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Shang Han Lun · Treatise on Cold Damage
6. Taiyang Illness, Part II · Pulses, Signs and Treatment
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In Taiyang illness with stiff, drawn-up nape and back, no sweating and aversion to wind, Gegen Tang governs.
Gegen Tang formula:
Gegen, four liang; Mahuang, three liang, nodes removed; Guizhi, two liang, outer bark removed; Shengjiang, three liang, sliced; Gancao, two liang, roasted; Shaoyao, two liang; Dazao, twelve fruits, split.
For these seven ingredients, first boil Mahuang and Gegen in one dou of water until the volume has decreased by six sheng, as stated in this copy. Skim off the white foam, add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm. Cover to obtain the slightest appearance of sweat.
In combined Taiyang and Yangming illness, spontaneous diarrhea must occur. Gegen Tang governs.
In combined Taiyang and Yangming illness, if there is no diarrhea but only vomiting, Gegen Jia Banxia Tang governs.
Gegen Jia Banxia Tang formula:
Gegen, four liang; Mahuang, three liang, nodes removed; Gancao, two liang, roasted; Shaoyao, two liang; Guizhi, two liang, outer bark removed; Shengjiang, two liang, sliced; Banxia, half a sheng, washed; Dazao, twelve fruits, split.
For these eight ingredients, first boil Gegen and Mahuang in one dou of water until the volume has decreased by two sheng. Skim off the white foam, add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm. Cover to obtain the slightest appearance of sweat.
In Taiyang illness with a Guizhi presentation, if the physician instead purges, unceasing diarrhea follows. A hurried pulse means the exterior remains unresolved. With panting and sweating, Gegen Huangqin Huanglian Tang governs.
Gegen Huangqin Huanglian Tang formula:
Gegen, half a jin; Gancao, two liang, roasted; Huangqin, three liang; Huanglian, three liang.
For these four ingredients, first boil Gegen in eight sheng of water until the volume has decreased by two sheng. Add the other ingredients and boil until two sheng remain. Remove the dregs, divide, and take warm in two doses.
In Taiyang illness with headache, fever, bodily pain, lower-back pain, aching bones and joints, aversion to wind, no sweating and panting, Mahuang Tang governs.
Mahuang Tang formula:
Mahuang, three liang, nodes removed; Guizhi, two liang, outer bark removed; Gancao, one liang, roasted; Xingren, seventy kernels, skins and tips removed.
For these four ingredients, first boil Mahuang in nine sheng of water until the volume has decreased by two sheng. Skim off the foam, add the other ingredients and boil until two and a half sheng remain. Remove the dregs and take eight he warm. Cover to obtain the slightest appearance of sweat; rice gruel need not be sipped. Other care follows the Guizhi method.
In combined Taiyang and Yangming illness with panting and chest fullness, purging is forbidden. Mahuang Tang is appropriate.
When Taiyang illness has lasted ten days or more, a floating, fine pulse and desire to lie down indicate that the exterior has resolved. If there is chest fullness and flank pain, give Xiao Chaihu Tang. If the pulse is only floating, give Mahuang Tang.
In Taiyang wind-strike with a floating, tight pulse, fever, aversion to cold, bodily pain, no sweating, agitation and restlessness, Da Qinglong Tang governs. If the pulse is faint and weak, with sweating and aversion to wind, it must not be taken. Taking it produces reversal counterflow, twitching sinews and quivering flesh: this is contrary treatment.
Da Qinglong Tang formula:
Mahuang, six liang, nodes removed; Guizhi, two liang, outer bark removed; Gancao, two liang, roasted; Xingren, forty kernels, skins and tips removed; Shengjiang, three liang, sliced; Dazao, ten fruits, split; Shigao, a piece the size of a hen's egg, crushed.
For these seven ingredients, first boil Mahuang in nine sheng of water until the volume has decreased by two sheng. Skim off the foam, add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm, obtaining the slightest appearance of sweat. If sweating is excessive, apply warm powder to the body. If one dose produces sweating, stop the remaining doses. Taking it again may cause excessive sweating and loss of yang, followed by deficiency, aversion to wind, agitation, restlessness and inability to sleep.
In cold damage with a floating, relaxed pulse, bodily heaviness without pain, occasional periods of lightness and no Shaoyin presentation, Da Qinglong Tang is used to induce sweating.
In cold damage with an unresolved exterior, water qi below the Heart, dry retching, fever and cough, possibly thirst, diarrhea, choking, difficult urination with lower-abdominal fullness, or panting, Xiao Qinglong Tang governs.
Xiao Qinglong Tang formula:
Mahuang with nodes removed, Shaoyao, Xixin, Ganjiang, Gancao roasted, and Guizhi with outer bark removed, three liang each; Wuweizi, half a sheng; Banxia, half a sheng, washed.
