Line3-4 (wen bing tiao bian)

    三, In disease of greater yang, the pulse is stirring with rapid without being moderate and tight, or is large only in both inch, and there is feeling of heat in the inside skin from wrist to elbow, headache, mild aversion to wind and cold, generalized heat, spontaneous sweating, thirst, or cough without thirst, severe heat effusion in the afternoon, this is called Warm disease.

If the pulse is not moderate, this is not greater yang wind strike. If the pulse is not tight, this is not greater yang cold damage. The stirrgin and rapid pulse indicates the image of wind and fire which blazing up. This is said ‘agiation’ in Nei Jing (內經). The reason of large pulse only in both inch is because fire restrains metal. Feeling of heat in the inside skin from wrist to elbow means that contrarily fire restrains water. Headache, aversion to wind and cold, generalized heat, are spontaneous sweating not different with greater yang wind strike, so it is easy to be confused, how to discriminate? One should distinguish this by the pulse which is stirring with rapid without being moderate and tight, or thirst, or cough, or feeling of heat in the inside skin from wrist to elbow, and severe heat effusion in the afternoon. In case of greater yang headache, the evil of wind and cold ascend to head and nape following greater yang channel, therefore there is stiff nape, and headache. Contrary to this, in case of greater yin headache, the lung controls heaven qi, if the heaven qi gets depressed, headache also occurs. And qi is in head in spring and fire blazes upward. Wu You Ke (吳又可) states that this is due to evil heat overflowing to greater yang channel, this is conjecture. In case of aversrion to cold in cold damage, greater yang is related with cold and water and controls the exterior, therefore aversion to wind and cold occurs. In case of aversion to cold in warm disease, the lung is combined with the skin and body hair and also controls the exterior, therefore aversion to wind and cold also occurs. If greater yang contracts diease, the yang qi fo whole body becomes stagnant, therefore this brings about generalized heat. The lung controls transforming of qi, if the diseased lung cannot transform qi,  qi gets stagant and generalized heat occurs. Spontaneous sweating in greater yang wind strike is due to wind which makes defense qi loose the compact. Spontaneous sweating in greater yin warm disease is due to the opening of the skin and body hair, the lung also controls the defense. Thrist meanst that fire restrains metal. Cough means that lung qi is stagnant. Sever heat effusion in the afternoon is becases turbid evil gathers downward and the afternoon is the time when fire is exuberant. And this is also the image of yin restrained by fire.

    四, In wind warmth, warm heat, warm epidemic, winter warmth in greater yin, when the disease is about to occur in early stage, if there is aversion to wind or cold, Gui Zhi Tang (桂枝湯, Cinnamon Twig Decoction) treats this. But if there is heat effusion without aversion to cold, and thirst, this should be treated with Yin Qiao San (银翘散, Honeysuckle and Forsythia Powder) which is pungent and cool. Warm toxin, summerheat warmth, damp warmth, and warm malaria are not related with this example.

    According to the text of Shang Han Lun (傷寒論) of Zhang Zhong Jing (張仲景), in greater yang disease（this is same with greater yang pattern, in other words, this indicate headache, generalized heat, aversion to wind, and spontaneous sweating in the abobe）, there is aversion to heat without aversion to cold, and thirst, this is called warm disease, Gui Zhi Tang (桂枝湯, Cinnamon Twig Decoction) treats this. Generally in warm disease, promotion of sweating is avoid, resoving the flesh is best to warm disease, Gui Zhi Tang (桂枝湯) originaly resolves the flesh. And the aroma of Gui Zhi (桂枝) transforms turbidity, Shao Yao (芍药) contracts yin and fluids, Gan Cao (甘草) eliminates toxin and harmonizes the middlem Sheng Jiang (生薑) and Da Zao (大棗) regulate and harmonize defense and construction, therefore Gui Zhi Tang (桂枝湯) can be used in the early stage of warm disease. In this line, by changing the old method, if there is aversion to wind or cold, this is treated with Gui Zhi Tang (桂枝湯), and if there is absence of aversion to wind and cold, this is treated with herbs with pungent and cool, those treatement are not against an age-old teaching. The absence of aversion to wind and cold which Zhang Zhong Jing (張仲景) said does not mean that aversion to wind and cold never appear, but means that there is aversion to wind and cold at early stage but after heat effusion, the aversion to wind and cold disappears. The style of ancient writing is simple, furthermore, he tries to contrast aversion to wind and cold and heat effusion at the same time occurs in greater yang wind strike with warm disease, there is no chance to mention in detail. Generally the disease of cold water is related with winter qi, therefore this cannot be resolved without herbs with pungent and warm which are related with the qi of spring and summer.  In here, although it says warm disease, but there is already aversion to wind and cold, so it is clear that warm evil occurs form the interior and wind and cold evil fetter the exterior, therefore this becomes interior heat and exterior cold pattern. Therefore the method of resoving the flesh with pungent and warmth of Gui Zhi Tang can promotes sweat slightly and then both cold and heat evil get to resolve.

