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Wind-stroke (Fengzhong, a pattern of exterior deficiency with sweating) causes fever. If it persists for six or seven days without resolution and is accompanied by irritability, presenting both exterior and interior signs, where the patient desires to drink water but vomits immediately after swallowing, this condition is named "Water Reversal" (Shuini, vomiting due to water retention and failed qi transformation). It is primarily treated with Wuling San (Five-Ingredient Powder with Poria). After taking the medicine, drinking plenty of warm water to induce sweating will lead to recovery.

Wind-stroke originally presents with sweating. Because sweating occurs, if left untreated for a long time without employing methods to release the muscle layer (Jieji), excessive sweating merely damages body fluids without resolving the exterior pathogen. This exacerbates irritability and thirst. When the pathogen enters the fu organs (specifically the Bladder), causing immediate vomiting upon drinking water, it is called "Water Reversal." This occurs because heat pathogens accumulate and carry fluid retention upward, causing external water to be rejected and unable to enter. Taking Wuling San, followed by frequent intake of hot soup to induce sweating, resolves both the exterior and interior simultaneously, achieving two goals with one action. The Bladder is the mansion of body fluids, responsible for regulating water passages; thus, fire and heat are naturally transformed, and body fluids are preserved.

After inducing sweating, if neither water nor medicine can be tolerated, it is considered a reversal syndrome (Ni). If sweating is induced again, it will inevitably lead to incessant vomiting and diarrhea.

The inability to take in water or medicine constitutes a reversal, referring to Water Reversal. If sweating is induced again, leading to incessant vomiting and diarrhea, it is because the patient already has accumulated phlegm-fluids. Inducing sweating merely damages the clear yang qi in the stomach, inevitably causing middle jiao fullness. Further use of diaphoretic drugs causes fluids and dampness to steam like earth, leading to upward vomiting and downward leakage as diarrhea. This applies to all diaphoretic drugs, not just Guizhi Tang. Therefore, for Taiyang Water Reversal, exterior-releasing drugs are not used; only Wuling San is used to guide out the water. Drinking hot soup after administration induces sweating, which is the method of simultaneous resolution of the exterior and interior.

In Taiyang disease, after inducing sweating, if profuse sweating occurs, causing dryness in the stomach, irritability, insomnia, and a desire to drink water, give small amounts of water frequently. Recovery occurs when the stomach qi harmonizes. However, if the pulse is floating, urination is difficult, there is slight fever, and extreme thirst (Xiaoke), treat primarily with Wuling San.

Failure to use muscle-releasing methods and instead using diaphoresis consumes internal body fluids, causing irritability and insomnia, leading the patient to seek relief from water. If drinking water does not resolve symptoms, and the pulse becomes purely floating, there are no other changes, and the pathogen returns to the exterior. A floating pulse typically indicates the use of Guizhi Tang; why change to Wuling San? Heat pathogens interacting with water may not fully resolve but will significantly diminish. Since the pathogen returns to the exterior, the heat is mild. Combined with difficulty in urination and symptoms of extreme thirst, the interior heat remains. Thus, rather than treating the exterior alone, a simultaneous exterior-interior resolution is employed.

After inducing sweating, if the pulse is floating and rapid with irritability and thirst, treat primarily with Wuling Tang (Wuling San).

A floating, rapid pulse with irritability and thirst indicates that body fluids are consumed by heat, causing internal agitation and establishing interior signs. For consumed body fluids, Si Ling (Four-Poria Powder) nourishes the interior, while adding Guizhi releases the exterior. Consequently, Baizhu should be Cangzhu, and Gui should be Guizhi, which can be deduced. ○ Whenever "Gui" appears in formulas, distinguishing between Guizhi (Cinnamon Twig) and Rougui (Cinnamon Bark) is generally unnecessary; this applies here as well.

When the disease is in the Yang (exterior), it should be resolved by sweating. Instead, if cold water is sprayed or poured on the patient, the heat is constrained and cannot escape, increasing irritability. Gooseflesh appears on the skin. The patient feels the desire to drink water but actually lacks thirst. Treat with Wen Ge San (Clam Shell Powder). If there is no improvement, administer Wuling San.

This clause was historically combined with Xiao Xian Xiong Bai San, which is hard to understand. Since the exterior pathogen did not disperse from the exterior but was suppressed by water, the pathogen must have become internalized, either entering the Shaoyin meridian or attacking the root of Taiyang. Hence, two decoctions are used respectively. Wen Ge (Clam Shell) is a supreme remedy for thirst. Zhang Zhongjing uses it for cases where there is a desire to drink but no actual thirst. Why? Water and pathogenic factors infiltrate the Shaoyin meridian, whose channel runs up along the throat, hence the desire to drink. Since the pathogen is still in the channel and has not entered the interior, there is no actual thirst. At this time, if salty-cold herbs are not used to collect yin and drain yang, allowing the pathogen to linger and transform into heat, it will result in extreme thirst requiring large volumes of water. Thus, the *Jingui Yaolue* states: "For those who desire to drink water incessantly, Wen Ge San is primary." This indicates Wen Ge specifically treats internal and external fluid retention. If Wen Ge San fails, it indicates the pathogen is not in the Shaoyin meridian but has attacked the root of the Bladder, so Wuling San is undoubtedly indicated.

If body heat and gooseflesh persist without resolution, and the patient desires to cover themselves with clothes, spraying or washing with water further prevents heat dissipation. If sweating should occur but does not, irritability arises. If sweating occurs and is followed by abdominal pain, administer three liang of Shaoyao (Peony Root). Follow the method above.

