Chapter 14: Differentiation of Taiyang Disease: Pulse, Signs, and Treatment (Part 2)
Differentiating the Pulse, Syndrome, and Treatment of Taiyang Disease Part 2
In taiyang disease, when the neck and back are stiff and painful, with inability to move freely, absence of sweating, and aversion to wind, Gegen Tang (Pueraria Decoction) is the main treatment.
Gegen Tang Fang (Pueraria Decoction Formula)
Gegen (Pueraria) 4 liang, Mahuang (Ephedra) 3 liang (remove the nodes), Guizhi (Cassia Twig) 2 liang (remove the bark), Shaoyao (Peony) 2 liang, Gancao (Licorice) 2 liang (roasted), Shengjiang (Fresh Ginger) 3 liang (sliced), Dazao (Chinese Date) 12 pieces (broken apart).
These seven ingredients, use 1 dou of water. First boil Mahuang and Gegen until the water is reduced by 2 sheng. Skim off the froth, then add the other ingredients. Boil until 3 sheng remain. Remove the dregs. Take 1 sheng warm. Cover with a quilt to induce a slight sweating. It is not necessary to drink congee. The rest of the regimen and contraindications follow those of Guizhi Tang. All decoctions refer to this method.
When taiyang disease and yangming disease occur simultaneously, there will definitely be spontaneous diarrhea. Use Gegen Tang (Pueraria Decoction) as the main treatment. (The formula is seen above.) If there is no diarrhea but only vomiting, use Gegen Jia Banxia Tang (Pueraria plus Pinellia Decoction) as the main treatment.
Gegen Jia Banxia Tang Fang (Pueraria plus Pinellia Decoction Formula)
Gegen (Pueraria) 4 liang, Mahuang (Ephedra) 3 liang (remove the nodes), Guizhi (Cassia Twig) 3 liang (remove the bark), Shaoyao (Peony) 2 liang, Gancao (Licorice) 2 liang (roasted), Shengjiang (Fresh Ginger) 3 liang (sliced), Dazao (Chinese Date) 12 pieces (broken apart), Banxia (Pinellia) 0.5 sheng (washed).
These eight ingredients, use 1 dou of water. First boil Gegen and Mahuang until the water is reduced by 2 sheng. Skim off the froth, then add the other ingredients. Boil until 3 sheng remain. Remove the dregs. Take 1 sheng warm. Cover with a quilt to induce a slight sweating. The rest follows the method of Guizhi Tang.
In taiyang disease, when there is a Guizhi Tang syndrome, but the doctor mistakenly uses purgation, if the diarrhea does not stop and the pulse is rapid, it indicates that the heat pathogen has not been resolved. If there is panting and sweating, use Gegen Huanglian Huangqin Gancao Tang (Pueraria, Coptis, Scutellaria, and Licorice Decoction) as the main treatment.
Gegen Huanglian Huangqin Gancao Tang Fang (Pueraria, Coptis, Scutellaria, and Licorice Decoction Formula)
Gegen (Pueraria) 0.5 jin, Huanglian (Coptis) 3 liang, Huangqin (Scutellaria) 3 liang, Gancao (Licorice) 2 liang (roasted).
These four ingredients, use 8 sheng of water. First boil Gegen until the water is reduced by 2 sheng. Skim off the froth, then add the other ingredients. Boil until 2 sheng remain. Remove the dregs. Take warm in two divided doses.
In taiyang disease, with headache, fever, body pain, lumbar pain, joint pain, aversion to wind, absence of sweating, and panting, use Mahuang Tang (Ephedra Decoction) as the main treatment.
Mahuang Tang Fang (Ephedra Decoction Formula)
Mahuang (Ephedra) 3 liang (remove the nodes), Guizhi (Cassia Twig) 2 liang (remove the bark), Gancao (Licorice) 1 liang (roasted), Xingren (Apricot Kernel) 70 pieces (remove the skin and tip).
These four ingredients, use 9 sheng of water. First boil Mahuang until the water is reduced by 2 sheng. Skim off the froth, then add the other ingredients. Boil until 2.5 sheng remain. Remove the dregs. Take 8 he warm. Cover with a quilt to induce a slight sweating. It is not necessary to drink congee. The rest of the regimen follows the method of Guizhi Tang.
When taiyang disease and yangming disease occur simultaneously, with panting and chest fullness, purgation cannot be used; Mahuang Tang (Ephedra Decoction) is appropriate. (The formula is seen above.)
In taiyang disease, after ten or more days have passed, if the pulse is floating and fine and the patient prefers lying down, it indicates that the exterior syndrome has been resolved. If chest fullness and rib-side pain appear, give Xiao Chaihu Tang (Minor Bupleurum Decoction). If the pulse is merely floating, give Mahuang Tang (Ephedra Decoction). (The formula is seen above.)
Xiao Chaihu Tang Fang (Minor Bupleurum Decoction Formula)
Chaihu (Bupleurum) 0.5 jin, Huangqin (Scutellaria) 3 liang, Renshen (Ginseng) 3 liang, Gancao (Licorice) 3 liang (roasted), Shengjiang (Fresh Ginger) 3 liang (sliced), Dazao (Chinese Date) 12 pieces (broken apart), Banxia (Pinellia) 0.5 sheng (washed).
These seven ingredients, use 1 dou and 2 sheng of water. Boil until 6 sheng remain. Remove the dregs, then boil further until 3 sheng remain. Take 1 sheng warm, three times daily.
In taiyang cold damage, with a floating and tight pulse, fever, aversion to cold, body pain, absence of sweating, and restlessness, use Da Qinglong Tang (Major Green Dragon Decoction) as the main treatment. If the pulse is faint and there is sweating with aversion to wind, it cannot be taken. If taken, it will cause cold extremities and muscle twitching; this is an erroneous treatment method.
Da Qinglong Tang Fang (Major Green Dragon Decoction Formula)
Mahuang (Ephedra) 6 liang (remove the nodes), Guizhi (Cassia Twig) 2 liang (remove the bark), Gancao (Licorice) 2 liang (roasted), Xingren (Apricot Kernel) 40 pieces (remove the skin and tip), Shengjiang (Fresh Ginger) 3 liang (sliced), Dazao (Chinese Date) 12 pieces (broken apart), Shigao (Gypsum) the size of an egg (broken into pieces).
