CHAPTER FIVE - 2

SH Ch5 - 2

                      The left page: From the forth line from the left end,
                      the "original" text starts.
                      The TCM and Japanese Kanpo versions start from here.

 

 

Shinjiro's Note:

  5 - 1: Lin Yi Shang-han Lun which are used to be
  omitted by the TCM & Japanese Kanpo version Shang-han
  Lun.       
  5 - 2: Text after Lin Yi Shang-han Lun including
  all notes by Lin Yi et al which are used to be
  omitted by the TCM & Japanese Kanpo version Shang-han
  Lun.         

1) I broke the text into sections and numbered them following the Japanese standard text, the Nippon Kanpo Kyokai Edition.

2) The words in [] are Shinjiro’s notes, not in the original text.

3) The words in () are added by Shinjiro to facilitate comprehension in English.

4) The words in {} are notes in small characters in the original texts.

The Fifth (Chapter)

Discrimination of

the Tai-yang Illness

Pulse Evidence and Treatments

 Upper (Section)

Total 16 Rules and 14 Formulas

Njemile Carol Jones, L. Ac. Proofread.

Thanks.

Shinjiro's Notes

  • Each of the six Warp (jing) Illnesses in Song Text  starts with the same style sentence, "  --- zhi wei bing (when --- this becomes ill)," and this sentence is called "ji-gang," which means "to present a rule." The ji-gang defines each Warp Illness. Song Text is the first Shang-han Lun copy that starts  each Warp Illness description with "ji-gang" and define the Shang-han illness with the six Warp Illness (liu jing bing) theory.

     This "ji-gang" style differs from Nei-jing Chapter 31 in three ways. 1)  Nei-jing Chapter 31 describes the Six Warp Illness (liu jing bing) with the numbers of days'  development of the illness, such as "the first day, Tai-yang Warp receives the illness." This style is called "shi xi-lie," which means "time order."  Shang-han Lun copies, dated before Song Text all follow this style. 2) The strategy for treating Shang-han Illness in Nei-jing Chapter 31 is "Sweat the patient in 3 Yang Illnesses, and purge the patient in 3 Yin Illnesses."  In the Song Text, only the patient in Tai-yang Illness is sweated. The patient in Yang-ming Illness is purged, and Shao-yang Illness harmonized. 3 Yin Illnesses are warmed and supplemented. 3) In Nei-jing  Chapter 31, the order of the progress of illness in 3 Yang Warps is "Tai-yang - Yang-ming - Shao-yang," but in Song Text it is "Tai-yang (surface) - Shao-yang (half surface, half inside) - Yang-ming (inside)." These differences were due to one change in Song Text. That is;  in Yang-ming Illness, Stomach (wei = the general digestive system) becomes feverish (re) in the Song Text, instead of  Stomach Cold in Nei-jing Chapter 31. I will explain this change in detail in the Yang-ming Chapter.
Clause 1
When Tai-yang1 (Warps) becomes ill*, the pulse (of the patient) becomes Floating (fu)2, and (he/she suffers from) headache (tou-tong), nape stiffness (xiang-qiang), and then (er) Hating-cold (wu-han; chills)3.

Shinjiro's Notes

  • 1-1: Tai-yang:  Cheng Wu-ji explains in his Zhu Jie Shang-han Lun  that "Tai-yang masters (zhu) Surface (biao)." This means unlike Su-wen Chapter 31, in the Song Text,the term " Tai-yang" does not mean Tai-yang Warp, but the surface layer of the body. Japanese Kanpo and TCM follow this idea, but Mori Risshi in his Shang-han Lun Kao points out that in Clause 106 of Tai-yang Illness Pulse Discrimination and Treatment - Mid Section in Song Text it says, (When) Tai-yang Illness has not resolved, Heat (re) knots in Bladder, and in Clause 124 of Mid Section, because Tai-yang Illness follows the Warp (yi tai-yang sui jing), stagnated Blood exists in the Inside (yu xue zai li).

     

    The idea of "Tai-yang masters (zhu) Surface (biao)" is never expressed in Su-wen. Not only that, in Song Text, Tai-yang symptoms start from the head and nape and spread to the low back along the Tai-yang Bladder Warps, never spread all over the surface of the body.

     

    According to Makizumi in So Izen Sho-kan ron Ko, the order of the progression of illness in Bian-que is first Cao-li (dermal layer), second Blood vessels, and third intestines and stomach according to Shi-ji (see Bian-que in this site). According to Hua-tou, the first day pi (skin), the second day fu (dermal tissue), the third day ji (dermal fat tissue), the fourth day xiong (chest), the fifth day fu (abdomen), and the sixth day wei (stomach) according to Wei-tai-mi Yao-fang (Officials Medical Secrets, by Wan Tao, 752 Tang Dynasty). This Hua-tou theory could have guided Su-wen Chapter 31 theory. 

    1-2: Floating pulse: Fang You-zhi (1522-?) says in his Shang-han Tiao Bian: Nan-jing says that the Floating pulse exists and circulates above the meat (rou). Master Hua (Bo-ren; 1304-86) says that when the pulse exists and circulates above the meat (rou), it masters Surface (biao). Surface is where the skin layer (pi-fu), Rong (prosperous) Qi, and Wei (guarding) Qi line up. Thus, when the pulse becomes Floating on the Cun distal position and Chi proximal position, we know the illness exists in Tai-yang, and it is the diagnosis of (the) Tai-yang (illness). (from Shokanron Shu-gi  (Collection of Meanings on Shang-han Lun) (1822) by Taki Genkan (1755-1810)

    1-3: Wu-hang: Hating cold; chills. There are 2 important symptoms of Tai-yang Illness. One is Wu-hang (hating cold) and the other is Wu-feng (hating wind). Cheng Wu-ji explains that Wind is Yang, and Coldness is Yin. Wind harms Wei (qi), causing Fervescence (fa re), and perspiration.  Hating-wind (wu feng) is due to Wei (qi) having been Entere- by-wind (zhong feng). When Rong (qi) (Refer to My Translation) becomes ill, it causes Fervescence (fa-re) without perspiration or Hating-wind (wu-feng), but Hating-cold (wu-han).

    In Chapter 1 Clause 3, it says, when Yang is insufficient (bu-zu) and Yin qi arises into Yang inside, then (the patient) feels shivering Hating-cold (wu-han: chills). 

Clause 2
Tai-yang Illness1 (with the symptoms of) Fervescence (fa-re)2, perspiration, Hating-wind (wu-feng)3, with (the patient's) pulse being Gentle (huan)4, it is called Entered-by-wind (zhong feng)5.
  • *This clause is Ji-gang (presenting rule) of Zhong-feng.

  • 2-1: Mori Risshi says, I think Tai-yang Illness is the general term for when Evil invades the Skin and Body-hair (ji mao) region, but there are two different Evidences: when Evil of Meat and the Skin Layer (rou ji) goes into the Qi area (qi fen: Wei Qi region), it is called (Entered-by-wind).. Entered-by-wind (zhong fen), and when Evil of Tendon and Bone (jing gu)  goes into the Blood area (xue fen: Rong Qi region), it is called Shang-han. This Shang-han is different from general Shang-han.

    2-2: Fervescence (fa-re): Fang You-zhi says: Wind Evil invades the dermal fat layer (ji-fu) where it stagnates and steams.

    2-3: Hating-wind (wu-feng) ): Cheng Wu-ji explains

     that when Wei (qi) becomes ill, it causes Fervescence, perspiration,  without Hating-cold (wu-han) but with Hating-wind (wu-feng). Because Wei (qi) is Yang and it exists in the outer layer, the illness makes Wei (qi) unable to guard the outside. Thus, the skin (pi) and dermal layer (cao-li) are agitated (zao). This causes perspiration, and then Hating-wind (wu-feng).

    Fang You-zhi says: Wind Evil stagnates Wei qi, thus Wei qi Counter-flows and masters Hating-wind (wu-feng).  

    2-4: Huan: Gentle pulse: Habitually translated as slack pulse. In Chapter 1 Discrimination of Pulses, it says, when the Yang pulse is Floating, large and Soft, and the Yin pulse is Floating, Large and Soft, if the Yang pulse and the Yin pulse are equal, it is called Gentle (huan) pulse.   As the pulse of Tai-yang Illness is Floating (fu), actually this pulse should be Floating and Gentle, but the Gentle pulse is the Floating pulse in nature.  The Gentle (huan) pulse generally signifies a healthy, normal condition, even it has a Floating character.

    Cheng Wu-ji says: The reasons why the pulse of Shang-han is Tense (jing) and the pulse of Shang-feng (harmful wind: Shinjiro's Note: it is Zhong-feng here) is Gentle (huan) are;  the nature (xing) of Cold (han) is contracting (jing ji), and the nature of Wind (feng) is gentle (huan). 

    Fang You-zhi says: Gentle (huan) means Yang Floating (fu) and Yin Weak (ruo).

    2-5: Zhong-feng: Entered-by-wind. Common cold. Tai-yang Illness consists of Zhong-feng (Entered-by-wind), and Shang-han (harmful cold). Mori Risshi says the Evil (ye) of Zhong-feng and Shan-han is originally nothing but one. When a Surface Void (biao xu) person gets the Evil, it becomes Zhong-feng, and a Surface Replete (biao shi) person gets the Evil, it becomes Shang-han.  It is called Entered-by-wind (zhong-feng), not Harmful-wind (shang-feng), because the person is already Void and unguarded, and he/she is Entered-by-wind becoming ill. It is not same as the person, whose surface skin is fine, who is invaded by the Evil Qi and harmed by Cold Qi.
Clause 3
(In the case of) Tai-yang Illness, whether (the patient us having) already Fervescence or not Fervescence yet1, (if he/she has) Hating-cold (wu-han; chills) without fail2, body aches (ti tong)3, vomits adversely (tu ni)4, and  both Yin and Yang pulses are Tense (jing)5, it is called Harmful-cold (shang-han)6.

  • *This clause is Ji-gang of Shang-han (Harmful cold).

  • 3-1: whether -- or not: Cheng Wu-ji says: (The Classic says) as Cold is the Yin  Evil, it is unable to cause fever immediately.

  • 3-2: Hating-cold (wu-han; chills) without fail: Cheng Wu-ji says: (The Classic says) Wind harms Wei and Cold harms Rong*. Wei Xu (guarding qi  void) results in Hating-wind (wu feng), and Rong Xu (prosperous qi void)  results in Hating cold (wu han: chills). When Rong is harmed by Cold, it results in Hating cold (chills), without fail.  * Shinjiro's Note: Chapter 1 Clause 20.

  • 3-3: Body aches (ti tong): Qian Huang (?) says in Shang-han Su-yuan Ji in 1707, Qing Dynasty that the body aches are due to Cold harming Rong Qi, and Rong Qi falters (se)(its flow). (from Taki Genkan's Sho-kan Ron Shu-gi (1822)

  • 3-4: Vomit adversely (tu ni): ): Wu Qian et al in Yi Zhong Jing Jiang (Golden Mirror of Medicine: 1742 or 49) says that Qi inside of Stomach is inflicted by Cold and detained outside, being unable to initiate to surmount (Cold), thus vomiting  adversely (happens). (from Taki Genkan's Sho-kan Ron Shu-gi (1822)

  • Cheng Wu-ji says: (The Classic says) Wind makes Qi Gentle, and Cold moves Qi Adversely.

  • 3-5: Tense (jing) pulse: The Tense (jin) pulse is an antonym of the Gentle (huan) pulse. In Chapter 1, Clause 9 and 10, it says when the pulse is Floating and Tense, it is called String (xian). String means Decreasing (jian), and Decreasing (jian) means Cold. 

  • According to Mori Risshi, Yin and Yang pulses mean the Cu distal pulse and the Chi proximal pulse, rather than the floating or sunken positions. If both Yang and Yin pulses are Tense (jing), it signifies no perspiration.

  • 3-6:  Shang-han: In Song Text, there are two types of Shang-han, one is with a wider sense, and other a narrower sense. The narrow sense Shang-han is defined in this clause.

  • When Yellow Emperor said, " Generally speaking, the febrile diseases we see today all belong to a type of Shang-han (harmful cold)," in Chapter 31 of Su-wen, this Shang-han included Seasonal Illness (shi-qi bing), Febrile Illness (re bing), Warm Illness (wen bing) as well as Shang-han itself, thus it is a wider sense Shang-han.

