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The three types of conditions—Jing (spasm), Shi (dampness), and Re/Shu (heat/summerheat)—caused by Shanghan (cold damage) should be discussed separately. Because their symptoms are similar to those of Shanghan, they are presented here together. ("Jing" is commonly written as "Chi".)

In Taiyang disease, if there is fever, anhidrosis (absence of sweating), and aversion to cold, it is named Gang Jing (rigid spasm).
This occurs because one contracted Shanghan due to cold pathogen, resulting in fever and anhidrosis. When the condition progresses to spasm, the pathogen has penetrated deeply, yet aversion to cold persists; this is due to the meridians being affected by cold. Cold damaging the Ying (nutritive) blood causes obstruction in the meridian circulation, leading to stiffness and rigidity of the body, thus forming Gang Jing.
○ The *Jin Gui Yao Lue* also states: In Taiyang disease, if there is no sweating, but urination is unexpectedly scanty, with Qi rushing upward to the chest, inability to speak due to trismus (lockjaw), and impending rigid spasm, Ge Gen Tang (Kudzu Decoction) should be administered. This clause elucidates the meaning of the previous clause and supplements its treatment method. The combination of anhidrosis and scanty urination results from heat pathogens gathering in the chest from both the Taiyang and Yangming meridians, thereby injuring the Lung Metal's descending and purifying Qi, preventing the free communication between the interior and exterior.

In Taiyang disease, if there is fever, diaphoresis (sweating), and absence of aversion to cold, it is named Rou Jing (soft spasm).
This occurs because Wind pathogen damages the Wei (defensive) Qi, leading to fever, sweating, and absence of aversion to cold. Since Wind damages the Wei Qi, causing the pores to open, sweating occurs. If sweating is excessive, the meridians become empty. Although the symptoms appear slightly less tense than in Gang Jing, the condition is actually more severe because the root deficiency is present. Generally, Gang Jing belongs to Yang patterns caused by excess pathogens, whereas Rou Jing belongs to Yin patterns caused by Blood deficiency; hence, their treatment methods differ. ○ The *Jin Gui Yao Lue* also states: In Taiyang disease, if the symptoms are complete, the body is stiff and spasmodic, and the pulse is unexpectedly deep and slow, indicating Jing disease, Gua Lou Gui Zhi Tang (Trichosanthes Root and Cinnamon Twig Decoction) should be used. This is Gui Zhi Tang (Cinnamon Twig Decoction) plus two liang of Gua Lou Gen (Trichosanthes Root). Since the symptoms are described as "complete," details such as fever and sweating need not be repeated. ○ In Shanghan formulas, Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudtu) has already been used. Here, because the pulse is deep and slow, it is known that the exterior pathogen is constrained by internal dampness, representing a combination of Damp-Heat pathogens. It should not be treated using methods for Wind-Cold exterior syndromes; therefore, Ge Gen is not used, but replaced with Gua Lou Gen (Trichosanthes Root), changing the exterior-releasing method to a method of draining dampness.

In Taiyang disease, if there is fever and the pulse is deep and thin, it is named Jing.
A deep and thin pulse indicates that Dampness is prevailing, causing spasm. In febrile diseases, the pulse should typically be floating and rapid; however, a deep and thin pulse suggests that the pathogen is carried by Wind and adhered to by Dampness. Thus, although the body is hot, the pulse does not float or rapid. This represents a Yang syndrome presenting with a Yin pulse, which is why the *Jin Gui Yao Lue* points out that it is difficult to treat. For treating this condition, Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) should be urgently administered to warm the meridians and dispel dampness. One must not ignore the deep and thin pulse merely because it is considered the characteristic pulse of Dampness syndromes.

If Taiyang disease involves excessive sweating, it may lead to Jing disease.
Excessive sweating leads to emptiness in the meridians, allowing Wind pathogen to invade. Although it is attributed to Wind, it is essentially a pattern of meridian deficiency with strong pathogenic factors. Without Zhen Wu Tang (True Warrior Decoction), it would be difficult to save the patient.

