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[Background Information]
Book: Zhengzhi Zhunsheng · Shanghan (Standard of Diagnosis and Treatment · Cold Damage)
Author: Wang Kentang
Dynasty: Ming
Chapter: Unresolved After Sweating, Vomiting, or Purging / Asthma
Category: Shanghan (Cold Damage)

[English Translation]

(Previous Formula Articles)
On the fifth or sixth day, after sweating has been applied followed by purging, if there is fullness in the chest and hypochondrium with slight binding, dysuria, thirst without vomiting, only sweating on the head, alternating chills and fever, and irritability, this indicates the pathogen has not yet resolved; use Chaihu Guijin Tang (Bupleurum and Cinnamon Twig Decoction).
After sweating, vomiting, or purging in Taiyang disease (Disease of the Taiyang Channel), if there is epigastric stuffiness and hardness with persistent belching that does not resolve, use Xuanfuzhe Shi Tang (Inula and Hematite Decoction).
In Taiyang disease, if sweating was first applied but the condition did not resolve, followed by purging, and the pulse remains floating, it indicates the pathogen is still in the exterior; exterior resolution is required using Guizhi Tang (Cinnamon Twig Decoction).
After sweating or purging, if the condition remains unresolved accompanied by irritability and insomnia, use Fuling Sini Tang (Poria and Counterflow to Yang Decoction).
After profuse sweating or severe diarrhea leading to cold extremities, use Sini Tang (Counterflow to Yang Decoction).
After purging followed by sweating, if there is irritability during the day preventing sleep but quietness at night, without vomiting or thirst, no exterior syndrome, a deep and faint pulse, and no significant heat in the body, use Ganjiang Fuzi Tang (Dried Ginger and Aconite Root Decoction).
After purging followed by sweating, the patient will likely experience tremors and aversion to cold with a faint and fine pulse; this indicates deficiency in both interior and exterior.
Shanghan (Cold Damage) originates from cold pathogens; subsequent vomiting or purging may cause food to be vomited immediately upon entry; use Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction).
After sweating, vomiting, or purging, deficiency leads to irritability and insomnia; if severe, with tossing and turning and profound mental restlessness, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
After sweating or purging, if there is irritability and heat with a sensation of obstruction in the chest, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
After vomiting or purging, if there is constipation for five to ten days, evening tidal fever, aversion to cold absent, muttering as if seeing ghosts, picking at bedclothes and bedsides, a string-taut pulse indicates survival, while a choppy pulse indicates death; if only fever and delirium are present, use Dachengqi Tang (Major Order the Qi Decoction).
After vomiting or purging, abdominal fullness indicates heat evil entering the stomach; use Weichengqi Tang (Minor Order the Qi Decoction).
After Taiyang disease is treated with vomiting or purging, slight irritability, frequent urination, and hard stool indicate the use of Xiaochengqi Tang (Lesser Order the Qi Decoction).
After vomiting or purging, if seven or eight days pass without resolution, heat binds in the interior with exterior and interior heat, occasional aversion to wind, extreme thirst, dry tongue, and desire to drink water, use Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
After vomiting or purging, if there is rebellious fullness in the epigastrium, qi rushing to the chest, dizziness, and a deep, tight pulse, further sweating will disturb the collaterals causing body tremors; use Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction).

Cheng Wuji's Commentary: The Lung governs Qi. Physical cold or drinking cold substances injures the Lung, causing Qi to reverse and ascend. Rapid breathing, noisy respiration, opening the mouth and raising shoulders, shaking the body, and rolling the abdomen constitute asthma (wheezing/dyspnea).
When pathogenic factors are in the exterior causing Qi stagnation leading to asthma, use Mahuang Tang (Ephedra Decoction) or Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Plus Magnolia Bark and Apricot Kernel Decoction).
When water-fluid retention attacks the Lung causing asthma, use Xiaoqinglong Tang (Minor Green Dragon Decoction).
After sweating, excessive water intake inevitably causes asthma; bathing with cold water also causes asthma. In Shanghan with water-fluid retention in the epigastrium, presenting with dry heaves, fever, cough, or asthma, use Xiaoqinglong Tang.
Excessive water intake after sweating causes asthma due to cold damaging the Lung; cold water bathing causes asthma due to physical cold damaging the Lung. Some use Xiaoqinglong Tang plus Xingren (Apricot Kernel) or Zhuling Tang (Polyporus Decoction).
In Shanghan with water-fluid retention in the epigastrium, coughing with slight asthma, fever, and no thirst: if thirst occurs after taking medicine, it indicates cold has departed and the disease is resolving; the original formula is Xiaoqinglong Tang.
For patients with chronic asthma and sweating, Guizhi Tang plus Houpo (Magnolia Bark) and Xingzi (Apricot Kernel) is preferable. (Taiyang disease governs Yang Qi; excessive Wind causes Qi stagnation leading to asthma. Guizhi Tang disperses Wind, while Houpo and Xingzi direct Qi downward.)
If Taiyang disease is mistakenly purged leading to slight asthma, it is because the exterior syndrome remains unresoved; treat with Guizhi Jia Houpo Xingzi Tang. (Profuse asthma after purging indicates severe interior deficiency and impending collapse of Righteous Qi; slight asthma indicates interior Qi rebellion with pathogen remaining in the exterior. Guizhi Tang resolves the exterior, while Houpo and Xingzi direct rebellious Qi downward.)

