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Exterior-resolving formulas

解表剂 〔解表劑〕jiě biǎo jì

Medicinal formulas that resolve the exterior. Exterior-resolving formulas treat exterior patterns presenting with aversion to cold, heat effusion, headache, generalized pain, a white or yellow tongue fur, and a floating pulse. They have the actions of promoting sweating, resolving the flesh, and outthrusting papules. They correspond to sweating among the eight methods and to exterior-resolving agents among medicinals. See also resolving the exterior.

Exterior-resolving formulas when externally contracted disease evils assail the exterior and affect the lung and defense qì. In such cases, the evil has not penetrated deeply, so the conditions are mild, allowing them to be treated by acrid dispersing and light diffusing medicinals that expel the disease evil from the fleshy exterior. Sù Wèn (Chapter 5) states, When it is in the skin, promote sweating to effuse it. Respond to lightness by lifting. If appropriate treatment is not given or the treatment fails to achieve its intended aims, and the disease evil is not resolved in the exterior, it will penetrate the body, giving rise to other patterns. Hence the Sù Wèn, Chapter 5, says, [A practitioner] proficient in healing [first] treats the skin and body hair, then treats the skin and flesh, then treats the sinews and vessels, then the six bowels, then the five viscera. This emphasizes that in the initial stages of exterior contractions, timely use of exterior-resolving formulas is important.

Exterior-resolving formulas treat exterior patterns caused by wind-cold or initial-stage warm evils, including conditions such as initial stages of measles, sore3s, water swelling, malarial disease, and dysentery presenting with aversion to cold, heat effusion, headache, generalized pain, a white or yellow tongue fur, and a floating pulse.

Disease evils that cause exterior patterns differ in nature, including both cold and heat. Depending on the patient, there may be exterior repletion or exterior vacuity. For these reasons, formulas are divided into three categories, namely warm acrid exterior-resolving formulas, cool acrid exterior-resolving formulas, and right-supporting exterior-resolving formulas to treat cold patterns, heat patterns, and vacuity patterns respectively. See Subcategories below.

Cautions

Exterior-resolving formulas are composed of acrid dispersing and light diffusing agents, which should not be subjected to excessively long dedication if they are to retain their medicinal strength.

They should be taken warm to help promote sweating. The aim is to achieve a gentle generalized sweat. Sweating has to be sufficient to resolve the disease evils but not so much as to damage yīn.

If the exterior evil is not eliminated and interior patterns start to develop, the principle of treatment is to first resolve the exterior and then treat the interior.

If exterior and interior are equally urgent, then dual resolution of exterior and interior is called for.

Exterior-resolving formulas should not be used if the disease evil has already penetrated the interior and in conditions where measles papules have already erupted, sores have already burst, or vacuity water swelling is present.

See resolving the exterior.

Subcategories

Warm Acrid Exterior-Resolving Formulas

Warm acrid exterior-resolving formulas treat exterior patterns due to External contraction of wind-cold with signs including aversion to cold with heat effusion, headache and stiff nape, aching pain of the limbs, absence of thirst thin, a white tongue fur, and a pulse that is floating and tight or floating and moderate.

Main agents

Given that wind-cold assailing the exterior often affects lung qì diffusion, formulas often include medicinals that diffuse the lung and rectify qì and ones that relieve cough and transform phlegm.

Representative formulas

  • Ephedra Decoction (麻黃湯má huáng tāng)
  • Cinnamon Twig Decoction (桂枝湯 guì zhī tāng)
  • Nine-Ingredient Notopterygium Decoction (九味羌活汤 jiǔ wèi qiāng huó tāng)
  • Minor Black Dragon Decoction (小青龙汤 xiǎo qīng lóng tāng)
  • Mosla Powder[1] (香薷散[1] xiāng rú sǎn[1])

    • Cool Acrid Exterior-Resolving Formulas

    Cool acrid exterior-resolving formulas course and disperse wind-heat in the treatment of initial-stage exterior patterns caused by externally contracted wind-heat or warm disease, manifesting in heat effusion, sweating slight aversion to cold, thirst, painful pharynx, cough, a thin white or slightly yellow tongue fur and a pulse that is floating and rapid.

    Main agents

    Diseases caused by warm-heat evils develop and change rapidly, and often involve congestion of toxin. Furthermore, warm evil affects the upper body, first invading the lung, usually affecting lung qì diffusion. For these reasons, cool acrid exterior-resolving formulas usually include heat-clearing toxin-resolving medicinals or agents that diffuse the lung and disinhibit the pharynx.

    Representative formulas

  • Lonicera and Forsythia Powder (银翘散 yín qiào sǎn)
  • Mulberry Leaf and Chrysanthemum Beverage (桑菊饮 sāng jú yǐn)
  • Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction (麻黄杏仁甘草石膏汤 má huáng xìng rén gān cǎo shí gāo tāng)

    • Right-Supporting Exterior-Resolving Formulas

    Formulas that support right and resolve the exterior treat exterior patterns in people with vacuity constitutions. For such patients, exterior-resolving treatment to achieve adequate effusing and dispersing action due to the vacuity of right qì, while supplementing treatment alone can prevent the evil from being expelled.

    Because vacuity can take different forms, formulas for such patients can include qì-boosting, yáng-assisting, yīn-enriching, or blood-nourishing medicinals.

    Representative formulas

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