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Chapter 13 of 29
伤寒杂病论
The fundamental manifestations of Taiyang disease are: floating pulse (a pulse that is superficial and easily felt with light pressure), stiffness and pain in the head and neck, and aversion to cold. This is the typical response when external pathogens invade the body's outermost "Taiyang channel."
If Taiyang disease is accompanied by fever, sweating, aversion to wind, and a relaxed (slow) pulse, the ancients called it wind stroke (zhongfeng)—this does not refer to the modern concept of cerebrovascular accident, but rather a type of external contraction where wind pathogen injures the exterior and the defensive qi fails to secure the surface (the body's superficial defense function becomes lax). This belongs to the exterior deficiency pattern.
If Taiyang disease presents with aversion to cold, generalized body pain, nausea/vomiting, and a tight pulse across all three positions (inch, bar, cubit)—whether or not fever is yet present—it is called cold strike (shanghan). Here, "shanghan" in the narrow sense refers to exterior attack by cold pathogen with yang qi of the defensive layer being suppressed (exterior yang bound by cold pathogen), constituting an exterior excess pattern.
On the first day of cold damage, the disease lies in Taiyang. If the pulse is calm, the disease will not transmit inward; if there is marked nausea, restlessness and vexation, and a rapid and urgent pulse, it indicates that the pathogen is transmitting inward.
Two to three days into cold damage, if there are no Yangming signs (body heat, spontaneous sweating, no aversion to cold, aversion to heat instead, thirst, etc.) or Shaoyang signs (bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, etc.), the disease has not yet transmitted.
If Taiyang disease presents with fever, thirst, and no aversion to cold, it is called warm disease (wenbing). If after sweating the body becomes even more灼热 (scalding hot), it is named wind warmth (fengwen). The manifestations of wind warmth include: floating pulse at both yin and yang positions, spontaneous sweating, heavy body, excessive sleepiness, heavy snoring respirations, and difficulty speaking. If the purgation method is erroneously applied, there will be urinary difficulty, staring eyes, and enuresis; if the fire method is erroneously applied, there will be mild yellowing of the skin, or in severe cases, seizures resembling fright-epilepsy with paroxysmal convulsions; if fire fumigation is further applied, the first mistreatment may still allow delay for several days, but the second mistreatment will accelerate deterioration of the condition.
When fever and aversion to cold appear simultaneously, the disease arises from yang; when there is only aversion to cold without fever, the disease arises from yin. The ancients believed that yang-pattern diseases resolve in seven days and yin-pattern diseases in six days, because seven is a yang number and six is a yin number. If Taiyang disease with headache resolves spontaneously after more than seven days, it is because the qi of the Taiyang channel has completed one full circuit. If the disease is about to enter the next channel, acupuncture at the Yangming foot channel points can be applied to block transmission. Taiyang disease most readily resolves during the Si to Wei hours (approximately 9 AM to 3 PM) when yang qi is flourishing. If the patient still feels mentally sluggish after the exterior syndrome has resolved, recovery may take about twelve days.
If a patient has high fever yet paradoxically desires more clothing, this indicates heat in the skin and cold in the marrow—true cold with false heat. If the body feels intensely cold yet the patient dislikes covering up, this indicates cold in the skin and heat in the marrow—true heat with false cold.
In Taiyang wind-stroke pattern, the pulse shows floating at the yang position and weak at the yin position (excess on light pressure, insufficiency on heavy pressure), manifesting as fever, spontaneous sweating, huddling chills, dripping aversion to wind, flushing fever, nasal congestion, and dry retching. The ancients treated this primarily with Guizhi Decoction (Cinnamon Twig Decoction).