  • Mori Risshi says, I think when this text says "Shang-han" anywhere, it is a general term for the illness of Wind Cold Evil Qi. In Chapter 3, Shang-han Examples, it says the illness of Shang-han usually is caused by Wind Cold. It starts from Wind Cold in Surface (biao), and it does not vanish even if it goes into Rear (li). It will safely hide and surely dissipate. There are many clauses on shang-han in the  Tai-yang, Yang-ming, Shao-yang and Jue-yin sections. There is only one clause of shang-han in the Tai-yin section, and no clause of Shang-han in the Shao-yin section.  Even so, if you see one Evidence of Shao-yin Illness, you realize it is obviously Shang-han. That is why the text does not state that it is Shang-han. Then what could be the figure and Evidence of shang-han? When the Evil exists on Surface it causes Cold and Fever and headache. If Evil exists in Rear (li), it causes Anxiety, Wheezing, and Abdominal Fullness. When days pass, you see Shang-han is there. 

Clause 4
On the Shang-han (illness) first day, Tai-yang (Warps) receive it (the illness or the Evil). If the pulse (of the patient) is Quiet (jing)1, (the illness) has not communicated (chuan) (to other warps)2.When (the patient) wants to vomit (tuo)3 very much (po), (and he/she is) agitated (zao) and anxious (fan)4, with the pulse being Frequent (shu) and Impetuous (ji)5, (the illness) has communicated  (to other Warps).

  • 4-1: Quiet (jing) pulse: In Chapter 3 Shang-han Examples, it says when (the pulse is) first Agitated (zao) and after Quiet (jing), this all indicates a healing Evidence.

  • 4-2: communicate to other Warps: According to Chapter 31 of Su-wen, the second day the illness communicates to Yang-ming Warp, and the third day, Shao-yang Warp.

  • 4-3: vomit (tuo): Cheng Wu-ji says: When Stomach Warp receives the Evil, it causes frequent vomiting.

  • 4-4: agitated (zao) and anxious (fan): According to Chapter 31 of Su-wen, the symptoms of Yang-ming Illness are body fever (shen re), eye aching (mu teng), dry nose and inability  to lie down.  

  • Cheng Wu-ji says: When Cold Evil communicates to Rear (li), it changes to Fever (re). Cheng believes Stomach (wei = digestive tract) belongs to Rear (li).

  • 4-5: the pulse being Frequent (shu) and Impetuous (ji): Zhang Xi-ju (?) says in his Shang-han Zhi-ji,  Frequent (shu) and Impetuous (ji) are antonyms of Quiet (jing). (from Taki Genkan's Sho-kan Ron Shu-gi (1822).  Usually the words ji and huan (gentle) are antonyms. For instance, in Pulse Classic (mai jing) Chapter 10 Clause 2, it says when all Warps are replete, the Cu distal pulse becomes Impetuous (ji) and the Chi proximal pulse becomes Gentle (huan).  There is no definition of Ji pulse in Pulse Classic (mai jing). As  “Quiet,” and  “Impetuous” are not a pulse figure, but an adjective.  Shuo-wen Xi-jie says ji is a "too small cloth,"  which is later expressed as being impetuous.

  • In Chapter 1 Clause 18, it says, when Cun distal pulse is Frequent, the Evil exists in Fu organs.

  • Chapter 2 Clause1 Line 17: Fluid retention (zhi-yin) results in Impetuous (ji) and String (xuan) (pulses). Frequent (shu)(pulse) means Fever (re)  and Anxiety (fang).

  • Chapter 6 Clause 92: When the patient has Frequent pulse, Frequent means Fever
Clause 5
On the Shang-han (illness) second and third day, if Yang-ming or Shao-yang Evidences (zheng) １do not appear, then (the illness) has not been communicated to them.
Shinjiro's Notes
  • 5-1: Yang-ming or Shao-yang Evidences (zheng): In Chapter 8 Clause 2, it says "When Yang-ming (Warps) become ill, Stomach is Replete (shi) and that is it. One book says Stomach is Cold." In Chapter9 Clause 1, it says, "When Shao-yang (Warps) become ill, the mouth feels bitter, the throat dries, and the eyes grow dizzy (xuan)."
Clause 6
In the case of Tai-yang Illness, (the patient with symptoms of) Fervescence (fa-re) and then thirst (ke), without Hating-cold (wu-han), suffers from Warm Illness (wen bing)1. If (the patient) has finished sweating (fa han) and the body becomes red hot (zhuo-re), it is called Wind-warmth (feng-wen)2. The pulses of Yin and Yang are both Floating (fu), and (the patient) spontaneously perspires (zi han)3, feeling (his/her) body heavy (shen zhong)4, sleeping a lot (duo mian-shui), breath from the nose becoming snoring naturally, and they become unable to speak easily5. If (this patient is) purged, (he/she will be) unable to urinate (xiao-bian bu-li), staring forward (zhi-shi), and developing incontinence (shi-sou)6. When (the patient) is exposed by fire7, if it is minute, the yellow color appears (on the skin)8, and if it is severe (the patient) becomes as if he/she suffers from convulsions caused by astonishment (jing xian) or sometimes chronic convulsions (chi zong)9. If fire smoking (xun)10 (is applied to) the patient, one mistake (ni) causes to delay days (of treatment), the repeated mistake shortens the life.  

Shinjiro's Notes

  • 6-1: Without Hating-cold: Hating-cold (wu han) is a sign of the narrow sense Shang-han. Warm Illness (wen bing) is included in the wider sense Shang-han. Mori Risshi explains that, since the old days when Cold Evil invades the inside of the body, and causes a febrile illness, generally it is regarded as a warm illness. It is also called the febrile illness (re bing) or warm disease (wen yi).

  • There is an explanation of the relationship between Shang-han and Wen-bing in Chapter 3 Shang-han Examples. According to Shuo-wen Xi-jie, "Heat (or fever: re)" is "warmth (wen)."

  • In Shokanron Shu-gi  (Collection of Meanings on Shang-han Lun) (1822),  Taki Genkan says, all researchers consider Wen-bing (warm illness) and Feng-wen (wind warmth) as two different Evidences. Especially Cheng (Ying-mao ) noted that Feng-wen is a broken Evidence of Weng-bing. Even so, when the Song Woodblock text and the Gem Box text are examined, Wen-bing and Feng-wen are combined, making one word. According to Pang An-shi (1042-99) in Shang-han Zong Bing Lun, if the patient originally is being harmed by Wind and then is being harmed by Heat (re) again, then Wind and Heat struggle with each other (in the body) and cause Feng-wen.   

  • 6-2:  Wind-warmth (feng wen): In Shokanron Shu-gi  (Collection of Meanings on Shang-han Lun) (1822), Taki Genkan (1755-1810) says, Feng-wen has a similar Evidence of Wen-bing. Both the Yin and Yang pulses are Floating (fu), and it looks like the Evil exists on the Surface (Bian). The name of Wind is the same Wind as in the chronic Wind patient (feng ye) or Wind-dampness (feng). It means the Surface (biao) has the Evil. Thus,  Wind-warmth (feng wen) is a Warm Illness and a Surface (biao)(Illness).

  • There is an explanation of the relationship between Shang-han and Feng-wen in Chapter 3 Shang-han Examples.

    •

  • 6-3: In Chapter 3 Shang-han Examples, it says when Yang pulse is Floating (fu) and Slippery (Hua), and Yin pulse is Wet (ru) and Weak (ruo), (the patient) met Wind again, and it changed into Wind-warmth (feng wen). Mori Risshi says, if this self perspiration is due to Surface Void (biao xu), the pulse should be Floating (fu) and Weak (ruo), but here this perspiration is due to Qi Vigor (cheng), thus the pulse is Floating (fu) and Slippery (Hua). For Surface Void (biao xu), Gui-zhi Tang makes it a rule, and for Qi Vigor (cheng) White Tiger Decoction (bai hu tang) makes it a rule.

    •

  • 6-4: feeling (his/her) body heavy (shen zhong), sleeping a lot (duo mian-shui): Cheng Wu-ji explains that when Wei qi receives Wind-warmth (feng wen), Qi grows dark (hun). Mori Risshi says, heaviness of the body is due to lack of flow of Water and Fluids.

  •  

  • 6-5: sleeping a lot (duo mian-shui), : breaths from the nose becoming snoring naturally, unable to speak easily : Mori Risshi says, all are due to closing of the Qi pathway. When it progresses to Heat Stagnation, it ends up with Mind obscuration (xin hun). 

  •  

  • 6-6: unable to urinate (xiao-bian bu-li),  staring forward (zhi-shi): Cheng Wu-ji says, (Nei-jing says) Tai-yang Warp starts from the medial corner of the eye. Nei-jing says the pupils being high indicates insuficiency of Tai-yang Qi. Gazing upward with fixed eyes (dai yan) indicates Tai-yang Qi having come to an end (jue) already. Being unable to urinate with staring forward and incontinence (shi sou) are signs of the Body Fluids being exhausted in the lower body, and (this exhaustion) injuring the organ's Qi while Wind-warmth (feng wen) surpasses outside.

  •  

  • Mori Risshi says, because the Body Fluids (jin ye) are exhausted in the lower body, urination is impossible. I agree with this, but I do not agree with the lines that say when the Body Fluids are exhausted in the upper body, the eye system is unable to turn. Staring forward and incontinence mean Yin and Yang both escaped (tuo)(from the body), and it is incurable. 

  •  

  • 6-7: exposed to fire: Mori Risshi says, Fire means any Fire methods, fire needling, and moxibustion.

  •  

  • 6-8: yellow color: Mori Risshi says, Fire disturbs Blood, and Blood stagnates in Warps, and causes to color yellow.

  •  

  • 6-9: convulsions caused by astonishment (jing xian) or sometimes chronic convulsions (chi zong): Mori Risshi says, according to Chaos’s Zu-bing Yuan-hou Lun (Origins and Symptoms of Each Diseases (610) by Chao Yuan-fang (550?-630?) jing is a pediatric illness. In a child over ten years old, it is called dian, and less than ten years old it is called jing.

  • Chen Wu-ji says, Chi is muscle tightening (jin ji) and shrinking (suo). Zong is muscle loosening (jing zong) and stretching (shen). 

  •  

  • 6-10: fire smoking: Mori Risshi says, there are two types of smoking (xun), fire smoking and hot water smoking. Fire smoking is also called zheng (steaming). The smoking method appears three times in Song Text: Tai-yang Mid Section Clause 18, and Clause 88. In Unable To Purge Section Clause 18, 19 and 21. Also in Gem Box Volume Six Unable to Apply Fire Clause 21.

    •
Clause 7
If an illness (has symptoms of) Fervescence (fa-re) and Hating-cold (wu-han: chills), it started in Yang1. ( If an illness has symptoms of) no fever2 but Hating-cold (wu-han: chills), it started in Yin1. (The illness which) started in Yang heals in seven days. (The illness which) started in Yin heals in six days. This is because the number 7 is a Yang number (odd number), and the number 6 is a Yin number (even number)3.

Shinjiro's Notes

  • 7-1: Cheng Wu-ji says, Yang creates Heat (re), and Yin creates Cold (han). Having Fervescence (fa re) and Hating-cold (wu han) means Cold is harming Yang. Having no fever and Hating-cold (wu han) means Cold is harming Yin. Yang is ruled (fa) by Fire, and Yin is ruled by Water. Fire creates the number seven, and Water creates the number six. The Yang Illness heals on the seventh day, because the Fire number is reached. The Yin Illness heals on the sixth day, because the Water number is reached.

    Mori Risshi says, This clause explores and concludes the reasons how Zhong-feng and Shang-han begin and end. Generally in Tai-yang (Illness) all (patients) have Wu-han (chills). If (the patient) has Fervescence (fa-re) and Wu-han, (he/she) is Entered-by-wind and has Fervescence. That is talking about Zhong-feng. Wind is Yang and Wei is also Yang. Thus, the illness begins in Yang. If  (the patient) has no fever with Wu-han, Shang-han has not caused fever yet, thus there is no fever. That is talking about Tai-yang Shang-han. Cold is Yin and Building (Ying)* also is Yin, thus the illness begins in Yin.

    * Building (ying:営): Same as Prosperous (rong 栄). Both letters are originated from the letter "ying 熒," which means a lamplight in the house. Song Text never uses the letter "ying:営" for Prosperous (rong 栄).

