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Shāng Hán Lùn On Cold Damage

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An Eighteen-hundred-year-old Chinese Medical
T专xt on Externally Contracted Disease
by Zhang
]'i (Zhang Zhδng-]tng)
SHANG
林 险在 “龟酬幽
LUN
ON CoLD DAMAGE
Translation & Commentaries
E
A
R
L
L
H
C
T
M、1
G
IG
CF
回
HAN
N
’
E
NIGEL WISEMAN
号费
PARADIGM PUBLICATIONS
Brookli肘,Massachusetts
SHANG HAN LUN
On Cold Damage
伤寒论译释
Craig Mitchell,
Feng Y色,and Nigel Wiseman
Copyright © Paradigm Publications
44 Linden Street
Brookline, MA 02445 USA
Library of Congress Cataloging-in-Publication Data:
Chang, chung-ching, fl. 168 196.
[Shang han Lun. E吨lish]
Shang han lun = On cold damage / translation and commentaries
Craig Mitchell, Feng Ye, and Ni ge l Wiseman
p. cm.
Includes index.
ISBN 0-912111 57 7 (alk. paper)
Medicine, Chinese. I. Mitchell, Craig, 1966一 . II. Feng Ye, 1967III. Wiseman, Nigel. IV. Title. V. Title: On cold damage.
R60 1 . C425 13 1999
99 21069
610'.951- -dc21
CIP
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system or transmitted in any form by any means, electronic, mechanical,
photocopying, recording or otherwise, without the prior written permission of the
publisher.
Library of Congress Number: 99-21069
International Standard Book Number ( ISBN): 0-912111-57-7
Printed in the United States of America
Contents
XI
Preface
xv
Acknowledgements
149MqdA吐
吁’QdQunvqdA啥
VO阿t QUQU Od --
-qo
’i唱lτ-1i’iti
’i唱iqL叶,“
Introduction
The
The
The
The
The
Author
History of the Text
Relationship of the Shang H归Lim to the Su Wen . .
Development of Shang Han Lt'm Thought . .
Contents of the Shang Han Lim
The Concept of Cold Damage .
Six-Channel Pattern Identification .
Eight-Principle Pattern Identification . .
Bowel and Visceral Pattern Identification . . .
Diagnostic Difficulties . . . . .
Passage and Transmutation
Treatment
The Language of the Shang Han Lun . . . . .
Terms
Stylistic Features
Solving Ambiguities . .
Zhang
JI's
I. Greater
27
Preface
Yang
33
Disease
l. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.1 Signs and Pulses . . . . . . . . . . . . . . . . . . . . . . . . .
1.2 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.3 Schematic Overview
. . . . . . . . . . . . . . . . . . . . . . .
2. Essential Features of Greater Yang Disease . . . . . . . . . . . . . .
2.1 Identification of Disease Passage and Periods of Resolution . .
2.2 Section Appendix: Periods of Resolution for the Six Channels
3. Basic Greater Y缸g Disease Patterns
. . . . . . . . . . . . . . . . .
.
.
33
34
.
35
.
37
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41
.
52
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55
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58
IV
CONTENTS
u kd。onu
oo nu
月4月dn臼
vhuvhu
3 . 1 Wind Strike Exterior Vacuity Patterns
3. 1 . 1 Cinnamon Twig Decoction Patterns .
3. 1 . 2 Contraindications for Cinnamon Twig Decoction .
3. 1 . 3 Concurrent Patterns
3 . 2 Cold Damage Exterior Repletion Patterns .
3 . 2 . 1 Ephedra Decoction Pattern . . . .. . . . . . . . . . . 91
3 . 2 . 2 Contraindications for Ephedra Decoction . . . . . . . . 100
3.2.3 Concurrent Patterns . . . . . . . . . . . . . . . . . . . 1 08
3 .3 Mild Patterns of Exterior Depression . . . . . . . . . . . . . . . 121
4 . τ'ransmuted Patterns of Greater Y8.ng Disease . . .. . . . . . . . . . 13 1
4 . 1 Treatment Principles for Transmuted Patterns . . . . . . . . . . 13 2
4.2 Differentiation of Vacuity and Repletion Patterns . . . . . . . . 133
4 .3 Cold and Heat: Differentiation of τ'rue and False Patterns . . . 135
4. 4 Identifyin� the Order of the Promotion of Sweating and Use of
Precipitation . . . . . . . . . . . . . . . . . . . . . . . . . . 139
4. 5 Heat Patterns . . . . . . . . . . . . . . . . . . . . . . .. . . . . 142
4 . 5 . 1 Gardenia and Fermented Soybean Decoction Patterns . 1 43
4 . 5 . 2 Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction Patterns . . . . . . . . . . . . . . . . . . . . . 1 5 4
4 . 5 . 3 White Tiger Decoction Plus Ginseng Patterns .
. . . . 1 56
4 . 5 . 4 Pueraria, Scutellaria, and Coptis Decoction Patterns . 158
4 . 5 . 5 Scutellaria Decoction and Scutellaria Decoction Plus
Pinellia and Fresh Ginger Patterns . . . . . . . . . 15 9
4 .6 Vacuity Cold Patterns . . . . . . . . . . . . . . . . . . ... . . 1 61
4 .6. 1 Heart Yang Vacuity Patterns . . . . . . . . . . . . . . 161
Cinnamon Twig and Licorice Decoction Patterns . . . 162
Cinnamon Twig, Licorice, Dragon Bone, and Oyster
Shell Decoction Patterns. . . . . . . .
. . 163
Cinnamon Twig Minus Peony Plus Dichroa, Dragon
Bone, and Oyster Shell Counterflow-Stemming
Decoction Patterns . . . . . . . . . . . . . 165
Cinnamon Twig Decoction Plus Extra Cinnamon Patterns . . . . . . . . . . . . . . . . . . ... 167
4.6.2 Yang Vacuity and Water Qi Patterns . . . . . . . . . . 169
Poria ( Hoelen ) , Cinnamon Twig, Licorice, and Jujube
Decoction Patterns . . . . ... . . . . .. 169
Poria ( Hoelen ) , Cinnamon Twig, Ovate Atractylodes,
and Licorice Decoction Patterns . . . . . . 171
Cinnamon Twig Decoction Minus Cinnamon Twig Plus
Poria ( Hoelen ) and Ovate Atractylodes Patterns . . . . . . . . . . . . . . . . . . . . . 173
4 . 6 . 3 Spleen Vacuity Patterns . . . . . . . . . . . . . . . . . 176
C ONTENTS
v
Magnolia Bark, Fresh Gin�er, Pinellia, Licorice, and
Ginseng Decoction Patterns . . . . . . . . 176
Minor Center-Fortifying Decoction Patterns . . . . . 178
Cinnamon Twig and Ginseng Decoction Patterns
179
4.6.4 Kidney Yang Vacuity Patterns . . . . . . . . . . . . . 181
Dried Ginger and Aconite Decoction Patterns . . . . 181
Poria (Hoelen) Counterflow Cold Decoction Patterns 1 83
True Warrior Decoction Patterns
185
4.7 Yrn and Yang Vacuity Patterns . . . . . . . . . . . . . . . . . . 187
4.7.l Licorice and Dried Ginger Decoction Patterns and Peony and Licorice Decoction Patterns . . . . . . . . 187
4.7.2 Peony, Licorice, and Aconite Decoction Patterns . . . . 190
4.7.3 Honey-Fried Licorice Decoction Patterns . . . . . . . . 191
4.8 Water Amassment Patterns . . . . . . . . . . . . . . . . . . . . 194
4.9 Blood Amassment Patterns
202
4.10 Chest Bind Patterns . . . . . . . . . . . . . . . . . . . . . . . . 210
4.10.1 Heat Repletion Chest Bind Patterns . . . . . . . . . . 212
Major Chest Bind Pill Patterns . . . . . . . . . . . . 212
Major Chest Bind Decoction Patterns . . . . . . . . . 215
Minor Chest Bind Decoction Patterns . . . . . . . . . 222
4.10.2 Cold Repletion Chest Bind Patterns . . . . . . . . . . 223
4.11 Storehouse Bind Patterns . . . . . . . . . . . . . . . . . . . . . 225
4.12 Glomus Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . 228
4.12.1 Heat Glomus Patterns . . . . . . . . . . . . . . . . . . 230
Rhubarb and Coptis Heart-Draining Decoction Patterns230
Aconite Heart-Draining Decoction Patterns . . . . . . 233
4.12.2 Cold-Heat Complex Glomus Patterns . . . . . . . . . 234
Pinellia Heart-Draining Decoction Patterns . . . . . . 234
Fresh Ginger Heart-Draining Decoction Patterns . . . 237
Licorice Heart-Draining Decoction Patterns . . . . . . 239
4.12.3 Severe Patterns of Effiux Desertion, Glomus, and Diarrhea Affecti吨the Lower Burner (Halloysite and
Limonite Decoction Patterns) . . . . . . . . . . . . 242
4.12.4 Water Glomus Patterns (Poria Five Powder Patterns) 244
4.12.5 Phlegm Qi Glomus Patterns (Inula and Hematite De­
coction Patterns) . . . . . . . . . . . . . . . . . . . 245
4.13 Upper Burner Heat and Lower Burner Cold Patterns: Coptis
Decoction Patterns . . ‘………………. . 247
4 .14 Adverse Treatment by Fire Patterns . . . . . . . . . . . . . . . 249
4.15 Recovery Pattern Identification . . . . . . . . . . . . . . . . . . 258
5. Patterns Similar to Greater Yang Disease . . . . . . . . . . . . . . . . 263
5 .1 Ten Jujubes Decoction Patterns . . . . . . . . . . . . . . . . . . 263
Vl
CONTENTS
5 .2 Melon Stalk Powder Patterns . . . . . . . . . . . . . . . . . . . 266
6 . Chapter Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
II. Yang Brightness Disease
1 . Overview . .
1 .1 Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 .2 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.3 Schematic Overview . . . . . . . . . . . . . . . . . . . . . . . .
2. Essential Features of Yang Brightness Disease
2.1 Causes and Pathomechanisms . . . . . . . . . . . . . . . . . . .
2 .2 Pulses and Signs . . . . . . . . . . . . . . . . . . . . . . . . . .
3 .1 Heat Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.1.1 Gardenia and Fermented Soybean Decoction Patterns .
3 .1.2 White Tiger Decoction Patterns . . . . . . . . . . . . .
3.1.3 White Tiger Decoction Plus Ginseng Patterns . . . . .
3 .1 . 4 Polyporus Decoction Patterns . . . . . . . . . . . . . .
3.2 Repletion Patterns . . . . . . . . . . . . . . . . . . . . . . . . .
3 .2 .1 Qi-Coordinating Decoction Patterns . . . . . . . . . . .
Stomach-Regulating Ql-Coordinating Decoction Patterns . . . . . . . . . . . . . . . . . . . . .
Minor Ql-Coordinating Decoction Patterns . . . . . .
Major Ql-Coordinating Decoction Patterns . . . . . .
3.2.2 Moistening and Enema Patterns . . . . . . . . . . . . .
3 .2 .3 Precipitation Pattern Identification . . . . . . . . . . .
3 .2.4 Contraindications for Precipitation . . . . . . . . . . .
4 . y缸ig Brightness Disease and ’Transmuted Patterns . . . . . . . . . . .
4.1 Yellowing Patterns . . . . . . . . . . . . . . . . . . . . . . . . .
4.2 Blood Heat Patterns . . . . . . . . . . . . . . . . . . . . . . . .
5 . Yang Brightness Disease Pattern Identification . . . . . . . . . . . . .
5.1 Differentiation of Wind Strike and Cold Strike Patterns . . . . .
5.2 Differentiation of Vacuity and Repletion Patterns . . . . . . . .
6 . Chapter Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
297
III. Lesser Yang Disease
1. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 .1 Pulses and Signs . . . . . . . . . . . . . . . . . . .
1.2 Treatment . . . . . . . . . . . . . . . . . . . . . . .
1.3 Schematic Overview . . . . . . . . . . . . . . . . .
2 . Essential Features of Lesser Yang Disease . . . . . . . . .
3 . Basic Lesser Y缸g Disease Patterns . . . . . . . . . . . .
3 .1 Minor Bupleurum Decoction Patterns . . . . . . . .
3.2 Contraindications for Minor Bupleurum Decoction.
403
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2 97
298
299
300
301
302
308
312
312
316
320
324
327
327
327
331
336
351
356
363
367
367
376
382
382
388
393
403
404
40 5
406
407
410
410
426
CONTENTS
vu
4. Lesser Yang Disease and Transmuted Patterns
428
4. 1 Treatment Principles for Transmuted Patterns . . . . . . . . . . 428
4.2 Bupleurum and Cinnamon Twig Decoction Patterns . . . . . . . 429
4.3 Major Bupleurum Decoction Patterns . . . . . . . . . . . . . . . 431
4.4 Bupleurum Decoction Plus Mirabilite Patterns . . . . . . . . . . 434
4.5 Bupleurum, Cinnamon Twig and Dried Ginger Decoction Patterns437
4.6 Bupleurum Decoction Plus Dragon Bone and Oyster Shell Patterns439
4. 7 Disease Passage and Prognosis . . . . . . . . . . . . . . . . . . . 442
4.8 Section Appendix: Heat Entering the Blood Chamber . . . . . . 444
5. Chapter Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448
IV. Greater Yin Disease
1.
2.
3.
4.
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 . 1 Pulses and Signs
1.2 Treatment . . . . . . . . . . . . . . . . . . . . . . . .
1.3 Schematic Overview . . . . . . . . . . . . . . . . . .
Essential Features of Greater Yin Disease . . . . . . . . . .
2 . 1 Period of Resolution for Greater Yin Disease . . . . .
Basic Greater Yin Disease Patterns . . . . . . . . . . . . .
Greater Yin Disease and τ'ransmuted Patterns . . . . . . .
4. 1 Greater Yin Disease and Exterior Patterns . . . . . .
4.2 Greater Yin Abdominal Pain Patterns . . . . . . . .
4.3 Greater Yin Disease Shifting to Recovery and Shifting
Brightness . . . . . . . . . . . . . . . . . . . . . .
. . . . . .
451
45 1
451
452
452
453
454
455
456
456
457
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. . . . . .
into Y缸ig
. . . . . . 461
V . Lesser Yin Disease
1. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 . 1 Pulses and Signs . . . . . . . . . . . . . . . . . . . . . . . . . .
1 . 2 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 .3 Schematic Overview . . . . . . . . . . . . . . . . . . . . . . . .
2 . Essential Features of Lesser Yin Disease . . . . . . . . . . . . . . . . .
2 . 1 Primary Pulse and Signs of Cold Transformation Patterns . . .
2.2 Contraindications for the ’Treatment of Lesser Yin Disease . . .
3. Basic Lesser Yin Disease Patterns . . . . . . . . . . . . . . . . . . . .
3. 1 Cold τ恼,nsformation Patterns . . . . . . . . . . . . . . . . . . .
3 . 1 . 1 Counterflow Cold Decoction Patterns . . . . . . . . . .
3. 1 . 2 Vessel-Freeing Counterflow Cold Decoction Patterns . .
3 .1 .3 Scallion [Y缸g-]Freeing D eco cti on and Scallion [Yang] Freeing Decoction Plus Pig’s Bile Patterns . . . .
3 . 1 . 4 True Warrior Decoction Patterns . . . . . . . . . . . .
3 . 1 . 5 Aconite Decoction Patterns . . . . . . . . . . . . . . .
3. 1 .6 Evodia Decoction Patterns . . . . . . . . . . . . . . . .
465
4 65
465
467
4 68
469
4 69
4 74
4 75
475
475
478
480
483
486
489
Vlll
C ONTENTS
3 . 1 . 7 Peach Blossom Decoction Patterns . . . . . . . . . . .
3 .1 . 8 Needling and Moxibustion . . . . . . . . . . . . . . . .
3 .1 .9 Progno咀is . . . . . . . . . . . . . . . . . . . . . . . . .
Treatable Patterns of Y归g Return and Spontaneous
Recovery . . . . . . . . . . . . . . . . . .
Untreatable Patterns of Yang Collapse . . . . . . . .
3 . 2 Heat τ'ransformation Patterns . . . . . . . . . . . . . . . . . . .
3 .2.1 Coptis and Ass Hide Glue Decoction Patterns . . . . .
3 . 2 . 2 Polyporous Decoction Patterns . . . . . . . . . . . . .
4. Lesser Yin Disease and Transmuted Patterns . . . . . . . . . . . . . .
4 . 1 Ephedra, Aconite, and Asarum Decoction Patterns . . . . . . .
4.2 Urgent Precipitation . . . . . . . . . . . . . . . . . . . . . . . .
4.3 Counterflow Cold Powder Patterns . . . . . . . . . . . . . . . .
4 . 4 Patterns o f Heat Shifting into the Bladder . . . . . . . . . . . .
4. 5 Patterns of Fluid Damage and Blood Stirring . . . . . . . . . .
5 . Sore Throat Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 . 1 Pig Skin Decoction Patterns . . . . . . . . . . . . . . . . . . . .
5 . 2 Licorice Decoction and Platycodon Decoction Patterns .. . . .
5 . 3 Vinegar Decoction Patterns . . . . . . . . . . . . . . . . . . . .
5 . 4 Pinellia Powder and Decoction Patterns . . . . . . . . . . . . .
6 . Chapter Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
490
493
495
495
498
502
5 02
504
506
506
509
511
513
5 14
5 16
516
517
518
520
521
VI. Reverting Yin Disease
523
1. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
1 . 1’l'reatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
1 . 2 Schematic Overview . . . . . . . . . . . . . . . . . . . . . . . . 524
2 . Essential Features of Reverting Yin Disease . . . . . . . . . . . . . . . 526
3 . Upper Heat and Lower Cold Patterns . . . . . . . . . . . . . . . . . . 527
3 . 1 Mume Pill Patterns . . . . . . . . . . . . . . . . . . . . . . . . . 527
3 . 2 Dried Ginger, Scutellaria, Coptis, and Ginseng Decoction Patterns530
3.3 Ephedra and Cimicifuga Decoction Patterns . . . . . . . . . . . 532
4 . Differentiation of Overcoming or Relapse in Reversal Heat Patterns . . 5 3 4
5 . ldenti直cation of Reversal Patterns . . . . . . . . . . . . . . . . . . . . 541
5 . 1 Pathomechanism and Special Signs of Reversal Patterns . . . . 542
5.2 Heat Reversal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
5 . 3 Cold Reversal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546
5 . 3 . 1 Reversal from Yang Vacuity and Exuberant Cold . . . 546
5 . 3 . 2 Reversal from Blood Vacuity and Congealed Cold . . . 547
5 . 3 . 3 Reversal from Cold Bind in the Lower Burner . . . . . 551
5 . 3 . 4 Reversal Patterns and Moxibustion . . . . . . . . . . . 551
5 . 4 Other Reversal Patterns . . . . . . . . . . . . . . . . . . . . . . 552
IX
CONTENTS
P hle gm Reversal
552
5.4.2 Water Reversal
553
5.5 Contraindications for the τ'reatment of Reversal Patterns . . . . 554
Identification of Diarrhea Patterns . . . . . . . . . . . . . . . . . . . . 557
Identification of Retching and Hiccup Patterns . . . . . . . . . . . . . 564
7.1 Identification of Retchi ng Patterns . . . . . . . . . . . . . . . . 564
7.2 Iden tification of Hiccup Pat terns . . . . . . . . . . . . . . . . . 567
Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
8.1 Identification of Signs of Recovery in Cold Patterns . . . . . . . 569
8.2 Identification of Signs of Imp e nding Death in Vacuity Cold Pattems570
8.3 Identi且cation of Scenarios in Va c uity Cold Diarrhea Patterns . . 576
Chapter Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578
5.4.1
6.
7.
8.
9.
VII.
Sudden Turmoil
581
5568
030303n3
5555
Yin-Yang Exchange and Z边xation Relapse
1. Overview . .
2 . Yin-Yang Exchange
3. Taxation Relapse
VIII.
Appendixes
607
Appendix I: Text in Song Version Order . . . . . . . . . . . . . . . . . 607
Appendix II: Shang Han Um L angu age Study . . . . . . . . . . . . . . 633
Grammar
634
Vocabulary
658
甲·『414
0000nud
au RU EU
Bibliography
Shiing Han Lim Literature .
.
Sources Used
Indexes
Song Version Line Number Index . . . .
English Index of Terms . . . . . . . . . .
Pinyin Index of Terms . . . . . . . . . .
English Index of Medicinals & Formulae
Pinyin Index of Medicinals & Formulae .
693
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693
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713
731
740
Preface
自
序
Over the last five decades, attempts have been made in the People’s Republic of
China to distill all that is valuable amid the vast mass of traditional medical lit­
erature into a systematized body of knowledge. This is the inevitable outcome
of the challenge by Western medicine and the Western sciences. Throughout the
Chinese-speaking world, Western medicine has established itself 臼 the mainstream
medicine; scientific values dominate all fields of learning, and education is based
very closely on Western models. Despite this, there町e hopes in China that by
discovering its scientific bases, traditional medicine will evolve into a scientific dis­
cipline that can be integrated with modern medicine. So far, however, such efforts,
valid and necessary though they may be, have been unable to escape the fact that
Chinese medicine, rooted in the past, has for centuries looked back to its formative
period as a golden age, and that even today a sound knowledge of the classics is
still needed to gain a firm understanding of Chinese medicine.
The impressive array of Chinese medical literature now available in English
largely derives from the recent Chinese effort to distill what is valuable from the
knowledge of the past. In content and presentation, English textbooks of Chinese
medicine are English versions, for the most part simplified, of the primers used in
China. Nevertheless, the lamentable fact that remains is that while traditional ap­
proaches to Chinese medicine are still accessible to modern Chinese people, they are
unavailable to Westerners without linguistic access to the wealth of Chinese texts.
Anyone who, penetrating the language barrier, engages in the study of Chinese
texts, and goes to China to witness the teaching and practice of Chinese medicine in
the Chinese-language environment soon realizes that the classical literature contin­
ues to provide an invaluable source of information for advanced students. The sheer
volume of Chinese medical thought makes its complete transmission to the West
almost impossible. Nonetheless, until the seminal classical texts and traditional
commentaries are translated and widely read, Chinese medicine as transmitted to
the West will continue to lack an essential element that it h副on its home soil.
The earliest cl臼sics generally deemed to be the greatest seminal works of Chι
nese medicine are the Nei Jzng, the Nan Jzng, and the Shiing Han Um . Of these,
the Shiing Han Lim "On Cold Damage," attributed to Zhang JI ( 张机 , style伸景
Zhbng- Jing ) , who lived about 1 50-219 c.E., is undoubtedly the text of greatest
Xll
PREFACE
clinical relevance to the majority of those Chinese practitioners who use medicinal
therapy rather than acupuncture幽their principal method of treatment. While
the Nei Jfng and the Nan Jfng are studied for the theoretical elements that were
considered important by successive generations of physicians, the Shang Han Lun is
studied very much for its clinical value. Not only was the Shiing Han Lun the first
comprehensive and detailed treatise on externally contracted disease, it was also the
first attempt to incorporate medicinal therapy, previously practiced with a mini­
mum of theory, into the medicine of systematic correspondences and the channels
and network vessels. It is a seminal work in the development of a holistic under­
standing of disease conditions that considers not only the offending disease evil but
also the patient’s resistance to it; that is, an understanding of dise槌e in which the
focus is on patterns (证zheng) -groups of related symptoms-rather than specific
“diseases.” The Shang Han Lun was far ahead of its time in both theory and prac­
tice, and, not surprisingly therefore, the medicinal formulae it contains constitute
an important part of the modern formulary. Given the Western interest in the clin­
ical application of Chinese medicine rather than the historical evolution of medical
thought in China, the Shang Han Lun , of all the classical texts, is without doubt
the one that stands the greatest chance of evoking interest among Westerners, at
least those interested in Chinese medicinal therapy.
Despite the clinical interest that it attracts, the Shang Han Lun, as indeed other
ancient texts, is not easy reading-even for Chinese students. It is an ancient text
whose original form in the Shang Han Za Bing Lun ( 伤寒杂病论 “On Cold Damage
and Miscellaneous Diseases” ) has been lost . The阻缸t order of the original lines is
no longer known, and their content may have been changed through mistranscrip­
tion and possible deliberate reworking. Material is not presented as systematically
as in modern literature; there are many ambiguities that have given rise to endless
annotation and commentary over the centuries. Nonetheless, a rich body of com­
mentary that has appeared over the last millennium, now as much a part of Shang
Han Lun thought as what survives of the original text itself, constitutes valuable
reading matter for the present-day student .
Presenting classical literature to a clinically oriented Western readership is no
e臼y task. The difficulties in translating an ancient text containing numerous am­
biguities is the least of the problems. The greatest is providing notes and commen­
taries that make the text interesting and relevant to the modern Western student
and practitioner. In the past , translators have erred on the side of insufficient com­
mentary. With the sole exception of Paul Unschuld’s translation and commentary of
the Nan Jfng, no complete translation of any Chinese medical classic provides any
commentary sufficiently comprehensive to enable the Western reader to understand
the issues that have traditionally surrounded texts. Other translations of classic
texts provide an idea of the contents of the original texts, but fail to enable the
Westerner acquainted with Chinese medicine to make full sense of the work. Many
of these translations eliminate all the original ambiguities, while the commentaries
on the one hand 町e scant and fail to explain the underlying theories in terms of
current Western understanding of Chinese medicine, and on the other hand offer
overly simpli直ed explanations that obscure the variety of traditional interpretation.
The aim of our present volume is to enable the modern Western student and
practitioner to gain access to a classical text written eighteen hundred years ago
PREFACE
Xlll
and to the corpus of medical thought to which it gave rise. To that end we have
translated the original text with commentary, both modern and classical. Our
translation of the text is intended to be an accurate reflection of the original. It
is highly literal and avoids any idiomatic English paraphrasing that might obscure
any facet of meaning of the original text or enshrine in the translation any one
interpretation at the expense of all others. Although this may make reading more
difficult in certain places, we felt that it was the most appropriate approach to take
with this type of text . Difficulties that the reader may have in an initial literal
understanding of any line of the text, such as those posed by technical terms, are
dealt with in text notes that follow it. The commentaries consist of two different
types of information: a compilation of textual interpretations from the modern
literature, and direct translations of classical commentary. The modern material
is not a direct translation of any one source, but an attempt to present the major
schools of thought that one finds in current textbooks. The classical commentary is
translated directly to allow the reader to gain some understandin� of the complexity
of material present in the related literature. In the commentaries we explain the
technical significance of each line, discussing textual problems in greater depth and
major differences of interpretation among scholars. Yet since our aim has been
to reach the modern Western student and practitioner of Chinese medicine, we
have not dwelt excessively on the minutiae of traditional debate that might only
interest the medical historian, and have concentrated our main effort on detailed
explanation of widely recognized interpretations.
Neither the original text of the Shii.ng Han Za Bing Lun nor W缸g Shu-He's
original text of the Shang Han Lun survives. Consequently, the sequence of the lines
is subject to considerable doubt. The Song version became the standard version
up until the modern era. Modern scholars, as indeed scholars of the past, doubt
the reliability of the Song order, and have attempted a new order based on the
logic of the treatments. This order makes much greater clinical sense of the text
than the Song order. Although it separates some lines containing references to
foregoing lines that are not separated in the Song version, and therefore cannot
be regarded as a reliable historical reconstruction of the original text, it presents
a clinical understanding of the Shiing Han Lun that encourages modern readers to
appreciate the value of this work. Since our intended readership is one for whom
the clinical relevance is of greater interest than historical detail, we have二albeit
somewhat hesitantly-chosen the modern order for this volume. We nevertheless
include the text in the Song order in Appendix I.
The choice as to whether to set the Chinese text in the traditional complex
characters or the simpli自ed form recently adopted by the PRC W描 difficult. Even
in the PRC there is a continuing tendency to typeset ancient classics in complex
characters, in order to preserve for the modern reader the original form of the text.
Nevertheless, since most Western students studying Chinese learn the simplified
characters first , we have set the Chinese text of each line in the main chapters of
the book in simplified characters, but have set the Song version in Appendix I in
complex characters.
We have taken every opportunity to help the growing number of people who
recognize the need to learn Chinese in order to gain access to primary literature. In
addition to including the original Chinese text of each line and its Pinyin transcrip-
XIV
PREFACE
tion, we have also included in Appendix 2 an analysis of the grammatical structures
and the vocabulary used in the text. Students possessing a rudimentary knowledge
of basic Chinese characters and their components should 且nd this material helpful
in approaching the original Chinese text.
The English terminology used in the present volume is, with few exceptions,
that appearing in A Practical Dictiona叩of Chinese Medicine (Wiseman and Feng,
Paradigm Publications, 1998), in which Chinese terms are given largely literal equiv­
alents that can be used in the various senses in which the Chinese terms缸e used,
or have been used, over the centuries. Readers should note, however, that certain
terms appearing in the Shang Han Lim are used in senses that may not have been
recorded in A Practical Dictionary.
Although this present volume neither represents the full body of knowledge re­
lating to the Shang Han Lim , nor offers any fresh insights into it, we are nevertheless
confident that it will facilitate access to the original text and foster understanding
of its clinical value.
Acknowledgements
士ω
谢
First and foremost, we would like to thank the many students at Pacific College
of Oriental Medicine, New York, for their enthusiastic cooperation in improving
the didactic aspect of the book. We wish to acknowledge the feedback and input
given by our colleagues, and especially those within the New York community of
practitioners of Chinese medicine. We thank Thomas Dey for his careful editing of
the text , Kuo Nien-Feng (郭年峰) for help with computer programming, and Lin
I-Ch'ien (林怡倩) for help with the appendices. We express our appreciation to Mr.
Lin Lung-Ta (林隆建) for his fine calligraphy and to the China Medical College Lifu
Museum of Chinese Medicine (中圄雷粟事院立夫中臀栗展示筒 ) for permission to
reproduce the water-color painting of Zhang JI by Ji归g Zhao-He (蒋兆和 ) that
appears in the cover. Finally, we thank China Medical College (中圄臀栗肇院) for
granting us financial assistance for this project.
Introduction
总
论
The Shang Han Um ( 伤 寒 论 “On Cold Damage” ) is the oldest surviving, the
most copiously commented, and the most revered Chinese medical text devoted to
externally contracted disease (外感病wai gan bing). It also presents the oldest
extant systematized body of knowledge concerning the origin and development of
such diseases and their treatment, not by acupuncture, but principally by a highly
sophisticated use of medicinals combined in formulae that 町e skillfully modulated
to deal with a vast variety of disease manifestations.
The Shang Han Um originally formed part of the now inextant Shang Han Za
Bing Um ( 伤 寒杂病论 “On Cold Damage and Miscellaneous Diseases” ) , a com­
prehensive clinical manual written by the Eastern Han physician Zh副g Ji ( circa
150-219 c.E. ). The sections relating to exten时ly contracted dise副e, which Zh副g
JI 甜C由ed chiefly to contraction of wind and cold ( “cold damage” ) , were reorga­
nized by W归g Shu-He (王叔和) (210-285) in the Western Jln period (265-316) to
form the Shang Han L郎, and the sections relating to other diseases of internal me­
dicine ( “miscellaneous dise捕时’ ) were later arranged to form the Jzn Gui Ydo Lue
( 金匮要略 “Essential Prescriptions of the Golden Coffer” ) . Wang Shu-He's origi­
nal version of the Shang Han Lun has been lost, but several versions were handed
down to the Song period (960-1279), when the text w嗣 edited and printed. Medical
scholars of the Song onwards showed great interest in the text and produced a large
body of comment缸y. The corpus of knowledge concerning “cold damage” that h副
been passed down to us is a large and complex elaboration of Zhang JI’s original
ide蹈 , to which many medical writers have contributed over the last millennium. In
the Ming and Qing Dynasties, the Shang Han L伽further provided the basis for
a new systematic analysis of externally contracted disease, the doctrine of warm
disease (温病学说 , wen bing xue shuo), in which heat rather than cold w嗣 identi­
fied掘the major cause of disease. Despite the emergence of this new doctrine, the
Shang Han Lun has never been eclipsed, and in the curricula of Chinese medical
schools in China today, it occupies an equally if not more important place.
The Shang Han Lun's descriptions of externally contracted dise嗣es and their
treatment reflect a theoretical understanding which ostensibly descends from the
Hua叼 Di Nei Jfng ( 黄帝内经 “The Yellow Emperor’s Inner Canon” ) , Nan Jzng
( 难经‘'The Cl础sic of Difficult Issues” ) and Ben Cao Jfng ( 本草经 “The Materia
INTRODUCTION
2
Medica Canon” ) , but which evinces major advances in the integration of theφ
retical knowledge with clinical observation and practice. In the Shang Han Lim,
externally contracted disease in all its varied manifestations and possible courses is
understood in terms of evils, most notably wind and cold, which invade the body
from outside and pass through the channels and network vessels (经络 jfng luo),
causing disturbances of aspects of bodily function that can be recognized by dis­
tinct constellations of signs known as iiE zhe ng , “patterns . ” E ach pattern can be
treated by a V缸iety of methods ( sweating, vomiting, precipitation, harmonization,
warming, clearin g, dispersion, and supplementation ) , using medicinal drugs that
are combined on the basis of their therapeutic effects into a limited number of for­
mulae whose constituents can be varied to address different presentations. It is for
this re副on that the Shang Han Um is regarded as the basis of the approach to
diagnosis and treatment that in the Qing dynasty came to be called “determining
treatment on the basis of patterns identi且ed” ( 辨证论治 bian zheng lun zhi), which
is now considered to be the quintessence of Chinese medical genius, yet is somewhat
erroneously regarded as having been the mainstream of healing practices in China
since time immemorial.
THE AUTHOR
Zhang JI, whose style was Zhbng-Jing ( 仲 景) , lived in the Eastern Han (东汉
dong hiin) Dynasty, from circa 150 to 219 C.E. No record of him from his own time
survives, and the earliest records date from the Jin Dynasty. He is believed to have
been born in Nie-Y缸g (涅阳) in what is today N缸-Y缸g ( 南阳 ) county of HιNan
(河南) Province. According to Song records, he w甜 the Grand Protector (太守 tai
sh向) of Chang-Sha (长沙).
As to Zhang JI’ s medical training, we have little de且nitive knowledge. He is
believed to have studied medicine under Zhang BιZu (张伯祖) . Nevertheless, what
texts he studied, indeed what texts were available to him, are not fully known.
In the Zhen Jiu Ji a 盯 Jfng ( “The Systematized Canon of Acupuncture and
Moxibustion” ) , Hu缸g-Fu Ml (皇甫谧) states that Zhang JI ( 张机 , style 仲景 Zhbng­
Jing) had expanded the ( no longer extant) Yf Yin Tang Ye ( “YI Yin’s Decoctions" )
into several tens of fascicles, providing very effective remedies, and that Imperial
Physician W缸g Shu- 邸 , in reediting and selecting from Zhang JI’s work, enhanced
its essence.
Huang-F诅 Ml elsewhere expresses his high opinion of Zhang JI’s medical skills
with the following anecdote:
[ZhOng-Jing] had an audience with the Privy Secretary (侍中shi zhδng)
Wang Zhbng-Xuan (王仲宣),who that year w嗣 over twenty. He said to him,
“Sir, you缸e sick. [At the age of] forty, [your] eyebrows will fall ·out and
within half a year [you] will die. If [you] take Five Stones Decoction now,
[you] can avoid [this] . Wang Zhbng-X面n took his words as an offense, [and
although] he accepted the formula, did not ingest it . Three days later, upon
seeing W缸g ZhOng-Xu函,Zhbng-Jing 嗣ked,“Have you taken the formula?”
Wang Zhbng-Xuan replied [that he had] already taken it. Zhbng-Jing said,
“[Your] complexion 总 not that of [one who] has taken [a medicinal] decoction.
Why [do you thus] make light of [yo叫I证e?” Wa吨 Zhbng-Xuan remained in-
INTRODUCTION
3
credulous. Twenty years later, sure enough, ( Wang ZhOng-Xu缸’s] eyebrows
did fall out, ( and ] on the 187th day he died. (Thus] , in the end, it w甜甜
( ZhOng-Jing had ] said.
As to Zhang JI’ s personal motive for writing Shang Han Za Bing Lim, we know
that during the final ye缸s of the Eastern Han Dynasty, continual war and strife led
to the outbreak of many epidemics. According to Zhang JI’s original preface, which
is not fully authenticated (see p. 29), we learn that he apparently lost approximately
two thirds of his family members during this period and he reported that seven
tenths of these deaths were due to externally contracted disease. He sought the
counsel of ancient books, reviewed the remedies applied in his time, and combined
these findings with his own clinical experience. Out of that process grew the sixteen
fascicles of Shang Han Za Bing Lim.
THE HISTORY OF THE TEXT
The original Shang Han Za Bing Lim covered a broad area including the inter­
pretation of pulses, cold damage and six channel pattern identification of treatment,
miscellaneous disease ( including women’s and children’s disea叫 , and dietary con­
traindications. The text of the Shang Han Za Bing Lun did not survive the turbu­
lence of the Three Kingdoms period (220-265) fully intact, but in the Western Jin
period which followed, W总ng Shu-He collected and arranged surviving fragments,
and is believed to have organized all the parts relating to externally contracted
disease into the book we know as the Shang Han Lun. From the various extant
versions of the text and parts of it included in other works, it is no longer possible
to determine the exact contents and sequence of either the Shang Han Lun or Shang
Han Za Bing Lun. Wang Shu-He included elements of the Shang Han Lun in his
Mai Jzng ( “The Pulse Canon , but in the order of methods of treatment. Modern
scholars believe that this is most likely to have been the order of Shang Han Za
Bing Lun and that , in the creation of the independent Shang Han Lun, the contents
dealing with externally contracted disease were reordered to follow the sequence of
the channels.
During the upheavals of the Eastern Jin and Northern and Southern dynasties,
the Shang Han Lun text was not widely available. In the Tang Dynasty, Sun
SI-Miao (孙思遍) drew from the Shang Han Lun in B ei Ji Qian Jzn Yao Fang
( “A Thousand Gold Pieces Prescriptions for Emergencies汀 , but the full text w幽
apparently not available to him until later. When compiling the Qi伽 Jzn Yi Fang
( “Wings to the Thousand Gold Pieces Prescriptions
included most of the text, and this therefore constitutes the earliest known version
of the Shang Han Lun.
Since the Wai Tai Mi Yao ( “Essential Secrets from Outside the Metropolis” )
quotes over 200 lines of the Shang Han Lun, we infer that its author, Wang Tao
(王涛) (707一772 C.E., T缸g ) , placed great emphasis on the contribution of the
Shang Han Lun to the understanding of externally contracted disease. The first
fascicle gives the views of eight medical scholars on the Shang Han Lun, while
the second brings together the views of different scholars on twenty cold damage
patterns. Wang Tao ’ s importance with regard to the Shang Han Lun thus lies in
his presentation of a diverse group of pre-Tang writings discussing the Skiing Han
INTRODUCTION
4
Lun. Nevertheless, he did influence later scholars greatly since he did not include
the full text, but only quoted it.
In the Song Dynasty, the govern皿ent established a Medical Literature Editing
Bureau (校正医书局jiao zheng yz shu ju) responsible for collecting, editin?, and
publishing medical works, which now, with the invention of wood-block printing,
could enjoy a wider circulation than had previously been possible. The Bureau’s
official version of the Shii.ng Han Lun w础prep町ed under the supervision of Lin
Yl (林亿) and subsequently published. Unfortunately, no copy of this曲st printing
survives, and the earliest extant text is a Ming reprint (1056 C.E.) by Zhao Kai-M色i
(赵开美), which nevertheless is believed to be identical. The term “Song version"
now refers to this.
The Song version contains more than most modern versions of the Shii.ng Han
L伽. Ming scholars argued that the first four and the last seven f臼cicles should
be discarded on the grounds that they contained matter that either did not relate
to externally contracted disease or that was more representative of W缸g Shu-He's
thought than Zhang Ji’s.
THE RELATIONSHIP OF THE SH孟NG HA.N LuN To THE su矶TEN
In his original preface, Zhang Ji mentions a number of books he had studied.
All of these but the Nei Jzng and the Nan晶ig町e no longer extant. Consequently,
our picture of the theoretical origins of the Shii.ng Han Lun is not entirely clear.
The Nei Jfng devotes considerably more text to discussion of externally contracted
disease than the Nan Jfng, and given the importance accorded to it over history,
considerable effort has been made to tie the theories of the Shii.ng Han Lun in with
Below we present three passages from the Su Wen (“Elementary Questions”),
the直rst part of the Nei Jzng, discussing externally contracted disease:
Su Wen (胎L讪):
The Yellow Thearch says: Now l甜we know], all heat [effusion) dise脱is
of the cold damage category. . . .
QιBos町s:
On the first day of cold damage, greater yang G也yang) is affected, and
signs include stiffness and pain in the head and nape, and stiffness in the
lumbar spine.
On the second day, yang brightness (ya叼 ming) is affected. Since the
yang brightness governs the flesh, and its channel p描ses up the side of the
nose to connect with the eyes, there is generalized heat effusion (i.e., fever),
eye pain, and dry nose.
On the third day, the lesser yang (shdo yang) is affected. Since the lesser
yang governs the gallbladder, and its channel p础ses through the rib-side
and connects with the ears, signs include pain in the chest and rib-side, and
tinnitus.
On the fourth day, the greater yin ( tci.i yin) is affected. Since the greater
yin channel passes through the stomach and connects with the throat, signs
include fullness in the stomach and dry throat.
INTRODUCTION
5
On the fifth day, the lesser yin (shdo y&n) is affected. Since the lesser yin
channel p槌ses through the kidney, connects with the lung, and penetrates
through to the root of the tongue, signs include dry mouth and tongue, and
thirst.
On the sixth day, the reverting yin (ju句&n) is affected. Since the revert­
ing yin channel passes through the genitals and connects with the liver, signs
include agitation and retracted scrotum.
Su Wen (Yin Y缸g Ylng Xia吨 Da L讪):
[When there are] irregularities of joy and anger, and excesses of heat and
cold, Ii也is insecure. Hence weighted yin must [become] yang, and weighted
yang must [become] yin. Therefore it is said that in winter [there叫damage
by cold and in spring there must disease [caused by] warmth.
Su Wen (Tiao Jing Lim):
The Thearch says: The classics say that when yang is vacuous, there
is external cold, when yin is vacuous, there is internal heat; when yang is
exuberant there is external heat, when yin is exuberant there is internal cold.
I have already asked about this, [but] I do not know why it is so.
Qi-B6 says: Yang receives qi from the upper burner to w町m the area of
the skin and the divided flesh. Now, [when] cold φis in the outer body, the
upper burner is blocked. When the upper burner is blocked, cold qi alone
remains in the outer body, hence there is cold shivering.
The Thearch s町s: What of yin [being] vacuous [and) engendering internal
heat?
QιB6 s町s: [When) there is taxation fatigue, the body’s qi becomes de­
bilitated, and grain qi is not exuberant; the upper burner fails to move, and
the lower [stomach] duct is blocked; stomach qi is hot, and heat φ fumes into
the chest, hence there is internal heat.
The ’fhearch says: What of yang [being] exuberant and engendering ex­
ternal heat?
QιB6 says: When the upper burner is blocked and inhibited, the skin
becomes tight, the interstices become blocked, and the mysterious houses
[sweat pores) are blocked, [so that] defense qi cannot discharge outward; hence
there is external heat.
The T】learch s町s: What of yin [being] exuberant [and] engendering in­
ternal cold?
Qi-B6 says: Reverse qi ascends counterflow, cold qi accumulates in the
chest and does not drain [away]; [because] its does not drain [away), w缸m
qi departs; cold alone remains, so blood congeals; [when blood] congeals,
the vessels become blocked, and the pulse becomes exuberant and large, and
rough; hence [there is] cold strike.
From the first of these quotations, we see that the Nei Jfng agrees with the
Shii.ng Han Lun in categorizing heat disease as cold damage, and in understanding
cold damage as a progression through the six channels. The names of the channels
缸e the s创ne except that greater y缸g is referred to as巨阳 ju yang in the Nei Jrng.
6
INTRODUCTION
Furthermore, the two texts both ascribe unique sets of signs to disease in each of
the channels. Nevertheless, they agree only partially on which signs are associated
wi th each channel. In the comparison set o u t below, we provide full enumerations
of the channel disease signs listed in the Nei Jing, but, for the sake of simplicity,
we have chosen only the main signs given in the Shang Han Lun .
Greater y缸ig
NJ: Stiffness and pain of the head and nape; stiff lumbar spine
SH: Floating pulse; stiffness and pain in the head and nape; aversion to cold; heat
effusion
yang brightness
NJ: Generalized heat effusion; eye pain; dry nose; sleeplessness
SH: Generalized heat effusion; spontaneous sweating; thirst with desire to drink;
dry bound stool; tidal heat effusion; delirious speech
Lesser y运ng
NJ: Chest and rib-side pain; deafness
SH: Bitter taste in the mouth; dry throat; dizzy vision; chest and rib-side fullness;
alternating [aversion to ] cold and heat [effusion]
Greater yin
NJ: Abdominal fullness and dry throat
SH: Abdominal fullness; vomiting; inability to get food down; diarrhea; periodic
abdominal pain
Lesser yin
NJ: Dry mouth and tongue with thirst
SH: Pulse that is faint and fine; desire only for sleep; aversion to cold; lying curled
up; counterflow cold of the extremities
Reverting yin
NJ : Vexation and fullness; retracted scrotum
SH: Dispersion-thirst; qi surging up into the heart; pain and heat in the chest;
hunger with no desire to eat; vomiting of roundworms after eating; incessant
diarrhea
The signs differ in that in the Nei Jing they are all classifiable 臼 heat or
repletion; in the Shang Han Um, repletion and heat signs are associated with three
ya吨, while cold and vacuity signs are associated with the three yin. The Shang
Han Lim therefore envisages a much larger scope for externally contracted disease.
Furthermore, by associating heat and repletion patterns with the three y缸g, and
cold and vacuity signs with the three yin, it represents a more systematic application
of the yin-yang doctrine.
Th e si gn s given in the Su Wen are clearly associated with the channel pat hways
( or associated with the bowels and viscera to which the channels home ) . Those given
in the Shang Han Lun are less consistently associated with particular locations on
channel pathways. For example, the signs given for greater y缸g in the Su Wen
are located on the pathway of the greater y缸g channel ( stiffness and pain of the
INTRODUCTION
7
head and nape, 的iff lumbar spine) ; those given in the Shiing Han L肌 (floating
pulse, stiffness and pain in the head and nape, aversion to cold, heat effusion) are
predominantly general exterior signs. Such differences prompted M运i Chun-Hua ( 美
春 华 ) to comment, “One cannot use the six channels . . . of the Su Wen to explain
the six channels of Shang Han Lun .”
A further major difference between the Shiing Han Lun and Su Wen is seen in
the timing of passage from channel to channel. The Su W创 places the timing of
developments in the foreground, describing signs in a one-channel-per-day scheme.
The timing of channel passage in the Shiing Han Lim is much more complex. Al­
though many lines state what signs occur at a specified number of days after onset,
the timing is much less rigid, and is certainly not one of daily change. Attempts
have been made to reconcile the differences in timing by suggesting that Su Wen
presents a standard pattern that is not always seen in practice. A more cogent view,
however, is that while the Su Wen statements represent a neat theoretical scheme,
Zhang JI worked from clinical observation. Although the degree to which numbers
of days given by Zh加g Ji are to be taken literally has gi ven rise to much unresolved
debate, it is obvious that the Shiing Han Lun does not follow a one-channel-per-day
scheme.
We can therefore conclude that although similarities do exist between the Shiing
Han Lun and Su Wen, they are only partial, and that however much Zhang JI
drew on the Su Wen, the Shiing Han Lun represents a thorough reworking of ideas
contained in it . Ke Qin sums up the differences in the following words:
In the S也 Wen ( “Elementary Questions
and three yang] only have exterior and interior repletion and heat patterns, no
vacuity and cold patterns. As to treatment , we see only treatment by sweating
and precipitation, no use of supplementation and warming. In Zhong-Jing,
the six channels are broader in scope, including different aspects: cold, wind,
warmth, and heat evils; diseases caused either by external or internal evils;
the passage of diseases from exterior to interior; and diseases that are due
to cold or heat and to vacuity or repletion. The Shii.ng Han Lun is totally
inclusive.
A further major difference between the Nei Jing and the Shiing Han Lun lies
in the relative importance of drug and acupuncture therapy. The Nei Jing provides
considerably more detail on needle therapy than on medicinal therapy, while the
reverse is the case in the Shiing Han Lun.
THE DEVELOPMENT OF SHA.NG HAN LiJN THOUGHT
Before the appearance of the Song version, the value of the Shiing Han Lun
was asserted by influential figures in the development of Chinese medicine over
the centuries, such as Hu缸g-F诅 Mi (皇 甫 谧 ) , Sun SI-Miao (孙 思 遍 ) , and W缸g
T 磊0 ( 王 涛 ) . According to Sun SI-Miao, in southern China in the 7th century
(T缸g Dynasty) , the Shiing Han Lun was jealously guarded by those who possessed
copies. In the 8th century (τ咱ang Dynasty) , it was designated as an examina
text for medical officials. Yet it was in the Song-Jin-Yuan (宋 金 元 , 960-1368) that
the Shiing Han Lun began to make its fullest impact. This is partly due to the
8
INTRODUCTION
invention of printing, which allowed the text to become widely available. More
importa皿ly, however, developments in medical thought provided an environment
more conducive to the recognition of Zhang JI’s ideas. Before that period, medicinal
therapy in general remained conservatively based on a pragmatic, symptomatic
approach.
Although they held their classic, the Han Shen-nung pents ’ao ching
[Shen N6ng Ben Cao Jfng ] , in great respect, its insights represented only
a starting point for their own concerns and not, as was the case for
followers of the Huang-ti nei-ching/Na仔ching [Huang Di Nei Jfng/Nan
Jmg ] , the ultimate and complete stage in a particular field o f knowledge.
Unschuld 1985: 167
In the Song-Jin-Yuan, efforts were made to apply the yin-yang and five-phase
doctrines in the analysis of drug actions.
While the interest �enerated by Wang Shu-ho [Wang ShU-H司 (210-285 ) ,
fo r example, i n pulse diagnosis had been continued in more than seventy ti­
tles by the beginnin� of the Sung [Song] period, and while during the same
interval more than ninety works had been devoted to 缸upuncture and more
than fifty to physiology, not even ten authors followed the direction taken
by Chang Chi [Zh加g J斗 . It was only during the Sung [Song] and Chin [Jin]
epochs that a larger circle of scholars became interested in the surviving frag­
ments of Chang Chi; during the course of these two dynasties alone, so many
revisions or commentaries appeared on the problems of cold-related illness
that more than eighty titles have survived to the present day. The contrast
becomes even more striking when we compare the ten titles devoted specifi­
cally to the treatment of such illness written before the Sung period with the
more than three hundred encyclopedic works containing prescriptions for all
kinds of illnesses that appeared during the same time. The Chang Chi re­
naissance during the Sung-Chin-Yiian [Song- Jin-Yuan] era w臼 due primarily
to two characteristics of his writings. To scholars of the twelfth, thirteenth,
and fourteenth centuries, it w部 significant that Chang Chi had been the
first to combine the use of drug therapy with the theory of systematic cor­
respondence. In addition, Chang Chi, with his interest in the effects of cold
on illness, was the first and virtually only author whose work was devoted
exclusively to a specific etiology. All authors of the Sung-Chin-Yiian medi­
cal texts adopted these elements, which had virtually lain dormant for some
1 ,000 years, as the point of departure for their own, further-reaching delib­
erations. Consequently, in almost all of their works, drug prescriptions and
theoretical considerations are linked on the basis of systematic correspon­
Unschuld 1985: 168
dence.
Song scholars approached the Shang Han Lim in a number of different ways.
In the early period after the publication of the Song version, scholars such 描 P缸g
An-Shi (庞 安 时 , style 安 常 An-Chang ) and Zhu Gong ( 朱 脏 , style 翼 中 Yi-ZhOng)
believed that since Zh磊ng Ji’s original text had not survived intact and had been
reworked by Wang Shu-He and others, the Song version could be improved by re­
ordering the lines and filling in apparent gaps in the content. These scholars took
as their basis not only the text of the Shang Han Um but all of what had allegedly
INTRODUCTION
9
survived from the Shang Han Za Bing Lun. In some cases, they even introduced
parts of the Jzn Gui Yao Lue, and incorporated ideas concerning externally con­
tracted disease that had developed over the eight centuries since Zhang JI’s time.
This approach, however, w础 eventually sup缸seded by that of Cheng Wu-Ji (成 无 己
) , who believed that the Song version in its order and contents was, if not the origi­
nal text, the most faithful representation of Zhang JI’s understanding of externally
contracted disease, and that the text could be made clearer by carefully researched
commentary. Cheng W也Ji was highly influential because his ZhU Jie Shii.ng Han
Lun ( 注 解 伤 寒 论 “Annotated Shang Han Lun” ) , which contained the text of the
Song version altered in minor details and furnished with a detailed commentary,
came to replace the Song version.
Over recent decades, commentated editions of the Shang Han Lun have estab­
lished a new order that makes the clinical study of the text much easier. This is
the sequence adopted in the present volume, although the Chinese text in Song
order is presented in Appendix I. In this new order, the basic six-channel order
of the Song version is retained, but the individual lines 缸e ordered according to
the various formulae used. In the process of rearrangement, some lines appe缸 in
a chapter relating to a different channel than in the original Song version. Lines
that cannot be ordered according to this schema are related to appendixes, mostly
placed at the end of each chapter. Notably relegated to these appendices are lines
containing inconsistencies and ambiguous phrases, lines suspected of having been
added by transcribers, and lines that do not contain formulae or any clear indica­
tions as to where they might belong in the sequence. The meanings of such lines
have been subject to ceaseless debate among medical scholars over the centuries.
For students whose aim is a clinical grasp of the doctrine of cold damage, these
appended lines can be ignored. It should be noted that in the present volume the
lines are numbered according to their order in the Song version. Since these do not
coincide with the order of their appearance, a Song Version Line Number Index has
been included at the end of the book.
THE
C ONTENTS OF THE SHA.NG HAN LiJN
The Concept of Cold Damage
The term “cold damage” ( 伤 寒 shang Mn) has both broad and narrow mean­
ings. Su Wen states, “Now all heat diseases are of the cold damage kind.” The
58th difficulty of the Nan Jzng states, “There are five [types of] cold damage: wind
stroke, cold damage, damp warmth, heat disease, and wa口n disease.” According to
Zhang Zi-He ( 张 子 和 ) , “In spring, it is war皿 disease. In summer, it is summer-heat
disease. In fall, it is malaria and diarrhea. In winter, it is cold qi and cough. In the
four seasons, all qi that is not right qi is called cold damage.” The broad meaning
of cold damage is all externally contracted 面前副e; the na口ow meaning is external
contraction of wind-cold and the resultant dise槌es. The text of the Shang Han
Lun provides a great deal of information regarding the pathological chan?es, pat­
terns, and treatment of diseases resulting from external contraction of wind-cold,
but more importantly, it deals with cold damage in the broad sense. It discusses
10
INTRODUCTION
the six excesses 描 the cause of disease and combines internal and external factors
in an analysis of pathomechanisms, signs, and treatment .
Six- Channel Pattern Identification
The Shang Han Lun attributes cold damage to the invasion of the body by
evils such as wind and cold, and explains the vast variety of manifestations of cold
da皿age in terms of the way in which these evils affect various parts of the channel
and network ves时 system. As a rule, evils first affect the greater y缸g (tai yang) ,
and then, if the disease does not terminate there, they progress through the various
channels according to certain partially predictable patterns. In some cases, however,
disease evils directly affect channels other than the greater yang.
Disease in any of the six channels takes the form of different disease patterns
that are reflected in various constellations of signs and pulse conditions. It is for
this reason that each chapter title contains the words “Pulses and Signs.” These
disease patterns reflect certain specific etiologies.
The brief outline below presents the various patterns arising in disease of each
of the six channels. Readers should note that many of the technical terms appearing
in this outline 町e explained in the chapters ahead and may be accessed through
the index.
Greater Yang Disease (太 阳 病 tai yang bing) : The greater y缸g controls
the construction and defense, and governs the exterior of the body, which serves
副 the body’s external barrier. Externally contracted evils usually 且rst affect the
exterior. Accordingly, many of the signs associated with greater y缸g appear in the
e缸ly stages of disease. The essential features of greater y缸g disease are a pulse
that is floating, headache, stiffness and pain of the head and nape, heat effusion,
and aversion to cold.
The most important forms of greater y缸g disease exterior disease are wind
strike and cold damage, which are differentiated on the basis of the patient’s con­
stitution and the strength of the evil. Wi nd stri ke (中 风 zhOng Jeng) is attributed
to “construction-defense disharmony" (营 卫 不 和 ying wei bu he) characterized by
“streng也 in defense and weakness in construction” (卫 强 营 弱 wei qiang ying ruo) .
The major signs 缸e aversion to wind and cold, heat effusion (发 熟 fa re, i.e. , fever ) ,
stiffness and pain of the head and nape, spontaneous sweating, noisy nose, dry retch­
ing, and a pulse that is floating and moderate. The special signs associated with this
pattern are spontaneous sweating and a pulse that is floating and moderate; hence
it is also called exterior vacuity. Cold damage (伤 寒 shang Mn) is characterized by
aversion to cold, heat effusion, stiffness and pain of the head and nape, generalized
pain in the body and/ or bones and joints, absence of sweating, panting ( any form
of difficult breathing or breathlessness ) , retchi吨 counterflow, and a pulse that is
floating and tight . The defensive y缸g is obstructed and the construction yin is
stagnant; consequently sweat cannot issue, and the pulse is floating and tight. This
form of greater y缸g disease is often referred to 描 exterior repletion.
Greater yang disease can undergo a variety of irregular developments, which are
known 倒 tra nsm uted patterns (变 证 bian zh凯g). These include heat patterns (热
证 re zh凯g), vacuity cold patterns (虚 寒 证 xii ht如 zheng) , chest bind patterns (结
胸 证 jie xiδng zh切g) , and glomus pa忱erns (痞 证 pi zh切g). Also 且guring among
INTRODUCTION
11
the transmuted patterns 町e the interior patterns of greater yang disease affect­
ing the greater y缸g bowel the bladder-these being water amassment and blood
amassment . In greater ya ng water a m assment (太 阳 蓄 水 tai yang :cU shui) , an unre­
solved external evil enters the bladder and the yang ql is unable to transform water.
The major signs are heat effusion, sweating, vexation thirst or thirst with desire
to drink, vomiting immediately upon the ingestion of water, inhibited urination,
lesser abdominal fullness, and a pulse that is floating and rapid. In greater ya ng
blood a massment, (太 阳 蓄 血 tai yang X U xue) , heat evil penetrates deep into the
lower burner and binds the blood. The signs are a tense, bound lesser abdomen or
lesser abdominal hardness and fullness, mania or similar conditions, and uninhibited
unnat1on.
In greater yang dis e as e, there are also concurrent patterns, such as exterior
vacuity with concurrent stiffness of the nape and back, or with cough and panting, or
with water-rheum. There are also transmuted patterns due to incorrect treatment,
such as inappropriate promotion of sweati吨, use of precipitation, and/or use of 且re
therapies.
Yang Brightness Disease (阳 明 病 例ng ming bing) : The main feature of yang
brightness disease is yang hyperactivity and heat exuberance. An evil can directly
enter the yang brightness channel from the exterior, but it usually passes into the
channel from the greater yang. yang brightness disease is generally characterized
by generalized heat effusion, spontaneous sweating, aversion not to cold but to heat,
and a pulse that is large. Distinction is made between a heat pattern and a repletion
pattern. In the ya ng brightness heat pattern (阳 明 热 iiE yang ming re zh臼g ) , also
called a yang brightness channel pattern (阳 明 经 证 yang m如g jzng zheng) , an evil
enters the channel, transforms to heat, and scorches liquid and humor. In addition
to the general y缸g brightness disease signs just listed, this pattern is characterized
by dry mouth and ton伊e, and a great thirst that is un�uenchable. If the evil
transforms into heat and causes waste matter in the intestines to form a repletion
bind, this is called a ya ng brightness repletion pattern (阳 明 实 证 yang ming shi
zheng) , also known as a yang brightness bowel pattern (阳 明 腑 证 yang ming Ju
zheng) . Here, the generalized heat effusion takes the form of tidal heat effusion
( 的er at a certain time each day ) . Other specific signs include delirious speech,
sweat streaming from the extremities, abdominal distention with fullness and pain,
hard stool, and a pulse that is sunken and replete.
Lesser Y三ng Disease ( 少 阳 病 shao yang bing): Lesser y缸g disease manifests
as a half exterior half i nterior pattern ( 半 表 半 里 证 bdn biao bdn li zh切g), perhaps
more accurately described as a “halfway pattern” since it is correctly conceived as
disease located neither in the exterior nor in the interior, but between the two. It
can be the result of an evil passing in t o the lesser y归g from ano ther ch annel or may
originate in this channel itself. The essential features are bitter taste in the mouth,
dry throat, and dizzy vision. Other major signs are alternating aversion to cold
and heat effusion, fullness in the chest and rib-side, taciturnity with no desire for
food or drink, heart vexation, frequent retching, and white ton职ie fur. The pulse
of lesser yang disease is one that is fine and stringlike. There is neither the aversion
to cold that typically marks greater y缸g exterior patterns nor the exuberant heat
that characterizes y缸g brightness disease. Accordingly, promotion of sweating and
precipitation cannot be used; the appropriate treatment is harmonization.
12
INTRODUCTION
The lesser yang is often referred to 臼 the “pivot” ( 枢 shu) , the central element
of the three ya鸣. When disease evil enters the lesser ya鸣, it causes inhibition of
the pivot (枢 机 不 利 shu ji bu li) . Alternating aversion to cold and heat effusion,
for example, is a manifestation of “right and evil struggling by t盯ns” (正 邪 分 争
zheng xie fen zheng) . Aversion to cold occurs when evil φ prevails; heat effusion
occurs when right qi prevails, bu t right φ is unable to repel the evil through the
exterior, and the evil φ is unable to advance into the interior. Thus in lesser yang,
the disease, as it were, oscillates on the pivot. B臼ically, the pivot is one aspect of
the “qi dynamic" (气 机 qi ji) . Inhibition of the φ dynamic in lesser y缸g disease
can have varied consequences, not ably disturbance of spleen and stomach function.
It is for this re幽on that retching is one of the main signs of lesser y缸g disease.
Though lesser yang disease is typically a halfway pattern, there may be concur­
rent exterior or interior patterns. Lesser yang with a concurrent exterior pattern
may manifest in heat effusion, mild aversion to cold, vexation pain of the joints and
extremities, mild retching, and propping bind below the heart; lesser yang with a
concurrent interior pattern can manifest in alternating aversion to cold and heat
effusion, interior heat bind, persistent retching, distress below the heart, depression
and vexation, and absence of stool.
Greater Yin D isease (太 阴 病 tdi yzn bing) : Greater yin disease is 皿 inte­
rior vacuity cold pattern of spleen yang vacuity, and is characterized by abdominal
fullness, vomiting, inability to get food down, severe diarrhea, and occasional ab­
dominal pain. Greater yin disease can result from an unresolved ya鸣 channel
disease damaging spleen y归g, from direct invasion of wind-cold, or from internal
damage engendering cold-rheum. When the spleen yang is vacuous, cold and damp­
ness become exuberant , and movement and transformation are impaired. If greater
yin disease progresses further, it may become spleen-kidney vacuity cold and form
a lesser yin vacuity cold pattern.
L esser Yin Disease ( 少 阴 病 sh ao yfn bing): Lesser yin disease, a pattern
of interior vacuity, usually develops from disease that starts in one of the other
channels, although it can be the result of an evil penetrating directly into the
interior in someone with a vacuous constitution. It includes serious conditions that
may be fatal. The major manifestations of lesser yin disease are a pulse that 画 fine
and faint, and a desire to sleep. Distinction is made between cold transformation
and heat transformation patterns. Cold tra nsformation (寒 化 Mn hua) is the result
of heart-kidney yang qi debility and in addition to the above signs also includes
aversion to cold, curled-up lying posture, heart vexation, vomiting and diarrhea,
也irst with desire for hot flui巾, small intake of fluids, clear uninhibited urination,
and reversal cold of the extremities. In severe cases, when the yang qi is repelled by
the yin cold, one may see no aversion to cold, heat effusion, red face, and vexation
and agitation, which indicates true cold and false heat (真 寒 假 热 zhen han jia re) .
Heat tra nsformation (热化 re hua), a result of yin vacuity, is characterized by heart
vexation a且d inability to sleep, dry sore throat, diarrhea, thirst, crimson ton职览,
and a pulse that is fine and rapid.
Reverting Yin Disease (厥 阴 病 jue 仰 bing): Reverting yin disease generally
develops some time after the onset of cold damage disease. It is more complicated
and severe than disease of any other channel. The main forms are as follows:
upper-body heat and lower-body cold patterns; reverse-flow patterns; and patterns
INTRODUCTION
13
characterized by either diarrhea, reverse』ow, retching, or hiccup. The u pper- body
heat a nd lower- body cold (上 热 下 寒 shang re xia han) complex is characterized by
dispersion-thirst (severe thirst unallayed by fluid intake) , φ surging upward to the
heart, vexing heat in the heart, hunger with inability to eat and vomiting of round­
worms, and unceasing diarrhea. Reversal- heat exu bera nce a nd retaliation (厥 热 胜
复 jue re sheng Ju) patterns are characterized by reverse-flow and heat effusion.
The reverse-flow (厥逆 jue ni) , which is severe palpable coldness of the extremities
stretching up to the elbows and knees (also called “reversal cold of the extremities"
手 足 顾 冷 shOu zu jue leng) , is accompanied by diarrhea, and alternates with heat
effusion. The reverst:←flow marks the prevalence of yin, whereas the heat effusion
marks the retaliation of yang. Diarrhea , as it occurs in reverting yin disease, can
occur in cold or heat patterns, or in cold-heat complexes. Reverse-flow is the single
most important sign of reverting yin disease. It occurs not only in the reversal-heat
exuberance and retaliation pattern described above, but is also seen in a number of
other conditions: visceral reversal, cold reversal, heat reversal, roundworm reversal,
collected water reversal, and phlegm repletion reversal. Retching can be differenti­
ated into lower burner cold vacuity type, counterflow ascent of turbid yin type, and
a third type observed in heat patterns when a shift to the lesser yang takes place.
H iccu p can be differentiated into vacuity cold and repletion heat types.
Eight-Principle Pattern Ident ification
The notion of the eight principles, though it was not formalized until much
later in history, is implicit in Shang Han Lun pattern identification. Externally
contracted disease ( “cold dam age" in the broad sense ) is the result of disease evils
entering the body and the body’s response to them. The different manifestations
of disease are explained in terms of the outcome of the struggle between right and
evil. Six-channel pattern identification provides the framework for understanding
the specific ways in which externally contracted disease develops. Underlying it,
however, are the notions of exterior-interior, cold-heat, vacuity-repletion, and yin­
yang, which constitute a more general framework. This is reflected in line 7, p. 50,
which s町S: “When an illness [is characterized by] heat effusion and aversion to
cold, it is springing from yang; when [an illness is characterized by] the absence of
heat effusion and [the presence of] aversion to cold, it is springing from yin.”
In the theory of the Shang Han Lun, greater yang, yang brightness, and lesser
yang are called the three yang; greater yin, lesser y函, and reverting yin are called
the three yin. Broadly speaking, disease of the three yang is characterized by
exuberant right φ (strong resistance) and repletion of evil φ (powerful threat to
resistance) , and takes the form of heat or repletion, which in the eight principles 缸e
both yang patterns. By contrast, disease of the three yin is generally characterized
by debilitation of right qi with the continuing presence of evil qi, and largely takes
the form of cold or vacuity patterns, which in the eight principles are both yin
patterns.
The first of the eight principles are exterior and interior. These two terms
are somewhat confusing because they are used in different senses. In the Shang
Han Lun , the greater y缸g is exterior, the lesser yang lies between exterior and
interior, and the other channels are all interior. In another sense, however, the
three yang are all exterior, while the three yin are all interior. In this sense, the
14
INTRODUCTION
greater y缸g is exterior while the greater yin is interior. Within the yang channels,
the difference between exterior and interior is reflected in a sharp difference in
treatment: effusing the exterior ( promoting sweating ) in the one c副e and attacking
the interior ( precipitation ) in the second. For this reason, the concepts of interior
and exterior 町e of great importance in deciding treatment .
Cold and heat are the principles by which the nature of a disease is identi­
fied. Acute conditions attributable to exuberant yang evil usually manifest in heat
patterns; chronic conditions and ones due to exuberant yin evil are mostly cold
patterns. Diarrhea, for example, can be due either to cold or to heat, which have
to be differentiated by the presence or absence of thirst . In some cases, either the
cold or heat m町 be false ( see line 350, p. 545, and line 317, p. 478) .
The importance of vacuity and repletion is reflected not only in the overall
difference between the three yang and three yin, as explained above. Judging the
precise state of right qi in relation to evil qi can be of crucial importance even within
one channel. For example, line 70 , p. 133, states, “After sweating is promoted, if
[ there is] aversion to cold, [this] is because of vacuity. If aversion to cold is absent,
and only heat [effusion ] [is present ] , this indicates repletion.”
Bowel and Visceral Pattern Ident ificat ion
Like eight-principle pattern identification, the notion of bowel and visceral pat­
tern identification was not formulated until later in the development of Chinese
medicine. Yet , like the eight principles, it also helps our understanding of the
Shang Han Lun since diseases of the channels can affect their associated bowels
and viscera.
In greater y缸g disease, an exterior evil that fails to resolve can p出S into the
bladder, the bowel of the greater yang. This evil can impair φ transformation and
cause water-qi to collect internally, manifesting in inhibited urination or thirst with
desire to drink, but with immediate vomiting of fluids ingested.
The stomach and the large intestine are both y缸g brightness bowels. When
evils enter the yang brightness and damage the fluids, manifestations can include
generalized heat, sweating, and dry mouth and ton伊e. When dryness-heat in
the stomach and intestines causes stoppage of bowel φ, there is constipation with
abdominal distention and fullness with pain that refuses pressure.
The gallbladder and the triple burner are the bowels of the lesser y缸g. When
gallbladder 且re flames upward, there is bitter taste in the mouth, dry throat, and
visual dizziness. When regulated fl.ow through the waterways of the triple burner
is impaired, one of several things may happen: water may collect below the heart
giving rise to heart palpitations and inhibited urination; water-cold may invade the
lung, giving rise to cough; or inhibition of the lesser yang pivot could prevent cold
rheum from transforming, giving rise to alternating aversion to cold and heat effu­
sion, heart vexation, chest and rib-side fullness with slight bind, inhibited urination,
thirst and retching, and sweating only from the head.
The spleen is the viscus of the greater yin. When it is affected by externally
contracted disease, spleen y缸g is devitalized, and movement and transformation
is impaired. When the spleen viscus is vacuous, and cold, cold-damp collects and
INTRODUCTION
15
causes abdominal fullness and vomiting, inability to get food down, spontaneous
diarrhea, and periodic spontaneous abdominal pain.
The heart and kidney are the viscera of the lesser yin. When in externally
contracted disease they become vacuous, and qi and blood become insufficient , there
is a faint pulse, desire only for sleep, aversion to cold, curled-up lying posture ( in
severe cases, reversal cold of the extremities) , diarrhea, and retching counterflow. If
the heart fire becomes hyperactive and kidney yin is insufficient, signs of yin vacuity
heat such as vexation in the heart, sleeplessness, dry throat, red tongue body, and
a pulse that is fine and rapid may be observed.
The liver is the viscus of the reverting yin. When it is affected by disease, a
cold-heat complex arises and liver ql ascends counterflow, giving rise to dispersion­
thirst ( a thirst unallayed by drinking ) , heat and pain in the heart, hunger with no
desire to eat , and vomiting of roundworms on ingestion of food, or diarrhea.
Diagnost ic D ifficulties
The major difficulty in learning the Skiing Han Lim approach to externally
contracted diseases lies in the correct identification of patterns. Single signs rarely
provide conclusive evidence for diagnosis and a basis for treatment. While a pulse
that is stringlike and chest and rib-side fullness are each more or less a sure sign of
lesser yang disease in the context of externally contracted disease ( not beyond this,
however ) , aversion to cold, sweating, or vexation, for example, can be observed in
diseases of all channels. The majority of major signs can occur in the disease of
more than one channel. Since in each c础e the pathomechanism is different, the
precise nature of a speci且c sign and combinations in which it occurs can vary. The
art of diagnosis therefore lies in viewing each sign in its wider context and grasping
the pathomechanism from a synthesis of all signs present.
Below are a number of examples of such signs, the different conditions in which
they may be observed, and their different pathomechanisms.
Aversion to wind/aversion to cold (恶 风 、 恶 寒 wu Jeng, wu Mn) : A version
to wind is a feelin? of cold when exposed to wind; aversion to cold is a feeling of
cold. The distinction between aversion to wind and aversion to cold is ambiguous
because in greater y缸g disease the two terms seem to be used indiscriminately.
It is, however, worth noting that “aversion to wind" does not occur in the lines
presenting disease of the three yin.
GREATER YANG : Aversion to wind or to cold is a basic sign of greater yang.
It is due to impairment of the normal function of defense qi when evil φ is in
the exterior of the body.
YANG BRIGHTNESS : Yang brightness disease is typically characterized by heat
effusion with aversion to heat rather than cold. Nevertheless, heat effusion
is sometimes accompanied by aversion to cold, as in line 168, p. 323, where
heat in both the interior and exterior manifests in great thirst, dry tongue
fur, vexation, and aversion to cold. Aversion to cold here results from damage
to liquid and qi on the one hand causing the interstices of the flesh to loosen,
and on the other causing y缸g qi to become depressed in the interior.
16
INTRODUCTION
LESSER YANG : In line 99, p. 4 18, aversion to wind occurs with heat effu­
sion, stiffness and pain of the head and nape, and fullness below the rib-side.
This pattern is not a pure lesser yang pattern, and the aversion to wind is
considered to be a greater ya且g sign.
Heat effusion ( 热 、 发 热 时, fa re) : In this text, we render 发 热 fa re 副 “heat
effusion” rather than “fever,” since the Chinese term is somewhat wider in meaning
than the familiar English term. Heat effusion is associated with many conditions
and occurs both in externally contracted disease and miscellaneous disease ( 杂 病
za bing , disease due t o causes other than external evils) . In externally contracted
dise描es of the three yang channels, heat effusion is a manifestation of the struggle
between right qi and evil qi; it does not necessarily indicate the presence of evil
heat . In diseases of the three yin, right φ is not strong enough to counter evil qi;
hence heat effusion is absent , and instead only aversion to cold is present.
G REATER YANG: In exterior patterns, evil qi is in the exterior of the body, im­
pairing the normal function of defense qi; hence heat effusion is accompanied
by aversion to wind or cold.
YANG B RIGHTNESS: In yang brightness disease, the disease evil transforms into
heat and enters the interior. In heat patterns, heat effusion is accompanied
by aversion to heat rather than aversion to cold. In repletion patterns, the
heat is not so exuberant , and so the heat effusion is tidal, i.e., occurs in the
afternoon.
LESSER YANG : In lesser yang disease, the struggle is taking place between the
interior and exterior, so heat effusion alternates with aversion to cold.
Sweating (汗 出 hdn chii): Sweating occurs in a variety of patterns. A distinc­
tion is made between spontaneous and night sweating. Spontaneous sweating ( 自
汗 zi han) is so called because it occurs spontaneously without exertion. It has nu­
merous causes. Night sweating ( 盗 汗 da o han) is sweating during sleep that ceases
on awakening. The Chinese term literally means “thief sweating,” reflecting that
it occurs when the patient is unaware of it. The English term “night sweating" is
somewhat unsatisfactory because it suggests that sweating during daytime sleep is
excluded, which is not the case. Night sweating is usually a sign of yin vacuity, but
examples of this are not found in the Shang Han Lun. In the externally contracted
disease patterns described in the Shang Han Lun, spontaneous sweating is much
more common, although it is often simply referred to as sweating. Night sweating
in the Shang Han Lun is mentioned only in y归g brightness disease and lesser y缸g
disease.
G REATER YANG : Here, sweating is observed in exterior vacuity wind strike,
while absence of sweating is a sign of exterior repletion cold damage. In exte­
rior vacuity, the defense φ is vacuous and is easily damaged when an external
evil is contracted. When this happens, it fails to contain construction-yin,
which discharges outward in the form of sweat. This is known as “insecurity
of the defensive exterior" (Jl 表 不 固 wei biao bu gu). Conversely, in exterior
repletion, the interstices and fleshy exterior are secure.
YANG B RIGHTNESS: Sweating is copious and streams outward, in contrast to
that which occurs in greater yang wind strike, which is scant and issues slowly.
In heat patterns, the sweat is said to be copious over the whole body, whereas
INTRODUCTION
17
in repletion patterns, it is said to stream from the limbs. In both these cases,
sweating is spontaneous sweating. Line 20 1 , p. 390, and line 268, p . 448,
describe conditions in which night sweating is a sign of exuberant internal
heat forcing the fluids out to the exterior. In yang brightness disease, there is
also sweating only from the head after heat has been reduced by precipitation.
LESSER YANG : Line 269, p. 442, the last line of lesser y缸g in the present text,
speaks of “sweating after the eyes close,” which is the same as night sweating.
It is explained there as being a sign of y缸g exuberance. During sleep, 同ng
enters the interior so defense y归g decreases. Consequently, interior heat
becomes exuberant and distresses humor, which discharges outward in the
form of sweat.
Pulse that is floating (脉 浮 mai JU) : A pulse that is pronounced at the
superficial level.
GREATER YANG : A floating pulse in greater yang disease reflects exterior evil
in the exterior being resisted by right ql.
YANG BRIGHTNESS: In yang brightness disease, the pulse is typically large.
Nevertheless, line 22 1 , p . 312, describes a condition of rampant dryness-heat
in both the interior and exterior that gives rise to a pulse that is floating
and tight; line 1 76, p. 316, describes a similar condition where a pulse that is
floating and slippery is an outward manifestation of exuberant internal heat.
GREATER YIN : In greater yin disease, a pulse that is floating may indicate a
concurrent greater ya昭 exterior patt町n (as in line 276, p. 456) .
LESSER YIN : A pulse that is floating is not normally observed in lesser yin
disease. When the cubit pulse is floating as described in line 290, p. 521, it
means that the y归g qi is returning.
REVERTING YIN : A pulse that is slightly floating in reverting yin can be a sign
that the disease is moving outwards prior to recovery (line 280 , p. 460 ) .
Passage and ’l'ransmutation
Passage (传 chuan) means the development of the disease along a partic1由r
course; transmutation (变 bian) means change in the nature of disease contrary to
the normal laws. These are dependent upon a number of factors:
•
relative strength of right and evil qi
•
administration of appropriate or inappropriate treatment
•
constitution of the patient
•
presence or absence of other illnesses
As a general rule, externally contracted disease begins in the exterior, and if
it fails to resolve there, passes to the interior. Greater yang exterior patterns give
way to either y在ng brightness or lesser yang disease. Lesser y归g often progresses to
y归g brightness. Disease of the three yin is usually a later development occurring
when the body is severely weakened by the struggle against the disease evil. This is
18
INTRODUCTION
the general pattern, but in some cases, if right ql is restored and the evil ql weakens,
the disease may pass from the interior to the exterior.
Combination disease and dragover disease both involve more than one channel.
Any pattern of two or three channels is called com bi nation disease ( 合 病 M bing) .
There is greater y缸g and yang brightness combination disease, greater y缸g and
lesser y缸g combination disease, and three-yang combination disease. When the
signs of one channel abate as those of another develop, this is called d ragover disease
(并 病 bing bing). In the Shang Han Lun, there is greater y缸g and y归g brightness
dragover disease and greater y缸g and lesser yang dragover disease. In addition, in
debilitated patients, disease evils under some circumstances do not go through the
three yang, but instead enter the three yin channels directly. This i吕 called d i rect
stri ke [on the yin cham ls] (直 中 zhi zhong).
’Treatment
The Shang Han Lun text makes reference to several different forms of treatment
including acupuncture, moxibustion, fuming, and drug therapy. Zhang JI mostly
recommends medicinal treatments; only occasionally does he suggest acupuncture.
Other treatments mentioned in the Shang Han Lun are those that patients have
previously received, and often they are specifically stated to have been inappropri­
ate.
The medicinal therapy applied by Zhang JI is based on the notion that each drug
has certain properties that affect the body in a specific way. Different medicinals
are combined in innumerable ways to cope with the complex manifestations of
externally contracted disease. The treatments are not symptomatic, but address
specific pathomechanisms.
One treatment alone stands out as being based on different notions. The formula
Burnt Pants Decoction (shao kun san) , a decoction made from the ash of the crotch
of underp ants, seems to based on an older, magical conception of yin and yang.
According to Shang Han Lun, when the body is severely weakened by externally
contracted disease, the disease is easily transmitted through sexual intercourse. A
condition transmitted to a person in this way is treated by the burnt crotch of the
underpants of a person of the opposite sex. This formula is not applied in modern
practice.
Zha吨 JI uses medicinal formulae to promote sweating (汗 him), promote vomit­
ing ( 吐 tu ) , precipitate (下 xia) , harmonize (和 M), warm (温 wen), clear (清 qfng) ,
supp lement (补 bu) , and disperse (消 xiao) , alt hough the last three of these terms
do not appear in the therapeutic sense in the Shang Han Lun. Through the lines of
the Shang Han Lun , we can see that the notions of “supporting y缸g ql” (扶 阳 气
Ju yang qi) and “preserving yin humor" (存 阴 液 cun yfn ye) constitute the basic
approach to dispelling evil. In other words, the spearhead of Zhang JI’s treatments
consists in enhancing the body’s power to dispel evil. In diseases of the three y缸g,
the object is to dispel evil, but the treatments are mostly designed to adjust bodily
functions in such a way 部 to release or expel the evil. For greater y归g disease, the
main approach is to resolve the exterior. In exterior repletion this involves opening
the interstices, causing cold to dissipate by the promotion of sweating. In exterior
vacuity, it entails harmonizing construction and defense in order to resolve the flesh
INTRODUCTION
19
and dispel wind. In y缸g brightness disease, heat patterns 缸e treated by clear­
ing, whereas repletion patterns are treated by precipitation. In lesser yang disease,
where inhibition of the pivot gives rise to half exterior half interior patterns, the
treatment is harmonization and resolution. Disease of the three yin mostly mani­
fests in vacuity patterns, for which the treatment is primarily to support right qi .
For example, greater yin disease manifests in vacuity cold-damp patterns, so that
the treatment is primarily to warm the center, dissipate cold, and dry dampness.
Lesser yin disease manifests in heart-kidney debilitation with insufficiency of qi and
blood, there being, however, a distinction between cold transformation and heat
transformation. Cold transformation is treated by supporting y归g and repressing
!In, while heat transformation is treated by fostering yin and clearing heat. Revert­
ing yin disease manifests in a variety of complex patterns, where heat is treated by
clearing, cold is treated by warming, and cold-heat complexes are treated by dual
application of warming and clearing.
THE LANGUAGE OF THE SH.ANG HAN LUN
The main body of the Shang Han Lim is divided into short lines describing
patterns and their treatment, and sometimes their etiology. The content is not only
clinically oriented and matter-of-fact, but is also reasonably uniform. Accordingly,
its expression is also quite consistent as regards both terminology and sentence
patterns. Since our translation is highly literal, these and other features of the
language of the Shang Han Lun will also be apparent to the English-speaking reader.
Nevertheless, certain variations in terminology and certain specific sentence patterns
may be troublesome to the English-speaking reader, and these are discussed here.
Learners of Chinese wishing to read the original text 缸e referred to Appendix II for
a comprehensive analysis of the grammar and vocabulary of the Shang Han Lun.
Terms
The Shii.ng Han Lun is a book offering treatments for various different man­
ifestations of cold damage. Accordingly, terms can be divided into three broad
categories: sign nam战 pattern m皿战 and formula ( 皿d drug ) names. Pattern
names and formula and drug na皿es are the most consistent; each term denotes
only one concept and, discounting abbreviated forms, is the only term to denote
that concept .
Sign n创nes are more numerous and more variable. The notion of heat effusion
appears as 发 热 fa re and 身 热 sh en 时 , and simply as 热 re . Other clusters of
te口ns to a greater or lesser degree synonymous include:
( 口 ) 不 能 食 {kiiu} bu neng shi, inability to eat
食 不 下 shi bu xia, inability to get food down
不 欲 饮 食 bu yu yin shi, no desire for food or drink
不 得 眠 bu de m ia旬 , inability to sleep
不 得 卧 bu de wo, inability to sleep
不 得 卧 廉 bu de WO mei , inability to sleep
20
INTRODUCTION
手 足 冷 shOu zu leng , cold extremities
手 足 厥 冷 shOu zu jue Leng, reversal cold of the extremities
手 足 逆 冷 sh6u zu ni leng, counterflow cold of the extremities
E由 chuiin, panting
短 气 duiin qi, shortness of breath
少 气 sh iio qi, shortage of φ
Many terms contained in the Shii.ng Han Lim 缸e to this day used in the same
sense. 发 热 fa re and 恶 寒 wu han denote the same sign now 副 they did in the time
of Zhang JI. A few terms, however, have changed in their mea且ing. Readers should
be warned ag创nst reading into terms contained in the Shii.ng Han Lun de直nitions
and connotations that they accrued later in history.
The term dispersion-thirst (消 渴 xiii.o ke) appears in reverting yin dise臼e, and
describes a thirst that is unallayed by fluid intake. The same term also is more
commonly encountered outside the Shii.ng Han Lim 皿 denoting a disease entity that
corresponds in large measure to diabetes. Interestingly, the thirst in greater y缸g
disease is sometimes unquenchable, but “dispersion-thirst” is not used to describe
it .
Terms whose meaning have undergone change notably include certain pulse
terms that were given specific definitions that are not known to have applied in
Zhang JI's writings. Most of the pulse terms used in Chinese medicine are commonly
used adj ectives, and the absence in early literature of definitions for these terms
suggests that writers believed they were not using these terms in a technical sense
that required special explanation. The first attempt to systematically define pulse
terms was made by W缸g Shu-He, who, it will be remembered, gathered together
the parts of the Shii.ng Han Za Bing Lun relating to cold damage to form the Shii.ng
Han Lun . W缸g Shu-He based his Mai Jzng largely on Zh副g JI's work, but gave
definitions for the pulse that were clearly 皿ore specific than the sense in which
Zhang JI had used them. 1 For example, Wang Shu-He defined 动 dong, “stirred,”
as being a rapid quality of the pulse 岛lt only at the bar (关 guii.n ) point, despite the
fact that in one instance in the Shii.ng Han Lun a “stirred” quality is explained to
be palpable over an area not limited to the bar. Wang Shu-H的 丑arrower definition,
which was accepted by many physicians of subsequent generations, does not apply
in the Shii.ng Han Lun .
The Chinese 微 wei is sometimes used adverbially in the sense of “slightly”
(before line 23, p. 122) , and sometimes adj ectivally to describe a pulse quality (after
line 23, p. 122) . 促 cu, “skipping,'’ is sometimes taken to mean “rapid and urgent”
(line 34, p. 158) , and sometimes to mean “rapid and interrupted" (line 2 1 , p. 85) .
缓 huiin , “moderate,” is sometimes taken to be the opposite of “tight” (line 2, p. 43)
and sometimes to be slower than normal in speed (line 187, p. 462) . 阴 阳 yzn yang,
“yin and yang,” are sometimes taken to mean inch and cubit respectively (line 4,
p. 52, and line 6, p. 47) , and sometimes taken to mean super且cial level and deep
level (line 12, p. 60) .
1
Wang Shu-He also introduced the innovation of referring to single pulse qualiti创 in the format
“adjective (or qualifying noun) + pulse," eι “floating pulse"
p ulse is floating” used by Zhang Jr 缸id earlier writers.
as
compared with descriptive “the
INTRODUCTION
21
The usage of the terms yin and yang also deserves our attention. In the Shang
Han Lun , these terms are rarely used to denote the two 副pects of physiological
function (yin blood and yang φ) as they are in other literature. Rather, they most
commonly appear in the names of the channels and, as individual terms, 缸e most
frequently used to name pulse conditions or positions. In the context of the pulse,
the terms are polysemous. As classes of pulse types, yin refers to sunken, rough,
weak, stringlike, and faint pulses, while yang refers to large, floating, rapid, stirred,
and slippery pulses. In other pulse contexts, however, yin and yang refer to the
cubit and inch pulse (cf. line 290 , p . 5 2 1 ) .
Finally, the various terms denoting jaundice deserve some attention. I n the
Shang Han Lun , jaundice is usually referred to as 发 黄 fa huang, “yellowing,” or
身 发 黄 shen fa huang, “generalized yellowing.” The word 黄 瘟 huang diin, most
commonly used in modern texts, does not appear, but the 碎 , diin , a synonym
of 瘟 diin , appears in the term 谷 痒 gu diin, “grain jaundice.” These terms have
always meant the same thing since Zhang JI’s time. Nevertheless, understanding
of the causes has changed. Throughout most of the history of Chinese medicine,
jaundice was considered to be a disease of the spleen arising when damp-heat or
damp-cold obstructing the normal movement of fluids in the center burner affected
spleen function. The yellowness was considered to be a direct reflection of spleen
disease, since yellow is the color associated with spleen『earth. Zh磊ng Jing-Yu色 ( 张 景
岳 ) of the Ming Dynasty may have b een the first physician in China to propose the
term 胆 黄 diin huang, “gallbladder jaundice,” claiming that this disease arose when
damage to gallbladder qi caused bile to discharge, i.e. , leak from the gallbladder and
fl.ow to the skin. In the Qing Dynasty, Ye Gui (叶 桂 , style 天 士 Ti加-Shi) , in his Lin
Zh归g Zh'i Nan Yr A n ( 临 证 指 南 医 案 “Case Studies for Clinical Guidance” ) of 1766,
combined the theories of damp-heat and gallbladder involvement. Nevertheless, no
writer before the modern era ever stated that yellowing of the skin and the sclerae,
whatever the root cause, was always the manifestation of stray bile. It is only in this
century that the notion of j aundice has become central to the concept of jaundice,
so much so that even modern commentators introduce it into their explanations of
pathomechanisms in the Shang Han Lun.
Stylistic Features
With the sole exception of Zhang JI' s preface, the Shang Han Um is writ­
ten in straightforward style with no literary adornment. Given the similarity of
Chinese syntax to English, the word order can be almost perfectly replicated in
English. Nevertheless, two rather peculiar stylistic features deserve our attention.
Intercalation and inversion are two features of Han Dynasty Chinese that caused
interpretation difficulties in later ages. In the translation, we have reproduced these
features in English with the aid of parentheses. We give a few examples to warn
the unsuspecting reader.
Intercalation: Sometimes additional qualifying or explanatory phrases are
included in the text. In the English translation, in accordance with modern custom,
we have placed such phrases in brackets.
阳 明 病 , 俨 语 , 有 潮 热 , 反 不 能 食 者 , 胃 中 必 有燥 屎 五 六 枚 也 。 若
能 食者 . 但硬 耳 , 宜 大 承 气 扬 下 之 。
INTRODUCTION
22
[Line 215, p. 347:] When in yang brightness disease, [there is] delirious speech
and tidal heat effusion, but inability to eat, [this means that] there must be
five or six pieces of dry stool in the stomach. (If [the person] is able to eat,
[there i司 only hard [stool] .) Major Qi-Coordinati吨 Decoction ( da cheng qi
tang) is appropriate for precipitation.
Inversion: The appearance of a note or comment that can only be understood
after r e ading the predicate of the sentence that follows is called inversion. We have
marked inversions by placing them in parentheses.
太 阳 病 , 脉 浮 紧 , 无 汗 发 热 , 身 疼痛 , 八 丸 日 不 解 , 表 证仍 在 , 此 当
发其汗 。 服 药 已 , 微除 , 其 人 发 烦 目 眠 , 剧 者必烟 , 剧乃解 。 所 以 然
者 , 阳气重 故 也 。 麻黄汤主之 。
[Line 46, p. 96:] In greater ya吨 dise臼e, when a pulse that is floati吨 and
tight, absence of sweating, heat effusion, and generalized pain are unresolved
after eight or nine days, the exterior pattern is still present and one should
promote sweating. (After taking medicine, (the condition] is slightly relieved,
and the person is vexed and the eyes are heavy. If it is acute, there will be
spontaneous external bleeding, which will bring about resolution. Why [this]
is so is because the yang qi is we ight ed . ) Ephedra Decoction (ma huang t 伽g )
governs.
The parenthesized section in the above example is an inversi on since “ medicine ”
refers to Ephedra Decoction ( ma huang tang ) , which is not mentioned until the end
of the sentence.
伤 寒 心 下 有 7f'<. 气 , 咳 而 微 喘 , 发 热 不 渴 ; 服 汤 已 , 揭 者 , 此 寒 去 欲 解
也 ; 小 青龙汤主之 。
[Line 4 1 , p. 120:] When in cold damage, [there is] water qi below the heart,
mild panting, and heat ·effusion without thirst , (thirst , after taking
the decoction, means the cold is going and [the disease] is about to resolve)
Minor Green-Blue Dragon Decoction (xiao qing long ta叼 ) governs.
cou g h,
Here, the word “decoction” in the parenthesis refers t o Minor Green-Blue
Dragon Decoction, which has not yet been mentioned. The author jumps ahead
of his own thoughts, and the prompt to do so apparently comes from the wor d
“thirst” : the decoction treats a pattern without thirst, but may in fact cause thirst.
太阳病 , 发 热恶 寒 , 热 多 寒 少 , 脉微弱 者 , 此无阳也 , 不 可 发 汗 , 宜
桂 枝 二 越 脾 - ¥� 。
[Line 27, p. 127:] When in greater y缸g disease [there is] heat effusion and
to cold [with] more heat and less cold (a pulse that is faint and weak
means that y缸g is absent and one cannot promote sweating) , Two Parts
Cinnamon Tw ig and One P art Spleen-Effusi吨 Decoction (gui zM er yue bi
yi tang ) is appropriate.
aversion
INTRODUCTION
23
发汗后 , 不 可 更行桂枝 汤 , 汗 出 而 喘 , 无 大 热 者 , 可 与 麻 黄 杏 仁 甘 草
石膏汤 。
[Line 63, p. 154:] After the promotion of sweating, ( [one] cannot again use
Cinnamon Twig Decoction (gui zM ta叼 ) ) i f sweat issues, and [there is] pant­
ing and great heat is absent, one can use Ephedra, Apricot Kernel, Licorice,
and Gypsum Decoction (ma huang xing ren gan cao sM gao tang ) .
Solving Ambiguities
The Shang Han Lim contains a considerable number of textual ambiguities that
are clarified by considering contextual information. For example, the pattern can be
determined from the formula or from the pulse, or the formula can be determined
from the pattern.
Determining the pattern 仕om the formula: Many if not most of the
lines of the Shang Han Lim discuss a particular constellation of signs prefaced by
a generic pattern ( e.g. , “wind 由ike,” 飞reater yang disease” ) . Generally speaking,
the generic pattern is intended to evoke the basic signs, even when these are not
explicitly stated. Thus whenever the text of a line starts 副 “ [When] in greater yang
disease . . . ,” we can usually be sure that whatever signs follow, we are to understand
that the basic signs of greater y缸g disease ( floating pulse, stiffness and pain of head
and nape, etc. ) are also implied. Sometimes, however, there is no generic reference.
Given the speculation as to the original order of the lines, the absence of a generic
reference introduces potential ambiguity. In such cases, the formula mentioned in
the line very often provides the desired reference. Much interpretation of ambiguous
lines is based on the principle of working backwards from the formula. Let us look
at the following example:
脉 t孚 者 , 病 在 表 , 可 发 汗 , 宜 麻 黄 汤 。
[Line 5 1 , p. 93:] When the pulse is floating, the disease is in the exterior,
[and if] one can promote sweating, Ephedra Decoction (ma hua叼 tang ) is
appropriate.
Although it is not clear from the signs given here whether this is a cold damage
or wind strike pattern, the use of Ephedra Decoction (ma huang tang) clar诅es the
issue since this formula is only appropriate when there is no sweating, i.e., for cold
damage patterns.
大病差后 , 从腰以 下有水气者 , 牡肪泽泻散主 之 。
[Line 395, p. 601 :] When after a major illness has been cured, [there is] water
φ 丘om the lumbus down, Oyster Shell and Alisma Powder ( mu li ze xie s an )
governs.
This line is ambiguous because the appearance of water-ql after an illness can
be a sign of vacuity or repletion. An analysis of the formula, however, shows that
this line discusses a repletion pattern of water swelling from the lumbus down due
to damp-heat congestion and a loss of normal ql transformation in the lower burner.
Determining the pattern 仕om the pulse: In some instances, the pulse
provides information about the nature of the pattern.
24
INTRODUCTION
问 曰 : 病有结胸 , 有藏结 , 其状何 如 ? 答 曰 : 按之痛 , 寸脉浮 , 关脉
沉 , 名 曰 结胸 也 。
[Line 128, p. 2 1 1 :] Question: There is a disease [called] chest bind, and there
is [one called] storehouse bind. What form do they take? Answer: [If there
is] pain when pressure is applied, and the inch pulse is floating, and the bar
pulse is sunken, this is called chest bind.
何 谓 藏 结 ? 答 曰 : 如 结胸 状 , 饮 食 如 故 , 时时 下 利 , 寸脉浮 , 关 脉 小
细沉紧 , 名 日 藏结 。 舌 上 白 胎 滑 者 , 难 泊 。
[Line 129, p. 225:] What is storehouse bind? Answer: [When there are]
signs like chest bind, eating and drinking are normal, [and there is] frequent
diarrhea, an inch pulse that is floating, and a bar pulse that is small, fine,
sunken, and tight, it is called storehouse bind. When the tongue fur is white
and slippery, this [pattern] is difficult to treat.
Both chest bind and storehouse bind manifest in hard fullness below the heart
that is painful when pressed and in a pulse that is floating at the inch. Chest
bind is characterized by a pulse that is sunken at the bar, while storehouse bind
is characterized by a pulse that is small and 且ne, sunken, and tight. The pulses
clearly reflect the pathomechanisms: Chest bind is usually a yang or heat pattern
that arises when heat and water bind in the chest and rib-side and below the heart.
Because the bar pulse governs the center, it reflects the location of the disease ql
in the chest and diaphragm. Because this is a repletion pattern, the pulse that
is sunken at the bar is also forceful. In contrast, storehouse bind is a yin or cold
pattern that arises when, owing to center burner vacuity cold and debilitation of
yang φ, yin cold evil binds in the treasuries. Because the right is vacuous and evil
is exuberant, this is difficult to treat. The pulse that is small and fine at the bar
reflects debilitation of right ql, and the sunkenness and tightness reflect the yin evil
binding internally.
Determining the formula from the pattern: Sometimes the context pr。
vides information about a formula name.
太 阳 病 , 项 背 强 几 凡 , 反 汗 出 恶 风 者 , 桂 枝 加 葛 根 ¥-m 主 之 。
[Line 14, p. 79:] When in greater yang disease [there is] stretched stiff nape
and back, but also sweating and aversion to wind, it is treated with Cinnamon
Twig Decoction Plus Pueraria (gui zhf jia ge gen tang ) .
The formula prescribed contains ephedra (ma huang ) , which i s not appropriate
if there is sweating. From the context, therefore, it has been suggested that Cin­
namon Twig Decoction Plus Pueraria (gui zhz jia ge gen tang) means Cinnamon
Twig Decoction (gui zhz tang) with the addition of ge gen.
There are many places where the Chinese text is ambiguous at the level of
conceptual understanding. Although the wording of the text in such places may
be clear, different interpretations 描 to the clinical significance are given. Line 353,
p. 546, provides an example:
大 汗 出 , 热不 去 , 内 拘 急 , 四肢疼 , 又下利 , 厥逆而恶寒者 , 四逆汤
主之。
INTRODUCTION
25
[Line 353, p. 546:] When great sweat issues, the heat has not gone, and
[there is] internal hypertonicity, pain in the limbs, diarrhea, reverse-flow and
aversion to cold, Counterflow Cold Decoction ( si ni tang) governs.
It is generally clear that this line presents a condition of interior yin exuberance,
but whether this is accompanied by exterior yang collapse, or an unresolved exterior
pattern, has been a matter of debate.
Yet there are also places where the literal meaning of the text is unclear. Here
the problem may lie in , the grammatical ambiguity of phrases or the referential
ambiguity of words.
For example in line 17, p. 76, which reads 若 酒 客 病 , 不 可 与 桂 枝 汤 ruo jiu
ke bing, bu ke yu gui zhf tang, it is not clear if this is to be understood as “If a
liquor drinker is sick [ with greater ya吨 disease] , [one] cannot give Cinna皿on Twig
Decoction" or “If [the patient has] liquor drinker sickness ( i札 alcoholism, without
greater y缸g dise甜e ) , [one] cannot give Cinnamon Twig Decoction." In such cases,
we have tried to make the English translation as ambiguous as the Chinese text, so
that it supports either interpretation.
Ambiguity in the referential meaning is most commonly found in the words yin
and yang.
凡厥者 , 阴 阳 气 不 相顺接 , 便 为 厥 。 厥者 , 手足逆冷者是也 。
[Line 337, p. 542:] In al
smoothly, which means reversal. Reversal means counterflow cold of the
extrem1t1es.
Here, yin and yang are variously interpreted as meaning φ in the channels, the
relationship between organs, or the relationship between organ φ and channel ql.
Finally, we should also mention the word 必 bi, which is generally understood
to mean “must,” “ought to,” “bound to.” Zhang JI uses this word, for example, in
line 32, p. 1 1 1 , to indicate the likelihood of spontaneous diarrhea in greater yang
and y缸g brightness combination disease. Nonetheless, if one looks ahead to line 33,
p . 1 12, it is clear that in the same combination disease, diarrhea does not occur.
This and other apparent incongruities have led some commentators to suggest that
必 bi should be understood to mean “might” or “may.” Since we have found no
lexicographical source that notes 必 possesses this sense, the suggestion can only
be based on belief in Zhang JI’s infallibility. Of course, logical inconsistency in the
original text and transcription error are just as likely possibilities. In the translation,
we leave the question open by ren d ering the 必 bi as “will.”
Z hang JI's Preface
张机原序
←) 余 每 览 越 人 人 貌 之 诊 , 望 齐 侯 之 色 , 未 尝 不 慨 然 叹 其 才 秀
也 。 口 怪 当 今居世之士 , 曾 不 留神医药 , 精究方术 , 上以疗
君 亲 之 疾 , 下 以 救 贫 贱 之 厄 , 中 以 保 身 长 全 , 以 养 其生 , 但
竞逐荣势 , 企踵权豪 , 孜孜汲汲 , 惟 名 利 是 务 , 崇饰其末 ,
忽 弃 其 本 , 华 其 外 而 悴 其 内 , 皮 之 不 存 , 毛 将 安 附 焉 ? (斗 卒
然遭邪风之气 , 婴非常之疾 , 患及祸至 , 而方震栗 , 降志屈
节 , 钦望巫祝 , 告穷 归 天 , 束手受败 , 资百年之寿命 , 持至
贵 之 重 器 , 委 付 凡 医 , 您 其 所 措 , 咄 H差 呜 呼 ! (四) 厥 身 已 毙 ,
神 明 消 灭 , 变 为 异物 , 幽潜重泉 , 徒 为 啼 泣 。 痛 夫 ! 回 举世
昏 迷 , 莫 能 觉悟 , 不 惜其命 , 若是轻生 , 彼何荣势 之云哉 !
(六) 而 进 不 能 爱 人 知 人 , 退 不 能 爱 身 知 己 , 遇 灾 值 祸 , 身 居 厄
地 , 蒙 蒙 昧 昧 , 惹 若 游 魂 。 哀 乎 ! (匕) 趋 世 之 士 , 驰 竞 浮 华 ,
不 固根本 , 忘驱何物 , 危若冰谷 , 至于是也 。
( 1 ) Yu mei liin yue ren ru gu6 zhi zhe吼 叫叼 qi h6u zhi se, wei
chang bu kiii ran tan qi cai xiu ye. (2) Guai dang jin ju shi zhi shi,
ceng bu liu shen yi yao, jing jiu fang shu, shang yi liao jun qin zhi
ji, xia yi jiu pin jian zhi e, zhδng yi bao shen chang quan, yi yang
qi sheng, dan jing zhu r6ng shi, qi zhong quan hao, zi zi ji ji, wei
m仇g li shi w毡, ch6ng shi qi mo, hu qi qi ben, hua qi wai er cui qi
nei, pi zhi bu cun, mao jiang an JU yan ? (3) Zu ran zao xie Jeng
zhi qi, ying fei chang zhi ji, huan ji huo zhi, 白’· Jang zhen li, jiang
zhi qu jie, qin wang WU zhu, gao qi6ng gui tian, shu shou shou ba毛
ji biii nian zhi shou ming, chi zhi gui zhi zhong qi, wei fu fan u瓦 zi
28
ZHANG JI’s
PREFACE
qi suo cuo, duo jie wu hu! ( 4) Jue shen yi bi, shen ming xiao mie,
bian wei yi 圳, you qian zhong quan, tU wei ti qi. Tong ju! (5) Ju
shi hun mi, mo neng jue wu, bu xi qi ming, ruo shi qfng sheng, bi
he r6ng shi zhf y伽 zai. ( 6) Er jin bu neng ai ren zhz re·叽 tui bu
neng ai shen zhz ji, yu zai zhi huo, shen ju e di, meng meng mei
mei, chun ruo you hun. A f hu! (7) Qu shi zhf shi, chi ji叼 Ju hua,
bu gu g臼 b旬, wang qu xun wu, wei ruo brng gu, zhi yu shi ye.
( 1) Each ti me I read a bout Y峙 Ren 1 entering [the Ki ngd。m 。f] G L』
t。 exa m i ne [patients] a n d i n spect t h e com plexi。n 。f the M a rq u is of
Q I, I a lways sigh with great emoti。n a bout h is su perb talents. (2 ) [It
is] bewi lderi ng t hat the learned men 。f 。 u r age never pay attention to
m ed ici ne [a nd a re n。t] proficiently versed in the remedial a巾, [wh ic h
wou ld ena ble them] t。 treat t h e i l l nesses of t h e sovereign a n d 。f [thei r]
elders a bove, to relieve the sufferi ng of the poor a nd destitute below ,
a nd to safeguard [thei r 。wn] body a nd sustai n health a t center,2 [a ll]
in 。时er t。 cu ltivate life. I nstead , [they] o n ly com pete a nd pu rsue gl。叩
a nd power. [They] sta nd on the ti ptoe 。f expecta ncy for i nfl uenti a l
。fficials a nd fa m i l ies of power, d i ligently a n d u nt i ri ngly dev。ting thei r
eff1。rts 。 n ly t。 fa me a nd profit. Reveri n g a n d refi n i ng n。nessentia Is,
[they] neglect a nd a ba ndon the root. Wh i le em bell ishi ng the externa l ,
they i m p。ve巾h the i ntern a l .3 [If] the skin is a bsent , [how] ca n the
ha i r be secu 陀ly attached ? (3) [When they then] sudden ly su仔er [a n at­
tack of] evi l wind qi a nd [conseq uently] develop a n extraord i nary i l lness,
meeti n g m isfort u ne a nd d isaster, [they] tremble a nd sha ke. Aba ndoni ng
thei r i ntegrity, they lower themselves to grovel before magica l hea lers.
Decl a ri n g [thei r] helplessness, [they] attri bute [their m isfort u ne to fate
ord a i ned by] heave n ; 4 with h a nds tied , they accept defeat. Holdi ng a
l ife[叩a n] 。f [potentia l l y a] h u nd red yea凡 thei r m。st va l ua ble p。ses­
sion , they entrust themselves to com mon physicia ns, wh。 treat reek­
l essly, without 吨ard [for life ’ s va lue] . O h w。e! (4) The body already
d ead a n d the spi rit destroyed , they tra nsm ute int。 wei rd bei ngs, and
descend to roa m i n the u nderworld , weeping a nd sobbing to n。 ava i l .
O h , what pa i n ! ( 5 ) T h e whole world i s stu porous, nobody i s aware,
[ n。b。dy] d昭eri hes life . M a ki ng l ight 。f I i仨 i n t h is wa弘 why [al l] that
ta l k of gl。ry a nd power? (6) M。vi ng f。刚ard [i nt。 s。ciety, they a re]
u n a ble t。 l。ve a nd know others; retreati ng [i nt。 themselves, they a 叫
u na ble t o love a nd know t hemselves. Meeti ng d isaster a n d encou nter­
i ng m isf1。由 ne, placed i n preca ri。us p。sition , [they a re sti l l] clouded by
ZHλNG Ji’ s PREFACE
29
ignora nce, b l i n d as wa nderi ng sou ls. What sorrow ! (7) Men who pu rsue
the ways 。f the world race i n com petition for va i n ostentatio n , fa i li n g to
secu re the root. Neglecting the body i n pu rsu it of m ateri a l p。ssessions,
[thei r situation is as) da ngerous as if [they were wa l k i ng on th i n ) ice [ i n
the bottom 。f a deep ) va l ley, so serious i s it.
(寸 余 宗 族 素 多 , 向 余 二 百 , 建 安 纪 年 以 来 , 犹 未 十 捻 , 其 死
亡 者 , 三 分 有 二 , 伤 寒 十 居 其 七 。 (二) 感 往 昔 之 沦 丧 , 伤 横 夭
之 莫 救 , 乃 勤 求 古 训|| , 博 采 众 方 , 撰 用 《 素 问 》 、 《 九 卷 》
《 八 十 一 难 》 、 《 阴 阳 大 论 》 、 《 胎 月卢 药 录 》 并 《 平 脉 辨
证 》 , 为 《 伤 寒 杂 病 论 》 合 十 六 卷 。 仨) 虽 未 能 尽 愈 诸 病 , 庶
可 以 见 病 知 源 。 (四) 若 能 寻 余 所 集 , 思 过 半 矣 。
(1)
Yu z侃.g ZU SU duo, xiang yu er b iii, Jian A n ji nian yi ltii, you
wei sh{ r旬, qi si wang zh e, san fen you er, shang han sh{ ju qi qz.
(2)
Giin wii叼 xi zhz lUn sang, shang heng yao zhz mo jiu, niii qin qiu
gu xun, b6 ciii zhong fang, zhuan yong 《 SU wen》 ,
sh{ yz naη》 p
《 yzn yang da lun》 F
《jiu juan》 ,
《 ba
《 tai zu yao lU》 , b ii占g 《ping ma i
biaη zh 切g》 , wei 《 shang han za bing luη》
h e sh{ liu j包an. ( 3 ) Sur
wei n en叼g jin yu zhu bing, shu kε yi jiaη bi叼 zhz yua肌 (4) Ruo n en
X'l
yu SUO j{, SZ g包uo b an yi.
( 1 ) My fa m i ly was formerly large, 。nce [cou nti ng] over two h u nd red
mem bers, ( but] from (the begi n n ing 。f) the J ia n-An 陀ign , 5 i n less t h a n
ten yea rs, two t h i rds have d i ed , seven tenths of t hem from cold d a m age.
(2) La menti ng the fa l l 。f [。 u r glori。us] past a nd the u nti mely loss of s。
m a ny lives that cou ld n。t be saved , I h ave d i ligently sought the gu ida n ce
。f the a ncients, widely col lected the various remed ies, a n d consu lted the
Su Wen ( “ P la i n Questions” ) , Jiu Juan ( “The Nine Fascicles" ) , B a Shi
Yr Nan ( “The Eighty-One Difficult Issues” ) , Yzn Yang Da Lun ( “The
G reat Treatise 。n Y『n-Ya ng"
。f M ed ici n 时als” ) , a n d the Ping Mai Bian Zheng ( “The Assessment 。f
P u lses a n d Identification 。f Patterns” ) to create the Shang Han Za
Bing Lun, tota l i ng sixteen fascicles. (3) Although t h is book ca n not
com pletely cure a l l d iseases, it provides the mea ns to u ndersta n d t h e
origin of i l l nesses encou ntered . ( 4) If [the 阳der] follows the materials
herei n col lected , [ h e should be a ble to) t h i n k out 。ver h a lf [。f a l l med ica l
problems] .
ZH孟NG JI’ s PREFACE
30
付 夫 天布五行 , 以运万类 ; 人禀五常 , 以 有五藏 ; 经络府
俞 , 阴 阳 会通 , 玄冥幽微 , 变化难极 。 ω 自 非 才 高识妙 , 岂
能 探 其 理 致 哉 ! (斗 上 古 有 神 农 、 黄 帝 、 岐 伯 、 伯 高 、 雷 公 、
少 俞 、 少师 、 仲文 、 中世有长桑 、 扁鹊、 汉有公乘阳庆及仓
公 , 下 此 以 往 , 未 之 闻 也 。 (四) 观 今 之 医 , 不 念 思 求 经 旨 , 以
演其所知 , 各承家 技 , 终始顺 旧 , 省疾 问 病 , 务在 口 给 , 相
对斯须 , 便 处 汤 药 。 按 寸 不 及 尺 , 握 手 不 及 足 ; 人 迎肤阳 ,
三 部 不 参 ; 动 数 发 息 , 不 满 五 十 。 伍) 短 期 未 知 决 诊 , 九 fl芙 曾
无 旁 鬓 , 明 堂 阙 庭 , 尽 不 见 察 , 所 谓 窥 管 而 已 。 (功 夫 欲 视 死
别生 , 实为难矣。
( 1 ) Fu
tian bu w
四d zang; jfiηg
biaη ht
zai!
( 3)
nan
lt』d Ju shu, yfn yang hui tong, xuan ming you wεi,
ji. {2)
Zi fei cai gao shi miao, qi ne·叼 tan qi li zhi
Shang gil yo包 Shen Nong, Huang Di, Qi Bo, Bo Gao, Lei
Gong, Shao Yu, Shao Shz, Zhong Wen, zhong shi you Chang Sang,
Bian Que, Han you Gong Sh eng Yang Qing ji Gang Gong, xia ci yi
wang, w创 zhz wen ye.
( 4)
Guan jfn zhz yz, bu nian sf qiu jzng zhi,
yi yiin qi suo zhf, ge cheng jia ji, zhong shi shun jiu, xing ji wen
bing, WU zai kou ji, xiang dui sf xu, bian chil tang yiw . An cun bu
ji ch毛 WO shou bu ji zu; ren ying die yang, san bu bu can; dong shu
fa xz, bu man wil shi.
( 5)
Duan qi wei zhz jue zhe叫 jiu hou zeng wu
fang Ju, m仇g tang que ting, jin bu jian cha, suo wei kuf guiin er yi.
{6)
Fu yu shi si bie sh eng, shi wei nan u豆
{ 1 ) Heaven is w。ven with the five phases which move [t。 p时 uce) the
myriad types. M a n is constituted by the five consta nts,6 a nd therefore
has five viscera , 7 as wel l as cha n nels a n d network vessels a nd the poi nts.
Yin a n d ya ng i nteract with each other i n d a rk a n d su btle [ways and
i n] tra nsm 川ations hard to fathom . {2) Natu ra lly, without high ta lent
to u ndersta nd [these] mysteries, how ca n [a nyone] probe the logic t。
its l i m its ! (3) I n h igh a ntiq u ity, there were S hen- N6ng, H u a ng-DI , Qι
86, 86-Gao, Lei-Gδ吨, S hao-Sh 日 , S h 主。-S hi, a nd Zhong-Wen ; in m iddle
a ntiq u ity, there were Cha ng-Sang a n d 8i运n-Qt』占; i n the H a n , there have
been Gδng-Sh主n Ya ng- Ql ng a nd Cang-Gδng. After these, we kn。w of
n。 [fa mous p h ysicia n s] . ( 4) Looki ng at the physicia ns 。f today, [we
see that they) d。 not ponder on the mea n i ng of the [med ica l] classics
to develop their knowledge, [but i nstead] each i n herits the ski l ls passed
down i n thei r fa m i ly, consta ntly f。! lowi ng traditi。nal ways. I n reflecting
ZHANG JI’s PREFACE
31
。n i l l nesses a nd i n q u i ri n g 。f patients' sufferi ng, thei r e忏ort is placed
on the gift of the ga b, a n d after a brief c。nsu ltation , give a si m ple
presc巾ti。n f。r a decoction . (5) They feel the i nch pu lse a nd do not
b。ther with the cu bit , feel the h a n d [pu lse] a n d neglect the foot [pu lse] .
They d。 not correlate the th ree positions, [the wrist pu lse with] M a n ’s
P rognosis a n d I nstep Ya ng. When cou nti ng the beats a nd c。ntr。ll i n g
thei r breath , they d。 n。t c。『n plete t h e fifty [beats] .8 {6) They a re u n a ble
to d iagnose when the patient wi l l d ie, a nd even have n。 u ndersta n d i ng
of the n i ne i nd icators. They d。 not look at the bright ha 1 19 a nd the
tower gate10 at a l l . This is what is [proverbia l ly] ca l led “l。。king [at the
world] t h rough a tu be.” ( 7) If they expect to be a ble to d ifferentiate
life from death in this way, they i ndeed have a hard task .
忖 孔子云 , 生而知之者上 , 学则亚之 , 多 闻博识 , 知之次
也 。 (二) 余 宿 尚 方 术 , 请 事 斯 语 。
{ 1 ) Ko叼 Zi yu叽 sh臼g er zh'i zh'i zhe shang, xue ze yii zh'i, duo
b6 shi, zh'i zhz ci ye. {2) Yu su shang fang shu, qing shi sf yii..
w en
{ 1 ) Confucius says: Those who know natu ra l ly from bi此h a re greatest ;
those wh。 [u n dersta n d t h rough] study a re sec。nd t。 them ; th。se wh。
u ndersta nd th rough liste n i ng broad ly to lea rned opi n i。n a re i nferi。r.
{2) I h ave a lways prized remed i a l arts, in the hope of putti ng these
words i nto practice.
TEXT NOTES
1. The story of Bian Q时 (Qin Yue-It臼 ) entering the Kingdom of G凶 relates
how he revived the Prince of G uo from “deathlike reversal" (尸 厥 sh fjue), i. e.,
from an incurable state close to death.
2. Above, below, at center 上 、 下 、 中 shang, xia, zhiing: In Confucian philoso­
phy, above, below, and center describe social levels relative to the individual:
above the individual are the sovereign and the individual’s parents; below the
individual are those less fortunate; the center is the individual himself.
3. While embellishing the external, they impoverish the internal 华 其 外 而 悴 其 内
hua qi wai er cui qi nei: Foster overt ostentation at the expense of their inner
life.
4. Declaring [their] helplessness, [they] attribute [their misfortune to fate ordained
,,
by] heaven 告 穷 归 天 gao qi6ng guz tian: 告 ?ao means “to declare 穷 qi6ng
means “to run out,” “come to an end,” “to be impoverished.” 归 天 guz tian can
be interpreted to mean “go (back) , return to heaven” (to die) , or “to trace back
(here, their misfortune) to the will of heaven." Both speci且c interpretations
imply an acceptance of ill fate.
ZH孟NG Ji’s P REFACE
32
5. Jian An [reign] 建 安 Jian- A n : Literally,, “The Establishment of Peace,” the
title of the reign of Emperor Han-Xian (汉 献 帝 ) , which began in 196 C.E.
6. Five constants 五 常 wu
chang: The five phases.
7. Five viscera 五 藏 WU zang: The heart, liver, spleen, lung, and kidney.
8. Fifty beats 五 十 wil shi: Literally, “fifty,” the Chinese is understood to mean 五
十 动 wu shi dong , the fifty beats of the pulse considered to mark the minimum
time devoted to feeling the pulse. This theory comes from the Nan Jfng.
9. Bright hall 明 堂 ming tang: The nose.
10. Tower-gate court 阙 庭 que ting: The area between the two eyebrows. (The
“court” 庭 ting , is the forehead.) Inspection of this area was formerly a point
of attention when examining patients.
C OMMENTARY
Zhang JI’s original preface to the Sh iing Han Za Bing Lim, which is here divided
into four paragraphs, has not been completely authenticated.
In the first paragraph, Zhang JI comments on the practice of medicine in his
time. In it we can see a Confucianist axiom that the learned have a social and
moral obligation to be conversant with medicine. For Zhang Jr, medicine is ideally
not a service provided by a specialist, but a branch of knowledge in which learned
people should be knowledgeable for the benefit of society as a whole. Society ap­
parently does not come up to his standards, because men of learning do not concern
themselves with medicine and, when they fall ill, resort to magical healers.
In the second paragraph, the author tells us that he was motivated to write this
book by the rampant disease that had brought a severe toll on his own family and
presumably on the population in general. His solution consisted not in resorting to
magical healers but to studying the medical literature available at the time. When
we recall that this is the preface of a larger, more comprehensive work than the
Shiing Han Lim , we realize that Zh忌ng JI’s intention was to write a comprehensive
medical text for very real clinical needs.
Paragraph three, which in the k加g Ping edition appears in small print to
indic ate that it is ann ot ation , stresses the importance of yin and yang and the 且ve
phases in medicine elucidating the mysteries of health and sickness that allegedly
had received waning attention over the centuries. There is specific criticism here of
diagnostic practices, in particular the failure of contemporary physicians to apply
diagnostic techniques of which there is little or no mention in the Shiing Han Lun .
The 且nal paragraph is a statement of Confucian faith in learning.
C hapter O ne
Great er Y�主ng D isease
Pulses and Sign町 ’Treatment
辨太阳 病脉证并治
末
障言
OVERVIEW
Exte口na contracted disease ( cold damage in th road sen肥) is caused by evils
entering the body from outside. Since the greater yang channel governs the exterior
of the body, it is usually the first to be affected. For this reason, the discussion of
greater yang disease forms the first chapter of the Shang Han Lim. External evils
may enter other channels directly, but very often, externally contracted disease
begins with the greater y缸g contracting the evil. Greater y益ng disease is much
more varied in its manifestations than disease of any other channel. This is reflected
in the fact that the lines devoted to greater yang disease make up nearly half of the
entire book.
In greater yang disease, an evil invades the fleshy exterior. There are three
basic forms of greater y缸g disease-wind strike, cold damage ( in the narrow sense ) ,
and warm disease-reflecting Zhang JI’s understanding that externally contracted
disease is attributable to wind, cold, or warmth. Dise&es attributed to external
contraction of cold form the main body of information presented in this chapter.
Warmth is accorded relatively insignificant status, since only one line of greater
y缸ig disease deals with it.
Greater y缸g disease arises when external evil invades the fleshy exterior and
impairs the normal functioning of the defense qi. Wind strike is characterized by
fever一or as we refer to it in this text, “heat effusion” 一together with aversion
to cold or wind, and spontaneous sweating; cold damage is characterized by heat
effusion, aversion to cold, and absence of sweating; and warm disease is characterized
by heat effusion, thirst, and mild aversion to wind and cold 饵, in some cases,
absence of aversion to cold. Which of these three basic patterns occurs depends on
the constitution of the patient and the nature of the evil.
In 皿odern literature, exterior patterns are usually presented in a primary di­
vision of wind-heat and wind-cold. This represents a later development in the
1
1 . G REATER y ANG
34
. understanding of externally contracted disease. Neither of these terms occurs in
the Shang Han Um .
Inappropriate treatment or lack of treatment can give rise to a transmuted
pattern (变 证 bian zheng) or cause the evil to sh出 into another channel. These
changes depend on the type of inappropriate treatment , the p a t ient ’s constitution
and the nature of the evil. Although greater yang disease is associated with exterior
patterns, many transmuted patterns are interior in nature. These patterns are
varied in nature, as will be seen below, due to the combination of factors producing
them.
If an exterior evil falls inward and binds with phlegm-rheum, stagnant food,
or static blood, bind patterns may be observed, including water amassment, blood
amassmer此 , chest bin d , and glomus patterns.
1.1
S IGNS AND P ULSES
The main signs of greater yang disease are a pulse that is floating, stiffness and
pain of the head and nape, and aversion to cold. Whatever the disease evil or the
duration of the disease, the simultaneous presence of this pulse and these signs is a
certain indication of greater yang disease. Also important are heat effusion ( fever )
and the presence or absence of sweating.
A pulse that is floating 脉 捍 mdi ju : A pulse that is felt when light pressure
is applied is called “floating.” In greater y但g dise出e, a pulse that is floating usually
reflects a condition in which an external evil has invaded the fleshy exterior and
right qi is resisting the evil and pushing it out of the body.
Stiffness and pain of the head and nape 头 项 强 痛 t6u
xiang jiang tong:
The greater yang channel stretches from head to foot, passing over the back of
the body. When the greater y缸g channel contracts an evil, it invades the fleshy
exterior, and regardless of whether it is wind strike, in which the evil causes dishar­
mony between defense and construction, or cold damage, in which the defense and
construction become depressed and blocked, the greater yang channel qi becomes
congested and cannot move properly. When the movement of channel qi is impaired,
the channel loses its suppleness which, in this c坦e, gives rise to stiffness and pain
of the head and nape.
A version to cold 恶 寒 wu h<in: The Chinese term 恶 寒 wu htin is wider
in meaning than the usual translation “chill.” Unlike “chill,” it is not limited
to shivering, but includes sensitivity to cold. Hence we consistently render it as
“aversion to cold.” A version to cold is often speci直cally de直ned as a pronounced
sensation of cold that is felt even in the absence of external wind or cold and is
undiminished by adding extra clothing or bedclothes, and is often contrasted with
aversion to wind, which denotes a feeling of cold experienced on exposure to wind
or drafts. In practice, this is usually a distinction of degree. The pathomechanism
producing aversion to cold is an inability of yang qi to warm the body, either
because it is blocked and depressed or vacuous. In both exterior repletion and
exterior vacuity patterns, defensive yang, that is, the warming function of defensive
qi, is blocked and depressed by the exterior evil, while in exterior vacuity, defensive
y缸g may also be slightly vacuous. In interior patterns, the appearance of aversion
to cold is usually attributable to yang qi vacuity.
1 . GREATER YANG
Heat effusion 发 热 fa
35
re: The Chinese term 发 热 fii re is usually rendered as
“fever.” However, unlike “fever,” it includes subjective sensations of heat as well
as a palpable increase in body temperature. For this reason, we consistently render
it literally as “heat effusion.” Heat effusion is associated with many conditions
and occurs both in externally contracted disease and miscellaneous disease ( 杂 病
za bing , disease due to causes other than external evils ) . In externally contracted
diseases of the three y缸g channels, heat effusion is a manifestation of the struggle
between righ t qi and evil qi ; it does not necessarily indicate the presence of evil heat.
