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Subsequently, there are cases where the pulse is tight like a turning rope and variable; this indicates retained food (retained food). A tight pulse with headache indicates wind-cold; retained food in the abdomen that fails to digest. These two clauses only mention retained food without prescribing purgation, because external pathogenic factors' pulses and symptoms are also present; therefore, treatment should follow the principles for external pathogens.

If diarrhea resolves but recurs at the same time of year or month, it is because the pathogen was not completely eliminated; purgation should be used.
This clause in secular editions contains the five characters "suitable for Da Cheng Qi Tang" as an interpolation (superfluous text), so they are removed. Detailed analysis shows that residual pathogens can lie dormant for years before manifesting; this must be cold pathogen. Cold pathogens can only be treated with warm purgation using Bei Ji Wan, not cold purgation with Da Cheng Qi Tang. If it were a heat pathogen, there would be no logic for lying dormant for years.
The above lists examples of retained food.

If there is pulsating qi on the right side, sweating methods are contraindicated. Sweating will cause epistaxis and thirst, bitter vexation in the heart, and vomiting water immediately after drinking.
"Pulsating qi" refers to a throbbing sensation of qi movement. "On the right" means the qi moves on the right side of the umbilicus. Sweating disturbs Lung qi; when qi is deficient, it cannot protect the exterior, causing blood to move recklessly, resulting in epistaxis. Epistaxis leads to loss of body fluids and stomach dryness, hence thirst and bitter vexation in the heart. If one drinks water, damaging the Lung and Stomach, water is vomited immediately.

If there is pulsating qi on the left side, sweating methods are contraindicated. Sweating will cause dizziness, continuous sweating, twitching of sinews, and tremors of muscles. Continuous sweating from sweating methods leads to Yang collapse and exterior deficiency, hence dizziness, twitching of sinews, and muscle tremors.

If there is pulsating qi on the upper side, sweating methods are contraindicated. Sweating will cause qi to rush upward, striking directly at the tip of the heart.
Sweating leading to Yang collapse further damages Heart qi; Kidney qi takes advantage of Heart deficiency to ascend and oppress the Heart, hence qi rushes upward directly at the heart tip.

If there is pulsating qi on the lower side, sweating methods are contraindicated. Sweating will result in anhidrosis, severe mental restlessness, painful bone joints, aversion to cold with vertigo, vomiting after eating, and food failing to descend.
Anhidrosis after sweating indicates insufficient Kidney Water. Severe mental restlessness indicates Kidney deficiency failing to control Heart Fire. Painful bones/joints, vertigo, and aversion to cold are all Kidney diseases. Wang Taipu stated: "Food entering and then coming out indicates lack of fire." Treatment should primarily tonify the true Yang of the Kidneys.

If there is pulsating qi on the right side, purgation is contraindicated. Purgation will lead to internal exhaustion of body fluids, dry throat and nose, dizziness, and palpitations.
Purgation injures the Stomach and disturbs the Lung. Dry throat and nose indicate internal fluid exhaustion and desire to drink. Dizziness and palpitations indicate water retention injuring the Lung, Heart Master being unsettled, leading to vexation, palpitations, and vertigo.

If there is pulsating qi on the left side, purgation is contraindicated. Purgation will cause abdominal tension, inability to eat, worsening of pulsating qi, and even if there is body heat, a desire to curl up when lying down.
Abdominal tension, inability to eat, and worsening pulsating qi indicate Spleen damage from purgation, allowing Liver qi to overact on the Spleen. Desire to curl up despite body heat indicates exterior heat and interior cold.

If there is pulsating qi on the upper side, purgation is contraindicated. Purgation will cause hot palms with vexation, floating coldness on the body, spontaneous hot sweating, and a desire to pour water on oneself.
Purgation causing hot palms with vexation means although palms are hot, the grip remains clenched. Floating coldness on the body, spontaneous hot sweating, and desire to pour water on oneself indicate exterior cold and interior heat.

If there is pulsating qi on the lower side, purgation is contraindicated. Purgation will cause abdominal fullness, dizziness upon sudden rising, passing undigested food after eating, and epigastric stuffiness.
Abdominal fullness, dizziness, passing undigested food, and epigastric stuffiness occur because purgation injures Spleen and Kidney qi, triggering pulsating qi and Kidney pathogen oppressing the Heart.