Persistent body heat and gooseflesh with a desire to cover oneself indicate heat in the skin and cold in the bone marrow. The proper method is resolution through sweating. Washing with water causes external heat to become internalized and trapped. Although irritable and fearing cold, resembling thirst but not actually thirsty, it seems the pathogen is in the Shaoyin meridian. If Wen Ge San fails, the pathogen is definitely hidden in the Bladder, so the dual-resolution method of Wuling San is used. After taking it, if sweating occurs but abdominal pain arises, this is due to the interior-acting nature of Wuling San drawing the yang pathogen inward. However, for inwardly fallen yang pathogen causing abdominal pain, why not use Xiao Jian Zhong Tang but instead Shaoyao? And what does "follow the method above" mean? Generally, if internal yin qi is deficient and yang pathogen falls inward causing abdominal pain, Xiao Jian Zhong Tang should harmonize it. If mistaken use of Chengqi purgatives caused inward fall of yang pathogen and abdominal pain, Guizhi Jia Shaoyao Tang should harmonize it. Since Wuling San promotes urination and draws the yang pathogen inward, causing abdominal pain, Wuling San plus Shaoyao should still be used to harmonize. These three methods all revolve around Guizhi and Shaoyao. "Follow the method above" means adding the herb to the previously administered formula.

In Shanghan (Cold Damage), if sweating is accompanied by thirst, treat primarily with Wuling San. If there is no thirst, treat primarily with Fuling Gancao Tang.

Sweating with thirst indicates Wuling San is used because the pathogen has attacked the root (Bladder), inevitably causing difficulty in urination. If sweating occurs without thirst, although urination is difficult, it indicates the pathogenic heat intends to attack the Bladder but has not fully attacked the root. Thus, using three parts from Guizhi Tang and one part from Wuling San subtly indicates a ratio of three exterior to one interior, serving as a combined preparation.

In Taiyang disease, if urination is free, due to excessive water intake, there will likely be palpitations in the epigastrium. If urination is scanty, there will likely be distressing urgency in the interior.

Free urination with excessive water intake leads to water fighting with the pathogen, causing epigastric palpitations. Scanty urination with distressing interior urgency clearly indicates pathogenic heat consuming water, marking an urgent interior syndrome. Observing the previous clause, "no thirst, treat with Fuling Gancao Tang," the treatment method is complete.

Above: Wind damaging Wei and attacking the root.

If Taiyang disease does not resolve, heat knots in the Bladder. The patient appears manic. If blood passes spontaneously, the patient recovers. If the exterior is not yet resolved, attack is not yet permissible. One must first resolve the exterior. Once the exterior is resolved, if only the lower abdomen is tense and knotted, then attack is permissible. Taohe Chengqi Tang is appropriate.

Pathogenic heat combats blood, knotting in the Bladder, causing stagnation and harassing Heart Fire, so the patient appears manic. Although the Heart is not truly manic, it resembles mania. Blood belongs to Yin, unlike the wild excess of internal Yang pathogen. If blood passes spontaneously, pathogenic heat does not remain, so recovery occurs. If the lower abdomen is tense and knotted, blood in the Bladder is stored but not moving. Exterior must be resolved first before attacking. The method of attack differs; one must add Taoren (Peach Kernel) to Chengqi to reach the blood location, still adding Guizhi to resolve external pathogen. This is similar in meaning to the dual resolution of exterior and interior in Wuling San and Da Chaihu Tang.

In Taiyang disease, after six or seven days, if exterior signs remain, the pulse is faint and deep, and contrary to expectation, there is no chest binding. If the patient is manic, it is because heat is in the Lower Jiao. The lower abdomen should be hard and full. If urination is free, passing blood leads to recovery. The reason is that Taiyang pathogen follows the meridian, creating stasis-heat in the interior. Dishuidang Tang is primary.

The syndrome in this clause is more severe than the previous one. With exterior signs remaining after six or seven days, why not resolve the exterior first? Why not add Guizhi to the interior-attacking medicine? The faint, deep pulse and absence of chest binding indicate the pathogen is not in the Upper Jiao but in the Lower Jiao. If the lower abdomen is hard and full, and urination is free, the mania is undoubtedly due to blood stasis in the Lower Jiao. Thus, evacuating blood leads to recovery. Pathogen knotting in the chest uses Xianxiong Tang to cleanse residual pathogen; knotting in the lower abdomen uses Dishuidang Tang to purge blood. Without this method, the blood knotted in the lower abdomen, not moving with qi, would be impregnable.

In Taiyang disease, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, and urination is difficult, there is no blood stasis. If urination is free and the patient appears manic, it is definitively a blood stasis syndrome. Dishuidang Tang is primary.

Blood stasis syndromes are severe; Dishuidang is a heavy medicine. To prevent hesitation in its use, the principle is reiterated. Body yellow, deep knotted pulse, and lower abdominal fullness are signs of blood storage. However, seeing only these is close to jaundice. Only with mania and free urination is it undeniably blood stasis. If urination is difficult, it is heat knotting in the Bladder's formless qi, presenting as jaundice. If urination is free, Bladder qi transformation functions, making the lower abdominal fullness definitively formed blood stasis.

In Shanghan, with heat and lower abdominal fullness, urination should be difficult. If it is now free, it indicates blood stasis. It must be purged. Do not use other medicines; Dishuidang Wan (Pill) is appropriate.

Changing from decoction to pill is to avoid overly vigorous scouring. Boiling and taking with the dregs aligns with the intent of Daxiexiong Wan.

Above: Shanghan Ying damaging the root.