In the exterior patterns of greater y缸g disease, it occurs even in patterns caused
by the contraction of cold, which constitute the majority of patterns discussed in
this chapter. In exterior patterns, evil qi is in the exterior of the body, impairing
the normal function of defense ql; hence heat effusion is accompanied by aversion
to wind or cold. Heat effusion also occurs in yang brightness and lesser y缸g
disease. Here, however, different pathomechanisms and locations of the struggle
between right φ and evil φ are reflected in different accompanying signs. In yang
brightness disease, the disease evil transforms into heat and enters the interior, so
heat effusion is accompanied by aversion to heat rather than aversion to cold. In
lesser yang disease, the struggle is taking place between the interior and exterior,
so heat effusion alternates with aversion to cold. In diseases of the three yin, right
ql is not strong enough to counter evil ql; hence heat effusion is absent, and instead
only aversion to cold is present.
Sweating/ absence of sweating 汗 出 / 汗 不 出 hdn chii/hdn bu chii : Depend­
ing on the relative strength of the evil and the patient’s constitution, greater yang
disease takes one of two major forms: exterior vacuity wind strike and exterior reple­
tion cold damage. These are primarily differentiated by the presence or absence of
sweating. In exterior vacuity, the defense ql is vacuous, and is easily damaged when
an external evil is contracted. When this happens, it fails to contain construction­
yin, which dischar�es outward in the form of sweat. This is known as “insecurity of
the defensive exterior. " Conversely, in exterior repletion, the interstices and fleshy
exterior are secure. When an exterior evil is contracted, the defense ql struggles
against evil 啡, resulting in obstruction of the defense ql. The construction-yin be­
comes stagnant and sweat cannot issue. In greater yang disease that has persisted
for a long time, an exterior depression pattern may 町ise.
1 . 2 TREATMENT
The two basic patterns of greater yang exterior disease, wind strike and cold
damage, are each treated with a basic formula. For wind strike exterior vacuity
patterns, Cinnamon Twig Decoction (gui zh'i tang) is used to resolve the fleshy
exterior and dispel wind, and harmonize construction and defense. Ephedra Decoc­
tion ( ma huang tang ) is used in cold damage exterior repletion patterns to open the
interstices and promote sweating, diffuse the lung, and calm panting. These two
formulae are modi且ed· to treat variations on the basic patterns. In mild patterns
of exterior depression, a combination of the two formulae above is used to promote
mild sweating. If heat is depressed in the interior, these formulae are modi且ed to
include medicinals that clear interior heat.
36
1 . GREATER YANG
The greater yang disease patterns other than the two basic exterior patterns
are transmuted patterns ( 变 证 bian zh切g) . These are highly varied and are treated
in very different ways.
If yin humor have been damaged, the evil will generally shift to the lesser yang or
y归g brightness channel, or become a pattern of repletion heat. The main formulae
used in these patterns include Gardenia and Fermented Soybean Decoction ( zhf zi
chi tang), Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction (ma huang
xing ren g伽 ciio shi gao tang), White Tiger Decoction Plus Ginseng ( Mi hu jia ren
shen tang), Pueraria, Scutellaria, and Coptis Decoction (ge gen huang q{n huang
lian t伽g) , Scutellari
Pinellia and Fresh Ginger (ht』ang q{n jia bdη xia sheng jiang tang).
If the yang qi is damaged, the evil may shift to the yin channels or become a
pattern of vacuity cold. When this damage affects the heart ya吨, formulae such
as Cinnamon Twig and Licorice D e coc ti o n (gui zhz gan ciio tang), Cinnamon Twig
Decoction Plus Extra Cinnamon (gui zhz jia gui tang), Cinnamon Twig Minus
Peony Plus Dichroa Leaf, Dragon Bone, and Oyster Shell Counterflow-Stemming
Decoction (gui zhf qu shdo yao jia shu qz mu li long gu jiu ni tang) and Cinnamon
Twig, Licorice, Dragon Bone, and Oyster Shell Decoction (gui zhf gan cii.o long gu
mu li tang) are suggested.
When yang vacuity and water qi appear simultaneously, one of the following
formulae are suggested: Poria (Hoelen) , Cinnamon Twig, Licorice, and Jujube
Decoction (Ju l如g gui zhz gan cii.o da zii.o tang) , Poria (Hoelen) , Cinnamon Twig,
Ovate Atractylodes, and L ico rice Decoction (JU ling gui zhf bdi zhU gan cii.o tang),
and Cinnamon Twig Decoction Minus Cinnamon Twig Plus Poria (Hoelen) and
Ovate Atractylodes (gui zhf qu gui jia JU ling bdi zhU tang).
For greater yang disease that involves spleen vacuity, Magnolia Bark, Fresh
Ginger, Pinellia, Licorice, and Ginseng Decoction (him po sheng jiang ban xia gan
cii.o ren shen tang), Minor Center-Fortifying Decoction (xiii.o jian zhiing tang), and
Cinnamon Twig and Ginseng Decoction (gui zhz ren shen tang) are suggested.
For greater y缸ig disease with kidney vacuity, Dried Ginger and Aconite Decoc­
tion (gan jiang f边 zi tang), Poria (Hoelen) Counterflow Cold Decoction (Ju ling si
ni tang ) , and True Warrior Decoction (zhen wu tang) 缸e suggested.
In greater y臼g disease with yin-yang dual vacuity, one can use Licorice and
Dried Ginger Decoction (gan cii.o gan jiang tang), Peony and Licorice Decoction
(shao yao gan cii.o tang) , Peony, Licorice, and Aconite Decoction (shdo yao gan cii.o
Ju zi tang) , and Honey-Fried Licorice Decoction (zhi gan ciio tang).
Water am assm en t , blood amassme时, chest bind, and glomus patterns are com­
plex and are treated with a range of formulas too wide to be summarized here.
l.
1.3
SCHEMATIC
GREATER YANG
37
OVERVIEW
Basic Greater Yang Disease Patterns
• Essential features
- Pulse that is floating, stiffness and pain of the head and nape, aversion to cold,
and heat effusion
• Pattern types
- Wi nd stri ke: Heat effusion, aversion to wind or cold, spontaneous sweating,
and a pulse that is floating and moderate
- Cold da mage: Heat effusion, aversion to wind or cold, absence of sweating, and
a pulse that is floating and tight
- Warm d isease: Heat effusion, thirst, and absence of aversion to cold
· ’Treatment principles and primary formulae
- Wind strike: Harmonize construction and defense; resolve the exterior and
dispel wind: Cinna皿on Twig Decoction (gui zhf tang)
- Cold d amage: Open the interstices and promote sweating; diffuse the lung and
calm panting: Ephedra Decoction (ma huang tang )
- Warm disease: Resolve the exterior with coolness and acridity
• 1\哑ild patterns of exterior depression
- A condition l i ke malaria with red face and generalized itching: Cinnamon Twig
and Ephedra Half-and-Half Decoction (gui zhf ma huang ge bdn tang)
- Heart vexation and thi rst: Two Parts Cinnamon Twig and One Part Spleen­
Effusing Decoction (gui zhf er yue bi yif tang)
Identification and ’l'reatment of Transmuted Patterns
• Heat patterns
- Heat depressed in the chest a n d diaphragm with vexation heat in the chest and
anguish
*
Basic pattern with inability to sleep: Gardenia and Fermented Soybean De­
coction (zhf zi chi tang)
* With
*
shortage
of qi :
Gardenia, Licorice, and Fermented Soybean Decoction
( zhf zi gan cii.o chi tang)
With retching a nd vo m it in g Gardenia, Fresh Ginger, and Fermented Soybean
Decoction (zhf zi sheng jiang chi tang)
:
1 . GREATER y ANG
38
*
With a bdomi na l fu l l n ess: Gardenia and Magnolia Bark Decoction
(zhf zz him
po tang)
*
With d ecreased food inta ke, sloppy stool , a bdomi n a l ful l ness, a nd a bdomi n a l
pa i n : Gardenia and Dried Ginger Decoction (zhf zz gan jiang tang)
一 Other heat patterns
*
Evil heat congesting the lung and counterflow ascent of l u n g qi with sweating,
panting, and heat effusion: Ephedra, Apricot Kernel, Licorice, and Gypsum
Decoction (ma huang xing ren gan cii.o shi gao tang)
*
Exterior disease fa iling to resolve and evil entering the yang brightness with heat
effusion, diarrhea, sweating, and panting: Pueraria, Scutellaria, and Coptis
Decoction (ge gen huang qin huang lian tang)
*
Exu bera nt ya ng brightness heat with damage to qi and yin with great heat,
great sweating, great vexation, and thirst, and a pulse that is large and
surging: White Tiger Decoction Plus Ginseng (Mi hii. jia ren shen tang)
*
Lesser ya ng evil heat distressing yang brightness with diarrhea, abdominal pain,
and scorching heat in the anus: Scutellaria Decoction (huang qin tang)
*
Lesser ya ng evil heat distressi ng ya ng brightness with vomiting: Scutellaria
Decoction Plus Pinellia and Fresh Ginger (huang q仇 jia ban xia sheng ji伽g
ta叼)
• Vacuity cold patterns
一 Heart ya ng vacu ity
*
D a mage to heart ya ng with palpitations and in serious cases deafness: Cin­
namon Twig and Licorice Decoction (gui zhf gan cii.o tang)
*
Disq u ieted hea rt spi rit with vexation and agitation: Cinnamon Twig, Licor­
ice, Dragon Bone, and Oyster Shell Decoction (gui zhf gan cii.o long gii. mu
li tang)
*
Strayi ng of the heart spi rit with fright mania, and 且dgetiness whether lying
or sitting: Cinnamon Twig Minus Peony Plus Dichroa Leaf, Dragon Bone,
and Oyster Shell Counterflow-Stemming Decoction (gui zhf qu shdo ydo jia
shii. qf mu li long gii. jiu ni tang)
*
COi』nterf
lesser abdomen surging upward to the heart) : Cinnamon Twig Decoction
Plus Extra Cinnamon (gui zhf jia gui tang)
- Ya ng vacu ity with water qi
* I nsufficiency of heart ya ng with water collecting i n the lower burner with palpita­
tions below the umbilicus and running piglet about to occur: Poria (Hoelen) ,
Cinnamon Twig, Licorice, and Jujube Decoction (Ju ling gui zhf gan cii. o dd
zii.o tang)
l.
*
GREATER YANG
39
Spleen fa iling to move a nd tra nsform with water qi collecti ng i nternally with
counterflow fullness below the heart , qi surging up into the chest , dizzy
head upon standing, and a pulse that is sunken and tight : Poria ( Hoelen) ,
Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction (Ju ling gui zhZ
Mi zhU gan cao tang)
*
Spleen vacuity with collected water a n d a n u n resolved exterior pattern with
fullness and slight pain below the heart, and inhibited urination: Cinna­
mon Twig Decoction Minus Cinnamon Twig Plus Poria ( Hoelen ) and Ovate
Atractylodes (gui zhf qu gui jia JU ling bai zhU tang)
- Spleen vacuity
*
Spleen vacuity with tu rbid ql stagnation wi t h abdominal distention and full­
ness: Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoc­
tion (him po she:叼 jiang ban xia gan ciio ren shen tang)
*
Center burner vacuity cold with ql a nd blood vacuity with palpitations in the
heart, vexation, and pain in the abdomen: Minor Center-Fortifying Decoc­
tion ( xiiio jian zhong tang)
*
An u n resolved exterior evi l a nd spleen stomach vacuity cold with aversion to
cold, heat effusion, diarrhea, and hard glomus below the heart: Cinnamon
Twig and Ginseng Decoction (gui zhZ ren shen tang)
- Kid ney ya ng vacuity
*
Exu bera nt i nternal yin cold and yang qi floating astray with vexation in the
daytime and peacefulness at n ight , a pulse that is sunken and faint, and
absence of great heat: Dried Ginger and Aconite Decoction (g伽 jiang fu zi
tang)
*
Extreme vacu ity of yin a n d ya ng with true yTn a bout t。 desert, vexation and
agitation, aversion to cold, counterflow cold of the limbs, diarrhea, a丑d a
pulse that is faint and fine: Poria ( Hoelen ) Counterflow Cold Decoction (JU
ling si ni tang)
*
•
Debilitation of heart and kid ney ya ng with palpitations, dizzy head, generalized
twitching, quivering, and the person about to fall: True Warrior Decoction
( zhen wu tang)
Dual vacuity of yin and yang
- Yang qi vacuity a nd stomach ql disharmony with retching counterflow and reverse
fl.ow in the limbs: Licorice and Dried Ginger Decoction (gan ciio gan jiang
tang)
- I nsufficiency of yin-blood with hypertonicity of the legs and dryness in the
throat : Peony and Licorice Decoction (shdo yao gan ciio tang)
- Vacuity of the exterior a nd i nterior, and of yTn a nd ya ng with aversion to cold,
sweating, hypertonicity of the legs, and a pulse that is faint and fine: Peony,
Licorice, and Aconite Decoction ( shdo yao gan cao fu zi tang)
1 . GREATER
40
y ANG
- I nsufficiency of heart yTn a nd devitalized heart yang with a pulse that is bound and
intermittent, and stirring heart palpitations: Honey-Fried Licorice Decoction
( zhi gii.n cao tang)
•
Water amassment and blood amassment patterns
- Water a massment
*
Inhibited urination with lesser abdominal fullness, a pulse that is floating
and rapid, and in severe c臼es immediate vomiting of ingested fluids: Poria
( Hoelen ) Five Powder (WU ling san)
- Blood a massment
•
*
M i ld pattern of blood heat bound in the lower bu rner with uninhibited urina­
tion, mania, and tense, bound lesser abdomen: Peach Kernel Ql-Coordinat­
ing Decoction ( tao he cheng qi tang)
*
Severe pattern of blood heat bound i n the lower bu rner with uninhibited uri­
nation, mania, hardness and fullness of the lesser abdomen, and generalized
yellowing: Dead-On Decoction ( di dang tang)
Chest bind patterns
- M ajor chest bind with pain below the heart that is as hard as stone when
pressed, and sweating only from the head: Major Chest Bind Decoction ( da
xian xiδng tang)
- M i nor chest bi nd with fullness and oppresion below the heart that is painful
when pressed: Minor Chest Bind Decoction (xiao xian dδng tang)
- C。Id repleti。n chest bind with hardness, fullness, and pain below the heart,
inability to defecate, and absence of heat signs: Three Agents White Powder
( sii.n wu bdi san)
•
Glomus patterns
- Heat glomu s
*
Evil heat congested i n the stomach duct with glomus below the heart that is
soft when pressed and a pulse that is floating above the bar: Rhubarb and
Coptis Heart-Draining Decoction ( da huang huang lian xie z加 tang)
heat congested i n the stomach d uct a nd ya ng vacuity with glomus below
the heart, aversion to cold, and sweating: Aconite Heart-Draining Decoction
(Ju zi xie xfn tang)
* Evi l
- Heat a nd cold com plex glomt』s ( Disharmony of the spleen and stomach )
*
c。u nterflow ascent of stomach qi with glomus and fullness below the heart,
retching, and rumbling intestines: Pinellia Heart-Draining Decoction (bdn
xia xie xzn tang)
1 . G REATER YANG [LINE 1]
41
*
Stomach vacuity with hard glomus below the heart, dry belching and food
malodor, rumbling intestines, and di町rhea: Fresh Ginger Heart-Draining
Decoction ( sheng jiang xie xi"n tang)
*
Spleen vacuity with glomus, hardness and fullness below the heart, diarrhea,
dry retching, and heart vexation: Licorice Heart-Draining Decoction (gan
cao xie xzn tang )
- Water glomus with glomus below the heart, inhibited urination, dry mouth and
thirst, and heart vexation: Poria ( Hoelen ) Five Powder ( u
- Phlegm glomus with hard glomus below the heart , and incessant belching: Inula
and Hematite Decoction (xuan JU dai zhe tang )
• Upper body heat and lower body cold
- Desire to vom it and pai n i n the a bdome n : Coptis Decoction (huang lian tang)
• Patterns similar to greater y臼g disease
- Water-rheu m collected a nd bound i n the chest a nd ri b-side with glomus, hardness
and fullness below the heart, and dry retching: Ten Jujubes Decoction ( shi
zao tang )
- Ph legm-d rool obstructing the chest and diaphragm with hard glomus in the chest ,
and φ surging up into the throat and inability to breath: Melon Stalk Powder
(gu ii di san )
ESSENTIAL FEATURES O F GREAT ER YANG
DISEASE
The essential features of greater .yang disease are presented in line 1 . The
greater yang governs the fleshy exterior. When an exterior evil invades, it generally
affects the exterior 且rst. Right qi rises up against the evil and generally the first
signs are of greater y但g disease, also referred to 副 an exterior pattern. Signs of
greater y缸g disease include stiffness and pain of the head and nape, aversion to
cold, possibly heat effusion, possibly sweating, and a pulse that is commonly floating
and that may also be tight or moderate. These signs represent those commonly seen
in greater y缸g dise部e, but should not be seen 描 absolute indicators of any one
pattern because specific presentations vary widely. Greater yang disease represents
the early stages of an externally contracted disease, although this period cannot be
strictly defined.
2
LINE 1
太阳之为病 , 脉浮 , 头项强痛而恶寒 。
Tai yang zhz wei bing, mai Ju, t6u xiang jiang tong d俨 wu han.
I n d isease 。f the greater ya ng, the pulse is fl。ati ng, the head a nd na pe
a re stiff a nd pa i nfu l , 1 and [there is] aversi。n t。 cold . 2
42
1.
G REATER YANG
[ LINE 1 ]
TEXT NOTES
1. Head and nape are stiff and pain ful , 头 项 强 痛 t 6u xiang jiang tong: Headache,
and pain and stiffness in the back of the neck.
2. A version to cold, 恶 寒 wit Mn : Sensitivity to cold or a subjective sensation
of cold. A version to cold is now often specifically defined as a pronounced
sensation of cold that is felt even in the absence of external wind or cold and is
undiminished by adding extra clothing or bedclothes, and is often contrasted
with aversion to wind, which denotes a feeling of cold experienced on exposure
to wind or drafts ( see line 2, p. 43) . However, this distinction is not always
clearly made in Shang Han Lun and other literature.
In the Shang Han Lun , “aversion to cold" often occurs with heat effusion
( see note accompanying line 2, p. 43) , as a sign of wind-cold. In the absence
of heat effusion or other exterior signs, it is a sign of cold arising from within
due to yang ql vacuity.
The Chinese term 恶 寒 wit Mn is often translated 捕 “chill.” Strictly speak­
ing, however, it is wider in meaning, including not only an acute feeling of cold
with shivering, but general sensitivity to the cold. For this reason we consis­
tently render it as “aversion to cold.” A version to cold is often specifically
defined as a pronounced sensation of cold that is felt even in the absence of
external wind or cold and is undiminished by adding extra clothing or bed­
clothes, and is often contrasted with aversion t。 wind ( 恶 寒 wit Mn) , which
denotes a feeling of cold experienced on exposure to wind or drafts.
The term 恶 寒 wit han, aversion to cold, would appear to be a misnomer, if
we accept the definition conventionally given in Chinese medical literature as
a “sensation of cold that is felt even in the absence of wind and cold and that
is undiminished by adding extra clothing or bedclothes" since 恶 wit , aversion,
implies a response to the external stimulus 寒 Mn , cold, which the traditional
de且nition speci且cally states to be irrelevant.
SYNOPSIS
A general outline of the pulse and signs of greater y缸g disease.
COMMENTARY
The basic pattern associated with greater yang disease includes a pulse that
is 盟oating, headache, pain and stiffness in the back of the neck, and aversion to
cold. The greater yang governs the exterior and rules the construction and defense,
providing protection for the body. When an exterior evil attacks the body, right ql
is excited and rises up to contend with the evil. The signs of exterior disease are
evidence of the contention between right ql and evil φ. When right ql contends
with evil ql, the ql and blood quickly gather in the exterior of the body. The vessels
become full and the ql of the pulse is stirred. Thus the pulse is felt easily with light
pressure and is described as “floating.” The greater yang channel p回ses through
the head and neck. Wind-cold attacks and fetters the exterior, the channel receives
the evil, and the movement of qi and blood is blocked. This manifests as headache
and pain and stiffness in the back of the neck. The defense ql is damaged by the
evil and unable to warm the fleshy exterior and interstices normally; consequently,
aversion to cold arises.
l.
GREATER YANG [LINE 2]
43
This line presents the basic features of greater y缸g disease. In clinical practice,
however, variations are often observed, as we shall see in the lines ahead. Moreover,
the same signs may occur in other patterns. While a pulse that is floating and
aversion to cold occurring together indicate an exterior dise甜e, either of the two
can, in the presence of other signs, also indicate other patterns. For example, a
pulse that is floating and moderate, and accompanied by w町m extremities (line
278, p. 4 6 1 ) , occurs in greater yin disease. Aversion to cold occurs with a pulse
that is faint ( line 385, p. 585) in a pattern of severe y归g vacuity in sudden turmoil
disease.
The basic pulse and signs given in this line apply to all greater yang disease,
even when they are not specifically stated. The Shang Han Um is terse in its
expression. Basic pulses and signs are often not repeated in pattern descriptions.
LINE 2
太阳病 , 发热汗 出 , 恶风 , 脉缓者 ,
Tai yang bing, fa re han chii.,
Jeng.
WU Jeng,
名为中风。
mai huan zhe, ming wei zhong
When in greater ya ng d isease [there is] heat effusion , 1 sweating, 2 aver­
sion t。 wi nd,3 a n d a pu lse that is moderate,4 it is ca lled wi nd stri ke.5
TEXT NOTES
1. Heat effusion, 发 热 fa re : Abnormal heat in the body that can be detected
by palpation or that is experienced subjectively. The English term “fever,'’
which is often used to render this term, implies an objective elevation of body
temperature only. To cover the broader meaning of 发 热 fa 时 , we consistently
translate the term literally as “heat effusion,” even though in the context of
the present line, fever detectable by palpation is intended.
The Chinese 热 时, heat, is used in the sense of 发 热 fa 时 , heat effusion,
that is the manifestation of illness, in a number of terms including 烦 热 fan
re , “heat vexation" ( line 77, p. 148) and 潮 热 chao 时 , “tidal heat effusion”
( line 104, p. 434). In other contexts, it denotes a cause of illness, e.g. , heat
entering the blood chamber, 热 入 血 室 re f吩 xue shi ( line 216, p. 378) and heat
binding the bladder, 热 结 膀 脱 re jie pang guling ( line 106, p. 202 ) .
2. Sweating, 汗 出 hdn chu: The expulsion o f sweat from the skin. Literally
“sweat issuing,” this is a sign that should be differentiated from “promotion
of sweating" ( 发 汗 fa hdn ) as a method of treatment.
3. A version to wind, 恶 风 wu Jeng : A sensation of cold experienced upon exposure
to wind or drafts that abates when the patient is no longer exposed. Compare
“aversion to cold" ( line I , p. 41 ) .
4. A pulse that i s moderate, 脉 缓 mdi huiin : A pulse that is loose, soft , and
harmonious; hence opposite to a pulse that is tight. “Moderate” does not
refer to the speed of the pulse, as it usually does in modern usage.
1 . G REATER YANG [ LINE 3]
44
It is important to note that in greater yang disease patterns, a pulse that is
floating is usually assumed present, even if it is not explicitly stated.
5 . Wind strike, 中 风 zhong Jeng : An exterior pattern caused by externally con­
tracted wind-cold. Note that in other literature, the same term is used denote
stroke ( apoplexy ) .
SYNOPSIS
An outline of the pulse and signs of greater yang wind strike pattern.
C OMMENTARY
Greater yang disease takes different forms. Heat effusion, sweating, aversion to
wind, and a pulse that is floating and moderate is know丑 剧 greater y缸g wind strike
and also referred to as a greater yang exterior vacuity pattern. Exterior vacuity
refers to the constitution of the patient and means a slack quality in the fleshy
exterior and interstices. When a patient with this type of constitution contracts
an exterior evil, the exterior of the body easily becomes insecure. Heat effusion is
an indication that the defensive yang rises to the exterior of the body to contend
with the evil and it is in this struggle that the defensive yang is damaged. The
defensive ya鸣, already weak in this type of patient, is further weakened by this
struggle. Construction fails to be contained in the interior and construction-yin
discharges outward, giving rise to sweating. The exterior is insecure and cannot
overcome wind; consequently, aversion to wind arises.
Spontaneous sweating is a key diagnostic feature of greater y缸g wind strike.
This kind of sweating is a pathological reaction, and not the same as that resulting
from the promotion of sweating using medicinals. It cannot reduce the body tern­
perature, and cannot expel the exterior evil. A pulse that is floating indicates evil
in the exterior, and a pulse that is moderate means that construction-yin is weak.
Hence the pathomechanism of the pulse is directly related to that of spontaneous
sweatmg.
LINE 3
太阳病 , 或 已 发 热 , 或未发热 , 必恶寒 , 体痛 , 呕逆 , 脉阴
阳俱紧 者 , 名 为伤寒 。
Tai yang bing, huo y'i fa re, huo wei fa re, bi WU han, ti tOng, OU ni,
mai yifn yang ju j'in zhe, m伽g wei shang han.
G reater ya ng d isease, whether heat has effused 。r n。t, as I。ng as there
is aversion t。 c。ld , 1 with genera l ized pa i n , 2 retc h i n g cou nterflow,3 a nd
泸n a nd ya ng [pulses] both tight,4 is ca l led cold d a m age.5
TEXT NOTES
1. As long as [there is] aversion to cold, 必 恶 寒 bi wu han : Aversion to cold is
a primary sign when identifying cold damage patterns. This phrase literally
means “there must be aversion to cold,” but here is interpreted as introducing a
condition for qualification of cold damage, irrespective of whether heat effusion
has developed or not. A version to cold is generally taken to be the only
1 . GREATER Y.ANG [LINE 3]
2.
3.
4.
5.
45
essential condition, but it is not clear from the text , when taken literally,
whether the signs subsequently enumerated are also necessary.
Generalized pain, 体 痛 ti tong: Pain that is felt throughout the body, not in
any specific place. This term is synonymous with 身 痛 shen tOng.
Retching counterflow, 呕 逆 6u ni: The act of vomiting, 呕 6u , without neces­
sarily producing any vomitus, and attributed to counterflow 部cent of ql (气
逆 qi ni ) .
The yin and y缸g pulses, 脉 阴 阳 mdi yfn yang : Either: a ) the cubit (尺 chi)
and inch (寸 cun) positions or b ) the deep-level and superficial-level pulses.
Because the basic pulse associated with greater yang disease is floating, any
change in the form of the pulse is indistinct at the deep level, so that the first of
the two possible interpretations is more reasonable. This interpretation holds
that “yin and yang,” though literally referring to the inch and cubit positions,
means the inch-cubit axis as a whole and, consequent坊, that the pulse at the
bar as well as the inch and cubit is tight. Compare line 283, p . 473, fo r another
occurrence of this pulse description .
Cold damage, 伤 寒 skiing Mn : In the broad sense, all externally contracted
dise描es, and in the narrow sense, the group of signs resulting from externally
contracted wind-cold and treated with Ephedra Decoction ( ma huang tang ) .
Within the Skiin g Han Lim , externally contracted wind-cold disease is fre­
quently discussed, but many patterns also involve other types of externally
contracted disease, as well as miscellaneous internal diseases. It should be
noted that the Chinese term 伤 寒 shang han, has been adopted in modern
medicine as the equivalent of the English “typhoid” ( an acute infectious dis­
ease caused by the bacillus Sa lm o n e lla typhi and acquired by ingesting food or
water contaminated by excreta ) . It is is sometimes erroneously translated as
“typhoid” in the Chinese medical literature. See the introduction for further
discussion of the issues surrounding the definition of this term.
SYNOPSIS
An outline of the pulse and signs of greater y缸g cold damage pattern.
COMMENTARY
As line 1, page 4 1 , states, aversion to cold is a major distinguishing characteristic
of greater y缸g disease. The evil invades the exterior, depressing and fettering the
defense ql. The defense ql is unable to warm the fleshy exterior and this causes
aversion to cold. When aversion to cold, generalized pain, retching counterflow,
and a pulse that is tight are present , it is not necessary to observe heat effusion to
diagnose a cold damage pattern. Furthermore, at the beginning of a cold damage
pattern, heat effusion may be absent if the evil has severely blocked the exterior.
A short period of time may p副s after contraction of the evil before heat effusion
develops. Typically, in patients whose constitutions tend toward yang exuberance,
heat effusion develops earlier. Whether or not heat effusion has developed, there
must nevertheless be aversion to cold if cold damage is to be diagnosed.
When the exterior is blocked by an evil and the defense ql is fettered, generalized
pain often occurs, 描 a result of blockage of the normal movement of ql in the
channels. When the movement of ql is blocked, the pulse 皿ay become tight at the
46
1 . G REATER YANG [LINE 3 ]
inch, bar, and cubit . Abnormal qi movement often results i n qi counterflow and
retching, 国 addition to the other signs.
In this line, the defense qi is blocked and the construction-yin is depressed and
stagnant. This pattern is different from wind strike, in which the defensive exterior
is insecure and the construction-yin discharges to the exterior. An important con­
cept, 直rst introduced in the Nei Jzng and elucidated further in Shang Han L侃 , is
that both the patient ’ s constitution and the strength of the evil influence the course
of a disease. From clinical experience, one of the characteristics distinguishing wind
strike from cold damage is the constitution of the patient. Wind strike is more
commonly seen in patients with weak constitutions, whereas cold damage is more
common in patients with strong constitutions. A patient with a weak constitution
becomes sick more easily and the pulse is moderate because the y归g qi is not suf­
直dent to counter evil qi strongly. A patient with a strong constitution will have a
tight pulse because the yang qi offers strong resistance to the evil. Although this
line contains no mention of sweating, the formula prescribed, Ephedra Decoction
( ma huang tang), is specifically noted to be for patients in whom sweating is absent
( see line 35, p. 91) . Thus, the key criterion for distinguishing between wind strike
and cold damage is that the former is associated with spontaneous sweating and
the latter is associated with the absence of sweating.
So far, we have explained the difference between wind strike and cold damage
in terms of constitutional differences. However, the naming of the two patterns
suggests that the author considered them to have different causes ( wind or cold ) .
However, since wind and cold as evils in the body cannot be detected directly, the
cause is a matter of speculation. Modern writers tend to attribute both patterns t。
“wind-cold” and explain the difference between the two patterns in terms of both
constitutional differences and the strength of the wind-cold evil, attributing cold
damage to a stronger constitution and a stronger evil.
The difference between wind strike and cold damage is also to some extent
mirrored in the difference between “aversion to wind" and “aversion to cold.” Wind
strike and cold damage are both greater yang patterns. According to line 2, aversion
to wind is associated with wind strike, and according to line 3, aversion to cold is
associated with cold damage. However, in the basic outline given in line 1, greater
yang disease is said to be characterized by “aversion to cold" rather than “aversion
to wind or to cold.” The distinction between aversion to wind and aversion to cold
seems to be based as much on the supposed cause of illness, wind or cold, 描 it is
on any subjective difference between these two signs.
l.
GREATER YANG [LINE 6]
47
LINE 6
(寸 太 阳 病 , 发 热 而 渴 , 不 恶 寒 者 , 为 温 病 。
ω 若发汗已 ,
身灼热者 , 名 风温。
同 风温为病 , 脉阴阳俱浮 , 自 汗出 ,
身 重 , 多 眠 睡 , 鼻 息 必 斯 , 语 言 难 出 。 但) 若 被 下 者 , 小 便
不 利 , 直 视 失 漫 ; 若 被 火 者 , 微发 黄色 , 剧 则 如 惊厢 , 时厢
蚁,
若 火 熏 之 ; 一逆 尚 引 日 , 再逆促命期 。
( 1 ) Tai ya叼 bing, fa re er K已 bu WU han zhe, wei wen bing. (2) Ruo
fa han u记 sh臼 zhu6 re zhe, m伽g Jeng w臼. (3) Feng wεn wei bing,
mdi yin yang ju fu, zi han chu, sh臼 zhong, duo mian shui, bi xr bi
han, yu yan nan chu. (4) Ruo bei xia zhe, xiiio bian bu li, zhi shi
sh?: s侃, ruo bei huo zhe, wei fa huang se, ju ze rU j?:ng xian, shi ji
zong, ruo huo xun zhr; yi ni shang yin ri, zai ni cu ming qi.
( 1 ) When i n greater ya ng d isease [there is] heat effusion a n d t h i rst ,
without aversion to cold , [th is] is warm d isease . 1 (2) If, after sweat­
i ng has been prom。ted ,2 there is genera l ized scorching heat,3 t h is is
ca l led wi nd-wa rmth .4 (3) [When] wind-wa rmth ca uses d isease, the 泸n
a n d ya ng pu lses a re b。th floating,5 [there is] sponta ne。us sweati鸣,6
genera l ized heavi ness,7 a tendency to sleep,8 the breath [f
wi l l [ma ke a] snori ng [s。u nd] ,9 a nd speech is d ifficult . 10 ( 4) If preci pi­
tation has been used , 1 1 [there is] i n h i bited u ri nati。n , 12 forward stari ng
eyes, a nd feca l i nc。ntinence; 叫f fi re has been used , 14 [there is] sl ight
yel lowing, a n d i n acute cases [there is] fright epilepsy, 1 5 peri。d ic tug-
gi ng a nd slacke『1 i 『1
[i nsta nce 。可 of adverse [treatment] 18 wi l l lengthen the t i me [。f d isease] ,
a n d fu rther adverse [treatment] wi l l lead to the term of I i也_ 19
TEXT NOTES
l. Warm disease , 温 病 wen bing: An externally contracted disease characterized
at onset by heat effusion, thirst, and absence of aversion to cold.
2. Promote sweating, 发 汗 fa hdn: In t he Shang Han L郎, 发 汗 fa h dn means
the therapeutic action of promoting sweating. Sweating as a manifestation of
disease is usually referred to has t干 出 hdn chii. In modern Chinese medical
texts, 发 汗 fa hd n can also denote this sign.
3. Generalized scorching heat, 身 灼 热 shen zhu6 re : The body feels hot to the
touch.
4. Wind warmth, 风 温 Jeng wen: A transmuted pattern caused by the inappro­
priate use of warm, acrid medicinals to promote sweating in warm disease. It
is not the concept of wind warmth developed later in the warm disease school.
48
1 . G REATER YANG [LINE 6]
5. Yin and yang [pulses] both floating, 阴 阳 俱 浮 yfn yang ju JU: The cubit
and inch pulses 町e both floating. The floating pulse here does not reflect an
exterior pattern; it is attributed to a heat evil in the interior, with heat being
expressed in the exterior of the body.
6. Spontaneous sweating, 自 汗 出 zi han chu: Sweating that occurs in the absence
of any treatment.
7. Generalized heaviness, 身 重 shen zho ng : A subjective feeling of increased
weight and loss of agility. This sign occurs in three conditions:
a ) Following the use of precipitation, debilitation of interior qi m町 result in
generalized heaviness, which is often accompanied by palpitations and a
pulse that is faint.
b ) Heat congestion and qi stagnation may result in obstruction of the qi and
blood and inhibition of the channels, which causes generalized heaviness.
This pattern is frequently seen with tidal fever, abdominal fullness, and
panting.
c ) In warm disease, as defined above, the inappropriate promotion of sweating
can cause fluid damage and exacerbate the heat. The qi is damaged by the
heat, resulting in generalized heaviness.
8. Tendency to sleep, 多 眠 睡 duδ mian shui : A desire to sleep and tendency
to sleep for long periods of time. This term means the presence of heat evil
congested in the interior, harassing the heart spirit.
9. The breath from the nose will [sound of] snoring, 鼻 息 必 鼻r b i xi b i han: lnhib­
ited breathing with an audible sound accompanying the breath. Although not
necessarily occurring during sleep, inhibited breathing is related to tendency
to sleep, because when an interior heat evil, which can cause an increased
tendency to sleep, becomes congested in the lungs, it can cause an inhibition
of the lung qi, resulting in congestion of heat and phlegm, and snoring.
10. Speech is difficult, 语 言 难 出 yu yan nan chu: Inability to speak with normal
ease and fluency. Here, it is associated with lack of mental clarity, due to
severe heat harassing the heart.
1 1 . Precipitation, 下 xid : To cause expulsion of stool; to eliminate evil through
the bowels.
1 2 . Inhibited urination, 小 便 不 平lj xiao bian bu li: Difficult voiding of scant urine.
1 3 . Fecal incontinence, 失 理 shf sou : According to Ri Ben Yf Ji a Sh<ing Han
Lun Zhu Jie Ji Yao ( 日 本 医 家 伤 寒 论 注 解 辑 要 “Collected Commentaries of
Japanese Medical Scholars on the Sh ang Han Lun'
fecal or urinary incontinence. In the explanation of this line, the authors of
Gao D eng Zhang Yf Yan Jiu Can Kao Cong ShU ( 高 等 中 医 研 究 参 考 丛 书
“Advanced-Level Chinese Medical Reference Series” ) concur with this opinion.
Nonetheless, because inhibited urination is mentioned previously, the authors
of Shang Han Lun Jiang Yi (伤 寒 论 讲 义 “Shang Han Lun Lectures” ) suggest
that here it only refers to fecal incontinence.
14. Fire, 火 huo: Any method of treatment involving the application of heat, i.e. ,
warm needling, moxibustion, fuming, hotpack, etc.
1 . GREATER YANG [LINE 6]
49
15. Fright epilepsy, 惊 踊 jing xian : A disease pattern characterized by clouding
and loss of consciousness, convulsions, and forward-staring eyes.
16. Tugging and slackening, 时 厢 瘾 skiji zong : Convulsive spasm characterized by
alternating tensing and relaxing of the 皿uscles; clonic spasm. The character
躏 ji is now usually written as 瘦 ji .
17. [The skin] appears as if fumed by fire, 若 火 熏 之 ruo hu6 xun zh仨 The skin ap­
pears darkened as though fumed by fire. According to another interpretation,
若 is taken to mean not “appears 副 if” but simply “if," introducing a condi­
tion for the final part of the line: “If [the patient has been] fumed by fire, one
[instance] of adverse [treatment] will . . .” Fuming is a method of treatment
that uses the smoke generated by burning medicinal ingredients or steam to
force sweating (generally considered by Zhang JI to be a mistreatme叫 . In
this latter interpretation, fuming by fire appears as another mistreatment in
addition to the others previously described (precipitation and fire treatment) .
This interpretation is considered less likely since a) fuming is in itself one form
of fire treatment, b) no signs 缸e given as for the other two mistreatments, and
c) the grammatical construction is not parallel with the previous two descrip­
tions of mistreatment (the phrase reads 火 熏 之 hu6 xun zhf, not 被 火 熏 bei
hu6 xun ) .
1 8 . Adverse [treatment] , 逆 时: A treatment that i s contrary t o proper treatment
strategy. The character 逆 时 means to oppose, contrary to, go against , to
rebel. It is most commonly used in medicine to describe movement in the
wrong direction (counterflow) . In the Shang H伽 L仙, it is also used to mean
going against normal therapeutic procedures.
19. Term of life, 命 期 ming qi: The ter皿ination of life; death.
SYNOPSIS
The primary distinguishing features of warm disease and transmuted patterns
occurring after mistreatment.
COMMENTARY
Warm disease is characterized by heat effusion and thirst, without aversion to
cold, whereas in greater y缸ig disease, aversion to wind or cold is present but thirst
is generally absent. Wind-warmth evil, the cause of warm dise描e, easily damages
the fluids; consequently, early in these patterns, at the same time as heat effusion
occurs, thirst is also observed. Because w缸m evil tends to damage not y归g qi but
yin humor, aversion to cold is generally absent in these patterns. If, in the course of
greater yang or cold damage dise皿e, one sees heat effusion, thirst , and no aversion
to cold, these signs may signify a transmuted pattern. These transmuted patterns,
although similar in appearance to the group of diseases known 础 W町m disease, have
a completely different patho皿echanism, treatment method, and disease course.
Warm disease should be treated through cool acrid exterior-resolution. Because
the warm-heat evil invades the lung, it may cause the loss of normal defensive 啡
function and the temporary appearance of slight aversion to wind-cold. If this aver­
sion is mistaken for an indication of wind-cold fettering the exterior and sweating
is promoted, it will result in more severe damage to the fluids because the warmth
of the formula will assist the interior heat and the body will become scorching hot.
50
1 . G REATER y ANG [LINE 7]
Exuberant internal heat damages the fluids and causes palpable heat in wind­
warmth disease. In this disease, the pulse is floating and forceful, since the heat
effuses towards the exterior. The exuberant heat forces the construction-yin to
be discharged outward, resulting in the spontaneous issuing of sweat. The heat
damages both the qi and the fluids and this damage results in a feeling of generalized
heaviness. Heat has a tendency to rise and become congested in the upper burner,
where it can harass the heart and the lung. This harassment results in a tendency
to sleep, and inhibited breathing and snoring. This type of sleeping is stuporous
and not res t ful . Because the heart governs sp eech and the tongue is the sprout of
the heart, harassment of the heart spirit also results in difficulty speaking.
Wind warmth disease is characterized by exuberant heat and fluid damage. It
should be treated by clearing heat and nourishing yin. If precipitation is used, the
fluids will become desiccated and the urination will be inhibited. Fluid depletion in
the lower burner results in insufficient yin essence to nourish the eyes. There is also
exuberant heat harassing the spirit. The combination of these two factors results
in forward-staring eyes and an inability to move the eyes with normal ease.
If wind warmth is treated with fire, the result will b e yellowi吨 , fright tetany,
and tugging and slackening. Yellowing is a result of exuberant heat scorching the
blood. The construction aspect of the blood is forced out to the exterior and the
skin yellows. If the condition is severe, the heat may stir liver wind and cause an
epilepti c- li ke state and spasmodic movement of the limbs. In addition, the skin is
darkened as if it had been fumed by fire.
Zhang Ji record s the results of mistreatment. H e cautions that one mistreatment
may lengthen the course of the disease and further mistreatment may be fatal.
(This line is line 6 , 缸id in this version it follows line 3. Note that the line num­
οers given 缸e those of their appearance in the Song text, not of their appearance
in this text. )
LINE 7
忖 病有发热恶寒者 , 发于阳也 ; 无热恶寒者 , 发于阴 也 。 ω
发于阳 , 七 日 愈。
向 发于阴 , 六 日 愈。
倒 以阳数七 、 阴数
六故也。
( 1 ) Bing you fa re WU han zhe, fa yu yang ye; Wu re WU han zh己 fa
yu yin ye. (2) Fa yu y ang, qi ri yu. (3) Fa yu yin, liu ri yu . ( 4) Yi
yang shu qi, yin shu liu gu ye.
( 1 ) When a n i l l ness [is characterized by] heat effusion a nd aversion to
cold , it is spri ngi ng from ya ng; when [an i l l ness is characterized by] the
a bsen ce of heat effusion a nd [the presence of] aversion to cold , it is
spri ngi n g from 向 . (2) [I n i l l ness] spri ngi ng from ya ng, [the patient]
recovers i n seven days. (3) [ I n i l l n ess] spri ngi ng from yin , [the patient]
1 . G REATER YANG
51
阳。vers i n six days. ( 4) This is beca use ya ng n u m bers seven a nd 向
n u m bers six. *
TEXT NOTE
*
y缸g numbers seven and yin numbers six: 以 阳 数 七 , 阴 数 六 故 也 yang shu
qf, y丽 shU liu gu ye: Seven, as all odd numbers, is yang, and six, as all even
numbers, is yin.
SYNOPSIS
A differentiation of the two main types of externally contracted disease ( yin and
y问) , and determination of the recovery period.
C OMMENTARY
In externally contracted heat dise邸e, heat effusion with aversion to cold con­
stitutes a yang sign; absence of heat effusion with aversion to cold is a yin sign.
Right 啡, when it is exuberant, contends with the evil, giving rise to a yang pattern
with heat effusion. When right qi is vacuous, it is incapable of struggling against
the evil; hence we observe a yin pattern of aversion to cold and absence of heat
effusion.
The terms "yin” and "yang” in this line have been interpreted in different ways:
1 . You Yi ( 尤 怡 , style 在 泾 Zru-Jing ) and Zhang Lu ( 张 璐 , style 路 玉 Lu-Y也 )
write that the terms "yin” (阴 yfn) and V缸g” (阳 yang) represent the three
yin channels and the three y缸g channels. Thus, “springing from yin” or
“springing from yang” refers to disease which starts in either a yin or a yang
channel, respectively. In the Shang Han L伽, pattern identification is based
on the six channels: greater y臼g (太 阳 tai yang), yang brightness (阳 明 yang
m ing) , lesser y归g ( 少 阳 shao yang) , greater yin (太 阴 tai yfn) , lesser yin ( 少
阴 shdo yfn) , and reverting yin (厥 阴 jue yfn ) . Heat effusion is associated with
diseases of all three yang channels, signifying that right qi is still effulgent and
able to oppose the evil strongly. In these basic patterns, right qi is exuberant
and the evil is replete. Absence of heat effusion and presence of aversion to cold
is associated with disease of all three yin channels. It signifies y归g vacuity,
yin exuberance, and debilitation of right qi.
2. In the Yr z,δng Jzn Jian ( 医 宗 金 鉴 “The Golden Mirror of Medicine” ) these
terms are interpreted more specifically, so that “yin” represents construction­
yin, 皿d "y缸g” represents defensive y缸g. Greater y缸g wind strike with
wind evil damaging the defensive y缸ig is “springing from yang” and greater
y缸ig cold damage with cold evil damaging the construction-yin is “springing
from yin.”
3. Ke Qin ( 柯 琴 , style 韵 伯 Yun-B6 ) comments that yin and y缸g refer not to
construction and defense or the different channels, but simply to cold and heat
seen in externally contracted disease patterns.
Yin and yang 缸e relative concepts which may be applied in many different ways
from various perspectives. The three interpretations presented differ one from the
other, but they 缸e not mutually con咀icting or irreconcilable.
52
l . GREATER YANG ( LINE 4]
2 . 1 IDENTIFICATION OF DISEASE PASSAGE AND PERIODS OF
RESOLUTION
This section presents information that can be used to determine if an evil h副
passed from the greater yang channel into another channel. The final group of lines
discuss the period of the day when a ce此ain pattern should resolve. This 且nal
group takes as its foundation the relationship between the channels and the earthly
branches, such that by knowing in which of the channels an evil is located, one can
predict the hour of the day during which it will resolve.
LINE 4
伤寒一 日 , 太阳受之 , 脉若静者 , 为不传 ;
颇欲吐 , 若躁
烦 , 脉数急者 , 为传也 。
Shang han yi 时, tdi yang shou zh毛 mai ruo jing zhe, wei bu chuan;
po yu tu, ruo zao fan, mai shuo ji zhe, wei chuan ye.
O n the fi rst d ay1 of cold da mage, greater ya n g contracts [the d isease] .
If the p u lse i s t ra n q u i l ,2 t h is mea ns n。 passage;3 a strong desi re to
vom it, if [there is] agitation a nd vexati。n,4 a n d the pu lse is ra pid a n d
u rgent, m ea n s passage.
TEXT N OTES
l. On the first day, 一 日 yi ri: At the onset.
2. The pulse is tranquil, 脉 若 静 mai ruo jing: “’Tranquil” is the opposite of
“stiηed” and means that the pulse has not undergone any changes and is
congruent with the current signs.
3. No passage, 不 传 bu chuan : The disease does not pass to another channel.
Implicit in this is that the disease does not enter the interior.
4. Agitation and vexation, 燥 烦 zao fan: The terms “vexation,” “agitation," and
their combinations “agitation and vexation" and “vexation and agitation ” all
of which appear in the Shang Han L郎, have distinct meanings. “Agitation”
means a subjective feeling of restlessness outwardly expressed by pronounced
abnormal movement. “Vexation” means a feeling of restlessness in the area
of the heart . When these two terms 缸e combined, 拙 in “vexation and agi­
tati on,” it refers to a subjective feeling of heat and disquietude in the chest
(vexation) and objective fidgetiness of the limbs (agita刷n) . There is not com­
plete agreement on whether or not “agitation and vexation" is different from
“vexation and agitation,” although some commentators suggest that the first
term in the pair is the more predominant sign of the two.
SYNOPSIS
How to determine, on the basis of the pulse and signs, whether a greater yang
disease will pass (to another channel] .
C OMMENTARY
When wind-cold first attacks the body, the greater y缸g contracts the evil.
1 . GREATER YANG [LINE 5]
53
Differences not only in the strength or weakness of the evil, but also in the pa­
tient’s constitution will determine the progression of the disease. When determining
whether or not passage has taken place, the pulse and signs are the main criteria.
In cold damage, the pulse is floating and tight . If it does no t change , it is described
础 being “tranquil” and one knows that passage has not occurred. The presence of
this pulse suggests that right qi is prevailing, evil φ is retreating, and no treatment
is necessary to resolve the disease. It may also mean that right qi is contending
with evil φ in the exterior and that the disease is contained in the greater yang.
If the pulse becomes rapid and urgent , and if a desire to vomit and agitation and
vexation arise, one knows that passage has already occurred. Desire to vomit and
vexation and agitation are explained in several different ways. According to Hua且g
Yu缸-Y也 ( 黄 元 御 , style 坤 载 Kun-Zai ) desire to vomit is a lesser yang sign and
vexation is a yang brightness sign. Thus the disease is passing through the lesser
yang into the y缸g brightness. Shen Jin-A6 ( 沈 金 麓 , style 丰 绿 Qian-L u ) ascribes
all of the signs to the y缸g brightness, and contends that the disease is passing
directly into the y归g brightness. Zhang Zhl-Cong ( 张 志 聪 , style 隐 庵 Yin-An )
considers these to be lesser yin signs, indicating exuberance of yin cold. Thus the
disease is passing from the exterior, greater yang, directly into the interior, lesser
yin. The original text is quite short and the information is limited; therefore the
opinions of the authors above should be thought of as references to be considered
in the light of clinical presentation, not de且nitive answers to the questions which
the line raises.
LINE 5
伤 寒 二 三 日 , 阳 明 、 少 阳 证不 见者 ,
为 不传也 。
Shang han er san 时, yang m仇g、 shao yang zheng bu jian zhe, wei
bu chuan ye.
When on the second or th i rd d ay of cold da mage, ya ng brightness a n d
lesser ya ng signs* are a bsent, i t mea ns n。 passage [has 。cc川ed] .
TEXT NOTE
*
Signs, 证 zh创g : Individual pathological “signs,” such as pain or localized
discomfort, heat effusion, poor appetite, abnormalities of stool, urine, menses,
etc. This character j.iE zheng is also used in the sense of a group of signs,
comprising a manifestation of human sickness understood to reflect the nature,
location, and the constitution of the patient. Hence the character 证 zheng is
translated 捕 “sign” or “pattern,” depending on context.
The concept of pattern is distinct from that of “disease” 病 bing, in the
sense of a disease entity ( e.g. , measles or cholera ) as a specific kind of morbid
condition that is recognizable as such in all patients it affects. A disease entity
may manifest in different patterns during its course and may vary to some
extent from one patient to another.
l.
54
G REATER YANG [LINE 8]
SYNOPSIS
Further discussion of a greater y缸ig disease in which passage does not occur,
continuing from the preceding line.
COMMENTARY
The preceding line describes the situation in which the patient has just con­
tracted an exterior evil, which manifests 臼 greater y缸g cold damage. In this line,
the patient has already had the disease for a short period of time. The phrase “two
or three days’ , is generally considered to be an approximation and is not taken liter­
ally. When determining whether or not the disease has shifted to another channel,
one must be familiar with the major signs associated with the other patterns. The
text states, “yang brightness and lesser y缸g signs are absent.” The major y缸g
brightness signs are generalized heat effusion, spontaneous sweating, no aversion to
cold, aversion to heat, thirst, vexation, and a large pulse. The major signs of lesser
yang disease are bitter taste in the mouth, alternating aversion to cold and heat
effusion, dry throat, dizzy vision, fullness in the chest and rib-side, and a pulse that
is s trin glike . Although the Su Wen states, “Cold damage for one day, greater yang
contracts [ the disease ] . . . the second day, ya吨 brightness contracts [it ] . . . the third
day, lesser yang contracts [ it ] . . . ,” it is clear that in clinical practice, diseases do
not progress with such regularity. Line 4, p. 52, and line 5, p. 53, emphasize that
one must examine the patient carefully in order to determine the progress of the
disease, not simply count the number of days. For a discussion of the re lat io n s hip
of the Shiing Han Lun to Su Wen, see the Introduction, p. 9.
LINE
8
付 太阳病 , 头痛至七 日 以 上 自 愈者 , 以行其经尽 故也 。
问 若
欲 {乍 再 经 者 , 针 足 阳 明 , 使 经 不 传 则 愈 。
( 1 ) Tai yang bing, t6u tong zhi qi ri yz sl山ig zi yu zhe, yz xing qi
jing jin gu y e. (2) Ruo yu zuo zai jing zhe, zhen zu yang m仇g, shz
jing bu chuan ze yu.
( 1 ) When in g阳ter ya ng d isease, a headache lasts for more t h a n seven
days, [a nd then the patient] sponta ne。usly rec。vers, t h is is beca use [the
evi l] has gone right t h ro吨h the ch a n nel . (2) If it is a bout to pass to
a nother c h a n nel, a nd [one] need les the foot ya ng brightness* to p刚ent
passage, then [the patient wi l l] recover.
TEXT N OTE
*
The foot y缸ig brightness, 足 阳 明 zu yang ming:
channel.
The
foot y拍g brightness
S YNOPSIS
The mechanism of spontaneous recovery in greater y缸g disease and a method
for blocking p凶sage of a greater yang disease.
1 . G REATER YANG [LINE 9]
55
COMMENTARY
Headache is the only sign explicitly mentioned in this line, although others are
implied. Y边 W也Y归 ( 余 元 言 ) explains this in the following way: “Greater yang
disease includes a floating pulse, headache, pain and stiffness in the back of the
neck, and aversion to cold.” When an evil attacks the greater ya吨, but the bowels
and viscera 缸e not damaged, it is possible for the body’s regulatory and defense
mechanisms to contend with and expel the evil. The disease may resolve sponta­
neously, that is without the patient taking medicinals or receiving other treatment.
It is not uncommon for diseases of this nature to resolve spontaneously in approxi­
mately one week; hence the number “seven” should be taken as an approximation.
The number seven is possibly an allusion to the line of the Nei J'tng that reads: “In
seven days the greater yang disease is weakened and the headache [has undergone a]
slight recovery.” If the disease does not resolve spontaneously, the physician should
take the necessary steps to prevent the shift of the disease. Following the typical
progression of greater yang disease inward to the yang brightness, one can first
needle the foot yang brightness channel. In this way, one can course the channel qi,
rouse the stomach y归g, support the right, dispel the evil, and prevent the shift.
2 . 2 SECTION APPENDIX : PERIODS OF RESOLUTION FOR THE
SIX CHANNELS
Generally, lines are placed in chapter or section appendices such as this one
either because commentators have been unable to explain them, or, 部 in the present
case, because their authorship is doubtful. Although the meaning of lines below is
clear, they reflect the influence of the Su Wen and many commentators believe that
they were added by a later author. Furthermore, they appear to be inconsistent
with clinical reality and therefore are considered to be less important for modern
clinicians.
LINE 9
太阳病 , 欲解时 , 从 巳 至未上 。
Tai yang bing , yu jie shi, c6ng si zhi wei shang.
The time when greater ya ng d isease is a b。ut to resolve is f
t。 wei { 88 ) . *
TEXT NOTE
*
B6 to B8, 从 巳 至 未 上 c6ng si zhi wei shdng: 9 A . M .-3 P . M . See the table
below.
1 . GREATER y ANG [LINE 275]
56
THE TWELVE HOURS
子 时 zi shi Bl, 11 P . M . 1 A . M .
丑 时 chem shi B2, 1 A . M 「3 A . M .
寅 时 u臼 shi B3, 3 A . M.-5 A . M .
卵 时 mao shi B4, 5 A . M . 7 A . M .
辰 时 chen shi B5, 7 A . M .-9 A . M .
巳 时 si ski B6, 9 A . M .-1 1 A . M .
午 时 wu shi B 7 , 1 1 A . M 「 1 P . M .
未 时 wei shi B B , 1 P . M .-3 P . M .
申 时 shen shi B9, 3 P . M.-5 P . M .
国 时 you shi BlO, 5 P . M . 7 P . M .
戌 时 xU shi Bl l, 7 P . M . -9 P . M .
亥 时 hai shi B 1 2, 9 P . M.- 1 1 P . M .
SYNOPSIS
On the basis of the intimate relationship between humans and the natural world ,
inferring the favorable periods ( three of the 12 twφhour periods into which the day
was traditionally divided ) during which a greater yang disease will resolve.
LINE
193
阳 明 病 , 欲解时 , 从 申 至成上 。
Yang m伽g bing, yu jie sh{, c6ng shen zhi xu shang.
The ti m e when ya ng brightness d isease is a b。ut t。 resolve is from shen
( 8 9 ) t。 XU ( 8 1 1 ) . *
TEXT N OTE
*
B9 to B 1 1 ,
从 申 至 戌 上 c6ng shen zhi xii. shdng: 3 P . M . -9 P . M .
SYNOPSIS
How to predict the favorable period during which yang brightness disease will
resolve.
LINE 272
少阳病 , 欲解时 , 从寅至辰上 。
Shao yang bing, yu jie shi, c6ng yin zhi chen shang.
The ti m e when lesser ya ng d isease is a b。ut t。 阳。Ive is from yin ( 83)
t。 chen ( 85) . *
T E XT
*
NO T E
B3 to B5,
从 寅 至 辰 上 c6ng yin zhi cheng shdng: 3 A . M .-9 A . M .
S YNOPSIS
How to predict the favorable period during which lesser yang disease will resolve.
LINE
275
太阴病 , 欲解时 , 从亥至丑上 。
Tai yfn bing, yu jie shi, c6ng hai zhi chou shang.
1 . GREATER YANG (LINE 10]
57
The time when greater 泸n d isease is a b。ut t。 resolve is from hai { 8 12)
t。 chou { 8 2 ) . *
TEXT NOTE
*
B12 to B2,
从 亥 至 丑 上 c6ng hdi zhi chOu shdng: 9 P.M.-3 A . M .
SYNOPSIS
How to predict the favorable period during which greater yin disease will r esolve .
LINE 291
少阳病 , 欲解时 , 从 寅至辰上 。
Shao yin bing, yu jiε shi, c6ng zi zhi yin shang.
The ti me when lesser 向 d isease is a b。ut t。 阳。Ive is from zi { B l ) t。
yin { 83) . *
TEXT NOTE
*
Bl
to
B3 从 子 至 寅 上 c6ng zi zhi g仇 shang: from 1 1 P . M . -5 A . M .
SYNOPSIS
How to predict the favorable period during which lesser yin disease will resolve.
LINE
328
厥阴病 , 欲解时 , 从丑至 卵 上 。
Jue yin bing, yu jie shi, c6ng chou zhi miio shang.
The time when reverti ng yin disease is a b。ut t。 res。Ive is fr。m chou
{ 82) t。 miio { 84) . *
TEXT NOTE
*
B2 to B4,
从 丑 至 卵 上 c6ng chOu zhi mao shdng: from 1 A . M .-7 A . M .
SYNOPSIS
How to predict the favorable period during which reverting yin disease will
resolve.
LINE 1 0
风家 , 表解而不 了 了 者 , 十 二 日 愈 。
Feng jia, biiio jie er bu liiio liiio zhe, shi er ri yu.
Wi nd patients1 i n whom the exteri。r has res。lved , but n。t clea rly,2 wi l l
rec。ver i n twelve days.
58
1 . G REATER YANG
T EXT NOTES
1. Wind patients, 风 家 Jeng jia: Three interpretations of this term have been
offered, but modern commentators generally agree that the third is most likely
the author’s intended meaning.
a) According to F加g You-Zhi ( 方 有 执 , style 中 行 Zhδng-Xing) , “wind pa­
tients [means those patients with] wind strike disease.”
b) Gao Xu令Shan (高 学 山 ) explains that the use of 家 jia means abiding
disease. Thus, this term means a person prone to wind disease.
c) Cheng Ylng-Mao (程 应 施 , style 程 郊 倩 Cheng Jiac←Qi归) writes that the
origin of this patient’s disease is wind and that the disease could be any
greater y但g disease, such as wind strike or cold damage.
2. Not clearly, 不 了 了 bu liii.o liii.o: Not decisively, not definitively. Although the
exterior signs have resolved, the patient has not recovered completely.
SYNOPSIS
After the exterior resolves, when the person still does not feel well, one can wait
for spontaneous recovery.
COMMENTARY
A patient who no longer has any exterior signs but still does not feel completely
well may simply need some time to rest, eat well, and allow the body to recuperate
naturally. This patient does not need to take more medicinals. Again, the use of
the number twelve should be understood as an approximate measurement of the
time needed for full recovery.
3
BA SIC GREATER YANG DISEASE PATTERNS
Greater yang disease is differentiated into wind strike exterior vacuity and cold
damage exterior repletion. These patterns are identified on the basis of observed
pulses and signs, as described below.
3. 1
飞iVIND STRIKE EX TERIOR VACUITY PATTERNS
The primary signs of wind strike are headache, heat effusion, aversion to wind
and cold, spontaneous sweating, and a pulse that is floating and moderate. The
pathomechanism of these signs can be summed up by the phrase, “weakness in the
construction and strength in the defense.” The defense is yang and defends the ex­
terior of the body. The construction is yin and nourishes the fleshy exterior. When
an evil invades the exterior, the defense yang floats exuberantly to the exterior to
resist the evil, giving rise to heat effusion. Thus, here “strength in the defense"
means that the defense has contracted the evil. It is not a statement of the physi­
ological strength of the defense ya吨. (If this were the case, the exterior would be
secure and the evil would be unable to invade. ) In fact, here, the defense yang is
less effective in performing its basic functions and when the evil invades, it is unable
to secure the exterior; consequently, construction-yin is not contained and sponta­
neous sweating occurs. Sweating is called “weakness in the construction,” referring
to the vacuity of the defense φ and its inability to contain the construction. As
a result of sweating, the interstices of the flesh become loose and construction-yin
l.
G REATER
y ANG
59
becomes insufficient, causing the pulse to be not only floating, but also moderate,
a quality that indicates weakness. As a result of vacuity of defense ql (y缸g φ)
and an evil blocking the exterior of the body, the patient experiences aversion to
cold and wind. In summary, wind strike patterns are characterized by spontaneous
sweating, which indicates that the interstices of the flesh are open and right ql is
relatively weak; therefore this pattern is also called an “exterior vacuity pattern.”
3.1.1
Cinnamon Twig Decoction Patterns
In greater y缸g exterior vacuity patterns, treatment focuses on harmonizing
the construction and defense, and Cinnamon Twig Decoction (gui zhf tang ) is the
representative formula. The signs associated with Cinnamon Twig Decoction (gui
zhZ tang ) patterns are aversion to wind and cold, heat effusion, sweating, headache,
pain and stiffness in the back of the neck, nasal congestion, possibly dry retching,
and a pulse that is floating and moderate. The cause of the disease is external
contraction of wind-cold evil. The pathomechanism is one of wind-cold evil fettering
the exterior and defense ql resisting the evil. In this process the defense qi strives to
confront the evil and the construction ql is weakened by this struggle. Construction
and defense lose normal regulation and the channel qi becomes inhibited. When
evil ql and right ql contend, the evil may interfere with the lungs. τ'reatment
consists in using warm acrid medicinals to resolve the fleshy exterior, dispel wind,
and harmonize the construction and defense. In cases where the evil is more severe,
acupuncture may be used to strengthen the treatment. Cinnamon Twig Decoction
( gui zhf tang) is the formula of choice.
Cinnamon Twig Decoction (gui zhf tang) is appropriate for the following con­
ditions:
a) greater ya吨 disease with unresolved exterior signs in which the pulse is
floating and weak
b) greater yang cold damage in which sweating has been promoted, but the
evil has not been completely eliminated and the promotion of further mild
sweating is required
c) greater yang disease in which erroneous precipitation has not caused a shift
to another disease pattern and the exterior signs are still present
d) greater yang disease in which the patient has not defecated for six or seven
days, but the urine is still clear
e) miscellaneous diseases in which, in the absence of internal organ disease,
the construction and defense are disharmonious and frequent spontaneous
sweating or intermittent heat effusion and sweating occur.
60
1 . GREATER YANG [LINE 1 2]
LINE 1 2
付 太阳 中风 , 阳浮而阴 弱 , 阳浮者 , 热 自 发 , 阴 弱 者 , 汗 自
出 。 问 啬 啬 恶 寒 , 渐 渐 恶 风 , 翁 翁 发 热 , 鼻 鸣 干 H区 者 , 桂枝
汤主之 。
( 1 ) Tai yang zhong Jeng, yang Ju er yfn ruo, yang ju zhe, re zi fa,
yfn ruo zhe, han zi chu. (2) Se se WU han, xf xr WU Jeng, xi xi fa re,
bi m仇g gan ou zhe, gui zhr tang zhu zhr.
( 1 ) I n greater ya ng wi n d stri ke with fl。ati ng ya ng a n d wea k 泸n , 1 floati ng
ya ng is sponta ne。us heat effusi。n ,2 a nd wea k yTn is sp。nta ne。us issue
of sweat.3 (2) If [there is] h udd led aversi。n t。 c。ld ,4 wetted aversi。n
to wi n d , 5 feather-wa rm heat effusi。n,6 n。isy n。se,7 a nd d ry retc h i ng,
C i n n a m。n Twig Dec。ction (gui zhf tang) governs.
TEXT NOTES
l . Floating y缸g and weak yin, 阳 浑 阴 弱 yang JU yzn ruo: There are two inter­
pretations of this phrase, one from the perspective of the pulse and the other
considering the pathomechanism. The interpretation relative to the pathome­
chanism provides greater insight into these patterns, and consequently may be
given precedence.
a ) The superficial pulse 岛It by applying light pressure is y缸g, the deep pulse
felt by applying heavy pressure is yin. “Floating yang and weak yin” means
a floating moderate pulse. This pulse is forceful when light pressure is
applied and forceless when heavy pressure is applied. Cheng Ylng-Mao
writes, “‘Yin [ and] yang' describe floating and deep [ qualities of the pulse] ;
[they] do not describe the cubit and inch [positions] .”
b ) A pathomechanism in which wind-cold fetters the exterior and exuberant
defensive yang fl.oats up to contend with an evil. The defensive exterior
becomes insecure and the construction cannot be contained. This phrase
is the same as strength in the defense and weakness in the construction.
Cheng W守Ji writes, “Y归g is an indicator of defense; yin is an indicator
of construction. When the y缸g pulse is floating, [there is] wind in the
defensive [阻terior] . When the yin pulse is weak, the construction qi is
weak. Wind merges with the defense so [there is] strength in the defense and
weakness in the construction. Thus, [ there is] heat eff四on a时 spontaneou
sweating."
2. Floating yang is spontaneous heat effusion, 阳 浮 者 , 热 自 发 yang Ju zhe, re
zi fa: Describes the pathomechanism of greater y缸g wind strike and the
production of heat effusion. When wind evil fetters the exterior, exuberant
defensive y阳g fl.oats to the exterior and contends with the evil. This struggle
produces heat which effuses from the surface of the body.
3. Weak yin is spontaneous issue of sweat, 阴 弱 者 , 汗 自 出 yfn ruo zhe, han zi
chu: Describes the pathomechanism of greater yang wind strike involving the
production of sweat. When the defensive yang is striving to contend with the
1 . GREATER YANG [LINE 1 2]
61
evil, its normal function of securing the exterior and regulating the opening
and closing of the interstices is compromised. Consequently, the construction­
yin is not contained in the interior and sweat issues. Here weak yin refers to
weak construction, 营 弱 ying ruo.
4. Huddled aversion to cold, 啬 啬 恶 寒 se se WU han : Severe aversion to cold.
The Chinese 啬 se , usually meaning stingy, is here used to describe how the
patient huddles up to preserve his own bodily warmth. Fang You-Zhi writes,
“Huddled’ means aversion to cold that stems from dispirited qi , which is in­
sufficient to delay [in ward] percolation [of the exterior evil] , and so the aversion
is severe.”
5. Wetted aversion to wind, 渐 渐 恶 风 xi xf 川 Jeng: Acute aversion to wind. 浙
xf, which usually means to wash or soak rice, is taken in this context to mean
to spray or to splash. When the surface of the body is splashed with water, it
is more sensitive to wind. Fang You-Zhi writes, “Wetted’ refers to aversion
to wind owing to looseness of the external body, as if there is fear and hatred
of rain-water suddenly splashing the body, and means the feeling of aversion.”
6. Feather-warm heat effusion, 靠 靠 发 热 xi xi fa re : Gentle heat effusion, felt in
the skin and fleshy exterior, as if the body were wrapped in feathers. It does
not mean a great sweltering heat eff1回on. Fang Y讪-Zhi writes, “ . . . [this
means] w缸m heat and not a great steaming heat."
7. Noisy nose, 鼻 鸣 bi ming: Nasal congestion which results in audible breathing.
FORMULA
Cinnamon Twig Decoction
0
(gui zhz tang)
R启solve the flesh and dispel wind; harmonize construction and defense.
桂枝三 两 ( 去皮 )
苟药三两 甘草二 两 ( 炙 )
生姜三两 ( 切 )
大枣十二枚 ( 壁 )
卜) 右 五 昧 , 吠 咀 三 昧 , 以 水 七 升 , 微 火 煮 取 三 升 , 去 淳 , 适 寒
温 , 服 一 升 。 ω 服 已 须 贝 , 散 热 稀 粥 一 升 余 , 以 助 药 力 。 (三) 温 覆 令
一 时 许 , 遍 身 亵 架 微 似 有 汗 者 益 佳 , 不 可 令 如 水 流 漓 , 病 必 不 除 。 (四)
若 一 服 汗 病 差 , 停 后 服 , 不 必 尽 剂 。 间 若 不 汗 , 更 服 依 前 法 。 (对 又
不 汗 , 后 服 小 促 其 间 , 半 日 许 令 三 服 尽 。 (七) 若 病 重 者 , 一 日 一 夜 服 ,
周 时 观 之 。 (八) 服 一 剂 尽 , 病 iiE 犹 在 者 , 更 作 服 。 (时 若 汗 不 出 , 乃 服
至 二 、 三 剂 。 (甘 禁 生 冷 、 粘 滑 、 肉 面 、 五 辛 、 酒 酶 , 臭 恶 等 物 。
Gui zhf siin liang ( qu pf) shao yao s伽 liang g伽 cao er Lia ng (zhi) sheng
jiang siin Liang ( qie) da zao shi er m ei ( bO)
( 1) You w
z瓦 shi Mn wen, fu yf shεY』g. (2) Fu yz xu 肘, chuo re xf zh伽 yz sh eng yu, yi zhu
yao li. (3) Wen fu ling yz shi xu, piiin shen zhe zhe wei si u伽 hdn zhe yi jiii, bu ke
ling ru shui Li u li, bing bi bu chU. (4) Ruo yz Ju han bing chai, ting hOu JU, bu bi
jin ji. (5) Ruo bu han, g e ng JU yz qian fa. (6) You bu hdn, hou JU xiao cu qi ji侃,
bdn 叫 “ ling siin Ju jin. (7) Ruo bing zhong zhe, yf ri yz ye Ju, zh向 sh{ gu伽 zhf.
( 8) Fu yz ji jin, bing zheng you zai zh已 geng zuo JU. ( 9) Ruo hdn bu chU, nai Ju zhi
1.
62
G REATE R y ANG [LINE 1 2)
er、 san ji. ( 10) Jin sheng Zeng、 nian hua、 rou mian、 创 xfn、 jiu luo、 chou
e deng wit.
ci n n a mon twig (桂枝 gui zhf, C i n n a momi Ram u l us) 3 li�ng ( remove bark)1
peony (巧药 sh<i.o yao, Paeoniae Radix)2 3 li�ng
m ix-fried3 licorice (甘 草 gan cifo, G lycyrrhizae Radix) 2 li�ng
fresh gi nger (生 姜 sheng ji伽g, Zingiberis Rhizoma Recens) 3 l i �ng (cut)
j uj u be ( 大 枣 da zao, Zizi phi Fn』
( 1 ) [For] the preced i n g five ingredients, brea k the [币叫 th ree i ngredients i nto sma ll
pieces a nd use seven sheng of water. Boil over a mild fla m e to get th ree sh副g a nd
remove the d regs. Ta ke one she暗 at moderate tem peratu 陀 (2) S hortly after ta king
[the fi rst dose] d ri n k a pproxi mately one she吨 。f hot, thin gruel to rei nforce the strength
of the medici na ls. (3) Warm [the body] by covering [with a bla n ket] for a sh。此 period ,
idea lly u ntil the whole body is moist, as if sweating very lightly. One ca n not a llow [the
sweat] to flow l i ke water, since the disease will not be elimi n ated [in this way] . ( 4) If one
dose [ca uses] sweati ng a nd the disease is d i m i n ished , cease taking fu rther [doses] . One
need not fi n ish the whole packet. (5) If sweati 吨 is a bsent, ta ke a nother dose accord ing
to the previous method. (6) If sweating is aga i n absent, reduce the time between doses,
fi n ishing t h ree doses i n half a day. (7) If the disease is severe, ta ke [doses] throughout
the whole day, a n d observe [the patient] the whole time. (8) After fi n ishi ng one packet,
[if] the d isease signs a 陀 still evident, take aga i n . (9) If sweating is a bsent, one can
ta ke u p to two or th ree packets. ( 10) Foods contraindicated [while ta king the formu la]
i nclude raw and cold foods, sticky and slimy foods, meat a nd noodles, the five acrids,4
liq uor, m i l k prod ucts, and foods with a peculiar or spoiled flavor or odor.
FORMULA N OTES
1 . Remove bark, 去 皮 qu pi: Because the flavor ( and hence the medicinal strength )
cinnamon twig (gui zhf) is contained in the bark, the instruction to remove
the bark has led to different interpretations. According to Ke Q缸, “removing
the bark" refers to the removal of the rough outer bark of Cinn
zhf) . According to Zhang Zhi-Cong, it means using tender twigs without skin.
Both interpretations are considered acceptable.
2. Peony, 巧 药 sh<i.o yao : Peony ( sh<i.o yao) is taken to mean white peony (Mi
shao yao ) .
3. Mi - fried, 炙 zhi In modern terms, this refers t o stir-frying with liquid adju­
x
4.
:
Va.I邸, but it is unclear what it means in this text. It may simply mean that
the medicinal agent is roasted, not necessarily stir-fried with honey, vinegar,
or wine, as is common today.
Five acrids, 五 辛 wu xzn : This term refers generally to foods with a pene­
trating and stimulating odor or flavor, but it has been the subject of much
disagreement 缸nong authors. Below are some of the main lists as recorded in
the Shang Han Lun Yan Jiu Da Ci D甜n (伤寒 论 研 究 大 辞 典 “Shang Han Lun
Studies Diction ry” ) .
a ) According to the authors of the dictionary: s创lion ( cong), Chinese chive
(xie), Chinese leek (jiu) , g缸lic ( suan) , and 出afetida ( qu ) .
1 . G REATER YANG [LINE 1 2]
63
Shi-Zh函 ( 李 时 珍 , sobriquet 滨 湖 Bin Hu) , in the Ben Cao Gang Mu (本
草 纲 曰 “The Comprehensive Herbal Foundation” ) writes, “The five strong­
smelling vegetables are the five acrid; those that are acrid, malodorous, and
cloud the spirit with an attacking nature. [ According to] those who cultivate
their bodies, the five strong-smelling vegetables are sand garlic (xiao suan) ,
garlic (da suan) , oil rape (yun tai), and coriander (hU suf) . [According to]
Taoist [teaching] , the 且ve strong-smelli吨 vegetables are Chinese leek (jiu),
Chinese chive (xie), garlic (su an ) , oil rape (yun tai), and coriander (hu suf) .
[According to] Buddhist [teaching] , the 且ve strong-smelling vegetables 缸e
garlic ( da suan), sand garlic (xiao suan ) , asafetida (ring qu) , scallion ( ci
cδng) , Chinese leek (jiu) , and victorialis (ge c δng) .
According to Gao Deng Cong Shu, the significance of the contraindication is
that one must avoid foods that have a penetrating fragrance and a stimulating
or irritating t部te.
b)
Li
SYNOPSIS
The pathology, clinical manifestation, and treatment of the greater yang wind
strike pattern.
COMMENTARY
The signs of greater yang wind strike include heat effusion, aversion to wind and
cold, sweating, 的iffness and pain of the head and nape, noisy nose, dry retching ,
and a pulse that is floating and moderate. The pulse is not only moderate, but also
floating since this quality is common to greater y缸g disease. In this pattern, wind­
cold fetters the exterior and defensive yang floats to the exterior to resist the evil.
Because of existing yang qi ( defense qi ) vacuity, the exterior becomes insecure and
construction-yin is not contained. This pathomechanism is described in the text
as “floating y但g and weak yin.” The struggle between defense qi and the exterior
evil produces heat effusion. The presence of an evil in the exterior and vacuity of
defense qi gives rise to wetted aversion to wind and huddled aversion to cold. The
construction-yin issues outward in the form of sweat and the nourishment normally
provided by the construction-yin is lost or diminished. This loss of nourishment
results in stiffness and pain. The evil m町 also interfere with the lung and / or
stomach. If it attacks the lung, inhibiting lung 啡, the patient will have a noisy
nose. If it attacks the stomach, causing counterflow ascen t of qi, retching will be
observed.
Cinnamon Twig Decoction (gui zhf tang) is the formula of choice for greater
y缸g wind strike. Cinnamon twig (gui zhf) is 配rid and warm. Because acrid­
flavored medicinals dissipate and warm-natured medicinals dispel cold and free
ya吨, cinnamon twig (gui zhf) resolves exterior wind and cold from the fleshy ex­
terior and interstices. Peony ( shd。 ”。) is sour and cold. Because sour-flavored
medicinals contract and cold-natured medicinals penetrate the construction-yin,
peony ( sh<i.。 ”。) contracts yin and harmonizes construction. These two medicinals
used together harmonize construction and defense, which is the basic action of Cin­
namon Twig Decoction ( gu i zhf tang) . Acrid and warm, fresh ginger ( sheng jiang)
not only assists cinnamon twig (gui zhf) in resolving the exterior, but also down­
bears counterflow and checks retching. This last action is particularly useful when
the exterior evil impairs the function of the stomach. Sweet jujube ( da zao) boosts
l.
64
G REATER y ANG [LINE 1 3]
the center and assists peony (sha。 ”。) in boosting yin and harmonizing construe­
tion. Sweet, balanced, mix-仕ied licorice (giin cao) harmonizes all the ingredients in
the formula and promotes interaction between the construction and defense. This
formula can be used for any disharmony of the construction and defense, not just
greater y缸ig wind strike.
After taking the decoction, the patient should drink a bowl of thin, warm gruel.
Eating rice gruel provides fluid nourishment and stomach φ, which supports right
qi; hence sweating occurs easily. If after the first dose sweat issues, no more doses
should be taken. If sweating is absent, another dose may be taken, up to three times
in a roughly twelve hour period. Zhang JI cautions against the excessive promotion
of sweating. Generally, the sweat should issue very lightly, and as soon as it does,
the patient is not allowed to take the decoction again. If the illness is severe, doses
may be given continuously and two to three whole packets may be used in one day.
When Cinnamon Twig Decoction (gui zh f tang) is prepared, it is divided into three
doses. A dose is one-third of the whole decoction prepared from one packet . The
terms used in the Han Dynasty to denote weights and measures are largely the
same as those used in modern texts, but the amounts are different. For example,
in the Han Dynasty, a liang was equivalent to 1 5.625 grarr邸, whereas today a liang
is equivalent to 3 1 .25 grams. Many authors have written commentaries on this
issue and after researching historical commentaries and modern clinical ingredient
dosages, Ke XuιF缸 ( 柯 雪 帆 ) suggests the following equivalents:
one jin = 250 grams
one liang = 1 5.625 grams
one zhu = 1 /24 of a liang
one g总 = 20 milliliters
one sheng = 200 milliliters = 6. 76 日uid ounces
one dou = 10 sheng
Note: Sheng is a unit of volume used for any liquid as well as for solid materials,
such as pinellia ( ban xia) or schisandra ( wu wei zi) , which can be conveniently
measured with a scoop.
LINE 1 3
太 阳 病 , 头痛 , 发 热 , 汗 出 , 恶 风 , 桂枝 汤 主 之 。
Tai yang bing, t6u tOng, fa re, han chu, WU Jeng, gui zhz tang zhu
zhr.
[ For] greater ya ng d isease with headache, heat effusi。n , sweating, a nd
a version to wi n d , C i n n a mon Twig Dec。cti。n (gui zhz tang) governs.
SYNOPSIS
The primary manifestations and treatment of greater y如g wind strike patterns.
COMMENTARY
In this line, no pulse is described. Nevertheless, if the patient has the four basic
1 . GREATER
y ANG
[LINE 95]
65
signs of headache, heat effusion, sweating, and aversion to wind, the pulse need not
be floating and moderate for one to use Cinnamon Twig Decoction (gui zhf tang)
or to classify this pattern as greater y缸g wind strike. A comparison of this set of
signs with those of cold damage shows that the only difference is the presence or
absence of sweating, an important point in the differentiation of these two patterns.
LINE 95
太阳病 , 发热汗出 者 , 此为荣弱卫强 , 故使汗出 , 欲救邪风
者 , 宜桂枝汤 。
Tai y ang bing, fa re han chu zhe, ci wei r6ng ruo wei qiang, gu shi
han chu, yu jiu xie Jeng zhe, yi gui zhz tang.
When i n greater ya ng d isease [there is] h eat effusi。n a n d sweati ng,
this mea ns wea kness in the construction and strength in the defense, 1
[wh ich] c。nseq uently ca uses sweat to issue; t。 el i m i n ate the evi l wi n d , 2
Cin 阳n。n Twig Decocti。n (gui zhz ta叼 ) is a ppropriate.
TEXT NOTES
1. Weakness in the construction and strength in the defense, 集 弱 衡 强 r6ng ruo
wei qiang: 祭 r6ng is interchangeable with 殖 U加g, construction. There are
different interpretations of this phrase, but common to all is the notion that
“weakness in the construction" means weakness in the construction-yin and
inability to contain the interior. “Strength in the defense" means that the
defensive yang rises up to meet an evil that is in the defensive exterior. The
commentaries below provide additional insight into this phrase.
Fang You-Zhi: “In line 3, it says floating yang and weak yin. Here it says
weakness in the construction and strength in the defense. Strength in the
defense is floating yang and weakness in the construction is weak yin. Each
explains the other."
Yf Zang Jfn Jian: “This explains the meaning of floating yang and weak yin
from the line above. In the Huang Di Nei Jzng, [it states that ] ‘ Exuberant evil
ql is repletion. Despoliation of essence φ is vacuity. ’ The defense is entered
by the wind and then [there is] heat effusion. The cause is repletion evil φ.
Thus, strength in the defense is strong evil φ in the defensive [exterior] . The
construction receives the evil and is steamed, then sweat issues. The cause
is weak essence ql. Thus weakness in the construction is weak yin qi in the
construction [ aspect ] .”
2. Evil wind, 邪 风 xie Jeng: Wind evil.
SYNOPSIS
Further discussion of the cause, pathology, and treatment of greater y缸g wind
strike patterns.
COMMENTARY
In greater yang disease, the presence of heat effusion and sweating means that
66
1 . G REATER YANG [LINE 24]
this is a wind strike pattern as compared with a cold damage pattern, in which
heat effusion may or may not have developed and in which sweating is absent. The
pathomechanism of greater y归g wind strike is described in the phrase, “weakness
in the construction and strength in the defense.” When a wind-cold evil fetters the
exterior, the defensive yang floats to the outer body. This phenomenon is described
as “strength in the defense.” “Weakness in the construction" means that when the
defensive exterior becomes insecure, the construction-yin is not contained and issues
outwards as sweat . “Weakness in the construction and strength in the defense" is
a concrete explanation of the phrase, ‘咀oating yang and weak yin” from line 12,
p. 60. In these patterns, wind evil is often involved. Cinnamon Twig Decoction
( gui zhi t伽g) resolves the fleshy exterior and expels wind.
LINE 24
太阳病 , 初 服桂枝汤 , 反烦不解者 , 先刺风 池 、 风府 ,
桂枝汤 则愈 。
却与
Tai yang bing, chu JU gui zhz tang, fan fan bu jie zhe, xian ci Jeng
ch ι Jeng j证F que yu gui zhz tang ze yu.
When i n greater ya ng disease, [the patie 叫 has i n itia lly ta ken Ci n na mon
Twig Dec。ction (g包i zhz tang ) , * but is vexed a nd [the exterior) is u n­
resolved , fi 附 need le Wi nd p。。I (Jeng chi, G B-20) a nd Wi nd M a nsion
(Jeng j泣, GV- 16) , then give Ci n n a mon Twig Decoction (gui zhz tang ) ,
a nd [the patient ) wi l l recover.
TEXT NOTE
*
In which [ the patient ] has initially taken Cinnamon Twig Decoction (gui zhr
tang ) , 初 服 桂 枝 汤 chu Ju gui zhf tang: According to Ke Qin and Chen Nian­
Z毡, this phrase may be taken to mean that only the initial dose of the formula
has been given. In the directions for Cinnamon Twig Decoction (gui zhf tang) ,
one is cautioned against giving more than one dose of the formula, unless all of
the signs remain unchanged. The precise meaning in Chinese is unclear and,
according to the Gao Deng Cong Shu , it would be reasonable to explain this
phrase as meaning that a few doses or even a whole packet has already been
taken. It simply means that it is early in the disease process and the patient
has started taking Cinnamon Twig Decoction (gui zhf tang) .
SYNOPSIS
In greater yang wind strike patterns, when evil qi is severe, one should treat
using needles and medicinals.
COMMENTARY
After the initial ingestion of Cinnamon Twig Decoction (gui zhf tang), not only
has the exterior not resolved, but the patient is now also experiencing vexation. Two
explanations are possible. The first is that the formula was not strong enough for the
strength of the evil and the second is that the evil has already passed into another
1 . GREATER
YANG [LINE 42]
67
channel. If the evil has transformed to heat and entered the interior, harassing
the spirit and causing vexation, one would expect changes in the pulse and other
signs to be described. However, this line speaks only of vexation and mentions no
pulse or other signs. Furthermore, it speaks only of “vexation” ( also called “heart
vexation ; it does not speak of the more severe “agitation and vexation旷 which
would be more likely in the case of internal heat. One may conclude therefore that
the evil is still in the greater yang, right qi and evil qi are contending with each
other, and that the vexation is a consequence of an unresolved evil qi depressed in
the exterior. When the evil is stronger than the formula used, right qi acts to assist
the medicinals in expelling the evil. If the formula is not strong enough to expel a
strong evil, when right qi and evil φ contend, vexation occurs. Furthermore, the
injunction to apply acupuncture before giving Cinnamon Twig Decoction (gui zh'i
tang) gives a further indication that this pattern is a more severe form of greater
yang wind strike, since needling the points suggested has the effect of dispelling
wind and resolving the exterior, thus strengthening the treatment.
LINE 42
太 阳 病 , 外 证 未 解 , 脉 浮 弱 者 , 当 以 1干 解 , 宜 桂 枝 汤 。
Tai yang bing, wai zheng wei jie, mai Ju ruo zhe, dang yi han jie,
yi gui zhz tang.
When i n greater ya ng disease the exterior pattern has n。t resolved a nd
the pu lse is floati ng a nd wea k,* t h is should be res。lved t h rough [the
promotion of] sweati ng; [therefore,] C i n n a mon Twig Dec。ction (gui zhz
tang) is a ppropriate.
TEXT NOTE
*
The pulse is floating and weak, 脉 浮 弱 mdi Ju ruo: A pulse that is felt with the
application of only light pressure and that is forceless. The term “weak pulse"
is taken at face value to mean forceless, lacking in strength. The more specific
definition of “sunken and forceless” that usually applies in modern texts was a
later development. See the Introduction, for a further discussion of this issue.
SYNOPSIS
In greater yang wind disease, when the pulse is floating and weak, it is appro­
priate to use Cinna皿on Twig Decoction (gui zM tang).
COMMENTARY
Cheng Wu-Ji and Fang You-Zhi both write that “the pulse is floating and
weak" means the same as “floating yang and weak yin,” referring to weakness in
the construction and strength in the defense. This pulse is the basic one expected in
greater y缸g wind strike and it means that although the disease has not resolved,
no transmutation has occurred. A slight variation on this idea is presented by
Ke Qin and the authors of Yr Zδng J丽 Jian, who take “the pulse is floating and
weak" to mean not ‘咀oating y三ng and weak yin,'’ but a pulse that is floating and
moderate, as distinct from a pulse that is floating and tight seen in greater yang
68
1 . G REATER y ANG [LINE 5 7]
cold damage. One of the important differences between greater y缸g wind strike
and greater y缸g cold damage is a pulse that is floating and moderate, as opposed
to a pulse that is floating and tight. Thus, since Cinnamon Twig Decoction (gui zhf
tang) is suggested, this pattern is probably wind strike with its associated pulse.
The two interpretations presented above are not contradictory, since the clinical
significance of both is the same. Since the exterior pattern h副 not resolved, the
basic signs of greater y缸ig wind strike are still present , so that Cinnamon Twig
Decoction (gui zhf tang) is appropriate for the mild promotion of sweating.
LINE 57
伤 寒 发 ?干 己 解 , 半 日 许 复 烦 , 脉 浮 数 者 , 可 更 发 汗 , 宜 桂 枝
汤。
Shiing han fa han yi jie, ban ri
fa han, yi gui zhz tang.
XU
ju fan, mai ju shuo zhe, ke geng
When i n cold da mage, sweating has a l ready brought res。l ution , a nd
then after h a lf a d ay or s。 [there is) aga i n vexation a n d a pu lse that
is ra pid and floating, [。ne) ca n aga i n promote sweating; [therefore,)
C i n n a m。n Twig Dec。cti。n (gui zhz tang) is a ppr。p巾te.
S YNOPSIS
After the promotion of sweating in a greater yang cold damage pattern, when
a residual evil has not been exhausted, it is still appropriate to resolve the exterior
through the promotion of sweating.
C OMMENTARY
In greater yang cold damage, the promotion of sweating is the appropriate
treatment method. Nevertheless, in this case, after resolution of the dise臼e, vexa­
tion appears. One might conclude that the evil has shifted to the y缸g brightness
channel and that the vexation is a sign of an exterior evil entering the interior and
transforming into heat. This transformation is further suggested by the presence
of a rapid pulse. The pulse, however, is also floating and no other signs of internal
heat are present. Furthermore, vexation, also known as heart vexation, is consid­
ered a mild sign of the contention between right φ and residual evil ql that h副 not
been completely eliminated and is depressed in the exterior because of a particu­
larly strong evil ql, weakened right ql, or some combination of these factors. The
pathomechanism associated with this transmutation has been described by various
commentators.
Zha吨 Zhl-Cδng writes, “An unfinished residual evil passes [ into] and abides in
the fleshy exterior and interstices.”
According to Cheng Ying-Mao, “The cold evil abates and then gathers again.”
Fang You-Zhi ( 方 有 执 , style 中 行 Zhong-Xfng ) explains that , “ [When] sweating
is promoted improperly, after sweating, [if] one is not careful, it is easy for wind
evil to ree丑ter [the exterior] .”
1.
G REATER YANG [LINE 44]
69
Finally, Zhou Yang-Jim (周 扬 俊 ) comments, “ [ There has] been sweating, [so]
the old evil is already gone. [ Because there i司 new vacuity, [there is] again an attack
from evil wind."
According to all these interpretations it would be an error to use a treatment for
an interior heat condition. The text tells us that sweating can be promoted again.
Cinnamon Twig Decoction (gui zhf tang) is used rather than Ephedra Decoction
(ma huang tang) because we assume that the latter formula has already been used
once. Although the text does not tell us if the newly appearing signs constitute a
greater y缸g cold damage pattern, the fact that Cinnamon Twig Decoction (gui zhf
tang) is suggested means that mild sweating is appropriate, rather than the strong
sweating induced by Ephedra Decoction (ma huang tang).
LINE
44
太 阳 病 , 外 证未解 , 不 可 下也 , 下 之 为 逆 , 欲解 外 者 , 宜桂
校汤 。
Tai yang bing, 四ai zheng wei jie, bu ke xia ye, xia zhz wei ni, yu jie
wai zhe, yi gui zhz tang.
Greater ya ng d isease i n which the exterior pattern has not resolved
ca n not be precipitated [si nce] preci pitation w。u ld be a n a dverse [treat­
ment] . When [one] d esi res t。 resolve the exteri町, C i n n a mon Twig
Dec。ction (gui zhz tang) is a ppropriate.
SYNOPSIS
It is a treatment principle that in greater yang disease the promotion of sweating
is appropriate and the use of precipitation is not.
C OMMENTARY
In any pattern with exterior signs, promotion of sweating is the appropriate
treatment . When interior signs are present as well as exterior signs, precipitation
may be used, but it should only be used before promotion of sweating if the interior
signs require more urgent treatment than the exterior signs. Prior to resolution of
exterior signs, the use of precipitation usually constitutes an error in treatment,
since it causes the exterior evil to fall inward and gives rise to such signs as panting,
fullness in the chest , glomus, and diarrhea. According to Gao Deng Cong Shu,
Cinnamon Twig Decoction (gui zhf tang) is just one example of an appropriate
exterior-resolving formula. It is still necessary to examine the signs before choosing
the formula and one should not be restricted to Cinnamon Twig Decoction (gui zhf
tang) .
1 . GREATER YANG [LINE 45]
70
LINE
45
(→ 太 阳 病 , 先 发 汗 不 解 , 而 复 下 之 , 脉 浮 者 不 愈 。
(二) 浮 为
在外 , 而 反 下 之 , 故令不愈 , 今脉浮 , 故在外 , 当 须解外 则
愈 , 宜桂枝汤 。
( 1 ) Tai yang b切g , xian fa han bit ji已 er fit xia zh豆 mai JU zhe b it
yi.t. ( 2) Fu wei zai wai, er Jan xia zh毛 git ling bit yit, fin mai Ju , git
zai wai, dang
xii,
jie wai ze yit, yi gui zhr tang.
( 1 ) When i n greater ya ng d isease i n itia l promotion 。f sweating fa i ls t。
resolve [the d isease] a nd preci pitati。n then is used , [so that] the p u lse is
fl。ati ng; [there wi l l be] no rec。ve啡 (2) [A pu lse that is] floati ng mea ns
locati。n in the outer body, a nd [if] i nstead preci pitation [is used] , it
wi l l prevent recovery. The p u lse is n。w* floati ng so [we know that the
d isease is] located in the outer b。dy a nd t h is 叫 u i res res。l ution of the
outer b。dy t。 ach ieve 阳。very; [therefi。陀,] Ci n r『1
(g包i zhr tang ) i s a ppropriate.
TEXT N OTE
*
Now, 今 fin : In the present case.
SYNOPSIS
In a greater yang disease, after sweating has been promoted and precipitation
has been used, if the disease is still in the exterior and has not become a transmuted
pattern, one should still treat by resolving the exterior.
C OM MENTARY
In this line, the patient has already been treated through sweating and precip­
itation. The evil is still in the exterior, as indicated by the presence of a pulse that
is still floating, even after erroneous precipitation, which can cause an evil to fall
into the interior. This line illustrates an important principle of the Shang Han Um,
namely that one should choose the treatment on the basis of the observed signs.
This patient still has the signs of greater y缸g disease and no transmuted pattern
h副 arisen from mistreatment . Since the eyil is still in the exterior, it is appropri­
ate to promote sweating. It would be wrong to assume that because promotion
of sweating and precipitation have already been used the promotion of sweating
cannot be used again. Nevertheless, it is important to bear in mind that in view
of the damage to ri'?ht φ caused by both sweating and precipitation, although the
promotion of sweating is the correct treatment method, a mild formula must be
used rather than a strong one. The formula of choice is Cinnamon Twig Decoction
(gui zh'i tang), which will not further damage right qi.
l.
G REATER YANG [LINE 56]
71
LINE 56
忖 伤寒不 大便六 七 日 , 头痛有热者 , 与承气汤 。
仁) 其 小 便
清者 , 知不在里 , 仍在表也 , 当 须发汗 ; 若头痛者 , 必陋 ,
宜桂枝汤 。
( 1 ) Shang han bu da bian liu qz 叫, t6u tong yo u re zhe, yu cheng qi
tang. (2) Qi xiao bian qfng zhe, zhz bu zai κ 俨eng zai biao ye, dang
XU fa han; ruo t6u tong zhe, bi nu, yi gui zhf tang.
( 1 ) When c。Id d a mage1 [is cha racterized by] i n a bi l ity to defecate for
six 。r seven days, headache, a nd heat [effusi。n] , give a Ql-C。。rd i n at­
i ng Dec。ction ( c heng qi tang).2 (2) If the u ri n e is clear, [we] know
[the disease] is not located i n the i nterior, [but] is sti l l i n the exteri。r,
a nd sh。uld [be treated by] the prom。ti。n 。f sweati ng, [a nd] ( if [there
is sti l l] a headache, [after ta ki ng the dec。ction] , there wil l be sponta­
ne。us extern a l bleed i ng) , Ci n na mon Twig Dec。ction (gui zhf tang) is
a ppropriate. 3
TEXT NOTES
1 . Cold damage, 伤 寒 shang hdn : In this context, “cold damage" is used in its
broader sense of any externally contracted disease because the treatment used
for the resolution of the exterior disease is Cinnamon Twig Decoction (gui
zhZ tang) . If it were used in the narrow sense of exterior repletion, Ephedra
Decoction ( md hudng ta叼) would be the formula.
2. Qi-coordinating decoction, 承 气 汤 cheng qi tiing : Any of the formulae whose
name contains “qi-coordinating.” These formulae clear heat and free the stool.
3. Cinnamon Twig Decoction (gui zhi tang) is appropriate, 宜 桂 枝 汤 yz gui zhf
tang: This, 缸cording to Y 6u Yi (尤 怡 , style 在 泾 Zai-Jing) , is an example
of grammatical inversion. The clause containing the formula belongs directly
after the clause, “should be treated by the promotion of sweating,” 当 须 发 汗
dang xii. fii him, since it indicates what should be used to promote sweating.
In that case, this line would be, “In cold damage with inability to defecate
for six or seven days, headache, and heat effusion, give Qi-Coordinating De­
coctions ( cheng qi tang) . If the urine is clear, [one] knows [ the disease] is not
located in the interior, [but] is still in the exterior, and should [be treated by]
the promotion of sweating. Cinnamon Twig Decoction (gui zhf tang) is ap­
prop ria te . If [there is still] a headache [a此er taking the decoction] , there will
be spontaneous external bleeding.”
S YNOPSIS
a) On the basis of whether or not the urine is clear, one can differentiate exterior
and interior patterns.
b) If the urine is clear, the pattern belongs to the exterior and it is appropriate
to use Cinnamon Twig Decoction (gui zhf tiing ) .
72
1 . GREATER YANG [LINE 1 5]
COMMENTARY
When defecation is absent for about a week, one might conclude that the evil
has entered the interior and transformed to heat. In that case, in addition to
a headache, the patien urine would be turbid, dark yellow or reddish and/ or
feel hot, suggesting the presence of interior heat bind repletion for which offensive
precipitation ca且 be used. When, as is actually the case here, the urine is clear or
light colored, one knows that the evil is not in the interior, but is still in the exterior;
hence precipitation is inappropriate and the promotion of sweating is appropriate.
Urination is one important indicator used to determine whether an evil is located
in the interior or exterior. In the line above, Cinnamon Twig Decoction (gui zhf
tang) is used to promote sweating.
If, after giving the decoction, the headache is still present or actually becomes
more severe, one knows that the evil is depressed in the exterior. The evil may
then damage the channels and cause spontaneous external blee ding. “Sp on tan eou s
external bleeding" is blood issuing from the nose, gums, or skin, without the pres­
ence of exterior damage or injury. In t he Shang Han Lim , it commonly refers
to nosebleed, but not exclusively. Spontaneous external bleeding occurs in three
basic patterns. The first is in a greater yang disease without sweating when the
evil becomes depressed in the exterior and damages the y缸g channels, causing
impaired movement of the blood and fluids. The second is when y缸g brightness
heat distresses the blood aspect and scorches the yang channels, causing the hot
blood to move recklessly and leave the channels. The third possibility is that the
erroneous use of a heating method to force sweating scorches the y缸g channels,
causing bleeding.
LINE 1 5
(寸 太 阳 病 , 下 之 后 , 其 气 上 ;中 者 , 可 与 桂 枝 汤 , 方 用 前 法 。
ω 若不上冲者 , 不得与之。
( 1 ) Tai yang bing, xia zh?: hiJU, qi qi shang chong zhe, ke yii gui zh?:
tang, fang yong qian fa. (2 ) Ruo bu sha叼 chδng zhe, bu de yii zhz.
( 1 ) When i n greater ya ng disease, a仕er preci pitation , qi su 咆es u pward , 1
[。ne] m ay give Ci n na m。n Twig Dec。ction (gui zhi: ta·叼 ) , ace。rd i ng to
the p陀vi。usly mentioned method .2 (2) If [there is] no u psu rge, ['。ne]
ca n not give t h is form u l a .
T EXT NOTES
1. Qi surges upward, 气 上 冲 qi shang chδng: A s u bj ec ti ve feeling of qi ascending
counterflow into the heart and chest. This pattern is different from running
piglet φ, 奔 豚 气 ben tun qi, in which the ql counterflow starts lower, in the
lesser abdomen. Running piglet φ will be discussed further in line 1 17, p. 167.
2 . According to the previously mentioned method , 方 用 前 法 fang yong qian fa:
The method of decocting and taking Cinnamon Twig Decoction (gui zhf t伽g),
described in line 1 2 , p. 60 .
l . G REATER YANG [LINE 53]
73
SYNOPSIS
After the inappropriate use of precipitation in a greater yang dise槌e, if the
exterior pattern is still �resent, one should treat by resolving the exterior, but if the
exterior evil has fallen into the interior, the promotion of sweating is contraindi­
cated.
C OMMENTARY
In greater yang dise部e, precipitation is usually in appropri a te and its use may
result in a transmutation, the patterns above being two possibilities. The key diag­
nostic point is the presence or absence of ql surging upward. When this is present,
it means that right φ is still strong and is contending with evil ql and the exterior
evil has not yet fallen inward. The exuberant right qi attempts to push evil qi out,
and because evil ql is still blocking the exterior, right qi rises up. One should resolve
the exterior to allow the outward passage of evil ql. Following the inappropriate
use of precipitation, on e must be careful not to further damage right qi. Therefore,
it is suggested that the exterior be resolved using Cinnamon Twig Decoction (gui
zhr tang) , which is mild and harmonizing, not Ephedra Decoction ( ma huang tang) ,
which might damage right φ. The absence of any feeling of upsurge means that
the evil has already sunk into the interior; consequently, resolving the exterior is
inappropriate. Once the evil falls into the interior, the p ossib le transmutations are
varied. No particular treatment method is suggested, since one must choose an
appropriate treatment on the basis of presenting signs.
LINE 53
(→ 病 常 自 汗 出 者 , 此 为 荣 气 和 , 荣 气 和 者 , 外 不 谐 , 以 卫 气
不共荣气谐和 故尔 。
口 以荣行脉 中 , 卫行脉 外 , 复发其汗 ,
荣 卫 和 则愈 , 宜桂枝 汤 。
( 1 ) Bing cha叼 zi han chu zhe, ci wei rong qi h已 r6叼 qi he zhe, wai
bu xie, yi wei qi bu gong r6ng qi xie he gu er. {2) Yi r6叼 xing mai
zhong, wei xing mai wai, Ju fa qi han, rong wei he ze yu, yi gui zhi
tang.
{ 1 ) When i l l ness [is cha racterized by] freq uent sponta ne。us sweating,
it mea ns c。nstructi。n qi is in harmony* a n d when [i n such cases] c。n­
structi。n qi is in h arm。ny, [ it is] the outer body [that] is not h armo­
n ious; that is [to say] it is beca use defense qi is not i n harmony with
construction qi . {2) Beca use c。nstruction [qi ] moves i n the vessels,
a nd defense [qi] moves outside the vessels, by the fu rther promotion
of sweating, construction a nd defense will h a rm。n ize, bringing a b。ut
陀covery; [therefore,] Ci n n a mon Twig Decoction (gui zhi tang) is a p­
propriate.
74
l . GREATER YANG [ LINE 54]
T EXT N OTE
事 Construction φ is in harmony., 荣 气 和 r6ng qi he: The construction qi is
not affected by the disease. According to Xu Da Chun ( 徐 大 椿 , style 灵 胎
Ling-Tai ) , although the construction φ is not affected by the dis栅e, it is not
harmonious in the sense of harmony between the construction and defense.
SYNOPSIS
a) The � athology and treatment of disease characterized by frequent sponta­
neous sweatmg.
b ) This is a suitable pattern for treatment with Cinnamon Twig Decoction ( gui
zhi tang) .
C OMMENTARY
This line does not specifically refer to greater y缸g disease, but instead refers
to dise甜es with frequent spontaneous sweating. The pathomechanism of this is ex­
plained as defense qi not being in harmony with construction qi. Xu Da Chun makes
a distinction between spontaneous sweating and the promotion of sweating: “Sp on­
taneous sweating is the separation of construction and defense. The promotion of
sweating causes construction and defense to unite.” Coordination between the con­
struction qi within the vessels and the defense qi outside the vessels is impaired.
Cinnamon Twig Decoction ( gui zhi tang ) is the primary formula for harmonizing
construction and defense. It can be used whenever there is construction-defense
disharmony, and its use is not restricted to treatment of wind strike.
LINE 54
病 人藏无他病 , 时 发 热 自 汗 出 而 不 愈者 , 此卫气不和也 , 先
其 时 发 汗 则 愈 , 宜桂枝 汤 。
Bing ren zang WU ta bing, shi fa re zi han chu er bu yu zhe, ci wei
qi bu he ye, xian qi shi fa han ze yu, yi gui zhf tang.
When patients wh。se viscera have n。 。ther d isease1 have peri。die heat
effusi。n a n d sponta neous sweating, a n d are fai l i ng to recover, this
mea ns defense q i is d isharmon ious and the promoti。n of sweating a head
of time2 wi l l bri ng a bout recove叩; [therefo陀,l C i n n a mon Twig Decoc­
ti。n (gui zhf tang ) is a ppropriate.
T EXT NOTES
1 . Patients whose viscera have no other disease 病 人 藏 无 他 病 bing ren zang WU
ta bing : There is no disease in the bowels or viscera; no interior pattern.
2. Promotion of sweating ahead of time, 先 其 时 发 汗 xian qi shi fa h dn : Promo­
tion of sweating while the patient is not experiencing the signs of heat effusion
and sweating.
l.
GREATER YANG
[ LINE 1 6B]
75
SYNOPSIS
a) The pathology and treatment of patterns with periodic heat effusion and
spontaneous sweating.
b) This is a suitable pattern for treatment with Cinnamon Twig Decoction ( gui
zhf tang ) .
COMMENTARY
This pattern is characterized by the presence of periodic heat effusion and spon­
taneous sweating, and the absence of interior signs. The pathomechanism of this
exterior pattern is disharmony of the defense ql, 描 in the previous line.
Although this is an exterior pattern in which construction and defense 缸e in
disharmony, the periodicity of the heat effusion indicates a difference from greater
yang wind strike patterns. The use of Cinnamon Twig Decoction ( gui zhf tang )
should not be construed as indicating the presence of wind strike exterior vacuity.
The promotion of sweating with Cinnamon Twig Decoction ( gui zhf tang ) , which
harmonizes construction and defense, is suggested in this line and the previous
one to treat spontaneous sweating. In this line, the formula is given prior to an
episode of heat effusion. Once sweat issues, construction and defense will become
harmonious and heat effusion will cease.
3 . 1 .2
Contraindicat ions for Cinnamon Twig Decoction
The contraindications for Cinnamon Twig Decoction ( gui zhf tang ) are as 岛1lows:
a) Patients with greater yang cold damage signs
b ) Patients with interior damp-heat
c ) Patients with hyperactivity of exuberant interior heat
d ) Greater ya吨 disease in which precipitation h描 been used erroneously and
no extenor signs are present.
LINE 1 6B
卜) . . . 桂 枝 本 为 解 肌 , 若 其 人 脉 浮 紧 , 发 热 汗 不 出 者 , 不 可 与
之也 。 ω 常 须识此 , 勿 令 误也 。
( 1 ) . . . gui zh'i ben wei jie jf, ruo q{ ren mai Ju fin, fa re han bu chu
zhe, bu ke yu zhi ye. ( 2) Chang xii shi ci, WU ling WU ye.
( 1 ) . . . C i n n a mon Twig [Dec。ction] 1 is basica l ly fi。r resolvi ng the flesh ;2
if the person ’s3 p ulse is tight a n d floati ng, [a n d there is] heat effusi。n ,
a nd sweati ng i s a bsent, i t ca n not be given . (2) [One] needs a lways to
be awa re of t h is, so as not t。 ca use t h is err。r.
TEXT NOTES
1. Cinnamon Twig, 桂 枝 gui zhf: An ellipsis of Cinnamon Twig Decoction ( gui
zhf tang ) .
1 . G REATER YANG [LINE 1 7)
76
2. Resolving the flesh, 解 肌 jie jf: To resolve the fleshy
exterior of
wind evil,
through the mild promotion of sweating. This is different from the action of
Ephedra Decoction (ma ht凶ig tang), which strongly promotes sweating.
3. The person, 其 人 qi ren: Literally, “this person,” but here meaning “the
patient.”
S YNOPSIS
Cinnamon Twig Decoction
cold damage patterns.
(gui zhf tang) should not be used in greater y归g
C OMMENTARY
The resolution of the fleshy exterior and the regulation of the construction and
defense 缸e the chief actions of Cinnamon Twig Decoction (gui 劝E tang), which
promotes mild sweating. In the line above, the p atient has a pulse that is float­
ing and tight, heat effusion, and absence of sweating, indicating greater y缸g cold
damage, which should be treated with Ephedra Decoction (ma huang tang). The
promotion of strong sweating is appropriate and a mild formula such as Cinnamon
Twig Decoction (gui zh'i t副g) must not be given. This line suggests that when us­
ing promotion of sweating to resolve the exterior , the formula should be sufficiently
strong , since if it is not strong enough, the opportunity for the most effective dis­
pelling of evil will be lost. Previous lines have also emphasized that if a formula is
too strong, right qi will be damaged. If a formula is not strong enough or is too
strong, transmuted patterns can arise.
This line and line 16A, p . 132, are, in some texts, written as a single line.
LINE 1 7
若酒客 病 , 不 可 与 桂枝 汤 , 得 之 则 岖 , 以 酒 客 不 喜 甘故也 。
Ruo jiu ke bing, bu ke yu gui zhr tang, de zhz ze ou, yi jiu ke bu xi
gan gu ye.
a d ri n ker is sick, 1 C i n n a mon Twig Decocti。n (gui zhr tang) ca n n。t
be given , si nce it wil l ca use retch i ng. This is becau se d r i n kers do not
l i ke sweet t h i ngs.2
If
TEXT N OTES
1. If a drinker is sick, 若 酒 客 病 ruo jiu ke b i ng : The Chinese phrase can actually
be read in two different ways.
a) If [叫 drinker 。s) sick, i.e., if a person given to drinking liquor [contracts
greater yang] 也.se臼e . . .
b) If [ this isJ drinkers" sickness, i.e . , if the condition is due to drinking . . .
The term 酒 害 jiU ke seems to imply disapproval (客 ke, literally “visitor,"
is often used to describe a person engaged in a specific activity, often one that
is 仕owned upon ) ; but it is not clear if it refers to someone given to drinking
or one who is habitually drunk.
2. Do not like sweet things, 不 喜 甘 bu xi gan: Cannot tolerate sweet things.
1 . G REATER YANG [LINE 1 9]
77
SYNOPSIS
Using the example of a drinker, this line points out that Cinnamon Twig De­
coction (gui zhf tang) is contraindicated when there is damp-heat in the interior.
COMMENTARY
The grammatical meaning of the opening clause is not clear since we do not
know if 酒 害 病 jiu ke bing is intended to be read as a disease name ( “drinker’s
sickness,” i.e叮 alcoholism) or whether it is a drinker (酒 客 jiu ke) who is sick (病
bing) . If the latter interpretation is correct, the referential meaning is still not clear,
since we do not know whether the drinker is sick from drinking or from contracting
greater yang disease. According to the n Zong Jfn Jian, the patient described
in this line is sick not from greater yang disease, but from excessive consumption
of liquor; in other words , no exterior evil is present. According to the other view,
which is attributed to W色i Li-Tong ( 魏 荔 彤 , style 念 庭 Nian-Ting) , the patient is
a person given to drinking who has contracted greater yang disease. Nevertheless,
this distinction is not critical from a clinical perspective because the underlying
principle of this line is not fundamentally changed by the different interpretations.
The key point is that a person given to drinking has a tendency towards interior
damp-heat. Cinnamon Twig Decoction (gui zhf tang) is an acrid, sweet formula.
Acrid flavors reinforce heat and sweet flavors reinforce dampness. Any patient with
interior damp-heat, due to drinking liquor or to other causes, should not be given
Cinnamon Twig Decoction (gui zhf tang).
The contraindication stated here, like many others appearing i n the Shang Han
Lim , should not be taken as absolute, but should be considered as a strong can­
tion against using this formula. When a patient with interior damp-heat contracts
greater yang disease and one desires to resolve the exterior through the promotion
of sweating, a cool acrid exterior-resolving formula should be given.
LINE
19
凡 服桂枝汤吐者 , 其后 必吐瞅血也 。
Fan JU gui zhτ tang tu zhe, qi hou bi tu n6ng xue ye.
Whenever ta king Ci n na mon Twig Dec。ction (gui zhi tang ) [ma kes the
person ] v。mit, there wil l be v。m iting of pus a nd bl。。d afterwa rds.
SYNOPSIS
a) Cinnamon Twig Decoction (gui zhz tang) is not appropriate for use in pat­
terns with interior heat.
b) An example of contraindications for the use of this formula.
COMMENTARY
Vomiting following the ingestion of Cinnamon Twig Decoction (gui zhf tang)
means exuberance of interior heat. Cinnamon Twig D ec o c tion (gui zhf tang) is
a warm acrid formula, and warm acrid medicinals cannot be given to patients
with interior heat since they reinforce y缸g, causing exuberant heat and stomach
counterflow, which manifest in vomiting . The vomiting of pus and blood following
the inappropriate use of Cinnamon Twig Decoction (gui zhf tang) is the result of
78
1 . G REATER y ANG [LINE 1 9]
exuberant heat damaging the blood network vessels. The main point of the line is
that Cinna皿on Twig Decoction (gui zhi tang) should not be given when there is
internal heat .
Concurrent Patterns
Concurrent patterns are those in which the main signs of a pattern are still
present , but signi且cant new signs also are observed. The six concurrent patterns
related to greater yang wind strike can be differentiated by formula, as below.
l . Cinnamon Twig Decoction Plus Pueraria (gui zhf jia ge g臼 tang) pattern:
Greater yang wind strike signs plus distinct hypertonicity in the nape and back.
This is the simultaneous appearance of greater yang wind strike ( disharmony
of the construction and defense ) and constrained greater y缸g channel φ. The
fluids are damaged and cannot moisten and nourish the channels normally.
The treatment method is to resolve the fleshy exterior and dispel wind, and
engender liquid and soothe channels.
2. Cinnamon Twig Decoction Plus Magnolia Bark and Apricot Kernel (gui zhf
jia hou po xing zi tang) pattern: Greater yang wind strike signs plus panting.
It is the simultaneous appearance of greater yang wind strike and lung cold
causing qi counterflow. This pattern can occur through the inappropriate use
of precipitation, which allows evil qi to fall inward, distress the lungs, and
inhibit downbearing of lung qi. It can also arise when a patient who originally
had breathing difficulty contracts an exterior evil, which causes the panting
to recur. The treatment method consists in resolving the fleshy exterior and
dispelling wind and in downbearing lung qi and stabilizing panting.
3. Cinnamon Twig Decoction Plus Aconite (gui zhfjia Ju zi tang) pattern: Greater
yang wind strike signs plus aversion to wind-cold, incessant leaking sweat, hy­
pertonicity of the extremities, and difficult scant urination. Greater yang wind
strike and yang vacuity simultaneously appear. If sweating is promoted ex­
cessively, it damages the defensive yang and the fluids. The fluids are further
depleted through leaking sweat and are unable to nourish the extremities. The
treatment method is to support yang and resolve the exterior.
4 . Cinnamon Twig Decoction Minus Peony (gui zhf qu shao yao tang) pattern:
Greater y缸tg wind strike signs plus fullness in the chest and a pulse that is
short and skipping. This pattern is the result of erroneous precipitation. The
exterior is not resolved and instead the evil falls into the chest, the chest y缸g
is devitalized, and the evil φ and right φ contend. The treatment method
consists in resolving the fleshy exterior and dispelling wind and in eliminating
yin and freeing yang.
5 . Cinnamon Twig Decoction Minus Peony Plus Aconite (gui zhi qu shao yao jia
Ju zi tang) pattern: Greater yang wind strike signs plus chest fullness, severe
aversion to cold, and a pulse that is faint and weak. This pattern is also the
result of erroneous precipitation. The exterior is not resolved and the evil falls
into the chest; the chest yang is damaged and the yang qi is insufficient. The
treatment method consists in resolving the fleshy exterior and dispelling wind
and in warming the channels and restoring yang.
3 . 1 .3
1 . G REATER yANG [LINE 14]
79
6. Cinnamon Twig Decoction Newly Supplemented with One Liang Each of Pe­
ony and Fresh Ginger and Three Li归g of Ginseng ( gu i zh'i ji a shao yao sh臼g
jiang ge yf liang ren shen san liang xfn jia tang) pattern: Greater y缸g wind
strike signs plus generalized pain and a pulse that is sunken and slow. This
pattern is caused either by the excessive promotion of sweating, which da皿-
ages the qi and blood, or by contraction of an exterior evil when φ and blood
are insufficient. The treatment method consists in harmonizing construction
and defense and boosting the qi.
LINE 1 4
太阳病 , 项背 强几凡 , 反汗出 恶风者 , 桂枝加 葛根 汤主之 。
Tai yang bing, xiang bei jiang shu shu, fan han chu wu Jeng zhe, gui
zhz jia ge gen tang zhu zhz.
When i n greater ya ng d isease [there is] stretched sti忏 n a pe a nd bac k , *
b u t a ls。 sweating a nd aversion t。 wi n d , i t is treated with C i n n a mon
Twig Decocti。n P l us P ue阳ia ( gui zhz jia ge gen tang) .
TEXT NOTE
*
Stretched stiff nape and back, 项 背 强 几 几 xiang bei jiang shu shU: Hyper­
tonicity of the neck and back and discomfort when looking up and down, as if
the neck were forcefully stretched, a condition that is considered more severe
than simple stiffness and pain in the neck. The reduplication 几 几 shu shu is
said to describe a short-feathered bird stretching its neck to fly but unable to.
FORMULA
Cinnamon Twig Decoction Plus Pueraria (gui zhf jia ge g臼 tang)
o
Resolve the fleshy exterior and expel wind; engender fluids and soothe chan­
nels.
葛 根 四 两 麻 黄 三 两 ( 去 节 ) 桂枝 二 两 ( 去 皮 )
三两 ( 切 ) 甘草二两 ( 炙 )
大枣十二枚 ( 擎 )
苟药二两
生姜
右 七 昧 , 以 水一 斗 , 先煮麻黄 、 葛根 , 减 二 升 , 去 上沫 , 内 诸药 ,
煮取三 升 , 去津 , 温服一升 , 覆取微似汗 , 不 须歌粥 , 余如桂枝法将
息及禁忌 。
Ge gen si liang ma huang san liang ( qu jie) gui zhf er liang ( qu pf) shdo
yao er liang sh eng jiang san liang ( qie) gan cao er liang ( zhi) dd za o shi er
mei (bo)
You qf w剖, yi shui yf dou, xian zhii ma huang、 ge gen jian er sheng, qu shdng
mo, na zhu yao, zhii qu san sheng, qu z瓦 wen ju yf sh eng, Ju qu wei si han, bu xii
chuo zhδu, yu ru gui zhf fa jiang xf j{ jin ji.
pueraria (葛 根
ephed ra ( 麻 黄
ge g旬, Puerariae Radix) 4 Ii温 ng
m a huang, Ephed rae Herba ) 3 li�ng ( remove
nodes)
80
1 . G REATER y ANG ( LINE 14]
ci n n a mon twig (挂 枝 gui zh豆 Cinna momi Ram u l us ) 2 li�ng ( remove bark )
peony (巧 药 shdo yao, Paeoniae Radix ) 2 li�ng
fresh gin ger (生 姜 sheng jiang, Zingi beris Rh izoma Recens ) 3 Ii温ng ( cut )
mix-fried licorice (甘 革 gan cao, G lycyrrh izae Rad ix ) 2 li�ng
j uj u be ( 大 枣 da zao , Ziziphi Fn
For the preceding seven i ngredients use one dCSt』 of wa ter. First boil ephed ra ( ma
huang) and pueraria (ge gen) to red uce [the water] by two sheng. Remove the foa m
[collecti 暗l on top a nd add a l l [the othe 什 i ngredients. Boi l to get th ree sheng a nd
remove the d regs. Ta ke one she吨 warm. Cover [w ith bedclothes] to obta in slight
sweati ng. [The patient) does not need to si p gruel . The remainder is as for C i n n a mon
Twig Decoction (gui zh飞 tang) [with regard toj rest and contraind ications.
SYNOPSIS
The signs and treatment of greater yang wind strike with inhibited greater yang
channel ql.
COMMENTARY
The use of 反 fan , “but” in this line suggests an important clinical distinction
made between this line and line 3 1 , p. 109. A stretched stiff nape and neck is
considered a severe form of the stiff nape mentioned in the outline of greater y缸g
disease given in line 1 , p . 4 1 . It generally occurs in greater y缸g cold damage as the
result of an evil fettering the exterior to the point that the channel qi is unable to
flow smoothly. When the qi does not flow, the fluids cannot moisten and nourish the
channels. The presence of sweating, however, means that this is not cold damage,
in which sweating is generally absent, but greater yang wind strike with constrained
channel qi. A formula based on Cinnamon Twig Decoction (gui zhf tang) would
seem the most likely choice, whereas in line 3 1 , p. 109, in a pattern without sweating,
Pueraria Decoction (ge gen tang), which contains ephedra (ma huang) , is used. The
formula Cinnamon Twig Decoction Plus Pueraria (gui zhf jia ge gen tang) is used
for the treatment of greater yang wind strike with constrained greater yang channel
qi. The addition of pueraria (ge gen), which resolves the fleshy exterior, abates
heat effusion, upbears yang, and engenders fluids, seems completely reasonable.
Ephedra ( ma huang), however, also appears i n the formula. This inclusion seems
unreasonable, since the patient is already sweating. In the Song Dynasty version of
the Shang Han Lun , Lin Yi and his team added the following commentary to this
formula:
We have carefully followed the original text of Zhang JI. In greater y缸g
wind strike with spontaneous sweating, [one should] use Cinnamon Twig
[Decoction] . In cold damage without sweating, [one should] use Ephedra
[Decoction] . [In this line] the signs are sweating and aversion to wind and
the formula contains ephedra (ma hu伽�) . [We] fear this is not the original
idea. The fascicle contains the Pueraria Decoction (ge gen tang) pattern
[with the signs of] absence of sweating and aversion to wind. It is correct to
give this formula, since the use of ephedra (ma h uang ) is proper. This s可s
[the name of the formula above is] Cinnamon Twig Decoction Plus Pueraria
(gui zM jia ge g 臼 tang ) , [but] we fear that [the formula of this name should
be] Cinnamon Twig Decoction (gui zM tang) plus only pueraria (ge gen ) .
1 . G REATER YANG [LINE 18]
81
Thus, according t o this interpretation, the formula should simply b e Cinnamon
Twig Decoction (gu i zhf tang) plus puer町ia (ge gen).
LINE 18
喘家 作桂枝汤 , 加 厚 朴 、 杏子佳 。
Chuan jia zuo gui zh?: tang, jia hou po、 xing zi Jiα.
For pa nting patients1 sufferi 鸣 fr。m 2 C i n n『1
zh?: tang) [ pattern ] , i t i s best t。 add magnolia bark ( hou p o ) a n d a pric。t
kernel ( xing zi) . 3
TEXT NOTES
1. Panting patients, 喘 家 chuii.n jia: Patients ordinarily suffering from panting.
Panting is hasty, rapid, labored breathing with discontinuity between inhala­
tion and exhalation and in severe c副es with gaping mouth, raised shoulders,
flaring nostrils, and inability to lie down.
2. Suffering from a Cinnamon Twig Decoction [pattern] , 作 桂 支 汤 zuo gui zhf
tang : 作 is here taken to mean 发 作 to have an attack of, to be afflicted by.
The word “pattern” does not appear in the Chinese.
3. Apricot kernel, 杏 子 xing zi: An alternate name for apricot kernel ( xing ren) .
FORMULA
Cinnamon Twig Decoction Plus Magnolia Bark and Apricot Kernel ( gui zh f jia hou
p o xing zi tang)
0
R启solve the fleshy exterior and dispel wind; downbear qi and stabilize panting.
桂枝三 两 ( 去皮 )
甘草二两 ( 炙 ) 生姜三两 ( 切 )
苟药三两
大枣十二枚 ( 肇 ) 厚朴二两 ( 炙 , 去皮 ) 杏仁五十枚 ( 去皮尖 )
右 七 昧 , 以 水七 升 , 微火 煮取三升 , 去津 , 温服一升 , 覆 取微似
汗。
Guz zhf san liiin g ( qu pf) gan cc'i.o er liii.ng ( zhi ) sheng jiang san liii.ng ( qie)
shcfo yao san liiing da ziio shi er mei ( bo) hou po er liii.ng ( zhi, qu pf) xing ren
WU shi mei ( qu p { jian)
You qf w剖, yi shui qf sheng, wei huo zhU qu san sheng, qu zi, wen ju yf sheng,
wei si han .
qiJ.
如
cinna mon twig (挂枝 gui zh豆 Cinnamomi Ra m u l us) 3 Ii昌ng ( remove bark)
mix-fried licorice (甘 草 gan cii.o, G lycyrrhizae Radix) 2 li�ng
fresh ginger (生 姜 sheng jiang, Zingiberis Rh izoma Rece叫 3 li�ng (cut)
peony (巧 药 shci.o yao, Paeoniae Radix) 3 li�ng
j uj ub e ( 大 枣 da zao, Ziziphi Fructus) 12 pieces ( broken)
magnolia bark (厚 朴 ho叩o, M agnoliae c。此ex) 2 li�ng ( remove bark a nd mix-fry1)
1 . G REATER YANG [LINE 1 8]
82
apricot kernel
( 杏 子 xing zi, Armeniacae Semen) 50 pieces ( remove skin and tips2 )
( 1 ) [For) the a bove seven i ngredients use seven sheng of water. Boil over a m i ld
fla m e to get th ree she咆. Remove the d regs a nd take one she鸣, warm . Cover [with
bedclothes) to obtai n slight sweating.
