Wang Haogu (王好古) is often lumped together with Ligao (李杲), both having been disciples of Zhang Yuansu in Hebei, North China. Wang Haogu later put himself under the discipleship of Li Gao. We will naturally see him as a Spleen-Stomach kind of guy. But in fact, he was never affixed to any one idea, using cold herbs as and when necessary.
His most oft-used formulas included siwu tang (四物汤), lizhong tang (理中汤) and pingwei san (平胃散), each of which he had manifold modifications of — 60 for siwu tang alone. He would also use “colder” formulas like baihu tang (白虎汤), xijiao dihuang tang (犀角地黄汤), ganlu yinzi (甘露饮子) and xie bai san (泻白散), so readers see the broad nature of his herb usage. The important thing to him was to have the herb combination fit the disease situation at hand.
On Yin Patterns?
Wang Haogu is known for his views on Yin patterns. One of his views (the quote above) is that “Yang patterns are easy to diagnose and treat;Yin patterns are difficult to diagnose and treat.”
Who gets Yin patterns (阴证)? Not the hardy person riding on horseback. The hardy person will likely show Yang patterns (阳证) however mild the pathogenic attack. But the bloke with constitutional deficiency will exhibit Yin patterns, even if it is caused by a heat pathogen (热邪).
This, to me, concerns the inflammatory process. Imagine a kid with fever – this kid has alot of yang qi (阳气) and so the fever is high. Compare the kid against a grown man with weak immunity – it could be because he has a weak constituion (体质弱) or because of a chronic disease (慢性病). He will exhibit low fever or none at all.
Greater Yin Disease (太阴病) in the Shang Han Lun (伤寒论)?
When discussing the treatment of cold patterns (寒证) in the Shanghanlun, Wang Haogu says that a person who gets Greater Yin disease (太阴病) is ill not so much because of pathogen invasion, but rather because this person already has deficiency in Spleen yang. If you think about it, it is a very enlightened statement for his time.
This Spleen yang deficiency manifests as diarrhea and occasional abdominal pain. We can push it further and conclude that lizhong wan (理中丸) is not for treating Cold Damage (伤寒). Rather, it is for treating diseases of miscellaneous internal damage (内伤杂病).Y
In a similar vein, he views the person with Shao Yin disease as having Kidney Yang Deficiency. As for Jue Yin Disease, tongmai sini tang (通脉四逆汤) is used to rebalance a Liver yang deficiency (肝阳不足). The formula danggui sini tang (当归四逆汤) is also used.
Regarding the three yin diseases (三阴证):
The issue here is that the person is already deficient (病人体质), and yin pathogen is thought to be hiding inside the body (内已伏阴). The treatment principle is first to strengthen the Right Qi (扶正).
Note too that Zhang Zhongjing was already accounting for deficiency in people with the three yang patterns (三阳证). For example, when using baihu tang (白虎汤), ginseng (人参) is being added for the deficient types. He also made it very clear that mahuang tang (麻黄汤) is not suitable for people who sweat easily (汗家). Similar considerations are made in the case of guizhi jia fuzi tang (桂枝加附子汤).