For these eight ingredients, first boil Mahuang in one dou of water until the volume has decreased by two sheng. Skim off the foam, add the other ingredients and reduce to three sheng. Remove the dregs and take one sheng warm.
If thirsty, remove Banxia and add three liang of Gualougen. For slight diarrhea, remove Mahuang and add Raohua in an amount the size of a hen's egg, heated until red. For choking, remove Mahuang and add one roasted Fuzi. For difficult urination and lower-abdominal fullness, remove Mahuang and add four liang of Fuling. For panting, remove Mahuang and add half a sheng of Xingren, skins and tips removed.
The supplied editorial comment says: Raohua does not treat diarrhea, while Mahuang governs panting. The present wording reverses these uses, and is suspected not to represent Zhongjing's intention.
In cold damage with water qi below the Heart, cough and slight panting, fever but no thirst, thirst appearing after the decoction indicates that cold has departed and resolution is approaching. Xiao Qinglong Tang governs.
In Taiyang illness with unresolved exterior signs and a floating, weak pulse, sweating should bring resolution. Guizhi Tang is appropriate.
Slight panting after purging Taiyang illness is due to the unresolved exterior. Guizhi Jia Houpo Xingzi Tang governs.
Guizhi Jia Houpo Xingzi Tang formula:
Guizhi, three liang, outer bark removed; Gancao, two liang, roasted; Shengjiang, three liang, sliced; Shaoyao, three liang; Dazao, twelve fruits, split; Houpo, two liang, roasted and outer covering removed; Xingren, fifty kernels, skins and tips removed.
Boil these seven ingredients in seven sheng of water over a low fire until three sheng remain. Remove the dregs and take one sheng warm. Cover to obtain the slightest appearance of sweat.
Taiyang illness with unresolved exterior signs must not be purged. Purging is contrary treatment. To resolve the exterior, Guizhi Tang is appropriate.
If Taiyang illness remains unresolved after sweating and is then purged, a floating pulse means it has not recovered. Floating signifies that the illness is outside; purging instead is why it has not recovered. The present floating pulse shows that it remains outside. Releasing the exterior is required for recovery; Guizhi Tang is appropriate.
In Taiyang illness with a floating, tight pulse, no sweat, fever and bodily pain that remain unresolved after eight or nine days, the exterior presentation is still present and sweating should be induced. After medicine brings slight relief, the person develops agitation and closes the eyes. In a severe case, nosebleeding must occur, after which the illness resolves. This happens because yang qi is heavy and congested. Mahuang Tang governs.
In Taiyang illness with a floating, tight pulse, fever and no sweat on the body, spontaneous nosebleeding brings recovery.
In merged illness of the two yang divisions, Taiyang illness is first treated with sweating, but sweat does not initially come through completely. The illness consequently turns to Yangming, with continuing slight spontaneous sweating and no aversion to cold. If the Taiyang presentation has not ceased, purging is forbidden and would be contrary treatment. Slight sweating may be induced instead.
If the face is uniformly red, yang qi is constrained at the exterior; release it by fumigation. Incomplete sweating is insufficient: constrained yang qi cannot escape. When sweat should emerge but does not, the person becomes restless and agitated and cannot identify where the pain lies—now in the abdomen, now in the limbs, with nothing found on pressure. There is shortness of qi and the person only sits. This is all due to incomplete sweating. Inducing sweating again brings recovery. How is incomplete sweating recognized? By the rough pulse.
A floating, rapid pulse ordinarily calls for sweating to bring recovery. If purging instead leads to bodily heaviness and palpitations, sweating must not be induced: spontaneous sweating should be allowed to bring resolution. The reason is a faint pulse at the chi, indicating internal deficiency. Only when exterior and interior become replete and fluids harmonize naturally will spontaneous sweating bring recovery.
A floating, tight pulse ordinarily means bodily pain, appropriately resolved by sweating. But if the chi pulse is slow, sweating must not be induced. How is this known? Nutritive qi is insufficient and blood is scant.
A floating pulse means the illness is at the exterior and sweating may be induced. Mahuang Tang is appropriate.
With a floating, rapid pulse, sweating may be induced. Mahuang Tang is appropriate.
Persistent spontaneous sweating in illness means nutritive qi is harmonious but the exterior is not: defensive qi is not harmonizing with nutritive qi. Nutritive qi travels within the vessels and defensive qi outside them. Induce sweating again; when nutritive and defensive qi harmonize, recovery follows. Guizhi Tang is appropriate.
If the patient's viscera have no other illness, but periodic fever and spontaneous sweating fail to resolve, defensive qi is disharmonious. Induce sweating before the expected time, and recovery follows. Guizhi Tang is appropriate.
In cold damage with a floating, tight pulse, failure to induce sweating leads to nosebleeding. Mahuang Tang governs.
