Section on Fox Confusion Disease01 Overview of Fox Confusion DiseaseArticle 10: Fox confusion as a disease resembles a cold, with a silent desire to sleep, inability to close the eyes, restlessness when lying down or getting up, ulcers in the throat indicating confusion, ulcers in the lower regions indicating fox, lack of desire for food, aversion to the smell of food, and a face that alternates between red, black, and white. If the upper part is affected, the voice becomes hoarse. The main treatment is Gan Cao Xie Xin Tang (Licorice Decoction to Drain the Heart).Gan Cao Xie Xin Tang Formula 4 Liang of Gan Cao (Licorice), 3 Liang each of Huang Qin (Scutellaria), Ren Shen (Ginseng), Gan Jiang (Dried Ginger), 1 Liang of Huang Lian (Coptis), 12 pieces of Da Zao (Jujube), and 0.5 Sheng of Ban Xia (Pinellia).Combine the seven ingredients with 10 Dou of water, boil to obtain 6 Sheng, strain, and then re-boil. Take 1 Sheng warm, three times a day.①Fox confusion as a disease resembles a cold—The onset of fox confusion disease includes fever and aversion to cold, resembling a cold, which can easily lead to misdiagnosis.②Silent desire to sleep, inability to close the eyes, restlessness—These symptoms, aside from physical conditions, seem to also involve emotional states.③Ulcers in the throat indicate confusion, ulcers in the lower regions indicate fox—Ulcers appearing in the throat are called confusion, while those in the lower regions are called fox. If both the throat and lower regions have ulcers, it is termed fox confusion.④ Lack of desire for food, aversion to the smell of food—Loss of appetite, unable to tolerate the smell of food, combined withsilent desire to sleep, easily reminds one of Xiao Chai Hu Tang syndrome, but clearly, the symptoms of fox confusion disease are much more extensive.⑤Face alternates between red, black, and white—The complexion of a patient with fox confusion changes unpredictably, reflecting internal disharmony of Qi.⑥Ulcers in the upper part lead to hoarseness—Throat ulcers naturally cause hoarseness.⑦ With so many strange symptoms, what is the cause? The etiology of fox confusion disease is damp-heat and insect toxins. Damp-heat causes silent desire to sleep and loss of appetite; insect toxins lead to restlessness and variable complexion. Damp-heat and insect toxins erode the throat above and the lower regions below; why not affect other areas? Perhaps because the upper and lower orifices are the easiest pathways for heat toxins to exit.⑧ Treatment uses Gan Cao Xie Xin Tang. In the formula, we can see the pairs of herbs in Xie Xin Tang: Ban Xia, Huang Qin; Gan Jiang, Huang Lian, which are pungent and bitter to descend. Pungent and drying transform dampness, clear heat, and detoxify. Accompanied by Ren Shen, Gan Cao, and Da Zao to tonify the stomach and support the upright Qi. Gan Cao is used in 4 Liang, and its functions include:Strengthening the spleen and benefiting Qi, as it can supplement the spleen; clearing heat and detoxifying; alleviating pain; harmonizing various herbs. Here, it is clearly used for its heat-clearing and detoxifying effects.Remember that Teacher Nan Dao mentioned in the 2024 live broadcast of “How to Learn Warm Diseases from Scratch” that during treatment, it was discovered that the patient had a small ulcer on the tongue surface, focusing on treating the ulcer. Once the tongue ulcer healed, there was pain during urination, with a sense of ulceration. This confirmed the teacher’s suspicion that this was fox confusion disease, and the formula used was Gan Cao Xie Xin Tang combined with Zhu Ling Tang with modifications. Why combine with Zhu Ling Tang? This will be explained in the following text.For moxibustion, select points at the left San Yin Jiao (Spleen 6) and right Dai Mai (Girdle Vessel), why these points are selected will be explained in the following text. Every step is grounded in the classics.The etiology and pathogenesis of this case of fox confusion disease is a mixture of cold and heat in the middle jiao, leading to stagnation of Qi in the middle jiao. The mixture of cold and heat results in ulcers both above and below. Treatment must not only tonify Yin but also consider the Qi mechanism of ginger, using pungent to open and bitter to descend to treat the middle jiao.02 Local Therapy for Fox Confusion Disease Article 11: If there are ulcers in the lower part, the throat becomes dry; wash with Ku Shen Tang (Sophora Decoction).Ku Shen Tang Formula: 1 Sheng of Ku Shen (Sophora) Combine with 10 Dou of water, boil to obtain 7 Sheng, strain, and wash the affected area, three times a day.