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Yuanhua (processed by roasting) [Genkwa Flos], Gansui [Radix Kansui], Daji [Radix Euphorbiae Pekinensis], Dazao (broken open) [Fructus Jujubae] ten pieces.
The above three ingredients are of equal parts, each separately pounded into powder. Using one sheng and half of water, first decoct the ten plump Dazao, obtain eight ge of liquid, remove the dregs, add the medicinal powder. Strong individuals take one qianbi, weak individuals take half a qianbi, take warm, administer on an empty stomach in the early morning. If the purgation is slight and the disease is not eliminated, continue to take medicine the next day, increase by half a qianbi. After obtaining thorough purgation, nourish oneself with millet porridge.

[Formula Analysis]
Zhang Zhongjing's formulas for treating fluid retention vary greatly; this is the most峻猛 (potent/aggressive) among them. Whenever fluid qi causes pathology, whether presenting as panting, cough, palpitations, dysphagia, vomiting, or diarrhea, the pathology is localized to one area and stops there. Here, however, pathogenic water remains within the interior, causing fullness, distension, and pain in the heart and abdomen as well as the hypochondrium, obstructing the ascending and descending qi of the Sanjiao (Triple Burner), making it difficult to unblock. At this time, exterior pathogens have ceased, so diaphoretic methods are inappropriate; interior fluid retention is substantial and robust, so bland and permeating diuretic agents cannot overcome it. Without selecting extremely potent phlegm-draining herbs to directly subdue the pathogen, the Middle Qi will collapse, leaving one helpless awaiting death. Gansui, Yuanhua, and Daji are all acrid, bitter, and cold in nature, possessing the most toxic properties. Used together, their flavors complement and enhance each other, thus allowing them to directly attack the nest of pathogenic water, drain its channels, and induce severe purgation, thereby resolving the affliction in one stroke. However, where pathogenic factors gather, vital Qi must be deficient. Using toxic substances to attack pathogens inevitably damages the Spleen and Stomach. Without harmonious and sweet-soothing substances to act as masters, once the pathogens are exhausted, life itself will also perish. Since these medicines are extremely toxic and potent, Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome) cannot serve as sovereigns, and Gancao (Licorice Root) is incompatible with them. Therefore, ten large and plump Dazao are selected as the sovereign herb. One purpose is to protect the Spleen and Stomach, another is to moderate their harsh toxicity. After obtaining thorough purgation, nourishing oneself with millet porridge serves to replenish internal grain Qi internally and prevent the recurrence of pathogens. This is Zhang Zhongjing's method of using toxicity to attack disease, perfect in both beauty and goodness. Ignorant people, confused by the theory that "sweetness can cause fullness in the center," dare not use it, failing to understand the principle of mutual restraint!

In Taiyang disease, if exterior symptoms are unresolved, purgation should not be used; using purgation is contrary to treatment principles. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
[Annotation]
"Taiyang disease with unresolved exterior symptoms" refers to the unresolved exterior syndrome suitable for Guizhi Tang. Whenever exterior symptoms are unresolved, regardless of whether sweating has been induced previously, even if there are indications for purgation, unless it falls under the category of urgent purgation, purgation must not be used. Using purgation is contrary to treatment principles. To resolve the exterior, Guizhi Tang should still be administered as the primary treatment.
[Collected Notes]
Wang Kentang stated: Even the slightest headache and aversion to cold indicate unresolved exterior symptoms, and purgation should not be used.
Cheng Yingmao stated: If exterior symptoms remain unresolved after purgation, the exterior should still be resolved. If specific indications match the medication, one should not assume that because purgation was already performed, Guizhi Tang is no longer applicable.
Wang Hu stated: Using purgation is contrary; "contrary" means attacking the interior when the disease is in the exterior, which is inconsistent with treatment principles.

