Differentiation of Yin–Yang and Prescriptions for Some Special Diseases (Yang Deficiency or Yang Escaping)

Table of contents
  1. Diagnosis and Treatment Analysis
  2. Case Study
  3. List of Prescriptions Used in This Chapter
  4. Possible Reactions to Herbs for Restoring Yang

Diagnosis and Treatment Analysis

The following groups of symptoms describe the dangerous situation of Yuan Qi (vital energy) leaving the body’s foundation, as a result of such serious deterioration of Yang that Yang Qi escapes from the body. Although the symptoms may appear differently, the root cause remains the same. If a doctor can observe carefully and diagnose based on solid evidence and theory, he or she can confidently identify and properly treat the presenting syndrome. Even if the doctor cannot completely cure each and every patient, at least a misdiagnosis will not be made on the patient. However, an illness has numerous causes, and therefore cannot be fully covered in just a few dozen cases. We must determine the presence of excess and deficiency, and the true situation of Yuan Qi. In this way, even if there are thousands of illnesses, there are only a small number of differentiable syndromes.

There is another concept to grasp: the human body has approximately 360 bones, all of which are imbued with Shen ( “Yang spirit”) and Gui (, “Yin spirit”). Shen is the spirit of Yang, the master of Qi; thus, every part of a person is filled with and protected by vital Qi. Gui is the spirit of Yin, the master of Blood; similarly, every part of a person is filled with and protected by true Yin. It is said that both Gui and Shen represent and actually are the fullness of the universe. The universe refers to not only the Earth, the heavens, and beyond (macrocosm), but also the entirety of the human body (microcosm). As Shen is Yang, Fire, and Qi, while Gui is Yin, Water, and Blood, they complement and balance each other. Therefore, we can treat Yin diseases with Yang and treat Yang diseases with Yin. Using the source of Fire to eliminate Yin shade is equivalent to using Fire to control Water. No matter which Gui phenomenon (Yin pathogen) manifests, we can treat Shen (Yang spirit) to achieve a good result. The appropriate herbs are Guizhi (Cinnamon twig), Fuzi, Shengjiang (Fresh ginger), Sharen, etc. . This method is effective no matter which part of the body has been invaded by the pathogenic Qi (here “pathogenic Qi” refers to pathogenic Fire or Wind, etc., not the vital Qi).

The universe is full of vital Qi, which will not harm people. However, pathogenic Qi (e.g. pathogenic Fire) can cause harm, hence the name “pathogenic Shen”). One can use Gui (Yin) to control pathogenic Shen (Yang). As we use Water to control Fire, we can strengthen Yin and reduce Yang. The herbal formulas for this purpose are Sanhuang Shigao Tang (12) and Da Chengqi Tang or Xiao Chengqi Tang (18 or 21). It is imperative to note that many doctors refer to “nourishing Yin and reducing Fire” with the misunderstanding that it is always pathogenic Fire damaging Yin. This is incorrect since there is no real “Yin deficiency.” The so-called “Yin deficiency” is actually Yang deficiency.

We must always remember that Yin and Yang are derived from the same Qi and cannot be separated. The classic book says that “when Qi is strong, Blood is strong; when Qi is deficient, Blood is deficient; as Qi increases, Blood increases; as Qi decreases, Blood decreases; where Qi exists, Blood exists; when Qi dies, Blood also dies.” Understanding this theory, one then should know the origin and fundamentals of the heaven generating water, and that sweet warm and pungent warm elements restore Yang. We can understand the terms “Gui” and “Shen” as an analogy of the Yin and Yang of our body. When one uses medicines based on the theory of Yin and Yang, knowing the key points of pathogenic and vital Qi, and being able to identify and learn from the mistakes of others, one can surpass the mediocre to become a great doctor.

This chapter presents several severe cases and symptoms of Yang deficiency. A brief description of each symptom is given, along with the cause, theory, and treatment of the illness. Some symptoms have been compared with and differentiated from others for clarity. For example, there are nine symptoms of body warmth. First, the body is warm but without Spirit; the patient feels no pain, but feels tired and sleepy, and is neither hungry nor thirsty. This is due to Yuan or Yang Qi (vital energy) leaking from the body, and one must retrieve Yang. However, if one mistakenly treats this condition as if it were an invading external Cold pathogen, it will quickly evolve into a very dangerous situation. Second, hematemesis and body warmth is more likely a deficiency of Qi and a compromised ability to control the Blood, with Yuan or Yang Qi leaving the body. One must restore Yang immediately, instead of attempting to cool the body and reduce Fire. Third, the body becomes very warm after a major expectoration. One should observe if there are three Yang meridians symptoms or extra pathogenic cases present. It is most likely the Yuan Qi of the Spleen and Stomach leaking out. Therefore, the focus must be on retrieving the Yang Qi of the Middle Jiao. Fourth, the body becomes very warm after a major purgation. This is due to Yin leaking downward, while Yang is deficient above. To remedy the situation, one must warm the interior, and retrieve and maintain Yang immediately. If it is mistakenly treated as the invasion of an external pathogen or as a dietary cause, i.e. resolving the exterior or inducing purgation and diuresis, health-threatening results will occur immediately. Fifth, the body feels warm in the afternoon or at night. This is not due to Yin deficiency, as is commonly thought, but is because Yang has become isolated by Yin and must move downward. Such patients may not feel thirsty and have no desire to drink. The condition can usually be resolved by treating with Baitong Tang (54). So it is proven that this is not due to Yin deficiency. Sixth, the feet become so hot in the afternoon or at night that the patient wants to step on cool stone or soak the feet in cool water for relief. He or she also feels tired and sleepy, and is without Spirit. This is also a sign of Yang dying, so one must retrieve and restore Yang immediately. It is not appropriate to nourish Yin at this time. Seventh, both hands swell and become intolerably hot in the afternoon and at night. This occurs because Yin is too strong and is forcing Yang out from the hands. Again, one must retrieve and restore Yang in such a case. Eighth, the exterior of the body is cold but the interior is hot. One needs to be very careful with this case. If the patient is thirsty and wants to drink cold beverages, and also has good Spirit and energy, it could be epidemic infection. However, the patient may feel the internal heat intolerable, but may crave cold beverages and cannot actually drink them, having a dark tongue with a slippery coating, and having neither a good Spirit nor energy, with normal feces and urine. This complicated case is due to excess Yin moisture forcing Yang out, which can be resolved only by restoring Yang, not by nourishing Yin. Finally, in the ninth case, the exterior of the body is very hot but the interior is very cold, and the patient wants several layers of bedding. It is due to Yang jumping to the exterior while Cold becomes isolated in the interior. If Yang is restored immediately, the condition will be cured automatically. It is not a case of an exterior syndrome. However, if this is a strong exterior syndrome of a Yang nature, it can be treated well with a large dose of Yang-restoring formulas, perhaps with added Mahuang (Ephedra) and Guizhi (Cinnamon twigs).

Other cases have their defining characteristics, such as a “splitting headache.” Actual clinical patient experience is described for each case, for the purposes of reference and verification. In the “deficiency and strong pulse” case, the symptoms may seem closer to Yin deficiency, but it is actually Qi deficiency (“shortness of breath, dislike of talking, sensation of bodily heaviness, preference to lie down, feeling clammy and warm but not thirsty, reduced appetite, reduced movement with lack of energy and Spirit”). It is clearly Yang deficiency, with no aspect of either strong Fire pathogen or Yin deficiency.

Unfortunately, many doctors mistakenly diagnose the condition as Yin deficiency, treating with sweet cold herbs to nourish Yin. This could cause death, not from the illness but from the wrong prescription; not due to the herbs but due to the doctor’s mistakes. There are different symptoms in the final summarization of several dozen cases; however, the root cause is the same. Observe the patient carefully, and understand the patient’s health history and presenting symptoms — you will recognize it once you see it, and will not make a mistake in treatment and prescribing medicine. As long as it is Yang deficiency, all the treatments for restoring Yang should be fine. The main consideration is the correct dosage, but it will not deteriorate a pure Yin or lack of Yang syndrome.

At the end, because of the relationship of the human body’s Yin and Yang, Water and Fire, and Blood and Qi, no matter where the Yin pathogen originated, “treat Yin with Yang, as using the source of Fire to eliminate the Yin shade. This is the same as strengthening the South and discharging the North. This is also the same as using Fire to control Water.” The appropriate herbs are Guizhi (Cinnamon twigs), Fuzi (Prepared aconite root), Jiang (Ginger), Sharen, etc. . In the case of a Yang pathogen, we may use Water to treat Fire, nourish Yin, and reduce Fire. The herbal formulas are Sanhuang Shigao Tang (12), Da Chengqi Tang (18), and Xiao Chengqi Tang (21). Also, in the case of the so-called Yin deficiency, it is most likely due to pathogenic Fire harming Yin, not an actual deficiency of Yin. Real Yin deficiency cases are mostly caused by Yang deficiency. When returning to the fundamentals and root causes, we should remember that Yin and Yang are derived from the same Qi; and Qi can control Blood. The famous Dr. Li Dongyuan’s method of “employing sweet warm herbs to reduce Heat” was probably based on this theory.

Case Study

Diagnosis and Treatment for Yin Excess/Yang Deficiency and Yang Escaping

Splitting headache 
Patients with intrinsic Yang deficiency, but without body pain, may sometimes suddenly experience a splitting headache. In most cases they will have blue lips, dark nails, or asthma, or a floating empty pulse or a sunken hard pulse. This is due to Yang being blocked in the Upper Jiao. Emergency treatment is needed to recover Yang.

We can use Qianyang Dan (168) for such patients. One dose can reduce the symptoms; extreme cases may need four or five doses to heal. There is an about 40–50% cure rate when this treatment is applied.
Cleaving pain through the eyes 
Observation of these patients yields neither Exogenous nor Fire pathogens, but the pulse is as described above. If most of the symptoms are the same, the patient’s case must be considered an emergency and treated immediately to recover Yang (like (48) or (168)). It is strictly forbidden to nourish Yin and dissolve Fire. This erroneous treatment may cause patient death.
Unbearable itching of the ear 
If there are no symptoms such as dry mouth and throat or alternating attacks of fever and chills, and in the absence of hepatobiliary disease, this condition is the result of Kidney-Qi rising to and escaping from the ears. There will be a number of Yin symptoms in evidence. It is necessary to expeditiously recover Yang energy.

