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General Treatment Principle: In spring and summer, sweating therapy is appropriate. When inducing sweat, it is desirable to have uniform perspiration from the hands and feet, appearing as a slight moisture, lasting for about the time it takes to eat one meal; this is optimal. One must not allow excessive sweating like a flowing stream. If the pathogen is not resolved, sweating may be repeated. However, excessive sweating will inevitably lead to Yang collapse; in cases of Yang deficiency, repeated sweating is contraindicated.

When taking herbal decoctions to induce sweat, stop once the condition improves (Zhong Bing), without necessarily finishing the entire dose. Whenever sweating is indicated but no decoction is available, pills or powders may be used, with the resolution marked by sweating. However, their efficacy is inferior to decoctions tailored to specific syndromes.

In Taiyang disease, if exterior symptoms persist and the pulse is floating and weak, sweating should be used to resolve the exterior. If the pulse is floating and rapid, sweating may be employed. In Yangming disease, if the pulse is slow, there is profuse sweating, and slight aversion to cold, the exterior remains unresolved, and sweating is permissible.

Regarding the query: If the pulse is floating and large, and the patient reports only constipation, using purgatives would be a major error. If constipation is due to excess, sweating can return fluids to the stomach, resolving the issue. Why? Because a floating pulse indicates the pathogen is in the exterior, requiring sweating. In Shanghan, if the pulse is not wiry and tight but weak, thirst may occur. If treated with fire therapy, delirium may ensue. Weakness with fever and a floating pulse requires exterior resolution through sweating.

Patients with irritability and heat who feel relief after sweating indicate improvement. Similar to malaria, fever occurring at Ding-shi (3-5 PM) belongs to Yangming disease. A floating and deficient pulse indicates the need for sweating.

Chronic spontaneous sweating occurs because Ying Qi is harmonious, but Wei Qi does not harmonize with Ying Qi. Ying circulates within the vessels, while Wei circulates outside. Re-inducing sweating restores harmony between Ying and Wei.

If internal organs are healthy but intermittent fever and spontaneous sweating persist, this indicates disharmony of Wei Qi. Sweating before the onset of fever resolves the condition.

In Taiyang disease, if heat binds to the Bladder causing manic behavior, spontaneous bleeding may resolve it. If exterior symptoms remain, interior attack is contraindicated; exterior resolution must precede interior treatment.

In Taiyin disease, a floating pulse permits sweating.

In Shanghan, if there is constipation for six to seven days with headache and fever, Chengqi Tang may be given. If urine is clear (or stool is green), the pathology is in the exterior, not the interior, and sweating is required. Headache may lead to epistaxis.

For diarrhea with abdominal fullness and body pain, warm the interior first, then treat the exterior. After diarrhea, if body pain persists but bowel movements normalize, urgently treat the exterior.

Taiyang disease with headache, fever, sweating, and aversion to wind/cold is Taiyang Wind Strike syndrome. The pulse is floating on the superficial layer and weak on the deep layer. Superficial floating indicates spontaneous heat generation; deep weakness indicates spontaneous sweating. Symptoms include shivering aversion to cold, chilly aversion to wind, mild fever, nasal congestion, and dry retching. This is caused by weak Ying Qi and strong Wei Qi. To rescue from pathogenic wind, Guizhi Tang is indicated.

After purgation in Taiyang disease, if Qi rushes upward, it belongs to Guizhi Tang syndrome.

If initial administration of Guizhi Tang causes increased irritability without resolution, puncture Fengchi (GB20) and Fengfu (DU16) first, then administer Guizhi Tang.

If needle-induced sweating leads to cold invasion at the puncture site, forming red nodules, Ben Tun (Rolling Gas) may occur, with Qi rushing from the lower abdomen to the heart. Moxibustion on each nodule (one moxa cone) followed by Guizhi Jia Gui Tang is indicated.

If purgation in Taiyang disease causes slight wheezing, indicating unresolved exterior, Guizhi Jia Houpo Zizi Tang is suitable.

