After listening to Teacher Tu Huaxin’s explanation of the Yin-Yang Toxic Decoction, I gained a significant understanding of this formula’s patterns. However, the key application of this formula lies in the pulse diagnosis, specifically the arterial pulse. This aspect has always been difficult to grasp. Now, I would like to share my insights.
First, I will introduce the notes on the Yin-Yang Toxic Decoction as follows:
From the “Essentials of the Golden Chamber: The Pulse Patterns and Treatments of Yin-Yang Toxic Diseases”
14. The disease of Yang Toxicity (阳毒) is characterized by a red, mottled face like brocade, sore throat, and expectoration of pus and blood. It can be treated within five days, but not after seven days. The formula Shengma Bieja Decoction (升麻鳖甲汤) is indicated.
15. The disease of Yin Toxicity (阴毒) presents with a bluish face, body pain as if beaten, and sore throat. It can be treated within five days, but not after seven days.
Note: ① Toxicity: merely a symptom designation. ② Expectoration of pus and blood: indicates heat-type secretions or bleeding symptoms. ③ The number five corresponds to the Xun hexagram, which signifies wind and ease of transmission, indicating that during the disease’s development phase, treatment is possible. The number seven corresponds to the Gen hexagram, which represents earth, where nothing can be transmitted again, indicating that if the stomach qi does not return, treatment is not possible. ④ Being beaten: refers to pain similar to that experienced after a beating, such as post-COVID body pain and sore throat. Red spots and sore throat indicate Yang toxicity, with the measurement around the Bieja (tortoise shell) being one finger’s width.
The formula consists of:
Bieja (crushed) 30g, Danggui (Angelica sinensis) 15g, Shengma (Cimicifuga) 30g, Gancao (Licorice) 15-30g, Xionghuang (Realgar) 7g, Chuanjiao (Sichuan Pepper) 15g.
Boil in 800ml of water, soak thoroughly, and simmer on low heat for 40 minutes until reduced to 200ml. Take the entire dose at noon to induce a slight sweat. For children, divide into two doses (afternoon and evening). If there is body pain and sore throat with a bluish complexion, the Yin Toxicity is severe. Use the above formula as prescribed, ensuring to remove the Xionghuang carefully.
Formula explanation: Shengma clears heat and detoxifies, Gancao detoxifies and retains fluids, Danggui both nourishes and invigorates blood (Xionghuang detoxifies and kills parasites but can easily cause headaches when taken internally. Chuanjiao mitigates the toxicity of Xionghuang and reduces side effects). Bieja detoxifies, protects the liver, and resolves symptoms. All ingredients are detoxifying herbs, and they all enter the liver meridian. Therefore, this formula is also the best liver-protecting medicine. If Xionghuang is not used, then Chuanjiao is not needed. Both can be replaced with 15g of Jiegang (Platycodon), which treats Shaoyin sore throat and helps expel pus and detoxify, aligning well with the Yin-Yang Toxicity pattern. Precautions:
1. Shengma must be the northern variety, which needs to be identified. 2. Boil the water down to below 200ml; it must be taken hot at noon to induce a slight sweat. 3. Gancao has a fluid-retaining effect; for patients with hypertension or edema, the dosage can be reduced to 15g. 4. For those with exterior symptoms, a slight sweat must be induced. 5. For severely ill patients, the dosage can be increased to 1-6 doses per day.
Pattern and symptoms:
① Toxicity as a disease → epidemic toxins (vaccines), various viruses, hepatitis viruses, etc., and severe cancers. ② Exterior symptoms: epidemic toxins or common viral bacterial infections first attack the exterior, presenting with fever, body pain, sore throat, etc., which are highly infectious and easily enter the blood, hence the presence of blood symptoms. (Lung system: rhinitis, runny nose, pharyngitis, sore throat, etc.; the lungs open to the skin, and skin diseases can also be observed, such as dark skin, rashes, eczema, etc.) ③ Blood stasis pattern: fever in the evening, worse at night, tenderness in the lower abdomen, a feeling of fullness (if the abdomen is not full, the person will say they are full, indicating blood stasis), palms feel hot, lips and mouth dry (wanting to rinse but not swallow), dark complexion. The skin on the shins is dry, and if the skin is severely dry, it resembles snake skin or fish scales. The tongue base shows stasis veins and stasis threads. ④ Residual symptoms of epidemic toxins after the exterior symptoms have subsided. ⑤ Pulse: arterial. The Yin-Yang toxic pulse is the same.
