Opening the chapter
Loading the text. Please wait.
Shang Han Lun · Treatise on Cold Damage
7. Taiyang Illness, Part III · Pulses, Signs and Treatment
Read in English. Switch to Original for word notes, or select text to ask a question.
Question: Illness may involve chest binding or visceral binding. What are their forms? Pain on pressure, a floating cun pulse and a deep guan pulse are called chest binding.
What is visceral binding?
Answer: It resembles chest binding, but eating and drinking remain normal and diarrhea occurs from time to time. The cun pulse is floating, while the guan pulse is small, fine, deep and tight. This is called visceral binding. A white, slippery tongue coating makes it difficult to treat.
Visceral binding has no yang presentation and no alternating chills and fever. The person is instead quiet. If the tongue coating is slippery, attacking treatment is forbidden.
If illness begins in yang but is instead purged, heat enters and produces chest binding. If it begins in yin but is instead purged, focal obstruction results. Chest binding forms because purging was done too early. In chest binding, the nape is also stiff, resembling soft jing spasm disorder. Purging brings harmony; Da Xianxiong Wan is appropriate.
Da Xianxiong Wan formula:
Dahuang, half a jin; Tinglizi, half a sheng, heated; Mangxiao, half a sheng; Xingren, half a sheng, skins and tips removed and heated.
Of these four ingredients, pound and sift two. Add Xingren and Mangxiao, grind together to a fatty paste and combine with the powder. Take one portion the size of a pellet. Separately pound Gansui to powder, using one qianbi; add two he of white honey and two sheng of water, and boil until one sheng remains. Take warm, all at once. Downward discharge occurs after one night. If it does not occur, take another dose; downward discharge is the criterion of effect. Follow the medicinal restrictions.
In a chest-binding presentation, a floating, large pulse forbids purging. Purging then causes death.
If all signs of chest binding are present and agitation and restlessness occur, death also follows.
In Taiyang illness, the pulse may be floating, stirring and rapid. Floating signifies wind, rapidity heat, stirring pain, and rapidity also deficiency, as the source states. Headache, fever, slight night sweating and unexpected aversion to cold mean that the exterior remains unresolved. If the physician instead purges, the stirring and rapid qualities change to slowness, with resistant pain inside the diaphragm. The Stomach becomes empty and deficient; guest qi disturbs the diaphragm, producing shortness of qi, restlessness, agitation and distressing vexation in the Heart region. Yang qi sinks inward, making the region below the Heart hard: this is chest binding. Da Xianxiong Tang governs. If chest binding does not form, but only the head sweats and sweat stops at the neck, with no sweat elsewhere and difficult urination, the body must turn yellow.
Da Xianxiong Tang formula:
Dahuang, six liang, outer covering removed; Mangxiao, one sheng; Gansui, one qian.
For these three ingredients, first boil Dahuang in six sheng of water until two sheng remain. Remove the dregs, add Mangxiao and boil once or twice. Add powdered Gansui and take one sheng warm. Once free diarrhea occurs, stop the remaining dose.
On the sixth or seventh day of cold damage, chest binding with heat repletion, a deep, tight pulse, and pain below the Heart that feels stone-hard on pressure is governed by Da Xianxiong Tang.
After more than ten days of cold damage, if heat is bound within and alternating chills and fever recur, give Da Chaihu Tang. If there is only chest binding without great heat, water is bound in the chest and flanks. With slight sweating only on the head, Da Xianxiong Tang governs.
In Taiyang illness, repeated sweating followed by purging, no bowel movement for five or six days, a dry tongue and thirst, slight tidal fever toward late afternoon, and hard fullness and pain extending from below the Heart to the lower abdomen, so painful that it cannot be approached, are governed by Da Xianxiong Tang.
Small chest-binding illness is located precisely below the Heart. With pain on pressure and a floating, slippery pulse, Xiao Xianxiong Tang governs.
Xiao Xianxiong Tang formula:
Huanglian, one liang; Banxia, half a sheng, washed; Gualou fruit, one large fruit.
For these three ingredients, first boil Gualou in six sheng of water until three sheng remain and remove the dregs. Add the other ingredients and boil until two sheng remain. Remove the dregs, divide, and take warm in three doses.
