治温病，表里俱觉发热，脉洪而兼浮者。
薄荷叶（三钱） 蝉蜕（二钱，去足土） 生石膏（一两，捣细） 甘草（一钱五分）
春温之证，多有一发而表里俱热者，至暑温尤甚，已详论之于前矣。而风温证，两三日间，亦多见有此
脉、证者。此汤皆能治之，得汗即愈。
西人治外感，习用阿斯匹林法。用阿斯匹林一瓦，和乳糖（可代以白蔗糖）服之，得汗即愈。愚屡次试之，
其发汗之力甚猛，外感可汗解者，用之发汗可愈。若此凉解汤，与前清解汤，皆可以此药代之，以其凉而能散
也。若后之寒解汤，即不可以此药代之，盖其发汗之力有余，而清热之力，仍有不足也。
治周身壮热，心中热而且渴，舌上苔白欲黄，其脉洪滑。或头犹觉疼，周身犹有拘束之意者。
生石膏（一两，捣细） 知母（八钱） 连翘（一钱五分） 蝉蜕（一钱五分，去足土）
或问∶此汤为发表之剂，而重用石膏、知母，微用连翘、蝉蜕，何以能得汗？答曰，用此方者，特恐其诊
脉不真，审证不确耳。果如方下所注脉证，服之复杯可汗，勿庸虑此方之不效也。盖脉洪滑而渴，阳明府热已
实，原是白虎汤证。特因头或微疼，外表犹似拘束，是犹有一分太阳流连未去。故方中重用石膏、知母以清
胃府之热；而复少用连翘、蝉蜕之善达表者，引胃中化而欲散之热，仍还太阳作汗而解。斯乃调剂阴阳，听其
自汗，非强发其汗也。况石膏性凉（《神农本草经》谓其微寒即凉也）味微辛，有实热者，单服之即能汗乎？
曾治一少年，孟夏长途劳役，得温病，医治半月不效。后愚诊视，其两目清白，竟无所见，两手循衣摸床，
乱动不休， 语不省人事。其大便从前滑泻，此时虽不滑泻，每日仍溏便一两次。脉浮数，右寸之浮尤甚，两
尺按之即无。因此证目清白无见者，肾阴将竭也。手循衣摸床者，肝风已动也。病势之危，已至
极点。幸喜脉浮，为病还太阳。右寸浮尤甚，为将汗之势。其所以将汗而不汗者，人身之有汗，如天地之有雨。
天地阴阳和而后雨，人身亦阴阳和而后汗。此证尺脉甚弱，阳升而阴不能应，汗何由作？当用大润之剂，峻补
真阴，济阴以应其阳，必能自汗。遂用熟地、玄参、阿胶、枸杞之类，约重六七两，煎汤一大碗，徐徐温饮下，
一日连进二剂，即日大汗而愈。审是，则发汗原无定法。当视其阴阳所虚之处，而调补之，或因其病机而利导
之，皆能出汗，非必发汗之药始能汗也。按∶寒温之证，原忌用粘腻滋阴、甘寒清火，以其能留邪也。而用以
为发汗之助，则转能逐邪外出，是药在人用耳。
一人，年四十余。为风寒所束不得汗，胸中烦热，又兼喘促。医者治以苏子降气汤，兼散风清火之品，数
剂病益进。诊其脉，洪滑而浮，投以寒解汤，须臾上半身即出汗。又须臾，觉药力下行，至下焦及腿亦皆出汗，
病若失。
一人，年三十许。得温证，延医治不效，迁延十余日。愚诊视之，脉虽洪而有力，仍兼浮象。问其头疼乎？
曰∶然！渴欲饮凉水乎？曰∶有时亦饮凉水，然不至燥渴耳。知其为日虽多，而阳明之热，犹未甚实，太阳之
表，犹未尽罢也。投以寒解汤，须臾汗出而愈。
一人，年三十余。于冬令感冒风寒，周身恶寒无汗，胸间烦躁。原是大青龙汤证，医者投以麻黄汤。服后汗
无分毫，而烦躁益甚，几至疯狂。诊其脉，洪滑异常，两寸皆浮，而右寸尤甚。投以寒解汤，复杯之顷，汗出
如洗而愈。审是则寒解汤不但宜于温病，伤寒现此脉者，投之亦必效也。
一叟，年七旬。素有劳疾，薄受外感，即发喘逆，投以小青龙汤，去麻黄，加杏仁、生石膏辄愈。上元节
后，因外感甚重，旧病复发，五六日间，热入阳明之府。脉象弦长浮数，按之有力，
