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医宗金鉴

<<Yi Zong Jin Jian>>

订正仲景全书伤寒论注

Revised version of Zhongjing Quanshu << Shanghan Lun >>, explanations and re-written corrections

『伤寒论』後汉张机所着,发明『内经』奥旨者也。并不引古经一语,皆出心裁,理无不该,法无不备。盖古经皆有法无方。自此始有法有方。启万世之法程,诚医门之圣书。但世远残阙,多编次传写之误。今博集诸家注释,采其精粹,正其错哵,删其驳杂,补其阙漏,发其馀蕴,於以行之天下,则大法微言,益昭诸万世矣!

Book << Shanghan Lun >> is written by Master Zhang Ji.[1] This is a great book to explain and apply the principle in the TCM bible Book << Huang Di Nei Jing >>. However in this book, though never indicating the citation from the bible, no sentence is meaningless and no therapeutic principle is away from the bible. Since from the very old time, the medical books introduce mostly the therapeutic principles but no practical formula. The book << Shanghan Lun >> is the first one that introduce the practical herbal formula. It is this book that start to shine the great light on the daily clinic work of the Traditional Chinese Medicine. However, it is written thousands of years ago (it was written in AD year 220) and there are several versions of this book with some differences here and there. The mistakes happened during the copy, print and re-written by various scholars and doctors during this long time history. The book here, the <<Yi Zong Jin Jian>> is to collect the explanations from various famous doctors, to correct the possible mistakes in the << Shanghan Lun >>, and to explain the exact possible meanings in this << Shanghan Lun >>, with the hope to help later TCM practitioners in their clinic.

 

医宗金鉴卷一

<<Yi Zong Jin Jian>> Chapter 1

辨太阳病脉证并治上篇

Taiyang stage, its condition, pulse and treatment (1)

太阳主表,为一身之外藩,总六经而统荣卫。凡外因百病之袭人,必先於表。表气壮,则卫固荣守,邪由何入!经曰:虽有大风苛毒,勿之能害是也。若表气虚,则荣卫之气不能御外,故邪得而乘之。经曰:虚邪不能独伤人,必因身形之虚而後客之也。卫,阳也。荣,阴也。风,阳邪也。寒,阴邪也。邪之害人,各从其类,故中风则卫受之,伤寒则荣受之。卫分受邪,则有汗为虚邪,桂枝证也。荣分受邪,则无汗为实邪,麻黄证也。荣卫俱受邪,均无汗,皆为实邪,大青龙证也。大纲三法,用之得当,其邪立解,用违其法,变病百出。缘风为百病之长,故以风中卫列为上篇,寒伤荣与风寒两伤,列为中、下二篇。其条目俱详於本篇之下,俾读者开卷了然,有所遵循也。

There are six major meridians, phases, or levels in the body, e.g. Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin. The Taiyang level is the surface level that governs all other meridians or levels. It is the surface defense system of the body agaist the invasion of a disease causing things that we call them Xieqi. When a disease comes from outside of the body, it attacks the body surface, the Taiyang first. If the body surface defense system is strong, e.g. the Weiqi[2] and the Rongqi[3] is strong and in harmony each other, how can a disease comes in! This is what the book << Huang Di Nei Jing >> said: if the body surface is strong, even a strong Wind Xieqi can not come in. If the body surface Qi is weak, e.g. the Weiqi and Rongqi are weak to defense, the Xieqi will come in to cause health trouble. Book << Huang Di Nei Jing >> said, a disease is caused due to the weak in the body defense system first. Weiqi belongs to Yangqi in the body. Rongqi belongs to the Yinqi in the body. Wind is a Yang Xieqi, while a Cold is a Yin Xieqi. Each Xieqi has different ways to affect the body structure and function. The Wind will attack the Weiqi, while the Cold affects the Rongqi. When the Weiqi is attacked, the body will have sweat, so the Wind is also called a weak Xieqi, in which herb Guizhi Tang is used. When the Rongqi is affected by the Cold Xieqi, the body has no sweat. So the Cold Xieqi is also called a Cold Xie (Qi), in which herb Mahuang Tang is used. If the Weiqi and the Rongqi both are affected, the body has no sweat, herb Da Qinglong Tang is used. If doctor understand this, has correct evaluation and analysis for the nature and position of the disease, the corresponding herbal therapy should solve the disease right away. If he fails to do so, clinic condition could turn to worse and the disease will develop into much more complex conditions to treat. Since the Wind is the most important Xieqi to cause a disease, so we list the Wind-invasion in the first chapter; the Cold-invasion in the second chapter and the co-invasion by the Wind and Cold is listed in the later third chapter.

01 太阳之为病,脉浮,头项强痛而恶寒。

Whenever patient has floating pulse, tight and pain on neck, and chilly[4], his disease is in Taiyang stage[5].

02 太阳病,发热,汗出,恶风,脉缓者,名为中风。

In the Taiyang stage, if the person feels fever, sweat, dislike wind, pulse feels slow, he is further diagnosed as in Wind-invasion type Shanghan disease.[6]

03 太阳中风,阳浮而阴弱。阳浮者,热自发;阴弱者,汗自出。啬啬恶寒,淅淅恶风,翕翕发热,鼻鸣干呕者,桂枝汤主之。

For Wind-invasion and in the Taiyang stage, person’s floating pulse[7] (the pulse felt with light touch on the pulse, the Yang pulse) feels as floating, whereas the Yin pulse (e.g. the pulse felt when press harder to bottom against the bone) is weak. Because the deeper Yin pulse is weak, one has sweat, has chilly, dislike-wind feeling, gentle hot feeling, nausea (no vomiting) and stiff nose. In this case, herbal formula of Guizhi Tang[8] should be used principally

桂枝汤方

Guizhi Tang:[9

桂枝三两, 芍药三两, 甘草(炙)三两, 生姜(切)三两, 大枣(擘)十二枚

Guizhi 45 grams, Shaoyao 45 grams, Gancao 30 grams, Fresh ginger 45 gram and Chinese date 12 badges.[10]

右五味,俰咀三味,以水七升,微火煮取三升,去滓,适寒温,服一升。服已须臾,啜热稀粥一升馀,以助药力。温覆令一时许,遍身傃傢微似有汗者益佳,不可令如水流漓,病必不除。若一服汗出,病差,停後服,不必尽剂;若不汗,更服,依前法;又不汗,後服,当小促其间,半日许,令三服尽。若病重者,一日一夜服,周时观之。服一剂尽,病证犹在者,更作服,若汗不出者,乃服至二、三剂。禁生冷、黏滑、肉面、五辛、酒酪、臭恶等物。

Cut and chop all of the ingredients into small pieces. Add the herbs and about 1800 ml water to a herbal pot. Bring to boil and keep in mild boiling until the total water volume in the pot (Clay pot, but not metal pot, should be used) reduces down to about 750 ml. Remove the residue and collect the liquid part (the herbal tea). Wait a movement until it turns little bit cold down. Drink about one third of the collected herbal tea[11]. After about 40 to 50 minutes[12], drink a bowl of rice soup (about 250 ml) to help the herb to work. Cover the body and lie down, hoping that the body is with little sweat, but not too much sweat. If the body has too much sweat, the disease wouldn’t be cured.[13]

If the patient feels better, stop to drink the remaining herb tea; if there is no sweat, continue the drinking of the second part of the tea and keep the patient the same way (as drink the rice soup). If there is still no sweat, drink the remaining one third of the tea. Whole of the tea can be finished within about 4 to 5 hours; For those with severe illness condition, continue drinking the tea as such with close monitoring the reaction. If after finish the first dose (e.g. the whole herbs collected, about 750 ml), if the disease remains no change, continue to drink the second doses of the herbal tea. If there is still no sweat, try up to three doses. When drinking the Guizhi Tang, it is forbid the cold food, spicy food, meat, sticky food (fried food), wine, fertilized food, or other food with terrible smell.