In cold damage with no bowel movement for six or seven days, headache and heat, Chengqi Tang is given. If the urine is clear, however, this shows that the illness is not in the interior but remains at the exterior, and sweating is required. If headache persists, nosebleeding must occur. Guizhi Tang is appropriate.
If cold damage resolves after induced sweating but agitation returns after about half a day, with a floating, rapid pulse, sweating may be induced again. Guizhi Tang is appropriate.
In any illness, sweating, vomiting, purging or blood loss may cause loss of fluids. If yin and yang harmonize by themselves, spontaneous recovery must follow.
Difficult urination after drastic purging followed by sweating is due to loss of fluids. Do not treat it; when urination becomes free, spontaneous recovery must follow.
Purging followed by further sweating must produce shaking chills and a faint, fine pulse, because both interior and exterior have become deficient.
After purging followed by sweating, if daytime agitation and restlessness prevent sleep but the person is quiet at night, with no vomiting, no thirst, no exterior presentation, a deep, faint pulse and no great bodily heat, Ganjiang Fuzi Tang governs.
Ganjiang Fuzi Tang formula:
Ganjiang, one liang; Fuzi, one piece, used raw, peeled and cut into eight pieces.
Boil these two ingredients in three sheng of water until one sheng remains. Remove the dregs and take it all at once.
62. After induced sweating, if there is bodily pain and a deep, slow pulse, the newly augmented Guizhi formula, with an additional one liang each of Shaoyao and Shengjiang and three liang of Renshen, governs. The supplied clause retains its embedded number 62.
Guizhi Jia Shaoyao Shengjiang Ge Yi Liang Renshen San Liang Xinjia Tang formula:
Guizhi, three liang, outer bark removed; Shaoyao, four liang; Gancao, two liang, roasted; Renshen, three liang; Dazao, twelve fruits, split; Shengjiang, four liang.
Boil these six ingredients in one dou and two sheng of water until three sheng remain. Remove the dregs and take one sheng warm.
After sweating, Guizhi Tang must not be given again. If there is sweating and panting without great heat, Mahuang Xingren Gancao Shigao Tang may be given.
Mahuang Xingren Gancao Shigao Tang formula:
Mahuang, four liang, nodes removed; Xingren, fifty kernels, skins and tips removed; Gancao, two liang, roasted; Shigao, half a jin, crushed and wrapped in cloth.
For these four ingredients, boil Mahuang in seven sheng of water until the volume has decreased by two sheng. Skim off the foam, add the other ingredients and boil until two sheng remain. Remove the dregs and take one sheng warm.
After excessive sweating, if the person crosses the hands over the Heart region, with palpitations below the Heart and a wish for pressure there, Guizhi Gancao Tang governs.
Guizhi Gancao Tang formula:
Guizhi, four liang, outer bark removed; Gancao, two liang, roasted.
Boil these two ingredients in three sheng of water until one sheng remains. Remove the dregs and take it all at once.
After sweating, palpitations below the navel indicate that running-piglet qi is about to arise. Fuling Guizhi Gancao Dazao Tang governs.
Fuling Guizhi Gancao Dazao Tang formula:
Fuling, half a jin; Guizhi, four liang, outer bark removed; Gancao, two liang, roasted; Dazao, fifteen fruits, split.
For these four ingredients, first boil Fuling in one dou of ganlan water until the volume has decreased by two sheng. Add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm, three times daily.
Method for making ganlan water: put two dou of water in a large basin and repeatedly lift and pour it with a ladle. When five or six thousand bead-like bubbles chase one another on the surface, take this water for use.
For abdominal distention and fullness after sweating, Houpo Shengjiang Banxia Gancao Renshen Tang governs.
Houpo Shengjiang Banxia Gancao Renshen Tang formula:
Houpo, half a jin, roasted and outer covering removed; Shengjiang, half a jin, sliced; Banxia, half a sheng, washed; Gancao, two liang, roasted; Renshen, one liang.
Boil these five ingredients in one dou of water until three sheng remain. Remove the dregs and take one sheng warm, three times daily.
After vomiting or purging in cold damage, there may be counterflow fullness below the Heart, qi surging upward into the chest, dizziness on rising and a deep, tight pulse. Induced sweating then disturbs the channels and makes the body shake and sway. Fuling Guizhi Baizhu Gancao Tang governs.
Fuling Guizhi Baizhu Gancao Tang formula:
Fuling, four liang; Guizhi, three liang, outer bark removed; Baizhu, two liang; Gancao, two liang, roasted.
Boil these four ingredients in six sheng of water until three sheng remain. Remove the dregs, divide, and take warm in three doses.
If sweating does not resolve the illness and aversion to cold appears instead, deficiency is the cause. Shaoyao Gancao Fuzi Tang governs.
