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Taiyang disease, after initially taking Guizhi Tang (Cinnamon Twig Decoction), if there is a rebound of vexation, it indicates that Yang pathogenic factors are obstructed in the Yang aspect and cannot dissipate. Therefore, Fengchi (GB20) and Fengfu (GV16) acupoints should be needled first to unblock the obstruction.

When Yang pathogenic factors are suppressed but not resolved, they should still be expelled by following the trend of Yang. This explains the rationale behind removing Shaoyao (Paeoniae Radix Alba) from Guizhi Tang.

If the pathology is at the exterior (Yang) but purgation is mistakenly applied, the pathogenic factor is suppressed and fails to recover, while the healthy Qi is just weakened and unable to振奋 (stir up). Consequently, the pulse often presents as Cu Mai (Surging Pulse). However, differentiation is required: if the pathogen remains at the exterior, purely acrid-sweet herbs for diaphoresis should be used; Guizhi Qushaoyao Tang (Cinnamon Twig Decoction without Paeonia) is such a formula. If it is differentiated that the pathogen has entered the interior along with the exterior, bitter-cold herbs for clearing heat should be combined; Gegen Huangqin Huanglian Tang (Kudzu Root, Scutellaria and Coptis Decoction) is such a formula.

Residual pathogens remain unsettled and combine to cause chaos; lingering evil qi is not cleared and gathers to cause disease. For example, after sweating resolves Taiyang Shanghan (Cold Damage), vexation recurs after half a day.

The three scenarios involving severe purgation followed by sweating all refer to conditions after both sweating and purgation have been used. However, if there is difficulty in urination, Yin fluids are injured; if there is trembling chills and a faint, fine pulse, both Yin and Yang are injured; if there is daytime irritability and inability to lie down, Yang is injured but Yin is spared. From this, we can see the differences in pathological changes. Sweating causing disturbance of the meridians occurs when there is no pathogen to expel, yet the meridian Qi is disturbed. I believe that interpreting this scenario as related to Yin Syndrome (Fluid Retention) is likely not erroneous.

After sweating, if water and medicine cannot enter the mouth, it indicates disturbance of meridian Qi. If only the Yang pulse is faint, resolution is achieved through sweating first; if only the Yin pulse is faint, resolution is achieved through purgation. This represents the method of driving out hardness and attacking flaws.

Wheezing accompanied by sweating may result from collapse of Yang Qi or from internal pressure of hot Qi. In Taiyang disease, mistaken purgation leads to diarrhea, a surging pulse, wheezing, and sweating; Gegen Huanglian Huangqin Tang (Kudzu Root, Coptis and Scutellaria Decoction) is indicated.

Promoting urination and dispelling blood stasis are the two major approaches for Heat entering the Bladder. For promoting urination, distinguishing between clear/turbid and warm/cool, Wuling San (Five-Ingredient Powder with Poria) and Zhuling Tang (Polyporus Decoction) are examples. For dispelling blood stasis, distinguishing between mild and severe cases, Tao Ren Chengqi Tang (Prunus Seed and Rhubarb Decoction) and Didang Tang/Wan (Toughness Overcoming Decoction/Pill) are examples.

Da Qing Long Tang (Major Blue Green Dragon Decoction) primarily disperses exterior cold and clears interior heat, hence Mahuang (Ephedra) dosage exceeds Shigao (Gypsum). Maxing Shigan Tang (Ephedra, Apricot Kernel, Ginseng, and Gypsum Decoction) primarily clears Lung heat and disperses Lung pathogens, hence Shigao (Gypsum) dosage exceeds Mahuang (Ephedra). Guizhi Tang (Cinnamon Twig Decoction) primarily disperses exterior pathogens, so Guizhi (Cinnamon Twig) doubles Shaoyao (Paeonia), enhancing the acridity of Shengjiang (Fresh Ginger); Jianzhong Tang (Middle-Building Decoction) primarily establishes Middle Qi, so Shaoyao (Paeonia) doubles Guizhi (Cinnamon Twig), enhancing the sweetness of Yitang (Maltose). Although the ingredients are similar, the roles of Sovereign and Minister herbs differ, leading to different effects on exterior/interior and tonification/draining.

The transition from Taiyang to Yangming has two beginnings: First, incomplete sweating allows the pathogen to persist and transmit. The text states: "When Taiyang disease is first acquired, frequent sweating is attempted; if the sweat is initially incomplete, it transforms into Yangming." Second, excessive sweating dries the Stomach, leading to transmission. The text states: "In Taiyang disease, if sweating, vomiting, purgation, or diuresis are used, resulting in loss of Jin-Ye (Body Fluids) and dryness in the Stomach, it transforms into Yangming."

Pathogenic factors in the meridians cannot gather, so upon transmitting to the Fu organs, they gather and cease transmitting. Since the meridian pathogen has not changed nature, chills persist; upon entering the Fu organs, it transforms into heat and chills cease. The text states: "Yangming resides in the center, belonging to Earth, where all things return and no further transmission occurs. Although chills occur initially, they stop spontaneously by the second day; this is the symptom pattern of Yangming entering the Fu organs."

In Yangming disease, profuse sweating is the norm; conversely, anhidrosis with a sensation like insects crawling under the skin indicates internal steaming of heat with failure of fluids to reach the surface.

For Pi Syndrome (Glomus) with unresolved exterior symptoms, the exterior should be resolved first, and one should not immediately treat the Pi. If accompanied by persistent diarrhea, this rule does not apply, and simultaneous treatment of exterior and interior is appropriate. In Taiyang disease, if exterior symptoms persist but multiple purgations are used, leading to diarrhea with fever, persistent loose stools, epigastric fullness/hardness, and simultaneous exterior-interior involvement, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is indicated.

In Yangming disease, dry tongue and mouth due to fluid depletion are not alarming; however, if Yang Qi is also lost, it is dangerous. In Shaoyin disease, sweating and cold limbs due to Yang deficiency are not alarming; however, if Yin is also damaged, it is critical. Therefore, in Yangming dry thirst, those who can drink cold liquids survive, while those who cannot die; in Shaoyin cold limbs, those with non-dry tongues survive, while those with dry tongues die.

In Shaoyin disease lasting eight or nine days, if the whole body and extremities become hot, the pathogen has moved from the root (Zang) to the branch (Fu), from the Zang organs to the Fu organs. Even if hematochezia (blood in stool) occurs, it is treatable.