Understanding the Treatise on Febrile Diseases

Terminology Explanation:

1. Shānghán (Febrile Disease): The term has both broad and narrow meanings. Broadly, it refers to all externally contracted febrile diseases, while narrowly, it refers to diseases caused by the invasion of wind, cold, and dampness.

2. Zhízhōng (Direct Entry): The pathogenic qi enters the three yin meridians directly without passing through the three yang meridians.

3. Hé Bìng (Combined Disease): Refers to the simultaneous onset of two or three meridians without a sequence.

4. Bìng Bìng (Concurrent Disease): Refers to the symptoms of one meridian not having resolved while another meridian’s symptoms arise, indicating a sequence.

5. Mài Yīn Yáng Jù Tǐng (Pulse Tension in Yin and Yang): Refers to the pulse at the cun and chi positions being tight.

6. Yáng Fú Ér Yīn Ruò (Yang Floating and Yin Weak): This is indicated by the pulse. A light touch reveals a floating pulse, hence termed “yang floating,” indicating that the defensive qi is abundant on the exterior; a deep touch reveals a weak pulse, hence termed “yin weak,” indicating insufficient nutritive yin internally.

7. Xī Xī Fā Rè (Mild Fever): Indicates a relatively mild heat condition.

8. Yù Jiù Xié Fēng (Desire to Rescue from Wind Evil): “Rescue” refers to alleviating or treating; “wind evil” refers to the pathogenic wind. This indicates the treatment of wind evil causing Taiyang wind syndrome.

9. Xiàng Bèi Qiáng Jī Jī (Stiffness in Neck and Back): “Jī jī” implies tightness and rigidity. This describes the discomfort and tightness in the neck and back, making it difficult to turn or tilt the head.

10. Jīn Tì Ròu Dǔn (Muscle Spasms): Refers to involuntary twitching of muscles.

11. Xīn Zhōng Ào Nè (Heart Distress): Refers to a profound sense of unease in the heart that is difficult to describe.

12. Chā Shǒu Zì Mào Xīn (Crossing Hands on Heart): Refers to placing both hands crossed over the area of the heart.

13. Hé Qǐ Ér Hóng (Nodules that are Red): Refers to localized redness and swelling at the acupuncture point due to cold obstructing yang and causing stagnation.

14. Rè Jié Páng Guāng (Heat Accumulation in the Bladder): Here, the bladder refers to the lower jiao. This indicates the accumulation of pathogenic heat and blood stasis in the lower jiao.

15. Shǎo Fù Jí Jié (Acute Pain in the Lower Abdomen): Refers to tightness and pain in the lower abdomen.

16. Jié Xiōng (Chest Congestion): Refers to the accumulation of pathogenic qi and phlegm-water in the chest, diaphragm, and abdominal cavity, with pain as the main symptom.

17. Fù Zhōng Léimíng (Thunder in the Abdomen): Refers to the rumbling sound in the intestines.

18. Wèi Jiā Shí (Stomach Fullness): Refers to the presence of pathogenic qi in the entire gastrointestinal system.

19. Pí Yuè (Spleen Constraint): Refers to the spleen’s transport function being constrained by stomach heat, leading to dryness and injury to fluids, resulting in constipation.

20. Hàn Chū Jǐng Jǐng Rán (Profuse Sweating): Refers to continuous and profuse sweating.

21. Zhēng Zhēng Fā Rè (Steaming Fever): Describes a fever that rises from within to the outside, resembling steam rising from a steamer.

22. Mù Zhōng Bù Liǎo (Unclear Vision): Refers to unclear vision.

23. Jīng Bù Hé (Eye Movement Incoordination): Refers to the inability of the eyeball to move freely.

24. Wǎng Lái Hán Rè (Alternating Cold and Heat): Refers to the alternating appearance of chills and fever.

25. Xiōng Xié Kǔ Mǎn (Chest and Flank Fullness): Refers to the patient suffering from fullness and discomfort in the chest and flanks.

26. Hēi Hēi (Silence): Refers to a silent expression, indicating a reluctance to speak.

27. Zhēng Zhēng Ér Zhèn (Steaming and Shaking): Refers to internal heat manifesting outward, causing the body to tremble and shiver, indicating chills and high fever.

28. Yáng Wēi Jié (Mild Yang Stagnation): Refers to a slight stagnation of the three yang qi mechanisms.

Short Answer and Discussion Questions:

1. Briefly describe the syndrome and treatment of Má Xìng Shí Gān Tāng.

Main Symptoms: Sweating and wheezing, thirst, yellow tongue coating, rapid pulse. Pathogenesis: Pathogenic heat obstructing the lungs.

Treatment Method: Clear heat, disseminate lung qi, descend qi, and relieve wheezing.

Formula: Má Xìng Shí Gān Tāng.

2. What are the differences between Má Xìng Shí Gān Tāng, Guì Zhī Jiā Hòu Pò Xìng Zǐ Tāng, Xiǎo Qīng Lóng Tāng, and Má Huáng Tāng?

