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Although the condition is slightly milder, it is still referred to as inducing sweating (inducing perspiration), but in reality, it merely employs medications that release the muscle layer (release the exterior through the muscle layer). Therefore, Zhang Zhongjing stated regarding Guizhi Tang syndrome: the patient should have a slight perspiration over half of the body, not profuse sweating like pouring water; otherwise, the pathogen will certainly not be eliminated. This indicates that for Wind-stroke (Taiyang Wind Strike), one must not induce excessive sweating. If sweating is excessive, it will disturb Ying Blood (nutritive blood), allowing pathogens to invade due to deficiency, thus failing to cure the disease. Cold damaging Ying (Nutritive level) means cold pathogens enter the Yin blood, and Ying Qi (nutritive qi) circulates within the vessels. When cold pathogens reside within the vessels, not only does Ying suffer from the pathogen, but the pathogen generates internally and merges with Wei Qi (defensive qi) to attack the exterior. Over time, it infiltrates into the bones. Hence, symptoms include absence of sweating, fever, dry teeth, and inner restlessness/oppression. Zhang Zhongjing uses Mahuang (Ephedrae Herba) to induce sweating, and combines it with Guizhi (Cinnamomi Ramulus) and Gancao (Glycyrrhizae Radix et Rhizoma) to assist dispersion, aiming to cleanse internal and external pathogens and treat disorders of Ying and Wei. Generally, both types of herbs induce sweating; however, Guizhi primarily disperses pathogens in the Wei level, while Mahuang treats both Ying and Wei levels, possessing inherent differences in depth. How can this be verified? In Article 19 of the Guizhi Tang conditions, Zhang Zhongjing states: "When a patient constantly sweats spontaneously, it is because Ying Qi is harmonious. In those with harmonious Ying Qi, the exterior is disharmonious because Wei Qi does not coordinate with Ying Qi. Since Ying Qi circulates within the vessels and Wei Qi outside, re-inducing sweating will restore harmony between Ying and Wei, leading to recovery; Guizhi Tang is indicated." In Article 47, he states: "Fever with sweating occurs because Ying is weak and Wei is strong, causing spontaneous sweating. To rescue from evil wind, Guizhi Tang is indicated." Thus, sweating in Wind-stroke indicates harmonious Ying but disharmonious Wei. Furthermore, in Volume 1, it is stated: "The Cun Kou pulse is floating and tight. Floating indicates Wind, tight indicates Cold. Wind damages Wei, Cold damages Ying. When both Ying and Wei are diseased, causing severe joint pain, sweating should be induced." This confirms that a floating-tight pulse in Cold Damage indicates simultaneous disease of Ying and Wei. The inclusion of Guizhi in Mahuang Tang reflects Zhang Zhongjing's intent. Regarding Da Qing Long Tang, although it treats Wind-strike presenting with Cold pulses or Cold damage presenting with Wind pulses, Zhang Zhongjing also warns: "If there is sweating and aversion to wind, it must not be taken; doing so may lead to limb reversal-cold (cold extremities) and twitching muscles." Therefore, the use of Da Qing Long Tang requires precise matching of signs and symptoms. Wang Shifu cautiously used only Gui Zhi Ma Huang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) for treatment.

Tao Hua noted: High heat with irritability and naturally warm hands/feet with a floating-tight pulse indicates Wind-strike showing Cold pulses. Lack of irritability, slight heat, slightly cold limbs, and a floating-slow pulse indicate Cold damage showing Wind pulses. Both represent simultaneous disease of Ying and Wei, ideally treated with Da Qing Long Tang. However, this formula is potent and dangerous; it should only be used when both Wind and Cold pathogens are severe and accompanied by irritability. Otherwise, Gui Zhi Ma Huang Ge Ban Tang is safer, and even better, Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) added with Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma) and Zhike (Aurantii Fructus).

Wen Fen Fang (Warm Powder Formula): Baizhu (Atractodis Rhizoma), Bencao (Ligustici Chuanxiong Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix) in equal parts. Grind into fine powder. Mix one tael of powder with three taels of rice flour. Apply to the whole body to stop sweating. If sweating is excessive, risking Yang collapse leading to reversal-cold, aversion to wind, irritability, and insomnia, this powder is suitable to arrest sweating.

