1 、Simultaneous Treatment of Exterior and InteriorThe treatment of exterior and interior diseases is based on two main principles: resolving the exterior and attacking the interior. During the progression of a disease, it is common to encounter simultaneous exterior and interior conditions. Zhongjing advocates that when the exterior is urgent, the exterior should be resolved first; when the interior is urgent, the interior should be rescued first. He is particularly adept at combining exterior and interior medicines in one formula to treat both simultaneously and eliminate pathogenic factors.1.1 Resolving the Exterior and Clearing the Interior: This method targets exterior pathogens with interior heat. For example, the formula Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) is used to treat interior heat with accompanying exterior pathogens causing diarrhea. In this formula, Ge Gen (Kudzu) is acrid and cool, resolving the exterior pathogen, while Huang Qin (Scutellaria) and Huang Lian (Coptis) are bitter and cold, effectively clearing interior heat and stopping diarrhea. Another example is Da Qing Long Tang (Major Blue Dragon Decoction) for treating excess fluid retention with symptoms of fever and cough, where the formula induces sweating, disperses water, and clears heat, treating both exterior and interior simultaneously.1.2 Resolving the Exterior and Attacking the Interior: This method is for cases where the exterior pathogen has not been resolved, and there is an interior accumulation. For instance, Hou Po Qi Wu Tang (Magnolia Bark and Seven Herbs Decoction) treats abdominal fullness with exterior symptoms, where the exterior pathogen has not been resolved and there is an interior accumulation in the Yangming organ. This formula uses Gui Zhi Tang (Cinnamon Twig Decoction) to resolve the exterior and harmonize the nutritive and defensive Qi, while adding Hou Po (Magnolia Bark) and other herbs to promote Qi and relieve fullness, addressing the interior accumulation.1.3 Resolving the Exterior and Transforming Phlegm: This method addresses phlegm retention in the lungs that is aggravated by external pathogens. The representative formula is Xiao Qing Long Tang (Minor Blue Dragon Decoction), which discusses the treatment of exterior cold with interior phlegm retention. This is characterized by symptoms such as wheezing, coughing, and dry retching, and the treatment focuses on warming and resolving the exterior while transforming phlegm. The formula includes Ma Huang (Ephedra) to induce sweating, relieve wheezing, and promote urination, while Gui Zhi (Cinnamon Twig) and Shao Yao (Peony) harmonize the nutritive and defensive Qi, and Gan Jiang (Dried Ginger) and Xi Xin (Asarum) disperse cold and transform phlegm, making it a dual-purpose formula for resolving both the exterior and phlegm.2、Simultaneous Treatment of Cold and Heat2.1 Warming the Defensive Yang and Draining Heat with Fu Zi Xie Xin Tang (Aconite Decoction to Drain the Heart). The Shang Han Lun states, “If there is a sensation of fullness below the heart and a dislike of cold with sweating, Fu Zi Xie Xin Tang is indicated.” This formula addresses heat accumulation with Yang deficiency. It includes Da Huang (Rhubarb), Huang Lian (Coptis), and Huang Qin (Scutellaria), which are bitter and cold, soaked in Ma Fei Tang (Aconite Decoction) to extract their light and thin flavors to clear and drain the upper heat. Fu Zi (Aconite) is simmered separately to extract its juice, allowing the warming and Yang-supporting properties to take effect. Although the herbs work together, their functions are distinct, showcasing the wisdom of the ancients.2.2 Clearing the Upper and Warming the Lower with Huang Lian Tang (Coptis Decoction). The Shang Han Lun states, “In cases of cold damage, if there is heat in the chest, evil Qi in the stomach, and abdominal pain with a desire to vomit, Huang Lian Tang is indicated.” This formula addresses the condition of upper heat and lower cold, with abdominal pain and a desire to vomit. Huang Lian (Coptis) is bitter and cold, clearing the heat above, while Gan Jiang (Dried Ginger) is acrid and warm, warming the cold below, thus harmonizing the upper and warming the lower to descend rebellious Qi.2.3 Using Cold and Heat Together with Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Heart). The Jin Gui Yao Lue states, “For vomiting and rumbling in the intestines with a sensation of fullness below the heart, Ban Xia Xie Xin Tang is indicated.” This formula discusses the treatment of mixed cold and heat conditions. The pathogenesis involves the pathogen invading the interior, causing a mix of cold and heat in the middle burner. Therefore, the formula uses Gan Jiang (Dried Ginger) and Ban Xia (Pinellia) to disperse cold and descend rebellious Qi, while Qin (Scutellaria) and Lian (Coptis) clear heat. The later interpretations of bitter and acrid, bitter descending and acrid opening, and bitter descending and acrid connecting all originate from this principle.3、Simultaneous Treatment of Deficiency and Excess“Great excess can appear as weakness, and extreme deficiency can present as fullness.” The combination of deficiency and excess is a characteristic of difficult and complicated diseases. Zhongjing often treats specific conditions by