Má Xìng Shí Gān Tāng	Guì Zhī Jiā Hòu Pò Xìng Zǐ Tāng	Xiǎo Qīng Lóng Tāng	Má Huáng Tāng
Pathogenesis	Pathogenic heat obstructing the lungs	Wind-cold on the surface, disharmony of nutritive and defensive qi, lung qi ascending	Wind-cold binding the surface, water retention internally	Wind-cold binding the exterior, defensive yang obstructed, nutritive yin stagnated, lung qi failing to disperse
Pulse and Symptoms	Sweating and wheezing, thirst, yellow tongue coating, rapid pulse	Fever, aversion to wind, sweating, headache, cough, wheezing, reversed qi	Aversion to cold, fever, cough, wheezing, nausea, floating tight (or floating slippery) pulse	Aversion to cold, fever, no sweating but wheezing, headache, body aches, floating tight pulse
Treatment Method	Clear heat, disseminate lung qi, descend qi, relieve wheezing	Release the exterior, descend qi, relieve wheezing	Warm and release the exterior, transform water retention	Warm and induce sweating, disseminate lung qi, relieve wheezing
Formula	Má Xìng Shí Gān Tāng	Guì Zhī Jiā Hòu Pò Xìng Zǐ Tāng	Xiǎo Qīng Lóng Tāng	Má Huáng Tāng

3. Differentiate between Zhēn Wǔ Tāng and Líng Guì Zhú Gān Tāng.

Zhēn Wǔ Tāng	Líng Guì Zhú Gān Tāng
Pathogenesis	Kidney yang deficiency, water evil rampant
Pulse and Symptoms	Patient still has fever, palpitations below the heart, dizziness, body tremors, and a tendency to collapse	Rebellious fullness below the heart, qi rushing up to the chest, dizziness upon rising, deep tight pulse
Treatment Method	Warm yang, promote water metabolism	Warm yang, strengthen the spleen, promote water metabolism, descend qi
Formula Composition	Fú Líng, Sháo Yào, Shēng Jiāng, Bái Zhú, Fù Zǐ	Fú Líng, Guì Zhī, Bái Zhú, Gān Cǎo

4. What are the symptoms, pathogenesis, formula, and significance of Xiǎo Jiàn Zhōng Tāng? Why is it named “Jiàn Zhōng”?

Symptoms: Palpitations in the heart and anxiety, acute abdominal pain.

Pathogenesis: Middle jiao deficiency cold, qi and blood deficiency, further disturbed by evil.

Formula: Guì Zhī, Gān Cǎo, Dà Zǎo, Sháo Yào, Shēng Jiāng, Yí Táng.

Formula Significance: Xiǎo Jiàn Zhōng Tāng is formed by doubling the Sháo Yào in Guì Zhī Tāng and adding Yí Táng. The heavy use of Yí Táng warms and supplements the middle; combined with Gān Cǎo and Dà Zǎo, it nourishes the spleen and stomach, cultivating the source of transformation; doubling Sháo Yào nourishes yin and harmonizes the nutritive; the combination of Sháo and Cǎo can also sour and sweeten yin, alleviating urgency and stopping pain; Guì Zhī and Shēng Jiāng warm the middle and disperse cold. The combination of all herbs works together to establish central qi, nourish qi and blood, harmonize yin and yang, alleviate urgency, and stop pain.

Reason: Since the source qi is the source of qi and blood transformation, and this formula emphasizes warming the middle and supplementing deficiency, it subsequently nourishes qi and blood, hence the name “Jiàn Zhōng”.

5. Briefly describe the symptoms, pathogenesis, and formula composition of Zhì Gān Cǎo Tāng.

Symptoms: Palpitations, irregular pulse.

Pathogenesis: Palpitations: Qi and blood deficiency, heart not nourished.

Irregular pulse: Qi and blood deficiency, pulse channels not filled.

Formula Composition: Gān Cǎo, Shēng Jiāng, Rén Shēn, Shēng Dì Huáng, Guì Zhī, Ā Jiāo, Mài Mén Dōng, Má Rén, Dà Zǎo.

6. Briefly describe the types of heart yang deficiency, treatment methods, and representative formulas.

① Guì Zhī Gān Cǎo Tāng (Heart Yang Deficiency with Palpitations).

Treatment Method: Warm and circulate heart yang.

Formula: Guì Zhī Gān Cǎo Tāng.

② Guì Zhī Gān Cǎo Lóng Gǔ Mǔ Lì Tāng (Heart Yang Deficiency with Irritability).

Treatment Method: Warm and supplement heart yang, subdue and calm the spirit.

Formula: Guì Zhī Gān Cǎo Lóng Gǔ Mǔ Lì Tāng.

③ Guì Zhī Qù Sháo Yào Jiā Shǔ Qī Mǔ Lì Lóng Gǔ Jiù Nì Tāng (Heart Yang Deficiency with Panic).

Treatment Method: Warm and circulate heart yang, subdue and calm the spirit, and also clear phlegm.

Formula: Guì Zhī Qù Sháo Yào Jiā Shǔ Qī Mǔ Lì Lóng Gǔ Jiù Nì Tāng.

④ Guì Zhī Jiā Guì Tāng (Heart Yang Deficiency with Rebellious Qi).

Treatment Method: Warm and circulate heart yang, pacify and descend rebellious qi.

Formula: Guì Zhī Jiā Guì Tāng.

⑤ Fú Líng Guì Zhī Gān Cǎo Dà Zǎo Tāng (Heart Yang Deficiency with Desire to Rebellious Qi).

Treatment Method: Warm and circulate heart yang, transform qi and promote water.

Formula: Fú Líng Guì Zhī Dà Zǎo Gān Cǎo Tāng.

