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[Outline] Zhang Zhongjing stated: In cases of Shanghan (Cold Damage), if emesis or purgation has been performed, and the patient presents with fullness and rebellious Qi in the epigastrium, Qi rushing upward to the chest, dizziness upon rising, and a deep, tight pulse. If sweating is induced at this stage, it will disturb the meridians, resulting in tremors and shaking of the body. It should be treated with Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction).

[Commentary] Yu Chang stated: Fullness and rebellious Qi in the epigastrium, with Qi rushing upward to the chest, indicates fluid retention obstructing and surging in the diaphragm, which causes dizziness upon rising. The appearance of a deep, tight pulse clearly indicates that pathogenic factors are retained within fluids and combined with external pathogens. If one merely induces sweating to forcibly resolve the exterior, although the exterior pathogens may be resolved, the body fluids will be completely depleted, thereby damaging the meridians and causing the affliction of bodily tremors and shaking. Generally, the human body's meridians rely on body fluids for nourishment. Emesis and purgation injure the fluids once; inducing sweating injures them again. Consequently, the meridians lose nourishment, leading to bodily shaking. Therefore, when encountering such conditions, priority must be given to the exterior. In this condition, the external pathogens have already dispersed, leaving only the pathogen of retained fluids. Thus, Guizhi (Cinnamon Twig) is added to the formula controlling fluids, allowing the pathogens to be thoroughly dispersed and the fluids to distribute evenly, thereby nourishing the meridians. For thousands of years, who has perceived the subtlety of analyzing the key points and guiding the flow?

Wei Litong stated: A deep pulse indicates interior involvement, and a tight pulse indicates cold. This signifies interior deficiency and weak Yang, with Yin-cold pathogens causing disease. Originally an ailment of the meridians, mistaken use of emesis and purgation transformed it into an ailment of the Zang-Fu organs. Furthermore, failing to treat from the interior and instead inducing sweating damages the exterior of the meridians. The Wei-Yang (Defensive Yang) protecting the exterior becomes deficient due to spontaneous sweating. Tremors and shaking of the body are signs of Yang depletion. Zhang Zhongjing uses Fuling (Poria), Guizhi (Cinnamon Twig), Baizhu (Atractodes Macrocephala), and Gancao (Licorice) internally to treat the deep, tight pulse and eliminate the Yin-cold rebellious pathogen; externally, they treat the tremors and shaking, stopping the signs of exterior deficiency and aversion to cold. All four herbs act on the Yang aspect; this is the most appropriate formula for treating Yin-cold pathogens in both the interior and exterior. Fang Yi and Yu Chang attribute the pathology to combined fluid retention. They fail to realize that excessive internal Yin-cold manifests similarly whether fluid retention is present or not. Fluid retention may arise due to Yin excess, but it is not the sole cause of disease. When Yin-cold dissipates, the fluid retention stabilizes naturally, not because the fluid itself stabilizes. Therefore, there is no need to specifically discuss fluid retention.

Shen Jin'ao's Note: Yu Chang's theory regarding retained fluids is not incorrect as an etiology for this clause. However, Wei Litong’s focus on excessive internal Yin-cold encompasses retained fluids, making his reasoning more comprehensive and logical. Indeed, there are individuals with chronic phlegm-fluid retention who suffer from the symptoms described in this clause, indicating that Yu Chang is not entirely erroneous. Conversely, there are those without a history of fluid retention who contract these symptoms, suggesting that Wei Litong’s view is particularly appropriate. Therefore, both views are preserved.