Shaoyao Gancao Fuzi Tang formula:
Shaoyao, three liang; Gancao, three liang, roasted; Fuzi, one piece, roasted, peeled and broken into eight pieces.
Boil these three ingredients in five sheng of water until one sheng and five he remain. Remove the dregs, divide, and take warm in three doses.
If illness remains unresolved after sweating or purging, with agitation and restlessness, Fuling Sini Tang governs.
Fuling Sini Tang formula:
Fuling, four liang; Renshen, one liang; Fuzi, one piece, used raw, peeled and broken into eight pieces; Gancao, two liang, roasted; Ganjiang, one and a half liang.
Boil these five ingredients in five sheng of water until three sheng remain. Remove the dregs and take seven he warm, twice daily.
Aversion to cold after sweating is due to deficiency. Heat alone without aversion to cold indicates repletion. Harmonize Stomach qi by giving Tiaowei Chengqi Tang.
In Taiyang illness, profuse sweating after sweat induction dries the Stomach. If agitation and restlessness prevent sleep and the person wishes to drink water, give small amounts so that Stomach qi harmonizes and recovery follows. With a floating pulse, difficult urination, slight fever and wasting-thirst, Wuling San governs.
Wuling San formula:
Zhuling, eighteen zhu, outer covering removed; Zexie, one liang and six zhu; Baizhu, eighteen zhu; Fuling, eighteen zhu; Guizhi, half a liang, outer bark removed.
Pound these five ingredients into powder. Mix one fangcunbi with plain rice drink and take it three times daily. Drink plenty of warm water; sweating brings recovery. Follow the prescribed care method.
After sweating, with a floating, rapid pulse, agitation and thirst, Wuling San governs.
In cold damage with sweating and thirst, Wuling San governs. Without thirst, Fuling Gancao Tang governs.
Fuling Gancao Tang formula:
Fuling, two liang; Guizhi, two liang, outer bark removed; Gancao, one liang, roasted; Shengjiang, three liang, sliced.
Boil these four ingredients in four sheng of water until two sheng remain. Remove the dregs, divide, and take warm in three doses.
In wind-strike with fever unresolved after six or seven days, agitation, both exterior and interior presentations, thirst and a wish to drink, vomiting as soon as water enters is called water counterflow. Wuling San governs.
Before the pulse is taken, the patient crosses the hands over the Heart region. The master asks the patient to try coughing; if they do not cough, both ears must be deaf and unable to hear. This occurs because repeated sweating has caused deficiency. Drinking much water after sweating must cause panting; pouring water over the person also causes panting.
After sweating, inability to take water or medicine into the mouth is an adverse condition. Inducing more sweating must cause unceasing vomiting and diarrhea. After sweating, vomiting or purging, deficient agitation may prevent sleep. In a severe case, the person must toss and turn repeatedly, with distressing vexation in the Heart region. Zhizi Chi Tang governs. If qi is scant, Zhizi Gancao Chi Tang governs; if there is vomiting, Zhizi Shengjiang Chi Tang governs.
Zhizi Chi Tang formula:
Zhizi, fourteen fruits, split; Xiangchi fermented soybeans, four he, wrapped in cloth.
For these two ingredients, first boil Zhizi in four sheng of water until two and a half sheng remain. Add the fermented soybeans and boil until one and a half sheng remain. Remove the dregs and divide into two doses. Give one dose warm. The parenthetical instruction says to stop the remaining dose if vomiting occurs.
Zhizi Gancao Chi Tang formula:
Zhizi, fourteen fruits, split; Gancao, two liang, roasted; Xiangchi fermented soybeans, four he, wrapped in cloth.
For these three ingredients, first boil Zhizi and Gancao in four sheng of water until two and a half sheng remain. Add the fermented soybeans and boil until one and a half sheng remain. Remove the dregs and divide into two doses. Give one dose warm. The parenthetical instruction says to stop the remaining dose if vomiting occurs.
Zhizi Shengjiang Chi Tang formula:
Zhizi, fourteen fruits, split; Shengjiang, five liang, sliced; Xiangchi fermented soybeans, four he, wrapped in cloth.
For these three ingredients, first boil Zhizi and Shengjiang in four sheng of water until two and a half sheng remain. Add the fermented soybeans and boil until one and a half sheng remain. Remove the dregs and divide into two doses. Give one dose warm. The parenthetical instruction says to stop the remaining dose if vomiting occurs.
After sweating or purging, agitation, heat and obstruction within the chest are governed by Zhizi Chi Tang.
In cold damage of five or six days, persistent bodily heat and bound pain in the Heart region after drastic purging mean resolution is not yet approaching. Zhizi Chi Tang governs.
After purging cold damage, if there is vexation, abdominal fullness and restlessness whether lying down or rising, Zhizi Houpo Tang governs.
