典藏书目

Zhao Sizhen stated: A detailed examination of Zhang Zhongjing’s treatise on sweating-inducing decoctions reveals that they are categorized into varying degrees of heaviness and lightness. For instance, Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), Da Qinglong Tang (Major Green Dragon Decoction), Xiao Qinglong Tang (Minor Green Dragon Decoction), Ge Ban Tang (Half-Volume Decoction), and Yuespi Tang (Tiger-Skin Dispelling Decoction) each have their specific gradations. Regarding the two formulas for inducing sweating in Shaoyin disease (Shaoyin Syndrome), although both utilize Mahuang (Ephedrae Herba) and Fuzi (Aconiti Lateralis Radix Praeparata), there are naturally differences in dosage adjustments indicating severity. Thus, the addition of Xixin (Asari Radix et Rhizoma) denotes a heavier formula, while the addition of Gancao (Glycyrrhizae Radix et Rhizoma) denotes a lighter one, based on the principle that acrid flavors disperse and sweet flavors moderate.

In the first syndrome, since Shaoyin inherently lacks heat, the emergence of fever is termed "fan" (reversed/unexpected). Generally, fever indicates pathogenic factors at the exterior, requiring diaphoresis; however, the concomitant deep pulse (Chen Mai) belongs to Yin, necessitating warming. Therefore, Fuzi warms the meridians, Mahuang disperses cold, and because the heat must be resolved through sweating, Xixin is added. This constitutes a heavy sweating formula.

Since the first syndrome presents no interior cold requiring warming and no interior heat requiring purgation, the rationale for using Mahuang and Fuzai is deduced as follows: only when the pulse is deep can it be named Shaoyin disease; only when the body exhibits fever can exterior-releasing medications be administered. Furthermore, having contracted the disease for two or three days implies the pathogenic qi is still shallow, making this syndrome slightly milder than previous descriptions. Hence, the pulse and syndromes are not heavily emphasized, but rather it states "slightly induce sweating." Consequently, Xixin is removed and Gancao is added, constituting a light sweating formula.

If the pulse were not deep, the body not hot, and no other symptoms present, the individual would be considered free of disease, rendering medication unnecessary. Zhang Zhongjing originally separated these two syndromes to distinguish the heaviness and lightness of sweating formulas. However, *Ren Shu* (The Book of Human Life) deleted the phrase "no symptoms" from the second syndrome and revised it to "commonly seen Shaoyin Heat-Yang syndromes." Such Shaoyin Heat-Yang syndromes include, as per the classic text: mental restlessness and inability to sleep, throat sores with loss of voice, cough with vomiting and thirst, dry mouth and throat, or abdominal distension with constipation. Could such syndromes possibly be treated by Mahuang Fuzi Gancao Tang, a sweating formula?

Furthermore, it is noted that Mahuang Fuzi Xixin Tang is indeed used for Shaoyin disease presenting with a deep pulse and reversed fever. Yet Zhang Zhongjing also employed Sini Tang (Four Reversal Decoction) for Taiyang disease presenting with fever and a reversed deep pulse, referring to both situations as "fan" (reversed).

Zhang Zhongjing stated: "When a patient has fever and headache, but the pulse is reversedly deep, if it does not improve, and body and head pain persist, one should rescue the interior,适宜 Sini Tang." This case appears in the Taiyang Chapter. He further stated: "At the onset of Shaoyin disease, with reversed fever and a deep pulse, use Mahuang Fuzi Xixin Tang." This case appears in the Shaoyin Chapter.

Careful analysis reveals that for Taiyang disease with fever and headache, the pulse should normally be floating (Fu Mai); now it is reversedly deep. For Shaoyin disease, the pulse is deep, and there should normally be no fever; now there is reversed fever. Zhang Zhongjing uses "fan" in both cases to denote abnormality. Essentially, the Taiyang pulse resembles Shaoyin, and the Shaoyin syndrome resembles Taiyang, hence the term "reversed," leading to different treatments.

Upon deeper investigation, both involve deep pulses and fever. Because headache is present, it is classified as a Taiyang Yang syndrome, where the pulse should be floating; the failure to float is due to interior deficiency and chronic cold, causing interior righteous qi to be weak. Due to body pain, rescuing the interior is appropriate to strengthen interior righteous qi, forcing pathogens outward. Dried Ginger (Ganjiang) and Raw Aconite (Sheng Fuzi) can also induce sweating to resolve the condition. If the interior were not deficient and cold, the pulse would be floating, fitting the Taiyang Mahuang Tang syndrome.

Similarly, regarding deep pulse and fever, the absence of headache classifies it as a Shaoyin Yin syndrome, where there should be no fever; the presence of fever occurs because cold pathogens are at the exterior, not yet transmitted to the interior, causing heat due to stagnation in the skin and pores, while the interior remains unaffected. Thus, Mahuang and Xixin are used to release exterior pathogenic heat, and Fuzi is used to warm the Shaoyin meridians. If cold pathogens had entered the interior, there would be no exterior fever, and symptoms such as vomiting, diarrhea, and cold extremities would appear, fitting the standard Shaoyin Sini Tang syndrome.

From this perspective, superficial exterior pathogens with reversed fever represent a milder reversal, whereas weak righteous qi with a deep pulse represents a more severe reversal. It cannot be said that Sini Tang is heavier than Mahuang Fuzi Xixin Tang. Moreover, it demonstrates that Prepared Aconite (Shu Fuzi) paired with Mahuang provides tonification within dispersion, while Raw Aconite paired with Dried Ginger provides dispersion within tonification. Zhang Zhongjing’s intent is subtle. Alas, common diseases are treated with common methods, which everyone knows. However, when syndromes or pulses change, creating ambiguity, attempting to apply common methods leads to confusion. Although Zhang Zhongjing’s Taiyang and Shaoyin syndromes both feature deep pulses and fever, the etiology and treatment differ. This represents the extraordinary method for treating excess syndromes and the profound subtlety of medical theory, warranting inclusion here.

Respectfully noting: Zhang Zhongjing’s principles for the Six Meridians of Cold Damage encompass the drugs for the exterior and interior of all six meridians. By distinguishing the heaviness and lightness of pulses and syndromes within each exterior-releasing category, he provided an enduring benefit for ten thousand generations. Yet, through the ages, how few have grasped the subtlety of these principles? In recent times, customs have neglected seeking the underlying meaning, attributing errors to temporal and geographical differences, or incorrectly using Qi-regulating herbs to treat exterior Cold Damage pathogens, leading to many reversals and mistakes. Discussions on interior-deficient syndromes follow below under the various exterior-releasing formulas.