Note: Pulsating qi originates from Spleen Earth weakness, failing to control Kidney Water, leading to condensation of water retention. Although it is a minor pathogen of Water attacking the upper positions, Zhang Zhongjing prohibits both sweating and purgation because these methods first disturb Spleen fluids. Therefore, Li Dongyuan often uses this to test Spleen Qi strength/weakness. Where pressing feels firm and painful, it is pulsating qi. Pulsating qi fundamentally belongs to Spleen disease; whichever of the four Zang organs is deficient, the pathogen attacks its corresponding region. Thus, erroneous sweating injures Yang; Yang injury causes pathogen to merge with qi, leading to vomiting, epistaxis, retching, vertigo, and qi rushing upward. Erroneous purgation injures Yin; Yin injury leaves deficient Yang uncontrolled, leading to curling up despite fever and clenched hands. These are signs of Stomach Qi deficiency, cold, and exhaustion. For patients with existing accumulations connected to the umbilicus, also called pulsating qi, sweating and purgation are especially forbidden. Generally, Li Zhong Tang removing Bai Zhu and adding Gui Zhi and Fu Ling is suitable, using Fu Ling to drain water and Gui Zhi to subdue running piglet. Bai Zhu is removed because it stagnates qi. However, for chronic illness with extreme Spleen Qi deficiency and no exogenous pathogen, using raw Bai Zhu with prepared Fu Zhi is acceptable. One must prioritize observed symptoms rather than rigidly adhering to formulas in books like *Huo Ren Shu*.
The above lists examples of pulsating qi.

Question: What is Huo Luan? Answer: Vomiting and diarrhea constitute Huo Luan.
Huo Luan involves chaos in the San Jiao, mixing of clear and turbid, separation of Yin and Yang, and dominance of cold or heat, leading to retching, vomiting, diarrhea, and potentially tendon spasms and cold extremities, causing chaotic turmoil.

Question: What disease is characterized by fever, headache, body pain, aversion to cold, vomiting, and diarrhea? Answer: This is named Huo Luan. After self-induced vomiting stops and diarrhea ceases, fever returns.
Fever, headache, body pain, and aversion to cold are due to exogenous wind-cold and endogenous injury from cold/raw food, causing Huo Luan. Now that vomiting has stopped and diarrhea has ceased, yet fever returns, it indicates internal pathogens have been expelled but external contraction remains.
At this point, mild clearing is appropriate, followed by self-regulation. Later, if body pain persists, urgent rescue of the exterior is required, treating according to standard protocols.

For Huo Luan with headache, fever, body pain, abundant heat, and desire to drink water, Wu Ling San is indicated. For abundant cold and no desire to drink, Li Zhong Wan is indicated.
Headache, fever, and body pain in Huo Luan indicate exogenous contraction. Desire to drink indicates heat pathogen entering the interior; thus, Wu Ling San is used to resolve both exterior and interior. No desire to drink indicates interior cold; thus, dried Ginger's pungency warms the middle and disperses pathogens, while Ginseng, Atractylodes, and Licorice's sweetness supports Yang and boosts Qi. Sweetness combined with pungency prevents stagnation; pungency combined with sweetness prevents dryness. Together, they regulate middle Qi deficiency and stagnation. Since vomiting and diarrhea occur simultaneously, interior symptoms take priority.

