典藏书目

Radix Puerariae (Ge Gen) four liang, Radix Ephedrae (Ma Huang) [devoid of nodes] three liang, Ramulus Cinnamomi (Gui Zhi) two liang, Radix Paeoniae Albae (Bai Shao) two liang, Radix Glycyrrhizae (Zhi Gan Cao) [roasted] two liang, Rhizoma Zingiberis Recens (Sheng Jiang) [sliced] three liang, Fructus Jujubae (Da Zao) [split open] twelve pieces.

The above seven ingredients are coarsely crushed. Decoct with ten dou of water, first boiling Radix Ephedrae and Radix Puerariae until the volume reduces by two dou, skim off the foam, then add the remaining herbs. Boil to obtain three sheng of decoction. Take one sheng warm. After ingestion, cover with blankets to induce a slight sweat. There is no need to drink hot porridge. Other dietary regimens and contraindications follow the method of Guizhi Tang (Cinnamon Twig Decoction).

To Ge Gen Tang (Kudzu Root Decoction), add Banxia (Pinelliae Rhizoma) half sheng. All other procedures remain according to the method of Ge Gen Tang.

[Formula Analysis]
This formula consists of Guizhi Tang (Cinnamon Twig Decoction) supplemented with Radix Ephedrae and Radix Puerariae. Radix Ephedrae assists Ramulus Cinnamomi to induce sweating and release the Ying and Wei pathogens in the Taiyang (Greater Yang) channel. Radix Puerariae, as the sovereign herb combined with Ramulus Cinnamomi, resolves pathogenic factors on the muscle layer of the Yangming (Yang Brightness) channel. It is named after Radix Pueraria rather than being called Guizhi Tang plus Radix Ephedra and Radix Pueraria because the emphasis lies on the Yangming channel, as vomiting and diarrhea often belong to Yangming disorders. When both Taiyang and Yangming exterior syndromes are urgent, if not taken warm and covered to induce sweat, the exterior pathogens will not be easily resolved. If there is vomiting or diarrhea, the interior harmony is already lost; even if hot porridge is consumed, the Stomach cannot transport essence to the skin and hair. Therefore, drinking hot porridge is unnecessary.

[Collected Commentaries]
Ke Qin stated: Li Gao designated Radix Pueraria as a herb for the Yangming channel. Jiegu said: "If the pathogen has not entered the Yangming, it should not be taken immediately." Did these two scholars fail to read Zhang Zhongjing's works? In essence, Radix Pueraria and Ramulus Cinnamomi are agents that resolve the muscle layer and harmonize the interior. Thus, they can be used whether there is sweat or not, and whether there is diarrhea or not. This differs from Radix Ephedrae, which specializes in releasing the exterior.

Wang Hu stated: The *Waitai Mi Yao* asks: The classics state that diarrhea should not be treated with sweating methods, as sweating leads to abdominal distension. Why does this formula treat diarrhea while using sweating methods? The answer is: Diarrhea with clear undigested food in Shaoyin (Lesser Yin) disease indicates interior deficiency. If sweating is applied further, Spleen deficiency and distension occur. However, here the Taiyang disease has not yet ceased; symptoms such as headache and aversion to wind and cold persist at the exterior, and the pulse remains floating. The pathogen has transmitted to Yangming, presenting with thirst and fever, accompanied by diarrhea. It is necessary to use this formula to release the Taiyang exterior pathogen, as it contains Radix Pueraria to eliminate Yangming pathogens. Therefore, among various syndromes featuring fever with interior involvement and a floating pulse, this formula is most suitable.

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In concurrent diseases of Taiyang and Yangming, characterized by wheezing and chest fullness, purgation is contraindicated; Mahuang Tang (Ephedra Decoction) is indicated.

[Annotation]
In concurrent diseases of Taiyang and Yangming, without diarrhea or vomiting, it indicates that the interior Qi is solid and resistant to pathogenic invasion. Wheezing and chest fullness indicate that exterior pathogens are abundant, causing Qi stagnation between the chest and lungs. Since the pathogen resides in the high-level exterior and is not a Jie Xiong (chest binding) syndrome, purgation is contraindicated. Mahuang Tang (Ephedra Decoction) should be used to release the exterior and unblock the Lungs; the wheezing and fullness will resolve spontaneously.

