Taiyang stage, its condition, pulse and treatment (2)

太阳统摄之荣卫，乃风寒始入之两途，风则伤卫，寒则伤荣。卫气疾，统气而行脉外，其用疏泄而属阳，邪之犯也易，故其犯之也，则有汗，为虚邪。荣气专精，统血而行脉中，其体固密而属阴，邪之犯也难，故其犯之也，则无汗，为实邪。夫冬固寒令也，然春月馀寒，秋末早寒，皆能致病，但有无汗，实邪证候显然，即可谓之伤寒，不必尽属隆冬也。然太阳经也，膀胱府也，由经视府，则经为表，而府为里矣。上篇用桂枝汤解肌，所以治风伤卫之表也，而未及卫分之里，故又立五苓散一方，佐桂枝以和卫分之焉。此篇用麻黄汤发汗，所以治寒伤荣之表也，而未及荣分之，故又立桃核抵当方，佐麻黄以攻荣分之焉。至於汗下失宜，过之则伤正而虚其阳，不及则热炽而伤其阴。虚其阳、则从少阴阴化之证多，以太阳少阴为表也。伤其阴，则从阳明阳化之证多，以太阳、阳明递相传也，此篇中所以又有四逆、承气之治也。凡风伤卫之虚邪已列上篇，兹以寒伤荣之实邪疏为中篇，使读者先会大意於胸中，斯临证处分，自不致误矣。

Taiyang meridian governs Rongqi and Weiqi in the body. Wind and Cold attach the body through the Rongqi and Weiqi. The Wind attaches the Weiqi and the Cold invades in the Rongqi. Weiqi moves outside of blood vesicle and its movement is fast. It works to release disease, so it belongs to Yang. A disease is easy to meet it first. Once on attack, there will be sweat and the disease belongs to a weak invasion. Rongqi moves in the blood and controls life essence inside the blood. It belongs to Yin and an invasion is hard to attack it. Therefore, once attacked, there is no sweat and the invasion is a strong one. Though the winter is associated to cold, but there remaining cold in spring and there is also a possible early cold in the fall, all kinds of cold may cause disease. No matter the body is attacked by the Wind or Cold, it can be called Shanghan disease, independent of where it is in Winter or not. The Taiyang meridian is associated, connected, or linked to urine bladder organ. The meridian belongs to the surface, and so the Urine bladder belongs to inside organ. In the previous chapter, we talked about the use of Guizhi Tang to relax muscle, the meridian level of the Weiqi, but it does not deal with the inside level of the Weiqi, the urine bladder, so the herb Wuling San is introduced, which helps the Guizhi Tang to balance/harmony the Weiqi inside. In this chapter, we introduce the Mahuang Tang, to deal with the surface level of the Rongqi. For the inside level of the Rongqi, herbal Taohe Didang Tang is the consideration. It should know that the sweat therapy should be used carefully. Over healing sweat depletes body’s Yang Qi, while insufficient healing sweat causes more inside hot to burn out its Yin. When the Yang is depleted, the disease turns deeper to Shaoyin stage, the Yin side, showing as Taiyang Shaoyin stages; Burning of body Yin, the disease is easy to turn to Yangming, the Yang side, showing Taiyang Yangming stages at the same time. For this reason, several other herbal formula, such as Chengqi and Sini Tang are introduced to correct the side effects of improper treatments. In this book, the diagnosis and treatment of Wind-invasion in the Weiqi has been introduced in the previous chapter. So, in this chapter, the diagnosis and treatment for the Cold-invasion in the Rongqi is introduced. Readers should now understand the schedule and the organization of the book.

01 太阳病，或已发热，或未发热，必恶寒，体痛，呕逆，脉阴阳俱紧者，名曰伤寒。

When in the Taiyang stage, if the person feels chilly, pain in the body, nausea, cough or asthma, and with tight pulse, he is Cold-invasion type Shanghan disease.

02 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。

When in the Taiyang stage, if the person has headache, fever, pain in whole body, pain in lower back, pain in joints, dislike wind, no sweat but has asthma-like shot of breath, the herbal Mahuang Tang should be used mainly. [1]

麻黄（去节）三两，桂枝二两，甘草（炙）一两，杏仁（汤浸，去皮、尖）七十个．

Mahuang (remove stem joints) 45 gram, Guizhi (remove skin) 30 gram, Gancao (Processed) 15 gram, Xingren (remove skin and tips) 30 gram.

右四味，以水九升，先煮麻黄，减二升，去上，内诸药，煮取二升半，去渣，温服八合，覆取微似汗，不须啜粥，馀如桂枝法将息。

Add Mahuang and 2250 ml water into herbal pot. Bring to boil until the liquid in the pot is about 1750 ml (remove the floating residue from time to time). Add the remaining herbs in and continue to boil until the liquid volume is about 600 ml. Collect the liquid part (the herbal tea). Drink one third of the herbal tea. Lie down and cover the body for sweat. Not need to drink rice soup. Other requirement as for Guizhi Tang.

03 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。

On the first day for the Cold-invasion Shanghan disease, the Wind or Cold are still in the body surface or in the Taiyang meridian. If the pulse is calm and normal, it indicates that the disease will not pass to next stage. If person feels nausea, annoyed emotionally and physically, and pulse is faster, it suggests the pass of the Shanghan from the Taiyang stage to others.[2]

For the second and the third day of the Cold-invasion Shanghan disease, if it remains in the Taiyang stage, no any sign for Yangming or Shaoyang stage, it means the Taiyang stage will not pass further deeper. [3]

05 脉浮者，病在表，可发汗，宜麻黄汤。脉浮而数者，可发汗，宜麻黄汤。

If a person has floating pulse, his disease is in Taiyang stage, and a healing sweat is needed. Mahuang Tang is recommended. If the pulse is floating and fast, the healing sweat with Mahuang Tang is still recommended. [4]

When there are indications to Taiyang stage but the pulse is floating and weak, healing sweat therapy is needed and Guizhi Tang should be used. [5]

07 伤寒发汗已解，半日许复烦，脉浮数者，可更发汗，宜桂枝汤。

For Cold-invasion Shanhan disease, if the sweat therapy (by use of Mahuang Tang) has caused sweat, the person feel annoyed emotionally again after half day, his pulse feels floating and fast, the sweat therapy can be repeated. Use Guizhi Tang.

