coughing and airway obstruction began last early winter, requiring leaning forward to breathe, with expectoration of saliva and foam. He considered it phlegm-fluids. Current pulse is floating, wiry, and large; tongue coating is greasy. During喘息, water-like sounds are heard in the chest. Obstruction of Lung Qi is undeniable. Historically, Mahuang is considered a key herb for calming asthma. I propose using Shegan Mahuang Tang.

Shegan (Belamcandae Rhizoma) 4 qian, Purified Mahuang 3 qian, Kuandonghua (Farfarae Flos) 3 qian, Ziwan (Asteri Radix et Rhizoma) 3 qian, Bei Xixin 2 qian, Zhi Banxia 3 qian, Wuweizi 2 qian, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Hongzao (Jujubae Fructus) 7 pieces, Sheng Yuanzhi (Polygalae Radix) 4 qian, Jiegeng 5 qian. Note by Zhuochao: Recovered.

Cao Yingfu stated: "Mr. Zhang Dayuan previously suffered from chronic phlegm-fluids. Initially, he expectorated several liters of phlegm daily and nightly. Later, volume decreased, but he felt shortness of breath, especially at night when lying down, with a 'water-frog' sound in the throat persisting all night. Following the *Jinkui Yaolue*, I prescribed Shegan Mahuang Tang, resulting in quick recovery. Another patient, Mrs. Yang, suffered from chronic phlegm-wheezing triggered by washing clothes with cold water. During attacks, she heard a 'water-frog' sound in her throat. Shegan Mahuang Tang from *Jinkui Yaolue* was effective immediately. However, during severe attacks with phlegm obstructing the upper jiao and qi mechanism rising without descending, one should first administer Kongyan Dan (Control Phlegm Pill) in small doses to break up turbid phlegm, followed by Shegan Mahuang Tang. This is a modified approach."

Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang Syndrome

Ye Ruichu, Lihua Company Cosmetics Department, first consultation on February 17th. Cough persisted for four months, with frequent expectoration of saliva and foam. Pulse in the right three positions is wiry. The rebellious Qi should be directed downward.

Fuling (Poria) 3 qian, Sheng Gancao 1 qian, Wuweizi 1 qian, Ganjiang 1.5 qian, Xixin 1 qian, Zhi Banxia 4 qian, Guang Xingren 4 qian.

Second consultation on February 19th. After two doses of Ling Gan Wu Wei Jiang Xin Ban Xia Xing Ren Tang, cough slightly subsided, but saliva/foam remains abundant, and phlegm is difficult to expectorate. Add Jiegeng to the original formula.

Fuling 3 qian, Sheng Gancao 1 qian, Wuweizi 5 fen, Ganjiang 1 qian, Xixin 6 fen, Zhi Banxia 3 qian, Guang Xingren 4 qian, Jiegeng 4 qian.

[Commentary] Mr. Ye was formerly a colleague of Mr. Shi Huifu. He suffered from cough for four months and sought treatment from Mr. Shi. Mr. Shi declined, citing his limited medical experience. Subsequently, blood appeared in Mr. Ye's sputum, causing him to fearfully seek my treatment. After two doses of the first prescription, his condition improved. After the second prescription, he fully recovered.

Zao Jiao Wan Syndrome I

The *Jinkui Yaolue* states: "Coughing with airway obstruction, frequent expectoration of turbid material, ability only to sit, inability to lie down and sleep; Zao Jiao Wan (Soapberry Pill) is indicated." Regarding Shegan Mahuang Tang syndrome, it mentions "coughing with airway obstruction," implying that when not coughing, the Qi does not necessarily rush upward.

In contrast, this syndrome features continuous coughing and airway obstruction with unstoppable wheezing. The patient must pile six or seven layers of blankets behind their back to lean forward and sleep slightly. With fewer blankets, they suffer from nocturnal choking coughs, expectorating thick, yellow, sticky phlegm.

