In

1. Exterior Cold, Inner Heat

Liu Du Zhou

Case from: Dr. Liu Du Zhou

This patient was a 10-year-old girl who received a cold Qi in late autumn. She developed fever and an aversion to cold and had episodes of this many times a day. This went on for several months. Her pulse was floating and without strength. Her tongue body was red and the moss was thin and white. Her food and drink intake and excretions were normal. This was a case of wind cold stagnating on the outside chronically without resolution. The cold had transformed to heat but was a light case. I gave her two packages of Gui Zhi Er Yue Bi Yi Tang (modified).

  • Gui Zhi5g
  • Bai Shao5g
  • Chao Xing Ren3g
  • Zhi Gan Cao3g
  • Sheng Jiang3g
  • Ma Huang3g
  • Da Zao4g
  • Zhu Ru3g

There was slight sweating and this brought resolution.

Discussion:

In this case there was fever and an aversion to cold that came in frequent episodes every day.  This indicated unresolved Tai Yang evil.  These external evils have a tendency to enter the interior and transform into heat.  The pulse was floating but without strength.  This is an indication that the cold evil is wanting to journey out to the fleshy exterior.  The original text says, “The pulse is slightly weak and this means an absence of Yang”.  So treatment should not rashly use pungent and warm Ma Huang and Gui Zhi.  One should treat this patient by using Gui Zhi Er Yue Bi Yi Tang with the addition of Zhu Ru to resolve the exterior and clear the interior, generate fluids and nourish moisture.

Commentary:

In regard to the sentence “The pulse is slightly weak and this indicates an absence of Yang”, many scholars think that this means there is Yang depletion.  Because the clause has two parts, they connect the use of Gui Zhi Er Yue Bi Yi Tang to the part that says “fever is greater than cold”.  I do not agree with this.  In this case, the pulse being slightly weak is the opposite of being floating and tight.  This is a pulse that was floating and tight and it changed to be scattered and weak.  The exterior evil, though wanting to leave then has a tendency to enter the interior and transform into heat. This is not the expiring pulse of Yang depletion.  This “absence of Yang” is speaking about the evil wanting to leave the exterior.  This is exactly like that impartial saying “The absence of Yang that stagnates the exterior pattern”.  The evil qi moves into the interior from the exterior and therefore one should not use Ma Huang and Gui Zhi to promote sweating.  One should use Gui Zhi Er Yue Bi Yi Tang to resolve the exterior and clear the interior.

Gui Zhi Er Yue Bi Yi Tang

  • Gui Zhiu4g
  • Sheng Jiang3g
  • Bai Shao3g
  • Zhi Gan Cao3g
  • Ma Huang3g
  • Da Zao4pieces
  • Shi Gao3g

This formula is indicated when there is external wind cold and internal stagnant heat. This formula is differentiated from Xiao Qing Long Tang by the degree of seriousness. In the Xiao Qing Long Tang pattern, in addition to the cold and heat with fever predominant, there is also lack of sweating, headache, mouth thirst and agitation. This formula is used when one wants to create a mild sweat while clearing inner heat.

** Translated by: Sharon Weizenbaum

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Comments
  • Steve Bonzak
    Reply

    Sharon-

    Don’t you mean to differentiate Guizhi Er Yuebu Yi Tang with *Da* Qinglong Tang and not *Xiao* Qinglong tang? There is no shigao in XQLT and its additional indication is for cough, not agitation.

    -Steve

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