After sweat therapy, the Taiyang stage remains[7], the person feels chilly, it means the his condition is weak. Shaoyao Cancao Fuzi Tang should be used.

芍药三两，甘草（炙）二两，附子（炮去皮，破八片）一枚．

Add the herbs and about 1250 ml water into herbal pot. Bring to boil until the liquid volume in it is about 375 ml. Collect the liquid (herbal tea). Separate it into three parts. Drink one third each time, three times a day.

09 发汗後恶寒者，虚故也；不恶寒但热者，实也，当和胃气，与调胃承气汤。

After sweat therapy, if the person feels chilly, it means that he is weak. If the person does not feel chilly but hot, it indicates that his condition is not weak but extensive. Tiaowei Chengqi Tang should be used, to harmony stomach Qi.

10 脉浮紧者，法当身疼痛，宜以汗解之，假令尺中迟者，不可发汗。何以知之？然以荣气不足血少故也。

If the person has floating and tight pulse, he should feel pain on the body. Healing sweat therapy should be used (with Mahuang Tang). If his pulse feels slow on the Chi position, the sweat therapy should not be used. The reason is: there is insufficient Rongqi in the blood and blood volume is not enough (to allow the sweat therapy). [8]

11 发汗後，身疼痛，脉沉迟者，桂枝加芍药生姜各一两，人参二两，新加汤主之。

After sweat therapy, the person feels pain on the body, and if his pulse feels deep and slow, Xinjia Tang is the main recommended herb formula.

桂枝一两，芍药四两，甘草二两，人叁三两，生姜（切）四两，大枣（擘）十二枚．

Guizhi 15 gram, Shaoyao 60 gram, Gancao 30 gram, Renshen 45 gram, Shenjiang 60 gram, Chinese Date 62 gram.

右六味，以水一斗二升，微火煮取三升，去滓，分温服，如桂枝法。

Add all of the herbs and 3000 ml into herbal pot. Bring to boil and keep to small boiling until the liquid in the pot is about 750 ml. Collect the liquid (herbal tea), separate it into three parts. Drink one third each time, repeat three times a day.

12 病发热头痛，脉反沉，若不差，身体疼痛，下利清谷[9], 当温其里，宜四逆汤。

If the person feels fever and headache, if his pulse is deep, and if he has continuous diarrhea with non-digested food in the stool and pain in whole body, Sini Tang should be used to warm the body to release the pain. [10]

13 伤寒，若汗[11]若吐若下後，七、八日不解，热结在里，表里俱热，时汗恶风，大渴，舌上乾燥而烦，欲饮水数升者，白虎加人参汤主之。

After sweat therapy, vomiting or bowel-cleansing therapy, if the Cold-invasion disease lasts for seven or eight days without improvement, and if the person still feel hot/fever, sweat and dislike-wind feeling from time to time, very thirsty, dry mouth, annoyed emotionally and willing to drink liters of water, herb Baihu jia Renshen Tang should be used mainly. [12]

After sweat therapy, the person has sweat, if he also feels thirsty, hard in urine, and his pulse is floating and fast, use herb Wuling San. [14]

15 伤寒汗出而渴者，五苓散主之；不渴者，茯苓甘草汤主之。

For Cold-invasion Shanghan disease, if the person feels sweat, thirsty, (and hard to urine) the herb Wuling San is the main herbal formula to use. If the one feels sweat, (and hard to urine), but no thirsty, herb Fuling Gancao Tang should be used.

Fuling 30 gram, Guizhi 30 gram, Fresh Ginger 45 gram, Gancao (processed) 15 gram.

Add all herbs and 1000 ml water in to herbal pot. Bring to boil and continue to boil until the liquid in the pot is about 750 ml. Collect the herbal tea. Separate it into three parts. Drink one third of the tea each time, repeat three times a day.

16 脉浮数者，法当汗出而愈，若下之，身重心悸者，不可发汗，当自汗出乃解。所以然者，尺中脉微，此里虚，须表里俱实，津液自和，便自汗出愈。

If one has floating and fast pulse, the sweat therapy is the choice for cure. However, if his pulse is weak at the Chi position, the sweat therapy should not be used. Otherwise, sweat therapy will cause heaviness in body and palpitation. Such condition should wait for a self sweat to cure when the inside of the body turns stronger (by use of Xiao Jianzhong Tang). [15]

With Cold-invasion Shanghan disease for 2 to 3 days, no any sweat or bowel-cleansing therapy has been used, the person feels however palpitation and annoyed emotionally[16], (the sweat therapy should not be used), the main formula should be Xiao Jianzhong Tang[17].

桂枝三两，芍药六两，甘草二两，生姜（切）三两，胶饴一升，大枣（擘）十二枚．

Guizhi 45 gram, Shaoyao 90 gram, Gancao 30 gram, Fresh Ginger 45 gram, Jioyi 120 gram, Chinese date 62 gram.

右六味，以水七升，煮取三升，去滓，内胶饴，更上微火消解，温服一升，日三服。呕家不可用建中汤，以甜故也。

Add all the herbs expect the Jiaoyi, and 1750 ml water into herbal pot. Bring to boil and continue the boil until the liquid part is about 750 ml. Remove the residue, add the Jiaoyi in. Warm it with stirring until the Jiaoyi is melt/dissolved. Drink one third of the herbal tea, three times a day. If the person has nausea, this herb tea should not be given, since sweet taste make stimulate nausea and vomiting.