If a patient presents with fever in the body but cold feet, stiffness in the neck and nape, sudden aversion to cold, occasional fever in the head without sweating, redness in the eye vessels, only shaking of the head and face, sudden trismus (lockjaw), and opisthotonos (arching of the back), this is Jing disease.
Fever in the body with cold feet indicates injury from Dampness combined with Wind. The lower-body symptoms are signs of Wind deficiency and Dampness binding. Generally, Wind governs movement and shaking, while Dampness governs contraction and urgency. Wind belongs to Yang and follows Heaven, tending toward the upper part; thus, only the head and face shake. Dampness belongs to Yin and follows Earth, tending toward the lower part; thus, the calves and shins are cold and rebellious. Following this clause in the *Jin Gui Yao Lue*, there are additional sentences regarding sweating: if sweating is induced, Cold-Damp binds to the exterior, causing greater weakness and severe aversion to cold; after sweating, the pulse resembles a snake's movement. If sweating induces severe aversion to cold, it is because only exterior-releasing herbs were used without adding Bai Zhu (Atractylodes Macrocephala Rhizome). After sweating, when the pulse resembles a snake, it is because during sweating, Yang Qi disperses outward, making the pulse surging and full; after sweating, the pores close, Yang Qi retreats inward, and the Cold-Damp pathogen, drawn outward by the sweating-inducing herbs, causes the pulse to reappear as floating and choppy, feeling sluggish under the fingers, resembling the slithering motion of a snake previously. ○ According to the *Jin Gui Yao Lue*, five more clauses follow. One states: If Wind disease is treated with purgatives, it becomes Jing; if treated with sweating, it results in stiffness. Generally, in Wind disease with heat, the pathogen has already affected the sinews; further purgation injures the Ying Blood, causing the sinews to lose nourishment and develop spasm; sweating injures the Wei Qi, causing the pulses to lose nourishment and become stiff. Another states: Sudden abdominal distension indicates impending recovery; if the pulse remains unchanged but becomes hidden and wiry, it is Jing. Generally, Spleen Earth experiencing Wood-Fire energy causes sudden distension; knowing that Fire stagnating in the Liver has moved to the Spleen, Wood-Fire Qi moving should result in a floating and large pulse. Now, since the pulse is not floating and large but unchanged, it indicates Wind still stagnates in the Liver, causing sinew pathology and spasm. However, this must occur after signs of resolution have appeared prior to the sudden distension. Another states: The pulse in Jing disease is tight like a string, running straight up and down. Tightness like a string is the Liver pulse, while running straight up and down indicates disease of the Du Mai (Governing Vessel), resulting in stiffness and厥 (reversal/collapse). This aligns with the *Mai Jing* stating that patients with Jing have a hidden, firm, and straight-up-and-down pulse. Another states: Jing disease with moxibustion sores is difficult to treat. Generally, Jing disease involves Wind-Heat and dryness/urgency; applying fire moxibustion allows Heat to penetrate deeper, assisting Yang and Wind-Heat, making them more entrenched and dispersed. Another states: In Jing disease, with chest fullness, trismus, inability to lie flat on a mat (due to opisthotonos), leg cramps, and teeth grinding (bruxism), Da Cheng Qi Tang (Major Order the Qi Decoction) can be given. Generally, Heat transmitting to the Yangming channel and extreme Wind-Heat cause these symptoms; only bitter-cold purgation is sufficient to clear the Heat and rescue the Yin fluids. Even in Shanghan, convulsions caused by Heat generating Wind are difficult to treat; how much more so for conditions worse than convulsions? As for bruxism and leg cramps without internal excess or lower fu organ symptoms, and with spontaneous bowel movements, it is incurable. The *Ling Shu* states: Death occurs in Heat-induced Jing, characterized by spinal rigidity, convulsions, and bruxism.
These are cases of Jing disease.

In Taiyang disease, if joint pain is accompanied by vexation and the pulse is deep and thin, this is named Shi Bi (Damp Bi). The manifestation of Shi Bi includes difficulty in urination and loose stools. The primary treatment should be to promote urination.
Joint pain with vexation indicates Dampness lingering in the bones and joints, causing heat and painful vexation. A deep and thin pulse clearly indicates a Dampness syndrome. Although the painful area feels hot and vexed, it is certainly not Wind-Cold; thus, promoting water metabolism is essential. ○ Generally, this condition requires promoting urination to unblock Yang Qi. Currently, internal excess of Dampness causes difficulty in urination; promoting urination allows Yang Qi to circulate, even dissipating Dampness in the joints. If, after urination becomes normal, the joint Bi syndrome persists, treatment should then focus on the exterior.

