Dual exterior-interior resolution formulas

Medicinal formulas that treat dual disease of the exterior and interior. Since both exterior and interior are susceptible to heat, cold, vacuity, and repletion, in theory there are numerous possible combinations: exterior cold and interior heat; exterior heat and interior cold; exterior repletion and interior vacuity; exterior vacuity and internal repletion; as well as dual cold of the exterior and interior; dual heat of the exterior and interior; dual vacuity of the exterior and interior; and dual repletion of the exterior and interior. Depending on the condition, dual exterior-interior resolution formulas are exterior-resolving medicines combined with heat-clearing, draining-precipitant, interior-warming, or supplementing agents. Some sources consider these formulas as a subcategory of harmonization formulas.

According to the cold damage theory of the Shāng Hán Lùn, external evils in the fleshy exterior are treated by resolving the exterior. When they pass into the interior, methods such as clearing heat, draining-precipitation, and interior warming are used. Dual exterior-interior resolution formulas are used for dual disease of the exterior and interior when interior patterns appear before the exterior pattern has been resolved or when external evils are contracted in patients already suffering from an interior pattern due to a previously existing illness.

It is generally believed that dual exterior-interior resolution formulas in practice are appropriate for patterns in which the exterior and interior evils are both exuberant, or when the interior evil is exuberant. By contrast, when the exterior evil is pronounced and the interior evil is mild, the appropriate action is to first resolve the exterior, and then treat the interior or treat them both together with an emphasis on resolving the exterior.

Cautions

First, it is important to establish that exterior and interior patterns are both present.

Second, it is important to determine whether the exterior and interior patterns are each attributable to cold or heat and vacuity or repletion.

Third, establish the relative severity of the interior patterns to avoid insufficient or excessive dosing of medicinals.

Subcategories

• Exterior-resolving interior-clearing formulas
• Exterior-resolving interior-warming formulas
• Exterior-resolving interior-attacking formulas

Exterior-Resolving Interior-Clearing Formulas

Formulas that resolve the exterior and clear the interior are suitable for conditions where the exterior evil has not been resolved and the interior heat is already intense. These manifest in exterior signs including aversion to cold with heat effusion together with interior heat signs such as vexation and agitation, in some cases heat diarrhea or panting, as well as a yellow tongue fur and a rapid pulse.

Main agents: Exterior-resolving agents:

Combined with heat-clearing agents:

Representative formula: Pueraria, Scutellaria, and Coptis Decoction (葛根黄芩黄连汤 gé gēn huáng qín huáng lián tāng).

Exterior-Resolving Interior-Warming Formulas

Formulas that resolve the exterior and warm the interior treat conditions in which the exterior evil has not been resolved and an interior cold pattern has already developed. These manifest in exterior signs such as aversion to cold with heat effusion and interior cold sights such as cold pain in the heart region and stomach, fullness in the chest, aversion to food, with a white tongue fur and a slow pulse.

Main agents

• Dried ginger (Zingiberis Rhizoma, 干姜 gān jiāng),
• Cinnamon bark (Cinnamomi Cortex, 肉桂 ròu guì)

If the condition has persisted for some time, dampness may collect and engender phlegm, in turn causing qì stagnation. In such cases, dampness-drying, phlegm-transforming qì-moving, and blood-quickening agents such as atractylodes (Atractylodis Rhizoma, 苍朮 cāng zhú), poria (Poria, 茯苓 fú líng), pinellia (Pinelliae Rhizoma, 半夏 bàn xià), bitter orange (Aurantii Fructus, 枳壳 zhǐ ké), tangerine peel (Citri Reticulatae Pericarpium, 陈皮 chén pí), officinal magnolia bark (Magnoliae Officinalis Cortex, 厚朴 hòu pò), and chuanxiong (Chuanxiong Rhizoma, 川芎 chuān xiōng).

Exterior-Resolving Interior-Attacking Formulas

Formulas that resolve the exterior and attack the interior treat exterior patterns with interior repletion accumulations. The exterior signs include heat effusion and aversion to cold, while the interior signs include abdominal fullness, constipation, and a red tongue with yellow fur. To treat this, exterior-resolving agents such as:

Main agents: Exterior-resolving agents (first six below) are combined with draining-precipitants (last two).

Since interior heat and binding repletion often involve qì depression, blood stagnation, and damage to liquid, agents such as unripe bitter orange (Aurantii Fructus Immaturus, 枳实 zhǐ shí), Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), chuanxiong (Chuanxiong Rhizoma, 川芎 chuān xiōng), and white peony (Paeoniae Radix Alba, 白芍药 bái sháo yào) can be added

Representative formulas

• Major Bupleurum Decoction (大柴胡汤 dà chái hú tāng)
• Saposhnikovia Sage-Inspired Powder (防风通圣散 fáng fēng tōng shèng sǎn)