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Shang Han Lun · Treatise on Cold Damage
12. Jueyin Illness · Pulses, Signs and Treatment
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326. Jueyin illness has wasting-thirst, qi surging upward against the Heart, painful heat in the Heart region, hunger without desire to eat, and vomiting of roundworms after eating. Purging causes unceasing diarrhea.
327. In Jueyin wind-strike, a slightly floating pulse indicates approaching recovery; absence of floating means recovery has not occurred.
328. The time when Jueyin illness tends to resolve runs from the chou period through the beginning of mao.
329. In Jueyin illness with thirst and a wish to drink, give water in small amounts, and recovery follows.
330. Conditions with reversal cold of all four limbs must not be purged. The same applies to people with deficiency.
331. In cold damage, if reversal cold comes first and fever afterward, diarrhea must stop spontaneously. If reversal cold appears again, diarrhea returns.
332. In cold damage, fever initially lasts six days, but reversal cold then lasts nine days with diarrhea. Someone with reversal cold and diarrhea should be unable to eat. An unexpected ability to eat raises concern for elimination of the middle. Feed the person suobing noodles; if fever does not develop, Stomach qi is still present and recovery must follow. The concern is that sudden heat may emerge and then depart again.
Examine the pulse three days later. If heat continues, expect recovery at midnight of the following day. Originally fever lasted six days and reversal cold nine; renewed fever for three days added to the earlier six makes nine, matching the reversal cold. Hence recovery is expected at midnight of the following day. If examination after three days finds a rapid pulse and heat does not cease, heat qi is excessive and abscesses and pus must form.
333. In cold damage with a slow pulse on the sixth or seventh day, Huangqin Tang may instead be given to clear heat. A slow pulse signifies cold; further removing heat with Huangqin Tang should make the abdomen cold and eating impossible. If eating is unexpectedly possible, this is called elimination of the middle and must be fatal.
334. In cold damage with reversal cold first and fever afterward, diarrhea must stop spontaneously. If sweating and throat pain occur instead, throat impediment develops. Fever without sweating must bring spontaneous cessation of diarrhea. If diarrhea does not stop, pus and blood must be passed. When pus and blood are passed, throat impediment does not occur.
335. In cold damage, reversal cold from the first or second through the fourth or fifth day must be followed by fever. Earlier heat must be followed by reversal cold. Deep reversal cold means deep heat; slight reversal cold means slight heat. Reversal cold that calls for purging, if instead treated with sweating, must produce red ulceration of the mouth.
336. In cold damage, reversal cold lasts five days and heat also five days. On the sixth day reversal cold should return; if it does not, spontaneous recovery follows. Reversal cold ultimately does not exceed five days. Because heat lasted five days, spontaneous recovery is recognized.
337. Reversal occurs when yin and yang qi fail to connect in proper succession. Reversal means counterflow cold of the hands and feet.
338. In cold damage with a faint pulse and reversal cold, by the seventh or eighth day the skin may be cold and the person restless without a moment's peace. This is visceral reversal, not roundworm reversal. In roundworm reversal, worms should be vomited. If the person is quiet but intermittently agitated, the viscera are cold. Worms rise into the diaphragm and cause agitation, which soon stops again. Eating produces vomiting and renewed agitation because the worms emerge on sensing the odor of food; the person frequently vomits worms spontaneously. Wumei Wan governs roundworm reversal and also longstanding diarrhea.
Wumei Wan formula:
Wumei, three hundred fruits; Xixin, six liang; Ganjiang, ten liang; Huanglian, sixteen liang; Fuzi, six liang, roasted and peeled; Danggui, four liang; Shujiao, four liang, made to sweat; Guizhi, six liang, outer bark removed; Renshen, six liang; Huangbo, six liang.
Pound and sift these ten ingredients separately, then combine. Soak Wumei overnight in bitter wine or vinegar, remove the stones and steam beneath five dou of rice. When the rice is cooked, pound the fruit into a mash and mix thoroughly with the other medicines. Put in a mortar with honey and pound two thousand times. Make pills the size of wutong seeds. Take ten pills with a drink before food, three times daily, gradually increasing to twenty pills. Avoid raw and cold foods, slippery foods, foul-smelling foods and similar things.
339. In cold damage with little heat and slight reversal cold, cold fingertips, quiet withdrawal, no desire to eat, agitation and restlessness, free white urination after several days means heat has been removed. A desire for food indicates recovery. If reversal cold and vomiting accompany distressing fullness of the chest and flanks, blood must later be passed.
