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Also greater yáng (tài yáng) exterior pattern. Disease characterized by aversion to cold or wind, headache, and a floating pulse. On Cold Damage (伤寒论 shāng hán lùn) states, In disease of greater yáng (tài yáng), the pulse is floating, the head and nape are rigid and painful, and there is aversion to cold. Usually there is heat effusion (fever). Other possible signs include generalized pain, together with tension and stiffness in the neck and back. This pattern is seen in many initial-stage externally contracted febrile diseases, and in terms of eight-principle pattern identification, it is an exterior cold pattern. According to the doctrine of cold damage, externally contracted febrile diseases are mostly attributable to contraction of wind-cold evil, which first affects the yáng channels.

Of the yáng channels, the greater yáng (tài yáng) is the first to be affected; consequently, it is said to govern the exterior of the body. The greater yáng (tài yáng) channel passes through the head and neck so that when its qì is depressed by an invading wind-cold evil, stiffness and pain occur in this region. Aversion to cold or wind and heat effusion are the pathological reactions of a body whose right qì (provisioning and defense) is struggling to resist evil qì. The floating pulse reflects disease in the exterior. Although On Cold Damage makes no reference to the tongue or its fur, it is important to note that in most cases the tongue fur is thin, white, and moist.

Differentiation between greater yáng (tài yáng) wind strike (exterior vacuity) and greater yáng (tài yáng) cold strike (exterior repletion patterns) is of crucial importance in identifying greater yáng (tài yáng) diseases. Judgment rests largely on the following factors: the presence or absence of aversion to cold or wind; whether the floating pulse is tight or moderate; and most crucially, the presence or absence of sweating. Exterior vacuity patterns involve sweating. They most commonly occur where, owing to provisioning-defense disharmony, the interstices are unsound and allow sweat to flow, whereas resistance is inadequate to expel the evil. In exterior repletion patterns, which occur when cold evil invades greater yáng (tài yáng), sweating does not occur since the evil impedes provisioning qì, leading to blockage of the interstices.

Medicinal therapy: The principal method used to treat greater yáng (tài yáng) diseases is sweating, i.e., exterior resolution. Its effect is to free defense qì, open the interstices, and expel the evil from the body through sweating. greater yáng (tài yáng) diseases characterized by the cold evil present in the exterior are treated by resolving the exterior with warm acrid medicinals (warm acrid exterior resolution).

Greater yáng (tài yáng) exterior repletion patterns—pathomechanically explained as obstruction of defense qì by an external evil leading to blockage of the interstices—are treated by promoting diffusion and dispersing the evil using Ephedra Decoction (麻黄汤 má huáng tāng), which effuses sweat (i.e., is diaphoretic).

Exterior vacuity patterns, pathomechanically explained as provisioning-defense disharmony preventing expulsion of the evil, are primarily treated by harmonizing provisioning and defense, using Cinnamon Twig Decoction (桂枝汤 guì zhī tāng), which resolves the flesh. Ephedra Decoction, containing both ephedra (Ephedrae Herba, 麻黄 má huáng) and cinnamon twig (Cinnamomi Ramulus, 桂枝 guì zhī), disperses the evil. Cinnamon-Twig Decoction, containing cinnamon twig (Cinnamomi Ramulus, 桂枝 guì zhī) and white peony (Paeoniae Radix Alba, 白芍药 bái sháo yào), is designed to harmonize provisioning and defense as a prerequisite for expulsion of the evil.

Both Ephedra Decoction and Cinnamon Twig Decoction are frequently varied. Several important formulas are derived from Ephedra Decoction.

• For example, Major Black Dragon Decoction (大青龙汤 dà qīng lóng tāng) treats patterns comprising signs such as agitation and absence of sweating, which arise when exterior cold, failing resolution by sweating (diaphoresis), becomes depressed and transforms into heat.
• Minor Black Dragon Decoction (小青龙汤 xiǎo qīng lóng tāng) is used for dual patterns of exterior cold and interior rheum, where exterior signs such as aversion to cold, heat effusion, and absence of thirst are accompanied by pronounced cough and panting.
• Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction (麻杏甘石汤 má xìng gān shí tāng), a variant of Ephedra Decoction, treats heat brewing in the lung with heat effusion, thirst, cough, and panting.

Cinnamon Twig Decoction (桂枝汤 guì zhī tāng) may be varied depending on the signs. For instance, pueraria (Puerariae Radix, 葛根 gé gēn) may be added when signs include stiffness in the neck and back, whereas officinal magnolia bark (Magnoliae Officinalis Cortex, 厚朴 hòu pò) and apricot kernel (Armeniacae Semen, 杏仁 xìng rén) may be added for the treatment of patterns that include panting.

Most patterns treated by Cinnamon Twig Decoction, Ephedra Decoction, and their variations fall within the scope of greater yáng (tài yáng) disease.

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