If a person with Shanghan disease has irregular pulse and feel palpitation, Zhi Gancao Tang should be used mainly.[18]

甘草（炙）四两，生姜（切）三两，桂枝三两，麦门冬半升，麻子仁半斤，大枣（擘）十二枚，人参二两，阿胶二两，生地黄一斤．

Gancao (processed) 60 gram, Fresh ginger 45 gram, Guizhi 45 gram, Maimendong 65 gram, Maziren 65 gram, Chinese Date 62 gram, Renshen 30 gram, Ajiao 30 gram, Shendihuang 150 gram.

右九味，以清酒七升，水八升，先煮八味，取三升，去滓，内阿胶，烊消尽，温服一升，日三服。一名复脉汤。

Add all of the herbs (except Ajiao), 1750 ml wine, and 2000 ml water into herbal pot. Bring to boil and continue with mild boiling until the total liquid in the pot is about 750 ml. Remove the herbal residue, add Ajiao with stirring until it is completely dissolved. Drink one third of the herbal tea. Three times a day. This herbal formula is also called Fumai Tang

19 未持脉时，病人叉手自冒心，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。

Before tough the pulse, the person cross his hands and hold/press his front chest. Doctor asked him to try to cough but he did not follow. This indicates that the person is deaf. The reason for this might be due to a heavy sweat therapy, which makes him weak. [19]

20 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。

Due to heavy sweat therapy, the person crosses his hands over the heart area, feels palpitation and tends to press the upper stomach. In this case, Guizhi Gancao Tang is the main formula. [20]

Add the herbs and 750 ml water into herbal pot. Bring to boil and keep in mild boiling until there is about 250 ml liquid left. Collect the herbal tea. Drink all the tea once.

21 发汗後，其人脐下悸者，欲作奔豚，茯苓桂枝甘草大枣汤主之。

If after sweat, the person feels heart beat in the upper stomach area, feels to have a Bentun feeling[21], though not really so yet, Fuling Guizhi Gancao Dazao Tang should be used mainly.[22]

Fuling 90 gram, Guizhi 60 gram, Gancao (processed) 15 gram, Chinese date 78 gram.

右四味，以甘澜水一斗，先煮茯苓，减二升，内诸药，煮取三升，去滓，温服一升，日三服。作甘澜水法：取水二斗，置大盆内，以杓扬之，水上有珠子五六千颗相逐，取用之。

Add the Fuling and 2500 ml of Ganlan water in herbal pot. Bring to boil then keep to mild boiling until there is only 2000 ml left. Add the remaining herbs in and continue to cook until the liquid volume in the pot is about 750 ml. Collect the herbal tea. Drink one third of the tea each time, three times a day.

22 服桂枝汤或下之，仍头项强痛，翕翕发热，无汗，心下满，微痛，小便不利者，桂枝汤去桂加茯苓白术汤主之。

After drinking the Guizhi Tang or have had bowel-cleansing therapy, if the person still has tight and pain in the neck, headache, mild fever, no sweat, fullness and mild sour in upper stomach, difficult in urine, herb Guizhi que Shaoyao[23] jia Fuling Baishu Tang should be used mainly. [24]

於桂枝汤方内去桂，加茯苓、白术各三两，馀依桂枝汤法煎服，小便利则愈。

Remove Shaoyao from Guizhi Tang, but add Fuling 45 gram, and Baishu 45 gram in. Cook and drink as Guizhi Tang. The disease will be released when urine.[27]

23 伤寒若吐若下後，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，茯苓桂枝白术甘草汤主之。

In Cold-invasion, when with vomiting therapy or bowel-cleansing therapy, if the person feels verse fullness in the stomach area, feels reverse pushing feeling to the chest, feel dizziness when gets up, has deep and tight pulse[28], sweat therapy will cause irritable in muscle and shaking in the body. In his case, Fuling Guizhi Baishu Gancao Tang should be used mainly. [29]

Add the herbs and 1500 ml water into herb pot. Bring to boil and keep in mild boiling until the liquid part in the pot is about 750 ml. Collect the herbal tea. Drink one third of the tea each time, three times a day.

When after sweat therapy or bowel-cleansing therapy, the person feels hot, annoyed emotionally, fullness and pressing feeling in the chest, herb Zhizi Zhi Tang should be used mostly.

右二味，以水四升，先煮栀子，得二升半，内豉煮取一升半，去滓，分为二服，温进一服，得吐者，止後服。

Add the Zhizi and 1000 ml water into herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 625 ml. Drink half of the herbal tea. If there is vomiting, stop to the next drink.

After bowel-cleansing therapy, if the person feels more annoyed emotionally, if the stomach area is soft when press, the annoyed is weak/hollow annoyed[30], herb Zhizi Zhi Tang should be used.

26 发汗吐下後，虚烦不得眠，若剧者，必反覆颠倒，心中懊倄，栀子豉汤主之；若少气者，栀子甘草豉汤主之；若呕者，栀子生姜豉汤主之。

After sweat therapy, vomiting therapy or bowel-cleansing therapy, if the person feels hollow annoyed emotionally and in severe case, the person may be annoyed even physically, and feels as to vomiting but cannot vomit. In this case, if he further more feels short of breath, Zhizi Gancao Zhi Tang is used; or Zhizi Shenjiang Zhi Tang should be used if he feel nausea.

Add Gancao 30 gram in the Zhizi Zhi Tang. Cook and drink as the Zhizi Zhi Tang. Stop to drink the tea after the person has vomit.

Add Fresh Ginger 78 gram into the Zhizi Zhi Tang. Cook and drink as the Zhizi Zhi Tang. Stop to drink the tea whenever the person has vomit.

