Taiyang wind invasion syndrome featured by outward floating of Yang Qi manifested as fever,and inadequate Yin fluid as spontaneous sweating, marked by mild aversion to cold, chilly aversion to wind, superficial fever, stuffy nose with coares noise and retching, should be treated mainly with Guizhi Tang .

Gaizhi 9 g, Baishao 9 g, Shengjiang 9 g, Dazao 3 pieces, and Zhi Gancao 6 g.

Break the above ingredients into small pieces, decoct them with 1400 ml water over a mild fire to get 600 ml decoction, and then remove the dregs.Take 200 ml of the decoction first at a warm temperature. Drink approximately more than 200 ml of hot gruel to reinforce the action of the decoction, shortly after taking the first dose. Then warm the patient’s body by covering with a blanket to make the body skin moist due to slight sweating, but don’t excessive sweating massively since the disease will not be relieved in this way. Cease taking the rest of the decoction if the disease is relieved with adquate sweating after taking the first dose; take the second dose in the same way if he has no sweating; and take the third dose in half a day while decreasing the period between two doses taken if sweating is still absent. If disease is severe, this decoction can be taken continueously throughout the day and carefully observe the patient’s situation. Take another one or two packages of the same herbal medicines if the main symptoms are not resolved after finishing the first package of the decoction.

The foods including uncooked and cold foods and drinks, sticky and slimy foods, meats, noodles, the five acrid flavorings (the five strongsmelling vegetables, i.e., garlic, Chinese chive, Chinese leek, coriander and oil rape), liquor, milk products, and foods with a foul odor and spoiled quality, are all contraindicated while taking Guizhi Tang.

Taiyang exterior syndrome with headache, fever, sweating and aversion to wind, should be treated mainly by Guizhi Tang.

The basic pathogenesis, basic manifestations and main formula of Taiyang wind invasion syndrome.

The two articles introduce the major symptoms, pulse and formula of Taiyang wind invasion syndrome, which arises from disharmony between nutritive Qi and defensive Qi induced by invasion of wind-cold in the exterior, in other words, wind-cold exterior syndrome with exterior deficiency, so low fever, aversion to wind, spontaneous sweating and floating-moderate pulse are regarded as key points for syndromedifferentiation. Here, “mild”, “chilly” and “superficial” are used to vividly describe the clinical features of the fever with aversion to wind, which differ from Taiyang cold invasion syndrome, wind-heat exterior syndrome and others. Its accompanied symptoms may include headache, body aches, stuffy nose with coarse noise, retching, etc.

Guizgi Tang is the first formula in Shanghan Lun and also a basic remedy for Taiyang wind invasion syndrome. Among the ingredients in this formula, Guizhi with ShengJiang expels wind-cold to strengthen defensive Qi by inducing sweating, Baishao with Dazao nourishes blood and astringes nutritive Qi, and Shengjiang, Dazao and Zhi Gancao together can replenish stomach- Qi and assist Guizhi and Baishao to harmonize nutritive Qi and defensive Qi. Therefore, it has an intelligent combination of ingredients, and thus has a very effective clinical action. The preparation and administration of Guizhi Tang are here recorded in detail, and should be highlighted by students, because they are a part of essential of Zhongjing’s clinical experience in medication and also a necessary precondition for obtaining a satisfactory therapeutic effect. Furthermore, the preparations and administrations of the other formulas in this textbook might be identical to those of Guizhi Tang in principle, and subsequently those of others in the textbook will be left beyond their peculiarities.

1.These two articles tell us the key points for differentiating Taiyang wind invasion syndrome from the others and using Guizhi Tang clinically, so we may correctly apply this formula in the light of key points, namely disharmony between nutritive Qi and defensive Qi with wind pathogen invasion, mainly marked by spontaneous sweating,aversion to wind, low fever, headache, and floating-moderate pulse.

2.It offers an outstanding example for preparation and administration of herbal medicine in order to achieve the best therapeutic effect, so the other herbal medicines can be prepared and administrated in the similar way.

3. Guizhi Tang has been respectfully known as the ancestor of all herbal prescriptions, because it is not only the first formula in Shanghan Lun and a main formula for Taiyang wind invasion syndrome, but also it and its modified formulas such as Guizhi Jia Gegen Tang, Guizhi Jia Houpo Xingren Tang, Guizhi Jia Fuzi Tang, Xiao Jianzhong Tang, Guizhi Xinjia Tang, Guizhi Jia Longgu Muli Tang, Danggui Sini Tang and Huangqi Guizhi Wuwu Tang, are extensively applied in the concomitant syndromes of Taiyang wind invasion syndrome as well as the endogenously damaged diseases due mainly to deficiency of both Qi and blood or both Yin and Yang.