而无洪滑之象（此外感兼内伤之脉）。投以寒解汤，加潞参三钱，一剂汗出而喘愈。再诊其脉，余热犹炽，继
投以白虎加人参以山药代粳米汤一大剂，分三次温饮下，尽剂而愈。
一妊妇，伤寒两、三日。脉洪滑异常，精神昏愦，间作 语，舌苔白而甚浓。为开寒解汤方，有一医者在
座，问方中之意何居？愚曰∶欲汗解耳。曰∶此方能汗解乎？愚曰∶此方遇此证，服之自能出汗，若泛作汗解
之药服之，不能汗也。饮下须臾，汗出而愈。
一妇人，年二十余，得温病。咽喉作疼，舌强直，几不能言，心中热而且渴，频频饮水，脉竟沉细异常，
肌肤亦不发热。遂舍脉从证，投以寒解汤，得微汗，病稍见愈。明晨又复如故，舌之强直更甚。知药原对证，
而力微不能胜病也。遂仍投以寒解汤，将石膏加倍，煎汤两盅，分二次温饮下，又得微汗，病遂愈。
按∶伤寒脉若沉细，多系阴证。温病脉若沉细，则多系阳证。盖温病多受于冬，至春而发，其病机自内
向外。有时病机郁而不能外达，其脉或即现沉细之象，误认为凉，必至误事。又此证，寒解汤既对证见愈矣，
而明晨，舌之强直更甚，乃将方中生石膏倍作二两，分两次前后服下，其病即愈。由是观之，凡治寒温之热者，
皆宜煎一大剂，分数次服下，效古人一剂三服之法也。
门人高××曾治一媪，年近七旬。于春初得伤寒证，三四日间，烦热异常。又兼白痢，昼夜滞下无度，其
脉洪滑兼浮。高××投以寒解汤，加生杭芍三钱，一剂微汗而热解，痢亦遂愈。
又∶吴又可曰∶“里证下后，脉浮而微数，身微热，神思或不爽。此邪热浮于肌表，里无壅滞也。虽无汗，
宜白虎汤，邪可从汗而解。若下后，脉空虚而数，按之豁然如无者，宜白虎加人参汤，复杯则汗解。”按∶白
虎汤与白虎加人参汤，皆非解表之药，而用之得当，虽在下后，犹可须臾得汗，况在未下之前乎。不但此也，
即承气汤，亦可为汗解之药，亦视乎用之何如耳。
又洪吉人曰∶“余尝治热病八、九日，用柴葛解之、芩连清之、硝黄下之，俱不得汗。昏愦扰乱，撮空摸床，
危在顷刻。以大剂地黄汤（必系减去桂附者），重加人参、麦冬进之。不一时，通身大汗淋漓，恶证悉退，神
思顿清。”
按∶此条与愚用补阴之药发汗相似，所异者，又加人参以助其气分也。上所论者皆发汗之理，果能汇通参
观，发汗之理，无余蕴矣。
附录∶
直隶盐山李××来函∶
天津××，得温病，先服他医清解之药数剂无效。弟诊其脉象，沉浮皆有力，表里壮热无汗。投以寒解汤
原方，遍身得汗而愈。山斯知方中重用生石膏、知母以清热，少加连翘、蝉蜕以引热透表外出，制方之妙远
胜于银翘散、桑菊饮诸方矣。且由此知石膏生用诚为妙药。从治愈此证之后，凡遇寒温实热诸证，莫不遵书中
方论，重用生石膏治之。其热实脉虚者，亦莫不遵书中方论，用白虎加人参汤，或用白虎加人参以生山药代粳
米汤，皆能随手奏效。
直隶盐山孙××来函∶
斯年初冬，适郭姓之女得伤寒证，三四日间阳明热势甚剧，面赤气粗，六脉洪数，时作谵语。为开寒解汤，
因胸中觉闷，加栝蒌仁一两，一剂病愈。
治疗温病，患者感觉表里都发热，脉象洪大且兼有浮象的方剂。
薄荷叶（三钱） 蝉蜕（二钱，去掉足和泥土） 生石膏（一两，捣碎成细粉） 甘草（一钱五分）
春季温病的病症，大多是一发病就出现表里俱热的情况，到了暑温更是严重，这在前文已经详细论述过了。而风温证，在两三天内，也常见到这种脉象和症状。这个汤剂都能治疗，服用后出汗即可痊愈。