After bowel-cleansing therapy in a Cold-invasion Shanghan disease, if the person feels annoyed emotionally, full in stomach, irritable to sleep, herb Zhizi Houpo Tang is used mostly. [31]

栀子（擘）十四枚，厚朴（姜炙）四两，枳实（去穰，炒）四两．

Zhizi (cut into pieces) 22 gram, Houpo (processed with ginger) 60 gram, Zhishi (remove the kernel, fried) 60 gram.

已上三味，以水三升半，煮取一升半，去滓，分三服，温进一服，得吐，止後服

Add the herbs and 875 ml water into herbal pot. Bring to boil and keep in mild boil until the liquid in the pot is about 375 ml. Collect the herbal tea. Drink one third of the tea, repeat every two to three hours until there is vomiting.

28 伤寒医以丸药大下之，身热不去，微烦者，栀子豉汤[32]主之。

After bowel-cleaning therapy (with big pills) in a Cold-invasion Shanghan disease, if the person feels hot, mild annoyed emotionally, Zhizi Chi Tang is needed.

右二味，以水三升半，煮取一升半，去滓，分二服，温进一服，得吐者，止後服。

29 伤寒五六日，大下之後，身热不去，心中结痛者，未欲解也，栀子干姜汤主之[33]。

After five to six days with Cold-invasion Shanhang disease and after strong bowel-cleansing therapy, if the person feel hot in the body and hard and pain in the upper stomach area, herb Zhizi Ganjiang Tang should be used mostly.

The herb Zhizi Zhi Tang should not be used if the person has a history of mild diarrhea. [34]

31 太阳病，脉浮紧，无汗，发热，身疼痛，八、九日不解，表证仍在，此当发其汗，麻黄汤主之, 服药已，微除，其人发烦目瞑；剧者，必衄，衄则解。所以然者，阳气重故也。

For Taiyang stage, if the person feels hot, pain in the body, no sweat and his pulse feels floating the tight, and if the condition has no improvement after eight to nine days, sweat therapy is needed by using Mahuang Tang. After drink the tea and if the condition is improved slightly, but the person feel annoyed and blurring in eyes, he will has bleeding in nose. After bleeding, the condition will then be improved since the Yangqiin the body is strong now.

For Taiyang stage, the person has floating and tight pulse, hot/fever but no sweat, and has bleeding in nose, will gain recover by himself. [35]

For Cold-invasion Taiyang stage, if the person has floating and tight pulse, but no sweat therapy is given, he may have bleeding in nose. To promote sweat, Mahuang Tang should be used.

34 伤寒不大便六、七日，头痛有热者，与承气汤，其小便清者，知不在里，仍在表也，当须发汗，苦头痛者[36]，必衄，宜桂枝汤。

If a person with Cold-invasion Shanghand disease and has no bowel movement for six to seven days, and has headache and fever, herb Da Chengqi Tang should be used. If in this case, his urine is clear as pure water, the Da Chenqi Tang should not be used, instead, herb Guizhi Tang is needed, since the clear urine indicates the disease is still in the surface Taiyang stage, not in Yangming stage yet.[37] The constipation is due to the disease in the Taiyang, not in Yangming. The person with severe headache will have nose bleeding.

35 太阳病不解，热结膀胱，其人如狂，血自下，下者愈，其外不解者，尚未可攻，当先解其外，外解已，但少腹急结者，乃可攻之，宜桃核承气汤。

If the Taiyang stage continues, the disease may attack and invade further deeper into the urine bladder system. If this is true, the person will feel mad, and has bleeding in urine. After the urine bleeding, the clinic condition will cure. If no bleeding, and there is evidence suggesting the disease remains also in the surface meridian, the priority for the treatment is to solve the disease in the surface meridian (by using Mahuang Tang). After that, if the person still feels tight, urgent, hard feeling in the lower stomach, the herbal Taohe Chengqing Tang is to be considered.[38]

桃核（去皮、尖）五十个，桂枝三两，大黄四两，芒硝二两，甘草（炙）二两

Taohe (remove skin and tips) 20 gram, Guizhi 45 gram, Dahuang 60 gram, Mangxiao 30 gram, Gancao (processed) 30 gram.

右五味，以水七升，煮取二升半，去滓，内芒硝，更上火微沸，下火，先食温服五合，日三服，当微利。

Add the herbs (except Mangxiao) and 1750 ml water in a herbal pot. Bring to boil and keep in mild boiling until there is about 625 ml liquid left. Remove the herbal residues, add the Mangxiao in and stirring to dissolve. Drink one third of the herbal tea each time, three times a day. After drinking of the tea, the person should has slight diarrhea.

36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，少腹当僐满，而小便自利者，下血乃愈。所以然者，以太阳随经瘀热在里故也。宜下之以抵当汤。

If the disease has been in the Taiyang stage for six to seven days without improvement, if the person has weak and deep pulse[39], but unexpectedly no Jiexiong condition, but behaviors madness, it means he has Fire in he lower Jiao (lower part of the stomach area). If he has easy urine，bleeding therapy will cure it. This is because the accumulated Fire and dead blood will deplete out of the body through the bleeding. Herb Didang Tang should be used.

水蛭（熬）三十个，虻虫（熬，去头、足）三十个，大黄（去皮，破六片）三两，桃核（去皮、尖）二十个．

Shuizhi (cocked) 30 badges, Mangchong (cocked, remove head and feet) 30 badges, Dahuang (remove skin, cut) 45 gram, Taohe (remove skin and tips) 20 badges.

右四味，以水五升，煮取三升，去滓，温服一升。不下者更服。

Add the ingredients and 1250 ml water into the herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml lest. Collect the herbal tea. Drink one third of the tea. Repeat the drinking every two to three hours until there is bleeding in urine.