Guizhi Decoction consists of five ingredients: Guizhi (cinnamon twig), Shaoyao (peony), Gancao (licorice), Shengjiang (fresh ginger), and Dazao (jujube). The ancient record describes the preparation as: cut the herbs into pieces, add seven sheng of water, simmer over low heat until three sheng remain, strain out the dregs, and take one sheng warm. Shortly after taking the decoction, drink one bowl or more of hot thin congee to assist the medicinal strength; cover with bedding to keep warm for approximately one shichen (two hours), aiming for a light moistening sweat over the whole body. Profuse sweating should be avoided, as it will make the disease harder to eliminate. If sweating occurs with the first dose and the condition resolves, stop further doses—do not finish the entire prescription; if no sweating occurs, take another dose following the same method; if still no sweating, shorten the interval between doses and complete all three doses within half a day; for severe cases, continuous administration day and night may be needed while observing changes in the condition. If the entire prescription is finished but the patterns persist, a new decoction may be prepared; if still no sweating, two to three courses may be taken. During the medication period, avoid raw/cold foods, sticky/slippery foods, meat and noodles, the five pungent vegetables, alcohol and dairy products, and foul-smelling foods.
For Taiyang disease manifesting as headache, fever, sweating, and aversion to wind, Guizhi Decoction remains the primary treatment.
If Taiyang disease presents withstiffness and tightness of the nape and back, accompanied by sweating and aversion to wind, Guizhi plus Gegen Decoction is the primary treatment. The formula uses Gegen (kudzu root) as the chief ingredient, combined with Guizhi Decoction to resolve the muscles, generate fluids, and relax the nape and back. The ancient method involves boiling Gegen first and removing the foam, then adding the remaining herbs. Take warm to induce slight sweating; no congee is required. Other care instructions follow the Guizhi Decoction method.
If after erroneous purgation in Taiyang disease, the patient senses a sensation of qi rushing upward, this indicates that the exterior patternstill present—Guizhi Decoction may continue to be used; if there is no upward rushing sensation, it should not be used. In Taiyang disease of three days' duration, if the condition remains unresolved after treatment with sweating, emesis, purgation, and warm-needling, it is called a mishandled disease (huai bing)—at this point the condition is chaotic and one should no longer rigidly adhere to Guizhi Decoction. Instead, one must observe the pulse and manifestations, discern what error was committed, and treat according to the presenting pattern.
The Guizhi Decoction is fundamentally a formula for resolving the flesh (jiē jī) suitable for exterior deficiency with sweating. If the patient has a floating-tight pulse, fever, and no sweating, this is an exterior excess pattern—Guizhi Decoction must not be used. Those who habitually consume alcohol should also avoid Guizhi Decoction, as they tend not to appreciate sweet flavors and are prone to vomiting after taking it. For those with a pre-existing asthma condition who present with a Guizhi Decoction pattern, Houpo (magnolia bark) and Xingren (apricot kernel) may be added. Those who vomit after taking Guizhi Decoction generally have internal heat or damp-heat exuberance—the pungent-warm, sweet treatment should not be continued.
If Taiyang disease is treated with excessive sweating, leading to incessant sweating leaking from the pores, aversion to wind, difficult urination, and slight stiffness of the limbs making flexion and extension difficult, this is due to excessive sweating damaging yang and depleting fluids. Guizhi plus Fuzi Decoction (adding prepared aconite to Guizhi Decoction) is the primary treatment, intended to restore yang and secure the exterior. If after erroneous purgation there is a hurried pulse and chest fullness, this indicates that the exterior pathogen remains unresolved while chest yang has been damaged; Guizhi without Shaoyao Decoction is used; if aversion to cold is also present, Fuzi is added, forming Guizhi without Shaoyao plus Fuzi Decoction.
In Taiyang disease of 8–9 days' duration, if the condition resembles malaria—fever with chills where heat predominates over cold—without vomiting, with normal urination and defecation, occurring two to three times daily: if the pulse is slightly relaxed, this indicates impending recovery. If the pulse is faint with aversion to cold, this belongs to deficiency of both yin and yang—sweating or purgation/emesis should not again be induced. If the face instead shows a heat-flushed color with body itching, the exterior pathogen remains unresolved because mild sweating has not occurred; Guizhi-Mahuang Half-and-Half Decoction may be used to induce a light sweat.