There was a patient with such a condition who was treated with one dose of Sini Tang (48) plus Silkworm (Jiangcan). The itching sensation stopped and the formula was modified by removing Silkworm and adding Codonopsis (Dangshen), Chinese Wolfberry (Gouqizi), and Cistanche (Roucongrong) to promote the Kidney function. After four or five doses, the patient recovered.
Mirror-like Yintang area 
When a patient has been very ill with long-term weakness and suddenly the Yintang (EXHN 3) area of the forehead appears as shiny as a mirror, Yang exhaustion has occurred and will lead to Overnight Death Syndrome. It is imperative to immediately give a large dose of Sini Tang (48) to recover the patient’s Yang energy. If, over the course of seven days, the reflective quality of the Yintang area dissipates and the patient resumes eating, the Shen may increase to the point where recovery is possible. If appropriate emergency treatment is not given, there is little chance of survival.
Deep-red lips 
If a patient is suffering from a long-term illness with no Fire symptoms, and yet suddenly the lips become deep-red like cinnabar, an emergency situation exists. This is Real-Yang escaping from the lips and Overnight Death Syndrome will ensue without intervention. The appropriate treatment is at least one dose of Sini Tang (48) to recover Yang Qi. In spite of emergency treatment, the survival rate is about 20–30%.
Bright-red cheeks (malar redness, )
When bilateral malar redness occurs in patients who suffer from a long-term illness or are enduring Yang deficiency, it is a sign of Yang Qi exhaustion. Emergency treatment must focus on recovery of Yang (like Sini Tang (48)). Any other treatment is inadvisable, as it may lead to death.
Sudden-onset severe rhinorrhea 
If a patient suffers from a severe long-term illness causing extreme weakness and suddenly experiences an unusually runny nose, this is an indication of impending death. This syndrome features a sharp decline in the remaining strength, followed by death. If an emergency treatment is applied with the purpose of recovering Yang Qi, about 10–20% of the patients may be healed.

We had such a case and, because this sudden-onset syndrome manifested with no hint of exogenous disease, we used Sini Tang (48) plus Rougui (Cinnamon). This treatment helped reduce the rhinorrhea. However, because of the extreme weakness associated with the long-term nature of the illness, the patient needed 20 doses of Fuzi Lizhong Tang (95) with additional herbs. After 20 doses, he recovered.
Mouth agape with exhalation 
In cases of severe, long-term illness with extreme weakness where the mouth suddenly opens and the breath escapes, it is necessary to quickly give a dose of Sini Tang (48) to recover Yang. This is an example of Yang Qi exhaustion leading to Overnight Death Syndrome. It is of utmost importance to work quickly and persevere to increase the patient’s chances of survival.
Loss of eyelid control 
When a patient is close to death, his or her eyelids may no longer respond as in normal health and shrink down deeply. This is an indication that the strength of Yang Qi has left the five viscera. Most patients will die overnight; however, if a large dose of Sini Tang (48) is administered, Yang may be recovered in about 10–20% of the cases.
Color change of the sclera 
After a long illness, the sudden change of a patient’s sclera to a dark-blue color indicates Yang exhaustion and approaching death. It is advised to recover Yang Qi immediately. If treatment is applied, 50–60% of the cases may be restored to health.
Sudden severe swelling of the eyes 
A patient who has been ill for a long time or who has intrinsic deficiencies may suddenly experience severe swelling of the eyes accompanied by Yin-Qi filling the whole body, and yet no indication of the presence of extra-pathogens, like wind cold or heat. This is an emergency situation: Essence Qi is leaving the body through the eyes. It is urgently advised to recover Yang so that the patient will be safe.
The eyes staring straight ahead 
In cases of patients with severe long-term illnesses that have rendered them very weak, the sudden manifestation of uncontrolled staring eyes is a sign of the extinguishing of genuine Qi. Although this is usually a sign of impending death, if quick action is taken it is possible to recover Yang Qi.

We recommend treating this condition with Bai Tong Tang (54) with added Evodia (Wuzhuyu), yielding good results; about 10–20% of the patients may experience healing.
Visual hallucination: Multicolored lights 
If a patient who has suffered intrinsic weakness or an enduring illness has visual hallucination of multicolored lights, it is a sign that the Qi of the five viscera is escaping the body. Yang will also begin to dissipate, so death is a strong possibility. It is important to act quickly to recover Yang Qi.

We have treated this condition using Sini Tang (48) with added Cinnamon (Guizhi). Typically, the success rate is about 50–60%.
Lustrous complexion 
Another sign of Overnight Death Syndrome can be the sudden transformation of the face of a patient suffering from a longstanding wasting disease. If the complexion changes to a healthy looking brightness, as that of a disease-free person, genuine Yang is, in fact, leaving the body and has “dried” on to the face. To provide the best chance of recuperation at this point, it is necessary to recover Yang Qi. If the patient’s complexion and Spirit improve slightly and experience no reversal or deterioration over the following seven days, then the chance of survival increases.
Skeletal facial appearance 
This dire development may occur suddenly, prior to death, in patients who have been very sick or debilitated. A skeletal facial appearance indicates the extinguishing of Yang and the onset of Overnight Death Syndrome. Although this is a most serious situation, there is a 10–20% recovery rate with quick intervention. Appropriate treatment involves drinking a dose of Sini Tang (48).
Change of complexion color 
Colors of note include deep-red (like cinnabar), paper-white, black like coal, or the greenish shade of withered grass.

If one encounters a patient suffering from longstanding illness whose face suddenly turns deep-red, and yet has no signs of pathogenic Fire, Yang has been extinguished. There is a 10–20% chance of revival if Yang can be recovered as quickly as possible.

However, if the situation has gotten worse to the point where the complexion is red like stagnated blood, or is white, black, or green, the opportunity to treat the patient has passed. There is no chance of healing, and further treatment should not be administered.
Bleeding teeth 
A patient with intrinsic Yang deficiency (i.e. exhibiting Yin syndromes with no pathogenic Fire symptoms) may experience sudden issuing of blood from all the teeth. This is a manifestation of intrinsic Kidney-Yang deficiency with Yin-Blood spillover, leading to the loss of control of Blood.

The only way to correct this situation is to recover Yang Qi. It will be a deadly error to promote Yin by the use of Liuwei Dihuang Tang.

We recommend treating this condition with large doses of Paojiang Tang (Decoction of Blast-Fried Ginger Gancao (42)) to stop the bleeding, followed by Sini Tang (48) with added Kidney-healing herbs. This protocol typically works well.
Severe swelling and discoloration of the gums 
Where a patient suffers from severe intrinsic Yang deficiency and resultant Yin syndromes abound in the absence of Stomach Fire and Wind-Heat pathogenic factors, sudden extreme swelling and darkening of the gums to an eggplant color can occur. Yang Qi is leaving the body.

Urgent treatment is required to recover Yang Qi and settle it within the body. It is incorrect and irresponsible to risk the patient’s life by promoting Yin and reducing Heat.

We have successfully treated patients suffering from gum swelling and pain and multiple Yin syndromes with Qian Yang Dan (Submerge the Yang Pellets 168).
Painless swelling of the ear 
Should a patient experience swelling of the ear that is without pain but accompanied by a change in skin color (reddish to bluish), an extreme imbalance of Yin and Yang is occurring. Yang Qi is drastically reduced and the relative excess of Yin manifests as multiple Yin syndromes.

Such cases must be carefully reviewed to avoid misdiagnosis (i.e. this is neither Liver and Gall Bladder Wind-Heat nor an exogenous syndrome) and improper treatment. The only hope for successful treatment of the patient is to recover Yang.
Pharyngitis and preference for hot water 
Sometimes an ill patient who has a sore throat likes to drink hot water. This person has no spirit in his or her voice or pulse, and yet is not afflicted with Wind-Heat. Although the symptoms may lead one to diagnose a Yin syndrome, this is not the case. Actually, Yang Qi is floating upward and must not only be restrained but guided back to its source. Strong Yang herbs are decocted to recover Yang Qi.

If one follows the incorrect path of treating Wind-Heat pathogens, the patient’s health may be further endangered.
Incessant coughing 
If a patient has had a long-term illness or suffers from intrinsic weakness or has taken too many cool and dispersing herbs, a sudden abnormal cough may occur. The cough will be unremitting and will occur in conjunction with multiple Yin syndromes. This is the manifestation of Yin pathogens disturbing the upper meridians while Essence-Yang is dissipating from the Lungs.

It is of paramount importance to realize the true nature of this disease and treat it accordingly: flagging Yang must be restored and Yin reduced. If Yang is strong and Yin relatively reduced, the coughing will stop immediately. However, misdiagnosis and incorrect treatment (i.e. with Yin-promoting formulas and herbs typically used for coughing) will eliminate any chance of recovery.

We have treated this disease with large doses of Sini Tang (48) supplemented with Mahuang (Ephedra), Guizhi (Cinnamon Twig), Xixin (Asarum), Fuzi (Aconite), and Ganjiang (Dried Ginger). Substantial amounts of the extra herb are sometimes added.
Asthma with cyanosis of the lips 
Another serious situation occurs when a patient with either long-term illness or intrinsic weakness experiences a sudden attack of asthma with blue lips. This is a sign that Yang is floating to the surface of the body and death is imminent. Although the condition is indeed very dangerous and difficult to heal, an urgent appropriate treatment can recover Yang and seal it in the body. Signs that the healing process is underway include the ebbing of asthmatic symptoms, the return of a healthy reddish lip color, and the exhalation of a sigh of vitality.

We have successfully treated this disease with large doses of Qian Yang Dan (168). In addition to the technical aspect of choosing the correct formula, it is also important to engender a trusting relationship with the patient as it can have an impact on the outcome.
Sudden onset of heartburn or heart pain 
The sudden onset of serious Heart pain or heartburn that is accompanied by a red face or cyanotic lips should prompt a doctor to carefully determine whether the disease is of a Yin or Yang nature.

In cases where there is Heart pain and a red face, and drinking cold water produces some sensation of relief, the diagnosis is Heat evil invading the Heart and the condition is treated by clearing the Fire.