37 太阳病，身黄，脉沉结，少腹硬满，小便不利者，为无血也；小便自利，其人如狂者，血证谛，属抵当汤。

If a disease is in Taiyang stage, if the person has yellow in color on skin (jaundice), feels hard and fullness in lower stomach, difficult in urine, and if his pulse feels deep and not smoothly, it means that he has no accumulated dead blood, (but water) in the urine bladder[40]. If he has easy urine, and behaves mad, it indicates an accumulation of dead blood in the lower cavity of the stomach (pelvic cavity), not in the urine bladder. Herb Didang Tang is needed to clear the dead blood.

38 伤寒有热，少腹满，应小便不利，今反利者，为有血也，当下之，宜抵当丸。

For Cold-invasion Shanghan disease, if the person has Fire, feels full in lower stomach, his urine should be difficult. If his urine is easy, it means that there is accumulated dead blood in the lower cavity of the stomach, not exactly in the urine bladder. Herb Didang Wan[41] should be used to remove the dead blood.

水蛭（熬）二十个，虻虫（熬，去头、足）二十个，大黄（去皮，破六片）三两，桃核（去皮、尖）二十个．

Shuizhi (cocked) 20 badges, Mangchong (cocked, remove head and feet) 20 badges, Dahuang (remove skin, cut) 45 gram, Taohe (remove skin and tips) 20 badges.

右四味，捣筛为四丸，以水一升，煮一丸，取七合，服之。卒时当下血，若不下者更服。

Grind the herbs into powder and make them into 4 pills. Add 2500 ml water and one pill into herbal pot. Bring to boil and keep in mild boiling until there is about 1750 ml liquid left. Drink all of the tea. There should be bleeding in the urine. If not, repeat a second dose drinking.

39 伤寒大下後，复发汗，心下痞，恶寒者，表未解也，不可攻痞，当先解表，表解乃可攻痞。解表宜桂枝汤，攻痞宜大黄黄连泻心汤。

With the Cold-invasion Shanghan disease, and after heavy bowel-cleansing therapy, followed by a sweat therapy again, the person feels fullness in the upper stomach (the fullness syndrome, also called Pi syndrome in TCM) and chilly, it indicates that the disease is still in the surface level. The treatment should focus on the release of the surface disease with Guizhi Tang, then solve the inside Fullness syndrome with Dahuang Huanglian Xiexin Tang.

Fold the herb powder with gauze, rinse it in the Mahuang Tang 500 ml. Keep for 2 to 5 min. Remove the herbs, drink the herbal tea from time to time, little by little.

40 脉浮而紧，而复下之，紧反入里，则作痞，按之自濡，但气痞耳。

When a person has floating and tight pulse, a sweat therapy should be used. However a bowel-cleansing therapy is used, that makes the disease comes deeper and results in a fullness syndrome in upper stomach area. For such fullness, it touches soft, nor hard, because it is the air/gas/Qi that accumulates.

41 心下痞，按之不濡[42]，其脉关上浮者，大黄黄连泻心汤主之。

If one feels fullness in the upper stomach, it feels not soft when touch, and the pulse is floating on the Guan position, herb Dahuang Huanglian Xiexin Tang is the main herbal formula to use.

If one has the fullness syndrome[43] and feels chilly and sweat[44], herb Fuzi Xiexin Tang should be used.

大黄二两，黄连一两，黄芩一两，附子（炮，去皮，破、别煮取汁）一枚．

Dahuang 30 gram, Huanglian 15 gram, Huangqin 15 gram, Fuzi (processed, remove skin, cut into pieces, cook separately to collect the juice) 30 gram.

右四味，切三味，以麻沸汤二升渍之，须臾绞去滓；内附子汁，分温再服。

Make the Dahuang, Huanglian, and Huangqin into powder. Fold them in gauze. Rinse it in herb Mahuang Tang for 2 to 5 min. Remove the herbs, mix the herbal tea with the Fuzi juice. Drink one third of the tea, three times a day.

43 伤寒中风，医反下之，其人下利，日数十行，谷不化，腹中雷鸣，心中痞僐而满，乾呕，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，故使僐也，甘草泻心汤主之。

The person was attacked by a Wind invasion and Cold-invasion, but a bowel-cleansing therapy was given. This caused diarrhea, several times a day, with undigested food in the stool. The person felt big noise in the stomach (intestine movement), hard and fullness in stomach, nausea but no vomiting, annoyed emotionally. For such case, doctor believes it is fullness syndrome so uses a bowel-cleansing therapy. This makes the fullness worse. This condition is actually not a condensed Fire/Hot. It is the weakness in the stomach area and the disease energy accumulates there to cause the hard feeling. Herb Gancao Xiexin Tang is the main formula.

甘草（炙）四两，黄芩三两，黄连一两，乾姜三两，半夏（洗）半升，大枣（擘）十二枚

Gancao (processed) 60 gram, Huangqin 45 gram, Huanglian 15 gram, Ganjiang 45 gram, Banxia (washed) 124 gram, Chinese date 62 gram.

右六味，以水一斗，煮取六升，去滓，再煎取三升，温服一升，日三服。

Add the herbs and 2500 ml water in a herbal pot. Bring to boil and keep in mild boiling until there is about 1500 ml liquid left. Remove the herbal residue, continue to cook until there is about 750 ml left. Drink one third of the herbal tea each time, three times a day.

44 伤寒汗出，解之後，胃中不和，心下痞硬，乾噫食臭，胁下有水气，腹中雷鸣下利者，生姜泻心汤主之。

With Cold-invasion Shanghan disease, the person has sweat therapy the original symptoms stop, but starts to feel discomfort and hard in the upper stomach, nausea, bad odor from the mouth, burping, big noise in the stomach and diarrhea. In this case, use Shengjiang Xiexin Tang mostly.

甘草（炙）三两，人参三两，乾姜一两，半夏（洗）半升，黄芩三两，黄连一两，生姜（切）四两，大枣（擘）十二枚．

Gancao (processed) 45 gram, Renshen 45 gram, Ganjiang 15 gram, Banxia (washed) 65 gram, Huangqin 45 gram, Huanglian 15 gram, Fresh ginger 60 gram, Chinese date 62 gram.