西方人治疗外感病，习惯使用阿司匹林法。用阿司匹林一瓦（约0.06克），混合乳糖（可用白蔗糖代替）服用，出汗即愈。我多次尝试，其发汗之力非常猛烈，对于可以通过发汗解除外感的病症，用它发汗可以痊愈。如果像这个凉解汤，以及前文的清解汤，都可以用阿司匹林来替代，因为阿司匹林性质清凉且具有发散作用。但是后面的寒解汤，就不能用阿司匹林替代了，因为阿司匹林发汗的力量有余，但清热的力量仍然不足。
治疗全身高热，心中烦热且口渴，舌苔白而欲变黄，脉象洪滑。或者头部仍觉疼痛，全身仍有拘紧不适感的方剂。
生石膏（一两，捣碎成细粉） 知母（八钱） 连翘（一钱五分） 蝉蜕（一钱五分，去掉足和泥土）
有人问：此汤是发表（发散表邪）的药剂，却重用石膏、知母，少用连翘、蝉蜕，怎么能让人出汗呢？回答说：使用此方的人，只是担心医生诊脉不精准，辨证不确切罢了。如果确实如方子下面所注的脉象和症状，服药后片刻即可出汗，不必担心此方无效。因为脉象洪滑且口渴，说明阳明腑热已经实证，原本是白虎汤证。只是因为头部偶尔微痛，外表仍有拘束感，说明还有一分太阳经的病邪留恋未去。所以方中重用石膏、知母以清除胃腑之热；又少量使用善于通达体表的连翘、蝉蜕，引导胃中化散的热邪，仍回归太阳经通过出汗而解除。这是调和阴阳，听任其自然出汗，而不是强行发汗。况且石膏性凉（《神农本草经》说它微寒即凉），味微辛，有实热的人，单服它就能出汗吗？
曾治疗一个少年，在孟夏时节长途劳役，得了温病，医治半个月不见效。后来我诊治，他两眼清白，竟然看不见东西，双手循着衣服摸床，乱动不停，胡言乱语，神志不清。他的大便从前滑泻，此时虽然不再滑泻，但每天仍溏便一两次。脉象浮数，右寸脉的浮象尤其明显，两尺脉按之即无。因为这个证候眼睛清白看不见，说明肾阴即将枯竭。手循衣摸床，说明肝风已动。病势之危，已到极点。幸好脉浮，说明病邪还留在太阳经。右寸脉浮尤其明显，说明有将要出汗的趋势。之所以将要出汗却不出汗，是因为人身出汗，就像天地下雨一样。天地阴阳调和然后才下雨，人身也是阴阳调和然后才出汗。此证尺脉很弱，阳气上升而阴气不能应和，汗从哪里产生？应当用滋润的大剂药，峻补真阴，济助阴气以应合阳气，必然能自然出汗。于是用熟地、玄参、阿胶、枸杞之类，大约重六七两，煎汤一大碗，慢慢温热饮下，一天连进两剂，当天大汗而出而痊愈。由此看来，发汗原本没有固定的方法。应当视其阴阳亏损之处进行调补，或者顺着病机加以引导，都能出汗，并非一定要用发汗药才能出汗。按：伤寒和温病，原本忌讳使用粘腻滋阴、甘寒清火的药物，因为它们会留滞邪气。但如果将其作为发汗的辅助，则反而能驱除邪气外出，这是药物在于人的运用罢了。
有一人，四十多岁。被风寒束缚不得出汗，胸中烦热，又兼喘促。医生用苏子降气汤，配合散风清火的药物，几剂后病情加重。诊其脉，洪滑而浮，投以寒解汤，片刻后上半身即出汗。又片刻，觉得药力下行，到下焦及腿部也都出汗，病若失。
有一人，三十岁左右。得温证，延医治疗不见效，拖延十余日。我诊治，脉虽洪大有力，仍兼有浮象。问他头疼吗？回答说：是的！想喝凉水吗？回答说：有时也喝凉水，但不至于燥渴。知道他为时虽多，但阳明之热，尚未甚实，太阳之表，也未完全解除。投以寒解汤，片刻后汗出而愈。
有一人，三十多岁。在冬季感冒风寒，周身恶寒无汗，胸间烦躁。原是大青龙汤证，医生投以麻黄汤。服后汗无分毫，而烦躁更甚，几乎至疯狂。诊其脉，洪滑异常，两寸皆浮，而右寸尤甚。投以寒解汤，片刻后，汗出如洗而愈。由此看来，寒解汤不仅适宜于温病，伤寒现此脉者，投之亦必效也。