FORMULA NOTES
l. Magnolia bark ( h创 po) : “Removi吨 the bark” refers to removing the coarse
outer bark. The inner bark is used here. ’Traditionally, it is mix-fried with
fresh ginger (sheng jiang) , although it is unclear as to whether that particular
process is specified in this case. In the context of the Shang Han Um , what
is referred to as mix-frying may simply be dry frying. The frying process
moderates the more stimulati吨 nature of the agent; using fresh gi nger ( sheng
ji伽g) increases its ability to harmonize and warm the center burner.
2. Apricot kernel (xing ren): The tips and the skin are considered to have a
powerful effusing and dissipating action; therefore they are generally removed
for clinical use. This agent is fried in order to increase its ability to warm the
lung and dissipate cold. This process reduces the oil and increases the efficacy
for diffusing the lung, eliminating phlegm, and stabilizing panting. Frying is
done by placing the agent in a metal pan and lightly stir frying until the color
changes to a deep yellow or sli ghtly burnt appearance.
SYNOPSIS
The treatment of panting, when it is an abiding ailment that is caused to recur
by contraction of an exterior wind-cold pattern.
C OMMENTARY
This line describes a situation in which a patient who ordinarily has some
breathing difficulty contracts wind-cold, giving rise to Cinnamon Twig Decoction
(gui zhf tang) great凹 y归g wind strike pattern, manifesting in panting respiration,
heat effusion, sweating, aversion to wind, headache, and a pulse that is floating and
moderate. The pathomechanism is one of wind-cold distressing the lungs, causing
lung cold and qi counterflow and impaired diffusion and downbearing of the lung ,
manifesting in panting. Magnolia bark ( hou po ) and apricot kernel ( xing zi) are bit­
ter, acrid, and w缸m medicinals that diffuse the lung and disinhibit qi. Cinnamon
Twig Decoction (gui zhr tang) with the addition of these two medicinals resolves
the flesh and dispels wind, and downbears ql and stabilizes panting.
Rather than using the custom町 “govern” ( 主 zhu ) , here it is written that “it
is best" (佳 jia) , to add magnolia bark ( hou po ) and apricot kernel (xing zi) since
the addition of these two medicinals treats only the present pattern; it does not
eradicate the patient ’s panting problem.
1 . GREATER YANG [LINE 20]
83
LINE 43
太 阳病 , 下之微喘者 , 表未解故也 , 桂枝加厚朴杏子汤主
之。
Tai yang bing, xia zhz wei chuiin zhe, biiio wei jie gu ye, gui zhz jia
him po xing zi tang zhil zhz.
When i n greater ya ng d isease, [there is] m ild pa nti ng followi ng preci pita­
tion , it m ea ns that the exterior has n ot resolved ; [the时。陀 ,l C i n n a mon
Twig Decoction P l us M agnolia Bark a n d A pricot Kernel (gui zhr jia
hou po xing zi ta叼) g。verns.
SYNOPSIS
The treatment of panting that is the result of lung ql counterflow ascent, which
occurs after the inappropriate use of precipitation, when the exterior evil has not
resolved.
COMMENTARY
A comparison between this line and the preceding line is instructive. In this line,
greater yang wind strike is not treated by promotion of sweating in the proper way.
Instead, it is inappropriately treated by precipitation, which causes the patient to
pant , because the exterior evil is forced into the lung, giving rise to dual disease of
the exterior and interior. In the previous line, panting in a patient who ordinarily
tend s to suffer from panting, is induced by the contraction of an ex t eri or evil.
Both lines describe cases of greater yang disease with panting. Although their
pathomechanisms, signs, and treatment are the same, the cause and history are
different.
Inappropriate precipitation often causes the disease to enter the interior, and,
in such cases, all exterior signs disappear; therefore, promotion of sweating is no
longer appropriate. This line, however, describes a case in which inappropriate
precipitation has given rise to dual disease of the interior and exterior, with the
continuing presence of exterior signs. For this reason, promotion of sweating is still
叩propriate, albeit with the addition of Magnolia bark (him po) and apricot kernel
(xing zi') to diffuse the lung and disinhibit φ.
LINE 20
太 阳 病 , 发 汗 , 遂漏不止 , 其 人 恶 风 , 小 便难 , 四 肢微急 ,
难 以 屈 伸 者 , 桂 枝 力日 附 子 汤 主 之 。
Tai yang bing, fa han, sui lou bu zh毛 q{ ren WU Jeng, xiiio bian nan,
si zhr. wεt ji, nan yi qii shen zhe, gui zhr jia Ju zi tang zhil zhr.
When i n greater ya ng d isease, sweati ng is pr。m。ted a n d then gives
way t。 incessa nt lea king, * the pers。n is averse to wi n d , has d ifficult
u ri n ation , and the l i m bs are slightly tensed s。 that they bend a nd stretch
84
1 . G REATER YANG [LINE 20]
with d ifficu lty, C i n n a mon Twig Dec。ction P l us Aconite (gui zhi jia j边
zi tang) governs.
TEXT NOTE
*
Sweating is promoted and then gives way to incessant leaking, 发 汗 , 遂 漏 不 止
fa hdn, sui lou bu zhi: Sweating that fails t o run a normal course and develops
into an incessant flow of a small amount of sweat. This kind of sweating is
now called “leaking sweat” (漏 汗 lou hdn) .
FORMULA
Cinnamon Twig Decoction Plus Aconite
(gui zhf jia Ju zi tang)
o Support yang and resolve the exterior. (Harmonize construction and defense;
supplement y缸g and constrain sweat.)
挂枝三 两 ( 去皮 )
苟药三两 甘草三两 ( 炙 )
大枣十二枚 ( 擎 )
附子一枚 ( 炮 , 去皮 , 破 八 片 )
生姜三两 ( 切 )
付 右 六 昧 , 以 水 七 升 , 煮 取 三 升 , 去 淳 , 温 服 一 升 。 仁) 本 云 , 挂
枝汤 , 今 加 附子 。 问 将 息如前法 。
Gui zh'i s伽 liiing ( qu pi) shdo yao S伽 liiing gan ciio san liiing (zhi) sheng
jiang san liiing ( qie) da ziio shi er mei ( bo) β zi yf mei (pao, qu p{, po ba pian)
(1) You liu w剖, yi shui qf sheng, zhU qu san sheng, qu zi, wen JU yf sheng.
(2) Ben yun: gui zhf tang, jfn jia ju zi. (3) Jiang xf nJ. qitin fa.
ci n n a mon twig (桂 枝 gui zhf, Ci n n a momi Ram u l us) 3 li�ng ( remove bark)
peony (巧 药 shtio yao, Paeoniae Radix) 3 Ii温ng
m ix-fried licorice (甘 草 g伽 ciio, G lycyrrhizae Radix) 3 li�ng
fresh gi nger (生 姜 sheng jiang, Zingi beris Rhizoma Recens) 3 Ii温 ng (cut)
j uj u be (大 枣 da ziio, Ziziphi Fructus) 12 pieces (broken)
acon ite ( 附 子 Ju zi, Aconiti Tu ber Laterale) 1 piece (blast-fry., 陀move ski n , break
i nto eight pieces*)
( 1) [ For] the a bove six i ngred ients, use seven sheng of water. Boil to get three
she吨, 陀move the d 吨s a nd ta ke one she吨, 附rm . (2) [This is) Cin namon Twig
Decoction (gui zhf tang) with the addition of aconite (Ju zi) . (3) One should rest [as
descri bed] i n the method [for C i n n a mon Twig Decoction (gui zhf tang)] .
FORMULA NOTE
Aconite (Ju zi) : Blast-frying involves stir-frying vigorously in an iron wok
over a fierce 且re until the medicinal smokes and the surface becomes scorched,
swollen, and cracked. Medicinals are blast-fried to reduce harshness and toxi­
city.
SYNOPSIS
The clinical manifestation and treatment of a greater yang disease pattern in
which excessive sweating is promoted, leading to yang vacuity leaking sweat and
an unresolved exterior pattern.
1 . G REATER YANG [LINE 2 1 ]
85
COMMENTARY
In greater y缸g disease, the promotion of sweating is the treatment of choice.
Nevertheless, excessive promotion of sweating is clearly inappropriate. One may
refer back to the directions for Cinn
decoction is to be taken: “ . . . until the body is moist, as if sweating very lightly . . .
One cannot allow [the patient to sweat] like water flowing. The disease will not be
eliminated [this way] .” When sweating is promoted excessively, it damages both
yang φ and yin liquid. Leaking sweat means that the y缸g φ has been damaged,
and vacuous exterior yang on the one hand fails to check the fl.ow of sweat, and on
the other fails to warm and secure the exterior, so that there is aversion to wind.
These signs, when analyzed in the light of the formula, indicate y缸ig vacuity, but
difficult urination and slight tension of the sinews indicate that yin liquid has also
been damaged. However, although yin liquid is depleted, the treatment does not
address this directly. The treatment method is primarily that of supporting yang,
and secondarily resolving the exterior. This is because with the restoration of yang
qi and resolution of the exterior evil, the exterior will be secure, sweating will stop,
and yin liquid will be engendered. Once yin liquid is sufficient, the other signs will
resolve spontaneously. The formula, Cinnamon Twig Decoction Plus Aconite (gui
zM jia j边 zi' tang), is simply Cinnamon Twig Decoction (gui zhi tang) plus aconite
伽 利 , which can be used either raw or blast-fried. Raw, it returns yang and stems
counterflow. Blast-fried, it warms the channels and restores yang. In this formula,
blast-fried aconite (Ju zi') is used in order to secure the exterior and check sweating.
This addition to Cinnamon Twig Decoction (gui zhz tang ) elimi n a t es the evil and
returns y缸ig so that liquid and humor are spontaneously restored.
LINE 2 1
太 阳 病 , 下 之 后 , 脉促 , 胸 满 者 , 桂校 去 巧 药汤 主 之 。
Tai yang bing, xia zhi hiJU, mai cu, xiong man zhe, gui zhi qu shao
yao tang zhu zhi.
I n greater ya ng disease, when after preci pitati。n the pu lse is ski ppi ng*
and (there is] fu l l ness in t he chest, Ci n n a m。n Twig Dec。cti。n M i n us
Pe。ny (gui zhi qu shao yao tang) g。verns.
TEXT NOTE
*
Skipping, 脉 促 mai cu: Urgent and forceful. It does not here mean rapid and
periodically interrupted, 出 it does in modern texts. See the Introduction for
a further discussion of this issue.
FORMULA
Cinnamon Twig Decoction Minus Peony
(gui zhi qu sMo yao tang)
。 Resolve the fleshy exterior and expel wind; eliminate yin and free yang.
桂枝 三 两 ( 去 皮 )
(擎)
甘草二两 ( 炙 )
生姜三两 ( 切 )
大枣十二枚
86
1 . G REATER YANG [LINE 2 1 ]
付 右 四 昧 , 以 水 七 升 , 煮取三升 , 去淳 , 温服一升 。
枝 汤 , 今 去 苟 药 。 (三) 将 息 如 前 法 。
ω 本云 , 桂
Gui zhi san liang ( qu p i') gan cao er liang ( zhi) sheng jiang san liang ( qie)
da zao shi er mei ( bo)
(1) You si wei, yi shui q'i sheng, zhU qu s伽 she1矶 qu zi, wen JU yr sheng.
(2) Ben yun: gui zhi tang, jzn qu shao yao. (3) Jiang xz ro qian fa.
ci n n a mon twig (桂枝 gui zh豆 C i n n a momi Ram u l us) 3 liling ( remove bark)
m ix-fried licorice (甘 草 gan cao, G lycyrrhizae Radix) 2 liling
fresh ginger (生 姜 sheng jiang, Zingi beris Rhizoma Recens) 3 lil!ng (cut)
j uj u be ( 大 枣 da za o , Ziziphi Fructus) 12 pieces {broken)
(1) [For) the a bove fo u r ingred ients, use seven she咆 of water. Boil to get th ree
she鸣, remove the d regs and ta ke one sheng, warm. (2) T h is is Cinnamon Twig De­
coction (gui zhi tang) [after) removi ng peony (sM。 ”。) . (3) One should rest [as
descri bed) in the previous method [for C i n n a mon Twig Decoction (gui zhf tang)].
S YNOP S I S
The distinguishing features and treatment of a greater yang disease pattern, in
which, after the inappropriate use of precipitation, the exterior pattern is unresolved
and the chest yang is devitalized.
C OMMENTARY
In greater yang disease the appropriate treatment is exterior resolution, not
precipitation. Here, after precipitation, the pulse becomes skipping and fullness in
the chest is observed. We also know that Cinnamon Twig Decoction (gui zhi tang)
i s still used, but without peony ( shao yao ) . In general, when precipitation is used
in cases of an exterior evil, one expects that the evil will fall into the interior. The
following interpretations of this pathomechanism are given:
Che吨 Wti-Ji states, “In greater yang disease, [after] precipitation, [when] the
pulse is skipping and [there is] no chest bind, this means [the disease] is about to
resolve. Here, [after] precipitation, the p由e is skipping and also [there is] follness in
the chest. This means that [the disease] is not about to resolve. [In this ca叫 after
precipitation yang vacuity [exists] , the exterior evil gradually enters [the interior]
and [this] visiting [evil] is in the chest. Give Cinnamon Twig Decoction (gui zhf
tang) in order to dissipate the visiting evil and free the ya吨 qi. Peony ( shao yao)
boosts y函, and [when there is] y缸ig vacuity it is not appropriate, so it is removed.”
Ke Qin presents the view that “ [When] y缸g is exuberant, [the pulse may be]
skipping . . . . After precipitation, a pulse that is skipping, [accompanied by] ab­
sence of sweating, fullness in the chest and absence of panting, does not (indicate]
exuberant yang, [but indicates] a cold evil bound in the interior.”
In contrast, Chen Nian-Z诅 (陈 念 祖 , style 修 园 Xiu-Yuan) explains that fullness
in the chest represents qi stagnation in the chest.
Thus these three authors present three different interpretations: yang vacuity
with an evil falling into the chest , cold evil bound in the interior, and qi stagnation
in the chest. These commentators agree that in exterior diseases, since the right and
evil are in contention, the use of precipitation will cause right qi to be damaged and
1 . G REATER YANG [LINE 22]
87
evil φ to fall inward. After this, the transmutations and pathomechanisms can be
explained differently. The formula reveals several key points. The first is that this
is still considered an exterior condition, so Cinnamon Twig Decoction (gui zhf tang)
is used. The second is that the movement in the chest is impaired, so cinnamon
twig (gui zhf) , which warms the channels and frees ya吨, is used to open the chest
and resolve the chest fullness. Peony ( shao yao) is not used because not only does
it boost yin, but it also promotes contraction, and if used in this situation, would
prevent the evil from moving out of the chest.
LINE 22
若微寒者 , 桂校去巧药加 附子 汤 主 之 。
Rua wei han zhe, gui zhz qu shao yao jia JU zi tang zhu zhz.
When [the pu lse is] fa i nt a nd [there is aversion t。] c。Id , * C i n na m。n
Twig Dec。cti。n M i n us Peony P l us Aconite (gui zhz qu shao yao jia Ju
zi tang) governs.
TEXT NOTE
*
[ The pulse is ] faint and [there is aversion to] cold, 微 寒 wei han: For a discussion of the interpretation of this phrase, see the commentary below.
FORMULA
Cinnamon Twig Decoction Minus Peony Plus Aconite
tang)
o
(gui zhf qu shao yao jia Ju zi
Resolve the fleshy exterior and expel wind; warm the channels and restore
yang.
桂枝 三 两 ( 去 皮 )
甘草二两 ( 炙 ) 生姜三两 ( 切 )
(擎)
附子一枚 ( 炮 , 去皮 , 破 八 片 )
大 枣十 二 枚
付 右 五 昧 , 以 水 七 升 , 煮 取 三 升 , 去 j宰 , 温 服 一 升 。
枝 汤 , 今 去 巧 药 加 附 子 。 (三) 将 息 交日 前 法 。
仁) 本 云 , 桂
G创 zhf san liiing ( qu pi) g伽 ciio er liiing (zhi) sheng jiang s伽 liiing ( qie)
da ziio shi er mei ( bo) Ju zi yz mei (pao, qu pi, po ba pian)
(1) You WU wei, y i shui qz sheng, zhU qu s伽 sheng, qu z民 w en Ju yz sh臼g.
(2) Ben yun: gui zhr tang, jzn qu shao yao jia Ju zi. (3) Jiang xr ru qian fa.
cin namon twig (桂 枝 gui zhf, Ci『1『1a momi Ram 1山
mix-f1『ied licorice (甘 草 giin ciio, G lycyrrhizae Radix) 2 Ii昌『1g
fresh ginger (生 姜 sheng jiang, Zingiberis Rhizoma Recens) 3 Ii温ng (cut)
j uj u be ( 大 枣 da ziio, Ziziphi Fructus) 12 pieces (broken)
acon ite ( 附 子 Ju z瓦 Acon iti Tuber Late时e) 1 piece ( blast-fry, 陀move skin , brea k
into eight pieces)
88
1 . G REATER
y ANG
[LINE 22]
(1) [For] the a bove 币ve i n g redie n ts , use se ve n she吨 。f water. Boil to get three
she吨, remove the dregs a nd ta ke one she鸣, warm . (2) This is Cinnamon Twig De­
coction (gui zhτ tang) w i th the addition of aconite (j边 zi') a nd without peony ( sM。
”。) . (3) One shou l d rest [as desc巾ed] in the previous method [for Cinna mon Twig
Dec。ction (gui zhf ta叼)] .
SYNOPSIS
Continuing from the previous line, the treatment of a greater yang disease
pattern in which, after the inappropriate use of precipitation, the exterior pattern
is unresolved and chest yang is damaged.
COMMENTARY
The three characters that begin this line have generated a great deal of con址。
versy 缸nongst scholars. The phrase 若 微 寒 ruo wei Mn is literally taken to mean
“if [the patient ] is slightly cold,” i.e. , suffering from slight aversion to cold, and this
interpretation has been offered. Shen Ming-Zang (沈 明 宗 ) considers this line to be
a continuation of the previous line and writes, “If the pulse is skipping and [there
is] fullness in the chest and slight aversion to cold, this indicates vacuity and [the
yang qi] is hampered and about to desert . . . Remove peony ( sM。 ”。) and add
aconite (Ju zi') to protect and secure the true yang.”
Nevertheless, it is difficult to rationalize the use of aconite (JU zi') with a patient
whose only sign is mild aversion to cold. Chen Nian-Zu also makes a connection
between these two lines, but comes to a different conclusion based on the interpre­
tation of 微 寒 wei han as a pulse that is faint and aversion to cold: “After erroneous
precipitation in greater yang disease, the y缸g φ is debilitated and cannot move
inward or outward . . . if the pulse is not skipping, [b叫 is faint and [there is] aver­
sion to cold, it means yang vacuity is already extreme . . . [There is] fear that the
strength of cinnamon [ twig] and [fresh] ginger is [too] 皿ld and one must 础sist with
aconite (JU zi') .”
According to Chen Nian-Z毡, after erroneous precipitation of greater yang dis­
ease, the pulse is faint and aversion to cold and fullness in the chest are present,
indicating extreme vacuity of y缸g; therefore, aconite (Ju zi') is used. Comparing
Cinnamon Twig Decoction Minus Peony ( g u i zhf qu shao yao tang ) from the previ­
ous line with Cinnamon Twig Decoction Minus Peony Plus Aconite ( gui zhf qu shao
yao jia Ju zi' t伽g) in this line, one finds that although both formulae resolve the
fleshy exterior and dispel wind, the previous formula emph掘izes freeing the chest
yang, while the cuηent formula emphasizes restoring yang. The previous formula
is used when the chest yang is depressed and stagnant, while the current formula is
used when the y缸g qi is insufficient. A comparison of these two formulae illustrates
that a difference of even one ingredient can completely alter the main action of a
formula.
All three interpretations rest on the notion that the vacuity of y缸ig qi is severe,
even if 微 寒 wei han is taken to mean slight aversion to cold, since aconite (Ju zi') is
used. However, the authors of the Gao Deng Cong Shu believe that 微 寒 wei han
should be interpreted as “a pulse that is faint and aversion to cold,” and suggests
that the original may have read 脉 微 恶 寒 mai wei WU han.
l . G REATER YANG [LINE 62]
89
LINE 62
发 汗后 , 身疼痛 , 脉沉迟者 , 桂枝加苟药生姜各一两人 参 三
两新加 汤主 之 。
Fa han him, shen teng tong, m ai chen chi zhe, gui zhi jia shao yao
sheng jiang ge yi liang ren shen san liang xin jia tang zhu zhi.
When a仕er the promoti。n of sweati ng, [there is] genera lized pa i n , a nd
a pu lse that is su n ken a n d sl。w, C i n n a m。n Twig Decoction Newly S u p­
plemented with One Lia ng Each 。f Pe。ny a n d Fresh G i nger a nd Th ree
Liang 。f Gi nseng (gui zhi jia shao yao sheng jiang ge yi liang ren
shen san lia叼 xin jia tang) governs.
FORMULA
Cinnamon Twig Decoction Newly Supplemented with One Liang Each of Peony
and Fresh Ginger and Three Liang of Ginseng ( gui zhf jia sha。 ”。 sheng jiang ge
yf liiing ren shen san liiing xfn jia tang)
o
Harmonize construction and defense; boost qi and harmonize construction.
桂枝 三 两 ( 去 皮 )
苟药 四 两
二枚 ( 壁 )
生姜 四 两
甘草二两 ( 炙 )
人参三两
(寸 右 六 昧 , 以 水 - 斗 二 升 , 煮 取 三 升 , 去 淳 , 温 服 一 升 。
云 , 桂枝汤 , 今 加 苟药 、 生姜 、 人 参 。
大枣十
(斗 本
Gui zhf s伽 liiing ( qu pf) shao yao si liiing g伽 ciio er liiing ( zhi) ren shen
san liiing da ziio shi er mei ( bδ) she叼 jia叼 si liiing ( qi e)
(1) You liu wei, yi shui yf dδu er sheng, zhU qu s伽 sheng, qu zi, wen JU yf
sheng. (2) Ben yun: gui zhf tang, j如 jia shao yao、 sheng jiang、 ren shen.
ci nna mon twig ( 桂 枝 gui zh豆 C i n n a momi Ram1』l us) 3 li3ng ( remove bark)
peony (巧 药 ska。 ”。, Paeoniae Radix) 4 li3ng
mix-fried licorice (甘 草 gan cao, G lycyrrh izae Radix) 2 li3ng
gi nseng (人 参 ren sh旬, Ginseng Rad ix) 3 li3ng
j uj u be ( 大 枣 da zii.o, Ziziphi Fructus) 1 2 pieces {broken)
fresh gi nger (生 姜 sheng jiang, Zingiberis Rh izom a Recens) 4 Ii温ng (cut)
(1) [For] the a bove six i ngredients U现 one d�u a nd two sheng of water. Boil to get
th ree sheng, 陀move the d regs and take one she吨, warm. (2) This is Cinnamon Twig
Decoction (gui zhf tang) with extra peony ( shcio yao ) , fresh ginger ( sheng jiang ) . a nd
gi nseng (ren shen) .
SYNOPSIS
The distinguishing features and treatment of generalized pain that is the result
of damage to the qi and construction, following the issuing of sweat.
90
1 . GREATER YANG
COMMENTARY
This apparently simple line conveys important information about disease trans­
mutation and treatment . Generalized pain is a primary sign of exterior diseases,
which are generally resolved through the promotion of sweating. Here, sweating
has been promoted, but the generalized pain is still present, suggesting that this
sign no longer simply indicates exterior disease. It means that the construction
qi has been damaged through the promotion of sweating and is unable to nourish
the sinews. Furthermore, the pulse has changed and is no longer floating. A pulse
that is sunken and slow here indicates insufficiency of qi and blood. By analyzing
the formula, the signs, and the pulse, one can infer that sweating was promoted
excessively and both yang qi and yin humor have been damaged. The construction
and defense are in disharmony, the exterior disease has not resolved and the y缸g
ql and yin humor are insufficient.
This pattern is simultaneous exterior-interior dise槌e, but the internal damage
is more severe than the exterior evil, so treatment involves supporting right and
dispelling evil simultaneously, with emphasis on the former, using Cinnamon Twig
Decoction Newly Supplemented with One Li总且g Each of Peony and Fresh Ginger
and Three Lia吨 of Ginseng (gui zhf jia shao yao sh臼g jiang ge yr liiing ren shen
san liii ng xrn jia tang) . This formula is Cinnamon Twig Decoction (gui zhf tang)
with ginseng ( ren shen). Ginseng (ren shen) supplements the φ and engenders
fluids. It supports right ql so that harmony may be restored and is often used
when excessive sweating has damaged the yang qi and yin humor. Cinnamon Twig
Decoction (gui zhr tang) restores harmony to the defense and construction, mildly
promotes sweating, and will resolve the exterior disease. A larger dose of peony
(sha。 ”。) is used to supplement the damaged y画 and nourish blood. Fresh ginger
( sheng jiang) is also used in a larger dose to diffuse and free the y缸g φ.
3 . 2 C OLD DAMAGE EXTERIOR REPLETION PATTERNS
The primary signs and pulse of cold damage exterior repletion are heat effusion
( which m叮 or m町 not be present in the early stages of the illneE叫 , aversion to
cold, generalized pain, absence of sweating, panting, and a pulse that is floating and
tight . In the Shang Han Lim these patterns are referred to simply as cold damage.
The distinguishing feature of the pathomechanism of cold damage is that a
cold evil fetters the exterior, blocking the defense and depressing the construction.
Obstruction of the defense yang causes aversion to cold and the struggle between
defense yan g and exterior evil caus臼 beat effusion; therefore, it is common for
these two signs to occur simultaneously. When heat effusion does not occur, it
is a sign that defense yang has been severely obstructed and cannot yet struggle
with the cold evil. This is tempor町y and should quickly give way to heat effusion.
It should be noted that aversion to cold and aversion to wind 缸e not criteria for
differentiating wind strike and cold damage. These two signs differ primarily in
degree of severity, with aversion to cold being more severe, and can both appe缸
in either of the patterns. When defense y缸g is blocked and construction-yin is
depressed, the sinews and bones are not warmed and moistened; consequently, the
patient experiences generalized and joint pain. The interstices are blocked by the
cold evil and no sweat can issue. When right qi rises to the exterior to combat
1 . G REATER YANG (LINE 35]
91
the evil, the pulse becomes floating and tight. Because the lungs are in charge
of breathing and the opening and closing of the interstices, when an evil fetters
the exterior, the interstices are unable to diffuse properly and the lung qi becomes
inhibited, giving rise to panting. In cold damage, the interstices of the flesh 町e
blocked, there is absence of sweating, and right qi is relat i vely strong; th ere fore ,
this pattern is also called an “exterior repletion pattern.” In greater y缸ig exterior
repletion pattern日, treatment focuses on the promotion of sweating in order to
open the interstices of the flesh, and Eph edra Decoction (ma huang tang ) is the
representative formula.
3.2.l
Ephedra Decoction Pattern
This section describes the characteristic signs of Ephedra Decoction ( ma huang
tang) patterns. The main signs are aversion to wind and cold, heat effusion, stiffness
and pain of the head and nape, generalized pain, lumbar pain, joint pain, absence
of sweating, a floating tight or floating rapid pulse, and possibly panting or retching
counterflow. In these patterns, right ql is generally strong and able to contend with
the evil. After contraction of an external wind-cold evi l that fetters the exterior,
the defensive yang is restrained, the construction-yin is depressed and stagnant, the
channel ql is inhibited, and right ql contends with evil ql. The evil may interfere
with the lungs and stomach. The treatment method is to resolve the exterior with
acridity and warmth, promote sweating, diffuse the lung, and stabilize panting. The
main formula is Ephedra Decoction (ma huang tang).
Ephedra Decoction (ma huang tang) is appropriate fo r the treatment o f the
following conditions:
a) enduring greater yang cold damage with unresolved exterior repletion;
b ) greater y归g cold damage in which sweating has not yet been promoted and
部 a result nosebleed occurs and the exterior signs are still present; and
c ) greater y归g and y缸g brightness combination disease in which the greater
yang signs 缸e more severe, with panting and chest fullness as the main
manifestations.
LINE 35
太 阳 病 , 头痛 发 热 , 身 疼腰痛 ,
骨节疼痛 , 恶风 , 无汗而喘
者 , 麻黄汤主之。
Tai yang bing, t6u tong fa re, shen teng yao tong, gu jie teng t o ng,
WU Jeng, WU han er chuan zhe, ma huang tang zhu zhi.
When i n greater ya ng disease [there is] headache, heat effusion , gen­
eral ized pa i n , * l u m ba r pai n , j。i nt pai n , aversion to wi n d , a bsence of
sweati ng, a n d pa nti ng, Ephed ra Decocti。n ( ma h叫ng tang) g。verns.
TEXT NOTE
*
Generalized pain, 身 疼 s hen teng: This term can mean the whole body or only
the trunk. The translation “generalized pain" is intended to cover both these
ideas. Terms like “body pain" seem to suggest the trunk, 副 opposed to the
1 . G REATER YANG ( LINE 35]
92
limbs. Clearly, in some cases, a distinction can be drawn between different
body are也. Unfortunately, this is often unclear and 身 shen may include the
limbs.
FORMULA
Ephedra Decoction
(ma huang tang)
o Pro mo te s weatin g with acridity and warmth; diffuse the l ung and stabilize
panting.
麻黄三两 ( 去节 )
个 ( 去皮尖 )
桂枝二 两 ( 去皮 )
甘草一两 ( 炙 )
杏仁七 十
付 右 四 昧 , 以 水 九 升 , 先 煮麻 黄 , 减 二 升 , 去上沫 , 内 诸药 , 煮
取 二 升 半 , 去 淳 , 温 服 八 合 。 。 覆 取 微 似 汗 , 不 须 歌 粥 。 (三) 余 如 桂
枝法将息 。
Ma huang siin liiin g ( qu jie) gui zhf er liang (qu p {) giin cifo yf liang (zhi)
xing ren qf shi ge ( qu pi jiiin)
(1) You si wei, yz shuz jiu sheng, xiiin zhii. ma huang, jian er sheng, qu shang
mo, na zhu yao, zhii. qii. er sheng ban, qu zz, wen JU bii ge. (2) Fu qii. wei si han, bu
xii chuo zhou. (3) Yu 叫 gui zhf fa jiiing xi.
ephed ra (麻 黄 ma huang, Ephed rae He阳) 3 li�ng ( remove nodes*)
ci n na mon twig (桂 枝 gui zh豆 C i n n a momi Ram u l us) 2 li�ng ( remove bark)
m ix-fried licorice (甘 草 giin cao, Glycyrrhizae Radix) 1 li�ng
a p ri cot kernel (杏 仁 xing ren, Armeniacae Semen) 70 pieces (remove skin and tips)
(1) [For] the a b ove four ingredients use n i ne sh否ng of water. Fi rst boil ephed ra (ma
huang) to red uce [the water] by two she鸣. Remove the foa m [collecting] on top a nd
add a l l the i ngred ients. Boil to get two a n d a half sheng, remove the d regs a nd take
eight g运 wa rm. (2) Cover [with bedclothes] to obtai n m ild sweating. It is not necessa叩
to eat rice gruel [with the decoction] . (3) [One shou ld] rest a n d [follow] the remainder
of the d i rections as for C i n n a mon Twig Decoction (gui zhf t伽g) .
FORMULA N OTE
Ephedra ( ma huang): According to the traditional understanding, for which
laboratory tests have found no supporting evidence, the nodes of ephedra ( m
ht
used to promote sweating. The foam produced when ephedra (ma huang)
boiled is traditionally removed because it is thought to cause vexation.
is
SYNOPSIS
The distinguishing features and treatment of greater yang cold damage patterns.
COMMENTARY
This line discusses greater ya且g cold damage. Although the term “cold damage"
does not appear in the text, we know that this is cold damage because Ephedra
Decoction (ma huang tang) is suggested. From this line and lines 1 and 3, the signs
of greater y归g cold damage are seen to include heat effusion or as yet no heat
effusion, aversion to wind or cold, absence of sweating, and headache, as well as
1 . GREATER YANG [LINE 5 1]
93
pain and stiffness in the back of the neck, generalized pain, lumbar pain, joint pain,
panting, and a pulse that is floating and tight. Of all these, the key sign is absence
of sweating since, by indicating exterior repletion, it is the chief sign differentiating
greater yang cold damage from greater y缸g wind strike. Sweating fails to occur
when evil φ is strong and the patient’s right φ is also strong. The right and
evil ql contend and right qi cannot push out evil qi, which becomes lodged in the
exterior and obstructs the outward movement of sweat. Headache, and pain and
stiffness in the back of the neck, generalized pain, lumbar pain, and joint pain, occur
when the evil, which is lodged in the exterior, inhibits the greater y缸g channel ql.
Panting occurs when the evil interferes with the lung, impairing lung diffusion and
downbearing.
The basic pulse of greater y缸g cold damage is tight and floating. However,
this pulse is not generally considered absolutely essential for the identification of
cold damage, and, in fact, it is not mentioned in this line. The following two lines
describe patterns treated with Ephedra Decoction (ma huang tang), in which the
pulse is floating but not tight .
Ephedra Decoction ( ma huang tang) contains acrid, warm ephedra ( ma huang ) ,
which promotes sweating, diffuses the lung, and stabilizes panting. Cinnamon twig
(gui zhf) resolves and dissipates wind and cold and assists ephedra ( ma huang)
in the promotion of sweating. Apricot kernel (xing ren) diffuses and downbears
lung ql, thereby increasing the panting-stabilizing strength of ephedra (ma huang ) .
Licorice (gan cii.o) harmonizes all the ingredients. Two aspects of the preparation
method illustrate important points. Ephedra (ma huang) is cooked for a long time,
moderating its ability to promote sweating and aiding in the prevention of excess
sweating. The patient is not advised to eat rice gruel with the formula, although
he / she is still advised to cover up with bedclothes. By contrast, Cinnamon Twig
Decoction (gui zhf tang) is designed for patients with weakness in construction
and strength in defense; therefore eating rice gruel helps the formula to produce
sweating, to boost the source of sweat, and to prevent excessive damage to right.
In patients taking Ephedra Decoction (ma huang tang) defense φ is obstructed,
construction-yin is depressed, and right is struggling with evil; there is no weakness
in construction and therefore supplementation with rice gruel is unnecessary. Note
that even in repletion patients, one can still damage the y缸g qi by promoting
sweating too harshly.
This line speaks not of “aversion to cold,” which one would expect in a pattern
treated with Ephedra Decoction (ma huang tang), but o f “aversion t o wind" ( see
line 2, p. 41) .
LINE 5 1
脉浮者 , 病在表 , 可发汗 , 宜麻黄汤 。
Mai Ju zhe, bing zai biao, ke fa han, yi ma huang tang.
When the pu lse is floati ng, the disease is i n the exterior, [a nd if] one ca n
prom。te sweati ng, Ephed ra Dec。ction ( ma h侃ng tang ) is a ppropriate.
94
l . GREATER YANG [LINE 52]
SYNOPSIS
Using the pulse to represent the pattern, when disease is in the greater yang
and the promotion of sweating is appropriate, one can choose Ephedra Decoction
(ma huang tang).
COMMENTARY
A pulse that is floating 田 an indication of exterior disease is one that can
be easily felt with light pressure and that is felt less distinctly, but not empty,
when heavy pressure is applied. A pulse that is floating may also occur in internal
damage miscellaneous disease manifesting in vacuity patterns, but in such cases, it
feels empty when heavy pressure is applied.
This line tells us that a pulse that is floating indicates disease of the exterior,
which is treated by promoting sweating with Ephedra Decoction (ma huang tang) .
From our understanding of other lines of the Shang Han Lim , however, we know
that not all exterior patterns are treated by promoting sweating with this formula.
Ephedra Decoction (ma huang tang) is only used for greater y缸g cold damage,
which is characterized by absence of sweating with other greater yang signs and
usually a pulse that is floating and tight. As Cheng Ylng-Mao 8町s, “If [there is]
absence of sweating, sweating can be promoted, and Ephedra Decoction (ma huang
tang) is 叩propriate.”
For more information about Ephedra Decoction (ma huang tang) pattern, see
line 3, p. 44, and line 35, p. 9 1 .
LINE 52
脉浮而数者 , 可发汗 , 宜麻黄汤 。
Mai Ju er shuo zhe, ke fa han, yi ma huang tang.
When the pu lse is floati ng a n d ra pid , [if] one ca n pr。m。te sweating,
Ephed ra Decoction ( ma huang tang) is a ppropriate.
SYNOPSIS
In a greater yang cold damage pattern, when the pulse is floating and rapid, it
is still appropriate to use Ephedra Decoction (ma huang tang).
COMMENTARY
This line is similar in structure to the previous line, describing an Ephedra
Decoction ( ma huang tang) pattern with very little detail. However, unlike the
previous line, it describes a specific pulse condition-floating and rapid. Because
Ephedra Decoction (ma huang tang) is prescribed, we conclude that this is greater
y缸g cold damage. In cold damage, a pulse that is floating and rapid is not nor­
mally expected. However, heat effusion can occur in cold damage, and when the
body temperature rises, the pulse can become rapid. Thus, this line appears to be
pointing out that a pulse that is floating and rapid may be observed in greater yang
cold damage. One must not be misled by only observing the pulse description that
this is wind-warmth or a heat pattern; one should evaluate the signs as a whole.
1 . GREATER YANG [LINE 3 7]
95
LINE 37
付 太 阳 病 , 十 日 以 去 , 脉 浮 细 而 嗜 卧 者 , 外 已 解 也 。 (斗 设
胸满胁痛者 , 与 小 柴胡汤 ; 脉但浮者 , 与麻黄汤 。
( 1 ) Tai yang bing, shi ri yi qu, mai Ju xi er shi WO zhe, wai yi jie
ye. (2) She xiong man xie tOng zhe, yu xiao chai hu tang; mai dim
Ju zhe, yii ma huang tang.
( 1 ) When i n greater ya ng d isease, 拍er ten d ays h ave passed , the pu lse
is fl。ati ng a n d fi ne, a nd [there is] s。『n nolence, * the outer body has
a l ready resolved . (2) If [there i 斗 fu l l ness i n the chest a nd ri b-side pai n ,
give M i nor Bu pleu ru m Decoction (xiao chai hu tang) ; i f the pu lse is
floati ng only, give Ephed ra Decoction ( ma huang tang ) .
TEXT NOTE
*
Somnolence, 嗜 卧 shi wo: The Chinese term literally means “to like sleeping.”
In this context, the implication is that the patient tends to rest quietly and
sleep, in order to regain his physical strength.
SYNOPSIS
Three possible scenarios that can occur in a patient with enduring greater yang
disease.
COMMENTARY
When a greater yang disease has lasted for ten days or more and signs of exterior
repletion are still observed, Ephedra Decoction (ma huang tang) is still appropriate.
In this line, a pulse that is described as “only floating” indicates an exterior repletion
pattern, as in line 5 1 , p. 93; This line emphasizes that no matter how long the
disease has lasted, one can still use Ephedra Decoction (ma ht
pattern has not changed, the treatment need not change. Only when the pattern
has changed must one adjust the treatment accordingly.
Three developments are described in this line. In the 且rst, which is described
above, the exterior repletion pattern is still present.
The second is that the patient, after ten days or more of a greater yang disease,
has a tendency to sleep. This sign indicates recovery and should not be interpreted
as a sign of vacuity. Because Zhang JI states that the exterior has resolved, we
know that somnolence, here, indicates the evil has been eliminated, and right qi
is not struggling with the evil any longer but has not yet been restored. In this
situation, the patient tends to sleep in order to regain his or her strength. Whenever
somnolence appears, one must investigate the pulse and all signs, since it does not
necessarily mean that the patient is recovering. (See, for example, desire only to
sleep as a manifestation of yang vacuity in lesser yin disease, line 282, p. 471 . )
A pulse that is floating and 且ne accords with this, since a pulse that is floating
indicates that the evil has not entered the interior, and a pulse that is fine means
that evil φ has abated, but right qi has not yet been restored.
96
1 . GREATER YANG [LINE 46)
The third development is that the evil has shifted into the lesser y缸g. This
transmutation is indicated by the presence of fullness in the chest and rib-side pain.
Minor B叩leurum Decoction (xiao ch ai hu tang ) constitutes appropriate treatment.
The pulse and accompanying signs should be considered, but one need not see all of
the lesser yang signs to conclude that it is a lesser yang disease. See line 96, p. 410,
for a complete discussion of Minor Bupleurum Decoction ( xiao chdi hu tang ) .
LINE 46
卜) 太 阳 病 , 脉 浮 紧 , 无 汗 发 热 , 身 疼 痛 , 八 丸 日 不 解 , 表 证
仍在 , 此 当 发其汗。
者必陋 , 阻乃 解 。
ω 服药已 , 微除 , 其人发烦 目 惧 , 剧
(斗 所 以 然 者 , 阳 气 重 故 也 。
侧 麻黄汤主
之。
( 1 ) Tai yang bing, mai Ju j仇, wu han fa 时, shen teng tang, ba jiu
ri bu jie, biiio zh切g reng zai, ci dang fa qi han. ( 2) Fu yao 以 wei
chu, qi ren fa fan mu m加g, ju zhe bi n击, n?i niii jie. (3) Suo yi ran
zhe, yang qi zhong gu ye. ( 4) Ma huang tang zhu zhr.
( 1 ) I n greater ya ng d i sease, when a pu lse that is floati ng a n d tight,
a bsence of sweating, heat effusion , a nd genera l ized pa i n a re u n resolved
after eight or n i ne d ays, the exteri。r pattern is sti l l present a n d 。ne
sh。uld prom。te sweati ng. (2) ( A仕er ta ki ng med icine, [the cond ition ]
is sl ightly relieved , a nd the person is vexed a nd the eyes a re heavy. 1
If it is acute, there wil l be sponta neous externa l bleed i ng, 2 which wil l
bri ng a bout resol ution . (3) Why [t h is] i s so i s beca use the ya ng qi is
weighted .3 ) (4) Ephed ra Decoction ( ma h侃叼 ta叼) governs.4
TEXT NOTES
1. Heavy eyes, 目 膜 mu ming : A tendency to close the eyes and a reluctance to
open them, with aversion to the stimulation of strong light. 膜 means to close
the eyes.
2 . Spontaneous external bleeding, ’IH nli: Bleeding from the nose, ears, flesh,
gums, tongue, or breast not due to injury. Often, as here, it speci且cally denotes
nosebleed, the most common form of this sign.
3. Yang φ is weighted: 阳 气 重 yang qi zhOng: Different interpretations of this
term are offered. The yang qi can be interpreted as either the patient’s yang
qi or a yang evil φ.
a) A severe evil qi in yang. You Yi states, “In severe [patterns] , the blood
contends with the heat [ and] the dynamic must cause spontaneous external
bleeding . . . . This is because the yang φ is too heavy [and] the construction
and defense are both replete . . . . Yang ql means an evil qi in y缸g.”
1.
GREATER YANG (LINE 46]
97
b ) An exuberant heat evil. Cheng Wu-Ji states, “In severe [patterns] , [there
is] exuberant heat in the channels . . . . 'The y缸g φ is weighted’ means that
the heat qi is weighted . . . .”
。 Severe depression and obstruction of the yang φ. Huang Yu缸-Y也 (黄 元
御 ) states, “This is because in enduring illness that fails to resolve, the
depression and obstruction of the y缸g φ is very heavy.”
4. Ephedra Decoction governs, 麻 黄 汤 主 之 ma huang tang zhU zhf: Zhang Jian­
Shan ( 张 兼 善 ) writes that the phrase, “Ephedra Decoction ( ma huang tang)
governs” should be placed directly after "one should promote sweating.”
SYNOPSIS
A supplementary discussion of the primary pulse in greater y缸g cold damage
patterns and possible reactions that may appear following the ingestion of Ephedra
Decoction (ma hua叼 tang) .
COMMENTARY
The reader is presented with the signs of a typical case of cold damage exterior
repletion. The only remarkable feature is that the disease has continued for a
protracted period of time. Because of thi s fact, a more complicated picture emerges.
Y6u Yf writes:
A pulse that is floating and tight, absence of sweating, heat effusion,
and generalized pain [indicate] a greater yang Ephedra Decoction (ma huang
tang) pattern. For eight or nine days, there has been no resolution, the
exterior signs are still present and Ephedra Decoction ( ma hua叼 tang) is
still appropriate. In the treatment of cold damage, one cannot be restricted
by the number of days. If there 缸e exterior signs and a floating pulse, even
though it has been ma町 days, [the promotion of] sweating h 叩propriate.
Although the medicinals have been taken and the disease has been partially
eliminated, the patient experiences vexation and heavy eyes. [This means]
the evil in the defense has been eliminated and the heat in the construction
has not yet been eliminated. In severe (patterns] , the blood contends with
th e heat and this dynamic results in spontaneous external bleeding. [After]
bleeding, the heat in the construction is eliminated and the disease resolves.
It is so because the yang ql is too heavy. The construction and defense are
both replete, so there must be outward movement of both blood and sweat ,
followed by the resolution o f evil ql. “Yang ql” means a n evil ql i n yang
aspect.
According to this interpretation, enduring illness results in depression of a y缸ig
evil which, in severe cases, is only fully resolved through the outward movement of
both sweat and blood. Cheng Wu-Ji, however, presents another possibility:
A pulse that is floating and tight, absence of sweating, heat effusion, and
generalized pain [indicates] greater yang cold damage. Even though it has
been eight or nine days, the exterior signs 缸e still present. One should prφ
mote sweating. [The patient] has taken warm, moderate, effusing medicinals
and although there has been no great sweating, [the d画ease] h回 been p缸-
tially eliminated. Vexation means generalized heat. Evil ql, not resolved
1 . G REATER YANG [LINE 47)
98
through sweating, becomes depressed and transmutes into heat. It steams
the channels and network vessels, effusing in the fleshy exterior and engen­
dering heat vexation. The liver receives the blood; hence [there 总l vision. At
the start , the [evil] qi damages the construction, and as the cold transmutes
into heat, it contends with the blood, and liver φ becomes disorderly; conse­
quently, the eyes are heavy. In severe [cases] , [there is] exuberant heat in the
channels, causing 仕enetic movement of the blood, which means spontaneous
external bleeding. [Aft叫 [there is] bleeding then the heat follows the blood
and dissipates and [the disease] resolves. “The yang qi is weighted" means
that the heat φ is weighted. Give E�hedra Decoction (ma huang tang ) to re­
solve the evil previously [mentioned in the c嗣e of] greater yang cold damage.
These two authors present two pathomechanisms that are fairly similar. The
basic ideas can be summarized as follows. To treat this disease, Ephedra Decoc­
tion ( ma huang tang) is the appropriate formula. Nevertheless, because this is an
enduring disease, after the formula is given, there are two possible outcomes. The
first is that the disease is partially eliminated, but the exterior evil is blocked and
depressed. In the opinion of Cheng Wu-Ji, the evil is depressed in the fleshy exterior
and the channels, whereas Y6u Yi explains it 副 being depressed in the construe­
tion. Vexation and heavy eyes are indications of this depressed evil. In severe c描es,
the heat contends with the blood and causes frenetic movement and spontaneous
external bleeding. The heat follows the blood out and the disease resolves.
While in the first two interpretations, “yang qi is weighted" refers to the preva­
lence of evil qi, a contrasting idea is offered by Huang Yuan-Yu, who interprets it in
terms of the yang qi of the body. In enduring illness, the yang qi becomes depressed
or “weighted” and is unable to outthrust evil qi.
LINE 47
太阳病 , 脉浮紧 , 发热 , 身无汗 ,
自 烟者愈 。
Tai yang bing, mai Ju fin, fa re, shen WU han, zi nu zhe yu.
When i n greater ya ng disease, the p u lse is floati ng a n d tight, [ and there
is] heat effusion a nd a bsence of sweati鸣, sponta neous externa l bleed i ng
wi l l bri ng a bout rec。very.
SYNOPSIS
The mechanism of recovery through spontaneous external bleeding in greater
y缸g cold damage patterns.
C OMMENTARY
In greater yang disease, a pulse that is floating and tight and absence of sweating
indicate cold damage exterior repletion. Both evil qi and right qi 缸e strong and
the contention between them results in heat effusion. In such cases, the evil may
become depressed in the exterior and transform into heat. The heat damages the
blood network vessels and may cause spontaneous bleeding. If it does, the heat will
follow the blood out and the disease will resolve.
1 . G REATER YANG [LINE 36]
99
Like the previous line, this line describes the resolution of disease by sponta­
neous external bleeding. In this line, bleeding is due to failure to apply treatment
in time, whereas in the previous line it occurs after taking Ephedra Decoction (ma
huang tang ) .
LINE 55
伤 寒 脉 浮紧 , 不 发 汗 , 因 致阻者 , 麻 黄 汤 主 之 。
Shang han mai Ju fin, bu Ja han, yfn zhi nu zhe, ma huang tang zhu
zhr.
When , i n c。Id d a mage with pu lse that is floati n g a nd tight, sweati ng
is n。t prom。ted a nd t h is gives rise t。 Sp。nta ne。us externa l bleed i ng,
Ephed ra Decocti。n ( ma h侃”g tang) g。vern
SYNOPSIS
If sweating is not promoted in a greater yang cold damage pattern and, as a
result, there is spontaneous external bleeding, one must still promote sweating to
resolve the exterior and should use Ephedra Decoction ( ma huang tang ) .
COMMENTARY
This line is similar to line 47, p. 98, in that it refers to greater y缸g cold
damage in which failure to apply treatment in time causes spontaneous external
bleeding. In this line, the disease does not resolve after bleeding occurs and it is
necessary to treat with Ephedra Decoction ( m a huang tang ) . The pathomechanism
of spontaneous external bleeding in these two lines is the same.
LINE 36
太阳与阳明合病 , 喘而胸满者 , 不 可下 , 宜麻黄汤 。
Tai yang yu yang m伽g he bing, chuan er xiδng man zhe, bu ke xia,
yi ma huang tang.
When i n greater ya ng a nd ya ng brightness com bi n ation d isease* (there
is] pa nting a n d fu l l n ess i n the chest, [。ne] ca n not use preci pitati。 n , [but
instead] Ephed ra Dec。ction ( ma huang tang) is a ppropriate.
TEXT NOTE
Combination disease, 合 病 he bing: In combination disease, signs of two or
three channels appear at the same time. The Shang Han Um describes co皿-
bination disease of the greater y缸g and yang brightness, greater y缸g and
lesser M吨, and y缸g brightness and lesser y缸g. Combination disease should
be differentiated from dragover disease, 并 病 bing bing, in which the signs of
one channel have not yet ceased and signs of another channel appear. Dragover
1 . GREATER YANG [LINE 83]
100
disease occurs in greater yang and yang brightness and greater y但g and lesser
yang disease.
SYNOPSIS
In greater y缸ig and yang brightness combination disease, when greater y缸g
disease is primary, the appropriate treatment method 扭 曲st to resolve the exterior.
C OMMENTARY
The description of this pattern as a combination disease implies that signs of
both greater yang and yang brightness disease are present, even though these are
not explicitly stated. However, by mentioning only panting and fullness in the chest,
the text suggests that these are focal signs in this particular case, indicating that the
exterior has been fettered by cold evil and the lung qi is obstructed. Although this is
combination dise挝、 the main signs involve the lung; therefore the exterior disease
is more urgent than the interior. Precipitation, which would be appropriate if the
y缸ig brightness interior repletion were urgent, is contraindicated. The promotion
of sweating is the correct treatment and Ephedra Decoction (ma huang tang) is
suggested, indicating that the main pattern is greater y缸g cold damage. When
there are primary a且d secondary patterns, the primary pattern should be treated
before the secondary one. In this case, the primary and secondary patterns are
quite distinct, so that the principle of “treating the exterior before the interior" can
be applied without any reservation. Precipitation would only be used 且rst if the
y缸g brightness disease were more urgent than the greater yang disease. See line
35, p. 9 1 , for a complete discussion of Ephedra Decoction ( ma huang tang).
3.2.2
Contraindications for Ephedra Decoction
This section describes the contraindications for Ephedra Decoction (ma huang
tang ) . This formula is cm山aindicated in the following conditions:
a)
b)
c)
d)
LINE
debilitation of fluids and vacuity of blood;
insufficie配y of fluids and lower burner heat;
debilitation of the qi and blood; and
yang φ vacuity or y归g vacuity and yin damage.
83
咽喉干燥者 , 不 可发 汗 。
Yan h6u gan zao zhe, bu ke fa han.
When the t h roat is d ry, [。ne] ca n not promote sweati ng.
SYNOPSIS
This line points out that the promotion of sweating is contraindicated in insuf­
且ciency of yin liquid, as manifest in a dry throat.
C OMMENTARY
When the throat is dry, yin liquid is insufficient and failing to bear upward to
nourish and moisten the throat. Because the promotion of sweating would further
1 . GREATER YANG [LINE 84]
101
deplete yin liquid, the promotion of sweating is contraindicated. This line should
not be taken to mean that the promotion of sweating is contraindicated only in
C出es of dry throat. In wind-cold exterior patterns, whenever signs of yin liquid
insufficiency are observed, acrid, warm exterior-resolving formulae should not be
used unless they are modified so as not to damage yin further.
LINE 84
淋家 , 不 可发汗 ,
发汗必便血 。
Lin jia, bu ke fa him, fa him bi bian xue.
[With] stra ngu ry patients , 1 one ca n not prom。te sweati ng [beca use if]
sweati ng is prom。ted there wi l l be bl。。dy excretions. 2
TEXT NOTES
1. Strangury patients, 淋 家 1如 jia: Patients who have a history of or frequently
suffer from strangury ( frequent, painful urinati
2. Bloody excretions ’ 便 血 biaη Xt』e : The term 便 血 bian xue has, in modern
usage, come to be almost synonymous with bloody stool, but in the Shang
Han Um this is not the case, and in this line, “bloody urine" is the accepted
interpretation. 小 便 xiiio bian, literally “lesser convenience,” means urine or
urination; 大 便 da bian , literally “greater convenience,” means stool. 便 bian
by itself can be interpreted as either urine or stool, depending on the context;
we use the term “excretions” here to cover both possibilities. ( See line 293,
p. 513, for another example of 便 血 bian xue 副 “bloody urine” and line 339,
p. 544, for the only example in the Shang Han Lim where 便 血 bian xue refers
to “bloody stool.” )
SYNOPSIS
Using strangury patients as an example, this line points out that when yin
is depleted and heat a皿asses in the lower burner ' the promotion of sweating is
contraindicated.
COMMENTARY
This line suggests that care should be taken in treating patients for external
contractions when they suffer from enduring and abiding diseases. Whereas a pa­
tient who presents with greater y缸g cold da皿age signs accompanied by internal
heat signs is usually treated according to the principle of first resolving the exterior
and then treating the interior, patients with enduring disease cannot be treated the
same way; both the internal contraction and the enduring disease have to be c町e­
fully considered. Strangury patients, who suffer from frequent, painful urination,
often have depletion of yin liquid and heat amassed in the lower burner. Even in
greater yang cold damage, one must not apply the method of promoting sweating
with warmth and acridity, since it will cause further damage to yin liquid that will
exacerbate the evil heat, thereby causing bloody urine. Formulae given for exterior
resolution in strangury patients or patients with yin depletion and lower burner
heat amassment must be modified to safegu町d yin.
1. GREATER yANG [LINE 86]
102
LINE 85
疮家 , 虽 身 疼痛 ,
不可发汗 , 汗 出 则座 。
Chuang jia, suz shen teng tOng, bu ke fa him, him chu ze ci.
[With] sores patients , 1 a lthough they have genera lized pa i n , [。ne] ca n­
n。t promote sweating; if they sweat, there wi l l be teta ny.2
TEXT N OTES
1 . Sores patients, 疮 家 chuang jia: Patients with a history of sores on the body,
typically over an extended period of time.
2. Tetany, 撞 ci, ce : Severe spasm or convulsion as observed in lockjaw. 在 ci,
ce is a synonym of 庄 jing .
SYNOPSIS
Using sores patients 础 an example, this line points out that when both qi and
blood are vacuous, although there is an exterior pattern, the promotion of sweating
is contraindicated.
COMMENTARY
Patients with a long history of body sores are considered to have dual vacuity of
ql and blood. When they suffer a new contraction of externally contracted disease,
the promotion of sweating with warmth and acridity will further damage both the
yang qi and the yin blood, and since this constitutes the error of “evacuating vacu­
ity” (虚 虚 而 而, i.e. , exacerbating vacuity) , such a treatment is contraindicated.
If promotion of sweating with warmth and acridity is applied in sores patients or
other patients suffering from dual vacuity of qi and blood, it will wear yang qi and
further damage construction-blood, so that qi will be unable to warm and nourish
the channels and the blood will be unable to moisten the sinews, resulting in tetany.
LINE
86
血E 家 , 不 可 发 汗 ,
汗 出 必额上 陷脉急 紧 , 直视不能胸 , 不得
眠。
Nu jia, bu ke fa han, han chu bi e shang xian mai ji fin, zhi shi bu
neng xuan, bu de mian.
[With] sponta neous extern a I bleed i ng patients, 1 。ne ca n not prom。te
sweati ng; [if] sweat issues, the pu lse in the depressi。ns of the forehead
wi l l be tense a nd tight,2 [the eyes wi l l] be stari ng straight a nd u n a ble
to m。ve , a nd there wil l be i n a bility t。 sleep.
TEXT NOTES
1. Spontaneous external bleeding patients, ’E 家 n il jia: Patients with a history
of bleeding not due to any physical damage. The most common form of spon-
1 . GREATER YANG [LINE 86]
2.
103
taneous external bleeding is nosebleed and, in this context, it is taken to refer
specifically to nosebleed.
The pulse in the depressions of the forehead will be tense and tight, 额 上 陷 脉
急 紧 d shang xian mai j{ fin: There are differing interpretations of this clause.
a ) You Yi and Chen Nian-Zii agree that this means that the pulse 岛lt in the
depression ne缸 the temples is tense and tight.
b ) y也 Ch加g ( 喻 昌 , style 嘉 言 Jia-Y归 ) explains that 额 上 陷 e shdng xian
means that an abnormal depression on the forehead ( abnormal depression
of the temples ) , and that 脉 急 紧 mai j{ fin means the sinews ( of the eyes )
缸e tense and tight, 脉 mdi here being taken to mean 筋 脉 jfn mai' sinews.
Yu Chang believes that this is a critical indicator of exhaustion of upper
burner yin essence. The authors of the Gao Deng Cong Shu do not accept
this explanation. All these explanations may be considered, depending on
the clinical presentation.
SYNOPSIS
Using spontaneous external bleeding patients as an example, this line points out
that when yin and blood are depleted, the promotion of sweating is contraindicated.
COMMENTARY
People with a long history of spontaneous external bleeding ( especially nose­
bleed ) generally suffer from yin blood depletion. Y6u Yi, Chen Nian-Z毡, and Y也
Chang agree that promotion of sweating with warmth and acridity should not be
applied to spontaneous external bleeding patients or those who suffer from yin blood
depletion even in the case of an external contraction, because it will further deplete
yin blood. Chen Nian-Zii explains:
People who habitually suffer from spontaneous external bleeding are
called spontaneous external bleeding patients. The blood in the three yang
channels is vacuous; therefore, one cannot promote sweating. [If] sweat is­
sues, there will be yin collapse. . . . . The blood of the three yang [cham ls I
cannot nourish the vessels; consequently, the pulse in the depressions of the
forehead is tense and tight. The blood of the three yang does not pass into
the eyes; consequently, the eyes are staring straight and unable to move. The
yang blood is vacuous and scant, so the defensive φ cannot move into yin
[at night] ; hence [there is] sleeplessness. This is a critical pattern of the three
yang [cham ls] .
Because sweat and blood are of the same source, following the promotion of
sweating in patients suffering from yin blood depletion, yin and blood will be further
damaged, resulting in 皿any different possible transmutations. Depleted yin and
blood are unable to nourish the channels and the pulse on the forehead becomes
tense and tight .
Depleted blood is unable to nourish the eyes, which stare straight ahead and do
not move normally. It is also unable to nourish the heart, so that the heart spirit
is not contained and the patient cannot sleep normally.
104
1 . GREATER YANG [LINE 88]
LINE 87
亡血家 , 不可发汗 , 发汗则寒栗而振。
Wang xue j侃, bu ke fa han, fa han ze han li 白’. zhen.
[With ] bl。。d c。I l a pse patients, 1 。ne ca n not prom。te sweating, [beca use]
the promotion 。f sweati ng wil l lead t。 cold sh udderi ng a nd q u iveri ng.2
TEXT NOTES
1. Blood collapse patients, 亡 血 家 wang xue jia: Patients who suffer frequent
loss of blood and consequently have blood vacuity. In the Shang Han Lim,
blood collapse does not have the modern definition of critical blood vacuity.
A blood collapse patient is a patient who for constitutional reasons frequently
suffers from blood collapse. In this line, it is usually explained as specifically
meaning a patient who has blood vacuity due to frequent loss of blood.
2. Cold shuddering and quivering, 寒 栗 而 振 Mn li er zhen: Cold qi stirring in the
interior with generalized cold, aversion to cold, and uncontrollable trembling.
SYNOPSIS
Using blood collapse patients as an example, this line points out that when
blood is vacuous and qi is debilitated, the promotion of sweating is contraindicated.
C OM MENTARY
The preceding line presented the negative outcome of promoting sweating in
a patient who has vacuity of yin and blood. This line takes that idea one step
further and presents a similar situation, but here the result of the mistreatment
manifests in both y缸ig qi and yin blood. Blood collapse patients are known to have
blood vacuity and qi debilitation; therefore, when such a patient suffers from an
external contraction, promotion of sweating with warmth and acridity cannot be
used since this will wear yin blood and discharge y归g qi, not only exacerbating the
vacuity, but also preventing the evil from being dispelled. When the y归g qi vacuity
is thus exacerbated, yang qi will lose its warming function and will fail to defend
the exterior, so that there will be shivering. When the yin blood is exacerbated,
the sinews will be deprived of nourishment so there will be shaking. This latter
development is an example of blood vacuity engendering wind.
Yin blood and yang qi are mutually dependent; consequently, when yin becomes
vacuous, yang loses harmony. If sweating is employed, yin will be damaged and y缸g
will be disharmonious. When the yang is unable to warm the exterior, the patient
feels cold and shudders. Quivering is a result of the loss of nourishment to the
sinews because of yin vacuity. This is a pattern of dual vacuity of the yin blood
and yang qi.
LINE 88
汗家 , 重发汗 ,
必恍惚心乱 , 小 便 已 阴疼 , 与 禹 余粮丸 。
Han jia, ch6ng fa han, bi h包iing hi.i xi"n luan, xiiio bian yi yin teng,
yu yu yu liang wan.
l . GREATER
y ANG
[LINE 88]
105
[When ] a person who suffers from excessive sweating1 is a ga i n 2 made
t。 sweat, there wi l l be a bstraction and dera ngement3 and yin pa i n after
u ri nation .4 Give Li monite P i l l ( yu yu liang wan) .
TEXT NOTES
1. A person who suffers from excessive sweating, 汗 家 han jiii: Patients who
frequently sweat without physical exertion or w町m temperatures.
2. Again, 重 ch6ng: This character can be read as ch6ng meaning “again” or as
zh<'>ng meaning “heavy” or “severe.” In this line, 重 发 汗 ch6ng fa han means
a mistreatment. It is a mistreatment because the patient is already sweating
and sweating is promoted again, not because sweating is promoted too heavily.
The promotion of heavy sweating is always inappropriate, regardless of the
patient’s constitution.
3. Abstraction and derangement, 恍 惚 心 乱 huang hii xfn luan: Abstraction is a
condition in which the spirit is unstable and the patient is incapable of self­
control. Derangement is inability to think coherently and act decisively due
to vacuity of the spirit.
4. Yin pain after urination, 小 便 已 阴 疼 xiao bian yi yfn teng: Pain in the urethra
following urination. “Yin” often refers to the “private parts” and here it refers
specifically to the urethra.
FORMULA
Limonite Pill
(yu yu liang wan )
This formula has been lost.
SYNOPSIS
Using patients who suffer from excessive sweating as an example, this line points
out that when yang is vacuous, the promotion of sweating is contraindicated.
COMMENTARY
Frequent sweating ( night sweating or especially spontaneous sweating ) is 础。-
dated with constitutional dual vacuity of yin and yang. It is associated with y缸g
vacuity because sweating wears yang qi and causes insecurity of the exterior, and
with yin vacuity since sweating allows yin humor to discharge causing damage to
yin blood. However, yang qi vacuity is the more important element because y缸g
φ vacuity is both a cause and a result of excessive sweating, so it creates a vicious
circle, while yin vacuity is merely a consequence. In this type of patient, even in
external contractions, the further promotion of sweating with warmth and acridity
is contraindicated. If sweating is promoted, further damage to yin and yang will
occur. Exacerbated dual vacuity of yin and yang will deprive the heart of nour­
ishment and cause the heart spirit to float astray, giving rise to abstraction and
derangement. Furthermore, when liquid and humor 町e further damaged, they 缸e
unable to moisten the urinary orifice, which becomes rough and dry, causing pain
following urination.
The formula is unknown to any Shiing Han Um commentator. However, its
name suggests that the chief ingre也ent is limonite (yu yu liang ) , which promotes
astriction and checks sweating. Furthermore, judging by the problem that it ad-
1 06
1 . GREATER YANG [ LINE 89)
dresses, the formula seems to be used to supplement vacuity and address an emer­
gency.
LINE 89
病人有寒 , 复 发 汗 , 胃 中 冷 , 必吐航 。
Bing ren you han, 如 fa han, wei zhiing leng, bi tu hui.
A patient who h as cold 1 a nd yet 2 is made to sweat has cold i n the
stomach3 a n d wi l l v。m it rou ndworms.4
TEXT NOTES
l. A patient who has cold, 病 人 有 寒 bing ren you hdn: This phrase can be
interpreted in several ways. Gao Deng Cong Shu interprets this phrase as
yang vacuity cold. Zhang XI-Ju writes, ‘“A patient who has cold' means that
the stomach φ [of the patient] is usually cold.” Zha鸣 Zhi-Cδng comments
that this phrase means stomach qi vacuity.
2. Yet 复 fo, : Fang You-Zhi writes that 复 ju should be read 副 “but instead,”
反 f伽 , implying that the treatment is erroneous.
3. Cold in the stomach, 胃 中 冷 wei zhiing leng: Cold may be the result of mis­
treatment or a restatement of the patient’s original condition. Fang You-Zhi,
Zhang XI-Ju, and Zhang Zhi-Cong emphasize that the use of an inappropriate
treatment method exacerbated the original cold condition.
4. Vomit roundworms, 吐 蜕 tu hui: Because of vomiting and stomach counter­
flow, the contents of the intestines may move into the stomach. If there 缸e
parasites present, they will then be vomited out. However, in modern clinical
practice, this phenomenon is rarely seen. Note that 就 hui is the same as 蛐
hui.
SYNOPSIS
When there is yang vacuity and cold, the promotion of sweating is contraindi­
cated.
COMMENTARY
The presence of cold suggests that the patient h甜 y缸g vacuity, stomach qi
vacuity, or stomach cold. Although there is an exterior pattern, one should not
promote sweating, since this treatment will further damage the y缸g qi and exac­
erbate the cold. If the patient originally has vacuity cold in the stomach, further
damage to the yang qi incurred during sweating will exacerbate the condition. If,
originally, there is y缸g vacuity cold, further damage to the yang qi can cause stom­
ach cold and stomach qi counterflow. In either case, cold in the stomach causes the
loss of normal stomach downbearing so that there is retching or vomiting.
1 . G REATER YANG [LINE 49]
107
LINE 50
忖 脉 浮 紧 者 , 法 当 身疼痛 , 宜 以 汗解之 。
假令尺 中 迟者 , 不
可发汗 。 ω 何 以知然 ? 以荣气不足 , 血少故也 。
( 1 ) Mai Ju jin zhe, fa dang sh切 teng tong, yi yi han jie zhz. (2) Jia
ling chi zhii叼 chi zhe, bu ke fa han. (3) He yi zhz ran ? Yi r6ng qi
bu zu, xue shao gu ye.
( 1 ) When the pu lse is floati ng a nd tight, as a rule there sh。u ld be
genera lized pa i n a n d [the时。陀,l it is a ppropriate to resolve [the i l l ness]
by sweating. (2) [However,] if the pu lse at the cu bit is slow , * [。ne]
ca n n。t prom。te sweati ng. (3) H。w d。es 。ne know t h is? Beca use the
construction q i is i nsufficient and the blood is sca nt.
TEXT NOTE
*
The pulse at the cubit is slow, 尺 中 迟 chi
the cubit position.
zhong chi: 尺 中 chi zhong means
SYNOPSIS
When construction and blood are insufficient, although there is an exterior
pattern, the promotion of sweating is contra皿dicated.
COMMENTARY
A pulse that is floating and tight is a characteristic pulse felt in greater yang
cold damage. Furthermore, in this pattern, generalized pain is usually present and
the promotion of sweating is the appropriate treatment. If the pulse at the cubit
position is slow, one should not promote sweating. When the pulse at the cubit
position is slow, it means that the construction qi and the blood are insufficient.
The promotion of sweating would further damage the construction directly and the
blood indirectly through the fluids; therefore it is contraindicated.
LINE 49
付 脉浮数者 , 法 当 汗 出 而 愈 。
(二) 若 下 之 , 身 重 心 悸 者 , 不
可 发 汗 , 当 自 汗 出 乃解 。 同 所 以 然者 , 尺 中脉微 , 此 里虚 ,
须表里实 , 津液 自 和 , 便 自 汗 出 愈 。
( 1 ) Mai JU shuo zhe, fa dang han chu er yu. (2) Ruo xia zhz, shen
zhong xzn ji zhe, bu ke fa han, dang zi han chu nai jie. (3) Suo yi
ran zhe, chi zhong mai w函, ci li xu, xu biao li shi, jzn ye zi he, bian
zi han chu yu.
( 1 ) When the pulse is floati ng a n d ra pid , as a rule there shou ld be
sweati ng a nd [then] 限。ve啡 (2) If preci pitation [is used] , a nd [there
is] genera l ized heavi ness a n d heart pa l pitations, [one] ca n not promote
108
1 . GREATER YANG [LINE 49]
sweating; [the person] m ust sweat sponta neously s。 that [the i l l ness] is
resolved . (3) Why [this] is so is beca use the pu lse at the cu bit is fa i nt ,
wh ich i nd i cates i n teri。r vacuity. Exterior a nd i nteri。r need t。 be made
repl ete, 1 [s。 that] l iq u id a n d h u mor2 n at u ra l ly become h a rmonious [a nd]
then sp。nta n e。us sweati ng [wi l l bring a bout] rec。ve啡
T EXT NOTES
1. Replete, 实 shi: In a healthy state.
2. Liquid and humor, 津 液 j彷z ye : “Liquid,” 津 jz弛, is any of the thinner fluids of
the human body. “Hu皿or,” 液 肘, is any of the thicker fluids. Since compound
nouns in Chinese are made from near synonyms, it is possible to translate fin
ye loosely as 咀uids.” Here, we have used both terms to reflect the original
Chinese.
SYNOPSIS
When the inappropriate use of precipitation has led to interior vacuity, the treat­
ment should be to supplement vacuity and support the right, and the promotion of
sweating is contraindicated.
C OMMENTARY
The promotion of sweating is appropriate for the treatment of greater y归g
disease with a pulse that is floating and rapid. If, however, precipitation is used,
pathological transmutations will occur. The new s地ns of generalized heaviness and
palpitations 缸e explained in the text. The reader is told that the pulse at the cubit
is faint and this indicates interior vacuity. Therefore, one knows that erroneous
precipitation has resulted in interior vacuity. One should not promote sweating, but
must wait for spontaneous sweating to occur. In order for spontaneous sweating
to occur, one must supplement the vacuity. So although one should not promote
sweating, treatment is still possible by strengthening the exterior and interior, so
that the 组uids become harmonized. In this way, the patient will be able to sweat
and the disease will resolve.
3.2.3
Concurrent Patterns
The four concurrent patterns in greater yang cold damage 町e represented by
the following formulae: Pueraria Decoction (ge gen tang), Pueraria Decoction Plus
Pinellia (ge gen jia ban xia tang), Major Green-Blue Dragon Decoction (da qfng
long tang) and M inor Green-Blue Dragon Decoction (xiao qfng long tang).
a ) Pueraria Decoction (ge gen tang) pattern: Greater yang cold damage signs
plus marked hypertonicity and discomfort of the nape and back. The pro­
cess is one in which wind-cold fetters the exterior, the defense and construc­
tion are blocked and depressed, the greater yang channel ql is inhibited, the
fluids are unable to ascend and the channel is not nourished and moistened.
The appropriate treatment is to promote sweating and resolve the exterior
and to engender liquid and moisten the channels.
b ) Pueraria Decoction Plus Pinellia (g句句 jia ban xia t副.g) pattern: Greater
y缸g cold damage signs with di缸rhea, or with retching and vomiting. In
1 . GREATER YANG [LINE 3 1 ]
109
this pattern, wind-cold fetters the exterior, the defense and construction are
blocked and depressed, and the exterior evil moves inward. It may distress
the y归g brightness, causing the loss of normal large intestine function
and diarrhea, or it may attack the stomach causing q1 counterflow and
retching and vomiting. The appropriate treatment is to promote sweating
and resolve the exterior, to raise liquid and check diarrhea, or to downbear
counterflow and check retching.
c) Major Green-Blue Dragon Decoction ( da qfng long tang) pattern: Greater
yang cold damage signs plus vexation and agitation. The pulse is floating
and tight, and no generalized pain exists, only heaviness which occasionally
lightens. The process is one in which wind-cold fetters the exterior, the
defense and construction are blocked and depressed, and depressed heat in
the interior cannot be diffused and discharged. The appropriate treatment
is to resolve the exterior with warmth and acridity and to clear interior
heat.
d ) Minor Green-Blue Dragon Decoction (xiao qfng long tang) pattern: Greater
yang cold damage signs plus cough, panting, and retching counterflow.
Thirst, diarrhea, dysphagia, inhibited urination, and fullness in the smaller
abdomen may also be observed. In this pattern, wind-cold fetters the ex­
terior, the defense and construction 町e blocked and depressed, and water­
rheum collects in the interior. The fluids are not transformed and the
rheum seeps into the bowels and viscera. The appropriate treatment is to
resolve the exterior with warmth and acridity, and to flush a丑d transform
water-rheum.
LINE 3 1
交阳 病 , 项 背 强 凡 几 , 无 汗 恶 风 , 葛 根 汤 主 之 。
Tai yang bing, xiang bei jiang shu shu, wu han wu Jeng, ge gen tang
zhu zhi.
[ I n] greater ya ng d isease with a stretched stiff n a pe a nd back, * a bsence
of sweati ng , a nd aversion to cold , Pueraria Decoction (ge gen tang)
governs.
TEXT NOTE
*
Stretched stiff nape and back, 项 背 强 几 几 xiang bei jiang shu shu: This is the
same expression as that used earlier in line 14, p. 79. In this line, however,
the disease is cold damage exterior repletion, whereas in line 14, p . 79, it is
wind strike exterior vacuity. Thus, this formula includes ephedra ( ma huang) ,
whereas Cinnamon Twig Decoction Plus Pueraria (gui 劝r jia ge gen tang),
which i s used in line 1 4 , p. 79, does not. Note that both formulae below contain
pueraria ( ge gen).
FORMULA
Pueraria Decoction
(ge gen tang)
1 . GREATER YANG [LINE 3 1 ]
1 10
o
Promote sweating and resolve the exterior; engender liquid and soothe chan­
nels.
葛 根 四 两 麻 黄 三 两 ( 去 节 ) 桂枝 二 两 ( 去 皮 )
甘草二两 ( 炙 )
巧药二两 大枣十二枚 ( 擎 )
生姜三两 ( 切 )
去 白 沫 , 内诸
药 , 煮 取 三 升 , 去 淳 , 温 服 一 升 。 (二) 覆 取 微 似 汗 。 (斗 余 如 桂 枝 法 将
息 及 禁 忌 。 (四) 诸 汤 皆 仿 此 。
(寸 右 七 昧 , 以 水 一 斗 , 先 煮 麻 黄 、 葛 根 , 减 二 升 ,
Ge gen si liang ma huang san li
jiang san liang ( qie) gaη cao er liang (zhi) shdo yao er liang da zao shi er mei
( bo)
( 1 ) You qz wei, yi shui yz dou, xian zhu ma huang、 ge gen, jian er sheng, qu
bdi mo, na zhu yao, zhU qu san sheng, qu zi, wen JU yz sheng. (2) Fu qu wei si hdn.
(3) Yu ru gui 劝z fa jiang xz ji jin ji. ( 4) Zhu tang jie fang ci.
puera ria ( 葛 根 ge g旬, P uerariae Radix) 4 Ii温 ng
ephed ra (麻 黄 ma huang, Ephed ra e He阳) 3 li�ng (remove nodes)
c i n n a mon twig (桂 枝 gui zhf, Cin namomi Ra 『n u l us) 2 Ii单 鸣 ( remove bark)
fresh gi nger (生 姜 sheng jiang, Zingiberis R hizoma Recens) 3 li�ng (slice)
m ix-fried licorice (甘 草 gan cao, Glycyrrhizae Radix) 2 li�ng
peon y ( 苟 药 sha。 ”。, Pa eo n iae Radix) 2 li�ng
j uj u be ( 大 枣 da ziio, Zizi p h i Fructus) 12 pieces ( broken)
( 1 ) (For] the a bove seven ingredients, use one d�u of water. First boil ephed ra
(ma huang) a nd pueraria (ge gen) to reduce (the water] by two sheng. Remove the
wh ite foa m a nd add all the ingred ients. Boil to get three sheng, remove the d regs, a n d
ta ke o n e she吨, warm . (2) Cover (with bedclothes] to obtai n m i l d sweati ng. ( 3 ) T h e
rem a i nder i s as for C i n n a mon Twig Decoction (gui zhf tang) (with regard to] rest a nd
contra i n d icatio盹 ( 4) ( I n fact,] a l l form ulae based on Cin n a mon Twig Decoction (gu
zhτ tang) should be used acco时ing to this method .
SYNOPSIS
The distinguishing features and treatment of greater yang cold damage with
greater yang channel qi constraint.
COMMENTARY
The author tells us that this is greater y缸ig disease, but does not explicitly
state if it is wind strike or cold damage. Absence of sweating is indicative of cold
damage, but aversion to wind is more indicative of wind strike. Generally, in such
situations, the condition is inferred from the formula. One can better understand
a poorly described disease pattern by looking at the prescribed treatment.
This formula is Cinnamon Twig Decoction (gui zhf tang) plus ephedra ( m
huang) and pueraria (ge gen). The addition o f ephedra (ma huang) promotes
sweating and dispels evil. It is this addition which tells the reader that this pattern
belongs to cold damage. Sweet and balanced pueraria (ge gen) engenders liquid
and soothes the channels. It is able to raise the clear y缸g qi and check diarrhea.
1 . GREATER y ANG [ LINE 32]
111
It also reinforces the action of ephedra (ma huang) and cinnamon twig (gui zhf) in
prom。ting sweating and resolving the exterior.
One may ask why a formula based on Cinnamon Twig Decoction (gui zhf tang)
is chosen if this is greater yang cold damage. The answer sheds light on the author’s
view of the pathomechanism and his therapeutic approach. We already know that
in cold damage, wind-cold evil fetters the exterior, resulting in the depression and
stagnation of the construction and defense. In this pattern, normal diffusion of fluids
through the greater yang channel may be impaired. The fluids are insufficient to
moisten and nourish the channel; hence stiffness and discomfort are felt in the nape
and back along the channel pathway. In choosing a formula, one must be aware that
although the exterior must be resolved, normal fluid movement has already been
disrupted and normal moistening along the channel has been lost. Therefore, it is
wise to promote sweating moderately, not harshly, and to harmonize construction
and defense with Cinnamon Twig Decoction (gui zhr tang). Nevertheless, absence of
sweating is observed, so ephedra (ma huang) is also given, as in other cold damage
situations. As above, pueraria (ge gen) has the important action of engenderin
自uids and raising the clear qi from the lower burner. In this way, it soothes the
channels that have been deprived of fluid nourishment.
LINE 32
太 阳 与 阳 明 合病者 , 必 自 下利 , 葛根汤主之 。
Tai yang yu yang m仇g he bing zhe, bi zi xia li, ge gen tang zhu zhi.
I n greater ya ng a nd ya ng brightness com bi n ation d isease, there wil l
be1 sponta neous d iarrhea ,2 a n d [therefore,] P uera ria Decocti。n (ge gen
t ang) governs.
TEXT NOTES
1. Will be, 必 bi : If 必 bi is assumed to have its normal meaning of “must”
or “certainly.,” the present line means that diarrhea will definitely occur in
greater yang and yang brightness combination disease. This statement would
nevertheless contradict the following line ( line 33) , which describes the same
disease pattern without diarrhea. In an attempt to reconcile the app缸ent con­
tradiction, some commentators have interpreted bi here as meaning “might.”
2. Spontaneous diarrhea, 自 下 利 zi xia Li: Loose stool that occurs without any
known natural or iatrogenic cause, such as inappropriate precipitation.
SYNOPSIS
The treatment of diarrhea in greater yang and y缸g brightness combination
disease.
COMMENTARY
This line and the one that follows provide another example of app缸ent incon­
sistencies in the text. This line presents greater yang and yang brightness disease
that “must” include diarrhea, while the following line presents the same disease
pattern, without diarrhea. See the Introduction for further discussion of this issue.
1 . GREATER YANG [LINE 33]
112
This pattern is simultaneous disease of the exterior and the interior. The interior
disease, however, is considered secondary to the exterior one. We can infer this
through an a.I时ysis of the formula. Pueraria Decoction (g e gen tang) is based on
Ephedra Decoction ( ma huang tang), which h副 the primary action of promoting
sweating and resolving the exterior. In this line, the presence of diarrhea indicates
an interior condition, yet Pueraria Decoction (ge gen tang) is still used because once
the exterior is resolved, the interior will spontaneously harmonize. P u eraria (ge
gen) is particularly appropriate here because it not only has mild exterior-resolving
properties, but it also raises yang and checks diarrhea.
LINE
33
太 阳 与 阳 明 合 病 , 不 下 利 , 但 E区 者 , 葛 根 加 半 夏 汤 主 之 。
Tai yang yu yang ming he bing, bu xia li, dan OU zhe, ge gen jia ban
xia tang zhu zhi:.
When i n greater ya ng a n d ya ng brightness c。m bi nation d isease, diar­
rhea is a bsent, [a nd] only 时ch i 鸣 [is present] , Puera ria Decocti。n Plus
P i nell i a ( ge gen j幅 ban xia tang) governs.
FORMULA
Pueraria Decoction Plus Pinellia
(ge gen jia ban xia tang)
o Promote sweating and resolve the exterior; downbear counterflow and stanch
vom1tmg.
葛根四 两
两 ( 去皮 )
麻 黄 三 两 ( 去 节 ) 甘 草 二 两 ( 炙 ) 巧 药 二 两 桂枝 二
半夏半升 ( 洗 )
大枣十二枚 ( 壁 )
生姜 二 两 ( 切 )
付 右 八昧 , 以 水- 斗 , 先煮葛根 、 麻黄 ,
减二升,
去 白 沫 , 内诸
药 , 煮取三升 , 去浑 , 温服一升 。 ω 覆取微似汗 。
Ge gen si Liang ma huang san Liang ( qu ji e ) gan cao er liang (zh i) shtio yao
e俨 liang gui zhr er Liang ( qu p() sheng jiang d俨 Liang ( qie) bdη xia bdn shen
(xi) da zao sh i er mei ( bo )
(1) You ba wei, yi shui yz dou, xian zhU ge gen、 ma huang, jian er sheng, qu
btii mo, na zhU yao , zhU qii, s伽 sheng, qu z记 wen JU yz sM叼. (2) Fu qu wei si han.
pueraria ( 葛 根 ge gen, Puerariae Ra d i x ) 4 Ii温ng
ephed ra (麻 黄 ma huang, Ephed rae Herba ) 3 Ii昌ng ( remove nodes)
mix-fried licorice (甘 草 gan cao, Glycyrrhizae Radix) 2 l i� ng
peony (巧 药 shtio yao, Paeoniae Radix)1 2 li�ng
ci n n a mon twig (桂 枝 gui zh瓦 Ci n n『1 a 『no『ni Ra『m』IL』s) 2 Ii昌『1g ( remove ba咔
fresh gi nger (生 姜 sheng jiang, Zi ngiberis Rhizoma Recens) 2 li�ng (slice)
pinellia ( 半 夏 b d n xia, Pinelliae Tu ber) h a lf sheng (washed) 2
j uj u be ( 大 枣 da zao, Ziziphi Fructus) 12 pieces (broken)
1 . G REATER YANG
[ LINE 38]
113
( 1 ) [For] t h e a bove eight ingredients use o n e d CS u o f water. Fi rst boil pueraria (ge
gen) and ephed ra (ma huang) to red uce [the water] by two sheng. Remove the wh ite
foa m a nd add a l l the i ngredients. Boil to get three sheng, remove the d regs, a nd ta ke
one sheng, warm . (2) Cover [with bedclothes] to obta i n m i ld sweati ng.
FORMULA NOTES
1. Peony: Raw white peony (生 自 苟 药 sheng blii shlio yao, Paeoniae Radix Alba
Cruda) .
2. Wash ed, 洗 xi: Because of th e known toxicity of pinellia ( 半 夏 ban xia, Pinelliae
Tuber ) , we can speculate that some procedure was possibly used to reduce the
toxic effects. Precisely what procedure was used at the time when the Shang
Han Lim was written is now unknown. It is likely that this medicinal was
washed until its ability to make the tongue numb was reduced or eliminated.
SYNOPSIS
The treatment of retching counterflow in greater yang and y缸g brightness
combination disease.
C Ol.VIMENTARY
In combination disease of the greater yang and the yang brightness, the exte­
rior evil enters the interior and distresses the y缸g brightness. The stomach and
intestines are both part of the yang brightness, and either may be affected by the
evil. In the previous line, intestinal function is impaired, giving rise to diarrhea. In
this line, it is the stomach that is affec t ed and disharmony of the stomach qi gives
rise to retching. Again, the treatment addresses the root; therefore, the focus is on
resolving the exterior.
This formula is Pueraria Decoction (ge gen tang) plus pinellia ( ban xia) . Acrid,
warm pinellia ( ban xia) is added to downbear counterflow and stanch retching.
LINE 38
付 太阳 中 风 , 脉浮紧 , 发 热 恶 寒 , 身 疼痛 , 不 汗 出 而烦躁
者 , 大青龙汤主之。
(二) 若 脉 微 弱 , 汗 出 恶 风 者 , 不 可 服 之 。
(三) 服 之 则 厥 逆 , 筋 ↑易 肉 H闰 , 此 为 逆 也 。
( 1 ) Tai yang zho 叼 Jeng, mdi JU fln, fa re wU han, shen teng to叼p
bu han chu er fan zao zhe, da qing long tang zhu zhι (2) Ruo mdi
wei ruo, han chu WU Jeng zhe, bu ke JU zhf. (3) Fu zhf ze jue ni, jfn
ti rou run, ci wei ni ye.
( 1 ) When i n g阳ter ya ng wi n d stri ke the pu lse is floati ng a nd tight,
and [there is] h eat effusio n , aversion to cold , genera lized p:ai n , a bsence
。f sweating, a n d vexati。n a nd agitati。n , M aj。r G reen- Blue D rag。n De­
c。ction ( da q伽g long tang) governs. (2) If the pu lse is fa i nt a n d wea k
a nd [there is] sweati ng a nd aversion t。 wi nd , [the person] ca n not ta ke
1. GREATER YANG [LINE 38]
114
this [f1。rm u l a] . {3) If [he] ta kes it there wil l be 刚erse-flow1 a n d jerking
si news a nd twitc h i n g fles h , 2 i nd icating an adverse ft阳tment] .
TEXT NOTES
1. Reverse-fl.ow, 厥 逆 jue ni: Cold in the extre皿ities. In the Shang Han Lim,
but not necessarily in other texts, “reverse-flow” is taken to be synonymous
with “reversal-cold of the limbs, ” 四 肢 厥 冷 s i zhf jue Ieng.
2. Jerking sinews and twitching flesh , 筋 惕 肉 嗣 jfn ti rou shim (run) : M ild
jerking of the sinews, which can be due to blood or fluid insufficiency, cold­
damp, or yang vacuity. Here, it is due to y缸g collapse, which stems from the
inappropriate promotion of sweating.
FORMULA
Major Green-Blue Dragon Decoction
o
(da qfng long tang).
Resolve the exterior with warmth and acridity; clear interior heat.
麻黄六两 ( 去节 )
桂枝 二 两 ( 去皮 ) 甘 草 二 两 ( 炙 ) 杏 仁 四 十
枚 ( 去皮尖 ) 生姜三两 ( 切 ) 大枣十枚 ( 壁 ) 石膏如鸡子大 ( 碎 )
卜) 右 七 昧 , 以 水 丸 升 , 先 煮 麻 黄 , 减 二 升 , 去 上 沫 , 内 诸 药 , 煮
取 三 升 , 去 津 , 温 服 一 升 。 ω 取微似 汗 。 问 汗 出 多 者 , 温粉粉 之 。
但) 一 服 汗 者 , 停 后 服 。 伍) 若 复 服 , 汗 多 亡 阳 遂 虚 , 恶 风 , 烦 躁 , 不
得眼也 。
Ma huang liu liiing ( qu jie) gui zhf er liiing ( qu p {) gan ciio er liiing ( zhi)
xing ren si shZ mei ( qu p { jian) sheng jiang san liiing ( qie) da ziio sM mei ( bo)
sh< gao ru jf zi da (sui)
(1) You qr w剖, yi shut jiu sheng, xian zhil ma huang, jiiin er she叨, qu sl』dr』
mo, na zhu yao, zhU qu s伽 sheng, qu zi, wen Ju yi: sheng. (2) Qu wei si han.
(3) Han chu duδ zhe, wen fen fen zh汇 (4) Yi: Ju hdn zhe, Ung hou Ju. (5) Ruo Ju
h’, hdn duδ wang yang sui XU, 叫 Jeng, Jan za o bu de mian ye.
,
ephed ra (麻 黄 ma huang, Ephed rae He阳) 6 li�ng ( remove nodes)
ci n n a mon twig (挂 枝 gui zhf, Cin 阳nomi Ra『n u l us) 2 li�ng (remove bark)
m ix-fried licorice (甘 草 g伽 cii.o, Glycyrrhizae Radix) 2 li�ng
a pricot kernel (杏 仁 xing ren, Armen iacae Semen) 40 pieces (remove skin and tip)
fresh ginger (生 姜 sheng jiang, Zingi beris Rh izoma Recens) 3 li�ng (cut)
j uj u be (大 枣 da zii.o, Ziziphi Fructus) 10 pieces ( broken)
gypsu m ( 石 膏 sM g ao , Gypsum) a piece the size of a chicken ’ s egg (crushed )
( 1 ) [For] the a bove seven i ngredients use nine sheng o f water. First boil ephed ra
( ma huang) to red uce [the water] by two she吨. Remove the foam [collecti ng] on top
a n d add all the i ngred ients. Boil to get th ree sheng, remove the d regs, a nd ta ke one
she略 warm . (2) O bta i n m i ld sweati ng. (3) If [there is] copious sweating, [a pply] warm
[rice] powder.申 (4) As so。 n as [there is] sweating, stop ta king the decoctio n . (5) [After
sweati 吨,l if the formula is ta ken aga i n , there wi ll be copious sweating and ya ng col la pse,
a nd then vacuity, aversion to win d , vexation and agitation , a nd i n a bi lity to sleep.
1 . G REATER YANG [ LINE 38]
115
FORMULA N OTE
* [Apply] warm [rice] powder, 温 粉 粉 之 ωεn fen Jen zh仨 The application of
warm rice powder to the outside of the body was a method used to check
copious sweating. Commentators disagree about the exact ingredients to be
us ed, as well 础 the exact method.
SYNOPSIS
a) The signs and treatment of greater y缸g cold damage with interior heat.
b) Contraindications for the use of Major Green-Blue Dragon Decoction ( da
qfng long tang) .
COMMENTARY
The interpretation of this line is problematic because Zhang JI states that this
pattern belongs to greater yang wind strike. In greater yang wind strike, we expect a
pulse that is floating and moderate, not floating and tight. A pulse that is floating
and tight is the basic pulse in cold damage pattern. Furthermore, all the other
signs-heat effusion, aversion to cold, generalized pain, and absence of sweating­
are all typically seen in greater y归g cold damage. Previously an analysis of the
formula has been used to clarify issues of this sort. In this line, the use of Major
Green-Blue Dragon Decoction ( da q问 long t ang ) is suggestive of cold damage
because a large amount of ephedra (ma h uang) is used. Ultimately it is impossible to
resolve this issue because the text is unclear. Some commentators have asserted that
Zh副g JI meant not wind strike but a general exterior condition. If this assertion
is true, however, it is not clear why he did not simply write greater yang disease,
as in other lines.
The pattern presented is a representative greater y缸g cold da皿age pattern,
with the addition of vexation and agitation. The presence of vexation and agitation
cannot be explained through the pathomechanism of wind-cold evil fe“ering the
exterior alone, and suggests that another disease process is also operant. We assume
this to be interior heat because the formula suggested includes gypsum ( shi gao),
which clears interior heat. When the exterior is fettered by wind-cold, n o outward
pathway exists for the interior heat; consequently, vexation and agitation arise.
Both the exterior cold and the interior heat 缸e repletion patterns. Major Green­
Blue Dragon Decoction ( da qfng long tang) contains Ephedra Decoction ( ma huang
tang) in order to resolve the exterior. Fresh ginger ( sheng jiang ) is added and,
in combination with cinnamon twig (gui zhf) and a large dose of ephedra ( ma
huang), promot es sweating and dispels cold. These actions are offset by sweet, acrid,
very cold gypsum ( shi gao) , which clears interior heat, drains 且re, and eliminates
vexa t ion . Mix-fried licorice (gan ciio ) and jujube ( da ziio) are added to harmonize
and protect the center and the fluids. This is a strong formula for the pro皿otion
of sweating, yet Z hang JI wri tes that “mild sweating" should be obtained. Why is
this formula used to obtain mild sweating? The presence of vexation and agitation
means that the exterior is fettered and depressed, leaving no outward pathway for
the sweat. Therefore, a strong formula is needed to obtain even a mild sweat.
Zhang JI cautions against the promotion of excessive s wea ting. As soon as mild
sweat issues, ingestion of the fo口nula should stop. Furthermore, if copious sweat
issues, one is advised to apply warm rice powder to the exterior of the body to
1 16
1 . GREATER y ANG
[LINE 39]
check the sweating. This is another indication of the importance of controlling the
degree to which sweating is promoted.
In the second part of the line, the pulse is weak and faint, and sweating and
aversion to wind are observed, which means that both the interior and exterior are
vacuous and Major Green-Blue Dragon Decoction ( da qzng long tang) must not be
given. To give this formula would be to use a strong formula for the promotion of
sweating with a vacuous patient. This constitutes an adverse treatment, since the
loss of sweat will exacerbate the vacuity. In this case, the loss of sweat causes y缸g
collapse. The y缸g qi is unable to warm and nourish the flesh and channels, giving
rise to reverse-flow and to jerking sinews and twitching flesh.
LINE 3 9
伤寒脉浮缓 , 身 不 疼 , 但重 , 乍有轻时 , 无 少 阴 证者 , 大 青
龙汤发之。
Shang han mai Ju huiin, shen bu teng, dan zhong, zha you qfng shi,
wu shao yfn zheng zhe, da qfng l6ng tang fa zhf.
When i n cold da mage, the pulse is floati ng a nd moderate, a nd [there is]
no genera l ized pa i n , 。n ly [genera l ized] heaviness, with sudden periods 。f
lightness, a n d [there is] no lesser yTn d isease, M aj。r G reen- B l ue D ragon
Dec。cti。n ( da qfng long tang ) wil l promote [sweati ng a nd resolve the
d isease] .
SYNOPSIS
A further discussion of the pattern of greater y缸g cold damage with interior
heat, its transmutations and treatment, on the basis of the previous line.
COMMENTARY
As the previous line, this line poses some apparent contradictions. In cold
damage, one expects a floating, tight pulse and generalized pain, yet in this line
cold da皿age disease is described with a pulse that is floating and moderate, and
no generalized pain. As before, an analysis of the formula can shed light on the
disease. The use of Major Green-Blue Dragon Decoction ( da qzng long tang) appears
to indicate exterior repletion . If this is so, then how is one to explain the absence of
generalized pain and the presence of heaviness with periods of lightness? According
to the Yz z,δng Jzn Jian, “In cold damage, there should be generalized pain, [but ]
now [there is] no pain. This is a cold damage disease which simultaneou句 has wind
strike signs. [When] the body [feels] light, the evil is in y缸g. [Wh叫 the body
[feels] heavy, the evil is in yin.”
The signs of cold da皿age, as they 缸e seen in clinical practice, often vary from
the presentation in the text. This pattern belongs to cold damage, but the signs
are not typical. Exterior wind-cold may be mild or it may be severe, so the pulse
may vary. The pulse is also influenced by the constitution of the patient. In line
38, p. 1 13, the severe evil and fierce contention between right qi and evil qi give
rise to a pulse that is tight and to generalized pain. In the present line, a milder
1 . GREATER YANG [LINE 40]
117
evil and more moderate struggle between right ql and evil ql manifest in a pulse
that is floating and moderate, and in heaviness only, without generalized pain. The
heaviness occasionally lightens because the disease is in the exterior and the yang
ql is temporarily able to push it out. When the heaviness returns, it is because the
yang ql retreats and the evil falls back into the construction-yin.
This line illustrates that one must not equate individual signs or pulse qualities
with a given pattern. Generalized heaviness may occur in lesser yin disease; conse­
quently, we are reminded in this line that “there are no lesser yin signs.” Heaviness
that occurs in lesser yin disease is unceasing 缸id accompanied by reversal cold of
the limbs, no heat effusion or aversion to cold, and a faint, 且ne pulse. In this pat­
tern, the generalized heaviness is not unceasing; therefore, this is not a lesser yin
pattern. The heaviness in this line is the result of an evil fettering the exterior
and obstructing the outward movement of sweat. Major Green-Blue Dragon De­
coction ( da qzng long tang) is used because heat is harassing the interior, producing
vexation and agitation. In cold damage patterns with generalized heaviness, but
without lesser yin signs, one may use this formula. If vexation and agitation occur
without greater y归g cold damage signs, this formula should not be used.
LINE 40
伤寒表不解 , 心下有水气 ,
干 H区 发 热 而 咳 , 或 渴 , 或 利 , 或
噎 , 或 小 便 不 利 , 少 腹 满 , 或 H击 者 , 小 青 龙 汤 主 之 。
Shang han biiio bu jie, xfn xia you shui qi, gan OU fa re er ke, huo
ke, huo li, huo ye, huo xiiio bian bu li, shao j边 man, huo chuiin zhe,
xiiio qzng long tang zhu zhz.
When i n c。Id da m age the exterior has not resolved a nd [there is] water
qi bel。w the hea rt , 1 with d ry retchi ng, heat effusion a nd cough , a n d pos­
sibly t h i rst or diarrhea , 。r dysphagi a , 2 。r i n h ibited u ri n ation a nd lesser
a bdom i n a l fu l l ness,3 or pa nting, M i nor G reen- Blu e D ragon Dec。cti。n
( xiiio qfng long tang ) g。verns.
TEXT NOTES
1. Water ql below the heart, 心 下 有 水 气 xzn xia u伽 shui qi : 咱 elow the heart"
means the upper abdomen and stomach duct region. “Water ql” refers to
water swelling or water-rheum, depending on the context. When understood
as water swelling, it means pathological excesses of water in the body and,
specifically, the swelling provoked by it. Th e main cause is impairment of
movement and transformation of water due to spleen-kidney y缸g vacuity.
“Ql'’ in the term “water φ” reflects the notion of water in this context as a
perv.部ive ( pathological ) phenomenon. When u n ders t o od as water-rheum, it
means fluid exuded by diseased organs. Clear thin fluid is known as “water”
whereas thin sticky fluid is known as “rheum.” These differ in name and form,
but are in essence the same; hence the compound term.
1 . GREATER YANG [LINE 40]
1 18
a) According to the Shang Han Lim Yan JiU Da Ci Dian, “water φ” refers to
water-humor collecting in the interior of the body and all the pathological
changes that occur as a result of the collected fluid.
b) According to the Shi Yong Zhδng Yf α Dian, “water φ” can refer to water
swelling, wat盯-rheum, and/or phlegm-rheum.
2. Dysphagia, 噎 ye: A feeling of blockage in the throat.
3. Lesser abdominal fullness , 少 腹 满 shd o fo, ma n : A subjective sensation of
expansion and pressure, which may or may not be associated with objectively
perceptible distention felt in the region of the abdomen below the umbilicus.
The term “lesser abdomen" ( 少 腹 shdo Ju) refers to the part of the abdomen
below the umbilicus (called lower abdomen in Western medicine) , as opposed
to the “greater abdomen" ( 大 腹 da fu ) , which refers to the part above the um­
bilicus (epigastrium) . The lesser abdomen is also called 小 腹 xiao 舟 , smaller
abdomen. However, according to some, “lesser abdomen" specifically denotes
the two lateral regions of the abdomen below the umbilicus.
FORMULA
Minor Green-Blue Dragon Decoction ( xia o
qfng long tang)
o Resolve the exterior with acridity and warmth; warm and transform water­
rheum.
麻黄 ( 去节 )
两 五昧子半升
苟药 细辛 干姜
半夏 ( 洗 ) 半升
甘草 ( 炙 )
桂枝 ( 去 皮 ) 各 三
忖 右 八昧 , 以 水一斗 , 先煮麻黄 , 减二升 , 去上沫 , 内诸药 , 煮
取 三 升 , 去 淳 , 温 服 一 升 。 (二) 若 渴 , 去 半 夏 , 加 括 楼 根 三 两 。 (三) 若
微 利 , 去 麻 黄 , 加 莞 花 , 如 一 鸡 子 , 熬 令 赤 色 。 (四) 若 噎 者 , 去 麻 黄 ,
加 附 子 一 枚 , 炮 。 (五) 若 小 便 不 利 , 少 腹 满 者 , 去 麻 黄 , 力日 夜 苓 四 两 。
(对 若 喘 , 去 麻 黄 , 加 杏 仁 半 升 , 去 皮 尖 。 (七) 且 莞 花 不 治 利 , 麻 黄 主
喘 , 今此语反 之 , 疑非仲景意 。
Ma huang ( qu jie) shdo yao xi xrn giin jiang giin cao (zhi) gui zhf ( qu
ge siin liang wu we i zi bdn sheng bdn xia (xi) bdn sheng
( 1 ) You ba w剖, yi shui yf dou, xian zhU ma huang, ji a n er sheng, qu shang mo,
n a zhu yao, zhU qu san sheng, qu zi, wen Ju yr sheng. (2) Ruo ke, qu bdn xia, jia
gua l6u gen san Lia ng . (3) Rub wei Li, qu ma huang, jia rao hua, ru yr jf zi, ao ling
chi se. ( 4) Ruo ye zhe, qu ma huang, jia Ju zi yr mei, pao. (5) Ruo xiao bian bu li,
shii.o Ju m a n zhe, qu ma huang, jia Ju ling si Liang . (6) Ruo chuan, qu ma hi山肌
jiii xing ren bdn sheng, qu p i jiiin. (7) Qie rao huii bu zhi li, ma huang zhU chuiin,
j伽 ci yu Jan zhf, yi Jei zhong jing yi.
p {)
ephed ra (麻 黄 ma ht而ig, Ephed rae Herba) 3 Ii温ng ( remove nodes)
peony (巧 药 shdo yao, Paeoniae Radix) 3 li�ng
asa rum ( 细 辛 xi xfn, Asiasari Herba cum Radice) 3 lil!ng
d ried gi nger (干 姜 gan jiang, Zi『lgiberis R hizoma Exsiccatu m) 3 Ii温ng
m ix-fried licorice (甘 草 gan ciio, Glycyrrhizae Radix) 3 lil!ng
1 . G REATER YANG [LINE 40]
119
cinna mon twig ( 桂 枝 g创 zh豆 C i n 『1 a m。 m i Ra m u l us) 3 Ii昌ng (remove bark)
schisa ndra (五 昧 子 wu wei zi.’ Schisa n d rae Fr tus) half she『1
pinel lia ( 半 夏 bdn xia’ Pinelliae Tu ber) h a lf she鸣 (washed )
( 1 ) [For] the a bove eight i ngredients use one d训 of water. First boil ephed ra ( ma
h uang) to reduce [the water] by two sheng. Remove the foa m [col lecti ng] on t。p a nd
add a l l the i ngredients. Boil to get th ree sheng, remove the d regs, and ta ke one sheng,
warm. (2) If [there is] t h i rst, 陀move pi『1ellia ( bdη xia) a nd add 3 Ii温ng 。f t
root (g回 l6t』 gen) . (3) If [there is] m i ld diarrhea , remove ephed ra ( ma huang), a d d a
piece of gray wikstroem ia flower (rao hua) the size of a ch icken’s egg, a nd d ry-fry u ntil
it is a red color. (4) I f [there is] dysphagia , remove ephed ra (ma huang) and add one
piece of blast-fried aconite (Ju zi) . (5) If u ri nation is i n h i bited a n d [there is] ful l ness in
the lesser a bdomen , rem。ve ephed ra ( ma huang) and add 4 li�ng of poria (Ju l加g) .
(6) If [there is] pa nting, remove ephed ra ( ma huting) a nd add h a lf a sheng of a pricot
kernel (xing ren), without the ski n a nd tips. (7) Actual ly, g叫 wikstroem ia fl。wer (rdo
hua) does not treat diarrhea a nd ephed ra ( ma huting) treats pa nting. [As the text]
now [sta nds] , these statements are reversed a nd it is [therefo叫 dou bted that this was
Zhong J i ng’s i ntention . *
FORMULA NOTE
*
The final section of text is clearly an addition by a later editor pointing out
an obvious transcription error.
SYNOPSIS
The pathology, clinical manifestations, and treatment of greater y缸g disease
with water-rheum collecting in the interior.
COMMENTARY
In this line, a patient who has water-rheum collecting in the interior contracts
greater y缸ig cold damage disease. The exterior signs have not resolved, so although
it is not written, one would expect to see signs including aversion to cold, absence
of sweating, and heat effusion. This condition, however, is modified by the presence
of water-rheum in the interior. The basic signs associated with this pattern and
with Minor Green-Blue Dragon Decoction (xiao qzng long tang) are dry retching
and cough. The cough results from water-rheum assailing the lung and causing the
loss of normal diffusion and downbearing. The retching results from water-rheum
assailing the stomach and causing counterflow of stomach qi. This type of retching
is dry and occurs in the presence of water-rheum because the regulation of water
movement is impaired. Although water-rhuem collects in the interior, its presence
does not imply excess fluid throughout the body, and the other signs in this line
support this conclusion. Thirst, inhibited urination, diarrhea, and lesser abdominal
fullness indicate the presence of fluid where it should not be and a lack of fluid where
it should be. It should be noted that modern physicians often use this formula to
treat what Western medicine calls asthma.
A comparison with two other related formulae is instructive. Major Green-Blue
Dragon Decoction ( da qzng long tang) is used in greater ya吨 cold damage patterns
with interior heat manifesting as agitation and vexation. Minor Green-Blue Dragon
Decoction (xiao qzng long tang) is used for greater yang cold damage patterns with
water-rheum collected in the interior, which manifests as cough, panting, and dry
1 . G REATER YANG [LINE 4 1 ]
120
retching. For cough and panting, Cinnamon Twig Decoction Plus Magnolia Bark
and Apricot Kernel (gui zhf jia hOu po xing zi tang) m町 be considered, but it
should be used for greater y缸g wind strike (a condition of exterior vacuity) , not
for exterior repletion.
LINE
41
伤寒心下有水气 , 咳而微喘 , 发热不渴 ; 服汤 已 , 渴者 , 此
寒去欲解也 ; 小 青龙汤主之 。
Sh ang han xrn xia you shui qi, ke er wei chuan, fa re bu ke; Ju tang
u记 ke zhe, ci han qu yu jie ye; xiao qing long tang zhu zhz.
When i n cold d a mage, [there is] water ql 1 bel。w the hea rt , c。ugh ,
m i ld pa nti ng, a nd heat effusi。n without t h i rst, {t h i rst, after ta king the
dee。ction , 2 mea ns the cold is g。i ng and [the disease] is a b。ut t。 resolve )
M i nor G reen- B l ue D ragon Dec。cti。n ( xiiio qifng l6叼 tang) governs.
TEXT N OTES
1. Water φ, * 气 shui qi: Here, water-rheum.
2. After taking the decoction, 服 汤 已 Ju tang yi: Minor Green-Blue Dragon
Decoction ( xiao qfng long tang) has already been taken.
SYNOPSIS
A further discussion of the primary distinguishing features and treatment of
greater yang disease with collected water-rheum and evidence that can be used to
evaluate the efficacy of the treatment following the ingestion of medicinals.
C OMMENTARY
The combination of water-rheum and cold damage exterior repletion may pro­
duce variable patterns, but cough and panting are commonly observed. The absence
of thirst may indicate a slightly different water-rheum pattern, but in the preceding
line the reader was alerted that thirst may or may not be present in these patterns.
As in the previous line, cold damage with interior water-rheum is treated with Mi­
nor Green-Blue Dragon Decoction (xiao qfng long tang). The signi自cance of thirst
following the ingestion of the formula has been interpreted in slightly different ways.
According to the Yf Ziing Jfn Jian, it is a positive sign and no further treatment
is necessaη. “Thirst that occurs after taking the decoction and the resolution [of
the disea叫 through sweating is the thirst that follows s weat ing [observed when] the
cold has gone and the interior is d可. It is not the thirst [with] absence of sweating
[observed when] water-rheum impairs [fluid] transformation . . . . One should 国ve
a small amount of water to nourish dryness and allow the stomach to harmonize,
thereby allowing recovery.” This perspective is also held by Ke Qin who adds, “The
decoction is taken, yet there is thirst. The interior water qi is dissipated and the
exterior cold evil is also dissipated. This line aims to clarify that this thirst is a
sign that [the dise出e] has resolved. [ The author] feared that medicinals to allay
thirst would be taken, which would nourish the water qi.” In short , after taking
l . G REATER YANG
12 1
the decoction, thirst is a positive result that means the treatment was correct. The
patient should not be given medicinals for thirst, but should be instructed to drink
a small amount of water.
Nevertheless, Wang H诅 ( 汪 晓 , style 苓 友 Ling『Y凸u ) offers a second interpre­
tation and he writes: “The “thirst” in the previous line ( line 40) is thirst before
taking the decoction [which means] the fluids 町e not moving. The “thirst” in this
line occurs after taking the decoction and [it means] fluid collapse after sweating.”
According to this interpretation, further medicinal treatment is indicated to re­
plenish the fluids that have been lost t hrough sweating; drinking water would be
insufficient and ineffective.
3 . 3 MILD PATTERNS OF EXTERIOR DEPRESSION
Cinnamon Twig Decoction (gui zhf tang) , which harmonizes the construction
and defense, is the primary formula for treating exterior vacuity patterns, while
Ephedra Decoction (ma huang tang), which promotes sweating and diffuses the
lungs, is used to treat exterior repletion patterns. When disharmony of the con­
st ruction and defense occurs simultaneously wi t h a mild evil d epressed in the exte­
rior, neither of these formulae can be used individually. Combinations of these two
formulae are used to treat these patterns, as described below.
a ) Cinnamon Twig and Ephedra Half-and-Half Decoction (gui zhf ma huang ge
ban tang) is used for patients who have had a greater yang exterior pattern
for an extended period of time. The main sign is alternating aversion to
cold and heat effusion, in which the heat is more pronounced than the
cold, and which occurs two or three times per day. The patient’s face may
be red, and generalized itching may be observed. No lesser yang or yang
brightness signs should be observed. In these patterns, wind-cold fetters
the exterior for an extended period of time, and an evil becomes depressed
in the exterior. This formula, which is acrid, warm, and mild, promotes
mild sweating.
b) Two Parts Cinnamon Twig One Part Ephedra Decoction (gui zhf er ma
huang yf tang) patterns are characterized by alternating aversion to cold
and heat effusion, in which the heat is more pronounced than the cold,
and which occurs two times per day. This pattern is similar to the one
above, but milder. The formula is a mild warm acrid one that promotes
mild sweating.
c ) In Two Parts Cinnamon Twig and One Part Spleen-Effusing Decoction (gui
zhf er yue bi yf tang) patterns, alternating aversion to cold and heat effu­
sion, in which the heat is more pronounced than the cold, is accompa且ied
by thirst and heart vexation. In this pattern, wind-cold fetters the exterior
and mild interior heat is present. This formula promotes mild sweating and
clears interior heat .
122
1.
GREATER y ANG [LINE 23]
LINE 23
←) 太 阳 病 , 得 之 八 九 日 , 友日 症 状 , 发 热 恶 寒 , 热 多 寒 少 , 其
人 不 岖 , 清便欲 自 可 , 一 日 二 三 度 发 。 ω 脉微缓者 , 为 欲愈
也 : 脉微而 恶 寒者 , 此 阴 阳 俱虚 , 不 可 更 发 汗 、 更下 、 更吐
也 ; 面色反有热色者 , 未欲解也 , 以其不能得小 汗 出 , 身 必
痒 , 宜桂校麻 黄 各 半 汤 。
( 1 ) Tai yang bing, de zh?: ba jiu 付' rU niie zhuang, fa re WU han, re
duo han shao, qi ren bu au, q?:ng bian yu zi ke, yi ri er san du fa.
(2) Mai wei huan zhe, wei yu yu ye; mai wei er WU han zhe, d yin
yang ju xu, bu ke geng fa han. g切g xia. geng tU ye; mian se fan
you re se zhe, wei yu jie ye, yz qi bu neng de xiao han chu, shen bi
yang, yi gui zhz ma huang ge ban tang.
( 1 ) [I n] greater ya ng d isease [lasting] eight or n i ne d ays a nd resembling
m a l a r ’ 1 i n which [there is] heat effusion a nd aversi。n to cold ( with the
heat effusi。n m。re pronou nced t h a n the aversion to cold ) , a nd i n which
the person d。es not retch , the exc陀tions a re sti l l norma l , 2 a nd [epis。des]
occ u r tw。 。r th ree times per d ay, then [the followi ng a ppl ies] : (2) If
the pu lse is slightly mode时e3 this mea ns [that there is] a bout to be
m。very. If the pu lse is fa i nt a nd [there is] aversion t。 c。Id , t h is means
that b。th yin a nd ya ng a re vacuous4 a nd 。ne ca n not fu rther promote
sweating, fu rther preci pitate, 。r fu rther [ca use] v。m iti ng. H。wever, a
facia l c。m plexi。n with the c。l。r 。f heat5 mea ns [that the d isease] is
not a b。ut to resolve; a n d beca use the pers。n ca n n。t get up a l ight
sweat, there wi l l be genera lized itchi ng; [the陀f。陀’] C i n 『1
a n d Ephed ra H a lf-a nd- H a lf Dec。cti。n (gui zhz m a huang g e ban tang)
is a ppropriate.
TEXT NOTES
1. Resembling malaria, 在日 症 状 ni nue zhuang : Periodic occurrence of heat effu­
sion and aversion to cold, without a set periodicity. It is not considered true
malaria, because of the lack of set periodicity.
2. The excretions are still normal, 清 便欲 自 可 qzng b ia n yu zi ke: No abnormality
in the stool and urine. 清 qzng is understood as 圄 qzng, which means toilet.
The phrase 清 便 qzng bian, rendered here 副 “excretions,'’ means stool and / or
urine. The character 欲 抖 , which means “about to,'’ is here interpreted as
“still” by the authors of both Shang Han Lun Yan JiU Da Ci Dian and Gao
Deng Zh ong Yz Yan JiU Can Kao Cong ShU.
3. The pulse is slightly moderate, 脉 微 镜 mdi w ei huiin: It is possible to interpret
this 臼 the “pulse is faint and moderate,” but here 微 wei is taken to mean
1 . G REATER YANG [LINE 23]
1 23
“slightly” because t h e pulse means that the disease is about to resolve. If the
pulse were faint, one would not expect imminent resolution, since a faint pulse
is an indication of severe vacuity.
4. Both yin and yang are vacuous, 阴 阳 俱 虚 yfn y ang ju xii : Vacuity of the
interior and the exterior. Cheng wιJi writes, “ [With] a pulse that is faint
and aversion to cold, the exterior and interior are vacuous; 同ng means the
exterior, �In means the interior. A pulse that is faint indicates interior vacuity,
and aversion to cold indicates exterior vacuity.”
5. The color of he at , 热 色 re se: The color of heat is red. Cheng Wu-Ji writes,
“ [The term] ‘heat color' means red.”
FORMULA
q inn创non Twig and Ephedra
Half-and-Half
Decoction
(gui zhf ma huti.ng ge ban
tang)
o
A mild acrid warm formula (that ] promotes slight sweating.
挂枝一两十六妹 ( 去皮 )
( 去节 ) 各一两
仁者 )
苟药 生姜 ( 切 )
大枣四枚 ( 壁 )
甘草 ( 炙 )
麻黄
杏仁二 十 四枚 ( 汤浸 , 去 皮 尖 及 两
忖 右七 昧 , 以 水五升 , 先煮麻黄一 二 沸 , 去上沫 , 内诸药 , 煮 取
一 升 八 合 , 去淳 , 温服 六 合 。 同 本云 , 挂枝汤 三合 , 麻 黄 汤 三 合 ,
并 为 六 合 , 顿 服 。 (斗 将 息 如 上 法 。
Jiang shi liu zhu ( qu pf) shti.o yiw , sheng jiang ( qie) . g副 cao
(zhi) . ma huti.叼 (qu jie) ge yf liang da zao si mei ( bO) xing ren er sh{ si mei
( tang jin, qu pi jian ji liang ren zhe)
(1) You qf wei, yi shui WU sheng, xian zhU ma huti.ng yf er fei, qu shang mo, na
zhU yao, zhil qu yr sheng ba 肘, qu z瓦 wen JU liu ge. (2) Ben yun gui zhZ tang s伽
ge, ma huang tang san ge, bing wei liu ge, dun Ju. (3) Jia·叼 xf 叫 shdng fa.
Gui
zhZ yr
ci nna mon twig (桂枝 gui zhZ, Cinnamomi Ra m u l us) 1 li�ng 16 zh u (remove bark)
peony (巧 药 shti.。 ”。, Paeoniae Radix) 1 Ii昌ng
fresh ginger (生 姜 sheng jiang, Zingiberis Rhizoma Recens) 1 li�ng (cut)
mix-fried licorice (甘 草 gan cao, Glycyrrhizae Radix) 1 li�ng
ephed ra (麻 黄 ma huang, Ephed rae He阳) 1 li�ng ( 陀 move nodes)
juj u be (大 枣 da zao, Ziziphi Fructus) 4 pieces ( broken)
apricot kernel (杏 仁 xing T缸, Armen iacae Semen) 2 4 pieces (scald i n hot wa也r,
and remove the ski n , the tips, a nd the two kernels)申
(1) (For] the a bove seven ing时ients use 币ve she鸣 of water. First boil ephedra
(ma huti.ng) once or twice a nd remove the foam [collecting) on top. Add all (the other)
ingredients and boi l to get one sheng eight g�. Remove the d regs a nd ta ke six g运
warm . (2) This is th ree g运 of Cinna mon Twig Decoction (gui zhZ tang) a n d three g�
of Ephedra Decoction ( ma huang t ang) com bi ned to make six g运 a nd taken as a single
dose. (3) [One shou ld] rest, as in the previous method (for Cinna mon Twig Decoction
(gui zhZ t ang)) .
1 24
1 . GREATER YANG [LINE 23]
FORMULA NOTE
*
Scald in hot water, and remove the skin, the tips, and the two kernels, 汤 浸 ,
去 皮 尖 及 两 仁 者 tang jin, qu pi jian ji liii.n� ren zhe: We do not know what
the meaning of the phrase, “two kernels" is in this context.
SYNOPSIS
a) Three possible scenarios that may appear in unresolved greater y缸g disease.
b) The distinguishing clinical features and treatment of greater yang mild ex­
terior depression patterns.
COMMENTARY
Eight or nine days is considered to be a long course for greater yang disease.
Heat effusion and aversion to cold, with the heat effusion predominant, is said to
be similar to but not the same 凶 malaria. It is not the same as malaria because
it does not have the same set periodicity typical of malaria. It is not clear whether
this means heat effusion and aversion to cold occurring simultaneously or whether it
means alternating aversion to cold and heat effusion, as is seen in malaria. Regard­
less of which is the correct interpretation, it is clearly stated that the patient does
not retch and the urine and stool are normal. This information is provided because
after a protracted disease course, particularly when malaria-like signs are observed,
one may be concerned that the disease has shifted to the lesser y缸g. That the
patient does not retch is one indication-although not an absolute assurance-that
the disease has not shifted to the lesser y缸g. Another possibility is that the disease
has shifted to the y缸g brightness, but since the heat and cold signs 町e not char­
acteristic of a y缸g brightness pattern and the stool and urine 町e normal, this is
unlikely. On the basis of the information in the text, one can infer that the disease
is still in the exterior and an unresolved evil is depressed in the exterior.
At this point, the reader is presented with three possible transmutations. The
first is that the pulse is slightly moderate. If this pulse appears, one knows that the
disease is about to resolve and no treatment is necessa可. In the second, the pulse
is fai时, the heat effusion ceases, and aversion to cold continues, indicating that
both the interior and the exterior have become v配uous. As a result, one cannot
use sweating, precipitation, or vomiting to treat this patient, but must supplement
the vacuity, so that right qi can expel the depressed evil. The third, in which
the disease is not about to resolve, is characterized by red facial complexion and
generalized itching, which occur because the patient is not able to sweat and the evil
remains depressed in the exterior. You Yi explains the itching as follows: “[When]
an exuberant [exterior] evil attacks the channels and sinews, [there is] pain. [When]
a mild evil moves 国 the skin, [there is] itching.” According to You Yi, this last
condition occurs because the patient cannot get up a light sweat. The exterior is
not obstructed by a repletion evil, for which the strong promotion of sweating with
Ephedra Decoction (ma huang tang) would be 叩propriate. Here, a mild evil is
depressed in the exterior and the patient is unable to sweat normally. The defense
and construction must be harmonized through the use of Cinnamon Twig Decoction
(gui zh'i tang) and light sweating must be promoted through the use of Ephedra
Decoction (ma huang tang). As You Yi writes:
Seeing that (the patient ] has not yet been able to sweat, this is not ( a
disease] Cinnamon Twig Decoction ( gui zM tang ) can resolve. Also, the evil
1.
GREATER yANG [LINE 25]
125
is mild, so Ephedra Decoction (ma huang tang) cannot [be used] to promote
sweating. Thus the two formulae are combined into one formula.
Cinnamon Twig and Ephedra Half-and-Half Decoction (gui zhf ma huang ge
ban tang) contains equal proportions of the two formulae and the dosage of all in­
gredients is one-third of the original. This formula promotes sweating more strongly
than Cinnamon Twig Decoction (gui zhf ta叼) but less strongly than Ephedra De­
coction (ma huang tang) . It resolves the exterior, mildly promotes sweating, and
will not damage right φ.
LINE 25
付 服 桂校 汤 , 大 汗 出 , 脉 洪 大 者 , 与 桂 校 汤 , 如 前 法 。
仁) 若
形似疤 , 一 日 再发 者 , 汗 出 必解 , 宜桂校 二 麻 黄一汤 。
( 1 ) Fu gui zhz tang, da han chu, mai h6叼 da zhe, yu gui zhz tang,
T甘 qian fa. (2) Ruo xing si nue, yi ri zai fa zhe, han chu bi M己 yi
gui zhz er ma huang yf tang.
( 1 ) When after ta king Ci n n a mon Twig Dec。ction (gui zhf tang ) , [t here
is] great sweating a n d the pu lse is su rgi ng a nd l a rge, use C i n n a m。n
Twig Dec。cti。n (g创 zhf tang) as before. (2) If [the disease] resembles
m a l a ria , occu rri ng twice a day, * sweating wi l l resolve [the d isease] a nd
[therefore, ] T w。 Pa rts C i n n a mon Twig One Part Ephed ra Decocti。n
(gui zhf er ma huang yi tang) is a ppr。priate.
TEXT NOTE
*
Occurring twice a day, 一 日 再 发
zai means a second occurrence.
yf ri zai fa: Two occurrences each day. 再
FORMULA
Two Parts Cinnamon Twig One Part Ephedra Decoction
(gui zhf er ma huang yf
tang)
o
A
mild acrid warm formula [that] promotes slight sweating.
桂枝 一 两 十 七 株 ( 去 皮 ) 苟药一 两 六 株 麻 黄 十 六 株 ( 去 节 )
姜一两 六株 ( 切 ) 杏仁十 六 个 ( 去皮尖 )
甘草一两 二株 ( 炙 )
枣五枚 ( 擎 )
生
大
付 右七 昧 , 以水五升 , 先煮麻黄一二沸 , 去上沫 , 内诸药 , 煮取
二升 , 去津 , 温服一升 , 日 再服 。 问 本云 , 桂枝汤 二 分 , 麻 黄汤一
分 , 合 为 二 升 , 分 再 服 。 仨) 今 合 为 一 方 , 将 息 如 前 法 。
Gui zhf yf liang shi qf zhu ( qu p f) sMo yao yf liang liu zhU ma huang shi
liu zhu ( qu jie) sheng jiang yf liang liu zhU ( qie) xing T印 shi liu ge ( qu pi jian)
gan cao yf liang er zhu (zhi) da zao 叫 mei ( bo)
1.