04 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。

When in Taiyang Stage, if the person has fever and sweat, it means that his Rongqi is weak but Weiqi[14] is strong, that stimulates the sweat. To remove the disease-causing thing (the Xieqi), Guizhi Tang is needed.

05 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。

If the person has no any disease inside the body, but feels hot and sweat from time to time, it means his Weiqi is in disturbed condition. To produce a healing sweat before its own sweat onset can stop it (to cure). Guizhi Tang is needed for this aim[15].

06 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,以荣行脉中,卫行脉外,复发其汗,荣卫和则愈,宜桂枝汤。

If the health problem is simply a easy sweat, it suggests that Rongqi is in harmony. When the Rongqi is in harmony, the Weiqi is not in a harmony, since the Rongqi is traveling inside of the blood while the Weiqi is outside of the blood vesicle.[16] Use a healing sweat therapy, both Qi will come to harmony together. Guizhi Tang is needed.

07 太阳病,初服桂枝汤,反烦不解者,先刺风池、风府,却与桂枝汤则愈。

In the Taiyang stage, after the first drinking of the Guizhi Tang, there is no any improvement of the condition and the person feels annoyed, acupuncture should be used: stimulate the Fengchi and Fengfu points (on the back of the neck). Then use the Guizhi Tang again.

08 欲自解者,必当先烦,乃有汗而解,何以知之?脉浮,故知汗出解也

(When in the Taiyang stage) and if the disease is to cure by itself, one will feel annoyed (irritable in emotion) first, then has sweat. Why this way? It is because the pulse is floating, indicating that a sweat will follow to remove the Xieqi out of the body. [17]

09 病六七日,手足三部脉皆至,大烦而口噤不能言,其人躁扰者,必欲解也。

When a disease is in the Taiyang stage for up to six or seven days, the floating pulse can be find in the wrists and font of ankles, even if the person feels tight in mouth that prevent opening of the mouth to speak, and even if he feel irritable in body, the disease will cure by itself. [18]

10 若脉和,其人大烦,目重,内际黄者,此欲解也。

If the pulse is harmony (not floating or others), the person feels strongly annoyed/impatient, his upper eye lids[19] falls to close, and his inner corner of the eye turns yellow in color, the disease is to cure by  itself.

11 问曰:脉病欲知愈未愈者,何以别之?答曰:寸口、关上、尺中三处,大小、浮沉、迟数同等,虽有寒热不解者,此脉阴阳为和平,虽剧当愈。

Asked: how to know a disease is to recovery, by feeling pulse? The Master[20]: it will cure by itself if the pulses in the Chun, Guan and Chi positions in the wrist[21] are pretty much the same, e.g. no matter they all felt floating or deeper; small or big; fasting or slower, even if the person has continuous fever or cold.[22]  

12 病有发热恶寒者,发於阳也,无热恶寒者,发於阴也,发於阳者七日愈,发於阴者六日愈,以阳数七、阴数六故也。

If a disease shows up with fever and chilly, it occurs from Yang[23]; if it is without fever, but still chilly, it occurs from Yin. Disease occurring from Yang will get recover within seven days. Disease occurring from Yin will recover within six days. This is because the number seven associated to Yang and number six is associated to Yin.

13 问曰:凡病欲知何时得,何时愈?答曰:假令夜半得病者,明日日中愈。日中得病者,夜半愈。何以言之?日中得病,夜半愈者,以阳得阴则解也。夜半得病,明日日中愈者,以阴得阳则解也。

Asked: how to know when a disease is gained and when it will recover? Master: if a disease is gained in the middle of the night, it will recover at noon next day. If it is gained at the noon, it will recover at the middle of the night the same day. That gained at the noon and recover at the middle of night is for the fact that the Yang (at the noon) will get recovered at Yin time (middle night); That gained at the middle of night but recovered at the noon is for the reason that the Yin disease (middle of night) needs more Yang (at the noon) to recover.[24]

14 太阳病,头痛至七日已上自愈者,以行其经尽故也。若欲作再经者,针足阳明,使经不传则愈。

When in the Taiyang stage, if one’s headache disappears by itself (without treatment) after seven days, it means the disease reaction has finished the circle in all stages[25]. If the headache comes back again after the seven days, we should use acupuncture on the Yangming meridian to stop its second circle.[26]

15 风家表解而不了了者,十二日愈

For Wind person[27], if he recovered from the Taiyang stage (e.g. no more fever, no more tight and pain on the neck, the pulse is not so floating), but still feels tired and feels no normal energy as usual, he needs 12 days to recover naturally.

16 桂枝本为解肌,若其人脉浮紧,发热,汗不出者,不可与也,常须识此,勿令误也。

The function of the Guizhi Tang is to lose muscle[28], therefore, if the pulse feels floating and tight, and there is fever but no sweat, it should not be used[29]. This is common sense and principle in the use of Guizhi Tang. Keep this in mind!

17 若酒客病,不可与桂枝汤,得之则呕,以酒客不喜甘故也。

Guizhi Tang should not be used to Wine person[30]. Otherwise the person will vomit, since the body constitution of the Wine person cannot tolerate sweet taste.

18 凡服桂枝汤吐者,其後必吐脓血也。

For those who vomit after drinking the Guizhi Tang, they will vomit pus and blood later.[31]

19 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,桂枝加附子汤主之。

In the Taiyang stage, if sweating therapy[32] causes continuous sweat, and if the person feels dislike wind, has difficulty in urination, arms and legs feels tight and hard to bends or stretch, Guizhi jia Fuzi Tang should be used.[33]

桂枝加附子汤方

Guizhi jia[34] Fuzi Tang

於桂枝汤方内,加附子一枚,馀依桂枝汤法。

Add herb Fuli 30 gram in the Guizhi Tang. Cook and Drink the tea as for Guizhi Tang.

20 服桂枝汤,大汗出後,大烦渴不解,脉洪大者,白虎加人参汤主之。

After drinking of Guizhi Tang, if person has strong sweat, feels very annoyed, very thirsty and drinking water does not help to calm down the thirsty, pulse is big, Baihu jia Renshen Tang should be used.

21 太阳病三日,发汗不解,蒸蒸发热者,属胃也,调胃承气汤主之。

When the disease is in Taiyang stage for three days and if the person has had sweat therapy, but still feels continuous fever, it means that the disease has past into Yangming stage. Tiaowei Chengqi Tang should be the main formula.

22 太阳病,发汗後,大汗出,胃中乾,烦躁不得眠,欲得饮水者,少少与饮之,令胃气和则愈。若脉浮,小便不利,微热,消渴者,五苓散主之。

When in Taiyang stage and after sweat therapy, if the person has hand heavy sweat which makes him dry in stomach, feels annoyed (irritable in emotion and in body), simply give him little water to drink to easy the stomach. If his pulse is floating, his urine is difficult, and if he feels slight hot and very thirsty, herb formula Wuling San[35] should be used mainly.[36]

23 中风发热,六、七日不解而烦者,有表 证,渴欲饮水,水入则吐者,名曰水逆,五苓散主之。

With Wind-invasion, if the disease continued in Taiyang stage for six to seven days without recovery, and if the person feels hot, very thirsty, but has vomiting after drinking, it means he has water reversing syndrome. Wuling San is the main formula.

五苓散方

Wuling San 

猪苓(去黑皮)十八铢, 茯苓十八铢, 泽泻一两六铢, 白术十八铢,桂枝半两

Zhuling 12 gram, Fuling 12 gram, Zexie 20 gram, Baishu 12 gram, Guizhi 8 gram.

右五味为散,更於臼中杵之,白饮和方寸匕服之,日三服,多饮暖水,汗出愈。

Grind all herbs into powder, drink 1 gram[37] each time, three times a day. Drink more warm water after the herb drinking. It will be cured after a sweat.