一位老人，七十岁。素有劳疾，稍受外感，即发喘逆，投以小青龙汤，去麻黄，加杏仁、生石膏辄愈。上元节后，因外感甚重，旧病复发，五六日间，热入阳明之府。脉象弦长浮数，按之有力，而无洪滑之象（这是外感兼内伤之脉）。投以寒解汤，加潞参三钱，一剂汗出而喘愈。再诊其脉，余热犹炽，继投以白虎加人参以山药代粳米汤一大剂，分三次温饮下，尽剂而愈。
一位孕妇，伤寒两、三日。脉洪滑异常，精神昏愦，间作谵语，舌苔白而甚浓。为她开寒解汤方，有一位医者在座，问方中之意何居？我说：欲汗解耳。曰：此方能汗解乎？我说：此方遇此证，服之自能出汗，若泛作汗解之药服之，不能汗也。饮下须臾，汗出而愈。
一位妇人，二十多岁，得温病。咽喉作疼，舌强直，几不能言，心中热而且渴，频频饮水，脉竟沉细异常，肌肤亦不发热。遂舍脉从证，投以寒解汤，得微汗，病稍见愈。明晨又复如故，舌之强直更甚。知药原对证，而力微不能胜病也。遂仍投以寒解汤，将石膏加倍，煎汤两盅，分二次温饮下，又得微汗，病遂愈。
按：伤寒脉若沉细，多系阴证。温病脉若沉细，则多系阳证。盖温病多受于冬，至春而发，其病机自内向外。有时病机郁而不能外达，其脉或即现沉细之象，误认为凉，必至误事。又此证，寒解汤既对证见愈矣，而明晨，舌之强直更甚，乃将方中生石膏倍作二两，分两次前后服下，其病即愈。由是观之，凡治寒温之热者，皆宜煎一大剂，分数次服下，效古人一剂三服之法也。
门人高××曾治一媪，年近七旬。于春初得伤寒证，三四日间，烦热异常。又兼白痢，昼夜滞下无度，其脉洪滑兼浮。高××投以寒解汤，加生杭芍三钱，一剂微汗而热解，痢亦遂愈。
又：吴又可曰：“里证下后，脉浮而微数，身微热，神思或不爽。此邪热浮于肌表，里无壅滞也。虽无汗，宜白虎汤，邪可从汗而解。若下后，脉空虚而数，按之豁然如无者，宜白虎加人参汤，复杯则汗解。”按：白虎汤与白虎加人参汤，皆非解表之药，而用之得当，虽在下后，犹可须臾得汗，况在未下之前乎。不但此也，即承气汤，亦可为汗解之药，亦视乎用之何如耳。
又洪吉人曰：“余尝治热病八、九日，用柴葛解之、芩连清之、硝黄下之，俱不得汗。昏愦扰乱，撮空摸床，危在顷刻。以大剂地黄汤（必系减去桂附者），重加人参、麦冬进之。不一时，通身大汗淋漓，恶证悉退，神思顿清。”
按：此条与愚用补阴之药发汗相似，所异者，又加人参以助其气分也。上所论者皆发汗之理，果能汇通参观，发汗之理，无余蕴矣。
附录：
直隶盐山李××来函：
天津××，得温病，先服他医清解之药数剂无效。弟诊其脉象，沉浮皆有力，表里壮热无汗。投以寒解汤原方，遍身得汗而愈。山斯知方中重用生石膏、知母以清热，少加连翘、蝉蜕以引热透表外出，制方之妙远胜于银翘散、桑菊饮诸方矣。且由此知石膏生用诚为妙药。从治愈此证之后，凡遇寒温实热诸证，莫不遵书中方论，重用生石膏治之。其热实脉虚者，亦莫不遵书中方论，用白虎加人参汤，或用白虎加人参以生山药代粳米汤，皆能随手奏效。
直隶盐山孙××来函：
斯年初冬，适郭姓之女得伤寒证，三四日间阳明热势甚剧，面赤气粗，六脉洪数，时作谵语。为开寒解汤，因胸中觉闷，加栝蒌仁一两，一剂病愈。
Treatment for warm diseases (Wenbing, febrile diseases caused by warm pathogens), where the patient feels heat in both the exterior and interior, with a pulse that is surging (Hong) and floating (Fu).