7. Briefly describe the differences between Taiyang Water Accumulation Syndrome and Taiyang Blood Accumulation Syndrome.

Taiyang Water Accumulation Syndrome	Taiyang Blood Accumulation Syndrome
Similarities	Both are caused by pathogenic qi entering the Taiyang meridian and affecting the bladder.
Pathogenesis	Water accumulates in the bladder, qi transformation is obstructed, with exterior symptoms not resolved.	Blood heat accumulates in the lower jiao, with the disease in the blood aspect.
Pulse and Symptoms	Floating pulse, difficult urination, slight fever and thirst.	Patient appears manic, urination is self-limited, acute lower abdominal pain.
Treatment Method	Promote yang, transform qi, promote water, and also resolve the exterior.	Drain heat and resolve blood stasis.
Formula	Wǔ Líng Sǎn.	Táo Hé Chéng Qì Tāng or Dǐ Dàng Tāng or Dǐ Dàng Wán.

8. What is Jié Xiōng? Discuss its pathogenesis and classification.

Concept: Pathogenic qi and phlegm-water accumulate in the chest, diaphragm, and abdominal cavity, with pain as the main symptom.

Classification: (1) Heat Excess Jié Xiōng (Pathogenesis: Heat evil and phlegm-water mutually accumulate).

① Dà Jié Xiōng (Pathogenesis: Water and heat mutually accumulate) located in the upper, middle, or lower. Main symptoms include pain below the heart, hard upon palpation, and a deep tight pulse. Stiff neck, resembling soft paralysis.

② Xiǎo Jié Xiōng (Pathogenesis: Phlegm-heat mutually accumulate) located directly below the heart and stomach. Main symptoms include pain directly below the heart, painful upon palpation, and a floating slippery pulse.

(2) Cold Excess Jié Xiōng (Pathogenesis: Cold evil and phlegm-water mutually accumulate) main symptoms include chest and flank hardness and fullness, pain without heat symptoms, and a deep solid pulse.

9. How to differentiate between the three formulas for heat excess Jié Xiōng? What are the differences in their medications?

Dà Xiàn Xiōng Tāng	Dà Xiàn Xiōng Wán	Xiǎo Xiàn Xiōng Tāng
Main Symptoms	Jié Xiōng heat excess, deep pulse, pain below the heart, hard upon palpation.	Heart pain, stiff neck, resembling soft paralysis.	Pain upon palpation, floating slippery pulse.
Pathogenesis	Water and heat mutually accumulate below the heart and chest. Located in the middle and lower.	Water and heat mutually accumulate, disease located above.	Phlegm-heat mutually accumulate, located directly below the heart.
Treatment Method	Drain heat, expel water, and harshly purge the accumulation.	Drain heat, expel water, and gently purge the accumulation.	Clear heat, transform phlegm, and open the accumulation.
Formula Composition	Dà Huáng, Máng Xiāo, Gān Suì.	Dà Huáng, Tíng Lì Zǐ, Máng Xiāo, Xìng Zǐ, Gān Suì, Bái Mì.	Huáng Lián, Bàn Xià, Guā Lóu Shí.

10. Briefly describe the classification of Pi Syndrome and the formulas included in each type.

(1) Heat Pi Syndrome ① Dà Huáng Huáng Lián Xiè Xīn Tāng.

② Fù Zǐ Xiè Xīn Tāng.

(2) Mixed Cold and Heat Pi Syndrome ① Bàn Xià Xiè Xīn Tāng.

② Shēng Jiāng Xiè Xīn Tāng.

③ Gān Cǎo Xiè Xīn Tāng.

(3) Similar Pi Syndrome ① Xuán Fù Dài Zhě Tāng.

② Wǔ Líng Sǎn.

11. What two formulas are included in Heat Pi Syndrome, what are their differences, and how should they be differentiated and treated? What are the characteristics of their decoction methods, and why?

Dà Huáng Huáng Lián Xiè Xīn Tāng	Fù Zǐ Xiè Xīn Tāng
Pathogenesis	Invisibly evil heat, obstructing below the heart.
Main Symptoms	Below the heart obstruction, upon palpation it is soft, pulse is floating above.
Treatment Method	Drain heat and eliminate obstruction.
Formula	Dà Huáng Huáng Lián Xiè Xīn Tāng.

Distinguishing Treatment: Both formulas treat heat Pi syndrome, but Dà Huáng Huáng Lián Xiè Xīn Tāng treats pure heat Pi, while Fù Zǐ Xiè Xīn Tāng treats heat Pi with yang deficiency.

Decoction Characteristics: Dà Huáng Huáng Lián Xiè Xīn Tāng: Dà Huáng, Huáng Lián, Huáng Qín, soaked in Mǎ Fèi Tāng to take its cold and cool nature to clear heat.

Fù Zǐ Xiè Xīn Tāng: In addition to Dà Huáng, Huáng Lián, Huáng Qín, soaked in Mǎ Fèi Tāng to take its cold and cool nature to clear heat, Fù Zǐ is separately decocted to extract its juice, taking its spicy and warm thick flavor to support yang qi.

12. How to differentiate between the three formulas for mixed cold and heat Pi Syndrome?

Bàn Xià Xiè Xīn Tāng	Shēng Jiāng Xiè Xīn Tāng	Gān Cǎo Xiè Xīn Tāng
Pathogenesis	Mixed cold and heat, obstructing the middle jiao.
Main Symptoms	Below the heart obstruction, nausea, rumbling intestines, diarrhea, tongue red with greasy coating.
Treatment Method	Harmonize the middle, descend rebellious qi, eliminate obstruction.
Formula Composition	Bàn Xià, Huáng Qín, Gān Jiāng, Rén Shēn, Gān Cǎo, Huáng Lián, Dà Zǎo.

