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Taiyang disease (Disease of the Taiyang/Bladder channel) for six or seven days, with exterior symptoms still present, but mistakenly treated with purgation. The pulse is faint and deep. There is no formation of Jie Xiong (Chest Binding), yet the patient becomes manic. This is due to heat in the Lower Jiao (Lower Burner). The lower abdomen should be hard and full. If urination is normal, recovery comes only after evacuating blood. The reason for this is that heat from the Taiyang channel has followed the meridians into the interior, where stasis-heat resides. Di Dang Tang (Resist the Decoction) is the primary treatment.

This is also a case of illness originating in Yang, where mistaken purgation caused heat to enter inward. The phrase "exterior symptoms still present" implies a contrast with "mistakenly treated with purgation." In Taiyang disease lasting six or seven days without resolution, if the pulse becomes faint and deep, Si Ni Tang (Frigid Extremities Decoction) should ideally be used to rescue the condition. Here, due to mistaken purgation, pathogenic heat follows the meridians into the Fu organs, knotting in the Bladder. Thus, the lower abdomen is hard and full without forming Jie Xiong, and urination is free without jaundice. The Taiyang channel has little Qi and much Blood. After six or seven days, with exterior symptoms still present, it can be known that Yang Qi is heavy. Extreme Yang disturbs Yin, causing Blood to become dry and accumulate in the middle. When Blood is diseased, perception becomes confused, leading to mania. This represents the transmission of Jing (Channel) disease to Fu (Organ), exterior disease to interior, Qi disease to Blood, and Upper Jiao disease to Lower Jiao. The lower abdomen resides in the Lower Jiao and is the chamber of the Bladder, the gathering place of the Jueyin channel, and the source of the Chong and Ren vessels (Sea of Blood). Stasis-blood remains and knots, causing hardness and fullness. However, by attacking the Blood, Qi naturally relaxes; by attacking the interior, the exterior naturally resolves. The Nan Jing states: "When Qi knots and cannot move, it is Qi that is sick first; when Blood stagnates and cannot nourish, it is Blood that is sick later." This deeply fits the meaning of this syndrome.

In Taiyang disease, if there is yellowing of the body, a deep and knotted pulse, and a hard lower abdomen, but urination is difficult, this indicates no Blood stasis (it is water retention). If urination is free and the patient appears manic, this is a Blood Knot syndrome, treated with Di Dang Tang.

There is a distinction between Qi and Blood in Taiyang disease presenting with jaundice versus mania. Jaundice with difficult urination belongs to the Qi level and is a Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Small Soybean Decoction) syndrome. If urination is free and mania occurs, it belongs to the Blood level and is a Di Dang Tang syndrome. Damp-heat lingering in the skin causes jaundice due to the failure of Wei Qi (Defensive Qi) to circulate. Dry-blood knotting in the Bladder causes jaundice due to the failure of Ying Qi (Nutritive Qi) to distribute. A deep pulse indicates disease in the interior. For any condition where heat enters inward after purgation, such as Jie Xiong, jaundice, or Blood Accumulation, the pulse must be deep. It may be tight, faint, or knotted, depending on the severity of the pathogen, and should not be differentiated solely by symptoms. Both Water Knot and Blood Knot are diseases of the Bladder, hence both present with a hard and full lower abdomen. Difficult urination indicates Water Knot; free urination indicates Blood Knot. The character "Ru" (like/as if) here is an interjection. Interpreting it literally to distinguish the severity of Blood Accumulation and mania would be erroneous.

In Shang Han (Cold Damage) with fever and a full lower abdomen, urination should be difficult. Now that it is free, there is Blood stasis. It should be purged. Do not use other medicines; Di Dang Wan (Resist the Pill) is suitable.

"Having heat" means exterior symptoms are still present. The lower abdomen is full but not hard, and the patient has not become manic. Relying only on free urination, one anticipates Blood Accumulation. Therefore, the dosage is reduced and made into pills to act gently.

Di Dang Tang Formula:
Shui Zhi (Leech, processed) - amount unspecified in text snippet but implied equal parts contextually or standard dosage; here listed as ingredient.
Meng Chong (Dragonfly larva, wings and feet removed, processed) - 30 units.
Tao Ren (Peach Kernel) - 20 units.
Huang Di Huang (Raw Rhubarb Root, washed with wine) - 3 liang.
These four ingredients are boiled in 5 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm. If stool does not pass, take again.

Di Dang Wan Formula:
Shui Zhi (Leech) - 30 units.
Meng Chong (Dragonfly larva) - 25 units.
Tao Ren (Peach Kernel) - 20 units.
Da Huang (Rhubarb Root) - 3 liang.
These four ingredients are pounded and divided into four pills. Boil one pill in 2 sheng of water to obtain 7 he of liquid. Take this dose. Stool containing blood should pass at this time. If it does not pass, take another dose.

The leech is an insect that drinks blood and excels in water. The dragonfly larva sucks blood and excels on land. Using these creatures, skilled at taking blood from water and land, to attack Bladder Blood Accumulation allows the blood to exit via the anterior yin. Peach Kernel assists with its bitter-sweet nature to push out the old and generate the new. Rhubarb assists with its bitter-cold nature to sweep away pathogenic heat. It is named "Di Dang" (Resist the/Directly Hit the), meaning to strike directly at the site requiring attack.

