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Cheng Wuji's Commentary: The *Neijing* states: "Yang qi, when pure and refined, nourishes the spirit; when soft and flexible, it nourishes the sinews." Sweating leads to a depletion of body fluids and a severe deficiency of Yang qi, causing the muscles and sinews to lose their nourishment. Consequently, there is trembling and twitching of the muscles. In such cases, one should directly employ methods to warm the meridians and benefit Yang qi; formulas similar to *Zhenwu Tang* (True Warrior Decoction) are appropriate. Furthermore, after Taiyang disease has undergone vomiting or purging, and sweating is induced again, resulting in trembling and twitching of the sinews, this condition may develop into flaccidity syndrome (*Wei*) over time. Similarly, if Taiyang disease is treated with sweating followed by purging, leading to deficiency in both the exterior and interior, and then cauterization (burning needle) is applied to the skin, these conditions are difficult to treat. Both scenarios represent severe deviations from proper treatment principles. These situations are not comparable to those where only sweating was performed; how can treatments involving sweating, vomiting, and purging be neglected?

Taiyang Chapter: In patients with Taiyang disease presenting with a faint pulse, spontaneous sweating, and aversion to wind, *Da Qinglong Tang* (Major Green Dragon Decoction) must not be administered. If taken, it will lead to cold extremities (*Jue Ni*) and muscle twitching (*Jin Ti Rou Yu*). *Zhenwu Tang* (True Warrior Decoction) is indicated. For Taiyang disease where symptoms persist despite prior sweating, accompanied by continued fever, vertigo, body tremors, and a sensation of falling, *Zhenwu Tang* (or *Renshen Yangrong Tang* [Ginseng Nourishing Qi and Blood Decoction] with doubled doses of *Renshen* [Ginseng Root] and *Danggui* [Angelicae Sinensis Radix]) should be used. After Taiyang disease has been treated with vomiting and purging, followed by sweating, if deficiency irritability appears, the pulse becomes extremely faint, and after eight or nine days, epigastric fullness (*Xia Pi*), hypochondriac pain, Qi rushing up to the throat, dizziness, vertigo, and pulsation of the meridians occur, this may eventually develop into flaccidity syndrome (*Wei*). Treat with *Zhenwu Tang* (True Warrior Decoction) or *Guizhi Lingzhu Gancao Tang* [Cinnamon Twig, Poria, Atractodes, and Licorice Decoction].

Yangming Chapter: After Taiyang disease has undergone vomiting and purging but remains unresolved, with constipation lasting from five to six days up to ten-plus days, tidal fever occurs in the late afternoon. There is no aversion to cold, but rather delirious speech as if seeing ghosts, picking at bedclothes and bedsheets, fearfulness and restlessness, panting, fixed gaze, a wiry pulse indicates survival, while a choppy pulse indicates death. If there is only fever and delirium, *Da Chengqi Tang* (Major Order the Qi Decoction) is indicated. In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness and distension, panting, fever, sweating, aversion to heat rather than cold, and heaviness of the body, applying cauterization will inevitably cause fright, terror, irritability, and insomnia. If "moving Qi" manifests on the left side with persistent head sweating, the *Ren Shu* (Book of Vitality) suggests using *Fangfeng Baizhu Muli San* (Saposhnikovia, Atractodes, and Oyster Shell Powder), followed by *Jianzhong Tang* (Establish the Middle Decoction).

Diagnosis Chapter: After treatments involving sweating, purging, vomiting, warming, or needling, if the patient exhibits skin twitching, chest distress and irritability, and a bluish-yellow complexion, the prognosis is poor (see discussion on "Pi" [Glomus/Fullness]).

*Ren Shu* (Book of Vitality): After Taiyang disease undergoes vomiting and purging followed by sweating, if the pulse is faint, there is epigastric fullness, hypochondriac pain, Qi rushing upward, and trembling/twitching of the sinews, this represents a severe therapeutic deviation.

Wu Qian et al.'s Commentary: This syndrome arises because excessive sweating to attack the exterior leaves pathogenic heat unresolved, leading to deficiency and exhaustion of blood and Qi, causing the muscles and sinews to lose nourishment. Alternatively, it may stem from a constitutional deficiency of blood, where pathogenic heat combats within the blood vessels; since fire nature is active, it causes trembling and twitching of the sinews. I once treated a patient with Taiyang disease who had not undergone sweating. After seven or eight days, sinew trembling and twitching occurred, with tidal fever being more severe, muscle twitching, constipation, dark and scanty urine, and hardness and pain upon pressing around the umbilicus. This indicated dry fecal matter (*Zao Shi*), which was resolved using modified *Da Chaihu Tang* (Major Bupleurum Decoction). Another patient suffered from Taiyang disease for over ten days and underwent sweating three or four times excessively. This resulted in muscle twitching, body tremors, and sinew pulsation due to severe deficiency of Qi and blood from excessive sweating. This was cured with two doses of modified *Renshen Yangrong Tang* (Ginseng Nourishing Qi and Blood Decoction). A third patient experienced deficiency irritability and insomnia after sweating, along with muscle twitching and internal heat, which was cured using modified *Wendan Tang* (Warm Gallbladder Decoction). When treating this syndrome, one must always distinguish between deficiency and excess.