These seven ingredients, use 9 sheng of water. First boil Mahuang until the water is reduced by 2 sheng. Skim off the froth, then add the other ingredients. Boil until 3 sheng remain. Remove the dregs. Take 1 sheng warm, and induce a slight sweating. If sweating is profuse, apply a warm powder to the body. If sweating occurs after one dose, stop taking the remaining doses. If taken again, excessive sweating will cause a loss of yang qi, leading to weakness, aversion to wind, restlessness, and inability to sleep peacefully.
In taiyang wind strike, with a floating and slow pulse, the body is not painful but only heavy, with occasional relief, and there is no shaoyin disease syndrome, use Da Qinglong Tang (Major Green Dragon Decoction) to dissipate. (The formula is seen above.)
In cold damage, when the exterior syndrome has not been resolved and there is water qi below the heart, with dry retching, fever, and cough, sometimes with thirst, sometimes with diarrhea, sometimes with choking sensation, sometimes with difficult urination and lower abdominal fullness, sometimes with panting, use Xiao Qinglong Tang (Minor Green Dragon Decoction) as the main treatment.
Xiao Qinglong Tang Fang (Minor Green Dragon Decoction Formula)
Mahuang (Ephedra) 3 liang (remove the nodes), Shaoyao (Peony) 3 liang, Xixin (Asarum) 3 liang, Guizhi (Cassia Twig) 3 liang, Ganjiang (Dried Ginger) 3 liang, Gancao (Licorice) 3 liang (roasted), Wuweizi (Schisandra) 0.5 sheng, Banxia (Pinellia) 0.5 sheng (washed).
These eight ingredients, use 1 dou of water. First boil Mahuang until the water is reduced by 2 sheng. Skim off the froth, then add the other ingredients. Boil until 3 sheng remain. Remove the dregs. Take 1 sheng warm, three times daily.
If there is thirst, remove Banxia and add Gualou Gen (Trichosanthes Root) 3 liang. If there is mild diarrhea, remove Mahuang and add Raohua (Wikstroemia) the size of an egg, stir-fried until red. If there is a choking sensation, remove Mahuang and add Fuzi (Aconite) 1 piece. If there is difficult urination and lower abdominal fullness, remove Mahuang and add Fuling (Poria) 4 liang. If there is panting, remove Mahuang and add Xingren (Apricot Kernel) 0.5 sheng (remove the skin and tip).
In cold damage, when there is water qi below the heart, with cough and mild panting, fever without thirst. If thirst appears after taking the decoction, this indicates that the cold qi is departing and the disease is about to be resolved. Use Xiao Qinglong Tang (Minor Green Dragon Decoction) as the main treatment. (The formula is seen above.)
In taiyang disease, when the exterior syndrome has not been resolved and the pulse is floating and weak, sweating should be used to resolve it; Guizhi Tang (Cassia Twig Decoction) is appropriate. (The formula is seen in the previous volume.)
In taiyang disease, when there is mild panting after purgation, it is because the exterior syndrome has not been resolved. Use Guizhi Jia Houpo Xingzi Tang (Cassia Twig plus Magnolia Bark and Apricot Kernel Decoction) as the main treatment.
Guizhi Jia Houpo Xingzi Tang Fang (Cassia Twig plus Magnolia Bark and Apricot Kernel Decoction Formula)
Guizhi (Cassia Twig) 3 liang, Shaoyao (Peony) 3 liang, Gancao (Licorice) 2 liang (roasted), Shengjiang (Fresh Ginger) 3 liang (sliced), Dazao (Chinese Date) 12 pieces (broken apart), Houpo (Magnolia Bark) 2 liang, Xingren (Apricot Kernel) 50 pieces (remove the skin and tip).
These seven ingredients, use 7 sheng of water. Boil over a small fire until 3 sheng remain. Remove the dregs. Take 1 sheng warm. Cover with a quilt to induce a slight sweating.
In taiyang disease, when the exterior syndrome has not been resolved, purgation cannot be used; using purgation is an erroneous treatment method. If one wishes to resolve the exterior syndrome, Guizhi Tang (Cassia Twig Decoction) is appropriate. (The formula is seen in the previous volume.)
In taiyang disease, when sweating is first applied and the disease is not resolved, and then purgation is used, if the pulse is floating, recovery will not occur. A floating pulse indicates that the disease is in the exterior; using purgation instead is the reason for non-recovery. Now that the pulse is floating, it is known that the disease is in the exterior. The exterior syndrome should be resolved, and recovery will follow; Guizhi Tang (Cassia Twig Decoction) is appropriate. (The formula is seen in the previous volume.)
In taiyang disease, with a floating and tight pulse, absence of sweating, fever, and body pain, if after eight or nine days the disease has not resolved and the exterior syndrome is still present, sweating should be induced at this time. After taking the medication, the condition slightly improves, but the patient develops restlessness and blurred vision. In severe cases, there will definitely be epistaxis (nosebleed). After the epistaxis, the disease will be resolved. The reason for this is that the yang qi is too heavy. Use Mahuang Tang (Ephedra Decoction) as the main treatment. (The formula is seen above.)
In taiyang disease, with a floating and tight pulse, fever, absence of sweating, spontaneous epistaxis will lead to recovery.
In combined taiyang and yangming disease, when taiyang disease first occurs, sweating is induced, but the sweat does not come out thoroughly. Therefore, it turns to yangming, and then spontaneous slight sweating occurs without aversion to cold.
If the symptoms of taiyang disease have not been eliminated, purgation cannot be used; using purgation is an erroneous treatment method. In this case, mild sweating can be induced. If the complexion is red, it indicates that yang qi is bound in the exterior. Sweating or fumigation should be used to resolve it. If sweating is not thorough and insufficient, the yang qi becomes bound and cannot be dispersed. When sweating should be induced but is not, the patient will become restless, not knowing the location of the pain. Sometimes it is in the abdomen, sometimes in the limbs. Pressing does not reveal any tender point. If sweating is induced again, recovery will follow. If the patient has shortness of breath and can only sit up, it is because the sweating was not thorough. How is it known that the sweating was not thorough? It is known from the rough and choppy pulse.