Taiyang pattern with fever and sweating suggests the outward floating of defensive Qi and inadequacy of nutritive Qi, which consequently cause fever and sweating respectively, and can be treated by Guizhi Tang efficiently in order to expel wind-pathogen.

The basic pathogenesis and treatment of Taiyang wind invasion syndrome.

Taiyang wind invasion syndrome treated appropriately with Guizhi Tang involves two pathogeneses. Intrinsically, disharmony between nutritive Qi and defensive Qi, in other words, defensive Qi is obstructed by wind-cold in the body surface, and manifested as fever with aversion to wind,simultaneously, nutritive Qi involving in blood and body fluid lets out excesively, such as much spontaneous sweating resulting from inability of weak defensive Qi to secure the exterior body. Extrinsically, exogenous wind invades into the exterior and opens sweat pores, and further weakens defensive Qi. Therefore, the intrinsic and extrinsic pathogenic factors in combination lead to the Guizhi Tang syndrome.

This article obviously points out that disharmony between nutritive Qi and defensive Qi combined with wind-cold invasion is the basic pathogenesis of Taiyang wind invasion syndrome, and also the indication of Guizhi Tang. Both have guided the theoretical explanation and clinical application of this syndrome and formula.

Taiyang pattern treated initially by Guizhi Tang , but the exterior syndrome is unrelieved and furthermore vexation occurs, needling Fengchi（风池 GB20） and Fengfu（风府 GV16） first,the patient may recover after given Guizhi Tang once again.

Taiyang wind invasion syndrome with a stronger pathogen should be treated by using a combination of acupuncture and herbal medicines.

Guizhi Tang applied for Taiyang wind invasion syndrome is appropriate, but the syndrome is not relieved and a new symptom, vexation, is added,because a stronger wind pathogen gives rise to an intense struggle between vital Qi and pathogen, so as to cause a severer obstruction in the meridian,hence presenting vexation as one of the results of this pathological situation.Therefore, first needle acupoints Fengchi (GB20) and Fengfu (GV16) to expel exogenous wind to unblock the meridian, then give Guizhi Tang to expel the residual wind-cold pathogen by inducing mild sweating and harmonizing nutritive Qi and defensive Qi, so the severe case of Taiyang wind invasion syndrome may then be relieved completely.

It is a typical modality for applying herbal medicine and acupuncture together, which then enhance the therapeutic action because it gives full play to the strong points of the two therapies in regulating-reinforcing Qiblood and unblocking the relevant meridian and collaterals respectively.

Taiyang pattern with unrelieved exterior syndrome cannot be inappropriately treated by catharsis, and should be treated appropriately by Guizhi Tang to relieve exterior syndrome.

The lingering Taiyang exterior syndrome can be treated exclusively by mild diaphoresis, instead of catharsis.

The principal syndrome of Taiyang pattern lasting for a long time should be treated by mild diaphoresis, namely, using Guizhi Tang to induce sweating mildly only if the exterior symptoms still exist regardless whether it has been treated wrongly or not. However, Taiyang exterior syndrome can’t be treated by catharsis, because catharsis would lead to damage of Qi of the Zanfu-organs, especially Qi of the spleen-stomach,and further deeper invasion of the exogenous pathogen, which then brings about some transmuted or deteriorated syndromes. Consequently,purgation is contraindicated for Taiyang exterior syndrome.

Any syndrome within the six meridian patterns has its own specific pathogenesis, symptoms, therapeutic rule and major formula. When the key symptoms of a syndrome remain unrelieved, this basically indicates that the syndrome does not change, so the corresponding therapeutic rule and the formula can be still used. Moreover, Guizhi Tang belongs to mild diaphoretics, so it can be used for a lingering wind-cold exterior syndrome, whereas Taiyang pattern is a contraindication to cathartics.

The Taiyang pattern with upward rushing of Qi after inappropriate catharsis may be still treated by Guizhi Tang with the preparation and administration method mentioned previously.If there is no upward rushing of Qi, this formula can’t be given.

Taiyang pattern with upward rushing of Qi after wrong catharsis can be treated still with Guizhi Tang.

“Upward rushing of Qi” here refers to a pathological tendency that the patient’s vital Qi still tends to expel the pathogen upward and outward although the Taiyang pattern has been treated wrongly by catharsis,manifesting as a subjective symptom, i.e., a feeling of Qi rushing upward from the epigastric region to the throat, in addition to the exterior syndrome, so Guizhi Tang can still be used with the same preparation and administration mentioned in Article 12 in order to support vital Qi to expel the pathogen by following the pathological tendency. Of course,absence of the upward rushing of Qi suggests vital Qi has been damaged seriously and the exterior syndrome has been transformed into the other transmuted syndrome, so Guizhi Tang cannot be given again.

