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The three syndromes of JING (Spasm), SHI (Dampness), and SHU (Summerheat) in Taiyang disease should be discussed separately. Since they are caused by Shanghan (Cold Damage) and their symptoms resemble those of Shanghan, they are discussed here together.

Taiyang governs the exterior, and all six climatic pathogens can damage it; thus, these three syndromes differ from typical Shanghan. However, some arise due to Shanghan with symptoms similar to it, which is why they are included in this discussion.

In Taiyang disease, if sweating is induced excessively, JING (Spasm) may result. The pulse is deep and fine, the body is hot while the feet are cold, there is stiffness and tightness of the head and neck, aversion to cold, occasional heat in the head and redness of the face, congestion of the eye vessels, isolated shaking of the head and face, sudden locking of the jaw (Jin Kou), and opisthotonos (back arching like a bow). This is JING disease.

Yang Qi, when refined, nourishes the Shen (Spirit); when soft, it nourishes the Jin Mai (Sinew Vessels). Excessive sweating depletes fluids, failing to nourish the sinews; damaged sinews become spasmodic and lead to opisthotonos. Taiyang governs the sinews, hence these pathologies arise. It must be understood that JING does not occur without cause; it results from improper sweating therapy during Shanghan. The Taiyang pulse should normally be floating; a deep pulse indicates weak Ying Qi (Nutritive Qi). A fine pulse indicates insufficient Yang Qi. Body heat with cold feet indicates deficiency in the Lower Jiao (Lower Burner). Although the headache has ceased, symptoms such as neck stiffness and aversion to cold persist, accompanied by intermittent facial redness and eye congestion, suggesting a potential transition to Yangming disease. However, most symptoms resemble Shanghan rather than specific signs of JING. Only the shaking of the head and face, sudden jaw locking, and opisthotonos resembling a drawn bow distinguish it from Shanghan, hence the name JING. This occurs because excessive sweating led to fluid loss without transitioning to Yangming, but forming JING instead. Due to abrupt and excessive sweating, surface fluids were suddenly depleted, while stomach fluids remained relatively intact; thus, the resulting symptoms still belong to Taiyang exterior syndrome. The treatment should focus on nourishing Yin to urgently harmonize the interior, avoiding warming methods simply because the pulse is deep and fine. The primary formula is Zhigancao Tang (Honey-Processed Licorice Decoction). Guizhi Tang plus Gualou Gen (Trichosanthes Root) used in *Jinkui Yaolue* is likely insufficient.

In Taiyang disease, fever with no sweat and paradoxical aversion to cold is called Gang JING (Rigid Spasm); fever with sweating and no aversion to cold is called Rou JING (Flexible Spasm).

This distinction between Rigid and Flexible is based on the deficiency or excess of Exterior Qi, naming them according to their root causes. This also helps assess the severity of initial illness and the patient's constitutional strength for appropriate treatment. Using Gegen Tang (Kudzu Decoction) as suggested in *Jinkui Yaolue* is erroneous.

The above discusses JING syndromes.

When a patient suffers from generalized body pain, fever, and exacerbation in the late afternoon (Ri Wu), this is named Feng Shi (Wind-Dampness). This condition arises from sweating followed by exposure to wind, or prolonged exposure to cold.

Sweating with wind exposure causes cold to prevent normal perspiration, leading to stagnation in the joints and generalized pain. Closure of the Xuan Fu (pores) causes fever. Late afternoon corresponds to the Yangming meridian's time of dominance; stagnation of Taiyin Damp Earth prevents free flow, causing exacerbation. Although caused by Dampness, it is fundamentally due to Wind-Cold. *Jinkui Yaolue* recommends Mahuang Xingren Yiyi Ren Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction).

In Wind-Dampness disease, the pulse is floating at all positions (Yin and Yang), with spontaneous sweating, heavy body, somnolence, snoring nasal breathing, and difficulty speaking. If mistakenly treated with purgatives, it leads to difficult urination, fixed gaze, and incontinence. If treated with fire therapy, mild cases show slight yellow discoloration, while severe cases present like convulsive epilepsy with periodic clonic spasms.