126
G REATER YANG [ LINE 25]
(1) You qz wei, yz shuz 叫 she-ηg, xian zhii ma huang yf er fei, qu shdng mo, n
zhii ydo, zhii qii er sheng, qu z记 wen Ju yz sheng, ri zai Ju. (2) Ben yun gui zhf tang
er Jen, ma huang tang yz Jen, M wei er sheng, Jen zai Ju. (3) Jzn M wei yz Jang,
jiang xf ru qian Ja.
cin n a mon twig ( 挂 枝 gui z机 Cinna momi Ram u l L时 1 li�ng 17 zhu ( remove bark)
peony (巧 药 shao yao, Paeoniae Radix) 1 Ii温 ng 6 zh u
ephedra (麻 黄 ma huang, Ephed rae He阳) 16 zh u (remove nodes)
f『esh gin ger (生 姜 sheng jia叼, Zingiberis Rhizoma Recens) 1 Ii.ling 6 zhu (cut)
apricot kernel ( 杏 仁 xing ren, Armen iacae Semen) 16 pieces ( re m ove skin and ti ps)
m i x- fr i ed licorice (甘 草 gan cao, G lycyrrhizae Radix) 1 li� ng 2 zhu
j uj u be (大 枣 da zao, Ziziphi Fructus) 5 pieces ( broken)
(1) [For] t h e a bove seven i ngredients use five she吨 of water. Fi rst boil ephedra
( ma huang) once or twice and remove the foa m [collecting] on top. Add a l l {the other]
i ngredients and boil to get two sheng. Remove the d regs and ta ke one sheng warm ,
then ta ke aga i n [the sa m e] day. (2) This is two pa巾 Ci n n a mon Twig Decoction (gui
zhf tang) a nd one pa 内 Ephed ra Decoction ( ma hua叼 tang) com bined [to ma ke] two
sh否咯 Separate [into two parts] , [take one] then ta ke aga i n . (3) Nowadays, [these
two form u la] a 陀 combined into 。ne form u la , a n d (one should] rest, as in the previous
method [for Ci n n a mon Twig Decoction (gui zhf tang)].
SYNOPSIS
a) Three possible scenarios tl刚 may appear in u盯esolved greater y缸g patterns.
b ) The distin guishi ng clinical features and treatment of greater y缸g mild ex­
terior depression p atterns .
COMMENTARY
When Cinnamon Twig Decoction (gui zhf tang) is given , the patient should
sweat lightly so that the body just becomes moist. Above, following the ingestion
of Cinnamon Twig Decoction (gui zhf tang) , copious sweat issues. This type of
sweating is inappropriate and as Zhang JI writes in line 12, p. 60, “One cannot
allow [the sweat] to flow like water, since the disease will not be eliminated [in t hi s
way] .” The disease does not resolve and in the line above, the reader is presented
with two possible transmutations. The 直rst is that the pulse becomes surging and
large. It mi gh t be i nferre d that the disease has shifted to the yan g bri ght n ess , but
this does not appear to be the case since none of the signs generally associated
with y缸g brightness disease, like vexing thirst and great heat , are present. Fur­
thermore, Cinnamon Twig Decoction (gui zhf tang) is prescribe d as it was given
before. Although treated inappropriately, the disease has not tr ansmu t ed and a
greater yang exterior pattern still exists. The other possibility is that the disease
c o ndit io n changes and gives the appearance of malaria. As in the previous line, this
suggests periodic occurrences of h eat effusion and aversion to cold and is indicative
of an ev il depressed in the exterior. The treatment in both lines is similar, although
here the formula is two parts Cinnamon T wig Decoction (gui zhf tang) to on e p art
E phedra Decoction ( m a huang tang), while in the previous line equal parts of both
are gi ven . Xti Da Chun co mments , “ T he 皿e aning of t his [formula and that of]
Cinnamon Twig and Ephedra Half-and-Half D eco ction (gui zhf ma hua叼 ge ban
tang) is similar, but b ec ause great sweating has occurred , [ the dose] of Cinnamon
1.
GREATER YANG [LINE 27]
127
Twig Decoction (gui zhr tang) is slightly more and [the dose ] of Ephedra Decoction
(ma huang tang) is slightly less.”
One question that unfortunately remains unanswered is why, in a case of pro­
fuse sweating, a formula containing ephedra (ma huang) is suggested . A possible
answer to this question is that whenever Zhang JI encountered a dise槌e with the
appearance of malaria, but which was not malaria, he used a combination of Cinna­
mon Twig Decoction (gui zhf tang) and Ephedra Decoction ( ma huang tang), even
if sweating had already occurred.
LINE 2 7
太阳病 , 发热恶寒 , 热 多 寒 少 , 脉微弱 者 , 此无阳也 , 不 可
发 汗 , 宜桂枝 二 越牌一汤 。
Tai yang bing, fa re WU han, re duδ han shao, mai wei ruo zhe, ci
WU yang ye, bu ke fa han, y{ gui zhi: er yue bi yi: tang.
When i n greater ya ng disease [there is) heat effusi。n a nd aversion to
cold [with] more heat a nd less c。Id (a pu lse that is fa int a n d wea k
mea ns that ya ng is a bsent* a nd 。ne ca n not prom。te sweati 昭) , Two
Parts C i n n a mon Twig a nd One Part Splee忏Effusi ng Decoction ( gui zh i:
er yue bi yi: tang) is a ppropriate.
TEXT NOTE
*
y缸g is abse时 , 无 阳 wu
yang:
Great vacuity of yang ql.
FORMULA
Two Parts Cinnamon Twig and One Part Spleen-Effusi吨 Decoction (gui zhf er
yue
bi yf tang)
。 Promote sweating mildly; clear interior heat.
挂枝 ( 去 皮 )
苟药 麻黄 甘草 ( 炙 ) 各十 八株
生姜一两 二株 ( 切 )
石膏 二 十 四 株 ( 碎 , 绵裹 )
大枣四枚 ( 壁 )
忖 右七昧 , 以 水五升 , 煮麻黄一二 沸 , 去上沫 , 内诸药 , 煮取二
升 , 去 淳 , 温 服 一 升 。 (二) 本 云 , 当 裁 为 越 牌 汤 、 桂 枝 汤 合 之 , 饮 一
升 。 (三) 今 合 为 一 方 , 挂 枝 汤 二 分 , 越 牌 汤 一 分 。
G时 zhf ( qu pi') ' shao yao. ma huang. gan cao (zhi) ge shi ba zhii da zao si
mei ( bo) sheng jiang yf l巾ig er zhU ( qie) shi gao er shi si zhii ( sui, mian guo)
(1) You qf w剖, yz shui wu sheng, zhu mti huang yf er fei, qu shang mo, na zhii
yao, zhU qu er sheng, qu zz, wen Ju yf sheng. (2) Ben yun dang ctii wei yue bi tang、
gui zhf tang he zhf, yin yf sheng. (3) Jfn he wei yf fang, gui zhf tang er fen, yue bi
tang yf fen.
cin n a mon twig
(桂枝 gui zh瓦 Cinnamomi Ra m u h 』s) ( remove bark)
1 8 z h ii
1 28
1 . GREATER y ANG [LINE
27]
peony (巧 药 sh<i.o yiw, Paeon iae Radix ) 18 zhii
ephed ra (麻 黄 ma huang, Ephed rae H erba ) 18 z h ii
mix-fried licorice (甘 草 giin ciio, G lycyrrhizae Radix ) 18 zh ii
j uj u be (大 枣 da ziio, Ziziphi Fructus ) 4 pieces ( broken )
fresh gi nger (生 姜 sheng jiang, Zingiberis Rhizoma Recens ) 1 liling 2 zhii ( = 32
gra ms ) ( cut )
gypsu m ( 石 膏 shi gao, Gypsu m ) 24 zh ii (= 16 grams ) ( crushed , cotton-wra pped )
( 1) [ For] the a bove seven i ngred ients use five sheng of water. First boil ephed ra
( ma huang) once or twice, then 陀move the foa m [collecting] on top. Add a l l the
i ngredients a nd boil to get two sheng. ( 2 ) Remove the d regs a nd ta ke one she略 warm .
( 3 ) T h is should be considered to be a combination of C i n n a mon Twig Decoction (gui
zhf t伽g) a nd S pleen- Effusing Decoction ( yue bi tang) taken in a one-she吨 [dose] .
( 4) Nowadays, they a 陀 com bined into one formula, with two pa巾 of Cinna mon Twig
Decoction (gui zhf tang) to one pa此 of S pleen-Effusi吨 Decoction ( yue bi tang) .
S YNOPSIS
a) The distinguishing clinical features and treatment of a mild pattern of an
exterior evil depressed in the greater yang with interior heat .
b ) An example of a contraindication for the use of Two Parts Cinnamon Twig
and One Part Spleen-Effusing Decoction (gui zhf er yue bi y'i tang).
C OMMENTARY
In greater yang disease, heat effusion and aversion to cold are often present.
The phrase “more heat and less cold" occurs only twice in the Shiing Han Lim ,
here and in line 23, p. 122. The situation described in this line is similar but not
identical to that of line 23. In that line, the signs are periodic, whereas in this line,
there is no indication of periodicity. Given the conditions described in the lines
above, one would consider this pattern to be one of an evil depressed in the exterior
and would expect a combination of Cinnamon Twig Decoction (gui zhf tang) and
Ephe的 Decoction (ma huang tang) to be used. In fact , Two Parts Cinna皿on
Twig and One Part Spleen-Effusing Decoction (gui zh'i er U时 bi y'i tang) contains
elements of these two formulae, but it also includes gypsum ( shi giio) . Because
this ingredient clears interior heat, the authors of Gao Deng Cong ShU write that
interior heat is also present in this pattern.
The middle section of this line has been explained in two ways. The 且rst is that
this line presents only one pattern and the phrase, “one cannot promote sweating,”
不 可 发 汗 bu ke fa hdn, means that ·because the pulse is faint and weak, one cannot
promote great sweating. As Wang Hii writes, “The four words ‘one cannot promote
sweating’ mean that one should not again promote great sweating, because this
patie1的 pulse is faint and weak, [there is] no M吨, and the fluids 缸e scant. This
formula, compared to the previous one, which lightly promoted sweating, is even
milder."
Another possibility, as suggested by Zhang Nan ( 章 楠 , style 虚 谷 Xu-G 训 , is
that this line contains a grammatical inversion and in actual fact , describes two
patterns. “This line is appropriately seen as two [lines] . [The section] “Two Parts
Cinnamon Twig and One Part Spleen-Effusi吨 Decoction (gui zh'i er yue bi y'i tang)
is appropriate" should be placed after “more heat and less cold.” If the pulse is faint
1.
GREATER YANG [LINE 48)
129
and weak, and this means that there is no ya吨, how can one promote sweating
again? Therefore, Zhang JI is stating a contraindication, that one cannot promote
sweating."
Of the two interpretations presented above, the second is the more reasonable
because of the general contraindication against the promotion of sweating. That
is, even if the patient ’s pulse is not faint and weak, great sweating is generally not
appropriate.
LINE
48
忖 二 阳并病 , 太阳初得病时 , 发其汗 , 汗先 出 不彻 , 因转属
阳 明 , 续 自 微汗 出 , 不 恶 寒 。 。 若太阳病证不 罢者 , 不 可
下 , 下 之 为 逆 , 如 此 可 小 发 汗 。 (斗 设 面 色 缘 缘 正 赤 者 , 阳 气
↑弗 郁 在 表 , 当 解 之 、 熏 之 。 (四) 若 发 汗 不 彻 , 不 足 言 , 阳 气 佛
郁不得越 , 当 汗不 汗 , 其 人躁烦 , 不 知痛处 , 乍在腹 中 , 乍
在 四 肢 , 按 之 不 可得 , 其 人短气但坐 , 以 汗 出 不 彻 故也 , 更
发汗则愈。 间 何 以知 汗 出 不彻 , 以脉清故知也 。
( 1 ) Er yang bing bing, tai yang chu de bing shi, fa qi han, han xian
chu bu che, yin zhuan shu yang ming, xu zi wei han chu, bu wu han.
(2) Ruo tai yang bing zheng bu ba zhe, bu ke xia, xia zhz wei 时, rU
ci ke xiao fa han. (3) She mian se 仰an yuan zheng chi zhe, yang
qi JU yu zai biao, dang jie zhι xun zhι ( 4) Ruo fa han bu che, bu
zu yan, yang qi Ju yu bu de yue, dang han bu han, qi ren zao fan,
bu zhi tong ch毡, zha zai Ju zhong, zha zai si zh'i, an zh'i bu ke de, qi
ren duan qi dan zuo, yi han chii bu che gu ye, geng fa han ze yu.
(5) He yi zhr han chu bu che, yi mai se gu zhr ye.
( 1 ) I n d 吨over d isease of the two y a ng , 1 the d isease begi ns i n the
greater ya ng; sweating is promoted a n d the sweating is i n complete,
wh ich ca uses the d isease t。 s h ift t。 the ya ng brightness a nd [there is]
c。ntim 』。us sl ight sponta neous sweati ng a nd a bsence of aversi。n t。 cold .
(2) If the greater ya ng d isease pattern has not ceased , 。ne can n ot p陪
ci pitate, beca use precipitation [wou ld be] a n adverse [treatment] a n d i n
this case, 。ne ca n promote sweati ng m i ld ly. (3) I f the fa cia l c。m plexi。n
is contin uously fu l l red , 2 the yang ql3 is depressed in the exterior a n d
h叫 sh。u ld res。Ive [the exterior a nd] fu me.4 (4 ) I f sweating i s promoted
i n c。m pletely, [that is to say] i nsufficiently to spea k 。f,5 the ya ng qi is
depressed a nd ca n not pass out so there should be sweating but [there
is] not. The person is agitated a nd vexed a nd does not know where the
130
1 . G REATER YANG [LINE 48]
pa i n is located ; n。w it is in the a bdomen , now it is in the ext remities,
a nd [when ] pressi ng, 。ne ca n n创 fi nd it.6 The person is sh。目 。f breath
a nd ca n 。 n ly sit.7 This is beca u se sweating was i ncom plete a nd fu rther
promotion 。f sweating wil l lead to rec。very. (5) H。w ca n one know that
the sweati ng was i ncom plete? One knows beca use the pu lse is rough .
TEXT N OTES
1. Dragover disease of the two yang, 二 阳 并 病 er yang bing bing: Dragover dis­
ease of the greater yang and yang brightness channels. As in the Yr Zang
Jzn Ji an, “ . . . the two yang means greater yang and yang brightness . . . .”
Dragover disease is differentiated from combination disease in terms of tern­
poral appe町ance of signs. In both dragover disease and combination dise副e,
signs of more than one channel appe缸. In dragover disease, disease of one
channel has not yet ceased when signs of another channel appear. In combina­
tion dise副e, signs belonging to more than one channel appear simultaneously.
See also line 36, p. 99.
2 . The facial complexion is continuously full red, 面 色 缘 缘 正 赤 mian se yuan
yuan zheng chi: 缘 缘 yuan yuan means unceasing ; 正 赤 zh e ng chi means a
full red color.
3. y缸g qi , 阳 气 yang qi: Evil 啡, not the defensive y缸ig of the patient .
4. [One] should resolve [the exterior an叫 fume , 当 解 之 , 熏 之 dang jie zh毛 run
zhf: The promotion of sweating to resolve the exterior, and fuming the ex­
terior. Although in many places in the text Zh加g JI describes fuming as a
mistreatment, he appears to regard it as appropriate in this situation.
5. [That is to say] insufficiently to speak o f., 不 足 言 b u zu yan: Three different
interpretations 町e offered for this phrase.
a) The first interpretation, which we have used in the translation, is that the
amount of sweat is so small that it is not worth mentioning. The authors
of Shang Han Lim Yi Shi state, “Sweati吨 is promoted, [but the sweat]
does not outthrust; [therefore,] although there is sweating, it is not worth
mentioning.'’
b) The second interpretation is that it refers to the phrase that follows, and
means that it goes without saying that when there is incomplete sweating,
the y缸ig qi must be depressed; it is unnecessary to state this point . Wang
H诅 writes, “[Describing] this situation, sweati吨 is promoted i配ompletely,
and this person’S yang φ is depressed and cannot pass out ; it is insufficient
to speak of. ‘Insufficient to speak of' means that it (incomplete sweating)
follows as a matter of course (when y归g qi is depressed) ; [therefore,] it is
unnecessary to state this.”
c) The final interpretation is that it relates to the phrase that follows and
means that incomplete sweating is insufficient to produce a condition of
yang qi depression. Cheng wιJI writes, “If the promotion of sweating is
incomplete, this is insufficient to then say that yang qi is depressed. [One
can] only [say] that there should have been [an appropriate amount of]
sweating and there was not [this amount of] sweati吨. [It is true that] the
1.
GREATER yANG
131
yang qi cannot pass out; the evil has no exit and is severely congested in
the channel; therefore [there is] vexation and agitation.”
6. [When] pressing, one cannot 且nd it, 按 之 不 可 得 an zh'i bu ke de: No pain when
the area is palpated. Zhδu Yang-Jun writes, “ [There is] no real pain, that is
why it says, ‘when pressing, one cannot find it'.”
7. Short of breath and can only sit , 短 气 但 坐 duiin qi dan zuo: The patient ’s
breathing is short, rapid, and shallow and may be discontinuous. The patient
is not comfortable lying down and can only sit up.
SYNOPSIS
The distinguishing clinical features and treatment of two scenarios that can
occur following the incomplete promotion of sweating in a greater yang disease.
COMMENTARY
In dragover disease of the greater yang and yang brightness channels, the greater
yang signs have not yet ceased and yan? brightness signs appear. This occurs
because the promotion of sweating was incomplete. That is, the sweating was
insufficient to expel the evil and it shifts into the yang brightness. A version to
cold ceases and aversion to heat and continuous slight sweating may be observed,
indicating a shift to the yang brightness. Although the evil is shifting into the
yang brightness, if the greater yang signs have not completely ce臼ed, one cannot
precipitate the interior. This treatment would cause any residual exterior evil to
fall inward and it is described by Zhang JI as an adverse [treatment ] , 逆 时. One
may promote sweating, but only mild sweating, since sweat has already been lost.
If the face appears continuously red, it means that the evil is depressed in the
exterior and one should promote sweating and fume the exterior.
The section of text starting from “if sweating is promoted incompletely” refers
back to the beginning of the line. Sweating has been promoted incompletely, but
the disease has not shifted to the y扭g brightness. The signs in this section indicate
an evil depressed in the exterior. Sweating was promoted to expel the evil, but
because of the method used or the patient’s constitution, the evil has not resolved
and blocks the exterior. Movement of the y缸g qi is impaired, resulting in vexation
and agitation. The patient feels discomfort, but cannot identify the exact location.
When the exterior is blocked, lung qi becomes inhibited, resulting in shortness of
breath and ability to feel comfortable only when sitting up. Zh缸ig JI explains that
this is all the result of incomplete sweating and that sweating should be promoted
again in order to bring about resolution.
In the final section, Zhang JI suggests that the pulse provides a basis for deter­
mining whether the sweating is incomplete. He explains that if the pulse is rough,
it means that sweating is incomplete. When sweating is incomplete, evil qi becomes
depressed in the exterior and blocks the flow of y 缸g qi.
4
TRANSMUTED PATTERNS OF GREATER
YANG DISEASE
’Transmuted patterns can occur either as a result of inappropriate treatment,
when an extremely severe exterior evil is contracted, or as a result of factors related
to the constitution of the patient. Many of the transmuted patterns presented
132
l. GREATER YANG [LINE 1 6Aj
here 缸e the result of inappropriate treatment, including sweating, precipitation,
vomiting, and fire. These transmuted patterns 缸e not the only outcomes of inap­
propriate treatment; by reading further we can understand the pathomechanism of
the pattern, the method of identifying the pattern and differentiating further treat­
皿ents, and the principles for choosing formulae and individual medicinals. Looking
at these transmuted patterns, we will see that many 町e commonly encountered in
clinical practice and that the suggested formulae are commonly used in the treat­
ment of these patterns. These treatment principles and accompanying formulae
can, therefore, be used not only in greater y归g transmuted patterns, but if they
are well understood, in a wide range of clinical applications. In greater y缸ig disease,
transmuted patterns are classified into patterns of heat, vacuity cold, yin-yang dual
vacuity, water amassme时, blood amassment, chest bind, storehouse bind, glomus,
heat above and cold below, adverse treatment with fire, and those that are about
to resolve.
4 . 1 TREATMENT PRINCIPLES FOR TRANSMUTED PATTERNS
LINE 1 6 A
忖 太 阳病三 日 , 已 发 汗 , 若吐 、 若下 、 若温针 , 仍不解者 ,
此 为 坏 病 , 桂 校 不 中 与 之 也 。 (二) 观 其 脉 证 , 知 犯 何 逆 , 随 证
治之 。 .
( 1 ) Tai ya叼 bing s伽 时, yi fa him, ruo tu、 ruo xia、 ruo wεn
zhen, reng bu jie zhe, ci wei huai bing, gui zhz bu zhong yu zhi ye.
(2) Guan qi mai zh切g, zhz fan he 叭 sui zh切g zhi zhf. . . .
( 1 ) When greater ya ng disease [has lasted for] th ree days [a nd] sweati ng
has a l ready been prom。ted , if v。m iti ng, [。r] if preci pitation , [。r] if wa rm
need I i 鸣1 [has been used] a nd sti l l [there is] no resol ution , 2 th is is a n
agg刚ated d i sease3 [i n wh ich] C i n n a mon Twig [Dec。ction] (gui zhz
[tang] )4 should not be given . (2) O bserve the pu lse a n d signs, know
what error [you] have com mitted , 5 [a nd t hen] treat accord i ng t。 the
signs. …
TEXT NOTES
1 . Warm needling, 温 针 wen zhen: After the needle is inserted, moxa floss is
placed on the handle and lit in order to warm the needle and the local 缸ea.
This technique is used to warm the channels and free the vessels and to move
the ql and quicken the blood.
2. Still [there is] no resolution, 仍 不 解 者 reng bu jie zhe: The disease has not
resolved, but the exterior evil is no longer present. Exterior signs are absent,
but the patient has not recovered and a negative transmutation has taken
place.
3. This is an aggravated disease, 此 为 坏 病 ci' wei huai bing: A negative change
in the disease course following inappropriate treatment .
1.
GREATER yANG [LINE 70]
1 33
4. Cinnamon Twig [ Decoction] ( g ui zhf [tang]) 挂 枝 gui zh仨 The full name is not
written in the text, but this is assumed to mean the formula, not the single
medicinal cinnamon twig (gui zhf) .
SYNOPSIS
The treatment principles for transmuted patterns that occur following the mis­
treatment of a greater yang disease.
COMMENTARY
In greater yang disease, the standard treatment is the promotion of sweating.
Here, sweating has been promoted, but apparently it was unsuccessful and conse­
quently, other treatments were used. The disease has not resolved and has instead
transformed into what Zhang JI refers to as an aggravated disease, 坏 病 huai bing.
One may observe many different transmutations depending upon what treatments
have been given. The reader is advised not to give Cinnamon Twig Decoction (gui
zhf tang), but to investigate the patien current condition and treat accordingly.
This line expresses an important element of the spirit of the text. The Shang Han
Lim was ar伊ably the 且rst text to explicitly suggest the principle that much later in
history came to be called “determining treatment by the patterns identified,” 辨 症
论 治 bian zh eng Lim zhi. That is, it is not simply a matter of which formula t o use
for the treatment of which sign, but also one of understanding the pathomechanism
and any transmutations. The result of this approach is that different patterns may
be treated with the same formula and that different formulae may be used to treat
the same pattern. One must use th e diagnostic tools of inspection, listening and
smelling, inquiry, and palpation to identify the pattern. Once the pattern is clearly
understood, the choice of the correct treatment can then be made. The suggestion
of this approach is important, of course, not only in the treatment of aggravated
diseases, but in the physician’s general approach to treatment.
4 . 2 DIFFERENTIATION O F VACUITY AND REPLETION
PATTERNS
LINE 70
卜) 发 汗 后 恶 寒 者 , 虚 故 也 。
ω 不 恶寒 , 但热者 , 实也 。
问
当 和 胃 气 , 与调 胃 承气汤 。
( 1 ) Fa hem hou WU han zhe, XU gu ye. (2) Bu WU ha叽 dan re zhe,
sh{ ye. (3) Dang he wei qi, yu tiao 时i cheng qi tang.
( 1 ) After sweating is promoted , if [there is] aversion t。 c。Id , [t h is] is
beca use 。f vacu ity. (2) If aversi。n t。 c。Id is a bsent, a nd only heat (ef­
fusion ] * [ is present] , t h is i ndicates repletion . (3) O n e sh。uld h armonize
the stomach qi with Stomach- Regu lating Ql-C。。rd i n ati ng Dec。ction
( tiao t州 c heng qi tang ) .
1.
134
GREATER YANG [LINE 60]
TEXT NOTE
Heat [effusion] , 热 re: The term translated as “heat effusion” is usually 发 热
*
fa re, but here this single character, r;.� re , is considered equivalent .
FORMULA
Stomach-Regulating Qi-Coordinating Decoction ( tiao wei
248, p. 327, for a full discussion of this formula.
cheng qi tang) . See line
SYNOPSIS
The differentiation of vacuity and repletion scenarios after the promotion of
sweating.
COMMENTARY
This line presents two scenarios which may occur when a disease fails to resolve
after the promotion of sweating. The 且rst is characterized by aversion to cold and
the second by heat effusion. The promotion of sweating does, in fact, cause some
damage to the body, but Zhang JI recognized that the presence of an evil also
damages the body. The use of a mildly harmful treatment method will ultimately
bene直t the patient.
This line speci直es the damage that may result from of the promotion of sweat­
ing. A version to cold is the result of an inability of vacuous y缸ig qi to warm the
exterior, following damage to right φ. Heat effusion without aversion to cold is
the result of damage to the fluids and transformation to heat repletion. The pa­
tient’s constitution also plays a role in the development of disease; consequently,
in patients who are already vacuous, treatment may exacerbate the vacuity and in
patients with exuberant yang, treatment may damage yin humor. An examination
of the formula reveals that it is used for yang brightness disease with dryness, heat,
and internal bind and is appropriate for repletion patterns. The repletion pattern
in the second part of this line is one of internal dryness and heat that is the result
of damage to the fluids caused by the promotion of sweating. This type of trans­
mutation, following the promotion of sweating, is most likely to occur in a patient
with a preexisting condition of yang exuberance and yin vacuity.
LINE 60
付 下之后 , 复发 汗 , 必振寒 , 脉微细 。
ω 所以 然者 , 以 内
外俱虚故也 。
( 1 ) Xia zh?: hou, j边 fa han, bi zh切 han, mai wei xi. (2) Suo yi ran
zhe, yi nei wai ju xii, gu ye.
( 1 ) After preci pitati。n , [if) sweating is pr。『noted , there wi l l be q u iveri ng
with c。ld1 and a pu lse that is fa i nt a nd fi ne.2 (2) Why [th is) is so is
beca use b。th the interior a n d the exterior a re vacuous.3
TEXT NOTES
1 . Quivering with cold, 振 寒 zhen Mn : A subjective feeling of cold with trembling
and aversion to cold.
1 . GREATER YANG [LINE 1 1]
135
2. A pulse that is faint and fine, 脉 微 细 mai wei xi: A pulse that feels indistinct
3.
and that is as thin as a thread. Readers should be careful to avoid associating
with this pulse description the definitions given to pulse terms after Zhang JI’s
ti皿e, according to which “fine” is taken to mean not only thin and thread­
like, but also clearly defined, and hence cannot be used to describe a pulse
that is described as “faint.” For other examples, see the discussion in the
Introduction, p. 20.
Interior and exterior vacuity, 内 外 俱 虚 nei wai ju xu: When precipitation is
used, the interior yin fluids are damaged and when sweating is promoted, the
exterior yang qi is damaged. This results in dual vacuity of the interior yin
humor and the exterior y缸g ql.
SYNOPSIS
A transmuted pattern that occurs when, after precipitation, sweating is pro­
mated, resulting in vacuity of interior, exterior, yin, and yang.
COMMENTARY
In general, precipitation is not a method often recommended in the Shang Han
Lun and even more rare is its use prior to the promotion of sweating to resolve an
existing exterior pattern. Precipitation followed by the promotion of sweating is
used when, in a simultaneous interior-exterior pattern, the treatment of the interior
pattern is considered ur�ent due to its severity and the exterior pattern is mild.
Therefore, precipitation in an existing exterior pattern is usually a mistreatment .
Quivering with cold occurs when the yang is damaged and unable to warm the
exterior. The damage to the yang qi is also reflected in a faint pulse. A pulse that
is fine indicates damage to yin humor.
The causal relationship between the different parts of this line should be noted.
The pattern described in the first sentence is not the only possible pattern resulting
from this type of erroneous trea t men t . In line 59, p. 259, the same mistreatment
results in inhibited urination and fluid collapse. In this line, Zhang JI emphasizes
that if the result of mistreatment is dual vacuity of the interior and exterior, one
will see certain signs. If the result of the mistreatment is another pattern, perhaps
because of constitutional differences or slightly different treatment methodology,
these particular signs probably will not appear.
4 . 3 COLD AND HEAT : DIFFERENTIATION O F TRUE AND
FALSE PATTERNS
LINE 1 1
病 人 身 大 热 , 反欲得衣者 , 热在皮肤 , 寒在骨髓也 ;
寒 , 反 不欲近衣者 , 寒在皮肤 , 热在骨髓也 。
身大
Bing ren shen da re, Jan yu de yf zhe, re zai pi Ju, han zai gu sui
ye; shen da han, Jan bu yu jin yf zhe, han zai pi fii,, re zai gu su{ ye.
When the patient has great genera l ized heat , * but desi res t。 put [m。叫
cl。thes 。n the heat is i n the skin a nd the c。Id is i n the b。ne marrow;
136
1 . GREATER YANG [LINE 1 20]
when [there is] great genera l ized c。I d , * but [the patient] has no desi re
f。r cl。thes, the cold is i n the ski n a n d the heat is i n the bone marrow.
TEXT NOTE
Great generalized heat, 身 大 热 shen da re; great generalized cold, 身 大 寒
shen da han : Differences of opinion exist on how to interpret these terms.
It is possible to ar伊e for an interpretation as heat effusion, 发 热 fa 时 , and
aversion to cold, 恶 寒 wu hlin , as Zhang JI sometimes uses simply heat, 热 时 ,
and cold, 寒 han , t o represent these concepts. Nevertheless, these terms may
only mea且 a subjective feeling of heat or cold on the part of the patient. This
heat or cold may or may not be palpable upon examination. The authors of
the Shang Han Lim Yan JiU Da Ci Dian interpret these terms as heat or cold
that is palpable upon examination.
SYNOPSIS
From the patient ’s desire for or aversion to putting on more clothes, one can
identify true and false signs.
COMMENTARY
In this line, the skin represents the exterior and the bone marrow represents the
interior. This distinction may be used to determine true and false signs. When the
patient feels hot , subjectively or objectively, yet has a fear of the cold and wants to
wear more clothing, it indicates false heat and true cold . Exuberant yin cold in the
interior and vacuous yang floating to the exterior give a false impression of heat .
Conversely, when the patient feels cold but fears heat and wants to remove layers
of clothing, it indicates false cold and true heat. Exuberant heat is d epressed in the
interior and obstructs the passage of y归g qi to the exterior. The vacuous y缸g φ
is unable to warm the exterior and gives a false impression of cold. According to
yin-y缸ig theory, extreme cold resembles heat and extreme heat resembles cold. In
fact , extreme heat or cold can convert into its opposite. Because false signs occur
in severe conditions and their misidentification as true signs can lead to a critical
exacerbation of the condition method based on false signs may be damaging to the
patient , considerable importance is given to identifying them correctly.
LINE 1 2 0
付 太阳病 , 当 恶 寒 发 热 , 今汗 自 出 , 反 不 恶寒发 热 , 关 上脉
细数者 , 以 医吐之过也 。
仁) 一 、 二 日 吐 之 者 , 腹 中 饥 , 口 不
能 食 ; 三 、 四 日 吐之者 , 不喜朦粥 , 欲食冷食 , 朝食暮吐 ,
以 医吐 之所致也 , 此 为 小 逆 。
( 1 ) Tai yang bir叨, dang WU han fa re, fin him zi chu, fan bu WU han
fa 吮 guan shang mai xi shuo zhe, yi yf tu zhz guo ye. (2) Yz, er ri
tu zhf zhe, ju zhong jf, kou bu neng sh{; san、 si ri tu zhf zhe, bu xi
mi zhou, yu shi Ieng shi, zhao shi mu tu, yz yf tu zhf SUD zhi ye, cZ
wei xiao ni.
1.
GREATER YANG [LINE 1 20]
137
( 1 ) In greater ya ng d isease, [when] there should be aversion to cold a nd
heat effusion , [there is] now sponta ne。us sweati ng, but aversion to cold
a nd heat effusion a re a bsent a nd the bar pu lse is fi ne a n d ra pid , 1 [it
is] beca use vom iting [treatment] was used [incorrectly) .2 (2) If vomiti ng
[is used] 。n the fi rst or second day 。f [greater ya ng disease] , [there is
a feel ing of] h u nger in the a bdomen , but [the person] ca n not eat. If
vom iti ng [is used] on the t h i rd or fou rt h day 。f [greater ya ng d isease] , the
person d isl i kes gruel , desi res to eat c。Id f。。d , and v。mits i n the even i ng
food eaten i n the morn i吨. This is the resu lt of vom iting [treatment] ,
[wh ich] mea n s t h is is a m inor adverse [treatment] .
TEXT NOTES
1. Used incorrectly, 过 guo : A therapeutic error. 过 , literally “to cross,” is here
used in the extended sense of “transgression.”
2. The bar pulse is fine and rapid , 关 上 脉 细 数 g u an shang mai xi shuo: The bar
pulse is speci且ed because it gives information about the center burner. Qian
Hu在ng (钱 潢 , style 天 来 Ti磊n-Lai) writes, “‘Above the bar' (关 上 guiin shdng)
means the bar pulse.”
SYNOPSIS
a) A transmu t ed pattern of vac ui ty cold in the stomach that is the result of
mistreatment of a greater y缸g disease.
b) The differentiation of vacuity heat and vacuity cold in the stomach.
COMMENTARY
The patient in this line originally contracted greater yang disease. But at this
point the absence of heat effusion and aversion to cold and the presence of a pulse
that is fine and rapid indicate that the exterior disease has already transformed, as
a result of the misuse of vomiting treatment. Vomiting is suggested as appropriate
treatment generally only in cases of heat evil depressed in the chest. Vomiting
treatment has the action of effusing and dissipating, but it cannot be used as a
replacement for exterior resolution. Furthermore, as suggested by the presence of
spontaneous sweating and a fine, rapid pulse, the use of this type of treatment has
damaged the ql, particularly the stomach ql.
The specification of the number of days is probably not to be taken literally, but
rather as an approximation of the length of the illness. In the beginning, the evil is
mild and the damage to the stomach ql from the use of vomiting is also relatively
mild. The patient still feels hungry, but is not able to eat. After a longer course
of dise描e, the evil is deeper and more severe; hence the damage to the stomach
ql is more serious. Even a desire for easily digestible foods like gruel is lacking.
In fact, one of the results of the presence of an exterior evil is that the stomach
becomes both vacuous and dry. Dryness easily engenders heat; consequently the
patient desires cold foods. A vacuous-cold stomach does not digest food well, so
the food collects in the stomach and is vomited up at night. This therapeutic error
is considered minor because the pathological changes are restricted primarily to the
local region of the stomach and recovery is still possible.
138
1.
GREATER yANG [ LINE 1 22]
LINE 1 22
忖 病人脉数 , 数为热 , 当 消 谷 引 食 , 而反吐者 , 此 以发汗 ,
令 阳气微 , 脯气虚 , 脉乃数也 。 ω 数为 客 热 , 不 能消 谷 ,
以 胃 中 虚冷 , 故吐也 。
( 1 ) Bi叼 的z mdi shuo, shuo wei re, dang xiao gu yin sht, er fan
tu zhe, ci yi fa han, ling yang qi wei, ge qi xu, mai nai shuo ye.
(2) SI阳O wei ke re, bu neng xiao gu, yi 创i zhδ叼 XU le叼, git tu ye.
( 1 ) When the patient’s pu lse is ra pid , ra pid ity mea ns heat , [s。l there
s h o u l d be ra pid h u ngering a nd [large] food i nta ke, 1 but if i nstead [there
is] v。m iti鸣, t h is is beca use the promoti。n 。f sweati ng ca used ya ng qi
debi l itation a nd d i a ph ragm qi vacu ity2 (a nd therefore] the pu lse is ra pid .
(2) [A pu lse that is] ra pid mea ns visiting heat3 a nd [the person] ca n not
digest food . Beca use [there is] vacu ity c。Id i n the stomach , [there is]
vom iti ng.
TEXT NOTES
1. Rapid hungering and [large]
food intake, 消 谷 引 食 xiao gu yin shi: Excessive
appetite and ability to consume large amounts of food, which is generally
associated with stomach repletion heat.
2. Diaphragm qi vacuity., 隔气虚 ge qi xu : Here, the indication is that the stomach
qi has become vacuous. The diaphragm separates the lung and heart from
the center burner and the area below the diaphragm is considered the region
of the stomach. Qi益n Hming explains, “If the y缸g φ of the stomach and
stomach duct is exuberant , then [ the patient ] is able to digest [food] swiftly
and to drink. This type [of pattern] is not exuberant heat qi in the stomach.
Following erroneous sweating, the yang qi is debilitated; the diaphragm region
is empty and vacuous. [ These signs are] the result of vacuous yang straying to
the outer body.”
3. Visiting heat , 害 热 ke re : False heat or vacuity heat . The term “visiting,” 客
ke , is generally used in descriptions of exterior evils invading the body. In this
line, however, “visiting” refers to the the ephemeral, insubstantial nature of
false or vacuity heat .
SYNOPSIS
a) Inappropriate promotion of sweating m町 lead to a pattern of vacuity cold
in the stomach.
b) A differentiation between true and false, cold and heat patterns that may
occur when the pulse is rapid.
COMMENTARY
Following the use of sweating, the yang qi is damaged and vacuity cold is present
in the stomach. Because Z hang Ji is discussing d amage following the promotion
of sweating, we know that the use of this method was either inappropriate for the
l . GREATER YANG [LINE 90]
139
disease or it was used excessively. Digestion is impaired, giving rise to counterflow
vomiting. Although a rapid pulse often occurs in heat patterns, if true stomach heat
existed, one would expect rapid hungering and increased food intake. These signs
are absent and instead vomiting is observed. Looking again at the pulse, a true
stomach heat pulse should not only be rapid, but also forceful. We may surmise
that the pulse is rapid and forceless because the yang qi has been damaged. This
pattern is true cold and false heat. Here, Zhang JI emphasizes that a rapid pulse
does not always mean true heat.
4 . 4 IDENTIFYING THE ORDER OF THE PROMOTION OF
SWEATING AND USE OF PRECIPITATION
LINE 90
付 本发 汗 , 而 复 下 之 , 此 为 逆也 ; 若先发 汗 , 治不 为 逆 。
ω
本先下之 , 而反汗之 , 为逆 ; 若先下之 , 治不 为逆 。
( 1 ) Ben fa han, er j边 xia zh再 ci wei ni ye; ruo xiiin fa han, zhi bu
wei ni. (2) Ben xiiin xia zh毛 er fan han zh豆 wei ni; ruo xian xia
zh毛 zhi bu wei ni.
( 1 ) When sweating [shou ld have been] promoted 。rigi n a lly, yet p reci p­
itati。n [was used] , * this is a n adverse [treatment] . If sweating is fi rst
promoted , it is not adverse treatment. (2) When preci pitation [sh。uld
have been] used origi n a l ly, but sweati ng is promoted , this is an adverse
[treatment] . If preci pitation is fi rst used , it is n。t a n adverse treatment.
TEXT NOTE
*
Yet precipitation [w副 used ] , 而 复 下 之 er Ju xia zhf: The promotion of sweating
is the correct treatment, yet precipitation w凶 used instead. In this context ,
复 JU implies that one is acting counter to the correct treatment strategy.
SYNOPSIS
In simultaneous interior-exterior disease, the order of promotion of sweating
and use of precipitation is described.
COMMENTARY
To treat greater yang disease, the promotion of sweating is the correct treat­
ment. It allows the evil to be resolved through sweating. If precipitation is used, the
evil may fall into the interior. In simultaneous disease of the exterior and interior,
one must choose the treatment according to the severity and urgency of the two dis­
eases. One may first treat the exterior and then treat the interior, or 且rst treat the
interior and then treat the exterior, or simultaneously treat both. These principles
are presented in this line. The 且rst section explains that it is an adverse treatment
if one first uses precipitation, when the promotion of sweating is appropriate. It
is also an adverse treatment if one first promotes sweating when precipitation is
appropriate. To illustrate these principles, we will refer to two lines from the text ,
line 36, p. 99, and line 124, p . 205 .
1.
1 40
G REATER YANG [LINE 91]
Line 36 i s a n example of simultaneous interior-exterior disease i n which sweating
is promoted appropriately.
Line 124 is an example of using precipitation first, even though the exterior
disease is still present . The simultaneous promotion of sweating and use of pre­
cipitation may be appropriate when the exterior and interior patterns are equally
severe.
LINE
91
付 伤 寒 , 医 下 之 , 续 得 下 不lj , 清 谷 不 止 , 身 疼 痛 者 , 急 当 救
里 。 ω 后 身 疼痛 , 清便 自 调 者 , 急 当 救表 。
汤 , 救表宜桂枝汤 。
(三) 救 里 宜 四 逆
( 1 ) Shang han, yz xia zhf, xii, de xia li, qzng gu bu zhZ, shen teng tOng
zhe, ji dang jiu li. (2) Hou shen teng tong, qzng bian zi tiao zhe, ji
dang jiu biao. (3) Jiu li yi si ni tang, jiu biao yi gui zhz tang.
( 1 ) When cold da mage is treated with preci pitation , a n d [t h is is] fol­
lowed by i ncessa nt clea r-fi。。d d i arrhea 1 a nd genera lized pa i n , 。ne should
u rgently relieve the i nterior [d isease] . (2) After [treating the i 『1 teri。 r]
[if there is] genera l ized pa i n , a n d the exc陀tions become 吨ulated , 2 。ne
sh。u ld u rgently relieve the exterior [d isease] . (3) For relievi ng the i nte­
rior [d isease] , Cou 『阳rfl。w Cold Dec。ction ( si ni tang ) is a ppropriate;
f。r relievi ng the exterior [ d iseas叶 , C i n阳 n
tang ) is a ppropriate.
TEXT NOTES
1. Incessant clear-food diarrhea, 下 利 情 谷 不 止 xia li qfng gu bu zhi: Incessant
diarrhea that is watery and contains undigested food.
2 . The excretions become regulated, 清 {更 自 调 qzng b ia n zi ti ao : Earlier in the
line, a reference is made to the stool; therefore, both the Skiing Han Lun Yan
Jiu Da Ci Dian ( “Skiing Han L伽 Studies Dictionary” ) and the Gao Deng
Cong Shu ( “Advanced Reference Series” ) explain this phrase as meaning that
the stool becomes normal. Nevertheless, according to Y也 Chang the phrase
above means that the urine is clear and the stool is regul缸, indicating that
the interior y缸ig has been restored.
SYNOPSIS
a ) A pattern that occurs following the inappropriate use of precipitation in 皿
exterior pattern.
b ) Identi且es the order and urgency of interior and exterior treatment .
COMMENTARY
In greater yang cold damage, the use of precipitation is an adverse treatment,
as is stated in line 44, p . 69: “Greater y缸g disease in which the exterior pattern
1.
GREATER YANG [LINE 92]
141
has not resolved cannot be precipitated [ since] precipitation would be an adverse
[ treatment] . When [one] desires to resolve the exterior, Cinnamon Twig Decoction
(gui zhf tang) is appropriate.” The results of this mistreatment vary depending on
the particular circumstances of the case. As Y6u Yi writes, “The disease [course]
depends on the heat and cold of the patient ’s qi and evil 啡, [ as well as] yin and y缸g
of the viscera qi. ” In the situation described above, incessant clear-food diarrhea
and generalized pain result from erroneous precipitation. According to Cheng Wu­
Ji, these signs indicate that the interior ql is insufficient. He does not ascribe the
signs to any one organ system. Yu Chang ascribes these signs to the spleen, writing,
“Clear-food diarrhea indicates debilita刷n of the spleen yang and inability [of the
spleen] to transform food and drink. Generalized pain indicates there is exuberant
yin evil in the interior, obstructing the sinews and channels.”
This type of diarrhea may also be considered a sign of the kidney, as described
in Gao Deng Cong Shu. Incessant clear-food diarrhea, as a sign of damage to the
kidney y但g, is considered an indication of more severe damage to y缸g from the
misuse of precipitation, and is thought to be different from the diarrhea resulting
from damage to the spleen and stomach. Generalized pain indicates that the exterior
disease has not yet resolved; hence an interior and an exterior disease are both
present . No matter how one explains these signs, it is clear from the text that
incessant clear-food diarrhea is a serious sign and should be treated first . The
exterior signs can only be treated after resolving the urgent interior signs. If one
considers that the original disease is the root and later dise臼es are the tips, this
is an example of first treating the tip, then treating the root . It can also be said
that in a situation where the yang qi is vacuous, one should not use medicinals that
resolve the exterior, even mild ones, since the promotion of sweating may further
damage the yang qi. One must first restore yang with a formula such as Counterflow
Cold Decoction (si ni tang) and only then can one resolve the exterior. See line
323, p. 475 , for a comprehensive discussion of Counterflow Cold Decoction (si ni
tang).
LINE 92
(一) 病 发 热 头 痛 , 脉 反 沉 , 若 不 差 , 身 体 疼 痛 , 当 救 其 里 。
(斗
四逆汤 方 。
( 1 ) Bing fa re t6u tO叼F mai fan chen, ruo bu chai, shen ti teng tong,
dang jiu qi lι (2) Si ni t ang fang.
( 1 ) [When) i n i l l n ess [there is) heat effusi。n a n d headache, but the pu lse
is su n ken , a nd if (after ta ki吨 Ephed 阻 Asaru m , a n d Acon ite Dec。cti。n
(ma h侃”g xi xin Ju zz tang ) )1 [there is) n。 阳。very2 a n d [there is)
genera l ized pa i n , 。ne shou ld rel ieve the i nterior. (2) C。u 阳rfl。w Cold
Decoction ( si ni tang) [is a ppropriate) . 3
142
1 . GREATER YANG
TEXT NOTES
1. After taking Ephedra, Asarum, and Aconite Decoction (ma huang xi xfn Ju zi
tang): This clause does not appear in the original text . See the commentary
below for a c om plete discussion.
2 . If [there is] no recover弘 若 不 差 ruo bu chai: In this phrase, 差 chai means 在
chai , “to recover.”
3. Counterflow Cold Decoction ( si ni tang) [is appropriate] , 四 逆 汤 方 si ni tang
fang: The style of this clause does not conform to the rest of the text . Nonethe­
less, it is taken to mean that the formula is appropriate.
SYNOPSIS
In simultaneous interior-exterior disease, one may have to reject the signs and
follow the pulse; treat the interior first and then the exterior.
COMMENTARY
A disease in which the main signs are heat effusion and headache is usually
an exterior disease. In exterior patterns the pulse is generally floating, but here
it is sunken. Zha且g JI uses the word “but” 反 f旬 , to mean that this is not the
pulse characteristic that is expected; consequently this may be not an exterior
pattern, but an interior one. Line 301 , p. 506, describes a lesser yin disease with
heat effusion and a pulse that is sunken. In that situation, Ephedra, Asarum, and
Aconite Decoction (ma huang xi xfn Ju zi tang) is used. The rationale for the
form1
phrase implies that treatment was attempted and was unsuccessful. Clearly, this
pattern is similar to that presented in line 30 1 , p. 506, and that is why the formula
is included here. This pattern can be seen as simultaneous disease of the greater
yang and the lesser yin. Ephedra, Asarum, and Aconite Decoction (ma huang xi
xfn Ju zi tang) has been given, but generalized pain, an exterior sign, is still present .
The pulse is sunken , though , so the first step is to warm the interior and invigorate
yang, lest by further promoting sweating one should cause yang collapse. Once
the yang is strengthened, the body should be able to expel any remaining exterior
evil . If not, once the patient’s condition is stabilized, additional treatment can be
attempted .
4 . 5 HEAT PATTERNS
In greater yang disease, a transmuted pattern of heat can occur as the result
of inappropriate precipitation or vomiting, when early in the disease an exterior
evil moves quickly from the exterior into the interior owing to the strength of the
evil or weakness of right qi, or when late in t h e disease residual heat remains in
the interior. One basic pattern, referred to as “vacuity vexation,” is characterized
by heart vexation, inability to sleep, and anguish in the heart, and it is treated
with Gardenia and Fermented Soybean Decoction (zhf zi chi tang) , which clears
and diffuses depressed heat. When vacuity vexation is accompanied by shortage
of 啡, it is treated with Gardenia, Licorice, and Fermented Soybean Decoction (zhf
zi g伽 ciio chi t伽g) , which also supplements the φ. When vacuity vexation is
accompanied by retching, it is treated with Gardenia, Fresh Ginger, and Fermented
Soybean Decoction ( zhf zi she叼 jiang chi tang), which also harmonizes the stomach
1 . GREATER YANG
143
and checks retching. When depressed fire in the chest influences the qi dynamic
of the stomach, resulting in not only heart vexation but also abdominal fullness,
the appropriate formula is Gardenia and Magnolia Bark Decoction ( zhf zi hδ u p o
tang) , which clears heat and dissipates fullness. When a pill medicine is used to
precipitate and this damages the center so that there is heat in the upper body and
cold in the center, the appropriate formula is Gardenia and Dried Ginger Decoction
(zhf zi gan jiang tang), which clears heat from the upper burner and w缸ms the
center burner. It should be noted that in patterns of spleen and / or kidney y归g
vacuity with enduring sloppy stool, the original formula is contraindicated.
In a greater yang disease, when as a result of inappropriate promotion of sweat­
or
the use of precipitation , an exterior evil falls into the interior, transforms to
ing
heat , and distresses the lungs, causing congestion of the lung qi and panting, the
appropriate formula is Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction
( ma huang xing ren gan cao shi gao tang), which clears heat and diffuses the lung.
White Tiger Decoction Plus Ginseng ( Mi hii. jia r印 shen tang) , which clears heat ,
boosts the qi, and engenders liquid, is used when sweating is promoted and copious
sweat issues, with the result that the qi and yin are damaged and evil φ shifts into
the yang brightness, giving rise to signs such as vexation thirst and a pulse that is
surgin?, and large. If precipitation is used inappropriately in a greater yan? disease,
the evil can enter the interior, transform to heat , 创id distress the large intestine,
causing incessant diarrhea. This pattern is treated with Pueraria, Scutellaria, and
Coptis Decoction (ge gen huang qin huang lidn tang) , which clears heat and checks
di arrhe a . Scutellaria Decoction (hua叼 qin tang) and Scutellaria Decoction Plus
Pinellia and Fresh Ginger (huang qin jia bdn xia sheng jiang tang) can both be
used in greater yang and lesser yang combination disease. The former is used when
heat in the interior distresses the lower burner, causing diarrhea, and the latter is
used when heat in the interior distresses the stomach, causing counterflow ascent
of the stomach qi , which manifests as retching.
4.5.1
Gardenia and Fermented Soyb ean Decoct ion
Patt erns
The pattern treated with Gardenia and Fermented Soybean Decoction (zh'i zi chi
tang) is known as vacuity vexation. If heat evil falls inward and becomes depressed
in the chest and diaphragm, it will harass the heart and the chest regi on . Vacuity
vexation is the result either of treatment or of residual heat from a heat disease .
It is not the result of repletion heat evil invading the body. There are three main
pathomechanisms associated with vacuity vexation.
a ) Heat evil falling inward and collecting in the chest and diaphragm following
the inappropriate use of vomiting or precipitation.
b ) Heat evil directly entering the interior and becoming depressed in the chest
in the early stage of an externally contracted disease.
c ) In a protracted illness, a heat evil which has not been completely expelled
becomes depressed in the chest.
Heart vexation and inability to sleep, which in severe cases becomes tossing and
turning, and anguish in the heart , are commonly associated with these patterns .
Gardenia and Fermented Soybean Decoction ( zhf zi chi tang) clears and diffuses
1 44
1 . GREATER YANG [LINE 76BJ
heat evils, resolves depression, and eliminates vacuity vexation. If vacuity vexation
occurs with shortage of φ, one should add mix-fried licorice (gan cii.o ) , which sup­
plements vacuity. If the stomach qi loses harmony, add fresh ginger { sheng ji伽g)
to check retching. For fire depressed in the chest which influences the qi dynamic
and results in stuffiness in the chest and / or pain, the basic formula m町 be used.
If irre伊larity of the qi dynamic results in heart vexation, abdominal fullness, and
disquiet lying and sitting, use Gardenia and Magnolia Bark Decoction (zhf zi hou
p o tang) to clear heat and dissipate fullness. If inappropriate use of precipitation
results in di arrh e a with a pattern of heat in the upper burner, cold in the center
burner, generalized heat effusion, and mild heart vexation, use Gardenia and Dried
Ginger Decoction (zhf zi gan jiang tang) to clear heat in the upper burner and warm
the center burner. Gardenia and Fermented Soybean Decoction (zhf zi chi tang)
should not be used if the patient usually has sloppy stool, since this may indicate
yang qi vacuity and use of this formula would cause further damage.
LINE 76 B
发 汗 吐 下 后 , 虚 烦 不 得 眠 , 若 剧 者 , 必 反 覆 颠 倒 , 心 中 ↑奥
侬 , 扼 子 鼓 汤 主 之 ; 若 少 气 者 , 梳 子 甘 草 或 汤 主 之 ; 若 H区
者 , 梳子生姜跤汤 主 之 。
Fa han tu xia hiJU, xu fan bu de mian, ruo ju zhe, bi fan fu dian
dao, xfn zhong ao n6ng, zhi zi chi tang zhu zhf; ruo shao qi zhe, zhf
zi gan cao chi tang zhu zhi; ruo OU zhe, zhf zi sheng jiang chi tang
zhu zhi.
(When] after the promotion 。f sweating, the use of vomiti ng, 。r the use
of preci pitation , [there is] vacu ity vexati。 『1 1 a nd i n a bi l ity to sleep, a nd if
(the con d ition] is seve毗 (with ] t。ssi ng a n d tu rni ng2 a n d a nguish i n the
heart, 3 G a rden ia a nd Fer『Y
g。verns. If (there is] sh。rtage of ql ,4 Gardenia , Licorice, a nd Fer『r
Soybea n Dec。ction ( zhi zi gan cao chi tang) governs. If (there is]
retch i ng, Garden ia , Fresh G i n ger, a nd Fermented Soybea n Decoction
( zhi zi sheng jiang chi ta叼) g。verns.
TEXT NOTES
1 . Vacuity vexation, 虚 烦 xu fan: Heat depressed in the chest, harassing the chest
and diaphragm. The question that arises is why the term “vacuity vexation"
is used.
You Yi explains that “ [ ’fhe use] of vomiting, precipitation, or sweating
repeatedly damages the fluids and evil qi falls inward; this is vacuity vexation.
Vac ui ty vexation means the right [qi] is insu血cient and evil qi harasses, so
[there is] vexation .
The authors of Yf Zong Jfn Jian sta战 “Most vexation [that occu叫 without
precipitation, vo mi ti n g , or s wea t in g belongs to heat; hence it is called heat
1 . GREATER yANG [LINE 76B]
145
vexation. Most vexation [that occurs] following precipitation, vomiting, or
sweating belongs to vacuity; hence it is called vacuity vexation. ” Any of the
methods described above may da皿age right ql. Evil ql is then able to exploit
the vacuity and sink inward to the chest. From this point of view, vacuity
vexation is a result of vacuity of the right qi, with evil falling into the chest.
Ke Qin offers another explanation: “If one wants to know yang brightness
vacuity vexation, it is the opposite of repletion heat in the stomach domain.
That is, it is the vacuity of emptiness and vacuity, not the vacuity of weakness
and vacuity.” In other words, vacuity vexation means vexation due to vacuity
heat as distinct from vexation due to repletion heat . It does not mean vexation
due to vacuity of right qi.
One may also consider the opinion of Shen Ming-Zang, who writes, “Sweat­
ing, precipitation, and vomiting damage the ql of the chest and stomach. A
formless evil falls inward and harasses the chest , and [there is] no phlegm­
rheum bind. Thus [ there is] vacuity vexation. In this explanation, which is a
combination of the two previous ones, a formless or empty heat evil harasses
the interior and the treatment results in vacuity of right qi.
2. Tossing and tur n ing, 反 复 颠 倒 fan j边
repeated turning and tossing in bed.
diiin dao:
Inability to fall asleep with
3. Anguish in the heart , 心 中 懊 侬 xzn zhiing do n6ng: A subjective feeling of
severe vexing depression in the heart. The patient feels harassed, even to the
point of derangement , and cannot calm down.
4. Shortage of ql , 少 气 shao qi: Weak, short , hasty breathing, a weak voice, and
a tendency to take deep breaths in order to continue speaking.
FORMULAE
Gardenia and Fermented Soybean Decoction
(zhZ zi chi tang)
。 Clear and diffuse depressed heat.
梳子十 四 个 ( 擎 )
香鼓四 合 ( 绵裹 )
右 二昧 , 以 水 四 升 , 先煮梳子 , 得 二 升 半 , 内鼓 , 煮取一升 半 ,
去淳 , 分 为 二 服 , 温进一 服 , 得吐者 , 止后 服 。
zhZ zi sM si ge ( bo) xiiing chi si ge ( mian guo)
You er w剖, yi shui si sheng, xiiin zhU zhZ zi, de er sheng
bdn, na ch瓦 zhU qu yz
sheng bdn, qu zi, fen wei er Ju, wen jin yz JU, de tu zhe, zhi h创 JU .
gardenia (槌子
fer『T
wra p ped)
zhZ zi, Ga毗niae Fructus) 14 pieces ( broke n )
[For] the a bove two ingredients use four sheng of water. First boil gardenia (zhZ zi)
to get two and a h a lf sheng. Add fermented soybea n (xiiing chi) and boil to get one
a nd a half sheng. Remove the dregs. Divide into two doses a nd take one warm . (If
vomiting occu rs, stop givi ng [doses] . 2 )
FORMULA NOTES
1 . Fermented soybean ( xiiing
chi)
is now referred to as 谈 豆 鼓
da dou chi.
n
l . G REATER YANG [LINE 76B]
146
2. If vomiting occurs, stop giving [ doses] , 得 吐 者 , 止 后 服 de tu zhe, zhi him JU:
The significance of this phrase is controversial, and different commentators
have offered many varied opinions.
Cheng Wu-Ji represents the school of thought that this is a vomiting for­
mula. This point of view is based on three main points:
a ) Zhang JI wrote this phrase to explain that after giving this formula, the
patient should vomit, after which time no more doses should be given. This
con鱼rms that it is a vomiting formula.
b ) This formula and Melon Stalk Powder (guii di san) contain fem
bean (xiang chi) . The latter formula is known to be a vomiting formula;
therefore this confirms that the former has the same use.
c ) The disease position in the original pattern is in the upper body. After
taking the medicinals, depressed heat will be loosened and able to move.
The right qi takes advantage of this opportunity to expel the evil. Following
the principle of “bring up and out what is high,” we can understand that
this formula is used to induce vomiting, thereby bringing out the evil in the
chest .
Chen Yuan-XI (陈 元 犀 ) represents the school of thought that this is not a
vomiting formula. This point of view is based on four main points:
a) The formula is only composed of two ingredients and neither clearly induces
vomiting.
b ) In the original pattern, following the use of sweating, vomiting, and pre­
cipitation, a heat evil remains and harasses the chest and diaphragm. If
one again uses vomiting, this will increase the vacuity, and goes against the
intention of the line.
c ) This line contains the suggestion that if the patient vomits, one can add
fresh ginger ( sheng jiang) . How can one add a medicinal that checks retch­
ing to a formula used to induce vomiting?
d ) In clinical practice, after giving this formula, it is rare to have a patient
vomit .
I n our opinion, this formula i s not intended t o induce vomiting.
Gardenia, Licorice, and Fermented Soybean Decoction
椅子十 四 个 ( 孽 )
甘草二两 ( 炙 )
( zhf zi' gan cao chi tang)
香鼓四合 ( 绵裹 )
右三昧 , 以 水 四 升 , 先 煮扼子 、 甘草取二 升 半 , 内 鼓 , 煮取一升
半 , 去淳 , 分 二 服 , 温进→服 , 得吐者 , 止后 服 。
zhf zi' sM si ge ( bO) gan ciio er liiing (zhi) xia叼 chi si ge ( mian guo)
You san wei, yi' shui' si sheng, xian zhU zhf zi' 、 gan cao, qil er sheng bdn, na
ch民 zhU qil yf sheng bdn, qu zi', fen er JU, wen jin yf ju, de tu zhe, zhi hou Ju.
gardenia (柜子 zhτ zi', Gardeniae Fn』
m ix-fried licorice ( 甘 草 gan cao , G lycyrrhizae Rad ix) 2 li�ng
1.
fermented soybean
wra pped )
GREATER YANG [LINE 76Bj
147
( 香 旺 xiang chi, G lycines Semen Fermentatum) 4 g� (cotton­
For the a bove th ree ingredients, use fou r sheng of water. Fi rst boil gardenia (zhi
zi) a nd mix-fried licorice (gan cao) to get two a nd a half she吨, [then] add fermented
soybea n (xiiing chi) a nd boil to get one a n d a half she咆. Remove the d regs a nd divide
into two doses. Take one dose warm . If [the patient] vomits, cease ta king [the formu la] .
Gardenia, Fresh Ginger, and Fermented Soybean Decoction
(zhf zi sheng jiang chi
tang)
槌子十 四 个 ( 壁 )
生姜五两
香鼓四 合 ( 绵裹 )
右三昧 , 以 水 四 升 , 先 煮梳子 、 生姜 , 取 二 升 半 , 内 跤 , 煮取一
升半 , 去津 , 分 二 服 , 温进一服 , 得吐者 , 止后服 。
zhf zi sM si ge ( bo) sheng jiang wu liang xiang chi si ge ( m 伯z guo)
You san wei, yi shui si sheng, xian zhU zhf zi 、 sheng jiiing, qu er sheng ban,
na chi, zhU qu yf sheng ban, qu zi, fen er Ju, wen jin yf Ju, de tu zhe, zhi hOu JU.
gardenia ( 帽 子 zhf z瓦 Gardeniae Fructus) 14 pieces (broken)
fresh ginger (生 姜 sheng jiang, Zingiberis Rh izoma Recens) 5 lillng
fermented soybea n (香 鼓 xiiing chi, G lyci nes Semen Fermentatu m ) 4 g� (cotton­
wra pped)
For the a bove th ree ingredients, use fou r sheng of water. First boil garden i a (zhf
zi) a nd fresh gi nger (sheng jiang) to get two a nd a half sheng, [then] add fermented
soybea n (xiang chi) and boil to get one and a h a lf she吨. Remove the d regs a nd d ivide
i nto two d。ses. Ta ke one dose warm . If [the patient] vomits, cease ta king [the form ula] .
SYNOPSIS
The identification and treatment of vacuity vexation that is the result of heat
harassing the chest and diaphragm.
COMMENTARY
Three main pathomechanisms are associated with depressed hea t h arassing the
chest and diaphragm. One is that following inappropriate treatment of cold damage,
unresolved heat becomes depressed in the chest . The second is that an external evil
transforms to heat and becomes depressed in the chest. The third is that following
a heat dise甜、 residual heat becomes depressed in the chest . In this line, the formed
heat is eliminated through the treatment , but residual heat becomes depressed in
the chest . The signs of this condition are vacuity vexation, inability to sleep, tossing
and turning, and anguish in the heart .
An analysis of the formula makes the meaning of the line clearer. There are
only two ingredients in the formula, gardenia (zhf zi) and fermented soybean (xiang
chi) . Bitter, cold gardenia (zhf zi) clears heat in all three burners. It also resolves
heat depression and eliminates vexation. Fermented soybean (xiiing chi) resolves
the exterior and diffuses heat. Combined, these two ingredients clear heat, eliminate
vexation, and do not have any supplementing qualities, reinforcing the idea that
vacuity vexation is not right qi vacuity, but vexation that is the result of residual
l . GREATER YANG [LINE 77]
148
heat , not replete heat , depressed in the chest. If vacuity vexation were the result of
right qi vacuity, one would expect the formula to contain medicinals that supplement
vacuity. Therefore, as Ke Qin suggests, vacuity vexation probably does not mean
vacuity of right qi. Here, the term “vacuity” seems to suggest that vexation is the
result of the treatment, not the result of a repletion heat evil falling into the chest.
Therefore, it is termed vacuity vexation by contrast to vexation that is the result of
repletion heat. The heat evil in the chest is formless; therefore, mass and a glomus
lump are absent .
The other two formulae included in line 76B above are straightforward mod­
ifications of the initial formula. In the first , sweet licorice (giin cii.o) is added to
supplement qi shortage, because it supplements the spleen, boosts φ, and has mild
heat-clearing ability. In the second, fresh ginger ( sheng jiii叼), which downbears
counterflow and checks retching, is added to treat retching.
LINE 77
发 汗 , 若下之 , 而烦热 , 胸中窒者 , 梳子或汤主之 。
Fa han ruo xia zhf, er fan re, xiong zh侃g zhi zhe, zhz zi chi tang
zhu zhz.
,
[After] sweati ng is promoted , if preci pitati。n is used a n d [there is] heat
vexation 1 a nd stuffi ness in the chest,2 Garden ia a n d Fermented Soybea n
Decocti。n ( zhz zi chi tang) governs.
TEXT NOTE S
1 . Heat vexation, 烦 热 Jan re: This term has been interpreted in two slightly
different ways: heart vexation accompanied by heat effusion, or agitation with
a subjective feeling of heat and oppression. Cheng Ying-Mao writes, “Vexation
and heat : the two words are connected. Vexation is in the interior and heat
is in the exterior. Fire depressed in the chest exploits this vacuity and settles
[in the chest ] . "
In the line above, heat vexation appears following the use of precipitation in
an exterior pattern; therefore it is likely that it is the result of an exterior evil
falling into the interior and becomin� depressed in the chest. In line 240, p. 400,
the s缸ne term is thought to be evidence of an unresolved exterior pattern.
Zhang Lu writes, “Heat vexation is depression, oppression and disquiet , and
a manifestation of heat that has not effused. When vexation occurs in the
absence of sweating, vomiting, or precipitation, it indicates a greater yang
exterior pattern. In the Nei Ju肌 [it is written, ] ‘ [ For] a patient with heat
vexation, [when ] sweat issues, [there will] then be resolutio旷 ’
2 . Stuffiness in the chest , 胸 中 窒 xiong zhδng zhi: A feeling of blockage and
inhibited movement in the chest.
S YNOPSIS
The signs and treatment of heat depressed in the chest, congesting the qi dy­
na口UC.
1.
GREATER YANG [ LINE 78]
149
COMMENTARY
This line is an extension of the previous line, in which Gardenia and Fermented
Soybean Decoction ( zhf zi chi tang) was introduced. Following the promotion of
sweating and the use of precipitation, residual heat becomes depressed in the chest ,
giving rise to agitation with a subjective feeling of heat and stuffiness in the chest .
Depressed heat in the chest inhibits lung function, which causes the ql dynamic
to lose regulation. The ql does not move smoothly and a feeling of blockage and
oppression in the chest arises. A comparison of this line with the previous one
reveals slight differences in the presenting signs, but a great similarity in the basic
pathomechanism; therefore the formula is the same.
LINE 78
伤寒五六 日 , 大下之后 , 身 热不 去 , 心 中 结痛者 , 未欲解
也 , 据子或汤主之 。
Shang han wii. liu ri, da xia zhz him, sh en re bu qu, xzn zhong jie
tong zhe, w e i yu jie ye, zhz zi chi tang zhii zhz.
When i n cold d a m age [that has lasted for] five or six d ays, [i可 after great
preci pitation , the genera lized heat has n。t g。ne1 a n d [there is] bi n d i ng
pa i n i n the hea rt ,2 the d isease is not a bout t。 resolve a nd Gardenia a n d
Ferme
TEXT NOTES
1. Generalized heat has not gone, 身 热 不 去 shen re bu qu: There are different
interpretations of this phrase.
a) According to Zhang Z恤, Cong, Wang K en- Tan g ( 王 肯 堂 , style 宇 泰 Yu­
T 训 , and Cheng Yln g- M岛, this phrase means an unresolved exterior heat
evil.
b ) According to Ke Qin, this phrase means heat bound in the chest .
2 . Binding pain in the heart, 心 中 结 痛 xfn zhiing jie tong: Pain in the chest due
to binding depression of ql.
SYNOPSIS
The signs and treatment of heat depressed in the chest, inhibiting the qi and
blood, with binding pain in the heart.
COMMENTARY
The use of precipitation is inappropriate in cold damage patterns and as in
the previous two lines, following treatment , residual heat becomes depressed in the
chest . It congests the ql dynamic and in mild cases can cause stuffiness in the chest ,
and in severe cases, binding pain in the heart. Both these chest signs are the result
of depressed heat ; therefore, both may be treated with Gardenia and Fermented
Soybean Decoction (zhf zi chi tang), which clears heat and diffuses depression.
Although depressed heat in the chest influences the movement of qi and blood,
1 . GREATER YANG [LINE 79]
1 50
no medicinals are added to move the ql or quicken the blood because the root is
depressed heat . Once the root is resolved the signs will resolve.
To avoid confus i on later, it will be helpful to discuss some of the differences
between binding pain in the heart, 心 中 结 痛 xzn zhOng jie to ng , and chest bind, 结
胸 jie xiδng. Pain in the chest occurs in both conditions, but it differs in intensity
and sensitivity to palpation. Binding pain in the heart is characterized by a chest
that is soft when palpated and pain that is not severe, whereas chest bind is marked
by hardness upon palpation that may extend into the lesser abdomen, and severe
pain that is exacerbated by pressure. The pathomechanism and the treatment of
chest bind are discussed further in line 1 28, p. 2 1 1 .
LINE 7 9
伤 寒 下 后 , 心烦腹满 , 卧起不 安者 , 梳子 厚 朴 汤 主 之 。
Shang han xia him, xzn fan j边 man,
WO
qi
bu
an zhe, zhz zi hou p o
tang zhu zhz.
When , after precipitation has been used i n c。Id da mage, [there is] heart
vexati。n , 1 a bdom i n a l fu l l ness, a n d fidgetiness whether lyi ng o r sitti ng,2
Garden ia and Magnolia Bark Decoction ( zhi zi him p o tang ) governs.
TEXT NOTES
1 . Heart vexation, 心 烦 xzn fdn: This sign is considered milder than, but similar
to, vexation and agitation 烦 燥 fan zao.
2 . Fidgetiness whether lying or sitting, 卧 起 不 安 wo qf bu an : Inability to find a
comfortable resting position , accompanied by fidgeting.
FORMULA
Gardenia and Magnolia Bark Decoction
(zhZ zf f时U po t ang) .
。 Clear heat and eliminate vexation; loosen the center and disperse fullness.
据子十四 个 ( 孽 )
令黄 )
厚朴四两 ( 炙 , 去皮 )
积实 四 枚 ( 水浸 , 炙
右三昧 , 以 水三升 半 , 煮取一升 半 , 去淳 , 分二服 , 温进一服 ,
得吐者 , 止后服 。
ZhZ zf sM si ge ( bo) hδ u po si liang ( zhi, qu pf') zhi shi si mei ( shui jin, zhi
ling huang)
You san wei, yi shui san sheng ban, zhU qu yz sh eng ban, qu zi, fen er ju, wen
jin yz Ju, de tu zhe, zhi hou JU.
gardenia (帽子 zhZ zi, Gardeniae Fr u ct u s ) 14 pieces (broken)
magnolia bark (厚 朴 hou po, M agnoliae Cortex) 4 Ii昌ng ( remove bark, mix-fry)
u n ripe bitter ora nge (帜 实 zhi shi, A u ra n ti i Fructus l m ma t u rus ) 4 pieces ( soa ked
i n water a nd mix-fried u ntil yellow申)
1.
GREATER y ANG [LINE 79]
151
[For] t h e a bove th ree i ngredients use th ree a nd a h a lf she暗 of water. Boi l t o get
one a nd a h a lf sheng and remove the d regs. Divide i nto two doses a nd ta ke one, warm .
( If vom iting occu凡 stop giving [doses] . )
FORMULA NOTE
Unripe bitter orange (zhi sM) : This medicinal is steeped in water 缸id then
mix-fried until it turns a deep yellow color. The goal of mix-frying the fruit
is to moderate the bitter, cold nature of the raw agent . In modern practice,
unripe bitter orange (zhi sM) is primarily used stir-fried. When processed in
this way it dissipates accumulation and disperses glomus. Used raw, it has a
stronger ability to break ql and transform phlegm. In modern practice, mix­
frying speci且cally refers to stir-frying with liquid adjuvants, but at the time of
the Shang Han Um , it is not clear what specific processing method was used
and it may refer simply to stir-frying. In the modern method the adjuvant and
materials are first blended, covered, and left to stand for a short time before
frying, so that the adjuvant soaks well into the materials. The most commonly
used adjuvants are honey, vinegar, wine, and brine.
S Y NO P S IS
The signs and treatment of heat harassing the chest and diaphragm, with heart
vexation and abdominal fullness.
COMMENTARY
Following inappropriate precipitation in a cold damage disease, the exterior
evil falls inward to the 巳hest. In this pattern, the evil becomes depressed in the
chest and accumulates in the stomach, resulting in not only heart vexation, but
also abdominal fullness. Discomfort in the chest region and the stomach results in
the patient’s inability to find a comfortable resting position. Heart vexation and
abdominal fullness may also be seen in yang brightness bowel repletion, but here the
absence of any signs of stool bind suggests that yang brightness disease is unlikely.
This. pattern is depression of a formless evil heat in the chest and abdomen. The
evil heat is described as formless because neither abdominal pain nor stool bind is
present.
Gardenia and Magnolia Bark Decoction (zhZ zi hO叩O tang) is used to treat this
disease. In this variation of Gardenia and Fermented Soybean Decoction ( zhZ zi" chi
tang), fermented soybean (xiiing chi) , which resolves the exterior and diffuses heat,
is replaced by magnolia bark (him po) and unripe bitter orange ( zhi shz') . Here,
the heat diffusing properties of fermented soybean (xiiing chi) 缸e not considered
important, whereas the ability of magnolia bark (hOu po) and unripe bitter orange
( zhi shi') to move the φ and dissipate accumulation is crucial.
One may want to comp町e this formula with the Ql-Coordinating Decoctions.
If one substitutes rhubarb (da huang) for gardenia (zhZ zi) , the formula becomes
Minor Ql-Coordinating Decoction ( xiao cheng qi tang ) . The addition of mirabilite
( mang xiao) to Minor Qi-Coordinating Decoction ( xiii.o cheng qi tang) creates Major
Ql-Coordinating Decoction (da eking qi tang) and the substitution of licorice (giin
cii.o) for the magnolia bark ( hou po) and unripe bitter orange ( zhi sM) in Major
Qi-Coordinating Decoction ( da cheng qi tang) creates Stomach-Regulating Ql-Co­
ordinating Decoction ( tiao 时t cM叼 qi tang) . Apart from being helpful in terms of
1.
152
GREATER y ANG [LINE 80]
remembering the formulae, this comp町ison illustrates the differences between the
signs described here and those associated with yang brightness bowel repletion.
LINE
80
伤 寒 , 医 以 丸药 大 下 之 , 身 热不 去 , 微烦者 , 梳子干姜汤主
之。
Shang hdn, yz yz wan νdo
da xia
zhZ, shen
re bu qu, wei fan
zhe, zhz
zi gan jiang t ang zhii zhz.
When i n c。Id d a mage great preci pitati。n is perf,。rmed with a pi l l me­
d ici 盹 * the genera l ized heat is not gone a n d [there is] m i ld vexati。n ;
[therefore,] Gardenia a nd D ried G i nger Decocti。n ( zhz zi gan jiang
t ang ) g。verns.
TEXT NOTE
*
Pill medicine, 丸 药 wan yao: A powerful draining precipitant medicine sold in
pill form and popular during the Han Dynasty. There were two types of pill
medicine: a hot-natured one based on croton (ba dou) and a cold-natured one
based on kansui (g归 sui).
FORMULA
Gardenia and Dried Ginger Decoction
(zhf zi' gan jiang tang)
。 Clear upper [ burner] heat; warm center [burner] cold.
帽子十 囚 个 ( 壁 )
干姜二两
右 二 昧 , 以 水 三 升 半 , 煮 取 一 升 半 , 去 j宰 , 分 二 服 , 温 进 一 服 ,
得吐者 , 止后服 。
Zhf zi' shi si ge ( bO) gan jiang er liang
You er w剖, yi' shui' san sheng bdn, zhii. qu yf sheng bdn, qu zi', fen er Ju, wen
jin yf Ju, de tu zhe, zhi' hou JU.
ga rd e n ia (帽 子 zhf zi, Gardeniae Fructus) 14 pieces ( bro ken )
d ried gin ger (干 姜 gan jiang, Zingiberis Rh izoma Exsiccatu m ) 2 li� ng
[For) the a bove two i ngredients use th ree sheng of water. Boil to get one and a half
she咆 a nd remove the d regs. Divide into two doses and ta ke one, warm . ( If vom iting
occu rs, stop giving [doses].)
SYNOPSIS
The signs and treatment of heat harassing the chest and diaphragm with diar­
rhea from cold in the center burner.
COMMENTARY
This is a further refinement of the patterns already presented. Inappropriate
1 . GREATER YANG [LINE 8 1 ]
153
treatment of cold damage causes an exterior evil to fall inwards and become de­
pressed in the chest . The generalized heat does not resolve and mild vexation arises.
In addition, the treatment used here is strong draining precipitation. Draining pre­
cipitation easily damages the qi of the spleen and stomach. One may surmise that
vacuity in the center burner results from this type of treatment and an analysis of
the formula supports this supposition. This is a pattern of heat in the upper burner
and cold in the center burner. Gardenia ( zhf zi') clears heat from all three burners
and eliminates vexation, while dried ginger (gan jiang) warms the center burner.
Later in the text, Cop tis Decoction ( huang litin tang) is also used in the treatment
of upper heat and lower cold. The difference is that this pattern is characterized
by generalized heat effusion and mild vexation, while in that case the main sign is
vomiting. See line 173, p. 247, for a further discussion of Coptis Decoction (huting
litin ta叼) .
LINE 8 1
凡用 梳子汤 ,
Fan yong
病 人 旧 微糖者 , 不 可 与 服 之 。
zhi zi tang,
bing ren
jiu wεt
tang
zhe, bu ke
yu
Ju
zhi.
I n a l l a ppl ications1 of Gardenia Dec。ction ( zhi zi ta叼 ) , 2 i f t h e pers。n
usually has slightly sloppy stool,3 。ne ca n n。t give [th is form u la] .
TEXT N O TE S
1 . In all applications, 凡 用 f<i.n yong: All patterns that have been described in
which Gardenia and Fermented Soybean Decoction (zhf zi' chi tang) is appro­
priate.
2 . Gardenia Decoction (zhτ zi' tang) is taken to mean Gardenia and Fermented
Soybean Decoction ( zhf zi' chi tang) or its variants.
3. Usually has slightly sloppy stool, 旧 微 搪 jiu wei tang: A person who, prior to
the onset of illness, has thin, watery stool.
SYNOPSIS
Contraindications for the use of Gardenia and Fermented Soybean Decoction
( zhf zi' chi t伽.g).
COMMENTARY
Sloppy stool, generally an indication of weakness in the spleen and stomach
or weakness in the spleen and kidney, may in some C皑白 indicate heat, but in this
C副e it indicates vacuity of the spleen y归g and/ or kidney yang. It is unnecess缸y to
decide exactly which organ is vacuous. This formula should not be used in vacuity­
type stool patterns; the key point being the presence of vacuity, not sloppy stool. A
particular interdiction exists against its use in cases of enduring vacuity-type sloppy
stool because, as in any enduring condition, right qi is weakened. G缸denia and
Fermented Soybean Decoction ( zhf zi' chi tang) is contraindicated because its main
ingredient, gardenia (zhf zi), is cold and bitter. Use of this type of formula in a pa­
tient with center burner vacuity will further damage the qi of the center burner and
result in an exacerbation of the sloppy stool. In a pattern of upper burner depressed
l . GREATER y ANG [LINE 63, 1 62]
154
heat, where this formula seems the most appropriate, with sloppy stool, the dosage
of gardenia (zhf zi) should be reduced and / or additional ingredients that supple­
ment and w缸m the center burner should be included, as in Gardenia and Dried
Ginger Decoction ( zhf zi gan jia叼 tang ) . This contraindication m町 be extended to
include a wide spectrum of cases. When the φ of the center burner is insu值cient,
cold and bitter formulae should be used cautiously or avoided altogether.
4.5.2
Ephedra, Apricot Kernel, Licorice, and Gypsum
Decoction Patterns
LINE 6 3 , 1 6 2
发 汗后 , 不 可更行桂校汤 , 汗 出 而 喘 , 无大热者 , 可与麻黄
杏仁甘草石膏汤 。
Fa han hou, bu ke geng xing gui zhr tang, him chu er chuan, WU da
re zhe, ke yu ma huang xing ren gan cao sh{ gao tang.
After t h e promoti。n of sweating, ( [。ne] ca n n 。t aga i n use Ci n n a mon
Twig Decocti。n (gui zhr tang ) 1 ) if sweat issues, a n d [there is] pa nti ng2
a nd great heat is a bsent, 。ne ca n use Ephed ra , Apricot Kernel , Lie。rice,
a nd Gypsu m Dec。ction ( ma huang xing ren gan cao sh{ gao tang) .
下后 , 不 可 更行桂枝汤 , 若汗出 而喘 , 无大热者 , 可与麻黄
杏子甘草石膏汤 。
Xia hou bu ke geng xing gui zhz tang, ruo han chu er chuan, WU da
re zhe, ke yu ma huang xing zi gan cao sh{ gao tang.
After preci pitation , ( [。ne ca n n。t aga i n use C i n 『1
(gui zhr ta·叼)] 1 ) i f sweat issues, a nd [there is] pa nti ng,2 a nd great heat
is a bsent, one ca n use Ephed ra , Apricot Kernel , Licorice, a nd Gypsu m
Dec。ction ( ma h叫ng xing zi gan cao sh{ gao tang ) .
TEXT NOTES
1. Two of the Song lines are treated here together because they 缸e identical
except that one begins with “after the promotion of sweating" and the other
with “after precipitation.” This and the following note apply to both lines.
Some commentators suggest that this is an example of grammatical inversion
and that this clause could be moved ahead so that the line reads: “After
promoting sweating, [if] sweat issues, and [there is ] panting, and great heat
[effusion] is absent, one cannot again use Cinnamon Twig Decoction (gui zhf
tang ) . One can use Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction
( ma hua叼 xing ren gan cao shi gao tang).”
2 . Panting , 喘 c hu a n : Urgent , hasty, and difficult breathing. When severe, it
may be accompanied by gaping mouth, raised shoulders, flaring nostrils, and
inability to lie flat.
1 . GREATER yANG
[ LINE 63, 162]
155
FORMULA
Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction ( ma huang xing ren gan
cao shi gao tang ) .
o
Clear heat and diffuse the lung.
麻黄四两 ( 去节 )
半斤 ( 碎、 绵裹 )
杏仁五十个 ( 去皮尖 )
甘草二两 ( 炙 )
石膏
忖 右四昧 , 以水七升 , 先煮麻黄 , 减二升 , 去上沫 , 内诸药 , 煮
取 二 升 , 去 淳 , 温 服 一 升 。 仁) 本 云 , 黄 耳 枉 。
Ma huang si li a ng ( qu ji e ) xing ren wu shi g e ( qu pi ji an ) gan cao er liang
(zhi) shi gao ban fin (sui, mian guo)
( 1 ) You si wei, yi shui qf sheng, xian zhU ma huang, jian er sheng, qu shang
mo, na zhu yao, zhU qu er sheng, qu zi, wen Ju yf sheng. (2) Ben yun, huang er
p ei.
ephed ra (麻 黄 ma huang, Ephed rae Herba ) 4 li�ng ( remove nodes)
apricot kernel ( 杏 仁 xing ren, Armeniacae Semen ) 50 pieces ( remove ski n a nd ti ps)
mix-fried licorice ( 甘 草 gan cao, G lycyrrhizae Radix) 2 li�ng
gypsum ( 石 膏 shi gao, Gyps u m ) half jTn (crushed and cotton-wra pped)
( 1 ) [For] the a bove fo u r i ngred ients, use seven sheng of water. Fi rst boil ephed ra
( ma huang) to red uce [the water] by two sheng. Remove the foa m [collecti ng] on top
a nd add all the i ngredients. Boil to get two sheng, remove the d regs, and ta ke one
she昭 wa rm . (2) This [form u la] is [to be put i n] a yellow-eared cup.*
FORMULA NOTE
*
A yellow-eared cup, 黄 耳 桩 huang er pei : A Han Dynasty drinking vessel that
is yellow and has loop handles (the “ears” ) . In this phrase 枉 pei is read as 杯
bei . The significance of this cup is unknown to modern commentators.
SYNOPSIS
The signs and treatment of panting that is the result of evil heat congested in
the lungs after the promotion of sweating.
COMMENTARY
Greater yang disease is properly treated through the promotion of sweating.
In this line, because the disease has not resolved following the use of this method,
one knows that the formula was inappropriate for the patient or not strong enough
to expel the evil. Also, it is clear that precipitation is an inappropriate method
for use in greater yang disease. In both c副es the evil, instead of being resolved,
falls inward and becomes congested in the lung, causing qi counterflow. The loss of
normal diffusing and downbearing causes panting. Heat congesting in the lung also
steams the fluids in the lung, forcing them out through the surface of the body in
the form of sweat.
An analysis of the formula reinforces the idea that “great heat is absent" means
that there is no great heat in the exterior, despite the presence of exuberant heat
congestion in the lung. The combination of ephedra (ma huang) and gypsum ( shi
1 . GREATER YANG [LINE 2 6]
1 56
gao) clears and diffuses lung heat and stabilizes panting. Ft川hermore, when a
large dose of gypsum (shi gao) is given with a smaller dose of ephedra (ma huang),
the two diffuse the lung without drying and clear lung heat without causing stag­
nation, because the cold, sweet nature of gypsum ( shi gao) moderates the warm,
acrid nature of ephedra ( ma ht凶ig) . Apricot kernel ( xing ren) diffuses and down­
bears lung qi. It increases the formula,’s ability to stabilize panting. Licorice (gan
cao) harmonizes all the ingredients, as well 描 harmonizing the center and mildly
supplementing the qi.
Three other formulae are also used to treat sweating and panting: a) Cinnamon
Twig Decoction Plus Magnolia Bark and Apricot Kernel (gui zhf jia hOu po xing zi
tang) , which can be used when exterior-resolution is required; b) Ephedra Decoction
( ma ht而ig tang) , which can be used when sweating is absent; and c) White Tiger
Decoction ( Mi hU tang) , which can be used to treat yang brightness interior heat.
4品3
White Tiger Decoction Plus Ginseng Patterns
LINE 26
服桂校汤 , 大 汗 出 后 , 大烦渴不解 , 脉洪大者 , 白 虎加 人 参
汤主之。
Fu gui zhz tang, da han chu hou, da fan ke bu jie, mai hong da zhe,
bai hu jia ren shen tang zhu zhf.
When , after C i n 阳non Twig Dec。ction (g创 zhf tang) is ta ken a n d a
g阳t sweat has issued , [there is) great vexati。n a nd thirst, a nd [the
d isease) is u n res。lved * a nd the pu lse is su rgi ng a n d large, Wh ite Tiger
Dec。cti。n P l us G i n seng ( bai hu jia ren shen tang) governs.
TEXT NOTE
*
Great vexation and thirst, and [the disease] is unresolved, 大 烦 渴 不 解 da ft.in
ke b也 jie: This phrase can be interpreted in several ways, depending upon
where one chooses to break the phrase. The most likely interpretation, as
reflected in our translation, is that there is great vexation, great thirst, and
an unresolved disease. Some commentators, however, have interpreted this
phrase as meaning that there is great vexation and unresolved thirst .
FORMULA
White Tiger Decoction Plus Ginseng ( btii hu jia ren shen tang).
o
Clear qi 问pect] and discharge heat; boost φ and engender liquid.
知母六两
参三两
石膏一斤 ( 碎 , 绵裹 )
甘草二两 ( 炙 )
梗米六合
人
右五昧 , 以 水一 斗 , 煮 米 熟 , 汤成 , 去津 , 温服一升 , 日 三服 。
Zhf mu liu liang shi gao yz jzn ( s时, mian guo)
mi liu ge ren shen san liang
gan cao er lia叼 (zhi)
geng
1 . G REATER YANG
san
You
Ju.
[ LINE 26]
157
wu wei, yi shui yf do包, zhU mi shu, tang eking, qu zi, wen JU yτ sheng, ri
anemarrhena ( 知 母 zhf mu, Anema rrhenae R h i zoma ) 6 Ii温ng
gypsu m ( 石 膏 sh i giio, Gy p su m ) 1 jin = 16 li�ng ( crushed a nd cotton-w ra p p e d )
mix-fried licorice ( 甘 草 giin ciio, Glycyrrhizae Radix) 2 li�ng
rice ( 梗 米 geng m式 Oryzae Semen ) 6 g�
gi nseng ( 人 参 ren sh旬, G i n seng R ad i x ) 3 li�ng
[For] the a bove five i ngredients use one dδu of water. Boil [u ntil] the rice is cooked
a nd it becomes a sou p . Remove the d regs a nd ta ke one sheng , warm , th ree times a day.
SYNOPSIS
The signs and treatment of damage to the ql and yin that is the result of
exuberant yang brightness heat after the ingestion of Cinnamon Twig Decoction
(gui zhf tang ) .
COMMENTARY
Recalling previous lines in which Cinnamon Twig Decoction ( gu i zhf tang) was
given, it is clear that the problem this line presents originates in “great sweating.”
When Cinnamon Twig Decoction ( gu i zhf tang) is given, sweat should issue mildly,
so that the body becomes damp. One is cautioned against causing profuse sweating
or continuing to use the formula after the initial sweating. The yang ql steams the
fluids to produce sweat, so when sweating is excessive, it damages both the yang
ql and yin liquid. When yin liquid is damaged, the heat is reinforced and may
transfer to the yang brightness. The key signs in this pattern are great vexation
and unquenchable thirst . Vexation and thirst result from damage to the ql and
liquid and belong to a pattern of yang brightness exuberant heat. A pulse that is
surging and large indicates heat steaming in the y缸g brightness and causing the
ascension of ql and blood.
This disease is considered a yang brightness stomach heat pattern and one may
ask why White Tiger Decoction ( Mi hu tang) is not used. In this disease stomach
heat damages the fluid. The fluid damage is serious, as indicated by the presence
of great vexation and unquenchable thirst. Thus, although one must clear heat, it
is also necessary to engender liquid and boost the ql, as both have been damaged.
Anemarrhena ( zhf mu) and gypsum ( shi giio) both clear heat and nourish yin.
Gypsum (shi giio) also eliminates vexation and allays thirst. Mix-fried licorice (gan
ciio) and rice (geng m i) nourish the stomach and harmonize the center. These four
ingredients constitute White Tiger Decoction ( Mi h u tang) . The addition of ginseng
( ren sh en) is necessary because of the damage to the fluid and the φ. Ginseng ( ren
sh en ) supplements the ql and engenders fluid. The heat-clearing action of White
Tiger Decoction ( Mi hU tang) is not sufficient to resolve the disease, so it is used
in combination with the liquid-engendering, φ-supplementing properties of ginseng
( ren sh en ) . Great sweating following the ingestion of Cinnamon Twig Decoction
( gu i zhf t伽.g) and a pulse that is surging and large is also mentioned in line 25,
p. 125. In line 25, however, “great vexation and unquenchable thirst" is absent;
therefore, the evil is still in the exterior and the s u ggest ed treatment is another dose
of Cinnamon Twig Decoction (gu i zhf tang) .
1.
1 58
GREATER y ANG [LINE 34]
Pueraria, S cutellaria, and Coptis Decoct ion
Pat t erns
4.5.4
LINE 34
太 阳 病 , 桂 枝 证 , 医 反 下 之 , 不lj 遂 不 止 , 脉 促 者 , 表 未 解
也 ; 喘而汗出 者 , 葛根黄苓黄连汤主之 。
Tai yang bing, gui zhi zheng, yi fan xia zhi, li sui bu zhi, mai cu
zhe, biiio wei jie ye; chuiin er han chu zhe, ge gen huang q伽 huang
lian tang zhu zhi.
When i n a greater ya ng disease [the cond ition is a] C i n n a mon Twig
[Dec。cti。n] ( gui zhi [tang] ) patte矶 but the physicia n preci pitates,
[ca usi ng] i ncessa nt d i arrhea and a p u lse that is ski ppi ng, it mea ns that
the exterior has not resolved ; when [there is] pa nti ng a nd sweating,
P u era ria , Sc川el lari a , and c。ptis Decocti。n (ge gen h叫叼 qin huang
lian tang) g。verns.
FORMULA
Pueraria, Scutellaria, and Coptis Decoction (g e g en huang qin huang lian
o
tang) .
Clear heat and check diarrhea; resolve interior and exterior [patterns] .
葛根半斤
甘草二两 ( 炙 )
黄苓三两
黄连三两
右 四 昧 , 以 水 八 升 , 先煮葛根 , 减二 升 , 内 诸药 , 煮取二 升 , 去
淳 , 分温再服 。
Ge
gen ban fin gan cao er liang ( zh i) huang qin san liang huang lian san
liang
You si ω剖,
qii, er sh eng, qu
yi shui ba sheng, xian zhii. ge g en jian er sheng, na zhu yao, zhu
z记 fen wen zai JU.
,
pue 阳 ia ( 葛 根 ge g旬, P uerariae Radix ) half Jin (8 Ii温ng )
mix-fried licorice ( 甘 草 gan cao, Glycyrrhizae Radix ) 2 li�ng
scutella ria ( 黄 苓 huang q巾, Scutellariae Radix ) 3 li�ng
coptis ( 黄 连 huang lian, Coptidis Rhizoma ) 3 li�ng
[For) the a bove fo u r ingredients, use eight she吨 of water. Fi rst boil pueraria (ge
gen) to red uce [the water] by two she吨. Add a l l the ingredients. Boil to get two she『I
a nd rem。ve the d regs. Divide [ i nto two 阴阳] , a nd ta ke warm twice a day.
SYNOPSIS
A discussion of the signs and treatment of diarrhea from interior heat compli­
cated by an exterior evil.
COMMENTARY
When precipitation is used in cases of an exterior evil, the evil falls inward
1 . GREATER YANG [LINE 1 72]
159
resulting in chest bind or, as in this case, diarrhea. The action of precipitation, by
causing downward movement in the b o dy, actually drags the evil into the body and
down into the lower burner. On the basis of the formula one can infer that evil qi
has transformed into heat and harassed the intestines, causing incessant di缸rhea.
Nevertheless, the patient’S yang qi is exuberant and still has strength to contend
with the evil in the exterior, as indicated by a pulse that is skipping. This pulse
also indicates that the exterior has not yet resolved and heat is harassing the lung.
Pantin� means that the lungs have lost the ability to depurate and downbear. The
heat evil steams the fluids and forces them to stray to the exterior, so sweat issues.
Pueraria (ge gen) is the most important ingredient in the formula. It resolves
the fleshy exterior, raises the clear y缸g, and checks diarrhea. Also important
to treat di缸rhea are scutellaria (huang qin) and coptis (huang l仰i) , which clear
interior heat , thicken the intestines and stomach, and check diarrhea. “Thickening”
refers to strengthening and fortifying stomach and intestinal function. Licorice
( gan ciio) harmonizes the center, boosts the qi, and moderates the actions of the
other ingredients. Although this formula is thought to resolve both the exterior and
the interior conditions, it is primarily a formula to clear interior heat and resolve
diarrhea. It may also be used for i nc essant diarrhea without exterior signs.
4.5.5
S cutellaria Deco ction and Scutellaria Decoction
P lus P inellia and Fresh Ginger Patterns
LINE 1 72
太 阳 与 少 阳 合 病 , 自 下 利 者 , 与 黄 苓 汤 ; 若 H区 者 , 黄 苓 加 半
夏生姜汤主之 。
Tai yang yil shao yang he bing, zi xia li zhe, yil huang q伽 tang; ruo
ou zhe, huang qin jiii ban xia sheng jiiing tang zhil zhf.
When i n greater ya ng a n d lesser ya ng com bination d isease [there is]
sp。nta neous diarrhea , * give Scutel laria Decoction ( huang qin tang ) ; if
[there i 斗 时ch i 吨, Scutel la ria Decoction P l us Pi nel lia a n d Fresh Gi nger
( huang qin jia ban xia sheng jiang ta叼) governs.
TEXT NOTE
*
Spontaneous diarrhea, 自 下 利 zi xia li: Loose stool that occurs without any
known cause, such as inappropriate precipitation.
FORMULAE
Scutellaria Decoction
o
(huang q{n tang).
Clear heat and check diarrhea.
黄苓三两
巧药二两
甘草二两 ( 炙 )
大枣十二枚 ( 孽 )
右 四 昧 , 以 水一 斗 , 煮取三升 , 去淳 , 温服一升 , 日 再 、 夜一 服 。
1.
160
GREATER YANG [LINE 1 72]
huang qin san liii.ng shao yao er liii.ng gan cii.o er liii.ng (zhi) da zii. o shi e r
mei ( bO)
You si ω剖, yi shui yz dou, zhU qii. san sheng, qu z瓦 wen JU yf sheng, ri za i 、
ye yr JU.
scutel laria ( 黄 苓 hu ang qin, Scutellariae Radix) 3 li�ng
peony (苟 药 sh ao yao, Paeo n iae Radix) 2 li�ng
mix-fried licorice (甘 草 gan cii.o, Glycyrrh izae Radix) 2 li�ng
j uj u be ( 大 枣 da zii.o, Zizi phi Fn
[F。r] the a bove fo u r ingredients use one dC5u of water. Boil to get th ree sheng a nd
remove the d regs. Ta ke one sheng warm , [then] once [d u ring] the day a nd aga i n at
n ight.*
Scutellaria Decoction Plus Pinellia and Fresh Ginger
(huang q{n jia bdn xia sheng
jiang tang) .
o
Downbear counterflow and check retching.
黄苓三两 苟药二两 甘草二两 ( 炙 )
升 ( 洗 ) 生姜一两 半 ( 一方三两 , 切 )
大枣十二枚 ( 壁 )
半夏半
右 六 昧 , 以 水 一 斗 , 煮取三升 , 去淳 , 温服-升 , 日 再 、 夜一 服 。
Huang q{n san liiing sM.o yao er liang g伽 ciio er liiing (zhi) da ziio shi er
mei ( bO) bdn xia bdn sheng (xi) sheng jiang yf liiing ban (yz fang san liiing, qie)
You liu w剖, yi shui yz do包, zhii. qu san sheng, qu zi, wen Ju yz sheng, ri zai 、
ye yr JU.
scutellaria (黄 苓 huang q阳, Scutellariae Radix) 3 li�ng
peony (巧 药 sM.o yao, Paeoniae Radix) 2 li�ng
m ix-f1『ied licorice (甘 草 gan ciio, Glycyrrhizae Radix) 2 li�ng
juj u be ( 大 枣 d a zii.o, Zizi phi Fructus) 1 2 pieces ( broken)
pinellia ( 半 夏 ban xia, Pinelliae Tu ber) half sheng (washed)
fresh ginger (生 姜 she呼 jia叼, Zingiberis Rhizoma Recens) 1 li�n g {cut)
[For] the a bove six i ngredients use one dC5u of water. Boil to get th ree she吨 a nd
remove the d regs. Ta ke one sheng warm , [then] once [du ring] the day and again at
n ight.丰
FORMULA
*
NOTE
Take one sheng warm, [then] once [during] the day and again at night, 日 再 、
夜 一 服 时 zai, ye yz JU : One sheng of the three sheng decoction is taken
immediately, then one sheng is taken during the day, and the final sheng is
taken in the evening.
SYNOPSIS
The signs and treatment of diarrhea and retching or vomiting that may occur
in greater y缸g and lesser yang combination disease.
1.
GREATER YANG
161
COMMENTARY
As in previous lines, when the pattern is referred to 描 a combination disease one
may assume that signs of both channels are present. Nevertheless, any particular
sign that is explicitly mentioned in the text should be given more significance. In
this pattern signs of both greater yang disease and lesser yang disease are present,
but spontaneous diarrhea is highlighted by its inclusion in the text. This line
presents a lesser yang disease, rather than a greater yang pattern, since spontaneous
diarrhea is more common in lesser y归g patterns. Heat evil depressed in the lesser
yang may move inward and harass the yang brightness, causing heat diarrhea.
An analysis of the formula reinforces this idea. Scutellaria Decoction (huang q如
tang) is suggested for this pattern. Scutellaria (huang qin), after which the formula
is named and which is used in the highest dosage, is bitter and cold. It clears
liver and gallbladder heat and checks diarrhea. Peony (ska。 ”。) nourishes liver
yin and quells the liver. It can control liver and gallbladder ql which counterflow
transversely, overwhelming the spleen and stomach, and causing diarrhea. This
combination is important for the treatment of heat diarrhea.
Another possibility suggested by this line is that when heat evil becomes de­
pressed in the lesser y缸g, it may invade the stomach and cause retching. In this
event, the same basic formula is used, but pinellia ( ban xiii) and fresh ginger ( sheng
jiang) are added. These two ingredients harmonize the stomach, downbear coun­
terflow, and suppress retching.
4 . 6 VACUITY COLD PATTERNS
Inappropriate treatment of a grea t er y缸g disease can result in a transmuted
pattern of vacuity cold. These patterns can be divided into heart yang vacuity,
yang vacuity with water ql, spleen vacuity, and kidney yang vacuity.
4.6. 1
Heart Y�主ng Vacuity Patterns
In the patterns below, excessive promotion of sweating or the use of fire methods
to force sweating damages the heart yang and causes conditions such as heart
palpitations and fright mania. These are patterns of heart y缸ig vacuity, but because
the process of damaging the heart yang varies, the signs also vary. If the heart yang
is damaged through excessive sweating, giving rise to signs such as heart palpitations
with a liking for pressure, the appropriate formula is Cinnamon Twig and Licor­
ice Decoction (gui zhi gan cao tang), which w缸ms and frees the heart y缸g. If
a fire method is used and then precipitation is also used, it can cause heart y缸g
vacuity. The heart spirit strays, giving rise principally to vexation and agitation.
This pattern is a more severe vacuity than the previous one and is treated with
Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction (gui zhi gan
ciio tong gu mu li tang) , which warms and frees the heart M吨, and quiets the spirit
by subduing and settling. If the damage to the heart y缸g is even more severe and
yang collapses, signs such as fright mania may result. In this case, the appropriate
formula is Cinnamon Twig Minus Peony Plus Dichroa Leaf, Dragon Bone, and
Oyster Shell Counterflow-Stemming Decoction (gui zhf qu shao yao jia shii qf mu li
long gii. jiu ni tang) , which warms and frees the heart ya吨, settles fright and quiets
the spirit, and constrains floating yang. If the use of red-hot needling damages the
heart y缸g and lower burner cold ql ascends counterflow, giving rise to running
1.
162
GREATER YANG [LINE 64]
piglet , the appropriate formula is Cinnamon Twig Decoction Plus Extra Cinnamon
(gui zhf jia gui tang ) , which warms and frees the heart yang, and calms upsurge
and downbears counterflow.
4.6. 1 . 1
Cinnamon Twig and Licorice Decoction Patterns
LINE 64
发 汗 过 多 , 其 人 叉 手 自 冒 心 , 心 下 悸 , 欲得 按 者 , 桂枝 甘 草
汤主之 。
Fa han guo duo, qi ren cha shou zi mdo xfn, xfn xia ji, yu de an
zhe, gui zhi gan cao t ang zhu zhf.
When c。pious sweating has been prom。ted a n d the person ’ s ha nds are
er。ssed 。ver the heart1 a nd there a re pa l pitations below the heart,2 with
a d esi re for press u 毗 C i n n a mon Twig a nd Licorice Dec。ction (gui zhf
gan cao tang) governs.
TEXT NOTES
1. Hands crossed over the heart , 叉 手 自 冒 心 cha shou zi mao xi"n : The hands
缸e crossed and covering the chest in the area where the movement from the
palpitations is felt.
2. Palpitations below the heart, 心 下 悸 xi"n xia ji: A feeling of light pounding
in the upper stomach region, just below the tip of the breast bone, not in the
heart.
FORMULA
Cinnamon Twig and Licorice Decoction
o
(gui zhf gan cao tang)
Supplement heart yang.
桂枝 四 两 ( 去皮 )
甘草二两 ( 炙 )
右二昧 , 以 水三升 , 煮取-升 , 去淳 , 顿服 。
Gui zhf si liang ( qu p i') gan c ao er liang ( zhi)
You er ω剖, yi shui san sheng, zhi1 qu yf sheng, qu z瓦 dun fu.
cin n a mon twig (挂枝 gui zh豆 C i n n a momi Ra m u l us ) ( remove bark ) 4 liiing
m ix-fried licorice ( 甘 草 gan cao, G lycyrrhizae Radix ) 2 li�ng
[ For] the a bove two i ngredients use three sheng of water. Boil to get one st巾eng.
Remove the d regs and ta ke in 。ne single d。se.
SYNOPSIS
The signs and treatment of heart palpitations that occur after sweating is pro­
moted excessively and damages the heart yang.
COMMENTARY
Sweat is the humor of the heart and is produced through the steaming action of
1 . GREATER YANG (LINE 1 1 8]
163
the heart y缸g. When copious sweating is promoted, it may damage the heart y缸g.
Damage to the heart y缸g results in a loss of the normal defense and protection of
the heart 创id produces palpitations. A desire for pressure means that the palpita­
tions are vacuous in nature. The indication of vacuity is further suggested by the
patient’s posture. The patient covers the heart in order to quiet the palpitations
and protect from the outside what cannot be protected from the inside. The heart
cannot protect itself because the heart yang has been damaged.
Cinnamon Twig and Licorice Decoction (gui zhf gan cao tang) supplements and
boosts the heart yang. Acrid, sweet , and warm, cinnamon twig (gui zhf) enters the
heart , warming the channels, freeing yang, and assisting y缸g. Mix-fried licorice
(gan cao) is sweet and warm. It supplements the center and boosts the ql. The
combination of these two medicinals engenders the yang qi and returns the heart
yang, thereby relieving palpitations.
4.6. 1 . 2
Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell
Decoction Patterns
LINE 1 1 8
火 逆下 之 , 因 烧针烦躁者 , 桂校 甘 草 龙 骨牡断汤主 之 。
Huo ni xia zh豆 yin shao zhen fan zao zhe, gui zhi gan cao long gu
mu li tang zhu zhι
If adverse [treatment] by fi re1 [is fol lowed by] preci pitation , a n d beca use
of red-hot need l i 咆2 [there is] vexation a nd agitati。n , C i n na m。n Twig,
Licorice, D ragon Bone, and Oyster Shel l Decocti。n (gui zhi gan cao
long gu mu li tang) g。verns.
TEXT NOTES
1. Adverse [treatment ] by fi re, 火 逆 hu6 ni: Inappropriate use of a 且re treatment.
2 . Red-hot needling, 烧 针 sha o zhen: In Gao Deng Cong Shu this method is
referred to as warm needling. The Shang Han Lim Yan Jiu Da Ci Dian,
however, explains that this technique, also referred to as fire needling (火 针
hu6 zhen), involves heating the tip of the needle until it is red hot, quickly
inserting it , and then massaging the needle site after removal. This method
warms the channels and frees the vessels, and moves ql and quickens blood. It
is appropriate for cold-damp impediment (寒 捏 痹 Mn shf bi) pain and other
similar patterns. Red-hot needling is to be clearly distinguished from warm
needling (温 针 ω伽 zhen) , which involves the placing of moxa floss, 支 绒 M
r6ng, on the handle of the needle and burning it to warm the needle and the
local area. See line 16A, p. 132, and line 119, p. 277, for warm needling.
FORMULA
Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction
cao long gu m
o
Supplement heart yang; subdue, settle, and pacify the spirit.
(gui zhf gan
1 . G REATER YANG [LINE 1 18]
164
挂枝一两 ( 去皮 )
甘草二两 ( 炙 )
牡隔二两 ( 熬 )
龙骨二两
右 四 昧 , 以水五升 , 煮取二升 半 , 去淳 , 温服 八合 , 日 三服 。
Gui zhf yf liiing ( qu p i') giin cii.o er liii.ng (zhi) mu li er liiing ( ao) long gu
er liiing
You si w函, yi shui wu sheng, zhU qu er sheng ban, qu zi, wen ju bii ge, ri siin
Ju.
ci n namon twig (桂 枝 gui zh豆 C i n n a momi b 『n u lus ) 1 li�ng ( remove bark)
m ix『fried licorice (甘 草 giin cii.o, Glycyrrhizae Radix) 2 Ii革n
oyster shell (牡邮百 mu li, Ostreae Concha) 2 li�ng {dry-fry )
d ragon bone (龙 骨 long gu, M astod i Ossis Fossil i a ) 2 Ii温ng
[For] the a bove four ingred ients use five sheng of water. Boil to get two and a half
sheng. Remove the d regs and take eight g� warm , th ree times a day.
SYNOPSIS
The signs and treatment of heart y缸g vacuity vexation and agitation.
COMMENTARY
Two ambiguities arise in this line. The first ambiguity concerns the nature of
the red-hot needling method discussed in the note above. The second concerns the
number of erroneous treatments the patient has received. The 且rst mistreatment is
the inappropriate use of an unspecified fire method. The second is the inappropriate
use of precipitation. The ambiguity lies in whether “reιhot needling,” mentioned
after precipitation, is a third mistreatment or whether it refers to the first mistreat­
ment , adverse treatment by fire. Zhang Zhi-Cong and Cheng Wu-Ji agree that the
red-hot needling constitutes a third mistreatment, whereas Yu Chang and Qi缸
Huang believe that only two mistreatments occurred and that red-hot needling is
the fire method.
Despite these differences of interpretation, all the commentators agree that the
use of fire methods to force sweating damages the heart yang. Not only that, but
because fire methods 缸e generally uncomfortable for the patient, they also easily
disquiet the heart spirit. After damage to the heart yang it loses warmth and
nourishment and the heart spirit cannot be contained. The result of this treatment
is vexation and agitation; hence Cinnamon Twig, Licorice, Dragon Bone, and Oyster
Shell Decoction (gui zhf gan cii.o long gu mu li tang) is used. Dragon bone (long
gu) and oyster shell (mu li) subdue and settle and quiet the spirit. Cinnamon twig
(gui zhf) and mix-fried licorice (gan cii.o) warm and free the heart yang.
l.
4.6. l . 3
165
GREATER YANG [LINE 1 1 2]
Cinnamon Twig Minus Peony Plus Dichroa, Dragon
Bone, and Oyster Shell Counterflow-Stemming Decoction
Patterns
LINE 1 1 2
伤寒脉浮 , 医以火迫劫之 , 亡阳 , 必惊狂 , 卧起不安者 , 桂
校 去 走7 药 加 蜀 漆 牡 航 龙 骨 救 逆 汤 主 之 。
Shang han mai Ju, yf yi huo po jie zhr, wang yang, bi jfng kuang,
WO qi bu an zhe, gui zhf qu shao yao jia shu qf mu li long gu jiu ni
tang zhu zhf.
When i n cold d a m age the pulse is floati ng a nd the physicia n uses fi re
[treatment] t。 force [sweati ng] , 1 a nd [as a resu lt] ya ng c。l l a pses,2 [then]
there wil l be fright m a n ia3 and fidgetiness whether lyi n g 。r sitting;
Cin na m。n Twig M i n us Pe。ny P l us Dich roa Leaf, D ragon Bone, a nd
Oyster Shell Cou nterflow-Stem m i ng Decoction ( gui zhr qu shao yao
jia shu qf mu li long gu jiu ni tang ) governs.
TEXT NOTES
1. Fire [treatment] is used to force [sweating] , 火 迫 劫 之 huo po ji e zhf: Using a
且re method (red-hot needli吨, fire fuming, moxibustion) to force sweating.
2. yang collapse, 亡 阳 wang yang : Critical vacuity of yang qi. Here yang collapse
is understood to mean collapse of the heart yang. Sweat is the humor of the
heart and is produced through the steaming action of the heart y缸g. When
sweating is forced or promoted improperly, it may damage the heart yang.
3. Fright mania, 惊 狂 jfng kuang: Apprehension and manic derangement.
FORMULA
Cinnamon Twig Minus Peony Plus Dichroa Leaf, Dragon Bone, and Oyster Shell
Counterflow-Stemming Decoction (gui zhf qu shao yao jia shu qf mu U l6ng gu jiu
ni tang)
o
Supplement heart yang; settle fright and quiet the spirit.
桂枝 三 两 ( 去 皮 )
(壁)
牡隔五 两 ( 熬 )
甘草二两 ( 炙 )
生姜三两 ( 切 )
蜀漆三两 ( 洗去腥 )
大枣十 二枚
龙骨 四 两
←) 右 七 昧 , 以 水 一 斗 二 升 , 先 煮 蜀 漆 , 减 二 升 , 内 诸 药 , 煮 取 三
升 , 去 淳 , 温 服 一 升 。 问 本 云 , 桂枝 汤 , 今 去 苟 药 , 加 蜀 漆 、 牡畅 、
龙骨 。
Gui zhf s ii.n liii.ng ( qu pf) gii.n cii.o er liii.ng ( zhi) she叼 jiang
da zao shi er mei ( bo) mu li wu Jiang ( ao) shU qf S伽 liang (xi
gu si liang
sii.n liii.ng ( qie)
qu xzng) long
1 . GREATER YANG [LINE 1 1 2]
166
( 1 ) You qf wei, yi shui yr dou er sheng, xian zhil shU qf, jiiin er sheng, na zhii
yao, zhu qu san sheng, qu zi, wen JU yr sheng. (2) Ben yun gui zhf tang, jfn qu sMo
yao, jia shU qf、 mu li、 long gu.
cinna mon twig (桂枝 gui zh豆 C i n namomi Ra m u l us) 3 liling ( remove bark)
m ix-fried lie。rice ( 甘 草 gan ciio, G lycyrrhizae Rad ix) 2 l ili ng
fresh ginger (生 姜 sheng jiang, Zingi beris Rhizoma Recens) 3 liling (cut)
j uj ube (大 枣 da ziio, Ziziphi F『t
。yster shell (牡 虫厉 mu li ’ O streae Concha) 5 liling ( d 吁f的
dichroa leaf (蜀 襟 shU qi, Dichroae Fol i u m ) * 3 Ii温 吨 (wash to remove fishy smel l )
d ragon b o n e ( 龙 骨 16叼 gu , Mastod i O臼is Fo臼ilia) 4 liling
(1) ( For] the a bove seven i ngredients use one d�u and two sheng 。f water. Fi rst boi l
dichroa leaf (shU qf) a nd red uce by two she略 Add a l l [the othe r] ingredients and boi l
to get th ree sheng. Remove the d regs and ta ke one sheng warm . (2) This is Cinnamon
Twig Decoction (gui zhf t伽g) without peony ( sM。 ”。) , a nd with dichroa leaf (shU
qi) , oyster shell (mu li) , a nd d ragon bone (long gu) .
FORMULA NOTE
Dichroa leaf (shu
qz) : The leaves of dichroa (cMng shan}.
S YNOPSIS
The signs and treatment of fright mania from collapse of the heart yang caused
by inappropriate use of a fire method.
COMMENTARY
When in cold damage the pulse is floating, one should promote sweating. Never­
theless, heavy sweating is contraindicated. Here a 直re method is used which causes
excessive sweating, yang collapse, and the heart spirit to float astray. Yang collapse
may take the form of collapse of kidney y缸g, heart y缸ig, or defensive y缸g. Kidney
yang collapse is treated by warming the kidney and returning y缸ig with formulae
such 甜 Counterflow Cold Decoction ( si ni tang). Cinnamon Twig Decoction Plus
Aconite (gui zhf jia j边 zi tang) , which secures the exterior and protects M鸣, is ap­
propriate to treat collapse of the defensive y缸ig. The signs above, however, clearly
indicate collapse of the heart y缸g. When the heart yang collapses, the heart spirit
cannot be contained and subdued, so it floats outward. Mild patterns may include
palpitations or agitation and vexation, whereas more severe patterns may include
fright mania.
Cinnamon Twig Minus Peony Plus Dichroa Leaf, Dragon Bone, and Oyster
Shell Counterflow-Stemming Decoction (gui zhf qu sMo yao jia shU qf mu li long gu
jiu ni tang) contains cinnamon twig (gui zhf) and licorice (gan ciio), which engender,
warm, and free the y臼g qi, so that it returns to the heart. Fresh ginger ( sheng
jiang) and juj ube ( da ziio) boost the center and harmonize. Oyster shell (mu li) and
dragon bone ( l6叼 抖) 町e heavy settlers that pacify the heart spirit by subduing
and restraining ya吨. The use of dichroa leaf ( shU qif} has been explained in two
ways. Zhang XI-Ju, Cheng wιJi, and Fang You-Zhi explain that the adverse use
of fire treatment gives rise to fire evil, which acrid dichroa leaf ( shu qif} dissipates
and discharges. Wang Zi-Jie (王 子 接 , style 晋 三 Jin-San} and Zeng Ying-F诅 ( 曾 颖
甫 ) offer the explanation that by dispelling phlegm-rheum, dichroa leaf ( shU qif} is
1 . G REATER YANG [LINE 1 1 7]
167
able to resolve fright mania and other disorders of the spirit. Although this formula
is very similar to that used in the previous line, the dosages 町e all increased,
indicating the increased severity of this pattern.
Lines 64, 1 18, and 1 12 deal with disorders of the heart yang. These patterns
vary in degree of severity, sign pattern, and treatment. A simple comparison of the
three lines will be illustrative. The pattern in line 64, p. 162, can be described as
heart yang insufficiency or mild heart yang vacuity and is characterized by palpi­
tations and a desire for pressure on the chest in the region of the heart. Line 1 1 8 ,
p . 1 63, describes mild heart yang vacuity characterized by vexation and agitation.
Damaged heart yang or severe heart ya且g vacuity is the pattern in line 1 1 2 , p. 165.
Fright mania and generalized discomfort characterize severe heart y缸g vacuity. All
the formulae include cinnamon twig (gui zhr) and licorice (gan cao ) , which supple­
ment and free the heart yang. In the mild case, these medicinals are sufficient, but
in the case of moderate heart yang vacuity, dragon bone ( long gu) and 叮ster shell
(mu li) are added to subdue and settle, and thus quiet spirit. F址esh ginger ( shεn
jiang) and jujube ( da zao ) ’ which boost the center and harmonize, and dichroa
leaf ( s h ii. qi) , which dispels turbid phlegm and dissipates 趾e, 缸e included in the
formula for the treatment of severe heart yang vacuity.
4.6 . 1 . 4
Cinnamon Twig Decoction Plus Extra Cinnamon
Patterns
LINE 1 1 7
忖 烧针令其汗 , 针处被寒 , 核起而赤者 , 必 发 奔 豚 。
ω 气
从 少腹 上 冲 心 者 , 灸 其核 上 各 一 壮 , 与 桂枝 加 桂汤 , 更 加 桂
二两也。
( 1 ) Shao zhen ling qi him, zhen chu bei han, he qi er chi zhe, bi fa
ben tu肌 (2) Qi c6叼 shew Ju shang cho叼 x'in zhe, jiu qi he shang
ge yi zhuang, yii gui zhz jia gui tang, geng jia gui er liang ye.
( 1 ) When red-hot need l i ng [is used to] ca use sweati ng,1 the need l i ng
site contracts c。ld ,2 a nd if a red node forms, [the person] wi l l develop
ru n n i n g piglet.3 (2) When q i from the lesser a bdomen su rges u pward
to the heart, use one con e of m。,xa on each node a nd give C i n n a mon
Twig Decoction P l us Extra Ci n n a mon (gui zhz jia gui tang ) , add i ng 2
I i 温 ng of ci n n a mon (gui ) .4
TEXT NOTES
1. Red-hot needling [is used to] cause sweating, 烧 针 令 其 汗 shao zhen ling qi
han : Red-hot needling is generally said to force sweating, that is, it is a harsh
way to promote sweating.
1.
168
GREATER YANG [LINE 1 1 7]
2. The needling site contracts cold, 针 处 被 寒 zhen chu b ei Mn: Following the
use of a red-hot needle, the needling site is not properly protected and cold
evil invades and blocks the area.
3. Running piglet, 奔 豚 ben tun: The· sensation of qi surging upward from the
lesser abdomen into the chest and heart .
4. Cinnamon (gui): According to Fang You-Zhi, this refers to cinnamon bark
( rou gui), but according to X乱 Da Chun and the authors of Gao Deng Cong
Shu, this refers to cinna皿on twig ( gui zhf).
FORMULA
Cinnamon Twig Decoction Plus Extra Cinnamon ( gui
zM jia gui tang)
。 Warm and free the heart y归g; calm [upward] surging and downbear counter­
fl.ow.
挂枝五 两 ( 去皮 )
大枣十二枚 ( 壁 )
苟药三两
生姜三 两 ( 切 )
甘草二两 ( 炙 )
付 右五昧 , 以 水 七 升 , 煮取三 升 , 去淳 , 温服一升 。
枝 汤 , 今 加 桂满五 两 , 所 以 加桂者 , 以能泄 奔豚气也 。
ω 本云 , 桂
Gui zM wu liiing ( qu p {) shao yao san liang sheng jiang san liang ( qie) gan
cao er liang ( zhi) da zao shi er mei ( bo)
( 1 ) You wu wei, yi shui qz sheng, zhU qu san she叼, qu zi, wen Ju yz she叼·
(2) Ben yun gui zhf tang, jzn jia gui man 时 liang, suo yi jia gu i zhe, yi neng xie
b en tun qi ye.
cin na mon twig (桂枝 gui zhf, Cin namomi Ra 『n u l us) 5 li�ng ( remove bark)
peony (巧 药 shao yao , Paeoniae Radix) 3 li�ng
fresh ginger (生 姜 sheng 1幅ng, Zingiberis Rhizoma Rece叫 3 Ii温ng (cut)
m ix-fried licorice (甘 草 gan cao , Glycyrrhizae Radix) 2 li�ng
j uj u be (大 枣 da zao , Ziziphi Fructus) 1 2 pieces (broken)
(1) [For] the a bove five i ngredients use seven she咆 of water. Boil t。 get three sh吕『1
remove the d regs a nd ta ke one sheng warm. (2) This is Cinna mon Twig Decoction (gui
zhf tang) with ci n n a mon (twig] ( gu i zhf) added to a full five li�ng. Cinnamon (twig]
(gui zhf) is added in order to discharge ru n n i ng piglet qi .
SYNOPSIS
The signs and treatment of running piglet caused by heart y缸g vacuity.
COMMENTARY
Red-hot needling is used to force sweating. When a red-hot needle is applied
the interstices open and allow sweat to issue. If appropriate care is not taken, the
opening of the interstices may allow an evil to enter the body, as it does in the
present line. Cold evil lodges in the needle site and causes a node to form. Another
result of red-hot needling is that forced sweating damages the heart yang. When
the heart yang is d缸丑aged, it cannot warm the kidney yin. Running piglet occurs
when kidney yin cold exploits heart y归g vacuity and qi surges upward. Running
piglet may be caused by different factors. In Jfn Gui Yao Lue it is said to be caused
1 . G REATER YANG [LINE 65]
169
by fright . In the line above, it is the result of yin cold exploiting yang vacuity and
surging upward.
Moxibustion is used on the surface of the body to w缸m and dissipate the con­
gealed cold. Cinnamon Twig Decoction Plus Extra Cinnamon (gui zhf jia gui tang)
is Cinnamon Twig Decoction (gui zhf t伽g) with an increased dosage of cinnamon
twig ( gui zhf) . It harmonizes the construction and defense and, because of the addi­
tional cinna皿on twig (gui z闷 , it also warms and frees the heart y问. The formula
calms upsurge and downbears counterflow. The action of the formula is different,
however, if “add cinnamon" is taken to mean cinnamon bark (rou gui) rather than
cinnamon twig (gui zhf) . Zh画,吨 N缸 mentions this ambiguity and offers a rational
solution to it:
As handed down [traditionally, did] the formula add cinnamon twig ( gui
zhf) or cinnamon bark ( riJU gui)? If calming a kidney evil, adding cinnamon
bark ( rou gui) is appropriate. If resolving a greater yang evil, cinnamon twig
( gui zh'i) is appropriate.
4.6.2
Yang Vacuity and Water Qi Patterns
In greater yang disease the promotion of sweating or use of vomiting or precip­
itation can damage yang qi, causing yang vacuity. In some patients, constitutional
factors can cause the development of water qi patterns or acute conditions. When
in yang vacuity with water qi, the patient experiences palpitations in the abdomen
and running piglet is about to occur, the appropriate formula is Poria (Hoelen) , Cin­
namon Twig, Licorice, and Jujube Decoction (Ju ling gui zhf giin ciio da ziio tang) ,
which warms and frees the ya吨, and moves water φ. Poria (Hoelen) , Cinnamon
Twig, Ovate Atractylodes, and Licorice Decoction (JU’ ling gui zhf bdi zhu gan ciio
tang) is used when the inappropriate use of vomiting or precipitation damages the
yang, giving rise to signs such as fullness below the heart and qi surging up to the
chest . If following the promotion of sweating water qi collects in the interior and
the greater y归g channel qi is inhibited, resulting in signs such as headache, nape
and neck pain, and fullness and pain below the heart, the appropriate formula is
Cinnamon Twig Decoction Minus Cinnamon Twig Plus Poria (Hoelen) and Ovate
Atractylodes (gui zh'i qu gui jia Ju ling bai zhU tang), which fortifies the spleen and
moves water.
4.6.2.1
Poria (Hoelen) , Cinnamon Twig, Licorice, an d Jujube
Decoction Patterns
LINE 65
发 汗后 , 其 人脐下悸者 , 欲 作 奔 豚 , 获苓桂枝 甘 草 大 枣 汤 主
之。
Fa ha n hou, qi ren qi xia ji zhe, yu zuo ben tun, JU ling gui zhf g伽
ciio da ziio tang zhu zhz.
1 . G REATER y ANG [ LINE 65]
1 70
When , after sweati ng has been prom。ted , the pers。n has pa l pitations
below the u m bi l icus a b。ut t。 become ru n ni ng piglet, Poria ( H。ele n ) ,
C i n n a mon Twig, Licorice, a nd J uj u be Decoction (JU ling gui zhz g an
cao da zao tang ) g。verns.
FORMULA
Poria ( Hoelen ) , Cinnamon Twig, Licorice, and Jujube Decoction
(JU ling gui zhf
gan cao da zao tang)
o
Warm and free the heart y缸g; transform qi and move water.