When the pulse is superficial and tight, it stands to reason that after sweating the disease should be relieved. If the body is heavy and there is palpitation, one cannot induce sweating; one must wait for natural sweating to occur before recovery. The reason for this is that the chi pulse is faint and weak—this indicates interior deficiency. One must wait until the interior qi is replete and the fluids are harmonized; then natural sweating will occur and recovery will follow.
When the pulse is superficial and tight, it stands to reason that there should be generalized pain, and it is appropriate to relieve it by inducing sweating. If the chi pulse is slow, one cannot induce sweating. Why is this? Because the nutritive qi is insufficient and the blood is weak.
When the pulse is superficial, the disease is in the exterior; sweating can be induced, and it is appropriate to use Mahuang Decoction. (The formula is given above.)
When the pulse is superficial and tight, sweating can be induced, and it is appropriate to use Mahuang Decoction. (The formula is given above.)
When a patient frequently sweats spontaneously, this indicates that the nutritive qi is harmonious but the defensive qi is not coordinated. The reason for this is that the nutritive qi moves within the vessels, while the defensive qi moves outside the vessels; the defensive qi is unable to harmonize with the nutritive qi. If sweating is induced again, recovery will follow, and it is appropriate to use Guizhi Decoction. (The formula is given in the previous volume.)
When the patient has no other disease in the zang and fu organs but regularly has fever and spontaneous sweating that does not resolve, this is due to disharmony of the defensive qi. If sweating is induced before the onset of fever and sweating, recovery will follow, and it is appropriate to use Guizhi Decoction. (The formula is given in the previous volume.)
Cold damage with a superficial and tight pulse, where sweating has not been induced and consequently nosebleed occurs, is treated with Mahuang Decoction. (The formula is given above.)
In cold damage, when there is no bowel movement for six or seven days, with headache and fever, administer Chengqi Decoction. If the urine is clear, it is known that the disease is not in the interior but is still in the exterior; sweating should be induced, and it is appropriate to use Guizhi Decoction. (The formula is given in the previous volume.)
In cold damage, after sweating the disease has been relieved, but after about half a day there is again vexation, and the pulse is superficial and tight; sweating can be induced again, and it is appropriate to use Guizhi Decoction. (The formula is given in the previous volume.)
In all diseases, if sweating has been induced, or vomiting has been induced, or purging has been performed, or there has been blood loss, or fluids have been damaged, and if yin and yang can harmonize themselves, then spontaneous recovery will certainly occur.
After vigorous purging, and then further purging, if urination is not free, this is due to damage to the fluids. Do not treat it; after a period of time urination will certainly become free on its own.
After vigorous purging, and then sweating is induced, the patient will certainly experience chills and shivering, and the pulse will be faint and thin. The reason for this is that both the interior and exterior are deficient.
After purging, and then sweating is induced, if there is daytime vexation, inability to sleep peacefully, but quietness at night, no vomiting, no thirst, no exterior pattern, a pulse that is deep and faint, and no marked fever in the body, treat it with Ganjiang Fuzi Decoction.
Ganjiang Fuzi Decoction Formula:
Ganjiang (dried ginger) 1 liang (processed)
Fuzi (prepared aconite) 1 piece (processed, skin removed, broken into 8 pieces)
These two herbs: use 3 sheng of water, decoct until 1 sheng remains, remove the dregs, and take in one dose.
After sweating, if there is generalized pain and the pulse is deep and slow, treat it with Guizhi Decoction minus Shaoyao plus Rensheng and Shengjiang.
Guizhi Decoction minus Shaoyao plus Rensheng and Shengjiang Formula:
Guizhi (cinnamon twig) 3 liang (skin removed)
Gancao (licorice) 2 liang (honey-fried)
Dazao (jujube) 12 pieces (split)
Rensheng (ginseng) 3 liang
Shengjiang (fresh ginger) 4 liang (sliced)
These five herbs: use 1 dou 2 sheng of water, decoct until 3 sheng remain, remove the dregs, take 1 sheng warm, three times daily.
After sweating or purging, Guizhi Decoction can no longer be used. If there is sweating and panting, but no marked fever, use Mahuang Xingren Gancao Shigao Decoction.
Mahuang Xingren Gancao Shigao Decoction Formula:
Mahuang (ephedra) 4 liang (nodes removed)
Xingren (apricot kernel) 50 pieces (skin and tips removed)
Gancao (licorice) 2 liang (honey-fried)
Shigao (gypsum) half jin (crushed, wrapped in cloth)
These four herbs: use 7 sheng of water, first decoct mahuang until 2 sheng have evaporated, remove the foam, add the other herbs, decoct until 2 sheng remain, remove the dregs, take 1 sheng warm, twice daily.
When sweating has been excessive, and the patient presses the chest with crossed hands, with palpitation below the heart that desires pressure, treat it with Guizhi Gancao Decoction.
Guizhi Gancao Decoction Formula:
Guizhi (cinnamon twig) 4 liang (skin removed)
Gancao (licorice) 2 liang (honey-fried)
These two herbs: use 3 sheng of water, decoct until 1 sheng remains, remove the dregs, and take in one dose.
After sweating, if there is palpitation below the navel, this indicates that running piglet (bentun) is about to erupt. Treat it with Fuling Guizhi Gancao Dazao Decoction.
Fuling Guizhi Gancao Dazao Decoction Formula:
Fuling (poria) half jin
Guizhi (cinnamon twig) 4 liang
Gancao (licorice) 2 liang (honey-fried)
Dazao (jujube) 15 pieces (split)
These four herbs: use 1 dou of sweet-flowing water (ganlan shui), first decoct fuling until 2 sheng have evaporated, add the other herbs, decoct until 3 sheng remain, remove the dregs, take 1 sheng warm, three times daily.
Method for making sweet-flowing water: take 2 dou of water, place it in a large basin, use a wooden ladle to scoop and pour the water repeatedly, until there are five to six thousand beads on the surface chasing each other; then use this water.
