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Formulas pungent in flavor and cool in property for relieving exterior syndromes are indicated for exterior heat syndromes due to exogenous wind-heat or warm pathogenic diseases in the early stage when the pathogen lies in the defensive qi of the lung. The usual symptoms are fever, slight aversion to windcold, cough, thirst, a red tip of the tongue, a thin yellowish tongue coating, a floating and rapid pulse, and so on. Since the yang pathogens of warmth and heat often enter first through the mouth and nose, and the illness is often transformed from heat, the symptoms of fever, thirst, distention and sore throat, and so on, are often relatively distinct in an exterior heat syndrome. Formulas pungent in flavor and cool in property for relieving exterior syndromes mainly comprise medicinals with pungent flavor and cool property, with the effects of relieving the exterior syndrome, such as sāng yè (桑叶, Folium Mori), jú huā (菊花, Flos Chrysanthemi), bò he (薄荷, Herba Menthae), niú bàng zĭ (牛蒡子, Fructus Arctii), sh ēng má (升麻, Rhizoma Cimicifugae), gé gēn (葛根, Radix Puerariae Lobatae), and so on. In regards to combination, according to the degree of warmth and heat of the pathogenic qi and the combining pathogen, and also according to the differences in degree of injury of yin and exhaustion of fluid, there are the following main aspects:
For example, jīn yín huā (金银花, Flos Lonicerae Japonicae), lián qiào (连翘, Fructus Forsythiae), zhú yè (竹叶, Herba Lophatheri), shí gāo (Gypsum Fibrosum), and zhī mŭ (Rhizoma Anemarrhenae), etc. As the degree of fever and thirst is relatively severe in exterior heat syndromes, and the pathogen of wind-heat usually combines with heat toxicity to form the illness, targeting the nature of the toxic pathogen of warmth and heat, with formulas pungent in flavor and cool in property for relieving exterior syndromes, medicinals with the function of clearing heat are often equally used for strengthening the actions of clearing and relieving the toxicity of wind, heat and warmth. The meaning of this combination is somewhat different than the combination of medicinals for clearing heat in formulas pungent in flavor and warm in property for relieving exterior syndromes. Yu Gen-chu stated that: “ To treat a syndrome of injury due to cold, sweating should first be induced to relieve the exterior syndrome; to treat warm and heat syndrome, one should mainly clear the interior ” (伤寒以发表为先，温热以清里为主), cited from the Revised Popular Guide to the Discussion on Cold Damage ( Chóng Dìng Tōng Sú Shāng Hán Lùn , 重订通俗伤寒论). This not only explains the different emphases in therapeutic methods and formulation of formulas between relieving exterior syndromes with medicinals pungent in flavor and warm in property and relieving exterior syndromes with medicinals pungent in flavor and cool in property, but also reveals the significance of the combination of medicinals for clearing heat in formulas pungent in flavor and cool in property for relieving exterior syndromes. An example is Yín Qiào Săn (Lonicera and Forsythia Powder) , recorded in the Systematic Differentiation of Warm Pathogenic Diseases ( Wēn Bìng Tiáo Biàn , 温病条辨), in which bò he (Herba Menthae) and niú bàng zĭ (Fructus Arctii) are for calming and dispelling wind and heat, jīng jiè suì (荆芥穗, Spica Schizonepetae) and dàn dòu chĭ (淡豆豉, Semen Sojae Praeparatum) are for expelling the pathogens outward, and at the same time, yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae), and zhú yè (Herba Lophatheri) are used for clearing heat and resolving toxicity. Combined with medicinals for benefitting the throat and promoting the production of fluid, this formula is broadly used for warm pathogenic diseases in the early stage with heat stasis in the lung’s defensive qi, and some illnesses in the throat and mouth. Another example is Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage) , recorded in the Systematic Differentiation of Warm Pathogenic Diseases , in which it is combined with lián qiào (Fructus Forsythiae) in the formula to clear heat and relieve toxicity, and has also been explained as an example of a modifying method in the following annotation: “ For syndromes that cannot be relieved for two or three days, with asthma-like breathing, dryness at the qi level, shí gāo (Gypsum Fibrosum) and zhī mŭ (Rhizoma Anemarrhenae)may be combined ” (二三日不解，气粗似喘，燥在气分者，加石膏、知母). This indicates that to treat wind-warm pathogenic diseases in the early stage combined with severe heat in the yangming at the qi level, there should be an increase in the compatible proportion of medicinals for clearing heat. This holds significant meaning in guiding