     

    7-2: No fever (wu re): In  the copies of the Jin-gui Yu-han Jing: Golden Casket Gem Box (variant copy of Shang-han Lun): Compiled by Lin Yi et al, 1066 North Song Dynasty and Bei-ji Qian-jing Yi-fang: Equipping for Emergency Thousand Supplementing Prescriptions: By Sun Si-miao, 682 Tang Dynasty, it is written as "bu re (not causing fever)."

     

    7-3: Mori Risshi says, the numbers of six and seven relate Yin and Yang, but do not have any deeper meanings.

Clause 8

(In the case of) Tai-yang Illness, when (the patient suffers from) headache more than 7 days, and it healed by itself, then it is because (the illness) has circulated all Warps. If (the illness) is going to suffer the Warp (jing) again, then needle the Foot Yang-ming (Warp) and don't let the Warp communicate (chuan) (the illness to the other Warps). Then (the patient will be) healed1.

Shinjiro's Notes

  • 8-1: Cheng Wu-ji says, when (Tai-yang Illness) has not been healed at the seventh day,  that is because the Evil in Tai-yang communicated further to Yang-ming. Needling Foot Yang-ming means engaging the Evil and repulsing it.

    Mori Risshi says that, I think that at the seventh day the illness is still a Warp illness (jing bing), not communicating to Fu organs. Yang-ming Warp exists in the layer between Fat (ji) and Meat (rou). Therefor,  needle this Warp to perform Transfer Method (xie fa). This  exudes the remaining Evil into the layer of skin and hairs. St43, 42, and 41.  

Clause 9
The time when the Tai-yang Illness is going to be resolved is between the Snake time (si; from a.m. 9 to 11 a.m.) and the Upper Sheep time (wei shang; from 1 p.m. to 2 p.m. )1.
Shinjiro's Notes

  • 9-1: Cheng Wu-ji says, the Snake (time) is the Correct (zheng) Yang time. The six Warps each resolve within three (ancient) hours. Tai-yang resolves during Snake, Horse and Sheep. Yang-ming resolves during Monkey, Cock and Dog. Shao-yang resolves during Tiger, Rabbit and Dragon. Tai-yin resolves during Boar, Mouse and Ox. Shao-yin resolves during Mouse, Ox and Tiger. Jue-yin resolves during Ox, Tiger and Rabbit.

  • Mori Risshi says, what Cheng Wu-ji notes is similar to the theory of Five Circulation Great Reasons (wu xing da yi). You have to realize that in this theory, Shao-yang and Jue-yin* occupy the same spot. Yet, there is a difference of Yion and Yang between them. Ox belongs to Yin and Tiger belongs to Yang.

  • *Shao-yang (Tiger, Rabbit, Dragon) and Jue-yin (Ox, Tiger, Rabbit).

Clause 10
The chronic Wind patient (feng  jia)1, who is (treated by) Resolving Surface (jie biao) and is not feeling refreshed, will be healed on the twelfth day2. 
Shinjiro's Notes

  • 10-1: feng jia: Cheng Wu-ji says, chronic Zhong-feng (Entered-by-wind) patient.

    Mori Risshi says, many annotators note "feng (wind)" as  "Zhong-feng (Entersd-by-wind)", but it is not. Wind itself is just like an Evil. When it exists between the heaven and earth, it is called Wind, but when it is in the human body, it is called an Evil. 

     

    10-2: twelfth day: Chapter 3 Shang-han Examples Clause 13 and Su-wen Chapter 31,  At the twelfth day, Big Qi (Evil qi) all leave (the body) and the illness ends.

Clause 11
(In the case of) a sick person (bing ren) who has high fever but wants to wear more clothes against our expectation, fever exists in the skin layer (pi-fu), and coldness exists in the bone marrow (gu-sui)1. (In the case of a patient who feels) severe cold but does not want (to keep) clothes near (by him/her), against our expectation, coldness exists in the skin layer, and body heat exists in the bone marrow1

Shinjiro's Notes

  • 11-1: Cheng Wu-ji says, the Skin layer (pi fu) means shallowness, and the bone marrow means deepness. The Skin layer (pi fu) means Outside (wei), and the bone marrow means Inside (nei). (The person who has) high fever and wants to wear more clothes has (the Evidence of) Surface (biao) Heat (re) and Rear (li) Cold (han). (The person who has) body coldness and does not want to wear more clothes has (the Evidence of) Surface (biao) Cold (han) and Rear (li) Heat (re).

    Mori Risshi says that I think (the Evidence of) Cold existing in the bone marrow is mastered by Ren-shen Fu-zi Tang, and (the case of) Heat existing in the bone marrow is mastered by Shi-gao Ma-huang Tang.

Clause 12

(In the case of) Tai-yang Entered-by-wind (zhong feng), when Yang (pulse) is Floating (fu) and Yin (pulse) is Weak (ru)1, Yang (pulse) is Floating (fu) because Fever rises (fa) by itself (zi). Yin (pulse) is Weak (ru) because sweats come out (chu) by themselves (zi)2.  Shivering (se se) Hating-cold (wu-han: chills), wheezing (xi xi) Hating-wind (wu-feng), glowing (xi xi with different characters) Fervescence (fa-re), a snorting nose (bi-ming)2 and a dried throat, Gui-zhi Tang masters (zhu) those symptoms. Formula1.

Gui-zhi Tang3 Formula:

Gui-zhi 3 liang4, remove the epidermis5. Shao-yao 3 liang. Gan-cao 2 liang, roast. Sheng-jiang 3 liang, cut into pieces. Da-zao twelve pieces, tear.

(Total) five savors (wei)6 (listed) above. Crunch7 (fu-ju) (first) three savors, then with 7 sheng8 water, on a minute fire, cook (all of) them until (water reduces to) 3 sheng.  Remove dregs, cooling or reheating to fit (for drinking) and drink 1 sheng. Immediately after drinking, sip hot diluted rice gruel (xi zhou) about 1 sheng to help the medicinal effect (of the formula)9. Make (the patient) cover warmly for a little while. If the whole body becomes slightly clammy (zhe zhe) as if it is sweating, it is better.  Do not let (the patient sweat) as if water flows, (because) the illness cannot be removed. If one dosage makes (the patient) sweat, the illness will be healed. Stop taking more. (The patient) does not need to finish medicine. If (the patient) does not perspire, take the decoction again following the same method (fa). Also, if (the patient) does not perspire, let him/her take the decoction at close intervals (such as) taking 3 times over  a half day.  If the illness is severe,  let (the patient) take the decoction day and night and observe (the patient) the whole day through. If, after finishing one decoction, still the illness Evidence (bing zheng) exists, then decoct again and let (the patient) take. If (the patient) does not perspire, then (the patient) can take two or three decoctions. Prohibit (the patient) from eating raw food, cold food, sticky food, slimy food, meat, noodles, five pungent (flavors) (wu xin)10, liquor, vinegar (lao)11, smelly food. 

Shinjiro's Notes

  • 12-1: when Yang (pulse) is Floating (fu) and Yin (pulse)

  • is Weak (ru): Cheng Wu-ji says, Yang serves Guarding (wei), and Yin serves Prosperous (rong). The "Yang pulse is Floating" means Guarding (wei) has been Entered by wind. The "Yin pulse is Weak (ru)" means Prosperous (rong) Qi is Weak. Wind unites with Wei, and Yang becomes Replete (shi) and Yin becomes Void (xu). Thus, (the patient) will have Fervescence (fa re) with spontaneous perspiration.

     

    12-2: snorting nose (bi-ming): Mori Risshi says, in the clause of Gui-zhi Tang all annotators of  bi-ming note that the nose is stuffed and makes noises, but when the nose is stuffed, this nose is dry.  Check Chapter 3 Shang-han Examples, "the second day Yang-ming receives the illness" clause. The dried nose is the Evidence of Yang-ming Zhong-feng, and not the Tai-yang Illness Evidence.  Thus, I think bi-ming means sneezing. Whenever there is a voice accompanied,  (Chinese) use the character ming.

     

    12-3: Gui-zhi Tang: Please refer to Shinjiro's Note of Clause 1 in Lin yi Shang-han Lun. This formula is also called Yang-dan Tang. “Dan” means “early morning, evident.” There is a formula also called Yin-dan Tang.

     

    12-4: liang: a unit of weight. The actual quantity of each unit had been changed in each dynasty. 1 liang was 13.92g (0.491ozs) in the later Han Dynasty when the original Shang-han Lun was published, but 1 liang was 37.30g in the Song Dynasty when Song Text was published. As these formula recepies were added by Lin Yi et al, 1 liang should be 37.30g.

     

  • 12-5:  remove the epidermis: According to Bao Sheng's note of Gui in the Ben-cao Gan-mu, "Gui-zhi, the other name is Rou-gui. When the epidermis is removed, it is called Gui-xin." Shinjiro's Note: Gui-zhi is Cinnamon Cortex same as Rou-gui, not Cinnamon twing in Japanese Kanpo.  

     

    12-6: savor (wai): habitually translated as “taste” or “ingredient.”

     

    12-7: crunch (fu-ju): Original meaning is “crunch,” but here it means “crush.”

     

    12-8: sheng: a unit of water quantity. The actual quantity of each unit had been changed in each dynasty. In the later Han Dynasty, 1 sheng was 198.1 milli-litters (0.832cup). This measurement was added in the Song Dynasty, when 1 sheng was 664.1 ml.

     

    12-9: rice gruel: This sub prescription is very important when we prescribe Gui-zhi Tang, because Gui-zhi Tang itself does not have enough power to cause sweating.

     

    12-10: five pungent flavors (wu xin): According to Taki Genkan, they are listed in the Buddhist classic, Leng Yan Jing (Strict Buddha’s Authority) as Da-suan (ninniku in Japanese: garlic: Allium sativum L.), Ge-cong (nira in Japanese: Allium tuberosum Rottl.) , Ci-cong (wakegi in Japanese: Allium fistulosum L.), Lan-cong (?), and Xing-qu (agi in Japanese: Ferula assa-foetida L.).

    In  Shi Yi Xin JIng (core mirror of the  dietary doctor) by Zan Yin, Tang Dynasty, it says, "At the Joint (jie) of January, eat Five Pungent Flavors, Suan, Cong, Jiu, Xie (scallion), and jiang (ginger),  to avoid epidemic diseases (li qi)."

    According to Ben-cao Gang-mu (materia medica epitomized)(1578 or 96?) by Li Shi-zhen (1518-1593), Da-suan, Xiao-suan (nobiru in Japanese: Allium grayi Regel), Jiu (nira in Japanese: Allium tuberosum Rottl.), Hu-sui (xiang-cai: coriander) and Yun-tai (you-cai: cole).

     

  • According to Okada Kenkichi in his On "Five Pungent Flavors Prohibition" in the Song Text, So Izen Sho-kan Ronko, it is wrong to understand the "Five Pungent Flavors prohibition" in Song Text as the influence of Buddhism. According to him, "In Volume 9 of Tai-ping Sheng-hui Fang (982-992), during the Three Yang Illness Stages, it prescribes "leeks, fu-zi, Ge-cong, and Da-suan" for the Pungent Warm Herb Sweating method and after taking the decoction it suggests to eat rice gruel with leeks in it.  Contrarily Song Text uses only the Gui-zhi Tang and Ma-huang Tang group, prohibiting the eating of "raw, cold, sticky, slimy foods, meat, noodle and five pungent herbs" after taking the decoction and suggesting to sip "white rice gruel." It means the illness, for which Song Text Six Warp sections apply, is the morbid state which "rejects Pungent, warm leeks or Ge-cong and needs a  small amount of white rice gruel." It is not general cold, but the illness for which the treatment is designed to harmonize Stomach and Intestine Qi of delicate people."  Also, Okada points out the difference between Chapter 61 Five Prohibition Catechism and Chapter 63 Five Savor Catechism of  Lin-xu. In Chapter 61, it argues about Building (ying) and Guarding (wei) with leeks. In Chapter 63, it argues about Building (ying) and Guarding (wei) of Stomach with fresh ginger. 

     

    12-11: vinegar (lao): Lao:  Habitually translated as milk products similar to yogurt or cheese.  Mori Risshi says, "this character meant originally not milk products. In Han Dynasty History (Han Shu), it says "In the end of year, a few people boiled wood and made lao. It is not good to eat lao." It meant sour thick fluids (cu jiang ) made by cooking grasses or wood." The original  Shuo-wen Xi-jie does not have this character. According to the additional section of Shuo-wen Xi-jie, lao is thick milk fluids (ru jiang).  Milk products similar to yogurt or cheese (lao) came into China in the Wei and Jin Dynasties (265-420 A.D.) , that is after Zhong-jing's time.