If the face is red but the lips and tongue are bluish and the person prefers to drink hot water, then the diagnosis is Cold evil invading the Heart. In this case, Yang Qi must urgently be recovered. We have had success in treating this type of illness with Wuyu Sini Tang (85) with added Yuanhusuo (Corydalis).
Sudden, severe abdominal pain 
When patients experience any serious abdominal pain, syndromes affecting every part of the body should be carefully evaluated.

If there is cyanosis of the lips and tongue, this is Cold stagnation and Yang cannot move freely. Yang must be recovered urgently.

In cases where the tongue is yellow and yet the whole body is cold and the patient is breathing heavily and neither urine nor stools can pass, Heat pathogen is within the body and has blocked the meridians. In this emergency situation, pathogenic Heat must be dispersed and stagnation removed. Wanying Lingtong Wan (also known as Duijin Pills, Lingbao Wishful Pills, or Chuangdu Puji Pills) is used; the pills are crushed to a fine powder with half of the dosage dispersed onto the patient’s nasal mucosa and the other half dissolved in water to be swallowed by the patient. Absorption through the nasal mucosa should bring immediate relief; drinking the beverage will heighten the effects.
Borborygmus accompanied by diarrhea 
The presence of borborygmus and continuous diarrhea in a patient with chronic illness or intrinsic weakness is a sign of Kidney-Yang Qi exhaustion with extreme internal Cold. It is necessary to recover Yang as soon as possible. The use of diuretic herbs will not be effective in such cases.

We have had positive experiences in using large doses of Sini Tang (48) with added Rougui (Cinnamon Bark) to boost the Mingmen fire, along with Fuzi (Aconite) and Ganjiang (Dried Ginger). A large amount of Fuzi and Ganjiang can be safely and successfully added.
Sudden onset of hemafecia 
A patient with intrinsic weakness or chronic illness may experience the sudden onset of blood in the stools that will not cease. This is a dire condition where there is no Fire in the Lower Jiao and blood is moving recklessly and exiting the body. It is imperative to intervene by recovering Yang with formulas such as Fuzi Lizhong Tang (95) or Hui Yang Decoction (64).

We have successfully treated cases involving the reckless movement of blood (i.e. blood in the stools, urine or vomit, and nosebleeds), if there are enough Yin syndromes, with this type of Yang-supporting formula.
As with the treatment of hemafecia above, we have had excellent results in treating hematuria. It is important to determine that there are no Heat pathogens present and to focus on recovering Yang.
If a patient has intrinsic weakness or an unusually high libido, spontaneous seminal emission may occur. Both of these predisposing conditions consume Yang Essence, causing uncontrolled ejaculation. The correct treatment for this critical situation is to recover Yang Qi and promote communication between Fire (Heart) and Water (Kidney).

The most successful treatment in our experience is large doses of Bai Tong Tang (54). In addition, our patients who experienced spermatorrhea after urination were returned to good health by using Bai Tong Tang and a suitable Kidney tonic.
Red face in the afternoon 
If a patient’s face appears red in the afternoon or there is afternoon fever, it would be easy to say that the person is Yin-deficient.

However, it is imperative to explore the situation further. It may be the case that the patient suffers from a chronic illness or an intrinsic weakness; Yang energy may be dissipated and can no longer receive or control Yin. It is also possible that Yin pathogens are present or that Yang is no longer anchored and is floating to the exterior. If the afternoon is Yin-dominated and Yang is weaker, Yin can overpower Yang and force it away. Therefore, the Yin spirit rises rather than falls and the face reddens or fever develops. These are all syndromes of strong Yin. If this condition is treated as a Yin deficiency, the disease will flourish and the patient’s health will deteriorate.

The appropriate treatment involves recovering Yang to balance it with Yin, thus allowing Qi to travel up and down the body harmoniously. Our patients have recuperated with Bai Tong Tang (54).
Extreme pruritus of the whole body 
A sudden onset of generalized pruritus or small rubella-like spots may occur in a person suffering from chronic disease or intrinsic weakness. Rubella can be ruled out because this itching is extreme and there will be no fever, body pain, or aversion to Wind or Cold. If any fever is present, the patient’s urine will remain clear, he or she will be thirsty for hot water, and Yin syndromes will be present. The pulse will be floating, empty, or tight like a rope.

One must not mistake the symptoms for rubella, otherwise it will hasten death. The most important emergency treatment in this situation should be large doses of formulas that recover Yang.

In the case of an elderly patient who is experiencing itching due to blood deficiency, effective treatment involves using a formula to promote Yang, increase blood, and expel Wind-Heat pathogens.
Should there be a sudden onset of continuous excessive sweating in a patient with intrinsic weakness or who suffers from a chronic disease, the patient is experiencing Yang exhaustion. However, there are cases of sudden attacks of sweating that stop after a few minutes. This is not Yang exhaustion but the purging of Yin pathogens through the pores — a syndrome of healing.

If a patient is dying and the body temperature is dropping, he or she could indeed be suffering from Yang exhaustion. If this is the case, there may be a possibility of reviving the patient by administering a formula to recover Yang.

It is important to differentiate the pattern. If Yangming Heat is steaming from the body, there will also be excessive sweating and Yang-based syndromes. Baihu Tang (White Tiger Decoction (55)) is appropriate in this case.

In our experience, we have observed Yin syndromes. Some patients have had a Yang deficiency sweating disease of exogenous origin; we administered Guizhi Tang (Cinnamon Twig Decoction (118)), Huangqi Jianzhong Tang (Astragalus Build-the-Center Decoction (146)), and Fuzi Lizhong Tang (Aconite, Ginseng, and Ginger Decoction (95)) with added herbs.
Simultaneous diaphoresis and hiccoughs 
If a patient who has a chronic illness or intrinsic weakness, or who has taken too many herbs of a cool nature, suddenly experiences sweating and hiccoughs at the same time, it is another manifestation of Yang leaving the body. Qi of both the Spleen and the Kidney is exhausted and Overnight Death Syndrome will occur. Therefore, it is urgently advised to recover Yang.

After medication, if both the sweating and the hiccoughing stop, there is a chance for the patient’s recovery. However, it is of the utmost importance to avoid any formula that contains Mahuanggen (Ephedra Root), Fuxiaomai (Floating Wheat), Dingxiang (Cloves), Shidi (Persimmon Calyx), or other similar astringent herbs, as this will drastically worsen the condition and lead to the patient’s death.
Fever without spirit 
For a patient with a chronic illness, intrinsic weakness, or the tendency to spend an inordinate amount of energy thinking, high fever is a dangerous signal. If the fever is accompanied by fatigue, lack of Spirit, thirst and appetite, but with no pain or suffering, it indicates the escape of Yang from the body. It is very important to discern that the fever is not exogenous; if it is treated as such, the patient will further deteriorate. One dose of a formula to recover Yang Qi should be sufficient to recover Yang and set the patient on the path to health.
Hematemesis accompanied by fever 
When a person vomits blood, he or she is also vomiting Qi. As the level of Qi declines, it will be more difficult to build new blood. Although with the loss of blood and Qi there is also an increase in body heat, this situation must not be confused with the presence of Heat or Fire pathogens and treated with cool formulas. Therefore, the correct procedure is to recover Yang.
Severe vomiting accompanied by fever 
The Classics of Chinese medicine say that “vomiting will cause Yang exhaustion” and that “vomiting belongs to the Taiyin Meridian.” Typically, severe vomiting indicates Stomach and Spleen Cold or Heat, or food stagnation. If, after vomiting, a fever occurs and is felt throughout the body, and yet there are no exogenous syndromes in the three Yang meridians, it is very likely that Stomach-Yang and Spleen-Yang are escaping the body. This emergency situation requires treatment to restore Yang to the Stomach and Spleen. It is imperative not to use a formula such as Huoxiang Zhengqi San (Powder of Agastache Correcting Qi).

We have successfully treated such patients with Gancao Ganjiang Tang (Licorice and Ginger Decoction (42)) with added Sharen (Cardamom, Fructus Amomi).
Severe diarrhea with fever 
A sudden onset of severe diarrhea and a gradual onset of a high fever in a patient with intrinsic weakness or a chronic disorder is an emergency situation that must be carefully and correctly diagnosed. It is imperative to see the illness for what it is: Yang Qi exiting the body. The high fever indicates a drying of Yang energy, while severe diarrhea shows an underlying exhaustion of Yin. Appropriate treatment involves warming the Middle and restoring Yang.

It is incorrect and possibly fatal to diagnose and treat the fever as if it were due to an exogenous pathogen, and the diarrhea as if it were due to a dietary issue. Actions such as releasing the exterior or improving digestion and the flow of urine incorrectly address the situation and will have disastrous results for the patient.
Afternoon fever 
Again, we can refer to the Classics of Chinese medicine: “Yin deficiency grows inner Heat.” That is to say, strong Heat pathogens cause blood shortages; it is not stating that there is a causal relationship between Yin deficiency and afternoon or night fever.

Unfortunately, we have often strayed from the understanding of our Chinese medicine pioneers. It is imperative to recognize and correctly interpret the signs of the waxing and waning of Yin and Yang as the most important information. A contemporary practitioner may identify the afternoon or night fever or Heat as Yin deficiency and treat it by promoting water. In fact, the practitioner sees the afternoon as Yin without grasping the concept that this time is Yin-dominated, not Yin deficient. Fever, typically caused by disproportionately strong Yin which drives out Yang, is the result of Yang floating to the surface of the body in the form of Heat. The Yang element of one’s genuine Qi is launched from Zi time period, the hour of midnight, and grows as time moves through the Earthly Branches of Chou, Yin, Mao, Chen, and Si until it reaches Wu (noon). As Qi continues to cycle past Wu and through Wei, Shen, You, Xu, and Hai, Yang declines and is stored within. If Yang were blocked by Yin, its attempt to run its normal afternoon and evening phase of decline and inner storage would result in Yang energy floating to the surface as Heat. This key concept of the interrelationship of Yin and Yang is vital to the understanding of Chinese medicine.