In Taiyang disease, if initial diaphoresis fails to resolve the condition, followed by purgation, and the pulse remains floating, recovery will not occur. Floating indicates the pathogen is in the exterior, but purgation was incorrectly applied, hence failure to recover. Now that the pulse is floating, we know the pathogen is still in the exterior; resolving the exterior is necessary for recovery, so Guizhi Tang is appropriate.
[Annotation]
In Taiyang disease, if initial diaphoresis fails to resolve the exterior, diaphoresis should still be indicated, but subsequent purgation represents an inappropriate treatment. The failure to recover with a floating pulse is because the pathogen is in the exterior, yet purgation was incorrectly applied. Although the incorrect purgation has not yet led to a fully adverse state, the pulse remains floating, indicating the pathogen is still in the exterior; therefore, Guizhi Tang should still be used to resolve the exterior for recovery.
[Collected Notes]
Cheng Yingmao stated: Recovery or non-recovery is distinguished by the pulse. Those who recover will have a pulse that is no longer floating and has left the exterior. If the pulse is floating, it indicates the pathogen is still in the exterior, meaning the previous purgation was incorrect, leading to non-recovery. Do not dwell on past errors; focus only on the present. Regarding current symptoms, do not dwell on them; focus only on the pulse. If the pulse is floating, knowing the pathogen is still in the exterior, even if many days have passed, resolving the exterior is still required for recovery. With such a pulse, use such a medication; do not assume that because purgation was performed, Guizhi Tang is no longer applicable.

Originally, diaphoresis should have been used, but purgation was applied instead; this is contrary. If diaphoresis is used first, the treatment is not contrary. Originally, purgation should have been used first, but diaphoresis was applied instead; this is contrary. If purgation is used first, the treatment is not contrary.
[Annotation]
The principles for managing contraindicated treatments revolve around the Exterior and Interior; treatment of the Exterior and Interior revolves around diaphoresis and purgation. For diseases presenting with both exterior and interior syndromes, one must determine whether diaphoresis or purgation should come first. Proper sequencing is compliant; improper sequencing is contrary. If the exterior urgency exceeds the interior, diaphoresis should be used first, but purgation was incorrectly applied; this is contrary. If diaphoresis is used first, followed by purgation, the treatment is not contrary. If the interior urgency exceeds the exterior, purgation should be used first, but diaphoresis was incorrectly applied; this is contrary. If purgation is used first, followed by diaphoresis, the treatment is not contrary.
[Collected Notes]
Cheng Zhi stated: This discusses the sequence and urgency of diaphoresis and purgation; one must not act backwards or against the natural order. Wang Hu stated: In treating Cold Damage, if exterior symptoms are urgent, diaphoresis is appropriate; if interior symptoms are urgent, purgation is appropriate. One should not rigidly adhere to "diaphoresis first, then purgation." Proper application of diaphoresis and purgation ensures the treatment is not contrary.