On the second or third day of Taiyang illness, inability to lie down and a wish only to rise mean binding must be present below the Heart. A faint, weak pulse indicates an original component of cold. If purging is instead applied and the diarrhea stops, chest binding must form. If it has not stopped and purging is repeated on the fourth day, diarrhea accompanied by heat develops.
After purging Taiyang illness, a hurried pulse without chest binding indicates approaching resolution. A floating pulse means chest binding must form; a tight pulse means throat pain; a wiry pulse means tension of both flanks; a fine, rapid pulse means headache has not ceased; a deep, tight pulse means an inclination to vomit; a deep, slippery pulse means diarrhea accompanied by heat; a floating, slippery pulse means blood must be discharged downward.
141. Illness in yang should be resolved by sweating. If cold water is instead splashed or poured over the person, heat is forcibly checked and cannot depart. Agitation increases, gooseflesh arises, and the person wishes to drink yet is not actually thirsty. Give Wenge San; if there is no recovery, give Wuling San. For cold-repletion chest binding without heat signs, give what this passage calls Sanwu Xiao Xianxiong Tang; White Powder may also be taken. The supplied formula below is headed Sanwu Xiao Bai San, a name not silently substituted here.
Wenge San formula:
Wenge, five liang.
Powder this single ingredient. Mix one cunfangbi—the measure as written here—with five he of boiling water and take it. If bodily heat and gooseflesh remain unresolved and the person wishes to pull clothing over themselves, splashing or washing with water only traps heat more firmly so that it cannot depart. When sweating should occur but does not, agitation results. If sweating has already occurred but abdominal pain develops, give three liang of Shaoyao by the preceding method.
Sanwu Xiao Bai San formula:
Jiegeng, three fen; Badou, one fen, skin and core removed, heated black and ground to a fatty paste; Beimu, three fen.
Powder these three ingredients, add Badou and pound again in a mortar. Mix with plain rice drink and take. A robust person takes half a qianbi; reduce this for a frail person. If the illness is above the diaphragm, vomiting must occur; if below it, diarrhea must occur. If diarrhea does not occur, give one cup of hot gruel. If excessive diarrhea does not stop, give one cup of cold gruel.
142. In merged Taiyang and Shaoyang illness with stiffness and pain of the head and nape, possible dizziness and clouded oppression, occasional sensations resembling chest binding, and focal obstruction and hardness below the Heart, needle the first space at Dazhui, Feishu and Ganshu. Take care not to induce sweating: it produces delirious speech and a wiry pulse. If delirious speech does not stop for five days, needle Qimen.
143. A woman with wind-strike has fever and aversion to cold just as menstruation begins. After seven or eight days, heat departs, the pulse becomes slow and the body cool, but fullness below the chest and flanks resembles chest binding, with delirious speech. This is heat entering the blood chamber. Needle Qimen, selecting treatment according to the repletion present.
144. A woman with wind-strike develops continuing chills and fever on the seventh or eighth day, with timed attacks, just as menstruation stops. This is heat entering the blood chamber. Blood must bind, producing a nüe-like condition with periodic attacks. Xiao Chaihu Tang governs.
145. A woman with cold damage and fever just as menstruation begins is clear-minded by day but speaks deliriously at dusk, as if seeing spirits. This is heat entering the blood chamber. Do not disturb Stomach qi or the upper two burners; spontaneous recovery must follow.
146. On the sixth or seventh day of cold damage, with fever, slight aversion to cold, distressing limb and joint pain, slight vomiting, supporting binding below the Heart and exterior signs not yet gone, Chaihu Guizhi Tang governs.
Chaihu Guizhi Tang formula:
Guizhi, one and a half liang, outer bark removed; Shaoyao, one and a half liang; Huangqin, one and a half liang; Renshen, one and a half liang; Gancao, one liang, roasted; Banxia, two and a half he, washed; Dazao, six fruits, split; Shengjiang, one and a half liang, sliced; Chaihu, four liang.
Boil these nine ingredients in seven sheng of water until three sheng remain. Remove the dregs and take one sheng warm.
The original note says: Renshen Tang is made by the Guizhi method, adding Banxia, Chaihu and Huangqin; it also follows the Chaihu method. Renshen is now used, and a half preparation is made. This supplied explanatory wording is retained without reconstructing a different recipe.
