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In the prescription of Sini Tang (Four Reversal Decoction), add Ren Shen (Ginseng Radix) 1 liang, and follow the preparation and administration method of Sini Tang for the rest.

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When vomiting, diarrhea, and sweating occur, and the pulse becomes level/normal, but slight restlessness persists, this is because the spleen and stomach qi are newly deficient and cannot withstand the grain qi generated from food digestion.

[Annotation]
In Huoluan (Cholera-like disease with sudden vomiting and diarrhea), if vomiting and diarrhea have ceased, sweating has stopped, and the pulse is peaceful, it indicates that pathogenic factors inside and outside have been resolved. According to standard practice, one should eat. If slight restlessness occurs after eating, it is because the middle jiao (middle burner) is newly deficient following vomiting and purging, and cannot tolerate the grain qi. By regulating diet, recovery will naturally occur.

[Collected Annotations]
Zheng Zhongguang stated: After vomiting, diarrhea, and sweating, a normal pulse indicates the retreat of yin pathogens and the return of yang qi, resulting in this manifestation. However, due to new deficiency, the body cannot withstand grain qi, leading to slight restlessness. Generally, in Huoluan, food and drink should not be given within twenty-four hours after vomiting and diarrhea, as the stomach qi is rebellious and the digestive system is not yet stable; rice should not be introduced immediately.

Zhang Xiju stated: Huoluan is most common in summer and autumn. Pathogens such as wind, cold, summerheat, and dampness can all attack humans and cause Huoluan, not just cold pathogens alone. If vomiting and diarrhea are excessive, damaging the qi of the middle jiao, causing an interruption of yin and yang, cold limbs, and a faint pulse nearly imperceptible, Sini Tang or Lizhong Tang should be used regardless of cold or heat seasons. Generally, when pathogens are strong and healthy qi is solid, one should drain the pathogens; when pathogens are strong and healthy qi is weak, one should support the healthy qi. Moreover, in summer, yang qi floats on the exterior while yin qi hides within. Coupled with cold wind chilling the body and cold water chilling the stomach, both interior and exterior become cold. Wind and summerheat pathogens inevitably enter the yin meridians by taking advantage of this deficiency. Therefore, in summer, there are only yin syndromes, no typical Shanghan (Cold Damage). When people die from summerheat syndromes with cyanosis of the fingernails and toenails, it is a yin syndrome. The ancients used Dashun San (Great Harmony Powder) to treat summerheat, which was well-founded.

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Considering that diseases often arise urgently, and key treatments are difficult to locate in haste, I have recompiled the principles of what methods are permissible and impermissible. Compared to the chapters on the Three Yin and Three Yang meridians, these are easier to understand. Additionally, sometimes conditions extend beyond the scope of the Three Yin and Three Yang chapters, appearing within these principles of permissibility and impermissibility.

[Annotation]
Since diseases arise urgently, and essential treatments are hard to find in haste, the key lies in diaphoresis (sweating), emesis, and purgation. Thus, I have recompiled the principles regarding which methods of diaphoresis, emesis, and purgation are permissible and which are not. Compared to the Three Yin and Three Yang chapters, these are easier to grasp. Sometimes conditions do not strictly fit within the Three Yin and Three Yang chapters but appear in these principles of permissibility and impermissibility.

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The general principle is that diaphoresis is suitable in spring and summer.

[Annotation]
In spring and summer, yang qi is smooth and ascending, so diaphoresis is suitable. This is the routine method of treatment and constitutes a fundamental principle.

[Collected Annotations]
Cheng Yingmao stated: Diaphoresis is suitable in spring and summer because sweating helps to disseminate yang qi, analogous to the generative and nurturing functions of spring and summer. Many people today consider Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) as contraindicated in spring and summer. Those who lightly disregard classic theories fail to understand the laws of nature.