We have repeatedly successfully treated the afternoon or night fever or Heat, regardless of accompanying symptoms such as a red face, red lips, a desire to drink hot water, and an empty pulse of lack of Spirit, with Bai Tong Tang (White Penetrating Decoction (54)).
Superficial bleeding 
Should superficial bleeding suddenly occur in a much-debilitated patient, it is due to Yang migrating to the outside of the body to bolster insufficient defense. This is an emergency situation that must be remedied as quickly as possible by recovering Yang Qi.
Retraction of the scrotum into the body 
A chronically ill or intrinsically weak patient may develop an emergency situation involving sudden abdominal pain and the retraction of the scrotum into the body. This is due to excess Yin Cold in the Jueyin (Liver) Meridian and a critical reduction in Yang Qi.

Appropriate treatment recovers Yang Qi. One way is to burn moxa (Ai Ye, Artemisiae Argyi folium) over the Dantian (Guanyuan, RN 4) or umbilicus (Shenque, RN 8). Another method, suitable for practitioners who cultivate their Qi by meditation, puts Hu Jiao (black pepper) powder wrapped in the patient’s umbilicus, and then, with focused healing intention, blows into the belly area until the pain is released.
Burning sensation in the feet 
A patient who has an intrinsic weakness or long-term illness may be overcome by a sudden extreme burning sensation in the feet in the afternoon or when he or she is lying down at night. The patient is typically fatigued and without Spirit. This is Essence Qi escaping through the feet, and Yang is being depleted. The correct procedure is to urgently arrest and recover Yang Qi. It is dangerous to misdiagnose the situation as Yin deficiency. Do not use formulas to promote Yin.
Unbearable heat and swelling of the hands 
A debilitated patient’s hands may suddenly swell, acquire a reddish appearance, and become unbearably hot in the afternoon or at night. This is due to disproportionately strong Yin driving Yang out through the hands. It is advised to urgently recover Yang Qi.

We have successfully treated such cases with Guizhi Longmu Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell (119)) with added Fuzi.
Sudden swelling of the breasts 
Should a chronically ill or intrinsically weak patient experience sudden swelling of both breasts with no change in skin color, it is an indication that Yang Qi is exiting the body through the breasts. The patient must be treated to recover Yang Qi. It is incorrect to treat the patient as if the disease were due to a sore or ulcer.
Non-convergence of wound edges 
If wounds or sores continue to lie open rather than contract properly, it is a sign that the patient’s vitality Qi is injured and the body is not capable of detoxification and recuperation. Yang Qi must be recovered so that energy will return to the body and promote the healing process of toxin elimination and wound convergence. It is important to take a holistic view of the patient (i.e. do not focus solely on the sores and treat them; understand the patterns at play) and to avoid the use of cool herbs that promote Yin.

In our experience, patients have been successfully treated using Fuzi Lizhong Tang (95) and Ivory Powder Steaming Eggs. If both formulas are taken twice daily and the former is also applied topically to the wound edges, the rate of healing is dramatically increased.
Pox collapse 
When poxes collapse, it is due to a lack of Essence-Fire. This condition can be resolved by administering large doses of Yang Qi nourishing yang formulas. It is inappropriate to include herbs that nourish Yin.
Non-retracting rectal prolapse 
A prolapsed rectum that no longer retracts may occur in a person with chronic illness or intrinsic weakness, or who has suffered severe diarrhea or a bout of dysentery. The lack of Essence-Fire is the reason for the inability to retract the prolapsed rectum. The correct treatment is to recover Yang and restore Kidney-Qi.

Applying moxibustion to Baihui (DU 20), the main point for prolapse, is an excellent remedy. In treating this illness, we have often used Fuzi Lizhong Tang (95) with added Shengma (Cimicifuga rhizome) and Yingsuke (Opium Poppy Husk). Another excellent formula is Buzhong Yiqi Tang (88) modified by using a doubled amount of Shengma and adding Yingsuke. A high cure rate has been noted with this formula.

Cases in which women suffer uterine prolapse, post-partum weakness, and loose muscles or diminished Qi can all be treated similarly. Even if the prolapse is severe, it can be treated successfully using the methods described in the preceding paragraph.
Persistent enuresis 
Debilitated patients may experience a sudden onset of persistent enuresis. This can involve voiding large quantities of clear urine dozens of times a day. Again, flagging Essence-Fire is the basis of the affliction; Yang must be recovered and Kidney-Qi restored. The majority of patients who experience persistent enuresis are elderly with Cold in the Kidney and Bladder which disables the proper opening and closing of the Bladder.

We have demonstrated successful treatment of this illness by using Fuzi Lizhong Tang (95) with added Guizhi (Cinnamon Twig), Xiaohuixiang (Fennel Fruit), and Yizhiren (Black Cardamom). Of course, it is inadvisable to use diuretic herbs.
Abdominal pain and persistent diarrhea 
Lower abdominal pain followed immediately by diarrhea may occur in a person suffering from chronic illness or intrinsic weakness. The patient will defecate many times a day and the stools may vary in quality. This dangerous condition is due to declining Fire in the Lower Jiao along with Cold and Qi stagnation. It must be addressed urgently by warming the Middle and rescuing Yang Qi. It is not advised to dredge Qi or use anti-diarrhea herbs.
Body pain without fever 
If a debilitated patient suddenly experiences body pain but no fever, it is due to the presence of Cold within. The correct treatment involves warming the interior with herbs. If, after using the warming herbs, the pain recurs and is accompanied by a high fever, it is actually a sign of healing: the Yin pathogen has been overcome and scattered. It is important not to tamper with the process by rushing to use cooling herbs to stop the pain.
Fever without pain 
A chronically debilitated patient who takes too many herbs that reduce or dredge energy may suddenly experience excessive body heat but no pain or suffering. Although it may seem that a Yin syndrome is the cause, it is actually Yang escaping from the body. It is vital to recover Yang Qi as quickly as possible. Yin should not be promoted, nor should the Qi be diffused.
Cold in the exterior and heat in the interior 
Patients with severe long-term illnesses that have rendered them very weak may experience an unbearable feeling of heat within, and yet their skin may feel cold. They may drink cool beverages but it will not bring relief. Accompanying symptoms are a cyanotic tongue, a depressed Spirit, and uncontrolled urination and defecation. This is surging Yin, which should be treated by restoring Yang so as to arrest and prevent the further surging of Yin (i.e. bring balance to Yin and Yang). To restore Yang, in this case, large doses of Yang-supporting herbs must be used.

If the syndrome of cool exterior and interior heat is due to infectious epidemic disease, the patient will still possess a lively Spirit and will be thirsty for cold beverages but will neither urinate nor defecate easily. In this case, purgation is advised. It would be dangerous to promote Yang.
Heat in the exterior and cold in the interior 
In contrast to the previous case, a debilitated patient may suddenly feel very cold inside and may want to have more blankets, and yet his or her skin will still feel hot. This is a case of Yang escaping from the body with Cold trapped within. It should be treated by urgently recovering Yang. Once Yang is restored, the interior will no longer feel cold and the exterior will no longer feel hot.

It is imperative not to misdiagnose this case as exogenous infection. Treating as such causes immediate suppression of Essence energy, and will be fatal. While there are usually no exogenous syndromes, should one happen to be within the Taiyang (Bladder, Small Intestine) Meridian, the patient should still use large doses of Yang herbs with added Guizhi (Cinnamon twig) and Mahuang (Ephedra) to ensure recuperation.
Sensation of bodily heaviness with aversion to cold 
An imbalance of Yin and Yang (i.e. Yin is strong and Yang is weak) can impart a sudden feeling of bodily heaviness and a strong aversion to cold in a chronically ill patient. It is necessary to treat this emergency situation by recovering Yang Qi.
Stiffness and impaired mobility 
A sudden onset of stiffness and impaired mobility is a serious situation for a patient with a long-term illness or intrinsic weakness. It is due to an imbalance of Yin and Yang. Yin is disproportionately strong and has blocked the meridians. At the same time, Yang energy is extremely weak, so much so that the Mind is unable to control the body. Appropriate treatment involves large doses of formulas that recover Yang Qi. Once Yang has been fortified and Yin reduced, healthy Qi will be recharged and the syndrome will heal automatically.

If a doctor mistakes the condition for Wind-Stroke and uses Wind-expelling herbs, the patient’s condition will be further compromised.
Sensations of lightness in the feet and heaviness in the head 
These peculiar sensations may suddenly come over a debilitated patient and are due to Yin taking over the head while Yang has declined within. Large doses of formulas to recover Yang and gather genuine Qi are urgently needed. When Yang is once again strong and Yin reduced, the feeling of heaviness in the head will be gone and the patient’s health will improve.
Foot numbness and bodily weakness 
Patients suffering from chronic illness or having intrinsic weakness are susceptible to experiencing simultaneous numbness of the feet and bodily weakness. As Yang tends to be depleted in chronic illness, it is not surprising that Yang may be so deficient as to no longer be able to fill the whole body. Thus, it is necessary to promote Yang with sweet and warm herbs. Once Yang is again sufficient, this syndrome will automatically heal.

We have had excellent results using Fuzi Lizhong Tang (95) with added Niuxi (Achyranthes root).
Asthma accompanied by a strong pulse 
For a patient with a chronic illness to suddenly experience asthma accompanied by a strong pulse is a very serious situation. This is exhausted Yang in the upper, and Overnight Death Syndrome usually occurs. Even the best emergency treatment may only yield a 10–20% survival rate. The appropriate treatment is to recover Yang; Yang-boosting formulas may help. It is also necessary to speak frankly and compassionately with the patient and the patient’s family so as to avoid enmity.

A doctor must not misinterpret the patient’s strong pulse as an excess of Fire and use treatment to promote Yin and reduce Fire.
Hematemesis accompanied by a strong pulse 
When a patient is vomiting blood but has a full pulse, it is a condition of exhausted Yang in the upper and the syndrome of death.

It is imperative to understand that hematemesis and a full pulse are not always indicative of the presence of Fire. One must be familiar with the workings of Yin and Yang to avoid this mistake.
Extreme weakness with a tremulous pulse 
The typical pulse for a much debilitated patient is deep and small. Other pulses, such as, a tremulous, full or strong, fast, wiry or ropy, tight, “bird-pecking,” “kettle boiling,” or stone pulse, show the death syndrome. It is advisable not to give any herbal treatment. However, if pressed, one may attempt using a formula with strongly warming and bitter herbs to promote Yang. If the pulse becomes peaceful, there is hope for the patient’s survival. It is of the utmost importance not to promote Yin.