Clause 13
(In the case of) Tai-yang Illness, (if the patient has) headache with Fervescence (fa-re), perspiring sweats  (han chu), Hating-wind (wu-feng), Gui-zhi Tang masters (zhu) symptoms1. Formula 2. Use the previously shown Formula 12. 

Shinjiro's Notes

  • 13-1: Cheng Wu-ji says, this is Zhong-feng (Entered-by-wind).

    According to Ke Qin, Shang-han Lun Zhu, Early Qing Dynasty, this clause is the Gui-zhi Tang Evidence, which means you can prescribe Gui-zhi Tang when the patient has these symptoms.

    Mori Risshi says, this clause does not say whether already many days have passed or not. When the patient has this Evidence, Gui-zhi Tang has to be prescribed. By the way, "perspiration" and "headache" are both main points of Surface Void (biao xu)(condition).

    13-2: Use...: This note of Lin Yi et al is omitted in the Cheng Wu-ji Shang-han Lun.

Clause 14

(In the  case of ) Tai-yang Illness, (if the patient's)  nape and back stiffness (qiang) bending (the patient) down (ji ji1), and against our expectation (fan)2 (the patient) perspires with Hating-wind (wu-feng), Gui-zhi jia (adding) Ge-gen Tang masters (zhu) those symptoms3. Formula 3.

 [Gui-zhi jia Ge-gen Tang Formula]

Ge-gen 4 liangs. Ma-huang 3 liangs, remove the joints. Shao-yao 2 liangs. Sheng-jiang 3 liangs, cut into pieces. Gan-cao 2 liangs, roast. Da-zao twelve pieces, tear. Gui-zhi 2 liangs, remove cortex.

(Total) 7 savors (wei) (listed) above. Cool with water 1 dou4. First cook Ma-huang and  Ge-gen until water is reduced to 2 sheng. Remove floating foam (mo), and add other recipes. Cook until water becomes 3 sheng. Remove dregs, and take 1 sheng warm. Cover (the patient) and let sweat slightly. Do not let (the patient) sip hot rice gruel. Others are the same as the Gui-zhi Tang method (fa), such as recuperation (jiamg-xi) and prohibitions (jin-ji).
Subject Yi et al humbly examined Zhong-jing's real theory; For spontaneous perspiration of Tai-yang Entered-by-wind (zhong-feng), (he uses) Gui-zhi, and for no perspiration of (Tai-yang) Shang-han (harmful cold), (he uses) Ma-huang. Now the Evidence (zheng) (of  this case) says perspiration with Hating-wind (wu-feng), and the formula includes Ma-huang. We assume this is not his intention. In Volume Three there is the Ge-gen Tang Evidence and it says no perspiration but Hating-wind (wu fen), which is correctly the same as this formula, and it uses Ma-huang together. Here it says Gui-zhi jia Ge-gen Tang. We assume only Ge-gen is added to Gui-zhi Tang formula5

Shinjiro's Notes
    • 14-1: ji ji: 几几: Please refer to Lin Yi Shang-han Lun Clause 4, Shinjiro's note 1. Mori Risshi says, this character is used only in this book and Shuo-wen Xi-jie, no other books in the world use.

      14-2: against our expectation (fan): Cheng Wu-ji says, when (the patient's) nape and back are jerking, (the patient) should have no perspiration (wu han). If (the patient) has perspiration and Hating-cold (wu han) against our expectation, it is Entered-by-wind (zhong feng) Surface Void (biao xu). Give Gui-zhi Tang to harmonize (he) Surface (biao), adding Ma-huang and Ge-gen to remove Wind. Also Ma-huang masters Surface Repletion (biao shi). 

    • 14-3: Please refer to Shinjiro’s Note 3 of Lin Yi Version Shang-han Lun. In the Gem Box (Jin-gui Yu-han Jing) and the Wing Prescriptions (Bei-ji Qian-jing Yi-fang), they say that "(In the  case of ) Tai-yang Illness, (if the patient's)  nape and back stiffness (qiang) bending (the patient) down (ji ji1), and against our expectation (fan)2 (the patient) perspires with Hating-wind (wu-feng), Gui-zhi Tang masters (zhu) those symptoms."

    • Mori Risshi says, I think Shen Shi (Song and Qi Dynasties) calls Gui-zhi Tang adding Ge-ge just like in the Gem Box (Jin-gui Yu-han Jing) and the Wing Prescriptions (Bei-ji Qian-jing Yi-fang).  Maybe this could be Zhong-jing's original writing.

    •  

    • 14-4: dou (斗): a unit of water quantity. 1 dou = 10 sheng.

    •  

    • 14-5: Subject Yi ...: This original note of Lin Yi et al was omitted by Cheng Wu-ji in his Shang-han Lun, accordingly TCM Shang-han Lun ignores.

Clause 15
(In the case of)  Tai-yang Illness,  after the patient is purged1, if his/her Qi climbs  up thrusting (chong)(upwards)2, give (the patient) Gui-zhi Tang. To formulate, use the same method shown before. If it does not climb up thrusting (upwards), do not give it3.

Shinjiro's Notes

  • 15-1: after the patient is purged1: Cheng Wu-ji says, even though Tai-yang Illness belongs to Surface (biao), if (the doctor) purges (the patient) against our expectation (fan), it will make Rear (li) Void (xu). The Evil (xie) takes advantage of it and rides over the Void (status) and communicates to Rear (li).

     

    15-2: Qi climbs up thrusting (shang chong)(upwards): Cheng Wu-ji says, if (the patient's) Qi climbs  up thrusting (shang chong)(upwards), Rear (li) has not received the Evil (xie), thus reversely climbed up Qi fights against the Evil (xie). It means the Evil (xie) exists on Surface (biao), thus naturally giving (the patient) Gui-zhi Tang again resolves Outside (wei).

     

    Mori Risshi says, the meaning of "shang chong" is not the same (in the annotations). Some says  "shang chong" means Qi thrusts against the Heart, chest and throat. Some says it means Qi thrusts against the Head and face.  Even though Chest Phlegm (xiong tan) thrusts upwards, it causes Qi Counter-flowing to the Head-brain, and headache. There are not only two reasons.  

    In Kanpo, we use Gui-zhi Tang for Yang Qi Up-thrusting as in the case of menopause.

     

    15-3: If it does not climb up Thrusting Upwards (shang-chong), do not give it: Cheng Wu-ji says, the Rear Void (li xu)(state) cannot fight with the Evil (xie). The Evil Qi has already communicated to Rear (li), so you cannot give Gui-zhi Tang (to the patient) to attack Surface (biao).

    Taki Genkan says, I think no masters could make "Thrusting Upwards" clear yet, but it is Qi of Tai-yang Warp Thrusting Upwards and causes the Evidences such as headache and nape cramping. It does not mean Qi Thrusting Upwards to the Heart not at all.

Clause 16

On the third day of the Tai-yang Illness1, after finishing sweating if (the patient) has been made to vomit (by given an emetic), or  purged, or warm needles (wen zhen)2 has been applied, and still (the illness) is not resolved, then it becomes Broken-illness (huai-bing)3. To give (the patient) Gui-zhi does not hit (zhong) (the target). Examine the (patient's) pulse Evidence (mai zheng) and know what type of mistake (ni) was done, and treat according to the Evidence (zheng). Gui-zhi primarily (ben) resolves (jie) the dermal tissue (ji)3. If the person has the Floating (fu) and Tight (jing) pulse, Fervescence (fa-re), and does not perspire, then do not give this (Gui-zhi). Remember always this, and do not commit a mistake4. (Formula) 5. 

Shinjiro's Notes

  • 16-1: third day of Tai-yang Illness: Zhang Zhi-cong (1610-74) in  Shang-han Lun Ji-zhu (Collected Notes on Shang-han Lun, 1669) says, Tai-yang Illness reached the third day, and sweating has finished. It means the Evil on dermal (ji) Surface (biao) has already left. In case Rear Evidence (li zheng) has not removed yet, and either (the doctor inhduced) the patient vomiting to treat the diaphragm (zhong ge), or (the doctor) purged the patient to clean the intestines and the stomach, or (ther doctor)practiced warm needles to manage (li) the Warp-Choroid (jing luo), but still the Rear Evidence (li zheng) has not resolved, then it (the illness) has become Broken-illness (iatrogenic disorder). That is because Rear Qi (li qi) becomes Void by itself (zi xu), and defeated by itself (zi bai).  

     

    16-2: Warm needle (wen zhen): Taki Gen-kan notes, Wan Lun (Ming Dynasty) in his Ming Yi Za -zhu (a bright doctor's miscellaneous publication, 1502) says it is a method of the Chu people. In this method, place on an acupuncture point a needle, which on top covered by a round dumpling of flagrant (xiang) Bai-zhi. With mugwort (ai,) steam it warming. It is the most effective. The ancient people never applied moxibustion when they apply needles. When they applied moxibustion they never applied needles. To apply needles and moxibustion is a recent mundane method. This method is applied by remote place people and poor people. When Warp-choroids receive Wind-cold and become illnesses, maybe it is effective. It will warm Warps and let Qi pass. Zhong-jing belonged to the Chu people, thus he introduced this ancient Warm Needles method which is a holdover method.     

     

    16-3: Broken-illness (huai-bing): Cheng Wu-ji says, it is the illness which the doctor broke.

    Taki Gen-kan notes, When Tai-yang Illness is broken by the doctor and  it transfers (zhuan) itself and becomes Shao-yang (Illness),  or becomes Yang-ming (Illness), then it should not be called Broken Illness.

    Mori Risshi says, about Broken Illness, the Shao-yang section discusses later again. The Tai-yang Gui-zhi Evidence and the Shao-yang Chai-hu Evidence, these two Evidences have the amount of Outside Evil (wei xie) most, thus they become Broken Illnesses. Master Jian (Huang) says "among the six illnesses, Zhong-jing only mentions (Broken-illness) in Tai-yang and Shao-yang cases, because (we commit) mistaken treatments more often in Surface, and less in Rear."  

     

    16-4: Skin-tissue (ji): Please refer to my note of Lin Yi Version Shang-han Lun, Clause 5-2.

    Fang You-zhi says, "Ji" means dermal meat (fu rou). Wind hits Wei, and Wei can not guard. Thus, Fervescence, perspiration and Hating-wind occur. Wei circulates outside of Veins, the area of dermal meat (fu rou).

     Mori Risshi says, this opinion of understanding “ji” of “ge ji” as “ji” in “ji fu” is following the opinion of Master Fang, (that is under the skin, the first layer is white skin (fu: skin), the second layer is yellow fat (huang ji), and the third layer is red meat (chi rou)). It is almost a rule. I declare here that “ji” in “jie ji” must be yellow fat (huang ji).Because, Gui-zhi and Shao-yao both mostly pass Wei and Rong (Qi) and benefit Blood. Thus, Evil Qi cannot invade deep, and exit (the body) with sweats. This section exists between the white skin and red meat, where Wei and Rong are separated.

     

    Taki Genkan says, I think "resolving the Skin-tissue (jie ji)" means to break up Evil Qi on Surface of the Skin-tissue.

     

    16-5: Cheng Wu-ji says, Floating Pulse with Fervescence, perspiration and Hating-wind means it is Zhong-feng (Entered-by-wind). Give Gui-zhi Tang and resolve the dermal layer. Floating and Tight pulse with Fervescence, no perspiration means Shang-han (harmful cold). Give Ma-huang Tang.  Avoid mistaking this and treating unreasonably.

Clause 17
If the drinker (jiu ke) suffers from an ill, do not give Gui-zhi Tang. If you give, (the drinker) will vomit, because the drinker does not appreciate sweet1.

Shinjiro's Notes

  • 17-1: Cheng Wu-ji says, Drinkers have Inside Heat (nei re) and love spiciness and hate sweetness. As Gui-zhi Tang is sweet, when drinking people take it, their Middles become full, thus they vomit.

     

    Ke Qin (early Qin Dynasty) in his Shang-han Lun Zhu (Annotations of Shang-han Lun) says, Zhong-jing was very cautious to use formulas like this.

    Taki Genkan says, drinkers have the Floating pulse and spontaneous perspiration, the same as when Wind harms Wei.

