典藏书目

Guizhi Tang (Cinnamon Twig Decoction) variant: Guizhi (Cinnamon Twig) 3 qian, Shaoyao (White Peony Root) [roasted with wine] 2 qian, Gancao (Licorice Root) [honey-fried] 2 qian, Huangqin (Scutellaria Root) [stir-fried with wine] 3 qian, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube Fruit) [split open] 2 pieces.
Decoct the above ingredients in water, remove the dregs, and take warm at any time, twice or three times a day. If Ganjiang (Dried Ginger) is added to this formula, it is named Yindan Tang (Yin Dawn Decoction).

Gancao (Licorice Root) [honey-fried] 4 liang, Ganjiang (Dried Ginger) [pao-processed] 2 liang.
Take the above two herbs, add 3 sheng of water, decoct to obtain 1.5 sheng of liquid, remove the dregs, and divide into two doses to be taken warm.

Shaoyao (White Peony Root) 4 liang, Gancao (Licorice Root) [honey-fried] 4 liang.
Take the above two herbs, add 3 sheng of water, decoct to obtain 1.5 sheng of liquid, remove the dregs, and divide into two doses to be taken warm.

@@@
After Shanghan (Cold Damage) has been treated with emesis or purgation, followed by sweating, deficiency vexation occurs, the pulse is extremely faint; after eight or nine days, epigastric fullness/stuffiness, pain below the costal region, qi rushing up to the throat, dizziness, and twitching/trembling of the meridians occur, which may eventually develop into Wei syndrome (flaccidity syndrome).
[Commentary]
The phrases "after eight or nine days, epigastric fullness/stuffiness, pain below the costal region, qi rushing up to the throat" do not align with the context and are likely due to misplaced bamboo slips. Commentators have thus provided forced and disjointed interpretations for these lines. In reality, this condition arises primarily from excessive sweating causing severe damage to body fluids. It should be treated with herbs that tonify Qi and blood, nourish tendons, and strengthen bones, and recovery may take about a year.
[Annotation]
In Shanghan, after emesis and purgation, administering sweat-inducing therapy again is inappropriate, leading to dual deficiency of Yang Qi and Yin fluids. Deficiency of Yin fluids causes deficiency vexation; deficiency of Yang Qi causes a faint pulse. When Yang Qi is weak and fails to ascend, dizziness and vertigo occur; when Yin fluids are deficient and fail to moisten, twitching and trembling of the meridians occur. Long-term depletion of Yang Qi and Yin fluids leads to loss of nourishment throughout the body, resulting in weakness and soft tendons, forming Wei syndrome (flaccidity syndrome).

@@@
In Shanghan, after six or seven days, following aggressive purgation, if the cun (inch) pulse is deep and slow, hands and feet are cold, the radial pulse at the lower position is imperceptible, there is throat discomfort, expectoration of pus and blood, and unceasing diarrhea, this is difficult to treat and should be managed with Mahuang Shengma Tang (Ephedra and Ma-Huang Decoction).
[Annotation]
In Shanghan, on the sixth or seventh day, as pathogenic factors transmit to the Jueyin (Lesser Yin) stage, characterized by alternating cold and heat, if the physician fails to carefully examine Yin and Yang and administers aggressive purgation, it results in a complicated syndrome of middle-cold and lower exhaustion. Middle-cold manifests as deep and slow cun pulses and cold extremities; lower exhaustion manifests as an imperceptible chi (cubit) pulse and unceasing diarrhea. Prior to purgation, latent heat existed in the Yang channels; after aggressive purgation, this heat sinks downward due to deficiency, invading the Jueyin channel. The Jueyin channel traverses the throat, passes through the diaphragm, and connects to the lungs, hence throat discomfort and expectoration of pus and blood. This is a syndrome of mixed Yin and Yang, and confused interior and exterior. Warming the lower part may exacerbate upper heat, while clearing upper heat may worsen middle cold. Zhang Zhongjing uses this formula to illustrate that mixed Yin and Yang syndromes are difficult to treat, requiring therapeutic strategies addressing both exterior/interior and upper/lower aspects. Since there is lower cold and upper heat, warming alone is difficult; since there is interior cold without sweating, releasing the exterior is still indicated. Thus, Mahuang Shengma Tang is used to release the exterior and harmonize the interior, clear the upper and warm the lower, treating according to the specific presentation.
[Collected Annotations]
Cheng Zhi states: This discusses cases of Jue-ni (cold limbs) caused by complications from erroneous purgation. In cases where Shanghan heat is intense, Yin is inevitably deficient. Although the sixth or seventh day is typically when transmission to the interior occurs, if exterior symptoms persist and aggressive purgation is administered, Yin is damaged and Yang collapses inward. Deep and slow cun pulses, cold extremities, and unceasing diarrhea indicate damage to Yang Qi and inward collapse of Qi; an imperceptible lower pulse, throat discomfort, and expectoration of pus and blood indicate damage to Yin fluids and internal pressure from heat. One error in purgation damages both Yang and Yin, making it difficult to treat. Mahuang Shengma Tang is given to raise Yang Qi, regulate the lower, clear heat, and nourish Yin. Generally, heat pathogens transmitted from exterior to interior should be expelled from interior to exterior, hence it is said: "recovery follows sweating."
Yu Chang states: A deep and slow cun pulse clearly indicates Yang Qi retreating into Yin, not merely Yang Qi deficiency. Therefore, despite cold extremities, an imperceptible lower pulse, and unceasing diarrhea, it cannot be considered a pure Yin syndrome without Yang. Moreover, throat discomfort and expectoration of pus and blood are signs of Yang pathogens clashing with Yin and regurgitating upward. Thus, Zhang Zhongjing specifically extracts Yang Qi from within the Yin syndrome, allowing the mixed pathogens to be resolved completely through sweating.