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Formulas for relieving the exterior syndromes are mainly composed of medicinals for releasing the exterior. They have the effects of inducing sweating, releasing the flesh, promoting eruption of papules and resolving toxins, and are used to treat the exterior syndrome due to externally-contracted six pathogenic factors. Wang Ang called them as formulas for dispersing the exterior. Wu Yi Luo collected them in the category of dissipating the exterior, and the treatment method applied in these formulas pertains to the method of promoting sweating in the eight treatment methods.
About the origination and development of the formulas for releasing the exterior, the Basic Questions-The Jade Swivel Treatise on True Visceral Pulses ( Sù W è n - Yù Jī Zhēn Zàng Lùn , 素问·玉机真藏论) said that “ wind-cold attacks the body, and makes the fine hairs rise and the skin close, then the body becomes hot. It is at this time that the treatment of promoting sweating should be used to disperse wind-cold ”. (风寒客于人，使人毫毛毕直，皮肤闭而为热，当是之时，可汗而发也).
The Basic Questions-Great Treatise on the Correspondences and Manifestations of Yin and Yang ( Sù Wèn-Yīn Yáng Yìng Xiàng Dà Lùn , 素问·阴阳应象大论) emphasized that “ In the treatment for the pathogens of the exterior syndrome, it needs to decoct, steam or infuse medicinals to promote sweating. If the pathogens attack at the skin, it needs to promote sweating to disperse them .” (其有邪者，渍形以为汗，其在皮者，汗而发之). These are the theoretical foundations and the application principles of the formulas for releasing the exterior.
During the Eastern- Han Dynasty, in his two works, the Discussion on Cold Damage and the Essentials from the Golden Cabinet , Zhang Zhong-jing developed and propounded the theory for composing formulas recorded in the Inner Classic , and created many famous formulas, such as Má Huáng Tāng (Ephedra Decoction), Guì Zhī Tāng (Cinnamon Twig Decoction), Gé Gēn Tāng (Pueraria Decoction, 葛根汤), Dà Qīng Lóng Tāng (Major Green-Blue Dragon Decoction), Xiăo Qīng Lóng Tāng (Minor Green-Blue Dragon Decoction, 小青龙汤), Má Huáng Xìng Rén Gān Căo Shí Gāo Tāng (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction, 麻黄杏仁甘草石膏汤), and so on. Moreover, he outlined in detail the methods of taking and decocting formulas, as well as cautions and modifications of these formulas which can be considered as the“ancestor formulas” of formulas for relieving the exterior syndromes.
Literature in the Sui and Tang Dynasties, such as the Important Formulas Worth a Thousand Gold Pieces [for any Emergency] compiled by Sun Si-miao and the Arcane Essentials from the Imperial Library compiled by Wang Tao, recorded many collected formulas and accepted many views of the ancient doctors, and have preserved the valuable experiences of ancient doctors for the treatment of exterior syndromes. They also helped to supplement the deficiencies of Zhang Zhong-jing in the syndrome differentiation and medicinal selection from the aspect of combination in formulas for nourishing yin to relieve exterior syndromes and enriching blood to relieve exterior syndromes.
Due to the fact that Má Huáng Tāng (Ephedra Decoction) and Guì Zhī Tāng (Cinnamon Twig Decoction) have strict parameters for treating taiyang syndrome caused by cold damage, “ if taken incorrectly, the diseases will present with various changes ” (若差服，则其变不可胜数) cited from the Medicine Difficult to Know ( Cĭ Shì Nán Zhī , 此事难知), during the period of the Song, Jin and Yuan Dynasties, Zhang Yuan-su created Jiŭ Wèi Qiāng Huó Tāng (Nine-Ingredient Notopterygium Decoction, 九味羌活汤), consisting of pungent and warm medicinals along with sweet and cold, or bitter and cold medicinals, which has become an allpurpose formula for inducing sweating and dispersing cold for the four seasons. Based on the theory that “ the six pathogenic factors are all developed from fire ” (六气皆从火化)( Basic Questions -Mysterious Mechanism at the Origin of Pathology , Sù Wèn - Xuán Jī Yuán Bìng Shì , 素问·玄机原病式), Liu Wan-su initiated the treatment of pungent and warm medicinals to relieve exterior syndromes and relieving exterior and interior syndromes at the same time. He combined the medicinals with the effects of relieving exterior syndromes with the medicinals that can clear heat in one prescription, and created Fáng Fēng Tōng Shèng Săn (Saposhnikovia Sage-Inspired Powder, 防风通圣散), Shuāng Jiĕ Săn (Double Resolution Powder, 双解散) and other formulas. Zhang Cong-zheng accomplished in treatments for dispelling pathogens by inducing sweating. He deemed that: “ When the pathogenic qi of wind, cold, heat or dampness has entered the skin but has not yet progressed into the deep parts of the body, there is no method superior to that of inducing sweating in order to dispel them quickly ” (风寒暑湿之气，入于皮肤之间而未深，欲速去之，莫如汗法). He also emphasized that: “ Formulas, pungent in flavor and warm in property, should be used for syndromes of heat in the exterior and cold in the interior, while formulas pungent in flavor and cold in property should be used for the syndrome of cold in the exterior and heat in the interior ” (外热内寒宜辛温，外寒内热宜辛凉). He enriched the differentiation and treatment content of formulas for relieving exterior syndromes, and further enlarged the category of differentiation and treatment for exterior syndromes.
