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Shang Han Lun · Treatise on Cold Damage
5. Taiyang Illness, Part I · Pulses, Signs and Treatment
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Taiyang illness is characterized by a floating pulse, stiffness and pain of the head and nape, and aversion to cold.
Taiyang illness with fever, sweating, aversion to wind and a relaxed pulse is called wind-strike.
Taiyang illness may already have fever or may not yet have it, but must have aversion to cold, bodily pain, counterflow vomiting and tight pulses in both yin and yang. This is called cold damage.
On the first day of cold damage, Taiyang receives it. If the pulse is calm, transmission is not occurring. A considerable desire to vomit, or restlessness and agitation with a rapid, urgent pulse, indicates transmission.
On the second or third day of cold damage, absence of Yangming and Shaoyang presentations means transmission is not occurring.
Taiyang illness with fever and thirst but no aversion to cold is warm disease. If sweating has already been induced and the body becomes burning hot, this is called wind-warmth. Wind-warmth has floating pulses in both yin and yang, spontaneous sweating, bodily heaviness, much sleep, invariably snoring nasal breathing, and difficulty bringing out speech.
If purging is applied, urination becomes difficult, the eyes stare fixedly and urinary control is lost. If fire is applied, a mild case develops a yellow coloration; a severe case resembles fright seizures, with intermittent convulsions. If the person is fumigated with fire, one contrary treatment may still leave some days of life, but a second shortens the time remaining.
Illness with fever and aversion to cold arises in yang; illness with aversion to cold but no heat arises in yin. That arising in yang resolves in seven days; that arising in yin in six days, because seven is the yang number and six the yin number.
In Taiyang illness, headache that resolves spontaneously after seven days or more does so because the course through its channel is complete. If it is about to make another circuit, needle Foot Yangming to prevent channel transmission and bring recovery.
The time when Taiyang illness tends to resolve runs from the si period through the beginning of wei.
In someone prone to wind disorders, if the exterior is released but recovery remains incomplete, recovery comes on the twelfth day.
If the patient's body is very hot but they wish for more clothing, heat is in the skin and cold in the bones and marrow. If the body is very cold but they do not wish clothing near them, cold is in the skin and heat in the bones and marrow.
In Taiyang wind-strike, yang is floating and yin weak. Floating yang produces spontaneous fever; weak yin produces spontaneous sweating. With shivering aversion to cold, sensitivity to wind, gently rising fever, noisy nasal breathing and dry retching, Guizhi Tang governs.
Guizhi Tang formula:
Guizhi, three liang, outer bark removed; Shaoyao, three liang; Gancao, two liang, roasted; Shengjiang, three liang, sliced; Dazao, twelve fruits, split.
Coarsely cut three of the five ingredients above, as stated in the supplied text. Add seven sheng of water and simmer over a low fire until three sheng remain. Remove the dregs, let the temperature become suitable, and take one sheng. A short while afterward, sip a little over one sheng of hot, thin rice gruel to assist the medicine. Cover warmly for about one shi. The best response is a slight, moist appearance of sweat over the whole body; do not let sweat stream like water, for the illness will then certainly not be removed.
If one dose brings sweating and recovery, stop the remaining doses; there is no need to finish the preparation. If sweating does not occur, take another dose by the preceding method. If there is still no sweating, shorten the interval before the next dose and finish the three doses within about half a day. In severe illness, administer through a day and night and observe throughout the full cycle. If one preparation has been finished and the presentation remains, make and take another. If sweat does not emerge, two or three preparations may be taken. Avoid raw and cold foods, sticky and slippery foods, meat and flour foods, the five pungent foods, wine and lao, and foul or offensive substances.
In Taiyang illness with headache, fever, sweating and aversion to wind, Guizhi Tang governs.
In Taiyang illness with stiff, drawn-up nape and back, but with sweating and aversion to wind, Guizhi Jia Gegen Tang governs.
Guizhi Jia Gegen Tang formula:
Gegen, four liang; Mahuang, three liang, nodes removed; Shaoyao, two liang; Shengjiang, three liang, sliced; Gancao, two liang, roasted; Dazao, twelve fruits, split; Guizhi, two liang, outer bark removed.
Boil Mahuang and Gegen first in one dou of water until the volume has decreased by two sheng. Skim off the foam, add the other ingredients, and boil until three sheng remain. Remove the dregs and take one sheng warm. Cover to obtain the slightest appearance of sweat; rice gruel need not be sipped. Other care and restrictions follow the Guizhi method. All decoctions are to follow this pattern where applicable. The seven-ingredient list above is retained as supplied, including Mahuang.