In running piglet disease, when qi rushes upward from the lower abdomen to the throat, and during an attack it seems as if death is imminent, but then it stops, this is always obtained from fright or fear.
In running piglet disease, when qi rushes upward to the chest, with abdominal pain, alternating cold and heat, treat it with Bentun Decoction.
Bentun Decoction Formula:
Gancao (licorice) 2 liang (honey-fried)
Chuanxiong (Ligusticum) 2 liang
Danggui (Chinese angelica) 2 liang
Huangqin (Scutellaria) 2 liang
Shaoyao (peony) 2 liang
Banxia (pinellia) 4 liang (washed)
Shengjiang (fresh ginger) 4 liang
Gegen (kudzu root) 5 liang
Guizhi (cinnamon twig) 3 liang
These nine herbs: use 2 dou of water, decoct until 5 sheng remain, take 1 sheng warm, three times daily, and twice at night.
After sweating, if there is abdominal distention, treat it with Houpo Shengjiang Banxia Gancao Rensheng Decoction.
Houpo Shengjiang Banxia Gancao Rensheng Decoction Formula:
Houpo (magnolia bark) half jin (processed, skin removed)
Shengjiang (fresh ginger) half jin (sliced)
Banxia (pinellia) half sheng (washed)
Gancao (licorice) 2 liang (honey-fried)
Rensheng (ginseng) 1 liang
These five herbs: use 1 dou of water, decoct until 3 sheng remain, remove the dregs, take 1 sheng warm, three times daily.
In cold damage, if vomiting or purging has been used, and subsequently there is rebellious qi and distention below the heart, qi rushing upward to the chest, dizziness upon standing, and a pulse that is deep and tight, inducing sweating will disturb the channels and vessels, causing the body to tremble and shake. Treat it with Fuling Guizhi Baizhu Gancao Decoction.
Fuling Guizhi Baizhu Gancao Decoction Formula:
Fuling (poria) 4 liang
Guizhi (cinnamon twig) 3 liang
Baizhu (atractylodes) 2 liang
Gancao (licorice) 2 liang (honey-fried)
These four herbs: use 6 sheng of water, decoct until 3 sheng remain, remove the dregs, and take in three warm doses.
After sweating, if the disease has not been relieved but instead there is aversion to cold, this is due to deficiency. Treat it with Shaoyao Gancao Fuzi Decoction.
Shaoyao Gancao Fuzi Decoction Formula:
Shaoyao (peony) 3 liang
Gancao (licorice) 3 liang (honey-fried)
Fuzi (prepared aconite) 1 piece (processed, skin removed, broken into 8 pieces)
These three herbs: use 5 sheng of water, decoct until 1 sheng 5 ge remain, remove the dregs, and take in three warm doses.
After sweating or purging, if the disease still has not been relieved and there is vexation, treat it with Fuling Sini Decoction.
Fuling Sini Decoction Formula:
Fuling (poria) 6 liang
Rensheng (ginseng) 1 liang
Fuzi (aconite) 1 piece (unprocessed, skin removed, broken into 8 pieces)
Gancao (licorice) 2 liang (honey-fried)
Ganjiang (dried ginger) 1 liang and a half
These five herbs: use 5 sheng of water, decoct until 3 sheng remain, remove the dregs, take 7 ge warm, three times daily.
After sweating, if there is aversion to cold, this is due to deficiency; if there is no aversion to cold but only fever, this is due to excess. One should harmonize the stomach qi and administer Tiaowei Chengqi Decoction. (The formula is given in the previous volume.)
In taiyang disease, after sweating, if there is profuse sweating, dryness in the stomach, vexation, inability to sleep peacefully, and a desire to drink water, give water in small amounts to drink; when the stomach qi becomes harmonized, recovery will follow. If the pulse is superficial, urination is not free, there is mild fever, and thirst with much drinking of water, treat it with Wuling San.
Wuling San Formula:
Zhuling (polyporus) 18 zhu (skin removed)
Zexie (alisma) 1 liang 6 zhu
Baizhu (atractylodes) 18 zhu
Fuling (poria) 18 zhu
Guizhi (cinnamon twig) half liang
These five herbs: grind into a powder, take one square-inch spoonful with rice water, three times daily. Drink plenty of hot water; sweating will occur and recovery will follow. Rest and recuperate according to the usual method.
In taiyang disease, after sweating, if the pulse is superficial and string-like, with vexation and thirst, treat it with Wuling San. (The formula is given above.)
In cold damage, if there is sweating and thirst, with urination not free, treat it with Wuling San. If there is no thirst, treat it with Fuling Gancao Decoction.
Fuling Gancao Decoction Formula:
Fuling (poria) 2 liang
Guizhi (cinnamon twig) 2 liang
Gancao (licorice) 1 liang (honey-fried)
Shengjiang (fresh ginger) 3 liang (sliced)
These four herbs: use 4 sheng of water, decoct until 2 sheng remain, remove the dregs, and take in three warm doses.
Wind strike with fever, unresolved for six or seven days, with vexation, both exterior and interior patterns, thirst with desire to drink water, but when water is drunk it is immediately vomited out—this is called water counterflow (shui ni). Treat it with Wuling San. (The formula is given above.)
Before taking the pulse, if the patient crosses his hands over his chest and the doctor tries to have him cough, but he does not cough, this is definitely because both ears are deaf and cannot hear sound. The reason for this is excessive sweating, which has caused deficiency.
After sweating, if the patient drinks too much water, he will definitely develop wheezing; if water is poured over his body, he will also wheeze. After sweating, if neither water nor medicine can be taken, this is a reversed pattern; if sweating is induced again, there will definitely be unremitting vomiting and diarrhea. After sweating, as well as after vomiting and purging, if there is vexation in the heart with inability to sleep, and if severe, the patient will toss and turn with oppressive vexation, treat it with Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction). If there is shortness of breath, treat it with Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction). If there is vomiting, treat it with Zhizi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction).
Zhi Gan Jiang Tang Fang (Gardenia and Dried Ginger Decoction Formula):
Gardenia fruit 14 pieces (split open), Dried ginger 2 liang (sliced).
These two ingredients, with 3.5 sheng of water, decoct to obtain 1.5 sheng, remove the dregs, and take warm in two doses. If vomiting occurs after the first dose, stop the remaining dose.