Guizhi Tang used for Taiyang pattern with a feeling of Qi rushing upward in the chest suggests that the patient has a pathological tendency of vital Qi to expel the pathogen upward and outward, and this is an example of a clinical application of the therapeutic principle, “guiding a matter along its course of development”（ Yin Shi Li Dao 因势利导）.

A disease characterized by frequent spontaneous sweating, means that the nutritive Qi is unaffected, yet not harmonized with the dysfunctional defensive Qi . Since nutritive Qi circulates within the vessels and defensive Qi flows outside the vessels, both should become well coordinated, and the patient will recover, after another induction of sweating. In such case, Guizhi Tang is available.

A patient suffering from frequently and lingeringly fever and spontaneous sweating, has no disorders of the Zangfu -organs, implying a dysfunction of defensive Qi, and can be relieved through diaphoresis, thus Guizhi Tang is available for this.

The pathogenesis and treatment of endogenous disease marked by frequent spontaneous sweating and lingering fever.

Here, “a disease” refers to an endogenously damaged disease which takes spontaneous sweating as a chief symptom. Here “no disorders of the Zangfu-organs” means interior syndromes have been excluded. The diseases in both articles are caused by disharmony between nutritive Qi and defensive Qi, so Guizhi Tang can be used for harmonizing both by mild diaphoresis. In this case, the root cause of the disharmony lies in dysfunctional or weak defensive Qi instead of nutritive Qi, namely,inability of weak defensive Qi to secure nutritive Qi, leads to undue outward discharge of nutritive Qi, thus presenting frequent spontaneous sweating or with a lingering fever sometimes due to abnormal openingclosing of the sweat pores.

In Guizhi Tang, Guizhi, Shengjiang and Zhi Gancao strengthen defensive Qi ( Yang Qi) to preserve nutritive Qi ( Yin fluid), Baishao and Dazao nourish Yin-blood and reduce sweating by astringing, so the formula can cure this disorder.

This is an extensive application of Guizhi Tang in endogenous miscellaneous diseases. In addition to Taiyang wind invasion syndrome seen in exogenous disease, Guizhi Tang can be also used for disorders due to disharmony between nutritive Qi and defensive Qi in endogenous diseases, manifested as frequent spontaneous sweating, or/and lingering fever, aversion to wind, easily catching a cold, lassitude, shortness of breath, dizziness, pale complexion and tongue, and thready-weak pulse,which can be treated by Guizhi Tang. In case of more serious deficiency of defensive Qi, this formula may be combined with Yu Pingfeng San（玉屏风散）, and in case of more serious Yang deficiency with persistent cold sweating, intolerance of cold, and cold-pain in limbs and joints, it can be combined with Zhi Fuzi and Baizhu. It is not necessary for the patient to cover with a blanket and drink hot porridge when taking this decoction since he has sweated much already.

Guizhi Tang is originally for releasing muscular symptoms. If the patient has a floating-tense pulse, fever with no sweating, it is contraindicated. A physician should keep in mind so as not to make this mistake.

If a heavy drinker suffers from exterior syndrome, Guizhi Tang cannott be given, otherwise it may cause vomiting because the sweet-warm quality would be unbearable.

Two contraindications of Guizhi Tang.

Guizhi Tang can expel wind to relieve the exterior syndrome mildly,through harmonizing both defensive Qi and nutritive Qi, also known as“releasing muscular symptoms”. This differs from the action of Mahuang Tang, i.e., expel cold to relieve exterior syndrome by strongly inducing sweating, so Guizhi Tang is used exclusively for wind-cold exterior deficiency syndrome instead of wind-cold exterior excess one, marked by aversion to cold with fever, absence of sweating, and a floating-tense pulse.

Guizhi Tang is sweet in flavor and warm in nature, and a person indulging in excessive alcohol drinking usually contracts damp-heat accumulation in the middle Jiao. Therefore, a heavy drinker takes Guizhi Tang will suffer from nausea, vomiting and epigastric stuffiness resulting from worsening damp-heat pathogen in the middle Jiao and further causing adverse ascending of stomach- Qi.

Although Guizhi Tang has an extensive clinical application, however it belongs to the category of sweet-warm and tonifying-astringing formulas,thus cannot be used to treat Taiyang cold invasion syndrome and other interior heat or damp-heat syndromes.