Library

[General Principle] Zhang Zhongjing said: In Taiyang disease, after purgation, if the pulse is rapid (Cu) and there is no Jie Xiong (Chest Binding), this indicates that the condition is about to resolve. If the pulse is floating (Fu), Jie Xiong will definitely occur. If the pulse is tight (Jin), throat pain will definitely occur. If the pulse is wiry (Xian), bilateral hypochondriac stiffness and urgency will definitely occur. If the pulse is fine and rapid (Xi Shu), the headache will not cease. If the pulse is deep and tight (Chen Jin), vomiting will definitely be desired. If the pulse is deep and slippery (Chen Hua), Xie Re Li (Diarrhea with Heat) will occur. If the pulse is floating and slippery (Fu Hua), lower bleeding (Xia Xue) will definitely occur.

[Detailed Commentary] Wei Litong stated: This clause discusses both Wind Strike and Cold Damage of the Taiyang stage, where the pathogen remains in the exterior. Mistaken use of purgation leads to various transformed syndromes. A rapid pulse without Jie Xiong indicates that Yang Qi is still abundant and not constrained by Yin-cold herbs; it soon penetrates the exterior to heal, hence described as "about to resolve." This is a fortunate case where purgation caused no harm. Otherwise, if the pulse is floating, although the disease is in the exterior, the Wind pathogen has been drawn into the chest by Yin-cold herbs and binds with Yang, forming Jie Xiong. If the pulse is floating yet tight, this is Cold damaging the Ying (Nutrient) level followed by mistaken purgation; thus, Cold pathogen agitates with Liver Heat, causing throat pain. Jie Xiong does not involve throat pain; it is a syndrome for Xia Xiong Tang (Drain the Chest Decoction). Throat pain without Jie Xiong is not a syndrome for Gan Cao Jie Geng Tang (Licorice and Platycodon Decoction of Shaoyin), but rather remains a syndrome for Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction of Taiyang). This is still relatively easy to diagnose and treat after purgation. Regarding a wiry pulse, Yin-cold herbs draw Cold pathogen into the hypochondrium causing stiffness, but this is not a Chai Hu Tang (Bupleurum Decoction) syndrome of Shaoyang; one should seek treatment by analogy within the Taiyang clauses concerning fullness below the ribs. A fine and rapid pulse resembles Shaoyin, but since the headache persists, the syndrome remains Taiyang; this is Yang Qi constrained and depressed after purgation manifesting as a fine and rapid pulse. One should still seek combined exterior-interior treatment methods within the Taiyang mistaken-purgation clauses. However, in these cases, the pulses all retain a floating quality, making them relatively easy to recognize. Furthermore, a deep and tight pulse appears completely unlike Taiyang. Yet, the deep and tight pulse after mistaken purgation indicates Yang Qi depressed by Yin, counter-flowing upward to cause vomiting; thus, one should still seek combined exterior-interior treatment within the Taiyang clauses. A deep and slippery pulse with Xie Re Li should be treated according to the Taiyang diarrhea clauses. These two conditions should not be hastily dismissed as non-Taiyang simply because the pulse is deep and not floating. As for a floating or slippery pulse, distinguishing between exterior and interior is difficult. However, knowing that lower bleeding will occur indicates the Taiyang stage has affected its root organ (Bladder); treatment should be sought within the Taiyang root-organ lower bleeding clauses. In summary, mistaken purgation causes myriad transformed syndromes; the key lies in careful examination. One must never abandon the Taiyang framework to seek treatment elsewhere; repeated errors will hasten death.

[General Principle] Zhang Zhongjing said: When Taiyang disease is unresolved, Heat accumulates in the Bladder region. The patient exhibits a manic-like state (Ru Kuang). If blood flows out spontaneously, the patient heals. If the exterior symptoms are not yet resolved, internal attack is contraindicated; one must first release the exterior. Once the exterior is resolved, if only the lower abdomen feels urgent and knotted (Ji Jie), then internal attack may proceed, using Tao Ren Cheng Qi Tang (Peach Kernel and Magnolia Bark Decoction).

[Detailed Commentary] Shen Jin'ao noted: This refers to hematuria (blood in urine). It arises because Yang Qi is excessive, affecting both the root and branch. Blood moves freely when heated, hence hematuria occurs. If heat becomes extreme, blood coagulates instead. The lower abdomen is the chamber of the Bladder; thus, Bladder Heat accumulation causes lower abdominal urgency and knotting. Tao Ren Cheng Qi Tang is used to purge the internal blood stasis, thereby resolving the condition.

[General Principle] Zhang Zhongjing said: Patients with Lin Syndrome (Dysuria) must not undergo sweating therapy; inducing sweat will inevitably lead to lower bleeding.

[Detailed Commentary] Wei Litong stated: Why is there blood in Bladder Qi transformation? Because there is pre-existing accumulated Heat in the Bladder Fu organ. Combined with the metabolic changes of Cold Damage water, inducing sweat from the Taiyang channel injures the branch (exterior) which connects to the root (interior). Fluid deficiency leads to reckless blood overflow. This bleeding is similar to, yet distinct from, rectal bleeding caused by Wind Strike affecting the root organ. The latter results from exterior pathogens remaining unresolved, invading the Yin aspect of the root Fu. This case results from sweating depleting the exterior, injuring the Yang aspect of the root channel. Blood of the Yin aspect belongs to the Lower Jiao Blood Sea and exits via the large intestine (feces). Water of the Yang aspect fails to transform Qi adequately; Blood Heat overflows and exits via the small intestine (urine).

Shen Jin'ao noted: This clause's "lower bleeding" also refers to hematuria. The Bladder of a Lin patient is chronically closed by Heat; inducing sweat further disturbs the Bladder, causing blood to exit via urine. In medical texts, "lower bleeding" differs between fecal and urinary sources; students must examine this carefully.

[General Principle] Zhang Zhongjing said: In Taiyang disease, if Fire Moxibustion/Fumigation is applied and sweat does not ensue, the patient will become irritable. If the disease passes the meridian cycle without resolving, lower bleeding will definitely occur; this is termed Huo Xie (Fire Pathogen).

[Detailed Commentary] Ke Qin stated: In other clauses, fire-induced sweating leads to epistaxis (nosebleed) because Yang pathogen is abundant in Yang positions, occurring before the meridian cycle passes. In this clause, fire fumigation without sweating leads to lower bleeding because Yang pathogen sinks into the Yin aspect, occurring when the meridian cycle has passed and remains unresolved.

[General Principle] Zhang Zhongjing said: If a patient presents with neither exterior nor interior symptoms, fever, and constipation for seven to eight days, even if the pulse is floating and rapid, purgation may be used. If purgation has already been administered and the rapid pulse persists, combined Heat causes excessive hunger and digestion. If, after six or seven days, constipation recurs, this indicates Blood Stasis; Dang Dang Tang (Tussuck Pill) is indicated. If the rapid pulse persists and diarrhea continues incessantly, this is Xie Re Bian Nong Xue (Heat-associated pus and blood in stool).

[Detailed Commentary] Ke Qin stated: "Combined Heat" and "Xie Re" refer to internal and external Heat. Extreme internal and external Heat, characterized by Yang excess and Yin deficiency, damages the Yin collaterals. Thus, constipation indicates Blood Accumulation (Xu Xue); continuous hot diarrhea indicates pus and blood in stool. Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is indicated.