www.needleplant.com

In the analysis of both these prescriptions, we see a situation where both the 太阳 and 阳明 are implicated. Let’s take a look at the original text one by one:

1. 葛根芩连汤 from 《伤寒论》:

“太阳病，桂枝证，医反下之，利遂不止，脉促者，表未解也；

喘而汗出者，葛根黄芩黄连汤主之。” (line 34)

The first part of the line tells us a situation where there is a Greater Yang disease of the Cinnamon Twig variety. Instead of using perspiration as treatment, precipitation is used instead. How silly. In any case, the guy ends up with non-stop diarrhea, a fast and uneven pulse. This means that the exterior is not resolved. I would look at it as an immune reaction that is treated wrongly, but now, on top of the original symptoms, we also get diarrhea and a rushing pulse. If the exterior manifests more significantly than the diarrhea, then we can use the 逆流挽舟 method, i.e. you resolve the exterior, and the interior problem (diarrhea here) will take care of itself. 桂枝加葛根汤 is recommended in some books, most matching of course if you also have a stiff nape!

The second part of the line says that “if the guy is panting (breathing difficulty) and perspiring, use 葛根黄芩黄连汤 as treatment. From the prescription itself, we can infer that the interior problem has to do with damp-heat - see use of 黄连 and 黄芩, and we can infer from the herbs that it’s heat that is causing the breathing difficulty.

Note: Although 葛根黄芩黄连汤 is a 表里双解剂, we can use it when the problem is strictly ‘interior’. Some contemporary disease treated using this formula include: colitis, ’stomach flu’, bacillary dysentery, typhoid fever, that present with similar symptoms. I don’t know if i’d use it for bacillary dysentery or typhoid fever, quinolones like ciprofloxacin (环丙沙星) should give more assurance. however, it might be useful for chronic bacillary dysentery.

2. 厚朴七物汤 from 《金匮要略》:

“病腹满，发热十日，脉浮而数，饮食如故，厚朴七物汤主之。”

The two problems we have here is abdominal distension and fever (heat effusion) for ten days. The pulse is floating, which shows that the immune system is still hard at work trying to rectify the imbalance. The pulse is also rapid, and here the concept of heat is important - the pathogen is creating heat in the system. But appetite is as normal, and we understand this as a healthy stomach qi, or put simple a system that is still strong enough to weather strong precipitating drugs.

To understand further what this line means, we need to look at the herbs in the prescription. Put simply, it is a combination of  厚朴三物汤 (heavy on the 厚朴 - 8兩) and 桂枝汤 without the 芍药 - check out the variations on 桂枝汤 here. Explained simply, this combination helps ’shit’ away the interior heat/dryness, while resolving the exterior cold. There is enough heat/dryness to warrant using the entire army that makes up 小承气汤, but realize that the focus is on 厚朴 to bear downwards and get rid of the abdominal bloatedness/distension.

The textbook says that this is a case where both the exterior and interior illness are quite intense. I prefer to understand it as a heavy-duty exterior illness (10 days of fever!) coupled with a constitution that can handle it, hence manifesting interiorly on as abdominal distension.

Again, we need to 以方测证, and can infer from the presciption combination that there must be an exterior symptoms present of the 桂枝汤 variety, OR more interestingly, the person is a 桂枝汤 person who needs to 调和营卫. In any case, we have the constitution of the person more or less spelt out. Now, the abdominal distention and fever has lasted for quite a long time, probably without any medical intervention so far. And we need to do something.

I think that the key point here is the strong 胃气 (stomach qi) . It allows us to solve the stomach-channel problem using the most textbook-like method. Then of course, there’s the use of Cinnamon Twig Decoction to resolve the exterior - something which could have been done a long time back, just late in the coming. The absence of 芍药 (white peony) is pretty much explainable if you’ve read the rest of Mr. Zhongji (author of this entire compendium). The abdominal distension is NOT accompanied by pain.

Difference between the two prescriptions:

While both are treatment for an exterior disease lunging inward into the Yangming domain, the problems seen in the gastrointestinal tracts are different:

1. GGQLT is about stemming diarrhea that accompanies an unresolved exterior, while HPQWT is about clearing a bloated tummy that accompanies an unresolved exterior.
2. The methods used: GGQLT uses bitter, drying herbs to stem diarrhea, while HPQWT uses precipitation to downbear the distension.