In Taiyang illness after purging, Guizhi Tang may be given if qi surges upward; use the preceding method. If qi does not surge upward, it must not be given.
If Taiyang illness on the third day remains unresolved after sweating, vomiting, purging or warm-needling, it is a ruined illness. Guizhi is unsuitable. Observe the pulse and presentation, determine which contrary treatment was committed, and treat according to the resulting signs. Guizhi was originally intended to release the muscle layer. If the pulse is floating and tight, with fever and no sweating, it must not be given. Always recognize this distinction and avoid error.
If a habitual wine drinker becomes ill, Guizhi Tang must not be given: it causes vomiting, because such a person does not tolerate sweetness well.
When a person prone to panting has an attack, adding Houpo and Xingzi to Guizhi Tang is good.
Someone who vomits after taking Guizhi Tang must later vomit pus and blood.
In Taiyang illness, if induced sweating leads to unceasing leakage of sweat, with aversion to wind, difficult urination and slight tension of the limbs that makes flexion and extension difficult, Guizhi Jia Fuzi Tang governs.
Guizhi Jia Fuzi Tang formula:
Guizhi, three liang, outer bark removed; Shaoyao, three liang; Gancao, two liang, roasted; Shengjiang, three liang, sliced; Dazao, twelve fruits, split; Fuzi, one piece, roasted, peeled and broken into eight pieces.
Boil these six ingredients in seven sheng of water until three sheng remain. Remove the dregs and take one sheng warm.
In Taiyang illness after purging, with a hurried pulse and chest fullness, Guizhi Qu Shaoyao Tang governs. If there is slight cold, Guizhi Qu Shaoyao Jia Fuzi Tang governs.
Guizhi Qu Shaoyao Tang formula:
Guizhi, three liang, outer bark removed; Gancao, two liang, roasted; Shengjiang, three liang, sliced; Dazao, twelve fruits, split.
Boil these four ingredients in seven sheng of water until three sheng remain. Remove the dregs and take one sheng warm.
Guizhi Qu Shaoyao Jia Fuzi Tang formula:
Guizhi, three liang, outer bark removed; Gancao, two liang, roasted; Shengjiang, three liang, sliced; Dazao, twelve fruits, split; Fuzi, one piece, roasted, peeled and broken into eight pieces.
Boil these five ingredients in seven sheng of water until three sheng remain. Remove the dregs and take one sheng warm.
After eight or nine days of Taiyang illness, the condition may resemble nüe fever, with fever and aversion to cold, more heat than cold, no vomiting, bowel evacuation tending to become normal, and two or three attacks daily. A slightly relaxed pulse indicates approaching recovery. A faint pulse with aversion to cold means both yin and yang are deficient: no further sweating, purging or vomiting may be induced. If the complexion instead shows the color of heat, resolution is not yet approaching. Because a slight sweat cannot emerge, the body must itch. Guizhi Mahuang Geban Tang is appropriate.
Guizhi Mahuang Geban Tang formula:
Guizhi, one liang and sixteen zhu, outer bark removed; Shaoyao, Shengjiang sliced, Gancao roasted, and Mahuang with nodes removed, one liang each; Dazao, four fruits, split; Xingren, twenty-four kernels, soaked in hot water, with skins, tips and double kernels removed.
For these seven ingredients, first boil Mahuang in five sheng of water for one or two boils and skim off the foam. Add the other ingredients and boil until one sheng and eight he remain. Remove the dregs and take six he warm.
In Taiyang illness, if the first dose of Guizhi Tang instead produces agitation without resolution, first needle Fengchi and Fengfu, then give Guizhi Tang, and recovery follows.
If Guizhi Tang causes profuse sweating and the pulse is surging and large, give Guizhi Tang by the preceding method. If the condition resembles nüe fever with two attacks daily, sweating must resolve it; Guizhi Er Mahuang Yi Tang is appropriate.
Guizhi Er Mahuang Yi Tang formula:
Guizhi, one liang and seventeen zhu, outer bark removed; Shaoyao, one liang and six zhu; Mahuang, sixteen zhu, nodes removed; Shengjiang, one liang and six zhu, sliced; Xingren, sixteen kernels, skins and tips removed; Gancao, one liang and two zhu, roasted; Dazao, five fruits, split.
For these seven ingredients, first boil Mahuang in five sheng of water for one or two boils and skim off the foam. Add the other ingredients and boil until two sheng remain. Remove the dregs and take one sheng warm, twice daily.
After Guizhi Tang and profuse sweating, if great agitation and thirst remain unresolved and the pulse is surging and large, Baihu Jia Renshen Tang governs.