In Taiyang disease, if there is stiffness and discomfort in the neck and back (KT KT), accompanied by spontaneous sweating and aversion to wind, Guijia Gegen Tang (Guizhi plus Puerariae Radix Decoction) is the primary treatment. (Note: The term KT KT refers to a state of constraint or rigidity, likened to being bound. It describes the rigid sensation in the neck. If interpreted as bird feathers, the pronunciation would differ, making it less accurate for describing rigidity. The subsequent Gegen Tang involves adding Mahuang and Gegen to Guizhi Tang for cases without sweating, using Mahuang to induce sweat. This case has sweating, so Mahuang is omitted, hence Guijia Gegen Tang. Cheng Wuji’s doubt was unnecessary and confusing; thus, this clarification is provided.)

Guijia Gegen Tang Prescription:
Gegen (Puerariae Radix) - 4 liang; Shaoyao (Paeoniae Radix Alba) - 2 liang; Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang; Shengjiang (Zingiberis Rhizoma Recens) - 3 liang, sliced; Guizhi (Cinnamomi Ramulus) - 2 liang, bark removed; Dazao (Jujubae Fructus) - 12 pieces, split. Boil these seven ingredients in 10 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm.

In Taiyang disease, if there is stiffness and discomfort in the neck and back (KT KT), absence of sweating, and aversion to wind, Gegen Tang (Puerariae Radix Decoction) is the primary treatment.

Gegen Tang Prescription:
Gegen (Puerariae Radix) - 4 liang; Mahuang (Ephedrae Herba) - 3 liang, nodes removed; Guizhi (Cinnamomi Ramulus) - 2 liang, bark removed; Shaoyao (Paeoniae Radix Alba) - 2 liang, sliced; Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang, honey-fried; Shengjiang (Zingiberis Rhizoma Recens) - 3 liang, sliced; Dazao (Jujubae Fructus) - 12 pieces, split. Coarsely crush these seven ingredients. Boil in 10 sheng of water. First boil Mahuang and Gegen, reduce by 2 sheng, skim off foam, then add remaining herbs. Boil to obtain 3 sheng. Strain and take 1 sheng warm. Cover with blankets to induce slight perspiration. No need to drink hot porridge afterwards. Rest and dietary restrictions follow Guizhi Tang guidelines. (Ben Cao states: "Light substances can remove excess," referring to Mahuang and Gegen. Here, they are added to Guizhi Tang for Wind-strike with exterior excess.)

In Taiyang disease, after eight or nine days, resembling malaria with fever and chills, where heat predominates over cold. If the patient does not vomit and bowel/bladder functions are relatively normal, and symptoms occur two or three times a day with a slightly slow pulse, recovery is imminent. If the pulse is faint and there is aversion to cold, it indicates deficiency of both Yin and Yang; do not induce sweating, purge, or emeticize. If the face appears flushed, the disease has not resolved because slight sweating could not be achieved, leading to itching. Gui Zhi Ma Huang Ge Ban Tang (Guizhi and Mahuang Half-Dose Decoction) is indicated. (Cheng Wuji notes: After eight or nine days, pathogens have circulated through the three Yang meridians and may transmit to the Yin. Transmission order: Day 3 completes Yang transmission; Day 4 enters Yin. If it doesn't enter Yin, it resolves. Day 6 completes Yin transmission. If unresolved, it repeats Yang transmission on Day 9. Malaria-like periodicity occurs. More cold indicates progression; more heat indicates retreat. As per classics: "Less Jue, more heat means cure; more cold, less heat means retreat." Current heat-dominant chills/fever indicates advancing Yang Qi and retreating pathogens. Normal digestion indicates interior harmony. Intermittent fever implies deep pathogens; daily occurrence implies shallow pathogens. A faint, slow pulse amidst frequent symptoms indicates waning pathogens, signaling impending cure. Faint pulse with aversion to cold indicates total deficiency of Yin/Yang and Exterior/Interior. Thus, harsh treatments are contraindicated. Flushed face despite deficiency suggests exterior pathogen remains. Slight sweating resolves it; lack thereof causes skin itching. Gui Zhi Ma Huang Ge Ban Tang induces slight sweating to dispel exterior pathogens. The first section describes current symptoms; the rest predicts complications. Divide into three parts: 'imminent cure' requires no treatment; 'vomiting' requires warming; the end describes slight sweating via alternating Mahuang and Guizhi actions.)