clinical applications. With further pharmacological research on the anti-bacterial, anti-viral, anti-febrile and anti-inflammatory functions of the medicinals for clearing heat, this kind of combination has been expanded to some extent regarding the selection of medicinals and the formulation of formulas. Examples are Qiāng Bàng Pú Bò Tāng (Notopteryguim, Arctium, Dandelion, and Mint Decoction, 羌蒡蒲薄汤) and Sān Yáng Qīng Jiĕ Tāng (Triple Yang Clearing and Resolving Decoction, 三阳清解汤) , recorded in the Practical Chinese Medicinal Formula ( Shí Yòng Fāng Jì Xué , 实用方剂学). In the former formula, qiāng huó (Rhizoma et Radix Notopterygii) is used for inducing sweating to relieve the exterior syndrome, bò he (Herba Menthae) and niú bàng zĭ (Fructus Arctii) are used for calming and dispelling wind-heat, pú gōng yīng (蒲公英, Herba Taraxaci) is combined in a large dosage to not only to strengthen the antifebrile function, but also to enhance the actions of relieving toxicity and reducing swelling; in the latter formula, gé gēn (Radix Puerariae Lobatae) and chái hú (Radix Bupleuri), with their pungent flavor and cool property, are used for dispelling pathogens in the exterior, and yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae), raw shí gāo (Gypsum Fibrosum), pú gōng yīng (Herba Taraxaci), dà qīng yè (大青叶, Folium Isatidis), huáng qí (Radix Astragali)and gān căo (Radix et Rhizoma Glycyrrhizae) are combined for clearing heat and relieving toxicity, benefitting the throat and eliminating swelling. Both of the formulas may be used for influenza, upper respiratory tract infection, tonsillitis, parotitis and other infectious diseases, and can achieve considerable curative effects.
When combining medicinals for clearing heat in formulas pungent in flavor and cool in property for relieving exterior syndromes, it is first suitable to select medicinals with the functions of clearing heat and relieving toxicity, which are at the same time light in property and can dispel exterior pathogens, such as yín huā (Flos Lonicerae Japonicae) and lián qiào (Fructus Forsythiae). They are pungent in flavor and light in property, can enhance the effects of penetrating while clearing; they are not only pungent and cool so as to exhibit effects of dispelling pathogens and eliminating fever, but they are also aromatic with the functions of dispersing turbidity and relieving toxicity, so they are the first choices in formulas pungent in flavor and cool in property for relieving exterior syndromes. Secondly, it is appropriate to select medicinals with the function of clearing heat and which can tonify ying to promote the production of fluids, such as shí gāo (Gypsum Fibrosum)and zhī mŭ (Rhizoma Anemarrhenae), because wind and heat are yang pathogens, they easily injure body fluids, and can induce the severe heat syndrome at the qi level, such as shí gāo (Gypsum Fibrosum) and zhī mŭ (Rhizoma Anemarrhenae), which can clear heat, promote the production of fluids and relieve thirst, and not only can they target wind-heat syndromes combined with injury to body fluids due to excessive heat, but they also can prevent and stop the transfer and transformation of heat. In addition, modern pharmacological research has revealed that besides the aforementioned yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae) and zhī mŭ (Rhizoma Anemarrhenae), all medicinals which can clear heat and have antiviral and anti-bacterial functions as well as the action of inhibiting other pathogenic microbes, such as pú gōng yīng (Herba Taraxaci), dà qīng yè (Folium Isatidis), băn lán gēn (板蓝根, Radix Isatidis), guàn zhòng (贯众, Rhizoma Cyrtomii), zăo xiū (蚤休, Rhizoma Paridis), yú xīng căo (鱼腥草, Herba Houttuyniae) and other medicinals for clearing heat and relieving toxicity could also be combined according to the particular illness. In other words, combining medicinals with the function of clearing heat with medicinals pungent in flavor and cool in property for relieving exterior syndromes can strengthen the effects of relieving exterior syndromes and eliminating fever. Clinically, if the exterior syndrome is serious and the heat syndrome is mild, the proportion of medicinals for clearing heat may be smaller than that of the medicinals pungent in flavor and cool in property for relieving the exterior syndrome; if the heat syndrome is serious and the exterior syndrome is mild, then the proportion of medicinals for clearing heat may be increased accordingly. Balancing the proportion of medicinals, which are “pungent and penetrating” and those which are “clearing and relieving” according to the degree of “exterior” and “heat” in the exterior heat syndrome, is the key to enhancing curative effects clinically.