147. On the fifth or sixth day of cold damage, after sweating followed by purging, fullness and slight binding of the chest and flanks, difficult urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and vexation mean the illness is unresolved. Chaihu Guizhi Ganjiang Tang governs.
Chaihu Guizhi Ganjiang Tang formula:
Chaihu, half a jin; Guizhi, three liang, outer bark removed; Ganjiang, two liang; Gualougen, four liang; Huangqin, three liang; Muli, two liang, heated; Gancao, two liang, roasted.
Boil these seven ingredients in one dou and two sheng of water until six sheng remain. Remove the dregs and decoct again until three sheng remain. Take one sheng warm, three times daily. The first dose causes slight agitation; after another dose, sweating occurs and recovery follows.
148. On the fifth or sixth day of cold damage, sweating on the head, slight aversion to cold, cold hands and feet, fullness below the Heart, no desire to eat, hard stool and a fine pulse indicate slight yang binding. There must be an exterior component as well as an interior one. A deep pulse also indicates the interior, while sweating indicates faint yang. Pure yin binding could not retain exterior signs: everything would have entered the interior. Here the illness is half inside and half outside. Even with a deep, tight pulse, it must not be called Shaoyin illness, because yin cannot have sweating; sweating on the head shows that this is not Shaoyin. Xiao Chaihu Tang may be given. If resolution remains incomplete, passage of stool brings it to an end.
149. On the fifth or sixth day of cold damage, vomiting and fever constitute a Chaihu Tang presentation. If another medicine is used to purge but the Chaihu presentation remains, give Chaihu Tang again. Although purging has occurred, this does not amount to contrary treatment here. A steaming sensation and shaking must occur, followed by fever and sweating that bring resolution. If there is fullness below the Heart with hardness and pain, this is chest binding, governed by Da Xianxiong Tang. If there is fullness without pain, this is focal obstruction: Chaihu is unsuitable, and Banxia Xiexin Tang is appropriate.
Banxia Xiexin Tang formula:
Banxia, half a sheng, washed; Huangqin, Ganjiang, Renshen and Gancao roasted, three liang each; Huanglian, one liang; Dazao, twelve fruits, split.
Boil these seven ingredients in one dou of water until six sheng remain. Remove the dregs and decoct again until three sheng remain. Take one sheng warm, three times daily.
150. If merged Taiyang and Shaoyang illness is instead purged, chest binding forms, with hardness below the Heart, unceasing diarrhea, inability to take water or gruel, and vexation.
151. If a floating, tight pulse is followed by purging, tightness instead enters the interior and produces focal obstruction. It is soft on pressure: this is only qi focal obstruction.
152. In Taiyang wind-strike with diarrhea and counterflow vomiting, attacking treatment is permissible only after the exterior resolves. Damp sweating with periodic attacks, headache, focal obstruction, hardness and fullness below the Heart drawing into pain below the flanks, dry retching, shortness of qi, sweating and no aversion to cold mean the exterior is released but the interior is still disharmonious. Shizao Tang governs.
Shizao Tang formula:
Yuanhua, heated; Gansui; Daji.
Take equal parts of these three ingredients and pound each separately into powder. First boil ten plump Dazao fruits in one and a half sheng of water until eight he remain. Remove the dregs and add the medicinal powder. A robust person takes one qianbi; a frail person half a qian, as the two measures are written in the source. Take warm at dawn. If the illness remains after purging, take another dose the next day, increasing it by half a qian. After free diarrhea occurs, nourish oneself with thin rice gruel.
153. In Taiyang illness, the physician induces sweating and fever and aversion to cold follow. Purging is then applied, causing focal obstruction below the Heart. Exterior and interior are both deficient; yin and yang qi are exhausted together, leaving yin alone when yang is absent. Adding fire-needling causes agitation in the chest. A blue-green and yellow complexion with quivering skin is difficult to treat. A slightly yellow complexion with warm hands and feet is easy to resolve.
154. Focal obstruction below the Heart that is soft on pressure, with a floating pulse above the guan, is governed by Dahuang Huanglian Xiexin Tang.
Dahuang Huanglian Xiexin Tang formula:
Dahuang, two liang; Huanglian, one liang.