Clause 18

For the chronic wheezing person (chuan jia)1, to make Gui-zhi Tang adding Hou-po (magnolia bark)2 and Xing-zi (apricot seeds)3 is good (jia). (Formula) 6.

Shinjiro's Notes
  • 18-1: chronic wheezing person (chuan jia): Cheng Wu-ji says, in the case of  Tai-yang Illness, as all Yangs master Qi, when Wind is severe Qi cannot protect, and wheezing starts.

    • Mori Risshi says, “Chuan jia” means the person who suffers from coughing for a long time. Later it is called asthma. “Jia” in “chuan jia” means a chronically ill person.

    18-2: Huo-po (magnolia bark): Please refer to Lin Yi Version Shang-han Lun #6 Shinjiro's notes:In Shen-non Ben-cao Jing, it says:

    Huo-po: Savor: Bitter, Warm and poisonless. Treats Zhong-feng, Shang-han, headache, coldness or fever, startled palpitations, Blood bi, dead dermal layer (shi ji), and removes three worms*.

    *three worms (san hui): In the Daoism religion, it is believed that three.  White worms (shi) live inside of the human abdomen, which go out of the body at the night of Geng-shen (Elder brother of Fire, and Monkey) and fly to heaven and tell Tian Di (heavenly emperor) the sins the person committed. This report of three worms decides whether the person goes to hell or heaven. Thus, people tried to get rid of three worms. The   existence of three worms was widely believed in the Edo era (1603-1867) Japan.

    Mori Risshi says, I think “houpo” is spicy and warm, which is the same as Ma-huang, and treat Entered-by-wind or Shang-han headache. Generally it is a necessary ingredient for conditions when Outside Evil and Inside Fluids are fighting each other.

    18-3: Xing-zi (apricot seeds): Xing-he (kernel)-ren : Please refer to my note of Lin Yi Version Shang-han Lun #6.

    Mori Risshi says, the way xing-ren resolves Skin Tissue (ji) is not the same as (the way) Gui-zhi (does). Originally (the patient) has stagnated fluids in the chest, and Outside Evil gathers there, without scattering. Thus, xing-ren, which is oily, scatters Fluid Knots (yin jie) very well. Once Fluids Knots scatter away, there would not be any place where Evil Qi can stay and rest. That is why (the patient) perspires and is going to resolve. This is a splendid way of the Shen-non specialist. This opens our eyes.

Clause 19
Generally (the person who) vomits (after) taking Gui-zhi Tang 1, will vomit blood with pus (nong-xue: pyemia) afterword2.

Shinjiro's Notes
  • 19-1: Cheng Wu-ji says, (when the person who has) Inside Heat (nei re) takes Gui-zhi Tang, he/she vomits. It s is as the same as drinkers. He/she has lost Body Fluids (jin ye) and also Heat (of Gui-zhi Tang and Inside Heat) fight with each other, thus after taking it, without fail, he/she vomits Blood with pus. Vomiting Blood with pus indicates Lung Wasting (fei wei).

    Mori Risshi says, the person who vomits after taking Gui-zhi Tang is the person who has thriving Accumulated Fluids originally. When (this person) vomits once in emergency, it will be alright. It is better to use such as Ge-gen Qin Liang Tang after considering well. If (this person) continues to take Gui-zhi Tang, after several days he/she ends up vomiting white phlegm or red blood without fail. White phlegm means sputum. When (he/she) expectorates Sputum, then he/she will expectorate red blood one upon the other. 

    Wang Hu (?) says in his Shang-han Bian Zhu(1680) that this clause does not posses Zhong-jing's treatment method. In Bu Wan Lun, Chang Qi-zhi (?) says, take a kind of Shao-yao Di-huan Tang. Guo Bai-yun (?) says, after observing bloody sputum, take it.

Clause 20

(In the case of) Tai-yang Illness, sweating causes a leakage (of the body fluids) and (it) does not stop. For this person with Hating-wind (wu-feng)1, urination difficulty, four extremities minutely cramping, and being difficulty extending and flexing, Gui-zhi jia (adding) Fu-zi Tang masters (zhu) this case2. Formula 7. 

Gui-zhi jia Fu-zi Tang Formula3:

Gui-zhi 3 liangs, remove cortex. Shao-yao 3 liangs. Gan-cao 3 liangs, roast. Sheng-jiang 3 liangs, cut into pieces. Da-zao twelve pieces, tear. Fu-zi 1 piece, wrap and roast (pao). Remove cortex and tear into 8 pieces.

(Total) 6 savors (wei)(listed) above (right side). Cook with 7 sheng water, until water reduces to 3 sheng. Remove dregs, and take 1 sheng warm. Originally it is called Gui-zhi Tang, but now Fu-zi is added. Recuperation (jiang-xi)  should be same as the former method.

Shinjiro's Notes

    • 20-1: Hating-wind (wu feng): Mori Risshi says, I think Hating-wind (wu feng) means (the patient) is Surface Yang Qi Void (biao yang qi xu), thus he/she hates wind coming from doors or a fan.

       

      20-2: Cheng Wu-ji says, (in the case of) Tai-yang Illness, due to sweating, sweat does not stop, and (this causes) leakage (of the body fluids), then (the patient) has Hating-wind (wu feng). This is because Yang Qi is not sufficient (bu zu). Due to sweating Yang Qi increases its Void (status), and the Skin Tissues (pi cao) are unable to tighten (themselves) (bu gu). Nei-jing says that Bladder is the officer of the state capital, and the storehouse of the Body Fluids. Qi (jin ye) transforms (hua) and exits (chu) (from the body). Urinary difficulty is due to sweating and losing the Body Fluids. When Yang Qi is weak, it cannot transform (itself). Four extremities are the origins of all Yang (Warps). Minute Cramping of four extremities and being unable to flex and extend the body are (due to) (the patient's) Yang is lost (wang) and the Body Fluids are dehyderated (tuo).                                                                                        

      According to Mori Risshi, I-shin-po Volume 14, Chapter 50 Treatment of Shang-han Illness After Sweating Formula, quoting from  Xiao-ping Fang (500? in the Nan Pei Zhao era) it says  "To treat after sweating causes leakage and sweating does not stop. If this person has  Hating-wind (wu feng), urination difficulty, four extremities minutely cramping and being difficult to extend or flex, it means Stomach is dried. Gui-zhi Tang Jia Fu-zi masters this (condition)." [Underlined by Shinjiro: This sentence is almost same as Clause 20, except these underlined parts. Remember Zhong-jing said in his preface, he compiled this book with other classics. Then are those parts omitted by Zhong-jing or the compilers?]

                                                                     

      20-3: Please refer to my note in the Li Yi Shang-han Lun page.  Here, Gui-zhi jia Fu-zi Tang stops perspiration. Its ingredients are Gui-zhi, Fu-zi, Sheng-jiang, Gan-cao, Shao-yao, and Da-zao. In Volume 9 Chapter 1 of the Tai-ping Sheng-hui Fang,  Gui-zhi Tang, which resolves the Surface by sweating, is prescribed with the ingredients; Gui-zhi, Fu-zi, Gan-jiang, Gan-cao, and Ma-huang and sugested to take with hot rice gruel with leek. The question is "does the combination of Gui-zhi and Fu-zi stop perspiration or enhance perspiration?"

Clause 21

(In the case of) Tai-yang Illness, when after the purgation the pulse (becomes) Urging (cu)1 with the Chest Fullness (xiong-man)2, Gui-zhi chu (removing) Shao-yao Tang masters (zhu) this (condition). Formula 8. One copy makes the character "cu (urging" as "zong (vertical)."3    

Gui-zhi chu Shao-yao Tang Formula4:

Gui-zhi 3 liangs, removing cortex. Gan-cao 2 liangs, roast. Sheng-jiang 3 liangs, cut into pieces. Da-zao twelve pieces, tear.

(Total) ) 4 savors (wei)(listed) above. Cook with 7 sheng water, until water reduces to 3 sheng. Remove dregs, and take 1 sheng warm. Originally it is called Gui-zhi Tang, but now shao-yao is removed. Recuperation is the same as for the former formula.  

Shinjiro's Notes

    • 21-1:  Urging (cu) pulse:  Cheng Wu-ji says, when the pulse comes Frequent (shu) and sometimes stops and comes again, it is called Urging (cu) pulse. Urging (pulse) means Yang Thriving (cheng) and it is not due to (the condition that) after purging the (patient's) pulse becomes Urging.  After purging with Urging pulse, it is impossible to be Yang Thriving. In Tai-yang Illness, if (the doctor) purges (the patient) and his/her pulse becomes Urging with Chest Fullness, then it means the illness is going to be resolved.   

      Jian Huan (?) says in his Shang-han Shuo-yuan Ji (1707) that Urging (cu) pulse is not the pulsethat comes Frequent (shu) and stops once then comes back.  It is Hurrying and Urging, that is why it is called Urging.

      Taki Genkan notes, I think Master Jian is trying to argue against Master Cheng. Shang-han Shuo-yuan Ji says Urging (cu) means "shortly urging."

      Mori Risshi says, Urging (cu) pulse is in Chapter 1. It says “when the pulse comes Frequent (shu) and sometimes stops, then comes again, it is called Urging (cu) pulse. When pulse Yang is thriving, it becomes Urging (cu). ” According to this description, generally in the case of Tai-yang Illness, due to being sweated a lot or mistakenly purged, later Stomach and Intestines are declined, with Up-thrusting (shang chong), and the chest is filled with body fluids. Then the Urging (cu) pulse will show up. When stoppage of the Body Fluids is cleared, then the Urging (cu) pulse will not come back again.  

       

      21-2:  Chest Fullness (xiong-man): Cheng Wu-ji says, after purging, the pulse (becomes) Urging with Chest Fullness also, this means (the illness) is unable to resolve. Because after purging Yang (becomes) Void, Surface Evil gradually goes in and stays in the chest. Giving Gui-zhi Tang disperses (san) the Staying Evil (ke ye), and passes and circulates Yang Qi. Shao-yao benefits Yin, and it is not good for the Yang Void (condition). Thus, it is removed (from the formula).

       

      21-3: This note of Lin Yi et al is omitted in Cheng Wu-ji Shang-han Lun.

       

      21-4: Please refer to my note in the Li Yi Shang-han Lun page.

Clause 22

If (the patient) complains of minute coldness (wei han)1, Gui-zhi chu Shao-yao jia Fu-zi Tang masters (zhu) this condition2. Formula 9.

Gui-zhi chu Shao-yao jia Fu-zi Tang Formula3:

Gui-zhi 3 liangs, removing cortex. Gan-cao 2 liangs, roast. Sheng-jiang 3 liangs, cut into pieces. Da-zao twelve pieces, tear. Fu-zi 1 piece, wrap and roast. Remove cortex and tear into 8 pieces.

(Total) 5 savors (wei)(listed) above. Cook with 7 sheng water, until water reduces to 3 sheng. Remove dregs, and take1 sheng warm. Originally it is called Gui-zhi Tang, but now, Shao-yao is removed and Fu-zi is added. Recuperation is the same as the former method.

Shinjiro's Notes

    • 22-1: minute coldness(wei han): It is "wei han" in the standard Song Text, but in Cheng Wu-ji Shang-han Lun, it is "wei wu han," that is "minutely Hating-cold." Mori Risshi says, in Cheng Wu-ji's Shang-han Lun, this word (wei han)is written as "minute Hating-cold." Even though, in his explanation he says "minute coldness" and he does not say "minute Hating-cold." Thus the character "wu" is mistakenly added. I think "minute coldness (wei han)" is different from "minute Hating-cold (wei wu han)." It means minute Reverse-cold (jue leng:　厥冷) of hands and feet. The word "minute coldness" is an opposite word of "minute fever (wei re)."   

       

      22-2: Cheng Wu-ji says, Yang Qi is already Void, so if it (shao-yao) is added further, (it causes) minute Coldness. Thus, it is necessary to use a warm medicine and disperse it (cold), and so Fu-zi is added.

      It means minute Reverse-cold (jue leng) of hands and feet. The word "minute coldness" is an opposite word of "minute fever (wei re)."   

       

      22-3: Please refer to my note in the Li Yi Shang-han Lun page.

