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Cheng Wuji: Inability to speak and difficulty in speech manifest as two syndromes. One is Taiyang Wind-Warmth (Taiyang Fengwen), and the other is sores arising in the throat of Shaoyin. Both are caused by pathogenic heat qi obstructing and closing due to transmitted disease, not by Yin-cold syndromes. When Qi and Blood circulate freely, joints open up, and speech can be produced.

Taiyang Disease: After sweating therapy, if the body remains burning hot, it is named Wind-Warmth (Fengwen). The pulse at both Cun and Chi positions is floating; there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring, and difficulty in speech. (See detailed discussion under Wind-Warmth).

Shaoyin Disease: If the throat is injured with sores, leading to inability to speak and voice loss, treat with Kujiu Tang (Bitter Wine Decoction).

Wu Qian: There are six types of aphonia and muteness. First, Shaoyin disease where throat injury causes sores and inability to speak; treat primarily with Jizi Kujiu Tang (Egg Yolk Bitter Wine Decoction, i.e., Kujiu Tang). Second, Huhu (Fox-Confusion) Cold Damage affecting the upper lip with sores, dry throat, and hoarseness; treatment is found in that section. Third, Spasm syndrome (Jingzheng) with locked jaw preventing speech; also found in that section. Fourth, Heat disease causing aphonia without sweat for three to four days indicates a fatal prognosis. Fifth, extreme heat injuring Lung Metal causing inability to speak; clear Lung heat and descend fire to cure. Sixth, excess Wind-Heat obstructing causing cough and hoarseness; treat by dispelling Wind and descending Phlegm-Fire. Additionally, cases where failure to disperse allows Wind pathogen to lodge in the Lungs require dispersing Wind pathogen.

Cheng Wuji: Wind-Warmth presents with snoring, while Taiyang Wind Strike presents with nasal humming. Both result from Wind Qi obstruction impairing Wei-Qi circulation. Although Yangming, Shaoyin, and the Three Yang meridians may experience Wind Strike, since the pathogen is not on the exterior, there is no nasal humming or snoring.

Taiyang Disease: Wind Strike characterized by floating Yang pulse and weak Yin pulse. Floating Yang leads to spontaneous heat generation; weak Yin leads to spontaneous sweating. Symptoms include aversion to cold (Se-se), shivering aversion to wind (Xi-xi), mild fever (Xi-xi), nasal humming, and dry retching. Treat with Guizhi Tang (Cinnamon Twig Decoction). If after sweating the body remains burning hot, with floating pulse, spontaneous sweating, body heaviness, somnolence, snoring, and speech difficulty, do not use purgation or fire therapy.

(Urination Difficulty)
Cheng Wuji: Impaired urination has several types. Post-mistaken-purgation impairment results from internal fluid depletion. Post-sweating impairment results from external fluid loss. Jaundice, Pi (Glomus) syndrome, and Heat diseases causing impaired urination stem from Heat stagnation. Rheumatism interaction and Yangming Wind invasion causing impaired urination, or Cold pathogen assault causing difficult urination, often arise post-sweat/purge and must be differentiated carefully.

Taiyang Disease: Cold Damage with unresolved exterior and fluid retention below the heart, presenting with dry retching, fever, cough, thirst, diarrhea, dysphagia, impaired urination, hypogastric fullness, or wheezing. Treat with Xiao Qinglong Tang (Minor Blue Dragon Decoction), removing Mahuang (Ephedrae Herba) and adding Fuling (Poria). After excessive sweating in Taiyang disease, stomach dryness causes irritability, insomnia, thirst, and impaired urination. If pulse is floating, use Wuling San (Five-Ingredient Powder with Poria); if not floating, use Zhuling Tang (Polyporus Decoction). For Pi syndrome unrelieved by Xixin Tang (Heart-Piercing Decoctions) following purgation, accompanied by thirst, oral dryness/irritability, and impaired urination, use Wuling San. After Guizhi Tang or post-sweat/purge, if head/neck stiffness, mild fever, anhidrosis, chest fullness/mild pain, and impaired urination persist, use Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction). Excessive drinking in Taiyang disease causing epigastric palpitations and scant urine requires Fuling Gancao Jiangtang (Poria Licoricia Ginger Decoction). If accompanied by jaundice, hard hypogastric region, and sinking/knotted pulse, use Yinchen Tang (Artemisia Capillaris Decoction). If exterior unresolved and mistaken purgation occurs, resulting in no Jie Xiong (Chest Binding) but only head sweating and impaired urination, jaundice will likely develop; treat with Yinchen Tang (Zhi Zi Bai Pi Tang [Gardenia and Phellodendron Bark Decoction]).