Steep these two ingredients briefly in two sheng of vigorously boiling water. Squeeze out and discard the dregs, divide, and take warm in two doses.
155. Focal obstruction below the Heart with additional aversion to cold and sweating is governed by Fuzi Xiexin Tang.
Fuzi Xiexin Tang formula:
Dahuang, two liang; Huanglian, one liang; Huangqin, one liang; Fuzi, one liang, roasted, peeled, broken up and separately decocted to obtain its liquid.
Of these four ingredients, cut the first three and steep briefly in two sheng of vigorously boiling water. Squeeze out and discard the dregs, add the Fuzi decoction, divide, and take warm in two doses. The supplied Fuzi amount is one liang.
156. Purging originally caused focal obstruction below the Heart. If Xiexin Tang is given but the obstruction remains, with thirst, dry mouth, agitation and difficult urination, Wuling San governs.
157. After cold damage resolves through sweating, disharmony in the Stomach, focal obstruction and hardness below the Heart, dry belching with the odor of food, water qi below the flanks, thunderous abdominal rumbling and diarrhea are governed by Shengjiang Xiexin Tang.
Shengjiang Xiexin Tang formula:
Shengjiang, four liang, sliced; Gancao, three liang, roasted; Renshen, three liang; Ganjiang, one liang; Huangqin, three liang; Banxia, half a sheng, washed; Huanglian, one liang; Dazao, twelve fruits, split.
Boil these eight ingredients in one dou of water until six sheng remain. Remove the dregs and decoct again until three sheng remain. Take one sheng warm, three times daily.
The original note for Fuzi Xiexin Tang says to add Fuzi. Banxia Xiexin Tang and Gancao Xiexin Tang have the same basic form and differ only in name. The original note for Shengjiang Xiexin Tang calls it Lizhong Renshen Huangcha Tang, removing Guizhi and Zhu and adding Huanglian; all follow the method of draining the Liver. The supplied name Huangcha and the reference to the Liver are retained rather than silently corrected.
158. In cold damage or wind-strike, if the physician instead purges, the person develops diarrhea dozens of times daily, with undigested grain, thunderous abdominal rumbling, focal obstruction, hardness and fullness below the Heart, dry retching, vexation and inability to settle. Seeing the focal obstruction, the physician thinks the illness is not fully removed and purges again, making it worse. This is not bound heat: the Stomach is deficient, and guest qi counters upward, producing hardness. Gancao Xiexin Tang governs.
Gancao Xiexin Tang formula:
Gancao, four liang, roasted; Huangqin, three liang; Banxia, half a sheng, washed; Dazao, twelve fruits, split; Huanglian, one liang; Ganjiang, three liang.
Boil these six ingredients in one dou of water until six sheng remain. Remove the dregs and decoct again until three sheng remain. Take one sheng warm, three times daily.
159. In cold damage, taking decoction is followed by unceasing diarrhea and focal obstruction and hardness below the Heart. After Xiexin Tang, another medicine is used to purge, but diarrhea does not stop. The physician gives Lizhong, making it still worse. Lizhong regulates the middle burner, whereas this diarrhea is in the lower burner. Chishizhi Yuyuliang Tang governs. If it still does not stop, promote urination.
Chishizhi Yuyuliang Tang formula:
Chishizhi, one jin, crushed; Taiyi Yuyuliang, one jin, crushed.
Boil these two ingredients in six sheng of water until two sheng remain. Remove the dregs, divide, and take warm in three doses.
160. In cold damage, sweating after vomiting and purging causes deficient agitation and a very faint pulse. By the eighth or ninth day, focal obstruction and hardness below the Heart, pain below the flanks, qi surging to the throat, dizziness and clouded oppression, and trembling movements of the channels and vessels may occur. If prolonged, this develops into wilting weakness.
161. After cold damage resolves following sweating, vomiting or purging, persistent focal obstruction and hardness below the Heart with unceasing belching are governed by Xuanfu Daizhe Tang.
Xuanfu Daizhe Tang formula:
Xuanfuhua, three liang; Renshen, two liang; Shengjiang, five liang; Daizhe, one liang; Gancao, three liang, roasted; Banxia, half a sheng, washed; Dazao, twelve fruits, split.
Boil these seven ingredients in one dou of water until six sheng remain. Remove the dregs and decoct again until three sheng remain. Take one sheng warm, three times daily.