13. Differentiate between Taiyang Shāng Hán Syndrome and Taiyang Zhōng Fēng Syndrome.

Taiyang Shāng Hán Syndrome	Taiyang Zhōng Fēng Syndrome	Warm Disease
Pathogenesis	Cold evil attacks the exterior, defensive qi is closed, and nutritive qi is obstructed.	Wind evil attacks the exterior, defensive qi is strong, and nutritive qi is weak, leading to disharmony.
Symptoms	Aversion to cold, body aches, vomiting, pulse both yin and yang are tight.	Fever, sweating, aversion to wind, pulse is relaxed.
Treatment Method	Spicy warm dispersing, resolve the exterior and disperse cold.	Release the muscles and resolve the exterior, harmonize the nutritive and defensive qi.
Formula	Má Huáng Tāng.	Guì Zhī Tāng.

14. Discuss the symptoms, pathogenesis, treatment methods, formulas, and significance of Dà Qīng Lóng Tāng and Xiǎo Qīng Lóng Tāng.

Dà Qīng Lóng Tāng	Xiǎo Qīng Lóng Tāng
Similarities	Both use Má Huáng as the base formula and are formulas that treat both the exterior and interior.
Symptoms	Floating tight pulse, fever, aversion to cold, body aches, no sweating but irritability.	Aversion to cold, fever, cough, wheezing, nausea, floating tight (or floating slippery) pulse.
Pathogenesis	Wind-cold binding the exterior, with internal heat.	Wind-cold binding the exterior, with water retention internally.
Treatment Method	Disperse wind-cold externally, clear internal heat.	Spicy warm release the exterior, warm and transform water retention.
Formula Composition	Má Huáng, Guì Zhī, Xìng Zǐ, Gān Cǎo, Shēng Jiāng, Dà Zǎo, Shí Gāo.	Má Huáng, Guì Zhī, Gān Jiāng, Xìng Zǐ, Bàn Xià, Gān Cǎo, Sháo Yào, Wǔ Wèi Zǐ.
Significance of Composition	Heavily using Má Huáng to induce sweating, lightly using Shí Gāo to address internal heat.	Má Huáng induces sweating, relieves wheezing, and promotes water; combined with Guì Zhī enhances the ability to disperse yang; Sháo Yào and Guì Zhī harmonize the nutritive and defensive qi; Gān Jiāng and Xìng Zǐ warm and transform the water retention evil.

15. Differentiate between Má Huáng Tāng and Gè Gēn Tāng.

Má Huáng Tāng	Gè Gēn Tāng
Pathogenesis	Wind-cold binding the exterior, defensive yang obstructed, nutritive yin stagnated, lung qi failing to disperse.
Main Symptoms	Headache, fever, body aches, aversion to wind, no sweating but wheezing.
Treatment Method	Spicy warm induce sweating, disseminate lung qi, relieve wheezing.
Formula Composition	Má Huáng, Guì Zhī, Xìng Zǐ, Gān Cǎo.	Gè Gēn, Má Huáng, Guì Zhī, Shēng Jiāng, Gān Cǎo, Sháo Yào, Dà Zǎo.

16. Why is Guì Zhī Jiā Fù Zǐ Tāng used to treat Yang deficiency and Yin deficiency, but only Fù Zǐ is added to support Yang without using Yin nourishing herbs?

Although the syndrome has both Yang deficiency and Yin deficiency pathophysiological mechanisms, the main contradiction lies in Yang deficiency not being solid. Therefore, the treatment method should focus on supporting Yang and resolving the exterior. After the herbs are administered, Yang qi is restored, which stops sweating, prevents fluid loss, and eliminates the cause of Yin consumption. Furthermore, Yang generates Yin, and the qi transformation function is restored, thus the main formula is Guì Zhī Jiā Fù Zǐ Tāng.

17. What syndrome does Guì Zhī Jiā Fù Zǐ Tāng treat? Discuss its symptoms, pathogenesis, treatment method, and formula significance.

① Main Treatment: Continuous sweating, aversion to wind, difficult urination, slight tightness in the limbs, difficulty in flexing and extending.

② Symptoms: Continuous sweating: refers to continuous small amounts of sweating → sweating is not appropriate, injuring Yin.

Aversion to wind → ① because Yang qi fails to warm; ② because there is evil qi injuring Yang.

Difficult urination → ① because Yin is injured, insufficient transformation; ② Yang qi is already injured, qi transformation is lost.

Slight tightness in the limbs, difficulty in flexing and extending → ① because fluids are insufficient, muscles and tendons are not nourished; ② Yang qi is insufficient, muscles and tendons are not warmed.

③ Pathogenesis: Exterior syndrome unresolved, Yang qi is weak, and Yin is also insufficient.

④ Treatment Method: Support Yang and resolve the exterior.

⑤ Formula Significance: This formula is formed by adding Fù Zǐ to Guì Zhī Tāng. Guì Zhī Tāng harmonizes the nutritive and defensive qi; Fù Zǐ warms the channels, restores Yang, and secures the exterior to stop sweating.

18. How to understand the terms “not thirsty,” “or thirsty,” and “thirst after taking the decoction” in the context of Xiǎo Qīng Lóng Tāng?

Not thirsty: This is because water retention is internal, Yang does not transform water, and cannot eliminate water.

Or thirsty: Water retention is internal, fluid metabolism is abnormal, and the body’s fluids cannot transform, thus cannot ascend.

Thirst after taking the decoction: Xiǎo Qīng Lóng Tāng is spicy and warm, which is excessive and injures fluids, leading to temporary fluid insufficiency.

19. Why is Guì Zhī Tāng Jiā Gè Gēn used for exterior deficiency syndrome with neck and back stiffness, while Guì Zhī Tāng Jiā Gè Gēn is not used for exterior excess syndrome with neck and back stiffness?