If after taking Guizhi Decoction there is vexation and failure to resolve, one may first needle Fengfu and Fengchi, then administer Guizhi Decoction again. If after taking Guizhi Decoction there is profuse sweating and a surging-large pulse: if the exterior pattern has already resolved and the condition has transformed to interior heat, Baihu Decoction (White Tiger Decoction) is used; if the condition resembles malaria occurring twice daily, Guizhi-Ermahuang-One Decoction is used for mild sweating. If after profuse sweating there is intense vexation and thirst with a surging-large pulse, this indicates dual injury to qi and fluids; Baihu plus Renshen Decoction (White Tiger plus Ginseng Decoction) is used.
In Taiyang disease with fever and aversion to cold where heat predominates over cold: if the pulse is faint and weak, this belongs to absence of yang—sweating must not be induced; if the pulse is floating and large, Guizhi-Eryuebi-One Decoction may be used to mildly induce sweating while clearing interior heat. If after taking Guizhi Decoction or erroneous purgation, the patient still has stiffness and pain of the head and nape, flushing fever, no sweating, fullness with slight pain below the heart, and difficult urination, Guizhi without Gui plus Fuling and Baizhu Decoction is used—focusing on promoting diuresis; when water is eliminated, the exterior becomes unblocked as well.
In cold damage presenting with floating pulse, spontaneous sweating, frequent urination, vexation in the heart, slight aversion to cold, and cramping of the feet—originally a condition of dual deficiency of yin and yang—if Guizhi Decoction is erroneously used to attack the exterior, it will lead to counterflow cold of the extremities, dry throat, vexation and restlessness, and vomiting with retching. At this point, Gancao-Ganjiang Decoction should be administered first to restore yang qi; if the counterflow resolves and the feet become warm, then Shaoyao-Gancao Decoction is used to nourish yin fluids, resolving the foot cramping; if stomach qi disharmony appears with delirium, a small amount of Tiaowei Chengqi Decoction may be given to harmonize the stomach and drain heat; if heavy sweating combined with burning needle treatment has caused yang depletion, Sini Decoction is used to rescue the yang.
Gancao-Ganjiang Decoction consists of licorice and dried ginger, working through pungent-sweet transformation of yang; Shaoyao-Gancao Decoction consists of peony and licorice, working through sour-sweet transformation of yin; Tiaowei Chengqi Decoction consists of licorice, mirabilite (Glauber's salt), and rhubarb, draining heat and harmonizing the stomach; Sini Decoction consists of ginseng, licorice, dried ginger, and prepared aconite, restoring yang and rescuing from collapse.
Someone asks: When the manifestations of Taiyang disease are all present, and treatment following the Guizhi Decoction method instead worsens the condition—producing counterflow cold of extremities, dry throat, vexation, vomiting, and delirium—why is this?
The teacher answers: This is the Yangdan pattern. It is essentially an exterior contraction occurring in a deficient individual and must not be rashly attacked at the surface. The inch (cun) pulse is floating; floating indicates wind, and it also indicates deficiency. Wind can generate heat; deficiency causes sinews and vessels to cramp. If the exterior is erroneously attacked, sweating leads to yang depletion. Excessive sweating exhausts the fluids, and when the sinews lose nourishment, cramping ensues. Yangming dry-heat binding internally produces vexation, restlessness, and delirium. The treatment should first employ Gancao-Ganjiang Decoction to restore yang, then Shaoyao-Gancao Decoction to rescue the fluids, and finally Tiaowei Chengqi Decoction to stop the delirium. This is a mishandled disease requiring treatment according to the presenting pulse and manifestations.
If the Yangdan pattern presents with fever that is not tidal, sweating, dry throat, somnolence with restless sleep, yet quietness after midnight, the ancients used Dihuang-Banxia-Muli-Suanzaoren Decoction; if there is thirst, vexation, reddish urine, and delirium, Zhuye-Shigao-Huangqin-Zexie-Banxia-Gancao Decoction governs. These two formulas also represent the ancients' record of treating Yangdan pattern variations, provided here for study of the principles and methods.
This chapter's core is establishing the diagnostic framework for Taiyang disease and developing treatment for exterior deficiency patterns centered on Guizhi Decoction, along with management of mistreatment and rescue.