Generally, when inducing sweating, one desires sweat to emerge uniformly from the hands and feet, appearing moist and continuous, lasting for about an hour, which is also acceptable. One must not allow sweat to pour out like water. If the disease does not resolve, diaphoresis may be repeated. However, excessive sweating will certainly lead to the loss of yang qi; those with deficient yang must not undergo repeated diaphoresis.

[Annotation]
When inducing sweating, ensuring uniform emergence from the hands and feet implies that sweat should exit slowly and cover the whole body, thereby eliminating pathogenic factors completely without injuring healthy qi. The goal is to avoid excessive, rapid sweating. If sweat exits too rapidly and excessively, pathogenic factors will not be fully eliminated, and healthy qi will be damaged. If the disease remains unresolved, diaphoresis should be repeated. But if previous sweating was already excessive, further sweating will deplete yang qi. Since yang deficiency leads to unresolved disease, one dare not induce sweating again.

[Collected Annotations]
Cheng Wuji stated: Slow sweating eliminates pathogenic factors in both the exterior and interior. Profuse sweating fails to remove pathogens and only leads to the loss of yang qi. Yang deficiency implies a lack of body fluids, so repeated diaphoresis is contraindicated.

Fang Youzhi stated: This is a careful instruction on the degree of diaphoresis.

Zhang Xiju stated: Sweat is body fluid; profuse sweating depletes body fluids. Why is it said to deplete yang qi? The Classic states: The Upper Jiao opens the cou-li (pores and interstices), steams the skin, fills the body, and moistens the hair, like mist and dew. Although sweat is body fluid, it must rely on the steaming and dissemination of yang qi to be excreted. Therefore, profuse sweating depletes body fluids, and yang qi is lost along with it.

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Whenever decoctions are taken to induce sweating, stop medication once the disease is addressed; there is no need to consume the entire dose.

[Annotation]
After taking decoctions to induce sweating, if sweating occurs and the disease resolves, discontinue further administration. There is no need to insist on finishing the entire prescription.

[Collected Annotations]
Cheng Yingmao stated: "Stop when the disease is addressed" applies to both Mahuang Tang and Guizhi Tang, emphasizing the character "zhong" (addressing/hitting the mark) to strictly prohibit improper medication.

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Whenever it is stated that diaphoresis is permissible, if no decoction is available, pills or powders may also be used, provided that sweating occurs to resolve the condition. However, this is inferior to decoctions, which offer better efficacy through flexible adjustment according to symptoms.

[Annotation]
Whenever diaphoresis is indicated but no decoction is available, pills or powders may serve as substitutes in emergencies. The key is achieving sweating to resolve the condition. However, pills and powders have fixed dosages and cannot be adjusted flexibly based on changing symptoms like decoctions can. Their efficacy is therefore less precise, hence described as "good" but inferior to decoctions.

[Collected Annotations]
Cheng Yingmao stated: Pills and powders are merely temporary measures; they cannot match the flexibility of decoctions in treating specific symptoms.

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If a patient presents with a floating and large pulse, and upon inquiry reports only constipation, assuming purgation is used constitutes a major error. Constipation indicates excess; however, diaphoresis resolves the condition. Why? Because a floating pulse requires resolution via diaphoresis.

[Annotation]
A floating and large pulse indicates that the exterior syndrome is unresolved. Even if there is internal excess manifesting as constipation, purgation must not be used. Why? Because the pulse is floating. One must first resolve the exterior. Once the exterior is resolved and heat dissipates, the interior harmonizes, and bowel movements normalize naturally. Using purgatives in this scenario constitutes a major error.

[Collected Annotations]
Cheng Wuji stated: Even in urgent Jie Xiong (Chest Binding) cases, a floating and large pulse absolutely contraindicates purgation; purging leads to death. How much more so for simple constipation? The Treatise states: Originally indicating diaphoresis but instead using purgation is incorrect; initiating with diaphoresis is not incorrect. This refers to such situations.