I witnessed this syndrome firsthand in the second year of the Xuantong era while caring for my late mother, Lady Xing. My mother usually enjoyed rich foods and had a smoking habit. The rich foods, heated by internal fire, transformed into turbid phlegm, causing Qi to rise upwards and blocking bowel and bladder movements. Reluctantly, I prepared Zao Jiao Wan for her. My eldest daughter, Zhaohua, decocted Jujube Paste Soup and administered it according to the method, four times day and night. Due to difficulty swallowing, we changed the pills to the size of mung beans, nine per dose. After four doses, spanning one full day, bowel and bladder movements resumed, allowing her to remove the blankets and sleep peacefully. A year later, I heard of an elderly woman surnamed Zhu in the north of our village who died after sitting uncomfortably for a month due to this syndrome—what a pity!

Cao Yingfu stated: "Mr. Huang Songtao, residing near Guangfu Temple in the city, ran a jade shop. His mother, around seventy years old, had a history of chronic phlegm-fluids that had been dormant for years, keeping her healthy. One autumn, she suddenly developed severe coughing with thick, sticky phlegm, pain radiating to the chest and flanks, and insomnia. Lying down worsened the cough and pain. Seeking my consultation on the third day, her pulse was wiry and rapid, breathing急促, no bowel movement for three days, fatigue, hoarseness, and inability to sustain breath. The condition was critical. I told her family, 'This is a severe phlegm-fluid syndrome, approaching collapse. Immediate rescue is necessary; any delay will be futile.' We urgently administered Kongyan Dan 1.5 qian, swallowed with Yuanmingfen (Mirabilite) 3 qian dissolved in boiling water. Soon, coughing decreased, and breathing stabilized. That evening, black stool passed, and she slept peacefully. By dawn, all symptoms vanished. Thus, I learned that Kongyan Dan is a modification of Shizao Tang, prepared for emergencies.

However, this case fundamentally matches Zao Jiao Wan syndrome: 'Coughing with airway obstruction, frequent expectoration of turbid material, ability only to sit, inability to lie down and sleep; Zao Jiao Wan is indicated.' But given the sudden onset and frailty, Zao Jiao Wan's slow action might be insufficient for emergency relief."

Zao Jiao Wan Syndrome II

Mr. Cao Dianguang, teacher of my disciple Lu Fuyao, a native of Wuhu, aged fifty, suffered from chronic phlegm-fluids for over ten years. Lu Fuyao could not cure him and sent him to me. Symptoms included hardness and fullness in the epigastrium, pain radiating to the chest and flanks, occasional wheezing, continuous coughing spells, frequent expectoration of extremely thick and congealed turbid phlegm, and inability to lie down during severe episodes. I diagnosed the wheezing and coughing as Zhi Yin (Fluids under the diaphragm), similar to "fluid retention in the epigastrium" in *Shanghan Lun* and "coughing with inability to lie down" in the *Phlegm-Fluids Chapter*. I prescribed Xiao Qing Long Tang, but it failed. Then I tried Shegan Mahuang Tang combined with Xiao Banxia Tang, also failing. The coughing and airway obstruction worsened, causing great anxiety. I considered attacking with Shizao Tang, but that is for Xuan Yin (Hanging Fluids in the chest/flanks). I thought of Tingli Dazao Xiefei Tang to drain the Lungs, but that is designed for Fei Zhang (Lung Distension) and Fei Yong (Lung Abscess). Neither was appropriate; administering them would only damage righteous Qi. Recalling his frequent expectoration of turbid phlegm and inability to lie down, it closely matched the Zao Jiao Wan syndrome in *Jinkui Yaolue*. I therefore used 4 liang of roasted Zao Jiao powder, mixed with Red Sugar instead of Jujube Paste, alternating with Shegan Mahuang Tang. After eight doses, phlegm cleared, wheezing stopped, and all symptoms resolved.