For example, lú gēn (芦根, Rhizoma Phragmitis), shēng dì (Radix Rehmanniae), mài dōng (麦冬, Radix Ophiopogonis), yù zhú (玉竹, Rhizoma Polygonati Odorati), and bĕi shā shēn (北沙参, Radix Glehniae).Since body-fluids are easily injured in a windheat syndrome or a syndrome of warm and dry pathogens, when the body is subjected to a wind-heat syndrome or the lung is injured by warmth and dryness, symptoms such as dryness in the throat, sore and painful throat, thirst, and red tip of the tongue, manifest due to damage and exhaustion of fluids in ying property in the lung and stomach. Therefore, in treatment, besides combining medicinals for clearing heat with medicinals pungent in flavor and cool in property for relieving exterior syndromes, medicinals with the function of tonifying ying to promote the production of fluids should be used to assist the prevention of damage to fluids by severe heat. The use of lú gēn (Rhizoma Phragmitis) in the above combination of Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage) and Yín Qiào Săn (Lonicera and Forsythia Powder) is for clearing heat, tonifying ying and promoting the production of fluids. Additional examples are the two formulas recorded in the Systematic Differentiation of Warm Pathogenic Diseases , Yín Qiào Tāng (Lonicera and Forsythia Decoction, 银翘汤) and Sāng Xìng Tāng (Mulberry Leaf and Apricot Kernel Decoction, 桑杏汤). The former formula is combined with shēng dì (Radix Rehmanniae) and mài dōng (Radix Ophiopogonis) for nourishing yin to promote the production of fluids and clearing heat to eliminate dysphoria, and is indicated for warm pathogenic diseases in the yangming marked by absence of sweat and a floating pulse; the latter formula is combined with shā shēn (Radix Glehniae) and lí pí (梨皮, Pericarpium Pyrus Bretschneideri) for clearing heat and nourishing ying, promoting the production of body fluids and moistening dryness, and is suitable for syndromes of damage to fluids in the lung and stomach due to warmth and dryness invading the exterior. It is not difficult to see that the purpose of combining medicinals pungent in flavor and cool in property for relieving exterior syndromes, or medicinals pungent in flavor and cool in property for clearing and moistening, with medicinals for tonifying yin and promoting the production of fluid is to pay equal attention to supporting the right qi and dispelling the pathogenic qi, to supplementing each other and enhancing the curative effects.