If there is throbbing above the umbilicus, indicating Kidney qi movement, remove Bai Zhu and add Gui Zhi 4 liang. For excessive vomiting, remove Bai Zhu and add fresh Ginger 3 liang. For excessive diarrhea, retain Bai Zhu. For palpitations, add Fu Ling 2 liang. For thirst and desire to drink, increase Bai Zhu to total 4.5 liang. For abdominal pain, add Ren Shen to total 4.5 liang. For severe cold, add dried Gan Jiang to total 4.5 liang. For abdominal fullness, remove Bai Zhu and add one Fu Zi. After taking the decoction, wait about the time it takes to eat a meal, then drink about one sheng of hot porridge to maintain slight warmth; do not uncover clothes or blankets.
Throbbing above the umbilicus, vomiting, and abdominal fullness all relate to qi disorders. Bai Zhu is removed because its cloying nature hinders qi flow. However, for excessive diarrhea, even with throbbing and vomiting, Bai Zhu may be used temporarily to assist the middle and upper jiao in controlling Kidney pathogens, as qi is already stagnant and such symptoms are secondary. For palpitations, only Fu Ling is added, retaining Bai Zhu, because palpitations stem from water retention, unrelated to qi issues. Moreover, Bai Zhu paired with Ren Shen benefits water metabolism and generates fluids, so it is retained. Adding Bai Zhu for thirst, Gan Jiang for cold, fresh Ginger for vomiting, Gui Zhi for umbilical throbbing, and Fu Ling for palpitations are common knowledge. Adding Fu Zi for abdominal fullness and Ren Shen for abdominal pain requires profound understanding. The back is Yang, the abdomen is Yin. Exogenous Yang pathogens sinking inward cause chest binding; endogenous Yin pathogens knotting inward cause abdominal fullness. Only the potent force of Fu Zi can break the solid knotting of Yin pathogens. Abdominal pain is undoubtedly Yin pathogen. In Taiyang, if original pathogen oppresses the upper, Xiao Jian Zhong Tang harmonizes Yin and separates Yang. In Yin meridians, warming and tonifying Yang is necessary to harmonize Qi and withstand pathogen expulsion. ○ Huo Luan involves rebellious Stomach Qi; consuming grain aggravates it, making rebellion irreversible. The instruction to drink hot porridge after taking the decoction refers to the general method for Li Zhong Tang, not specifically for Huo Luan itself.

If vomiting and diarrhea cease but body pain persists, one should assess and harmonize the exterior; Gui Zhi Tang is suitable for mild harmonization.
Cessation of vomiting/diarrhea with persistent body pain indicates unresolved exterior pathogen. Assessment and harmonization mean judging the severity of the exterior pathogen to adjust the dosage. Despite sudden deficiency from vomiting/purging, Gui Zhi Tang can be used even in summer to harmonize Ying and Wei.

After vomiting and diarrhea, if the pulse is calm and there is slight vexation, it is because the body is too weak to handle the qi of grain.
During Huo Luan vomiting/diarrhea, diet should be avoided because Stomach Qi is rebellious. Even after recovery, if the pulse is calm but slight vexation occurs, dietary restraint is crucial because the digestive capacity is not yet solid.
The above lists examples of Huo Luan.

For relapse due to overexertion after a major illness resolves, Zhi Shi Zhi Zi Chi Tang is indicated. If there is retained food, add Da Huang, sized like a chess piece, 5-6 pieces.
Relapse due to overexertion refers to residual heat arising from physical labor. Annotations claiming "female sexual relapse" are gross errors. Female sexual relapse is a strict taboo after typhoid, often fatal, never treated with purgatives. For residual heat after Taiyang purgation or post-sweating/vomiting/purging with empty vexation, this formula's bitterness induces slight emesis to expel pathogens; this is not an emetic method. Adding Zhi Shi to Zhi Zi Chi induces slight sweating to dispel empty heat in the chest, aligning with the *Neijing* principle: "For excess fire, use bitterness to induce release." If retained food knots internally, urgently add Da Huang to purge; delay allows heat to persist and deplete True Yin. Using seven sheng of sour rice water, boiled down to four sheng before adding herbs, ensures the liquid sinks downward rather than rising. Hence, covering the patient to induce slight sweating is key.

For fever recurring after Typhoid resolves, Xiao Chai Hu Tang is indicated. If the pulse is floating, resolve via sweating; if deep and solid, resolve via purgation.
Recurrent fever after resolution indicates residual heat within, attracting more heat. Residual heat must be localized; generic treatment worsens deficiency. If in half-exterior/half-interior, use Xiao Chai Hu Tang to harmonize. If in the exterior, use sweating; if in the interior, use purgation. This parallels previous clauses: sweating with Zhi Shi Zhi Zi Tang for slight sweating, purging with Zhi Shi Zhi Zi Tang plus Da Huang for slight purging.

