Traditional Medicine: Exterior-resolving Medicines

Generally speaking, exterior-resolving medicines include medicinals which can relieve or resolve exterior patterns. Typically, they expel external evils by promoting mild sweating. This diaphoresis out-thrusts and expels the pathogens. In addition, they resolve the muscles and promote the eruption of rashes or pox. They may also be used for the treatment of sores in the exterior and recent onset edema if either are accompanied by aversion to cold, fever, and other exterior pattern signs and symptoms. Exterior patterns are due to external invasion of the six environmental excesses. These include wind, cold, summerheat, dampness, dryness, and fire. The distinguishing characteristics of an exterior pattern are aversion to cold and wind, fever, headache, muscular aches and pains, and a floating pulse.

There are two main types of exterior patterns: hot and cold. Because the causative factors and the bodys reaction to disease is different, these two types of exterior patterns require treatment with different medicinals. In exterior cold patterns, aversion to cold is pronounced, there is slight fever, no particular thirst, either no sore throat or just a tickle in the throat, a clear nasal discharge, a floating, tight pulse, and a thin, white tongue coating. In an exterior heat pattern, there is less aversion to cold and wind, more extreme fever, definite thirst, definite sore throat, yellow, sticky nasal mucus, a floating, rapid pulse, and a red tongue tip with a yellow coating. Based on these two main types of exterior patterns, exterior-resolving medicines are divided into two main subcategories: 1) acrid, warm, exterior-resolving formulas and 2) acrid, cool, exterior-resolving formulas. However, a third subcategory also exists, called formulas for exterior conditions with interior vacuity.

Cautions in using exterior-resolving medicines:
The right degree of perspiration induced by exterior-resolving medicinals is a mild perspiration over the entire body. If perspiration is too much, righteous qi will be damaged. This is especially so in children and the aged. Excessive perspiration will also damage fluids and humors.

Patients may exhibit both exterior and interior patterns. In such cases, first relieve the exterior and then treat the interior. However, if both exterior and interior are affected to the same degree, treat both simultaneously.
The five contraindications of exterior-resolving medicines:

Do not resolve the exterior once exterior patterns have transmuted into interior patterns.
Do not resolve the exterior once pox and rashes have erupted.
Do not resolve the exterior once sores have ulcerated.
Do not resolve the exterior for the treatment of edema due to vacuity.
Do not resolve the exterior if there is dehydration due to vomiting and diarrhea.

Acrid, warm, exterior-resolving medicines

Name	Ge Gen Wan (Pueraria Pills).
Ingredients	Radix Puerariae (Ge Gen) Radix Ephedrae (Ma Huang) Ramulus Cinnamomi Cassiae (Gui Zhi) Radix Albus Paeoniae Lactiflorae (Bai Shao) uncooked Rhizoma Zingiberis (Sheng Jiang) Radix Glycyrrhizae (Gan Cao) Fructus Zizyphi Jujubae (Da Zao)
Functions	Dispels wind and resolves the exterior, resolves the muscles and engenders fluids
Indications	Stiffness and pain in the upper back, shoulders, nape of the neck, and occipital regions
Main signs & symptoms	Aversion to cold and effusion of heat, no sweating, neck and upper back stiffness and rigidity, thin, white tongue fur, and a floating, tight pulse
Dosage	8 pills three times per day
Formula explanation	The sovereign medicinal in this formula, Pueraria, resolves the exterior and particularly the muscles of the upper back and neck. This is because this medicinal enters the tai yang channel. Ephedra and Cinnamon Twigs are the ministerial medicinals which resolve the exterior and scatter cold. Peony is an assistant medicinal which astringes yin and thus prevents the strong exterior-resolves from damaging the qi and fluids. Together with Cinnamon Twigs, it harmonizes the constructive and defensive. This harmonization of the constructive and defensive is further carried out by the other assistant medicinals, Ginger and Red Dates. In addition, they harmonize the stomach. Licorice is the messenger medicinal which harmonizes all the other ingredients. Together with Peony, Licorice also relaxes tension (i.e., cramping) and is, therefore, useful in the treatment of upper back and neck stiffness and pain.
Comments	Some Chinese doctors use this basic formula to treat a wide variety of patterns and conditions. This is because it does supplement the spleen and, therefore, the qi and blood at the same time as it strongly upbears and effuses the qi. Upbearing and effusing can clear internal heat and upbearing and effusing can also disinhibit the qi mechanism, thus relieving depression. Therefore, when used skillfully, this formula can treat more than simple wind cold exterior patterns which are not that commonly met in Western patients. However, when used as a ready-made pill without modifying additions and subtractions, this formulas scope of use is not as great as when prescribed as an individually tailored, bulk-dispensed decoction.