As for the body with depletion of yin and deficiency of blood, when it is affected by exogenous pathogens, the body often manifests an exterior wind-heat syndrome. Even if it were just infected with wind-cold occasionally, it would still mostly experience the transformation of heat from yang qi due to the transformation of the bodily constitution. Added to that is the theory in Chinese medicine that sweat and blood originate from the same source, and sweat is transformed from yin and blood, Wu Tang indicated: “ The formation of sweat is through the promotion of yang qi, and uses yin and body fluid as a material basis ” (汗之为物，是以阳气为运用，以阴津为材料), cited from Systematic Differentiation of Warm Pathogen Diseases . It elucidated that yin and blood are important material conditions for forming sweat in order to dispel pathogens. Therefore, an exterior wind-heat syndrome, due to exogenous factors, with depletion of yin and blood, often cannot be relieved if treatment were simply to induce sweating to relieve the exterior, because the source of sweat is not sufficient, and it is difficult to form sweat for penetrating the pathogens; if sweating were induced regardless, then the shortcoming of injuring yin and blood may appear, and would increase the severity of the disease. So in combining the medicinals for inducing sweating to relieve the exterior syndrome and medicinals for nourishing yin and tonifying blood to promote the production of body fluid, we not only can nourish yin to complement the source of sweat, but can also induce sweating to dispel the exterior pathogen. In this way, we can pay equal attention to both pathogenic and right qi, relieve the exterior syndrome and leave the right qi unharmed. Both in Cōng Bái Qī Wèi Yĭn (White Scallion Seven-Ingredient Beverage, 葱白七味饮) , recorded in the Arcane Essentials from the Imperial Library and in Jiā Jiăn Wēi Ruí Tāng (Solomon’s Seal Variant Decoction, 加减葳蕤汤) , recorded in the Popular Guide to the Discussion on Cold Damage , cōng bái (Bulbus Allii Fistulosi), dàn dòu chĭ (Semen Sojae Praeparatum), bò he (Herba Menthae), and dry gé gēn (Radix Puerariae Lobatae) are used for relieving the exterior syndrome, and at the same time, dì huáng (Radix Rehmanniae), mài dōng (Radix Ophiopogonis), yù zhú (Rhizoma Polygonati Odorati) and other medicinals with the functions of nourishing yin and tonifying blood are combined. These are truly representative formulas for nourishing yin and tonifying blood to relieve exterior syndromes.
What should be explained further is that the medicinals in this kind of combination should be selected strictly from two aspects. Firstly, in selecting medicinals for relieving exterior syndromes, the medicinals pungent and bland in flavor, and cool and light in property, with the functions of eruption and sweating should be used first, and overly aromatic and dry medicinals should be used carefully to prevent the probability of injuring yin and exhausting blood. As indicated by Xu Da-chun: “ Aromatic and clear medicinals with very light property and very bland flavor should be used slightly to enable the pathogenic qi to be expelled outward from the skin and pores without hurting the middle jiao and body fluid ” (当用至轻至淡芳香清冽之品，使邪气缓缓从皮毛透出，无犯中焦，无伤津液) ( Treatise on the Evolution of Chinese Medicine , Yī Xué Yuán Liú Lùn , 医学源流论), which pertains precisely to the meaning above. So cōng bái (Bulbus Allii Fistulosi), dàn dòu chĭ (Semen Sojae Praeparatum), bò he (Herba Menthae), and gé gēn (Radix Puerariae Lobatae) are often selected first. Secondly, in selecting medicinals for nourishing yin and tonifying blood, soft and nourishing medicinals with a sweet and bland flavor and slightly cold in property should be chosen, and heavy and greasy medicinals, yin in property and soft in texture with the functions of astringing should be selected carefully to prevent the possibility of retaining pathogens and closing the exterior. Examples include yù zhú (Rhizoma Polygonati Odorati), which is “ sweet, neutral and moistening, and can tonify without obstructing the expulsion of pathogens ” (甘平滋润，虽补而不碍邪), cited from the Convenient Reader of Materia Medica ( Bĕn Căo Biàn Dú , 本草便读); dry dì huáng (Radix Rehmanniae), which is “ sweet, cold and light in texture, can especially clear heat in the lung, tonify yin and restrict yang ”(甘寒体轻，专清肺热，补阴而制阳), cited from the Bĕn Căo Zhèng Yào ( Rectification of the Materia Medica , 本草正要); shā shēn (Radix Glehniae), which can “e specially cool blood and nourish yin in the interior, moisten the luster of the skin in the exterior …because it shows the effect of moistening dryness without the detriment of being overly nourishing or greasy ” (内专凉血滋阴，外润皮肤荣泽，……以其有润燥之功，而无滋腻之患也), cited from the Encountering the Sources of the Classic of Materia Medica ( Bĕn Căo Féng Yuán, 本草逢原); lú gēn (Rhizoma Phragmitis), whose “ sweet flavor can benefit the stomach, and whose cold property can descend fire ” (甘能益胃，寒能降火), cited from the Grand Materia Medica .The aforementioned medicinals and others of this category should be especially selected first.