Since the Ming and Qing Dynasties, doctors who were skilled in the treatment of warm pathogenic diseases, such as Ye Gui, Wu Tang, Yu Gen-chu, especially elucidated and developed the method of relieving syndromes in the treatment of warm pathogenic diseases. They heavily emphasized the clinical applications of clear and light formulas and medicinals with the dispelling effects for the treatment of exterior heat syndromes at the defensive qi level, and summarized formulas pungent in flavor and cool in property for relieving exterior syndromes, such as Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage, 桑菊饮), Yín Qiào Săn (Lonicera and Forsythia Powder, 银翘散).They further enhanced the compatible theories on formulas for relieving exterior syndromes, and their clinical applications.
After the founding of the People’s Republic of China, there were great developments in both clinical application and experimental research for formulas for relieving exterior syndromes. They were used in early therapies for common cold, influenza, measles, parotitis, scarlet fever, epidemic cerebrospinal meningitis, and other infective diseases, and showed distinct curative effects for the treatment of acute nephritis, acute rheumatic fever, urticaria, anaphylaxis dermatitis and other allergic diseases. With an increase in in-depth research into their pharmacological effects, such as anti-microbial, anti-inflammatory, anti-febrile, sedative, anxiolytic, analgesic, immunity-regulating functions, along with many other effects, formulas for relieving exterior syndromes have become recognized by more and more clinical doctors, pharmacologists and pharmaceutical chemists, and have shown tremendous potential for wide use and application.
The range of exterior syndromes is very extensive, and the development of its disease syndrome and involved pathogens are also considerably complicated. Formulas for relieving exterior syndromes are divided into two types according to the characteristics of the syndrome and the warm or cool properties of the medicinals in the formula, namely formulas for relieving exterior syndromes with pungentwarm medicinals and those for relieving exterior syndromes with pungent-cool medicinals.
Analysis of the ingredients of the formulas for relieving exterior syndromes show that they are mostly pungent in flavor and either warm or cool in property. The medicinals with pungent flavor exhibit a dispelling characteristic, as stated in the Basic Questions - Great Treatise on the Essentials of Supreme Truth :“ Pungent property and sweet flavor shows dispelling characteristic and belongs to yang ”(辛甘发散为阳). Otherwise, because the lung governs the skin and hairs, and“ pungent property first enters the lung channel ”(辛先入肺) ( Basic Question - Great Treatise on the Essentials of Supreme Truth ), so it is prevalent that the formulas for relieving exterior syndromes are mainly composed of medicinals with a pungent flavor and show the effect of relieving the exterior syndrome.”
The general therapeutic principle is “f or cold syndromes, treat with a heating method; for heat syndromes, treat with a cold method; for warm syndromes, treat with a cooling method; for cool syndromes, treat with a warming method ” (寒者热之，热者寒之，温者清之，清者温之) ( Basic Questions - Great Treatise on the Essentials of Supreme Truth ). Therefore, to divide the formulas for relieving exterior syndromes into the two broad categories of pungent-warm and pungent-cold types is the correct method, but the characteristics of the syndrome are often highly varied due to the differences in the patients’bodies and in that of combined diseases. So based on these different situations, formulas for relieving exterior syndromes vary in order to adapt to the needs of the clinic.
A discussion on the compatible theories and main compatible methods in the representative formulas for relieving exterior syndromes in the past dynasties now follows: