An Overview of the Six Patterns of Differentiation and Treatment for Exogenous Diseases

Introduction: In Traditional Chinese Medicine (TCM), it is essential to emphasize the principle of differentiation and treatment based on syndrome differentiation. In the prevention and treatment of exogenous diseases, it is crucial to adapt to objective facts, considering factors such as time, place, and individual conditions, and to avoid a one-size-fits-all approach. During different stages of disease progression, timely adjustments to herbal formulas must be made according to the degree of the body’s righteous and evil forces, the changes in cold and heat, deficiency and excess, as well as the depth and severity of the condition, strictly following the inherent rules of TCM and employing TCM thinking for diagnosis and treatment.Structure Explanation: Part One: Overview of common symptoms of exogenous diseases; Part Two: Discussion on whether certain exogenous diseases belong to cold damage or warm disease; Part Three: Exploration of general herbal formulas for early intervention in certain exogenous diseases or influenza; Part Four: An overview of treating exogenous diseases using the “Six Patterns of Differentiation” (for discussion purposes only, not definitive).1. Common Symptoms of Exogenous Diseases Exogenous diseases present a variety of symptoms, which can vary seasonally, regionally, and individually due to differences in climate, geography, and personal constitution. Therefore, specific analysis is required for each clinical case. Common manifestations of exogenous diseases include: body aches, shoulder and back discomfort, limb soreness, fatigue, dizziness, headache, dry cough with little phlegm, dry and sore throat, bitter taste in the mouth, thirst, red eyes, poor appetite (or even no appetite), nausea, abdominal distension, diarrhea, mild chest tightness, severe shortness of breath (or even difficulty breathing), possible fever or no fever (usually presenting as low to moderate fever, with very few cases showing high fever), possible chills or no chills; some patients may not exhibit typical symptoms or may only have mild fatigue that is hard to detect.2. Discussion on Whether Certain Exogenous Diseases Belong to Cold Damage or Warm Disease For the treatment of exogenous diseases, the overall approach can follow the teachings of the medical sage Zhang Zhongjing in the “Shang Han Za Bing Lun” (Treatise on Cold Damage and Miscellaneous Diseases). In the preface of the “Shang Han Za Bing Lun,” it is mentioned:

“ My clan has many members, and since the Jian’an era, there have been fewer than two hundred, yet more than two-thirds have died, with seven out of ten due to cold damage. Reflecting on the past losses and the inability to save those who died young, I diligently sought ancient teachings, gathering various formulas, compiling the “Suwen,” “Nine Volumes,” “Eighty-One Difficulties,” “Yin Yang Great Treatise,” and “Tai Lu Medicine Record,” and through pulse diagnosis and syndrome differentiation, I compiled the “Shang Han Za Bing Lun” into sixteen volumes.”

From the preface, it is clear that this book is a classic TCM work for the prevention and treatment of epidemic and infectious exogenous diseases as well as miscellaneous internal diseases. The term “cold damage” in the “Shang Han Za Bing Lun” encompasses a wide range. The “Nan Jing – Difficulty 58” states: “Cold damage has five types: wind stroke, cold damage, damp warmth, heat disease, and warm disease, each causing different suffering,” thus encompassing both the narrow definition of cold damage and warm disease within Zhang Zhongjing’s broader concept of “cold damage.” In the “Shang Han Za Bing Lun – Cold Damage Examples,” there are discussions on both the narrow cold damage and warm disease. For example: “ Those harmed by the seasonal qi can all become ill; those who suffer from cold damage are affected by the most severe and lethal qi. If one becomes ill immediately, it is called cold damage; if not, the cold toxin hides in the skin and transforms into warm disease in spring, and into summer heat disease in summer, where heat is more severe than warmth.” This refers to the narrow definition of cold damage.Regarding warm disease, it is discussed: “ When qi is improperly received, it becomes very cold in early winter, and dryness is retracted within, causing qi to hide in the jueyin. After the winter solstice, the weather should be cold but instead becomes warm, leading to warm disease, called winter warmth. In spring and autumn, warm disease is common; in winter, it is a variation. When winter should store essence, qi loses its proper state, and in spring, yang qi emerges, and the two qi clash, causing illness, yet the physician does not understand the source of the disease for treatment, leading to the spread of epidemic.””Here, both cold damage and warm disease fall under the broad category of “cold damage” in the “Shang Han Za Bing Lun,” referring to severe infectious diseases.At the same time, the “Shang Han Za Bing Lun” is also patient-centered in treating miscellaneous internal diseases, with the most prominent characteristic being the holistic view and syndrome differentiation. For instance, the ancient version of the “Shang Han Za Bing Lun” discusses: “Cholera syndrome has deficiency and excess, depending on the individual’s inherent deficiency and excess, the syndrome changes accordingly.” The disease syndrome varies due to individual constitution differences.In fact, this is true for all diseases, as discussed in the “Yi Zong Jin Jian – Differentiating Tai Yin Disease Pulse and Syndrome” which states: “ The six qi evils affect people similarly, but why do individuals develop different diseases? It is because the human form has thickness and thinness, qi has abundance and deficiency, and organs have cold and heat. The evil one receives transforms according to the individual’s organ qi, thus leading to different diseases. Therefore, some transform from deficiency, some from excess, some from cold, and some from heat. It is like water and fire; when water is abundant, fire is extinguished, and when fire is abundant, water is consumed; things transform according to their abundance, which is a natural principle.”” Patients with different constitutions, even with the same pathogenic evil and the same disease name, will exhibit different pathogenesis due to the different yin-yang states of their constitutions, thus treatment plans should also vary from person to person, which is the principle of “same disease, different treatment.” Therefore, when guiding the treatment of diseases caused by “evil toxins,” the “Shang Han Za Bing Lun” places greater emphasis on protecting the body’s foundation. Although the external “evil toxins” may have the same cause, their effects on different bodies will vary. One cannot focus solely on the disease name and symptoms while neglecting the body’s constitution. Only by considering both can one treat the disease and seek the root cause. Thus, from the perspective of the “Shang Han Za Bing Lun” six patterns of differentiation, we will summarize the prevention and treatment of exogenous diseases based on the etiology, location of the disease (exterior, middle, interior), and nature of the disease (yin, yang), disease progression to provide a framework for treatment, while in specific diagnosis and treatment, flexibility and adaptability should be applied according to specific situations.3. Prevention and Early Treatment of Diseases In cases of abnormal climate or initial onset of disease (note: severe infectious diseases must be ruled out), with mild symptoms, it is especially important to pay attention and promptly implement general preventive measures:

• If feeling slightly cold, fatigued, and lacking appetite, one can use “Shen Xian Tang” (Immortal Soup) or other common kitchen ingredients to make soup for internal consumption. One can also use granules for wind-cold flu, flu dispersing granules, Ge Gen Tang (Kudzu Decoction) granules, or Jing Fang granules based on syndrome differentiation.

• If experiencing significant chills and cough, one can take Xiao Qing Long granules;

• If there is slight internal heat, one can consider using granules for clearing heat from colds or Lianhua Qingwen granules.

• If one has a weak stomach and diarrhea from eating cold foods, one can take Fu Zi Li Zhong Wan (Aconite Decoction for Strengthening the Middle) in conjunction;

• If there is thick and greasy tongue coating with nausea and gastrointestinal discomfort, one can try Huo Xiang Zheng Qi Shui (Agastache Correcting Qi Water) or granules;

• If one is prone to sweating due to a weak constitution, one can take Yu Ping Feng granules (Jade Windscreen Granules) in conjunction;

• If one has a cold constitution or low immunity, one can also consider moxibustion.

In summary, for prevention and medication during the initial stage of exogenous diseases, warm and pungent herbs that promote sweating and expel evil are essential; one should not abruptly use cooling and detoxifying herbs, as excessive cold may lead to retaining the evil!

3.1 Shen Xian Tang Recipe

Six slices of ginger, three jujubes, four sections of scallion (length and thickness similar to a middle finger), one small spoon of brown sugar, a few drops of vinegar, and for those with weak spleen and stomach, a small pinch of japonica rice can be added. Boil into a soup, strain out the dregs, and drink warm. After drinking the soup, cover oneself with a blanket to sweat slightly, avoid wind, and eat a light diet. (Adjust dosage for children.)This formula can warm the spleen and stomach, tonify qi and blood, and disperse evil qi, making it suitable for those with poor appetite, chills, and initial body aches. To help remember this formula, we have composed a simple rhyme:Shen Xian Tang uses six slices of ginger, four scallions and three jujubes with brown sugar. Boil well, add a little vinegar, drink warm to sweat and recover.

3.2Cold Constitution or Initial Chills with body aches, and significant runny nose, moxibustion on the Dazhui point can also be performed.

Specific operation: Take one moxa stick, light it, hold it over the Dazhui point, maintaining a moderate distance to avoid burns, and perform moxibustion for about 30 minutes until one sweats slightly. During the operation, avoid exposure to cold.Dazhui point location: Dazhui point is located in the depression below the spinous process of the seventh cervical vertebra.

Image source from the internet

3.3For Initial Exogenous Symptoms (must rule out severe infectious diseases) with chest tightness, cough, chills, fever, headache, and body aches, without significant cold or heat symptoms,(to be used under the guidance of a TCM physician) try this formula for prevention and treatment:

Jing Jie 10g, Fang Feng 10g, Chao Zhi Ke 10g, Fu Ling 10g, Ren Shen 10g, Chai Hu 10g, Qian Hu 10g, Jie Geng 10g, Zhi Gan Cao 6g, Qiang Huo 6g, Du Huo 6g, Bo He 3g, Chuan Xiong 6g, Zi Wan 10g, Kuan Dong Hua 10g, Huo Xiang 6g, and Cang Zhu 10g, Sheng Jiang 15g, Da Zao 10g.4. Overview of the Six Patterns of Differentiation and Treatment for Exogenous Diseases4.1. Disease Located in the Exterior When the disease is located in the exterior, it generally refers to the initial stage of the pathogenic evil, which has not yet entered the interior. This stage is particularly important, thus there are many analyses and prescriptions related to it in the “Shang Han Lun” and this article, and timely treatment can yield quick results, aligning with TCM’s principle of “treating diseases before they manifest.” The principle of treatment at this stage is to “expel the evil from the exterior.” Since the disease enters from the exterior (the skin, mouth, nose, and conjunctiva are all considered the TCM “exterior”), it should also be expelled from the “exterior.” It is crucial to avoid the rash use of excessively cold and detoxifying drugs at inappropriate stages. If treatment is not appropriate, it can easily delay the disease mechanism and even lead to the evil entering the interior, causing serious consequences.4.1.1 For Yang Conditions in the Exterior, Treat According to Tai Yang Disease“Tai Yang disease is characterized by a floating pulse, stiff neck, and aversion to cold.” Tai Yang disease represents the initial stage of yang syndrome, where the pathogenic evil is just beginning, and the struggle between the righteous and the evil is fierce. The key points for differentiation are: aversion to cold and fever, floating pulse, body aches, yang qi is not deficient, and the spirit is still relatively good. Symptoms at this stage often include aversion to cold, limb soreness, fatigue, aversion to cold and fever occurring together, floating or tight pulse (floating, rapid, floating, slippery, floating, tight, or sinking, tight, sinking, thin) and other pulse types. If the patient has a strong constitution, a rosy complexion, bright eyes, warm hands and feet, and presents with symptoms such as body aches, shoulder and back discomfort, limb soreness, fatigue, red eyes, headache, pale red tongue with thin white coating, and floating or slippery pulse, treatment can be based on Tai Yang disease exterior syndrome.4.1.1.1 If the above symptoms are mild, one can take Gui Zhi Ma Huang Ge Ban Tang, and if the main symptoms are significant shoulder and back heaviness with no sweating and aversion to cold, one can use Ge Gen Tang.[Treatment Method] Expel the evil from the exterior.[Reference Prescriptions] Ge Gen Tang, Gui Zhi Ma Huang Ge Ban Tang[Common Prescription Dosage] Gui Zhi Ma Huang Ge Ban Tang: Gui Zhi 15g, Sheng Bai Shao 15g, Zhi Gan Cao 10g, Sheng Ma Huang 9g, Chao Xing Ren 15g, Sheng Jiang 15g, Da Zao 15g.Ge Gen Tang: Ge Gen 30g, Gui Zhi 15g, Sheng Bai Shao 15g, Zhi Gan Cao 10g, Sheng Ma Huang 10~15g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding).4.1.1.2 If there is poor appetite or even no appetite, nausea, chest tightness, abdominal distension, and vomiting, one can use Ge Gen Jia Ban Xia Tang.[Treatment Method] Expel the evil from the exterior, descend the qi, and stop vomiting.[Reference Prescription] Ge Gen Jia Ban Xia Tang[Common Prescription Dosage]Ge Gen Jia Ban Xia Tang: Ge Gen 30g, Gui Zhi 15g, Sheng Bai Shao 15g, Zhi Gan Cao 10g, Sheng Ma Huang 10~15g, Qing Ban Xia 15~30g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding).4.1.1.3 If symptoms are similar, but the patient has sweating, and the pulse is not tight but rather soft and gentle, one can use Gui Zhi Jia Ge Gen Tang.[Treatment Method] Harmonize the nutritive and defensive qi, expel the evil and resolve the muscles.[Reference Prescription] Gui Zhi Jia Ge Gen Tang[Common Prescription Dosage]Gui Zhi Jia Ge Gen Tang: Ge Gen 30g, Gui Zhi 15g, Sheng Bai Shao 15g, Zhi Gan Cao 10g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding).

4.1.1.4 If accompanied by vomiting, abdominal distension, and poor appetite, add Qing Ban Xia 15g; if there is significant thirst, with severe fluid deficiency, remove Ge Gen and add Tian Hua Fen 30g.

4.1.1.5 If the tongue coating is slightly yellow and greasy, or white and greasy, with a sticky feeling in the mouth, chest tightness, slight aversion to cold, and good spirit, one can treat according to Tai Yang disease with dampness.[Treatment Method] Expel the evil and transform dampness.[Reference Prescriptions] Ma Xing Yi Gan Tang, Huang Qi Gui Zhi Fu Ling Xi Xin Tang[Common Prescription Dosage] Ma Xing Yi Gan Tang: Sheng Ma Huang 10g, Chao Xing Ren 15g, Sheng Yi Yi Ren 30g, Zhi Gan Cao 10g. Huang Qi Gui Zhi Fu Ling Xi Xin Tang: Sheng Huang Qi 20g, Fu Ling 30g, Gui Zhi 15g, Xi Xin 3g.4.1.1.6 If there are significant chills and body aches with thick and greasy tongue coating, and floating tight pulse, one can use Ma Huang Jia Bai Zhu Tang.[Treatment Method] Expel the evil, eliminate dampness, and relieve pain.[Reference Prescription] Ma Huang Jia Bai Zhu Tang[Common Prescription Dosage] Ma Huang 12g, Gui Zhi 10g, Chao Xing Ren 15g, Zhi Gan Cao 10g, Sheng Bai Zhu 15g.4.1.1.7 If the tongue coating is slightly yellow and the tongue body is slightly red, with mild aversion to cold and signs of internal heat, such as thirst and preference for cold, warm hands and feet, good spirit, and slight irritability, treat according to Tai Yang disease with damp heat.[Treatment Method] Expel the evil, transform dampness, and clear heat.[Reference Prescriptions] Ma Xing Yi Gan Tang combined with Ma Xing Shi Gan Tang[Common Prescription Dosage]

Ma Huang 10g, Chao Xing Ren 15g, Sheng Yi Yi Ren 20g, Sheng Shi Gao 18g, Zhi Gan Cao 10g.

4.1.1.8 If accompanied by dry cough with little phlegm or excessive phlegm, nausea, poor appetite, white thick tongue coating, and floating string tight pulse, treat according to Tai Yang disease with cold dampness.

[Treatment Method] Expel the evil, eliminate dampness, and warm the water.[Reference Prescription] Xiao Qing Long Tang[Common Prescription Dosage] Gui Zhi 10g, Sheng Ma Huang 10g, Gan Jiang 10g, Sheng Bai Shao 10g, Zhi Gan Cao 10g, Xi Xin 3g, Qing Ban Xia 15~30g, Wu Wei Zi 3g.4.1.1.9 If accompanied by chest tightness and shortness of breath, cough and wheezing with sweating, and aversion to wind and cold, treat according to Tai Yang disease with qi stagnation.[Treatment Method] Harmonize the nutritive and defensive qi, promote lung qi.[Reference Prescription] Gui Zhi Jia Xing Ren Hou Po Tang[Common Prescription Dosage] Gui Zhi 15g, Sheng Bai Shao 15g, Zhi Gan Cao 10g, Chao Xing Ren 15g, Hou Po 15g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding).4.1.1.10 If the tongue coating is white and thick, with thirst and difficulty urinating, treat according to Tai Yang disease with water retention.[Treatment Method] Warm yang, transform qi, and promote urination.[Reference Prescription] Wu Ling San[Common Prescription Dosage] Zhu Ling 15g, Sheng Bai Zhu 15g, Fu Ling 15g, Gui Zhi 12g, Ze Xie 30g.4.1.1.11 If there are significant chills, body aches, or heaviness, irritability, good spirit, cough, and shortness of breath, high fever without sweating, warm hands and feet, dry skin, thirst for cold drinks, and floating tight and rapid pulse, treat according to Tai Yang disease with stagnant heat.[Treatment Method] Expel the evil, disperse heat.[Reference Prescription] Da Qing Long Tang, Da Qing Long Jia Fu Zi Tang, Hou Po Ma Huang Tang[Common Prescription Dosage] Da Qing Long Tang: Gui Zhi 10g, Sheng Ma Huang 12g, Chao Xing Ren 15g, Sheng Shi Gao 30g, Zhi Gan Cao 10g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding).Da Qing Long Jia Fu Zi Tang: Gui Zhi 10g, Sheng Ma Huang 12g, Chao Xing Ren 15g, Sheng Shi Gao 30g, Zhi Gan Cao 10g, Hei Shun Pian 10g (boil for more than one hour), Sheng Jiang 15g, Da Zao 15g (cut open for guiding).Hou Po Ma Huang Tang: Hou Po 15g, Sheng Ma Huang 10g, Chao Xing Ren 15g, Gan Jiang 10g, Xi Xin 3g, Wu Wei Zi 3g, Huai Xiao Mai 15g, Sheng Shi Gao 30g, Qing Ban Xia 15~30g.4.1.2 For Yin Conditions in the Exterior, Treat According to Shao Yin Disease Shao Yin disease refers to individuals with a generally weak constitution and insufficient yang qi, who are affected by external evils (including external epidemic toxins). Symptoms include: aversion to cold, cold hands and feet, dark complexion, general or diminished spirit, and weakness. This can occur not only in the elderly and weak but also in some children and adults, requiring differentiation from Tai Yang disease.4.1.2.1 If the patient has a generally weak constitution, aversion to cold, cold hands and feet, dark complexion or slightly pale and floating, general or diminished spirit, weak speech, accompanied by body aches, aversion to cold, fever, and a floating red face, cough with floating tight or sinking tight pulse, treat according to Shao Yin disease.[Treatment Method] Warm yang, expel the evil, and support the righteous.[Reference Prescription] Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang, Ma Huang Fu Zi Xi Xin Tang, Ma Huang Fu Zi Gan Cao Tang[Common Prescription Dosage]Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang: Gui Zhi 15g, Zhi Gan Cao 10g, Sheng Ma Huang 6~15g, Zhi Fu Zi 10~15g, Xi Xin 3g, Pao Jiang 10g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding).Ma Huang Fu Zi Xi Xin Tang: Sheng Ma Huang 10g, Zhi Fu Zi 15g, Xi Xin 3g.Ma Huang Fu Zi Gan Cao Tang: Sheng Ma Huang 10g, Zhi Fu Zi 10~15g, Zhi Gan Cao 10g.4.1.2.3 If there are significant chills, cold hands and feet, generally weak spirit, dark complexion, cough with phlegm, body swelling, and white greasy tongue coating, treat according to Shao Yin disease with cold dampness obstructing.[Treatment Method] Support yang, transform qi, and expel the evil from the exterior.[Reference Prescription] Zhen Wu Tang[Common Prescription Dosage] Zhi Fu Zi 10~15g, Sheng Bai Shao 12g, Fu Ling 30g, Sheng Bai Zhu 20g, Sheng Jiang 15g (cut open for guiding);