When a person suffering from Dampness experiences generalized body pain, fever, and a yellowish skin color resembling smoke staining,
Yellowing in Dampness syndromes must be differentiated into Cold-Heat and Interior-Exterior. For Damp-Heat in the interior, Yin Chen Hao Tang (Artemisia Capillaris Decoction) is used; for Damp-Heat in the exterior, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) is used. For Cold-Damp in the interior, Bai Zhu Fu Zi Tang (Atractylodes and Prepared Aconite Decoction) is used; for Cold-Damp in the exterior, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) is used. This case describes Cold-Damp in the exterior causing yellowing. The *Jin Gui Yao Lue* states: For Dampness patients with painful vexation, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) can be used to induce mild sweating. Fire therapy must strictly be avoided. Generally, the combination of Dampness and Cold causes body pain; because Dampness adheres to the exterior and Yang Qi in the exterior is insufficient, heavy sweating should not be induced. Therefore, Ma Huang Tang (Ephedra Decoction) is used with added Bai Zhu (Atractylodes Macrocephala Rhizome) to assist the Spleen in dispelling Dampness. With Bai Zhu, Ma Huang prevents sudden profuse sweating; with Ma Huang, Bai Zhu helps disseminate stagnant Dampness. However, for exterior Dampness, only sweating is appropriate, not fire therapy; fire therapy increases Heat and may lead to yellowing, hence the warning.

If a Dampness patient sweats only on the head, has a stiff back, desires to cover themselves with blankets, and seeks warmth from fire, premature use of purgatives will lead to hiccups, chest fullness, and difficulty in urination. The tongue may appear coated, indicating Heat in the Dan Tian (lower abdomen) and Cold in the chest. The patient may feel thirsty and desire water but be unable to drink, resulting in dry mouth and vexation.
This is a struggle between Cold and Dampness. Taiyang Cold Qi in the meridians causes the desire for blankets and warmth, back stiffness, and head sweating. Mistaking this for interior Excess Heat steaming upward and using purgatives incorrectly will inevitably cause hiccups, chest fullness, and urinary difficulty. Purgation causes Yang Qi to sink, creating Heat in the Dan Tian while Cold fluid accumulates in the chest, obstructing Jin Ye (body fluids), leading to dry mouth, vexation, thirst, and inability to drink. How do we know there is Cold in the chest? The white and slippery coating on the tongue indicates it. Treatment should utilize Huang Lian Tang (Coptis Decoction) to harmonize the Cold and Heat in the upper and lower jiao, resolving all symptoms.

If a Dampness patient sweats only on the forehead, has slight panting, and urinates freely, death ensues. Similarly, if diarrhea continues incessantly, death ensues.
This originally followed the example of Dampness patients with painful vexation, where Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) was indicated for sweating. Due to incorrect purgation, adverse reactions occurred. Sweating on the forehead with slight panting indicates the escape of Yang Qi. Free urination or incessant diarrhea indicates the depletion of Yin Qi. The separation of Yin and Yang is a sign of inevitable death. From this, we can infer: even if there is forehead sweating and slight panting, if urination and defecation are obstructed, Yin Qi is not depleted, and the root of Yang remains; if, after purgation, urination and defecation are free, but there is no forehead sweating or panting, Yang Qi does not escape, and the root of Yin remains; in such cases, it is not a separated state, and treatment can follow deficiency or excess to rescue the patient. However, if diarrhea continues incessantly, even without forehead sweating or panting (signs of Yang escaping upward), death still occurs. There is also a case of incessant diarrhea with constipation and forehead sweating, called Guan Ge (Obstruction and Reversal). The *Nei Jing* states: In Guan Ge obstruction, if there is no forehead sweating, it is treatable; if there is sweating, it is fatal.

Question: When Wind-Dampness binds, causing generalized body pain, the method dictates relief through sweating. If it rains continuously and the physician prescribes sweating, but the illness does not resolve, why? Answer: If sweating induces profuse perspiration, only the Wind pathogen is expelled, while Dampness remains; therefore, it does not resolve. To treat Wind-Dampness, inducing only a slight, continuous moisture-like sweat ensures both Wind and Dampness are expelled.
For Wind-Dampness binding, relief comes through sweating. Using Gui Zhi Jia Zhu Tang (Cinnamon Twig plus Atractylodes Decoction) allows gentle steaming of the interior and exterior, harmonizing Qi so that both Wind and Dampness are expelled. This is consistent with the principle for Dampness patients with painful vexation using Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction).