Taiyang disease with no sweating and aversion to wind indicates Taiyang Shāng Hán exterior excess syndrome, and neck and back stiffness is also present. This is due to wind-cold attacking the exterior, obstructing the Taiyang meridian, and qi and blood circulation being obstructed. Gè Gēn Tāng is formed by reducing the amount of Guì and Sháo in Guì Zhī Tāng and adding Gè Gēn. The main herb Gè Gēn elevates fluids and relaxes the muscles. The neck and back stiffness is due to cold evil in the meridian, causing muscle contraction, and fluids are already insufficient. Má Huáng Tāng’s spicy warm and drying nature is too strong, and its sweating power is strong, which injures fluids. Gè Gēn Tāng, on the other hand, resolves the exterior, harmonizes the nutritive and defensive qi, and treats aversion to wind without sweating in the case of exterior excess.

20. Differentiate between Guì Zhī Qù Sháo Yào Tāng, Guì Zhī Qù Sháo Yào Jiā Fù Zǐ Tāng, and Guì Zhī Jiā Fù Zǐ Tāng.

Guì Zhī Qù Sháo Yào Tāng	Guì Zhī Qù Sháo Yào Jiā Fù Zǐ Tāng	Guì Zhī Jiā Fù Zǐ Tāng
Pathogenesis	Chest Yang not vibrating, exterior evil unresolved.	Exterior evil unresolved, chest Yang injured.	Resolve the muscles, dispel wind, warm the channels, restore Yang.
Main Symptoms	Pulse is rapid, chest tightness.	Pulse is weak, aversion to cold.	Aversion to wind, fever, headache, continuous sweating, slight tightness in the limbs, difficult urination.
Treatment Method	Resolve the muscles, dispel wind, and promote Yang qi.	Resolve the muscles, dispel wind, warm the channels, restore Yang.	Support Yang and resolve the exterior.
Formula	Guì Zhī Qù Sháo Yào Tāng.	Guì Zhī Qù Sháo Yào Jiā Fù Zǐ Tāng.	Guì Zhī Jiā Fù Zǐ Tāng.

21. Differentiate between Guì Zhī Jiā Gè Gēn Tāng and Gè Gēn Tāng.

Guì Zhī Jiā Gè Gēn Tāng	Gè Gēn Tāng
Pathogenesis	Wind-cold binding the exterior, disharmony of nutritive and defensive qi, qi and blood not nourishing the meridians.	Wind-cold evil binding the exterior, Taiyang meridian qi not flowing smoothly.
Main Symptoms	Neck stiffness, aversion to wind with sweating.	Neck stiffness, sweating, aversion to wind.
Treatment Method	Resolve the muscles, dispel wind, harmonize the nutritive and defensive qi, elevate fluids, and relax the meridians.	Induce sweating and resolve the exterior, elevate fluids, and relax the muscles.
Formula	Gè Gēn, Sháo Yào, Shēng Jiāng, Gān Cǎo, Dà Zǎo, Guì Zhī.	Gè Gēn, Má Huáng, Guì Zhī, Shēng Jiāng, Gān Cǎo, Sháo Yào, Dà Zǎo.

22 Differentiate between Bái Hǔ Tāng and Bái Hǔ Jiā Rén Shēn Tāng.

Bái Hǔ Tāng	Bái Hǔ Jiā Rén Shēn Tāng
Pathogenesis	Yangming invisible evil heat is intense, filling both internally and externally.
Main Symptoms	Fever, sweating, thirst, floating slippery pulse.	High fever, intense thirst, profuse sweating, flooding pulse, aversion to wind, slight cold on the back.
Treatment Method	Spicy cold to clear heat.	Clear evil heat, nourish qi and fluids.
Formula	Zhī Mǔ, Shí Gāo, Gān Cǎo, Gēng Mǐ.	Zhī Mǔ, Shí Gāo, Gān Cǎo, Gēng Mǐ, Rén Shēn.

23 Differentiate between Zhū Líng Tāng and Wǔ Líng Sǎn.

Zhū Líng Tāng	Wǔ Líng Sǎn
Pathogenesis	Heat excess injuring yin, water and heat mutually accumulate in the lower jiao.
Main Symptoms	Floating pulse, fever, thirst, difficult urination.	Floating pulse, difficult urination, slight fever and thirst.
Treatment Method	Clear heat, promote water, nourish yin.	Promote yang, transform qi, promote water, and also resolve the exterior.
Formula	Zhū Líng, Fú Líng, Zé Xiè, Ā Jiāo, Huá Shí.	Zhū Líng, Zé Xiè, Bái Zhú, Fú Líng, Guì Zhī.

24 Differentiate between the three types of damp-heat jaundice.

Yīn Chén Hāo Tāng	Zhǐ Zǐ Bǎi Pí Tāng	Má Huáng Lián Yáo Chì Xiǎo Dòu Tāng
Similarities	All three formulas have the common characteristics of yellow skin and eyes, bright yellow like orange, and yellow urine that is not smooth.
Pathogenesis	Damp-heat is heavy, combined with stagnation of the bowels, leading to severe damp-heat jaundice.	Heat is heavier than dampness, leading to a slightly lighter damp-heat jaundice.	Damp-heat jaundice combined with wind-cold obstructing the exterior.
Main Symptoms	Only head sweating, no body sweating, neck and back sweating, difficult urination, thirst for water, body yellow like orange, slight fullness in the abdomen, heart distress.	Body yellow with fever.	Body yellow, fever, aversion to cold, no sweating.
Treatment Method	Clear heat, promote dampness, and reduce jaundice.	Clear and resolve internal heat, drain dampness, and reduce jaundice.	Clear heat, promote dampness, and resolve the exterior.
Formula	Yīn Chén Hāo Tāng.	Zhǐ Zǐ Bǎi Pí Tāng.	Má Huáng Lián Yáo Chì Xiǎo Dòu Tāng.