Gui Zhi Ma Huang Ge Ban Tang Prescription:
Guizhi (Cinnamomi Ramulus) - 1 liang 16 zhu, bark removed; Shaoyao (Paeoniae Radix Alba); Shengjiang (Zingiberis Rhizoma Recens), sliced; Gancao (Glycyrrhizae Radix et Rhizoma), honey-fried; Mahuang (Ephedrae Herba), nodes removed (all 1 liang each); Dazao (Jujubae Fructus) - 4 pieces, split; Xingren (Armeniacae Semen Amarum) - 24 kernels, soaked in hot water, skin and tips removed. Boil these seven ingredients in 5 sheng of water. First boil Mahuang for 1-2 boils, skim foam, add other herbs. Boil to obtain 1.8 sheng. Strain and take 0.6 sheng warm.

In Taiyang disease, if there is fever, aversion to cold, heat predominating over cold, and a faint pulse, this indicates "absence of Yang" (Yang deficiency). Do not induce sweating. Gui Zhi Er Yue Bi Yi Tang (Guizhi Double Yuebi One-Tenth Decoction) is indicated. (Previous case had faint-slow pulse, flushed face, itching, treated with slight sweating via Gui Zhi Ma Huang Ge Ban Tang, which was not yet weak. This case is weaker. Although slight sweating is needed, it is contraindicated here due to extreme weakness. However, since Taiyang exterior syndrome persists, some dispersing action is necessary, just not profuse sweating.)

Gui Zhi Er Yue Bi Yi Tang Prescription:
Guizhi (Cinnamomi Ramulus), bark removed; Shaoyao (Paeoniae Radix Alba); Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.75 qian); Shengjiang (Zingiberis Rhizoma Recens) - 1 liang 2 zhu, sliced; Dazao (Jujubae Fructus) - 4 pieces, split; Mahuang (Ephedrae Herba), nodes removed - 0.75 qian; Shigao (Gypsum Fibrosum) - 1 liang, crushed, wrapped in cloth. Coarsely crush these seven ingredients. Boil in 5 sheng of water. First boil Mahuang for 1-2 boils, skim foam, add other herbs. Boil to obtain 2 sheng. Strain and take 1 sheng warm. Originally, this formula was meant to be a combination of Yuebi Tang and Guizhi Tang in a 1:2 ratio, now combined into one prescription. The Stomach is the master of the twelve meridians; the Spleen manages water and grain, acting humbly like a maid. The Neijing states: "The Spleen transports fluids for the Stomach." Hence, it is called Yuebi (Excavating the Maid's Energy) to promote fluid circulation.

Generally, when Zhang Zhongjing mentions Taiyang disease, he refers to exterior syndromes with fever, aversion to cold, head/neck stiffness, and floating pulse. If the pulse is large and floating, it matches the syndrome, and sweating is appropriate. If the exterior syndrome presents with a faint pulse, it mismatches, so sweating is contraindicated. Harmonizing formulas like Ge Ban Tangs should be used instead.

If Taiyang Heatstroke (Zhong Shu) presents with fever, aversion to cold, faint pulse, cold extremities, and thirst, Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) is indicated. (See Heatstroke chapter for formula discussion.)

In Taiyang disease, after six or seven days, if exterior symptoms persist, the pulse becomes faint and sinking, there is no chest binding, but the patient experiences mania, it is because heat resides in the lower jiao. The lower abdomen should be hard and full, and urination is free. Evacuating blood clots will cure it. This is because Taiyang pathogens followed the meridians inward, causing blood stasis in the interior. Didang Tang (Mahuang, Mang Xiao, etc., specifically Di Dang Tang) is indicated. (See Blood Stasis chapter.) In Taiyang disease, if there is yellowing of the body, sinking-knotted pulse, hard lower abdomen, and difficult urination, it is not blood stasis. If urination is free and the patient resembles mania, blood stasis is confirmed. Didang Tang is also indicated. (See Blood Stasis chapter.) Generally, when Zhang Zhongjing mentions a sinking pulse in Taiyang syndrome, it refers to fever, aversion to cold, head/neck stiffness with a paradoxically sinking pulse. Combined with mania and lower abdominal hardness, it indicates blood stasis, treated with Didang Tang.

If accompanied by joint pain, difficult urination, and jaundice, it is Bi Syndrome caused by Dampness. (See Dampness chapter.)

If accompanied by sudden lockjaw and opisthotonos, it is Jing Disease (Spasm). If without sweating and with aversion to cold, it is Gang Jing (Rigid Spasm), treated with Gegen Tang. If with sweating and without aversion to cold, it is Rou Jing (Soft Spasm), treated with Gualou Guizhi Tang. (See Spasm chapter in Miscellaneous Diseases.)