A floating pulse indicates Wind; floating pulses at all positions with spontaneous sweating indicate Wind and Dampness battling internally. Dampness flowing into joints causes heaviness. When Dampness prevails, Wei Qi (Defensive Qi) moves within the Yin and cannot reach the Yang, causing sleepiness. During sleep, breath exits through the nose; Wind exits while Dampness remains, obstructing respiration and causing snoring. Dampness lodging in the epiglottis makes speech heavy and muffled, like speaking from inside a room, indicating Middle Jiao Dampness. The method should be diaphoresis, but purgation was used instead. Profuse stool leads to difficult urination. The Qi transformation of the Heart and Lung fails to circulate, the Gate of the Stomach fails to function, and the Spleen Earth fails to control, resulting in fixed gaze and incontinence. Fire therapy: mild heat retention causes Dampness to fail to vent, leading to jaundice via Heat; severe heat causes Yang collapse and symptoms resembling epilepsy, with fluid depletion causing periodic spasms.

Question: "During continuous rainy weather, Wind and Dampness battle, causing generalized pain. Theoretically, diaphoresis should resolve it. The doctor says sweating is indicated, yet the patient does not recover. Why?"

Answer: "If sweating induces profuse perspiration, only the Wind is expelled while Dampness remains, hence no recovery. To treat Wind-Dampness, induce only slight, continuous perspiration ('like wanting to sweat'), so both Wind and Dampness are eliminated."

The previous section detailed Wind-Dampness symptoms but omitted body pain. Note that Wind-Dampness body pain differs from Shanghan body pain; Shanghan pain is constant, whereas Wind-Dampness pain often peaks in the late afternoon. If combined with rainy weather, Wind and Dampness resonate with the climate, worsening pain regardless of the time. Continuous rain means continuous pain; diaphoresis is the method. Profuse sweating fails to remove Dampness because Wind is a Yang pathogen entering superficially, while Dampness is a Yin pathogen entering deeply. Wind damages the upper body, Dampness the lower; superficial/upper pathogens are easier to expel than deep/lower ones. Thus, mild diaphoresis to moisten the entire body is ideal.

After eight or nine days of Shanghan, if Wind and Dampness battle causing severe body pain, inability to turn over, no vomiting, no thirst, and a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is indicated. If the patient has hard stool and spontaneous urination, remove Cinnamon Twig and add Baizhu (Atractylodes Macrocephala Rhizome) decoction.

A floating pulse indicates exterior location; deficiency indicates Wind; choppy indicates Dampness. Severe body pain reflects exterior syndrome and pulse. No vomiting or thirst indicates no interior Heat. Therefore, add Cinnamon Twig to Guizhi Tang to treat Wind-Cold, remove Sour-Cold Shaoyao (Peony Root), and replace it with Pungent-Warm Fuzi (Prepared Aconite Root) to dispel Cold-Dampness. If stool is hard and urination is spontaneous, the exterior syndrome persists, and the pathology is not Stomach Excess but Spleen Deficiency. When Spleen is Excess, turbid matter clears naturally; when Spleen is Deficient, Damp Earth fails to control Water, leaving Dampness in the skin, causing apparent dryness in stool. No vomiting/thirst indicates clear Upper Jiao transformation, allowing spontaneous urination. In damp places, Wind lingers, preventing resolution of Wind-Dampness. The root is in the Spleen; Baizhu should be the sovereign herb, replacing Cinnamon Twig to tonify Spleen Earth and overcome Dampness. When Earth is robust, Wind calms. In the previous case, Wind prevailed over light Dampness, pulses were floating at all positions, interior Heat caused sweating, so Guizhi Tang was suitable. Here, Dampness prevails over weak Wind, pulses are floating, deficient, and choppy, no interior Heat, no vomiting/thirst, so Fuzi and Cinnamon Twig can regulate the Upper Jiao. Hard stool and free urination indicate Middle Jiao dysfunction, requiring removal of Cinnamon Twig. Normal stool and difficult urination indicate Lower Jiao dysfunction, requiring Cinnamon Twig.

Guizhi Fuzi Tang:
Guizhi (Cinnamomi Ramulus) (4 liang), Fuzi (Aconiti Lateralis Radix Praeparata) (3 pieces, processed), Dazao (Ziziphi Jujubae Fructus) (12 pieces), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (2 liang).
These five ingredients, boiled in 6 sheng of water, reduce to 2 sheng. Remove dregs, divide into three warm doses.