Guizhi Jia Houpo Xingzi Tang Formula
Guizhi (Cortex Cinnamomi, peeled), Shaoyao (Radix Paeoniae Rubra), Shengjiang (Rhizoma Zingiberis Recens, sliced, each 3 liang), Houpo (Cortex Magnoliae Officinalis, processed, peeled), Gancao (Radix Glycyrrhizae, processed, each 2 liang), Xingren (Semen Pruni Armeniacae, peeled and de-husked, 50 seeds), Dazao (Fructus Jujubae, 12 pieces, split). Seven ingredients. Boil in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm.

After sweating, do not use Guizhi Tang again. If there is sweating with asthma and no significant heat, Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be used. (Cheng Wuji notes: Post-sweating asthma should typically be treated with Guizhi Jia Houpo Xingzi Tang. If sweating exacerbates asthma, it indicates severe pathogenic congestion where Guizhi Tang cannot disperse; thus, Guizhi Tang is contraindicated. Significant heat indicates interior excess; absence of significant heat suggests exterior pathogen is severe. Use Ma Huang Xing Ren Gan Cao Shi Gao Tang to disperse the pathogen. Zhang Jingyue notes: Zhongjing often says "after sweating" implying exterior pathogens are fully resolved leaving only one syndrome. Here, sweating with asthma and no significant heat indicates residual upper Jiao pathogens requiring Ma Huang Xing Ren Gan Cao Shi Gao Tang. Guizhi Jia Houpo Xingzi Tang is for complete Guizhi syndrome with added asthma. The commentary claiming "sweating with asthma" implies severe congestion non-responsive to Guizhi Tang is erroneous. Furthermore, without significant heat or other signs, claiming severe exterior pathogen is inconsistent. Later comments on "post-purging" state that although sweating and purging differ, neither should damage Righteous Qi, implying consistency in principle. This reveals an error in the earlier post-sweating commentary due to lack of coordination.)
After purging, do not use Guizhi Tang. If there is sweating with asthma and no significant heat, Ma Huang Xing Ren Gan Cao Shi Gao Tang may be used. (Cheng Wuji notes: Similar to the previous article regarding post-sweating treatment. Although sweating and purging differ, neither damages Righteous Qi; since the pathogen transmission is similar, the same treatment applies, as stated in the Classics: "Whether after sweating, purging, or vomiting.")

Ma Huang Xing Ren Gan Cao Shi Gao Tang Formula
Mahuang (Herba Ephedrae, 4 liang, de-jointed), Xingren (Semen Pruni Armeniacae, 50 seeds, peeled and de-husked), Gancao (Radix Glycyrrhizae, processed, 2 liang), Shigao (Gypsum Fibrosum, 0.5 jin, crushed, wrapped in silk). Four ingredients. Boil in 7 sheng of water; first boil Mahuang to reduce by 2 sheng, remove foam, add remaining herbs, boil to obtain 2 sheng. Strain and take 1 sheng warm. (The Liver dislikes constraint and seeks sweetness to relax. Wind corresponds to the Liver; external Wind excess requires sweet agents to disperse.)

Taiyang Disease (Harmonizing Method): If a Guizhi syndrome is mistakenly purged, leading to continuous diarrhea and a rapid pulse indicating unresolved exterior, with asthma and sweating, use Gegen Qinlian Tang (Kudzu Root, Scutellaria, and Coptis Decoction). (See Diarrhea section).

Yangming Disease: Wind Strike (Sweating Method): Bitter taste in mouth, dry throat, abdominal fullness, slight asthma, fever, aversion to cold, floating and tight pulse. If purged, abdominal fullness and dysuria occur; use Mahuang Tang.
Yangming disease with floating pulse, no sweat, and asthma: sweating resolves it; use Mahuang Tang.
Yangming Disease (Harmonizing Method): Floating and tight pulse, dry throat, bitter taste, abdominal fullness with asthma, fever, sweating, aversion to heat rather than cold, heavy body: use Baihu Tang (White Tiger Decoction). Wuling San (Five-Ingredient Powder with Poria) is also applicable for Shanghan on the fourth or fifth day with deep pulse and asthma/fullness. Deep pulse indicates interior; mistaken sweating causes fluid loss and difficult defecation, leading to exterior deficiency and interior excess, eventually causing delirium. Use Dachengqi Tang (Major Order the Qi Decoction).
Yangming disease with slow pulse, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness with asthma, and tidal fever indicates exterior resolution and readiness for interior attack. Continuous sweating on hands and feet indicates hardened stool; use Dachengqi Tang.
Patients with dysuria, intermittent difficulty in defecation, slight fever, asthma, vertigo, and inability to lie down have dried feces; use Dachengqi Tang.