First, the General Principles of Taiyang Disease clarify the diagnostic essentials for exterior patterns: floating pulse, stiffness and pain of head and nape, and aversion to cold. From this basis, the distinction is drawn between wind-stroke exterior deficiency and cold-strike exterior excess: sweating with a relaxed pulse indicates wind-stroke; absence of sweating with a tight pulse indicates cold-strike. This distinction determines the intensity of the sweating method chosen.
Second, "Observe the pulse and manifestations, discern what error was committed, and treat according to the presenting pattern" is the most core principle of pattern-based differential treatment in the Shanghan Lun. It acknowledges that mistreatment creates "mishandled diseases," and one cannot simply continue with the original formula but must re-evaluate based on current pulse and manifestations. This embodies a dynamic, individualized approach to diagnosis and treatment.
Third, Guizhi Decoction is not simply a diaphoretic. Through the harmonization of cinnamon twig, peony, ginger, jujube, and licorice, it regulatesnutritive and defensive qi, thereby resolving the flesh and releasing the exterior while preserving yin and harmonizing the nutritive layer. The post-dose practices of drinking warm congee, keeping covered, and seeking light sweating demonstrate the ancients' emphasis on post-medication care—sweating should be "slightly moistened" and never excessive, to avoid damaging the righteous qi.
Fourth, the theme of mistreatment and rescue runs as another important thread through this chapter. Excessive sweating, erroneous purgation, and erroneous application of fire methods all produce pathological transformations involving yang injury, fluid depletion, and yang depletion. Formulas such as Gancao-Ganjiang Decoction, Shaoyao-Gancao Decoction, and Sini Decoction correspond respectively to restoring yang, rescuing yin, and retrieving depleted yang—demonstrating the ancients' layered approach to critical conditions.
Fifth, the discrimination of true cold with false heat versus true heat with false cold reminds us that surface manifestations of hot and cold cannot be taken at face value; one must combine the patient's subjective preferences and overall state to determine the essential nature of the condition.
From a modern viewpoint, the head/nape stiffness and pain, chills, fever, and floating pulse described in Taiyang disease correspond meaningfully to the early-stage symptom complex of acute infectious febrile illness. The distinction between exterior deficiency and exterior excess relates to different types of physiological responses in the early phase of infection, though TCM employs a different pathological model.
Contemporary experimental research on Guizhi Decoction and its derived formulas demonstrates antipyretic, anti-inflammatory, immune-regulating, and microcirculation-enhancing effects. Clinically, it is commonly used for common colds, autonomic nervous system dysfunction, allergic diseases, and other conditions—but strict pattern differentiation is essential. The "light sweating to release the exterior" nursing principle is conceptually compatible with modern recommendations for febrile patients: adequate hydration, avoiding overly aggressive antipyresis, and maintaining a comfortable environment.
The descriptions of warm disease and wind warmth in this chapter reflect ancient observations of febrile disease transmission and consequences of mistreatment. Specific manifestations—"burning heat after sweating," "urinary difficulty, staring eyes, and enuresis after erroneous purgation," "jaundice, seizures, and convulsions after erroneous fire treatment"—show phenomenological correspondence with modern understanding of high fever, dehydration, altered consciousness, and convulsions in critical illness. However, ancient attribution involved "erroneous sweating, purgation, and fire treatment," whereas modern medicine explains these through pathogens, immune responses, and organ dysfunction.
Numbers such as seven-day recovery, six-day recovery, and twelve-day recovery represent the ancients' empirical observations; they may relate to the natural course of some self-limited external-contraction diseases, but cannot be used as clinical predictive criteria. Taiyang disease resolves from Si to Wei hours represents an ancient time-medicine concept with limited modern evidence.
It must be rationally recognized that therapeutic methods mentioned in the original text—fire methods, burning needles, warm needling—are now essentially obsolete and carry risks including infection and burns. Ancient and modern dosages and weights differ; the original formulas must never be used verbatim. Some formulas, such as Sini Decoction, appear in this chapter with ginseng, which differs from common versions—those studying should remain attentive to textual variations.
This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication recommendation, or treatment advice. Please consult a qualified healthcare provider if you are unwell.