It must be emphasized that very weak patients are mostly Qi-deficient. Although their syndromes may appear similar to Yin deficiency, they are, in fact, Qi deficiency. We have seen debilitated patients with little energy or inclination to speak, experiencing bodily heaviness and only wanting to lie down, having hot flashes with no thirst, greatly reduced appetite, and an almost complete lack of Spirit — this is obviously Yang deficiency, without a single indication of Fire or of Yin deficiency. Unfortunately, this critical condition is often diagnosed, by current convention, as Yin deficiency. Diaphoretic and cold herbs to nourish Yin are given; very few doctors seem to use the bitter and warm herbs to nourish Yang. Nourishing Yin is improper treatment and some patients will become weaker still and the vast majority will die. Thus, death is not caused by the disease but the formula, and at the hands of doctors who cannot distinguish Yin from Yang. We sincerely hope that this trend will be halted and that practitioners of Chinese medicine can return to the basics and do their utmost to compassionately and astutely promote health and wholeness.

Diagnosis and Treatment for Extreme Pathogenic Heat Causing Blood Injury

Qualified TCM doctors must truly understand and distinguish between Yang deficiency and Yin deficiency. It is necessary to have a solid and deep comprehension of the principles of Chinese medicine in order to correctly interpret the various manifestations of these two diseases.

We wish to broaden the perspective and deepen the understanding of Chinese medicine students and doctors so that they can correctly and reliably differentiate syndromes in accordance with the principles of Yin and Yang, and then choose the most appropriate prescriptions to treat them. Two dozen examples are provided below to bolster understanding of these healing principles.

These 24 cases are concerned with conditions of Blood injured by strong Heat pathogens. They are all Yang diseases with pathogenic Fire. Each section summarizes the main points and gives brief, easy-to-follow methods of treatment. Although some cases, such as “Dazed Unconsciousness” and “Ice-cold Body with the Appearance of Death,” may be somewhat difficult to grasp, they are indeed syndromes of deep Heat caused by deep Cold or false Cold. Without extensive experience, it may be difficult to identify these conditions. However, such Fire-based Yang syndromes should only clear Heat and save Yin.

For each specific segment, we provide examples of the appropriate pairing of diagnosis, treatment method, and herbs, with explanations. For example, diaphoretic and cold herbs, such as those in Daochi San (Lead Out the Red Powder (73)), which cultivates Yin with sweet and cold herbs; as in Large and Small Chengqi Tang (18 or 21) formulas, are purgative with bitter and cold herbs to maintain Yin; Baihu Tang (White Tiger Decoction (55)) with Renshen (Ginseng) has light and cooler herbs to clear heat and promote Yin; Liuwei Dihuang Tang (Rehmannia Six Decoction (35)) and Si Ling San (47) plus E Jiao Huashi Tang (Ass Hide Glue and Talc Decoction) remove dampness to cultivate Yin; herbs that moisten dryness and rescue Yin are included in formulas such as Huanglian E Jiao Tang (Coptis and Ass Hide Gelatin Decoction (147)) and Shaoyao Gancao Tang (Peony and Licorice Decoction (74)); and formulas containing diaphoretic and warming herbs promote Yang and rescue Yin.

Finally, the differences between the pathogenic Fire of Yang syndromes and the Fire of Yin upsurge syndromes will be delineated. The distinguishing factors are to be found in the quality of the patients’ Spirit, pulse, and respiration, and in paying close attention to their preferences and even how they sound. To understand whether a patient is “with or without Spirit,” it is necessary to observe and interpret the strength or weakness of the vital energy.

If one masters these essential methods, it is possible to distinguish Yin syndromes from Yang syndromes, thus dispelling any mystery and providing a clear path ahead for promoting health and well-being.
Continued retching 
If a patient has been sick for two or three days and has a fever but the pulse, breath, and voice all have a liveliness of Spirit, any continued retching is a sign that Heat is obstructing the Yangming (Stomach) Meridians. It should be treated by expelling the pathogen from the muscles and clearing Heat.
Delirium with open eyes (delirious speech, )
A patient who has been sick for four or five days with fever and has an aversion to warmth along with a strong pulse, periodic delirious speech, restlessness and irritability, and complete insomnia where the eyes remain open all night is suffering an upsurge in pathogenic Heat. As the Qi rises, sleep is not possible and the patient will be on the verge of delirious speech. As the pathogenic Heat begins to affect the Heart, the patient may lapse into unconsciousness. Treatment should first aim at clearing Heat. As Heat is reduced, healthy Qi is restored and the wild-eyed delirium will resolve automatically.

Should delirious speech occur with closed eyes and an empty, spiritless pulse, one should recover Yang without promoting Yin.
Thirst and continuous drinking of cold beverages 
If a patient has been sick for six or seven days with a persistent fever and a full pulse and also continuously drinks cold beverages, this is an indication of the presence of pathogenic Heat. This pathogen is excessive and is harming body fluid. Therefore, the treatment must extinguish this Fire evil and preserve Yin.
Extreme diaphoresis 
Fever and drenching perspiration that occurs in a patient who has been sick for six or seven days, along with a strong pulse, halitosis, a loud clear voice, and thirst with a desire for cold drinks, is due to pathogenic Heat steaming in the interior. Very strong pathogenic Stomach Fire is also present. The treatment must urgently eliminate muscle Heat. This is an excess Yang syndrome and is not due to a long illness with depleted Yang.
Irritability and restlessness accompanied by a dry yellow tongue coating 
If a patient has been ill for seven or eight days with a persistent fever and a dry yellow tongue coating as well as irritability and restlessness, a strong pulse, and a sensation of bodily lightness except for a feeling of fullness in the Middle Jiao, he or she is considered to be suffering from excess Stomach Fire. This causes the drying of Body Fluid. To remedy this emergency case, a treatment should be applied to promote Yin and cause purgation.
Wild shouting with other antisocial behavior 
Patients who have been sick with fever for eight or nine days may have coarse breath, and a strong pulse but a sensation of bodily lightness, and may begin shouting, ignoring people, discarding their clothing, and running about. Excess pathogenic Fire has caused the patients to lose control of their mental faculties and behavior. Cool and purgative herbs should be used to extinguish the pathogenic Fire without delay.
Difficult urination and defecation 
If a patient has been sick for seven or eight days, is feverish and has an aversion to warmth, restlessness and irritability, thirst for cold drinks, a sensation of bodily lightness, a strong pulse, and difficulty in urinating and defecating, pathogenic Heat is harming Yin. Therefore, Blood cannot nourish the excretory pathways, resulting in difficult urination and defecation. The entire body is at risk of being overwhelmed by pathogenic Fire. Urgent treatment consisting of purgative herbs must be administered.
Darkened nose 
When a patient has been sick for eight or nine days with persistent fever, irritability, thirst for cold drinks, a sensation of fullness in the chest, no appetite, halitosis, and coarse breathing, he or she may suddenly find that the nose has darkened and appears sooty. This is due to very strong pathogenic Fire that has traveled upward. Treatment should be immediately administered with purgative herbs.
Burning sensation at the anus 
If a patient has been sick for more than 10 days and has persistent fever, is irritable and restless, drinks water incessantly, has coarse breathing and a strong pulse, and also feels a burning sensation at the anus, pathogenic Heat has attacked the Large Intestine. This can lead to the extinction of Yin, and thus it is an emergency situation. Purgative herbs should be administered without delay.
Painful trickling urination 
A patient may suffer from painful trickling urination after being sick with fever and an aversion to heat for eight or nine days. Symptoms such as irritability and thirst for cold drinks, a sensation of bodily lightness, a strong pulse, and a prickly yellow tongue coating will also be present. Pathogenic Heat has invaded the Small Intestine and is clustering in the Bladder. This critical situation must be treated urgently by clearing Heat and administering diuretic herbs.
Vomiting immediately after eating 
Patients with fever and an aversion to warmth, with halitosis, coarse breathing, and a strong pulse, may vomit immediately after ingesting food. This is due to pathogenic Fire in the Stomach blocking the passage of food. When the Fire flares upward, it forces food from the Stomach as vomit. The correct treatment involves attacking and eliminating the Fire pathogen so that food will automatically travel along its usual downward route.
Dazed unconsciousness 
If a patient has had a persistent fever for eight or nine days accompanied by coarse breathing and steaming hot breath, cold limbs, decreased amounts of reddish urine, thin yellow stools or clear watery diarrhea or bloody diarrhea, a pulse that may be either powerful or fine as silk, and a tongue that is bright-red at the back and covered with a bristly black coating, he or she may also be in a state of dazed unconsciousness. This is due to pathogenic Heat attempting to lodge itself deeply within. One must treat this emergency situation by using purgative herbs to clean the interior. It is inadvisable to use herbs with bitter and warm properties in this case.
Afternoon fever, delirium and thirst for cold drinks 
After a patient has suffered from unresolved exogenous pathogens for eight to more than ten days, Heat may enter the interior, causing fever that is decidedly worse in the afternoon, delirium, and an unquenchable thirst for cold beverages. At this point, Heat is damaging blood and the patient may easily lose consciousness. It is necessary to nourish Blood to promote Yin in this case. It is important to note that this is neither a case of Fire-Yin upsurging nor a case of Yang escaping from the body.
Persistent hiccoughs 
For a patient who has been sick for eight or nine days with an ongoing fever and incessant drinking of water due to increased thirst, it is possible that pathogenic Heat may attack the diaphragm and impede local Qi flow. Persistent hiccoughs can result. Purgative formulas will move the Heat out of the body, allowing proper movement of Qi and relief of hiccoughs.
Severe epistaxis 
Patients suffering from feverish irritability, difficult urination and defecation, halitosis, and coarse breathing may experience a sudden onset of severe nosebleeds followed by increased fever. This serious situation is caused by pathogenic Fire forcing the Blood from the vessels but can be resolved by clearing and purging Heat. Signs of healing to watch for are reduced fever and normalization of urination and defecation.
Sudden onset of skin eruptions 
Although potentially disturbing to the patient, a sudden onset of rashes or skin eruptions after a persistent fever with irritability and restlessness, thirst for cold drinks, coarse respiration, and a strong spirited pulse is a positive sign. It indicates that pathogenic Heat is leaving the body through the skin. It is appropriate, at this time, to direct the Qi upward to fully resolve the issue.
Dry cough with glue-like sputum 
A patient who has been sick for eight or nine days, whether having had a continuous or a sporadic fever, may have incurred damage to the Body Fluids as pathogen Heat has invaded the Lungs. Signs and symptoms to be aware of are unquenchable thirst for cold beverages, occasional lapses of consciousness, and an incessant dry cough with small amounts of thick glue-like sputum. One must use herbal formulas to extinguish the pathogenic Fire and to clean and restore the Lungs with moistening herbs.
Sore throat and cold limbs 
It is possible for a patient who has been ill for eight or nine days with an ongoing fever accompanied by a strong pulse, a sensation of bodily lightness, rough dry skin, passing small amounts of reddish urine, and shallow respiration and hot breath to suddenly experience a sore throat and cold limbs. This is pathogenic Heat moving into the Jueyin (Pericardium, Liver) Meridian, causing Fire to ascend to engender a sore throat and pushing interior Cold outward to the limbs. It is necessary to address this emergency situation by using herbs that in general promote Yin and in particular promote moisture, cleanse, and extinguish Fire.
Ice-cold body with the appearance of death 
If a patient has been sick for eight or nine days, starting with a fever and progressing to thirst for cold beverages, difficult urination and defecation, and irascible delirium, he or she may suddenly grow so cold and lifeless as to appear like a corpse. It is imperative to investigate thoroughly so as to correctly diagnose the condition of the patient in this emergency situation. One must test the temperature of the patient’s breath and examine urine and stool samples. It is entirely possible that Heat is trapped in the interior and Yang is not reaching the exterior, or that a pure Yin syndrome is present.