24 太阳病,小便利者,以饮水多,必心下悸,小便少者,必苦急也。

When in Taiyang stage, if one has more urine, it is due to too much water drinking[38]. The person will also feel palpitation. If he has little urine, he must feel urgent feeling during the urination.[39]

25 发汗後,饮水多必喘,以水灌之亦喘。

After sweat due to a sweat therapy, drinking more water will cause asthma-like short breath, so will with shower.

26 发汗後,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。

After sweat after sweat therapy, Guizhi Tang should not be repeated. In this case, if one has sweat, asthma but no fever, Mahuang Xingren Gancao Tang can be used.[40]

麻黄杏仁甘草石膏汤方

Mahuang Xinggren Gancao Tang

麻黄(去节)四两, 杏仁(去皮尖)五十枚, 甘草(炙)二两, 石膏(绵裹,碎)半两

Mahuang 60 gram, Xingren 50 badges, Gancao (processed) 30 gram, Shigao 30 gram.

右四味以水七升,先煮麻黄减二升,去白沫,内诸药,煮取三升,去滓,温服一升。

Add Mahuang and 1750 ml water in herbal pot. Bring to boil until the total liquid in the pot is about 1250 ml. Remove the floating residue. Add other herbs in. Continue to cook until the total liquid part is about 750 ml. Collect the liquid part (herbal tea). Drink one third of the herbal tea. Repeat three times a day. This is one-day dose.

27 下後不可更行桂枝汤,若汗出而喘,无大热者,可与麻黄杏仁甘草石膏汤。

After bowel-cleansing therapy, Guizhi Tang should not be used again. Otherwise, the person may have sweat and asthma, though no strong hot. If this happens, Mahuang Xingren Shigao Gancao Tang can be used. [41

28 太阳中风,不下利[42],呕逆,表解者,乃可攻之。其人絷絷汗出,发热(作)有时,头痛,心下痞满,引胁下痛,干呕短气,汗出不恶寒者,此表解里未和也,十枣汤主之。

When Wind-invasion in the Taiyang stage, the person also has constipation (or hard to have bowel movement)[43], nausea and vomiting, a bowel-cleansing therapy can be used only under the condition that the original Taiyang conditions have been cleared. If the person has mild sweat and fever that comes from time to time, headache, full in upper stomach area, pain in the side of the chest and stomach, nausea but no vomiting, short of breath, sweat but no cold feeling followed, it means that the disease is no longer in the surface Taiyang stage, but in inside stagees (Shaoyang and Yangming stages). In this case, Shi Zao Tang is the main herbal formula.[44]

十枣汤方

Shi Zao Tang

芫花(熬), 甘遂, 大戟, 大枣(擘)十枚

Yuanhua, Gansui, Daji, the same amount; Chinese date ten badges.

右三味,等分,各别捣为散,以水一升半,先煮大枣肥者十枚,取八合,去滓,内药末,强人服一钱匕,羸人服半钱,温服之,平旦服。若下少病不除者,明日更服,加半钱,得快下利後,糜粥自养。

Grind the Yuanhua, Gansui, Daji into powder. Add the Chinese date and about 375 ml water into herbal pot. Bring to boil for 30 min or until the liquid in the pot is about 200 ml. Collect the liquid part, mix it with the herbal powders. For strong body, drink 2 gram, and for weak person, drink 1 gram. If there is only little urine and the disease remains there, repeat the drink next day and increase the dose by 0.5 gram. After having had large urine, stop to take it. Eat rice soup for further recovery. 

29 太阳病,外证未解不可下也,下之为逆,欲解外者,宜桂枝汤。

When in Taiyang stage, bowel-cleansing therapy should not be used if the disease is still in the surface Taiyang stage. To clear the surface disease, Guizhi Tang should be used. [45]

30 太阳病,先发汗不解,而复下之,脉浮者不愈。浮为在外,而反下之,故令不愈。今脉浮,故知在外,当须解外则愈,宜桂枝汤。

When in Taiyang stage, sweat therapy caused sweat but the disease remains. If again a bowel-cleansing therapy is followed and if the pulse is still floating, the disease will not be cured. Floating pulse suggests the disease is still on the surface layer, proper treatment is sweating therapy to remove the disease from the out layer of the body. Guizhi Tang should be considered. 

32 太阳病,下之,其脉浮[46], 不结胸者,此为欲解也。脉促[47]者必结胸,脉紧者必咽痛,脉弦者必两胁拘急,脉细数者头痛未止,脉沉紧者必呕,脉沉滑者协热利,脉浮滑者,必下血。

When in Taiyang stage but a bowel-cleansing therapy is used, the pulse is still floating and no Jiexiong[48] in stomach area, such pure floating pulse suggests that the disease will leave the body from the out layer of the body. If the pulse is urgent, there will be Jiexiong[49]; if it is tight, there will be pain in the throat[50]; if it is as string, there will be spasm in the side chest[51]; if the pulse is thin and fast, there will be continuous headache[52]; if it is deep and tight, there will be vomiting[53]; and if the pulse feels deep and smooth, there will have hot-diarrhea[54], and if the pulse is floating and smooth, there will have bleeding in the stool. [55]

33 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,四日复下利,此作协热利也。

When in Taiyang stage for two to three days, the person has no willing to lie down but to stay up. Such person must have weak pulse and feel bloating in stomach area. This is because he has had cold in the stomach area but a bowel-cleansing therapy has been wrongly used. The cleansing therapy stops his diarrhea, but causes fullness in the stomach. If on the fourth day he has diarrhea again, it will be hot-diarrhea[56].

34 太阳病,外证未除,而数下之,遂协热而利;利下不止,心下痞硬,表 不解者,桂枝人参汤主之。

In Taiyang stage, the invaded disease remains but a bowel-cleansing therapy has been used repeatedly for several times, the diarrhea will be hot-diarrhea; if the diarrhea continuous, the person will feel fullness in stomach. If it is still in Taiyang stage, Guizhi jia Renshen Tang should be used mainly[57].

桂枝人参汤方

Guizhi jia Renshen Tang

桂枝  四两, 甘草(炙)四两, 白术三两,  人参三两,  乾姜三两.

Guizhi 60 gram, Gancao (proceeded) 60 gram, Baishu (45 gram), Renshen 45 gram, Ganjiang 45 gram.

右五味,以水九升,先煮四味,取五升,内桂更煮,取三升,去滓,温服一升,日再服,夜一服。

Add the Gancao, Baishu, Renshen and Ganjiang and 2250 ml water into herbal pot. Bring to boil until the liquid volume down to about 1250 ml. Add the Guizhi in and continue to cook until the total liquid volume in the pot is about 750 ml. Collect the liquid (herbal tea). Drink one third of the tea. Drink another one third during the day and the last one third at night.

35 太阳病,桂枝证,医反下之,利遂不止,脉促者,表未解也,喘而汗出者,葛根黄芩黄连汤主之。

When in Taiyang stage and it is Guizhi Tang condition but a bowel-cleansing therapy is mis-used, that causes continuous diarrhea, the person feels asthma and sweat, Gegen Huangqin Huanglian Tang should be used.

葛根黄芩黄连汤方

Gegen Huanglian Huangqin Tang

葛根半斤, 黄芩三两, 黄连三两, 甘草(炙)二两

Gegen 95 gram, Gancao (processed) 30 gram, Huanglian 45 gram, Huangqin 30 gram.

右四味,以水八升,先煮葛根,减二升,内诸药,煮取二升,去滓,分温再服。

Add Gegen and 2000 ml water in herbal pot. Bring to boil until the liquid volume is about 1500 ml. Add the remaining herbs in and continue to cook until the total liquid volume is about 500 ml. Collect the water part from the mixture. Separate the mixture into several parts. Drink each part in one to two hour interval (until the asthma and diarrhea stop).

