Library

Zhongfeng (Stroke) most requires differentiation between the Bi Syndrome (Closed Syndrome) and Tuo Syndrome (Open/Deficiency Syndrome). The Bi Syndrome presents with locked jaws, open eyes, clenched fists, phlegm-qi obstruction, and slurred speech; it is suitable for formulas that open orifices and unblock collaterals, clear fire, and resolve phlegm, such as Xixian San (Saliva-Thinning Powder) and Zhibao Dan (Precious Treasure Pill). The Tuo Syndrome presents with open mouth, closed eyes, relaxed hands, urinary incontinence, rigid body, and coma; it is suitable for major tonifying formulas, such as Shenfu Tang (Ginseng and Aconite Decoction) and Dihuang Yinzi (Rehmannia Infusion). However, there are cases of Bi Syndrome presenting with closed eyes, urinary incontinence, rigid body, and coma; these must be distinguished by observing for locked jaws, clenched fists, reddish face, coarse breathing, and a large pulse. There are also cases of Tuo Syndrome presenting with gurgling phlegm and inability to speak; these must be distinguished by identifying a deficient and large pulse. As for Qi obstruction in Bi Syndrome, there are cases where all six pulses are absent; one must not conclude it is Tuo Syndrome simply due to the absence of pulse.

Xu Lingtai, in his annotation of Baitouweng Tang (Coptis Decoction) in *Shanghan Leifang* (Classification of Formulas for Cold Damage), stated: "All cases of tenesmus belong to Heat." Note: *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: "When there is cold in the Small Intestine, the person experiences tenesmus and bloody stool." This indicates that tenesmus does not exclusively belong to Heat; rather, Heat patterns are more common. Treatment should be based on pulse and symptoms, and one must not adhere rigidly to a single view. Yangming governs closing, so its disease is Weijia Shi (Stomach-Fu Excess/Heat Constipation). Taiyin governs opening, so its disease is Zili (Spontaneous Diarrhea). Weijia Shi refers to the dryness and exhaustion of Stomach fluids, so thirst is inevitable; medications such as Zhizi (Gardeniae Fructus), Chichi (Perillae Folium), Baihu Tang (White Tiger Decoction), Renshen (Ginseng Radix et Rhizoma), Zhuyeqing (Bamboo Leaf), Shigao (Gypsum Fibrosum), and Chengqi Tang (Purgative Decoction) are used, primarily to preserve body fluids. Zili refers to Cold-Dampness in the Spleen, so there is no thirst; medications such like Lizhong Tang (Regulate the Middle Decoction) and Sini Tang (Frigid Extremities Decoction) are used, primarily to warm the middle.

Regarding the Zheng (Syndrome) of Taohua Tang (Peach Blossom Decoction) in *Shanghan Lun* (Treatise on Cold Damage), opinions vary: some consider it Cold, some Heat, some Cold-Heat disharmony, and some initial Heat followed by Cold. Shen Dihuai’s discussion in *Yixue Sanshu Lun* (Discussions on Three Books of Medicine) is particularly detailed and accurate, so it is recorded here. For Yang disease diarrhea with pus and blood, this is Xi Re Li (Diarrhea accompanying Heat). For Yin disease diarrhea with pus and blood, this is due to the lower Jiao's failure to constrain, resulting in interior Heat. Using Taohua Tang to consolidate the lower Jiao and scatter Cold aligns deeply with Zhang Zhongjing’s intent. Generally, Shaoyin transmitted Yin disease affects the Shaoyin meridian but actually knots in the Stomach; Shaoyin direct invasion Cold disease affects the Zang organ itself, where lower Jiao deficiency-cold loses its function of closure and storage. Thus, warming and tonifying methods are used to scatter interior Cold and secure the intestines and stomach. *Zhuanshen* (Compendium) incorrectly claims that Cheng Wuji’s explanation of interior Cold is wrong. Does it not occur to them that if Heat is present, using astringent intestinal-stopping agents would prevent the Heat from exiting? Wu Huan stated that this syndrome comes from the Three Yang meridians and is purely a Heat disease; since Chishizhi (Halloysitum Rubrum) is Cold-natured, Ganjiang (Zingiberis Rhizoma) is used to treat it via reverse synergy (fan zhi). He likely saw bleeding and assumed Heat, unaware that tangible Blood relies intangible Qi to hold it. Lower Jiao deficiency-cold cannot secure Blood; only warming and tonifying can assist Yang to control Yin. Why must it be Yang disease Heat before pus and blood appear? Chishizhi is Warm-natured, as Zhu Danxi and Li Dongyuan both stated. On what basis did Wu Huan claim it is Cold? Yu Chang understood Zhang Zhongjing’s intent to rescue Yang, yet he considered this clause a Heat syndrome, stating that when slipping/descending occurs, Cold medicines must not be used. Why then does Zhang Zhongjing frequently use Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) for spontaneous diarrhea? What about Baitouweng Tang? His annotations are fragmented and contradictory; students should examine them carefully. (Note by HT: In cases of diarrhea with more Heat than Cold, the method for differentiating Shaoyin Cold diarrhea is explained most thoroughly by Wang Lingyou in *Shanghan Bianzheng Guangzhu* (Expanded Annotations on Differentiation of Cold Damage Syndromes), appended here: Shaoyin interior Cold causing pus and blood in stool will have a dark, dull color, not bright. This is because the Kidney has received Cold-Damp pathogenic factors, condensing the fluids of food and drink, which ferment in the intestines and stomach to form pus and blood. This differs from Fire nature, which is rapid and produces bright colors. Ice energy is still, and the abdomen prefers warmth; pain stops only when pressed by hand.)