Zao Jiao Wan Syndrome III

I once suffered from phlegm-fluids myself, with wheezing, coughing, and expectoration of turbid phlegm radiating pain to the chest and flanks. I used four large Zao Jiao pods, roasted and powdered, placed in a bowl, mixed with Red Sugar, taken every other day. After four doses, I experienced diarrhea two to three times daily, expelling phlegm and feces together, sometimes entirely phlegm. After recovery, my body was significantly depleted. Thus, I realized Zao Jiao's purgative power is fierce, relying entirely on Jujube Paste for moderation. Gansui breaks water-fluids, Tingli drains lung distension/abscesses, and Zao Jiao dissolves sticky phlegm; these three are equally potent. Unfortunately, modern practitioners often view them as poisonous, discarding good medicines. Who is to blame? Cao Yingfu stated: "I treated Mr. Zhang Dayuan's wheezing and coughing with inability to lie down using Kongyan Dan, achieving a cure in one dose. In recent years, Mr. Dayuan developed a smoking habit, producing thick phlegm mixed with water, filling a large glass bottle overnight. All phlegm-fluid formulas were useless, and Zao Jiao ash provided no help. Perhaps when water-fluids are too severe, detergent methods are inappropriate, and when thick phlegm is present, warming herbs are ineffective."

Zao Jiao Wan Syndrome IV

Mr. Zheng Zuo, residing at Fangbang Road intersection, aged eighty-two, had a wet-phlegm constitution. He suffered from coughing and edema of the four limbs. The syndrome belonged to Yi Yin (Overflowing Fluids), originally requiring sweating and promoting urination. However, turbid phlegm blocked the chest and diaphragm, causing coughing with airway obstruction, inability to lie down, and very thick phlegm. In acute cases, treat the branch first; thus, Zao Jiao Wan should be used initially to descend phlegm from the chest/diaphragm, ensuring free bowel/bladder movements and restful sleep, marking a turning point. Currently, both pulses are Knotted and Intermittent (Jie Dai), which Zhang Zhongjing considered difficult to treat. With slight medicinal effect, discuss definitive treatment.

Native Zao Jiao, remove black skin, seeds, and strings, roast with butter, grind finely, honey-pill sized like Toona seeds. Take three pills per dose, three times daily. Send down with decoction of twenty black Jujubes, strained. Note by Zhuochao: The patient's family consulted other doctors, who advised against it due to the harshness of the formula. The outcome remains unknown.

Cao Yingfu stated: "Zao Jiao Wan treats sticky phlegm but cannot eliminate wet-phlegm. This is because Zao Jiao removes accumulated grease but not water-fluids. However, if phlegm-fluids cause persistent coughing/wheezing, there must be congealed phlegm in the Middle Jiao, so it can sometimes be effective. Only the use of Zao Jiao Ash was invented by my eldest daughter, Zhaohao. She suffered from phlegm-fluids, often vomiting thick phlegm, so she prepared and took it herself, curing her twenty-year phlegm-fluid root cause. I found it effective. When Mr. Cao Dianguang came from Wuhu with similar symptoms, I used it successfully.

[Commentary] The *Jinkui Yaolue* states: "Zao Jiao 8 liang, scrape off skin, roast with butter. Grind the single ingredient into powder, make honey-pills the size of Toona seeds, take three pills with Jujube Paste soup, three times daily, one at night. 'Scrape off skin' means removing the black outer layer. 'Roast with butter' means roasting over low heat until slightly yellow-brown, avoiding charcoal. 'Take three pills' means three per dose. 'Three times daily, one at night' means four doses total, twelve pills per day. Therefore, claims that the daily limit should not exceed three pills are incorrect. 'Jujube Paste soup' means pre-cooking Jujube flesh into paste, mixing with hot water to send down the pills. You Shi said: 'Drinking with Jujube Paste stabilizes the root.' This is correct. Elaborating, it prevents Zao Jiao from damaging precious stomach fluids while clearing turbid phlegm. My friend Wu Ningxuan explained this. My teacher substituted sugar for Jujube Paste for convenience, though its fluid-preserving power is inferior. Both are sweet, working similarly to Gancao (soothing intestines/generating fluids) and Yitang (building middle/stopping pain).

