Chapter 23, herbs for Shanghan disease
1．麻黄加知母汤
1.
Mahuang jia Zhimu Tang (Mahuang and Zhimu: names of two
herbs. Jia means to add).
治伤寒无汗。
This formula is used for the treatment of
Shanghan disease without sweat, e.g. a Cold- and Wind-attack
febrile disease, which is a concept in Chinese medicine. It
refers to a group of diseases that are caused by attack of
Cold and/or Wind Xie Qi from outside of body. The person
feels initial cold/chilly feeling, with or without hot
feeling. If the person has no sweat, but headache, pain or
tightness on the neck or whole body, it is a Cold-invading
Shanghan disease. If the person has sweat, the Shanghan is
caused due to the invasion of Wind. If the person has no
chilly feeling, or very little and/or only a flash of cold
feeling, but soon he feels very hot/fever with sweat, the
condition belongs to Summer-Hot disease or a Wen disease
(infectious disease). The herbal formula used for these
disease conditions are quite different. (Comment from
translator: according to these definitions, it is apparently
not correct to translate the Shanghan disease as the
exogenous febrile disease).
麻黄（四钱）
桂枝尖（二钱）
甘草（一钱）
杏仁（二钱，去皮炒）
知母（三钱）
Mahuang 12 gram, Guizhi tip 6 gram,
Gancao 3 gram, Xinren 6 gram (remove skin, fry), Zhimu 9
gram.
先煮麻黄五六沸，去上沫，纳诸药煮取一茶盅。温服复被，取微似汗，不须啜粥，余如桂枝法将息。
Cook the herb Mahuang first for five
to six boiling with removal of upper floating foam. Then add
other herbal ingredients in and continue to cook. Cover the
person heavily to get mild sweat. No need to eat rise soup.
For other requirement, see the paragraph for Guizhi Tang.
麻黄汤原方，桂枝下有去皮二字，非去枝上之皮也。古人用桂枝，惟取梢尖嫩枝折视之，内外如一，皮骨不分。若见有皮骨可分辨者，去之不用，故曰去皮。陈修园之侄鸣岐曾详论之。
In the original Mahuang Tang, it
indicated the need to remove the skin of the herb Guizhi. It
does not mean to remove the skin on the herb branch. The
ancient people, when use the herb Guizhi, used the tip part
of young branch. They broke the branch to see if the skin
and the inside stem is the same, e.g. hard to separate the
skin and the inside stem. If the skin is clear from the
inside stem, they would refuse to use it. This is what they
meant to “remove skin”. The nephew of Dr. Chen Xiuyuan, Mr.
Mingqi discussed this in detail.
《伤寒论》太阳篇中麻黄汤，原在桂枝汤后。而麻黄证多，桂枝证不过十中之一二，且病名伤寒，麻黄汤为治伤寒初得之主方，故先录之。
The herbal formula of Mahuang Tang is
originally listed behind the formula of Guizhi Tang in the
Taiyang Chapter in the book
《Shang Han
Lun》.
Howevere in clinic, more cases are with the Mahuang Tang
condition. There are about one to two out of ten cases with
the Guizhi Tang condition, among the Shanghan disease. In
addition, the name of the disease in Chinese is Shanghan and
the Mahuang Tang is the main formula for the early stage of
Shanghan disease. For these reasons, the Mahuang Tang is
cited here first.
伤寒之证，先自背受之，背者足太阳所辖之部位也。是以其证初得，周身虽皆恶寒，而背之恶寒尤甚，周身虽皆觉疼，而背下连腿之疼痛尤甚。其脉阴阳俱紧者，诚以太阳为周身外卫之阳，陡为风寒所袭，逼其阳气内陷，与脉相并，其脉当有力，而作起伏迭涌之势。而寒气之缩力（凡物之体热则涨，寒则缩），又将外卫之气缩紧，逼压脉道，使不得起伏成波澜，而惟现弦直有力之象。甚或因不能起伏，而至左右弹动。
The exogenous febrile disease is
attacked from the back of the body. The back is the area,
which is governed by feet Taiyan meridian. Therefore, in the
early stage of the disease, though the whole body may feel
chilly, the back feels more chilly. The whole body may feel
pain, the back as well as the leg would feel more severe
pain. The reason for the tight pulse in the floating and
deep position is that the Taiyang is the Yang Qi in the body
surface for defense. It is suddenly attracted by Cold-Wind,
which presses and pushes the Yang Qi sink inside. The sink
Yang Qi combined with the pulse, causing strong pulse as
waving feeling. The contracting force of the Cold (for
anything, the hot makes it expand and the clod makes it
contract.) contract the defense Qi deep and tight to press
the pulse vessels, to prevent it from waving, so that the
pulse became string and strong with power feeling. It is
even unable to form waving, but curving left and right.
凡脉之紧者必有力。夫脉之跳动，心脏主之。而其跳动之有力，不但心主之也；诸脏腑有热皆可助脉之跳动有力，营卫中有热亦可助脉之跳动有力。特是脉之有力者，恒若水之有浪，大有起伏之势。而紧脉虽有力，转若无所起伏，诚以严寒束其外表，其收缩之力能逼营卫之热内陷与脉相并，以助其有力；而其收缩之力又能遏抑脉之跳动，使无起伏。是紧脉之真相，原于平行中见其有力也。至于紧脉或左右弹者，亦蓄极而旁溢之象也。仲师治以麻黄汤，所以解外表所束之寒也。
Whenever the pulse is tight, it is
also strong upon feeling. The pumping of the pulse is
controlled and handled by the heart. Not only the heart, but
also the Hot in various organs can also push the pulse to
pump and to beat, as well as the Hot in the Ying-Qi and Wei-Qi
layer of the body. In these cases, the pulse is, as the wave
in water, has raising and falling form. The tight pulse,
though strong, has no such waving form, due to the sealing
by the Cold Qi. … So, in real tight pulse, the pulse feels
as flatten and strong. If the tight pulse feels moving to
the left and right, it indicates that the pulse is in full
and is to spill. Mater Zhang Zhongjin used Mahuang Tang, for
the aim to release the tight sealing and folding by the Cold
Qi.