We have treated many patients whose respiration was so shallow and weak that we initially believed them to have died. However, upon further examination, the breath was found to be hot and moist, the tongue red instead of blue, and the urine red.

In these cases, one should immediately administer appropriately purgative herbal formulas to allow the Heat to circulate freely. It is inappropriate to administer herbs such as Fuzi (Aconite) or Ganjiang (Dried Ginger).
Dry coarse skin and hair 
If a patient has been ill for seven or eight days with or without a fever, irritability, weak Qi, decreased urination, and pharyngeal dryness, there might follow sudden dryness and roughness of the hair or skin. This haggard appearance is brought on by a Fire pathogen damaging Yin and consuming Blood. It is necessary to purge the Fire pathogen and promote Yin.
Muscle and tendon spasm 
Excruciatingly painful spasm of the limbs may suddenly beset a patient who has been sick for eight to ten days with or without a fever, an irritable disposition, a dry throat, polydipsia but reduced amounts of reddish urine, and a marked preference for cold over heat. This situation is due to pathogenic Fire damaging Yin, so that Blood cannot properly nourish the tendons, resulting in severe spasm. It is remedied by promoting Yin and clearing Fire.
Sudden enlargement of the scrotum 
After eight to ten days of illness with or without fever, a male patient may exhibit a strong pulse, a loud ringing voice, and have a sensation of bodily lightness. Of more concern is sudden and painful swelling of the scrotum, which may occur. Abnormal pathogenic Heat may attack the penis, which is, of course, related to the scrotum, causing painful swelling. It is important to purge the body of pathogenic Fire, promote Yin, and nourish the Liver.
Red macules covering the body 
Patients with fever, a strong pulse, irritability, and restlessness may suddenly be covered in red macules and beset by extreme pruritus. Pathogenic Heat and Fire have attacked the muscles and must be purged from the body. Reducing Fire, clearing Heat, and loosening the flesh are the treatment goals.
Craniofacial pain and swelling 
If a patient who has been ill for two or three days and experiences craniofacial swelling and pain, pathogenic Heat has entered and is blocking the three upper body Yang meridians. To remedy this situation, one must scatter and clear the Heat.

The preceding section of brief summaries is representative of some but not all possible Fire syndromes. Depending on the details of the particular case, it may be appropriate to use cold, sweet herbs to promote Yin, or cold, bitter, purgative herbs to maintain Yin, moistening herbs to rescue Yin, or warm, sweet herbs to promote Yang and rescue Yin, and so on. It is always necessary to treat each case according to the syndrome.

Quite simply, righteous Qi supports life while pathogenic Qi destroys life. The ancient doctors of Chinese medicine called pathogenic Qi an “Evil Qi,” for obvious reasons.

Methods of promoting Yin are applied to Yang syndromes of pathogenic Fire but not to Yin syndromes of pathogenic Fire, where Yin surges upward. One should be aware that in the case of Yang syndromes of pathogenic Fire everything about the patient, including the voice, pulse, and respiration, is vibrant and forceful. Conversely, in the case of any Yin syndrome of pathogenic Fire, the patient’s attributes will lack spirit. This knowledge will help students and practitioners readily distinguish these potentially confusing cases.

List of Prescriptions Used in This Chapter

1.Erchen Tang : Banxia , Chenpi  Fuling , Gancao .

2.Shihui San : Daji , Xiaoji , Heye , Cebaiye , Qiancaogen , Maogen , Zhizi , Dahuang , Mudanpi , Zonglupi 

3.Shizao Tang : Daji , Yanhua , Gansui , Dazao .

4.Shiquandabu Tang : Renshen , Dihuang , Danggui , Baishao , Chuanxiong , Fuling , Baizhu , Rougui , Huangqi , Zhigancao .

5.Renshenbaihu Tang : Renshen , Zhimu , Shigao , Zhigancao , Jingmi .

6.Renshenbaidu San : Renshen , Chaihu , Qianhu , Qianghuo , Duhuo , Fuling , Zhike , Baishao , Jiegeng , Gancao .

7.Bazheng San : Bianxu , Qumai , Huashi , Mutong  Cheqianzi , Dahuang , Zhizi , Gancao .

8.Bazhen Tang : Renshen , Fuling , Baizhu , Zhigancao , Danggui , Dihuang , Baishao , Chuanxiong .

9.Jiuweiqianghuo Tang : Qianghuo , Fangfeng , Xixin , Cangzhu , Chuanxiong , Baizhi , Shengdi , Huangqin , Gancao .

10.Sanhuang San : Shengdahuang , Shengpuhuang , Jianghuang , Bingpian , Shexiang , Fengmi .

11.Sanxiao Fin : Houpu , Binlang , Shaoyao , Zhimu , Huangqin , Dahuang , Gegen , Qianghuo , Chaihu , Dazao , Gancao , Shengjiang .

12.Sanhuangshigao Tang : Huanglian , Huangbo , Huangqin , Shigao , Douchi , Zhizi , Mahuang .

14.Sanwubeiji Wan : Dahuang , Ganjiang , Badou , Shuangfengmi .

15.Daqing Fin : Daqingye , Shengma , Shengdi , Dahuang .

16.Dabuyuan Jian : Rensheng , Shudi , Shanyao , Duzhong , Danggui , Gouqi , Shanzhuyu , Gancao .

17.Dajianzhong Tang : Shujiao , Renshen , Ganjiang , Yitang .

18.Dachengqi Tang : Houpu , Zhishi , Dahuang , Mangxiao .

19.Dahuangmuxiang Tang : Dahuang , Muxiang , Danggui , Suye , Gancao .

20.Xiaoqinglong Tang : Mahuang , Guizhi , Shaoyao , Ganjiang , Wuweizi , Xixin , Banxia , Gancao .

21.Xiaochengqi Tang : Houpu , Zhishi , Dahuang .

22.Xiaochaihu Tang : Chaihu , Renshen , Banxia , Huangqin , Gancao , Dazao , Shengjiang .

23.Xiaojianzhong Tang : Guizhi , Shaoyao , Dazao , Shengjiang , Zhigancao , Yitang .

24.Wuling San : Fuling , Zhuling , Zexie , Baizhu , Guizhi .

25.Wulin San : Chfuling , Danggui , Chishao , Zhizi , Gancao .

26.Wuji San : Fuling , Banxia , Mahuang , Ganjiang , Zhike , Guixin , Houpu , Cangzhu , Jiegeng , Chenpi , Baizhi , Danggui , Shaoyao , Chuanxiong , Zhigancao .

27.Tianwangbuxin Dan : Dihuang , Renshen , Danggui , Fuling , Baiziren , Wuwei , Tiandong , Maidong , Xuanshen , Suanzaoren , Danshen , Yuanzhi , Jiegeng , Zhusha , Fengmi .

28.Wumei Wan : Wumei , Fupian , Ganjiang , Xixin , Chuanjiao , Huangbo , Huanglian , Renshen , Guizhi .

29.Huaban Tang : Shigao , Zhimu , Gancao , Xuanshen , Xijiao , Jingmi .

30.Shengjie San , (to be verified).

31.Shengyangsanhuo Tang : Gegen , Shengma , Qjianghuo , Duhuo , Renshen , Baishao , Chaihu , Fangfeng , Shengjiang , Dazao , Shenggancao , Zhigancao .

32.Shengmagegen Tang : Shengma , Gegen , Baishao , Gancao .

33.Danzhisiwu Tang : Danpi , Zhizi , Shengdi , Baishao , Danggui , Chuanxiong .

34.Danzhixiaoyao San : Danpi , Zhizi  Chaihu , Danggui , Shaoyao , Fuling , Baizhu , Bohe , Shengjiang , Gancao .

35.Liuwei Wan : Shudi , Fuling , Shanyao , Danpi , Zexie , Shanzhuyu .

36.Liujunzi Tang : Renshen , Fuling , Baizhu , Zhigancao , Banxia , Chenpi .

37.Pingwei San : Houpu , Cangzhu , Chenpi , Gancao .

38.Zhuogui Wan : Shudi , Shanyao , Shanzhuyu , Gouqi , Tusi , Guijiao , Niuqi , Lujiaojiao .

39.Fougui Wan : Shudi , Shanyao , Shanzhuyu , Gouqi , Tusi , Duzhong , Danggui , Lujiaojiao , Rougui , Fuzi .