If a patient has generalized body pain and fever that worsens at dusk (Shen and You hours), this is named Feng Shi (Wind-Dampness). This condition arises from sweating while exposed to wind or prolonged exposure to cold environments.
Worsening at dusk corresponds to the peak activity of Yangming Qi during the Shen and You hours. The *Jin Gui Yao Lue* suggests Ma Huang Xing Yi Gan Cao Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction). Generally, Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) treats Cold-Dampness, and Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction) treats Wind-Dampness. This case involves a combination of Cold-Dampness and Wind-Dampness. Consequently, the *Jin Gui Yao Lue* follows this with a clause on Wind-Dampness featuring a floating pulse, heaviness, sweating, and aversion to wind, treated with Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction). Generally, Wind-Dampness affects the exterior via Yang channels, resulting in a floating pulse, sweating, and heaviness. Astragalus consolidates the Wei Qi, assisted by Licorice; Stephania dispels Dampness, assisted by Atractylodes. Notably, there are no specific herbs for expelling Wind in this formula because profuse sweating indicates Wind has already dissipated; the exterior deficiency allows Wind to enter and exit, causing aversion to wind, lodging only in the Wei layer. When Zheng Qi (Upright Qi) is robust, Wind recedes naturally. After administration, sensations of insects crawling under the skin and water flowing below the waist may occur. Sitting on a blanket and wrapping another around the waist to induce mild sweating aids recovery. These details hold profound significance and should not be overlooked.

If a Dampness patient suffers from body pain, fever, yellow complexion, panting, headache, nasal congestion, and vexation, with a large pulse, normal appetite, and no abdominal discomfort, the pathology lies in Cold-Dampness in the head causing nasal congestion. Administering medicine intranasally will cure it.
Dampness patients typically present with deep, thin pulses and reduced appetite. Here, the pulse is large and appetite is normal, with only headache and nasal congestion, exactly as described in the *Nei Jing*: "Affected by Dampness, the head feels wrapped." Using Gua Di San (Thistle Powder) inserted into the nose to drain yellow fluid cures the condition.
These are examples of Zhong Shi (Internal Dampness).

Taiyang Zhong Re (Summerheat) is also known as Ye (Heatstroke). Patients exhibit sweating, aversion to cold, fever, and thirst.
Cheng Wuji notes that sweating with aversion to wind, fever, and no thirst indicates Wind strike; sweating with aversion to cold and thirst indicates Zhong Ye (Summerheat). However, he did not fully explain the underlying mechanism. This condition results from seasonal Fire Qi scorching Lung Metal. Lung injury leads to Wei Qi deficiency, causing sweating, fever, and aversion to cold, akin to the *Nei Jing*'s description of Ge Xiao (Diaphragmatic Consumption), both caused by Ministerial Fire injuring the Lung. The *Jin Gui Yao Lue* advocates using Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction) to rescue the Lung.

In Taiyang Zhong Ye (Summerheat), there is fever, aversion to cold, heaviness, and body pain. The pulse is wiry, thin, hollow, and slow. After urination, there is chills and piloerection, and cold extremities. Slight exertion causes immediate fever, open mouth, and dryness of the anterior teeth. If sweating is induced, aversion to cold worsens; if moxibustion is applied, fever worsens; if purgatives are used repeatedly, strangury worsens.
Fever, aversion to cold, heaviness, and pain are exterior symptoms of Taiyang Zhong Ye. Exterior syndromes typically present with a floating pulse; however, a wiry, thin, hollow, and slow pulse indicates insufficient Yuan Qi (Primordial Qi) failing to propel the pulse outward. Wiry and thin indicate Yang deficiency; hollow and slow indicate Yin deficiency. With both Yin and Yang deficient, the patient cannot tolerate exertion. Chills and piloerection after urination indicate latent Fire Qi in the Taiyang meridian. Cold extremities indicate weak Taiyin Qi unable to withstand seasonal Heat. An open mouth and dry anterior teeth are intrinsic symptoms of Yangming Zhong Ye and confirm internal injury to Jin Ye (Body Fluids). Thus, sweating further depletes Wei Qi, worsening aversion to cold; moxibustion damages Ying Blood, worsening fever; purgation injures the Stomach, worsening strangury, especially since Yin Qi resides internally during summer. The *Ling Shu* states: When both Yin and Yang are insufficient, tonifying Yang exhausts Yin, and tonifying Yin destroys Yang. Only sweet medicines should be used to tonify Zheng Qi and resolve Heat. Dong Yuan's Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) captures this essence well. Although Zhang Zhongjing refers only to Taiyang and not Spleen or Lung, it is because intense Heat pathogens inevitably constrain Han Shui (Cold Water/Kidney Water).