夜苓 半 斤
桂枝 四 两 ( 去皮 )
甘草二两 ( 炙 )
大枣十五枚 ( 壁 ) 。
药
卜) 右 四 昧 , 以 甘 澜 水 一 斗 , 先 煮 夜 苓 , 减 二 升 , 内 诸 , 煮 取 三
升 , 去 淳 , 温 服 一 升 , 日 三 服 。 (斗 作 甘 澜 水 法 : 取 水 二 斗 , 置 大 盆
内 , 以构扬之 , 水上有珠子五六 千颗相逐 , 取用 之 。
Fu ling ban fin gui zhi si liang ( qu pf) gan ciio er liiing ( zhi) da ziio shi WU
mei (bO)
(1) You si wei, yi gan Zan shui yz d归, xian zhU Ju ling, jiiin er sheng, na zhu
yao, zhU qu san sheng, qu 玛 丽n JU yf sheng, ri s伽 JU. (2) Zuo g伽 ltin shui fa:
qu shui er dou, zhi da pen nei, yi shtio yang zhf, shui shdng you zhU zi wu liu qian
ke xiang zhu, qu yong zhf.
poria ( 夜 苓 JU ling, Poria) half sheng
ci n namon 阳ig (桂 枝 gt』i zh豆 Cin『1
m ix-fried licorice (甘 草 gan cao ’ Glycyr『h izae Radix) 2 Ii昌『lg
j uj u be ( 大 枣 da ziio, Zizi phi Fructus) 1 5 pieces { broke n )
( 1 ) [For) the above fou r i n gredients use o n e d o u o f worked water.* First boil po时
(Ju l如.g) a n d red uce by two st璀-『 . Add a l l [the other] i ngredients, boil to get three
sheng, a n d remove the d regs. Take one sheng warm , three times a day. (2) Method for
making worked water: Ta ke two she鸣 。f water and put it i n a large basi n . [Repeatedly]
scoop [a nd pou r] using a ladle, u ntil there are five or six thousand water d roplets on the
surface, [wh ich ca n then) be used .
TEXT NOTE
*
Worked water 甘 澜 水 gan ltin shui: This method first appe町s in the Huang
Di Nei Jzng, and is thought to prevent the cooking water from assisting the
water evil in the body. Furthermore, water’s original nature is said to be salty,
and by preparing it in this way, it is changed to a sweet nature; therefore, it
does not assist the kidney, but instead boosts the spleen and stomach.
,
SYNOPSIS
The signs and treatment of running piglet that is about to occur caused by
heart y三且g vacuity.
C OMMENTARY
The heart above serves as a cover governing fire, while the kidney below governs
1 . GREATER YANG [LINE 67]
171
water. When the heart yang is sufficient, it settles and contains the kidney water,
preventing it from Hooding. If the heart y但g is damaged, it is unable to control
the kidney water, which begins to move. Movement of the kidney water is felt as
palpitations below the umbilicus and it may be followed by running piglet. These
preliminary palpitations, felt when the kidney water begins to move, are very mild
in comparison with those felt in running piglet. Poria (Hoelen) , Cinnamon Twig,
Licorice, and Jujube Decoction (Ju ling gui zhf gan ciio da ziio tang) is based on
Cinnamon Twig and Licorice Decoction (gui zhf gan ciio tang); hence an important
action is to warm and free the heart y归.g. The base formula also downbears coun­
terfiow and calms upward surging. Jujube ( da ziio) fortifies the spleen and banks
up earth, in order to disinl曲it water. Poria (Ju l 叼) , the sovereign ingredient, is
precooked, thereby increasing its ability to disinhibit the urine. Poria (JU l如g),
which quiets the heart, is useful in cases of heart yang vacuity and related spirit
disorders. Worked water, which is sweet and moderate, is used to prepare the for­
mula, because it is believed not to assist the water evil, but instead to boost the
spleen and stomach.
4 .6.2.2
Poria ( Hoelen ) , Cinnamon Twig , Ovate Atractylodes , and
Licorice Decoction Patterns
LINE 67
伤寒 , 若吐若下后 , 心下逆满 , 气上冲胸 , 起则头眩 , 脉
沉紧 , 发 汗 则 动 经 , 身 为 振振摇者 , 夜苓桂枝 白 术甘草汤主
之。
Shang han, ruo tU ruo xia hou, xin xia ni man, qi shang chong xiong,
qi ze t6u xuan, mai chen jin, fa han ze dong jmg, shεn wei zhen zhen
yao zhe, Ju ling gui zhi bai zhu gan ciio tang zhu zhi.
When , i n cold d a m a ge, after vom iting or precipitatio n , [there is] c。u n­
terflow fu l l ness below the hea rt, 1 the qi su rges u pward t。 the chest, [the
person experiences] d izzy head u pon sta nding, a nd the pu lse is su n ken
a nd tight, ( [ if] sweati ng is prom。ted , the cha n nels wil l be sti rred 2 a n d
there wi l l b e q u iveri ng a n d t附n bl i ng3 ) then p。由 ( Hoele吟 C i n n a mon
Twig, Ovate Atractylodes, a nd Licorice Decoction (Ju ling gui zhi bai
zhu gan ciio tang ) governs.
TEXT NOTES
1. Counterflow fullness below the heart, 心 下 逆 滴 xfn xia ni man: A feeling of
distention and fullness in the region of the stomach and stomach duct, with qi
rising up into the chest.
2. The channels are stirred, 动 经 dong jfng: Damage to the channels that is the
result of a loss of fluid nourishment, following fluid damage from the inappro­
priate promotion of sweating.
1 . GREATER y ANG
1 72
[ LINE 6 7]
3. Quivering and trembling, 振 振 摇 zhen zh创 悦。: Involuntary spasmodic move』
ments of the body related to channel damage.
FORMULA
Poria (Hoelen ) , Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction (Ju
ling gui zhZ Mi zhU g伽 ciio tang)
o Warm yang and fortify the spleen; disinhibit water and downbear [upward]
surging [qi] .
夜苓 四 两
桂枝三 两 ( 去皮 )
白术
甘草各二两 ( 炙 )
右 四 昧 , 以 水 六 升 , 煮取三升 , 去津 , 分温三服 。
Fu
ling si liiing gui zhZ san liiing ( qu pi) Mi zhU g伽 ciio ge er liiing (zhi)
You si wei, yz shuz liu sheng, zhii qu san sheng, qu zz, fen wen san Ju.
poria ( 夜 苓 Ju ling, Poria ) 4 Ii昌ng
ci n n a mon twig (桂枝 gui zhf. Cin n a momi Ra m山s ) 3 Ii温ng ( remove bark )
ovate atractylodes ( 白 术 btii zhU, Atractylodis Ovatae Rhizoma ) 2 li�ng
mix-fried licorice (甘 草 gii.n ciio, G lycyr『hizae Radix ) 2 li�ng
[ For) the a bove fou r ingred ients use six sheng of water. Boil to get three sheng and
remove the d regs. Divide into th ree [doses] and ta ke warm.
SYNOPSIS
The signs and treatment of water φ surging upward.
C OMMENTARY
The inappropriate use of precipitation or vomiting can damage the spleen and
stomach, leading to center qi vacuity. When this damage occurs, movement and
transformation of fluids is impaired, which here results in water-rheum amassment.
Water qi then ascends counterflow, intimidating the region below the heart and
invading the chest . Water qi collecting below the heart causes a feeling of fullness
and that invasion of the chest causes dizziness, since water qi, which should move
downward, instead rises. ( While the terms “water-rheum” and “water φ” both
refer to pathological fluids, water-rheum is generally stationary and localized, while
water qi is 缸tive and pervasive. ) A pulse that is sunken and tight further supports
the suggestion of water-rhe
[th剖 are] sunken, there should be water.” A pulse that is sunken indicates water
and a pulse that is tight indicates cold. Poria ( Hoelen ) , Cinnamon Twig, Ovate
Atractylodes, and Licorice Decoction (JU ling gui zhZ Mi zhU gii.n ciio tang) is used
to w町m y缸g and disinhibit water when cold-rheum collects in the center burner.
Possible gr创nmatical inversion allows this line to be interpreted in two ways.
If we assume that “ [ If] sweating is promoted, the channels will be stirred and there
will be generalized quivering and trembling" belongs after the formula name, we
may conclude that this formula treats the pattern presented in the first part of the
line and that the promotion of sweating constitutes an adverse treatment, 副 it will
damage the channels. The authors of Gao Deng Cong Shu use this rationale to
divide this line into two p缸ts. The section up to and including the pulse is the
1 . G REATER y ANG [LINE 28]
173
first p缸t, and the promotion of sweating is the second. They suggest that this line
contains grammatical inversion and that the formula should be used to treat the
original condition, but if sweating is erroneously promoted, severely damaging the
y缸ig qi and giving rise to generalized quivering and trembling, they suggest τ'rue
Warrior Decoction (zhen 川 tang), which contains aconite (Ju zi') and strongly
W町ms yang. ( For a complete discussion of True Warrior Decoction (zhen wii. t伽g) ,
see line 316, p. 483 . )
According t o a second interpretation put forward b y Yr Zδng Jfn Jian, one
should read the line as it stands since the formula treats damage to the channels
from promotion of sweating.
. [there is] erroneous precipitation or vomiting, so the chest [yang] is
vacuous and the evil falls [inward] . Thus, [there 叫 counterflow fullness below
the heart and qi surges upward to the chest . If the pulse is floating and tight,
the exterior has still not resolved and [if] sweating is absent , one should use
E�hedra Decoction (ma huti.ng ta叼 ) . Here the pulse i s sunken and tight, so
this patient must usually have intermingling cold and rheum. Dizziness upon
stand ing means the yang qi of the chest is al ready vacuous, so one cannot
[use] vomiting or [promote] sweating. If one instead [assumes] that the pulse
being sunken and tight indicates repletion, does not consider that dizziness
[means] vacuity, and erroneously promotes sweating, this is without reason.
The exterior channels will be stirred, the defensive yang will [become] more
vacuous, the whole body will [be unable] to depend [on the defensive yang] ,
and there will be generalized quivering and t rembling. This is governed by
Poria (Hoelen), Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction
(Ju l仿g gui zhf bai zhU g副 cao tang) , which on the one hand flushes rheum
and supports yang, and on the other regulates the defense and harmonizes
the construction.
One criticism of the view expressed in Yz Zδηg J?:n Jian is that Poria ( Hoelen ) ,
Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction (Ju ling gui zhf bdi
zhU giin cao tiing) does not contain ingredients that strongly support yang. In the
original condition , mild yang vacuity already existed as a result of the previous
mistreatment. If one then promotes sweating, further damaging y缸g ql that is
already vacuous, one would expect that the formula would contain ingredients that
more strongly support the y缸g qi.
4.6.2.3
Cinnamon Twig Decoction Minus Cinnamon Twig Plus
Poria (Hoelen) and Ovate Atractylodes Patterns
LINE 28
服桂枝汤 , 或下之 , 仍头项强痛 , 翁翁发 热 , 无汗 , 心下满
微痛 , 小 便 不 利 者 , 桂校 去 桂 加 夜 苓 白 术 汤 主 之 。
Fu gui zhz tang, huo xia zhr, reng t6u xiang jiang tang, xi xi fa re,
wu han, xrn xia miin wεt tang, xiiio bian bu li zhe, gui zhr qu gui jia
Ju ling bai zhu tang zhii zhr.
1 . GREATER YANG [LINE 28]
174
When C i n n a mon Twig Dec。ction ( gui zhr tang) is ta ken , 。r preci pita­
tion [ is used ] a nd [there is] sti ll stiffness a nd pa i n 。f the head a n d nape,
feather-wa rm heat effusi。n , a bsence of sweati ng, fu l l n ess below the
hea rt with slight pa i n , a nd i n h i bited u ri n ation , C i n n a m。n Twig Dec。u
ti。n M i n us C i n n a mon Twig P l us Poria ( H。elen ) a nd Ovate Atractylodes
(g创 zhr qu gui jia JU ling bai zhu tang) g。verns.
FORMULA
Cinnamon Twig Decoction Minus Cinnamon Twig Plus Poria ( Hoelen ) and Ovate
Atractylodes (gui zhr qu gui jia Ju ling btii zhU tang)
o
Fortify the spleen and disinhibit water in order to free y缸ig ql.
巧药三两
十二枚 ( 孽 )
甘草二两 ( 炙 )
生姜 ( 切 ) 、 自 术 、 夜苓各 三两
(一) 右 六 昧 , 以 水 八 升 , 煮 取 三 升 , 去 j宰 , 温 服 一 升 。
愈 。 (斗 本 云 , 挂 枝 汤 , 今 去 桂 枝 加 夜 苓 、 白 术 。
大枣
(斗 小 便 利 则
Shao yao siin liang giin cao er liang ( zhi) sheng jiang ( qie) btii zhU JU ling
ge san Liang da zao shi er mei ( bo)
( 1 ) You liu wei, yi shui ba sheng, zhU qii. siin sheng, qu z瓦 wen Ju yf sheng.
(2) Xiao bian li ze yu. (3) Ben yun gui zhf tang, jfn qu gui zhf jiii Ju ling、 btii zhU.
peo n y (苟 药 sM。 ”。, Paeoniae Rad ix} 3 li�ng
m ix-fried licorice ( 甘 草 giin cao, G lycyrrhizae Radix) 2 li�ng
fresh ginger ( 生 姜 sheng jiiing, Zingiberis Rh izoma Recens) 3 li�ng (cut)
ovate atractylodes ( 臼 术 btii zhU, Atractylodis Ovatae Rh izoma ) 3 li�ng
poria (夜 苓 Ju ling, Poria) 3 li�ng
j uj u be ( 大 枣 da zao, Ziziphi Fructus) 12 pieces ( broken)
(1) [For] the a bove six i ngredients use eight sheng of water. Boil to get th ree she吨,
remove the d regs a nd ta ke one sheng warm. (2) [After] urination is u n i n h i bited , then
[there wil l be] 陀covery. {3) This is Ci n n a mon Twig Decoction (gui zhf tang) without
ci n na mon [twig] (gui {zh矿) and with poria (Ju ling) and ovate atractylodes ( btii zhu) .
SYNOPSIS
The signs and treatment of the pattern in which, after the promotion of sweating
and the use of precipitation, water ql collects in the interior and the greater yang
channel ql is inhibited.
COMMENTARY
One can imagine that the physician whose actions are described in this line,
upon seeing a patient with stiffness and pain in the head and nape, feather-warm
heat effusion, and absence of sweating, may have thought of an exterior disease for
which Cinnamon Twig Decoction (gui zhf tang) would be appropriate. It is also
possible that, on encountering slight pain and fullness below the heart and inhibited
urination, the physician felt that this indicated interior repletion, which would be
1 . GREATER y ANG [LINE 28]
1 75
relieved by precipitation. Nevertheless, following the use of these treatments, the
original signs are still present and one may 描sume that this is neither a Cinna­
mon Twig Decoction (gui zh'f tang) pattern, nor a pattern for which precipitation
is appropriate. How, then, should one interpret this pattern? According to Cheng
Wu-Ji and Yi" Zong Jzn Jian, these signs indicate an unresolved exterior pattern
and rheum collecting in the interior. Nonetheless, Ke Qin writes that this is not an
exterior pattern, but water qi congesting and binding below the heart. He empha­
sizes that “ . . . the root of the disease is below the heart and the pathomechanism
involves the bladder.” Furthermore, Chen Nian-Zii and Tang Zδng-Hai (唐 宗 海 ,
style 容 J l l R6ng-Chuan ) suggest that the critical point for the understanding of this
line is the abnormal movement of water in the greater yang, by which they mean
the bladder, not the channel.
Diseases of the interior may manifest in exterior signs and vice-versa. Water
evil in the interior can inhibit bladder qi and disrupt qi transformation, resulting
in inhibited urination. When the qi of the bladder becomes inhibited, it may affect
both the organ and the channel. Bladder channel qi stagnates, giving rise to stiffness
and pain in the head and nape. Qi transformation in the bladder becomes impaired,
giving rise to inhibited urination. The presence of water qi in the interior may also
congest the φ dynamic, as indicated by the presence of fullness below the heart .
An analysis of the formula is normally used to help explain a line which is
unclear. Such an analysis does not shed much light on this line since the formula
itself is interpreted in three different ways. The focus of the disagreement is whether
or not one should remove cinnamon twig (gui zhf) from the formula.
a) The first interpretation, represented by the opinions of Fang You-Zhi, Chen
Nian-Zii, and Tang Zang-Hai, is that one should remove cinnamon twig (gui
zhf) . Sweating is absent, so these authors do not think that cinnamon twig
(gui zhz) is appropriate. Furthermore, although simultaneous disease of the
exterior and interior is present, the most important 描pect is water-rheum,
so one should not use cinnamon twig (gui zhf) to resolve the exterior. In­
stead, one should use poria (JU ling) , ovate atractylodes ( bai zhU ) , and
peo町 ( shd。 ”。 ) to treat the interior condition. According to this inter­
pretation, the evil is primarily in the bladder organ, not the channel, and
the treatment principle of resolving the fleshy exterior, appropriate for an
evil in the channel, should be changed to one of disinhibiting water.
b ) A second interpretation, represented by the Yi" Zong Jzn Jian, is that the
ingredient to be removed from this formula is not cinnamon twig (gui zhf) ,
but peony (shdo yao) . The rationale for this point of view is explained
as follows. First, if one removes cinnamon twig (gui zhf) , no medicinals to
treat the exterior disease remain and the exterior disease should be treated.
Second, in some versions of the text, directions are given indicating that the
formula should be prepared and taken just as Cinnamon Twig Decoction
(gui zhf tang). If cinnamon twig (gui zhz) is removed from the formula,
the actions of the formula are significantly altered and this preparation
method might not be appropriate. Third, the pattern of fullness and slight
pain below the heart is the same as the chest fullness pattern for which
Cinnamon Twig Decoction Minus Peony (gui zhf qu sMo yao tang) is used.
These three points, however, are problematic. The first, that without cin-
1 . G REATER YANG [LINE 66]
176
namon twig (gui zhf) the formula contains nothing to treat the exterior
disease, is problematic because cinnamon twig (gui zhf) , though used to
treat exterior patterns, is generally not used alone for conditions without
sweating. Regarding the directions for the use of the formula, the line re­
ferring to Cinnamon Twig Decoction (gui zhf t伽g) does not appear in all
versions of the text and its inclusion is open to question. The final point ,
regarding the si milarity with chest fullness, is problematic simply because
of differences between the two conditions with regard to disease location
and pathomechanism.
c) Finally, a third interpretation is represented by Cheng W在Ji , who writes
that neither cinnamon twig (gui zhf) n or peony ( shao ydo) should be r。
moved. In his opinion, Cinnamon Twig Decoction (gui zhf tang) is used to
treat the exterior condition, and poria (Ju ling) and ovate atractylodes ( bdi
劝u) are used to disi n h i bi t the urine and move the collecting rheum. The
criticism of this point of view is that Cinnamon Twig Decoction (gui zhf
tang) is not generally used to treat diseases without sweating.
4. 6 . 3
Spleen Vacuity Patt erns
Spleen vacuity transmuted patterns c创l be the result of inappropriate treat­
m en t or occur due to the constitution of the patient. When sweating is promoted
excessively, or the patient has a constitutional tendency toward spleen vacuity, and
signs such as abdominal fullness and distention appear, the appropriate formula is
Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction (him po
sheng jiang ban xid gan cii.o ren shen tang), which fort ifies t he spleen and elimi­
nates fullness. When following contraction of cold damage no treatment is given
and after a short period of time the patient develops signs of interior vacuity such as
heart palpitations and vexation, the appropriate formula is Minor Center-Fortifying
Decoction ( xiii.o jidn zhδng tang ) , which supplements the spleen and harmonizes qi
and blood. Cinnamon Twig and Ginseng Decoction (gui zhf ren shen tang) is used
in patterns when the inappropriate use of precipitation causes vacuity cold and
diarrhea because it warms the center and resolves the exterior.
4.6.3. 1
Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and
Ginseng Decoction Patterns
LINE 66
发 汗后 , 腹胀满者 , 厚朴生姜半夏甘草人 参汤主之 。
Fa han him, Ju zhang man zhe, hou po sheng jiang ban xia gan cao
ren shen tang zhu zhi.
When , 拍er the prom。tion of sweati ng, [there is] a bd。m i n a l d istention
a nd fu l l ness, M agn。l ia Bark, Fresh Gi nger, Pi nel l i a , Lie。rice, and Gin­
seng Decoction ( hou po sheng jiang ban xia gan cao ren shen tang )
governs.
1 . G REATER YANG [LINE 66]
1 77
FORMULA
Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction (hOu
pδ
sheng jiang ban xia gan cii.o ren shen tang)
o
Fortify the spleen and warm and move; loosen the center and eliminate full­
ness.
两
厚朴半斤 ( 炙 , 去皮 )
人参一两
生姜十斤 ( 切 )
半夏半升 ( 洗 )
甘草二
右五昧 , 以 水一 斗 , 煮取三升 , 去淳 , 温服一升 , 日 三服 。
Hou p o ban fin (zhi, qu p f) sheng jiang shi jzn ( qie) ban xiti ban sheng (xi)
gan cii.o er liii.ng ren shen yf liii.ng
You wii. w剖, yi shui yf do包, zhii. qii. san sheng, qu Z瓦 wen Ju yf sheng, ri san JU.
magnolia bark ( 厚 朴 hou po, Magnoliae c。此ex) half jin ( mix-fry, remove bark)
fresh gi nger ( 生 姜 sheng jiang, Zingiberis Rhizoma Recens) 10 Jin (cut)
pinel lia ( 半 夏 ban z的, Pinelliae Tuber) half sh吾吨 (washed)
licorice (甘 草 gan c ii.o , Glycyrrhizae Radix) 2 li� ng
gi nseng ( 人 参 T臼 sh旬, G inseng Rad ix) 1 l i� ng
[For] the above five i ngred ients use one d�u of water. Boil to get th ree sheng a n d
remove t h e d regs. Ta ke o n e shεng warm , three times a day.
SYNOPSIS
The signs and treatment of abdominal distention from spleen vacuity with qi
stagnation.
C OMMENTARY
The promotion of sweating damages the yang φ. Previously it has been empha­
sized that heart yang may be damaged, but spleen yang may also be damaged. This
dama�e ma� occur if sweating is promoted excessively or if sweating is promoted in
a patient with spleen vacuity. The spleen manages movement and transformation
and governs the abdominal region. When the spleen is vacuous, movement and
transformation are impaired, giving rise to damp turbidity. The qi stagnates, a
problem that can be considered a direct result of abnormal movement and trans­
formation or the result of damp turbidity congesting the qi dynamic. In view of
the formula chosen, the abdominal fullness in this pattern is understood to be a
mixture of repletion and vacuity. Licorice (gan cii.o) and ginseng ( ren shen) 缸e
used to supplement the spleen and stomach, and assist movement and transforma­
tion. The dosage, however, is relatively small compared to the other ingredients
because repletion is also present. Magnolia bark ( h归 p o ) , which disperses disten­
tion and eliminates fullness, is used with fresh ginger ( sheng jiang) and pinellia ( ban
xia) . Fresh ginger (sheng jiang) fortifies the spleen in order to dissipate fullness.
Pinellia (btin xia) harmonizes the stomach, downbears counterflow, opens binds,
and flushes phlegm. The formula strongly moves qi and disperses distention, while
mildly supplementing the spleen and assisting transformation.
Abdominal distention and fullness is a sign that is frequently seen in clinic prac­
tice. It can be differentiated into repletion and vacuity. The presence of persistent
1 . G REATER YANG [LINE 102]
1 78
abdominal distention and fullness that the patient refuses to allow one to palpate,
accompanied by dry and bound stool, suggests a pattern in which the yang bright­
ness stomach domain is replete. Intermittent abdominal distention and fullness
that likes pressure and is accompanied by diarrhea, indicates a greater yin spleen
vacuity cold pattern.
4.6.3.2
Minor Center-Fortifying Decoction Patterns
LINE 1 02
伤寒二三 日 , 心中悸而烦者 , 小建中汤主之 。
Shang han er san ri, xi:n zhong ji er fan zhe, xiiio jian zhong tang
zhu zhi.
When i n cold d a ma ge [that has lasted for] two or th ree days, [there
a re] pa l pitati。ns a nd vexati。n i n the heart , * M i nor Center- Fortifyi ng
Decoction ( xiao jian zhiing tang) governs.
TEXT NOTE
*
Palpitations and vexation, 心 中 悸 而 烦 xin zhδng ji er fan: Here the palpi­
tations are described as being “in” the heart, i.e. , not below the heart or in
the abdomen. The palpitations are accompanied by a subjective feeling of
vexation.
FORMULA
Minor Center-Fortifying Decoction
(xiao jian zhδng tang)
。 Fortify the center and supplement the spleen; harmonize qi and blood.
桂枝三两 ( 去皮 )
苟药六两
大 枣 十 二 枚 ( 擎 ) 胶怡一升
生姜 三两 ( 切 )
甘草二两 ( 炙 )
忖 右六昧 , 以 水七 升 , 煮取三升 , 去津 , 温服一升 , 日 三服 。
呕家不可用 小 建 中 汤 , 以甜故也 。
。
Gui zhf san liang ( qu pi") shao yao liu liang sheng jia·叼 san liang ( qie) gan
cao er liang ( zhi) da zao shi er mei ( bO) jiao y{ yf sheng
(1) You liu w剖, yi shui qf sheng, zhU qu san she:叼, qu zi', wen Ju y'i sheng, 时
san Ju. (2) Ou jia bu ke yang xiao jian zhδng tang, yi' tian gu ye.
(桂 枝 gu i zh瓦 Cin 『I
pe。ny (巧 药 shao yew, Paeoniae Radix) 6 Ii温ng
fresh ginger (生 姜 sheng jiang, Zingi beris Rhizoma Recens) 3 Ii昌 ng {cut)
mix-fried licorice (甘 草 gan cao, G lycyrrhizae Rad ix) 2 liling
juj u be ( 大 枣 da ziio, Ziziphi Fructus) 1 2 pieces (broken)
m a lt suga r (胶怡 jiao yi, G ra norum Saccharo n ) 1 sheng
cin『
n on
twig
1 . G REATER y ANG
[ LINE 163]
1 79
[For] the a bove six i ngredients use seven sheng of water. Boil to get t h ree st丽-『1
rem。ve the d regs a nd ta ke 。ne sh否『1g warm th ree times a day. Persons who are freq uently
nauseous ca n not use M i nor Center- Fortifying Decoction ( xiao jia n zhδng tang) beca use
it is sweet.
SYNOPSIS
The signs and treatment of heart palpitations and vexation in cold damage
complicated by interior vacuity.
COMMENTARY
The patient has only been ill for several days and no inappropriate treatment
has been given; therefore, the appearance of palpitations and vexation is a sign of
interior vacuity, reflecting the patient’s constitution. These signs indicate depletion
of the qi and blood and dual vacuity of the heart and spleen. Palpitations occur
because when the qi and blood are insufficient, the heart lacks what it normally
governs ( i.e. , the blood ) and is harassed by the exterior evil. Harassment by an evil
disquiets the heart spirit and produces vexation, but not the more severe sign of
“vexation and agitation" that indicates a heat evil harassing deeper in the interior.
An analysis of Minor Center-Fortifying Decoction ( xiao jia n zh伽g tang) reinforces
these conclusions. This formula is Cinnamon Twig Decoction (gui zhf tang) plus
malt sugar (jiao y{) . Malt sugar (jiao yi') W町ms and supplements the center,
regulates and nourishes the spleen and stomach, and relaxes tension and relieves
pain. The original formula, Cinnamon Twig Decoction (gui zhf tang), harmonizes
the construction and defense, while the variation harmonizes both the exterior and
the interior. The large dose of peony ( shti。 ”。) enriches yin and nourishes blood,
resolving the root of this disorder.
4.6.3.3
Cinnamon Twig and Ginseng Decoction Patterns
LINE 163
太 阳 病 , 外 证 未 除 , 而 数 下 之 , 遂 协 热 而 来lJ , 示lj 下 不 止 , 心
下痞硬 , 表里不解者 , 桂校人 参汤主之 。
Tai yang bing, wai zheng wei chu, e俨 shuo xia zhZ, sui xie re er li, li
xia bu zhz, xfn xia pi ying, biao lz bu jie zhe, gui zhf ren shen tang
zhil zhf.
When i n greater ya ng d isease, the exterior pattern has not yet been el i m­
i n ated , a n d preci pitati。n has been used repeated ly, [a nd c。nseq uentl弘
there i斗 incessa nt c。m plex d i a rrhea , 1 a hard glom us bel。w the heart,2
and [b。th] the exteri。r a n d the i nteri。r a re n创 陀solved , C i n n a 『non Twig
a nd Gi nseng Dec。cti。n ( gui zhf
TEXT NOTES
1. Incessant complex diarrhea, 协 热 而 利 , 利 下 不 止 xie re er li, li xia bu zhi:
Severe diarrhea that occurs in a mixed pattern of vacuity cold in the interior
1 . G REATER YANG (LINE 163]
1 80
and unresolved heat in the exterior. This type of diarrhea is often the result
of using precipitation when an unresolved exterior evil is still present . Precip­
itation causes vacuity cold in the interior, which the exterior evil exploits. It
harasses the interior and causes diarrhea. “Complex” refers to the complex
pattern of interior cold and exterior heat.
2. A hard glomus below the heart, 心 下 痞 硬 xi"n xia p f ying: Hardness in the re­
gion of the stomach and upper stomach duct that is the result of an impairment
of the qi dyna皿ic in the upper stomach duct 町ea.
FORMULA
Cinnamon Twig and Ginseng Decoction
o
(gui zhi" ren shen tang)
Warm the center and resolve the exterior.
挂 枝 四 两 ( 另lj 切 )
甘草四两 ( 炙 )
自 术三两
人参三两
干姜三
两
右五昧 , 以 水 丸 升 , 右煮 四昧 , 取五升 , 内 桂 , 更煮取三升 , 去
淳 , 温服一升 , 日 再 、 夜一服 。
Gui zhi" si liang ( bie qie) g伽 cao si liang (zhi) btii zhU san liang ren shen
san liang gan jiang san liang
You WU we i, yz shuz jiu sheng, you zhU si wei, qu WU sheng, na gui, geng zhu
qu san sheng, qu zz, wen JU yr sheng, ri zai、 ye yr Ju.
cinna mon twig (桂 枝 gui zh瓦 Cinnamomi Ra m u l us) 4 li:ing (cut separately)*
m ix-fried licorice (甘 草 gan cao, Glycyrrhizae Radix) 4 li:ing
ovate atractylodes ( 白 术 btii zh U, Atractylodis Ovatae Rhizoma) 3 l i :i ng
gi nseng (人 参 ren sh旬, G inseng Radix) 3 li:ing
d ried gi nger (干 姜 gan jiang, Zingi beris Rhizoma Exsiccatu m ) 3 Ii温ng
[For] the a bove five i ngred ients use nine sheng 。f water. Fi rst boil [the last four
i n gredients] t。 get five she吨. Add ci n n a mon twig (gui zhf) and boi l aga i n to get three
she鸣. Remove the d regs. Ta ke one sheng warm , once [d u ri 咄 the day and aga i n at
n ight.
FORMULA NOTE
*
Cut sep缸ately, 别 切 bie qie: In the ZhU Jie
the bark" ( 去 皮 qu pf) instea d.
Shang Han Lun, it says “remove
S YNOPSIS
The signs and treatment of cold-heat complex diarrhea from greater yin spleen
φ vacuity following inappropriate precipitation.
C OMMENTARY
In greater y缸g dise凶e, if precipitation is used instead of the promotion of
sweating, the disease not only fails to resolve, but may fall inward. In the present
line, precipitation is used repeatedly, damaging the spleen and stomach and causing
the evil to fall inward. The interior becomes cold and vacuous and the exterior heat
is still present ; consequently, incessant complex diarrhea is observed. Hard glomus
is the result of cold congealing in the interior. Because the diarrhea is severe, the
1 . GREATER YANG [LINE 6 1 ]
181
emphasis o f the treatment i s t o warm the interior i n order to check the diarrhea
and to dissipate congealed cold. Cinnamon Twig and Ginseng Decoction (gui zhf
ren shen tang) is Center-Rectifying Decoction (Li zhiing tang) plus cinnamon twig
(gui zhf) . Ginseng (r臼 shen) , ovate atractylodes ( Mi zhU), licorice (g伽 cao), and
dried ginger (gan jiang) warm the center, dissipate cold, supplement the spleen and
stomach, and check di缸rhea. The addition of cinnamon twig (gui zhf) resolves the
exterior and dissipates residual evil from the exterior.
One may compare Cinnamon Twig and Ginseng Decoction (gui zhτ ren shen
tang) with Pueraria, Scutellaria, and Coptis Decoction (ge gen huang qin huang
Lian tang) to illustrate the important differences between these two formulae. Both
are used to treat diarrhea resulting from inappropriate precipitation in greater yang
disease. The former is used when the evil enters the interior and transforms to cold,
while the latter is used for an evil which transforms to heat. Heat signs that may
accompany diarrhea in a Puera血, Scutellaria, and Coptis Decoction (ge gen huang
qin huang Lian tang) pattern include generalized heat, panting, and sweating.
4.6.4
Kidney Yang Vacuity Pat t erns
Inappropriate promotion of sweating and use of precipitation can damage y缸g,
and in certain patients this can cause transmuted patterns of kidney yang vacuity.
When exuberant yin distresses vacuous ya吨, resulting in vexation and agitation,
the appropriate formula is Dried Ginger and Aconite Decoction (g伽 jiang Ju zi
tang) , which warms and returns yang. When vexation and agitation is the result of
yin-y缸g dual vacuity following inappropriate promotion of sweating and use of pre』
cipitation, the appropriate formula is Poria ( Hoelen) Cour
(Ju ling si ni t伽.g ) , which returns yang and boosts yin. True Warrior Decoction
(zhen 川 tang) is used when excessive sweating damages yang and gives rise to y缸g
vacuity water flooding because of its ability to warm y ang and disinhibit water.
4.6.4.1
Dried Ginger and Aconite Decoction Patterns
LINE 6 1
下 之 后 , 复 发 汗 , 昼 日 烦 躁 不 得 眠 , 夜 而 安 静 , 不 H区 不 渴 ,
元表证 , 脉沉微 , 身无大热者 ,
干 姜 附子汤主之 。
Xia zhi him, Ju fa han, zhou ri fan zao bu de mian, ye er an jing,
bu OU bu ke, WU biiio zheng, mai chen w函, shen WU da re zhe, gan
jiang Ju zi tang zhu zhf.
When preci pitation [has been used] , yet sweati ng is then promoted so
that [the person] i n the d aytime is vexed , agitated , a nd sleepless, but
by n ight time bee。『nes peacefu l a nd retching, t h i rst, exterior signs, a nd
g陀at genera lized heat a re [a l l] a bsent, a nd the pu lse is sunken and
fa i nt, then D ried Gi nger a n d Acon ite Decoction (gan jia·叼 如 zi tang)
governs.
1 . G REATER y ANG [LINE 61]
182
FORMULA
Dried Ginger and Aconite Decoction
o
(gan jiang Ju zi tang)
Warm urgently and return y缸g.
干姜一两
附子一枚 ( 生用 , 去皮 , 切 八 片 )
右二昧 , 以 水三 升 , 煮取一升 , 去淳 , 顿服 。
Gan jiang yf liang Ju zi yf mei ( sheng yang, qu pi, qie ba pian)
You er wei, yi shui san sheng, zhu qu yf sheng, qu zi, dun JU.
d ried gi nger (干 姜 gan jiang, Zi ngi beris R hizoma Exsiccatu m ) 1 lil!ng
acon ite (附子 Ju z瓦 Aconiti Tu ber Latera le) 1 piece (use raw, remove ski n , cut into
eight slices)
[For] the a bove two i ngredients use th ree sheng of water. Boil to get one she吨,
rem ove the d regs and ta ke in one single dose.
SYNOPSIS
The signs and treatment for the pattern of yang vacuity and yin exuberance in
which yin distresses yang and causes vexation and agitation.
COMMENTARY
The use of precipitation easily damages the y归g qi and if sweating is then
promoted it will cause further damage, here leading to yang vacuity and yin ex­
uberance. The same inappropriate treatment in different patients may result in
different patterns, depending on the strength or weakness of the original evil, the
potency of the formula that is used, the constitution of the patient, and the patient’s
living environment. In a cold climate it is likely that many patients have weakened
yang. In these patients mistreatment may have easily resulted in y缸g vacuity. In
a warm climate, where many patients already exhibit signs of fluid insufficiency,
mistreatment may more likely result in yin depletion.
Vexation and agitation occur in greater yang disease, yang brightness disease,
and lesser yang disease. In greater yang disease, it can occur when an external evil
fetters the exterior and heat is depressed in the interior. In lesser yang disease,
this sign manifests as heart vexation with retching. If accompanied by great thirst,
agitation and vexation is indicative of yang brightness disease. In the present
line, exterior signs are absent; therefore this is not greater yang disease. Retching
and thirst are absent ; hence this pattern of vexation and agitation belongs to a
category that is different from the three above. The pulse is sunken and faint. The
sunken quality indicates exuberant yin in the interior and the faint quality indicates
debilitated y缸ig. Exuberant yin harasses yang and yang is unable to match the
strength of yin. Yang should be effulgent during the daytime and yin should enter
yang, but when yang is vacuous, it is unable to overcome yin and this struggle
results in vexation and agitation during the daytime. Normally, at night, the yang
qi recedes and yin becomes exuberant. In this situation, yang is debilitated and yin
overly exuberant, so at night the patient is tranquil because vacuous yang easily
enters exuberant yin.
The phrase “no great generalized heat" has been interpreted in several ways.
Cheng wιJi states, 飞reat generalized heat . . . absent' means no heat [effusion] in
1 . GREATER YANG [LINE 69]
183
the exterior . . . .” He and the authors of Yf Zong Jfn Jian agree that this phrase
means the absence of heat effusion, which would indicate an exterior pattern. An­
other interpretation is provided by the authors of Gao Deng Cong Shu who explain
that it refers not to the heat effusion seen in exterior conditions, but to false heat
from vacuous yang straying to the exterior. If great generalized heat were present
it would mean that yin and yang were about to separate and the situation would
be extremely critical. This condition has not reached the critical stage; therefore,
this interpretation is perhaps more difficult to substantiate in the text, but it may
still be considered.
The formula, Dried Ginger and Aconite Decoction (g伽 jiiing JU zi tang), is
Counterflow Cold Decoction ( si ni tang) without licorice (giin cii.o). It treats only
y但g and is used in cases of great vacuity of the y归g φ and exuberant yin in
the interior. Dried ginger (giin jiiing) warms the spleen yang, and aconite (Ju zi)
supports the kidney y归g. When yang is increased, the yin will dissipate. The yang
ql will return to the root and yin qi will then be restrained. Raw aconite (j边 zi) is
used for maximum effect and the moderating effects of licorice (giin cii.o) are not
considered appropriate, so it is removed.
4.6.4.2
Poria (Hoelen) Counterflow Cold Decoction Patterns
LINE 69
发汗 , 若下 之 , 病仍不解 , 烦躁者 , 夜苓 四 逆汤主 之 。
Fa him, ruo xia zhz, bing reng bu jie, fan zao zhe, Ju ling si ni tang
zhu zhι
After the prom。ti。n 。f sweati ng, if preci pitation [is used] a nd the dis­
ease sti l l does n。t resolve, a nd [there is] vexati。n a nd agitati。n , p。H
( H。elen) C。u 『1terfl。W Cold Dec。cti。n (Ju ling si ni tang) g。verns.
FORMULA
Poria (Hoelen) Counterflow Cold Decoction (Ju ling
o
两
si ni tang)
Return yang and boost yfn.
夜苓四两 人参一两
( 炙 ) 干姜一两半
附子一枚 ( 生用 , 去皮 , 破 八 片 )
甘草二
右五昧 , 以 水五升 , 煮取三升 , 去瘁 , 温服 七 合 , 日 二 服 。
Fu ling si liii.ng ren shen yf liii.ng Ju zi yf mei ( sheng yong, qu pi, po bii pian)
giin cii.o er liii.ng (zhi) giin jiiing yf l价ig ban
You wu w此 yi shui wu sheng, zhu qu siin sheng, qu z瓦 wen Ju qf ge, ri er JU.
poria (夜 苓 JU ling, Pori a ) 4 Ii司ng
ginseng (人 参 ren sh旬, Ginseng Radix) 1 li�ng
184
1 . G REATER YANG (LINE 69)
aconite ( 附 子 Ju z瓦 Acon iti Tuber Laterale) 1 piece (use raw, 陀move skin , break
i nto eight pieces)
mix-fried licorice (甘 草 gan cao, Glycyrrhizae Radix) 2 li�ng
d ried gi nger (干 姜 gan jiang, Zi ngi beris Rhizoma Exsiccatum ) 1 . 5 li�ng
[For] the a bove five i ngredients u se 币ve she吨 of water. Boil to get th ree she吨,
remove the d regs, a nd ta ke seven g还 warm twice a d ay.
S YNOPSIS
The signs and treatment of vexation and agitation from dual vacuity of yin and
yang that occurs following the promotion of sweating and use of precipitation.
C OMMENTARY
This line is similar to the previous one in that sweating is promoted, precipi­
tation is used, and vexation and agitation result from the treatment. It differs in
that it prescribes a different formula. From the differences between the formulae
one may infer that the vexation and agitation in the previous line is the result of
y缸g vacuity 缸id exuberant yin, whereas in this line it is the result of dual vacuity
of yin and yang. It is possible that one would also see such signs as reverse-flow,
fatigue, and a pulse that is sunken.
This example reinforces the concept that the same treatment or mistreatment,
used in different patients, may have a different result. In the previous line, ex­
terior signs are absent, whereas in this line, we are told that the disease has not
resolved. The meaning of this line is not that signs of greater yang disease 缸e still
present, but that a disease pattern still exists. Although this idea is not explicit
in the text , it can be deduced from the formula. Poria ( Hoelen) Counterflow Cold
Decoction (Ju ling si ni tang) contains aconite (JU zi) and dried ginger (g伽 jiang) ,
which return yang and stem counterflow. It does not contain any ingredients for
resolving exterior disease. Aconite (Ju zi) and dried ginger (gan ji伽.g) were also
used in the formula in the previous line. Ginseng (ren shen), which supplements
the original qi, boosts fluids, and quiets the spirit, is added. Ginseng ( ren shen) is
the main ingredient for boosting the fluids. Licorice (gan cao) boosts the φ and
harmonizes the center, further supporting y归g. The inclusion of poria (JU li1 时 , as
the sovereign, is perhaps more problematic since disinhibiting urination in patients
with yin vacuity is generally contraindicated. One explanation for its inclusion is
that poria (JU ling ) , which fortifies the spleen, nourishes the heart, and quiets the
spirit, disinhibits the urine without damaging yin and is considered to boost the
spleen yin. The term “spleen yin” means both the fluid component of the spleen,
which includes blood, humor, and fluids, and the relative yin nature of the spleen
in comparison to the stomach y归g. One can, by fortifying the spleen, boost spleen
yin. In other words, one fortifies the spleen without causing dryness.
1 . GREATER YANG [LINE 82]
4.6.4.3
185
’l'rue Warrior Decoction Patterns
LINE 82
太阳病发汗 , 汗出 不解 , 其人仍发热 , 心下悸 , 头眩 , 身响
动 , 振振欲捕地者 , 真武汤主 之 。
Tai yang bing fa hdn, hdn chu bu jie, qi ren reng fa re, xin xid ji,
t6u xuan, shen shun ( r电in) dong, zh创 zh创 yu pi di zhe, zh印 WU
tang zhii zhi.
When i n greater ya ng d isease, sweati ng has been promoted a nd sweat
issues [ but the d isease] d。es not resolve, the person sti l l has heat effu­
sion , a nd [there a re] pa l pitati。ns below the hea rt, d izzy head , genera l­
ized twitc h i 鸣 , 1 a n d [the person is] q u iveri ng a n d a b。ut t o fa l l ,2 True
Wa rri。r Decoction ( zhen wii tang) governs.
TEXT NOTES
l. Generalized twitching, 身 响 动 shen shun ( run) dong: Jerking and jumping of
the body’s sinews.
2. [The person is] quivering and about to fall, 振 振 欲 + zhen zhen yu pi di:
The patient is trembling and is unstable on his / her feet, 副 if about to fall.
He/ she feels une副肌 flustered, and dizzy and wants to sit down. When this sign
occurs with generalized twitching it is considered more severe than either one
appearing individually. Yu Chang writes, “Palpitations mean interior vacuity,
dizzy head means upper body vacuity, and generalized twitching where the
patient is quivering and about to fall means channel vacuity.” Ke Qin states,
气 . . [the phrase] 咄e patient is q回vering and about to fall’ qualifies generalized
twitching."
FORMULA
’True Warrior Decoction
o
(zhen 创 tang)
Warm yang and disinhibit water.
夜苓 苟药
破八片 )
生姜各三两 ( 切 )
自 术二两
附子一枚 ( 炮 , 去皮 ,
右五昧 , 以 水 八 升 , 煮取三升 , 去淳 , 温服七合 , 日 三服 。
Fu ling shao yao sh臼.g jiang ge san liiing ( qi e ) btii zhU er liang Ju zi yz
qu pi, po ba p ia n)
You wii. wei, yi shui ba sheng, zhii. qii. san sheng, qu zi, w en Ju qz ge, ri san Ju.
mei ( p ao ,
poria ( 夜 苓 Ju ling, Poria) 3 liling
peony ( 苟 药 shdo yao, Paeoniae Radix) 3 liling
fresh gi nger (生 姜 sh eng jiang, Zingi beris R hizoma Recens) 3 liling (cut)
186
1 . G REATER YANG
ovate atractylodes ( 臼 术 Mi zhU, Atractylodis Ovatae Rhizoma ) 2 li�ng
aconite ( 附 子 JU zi, Aconiti Tu ber Laterale ) 1 piece ( blast-fry, remove ski n , break
into 8 pieces )
[For] the above five ingredients use eight st诅否『 。f water. Boil to get three st丽E『1
remove the d regs, a nd take seven g运 warm , th ree times a d ay.
S YNOPSIS
The signs and treatment of yang vacuity water flooding caused by excessive
promotion of sweating that damages yang.
C OMMENTARY
In greater yang disease one should promote sweating, and if sweat issues but
the disease does not resolve, it suggests that the original diagnosis w甜 incorrect,
the formula chosen was incorrect, or the patient was too weak for the promotion of
sweating to be effective. One might infer from this line that because heat effusion
continues, the exterior evil is still present, but this would be incorrect . This sign
occurs after sweating and is due to vacuous yang qi floating to the exterior. One can
deduce this from the formula True Warrior Decoction (zh印 创 tang), which does
not contain any ingredients for the treatment of exterior conditions. Furthermore,
the other signs are also suggestive of y缸g vacuity. When yang is vacuous, it cannot
control water, which exploits the weakness and rises up, causing palpitations below
the heart . Y缸ig vacuity results in dizziness because normal movement of the clear
yang is impaired. If owing to vacuity, yang qi fails to perform its function of nour­
ishing and warming the sinews, generalized twitching may result. The pattern is one
of water flood due to spleen and kidney y归g vacuity. True Warrior Decoction (zhe:η
wu tang) contains poria (Ju l如g) , which disinhibits water, and ovate atractylodes
( Mi zhu) , which dries dampness; together they fortify the spleen and control wa­
ter. It also contains aconite (1边 zi) which invigorates the kidney y臼g. For further
discussion of True Warrior Decoction (zhen w'll tang), see line 316, p. 483.
Poria (Hoelen) , Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction
(Ju ling gui zhZ Mi zhU gan ciio t伽,g), discussed on line 67, p. 171, also treats
vacuity with invasion of water. The difference between the patterns treated by the
two formulae is one of severity. The pattern in line 67 involves water qi surging
upward with vacuity of the spleen and heart. The pattern here is water flooding
with spleen and kidney y缸g vacuity.
This pattern m町 also be compared with the Poria (Hoelen) Five Powder ( w
ling siin) pattern, in which water amasses internally (see line 71 , p. 195) . In that pat­
tern, internal water amassment impairs qi transformation in the bladder, whereas
here water floods as a result of yang vacuity. Poria (Hoelen) Five Powder ( wu ling
siin) treats disorders of the bladder, the greater yang, whereas True Warrior Decoc­
tion ( zhen wu tang) treats the kidney, the lesser yin. When compari吨 patterns one
should p町 attention to the dosages. Poria (Hoelen) Five Powder (川 ling siin) con­
tains more ingredients for disinhibiting water and appears to be a stronger formula,
even though it is used to treat a milder condition. This appe缸ance is deceiving,
though, because the amounts used in Poria (Hoelen) Five Powder ( wu ling san) are
very small in comparison to those used in True Warrior Decoction (zhen wu tang).
1 . GREATER YANG [LINE 29]
187
4 . 7 YiN AND YANG VACUITY PATTERNS
In greater y缸g disease the promotion of sweating and use of precipitation can
damage both yin and yang. When the inappropriate promotion of sweating damages
both yin and y缸g, giving rise to vexation and agitation, and vomiting counterflow,
the appropriate formula is Licorice and Dried Ginger Decoction (gan cii.o gan jiang
tang), which warms the center and returns y归g. When damage t o the yin impairs
the patient’s ability to extend the limbs, Peony and Licorice Decoction ( shao yao
gan ciio tang) is used to return yin because of its sweet, sour nature. Following
the promotion of sweating, if the disease does not resolve and aversion to cold is
observed as a sign of yin-yang dual vacuity, Peony, Licorice, and Aconite Decoction
( shdo yao gan cii.o ju zi tang) is suggested because it supports y缸g and boosts
yin. When, in the course of a greater yang dise描e, heart yin and y缸g become
vacuous and there 町e signs such as a pulse that is bound and inte口nittent and
palpitations, the appropriate formula is Honey-Fried Licorice Decoction ( zhi gan
ciio tang ) , which frees y ang and opens the pulse, and enriches yin and no盯ishes
the blood.
4.7.1
Licorice and Dried Ginger Decoction Patterns and
Peony and Licorice Decoction Patterns
LINE 29
忖 伤寒脉浮 , 自 汗 出 , 小 便数 , 心烦 , 微恶寒 ,
脚孪急 , 反
与 桂枝欲 攻 其 表 , 此误也 。 ω 得 之便厥 , 咽 中 干 , 烦躁吐逆
者 , 作甘 草 干 姜 汤 与 之 , 以 复其阳 ; 若厥愈足温者 , 更 作苟
药 甘 草 汤 与 之 , 其脚 即 伸 ; 若 胃 气不 和 ,
俨语者 , 少 与 调 胃
承气汤 ; 若重发 汗 , 复 加 烧针者 , 四 逆汤 主 之 。
{ 1 ) Sha叼 han mai Ju, 纣 han chu, xiao bian shuo, xi"n fan, wei wu
han, jiao luan j{, fan yu gui zhi" yu gong q{ biao, ci WU ye. (2) De zhi"
bian jue, yan zhong gan, fan zao tu ni zhe, zuo gan cao gan jiang
tang yu zhi", yi j边 qi yang; ruo jue yu zu wεn zhe, geng zuo shao yao
gan cao tang yu zhi", qi jiiio j{ sh臼; ruo wei qi bu he, zhan yu zhe,
shiio yii, tido wei cheng qi tang; ruo ch6ng fa han, Ju jia shao zhen
zhe, si ni tang zhu zhι
{ 1 ) When , i n c。Id d a mage, the pu lse is floating a n d [there is] spon­
ta neous sweati ng, freq uent u rination , heart vexation , m i ld aversion t。
cold , a n d hype巾n icity 。f the feet, but C i n 阳n。n Twig [Decocti。n]
(gui zhi" [tang] ) is given in 。时er to attack the exterior, t h is is a n error.
{2) If [the person] is given this [form u la] , there will be 刚ersa l , 1 a d ry­
ness i n the t h roat, vexation a nd agitation , a nd cou nterflow vom iti ng, 2
[s。 。ne sh。u ld use] Licorice a n d D ried G i n ger Dec。ction (gan cao gan
1 . GREATER y ANG [LINE 29]
188
jiang ta叼 ) to restore ya ng. If a c。u nterfl。w (patient] 阳。ve战 a nd
the feet bee。me wa rm , 。ne ca n then use Peony a nd Licorice Dec。c­
ti。n ( shao yao gan cao tang) a nd the feet wi l l then [be a ble to]
stretch . If the st。mach qi is d isharmon ious a nd [there is] deli rious
speech , give a l ittle3 St。mach-Regu lati ng Ql-C。。rd i nating Decocti。n
( tiao wei cheng qi ta·叼) . If sweating has been promoted repeatedly,
then red- h。t need l i ng is used , Cou 阳rflow c。Id Dec。ction ( si ni tang)
g。verns.
TEXT N OTES
l . Reversal, 厥 jue: Reversal cold of the extremities.
2. Counterflow vomiting, 吐 逆 tu ni: Vomiting is the external manifestation of
this condition and counterflow refers to the underlying pathomechanism.
3. Give a little, 少 与 shii.o yu : Give a smaller dosage than normal, not to precip­
ita钮, but to harmonize.
FORMULAE
Licorice and Dried Ginger Decoction
(gan cii.o gan jiiing tang )
。 First, warm the center to restore M吨, then [use a) sour and sweet [decoction]
to restore yin.
甘草四两 ( 炙 )
干姜二两
右 二 昧 , 以 水 三 升 , 煮 取 - 升 五合 , 去淳 , 分 温再 服 。
Gan cii.o si liang (zhi ) giin jiang er liii.ng
You er ω战 yz shui s an sheng, zhU qu yz sheng wu ge, qu zi, fen wen zai Ju.
mix-fried licorice ( 甘 草 gan cii.o, Glycyrrhizae Radix) 4 l i li ng
d ried ginger (干 姜 giin jiang, Zingiberis R h izoma Exsiccatu m ) 2 liling
(For] the a bove two i ngredients use three sheng of water. Boil to get one sheng a n d
five g� a nd remove the d regs. D ivide (i nto two pa叫 , a nd ta ke warm , twice a day.
Peony
and Licorice
Decoction
( shtio
yao giin cao tang)
白 巧药、 甘草 ( 炙 ) 各四两
右二 昧 , 以 水 三 升 , 煮取)升五合 , 去淳 , 分温再服 。
Bai shdo yao gan cii.o (zhi ) ge si liii.ng
You er wei, yi shuz san sheng, zhU qu yz sheng WU ge, qu zz, fen wen zai JU.
peony (巧 药 shdo yao, Paeoniae Radix) 4 lil! ng
m ix-fried licorice ( 甘 草 gan cii.o, G lycyrrhizae Radix) 4 Ii昌n
(F。r] the a bove tw。 i ngredients use three sheng of water. Boil to get one she吨 five
尉 a n d remove the d regs. Divide [int。 two pa叫 , a nd ta ke warm , twice a day.
1 . G REATER YANG [LINE 29)
189
SYNOPSIS
Transmuted patterns of cold damage complicated by vacuity that 缸e inappro­
P_riately treated by the promotion of sweating, and their treatment according to
signs .
COMMENTARY
The disease pattern in this line is described as “cold damage,” which is ap­
parently used here in its broader sense since although the pulse is floating, sweat
spontaneously issues. If the term were meant in the narrower sense of a cold damage
pattern for which Ephedra Decoction ( ma huang tang) is appropriate, no sponta­
neous sweating would be present. A pulse that is floating, spontaneous sweating,
and mild aversion to cold are suggestive of a Cinnamon Twig Decoction (gui zhf
tang) pattern, but the other signs must also be considered. Frequent urination
indicates a pattern of vacuous yang unable to contain the fluids. Heart vexation
and hypertonicity of the feet here indicate insu面ciency of yin humor. When the
yin humor are insufficient, they cannot nourish the heart or moisten the sinews.
This pattern is greater yang exterior vacuity with dual vacuity of yin and yang.
Cinnamon Twig Decoction (gui zhf tang), which harmoni zes the exterior by the
promotion of mild sweating, is not appropriate. One must support yang and re­
solve the exterior. The yin need not be treated because once yang is restored, the
fluids will be contained and yin replenished. This reflects the principle that it is
easier to treat y缸g than yin. When y缸g is secure, yin will be preserved and when
yang is engendered, yin will increase.
In this pattern if Cinnamon Twig Decoction (gui zhf tang) is given, patholog­
ical transmutations will occur. Resolving the exterior will exacerbate the exterior
vacuity and damage both yin and y归g. Further damage to y缸g results in re­
versal cold because the yang qi is unable to wa口n the extremities. Reversal cold
also indicates impairment of the qi dynamic, resulting from vacuity of the y缸g qi.
This impairment is further reflected in the presence of counterflow vomiting. The
loss of sweat further damages yin, and the throat becomes dry from lack of fluid
nourishment . Vacuous yang and debilitated fluids 缸e unable to nourish the heart;
hence the spirit is unquiet and vexation and agitation are observed. Licorice and
Dried Ginger D ecoction (gan cii.o gan jiang tang) is an acrid, sweet formula that
restores y缸g. Dried ginger (g伽 jiang) warms the center and restores the y缸g,
while licorice (gan cii.o) harmonizes the center. By restoring y缸g to the center
burner, spleen φ is fortifi ed and normal φ movement resumes. When this occurs
the limbs become warm because the yang qi is replete and flows normally. Peony
and Licorice Decoction ( shtio yao g伽 cii.o tang) is a sour, sweet formula which
boosts the yin and restores the fluids. Peony ( shti。 ”。) boosts yin and nourishes
the blood, while licorice (gan cii.o) supplements the center. These two ingredients
resolve hypertonicity of the sinews, restoring the ability to stretch and move freely.
One aspect of this pattern is insufficiency of yin humor. If w缸m medicinals to
restore yang are used excessively, it may further damage yin and cause a loss of
stomach harmony and delirious speech. This pattern is severe damage to yin fluids
and dryness- heat in the stomach; therefore, a small dose of Stomach-Regulating Qi­
Coordinating Decoction ( tiao wei cheng qi tang) is given to clear heat and harm ize
the stomach. See line 248, p. 327, for a further discussion of this formula.
1 . GREATER YANG (LINE 68]
190
If the pattern above is treated with repeated sweating, it will not resolve. If
one then uses red-hot needling to force sweating, it will cause severe damage to
the yang φ. In that case, Cm日巾rflow Cold Decoction ( si ni tang) m町 be used
to return the y扭g and eliminate counterflow. See line 323, p. 475, for a further
discussion of t hi s formula.
4. 7 .2
Peony, Licorice , and Aconite Decoction Patterns
LINE 68
发 汗 , 病不解 , 反恶寒者 , 虚故也 , 巧药甘草附子汤主之 。
Fa him, bing bu jie, fan WU han zhe,
zi tang zhu zhi.
XU
gu ye, shao ydo gan cao Ju
When sweati ng is promoted , [if] the disease does n。t res。Ive, a nd i n­
stead [there is] aversion t。 cold , [this is beca use 。f] vacuity; [hence]
Peony, Licorice, a nd Acon ite Dec。ction ( shao ydo gan ciio JU zi tang)
governs.
FORMULA
Peony, Licorice, and Aconite Decoction
o
(shdo yao gan cao Ju zi tang)
Support yang and boost yin.
巧药
甘草 ( 炙 ) 各三两
附子一枚 ( 炮 , 去 皮 , 破 八 片 )
(一) 右 三 昧 , 以 水 五 升 , 煮 取 一 升 五 合 , 去 淳 , 分 温 三 服 。
仲景方 。
仁) 疑 非
Shao yao gan cao (zhi) ge san liang Ju zi yf mei (pao, qu pi, po bii. pian)
(1) You san wei, yi shui wu sheng, zhu qu yf sheng wu g已 qu zi, fen wen san
JU. (2) Yi fei zhong jing fang.
peony (巧 药 shdo yao, Paeoniae Radix) 3 li�ng
m ix-fried l icorice ( 甘 草 gan cifo, Glycyrrhizae Radix) 3 li�ng
aconite ( 附 子 Ju z瓦 Aco n iti Tu ber Latera le) 1 piece (blast fry, remove ski n , brea k
i nt。 8 pieces)
( 1 ) [For] the a bove three ing陀die『1ts use five st诅否『1g 。f water. Boil t。 get 。ne st远否『1
a nd 币ve g善 a nd 『em。ve the d regs. Divide into th ree [parts] and ta ke warm , th ree times
!a d ay] . (2) It is doubted that t h is is [ZI由5咄 Zhon咆g 且ng's f。r『m』
FORMULA NOTE
It is doubted that this is [ Zhang] ZhOng Ji吨’s formula, 疑 非 l 张 l 仲 景 方 yi fei
zhong jing fang : This is an addition to the text by an unknown editor.
S YNOPSIS
The signs and treatment of yin and y缸ig dual vacuity following the promotion
of sweating.
1 . GREATER YANG [LINE 1 77]
191
COMMENTARY
In greater y缸g disease, when sweating is promoted properly, the exterior evil
should be eliminated and aversion to cold should cease. In this line, sweating is
promoted and not only does the disease not resolve, but aversion to cold persists.
Xu Bin ( 徐 彬 , style 忠 可 Zhong-K远 ) emphasizes that the aversion to cold has not
resolved and it has increased in severity: “Sweat has [issued] and the disease has
not resolved, so the pattern is still as before. “Instead” is only used with aversion
to cold, [which means] it is increased in comparison to the earlier [ condition] .” That
the disease has not resolved does not mean that the exterior has not resolved, but
that a transmutation has occurred.
Zhang Ji explains that the presence of aversion to cold indicates vacuity, and
commentators have offered different interpretations of what type of vacuity this
means. Cheng Wu-Ji explains this pattern as dual vacuity of construction and
defense. Qian Huang suggests that the signs indicate vacuity of the yang qi. The
yang ql is unable to warm the exterior and engenders exterior cold. Yz Zong Jfn
Jian defines this pattern more narrowly as vacuity of the defense ql, which is unable
to defend the exterior properly. Based primarily on the inclusion of aconite (Ju zi)
in the formula used in this line, the authors of Gao Deng Cong Shu conclude that
this pattern is dual vacuity of yin and y缸g.
In attempting to reconcile these different viewpoints, one may also consider
the statement of Cheng wιJi that, “ . . . Sweating is promoted, the disease is not
resolved and instead, [there is] aversion to cold. The construction [yin] and defensive
[yang] are both vacuous. Sweat issues and the construction [yin becom 刚uous.
Aversion to cold [means] vacuity of the defensive [yang] . . . ” If one considers that
defensive y缸g and construction-yin are simply specific types of y缸g and y函, one
can grasp a wider range of explanations. Because aconite (Ju zi) warms the channels
and restores yang, its use supports the indications of ya吨 vacuity. Peony ( sha。
”。) supplements the blood and contracts yin, supporting the idea that yin is also
vacuous. Licorice (g伽 cao) supports the other two ingredients by warming and
supplementing the center.
4.7.3
Honey- Fried Licorice D ecoction Pat t erns
LINE 1 77
伤 寒 脉 结 代 , 心 动 ↑季 , 炙 甘 草 汤 主 之 。
Shang han mai jie dai, xzn dong ji, zhi gan cao tang zhu zhz.
[ F。r] cold damage with a pulse that is bou nd a nd i ntermittent, a nd
sti rri ng hea rt pa l pitations , * Honey- Fried Licorice Decoction ( zhi gan
cao tang ) g。verns.
TEXT NOTE
*
Stirring palpitations, 心 动 悸 xin dong ji: Severe palpitations in which the
heart can be seen beating against the clothing.
192
l. G REATER YANG [LINE 1 77]
FORMULA
Honey-Fried Licorice Decoction
( zhi gan c ao tang)
。 Free yang and restore the pulse; enrich yin and nourish the blood.
甘 草 四 两 ( 炙 ) 生 姜 三 两 ( 切 ) 人 参 二 两 生 地 黄 - 斤 桂枝 三
两 ( 去皮 )
阿胶 二 两 麦 门 冬 半 升 ( 去心 ) 麻仁半 升 大枣三十枚
(孽)
卜) 右 九 昧 , 以 清 酒 七 升 , 水 八 升 , 右 煮 八 昧 , 取 三 升 , 去 淳 , 内
胶 佯 消 尽 , 温 服 一 升 , 日 三 服 。 仨) 一 名 复 脉 汤 。
Gan cao si liiiη.g (zhi) shεn叼g jiang saη liang ( qie) reη shen er Liang sl』en
di ht』ang yf j n gui zhf san Liang ( qu pf) e jiao er liang mai men dong bdn sheng
(qu Z丽) ma 俨en ban sheng da zao san shi mei ( bO)
( 1 ) You jiu wei, yi qzng jiu qz sheng, shui ba sheng, you zhU ba wei, qil san
sheng, qu z瓦 na jiao yang xiao jin, wen JU yf sheng, ri san JU. (2) Yf m如g Ju mai
tang.
mix-fried licorice ( 甘 草 gan cao, Glycyrrh izae Rad ix) 4 Ii温ng
fresh ginger (生 姜 sheng jiang, Zi ngi beris Rh izoma Rece叫 3 li�ng (cut)
ginse n g (人 参 ren shen, Ginseng Radix) 2 li� ng
d ried/f陀sh 陀 h m a n n ia (生 地 黄 sheng di huang, Reh m a n n iae Radix Exsiccata seu
Recens) 1 Jin
ci n n a mon twig (挂 枝 gui zM, Cinnamomi Ra m u lus) 3 Ii温ng ( remove bark)
ass hide gl u e ( 阿 股 e jiao, Asi ni Corii Gelatin u m ) 2 li�ng
。phiopogon (麦 门 冬 mai men dδng, Ophiopogonis Tu ber) half sheng ( remove
hea 由 1 )
h e m p seed (麻仁 ma ren, Ca n n a bis Semen) half sheng
j uj u be (大 枣 da ziio, Ziziphi Fructus) 30 pieces {broken)
(1) [For] the a bove nine ingredients use seven sheng of clear wine2 a nd eight sheng
。f water. Fi rst boil eight i ngredients [excluding ass hide gl ue ( e jiao )] to get th ree
sheng a n d remove the d regs. Add ass h ide glue ( e jiao) and warm [u ntil] com pletely
dispersed . Ta ke one she吨 warm , th ree times a day. (2) Another name is P ulse­
Restorative Decoction .
TEXT NOTES
1 . Remove the hearts, 去 心 qu xfn: The heart of ophiopogon ( mai men dong)
was considered to cause vexation and oppression, but this sid←effect has not
been validated by modern research.
2. Clear wine , 清 酒 qfng jiu: A form of aged rice wine. It frees the channels,
harmonizes the qi and blood, and dissipates congealed cold.
SYNOPSIS
The signs and treatment of heart yin and y缸g dual vacuity.
COMMENTARY
When a patient contracts an exterior evil, the presentation is influenced by the
1.
GREATER YANG [LINE 1 78]
1 93
pa胧时 ’s constitution, the strength of the evil, and any treatments used. This line
provides little information. It is possible that an exterior evil has entered the greater
y缸g channel and then shifted to the lesser yin heart channel. This transmutation
may have been the result of mistreatment, or a particularly strong evil or a weak
patient . Because of constitutional weakness some patients may exhibit a pulse that
becomes intermittent each time they contract an exterior evil.
The heart governs the blood vessels and relies on yin, ”吨, 啡, and blood. If any
of these elements is vacuous the heart loses nourishment and palpitations may occur.
Furthermore, if ql and blood are vacuous, movement in the vessels may become
abnormal. The vessels may lose fullness, which is felt as an intermittent quality.
Palpitations may be caused by many different factors, including vacuity resulting
from the promotion of sweating or the use of precipitation, heat evil harassing
the heart , insufficiency of the center ql with internal rheum, and ql and blood
debilitation. No treatment has been given, so one may rule out mistreatment as the
cause. Heat evil, phlegm-rheum, and insufficiency of center ql are not mentioned
and an analysis of the formula reveals no ingredients for the treatment of these
patterns, so one can eliminate these possibilities. Therefore, one can conclude that
this is probably a pattern of constitutional ql and blood debilitation.
Honey-Fried Licorice Decoction ( zhi giin ciio tang) contains ingredients that
address three different aspects of this pattern. Mix-fried licorice (g伽 ciio), ginseng
(r句 shen), and jujube (da ziio) supplement and warm the heart ql. Ophiopogon
(mdi men dong) , hemp seed (ma ren), dried/fresh rehmannia (sheng di huang),
and 副s hide glue ( e jiao ) nourish the heart yin and blood. Fresh ginger ( sheng
jiang) , cinnamon twig (gui zhf), and clear wine ( qfng jiu) rouse the heart y缸g. In
combination, these medicinals free yang, restore the pulse, enrich yin, and nourish
the blood.
LINE 1 78
付 脉按 之来缓 , 时一止 复 来者 , 名 曰 结 。 。 又脉 来动 而 中
止 , 更 来 小 数 , 中 有 还 者 反 动 , 名 日 结 , 阴 也 。 仨) 脉 来 动
而 中止 , 不能 自 还 , 因 而复动者 , 名 日代 , 阴也 。
但) 得 此
脉者 , 必难治 。
( 1 ) Mai an zhi lai huiin, shi yz zhi Ju lai zhe, m如g yue jie. (2) You
mai lai dong er zhong zh记 geng lai xiiio shuo, zhong you huan zhe
fan dong, ming yue jie, yin ye. (3) Mai lai dong er zhδπg zh记 bu
neng zi huan, yzn er j边 dong zhe, mil叼 yue dai, yin ye. ( 4) De ci
mdi zhe, bi nan zhi.
(1) When I。ne] presses the pu lse, [a nd fi nds t hat] it a rrives moderately,
stops, a n d then a rrives aga i n , t h is is ca l led b。u nd . (2) Als。, when the
pu lse arrives sti rri ng* a n d then stops, aga i n a rrivi ng sma l l a nd ra pid ,
retu rn i ng [to norma l] but sti rri ng [aga i n] , t h is, [t。。] , is ca l led b。u 时 ,
194
1. GREATER YANG
[wh ich is a] yin [pu lse] . (3) When the pu lse a rrives sti rri ng a nd stops,
[but] is u n a ble t。 时 u rn [to norm a l] . beca use it is aga i n sti rri ng, this is
ca l led i nterm ittent, [wh ich is a] 内 [pulse] . (4) When [one] get these
p u lses, [th e d isease] is d ifficu lt to treat.
TEXT N OTE
*
Stirring, 动 dong : The pulse suddenly appears after a period in which it had
stopped.
S YNOPSIS
The special evidence and prognosis associated with bound pulses and intermit­
tent pulses.
COMMENTARY
Pulses that 缸e bound or intermittent share the principal characteristic that the
movement in the vessel can be felt to stop temporarily, but they differ in important
ways. A pulse that is bound only stops for a short period, returns to normal spon­
taneously, and when it returns is felt to be slightly rapid. This pulse is associated
with ql and blood stagnation and inhibition of the ql pathways. Here, stagnation
is the result of vacuity, not of repletion. A pulse that is intermittent stops for a
longer period of time, does not spontaneou日ly return to normal, continues to exhibit
a stirring quality, and is not rapid. This type of pulse is associated with severe de­
bilitation of ql and ql-blood vacuity. A pulse that is intermittent is a more serious
sign than a pulse that is bound.
These pulses are considered to be yin pulses because they are generally associ­
ated with vacuity of yin, ya吨, ql, and blood. When such pulses are felt, one knows
that the disease is probably of a serious nature and therefore difficult to treat.
4 . 8 WATER AMASSMENT PATTERNS
During greater yang disease, if the spleen’s ability to move and transform fluids,
and the bladder’s qi transformative function are impaired, excessive intake of fluids
can cause water to collect in the interior. Water amassment patterns are charac­
terized by inhibited urination, dissipation thirst, vexation thirst, and immediate
vomiting of i吨ested fluids. Poria ( Hoelen ) Five Powder ( wu l如g sii.n ) is used in
these patterns because of its ability to transform qi and move water, and resolve
the exterior. This pattern should be differentiated from stomach vacuity with wa­
ter collecting, in which thirst is absent . For this pattern the appropriate formula
is Poria ( Hoelen ) and Licorice Decoction (Ju ling giin cii.o tang ) , which w缸ms the
stomach and disinhibits water.
1 . GREATER YANG [LINE 7 1 ]
195
LINE 7 1
忖 太阳病 , 发 汗后 , 大 汗 出 , 胃 中 干 , 烦躁不得眠 , 欲得饮
水者 , 少 少 与饮 之 , 令 胃 气和 则愈 。
微热消 渴者 , 五苓散主 之 。
。 若脉浮 , 小 便不 利 ,
( 1 ) Tai ya叼 bing, fa han hou, da han chu, 创t zhong gan, fan zao
bu de mian, yu de yin shui zhe, shao shao yu yin zh毛 ling wei qi he
ze yu . (2) Ruo mai Ju, xiao bian bu li, wei re xiao ke zhe, WU ling
san zhu zhz.
( 1 ) When i n greater ya ng d isease, after sweati ng is promoted a nd great
sweat issues, [if there is] d ryness i n the stomach , 1 vexation a nd agitati。n
with i nsom n ia , a nd a d esire t。 d ri n k water, givi ng a s m a l l a m。u nt of
water wil l harm。nize the stomach qi s。 that 阳。very [wi l l enst』e] . (2) If
the pulse is floati ng a nd [there is] i n h i bited u ri n ation , slight heat,2 a n d
d ispersion-t h i rst,3 Po巾 ( H。elen ) Five Powder ( wu ling san) g。verns.
TEXT NOTES
1. Dryness in the stomach, 胃 中 干 wei zhδng gan: Depletion of the fluids of the
stomach.
2. Slight heat, 微 热 wei re: A mild feeling of heat in the body, which may or
may not be palpable.
3. Dispersion-thirst, 消 渴 xiao ke: Thirst unallayed by copious intake of water,
accompanied by scant urination. The same term, often translated as "w部ting
thirst ,” is more commonly used outside the Shang Han Lun 甜 甜 the name
of disease that is characterized by this sign, among others, and that partly
corresponds to diabetes in Western medicine. Here, however, the term simply
denotes a sign, not a disease.
FORMULA
Poria ( Hoelen ) Five Powder ( wu ling san)
。 ’I'ransform qi and move water, in order to resolve the exterior.
猪苓十 八 株 ( 去皮 )
枝半两 ( 去皮 )
泽泻一 两 六 株
臼 术十 八株
付 右五昧 , 捣 为 散 , 以 白 饮和 服 方 寸 匕 ,
汗 出 愈 。 (三) 如 法 将 息 。
日 三服 。
夜苓十 八株
桂
(二) 多 饮 暖 水 ,
ZhU ling shi bii zhu ( qu pi') ze xie · yz liang liu zhU Mi zhU shi ba zhu JU ling
shi bii zhu gui zhz bdn liiing ( qu p i')
(1 ) You wu w剖, dao wei sii.n, yi bai y伽 huo Ju fang cun bi, ri san JU . (2) Duo
yin nuii.n shu瓦 him chii yu. (3) Ru fii. jiang xi:
polyp。 n
1 . GREATER YANG [LINE 7 1 ]
196
a l ism a ( 泽 泻 ze xi 击, Alis m a tis R hizoma ) 1 li�ng 6 z h u
ovate at阳tylodes ( 白 术 btii zhu, Atractylodis Ovatae R hizoma) 18 z h u
poria (夜 苓 ju ling, Pori a ) 18 zh u
ci n n a mon twig (桂 枝 gui zh豆 C i n n a momi Ra m ulus) half li�ng (remove bark)
(1) [For] the a bove five i ngredients, p o u nd to a powder. M ix i nto a white [rice] cool
decoction . 2 Ta ke the form ula with a sq 旧陪inch叩。on,3 three times a day. (2) Drink
copious a mou nts of warm water [a nd when] sweat issues, [there will be] 阳ove可. (3) Fol­
low the [p刚ious] method [desc巾ed for Cinna mon Twig Decoction (gui zhf ta叼) with
rega rd to] re民
FORMULA NOTES
1. Zhu, 株 zhu : 1 /24 of a liang.
2. Mix into a white [rice] cool decoction, 以 白 饮 和 y'i b<ii u伽 ht此 One should
make a soup with white rice and mix in the ingredient s .
3. Take the formula with a square』inch-spoon, 服 方 寸 七 JU Jang cun bi: An
ancient method for measuring the amount of a decoction to be taken that
involves using a squ缸e spoon, each side of which measures one c归, to measure
out the decoction. This amount is roughly equivalent to 6-9 grams.
SYNOPSIS
a) The signs and treatment of water amassment.
b) Differentiation of this pattern 企om depletion of stomach liquid, following the
promotion of sweating.
COMMENTARY
Greater yang disease is properly treated through the promotion of sweating,
but as has been stated previously, only a very light sweat should issue. In this line,
sweating has been promoted improperly because profuse sweat issues. The reader is
presented with two possible transmutations following this mistreatment. The first
is that the stomach becomes dry and the second is that the pulse is still floating
and urination is inhibited.
The promotion of sweating, particularly in excess, easily damages the body
fluids.
In the first part of this line, the damage primarily affects 由e fluids in
the stomach.
The stomach becomes dry and disharmonious, leading to vexation
and agitation. Dryness 面 the stomach also causes the patient to desire fluids. One
should not confuse the vexation and agitation in this pa忱em wi由 that seen in y.缸g
brightness disease. In y缸g brightness pat也ms, the vexation is generally described
as “great” and is accompanied by constipation or some other disruption of normal
bowel function. Disharmony of the stomach easily causes insomnia. On the basis
of these signs, one knows that the exterior disease has already resolved, but the
stomach fluids have been damaged.
The treatment consists of giving the patient
仕·equent, small amounts of water to drink. Because stomach function is impaired,
drinking of copious amounts of water may result in collecting rheum; therefore, the
patient should not be allowed to drink large quantities of water. Drinking 仕eque时,
small amounts of water will restore stomach harmony 缸id resolve the disease.
In the second situation, following copious sweating, the pulse is still floating
and urination is inhibited. Mild heat and thirst that is difficult to resolve are also
l.
GREATER y ANG
[ LINE 72]
197
observed. A pulse that is floating and mild heat indicate that the exterior evil has
not been eliminated, but the evil has also moved from the channel into the interior,
entering the bladder and impairing bladder function. When the qi transformation
of the bladder is impaired, the waterways are not regulated properly, the fluids do
not move, and the evil binds with collecting water. Collecting water am础ses in the
lower burner, inhibiting urination; and because fluid movement is impaired, thirst
arises.
Poria ( Hoelen ) Five Powder ( wu ling san) treats internal water amassment and
exterior patterns, although it may also be used in the absence of an exterior evil.
This formula is an example of simultaneously treating interior and exterior disease.
Poria (Ju ling) , polyporus (zhu ling) , and alisma (ze xie) percolate and disinhibit
water. Ovate atractylodes ( b<ii zhU) fortifies the spleen and dispels dampness. Cin­
namon twig (gui zhf) frees yang, transforms qi, and resolves the exterior. The most
important action of the formula is to disinhibit the urine, but in any disease where
water collects, the spleen should be fortified. When the spleen is strong, the water
can be controlled; therefore, the inclusion of ingredients to fortify the spleen is also
important . The movement of water also depends on the qi transformation of the
bladder. Cinnamon twig (gui zhf) warms and stimulates the bladder φ, so that
normal movement is restored. Eating rice gruel with the decoction is suggested, as
it is when giving Cinnamon Twig Decoction (gui zhz tang ) . The fluids have already
been damaged through excessive sweating and if one wants to disinhibit the urine,
providing extra fluid nourishment will assist this process.
LINE 72
发 汗 已 , 脉浮数 , 烦渴者 , 五苓散主之 。
Fa han yi, mai ju shuo, fan ke zhe, WU l伽g san zhu zhz.
When sweating has a l ready been prom。ted , the pu lse is floati ng a nd
ra pid , a nd (there is) vexati。n a nd t h i rst, * P。由 ( H。elen ) Five p。wder
( wu ling san ) g。verns.
TEXT NOTE
*
Vexation and thirst, 烦 渴 fan ke: According to Skiing Han Lim Yan Jiu Da Ci
Dian, this can be interpreted as vexation and thirst, indicating two separate
entities, or vexing thirst, indicating severe thirst.
SYNOPSIS
A supplementary description of the pulse and signs of the water amassment
pattern.
COMMENTARY
In the previous line, following the promotion of sweating the pulse was floating.
Here the pulse is floating and rapid, indicating that the exterior pattern has not yet
resolved and that heat is present . In the previous line mild heat was present, and
one may 副sume that in both c凶es an external evil has entered the bladder and
transformed to heat. The exterior evil impairs the qi transformation of the bladder,
which, in combination with the loss of fluids from sweating, results in abnormal fluid
198
l . G REATER YANG [LINE 74]
movement . The resultant internal dryness causes vexation. Likewise, abnormal fluid
movement can cause severe thirst. Whether one interprets 烦 渴 fan ke as vexation
and thirst or vexing thirst, the clinical signi且cance is the same. In either case, Poria
(Hoelen) Five Powder ( wu l如g s a n) can be used to restore normal function to the
bladder and allow the fluids to move freely. Fang You-Zhi writes of using: “ . . .
Poria Four, 四 苓 si ling [polyporus ( zhii ling) , alisma ( ze xie) , ovate atractylodes
( bai zh哟 , and poria (JU ling)] , to moisten . . . [and] cinnamon twig ( gui zhZ) in order
to harmonize [ the exterior] .”
In the prese丑ce of internal dryness and mild heat one uses a formula whose
ingredients disinhibit urine and dry dampness because the root is water amassment.
The signs indicate dryness , but the pathomechanism involves abnormal movement
of water. If the function of the bladder is restored, the water will move normally
and be properly distributed; consequently, the dryness will resolve.
Vexation and thirst appear in three basic patterns following the promotion of
sweating. In the previous line, the stomach fluids were damaged and frequently
drinking small amounts of water was suggest ed to restore harmony. In the second
part of that line and the line above, water am臼ses in the lower burner and an
exterior pattern remains unresolved; therefore, Poria (Hoelen) Five Powder ( wu ling
san) is used. The third pattern is exuberant qi-aspect heat damaging the &胁 in
y归g brightness disease. This pattern is treated with White Tiger Decoction Plus
G inseng ( Mi hu jia ren shen tang) . For a full discussion of White Tiger Decoction
Plus Ginseng ( bai hU jia ren shen t ang ) see lin e 26, p. 156. The signs in these
patterns are similar, but the pathomechanisms are different.
LINE 74
中 风 发 热 , 六 七 日 不 解 而 烦 , 有 表 里 证 , 渴欲饮 水 , 水 人 则
吐者 , 名 曰 水逆 , 五苓散主 之 。
Zhong Jeng fa re, liu qi ri b也 jie er fan, you biao li zheng, ke yu νin
shu毛 shui rU ze tu zhe, ming yue shui ni, WU ling san zhu zhi.
When i n wi nd stri ke [the person ha 斗 heat effusi。n u n resolved after six
or seven days a n d vexation , [ s。 that] [there is] a n exterior a nd a n i nteri。r
patter n 1 [ m a rked by] th i rst with a desi re t。 d ri n k water a nd i m medi­
ate v。m iti ng of i ngested fl u ids, [this] is ca l led water c。u 阳 rfl。iw , 2 [for
which ) P。由 ( Hoelen ) Five Powder ( WU ling sa时 governs.
TEXT NOTES
l. [There is] an exterior and interior pattern, 有 表 里 证 you biao lZ zh切,g: Wind
strike and heat effusion ar e signs of greater yang disease, which is an exterior
disease. Thirst and vomiting of fluids are signs of water 创nassme时, which is
an interior disease. Both exterior and interior signs are present at the same
ti日ie.
2 . Water counterflow, 水 逆 shui ni: A condition in wh ich the pa t ient feels thirst
and desires to dri nk , but immediately vomi ts ingested fluids. This sign is a
1 . G REATER YANG [ LINE 73]
199
manifestation of severe water amassment, which arises when rheum evil collects
in the interior and ingested water is not transformed into fluids ( “fluids” here
referring not to ingested fluids, but to bodily fluids. )
SYNOPSIS
The clinical manifestation and treatment of severe water amassment pattern.
COMMENTARY
This pattern is similar to those in the precedin� lines with an unresolved exterior
evil but signs of interior water amassment also exist . Known as water counterflow,
this sign reflects a more severe water amassment pattern in water that is ingested is
immediately regurgitated. In water counterflow the water evil attacks the stomach,
impairing downbearing. Because fluid movement is disturbed, the patient feels
thirsty; but the stomach cannot move the ingested fluids properly and vomiting
immediately occurs. Although this sign is more severe, the pathomechanism is the
same 描 in previous water amassment patterns and involves an unresolved exterior
evil; hence one can still give Poria (Hoelen) Five Powder ( wu ling san ) .
LINE 73
伤寒 汗 出 而 渴者 , 五苓散主之 ; 不 渴者 , 夜苓甘草汤主 之 。
Shang han han chu er ke zhe, 创 ling san zhu zh亏 bu ke zhe, JU ling
gan cao tang zhu zhi.
When i n c。Id da mage [there is] sweat i ng a nd t h i rst, Poria ( Hoelen ) Five
Powder ( WU ling sa叫 g。verns. [If] t h i rst is a bsent, P。ria ( H。ele n ) a nd
Licorice Dec。ction (JU ling gan cao tang ) governs.
FORMULA
Poria (Hoele时 and Licorice Decoction (Ju ling gan cao tang)
。 Warm the stomach and transform rheum; free y缸g and disinhibit water.
夜苓二 两
桂枝 二 两 ( 去 皮 )
甘草一两 ( 炙 )
生姜三两 ( 切 )
右四昧 , 以 水 四 升 , 煮取 二升 , 去津 , 分温三 服 。
Fu ling er liiing gui zhf er liiing ( bie qie) giin cao yf liang (zhi) sheng jiiing
s伽 liang (qie)
You si wei, yi shui si sheng, zhu qu er sheng, qu zi, fen wen san fu.
poria ( 夜 苓 JU ling, Poria) 2 Ii温ng
ci n n a mon twig ( 桂 枝 gui zhf, Cin namomi Ra m u l us) 2 liling ( remove the bark)
m ix-fried licorice ( 甘 草 gan cao, G lycyrrh izae Rad ix) 1 liling
fresh gi nger (生 姜 sheng jiiing, Zingi beris Rhizoma Recens) 3 liling (cut)
[For] the above fou r i ngred ients use fou r sheng of water a nd boi l to get two st丽5『1
Remove the d regs, divide i nto th ree [doses] a nd take warm .
200
1 . G REATER YANG [LINE 1 2 7]
SYNOPSIS
A differentiation between water amassment in the bladder and stomach vacuity
collecting water, in terms of signs and treatment.
COMMENTARY
In the previous lines sweating is promoted to resolve an exterior evil and causes
thirst and inhibited urination. An exterior evil enters the greater yang channel
and the bladder, impairing the movement of water and causing thirst and inhibited
urination. In those patterns water collects in the lower burner. In this line the
reader is presented with two possibilities and must make the connection with the
previous lines, since the key sign, inhibited urination, is not stated in the text . This
line clari且es which formula to use from the location of the collecting water.
In the first pattern, following the promotion of sweating, the ql is damaged and
bladder ql transformation becomes inhibited. Fluids are not properly distributed
and cannot move upward. The mouth and tongue become dry and the patient is
thirsty. This pattern, characterized by inhibited urination and thirst, is treated
with Poria ( Hoelen ) Five Powder (wu Ung san), indicating water collecting in the
lower burner.
In the second pattern, following the promotion of sweating it is not the bladder
ql that is damaged but the y缸g qi of the stomach. The stomach function of
decomposition is impaired and water collects in the center burner. The second
pattern, characterized by inhibited urination without thirst , is treated with Poria
( Hoelen) and Licorice Decoction (Ju ling gii.n cao tang), indicating that the water
is collecting in the center burner, not the lower.
Both patterns involve water collecting in the interior; consequently, both formu­
lae warm ya吨 and transform water. The emphasis of Poria ( Hoelen ) Five Powder
( wu ling san) is opening yang and disinhibiti吨 water, whereas the emphasis of Po­
ria ( Hoelen ) and Licorice Decoction (Ju ling gii.n cao tang) is warming the stomach
and dissipating water.
Poria ( Hoelen ) and Licorice Decoction (JU l仇.g gan cao tang) warms the stomach
and transforms water. Fresh ginger (sheng jiang), which warms the stomach in
order to dissipate water φ, is the sovereign. Poria (Ju ling) fortifies the spleen and
percolates and disinhibits water. Cinnamon twig (gui zhZ) 丘e臼 yang and transforms
qi . Licorice (gan cao) harmonizes the center. (Pori a (Hoelen) Five Powder (时 ling
san) is discussed in line 71 , p. 195.)
LINE 1 2 7
太 阳 病 , 小 便 利 者 , 以饮水 多 , 必心下悸 ; 小 便 少 者 , 必 苦
里急也 。
Tai yang bing, xiao bian li zhe, yi yin shui duo, bi xin xia ji; xiao
bian shao zhe, bi kii li ji ye.
1 . G REATER YANG [LINE 1 2 7]
201
When in greater ya ng disease [ i f] u ri nation is u n i n h i bited , the d ri n ki ng
。f c。pious [a m。u nts 。f] water will result i n pa lpitati。ns below the hea 此 ;
[if] u ri n ation is sca nt, [the person w i l l ] suffer from a bdom i n a l u rgen c俨
TEXT NOTE
*
Abdominal urgency, 里 急 li ji: A feeling of distention and fullness in the small
abdomen, accompanied by urgency to urinate and discomfort.
SYNOPSIS
The location of collecting water can be identified according to whether urination
is inhibited or uninhibited.
COMMENTARY
This line may be read in two ways, leading to different interpretations. The
basic question concerns the clause, “copious drinking of water,” a且d whether it
refers to both of the situations presented in this line or only the first.
Many commentators read this line as a discussion of two transmutations that
occur in greater yang disease following the drinking of large amounts of fluid. The
Yf Z,伽g Jzn Jian and Cheng wιJi suggest that “the drinking of copious [amounts
of] water" should be placed directly after “greater y缸g dise槌e.” Cheng Wu-Ji
writes, “ [Wh叫 copious water is inge创ed and urination is spontaneously l皿nhib­
ited, water does not am出s in the interior. Only in the abdomen is there copious
water and it causes palpitations below the heart . . . . [When] copious water is in­
gested and urination is inhibited, water amasses in the interior and does not move;
[the person] will suffer from abdominal urgency.” In the first transmutation, uri­
nation is uninhibited and in the second, urination is scant. The Yi" Ziing J仿z Jian
clarifies that in this type of pattern, the state of the stomach qi will also affect the
outcome: “In the onset of greater y缸g dise凶e, [there 叫 no desire to drink water.
[When the disease] shifts to the y缸g brightness, a desire to drink water [arises] .
These [patterns ] are normal. In the present line, at the beginning of greater yan
dise刨e, the copious drinking of water suggests that the person has constitutional
stomach dryness. If the stomach y缸g is not debilitated, the ingested water can
be distributed to the exterior, causing sweat [to issue] and [the disease] to resolve.
Copious water is ingested and the stomach qi is not full. Since the urination is
uninhibited, [water] will collect in the center burner and cause palpitations below
the heart. If, further, urination is scant, water collects in the lower burner and [the
patient] will suffer from abdominal urge配y.”
One may also consider that when urination is inhibited, one need not ingest
large a皿ounts of water for urination to be uncomfortable. It is possible that “suffer
from abdominal urgency” is simply a clarification of what occurs when urination is
scant . On the basis of this interpretation, abdominal urgency is a result of water
collecting in the lower burner because urination is inhibited, regardless of whether
or not copious amounts of water are ingested. During the course of a greater yang
dise甜、 if the patient takes in an excessive amount of water, water qi may collect
in the interior. This line describes signs that one can use to identify the location of
the collecting water. When the urination is normal, the water collects in the center,
not the lower burner, and impairs the movement and transformation functions of
the spleen and stomach. This collecting water is not transformed and invades the
202
1 . G REATER y ANG [LINE 1 06]
heart, causing palpitations in the upper abdomen. When urination is inhibited, the
amount becomes scant and water collects in the lower burner. Qi transformation in
the bladder becomes impaired and water is not transformed. The lesser abdomen
becomes distended and full, and a feeling of urinary urgency exists. Previous lines
in the text suggest that for water collecting in the center burner, Poria ( Hoelen )
and Licorice Decoction (Ju ling gan ciio tang) be given. Poria ( Hoelen ) Five Powder
( wtl ling siin ) is s ugges t ed for water collecting in the lower burner.
4 . 9 BLOOD AMASSMENT PATTERNS
In blood amassment transmuted patterns, spirit signs such as mania 缸e com­
monly observed because static blood and heat evil bind in the lower burner and
invade upward, affecting the spirit. Many of these patients develop hypertonicity,
fullness, and hardness in the lesser abdomen, and the pulse is generally deep. Be­
cause the evil is in the blood, bladder qi transformation is unaffected and urination
is usually normal in these patterns, which is an important difference between blood
am础sment and water amassment. If the exterior pattern has resolved and the
blood amassment is mild, Peach Kernel Qi-Coo血ating Decoction ( ta o M cMng
qi tang) , which expels stasis and discharges heat, is used. When blood amassment
is severe, Dead-On Decoction ( dz dang tang) is used because it breaks blood and
expels stasis. When blood amassment is severe, but the disease dynamic is mod­
erate, perhaps because the stasis is abiding and not acute, Dead-On Pill (dz dang
wan) is suggested because the harsh ingredients are moderated when prepared in
pill form.
LINE 106
(一) 太 阳 病 不 解 , 热 结 膀 脱 , 其 人 如 狂 , 血 自 下 , 下 者 愈 。
其 外 不 解者 , 尚 未 可攻 , 当 先解其外 。
。
(斗 外 解 已 , 但 少 腹 急
结 者 , 乃 可 攻 之 , 宜桃核承气汤 。
{ 1 ) Tai yang bing bu jie, re jie pang gu ang, qi ren ru kuang, xue 纣
xia, xia zhe yu. {2) Qi wai bu jie zhe, sha叼 时t ke gong, dang xi an
jie qi wai. {3) Wai jie 以 dan shao Ju j{ jie zhe, niii ke gong zhf, y{
tao he cheng qi tang.
{ 1 ) When a greater ya ng d isease is u n resolved a n d heat binds i n the
bladder, 1 the person is as if m a n ic,2 a nd sponta neous blood descent3 wil l
bri ng rec。very. {2 ) I f t h e exterior h as n。t been res。lved , [。ne sh。uld] n。t
yet attack,4 [but] should fi 时 resolve the exterior. (3) When the exterior
has been resolved a nd [there is] on l y tense b。u nd lesser a bd。men , [。ne]
ca n attack5 a nd [therefore,] Peach Kernel QI-Coord i nati ng Decoction
( tao he che:叼 qi ta·叼) is a ppropriate.
1 . G REATER YANG [LINE 1 06]
203
TEXT NOTES
l. Heat binds in the bladder, 热 结 膀 肮 re jie pang guang: Three slightly different
explanations are offered for this phrase.
a) Heat evil and blood stasis contending in the lower burner. You Yi writes,
“Heat evil enters the blood. This is a lower burner blood amassment pat­
tern."
b) Heat evil and blood stasis contending in the bladder. Cheng Wu-Ji writes,
“The bladder channel [belo吨s] to the greater ya吨. An unresolved greater
yang channel heat evil follows the channel and enters the mansion. This is
what ‘heat bound in the bladder' means.” (Mansion refers to the bladder
itself, as opposed to the bladder channel. )
c ) Heat evil and blood stasis contending i n the interior o f the body. Fang You­
Zhi writes, “Heat bound in the bladder [means] . . . heat [evil] and [blood]
stasis following the greater yang [chan1 I] in the interior . . . . ”
2. As if manic, 如 狂 ru kuang : A mild abn ormali ty of the spirit-mind, in which
the patient has episodes of mania and periods of normalcy.
3. Spontaneous blood descent, 血 自 下 xue zi xia : Blood in the urine or the stool.
4. Attack , 可 攻 ke gδng : In this context, attacking means freeing stasis and
discharging heat. This analysis is based on the formula used.
5. Tense bound lesser abdomen , 少 腹 急 结 sha o Ju ji jie: Hypertonicity, disten­
tion, fullness, hardness, and pain in the lesser abdomen.
FORMULA
Peach Kernel Qi-Coordinating Decoction ( tao he cheng qi tang)
o
Expel stasis and discharge heat.
桃仁五十个 ( 去皮尖 )
( 炙 ) 芒消二 两
大黄四两
桂枝 二 两 ( 去皮 )
甘草二两
(→ 右 五 昧 , 以 水 七 升 , 煮 取 二 升 半 , 去 淳 , 内 芒 消 , 更 上 火 微 沸 ,
下 火 , 先 食 温 服 五 合 , 日 三 服 。 (二) 当 微 利 。
Tao ren W U shi ge ( qu pi ji伽) da huang si liiing gui zh'i er li a ng ( qu pf)
gan cao er li a ng (zhi) mang xiao er liang
( 1 ) You W U w e i, yi shui qf sheng, zhii. qii. er sheng ban, qu z瓦 na mang xiao,
geng shang huo wei fei, xia huo, xian shi wen Ju 叫 ge, 时 san Ju. ( 2) Dang wei li.
peach kernel ( 桃 仁 tao T旬, Persicae Semen) 50 pieces ( remove skin a nd tips*)
rh u barb ( 大 黄 da huang, R hei R hizoma) 4 liling
ci nna mon twig ( 桂 枝 gui zhZ, C i n n a momi Ra m u l us) 2 liling ( remove bark)
mix-fried licorice ( 甘 草 gan cao ’ Glycy『『hizae Radix) 2 Ii昌 n
mir ilite (芒 硝 ma叼 xia o, M i ra bilitu m ) 2 Ii革『1g
(1) [For] the a bove five i ngredients use seven sheng of water. Boil [the fi rst fou r
i ngredients] to get two a nd a half she略 Remove the d 吨E a nd add m i ra bi l ite ( mang
xiao ) . Aga i n place on the fi re and boil slightly. Remove from the fi『e and before eati ng
ta ke five g� warm , th ree times a day. (2) [The叫 should be slight diarrhea .
204
1 . GREATER YANG [LINE 1 06)
FORMULA NOTE
*
Remove the skin and tips, 去 皮 尖 qu pi jiiin : It is not clear why Zhang JI
suggests that the skin and tips of peach kernel (tao ren) be removed. It may
reflect knowledge of the presence of toxic components concentrated in these
two 町eas of the seed. Since Zhang JI uses peach kernel ( tao ren) in this
formula to quicken the blood, he could not have been acting in accordance
with the notion arising in the Ming and Qing Dynasties that the skin and tips
of this medicinal should be removed when it is used to moisten the intestines,
but that they should be retained when it is used to move the blood since these
parts have the strongest blood-moving action.
S YNOPSIS
The signs and treatment of the mild blood a皿assment pattern.
COMMENTARY
When a greater y缸g evil is unresolved it 皿ay transform to heat and follow
the channel into the interior. “Interior” can be interpreted to mean the interior of
the body, the lower burner, or the urinary bladder. The heat causes a manic-like
state when it enters the blood. If the blood flows freely, the heat will cause frenetic
movement of the blood. The blood will move into the stool or the urine and the
heat will follow the blood and resolve. “ [If there is] spontaneous blood descent, it
will bring recovery.”
If, however, the blood is not flowing freely because of a preexisting condition
of blood stasis or because the heat damages the blood and causes blood stasis,
the heat will contend with the blood stasis, causing blood amassment in the lower
burner. The two clinical signs of blood amassment presented here are a mania-like
condition and tense lesser abdominal bind. Lesser abdominal bind is a direct result
of blood amassment in the lower burner. The mania-like condition is a result of
blood heat and blood stasis in the lower burner. The heat evil cannot flow out
below and because heat tends to rise upward, it harasses the upper body. The evil
moves upward in the blood and the heart governs the blood vessels, so the heat
affects the heart. Because the heart governs the spirit, a heat evil harassing the
heart can cause a mania-like condition.
When one is treating a pattern of blood am甜sment following contraction of a
greater y缸g exterior evil, the exterior must be resolved before the interior can be
treated. Zh磊ng Jr emphasizes this point because the treatment that he suggests for
blood amassment , expelling stasis and discharging heat, would cause an unresolved
exterior evil to fall inward and possibly exacerbate the condition. Once the exterior
is resolved, one may precipitate the blood. This general principle can be applied
not only to blood am描sment patterns, but generally to any disease pattern with
exterior signs.
Peach Kernel Qi-Coordinating Decoction ( tao he cheng qi tang) is Stomach­
Regulating Qi-Coordinating Decoction ( tiao wei cheng qi tang) with a smaller dose
of mirabilite ( mang xiiio) and with the addition of peach kernel (tao ren) and
cinnamon twig (g u i zhf) . The addition of peach kernel ( tao ren), which quickens
the blood and expels stasis, and cinnamon twig (gui zhf) , which warms and frees
the blood vessels, increases the ability of the formula to precipitate heat and stasis.
l.
GREATER YANG [LINE 1 24]
205
Because the formula’s most important action is expelling stasis, not freeing the
stool, the dosage of mirabilite ( mang xiiio) is reduced.
The location of blood amassment is in the lower burner. Peach Kernel Ql-Co­
ordinating Decoction ( tao he chi:叼 qi tang) attacks and precipitates blood stasis.
In order to speed the absorption of the decoction and maximize its efficacy, the
decoction should be taken on an empty stomach; consequently, in the directions for
the formula it is suggested that the decoction be taken before eating.
LINE 1 24
付 太 阳 病 六 七 日 , 表 证 仍 在 , 脉 微 而 沉 , 反 不 结胸 , 其 人 发
狂者 , 以 热在下焦 , 少 腹 当 硬满 ,
小 便 自 利者 , 下血乃愈。
(斗 所 以 然 者 , 以 太 阳 随 经 , 痕 热 在 里 故 也 , 抵 当 汤 主 之 。
( 1 ) Tai yang b i ng liu qz 时, biao zhe叼 re叼 zai, mai wei er chen,
fan bu jie xiong, qi ren fa kuang zhe, yi re zai xia jia o , shiw Ju dang
ying man, xiao b ian zi li zhe, xia xue nai yu. ( 2) Suo yi ran zhe, yi
tai yang sui jing, yu re zai li gu ye, di dang tang zhu zhi.
( 1 ) When i n greater ya ng d isease [that has lasted for] six 。r seven days,
the exterior pattern is sti l l present a nd the pu lse is fa i nt a nd su n ken , but
chest bind1 is a bsent, and the pers。n is ma nic,2 it is beca use the h eat
is i n the l。wer bu rner so the lesser a bdomen is hard a n d fu ll u ri n ation
is sp。nta ne。usly u n i n h i bited a n d preci pitatin g the blood [wi l l bri ng]
陀cove啡 ( 2 ) Why [t h is] is so is beca use [the evil ] fol l。wed th e greater
ya ng cha n nel , a nd [there is] stasis heat in the i nterior; [therefore,] Dead­
On Dec。cti。n ( di dang tang ) g。verns.
TEXT NOTES
l . Chest bind, 结 胸 jie xiiing: Pain with hardness and fullness in the area above
the diaphragm and below the heart.
2. Manic, 发 狂 fa kuiing: A severe spirit abnormality characterized by agita­
tion and signi且cant alterations in the patient’s speech, behavior, and thought.
Delirious speech, hallucinations, and inappropriate behavior may also be ob­
served.
FORMULA
Dead『On Decoction ( di dang tang)
o
Break blood and dispel stasis.
水蛙 ( 熬 )
蛇虫各三十个 ( 去翅足 , 熬 )
尖 ) 大黄三两 ( 酒洗 )
桃仁 二十个 ( 去皮
忖 右四 昧 , 以水五升 , 煮取三升 , 去淳 , 温服一升 。
服。
(二) 不 下 , 更
206
1 . G REATER y ANG [LINE 1 24]
Shuf zhi ( tio) meng ch6叼 ge san shi ge ( qu chi zu, ti o ) tao ren er shi ge ( qu
pi ji an ) da huting san liang (jiu xi)
( 1) You si wei, yf shuf wu sheng, zhU qit san sheng, qu zf, wen Ju yf sheng.
(2) Bu xi a, g e ng Ju.
leech ( 水 蛙 shuf zhi, H i rudo seu Whitmania) 30 pieces (d ry fry*)
ta bam (虫亡 虫 meng ch6ng, Taba『1U』s) 30 pieces (remove wi ngs a nd legs, d ry fry*)
peach kernel (桃 {二 tao ren, Persicae Semen) 20 pieces (remove ski n a nd ti ps)
rh u barb ( 大 黄 da hua叼, Rhei Rhizoma) 3 li:ing (wash with wi ne)
( 1 ) [For] the above fou r i ngred ients use 币ve she吨 of water a nd boil to get th ree
sheng. Remove the dregs a n d ta ke one she鸣 warm . (2) [If there is] no d iarrhea , ta ke
aga i n .
FORMULA NOTE
拿 Dry fry, 熬 tio: These two ingredients cannot be used raw so they are prepared
through some cooking process in order to make them safe for internal use. This
same Chinese term now usually refers to boiling over a low flame. In modern
practice, these medicinals are usually stone baked.
SYNOPSIS
The pulse, signs, and treatment of severe blood amassment pattern.
COMMENTARY
Greater yang disease that has failed to resolve in six or seven days is normally
characterized by a pulse that is floating. In the pattern described in the present
line, however, the pulse is faint and sunken, indicating that the evil has entered
the interior and transformed into heat . In interior heat patterns, it is important to
determine the precise location of the heat . In the present line, we 缸e told that chest
bind is absent . We may infer, therefore, that there is no hardness and pain below
the heart or oppression in the chest that would indicate that the heat were located
in the chest. Furthermore, this patient has a spirit disorder, mania, which Zhang JI
attributes to heat in the lower burner. As in the previous line, an unresolved exterior
evil has transformed to heat and entered the lower burner. It contends with the
blood 缸id the blood becomes static. In the previous line a mania-like condition and
tense lesser abdominal bind are present , but in this line the same pathomechanism
results in hardness and fullness in the lesser abdomen and mania. Blood heat and
blood stasis causes blood amassment. This pattern is further suggested by the
pulse, which is sunken and faint. A pulse that is sunken indicates interior disease.
A pulse that is faint indicates severe congestion of the qi and blood. This condition
is more severe than the one in the previous line, perhaps because of constitutional
differences between the patients or differences in the strength of the evil. Although
this pattern is more severe, the uninhibited urination suggests that the qi dynamic
of the bladder is still normal. Because of the severity of this pattern no spontaneous
resolution through bleeding is possible as in the previous line .
Dead-On Decoction ( dz dang tang) is a harsh formula for attacking and expelling
blood stasis. Leech ( shuf zhi) and tabanus ( meng ch6ng) expel malign blood and
break blood accumulation. Rhubarb ( da h u ting ) 也础es evil heat and moves stasis
in a downward direction, reinforcing the lubrication and disinhibition provided by
1 . GREATER YANG [LINE 1 25]
207
peach kernel ( tao r臼) . This formula powe由lly breaks blood and expels stasis;
therefore, it should only be used for cases of blood stasis in repletion patterns. In
elderly or weak patients or those with internal bleeding this formula can only be
used with extreme caution, if at all. Its use is contraindicated for patients who are
c urrently bleeding or pregnant.
LINE 1 2 5
太 阳 病 , 身 黄 , 脉 沉 结 , 少 腹硬 , 小 便 不 利 者 , 为 无血 也
小 便 自 不lj , 其 人 如 狂 者 , 血 证 谛 也 , 抵 当 汤 主 之 。
Tai yang bing, shen huang, mai chen jie, shao Ju ying, xiao bian bu
li zhe, wei WU xue ye; xiao bian zi li, qi ren rU kuang zhe, xue zheng
di ye, di dang tang zhu zhr.
When i n greater y a ng d isease , [there is] genera l ized yellowing, * a pulse
that is su n ken a nd bou nd hard ness in the lesser a bdomen a nd i n h i bited
u rinati。『1 , [th is] mea ns that [there is] n。 bl。。d [a ma臼『nent] . 阳he n ]
u ri
i n d icate] a true bl。。d p a tte 叽 [for wh ich] Dead-On Decoction ( dz dang
t ang ) governs.
TEXT NOTE
*
Generalized yellowing, 身 黄 shen huang: The facial complexion, general skin
color, eyes, and urine are all bright yellow. Also written as 发 黄 fa huang.
SYNOPSIS
a ) Further discussion of the pulse and signs of the severe blood amassment
pattern.
b ) The essential features for identifying this pattern.
COMMENTARY
This line provides guidance for the reader when identifying blood amassment
patterns. The key to this identification is whether or not urination is inhibited. The
signs of generalized yellowing and hardness in the lesser abdomen do not indicate
blood amassment if the urination is inhibited. When urination is inhibited, these
signs indicate damp-heat steaming in the interior, which is not related to blood
stasis or amassment.
These s i gns , however, do indicate blood am凶sment when urination is uninhib­
ited. A pulse that is sunken means that the disease is in the interior, and a pulse
that is bound means blood stasis. Hardness in the lesser abdomen is further indica­
tion of st描is in the lower burner. As described earlier, blood amassment can lead
to a manic-like condition, as in this line. Blood a皿assment in the lower burner can
give rise to blood heat and blood st asis , and lead to generalized yellowing.
Many modern commentators make reference to the liver and gallbladder in
describing the pathomechanism of generalized yellowing, although Zh磊ng JI did not
1 . G REATER y ANG [LINE 1 26]
208
understand it this way. Ke Qin provides an explanation that does not refer to the
liver and gallbladder and is presumably closer to Zhang JI’s original conception:
Greater yang disease with generalized yellowing and mania can be diι
ferentiated by blood and φ [臼pect] . (When] urination is inhibited and gen­
eralized yellowing (occurs] , the disease is in the qi 田p ect . . . . If urination is
u ninhi b it e d and generalized yellowing [occurs] , the disease is in the blood
aspect. Dami:←heat collects in the skin and generalized yellowing (occurs] be­
cause the defensive qi does not move. Dry blood binds in the bladder and
generalized yellowing (occurs] because the construction qi is not distributed.
LINE 1 2 6
伤 寒 有 热 , 少 腹 满 , 应 小 便 不 利 , 今 反 利 者 , 为 有血也 , 当
下 之 , 不 可余药 , 宜抵 当 丸 。
Shang han you re, shao Ju man, y加g xiao bian bu li, fin Jan li zhe,
wei you xue ye, dang xia zh毛 bu ke yu yao, y{ di dang wan.
I n c。Id d a m age with heat1 a nd lesser a bdom i n a l fu l l ness, u ri n ation
should be i n h i bited · but n。w u ri nation is u n i n h ibited wh ich mea ns
[there is] bl。。d [ a m assment, ] s。 。ne shou ld preci pitate [the blood ] .
[ O n e] ca n n 。t spa re [ a ny or a nyth i ng of the] medici nals [ 叫 u i 陀d ] 2 a n d
b 。] Dead-O n P i l l ( di dang wan) is a ppropriate.
TEXT NOTES
1. Cold damage with h eat , 伤 寒 有 热 sh ang Mn you re: A cold damage pattern
with generalized heat . Y6u Yi writes,
Ke Qin, however, interprets this phrase as indicating that the exterior evil has
not resolved: “With heat' means that the exterior pattern is still present.”
2. Cannot spare [any or anything of the] medicinals [required] , 不 可 余 药 bu ke
yu yao : Two meanings are suggested. One is that only this formula can
be used, since any other formula would not be efficacious. The other, more
likely, meaning is that when the medicinals are taken they must be taken with
the dregs; therefore, the pill is used here, not the decoction. Although the
preparation instructions do not specifically say so, it is generally held that the
dregs should not be strained off.
FORMULA
Dead-On Pill ( di dang wan )
o
Break blood and expel stasis; use harsh medicinals moderately.
水蛙二 十 个 ( 熬 )
皮尖 )
大黄三两
虹虫 二 十 个 ( 去翅足 , 熬 )
挑仁 二 十 五 个 ( 去
1 . G REATER y ANG [LINE 126]
付 右 四 昧 , 捣 分 四 丸 。 口 以 水一升 , 煮一丸 , 取 七 合 服 之 。
时 当下血 , 若不下者 , 更 服 。
209
(三) 悴
Shui zhi er shi ge ( ao) meng ch6ng er shi ge ( qu ch i zu, ao) tao ren er sh i
wu g e ( qu pi jian) da huang san liang
( 1 ) You si w e i , dao fen si wan. (2) Yi shui yf sheng, zhU yf wan, qu qf g e Ju
zhf. (3) Zu i shi dang xia xue, ruo bu xia zh己 geng Ju.
leech ( 水 蛙 sh u i zhi, H i rudo seu Whitmania ) 20 pieces (d 吁台y)
ta ba n 山 (蛇 虫 meng ch6ng, Ta ba n 叫 20 pieces (remove wing a nd legs, d ry-fry)
peach kernel ( 桃 仁 tao ren , Pe时cae Semen) 25 pieces ( remove skin a nd tip)
rh u barb ( 大 黄 da h u ang , Rhei Rhizoma ) 3 li�ng
( 1 ) (For] the a bove fo u r i ngredients, pou nd, separate a nd (form] i nto four pills.
(2) Use one sheng of water a nd boil one pil l to get seven g�. Take (the decoction] .
(3) Withi n one day, 1 there should be blood descent. 2 If [there is] no descent, ta ke aga i n .3
TEXT NOTES
1. One day, 阵 时 zu i shi: A period of twenty-four hours; a night and a day.
2. Blood descent, 下 血 xia xue: Here, this term means blood appearing in the
stool or the urine, but in other places it can refer to uterine bleeding. This
term can be used to describe a treatment, as in “precipitating the blood,” and
it can also be used to describe the downward movement of blood, as in “blood
descent."
3 . If [there is] no descent , take again, 若 不 下 者 , 更 服 ruo b u xi zh已 geng JU:
Because pill forms are gentler and slower acting than decotions, precipitation
using the pill form of Dead-On Pill ( di dang wan ) can be expected to take up
to a day to occur. The formula be taken again only if precipitation does not
occur within about one day.
SYNOPSIS
a ) The essential features for distinguishing water amassment from blood amass­
ment.
b) The treatment of the severe pattern of blood amassment when the disease
dynamic is mild.
COMMENTARY
This line further emphasizes the importance of urination as a diagnostic indica­
tor. The presence of an unresolved exterior pattern, “cold damage with heat" and
lesser abdominal fullness, suggests that the evil has entered the urinary bladder
and caused water amassment. In that case, however, urination should be inhibited,
whereas in this line, urination is uninhibited. Therefore, these signs indicate blood
amassment and should be treated by precipitating the blood.
Dead-On Pill (di dang wan) is a gentler version of Dead-On Decoction ( di da ng
tang ) . The dosages of leech (sh包i zhi) and tabanl
while the amount of peach kernel ( t ao 的。 is slightly incre描ed and rhubarb ( da
h u ang) remains the same. Furthermore, pill forms 缸e gentler and slower acting
than decoctions.
1. G REATER y ANG
210
This formula is considered moderate by comparison on the one hand with the
mild Peach Kernel Qi-Coordinating Decoction ( tao he cheng qi tang ) 旭d on the
other with the harsh Dead-On Decoction ( di dang tang ) . For mild cases of blood
amassment with mania-like signs and 皿ild lesser abdominal bind, Peach Kernel
Qi-Coordinating Decoction ( tao he ch臼g qi tang ) 皿町 be used. For severe cases
of blood amassment with mania and hardness in the lesser abdomen, Dead-On
Decoction ( di dang tang ) is necess町. When the si伊s are similar to those in which
Dead-On Decoction ( di dang tang ) is used but are less severe, or when the patient
is in a weakened condition, one may instead choose Dead-On Pill ( di dang wan ) .
4.10
CHEST BIND PATTERNS
Chest bind patterns are the result of a heat evil falling inward and binding with
water-rheum. They can be the result of inappropriate precipitation, but they can
also occur in the absence of mistreatment. Chest bind patterns are divided into two
main categories, heat repletion and cold repletion.
Heat repletion chest bind can be further subdivided into three categories on the
basis of the formula used to treat the pattern.
a ) Major Chest Bind Pill ( da xian Mδng wan ) is used when the location of the
chest bind is relatively high. Apart from hardness and pain in the chest re­
gion, this pattern is also characterized by stiffness of the nape that appears
similar to soft tetany. This fo口nula expels water and flushes repletion. Its
use 础 a pill moderates the harshness of the ingredients.
b ) In the Major Chest Bind Decoction ( da xian xiδng tang ) pattern, the chest
bind is below the heart , in the rib-side. In severe patterns it may stretch
down into the abdomen. This pattern is characterized by pain below the
heart that is stone-like when pressed, or hardness, fullness, and pain from
below the heart down into the lesser abdomen that the patient refuses to
allow one to palpate. Accompanying signs that may be observed include a
pulse that is sunken and tight, bound stool, and late afternoon tidal heat
effusion. This formula drains heat and expels water, and flushes repletion
and breaks binds. In this pattern 证 the pulse is floating one should not
precipitate since this will cause death. Furthermore, if the main signs of
chest bind are present, and vexation and agitation are observed, the patient
will die.
c ) Minor Ch创 Bind Decoction ( xiao xian xiδng tang ) is used when phlegm
heat gives rise to chest bind in a clearly circumscribed area directly below
the heart. The hardness and pain in this pattern does not extend down
into the abdomen. The 缸ea may be painful with or without pressure. The
pulse is floating and slippery. This formula disperses phlegm and opens
binds.
Cold repletion chest bind patterns occur when water-rheum and cold evil bind
below the heart . This pattern is characterized by pain in the region of the chest
and stomach duct. The stool may or may not be bound. This pattern is similar
to heat repletion chest bind, but heat signs such as heat effusion and vexation are
1 . GREATER YANG [LINE 1 2 8]
absent . Three Agents White Powder ( san
expel water and to break binds.
211
wu Mi sii.n) i s used t o attack cold and
LINE 1 2 8
(→ 问 曰 : 病 有 结 胸 , 有 藏 结 , 其 状 何 如 ? 仁) 答 曰 : 按 之 痛 ,
寸脉浮 , 关脉沉 , 名 日 结胸也 。
( 1 ) Wen νue: bing you jie xiδng, you zang jie, qi zhuang he ru ?
(2) Da yue: an zhi tong, cun mai JU, guan mai chen, m伽g yue jie
xiong ye.
Questi。n : There is a d isease [ca l led] chest bind , 1 a nd there is [。ne
ca l led] st。rehouse bin d . 2 What form does it ta ke? Answer: [If there is]
pa i n when pressu re is a pplied , a n d the i nch pu lse is fl。ati ng, a nd the
ba r pu lse is su n ken , t h is is ca l led chest bind .
TEXT NOTES
1. Chest bind, 结胸 jie xiong: The principal signs of chest bind are pain below the
heart and palpable hardness and fullness. In major chest bind, these signs may
extend down into the region of the stomach duct or further down into the lesser
abdomen. In minor chest bind, the signs are localized to the region directly
below the heart. The pathomechanism is that an exterior evil falls inward into
the region of the chest and diaphragm. Chest bind is often, but not necessarily,
the result of inappropriate precipitation. The exterior evil, once in the chest,
binds with phlegm-rheum or water-rheum, which are tangible evils. Chest
bind may be differentiated in terms of heat and cold, as well as severity.
2. Storehouse bind, 藏 结 zang jie: Visceral vacuity and yang debilitation with
bound yin cold. Also c alled “visceral bind,” 脏 结 zang jie.
SYNOPSIS
The primary pulse and signs of the chest bind pattern.
COMMENTARY
Zhang JI compares chest bind and storehouse bind because they are similar and
must be clearly differentiated. This line describes some of the key signs associated
with chest bind. In chest bind patterns, evil heat falls into the interior and becomes
bound in the region of the chest and diaphragm with tangible phlegm or water evil.
Chest bind is a repletion pattern; consequently, pressure on the area produces pain.
An inch pulse that is floating indicates a yang evil in the chest and diaphragm.
A bar pulse that is sunken indicates bound and congealed water evil in the chest
and diaphragm or the center. The center is important because phlegm and water
evils are said to arise from there. The phlegm or water evil, from the center,
contends with and becomes bound with heat evil in the region of the chest and
diaphrag皿. Therefore, the region of the chest and diaphragm and the center should
be considered in chest bind patterns.
1 . G REATER YANG [LINE 1 3 1 ]
212
4.10.1
4.10. 1 . 1
Heat Replet ion C hest B ind Patt erns
Major Chest Bind Pill Patterns
LINE 1 3 1
忖 病 发 于 阳 , 而 反 下 之 , 热 入 因 作结胸 , 病 发 于 阴 , 而 反 下
之 , 因 作痞也 。 ω 所 以 成结胸者 , 以 下 之太早故也 。 问 结
胸者 , 项亦强 , 如 柔 撞状 , 下之则和 , 宜 大 陷胸丸 。
( 1 ) Bing fa yu yang, er fan xia zh毛 re rU yin zuo jie xiδng, bing fa
yu yin, er fan xia zh毛 yin zuo pi y e. (2) Suo yi cheng jie xiong zh已
yi xia zhi tdi zao gu y e. (3) Jie xiδng zhe, xiang yi jiang, ru rou ci
zhuang, xia zhi ze he, y{ da xian xiδng wan.
(1) [When] the d isease spri ngs from ya ng, yet preci pitation is used , the
heat enters [the i nteri。r] a nd ca uses chest bi n d . [When] the d isease
spri ngs from 肉 , yet preci pitation is used , [the evil) ca uses a gl。m us.
(2) Why [the d isease] bec。mes chest bind [is] beca use precipitation was
used t。。 early. (3) I n chest bi nd , with n a pe stiffness as [i n] s。ft teta ny, *
preci pitate a nd then [there wi l l be] h a rmony. M ajor Chest B i n d P i l l ( da
xian xiong wan) is a ppropriate.
TEXT NOTE
*
Soft tetany, 柔 瘟 r伽 ci: Tetany is a disease characterized by neck and back
stiffness and an arched b配k When accompanied by sweating it is called soft
tetany. If sweating is absent it is called hard tetany.
F ORMULA
Major Chest Bind Pill ( da xian dδ叼 wan)
。 Expel water and break binds; attack moderately with harsh medicinals.
大黄半斤
事剪子 半 升 ( 熬 )
芒消 半升
杏仁半升 ( 去皮尖 , 熬
黑)
卜) 右 四 昧 , 捣 筛 二 昧 , 内 杏 仁 、 芒 消 合 研 如 脂 , 和 散 。 ω 取 如 弹
丸 一 枚 , 别 捣 甘 遂 末 一钱 匕 , 自 蜜 二 合 , 水 二 升 , 煮 取 一 升 : 温顿 服
之 , 一 宿 乃 下 ; 如 不 下 , 更 服 , 取 下 为 效 。 (三) 禁 如 药 法 。
Da hJ.tang bdn jzn ting li zi ban sheng ( ao) mang xiao ban sheng xing ren
bdn sheng ( qu p{ jian, ao hei)
( 1 ) yOU si wei, dii.o shai er wei, na xing T印、 mang xiao M yan ru zhf, huo
sii.n. (2) Qu 叫 dan wan yz mei, bie dii.o gan sui mo yz qian b瓦 Mi mi er 肘, shui
er sheng, zhu qu yz sheng; wen dun JU zhf, yz xiii. nii.i xia; rU bu xia, geng JU, qu xia
wei xiao. (3) Jin rU yao /ii..
1 . GREATER YANG [LINE 1 3 1 ]
213
rh u barb ( 大 黄 da huang, Rhei Rhizoma ) h a lf j"ln
tingli (事 荫 子 ting li zi, Descu rai n iae seu Lepidii Seme n ) h a lf sheng ( d ry-f1叩 )
mira bilite ( 芒 硝 mang xiao, M i 『a bilit 1』 町1 ) h a lf sh否『3
a pricot kernel (杏 仁 xing reη, Armen iacae Semen) h a lf she略 (remove skin a nd
ti ps, d ry-fry t i l l black)
(1) [For] the a bove four i ngred ients, pound a nd sieve the [fi叫 two [rh u barb ( da
huang) a nd ti ngli ( ting li zi)]. Grind mi毗ilite ( mang xiao) a n d a pricot kernel (xing
ren) [to m a ke a] fat-l i ke [mixtu re] a nd m ix i n [the other two i n g redients] . (2) M a ke
pellet pills.1 Separately pou n d 1 qia n叩oonful2 of ka nsui (gan sui) i nto powder and
[combine with] two g � of honey and two sheng of water. Boil to get one sheng. Take
wa rm as a single dose, a nd [the patient] will have diarrhea after a night. If [the patient]
does not h ave diarrhea , ta ke further doses u ntil diarrhea shows that [th e med ication]
has b ee n effective. (3) Follow these instructions caref1』l ly.3
FORMULA NOTES
1. Pellet pills, 弹 丸 dan wan: Pills approximately the size of a small ball, about
5-6 grams each.
2. Qi an -spoonful , 钱 匕 qian bi: The qi归-spoon is a me描uring device for powders
used in the H也 Dynasty. One qian-spoonful is equivalent to approximately
1 .5-1 .8 grams or 5 6 fen.
3. Follow these instructions carefully, 禁 如 药 法 jin ru yao fa : The character 禁
jin, normally meaning “forbid,'’ is here understood to mean “carefully.”
SYNOPSIS
a) A differentiation between the C肌ses of chest bind a:r of glomus.
b) The signs and treatment of chest bind when the evil is bound higher in the
upper burner.
COMMENTARY
In this line a comparison is made between disease springing from the yang and
disease springing from the yin and between chest bind and glomus. Disease springing
from the yang and disease springing from the yin can be interpreted in different
ways, reflec t ing several viewpoints that may help the reader to understand the text.
Yang and yin can be understood to denote the exterior and interior of the body,
the defense and the construction, or different channels. The broadest perspective
is offered by Ke Qin who writes, “Yang means external and describes the body’s
[exterior] . Yin means the interior and means the chest and below the heart.” Shii
Zhao (舒 诏 , style 驰 远 Chi-Yuan) offers a slight variation by referring not to the
exterior and the interior but to the defense and construction. “Disease springing
from yang means wind damaging the defense; disease springing from yin means
cold damaging the construction." From the interior and exterior, the construction
and defense, Qian Hu缸g narrows his explanation to the channels: “ . . . springing
from yang means an evil in the yang channels . . . [and] . . . springing from yin means
an evil in the yin channels.” Zh磊ng Zhl-Cong narrows this perspective further in
his commentary: “Disease s prin ging from y缸g means disease sprin ging from the
greater y但g channel; disease springing from yin means disease springing from the
lesser yin channel."