If Taiyang disease does not resolve, and heat knots in the Bladder, the patient appears manic. If Blood discharges spontaneously, discharge leads to recovery. If exterior symptoms remain unresolved, attack is not yet appropriate; one should first release the exterior. Once the exterior is resolved, if only the lower abdomen feels urgent and knotted, then attack is possible. Tao Ren Cheng Qi Tang (Peach Kernel and Minor Order the Qi Decoction) is suitable.

Yang Qi is excessively heavy, affecting both root and branch, so the patient appears manic. Blood moves when heated, so hematuria occurs. When Blood descends, it does not knot, so recovery ensues. The blood of the Chong and Ren vessels gathers in the lower abdomen. Extreme heat causes Blood not to flow but to knot, resulting in urgency. However, since the pathogen comes from outside, one must first examine the severity of exterior heat to treat the exterior, then use Tao Ren Cheng Qi Tang to attack the interior Blood knot. Since the lower abdomen is not yet hard and full, Di Dang Tang is not used. Taking five he (approx. half a sheng) aims for mild purgation, indicating an initial reluctance to purge aggressively.

The first clause uses "but no Jie Xiong" to identify this as a post-purgation syndrome. This clause uses "attack is not yet appropriate" to identify this as a pre-purgation syndrome. Urgent knotting requires release; Minor Order the Qi suffices. Hardness and fullness are difficult to release; Di Dang Tang is necessary. With exterior symptoms still present, using Di Dang Tang entirely ignores the exterior because the pathogen is severe in the interior, requiring immediate rescue of the interior. With exterior symptoms resolved, Tao Ren Cheng Qi Tang retains Gui Zhi (Cinnamon Twig) because the pathogen is severe in the exterior, requiring protection of the exterior.

Tao Ren Cheng Qi Tang Formula:
Tao Ren (Peach Kernel) - 50 units.
Gan Cao (Licorice Root) - 2 liang.
Gui Zhi (Cinnamon Twig) - 2 liang.
Mang Xiao (Mirabilite) - 2 liang.
Da Huang (Rhubarb Root) - 4 liang.
These five ingredients are boiled in 7 sheng of water to obtain 2.5 sheng. Strain, add Mang Xiao, boil briefly over fire. Remove from fire. Take 5 he warm before meals, three times daily. Mild purgation should occur.

In Yangming disease, if the patient suffers from forgetfulness, there must be Blood Accumulation. The reason is that there was originally long-standing stasis-blood, causing forgetfulness. Although feces are hard, defecation is surprisingly easy, and the color is definitely black. Di Dang Tang should be used to purge.

Stasis-blood is the root of the disease; forgetfulness is the manifestation. This describes symptoms prior to Yangming disease becoming apparent. Previously unknown, now investigated due to Yangming disease. Hard feces indicate Yangming disease. Hardness usually makes defecation difficult, but here it is easy, revealing a change in pathogenesis. Investigating the cause reveals old blood, as Blood moistens. Old blood turns black, representing Fire extreme transforming into Water imagery. By observing the ease of defecation and investigating the black color, the root of the disease is found, explaining the prior forgetfulness. Cheng Qi formulas are Yangming medicines. Tao Ren Cheng Qi Tang is not used because defecation is easy (no need for Mang Xiao); there is no exterior symptom (no Gui Zhi); stasis is old (no Gan Cao needed). Only Meng Chong and Shui Zhi can handle this task.

A patient with no exterior or interior symptoms presents with fever and constipation for seven or eight days. Even if the pulse is floating and rapid, purgation is permissible. Suppose purgation has been performed, but the rapid pulse persists. Combined heat causes efficient digestion and hunger. After six or seven days of constipation again, there is Blood stasis. Di Dang Tang is suitable. If the rapid pulse persists but diarrhea continues incessantly, it will likely involve heat and pus/blood in the stool.

No headache or aversion to cold indicates no exterior symptom. No irritability, vomiting, or thirst indicates no interior symptom, though heat exists. After seven or eight days, constipation should be expected. Thus, even with a floating-rapid pulse, purgation is logical, as seen by continued constipation post-purgation. "Combined heat" and "cooperating heat" refer to internal and external heat. The previous clause deduced origin from symptoms; this clause differentiates symptoms from pulse. Extreme heat in exterior and interior, with Excess Yang and Deficient Yin, damages the Yin collaterals. Continued constipation indicates Blood Accumulation. Heat-induced diarrhea indicates pus and blood in stool. Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is suitable. The previous case, with easy defecation, showed long-standing stasis, verified by formed symptoms. This case, with continued constipation, shows newly formed stasis, predicted by unformed symptoms. Among the Six Channels, only Taiyang and Yangming have Blood Accumulation syndromes because these two channels have abundant Blood. Thus, pulses and symptoms differ, but treatment principles are the same.

Taiyang cooperating-heat diarrhea can be deficient or excess-heat. Yangming is excess-heat without deficiency. Shaoyin pus/blood in stool is deficient; Yangming is heat. Rapid pulse indicates deficient heat, which cannot digest food efficiently. Efficient digestion and hunger indicate excess-heat.