Clause 23

 (In the case of ) Tai-yang Illness, 8 to 9 days after getting it1, (the symptom) becomes like the malarial  condition (nue  zhuang)2, Fervescence (fa-re) and Hating-cold (wu-han: chills) with more fever, less cold3. The person does not vomit, and is able to eliminate normal stools spontaneously4. (Even so,) (the patient) shows (the symptoms) two to three times a day5. If the pulse is minutely (wei) Gentle (hua), then (the illness) has started to be healed. If the pulse is Minute (wei)6 and (the patient feels) Hating-cold (wu-han), then it is (because) Yin and Yang both are Void (xu)7. Do not sweat, purge or vomit more8. If (the patient's) complexion has a feverish color against our expectation9, it is not going to be healed yet. If a small amount of sweat10 is not able to come out, the body  itches without fail11. Gui-zhi Ma-huang Ge Ban Tang10 is good (yi).  Formula 10.

(Gui-zhi Ma-huang Ge Ban Tang Formula12)

Gui-zhi 1 liang 16 zhu, remove cortex. Shao-yao, Sheng-jiang cut in pieces. Gan-cao, roast. Ma-huang, remove joints. (Above 4 savors) 1 liang each. Da-zao 4 pieces, tear. Xing-ren12  24 pieces, dip in warm water and remove skin and tip, also remove twin kernels.

(Total) 7 savors (listed) above (right side). With 5 sheng water, cook Ma-huang first till boiling up two or three times. Remove floating foam, and add other medicinals. Cook until (water becomes) 1 sheng 8 he13. Remove dregs, and take 6 he warm. A book says Gui-zhi Tang 3 he and Ma-huang Tang 3 he make 6 he. To be taken at one draft (dun-fu)14. Recuperation is the same method as shown before.

Subject Yi et al humbly examined Gui-zhi Tang formula, (which contains) Gui-zhi, Shao-yao and Sheng-jiang each 3 liangs. Gan-cao 3 liangs and Da-zao 12 pieces and Ma-huang Tang (which contains) Ma-huang 3 liangs, Gui-zhi 2 liangs, Gan-cao 1 liang, and Xing-ren 70 pieces. Now, if we calculate these formulations, take one third from each of the two formulas, that is Gui-zhi 1 liang 16 zhu, Shao-yao, Sheng-jiang, Gan-cao each 1 liang, Da-zao 4 pieces, Xing-ren 23 pieces and one third, so lets make it 24 pieces, and make this formula. To say precisely, this formula contains one third of each formulas, not a half. It is better to call this formula Summing To Half Decoction (He Ban Tang)15.

Shinjiro's Notes

  • 23-1: Tai-yang Illness, 8 to 9 days after getting it: Cheng Wu-ji says, 'Shang-han 8 to 9 days' means Evil has been communicated to Warps again. Also it is the time when it(Evil) has thoroughly gone around three Yang (Warps), and is going to communicate to three Yin (Warps). If it (Evil) does not communicate to Yin, then the illness will be resolved.

    Mori Risshi says, the phrase "8 to 9 days" means the time when Tai-yang Surface Evil will be removed comes and the illness is not resolved. The Evidence of "the malarial condition (nue  zhuang), Fervescence (fa-re) and Hating-cold (wu-han: chills) with more fever, less cold" is because the Evil exists in the Tendon, Vein and Blood areas and the illness is not resolved. Thus, even 8 to 9 days do by, and there is no Evidence of Shao-yang Illness, Vomiting, or Yang-ming Illness, or ) the Body Fluids constipation. We have to realize that inside of Stomach does not have the Evil.

     

    23-2: malarial  condition (nue  zhuang): Fang You-zhi says, it means Cold and Fever come and go alternatively.

     

    23-3: Cheng Wu-ji says, when (the patient) has symptoms of a Malaria-like condition, and is having an axcute attack, if he/she has more Coldness (than fever), the illness scatters. Having more Fever (than coldness), the illness will recede. When Coldness is much more and Fever is less, Yang Qi recedes, thus (the illness) scatters. Now, even though it says Fervescence and Hating-cold (wu han: chills),  it means much more Fever and less Cold, that is Yang Qi scatters, and Evil Qi is less. 

    Taki Genkan quotes from Shang-han Lei Fang (by Xu Da-chun,1759), this case is not mistreatment. Wind Evil coagulates on the main passage way of Tai-yang thus the medical power cannot flow through. That is why needling will resolve this coagulation.

     

    23-4: Cheng Wu-ji says, when Rear (li) is not harmonized, (the patient) vomits and has diarrhea. Now, if (the patient) does not vomit, and stools are in order, then Rear (li) is harmonized.

     

    23-5: Cheng Wu-ji says, when (bouts of alternating Cold and Fever) happen two to three times, the Evil is minute.

    Mori Risshi says, " happening two to three times" because Evil Qi exists shallowly and close to Surface. There is a chance to resolve. That is why it says " if the pulse is minutely (wei) Gentle (Hua), then (the illness) has started to be healed." Because when the pulse is Minute, Weak and Gentle, being harmonized,the  Evil has left the body and Stomach Qi is responding to it all right.

     

    23-6: Cheng Wu-ji says, Nei-jing says "Large means the Evil is at its peak, and Small means healthy. If Evil is very much, the pulse is Large and when Evil is less, the pulse is Minute (wei)." Now, if many days have passed and the pulse is Minute and Gentle, it means Evil Qi is Minute and Gentle. Thus, it says (the illness) is going to be healed. 

     

    23-7: Cheng Wu-ji says, The pulse is Minute and having Hating-cold (wu han: chills), (because) Surface and Rear both are Void. Yang is Surface and Yin is Rear. The Minute pulse means Rear is Void. Hating-cold (wu han: chills) means Surface is Void. Thus Surface and Rear both are Void.

     

    23-8: Yin and Yang both Void (xu). Do not sweat, purge or vomit more: This is an iron rule.

     

    23-9: Cheng Wu-ji says, if Yang and Yin are both Void, the complexion should be pale, but if there is feverish color against our expectation, Surface is not resolved yet.

     

    23-10: small amount of sweats: Wei Li-tong says in his Shang-han Lun Ben-yi that, do pay attention to the character "xiao (small amount)." This means Righteous Qi and Evil Qi are both minute (wei).

     

    23-11: Cheng Wu-ji says, if (the doctor can sweat) a small amount of sweat, then it is going to be harmonized. If a small amount of sweat does not come out, then Evil Qi is unable to be dispersed from the skin, and it causes itchiness.

     

    23-12: Please refer to my note in the Li Yi Shang-han Lun page.

    Mori Risshi says, this formula treats especially remnants of the Evil in the Tendon, Vein and Blood areas. Generally when Surface Evil is Stagnated and confined, Da Qing Rong Tang masters it. Gui Er Yue Yi Tang is the second choice, and Ge Ban Ma Tang is the third choice.

     

    23-13: Xin-ren: Takimura Chokkan in his Sho-kan-ron So-gi (1852) says for "ren," the old texts use the character for "man 人," not "kernel仁." The Song Text uses " kernel仁" but it could have been changed when Zhao Kai-mi published it and may not have been in the original Song Text.

     

    23-14:  he: 1/10 of sheng

     

    23-15: To be taken at one draft (dun-fu): Mori Risshi says, my son Yakushi says originally this formula is one dose of 6 he combining each 3 he of Gui-zhi Tang, which should be taken warm 1 sheng out of  decocted 3 sheng, and Ma-huang Tang, which should be taken warm 8 he out of  decocted 2 sheng and half. Naturally it is mild, thus it should be taken only at one draft. It does not have power to be taken again, but it will heal the illness. .

     

    23-16: This note of Lin Yi et al is omitted in Cheng Wu-ji Shang-han Lun.

Clause 24
(In the case of) Tai-yang Illness,( when the patient) first takes1 Gui-zhi Tang, and against our expectation, he/she has anxiety (fan)2, and (anxiety) does not resolve3, then first needle Feng-chi (GB20), and Feng-fu (GV16)4, then give Gui-zhi Tang. This will cure (the patient).

Shinjiro's Notes

  • 24-1: first take: Mori Risshi says, I think “the first take” means the first warm 1 sheng to take.

     

    24-2: Cheng Wu-ji says, fan (anxiety) is fever (re). Taki Genkan says, “fan” means agony due to fever.

     

    24-3: and (anxiety) does not resolve: Cheng Wu-ji says, if anxiety does not resolve against our expectation, Wind (feng) is excessive, and has not been able to be scattered yet.

     

    24-4:  first needle Feng-chi (GB20), and Feng-fu (GV16): Cheng Wu-ji says, to pass through Tai-yang Warp and push out (xie) Wind Qi.

    Taki Genkan quotes from Su-wen Chapter 60;  Gu Kong Lun (on Bone Emptiness), Wind enters from the outside and lets people tremble with cold, causing perspiration, headache, heavy body, and Hating-cold. The treatment should be found on GV16 (Feng-fu). In case of Severe Wind (da feng) with the neck and nape pain, needle Feng-fu. Feng-fu is found on the upper spine.

    Mori Risshi notes that in Su-wen Chapter 60 Catechism on Bone Emptiness it says, when Wind comes in from Outside, and makes people tremble with cold, Perspiration, headache, heavy body feeling, and Hating-cold (wu han), needle Feng-fu to balance Yin and Yang, to supplement insufficiency, and to transfer excess. When severe Wind causes neck pain, nape pain and headache, needle Feng-fu. Feng-fu is located on the upper spine (T-1)”. I think it is an established rule “when the illness exists on Surface, treat it by inserting a needle. When the illness exists in Rear treat it with a medicinal decoction.”

Clause 25

If taking Gui-zhi Tang (causes) lots of sweating, and makes the pulse Flooding (hong) and Large (da)1, then give Gui-zhi Tang according to the method shown. If the figure (of the patient) looks like Nue (malarial disease), and the symptoms repeat twice in a day2, sweating will resolve the illness without fail. Gui-zhi Er Ma-huang Yi Tang is good. Formula 12.

  [Gui-zhi Er Ma-huang Yi Tang Formula]3

  Gui-zhi 1 liang 17 zhu, Remove cortex. Shao-yao 1 liang 6 zhu. Ma-huang 16 zhu, remove joints. Sheng-jiang 1 liang 6 zhu, cut into pieces. Xing-ren 16 pieces, remove skin and tip. Gan-cao 1 liang 2 zhen, roast. Da-zao 5 pieces, tear.

(Total) 7 savors (listed) above. With 5 sheng water, cook Ma-huang first until boiling up two or three times. Remove floating foam, and add other medicinals. Cook (until water) becomes 2 shengs. Remove dregs, and take 1 sheng warm, twice a day. One book says Gui-zhi Tang 2 fen  and Ma-hua Tang 1 fen4 make 2 shengs together. Divide into two and take twice.  Now add both formulas and make one formula. The recuperation method is the same as shown before.

 Subject Yi et al humbly examined Gui-zhi Tang formula, (which contains) Gui-zhi, Shao-yao, and Sheng-jiang each 3 liangs, Gan-cao 2 liangs, and Da-zao 12 pieces, and Ma-huang Tang (which contains) Ma-huang 3 liangs, Gui-zhi 2 liangs, Gan-cao 1 liang and Xing-ren 70 pieces. Now, if we calculate this formulations, Gui-zhi Tang makes five twelfths, that is Gui-zhi, Shao-yao, and Sheng-jiang each 1liang 6 zhu, Gan-cao 20 zhu, Da-zao 5 pieces, and Ma-huang Tang makes two ninth, that is Ma-huang 16 zhu, Gui-zhi 10 zhu and two third which is roughly 11 zhu, Gan-cao 5 zhu and one third which is roughly 6 zhu, Xing-ren 15 pieces and four ninths which is roughly 16 pieces. When two formulas are added, Gui-zhi becomes 1 liang 17 zhu, Ma-huang becomes 16 zhu, Sheng-jiang and Shao-yao become 1 liang 6 zhu each, Gan-cao becomes 1 liang 2 zhu, Da-zao becomes 5 pieces, and Xing-ren becomes 16 pieces5.

Shinjiro's Notes

  • 25-1: (causes) sweating  lots, and makes the pulse Flooding (hong) and Large (da):  Cheng Wu-ji says, still the illness exists.

  • Mori Risshi says, the case of  "sweating lots, and the pulse being Flooded and Large" and not thirsty fits to Gui-zhi Tang (Yang Thriving (cheng) Evil minute), with thirst fits to Bai-hu Tang (Yang Thriving and Evil Thriving), and with the figure (of the patient) looks

  • like Nue (malarial disease) fits to Gui Er Ma Yi Tang (Yang Thriving, Evil minute). 