For example, chì sháo (Radix Paeoniae Rubra), dān pí (丹皮, Cortex Moutan), and zĭ căo (紫草, Radix Arnebiae), etc. Medicinals which can invigorate blood and cool blood are often combined in formulas pungent in flavor and cool in property for expelling pathogenic factors from the muscles and skin, in order to promote the eruption of measles, and to relieve toxicity, for the following indications: measles in the early stage which have not yet erupted, or measles which have not erupted completely and are due to heat toxicity in the lung and stomach which is hidden and stagnated in the skin and pores; or due to stasis retained in the blood and collaterals, so the color of the measles is not fresh and the measles have difficulty erupting; or for syndromes with the tendency for heat toxicity sinking to the blood level. This kind of combination not only can dispel stagnation at the blood level, but also can clear heat toxicity in the blood and collaterals, promote the eruption of measles, and often embodies the important clinical significance of turning the scale and heading off a dangerous condition. For example, in Shēng Má Gé Gēn Tāng (Cimicifuga and Pueraria Decoction, 升麻葛根汤) , recorded in Yan’s Prescriptions for Infantile Diseases ( Yán Shì Xiăo Ér Fāng Lùn , 阎氏小儿方论), shēng má (Rhizoma Cimicifugae) and gé gēn (Radix Puerariae Lobatae), which are pungent in flavor and cool in property and can expel pathogenic factors from the muscles and skin, promote the eruption of measles and relieve toxicity, and are used as the chief medicinals; chì sháo (Radix Paeoniae Rubra), which can clear heat and cool blood, invigorate blood and transform stasis, is used as the assistant medicinal; gān căo (Radix et Rhizoma Glycyrrhizae), which can harmonize the actions of the other medicinals, is used as the envoy medicinal; in this way it has become an effective formula for expelling pathogenic factors from the muscles and skin and promoting the eruption of measles. Another example is Chái Gĕ Jiĕ Jī Tāng (Bupleurum and Pueraria Flesh-Resolving Decoction, 柴葛解肌汤) , with the same but different composition, recorded in the Six Texts on Cold Damage and Medical Revelations (Y ī Xué Xīn Wù , 医学心悟). In both formulas, chái hú (Radix Bupleuri) and gé gēn (Radix Puerariae Lobatae), which can expel pathogenic factors from the muscles and skin and clear heat, are used as the chief medicinals. In the former formula, qiāng huó (Rhizoma et Radix Notopterygii) and bái zhĭ (Radix Angelicae Dahuricae), which are pungent in flavor and warm in property and can ascend and disperse, are combined to place particular emphasis on expelling pathogenic factors from the muscles and skin; in the latter formula, zhī mŭ (Rhizoma Anemarrhenae) and shēng dì (Radix Rehmanniae), which can clear heat and promote the production of body fluid, are combined to place particular emphasis on clearing heat. However, in both formulas, sháo yào (Radix Paeoniae Rubra), which can invigorate blood and cool blood is used as the assistant medicinal, and in the latter formula dān pí (丹皮, Cortex Moutan) is added, so the combination of medicinals for invigorating and cooling blood is more prominent.
What should be noted is that in the above Shēng Má Gé Gēn Tāng and Chái Gé Jiĕ Jī Tāng , the medicinal, sháo yào, in both of the original formulas was neither marked as bái sháo (Radix Paeoniae Alba) or chì sháo (Radix Paeoniae Rubra), which may easily give rise to misunderstanding, thus warranting further discussion.