Zhi Gan Cao Chi Tang Fang (Gardenia, Licorice, and Fermented Soybean Decoction Formula):
Gardenia fruit 14 pieces (split open), prepared licorice 2 liang (dry-fried), fermented soybeans 4 ge (wrapped in cloth).
These three ingredients, with 4 sheng of water, first decoct the gardenia and licorice to obtain 2.5 sheng, then add the fermented soybeans and decoct to obtain 1.5 sheng, remove the dregs, and take in two doses. Take the first dose warm. If vomiting occurs, stop the remaining dose.
Zhi Sheng Jiang Chi Tang Fang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction Formula):
Gardenia fruit 14 pieces (split open), Fresh ginger 5 liang, Fermented soybeans 4 ge (wrapped in cloth).
These three ingredients, with 4 sheng of water, first decoct the gardenia and fresh ginger to obtain 2.5 sheng, then add the fermented soybeans and decoct to obtain 1.5 sheng, remove the dregs, and take in two doses. Take the first dose warm. If vomiting occurs, stop the remaining dose.
After sweating or purging, if there is vexation with heat and a feeling of stuffiness and blockage in the chest, treat it with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
Zhi Zi Chi Tang Fang (Gardenia and Fermented Soybean Decoction Formula):
Gardenia fruit 14 pieces (split open), Fermented soybeans 4 ge (wrapped in cloth).
These two ingredients, with 4 sheng of water, first decoct the gardenia to obtain 2.5 sheng, then add the fermented soybeans and decoct to obtain 1.5 sheng, remove the dregs, and take in two doses. Take the first dose warm. If vomiting occurs, stop the remaining dose.
Five or six days into a cold damage, after severe purging with a drastic purgative, if the body heat has not subsided and there is focal distention and pain in the heart, it means the pathogen has not yet resolved. Treat it with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). After purging in cold damage, if there is vexation, abdominal distention, and inability to rest whether lying down or sitting up, treat it with Zhizi Houpo Zhishi Tang (Gardenia, Magnolia Bark, and Unripe Bitter Orange Decoction).
Zhi Zi Hou Po Zhi Shi Tang Fang (Gardenia, Magnolia Bark, and Unripe Bitter Orange Decoction Formula):
Gardenia fruit 14 pieces (split open), Magnolia bark 4 liang (dry-fried, skin removed), Unripe bitter orange 4 pieces (soaked in water, dry-fried until yellow).
These three ingredients, with 3.5 sheng of water, decoct to obtain 1.5 sheng, remove the dregs, and take in two doses. Take the first dose warm. If vomiting occurs, stop the remaining dose.
For cold damage, if the physician used pill medicine for drastic purging, and the body heat has not subsided with mild vexation, treat it with Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction). (Formula seen above.)
Whenever using Gardenia decoctions, if the patient originally has loose stools, do not administer them.
For taiyang disease, after sweating, if the disease has not resolved and the patient still has fever, palpitations below the heart, dizziness, muscle twitching, and tremors that threaten to cause falling, treat it with Zhenwu Tang (True Warrior Decoction).
Zhen Wu Tang Fang (True Warrior Decoction Formula):
Poria 3 liang, Peony 3 liang, Fresh ginger 3 liang (sliced), Atractylodes 2 liang, Prepared aconite 1 piece (dry-fried, skin removed, broken into 8 pieces).
These five ingredients, with 8 sheng of water, decoct to obtain 3 sheng, remove the dregs, and take 7 ge warm, three times daily.
For dry throat, do not induce sweating.
For those who habitually have painful, dribbling urination, do not induce sweating; sweating will definitely cause blood in the urine.
For those who habitually have sores, even if there is body pain, do not induce sweating; sweating will cause opisthotonos.
For those who habitually have nosebleeds, do not induce sweating; sweating will definitely cause sunken forehead, tight pulse, staring eyes without movement, and inability to sleep.
For those who have habitually lost much blood, do not induce sweating; sweating will cause chills and shivering.
For those who are prone to sweating, if sweating is induced again, there will definitely be mental confusion and vexation, with pain in the genitals after urination. Give Yuyuliang Wan (Limonite Pill).
Yu Yu Liang Wan Fang (Limonite Pill Formula):
Limonite 4 liang, Ginseng 3 liang, Prepared aconite 2 pieces (dry-fried, skin removed, broken into 8 pieces), Schisandra 3 ge, Poria 3 liang, Dried ginger 3 liang.
These six ingredients, form into pills with honey, the size of wutong seeds, and take 20 pills per dose.
If the patient has internal cold and sweating is induced, the stomach will become cold, and there will definitely be vomiting.
For cold damage, if sweating has not been induced and purging is used instead, this is an erroneous treatment; if sweating is induced first, the treatment is not erroneous. If purging should have been done first, and sweating is induced instead, this is erroneous; if purging is done first, the treatment is not erroneous.
For cold damage, after the physician has treated with purging, if the patient then has unremitting diarrhea with undigested food, along with body pain, the interior deficiency should be urgently treated. After that, if the body pain persists but the stools have returned to normal, the exterior pattern should be urgently treated. For treating interior deficiency, use Sini Tang (Four-Nerve Decoction); for treating the exterior pattern, use Guizhi Tang (Cinnamon Twig Decoction). (Formula seen in the previous chapter.)
For taiyang disease, if purging is used first without recovery, and then sweating is induced, this causes both exterior and interior to become deficient. The patient then develops dizziness and blurred vision. If the dizzy patient sweats spontaneously, recovery will follow. The reason is that the exterior qi has become harmonious. If the interior qi is not yet harmonious, then purging is used afterward.
For taiyang disease that has not resolved, if the pulse at all three positions (cun, guan, chi) is faint and weak, there will definitely be shivering and chills first, followed by sweating and resolution. If only the cun pulse is faint, sweating occurs first and the disease resolves. If the chi pulse is firm, purging resolves the disease. If purging is intended, it is appropriate to use Tiaowei Chengqi Tang (Stomach-Regulating Qi-Coordinating Decoction). (Formula seen in the previous chapter.)