方中用麻黄之性热中空者，直走太阳之经，外达皮毛，借汗解以祛外感之寒。桂枝之辛温微甘者，偕同甘草以温肌肉、实腠理，助麻黄托寒外出。杏仁之苦降者，入胸中以降逆定喘。原方止此四味，而愚为加知母者，诚以服此汤后，间有汗出不解者，非因汗出未透，实因余热未清也。佐以知母于发表之中，兼寓清热之意，自无汗后不解之虞。此乃屡经试验，而确知其然，非敢于经方轻为加减也。
The herb Mahuang in the formula is hot
in herbal nature and hollow in middle, so it goes into the
Taiyang meridian and to the skin and hair. It expels the
Cold through the sweat it created. Herb Guizhi is spicy and
warm and slight sweet in herbal nature. It works with Gancao
to warm the muscle, to enhance the fibro membrane, and help
the Muhuang to expel the Cold out. Xingren is bitter and
falling in herbal nature. It goes into the chest to suppress
the reversed Qi and to solve asthma. In the original formula
of Mahuang Tang, there are only these four ingredients. The
reason for me to add herb Zhimu is that, after drink of the
original formula, some person do not have improvement after
having the sweat. It is not due to the amount of sweat is
not enough, but to the remaining Fire, that has not been
cleared off yet. The addition of Zhimu in the formula bears
the meaning of Fire-clearing. By this way, there is no more
chase, in which the condition is not improved after having
sweat. This modified formula has been tested many times, so
I know it it true and it works. It does not mean that I
modified the bible formula without prudent.
或问：喘为肺脏之病，太阳经于肺无涉，而其证多兼微喘者何也？答曰：胸中亦太阳部位，其中所积之大气，原与周身卫气，息息相通。卫气既为寒气所束，则大气内郁，必膨胀而上逆冲肺，此喘之所由来也。又风寒袭于皮毛，必兼入手太阴肺经，挟痰涎凝郁肺窍，此又喘之所由来也。麻黄能兼入手太阴经，散其在经之风寒，更能直入肺中，以泻其郁满。所以能发太阳之汗者不仅麻黄，而仲景独取麻黄，为治足经之药，而手经亦兼顾无遗，此仲景制方之妙也。
It might be asked: the asthma is the
disease in the lung. The Taiyang meridian has nothing to do
with the lung. How the disorder in the Taiyang meridian is
usually with slight asthma? Answer: The chest is also the
governing area by the Taiyang meridian. The accumulated Qi
in the chest is connected with the Qi in any part of the
body, including the Wei-Qi. When the Wei-Qi is sealed by the
invading Cold, the Big Qi in the chest is also suppressed.
It would so be bloating to reverse up to push the lung, and
so to cause the asthma. In addition, when the Wind and Cold
invade in the skin and hair layer, it must come into the
lung meridian. It will bring the phlegm-saliva to block the
air tract in the lung. This is another reason for the
asthma. The herb Mahuang can go into the hand Taiyin
meridian, to expel the Wind and Cold in that meridian. It
can also go directly into the lung, to expel its stagnation
condition. For this reason, the herbs that can create sweat
in the Taiyang meridian are not only the herb Mahuang.
Master Zhang Zhongjing however used only the Mahuang, for
the reason that, the Mahuang is the herb for the feet
Taiyang meridian, its function covers the hand meridian too.
This is the marvelous way by which the Master created his
formula.
凡利小便之药，其中空者，多兼能发汗，
萹蓄、木通之类是也。发汗之药，其中空者，多兼能利小便，麻黄、柴胡之类是也。太阳经病，往往兼及于膀胱，以其为太阳之腑也。麻黄汤治太阳在经之邪，而在腑者亦兼能治之。盖在经之邪，由汗而解，而在腑之邪，亦可由小便而解。彼后世自作聪明，恒用他药以代麻黄汤者，于此义盖未之审也。
Among the herbs that can promote
urination, if it is hollow inside, it is usually also able
to create sweat, such as the herb Bianxu and Mutong. Also,
among the herbs that can create sweat, if it is hollow
inside, it can also promote the urination, such as the herb
Mahuang and Chaihu. The disorder in the Taiyang meridian is
usually affecting the urine bladder, since the bladder is
the organ of the Taiyang meridian. The formula Mahuang Tang
solves the Xie Qi in the Taiyang meridian, so that in the
urine bladder. The Xie in the meridian can be expelled
through the sweat, and that in the organ, through the urine.
Some later doctors believed them selves clever and replace
the Mahuang with other herbs. They actually did not
understand and meaning of the use of Mahuang here.
大青龙汤，治伤寒无汗烦躁。是胸中先有内热，无所发泄，遂郁而作烦躁，故于解表药中，加石膏以清内热。然麻黄与石膏并用，间有不汗之时。若用此方，将知母加重数钱，其寒润之性，能入胸中化合而为汁，随麻、桂以达于外，而烦躁自除矣。
The formula Da Qinglong Tang works for
Shanghan disease, in which the person has no sweat but
agitated and jarred. This is a condition, in which there is
Hot in the chest before the disease, that has no way to
release yet. Upon the attack by the Cold and/or the Wind, it
accumulated more in the chest, so as to cause agitate and
annoyed. For this reason, the herb Shigao was added in the
formula to clear the inside Hot. However, when the Mahuang
and Shigao are used together, some person may have no sweat.
If the formula here is used, with more Zhimu in it, the
cooling and wetting nature of the Zhimu can, after come into
the chest, develop liquid-fluid, which then follow the
Mahuang and Guizhi to expel out of the body, so that the
agitated and jarred are solved.