36 太阳病,下之後,脉促胸满者,桂枝去芍药汤主之。若汗出[58]微恶寒者,去芍药方中,加附子汤主之。

In the Taiyang stage, if one feels full in chest, pulse is fast, after bowel-cleansing therapy, use Guizhi qui Shaoyao Tang. If the one feels sweat and slight chilly, add Fuzi in this formula.[59

桂枝去芍药汤方

Guizhi qui Shaoyao Tang

於桂枝汤内去芍药,馀依前法。

Remove Shaoyao from the standard Guizhi Tang. Cook and drink the herbal tea as for Guizhi Tang.

桂枝去芍药加附子汤方

Guizhi qui Shaojiao jia Fuzi Tang

於桂枝汤方内去芍药,加附子一枚,炮去皮,破八片,馀依前法。

Remove Shaoyao from the Guizhi Tang but add Fuzi 30 gram in.

37 太阳病下之,微喘者,表未解故也,桂枝加厚朴杏子汤主之。喘家作桂枝汤加厚朴杏子佳。

When in Taiyang stage but has had bowel-cleansing therapy, the person has slight asthma and there is still indications to the Taiyang stage, Guizhi jia Houpo Tang is used mostly[60]. Asthma person[61] has asthma onset, Guizhi Tang can be used with addition of herb Houpo and Xingren. This is Guizhi jia Houpo Xingren Tang.

桂枝加厚朴杏仁汤方

Guizhi jia Houpo Xingren Tang

於桂枝汤方内,加厚朴二两,杏仁五十个,馀依桂枝汤方。

Add herb Houpo and Xingren in the standard Guizhi Tang. Cook and drink it as for Guizhi Tang. [62]

38 太阳病,下之,其气上冲者,可与桂枝汤,方用前法。若不上冲者,不可与之。

When in Taiyang stage and have had bowel-cleansing therapy, one may have reverse pushing feeling[63]. In this case, Guizhi Tang can still be used (the same way as standard procedure for the formula). If there is no such reverse pushing feeling, it should not be used.

39病如桂枝证,头不痛,项不强,寸脉微浮,胸中痞硬,气上冲咽喉不得息者,此为胸有寒也,当吐之,宜瓜蒂散。

Clinic condition indicating the use of Guizhi Tang, if the person has no headache, no stiffness in the neck, but the pulse feels slight floating in the Chun position and feels full in the chest, feels reverse pushing and hard to breath, it means that the person has cold in the chest. Vomiting therapy should be used. Formula: Guadi San.

瓜蒂散方

Guadi San

瓜蒂(熬黄)一分, 赤小豆一分

Guadi (process into yellow in color) 7.5 gram, Chixiaodou 7.5 gram.

右二味,各别捣筛,为散已,合治之,取一钱匕,以香豉一合,用热汤七合,煮作稀糜,去滓,取汁和散,温顿服之。不吐者,少少加服,得快吐乃止。诸亡血虚家,不可与瓜蒂散。

Grind the two herbs into powder. Mix it well. Add 1 gram of this mixture, herb Xiangzhi 20 gram, water 175 ml into herbal pot. Bring to boil to cook as a soup. Collect the liquid part. Drink all the herb tea once to stimulate vomit. If no vomit, drink little bit more amount next time. Stop to take this herb if there is big vomit. If a person has easy bleeding and very weak, this herb should not be used.

40 病发於阳,而反下之,热入因作结胸;病发於阴,而反下之,因作痞。所以成结胸者,以下之太早故也。

The disease comes from outside but a wrong bowel-cleansing therapy is used. This makes the invading disease brings hot into the chest to cause Jiexiong syndrome[64]. If the disease develops from inside organs, a wrong bowel-cleansing therapy will cause Fullness syndrome in stomach, because the bowel-cleansing therapy is used too early.

41 太阳病,脉浮而动数,浮则为风,数则为热,动则为痛,头痛发热,微盗汗出,而反恶寒者、表未解也。医反下之,动数变迟,膈内拒痛,胃中空虚,客气动膈,短气躁烦,心中懊倄,阳气内陷,心下因硬,则为结胸,大陷胸汤主之。若不结胸,但头汗出,馀处无汗,跻颈而还,小便不利,身必发黄。

When in Taiyang stage, if pulse feels floating, agitating and fast, the floating pulse means Wind; fast means fever/hot; agitating means pain, fast also means weakness. Headache, fever, slight night sweat and feeling dislike-cold all suggests that the disease is still in the Taiyang stage. At this time, a bowel-cleansing therapy will makes the agitating and fast pulse into slower, pain in the chest, empty in the stomach. The invading disease therefore stimulates the chest and diagram, causes short of breath, irritable in emotion and in physical body, annoyed, hardness in the stomach area when touch, all are called the Jiexiong syndrome. Da Xianxiong Tang should be used. If there is no such typical Jiexiong syndrome, but only sweat on head (not on other part of the body), difficulty in urine, the person’s skin will turn to yellow (jaundice).

大陷胸汤方

Da Xianxiong Tang[65]

大黄(去皮)六两, 芒硝一升, 甘遂(另碾)一钱

Dahuang (remove skin) 60 gram, Mangxiao 130 gram, Gansui (grind into powder) 1.3 gram.

右三味,以水六升,先煮大黄,取二升,去滓,内芒硝,煮一两沸,内甘遂末,温服一升,得快利,止後服。

Add Dahuang and 1500 ml water into herbal pot. Bring to boil until the liquid in the pot is about 1000 ml. Remove the residue, add the Mangxiao in and continue to cook for 5 to 10 min. Then add Gansui in. Drink half of the herbal tea. Stop to drink the tea if there is big bowel movement.

42 太阳病,重发汗而复下之,不大便五六日,舌上燥而渴,日晡所小有潮热,从心下至少腹硬满而痛,不可近者,大陷胸汤主之。

For a disease in Taiyang stage, the person was given repeated sweat therapy and followed bowel-cleansing therapy. This caused him no bowel movement for several days. He feels dry in mouth and feels thirsty, and slight fever in the later afternoon. He also feels hardness, fullness and pain (he dislike to touch his stomach), from upper stomach to lower stomach. This condition indicates the use of Da Xianxiong Tang (the Da Xianxiong Tang condition).

43 小结胸,病正在心下,按之则痛,脉浮滑者,小陷胸汤主之。

For small Jiexiong condition, the problem is in the upper stomach area. It feels pain when touch. The person’s pulse feels floating the smooth. This condition indicates the use of Xiao Xianxiong Tang. [66]

小陷胸汤方

Xiao Xianxiong Tang

黄连一两, 半夏(洗)半斤,栝蒌实(大者)一枚

Huanglian 15 gram, Banxia 124 gram, Gualushi 45 gram.

右三味,以水六升,先煮栝蒌,取三升,去滓,内诸药,煮取二升,去滓,分温三服。

Add the Gualushi and 1500 ml of water into herbal pot. Bring to boil until the inside liquid has about half left. Remove herb reside, add the remaining two herbs in and continue to cook until there is about 500 ml left. Collect the herbal tea. Drink one third of the tea each time, totally three times a day.

44 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.

With the Cold-invasion Shanghan disease for about six to seven days, the person has Jiexiong condition: feels hot, fullness and pain in the upper stomach area and the upper stomach feels hard as stone when touch, with deep and tight pulse. Da Xianxiong is the main herb formula to use.  [67]

45寒实结胸,无热证者,与三物白散[68]

If one has Cold-Fullness Jiexiong and has no fever, San Wu Bai San should be used. [69]

三物白散方

San Wu Bai San[70]

桔梗 三分, 巴豆(去皮心,熬黑,研如脂)一分, 贝母三分

Jiegen 12 gram, Badou (remove skin, process to dark in color, grind to mud) 4 gram, Beimu 12 gram.