Zhizi Houpo Tang formula:
Zhizi, fourteen fruits, split; Houpo, four liang, roasted and outer covering removed; Zhishi, four fruits, soaked in water and roasted yellow.
Boil these three ingredients in three and a half sheng of water until one and a half sheng remain. Remove the dregs and divide into two doses. Give one dose warm. The parenthetical instruction says to stop the remaining dose if vomiting occurs.
In cold damage, if the physician drastically purges with pill medicines and bodily heat persists with slight agitation, Zhizi Ganjiang Tang governs.
Zhizi Ganjiang Tang formula:
Zhizi, fourteen fruits, split; Ganjiang, two liang.
Boil these two ingredients in three and a half sheng of water until one and a half sheng remain. Remove the dregs and divide into two doses. Give one dose warm. The parenthetical instruction says to stop the remaining dose if vomiting occurs.
Whenever a Zhizi decoction is considered, it must not be given if the patient previously had slightly loose stool.
In Taiyang illness, if sweat emerges after induction but the illness does not resolve, with continuing fever, palpitations below the Heart, dizziness, quivering of the body and shaking as if about to fall to the ground, Zhenwu Tang governs.
Zhenwu Tang formula:
Fuling, three liang; Shaoyao, three liang; Shengjiang, three liang, sliced; Baizhu, two liang; Fuzi, one piece, roasted, peeled and broken into eight pieces.
Boil these five ingredients in eight sheng of water until three sheng remain. Remove the dregs and take seven he warm, three times daily.
Sweating must not be induced in someone with a dry throat.
Sweating must not be induced in a person prone to lin urinary disorder. If sweat emerges, blood must be passed during elimination.
Even with bodily pain, sweating must not be induced in a person prone to sores. Sweating produces jing spasm disorder.
Sweating must not be induced in a person prone to nosebleeding. If sweat emerges, the forehead must sink inward, the pulse become urgent and tight, and the eyes stare fixedly without blinking, with inability to sleep.
Sweating must not be induced in a person prone to blood loss. Inducing it produces cold trembling and shaking.
In a person prone to sweating, repeated sweat induction must cause bewilderment and mental disturbance, with genital pain after urination. Give Yuyuliang Wan.
Yuyuliang Wan formula:
Yuyuliang, four liang; Renshen, three liang; Fuzi, two pieces; Wuweizi, three he; Fuling, three liang; Ganjiang, three liang.
Combine these six ingredients with honey to make pills the size of wutong seeds. Take twenty pills per dose.
If a patient has cold and sweating is induced again, the Stomach becomes cold and roundworms must be vomited.
If sweating is originally indicated but purging is performed instead, this is contrary treatment. If sweating is done first, the treatment is not contrary. If purging is originally indicated but sweating is performed instead, this is contrary treatment. If purging is done first, the treatment is not contrary.
In cold damage, if the physician purges and unceasing diarrhea with undigested grain follows, together with bodily pain, urgently rescue the interior. Later, if bodily pain remains but bowel evacuation has regulated itself, urgently rescue the exterior. Sini Tang is appropriate for rescuing the interior; Guizhi Tang for rescuing the exterior.
With fever, headache and a pulse that is unexpectedly deep, if there is no recovery and the body is painful, rescue the interior. Sini Tang is appropriate.
In Taiyang illness, purging first without recovery and then inducing sweating makes both exterior and interior deficient, causing clouded oppression. Such a person recovers spontaneously when sweating occurs, because sweating harmonizes the exterior. If the interior is still disharmonious, purging may then be performed again.
In unresolved Taiyang illness, if both yin and yang pulses are held still, shaking and trembling must precede sweating and resolution. If only the yang pulse is faint, sweating comes first and brings resolution. If only the yin pulse is faint, purging brings resolution. When purging is intended, Tiaowei Chengqi Tang is appropriate.
Taiyang illness with fever and sweating means nutritive qi is weak and defensive qi strong, which causes the sweat. To rescue the person from harmful wind, Guizhi Tang is appropriate.
After five or six days of cold damage, or in wind-strike, there may be alternating chills and fever, distressing fullness of the chest and flanks, quiet withdrawal and no desire for food or drink, vexation and frequent inclination to vomit. There may instead be agitation in the chest without vomiting, thirst, abdominal pain, focal obstruction and hardness below the flanks, palpitations below the Heart with difficult urination, no thirst with slight bodily fever, or cough. Xiao Chaihu Tang governs.
Xiao Chaihu Tang formula:
Chaihu, half a jin; Huangqin, three liang; Renshen, three liang; Banxia, half a sheng, washed; Gancao, three liang, roasted; Shengjiang, three liang, sliced; Dazao, twelve fruits, split.
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.