Bohe Ye (Menthae Haplocalycis Herba, 3 qian) Chantui (Cicadae Periostracum, 2 qian, remove feet and soil) Sheng Shigao (Gypsum Fibrosum, 1 liang, crushed to fine powder) Gancao (Glycyrrhizae Radix et Rhizoma, 1.5 qian)
Spring warm diseases often present with heat in both the exterior and interior from the onset; this is even more severe in summer-heat warm diseases, as detailed in previous discussions. Wind-warm diseases (Fengwen) also frequently exhibit these pulse and symptom patterns within two to three days. This decoction can treat all such cases; recovery occurs upon sweating.
Western physicians commonly use aspirin for exogenous diseases. One grain of aspirin is taken mixed with lactose (or white sucrose as a substitute); recovery follows sweating. I have tested this repeatedly: its diaphoretic power is very strong. For exogenous conditions solvable by sweating, it induces sweat and cures. The Liangjie Tang (Cooling and Resolving Decoction) and the preceding Qingjie Tang (Clearing and Resolving Decoction) can be substituted with this drug because it is cooling and dispersing. However, the subsequent Hanjie Tang (Cold-Resolving Decoction) cannot be substituted, as aspirin has excessive diaphoretic power but insufficient heat-clearing capacity.
For treatment of high fever throughout the body, heat and thirst in the heart/mind, white tongue coating turning yellow, and a surging-slippery pulse. Or, when there is still headache and a sensation of stiffness/constriction throughout the body.
Sheng Shigao (Gypsum Fibrosum, 1 liang, crushed to fine powder) Zhi Mu (Anemarrhenae Rhizoma, 8 qian) Lianqiao (Forsythiae Fructus, 1.5 qian) Chantui (Cicadae Periostracum, 1.5 qian, remove feet and soil)
Question: This formula is an exterior-releasing agent, yet it heavily uses Shigao and Zhi Mu while lightly using Lianqiao and Chantui. How does it induce sweating? Answer: The concern lies only in the possibility of inaccurate pulse diagnosis or imprecise syndrome differentiation. If the pulse and symptoms match those noted under the formula, sweating will occur shortly after ingestion; there is no need to worry about inefficacy. A surging-slippery pulse with thirst indicates excess heat in the Yangming Fu organs, which originally constitutes a Baihu Tang (White Tiger Decoction) pattern. However, due to occasional slight headache and residual exterior constriction, a portion of Taiyang pathogen remains. Therefore, heavy doses of Shigao and Zhi Mu are used to clear stomach/fu heat, while small amounts of Lianqiao and Chantui, which excel at reaching the exterior, guide the transforming heat from the stomach back to the Taiyang channel to resolve via sweating. This harmonizes yin and yang, allowing natural sweating rather than forcing it. Moreover, Shigao is cool (Shennong Bencao Jing states "slightly cold" equals cool) and slightly pungent; can patients with excess heat sweat merely by taking it alone?