• If there is coughing, add Gan Jiang 10g, Xi Xin 3g, Wu Wei Zi 3g;
• If accompanied by diarrhea, remove Bai Shao and add Gan Jiang 15~20g.

4.1.2.4 If there is coughing with fever, diarrhea, cold hands and feet, dark complexion, extreme weakness, or agitation, treat according to Shao Yin disease with cold dampness obstructing.[Treatment Method] Open yang, disperse cold, and rescue the yang.[Reference Prescription] Bai Tong Tang[Common Prescription Dosage] Zhi Fu Zi 15g, Gan Jiang 15g, Scallion white 4 sections cut open for guiding.4.1.2.5 Coughing, shortness of breath, fatigue, diarrhea, dark complexion, cold hands and feet, thin white tongue coating, treat according to Shao Yin disease with deficiency.[Treatment Method] Warm and tonify the spleen and kidneys, support fire and assist yang.[Reference Prescription] Gui Fu Li Zhong Tang[Common Prescription Dosage] Gui Zhi 15g, Zhi Fu Zi 15g, Ren Shen 10g, Sheng Bai Zhu 10g, Gan Jiang 10g, Zhi Gan Cao 10g.4.2 Disease Located in the Middle4.2.1 For Yang Conditions in the Middle (Half Exterior, Half Interior), Treat According to Shao Yang Disease Half exterior and half interior yang conditions, i.e., Shao Yang disease, often arise from the transformation of disease after treatment or initially present as symptoms of Shao Yang disease. The pathogenic evil has not yet entered the exterior, nor has it completely entered the interior, and the struggle between the righteous and the evil is fierce, while the yang qi is still present. Symptoms often include: bitter taste in the mouth, dry throat, dizziness, sore throat, poor appetite, fullness in the chest and ribs, abdominal distension, alternating fever and chills, and joint aches. The treatment method is to “harmonize and resolve,” with the goal of “supporting the righteous and expelling the evil.”4.2.1.1 If the patient has fever, cough, nausea, dry heaving, chest tightness, accompanied by dry mouth and bitter taste, poor appetite, white or greasy tongue coating, dizziness, fatigue, and tight pulse, treat according to Shao Yang disease.[Treatment Method] Harmonize Shao Yang, support the righteous and expel the evil.[Reference Prescription] Xiao Chai Hu Tang[Common Prescription Dosage] Chai Hu 18~30g, Huang Qin 10g, Qing Ban Xia 15~30g, Ren Shen 10g, Zhi Gan Cao 10g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding);

• If there is severe coughing, add Gan Jiang 10g, Xi Xin 3g, Wu Wei Zi 3g;
• If there is abdominal rumbling, thick greasy tongue coating, and slightly loose stools, add Fu Ling 30g, Sheng Bai Zhu 20g.

4.2.1.2 If the patient has fever, cough, chest tightness, dry mouth, thirst without vomiting, poor appetite, loose stools, and yellow complexion, treat according to Shao Yang disease with heat.[Treatment Method] Harmonize Shao Yang, warm the middle.[Reference Prescription] Chai Hu Gui Zhi Gan Jiang Tang[Common Prescription Dosage] Chai Hu 18~30g, Gui Zhi 10g, Gan Jiang 12g, Zhu Sha 20g, Tian Hua Fen 15g, Zhi Gan Cao 10g, Huang Qin 10g.4.2.1.3 If the patient has a strong constitution, abdominal distension, constipation, bitter taste, dry mouth, good spirit, irritability, cough, and shortness of breath, treat according to Shao Yang disease with heat.[Treatment Method] Open the bowels, expel heat, and harmonize Shao Yang.[Reference Prescription] Da Chai Hu Tang[Common Prescription Dosage] Chai Hu 24g, Huang Qin 10g, Qing Ban Xia 15~30g, Sheng Bai Shao 15g, Sheng Da Huang 6~30g, Chao Zhi Shi 20g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding);

• If there is excessive phlegm, combine with Shang Ling Li Da Zao Xie Fei Tang: Ling Zhi Zi 30g (wrapped), Da Zao 15g (cut open for guiding).