Summarizing the four cases: Case 1 (Lady Xing) took twelve Toona-sized pills on day one, thirty-six Mung-bean-sized pills on day two. Modern Toona-sized honey-pills yield about ten per qian; thus, twelve pills equal roughly one qian. Case 2 (Cao Dianguang) used 4 liang of Zao Jiao powder over eight days. Day 1: 1 liang powder; Day 2: Shegan Mahuang Tang; Days 3,5,7: same as Day 1; Days 4,6,8: same as Day 2. Daily intake of 1 liang is much higher than Case 1's 1 qian, but this was charred ash (weak potency) vs. roasted yellow substance (strong potency), inversely proportional to dosage. Also, disease severity differed. Case 3 (Teacher himself): Four large pods yielded half a small bowl. Testing one pod (unprocessed) weighed ~1 liang; two pods (charred/powdered) weighed ~6 qian. Four pods ≈ 1.2 liang, consistent with Case 2. Case 4 follows ancient methods like Case 1. Since this is a harsh drug, inexperienced doctors should start with 5 fen per dose and titrate upwards.

Furthermore, Zao Jiao is used for its ability to cleanse sticky phlegm, attributed to its saponin content. Western expectorants like Senega Root contain saponins, as do TCM herbs like Yuanzhi, Jiegeng, and Zao Jiao, known as stimulant expectorants. Thus, Zao Jiao can replace Senega Root. Eastern and Western theories converge here.

Cao Yingfu stated: "Alkaline herbs are best for resolving phlegm. For stuck phlegm, Jiegeng Gancao Tang works quickly due to Jiegeng's alkalinity. For phlegm stuck in the chest/diaphragm, alkaline Jiegeng draws it out ('Above, induce vomiting'). For sticky phlegm in the Middle Jiao, alkaline Zao Jiao drives it down ('Below, exhaust it'). Understanding this vertical differentiation helps grasp herbal applications."

Zexie Tang Syndrome

Guan You, residing at Nanyang Bridge Flower Field, September 1st. Coughing and expectorating foam for many years, intermittent dizziness and vertigo, vomiting during vertigo, dry stools, scanty urine, chest fullness upon coughing. This is Zhi Yin (Fluids under the diaphragm); Zexie Tang is indicated.

Zexie (Alismatis Rhizoma) 1.3 liang, Sheng Baizhu (Atractylodis Macrocephalae Rhizoma) 6 qian.

[Commentary] Patient Guan, a woman in her thirties, whose husband grew flowers in Dachang, Shanghai. She had chronic phlegm-fluids since youth, worsening in winter with severe vertigo preventing lying flat. Teacher prescribed this decoction. After one dose, urination flowed freely, and coughing greatly subsided. Five more doses allowed her to pass the winter safely. Next spring, upon cooling weather, relapse occurred.

Teacher repeated the formula, increasing Zexie to 2 liang and Baizhu to 1 liang, adding Cangzhu (Atractylodis Rhizoma) to assist. Condition resolved. Relapsed again that winter. Such stubborn chronic diseases are hard to eradicate! From Xiao Qing Long Tang to Zexie Tang, these five syndromes all treat phlegm-fluids. Xiao Qing Long Tang focuses on fluid retention in the epigastrium; Shegan Mahuang Tang on 'water-frog' sounds in the throat; Ling Gui Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang on expectorating saliva/foam; Zao Jiao Wan on sticky phlegm; Zexie Tang on vertigo. These are the general principles.

Guizhi Jia Longgu Muli Tang Syndrome I