Guizhi Fuzi Qu Guizi Jia Baizhu Tang (Cinnamon Twig and Prepared Aconite Decoction minus Cinnamon Twig plus Atractylodes Macrocephala Rhizome):
Remove Guizhi from the previous formula, add Baizhu (4 liang). Rest follows the same method.

Upon first dose, the patient may feel numbness. After half a day, administer again. After three doses, the patient may feel dizzy; do not be alarmed. This is because Baizhu and Fuzi move through skin and flesh to drive out water qi, which has not yet been fully expelled. The method should add 4 liang of Guizhi. This is one formula with two applications: remove Guizhi for hard stool/free urination; add Guizhi for constipation/difficult urination. Three pieces of Fuzi may be too much; reduce dosage for frail patients and postpartum women.

If Wind and Dampness battle causing severe joint pain, pulling pain, inability to flex/extend, exacerbated by touch, sweating, shortness of breath, difficult urination, aversion to wind with desire to keep clothes on, or slight edema, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated.

Severe swelling/pain and immobility indicate Dampness prevailing externally. Aversion to wind indicates Wind invading externally. Sweating, shortness of breath, and difficult urination indicate unclear Qi transformation. Use Guizhi as sovereign to regulate Upper Jiao and disperse Wind; assist with Baizhu, Fuzi, and Gancao to drain Dampness and harmonize Qi.

Gancao Fuzi Tang:
Gancao (Processed) (2 liang), Baizhu (Atractylodis Macrocephalae Rhizoma) (2 liang), Guizhi (Cinnamomi Ramulus) (4 liang), Fuzi (Aconiti Lateralis Radix Praeparata) (2 pieces).
These four ingredients, boiled in 6 sheng of water, reduce to 3 sheng. Remove dregs, take 1 sheng warm, three times daily. Initial dose yielding slight sweat resolves symptoms and restores appetite; if restlessness recurs after sweating, take 3 he.

In Taiyang disease, painful and vexing joints with a deep, fine pulse is named Shi Bi (Damp Bi). Symptoms of Shi Bi include difficult urination and loose stools; the treatment is to promote urination.

*Neijing* states: "Combination of Wind, Cold, and Dampness forms Bi." Pain indicates excess Cold; vexation indicates Yang encountering Yin. Floating pulse is Wind, fine pulse is Damp. Taiyang pulse should be floating; in Wind-Dampness, pulses are floating at all positions or floating/deficient/choppy. Now, joint pain with deep/fine pulse indicates improper sweating, expelling only Wind while Dampness lodges in joints, forming Zhuo Bi (Fixed Bi). Dampness lingering in the body prevents Spleen Qi from ascending and Lung Qi from descending. Bladder fluid storage fails, Stomach gate fails to open, causing difficult urination. Spleen Earth fails to transform Dampness and control Water, causing loose stools. Promoting urination prevents water accumulation. For Wind-Dampness battle, use diaphoresis; for Wind gone/Damp remaining, use diuresis. These are the two major methods. Vomiting, purging, and fire therapy are incorrect.

Patients with chronic Dampness suffer generalized pain, fever, and sallow-yellow complexion (Xun Huang).

When Dampness cannot vent and Heat cannot escape, jaundice occurs. In Shanghan jaundice, body pain resolves. Here, Dampness flows into joints, so pain persists; Wuling San (Five-Ingredient Powder with Poria) is needed to drain Dampness.

Chronic Dampness patients may have only head sweating, back stiffness, and desire to cover up near fire. Purging causes hiccups, chest fullness, difficult urination, and tongue coating resembling moss, due to Heat in the Dantian and Cold in the Chest. Thirst with inability to drink and oral dryness/vexation occur.

Head-only sweating with free urination prevents jaundice. Back stiffness and aversion to cold indicate Taiyang Cold-Dampness, treated by diaphoresis. Purbing disturbs Yang in the Chest (fullness), damages Stomach Qi (hiccups), and fails to control Water in the Lower Jiao (difficult urination). Tongue coating is not Heart Heat, but unresolved Upper Jiao Dampness and Chest Cold, with Dantian Heat rising to orifices, causing dry mouth/vexation/coating. Inability to drink indicates Dampness in the Middle Jiao; use Wuling San minus Guizhi, substituting Rougui (Cinnamon Bark).