4.2.1.4 If the patient has unresolved exterior evil, symptoms include: slight fever, aversion to cold, bitter taste, dry throat, fatigue, body aches, poor appetite, nausea, chest tightness, and cough.[Treatment Method] Harmonize Shao Yang, expel the evil.[Reference Prescription] Chai Hu Gui Zhi Tang with Xing Ren and Hou Po[Common Prescription Dosage] Chai Hu 20~30g, Huang Qin 10g, Qing Ban Xia 15~30g, Ren Shen 10g, Zhi Gan Cao 10g, Gui Zhi 15g, Sheng Bai Shao 15g, Xing Ren 15g, Hou Po 15g, Sheng Jiang 15g, Da Zao 15g (cut open for guiding);

• If thirsty but not vomiting, remove Ban Xia and add Tian Hua Fen 15g;
• If qi deficiency, add Huang Qi 30g, Sheng Bai Zhu 15g, Fang Feng 10g.

4.2.1.5 If the patient has nausea, vomiting, poor appetite, abdominal distension, fever, and oral or oral cavity ulcers, treat according to Shao Yang disease with dampness.[Treatment Method] Harmonize the stomach, descend the qi, and resolve distension.[Reference Prescription] Ban Xia Xie Xin Tang, Gan Cao Xie Xin Tang, Sheng Jiang Xie Xin Tang, etc.[Common Prescription Dosage] Ban Xia Xie Xin Tang: Qing Ban Xia 30g, Huang Lian 3g, Huang Qin 10g, Gan Jiang 10~15g, Ren Shen 10g, Zhi Gan Cao 10g, Da Zao 15g (cut open for guiding);

• If there is discomfort in the stomach, belching, abdominal rumbling, diarrhea, or pain in the side, and difficulty urinating, use Sheng Jiang Xie Xin Tang: Ban Xia Xie Xin Tang plus Sheng Jiang 30g;
• If there is hardness and distension in the stomach, frequent diarrhea, and food not digesting, use Gan Cao Xie Xin Tang: Ban Xia Xie Xin Tang minus Zhi Gan Cao, add Sheng Gan Cao 30g.