①If there are ulcers in the lower part, the throat becomes dry—The main medication for fox confusion disease is in the Jue Yin (Liver) channel, which encircles the lower yin organs, connecting to the lower abdomen and communicating with the throat. This indicates that the heat toxin descends and attacks upwards, causing ulcers in the lower part (anterior yin) and dryness in the upper throat.② Treatment also focuses on the main contradiction in the lower part, using Ku Shen Tang to wash the affected area. Once the heat toxin is resolved, the throat dryness will also heal naturally.③ Ku Shen is bitter and cold in nature. It enters the Heart, Liver, Stomach, Large Intestine, and Bladder channels. Ku Shen has the effects of clearing heat, drying dampness, killing insects, and promoting urination.Article 12: If there are ulcers in the anus, use Xiong Huang (Realgar) for fumigation.Xiong Huang: Grind the previous ingredient into powder, combine with two pieces of tile, burn, and fumigate towards the anus.The “Pulse Classic” states: Patients may have their throat eroded from breathing or have their anus eroded from the lower jiao; erosion above indicates confusion, erosion below indicates fox. For fox confusion disease, Zhu Ling San (Zhu Ling Powder) is the main treatment.①If there are ulcers in the anus, use Xiong Huang for fumigation—Ulcers at the anus are treated with Xiong Huang.②Xiong Huang is pungent, warm, and bitter, and toxic, entering the Liver and Large Intestine channels. For knowledge, the main component of Xiong Huang, disulfide arsenic (As₂S₂), is relatively stable at room temperature, but decomposes into arsenic trioxide (As₂O₃) at high temperatures, which is more toxic. Xiong Huang has the effects of healing sores, killing insects, and treating wind.③ Fox confusion disease is a Jue Yin disease, and the lower yin is governed by the Kidney. Although it erodes the throat above and the anus below, the crux of the disease lies in the Liver and Kidney. Therefore, moxibustion is applied at the left San Yin Jiao and right Dai Mai to nourish the Liver and Kidney, dispel wind, and eliminate damp-heat.④ The “Pulse Classic” mentions using Zhu Ling Tang to treat fox confusion disease, which has the effects of nourishing Yin, clearing heat, and promoting urination, addressing the etiology of damp-heat and Yin deficiency in fox confusion disease.03 Development of Fox Confusion Disease into Yin-Yang Toxins Article 13: The patient has a rapid pulse, no fever, slight irritability, a silent desire to lie down, sweating, and after three to four days of onset, the eyes become red like a dove’s eyes; after seven to eight days, the eyes have yellow and black discoloration. If the patient can eat, it indicates that pus has formed; Chi Dou Dang Gui San (Red Bean and Angelica Powder) is the main treatment.Chi Dou Dang Gui San Formula 3 Sheng of Chi Xiao Dou (Red Bean), soak until sprouts appear, dry in the sun, 3 Liang of Dang Gui (Angelica).Combine the two ingredients, grind into powder, and take a tablespoon with water, three times a day.①The patient has a rapid pulse, no fever, slight irritability, a silent desire to lie down—indicating heat excess.②No fever, sweating—indicating that the disease is not on the surface, but in the Ying and Blood levels.③After three to four days of onset, the eyes become red like a dove’s eyes—indicating heat in the blood level, following the Liver channel to the eyes.④ After seven to eight days, the eyes have yellow and black discoloration—indicating that the whites of the eyes are black and yellow, suggesting internal accumulation of blood stasis.