The evil of warm and heat is related with the qi of spring and summer, and also the absence of aversion to wind and cold indicates that cold and wind are not combined. Therefore this cannot be resolved without herbs with pungent and cool which are the qi of autumn-metal. Gui Zhi (桂枝) is pungent and warm, if one tries to treat warm disease with this, this is like extinguishing fire with fire. Therefore I treats this according to Nei Jin (内经) which says that wind evil in the interior should be treated with pungent and cool and assistanted with bitter and sweet.

   

    Gui Zhi Tang (桂枝湯, Cinnamon Twig Decoction)

    Gui Zhi (桂枝, six qian）Shao Yao (芍药, stir-bake, three qian）Zi Gan Cao(炙甘草, two qian）Sheng Jiang (生姜, three pieces）Da Zao (大枣, two pieces）

Taking and decocting method need to follow as presented in Shang Han Lun (傷寒論). If it does not so, the wondrous effect of Gui Zhi Tang (桂枝湯, Cinnamon Twig Decoction) not only will be lost but also the disease never be eliminated.

   

 Yin Qiao San (银翘散, Honeysuckle and Forsythia Powder), pungent and cool

    Lian Qiao (连翘, one liang）Jin Yin Hua (金银花, one liang）Jie Geng (桔梗, six qian）Bo He (薄荷, six qian）Zhu Ye (竹叶, four qian）Sheng Gan Cao (生甘草, 五钱）Jing Jie Sui (荊芥穗, four qian）Dan Dou Chi (淡豆豉, five qian）Niu Bang Zi (牛蒡子, six qian）

 

Grind these into powder, decoct six qian every time with fresh Wei Gen Tang (苇根汤), when aroma spreads out greatly with water strating to boil, take this, do not decoct too long. The qi of drugs for the lung should be lignt and clear, decocting too long time makes the flavor thick [heavy] which tends to enter middle burner. If the disease is severe, take this every four hours, three times a day and one time at night. If the disease is slight, take this every six hours, two times a day and one time at night. In spite of taking this one day, if it dose not resolve, take this again. Generally the lung locates in the highest place, if the qi of drugs is too heavy, this passes the place of the disease and goes down, if drugs are used too small, there is worry that the force of medicine cannot reach the place of the disease. Therefore this follows the method of 时时清扬法 (shi shi qing yang fa)1) of Pu Ji Xiao Du Yin (普济消毒饮).  Nowadays, some people uses the pungent and cool method but lots of then do not take effect. Because, generally the disease is severe but the drugs are too light. After only one day use of drugs, if there is no effect, they change the formula easily, the more they change a formula, the more the formula get to be away from disease, finally they are almost at a lost and just spend days, in the end this brings about the pattern of middle or lower burner.

In oppression in the chest and diaphragm, add Huo Xiang (藿香, three qian) and Yu Jin (郁金, three qian) to protect chest center. In severe thirst, add Tian Hua Fen (天花粉). In swelling in the nape and sore throat, add  加 Ma Bo (马勃) and Yuan Shen (元参). In epistaxis, remove Jing Jie Sui (荊芥穗), Dou Chi (豆豉) and add Bai Mao Gen (白茅根, three qian) and Ce Bai Ye (侧柏葉, stir-bake to scorch, three qian),  Zhi Zi (栀子炭, stir-bake to scorch, three qian). In cough, add Xing Ren (杏仁) to disinhibit lung qi. On the second or third day of cold damage, even though the disease is in the lung but heat is entering ineterior gradually, add Sheng Di (生地) and Mai Men Dong (麦winter) to preserve (保) fluids. Still there is unresolved heat or short voidings of urine, add herbs with bitter and cold as Zhi Mu (知母), Huang Qin (黄芩), and Zhi Zi (栀子), with sweet and cold as Mai Men Dong (麥門winter) and Sheng Di Huang (生地黃). These combination treats exuberant heat by forming yin qi.

1)时时清扬法 (shi shi qing yang fa)

This method makes the qi of drugs to reach the upper part by taking drugs little by little, several times.