4.2.2 Disease Located in the Middle (Half Exterior, Half Interior) for Yin Conditions can be Treated According to Jue Yin Disease Jue Yin disease, like Shao Yang disease, is also a stage of half exterior and half interior, and may also present with poor appetite and fullness in the chest and ribs, which should not be ignored.4.2.2.1 If symptoms include: thirst, irritability, cold hands and feet, intermittent fever, cough, sore throat, discomfort in the stomach, and a floating red or dark complexion, even diarrhea, treat according to Jue Yin disease.[Treatment Method] Harmonize cold and heat, clear the upper and warm the lower.[Reference Prescription] Wu Mei Wan or Ma Huang Sheng Ma Tang[Common Prescription Dosage] Wu Mei Wan modified to decoction: Wu Mei 20g, Huang Lian 5g, Huang Bai 10g, Dang Gui 10g, Gan Jiang 10g, Zhi Fu Zi 10g, Xi Xin 3g, Hua Jiao 3g, Ren Shen 10g, Gui Zhi 10g. Ma Huang Sheng Ma Tang: Ma Huang 8g, Sheng Ma 10g, Zhi Mu 10g, Huang Qin 10g, Gui Zhi 10g, Zhi Gan Cao 10g.4.3 Disease Located in the Interior4.3.1 For Yang Conditions in the Interior, Treat According to Yang Ming Disease Yang Ming disease stage is often seen in individuals with a strong constitution and abundant yang qi. At this time, the exterior evil has entered the interior, and one can use pungent, cool, sweet, or bitter cold prescriptions as appropriate, but care must be taken to stop when the disease is resolved, to avoid harming the righteous qi.4.3.1.2 If there is high fever, thirst, cough, shortness of breath, excessive sweating, aversion to heat but not to cold, warm hands and feet, and good spirit, treat according to Yang Ming disease.[Treatment Method] Clear and drain internal heat, nourish yin and generate fluids.[Reference Prescriptions] Bai Hu Jia Ren Shen Tang, Zhu Ye Shi Gao Tang, Mai Men Dong Tang[Common Prescription Dosage]Bai Hu Jia Ren Shen Tang: Sheng Shi Gao 30g, Zhi Mu 12g, Zhi Gan Cao 10g, Jing Mi 15g, Sheng Bai Ren Shen 10g.Zhu Ye Shi Gao Tang: Zhu Ye 15g, Qing Ban Xia 10g, Shi Gao 30g, Ren Shen 15g, Mai Men Dong 20g, Zhi Gan Cao 15g, Jing Mi 30g.Mai Men Dong Tang: Mai Men Dong 30g, Qing Ban Xia 10g, Ren Shen 15g, Zhi Gan Cao 10g, Jing Mi 30g, Da Zao 15g.4.3.1.3 If there is constipation, shortness of breath, irritability, abdominal distension, good spirit, and hot hands and feet, treat according to Yang Ming disease.[Treatment Method] Open the bowels, drain heat, and preserve yin.[Reference Prescriptions] Da Cheng Qi Tang, Hou Po Qi Wu Tang[Common Prescription Dosage]Da Cheng Qi Tang: Da Huang 10~30g, Hou Po 15~30g, Zhi Shi 15~30g, Mang Xiao 6~15g (dissolved).Hou Po Qi Wu Tang: Gui Zhi 15g, Zhi Gan Cao 10g, Chao Zhi Shi 15~30g, Hou Po 15~30g, Da Huang 10~30g, Sheng Jiang 15g, Da Zao 15g.4.3.1.4 If there is cough, shortness of breath, excessive phlegm, rapid breathing, sticky and irritated mouth, thick and greasy tongue coating, normal urination, and slippery rapid pulse, treat according to Yang Ming disease.[Treatment Method] Drain the lungs, calm the wheezing, and clear heat and turbidity.[Reference Prescriptions] Ting Li Da Zao Xie Fei Tang combined with Qian Jin Wei Jing Tang[Common Prescription Dosage] Ting Li Zi 30~50g (wrapped), Lu Gen 30g, Chao Dong Gua Ren 30g, Sheng Yi Yi Ren 30g, Chao Tao Ren 15g, Da Zao 15g (cut open for guiding).4.3.2 For Yin Conditions in the Interior, Treat According to Tai Yin Disease Tai Yin disease is characterized by a weak constitution and insufficient yang qi, with the disease having entered the interior. Symptoms often include fatigue, weak yang qi, cold hands and feet, dark complexion, thin stools, and even undigested food. Therefore, the main treatment is to warm yang and support the righteous to preserve yang qi, which can save the patient from a critical condition.4.3.2.2 If there is fatigue, headache, pale complexion, poor appetite, weak spirit, cold hands and feet, thin stools, and cough with shortness of breath, treat according to Tai Yin disease.[Treatment Method] Warm the interior, disperse cold, and tonify qi and blood.[Reference Prescription] Gui Zhi Ren Shen Tang[Common Prescription Dosage] Gui Zhi 15g, Ren Shen 12g, Sheng Bai Zhu 12g, Pao Jiang 12g, Zhi Gan Cao 12g (for those with severe yang deficiency, add Zhi Fu Zi 10~30g).4.3.2.3 If the patient has normal stools, dark complexion, cold hands and feet, and cough worsens with cold, with excessive phlegm, and white greasy tongue coating, treat according to Tai Yin disease.[Treatment Method] Warm yang, transform fluids.[Reference Prescription] Fu Ling Gui Zhi Bai Zhu Gan Cao Tang[Common Prescription Dosage] Fu Ling 30g, Gui Zhi 15g, Sheng Bai Zhu 15g, Zhi Gan Cao 12g.4.3.2.4 If the patient has a floating body, cold hands and feet, and significant vomiting, treat according to Tai Yin disease.[Treatment Method] Descend the qi, stop vomiting, and warm the stomach.[Reference Prescription] Fu Ling Ze Xie Tang plus Ban Xia Gan Jiang San[Common Prescription Dosage] Fu Ling 30g, Gui Zhi 15g, Ze Xie 25g, Sheng Bai Zhu 20g, Zhi Gan Cao 10g, Qing Ban Xia 15~30g, Gan Jiang 15g, Sheng Jiang 15g (cut open for guiding).4.3.2.5 If the disease is severe: diarrhea, abdominal distension, agitation, cold hands and feet, and weak yang qi.[Treatment Method] Rescue the yang.[Reference Prescription] Si Ni Tang, Tong Mai Si Ni Tang, Si Ni Jia Ren Shen Tang[Common Prescription Dosage] Si Ni Tang: Zhi Fu Zi 15g, Gan Jiang 15g, Zhi Gan Cao 12g.Tong Mai Si Ni Tang: Zhi Fu Zi 30~60g, Gan Jiang 30~60g, Zhi Gan Cao 15~30g.Si Ni Jia Ren Shen Tang: Zhi Fu Zi 15g, Gan Jiang 15g, Zhi Gan Cao 12g, Ren Shen 15g.5. Precautions5.1. Preparation and Administration Methods Soak the herbs for more than 30 minutes, and each prescription should be decocted twice, with the decoction time depending on the herbs used. Generally, for herbs that do not require prolonged decoction, it should be around 30 minutes, while those that do require prolonged decoction should be boiled for more than one hour. For severe cases, take the medicine every three hours during the day and every six hours at night, referring to section 5.2 for dosage instructions. During acute episodes, small amounts should be taken multiple times, and in severe cases, one can take medicine more than ten times a day, including at night, allowing the medicinal effect to act continuously. After taking the medicine, avoid wind and allow the body to sweat slightly. It is not advisable to eat until full, and avoid raw, cold, sticky, spicy, and hard-to-digest foods. If sweating occurs and heat subsides, stop the medicine or adjust the dosage. Additionally, it should be noted that all prescriptions containing Zhi Fu Zi (black shun pian) must be decocted for more than one hour; all prescriptions containing Ma Huang may cause palpitations or muscle twitching depending on the patient’s constitution, and dosage should be adjusted as necessary. Some patients may experience excitement or insomnia after taking Ma Huang; if the condition is mild and not accompanied by fever, it can be taken in the morning and after lunch, but in urgent cases or when accompanied by fever, this should not be strictly adhered to, and the dosage should still refer to section 5.2.5.2. Dosage of Medicinal Herbs All decoctions need to be boiled, cooled, and taken warm. Adults generally take about: 200~250 ml each time, those with weak constitutions take about: 50~150 ml each time, multiple times a day; Children: 0 to 1 year old take about: 10 ml each time, 1 to 3 years old take about: 15~30 ml each time, 3 to 5 years old take about: 30~50 ml each time, 5 to 8 years old take about: 50 to 100 ml each time, 8 to 12 years old take about: 100~150 ml each time, 12 to 16 years old take about: 150~200 ml each time, 16 years and older according to adult dosage.5.3. Special Drug Instructions All prescriptions containing Zhi Fu Zi (black shun pian) must be decocted for more than one hour; all prescriptions containing Ma Huang may cause palpitations or muscle twitching depending on the patient’s constitution, and dosage should be adjusted as necessary. Some patients may experience excitement or insomnia after taking Ma Huang; if the condition is mild and not accompanied by fever, it can be taken in the morning and after lunch, but in urgent cases or when accompanied by fever, this should not be strictly adhered to, and the dosage should still refer to section 5.2.6. Conclusion