⑤ If the patient can eat, it indicates that pus has formed—heat in the blood has become toxic blood, and toxic blood with damp-heat spreads, affecting the Qi mechanism of the middle jiao, leading to inability to eat. If the patient can eat, it indicates that the toxic blood has formed pus, and the stomach Qi is not affected, hence the ability to eat.⑥ Chi Dou Dang Gui San—Red beans clear heat toxins, disperse evil blood, alleviate irritability, and Angelica replenishes new blood while removing old blood.By this point, Chi Dou Dang Gui San indicates that damp-heat has accumulated into toxins, forming abscesses. The accumulation of damp-heat into toxins is no longer a simple surface ulcer but has developed in the intestines, manifesting in the eyes. The “Heart Classic” states: Fox confusion and Yin-Yang toxins share the same origin but differ in flow. We can see that from fox confusion to Yin-Yang toxins, the condition progresses from oral and throat ulcers to red eyes and blackened whites; from lower yin ulcers to intestinal abscesses. The intensified version of fox confusion disease, the transition from Qi level to Blood level becomes Yin-Yang toxins.Section on Fox Confusion Disease and Yin-Yang ToxinsYin-Yang Toxins01 Overview of Yang Toxins Article 14: Yang toxins as a disease present with a red, mottled face like brocade, throat pain, expectoration of pus and blood; it can be treated within five days, but not after seven days. Sheng Ma Bie Jia Tang (Cimicifuga and Turtle Shell Decoction) is the main treatment.Sheng Ma Bie Jia Tang Formula 2 Liang of Sheng Ma (Cimicifuga), 1 Liang of Dang Gui (Angelica), 1 Liang of Shu Jiao (Sichuan Pepper) (stir-fried to remove sweat), 2 Liang of Gan Cao (Licorice), and a piece of Bie Jia (Turtle Shell) the size of a finger, roasted, and 0.5 Liang of Xiong Huang (Realgar), ground together. Use 4 Sheng of water, boil to obtain 1 Sheng, and take it all at once; the elderly and children can take it again. Induce sweating.①Yang toxins as a disease present with a red, mottled face like brocade, throat pain, expectoration of pus and blood—The main symptoms of Yang toxins. The etiology is heat excess in the blood level, hence the red and mottled face; heat scorches the throat, causing pain; heat excess leads to flesh rotting and pus formation, hence expectoration of pus and blood.②It can be treated within five days, but not after seven days—Early detection and treatment are crucial; do not delay.③Sheng Ma Bie Jia Tang is the main treatment—In the formula, Sheng Ma and Gan Cao clear heat and detoxify; Bie Jia and Dang Gui nourish Yin and disperse stasis; Xiong Huang and Shu Jiao detoxify. This formula clears heat, detoxifies, and disperses stasis.02 Overview of Yin Toxins Article 15: Yin toxins as a disease present with a greenish face, body pain as if beaten, throat pain; it can be treated within five days, but not after seven days. Sheng Ma Bie Jia Tang minus Xiong Huang and Shu Jiao is the main treatment.①Yin toxins as a disease present with a greenish face, body pain as if beaten, throat pain—The main symptoms of Yin toxins. Blood stasis leads to obstruction of blood vessels, resulting in a greenish face; poor blood flow leads to body pain; blood toxicity accumulates in the throat, causing throat pain.②It can be treated within five days, but not after seven days—Early detection and treatment are crucial; do not delay.③ Sheng Ma Bie Jia Tang minus Xiong Huang and Shu Jiao is the main treatment—In the treatment, Sheng Ma and Gan Cao clear heat and detoxify; Bie Jia and Dang Gui nourish Yin and disperse stasis without change. Remove Xiong Huang and Shu Jiao to prevent damage to Yin Qi.④ The Yin and Yang of Yin-Yang toxins do not refer to cold and heat, nor to exterior and interior, but are differentiated based on symptoms. The etiology and pathogenesis of Yin-Yang toxins are the same, both caused by the invasion of epidemic toxins leading to internal disharmony of Qi, Blood, Yin, and Yang. The disease is located in the blood vessels, in the blood level. Both use Sheng Ma Bie Jia Tang to clear heat and detoxify, invigorate blood, and resolve stasis. The decision to add or remove Xiong Huang and Shu Jiao depends on the presentation.That concludes today’s discussion.