Purging chronic Dampness patients causing forehead sweating, slight wheezing, and free urination is fatal; persistent diarrhea is also fatal.

Shi Bi has no fatal outcomes unless mistreated. Fire reversal causes epilepsy/spasms; purging causes fixed gaze/incontinence/hiccups, all death omens. Forehead sweating with difficult urination indicates Bi obstruction leading to jaundice. With slight wheezing, Water Qi enters the Lung. Failure to regulate water passages with free urination indicates Bladder failure. Persistent diarrhea indicates Spleen/Stomach failure to contain, leading to death.

Chronic Dampness patients with body pain, fever, yellow face, wheezing, headache, nasal congestion, vexation, large pulse, normal appetite, and peaceful abdomen have Cold-Dampness in the Head causing nasal congestion. Medication inserted into the nose cures it.

All symptoms are exterior. Nasal congestion without rhonchi, large but not floating pulse, rules out Wind; non-deep/fine pulse rules out Shi Bi. Abdominal softness rules out interior Stasis-Heat. Headache confirms Cold-Dampness in the Head. Cold-Dampness enters via the nose and should exit via the nose. Intranasal medication uses the "treat obstruction with obstruction" method.

The above discusses Dampness syndromes.

Taiyang Summerheat presents with body heat, heavy pain, aversion to cold, and weak pulse. This results from drinking cold water in summer, causing water qi to remain in the skin.

Summerheat differs significantly from Shanghan, though some cases stem from it. Taiyang Qi is Cold in Heaven and Water in Earth. Winter Shanghan is injured by Heavenly Cold Wind; Summer Shanghan is injured by Earthly Cold Water. Weak pulse indicates Yang loss; weak pulse with fever indicates this case. Body heat with weak pulse is Summerheat injuring Qi. Heavy pain and aversion to cold result from cold water bathing, lingering in the skin, also caused by Shanghan. Genti Tang in *Jinkui Yaolue* is incorrect; Wuling San or Huoxiang Yin (Agastache Drink) are suitable.

Taiyang Summerheat presents with fever, aversion to cold, heavy pain, and string-taut, fine, hollow, or slow pulse. After urination, chills and piloerection occur; hands/feet are cold; slight exertion causes fever; mouth opens, and anterior teeth are dry. String-taut, fine, hollow, slow pulses cannot be read continuously; they represent deficiency pulses in Summerheat with Cold. Floating/tight is string-taut; string-taut/fine is deficiency; string-taut/large is hollow; hollow/slow is Cold. Fever/aversion to cold/heavy pain in summer indicates deficiency-cold. Urination reflects Cold Water Qi transformation. Cold water lingering in skin fails to descend, causing chills after urination. Hands/feet are roots of Yang; coldness after urination indicates Cold Water in limbs. Summer acting like Winter is Shanghan-induced. Named Summerheat because the patient has inherent Yin deficiency; slight exertion causes fever, intense internal Heat, open mouth, and dry teeth. Diaphoresis worsens exterior Yang deficiency and aversion to cold. Fire therapy worsens Yin fluid deficiency and fever. Purging causes Water to flow through the intestines, worsening urination into strangury. Li Dongyuan's Buzhong Yiqi Tang aligns with Zhang Zhongjing's principles.

Taiyang Summerheat presents with sweating, aversion to cold, body heat, and thirst.

Summerheat with Cold, not from bathing but from cooling off (exposure to wind, open spaces, or night chill), affects the skin first, then Summerheat injures the Heart vessel internally, causing aversion to cold, body heat, sweating, and thirst. Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction) reflects Li Dongyuan's understanding.

The above discusses Summerheat syndromes.

All three syndromes originate from Shanghan; thus, aversion to cold, fever, and body pain resemble Shanghan. JING pulse resembles Dampness patients; Summerheat is largely similar but slightly different. The three pulses differ distinctly from Shanghan. Treaters must differentiate symptoms by pulse and treat according to the pulse.