For edema below the waist after a major illness resolves, Mu Li Ze Xie San is indicated.
Edema below the waist results from water accumulation. *Jin Gui* states: "Edema below the waist should be treated by promoting urination." This is a fixed rule. After major illness, Spleen Earth is exhausted and cannot control water, causing overflow. Using Mu Li Ze Xie San for aggressive attack seems to ignore deficiency. However, since water hasn't invaded the upper body, urgently driving water from below preserves much health. Mild agents would allow Yin water to invade Yang regions, becoming untreatable.

For frequent spitting lasting long after a major illness resolves, indicating cold in the Stomach, warm with pills; Li Zhong Wan is suitable.
Body fluids congeal into turbid saliva due to Stomach cold. Long-standing unclear saliva leads to emaciation; thus, decoctions for scouring are unsuitable, and slow-acting pills are preferred. Li Zhong Wan is excellent for separating Yin/Yang and warming/tonifying Spleen/Stomach. Zhang Zhongjing uses it only after external pathogens are gone. In Taiyang with intense pathogen, he combines it with Gui Zhi, renaming it Gui Zhi Ren Shen Tang. In *Jin Gui* for Chest Bi, it is named Ren Shen Tang. This reveals his naming logic. ○ Post-Typhoid deficiency often leaves residual heat, prohibiting warm tonics. Even for constitutional cold/deficiency, only Li Zhong Wan is suitable for regulation; Gui Zhi and Fu Zi are rarely used lightly.

After Typhoid resolves, if there is emaciation, shortness of breath, and rebellious Qi with urge to vomit, Zhu Ye Shi Gao Tang is indicated.
Body fluids consumed by heat pathogens leave residual heat, causing emaciation and shortness of breath. Rebellious Qi with urge to vomit indicates residual heat disturbing fluids with phlegm. Zhu Ye Shi Gao Tang tonifies Qi, clears heat, and directs rebellious Qi downward. Note: This formula is Ren Shen Bai Hu Tang removing Zhi Mu and adding Ban Xia, Mai Dong, and Zhu Ye. For post-illness empty vexation and shortness of breath due to residual heat, Mai Dong and Zhu Ye are added to Ren Shen and Gan Cao to clear heat and generate fluids. Ban Xia is added for phlegm-fluid rebellion causing vomiting. Post-illness residual heat differs from latent Qi inducing warmth; thus, Zhi Mu is omitted to avoid damaging Sha Yin.

If the pulse has resolved but there is slight evening vexation, it is because the patient recently recovered and forced food intake. Spleen/Stomach Qi is still weak and cannot digest food, causing slight vexation. Reducing food intake leads to recovery.
Post-illness food intake causing slight vexation is called food stagnation; reducing intake heals it naturally due to new Stomach Qi deficiency. If residual heat remains, quiet rest awaits fluid return; this is treating without treating. If medication is unavoidable, use bland prescriptions so drug power doesn't overwhelm Qi. Like wilting plants needing gentle watering to revive, excessive irrigation causes death. For deficiency with pathogens, urgent strong purging is needed; incomplete pathogen removal allows invasion and death.

Typhoid Yin-Yang Exchange disease presents with heavy body, shortness of breath, lower abdominal urgency, possibly drawing into the genitalia, heat rushing to the chest, heavy head unwilling to lift, visual disturbances, and knee/calf stiffness. Shao Kun San is indicated.
Annotations fail to clarify Yin-Yang Exchange, leading later generations to mistakenly call it female sexual relapse. If so, would intercourse between a recovering woman and healthy man be male sexual relapse? Heat toxins in Typhoid reside in Blood/Qi and gradually disperse via exterior/interior. Toxins hidden in essence/marrow cannot exit. Thus, contact between recovered and healthy individuals transmits toxin: male to female, female to male. Hence "Yin-Yang Exchange" (trading). Symptoms include visual disturbances, heaviness/stiffness, lower abdominal pain drawing to genitals, sudden exposure to Yin toxin. This cannot be driven by Gui Zhi/Fu Zi pungent heat. Burning the inner garment (kun) into powder works because it shares the same qi as the patient's past waste. Taking it promotes urination, slight penile swelling, and expels Yin toxin through the yin orifice.
The above lists post-recovery relapses and Yin-Yang Exchange.