2 14
1. GREATER YANG [LINE 1 3 1 ]
Disease springing from y缸g means an exterior pattern, and in exterior patterns
one should resolve the exterior. If precipitation is used, as it was in this case, the evil
may fall inward. When the evil falls inward it can cause chest bind. This pattern is
identi且ed as major chest bind on the basis of the suggested formula, Major Chest
Bind Pill ( da xian xiong wan ) . In all the lines in this section, chest bind involves
a repletion heat evil bound in the interior. Line 141B, p. 223, however, contains a
reference to a cold repletion chest bind, although most chest bind patterns involve
heat .
Disease springing from yin means an interior pattern, but this is not a repletion
pattern; therefore, precipitation should not be used. When it is, spleen and stomach
qi is damaged. Damage to the qi of the center burner impairs upbearing and
downbearing of qi and results in stagnation. This stagnation causes a glomus in the
region of the center burner just below the heart.
The phrase, “heat enters" is used to describe the exterior evil falling inward
and causing chest bind. No such phrase is used for the yin pattern because the
evil is already considered to be in the interior. In the yin pattern the use of pre­
cipitation does not cause the evil to fall inward, it simply damages the stomach qi.
Furthermore, we are told that precipitation was used too early in the yang pattern
and this mistreatment causes chest bind. No such indication of time is given for the
glomus. Appropriate timing is important when considering the use of a treatment
like precipitation in exterior diseases. Precipitation must not be used in exterior
patterns, particularly in the early states. In the case of interior diseases, however,
it is not the timeliness of precipitation that is important, but its suitability in terms
of the presence of repletion or vacuity.
The final section describes chest bind with signs of soft tetany. Major chest
bind occurs in the region of the chest , diaphragm, the center burner just below
the heart , and the lesser abdomen. When water and heat become bound in this
region they obstruct normal movement of fluids. Stiffness in the neck means that
the channels have been deprived of normal nourishment and moistening as a result
of the congestion.
Major Chest Bind Pill ( da xian xiδng wan) is Major Chest Bind Decoction ( da
xian xiong tang) with mirabilite ( mang xiiio) , apricot kernel ( xing ren ) ' and honey
( Mi mi) . Rhubarb (da huang) and mirabilite ( mang xiiio) drain heat, break binds,
and h础 phlegm. Kansui (giin sui) harshly expels water-rheum and breaks binds.
These are the most important ingredients in the formula. Tingli ( t如.g li zi) drains
the lungs and apricot kernel ( xing ren) disinhibits the lungs. These two ingredients
open and course the lungs. When the upper source of the water is free, the water
bound in the chest will be able to flow down and out . This phenomenon is similar
to what occurs if one punches a hole in a can and turns it upside down. The liquid
will not flow out until a hole is opened in the top of the can. The lungs, water’s
upper source, must be open for the water to flow out through the lower burner. This
method of treatment later became formally known as “lifting the pot and removing
the lid” ( 提 壶 揭 盖 ti hU jie gai) .
1 . GREATER YANG [LINE 1 34]
215
In the text the reader is told that both ches t bind and glomus may result from
the inappropriate use of precipitation. It should be noted that these two signs may
also occur in the absence of mistreatment.
4.10. 1.2
Major Chest Bind Decoction Patterns
LINE 1 34
卜) 太 阳 病 , 脉 浮 而 动 数 , 浮 则 为 风 , 数 贝11 为 热 , 动 则 为 痛 ,
数则为虚 ,
头痛发 热 , 微盗汗 出 , 而反 恶寒者 , 表未解也 。
ω 医反下之 , 动数变迟 , 厢内拒痛 , 胃 中空虚 ,
客 气动 脯 ,
短 气 躁 烦 , 心 中 懊 侬 , 阳 气 内 陷 , 心 下 因 硬 , 贝lj 为 结 胸 , 大
陷胸汤主之。
(斗 若 不 结 胸 , 但 头 汗 出 ,
余处无汗 , 剂颈而
还 , 小 便不利 , 身必发黄 。
( 1 ) Tai yang bing, mai Ju er dong shuo, Ju ze wei Jeng, shuo ze wei
re , dong ze wei tong, shuo ze wei XU, t6u tong Ja r e , wei dao han
chu, er Jiin WU han zhe, biiio wei jie ye. (2) Yi Jan xia zhZ, dong
shuo b i an chi, ge nei ju tong, wei zhδng kong XU, ke qi dong ge, duiin
qi zao Jan, xin zhδng do n6ng, yang qi nei xian, xin xia yin ying, ze
wei jie xiong, da xian xiong tang zhu zh i. (3) Ruo bu jie xiong, dan
t6包 han chu, yu chu wu han, ji jing er huan, xiiio bian bu li, shen bi
Ja huang.
( 1 ) I n greater ya ng d isease, when the pulse is floati ng, sti r时 , 1 a nd
ra pid , floating mea ns wi n d , ra pid mea ns heat, sti rred mea ns pai n , a n d
ra pid mea ns vacuity. [There is] headache, heat effusion , m i l d n ight
sweati ng, a nd yet aversion t。 c。Id , [ beca use] the exteri。r has not yet
res。lved . (2) But the physicia n uses preci pitation a n d the movement
a nd ra pid ity I 。f the p 比e] changes to slowness. In the d i a p h ragm [there
is] pa i n that refuses [ pressu 叫 . [With ] em pty vacu ity i n the stomach ,2
visiti ng q13 sti rs the d ia ph ragm and [there is] shortness 。f breath , vexa­
tion a n d agitation , a nd a nguish i n the h ea rt. The ya n g q14 fa l ls i nwa rd
and ca uses hard ness below the heart , wh ich mea ns chest bi n d ; [the陪
f。陀, ] Major Chest B i nd Dec。ction ( da xian xio叼 tang ) governs. (3) If
[there is] n。 chest bind , o n ly sweat iss山ng from the head-a nd with­
。ut sweat elsewhere-一that st。ps at the neck, a nd u ri『tati。n is i n h i bited ,
there wil l be genera l ized yellowi ng.
l. GREATER y ANG [LINE 1 34]
216
TEXT NOTES
1. The pulse is . . . stirred, 脉 动 mdi dong: The pulse is moving irregularly. This
pulse is not the same as the modern stirred pulse , 动 脉 dong mai ( a pulse that
is forceful, rapid, and slippery, like a bean that is bobbing) .
2. Visiting qi , 客 气 k e qi: A term for an exterior evil that emphasizes its entry
into the body from the exterior.
3. Empty vacuity in the stomach, 胃 中 空 虚 wei zhiing kong xu: Vacuity of the
stomach qi resulting from inappropriate precipitation. When this term is used,
it is followed by the term “visiting φ,” indicating that damage to the center
burner qi allows an exterior evil to invade the region of the diaphragm.
4. Yan g φ, 阳 气 yang qi: Here, an exterior evil that is yang in nature.
FORMULA
Major Chest Bind Decoction ( da xian xiong tang)
o
Harshly attack water-rheum; discharge heat and break binds.
大黄六两 ( 去皮 )
芒消一升
甘遂一钱 匕
忖 右三昧 , 以 水六升 , 先煮大黄取二升 , 去淳 , 内芒消 , 煮一两
沸 , 内 甘 遂 末 , 温 服 一 升 。 仁) 得 快 利 , 止 后 服 。
Da huang liu liang ( qu pf) mang xiao yf sheng gan sui yf qian bi
(1) You san wei, yi shui liu sheng, xiiin zhu da huang qu er sheng, qu zi, na
mang xiao, zhU yf liii.ng jei, na gan sui mo, wen JU yf sheng. (2) De kuai li, zhi hOu
JU .
rh u ba rb ( 大 黄 da huang, Rhei Rh izo『n a ) 6 Ii适『 { remove ski n )
『n i ra bilite ( 芒 硝 mang xiiio ’ M i ra bilitu m ) 1 sh否『1
ka nsui ( 甘 遂 gan sui, Kansui Radix) 1 q ia n-spoonfu l
( 1 ) [For] t h e above th ree ingredients use six sheng of water. First boil rh u barb (dd
huang) to get two she鸣. Remove the d regs a nd add 『nira bilite ( mang xiao ) . Bring to
a boi l once or twice. Add ka ns川 ( gan sui) powder a nd ta ke one she吨 warm . (2) As
soon as diarrhea occu rs, stop ta king [the decoction) .
SYNOPSIS
The signs and treatment of the pattern in which the inappropriate use of pr令
cipitation in an exterior pattern causes chest bind and yellowing.
C OM MENTARY
In greater yang disease one often finds a pulse that is floating, and 描 this line
explains, a pulse that is floating indicates a wind evil. Furthermore, a pulse that
is rapid indicates heat. Zhang JI explains that a pulse that is stirred indicates
pain, which may refer to the generalized pain that commonly occurs in externally
contracted diseases. He also states, “rapidity means vacuity. ” This clause, however,
is omitted in the Yf Zong Jfn Jian because of questions regarding its authorship
and difficulty in understanding its meaning, since a pulse that is rapid generally
indicates the presence of heat. Nonetheless, a pulse that is rapid can be found in
vacuous patients or when a repletion evil is absent in the interior, 描 is suggested
1 . G REATER YANG [LINE 1 3 4]
217
by the authors o f Gao Deng Zhδng Yr Yan Jiu Can Kao Cong Shu; therefore, this
omiss10n appears unnecess缸'Y·
It is clear that heat evil is present in the exterior and the appe缸ance of hea­
dache and heat effusion reinforces this idea. Mild night sweating, however, is also
present and is more indicative of an internal pattern in which yin has been damaged.
Zh缸ig JI attempts to clarify this by adding “ . . . yet aversion to cold.” The presence
of aversion to cold indicates an exterior condition. The night sweating can be
understood to be the result of two factors: the constitution of the patient and the
strength of the evil. At night , the defensive yang should move into yin. When the
defensive yang enters yin, the exterior is less secure. If the defensive ya且g is weak
and/ or the exterior evil is veη strong, the decreased security of the exterior m町
result in sweating.
Precipitation should not normally be used when an exterior pattern exists and
in this case inappropriate treatment causes the evil to fall inward, giving rise to chest
bind in which heat evil binds with water evil in the chest and the center burner.
This congestion impairs the qi dynamic, which causes the pulse to become slow.
Here, the pulse is slow not because of internal cold but because of congestion. The
impai口nent of the qi dynamic also results in pain in the region of the diaphragm.
The diaphragm is invaded by visiting qi because it has become vacuous. This vacuity
is the result of damage from inappropriate precipitation. This damage is indicated
by the phrase, “empty vac u i ty in the stomach." D amage in the center burner
impairs the movement of qi. When qi movement is impaired, the chest, which is the
sea of ql, cannot receive and disperse ql normally and the breath becomes short.
Agitation and vexation with anguish in the heart 缸e the result of heat binding
with water evil and harassing the heart. Finally, hardness below the heart is an
important sign, commonly seen in cases of chest bind. It is a concrete indication
that heat evil has fallen inward and become bound with a water or phlegm evil in
the region of the chest , diaphragm, and center burner. Major Chest Bind Decoction
(da xian xiδng tang) is the treatment of choice for chest bind.
If the evil falls inward but does not cause chest bind, it may combine with damp
evil in the center burner. Because it is a heat evil, sweat would normally issue, as the
heat moved outward, but when it combines with damp evil, the strength of the heat
is reduced and sweat only issues from the head. The damp evil, normally discharged
through the urine, combines with the heat and urination becomes inhibited. The
damp-heat steams in the interior and produces generalized yellowing.
Major Chest Bind Decoction ( da xian xiong tang) is an extremely harsh and
fierce formula. 肚ubarb ( da huang) drains heat and flushes repletion, and mirabilite
( mang xiao) breaks binds. These two ingredients drain bound heat from the chest
and heart . Kansui (gan sui) is a harsh agent that drains water and expels rheum.
This formula harshly attacks bound water-rheum evil. Since it can easily damage
right qi, 础 soon as the patient experiences diarrhea ingestion of the formula should
be stopped.
218
1 . GREATER YANG [LINE 1 36]
LINE 1 3 5
伤 寒 六 七 日 , 结胸热实 , 脉沉而紧 , 心下痛 , 按之石硬者 ,
大 陷 胸汤主之 。
Shang han liu qz 时, jie xiiing re sh{, mai chen e1” fin, x'in xia tong,
an zh'i sh{ ying zhe, da xian xiiing tang zhu zhz.
When i n cold d a m age [that has lasted for] six or seven days, [there is]
chest b i n d heat repleti。n , * i n which the pu lse is su n ken a nd tight a nd
[there is] pa i n bel。w the hea rt, which is stone-hard when pressu re is
a ppl ied , M aj。r Chest B i n d Decoction ( da xian xiδ叼 tang) g。verns.
TEXT NOTE
*
Chest bind heat repletion, 胸 结 热 实 xiiing jie re shi: Compare with cold
repletion chest bind in line 141B, p. 223.
SYNOPSIS
The primary pulse and signs of major chest bind.
C OMMENTARY
This pattern is an example of chest bind that occurs without inappropriate
precipitation. The transmutation from cold damage to chest bind, over a period of
six or seven days, may be the result of the patient’s constitution or a strong exterior
evil. In previous discussions of chest bind it has been mentioned that a distinction is
made between heat and cold patterns. Here, Zhang JI explicitly tells the reader that
this pattern is chest bind heat repletion. The three signs a pulse that is sunken and
tight , pain below the heart, and stonelike hardness-are the basic characteristics
of chest bind. A pulse that is sunken indicates interior disease and congestion. A
pulse that is tight indicates repletion and pain. Pain below the heart is the result of
congestion in the local area. This congestion occurs because of the heat evil and the
water or phlegm that become bound between the heart and the diaphragm. The
area below the heart is stone-like when pressure is applied, reflecting the repletion
present in this pattern. Major Chest Bind Decoction ( da xian xiiing tang ) , which
drains heat, expels water, and breaks binds, is the appropriate formula for this
pattern.
LINE 1 36
伤 寒 十余 日 , 热结在里 , 复往来寒热者 , 与 大 柴胡汤 ; 但结
胸 , 无 大 热 者 , 此 为 水结在胸胁也 , 但头微汗出 者 , 大 陷胸
汤主之。
Shang han shi yu 时, re jie zai l毛 j泣 wang lai han re zhe, yu da chai
hu tang; dan jie xiiing, WU da re zhe, ci wei shui jie zai xiiing xie ye,
dan t6u wεi han chu zhe, da xian xiong tang zhu zhι
1 . G REATER YANG [LINE 1 3 7]
219
When c。Id d a m age [has lasted for] more t h a n ten days, [a nd] h eat
binds i n the i nterior, yet [there is] a lternating [aversion 叫 c。Id a nd
heat [e忏usion] , * give M 习。r B u pleu ru m Dec。ction ( da chai hu tang) ;
if [there is] 。nly chest bind a nd great heat [effusi。n] is a bsent, i n d icating
water bind i n the chest a n d ri b-side, a n d slight sweat issuing only from
the head , M 句。r Chest Bind Decoction ( da xian xiong tang) governs.
TEXT NOTE
*
Alternating [aversion 叫 cold and heat [effusion] , 往 来 寒 热 切iing ltii h伽 re:
Alternating appearance of aversion to cold and heat effusion. When one is
present, the other is absent. In this pattern, the two signs are clearly differ­
entiated, but do not exhibit a set periodicity. See line 96, p. 410, for further
discussion of this sign in lesser y缸g disease.
SYNOPSIS
Comparing and distinguishing between the patterns of lesser yang internal re­
pletion and m时or chest bind.
COMMENTARY
In cold damage that has persisted for more than ten days, it is possible that
the evil will shift into the interior and transform into heat. In this line we are
told that the heat binds in the interior, but alternating aversion to cold and heat
effusion is also present; this combination of signs indicates yang brightness and lesser
yang combination disease. It is possible that these signs would be accompanied by
retching, glomus below the heart, or fullness under the rib-side. Maj or Bupleurum
Decoction ( da chtii hu tang) resolves both yang brightness and lesser y缸g disease.
(For a full discussion of this formula, see line 103, p. 431 . )
In the second part of the line only chest bind i s present; n o other signs are
observed. Great heat is absent and one may 臼sume the absence of alternating
aversion to cold and heat effusion. Chest bind is a pattern of heat and water evil
bound together. In this case Zh画g JI emphasizes that the water bind is the most
important aspect . The binding together of water and heat impairs the movement
of fluids. The fluids cannot outthrust , so no sweat issues over most of the body
and sweat only issues slightly from the head. One should use Major Chest Bind
Decoction ( da xian xiong tang) to clear heat, expel water, and break binds.
LINE 1 37
太阳病 , 重发汗而复下 之 , 不 大便五 六 日 , 舌上燥而渴 , 日
喃所 小 有潮 热 , 从 心 下 至 少 腹硬满 而痛不 可近者 , 大 陷胸汤
主之 。
Tai yang bing, ch6ng fa han er j边 xia zh毛 bu da bian WU liu ri, she
shang zao 白’. ke, ri bu SUD xiao you chao re, c6ng x'in xia zhi shao
Ju ying man er tong bu ke jin zhe, da xian xiiing tang zhu zhr.
220
1 . G REATER YANG [LINE 137]
When i n greater ya ng d isease, sweati ng is prom。ted repeatedly, yet
preci pitati。n is [a ls。 used] a n d [there is] i n a bi l ity to defecate f。r five 。r
six d ays, a d ry tongue a nd t h i rst, m in。r tid a l heat effusi。n1 in the late
afternoo n , 2 a n d hard n ess, fu l l ness, a n d pai n , [extendi ng] from below
the hea rt to the lesser a bd。men a n d [which the person wi l l] not a llow
[a nyone even to get] near,3 M ajor Chest Bind Decoction ( da xian xion
taηg ) g。verns.
TEXT NOTES
l. Tidal heat effusion, 潮 热 ch<i.o re: A feeling of heat that occurs at set intervals
and may or may not be accompanied by palpable heat effusion. See line 220,
p. 336, for further explanation.
2 . Late afternoon, 日 脯 所 ri bu suo: The period of time approaching the evening,
which includes both the ninth and tenth earthly branches, approximately 3-7
P.M.
3 . Pain . . . [ which the p町son will] not allow [anyone even t o get] ne缸, 痛 不 可
近 tong bu ke jin : Severe pain that is exacerbated by pressure. The patient
refuses any attempts to palpate the 町ea.
SYNOPSIS
Distinguishing between the patterns of chest bind and yang brightness bowel
repletion.
COMMENTARY
Although the promotion of sweating is appropriate in greater y归g disease,
repeated promotion of sweating is generally not appropriate. It is also clearly
not appropriate to follow it with precipitation. Repeated promotion of sweating
damages the fluids and precipitation causes the evil to fall inward. Water and heat
bind in the interior and yang brightness internal repletion is present. Damage to
the fluids impairs normal fluid movement, as does the congestion present in chest
bind. The stomach becomes dry, producing thirst, inability to defecate, and a dry
tongue. Heat in the yang brightness results in mild tidal heat effusion, which means
that this pattern may be slightly different from a yang brightness bowel repletion
pattern. The presence of bound heat and water is demonstrated by hardness and
fullness in the entire abdominal region. Major Chest Bind Decoction ( da xian xiiing
tang) expels water evils, clears heat, and breaks binds.
As w凶 stated above, this pattern is similar to, but not the same as, a yang
brightness bowel repletion pattern. In the pattern above, chest bind is present in
the region of the chest and diaphragm, whereas in bowel repletion, the repletion
heat is in the stomach and intestines. Tidal heat effusion occurs in bowel repletion
and it is not generally mild, as it is here. The area of fullness and hardness de­
scribed above includes the entire region from just below the heart down to the lower
abdomen; in bowel repletion the pain and fullness is around the umbilicus and in
the abdomen. Furthermore, the pain described here is much more severe than that
which is described in bowel repletion patterns.
1 . G REATER YANG (LINE 1 33]
221
LINE 1 3 2
结胸证 , 其脉浮大者 , 不可下 , 下之则死 。
Jie xiong zh 凯.g, qi mai Ju da zhe, bu ke xia, xia zh'i ze si.
When in chest bi nd patterns, the pu lse is floati ng a nd large, 。ne ca n not
precipitate, [beca use] preci pitation wil l lead t。 deat h .
SYNOPSIS
In chest bind patterns, when the pulse is floating and large, the use of offensive
precipitation is contraindicated.
COMMENTARY
The pulse in chest bind patterns is generally sunken, replete, and forceful, but
here it is floating and large. The pulse may be large and forceful or large and
forceless. In either case one should not precipitate. A pulse that is floating indicates
the presence of an exterior evil even though an evil has also fallen inward causing
the chest bind. If the pulse is floating, large, and forceless, it indicates vacuity of
right φ and exuberance of evil ql. Fang You-Zhi writes:
Floating means [an evil] in the exterior. Large means vacuity. The contention
between floating and vacuity means that an exterior [evil] is present and has
not yet completely entered the interior. One knows that the interior [ evil] is
not yet completely replete. Precipitation will result in the vacuous interior
ql deserting and the exterior evil that has not yet been eliminated falling
inward.
If one precipitates, the vacuous right qi will be further damaged. When vacuous
right φ is made more vacuous, it may result in death.
The other possibility is that the pulse is large and forceful, indicating internal
repletion. If the pulse is floating, large, and forceful, one must first resolve the
exterior and then precipi tat e the interior. If precipi tati on is used first, it will cause
the exterior evil to fall inward and exacerbate the chest bind.
LINE 1 3 3
结胸证悉具 , 烦躁者亦死 。
Jie xiong zheng x'i j毡, fan zao zhe yi si.
When a l l the signs of chest bind* a re p陀sent, a nd [there is] vexation
and agitati。n , [the patient wil l] d ie.
TEXT NOTE
*
The signs of chest bind, 结 胸 证 jie xiong zheng: An area of pain below the
heart that is hard when pressed. In severe cases, hardness, fullness, and pain
in the area between the heart and the lesser abdomen, accompanied by no
stool, dry tongue with thirst , and tidal heat effusion in the evening.
l.
222
G REATER yANG [LINE 1 38]
SYNOPSIS
The identification of the prognosis in chest bind patterns.
C OMMENTARY
Previously, in line 134, p. 215, vexation and agitation is presented as a possible
sign in cases of chest bind and it does not necessarily indicate a fatal condition.
Here Zhang JI writes that 证 the major signs of chest bind are present and one also
sees vexation and agitation, the patient will die. This apparent contradiction can
be reconciled by considering mild and severe disease patterns. Here we are told
that vexation and agitation is a critical sign of a fatal condition. This pattern is
more serious than the one presented in line 134, p. 215. The bound evil is lodged
deep within the chest and the right φ has been severely damaged. One hesitates to
precipitate because right qi is already debilitated, but without treatment the bound
evil will restrict the movement of qi and cause further damage. Neither option is
acceptable and the situation will easily become critical.
4.10.1.3
Minor Chest Bind Decoction Patterns
LINE 1 3 8
小 结 胸 病 , 正 在 心 下 , 按 之 贝lj 痛 , 脉 浮 滑 者 , 小 陷 胸 汤 主
之。
X必o jie xiong bing, zheng zai xi"n xia, an zhi" ze tong, mai ju hua
zhe, xiiio xian xiong tang zhu zhi".
When i n m i nor chest bi nd disease, [the location is] d i rectly below the
h ea rt* a nd pa i nful when pressu re is a pplied , a n d the p ulse is floati ng and
s l i p pery, M i nor C hest B i nd Decocti。n ( xiiio xian xiong tang) g。verns.
TEXT N OTE
丰 Directly below the heart 正 在 心 下 zheng zai xzn xia : In minor chest bind, the
disease is localized to the area directly below the heart, whereas in major chest
bind, the location may be in the chest, below the heart, or extending from the
chest down into the lesser abdomen.
FORMULA
Minor Chest Bind Decoction (xiii.a xian xiδng tang)
o
Clear heat, flush phlegm, and open binds.
黄连一两 半夏半升 ( 洗 )
括楼实 大者一枚
右三昧 , 以 水 六 升 , 先煮梧楼 , 取三升 , 去 淳 , 内诸药 , 煮取二
升 , 去淳 , 分温三 服 。
H叫ng lian yz liii.ng ban xia ban sheng (xi) gua l6u shi da zhe yz mei
You san w剖, yi shui liu sheng, xian zhii. gua l6u, qii. san sheng, qu zi, na zhu
yao, zhii. qii. er sheng, qu zi, fen wεn san fai.
1 . GREATER YANG [LINE 1 4 1 Bj
223
coptis ( 黄 连 huang lian, Coptidis R h izom a ) 1 Ii温 ng
pi nellia ( 半 夏 bdn xia, Pinelliae Tu ber) h a lf she吨 (washed )
trichosa nthes fru it (括 楼 实 gua l6u sh{, Trichosanthis Fructus) 1 large fruit*
[For] the a bove three ingredients use six sheng of water. First boil t
(g回 l6u) to get three sh言『 . Remove the d regs and add a l l [the other] ingredients.
Boi l to get two sh否ng a nd remove the d regs. Separate into th ree doses a nd ta ke warm .
FORMULA NOTE
*
One large fruit : The authors of Gao Deng Zhong Yf Yan Jiu Can Kiio Cong
Shu write that this is approximately 20 grams, but because of variety in the
size of the fruit any exact gram measure can only be an approximation.
SYNOPSIS
The signs and treatment of minor chest bind.
COMMENTARY
Minor chest bind is similar to, but milder than, major chest bind. Like major
chest bind it is the result of an exterior evil falling inward, either spontaneously or
as the result of inappropriate treatment. In minor chest bind the affected area is
smaller than in m刮or chest bind, involving only the area directly below the heart.
Whereas in major chest bind the pain is severe with or without pressure, in minor
chest bind, pain only occurs when pressure is applied. The pulse in minor chest
bind is floating and slippery. Floating means a yang evil whose location is more
super且cial, when compared with a pulse that is sunken, as in major chest bind.
Slippery means that whereas in major chest bind, water evil is present, in minor
chest bind, heat and phlegm evil predominate.
Minor Chest Bind Decoction ( xiiio xian xiiing tang) clears heat, 曲曲es phlegm,
and opens binds. This formula opens with acridity and downbears with bitterness.
Bitter, cold coptis (huang li伽) drains heat bind from the region of the heart.
Acrid, warm pinellia ( bdn xia) flushes phlegm-rheum. Sweet, cold trichosanthes
fruit (gua l6u shf) flushes heat and phlegm and conducts turbid phlegm downwards.
It also assists coptis (huang lian) in clearing heat and pinellia ( bdn xia) in both
transforming phlegm and opening binds.
4.10.2
Cold Repletion C hest Bind Patt erns
LINE 1 4 1 B
. . . 寒实结胸 , 无热证者 , 与 三物 小 陷胸汤 , 白 散亦 可 服 。
. Han shi jie xiong, WU re zheng zhe, yil siin WU xiao xian xiong
tiing, bai san yi ke Ju.
. When i n cold repletion chest bi nd , heat signs [are] a bsent, give
Th ree Agents M i n。r Chest B i nd Decoction ( siin wu xiao xian xiong
tang ) . Wh ite Powder ( bai san) ca n a lso be ta ken . *
1 . G REATER YANG [ LINE 1 4 1 B]
224
TEXT N OTE
*
Give Three Agents Minor Chest Bind Decoction ( san wu xiifo xian xiii叼 tang).
White Powder ( bti.i san) can also be taken, 与 三 物 小 陷 胸 汤 , 臼 散 亦 可 服 yil
san wu xiao xian xiong tang, bti.i san yi ke ju: According to the Qian Jin Yi
Fang and the Jin Gui Yu Han Jing (金 匮 玉 函 经 ‘'The Canon of the Golden
Coffer and Jade Sheatl川 , this line should appear as “give Three Agents White
Powder (san wu bti.i san). This opinion is generally accepted.
FORMULA
Three Agents White Powder ( san wu btii san)
o
Warm and expel cold evil; flush phlegm and break binds.
桔梗三 分
巴 豆 一 分 ( 去皮心 , 熬黑 , 研如脂 )
贝 母三分
(一) 右 三 昧 , 为 散 , 内 巴 豆 , 更 于 臼 中 样 之 , 以 白 饮 和 服 , 强 人 半
钱 匕 , 赢 者 减 之 。 。 病 在 踊 上 必 吐 , 在 隔 下 必 不IJ 。 (三) 不 利 , 进 热 粥
一 杯 ; 利 过 不 止 , 进 冷 粥一杯 。
Jie geng san fen ba dou yr fen ( qu pi xin, ao hei, yan ru zhf) bei mil san fen
( 1 ) You san wei, wei san, na ba dou, geng yu jiu zhδng chil zhf, yi bti.i yin huo
qiang
ren ban qian bi, lei zhe jian zhz. (2) Bing zai ge skiing bi tu, zai ge xia bi
fu,
li. (3) Bu li, jin re zhou yi bei; li guo bu zhi, jin leng zhiiu yr bei.
platycodon (桔梗 jie geng, Platycodonis Radix) 3 fen
croton frost ( 巴 豆 霜 ba dou sht而ig, Crotonis Sem i n is P ulvis) 1 fen ( remove skin
a nd center, d 叩-f叩 [u ntil] black, gri n d [to m ake] like fat)
fritillaria ( 贝 母 bei mil, Fritillariae B u l bus) 3 阳
( 1 ) [For] the a bove th ree i ngredients, [ma ke] into powder. Croton ( ba dou ) [should]
be pou nded aga i n in a mo由r. Mix i nto a white [rice] decoction and take. Strong people
[may ta ke] a h a lf qia n-spoonfu l . For thin a nd wea k [people] , reduce [the dosage] . (2) [If]
the disease is a bove the d i a p h 吨肌 there wil l be vomiting. [If] it is below the diaph吨m
there wi ll be diarrhea . (3) [If there is] no diarrhea , d ri n k one cup of hot gruel . [If there
is) incessa nt diarrhea , d ri n k one cup of cold gruel .
SYNOPSIS
The signs and treatment of cold repletion chest bind.
C OM MENTARY
Cold repletion chest bind is the result of a cold evil falling into the chest and
binding with phlegm-rheum. The signs are similar to those of heat repletion chest
bind, except no signs of heat such as thirst, dry ton伊e, or vexation 町e present.
The cold evil bound in the chest causes stagnation of the chest yang, disinhibits the
qi dynamic, and impairs the dissemination of fluids; consequently, one may also see
signs such as fear of cold and liking warmth, cough, shortness of breath, or difficult
defecation. Because cold repletion chest bind is a repletion pattern, the pulse is
generally sunken, tight, and forceful.
l . G REATER YANG [LINE 1 29]
225
Three Agents White Powder ( san w u bcii s an ) warms and expels cold evil,
flushes phlegm, and breaks binds. The chief ingredient in the formula is acrid, hot ,
and toxic croton (ba dou) , which attacks and expels cold and water, drains cold
accumulations downward, and breaks binds. Fritillaria ( bei mu) resolves depression,
opens binds, and eliminates phlegm. Platycodon (jie geng) opens the lung φ,
disinhibits the lung, dissipates binds, and eliminates phlegm. It also conducts the
other ingredients upward so the effect is strongest in the area of the bind. Because
this is a harsh formula it is taken with a white rice soup in order to protect the
stomach ql . Depending on the location of the chest bind, different reactions to the
formula may be observed. If the location is higher, above the diaphragm, the evil
will be expelled through vomiting. If the evil is located lower, below the diaphragm,
it will be drained through diarrhea. This formula is hot, but if it is not hot enough
to break the cold bind, hot gruel may be taken to strengthen the formula. On the
other hand, if ingestion of the fo口nula results in incessant diarrhea, cold gruel may
be taken to reduce stomach and intestinal heat engendered by the formula.
4 . 1 1 STOREHOUSE BIND PATTERNS
Storehouse bind transmuted patterns belong to y函, cold, and vacuity. They are
characterized by hardness, fullness, and pain below the heart, diarrhea, and other
signs of vacuity cold. These patterns 町e difficult to treat and the prognosis for
patients is poor.
LINE 1 29
(寸 何 谓 藏 结 ? 仁) 答 曰 : 如 结 胸 状 , 饮 食 如 故 , 时 时 下 利 ,
寸脉浮 , 关脉小 细沉紧 , 名 曰 藏结 。
(三) 舌 上 白 胎 滑 者 , 难
治。
( 1 ) He wei zang jie? (2) Da yue: ru jie xiδηg zh 叫ng, yin shi ru git,
shi shi xia li, cun mai JU, guan mai xiao xi chen fin, m仇g yue zang
jie. (3) She shang bai tai hua zhe, nan zhi.
(1) What is storehouse bi n d ? (2) Answer: [When there a re] signs l i ke
chest bi nd , eati ng a nd d ri n ki ng are norm a l , 1 [a nd there is] freq uent
d iarrhea , an i nch pu lse that is floati n g , and a ba r pulse that is sma l l ,
fi ne, su n ken , a nd tight, it is ca l led storeh。use bind . (3) When the
t。ngue fu r is white and gloss弘2 th is [pattern] is d ifficu lt t。 treat.
TEXT NOTES
1 . Eating and drinking are normal, 饮 食 如 故 yin shi ru gu: The patient’s intake
of food and drink is normal.
2. The tongue fur is white and glossy, 舌 上 自 胎 滑 she shdng btii tai hua: In this
phrase, the character 胎 t函, which means fetus or birth, has been substituted
for the standard character used for the tongue fur, 苔 tai .
226
1 . GREATER YANG [LINE 1 30]
SYNOPSIS
The pulse, signs, and prognosis of storehouse bind.
COMMENTARY
Storehouse bind and chest bind share some common signs, so Zhang JI uses
one to explain the other. In chest bind the pain and hardness below the heart may
extend down into the abdomen. In storehouse bind the pain and fullness is under
the rib-side and/ or the abdomen, but the basic similarity between the two patterns
ends there. Chest bind occurs when heat evil falls inward and binds with water
and/ or phlegm in the center and upper burners. In storehouse bind the viscera are
vacuous and yang is debilitated. A yin cold e vil exploi t s the vacuity and binds in
the viscera.
A patient with storehouse bind is able to eat and drink normally, whereas
with chest bind the feelings of congestion in the center and upper burners may
lead to decreased food intake. Yin cold bind in the viscera and yang vacuity is
reflected in frequent diarrhea, a sign of storehouse bind; in chest bind, however,
if the stool is abnormal it will probably be bound or difficult. Cold in the center
burner and debilitation of the yang qi is also suggested by the bar pulse, which
is small, 且ne, sunken, and tight . The inch pulse is floating, indicating that the
evil entered the body from the exterior, another similarity with chest bind. This
similarity also illustrates the importance of considering the patient’s constitution.
When an exterior evil falls inward in a patient who is strong, it may cause chest
bind, but if an evil falls inward in a patient who has y缸g vacuity, it may cause
storehouse bind. Storehouse bind is much more difficult to treat. Bound cold and
congealed yin humor are reflected in the white and glossy tongue fur.
Storehouse bind is difficult to treat because one should attack the bound evil in
the interior, but the patient is weak and yang is vacuous. One cannot attack for fe町
of causing further debilitation, and one cannot supplement for fear of strengthening
the bound evil.
LINE 1 3 0
藏结无阳证 , 不往来寒热 , 其人反静 , 舌上胎滑者 , 不 可 攻
也。
Zang jie WU yang zheng, bu wang lai han re, qi ren Jan jing, she
shang tiii hua zhe, bu ke gδng ye.
When i n storehouse bin d , yang signs1 [a陀] a bsent, [a nd there is n。]
a lternati ng [aversion t。] cold a nd heat [e忏usi。n] , but the person is
tra nq u i l a nd the t。ngue fu r is glossy,, 。ne ca n not attack.2
TEXT N OTES
1. yang signs, 阳 证 yang zheng : Signs of heat and/or exterior disease.
2 . Attack, 攻 gong : Here, precipitation.
1 . G REATER YANG
227
SYNOPSIS
A further description of the signs and treatment contraindications of the store­
house bind pattern.
COMMENTARY
Storehouse bind occurs when yin cold binds in the viscera of patients whose yang
qi is debilitated. Yang signs一including heat effusion alternating with aversion to
cold, and vexation and agitation-are absent. The absence of y缸g signs means the
absence of a greater y缸g pattern. Alternating aversion to cold and heat effusion
are absent, suggesting that this pattern does not belong to the lesser yang. The
patient is tranquil, without vexation and agitation, indicating that this is not a
yang brightness pattern. A white, glossy tongue fur reflects the presence of bound
yin cold in the interior. As in the previous line, in a patient with y缸ig debilitation
and bound yin cold, one cannot attack.
Although Zhang JI does not suggest any formulae for treating storehouse bind,
later commentators have suggested Center-Rectifying Decoction ( li zhong tang) plus
unripe bitter orange ( zhi sM) . Center-Rectifying Decoction ( li zhOng tang) w缸ms
the center and supplements ya吨, while unripe bitter orange (zhi sM) breaks qi and
dissipates binds.
LINE 1 6 7
病 胁 下 素 有 痞 , 连 在 脐 {旁 , 痛 引 少 腹 , 人 阴 筋 者 , 此 名 藏
结, 死。
Bing xie xia SU you pi, lian zai qi pang, tong yin shao Ju, rU yin j?:n
zhe, ci m仇g zang jie, si.
An i l lness i n which usually glom us u n der the rib-side extends to the side
of the u m bilicus, [but now] the pa i n stretches i nto the lesser a bdomen
and enters the 泸n si new* is ca l led st。陀house bind a nd [bodes] death .
TEXT NOTE
*
Yin sinew, 阴 筋 yfn jfn : The penis.
SYNOPSIS
The critical signs of storehouse bind.
COMMENTARY
This line presents a variation of storehouse bind. Here, without mistreatment
the patient h描 glomus under the rib-side, extending to the side of the umbilicus.
This is an abiding ailment that should be viewed differently than a new external
contraction. In abiding ailments, the original φ becomes vacuous and right φ
cannot restrain invading evil. The invading evil exacerbates the original stagnation
and a bind forms. The increased stagnation and bind produces pain that extends
into the lesser abdomen, and that when severe, enters the yin sinew ( penis ) . At this
point, yin cold is extreme and yang qi is expiring; therefore, this pattern cannot be
treated.
1 . G REATER YANG
228
4 . 1 2 GLOMUS PATTERNS
Glomus is a localized subjective feeling of fullness and blockage, and in the Shang
Han Lu n it generally develops as a result of inappropriate precipitation causing heat
evil to fall inward and bind with a formless evil in the interior, impairing the qi
dynamic. A glomus pattern may also occur when vacuous stomach qi is exploited
by a heat evil. The pathomechanism producing glomus can be seen as a direct result
of an evil in the interior or the presence of an evil impairing the qi dynamic. Both
processes probably play a role in t he production of this sign pattern. These patterns
involve a formless evil; therefore, generally, the area of congestion below the heart
is soft and pain is absent . Generally, one of the five Heart-Draining Decoctions (xie
xzn tang) is used to treat these patterns. Any exterior pattern should be resolved
before a glomus pattern is treated.
Glomus patterns are divided into category by the type of glomus and the ap­
propriate formula. The main categories are heat glomus, cold-heat complex glomus,
water glomus, and phlegm glomus.
a ) Rhubarb and Coptis Heart-Draining Decoction (da huang hu<ing lian xie
xzn tang) treats heat glomus in which heat evil congests the φ dynamic.
This pat tern is characterized by a glomus below the heart that is soft when
pressed. The pulse may be floating and the tongue fur may be yellow.
Heart vexation is also commonly present. This formula clears heat and
drains glomus.
b ) In Aconite Heart-Draining Decoction (Ju zi xie xzn tang) patterns, a heat
glomus is present and the exterior yang is insufficient. In addition to glo­
mus below the heart , there is aversion to cold and sweating. This formula
supports y缸g and drains glomus.
c) The gl om us treated with Pinellia Heart- Draining Decoction (ban x的
xie x£n tang) is 。此en the product of inappropriate pr1四ipitation used in
lesser y屋ng disease, which not only causes a glomus, but also causes coun­
terflow ascent of the stomach qi. It is a cold-heat complex glomus pattern
in which the glomus below the heart is soft, not painful, and accompanied
by retching counterflow and diarrhea. ’This 岛rmula harmonizes the stom­
ach and downbears counterflow, and opens binds and disperses glomus.
d) Stomach vacuity food stagnation and water-rhe
pattern characterized by a hard glomus below the heart, dry belching with
food m alodor , water qi under the rib-side, and int estin al rumbling and
diarrhea. Fresh Ginger Heart-Draining Decoction (sheng j而ig xie xzn tang)
is used to harmonize the stomach, dissipate rheum, and disperse glomus.
e ) When inappropriate precipitation is used repeatedly and the stomach φ bφ
comes severely vacuous, the appropriate formula is Licorice Heart-Draining
Decoction (gan cao xie xm tang) , which supplements the center, harmo­
nizes the stomach, and disperses glomus. In this pattern visiting qi ascends
counterflow and gives rise to a hard glomus below the heart that is accorn­
panied by local fullness. Other signs that may be observed include diarrhea
and intestinal rumbling, dry retching, and heart vexation.
1 . GREATER YANG [LINE 1 5 1]
229
Although the five patterns above are the most common glomus patterns, other
glomus patterns exist that are not treated with these five formulae. These patterns
are discussed below:
a) Water amassment in the lower burner can give rise to a glomus p at t ern in
which along with a glomu日 below the heart , other signs such as thirst, vex­
ation and agitation, and inhibited urination are also present. This pattern
is treated with Poria (Hoelen) Five Powder ( u
disinhibit water, and disperse glomus.
b) Inula and Hematite Decoction (xuan Ju dai zhe t伽g ) , which harmonizes
the stomach, downbears counterflow, and flushes rheum, is used for glomus
that occurs after the promotion of sweating, the use of precipitation, or
the use of vomiting. In this pattern stomach qi is vacuous and turbid qi
asce n ds counterflow. The main signs are hard glomus below the heart and
belching.
c) In the Halloysite and Limonite Decoction ( chi shi zhf yu yu liang tang)
glomus pattern, a hard glomus below the heart is accompanied by incessant
diarrhea. This pattern is glomus and effi.ux desertion; therefore, the main
action of this formula is to secure and astringe the lower burner.
LINE 1 5 1
脉浮而紧 , 而 复 下 之 , 紧 反 人 里 , 则作痞 , 按 之 自 濡 , 但气
痞耳。
Mdi JU er fin, er j边 xia zh毛 fin fiin r吐 li, ze zuo pi, an zhif zi rU, dan
qi pi
e r.
[When] the pulse is floati ng a n d tight, yet preci pitation is used , the
tightness i n stead enters the i nteri。r1 a nd ma kes a gl。m us, which when
pressed is s。仕. It is on ly a q i gl。m us.2
TEXT NOTES
1 . The tightness instead enters the interior, 紧 反 入 里 jin fan ru li: Here, “tight­
ness,” does not denote a pulse quality, but is used metonymically to refer to
cold, the evil indicated by a tight pulse; hence the phrase is taken to mean
that the cold evil falls inward following the inappropriate use of precipitation.
2. Qi glomus, 气 痞 qi pi: A qi glomus is soft and full, but not painful. This type
of glomus results from congestion of the qi dynamic.
SYNOPSIS
The causes and distinguishing signs of glomus.
COMMENTARY
A pulse that is floating and tight usually indicates greater y缸g cold damage;
therefore, it is appropriate to promote sweating. Zhang JI writes that here, precipi­
tation has instead been used; he uses the word “yet” 复 Ju, to mean that this is not
the correct treatment . That is, the physician observes a pulse indicative of exterior
1 . GREATER YANG [LINE 1 54]
230
disease, but uses a treatment that is appropriate only when an exterior pattern is
absent.
The use of precipitation damages the ql of the spleen and stomach. A formless
evil exploits this weakness and falls inward, binding below the heart. The term
“formless evil" is used because in these cases of glomus no water or phlegm evil binds
with the exterior evil, 出 in chest bind. Pain and hardness are absent, confirming
that this is not chest bind. Instead, a soft glomu日 is present , the manifestation of
a formless evil binding in the interior when precipitation has damaged the center
burner ql and impaired the ql dynamic. Normal upbearing and downbearing cannot
occur and the ql becomes congested in the center burner.
G lomus may occur 坦 the absence of mistreatment in people who have vacuity
of the spleen and stomach. In these people, glomus may occur spontaneously or
following the contraction of an external evil.
4.12.1
4.12.1.1
Heat G lomus Patt erns
Rhubarb and Coptis Heart-Draining Decoction Patterns
LINE 1 54
心下痞 , 按 之濡 , 其脉 关 上 浮者 , 大 黄 黄 连泻心汤 主 之 。
Xzn xia p毛 an zhf ru, q{ mai guan shang Ju zhe, da huang huang lian
xie xfn tang zhu zhι
When there is a gl。m us bel。w the heart that is soft when pressu re
is a ppl ied , a nd the pu lse is floating 。n the ba r , * Rh u barb a nd c。ptis
H ea rt- D ra i n i ng Decoction ( da huang hua叼 lian xie xfn tang ) govern
TEXT NOTE
*
The pulse is floating on the bar, 脉 关 上 浮 mdi guan shdng Ju : The pulse is
floating only in the bar position. Qian Hua吨 comments, “ [ In the expression]
“the pulse is floating on the b缸,” “floating” means a y缸ig evil, and floating
governs the upper [burner] . The bar [position] means the center burner. The
inch [position] means the upper burner. Because the evil is in the center
burner, [the pulse] is floati吨 on the bar. ” This term is thought to have been
created by Zhang JI.
FORMULA
肚ubarb and Coptis Heart-Draining Decoction ( da huang huang lidn 刷 刷 tang)
o
Drain heat and disperse glomus.
大黄二两
黄连一两
上 二 味 以麻沸汤 二 升渍之须哭 ,
Da huang
er liang huang lilin
yz liang
绞去津 , 分温再服 。
1 . G REATER y ANG [LINE 1 54]
231
Shdng er wei yi ma fei tang er sheng zi zhf m 肘, jiao qu zi, fen wen za i JU.
rh u barb ( 大 黄 da huting, Rhei Rh izoma) 2 Ii昌ng
coptis ( 黄 连 huting litin, Coptid is R hizoma ) 1 lil!ng
[For] the a bove two i ngredients use two sheng of boiled water a n d steep for a
moment. [Pour through a cloth and] wring [out the j u ice] * a nd remove the d regs.
Divide [into two parts] , and ta ke warm twice a day.
FORMULA NOTE
*
[Pour through a cloth and] wring [out the juice] , 绞 ji a o : After the ingredients
are steeped, the decoction is poured through a cloth and the dregs 缸e squeezed
in the cloth to extract the juice.
SYNOPSIS
The signs and treatment of heat glomus.
COMMENTARY
According to Zhang JI’s description, a glomus below the heart that is soft when
pressed is a “qi glomus.” This line specifically mentions that the bar pulse is floating.
The bar pulse reflects the state of the center burner, and a pulse that is floating
indicates exterior disease or heat. In view of the formula that is suggested, Rhubarb
and Coptis Heart-Draining Decoction ( da huting huang lidn xie xfn tang ) , one can
infer that heat is present in the center burner. The process of glomus formation is
that a formless heat evil binds below the heart, congesting the qi dynamic of the
center burner.
Rhubarb and Coptis Heart-Draining Decoction ( da huang huang lian xie xfn
tang) clears heat and disperses glomus. Bitter, cold rhubarb ( da huang) drains
heat, harmonizes the stomach, and opens binds. Coptis (hua叼 lian) , also bitter
and cold, clears fire from the heart and stomach. The preparation method is unique.
The ingredients are only steeped, not boiled, and then they 缸e pressed to remove
the juice. This method is said to extract the light, buoyant qi without getting the
heavy, turbid flavor. In this way the formula is made more moderate. Rhubarb
and Coptis Heart-Draining Decoction ( da huang huang li<in z始 xfn tang) , when
prep町ed in this way, clears formless heat evil from the upper burner, but does not
have the repletion-draining strength the ingredients would have if they were boiled
normally.
According to both Lin Yi and the Qian Jfn Yi Fang, this formula should also
contain scutellaria (huang qin) , which would strengthen the formula’s ability to
clear heat and disperse glomus. This assertion is based on the fact that the original
Heart-Draining Decoction ( xie xfn tang) contains rhubarb ( da ht
liar:』) , and scutellaria (ht』ang qin) . This point of view may be considered, but in
our opinion, although the original Heart-Draining Decoction (xie xfn tang) contains
scutellaria (huang qin) , Zhang JI writes 吐hubarb and Coptis Heart-Draining De­
coction” rather than “Heart-Draining Decoction" to reflect a variation in the latter
formula that does not contain scutellaria (huang q n ) . Therefore, it m町 not, i丑
fact, contain scutellaria (huang qin ) .
232
1 . GREATER y ANG
[ LINE 164]
LINE 1 64
卜) 伤 寒 大 下 后 , 复 发 汗 , 心 下 痞 , 恶 寒 者 , 表 未 解 也 。
可攻痞 , 当 先解表 , 表解乃 可攻痞 。
ω不
日 解 表 宜桂枝 汤 , 攻痞
宜大黄黄连泻心汤 。
( 1 ) Shang han da xia him, fu fa han, x?:n xia pi, wu han zhe, biiio
wei jie ye. (2) Bu ke gong p i, dang xian jie biiio, b必o jie niii ke
gong p i. ( 3) Jie biiio yi gui zhi tang, gong pi yi da huang h侃ng lian
xie x?:n tang.
( 1 ) When i n cold d a mage, a仕er great precipitati。n has been used ,
sweat i n g is then promoted , a nd [as a resu lt there is) a glom us below
the heart a nd aversion to cold this mea ns that the exteri。r has not
yet been res。lved . (2) O n e ca n n。t attack the gl。m L』
resolve the exterior a n d [a玩er) the exterior is res。lved , then one ca n
attack the glom L且 (3) Ci n n a mon Twig Dec。ction (gui zhi tang ) is
a ppropriate f。r resolvi ng the exteri。r a nd R h u barb a n d Coptis Hea 此-
D ra i n i n g Decoction ( da huang huang lian xie xzn ta·叼) is a ppropriate
for attacki ng the gl。m us.
SYNOPSIS
The signs and treatment of heat glomus occurring with an exterior pattern.
C OM MENTARY
In greater y缸g cold damage, the exterior should first be resolved before treating
any interior pattern that may be present. To first precipitate and then promote
sweating constitutes an inappropriate treatment, which may cause the exterior evil
to fall inward and damage the ql of the center burner. When the exterior evil
enters the interior and transforms to heat it binds below the heart, congesting the
ql dynamic and forming a ql glomus. The presence of aversion to cold indicates
that the exterior pattern is still unresolved, as Zhang Ji explicitly states.
Glomus is an interior pattern which, as Zhang Ji stresses, cannot be attacked
when an exterior pattern remains unresolved. One must first resolve the exterior
pattern and then treat the interior. Zhang JI suggests Cinnamon Twig Decoction
(gui zhf t ang) to resolve the exterior on the grounds that sweating has already been
promoted once and inappropriate precipitation has damaged the ql. Cinnamon
Twig Decoction (gui zhf ta叼) is a mild formula for resolving exterior patterns and
harmonizing the construction and defense. Rhubarb and Coptis Heart-Draining
Decoction ( da hua叼 hua叼 lian xie xzn tang) is the formula of choice for glomus
that is the result of an exterior evil falling inward and transforming to heat.
l . GREATER YANG [LINE 1 55]
4. 1 2 . 1 . 2
233
Aconite Heart-Draining Decoction Patterns
LINE 1 5 5
心下痞 , 而 复 恶 寒 汗 出 者 , 附子泻心汤 主 之 。
Xm
xia pi, er Ju WU han han chu zhe, Ju zi xie xzn tang zhu zhz.
When [there is] a gl。m us below the heart, yet a ls。 aversi。n t。 cold
a nd sweati ng, Acon ite Hea rt- D ra i n i ng Decoction (Ju zi xie xzn tang)
governs.
FORMULA
Aconite Heart-Draining Decoction (Ju zi xie z加 tang)
o
Drain heat and disperse glomus; support y但g and secure the exterior.
大黄二两
取汁 )
黄连一两
黄苓一两
附子一枚 ( 炮 , 去皮 , 破 , 别 煮
右 四 昧 , 切 三 昧 , 以 麻 沸 汤 二 升 渍之 , 须 哭 , 绞 去 津 , 内 附子汁 ,
分温再服 。
Da huang er Liang hua叼 Lian yi Liang huang qin yi liii.ng Ju zi yf mei (p ao,
qu pi, po, bie zhii. qii. zhf)
yOU si wei, qie san wei, yi ma fei tang er sheng zi zh'i, XU yu, jiii.o qu zi, na j边
zi zh'i, fen w臼 zai fU.
rh u barb ( 大 黄 da huang, Rhei R h izoma ) 2 li�ng
coptis (黄 连 huang Lian, Coptidis Rhizoma) 1 li�ng
scutellaria ( 黄 苓 huang q邸, Scutellariae Radix) 1 li�ng
acon ite ( 附 子 JU z瓦 Acon iti Tuber Latera le) 1 piece ( blast-f印, 陀move ski n , break,
boil separately to get the j uice)
[For] the a bove fo u r ing时ients, cut the !而叫 three ingred ients a nd u se two sheng
of boiled water to steep for a moment. [Pour th rough a cloth] a nd wring out [the juice] .
Remove the d regs a n d add aconite (β zi) j uice. Divide [into two parts] , a n d take warm
twice a day.
SYNOPSIS
The signs and treatment of heat glomus occurring with an exterior yang vacuity
pattern.
COMMENTARY
In line 154, p. 230, Rhubarb and Coptis Heart-Draining Decoction ( da huang
huang Lian xie xzn tang) is used to attack a φ glomus. The previous line instructs
physicians to resolve exterior conditions prior to attacking a glomus, which is an
interior pattern. In this line the signs of glomus, aversion to cold, and sweating are
present simultaneously. If aversion to cold alone is present 部 in the previous line, it
indicates an unresolved exterior condition that must be addressed first. One would
1 . G REATER YANG [LINE 1 49]
234
expect to see a pulse that is floating, a headache, or other exterior signs. Aversion
to cold with sweating, however, in the absence of other exterior signs, means y缸g
vacuity. Although differing interpretations of the pathomechanism exist, the basic
explanation of this pattern is vacuity of the exterior y三吨, 础 Cheng Wu-Ji writes.
Y 6u Yi agrees that “ [there is] insufficient y归g φ.” In the Yi" Zδng Jzn Jian the
explanation is narrower, referring directly to the exterior yang: 咱his is] not an
unresolved exterior [pattern] . [It is] vacuity of the exterior yang.” Qian Huang
further narrows this explanation: “the defensive yang is not sound . . . and sweat
issues . . . . Vacuous y归g cannot control the external φ . . . and [there is] aversion to
cold . . . .”
Therefore, the treatment chosen is to drain heat and disperse the glomus while
simultaneously supporting yang and securing the exterior. The formula used is
Aconite Heart-Draining Decoction (Ju zi xie x'in tang ) . Rhubarb ( da huang) , coptis
(hi ng li a叫 ’ and scutella’I
hot aconite (Ju zi) warms the channels, supports ya吨, and secures the exterior.
The preparation of this formula is slightly different from that of the preceding one.
Rhubarb ( da huang) , scutellaria (huang q例 , and coptis ( huang lian) are prepared
in the same w可. Aconite (j边 zi) , however, is boiled separately and its juice is then
added to the juice from the other three ingredients. In this way a mild preparation
of the 直rst three ingredients drains bound heat from below the heart, and the full
strength of aconite (!:也 zi) supports yang.
According to Qian Jtn Yi Fang, this formula is Rhubarb and Coptis Heart­
Draining Decoction ( da hi
classi直cation supports the inclusion of scutellaria (huang qin ) in Rhubarb and Cop『
tis Heart-Draining Decoction ( da h叫ng ht刷g lian xie x'in tang) . See the commen­
tary for line 154, p. 230, for further discussion of this issue.
4.12.2
Cold-Heat Complex Glomus Patterns
4. 1 2 . 2 . 1
Pinellia Heart-Draining Decoction Patterns
LINE 149
(寸 伤 寒 五 六 日 , 呕 而 发 热 者 , 柴 胡 汤 证 具 , 而 以 他 药 下 之 ,
柴 胡 证 仍 在 者 , 复 与 柴 胡 汤 。 仁) 此 虽 已 下 之 , 不 为 逆 , 必 蒸
蒸而振 ,
却发热汗出而解。
胸也 , 大 陷胸汤主之 。
同 若心下满而硬痛者 , 此 为 结
(四) 但 满 而 不 痛 者 , 此 为 痞 , 柴 胡 不 中
与 之 , 宜半夏泻心汤 。
( 1 ) Shang han WU liu ri, OU er fa re zh已 chai hu tang zheng ju, er yi
ta yao xia zhr, chai hu zheng reng zai zhe, ju yu chai hu tang. (2) Ci
suif yi xia zhif, bu wei ni, bi zheng zheng er zhen, que fii re han chu
er jie. (3) Ruo xrn xia man er ying tOng zhe, ci wei jie xiδng ye, da
1 . G REATER YANG [LINE 1 49]
235
xian xiong tang zhu zhz. ( 4) Dan miin er bu tong zh已 ci wei p主 chai
hu bu zhong yu zhi, yi ban xia xie xin tang.
( 1 ) When cold d a m age [has lasted for] five or six days, [a nd is marked by]
陀tch i ng a n d heat effusion , a nd [ M i n or] B u pleu ru m Decocti。n ( [ xiiio]
chai hu tang) signs are present, [i可 other med ici nals [are used] t。
preci pitate, [a nd the] [ M i nor] B u pleu ru m [Dec。ction] ( [xiiio] chai hu
[tang] ) signs a re sti II p陀sent, 。ne ca n sti l l give [M i nor] B u pleu ru m De­
coction ( [xiiio] chai hu tang ) . (2) Although preci pitati。n has a l ready
[been used] , it is not an adverse [treatment] [a nd after the form u la is
given] there wi l l be stea m i n g a nd q u iveri ng, * then heat effusi。n a nd
sweating [by wh ich the d isease] resolves. (3) If [there is] fu l l ness, h a rd­
ness, a nd pa i n below the heart , this indicates chest bind ; [therefore,]
Maj。r C hest Bind Decoction ( da xian xiong tang) governs. (4) [If
there is] fu llness only, without pai n , t h is i n dicates a glom町 [there­
fo陀,] 。ne shou ld not give [ M i n or] B u pleu rum [Decocti。n] [a nd] Pi nellia
Heart- D ra i n i ng Decoction ( ban xia xie xin tang) is a ppropriate.
TEXT NOTE
*
Steaming and quivering, 蒸 蒸 而 振 zheng zheng 命 zh切: “Steaming” describes
the force of the heat moving from the interior out to the exterior. “Quivering”
means the shivering and trembling movement that is a physical expression of
shiver sweating.
FORMULA
Pinellia Heart-Draining Decoction ( ban xia xie xfn tang )
o
Harmonize the center, downbear counterflow, and disperse glomus.
半夏半升 ( 洗 )
大枣十二枚 ( 壁 )
黄苓
干姜
人参
甘草 ( 炙 ) 各三两
黄连一两
忖 右七昧 , 以水一斗 , 煮取六升 , 去淳 , 再煎取三 升 , 温服一升 ,
日 三 服 。 (二) 须 大 陷 胸 汤 者 , 方 用 前 第 二 法 。
Ban xia ban sheng (xi) huang qin gan jiang ren shen g伽 ciio (zhi) ge san
liii.ng huang lian yf liiing da ziio shi er mei ( bO)
{1) You qf wei, yi shui yf diiu, zhii qu 刷 sheng, qu z式 zai ji伽 qU s伽 sheng,
wen Ju yf sheng, ri san Ju. (2) Xu da xian xiong tang zhe, fang yong qian di er fii.
pinellia ( 半 夏 ban xia, Pi nelliae Tuber) half sheng (washed )
scutellaria ( 黄 苓 huang qin, Scutella riae Radix) 3 li�ng
d ried ginger ( 干 姜 gan jiang, Zingiberis Rhizoma Exsiccatum) 3 liling
gi nseng ( 人 参 ren sh旬, G inseng Radix) 3 liling
mix-fried licorice ( 甘 草 gan cao, Glycyrrhizae Radix) 3 Ii温ng
coptis (黄 连 huang li<i.n, Coptid is R hizoma) 1 liling
236
1 . G REATER YANG [LINE 149]
j uj u be ( 大 枣 da ziio, Zizi phi Fructus ) 12 pieces ( broken )
(1) [ For] the a bove seven i ngred ients use one d�u of water a nd boil to get six she鸣-
Remove the d regs a nd decoct aga i n to get three sheng. Ta ke one sheng warm th ree
times a day. (2) If M ajor C hest Bind Decoction ( da xian xiii叼 tang) is needed , the
second previously mentioned method for the f。rmula should be used .*
FORMULA NOTE
*
The final sentence is not included in the Zhu Jie Shang Han Lun (注解 伤 寒 论
“Annotated Shang Han Lun"
S YNOPSIS
Possible treatments of a lesser yang disease, after inappropriate use of precip­
itation, with Minor Buple盯um Decoction (xiao chai hU tang), Major Chest Bind
Decoction ( da xian Mδng tang ) , and Pinellia Heart-Draining Decoction ( ban xia xie
xi"n tang ) .
COMMENTARY
When cold damage signs have persisted for five or six days and then one sees
retching and heat effusion, it suggests that the evil has shifted into the lesser yang.
In that case, Minor Bupleurum Decoction (xiiio chdi hU tang) is the appropriate
treatment. ( See line 96, p. 410.) In the 且rst pa此 of this line, Minor Bupleurum
Decoction (xiiio chdi hU tang) should be used, but precipitation is used instead.
After the use of precipitation three possible transmutations are described. In
the first the lesser y缸ig disease is still present. The patient’s right ql is still strong
and although precipitation has been used erroneously, the damage w部 not great
and the evil remains in the lesser y缸g. Because no transmutation has occurred, one
can still use Minor Bupleurum Decoction (xiiio chdi hU tang) and this mistreatment
is not considered an adverse treatment. Once Minor Bupleurum Decoction (xiiio
chdi hU tang) is given, the evil will be expelled from the lesser yang. This expulsion
is described by the phrase “steaming and quivering,” in which the movement of the
heat evil outward from the lesser yang causes heat effusion and shiver sweating.
Once the sweat issues, the disease will resolve.
In the second of the three possible transmutations, the patient is not strong
and the use of precipitation causes the evil in the lesser yang to fall inward, binding
with water-rheum and causing chest bind. Pain, fullness, and hardness below the
heart indicates chest bind, and Major Chest Bind Decoction ( da xian xiδng tang)
is the formula of choice.
In the third transmutation, the use of precipitation results in damage to the
spleen and stomach. The evil in the lesser yang exploits this weakness and attacks
the center. When this occurs the evil binds in the interior and congests the qi
dynamic in the center, causing abnormal upbearing and downbearing. Fullness
below the heart without pain indicates a glomus. Minor Bupleurum Decoction
(xiiio chdi hU tang) should not be used because the main problem is not an evil
in the lesser M吨, but congestion of the ql dynamic in the center burner due to
the presence of a bound, formless evil. Pinellia Heart-Draining Decoction ( ban xia
刷 刷 tang) is used to harmonize the center, downbear counterflow, and disperse
glomus. On the basis of the ingredients in the formula, this pattern is considered to
be one of mixed heat and cold. A heat evil binds below the heart, causing a glomus.
1 . G REATER YANG [LINE 1 5 7]
237
Cold in the stomach and intestines is the result of damage from precipitation. This
formula may be used for a pattern of mixed heat and cold, even without adverse
treatment. It is suitable for the treatment of glomus below the heart accompanied
by cold-type diarrhea, particularly when the tongue fur is thick and yellow.
Pinellia Heart-Draining Decoction ( ban xia xie xfn tang) is a modification of
Minor Bupleurum Decoction (xiao chai hU tang). It is Minor Bupleurum Decoction
( xiao chai hu tang) without bupleurum ( chcii hU) and fresh ginger (she:叼 jiang ) ,
with the addition of coptis (huang lian) and dried ginger (gan jiang) . Pinellia
( bdn xia) is the sovereign ingredient. Acrid and warm, pinellia (ban xia) down bears
counterflow, checks retchi吨, and dissipates glomu日 ql. Dried ginger (gan jiang) , also
acrid and warm, warms the spleen and dissipates cold. Bitter and cold scutellaria
(huang qin) and coptis (huang lian) clear heat. Ginseng ( r�n shen ) , licorice (gan
cdo ) , and j叫ube ( dd zao) supplement and boost the spleen and stomach. They
help restore the ql dynamic of the center burner to normal through a combination
of medicina that illustrate the following basic 凯iidelines: acrid flavors open, bitter
flavors downbear, and sweet 且avors regulate.
The directions for the preparation of this formula include the instruction to
remove the dregs and cook the decoction again. This formula is an example of a
harmonizing formula and it is cooked a second time to insure that the formula is
moderate and harmonized. This method is suggested for all the bupleurum formulae
and the three Heart-Draining Decoctions: Fresh Ginger Heart-Draining Decoction
(she:叼 jiang xie xi"n tang ) , Pinellia Heart-Draining Decoction ( ban xid xie xi"n tang) ,
and Licorice Heart-Draining Decoction (gan cao xie xi"n tang ) .
4.12.2.2
Fresh Ginger Heart-Draining Decoction Patterns
LINE 1 5 7
伤寒汗 出 , 解之后 , 胃 中 不 和 , 心下痞硬 ,
干 。意 食 臭 , 胁 下
有水气 , 腹 中 雷鸣 , 下利者 , 生姜泻心汤主之 。
Shang han han chu, jie zhi him, wei zhδng bu he, xin xia pi ying,
g an yi shi chem, xie xia you shui qi, fU zhong lei ming, xia li zhe,
sheng jiang xie xin tang zhu zh i.
When i n cold d a ma g e after sweat has issued a n d brou g ht res。l ution [。f
the exterior] , the stomach is i n d isham『Y
bel。W the hea rt , d ry belchi n g with m a l。d。r 。f food , 1 water q i u nder
the ri b-side, 2 t h u nder。us ru m bl i n g in the a bd。men , a nd d iarrhea , Fresh
Ginger Hea rt- D ra i n i n g Decoction ( sheng jiang xie xin tang) g overns.
T EXT NOTES
1 . Dry belching with malodor of food, 干 。意 食 臭 gan yf sM chou: Belching that
does not produce any fluid or reflux, but has a putrid odor.
2. Water ql under the rib-side, 胁 下 有 水 气 xie xia u归 shui qi : Water-rheum
inside the lower lateral part of the rib-cage.
238
l.
G REATER YANG [LINE 1 5 7]
FORMULA
Fresh Ginger Heart-Draining Decoction (sheng jia叼 xie xzn tang)
o Harmonize the stomach and downbear counterflow; transform rheum and
disperse glomus.
生姜四两 ( 切 ) 甘草三两 ( 炙 ) 人参三两
半夏半升 ( 洗 ) 黄连一两 大枣十二枚 ( 孽 )
干姜-两
黄苓三两
右 八 昧 , 以 水一 斗 , 煮取六升 , 去津 , 再煎取三升 , 温服一升 ,
日 三服。
Sheng jiang si liii.ng ( qie) gan cii.o san liii.ng (zhi) r印 shen san liii.ng gan
jiang yz liii.ng huang qin san Liang bdn xiii bdn sheng (xi) huang lian yz liii.ng
da zii.o shi er mei ( bδ)
You ba w剖, yi shui yz dou, zhii. qii. liu sheng, qu zi, zai jian qii. san sheng, wen
JU yz sh eng, ri san Ju.
fresh gi nger ( 生 姜 sheng jia叼, Zingi be巾 Rhizoma Rece叫 4 li�ng ( cut)
m ix-fried licorice ( 甘 草 gan cii.o, Glycyrrhizae Radix) 3 Ii温 n
ginseng ( 人 参 T印 shen, G inseng Radix) 3 Ii革ng
d ried gi nger ( 干 姜 gan jiang, Zingiberis Rhizoma Exsiccatu m ) 1 li�ng
scutel laria ( 黄 苓 huang q邸, Scutellariae Radix) 3 li�ng
pinellia ( 半 夏 ban xiii, Pinell iae Tu be『) h a lf she暗 (washed)
coptis ( 黄 连 huang li侃, Coptidis R hizoma) 1 li�ng
j uj u be ( 大 枣 da zii.o, Zizi phi Fructus) 12 p ieces ( broken)
[For] the a bove eight ingredients use one dou of water and boi l to get six sheng.
Remove the d regs a nd decoct aga i n to get three sh豆ng. Ta ke one sheng warm , three
ti mes a day.
SYNOPSIS
The signs and treatment of glomus that is the result of stomach vacuity, water­
rheum, and non-transformation of food.
C OMMENTARY
After sweating and the resolution of an exterior cold damage disease, the patient
in this line has disharmony of the stomach. This disharmony may be the result of
damage from the loss of fluids or it may be constitutional. In either c描e a weakness
in the center is exploited by a residual evil which attacks the center and binds in
the interior, causing congestion of the qJ. dynamic and the loss of normal upbearing
and downbearing. This congestion manifests as a hard glomus below the heart.
Previously glomus has been described as being soft , not hard. Hardness means
that the bound evil and the resultant congestion are more severe. Here, this sign is
not described as being painful, with or without pressure; hence it is not chest bind.
Stomach function may become impaired as the result of a disease process or a
constitutional weakness. In either case weakness of the stomach and qi congestion
in the center burner results in congestion of the qi dynamic. Food cannot be prop­
erly digested and assimilated; consequently, belching with the odor of rotten food is
1 . GREATER YANG [LINE 1 5 8]
239
observed. Because the ql dynamic is congested, turbidity, which should move down­
ward; rises. The presence of water ql, or water-rheum, further impairs the function
of the center and lower burners. This water-rheum may have been present prior
to the onset of the disease or it may have resulted from abnormal accumulation of
water, stemming from impaired spleen-stomach function. The clear and turbid qi
move abnormally, causing diarrhea. Intestinal rumbling reflects disharmony in the
center burner.
Fresh Ginger Heart-Draining Decoction (sheng jiang xie xin tang) is Pinellia
Heart-Draining Decoction ( ban xia xie xzn tang) with the addition of fresh ginger
(sheng jiang) and a reduced amount of dried ginger (gan jiang) . The action of
the formula is similar to that of Pinellia Heart-Draining Decoction ( ba n xia xie
xzn tang) ; it opens with acrid medicinals, downbears with bitter medicinals, and
regulates with sweet medicinals. In this formula, however, fresh ginger ( sheng jiang)
is the sovereign. Acrid and warm, it opens the stomach qi, repels foul turbidity, and
dissipates water qi. The pairing of fresh ginger ( sheng jiang) and dried ginger (gan
jiang) is very important to the action of this formula. The qi of fresh ginger ( sheng
jiang) is thin, so it diffuses and dissipates. Dried ginger (gan jiang) has thick
φ, so it promotes contraction. Thin and thick qi refer to mild and rich flavors,
respectively. Fresh ginger ( sheng ji伽g) penetrates and does not confine; dried
ginger (gan jiang) confines and does not penetrate. Used together, contraction
occurs within dissipation and confinement occurs within penetration. The pair
is able to diffuse and dissipate water-rheum, while simultaneously warming and
supplementing the center burner. Fresh ginger (she:叼 jiang) and pinellia ( ban xia )
down bear counterflow, transform rheum, and harmonize the stomach. The addition
of coptis (huang lian) and scutellaria (huang qin) clears heat and disperses the
glomus. Ginseng ( ren shen�, jujube ( da zao ) , and licorice (gan cao) support the
center and supplement vacuity.
4.12.2.3
Licorice Heart-Draining Decoction Patterns
LINE 1 5 8
付 伤寒 中 风 , 医反下之 , 其人下利 日 数十行 ,
雷鸣 , 心下痞硬而满 ,
谷不化 , 腹中
干岖 , 心烦不得安 。 。 医见心下痞 ,
谓病不 尽 , 复 下 之 , 其痞益甚 , 此 非结热 , 但 以 胃 中虚 , 客
气上逆 , 故使硬也 , 甘草泻心汤主 之 。
( 1) Shang han zhong Jeng, y?: fan xia zh毛 qi ren xia li 时 shu shi xing,
gu bu hua, Ju zhiing lei m仇g, xi:n xia pi ying er man, giin ou, xi:n
fan bu de an. ( 2 ) Yi: jian xfu xia pi, wei bing bu jin, JU xia zh毛 qi
pi yi shen, ci fei jie re, dan yi wei zhiing XU, ke qi shang ni, gu shi
ying ye, gan ciio xie xzn tang zhu zhf.
( 1 ) [When] i n c。Id d a mage [or] wi n d strike, the physicia n has used
precipitation , the person [wi l l have] d ia rrhea a b。ut ten times per day
240
1 . G REATER YANG [LINE 1 58]
[conta i n i ng] f1。。d that has n。t been t阳1sf1。r『Y
ru m bl i ng in the a bd。『ne『】 , fu l l n ess a nd a hard gl。m us below the hea rt ,
d ry 陀tc h i ng, a nd vexation t h a t ca n not be q u ieted . ( 2 ) [When] the
physici a n sees a glom us below the hea rt, suggesting the i l l ness has not
fi n ished , a n d aga i n uses preci pitati。n , [yet as a resu lt] the glom 山 i n­
creases i n severity, [it is beca use] heat bind is a bsent; only stomach
va cu ity [is present] with c。u 阳巾w ascent 。f visiting qi , ca usi ng hard­
n ess; [therefore,] Licorice Heart-Dra i n i ng Decoction (gan cao xie xzn
tang ) g。verns.
FORMULA
Licorice Heart-Draining Decoction (gan
cao xie xzn tang)
o Harmonize the stomach and supplement the center; disperse glomus and check
diarrhea.
甘草四两 ( 炙 ) 黄苓三两
枚 (壁)
黄连-两
干姜三两
半夏半升 ( 洗 )
大枣十二
右六昧 , 以水一斗 , 煮取六升 , 去淳 , 再煎取三升 , 温服-升 ,
日 三服 。
Gan cao si liang (zhi) huang qin s伽 liang gan ji伽g s伽 liang bdn xia bdn
she叼 (xi) da zao shi er mei ( bO) huang lian yf liang
You liu wei, yi shui yz dou, zhU qu liu sheng, qu zi, zai jian qu san sheng, wen
JU yf sheng, ri san Ju.
mix-fried licorice (甘 草 gan cao, G lycyrrhizae Radix) 4 Ii昌n
SCI』tellaria ( 黄 苓 ht』ang qin, Sci』tellariae Radix) 3 Ii温ng
d ried gi nger ( 干 姜 gan jiang, Zingiberis Rhizoma Exsiccatu m ) 3 Ii温ng
pinel lia ( 半 夏 bdn xia, P i nelliae Tu ber) h a l f she昭 (washed)
j uj ube ( 大 枣 da zao, Zizi phi Fructus) 12 pieces ( broken)
coptis ( 黄 连 huang lian, Coptidis Rhizoma) 1 Ii温ng
[For] the a bove six ingredients use one dou of water and boil to get six sh否
Remove the d regs a n d decoct aga i n to get three she『1g. Ta ke one sh否ng warm , three
ti mes a day.
SYNOPSIS
The signs and treatment of the pattern in which the inappropriate use of precip­
itation causes s pleen and stomach vacuity, leading to severe glomus and diarrhea.
COMMENTARY
Both cold damage and wind strike are exterior conditions that are treated with
exterior-resolving formulae. If precipitation is used it will damage the center qi and
possibly result in the evil fallin g into the interior. Precipitation causes vacuity in
the spleen, stomach, and intestines. The exterior evil exploits the vacuity and falls
inward, resulting in a hard glomus below the heart. When an exterior evil falls
1 . G REATER y ANG [LINE 1 58]
241
inward it easily impairs the ql dynamic. When the φ dynamic is impaired normal
upbearing and downbearing cannot occur, which can lead to a self-perpetuating
cycle. For example, vacuity cold in the lower burner impairs the movement of ql .
Because of this impairment, the spleen and stomach 町e unable to move and trans­
form clear and turbid qi properly. This impairment causes diarrhea, exacerbating
the spleen and stomach vacuity 础 clear essence φ is lost through the diarrhea. The
increasing vacuity means less qi is available to move and the qi stagnation increases.
The use of precipitation results in an exterior evil falling inward and obstructing
the qi dynamic. It also damages the qi of the center burner. The damage to center
qi from the use of precipitation results in frequent diarrhea with non-transfor皿ed
food and rumbling intestines. Here, precipitation causes severe diarrhea, perhaps
indicating that originally the center burner was vacuous. Fre�uent diarrhea with
non-transformed food, accompanied by intestinal rumbling, indicates extreme vacu­
ity of spleen and stomach ql.
These signs are accompanied by dry retching and heart vexation, signs of upper
burner heat ; hence this pattern is a mixed pattern of heat and cold, with vacuity
cold in the lower burner and heat in the upper burner. The retching and vexation
further indicate impairment of the qi d yn am ic 拥d the resultant loss of normal
upbearing and downbearing.
If the physician misdiagnoses this pattern and uses precipitation again, it will
exacerbate the vacuity in the center burner. This mistreatment will cause further
irregularity in the qi dynamic and the glomus will become worse. This glomus is
not the result of repletion heat bound in the interior, as in chest bind. As Zhang
JI explains, when the spleen and sto皿ach 町e vacuous and evil qi falls inward,
upbearing and downbearing become abnormal, the qi dynamic is congested, and a
hard glomus forms.
Licorice Heart-Draining Decoction (gan cao xie xfn tang) is Pinellia Heart­
Draining Decoction ( bdn xia z必 xfn tang) with a larger dose of licorice (gan cao ) .
Licorice (gan cao) enters the spleen and stomach, fortifying the center burner and
securing center qi. A large dose of licorice (gan cao) boosts the center and moderates
counterflow. If one accepts the point of view of both Lin Yi and the Qi伽 Jfn
Yi Fang, this formula should contain ginseng (ren shen ) . The combination of
jujube ( da zao) and ginseng ( r'臼 shen) strengthens the formula's qi-boosting action.
Pinellia ( ban xia) dow由ears counterflow and harmonizes the stomach, and disperses
glomus and checks retching. Coptis ( huang li6,n) clears heat and resolves vexation.
Dried ginger (giin jiiing) warms the center and dissipates cold.
1 . GREATER YANG [LINE 1 59]
242
4. 12.3
S evere Patterns o f Efflux Desertion , Glomus , and
D iarrhea Affecting the Lower Burner { Halloysite
and L imonite Deco ction Patterns )
LINE 1 5 9
付 伤寒 服汤 药 , 下利不止 , 心下痞硬。
以 他 药 下 之 , 不lj 不 止 。
仁) 服 泻 心 汤 己 , 复
(三) 医 以 理 中 与 之 , 利 益 甚 。
但) 理 中
者 , 理 中 焦 , 此 利 在 下 焦 , 赤 石 脂 禹 余 粮 汤 主 之 。 (五) 复 不 止
者 , 当 利其小便。
( 1 ) Shang han 庐i tang yao, xia li bu zhi, xfn xia pi ying. (2) Fu xie
xfn tang 以 j边 yi ta yao xia zh毛 li bu zhi. (3) Yr yi li zh伽g yu zhf,
li yi shen. ( 4) Li zhiing zhe, li zhiing jiao, ci li zai xia jiao, chi shi
zhτ yu yu liang tang zhu zhf. (5) Fu bu zhi zhe, dang li qi xiao bian.
( 1 ) In cold d a m age, a decoction med ici ne* has been ta ken a nd [t here
is] i ncessa nt d ia rrhea a nd a hard glom 山 below the heart . (2) Hea 此-
D ra i n i ng Decoction (xie xfn tang) has a l ready been ta ken , and then ,
beca use 。ther medici n a ls [are used] t。 preci pitate, [there is] i ncessa nt
diarrhea . (3) The physician gives [ a form ula ] to rectify the center a nd
the d ia rrhea i ncreases i n severity. (4) Rectifyi ng the center rectifies the
center bu rner, [but] t h is d ia rrhea is i n the l。wer bu rner, so H a l loysite
a nd Li mon ite Dec。ction ( chi shi zhf yu yu liang tang ) governs. (5) If
[the d ia rrhea] persists, 。ne shou ld d isi n h i bit the u ri ne.
T EXT NOTE
*
Decoction medicine, 汤 药 tang yao: A decocted formula for offensive precipi­
tation. Yu Chang writes, “Decoction medicine means medicinals to flush the
stomach and intestines.”
FORMULA
Halloysite and Limonite Decoction ( chi shi zhf yu yu liang tang )
o
Stem desertion and check diarrhea.
赤石脂一斤 ( 碎 )
太一 禹 余粮一斤 ( 碎 )
右二 昧 , 以 水六升 , 煮取 二 升 , 去淳 , 分温三服 。
Chi shi zhf yz jzn ( sui) tai yz yu yu liang yz jzn ( sui)
You er wei, yi shui liu sheng, zhU qu er sheng, qu zi, fen wen san JU.
h a l loysite ( 赤 石 脂 chi shi zhf, H a lloysit u m Rubrum) 16 Ii温ng ( broken)
li mon ite ( 太 一 余 粮 tdi yz yu liang, Limonitu m ) 16 li� ng ( broken)
1 . G REATER y ANG [LINE 1 59]
243
[For) the a bove two ingred ients use six she鸣 。f 附ter a nd boil to get three sheng.
Remove the d 吨s, separate [into) th ree [doses) a nd ta ke wa rm .
SYNOPSIS
The signs and treatment of the pattern in which inappropriate precipitation
leads to a glomus and incessant diarrhea.
COMMENTARY
Since cold damage is an exterior pattern it should be treated with a formula to
resolve the exterior. It is not clear what formula w描 given here, but it appears that
it was a precipitating formula because the result is incessant diarrhea and a hard
glomus below the heart. The treatment suggested in the text is one of the Heart­
Draining Decoctions (xie xin tang ) , probably Licorice Heart-Draining Decoction
(gii.n cii.o xie xi"n tang) or Fresh Ginger Heart-Draining Decoction (sheng jiang xie
xi"n tang).
One of these formulae is given, but then precipitation is used again and the
diarrhea does not cease. The original inappropriate treatment damaged the qi of
the spleen and stomach and caused the formation of a glomus below the heart. A
second mistreatment exacerbated the condition and the di缸rhea continues.
The physician perceives the diarrhea to be an indication of cold in the center
burner; therefore, Center-Rectifying Decoction ( li zhδng tang) is chosen to warm
the center burner. Nevertheless, after ingestion of the decoction the di缸rhea be­
comes worse. Center-Rectifying Decoction (li zhong tang) is appropriate for cases
of diarrhea that are the result of spleen vacuity and cold. In more serious c凶es
or in protracted illness, the original φ and the yang qi of not only the spleen, but
the kidney, may be damaged. Zhang JI explains that the diarrhea arises from the
lower burner, not the center burner. Repeated mistreatment damages the original
qi and the yang qi of the spleen and kidney. The securing and containing functions
of the spleen and kidney are impaired, producing a desertion patter丑 in the form of
incessant diarrhea. This pattern must be treated with medicinals that astringe the
lower burner.
Halloysite and Limonite Decoction ( chi shi zhi" yu yu Liang tang) contains sweet,
warm, and astringent halloysite ( chi shi zhi") , which astringes the int臼tines, st缸iches
bleeding, and stems desertion. Sweet, neutral, astringent limonite ( yu yu Liang)
的缸iches bleeding and checks diarrhea, but also supplements the spleen, secures the
stomach qi, and thickens the large intestine.
If a formula for checking diarrhea is used unsuccessfully, one should investigate
urination. If urination is inhibited, it suggests that the clear and turbid are not
being separated and that da皿pness is percolating into the large intestine. If one
then disinhibits the urine, this treatment will restore proper separation of the turbid
and clear, remove the dampness from the lower burner, and check the diarrhea.
1 . G REATER YANG [LINE 1 56]
244
4.12.4
LINE
Water Glomus Patterns (Poria Five Powder
Patterns)
1 56
付 本 以 下 之 , 故心下痞 , 与泻心汤 。
口 燥烦 , 小 便 不 利 者 , 五苓散主 之 。
ω 痞不解 , 其人渴而
( 1 ) Ben yi xia zh毛 gu xin xia p记 yu xie xi"n tang. (2) Pi bu ji己 qi ren
ke er kou zao fan, xiao bian bu li zhe, WU ling san zhu zhi". (3) Yr
fang yun, ren zhr yr ri nai yu.
( 1 ) When , beca use origi n a l ly preci pitation was used , [there is] there
f。陀 a glom us bel。w the hea rt , give Heart- D ra i n i ng Dec。ction ( xie xi"n
tang ) . (2) If the gl。 m 山 d。es n。t resolve, a n d the person is thi rsty,
has a d ry m。ut h , vexatio n , a nd i n h ibited urination , Poria ( Hoelen ) Five
p。wder ( wu ling san) governs. (3) Accordi ng t。 a nother method , if
[the patient] puts u p with it for a day, * he / she wi l l rec。ver [without
med ication] .
FORMULA NOTE
*
Putting up with it for a day., 忍 之 一 日 ren zhr yf 时: This is taken to mean
that the patient should put up with the thirst without drinking for one day.
Note that Cheng W毡,Ji’s ZhU Jie Shang Han Lim does not include this final
sentence, and some modern commentators believe it should be removed.
SYNOPSIS
The signs and treatment of glomus below the heart in water amassment pat­
terns.
COMMENTARY
When precipitation is used improperly it may result in the formation of a glo­
mus, as it does in this line. Generally, one of the Heart-Draining Decoctions (xie xin
tang) is used, 臼 it is here. The glomus should resolve, but it does not, suggesting
that it is not a typical heat glomus. From the signs that occur after the ingestion
of the original formula and the formula that is suggested, it is considered to be a
water glomus.
Water glomus occurs when the qi transformation of the bladder is impaired.
It may be the result of inappropriate precipitation, causing an exterior evil to
shift from the greater y缸g channel into the bladder, or it may be a constitutional
problem. In either case inhibited urination, thirst, a dry mouth, and vexation are
clear signs of the impairment of fluid movement in the body. Water collects in the
lower burner and then attacks upward, resulting in congestion of the qi dynamic in
the center burner. The typical treatment for glomus is not appropriate here, but
instead, one must transform qi and move water.
A typical φ glomus causes signs that reflect congestion of the φ dynamic like
retching counterflow and diarrhea. In comparison, in water glomus patterns signs
1 . GREATER YANG [LINE 1 6 1 ]
245
of qi dynamic congestion 缸e accompanied by signs of water amassme时 , such as
inhibited urination and thirst.
Although some present-day commentators believe the last line should be re­
moved, others believe that it has clinical significance. Because water amassment
often results from excessive intake of water, the patient only has to put up with the
thirst and desist from drinking for a day for the amassed water to be discharged
from the body without need of any medication.
4.12.5
Phlegm Qi Glomus Patterns (Inula and Hematite
Decoction Patterns)
LINE 1 6 1
伤寒发汗 , 若吐若下 , 解后 , 心下痞硬 , 喷气不 除 者 , 旋覆
代精汤主之 。
Shang han fa hem, ruo tu ruo xia, jie hou, xrn xia pi ying, yi qi bu
chu zhe, xuan j边 dai zhe tang zhu zhι
When i n cold d a mage, sweati ng is prom。ted or vom iti ng or precipitation
[is used ] a n d after res。l ution [。f the exterior d isease] , [there is] a hard
glom us below the heart a nd belch ing* that ca n n 。t be el i m i n ated , l n u la
a nd Hematite Dec。ction ( xuan J边 dai zhe tang) g。verns.
TEXT NOTE
Belching, 喷 气 yi qi: Expulsion of gas (φ) from the stomach that occurs after
eating to satiation or eating too quickly, and in stomach diseases. It is one
manifestation of counterflow ascent of stomach ql. The same 描 嚼 气 di qi .
FORMULA
lnula and Hematite Decoction (xucin Ju dai zhe tang)
o Harmonize the stomach and transform phlegm; subdue the liver and downbear
counterflow.
旋覆花三两 人 参 二 两 生姜五两
夏半升 ( 洗 )
大枣十二枚 ( 壁 )
代揣一两
甘草三两 ( 炙 )
半
右 七 昧 , 以 水 一 斗 , 煮 取 六 升 , 去 i宰 , 再 煎 取 三 升 , 温 服 一 升 ,
日 三服 。
Xucin jU hua san liiing ren shen er liiing sheng jiang wu liang dai zhe yf
liii.ng gan cao s伽 liang (zhi) bdn xia bdn she:叼 (xi) da zao shi er mei ( bO)
You qf wei, yf shuf yf do包, zhU qu liu sheng, qu z民 zai jian qu san sheng, wen
JU yf sheng, ri san JU.
i n u la flower (旋 覆 花 xucin Ju hua, l n u lae Fl os) 3 Ii温ng
gi nseng ( 人 参 ren sh旬, G inseng Radix) 2 liling
1 . G REATER YANG [LINE 1 6 1 ]
246
fresh gi nger (生 姜 sheng jiiing, Zingiberis Rhizoma Recens) 5 liiing
hematite ( 代 甜 石 dai zhe shi, Haematitum) 1 liling
m ix-fried licorice (甘 草 giin cao, G lycyrrh izae Radix) 3 liling
pinellia ( 半 夏 bdn xia, Pinelliae Tu ber) h a lf sheng (washed )
j uj u be ( 大 枣 da zao, Zizi phi Fructus) 12 pieces ( broke n )
(For] the a bove seven ingredients use one d � u o f water. Boil t。 get six she『1
rem。ve the d regs, a nd cook aga i n to get th ree sheng. Take one sheng warm , three
ti mes a day.
S YNOPSIS
The signs and treatment of phlegm-ql glomus.
COMMENTARY
Here , following the resolution of a greater yang cold damage pattern, a hard
glomus below the heart and belching arise. The presence of these signs means
that although the exterior pattern has resolved, the treatment method used w描
inappropriate. The use of vomiting or precipitation is clearly an inappropriate
method, but the promotion of sweating is appropriate treatment for an exterior
pattern. Here, sweating was promoted excessively or too strongly for the patient’s
constitution; hence although the principle was correct , its execution was not.
The inappropriate use of sweating, vomiting, or precipitation damages the ql of
the spleen and stomach, impairing digestate decomposition. Movement and trans­
formation become abnormal and phlegm-rheum is engendered. The signs in this
pattern do not necessarily reflect phlegm-rheum, but when viewed in combination
with the suggested formula, strongly suggest its presence. Phlegm-rheum, a result
of the treatment or a reflection of the patient’s original constitution, congests below
the heart. It obstructs the qi dynamic and causes ql counterflow. The congestion
below the heart manifests as a hard glomus and the belching provides evidence of
the ql counterflow.
The phrase “which cannot be eliminated" may be interpreted in two ways. It
may refer to the belching and mean that it is incessant and di伍cult to resolve. It
may, however, also refer to the glo mus . That is, after b elching , the patient feels no
relief from the discomfort below the heart.
The formula Inula and Hematite Decoction ( xuan Ju dai zhe tang) harmonizes
the stomach and transforms phlegm, as well 描 subdues the liver and downbears
counterflow. Inula flower (xuan Ju huii ) is the sovereign agent. It disperses phlegm
and downbears 啡, and softens hardness and dissipates binds; it is an important
agent for the resolution of phlegm glomus. Hematite ( dai zhe sM) settles the liver
and s u b d u es counterflow. Thus, these two agents alone perform the main actions
of the formula. Acrid, warm fresh ginger (she:叼 ji伽g) and pinellia ( ban xia) har­
monize the stomach, transform phlegm, and disperse glomus. Ginseng ( ren shen ) ,
mix-fried licorice (giin cao) , and jujube ( da zao) supplement the spleen and stomach
in order to fortify the vacuity present in the original condition. The combination
of these agents disperses phlegm and harmonizes the ql of the center burner. In
this way it allows for normal upbearing of the clear and downbearing of the turbid.
When the clear and the turbid move normally, and the spleen and stomach are
fortified, the disease will resolve.
1 . GREATER y ANG [LINE 1 73]
247
Because this formula subdues the liver, counterflow ascent of the liver qi and
the liver exploiting the vacuity of the spleen has been suggested as part of the
pathomechanism. W谊 Yi-Luo (吴 仪 洛 ) writes:
Vacuity of earth is exploited by liver wood, and [stomach φl ascends
counterflow with the φ [of liver] . Thus the sovereign [agent] is ginseng ( ren
shen ) , which supplements vacuity. The minister, bitter, cold hematite { ddi
zhe sM) , is a heavy settler which enters the liver and guides ginseng (ren
she叫 down to subdue and quiet the φ counterflow. Salty, warm im血 flower
(xutin ju h uii ) softens hardness, moves water, and precipitates φ.
This perspective may be compared with that offered by Cheng Wu-JI, who makes
no reference to the liver at all:
Salty flavors can soften hardness. Salty im山 flower (xutin ju huii) is used
to soften the hard glomus. [When there is] vacuity, the qi fl.oats [upward] .
Heavy formulae can subdue. Heavy hematite ( dai zhe sM) is used to subdue
the vacuit� counterflow. Acridity dissipates. Acrid fresh ginger (she叼 jia·叼 )
and pinellia ( bdn xia ) dissipate the vacuity glomus. Sweetness moderates.
Sweet ginseng ( ren she叫 , mix-fried licorice (giin cao ), and jujube ( dd zao )
supplement the stomach vacuity.
Both perspectives provide insight into the mechanism of the formula.
Im由 and Hematite Decoction ( xt
stomach, transforms phlegm, subdues the liver and downbears counterflow, may be
compared with Minor Bupleurum Decoction (xiao chdi hU tang) , which harmo血es
and resolves the lesser yang, since the ingredients are very similar. The former
contains inula flower (xuan Ju hua) and hematite { ddi zhe sM) , whereas the latter
contains bupleurum ( chdi hU) and scutellaria (huang q{n ) . The remaini吨 ingredi­
ents, ginseng ( ren shen ) , licorice (gan cao) , jujube (da zao) , pinellia ( ban xia) , and
fresh ginger (sheng jiang) , are the same in both.
4. 1 3 UPPER BURNER HEAT AND LOWER BURNER COLD
PATTERNS : COPTIS DECOCTION PATTERNS
LINE 1 73
伤寒胸 中有热 , 胃 中有邪气 , 腹 中痛 , 欲呕吐者 , 黄连汤主
之。
Shang han xiδng zhong you re, wei zhδng you xie qi, Ju zhong tang,
yu OU tU zhe, huang lian tang zhu zhz.
When i n c。Id d a m age, [there is] heat i n the chest , evi l qi i n the st。mach ,
pa i n i n the a bd。men , a n d a desi re t。 v。m it, Coptis Dec。ction ( huang
lian tang) governs.
248
1 . G REATER YANG [LINE 1 73]
FORMULA
Coptis Decoction ( huang lian tang)
。 Clear upper [burner heat] and w缸m lower [burner cold] ; harmonize the center
and downbear counterflow.
黄连三两 甘草三两 ( 炙 ) 干姜三两
两 半夏半升 ( 洗 )
大枣十二枚 ( 擎 )
桂枝 三 两 ( 去 皮 )
人参二
(一) 右 七 昧 , 以 水 一 斗 , 煮 取 六 升 , 去 津 , 温 服 , 昼 三 、 夜 二 。
疑非仲景方 。
ω
Huang lian san liiing giin cii.o siin liang (zhi) g伽 jiiing siin liang gui zhf
siin liiing ( qu pf) ren shen er liiing ban xia ban sheng (xi') da zii.o shi er mei
( bo )
( 1 ) You q f wei, yi shuf y z d伽, zhu qu liu sheng, q u zf, wen JU, zhou san、 ye
er. (2) Yi fei zhong jfng fang.
coptis ( 黄 连 huang lian, Coptidis Rh izoma) 3 lil:lng
mix-fried licorice ( 甘 草 giin ciio, G lycyrrhizae Rad ix) 3 lil:lng
d ried ginger ( 干 姜 giin jiang, Zingiberis Rh izoma Exsiccatu m ) 3 l i l:l ng
ci n n a mon twig ( 桂 枝 gui zhf, Cin namomi Ra m u l us) 3 Ii温ng ( remove ba此)
ginseng ( 人 参 ren sh旬, G in seng Radix) 2 Ii昌『1
p in ellia ( 半 夏 ban xia, P inel l i a e Tu ber) h a lf s hen g (washed )
j uj u be ( 大 枣 da zao, Zizip h i Fructus) 12 pieces {broke n )
( 1 ) [For) the a bove seven i n gredients use o n e d 总 u of water. B o i l t o get six sheng
a nd 陀move the d regs. Take warm , th ree ti mes [d u ri ng] the day and twice at night.
(2) I t is dou bted that this is (Zhang] Z hong Jl'ng ’ s form u l a . *
FORMULA NOTE
It is doubted that this is [Zhang] ZhOng Jing’s formula, 疑 非 [ 张] 仲 景 方 yi fei
zhong jfng fang: This is an addition to the text by an unknown author.
SYNOPSIS
The signs and treatment of abdominal pain with a desire to retch and vomit in
a pattern of upper burner heat and lower burner cold.
C O MMENTARY
The reader is told that a heat evil is present in the chest, that is, above the
diaphragm. An evil, not described as being hot or cold, is present in the stomach.
The region of the stom肌h is considered to include the stomach, spleen, and in­
testines or, more generally, the abdomen. An analysis of the formula suggests that
it treats cold in the abdomen. Thus, this line presents a c描e of heat in the upper
body and cold in the lower body. It should be noted here that the area affected by
this disease is larger than that treated with Pinellia Heart-Draining Decoction ( ban
xia xie xfn tii.1时 , although the sign pattern is similar.
Because of the cold evil, the spleen and stomach 缸e damaged. The cold congeals
and the qJ. stagnates; hence the abdomen becomes painful. When the qJ. is stag­
na时 , the stomach cannot downbear turbidity properly; hence the patient desires to
1.
GREATER YANG
249
vomit. Because a desire to vomit may also be the result of heat in the upper body,
it may here be a sign of heat in the upper body, congestion of the φ dynamic,
or a combination of both. In this pattern no evidence of either glomus or chest
bind exists, although evils are present in the interior. The absence of these signs
is another point differentiating this pattern from the one Pinellia Heart-Draining
Decoction ( bdn xia xie xzn tang) treats.
’Treatment must aim to clear heat from the upper burner, w缸m the center
burner, harmonize the stomach, and downbear counterflow. Coptis Decoction
(huang lian tang) is Pinellia Heart-Draining Decoction ( bdn xia xie xzn tang) with­
out scutellaria (huang q臼) and with cinnamon twig (gui zhz) . B it t er , cold coptis
(huang litin) clears heat in the upper body. Acrid, hot dried ginger ·(gan jiang)
warms the lower body. Acrid, w缸m cinnamon twig (gui zhf) dissipates cold and
frees yang. The emphasis of Cop tis Decoction ( huang li伽 tang) lies in using acrid
agents to free the ql dynamic. In Pinellia Heart-Draining Decoction (ban xia xie xzn
tang) on the other hand, the emphasis is on the use of bitter agents to downbear
the ql. Ginseng ( r印 shen) , licorice (g伽 cii.o ) , and jujube ( da zii.o) boost the ql and
harmonize the center. In combination these medicinals restore normal upbearing
and downbearing in the center burner. By down.bearing counterflow, harmonizing
the stomach, and checking retching, pinellia ( bdn xia) strengthens one of the chief
actions of the formula.
4 . 14 ADVERSE TREATMENT BY FIRE PATTERNS
Adverse treatment by fire patterns occurs as the result of inappropriate use
of fire methods. ’Treatment by fire is an ancient practice that was particularly
popular in the Han Dynasty. This treatment category includes warm needling, red­
hot needling, moxibustion, fuming, and hot packs. Fire methods, used to promote
sweating, dissipat e cold, open impediment, and relieve pain, are appropriate for use
with patients suffering from severe cold patterns.
Many of these treatments 町e not commonly used today, but the patterns dis­
cussed in this section still do appear in clinical practice. They typically involve yin
damage and stirring of blood or y缸g hyperactivity and stirring of wind.
The signs in adverse treatment by 且re patterns vary according to the treatment
used, the original disease, and the patient’s constitution. When 且re evil attacks
the interior, damaging the heart y缸g, it may give rise to a pattern in which the
heart spirit strays outward. This pattern is characterized by vexation and agitation,
fright mania, and disquiet lying and sitting. When fire evil instead damages yin
and construction, it may stir the blood, giving rise to signs such as blood ejection
and bloody stool. In certain patterns, the blood dissipates from the pulse and a
y缸g evil becomes depressed in the upper burner. The y缸g evil cannot outthrust
and this pattern is characterized by the absence of sweating below the lumbus,
impediment, and aversion to cold in the soles of the feet.
250
1 . G REATER YANG [LINE 1 1 0]
LINE 1 1 0
什 太阳病二 日 , 反躁 , 凡安其背 而 大 汗 出 , 大热入 胃 , 胃 中
水竭 , 躁烦 , 必 发沪语 。
欲解也。
ω 十余 日 , 振栗 , 自 下利者 , 此 为
同 故其汗从腰 以 下 不 得汗 , 欲 小 便不得 , 反岖 , 欲
失 泼 , 足 下 恶 风 , 大 便硬 , 小 便 当 数 而 反 不 数及 不 多 ; 大 便
已 , 头卓然而痛 , 其人足心必 热 ,
谷气下流故也 。
{ 1 ) Tai yang bing er 时, fan zao, fan u肌 qi bei, er da han chu, da
re rU wei, weυhong shu'i jie, zao fan, bi fa zhan yu. {2) Shi yu 叫,
zhen li, zi xia li zh已 c'i wei yu jie ye. ( 3) Gu qi han, cong yao y'i xia
bu de han, yu xiao bian bu de, fan ou yu shz so钮, zu xia WU Jeng, da
bian ying, xiao bian dang shuo d俨 fan bu shuo ji bu duδ; da bian 以
tou zhu6 ran er tong, qi ren zu xzn bi re, gii. qi xia liu gu ye.
{ 1 ) When greater ya ng disease [has lasted] two days, but [there is] agi­
ta ti。n whenever a h。t pack1 is used 。n the back, a nd [as a resu lt there
i斗 great sweati ng, [then] great heat enters the stomach , the stomach
water2 is exh a usted , [there is] vexati。n a nd agitati。n , [a nd] there wil l
be del i rious speech . { 2 ) I f [after] more t h a n ten d ays, [there is] shiv­
eri ng a nd s p。nta ne。us diarrhea , this mea ns [that the disease] is a b。ut
to resolve. {3) Conseq uently, sweating from the l u m bus down ca n n 。t
be 。 bta i n ed . [The person] desi res but is u n a ble to u ri nate, a nd i nstead
陀tches. [The person is] vergi ng on u ri n a ry i nconti nence a n d has aver­
si。n t。 wi nd i n the s。les 。f the feet a nd hard stool . U ri nati。n sh。uld
be freq u ent, but i n stead it is i nfreq uent a nd n。t co pi。us. Defecati。n
[occu 叫 a nd the head is sudden ly pai nfu l . This patient wil l feel heat i n
t h e s。les, beca use gra i n q13 fl。ws downwa rd .
TEXT N OTES
1. A hot pack , 贸 yun : A cloth bag that contains medicinals warmed by stir­
frying, and applied to the body to relieve pain, force sweating, or dissipate
cold. The same 出 热 贸 re yun.
2. Stomach water, 胃 申 7.1< wei zhδng shuf: The water in the stomach.
3. Grain φ, 谷 气 gu qi: Indicates the clear yang qi derived from food.
SYNOPSIS
’Transmuted patterns and the mechanism of spontaneous recovery in greater
yang disease after the inappropriate use of a fire method.
COMMENTARY
Vexation is not generally seen in greater yang disease. Its presence in the
beginning of this line suggests that the evil heat qi has moved into the interior, as
1 . G REATER YANG [LINE 1 1 0]
251
Cheng Wu-Ji writes. At that point, using a fire method to force sweating is clearly
inappropriate treatment. One should use acrid, cool medicinals to resolve the heat.
When a heating method is used and great sweat issues, the fluids 町e damaged, the
yin of the stomach is exhausted, and what was originally only vexation becomes the
more severe sign of agitation and vexation. The heat evil enters the stomach and
because it is exuberant , it gives rise to delirious speech. A ya且g brightness pattern
in which the stomach domain is replete is already starting as the result of adverse
treatment with heat .
If, after ten days, the disease has not become worse, it means that the patient’s
constitution was strong enough to withstand the evil and the heat evil is becoming
debilitated. Once the evil is debilitated, the fluids begin to return to normal.
Shivering and spontaneous diarrhea are, in that case, a sign of recovery and the
elimination of the residual evil qi.
The third part of this line describes one other possible transmutation, following
the use of an inappropriate treatment method. A modern student may wonder
about the value of this section since modern physicians do not use these methods
of treatment, but it is possible that one may see clinical signs that are similar to
these, even if a hot pack is not used. Perhaps more significantly, the value of this
section lies in the analysis of the pathomechanism. A group of signs are presented
that provide insight into both normal and abnormal mechanisms of physiological
function. The writing of Cheng Wu-Ji describes the signi且cance of this section in
the following words:
If [there is] absence of sweating from lumbus down, then the fluids are
unable to flow downward; consequently, [the patient] desires but is unable to
urinate and the heat φ ascends counterflow and instead, [he/she] retches. [If
this patient is] verging on urinary incontinence and has aversion to cold in the
soles of the feet, the qi is unable to flow downward and [there is] vacuity. [If]
the fluids are tending to percolate [out of the int estin es] , this makes the stool
hard and should [make] urination frequent . . . . Here, because the fire heat
has dried the interior, the fluids cannot flow downward; hence urination is not
frequent and not copious. If the fire heat disperses, the fluids harmonize, then
the bound stool will be moistened and will spontaneously evacuate. After the
stool (passes] , [there is] a sudden headache. At first , there W臼 hard stool and
the yang qi could not flow downward. As the stool has passed, the yang qi
downbears and [there is] vacuity in the head; consequently, [there 闯 a sudden
headache . . . . At first, when the yang qi could not flow downward, there was
aversion to cold in the soles of t h e feet. Now, the y缸g qi is able to descend,
so the soles [of the feet] are w缸m.
The use of inappropriate treatment damages both yin and yang. The signs, as
described by Ch eng wιJi, represent vacuity of both yang and yin. Heat evils tend
to attack upward, so sweat issues in the upper body. Because the fluids have been
damaged, as has the yang ql, neither is distributed properly and no sweat issues
in the lower body. A desire to urinate exists, but because the fluids cannot flow
downward, no urine is discharged. The inability to urinate reflects damage to the
y缸g φ and insufficient fluids. Damage to the y缸g φ also results in an inability
to control urination normally and a feeling of imminent incontinence. Often, hard
1 . G REATER YANG [LINE 1 1 1]
252
stool indicates that the fluids are percolating out of the intestines and exiting the
body through the urine, but this is not the c副e here because interior heat has
caused dryness. A version to cold in the soles of the feet indicates that the yang qi
is unable to flow downward. When the stool becomes moistened and can move, the
yang qi spontaneously flows downward and a headache is the result of y缸g vacuity
in the head. This downward flow of φ also warms the soles of the feet.
LINE 1 1 1
忡 太阳 病 中 风 , 以 火 劫发汗 , 邪风被火 热 , 血气流溢 , 失其
常 度 , 两阳相熏灼 , 其 身 发 黄 。
难。
仁) 阳 盛 则 欲 陋 , 阴 虚 小 便
(三) 阴 阳 皆 虚 竭 , 身 体 则 枯 燥 , 但 头 汗 出 , 剂 颈 而 还 ,
腹 满 微 目前 , 口 干 咽 烂 , 或 不 大 便 , 久 则 沪 语 , 甚 者 至 日岁 , 手
足躁扰 , 捻衣摸床 , 小 便利者 , 其人可治 。
( 1 ) Tai yang bing zhong Jeng, yi huo jie fa han, xie Jeng bei huo re,
xue qi liu yi, shi qi chang d毡, liiing yang xiang xun zhu6, qi shen
fa h悦ng. (2) Yang sheng ze yu 叫, yin XU xiiio bian nan. ( 3) Yin
yang ju XU jie, shen ti ze ku zao, dan t6u han chu, ji jing er huan,
Ju man wei chuiin, kou gan yan ldn, huo bu da bian, jiu ze zhan yu,
shen zhe zhi yue, shou zu zao riio, niiin yi m6 chuting, xiiio bian li
zhe, qi ren ke zhi.
( 1 ) [When i n] greater ya ng wind stri ke disease, fi re forcing1 is used t。
prom。1te sweating, the evi l wi nd is exacerbated by fi 陪 heat; [then] bl。。d
a nd qi fl。w a nd spi l l , 2 losing thei r n。rma lcy.3 (2) The tw。 ya ng4 fu me
a nd scorch each other a nd [there is] genera lized yell。wi ng. (3) Ya ng
i s exu bera nt, so [there is] a b。ut t。 be sp。nta ne。us externa l bleed i ng.
Yin is vacu。us, so u ri nation is d ifficult. (4) Yin a n d ya ng are both
exh a usted ; [there is] genera l ized desiccation5 a n d sweating 。n ly from
the head t h at stops j ust at the neck, a bdom i na l fu l l ness, slight pa nti ng,
d ry m。ut h , putrefecation of the th roat,6 。r i na bi lity t。 defecate. [If
th is] end u res, there wil l be d el i riot』s speech , a nd when severe, h iccu pi ng,
agitati。n 。f the extrem ities, a nd picki ng at bedcl。t hes. 7 When u ri nation
is u n i n h i bited , the person ca n be treated .
TEXT N OTES
1. Fire forcing, 火 劫 huo jie: A fire 皿ethod is used to force sweating. Fire
methods include warm or hot needling, application of hot medicinals to the
exterior of the body, and fuming.
2. Flow and spill, 流 溢 liu yi : Abnormal movement of the blood, which may
involve blood seeping out of the vessels.
1 . G REATER YANG [LINE 1 1 1]
253
3. Losing their normalcy, 失 其 常 度 shf qi ch<i.ng du: As above, a loss of normal
movement of the qi and blood.
4. The two yang, 两 阳 liiing yang: Here, the use of the term "yang” means wind
and fire evils, not the yang qi of the body.
5. Generalized desiccation, 身 体 枯 燥 shen ti kii zao: Emaciation, accompanied
by dry, lusterless skin.
6. Putrefecation of the throat, 日因 烂 yan lan : A condition in which the interior of
the throat is red, swollen, and eroded. Also known as “damage in the throat,”
咽 中 伤 yan zhδng shang.
7. Picking at bedclothes, 捻 衣 摸 床 nian yf mδ chuang: The patient unconsciously
rubs and 且吨ers the clothes and/or the bedclothes.
SYNOPSIS
Transmuted patterns and the prognosis for greater yang wind strike patterns in
which 且re forcing is used to promote sweating.
COMMENTARY
In this line Zhang JI explains the mechanism of damage that occurs following
inappropriate use of a fire method to force sweating. Wind and 且re are both yang
evils. When 直re is used to treat a y归g evil, yang reinforces yang and the strength
of the evil is increased. This mistreatment engenders internal heat and damages
both the qi and blood. The qi is stirred and the blood is harassed, which results in
the loss of normal movement of both.
Fire forcing damages yin and engenders internal heat. If fuming is then used,
the heat will become exuberant and scorch the blood. When the blood is damaged
in this way it becomes dry and part of it moves out of the vessels, resulting in
generalized yellowing. Modern authors attribute the yellowing to a loss of normal
function in the liver and gallbladder, which results in the abnormal movement of
gall, but this explanation was unknown to Zhang JI and subsequent generations of
doctors. See the Introduction for a further discussion of this issue.
Spontaneous external bleeding results from attack of exuberant y缸g heat, since
the heat forces the blood out of the vessels. Exuberant internal heat also damages
yin humor, resulting in yin vacuity and difficult urination.
Inappropriate treatment with fire damages both yang and yin. When yin and
blood are exhausted, they cannot moisten the skin. When yang and qi become
e对iausted, they cannot warm the body’s exterior. Thus, in this condition, the skin
is dry and lusterless.
As discussed previously, heat evils tend to attack upward. The heat causes
sweating, but only from the head. The area of sweating is reduced because of the
damage to the fluids caused by the heat evil. The heat evil flames in the upper p缸t
of the body, scorchin g the fluids and resulting in a dry mouth and inflamed throat.
Dryness in the interior indicates that fluids cannot move normally, which also causes
stagnation of the ql. When the qi is stagnant, the qi dynamic is congested, the
abdomen becomes full, and the patient pants. Dryness and qi stagnation may also
result in inability to pass the stool.
If the heat evil remains in the interior for a long time, it can affect the heart
and lead to delirious speech and a more serious pattern. Hiccuping means that the
1 . GREATER YANG [LINE 1 13]
254
stomach fluids have been seriously damaged and the stomach qi has lost regulation.
Agitation of the extremities and picking at the bedclothes are indicative of exuber­
ant heat desiccating the 咀uids and disrupting the ability of yin to contain yang.
These signs suggest that the patient is stuporous and are very dangerous signs.
If, however, urination is inhibited, the patient may still be treated successfully.
Although the heat evil is exuberant and yin humor have been damaged, uninhibited
urination indicates that there has not been total fluid collapse and that the bowels
and viscera are still functioning; therefore, recovery is still possible. If urination is
inhibited, it indicates fluid collapse and that the bowels and viscera are incapable
of processing the fluids. In this pattern, successful treatment is less likely.
LINE
1 13
形作伤 寒 , 其脉不 弦 紧 而 弱 , 弱 者必 渴 , 被 火 必俨语 , 弱 者
发 热脉浮 , 解 之 当 汗 出 愈 。
X仇g zuo shang han, qt mai bu xian fin er ruo, ruo zhe bi ke, bei
huo bi zhan yu, ruo zhe fa re mai Ju, jie zhz dang han chu yu.
[When] the f。rm [of the i l l ness] is that of cold d a mage1 a n d the pu lse
is not stri ngl i ke [or] tight, a nd is wea k, wea kness [mea ns] there wi l l be
t h i rst . [When) fi re is used ,2 there will be deli ri。us speech . When [i n
such cases the p u lse) is wea k , [if there is) heat effusi。n a nd t h e pu lse is
fl。ating, sweating shou ld [bri ng a bout) 限。very.
TEXT N OTES
l. [When] the form [of the illness] is that of cold damage, 形 作 伤 寒 xing zuo
shang Mn: An unspecified disease with signs that are similar to cold damage.
2. [When] fire is used, 被 火 bei huo: The patient is treated with a fire method.
SYNOPSIS
When warm disease damages yin, the use of fire methods is contraindicated.
COMMENTARY
This disease is similar to cold damage, which suggests that heat effusion, hea­
dache, or other signs commonly seen in cold damage may be present , although
differences also exist. The pulse in cold damage is generally floating and tight,
whereas here the pulse is weak and floating. In the Huang Di Nei Jfng, heat effusion
with a pulse that is weak means internal heat. Accordingly, Zhang JI writes that in
a disease like cold damage with signs such as heat effusion, when the pulse is weak,
thirst arises from internal heat.
If a fire method is used to treat a patient with internal heat, the fire will boost
the internal heat . Exuberant heat damages the fluids and affects the stomach,
causing delirious speech.
The pulse is weak and floating and heat effusion is present, indicating that an
evil is still present in the exterior. The disease will resolve if sweat issues.
1 . G REATER YANG [LINE 1 1 5]
255
LINE 1 1 4
太阳病 , 以火熏之 , 不得汗 , 其人必躁, 到经不解 , 必清
血, 名 为火邪。
Tai yang bing, yi huo xun zhz, bu de han, qi ren bi zao, dao jzng bit
jie, bi qzng xue, ming wei huo xie.
I n greater ya ng d isease, beca use fi re fu m i ng is used a nd sweating is n。t
。bta i n ed , the person will be agitated . [If the evi l] reaches the [。rigi n a l]
cha n 『 1 a nd [the disease] d。es n。t resolve, there wi l l be bl。。dy st。。1 .2
[This pattern] is ca l led fi re evil .
TEXT NOTES
1. [If the evil] reaches the [original] channel, 到 经 dao jfng: In six days, the evil
is said to make a complete p描sage through the channels. On the seventh day
it returns to the greater y缸g channel.
2. Bloody stool, 清 血 qfng xue : 清 qfng is used as 圃 qzng and means toilet or
using the toilet. Thus, this term means blood in the stool.
SYNOPSIS
An aggravated pattern in which fire evil descends and damages the yin network
vessels.
COMMENTARY
Greater yang disease is treated by resolving the exterior. Here, fire fuming is
used to force sweating, but it is unsuccessful. Because no sweat issues, the heat
evil is trapped in the interior, unable to move outward and exacerbated by the fire
treatment. Heat evil in the interior easily harasses the spirit and causes agitation.
If the evil makes a complete p描sage through the channel system and does not
resolve, it means that the y缸g evil is severe and that the heat has fallen deep into
the interior. Heat deep in the interior cannot be eliminated through sweating. It
scorches the yin channels and harasses the blood, causing 仕enetic movement of the
blood and ultimately the appearance of blood in the stool. Because this pattern
occurs following adverse treatment with a heat method that causes exuberant heat
in the interior, it is termed fire evil.
LINE 1 1 5
脉浮热甚 , 而反灸 之 , 此为实 , 实以虚治 , 因 火 而动 , 必咽
燥吐血 。
Mai Ju re sh切, er fan jiu zhz,
dong, bi yan zao tu xue.
ci
w
ei sh{, sh{ yi XU zhi, yzn huo er
[When] the pu lse is floating a nd the heat is severe, but moxi bustion [is
used] , this is repletion a nd [he叫 repletion is bei ng treated as vac u ity;
256
1 . GREATER YANG
[ LINE 1 1 6]
beca use [the bl。。d] is sti rred 1 by the fi 凡 there wi l l be d ry th roat a nd
bl。od ejection . 2
TEXT NOTES
1. Stirred, 动 dong: The blood moves in abnormal patterns.
2. Blood ejection, 吐 血 tu xue : The expulsion from the mouth of blood that
comes from the stomach ( v。因ting of blood ) or the lung and throat ( coughing
of blood ) .
SYNOPSIS
Blood ejection and dry throat from counterflow ascent of fire evil, following the
inappropriate use of moxibustion.
COMMENTARY
A floating pulse and great heat generally indicate an exterior pattern in which
the heat evil is exuberant. This is a repletion pattern, but it is treated as if it is
a vacuity pattern and moxibustion is used. The physician may have thought that
this was a c臼e of extreme y但g debilitation, in which the pulse was floating and
the heat was a result of the yang qi floating to the surface of the body, prior to
desertion.
The heat evil is further strengthened by the use of fire and it attacks the interior.
Exuberant heat scorches the blood vessels and damages the yin. Because the yin
is damaged, the throat becomes dry. The heat evil also causes stirring of the blood
and frenetic movement of the blood outside the vessels. Blood from the stomach or
from the lung and throat is ejected from the mouth.
LINE 1 1 6
(一) 微 数 之 脉 , 慎 不 可 灸 。
仁) 因 火 为 邪 , 贝lj 为 烦 逆 , 追 虚
逐实 , 血散脉 中 , 火 气 虽 微 , 内 攻有 力 , 焦 骨 伤筋 , 血难复
也。
仨) 脉 浮 , 宜 以 汗 解 。
侧 用 火 灸 之 , 邪 无从 出 , 因 火 而
盛 , 病从腰 以 下 , 必重而痹 , 名 火 逆也 。
先烦 , 烦乃有汗而解 。
(五) 欲 自 解 者 , 必 当
(六) 何 以 知 之 ? 脉 浮 , 故 知 汗 出 解 。
( 1 ) Wei shuo zhf mai, shen bu ke jiu. (2) Yfn huo wei xie, ze wei
fan 时, zhuf XU zhu shi, xue san mai zhong, huo qi suf W函, nei gong
y ou li, jiiio gu shang jzn, xue nan fit ye. (3) Mai JU, yi yi han jie.
(4) Yong huo jiu zh毛 xie WU c6ng chu, yin huo er sheng, bing c6ng
yao yi xia, bi zho叼 er bi, m 加g huo ni ye. (5) Yu zi jie zhe, bi dan
xiiin fan, fan ηai Uδu han er jie. (6) He yi zhf zhf? Mai JU, git zhz
han chu jie.
( 1 ) [When] the pu lse is fai nt a nd ra pid , [。ne m 川 be] ca uti。因 a n d
not use moxi bustio n . (2) Beca use fi re i s a n evil , it wi l l [ca use] vexation
1 . GREATER YANG
[ LINE 1 16]
257
c。u nterfl。w , 1 [ as if) seeki ng vacuity a nd p u rsuing repletion , 2 a nd [ it
wi l l ] d issi pate the bl。。d from the pu lse.3 Alth。ugh the fi re qi is m i ld ,
it attacks the i nterior forcefu l ly, pa rch i ng the b。nes a n d da magi n g t h e
si news ;4 a nd I。ne knows) the bl。。d is d ifficu lt t。 rest。阻5 ( 3 ) When
the pu lse is floati ng, it is a ppropriate to res。Ive [the exteri。r] th rough
sweating. ( 4) Usi ng fi re a nd moxi bustion , the evi l has no ( place) from
which t。 effuse a n d beca use 。f the fi 阻 [ it bec。mes) exu bera nt. From
the l u m bus down , there wil l be heavi ness a nd i m ped i ment6 a n d t h is
is ca l led adverse [treatment by) fi 陀 ( 5 ) When [the d isease) is a bout
to res。Ive, there wi l l fi rst be vexation , then sweatin g a nd resol ution .
(6) How does 。ne know th is? The pu lse is floati ng; hence 。ne knows
that sweati ng wi l l res。Ive [the d isease) .
TEXT NOTES
1. Vexation counterflow, 烦 逆 fan ni : Depressed heat in the interior and conn­
terfiow 拙cent of fire qi.
2. [As if] seeking vacuity and pursuing repletion, 追 虚 逐 实 zhuf xu zhU shi: The
use of a fire method increases the vacuity and the repletion. Originally, yin
vacuity and heat repletion were present; hence the use of a fire method exac­
erbates yin vacuity and fortifies heat repletion.
3. Dissipate the blood from the pulse, 血 散 脉 中 xue san mai zhδng : Blood vacuity
is a component of yin vacuity. Because the heat is severe, it damages the yin
and blood and causes an empty feeling in the pulse.
4. Parching the bones and damaging the sinews, 焦 骨 伤 筋 jiao gu shang jfn: The
heat disperses and scorches the yin humors. The bones and sinews lose normal
moistening and nourishment .
5 . The blood is difficult to restore, 血 难 复 也 xue nan JU ye: Once an evil enters
the blood, it becomes more difficult to treat. Furthermore, blood is a yin
substance and it is generally accepted that it is easier to boost y缸g than to
enrich yin.
6. Heaviness and impediment 重 而 痹 zhong er bi: A feeling of heaviness in the
lower limbs and difficulty in walking. Here, 痹 剖, often used to denote a
category of diseases that are caused by wind, cold, and dampness invading the
channels and that manifest in limb pain and joint pain ( notably conditions
classi且ed as rheumatis皿 or sciatica in modern medicine ) , is used descriptively
to mean impeded physical movement.
SYNOPSIS
τ'ransmuted patterns following the inappropriate use of moxibustion in vacuity
heat or unresolved exterior patterns.
COMMENTARY
This line comprises three sections, each presenting a basic concept. The 直rst is
the first two sentences, from the beginning of the line to “the blood is difficult
258
l.
G REATER YANG [LINE 58]
to restore.” The second is the third and fourth sentences, ending at “adverse
[treatment by] fire" ; and the last is from there to the end of the line.
The 且rst section presents the concept that in c臼es of vacuity heat, one cannot
use heat methods. Moxibustion is the example given in the text, but in vacuity heat
patterns, any heat method is inappropriate. The pulse is faint and rapid, indicating
yin vacuity with effulgent heat; therefore, one should enrich yin and clear heat. Fire,
although it can be used therapeutically, also represents an evil. If a 且re method
is used here, the fire will further damage yin and assist the heat. The fire evil
distresses the interior and contends with the vacuity heat, causing both the heat
and the vacuity to become more severe. As heat generally has a tendency to rise
in the body, this severe heat attacks upward and harasses the heart spirit, causing
vexation, na皿ed “vexation counterflow.”
When yin is damaged, the blood becomes vacuous. The original vacuity is made
worse by the use of an inappropriate method, damaging the blood to the point that
it dissipates from the pulse and the pulse begins to move abno口nally. Although the
heat method used, perhaps moxibustion, is described as mild, its effect on a patient
with yin vacuity heat is still quite strong. By dispersing the fluids and scorching yin,
it causes the loss of normal moistening and nourishment. This dries out the bones
and sinews and also is likely to affect the skin and flesh. At this point, because the
damage to yin and blood is severe, restoring it to normal is difficult.
When the pulse is floating, it is important to determine the presence or absence
of an exterior condition. If an exterior condition is present, it is appropriate to
resolve the exterior through the promotion of sweating, making the evil follow the
sweat out of the body. Use of a fire method constitutes using a supplementing
method to treat repletion and will deprive the evil of any path out of the body.
The fire boosts the heat evil, causing exuberant heat. The heat rises up, forcing
the qi and blood up with it. Heaviness and impediment in the lower body result
from the lack of qi and blood. This pattern is called “adverse [treatment by] fire.”
When the patient is about to recover, the pulse is floating and vexation and
then sweating occur. A pulse that is floating indicates that right qi is rising up
to dispel the evil from the exterior. When the right φ becomes hyperactive and
contends with the evil, vexation may be observed. Following vexation, sweat issues
and the disease resolves. One knows that vexation is a sign of imminent recovery
because the pulse is floating. Vexation is not a sign of an internal disease process,
but is a sign of right ql contending with the evil in the exterior.
4 . 1 5 RECOVERY PATTERN IDENTIFICATION
LINE 58
凡病 , 若发 汗 、
若吐 、
若下 、
若亡血 、
亡津液 , 阴阳 自 和
者, 必 自愈。
Fan bing, ruo fa han、 ruo 挝、 ruo xia、 ruo wang xue、 wang fin
y e , yin yang zi he zhe, bi zi yu.
1.
GREATER YANG [LINE 59]
259
I n a ny i l l ness, if sweati ng is prom。ted , [or] if vomiting [or] if precipitation
( has been used ] , [ a nd ] if [as a result] the bl。。d colla pses* [。r] liq uid
a n d h u mor c。l l a pse, when 泸n a nd ya ng sponta ne。usly h a rm。nize, [the
person ] wil l sponta neously recover.
TEXT NOTE
*
Blood collapses, 亡 血 wang xue : This term means blood vacuity, which can
be the result of blood or fluid loss and does not necessarily mean a pattern of
critical blood loss, as the modern usage of this term might suggest. See also
line 347, p. 555, and line 87, p. 104, for other examples of this term.
SYNOPSIS
In any disease, when yin and y归g spontaneously harmonize, there can be spon­
taneous recovery.
