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[Outline] Zhang Zhongjing stated: When a patient presents with difficulty in urination, alternating difficulty and ease in defecation, occasional slight fever, wheezing, dizziness, and inability to lie down, this indicates the presence of dry fecal impaction. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.

[Commentary] Wang Haogu stated: During the fifth to sixth day of Shaoyang disease transmission, symptoms may gradually evolve into unconsciousness and muteness, or speaking alone for one or two sentences during sleep. The eyes may be red, lips scorched, and tongue dry, yet the patient does not desire water. If given thin gruel, they will swallow; if not offered, they show no interest. The six pulses are fine and rapid but not surging and large. There is no epigastric fullness or abdominal distension, and bowel and bladder functions remain normal. If the condition persists for ten days or more, the patient's demeanor may resemble intoxication. In such cases, using Da Cheng Qi Tang would be an error. This occurs because the heat has transmitted to the Shaoyin Heart Meridian, though its origin from another meridian remains unclear. The answer is that it originated from Wind pathogen injuring the Taiyang meridian. As Wind is a Yang pathogen damaging the Wei (Defensive) qi, Yin blood naturally becomes dry. Heat accumulates in the Bladder. The pathology of Ren Water (Kidney/Bladder) transmits inversely to Bing Fire (Small Intestine). Since Bing and Ding (Small Intestine and Heart) are like siblings, the disease transmits to the Heart. Heart fire forces and steams the Lung from above, causing unconsciousness. Since the Lung is a clear and descending organ, internal pathogens cause this state. Zhi Zi Huang Lian Huang Qin Tang (Gardenia, Coptis, and Scutellaria Decoction) is suitable. If the pulse indicates involvement of Bing (Small Intestine), Dao Chi San (Guide Out the Red Powder) may be used; if the pulse indicates involvement of Ding (Heart), Xie Xin Tang (Drain the Epigastrium Decoction) is indicated. Misusing Liang Ge San (Cool the Diaphragm Powder) is inappropriate as it acts on blood within the Qi level. However, if the Cun position of the right hand pulse is deep, slippery, and forceful, it may be used. Alternatively, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) can be employed. If Rhinoceros Horn is unavailable, Sheng Ma (Cimicifugae Rhizoma) may substitute it; this is a medicine for the Yangming Meridian, resolving heat in the Blood level of the Yangming Meridian. If all pulses are deep and forceful, indicating heat in both Bing and Ding, Dao Chi San and Xie Xin Tang may be taken in equal halves.

[Outline] Zhang Zhongjing stated: After vomiting or purgation in Shaoyang disease, if the condition remains unresolved, constipation persists for five to six days or even over ten days. Tidal fever occurs around Shen hour (3-5 PM), without aversion to cold. The patient speaks alone as if seeing ghosts. In severe cases, upon onset, they fail to recognize people, grasp at clothing and bed rails, feel terrified and uneasy, exhibit slight wheezing, and stare fixedly. A wiry pulse indicates survival; a choppy pulse indicates death. In milder cases, there is only fever and delirium, treated primarily with Da Cheng Qi Tang. If relief occurs after one dose, discontinue further administration. Delirium combined with fixed staring, wheezing, and chest fullness indicates death; diarrhea under these conditions also indicates death.

[Commentary] Cheng Wuji stated: These scenarios reflect excessive pathogenic factors and depletion of righteous qi. If the patient has blurred vision and unsteady eyeballs, without exterior or interior syndromes, difficulty in defecation, and slight body heat, this is not fixed staring. This represents internal excess, treatable with Da Cheng Qi Tang or Da Chai Hu Tang via purgation. Fixed staring is considered incurable, whereas blurred vision is a sign of treatability. Although their manifestations are similar, careful differentiation is required.

Chen Shiduo stated: In Yangming syndrome of Shaoyang disease, texts mention that fixed staring with delirium, accompanied by wheezing and chest fullness, or diarrhea, leads to death. This implies simultaneous occurrence of all symptoms. If any single symptom is absent, fixed staring may not occur. If all three coexist, it is inevitably fatal. Nevertheless, fixed staring and delirium often result from excessive Stomach fire burning the Heart, while Kidney Water fails to ascend to nourish it, allowing the fire to rage unchecked. Wheezing and chest fullness indicate fire flaring upward causing Qi to attempt escape upwards; diarrhea indicates fire sinking downward causing Qi to attempt escape downwards. These represent critical conditions where Qi is about to deplete but has not yet done so. With proper treatment, survival is possible. Urgently administer Yuan Tuo San (Rescue Collapse Powder): Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Radix), and Bai Shao (Paeoniae Radix Alba) each 1 liang, Shi Gao (Gypsum Fibrosum) 5 qian, Zhu Ru (Bambusae Caulis in Taenia) 3 qian. Decoct in water and drink. This formula uses Ren Shen to rescue collapse, Shi Gao to calm fire, Mai Dong to stop wheezing, Bai Shao to stop diarrhea, and Zhu Ru to clear the Heart and calm spirit. Naturally, Qi remains intact, allowing for rescue. It is truly a miraculous prescription.