伤寒与温病，始异而终同。为其始异也，故伤寒发表，可用温热，温病发表必须辛凉。为其终同也，故病传阳明之后，无论寒温，皆宜治以寒凉，而大忌温热。兹编于解表类中，略取《伤寒论》太阳篇数方，少加疏解，俾初学知伤寒初得治法，原异于温病，因益知温病初得治法，不同于伤寒。至于伤寒三阴治法，虽亦与温病多不同，然其证甚少。若扩充言之，则凡因寒而得之霍乱、痧证，又似皆包括其中。精微浩繁，万言莫罄，欲精其业者，取原书细观可也。
The Shanghan and
the Wen disease are different in the early stage, but
similar in the later stage. Because they are different in
the early stage, it is needed the warm-hot herbs in the
treatment of Shanghan disease, while it is needed the
spicy-cooling herbs in the Wen disease. Because their later
stages are the same or similar, after the disease passes
into the Yangming stage, no matter it is from Shanghan or
Wen disease, both need Cold-Cooling herb, but inhibit the
use of Warm-Hot herbs. For this reason, in my book in the
chapter for the Xie Qi expelling from body surface, it is
cited some of the herbal formulas from the Taiyang Chapter
of the book
《Shang Han
Lun》.
They are explained little bit more, so that the beginners
can understand that the therapy for the early stage of
Shanghan disease is different from the Wen disease. So, the
treatment of the Wen disease is different from the Shanghan
disease. For the treatment of the three Yin stages in the
Shanghan disease, though they are some different from those
for Wen disease, the clinic cases are not common. In a broad
speaking, whenever a disease is got due to the Cold attack,
such as Cholera or skin bleeding conditions, they can be
included in the Shanghan disease for the similar treatment.
There are so many medical books, thousands and thousands of
them, in detail or in broad discussion. For doctors who wish
to really know the medicine, need to read the original
books.
2．加味桂枝代粥汤
2. Jiawei Guizhi Dai Zhou Tang
治伤寒有汗。
This formula is used for Shanghan
disease with sweat.
桂枝尖（三钱）
生杭芍（三钱）
甘草（钱半）
生姜（三钱）
大枣（三枚，掰开）
生黄芪
（三钱）知母（三钱）
防风（二钱）
Guizhi tips 9 gram, Baishao 9 gram,
Gancao 4.5 gram, Fresh ginger 9 gram, Chinese date three
granules (chop open), Huangqi 9 gram, Zhimu 9 gram, and
Fangfeng 6 gram.
煎汤一茶盅，温服复被，令一时许，遍身
微似有汗者益佳。不可如水流漓，病必不除。禁生冷、粘滑、肉面、五辛、酒酪及臭恶等物。
Cook the herbal tea to one cup amount.
Drink the herbal tea in warm. Cover the body for one hour to
get mild sweat. Do not let the sweat as heavy as water
flows. Other wise, the disease will not be solved. Inhibit
the intake of non-cooked food, the sticky food, slippery
food, meat, spicy food, wine-liquor, fermented food, strong
odor food, etc.
桂枝汤为治伤风有汗之方。释者谓风伤营则有汗，又或谓营分虚损，即与外邪相感召。斯说也，愚尝疑之。
This formula is for the Wind-attack
Shanghan with sweat. Some translators said that when the
body is invaded with the Wind, the body will have sweat. Or,
they may say that, if the Ying-portion is weak, the body
condition is vibrating with the out-coming Xie Qi. To such
explanation, I doubt.
人之营卫，皆为周身之外廓。卫譬则郭也，营譬则城也，有卫以为营之外围，外感之邪，何能越卫而伤营乎？
The Yin-portion and the Wei-portion of
the body are both the defense layer of the body in the body
surface. The Wei-portion is in the outside and the
Qing-portion is inner side. How could a Xie Qi invade the
Ying-portion by passing the Wei-portion?
盖人之胸中大气，息息与卫气相关，大气充满于胸中，则饶有吸力，将卫气吸紧，以密护于周身，捍御外感，使不得着体，即或着体，亦止中于卫，而不中于营，此理固显然也。有时胸中大气虚损，不能吸摄卫气，卫气散漫，不能捍御外邪，则外邪之来，直可透卫而入营矣。且愚临证实验以来，凡胸中大气虚损，或更下陷者，其人恒大汗淋漓，拙拟升陷汤下，载有数案，可参观也。是知凡桂枝汤证，皆因大气虚损，其汗先有外越之机，而外邪之来，又乘卫气之虚，直透营分，扰其营中津液，外泄而为汗也。究之，风寒原不相离，即系伤风，其中原挟有寒气，若但中于卫则亦能闭汗矣。故所用桂枝汤中，不但以祛风为务，而兼有散寒之功也。
The Big Qi in the chest is connected
always with the out layer of Wei-Qi. The Big Qi is located
in the chest, so it bears strong inhaling power to tightly
attract the Wei-Qi to the body, so that the Wei-Qi can seal
the body to defense against the invasion of Xie Qi from
outside. Even if the Xie Qi invades, it would stop at the
out layer, not reach the Yin-portion. This is clear. If the
Big Qi is not sufficient in the chest, it would not be able
to attract the Wei Qi, the Wei Qi would be in a loosen, a
dispersing matter, fail to defense the invading Xie Qi, so
that the invading Xie Qi can reach the Ying-portion of the
body directly. I know from my clinic experience that, when
the person has Big Qi deficiency condition, or it even sink,
the person usually has heavy sweat. In my formula of
Shenxian Tang, there are some case reports. Readers can
check there. It is so known that, person with the Guizhi
Tang condition, due to Big Qi deficiency originally, has
sweat escaping tendency. Upon attack of out Xie Qi in, the
Xie Qi takes the advantage of weak Wei-Qi, penetrates
directly into the Yin-portion of the body, to disturb the
fluid-liquid part in the Ying-portion, making it escape or
spill as sweat. In detail, the Wind and the Cold usually go
together. Even it is Wind-attack condition, it bears kind of
Cold Xie Qi too. Once it invades into the Wei-portion, it
can cause stop of the sweat. So, in the Guizhi Tang, the
main aim is to expel the Wind, as well as to expel the Cold.