For agitation in the chest without vomiting, remove Banxia and Renshen and add one Gualou fruit. For thirst, remove Banxia, increase the total Renshen to four and a half liang, and add four liang of Gualougen. For abdominal pain, remove Huangqin and add three liang of Shaoyao. For focal obstruction and hardness below the flanks, remove Dazao and add four liang of Muli. For palpitations below the Heart with difficult urination, remove Huangqin and add four liang of Fuling. If there is no thirst but slight exterior fever, remove Renshen and add three liang of Guizhi; take warm, and slight sweating brings recovery. For cough, remove Renshen, Dazao and Shengjiang, and add half a sheng of Wuweizi and two liang of Ganjiang.
When blood is weak and qi exhausted, the interstices open and harmful qi enters. It contends with proper qi and binds below the flanks. Proper and harmful influences struggle in separation, producing alternating chills and fever with periodic pauses and attacks, quiet withdrawal and no desire for food or drink. The viscera and bowels are connected, so the pain must descend. The harmful influence is high while the pain is low, hence vomiting occurs. Xiao Chaihu Tang governs. If thirst appears after Chaihu Tang, the condition belongs to Yangming and should be treated by its methods.
After six or seven days of illness, with a slow, floating, weak pulse, aversion to wind and cold, and warm hands and feet, the physician may purge two or three times. If inability to eat, fullness and pain below the flanks, yellowing of the face, eyes and body, stiff neck and nape, and difficult urination result, give Chaihu Tang; downward heaviness must follow afterward. If the original condition was thirst with vomiting after drinking water, Chaihu is unsuitable. Eating grain then produces hiccups.
On the fourth or fifth day of cold damage, with bodily heat, aversion to wind, stiff neck and nape, fullness below the flanks, warm hands and feet and thirst, Xiao Chaihu Tang governs.
In cold damage, a rough yang pulse and wiry yin pulse ordinarily mean urgent abdominal pain. First give Xiao Jianzhong Tang; if there is no recovery, Xiao Chaihu Tang governs.
Xiao Jianzhong Tang formula:
Guizhi, three liang, outer bark removed; Gancao, two liang, roasted; Dazao, twelve fruits, split; Shaoyao, six liang; Shengjiang, three liang, sliced; Jiaoyi malt sugar, one sheng.
For these six ingredients, use seven sheng of water and boil until three sheng remain. Remove the dregs, add the malt sugar and return to a low fire until it dissolves. Take one sheng warm, three times daily. A person prone to vomiting must not use Jianzhong Tang because it is sweet.
In cold damage or wind-strike with a Chaihu presentation, seeing even one of its signs is sufficient; they need not all be present. If a Chaihu Tang presentation is purged but the Chaihu signs persist, give Chaihu Tang again. There must be a rising, steaming sensation with shaking, followed again by fever and sweating, which bring resolution.
On the second or third day of cold damage, with palpitations and vexation in the Heart region, Xiao Jianzhong Tang governs.
If Taiyang illness has passed through its channel for more than ten days and is instead purged two or three times, then four or five days later the Chaihu presentation remains, first give Xiao Chaihu Tang. Unceasing vomiting, tension below the Heart and constrained slight agitation mean the illness is unresolved. Give Da Chaihu Tang to purge, and recovery follows.
Da Chaihu Tang formula:
Chaihu, half a jin; Huangqin, three liang; Shaoyao, three liang; Banxia, half a sheng, washed; Shengjiang, five liang, sliced; Zhishi, four fruits, roasted; Dazao, twelve fruits, split.
Boil these seven ingredients in one dou and two sheng of water until six sheng remain. Remove the dregs and decoct again; the parenthetical quantity is three sheng. Take one sheng warm, three times daily.
One version adds two liang of Dahuang. The supplied comment says that without it, this may not properly be Da Chaihu Tang.
In cold damage unresolved after thirteen days, with fullness of the chest and flanks, vomiting, tidal fever toward late afternoon and then slight diarrhea, the original condition was a Chaihu presentation. Purging it should not have produced diarrhea. Since diarrhea has instead occurred, we know the physician purged with pill medicines, which was not the proper treatment. Tidal fever indicates repletion. First take Xiao Chaihu Tang to release the exterior; afterward Chaihu Jia Mangxiao Tang governs.
Chaihu Jia Mangxiao Tang formula:
Chaihu, two liang and sixteen zhu; Huangqin, one liang; Renshen, one liang; Gancao, one liang, roasted; Shengjiang, one liang, sliced; Banxia, twenty zhu, washed; Dazao, four fruits, split; Mangxiao, two liang.
For these eight ingredients, boil in four sheng of water until two sheng remain. Remove the dregs, add Mangxiao and boil again gently. Divide and take warm in two doses. If unresolved, prepare it again.