I once treated a young man who contracted a warm disease after strenuous labor in early summer. Treatment failed for half a month. Upon my examination, his eyes were clear but blind, his hands wandered touching clothes and beds, he moved restlessly, spoke nonsense, and was unconscious. He previously had loose stools, which stopped, but he still passed soft stools one or twice daily. The pulse was floating and rapid, especially so in the right Cun position, while the Chi pulses disappeared upon pressure. Blindness indicated impending exhaustion of Kidney Yin. Hand wandering indicated stirring of Liver Wind. The condition was critical. Fortunately, the floating pulse indicated the pathogen remained in the Taiyang channel. The pronounced floating in the right Cun indicated an impending sweat. The reason for impending but absent sweating is that human sweating resembles heavenly rain: heaven and earth produce rain only when yin and yang harmonize; humans sweat only when yin and yang harmonize. Here, the weak Chi pulse meant rising yang could not be matched by yin, so how could sweat form? I prescribed a large dose of moistening tonics to severely supplement True Yin, aiding yin to respond to yang, expecting natural sweating. I used Shudi (Rehmanniae Radix Preparata), Xuanshen (Scrophulariae Radix), Ejiao (Asini Corii Colla), Gouqi (Lycii Fructus), totaling approximately 6–7 liang, decocted in a large bowl of water, administered slowly warm. Two doses were given in one day, resulting in profuse sweating and recovery on the same day. Thus, there is no fixed method for inducing sweating. One must tonify and regulate based on yin-yang deficiency, or guide according to pathogenesis; all can induce sweating without necessarily using diaphoretics. Note: In Shanghan (Cold Damage) and Wenbing, sticky yin-nourishing and sweet-cold heat-clearing herbs are generally contraindicated as they may trap pathogens. However, used as aids for sweating, they expel pathogens. It depends on application.
A man in his forties was bound by wind-cold, unable to sweat, with chest irritability and wheezing. Treated with Suzi Jiangqi Tang (Perillae Fructus Descending Qi Decoction) plus wind-dispersing and fire-clearing herbs, the condition worsened after several doses. Pulse was surging, slippery, and floating. Hanjie Tang was administered; upper body sweated within moments. Then, lower jiao and legs sweated, and the illness vanished.
A man around thirty contracted a warm disease. Treatment failed for over ten days. Pulse was surging and forceful, yet still floating. Headache confirmed. Thirst for cold water was occasional, not extreme. Although prolonged, Yangming heat was not fully established, and Taiyang exterior was not fully resolved. Hanjie Tang was given; sweating occurred shortly, and he recovered.
A man in his thirties contracted wind-cold in winter. Whole-body aversion to cold, no sweat, chest irritability. Originally a Daqinglong Tang (Great Green Dragon Decoction) pattern, but treated with Mahuang Tang (Ephedra Decoction). No sweat resulted, irritability worsened to near madness. Pulse was extremely surging and slippery, both Cun positions floating, right Cun particularly so. Hanjie Tang was administered; profuse sweating occurred immediately, and he recovered. Thus, Hanjie Tang is suitable not only for warm diseases but also for Shanghan presenting this pulse.
An elderly man, seventy years old, suffered from chronic劳疾 (consumptive disease). Mild external contraction triggered wheezing/inversion, cured by Xiao Qinglong Tang (Minor Green Dragon Decoction) minus Mahuang, adding Xingren (Prunus Armeniacus Semen) and Sheng Shigao. After Lantern Festival, severe external contraction relapsed the old disease. Within five to six days, heat entered the Yangming Fu. Pulse was string-taut, long, floating, and rapid, forceful upon pressure, lacking surging-slippery quality (pulse of external contraction combined with internal injury). Hanjie Tang plus Lushen (Codonopsis Radix, 3 qian) was given; one dose induced sweating and cured wheezing. Re-examination showed lingering heat. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) modified with Shanyao (Dioscoreae Rhizoma) replacing Jingmi (Oryza Sativa Germ) was administered in one large dose, divided into three warm intakes; full course cured him.
A pregnant woman, two to three days into Shanghan. Pulse extremely surging and slippery, mental confusion, intermittent delirium, thick white tongue coating. Prescribed Hanjie Tang. A physician present asked the rationale. I said: To resolve via sweating. He asked if it works. I said: For this pattern, it naturally induces sweat; generic diaphoretics would fail. Shortly after ingestion, sweating occurred, and she recovered.
A woman in her twenties contracted a warm disease. Sore throat, stiff tongue, nearly unable to speak, heart heat and thirst, frequent drinking, yet pulse was extremely deep and fine, skin not hot. Abandoning pulse for symptoms, Hanjie Tang was given. Slight sweating followed, condition improved slightly. Next morning, recurrence with worse tongue stiffness. Medication was correct but too weak. Hanjie Tang was repeated with doubled Shigao, decocted into two bowls, taken warm in two doses. Slight sweating ensued, and she recovered.