In Taiyang Zhong Ye, if there is fever, body pain, and heaviness with a faint pulse, this is caused by consuming cold water in summer, with water circulating within the skin.
Cheng Wuji notes that a void pulse with fever indicates injury from Summerheat. However, a faint pulse indicates Ye (Heatstroke), and body pain/heaviness indicates Water. In summer, bathing in cold water while hot causes this disease, treated with Yi Wu Gua Di Tang (Single Herb Thistle Decoction). Observing that Zhang Zhongjing discusses only three clauses regarding Ye, it is not accidental. He sets the standard for future generations: one clarifies exterior Heat in Ye; another addresses interior-exterior deficiency; this third addresses external pathogens郁 (stagnating) seasonal Heat to form Zhong Ye. If pathogen stagnates with seasonal Heat, analogies reveal countless causes: seeking cool breezes, exposure to fog/dew, eating raw/cold foods, pre-existing accumulated Heat, inherent Yin Blood deficiency unable to withstand great Heat, activation of old pathogens, or residing in damp places. All these can stagnate seasonal Heat, causing Zhong Ye of varying severity, location, and nature. Discussing treatments to eliminate pathogens and reduce heat involves complex weighing of factors, impossible to summarize in one statement. ○ Regarding Zhang Zhongjing's three clauses on Ye: the first describes "obtained through movement," termed Zhong Ye, belonging to external causes; the second describes "obtained through stillness," technically Zhong Ye but actually Shu Bing (Summerheat disease), belonging to internal causes; the third describes injury from Cold due to Heat, a variant of Zhong Ye, belonging to neither internal nor external causes. They should not be conflated.
These are examples of Zhong Ye.

If a patient presents with Gui Zhi syndrome symptoms but without headache or neck stiffness, with a slightly floating Cun pulse, chest oppression and hardness, and Qi rushing to the throat causing breathing difficulty, this indicates Cold in the chest. Vomiting therapy is indicated, using Gua Di San (Thistle Powder). Patients who have lost blood or are deficient should not receive Gua Di San.
Internal movement of Phlegm-Fluid often presents with sweating, fever, and aversion to cold, mimicking Wind strike. However, the absence of headache and neck stiffness indicates this is not external Wind, but internal Cold-Phlegm obstructing the chest. Gua Di San (Thistle Powder), utilizing bitter-cold properties, combined with Xia Dou (Adzuki Bean) to promote urination and Chi Xiao Dou (Red Bean) to disperse pathogens, effectively vomits solid Phlegm from above the diaphragm, following the *Nei Jing* principle: "Where pathology is high, induce vomiting." Patients with blood loss or deficiency are contraindicated because vomiting further depletes Qi in blood-loss patients and damages Yin in deficient patients.

If a patient has cold extremities and a pulse that suddenly becomes tight, with pathogen knotting in the chest, epigastric fullness, vexation, hunger but inability to eat, the disease is in the chest. Vomiting therapy is indicated, using Gua Di San.
Cold extremities resemble the deep Heat/deep Cold of Jue Yin reversal. However, the pulse being suddenly tight (and sometimes not tight) differs significantly. This indicates Phlegm knotting in the chest, moving with Qi, causing the pulse to fluctuate between tight and loose, along with vexation, fullness, and inability to eat. ○ This clause was traditionally placed in the Jue Yin chapter, discussing contraindications for vomiting and purgation. Another clause states: If a patient has cold extremities and a pulse that suddenly knots, with pathogenic Qi in the chest, epigastric fullness, vexation, desire to eat but inability to do so, the disease is in the chest, requiring vomiting. This is identical to the current clause, except one mentions a "suddenly tight" pulse and the other a "suddenly knotted" pulse. Tightness indicates Cold-Fluid accumulation; knotting indicates hidden Phlegm-Fluid. Both belong to Gua Di San indications, so both need not be retained separately. However, these cold extremities belong to chronic Cold-Fluid diseases and have little relation to Jue Yin pathology.