On the thirteenth day of cold damage, after the channel course has passed, delirious speech is due to heat, and a decoction should be used to purge. If urination is free, stool should be hard. If there is diarrhea instead and the pulse is harmonious, we know the physician purged with pill medicines, which was not the proper treatment. With spontaneous diarrhea, the pulse should be faint and reversed; its present harmony instead indicates internal repletion. Tiaowei Chengqi Tang governs.
If Taiyang illness remains unresolved and heat binds in the Bladder, the person behaves as if manic. Spontaneous discharge of blood brings recovery. If the exterior remains unresolved, attacking treatment is still impermissible: first release the exterior. Once it is released, if only urgent binding in the lower abdomen remains, attacking treatment may be used. Taohe Chengqi Tang is appropriate.
Taohe Chengqi Tang formula:
Taoren, fifty kernels, skins and tips removed; Dahuang, four liang; Guizhi, two liang, outer bark removed; Gancao, two liang, roasted; Mangxiao, two liang.
For these five ingredients, boil in seven sheng of water until two and a half sheng remain. Remove the dregs, add Mangxiao, return to the fire and bring to a gentle boil, then remove from the fire. Take five he warm before food, three times daily. Slight diarrhea should occur.
After purging on the eighth or ninth day of cold damage, if there are chest fullness, agitation and fright, difficult urination, delirious speech, and heaviness of the entire body preventing turning from side to side, Chaihu Jia Longgu Muli Tang governs.
Chaihu Jia Longgu Muli Tang formula:
Chaihu, four liang; Longgu, Huangqin, Shengjiang sliced, Qiandan, Renshen, Guizhi with outer bark removed, and Fuling, one and a half liang each; Banxia, two and a half he, washed; Dahuang, two liang; Muli, one and a half liang, heated; Dazao, six fruits, split.
For these twelve ingredients, use eight sheng of water and boil until four sheng remain. Add Dahuang cut into pieces like game counters, boil once or twice more, remove the dregs and take one sheng warm.
In cold damage with abdominal fullness, delirious speech and a floating, tight cunkou pulse, the Liver is overtaking the Spleen. This is called longitudinal overtaking. Needle Qimen.
In cold damage with fever, shivering aversion to cold and great thirst with a wish to drink, the abdomen must become full. With spontaneous sweating and free urination, the illness is approaching resolution. This is the Liver overtaking the Lung, called transverse overtaking. Needle Qimen.
If Taiyang illness on the second day instead produces restlessness, applying hot compresses to the back until profuse sweating occurs drives great heat into the Stomach and exhausts its water. Restlessness and agitation must then develop into delirious speech. After more than ten days, shaking, trembling and spontaneous diarrhea indicate approaching resolution.
The passage continues: sweat does not emerge below the waist; the person wishes to urinate but cannot, instead vomits and is on the verge of urinary incontinence. The soles are averse to wind. Stool is hard; urination should be frequent but is instead neither frequent nor abundant. After a bowel movement, a sudden sharp headache occurs, and the centers of the soles must be hot, because grain qi flows downward.
In Taiyang wind-strike, forcing sweat with fire exposes harmful wind to fire heat, making blood and qi overflow and lose their normal measure. The two yang influences scorch each other, and the body turns yellow. Abundant yang tends toward nosebleeding; deficient yin produces difficult urination. When yin and yang are both deficient and exhausted, the body becomes dry and withered. Sweat appears only on the head and stops at the neck, with abdominal fullness, slight panting, dry mouth and an ulcerated throat. There may be no bowel movement. With time, delirious speech appears; severe cases develop hiccups, restless hands and feet, picking at clothing and feeling over the bed. If urination is free, the person is treatable.
In cold damage with a floating pulse, if the physician forces sweating with fire and causes loss of yang, fright, mania and restlessness whether lying down or rising must follow. Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang governs.
Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang formula:
Guizhi, three liang, outer bark removed; Gancao, two liang, roasted; Shengjiang, three liang, sliced; Dazao, twelve fruits, split; Muli, five liang, heated; Shuqi, three liang, washed to remove the fishy odor; Longgu, four liang.
For these seven ingredients, first boil Shuqi in one dou and two sheng of water until the volume has decreased by two sheng. Add the other ingredients and boil until three sheng remain. Remove the dregs and take one sheng warm.
If the bodily presentation resembles cold damage but the pulse is weak rather than wiry and tight, thirst must occur. Applying fire must produce delirious speech. With the weak pulse, fever and a floating quality, release the illness; sweating should bring recovery.
If Taiyang illness is fumigated with fire but no sweat emerges, the person must become restless. If the channel course is reached without resolution, blood must be passed. This is called fire evil.
A floating pulse and severe heat indicate repletion. Applying moxibustion instead treats repletion as deficiency. Fire stirs the condition, and a dry throat and vomiting of blood must follow.