addressing both deficiency and excess, employing both attacking and tonifying methods.3.1 Using Blood-Invigorating Herbs with Qi-Tonifying Herbs: For example, Da Huang Zhe Chong Wan (Rhubarb and Insect Pill) is used to treat deficiency with blood stasis. Due to prolonged deficiency, the circulation of Qi and blood is affected, leading to blood stasis in the body. Therefore, the treatment focuses on tonifying the deficiency while alleviating stasis. The formula includes Da Huang (Rhubarb), Zhe Chong (Insect), Tao Ren (Peach Kernel), and Shui Zhi (Leech) to invigorate blood and resolve stasis, while Shao Yao (Peony) and Di Huang (Rehmannia) nourish blood and tonify deficiency. Gan Cao (Licorice) and Bai Mi (Honey) benefit Qi and harmonize the formula, achieving a balance of attacking and tonifying, supporting the righteous Qi while eliminating pathogens and resolving stasis without harming the righteous Qi.3.2 Using Tonifying Herbs with Dispersing Herbs: For example, Shu Yu Wan (Dioscorea Pill) treats “deficiency of various aspects and invasion of external wind causing numerous diseases.” This is primarily due to insufficiency of Qi, blood, Yin, and Yang in the body, combined with invasion of external wind. The treatment should focus on tonifying the righteous Qi, rather than simply expelling wind, which could harm the righteous Qi. Therefore, Shu Yu Wan is formulated to strengthen the spleen, with Chai Hu (Bupleurum), Gui Zhi (Cinnamon Twig), and Fang Feng (Siler) to dispel wind and eliminate pathogens, achieving the dual effect of supporting the righteous Qi and expelling pathogens.3.3 Using Kidney-Tonifying Herbs with Diuretic Herbs: A representative formula is Shen Qi Wan (Eight Flavor Kidney Qi Pill). The Jin Gui Yao Lue states, “For deficiency with low back pain, tightness in the lower abdomen, and difficulty urinating, Shen Qi Wan is indicated.” This formula addresses the condition of Kidney Yang deficiency. It assists the weak Yang in transforming water and nourishes the Yin deficiency to generate Qi, invigorating the Kidney Qi, leading to the resolution of various symptoms.4、Combination of Five Flavors4.1 Combination of Acrid and Sour: Acrid can disperse and open, while sour can gather and restrain. For example, in Gui Zhi Tang (Cinnamon Twig Decoction), acrid and warming Gui Zhi (Cinnamon Twig) is used to resolve the exterior and promote Yang, while sour and cold Shao Yao (Peony) is used to restrain Yin and harmonize the nutritive Qi. This combination allows for dispersing and restraining, with the ability to induce sweating while also retaining some sweat, harmonizing the nutritive and defensive Qi, dispersing wind-cold without harming Yin. In Xiao Qing Long Tang (Minor Blue Dragon Decoction), Gan Jiang (Dried Ginger) and Xi Xin (Asarum) disperse lung cold, while Wu Wei Zi (Schisandra) restrains lung Qi, achieving a balance of dispersing and restraining, without harming the righteous Qi or retaining pathogens.4.2 Combination of Acrid and Sweet: The combination of acrid and sweet can generate Yang Qi. For example, in the treatment of deficiency, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) uses sweet Yi Tang (Maltose) combined with acrid and warming Gui Zhi as the main herbs to generate Yang Qi and restore the function of the spleen and stomach. Another example is Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) for treating spleen and stomach deficiency and cold, combining Gan Cao (Licorice) with Gan Jiang (Dried Ginger) to restore Yang Qi in the middle burner, also embodying the principle of acrid and sweet generating Yang.4.3 Combination of Sour and Sweet: The combination of sour and sweet can generate body fluids and nourish Yin. The famous formula Shao Yao Gan Cao Tang (Peony and Licorice Decoction) from the Shang Han Lun addresses abdominal pain caused by disharmony of Qi and blood. This formula combines Gan Cao (Licorice) and Shao Yao (Peony), where sour and sweet interact to restrain Yin and nourish blood. When body fluids are sufficient, the tendons and meridians are nourished, and spasms and pain cease.In addition, there are many methods of combining herbs based on their properties, such as combining hard and soft herbs, moving and calming herbs, differentiating based on syndrome versus disease, and combining Qi and blood herbs. Through studying Zhongjing’s methods of herb combinations, one deeply realizes the necessity of distinguishing the properties of herbs, the deficiency and excess of diseases, and flexibly applying the methods of simultaneous treatment of exterior and interior, cold and heat, deficiency and excess, and other clever combinations of herbs to address various complex diseases and changing conditions, thus better inheriting and promoting Zhongjing’s theories and experiences in herb combinations, and skillfully applying them in clinical diagnosis and treatment of diseases.· The End · Note:This platform shares health-related graphic information for reference and learning purposes only and should not be used as a basis for medical diagnosis. Please consult a physician for guidance if needed.⊙ Copyright Statement: The article is sourced from the internet; if there is any infringement, please contact us for removal.
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