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Originally, sweating should have been induced, but purgation was applied instead; this is a contraindicated approach (Ni). If sweating is induced first, the treatment is not contraindicated. Originally, purgation should have been applied, but sweating was induced first; this is also a contraindicated approach. If purgation is applied first, the treatment is not contraindicated.

This clarifies the meaning of "contraindicated" (Ni) mentioned in the previous chapter: When wind-cold pathogens close the exterior, acrid-warm dispersing methods are appropriate, while purgation is inappropriate. When dry-heat pathogens bind internally, bitter-cold purging methods are appropriate, while sweating is inappropriate. If the exterior pathogen is unresolved and the interior pathogen becomes vigorous, one should induce sweating first and then purge. If the interior pathogen is urgent while the exterior pathogen is slight, one should purge first and then induce sweating. Reversing this order results in a contraindicated condition. If the treatment method is appropriate and the sequence is correct, it is not considered contraindicated.

The Yangming channel transforms according to the Qi of Dry Metal. In individuals with vigorous Yang, if the exterior is constrained, the internal dryness will stir. However, without mismanagement causing fluid consumption, how could the dryness suddenly become vigorous? Only after sweating, purgation, or warm needle therapy damages the fluids and exhausts the Yin, causing dryness to flare up significantly, do the channels and fu-organs simultaneously suffer from pathogens, forming a condition requiring purgation. Although not as perilous as Shaoyin diseases, Yin deficiency with Yang hyperactivity harbors hidden crises, so one must not act rashly.

In Taiyang disease (Disease of the Taiyang Channel), if sweating is induced first but symptoms persist, and purgation is subsequently applied, and the pulse remains floating, the disease is not cured. A floating pulse indicates the pathogen is still at the exterior. Applying purgation against this causes the disease to remain uncured. Since the pulse is currently floating, we know the pathogen is still at the exterior; thus, resolving the exterior will lead to recovery. Guizhi Tang (Cinnamon Twig Decoction) should be administered. (See Taiyang 5 for the formula.)

In Taiyang disease, if sweating is induced first but symptoms persist, and purgation is subsequently applied: assuming there is heat in the fu-organs internally, purgation should cure it. However, if the pulse remains floating, it indicates the exterior pathogen is unresolved, and recovery is impossible. Because a floating pulse signifies the pathogen is at the exterior, neglecting the exterior pathogen while applying purgation causes the disease to remain uncured. One must resolve the exterior to achieve recovery, and Guizhi Tang is appropriate. This describes a situation where the Taiyang exterior syndrome has not yet ceased, while an interior fu-organ syndrome exists, which inherently requires purgation. However, purgation can only be performed after the exterior is resolved. If purgation is hastily applied before the exterior resolves, and the pulse still appears floating, the exterior will certainly not heal; therefore, Guizhi Tang should still be used to resolve the exterior.

After severe purgation followed by sweating, if urination is difficult, it is due to the loss of body fluids. Do not treat this directly; when urination naturally becomes smooth, the disease will self-resolve.

The Bladder is the official of the capital region, storing fluids. It can discharge them only through Qi transformation. Dampness in Spleen Earth and stagnation in Lung Metal prevent Qi transformation. Water-Earth dampness and Liver Wood stagnation hinder water movement, all leading to difficulty in urination. The difficulty in urination treated by Xiao Qing Long Tang (Minor Blue Dragon Decoction) and Wu Ling San (Five-Ingredient Powder with Poria) stems entirely from Spleen Earth dampness causing water retention. In such cases, difficulty in urination is caused by excessive dampness. However, if difficulty in urination occurs after sweating and purgation, it is due to fluid loss causing dryness, not dampness. If there are no other signs of heat and thirst, the dryness is not severe. Do not use medication. Wait for the fluids to gradually recover; once urination becomes smooth, the disease will self-resolve. After sweating and purgation, difficulty in urination affects those with Yang deficiency by causing Yang collapse and damp pathology, and affects those with Yin deficiency by causing Yin collapse and dryness pathology. Here, since there are no signs of Yang collapse with dampness stirring, we know this is fluid loss causing dryness injury. This also falls under the category of Renshen Baihu Tang (Ginseng and White Tiger Decoction), but since dry-heat has not yet manifested, the pathological trend is mildest, so treatment is unnecessary.