25. Briefly describe the symptoms and treatment of Yīn Chén Hāo Tāng.

Pathogenesis	Damp-heat is heavy, combined with stagnation of the bowels, leading to severe damp-heat jaundice.
Main Symptoms	Only head sweating, no body sweating, neck and back sweating, difficult urination, thirst for water, body yellow like orange, slight fullness in the abdomen, heart distress.
Treatment Method	Clear heat, promote dampness, and reduce jaundice.
Formula	Yīn Chén Hāo Tāng.

26. What is the treatment for Má Zǐ Rén Wán?

Má Zǐ Rén Wán
Pathogenesis	Stomach heat, intestinal dryness, and fluid deficiency.
Main Symptoms	Hard stools, frequent urination, no abdominal pain.
Treatment Method	Drain heat, moisten the intestines, and promote bowel movements.
Formula Composition	Má Zǐ Rén, Sháo Yào, Zhǐ Shí, Dà Huáng, Hòu Pò, Xìng Zǐ.

27. Discuss the pathogenesis of heart distress in the context of Shāng Hán.

① Zhī Zǐ Chǐ Tāng Syndrome: Pathogenesis: Invisible heat evil lingers and disturbs the chest cavity, causing heat to disturb the heart.

② Yīn Chén Hāo Tāng Syndrome: Pathogenesis: Damp-heat mutually accumulates, disturbing the heart.

③ Dà Chéng Qì Tāng Syndrome: Pathogenesis: Heat evil and Yangming residue mutually accumulate, disturbing the heart.

④ Dà Jié Xiōng Tāng Syndrome: Pathogenesis: Water and heat mutually accumulate, disturbing the heart.

28. What are the characteristics of Shaoyang disease?

① Shaoyang disease easily involves the viscera.

② Shaoyang disease easily transforms qi stagnation into fire.

③ Easily leads to phlegm, fluid retention, and water.

④ Often accompanied by disharmony of Taiyang, Yangming, and Taiyin meridians.

29. Recite the text of the small Chái Hú Tāng and analyze the main symptoms of the small Chái Hú Tāng.

In the fifth or sixth day of Shāng Hán, wind, alternating cold and heat, chest and flank fullness, silent and unwilling to eat, heart distress with a preference for vomiting, or heart distress without vomiting, or thirst, or abdominal pain, or flank hardness, or heart palpitations, difficult urination, or not thirsty, slight fever, or cough, small Chái Hú Tāng is the main treatment.

Main symptoms: ① Alternating cold and heat: refers to the alternating appearance of chills and fever. Because Shaoyang has only one portion of Yang qi, when the evil qi is strong, aversion to cold appears, and when the righteous qi is strong, fever appears.

② Chest and flank fullness: refers to the patient suffering from fullness and discomfort in the chest and flanks. This is due to the Shaoyang meridian being affected by evil, and the qi of the Shaoyang meridian not flowing smoothly.

③ Silent and unwilling to eat: refers to a dull expression, unwilling to speak, and not wanting to eat. This is due to the Shaoyang being affected by evil, and the liver and gallbladder failing to regulate, leading to disharmony of stomach qi.

④ Heart distress with a preference for vomiting: Heart distress is due to gallbladder fire disturbing the heart spirit. Preference for vomiting is due to gallbladder disease affecting the stomach, leading to rebellious stomach qi.

⑤ Bitter mouth: because bitterness is the taste of fire, gallbladder fire is rising.

⑥ Dry throat: due to injury to fluids, gallbladder fire injures fluids.

⑦ Dizziness: Shaoyang fire rises through the meridian to disturb the clear orifices.

⑧ Thin and wiry pulse: due to qi stagnation in Shaoyang.

30. What is the significance of the composition of Xiǎo Chái Hú Tāng?

Chái Hú and Huáng Qín: Chái Hú resolves the stagnation of the meridians, and Huáng Qín clears the internal heat.

Shēng Jiāng and Bàn Xià: ① Both are spicy herbs that have a dispersing effect, assisting Chái Hú in resolving stagnation.

② They have the effect of transforming phlegm, eliminating fluid retention, and relieving water retention.

③ They also have the effect of harmonizing the stomach and descending rebellious qi to stop vomiting.

Rén Shēn, Gān Cǎo, Dà Zǎo: Sweet flavor enters the spleen. It supplements the Taiyin spleen qi, preventing the evil qi from transmitting to the Taiyin. It supplements the Shaoyang righteous qi to expel evil.

31. How to understand the phrase “only one symptom is seen, not all must be present”?

The small Chái Hú Tāng syndrome includes bitter mouth, dry throat, dizziness, thin and wiry pulse, alternating cold and heat, chest and flank fullness, silent and unwilling to eat, heart distress with a preference for vomiting. Not all symptoms must be present: this emphasizes that the clinical manifestations of Shaoyang disease are very complex, and not all main symptoms need to be fully present. Therefore, during clinical diagnosis, it is important to investigate the symptoms and analyze the causes, as only a portion of the main symptoms may be observed. As long as the characteristics of the pathogenesis of Shaoyang disease are reflected, it can be confirmed as Shaoyang disease, and treatment can be applied.