  •  

  • 25-2: looks like Nue (malarial disease), and the

  • symptoms repeats twice in a day: Cheng Wu-ji says, Evil

  •  Qi stays between Wei and Rong (Qi). Gui-zhi Er Ma-huang Yi Tang breaks up Evil of Wei and Rong.  

  •  

  • 25-3: Please refer to my note in the Li Yi Shang-han Lun page.

  • Taki Genkan quotes Shang-han Lei Fang, this formula is almost the same as Gui-zhi Ma-huang Ge Ban Tang. The difference is this formula is for use after extreme sweating. Thus Gui-zhi is a little heavier, and Ma-huang is a little lighter.

  •  

  • 25-4: Gui-zhi Tang 2 fen4 and Ma-hua Tang 1 fen: Adding Gui-zhi Tang and Ma-huang Tang in ratio of 2 and 1 and make total 2 sheng.

  •  

  • 25-5:  This  note of Lin Yi et al is omitted in Cheng

  • Wu-ji Shang-han Lun.

Clause 26

After taking Gui-zhi Tang and sweating lots, (the patient's) severe anxiety and thirst (fan ke) do not resolve and the pulse becomes Flooding (hong) and Large (da)1, Bai-hu jia Ren-shen Tang masters (zhu) this (condition)2. Formula 13.

Bai-hu jia Ren-shen Tang Formula:

Zi-mu 6 liangs. Shi-gao 1 jin, smash it and wrap into floss silk. Gan-cao, roast 2 liangs. Nonglutinous rice (jing-mi) 6 he. Ren-shen 3 liangs.

(Total) 5 savors (listed) above (right side). With 1 dou water, cook rice well. When (water) becomes soup, remove the dregs. Take 1 sheng warm, three times a day.

Shinjiro's Notes

  • 26-1: Cheng Wu-ji says, in case of sweating lots with Flooding and Large pulse without thirst, Evil Qi still exists on Surface. It is better to give Gui-zhi Tang again. If sweating lots with Flooding and Large pulse, and anxiety and thirst are not resolved, Surface and Rear both have fever.  Do not give Gui-zhi Tang. It is better to give Bai-hu jia Ren-shen Tang to create the Body Fluid, stop thirst, and harmonize Surface, and scatter Rear.

  •  

  • 26-2: Mori Risshi says, I consider this Bai-hu jia Ren-shen Tang Evidence as the true Bai-hu Tang Evidence. I think in the case of the person with Magnificently (zhuang) Replete Stomach Qi and drinking lots of water, after sweating lots, Evil stays in the Body Fluids (yin) thus the illness would not be resolved. Big fever, big thirst, big anxiety, big perspiration, and big pulse are called Five Big in our place. The Bai-hu Tang Evidence comes down Five Big. Five Big here means the Evidence of Water and Blood boiling over due to Evil Fire Magnificently Thriving. I think Zhi-cong (Zhang: Qin Dynasty )understands this Bai-hu Tang Evidence as the Yang-ming Warp Evidence. This is a farsighted  opinion and I agree. Other notes all understand this as the Yang-ming Fu-organ Fever Evidence, but I do not agree.  I think Bai-hu jia Ren-shen Tang prevents after big sweating Stomach Yang Void Dryness. This is as if we supply provisions in the war time.    

  •  

  • 26-2: Please refer to my note in the Li Yi Shang-han Lun page. Taki Genkan notes, according to Wei-tai-mi Yao-fang (Officials Medical Secrets) Total 5 savors. Cut them. Boil rice with 1 duo 2 sheng water. When rice is cooked, remove rice and add other savors. Cook until water becomes 6 sheng (half). Remove dregs. Warm and take 1 sheng 3 times a day. I think the way Wei-tai-mi Yao-fang records means this could be Zhong-jing's original formulation.

Clause 27

(In the case of) Tai-yang Illness, (the patient has) Fervescence (fa-re) and Hating-cold (wu-han: chills), having lots of fever and less cold feelings1, with  Minute (wei) and Weak (ruo) pulse, this means (the patient has) no Yang (wu yang)2. Do not sweat (the patient). Gui-zhi Er Yue-bi Yi Tang is good3. Formula 14.

Gui-zhi Er Yue-bi Yi Tang Formula4:

Gui-zhi, remove cortex, Shao-yao, Ma-huang, and  Gan-cao, roast, 18 zhen each. Da-zao 4 pieces, tear. Sheng-jiang 1 liang 2 zhen, cut into pieces. Shi-gao 24 zhen, smash it and wrap in floss silk.

(Total) 7 savors (listed) above. With 5 sheng water, cook Ma-huang boiling up two or three times. Remove floating foam, and add other medicinals. Cook until (water) becomes 2 shengs. Remove dregs, and take 1 sheng warm. One book says that it is better to make Yui-bi Tang and Gui-zhi Tang separately and take 1 sheng adding them, but here we add two formulas to make one formula. Gui-zhi Tang 2 fen and Yui-bi Tang 1 fen.

Subject Yi et al humbly examined Gui-zhi Tang formula, (which contains) Gui-zhi, Shao-yao, Sheng-jiang 3 liangs each, Gan-cao 2 liangs, Da-zao 12 pieces, and Yue-bi Tang, (which contains) Ma-huang 2 linags, Sheng-jiang 3 liangs, Gan-cao 2 liangs, Shi-gao a half jing and Da-zao 15 pieces. Now if we calculate these formulations, taking one fourth of Gui-zhi Tang, that is Gui-zhi, Shao-yao, Sheng-jiang 18 zhen each, Gan-cao 12 zhen, and Da-zao 3 pieces, and add to one eighth of Yue-bi Tang, that is Ma-huang 18 zhen, Sheng-jiang 9 zhen, Gan-cao 6 zhen, Shi-gao 24 zhen, and Da-zao 1 piece and seven eighths, which fractions are discarded. When two portioned formulas are added, that is Gui-zhi, Shao-yao, Gan-cao and Ma-huang 18 zhen each, Sheng-jiang 1 liang 3 zhen, Shi-gao 24 zhen, and Da-zao 4 pieces, to make one formula. One old book calls this formula as Gui-zhi 3, but here we take one fourths of Gui-zhi Tang, so it is correct to call Gui-zhi 2. Yue-bi Tang Formula is listed in Zhong-jing's Miscellaneous Formulas. Wei-tai-mi Yao-fang (Official's Medical Secrets) calls this formula as Qi Pi (Rousing Spleen) Tang3.

Shinjiro's Notes

  • 27-1: having lots of fever and less cold feelings: Taki Genkan quotes MasterShu (Zhao, Qin Dynasty; Shang-han ji zhu, 1750), Master Shu says the four characters of "having lots of fever and less cold feelings" are
    the keys to open the secret. The person has to have Thriving Fever from long ago and the Body Fluids are declined. Thus, the formula has Shi-gao in it to maintain the Body Fluids.

    •
  • 27-2: no Yang (wu yang): Mori Risshi says, no Yang (wu yang) means Lost Yang (wan yang). Lost Yang means Stomach Yang  Qi runs out and becomes short.

  • 27-3:  Please refer to my note in the Li Yi Shang-han Lun page.

  • Ke Qin says in this text, there is no Yue-bi Evidence and the Yue-bi formula. I do not know where I can find them. These two characters could be mistakes.

  • Cheng Wu-ji says, Stomach is the master of the 12 Warps. Spleen governs Water and Grain.(Spleen: pi) (is written as) Pi (low class people) or Pi (maidservant). Nei-jing says, "Spleen masters to circulate Fluids of Stomach." The reason why the name of this decoction ( is called), Yue-bi (maidservant from Yue), is it lets pass through Spleen Qi to pass and circulate the Body Fluids. In Wei-tai-mi Yao-fang (Official's Medical Secrets) it says "another name (of this formula) is Yue-pi (Passing through Spleen) Tang." This is why.

  •  27-4: This  note of Lin Yi et al is omitted in Cheng Wu-ji Shang-han Lun, thus TCM ignores it.

Clause 28

After taking Gui-zhi Tang, or purging this (patient), still (the patient has) headache and nape cramps, with hot (xi xi) Fervescence1 and no perspiration, his/her Epigastrium Fullness (xin xia man) which slightly hurting, and he/she cannot urinate spontaneously2, Gui-zhi qu (removing) Gui jia (adding) Fu-ling Bai-zhu Tang masters (zhu) these (conditions).  

[ Gui-zhi qu Gui jia Fu-ling Bai-zhu Tang Formula]3

Sha-yao 3 liangs. Gan-cao 2 liangs, roast. Sheng-jiang, cut into pieces, Bai-zhu, and Fu-ling, 3 liangs each. Da-zao 12 pieces, tear.

(Total) 6 savors (listed) above (right side). With 8 sheng water, cook (until water) becomes 3 sheng. Remove dregs. Take 1 sheng warm. When (the patient) urinates spontaneously, then he/she is cured. One book says from Gui-zhi Tang, here, remove Gui-zhi and add Fu-ling and Bai-zhu.

Shinjiro's Notes

  • 28-1: Cheng Wu-ji says, (having) headache and nape cramps, with hot (xi xi) Fervescence, and even Warps let down sweats, (it means) Evil Qi still exists on Surface.

  • 28-2: Cheng Wu-ji says, his/her Epigastrium Fullness (xin xia man) which slightly hurts, and he/she cannot urinate spontaneously because it is going to create Knotted Chest (jie xiong). Now, Outside Evidence does not stop yet. "(the patient has) no sweating and urination difficulty, thus Epigastrium Fullness (due to accumulation of fluids), with slight pain" mean Stoppage of the Body Fluids (ting yin).

  • Taki Genkan says, Cheng Wu-ji does not explain why Gui-zhi is removed, and says Gui-zhi Tang resolves Outside (wei).

  • Taki Genkan quotes Shang-han Lei Fang, generally when the formula is modified, the helper of the formula is added or removed. When the sovereign is removed, it forms a different formula. Here,  Gui-zhi is removed and still Gui-zhi is a part of the formula name. It is not understandable.

  • Jian Huan (Shang-han Shuo-Yuan-ji, 1707) says, the reason why Gui-zhi Qu Gui Jia Fu-ling Bai-zhu Tang is used not clear. It could be a miscopy of the later people. I am not sure of the usage of this formula. I am afraid if it would not necessarily work. When Zhong-jing prescribes a formula, there is not a chance that it would not match the Evidence. That is why it becomes an admonition to the later generation. I am really suspicious about this formula. So many years have passed and the later generation can make a mistake about what Zhong-jing really did or did not prescribe. Recent famous doctors all honor what Master Cheng (Wu-ji) wrote and force us to interpret, adapting his theory. They say when they employ Master Cheng’s theory, all Evidences can be healed. I do not believe this.

  • Otsuka Keisetsu, in his Rinsho Oyo Shakanron Kaisetsu(Clinically Applied Shang-han Lun), 1966, says this clause caused lots of arguments in the past, but I understand it this way; this clause explains the way of treatment of the case of the person who has weak Stomach and Intestines from the past to today who is attacked by Outside Evil and shows the false Gui-zhi Tang Evidence and the false Knotted Chest Evidence. It means, this case indicates the treatment method of  the case that looks like the Gui-zhi Tang Evidence but it is not and it looks like the Knotted Chest Evidence, but it is not. As the Evidences of Tai-yang Illness are  headache, nape cramps, Fervescence without perspiration, and if the person has all of them, then he/she has to have Hating-wind or Hating-cold. But, in this case, the person does not have Hating-wind or Hating-cold. Thus, we have to know that this illness is not caused by the Surface Evidence. This case is due to the person who has weak Stomach and Intestines from the past to today, and is attacked by Outside Evil, and, as his/her Rear is too Void, he/she shows just like a Surface Evidence. That is why the doctor mistook it as the Gui-zhi Tang Evidence and gave him/her Gui-zhi Tang. It did not work. Then the doctor purged him/her with such as De Xian Xiong Tang because he/she had Epigastrium Fullness and Tenderness, which looked like the Knotted Chest. Or may be with Da Chai-hu Tang or Yin-chen-hao Tang. The purgative worsened the case because this patient has Stomach Void and that caused Chest Fullness and Urination Difficulty. The patient's Rear Void worsened. Thus, we have to supplement Rear, and handle Rear Water. When Rear Water recedes and the physical strength thrives, the false Surface Evidence will disappear without using a formula.

