典藏书目

In the Shaoyang Chapter, there is a syndrome of concurrent diseases of the three Yang meridians. The outline details the pathological manifestations but does not list treatment methods. Was this perhaps lost in transmission? Or was it left for later generations to prescribe formulas when encountering such syndromes?

Presuming my own ignorance and narrowness, I originally intended to draft a formula to supplement this omission, yet feared that my prescription might not be effective. Now, attempting to study the pathology based on the recorded symptoms, and verifying them against clinical cases I have treated throughout my life, perhaps I can grasp the approximate principles of treating concurrent diseases of the three Yang meridians.

The original text of *Shanghan Lun* states: "Concurrent disease of the three Yang meridians presents with a floating and large pulse, prominent at the Guan position; the patient desires sleep, and sweats upon closing the eyes."

Mr. Tao Hua stated that the disease described in this section should be treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Gegen (Kudzu Root) and Baishao (White Peony Root). However, regarding this syndrome, I have two verified clinical cases, and I do not rigidly adhere to adding Gegen and Baishao to Xiao Chai Hu Tang. I will record these two cases in detail below for discussion within the medical community.

One patient, over thirty years old, contracted a Shanghan (Cold Damage) syndrome in early spring. After medical treatment failed to cure him, I consulted him after seven or eight days. Symptoms included headache, generalized fever, nausea with desire to vomit, occasional irritability, sweating only on the head but not on the body, and wiry pulses on both wrists. The right pulse was particularly wiry and forceful, feeling very solid upon heavy pressure, and notably floating anterior to the Guan position. Based on this pulse analysis: wiry pulses on both sides indicate Shaoyang disease; the right pulse being solid upon heavy pressure indicates Yangming disease; the pronounced floating anterior to the Guan position indicates Taiyang disease. This is undoubtedly a concurrent disease of the three Yang meridians. Although Shaoyang disease is present, there are no alternating chills and fever because the pathogen has merged with Taiyang and Yangming, leaving no room for the typical "going" and "coming" dynamics. Therefore, I prescribed: Sheng Shigao (Raw Gypsum) 1 liang, Xuanshen (Scrophularia Root) 1 liang, Lianqiao (Forsythia Fruit) 3 qian, Yichen (Capillaris Herba) 2 qian, and Gancao (Licorice Root) 2 qian. These were decocted together into one large cup and taken in one dose. Shortly after taking the medicine, profuse sweating occurred all over the body. After about an hour, the sweating ceased, and all symptoms resolved. His brother, who had some medical knowledge, questioned doubtfully: "There was not a single herb in this prescription designed to release the exterior (induce sweating), so why did the patient recover through sweating?" I replied: "The mechanism of sweating lies in harmonizing Yin and Yang, allowing natural sweating, rather than forcibly inducing it. If sweating is forced, recovery is often incomplete, and the condition frequently worsens. In this case of concurrent three-Yang disease, the pathological mechanism intended to reach the skin and hair via the collaterals of the Hand-Taiyin Lung meridian, which is why the pulse anterior to the Guan on the right was uniquely floating. However, due to its forcefulness upon heavy pressure, we knew that accumulated heat in the Yangming meridian was still consolidated. Thus, we used the cooling and moistening properties of Shigao and Xuanshen to regulate dryness and heat. The combination of cooling and resolving heat naturally generated sweat. Additionally, small amounts of Lianqiao and Yichen (which can substitute for Chaihu) were added to promote circulation. Consequently, the pathogen followed the pathological mechanism outward to the skin and hair, resolving through sweating. This is how the disease healed."

I also treated another patient, nearly thirty years old, who suffered severe wind-cold contraction after long-distance labor. He returned home hastily and became bedridden. Despite consultations with multiple doctors, his condition worsened over half a month. When I examined him, he exhibited mental confusion, incessant delirious speech, occasional tremors and restlessness of the limbs, fixed staring gaze as if unable to see, slight generalized fever with intermittent tidal fevers, inability to describe his internal sensations, and daily passage of loose stools. His pulses on both wrists were wiry, thin, and floating, exceeding six beats per cycle (rapid), disappearing upon heavy pressure. Based on the limb tremors, fixed gaze, and intermittent tidal fevers, this indicated Shaoyang disease; the mental confusion and delirious speech indicated Yangming disease; the wiry and markedly floating pulse indicated the pathogen returning from Shaoyang to Taiyang. Hence, it was called concurrent disease of the three Yang meridians. This corresponds to the concurrent disease of the three Yang meridians mentioned in the Shaoyang chapter of *Shanghan Lun*. However, what *Shanghan Lun* describes is the excess type of this syndrome, whereas this case was the deficiency type, specifically a severe deficiency. Generally, when concurrent disease of the three Yang meridians involves the pathogen returning to the exterior, it should resolve through sweating. Although this patient was deficient, it should still resolve through sweating. However, due to the rapid and rootless pulse indicating severe depletion of True Yin, the rising Yang could not be matched by Yin, preventing the formation of sweat. Treatment for this syndrome should first disregard the external contraction and focus primarily on nourishing and tonifying True Yin. After several doses, once the Yin aspect is sufficient, it can naturally combine with Yang Qi to generate sweat, leading to recovery upon sweating. If one only knows that the disease must resolve through sweating and uses drugs to forcibly induce sweating while the pulse is rapid and rootless, regardless of whether sweat is easily produced, even if sweat is induced, the patient would inevitably suffer collapse from deficiency.

Therefore, I prescribed: Sheng Dihuang (Rehmannia Root) 1 liang, Shu Dihuang (Prepared Rehmannia Root) 1 liang, Sheng Shanyao (Chinese Yam Rhizome) 1 liang, Da Gouqi (Wolfberry Fruit) 1 liang, Xuanshen (Scrophularia Root) 5 qian, Shashen (Glehnia Root) 5 qian, and Jing Yurou (Processed Cornus Fruit) 5 qian. These were decocted into one large bowl and taken warm in two divided doses. Two doses were administered continuously during the night. Upon re-examination the next morning, the pulse had slowed to less than six beats per cycle, and the spirit had become clearer. Since taking the medicine, no bowel movement had occurred. Therefore, I removed Yurou from the original formula and added Qing Lianqiao (Green Forsythia Fruit) 2 qian. After administration, the patient sweated all over, and the illness vanished.