    [方论] looking around carefully, promotion of sweating is banned in warm disease. Promotion of sweating do not resolve disseat, instead, this causes disease. When the disease is in hand greater yin lung channel, vaily damaging of foot greater yin [bladder] channel is useless. When the disease occurs form mouth and nose, it is useless to disperse the exterior. And sweat is heart humor, if heat yang gets damaged by the promotion of sweating, spirit light will be disturbed internally and the signs as delirious speechmania and withdrawal and the pattern of internal block and external collapse can occur. Looking around repeatedly, it is said that erroneous sweating damages yang, but sweat is one of five humoer, therefore in the end yin qi is also damaged.

   Referring to Shang Han Lun (傷寒論), it says that if the pulse at the cubit is faint, which indicates interior vacuity, promotion of sweating is banned. One can know the reason form this text.

    Therefore what it says that promotion of sweating damages yang, especially mentioned something damaged excessively in the damaged. Warm disease is good at damgagin yin, applied medicine also damaged yin. From the ancient days so far, it is a great fallacy that the method for cold damage is used to Warm disease.

Da Yua Yin (达原饮)1) is made first by Wu You Ke (吳又可), the meaning of Da Yua Yin (达原饮) is that this formula reaches and penetrates into membrane source and breaks down evil swiftly. When this is used to laborer or healthy or strong man, sometines this have a effect. This is because the aromatic nature eliminate turbid evil. But this will have a problem to someone who usually likes to oily food or is not strong constitutuion. In that formula, Bing Lang (槟榔), Cao Guo (草果), Hou Po (厚朴) act as sovereign. Bing Lang (槟榔) which is seed, seeds have a nature of descending, Bing Lang (槟榔) is bitter, pungent, and warm, and heavy in weight and is hard in quality. Therefore this descends toward lower burner and reaches to the anus via middle  burner. This is formula acted in middle and lower burner. Cao Guo (草果) is also seed. Its aroma is intense, its qi is great heat, the flavor is bitter, and acts in greater yin spleen channel. Hou Po (厚朴) is bitter and warn, and also acts in middle burner. How can formula with bitter and warm nature, and intense aroma, which can abuse the fluids of lesser yin, be used! Zhi Mu (知母) and Huang Qin (黄芩) which have bitter and dry natur enter middle burner, how can they be used? furthermore, he suggests adding method of Qiang Huo (羌活), Ge Gen (葛根),  Chai Hu (柴胡), which are related with three yang channels, by using the theory of warm evil overflowing to three yang channels, this is still mixing of the treatments of shan han (上寒, cold damage), he does not know the treatment for warm disease at all, about this, posterity criticize only that Wu You Ke (吳又可) does not classify three burner, this is shallow opinion. Speaking of San Xiao Yin (三消饮) with Da Huang (大黄) and Mang Xiao (芒硝) on warm disease, if evil entered yang brightness and the person is strong constitutuion,
fortunately, sometimes resoving after 
precipitation or shiver sweating occurs, but
this often causes vauity pattern and extremely vacuity person can die. Evil can be in defense, or in the chest, or in construction, or in blood, without checking these occasions, if precipitation is used unreasonably, the damage will be beyond description. How do one can see that people which is made of qi and blood as same as metal or stone?

    三、太阴之为病，脉不缓不紧而动数，或两寸独大，尺肤热，头痛，微恶风寒，身热自汗，口渴，或不渴，而咳，午后热甚者，名曰温病。

    不缓，则非太阳中风矣；不紧，则非太阳伤寒矣；动数者，风火相煽之象，经谓之燥；两寸独大，火克金也。尺肤热，尺部肌肤热甚，火反克水也。头痛、恶风寒、身热自汗、与太阳中风无异，此处最足以相混，于何辨之？于脉动数，不缓不紧，证有或渴、或咳、尺热、午后热甚辨之。太阳头痛，风寒之邪，循太阳经上至头与项，而项强头痛也。太阴之头痛，肺生天气，天气郁，则头亦痛也，且春气在头，又火炎上也。吴又可谓浮泛太阳经者，臆说也。伤寒之恶寒，太阳属寒水而主表，故恶风寒、温病之恶寒，肺合皮毛而亦主表，故亦恶风寒也。太阳病则周身之阳气郁，故身热；肺主化气，肺病不能化气，气郁则身亦热也。太阳自汗，风疏卫也；太阴自汗，皮毛开也，肺亦主卫。渴，火克金也。咳，肺气郁也。午后热甚，浊邪归下，又火旺时也，又阴受火克之象也。