COMMENTARY
This line is a general commentary on the process of recovery from disease. The
use of the term “all diseases" means that it is a discussion of any disease condition,
not specifically cold damage or greater y缸g disease. It does not matter what
treatment was used, be it vomiting, precipitation, or the promotion of sweating, or
what disharmonies exist, including fluid or blood collapse. In all these cases, yin
and yang must harmonize before recovery can occur.
The goal of pattern identification and treatment determination is to provide
treatment that allows yin and yang to return to a harmonious balance. The under­
lying principle of this concept and the reason the word “spontaneous,” 自 刻, is used,
is that the restoration of this balance is dependent on the ability of the body itself to
return to harmony. In many situations, the restorative process occurs without the
patient ingesting any medicine; when medicines are used, one must remember that
they provide assistance to a natural process, rather than being entirely responsible
for the cure.
LINE 59
付 大 下之后 , 复 发 汗 , 小 便 不 利 者 , 亡津液故也 。
之 , 得 小 便 不lj , 必 自 愈 。
ω 勿治
( 1 ) Da xia zhz hou, Ju fa han, xiao bian bu li zh已 wang jfn ye gu ye.
(2) Wu zhi zh豆 de xiao bian li, bi zi yu.
( 1 ) When after great preci pitation , sweati ng is then promoted , a nd [as
a resu lt] u ri
col la psed . (2) Do not t陀at [t h i s] ; [once] the u rine is d isi n h i bited , [the
person ] wi l l sponta neo叫y 附over.
SYNOPSIS
A pattern of inhibited urination from liquid damage following inappropriate
treatment .
260
l . GREATER y ANG [LINE 93]
COMMENTARY
If one patient is given both precipitation and sweating, it is normally in the
order of first promoting sweating and then precipitation, although this general rule
may be modified when the interior pattern is severe and the exterior pattern is mild.
In this case, precipitation is used 且rst and it fails to resolve the exterior condition
and da皿ages the fluids. Sweating is then promoted in an attempt to resolve a
condition that has probably shifted into the interior, and the fluids are further
da皿aged. Following these treatments, urination becomes inhibited, indicating that
the mistreatment has caused fluid collapse.
Zh加g JI advises us not to treat this patient and his admonition has been
interpreted in two w町s. Cheng Wu-Ji writes, “ . . . one cannot disinhibit [the urine]
with medicinals. Wait until the fluids are sufficient and the urine is uninhibited,
then there will be spontaneous recovery.” In this interpretation, one should provide
no treatment and should wait for the natural processes of the body to restore the
fluids. This interpretation reminds one of the previous line and the process of the
restoration of harmony between yin and y缸g.
Ke Qin, however, offers a slightly different perspective: “ [The admonition] not
to treat is a contraindication of [treatment ] to disinhibit the urine. It does not
suggest that one should wait for spontaneous recovery. When a patient with fluid
collapse is not [treated] to engender liquid, how can the urine be disi出ibited?
[If one] desires to disinhibit the urine, [one should] treat by boosting the fluids.”
According to this point of view, Zhang JI is cautioning against the use of medicinals
to disinhibit the urine, not the use of all medicinals. If one engenders the fluids,
it will 描sist the natural processes of the body, restore harmony, and bring about
recovery.
In either case, once the urine is disinhibited, one knows that the fluids have
been restored, either through the natural processes of the body or the 副sistance of
medicinal therapy. Once the fluids are restored, the disease will resolve.
LINE 93
付 太 阳病 , 先 下 而 不 愈 , 因 复发 汗 , 以 此 表 里俱虚 , 其人 因
致 冒 。 (斗 冒 家 汗 出 自 愈 。 (三) 所 以 然 者 , 汗 出 表 和 故 也 。 (四)
里未和 , 然后复下之。
{ 1 ) Tai yang bing, xi伽 xia er bu yu, yin Ju fa han, yi ci biiio li ju
XU, qi ren yin zhi mao. {2) Mao jia han chu zi yu. {3) Suo yi ran
zhe, han chu biao he gu ye. ( 4) Li wei he, ran him Ju xia zhz.
{ 1 ) [When i n] greater ya ng d isease, i n itia l precipitation fails to bri ng
a bout recovery [a nd] sweating is then promoted , a nd beca use 。f this
[there is] d u a l i n川ter 问xteri。r vacu ity, the person [wi l l be] en阳Cl』
by vei l i ng [d izzi『1ess] . * {2) Vei l i n g [d izziness] patients wi ll recover spon­
ta n eously after sweati ng. {3) This is beca use sweating harmonizes the
1 . G REATER YANG [LINE 93]
261
exterior. (4) The i n川teri。r is n。t yet har『T
sh。t』1 ld preci pitate.
TEXT NOTE
*
Veiling [dizziness] , 冒 mao: A feeling of cloudiness and dizziness in the head
and eyes, as if something is obscuring them.
S YNOPSIS
The treatment of veiling dizziness that occurs in greater y缸ig disease after the
promotion of sweating and use of precipitation.
COMMENTARY
In greater yang disease, it is generally not appropriate to precipitate 且rst. This
treatment may damage right qi and result in the evil falling into the interior. Here
precipitation is used, and because it is inappropriate treatment, the exterior pattern
does not resolve. Sweating is then promoted in an attempt to resolve the exterior
evil. The result of this mistreatment is that both the exterior and the interior
become vacuous. When the right qi is vacuous, the evil lingers and clouds the clear
yang in the upper body, causing veiling dizziness.
Cheng Wu-Ji explains the sign of veiling 础 follows: “Veiling means depression.
Precipitation results in interior vacuity and blood collapse. Sweating results in
exterior vacuity and yang collapse. The exterior and the interior are both vacuous,
the cold [ evil] qi is depressed, [ the cle缸 yang φ cannot ascend] and as a result , the
person [ experiences] veili吨-”
The use of precipitation causes interior vacuity. The promotion of sweating causes
exterior vacuity. In this situation, the evil obstructs the exterior and the yang qi
does not ascend properly. When the clear yang does not ascend, the patient feels
dizzy and unclear.
In this pattern, mistreatment causes vacuity of right qi, but this vacuity is not
severe. If right qi naturally returns, it will be able to overcome the evil qi. At that
point, sweating will occur and the disease will resolve. As Zhang JI explains in the
text, this resolution occurs because the outward movement of sweat dispels evil qi
and harmonizes the exterior. Because the patient w描 originally mistreated and has
some mild vacuity, it is possible that no treatment should be given to 甜sist in the
process of resolving the exterior. Nonetheless, one could gently effuse the exterior,
while simultaneously supporting right qi in order to expedite this process.
After the patient sweats, if the veiling dizziness resolves, but the interior is still
in disharmony and the stool is blocked, one can again use a formula to precipitate
the interior. This treatment will free the stool and harmonize the stomach.
This treatment process illustrates the importance of correct timing when treat­
ing simultaneous dise副es of the interior and exterior. One must 趾st identify the
exterior pattern and the interior pattern, then decide which is most severe. At that
point one can decide the order in which the two patterns should be treated. In
general, it is important to resolve an exterior pattern prior to treating the interior
pattern, as the example above illustrates.
262
1.
G REATER YANG [LINE 94]
LINE 94
卜) 太 阳 病 未 解 , 脉 阴 阳 俱 停 , 必 先 振 栗 汗 出 而 解 。
脉微者 , 先汗出 而解 ; 但阴脉微者 , 下之而解 。
口 但阳
(三) 若 欲 下
之 , 宜调 胃 承气汤 。
( 1 ) Tai yang bing wei jie, mai yin yang ju t伽g, bi xiiin zhen li han
chu er jie. (2) Dan ya叼 mdi wei zhe, xiiin han chu er jie; dan yin
mdi wei zhe, xia zhr er jie . (3) Ruo yu xia zhr, yi tiao wei che叼 qi
tang.
( 1 ) I n greater ya ng disease that has not yet resolved , [if) the yTn ya ng
pu lses b。th st。 p , 1 [the person) wi l l fi rst sh iver, [then) sweat , and then
[the disease) wi l l res。Ive. (2) If 。 n ly the ya ng pu lse [m。ves) slightly, 2
fi rst sweat [wil l) issue a nd then [the disease) wi l l res。Ive. If 。nly the
yTn pu lse [ moves) sl ightly, preci pitate a nd then [the disease) wi l l resolve.
(3) If one desi res to preci pitate, St。mach- Regu lati ng Ql-C。。rd i nati ng
Dec。cti。n ( tiao wei che·叼 qi tang ) is a p propriate.
TEXT NOTES
1. The yin y缸g pulses both stop, 脉 阴 阳 俱 停 mdi yzn yang ju ting: The inch
and cubit pulses 町e both hidden and cannot be felt.
2 . Pulse moves slightly., 脉 微 mdi wei: Slight movement can be felt, in comparison
to the beginning of the line, in which the pulse is hidden and cannot be felt.
Because 微 wei can be interpreted as “faint,” Wang Hu writes, “This is not
the ‘faint’ of a pulse that is faint and weak.”
SYNOPSIS
The relationship between the pulse suddenly stopping and shiver sweating.
COMMENTARY
When a greater y缸g disease has not resolved, one would expect the pulse to
be floating, but here it is hidden and cannot be felt. This pulse indicates that
the qi and blood have been depressed by the evil and cannot outthrust. It is one
manifestation of the struggle between right qi and evil φ. When right qi is able
to counter evil qi, the patient shivers, indicating that evil qi is being forced out
and is no longer depressed. Sweat will then issue and the disease will resolve. This
pattern is known as shiver sweating.
In the second p町t of this line, the pulse manifestation is used to determine
what course the disease will follow. Wang H诅 writes, “ [When] the evil stagnates in
the channel, the exterior qi cannot outthrust orderly; hence the y缸g pulse [moves]
slightly. [ When] the evil stagnates in the bowel, the interior qi cannot flow freely;
hence the yin pulse [moves] slightly.” If the ya吨 pulse moves slightly, it means
that the exterior y缸ig has been blocked and depressed by the exterior evil. Once
sweat issues, the disease will resolve. Modern commentators suggest that, although
no treatment is offered in the text, it may be necessary to supplement yin, yang,
1 . G REATER YANG [LINE 1 52]
263
qi, or blood of vacuous patients in order to assist the source of the sweat. If this
type of treatment is not provided, the patient may be unable to sweat .
If the yin pulse moves slightly, indicating that the evil is blocking the free flow
of φ in the interior, one must attack the interior. When the evil is discharged, the
qi will be able to fl.ow freely. Stomach-Regulating Qi-Coordinating Decoction ( tiao
时t cheng qi tiing) is suggested because it is a moderate formula for precipitating
the interior.
5
PATTERNS SIMILAR TO GREATER YA.NG
DISEASE
The section below presents two patterns that are similar to greater yang disease.
These patterns must be carefully distinguished because the formulae used to treat
them are harsh and easily damage the right qi. The first is a pattern of collected
rheum in the chest and rib-side, and it is treated with Ten Jujubes Decoction (ski
zao tiing) , a harsh formula that expels water-rheum. The second is phlegm repletion
in the chest and diaphragm, which is treated with Melon Stalk Powder (guii di san) ,
a formula that causes the patient to vomit.
5 . 1 TEN JUJUBES DECOCTION PATTERNS
LINE 1 5 2
←) 太 阳 中 风 , 下 利 , H区 逆 , 表 解 者 , 乃 可 攻 之 。
(斗 其 人 荣
毅 汗 出 , 发作有时 , 头痛 , 心下痞硬满 , 引 胁下痛 ,
干 H区 短
气 , 汗出不恶寒者 , 此表解里未和也 , 十枣汤主之 。
( 1 ) Tai ya叼 zho叼 Jeng, xia li, OU 叫 biao jie zhe, nai ke gong zhz.
(2) Qi 俨en zhe zhe han chu, fa zuo you sh{, t6u tong, xzn xia pi ying
man, yin xie xia tOng, gan δu duan qi, han chu bu WU han zhe, ci
biao jie li wei he ye, sh{ zao tang zhu zhf.
( 1 ) When , in greater ya ng wi nd stri ke with d i a rrhea 1 a nd 时chi ng cou n­
te州。w, the exterior has resolved , 。ne ca n attack. (2) When the person
has d 巾zly sweati ng2 that 。ccu rs at [set] ti mes, headache, hard glom u s
a nd fu l l ness bel。w t h e heart a nd pa i n extending u nder the ri b-side, d ry
retchi ng, shortness of breath , sweati ng, a n d a bsence of aversion to cold ,
this mea ns [th at] the exterior has resolved a n d the i nterior is not yet
harm。n ized . Ten J uj山es Decoction ( shi zao tang) g,。verns.
TEXT NOTES
1. Diarrhea, 下 幸Jj xid li : Here the character 和l li , which means disinhibit, un­
inhibited, or bene缸, is used in the specific sense of uninhibited movement of
stool, i.e. , diarrhea. In this sense, 手lj li has to some extent been replaced by
its homophone 躏 li , diarrhea or dysentery.
1 . GREATER YANG [LINE 1 52]
264
2. Drizzly sweating, 裴 亵 汗 出 zM zM him chu: Slight sweating. The character
荣 zM was originally used in descriptions of small amounts of rain or small
amounts of sweat .
FORMULA
Ten Juj由es Decoction ( shi zii.o tang)
o
Attack and expel water-rheum.
芫花 ( 熬 )
甘遂
大鞍
忖 右 三 昧 , 等 分 , 各 别 捣 为 散 。 仁) 以 水 一 升 半 , 先 煮 大 枣 肥 者 十
枚 , 取 八 合 , 去淳 , 内 药末 。 同 强 人 服一钱 匕 , 赢人服半钱 , 温服
之 , 平 旦 服 。 (四) 若 下 少 , 病 不 除 者 , 明 日 更 服 加 半 钱 , 得 快 下 利 后 ,
靡粥 自 养 。
win hua ( ao ) g伽 sui da jz
( 1 ) You san wei, deng fen, ge bie dii.o wei sii.n. (2) Yi shui yz sheng ban, xian
zhil da zii.o fei zhe shi mei, qii. bii g已 qu zi, na yao mo. (3) Qiang ren Ju yz qian
bi, lei ren Ju ban qian, wen Ju zhf, ping dan JU. ( 4) Ruo xia shii.o, bing bu chU zhι
ming 时 geng JU jia ban qian, de kuai xia Li hou, mi zhou zi yang.
gen kwa ( 芫 花 yuan h ua, Da phnes Gen kwa Flos) (d 吁fry)
ka nsui ( 甘 遂 g伽 sui, Kansui Radix)
eu phorbia/knoxia ( 大 斡 da ji, Euphorbiae seu Knoxiae Radix)
j uj u be ( 大 枣 da zii.o, Ziziphi Fructus) 10 pieces
( 1 ) [For) the above th ree i ngredients [use] eq u a l pa巾. Pound separately and [make
i nto) a powder. (2) U se one a n d a half sheng of water to fi rst boil ten plu m p juj u be
( da zii.o ) to get eight g�. Remove the d regs a nd add the medici n al powder. (3) Strong
people [ca n) ta ke one and a h a lf q ia n . Wea k people [can) take a h a lf q ia n . Take warm ,
at ca l m dawn .* (4) If diar阳a is sca nt a nd the disease is not elim i nated , take again the
next day a nd add a h a lf q i a n [mo叫 . As soon as diarrhea occu rs, [the person should
eat) rice gruel for nourish ment.
FORMULA N OTES
*
Calm dawn , 平 旦 pzng dan : Early in the morning. According to some sources,
this is 5-7 A . M . , and according to others it is 3-5 A . M .
SYNOPSIS
The signs and treatment of collected rheum in the chest and rib-side, and the
differentiation between this pattern and greater yang wind strike.
C OMMENTARY
Greater yang wind strike is an exterior condition characterized by signs such
as aversion to cold, heat effusion, and headache. When in the course of wind
strike disease one does not see these signs, but instead sees diarrhea and retching
counterflow, this transmutation indicates that the exterior pattern has resolved and
water-rheum has formed in the interior. Water-rheum accumulating in the lower
burner causes diarrhea and when it ascends counterflow, attacking the stomach, it
causes retching counterflow. After the exterior pattern has resolved one can attack
1 . G REATER y ANG [LINE 1 52]
265
the water-rheum in the interior. Zhang JI reinforces the idea that the exterior
pattern has resolved by reminding the reader, in the second line, of the absence of
aversion to cold.
This pattern is suspended rheum evil in the chest and rib-side. The presence
of this evil congests the ql dynamic and results in a hard glomus with fullness and
pain. One may 皿k if the presence of rheum evil directly causes the glomus or if
the glomus is the result of congestion of the φ dynamic. Both answers 町e valid.
A suspended rheum evil is thought to be able to cause a glomus directly and its
presence also congests the ql dynamic, one of the causes of glomus.
Rheum evil disrupts the ql dynamic and covers the clear y缸g, impairing its
ascent and giving rise to headache. The stomach likes dryness and when the rheum
seeps into the stomach, it causes disharmony and impairs downbearing; therefore,
stomach ql ascends counterflow. The rheum follows this counterflow 部cent and
harasses the lungs, causing an inhibition of lung ql and shortness of breath.
The presence of headache, sweating, and retching counterflow may indicate a
wind strike pattern, but the sweat only issues slightly and aversion to cold is absent .
These points are the keys to the differentiation of this pattern.
This pattern of suspended water rheum in the chest and rib-side is a repletion
pattern; therefore, one can attack and expel the water-rheum. Ten Jujubes De­
coction ( shi zii.o tang) is a harsh formula for expelling water-rheum and must be
used carefully. Genkwa ( yuan huii), kansui (g伽 sui), and euphorbia/knoxia ( da
ji) are cold, bitter, and toxic. They drastically precipitate and drain water, and
缸e the sovereign medicinals in the formula. The nature of the formula is drastic
and fierce, and when its use is appropriate, the effect is very rapid. Because these
medicinals are toxic and attack evil, they can also damage the ql of the spleen and
stomach, as well 幽 right ql; consequently, jujube ( da zii.o) is included in the formula
to supplement the spleen and support the right . Jujube ( da zii.o) also moderates
and harmonizes toxic medicinals. The amount of juj ube ( da zii.o) used is large when
compared to the other ingredients, which is why the formula is named after jujube
(da zii.o) .
The preparation and ingestion method is designed t o moderate the harshness
of the precipitating agents. Jujube ( da zii.o) is cooked to extract all of its supple­
menting action, but the other agents are made into powder and simply added to
the decoction; they 缸e not cooked at all. This method is similar to the one used
for Rhubarb and Coptis Heart-Draining Decoction ( da huang hu问 lian xie xrn
tang) and Aconite Heart-Draining Decoction (Ju zi xie xfn tang) in that the φ of
the harsh ingredients is extracted without the full flavor of those ingredients . One
qian seven fen of this formula may be used with strong patients and for weaker
patients, only a half qian should be used. This formula should not be used at all
for patients who are pregnant . The powdered ingredients can be irritating to the
throat, so modern texts suggest putting the powder into capsules.
If after taking the formula the disease has not been eliminated and mild diarrhea
is present, a slightly larger amount of the formula may be given the following day.
The dosage should be regulated on the basis of the patient’s constitution and the
disease condition. The patient should eat rice gruel in order to nourish the spleen
and stomach and consolidate the effect of the treatment .
1 . GREATER YANG [LINE 1 66]
266
5 . 2 MELON STALK POWDER PATTERNS
LINE 1 66
病 如 桂枝证 , 头 不 痛 , 项 不 强 , 寸脉微浮 , 胸 中 痞硬 , 气上
冲喉咽不得息者 , 此 为 胸有寒也 , 当 吐 之 , 宜瓜蒂散。
Bing ru gui zhz zheng, t6u bu tong, xiang bu jiang, cun mai w函 JU,
xiong zhδng pi ying, qi shang chong h6u yan bu de xf zhe, ci wei
xiong you han ye, dang tu zhZ, yi gua di san.
When i n a n i l l ness that resem bles a Cinna mon Twig [ Dec。cti。n ] pattern
headache a nd stiff n a pe a re a bsent, the inch pulse is slightly fl。ating,
[there is] h a rd glom 山 i n the chest, a nd qi su rges u pward t。 the t h roat
s。 [the person ] ca n not breathe, this i n dicates that [there i 斗 cold i n
t h e chest a nd that vom iti ng sh。u ld b e used ; [the时。陀, l Melon Sta l k
p。wder (gua di san ) i s a pp即riate.
FORMULA
Melon Stalk Powder (gua di siin)
o
Eject phlegm repletion.
瓜蒂一分 ( 熬黄 ) 赤 小 豆一分 付 右二昧 , 各别捣筛 , 为散 已 , 合
治 之 , 取 一 钱 匕 , 以 香 鼓 一 合 , 用 热 汤 七 合 , 煮 作 稀 靡 , 去 津 。 (斗
取 汁 和 散 , 温 , 顿 服 之 。 (三) 不 吐 者 , 少 少 加 , 得 快 吐 乃 止 。 诸 亡 血
虚 家 , (四) 不 可 与 瓜 蒂 散 。
Gua di yf fen ( ao huang) chi xiiio dim yf fen
( 1 ) You er w剖, ge bie diio sh函, wei siin yi, M zhi zhf, qu yz qian bi, yi xiang
chi yf ge, yong re tang qf g已 zhU zuo xz mi, qu zi. (2) Qu zhf huo s伽, ω旬, dun JU
zhf. (3) Bit tit zhe, shiio shiio jia, de kuai tu niii zhi. ( 4) Zhu wang xue XU jia, bit
ke yi gua di siin.
melon sta l k ( 瓜 蒂 gua di, C ucumeris Melonis Pedicellus) 1 fen (d ry-fry u ntil yellow)
rice bea n (赤 小 豆 chi xiiio dou, Phaseoli Calcarati Semen ) 1 伍n
( 1 ) [For] the above two ingredients pou n d a nd sieve separately. [Ma ke into] a powder
a nd co m bi n e to treat, using a qia n-spoonfu l . Ta ke one gl:? of fermented soybea n (xiang
chi) ; use seven g运 of hot water and boil to m a ke a thi n gruel . (2) Remove the d regs
a nd com bi ne the j u ice with the powder. Ta ke warm as a single dose. (3) [If the person]
does not vomit, add a little [mo陀] . As soon as [the person] vomits, stop. (4) All blood
col la pse and vacuity patients ca n not be given Melon Stal k Powder (gua di siin) .
SYNOPSIS
The signs and treatment of phlegm repletion in the chest and diaphragm, and
the differentiation between this pattern and greater yang wind strike.
l . G REATER YANG
[LINE 76A}
267
COMMENTARY
This pattern is described as bein� similar to wind strike, suggesting that heat
effusion, aversion to cold, and sweating may be present. The absence of heada­
che and neck stiffness and a pulse that is only slightly floating indicate that this
pattern perhaps is slightly different from an exterior condition. Furthermore, the
most important signs are hard glomus in the chest, qi surging up to the throat ,
and inability to breathe normally. Zhang JI tells us that cold is present in the
chest. This information, when combined with an analysis of the formula, suggests
the presence of phlegm-rheum congested in the area of the chest and diaphragm.
Phlegm-rheum repletion in the chest congests the φ dynamic and causes a h缸d
glomus to form. Qi ascends counter:且ow followed by phlegm surging up into the
throat and impairing normal breathing. The inch pulse reflects the status of the
upper burner. Phlegm-rheum congests in the chest and the right qi contends with
the evil; hence the inch pulse is floating. Because a repletion evil is present in the
upper burner, vomiting treatment is used.
Melon Stalk Powder (gua di sii.n) eliminates phlegm repletion in the upper
burner by causing the patient to vomit. The sovereign ingredient , melon stalk (guii
di) is extremely bitter, and causes vomiting. Sour rice bean ( chi xiii.o dim) increases
the ability of the formula to cause vomiting.
6
CHAPTER APPENDIX
LINE 76A
发汗后 , 水药不得入 口 , 为逆 ; 若 更发 汗 , 必吐下不止 。
Fa han hou, shui yao bu de ru kou, wei ni; ru<J geng fa han, bi tu
xia bu zhi.
After sweating is promoted , water medicinals have not entered the
mouth [ a n d there is vo m iting] beca use 。f [stomach qi] counterflow.
If sweating is aga i n pr。m。ted , there wi l l be i n cessa nt v。miti ng a n d
dia rrhea .
SYNOPSIS
If vomiting occurs after the promotion of sweating, further promoti on of sweat­
ing is contraindicated.
COMMENTARY
This line is the first part of line 76 and the rest of the line can be found under
line 76B , p. 144.
If after the promotion of sweating, the patient is vomiting before a decoction
even is swallowed, this means that the stomach qi is ascending counterflow. It
is possible that the stomach y缸ig qi is constitutionally vacuous a且d accompanied
by abiding rheum. The promotion of sweating causes the y缸g qi to stray to the
exterior, leaving the interior yang even more v配uous and stirring the abiding rheum
in the interior which then ascends counterflow. In this situation, although the
1 . G REATER YANG [LINE
268
141A]
exterior has not yet resolved, one cannot further promote sweating. If sweating is
again promoted, it will exacerbate the previous mistake and further damage the qi
of the spleen and stomach. This further da皿age will cause incessant vomiting and
diarrhea.
This line can be compared with line 74, p. 1 98, in which the patient vomits
after ingesting water. That is a pattern of water counterflow and it is treated with
Poria ( Hoelen ) Five Powder ( WU ling san ) .
LINE 1 4 1 A
忖 病在 阳 , 应 以 汗解 之 , 反 以 冷 水漠 之 , 若 灌 之 , 其热被劫
不 得去 , 弥 更益烦 , 肉 上粟起 , 意欲饮水 , 反不渴者 , 服文
始散 ; 若 不 差 者 , 与 五苓散 。
( 1 ) Bing zai yang, yzng yi han jie zhr, fan yi Zeng shui sun zhz, ruo
guan zhr, qi re bei jie bu qu, mi geng yi fan, rou shang SU qi, yi yu
yin sh叫 fan bu ke zh己 Ju wen ge san. (2) Ruo bu chai zhe, yu 时
ling san . . . .
( 1 ) When d isease is i n the ya ng, [。ne) shou ld [ promote) sweati ng to
res。Ive it, but here c。Id water is sprayed [on the patient) . * If [cold
water is) p。u red [over the patient ) , the heat wi l l be pl u ndered [ but] it
wi l l n ot be eli m i nated and in addition [there wi l l be) vexati。n , m i llet
[ pa p u l es] 。n the ski n , a desi re t。 d ri n k water but a bsence 。f [act u a l )
t h i rst [s。] ta ke Me陀trix C l a m S hel l p。wder ( wen ge san) . (2) If [there
is) no recovery, give p。ria ( H。elen ) Five Powder ( wu ling san) . . . .
TEXT NOTES
*
Cold water is sprayed [on the patient ] , 冷 水 撰 Zeng shuz sun : A treatment
method in which cold water held in the mouth was sprayed on the patient in
order to reduce heat in the body.
FORMULAE
Meretrix Clam Shell Powder ( wen ge san ) .
。
文蛤五两
忖 右 一 昧 , 为 散 。 (二) 以 沸 汤 和 一 方 寸 匕 服 , 汤 用 五 合 。
Wen ge wu liang. ( I ) You yf wei, wei san. (2) η fei tang hu o yf fang cun bZ
JU, tang yong w'ii ge.
me陀t rix cla m s h e l l
( 文 蛤 wen ge,
Meretricis Concha
)
5 Ii昌ng
(I) ( F。r) t h e i n gred ient a bove , [crush it i nto) a powd er. (2) M i x a sq u a re-i nch-spoon
[of the p owde r) i nt。 t h e boi led d ecoctio n . U se 5 g� of the decoction .
1 . G REATER YANG [ LINE
Poria ( Hoelen) Five Powder
( wu ling san )
30]
See l i n e
269
71, p. 1 95,
for a d iscussion of
this form u l a .
SYNOPSIS
The signs and treatment of cold depressed in the exterior.
COMMENTARY
This line is the first part of line 141 and the rest of the line can be found under
line 141B, p. 223 .
Disease of the y缸g means that there is a greater y缸g exterior pattern. The
appropriate treatment is to promote sweating in order to eliminate the evil from
the exterior. Here sweating is not promoted and cold water is instead sprayed on
the patient . Not only does this not resolve the exterior, it also causes the evil to
become depressed in the interstices. As a result , the heat effusion is not eliminated
and defense y缸g becomes increasingly blocked and depressed, causing vexation.
Cold governs contraction and when cold water fetters the fleshy exterior it causes
millet-papules to arise on the skin.
The patient has a desire to drink water in order to alleviate the vexation, but
becasue there is no heat in the interior actual thirst is absent. This manifestation is
one way to distinguish between vexation caused by depression of the exterior yang
and that caused by interior heat damaging fluid.
Meretrix Clam Shell Powder ( '11
trix clam shell ( wen ge) , wh ich is salty, cold and drying. It dissipates water-qi in
order to resolve the exterior depression in this pattern. Once the yang is unblocked,
the vexation should be eliminated. However, if this formula does not have the de­
sired effect , one can use Poria ( Hoele时 Five Powder ( wu ling sii叫 , which warms
yang, transforms 啡, disinhibits water, and harmonizes the exterior.
LINE 30
忖 问 曰 : 证象 阳 旦 , 按法治之而增剧 , 厥逆 , 咽 中 干 , 两 腔
拘急而沪语 。
师言。
ω 师 曰 : 言夜半手足 当 温 , 两脚 当 伸 ,
后如
(三) 何 以 知 此 ? 倒 答 曰 : 寸 口 脉 浮 而 大 , 浮 为 风 , 大
为 虚 , 风 则 生微热 , 虚 则 两 腔孪 , 病形象桂枝 , 因 加 附子 参
其 间 , 增桂令 汗 出 , 附子温经 , 亡阳故也 。
干 , 烦躁 , 阳明 内 结 ,
间 厥逆 , 咽 中
俨语烦乱 , 更饮 甘 草 干 姜 汤 。
(六) 夜
半 阳 气还 , 两 足 当 热 , 胚 尚 微拘 急 , 重 与 苟药甘 草 汤 , 尔 乃
腔伸 。
作) 以 承 气 汤 微 糖 , 员lj 止 其 俨 语 , 故 知 病 可 愈 。
( 1 ) Wen yue: zheng xidng ya叼 ddn, an fa zhi zhif 白’· zeng i毡, jue ni,
yan zhδng gan, Liang jing ju ji er zhan yil. (2) Shr yue: yan ye ban
shou zu dang wen, liiing jiao dang shen, hou ru shr yan. (3) He yi
zhif ci? ( 4) Da yue: cun kou mdi JU er dd, Ju wei Jeng, dd wei xii,
Jeng ze sheng wei re, xii ze Liang jing luan, bing xing xidng gui zhif,
270
1 . G REATER YANG (LINE 30]
yzn jia Ju zi can qi jian, zeng gui ling him chu, Ju zi wen jzng, wang
yang gu ye. (5) Jue ni, yan zhong gan, Jan zao, yang m仇g nei ji 已
zhan yu Jan lua叽 geng yin gan cao gan jiang tang. ( 6) Ye ban yaπ
qi hi』an, liang zu dang re, jing shang wei ju j{, zhong yu shao yao
gan cao tang, er nai jing shen. (7) Yi che·叼 qi tang wei M叼y ze zhi
qi zhan yu, gu zhz bing ke yu.
( 1 ) Q u estion : I n a pattern si m i lar to ya ng dawn , 1 (if the physicia n]
treats [t he patient] accordi n g to (the a ppropriate] method ,2 but [the
d isease] becomes more acute, [then] there is reverse-flow, d ryness in the
th roat, h yperto n icity of the lower legs, a nd delirious speec h . (2) The
master3 says: “ I n the middle 。f the n ight the extremities sho u ld be
warm a nd the two legs sh。uld be a ble to extend ." From here on,
proceed as the master sa id . (3) H ow does one know this? ( 4) Answer:
The i nch pu lse is floati ng a nd large; floating mea n s wi nd a nd large
mea ns vacuity. The wi nd engenders m ild heat, a nd (beca use 。f] vacu ity,
(there i斗 hype巾 n icity of the lower legs. The form of the i l l ness is l i ke
a Ci n n a mon Twig (Decoction pattern] , a n d beca use acon ite (Ju zi)
is added , it i ncreases [th e a bi l ity 。f] c i n 阳『1
t。 issue, a nd acon ite (Ju zi) [a lso] warms t h e cha n nels, so [there is]
ya ng c。l la pse. (5) [When there is] 陀verse-fl。w, d ryness i n the t h roat,
vexation a n d agitation , ya n g brightness i nterna l bind, del irious speech ,
a nd vexation a nd dera ngement, cha nge to Licorice a nd D ried Gi nger
Decoction (gan ciio gan jia·叼 tang) . (6) I n the middle of the n ight ,
the ya ng qi 时u rns, so the legs should become warm , (but if] (there is]
sti l l slight hype巾nicity of the lower legs, give a large (dose] of Pe。ny
a nd Licorice Dec。ct ion ( shao yao gan ciio tang ) , s。 that the lower legs
wi l l be a ble to extend . (7) Beca u se QI-Coord i nating Decocti。ns ( cheng
qi tang ) [ca use] slightly sloppy [stool] a nd then su ppress the delirious
speech , one knows (the person] ca n recover from the disease.
T EXT N OTES
1. In a pattern similar to yang dawn, 证 象 阳 旦 zheng xiimg yang dan : Yang dawn
pattern, 阳 旦 iIE yang dan zheng, is another name for the Cinnamon Twig
Decoction (gui zhr tang) patt ern . Nevertheless, on the basis of information
contained in Lei Zheng Hu6 Ren Shu ( 类 证 活 人 书 “The Life-Saving Book in
Systematized Patterns” ) , some commentators believe that 阳 旦 扬 y ang dim
tang is Cinnamon Twig Decoction (gui zhf tiing) plus scutellaria (huang qin) .
2. [if the physician] treats [the patient] according t o [the appropriate] method,
按 法 治 an fii zhi: Cinnamon Twig Decoction (gui zhf tang) should be given
according to the previous instructions for its ingestion.
l . G REATER y ANG [ LINE 75]
271
3. The master, 师 shf: It is not known to whom “the master" refers.
SYNOPSIS
Using a question and answer format , this line discusses the pathomechanism of
a pattern similar to y臼g dawn.
COMMENTARY
In this line, we are told that the patient exhibits signs that appear similar to
a Cinnamon Twig Decoction (gui zhf tang) pattern. We m町 refer back to line 29,
p. 187, and see such signs as a pulse that is floating and spontaneous sweating, but
also observed are heart vexation, hypertonicity in the limbs, and frequent urination ,
which are uncharacteristic of exterior vacuity patterns. Cinnamon Twig Decoction
(gui zh'i tang) is used to treat the patient, but instead of recovery, we observe
counterflow cold in the extremities, dry throat , hypertonicity of the lower legs, and
delirious speech.
As the line continues, it becomes more difficult to understand. We are told that
aconite (J边 zi) warms the channels and 副 a result , the yang collapses. This sequence
of events does not seem logical. Furthermore, the author combines y缸g brightness
internal bind signs of delirious speech, vexation, and derangement, with reverse
fl.ow, dry throat, and vexation and agitation, leaving the reader with the impression
that in this pattern, y缸g vacuity and exuberant heat appear simultaneously.
This line is placed in the appendix because of the difficulties in determining its
clinical significance, and because “master” may refer to Zhang JI, in which case the
reference would have been added to the original text .
LINE 75
(一) 未 持 脉 时 , 病 人 手 叉 自 冒 心 , 师 因 教 试 令 咳 , 而 不 咳 者 ,
此必两耳聋无 闻 也 , 所 以 然者 , 以重发汗虚故如 此 。
仁) 发 汗
后 , 饮水多 必喘 , 以水灌之亦喘。
( 1 ) wei ch{ mai sh{, bing ren shou cha zi mao xil叽 shi yin jiao shi
ling ke, er bu ke zhe, ci bi liang er long WU wen ye, suo yi 俨an zhe,
yi ch6叼 fa han xu gu ru ci. (2) Fa han hou, yin shui duo bi ch叫叽
yi shui guan zhi yi chuii.n.
( 1 ) [The master has] not yet 创t the pu lse a nd the person has thei r
ha nds crossed 。ver thei r hea rt. The master, beca use [of seeing this] ,
i nstructs the person t。 try to cough ; a n d [if the person] does n。t cough ,
t h is m ust be [beca use] the two ea rs a re deaf a nd do not hear. Why [th is]
is so is beca use of the repeated prom。ti。n 。f sweati ng, wh ich [ca used]
vacu ity. (2) When , followi ng the pr。motion 。f sweati ng, [t he person]
d ri n ks c。pi。us a m。u nts of water, there wi l l be pa nti ng; [a nd if] water
is pou red [ont。 the b。dy] * [there wi l l] a lso be pa nting.
272
1 . GREATER YANG [LINE 75]
TEXT N OTE
*
Water is poured [onto the body] , 以 水 灌 yz
bath or shower.
shuz guan:
The patient takes a
S YNOPSIS
a ) A diagnostic method for combining the looking examination with inquiry.
b ) Issues to which one should attend during the convalescent period after sweat­
ing and a transmuted pattern that can occur if inappropriate actions are taken.
COMMENTARY
This line is best understood when divided into two sections: the 且rst , comprising
the first two sentences; and the second, comprising the final sentence. When the
patient covers his / her heart , a pattern of heart vacuity and palpitations is likely.
The physician instructs the patient to cough, perhaps to investigate whether the
action of coughing will produce pain in the chest region. The patient does not
respond and it appe缸s that the patient ’s hearing is impaired. Deafness may be
differentiated into vacuity and repletion patterns. When combined with the sign of
covering the heart, it appears that this pattern belongs to vacuity. This conclusion
is reinforced by the statement in the text that the promotion of sweating has caused
vacuity. The reader is reminded that excessive promotion of sweating can damage
the essence ql of the heart and kidney. Although no treatment is indicated in the
text, one might consider using Cinnamon Twig and Licorice Decoction (gui zhr gan
ciio tang) with the addition of ingredients such as ginseng ( ren shen) and aconite
(Ju zi) , which w缸m the kidney yang.
In the second section of the line, following the promotion of sweating the patient
drinks a large 创nount of water. When sweating is promoted excessively, the fluids
缸e discharged through the exterior and the patient feels thirsty. If, however, a large
amount of water is ingested, it may collect in the interior leading to a pattern of
water amassment . In this pattern, the collected water-rheum counterflow ascends
and attacks the lungs, causing panting. Following the promotion of sweating, the
fleshy exterior is vacuous and the patient should be cautioned against bathing too
soon after the treatment . According to the authors of Gao Deng Cong Shu, if the
patient showers or bathes, water-cold ql can easily enter the body through skin and
body hair, to which the lung is connected. The evil, entering through the skin, then
blocks the lung φ and causes panting. These two panting patterns occur because
the patient is not sufficiently prudent following an illness. This line reinforces the
idea that a physician must not only diagnose and treat effectively, but also counsel
the patient with regard to prudent behavior.
1 . G REATER YANG [LINE 1 05]
273
LINE 1 0 5
忖 伤 寒十 二 日 , 过经沪语者 , 以有热也 , 当 以 汤 下 之 。
仁) 若
小 便利者 , 大便 当 硬 , 而反下利 , 脉调和 者 , 知医以丸药下
之 , 非 其 治 也 。 (三) 若 自 下 利 者 , 脉 当 微 厥 , 今 反 和 者 , 此 为
内实也 , 调 胃 承气汤主之 。
( 1 ) Sha叼 han shi san 叫p guo jfng zhan yii zhe, yi you re ye, dang yi
ta叼 xia zhr. (2) Ruo xiiio bian li zhe, da bian dang ying, er Jan xia
li, mai tiao he zhe, zhr yf yi wan yao xia zhf, fei qi zhi ye. (3) Ruo
zi xia li zhe, mai dang wei jue, jfn fan he zhe, ci wei nei shi ye, tiao
wei cheng qi tang zhu zhf.
( 1 ) When , i n c。Id d a m age [th at has lasted h什 th i rteen d ays, [there is]
cha n nel passage1 a nd deli rious speech , [it is] beca use 。f heat, a nd one
shou ld precipitate with a decocti。n . (2) If u ri nation is u n i n h i bited , the
st。。l sh。uld be hard ; but (if] i nstead [there is] diarrhea and the pu lse is
i n h arm。ny,2 one kn。ws the physicia n3 preci pitated with a pi l l med icine
a n d t h is is not the [c。r阳t] treatment. (3) If [there is] sp。nta n e。us d i­
a r阳a , the pu lse sh。uld be fa i n t a n d [there sh。u ld be] reversa l [cold] ,4
but now [there is] har『Y
f。re’] St。mach- RegL』 lating Ql-C。。rd i nati ng Dec。cti。n ( tiao wei cheng
qi tang) 6 g。verns.
TEXT NOTES
1. Channel passage, 过 经 guo jfng: The movement of evils from one channel to
another during the course of cold damage disease. The original disease pattern
ceases and a new pattern begins.
2. The pulse is in harmony, 脉 调 和 mai tiao he: Two interpretations have bee丑
offered for this term. The first is that the pulse is in harmony; that is normal.
The problem with this interpretation is that if the pulse were normal, disease
would be absent . The second and likelier interpretation is that the pulse is
in harmony with the current pattern, in this case a y缸g brightness disease.
Wang H诅 writes, “Now the pulse is instead harmonious. ‘Instead harmonim沛’
means that this pulse is not contrary to the yang brightness bowel pattern. If
the pulse were truly harmonious, disease would be absent."
3. The physician, 医 你 A physician other than Zhang JI himself. This is one
of a number of instances where Zhang JI is referring to the mistreatment of
a patient by another physician. In his preface to the text he is critical of
contemporary physicians and their poor skills.
4. The pulse should be faint and [there should be] reversal [co叫 , 脉 当 微 厥 mai
dang ω画 jue: This term may also be interpreted as meaning that the pulse
should be faint and reverting. The authors of Gao Deng Cong Shu do not
274
1 . GREATER YANG [LINE 1 05]
accept this interpretation on the grounds that it would be difficult to imagine
what a “reverting pulse" is.
5. Harmony,, 和 he: Harmony means that the pulse is not faint and there is no
reversal, as one would expect, but instead the patient appe缸S normal.
6. Stomach-Regulating Qi-Coordinating Decoction ( tiao 毗 ch何 qi tang): A
complete discussion of this formula can be found with line 248, p. 327.
SYNOPSIS
The signs and treatment of diarrhea that is the result of the inappropriate use of
a pill medicine for offensive precipitation in yang brightness bowel repletion pattern.
C OMMENTARY
When a cold damage disease persists for more than ten days and then delirious
speech is observed, it is likely that the evil has shifted from the greater yang into
the yang brightness. Heat in the ya且g brightness causes dry stool, which is the root
of delirious speech. When this pattern is observed, it is appropriate to precipitate,
probably using one of the Qi-Coordinating Decoctions ( cheng qi tang) in order to
flush dryness-repletion, discharge heat, and harmonize the stomach.
In y缸g brightness heat repletion internal bind patterns, dryness-heat can dis­
tress the fluids, so that they percolate into the bladder and cannot enter the in­
testines; consequently, urination is uninhibited and the stool is hard and bound. In
the pattern presented above, instead of hard bound stool the patient experiences
di缸rhea. Nonetheless, the pulse conforms with a heat repletion internal bind pat­
tern, in that it is likely to be sunken, replete, and large, and no signs of vacuity
exist . Because of this sign pattern, one can deduce that the patient was treated
inappropriate!! with a pill medicine. Inappropriate precipitation cannot resolve the
dryness-repletion and instead causes diarrhea.
Inappropriate precipitation damages the spleen and stomach and may lead to
vacuity cold di町rhea. The pattern of vacuity cold diarrhea should be differentiated
from the pattern described in this line. If the diarrhea is accompanied by a pulse
that is faint and reversal cold of the extremities, the pattern is one of vacuity cold.
In this pattern, however, the occurrence of diarrhea is marked by the word “instead”
in order to emphasize that it is unexpected and different from diarrhea that occurs
in the absence of erroneous treatment. Furthermore, the pulse is described as being
“in harmony,,” suggesting that it is replete, not faint as would be seen in a vacuity
cold pattern.
This pattern is described as “internal repletion” and therefore precipitation
is used to drain repletion. Nonetheless, the patient has already undergone harsh
precipitation that has damaged the stomach qi, so further harsh precipitation is
inappropriate. Stomach-Regulating Qi-Coordinating Decoction ( tiao 时t cheng qi
tang) is suggested because it will address the internal repletion and harmonize the
stomach φ.
1 . G REATER
YANG [LINE 108]
275
LINE 108
伤 寒 腹 满俨语 , 寸 口 脉 浮 而 紧 , 此 肝乘脾也 , 名 日 纵 , 刺 期
门。
Shang han JU man zhan yu, cun kou mai ju er fin, ci gan cheng pi
ye, ming yue zong, ci qi men.
When i n cold da mage, [there is] a bdom i n a l fu l l n ess, deli rious speech ,
a nd the i nch open i ng1 is floati ng a n d tight, this mea n s the l iver is
exploiti ng the spleen a nd it is ca l led restrai nt.2 One sh。uld need le Cycle
Gate ( qf m旬, LR- 14) .
TEXT NOTES
1. Inch opening, 寸 口 cun kou : The wrist pulse or specifically the inch position.
2. Restraint , 纵 zong : A five-phase relationship in which one viscus restrains
another viscus following the restraining sequence. An exa皿ple of this is wood
restraining earth. This is the normal restraining sequence, 相 克 xiang ke .
R启hellion, 横 heng , stands in opposition to restraint and expresses the sit­
uation in which one viscus restrains another viscus, but instead of following
the restrainin � cycle, the action is counter to the cycle. An example of this
is wood restraining metal. In the normal restraining sequence metal restrains
wood. This pattern is counter to the normal sequence, 相 {每 xiang wii .
SYNOPSIS
The signs and treatment of the liver exploiting the spleen.
COMMENTARY
This line describes a pattern of the liver exploiting the spleen. However, the
signs are suggestive of y缸g ming dise甜、 while the pulse is reminiscent of cold
damage.
The appearance of abdominal fullness and delirious speech during the course of
an external contraction is normally understood to indicate y缸g brightness. Here,
however, the pulse is not sunken, replete, and large, as one would expect in a yang
brightness disease, but instead is floating and tight . Furthermore, because tidal
heat effusion and abdominal pain are absent, one knows that this is probably not a
yang brightness pattern. The attribution of the signs described in this line to the
liver exploiting the spleen reflect lines from the Huang Di Nei Jzng which read, “The
liver governs speech . . . When the liver qi is exuberant, speech is profuse . . . The
spleen governs the abdomen . . . .” When liver qi is exuberant, speech may become
delirious and the abdomen may become full, indicating that the spleen has been
restrained by the liver φ. In the present line, the term “restraint” ( 纵 zong ) is used
to describe this pathomechanism.
A pulse that is floating and tight is a further indication that this is not yang
brightness disease. Nonetheless, how such a pulse would reflect the liver exploit­
ing the spleen is not immediately apparent , since it is normally considered to be
characteristic of cold damage. The rationale is supplied by Bian Mai Fii. (辨 脉
法 “Identifying Pulses” ) which states, “A pulse that is floating and tight is called
276
1 . G REATER y ANG [LINE 1 09]
stringlike.” Moreover, the text of the present line specifically states that the pulse
is floating and tight at the “inch opening.” If this term is taken to mean the inch
position, then the pulse would be tight and floating, which is characteristic of cold
damage.
In the present line, the needling treatment suggested would appear to throw
more light on the precise nature of the condition. Two different patterns may arise
when the liver exploits the spleen. One is a pattern of repletion, in which exuberant
liver ql rebels against a healthy spleen. The other is a pattern of vacuity, in which
the spleen is vacuous and the liver exploits the weakness. The vacuity pattern
must be treated by fortifying the spleen, whereas the repletion pattern is treated
by draining the liver. Needling Cycle Gate ( qz men, LR-14 ) courses and drains
repletion of the liver ql; hence one knows that this is a repletion pattern.
LINE 1 0 9
伤 寒 发 热 , 啬啬 恶 寒 , 大 渴欲饮 水 , 其腹必 满 , 自 汗 出 , 小
便 不lJ , 其 病 欲 解 , 此 肝 乘 肺 也 , 名 日 横 , 刺 期 门 。
Shang han fa re, se se WU han, da ke yu yin shui, q{ ju bi man, zi
han chu, xiao bian li, qi bing yu jie, ci gan cheng fei ye, ming yue
heng, ci qi men.
In cold d a mage with heat effusi。n , h udd led aversi。n t。 cold , a n d great
t h i rst with desi re to d ri n k water, there wi l l be a bdom i n a l fu l l ness. S p。n­
ta n e。us sweati ng a nd u n i n h i bited u ri nation i n d icate the d isease is a b。ut
t。 resolve. This is beca use the l iver is exploiting the l u ng a nd is ca l led
rebel lion . * One shou ld need le Cycle Gate ( qi men, L R-14).
TEXT NOTE
*
Rebellion, 横 heng : The opposite of the restraining sequence. Normally, metal
( lung) restrains wood ( liver ) , but here the opposite occurs, which is called
‘‘rebellion.”
SYNOPSIS
The signs and treatment of the liver exploiting 出e lung.
COMMENTARY
In cold damage disease patterns, the simultaneous appearance of a ) heat effusion
and aversion to cold which suggest greater y缸g disease and b ) great thirst and
abdominal fullness, which suggest y缸g brightness disease, is a strong indication of
greater y归g and y缸g brightness combination disease. Nonetheless, in this pattern,
combination disease is absent and the pattern is described 副 “the liver exploiting
the lung."
When the liver ql is exuberant it can rebel against the lung, particularly if the
lung is weak. The lung governs the skin and [body] hair and when exuberant liver
ql exploits the lung, the opening and closing of the interstices is impaired and the
exterior becomes blocked, giving rise to heat effusion and aversion to cold. The lung
l . G REATER YANG [LINE 1 1 9]
277
governs regulation of the waterways and when its functions 缸e impaired, 直uids 缸e
not properly distributed to the bladder, causing inhibited urination. When wood fire
torments metal and the lung is scorched, the patient feels thirst and desires to drink.
Water collects in the interior and is not transformed. This amassment causes stagna­
tion of the qi dynamic and abdominal fullness. Although the text does not explicitly
state that urination is inhibited or that sweating is absent, the presence of both signs
is implied by the phrase “spontaneous sweating and uninhibited urination indicates
the disease is about to resolve.” Furthermore, the most important 槌pect of this
pattern is impairment of lung function; therefore, the appearance of spontaneous
sweating and uninhibited urination indicates that normal lung function is returning.
This pattern may resolve spontaneously, although resolution is not certain. Because
the root of this pattern lies in exuberant liver qi, the liver is treated in order to
benefit the lung. Cycle Gate ( qf m旬, LR-14) is drained and when the liver qi is
not exuberant , lung function will return to normal.
LINE 1 1 9
太 阳 伤 寒 者 , 加 温 针 , 必 ↑京 也 。
Tai yang shang han zhe, jia wen zhen, bi fing ye.
When i n greater ya ng c。Id d a mage, a warm need le is used , there wi l l
be fright.
SYNOPSIS
A transmuted pattern that occurs when a warming needle is used in a cold
damage pattern, which is inappropriate.
COMMENTARY
Greater yang cold damage is characterized by heat effusion, aversion to cold,
absence of sweating , generalized pain, and a pulse that is floating and tight. It is
叩propriate to promote sweating with acrid, w町m Ephedra Decoction (ma huang
tang) , which expels cold evils. If warm needling is used, not only will the exterior
disease fail to resolve, but the construction-blood will be damaged and the heart φ
will be dissipated and chaotic, leading to fright and disquietude.
Another explanation of this line is that fright is a direct reaction to the needling,
not a reaction to changes in the body brought about by the needling. The idea is
that warm needling is a strong exterior stimulus that can elicit fright in certain
patients.
Chen Nian-Zii writes that warm needling may not always be inappropriate: “In
greater yang cold damage, if [ the evil] is in the channels, [oµe] should needle. If
[it] is in the exterior [or] the flesh, then the promotion of swbating is appropriate
[and] resolving the flesh is appropriate; needling is not appropriate. If [o叫 adds
a warm needle and damages the channels then the spirit qi of the channel vessels
floats outward; consequently, [there] will be fright.”
1 . G REATER YANG [ LINE 1 2 1 ]
278
LINE
121
太阳病吐之 , 但太阳病 当 恶寒 , 今 反 不 恶 寒 , 不欲近衣 , 此
为吐之内烦也。
Tai y ang bing tu zhf, dan tai yang bing dang WU han, jfn fiin bu WU
han, bu yu jin U毛 ci wei tu zhf nei fan ye.
[ I n ] g陀ater ya 略 d isease, vom iting [ has bee n used ] , but1 [since i n ]
greater ya ng d isease there should be aversion to cold , a nd now (there is]
no aversion to c。Id a nd the person has no desire to put on ( add itiona l ]
clothes, this m ea ns (the use of] vom iti ng ( ca used ] i ntern a l vexation.2
TEXT NOTES
1 . But 但 di m : Original峙, this character was most commonly used to mean
“only,” and this is its most common usage in the Shang Han Lim . Here,
however, it is used in the sense of “but" which developed in the Han Dynasty.
2 . Internal vexation 内 烦 nei fan: Several different interpretations are offered for
this term.
a) The authors of Gao Deng Cong Shu describe this sign as vexation and
oppression in the heart. “Internal” refers to the heart and “vexation” refers
to vexation and oppression.
b) The authors of Shang Han Lim Yi Shi write that when right qi is damaged,
vexation may be engendered in the interior. This type of vexation is differ­
ent from that which is the result of external evil and so it is called “internal
vexation."
c) The authors of Shang Han L i m Yan Jiu Da Ci Diiin describe internal vex­
ation as vexation and oppression in the chest which is the result of internal
heat . They refer to the following commentary from Y6u Yi: “This is a
transmuted pattern [following] the erroneous [use of] vomiting. The ab­
sence of aversion to cold and no desire to wear [more] clothes indicates
that although obvious exterior heat is absent, the heat is in the interior;
consequently, [the pattern] is called internal vexation. In internal vexation,
vomiting causes fluid collapse, dryness in the stomach, and internal heat
vexation."
SYNOPSIS
The signs of vexation heat in the stomach that occur when vomiting is used in
greater yang disease, which is inappropriate.
COMMENTARY
In greater yang exterior patterns the evil is in the fleshy exterior, and sweating
should be promoted to expel the evil. Although vomiting treatment can effuse
and dissipate evils and may resolve the exterior evil, the use of this method easily
damages the stomach fluids. Stomach dryness engenders heat and internal heat
engenders vexation; consequently, the patient feels vexation and oppression in the
heart . The absence of aversion to cold, as well as no desire for additional clothing
reinforces the idea that the evil has left the exterior and entered the yang brightness.
1 . G REATER y ANG [LINE 1 23]
279
When vomiting treatment is used in greater y缸g exterior patterns, the trans­
mutations may vary depending on the original constitution of the patient and on
what medicinals were given. In this pattern, fluid damage and a transformation to
dryness leads to dryness-heat in the stomach and internal vexation. If, however,
the treatment damages yang and gives rise to vacuity cold in the stomach, signs
such as vomiting in the evening of food eaten in the morning may be observed.
With regard to the treatment for this pattern, although none is included in
the text , we may look to other similar lines for information. In line 71, p. 195,
Stomach-Regulati吨 Qi-Coordinati吨 Decoction ( tiao wei eke-叼 qi tang) is used for
a pattern with heat and no aversion to cold to harmonize the stomach. The same
formula is used in line 212, p. 338, to resolve heart vexation. For a pattern with
constipation and abdominal fullness and distention, this formula may be used to
discharge heat and harmonize the stomach. If, in addition to the signs described
above, heat effusion and aversion to heat are also observed, further diagnosis is
necessary and a different formula may be required.
LINE 1 23
卜) 太 阳 病 , 过 经 十 余 日 , 心 下 温 温 欲 吐 , 而 胸 中 痛 , 大 便
反瘾 , 腹微满 , 郁郁微烦 , 先此时 自 极吐下者 , 与调 胃 承气
汤 。 (斗 若 不 尔 者 , 不 可 与 。 同 但 欲 呕 , 胸 中 痛 , 微 漉 者 ,
此 非 柴 胡 汤 证 , 以 B区 , 故 知 极 吐 下 也 。
( 1 ) Tai ya叼 bing, guo jzng shi yu ri, xzn xia u伽 yun yu tu, er xiδn
zhδng tong, da bian fan tang, Ju wei man, yu yu ω函 fiin, xian ci shi
zi ji tu xia zhe, yu tiao wei che叼 qi tang. (2) Ruo bu er zhe, bu ke
yu. (3) Dan yu ou, xiong zhong tang, wei ta叼 zhe, ci fei chai hu
tang zheng, yi o包y gu zhz ji tU xia ye.
( 1 ) When i n greater ya ng disease, ten or m。re days a仕er cha n nel pas­
sage [there is] seet h i n g below the hea rt with a d esi re t。 vom it1 a nd chest
pa i n , but sl。ppy stool , slight a bd。m i n a l fu l l ness, depression [a nd] m i l d
vexation ;2 [a nd if] before t h is time, extreme v。m iti ng a n d preci pitation
[were used] , give St。mach-Regulating Ql-C。。rd i nating Dec。ction ( tiao
wei che·叼 qi tang ) . (2) If it is n。t l i ke this (patte叫 , 。ne ca n n ot give
[th is form u la] . (3) A desi re only to retch with chest pa i n a nd slightly
sl。ppy [st。。I] is n。t a [M i n。r] B u pleu n
tang ) pattern . Beca use 。f the 陀tchi鸣, 。ne knows extreme v。m iting
a nd preci pitati。n (were used] .
TEXT NOTES
1. Seething below the heart with a desire to vomit, 心 下 温温欲吐 xzn xia yun yun
yu tu: Vexation and oppression felt below the heart accompanied by nausea
280
1 . G REATER y ANG [LINE 1 23]
and a desire but inability to vomit . See line 324, p. 477, for an occurrence of
a simil缸 sign.
2. Depression [and] mild vexation, 郁 郁 微 烦 yu yu 伯 fan : Inhibition of normal
emotional activity, expressing itself in the form of oppression, frustration, and
irascibility, accompanied by heart vexation. See line 103, p. 431 , for another
occurrence of this sign.
SYNOPSIS
a ) The signs and treatment of transmuted patterns that occur when vomiting
and precipitation are used in greater y缸g disease, which is inappropriate.
b ) Distinguishing between these patterns and the Minor Bupleurum Decoction
(xiao chai hU tang) pattern.
C OMMENTARY
In greater yang dise臼e, when the exterior disease has been resolved for more
than a week and the patient exhibits signs such as vexation and oppression below
the heart, nausea, and depression, one may notice the similarity with a lesser y缸g
disease. Nonetheless, abdominal fullness and sloppy stool are generally not char­
acteristic of lesser y缸g dise描e; therefore, one should conclude that this is not a
lesser yang pattern. Abdominal distention and heart vexation can appe町 in y缸g
brightness patterns, but sloppy stool is unlikely in those patterns; therefore, a yang
brightness pattern is unlikely. This patient w凶 treated with both vomiting and
precipitating medicinals which damaged the fiui缸, causing stomach dryness that
transformed to heat. The heat evil became depressed in the interior. This pat­
tern is a transmuted pattern that is the result of erroneous treatment. A desire
to vomit and sloppy stool are a continuing manifestation of the medicinals used
to cause vomiting and precipitation. Pain in the chest is the result of qi counter­
flow following vomiting. In this c描e one must remove stomach dryness-heat, but a
harsh formula would not be appropriate since the patient has already been through
several mistreatments. Stomach-Regulating Qi-Coordinating Decoction ( tiao wei
cheng qi tang) is appropriate to discharge heat, moisten dryness, and harmonize
the stomach.
In the second line of the text we are told that if the pattern does not present in
this particular way, one should not precipitate. This line applies to a situation in
which inappropriate treatment has led to a negative transmutation. If these s缸ne
signs arise spontaneously, a different treatment should be used. For example, in the
absence of precipitating treatment the combination of sloppy stool and abdominal
fullness can indicate a greater yin disease in which the spleen and stomach yang
is damaged by cold evil. If no medicinals have been used to cause vomiting and
the patient exhibits sign such as seething below the heart and desire to vomit, it
may indicate a greater yang evil h副 shifted into the lesser y缸g. In either of these
patterns, Stomach-Regulating Qi-Coordinating Decoction ( tiao 州 cheng qi tang)
is not appropriate.
The final section of this line emphasizes that the nausea that is present in this
pattern is the result of inappropriate vomiting and precipitation, it does not repre­
sent a lesser yang disease that can be treated with [ Minor] Bupleurum Decoction
( [xiao] chai hU tang ) .
l . G REATER y ANG [LINE 139]
281
It should be noted that several com皿entators interpret the second and third
sentences of this line differently than the commentary above. Ke Qin agrees that the
second line, “if it is not like this [pattern] , one cannot give [this formula] ,'’ refers to
whether or not the patient has received treatment with medicinals to cause vomiting
and precipitation. However, he interprets the word 温 U郎 , as meaning ''warm,”
and this choice is not accepted by most other commentators.
LINE
1 39
付 太 阳病 , 二 三 日 , 不 能卧 , 但欲起 , 心下必结 , 脉微弱
者 , 此本有寒分也 。 。 反下 之 , 若利止 , 必作结胸 , 未止
者 , 四 日 复 下 之 , 此作协热 利 也 。
{ 1 ) Tai yang bing, er sii.n 时, bu neng wo, dan yu qi, xfn xia bi jiι
mai w函 ruo zh已 ci ben yo包 han fen ye. (2) Fan xia zh毛 ruo li zh毛
bi zuo jie xiong, wei zhi zhe, si ri j边 xia zh毛 ci zuo xie re li ye.
{ 1 ) When greater ya ng disease [has lasted] two or th ree days, [a nd the
person] is u na ble t。 sleep, a nd d esi res on ly t。 get u p , [then] there will be
a bind below the hea rt a nd a pulse that is fa i nt a nd wea k , which mea n s
that 。rigi na l ly [there we叫 cold elements . * {2) But if precipitation is
used , a n d the [resu lti ng] d ia rrhea is checked , there wi l l be chest bind ;
[if the dia r巾a] is u nchecked a n d , after f。u r d ays, preci pitation is used
aga i n , t h is wi l l ca use c。m plex diarrhea .
TEXT NOTE
* Cold elements, 寒 分 han fen: Different interpretations have been offered for
this term. Ke Qin explains it 甜 cold rheum. Cheng Wu-Ji explains it simply
as cold evil. In the Qian Jin Yi Fang, Mai Jing, and J如 Gui Yu Han Jing,
the character 分 fen is eliminated, and in the Wai Tai Mi Yao (外 台 秘 要
“Essential Secrets from Outside the Metropolis” ) the term “cold,” 寒 分 h<i.n
fen , is replaced with “enduring cold,” 久 寒 jiu Mn.
SYNOPSIS
In people who normally have phlegm-rheum, and who contract greater y缸g
disease, the use of precipitation is inappropriate and can lead to the transmuted
patterns of chest bind or complex heat diarrhea.
COMMENTARY
This line describes the consequences of mistreating a greater yang exterior pat­
tern with precipitation. After a short period of time ( “two or three days” ) , the
greater yang exterior pattern is still present. At the same time, the patient cannot
lie or sleep quietly, prefers to sit up, and has a bind below the heart. These signs are
suggestive of an exterior evil falling into the interior and entering the yang bright­
ness, but in that c描e the pulse would be surging, 1缸ge, slippery, and replete. Here,
instead, the pulse is faint and weak, suggesting that this is not a pattern of yang
282
1 . G REATER y ANG [LINE
140]
brightness repletion heat , but one of cold. This patient has cold-rheum amassment
in the area below the heart , which congests the yang ql in the chest, giving rise to
bind. Cold-rheum also congests the movement of the ql in the vessels; consequently,
the pulse is faint and weak.
This pattern is simultaneous exterior cold and interior rheum so it should be
treated by resolving the exterior and transfo口ning cold-rheum. If bind below the
heart from the presence of cold-rheum is taken as an indication of repletion heat
and offensive precipitation is used, the evil will fall inward, giving rise to diarrhea.
If the diarrhea ceases, evil will bind with cold-rheum in the interior and form chest
bind. No explanation is provided for the mechanism by which the diarrhea ce副部.
If the diarrhea persists and precipitation is used again in an attempt to resolve
the original bind, this further mistreatment will damage the spleen and stomach.
Diarrhea from internal vacuity and an unresolved exterior evil will exist together,
in a pattern described as complex diarrhea.
LINE 1 4 0
太 阳 病 , 下 之 , 其脉促 , 不 结胸者 , 此 为 欲解也 ; 脉浮者 ,
必 结 胸 ; 脉 紧 者 , 必 日因 痛 ; 脉 弦 者 , 必 两 胁 拘 急 ; 脉 细 数
者 , 头 痛 未 止 ; 脉 沉 紧 者 , 必 欲 H区 ; 脉 沉 滑 者 , 协 热 幸lj ; 脉
浮滑者 , 必下血。
Tai yang bing, xia zhi, qi mai cu, bu jie xiδng zhe, ci wei yu jie ye;
mdi JU zhe, bi jie xiong; mai fin zhe, bi yan tOng; mai xian zhe, bi
liang xie ju ji; mai xi shuo zhe, tou tong wei zhi; mai chen jin zhe,
bi yu ou; mai ch 白z hua zhe, xie 叫 li; mai Ju hua zhe, bi xia xue .
When i n greater ya ng disease, preci pitation is used a nd the pu lse is
ski ppi ng, this is n。t chest bi nd , a n d it mea ns [the d isease] is a bout t。
resolve. If the pu lse is fl。ati ng, there wi l l be chest bi nd . If the pu lse
is tight, there wil l be sore t h roat . If the pu lse is stri ngl i ke, there wi l l
b e hypert。nicity 。f b。th ri b-sides. I f the pu lse i s fi ne a n d ra pid , there
wi l l be a n u n relieved headache. If the pu lse is su n ken a nd tight, there
wi l l be desi re t。 retch . If the p u lse is su n ken a n d slippery, there wil l
be com plex dia rrhea . I f t h e pu lse i s fl。ati ng a nd slippery, there will be
bl。od descent.
S YNOPSIS
After the inappropriate use of precipitation in greater y缸ig disease, the pulse
can be used to infer the different kinds of transmutations.
COMMENTARY
This line is a discussion of the significance of different pulse qualities in a greater
yang pattern following the inappropriate use of precipitation. In general, Zhang Ji
1 . G REATER y ANG [LINE 1 40]
283
stresses the correlating signs and pulses, and, as he states in his own preface, he
was critical of the practice already prevalent in his own time of taking the pulse
and ignoring the signs. This line places an emphasis on the pulse considered to be
inconsistent with the rest of the text, and for this re掘on is thought by some to be
the work of W缸g Shu-He, who is not only known to have laid great emphasis on
the pulse, but also suspected of having altered the original text when compiling the
Shang Han Um from the sections relating to externally contracted disease contained
in the now lost Shang Han Za Bing Um.
In greater y缸g disease the promotion of sweating is generally the most appro­
priate treatment and it will expel the evil. If precipitation is used instead, many
different transmutations are possible. This line outlines a group of these transmu­
tations, on the basis of the associated pulse.
If the pulse is skipping, evil qi will not bind in the chest and the disease will
resolve. In the Shang Han Lim “skipping” refers to a pulse that is urgent , but
this is not the same pulse 副 is denoted by the term “skipping pulse,” in which
the pulse is rapid and interrupted. It is considered a y缸g pulse that indicates the
movement of qi upward and outward. It is through this dynamic that the evil is
expelled outward and the disease resolves.
If the pulse is floating, it indicates that the exterior evil is still exuberant and has
not been debilitated by the precipitating treatment. Because precipitation causes
interior vacuity, the exterior evil exploits the interior weakness, falls into the upper
burner, and becomes bound with phlegm-water evil, causing chest bind.
If the pulse is tight , it indicates that exterior cold evil has entered the interior.
Following precipitation, cold evil directly enters the lesser yin. Yrn cold distresses
the lower burner, vacuous from the precipitating treatment . It follows the channel,
surging upward and causing sore throat .
A pulse that is stringlike suggests that following precipitation, the evil has
shifted into the lesser yang. The course of the lesser yang channel moves through
the rib-sides and consequently, the patient feels hypertonicity in these are嗣.
Following precipitation, a pulse that is fine indicates vacuity and a pulse that
is rapid indicates heat. Yang becomes vacuous and agitated and it runs upward to
the head, causing pain.
Inappropriate precipitation can damage the y缸g qi, causing yang vacuity. Vac­
uous y缸g is unable to move the pulse nor皿ally and it becomes sunken. When the
pulse is tight, it may indicate cold-rheum collecting in the interior. Vacuous yang
is unable to expel the cold-rheum and so it ascends counterflow, causing a desire to
retch.
In the c副e of a pulse that is sunken and slippery because this pattern is char­
acterized by complex diarrhea, the sunken quality is not thought to indicate y缸g
vacuity, as above, but rather an interior pattern. A pulse that is slippery indicates
internal repletion; here, evil heat follows the force of erroneous precipitation and
distresses the lower burner, causing food to stray downward and diarrhea to appear.
After precipitation, if the pulse is still floating and is also slippery it indicates
that the exterior evil has not been eliminated, but has instead fallen into the interior.
This heat evil harasses the blood and causes bloody stool.
284
1 . G REATER YANG [LINE 1 42]
LINE 142
付 太阳 与 少 阳并病 , 头项强痛 , 或眩 冒 , 时如结胸 , 心下痞
硬者 , 当 刺 大椎第 一 间 、 肺俞 、 肝俞 , 慎不 可发 汗 , 发汗则
俨语 , 脉弦 。
。 五 日 沪语 不 止 , 当 刺 期 门 。
( 1 ) Tai ya叼 yil shew ya叼 bi叼 bing, t6u xiang jiang tong, huo xuan
mao, shi ru jie xiong, xfn xia pf ying zhe, dang ci da zhuf di yi jian、
fei shu、 gan shu, sh创 bu ke fa han, fa han ze zhan yil, mai xian.
(2) Wu 叫 zhan yil bu zhz, dang ci qf men.
( 1 ) When i n greater ya ng a nd lesser ya ng d rag。ver d isease, [there is)
stiffness a nd pai n 。f the head a n d na pe, 。r vei l i ng d izziness, a nd it
is s。met i m es l i ke chest bi nd with a hard glomu s below the heart, 。ne
sh。u ld need le G reat Ha m mer ( da zh现 GV-14 ) , Lung T阳
shu, B L-13 ) ’ a nd Liver Tra nsp。rt ( gan shu, B L-18 ) . Be ca uti。us a nd
do not prom。te sweati ng [ beca use if] sweati ng is prom。ted [ it wi 11) ca use
deli ri。us speech a nd a pu lse that is stri ngl i ke. (2) [ If after) five days the
deli rioL』s speech does not stop, 。ne sh。uld need le Cycle Gate ( qf me·叽
L R- 14 ) .
SYNOPSIS
In greater yang and lesser y缸g dragover dise掘e, one should use acupuncture
and not promote sweating.
COMMENTARY
When a greater yang disease has not ceased and signs of a lesser yang disease
appear, the resultant pattern is called a greater y缸g and lesser yang combination
disease. Stiffness and pain of the head and nape is a sign of the greater yang
channel contracting an exterior evil. Veiling dizziness means that gallbladder fire
has followed the lesser y缸g channel and assaulted the clear orifices. A periodic
sign similar to chest bind is not true chest bind, but reflects an inhibition of lesser
yang channel ql. A hard glomus is present in the 缸ea below the heart . When the qi
congestion is severe, the area becomes painful and the pattern appears to be chest
bind. Nonetheless, the fullness and pain of chest bind is not periodic, but persistent ;
therefore, one may conclude that this sign does not constitute chest bind.
One way of approaching this line is to consider theory loosely characterized
by the idea that diseases of the organs 町e best treated with a decoction, while
diseases of the channels can be treated with acupuncture. Although this theory is
not universally accepted, it is one way to explain the use of acupuncture here. The
main signs of this pattern involve the greater y缸g and lesser y缸g channels. Great
Hammer ( da zhuf, GV- 1 4 ) is an intersection point for the three y缸g channels. It
h描 a strong action to dispel wind. Lung Transport (fei shU, BL-13 ) rectifies the
qi and dissipates evil qi. The喝e two points resolve the greater yang exterior evil.
Liver Transport ( gan sh玩 BL-18) , the liver transport point, drains gallbladder fire
and harmonizes the lesser yang.
l.
285
GREATER YANG [LINE 150]
If acupuncture is not used here and instead a decoction is given to promote
sweating, the fluids will be damaged. This damage allows lesser yang fire to become
intense. Intense wood fire rebels against earth, heat exploits the stomach, and the
stomach ql becomes disharmonious. This process leads to delirious speech. The
pulse is stringlike, a quality associated with lesser yang patterns. If the delirious
speech continues unabated, one can needle Cycle Gate ( qz m旬,LR-14) to drain
wood 且re. Once the fire is cleared, the delirious speech will cease.
LINE
150
太阳少阳并病, 而反下之, 成结胸, 心下硬, 下利不止, 水
浆不下, 其人心烦。
Tai yang shao yang bing bing, er fiin xia zhf, cheng jie xiiing, xin
xia ying, xia li bu zhi, shui j诅ng bu xia, qi ren x?:n fan.
When in greater ya ng a nd lesser ya ng d rag。ver disease, instead pre­
ci pitati。n is used , [it wi ll ] ca use chest bi nd , hard n ess below the heart,
incessa nt d iarrhea , [in a b il ity t。 get] fluids down, a nd heart vexation.
SYNOPSIS
The critical signs of chest bind that may occur in greater y归g and
dragover disease following the inappropriate use of precipitation.
lesser
y缸g
COMMENTARY
Greater y缸g disease and lesser yang disease are appropriately treated through
the promotion of sweating and harmonizing treatment, respectively. Neither of
these patterns nor the combination of the two is appropriately treated through
precipitation. Appropriate treatment consists in harmonizing the lesser yang and
resolving the exterior using a formula such as Bupleurum and Cinna皿on Twig De­
coction ( chti i hU gui zhf tang) or using acupuncture points such as Lung Transport
(lei shU, BL-13 ) , Great Hammer (da zhuf, GV-14 ) , and Heart Transport (xzn shu,
BL-15 ) . The use of precipitation causes the evil in the greater y缸g and lesser yang
channels to fall inward. In this case, this evil heat combines with phlegm evil in
the interior and forms chest bind; consequently, the patient feels pain and hardness
below the heart. Because of the presence of a repletion evil in th e chest, the patient
is unable to swallow fluids normally. Furthermore, the presence of a yang evil in
the interior causes heart vexation. At the same time, the use of precipitation also
damages the φ of the center burner, causing vacuity cold of the spleen and stomach.
The center ql falls and incessant diarrhea occurs. This pattern is repletion in the
upper burner and vacuity in the lower burner.
The formation of chest bind in this pattern is similar to heat repletion chest
bind, as described in line 131 , p. 212. “ [When] the disease springs from ya吨, yet
precipitation is used, the heat enters [the interior] and causes chest bind."
Both patterns are the result of erroneous precipitation in a greater y缸g dise甜e;
but in this pattern, in addition to the repletion pattern in the upper burner, a
286
1. GREATER
y ANG
[ LINE 153]
vacuity pattern is also present, whereas the pattern in line 131 is a pure repletion
pattern.
The treatment of this pattern presents a difficult problem. The presence of
a repletion evil in the chest suggests that attacking is appropriate, but incessant
diarrhea indicates vacuity of the right qi and the need for supplementation. To
attack the repletion would be to damage further the right ql and to supplement the
vacuity would be to boost the repletion. No treatment is suggested in the text, but
one may consider first supplementing the center vacuity and then addressing the
repletion. The rationale for this approach is that incessant diarrhea is an indication
of severe damage to right qi. Right ql is already straying and about to expire;
therefore, it must be supplemented before the repletion evil can be attacked.
LINE 153
卜) 太 阳 病 , 医 发 汗 , 遂发 热 恶 寒 。
(斗因复 下 之 , 心 下 痞 ,
表里俱虚 , 阴阳 气并竭 , 无 阳 贝lj阴独 。
(斗复 加 烧针 , 因胸
烦 。 (四) 面色青黄 , 肤榈者 , 难治 ; 今色 微黄 ,
易愈 。
手足 温 者 ,
(1) Tai yang bing, yf fa han, sui fa re WU ha凡(2) Yrn fu xia zh瓦
xfn xia p记 biao li ju xii, yfn yang qi bing jie, WU yang ze yfn du.
(3) Fu jia shao zhεn, yfn xiδng fa肌(4) Miaη se qi亏ig f讥T』d叼F fu ru
zhε' nan zhi; jfn se wei huang, shou zu wεn zhe, yi yu.
(1) In g陀ater ya ng disease, the physicia n promotes sweati ng a n d then
[there is) heat effusi。n and aversion to cold . (2) Beca use P阳i pitati。n
is then used , [there is] a gl。m us below the hea rt, d u a l i nteri。r-exterior
vacuity, exh a ustion 。f yin , ya ng, a n d qi , a n d no ya ng on ly yin . * (3) A
h ot n eed le is then added , so [there is) chest vexati。『1. (4) If the c。m­
plexion is green- b l u e a n d yel low a nd [there is] twitc h i ng 。f the flesh ,
t h is is d ifficult t。 treat. N。w, the c。m plexion is slight yel low a n d the
ext rem ities a re wa rm so [the patient wi l l) easi ly 附over.
TEXT NOTE
事 No yang only yin无阳 则 阴 独 WU yang ze yfn du: No exterior signs ( y缸g ) ,
only interior signs ( yin ) . After sweating and precipitation, evil qi falls into
the interior. Cheng Wu-JI writes, “ 'No ya吨’ means that the exterior pattern
ce回es. ‘Only yin’ means a glomus [is present ] in the interior.”
SYNOPSIS
The transmuted patterns and determination of prognosis following the use of
sweating, precipitation, and hot needles.
COMMENTARY
In greater y缸ig disease the promotion of sweating is an appropriate treatment;
1. GREATER YANG [LINE 1 60]
287
but after sweat issues, if heat effusion and aversion to cold are still observed, as
they· are here, it suggests that the treatment was ineffective and the exterior evil
is still present. Generally, it is appropriate to promote sweating again, mildly, but
in this case the physician instead uses precipitation. Precipitation is inappropriate
in greater yang disease and damages the qi of the spleen and stomach. The evil
qi exploits the weakness in the interior and falls inward, impairing upbearing and
downbearing. The qi dynamic becomes congested and a glomus forms below the
heart. The promotion of sweating damages the exterior, and precipitation damages
the interior; therefore, both become vacuous, “dual interior-exterior vacuity.” After
the evil falls inward, the exterior pattern ceases and only signs of an interior pattern
are present. This situation is described in the text 挝、O yang only yin,” since the
exterior is yang and the interior is yin.
The glomus in this pattern is the result of an evil that falls inward following the
inappropriate use of precipitation in a greater y归g disease. It is a mixed pattern of
heat , from the repletion evil, and cold, from the vacuity of the spleen and stomach.
It would be appropriate to use a formula such as Pinellia Heart-Draining Decoction
(bdn xia xie z如tang) to harmonize the stomach, disperse glomus, fortify the spleen,
and boost qi. Nonetheless, the physician in this line instead uses hot needling to
force further sweating. Fire evil attacks the interior and causes vexation in the
chest. This mistreatment exacerbates and further complicates the original pattern.
Because of the mistreatment not only has the evil not been resolved but the
exterior and interior are both vacuous. At this point, if the complexion is blue­
green and yellow, the liver qi is exploiting the spleen. When wood restrains earth,
yang becomes vacuous and cannot warm the fleshy exterior; consequently, twitching
is observed. The appearance of this sign indicates that the qi of the bowels and
viscera has been greatly damaged and the prognosis is poor. If the complexion is
slightly yellow and the extremities are warm, it i n dicates that the φ of the spleen
and stomach is still able to outthrust to the extremities. The stomach qi is still
present and the source of transformation has not expired. The patient still has the
strength to counter the evil and can recover.
LINE 160
伤寒吐下后, 发汗, 虚烦, 脉甚微, 八九日心下痞硬, 胁下
痛, 气上冲咽喉, 眩冒, 经脉动惕者, 久而成瘦。
Shang han tit xia ho包, fa han, XU fan, mai sh en wei, ba jiu ri xin xia
pi ying, xie xia tong, qi shang chiing yan h6u, xuan mao, fing mai
dong ti zhe, jiu er cheng wei.
When i n c。Id damage, vom iti ng a nd preci pitation [are used] a nd then
sweati ng is pro moted , [there is] vacuity vexati。n a n d the pu lse is
severely fa int. After eight or n i ne days, [there is] a hard glom us b舍
low the heart , pa i n u nder the rib-side, qi surging upward to the throat ,
vei l i ng d izzi ness, a nd jerki ng 。f the cha n nel vessels.1 [If] this end u res,
it wi l l become wi lti ng. 2
,
288
l.
GREATER
y ANG
[LINE 160]
TEXT NOTES
l. Jerking of the channel vessels,经脉动惕 jzng mai dong ti: Spasmodic move­
ment of the flesh and sinews of the body.
2. Wilting, 瘦wei: Weakness and limpness of the sinews that in severe c副es
prevents the lifting of the arms and legs. The condition is mainly found to
affect the legs, preventing the patient from walking.
SYNOPSIS
In cold damage, the inappropriate use of vomiting, precipitation, and sweating
can lead to water-rheum stirring in the interior and if this endures and is not treated,
it can lead to wilting.
COMMENTARY
In this line, vomiting and precipitation are used to treat a greater yang disease
and the disease does not resolve. As a result, sweating is then promoted. The
combination of these mistreatments damages right ql and liquid. The evil harasses
the vacuous interior and causes heart vexation. Because the yang ql is insufficie时,
the pulse becomes faint . After eight or nine days, right ql has not recovered and
yang vacuity is severe. Vacuous ya且g is unable to control water and water ql ascends
counterflow, causing a hard glomus to form below the heart and pain in the rib­
sides. Water qi congests in the center burner and impairs stomach downbearing.
Stomach ql ascends counterflow and causes a sensation of qi surging upward into
the throat. Furthermore, when the clear y缸g cannot ascend normally, the patient
feels veiling dizziness. Not only is the yang qi vacuous, but the fluids have also
been damaged. The sinews and vessels are not nourished and moistened because
the fluids are insufficient; they are also not warmed because the yang qi is vacuous.
As a result, jerking of the channels occurs and if this sign is not addressed properly,
it can progress into the more severe sign of wilting.
A comparison between this line with line 67, p. 171, shows that although the
signs and pathomechanisms are similar, y缸g vacuity in this line is more severe. In
both lines, a greater yang disease is treated inappropriately, resulting in an exterior
evil falling inward. In line 67, the signs are counterflow fullness below the heart,
φ surging upward to the chest, dizziness, and a pulse that is sunken and tight.
In the line preceding, the pulse is faint and the patient also feels pain under the
rib-side. Following the promotion of sweating, generalized quivering and trembling
is observed in line 67, whereas in the preceding line, sweating gives rise to jerking
and then wilting. These differences illustrate that yang vacuity in this line is more
severe than in line 67.
Although no treatment is suggested in this line, on the basis of the information
gleaned from line 67 one can surmise that a formula such as Poria ( Hoelen ) , Cinna­
mon Twig, Ovate Atractylodes, and Licorice Decoction (JU ling gui zhf btii zhu gan
cao tang ) would be used to warm the yang and control water. It is possible that
aconite (Ju zi) would possibly be added.
It should be noted that although most commentators agree on the general mean­
ing of this line, two different interpretations are offered for the pathomechanism.
Cheng Wu-Ji represents one school of thought, which is that erroneous treatment
damages both the ql and fluids and rheum evil is also present. The authors of the
Yz Zang Jzn Jian represent the other interpretation, in which vacuity of yin, ya吨,
l.
G REATER
YANG [LINE 171]
289
qi, and blood exists in this patient, without a rheum evil. Nonetheless, the且rst
explanation seems more plausible since it is able to explain the entire line, without
suggesting that errors exist in the original text, which the second explanation re­
quires. Furthermore, if one considers the comparison with line 67 and the formula
that is used, the suggestion of rheum evil seems quite plausible.
LINE 171
太阳少阳并病, 心下硬, 颈项强而眩者, 当刺大椎、 肺俞、
肝俞, 慎勿下之。
Tai yang shao yang bing bing, xin xia ying, jing xiang jiang er xuan
zhe, dang ci da zhuz. fei shu、 gii.n shu, shen wu xia zhi.
When i n greater ya ng a nd lesser ya ng d ragover d isease, [there is] hard­
ness bel。w the heart , stiffness of the neck a nd n a pe, a nd d izzi ness,
one sh。u ld need le G reat Ha m mer ( da zhur, GV-14), Lung Tra nsport
(lei shu, BL-13), a nd Liver Tra nsport (gan shu, BL-18), a n d shot』Id be
ca refu l not t。 use precipitation .
SYNOPSIS
In greater yang and lesser yang dragover disease, it is appropriate to use配u­
puncture and one cannot use offensive precipitation.
COMMENTARY
In greater y缸g and lesser yang dragover disease, stiffness of the neck and nape
indicates that the greater y缸g evil has not resolved, and hardness below the heart
and dizziness indicate that the lesser yang has contracted the evil. These signs can
all be seen as a reflection of inhibited movement of channel qi; therefore, the use
of acupuncture is recommended in this line. Great Hammer ( da zhuf, GV」4) and
Lung Transport (lei shu, BL-13) resolve the great田yang evil, and Liver Transport
(gan shu, BL-18) resolves the lesser y缸g evil. When a h缸d glomus is observed
below the heart following the inappropriate use of precipitation, a formula such
as Pinellia Heart-Draining Decoction (ban xia xie xin tang) may be used and one
should not precipitate further. Here a hard glomus occurs in dragover disease of the
greater and lesser yang. The channel qi is inhibited and depressed in the interior;
hence acupuncture is used and one is cautioned against the use of precipitation. If a
hard glomus appears in lesser yang and y缸g brightness dragover disease, one may
use Major Bupleurum Decoction ( da chai hU tang) to harmonize the lesser y缸g
and attack interior repletion.
If one considers this line and line 142, p. 284, together, it is clear that in greater
yang and lesser yang dragover disease neither the promotion of sweating nor the
use of precipitation is appropriate treatment. This line cautions against the use
of precipitation but does not record the outcome of using precipitation. Line 150,
p . 285, however, does record the following signs and symptoms as the result of this
mistreatment: “chest bind, hardness below the heart, incessant diarrhea, [inability
to get] fluids down, and heart vexation.”
1. GREATER YANG [LINE 1 74]
290
LINE 1 74
←)伤寒 八九日, 风湿相搏, 身体疼烦, 不能自转侧, 不H区不
渴, 脉浮虚而清者, 桂校附子汤主之。 ω若其人大便硬, 小
便自利者, 去桂加白术汤主之。
( 1) Shang han ba jiu ri, fe·叼 shz xiang b6, shεn ti tb fan, bu nen
zi zhuan ce, bu OU bu ke, mai 庐i XU er se zhe, gui zhf fu zi tang zhu
zhι(2) Ruo qi ren da bian ying, xiao bian zi li zhe, qu gui jia bai
zhu tang zhu zhz.
( 1 ) When cold da mage [has lasted] eight or n i ne days, [a nd] wind a nd
d a m pn ess c。ntend with each other, 1 [there is] genera l ized vexi ng pain, 2
i n a bility to t u rn sides,3 a bsence of retc h i ng, a bsence of t h i rst, a nd a
p u lse that is floati ng, vacu。us, a nd rough; C i n n a m。n Twig a nd Aconite
Dec。ction (gui zhf Ju zi tang) governs. (2) If the person has hard
stool a nd the u ri n e is sponta ne。usly u n i n h i bited , M i n us Ci n n a mon P l us
Ovate Atractylodes Decoction ( qu gui jia bai zhu tang ) g。verns.
TEXT NOTES
1. Wind and dampness contend with each other, 风湿相搏Jeng shr xiang b6:
Wind and dampness are understood to exacerbate each other and cause each
other to persist. When these two evils are in contention, they remain in the
flesh and inhibit the movement of qi and blood.
2. Generalized vexing pain,身体疼 烦 shen ti teng fan: Severe pain felt throughout
the body. Here, 烦 fan is an indication of severity, not vexation in the sense
of vexation and agitation, 烦 躁fan zao. Ya皿ada Seichin (山田正珍) writes,
‘“Vexing pain’means pain that is severe.”
3. Inability to turn sides, 不 能转侧bu neng zhuiin ce: Difficulty turning from
side to side or rolling over.
FORMULAE
Cinnamon Twig and Aconite Decoction (gui zhr JU zi tang)
o
Warm the channels and assist y归g; dispel wind and eliminate dampness.
桂枝四两(去皮)
大枣十二枚(擎)
附子三枚(炮, 去皮, 破)
甘草二两(炙)
生姜三两(切)
右五昧, 以水六升, 煮取二升, 去淳, 分温三服。
gui zhf si liiing ( qu pi') Ju zi san mei (pao, qu pi, po) sheng jiang san liiing
( qie) da ziio shi er mei ( bO) gan c iio er liiing ( zhi)
You WU wei, yi shui liu sheng, zhil qu er sheng, qu zi, fen wen san Ju.
ci n n a mon twig (桂枝gui zhz, Cin n a momi Ra mulus) 4 li�ng (remove ba此)
a conite (附子j边玩 Aconiti Tuber Laterale) 3 pieces (blast-fry, remove skin , crush )
1. GREATER YANG [LINE 1 74]
291
fresh ginger (生 姜 sheng jiang , Zingiberis Rhizoma Recens) 3 li�ng (cut)
jujube ( 大 枣 da ziio, Ziziphi Fn
mix-fried licorice ( 甘草g伽 ciio, Glycyrrhizae Rad ix) 2 li�ng
[For] the a bove five ingredients use six sheng of water. Boi l to get two she吨, and
remove the dregs. Separate into th ree [doses] a nd take warm .
Minus Cinnamon Plus Ovate Atractylodes Decoction (qu gui jia Mi zhU tang)
附子三枚(炮, 去皮, 破)
(炙)
大枣十二枚(擎)
白术四两 生姜三两(切)
甘草二两
←)右五昧, 以水六升, 煮取二升, 去淳, 分温三服。 仁)初一服,
其人身如痹, 半日许复服之, 三服都尽, 其人如冒状, 勿怪, 此以附
子、 术并走皮内, 逐水气未得除, 故使之耳, 法当加桂四两。 (三)此本
一方二法:以大便硬、 小便自利, 去挂也;以大便不硬、 小便不利,
当加桂。 侧附子三枚, 恐多也。 (五)虚弱家及产妇, 宜减服之。
Fu zi san mei (pao, qu pi, po) Mi zhU si liiing sheng jiang san liiing (qie)
gan ciio er liiing (zhi) da ziio shier mei (bo)
(1) You wil w剖, yi shui liu sheng, zhU qu er sheng, qu zi, fen wen san ju.
(2) ChU yf JU, qi ren shen ro bi, ban叫“j边 JU zhf, san JU dδu jin, qiren rU mao
zhuang, WU guai, ci yi Ju zi, zhU bing ZOU pi nei, zhU shui qi wei de chU, gu shi zhf
er, /ii dang jia gui si liiing. (3) Ci ben yf fang er /ii:“ da bian ying、 xiiio bian zi
li, qu gui ye; yi da bian bu ying、 xiiio bian bu li, dang jia gui. (4) Fu zi san mei,
kong duδ ye. (5) Xu ruo jia jichiin j毡, yi ji 伽 JU zhf.
aconite (附子ju zi, Aconiti Tuber Late时e) 3 pieces (blast-fry, remove ski n a n d
break)
ovate atractylodes (臼术bdi zhU, Atractylodis Ovatae Rhizoma) 4 l iiing
fresh gi nger (生 姜 sheng jiang, Zi『1gi beris Rhiz。『na Rece『1s) 3 Ii昌『1g (cut )
m ix-fried licorice (gan cii.o) 2 Ii革n
jujube ( 大 枣 da zii.o, Zizip h i F『"I
(1) [For] the a bove five ingredients, use six sheng of water and boil to get two
sheng. Remove the d regs, sepa rate into three [d。ses] and ta ke warm. (2) [If a仕er]
the first [dose], the person [has a condition] like genera lized i m pediment, ta ke again
i n a bout half a day. In three doses, [the formula] is fi nished a nd [if the person has a
condition] like veiling, this is not stra nge, [but] is because the acon ite (Ju zi) a nd ovate
atractylodes ( Mi zhU) have penetrated the i nterior of the ski n to expel the waterφ,
[which] has not yet been eliminated , so [there is this pattern] . As a rule, one should
add 4 liiing of ci nna mon [twig] (gui [zh司 ). (3) This is one form ula with two methods.
When the stool is hard and the urine is spontaneously uninhibited, remove cin namon
[twig] (gui [z叫). When the stool is not hard a nd the urine is i n h ibited, add ci nna mon
[twig] (gui [z,叫 ). (4) [In some cases] th ree pieces of aconite (Ju zi) may be fea时too
muc h . (5) For wea k patients and women who have just given bi 此h, it is a ppropriate to
take less.
292
1. GREATER YANG [LINE 1 74]
SYNOPSIS
The signs and treatment of wind-cold-damp evil impediment in the fleshy ex­
terior.
C OMMENTARY
In this line, wind, damp, and cold contend and give rise to generalized pain,
扭 扭曲ility to turn sides, and a pulse that is floating, vacuous, and rough. This
is a pattern of impediment, a description of which can be found in the Su Wen,
“Three miscellaneous φ wind, cold, dam「combine [into] impediment.” As a
result of wind-cold-damp in the fleshy exterior, construction and defense become
disharmonious, and movement of qi and blood is inhibited, giving rise to generalized
pain and inability to turn sides.
Although in cold damage patterns generalized pain is present, here the pain is
severe and the patient cannot turn freely, a sign not generally seen in cold damage
patterns. Furthermore, in Ephedra Decoction ( ma huang tang) patterns, the pulse
is generally floating and tight, indicating that wind-cold has fettered the exterior
and right qi is replete. Here, the pulse is floating, vacuous, and rough, indicat­
ing that the exterior yang is insufficient and that the wind-damp contention has
caused congestion in the channels and vessels. R启tching and thirst are indicative
of lesser y缸g and y缸g brightness disease, respectively, and the absence of these
signs corroborate the absence of these patterns.
Cinnamon Twig and Aconite Decoction ( gui zhf Ju zi tang ) 也suggested to W缸m
the channels, reinforce yang, dispel wind, and overcome dampness. Cinnamon twig
( gui zhf) frees yang and dispels wind. Aconite (JU zi) w缸ms the channels and re­
lieves pain. These two ingredients reinforce y缸g in order to W缸m the channels and
dissipate wind, cold, and dampness from the channels. Fresh ginger ( sheng jia·叼) is
acrid and penetrates outward. It assists the other ingredients in warming and dis­
sipating. Licorice (gan ciio) and jujube ( da zii.o) combine with fresh ginger ( sheng
jiang) to transform y缸g with acridity and sweetness and harmonize construction
and defense.
If the stool is hard and urination is uninhibited, it suggests that the fluids are
percolating. Therefore, cinnamon twig ( gui zhf) , which transforms φ and disinhibits
water, is removed from the formula and ovate atractylodes ( Mi zhU), which fortifies
the spleen, dries dampness, and distributes liquid, is added.
One final note: Cinnamon Twig and Aconite Decoction ( gui zhf JU zi tang)
and Cinnamon Twig Decoction Minus Peony Plus Aconite ( gui zhf qu shdo yao
jia JU zi t ang ) 町e identical except that the quantities of each ingredient differ.
As a consequence, the two formulae are used differently and these differences are
significant. The former is used for wind, cold, and dampness causing impediment,
with signs such 描 vexing pain and an inability to turn to the side. Large doses of
cinnamon twig (gui zhf) and aconite ( Ju zi) are used because the emphasis is on
warming the channels and expelling cold and da皿p in order to relieve pain. Peony
(sha.。”。) is not used, because it is cool, sour, and constraining and m叮cause
congealing in the channels. The latter formula is used in greater yang exterior
vacuity patterns with chest fullness, aversion to cold, and a pulse that is faint.
Smaller doses of cinnamon twig ( gui zhf) and aconite 伽 利 m used to warm the
channels and restore y三ng, in order to treat the milder signs of aversion to cold
1 . GREATER
yANG
[LINE 1 75]
293
and a pulse that is f创皿 Here, peony ( sh<i.。 ”。) is not used for fe町 th剖it would
further congest the chest yang.
LINE 1 75
风湿相搏 , 骨节疼烦 , 掣痛不得屈伸 , 近 之 则 痛剧 , 汗出短
气 , 小 便 不 利 , 恶风不 欲去衣 , 或 身 微肿者 , 甘草附子汤主
之。
Feng shz xiang b6, gu jie teng fan, che tong bu de qu shen, jin zhz ze
tOng ju, han chu duan qi, xiao bian bu li, WU Jeng bu yu qu u 毛 huo
shen wei zhong zhe, gan cao j边 zz tang zhu zhz.
When wi nd a n d d a m pness contend with each 。ther, [a nd there is] vexi ng
pa i n in the j。i nts , * p u l l i ng pa i n, a nd a n i n a bility to bend a nd stretch,
pai n that is exacerbated when [a ny1。ne even comes] nea r, sweati ng,
shortness of breat h i n h ibited u ri nati。n aversion t。 wi nd with no desi re
t。 rem。ve the clothes, 。r m i ld genera l ized swelli ng, Lie。rice a n d Aconite
Dec。ction (gan cao Ju zi tang) governs.
TEXT NOTE
*
Vexing pain in the joints, 骨节疼烦 gu jie teng fan: Severe joint pain.
FORMULA
Licorice and Aconite Decoction (gan cao JU zi' tang)
o
Warm yang and dissipate cold; dispel dampness and relieve pain.
甘草二两(炙)
( 去皮)
附子二枚(炮, 去皮, 破)
白术二两
桂枝四两
忖右四昧, 以水六升, 煮取三升, 去津, 温服一升, 日三服。 (二)
初服得微汗则解。 问能食汗止复烦者, 将服五合, 恐一升多者, 宜
服六七合为始。
Gan cao er liang (zhi)如 zi' er mei (p a o , qu pi, p o) Mi zhU er liang gui zhf
si liang ( qu pi)
(1) You si wei, yi' shui' liit sheng, zhU qu san sheng, qit zi', wen Ju y;;; sh eng, 叫
san Ju. (2) Chu JU de wei han ze jie. (3) Neng ski hdn zhi'JU fan zhe, jiang Ju WU
g己ko ng yz sheng duδ zhe, yi JU Liu q?: ge wei ski'.
licorice (甘草g伽 cao, Glycyrrhizae Rad ix) 2 li�ng
aconite (附子JU zi', Aconiti Tuber Laterale) 2 pieces (blast-f1叩,remove skin, brea k)
ovate atractylodes (自术 Mi zhU, Atractylodis Ovatae Rhizoma) 2 li�ng
ci n na mon twig (桂枝gui zhZ. Cin n a momi Ramuh』s) 4 filing (remove ba此)
294
1 . GREATER YANG [LINE 1 75]
(1) [For) the a bove four i ngred ients, use six sheng of water a nd boil to get th ree
she吨. Remove the d regs a nd ta ke one she吨 warm, th ree ti mes a day. (2) In the
begi n n i ng, [after) ta king [a dose) there should be slight sweating and resolution. (3) [If
the person) ca n eat, the sweating stops, a nd vexation 陀tu rns, give five g在. [If there is)
fear that 。ne sheng is too m uch , it is appropriate to ta ke six or seven g� to sta此with.
SYNOPSIS
The signs and treatment of wind-cold-damp evil impediment in the joints.
C OMMENTARY
In this pattern wind and dampness contend and become bound in the joints,
resulting in severe joint pain. The pain is so severe that it is exacerbated when
one even tries to approach the patient. In the previous line retching and thirst
are absent, suggesting that the interior is in harmony. Here, sweat issues and the
patient feels aversion to wind and does not desire to remove any clothes. These
signs suggest that the defensive yang is vacuous and insecure. Furthermore, when
damp evil congests the interior, ql transformation and diffusion are impaired. In
the upper burner the breath, becomes short, and in the lower burner, urination
becomes inhibited. Generalized swelling may be observed as a further indication of
damp congestion.
Licorice and Aconite Decoction (gan ciio Ju zi tang) is used to warm y缸g and
dissipate cold, and to dispel dampness and relieve pain. When wind and dampness
contend in the interior, cold is often engendered, and thus the formula contains
ingredients to address the cold evil. Aconite (Ju zi) w缸ms the channels and dis­
sipates cold. Ovate atractylodes ( btii zhU) forti且es the spleen and dries dampness.
Cinna皿on twig (gui zhf) warms and frees yang. These ingredients warm the ext令
rior y缸ig in order to secure the defensive yang, dispel wind-damp, . and warm the
channels. When the wind, damp, and cold 町e dispelled, the pain will cease. Once
the defensive yang is secure, aversion to wind and sweating will cease. These ingre­
dients also transform and move the ql to address the issues of inhibited urination,
shortness of breath, and generalized swelling. Licorice (gan ciio) harmonizes the
ingredients and supplements the center burner in order to support right φ.
This pattern is more severe than the one treated with Cinnamon Twig and
Aconite Decoction (gui zhf JU zi tang), but a smaller dosage of aconite (j边 zi) is
used in Licorice and Aconite Decoction (gan ciio Ju zi tang). The reason is that
in the previous pattern wind-damp evil collects in the flesh, but here it pours into
the joints a location that is considered to be deeper. Wind-damp in the joints is
difficult to eliminate quickly, and if too large a dosage of medicinals is employed,
the wind will be eliminated but the dampness will remain. Furthermore, licorice
(gan ciio) moderates the harsh nature of aconite (Ju zi) and ovate atractylodes
( btii zhU) so that their actions slowly come into play, eliminating both wind and
dampness. Thus, the importance of licorice (gan ciio) in this formula should not be
underestimated.
Three formulae are used to treat wind-cold-damp. Cinnamon Twig and Aconite
Decoction (gui zhi JU zi tang) is suggested for patterns in which wind-damp invades
the fleshy exterior and exterior wind is prevalent. Cinnamon Twig Decoction Minus
Cinnamon Twig Plus Poria ( Hoelen ) and Ovate Atractylodes (gui zhf qu gui jia fu
ling btii zhu tang) is used when wind-damp invades the fleshy exterior and interior
1. GREATER YANG [LINE 1 75]
295
dampness is prevalent. Licorice and Aconite Decoction (gan ciio JU zi tang) is used
when wind-damp invades the joints and both evils are equally prevalent.
Chapter Two
y�主ng Brightness Disease
Pulses and Signs;’Treatment
辨阳院病脉证并治
1
院
明
OVERVIEW
Y缸ig brightness disease is the stage of externally contracted disease in which
yang qi is hyperactive and evil qi is exuberant. The pathomechanism of y缸g bright­
ness disease is explained by the term “stomach domain is replete" (胃家实 wei jia
sM ) . “Stomach domain”refers to the stomach and intestines, and “replete”refers
to an evil transforming to heat and entering the interior, and food accumulation
and stagnation. In general, when an exterior evil enters the yang brightness, it
transforms to dryness and heat, resulting in a pattern of interior heat repletion.
Y缸g brightness disease can originate in the greater y归g channel, in the lesser
y缸ig channel, or directly in the yang brightness channel. yang brightness disease
can also originate in the yin channels, although these transmutations田e less fre­
quently encountered. Enduring depressed greater yin cold-damp can transform into
heat and give rise to a y缸g brightness pattern. A lesser yin evil can also transform
to heat and damage the fluids, giving rise to a yang brightness pattern. In rare
cases, if stomach y缸g is vacuous, yang brightness patterns of stomach cold with qi
counterflow can be observed. Also, an evil can fall inward and enter the three yin
channels, giving rise to a pattern of vacuity cold. The yang brightness is the final
y缸g channel through which an evil p部S四 prior to entering the three yin channels;
therefore, it is said that "y缸g brightness is the outer shelter of the three yin” ( 阳
明为三阴之外蔽 yang ming wei s an yin zhif wai bi).
yang brightness disease may be divided into heat patterns and repletion pat­
terns. Heat patterns, also referred to 嗣 yang brightness channel patterns, involve
formless dryness-heat and 町e characterized by great generalized heat effusion, great
sweating, great thirst, and a pulse that is surging and large or slippery an d rapid
( the four greats ) . Aversion to heat and heart vexation are also commonly observed
in yang brightness channel patterns. Repletion patterns, also referred to as yang
brightness bowel patterns, involve formed heat bind and缸e ch缸acterized by af­
ternoon tidal heat effusion, sweat strea皿ing from the limbs, abdominal distention,
298
2 . YANG B RIGHTNESS
fullness and pain, inability to defecate or heat bind with circumfluence, and a pulse
that is sunken, slow, and forceful, or slippery and rapid.
yang brightness disease generally involves the qi aspect, but y缸g brightness
heat can enter the blood aspect. In yang brightness blood amassment patterns heat
contends with enduring static blood and gives rise to signs such as forgetfulness and
hard, black stool that is e出y to expel.
In yang brightness disease we can also see wind strike or cold strike patterns
in which a wind or cold evil strikes yang brightness directly. Both these patterns
differ from the basic y缸g brightness patterns by the absence of heat and dryness
signs. These two patterns are differentiated primarily on the basis of whether or
not the patient is able to eat. In wind strike, the patient is able to eat, indicating
that stomach yang is still exuberant and a replete evil is absent from the bowel. In
cold strike, the patient is unable to eat because stomach y缸g is insufficient, as a
result of damage from cold evil.
1 . 1 SIGNS
Aversion to heat恶热wit re : Aversion to heat occurs instead of aversion to
cold because the exterior evil has entered the interior and transformed into heat,
giving rise to heat both in the exterior and the interior. Aversion to cold may be
seen in the early stages of y缸g brightness disease, but it should quickly give way
to aversion to heat and must be clearly differentiated from that which occurs in
greater y缸g disease.
Heat effusion发热fa re : In y但g brightness disease heat patterns, heat
effusion is strong and results from interior heat steaming outward. It is much
stronger than the feather-warm heat effusion of greater y革且g. In yang brightness
repletion patterns, heat binds in the interior and the outward effusion of heat is not
strong, but instead manifests副afternoon tidal heat effusion.
Spontaneous sweating自汗出zi him chu: In ya且g brightness disease, sweat­
ing is copious and streams outward, in contrast to sweating that occurs in greater
yang wind strike, which is scant and issues slowly. In heat patterns, the sweat is
said to be copious over the whole body, whereas in repletion patterns, it is said to
stream from the limbs. Nonetheless, in yang brightness patterns, sweating may be
absent or only observed on a small part of the body. If sweating is absent, it gener­
ally suggests that yin liquid is vacuous; if sweating is present only on a small part
of the bod� ( i.e. , the head ) , it m町 be the result of dampness and heat depressed
in the interior-as occurs in yellowing patterns.
Thirst with desire to drink water渴欲饮水ke yu yin shui: Thirst occurs in
both heat and repletion patterns because intense interior heat da皿ages the stomach
liquid and humor. For this reason, thirst is an important indication that an evil
has shifted into the y缸g brightness. In these patterns the patient has a dry mouth
and tongue, and drinks copious 缸nounts of water. Although thirst may also be
observed in greater y缸g water amassment patterns, the patient does not drink
copious amounts of water, and may vomit water. Furthermore, the tongue and
mouth are not dry in water amassment patterns.
Abdominal fullness, distention, and pain腹胀、 满、 痛j边zhang, man,
tong: These signs 缸e observed primarily in yang brightness repletion patterns as a
2 . YANG BRIGHTNESS
299
manifestation of formed dryness bind. Because a replete evil is bound in the interior,
these signs缸e usually severe and persistent. Furthermore, this is abdominal pain
that refuses pressure. These signs can be clearly distinguished from vacuity cold
abdominal fullness, which occurs in greater yin patterns and which is mild and
intermittent.
Inability to defecate不大便bu da bian: Inability to defecate refers to absence
of defecation, difficult defecation, and hard stool, all of which are a manifestation
of dryness repletion in yang brightness repletion patterns. Nonetheless, inability to
defecate should not be viewed as an unequivocal indicator of yang bright ness disease
because it can occur in the absence of replete interior heat, and is sometimes seen in
exterior patterns. Furthermore, diarrhea can also be observed in repletion patterns.
Referred to as “heat bind with circumfluence,” it occurs when loose stool passes
out around hard stool that partially obstructs the intestines. Inability to defecate is
also seen in straitened spleen patterns in which stomach heat fetters and constrains
the spleen, such that the spleen is unable to move fluids. The fluids percolate into
the bladder and the stool becomes hard. In this pattern, inability to defecate does
not generally cause abdominal fullness or pain.
Delirious speech俨语zhan yu: Delirious speech may occur in either heat or
repletion patterns as the result of replete heat ascending to the upper body. The
speech is incoherent and the voice is heavy and forceful. Furthermore, the spirit
may be clouded so that the person seems to be seeing apparitions. These are signs
of repletion. If there is repetitious speech, the voice is faint and forceless, and the
spirit-mind seems clear but then does not, this is not called “delirious speech,”but
is called “muttering,” and is considered to be a vacuity pattern.
Yellowing发黄fa huang: yang brightness disease includes jaundice patterns,
which in the Sh ang Han Lun are called "yellowing.” Yellowing is divided into
two basic types: yang yellowing and yin yellowing. Yang yellowing occurs when
heat and dampness combine in the interior giving rise to signs such as generalized
yellowing (in which the yellow is a bright color) , inhibited urination, generalized
heat, dry mouth, heart vexation, glomus, possible blocked stool, red tongue with a
yellow fur, and a pulse that is soggy and rapid. Yin yellowing occurs when cold and
dampness combine in the interior giving rise to signs such as generalized yellowing
in which the yellow color is dark and dull, aversion to cold and desire for warmth,
no heat effusion, sloppy stool, pale ton职ie with white fur, and a pulse that is sunken
and slow.
1.2 TREATMENT
Heat patterns (yang brightness channel patterns) should be treated with a for­
mula such as White Tiger Decoction ( Mi hii tang) to clear and resolve yang bright­
ness heat. Repletion patterns (yang brightness bowel patterns) should be treated
with one of the Qi-Coordinati吨 Decoctions ( eking qi tang).
In the straitened spleen pattern, Hemp Seed Pill ( ma zi r en wan) is used to
precipitate with moistness.
Yang yellowing patterns are treated with Capillaris Decoction ( yfn chin hao
tang) or Gardenia and Phellodendron Decoction ( zhf zi bai pi tang) to clear heat,
eliminate dampness, and abate yellowness. In yang yellowing patterns with exterior
2. YANG BRIGHTNESS
300
signs, Ephedra, Forsythia, a且d Rice Bean Decoction ( ma huang lian qiao chi xiiio
dou tang) may be used. Although the text suggests no formulae to treat yin yel­
lowing, this pattern is treated by warming the center, dissipating cold, and drying
dampness.
Yang brightness blood amassment patterns in which heat enters the blood as『
pect and contends with static blood is treated with Dead-On Decoction ( di dang
tang) to break st凶is and expel blood.
1.3
SCHEMATIC OVERVIEW
Basic Yang Brightness Disease Patterns
•I王eat patterns
with great heat, great sweating,
great thirst and desire to drink, great vexation, and a pulse that is surging
and large: White Tiger Decoction ( Mi hU tang)
- Exuberant dryness heat (Channel repletion):
- Other heat patterns
*
Heart vexation and anguish:
Gardenia and Fermented Soybean Decoction (zhf
zi chi tang)
*
*
Damage to qi and yin with dry mouth, great thirst and desire to drink, and
vexation: White Tiger Decoction Plus Ginseng ( Mi hU jiii ren shen tang)
Unresolved heat, yin damage, and collected water with a pulse that is floating,
heat effusion, thirst with desire to drink, and inhibited urination: Polyporus
Decoction (zhil ling tang )
• Bowel repletion patterns
- Treated
*
*
*
by precipitation
with hard stool or inability to defecate, steaming heat
effusion, sweating, heart vexation, and dry yellow tongue fur: Stomach­
Regulating Qi-Coordinating Decoction ( tiao 创t cheng qi tang)
Mild dryness repletion
Heat bind repletion with hard stool or inability to defecate, abdominal dis­
tention and fullness, tidal heat effusion and delirious speech: Minor Qi-Co­
ordinating Decoction ( xiiio cM叼 qi ta ng )
Severe bowel repletion with inability to defecate or heat bind with circumflu­
ence, abdominal fullness, hardness and pain, 也idal heat effusion, and delirious
speech: Major Qi-Coordinating Decoction ( da cheng qi tang)
- Treated by moistening and enema
*
with difficult defecation, 皿ild abdominal fullness, copious
urination: Hemp Seed Pill ( ma zi ren wan)
Straitened spleen
2. YANG B RIGHTNESS [LINE 180]
301
- Enema: Honey Brew Formula (mi jian fang), Cucumber Gourd Root Formula
(tu gua gen fang) , Pig’s Bile Formula (zhu dan zhZ fang )
’l'ransmuted Patterns
•
Damp-heat yellowing patterns
- Generalized yellowing, yellow inhibited urination, absence of sweating, thirst ,
and abdominal fullness: Capillaris Decoction ( yfn chen hao tang)
- Yellowing, heat effusion, heart vexation and anguish, and thirst: Gardenia and
Phellodendron Decoction ( zhf zi' bai p i tang )
- Yellowing, inhibited urination, heat effusion and aversion to cold, absence of
sweating, and generalized itching : Ephedra, Forsythia, and Rice Bean Decoc­
tion ( ma huang lian qiao chi xiao do u tang)
•
•
2
Blood heat patterns with the possibility of spontaneous external bleeding, dry
mouth, heat effusion, delirious speech, black stool that is easy to p甜s, or pus and
blood in the stool: Dead-On Decoction (di dang tang) .
Vacuity cold with retching , inability to eat, and hiccup: Evodia Decoction ( wu
zl国 yu tang)
ESSENTIAL FEATURES OF
BRIGHTNESS DISEASE
YANG
This section of the yang brightness chapter presents the essential features of
this disease: its causes, pathomechanisms, and signs.
LINE 180
阳明之为病, 胃家实是 也 。
Yang ming zh?: wei bing, wei jia shi shi ye.
In d isease 。f ya ng brightness, the st。m ach dom a i n is replete.
SYNOPSIS
The essential feature of yang brightness heat repletion patterns.
C OMMENTARY
The essential feature of yang brightness heat repletion patterns is that the
“stomach domain is replete.” We should first of all explain the meaning of “stomach
domain.” This term is interpreted as the stomach and the large intestine because in
the channel and network vessels both of these belong to y缸g brightness. However,
the term can also be taken to mean the stomach, the large intestine,阻d the small
intestine. This interpretation rests on the statement contained in the Ling Shu
( 灵枢 “The Magic Pivo t" ) that “the large and small intestine both belong to the
stomach.” The stomach is connected to the small intestine and large intestine
302
2. YANG B RIGHTNESS [LINE 1 79]
below, and all three bowels are engaged in the conveyance and transformation of
food.
In the phrase “the stomach domain is replete,” the word “replete” is most clearly
explained by Yu Wu-Y缸, who states: “The word 'replete’ in 'the stomach domain
is replete' has two meanings. One is repletion from food accumulation and stagnat­
ion. The other is repletion from exterior heat passing into the interior.” Both these
meanings are included in the notion of “repletion of evil qi," which derives from the
statement contained in the Su Wen which reads: “When evil qi is exuberant, there
is repletion; when essential qi is despoliated, there is vacuity.”
Since yang brightness governs dryness, when an evil enters the y缸g bright­
ness it tends to transform into dryness. As it transforms into dryness the interior
heat becomes exuberant and damages the fluids. Yang brightness disease can take
either of two forms: a channel pattern or a bowel pattern. If the patient is not
suffering from abiding waste and stagnation in the stomach and intestines when
yang brightness disease develops, this exuberant heat follows the channels, so that
it affects both the inner and outer body, giving rise to great heat, great thirst,
great sweating, and a pulse that is large and surging-a pattern known as a y缸g
brightness channel pattern. If, by contrast , exuberant dryness-heat contends with
abiding stagnation in the stomach and intestines, it may cause the stool to become
bou且d and dry, blocking the intestines. Bound stool blocking the intestines may
cause tidal heat effusion, absence of defecation, and abdominal fullness, hardness,
and pain; in severe cases it may cause delirious speech. This pattern is known 描
a y缸ig brightness repletion pattern. Both these conditions are manifestations of
“evil qi repletion"; hence “the stomach domain is replete” constitutes the essential
feature of y缸ig brightness disease.
The essential features of all the channel diseases other than y归g brightness
are expressed in terms of signs and pulses. Only that of y缸ig brightness disease is
expressed in terms of a pathomechanism. This pathomechanism does not explain
all the variants of yang brightness disease since there are also conditions of cold,
dampness, and / or vacuity.
2 . 1 CAUSES AND PATHOMECHANISMS
LINE 1 79
忖 问曰: 病 有 太 阳阳明 , 有正阳 阳 明 , 有少阳 阳明 , 何谓 也
? 口 答 曰: 太 阳 阳明 者 , 脾约是 也 ;正阳阳明 者 , 胃 家实
是 也 ; 少 阳 阳 明者 , 发 汗 利 小 便 已 , 胃 中 燥 烦实 , 大 便 难 是
也。
( 1 ) wen yue: bing you tai ya叼 yang m伽g, you zheng yang yang
ming, you shao yang ya叼 ming, he wei ye? (2) Da yue: tai yang
yang m仇g zhe, pi yue shi ye; zheng yang yang ming zhe, wei jia shi
shi ye; shao yang yang m伽g zhe, fa han li xiao bi an u式wei zhiing
zao fan shi, da bi an nan shi ye.
2.
y ANG
B RJGHTNESS [LINE 1 79]
30 3
( 1) Q uestion : [Ya ng brightness] d isease i ncl udes greater ya ng ya ng
brightness, 1 right ya ng ya ng brightness, 2 a nd lesser ya ng ya ng brightness.3
What does this mea n ? (2) Answer: I n greater ya ng ya ng brightness,
the spleen is stra itened . 4 I n right ya ng ya ng brightness, the st。m ach
d。ma i n is replete. In lesser ya ng ya ng bright ness, when sweati ng is
promoted a n d u ri ne is d isi 『1 t
st。『nad】5 a n d d ifficult defecation .
TEXT NOTES
1. Greater yang y缸g brightness, 太 阳 阳 明 tai yang yang ming : The evil p副ses
from the greater yang channel into the y缸g brightness channel.
2. Right yang y缸ig brightness, 正 阳 阳 明 zheng yang yang m仇.g: The evil invades
directly into the yang brightness channel.
3. Lesser yang yang brightness, 少 阳 阳 明 shdo yang yang ming : The evil passes
from the lesser y缸g channel into the y缸g bright n es s channel as a result of
inappropriate treatment.
4. The spleen is straitened, 脾 约 pi yue: Stomach heat binds the spleen, disturb­
ing the spleen’s functions of movement and transformation. This disturbance
causes dryness in the intestines and constipation.
5. Dry vexing repletion in the stomach, 胃 中 燥 烦 实 wei zhong zao f<i,n shi: A
repletion evil in the stomach engendering exuberant dryness and heat that
causes vexation.
SYNOPSIS
The causes and origins of y缸ig brightness disease.
COMMENTARY
Yang brightness disease is characterized by dryness-heat repletion. It h皿 many
causes. This line proposes three causes on the basis of the laws governing the
development of disease in the triple yang and the processes of passage from one to
the other.
The 且rst possibility is that an exterior evil in the greater yang shifts into the
y缸g brightness. This shift may occur 凶 a result of mistreatment or in the absence
of timely treatment. In either case an exterior evil enters the interior and transforms
to heat. The stomach becomes hot and the intestines become dry. The fluids are
damaged and the spleen’s function of movement and transformation is restrained,
giving rise to bound stool without hardness, fullness, and pain in the abdomen.
This is called “straitened spleen."
In the second situation an exterior evil directly invades the yang brightness.
This happens in patients with hyperactive stomach y归g. When the evil enters
the y缸g brightness, it transforms into dryness, further damages liquid, and further
transforms into heat . If the patient happens to have accumulation and stagnation
in the stomach and intestines, the dryness-heat will exacerbate the congestion so
that the stool will become blocked.
Zhang JI includes the term “the stomacli domain is replete” in this line to
emphasize that exuberant dryness-heat in the stomach and intestines is a major
2 . YANG B RIGHTNESS [LINE 1 8 1 ]
304
characteristic o f yang brightness disease. I n all three o f these patterns, the stomach
domain is replete.
The third situation is that an evil from the lesser y归g shifts into the yang
brightness. Appropriate treatment for lesser y缸g disease is harmonization. In this
case, however, sweating is promoted and urination is disinhibited. This mistreat­
ment damages the fluids and the evil easily transforms to heat and dryness. The
heat and dryness enter the yang brightness and disturbs the movement of the stool,
which becomes difficult to expel.
Modern commentators tend to agree that the present line is misleading because
it suggests that yang brightness disease varies in form depending on the provenance
of the evil. This line is notably contradicted by line 181, p. 304, which states that
y缸g brightness disease coming from greater yang may take the form of no change
of clothes, internal repletion, or di伍cult defecation, depending on the severity. It
is therefore now believed that irrespective of where the evil comes from, the three
different forms mentioned may arise.
LINE
181
(-) 问 曰 : 何 缘 得 阳 明 病 ? 仁) 答 曰 : 太 阳 病 , 若 发 汗 , 若 下 ,
若 利 小 便 , 此 亡 津液 , 胃 中 干 燥 , 因 转 属 阳 明 。
(三) 不 更 衣 ,
内 实 , 大便难者 , 此名 阳明也 。
( 1 ) Wen yue: he yuan de yang m伽g bi叼 ? (2) Da yue: tdi yang
bing, ruo fa hdn, ruo xid, ruo li xiao bidn, ci wang fin ye we i zhong
gan zao, yzn zhuiin shu yang m伽g. (3) Bu geng u毛 nei shi, da bian
nan zhe, ci m伽g yang ming ye.
,
( 1 ) Q u estio n : Why d。es one gets ya ng brightness disease? (2) Answer:
I n greater ya ng d isease, if sweati ng is pr。m。ted , if preci pitati。n [ is used , ]
。r if u 巾ati。n is d isi 州 bited , this [ca uses] l iq u id a nd h u mor c。lla pse a nd
d ry n ess i n the stomach ; hence [there is a ] sh ift t。 the ya ng brightness.
(3) N。 cha nge of clothes , * i nterna l repleti。n , a nd difficu lt defecati。n ;
t h ese [signs] a re ca l led ya ng brightness.
TEXT NOTE
*
No change of clothes, 不 更 衣 bu geng u仨 Former!� it was customary to change
one’s clothes after defecation, and so the expression “changing one’s clothes"
was a euphemism for defecation.
S YNOPSIS
When greater yang disease is treated inappropriately, it can shift into yang
brightness disease.
COMMENTARY
When in greater yang disease an inappropriate treatment is used, it can cause
the evil to move into the y缸g brightness. The mistreatments described in this
2 . YANG BRIGHTNESS [LINE 1 85]
305
line 缸e the ( excessive ) promotion of sweating, precipitation, and disinhibiting the
unne.
The promotion of sweating is normally an appropriate treatment for greater
yang exterior patterns. Appropriate promotion of sweating should give rise to a
generalized mild sweating. If the sweating is excessive or incomplete, it can induce
the evil to enter the interior. Incomplete sweating is discussed in the following
line. Copious sweating can damage the fluids and the 啡, so that if the evil passes
into the interior it easily transforms into dryness, causing the disease to shift int o
yang brightness. Inappropriate precipitation or disinhibition of urine instead of
sweating can likewise damage the fluids and encourage the disease to shift into
yang brightness. Furthermore, as stated in the commentary on the first line of y缸g
brightness dise出e, preexisting stagnation of the stomach and intestines is another
major disposing factor for development of yang brightness repletion pattern. When
the evil enters the interior and transforms into dryness it contends with the waste
in the intestines, causing the bowel ql to become bound and blocked.
The three signs in the second part of this line may be seen as a single de­
scription of a y但g brightness disease or as sep缸ate signs. Cheng Wu-Ji (成 无
己 ) writes: “When people in ancient times went to the toilet, they would change
their clothes. Not changing clothes meant failure to defecate. Not changing clothes
means that the stomach contents cannot be discharged; hence [there is] internal
repletion. [When] there 缸e no fl1削s in the stomach, and, in addition, there is heat
amassment , defecation is difficult and this is y缸g brightness internal repletion.”
In his explanation, all three terms describe the same condition. The authors of Yi"
Zδng Jfn Jian write that these signs refer back to the preceding line: “Stomach
repletion disease can be divided into three forms: not changing clothes, which is
greater y缸g yang brightness straitened spleen; internal repletion, which is right
y缸g yang brightness repletion in the stomach domain; and difficult stool, which is
lesser yang yang brightness difficult stool. These three signs can all be treated by
precipi tat ion , but differ in severity. Straitened spleen is milder than difficult defe­
cation; difficult defecation is milder than repletion in the stomach domain.” Thus,
these signs 缸e considered three different conditions or as a single condition.
LINE
185
付 本太阳初得病时 , 发其汗 , 汗先出 不彻 , 因 转属 阳 明 也 口
问 伤 寒 发 热 无 汗 , H区 不 能 食 , 而 反 汗 出 满 满 然 者 , 是 转 属 阳
明 也。
{ 1 ) Ben tai yang chu de bing sh{, fa qi han, han xian chu bu che, yfn
zhuan shu ya叼 m仇g ye. {2) Sha叼 han fa re WU han, OU bu neng
sh{, er fan han chii j{ j{ ran zhe, shi zhuan shu yang ming ye.
( 1 ) O rigi n a l ly, at the begi n n ing of greater ya ng d isease, sweating is
promoted , [but it] is i n com plete, which ca uses a shift to yang brightness.
{2) When i n cold da mage, [there i 斗 heat effusion , sweati ng is a bsent,
306
2 . YANG B RIGHTNESS [LINE 185]
[a nd there is] 时ch i ng a n d i n a bility to eat, a n d [sweati ng 。CCU 叫 but it
is a strea m i ng sweat, * this mea n s a sh ift to ya ng brightness.
TEXT NOTE
*
Streaming sweat, 汗 出 潇 潇 然 hdn chu j{ j{ ran : A continuous flow of sweat .
The word 滞 j{ comes from 黠 j{, which means “to collect" or 气o gather."
This phrase would appear to describe how the sweat gathers into rivulets
or streams. According to traditional commentators, yang brightness disease
is usually characterized by profuse sweating. “Streaming sweat" is normally
taken to imply profusion, although in the following line, the phrase 油 然 微
汗 出 ji ran wei han chU means “mild streaming sweat.” For this reason,
“streaming sweat" is generally assumed to emphasize continuity rather than
profusion. Nevertheless, mild continuous sweating implies the discharge of a
large amount of sweat over time.