If there are various Excess conditions in the upper chest, with oppressive distress and pain in the chest, inability to eat, sensation of food sticking, salivation upon palpation, and diarrhea occurring over ten times a day, with a surprisingly slow pulse and a slightly slippery Cun pulse, vomiting is indicated. Vomiting will stop the diarrhea.
Pain, inability to eat, and salivation upon palpation indicate Cold-Phlegm in the chest. Diarrhea with a slow pulse and a slightly slippery Cun pulse indicates Excess above the diaphragm; thus, vomiting stops the diarrhea. ○ Combining these three clauses, if Phlegm symptoms are present, vomiting is indicated rather than sweating. Considering Food Retention, Empty Vexation, and Hong Jiao (Podagra/Gout), none should be classified as Shanghan-like syndromes contraindicating sweating. Food retention implies failure of Yang Qi distribution in the chest; sweating causes Yang to escape externally, leaving Yin to dominate, worsening the critical condition. Empty vexation implies exhaustion of Stomach Jin Ye; sweating consumes remaining fluids. Hong Jiao (Podagra) stems from Earth Dampness entering through the feet, consistent with the principle that Dampness patients should not sweat.
These are examples of Phlegm syndromes.

Question: How can one distinguish Food Retention in a patient? Master says: If the Cun Kou pulse is floating and large, but feels choppy upon pressing, and the Chi position is also faint and choppy, one knows there is Food Retention. Purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Cun Kou (Radial Pulse) is discussed in the *Ling Shu* relative to the Dai Ying pulse. A floating and large Cun Kou pulse that feels choppy upon pressure indicates injury to Ying Qi in the Stomach. Thus, although the pulse is floating and large, it lacks the slippery solidity of a healthy pulse and feels choppy upon deep pressure. The Chi position being faint and choppy indicates that putrid waste has moved to the Large Intestine. Since Lung and Large Intestine are exterior-interior pairs, the pulse reflects this choppy quality. The term "also faint and choppy" implies continuity from the upper description: floating and large with slight choppieness upon pressure, not necessarily weak and powerless. If floating and large with slight choppieness, Da Cheng Qi Tang can be used. If purely choppy, one should use Zhi Shi Li Zhong Wan (Immortelle and Magnolia Fruit Regulating Middle Pill) to aid digestion and strengthen the Stomach, rather than using Da Cheng Qi Tang. ○ Following this clause, the *Jin Gui Yao Lue* states: A rapid and slippery pulse indicates Excess. If there is Food Retention, purging resolves it, using Da Cheng Qi Tang. Rapid indicates pathology in the Fu organs; slippery indicates smooth flow, like pearls rolling. This signifies Excess. Generally, Food Retention in the Fu organs manifests externally.

If there is diarrhea with lack of appetite, it is due to Food Retention. Purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Lack of appetite, rather than inability to eat, is a clear sign of food injury and aversion to food.

If diarrhea presents with a surprisingly slippery pulse, there is something to be removed. Purging brings cure, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Diarrhea is often feared to be Yin-Cold or intestinal deficiency-cold with sliding incontinence. However, a slippery and solid pulse indicates internal Heat binding. Something must be removed; stopping it is inappropriate. Da Cheng Qi Tang should be used to attack the Excess Heat. Once putrid waste is eliminated, diarrhea stops spontaneously.

If the pulses in all three positions are normal in a patient with diarrhea, but palpation reveals hardness in the epigastrium, urgent purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Normal pulses in all three positions indicate the patient has strong Yuan Qi. Hardness in the epigastrium upon palpation confirms Food Stagnation in the Middle Jiao.

If diarrhea presents with a slow and slippery pulse, there is internal Excess. Diarrhea has not ceased; purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
A slow pulse indicates Yangming stagnation. Slow without slipperiness indicates indeterminate hardness, unsuitable for purging. Now, with slow and slippery-solid qualities, purging is necessary even with spontaneous diarrhea. After purging, once interior Qi flows freely, the pulse will no longer be slippery or slow.

If there is abdominal fullness and pain, this is Excess. Purging is indicated, using Da Cheng Qi Tang (Major Order the Qi Decoction).
Abdominal pain without fullness indicates Yin-Cold; fullness without pain indicates Deficient Qi. Here, both fullness and pain indicate definite Excess binding, requiring urgent purging.

If Food Retention is in the Upper Jiao, vomiting is indicated.
Food Retention generally should not be treated with vomiting. However, if the patient habitually has Phlegm-Fluid carrying Food Retention to the Upper Jiao, vomiting is appropriate. "Where pathology is high, induce vomiting." ○ The *Jin Gui Yao Lue* adds the phrase "Yong Gua Di San" (Use Thistle Powder) to this clause.