上件二味为末,内巴豆,更於臼中杵之,以白饮和服,强人半钱匕,羸者减之。病在膈上必吐,在膈下必利。不利,进热粥一杯;利过不止,进冷粥一杯。

Grind the Jiegen and Beimu into powder first. Add the Badou in and continue to grind. Drink the herbal powder, 0.5 gram each time for strong body constitution (for thin person, reduce the amount). If the disease is located over the diagram, the person will vomit; if it is under the diagram, the person will have diarrhea. If he has no diarrhea after taking of the herb powder, eat one cup of warm rice soup; if the diarrhea continues, drink cold rice soup to stop it. [71]

46 伤寒十馀日,热结在 里,复往来寒热者,与大柴胡汤。但结胸无大热者,此为水结在胸肋也,但头微汗出者,大陷胸汤主之。

If the Cold-invasion Shanghan disease has existed for more than ten days, the hot Jiexiong remains with repeated fever and chilly, Da Chaihu Tang should be used. If there is the Jiexiong syndrome, but no strong fever, it means a situation of water-condensed in the upper stomach area. In this case, if there is slight sweat in only the head, Da Xianxiong Tang is the main herbal formula. [72]

47 结胸者,项亦强,如柔痉状,下之则和,宜大陷胸丸。

With Jiexiong syndrome, the person also fees hard and tight on the neck, similar to mild Jing syndrome[73]. Bowel-cleansing therapy will solve this problem. Da Xianxiong Wan[74] should be used.

大陷胸丸方

Da Xianxiong Wan

大黄半斤, 葶苈子(熬)半升, 芒硝 半升, 杏仁(去皮、尖,熬黑)半升

Dahuang 90 gram, Tinglizi (Cook processed) 60 gram, Manxiao 60 gram, Xingren (remove skin, tips, cook process to black in color) 60 gram.

右四味,捣筛二味,内杏仁、芒硝,合研如脂,和散。取如弹丸一枚,别捣甘遂末一钱匕,白蜜二合,水二升,煮取一升,温顿服之,一宿乃下。如不下,更服,取下为效。禁如药法。

Grind the Dahuang and Tinglizi into powder. Mix it with Mangxiao and Xingren, continue grand into powder, make it into pills, about 1 cm in diameter each. Add one pill, herb Gansui powder 1 gram, white honey 40 gram and water 500 ml in a herbal pot. Bring to boil until the liquid volume in the pot is about 250 ml. Drink all the herbal tea once. The person should have big bowel movement overnight. If not, repeat one or more times, once a day, until there is big bowel movement.

48 结胸证,其脉浮大者,不可下,下之则死。

For Jiexiong syndrome, if the person’s pulse feels floating and big, the bowel-cleansing therapy should not be used, otherwise he may die.[75]

49结胸证悉具,烦躁者亦死。

For the Jiexiong syndrome, if the person is annoyed (irritable emotionally and physically), he will die. [76]

50 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,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,名曰藏结。舌上白胎滑者,难治。

Asked: There are Jiexong and Zangjie. How to distinguish them? Answer: For Jiexiong, the person feels pain when press his upper stomach and his pulse is floating on the Chun position but deep in the Guan position. For the Zangjie syndrome, the person also feel fullness and hard in the upper stomach, but his appetite is normal as usual, he has diarrhea from time to time, and his pulse feels floating on the Chun position but deep, small, thin, on the Guan position. If the person’s tongue covering is white, thick, slippery like, his (Jiexiong) is hard to treat. [77]

51 病胁下素有痞,连在脐旁,痛引少腹,入阴筋者,此名藏结,死。

If a person has a history of Fullness syndrome (e.g. bloating and fullness feeling in the upper stomach of side stomach area), and the fullness expands to the navel, the pain expands to the lower stomach, to the pennies or vagina, it is called Zangjie. The one will die.

52 藏结无阳证,不往来寒热,其人反静,舌上胎滑者,不可攻也。

Zangjie is Yin condition, not a Yang condition. There is no cold-hot repeat, and the person is calm and his tongue covering is white, thick and slippery, the bowel-cleaning therapy should not be used. [78]

53 病在阳,应以汗解之,反以冷水洗之,若灌之,其热被却不得去,弭更益烦,肉上粟起,意欲饮水,反不渴者,服文蛤散;若不差者,与五苓散。身热皮粟不解,欲引衣自覆者;若水以 之洗之,益令热被却不得出,当汗而不汗则烦。假令汗出已,腹中痛,与芍药三两如上法。

When a disease is in Taiyang stage, it should be resolved with a sweat therapy. If the person is given cold water to wash, to shower, to drink, his fever will remain and gain more annoyed emotionally. There will be lots of millet-like dotes on the skin (higher than the skin surface). The person has desire to drink water, but does not feel thirsty, herb Wenhe San should be used; if this herb does not work, try Wuling San. If the fever and skin dots remain, and he is eager to cover himself[79], but water wash is given, the cold water closes the skin to prevent evaporation of the fever, and causes annoyed feeling. If a correct sweat therapy has been used with sweat, but the person feels stomach pain, add herb Shaoyao (into the Guizhi Tang). 

文蛤散方

Wenhe San

文蛤[80] 五两

Wenhe 78 gram.

右一味,为散,沸汤和一钱匕服,汤用五合。

Grind the herb into powder. Drink 1 gram with about 125 ml of hot water.



[1] Master Zhang Ji has another name: Zhang Zhongjing. In Chinese, family name is the first, given name is the second. There is no middle name usually.

[2] Qi means something as air, as gas, as vapour, as something you can feel its function but hard to see its shape or mass. There are different Qi in the body. The Qi that works to maintain the body normal function is called Zhengqi. The Qi that causes a disorder or a disease is called a Xieqi. The Xieqi can be a bacteria, a virus, a fungers, or simply a climate change, a cold temperature, a high temperature, a wind weather, a raining, a humidity environment, etc. So, a Xieqi in the Chinese Medicine is a very broad concept. Whenever there is no proper English word to express the TCM meaning, we will use the Chinese Pingyin but not a Chinese character to mean it. In addition, the Xieqi is translated into evil in some TCM book. We don’t think this is a proper word. The Xieqi can be wind, cold, hot, fire, wet, dryness, etc. They are normal and ordinary nature factors. They do not cause disease normally, unless they come into the body in the improper time, either when the body defense system is weak, or when they selves are too strong. They are not always “evil”. Therefore, only after they come into the body and caused disease, they are called the Xieqi. Xieqi is also called Xie, for example, Wind Xie, Cold Xie, Wet Xie, Hot Xie, Fire Xie, Dry Xie. Different Xieqi could cause different clinic manifestations, which are very important to tell the nature of the disease and to decide a proper treatment principle. Identification of the Xieqi is a very basic requirement to a TCM doctor.

[3] Weiqi moves outside of the blood vessels, works as the first level of defense system for the body. Rongqi transports inside of the blood vessels and works as the inside defense system of the body.

[4] In clinic, to feel hot does not mean a fever. Fever means a high body temperature, but a person could feel hot but the body temperature is not high. Such condition can be seen in person with menopause syndrome and in many other conditions. In this book, to feel hot does not mean an increase in body temperature. If it is fever, it means a higher body temperature. Similarly, that people feel chilly does not mean that their body temperature is low, but rather, their body temperature is usually high. If we say that a person feels cold, his body (or hands or feet) also feels cold by touch. Patient with chilly or shaking wants to cover himself with more clothes or other coverings. More covering can not reduce his chilly. At this movement, his temperature is high or will pretty soon much high. A dislike cold feeling also needs to be separated with the Jue condition feeling. Many people can feel cold in hands and feet, that suggests that they are not at all in the Taiyang stage, but in others, mostly in Shaoyin and Jueyin stage. We will introduce it in later chapters. Readers should pay attention in this book whenever we mean “feel chilly” or “feel cold”. It bears different meaning. In most of times, TCM pay much attention to the person’s feeling, not the exact body temperature measured.