Firstly, although the differentiation of chì sháo (Radix Paeoniae Rubra) and bái sháo (Radix Paeoniae Alba) was first recorded in the Collections of Commentaries on the Classic of the Materia Medica ( Bĕn Căo Jīng Jí Zhù , 本草经集注), compiled by Tao Hong-jing in the Liang Dynasty, they were not used separately, so until the Song and Ming Dynasties, they were still listed as sháo yào in formula books. According to the textual research of relevant literature, the sháo yào recorded in the herbal literature before the Tang Dynasty was the chì sháo (Radix Paeoniae Rubra) of today; and the medicinal used as bái sháo (Radix Paeoniae Alba) at present, was also named golden sháo yào . In fact, the separate application of bái sháo (Radix Paeoniae Alba) and chì sháo (Radix Paeoniae Rubra) began from the Song Dynasty( Academic Journal of Beijing University of Traditional Chinese Medicine , 1991, 1:49). As the evolutionary process of the name and herbs of sháo yào is quite lengthy, the sháo yào recorded in formulary books in the Song and Ming Dynasties still may be bái sháo (Radix Paeoniae Alba) or chì sháo (Radix Paeoniae Rubra). When we analyze according to the effective characters put forward firstly by Cheng Wu-ji in the Jin Dynasty: “ As for sháo yào, bái sháo (Radix Paeoniae Alba) can tonify and chì sháo (Radix Paeoniae Rubra) can purge; bái sháo (Radix Paeoniae Alba) can astringe and chì sháo (Radix Paeoniae Rubra) can dispel ”(芍药, 白补而赤泻，白收而赤散) ( Annotation and Explanation of the Discussion on Cold Damage - Zhù Jiĕ Shāng Hán Lùn, 注解伤寒论), and because both of the above formulas use sháo yào for expelling pathogenic factors from the muscles and skin, promoting the eruption of measles, and invigorating and cooling blood, this seems to point to the medicinal, chì sháo (Radix Paeoniae Rubra).
Secondly, according to clinical experience, when treating measles that cannot be erupted completely, chì sháo (Radix Paeoniae Rubra) is the more suitable medicinal. Chì sháo (Radix Paeoniae Rubra) shows the function of cooling and invigorating blood, so it can clear heat toxicity in the blood and collaterals to promote the eruption of measles. As Zhou Feng-wu said when he analyzed Shēng Má Gé Gēn Tāng (Cimicifuga and Pueraria Decoction): “ In this formula, sháo yào should mean chì sháo (Radix Paeoniae Rubra), because chì sháo (Radix Paeoniae Rubra) is bitter in flavor and slightly cold in property, and can enter blood, indicating the actions of invigorating blood while clearing heat and cooling blood, and may be used to clear heat toxicity in the blood and collaterals; however bái sháo (Radix Paeoniae Alba) is sour in flavor and can astringe, and is adverse to the eruption of measles, so combination with bái sháo (Radix Paeoniae Alba) in this formula is not suitable ” (方中芍药当用赤芍，赤芍苦而微寒，并入血分，清热凉血之中有活血作用，以清解血络热毒，而白芍酸敛，不利于麻疹的透发，故不宜配伍白芍), cited from the Practical Chinese Medicinal Formula .
Thirdly, after the Ming and Qing Dynasties, in formulas for early-stage measles and measles which cannot erupt completely, when sháo yào was used, doctors mainly gave clear instructions for chì sháo (Radix Paeoniae Rubra). Examples are Shēng Má Jiĕ Dú Tāng (Cimicifuga Toxin-Resolving Decoction, 升麻解毒汤) , recorded in the Indispensable Tools for Pattern Treatment ( Zhèng Zhì Zhŭn Shéng , 证治准绳) and Gé Gēn Jiĕ Jī Tāng (Pueraria Flesh-Resolving Decoction, 葛根解肌汤) , recorded in Book to Safeguard Life in Measles ( Má Kē Huó Rén Shū , 麻科活人书).