In Taiyang disease, after incorrect purgation, if the pulse is rapid-intermittent (Cu) and there is no Chest Binding (Jie Xiong), this indicates impending resolution. If the pulse is floating, Chest Binding will definitely occur; if tight, throat pain will definitely occur; if wiry, bilateral stiffness and spasm will definitely occur; if fine and rapid, headache will persist; if deep and tight, vomiting will definitely occur; if deep and slippery, heat-collateral diarrhea will occur; if floating and slippery, bleeding from below will definitely occur.
[Commentary]
"Cu" (rapid-intermittent) should likely be "floating"; only then does it align semantically with "no Chest Binding" indicating impending resolution. "Floating" should likely be "Cu"; only then does it align with the discussion of Chest Binding and chest fullness in the treatise. "Tight" should likely be "fine and rapid"; "fine and rapid" should likely be "tight"; only then does it conform to the fundamental pulses of the two meridians discussed. "Floating and slippery" should likely be "rapid and slippery"; floating-slippery is the pulse for Baihu Tang syndrome in the treatise, while rapid-slippery is the pulse for passing pus and blood. Careful study of various chapters will reveal this.
[Annotation]
When the disease is in Taiyang, incorrect purgation leads to different transformations due to individual differences in organ Qi, transforming according to where the pathogen enters. Incorrect purgation causing pathogen sinking should result in Chest Binding; conversely, if Chest Binding does not occur and the pulse is floating, this indicates interior harmony rejecting the pathogen, with the pathogen remaining in the exterior, signifying impending resolution. If the pulse is Cu, it is the pulse of Yang solidifying with excess pathogens, so Chest Binding will definitely occur. Fine and rapid is the pulse of Shaoyin pathogenic heat; throat pain is a Shaoyin pathogenic heat symptom; incorrect purgation causing pathogen sinking into Shaoyin requires treatment according to Shaoyin principles. Wiry is the pulse of Shaoyang; bilateral stiffness and spasm are Shaoyang symptoms; incorrect purgation causing pathogen sinking into Shaoyang requires treatment according to Shaoyang principles. Tight is the pulse of Taiyang; headache is a Taiyang symptom; incorrect purgation leaving the pathogen in the exterior requires treatment according to Taiyang principles. Deep and tight is the pulse of cold pathogens entering the interior; desire to vomit is a symptom of Stomach Yang repelling; having an exterior condition, incorrect purgation causes pathogen sinking into the Stomach, requiring treatment according to Yangming principles. Deep and slippery is the pulse of retained food; having an exterior condition, incorrect purgation causes heat-collateral entry into the interior leading to diarrhea, requiring treatment for heat-collateral diarrhea. Rapid and slippery is the pulse of accumulated heat; having an exterior condition, incorrect purgation causes pathogen sinking into Yin, damaging Ying (Nutritive Qi) and leading to lower bleeding, requiring treatment for passing pus and blood.
[Commentary]
Cu is indeed a Yang pulse. If Cu is forceful, it indicates excess, representing the syndrome of real pathogens in Chest Binding; if Cu is weak, it indicates deficiency, representing the syndrome of deficient pathogens in chest fullness. Thus, in the treatise, cases with Cu pulse, Chest Binding, head sweat, and minor tidal fever use Xiantong Tang to attack; cases with Cu pulse, chest fullness, sweating, and slight aversion to cold use Guizhi Qu Shaoyao Jia Fuzi Tang to warm. Observing the treatment methods for deficiency and excess in Cu pulses allows for analogy.
[Commentary]
Throat pain is a symptom present in both cold and heat conditions of Shaoyin. Dry, swollen, and painful throat indicates heat; non-dry, non-swollen but painful throat indicates cold. Thus, in the Shaoyin chapter, there are two treatment methods: Ganjie Tang and Tongmai Sini Tang.
[Collected Notes]
Fang Youzhi stated: All conditions in Taiyang are exterior syndromes. Incorrect purgation leads to mixed transformational symptoms, which cannot be restricted to a single approach.
Cheng Zhi stated: Improper purgation leads to countless transformations, which is what this refers to. Now, throat pain, abdominal urgency, and desire to vomit are transformations of cold pathogens entering the interior. Headache, hot diarrhea, and lower bleeding are transformations of wind pathogens entering the interior. The reason is that floating, slippery, and rapid pulses are Yang, while deep, wiry, tight, and fine pulses are Yin.
Cheng Yingmao stated: Based on pulse and symptoms, each uses the word "definitely," showing inevitability. Tracing the source, it always stems from Taiyang disease treated with incorrect purgation. Thus, although there is a distinction between formed and unformed damaged diseases, living methods should be used; one must not treat merely based on pulse or symptom alone.