 

Dislike wind and dislike cold are also different. For dislike wind, one does not want to stay in wind weather or in an environment with strong air moving (such as in an air-conditioned car or room). He will feel ok when he stays in a room without air conditioning. For dislike cold, one does not want to stay in a cold room. He cares more about the room temperature not the air moving. He could like the warm air moving, such as warm fan.

[5] This paragraph is very important. It tells how to diagnose and recognize Taiyang stage of the Shanghan disease. Furthermore, no matter what disease when people come to you, if he feels chilly with pain and tight on the neck from beginning, you should know that his current disease is in an early stage, the Taiyang stage. Pay attention to the condition here: pulse first. The pulse should be floating. If one feels headache, tight and pain on neck but the pulse is deeper and thin and weak, it suggests that the disease is no longer in the Taiyang stage, it might be in other deeper and severe stage, such as in Shaoying stage now. Second, it did not indicate the fever as the necessary condition for the diagnosis of Taiyang stage.

 

Different disease has difference clinic manifestations in the early Taiyang stage. The floating pulse, tight and pain on neck and chilly is common for the invasion of Wind and Cold. This book mostly focuses on the introduction of the clinic diagnosis and treatment for the invasion of Wind and Cold (Wind and Cold come into body alone or in a combination).

 

There are several other diseases that need distinguish with the Shanghan disease. One of them is the Ye disease, in which the invaded Xieqi is the Hot in summer.  In the Ye disease, one feels fever, very thirsty and pulse is weak, though he also feels chilly. For Ye disease, its Taiyang stage is very short.

 

Another disease is the Wen disease, in which the invaded Xieqi is Wet. In the Wen disease, the person feels fever and extremely tired, pulse is big but with flash cold, or in most case there is no chilly feeling.

 

So, follow me to remember the principle to make the diagnosis of  Shanghan Taiyang: floating pulse, tight and pain on the neck and chilly. In future, whenever we mention the Taiyang stage, it means that the person haa such clinic conditions. Chilly is very important since the severity of chilly is parallel to the severity of the Cold in the body surface.

 

Readers should also know that, to diagnosis the Taiyang stage of  Shanghan, only floating plus, or only a chilly feeling, or only the pain and tight on the neck is not enough to establish the diagnosis. Floating pulse can be seen in other diseases, such as in a Wind-Wen disease. Tight and pain on neck can be seen in Shaoyang stage (of any disease), so does the chilly feeling. More than two conditions should trigger us to consider the Taiyang stage of Shanghan disease, under the condition that there are no more evidences for other kind of diseases.  

 

[6] The Taiyang stage is separated into two types: Wind-invasion type and Cold-invasion type. For the Wind-invasion, one furthermore feels fever, sweat, dislike wind and pulse becomes slow (floating-slow). For the Cold-invasion type, one furthermore feels pain in the body (mostly on the back of the body, back of the neck, leg), burping, nausea (even vomiting), with floating-tight pulse, no matter he has fever or not. Pay attention that in both types, no strong thirsty (not as in the Ye disease or in Wen disease), and not very tired and no abnormal tongue covering  (not as in Wen disease – see blow).   

[7] In TCM, the pulse should be felt by three levels: light touch, middle press touch, and the deeper (harder touch). If the pulse is easy to be felt with the light touch, it suggests the disease is in the body surface, not severe yet. If the pulse is felt with hard press to the bottom (to the bone), it means the Yin pulse and suggests that the disease is in later stage, the inner organ and meridian system.

  Although commonly the pulse on the wrist is felt by doctor, the Master asked not to forget to touch the pulse on the neck and front of ankle for collecting more pulse for the information to establish diagnosis.

[8] Here, a clinic manifestation as mild hot, sweat, chilly, dislike wind, nausea, stiff nose and floating pulse indicate the use of Guizhi Tang. So, all of these clinic phenomenon are called Guizhi Tang condition. Basically if a person has most or all of such symptoms and clinic findings (pulse and tongue and others), the herb Guizhi Tang is strongly suggested to use. This book emphasizes such condition diagnosis. This is different from the regular Yin, Yang, Qi, Blood or Wei, Qi, Yin, Blood, of the five element diagnosis system in the current TCM textbooks.  This is actually the most useful and most simple way in the TCM practice, whereas you find more evidence towards the use of a herbal formula, your successful rate will be higher. In our experience, the herbal formula introduced in the Shanghan Lun work as to open a door by its key – very quick if the proper herbal formula is used. So, you are now following me to learn the herb parameter diagnosis system.

 

[9] Tang here means herbal formula that need to be cooked with water. Then the collected water supernatant is to drink for the treatment. English word close to the “Tang” is decoction. We insist to use the Chinese word “Tang” because it will be easier for a communication between the English-speaking people with the Chinese-speaking doctor when they mean the same thing during conversation. In this book, once a word, even if it is an original English word, bears special meaning if its first letter is a big letter.

[10] The dose for the herb ingredients in the <<Shanghan Lun>> has been a question for a long time. One of the major reasons that later doctors stop to use the herbal formula in this book is that they did not use the correct dose. The [Shanghan Lun] book is written 2000 years ago. The scale this book, say, one “liang” is equal to 15.625 gram, whereas it in the later 1000 years in China is about 3 gram. Therefore, doctors nowadays use 9 gram for the herb Guizhi in this formula, whereas according to the book itself, it should be more than 45 gram!  It has been well tested in our clinic and by others that when we apply the dose according to each “liang” is equal to 15.625 gram, the clinic healing effect becomes much fantastic. This result also triggers us to believe that the later doctors apply more and more kinds of herb ingredients in their herb prescriptions, for the fact that, for one reason, they wouldn’t be able to reproduce the marvelous effects by using the herbal formula in the book Shanghan Lun. In another words, the good clinic healing effect by using the herbal formula in this book, for one reason, is due to the higher dose (a proper dose) used, so there is no need to use more herbal ingredients in the formula (in this book, most herbal formula contain only less than 6 ingredients). The dose we translated here refers to the dose, one “liang” is equal to 15.625 gram.

 

For the names of the herbs in the herbal formula, we prefer to use the Chinese pingyin, rather than English or their Arabic names, for the consideration that, once it is listed as the English or Arabic names, even we ourselves cannot understand what do you mean when you ask question about the herbal formula. Anyway, for readers speaking English, we have a list of the herb names in both Chinese pingyin and Arabic names for your reference. 

 

Readers should know that, one herbal formula may be used in various disease stages. They may be used in the Taiyang stage, Taiyang-Shaoyang stages, or Shaoyin stage or others. They may also be used in other diseases rather than the Shanghan diseases. Here you need to remember in which clinic condition the herbal formula Guizhi Tang is to be used.

 

[11] Any herb should be chopped into small pieces before cooking unless it is indicated clear not to do so. Drink the water part of the cooked herbs (you can call it decoction or herbal tea) after cooling down for a while. This is principle for the herbal tea preparation. It will not be reminded in the future for other herbal formula unless it is reminded.

 

Most of the herbal tea does not need the drink of rice soup as the Guizhi Tang here. However, Guizhi Tang has other functions, rather than the sweat therapy here. If it is used for other healing pursers, it is not needed to drink the rice soup. Again, the rice soup should not be replaced with chicken soup or other kind of vegetable soup. Their healing property is not the same. If there is no way to cook a rice soup, you can break down bread into hot water. Keep it for 10 min to drink and eat the bread-water soup instead. There is ways to use some other herbs in the Guizhi Tang, to replace the rice soup drink. We will introduce it in later higher level of herbal therapy class.