Diagnosis:
After Shanghan vomiting/purging, constipation with tidal fever, progressing to unconsciousness, picking at bedclothes, slight asthma, fixed gaze, string-taut pulse indicates survival; choppy pulse indicates death.
Patients with dampness after purging, forehead sweating, slight asthma, and normal bowel/bladder function die. (See Body Pain discussion).
Shaoyin disease with high respiratory rate indicates death. (See Jue-Li and Sleepiness discussions).
Cold extremities, pulseless, unresponsive to moxibustion, with slight asthma indicates death. (See Jue-Li discussion).
Fixed gaze, delirium, asthma, and abdominal fullness indicate death. (See Delirium discussion).
Floating and洪 (surging) pulse, sweating like oil, wet hair, and incessant asthma indicate death of life force.

Appendix:
Living Methods:
Asthma with rapid breathing in Yin syndromes is treated with Fanyin Dan (Return to Yin Pill). Effective for cold extremities and rapid breathing. (See Yin Toxin section).
Patients with slight thirst who drink excessively may develop fluid retention and epigastric binding, leading to fatal asthma; treat with Wuling San (Five-Ingredient Powder with Poria) or Xianxiong Wan (Chest-Breaking Pill). (See Thirst and Chest Binding sections).

Dai Yuanli's Commentary:
Asthma and cough are differentiated by Yin and Yang. Taiyang asthma/cough is discussed previously.
Shaoyang presents with cough but not asthma; presence of asthma excludes Shaoyang. For Shaoyang symptoms with asthma, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Bei Wuweizi (Schisandra Berry) and Ganjiang (Dried Ginger).
Yangming presents with asthma but not cough; presence of cough excludes proper Yangming. For Yangming asthma with tidal fever, use Dachengqi Tang.
Yin syndrome asthma occurs only in Shaoyin. Heavy limbs, pain, normal urine, loose stool with cough: Zhenwu Tang (True Warrior Decoction) minus Shaoyao, plus Bei Wuweizi and Ganjiang, plus Xixin (Asarum). This is Yin within Yin.
Cold extremities, abdominal pain, dysentery with heaviness, and cough: Sini Tang plus Bei Wuweizi and Ganjiang.
Diarrhea, vomiting, thirst, irritability, insomnia with cough: Zhuling Tang. This is Yang within Yin.
Yin asthma is critical; use Fanyin Dan.

Wu Kun's Commentary:
Exterior Cold causing asthma: floating/tight pulse, aversion to cold, body pain, no sweat: use Mahuang Tang to sweat.
Exterior Wind causing asthma: floating/relaxed pulse, aversion to wind, spontaneous sweating: use Guizhi Tang plus Houpo and Xingzi.
Yangming interior excess with constipation, abdominal fullness, shortness of breath, tidal fever, and asthma: Da Chaihu Tang plus Houpo and Xingzi, or Xiaochengqi Tang.
Yin syndrome Jue with deep/faint pulse, rapid breathing, asthma, no sweat: Sini Tang plus Wuweizi and Xingzi.
Deficiency pulse hidden, cold extremities with asthma: Wuweizi Tang.
Sudden exposure to Wind-Cold, floating pulse, no sweat, asthma: Su Shen Jiu Bao Tang.
Heat excess with phlegm, string-taut/rapid pulse, asthma (no sweating or purging): Xiaochaihu Tang plus Zhimu (Anemarrhena), Beimu (Fritillaria), Gualouren (Trichosanthes Seed). Add Zhike (Aurantii Fructus) and Jiegeng (Platycodon) for chest fullness; add Zhishi (Aurantii Fructus Immaturus) and Huanglian (Coptis) for epigastric fullness; add Zhimu and Shigao (Gypsum) for dry tongue/thirst.
Ancients state asthma is serious. Hua Tuo said: "Excess leads to asthma," meaning Lung Fire excess, not Lung Qi excess. Xiebai San clears Lung Fire. Xiexin Tang clears epigastric fullness. *Wei Sheng Bao Jian* states: Treat apparent excess as deficiency, as the body is deficient while pathogen is excess.

Wuweizi Tang (See Jue Section).

Su Shen Jiu Bao Tang
Sangbaipi (Cortex Mori Radicis), Gancao (Radix Glycyrrhizae), Dafupi (Pericarpium Arecae Catechu), Guangui (Cortex Cinnamomi Cassiae), Mahuang (Herba Ephedrae), Bohe (Herba Menthae), Chenpi (Pericarpium Citri Reticulatae), Zisu (Folium Perillae), Xingren (Semen Pruni Armeniacae), Shengjiang (Rhizoma Zingiberis Recens), Wumei (Fructus Mume). Boil in 2 zhong of water to 8 fen. Strain and drink.

Jiajian Xiebai San
Treats irritability, chest discomfort, upper asthma, dry mouth, or cough.
Sangbaipi (2 qian), Zhimu (Anemarrhena Rhizoma), Juhong (Pericarpium Citri Reticulatae Viride), Gualouren (Semen Trichosanthis), Huangqin (Radix Scutellariae), Beimu (Bulbus Fritillariae Cirrhosae), Jiegeng (Radix Platycodonis), Gancao (Radix Glycyrrhizae, each 1.5 qian), Digupi (Cortex Lycii Radicis, 1 qian). Decoct and take as before.