162. After purging, Guizhi Tang must not be given again. With sweating and panting but no great heat, Mahuang Xingzi Gancao Shigao Tang may be given. The supplied formula name here uses Xingzi.
163. In Taiyang illness, repeated purging before exterior signs are removed causes diarrhea accompanied by heat. With unceasing diarrhea, focal obstruction and hardness below the Heart, and unresolved exterior and interior, Guizhi Renshen Tang governs.
Guizhi Renshen Tang formula:
Guizhi, four liang, cut separately; Gancao, four liang, roasted; Baizhu, three liang; Renshen, three liang; Ganjiang, three liang.
For these five ingredients, first boil the four other ingredients in nine sheng of water until five sheng remain. Add Guizhi and boil again until three sheng remain. Remove the dregs and take one sheng warm, twice by day and once at night.
164. After drastic purging followed by sweating in cold damage, focal obstruction below the Heart and aversion to cold mean that the exterior remains unresolved. Do not attack the obstruction. First release the exterior; only afterward may the obstruction be attacked. Guizhi Tang is appropriate for releasing the exterior, and Dahuang Huanglian Xiexin Tang for attacking the obstruction.
165. In cold damage with fever unresolved despite sweating, focal obstruction and hardness in the Heart region, vomiting and diarrhea, Da Chaihu Tang governs.
166. An illness resembles a Guizhi presentation, but there is no headache or stiff nape. The cun pulse is slightly floating, the chest has focal obstruction and hardness, and qi surges to the throat so that breathing is obstructed. This is cold in the chest. Vomiting should be induced; Guadi San is appropriate.
Guadi San formula:
Guadi, one fen, heated yellow; Chixiaodou, one fen.
Pound and sift the two ingredients separately into powder, then combine them. Take one qianbi. Cook one he of Xiangchi fermented soybeans in seven he of hot water into a thin gruel and remove the dregs. Mix the liquid with the powder and take it warm, all at once. If vomiting does not occur, increase the amount little by little. Stop once free vomiting occurs. Guadi San must not be given to those with blood loss or deficiency.
167. A longstanding focal obstruction below the flanks, connected beside the navel, with pain drawing into the lower abdomen and entering the genital sinews, is called visceral binding and means death.
168. In cold damage unresolved seven or eight days after vomiting or purging, with heat bound internally, heat in both exterior and interior, intermittent aversion to wind, great thirst, a dry tongue and agitation, and a wish to drink several sheng of water, Baihu Jia Renshen Tang governs.
169. In cold damage without great heat, but with dry mouth, thirst, vexation and slight aversion to cold on the back, Baihu Jia Renshen Tang governs.
170. In cold damage with a floating pulse, fever and no sweat, the exterior is unresolved and Baihu Tang must not be given. With thirst and a wish to drink but no exterior presentation, Baihu Jia Renshen Tang governs.
171. In merged Taiyang and Shaoyang illness with hardness below the Heart, stiff neck and nape, and dizziness, needle Dazhui, Feishu and Ganshu. Take care not to purge.
172. In combined Taiyang and Shaoyang illness with spontaneous diarrhea, give Huangqin Tang. If there is vomiting, Huangqin Jia Banxia Shengjiang Tang governs.
Huangqin Tang formula:
Huangqin, three liang; Shaoyao, two liang; Gancao, two liang, roasted; Dazao, twelve fruits, split.
Boil these four ingredients in one dou of water until three sheng remain. Remove the dregs and take one sheng warm, twice by day and once at night.
Huangqin Jia Banxia Shengjiang Tang formula:
Huangqin, three liang; Shaoyao, two liang; Gancao, two liang, roasted; Dazao, twelve fruits, split; Banxia, half a sheng, washed; Shengjiang, one and a half liang, sliced—one version gives three liang.
Boil these six ingredients in one dou of water until three sheng remain. Remove the dregs and take one sheng warm, twice by day and once at night.
173. In cold damage with heat in the chest, harmful qi in the Stomach, abdominal pain and an inclination to vomit, Huanglian Tang governs.
Huanglian Tang formula:
Huanglian, three liang; Gancao, three liang, roasted; Ganjiang, three liang; Guizhi, three liang, outer bark removed; Renshen, two liang; Banxia, half a sheng, washed; Dazao, twelve fruits, split.