32. What is meant by “Wei qi strong, Ying qi weak”?

Wei qi strong does not refer to the normal function of Wei qi being strong, but rather refers to an abnormal hyperactive state of Wei qi, which means “Yang floating, heat self-releasing.” Ying qi weak does not refer to the true weakness of Ying yin, but rather refers to the external weakness of Wei, leading to the leakage of Ying yin, sweating injures Ying, which means “Yin weak, sweating self-releasing.” Knowledge Points.

33. Compare the differences between Táo Hé Chéng Qì Tāng and Dǐ Dàng Tāng and Dǐ Dàng Wán.

Táo Hé Chéng Qì Tāng	Dǐ Dàng Tāng	Dǐ Dàng Wán
Pathogenesis	Heat and blood accumulate in the lower jiao.
Heat is heavier than stasis, blood heat initially accumulates.	Stasis is heavier than heat, the disease is acute.	Both stasis and heat are light, the disease is slower.
Main Symptoms	Self-limited urination, or fever, red tongue, purple spots, yellow coating, deep pulse.
Manic, acute lower abdominal pain.	Fever or manic, hard fullness in the lower abdomen.	Fullness in the lower abdomen.
Treatment Method	First resolve the exterior, then attack the interior.	Urgently rescue the interior, break blood and expel stasis.	Attack and expel stasis and heat, using harsh medicine to achieve a gentle approach.

Heart Yang Deficiency and Desire to Rebellious Qi Comparison

Heart Yang Deficiency	Desire to Rebellious Qi
Pathogenesis	Upper jiao heart yang deficiency, not treating lower jiao cold.
Lower jiao cold water rising.
Main Symptoms	Rebellious qi has already risen.
Rebellious qi is about to rise.
Paroxysmal qi rising from the lower abdomen to the heart accompanied by palpitations.	Palpitations below the navel, wanting to rise.
Treatment Method	Warm and circulate heart yang.
Pacify and descend rebellious qi.
Formula	Guì Zhī Jiā Guì Tāng.
Fú Líng Gān Zǎo Tāng.

Jié Xiōng and Pi Syndrome Comparison

Jié Xiōng	Pi Syndrome
Main Symptoms	After purging, the evil is trapped in the interior, involving the heart.
Pathogenic qi and phlegm-water mutually accumulate in the chest and diaphragm.	Invisible pathogenic qi obstructs the heart and stomach.
Main Symptoms	Chest and flank hardness and fullness, pain upon palpation.	Heart and stomach fullness, not hard, not painful upon palpation.
Treatment Method	Attack and break the accumulation.	Regulate qi and eliminate fullness.

Three Chéng Qì Tāng Comparison

Tiáo Wèi Chéng Qì Tāng	Xiǎo Chéng Qì Tāng	Dà Chéng Qì Tāng
Pathogenesis	Initial accumulation in the viscera, internal heat is strong, qi stagnation is not severe.
Heat is strongly accumulated, the viscera is not open. Internal heat is not severe.
Dry stool is strongly accumulated, Yangming heat is strong, both dryness and qi stagnation are heavy.
Main Symptoms	Abdominal fullness, difficult bowel movements.
Hard stools or heat accumulation with side flow, abdominal fullness.
Difficulty in bowel movements, heat accumulation, side flow, abdominal fullness and pain.
Steaming heat	Fever (heat)	Fever (heat)
Profuse sweating, even delirium.	Profuse sweating, even delirium.	Profuse sweating, agitation, even delirium, severe cases may not recognize people, feel around for clothes, restless, and staring.
Red tongue with yellow coating, pulse slippery and rapid or deep and solid.	Red tongue with yellow coating, pulse slippery and rapid.	Red tongue with old yellow coating, pulse solid and powerful.
Treatment Method	Drain heat and harmonize the stomach.	Open the viscera, drain heat, eliminate stagnation, and relieve fullness.	Harshly purge the dry accumulation and clear the heat.
Formula Composition	Dà Huáng, Máng Xiāo, Gān Cǎo.	Dà Huáng, Hòu Pò, Zhǐ Shí.	Dà Huáng (added later), Máng Xiāo, Zhǐ Shí, Hòu Pò.

Yangming Damp-Heat Jaundice Three Formulas

Damp-Heat Heavy Syndrome	Heat Heavier than Damp Syndrome	Damp-Heat with Exterior Symptoms
Pathogenesis	Damp-heat accumulates.
Steaming liver and gallbladder, obstructing the qi of the viscera.	Heat heavier than dampness, obstructing the three jiaos.	Combined with wind-cold binding the exterior.
Main Symptoms	Body yellow like orange, eyes yellow, deep yellow urine that is not smooth, fever.
Profuse sweating, abdominal fullness, thirst, red tongue with yellow coating.	Thirst, heart distress, red tongue with yellow coating.
Treatment Method	Clear heat, promote dampness, and reduce jaundice.
Clear internal heat, drain dampness, and reduce jaundice.
Clear heat, promote dampness, and resolve the exterior.