Baihu Jia Renshen Tang formula:
Zhimu, six liang; Shigao, one jin, crushed and wrapped in cloth; Gancao, two liang, roasted; Jingmi rice, six he; Renshen, three liang.
Boil these five ingredients in one dou of water until the rice is cooked and the decoction complete. Remove the dregs and take one sheng warm, twice daily.
In Taiyang illness with fever and aversion to cold, more heat than cold, and a faint, weak pulse, yang is absent. Sweating must not be induced. Guizhi Er Yuebi Yi Tang is appropriate.
Guizhi Er Yuebi Yi Tang formula:
Guizhi with outer bark removed, Shaoyao, Mahuang, and Gancao roasted, eighteen zhu each; Dazao, four fruits, split; Shengjiang, one liang and two zhu, sliced; Shigao, twenty-four zhu, crushed and wrapped in cloth.
For these seven ingredients, boil Mahuang in five sheng of water for one or two boils and skim off the foam. Add the other ingredients and boil until two sheng remain. Remove the dregs and take one sheng warm.
The original note says that Yuebi Tang and Guizhi Tang should be apportioned and combined, and one sheng drunk. They are now combined into one formula: two parts Guizhi Tang and one part Yuebi Tang.
After Guizhi Tang or purging, if stiffness and pain of the head and nape remain, with gently rising fever, no sweat, fullness and slight pain below the Heart, and difficult urination, Guizhi Qu Gui Jia Fuling Baizhu Tang governs.
Guizhi Qu Gui Jia Fuling Baizhu Tang formula:
Shaoyao, three liang; Gancao, two liang, roasted; Shengjiang sliced, Baizhu, and Fuling, three liang each; Dazao, twelve fruits, split.
Boil these six ingredients in eight sheng of water until three sheng remain. Remove the dregs and take one sheng warm. Recovery follows when urination becomes free.
In cold damage with a floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold and contracted legs, giving Guizhi to attack the exterior is a mistake. If it immediately produces reversal cold, dry throat, agitation, restlessness and counterflow vomiting, prepare Gancao Ganjiang Tang to restore yang. If reversal resolves and the feet become warm, then prepare Shaoyao Gancao Tang, after which the legs extend. If Stomach qi is disharmonious and there is delirious speech, give a small amount of Tiaowei Chengqi Tang. If sweating is induced again and fire-needling is added, Sini Tang governs.
Gancao Ganjiang Tang formula:
Gancao, four liang, roasted; Ganjiang, two liang.
Boil these two ingredients in three sheng of water until one sheng and five he remain. Remove the dregs, divide, and take warm in two doses.
Shaoyao Gancao Tang formula:
Shaoyao and Gancao roasted, four liang each.
Boil these two ingredients in three sheng of water until one sheng and five he remain. Remove the dregs, divide, and take warm in two doses.
Tiaowei Chengqi Tang formula:
Dahuang, four liang, outer covering removed and washed with clear wine; Gancao, two liang, roasted; Mangxiao, half a sheng.
For these three ingredients, use three sheng of water and boil until one sheng remains. Remove the dregs, add Mangxiao, return to a low fire and bring to a boil. Take warm in small amounts. The sequence retains the source's later addition of Mangxiao.
Sini Tang formula:
Gancao, two liang, roasted; Ganjiang, one and a half liang; Fuzi, one piece, used raw, peeled and broken into eight pieces.
Boil these three ingredients in three sheng of water until one sheng and two he remain. Remove the dregs, divide, and take warm in two doses. For a robust person, one large Fuzi and three liang of Ganjiang may be used.
Question: The presentation resembled Yangdan, but treatment according to its method made it more severe, with reversal counterflow, a dry throat, contraction of both shins and delirious speech. The master said that by midnight the hands and feet should become warm and both legs extend. Later it happened as he said. How was this known?
Answer: The cunkou pulse was floating and large. Floating means wind and largeness deficiency. Wind produces slight heat; deficiency contracts both shins. The illness resembled the Guizhi presentation, so Fuzi was added and Guizhi increased to induce sweat, while Fuzi warmed the channels; yang had been lost. With reversal counterflow, dry throat, agitation and restlessness, internal binding in Yangming, and delirious speech and confusion, Gancao Ganjiang Tang was then drunk. At midnight yang qi returned, so both feet should become hot. As the shins remained slightly contracted, Shaoyao Gancao Tang was given again, and then they extended. Chengqi Tang slightly loosened the stool and thereby stopped the delirious speech. Thus it was known that the illness could be cured.
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