陈古愚曰：“桂枝辛温，阳也。芍药苦平，阴也。桂枝又得生姜之辛，同气相求，可恃之调周身之阳气。芍药而得大枣、甘草之甘苦化合，可恃之以滋周身之阴液。既取大补阴阳之品，养其汗源，为胜邪之本，又啜粥以助之，取水谷之津以为汗，汗后毫不受伤，所谓立身于不败之地，以图万全也。”
Mr. Chen Guyu said: “the herb Guizhi
is spicy and warm, belongs to the Yang. The Shaoyao is
bitter-calm, belongs to the Yin. The Guizhi, accompanied by
the spicy of the fresh ginger, the spicy nature works
together, to adjust, to balance, or to harmony the Yang Qi
in the whole body.
The Shaoyao, when accompanied
by the Chinese date and Gancao, the sweet and the bitter
meet, can create more fluid to the body Yin portion. By this
way, both Yin and Yang of the body are nourished, so the
source of the sweat is rich, which is the base to combat the
invading Xie Qi. In the original formula, it is asked to eat
soup after drinking of the herbal tea. The aim of it is to
absorb the nutrition of the soup to create sweat, so that
after sweat, the body liquid-fluid portion is not damaged.
This is so called the way of always win, to ensure the
success.”
按：此解甚超妙，而于啜粥之精义，犹欠发挥。如谓取水谷之津，以为汗，而人无伤损，他发汗药，何以皆不啜粥？盖桂枝汤所主之证，乃外感兼虚之证，所虚者何？胸中大气是也。《内经》曰：“谷始入于胃，其精微者，先出于胃之两焦，以溉五脏，别出两行营卫之道，其大气之抟而不行者，积于胸中，命曰气海。”由斯观之，大气虽本于先天，实赖后天水谷之气培养而成。
Comments: the above explanation for the
herbal formula is very good. However, the meaning of eating
soup appears not explained completely. If to take the
liquid-fluid from the food to make it into sweat, how, when
man is without sick and when taking other sweat-creating
herbs, it is not asked to drink the soup? In fact, the
Guizhi Tang is mostly used in a person who is originally
weak but attacked by out-invading Xie Qi. What means his
weakness? He is weak in his Big Qi in chest. … The Big Qi is
rooted from original life energy, but nourished by the late
life nutrition actually.
The Guizhi Tang
condition is used in Big Qi deficiency, which causes the
loss or scatter of the Wei-Qi. When the Xie Qi invades, the
Xie Qi so can pass the Wei portion and directly into the
Ying-portion of the body. So, after drink of the herbal tea,
it is needed to drink soup, to nourish the Big Qi in the
chest. It can also distribute the ginger and Guizhi to expel
the Xie Qi. This formula really means, once start the war,
it must win. The doctors in later time are usually not
understood this meaning, so they do not let the patient to
drink soup. Therefore the formula does not work properly and
causes the Xie Qi deeper. For this reason, Dr. Wang Qingren
in his book
《Yi Lin Gai
Cuo》criticize
the herbal formula of Guizhi Tang as no use. In fact, it
does not mean it is no use, but doctor did not ask to drink
soup. For this reason, whenever I used this formula, I added
Huangqi in the formula to replace the soup to nourish the
Big Qi; added Fangfeng to disperse the Ying-portion and
Wei-portion, to replace the soup to disperse. After drink
the modified Guizhi Tang, it is better also to drink soup,
but it still worked even without the soup drink. The
addition of Zhimu is to prevent the Hot side effect of the
Huangqi.
按：凡服桂枝汤原方，欲其出汗者，非啜粥不效。赵晴初曰：族侄柏堂，二十一岁时，酒后寐中受风，遍身肌肤麻痹，搔之不知疼痒，饮食如常。时淮阴吴鞠通适寓伊芳家，投以桂枝汤，桂枝五钱、白芍四钱、甘草三钱、生姜三片、大枣两枚，水三杯，煎二杯，先服一杯，得汗止后服，不汗再服。并嘱弗夜膳，临睡腹觉饥，服药一杯，须臾啜热稀粥一碗，复被取汗。柏堂如其法，只一服，便由头面至足，遍身
得微汗，汗到处，一手搔之，辄知疼痒，次日病若失。观此医案，知欲用桂枝汤原方发汗者，必须啜粥，若不啜粥，即能发汗，恐亦无此功效。
Comments: when use the original Guizhi
Tang with aim to create sweat, the person must drink soup.
Mr. Zhao Qingchu said: my nephew Botang, when he was 21
years of old, got Wind-attack after drinking liquor. He felt
numb in whole body, no itch or pain feeling on the skin, but
had normal appetite. At that time, Mr Wu Shitong, who lived
in Huaiyang city, visited my home by chance. He give the
patient Guizhi Tang, using Guizhi 15 gram, Baishao 12 gram,
Gancao 9 gram, fresh ginger three pieces, Chinese date two
granules. The herbs were mixed with thee cups of water to
cook until there is two cup left in the pot. The patient
should drink one cup first. If he get sweat, he does not
need to drink the remaining herbal tea. Prepare some soup
for night. If he feels hungry before going to bed, let him
drink one cup of the herbal tea, and after while, drink warm
soup one bowl, followed by covering body to get sweat. The
patient followed this requirement. Only one drink, he got
sweat from the head to the feet, all over the body. When the
sweat showed, the skin could feel
pain and itch upon scratch by
hands. The next day, the disease almost cured. Referring to
this case, it is known that, to apply the original Guizhi
Tang to create sweat, the person must drink rice soup. If
not, even if the person could also have sweat, the cure of
the disease is doubted.