If fever, headache, and a paradoxically sinking pulse occur, without itching but with body pain, the interior must be rescued first with Sini Tang (Four Reversals Decoction). In Shaoyin disease, if initial presentation includes fever and a sinking pulse, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) is indicated.

Zhao Sizhen commented: Carefully examining Taiyang fever and headache, the pulse should be floating, but is now sinking. Shaoyin sinking pulse should present without fever, but now there is fever. Zhang Zhongjing uses "paradoxical" (fan) to denote abnormality. Taiyang pulse resembles Shaoyin; Shaoyin disease resembles Taiyang. Treatments must differ. Analyzing the essence: both have sinking pulse and fever. With headache, it is Taiyang (Yang syndrome), expecting floating pulse. Failure to float indicates interior deficiency and chronic cold, causing Qi decline. Body pain necessitates rescuing the interior to restore Qi and expel pathogens; Ganjiang (Dried Ginger) and Sheng Fuzi (Raw Aconite) can induce sweating. If interior were not deficient/cold, pulse would be floating, fitting Taiyang Mahuang syndrome. Without headache, it is Shaoyin (Yin syndrome), expecting no fever. Fever indicates exterior cold trapped in pores, not yet interior. Use Mahuang/Xixin to release exterior heat, Fuzi to warm Shaoyin channels. If cold entered interior, exterior would lack heat, presenting with vomiting/diarrhea/cold extremities, requiring Sini Tang. Thus, superficial exterior heat paradox is lighter than Qi deficiency sinking pulse paradox. Sini Tang is heavier/more critical than Mahuang Fuzi Xixin Tang. Also, cooked Fuzi with Mahuang provides tonification within dispersion; raw Fuzi with Ganjiang provides dispersion within tonification. Zhang Zhongjing's subtlety is profound.

Mahuang Fuzi Xixin Tang Prescription:
Mahuang (Ephedrae Herba) - 2 liang, nodes removed; Xixin (Asari Radix et Rhizoma) - 2 liang; Fuzi (Aconiti Lateralis Radix Praeparata) - 1 bulb, processed, bark removed, broken into 8 pieces. Boil these three ingredients in 10 sheng of water. First boil Mahuang, reduce by 2 sheng, skim foam, add other herbs. Boil to obtain 3 sheng. Strain and take 1 sheng warm, twice daily.

Cheng Wuji noted: The Neijing states: "For cold invading the interior, treat with sweet-hot, assist with bitter-pungent." Use pungent to moisten. Mahuang's sweetness resolves Shaoyin cold; Xixin and Fuzi's pungency warms Shaoyin channels.

Zhao Sizhen detailed: Zhang Zhongjing's sweating formulas vary in weight. Shaoyin sweating formulas (Mahuang Fuzi Xixin vs. others) use Mahuang/Fuzi but differ in dosage/additions. Adding Xixin increases potency (pungent dispersion); adding Gancao decreases it (sweet moderation). Case 1: Shaoyin normally lacks heat; inducing sweating creates "paradoxical" fever. Fever indicates exterior pathogen needing sweating; sinking pulse indicates Yin needing warming. Fuzi warms, Mahuang disperses, Xixin aids sweating. This is heavy sweating. Case 2: No interior cold to warm, no interior heat to purge. Sinking pulse allows Shaoyin diagnosis; fever allows sweating. Onset 2-3 days implies shallow disease, milder than Case 1. Hence, "slight sweating" is prescribed by removing Xixin and adding Gancao. This is light sweating. Generally, "no aversion to cold" in Taiyang refers to fever, head/neck stiffness, floating pulse without aversion to cold. Thirst indicates Warm Disease; sweating indicates Soft Spasm.

In Cold Damage, after six/seven days, if there is slight fever, mild aversion to cold, joint pain, slight vomiting, epigastric fullness/constraint, and exterior symptoms persist, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is indicated. (Cheng Wuji notes: Day 6/7 is when pathogens transmit inward. Vomiting/epigastric constraint are interior signs, suggesting purging. But exterior signs persist, so purging is contraindicated. Use Chaihu Guizhi Tang to harmonize. "Zhi" means scattered/spread. "Zhi jie" refers to branch-like joints; "Zhi jie" in epigastrium means support/constraint. It should be viewed flexibly. Zhang Zhongjing said: "Exterior unresolved, epigastric oppression is not Pi, but Zhi Jie.")

