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Click to view: Article 47: Taiyang disease, pulse is floating and tight, fever, no sweating, those with spontaneous bleeding recover.
Article 48: When both Yang diseases occur, at the initial stage of Taiyang disease, induce sweating; if sweating occurs but is not thorough, it then transitions to Yangming. If there is continued slight sweating, there is no aversion to cold. If the Taiyang disease does not resolve, do not purge; purging would be counterproductive, thus slight sweating may be appropriate. If the complexion is bright red, it indicates that Yang Qi is constrained at the surface, and it should be resolved through steaming. If sweating is not thorough, it is insufficient to say; Yang Qi is constrained and cannot be released, thus one should not sweat. The person is agitated and does not know where the pain is, sometimes in the abdomen, sometimes in the limbs, and pressing does not yield results; the person is short of breath and can only sit due to insufficient sweating. Further sweating would lead to recovery. How do we know sweating is not thorough? It is known by the pulse being rough.
“When both Yang diseases occur, at the initial stage of Taiyang disease, induce sweating; if sweating occurs but is not thorough, it then transitions to Yangming. If the Taiyang disease does not resolve, do not purge; purging would be counterproductive, thus slight sweating may be appropriate.” This passage mainly discusses the condition of both Yang diseases.
What is meant by concurrent diseases? In Zhang Zhongjing’s writings, it refers to the transmission from exterior to interior, or a half-exterior, half-interior transmission. Concurrent Yang diseases refer to the transmission of Taiyang disease to Yangming, where the exterior and interior are interconnected. When the interior is affected while the exterior symptoms have not resolved, this is termed concurrent disease. First the exterior, then the interior; if the exterior has not resolved and the interior symptoms appear, it is termed concurrent disease. The term ‘concurrent’ refers to the merging of diseases, similar to how “Qin unified the six states.”The first disease occurs alongside the second disease, hence it is called concurrent disease.
Concurrent Yang diseases refer to the simultaneous presence of Taiyang and Yangming diseases. It states, “At the initial stage of Taiyang disease, sweating should be induced; however, if sweating occurs but the disease does not improve, this ‘not thorough’ indicates that the disease has not been eliminated, thus transitioning to Yangming.
It is not that sweating should not be induced; if there is a severe exterior condition, inducing sweating is appropriate and can alleviate the severity of the disease. However, if the disease is severe, it may not improve. If it is a mild disease, then it is not a problem. For instance, when encountering a cold, a mild Taiyang disease can be treated with ginger water, and slight sweating can be beneficial. However, in the case of a severe disease, following the proper treatment may still not yield improvement. This is often due to being in a half-exterior, half-interior state, where the interior needs to be addressed.
This describes a situation where the initial Taiyang disease was treated according to the law of inducing sweating, and although sweating was induced, the disease did not improve, leading to a transition to Yangming.
“Continued slight sweating” reflects an external symptom of Yangming disease, which we will discuss in the Yangming section. “Yangming disease, the treatment often involves sweating,” as Yangming disease indicates heat accumulation in the stomach and intestines. Heat accumulates internally and manifests externally, leading to continuous sweating. “Continued slight sweating” indicates a persistent, gentle sweating, which signifies the transition to Yangming disease.
Since concurrent disease exists, and the Taiyang disease is still present, we should not hastily use purgatives. If we observe that the Taiyang disease is still present, with body aches and aversion to cold, this indicates that purging is inappropriate; purging would be counterproductive.Yangming disease should be purged, but if the exterior symptoms are still present, purging is not appropriate; this is a definitive principle.Thus, we must first resolve the exterior.To purge would be counterproductive, as it would be a misapplication of treatment.
What medicine should be used to induce sweating? Of course, we should use Gui Zhi Tang (Cinnamon Twig Decoction), which can induce slight sweating, “continued slight sweating.” We have discussed Gui Zhi Tang extensively.Any exterior symptoms following the loss of body fluids should be treated with Gui Zhi Tang. Although this is not explicitly stated in the text, it implies the use of Gui Zhi Tang.
If the complexion is bright red, it indicates that Yang Qi is constrained at the surface, and it should be resolved through steaming. This is another segment. It states that during the period of Taiyang disease, after inducing sweating, some may transition to Yangming, resulting in concurrent Yang diseases.
If a person has a “bright red complexion,” it indicates that the exterior has not been resolved; Yang Qi is constrained at the surface, and sweating has not occurred. This is unrelated to concurrent Yang diseases. “It should be resolved through steaming,” meaning that a slight sweating method should be used to resolve it. We previously discussed the Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Decoction), which is suitable for this situation. Steaming can also be done; the ancients used herbs like Jing Jie (Schizonepeta) and Ai Ye (Mugwort) for steaming, boiling them in a basin and covering the body with a blanket to induce slight sweating.“Resolved through steaming” refers to a slight dosage of sweating medicine to alleviate the constrained exterior evil, which does not concern the interior. Alternatively, steaming can be done to induce slight sweating.