    四、太阴风温、温热、温疫、冬温，初起恶风寒者，桂枝汤主之；但热不恶寒而渴者，辛凉平剂银翘散主之。温毒、暑温、湿温、温疟，不在此例。

    按仲景《伤寒论》原文，太阳病（谓如太阳证，即上文头痛身热恶风自汗也），但恶热不恶寒而渴者，名曰温病，桂枝汤主之。盖温病忌汗，最喜解肌，桂枝本为解肌，且桂枝芳香化浊，芍药收阴敛液，甘草败毒和中、姜、枣调和营卫，温病初起，原可用之。此处却变易前法，恶风寒者主以桂枝，不恶风寒主以辛凉者，非敢擅违古训也。仲景所云不恶风寒者，非全不恶风寒也，其先亦恶风寒，迨既热之后，乃不恶风寒耳，古文简、质，且对太阳中风热时亦恶风寒言之，故不暇详耳。盖寒水之病，冬气也，非辛温春夏之气，不足以解之，虽曰温病，既恶风寒，明是温自内发，风寒从外搏，成内热外寒之证，故仍旧用桂枝辛温解肌法，俾得微汗，而寒热之邪皆解矣。温热之邪，春夏气也，不恶风寒，则不兼寒风可知，此非辛凉秋金之气，不足以解之。桂枝辛温，以之治温，是以火济火也，故改从内经“风淫于内、治以辛凉、佐以苦甘”法。

   

    桂枝汤方

    桂枝（六钱）芍药（炒，三钱）炙甘草（二钱）生姜（三片）大枣（去核，二枚）煎法服法，必如伤寒论原文而后可，不然，不惟失桂枝汤之妙，反生他变，病必不除。

   

    辛凉平剂银翘散方

    连翘（一两）银花（一两）苦桔梗（六钱）薄荷（六钱）竹叶（四钱）生甘草（五钱）芥穗（四钱）淡豆豉（五钱）牛蒡子（六钱）上杵为散，每服六钱，鲜苇根汤煎，香气大出，即取服，勿过煎。肺药取轻清，过煎则味浓而入中焦矣。病重者，约二时一服，日三服，夜一服；轻者三时一服，日二服；夜一服；病不解者，作再服。盖肺位最高，药过重，则过病所，少用又有病重药轻之患，故从普济消毒饮时时清扬法。今人亦间有用辛凉法者，多不见效，盖病大药轻之故，一不见效，随改弦易辙，转去转远，即不更张，缓缓延至数日后，必成中下焦证矣。胸膈闷者，加藿香三钱、郁金三钱∶护膻中；渴甚者，加花粉；项肿咽痛者，加马勃、元参，衄者，去芥穗、豆豉，加白茅根三钱、侧柏炭三钱、栀子炭三钱；咳者，加杏仁利肺气；二、三日病犹在肺，热渐入里，加细生地、麦冬保津液；再不解或小便短者，加知母、黄芩、栀子之苦寒，与麦、地之甘寒，合化阴气，而治热淫所胜。

    方论按温病忌汗，汗之不惟不解，反生他患。盖病在手经，徒伤足太阳无益；病自口鼻吸受而生，徒发其表亦无益也。且汗为心液，心阳受伤，必有神明内乱，谵语癫狂、内闭外脱之变。再，误汗虽曰伤阳，汗乃五液之一，未始不伤阴也。

    《伤寒论》曰∶“尺脉微者为里虚，禁汗，”其义可见。

    其曰伤阳者，特举其伤之重者而言之耳。温病最善伤阴，用药又复伤阴，岂非为贼立帜乎？此古来用伤寒法治温病之大错也。至若吴又可开首立一达原饮，其意以为直透膜原，使邪速溃，其方施于藜藿壮实人之温疫病，容有愈者，芳香辟秽之功也；若施于膏粱纨及不甚壮实人，未有不败者。盖其方中首用槟榔、草果、厚朴为君∶夫槟榔，子之坚者也，诸子皆降，槟榔苦辛而温，体重而坚，由中走下，直达肛门，中下焦药也。草果亦子也，其气臭烈大热，其味苦，太阴脾经之劫药也；厚朴苦温，亦中焦药也，岂有上焦温病，首用中下焦苦温雄烈劫夺之品，先劫少阴津液之理！知母、黄芩，亦皆中焦苦燥里药，岂可用乎？况又有温邪游溢三阳之说，而有三阳经之羌活、葛根、柴胡加法，是仍以伤寒之法杂之，全不知温病治法，后人止谓其不分三焦，犹浅说也。其三消饮加入大黄、芒硝，惟邪入阳明，气体稍壮者，幸得以下而解，或战汗而解，然往往成弱证，虚甚者则死矣。况邪有在卫者，在胸中者，在营者，入血者，妄用下法，其害可胜言耶？岂视人与铁石一般，并非气血生成者哉？