[Collected Notes]
Yu Chang stated: In concurrent diseases of two channels, herbs from both channels should be used. How can Mahuang Tang (Ephedra Decoction) be used exclusively? Generally, when pathogens of Taiyang and Yangming combine and attack the Stomach, vomiting or diarrhea occurs, hence Ge Gen Tang (Kudzu Root Decoction) is used. Now, since the pathogen attacks the Lungs, resulting in wheezing and chest fullness, Radix Ephedrae and Semen Armeniacae Amarum (Xing Ren) are specific herbs for treating Lung Qi rebellion and wheezing.

Wei Litong stated: In concurrent diseases of two channels, symptoms manifest solely in the chest and lungs, with wheezing and fullness. This is caused by exterior pathogens of both channels. One must not mistakenly identify the chest and diaphragm as interior and recklessly apply purgative methods, such as Da Xian Xiong Tang (Major Chest Binding Decoction) or Xiao Xian Xiong Tang (Minor Chest Binding Decoction).

In concurrent diseases of Taiyang and Shaoyang (Lesser Yang), spontaneous diarrhea occurs; Huang Qin Tang (Scutellaria Decoction) is administered. If vomiting is present, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction with Added Pinellia and Fresh Ginger) is the primary treatment.

[Annotation]
Concurrent diseases of Taiyang and Shaoyang refer to the simultaneous appearance of Taiyang symptoms (fever, aversion to cold) and Shaoyang symptoms (alternating chills and fever). If exterior pathogens are abundant, causing vexation and pain in the limbs and joints, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used to resolve the exterior of both channels. Currently, with abundant interior heat causing spontaneous diarrhea, Huang Qin Tang (Scutellaria Decoction) should be used to clear heat and harmonize the interior. If vomiting occurs, adding Pinelliae Rhizoma (Ban Xia) and Rhizoma Zingiberis Recens (Sheng Jiang) incorporates a descending method within the clearing and harmonizing approach.

[Collected Notes]
Cheng Zhi stated: This discusses concurrent diseases of Taiyang and Shaoyang with diarrhea, indicating the suitability of the harmonizing method. Mentioning Taiyang implies residual exterior symptoms. However, the presence of diarrhea clarifies that interior heat has entered. Therefore, the exterior is not released, but the interior is cleared. Cheng Wuji stated: In concurrent diseases of Taiyang and Yangming, diarrhea indicates the pathogen is at the exterior, treated with Ge Gen Tang (Kudzu Root Decoction); in concurrent diseases of Yangming and Shaoyang, diarrhea indicates the pathogen is at the interior, treated with Chengqi Tang (Gastrointestinal Replenishment Decoctions). Here, in concurrent diseases of Taiyang and Shaoyang, diarrhea indicates the pathogen is in the half-exterior, half-interior region, where neither sweating nor purgation is appropriate. Hence, Huang Qin Tang (Scutellaria Decoction) and Bai Shao (White Peony Root) are used to harmonize. Vomiting results from pathogenic Qi rebelling upward. Therefore, Pinelliae Rhizoma (Ban Xia) and Rhizoma Zingiberis Recens (Sheng Jiang) are added to disperse rebellious Qi.

Wang Hu stated: When concurrent diseases of Taiyang and Shaoyang lead to diarrhea, it means the exterior cold pathogens have fully entered the interior and transformed into heat. Although the interior heat is abundant, it has not formed an excess pattern. Thus, Huang Qin Tang (Scutellaria Decoction) is used to clear interior heat, allowing the exterior pathogens to harmonize naturally. Consequently, for this condition, not only is Guizhi Tang (Cinnamon Twig Decoction) for Taiyang contraindicated, but also Chai Hu (Bupleuri Radix) formulas for Shaoyang are unnecessary.