Chaihu Jia Guizhi Tang Prescription:
Guizhi (Cinnamomi Ramulus), bark removed; Huangqin (Scutellariae Radix); Renshen (Ginseng Radix) (each 1.5 liang); Gancao (Glycyrrhizae Radix et Rhizoma), honey-fried (1 liang); Shaoyao (Paeoniae Radix Alba); Shengjiang (Zingiberis Rhizoma Recens), sliced (each 1.5 liang); Dazao (Jujubae Fructus) - 6 pieces, split; Chaihu (Bupleuri Radix) - 4 liang; Banxia (Pinelliae Rhizoma) - 2.5 he. Boil these nine ingredients in 7 sheng of water to obtain 3 sheng. Strain and take warm.

Generally, "exterior unresolved" refers to Taiyang fever, aversion to cold, head/neck stiffness, floating pulse. Even if Taiyang exterior syndrome exists with interior complications, it is termed "exterior unresolved" rather than specifying Taiyang. Epigastric constraint is treated with Chaihu Guizhi Tang.

Epigastric fluid retention with dry heaving and cough is treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). (See Cough chapter.) Hypochondriac pain, warm hands/feet, and thirst are treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). Epigastric fullness/stuffiness requires resolving the exterior first with Guizhi Tang, then treating the Pi (stuffiness) with Xi Xin Tang (Draining Heart Decoctions). (See Pi chapter.) Diarrhea with abdominal fullness/bloating requires warming the interior first with Sini Tang, then resolving the exterior with Guizhi Tang. (See Diarrhea chapter.)

Taiyang disease resolves between Si (9-11 AM) and Wei (1-3 PM). If unresolved, and both Yin and Yang pulses cease, the patient will first tremble/shiver, then sweat and resolve. If only the Yang pulse is faint, sweating resolves it. If only the Yin pulse is faint, purging resolves it. If purging is intended, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) is indicated. In Taiyang disease, if the pulse is floating-tight, with fever and no sweating, spontaneous nosebleed (xu) leads to resolution.

If Taiyang exterior symptoms are unresolved, do not purge. Purging is an error. To resolve the exterior, use Guizhi Tang. (Classic: Initiating purging before sweating is error; sweating first is correct.)

Hai Zang commented: Da, Xiao, and Tiao Wei Cheng Qi Tangs require complete resolution of exterior symptoms (floating pulse, headache, aversion to wind/cold) before use, followed by recurrence of fever, aversion to heat, delirium, and constipation. If floating-tight pulse, purging causes Chest Binding (Jie Xiong). If floating-slow pulse, purging causes Pi (Stuffiness).

Xu Shimowei recalled a relative with Cold Damage: fever, headache, no sweating, constipation for 4-5 days. The physician wanted to purge with Dahuang (Rhei Radix et Rhizoma) and Pomiao (Natrii Sulfas). Xu examined the patient: floating-slow pulse, severe aversion to wind in a closed room. He advised against purging, noting abdominal distension was absent and no other complaints existed. Following Zhang Zhongjing's principle, exterior symptoms must resolve before purging; otherwise, pathogens invade, causing Chest Binding or Heat Dysentery. Xu prescribed Gui Zhi Ma Huang Ge Ban Tang, followed by Xiao Chai Hu Tang. Sweating occurred, bowels moved, and the patient recovered.

Zhang Zhongjing stated: Cold Damage usually originates from Wind-Cold. Initially at the exterior, if it enters the interior, it does not dissipate. To attack it, resolve the exterior first, then purge. If exterior is resolved but interior excess remains (severe fullness, firmness, dry feces), purging is safe even after several days. If purging is inappropriate, interior deficiency allows heat invasion, causing complicated Heat Dysentery and irritability. Outcomes range from worsening to death. The original text had redundancies, which I corrected. Clearly, Wind-Cold entering the interior without dissipating implies dry feces or constipation. Purging is only safe when the pulse is not floating, there is no aversion to wind, and exterior symptoms have ceased. Constipation for 4-5 days is harmless if these conditions are met. Ignoring the exterior leads to Heat Dysentery. Gui Zhi and Mahuang are Zhang Zhongjing's primary exterior-resolving formulas, yet unskilled practitioners often misuse them fatally. The Yishui School replaced them with other drugs, claiming Zhang left out clever methods. I argue this shows the Yishui School's inadequacy compared to Zhang, albeit well-intentioned. Adhering to Chinese Medicine ensures safety. I present these examples of exterior treatment and combined tonification/dispersion for future scholars to study carefully.