For example, jīng jiè (Herba Schizonepetae), sū yè (Folium Perillae), and cōng bái (Bulbus Allii Fistulosi), etc. Although formulas pungent in flavor and cool in property for relieving exterior syndromes mainly comprise medicinals pungent in flavor and cool in property for relieving exterior syndromes, sometimes they also combine with medicinals pungent in flavor and warm in property for relieving exterior syndromes. The reason for this is two-fold.
Firstly, in the early stage, exterior wind-heat syndromes due to exogenous factors are often combined with symptoms of slight aversion to wind-cold, incomplete sweating, or even absence of sweating. However, the function of inducing sweating to relieve exterior syndromes in medicinals pungent in flavor and cool in property for relieving exterior syndromes is relatively weaker. If the skin and pores are all closed due to stasis, along with a slight cold which cannot be relieved, it often affects the outgoing of the wind-heat pathogen, and can even defer the disease or transform it into other diseases.
Secondly, in formulas pungent in flavor and cool in property for relieving exterior syndromes, medicinals that are pungent in flavor and cold in property with the function of clearing heat are often combined or used in a large dosage. Although this kind of combination implies the function of eruption while clearing and can clear heat and relieve toxicity, it is difficult to avoid the possibility of closing the exterior due to cool medicinals. Therefore, according to the degree of aversion to cold, the quantity of sweat in the exterior, and according to the proportion of combined medicinals with the function of clearing heat, proper medicinals pungent in flavor and warm in property for relieving exterior syndromes are often combined in formulas pungent in flavor and cool in property for relieving exterior syndromes. It not only can open and purge the skin and pores to expel the pathogens outward and strengthen the action of relieving the exterior, but can also prevent medicinals which are cold or very cold in property from closing up the skin and pores. In this way, the compatible characteristics of formulas pungent in flavor and cool in property for relieving exterior syndromes were formed after the Ming and Qing Dynasties, which distinctly indicates the maturity of the techniques for formulating formulas and selecting medicinals for formulas pungent in flavor and cool in property for relieving exterior syndromes. An example is Yín Qiào Săn (Lonicera and Forsythia Powder) , recorded in the Systematic Differentiation of Warm Pathogenic Diseases , in which bò he (Herba Menthae) and niú bàng zĭ (Fructus Arctii) are used for calming and dispelling wind-heat, yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae) and zhú yè (Herba Lophatheri)are used for clearing heat, lú gēn (Rhizoma Phragmitis), jié gĕng (Radix Platycodonis) and raw gān căo (Radix et Rhizoma Glycyrrhizae) are used for clearing heat, promoting the production of body fluid and benefitting the throat. At the same time, medicinals pungent in flavor and warm in property for relieving exterior syndromes, such as jīng jiè suì (Spica Schizonepetae) and dàn dòu chĭ (Semen Sojae Praeparatum), are combined to not only strengthen the function of medicinals for calming and dispelling wind-heat thus relieving the exterior, but also to restrict the cold and cool properties of medicinals for clearing heat and to achieve the great effect of masking its property while retaining its function. When Yín Qiào Săn (Lonicera and Forsythia Powder) is used to treat seasonal diseases in the early stage, the famous contemporary doctor, Pu Fu-zhou, mostly added cōng bái (Bulbus Allii Fistulosi)into the formula, namely combining it with Cōng Chĭ Tāng (Scallion and Fermented Soybean Decoction) in order to strengthen the action of expelling pathogens outward. This is also a further development in selecting medicinals in this kind of combination. In Qiāng Bàng Pú Bò Tāng (Notopteryguim, Arctium, Dandelion, and Mint Decoction, 羌蒡蒲薄汤) , recorded in Practical Chinese Medicinal Formula , qiāng huó (Rhizoma et Radix Notopterygii) is used, because inspite of the fact that it is a medicinal pungent in flavor and warm in property, when it is combined with bò he (Herba Menthae) and niú bàng zĭ (Fructus Arctii), which are pungent in flavor and cool in property for relieving exterior syndromes, and with pú gōng yīng (Herba Taraxaci), which is cold and cool in property and used for clearing heat, the purpose of dispelling exogenous pathogens is achieved. Thus it can be seen that combining a few medicinals pungent in flavor and warm in property in formulas pungent in flavor and cool in property for relieving exterior syndromes, would not affect the pungent and cool property of the whole formula. On the contrary, this can strengthen the function of calming and dispelling wind-heat, relieving exterior syndromes and diffusing pathogens. From the aspect of selecting medicinals pungent in flavor and warm in property for relieving the exterior, medicinals neutral and soothing in property and warm, but not dry, are suitable.