或问：桂枝汤证，其原因既为大气虚损，宜其阳脉现微弱之象，何以其脉转阳浮而阴弱乎？答曰：人之一身，皆气之所撑悬也。此气在下焦为元气，在中焦为中气，在上焦为大气，区域虽分，而实一气贯注。故一身之中，无论何处气虚，脉之三部，皆现弱象。今其关前之脉，因风而浮，转若不见其弱，而其关后之脉，仍然微弱，故曰阳浮而阴弱也。如谓阴弱为下焦阴虚，则其脉宜兼数象。而愚生平所遇此等证，其脉多迟缓，不及四至，其为气分虚损，而非阴分虚损可知。即所谓啬啬恶寒、淅淅恶风，翕翕发热，亦皆气分怯弱之形状也。
It might be asked: If the Guizhi Tang
condition is due the weakness of the Big Qi in the chest, it
should show the weak pulse in the Yang pulse position. Why
the person’s pulse is floating in the Yang, but weak in the
Yin position? Answer: the whole body of human is hold up by
the Qi. In the Lower Jiao, this Qi is called Yuan Qi; in the
Middle Jiao, it is called Zhong Qi; and in the chest, it is
called the Big Qi. Though it is separated in such different
zones, they are the same Qi. Therefore, no matter where is
the Qi insufficiency, the pulse in all the position should
show weakness. Now, the pulse in the Chun position is
floating but not weak; the pulse in the Chi position remains
mild weak. So, it is called the Yang floating and the Yin is
weak. If the Yin weakness means the Yin deficiency in the
Lower Jiao, the pulse should also feel frequent. However, in
my life when I met such patient, their pulse was late, not
up to four times per breath circle. It clearly indicates the
Qi deficiency, not Yin deficiency. Even the so described
mild chilly, mild dislike wind, and mild hot, such symptoms
for the Guizhi Tang condition, all are the evidence for a Qi
deficiency, not a Yin deficiency.
3．从龙汤
3. Conglong Tang (Cong here means to
follow, or to mimic, in Chinese; Long here means Xiao
Qinglong Tang. The meaning of the formula name means an
herbal formula that is to be taken after the Xiao Qinglong
Tang).
治外感痰喘，服小青龙汤，病未全愈，或愈而复发者，继服此汤。
This formula is used for the phelgm
and asthma due to Xie Qi invasion. The person has drunk the
Xiao Qinglong Tang, but the disease was not cured
completely; or it recurred after cure. In the later
situation, drink this formula.
龙骨（一两，不用
捣）
牡蛎（一两，不用
捣）
生杭芍（五钱）
清半夏（四钱）
苏子（四钱，炒捣）牛蒡子（三钱，炒捣）
Longgu 30 gram (no grind), Muli 30
gram (no grind), Baishao 15 gram, Banxia 12 gram, Souzi 12
gram (fry and grind), Niubangzi 9 gram (fry and grind).
热者，酌加生石膏数钱或至一两。
If the person feels hot, add herb
Shigao several gram to 30 gram.
从来愚治外感痰喘，遵《伤寒论》小青龙汤加减法，去麻黄加杏仁，热者更加生石膏，莫不随手而愈。然间有愈而复发，再服原方不效者，自拟得此汤后，凡遇此等证，服小青龙汤一两剂即愈者，继服从龙汤一剂，必不再发。未全愈者，服从龙汤一剂或两剂，必然全愈。名曰从龙汤者，为其最宜用于小青龙汤后也。
When treat phlegm and asthma due to
out-invading common cold, I always followed the way of
modification of the formula Xiao Qinglong Tang, to remove
herb Mahuang but add Xingren. If the condition is Hot, add
Shigao. It worked always. However, from time to time, there
was some case, which has been cured before, but recurred
again and the previous formula no longer worked. After I set
up this formula, I let patient use Xiao Qinglong Tang first
to solve the problem, then asked them to drink this Conglong
Tang one or two doses. Their diseases must be cured really.
To term it Conglong Tang, is for its use after the Xiao
Qinglong Tang.
或疑，方中重用龙骨、牡蛎，收涩太过，以治外感之证，虽当发表之余，仍恐余邪未尽，被此收涩之药固闭于中，纵一时强制不喘，恐病根益深，异日更有意外之变。答曰：若是以品龙骨、牡蛎，浅之乎视龙骨、牡蛎者也，斯可征之以前哲之说。
It might be doubted: large amount of
Longgu and Muli is used in the formula. They bear strong
restraining herbal nature. To solve the common cold, at the
time to expel the Xie Qi out of the body, they may hold the
Xie Qi somehow in the body. Even if the person does not have
asthma or cough at this movement due to the strong suppress
by the two herbs, they may make the Xie Qi deeper and cause
trouble later. Answer: if look at the Longgu and Mulin in
this way, you look down the two herbs. Let’s see how the
previous famous doctors said about them.
徐灵胎曰：龙骨最粘涩，能收敛正气，凡心神耗散，肠胃滑脱之疾，皆能已之。此药但敛正气，而不敛邪气。所以仲景于伤寒邪气未尽者，亦恒与牡蛎同用，若仲景之柴胡加龙骨牡蛎汤，桂枝、甘草、龙骨、牡蛎汤诸方是也。愚于伤寒、温病，热实脉虚，心中怔忡，精神骚扰者，恒龙骨与萸肉、生石膏并用，即可随手奏效。
Mr. Xu Lingtai said: the Longgu is
very sticky and glue-like. It can seal the Zheng Qi, e.g.
the body defense Qi, or the body normal Qi. It can work in
case with Heart spirit escaping, and stomach-intestine
slippery conditions. It only restrains the normal Qi, but
not the Xie Qi. Therefore, the Master Zhang Zhongjing, when
the Xie Qi is not completely expelled out, use the Longgu
and Muli together, such as in his Chaihu Jia Longgu Muli
Tang and others. Whenever I meet the person with sthenic
Fire, but weak pulse; palpitation or shacking feeling in
heart, agitate in mode, etc. in various Shanghan disease or
Wen disease, I used the Longgu and Muli, and the Shanyurou
and Shigao. The disease can be cured always with the herbal
tea used. (the herbal tea comes, the sick goes).
门人高××曾治一外感痰喘，其喘剧脉虚，医皆诿为不治。高××投以小青龙汤，去麻黄，加杏仁，又加生石膏一两、野台参五钱，一剂而喘定。恐其反复，又继投以从龙汤，亦加人参与生石膏，其病霍然顿愈。
My student, Mr. Gao, treated a person
with Xie Qi-attack, that causes asthma and phlegm condition.