 

Although we introduce the classical herbal tea preparation, in current clinic and in our clinic too, we used already-cooked herbal granule for the treatment. It means that you can buy the Guizhi Tang in a granule form that does not need any cooking process any more. Simply take several tea spoons of the herbs and mix it with water and then drink it. It is pretty simple and easy to use. On our experience, it works as well as the classical fresh cooked herbal tea. If you are TCM practitioner, you can buy it from herb distributor in your area.

 

Basically we do not explain the function of each herbal ingredient in the herbal formula. One of the reasons for doing this is that the understanding of the herbal function in a herbal formula is different among the TCM practitioner/doctor. Our understanding of their pharmaceutical function is different from those explained in TCM text book. We will introduce the herbal function in later advanced learning course.

[12] Yes, wait for 40 to 50 min and do not drink the rice soup right after drinking the herbal tea, though some doctor and the current TCM text book interprets to drink the rice soup right after the herbal tea.

[13] Heavy sweat after drinking the Guizhi Tang will exhaust the body Yang Qi, so tends to make the disease lasted longer with more disorders. This is because the fact that people need the Guizhi Tang is those who are Wind person whose physical condition are not strong enough to endure heavy sweat therapy.

 

Guizhi Tang is one of the most important herbal formula in TCM. The clinic application can cover from common cold to asthma, various allergic reactions, bronchitis, chronic fatigue, chronic sweat, hot flash, skin rash, urticaria, shoulder stiff, lower back pain, night urine, eczema, dizziness, and many more. It is also the most important stem herb formula that many other herbal formula are developed from.    

[14] In the Guizhi Tang condition, the Rongqi is weak but the Weiqi is strong. That’s the reason to cause the sweat.   

[15] For the fact that menopause syndrome shows hot flash and sweat, the Guizhi Tang can be considered.

[16] This paragraph is hard to understand.

[17] Basically if the disease is in Taiyang stage,  the person’s pulse is floating, he does not feel emotional. Now if he starts to feel annoyed (emotional), it suggests the cure of the disease after soon-coming self sweat. It reminds that the annoyed feeling does not suggests the worse of the disease. Doctors should know this and not to give over-treatment. If the disease further develop, it comes into Yangming stage, in which, one feels fever, heavy sweat with strong annoyed feeling (irritable in emotion and body too), but the pulse turns to big, no longer floating. The distinguish between these two stages are very important by carefully feeling of the pulse.

[18] This paragraph tells another clinic situation that a disease may cure by itself, even if the person feels annoyed and tight in mouth that makes him hard to speak. The floating pulse in both wrist and ankle position is important. Theoretically, pulse should be touched in the wrist, the neck and the ankle positions for diagnosis.

[19] In original version, it is the face, not the eye lids.

[20] The answer from Master Zhang Zhongjing.

[21] Normally, when we touch the pulse, we use three fingers to touch the pulse on the wrist (neck and front of the ankles). The finger close to the patient’s hand is called Chun pulse, followed by the Guan pulse and then the Chi pulse that is close to the arm pitch of the patient.

[22] In clinic, the pulse feeling on the Chun, Guan and Chi position are not so evenly the same, therefore a healing is needed.

[23] Yang means the Xieqi comes from surface to deeper of the body. Many kinds of common cold, infectious diseases belong to this group. Yin means the disease shows up from the deeper stage, such as from the Taiyin, Shaoyin or Jueyin stage. Many diseases, if they are due to exhaust of body energy, wear of the body function, belong to this.  

[24] It can be understand this way: the reason for a disease occurs in the middle of night is too much Yin invaded in the body  (night belongs to Yin), therefore, at noon, when the Yang is the most during the day, the disease will be balanced by the influence of Yang. For the same reason, if a disease is get at noon, it will be better at night. This is a very important concept in TCM.

[25] Here means the six meridian/stage: Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin. Typical circle of the Shanghan disease is one day in each stage. The stage is correlated to the meridian. Once the disease in a given stage, it means that it is also in the meridian of the same name. For example, if a disease is in Taiyang stage, it also means that it affects the Hand Taiyang meridian and/or Feet Taiyang meridian. The neck is the body surface where the Hand Taiyang and Feet Taiyang meridian meet very close. So, no matter the Cold or Wind invades in the body through the Hand Taiyang meridian or through the Feet Taiyang meridian, they all could cause tight and pain on the neck.

 

That the disease circled whole stages/meridians does not mean that the body has necessarily shown the clinic manifestation in each stage.

[26] In TCM, when a disease is in a stage, it also means that the disease is in the same meridian. For example, when a disease is in Taiyang stage, it also means the disease is in Taiyang meridian. Because the Yangming stage follows the Taiyang stage, the Master tells to stimulate the Yangming meridian to stop the pass of the Cold/Wind from the Taiyang stage to the Yangming stage.

[27] Wind person refers to one who is easy to be invaded by Wind to cause health trouble. This Wind person is usually thin in body ship, easy to have sweat, running nose or cough or skin rash. They also have less tolerance to the fluctuation in temperature or emotional stimulation, e.g. they can not tolerate hot weather neither cold weather, and sensitive to emotional stimulations, etc. Such Wind person can mostly be seen in young girls.

[28] There are different opinions how to understand the function of muscle losing function of Guizhi Tang.

[29] Floating and tight pulse, fever without sweat suggests the use of Mahuang Tang (see bellow).

[30] Wine person means person who drink lots of wine or liquor. Such person also tends to feel hot with sweat. It seems that Guizhi Tang is also evidenced to be used to his condition, but it should not.

[31] Vomiting after drinking of Guizhi Tang (but the person do not vomit when drink other herbs or medicine), suggests the presence of hot and toxic inside of the body. Guizhi Tang is warm in nature. It may disturb the inside hot and toxic to vomit. In this case, stop to use the Guizhi tang. 

[32] Sweating therapy means a herbal therapy that creates sweat. Sweat is one of the ways Chinese medicine use it to expel Xieqi out of body. Many herb formula work as a sweating therapy. Guizhi Tang is among the most commonly used.

[33] Continuous sweat after sweat therapy suggests the person is weak inside and his body cannot tolerate ordinary extent of sweat therapy. The involvement of herb Fuzi here is to support the body condition.

[34] Jia here means to add and to include in.

[35] San here means herb powder.

[36] This paragraph reminds what may happen with extensive sweat therapy.

[37] Yes, the dose is very little, only 1 gram each time.

[38] If one has too much urine but not in the Taiyang stage, the frequent urine may be due to some other reasons. So the person in the Taiyang stage should not drink too much water in the Taiyang stage.

[39] Commonly one does not feel very thirsty in the Taiyang stage. If the person drinks too much water, the blood circulation volume is expanded but it cannot be distributed evenly to the body surface (the body surface now is pressed/chocked by the invaded wind), therefore the heart has to work hard to cause palpitation. If the person has little urine, it suggests that the disease has invaded in the urine bladder to cause urgent feeling during urination.  Readers should know that the Hand Taiyang meridian is associated

[40] After sweat, no strong fever and no dislike cold, suggests that the disease is no longer in the Taiyang stage; sweat but no dislike hot suggests that the disease is not in Yangming stage. Athma with sweat only suggests that the disease is in Taiyin (lung) stage.

 

Remember: asthma followed bowel-cleansing therapy when the disease is in Taiyang stage needs Guizhi-plus-Houpo Xingren Tang; if in this case, the person has asthma, sweat, diarrhea with fast pulse, Gegen Huanglian Huangqin Tang is needed. Now, asthma with sweat but no apparent fever needs Mahuang Xingren Cancao Shigao Tang. This is pretty commonly used herbs for asthma. 

[41] Here clearly indicated that the Mahuang Xingren Shigao Gancao Tang can be used for the treatment of asthma: asthma, sweat, but not strong fever, after sweat therapy or after bowel-cleansing therapy. In practice, even if the person has no history of sweat therapy or cleansing therapy but has asthma and sweat, this herb formula can be tried. If one has asthma but no sweat, herb Xiao Qinglong Tang is commonly used.