For taiyang disease with fever and sweating, this indicates weak nutritive qi and strong defensive qi, which is why sweating occurs. If wind is to be treated, it is appropriate to use Guizhi Tang (Cinnamon Twig Decoction). (Formula seen in the previous chapter.)
Five or six days into cold damage, or in wind strike, if there is alternating chills and fever, a feeling of fullness and oppression in the chest and rib-side, silence and unwillingness to eat, vexation in the heart with a tendency to vomit, or chest vexation without vomiting, or thirst, or abdominal pain, or focal distention and hardness below the rib-side, or palpitations below the heart with difficult urination, or absence of thirst with mild body heat, or coughing, treat it with Xiao Chaihu Tang (Minor Bupleurum Decoction).
Xiao Chai Hu Tang Fang (Minor Bupleurum Decoction Formula):
Bupleurum 8 liang, Scutellaria 3 liang, Ginseng 3 liang, Pinellia 0.5 sheng (washed), Prepared licorice 3 liang (dry-fried), Fresh ginger 3 liang (sliced), Chinese jujube 13 pieces (split).
These seven ingredients, with 1 dou 2 sheng of water, decoct to obtain 6 sheng, remove the dregs, then re-decoct to obtain 3 sheng, and take 1 sheng warm, three times daily.
If there is chest vexation without vomiting, remove pinellia and ginseng, and add 1 piece of Trichosanthes fruit. If there is thirst, remove pinellia, add ginseng bringing the total to 4.5 liang, and add Trichosanthes root 4 liang. If there is abdominal pain, remove scutellaria, and add peony 3 liang. If there is focal distention and hardness below the rib-side, remove Chinese jujube, and add oyster 4 liang. If there are palpitations below the heart with difficult urination, remove scutellaria, and add poria 4 liang. If there is no thirst with mild body heat, remove ginseng, and add cinnamon twig 3 liang, covering with a quilt to induce mild sweating for recovery. If there is coughing, remove ginseng, Chinese jujube, and fresh ginger, and add schisandra 0.5 sheng and dried ginger 2 liang.
When the qi and blood are deficient, the interstices open, allowing pathogens to enter and bind with the righteous qi, forming a mass below the rib-side. The struggle between right and evil produces alternating chills and fever, occurring at intervals, with silence and unwillingness to eat. Since the viscera are connected, the pain will inevitably move downward. With the pathogen above and the pain below, vomiting results. Treat it with Xiao Chaihu Tang (Minor Bupleurum Decoction). After taking Xiao Chaihu Tang, if thirst develops, this belongs to yangming disease, and treat it according to the method for yangming disease. (Formula seen above.)
For taiyang disease at six or seven days, with a slow, floating, and weak pulse, aversion to wind and cold, warm hands and feet, if the physician has used purging two or three times, resulting in inability to eat, distention and pain below the rib-side, yellowing of the face, eyes, and body, stiff neck, and difficult urination, give Xiao Chaihu Tang (Minor Bupleurum Decoction). Afterward, there will definitely be tenesmus. If the patient was originally thirsty and vomits after drinking water, Chaihu Tang is no longer appropriate. Hiccups will occur after eating grain.
For cold damage at four or five days, if there is body heat, aversion to wind, stiff neck, distention below the rib-side, warm hands and feet, and thirst, treat it with Xiao Chaihu Tang (Minor Bupleurum Decoction). (Formula seen above.)
In cold damage, if the inch pulse is rough and the cubit pulse is tight, it should logically cause acute abdominal pain. First administer Minor Center-Fortifying Decoction (Xiao Jian Zhong Tang); if not cured, give Minor Bupleurum Decoction (Xiao Chai Hu Tang). (Formula seen above.)
Minor Center-Fortifying Decoction formula:
Cinnamon twigs 3 liang, Peony 6 liang, Licorice 2 liang, Fresh ginger 3 liang (cut), Chinese dates 12 pieces (split), Malt syrup 1 sheng.
These six ingredients, use 7 sheng of water. First boil five ingredients, take 3 sheng, remove the dregs, add the malt syrup, then dissolve over low heat. Warm one dose of 1 sheng, take three times daily. Vomiting patients cannot use it, because of the sweet flavor.
In cold damage and wind strike, if there is a Bupleurum Decoction pattern, seeing only one symptom is sufficient; it is not necessary to have all of them.
Whenever a Bupleurum Decoction disease pattern has been mistakenly treated with purging, if the Bupleurum pattern has not disappeared, administer Minor Bupleurum Decoction again. The patient will certainly experience steaming heat and shivering, then fever with sweating, and the disease will resolve.
In cold damage of two or three days, if there is palpitation and vexation, use Minor Center-Fortifying Decoction as the main treatment. (Formula seen above.)
In a taiyang disease, after the course of the channel has passed for ten or more days, if purging has been mistakenly applied two or three times, and then after four or five days the Bupleurum pattern still exists, first administer Minor Bupleurum Decoction. If vomiting does not stop, there is epigastric constraint, and a feeling of depression with slight vexation, the disease is not yet resolved. Use Major Bupleurum Decoction to purge, and it will be cured.
Major Bupleurum Decoction formula:
Bupleurum half a jin, Scutellaria 3 liang, Peony 3 liang, Pinellia half a sheng (washed), Fresh ginger 5 liang (cut), Immature bitter orange 4 pieces (roasted), Chinese dates 12 pieces (split), Rhubarb 2 liang.
These eight ingredients, use 1 dou 2 sheng of water. Boil to obtain 6 sheng, remove the dregs, then decoct again. Warm one dose of 1 sheng, take three times daily.
In cold damage of thirteen days not resolving, there is fullness in the chest and flanks with vomiting, tidal fever appearing at around three to five in the afternoon, followed by mild diarrhea. This was originally a Bupleurum pattern. Using purging, there should be no free passage, but now there is free passage, indicating that a doctor used pill-type medicines to purge, which is not the correct method. Tidal fever indicates internal excess. One should first take Minor Bupleurum Decoction to relieve the exterior pattern, then use Bupleurum plus Mirabilite Decoction as the main treatment.