The asthma was very severe and the pulse was very week.
Doctors refused to treat him. Mr. Gao however used the Xiao
Qinglong Tang to him, in which the Mahuang was removed but
the Xingren and Shigao (30 gram), and wild Taishen 15 gram
were added. One dose stopped the asthma. For fearing its
recurrence, the patient was given this Conglong Tang, with
addition of Renshen and Shigao. The disease was solved very
soon.
又：子××治曲姓叟，年六十余，外感痰喘，十余日不能卧。医者投以小清龙汤两剂，病益加剧（脉有热而不敢多加生石膏者其病必加剧）。××视之，其脉搏一息六至，上焦烦躁，舌上白苔满布，每日大便两三次，然非滑泻。审证论脉，似难挽回。而××仍投以小青龙汤，去麻黄，加杏仁，又加野台参三钱，生龙骨、生牡蛎各五钱，生石膏一两半。一剂病愈强半，又服一剂全愈。
In addition, my son treated Mr. Yu,
who was 60 years of old. He suffered from out-coming Xie Qi
attack and had asthma and phlegm. He could not have a sleep
for ten days. Previous doctors used Xiao Qinglong Tang, but
the condition became worse (when the pulse showed Hot, but
the doctor dared to add more Shigao, so that the condition
become worse). My son saw him. His pulse was up to 6 times
per breath circle. He was very agitated; his tongue covering
was white in whole tongue surface; and he had bowel movement
two to three time a day, but not a slippery stool. According
to the symptom and the pulse, it appeared hard to save him.
However, he sued the Xiao Qinglong Tang, with removal of
Mahuang, and with addition of Xingren, wild Taishen, Longgu,
Muli, 15 gram each, and Shigao 45 gram. One dose made the
patient’s condition calm down half. Another dose solved the
condition completely.
按：前案但加补气之药于小青龙汤中，后案并加敛气之药于小青龙汤中，似近于少年卤莽，而皆能挽回至险之证，亦可为用小青龙汤者多一变通之法矣。
Comments: in previous case report, the Qi-nourishing
herbs were added in the Xiao Qinglong Tang. In the later
case, the Qi-restraining herbs were added in the Xiao
Qinglong Tang. It seemed that the young doctor was very
reckless, however both ways in the use of the herbs saved
life. It created an additional way to modify the Xiao
Qinglong Tang.
邑，郑××，年五十许。感冒风寒，痰喘甚剧，服表散、清火、理痰之药皆不效，留连二十余日，渐近垂危。其甥刘××，从愚读书，与言医学，颇能记忆。闻其舅病革，往省之，既至，则衣冠竟属纩矣。刘××用葶苈（四钱生者布包）大枣（五枚擘开）汤，加五味子二钱，煎汤灌之，豁然顿醒，继服从龙汤一剂全愈。盖此证乃顽痰郁塞肺之窍络，非葶苈大枣汤，不能泻之。且喘久则元气必虚，加五味子二钱，以收敛元气，并可借葶苈下行之力，以纳气归肾也。可知拙拟从龙汤，固宜于小青龙汤后，而服过发表之药者，临时制宜，皆可酌而用之，不必尽在小青龙汤后也。
Mr. Zheng, 50 years of old, was attacked
by out-coming Xie Qi. He had asthma and phlegm very much. He
tried Xie-expelling, Fire-clearing and Phlegm-removing
herbs, but none worked for him. The condition has been last
for twenty days and close to death. His nephew, Mr. Liu,
studied medicine with me. When talk medicine with him, he
was good at memory. After heard that his uncle was very
sick, he went to have a greeting visit. Upon his arrive, the
family was ready to have funeral clothes to the patient. Mr
Liu used Tinglizi 12 gram (fold with gauze), Chinese date 5
granules (chop open) to prepare herbal tea for his uncle.
After the tea was poured in the mouth, his uncle suddenly
waked up. Later, one dose of the Xiao Qinglong Tang was
given and the condition was solved. In this case, it is the
stubborn phlegm that blocked the lung. No other herbal
formula, except the Tinglizi Dazao Tang, could solve the
problem. In addition, a long time of asthma usually causes
weakness in body Yuan Qi. The addition of Wuweizi 6 gram is
to restrain the Yuan Qi. It can also seal the Yuan Qi back
in the Kidney, with the down-falling power of the Tinglizi.
It is therefore known that, my Conglong Tang, can be drunk
after the use of the Xiao Qinglong Tang, but can also be
used after the use of Xie-expelling herbs, not always after
the Xiao Qinglong Tang.
4．馏水石膏饮
4. Liushui Shigao Yin (Liu
治胸中先有蕴热，又受外感，胸中烦闷异常，喘息迫促，其脉浮洪有力，按之未实，舌苔白而未黄者。
This formula is used for a person, who
had had accumulated hidden Fire in the chest, then affected
by out-coming Xie Qi. He feels agitated very much in the
chest, has urgent asthma and short of breath. The pulse is
floating, waving feeling and strong. It is not sthenic
feeling when touched harder. His tongue covering is white in
color, not in yellow yet.
生石膏（二两，轧细）
甘草（三钱）
麻黄（二钱）
Shigao 60 gram (grind), Gancao 9 gram,
Mahua 6 gram.
上药三味，用蒸汽水煎两三沸，取清汤一大碗，分六次温服下。前三次，一点钟服一次，后三次，一点半钟服一次。病愈则停服，不必尽剂。下焦觉凉者，亦宜停服。僻处若无汽水，可用甘澜水代之。
Cook the three ingredients in steam
water for two to three boiling. Collect clear supernatant
one big bowl. Separate the tea into six parts. Drink them as
six times. For the first three times, drink it once every
hour. For the later three times, drink it once every one and
half hour. If the disease is cured, stop to drink it. Not
need to finish all of them. If there is cold feeling in the
Lower Jiao of the body, also stop to drink it. If there is
no steam water, use Ganlan water in stead.