[42] In original version, it is “diarrhea”.

[43] In another version of the book, it is diarrhea.

[44] If there is original water accumulation in the stomach, the attach of the disease will cause nausea, Xiao Qinglong Tang is indicated. If the person has nausea, vomiting, dry mouth and hard in urine, Wuling San is needed. Both herbal formula work to solve the surface and the inside disease. The Shi Zao Tang here is used after the surface disease has been improved or is no longer the main problem but the inside trouble is the major problem. The person suitable for the Shi Zao Tang should be strong. Shi here means number ten. Zao means Chinese date. So Shi Zao Tang means ten Chinese date herb formula. Another formula is similar to the Shi Zao Tang. It is Guizhi qui Shao jia Baishu Fuling Tang that is used for fever, headache, nausea, full in stomach, but no sweat.

 

Shi Zao Tang belongs to very strong herbal formula. Most doctors are now hesitated to use it but in many clinic condition, it works much better than most other herbs. The most common clinic condition indicating the use of the Shi Zao Tang is water accumulation in the chest, e.g. hydrothorax, a condition that is very difficult for conventional medicine.

[45] Most importance parameter to tell the exist of disease in the surface of the body is the feeling of chilly. If there is such chilly feeling, the bowel-cleansing therapy should not be used. This is principle.

[46] In original version, the pulse is urgent pulse, not the floating pulse.

[47] In original version, the pulse here is floating pulse.

[48] Jiexiong is a TCM concept, referring to the fullness and pain the upper or whole stomach area.

[49] The disease turns into Yangming stage.

[50] The disease turns into Taiyin stage. It needs Ganjie Tang or Tongmai Sini Tang to treat.

[51] The disease turns deeper into the Shaoyang stage.

[52] The disease turns into Yangming or still in Taiyang stage.

[53] The disease turns deeper into Yangming stage. 

[54] The disease turns deeper into Yangming stage.

[55] If the Taiyang stage is treated by a wrong way – the bowel-cleansing therapy, there could be various worse conditions happen, depending on the person’s body health situation before the treatment. The possible consequence can be told from the pulse.

[56] Hot-diarrhea: one has diarrhea, urgent feeling to have bowel movement, hot in the anus area, or spasm pain the stomach before and during the bowel movement. He may have fever and the stool may have bleeding in it.

 

This paragraph introduced another clinic situation after mis-use of bowel-cleansing therapy in the Taiyang stage.

[57] If in this situation, the pulse is not weak, Gancao Xiexing Tang can be considered.

[58] In original version, there is no word “sweat”.

[59] Improper use of bowel-cleansing therapy in this Taiyang stage will deplete the body Yang Qi, so person feels bloating in the chest with faster pulse. Dislike-cold feeling suggests the depletion is too much, so herb Fuzi should be furthermore added. 

[60] Remember we said before that, if the person has asthma and diarrhea, Gegen Huangqin Huanglian Tang is considered?

[61] Person with long history of asthma is called Asthma person.

[62] For Taiyang stage, asthma and cough without sweat needs Mahuang Xingren Shigao Gancao Tang; asthma with sweat: Guizi jia Houpo Xingren Tang; cough without sweat: Xiao Qinglong Tang; there is cough but no asthma in Shaoyang stage: Xiao Chaihu Tang; or Xiao Chaihu Tang jia Ganjiang and Wuweizi; there is asthma but no cough in Yangming stage: it needs Da Chengqi Tang. Yangming stage, asthma with diarrhea: Gegen Huangqing Huanglian Tang;

 

For the three Yin stages, only in the Shaoyin stage, is there either cough or asthma. In this case, asthma needs Sini Tang jia Ganjiang and Wuweizi; cough needs Zhenwu Tang jia Ganjiang and Wuweizi. Couth and asthma with diarrhea: Zhuling Tang.

[63] Reverse pushing feeling: one feels as an air or gas pushing from stomach to chest or to the throat.

[64] For Jiexiong syndrome, one feels hardness, fullness and pain in the stomach; whereas in the Pi syndrome, one feel fullness, slight pain in the stomach. When press the Jiexiong area, it feels hard. When press the Pi area, it feels soft, not very hard.

[65] Da here means big, or great. Xiao means small in Chinese when we use it in the name of herbal formula. This formula is called Da Xianxiong Tang, there is another herbal formula called Xiao Xianxiong Tang.

[66] For the Small Xianxiong Tang condition, one feels fullness and hard in the upper stomach. He feels pain when touch, but no pain if no touch. This condition is less severe than the Da Xianxiong Tang. In clinic, they need to be distinguished.  Note: for Pi syndrome, the person also feels fullness and hard, but no pain even if at touch.

[67] This paragraph tells that the Big Jiexiong condition can happen without mis-use of bowel-cleansing therapy too. Note: the pulse turns deep and tight now, no longer floating.

[68] In original version, it is Xiao Jiexiong Tang.

[69] Jiexiong condition has both hot and cold conditions. The previous paragraph talks about the hot Jiexiong, in which the person feels hot and thirsty. Here talks about cold Jiexiong, in which one does not feel thirsty or fever. The stomach situation is pretty much the same: fullness. In clinic, the Xianxiong Tang may be used regardless of it hot or cold nature. If it does not work, Zhishi Lizhong Tang is used. It works as such in most situations.

[70] San means number three; Wu: material, mass, stuff; Bai: white color; and San: powder. So the meaning of this herb formula is: three white color herbal powder.

[71] The rice soup should not be replaced with water.

[72] Here introduces a new kind of Jiexiong syndrome: Water-condensing type of Jiexiong syndrome, in which one feels slight sweat only on head, as well as typical fullness and hardness in the upper stomach area.

[73] Jing syndrome means a syndrome with muscle spasm. For people in Taiyang stage, it is called Severe (Strong) Jing syndrome if the person has fever, not sweat, but dislike cold. It is called Mild (soft) Jing syndrome if the person feels fever, sweat but not dislike cold. If the one is in the Taiyang disease and has fever, but his pulse is deep and thin, it is called Yin Jing syndrome. Here the Master remind to distinguish the Jiexiong syndrome with the various Jing syndromes. With the Jing syndrome, the person’s arms, legs, neck, all tend to stretch out (hard to bend), whereas in the Jiexiong, mostly the neck is hard to bend.

[74] Note: it is Da Xianxiong Wan. Wan here means pills. It is different from the Da Xianxiong Tang.

[75] The Jiexiong syndrome with floating pulse suggests the disease remains partly in the surface Taiyang stage. Bowel-cleansing therapy will bring the disease deeper to cause more trouble. Only if the pulse is floating on the Chun position but deep in the Guan position, the bowel-cleansing therapy can be used.  

[76] This paragraph should be understood together with the previous one: if the one with floating and big pulse, together with annoyed, he may die, unless proper treatment is used. One with the Jiexiong syndrome is in a very danger stage of life. The bowel-cleansing therapy is the most effective way to save the life, But tt is apparently very important when to use this therapy.

[77] Here continue the distinguish between the Jiexiong and Zangjie. A white, thick and slippery tongue covering suggests there is no hot in the chest, if one with Zangjie, it could still be solved with warming therapy. The tongue covering is in harmony with the Yin condition inside the body. If it happens in Jiexiong syndrome, more bowel-cleansing therapy will make the person much weaker.

[78] No hot/fever, the disease (Zangjie) is not in Taiyang stage; no cold-hot repeat, it is not in Shaoyang stage; and the one is calm, not annoyed or irritable emotionally or physically, it is not in Yangming stage either. Zangjie syndrome is hard to treat, but does not mean no treatment.

[79] Suggests he feels chilly and so the disease is still in the Taiyang stage.

[80] Wenhe is also named Wubeizi.