Note: Deep-fine pulses in Shanghan usually indicate Yin patterns. In warm diseases, deep-fine pulses often indicate Yang patterns. Warm diseases are often acquired in winter and manifest in spring, with pathogenesis moving from interior to exterior. Sometimes pathogenic qi stagnates and cannot reach the exterior, presenting a deep-fine pulse. Mistaking this for cold leads to error. Also, although Hanjie Tang worked, next morning tongue stiffness worsened. Doubling Shigao to 2 liang, divided into two doses, cured the illness. This shows that for treating heat in cold/warm diseases, decocting a large dose and dividing it into multiple intakes mimics the ancient method of one dose taken three times.
My disciple Gao XX treated an elderly woman, nearly seventy. Early spring, Shanghan pattern, extreme irritability/heat within three to four days. Accompanied by white dysentery, frequent diarrhea day and night. Pulse surging, slippery, and floating. Gao XX administered Hanjie Tang plus Sheng Hangshao (Paeoniae Radix Alba, 3 qian). One dose brought slight sweating, heat resolved, and dysentery cured.
Furthermore: Wu Youke stated: "After purgation for interior patterns, if the pulse is floating and slightly rapid, with slight body heat and unclear spirit, this indicates pathogenic heat floating on the muscle surface with no interior obstruction. Even without sweat, Baihu Tang is appropriate; the pathogen can resolve via sweating. If after purgation the pulse is empty and rapid, feeling hollow upon pressure, Baihu Jia Renshen Tang is appropriate; sweating occurs rapidly." Note: Neither Baihu Tang nor Baihu Jia Renshen Tang are exterior-resolving agents. Yet, when used correctly, even after purgation, sweating can occur quickly, let alone before purgation. Not only this; Chengqi Tang (Harmonizing Harmony Decoctions) can also serve as diaphoretics depending on usage.
Furthermore: Hong Jiren stated: "I once treated heat disease for eight or nine days. Using Chai Ge Jie Biao Tang (Bupleurum and Pueraria Exterior-Resolving Decoction), Qin Lian Qing Re Tang (Scutellaria and Coptis Heat-Clearing Decoction), and Xiao Huang Xia Zhi Tang (Sodium Nitrate and Rhubarb Purging Decoction), none induced sweat. Mental confusion, agitation, grasping at air, touching beds, critical condition. I prescribed a large dose of Dihuang Tang (Rehmannia Decoction, definitely minus Guizhi and Fuzi), heavily supplemented with Renshen and Maidong. Soon, profuse whole-body sweating occurred, evil signs retreated, and spirit cleared."
Note: This resembles my use of yin-tonifying herbs to induce sweating, differing only by adding Renshen to boost Qi. The above discusses the principles of sweating. Integrating these views exhausts the theory of diaphoresis.
Appendix:
Letter from Li XX of Yanshan, Zhili:
Patient XX in Tianjin contracted a warm disease. Previous clearing/resolving formulas failed. Pulse was forceful in both floating and sunken positions; exterior and interior blazing heat with no sweat. Original Hanjie Tang formula was given; whole-body sweating occurred, and he recovered. From this, I learned that heavy use of Sheng Shigao and Zhi Mu clears heat, while small amounts of Lianqiao and Chantui guide heat out through the exterior. The formulation is far superior to Yinqiao San (Honeysuckle and Forsythia Powder) and Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction). Furthermore, raw Shigao is indeed a miraculous drug. Since curing this case, for all solid-heat patterns in cold/warm diseases, I strictly follow the book's theory, using heavy raw Shigao. For heat-solid with pulse-deficiency, I use Baihu Jia Renshen Tang or Baihu Jia Renshen Tang with Shanyao replacing Jingmi, achieving immediate results.
Letter from Sun XX of Yanshan, Zhili:
Early winter this year, a Ms. Guo contracted Shanghan. Within three to four days, Yangming heat was severe: red face, coarse breathing, six pulses surging and rapid, occasional delirium. Prescribed Hanjie Tang. Due to chest stuffiness, added Gualou Ren (Trichosanthis Semen, 1 liang). One dose cured the illness.