右八味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。

Add the herbs and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid part is about 1500 ml. Remove the residue, continue to cook until the liquid is about 650 ml. Drink one third of the herbal tea each time, three times a day.

45 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，此虽已下之不为逆，必蒸蒸而振，却产热汗出而解。若心下满而硬痛者，此为结胸也，大陷胸汤主之。但满而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤

With Cold-invasion Shanghan disease for five to six days, the person feels nausea and hot. Together with the presence of other clinic indications to the use of Xiao Chaihu Tang, but the doctor gives bowel-cleansing therapy. If after that, the indication to the Xiao Chaihu Tang remains, it should be used again. In this case, the bowel-cleansing therapy is not so wrong. The person will feel continuous hot, then sweat, all will help to recover. If the person, after the bowel-cleansing therapy, has fullness, feels hard and pain in the stomach, it is Jiexiong syndrome. Da Xianxiong Tang should be used. If he only feels fullness but no pain, it is Fullness syndrome. In the Fullness syndrome, the Xiao Chaihu Tang doesn’t work. The herb Banxian Xiexing Tang should be used. [45]

半夏（洗）半升，黄芩三两，乾姜三两，人叁三两，黄连一两，甘草（炙）三两，大枣（擘）十二枚

Banxia (washed) 124 gram, Huangqin 45 gram, Ganjiang 45 gram, Renshen 45 gram, Huanglian 15 gram, Gancao (Processed) 45 gram, Chinese Date 62 gram.

右七味，以水一斗，煮取六升，去滓再煮，取三升，温服一升，日三服。

Add the herbs and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid volume in the pot is about 1500 ml. Remove the herbal residue, continue to cook until there 750 ml left. Drink one third of the herbal tea each time, three times a day.

46 本以下之，故心下痞，与泻心汤。痞不解，其人渴而口燥烦，小便不利者，五苓散主之。

The bowel-cleansing therapy may cause Fullness syndrome[46]. Various Xiexing Tang is needed. If none of them work, the person feels thirsty, dry in mouth, annoyed emotionally, hard in urine, herb Wuling San should be the main formula to try.[47]

47 伤寒服汤药，下利不止，心下痞硬，服泻心汤已，复以他药下之，利不止，医以理中与之，利益甚；理中者，理中焦，此利在下焦，赤石脂禹馀粮汤主之，复利不止者，当利其小便。

After a treatment, the person has continuous diarrhea and Fullness syndrome in the stomach. Xiexing Tang is the right choice. If a bowel-cleansing therapy is given again, the diarrhea continues. Doctor gives Lizhong Tang, the diarrhea becomes worse. It is wrong. In this case, herb Chishizhi Yuyuliang Tang[48] should be the main herbal formula, since the disease is now in the Lower Jiao cavity (the lower stomach area). The herbal Lizhong Tang however works in the Middle Jiao cavity of the body (the middle part of the body). [49] For person with continuous diarrhea, urine therapy should be used. [50]

Grind the herbs into small pieces, mix with 1500 ml water. Add into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is about 500 ml. Drink one third of the herbal tea each time, three times a day.

48 伤寒发汗，若吐若下，解後，心下痞僐，噫气不除者，旋覆代赭石汤主之。

If after sweat therapy, vomiting therapy or bowel-cleansing therapy in a Cold-invasion Shanghan, the person feels released from the disease per se, but still feel fullness[51] in the upper stomach and burping[52], herb Xuanfu Daizheshi Tang is the main herbs.[53

旋覆花　三两，人参　二两，生姜（切）五两，代赭石一两，半夏（洗）半升，甘草（炙）三两，大枣（擘）十二枚．

Xuanfuhua 45 gram, Daizhishi 15 gram, Shenjiang 78 gram, Renshen 30 gram, Banxia (washed) 124 gram, Gancao (processed) 45 gram, Chinse date 62 gram.

右七味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。

Add the herbs and 2500 ml water into a herbal pot. Bring to boil and keep to mild boiling until there is 1500 ml liquid left. Remove the herb residue, continue to cook until there is about 750 ml left. Drink one third of the herbal tea each time, three times a day.

49 伤寒大吐、大下之，极虚，复极汗出者，以其人外气怫郁，复与之水，以发其汗，因得哕。所以然者，胃中寒冷故也。

With the Cold-invasion Shanghan disease and after heavy vomiting, heavy bowel-cleansing therapy, the person becomes very weak so that he feels lots of sweat, looks pink on face. If he is given water to drink with the aim to help sweat therapy, he will develop hiccup[54], because his stomach is in cold condition[55].

[1] Mahuang Tang is very important herbal formula. Compared with the Gegen Tang, both are used for one with fever but no sweat (Guizhi Tang condition has sweat), but the Mahuang Tang condition is used for more severe conditions: one has higher fever, larger area of pain in the body, and has asthma-like short of breath. Whereas in the Gegen Tang, the muscle tightness is narrow in shoulder area, fever is not very high, and asthma-like short of breath comes after misuse of bowel-cleansing therapy that caused diarrhea.

Compared with the Guizhi Tang, the Mahuang Tang is used for one without sweat, whereas the Guizhi Tang is used for one with sweat. The body indicating to the Mahuang Tang is stronger than the body condition to the Guizhi Tang. In other words, Mahuang Tang is used to persons who is strong physically with more muscle mass in the body (usually the labor workers), whereas the Guizhi Tang is used for those who is thin and weak and who are commonly office workers.

[2] Here it tells how to know if the Taiyang stage will pass or not pass deeper to other stages.

