This paper reveals the formation of the decoctions in the Shanhanlun by comparisons of its pills, powders formulations and decoctions. In the early medicine found in the Huatuofang, pills and powder formulations, which have intense diaphoretic, emetic and laxative effects, were adopted. Although the Shanhanlun steers away from these extreme medicines, in the chapter Kebukepian there are two medical indications for such pills and powder formulations for basic treatment, and for such decoctions for relatively complicated symptoms of diseases. Focusing on the decoction preparations:the doses of the decoctions are related to those of the pills and the powder formulations. In addition, some of the decoction ingredients come from soup or gruel to take with a pill or a powder formulation. These mean that dosage forms are changed from pills and powders, to decoctions in stages. We therefore conclude that the decoctions in the Shanhanlun are derived from pills and powder formulations.

In oriental medicine, when an exopathogen enters the body, the inner spirits (内精) and the exopathogen conflict with each other. Disease occurs in this deficient condition of inner spirits. In most classical formulary, such as the Shanghanlun (傷寒論), the cause of disease is regarded as the external circumstance, such as the cold, the wind or warmth. Here, the authors surveyed the significance of exopathogens and endogenous factors in medical books such as the Shanghanlun, as well as the Jinkuiyaolue (金匱要略), the Suwen (素問), the Lingsue (霊枢) and the others, to obtain the results herein. In the original pathology of a disease concurrent with both an exogenous and an endogenous factor, there is conflict between well-regulated seasonal Qi (四時正気) and unregulated inner spirits. Previous to the development of internal mechanisms for disease causes,this concurrent pathology thinking is concerned significantly with the external world and Shenxien (神仙) thought. Furthermore ambiguities arise from various relationships between exogenous factors and endogenous factors.