40.Ganju Tang : Gancao , Jiegeng .

41.Ganlu Fin : Shengdi , Shudi , Tiandong , Maidong , Shihu , Yinchen , Huangqin , Zhike , Gancao , Pibaye .

42.Gancaoganjiang Tang : Zhigancao , Paoganjiang .

43.Ganjuerdong Tang : Gancao , Jiegeng , Tiandong , Maidong , Digupi , Sangpi , Huangqin , Xingren , Baimi .

44.Zhufu Tang : Baizhu , Fuzi .

45.Longdanxiegan Tang : Longdancao , Huangqin , Zhizi , Zexie , Mutong , Cheqianzi , Danggui , Shengdi , Chaihu , Gancao .

46.Siwu Tang : Dihuang , Danggui , Baishao , Chuanxiong .

47.Siling San : Fuling , Zexie , Zhuiling , Baizhu .

48.Sini Tang : Fuzi , Ganjiang , Zhigancao .

49.Sishen Wan : Buguzhi , Wuzhuyu , Wuwei , Shengjiang , Dazao , Roudoukou .

50.Simo Tang : Renshen , Binlang , Chenxiang , Taiwu .

51.Sijunzi Tang : Renshen , Fuling , Baizhu , Zhigancao .

52.Siwujiarenshen Tang : Dihuang , Danggui , Baishao , Chuanxiong , Renshen .

53.Silinghuashiejiao Tang , Fuling , Zhuling , Zexie , Baizhu , Huashi , Ejiao .

54.Baitong Tang : Fuzi , Ganjiang , Congbai .

55.Baihu Tang : Shigao , Zhimu , Gancao , Jingmi .

56.Baitongweng Tang : Baitouweng , Huanglian , Huangbo , Qinpi .

57.Shengdisiwu Tang : Shengdi , Baishao , Danggui , Chuanxiong .

58.Shengdiqinlian Tang : Shengdi , Chaihu , Huanglian , Huangqin , Shanzhizi , Xijiao , Chuanxiong , Jiegeng , Shaoyao .

59.Guipi Tang : Renshen , Baizhu , Huangqi , Longyan , Roufushen , Muxiang , Suanzaoren , Zhigancao .

60.Guifu Tang : Danggui , Fuzi .

61.Ningshen Dan : Renshen , Tianma , Baizhu , Danggui , Fuling , Chenpi , Jingjie , Jiangcan , Duhuo , Yuanzhi , Xijiao , Xingren , Fushen , Banxia , Suanzaoren , Chuanxiong , Yujin , Shigao , Nanxing , Baifuzi , Chensha , Niuhuang , Zhenzhu , Shengdi , Gancao .

62.Banxiashengjiang Tang : Banxia , Shengjiang .

63.Dayuan Yin , Houpu , Changshan , Binlang , Zhimu , Caoguo , Changpu , Huangqin , Qingpi , Gancao .

64.Huiyang Yin : Fuzi , Ganjiang , Zhigancao , Renshen .

65.Danggui San : Danggui , Chishao , Shengdi , Huanglian , Honghua , Shigao .

66.Dangguiliuhuang Tang : Danggui , Shengdi , Shudi , Huanglian , Huangqin , Huangbo , Huangqi .

67.Dangguisini Tang : Danggui , Guizhi , Baishao , Xixin , Mutong , Dazao , Zhigancao .

68.Dangguiluhui Wan : Danggui , Luhui , Zhizi , Huanglian , Huangqin , Huangbo , Dahuang , Qingdai , Muxiang , Longdancao , Shexiang , Fengmi .

69.Roukou San : Roukou , Huanglian , Ganjiang , Helile , Houpu , Gancao , Baizhu , Chifuling .

70.Yinbawei  or Zhibodihuang Wan : Zhimu , Huangbo , Shudi , Fuling , Shanzhuyu , Shanyao , Danpi , Zexie .

71.YangbaWei  or Shengqi Wan : Shudi , Fuling , Shanyao , Danpi , Shanzhuyu , Zexie , Rougui , Fuzi .

72.Yangdan Tang : Guizhi , Baishao , Dazao , Shengjiang , Zhigancao , Huangqin .

73.Daochi San : Shengdi , Mutong , Danzhuye , Gancao .

74.Shaoyaogancao Tang : Baishao , Gancao .

75.Zhuangshuimingmu Wan : Shudi , Shanyao , Zexie , Shanzhuyu , Fuling , Chuanxiong , Danpi , Shengdi , Manjingzi , Juhua , Danggui , Huanglian , Chaihu , Wuweizi .

76.Bingpeng San : Xuanmingfen , Zhusha , Pengsha , Bingpian .

77.Maidong Yin : Renshen , Maidong , Jupi , Lingyangjiao , Shengjiang .

78.Qijudihuang Wan : Gouqi , Juhua , Shudi , Huaishan , Shanzhuyu , Danpi , Fuling , Zexie .

79.Chuihou San : Yaxiao , Pengsha , Xionghuang , Jiangcan , Bingpian .

80.Qifu Tang : Huangqi , Fuzi .

81.Suzijiangqi Tang : Suzi , Juhong , Banxia , Danggui , Houpu , Qianhu , Rougui , Shengjiang , Zhigancao .

82.Suchenjiubao Tang : Zishu , Chenpi , Mahuang , Guangui , Dafupi , Bohe , Xingren , Sangpi , Gancao .

83.Qinliansiwu Tang : Huangqin , Huanglian , Dihuang , Danggui , Baishao , Chuanxiong .

84.Wuzhuyu Tang : Wuzhuyu , Renshen , Dazao , Shengjiang .

85.Wuyusini Tang : Wuzhuyu , Fuzi , Ganjiang , Zhigancao .

86.Zaojia Wan : Zaojia , Dazao , Fengmi .

87.Buxue Tang : Danggui , Huangqi .

88.Buzhongyiqi Tang : Renshen , Huangqi , Baizhu , Danggui , Chenpi , Chaihu , Shengma , Paojiang , Dazao , Zhigancao .

89.BukanyiliDan : Guizhi , Fuzi , Haige , Shengjiang , Zhigancao .

90.Xinyi San : Xinyi , Xixin , Shengma , Gaomu , Chuanxiong , Mutong , Fangfeng , Baizhi , Qianghuo , Zhigancao .

91.Jiming San : Suye , Wuzhuyu , Jiegeng , Mugua , Jupi , Binglang , Shengjiang .

92.Jizihuanglian Tang : Huanglian , Huangqin , Baishao , Ejiao , Jizihuang .

93.Fuqiang Tang , (to be verified).

94.Fuzigancao Tang : Fuzi , Gancao .

95.Fuzilizhong Tang : Fuzi , Renshen , Baizhu , Paojiang , Zhigancao .

96.Shenzhu Tang : Fuling , Baizhu , Ganjiang , Gancao .

97.Dingzhi Wan : Renshen , Fuling , Yuanzhi , Changpu , Fengmi .

98.Dingchuan Tang : Mahuang , Baiguo , Sangpi , Suzi , Xingren , Huangqin , Banxia , Donghua , Gancao .

99.Qianghuofuzi Tang : Qianghuo , Fuzi , Ganjiang , Muxiang , Huixiang .

100.Zexie Tang : Zexie , Baizhu .

101.Zhigancao Tang : Zhigancao , Renshen , Guizhi , Ejiao , Dihuang , Maidong , Maren , Dazao , Shengjiang .

102.Shenfu Tang : Renshen , Fuzi .

103.Shensu Tin : Renshen , Zisu , Gergen , Qianhu , Fuling , Zhike , Banxia , Juhong , Jiegeng , Muxiang , Gancao .

104.Shenlingbaizhu San : Renshen , Fuling , Baizhu , Chenpi , Zhigancao , Shanyao , Biandou , Sharen , Yiren , Lianzirou , Jiegeng , Dazao .

105.Houpuqiwu Tang : Houpu , Zhishi , Gancao , Dahuang , Guixin , Dazao , Shengjiang .

106.FengsuiDan : Huangbo , Sharen , Zhigancao .

107.Weiling Tang : Houpu , Cangzhu , Chenpi , Gancao , Fuling , Zhuling , Zexie , Baizhu , Guizhi .

108.Jingfangbaidu San : Jingjie , Fangfeng , Renshen , Qianghuo , Duhuo , Chaihu , Qianhu , Jiegeng , Zhike , Fuling , Chuanxiong , Gancao .

109.Jionglong Tang : Tongbian .

110.Xiangshaliujun Tang : Renshen , Fuling , Baizhu , Zhigancao , Banxia , Chenpi , Muxiang , Sharen .

111.Jianggui Tang : Shengjiang , Guizhi .

112.Jiangguifuban Tang : Shengjiang , Guizhi , Fuling , Banxia .

113.Jiangfu Tang : Ganjiang , Fuzi .

114.Juban Tang : Danggui , Chishao , Shengma , Baizhi , Chuanshanjia , Chaihu .

115.XiebaiSan : Sangbaipi , Digupi , Gancao , Jingmi .

116.Xiegan Tang : Chaihu , Qianhu , Sangpi , Xixin , Yuzhu , Zhizi , Huangqin , Shengma , Juemingzi .

117.Zhichi Tang : Zhizi , Dandouchi .

118.Guizhi Tang : Guizhi , Baishao , Dazao , Shengjiang , Zhigancao .

119.Guizhilongmu Tang : Guizhi , Baishao , Dazao , Shengjiang , Zhigancao , Longgu , Muli .

120.Guilingzhugan Tang : Guizhi , Fuling , Baizhu , Gancao .

121.Guizao Wan , (to be verified).

122.Guilingjiangban Tang : Guizhi , Fuling , Ganjiang , Banxia .

123.Guizhidahuang Tang : Guizhi , Baishao , Dazao , Shengjiang , Zhigancao , Dahuang .

124.Taohua Tang : Chishizhi , Ganjiang , Jingmi .

125.Taorensiwu Tang : Taoren , Guiwei , Chishao , Chuanxiong , Shengdi , Xiangfu , Danpi , Honghua , Yuanhu .

126.Taorendihuangxijiao Tang , (to be verified).

127.Tongzhi Tang , (to be verified).