With a faint, rapid pulse, take care never to apply moxibustion. Fire becomes a harmful influence and produces agitated counterflow. Pursuing deficiency and driving out repletion scatters blood within the vessels. Even slight fire qi attacks forcefully within, scorching bones and injuring sinews; blood is difficult to restore.
A floating pulse should be resolved by sweating. If fire moxibustion is used, harmful influence has no route out and becomes abundant through fire. The body below the waist must become heavy and numb: this is called fire counterflow. If spontaneous resolution is approaching, agitation must come first, followed by sweat that resolves it. How is this known? The floating pulse shows that sweating will bring resolution.
When fire-needling is used to induce sweating and cold strikes the needle sites, red nodules arise and running-piglet qi must develop. If qi surges from the lower abdomen to the Heart, apply one zhuang of moxibustion to each nodule and give Guizhi Jia Gui Tang, adding a further two liang of Gui.
Guizhi Jia Gui Tang formula:
Guizhi, five liang, outer bark removed; Shaoyao, three liang; Shengjiang, three liang, sliced; Gancao, two liang, roasted; Dazao, twelve fruits, split.
Boil these five ingredients in seven sheng of water until three sheng remain. Remove the dregs and take one sheng warm.
If fire counterflow is purged and fire-needling causes agitation and restlessness, Guizhi Gancao Longgu Muli Tang governs.
Guizhi Gancao Longgu Muli Tang formula:
Guizhi, one liang, outer bark removed; Gancao, two liang, roasted; Muli, two liang, heated; Longgu, two liang.
Boil these four ingredients in five sheng of water until two and a half sheng remain. Remove the dregs and take eight he warm, three times daily.
Adding warm-needling to Taiyang cold damage must produce fright.
Taiyang illness should have aversion to cold and fever. If spontaneous sweating instead occurs without the expected aversion to cold and fever, and the pulse above the guan is fine and rapid, the physician's excessive induction of vomiting is responsible. If vomiting was induced on the first or second day, there is abdominal hunger but inability to eat. If it was induced on the third or fourth day, the person dislikes thin rice gruel, wishes for cold food, and vomits in the evening what was eaten in the morning. The physician's emetic treatment caused this. It is a minor contrary treatment.
In Taiyang illness treated with vomiting, aversion to cold should ordinarily be present. Its unexpected absence, with no wish for clothing nearby, is internal agitation caused by the emetic treatment.
A rapid pulse signifies heat and should digest grain and draw the person to food. Vomiting instead occurs because induced sweating has made yang qi faint and diaphragm qi deficient, producing the rapid pulse. Its rapidity signifies guest heat, which cannot digest grain. Deficiency and cold within the Stomach therefore cause vomiting.
After Taiyang illness has passed its channel course for more than ten days, there may be wenwen uneasiness below the Heart with a desire to vomit, chest pain, unexpectedly loose stool, slight abdominal fullness and constrained slight agitation. If excessive vomiting and purging had already occurred before this, give Tiaowei Chengqi Tang. Otherwise it must not be given. A mere desire to vomit, chest pain and slightly loose stool do not constitute a Chaihu Tang presentation. The vomiting indicates that excessive vomiting and purging have occurred.
On the sixth or seventh day of Taiyang illness, if the exterior presentation remains, the pulse is faint and deep, and mania appears instead of chest binding, heat is in the lower burner. The lower abdomen should be hard and full, but urination remains free; discharge of blood brings recovery. This occurs because Taiyang has followed its channel and congealed heat remains within. Didang Tang governs.
Didang Tang formula:
Shuizhi, thirty, heated; Mengchong, thirty, wings and legs removed and heated; Taoren, twenty kernels, skins and tips removed; Dahuang, three liang, washed with wine.
Boil these four ingredients in five sheng of water until three sheng remain. Remove the dregs and take one sheng warm. If downward discharge does not occur, take another dose.
In Taiyang illness with a yellow body, a deep, bound pulse and a hard lower abdomen, difficult urination means there is no retained blood. If urination is naturally free and the person behaves as if manic, the blood presentation is certain. Didang Tang governs.
In cold damage with heat and lower-abdominal fullness, urination should be difficult. If it is instead free, retained blood is present and should be purged. Other medicines are unsuitable; Didang Wan is appropriate.
Didang Wan formula:
Shuizhi, twenty, heated; Mengchong, twenty, wings and legs removed and heated; Taoren, twenty-five kernels, skins and tips removed; Dahuang, three liang.
Pound these four ingredients and divide into four pills. Boil one pill in one sheng of water until seven he remain and take it. Blood should be discharged within a full day-and-night cycle. If no discharge occurs, take another dose.
In Taiyang illness with free urination, drinking much water must cause palpitations below the Heart. If urination is scant, the person must suffer internal urgency.
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