  • This is why we use Gui-zhi Qu Gui Jia Fu-ling Bai-zhu Tang removing Gui-zhi which works on Surface, and adding Fu-ling and Bai-zhu which remove Rear Water. This formula will increase the amount of urine and remove stagnated Water in the Epigastrium. This removes Chest Fullness and sweats the patient to alleviate fever. Headache and nape cramps will go away naturally. If after receding Rear Water, still the patient has the Surface Evidence, then treat Surface for the first time. 

  •  

  • Modern TCM Shang-han Lunists Li Du-zhou et al, in their Gendaigo-yaku So-hon Shokanron, 2000, say this clause explains the Evidence and Treatment of the case which Qi of Tai-yang stagnates due to Water Body Fluids.

  •  

  • Mori Risshi says, there are 4 clauses (in the Song Text) which say "after Gui-zhi Tang is taken," and all are not mistreatments. Even though, there are some who would not be healed. Each case differs the Evidence. This case is one example. There are three clauses which say "after purging this patient." One case is " Qi Thrusting Upwards," the other case is "with pulse Urging and Chest Fullness," and the last "with Epigastrium Fullness." All are the Evidences which (the patient) after being wrongly purged, Fluids (yin) exists (in the body). This Evidence formed after being sweated and purged. I think this Evidence is due to(the patient having) Excess Phlegm from long ago. (The doctor) tries to resolve the Surface with Gui-zhi Tang, but excess Evil is covered by the Body Fluids which form a barrier, and the medicinal power cannot reach the Skin Surface. Or if (the doctor) even uses a purgative, it indiscriminately harms Yuan Qi. Thus, the Body Fluids approach the Epigastrium more and more. If Surface Evil is not resolved by itself, the Surface Evidences such as headache and nape cramping still exists. Thus, Fluids Repletion such as Chest Fullness (xin man) and anuria (niao-bi) is Thriving, and there is no way to obtain passing routes of sweat. That is why Gui-zhi qu Gui jia Fu-ling Bai-zhu Tang humbly expels stagnated Phlegm from Middle Jiao, and passes urination pleasantly. (When urination passes) two or three times, the Evil which is active against Warps will be resolved also with sweating.

    •

Clause 29

(In the case of) Shang-han (harmful cold), when the pulse is Floating (fu)
and (the patient) perspires spontaneously and frequently urinates, with
Heart anxiety, minute Hating-cold (wu-han: chills)1, and his/her legs
contracting and cramping, against our expectation, (the patient is) given
Gui-zhi Tang, (as the doctor) wants to attack his/her Surface (biao). This is
wrong (wu). If (the patient) takes this (formula), he/she will have Jue (cold extremities), and his/her throat will dry with anxiety and agitation (fan
zao), then he/she vomits. Make Gan-cao Gan-jiang Tang and give (the
patient). This will recover his/her Yang. If Jue (cold extremities) is cured
and feet get warm, then make Shao-yao Gan-cao Tang and give (the
patient). His/her legs will be stretched. If Stomach Qi is not harmonized
(he)2 and (the patient) talks in delirium, then give a little Tiao-wei Cheng-
Qi (harmonize Stomach and  receive Qi) Tang. If (the patient) is repeatedly
sweated and moreover treated with the red-hot needle (shao-zheng)3, then
Si-ni Tang masters (zhu) this (condition).

[Gan-cao Gan-jiang Tang Formula]4 

Gan-cao 4 liangs, roast. Gan-jiang 2 liangs.

(Total) 2 savors (listed) above. With 3 shengs water, cook (until water
reduces to) 1 sheng 5 he. Remove dregs, and divide into two and take twice
warm.

[Shao-yao Gan-cao Tang Formula]5

Bai-Shao, Gan-cao each 4 liang, both roasted

(Total) 2 savors (listed) above. With water 3 sheng, boil down to 1 sheng
and 5 he. Remove dregs. Divide into two,  and take twice warm.

[Tiao-wei Cheng-Qi Tang Formula]6

Da-huan 4 liangs, remove cortex and wash with clear liquor (qing jiu).  Gan-cao 2 liangs, roast.
Mang-xiao a half jing.

(Total) 3 savors (listed) above. With 3 sheng water, cook (until water
reduces to) 1 sheng. Remove dregs, and add Mang-xiao. Put (the pot) on fire again, and cook minutely and let it boiling up. Slightly warm it and take.

[Si-ni Tang Formula]7

Gan-cao 2 liangs, roast. Gan-jiang 1 liang half. Fu-zi 1 piece. Use fresh one, remove cortex and break into 8 pieces.

 (Total) 3 savors (listed) above (right side). With 3 sheng water, cook (until water reduces to) 1 sheng 2 he. Remove dregs, and divide into two, then warm and take twice. For stronger person, (you can use) one big piece of Fu-zi, and 3 liangs of Gan-jiang.

Shinjiro's Notes

  • 29-1: pulse is Floating (fu) and (the patient) perspires spontaneously and frequently urinates, with Hating-cold (wu han): Cheng wu-ji says, pulse is Floating (fu) and (the patient) perspires spontaneously and frequently urinates, with Hating-cold (wu han), that is because Yang Qi is insufficient (bu zu). Heart anxiety and legs contracting and cramping because Yin Qi is insufficient. If Yin, Yang and Blood all are Void, it is not possible to sweat.

  • Wan Hu says, Floating pulse with spontaneous  perspiration and frequent urination means Yang Qi is Void and unable to store Water. Heart Anxiety means True Yang is Collapsed (xu tuo) and its Qi floats and runs upward. Dryness inside of throat is due to being mistakenly sweated, which damaged Yang to cause the Body Fluids to be exhausted. Yang Void Anxious Agitation creates False Heat signs. Vomiting means Yin Cold Qi is Thriving and rejects (ju) Diaphragm.   

  • Mori Risshi says, the Floating pulse in this clause has a reason. The pulse is out of the Gentle and Tight (hua jing) figures and it is Empty and Floats by itself. It means Floating and Leek (kou: 芤). That is why the text says only Floating. "Spontaneous perspiration and slight Hating-cold" means an indication of  Surface Yang Qi Void. "Frequent urination and leg cramps" means an indication of Rear Yin Blood Void. Qi and Blood both are Void. "Heart Anxiety" is an Evidence of Evil in the Body Fluids. This is rather a joyful indication. If we give Gui-zhi Tang to this patient, he/she will have "four extremities Counter-flow cold, throat dryness, Anxiety, Agitating and Vomiting" over and over. This Evidence belongs to the case of "When Qi and Blood both are Void, the patient should not be sweated." However the doctor misused Gui-zhi Tang, thus the patient shows such Evidences. This patient has the long term, excessive Lodged Fluids and strong, thriving Stomach Qi, thus after obtaining Evil Qi, suddenly he/she has Evidences of his/her pulse becomes Floating,  perspiration, and frequent urination. The Evidences of Hating-cold and Leg cramps follow. If we give Gui-zhi Tang, and his/her Body Fluids are Lost, then the Evidences such as Counter-flow Anxiety (jue fan) will uprise.      

  • 29-2: Stomach Qi is not harmonized (he): Mori Risshi says, In the cases of  Stomach Qi Not Harmonized, there is a case which Tiao-wei Cheng-qi tang fits, or in some cases Xiao Cheng-qi Tang fits. Even in some cases Water is good enough. All relate to Heat Repletion. Also some fits to Xiao Chai-hu Tang, and some fits to Shen-jiang Xie-xin Tang. All relate to Void Cold. After all it is an Evidence of the Body Fluids and Evil are knotted. Each patient differs.  

  • 29-3:  red-hot needle (shao-zheng): Cheng Wu-ji says, to apply a red-hot needle damages (sun) Yin. Nei-jing says, "if the patient has minute Rong Qi, applying the red-hot needle will stop circulation of Blood." Repeatedly sweating and also(applying ) the red-hot needle make Yang and Yin Qi greatly Void.

  • Mori Risshi says, Sweating loses Yang Qi and the red-hot needle loses Yin Qi. If repeatedly Qi and Blood are lost, then Counter-flow (jue ni) Sinking pulse happens. Of course Si-ni Tang masters this condition.

  • 29-4: Please refer to my note in the Li Yi Shang-han Lun page. Cheng Wu-ji's note: Nei-jing says Spiciness (xin)and Sweetness (gan) scatters Yang. Gan-cao and Gan-jiang are put together to recover Yang Qi.

  • 29-5: Please refer to my note in the Li Yi Shang-han Lun page. . Cheng Wu-ji's note: Shao-yao, white one, supplements and red gives exit. White obtains, and red scatters. Sourness obtains it and sweetness loosens it. Sourness and sweetness are put together to use for supplementing Yin Blood.

  • 29-6: Please refer to my note in the Li Yi Shang-han Lun page. . Cheng Wu-ji's note: Nei-jing says when Heat soaks (yin) Inside (nei), treat with Spreading Coldness (xian han), helping with Bitterness and Sweetness. Mang-xiao spreads Coldness and removes Heat. Da-huang is Bitter and Cold to move (dang) Repletion. Gan-cao is sweet and Flat (ping) to help (former) two savors. Renewing (tui -chen) and loosening the middle (zhong).

  • 29-7: Please refer to my note in the Li Yi Shang-han Lun page. . Cheng Wu-ji's note:  Nei-jing says, "when Cold soaks Inside, treat with Sweet and Hot." Also it says "when Cold soaking surpasses,  suppress with Spiciness and Heat. Gan-cao , Gan-jiang and Fu-zi put together to make a Sweet, Spicy and very hot formula.  It enables to  scatter Yin and Yang Qi.

Clause 30
(One) asks a question1, "The Evidence (zheng) figures (xiang) the  Yang-dan (Yang Clearly)2. I came up (an) with the way (fa) and treated, but it worsened farther. (The patient had) Jue-ni (cold extremities), inside of the throat dried, both shins (jing) being Ju-ji (rigidity), and talking in delirium (zhan-yu). Master said, "Tell (him/her) to warm hands and feet in the night, then both legs can be stretched." Later it became like Master told me. Why do you know this?" (Master) answered saying, "When the Cun distal pulse is Floating (fu) and Large (da), it is Floating (fu) due to Wind (feng) and it is Large (da) due to Void (xu)3. Wind (feng) creates minute fever4, and the Void (condition) (creates) both shins contraction (luan). The Figure (xing-xiang) of the illness was the Gui-zhi (Tang Evidence). Thus, (you) added Fu-zi to Gui-zhi Tang savors and increased (the amount of) Gui-zhi to sweat (the patient). Fu-zi warmed Warps (jing), but because (the patient) Lost (wang) Yang, (the patient's) extremity coldness (jue-ni), throat inside dryness (yan zhong gan), Anxious and Agitated (fan-zao), (the patient's) Yang-ming (Warps) knotted Inside (nei), talking in delirium (zhan-yu), and (the patient was) anxiously disturbed (fan-luan) (happened). Furthermore, if (the patient) drinks Gan-cao Gan-jiang Tang, it will recover Yang Qi in the night, and both feet will be heated. If (the patient's) shins are still slightly rigid (ju-ji), give Shao-yao Gan-cao Tang again. Then shins can be stretched. If Cheng-qi Tang causes slight loose stools, then talking in delirium will stop. Thus, I know the illness can be healed." 

Shinjiro's Notes

  • 30-1: (One) asks a question: Mori Risshi says, I think 44 characters following this are the words of a catechism (wen-da). This clause makes  it clear what the former clause (Clause 29) left to explain. For this reason it took the style of a catechism.

    30-2: Yang-dan (Yang Clearly): Cheng Wu-ji says, Yang-dan is another name of Gui-zhi Tang.

    30-3: Cheng Wu-ji says, these (symptoms) go along with Gui-zhi Tang jia Fu-zi to warm Warps and supplement Void. To increase (the amount of) Gui-zhi will sweat and remove Wind. If treating this way increases Cold Extremities (jue), give Gan-cao Gan-jiang Tang to recover Yang and warm feet. Further give Shao-yao Gan-cao Tang to harmonize Yin and stretch tendons. When Surface Evil is resolved already and Yang and Yin are recovered but Knotting (jie) of Yang and Yin exists Inside, with talking in delirium, give a little bit of Tiao Wei Cheng Qi Tang to cause minute diarrhea and harmonize Stomach. Thus, Yin and Yang Qi all harmonize, and Inside and Outside Evil all leaves.

     

[End of Tai-yang Illness Upper Section]

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