As for the formulating of formulas pungent in flavor and cool in property for relieving exterior syndromes, some formulas are also formulated by combining medicinals pungent in flavor and cool in property, for relieving exterior syndromes with medicinals cold and cool in property for clearing heat. Examples are the combination of má huáng (Herba Ephedrae) with shí gāo (Gypsum Fibrosum) in Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) , recorded in the Discussion on Cold Damage , and the combination of qiāng huó (Rhizoma et Radix Notopterygii) and bái zhĭ (Radix Angelicae Dahuricae) with huáng qí (Radix Astragali)and shí gāo (Gypsum Fibrosum) in Chái Gĕ Jiĕ Jī Tāng (Bupleurum and Pueraria Flesh-Resolving Decoction) , recorded in the Six Texts on Cold Damage . They are also representative formulas pungent in flavor and cool in property for relieving exterior syndromes. However, for this kind of compatible method, medicinals cold and cool in property for clearing heat must be the main aspects in a formula, otherwise if medicinals pungent in flavor and warm in property for relieving exterior syndromes are used in large dosages and medicinals for clearing heat are used as the combining medicinals, this would belong to the compatible range of formulas pungent in flavor and warm in property for relieving exterior syndromes. The shí gāo (Gypsum Fibrosum) used in large dosages in Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction), and the proportion of pungent and warm medicinals and cold and cool medicinals in Chái Gĕ Jiĕ Jī Tāng (Bupleurum and Pueraria Flesh-Resolving Decoction) may be regarded as the corroborative evidence for this kind of combination. As for the proportion of medicinals cold and cool in property for clearing heat and medicinals pungent in flavor and warm in property for relieving exterior syndromes, it should be determined according to specific diseases. For example, in the original formula of Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction), the proportion of shí gāo (Gypsum Fibrosum) and má huáng (Herba Ephedrae) was 2:1. In the modern clinic, when differentiating the variance in pathogenic mechanisms and syndromes, if there is sweating and asthma due to stagnation of the heat pathogen in the lung, or if there is adiaphoresis and asthma due to the obturation of the heat pathogen in the lung, the compatible proportions of 5:1 or 3:1 have been adopted respectively to treat the different diseases. According to his experience, Zhang Xi-chun emphasized that “ this formula was originally used for warm pathogenic diseases marked by sweating without high fever. If the syndrome were marked by adiaphoresis and relatively high fever, in the application of this formula, the proportion of medicinals in this formula should be changed due to the change in the syndrome. So when I use this formula, the dosage of shí gāo (Gypsum Fibrosum) is always ten times that of the dosage of má huáng (Herba Ephedrae), maybe one qian (one qian is equal to 5g) of má huáng (Herba Ephedrae) to one liang of shí gāo (Gypsum Fibrosum); or one and a half qian of má huáng (Herba Ephedrae) to one and a half liang of shí gāo (Gypsum Fibrosum) ” (此方原治温病之汗出无大热者，若其证非汗出且热较重者，用此方时，原宜因证为之变通，是以愚用此方时，石膏之分量恒为麻黄之十倍，或麻黄一钱，石膏一两；或麻黄钱半，石膏两半), cited from the Essays on Medicine Esteeming the Chinese and Respecting the Western . The balance in dosage and proportion of medicinals in these methods according to the particular diseases points to the value of clinical experience.