[3] Normally, a disease, if it invades from outside of the body, is in the Taiyang stage on the first day, in Yangming stage on the second day, in the Shaoyang stage the third day, in the Taiyin stage the fourth day, in the Shaoyin stage the fifth day and in the Jueyin stage on the sixth day. However in clinic, many reasons could affect the speed and the sequence of the transport of a disease in the body. For example, a disease may stay in the Taiyang stage for days, months or years. It could also pass from the Taiyang stage directly to the Shaoyin stage, or from the Taiyang to the Shaoyang and Yangming stage at the same time. It can also reverse transport from a Shaoyin or Taiyin back to the Yangming stage. Also, in each stage, the disease may affect its meridian system, or only in the organ system, or stay in both its meridian or organ system. The organs correlated to the meridian are: to Taiyang: urine bladder and small intestine; to Shaoyang: gall bladder; to Yangming: stomach, large intestine; to Taiyin: spleen and lung; to Shaoyin: heart and kidney, to Jueyin: liver.

[4] When the Mahuang Tang is to use, check and make sure the person has no his own sweat.

[5] If the pulse is floating but weak and if the person has his own sweat, Guizhi Tang, but not the Mahuang Tang should be used.

[6] In original version, it is “after sweat therapy, the Taiyang stage is resolved.”

[7] In another version, it said the Taiyang stage has gone after the sweat therapy but the one feels chilly.

[8] In this case, Xiao Jianzhong Tang can be tried to harmony but not to bring sweat.

[9] In original version, there is no the setence of “diarrhea with non-digested food in stool”.

[10] In this case, if there is no diarrhea, Mahuang Fuzi Xixing Tang should be used to create sweat. If there is slight diarrhea, Mahuang Fuzi Gancao Tang should be used. Here, the person has continuous diarrhea and the stool is undigested food, Sini Tang is used.

[11] In original version, there is no “sweat therapy”.

[12] Da Qinglong Tang is also for the hot in both body surface and inside in Taiyang stage, but more hot in the surface but less in the inside, so the person does not feel very thirsty. Baihu Tang is for hot/fever in the surface and inside in the Yangming stage, more hot in inside, so the person feels thirsty. Here, the person feels hot, thirsty, sweat with dislike wind, all suggest the disease in both Taiyang (e.g. dislike wind) and Yangming stages, so the Baihu jia Renshen Tang is used. The addition of Renshen is to improve the defense system.

[13] In original version, there is no “difficulty in urine”.

[14] Floating pulse, thirsty with difficult in urine suggests that the disease attacks the Taiyang Organ - urine bladder. If one has thirsty, and his pulse is big, and the urine is easy (no problem), it suggests Baihu Tang condition – the disease is in Yangming stage. Both Wuling San and Fuling Gancao Tang work to correct the disorder in the water metabolism and/or distribution. Compared with the Wuling San condition, the person has little bit disorder in the water metabolism and distribution: difficult in urine and no thirsty.

[15] When the body inside is weak, that is suggested by weak pulse in the Chi position, the sweat therapy should not be used right away. Instead, we need to support the inside by use of Xiao Jianzhong Tang or others, to improve the inside condition first. In most cases, the body will have sweat by itself that will also be able to remove the invade disease.

[16] Palpitation and annoyed suggests the weakness inside, therefore a sweat therapy should not be used.

[17] Palpitation and annoyed emotionally suggest weakness inside of the body. Xiao Jiangzhong Tang works to improve the condition in the middle part of the body, e.g. the Spleen and Stomach system so to help to expel disease out of the body.

[18] This situation happens more in person who is weak and short of blood and Qi before the Shanhan disease, that makes his heart unable to manage regular heart beat. In this case, Zhi Gancao Tang works to improve the function of the heart, even if the Shanghan disease still exists. This and previous paragraph introduced that it is important to support the body inside first, if it is weak during the Shanghan disease, other than to use sweat therapy to solve the disease directly.

[19] In Shaoyang stage, the person could also have deaf or loss hearing temporarily. However, if the deaf comes together with cross hands over heart, it suggests a Yang deficiency condition.

[20] In TCM, the sweat and the blood is connected, the same source. Over sweat will also exhaust the amount of blood. Lack of the blood then makes the heart weak in function. Therefore the person feel palpitation and hollowness in the heart area.

[21] Bentun is a kind of feeling, in which one feels as there is a big running in the lower stomach. It is a very strong movement, but feels not as usual bowel movement. In TCM, this feeling suggests the move of Kidney Qi: the Kidney Qi is disturbed. After over sweat to make the heart weak, e.g. the Heart Fire is weak, so the Kiney Water reverses up to attack the Heart.

[22] If there is typical Bentun syndrome, it means extensive Kidney Yin. Herb Guizhi qui Shaoyao Tang should be used.

[23] In original version it is Guizhi que Guizhi jia Fuling Baishu Tang.

[24] Such condition may happen when the person has had Shuiqi accumulation in the upper stomach area. Shuiqi is a TCM term, meaning kind of water, or humidity, or water vapor. This condition is also similar to Jiexiong syndrome, but the Shuiqi accumulation syndrome has difficult in urine. Suiqi accumulation belongs to Liquid syndrome (water syndrome) in TCM.

[25] In original version, it is to remove Guizhi not the Shaoyao.

[26] In original version it is Guizhi que Guizhi jia Fuling Baishu Tang.

[27] For liquid/water syndrome, the liquid or water has to be removed from the urine.

[28] Deep and tight pulse suggests that the person has had Cold and Water syndrome before the treatment. Feeling dizziness when gets us suggests that the person is weak in the Yang Qi in the chest. Sweat therapy is no longer indicated. If there is no dizziness, herbal Guadi San can be used for vomiting.

[29] If the disease is still in the Taiyang stage after sweat or other therapy, this herb formula is needed. If the disease is or has come into Shaoyin stage, herb Zhenwu Tang should be used to treat the body shaking.