In Taiyang disease, on the second or third day, inability to lie down, only desiring to rise, with必定 (must) knotting in the epigastrium, and a weak and faint pulse indicates pre-existing cold accumulation. Applying purgation contrary to this, if diarrhea stops, Chest Binding will definitely develop; if it does not stop, and on the fourth day purgation is repeated, this results in heat-collateral diarrhea.
[Commentary]
The character "zhi" (of/it) in "repeat purgation on the fourth day" should be "li" (diarrhea). Given the previous statement that diarrhea had not stopped, how could purgation be repeated? Careful study reveals this must be a transcription error.
[Annotation]
Taiyang disease refers to stiffness and pain in the head and neck with aversion to cold. On the second or third day, seeing symptoms of inability to lie down and only desiring to rise indicates transmission to Yangming. "Epigastrium" refers to the Stomach region; "must knot" means there must be knotting in the Stomach region. If the pulse is substantial and large, it indicates heat knotting in the Stomach region, warranting purgation. Now, the pulse is weak and faint, indicating cold knotting in the Stomach region; purgation is not indicated. Applying purgation when not indicated is called "contrary purgation." On the second or third day, normally resolving Taiyang and Yangming exterior, applying contrary purgation allows exterior heat to enter the interior via deficiency,必定 (must) causing spontaneous diarrhea. If diarrhea stops spontaneously, it indicates the person has Stomach excess transforming with dryness,必定 (must) developing Chest Binding. Now, since diarrhea has not stopped, and on the fourth day diarrhea recurs, it indicates the person has Stomach deficiency transforming with dampness, thus必定 (must) developing heat-collateral diarrhea.
[Collected Notes]
Cheng Zhi stated: This shows that incorrect purgation of exterior symptoms can lead to transformations of Chest Binding and hot diarrhea; caution is essential. Since the pulse is weak and faint, it indicates cold knotting in the epigastrium, requiring warming and dispersing. The physician sees epigastric knotting and applies purgation to induce diarrhea, which is contrary to proper treatment.
Wang Hu stated: In Taiyang disease, on the second or third day, inability to lie down, desiring to rise, and heat knotting in the epigastrium seem amenable to purgation; however, with a weak and faint pulse, the person inherently has cold accumulation; how can purgation be used?

In Taiyang disease, if exterior symptoms remain unresolved, and multiple purgations are applied, resulting in heat-collateral diarrhea; if diarrhea continues incessantly, with epigastric fullness and obstruction, and both exterior and interior remain unresolved, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) is the primary treatment.
[Annotation]
This follows the previous clause regarding weak/faint pulse and heat-collateral diarrhea, detailing the symptoms to clarify the treatment. "Exterior symptoms unresolved" means Taiyang disease persists, and "multiple purgations" implies purgation was not a one-time event. The interior becomes deficient due to repeated purgation, subsequently collaborating with exterior heat to cause diarrhea; incessant diarrhea indicates interior deficiency failing to secure. Epigastric fullness and obstruction indicate interior deficiency with pathogenic knotting. Since exterior symptoms are unresolved, the exterior is not cleared; thus, Guizhi is used to resolve the exterior. Diarrhea with epigastric fullness and obstruction indicates the interior, due to deficiency from purgation, transforms into cold; the pulse will undoubtedly be weak and faint as described earlier; thus, Renshen, Baizhu, Shengjiang (Fresh Ginger), and Gancao are used to warm the interior. This is a method of warming and tonifying while simultaneously resolving the exterior and interior. If the pulse is forceful, one should follow the method of Ganxiao Xiexin Tang (Licorice and Pinellia Decoction).
[Collected Notes]
Yu Chang stated: Incorrect purgation leads to interior deficiency, allowing external heat to invade, transforming into incessant diarrhea due to interior deficiency failing to guard. Fullness and obstruction indicate righteous deficiency and pathogenic excess, creating stagnation in the middle, resulting in cold fullness without unblocking. Because the exterior is unresolved, Guizhi is used to resolve it. Because the interior is appropriately deficient, Lizhong Tang is used to harmonize it. This formula is essentially Lizhong Tang plus Guizhi with a changed name, serving as a method for treating deficient fullness and diarrhea.
Li Zhongzi stated: The Classics state: If a Guizhi syndrome patient is incorrectly purged, leading to incessant diarrhea, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) is given. Here, Guizhi Renshen Tang is given instead. Why the difference in warming and cooling medications? That case merely says "purged," whereas this case says "repeatedly purged"; that case says "diarrhea," whereas this case says "incessant diarrhea." Comparing the two discussions reveals the distinction between deficiency and excess.
Cheng Zhi stated: For exterior symptoms incorrectly purged, leading to incessant diarrhea, panting, and sweating, Gegen Qinlian Tang is used. For epigastric fullness and obstruction, Guizhi, Renshen, and Baizhu are used. One rescues real heat entering the interior from exterior pathogens; the other rescues deficient cold entering the interior from exterior pathogens. Both are methods of simultaneously resolving the exterior and interior.
Cheng Yingmao stated: Heat-collateral diarrhea has traditionally been viewed as Yang pathogens sinking into the Lower Jiao. If so, how could Lizhong Tang be used? This is because one does not know that diarrhea has both cold and heat syndromes.