Name	Xiao Qing Long Wan (Minor Blue Dragon Pills)
Ingredients	Radix Ephedrae (Ma Huang) Radix Albus Paeoniae Lactiflorae (Bai Shao) Herba Asari Cum Radice (Xi Xin) Ramulus Cinnamomi Cassiae (Gui Zhi) Rhizoma Pinelliae Ternatae (Ban Xia) Radix Glycyrrhizae (Gan Cao) dry Rhizoma Zingiberis (Gan Jiang) Fructus Schisandrae Chinensis (Wu Wei Zi)
Functions	Resolves the exterior and washes away rheum, stops cough and levels panting
Indications	Wind cold lodged in the exterior, water rheum collecting internally
Main signs & symptoms	Aversion to cold and emission of heat, no sweating, panting and coughing, profuse, thin phlegm, possible phlegm rheum coughing and panting, inability to lie down flat, possible generalized bodily aching and heaviness, puffy swelling of the face and four limbs, glossy, white tongue fur, and a floating pulse
Dosage	8 pills three times per day
Formula explanation	In this formula, Ephedra and Cinnamon Twigs are the sovereign ingredients. They effuse the sweat and resolve the exterior, eliminating external cold and diffusing the lung qi. Dry Ginger and Asarum are the ministerial medicinals. They warm the lungs and transform rheum while simultaneously assisting Ephedra and Cinnamon Twigs in resolving the exterior. Schisandra and Peony are the assistant medicinals. Schisandra constrains the qi, while Peony nourishes the blood. Thus they prevent consumption and damage of the lung qi and drying and damage of the fluids and humors by the acrid, warm, scattering, and effusing main medicinals. Pinellia dispels phlegm, harmonizes the stomach, and scatters nodulation. It is also an assistant medicinal. Mix-fried Licorice boosts the qi and harmonizes the stomach. It is also able to regulate and harmonize the acrid and scattering with the sour and astringing. It is simultaneously an assistant and messenger medicinal. When these eight flavors are combined together, they promote the resolution of wind and cold, the dispelling of water and rheum, and the soothing of the lung qi. Diffusion and downbearing are restored to their duty and all the symptoms are automatically leveled or calmed.
Comments	This formula is especially good for treating acute episodes of cold asthma and cold-natured allergic rhinitis attacks in those whose constitutions are not very robust, such as children, and who have habitual, deep- lying phlegm rheum in their lungs. Because Schisandra and Peony restrain the draining and scattering effects of Ephedra, this formula is usually quite safe to use. During remission stages of asthma or before the seasonal occurrence of airborne allergies, one should use other formulas which primarily supplement the lungs, spleen, and/or kidneys and transform phlegm and eliminate dampness. This formula is not appropriate for long-term administration or during remission due to the presence of Ephedra.

Name	Xin Yi Wan (Magnolia Flower Pills)
Ingredients	Flos Magnoliae Liliflorae (Xin Yi Hua) Rhizoma Atractylodis (Cang Zhu) Radix Ledebouriellae Divaricatae (Fang Feng) Herba Asari Cum Radice (Xi Xin) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Et Rhizoma Ligustici Chinensis (Gao Ben) Rhizoma Cimicifugae (Sheng Ma) Caulis Akebiae (Mu Tong) Radix Ligustici Wallichii (Chuan Xiong) Radix Glycyrrhizae (Gan Cao)
Functions	Dispels wind and scatters cold, eliminates dampness and disinhibits the orifices of the nose
Indications	Wind cold exterior pattern runny nose and stuffy nose. Allergic rhinitis, common cold
Contraindications	Do not use this medicine if the nasal mucus is yellow or green due to wind heat, phlegm heat, or upward counterflow of depressive heat.
Main signs & symptoms	Acute or recent onset of sneezing, runny nose, nasal congestion, profuse phlegm which is clear and white in color, white tongue fur, and a floating, bowstring pulse
Dosage	8 pills three times per day
Formula explanation	Magnolia Flowers are the sovereign medicinal in this formula. They dispel wind, scatter cold, and disinhibit the orifices of the nose. Ledebouriella, Notopterygium, Ligusticum Chinensis, Asarum, and Cimicifuga are all the minister medicinals which also dispel wind and resolves the exterior. Asarum also warms cold and transforms phlegm as well as strongly disinhibits the orifices of the nose. Atractylodes and Akebia are the assistant medicinals. The former aromatically dries dampness, while the latter percolates1 dampness. Licorice and Ligusticum Wallichium are the messenger medicinals. Licorice harmonizes and regulates all the other medicinals in the formula. Ligusticum Wallichium leads the action of the other medicinals upward to the head and face region.
Comments	This is a very good Chinese ready-made medicine for treating the symptoms of stuffy nose and runny nose when these are characterized as a wind cold pattern. This medicine can be used alone, or it can be combined with other Chinese ready-made medicines when nasal congestion and runny nose are important symptoms in a more complex pattern. Since most allergic rhinitis displays a wind cold pattern, at least in its acute stage, this medicine is a very good one for hayfever and animal dander allergies, whereas Xiao Qing Long Wan (Minor Blue Dragon Pills) discussed above are better for allergic asthma due to their inclusion of the lung diffuser and counterflow downbearer Ephedra. This medicine should not be used during the remission stages of allergic rhinitis when the treatment principles should be to supplement the lung and spleen and transform deep- lying phlegm.