Boil these seven ingredients in one dou of water until six sheng remain. Remove the dregs and take warm, three times by day and twice at night. No individual dose volume is supplied here.
174. On the eighth or ninth day of cold damage, wind and dampness contend, causing distressing bodily pain and inability to turn from side to side, without vomiting or thirst, and with a floating, deficient, rough pulse. Guizhi Fuzi Tang governs. If stool is hard and urination naturally free, Qu Gui Jia Baizhu Tang governs.
Guizhi Fuzi Tang formula:
Guizhi, four liang, outer bark removed; Fuzi, three pieces, roasted, peeled and broken up; Shengjiang, three liang, sliced; Dazao, twelve fruits, split; Gancao, two liang, roasted.
Boil these five ingredients in six sheng of water until two sheng remain. Remove the dregs, divide, and take warm in three doses.
Qu Gui Jia Baizhu Tang formula:
Fuzi, three pieces, roasted, peeled and broken up; Baizhu, four liang; Shengjiang, three liang, sliced; Gancao, two liang, roasted; Dazao, twelve fruits, split.
Boil these five ingredients in six sheng of water until two sheng remain. Remove the dregs, divide, and take warm in three doses. After the first dose, the body feels numb. Take the next dose after about half a day. When all three doses are finished, the person may feel clouded oppression; do not regard this as surprising. Fuzi and Zhu both travel inside the skin to expel water qi that has not yet been removed, producing this effect. The method calls for adding four liang of Gui.
This is originally one formula with two methods: remove Gui when stool is hard and urination free; add Gui when stool is not hard and urination difficult. The supplied comment warns that three Fuzi may be too much, and that weak people and women who have recently given birth should take a reduced amount.
175. Wind and dampness contend, causing distressing pain in bones and joints, pulling pain that prevents flexion and extension, and worse pain when the area is approached. With sweating, shortness of qi, difficult urination, aversion to wind, unwillingness to remove clothing, and possibly slight bodily swelling, Gancao Fuzi Tang governs.
Gancao Fuzi Tang formula:
Gancao, two liang, roasted; Fuzi, two pieces, roasted, peeled and broken up; Baizhu, two liang; Guizhi, four liang, outer bark removed.
Boil these four ingredients in six sheng of water until three sheng remain. Remove the dregs and take one sheng warm, three times daily. Obtaining a slight sweat at first brings resolution. If the person can eat and sweating stops but agitation returns, take five he for the next dose. If one sheng is feared excessive, six or seven he should be used initially. These differing dose instructions are retained as supplied.
176. In cold damage with a floating, slippery pulse, there is heat at the exterior and cold in the interior, as stated in this copy. Baihu Tang governs.
Baihu Tang formula:
Zhimu, six liang; Shigao, one jin, crushed; Gancao, two liang, roasted; Jingmi rice, six he.
Boil these four ingredients in one dou of water until the rice is cooked and the decoction complete. Remove the dregs and take one sheng warm, three times daily.
177. In cold damage with bound and interrupted pulses and throbbing palpitations of the Heart, Zhi Gancao Tang governs.
Zhi Gancao Tang formula:
Gancao, four liang, roasted; Shengjiang, three liang, sliced; Renshen, two liang; Guizhi, three liang, outer bark removed; Sheng Dihuang, one jin, washed with wine; Ejiao, two liang; Maimendong, half a jin, core removed; Maren, half a sheng; Dazao, thirty fruits, split.
For these nine ingredients, first boil the eight other ingredients in seven sheng of clear wine and eight sheng of water until three sheng remain. Remove the dregs, add Ejiao and melt it completely. Take one sheng warm, three times daily. Another name is Fumai Tang.
178. A pulse that arrives relaxed under pressure, occasionally stops once and then returns, is called bound. The text also describes a pulse that arrives with movement, stops in its course, returns slightly rapid, and has a returning movement within it: this is called bound and belongs to yin. A pulse that arrives with movement, stops in its course and cannot return by itself, then moves again, is called interrupted and belongs to yin. A person with this pulse must be difficult to treat. The closely overlapping descriptions are retained without imposing a new rhythm classification.
Use ← / → or swipe left or right to change chapters