[30] Opposite concept is concrete annoyed or solid annoyed, meaning that the annoyed is caused by some solid disease mass. This is a pretty common TCM term. If it is solid annoyed, herb Dahuang Huanglian Xiexin Tang should be used.

[31] After bowel-cleansing therapy, and if the person feels full in stomach but no annoyed, if the reason is accumulation of Hot in the stomach, herb Da Chenqi Tang is needed; if it is caused by attack of Cold in the stomach, herb Hou Jiang Xia Cao Renshen Tang is needed. If the person feels annoyed but no such fullness in stomach, if it is due to Hot in the chest, herb Zhuye Shigao Tang is the choice; if it is with nausea, herb Zhizi Zhi Tang is the main formula. Now, the person feels both fullness and annoyed, the Zhizi Houpo Tang is the best one.

[32] In original version, it is Zhizi Ganjiang Tang.

[33] In original version, it is Zhizi Ganjiang Tang.

[34] There are many ways to create the vomiting effect to remove the disease from stomach and chest area, not only the Zhizi Zhi Tang. In clinic, it is needed to distinguish the reasons for the fullness feeling in the stomach and chest: Cold, Hot, Food, Water, Phlegm, or Qi. If the reason is Cold, Ganjiang (dried ginger), Guipi should be used; if it is due to Hot, use the Zhizi KuCha; if it is due to accumulation of Food, Pingwei, sald are the choice; if it is due to Water, Wuling, fresh ginger is used; if it is due to Phelegm, Jupi is the choice; and if it is due to Qi, Zhishi Houpo is the mostly used herbs. For person with weak body condition, other herbs that works to support the middle Qi is added; if the body is strong, Guadi, Lilou is applied too.

[35] The disease will be released from the bleeding.

[36] In original version, it is “if there is headache”.

[37] Fever and headache can be seen in both Taiyang and Yangming stage. If it is hard to tell, check the urine. In Yangming, the urine should be yellow or little.

[38] Remember: if the disease is in both meridian and the organs (the urine bladder), first to solve the disease in meridian, then the one in the bladder. Check that if the disease comes into the urine bladder and causes difficult in urine but no emotional disorders (such as the madness), herb Wuling San is used.

[39] If the disease has been for six to seven days with deep and weak pulse, if there is no such strong emotional disorder as mad, it indicates the disease is also deeper in the Shaoyang stage. Herbal Mahuang Fuzi Xixing Tang should be used.

[40] Herb Wuling San, or Yinchen Wuling San, or Yinchen Tang can be used.

[41] Be careful, here is Didang Wan, not Didang Tang.

[42] In original version, it is “feels soft when touch”.

[43] Remember, with the fullness syndrome, the person feels full but not hard nor pain in the upper stomach.

[44] In this case, chilly and sweat suggests a Yang deficiency in the body, so herb Fuzi is involved in the formula.

[45] Note: the for treatment of Fullness syndrome, the Banxia Xiexing Tang is needed.

[46] Depending on the personal health condition before the Shanghan disease, the Fullness after a bowel-cleansing therapy could be varies. If the Fullness is due to accumulation and stagnation of Fire, herb Dahuang Huanglian Xiexing Tang is the choice. If it is due to a Fire inside, but a Cold from outside of the body, herb Fuzi Xiexing Tang is used. If it is due to the mixture of Fire and Shuiqi, herb Shengjiang Xiexing Tang can be used. If it is due to hollow Fire with nausea, Banxian Xiexing Tang is the best. IF is is stronger hollow Fire, this Gancao Xiexing Tang should be the main herbs.

[47] Always remember, if there is hot, thirsty and hard in urine, the herb Wuling San is in the list to choose. It works to deplete Shuiyin out of the body. Shuiyin is a kind of water, humidity, moisture, that does not participate the alive water metabolism in the body. Its presence prevents energy flow to cause disease.

[48] This herb formula works to contract the intestine, to reduce its movement, to increase water absorption, so to stop the diarrhea.

[49] The chest and the stomach are regarded as a whole Jiao cavity. The Heart and Lung are in the Upper Jiao cavity; the Spleen and Stomach are in the Middle Jiao cavity, and the Liver and Kidney are in the Lower Jiao cavity.

[50] It is a common concept in TCM: if the water goes to the colon to cause diarrhea, the person tends to have hard in urine; if he has too much urine, he also tends to have constipation. Only in very severe conditions, the person has both too much urine and diarrhea (loss control in urine and bowel movement); or stop of both urine and bowel movement.

[51] Weiqi is weak.

[52] Weiqi reverse pushing up.

[53] Fullness syndrome is caused after bowel-cleansing therapy, sweat therapy or vomiting therapy. The standard herbs for this condition is various Xiexing Tang. Here, the burping is an additional problem on the common back ground of the Fullness syndrome. So, add Xuanfuhua and Daizhishi in the Shenjiang Xiexing Tang to reverse the reversed Weiqi.

[54] Here, Yue means an air/gas pushing from stomach. It is a kind of dry nausea without vomiting anything in mouth, but it is neither hiccup, Chini, or Yiqi. Hiccup means a gas up pushing from lower stomach and cause “ge”, “ge” sound in the mouth. Chinese word Chini are similar to English word burping or belching, in which a gas comes up to the mouth without food smell. If the gas in the mouth is strong with bad odor of previous ate food, it is called Yiqi. Chini and Yiqi are also called Aqi in Chinese. Their clinic means are different.

The Chinese Pingyin is used her, for the reason that we cannot find proper English word. The Yue can occur in all of the disease stages. Yue during the three Yang stages suggests a concrete disease and a Fire. Yue during three Yin conditions indicates weak and Cold. For weak and cold Yue, herb Sini, Lizhong, Wuzhuyu Tang can be used. For concrete and hot Yue, Tiaowei, Da Chengqi, Xiao Chengqi Tang is used.

[55] In this case, Wuzhuyu Tang is the choice.