340. The patient's hands and feet are reversely cold, and they say, 'I do not have chest binding.' Lower-abdominal fullness with pain on pressure means cold is bound in the Bladder and Guanyuan region.
341. In cold damage, four days of fever followed by only three days of reversal cold and then another four days of heat indicate approaching recovery: reversal cold is shorter and heat longer. If heat does not depart from the fourth through the seventh day, pus and blood must be passed.
342. In cold damage, four days of reversal cold followed by only three days of heat and then another five days of reversal cold mean the illness is advancing. Cold exceeds heat and yang qi retreats; hence the illness advances.
343. On the sixth or seventh day of cold damage, with a faint pulse, reversal cold of the hands and feet, agitation and restlessness, apply moxibustion to Jueyin. If the reversal cold does not reverse course, death follows.
344. Cold damage with fever, diarrhea, reversal counterflow and restlessness preventing lying down means death.
345. Cold damage with fever, very severe diarrhea and unceasing reversal cold means death.
346. On the sixth or seventh day of cold damage there was no diarrhea, but fever and diarrhea then appear. Unceasing sweating means death, because yin is present without yang.
347. On the fifth or sixth day of cold damage, absence of chest binding, a soft abdomen, a deficient pulse and renewed reversal cold forbid purging. Blood has been lost, and purging causes death.
348. Fever with reversal cold and diarrhea on the seventh day is difficult to treat.
349. In cold damage with a hurried pulse and reversal counterflow of the hands and feet, moxibustion may be applied.
350. In cold damage with a slippery pulse and reversal cold, heat is within. Baihu Tang governs.
351. Reversal cold of the hands and feet with a fine pulse on the verge of expiring is governed by Danggui Sini Tang.
352. If longstanding cold is present within, Danggui Sini Jia Wu Zhuyu Shengjiang Tang is appropriate.
Danggui Sini Tang formula:
Danggui, three liang; Guizhi, three liang, outer bark removed; Shaoyao, three liang; Xixin, three liang; Gancao, two liang, roasted; Tongcao, two liang; Dazao, twenty-five fruits, split—one method uses twelve fruits.
Boil these seven ingredients in eight sheng of water until three sheng remain. Remove the dregs and take one sheng warm, three times daily.
Danggui Sini Jia Wu Zhuyu Shengjiang Tang formula:
Danggui, three liang; Shaoyao, three liang; Gancao, two liang, roasted; Tongcao, two liang; Dazao, twenty-five fruits, split; Guizhi, three liang, outer bark removed; Xixin, three liang; Shengjiang, half a jin, sliced; Wu Zhuyu, two sheng.
Boil these nine ingredients in a mixture of six sheng of water and six sheng of clear wine until five sheng remain. Remove the dregs, divide, and take warm in five doses. One version uses four sheng each of water and wine.
353. After profuse sweating, persistent heat, internal contraction, painful limbs, diarrhea, reversal counterflow and aversion to cold are governed by Sini Tang.
354. Profuse sweating or severe diarrhea with reversal cold is governed by Sini Tang.
355. Reversal cold of the hands and feet with a suddenly tight pulse means harmful influence is bound in the chest. Fullness and agitation below the Heart, with hunger but inability to eat, locate the illness in the chest. Vomiting must be induced; Guadi San is appropriate.
356. In cold damage with reversal cold and palpitations below the Heart, first treat water by giving Fuling Gancao Tang, then treat the reversal cold. Otherwise water soaks into the Stomach and must cause diarrhea.
357. On the sixth or seventh day of cold damage, after drastic purging, a deep, slow cun pulse, reversal of the hands and feet, absence of the lower-region pulse, obstruction of the throat, spitting of pus and blood, and unceasing diarrhea are difficult to treat. Mahuang Shengma Tang governs.
Mahuang Shengma Tang formula:
Mahuang, two and a half liang, nodes removed; Shengma, one liang and one fen; Danggui, one liang and one fen; Zhimu, eighteen zhu; Huangqin, eighteen zhu; Weirui, eighteen zhu—one version gives Changpu; Shaoyao, six zhu; Tianmendong, six zhu, core removed; Guizhi, six zhu, outer bark removed; Fuling, six zhu; Gancao, six zhu, roasted; Shigao, six zhu, crushed and wrapped in cloth; Baizhu, six zhu; Ganjiang, six zhu.