A floating and tight pulse indicates Wind and Cold respectively. Wind injures Wei Qi, Cold injures Ying Qi. Disharmony of Ying and Wei causes joint pain; sweating is indicated. In Shanghan, failure to sweat with a floating-tight pulse may lead to epistaxis.

Yangming disease with a floating pulse, anhidrosis, and wheezing requires sweating.

Taiyang disease with a floating-tight pulse, anhidrosis, fever, and body pain lasting eight to nine days, with persistent exterior symptoms, requires repeated sweating. After medication, slight relief may occur with irritability and eye closure; severe cases may resolve via epistaxis due to intense Yang Qi. Floating pulse indicates exterior pathology requiring sweating.

Taiyang disease with headache, fever, body/lower back/joint pain, aversion to wind, anhidrosis, and wheezing belongs to Mahuang Tang syndrome.

Combined Taiyang and Yangming disease with wheezing and chest fullness belongs to Mahuang Tang syndrome.

Yangming Wind Strike with only a floating pulse and no other symptoms belongs to Mahuang Tang syndrome.

Taiyang disease lasting ten days with only a floating pulse belongs to Mahuang Tang syndrome.

Shaoyin disease presenting with fever and deep pulse initially is treated with Mahuang Fuzi Xixin Tang.

Shaoyin disease presenting after two to three days is treated with Mahuang Fuzi Gancao Tang for mild sweating, as there are no interior symptoms.

Taiyang Wind Strike with floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and irritability is treated with Da Qing Long Tang. If the pulse is weak with sweating and aversion to wind, it is contraindicated; misuse leads to cold limbs, muscle twitching, and adverse effects.

Shanghan with floating-slow pulse, body heaviness without pain, fluctuating severity, and no Shaoyin signs may be treated with Da Qing Long Tang.

Shanghan with unresolved exterior and fluid retention in the Heart Lower Jiao, causing dry retching, fever, cough/wheezing, thirst, diarrhea, dysphagia, urinary difficulty, and hypogastric fullness, is treated with Xiao Qing Long Tang. If drinking the medicine causes thirst, it indicates cold dispersal and impending resolution.

Taiyang disease with stiff neck/back, sweating, and aversion to wind is treated with Guizhi Jia Gegen Tang. With anhidrosis and aversion to wind, Gegen Tang is indicated.

Combined Taiyang and Yangming disease with spontaneous diarrhea but no vomiting is treated with Gegen Tang. With vomiting but no diarrhea, Gegen Jia Banxia Tang is indicated.

If Guizhi syndrome is incorrectly purged, leading to unceasing diarrhea with a rapid pulse (indicating unresolved exterior) and wheezing with sweating, Ge Gen Huang Qin Huang Lian Tang is suitable.

Yangming Wind Strike with wiry-floating-large pulse, shortness of breath, abdominal fullness, flank/heart pain, nasal dryness, anhidrosis, lethargy, jaundice, difficult urination, tidal fever, and hiccups requires acupuncture. If exterior symptoms persist beyond ten days with a continuing floating pulse, Xiao Chai Hu Tang is given.

Taiyang disease after ten days with floating-thin pulse and lethargy indicates resolved exterior. If chest/flank fullness persists, Xiao Chai Hu Tang is indicated.

Wind strike with alternating chills and fever, or Shanghan after five to six days with chest/flank fullness, poor appetite, irritability, vomiting, or variations like thirst, abdominal pain, hypochondriac hardness, palpitations, urinary difficulty, or cough, is treated with Xiao Chai Hu Tang.

Shanghan after four to five days with fever, aversion to wind, neck stiffness, flank fullness, warm extremities, and thirst is treated with Xiao Chai Hu Tang.

Shanghan after six to seven days with mild fever/chills, joint pain, slight vomiting, and sub-diaphragmatic constraint, with unresolved exterior symptoms, is treated with Chai Hu Gui Zhi Tang.

Floating pulse with urinary difficulty, mild fever, and polydipsia is treated with Wu Ling San to promote urination and induce sweating.