Yangming Disease: Facial redness contraindicates purgation; doing so causes fever, yellow complexion, and impaired urination. In Yangming disease with impaired urination, if Cold damages the Stomach preventing eating, with constant hand/foot sweating, initial hard stool followed by loose stool, this suggests impending Gujia (Solid Mass). If eating normally and stools regulate, joint pain, mild fever sensation, sudden madness, constant sweating indicating resolution, implies Water failing to overcome Grain Qi combined with sweat; tight pulse indicates recovery. Anhidrosis, mental restlessness, or post-fire therapy showing slight forehead sweat or head-only sweat with neck-down anhidrosis, thirst for fluids, all indicate impending jaundice. If floating pulse, fever, thirst, and impaired urination occur, use Zhuling Tang. (Note: "Floating" here is likely an error; *Ren Shu* states floating pulse uses Wuling San, sinking pulse uses Zhuling Tang. Thus, "not floating" was likely omitted. Wuling San adds Guizhi and Baizhu to Zhuling, Zexie, Fuling; these are Yang/acrid-sweet acting externally. Zhuling Tang adds Ejiao and Huashi; these are Yin/sweet-cold acting internally. This distinction aligns with Zhang Zhongjing's intent. Cheng Shi interpreted via floating pulse, Zhu Xi via sinking pulse, both deviating. Correctly: floating pulse = Wuling San; non-floating = Zhuling Tang.) Regarding Shaoyin disease with diarrhea, cough, vomiting, thirst, irritability, insomnia for 6-7 days, Zhuling Tang is used despite no mention of sinking pulse, as Shaoyang/Shao Yin pulses are typically sinking. Cheng Shi’s textual interpretation is flawed. Patient with impaired urination, alternating hard/loose stools, occasional mild fever, wheezing/dizziness unable to lie down, indicates Dry Stool; use Dachengqi Tang (Major Order the Qi Decoction). Early stage (2-3 days) with weak pulse, no Taiyang/Shaoyang signs, irritability, epigastric hardness: give Xiaochengqi Tang (Minor Order the Qi Decoction) sparingly to harmonize. If no bowel movement for 6-7 days and scant urine, even if unable to eat, initial hardness suggests later looseness; wait for free urination to confirm hard stool before using Dachengqi Tang.

Shaoyang Disease: Cold Damage/Wind Strike after 5-6 days, with alternating chills/fever, hypochondriac pain, anorexia, irritability, frequent vomiting, epigastric palpitations, or impaired urination. Use Xiaochaihu Tang (Minor Bupleurum Decoction). Post-sweat/purge with hypochondriac fullness/knotting, impaired urination, thirst, no vomiting, head sweat, irritability, alternating chills/fever: use Chaihu Guijiang Tang (Bupleurum and Cinnamon Twig Decoction). Post-purgation after 8-9 days with chest fullness, fright, impaired urination, delirium, body heaviness/inability to turn: use Chaihu Jia Longgu Muli Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction).

Shaoyin Disease: Impaired urination with normal stool and abdominal pain is Shaoyin disease. With heavy limbs/water retention, use Zhenwu Tang (True Warrior Decoction). With pus/blood in stool, use Taohua Tang (Peach Blossom Decoction). With Si Ni (Cold Extremities), use Sini San (Frigid Extremities Powder) plus Fuling.