For these fourteen ingredients, first boil Mahuang in one dou of water for one or two boils and skim off the foam. Add the other ingredients and boil until three sheng remain. Remove the dregs, divide, and take warm in three doses, allowing an interval about as long as cooking three dou of rice between doses, until finished. Sweating brings recovery.
358. On the fourth or fifth day of cold damage, abdominal pain with qi turning and tending downward toward the lower abdomen indicates that spontaneous diarrhea is approaching.
359. In cold damage with original cold diarrhea, if the physician again induces vomiting and purging, cold obstruction forms and vomiting and diarrhea become still more adverse. If food is vomited as soon as it enters the mouth, Ganjiang Huangqin Huanglian Renshen Tang governs.
Ganjiang Huangqin Huanglian Renshen Tang formula:
Ganjiang, Huangqin, Huanglian and Renshen, three liang each.
Boil these four ingredients in six sheng of water until two sheng remain. Remove the dregs, divide, and take warm in two doses.
360. Diarrhea with slight fever, thirst and a weak pulse is now approaching spontaneous recovery.
361. Diarrhea with a rapid pulse, slight fever and sweating is now approaching spontaneous recovery. If the pulse becomes tight again, the illness remains unresolved.
362. With diarrhea, reversal cold of the hands and feet and no pulse, apply moxibustion. If warmth does not return, the pulse does not return and slight panting appears instead, death follows. Shaoyin yielding to Fuyang is favorable.
363. In diarrhea, an unexpectedly floating, rapid cun pulse and a naturally rough chi pulse mean pus and blood must be passed.
364. In diarrhea with undigested grain, do not attack the exterior. Sweating must produce distention and fullness.
365. In diarrhea, a deep, wiry pulse indicates downward heaviness; a large pulse means diarrhea has not yet stopped; a faint, weak, rapid pulse means it is about to stop spontaneously. Even with fever, the person does not die.
366. In diarrhea with a deep, slow pulse, a slightly red face, slight bodily heat and undigested grain in the stool, clouded oppression followed by sweating must bring resolution. The patient must have slight reversal cold. This occurs because yang is borne on the face while the lower region is deficient.
367. Diarrhea with a rapid pulse and thirst is now approaching spontaneous recovery. If it does not improve, pus and blood must be passed because heat is present.
368. After diarrhea, the pulse may disappear and the hands and feet become reversely cold. If the pulse returns within a full day-and-night cycle and the hands and feet become warm, the person lives. If the pulse does not return, the person dies.
369. In cold damage with diarrhea more than ten times daily, an unexpectedly replete pulse means death.
370. Diarrhea with undigested grain, interior cold, exterior heat, sweating and reversal cold is governed by Tongmai Sini Tang.
371. Heat diarrhea with downward heaviness is governed by Baitouweng Tang.
Baitouweng Tang formula:
Baitouweng, two liang; Huangbo, three liang; Huanglian, three liang; Qinpi, three liang.
Boil these four ingredients in seven sheng of water until two sheng remain. Remove the dregs and take one sheng warm. If recovery does not occur, take another sheng.
372. For diarrhea with abdominal distention and fullness and bodily pain, first warm the interior, then attack the exterior. Sini Tang is appropriate for warming the interior; Guizhi Tang for attacking the exterior.
373. A wish to drink water during diarrhea is due to heat. Baitouweng Tang governs.
374. Diarrhea with delirious speech indicates dry stool. Xiao Chengqi Tang is appropriate.
375. Renewed agitation after diarrhea, with the region below the Heart soft on pressure, is deficient agitation. Zhizi Chi Tang is appropriate.
376. If a person prone to vomiting has an abscess with pus, do not treat the vomiting. Once the pus is exhausted, spontaneous recovery follows.
377. Vomiting with a weak pulse, free urination and slight bodily heat becomes difficult to treat if reversal cold appears. Sini Tang governs.
378. Dry retching, vomiting of thin saliva and foam, and headache are governed by Wu Zhuyu Tang.
379. Vomiting with fever is governed by Xiao Chaihu Tang.
380. In cold damage, drastic vomiting and purging produce extreme deficiency. If profuse sweating then occurs, the person's external qi becomes constrained. Giving water again to induce further sweat causes hiccups, because the Stomach is cold.
381. In cold damage with hiccups and abdominal fullness, examine the front and rear passages to determine which is obstructed. Freeing that passage brings recovery.
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