Zhang Zhongjing’s works are profound. For sweating syndromes: Taiyang Wind Strike uses Guizhi Tang; with wheezing, Guizhi Jia Houpo Zizi Tang; stiff neck with sweating/aversion to wind, Guizhi Jia Gegen Tang; malaria-like episodes 2-3 times daily, Guizhi Mahuang Ge Ban Tang; twice daily, Guizhi Er Mahuang Yi Tang; weak pulse, Guizhi Er Yuebi Yi Tang. For Wind Strike with stiff neck/anhydrosis/aversion to wind, Gegen Tang; with wheezing, Mahuang Tang; with irritability, Da Qing Long Tang. Treatments vary by pathogen severity.

Huoren Shu: Shanghan with floating-tight pulse, rigid body, aversion to cold, anhidrosis, more cold than heat, pale face, back pain, and cold extremities is Mahuang syndrome. Floating-slow pulse, large cun/weak chi, spontaneous sweating, fever, headache, aversion to wind/cold, more heat than cold, bright face, irritability, warm extremities is Guizhi syndrome. Shanghan has tight/rough pulse; Wind Strike has floating-slow pulse. Shanghan has anhidrosis; Wind Strike has sweating. Shanghan fears cold but not wind; Wind Strike fears wind but not cold. Generally, Taiyang disease features floating pulse, fever, aversion to wind/cold. Fear of cold occurs without wind; fear of wind occurs with wind. All six meridians can suffer Wind Strike or Shanghan with different presentations. Taiyang: floating pulse, sweating = Wind Strike; tight pulse, anhidrosis = Shanghan. Yangming: hunger = Wind Strike; anorexia = Shanghan. Shaoyang: deafness, red eyes, chest fullness/irritability = Wind Strike; bitter taste, dry throat, vertigo = Shanghan. Three Yin Wind Strike presents with limb pain similar to Shanghan. Shanghan showing Wind Pulse (floating-slow) with more cold than heat, no irritability, cold extremities is actually Wind Strike. Wind Strike showing Shanghan Pulse (floating-tight) with fever, irritability, warm extremities is actually Shanghan. (Wind Strike with Cold signs or Shanghan with Wind signs indicates Da Qing Long Tang syndrome.)

Lou Quanshan: Exterior release in Shanghan must follow symptom severity. Zhang Zhongjing used sweating (Mahuang Tang, Guizhi Tang, Da Qing Long Tang) and harmonizing (Xiao Qing Long Tang, Guizhi Mahuang Ge Ban Tang, Bai Hu Tang, Guizhi Er Yuebi Yi Tang, Chai Hu Gui Zhi). Later physicians failed to distinguish pathogen depth and drug potency, leading to death or chronic illness due to excessive sweating/purging damaging Yin/Yang and Qi/Blood. For mild cases, harmonization (regulating Ying/Wei, promoting fluids) is preferred. Danxi used Buzhong Yiqi Tang; Haicang used Shenzhu Tang, Baizhu Tang, Jiwei Qianghuo Tang. These harmonize rather than deplete true Qi.

For Shanghan where medicines fail to induce sweat, use steaming method: burn wood, sweep ashes, sprinkle water, spread mulberry sand, mulberry leaves, peach leaves, and bran (1 cun thick), place mat, lie patient, cover warmly until sweat reaches soles, then apply powder. Mulberry sand and peach/cypress leaves are most effective.

For common cold with headache, aversion to cold, rigidity: boil scallion white (with root), ginger, tangerine peel, tea, and plum. Steam head, drink hot, cover for sweat. Alternatively, scallion and fermented soybean tea, or Perilla/Scallion/Ginger tea. Single Perilla decoction also works. Another method: Seven-Boil Water (boil water in red-hot pot seven times), drink hot, cover for sweat.

For anhidrosis, foot soaking: Sea clam powder, Aconite (each 2 liang), Pangolin scales (3 liang) made into pills, placed on soles, covered with scallion, wrapped, soak feet in hot water up to knees in warm room, replenish heat until sweating occurs. Do once every 1-2 days until cured.