S YNOPSIS
Greater y缸g disease with incomplete promotion of sweating or cold damage
with exuberant evil heat can shift into y缸g brightness disease.
COMMENTARY
The 也wo sentences of this line present different situations in which greater y缸ig
disease shifts to the y缸g brightness. The first 町ises after sweating has been pro­
moted, while in the second, no inappropriate treatment has been given.
The first condition arises after the promotion of sweating. The promotion of
sweating is the appropriate treatment in greater y归g diseases, but here it leads to
a pathological transmutation. Sweating is promoted, but it is incomplete; that is,
the sweating started and then stopped, or was of excessively short duration, or the
sweating was too mild and failed to occur over the entire body. Thus the evil has
not been expelled, and owing to hyperactivity of stomach yang, it has entered the
interior, transformed to heat, and settled in the yang brightness. This is therefore
a transmutation that is ascribed t? constitutional factors.
The second part of the line presents another situation in which greater y缸ig
evil shifts into the yang brightness. Here there is no mention of any treatment. We
assume, therefore, that there has been no promotion of sweating and no inappro­
priate treatment . In the shift into y缸g brightness, the original heat effusion and
absence of sweating of greater yang cold damage gives way to a “streaming sweat"
characteristic of y缸g brightness. We infer from this development that the aversion
to cold of greater y缸g has given way to heat effusion, sweating, and aversion to
heat rather than cold. The line seems to suggest that the original greater y缸g
condition was also marked by retching and inability to eat. Given the subsequent
shift into y缸ig brightness, retching and inability to eat is usually taken to reflect
hyperactivity of stomach y缸g, which is a predisposing factor for y缸g brightness
disease. Hyperactivity of stomach yang easily leads to impairment of the harmony
and downbearing of the stomach, in which counterflow ascent of stomach qi gives
rise to retching and i皿.pairment of the stomach’s governing of intake causes inability
to eat.
Whether inappropriate treatment, or exuberant interior heat, causes the evil to
enter the yang brightness, the result is streaming sweat. This type of continuous
2 . YANG B RIGHTNESS [LINE 1 88]
307
sweating leads to a great loss of sweat, which is the external sign of yang brightness
disease. It reflects dryness-heat in the stomach and intestines, steaming the fluids
and forcing them towards the exterior. However, this type of sweating not only f剖ls
to resolve the evil, it also damages liquid. The only method of treatment is to clear
and drain y缸g brightness dryness-heat. When the evil is eliminated, the sweating
will stop and the fluids will be safeguarded.
This line and the preceding one present three situations in which a greater yang
evil may shift into the y缸g brightness. In the first, sweating is promoted excessively
and the fluids are da皿aged. In the second, sweating is promoted incompletely and
the evil heat enters the interior. In the third, without promotion of sweating or
inappropriate treatment, hyperactive interior heat encourages an exterior evil to
enter the interior spontaneously.
LINE 188
伤 寒 转 系 阳 明 者 , 其 人 满 然微 汗 出 也 。
Shang han zhuan xi yang ming zhe, qt ren jt ran w函 him chu ye.
When [the evi l] i n c。Id da mage* sh ifts t。 ya ng brightness, the person
wi l l h ave slight strea m i ng sweat .
TEXT NOTE
*
Cold damage, 伤 寒 shii.ng htin: In this context the term is used in its broader
sense of externally contracted heat disease, not in the narrower sense of greater
y缸g cold damage, since any evil entering yang brightness, not only disease
passing from the greater y缸g to y缸g brightness, will give rise to streaming
sweat.
S YNOPSIS
The signs appearing when cold damage shifts into the yang brightness.
COMMENTARY
Yang brightness governs the flesh and diseases affecting the fluids. When ex­
terior evil enters yang brightness, dryness-heat stea皿s the fluids and forces them
out through the interstices of the flesh. Consequently, sweating is a major feature
of yang brightness. “Slight streaming sweat" in this line describes a mild, con­
tinuous flow of sweat . This sign is insufficient to determine that the disease is in
yang brightness; the presence of heat effusion with no aversion to cold, but rather
aversion to heat, is required as corroboration. Further, in formless yang brightness
dryness-heat, there is usually also great thirst and a large surging pulse; in y臼g
brightness dryness-heat contending with formed accumulation and stagnation, there
is usually also abdominal fullness, hardness, and pain; inability to evacuate; and
tidal heat effusion and delirious speech. The most important references to sweating
in y缸g brightness disease are to be found in the following lines: line 182, p. 308;
line 219, p. 318; line 213, p. 331 ; line 230, p. 422; and line 253, p. 343.
In certain conditions, yang brightness disease does not manifest in sweating.
Absence of sweating occurs when, owing to insufficiency of fluids, sweat cannot
be produced, despite exuberant heat. Absence of sweating, or sweating from the
2 . YANG BRIGHTNESS [LINE 182]
308
head only, is observed when y缸g brightness heat binds with internal dampness evil,
obstructing the qi dynamic, causing absence of sweating or sweating from the head
only, and inhibited urination. In such cases yellowing is more likely to occur.
2 . 2 PULSES
LINE 182
AND
SIGNS
忖 问 曰 : 阳明病外证云何 ? ω 答 曰 : 身热 , 汗 自 出 , 不 恶
寒 , 反恶热也 。
( 1 ) Wen yue: yang M叼 bing wai zheng u 伽 he? (2) Da yue: shen
re, han zi chu, bu WU han, fan WU re ye.
( 1 ) Question : What a re the 。utwa rd signs of ya ng brightness disease?
(2) Answer: [There is] genera l ized heat [etfusi。 吨 sp。nta neous sweati ng
a nd n。 aversion t。 cold , but aversion t。 heat.
SYNOPSIS
The exterior signs of y缸g brightness disease.
COMMENTARY
Yang brightness disease is caused by evil heat entering the interior, and is
characterized by dryness-heat repletion. Dryness-heat in the interior is not directly
accessible to the senses. Its presence is deduced from outward signs that are detected
through the four examinations.
Heat is formless. When it originates in the stomach and steams the flesh, both
the inner body and the outer body 缸e hot. Hence the outward sign is generalized
heat. Generalized heat may be seen in diseases of all of the six channels, so one must
differentiate carefully. When it occurs in greater y缸g dise甜e, it is accompanied by
aversion to cold, a pulse that is floating, headache, and sweating or no sweating,
depending on whether it is exterior repletion or vacuity. In lesser yang disease,
generalized heat alternates with aversion to cold. Heat effusion does not normally
appe缸 in disease of the triple yin because generally the sign patterns do not indude
heat. If it does occur, it indicates more complex patterns, which will be discussed
later.
Heat effusion in y但g brightness disease differs from that of any other chan­
nel disease in that the heat is more exuberant, is ( with minor exceptions ) always
accompanied by but not abated by一--sweating, and is associated with aversion to
heat rather than to cold. The heat effusion is accompanied by sweating because
the dryness-heat causes the yang brightness bowel's copious qi and blood to steam.
The heat effusion is associated with no aversion to cold because the exterior pattern
has already ceased and the disease evil has completely entered the y缸g brightness.
Because y但g brightness is marked by exuberant interior heat, there is also aversion
to heat rather than aversion to cold. This marks a clear difference between y缸g
brightness and greater yang.
2 . YANG B RIGHTNESS
( LINE 1 8 3)
309
The present line makes no mention of tidal heat [effusi叫 and delirious speech,
which are also outward signs of yang brightness disease. However, these signs are
only observed in severe or critical conditions. If one waits for the appearance of these
signs to identify yang brightness disease, one will have missed an early opportunity
for successful treatment .
LINE
1 83
付 间 曰 : 病有得之一 日 , 不发热而恶寒者 , 何也 ? 问 答 曰 :
虽 得之一 日 , 恶寒将 自 罢 , 即 自 汗 出 而恶 热也 。
( 1 ) Wen u包t bing you de zhr yr 时p bu fa re er WU han zhe, he ye ?
( 2) Da yue: sui de zhr yr 叫, wu han jia叼 zi ba, ji zi han chu er 四d
re ye.
( 1 ) Question : What of disease [th at has lasted h叶 a day, [when] heat
effusion is a bsent [a nd t here is] aversi。n to cold? (2) Answer: Alth。ugh
[the陀 has been d isease for] 。nly a d ay, the ave时。n to cold will sponta­
ne。usly cease a nd then there wi l l be sp。nta neous sweati ng a nd aversion
t。 heat.
SYNOPSIS
Signs presenting when the y缸g brightness contracts external evil right at the
onset of illness.
COMMENTARY
In the present line, yang brightness has just contracted external evil, but the
evil has not yet transformed into heat. This line describes an illness that is in the
early stages, probably the first couple of days, not necessarily the first day. The
disease is still in the process of development, and so the classical signs of y缸g
brightness have not yet developed. Hence there is aversion to cold without heat
effusion.
We can analyze the differences between the aversion to cold described in the
present line and that of other patterns from three angles. As regards the man­
ifestation of disease, aversion to cold here is not accompanied by heat effusion.
Nevertheless, since yang brightness is essentially dryness-heat, the aversion to cold
is mild and may be accompanied by signs such 描 vexation and agitation or red
tongue. Hence this is not the aversion to cold of greater yang, which is accom­
panied by heat effusion. As regards the course of the disease, the appe町ance of
aversion to cold at onset of y但g brightness disease is tempor町y and will swiftly
disappear without being treated. This is different from the aversion to cold appear­
ing in other patterns. As regards pathomechanism, although disease entering yang
brightness is marked by dryness-heat which normally manifests as heat effusion
with aversion to heat, nevertheless, aversion to cold can arise when an external evil,
having just entered, has not yet given rise to exuberant dryness-heat, and blocks
the yang 啡, preventing it from reaching outward.
2 . YANG B RIGHTNESS [ LINE 1 84]
310
Yang brightness disease develops very swiftly, giving rise to heat effusion with
aversion to heat rather than to cold, and with profuse sweating. Although the
classical yang brightness signs have not fully developed, the phrase “the aversion
to cold will ce副e,” hints that they are about to appear. When one recognizes that
the aversion to cold is different from that seen in greater y缸g dise出e, one will be
able to anticipate the change to the y归g brightness and treat the patient correct坊.
LINE
1 84
卜) 问 曰 : 恶 寒 何 故 自 罢 ? ω 答 曰 : 阳 明 居 中 , 主 土 也 , 万
物所归 , 无所复传 , 始 虽 恶 寒 , 二 日 自 止 , 此 为 阳 明 病也 。
( 1 ) W1切 yue: Wu han he gu zi bd ? (2) Da yue: ya叼 ming ju zh o叼y
zhii. tu ye, wan WU suo guf, WU suo Ju chuan, sh'i suf WU han, er ri
zi zh'i, c'i wei yang m伽g bing ye.
( 1 ) Q u estion : Why does aversion to c。Id cease sp。nta ne。usly? (2) An­
swer: Ya ng brightness resides in the center a nd g。verns ea 同 h . A l l
t h i ngs c。nverge [here a nd] noth i ng passes fu rther. Although a t the be­
gi n n ing [t here is] aversion to cold , i n two days [it wil l] sponta neously
cease, i n d icating ya ng brightness d isease.
SYNOPSIS
Continuing from the preceding line, an explanation of why aversion to cold
spontaneously ceases.
COMMENTARY
The foot yang brightness stomach is dry earth. The hand y缸g brightness large
intestine is dry metal. The qi of these two channels is the same; consequently, the
yang brightness governs dryness. Since the greater yin and the yang brightness
stand in interior』exterior relationship, stomach dry earth receives enriching and
moistening from the damp earth of the spleen, and large intestine dry metal is
cleared and harmonized by the clear metal of the lung. Under normal circumstances,
yang brightness and greater yin balance each other, so that the dryness of yang
brightness is not apparent. It becomes apparent only when this balance is upset. If
y缸g brightness dryness becomes excessive, then greater yin dampness is insufficient ,
giving rise to a yang brightness dryness-heat repletion pattern. If yang brightness
dryness becomes insu面cient, then greater yin dampness is excessive, giving rise to a
yang brightness cold pattern or shifting to the greater yin. The present line discusses
excessive y缸g brightness dryness with insufficient greater yin dampness. yang
brightness is characterized by dryness transformation, and however long or short
the course of the disease so far, aversion to cold is bound to ce嗣e spontaneously, as
explained in the preceding line. The practitioner needs to be aware that aversion
to cold can appear in y缸g brightness di阻挡e, although only at its onset .
A version to cold can appear in disease of any of the six channels. However ,
there are certain distinguishing features. In greater y缸ig dise描e, aversion to cold
appears and recedes as the disease begins and ends. If greater yang disease persists
2 . YANG BRIGHTNESS [LINE 1 86]
311
and timely treatment is not given, aversion t o cold can continue for eight o r nine
days. When aversion to cold appears in lesser yang disease, it is generally 槌 part of
alternating aversion to cold and heat effusion. In disease of the three yin, aversion
to cold appears without heat effusion and will persist unless treatment to warm the
center and return y缸ig is given.
The present line explains the spontaneous cessation of aversion to cold in y缸ig
brightness disease in terms of the doctrine of the five phases. In the natural world,
earth engenders and fosters all things. All things grow, develop, become debilitated,
and die, after which they return to the eart h In the body, the spleen and stomach
are center earth, because they are located in the center burner and because food and
drink taken in are transformed into essence and distributed through the body, nour­
is hi
and] nothing passes further" is explained as meaning that any evil-exterior or in­
terior, cold or heat-can, under certain conditions, converge in the y缸g brightness,
just as all things return to earth. Yang brightness governs dryness transformation;
all evils can transform into dryness. After an evil has transformed into dryness and
formed repletion, the bowel qi is blocked, and the condition can only be treated
by clearing and precipitation. “Nothing passes further" is understood to allude to
this situation, rather than meaning that the evil in yang brightness cannot pass
to another channel. Indeed, yang brightness disease can shift into the yin chan­
nels, such as when yang brightness disease marked by exuberant heat stirring the
blood manifests in nosebleed. If, in this condition, the clearing and precipitating
treatment is excessive, it can cam;e the evil to pass into the triple yin .
.
LINE
186
伤 寒 三 日 , 阳 明 脉大 。
Shang han san ri, yang m加g mai da.
I n c。Id d a mage 1 [that has lasted] t h ree days, 2 the ya ng bright ness p山e
is l a rge.
TEXT NOTES
1 . Cold damage, 伤 寒 shiing Mn : Here, cold damage should be understood in
the broad sense of externally contracted disease, since it is not only in greater
yang cold damage that one may find a pulse that is large following the shift
to the y缸ig brightness.
2 . Three days, 三 日 siin ri : A short period of time has passed, not necessarily
exactly three days.
SYNOPSIS
The primary pulse for yang brightness disease.
COMMENTARY
Yang brightness has copious qi and blood, and insofar as it is equated with the
stomach, it is the sea of grain and water. For these reasons, yang brightness disease
is characterized by a pulse that is large. Because the yang brightness governs
dryness, when an evil enters, it easily transforms into dryness-heat and spreads
312
2 . YANG BRIGHTNESS [LINE 221]
throughout the body. It steams and distresses the qi and blood, forcing movement
and causing the pulse to become large.
A pulse that is large is not the only pulse seen in yang brightness. In yang
brightness disease, formless dryness-heat rampant in the interior and exterior can
cause the pulse to be surging, large, slippery, and rapid. Nevertheless, when heat­
dryness forms repletion and causes stoppage of bowel qi, the pulse becomes sunken,
replete, and in some c臼es slow.
A large pulse is also seen in disease other than y缸g brightness. For example,
line 25, p. 125, describes an exterior pattern arising in greater y缸g disease in which
the pulse is surging and large. Again, line 30, p. 269, states, “The inch pulse is
floating and large; floating means wind and large means vacuity.” Here “large” as
a sign of vacuity clearly refers to a pulse that is large and forceless. In the present
line, however, “the yang brightness pulse is large" refers to a pulse that is large and
forceful. We may infer from these examples that according to Zhang JI’s usage,
“large” refers to breadth of the pulse only, and has no connotations of strength.
3
BASIC YANG BRIGHTNESS DISEA SE
PATTERNS
3.1
3.1.1
HEAT PATTERNS
Gardenia and Fermented Soybean Decoct ion
Patterns
The following two lines describe the Gardenia and Fermented Soybean Decoc­
tion (zhi" zf chf tang) pattern occurring in yang brightness disease. This pattern
may also occur in greater y缸g disease, but the initial course of the disease is diι
ferent. In greater y缸g disease, it is mostly the result of exterior evil shifting into
the interior and becoming depressed in the region of the chest and diaphragm after
inappropriate treatment. In yang brightness dise副e, this pattern occurs 臼 a result
of residual heat following precipitation. In both cases, this pattern is characterized
by heart vexation and anguish as the main sign, and is attributable to the path­
omechanism of formless evil heat harassing the upper burner. For this reason, the
treatment is the s缸ne in both cases.
LINE
221
(一) 阳 明 病 , 脉 浮 而 紧 , 咽 燥 口 苦 , 腹 满 而 喘 , 发 热 汗 出 , 不
恶寒 , 反恶热, 身重。
ω 若 发 汗 !J!IJ 躁 , 心 愤 愤 , 反 俨 语 ;
若 加 温针 , 必怵惕 , 烦躁不得眠 ;
若 下 之 , 贝lj 胃 中 空 虚 ,
客 气动 脯 , 心 中 懊侬 , 舌 上胎 者 , 梳子鼓汤 主 之 。
yang ming bing, mai Ju er fin, yan zao kou ku, Ju man er chuan, fa
re han chii, bu WU han, fan WU re, shen zhong, ruo fa han ze zao,
xin kui kui, Jan zhan yu; ruo jia wen zh旬, bi chu ti, fan zao bu de
2 . YANG B RIGHTNESS [LINE 2 2 1 ]
313
mian; ruo xia zhi, ze wei zhiing kiing xii., ke qi dong ge, xin zhiing do
n6ng, she shang tai zhe, zhi zi chi tang zhu zhi.
When i n ya ng brightness d isease, the pu lse is floati ng a n d tight, t h e
t h roat is d ry a nd [there i 斗 a bitter taste i n the mouth , a bd。m i n a l fu ll­
ness, pa nting, heat effusi。n , sweating, a bsen ce of aversi。n to c。Id , a n d
i nstea d , aversi。n to heat [is present] a nd [there is] genera lized heavi­
ness, if sweati ng is promoted , there wil l be agitation , restiveness of the
heart 1 but 2 deli rious speech . If 。ne adds a warm need le, t here wi l l be
a pprehensiveness and vexation a n d agitation with i n a bi l ity t。 sleep. If
one precipitates, there wil l be em pty vacuity in the st。mach , visiting qi
sti rri ng the dia ph ragm , a nguish i n the heart, a nd if fur [a rises] 。n the
tongue, Garden ia and Fermented Soybea n Dec。ction ( zhi zi chi t伽.g )
g。verns.
TEXT NOTE
1. Restiveness of the heart, 心 愤 愤 xzn kui kui : A feeling of disorder, vexation,
and unrest centered in the heart.
2. But 反 fan: This occurrence of 反 Jan is considered by many commentators
to be a mistake because the appearance of delirious speech seems reasonable
given that a y缸g brightness disease is mistakenly treated with an acrid, warm,
exterior-resolving formula, which exacerbates the heat, disturbing the heart
and resulting in delirious speech. Its presence might however be justified, 证 it
suggests that the mistaken use of this formula not only exacerbates the heat,
but also damages heart liquid, resulting in a complex pattern of heat repletion
and yin vacuity. In patterns of vacuity, muttering, not delirious speech, is
often observed; therefore, we can understand the phrase as, “but instead of
muttering, there is delirious speech."
SYNOPSIS
a ) ’Transmuted patterns that m町 occur following inappropriate treatment of
yang brightness heat patterns.
b) The signs and treatment of heat remaining in the chest and diaphragm
following precipitation in yang brightness heat patterns.
COMMENTARY
As stated in the commentary on the preceding line, a pulse that is large is the
main pulse of yang brightness disease. The present line describes yang brightness
disease with a pulse that is floating and tight. The pulse here is a mutation. A pulse
that is tight generally indicates cold or pain; it may also occur in abiding food or
phlegm-rheum. The reason why a pulse that is tight occurs in these c副es is because
of fierce contention between right φ and evil qi. The condition described in the
present line is one of repletion of evil and repletion of right, arising when exuberant
yang brightness dryness-heat contends with right qi. The tension between evil and
right results in a pulse that is tight. When the pulse is floating, one usually considers
the possibility of an exterior pattern. In yang brightness disease, however, a pulse
314
2. YANG BRIGHTNESS [LINE 2 2 1 ]
that i s floating indicates dryness-heat rampant i n both the interior and exterior. In
both cases, when light pressure is applied, the pulse is superabundant; for this re臼on
the pulse is described as floating. However, when heavy pressure is applied, there is
a difference. In exterior patterns, the pulse is less forceful, but it is not empty when
heavy pressure is applied. This pulse is due to right φ thrusting toward the exterior
to expel the evil. In yang brightness dise嗣e, by contrast, it is still forceful under
pressure, reflecting exuberant interior heat. Furthermore, of course, these patterns
can be differentiated on the basis of the other signs present, such as heat effusion,
aversion to cold, and headache, in the c副e of greater y缸g disease, or aversion to
heat, thirst, and streaming sweat, in the case of y缸g brightness disease.
Dry throat and bitter t出te in the mouth reflect steaming dryness-heat impairing
stomach harmony and downbearing and causing turbid heat qi to surge upward.
These two signs also appear in the description of the essential features of lesser
y缸g disease ( see line 263, p. 407) . However, it is not difficult to distinguish the
two conditions since the accompanying signs are different in each case. For example,
in lesser y缸g disease, fullness in the chest and under the rib-side and a pulse that
is stringlike and fine are also present. Here, the fullness is in the abdomen, and the
pulse is floating and tight.
Abdominal fullness and panting arise when internally exuberant dryness-heat
causes congestion of ql dynamic and counterflow ascent of lung qi. Abdominal full­
ness and panting occur in both formless y缸g brightness dryness-heat and repletion
patterns, which are readily distinguished by other presenting signs.
Heat effusion, sweating, and aversion to heat instead of cold are attributable to
dryness-heat in the interior steaming the fluids and forcing them out to the exterior.
These are the outward indicators of y缸g brightness disease. yang brightness heat
patterns usually include vexation and agitation. However, the present line speaks of
generalized heaviness. This arises when interior heat damages original 啦, causing
congestion in the channel vessels.
This line discussed several inappropriate mistreatments, including two that ex­
acerbate the heat. The signs enumerated in the first part of the line are all at­
tributable to internal dryness-heat . In this situation, 气reating heat with heat" ( 以
热 治 热 yi re zhi re) constitutes “replenishing repletion" (实实 shi shi) . I f heat effu­
sion and a pulse that is floating and tight 缸e misinterpreted as an exterior pattern,
and sweating is inappropriately applied, it will exacerbate the condition. Warm,
acrid exterior-resolving medicinals will exacerbate the heat , and the promotion of
sweating will further damage the fluids. As a result, the even more exuberant evil
heat will harass the heart spirit, causing agitation and restiveness, and in severe
cases delirious speech. Again, the presence of generalized heaviness and a pulse
that is floating and tight, if taken to indicate internal cold-damp, might prompt the
use of warm needling. However, such treatment would be inappropriate because
it would boost the interior heat, which would harass the heart spirit and cause
apprehension, vexation and agitation, and sleeplessness as well.
Precipitation is appropriate for treating y缸ig brightness repletion patterns. It
s
i not suitable for a condition caused by formless dryness-heat in the interior such as
is described in the present line. Precipitation in this c臼e will damage the stomach
and intestines; it will not promote but even hinder the elimination of evil heat,
which will then harass the [region of the] chest and diaphragm. This is described
2.
YANG
B RIGHTNESS [LINE 2 28]
315
as “visiting qi stirring the diaphra伊l,” which gives rise to anguish in the h�art, 回
well as a white, yellow, or mixed yellow and white tongue fur.
Gardenia and Fem
扭d diffuse depressed heat in the chest and diaphragm. ( See line 76B, p. 144, for a
discussion of this formula. ) In the present line, the depressed heat in the chest and
diaphragm is due to the inappropriate use of precipitation in yang brightness form­
less heat. In the greater y臼g section, the same formula was used to treat depressed
heat in the chest and diaphragm resulting from the inappropriate treatment ( vom­
iting or precipitation ) . These two C出es differ 槌 to the location of the evil prior to
inappropriate treatment ( exterior in greater y缸g and interior in yang brightness ) .
However, in both cases, inappropriate treatment causes heat to become depressed
in the chest and diaphragm region, giving rise to anguish in the heart, even though
the accompanying signs are slightly different.
LINE 228
阳 明 病 , 下 之 , 其 外 有 热 , 手 足 温 , 不 结 胸 , 心 中 懊侬 , 饥
不 能食 , 但头汗 出 者 , 扼子鼓汤 主之 。
yang ming bing, xia zhf, q{ wai you re, shou zu wen, bu jie xiong,
xrn zhδng ao nong, jr bu neng sh{, dan t6u han chu zhe, zhr zi chi
tang zhu zhi.
When i n ya ng brightness d isease, precipitation is used a nd [there is]
heat in the exteri町, * wa rm extremities, no chest bi nd , a n gu ish i n the
heart , h u nger with i na bi l ity t。 eat, a nd sweati ng 。 n ly fr。m the head ,
Gardenia a nd Fer『Y
TEXT NOTE
the exterior, 其 外 有 热 qi wai you
the outside of the body.
Heat in
re :
Generalized heat expressed to
SYNOPSIS
The signs and treatment of yang brightness disease when, following precipita­
tion, residual heat that has not been eli皿inated, harasses the chest and diaphragm.
COMMENTARY
The present line describes another Gardenia and Fermented Soybean Decoction
(zhi zi: chi: tang ) pattern arising after precipitation in y缸g brightness disease. Here,
yang brightness dryness repletion with bowel qi stoppage is appropriately treated
by attacking with coldness and bitterness, but although the dryness bind has been
freed, the treatment is not completely successful, since residual heat remains. In
such a situation, precipitation cannot be used again, and the coηect treatment is
to clear and diffuse the residual heat to provide a final adjustment.
Heat in the exterior with warm extremities after precipitation is the outward
manifestation of residual heat. It suggests that the heat w臼 even more severe prior
to precipitation.
2. YANG BRIGHTNESS [LINE 1 76]
316
The absence of chest bind is a key pattern-identification point in the present
line. It reflects formless evil heat harassing the region of the chest and diaphragm,
rather than heat repletion chest bind resulting from heat and water-rheum binding
together in the chest. Here there is no pain in the diaphragm that refuses pressure,
or hard fullness below the heart; rather, there is only anguish in the heart with no
pain or only slight pain, but no hardness and fullness. Hence both conditions are
caused by heat in the chest and diaphragm, but should not be confused.
The anguish in the heart is due to evil heat harassing the inner body. Hunger
with inability to eat is explained as meaning a sensation “similar to hunger but not
hunger,” which is often called “clamoring stomach" (嘈杂 cao za) . This is caused by
heat harassing the stomach duct disturbing normal digestion. Finally, when yang
brightness heat is pronounced, there is great sweating or sweat streaming from the
hands a且d feet. However, in this case, heat has been reduced by precipitation and
is only strong enough to manifest in warmth in the extremities. The residual heat
rises upwards; it is incapable of producing a generalized sweat and merely causes
sweating from the head.
3.1.2
Whit e Tiger D ecoction Pat terns
The White Tiger Decoction ( btii hii, t伽.g) pattern is one of exuberant y缸g
brightness dryness-heat. The characteristic signs are great heat, great thirst, great
sweating, and a pulse that is surging and large. The pulse may also be floating
and slippery. The primary signs presented for this pattern are abdominal fullness
and generalized heaviness, 画面culty turning sides, insensitivity of the mouth, grimy
complexion, delirious speech, and enuresis.
Frequent aversion to wind, great thirst, dry tongue, and increased desire to drink
water, heart vexation, and slight aversion to cold in the back are all considered signs
of fluid damage, in which c副e White Tiger Decoction Plus Ginseng ( btii hU jia r印
shen tang) is suggested.
These formulae should generally not be used if the exterior pattern has not yet
resolved.
LINE 1 76
伤寒 , 脉浮滑 , 此表有热 , 里有寒 , 自 虎汤主之 。
Shang han, mai 庐i hua, ci b必o you 吨, H you ha饨, bai hii tang zhii
zhz.
When i n cold d a m age the pulse is floati ng a nd sl i ppery, this [mea ns
there is] heat in the exterior a nd c。Id in the i nterior.* Wh ite Tiger
Dec。cti。n ( bai hii tang) governs.
TEXT NOTE
Cold in the interior, 里 有 寒 H you htin : Lfn Yl (林 亿 ) et al. , the editors of the
Song version, believe that this is an error and that the text should read “heat
in the interior,” 里 有 热 li y伽 re . They state, “ [When there is] heat bound
in the interior, and [there is] heat in both the interior and exterior, White
2 . YANG BRIGHTNESS [LINE 1 76]
317
Tiger Decoction ( Mi h U tang ) governs . …” This interpretation is generally
accepted.
FORMULA
White Tiger Decoction ( Mi hU tang )
o
Clear heat with cold and acridity.
知母六两
石膏一斤 ( 碎 )
甘草二两 ( 炙 )
梗米六合
右 四 昧 , 以 水一 斗 , 煮 米 熟 , 汤成去淳 , 温服一升 , 日 三 服 。
Zhf mu liu liiing sM gao yf jfn (sui) gan cao e r liang (zhi) geng mi liu ge
You si wei, yi shui yf dou, zhu mi shu, tang cheng qu zi, wen JU yf sheng, ri
s an fu
.
anemar巾na (知 母 zhf mu, A『1e『narrhe
盯阿 u m ( 石 膏 shi g ao G ypsum ) 1 Jin (crushed)
mix-fried licorice ( 甘 草 gan cao, Glycyrrhizae Radix} 2 li�ng
rice (梗 米 geng mi, Oryzae Semen) 6 g�
,
[For] the above fou r ingredients use one d�u of water. Boil until the rice is cooked .
When the decoction is ready,* remove the dregs and take one sheng warm , three times
a day.
FORMULA NOTE
丰 When the decoction is r eady, 汤 成 t ang cheng : Since the instructions state
that one sheng should be taken warm, three times a day, the phrase “when the
decoction is ready" is taken to mean “when the decoction has been reduced
to three sheng.”
S YNOPSIS
The pulse, si?11s , and treatment of yang brightness disease with heat in both
the exterior and interior.
COMMENTARY
The present line begins with the phrase “cold damage,” which is here meant in
its broader sense of any externally contracted heat disease. The line describes the
signs and treatment of a condition resulting from externally contracted disease evil
that passes from the exterior into the interior and enters yang brightness.
The line discusses a pathomechanism on the basis of the pulse alone, without
consideration of signs. Here we can infer from the formula that the signs will be
those of formless exuberant dryness-heat mentioned in line 26, p . 156; line 168,
p. 323; and line 182, p. 308.
The pulse is described as floating and slippery. Here, floating does not signify
evil in the exterior; rather it is the outward manifestation of exuberant internal heat,
and accompanying signs ought to include heat effusion, spontaneous sweating, and
aversion to heat rather than to cold. Hence the text attributes the floating quality
of the pulse to “heat in the exterior. " However, this is not to be misinterpreted
as greater y缸g exterior heat .
“Slippery” is the direct manifestation of exub erant
internal heat . This is because exuberant internal heat stirs qi and blood, so that
318
2 . YANG BRIGHTNESS [LINE 2 1 9]
the pulse comes and goes smoothly (往 来 流 和l wiing lai liu li) , like “pearls rolling in
a dish” ( 如 盘 走 珠 时 pan zou zhu) , and accompanying signs should include great
vexation and thirst with intake of fluid, and a dry yellow tongue fur. On the basis
of the descriptions of pulses in yang brightness disease given in line 186, p. 31 1 , and
line 221 , p. 312, we can assume that in the present line the pulse is forceful when
heavy pressure is applied.
White Tiger Decoction ( bai hU tang) is used to treat formless internal drynes坠
heat spreading through the whole body so that there is heat in both the interior
and exterior. Gypsum (shi gao) is acrid, sweet, and very cold, and clears heat.
Anemarrhena (zhf mu) is bitter, cold, and moistening; it discharges fire and enriches
dryness. Together, these two ingredients clear exuberant yang brightness heat and
safeguard stomach liquid. Mix-fried licorice (gan cao) and rice (geng mi) together
boost the φ and harmonize the center, since when qi is sufficient, the fluids will be
engendered. Furthermore, these two ingredients help avoid damage to the stomach
from the use of cold medicinals.
LINE 219
←) 三 阳 合病 , 腹 满 身 重 , 难 以 转 侧 , 口 不 仁 面 垢 ,
尿 , 发 汗 则 俨 语 , 下 之 则 额 上 生 汗 , 手足 厥 冷 。
俨语遗
仁) 若 自 汗
出 者 , 白 虎汤主之 。
( 1 ) San yang he bing, f位 man shen zhong, nan yi zh时n ce, kou bu
ren mian gou, zhan yu y{ niao, σd han ze zhan yu, xia zhf ze e shang
she叼 han, shou zu jue Zeng) . (2) Rua zi han chu zhe, bai hu tang
zhu zhr.
(1) I n c。m bi n ation d isease of the th ree ya ng, 1 [there is] a bd。m i n a l
fu l l ness, genera lized h eavi ness, d ifficu lty t u r n i ng sides, i nsensitivity 。f
t h e mouth , 2 gri my face, 3 deli riot』s speech a nd en u resis. ( [If] sweating is
pr。m。ted , t here wi l l be del i riot』s speech4 a nd [if] preci pitation is used ,
sweat w i l l a rise 。n the forehead a nd [t here wil l be] reversa l c。Id 。f the
extre m ities . ) (2) If sweat sponta ne。usly issues, Wh ite Tiger Decoction
( bai hu tang) governs.
TEXT NOTES
1 . Combination disease of the three ya吨, 三 阳 合 病 s伽 yang he bing: Simultane­
ous appearance of the signs of greater y缸ig, lesser yang, and yang brightness
disease.
2. Insensitivity of the mouth, 口 不 仁 kou bu ren: Inhibition of normal speech
and a loss of normal taste.
3. Grimy face, 面 垢 mian gou : The face appears as if concealed by a layer of oily
dirt.
2 . YANG BRIGHTNESS [LINE 2 1 9]
319
4. [If] sweating is promoted, there will be delirious speech, 发 汗 贝lj iJ"' 语 fa hdn
ze zhan yu: The Jfn Gui Yu Han J: ng version reads 发 汗 贝lj 俨 语 甚 fa han
ze zhan yii, sh饵, “[if] sweating is promoted, delirious speech will be [more]
pronounced.” This would make more sense in the context, since delirious
speech is said to be present prior to promotion of sweating.
S YNOPSIS
The signs, treatment, and contraindications for combination disease of the three
yang with the emphasis strongly on yang brightness.
C OMMENTARY
The latter part of this line takes the form of gra皿matical inversion. The last
sentence, “If sweat spontaneously issues, White Tiger Decoction ( Mi hU tang) gov­
erns,” should logically follow after “enuresis.”
This line st缸ts off with “simultaneous disease of the three yang,'’ but the signs
enumerated can all be explained in terms of yang brightness disease, and the treat­
ment suggested is a formula specifically addressing yang brightness disease. One
explanation put forward for this discrepancy is that although this illness may have
begun as simultaneous disease of the three yang, at this point the emphasis has al­
ready shifted to yang brightness. Because yang brightness dryness-heat is congested
in the interior, stomach qi cannot descend and the qi stagnates in the abdomen,
causing abdominal fullness. However, the abdominal fullness is milder than the
abdominal fullness with absence of defecation observed in yang brightness bowel
repletion. Exuberant yang brightness heat damages liquid and consumes qi, caus­
ing generalized heaviness and difficulty turning sides. Damage to liquid also causes
the mouth and tongue to be parched and dry, which leads to a loss of normal
taste sensation and an inhibition of normal speech. Both the foot yang brightness
and the hand yang brightness channel are distributed over the face. Consequently
yang brightness evil heat congested in the interior ste缸ns turbid qi of the stomach
and intestines, and causes it rise to the face, giving the face a grimy or dirty ap­
pearance. Exuberant stomach heat rising to harass the spirit-light causes delirious
speech. In clouded spirit with delirious speech due to exuberant heat, the bladder
loses restraint, resulting in urinary incontinence. The above-mentioned signs are
attributed to exuberant y扭g brightness heat in t h e inner body. Whether or not
White Tiger Decoction ( Mi hu tang) is used depends on whether or not there is
sweating. If sweat spontaneously issues, it means that although the fluids have been
damaged, they have not been completely exhausted. White Tiger Decoction ( Mi
hu tang) clears internal heat and safeguards liquid. If there is no sweating, this is
because of severe damage to fluids, which may give rise to a y缸g brightness re­
pletion pattern. White Tiger Decoction ( bai hU tang) treats formless dryness-heat,
and is inadequate to treat severe damage to fluids. The appropriate treatment will
depend on the signs and pulse.
If heat effusion and generalized heaviness are misinterpreted as an exterior pat­
tern and sweating is promoted with wa口n acrid agents, this treatment will exacer­
bate the internal heat and the resultant loss of sweat will exacerbate the damage to
liquid caused by the stomach heat. Consequently, the delirious speech will become
more pronounced
2 . YANG BRIGHTNESS [LINE 1 70]
320
If the abdominal fullness is misinterpreted as constituting y缸g brightness bowel
repletion, and precipitation is given, this treatment will lead to exhaustion of yin
humor in the lower body. Y三且g will then have nothing to depend on and will stray
to the upper body. As a result, sweat will issue only from the forehead. When yang
strays to the head from the rest of the body, it cannot warm the limbs, hence the
reversal cold of the extremities.
3 . 1 .3
White Tiger Decoction P lus Ginseng Patterns
LINE 170
伤 寒 , 脉 浮, 发 热 无 汗 , 其 表 不 解 , 不 可 与 白 虎 汤 ; 渴 欲 饮
水 , 无 表 证 者 , 白 虎 加 人 参 汤 主之 。
Shang han, mai Ju, fa re WU han, qi biao bu jie, bu ke νd bai hu
tang; ke yu yin shu毛 WU b低o zheng zhe, bai hil jia ren shen tang zhil
zh?:.
When i n cold d a m age, the pu lse is floating, [a nd there is] heat effusion
[a nd] sweating is a bsent, the exterior has n。t res。lved ; 。ne ca n n ot give
Wh ite Tiger Decoction ( bai hu tang ) ; if [t here is) t h i rst with a desi re
f。r fl u ids a nd no exterior signs, Wh ite Tiger Dec。ction P l us Gi nseng
( bai hu j幅 的B shen tang) g。verns.
SYNOPSIS
a) Before an exterior pattern has resolved, White Tiger Decoction ( Mi hii tang )
is contraindicated.
b ) The signs and treatment of y臼g brightness disease with exuberant heat and
liquid damage.
C OMMENTARY
As in line 176, p. 316, the phrase “cold damage" in the present line refers to
externally contracted heat disease in general. The first half of the present line
discusses a greater y缸g exterior pattern (cold damage in the narrow sense ) , as we
can tell from the signs and pulse. The latter half describes the signs and treatment
of an externally contracted disease evil entering y缸g brightness, transforming into
heat, and damaging liquid.
Since a pulse that is floating and slippery can appe缸 in a White Tiger Decoction
(bdi hu tang) pattern ( see line 1 76, p. 316) , and a pulse that is floating and tight
can appear in exuberant y臼g brightness heat ( see line 221 , p. 312) , a pulse that
is floating is not necessarily an indication of a greater yang exterior pattern. A
pulse that is floating m町 (回 in line 1 , p. 4 1 ) , reflect right qi hastening toward the
exterior to. resist an externally contracted disease evil, or ( as in line 176, p. 316) ,
it may be the outward manifestation of exuberant internal heat . Identification is
made on the basis of accompanying signs.
In the 且rst part of the present line, a pulse that is floating with heat effusion
and absence of sweating is explained as being a greater y缸g cold damage pattern.
2 . YANG B RIGHTNESS [LINE 1 69}
321
Since the phrase “the exterior has not resolved" means that the exterior evil has
not yet been eliminated, we may expect aversion to cold to be present . When a
pulse that is floating occurs in y缸g brightness dryness-heat, it will be acco皿panied
by heat effusion, aversion to heat rather than to cold, and spontaneous sweating.
Before a greater yang exterior pattern has resolved, the method of treatment is
promoti吨 sweating to resolve the exterior, as with Ephedra Decoction (ma ht凶z
taηg ) . Even if y缸ig brightness interior heat appears simultaneously, the treatment
is dual resolution of the exterior and interior as with Major Green-Blue Dragon
Decoction ( da qfng l6ng tang ) . Zha吨 JI e皿phasizes that when 咄e exterior has
not resolved, one cannot give White Tiger Decoction ( bdi hu tang ) ” because cold and
cool medicinals will not only fail to eliminate the external evil, but will also damage
center y缸g and cause the external evil to fall inward, giving rise to transmuted
patterns.
In the latter part of the present line, the absence of exterior signs means that
the exterior has resolved, and that the disease evil has completely entered the
interior. The presence of thirst with a desire to drink means that the disease evil
has transformed into y缸g brightness dryness-heat and has damaged liquid and
consumed qi. In view of this, we assume that the pulse is still floating or surging
and large, but since liquid a且d qi have been damaged, it is likely to be relatively
forceless when heavy pressure is applied. The absence of sweating in the first
half of the line should now have given way to spontaneous sweating, and although
heat effusion persists, aversion to cold should have given way to aversion to heat.
These are the outward manifestations of yang brightness dryness-heat . White Tiger
Decoction Plus Ginseng ( Mi hU jia ren shen tang ) is suggested because it clears
heat and engenders liquid, boosts 啡, and nourishes yin.
LINE 1 6 9
伤寒无大热 , 口 燥渴 , 心烦 , 背微恶寒者 , 白 虎加 人参汤主
之。
Shii.ng han WU da re, kou zao ke, xi"n fan, bei wei WU han zhe, bai hu
jiii. 俨en shen tang zhu zhi".
When i n cold d a mage great heat [effusion] is a bsent1 [a nd there is] a
dry mouth , t h i rst, heart vexati。 n , a nd sl ight aversion to c。Id i n the
back, 2 White Tiger Decoction P l us Ginseng ( bai hu jia ren shen tang)
governs.
TEXT NOTES
1. Great heat [effusion] is absent, 无 大 热 WU da re: No great heat in the exterior.
2. Slight aversion to cold in the back, 背 微 恶 寒 bei wei wu han : A mild fear of cold
felt in the back of the body. Different interpretations of the pathomechanism
of this, sign are discussed below.
322
2. YANG B RIGHTNESS [LINE 1 69]
S YNOPSIS
The signs and treatment of yang brightness disease in which the interior heat
is very exuberant and damages both liquid and qi.
C OMMENTARY
The phrase “great heat is absent" appears in several places in the descriptions
of triple yang disease. In the present line, as in several other lines ( line 63, p. 154,
and line 136, p. 218) , it refers to great heat present in the interior but absent fro皿
the exterior, although the precise location of the heat in the interior is different. In
one place ( line 6 1 , p . 1 8 1 ) , i t refers to false heat arising when vacuous ya吨 floats
to the exterior.
Exuberant interior heat damages the fluids causing dry mouth and thirst. Fur­
thermore, heat in the yang brightness easily ascends and harasses the heart, causing
heart vexation. In such c描es there is usually “generalized heat" ( line 182, p. 308) .
In the present line, however, profuse sweating due to exuberant y缸g brightness
dryness-heat has da皿aged liquid and qi一-on the one hand causing the interstices
of the flesh to loosen, and on the other causing yang qi to become depressed in the
interior-so that the body cannot resist wind and cold. As a result, not only has
the original heat effusion abated ( “great heat is abse旷 ) , but there is even slight
aversion to cold in the back. Although the outward signs of the y缸ig brightness
dryness-heat have abated, the internal heat is still pronounced. Here, slight aver­
sion to cold in the back should not be misinterpreted 描 constituting an exterior
pattern or interior cold pattern. Because there is interior heat, the aversion to cold
in the b缸k is only “slight ,” and, in addition, there is dry mouth and heart vexation.
Although the pulse is not described in the present line, it should support this con­
clusion. As to treatment, White Tiger Decoction ( Mi hii. tang) is still recommended
because of exuberant interior heat. Nevertheless, ginseng ( ren sh en ) is added to
boost qi and engender liquid, addressing the looseness of the interstices of the flesh.
“Slight aversion to cold in the back" must be clearly distinguished from the
aversion to cold occurring at the onset of disease. Line 1 83 , p . 309, describes a
condition in which externally contracted evil enters the yang brightness directly.
There is aversion to cold at the onset of disease, but 描 y归g brightness dryness­
heat develops, it quickly ceases. The situation described in the present line differs
in that the “slight aversion to cold in the back" appe缸s not at onset, but after great
heat and greater sweating, and that owing to damage to liquid and qi it will not
cease spontaneously. “Slight aversion to cold in the back" must also be distinguished
from the aversion to cold occurring in greater yang disease and the aversion to cold
of triple yin disease. A version to cold in greater yang disease is generalized over the
whole body and is associated with heat effusion, headache, generalized pain, and a
pulse that is floating. It appears with onset of greater yang disease and disappears
with its cessation. A version to cold in diseases of the three yin channels is likewise
generalized; it is associated with curled lying posture, cold limbs, and a pulse that
is sunken and faint . In greater y缸g and triple yin disease, the aversion to cold is
pronounced, never “slight,” and never limited to the back; it is never accompanied
by thirst with heart vexation, which is strictly a manifestation of exuberant internal
yang brightness heat.
2 . YANG BRIGHTNESS [LINE 1 68]
323
LINE 168
伤寒若吐若下后 , 七 八 日 不解 , 热结在里 , 表里俱热 , 时时
恶风 , 大渴 , 舌 上 干燥而烦 , 欲饮水数升者 , 白 虎加 人 参 汤
主之 。
Shiing han ruo tu T?J,_o xia hou, qi: bii ri bu jie, re jie zai l玩 “iio li
ju re, shi shi WU Jeng, da ke, she shang giin zao e1’· fan, yu yin shui
shuo sheng zhe, bai hu jiii ren shen tang zhu zhf.
When i n c。Id damage, if vom iti ng [is used ] , 。r if preci pitation [is used ]
a nd after seven 。r eight days [there is] n。 res。luti。n , the heat is b。u nd
i n the interior, with heat i n both the exterior a nd i nterior, freq uent
aversion t。 wi nd , * great t h i rst, d ry tongue, vexati。n , a nd a desi re to
d ri n k severa l s heng of water, [t h en ] White Tiger Decoction Plus G i nseng
( bai hu jiii ren shen tii叼 ) governs.
TEXT NOTE
*
Frequent aversion to wind, 时 时 恶 风 shi shi
cold on exposure to wind or drafts.
wu
Jeng: Recurrent sensation of
SYNOPSIS
The signs and treatment of cold damage when, after the use of vomiting and
precipitation, there is heat bound in the interior, and exuberant heat damages
liquid.
COMMENTARY
If greater yang cold damage is mistreated with vomiting or precipitating treat­
ment, the disease will not resolve through the exterior. Instead, the damage to liquid
caused by the mistreatment may cause the evil to fall into the interior and trans­
form into yang brightness dryness-heat , causing further damage to liquid. This is
described in the present line, and bound heat in the interior gives rise to symptoms
in the interior and exterior. On the one hand, great thirst, dry tongue, vexation,
and desire to drink large amounts of water indicate yang brightness interior heat;
on the other, generalized heat ( with aversion to heat rather than to cold ) and spon­
taneous sweating are the outward signs of yang brightness heat. This is what is
meant by “'heat in both the exterior and interior.”
Frequent aversion to wind is not the aversion to wind of greater y缸g cold
damage. Rather it arises for the same re臼ODS as “aversion to cold in the back" in
the preceding line, i.e. , exuberant interior heat steaming the fluids, causing profuse
sweating, which loosens interstices of the flesh and damages both qi and yin.
The major difference between the two lines is the presence or absence of great
heat in the exterior. This difference, however, is not of major importance, since the
underlying pathomechanism is the same.
Exuberant dryness-heat in the interior damages the fluids and the qi; hence
White Tiger Decoction Plus Ginseng ( Mi hU jia ren shen tang) is used to clear
yang brightness interior heat, boost the 啡, and engender liquid.
2. YANG BRIGHTNESS [LINE 223]
324
LINE
222
若渴欲饮水 ,
口 干 舌燥者 , 白 虎加 人 参 汤 主之 。
Ruo ke yu yin shui, kou gan she zao zhe, bai hu jia ren shen tang
zhu zhf.
If (there is] t h i rst with d esi 削。 d ri n k water, d ry mout h , a n d d ry t。ngt』
[then] Wh ite Tiger Dec。ction Plus G in seng ( bai hu jia 俨en shen tang)
governs.
SYNOPSIS
Continuing from line 221, p. 312, a description of the signs and treatment of
y归g brightness disease in which exuberant heat damages liquid.
C OMMENTARY
This line is regarded as a further discussion of the situation presented in line 22 1 ,
p. 3 1 2 . When formless dryness-heat i n the yang brightness i s mistreated through the
use of precipitation or sweating, the heat may remain in the chest and diaphragm,
harassing the heart . This pattern is treated with Gardenia and Fermented Soybean
Decoction (zM zi chi tang) . If the evil does not resolve and the fluid damage
becomes more severe, thirst with desire to drink and a dry mouth and ton职ie may
arise. In this case, White Tiger Decoction Plus Ginseng ( bai hu jiii. ren shen tang)
is used to clear interior heat and engender liquid.
3 . 1 .4
Polyp orus Decoction Patterns
In a yang brightness disease, following inappropriate precipitation, yin may be
damaged and residual heat may remain in the presence of collected water. Polyporus
Decoction (zhu ling tang) may then be used to clear heat, disinhibit water, and foster
yin. Nonetheless, following copious sweating and fluid damage, with signs such as
thirst and inhibited urination, one must identify patterns carefully to determine if
this formula is appropriate.
L INE
223
若脉浮发 热 , 渴欲饮水 , 小 便不 利 者 , 猪苓汤主之 。
Ruo mai JU fa re, ke yu yin shui, xiao bian bu li zhe, zhu ling tang
zhu zhf.
If the pu lse is floating a n d [there is] heat effusio n , t h i rst with a desi re to
d ri n k water, a n d i n h i bited u ri n ati。 n , [then] p。lyp。m Dec。cti。n (zhu
l仇g ta叼 ) g。verns.
FORMULA
Polyporus Decoction ( zhU ling tang)
。 Clear heat and disinhibit water; foster yin and moisten dryness.
2. YANG B RIGHTNESS [LINE 2 23 ]
猪苓 ( 去皮 )
夜苓
泽泻
阿胶
325
滑石 ( 碎 ) 各 一 两
右五昧 , 以 水 四 升 , 先 煮 四 昧取 二 升 , 去淳 , 内 阿胶佯消 , 温服
七合, 日 三服。
Zhu ling ( qu pi) Ju ling ze xi e e jiiio hua shi ( su i) ge y'i liiing
You wu w剖, yi shui si sheng, xiiin zhU si we i qu er sheng, qu zi, na e jiiio yang
xiiio, wen JU q'i ge, 叫 s伽 Ju.
polyporus ( 猪 苓 zhu ling, Polyporus) (remove ski n )
por i a (夜 苓 JU ling, Poria )
alisma (浑 泻 ze xie, Alismatis Rhizoma)
ass hide gl ue ( 阿 胶 e jiiio, Asi n i Corii Gelati n u m )
talcu m (滑 石 hua sh{, Ta lcu m ) (crushed)
each i n gred ient 1 li�ng
[For] the a bove five ingred ients use four sheng of water. First boil the four i ngre­
dients [not i ncl uding ass h ide glue ( e jiiio )] to get two sheng. Remove the dregs a nd
blend i n the ass h ide glue ( e jiiio ) . Take seven g� warm th ree times a day.
SYNOPSIS
Continuing from line 221 , p. 312, an explanation of the signs and treatment of
yang brightness disease with liquid damage and bound water and heat.
COMMENTARY
This line presents a scenario that may occur following the inappropriate treat­
ment of yang brightness disease. Line 221 , p. 312, line 222, p . 324, and line 223,
p. 324, present three possibilities; in this line, a fourth is presented. After the
mistreatment , the interior heat evil is not eliminated and severely damages the flu­
ids. However, a water evil is also present as the result of another disease process
or the patient’s constitution. Water and heat become bound in the interior and
the qi cannot transform fluids. Thirst with a desire to drink indicates that the
fluids have been damaged by exuberant interior heat and that the internal bind
has obstructed normal ql transformation, so the fluids 缸e not being transformed
properly. Inhibited urination indicates that water amassment in the lower burner
has obstructed the normal movement of fluids. Heat effusion and a pulse that is
floating are exterior expressions of exuberant yang brightness heat.
Polyporus Decoction (zhu ling tang) clears heat, disinhibits the urine, and
moistens dryness. Polyporus ( zhU l如g) , poria (Ju ling) ' and alisma ( ze x均 perco­
late dampness and disinhibit the urine. Talcum (hua sM) disinhibits binds in the
six bowels, and because it is cold in nature, it not only disinhibits bound water but
it also clears heat. Sweet and neutral, ass hide glue ( e jiiio) fosters yin and clears
heat . Polyporus Decoction (zhu ling tang) clears heat without causing dryness and
disinhibits water without damaging yin. It is particularly appropriate in patterns
where damage to yin humor occurs with collected water and heat.
This line is similar to line 71, p . 195, in which the pulse is floating, and inhibited
urination, slight heat, and dissipation thirst are observed. Although the signs are
simil缸, the pathomechanisms are completely different. That pattern arises from
326
2. YANG BRIGHTNESS
a greater yang exterior evil that shifts into the bladder, impairing the ql transfor­
mation, whereas this pattern arises when a y缸g brightness interior heat evil binds
with collected water. In the preceding pattern, Poria ( Hoelen ) Five Powder ( wu ling
san) is used because it contains not only ingredients to disinhibit the urine, but
also contains cinnamon twig ( gui zhf) , which warms the yang and restores the ql
dynamic. In this case, Polyporus Decoction (zhu ling tang) is given because it does
not include cinnamon twig (gui zhf) , but instead contains talcum ( h叫 sM) and ass
hide glue ( e jiao) , which clear heat and moisten dryness. Polyporus Decoction ( zhu
ling ta叼) is used when the heat is considered to be deeper in the body; hence the
tongue color may be deep red or even purple, whereas in line 7 1 , it will probably
be light red.
LINE 2 24
阳 明 病 , 汗 出 多 而渴者 , 不 可 与猪苓汤 , 以 汗 多 胃 中燥 , 猪
苓汤复利其小便故也 。
Yang ming bing, han chu duδ er ke zhe, bu ke yu zhu ling tang, yi
han duo wei zhδng zao, zhu ling tang JU li qi xiii,o bian gu ye.
When i n ya ng brightness d isease, [there is) copious sweati ng a nd t h i rst,
one ca n not give p。lyp。m Decocti。n (zhu li叼 ta叼) beca use with
c。pious sweat the st。mach is d ry a n d p。lyp。rus Dec。ction ( zhii ling
tang ) d isi n h i bits the u ri ne.
S YNOPSIS
Contraindications for the use of Polyporus Decoction ( zhU l仇g tang) .
COMMENTARY
In yang brightness disease, exuberant interior heat steams the fluids and forces
them out to the exterior, resulting in copious sweating and fluid damage. Fluid
damage may give rise to thirst and inhibited urination. Although inhibited uri­
nation is not explicitly described in the text, its presence is likely because Zhang
JI is discussing Polyporus Decoction (zhu ling tang) , which is generally used when
urination is inhibited. An important differentiation that should be made here is
that fluid damage may cause thirst and inhibited urination, but water amassment
bound with internal heat may also cause these signs. In the first situation, one is
cautioned against using Polyporus Decoction ( zhu ling tang) , while in the second
situation, Polyporus Decoction (zhu ling tang) is the formula of choice. In this case
copious sweating causes stomach dryness. When internal dryness is the pattern,
one must not disinhibit the urine. Although Polyporus Decoction (zhU ling tang)
clears heat and nourishes the yin, one of its primary actions is to disinhibit the
urine; hence it should not be used. If, as in the preceding line, sweat has not issued,
yet the patient is thirsty and has inhibited urination, then one may consider using
Polyporus Decoction ( zhU ling tang) .
2 . YANG B RIGHTNESS [LINE 248]
327
3 . 2 REPLETION PATTERNS
3.2.1
Qi- Coordinating Deco ction Patt erns
It is helpful first to understand the name of the “Qi-Coordinating Decoction.”
The stomach is the sea of grain and water; it decomposes food and p掘ses it on to the
small intestine, which separates the clear and the turbid. The turbid part passes on
down to the large intestine, where it is formed into stool ready for expulsion from the
body. A ccording to the Ling Shu, when food enters the stomach , “the stomach fills
and the intestines are vacuous,” and when food passes downward, “the intestines
fill and the stomach is vacuous.” In this way, “vacuity gives way to fullness, and
fullness to vacuity.” The name of this formula alludes to its ability to promote the
continuity of this movement. The Chinese 承 cheng means to “continue,” “C缸ry
on,” or “inherit .” Coordinating the qi means promoting the harmonious action of
the stomach and intestines.
The Stomach-Regulating Qi-Coordinating Decoction ( tiao wei cheng qi tang)
pattern is a mild pattern of y缸g brightness bowel repletion. The primary path­
omechanism in this pattern is that dryness-heat binds in the interior and the bowel
qi is blocked. The main signs are mild glomus and fullness, and steaming heat
effusion may also be observed. The formula drains heat and moistens dryness, and
harmonizes the stomach. Medicinals to rectify the qi and disperse glomus are not
included in this formula because the signs are not severe.
In Minor Qi-Coordinating Decoction (xiao cheng qi tang) pattern, dryness-heat
also binds in the interior, blocking the bowel qi. Glomus and fullness are the main
signs, but they are more severe than in the pattern described above and may be
accompanied by hard stool. This formula drains heat and frees the stool, and
disperses glomus and fullness. The formula contains i ngredient s to rectify the qi
and disperse glom毗 but does not contain hardness-softening mirabilite ( mang xiao)
because severe hardness is absent in these patterns.
The Major Qi-Coordinating Decoction ( da cheng qi tang ) pattern is the most
severe of these three. Glomus, fullness, dryness, and repletion are all present. The
commonly observed signs 缸e tidal heat effusion, delirious speech, bound stool or
heat bind with circumfluence, abdominal fullness, hardness and pain, streaming
sweat, a dry yellow tongue, and a pulse that is sunken and replete or slow and
forceful. This formula offensively precipitates heat repletion and flushes dryness
bind. It is the harshest of these three formulae and must be used cautiously. This
pattern is sometimes observed in fatal conditions.
3.2.1.1
Stomach-Reg ulating Qi-Coordinating Decoction Patterns
LINE 248
太 阳 病 三 日 , 发 汗 不 解 , 蒸蒸发 热 者 , 属 胃 也 , 调 胃 承气汤
主之。
Tai yang bing san 时, fa han bu jie, zhεng zheng fii, re zhe, shu wei
ye, tiao wei cheng qi tang zhu zhi:.
328
2 . YANG B RIGHTNESS [LINE 248]
When greater ya ng d isease [has lasted for] th ree d ays, a nd sweating
is promoted ( but there is] no resol ution [。f the d isease] a nd [there is]
stea m i ng heat effusion , * t h is bel。ngs t。 the st。mach , a nd St。mach­
Regu lating Ql- C。。rd i nating Dec。cti。n ( tiao 创t cheng qi tang) g。v­
erns.
TEXT NOTE
*
Steaming heat effusion, 蒸 蒸 发 热 zheng zheng fa re : A feeling of strong heat,
as if it is moving from the interior of the body to the exterior, like steam rising
from boiling water.
FORMULA
Stomach-Regulating Qi-Coordinating Decoction ( tiao wei cheng qi tang )
。 Drain heat and harmonize the stomach; moisten dryness and soften hardness.
大黄 四 两( 去皮, 清 酒 洗 )
甘 草 二两(炙)
芒 消 半升
右 三昧, 切 , 以水三升, 煮 二 物 至 一 升 , 去 津 , 内 芒 消 , 更 上 火
一 二 沸 , 温 顿服之以调 胃 气 。
Da huang si liiing ( qu pi, qzng jiu xi) gan ciio er liiing ( zhi ) mang xiao ban
sheng
yOU san wei, qie, yi shui san sheng, zhU er WU zh i yf sheng, qu zi, na mang
xiao, geng sMng wei huo yz er fei, wen dun ju zhf, yi tiao wei qi.
rh ubarb ( 大 黄 da h叫叼, Rhei Rh izoma) 4 Ii�鸣 ( washed with clear wi ne*)
m ix-fried licorice ( 甘 草 gan ciio, G lycyrrh izae Rad ix) 2 li�ng
m i r ilite ( 芒 硝 M叼 xiao, Mirabilitum) h a lf she『1
[F。r] the a bove th ree i ngredients, cut [them] and use th ree she咆 of water. Boi l
[the 币 rst] two ingredients down to one sheng and remove the d regs. Add the m i rabilite
( ma叼 xiao� . Place [the decoction] again on a m i ld flame a nd boil once or twice. Ta ke
warm a s a si n gle dose, to regulate the stomach qi .
FORMULA NOTE
Washed in cle町 wine, 清 酒 洗 qfng jiii, xi: 阳ubarb ( da h u a ng ) may be prepared
with wine in one of two ways:
a) It may be placed in wine, allowed to steep briefly, and then stir-fried until
the color changes slightly.
b ) It may be sprayed with wine, steamed briefly, and then dried.
The goal of processing rhubarb ( da huang ) with liquor is to give it ascending
properties. Raw, its main direction of action is downward. In diseases with signs
in the center or upper burners, the liquor-treated agent is more suitable.
SYNOPSIS
The signs and treatment of greater y缸g disease that shifts to y缸ig brightness
stomach repletion following the pro皿otion of sweating.
2 . YANG B RIGHTNESS [LINE 248)
329
COMMENTARY
The appropriate treatment for greater yang disease is the promotion of sweating.
After three days, when sweating has been promoted and the disease has not resolved,
one should consider that the evil may have fallen into the interior. Steaming heat
effusion is a sign of exuberant internal heat. Exuberant heat steams in the interior,
resulting in a feeling of heat moving from the interior to the exterior. This sign may
be accompanied by streaming sweat, a sign of interior heat steaming the fluids, or
aversion to heat. This pattern belongs to the yang brightness, or 皿 in the text,
“belongs to the stomach."
Stomach-Regulating Qi-Coordinating Decoction ( tiao wei cheng qi tang) is used
to treat yang brightness bowel repletion in cases where dryness repletion is primary.
These patterns are characterized by abdominal fullness, absence of defecation, and
a dry tongue with yellow fur. In severe cases the patient may be vexed and speak
deliriously. In this case, abdominal fullness and blocked stool are not yet observed,
so Stomach-Regulating Qi-Coordinating Decoction ( tiao wei ch臼g qi tang) is used
to clear heat and harmonize the stomach, and the attacking and bind-breaking
abili即 of Major Qi-Coordinating Decoction ( da cM叼 qi tang) is not considered
necess缸y. The identification of this pattern, on the basis of the text alone, would
be very difficult ; therefore, this line is another example of the formula being used
to work back to the pattern.
In this line, blocked bowel qi and yang brightness heat 缸e thought to be present.
White Tiger Decoction ( Mi hiJ, tang) would clear the heat, but not address the bowel
repletion. Major Qi-Coordinati吨 Decoction ( da cheng qi tang) would also not
be appropriate because great repletion and great fullness are absent. The ability
of Minor Qi-Coordinating Decoction ( xiii.o cheng qi tang) to regulate the qi and
eliminate fullness is not considered necess缸y because clear distention and fullness
are also absent. Stomach-Regulating Qi-Coordinating Decoction ( tiao wei ch臼g
qi tang) is used for mild repletion, fullness, and dryness. It drains dryness-heat,
supports and normalizes the stomach qi, and safeguards the fluids. Bitter, cold
rhubarb ( da huang) drains heat and eliminates repletion. It pushes out the old
to make room for the new. In patterns for which this formula is used, abdominal
signs are generally present. Rhubarb ( da huang) is treated with liquor so that its
actions will ascend into the abdomen, as well as descend into the bowels. Salty, cold
mirabilite ( mang xiiio) drains heat, moistens dryness, and softens hardness. The
two together cle缸 heat, open the bowel, attack hardness, and break binds. These
actions are moderated by the addition of mix-fried licorice ( g伽 cii.o) . Mix-fried
licorice (gan cii.o) supplements the center and protects the stomach φ and fluids
from being damaged by the cold, bitter ingredients.
The method of taking the fo口nula should be noted. In line 29, p. 187, taking
a small amount of Stomach-Regulating Qi-Coordinating Decoction ( tiao wei cheng
qi tang) is suggested for disharmony of the stomach qi and delirious speech. That
is a pattern of stomach heat in which bowel repletion is absent. A small amount of
the formula is taken to clear stomach heat, illustrating moderate use of a moderate
formula. In this line, the dryness-heat is more severe and the bowel qi is blocked.
Although great repletion and fullness are absent, if only a small amount of a mild
formula is taken, it may be difficult to resolve the disease. In order to avoid this
330
2 . YANG B RIGHTNESS [LINE 249]
problem, the formula is prepared and taken as a single dose; this is an example of
using a larger dose of a mild formula in an severe pattern.
LINE 249
伤 寒吐后 , 腹胀满者 , 与 调 胃 承气汤 。
Shang han tu him, Ju zhang man zhe, yu tiao wei cheng qi tang.
When i n cold d a m age, [if] after vom iting [is used] , [there is] a bd。m­
i n a l distenti。n a nd fu l l ness, give Stomach- Regu lating Ql-C。。rd i nating
Dec。cti。n ( tiao wei cheng qi tang ) .
S YNOPSIS
The signs and treatment of yang brightness dryness repletion with abdominal
fullness.
COMMENTARY
The use of vomiting treatment for cold damage is inappropriate treatment.
When vomiting is used, an evil in the center or upper burner may be expelled, but
an evil in the lower burner will remain. This evil, due to the patient’s constitution
or to environmental factors, may transform to dryness-heat and bind in the bowel,
causing blocked bowel qi. This pattern may be precipitated, but since the only
sign is abdominal distention and fullness, and all of the Qi-Coordinating Decoction
( cheng qi tang) patterns contain this sign, how should one choose? The choice is
made by the process of elimination, on the basis of the severity of the signs. In
this line, signs of great repletion or great fullness are absent, as are delirious speech
and tidal heat effusion. It is unlikely that the strength of Major Qi-Coordinating
Decoction ( da ch臼g qi tang) is required. The abdominal fullness and distention is
not described as painful or where the patient refuses pressure, so Minor Qi-Coor­
dinati吨 Decoction ( xiao cheng qi tang) is not considered to be necessary. Zh磊ng
JI suggests using Stomach-Regulating Qi-Coordinating Decoction ( titio 时t ch臼g
qi tang) to precipitate mildly and clear heat.
In previous cases, following the inappropriate use of vomiting, the qi of the
center burner w础 damaged. When the center burner qi is damaged, the spleen and
stomach are vacuous and movement and transformation is impaired. This results
in stagnation of the qi dynamic and fullness and distention in the abdomen. In
cases of center burner vacuity with fullness and distention, one should w町m the
center and fortify the spleen, and move the qi and disperse fullness. Although it
does mildly supplement the qi of the center burner, this is not the main action
of Stomach-Regulating Qi-Coordinating Decoction ( titio wei cheng qi tang ) , which
suggests that the abdominal fullness in this line is different from that observed
in cases of vacuity. When fullness and distention 缸e the result of center burner
vacuity, the signs 缸e generally periodic, not constant, and the discomfort decreases
with warmth and pressure and may not be painful. In this line, it is likely that the
abdominal fullness and distention is persistent, aggravated by heat and pressure,
and accompanied by other signs of yang brightness interior heat repletion, such as
thirst, vexation, and heat effusion.
2 . YANG BRIGHTNESS [LINE 2 1 3]
331
LINE 207
阳 明 病 , 不 吐不 下 , 心烦者 , 可 与 调 胃 承 气汤 。
Yang m伽.g bing, bu tU bu xia, xin fan zhe, ke yu tiao wei cheng qi
tang.
When i n ya ng brightness d isease, neither v。m iting nor preci pitation [was
used ] a nd [there is] hea rt vexation , one ca n give Stomach-Regu lating
Ql- C。。rd i nating Decocti。n ( tiao wei che·叼 qi tang ) .
SYNOPSIS
The signs and treatment of y缸g brightness repletion with depressed heat and
heart vexation.
COMMENTARY
In yang brightness disease, repletion dryness-heat is present in the interior. It
rises up and harasses the heart, causing spirit disorders such as vexation. It should
also be noted that the stomach channel divergence passes into the heart and heat
may follow the channel and enter the heart through this pathway.
Because Stomach-Regulating Qi-Coordinating Decoction ( tiao wei cheng qi tang)
is suggested, one would expect that the heart vexation in this pattern is accom­
panied by absence of defecation, fullness and distention in the abdomen that is
aggravated by pressure, steaming heat effusion, and sweating. These accompany­
ing signs help one differentiate between the heart vexation in this pattern, which
may be termed “repletion vexation,” and the heart vexation seen in Gardenia and
Fermented Soybean Decoction (彻 zi' chi' tang) patterns which is termed “vacuity
vexation.” In vacuity vexation patterns, precipitation or vomiting has already been
used and the substantial repletion evil has been eliminated. Residual heat harasses
the region of the chest and diaphragm, leading to heart vexation, but painful ab­
dominal distention and blocked stool are absent. One other type of vexation that
should be considered is that which occurs when the use of precipitation or vomiting
damages the qi of the spleen and stomach, leading to interior qi vacuity. This vacu­
ity may also lead to vexation, but in these cases, other signs of qi vacuity should
be observed, and if abdominal fullness and distention is present, it should be soft
and alleviated by pressure.
3.2.1.2
Minor Qi-Coordinating Decoction Patterns
LINE 2 1 3
忖 阳 明 病 , 其 人 多 汗 , 以津液外 出 , 胃 中燥 , 大便必硬 , 硬
则沪语 , 小 承气汤主之 。
ω 若一服俨语止者 , 更 莫 复 服 。
{ 1) Yang ming bing, qi ren duo han, yi jin ye wai chu, wei zhδng
zao, da bian bi ying, ying ze zhan yu, xiiio ch白ig qi tang zhu zhι
{ 2) Ruo yi JU zhan Y'il zhi zh e, geng mo j边Ju.
2 . YA NG BRIGHTNESS [ LINE 2 1 3]
332
( 1 ) [When ] i n ya ng brightness disease, the person is sweati ng copious印,
beca use liq u id a nd h u mor a re iss u i ng outwa rds, the st。mach becomes
d ry a nd the st。。l wil l be h a rd . With hard [st。。I ] , deli rious speech
wi l l f。llow, a nd M i nor Ql- C。。rdi 『lating Decoction ( xiao cheng qi tang)
g。verns. (2) If after 。ne d。se the delirious speech stops, no more should
be ta ken .
FORMULA
Minor Qi-Coordinating Decoction (xiao cheng qi tang)
o
Drain heat and free the stool; disperse stagnation and eliminate fullness.
大黄 四 两 ( 酒 洗 ) 厚 朴 二两 ( 炙, 去皮)
帜 实 三 枚 ( 大者 , 炙 )
忖 右 三 昧 , 以水 四 升 , 煮 取 一升 二 合 , 去 i宰 , 分 温 二 服 。
汤 当 更 衣 , 不 尔 者尽饮 之, 若 更 衣 者 , 勿 服 之 。
(二) 初 服
Da huang si liang (jiu xi) h im p o er li ang ( zhi, qu p {) zhi shi s伽 mei ( da
zhe, zhi)
(I) You siin wei, yi shui si sheng, zhU qu yf sheng er ge, qu zi, fen wen er Ju.
(2 ) Chu Ju tang dang geng yf, bu er zhe jin yin zhf, ruo geng yf zh已 WU Ju zhf.
rh u ba rb ( 大 黄 da huang, Rhei R hizoma ) 4 Ii温ng ( washed with wine )
m agnolia bark (厚 朴 hou p o, Magnoliae c。此ex ) 2 Ii温ng ( remove bark a nd mix-fry )
un ri pe bitter ora nge (积实 zhi shi, Aurantii Fructus l m matun』s) 3 pieces ([choose]
large ( pieces) * a nd m ix-fry )
( I ) [ For) the a bove th ree i ngredients use four she吨 。f water. Boil to get one sheng
a nd two g�. Remove the d regs and divide i nto two doses, a nd ta ke warm . (2) [After)
the 币 时 dose there should be a [ bowel movement) ; if not, fi nish the decoction . If [the陀
is) a change of clothes [( a bowel moveme 叫] . do not take a ny mo陀.
FORMULA NOTE
*
Unripe bitter orange (zhi shf) : “Pieces” here means whole pieces of the fruit.
The large fruit is considered to have a weaker ability to move qi.
SYNOPSIS
The signs and treatment of hard stool and delirious speech that are the result
of liquid damage from copious sweating in yang brightness disease.
COMMENTARY
Yang brightness bowel repletion with dryness bind generally occurs through one
of two primary pathomechanisms. The first is that damage to the fluids results in
dryness bind, and the second is that exuberant heat results in dryness bind. These
patterns are similar, but slight differences exist in the signs and treatment.
Fluid damage and dryness bind generally occur after copious sweating or when
the urine is disinhibited. The stomach and intestines become dry and the scant
fluids cannot oppose the dryness-heat. Abiding waste in the bowels becomes dry
and bound, blocking the intestines and obstructing the qi. When the stool is bound
2 . YANG B RIGHTNESS [LINE 2 1 4]
333
and the qi is blocked, abdominal fullness may be observed, although not the severe
fullness and glomus seen in Major Qi-Coordinating Decoction ( da ch臼g qi tang)
patterns. Turbid qi follows the heat upward and harasses the heart , causing delirious
speech. This pattern is treated with Minor Qi-Coordinating Decoction ( xiii.o cheng
qi tang) because great repletion and great fullness 缸e absent, but the signs 町e too
severe to be treated with Stomach-Regulating Qi-Coordinating Decoction ( tiao wei
cheng qi tang) .
While Major Qi-Coordinati吨 Decoction ( da ch印g qi tang) is used for patterns
with glomus, fullness , dryness, and repletion, Minor Qi-Coordinating Decoction
(xiii.o eke叼 qi tang) is used for patterns with dry stool, glomus, and fullne盹 where
the dryness-heat is less severe. Minor Qi-Coordinati吨 Decoction ( xiii.o cheng qi
tang) does not include mirabilite ( mang xiiio) because in this pattern the dry heat
is less severe and its ability to clear heat and moisten dryness is not necessary.
Rhubarb ( da huang) is sufficient to clear heat and precipitate. If the two were used
together, precipitation would be too strong for this patient. Because the qi dynamic
is congested and stagnant , and because Minor Qi-Coordinating Decoction (xiii.o
cheng qi tang) is suggested, the presence of at least mild abdominal distention and
fu
fullness. Cold, slightly bitter unripe bitter orange ( zhi sM) rectifies the φ and
disperses glomus. Because in this pattern the fullness and glomus are probably
mild, the dosages of these two ingredients, particularly unripe bitter orange ( zhi
shz') , are small in comparison to Major Qi-Coordinating Decoction ( da cheng qi
t ang) .
If after taking Minor Qi-Coordinating Decoction ( xiii.o cheng qi tang) the deliri­
ous speech stops, then one knows that the bowel qi is free and the dryness bind has
resolved. Therefore, one should not take the formula again, since it may da皿age
the ql of the stomach and splee丑, potentially leading to further adverse diseases.
The second pattern mentioned above involves dryness that is the result of exu­
berant internal heat. This pattern is characterized by severe fluid damage, dryness,
repletion, glomus, and fullness. Major Qi-Coordinating Decoction ( da cheng qi
tang) is used and will be discussed beginning with line 220, p. 336.
LINE
214
付 阳明病,
俨语 , 发 潮 热 , 脉滑而疾者 , 小 承 气汤主 之 。
(斗
因 与 承气汤一升 , 腹 中 转 气者 , 更 服一升 , 若 不 转 气者 , 勿
更 与 之 , 明 日 又不 大便 , 脉反微洁者 , 里虚也 , 为难治 , 不
可更与承气汤也。
( 1 ) Yang m伽g bing, zh副 圳, fa chao 时, mai hua er j{ zhe, xiao
cheng qi tang zhu zhz. (2) Yzn yu che叼 qi tang yif sheng, j边 zhong
zhuan qi zhe, geng JU yf sheng, ruo bu zhuan qi zhe, WU geng yu zhz,
ming ri you bu da bian, mai fan wei se zhe, l'i XU ye, wei nan zhi,
bu ke geng yu cheng qi tang ye.
334
2. YANG BRIGHTNESS [ LINE 2 1 4]
( 1 ) When i n ya ng brightness disease (there is] deli ri。us speech , tid a l
heat effusion , a nd a pu lse t h a t is slippery a nd raci ng, M i nor QI-Co­
ord i nating Decoction ( xiao che叼 qi tang) g。verns. (2) When , as a
resu lt of using 。ne she吨 。f ( M i nor] Ql-C。。rd i n at i ng Decoction ( ( xiao)
che·叼 qi tang ) (there is] shifting 。f qi * in the a bd。men , aga i n ta ke 。ne
sheng; if (there is] no shifting of qi , do not give it aga i n . The next day,
[if there is] aga i n i n a bi l ity to defecate, but the pulse is fai nt a n d rough ,
t h is i n d icates i nterna l vacuity. (Th is] is d ifficu lt to t阳t a nd 。ne ca n n。t
aga i n give [ M i nor] Ql- C。。rd i nati 鸣 Dec。cti。n ( ( xiao) che叼 qi tang) .
TEXT NOTE
Shifting of qi, 转 气 zhuan qi: A feeling of stirring in the intestines accompanied
by frequent flatulence.
SYNOPSIS
The treatment and contraindications for the mild pattern of y缸g brightness
organ repletion.
C OMMENTARY
In yang brightness disease with delirious speech and tidal heat effusion, one
knows that the stool is already bound, the bowel is replete, and the heat is severe.
One may consider whether to use Minor Qi-Coordinating Decoction ( xiao cheng
qi tang) or Major Qi-Coordinating Decoction ( da cheng qi tang ) , seeing that the
condition is severe. If the pulse is sunken, replete, and forceful, Major Qi-Coor­
dinating Decoction ( da cheng qi tang) should be used to drain repletion heat and
break hardness. Here, although there are signs of exuberant interior heat (such as
delirious speech and tidal heat effusion) , the pulse is slippery and racing, which
means that the heat , although exuberant, has not completely entered the bowel
and the hardness bind is not severe. Minor Qi-Coordinating Decoction (xiao cheng
qi tang) is used to clear heat and open the bowel, and move the qi and disperse
sta伊ation. As soon as the bowel opens, the dry heat will disperse and the delirious
speech and tidal heat effusion will resolve.
In the second part of this line, Zhang JI explains a method of using Minor
Qi-Coordinating Decoction (xiao cheng qi tang) in which one observes the changes
following ingestion and then decides if further ingestion is appropriate. The key
sign is shifting of qi, which reflects the effect of the medicinals on the bowel. Once
the heat is cleared and the φ moves, turbid φ in the stomach and intestines is
stirred and descends. Shifting qi indicates that although the bowels are not yet
open, the qi is moving and the dry stool can be expelled. If shifting qi is observed,
the decoction may be taken again to continue this process. If, however, shifting φ
is abse时 , it means that the stool is not moving and one must reassess the situation.
If, in the near future (not necessarily the n臼t day) , the stool ag创n becomes
bound, but the pulse is faint and rough, a new problem exists. The absence of
stool indicates a repletion evil congesting the stomach and intestines, but the pulse
has changed. A pulse that is weak indicates qi vacuity and a pulse that is rough
indicates scant blood. Here, vacuity exists within repletion, and Minor Qi-Coordin­
ating Decoction (xiao cheng qi tang) cannot be used. In cases of vacuity one should
2 . YANG BRIGHTNESS [LINE 250]
335
not precipitate and in cases of repletion one should not supplement; therefore, Zhang
JI writes that this disease is “difficult to treat.” The authors of Gao Deng Cong
Shu suggest that in this case one may consider using a formula like Yellow Dragon
Decoction ( huang long ta叼 ) , which contains the following ingredients:
rhubarb ( 大 黄 da huang, Rhei Rhizoma) 12g
mirabilite ( 芒 硝 mang xiao, Mirabilitum) 9g
unripe bitter orange ( 帜 实 zhi sh{, Aurantii Fruc t u s Immaturus ) 9g
magnolia bark (厚 朴 hou po, Magnoliae Cortex) 12g
licorice ( 甘 草 gan ciio, Glycyrrl山ae Radix) 3g
ginseng ( 人 参 的z shen, Ginseng Radix) 6g
t angk uei ( 当 归 dang guZ, Angelicae Sinensis Radi x ) 9g
This formula clears heat and frees the stool, and supplements ql and blood,
simultaneously treating both repletion and vacuity.
LINE 250
太 阳 病 , 若 吐 、 若 下 、 若 发 汗后 , 微烦 , 小 便数 , 大 便 因 硬
者 , 与 小 承气汤和 之愈 。
Tai yang bing, ruo tu, ruo xia, ruo fa han hou, wei fan, xiao bian
shuo, da bian yfn ying zhe, yii, xiao cheng qi tang he zhi: yu.
When in greater ya ng d isease, if after vom iting, precipitation , or the
promoti。n 。f sweati 鸣, [there is] m i ld vexation , freq uent u ri n ation , and
as a resu lt, h a rd stool , give M i nor QI-Coordi nating Decoction ( xiao
cheng qi tang) t。 h a rmon ize a nd bri ng a bout recovery.
SYNOPSIS
The signs and treatment of heat repletion bind from liquid damage caused by
inappropriate treatment of greater yang disease.
COMMENTARY
The three treatment methods in the line above represent mistreatments. In
greater yang disease the use of vomiting and precipitation is clearly inappropriate
and if sweating is promoted improperly, it, too, is inappropriate. Mistreatment of
an exterior disease may result in the evil falling inward. In this c臼e it enters the
yang brightness and transforms to heat and dryness. The heat causes vexation
and frequent urination, further damaging the fluids (which may have already been
damaged from the mistreatment) , and the stool becomes hard. Minor Ql-Coordin­
ating Decoction ( xiiio eking qi tang) is used to clear heat and free the stool. Once
the stool is free and the yang brightness bowel is open, the other signs will resolve
because harmony has been restored. Major Ql-Coordinating Decoction ( da cheng
qi tang) is not used in this case because tidal heat effusion and delirious speech
are absent and the vexation is described as mild. Although the fluids have been
damaged, the dryness-heat does not appe缸 to be severe; therefore Minor Ql-Coor­
dir时i吨 Decoction ( xiiio ch向g qi tang) is sufficient.
2 . YANG BRIGHTNESS [LINE 2 2 0]
336
Delirious speech and tidal heat effusion cannot be seen as unequivocal signs
in the differentiation of Major Qi-Coordinating Decoction ( da cheng qi tang) and
Minor Qi-Coordinating Decoction ( xiii.o cheng qi tang) patterns. One must consider
the entire pattern and the pathomechanism. In line 213, p. 331 , hard stool and
delirious speech are treated with Minor Qi-Coordinating Decoction ( xiii.o cheng qi
tang) because these signs are the result of copious sweating damaging the fluids
and causing dryness bind. The harsh precipitation used to treat exuberant internal
heat with dryness bind is not necess缸y. In line 214, p. 333, delirious speech and
tidal heat effusion 缸e present, yet Minor Ql-Coordinati吨 Decoction ( xiii.o cheng
qi tang) is given. In that case the pulse is slippery and racing, indicating that
the repletion bind in the bowel is not yet severe; therefore Major Qi-Coordinating
Decoction ( da cM叼 qi tang) is not yet necessary. Finally, in line 207, p. 331 , heart
vexation, similar to the mild vexation in the line above, is observed, yet Stomach­
Regulating Qi-Coordinating Decoction ( tiao wei cheng qi tang) is used. In that case,
clear signs of φ stagnation are absent and only signs of dryness-heat repletion are
present; therefore Stomach-Regulating Qi-Coordinating Decoction ( tiao wei cheng
qi tang) is used.
3.2.1.3
Major Qi- Coordinating Decoction Patterns
LINE 220
二 阳并 病 , 太 阳 证 罢 , 但 发 潮 热 , 手足 亵 亵 汗 出 ,
大便难而
俨语者 , 下 之则愈 , 宜大承气汤 。
Er yang bing bing, tdi yang zheng ba, dan fa chao re, shou zu zhe
zhe han chu, da bian nan er zhiin yii zhe, xia zhf ze yu, yi da cheng
qi tang.
When i n d ragover d isease of the two ya ng, the greater ya ng d isease has
ceased a nd [there is] only tid a l heat effusion , sweat strea m i ng from the
ext re m ities, d ifficu lt defecati。n a n d deli rious speech , preci pitation wil l
bri ng a bout recovery a n d [therefore,] M ajor Ql-Coord i 『1 ati ng Decoction
( da cheng qi tang ) is a ppr。priate.
FORMULA
Major Qi-Coordinating Decoction ( da cheng qi tang)
。 Offensively precipitate heat repletion; flush dryness bind.
大 黄 四 两 ( 酒洗 )
= A
厚朴半斤 ( 炙 , 去皮 )
积实五枚 ( 炙 )
芒消
一一 口
忖 右 四 昧 , 以 水一斗 , 先煮二物 , 取五升 , 去淳 , 内 大黄 , 更煮
取 二 升 , 去 淳 , 内 芒 消 , 更 上 微 火 一 两 沸 , 分 温 再 服 。 (斗 得 下 , 余
勿服。
2 . YANG B RIGHTNESS [LINE 220]
337
Da huang si liang (ji u xi) h<'m po bdn fin (zhi, qu p{) zhi sh i wu mei ( zhi}
mang mαo san ge
{1} You si w剖, yi shui yf d归, xian zhii er w边, qu wu sheng, qu z瓦 na da huang,
geng zhu qu er sheng, qu zi, na mang xiao, geng shang wei huo yf er fei, fen wen
zai JU. (2) De xia, yu 川 Ju.
rh u ba rb ( 大 黄 da huang, Rhei Rhizoma) 4 li�ng (washed with wine)
processed magnolia bark (厚 朴 hou po, Magnoliae Cortex) h a lf Jin (陀move bark)
processed un ri pe bitter orange (帜实 zhi shi, Aurantii Fructus Im 『naturus) 5 pieces
m i rabilite ( 芒 硝 mang xiao, Mirabilit u m ) 3 g�
{1} [For] the a bove fo u r ingredients use one d�u of water. First boil [the 币 rst] two
i ngredients to get five sheng. Remove the d regs a nd add rh u ba rb ( da huang) ; boil again
to get two sh否ng. Remove the dregs, add mirabilite (mang xiao} . Place aga i n on a
mild fla me and boil once or twice. Divide [into two pa叫 , a nd ta ke warm twice a day.
(2) O ne preci pitation has occurred , do not ta ke any more.
S YN O P SIS
The signs and treatment of dragover disease of the two yang that shifts into
y缸ig brightness organ repletion.
COMMENTARY
In dragover disease one disease pattern leads into an another. Originally, a
greater y缸ig disease pattern was observed and then yang brightness disease signs
began to appear. At this point, the greater y缸g signs have already ceased and only
yang brightness signs are present .
Tidal heat effusion is the type of heat effusion generally seen in yang brightness
patterns. Nevertheless, as is clear from line 214, p. 333, tidal heat effusion, in
the absence of other signs of y但g brightness repletion, is not sufficient to warrant
the use of Major Qi-Coordinating Decoction ( da cheng qi tang) . Here, tidal heat
effusion occurs with streaming sweat, difficult stool, and delirious speech. Tidal
heat effusion is heat effusion with a set periodicity which, when associated with
yang brightness patterns, is generally said to occur in the late afternoon and early
evening, roughly between the hours of 3 P . M . and 7 P . M . the hours when the qi of
the yang brightness is effulgent.
Exuberant y归g brightn ess heat can steam the fluids and force them to the exte­
rior, causing sweating. Yang brightness governs the four limbs ; therefore, streaming
sweat issues only from the extremities when exuberant heat has damaged the fluids.
Fluid d epletion is also reflected in di血cult defecation, which means that the stool
is dry, hard, and difficult to expel. Exuberant heat in the stomach easily 甜cends
a且d invades the heart-a process that has been explained in several previous lines.
Here, delirious speech is the result of exuberant heat harassing the heart spirit.
This pattern of yang brightness bowel repletion is treated by precipitation,
using Major Qi-Coordinating Decoction ( da cheng qi tang) to precipitate offensively
and drain dryness-heat . Bitter, cold rhu barb ( da huang) clears heat and removes
repletion, flushing the stomach and intestines. When dryness bind and hardness
are both present it is difficult to move the stagnation downward, so mirabilite
( mang xiao) is ad ded to soften hardness and moisten dryness. Bound stool results
in blockage of the intestines and congestion of the qi dynamic, which may cause
338
2.
YANG B RIGHTNESS [LINE
2 1 2]
to move the 啡, the qi congestion
m町 block the action of the precipitants; therefore, magnolia bark (hiJU p o) and
unripe bitter orange ( zhi shi) are added to move the φ and break binds. Zhang JI
advises that once the stool moves, the formula should not be ingested again because
excessive use of precipitation damages the φ.
Once again, we should examine the differences between the three Ql- Coordin­
ating Decoctions ( cheng qi tang) formulae for clarity. Stomach-Regulating Ql-Co­
ordinati吨 Decoction ( tiao u剧 ch臼g qi tang) does not include unripe bitter orange
( zhi shi) and magnolia bark ( hou p o) because ql stagnation is not evident in those
patterns, but a large dose of mirabilite ( mang xiao) is used to increase the formula’s
ability to drain heat and moisten dryness. Minor Qi- C oordin at ing Decoction ( xiiio
eke叼 qi tang ) does not contain mirabilite ( mang xiiio) because in those patterns
the dryness-heat is secondary, but unripe bitter orange (zhi shi) and magnolia bark
(hOu p δ) , which rectify the φ, are used in small doses because the signs of ql sta­
gnation 町e relatively mild. Major Qi-Coordinating Decoction ( da cheng qi tang)
treats patterns of severe reple ti on , dryness, fullness, and hardness.
glomus and fullness. Without including medicinals
LINE
212
卜) 伤 寒 , 若 吐 若 下 后 , 不 解 , 不 大 便 五 六 日 , 上 至 十 余 日 ,
日 脯所发潮热 , 不 恶 寒 , 独语如 见鬼状 , 若剧者 , 发则不识
人 , 循衣摸床 , 惕而不安 , 微喘直视 , 脉弦者生 , 清者死 ;
微 者 , 但 发 热 俨 语 者 , 大 承 气 汤 主 之 。 (斗 若 一 服 利 , 贝IJ 止 后
服。
( 1 ) Shang han, ruo tu ruo xia hou, bu jie, bu da bian WU liu 时,
s h a ng zhi sh{ yu ri, ri bu suo fa c h a o re, bu WU han, du yu TU jian
gui zhuang, ruo ju zhe, fa ze bu shi ren, xun yz mo ch uang, ti er bu
an, wei c h u iin zh{ shi, m a i xian zhe sheng, se zhe si; wei zhe, dan
fa re zh伽 yu zhe, da cheng qi tang zhu zhz. (2) Ruo yz ju li, ze zhz
hou JU.
( 1 ) I n cold d a m a ge, if after vom iting 。r preci pitation [there is] no reso­
l ution , i n a bi l ity to defecate for five or six days-even u p to ten days 。r
more-late afternoon tida l heat effusion , no aversion to cold , a nd so­
l i loq uy as if [the person is] seei ng ghosts, * [then the fol lowing a pplies:]
if serious, [when the disease] emerges, [the person] wil l not 陀cogn ize
pe。pie, wi l l pick at the bedclothes, [feel] fea r a nd disq u iet , pa nt slightly,
a nd sta re forwa rd . If the pu lse is stringl i ke [the person wil l] l ive, a n d if
the pu lse is rough [the person wi l l] d ie. When in m ild [cases] , [there is]
o n ly heat effusion a nd delirious speech , Major Ql-C。。rd inating Dec。c-
2 . YANG BRIGHTNESS [LINE 2 1 2]
339
tion ( da che;叼 qi ta叼) g。verns. (2) If one d。se disi n h i bits [the st。。I] ,
then stop ta ki ng it afterwa rds.
TEXT NOTE
*
Soliloquy as if [the person is] seeing ghosts. 独 语 如 见 鬼 du yu
The patient talks to himself/herself and the spirit is clouded.
nJ.
jian g毗
SYNOPSIS
Pattern identification, treatment, and prognosis for the severe y缸g brightness
bowel repletion pattern.
COMMENTARY
In cold damage patterns the use of vomiting or precipitation is inappropriate.
If one of these methods is used many different transmutations may occur. In this
line a transmutation to a yang brightness disease is presented. It is a pattern
of bowel repletion with absence of defecation for five, six, or even more than ten
days. The bowel φ is clearly congested and abdominal fullness and glomus are
also likely. Tidal heat effusion in the late afternoon is typical of yang brightness
patterns because that is the time the y缸g brightness φ is effulgent. Furthermore,
the absence of aversion to cold means that this is no longer an exterior pattern and
suggests that exuberant dry heat is bound in the interior; consequently aversion
to heat may be observed. When exuberant heat in the interior disturbs the heart
spirit , it may result in delirious speech. Soliloquy as if seeing ghosts represents one
type of delirious speech, which is seen in cases of more severe internal heat bind
repletion.
In an extremely severe pattern, exuberant heat damages the 且uids and harasses
the spirit to the point that the patient becomes stuporous and no longer recog­
nizes those around him/her. In this state of altered consciousness, the unconscious
movements of picking at the bedclothes may be seen. This spirit disturbance is
further reflected in the fear and disquiet of the patient. The patient easily becomes
agitated and frightened and is difficult to calm. Heat from the stomach ascends and
flames in the lungs, resulting in dryness. Lung downbearing and diffusing become
abnormal and mild panting results . When exuberant heat in the interior scorches
the fluids, the loss of normal moistening and nourishment impairs movement in the
sinews and channels. The eyes cannot move normally, and stare straight ahead in
a fixed position.
The pulse is used in this line to make a prognosis. A pulse that is stringlike
indicates that the patient ’s constitution is strong and/or the E旧ds have not been
totally exhausted and the qi is still vital. This patient may be treated successfully.
If the pulse is rough, it indicates vacuity of right qi and desiccated fluids from
extreme heat repletion in the interior. Here, the treatment will be very difficult and
the prognosis is not good.
The final section of this line suggests the use of Major Qi-Coordinating Decoc­
tion ( da cheng qi tang) if the disease is not severe, referring to the beginning of the
line. The original condition, characterized by absence of defecation, heat effusion,
delirious speech, and aversion to heat, should be treated with Major Ql-Coordin­
ating Decoction ( da cheng qi t伽.g) . If the disease becomes more severe, as in the
second p缸t of the line, no treatment is suggested. It is likely that Major Qi-Coor-
340
2. YANG BRIGHTNESS [LINE 241]
dinating Decoction ( da cheng qi tang) would be given again because this formula is
already an extremely harsh attacking formula and its strength cannot be increased.
This pattern is severe and will be difficult to resolve.
LINE 2 4 1
付 大 下后 , 六 七 日 不 大便 , 烦 不 解 , 腹满痛者 , 此有燥屎
也。
ω 所 以 然者 , 本有宿食故也 , 宜 大 承气汤 。
( 1 ) Da xia hou, liu qr ri bu da b他n, fan bu ji式 Ju man tong zh已 ci
you zao shi ye. ( 2) Suo yi ran zh已 ben you SU shi gu ye, yi da cheng
qi tang.
( 1 ) When after great preci pitation [there is] i n a bi l ity t。 defecate for six
。r seven d ays, u n res。lved vexation , a nd a bdom i n a l full n ess a nd pa i n ,
t h is [mea ns] t here i s d ry stool . 1 ( 2 ) Why [this] i s so i s beca use the r。。t
is a bi d i ng f。。d , 2 fi。r which M aj。r QI- Coord i nating Decocti。n ( da cheng
qi tang) is a pprop 巾 te.
TEXT NOTES
1. Dry stool, 燥 屎 zao shi: Dry and hard stool that is the result of abiding food
in the intestines desiccated by internal heat.
2 . Abiding food, 宿 食 su shi: Food and drink accumulating in the intestines.
SYNOPSIS
The signs and treatment of dry stool that binds again following the use of
precipitation.
C OMMENTARY
Yang brightness repletion should be treated with precipitation. Following pre­
cipitation, if the patient has a bowel movement, abdominal pain and fullness are
absent , and the appetite improves, then one knows the disease has been cured. In
this case, after precipitation the stool remains bound; vexation, abdominal fullness
and pain appear. After the initial precipitation, the patient may have evacuated
stool, but now the stool is bound again. This pattern is described by Zhang JI
as “dry stool,” indicating that the intestinal matter is st诅 being dried by internal
heat. Bound stool with abdominal pain and distention indicate the presence of yang
brightness bowel repletion. The heat evil in the stomach rises up and harasses the
heart, causing vexation. The vexation was present originally; therefore, following
precipitation, when it is still present, it is called “unresolved vexation.”
Zhang JI explains that the root of this disorder lies in abiding food, which
impairs the qi dynamic of the stomach and intestines. Following the initial precipi­
tation, the stool may have moved, but the interior heat is not completely eliminated.
The fluids have not yet returned to normal, nor h甜 the qi dynamic b四n restored;
hence the stool easily becomes dry and bound again. Major Qi-Coordinating De­
coction ( da cheng qi tang) may be used again to expel the dry stool. This second
2 . YANG BRIGHTNESS [LINE 242]
341
treatment should eliminate any remaining heat and allow the fluids and the ql
dynamic to return to normal.
Several different scenarios are possible following precipitation. In the 直rst, the
bowel ql is free, but residual heat remains, causing vexation and anguish. The
absence of both bound stool and abdominal pain suggests that Gardenia and Fer­
mented Soybean Decoction (zhf zi chi t ang ) , be used to clear residual heat and
resolve the vexation. If, after precipitation, bound stool, vexation, delirious speech,
and steaming heat effusion are observed, Stomach-Regulating Qi-Coordinating De­
coction ( tiao wei cheng qi tang ) is used. Minor Qi-Coordinating Decoction ( xiao
cheng qi tang) treats bound stool, abdominal fullness, and heart vexation following
precipitation. In short, following precipitation in y缸ig brightness bowel repletion,
the patient may recover, may need additional precipitation, or may need a formula
to clear residual heat.
LINE 242
病 人 小 便不 利 , 大 便 乍难 乍 易 , 时有微热 , 喘 冒 不 能卧者 ,
有燥屎也 , 宜 大 承气汤 。
Bing ren xiiio bian bu li, da bian zha nan zha yi, shi you wei re,
chuii,n mao bu neng WO zhe, you zao shi ye, y{ da cheng qi tang.
When the person has i n h i bited u ri n ation , i nterm ittently d ifficu lt a nd
easy stool , peri。d ie m i ld heat, pa nti ng a n d veil i ng, 1 a nd is u na ble to
sleep, 2 [this mea ns that] there is d ry st。。I , a nd [therefore,) M ajor QI­
c。。rd i nating Dec。ction ( da cheng qi tang) is a ppropriate.
TEXT NOTES
1 . Panting and veiling, 喘 冒 chuan mao: The simultaneous appe缸ance of hasty,
rapid, labored breathing and clouded head and dizzy vision.
2. Inability to sleep, 不 能 卧 bu neng wo : Insomnia that is the result of a spirit
disturbance caused by exuberant heat in the interior rising and harassing the
heart spirit . According to the Shang Han Lun Yan Jiu Da Ci Dian , this term
may mean insomnia or an inability to lie down.
SYNOPSIS
The signs and treatment of stool that is sometimes difficult , sometimes easy, in
yang brightness organ repletion internal bind.
COMMENTARY
In y归g brightness repletion, frequent urination and hard stool are often present
due to the interior heat , but in the pattern described in the present line, urination is
inhibited. Dryness-heat in the interior binds with waste, resulting in dry stool that
is sometimes difficult to expel. The interior heat, however, also steams the fluids
and a portion of the fluids are forced into the intestines. This portion of the fluids
moistens the stool and so stool may occasionally pass easily. When dryness-heat
forces the fluids into the intestines, the fluids cannot pass out through the urine, so
urination is inhibited.
342
2. YANG BRIGHTNESS [LINE 252]
Periodic mild heat is a pattern of internal heat evil deep inside the body, in
which evil φ only occasionally outthrusts to the exterior. Panting and veiling re』
flects heat from the stomach rising upward, which distresses the lungs and causes
hasty, labored breathing. This rising heat harasses the head ( causing dizziness and
mental confusion ) and the heart spirit ( causing an inability to sleep ) . Further­
more, when the stomach is disharmonious, the patient is unable to sleep normally.
“ [When ] the stomach is disharmonious, sleep is not quiet,” 胃 不 和 , 卧 者 不 安 wei
bu he, WO zhe bu an .
Here, dry stool, and sometimes easy, sometimes difficult stool, together with
the suggestion of M叫or Qi-Coordinating Decoction ( da c h eng qi ta ng ) , indicate a
pattern of yang brightness bowel repletion with dry stool. In addition to the signs
above, one should see abdominal fullness and pain, heat effusion, and other signs
of a true repletion pattern before using this type of harsh precipitating formula.
LINE 2 5 2
伤 寒 六 七 日 , 目 中 不 了 了 , 睛不和 , 无表里证 , 大便难 , 身
微热者 , 此 为 实也 , 急下之 , 宜大承气汤 。
Shang han liu qif ri, mu zhong bu liao liao, jifng bu he, WU biiio li
zheng, da bian nan, shen wei re zhe, ci wei sh{ ye, j{ xia zhif, y{ da
cheng qi tang.
When i n cold d a m age [that has lasted f。r] six 。r seven d ays, [there
is] u nclea r visi。 n , d isharmony 。f the eyes , 1 neither a n exterior nor a n
i nteri。r pattern , 2 d ifficu lt defecatio n , a nd m i ld genera l ized heat, this
i nd icates repletion , (s。] preci pita ti。n is u rgent a nd [therefore,] M ajor
QI-Coord i n ating Dec。ction ( da cheng qi tang ) is a ppropriate.
TEXT NOTES
1.
Disharmony of the eyes, 睛 不 和 jfng bu he: The eyes appear dull and cannot
turn and move flexibly.
2 . Neither an exterior nor an interior pattern, 无 表 里 证 wu biao Li zheng : No
clear signs of either an exterior pattern ( such as heat effusion or aversion to
cold ) or an interior pattern ( such as abdominal fullness or tidal heat effusion ) .
SYNOPSIS
In cold damage, when there is unclear vision and disharmony of the eyes, one
should urgently precipitate to preserve yin.
COMMENTARY
In cold damage, if exterior signs are absent after six or seven days, one must
consider that the disease has shifted into the interior. Here, this supposition is
supported by the appearance of difficult defecation and generalized heat, which have
both been discussed previously and may indicate y缸g brightness bowel repletion.
Zhang JI describes this as a repletion pattern and suggests urgent precipitation
2 . YANG BRIGHTNESS [LINE 2 5 3]
343
with Major Qi-Coordinating Decoction ( da cheng qi tang) . Precipitation is urgently
required because of the appearance of unclear vision and disharmony of the eyes.
Unclear vision and disharmony of the eyes indicate that the interior heat has
scorched the fluids to a more severe extent. In the Ling Shu it is written, “The
essence of the 且ve viscera and six bowels all pours upward to the eyes.” Qian
Huang writes, “Heat evil scorches the interior, the fluids are desiccated, and then
the essenc守spirit cannot pour upward to the eyes. Thus, [ there is] unclear vision
and disharmony of the eyes.” When the fluids are severely desiccated, the essence is
also affected. Not only the stomach flui巾, but also the kidney essence is damaged
by the interior heat . As Ye Gui ( 叶 桂 , style 天 士 Ti缸”Shl) writes, “ [When] heat
evil does not dry the stomach liquid, it will consume the kidney humor." The eyes
lose normal moistening and nourishment ; consequently they are disharmonious and
lack clarity. When the fluids and essence are damaged to this degree, the brain,
which is the sea of essence and marrow, may also be affected. Urgent precipita­
tion is appropriate to discharge heat and avoid complete fluid desiccation. This
treatment , a method of eliminating repletion heat by freeing the stool with cold­
natured draining precipitants, is referred to as “raking the 且rewood from beneath
the cauldron,” 釜 底 抽 薪 Ju di chiiu xzn .
LINE 253
阳明病 , 发热汗多 者 , 急下之 , 宜大承气汤 。
Yang m伽g bing, fii re him duo zhe, j{ xia zhr, y{ da cheng qi tang.
When i n ya ng brightness d isease [there is) heat effusion a nd copi。us
sweati ng, preci pitation is u rgently [req u i red a nd therefore,) M ajor QI­
Coord i nating Dec。ction ( da cheng qi ta叼 ) is a ppropriate.
SYNOPSIS
In yang brightness disease with heat effusion and copious sweating, one should
urgently precipitate to preserve yin.
COMMENTARY
In yang brightness disease, when Zhang JI suggests urgent precipitation, one
may assume the presence of bowel repletion bind with absence of defecation and
painful abdominal fullness and distention. In this situation, what is the significance
of heat effusion and copious sweating? Yang brightness dise槌es are generally char­
acterized by tidal heat effusion and streaming sweat from the extremities. Here, the
heat effusion is not tidal, but continuous, indicating that the interior and exterior
heat is very strong. It steams the fluids and forces them to the exterior, causing
copious sweating over the whole body. 引Tith strong interior heat and rapid loss
of sweat, the fluids are damaged quickly, which may lead to fluid desiccation and
the appearance of more critical signs. Although no critical signs 町e observed yet
urgent precipitation is su�gested in order to avoid the desiccation of the fluids and
the transmutation to a critical condition.
344
2. YANG BRIGHTNESS [LINE 255]
LINE 254
发 ?干 不 解 , 腹 满 痛 者 , 急 下 之 , 宜 大 承 气 汤 。
Fa han bu jie, Ju man t o ng zhe, ji xia zhf, yi da cheng qi tang.
When sweati ng is promoted , [but bri 鸣s] no res。l utio n , [a nd there is]
a bd。m i n a l fu l l ness a n d pa i n , p陀ci pitati。n is u rgent, a n d [therefore,]
M 句or Ql- C。。rdi nati ng Decocti。n ( da cheng qi tang) is a ppropriate.
SYNOPSIS
After the promotion of sweating has not brought resolution and there is y缸g
brightness organ repletion, it is appropriate to precipitate urgently to preserve yin.
C OMMENTARY
Sweating is generally promoted in greater y缸g disease. If the promotion of
sweating does not resolve the disease, but instead results in abdominal fullness and
pain, it means that the evil has already entered the interior and transformed to
dryness-heat repletion. The bowel φ is congested, the stool is bound, and abdom­
inal pain and fullness are present . This transmutation may have occurred due to
the inappropriate promotion of sweating, excessive promotion of sweating, or the
constitution of the patient.
Zhang JI suggests the use of urgent precipitation because of the speed with
which this transmutation occurred. In previous lines, he refers to the p幽sage of
several days or even six or seven days, before suggesting the use of Major Qi-Coor­
dinating Decoction ( da cheng qi tang) . This situation is urgent because immediately
following the sweating, signs of yang brightness bowel repletion appeared, suggest­
ing that the heat and dryness is severe, the fluids have already been damaged, and
the bowel φ is already blocked. If urgent precipitation is not used, a transmutation
to a more serious pattern may occur.
LINE 255
腹满不 减 , 减 不 足言 , 当 下之 , 宜大承气汤 。
Fu man bu jia叽 jian bu zu yan, dang xia zhi, y{ da cheng qi tang.
When a bdom i n a l fu l l n ess d。es n。t d e crease, [。r] decreases i nsufficiently
t。 spea k of, 。ne sh。uld preci pitate, a nd [i n such cases] Maj。r Ql-C。。r­
d i n ating Dec。cti。n ( dd che叼 qi tang) is a ppropriate.
SYNOPSIS
The signs and treatment of an abdominal fullness pattern for which precipitation
is appropriate.
COMMENTARY
Abdominal fullness has many causes. On the basis of the formula used here, the
abdominal fullness in this line may be attributed to y缸g brightness bowel repletion
and is considered a reference to the preceding line. Internal dryness-heat repletion
345
2 . YANG BRIGHTNESS [LINE 256]
congests the φ dynamic; consequently, abdominal fullness is likely accompanied by
bound stool, tidal heat effusion, and other signs of yang brightness bowel repletion.
The abdominal fullness present in this line, although occasionally diminishing
somewhat in severity, generally persists with very little change. Zhang Jr calls at­
tention to this point in order to differentiate this type of abdominal fullness 仕om
vacuity cold abdominal fullness. In vacuity cold abdominal fullness, the fullness pe­
riodically decreases. Vacuity cold abdominal fullness also responds well to warmth
and p ressure, factors that would exacerbate the dryness-heat repletion abdominal
fullness presented in this line. Therefore, precipitation using M时or Qi-Coordinating
Decoction ( da cheng qi tang) is appropriate.
LINE 256
付 阳 明 少 阳 合病 , 必下利 , 其脉 不 负 者 , 为顺也 。
ω 负者,
失也 , 互相克贼 , 名 为 负 也 , 脉滑而数者 , 有宿食也 。
同 当
下 之 , 宜大 承气汤 。
( 1 ) Ya叼 m如g shao ya叼 he bing, bi xia li, qi mai bu j边 zhe, wei
shun ye. (2) Fu zh已 shz ye, hu xiiing ke zei, ming wei j边 U己 mai
hua er shuo zhe, you SU sh{ ye. (3) Dang xia zh瓦 y{ da cheng qi
tang.
( 1 ) I n ya ng brightn ess a n d lesser yang combinati。n d isease, there will
be diarrhea a nd when the pu lse is not cont阳弘 it mea ns [that the
disease] is [in] favora ble [seq 阳1ce] . * (2) When the [pu lse] is contra ry,
[it mea ns] deviation [from the norma l seq 阳lee] * a nd m ut u a l restrai n i ng
a nd robbing, s。 it is ca l led c。ntra 叩. When the pu lse is sli ppery a nd
fast [it mea ns there is] a bid ing f。。d . (3) One sh。u Id preci pitate a nd
[theref1。re,] M 功。r Ql- C。。rd i n ating Dec。cti。n ( da cheng qi tang) is
a ppropriate.
TEXT NOTE
*
When the pulse is not contr町, it means [that the dise 叫 is [in] favorable
[sequence], 其 脉 不 负 者 , 为 顺 也 qi mai bu Ju zhι wei shUn ye; When th e
[pl由e] is contr町y, [it means] deviation [from the normal sequence] , 负 者 , 失
也 Ju zhe, shf ye: The pulse is used to determine if the disease is progressing
according to the five-phase engendering sequence or counter to it. The appear­
ance of a pulse that is in the five-phase sequence is a positive sign, and the
appe町ance of a pulse that is counter to this sequence is considered a negative
sign.
SYNOPSIS
The pulse, signs, and treatment of lesser y缸g and y缸g brightness combination
disease when precipitation is appropriate.
346
2 . YANG BRIGHTNESS [LINE 239]
COMMENTARY
Yang brightness belongs to earth and lesser yang belongs to wood. The spleen
and stomach belong to earth, and the liver and gallbladder belong to wood. In the
normal 且ve:-phase sequence, wood restrains earth. In yang brightness and lesser
yang combination disease, fire from the lesser yang and dryness from the yang
brightness produce dryness-heat bind in the center, and force the fluids to hasten
downward, causing a loss of normal conveyance and diarrhea. In this case the
diarrhea is likely malodorous, sticky, and accompanied by a heat sensation in the
anus.
In yang brightness and lesser yang combination disease, if the pulse is a y归g
brightness pulse ( such as slippery and rapid ) it is not contrary and means that the
wood evil has not restrained and damaged earth. The center qi is still effulgent
and this situation is said to be in sequence. If, however, the pulse is stringlike, it
is contrary, reflecting the influence of the lesser y缸ig and indicating that the yang
brightness is weak and is bein� restrained and harmed by the lesser yang. This
condition is described as deviating from the normal sequence.
When the pulse is slippery and rapid, it means that the y缸g brightness qi is
still effulgent and that abiding food has blocked the stomach and intestines. Heat­
type diarrhea is likely accompanied by abdominal fullness and pain, and a thick
yellow tongue fur, indicating a yang brightness bowel repletion pattern that can be
treated with Major Qi-Coordinating Decoction ( da eking qi tang ) .
I n line 172, p. 1 5 9 , Scutellaria Decoction ( huang q{n tang) is used t o treat
diarrhea that occurs in greater y缸g and lesser y缸g combination disease. In that
case, an exterior evil shifts into the lesser yang and distresses the stomach and
intestines. Because abiding food is absent , a bitter, cold formula is used to clear
heat and check the diarrhea. In line 32, p. 1 1 1 , diarrhea in greater yang and y缸g
brightness combination disease is treated with Pueraria Decoction (ge gen tang).
In that case, clear signs of an exterior pattern exist, and interior heat and abiding
food are absent. Pueraria Decoction (ge gen tang) is used to resolve the exterior,
upbear the fluids, and check the diarrhea. These patterns all have diarrhea as a
key sign, but the pathomechanisms and treatments are very different and must be
clearly differentiated.
LINE 239
病 人 不 大 便 五 六 日 , 绕脐痛 , 烦躁 , 发作有时者 , 此 有燥
屎 , 故使不 大便也 。
Bing ren bu da bian WU liu ri, rao qi tong, fan zao, fa zuo you sh{
zhe, ci you zao shi, gu shi bu da bian ye.
When the patient has not defecated for five or six days, a nd has pa i n
a rou nd t h e u m bi l icus a nd vexati。n a n d agitation that occ u r peri。d i­
ca l ly, * t h is mea ns [that there is] d ry st。。l ca usi ng [the person] not to
defecate.
2 . YANG BRIGHTNESS [ LINE 2 1 5]
347
TEXT NOTE
That occur periodically, 发 作 有 时 fa zuo you shi: This periodicity refers to
both the pain and the vexation.
*
SYNOPSIS
The signs of dry stool interior bind in yang brightness organ repletion.
COMMENTARY
When a patient does not defecate for about one week, one cannot assume that
it is a case of yang brightness bowel repletion, but must investigate the other signs.
The area around the umbilicus belongs to the intestines. Pain around the umbili­
cus, when defecation is absent, indicates intestinal blockage and stagnant bowel qi.
Zhang JI explains that this is the result of dry stool. Dry, bound stool is generally
caused by internal dryness-heat. When heat dries the bowels and the bowel qi can­
not move, heat and turbid qi rises, harassing the heart and causing vexation and
agitation. Because the turbid φ cannot pass out of the bowels normally, pain is felt
in the umbilical region.
The periodicity of these signs is similar to tidal heat effusion. As Qian Hming
writes, “ [ These signs, which] occur periodically, [belong to the] same category 出
late-afternoon tidal heat effusion.” Pain and vexation are the result of the movement
of exuberant interior dryness-heat and turbid qi that cannot be expelled because
the stool is blocked. During the yang brightness period the qi is effulgent, and these
signs are exacerbated. When the yang brightness period passes and the qi subsides,
the pain and vexation decrease.
Although no treatment is offered in this line, it is likely that precipitation
would be used, as in line 238, p. 350, “If [ there is] dry stool, Major Qi-Coordinating
Decoction ( da cheng qi tang) is appropriate.”
In the text , many different sign patterns and criteria are used to identify the
presence or absence of dry stool. Dry stool m町 be indicated by: a) absence of
defecation for 且ve or six days, pain in the umbilical region and vexation; b ) tidal
heat effusion, delirious speech, and sweat streaming from the extremities; c ) persis­
tent abdominal fullness; d ) unclear vision and disharmony of the eyes; e ) inhibited
urination, intermittent easy and difficult stool, periodic mild heat, and panting
and veiling; or f) shifting of φ following the ingestion of a small amount of Minor
Qi-Coordinating Decoction ( xiao cheng qi tang ) .
LINE
215
忖 阳明病 ,
枚也 。
俨语 , 有 潮 热 , 反 不 能 食者 , 胃 中 必有燥屎 五 六
仁) 若 能 食 者 , 但 硬 耳 , 宜 大 承 气 汤 下 之 。
( 1) Ya 叼 m俞ig biηg, zhan yil, yo包 chao re, fan bu M叼 shi zhe, we i
zhong bi you zao shi WU liu mei ye. (2) Ruo 怕
er, yi da cheng qi tang xia zh'i.
( 1 ) When i n ya ng brightness d isease, [there is] deli rious speech a n d tid a l
heat effusion , b u t i n a bility t o eat , [this mea ns that] there m ust be five
348
2 . YANG BRIGHTNESS [LINE 2 1 5]
。r six pieces 。f d ry st。。l i n the st。mach . 1 (2) ( If [the person] is a ble t。
eat , [there is] 。nly h a rd [st。。I] . ) M aj。r Ql- C。。rd i n ating Dec。cti。n ( da
cheng qi tang) is a ppr,。 priate for preci pitati。『, . 2
T EXT NO T ES
1 . Dry stool in the stomach, 胃 中 燥 屎 wei zhδng zao sM: Dry stool in the in­
testines. The character 胃 wei in this text is often thought to include the
stomach and intestines. Here, because of the reference to stool, it is simply
read as “intestines.” xu. Da Chun ( 徐 大 椿 , style 灵 胎 Ling-Tai ) writes, “The
stomach does not contain dry stool. This says ‘stomach’, but means the y缸g
brightness, which is the name for the stomach and intestines.” In line 157,
p. 237, however, the term 胃 中 wei zhδng refers only to the stomach.
2 . Major Qi-Coordinating Decoction ( da eke:叼 qi tang) is appropriate for precip­
itation, 宜 大 承 气 汤 下 之 yi da cheng qi tang xia zhf: This line is regarded 描
another example of grammatical inversion. Although it appe町s at the end of
the line, it actually refers to the pattern described in the first part of the line.
S Y NOPSIS
The signs and treatment of the severe pattern of hard bound stool in y缸g
brightness organ repletion.
COMMENTARY
In yang brightness bowel repletion, dryness-heat repletion blocks the bowel
qi and causes an upward movement of heat and turbidity. Heat and turbidity
harasses the heart spirit and causes delirious speech. Tidal heat effusion is the
outward manifestation of the exuberant interior heat. Its periodicity is related to
the periodicity of the ql of yang brightness.
The appearance of delirious speech and tidal heat effusion indicates the presence
of dry, bound stool in the intestines. Bowel repletion and dry stool may appear
with different degrees of severity. In these two lines, the ability to eat is used to
differentiate mild and severe patterns and to decide if precipitation is appropriate.
In cases of bowel repletion and internal heat, the patient is usually still able to
eat , and rapid hungering may be observed as a result of heat in the stomach. If
the patient is unable to eat, it indicates, as Zhang JI explains, “dry stool in the
stomach." Dry stool obstructs the movement of bowel qi and impairs stomach and
intestinal function; hence not only is the stool bound, but the patient cannot eat
either. Here, Major Qi-Coordinating Decoction (da cheng qi tang) is appropriate
to expel the dry stool. When the stool is expelled, the qi dynamic will return to
normal and the patient will be able to eat normally.
Delirious speech and tidal heat effusion in a patient who is able to eat suggests
that although the stool is hard, it is not dry and bound. Precipitation with Major
Qi-Coordinating Decoction ( dd cheng qi tang) is not necessary, although precipita­
tion with a milder formula, such as Minor Qi-Coordinating Decoction ( xiii.o cheng
q i tang ) m叮 be appropriate.
It is important to note here that the ability or inability to eat, although an
important sign used in the differentiation of these patterns, should not be seen as
an unequivocal indication of any one condition. In line 190, p. 382, inability to eat
indicates cold strike, and ability to eat indicates wind strike. In line 194, p. 366,
2 . YANG B RIGHTNESS [LINE 2 1 7)
349
inability to eat indicates vacuity cold in the stomach. These lines are reminders
that any individual sign must be interpreted in the context of the other signs and
should not be viewed in isolation.
LINE 2 1 7
付 汗 出 俨语者, 以 有燥屎在 胃 中 , 此 为 风 也 , 须 下 者, 过 经
乃 可 下 之。
ω 下之 若 早, 语 言 必 乱, 以 表 虚 里实 故也。
(斗
下 之 愈, 宜 大 承 气 汤 。
( 1) Han chu zhan yu zhe, yi you zao shi zai wei zh伽g, ci wei Jeng
u己 XU xia zhe, guo fing nai ke xia zh'i. (2) Xia zh'i ruo zao, yu yan
bi luan, yi b创o XU li shi gu ye. (3) Xia zh'i yu, yi da cheng qi tang.
( 1 ) When [there is] sweating a nd deli ri。us speech beca use of d ry st。。l
in the st。mach , this i nd i cates wi nd . O ne m ust preci pitate, [a nd si nce]
[there has] been cha n nel passage, 。ne ca n preci pitate. (2) P 阳i pitati。n
if [used t。。] ea rly, will [result in] dera nged speech , t h is bei ng because
。f exterior vacu ity a nd i nterior repletion . (3) P reci pitation [wil l bri ng
a bout] 限。very and [therefore,] M ajor QI-Coord i nati ng Dec。ction ( da
cheng qi tang ) is a p propriate.
SYNOPSIS
The differentiation of exterior vacuity and interior repletion patterns and for
which pattern precipitation should be used.
COMMENTARY
The sweating mentioned in the first part of this line indicates exterior vacuity,
which Zh画g JI refers to as “wind” and which we may interpret as an unresolved
greater y缸g exterior vacuity pattern. In order to decid e th at s weat ing means
greater yang exterior vacuity, it is likely that one would also have to see aversion to
cold, a pulse that is floating and/or other corroborating signs. Likewise, delirious
speech indicates yang brightness bowel rep leti on . Zhang JI explains that delirious
speech is the result of dry stool in the stomach and intestines. It is likely that
along with delirious speech, one would also observe bound stool, abdominal fullness,
and / or other corrob or a t i ng signs of y归g bri gh t n ess bowel repletion . Zh an g JI wri tes
that one “must precipitate,” but one must also be cautious about precipitating when
an exterior pattern still exists. Once channel passage has occurred and the pattern
is p u r ely a y缸g brightness pattern, one can safely precipitate.
If precipitation is used too early, before the exterior evil has been resolved, it will
result in a negative transmutation. Generally, exterior-interior diseases are treated
by first resolving the exterior condition and then t reat ing the interior, unless the
interior condition is urgent. In this case, precipitation prior to the resolution of the
exterior evil results in an exacerbation of the delirious speech, which is described as
deranged speech . This transmutation is the result of the ext erior evil falling inward
and boosting the heat that was present in the interior.
350
2. YANG BRIGHTNESS [LINE 238]
Exterior vacuity and interior repletion may be interpreted in two ways, both
of which provide useful perspectives. Qi益n Huang views this term as a description
of the state of the patient following treatment, and he writes, “The evil in the
exterior all falls into the interior; hence the exterior is empty; [ there is] no evil.
The evil is all in the interior; hence it is said that the exterior is vacuous and the
interior is replete.” According to this interpretation, vacuity and repletion refer
to the presence or absence of evil φ. Following erroneous precipitation, all evil
qi falls into the interior. Another perspective is provided by the authors of Gao
Deng Cong ShU who write that “exterior vacuity and interior repletion" refers to
the pattern of greater �ang exterior vacuity and y缸ig brightness interior repletion,
prior to treatment. This pattern is considered simultaneous exterior-interior disease
and should be treated by first resolving the exterior and then attacking the interior.
Inappropriate precipitation causes the evil to fall inward and the speech to become
deranged.
LINE 238
阳 明 病 , 下 之 , 心 中 懊 侬 而在页 , 胃 中 有 燥 屎 者 , 可 攻 , 腹 微
满 , 初头硬 ,
后必糖 , 不 可攻之 , 若有燥屎者 , 宜大承气
汤。
Yang m仇g bing, xia zhz, xfn zhong do n6ng er fan, wei zhong you
zao shi zhe, ke gong, Ju wei man, chi.i t6u ying, him bi tang, bu ke
gong zhif, ruo you zao shi zhe, y{ da cheng qi tang.
When i n ya ng brightness disease, preci pitation is used a nd [there is]
a nguish a nd vexati。n i n the hea rt a nd d ry stool i n the stomach , one
ca n attack. [If there is] m i ld a bdom i n a l fu l l ness, a nd [st。。l that is]
h a rd at the begi n n i ng a nd then sloppy, one ca n not attack. If [there
is] d ry st。。I , M ajor Ql-C。。rd i nati ng Dec。ction ( da che叼 qi tang ) is
a p pr。priate.
SYNOPSIS
The differentiation of whether or not attacking is appropriate in a yang bright­
ness disease after precipitation has been used.
COMMENTARY
Following the use of precipitation in yang brightness disease, any of three out­
comes are possible. The first is that it was the correct treatment and the disease
resolves. The second is that it was the correct treatment, but the evil has not
been totally eliminated and one must precipitate again. The last is that it was
an inappropriate treatment or was used excessively and a negative transmutation
occurs.
In this line, two transmutations that occur following the use of precipitation
in yang brightness disease are presented. The first is characterized by anguish in
the heart , vexation, and dry stool in the stomach and intestines. Dry stool in
2 . YANG BRIGHTNESS [LINE 2 4 7]
351
the intestines blocks the movement of bowel ql; consequently dryness-heat cannot
flow downward and heat and turbidity rise up , harassing the heart and causing
anguish and vexation . The initial precipitation did not comple t ely eliminate the
evil repletion in the bowel, although it was the correct treatment, and further
precipitation is requir ed . It is likely that in addit i on to anguish and vexation, signs
such as bound stool, abdominal pain and fullness, and pain around the umbilicus
would be observed.
In the second transmutation, the abdomen is mildly painful. This sign is not
the severe type of abdominal pain generally seen in yang brightness bowel repletion.
Furthermore, the stool is not dry and bound. It is hard at first and then sloppy.
Therefore, this is no longer yang brightness bowel repletion and precipitation should
not be used.
Finally, Zhang JI wr i tes that M叫or Qi- Coordinating Dec o ction ( da cheng qi
tang) should be used in cases of dry stool. This suggestion refers back to the
be gin n in g of the line, so we know that further precipitation is appro