Bupleurum plus Mirabilite Decoction formula:
Bupleurum 2 liang 16 zhu, Scutellaria 1 liang, Ginseng 1 liang, Licorice 1 liang (roasted), Fresh ginger 1 liang (cut), Mirabilite 2 liang, Chinese dates 4 pieces, Pinellia 20 zhu (washed).
These eight ingredients, use 4 sheng of water. Boil to obtain 2 sheng, remove the dregs, add the mirabilite, then boil until slightly bubbling. Divide into two warm doses. If not resolved, prepare again.
In cold damage of thirteen days, after the channel has passed, if there is delirium, it is because of heat. One should use a decoction to purge. If urination is free, the stool should be hard. If there is instead diarrhea, it indicates that a doctor used pill-type medicines to purge, which is not the correct method. If there is spontaneous diarrhea, the pulse should be faint and faint-cold. If instead it is harmonious, this is internal excess. Use Regulate the Stomach and Order the Qi Decoction (Tiao Wei Cheng Qi Tang) as the main treatment. (Formula seen above.)
In a taiyang disease not resolving, if heat has bound in the bladder, the patient is like one who is manic, and static blood spontaneously discharges downward. If it discharges, the patient will be cured. If the exterior pattern is not resolved, one still cannot attack downward. One should first resolve the exterior pattern. After the exterior pattern is resolved, if only the lower abdomen is tense and bound, then one can attack downward. It is appropriate to use Peach Kernel Qi-Coordinating Decoction (Tao Ren Cheng Qi Tang).
Peach Kernel Qi-Coordinating Decoction formula:
Peach kernels 50 pieces (remove skin and tip), Rhubarb 4 liang, Cinnamon twigs 2 liang, Licorice 2 liang (roasted), Mirabilite 2 liang.
These five ingredients, use 7 sheng of water. Boil four ingredients, take 2 sheng, remove the dregs, add the mirabilite, then bring to a slight boil over fire. Remove from heat, eat first, then take a warm dose of 5 ge, three times daily. There should be mild diarrhea.
In cold damage of eight or nine days, after using purging, there is chest fullness, vexation, palpitations, unsmooth urination, delirium, heavy body unable to turn over. Use Bupleurum plus Dragon Bone and Oyster Shell Decoction as the main treatment.
Bupleurum plus Dragon Bone and Oyster Shell Decoction formula:
Bupleurum 4 liang, Dragon bone 1.5 liang, Scutellaria 1.5 liang, Fresh ginger 1.5 liang, Ginseng 1.5 liang, Cinnamon twigs 1.5 liang (peeled), Poria 1.5 liang, Pinellia 2.5 ge (washed), Rhubarb 2 liang, Oyster shell 1.5 liang, Chinese dates 6 pieces (split), Lead dan 1.5 liang.
These twelve ingredients, use 8 sheng of water. Boil to obtain 4 sheng, add the rhubarb (cut into pieces the size of chess pieces), then boil once or twice. Remove the dregs, take a warm dose of 1 sheng, three times daily, and once at night.
In cold damage, with abdominal distension, delirium, a floating and tight inch pulse, and a tight bar pulse, this is the liver wood taking advantage of the spleen earth. It is called "vertical." Needle the Liver Shu point (Qimen).
In cold damage with fever, fear of cold and withdrawal, great thirst wanting to drink water, there must be abdominal distension, spontaneous sweating, unsmooth urination, a floating and rough inch pulse, and a tight and rapid bar pulse. This is the liver wood taking advantage of the lung metal. It is called "horizontal." Needle the Liver Shu point (Qimen).
In a taiyang disease of two days, with vexation, if one instead uses fire to iron the back, causing profuse sweating, fire heat enters the stomach, the stomach fluids dry up, and there is vexation. This will certainly cause delirium. After ten or more days, if there is shivering and trembling with spontaneous diarrhea, the disease is about to resolve. If sweating does not occur below the waist, there is a desire to urinate but inability, instead there is vomiting, a feeling of losing control, fear of wind under the feet, hard stool, frequent urination should occur but instead it is not copious. After a bowel movement, there is sudden headache, and the soles of the feet will certainly be hot. This is because the water and grain qi flows downward.
In taiyang disease wind strike, using the fire method to induce sweating, the wind pathogen is forced by fire heat. The qi and blood flow and spill, losing their normal regulation. The two yang of wind and fire mutually scorch each other, and the body becomes yellow. If yang is exuberant, there will be nosebleed; if yin is vacuous, urination is difficult. When both yin and yang are vacuous and exhausted, the body becomes dry and withered. Only the head sweats, stopping at the neck. There is abdominal distension with mild panting, dry mouth and sore throat, or no bowel movement. After a long time, delirium occurs. In severe cases, even hiccough occurs, with restless hands and feet, picking at clothes and touching the bed. If urination is free, the patient can be treated. It is appropriate to use Ginseng, Rehmannia, Dragon Bone, Oyster Shell, and Poria Decoction.
Ginseng, Rehmannia, Dragon Bone, Oyster Shell, and Poria Decoction formula:
Ginseng 3 liang, Rehmannia half a jin, Dragon bone 3 liang, Oyster shell 4 liang, Poria 4 liang.
These five ingredients, use 1 dou of water. Boil to obtain 3 sheng. Divide into three warm doses.
In cold damage with a floating pulse, if a doctor uses fire to forcibly induce sweating, there will be loss of yang qi, and there will certainly be mania and fright, with inability to rest peacefully in lying down or sitting. Use Cinnamon Twig Decoction minus Peony plus Oyster Shell and Dragon Bone to Rescue from Rebellion Decoction as the main treatment.
Cinnamon Twig Decoction minus Peony plus Oyster Shell and Dragon Bone to Rescue from Rebellion Decoction formula:
Cinnamon twigs 3 liang, Licorice 2 liang (roasted), Fresh ginger 3 liang (cut), Chinese dates 12 pieces (split), Oyster shell 5 liang (roasted), Dragon bone 4 liang.
These six ingredients, use 1 dou 2 sheng of water. Boil to obtain 3 sheng, remove the dregs. Take a warm dose of 1 sheng, three times daily.
Symptoms resembling cold damage, but the pulse is not tight or wiry, but weak. A weak pulse will certainly cause thirst. If fire is applied, there will certainly be delirium. If the pulse is weak with fever and floating, inducing sweating to resolve the exterior should cause sweating and cure it.