Due to the characteristics of TCM’s holistic differentiation and treatment, it is necessary to respond flexibly to climate differences, regional differences, and individual constitution differences. Therefore, there is no fixed treatment prescription for any disease; it must be flexibly prescribed according to the patient’s constitution, which is the yin-yang state. Moreover, some exogenous diseases change rapidly, requiring timely adjustments and decisive actions during treatment. The above content provides an overview of the differentiation and treatment of exogenous diseases based on the six patterns, but it still requires flexible responses based on the specific situation of etiology, nature, location, and progression of the disease to achieve good results.

Disclaimer: This article is intended for TCM practitioners and enthusiasts to learn from the analysis of classic formulas and is not a guiding document. All specific formulas, dosages, and related proportions must be used under the guidance of a professional TCM practitioner and should not be directly used as clinical references.

This article was organized by: Zang Yunxi, Zhang Jiale, Ku Xilong, Zhang Linlin, Song Yang, Yang Weichao, Zhang Yajing, Li Ningning, Zang Yuncai Previous Articles How can traditional Chinese medicine exert its effects after a thousand years? How does TCM treat the root cause? Insights from the classic texts during the medical process based on the performance of TCM and Western medicine in the COVID-19 pandemic. A brief discussion on the development direction of Chinese medicine. From drinking water to health preservation. I wish to stay in the apricot forest, guarding a peaceful place. Reflections on the treatment process of infant jaundice. The gentleman receives others with humility. From Tai Yang disease to Yang Ming disease transformation. Discussing “cutting off the source of the problem”. Reflecting on Confucian and Daoist culture in the face of a major epidemic. The necessity of syndrome differentiation and treatment. A case of suspected coronavirus pneumonia treated with TCM.Links to activities related to Dr. Zang Yuncai:1. Dr. Zang Yuncai has been awarded the title of “Most Praised Doctor of the Year” again! Only one person from Henan made the list.2. Come on! Let’s have face-to-face communication with excellent young TCM practitioners! The “Great Physician’s Path: Inheriting Medical Principles: The Third Zang Yuncai Student Reading Experience and Clinical Experience Exchange Conference” is about to open!3. Dr. Zang Yuncai: The problem of Westernization of TCM is becoming increasingly serious, and TCM practitioners need to follow their own path!4. Should we first expel the exterior or attack the interior? Dr. Zang Yuncai provides wonderful answers based on classics and practice! Sharing content from the third lecture in Singapore.5. Renowned TCM physician Zang Yuncai has been invited to lecture in Singapore and will be appointed as a visiting professor! He said: TCM and Chinese traditional culture have enough charm to make us confident! 6. Undoubtedly! Dr. Zang Yuncai has won the “Doctor of the Year” award! What is his biggest dream? 7. TCM physician Zang Yuncai has been invited to give a keynote speech at the 15th World TCM Conference. Let’s see what he said. 8. The story of Zang Yuncai: “I have been cured of asthma after more than 30 years, and I really thank Yuncai!” Editor | Yu Miaomiao Images | From the internet Original content. Unauthorized reproduction is prohibited.

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