Jueyin Disease: Cold Damage with hiccups and abdominal fullness: check anterior/posterior obstructions and relieve them. Anterior refers to urination; floating pulse with impaired urination uses Wuling San, non-floating uses Zhuling Tang. Joint pain with impaired urination, inability to flex/extend, sweating, aversion to wind, edema indicates Rheumatism; use Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction). Sinking/slow pulse with rapid stool indicates Damp-Bi; *Ren Shu* recommends Wuling San.

Appendix:
*Ren Shu*: Yin syndrome with impaired urination, cold extremities, faint/thin pulse: avoid diuretic/cold/slippery herbs. Use Fanyin Dan (Return to Yin Pill) and moxa Stone Men (Shimen CV5).
*Ji Zhu*: For Cold Damage urinary obstruction, select Yin Gu (KI10) and Yin Ling Quan (SP9).

Wu Qian: For Cold Damage urinary obstruction, puncture Ren Mai points 1 cun below umbilicus (deep needle 8 fen) and Zhigou (SJ6) 3 cun above wrist between bones (needle 2 fen). Differentiate by Six Meridians. Taiyin: Fullness, diarrhea, impaired urination, no heat, sinking pulse: Lizhong Tang (Regulate the Middle Decoction) combined with Wuling San, plus Houpo and Muxiang to separate fluids/stool. Jueyin Cold Closure: Cold extremities, hidden pulse, scrotal retraction, impaired urination: Sini Tang (Frigid Extremities Decoction), Tongcao, Fuling, or moxa Qihai (CV6)/Shimen (CV5), or Scallion moxibustion. Yin Deficiency with Fire Agitation: Red/astringent impaired urination: add Mutong, Shengdi, Zhimu, Huangbai Wan. Internal Heat with constipation/red urine: Bazheng San (Eight-Herb Powder for Rectification). Non-thirsty impaired urination indicates Heat in Blood level: use Zhimu, Huangbai, Shengdi. Bladder stores fluids; Qi transformation enables excretion. Profuse sweating depletes fluids, reducing urine; do not diurese to avoid further fluid loss. Wait for sweat to stop. Spontaneous frequent urination should not be forcibly stopped to avoid Heat entering Bladder and causing Blood Stasis.

Urination Difficulty
Post-sweat difficulty: Taiyang sweating leading to continuous leakage, aversion to wind, difficulty urinating, stiff limbs: Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). Fire-induced sweating in Taiyang Wind Strike causes blood/qi overflow, jaundice, Yang excess/Yin deficiency, epistaxis tendency, difficulty urinating. Fire-induced sweating in Shaoyin causes cough, diarrhea, delirium, difficulty urinating.

Post-purgation difficulty: Two types. Pulse slow/floating/weak, aversion to wind/cold, purged: hypochondriac fullness, jaundice, neck stiffness, difficulty urinating. Yangming Excess Heat, fever/chills, floating/tight pulse, purged: abdominal fullness, difficulty urinating.

Hypochondriac Pain, Jaundice, Difficulty Urinating: If Yangming Excess Heat untreated, use Xiaochaihu Tang. Post-purgation anorexia with neck stiffness: contraindicate Chaihu.

Zhao Xianke: Zhang Zhongjing discusses urinary difficulty in Cold Damage: continuous sweating post-treatment uses Guizhi Jia Fuzi Tang (Cinnamon Twig plus Aconite Decoction). Yangming Wind Strike with stringy/large pulse, tidal fever, hiccups, or floating/tight pulse mistaken purgation causing fullness, or floating/slow pulse with fullness-induced vexation/dizziness. *Ren Shu* distinguishes transmitted Heat from Leakage Wind/Yang Collapse. Guizhi Jia Fuzi Tang addresses Yang collapse/meridian deficiency, not merely Yin deficiency with Yang aggregation. It should be listed separately from transmitted Heat, noting "Profuse sweating causes Yang collapse and fluid insufficiency, also leading to urinary difficulty," linking it back to Guizhi Jia Fuzi Tang.