The interaction of Yin and Yang is called movement. When Yang moves, sweating occurs; when Yin moves, fever occurs. If the body feels cold and has chills, this indicates damage to the Sanjiao (Triple Burner). If the pulse is rapid and appears at the joints, with no head or tail, resembling a bean, and feels faint and shaky, it is called movement.
Body condition poem: The arterial pulse is rapid and appears at the joints, with no head or tail, resembling a bean-shaped cluster. Its essence is the interaction of Yin and Yang; the weak pulse shakes while the strong pulse remains steady. ⑥ Body constitution state: epidemic toxin exterior + blood stasis. Heat symptoms transform into heat-type Yin-Yang Toxic Decoction (expectoration of pus and blood). If the constitution is weak and fatigued, 60-120g of Xianhecao (Hedyotis) can be added. Cancer constitution: the pulse may be thin and attached to the bone (accumulated pulse), with a rapid pulse (the pulse is rapid and fluctuating, indicating the disease is in a developmental window, and treatment must be grasped). Merging with the marks of the shell, black spots on the palms.
From this, it can be seen that blood stasis patterns can present with arterial pulses. But what is the arterial pulse? In the past, it was imagined to be bean-sized, appearing at the joints, with no head or tail. It seems to be only concentrated at the joints. The key point is that it is rapid and feels faint and shaky, similar to a rapid and slippery pulse.
I encountered two patients with very similar constitutions. One was a patient with the surname Liu, who complained of chest tightness, watery eyes, and high blood pressure. At that time, the recorded pulse was deep and slippery. He had poor sleep, a red complexion, and red veins on his cheeks and nose tip. His palms felt hot, and the thenar area was red. He easily sweated on his chest and head. The tongue was slightly red with a thin white coating, and the base of the tongue showed significant stasis, which could not be described as merely stasis; the blood stasis was particularly evident. I used the Xuefu Zhuyu Decoction (Blood Mansion Eliminating Stasis Decoction) with added Chrysanthemum for five doses, which improved his chest tightness and watery eyes. Later, under a friend’s guidance, I gave him the Bentun Decoction (Running Pig Decoction), which improved his sleep and blood pressure. At that time, I was still wondering why a slippery pulse is often seen with phlegm-dampness, but this patient did not have phlegm-dampness symptoms. However, the choppy pulse indicated blood stasis; how could this patient present with a slippery pulse?
Now I encountered another patient, surnamed Lou, aged 73. He complained of chest pain and had a history of cerebral infarction. His initial pulse was also deep and slippery, but it was somewhat different from the usual slippery pulse. Limited by my understanding, I wondered if it could be phlegm-damp obstruction? But upon examining the tongue, there were no signs of phlegm-dampness. The tongue was slightly red, with a thin coating, not swollen, and had no tooth marks. The base of the tongue showed stasis veins and stasis threads. He had poor sleep, normal urination and defecation, occasional bitter mouth, and at night, he often felt thirsty and wanted to drink water. His palms were hot, and the thenar area was red. I diagnosed him with a Bentun Decoction pattern of Shaoyang depression heat combined with blood stasis, along with a Dan Shen Decoction pattern for chest pain.
Because these two patients had very similar constitutions and pulse patterns, I referred to the “Medical Classic of the Golden Mirror” for the explanation of the arterial pulse: the appearance of the arterial pulse is quite similar to a rapid pulse, but it has no head or tail, resembling a bean, and feels faint and shaky, hence the name movement. The term “faint and shaky” refers to a movement that seems to have roots, moving without displacing, unlike the flowing sensation of a slippery pulse, which moves without settling.
Now, looking back at the pulse patterns of the two patients, how similar they are to the classical descriptions.
The arterial pulse is often associated with blood stasis patterns, and the typical pulse pattern of the Yin-Yang Toxic Decoction is the arterial pulse, which is why I have recorded these notes on the formula.