“If sweating is not thorough, it is insufficient to say; Yang Qi is constrained and cannot be released, thus one should not sweat. The person is agitated and does not know where the pain is, sometimes in the abdomen, sometimes in the limbs, and pressing does not yield results; the person is short of breath and can only sit due to insufficient sweating. Further sweating would lead to recovery. How do we know sweating is not thorough? It is known by the pulse being rough.”
This segment fundamentally indicates that insufficient sweating leads to the persistence of the disease.“Insufficient to say, Yang Qi is constrained and cannot be released,” indicates that the bright red complexion is a minor exterior symptom that has not resolved. This is when sweating should still be induced. Observe that the person is agitated. The agitation indicates that the exterior has not resolved, leading to severe agitation, which means sweating should be induced. The body aches everywhere, with no specific location; this is an exterior symptom, with generalized soreness.They do not know where the pain is; sometimes it is in the limbs, sometimes in the abdomen, but pressing does not yield results.
Due to the unresolved exterior, sweating does not occur, causing Qi to surge upwards, leading to “shortness of breath and only sitting,” as the lack of sweating causes difficulty in breathing. The heat surges upwards, thus in this situation, further sweating is necessary.This situation resembles the Da Qinglong Tang (Major Blue Dragon Decoction) syndrome, which must be treated with Da Qinglong, as there is agitation without sweating.
How do we know this is due to insufficient sweating? It is indicated by the “rough pulse.” The rough pulse is generally interpreted as a result of the evil being too strong, obstructing the flow of blood, leading to a rough pulse. However, in my observation, the rough pulse often indicates some issues.The rough pulse is a response to the flow of blood within; all rough pulses indicate deficiency.It is rare to see a rough pulse in a truly full condition; it should be a floating or tight pulse, which is more accurate. There are many typographical errors in this text, and I will set this aside for now. You can see that various interpretations all align with my previous statement, suggesting that due to the strong exterior condition, sweating does not occur, and blood flow is obstructed, leading to a rough pulse. However, I believe this is a superficial interpretation of the ancients’ writings and may not necessarily be correct, but this is not important.
In cases of agitation without sweating, even a little sweating would resolve the issue, and this is unrelated to concurrent Yang diseases.Concurrent Yang diseases refer to the initial stage. The initial Taiyang disease, treated according to the law of inducing sweating, may still not resolve, leading to a transition to Yangming. If the exterior symptoms have not resolved, Yangming disease will manifest, thus the continued sweating indicates an external symptom of Yangming disease. How should we treat this concurrent disease? Of course, the exterior symptoms must be resolved first. We must observe how the concurrent disease presents in the interior.
Concurrent Yang diseases refer to the simultaneous presence of Taiyang and Yangming diseases.If there are exterior symptoms and the interior is deficient and cold, as in the case of Shaoyin and Taiyin concurrent diseases, one should not first resolve the exterior.
There are also cases where Taiyang disease transitions to Taiyin, indicating interior deficiency and cold; in such cases, one should not first resolve the exterior but should first rescue the interior. This has been previously discussed. If there is diarrhea with clear fluids, but the body aches, one must first rescue the interior before treating the body aches. Body aches are exterior symptoms, indicating that the exterior has not resolved. This is quite important in clinical practice, as it is a definitive principle. In clinical practice, if a person has not had a bowel movement for several days, and the interior is clearly full, but they still have a fever and aversion to cold, the exterior symptoms have not resolved; do not hastily give them purgatives, but first resolve the exterior. After resolving the exterior, then one can purge the interior.Thus, the ancients had a saying: “Purging should not be rushed,” meaning that for diseases that require purging, delaying is not harmful.If there is a deficiency and cold condition in the interior, even with exterior symptoms, one must prioritize rescuing the interior; this is a definitive principle in clinical practice.If one does not adhere to this method, it would be counterproductive, and recovery would not occur; this is something we must understand.
As for the rough pulse, I believe it is a typographical error.However, various interpretations do not suggest it is an error; they simply provide an explanation that states it is due to excessive fullness, causing blood flow obstruction, hence the rough pulse.
Recommended: Discussing the myriad changes, ultimately revolving around Yin and Yang, exterior and interior.
Recommended: Prioritizing the interior over the exterior and preserving body fluids is the true essence.