作甘澜水法：用大盆盛水，以杓扬之，扬久水面起有若干水泡，旁有人执杓逐取之，即甘澜水。
The way of preparing the Ganlan water:
add water in a big basin. Lift the water up with a big spoon
and pour it down. There would have some water bubble on the
basin surface. Another person on the side to collect the
bubble water, which is so called Ganlan water.
若以治温病中，似此证者，不宜用麻黄。宜用西药阿斯匹林一瓦，融化于汤中以代之。若僻处药局无阿斯匹林，又可代以薄荷叶二钱。
If this formula is used to treat Wen
disease with above symptoms, the herb Mahuang is not suit to
use. It should be used the Aspirin one tablet. Dissolve the
aspirin in the soup to drink. If there is no aspirin, use
Bohe (peppermint) leaves 6 gram.
奉天钱姓妇于仲冬得伤寒证，四五日间，喘不能卧，胸中烦闷异常，频频呼唤，欲自开其胸。诊其脉浮洪而长，重按未实，舌苔白浓。知其证虽入阳明，而太阳犹未罢也（胸中属太阳）。此时欲以小青龙汤治喘，则失于热。欲以白虎汤治其烦热，又遗却太阳之病，而喘不能愈。踌躇再三，为拟此方，取汽水轻浮之力，能引石膏上升，以解胸中之烦热。甘草甘缓之性，能逗留石膏不使下趋，以专其上行之力。又少佐以麻黄解散太阳之余邪，兼借以泻肺定喘，而胸中满闷可除也。汤成后，俾徐徐分六次服之。因病在上焦，若顿服，恐药力下趋，则药过病所，而病转不愈也。服至三次，胸间微汗，病顿见愈，服至尽剂，病愈十之八九。再诊其脉，关前犹似浮洪，喘息已平，而从前兼有咳嗽未愈，继用玄参一两，杏仁（去皮）二钱，蒌仁、牛蒡子各三钱，两剂全愈。
Mrs. Qian in Fengtian city got the
Shanghan disease in a winter. For four to five days, she had
severe asthma and could not lie down. She felt annoyed and
agitated in chest, crying again and again to cut open his
chest. Her pulse was floating, waving and long. The pulse
was not sthenic when touch harder. Her tongue covering is
white and thick. It was considered that her condition,
though in the Yangming stage yet, remained somehow in the
Taiyang stage too. If the Xiao Qinglong Tang was to use to
treat the asthma, it was feared too hot the herbs. If the
Baihu Tang was used for the annoyed hot, it was feared to
leave the Xie Qi in the Taiyang. After a long time
consideration, I prescribed her this formula. The air-water,
for its light and floating nature, was used to bring the
Shigao float up to solve the annoying hot in the chest. The
Gancao, for its sweet and buffering nature, can keep the
Shigao not sink down, but focus on the upper part of the
body. The little amount of Mahuang is used to dissolve the
remaining Xie Qi in the Taiyang stage, as well as to deplete
the lung to solve the phlegm, so as to solve the fullness in
the chest. The herbal tea was given six times to drink,
since the disease is localized in the Upper Jiao, to drink
it all together might cause the herbal healing effect tend
down and pass the diseased portion so affect the healing.
After the third drink, her chest felt mild sweat and the
disease was much improved. After fininsh the whole herbal
tea, the condition was improved to about ninty percent. To
touch her pulse, the Chun position felt kind of floating and
waving. The asthma stopped already, only the previous cough
remained. In the followed formula, herb Xuanshen 30 gram,
Xingren 6 gram (peel), Gualuren 9 gram, Niubangzi 9 gram was
used. After two doses, the cough was stopped too.
5．通变大柴胡汤
5. Tongbian Da Chaihu Tang (Tongbian here
means to change, to modify, in Chinese; Da means big one;
Chaihu is the name of a herb).
治伤寒温病，表证未罢，大便已实者。
This formula is used in the Shanghan
disease or Wen disease, in which the surface symptoms have
not been solved, but the stool has turned hard.
柴胡（三钱）
薄荷（三钱）
知母（四钱）
大黄（四钱）
Chaihu 9 gram, Bohe (peppermint) 9
gram, Zhimu 12 gram, Dahuang 12 gram.
此方若治伤寒，以防风易薄荷。
If this formula is used in Shanghan
disease, use herb Fangfeng to replace the Bohe.
《伤寒论》大柴胡汤，治少阳经与阳明府同病之方也。故方中用柴胡以解在经之邪，大黄以下阳明在府之热，方中以此二药为主，其余诸药，可加可减，不过参赞以成功也。然其方宜于伤寒，而以治温病、与表证不在少阳者，又必稍为通变，而后所投皆宜也。
The Da Chaihu Tang in the book
《Shang Han
Lun》treat
the combined Shaoyang and Yangming stages. The herb Chaihu
in the formula is to solve the Xie Qi in the meridian; the
Dahuang, to solve the Hot in the Yangming stage. They are
the main ingredients in the formula. The other herbs can be
modified to make the whole herbs work better. It is more
suit in the Shanghan disease. When used in the treatment of
Wen disease, or if the surface symptoms are not in the
Shaoyang meridian, the formula should be modified somehow.
或问：其表果系少阳证，固宜用柴胡矣。若非少阳证，既加薄荷、防风以散表邪，何须再用柴胡乎？答曰：凡表证未罢，遽用降药下之，恒出两种病证：一为表邪乘虚入里，《伤寒论》所载，下后胸满心下痞硬，下后结胸者是也；一为表邪乘虚入里且下陷，《伤寒论》所谓，下之利不止者是也。此方中用防风、薄荷以散之，所以防邪之内陷，用柴胡以升之，所以防邪之下陷也。
It might be asked: if the surface
symptoms are in the Shaoyang meridian, surely the Chaihu is
needed. If they are not in the Shaoyang meridian, it should
be enough to add Bohe or Fangfeng to expel the surface Xie
Qi, why still needs the herb Chaihu? Answer: to use the
bowel-cleansing herbs before the surface symptoms are not
expelled or solved, there would have two possible results:
first, the surface Xie Qi may penetrate deep inside the
body, as indicated in the book, the person will feel
fullness in the chest, fullness and hard in the upper
abdomen, of has chest-fullness condition, after
bowel-cleansing therapy. Second, the surface Xie sink deep,
as the book said, the person will have continuous diarrhea.