In a taiyang disease, using fire smoking, if there is no sweating, the patient will certainly be vexed. If it does not resolve at the end of the channel period, there will certainly be bloody stool. This is called fire pathogen.
If the pulse is floating and the heat is very intense, and one instead uses fire moxibustion as treatment, this is an excess pattern. Treating an excess pattern as if it were vacuity, because of the fire heat, there will certainly be dry throat and spitting of blood.
When the pulse is faint and rapid, moxibustion must absolutely not be used, because the fire heat will become a pathogen. It will then cause vexation and qi counterflow, consuming the right qi and assisting the pathogen, causing the blood to scatter within the vessels. Although the fire qi is small, its internal attacking power is very strong. It can scorch the sinews and bones, making it difficult for the blood to recover.
When the pulse is floating, one should use the sweating method to resolve the pathogen. If fire moxibustion is used as treatment, the pathogen has no outlet, and instead becomes more severe because of the fire heat. The disease will manifest as heaviness and numbness below the waist. This is called "fire rebellion." If the disease is about to resolve on its own, there will certainly be vexation first, then sweating and resolution. How is this known? Because the pulse is floating.
Using a burning needle to force sweating, if the needled site is invaded by cold, there will be a raised, red lump like a kernel. This will certainly trigger running piglet. If qi rushes upward from the lower abdomen to the heart, apply one moxa cone on each kernel, and administer Cinnamon Twig plus Cinnamon Decoction.
Cinnamon Twig plus Cinnamon Decoction formula:
Cinnamon twigs 5 liang, Peony 3 liang, Fresh ginger 3 liang (sliced), Licorice 2 liang (roasted), Chinese dates 12 pieces (split).
These five ingredients, use 7 sheng of water. Boil to obtain 3 sheng, remove the dregs. Take a warm dose of 1 sheng, three times daily.
In fire rebellion pattern, after using purging, and also because of a burning needle causing vexation, use Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction as the main treatment.
Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction formula:
Cinnamon twigs 1 liang, Licorice 2 liang (roasted), Dragon bone 2 liang, Oyster shell 2 liang (roasted).
These four medicinals, using five sheng of water, decoct to obtain three sheng, remove the dregs, and take one sheng warm, three times daily. In severe cases, add three liang of ginseng.
In a taiyang cold damage pattern, if a warm needle is used, there will inevitably be fright and palpitations.
In taiyang disease, there should originally be aversion to cold and fever; now instead there is spontaneous sweating, and instead there is no aversion to cold or fever, and the guan pulse is fine and rapid. This is due to the error of the physician who mistakenly used emetic therapy. If the disease has been present for one or two days and emesis was mistakenly applied, the patient will feel hunger in the abdomen but cannot eat; if the disease has been present for three or four days and emesis was mistakenly applied, the patient will dislike thin gruel, desire cold food, eat it in the morning and vomit it in the evening—this is a relatively mild rebellious pattern. If there is no aversion to cold and the patient is unwilling to approach clothing, this is internal vexation and heat. All of these are caused by the physician's mistaken use of emetic therapy.
The patient's pulse is rapid. A rapid pulse indicates heat, and it should be able to digest food and drink. Now, although the patient desires to eat, they instead vomit. This is because sweating has caused yang qi to become depleted, and the diaphragm qi is insufficient, so the pulse appears rapid. This rapid pulse is vacuity heat; therefore it cannot digest food and drink. Because the stomach is vacuous and cold, vomiting occurs.
In taiyang disease, after the pathogen has passed through the channel for ten or more days, there is oppression in the heart with a desire to vomit, pain in the chest, the stool is instead thin and loose, the abdomen is slightly distended and full, and there is mental depression with mild vexation. Before the appearance of these symptoms, if the patient has personally forced vomiting or vigorously attacked downward, then Tiao Wei Cheng Qi Tang can be given. If this is not the case, it cannot be given. If there is only a desire to vomit, pain in the chest, and the stool is slightly thin and loose, this is not a Chai Hu Tang pattern. The reason for this is that from the vomiting it can be inferred that it was caused by forced vomiting or vigorous attack downward. (Tiao Wei Cheng Qi Tang formula is seen in the previous scroll.)
In taiyang disease, after six or seven days, the exterior pattern is still present, the pulse is faint and deep, yet there is no formation of chest bind, and the patient develops mania. This is because the heat pathogen is located in the lower burner, and the lower abdomen should be hard and distended. If the urination is free, purging static blood will bring recovery. The reason for this is that the pathogen from the taiyang channel has entered the interior along the channel, and static heat has accumulated within the body. Use Di Dang Tang to govern.
Di Dang Tang Formula:
Thirty leeches (dry-fry), thirty gadflies (remove wings and feet, dry-fry), twenty peach kernels (remove skin and tip), three liang of rhubarb (wash with wine).
These four medicinals, using five sheng of water, decoct to obtain three sheng, remove the dregs, and take one sheng warm. If there is no purging, it can be taken again.
In taiyang disease, the body is yellow, the pulse is deep and bound, the lower abdomen is hard, and urination is not free—this is without blood accumulation. If urination is free and the patient appears as if manic, this is conclusive evidence of blood accumulation. Use Di Dang Tang to govern. (Formula seen above.)
In cold damage disease, there is fever, the lower abdomen is full, and it stands to reason that urination should not be free. Now if it is instead free, this is internal static blood, and the static blood should be attacked downward. Di Dang Wan can be used for treatment; it is not necessary to use a decoction.
Di Dang Wan Formula:
Twenty leeches (dry-fry), twenty gadflies (remove wings and feet, dry-fry), twenty-five peach kernels (remove skin and tip), three liang of rhubarb (wash with wine).
These four medicinals, pound into four pills. Using one sheng of water, decoct one pill, and take seven ge. After one day and night, static blood should be discharged. If none is discharged, it can be taken again.
In taiyang disease, if urination is free, it is because of excessive water drinking, and there will inevitably be palpitations below the heart. If the urine volume is scanty, there will inevitably be a sensation of urgency in the lower abdomen.