128.Qufeng San : Jingjie , Fangfeng , Qianghuo , Chuanxiong , Jiangcan , Houpu , Chantui , Shexiang , Renshen , Fuling , Chenpi , Gancao .

129.Qufengsanshi Tang , (to be verified).

130.Zhenwu Tang : Fuling , Fuzi , Baizhu , Baishao , Shengjiang .

131.Runzao Tang : Shengma , Shengdi , Shudi , Danggui , Dahuang , Maren , Taoren , Honghua , Gancao .

132.Chailing Tang : Chaihu , Zhuling , Fuling , Zexie , Baizhu , Huangqin .

133.Xiaoyao San : Chaihu , Danggui , Baishao , Fuling , Baizhu , Gancao , Bohe , Shengjiang .

134.Yiyuan San : Huanshi , Gancao , Chensha .

135.Yangxue Tang : Danggui , Shengdi , Qinjiao , Chuanxiong , Duzhong , Guizhi , Gancao .

136.Xiaoban Tang : Renshen , Shigao , Yuzhu , Zhimu , Gancao .

137.Liuqi Yin : Dahuang , Chuanxiong , Juhua , Niubang , Xixin , Fangfeng , Shanzhi , Huangqin , Xuanshen , Baijili , Manjing , Jingjie , Muzei , Cangzhu , Caojueming , Gancao .

138.Liangge San : Dahuang , Mangxiao , Zhizi , Lianqiao , Huangqin , Bohe , Zhuye , Zhigancao .

139.Liangxue Tang : Danggui , Dihuang , Huangqin , Huanglian , Huangbo , Zhimu , Fangfeng , Jingjie , Xixin , Manjing , Qianghuo , Gaoben , Shengma , Gancao .

140.Tiaoweichengqi Tang : Dahuang , Mangxiao , Zhigancao .

141.Huanglian Tang : Huanglian , Ganjiang , Gancao , Guizhi , Renshen , Banxia , Dazao .

142.Huanglianwuyu Tang : Huanglian , Wuyu .

143.Huanglianjiedu Tang : Huanglian , Huangqin , Huangbo , Zhizi .

144.Huanglianxiexin Tang : Huanglian , Huangqin , Shengdi , Zhimu , Gancao .

145.Huanglianmuxiang Tang : Huanglian , Muxiang , Huangbo , Mutong , Zhike , Chenpi , Dahuang .

146.Huangqijianzhong Tang : Huangqi , Guizhi , Baishao , Dazao , Zhigancao , Shengjiang , Yitang .

147.Huanglianyuzhuejiao Tang , (to be verified).

148.Huangqinshaoyao Tang : Huangqin , Shaoyao , Dazao , Gancao .

149.Lizhong Tang : Renshen , Baizhu , Paojiang , Zhigancao .

150.Lipidi Yin , (to be verified).

151.Mahuang Tang : Mahuang , Xingren , Guizhi , Zhigancao .

152.Maren Wan : Maren , Houpu , Zhishi , Dahuang , Baishao , Xingren , Fengmi .

153.Maxingshigan Tang : Mahuang , Xingren , Shigao , Gancao .

154.Mahuangdingchuan Tang : Mahuang , Xingren , Houpu , Donghu , Sangpi , Suzi , Huangqin , Banxia , Gancao .

155.Mahuangfuzixixin Tang : Mahuang , Fuzi , Xixin .

156.Zishen Wan : Huangbo , Zhimu , Rougui .

157.Zishenyanggan Wan , (to be verified).

158.Qingzhen Tang : Cangzhu , Shengma , Heye .

159.Qingwei San : Huanglian , Shengdi , Danggui , Danpi , Shengma .

160.Qingfei Yin : Huangqin , Jiegeng , Zhizi , Lianqiao , Tianhuafen , Xuanshen , Bohe , Gancao .

161.Qingzao Tang : Huangqi , Cangzhu , Baizhu , Chenpi , Zexie , Fuling , Danggui , Renshen , Shengdi , Shengma , Maidong , Shenqu , Huangbo , Zhuling , Chaihu , Huanglian , Wuwei , Zhigancao .

162.Qingshuyiqi Tang : Renshen , Baizhu , Maidong , Danggui , Huangqi , Wuwei , Qingpi , Chenpi , Shengma , Zexie , Cangzhu , Shenqu , Huangbo , Gegen , Shengjiang , Dazao , Zhigancao .

163.Gegen Tang : Gegen , Guizhi , Shengma , Baishao , Dazao , Shengjiang , Zhigancao .

164.Gegenqinlian Tang : Gegen , Huangqin , Huanglian , Gancao .

165.Xijiaodihuang Tang : Xijiao , Dihuang , Baishao , Danpi .

166.Wenfei Tang : Baishao , Ganjiang , Wuwei , Xixin , Rougui , Banxia , Chenpi , Xingren , Gancao .

167.Pujixiaodu Yin : Huanglian , Huangqin , Niubang , Xuanshen , Chenpi , Mabo , Lianqiao , Bohe , Shengma , Banlangen , Jiangcan , Chaihu , Jiegeng , Gancao .

168.Qianyang Dan : Fuzi , Guiban , Sharen , Zhigancao .

169.Juyu Wan , (to be verified).

170.Huoxiangzhengqi San : Huoxiang , Houpu , Baizhu , Chenpi , Banxia , Fuling , Baizhi , Jiegeng , Suye , Dafupi , Dazao , Shengjiang , Gancao .

171.Shenzhu San : Cangzhu , Baizhi , Chuanxiong , Gaomu , Xixin , Qianghuo , Gancao .

172.Baohe Wan : Laifuzi , Shanzha , Shenqu , Chenpi , Banxia , Fuling , Lianqiao .

173.Zhizhu Wan : Zhishi , Baizhu .

174.JinsuogujingDan : Jili , Qianshi , Lianxu , Longgu , Muli , Lianzifen .

Possible Reactions to Herbs for Restoring Yang

For the above-mentioned reason concerning time periods, Yang-supporting medicines may act slowly or have the following side effects on some patients, especially those who have long taken antibiotics and cold-natured medicines:

(1)Patients may suddenly feel vexed, have panting, and cannot fall asleep, the same as getting excess Fire. A very few patients may feel dizzy when they get up quickly (hypotension patients must act slowly), or have a bleeding nose; a fever blister on the lips or the tongue tip; a dry and sore throat; dry, red, and sore eyes (with much gum in the early morning); an earache; flushing; or numbness of the body surface (because the blood vessel tips are dredged; the symptom may disappear in two or three days).

(2)Patients may suddenly have dry cough or exuberant phlegm day and night, sometimes combined with edema of the eyelids, face, lower leg, foot surface, or the whole body, and even difficult urination; sweat all over the body; sore and itching erythema, herpes or papules all over the body and on the face.

(3)Patients may have acute stomachache, which disappears after they pass flatus, and evacuate loose or watery stools (some patients may have bowel movement 5–10 times a day for over 10 days, but do not feel the same fatigue as when suffering from diarrhea); poor appetite or nausea and vomit; aching pain in the waist; feel limp, fatigued, and sleepy (they sleep soundly); have a bad memory and lose hair during a period of time; a sharp sore in the glans or clitoris if they once had genital system disease; pimples, on the buttocks and face. These symptoms will disappear in half a month as long as the patients continue taking the medicine.

(4)Patients may suddenly have a running, stuffy nose and sneeze like having caught a cold, and become more intolerant of cold. In this case the patient should continue taking the medicine or increase the dose to improve the treatment effect. If the patient has a fever above 38°C, and the temperature (usually of the upper body)will go down in 24 h or three days, he or she can take the Chinese Ephedra, Aconite, and Asarum Decoction (Mahuangfuzixixin Tang).

(5)Patients may suddenly have a severe pain in muscle and condyles all over; sharp headache, probably at the rear, or splitting headache, at the vertex or forehead; gum ache.

(6)Women who suffer from irregular menstruation, metrorrhagia or metrostaxis induced by an excess Cold pathogen may have menstruation several days or more than ten days in advance, and recover normal menstruation in the next month; delay menstruation for one month, but will recover in the next month; have heavier menstrual flow than ever, but will not feel fatigued as usual; discharge gore or blood containing pus in the next several months. Deficient-Cold-type infertility patients may be cured by the medicine; ovarian cysts may slightly break and bleed, and later recover; some patients may have symptoms such as hematuria, urethritis, and colpitis, due to the expulsion of the Cold pathogen.

(7)Patients who have constipation or not may not evacuate feces temporarily, but usually have no feeling of inner oppression. In continuing to take the medicine, they may recover fecal evacuation in five or six days and the constipation may be cured. Some patients may have acupuncture points of Meridians and Collaterals jump or slightly ache, or feel thirsty for several days.

(8)The blood pressure of hypertension patients may rise temporarily, and then drop. The dose should be adjusted accordingly. Diabetes patients may have urine glucose and blood sugar level that rise temporarily, or increased foam in their urine. Patients with higher indices had better receive acupuncture treatment for better effect.

(9)Patients who once suffered from cholecystitis, hemorrhoids, or appendicitis may have symptoms similar to recrudescence; internal hemorrhoids may become external hemorrhoids. The symptoms will disappear in half a month as long as the patients continue taking the medicine.

For some patients, their past diseases may be recrudescent once or twice. Despite “recrudescence,” they will not have the same feeling as before.

All of the above symptoms manifest that the Genuine Yang is invigorated to expel the Cold pathogen in the Meridians and Collaterals. Therefore, patients should continue taking the medicine instead of seeing a doctor immediately, because the doctor will surely prescribe antipyretics and hormones, which will make the Cold pathogen astringed in the body.

Generally, all symptoms are normal and not caused by a diagnosis mistake or drug allergy as long as the patients have the pulse condition of Yin exuberance with Yang debilitation such as a sunken pulse, string-like pulse, hidden pulse, or fine pulse. As each symptom during the taking of medicine indicates the decrease of a pathogen in the human body, the patient should feel happy rather than being hypersensitive. Just like sweeping a living room, the proper application of Yang-supporting medicines can empower children to enjoy constitutional sufficiency, make youth vigorous, and help middle-aged adults to keep free from sub-healthy status and elders to live longer. After the reactions disappear, patients should have sufficient food and water, keep sound mental state, participate in entertainment and do exercises regularly.