Small Chái Hú Tāng Class Comparison

Pathogenesis	Main Symptoms	Treatment Method	Formula	Diagnosis
Small Chái Hú Tāng	Evil invades Shaoyang, gallbladder fire internally accumulates, and the pivot is not smooth.	Bitter mouth, dry throat, dizziness, thin and wiry pulse, alternating cold and heat, chest and flank fullness, silent and unwilling to eat, heart distress with a preference for vomiting.	Harmonize Shaoyang, regulate the pivot.	Chái Hú, Huáng Qín, Bàn Xià, Shēng Jiāng, Rén Shēn, Gān Cǎo, Dà Zǎo.	Shaoyang Disease.
Chái Hú Guì Zhī Tāng Syndrome	Combined with Taiyang exterior symptoms.	Fever, slight aversion to cold, body aches, slight fullness in the chest and flanks, thin white tongue coating, floating pulse.	Combined with exterior resolution.	Add Guì Zhī, Sháo Yào.	Combined with Taiyang exterior symptoms.
Dà Chái Hú Tāng Syndrome	Combined with Yangming interior excess.	Agitation, persistent vomiting, fullness below the heart, constipation, foul-smelling diarrhea, yellow urine, red tongue with yellow coating, pulse is wiry and rapid.	Open the interior.	Remove Rén Shēn, Gān Cǎo, add Sháo Yào, Zhǐ Shí, Dà Huáng.	Combined with Yangming interior excess.
Chái Hú Jiā Máng Xiāo Tāng Syndrome	Combined with Yangming interior excess, dryness is more severe, righteous qi is slightly deficient.	Daytime fever, slight urination after defecation.	Drain heat and resolve the interior.	Add Máng Xiāo.	Combined with Yangming interior excess, light symptoms.
Chái Hú Guì Zhī Gān Jiāng Tāng Syndrome	Combined with internal water retention.	Slight fullness in the chest and flanks, difficult urination, thirst but no vomiting, slight sweating.	Warm and transform water retention.	Remove Bàn Xià, Shēng Jiāng, Rén Shēn, Dà Zǎo, add Guì Zhī, Gān Jiāng, Guā Lóu Gēn, Mǔ Lì.	Combined with internal water retention.
Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng Syndrome	Spreading throughout the three jiaos, both interior and exterior are affected, with both deficiency and excess.	Palpitations, anxiety, delirium, difficult urination, heaviness throughout the body, unable to turn over.	Open the yang, drain heat, and calm the spirit.	Remove Gān Cǎo, add Lóng Gǔ, Lián Dān, Guì Zhī, Fú Líng, Dà Huáng, Mǔ Lì.	Spreading throughout the three jiaos, both interior and exterior are affected, with both deficiency and excess.

Lower Diarrhea Summary

1. Gè Gēn Tāng Syndrome: Taiyang exterior evil pressing on the large intestine, leading to abnormal transmission. Specific symptoms include watery stools without foul odor and no burning sensation in the anus.

2. Gè Gēn Qín Lián Tāng Syndrome: Heat pressing on the large intestine, symptoms include persistent diarrhea with foul odor, burning sensation in the anus.

3. Guì Zhī Rén Shēn Tāng Syndrome: Spleen deficiency leading to loss of function, clear yang not rising, symptoms include persistent diarrhea with watery stools.

4. Huáng Qín Tāng Syndrome: Shaoyang evil heat pressing on the large intestine, leading to loss of function, specific symptoms include sticky and foul-smelling stools, urgency, and heaviness in the anus.

Yang Jaundice vs. Yin Jaundice Comparison

Yang Jaundice	Yin Jaundice
Pathogenesis	Damp evil accumulates internally.
Damp evil accumulates internally, steaming the liver and gallbladder.	Spleen and stomach yang deficiency, cold dampness obstructing.
Main Symptoms	Body yellow, eyes yellow, difficult urination, yellow stools.
Bright yellow like orange. No sweating or only head sweating, fever, thirst, heart distress, constipation or difficulty.	Dark yellow. No thirst or preference for hot drinks. Loose stools. Pale tongue with white coating, deep and slow pulse.
Treatment Method	Clear dampness and reduce jaundice.
Clear heat, promote dampness, and reduce jaundice.

Sì Nì Tāng	Tōng Mài Sì Nì Tāng	Bái Tōng Tāng
Pathogenesis	Kidney yang deficiency, internal cold.
Yang is obstructed externally.
Yang is obstructed above (Dài Yáng Syndrome).
Main Symptoms	Clear diarrhea, cold limbs, curled body, aversion to cold, thin pulse, only wanting to sleep, or pale urination.
Pulse is weak, but the body does not feel cold.
Face is red.
Treatment Method	Warm the kidney and restore yang.
Break the cold and restore yang.
Open the interior and exterior.
Disperse and open the upper and lower.
Formula	Fù Zǐ, Gān Jiāng, Gān Cǎo.
Fù Zǐ, Gān Jiāng, Gān Cǎo (heavy use of Fù and Jiāng).
Scallion, white Fù Zǐ, Gān Jiāng.

※ Body Pain Summary: Má Huáng Tāng Syndrome – Wind-cold evil obstructing the muscle surface, stagnation of yin – fever, floating pulse, hands and feet are not cold.

Guì Zhī Xīn Jiā Tāng Syndrome – Qi and yin deficiency, body not nourished – after sweating, body pain, pulse is deep and slow.

Fù Zǐ Tāng Syndrome – Shaoyin yang deficiency, cold dampness obstructing – cold hands and feet, back pain, warm mouth, pulse is deep.

Fù Zǐ Tāng Syndrome	Zhēn Wǔ Tāng Syndrome
Pathogenesis	Kidney yang deficiency.
Internal cold dampness.
Main Symptoms	Back pain, warm mouth, body pain, cold hands and feet, joint pain, pulse is deep.	Abdominal pain, difficult urination, heavy limbs, diarrhea.
Treatment Method	Warm yang, disperse cold, relieve pain, and eliminate dampness.	Warm and supplement kidney yang, transform qi and promote water.
Formula	Fù Zǐ, Bái Zhú, Fú Líng, Gān Cǎo.
Pregnancy (use with caution). Focus on supplementing original yang, dispersing dampness. Support the righteous.	Shēng Jiāng. Focus on warming and dispersing water evil, expelling evil.