In this formula, use the herb Fangfeng and Bohe to expel the
Xie Qi, to prevent the Xie Qi sink deep, and use the Chaihu
to raise, and to prevent the Xie Qi sink downwards.
一人，年二十余。伤寒六七日，头疼恶寒，心中发热，咳吐粘涎。至暮尤寒热交作，兼眩晕，心中之热亦甚。其脉浮弦，重按有力，大便五日未行。投以此汤，加生石膏六钱、芒硝四钱，下大便二次。上半身微见汗，诸病皆见轻。惟心中犹觉发热，脉象不若从前之浮弦，而重按仍有力。拟投以白虎加人参汤，恐当下后，易作滑泻，遂以生山药代粳米，连服两剂全愈。
A man, 20 years of old, got the
Shanghan disease for six to seven days. He felt headache,
chilly, but hot in the heart, and spit stick saliva.
Especially upon the evening, he would have cold-hot shift
feeling with dizziness and the heart hot feeling became
worse. His pulse was floating and string. It is strong when
touch harder. He did not have bowel movement for five days.
He was given this formula, with addition of Shigao 18 gram,
Mangxiao 12 gram. He had bowel movement twice. He started to
have sweat in the upper half body. Other conditions were
also improved better, only still felt hot in the heart, but
the pulse was not so floating-string, but it felt still
strong when pressed harder. He was given the Baihu jia
Renshen Tang, for fear of slippery diarrhear after the bowel
movement, the herb Shanyao was used to replace the herb
Gengmi. Two continuous herbal tea solved the whole
condition.
6．加味越婢加半夏汤
6. Jiawei Yuebi Jia Banxia Tang
治素患劳嗽，因外感袭肺，而劳嗽益甚，或兼喘逆，痰涎壅滞者。
This formula is used for chronic
cough and again attacked by out-comign Xie Qi again. The
cough become worse, with asthma, or with heavy phlegm.
麻黄（二钱）
锻石膏（三钱，
捣）
生山药（五钱）
寸麦冬（四钱，带心）
清半夏（三钱）
牛蒡子（三钱，炒捣）玄参（三钱）
甘草（一钱五分）
大枣（三枚，擘开）
生姜（三片）
Mahuang 6 gram, Processed Shigao 9
gram (grind), Shanyao 15 gram, Meidong 12 gram (with
kernel), Banxia 9 gram, Niubangzi 9 gram (fry and grind),
Xuanshen 9 gram, Gancao 4.5 gram, Chinese date 3 (chop to
open), fresh ginger 3 pieces.
《伤寒论》有桂枝二越婢一汤，治太阳病发热恶寒，热多寒少。《金匮》有越婢汤，治受风水肿。有越婢加半夏汤，治外感袭肺，致肺中痰火壅滞，胀而作喘。今因其人素患劳嗽，外感之邪与肺中蕴蓄之痰，互相胶漆，壅滞肺窍而劳嗽益甚。故用越婢加半夏汤，以祛外袭之邪，而复加山药、玄参、麦冬，牛蒡子，以治其劳嗽。此内伤外感兼治之方也。
In the book
《Shang Han
Lun》,
there is formula of Guizhi Er Yuebi Yi Tang, for the
treatment of Taiyang disease, in which the person feels hot
and cold, but more hot than cold. In the book
《Jin Kui》,
there is formula Yuebi Tang, which is for Wind-attack
swelling condition. There is also another one: Yuebi Jia
Banxia Tang, to treat the Phlegm-Fire accumulation in the
lung, due to the out-coming Xie Qi invasion, which makes the
lung bloating and causing asthma. Now, for the formula here,
it is used for person who have had chronic cough for a long
time and affected by the Xie Qi invasion now. The Xie Qi is
combined with the accumulated phlegm in the lung, stick each
other, block the lung to cause more cough and severe asthma.
This herbal formula works to expel the invading Xie Qi, with
the addition of Shanyao, Xuanshen, Maidong, and Niubangzi to
solve the chronic cough. This is a formula working for both
inside and outside coming Xie Qi.
一叟，年近七旬。素有劳嗽，初冬宿病发动，又兼受外感，痰涎壅滞胸间，几不能息。剧时昏不知人，身躯后挺。诊其脉，浮数无力。为制此汤，一剂气息通顺，将麻黄、石膏减半，又服数剂而愈。
A man, 70 years of old, had long time
of cough. In a early winter, the old disease recurred,
together with new Xie Qi invasion. The phlegm accumulated in
his chest, so that he almost felt hard to have a breath.
When the condition was severe, he could loss consciousness
with body bends reverse back. His pulse was
floating-frequent and weak. He was given this formula. One
dose made his breath smooth. After reduce Mahuang and Shigao
to half, additional several doses solved the condition.
或问：子尝谓石膏宜生用，不宜熟锻用。以石膏寒凉之中，原兼辛散，锻之则辛散之力，变为收敛，服之转可增病。乃他方中，石膏皆用生者，而此独用锻者何也？答曰：此方所主之病，外感甚轻，原无大热。方中用麻黄以祛肺邪，嫌其性热，故少加石膏佐之。且更取
者，收敛之力，能将肺中痰涎凝结成块，易于吐出。此理从用锻石膏点豆腐者悟出，试之果甚效验。后遇此等证，无论痰涎如何壅盛、如何杜塞，投以此汤，须臾，药力行后，莫不将痰涎结成小块，连连吐出，此皆锻石膏与麻黄并用之效也。若以治寒温大热，则断不可锻。若更多用，则更不可锻也（锻石膏用于此方，且止三钱，自无妨碍。然愚后来志愿，欲全国药局，皆不备锻石膏，后有用此方者，若改用生石膏四钱更佳）。
