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Within the formula of Guizhi Tang (Cinnamon Twig Decoction), add two taels of Guizhi (Cinnamon Twig) more, making the total five taels. The rest should follow the preparation and administration method of Guizhi Tang.

[Collected Explanations]
Xu Bin stated: This is Wind-Evil affecting the Taiyang (Greater Yang) channel. Because burning needles were used to force sweating, cold evil was subsequently contracted. The pathogen entered from the Taiyang Fu organ (Bladder) and combined with its paired Zang organ (Kidney), resulting in Ben Tun (Rushing Pig disease). Therefore, it still follows the Taiyang treatment principle, using the complete Guizhi Tang. Doubling the dosage of Guizhi serves to drain Yin-cold internally while simultaneously expelling external pathogens.

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In a Taiyang disease, if fire moxibustion or fumigation is applied and sweating does not occur, the patient will inevitably become restless. If the disease duration passes without resolution, hematochezia (blood in stool) will definitely occur; this is named Huo Xie (Fire Evil).

[Annotation]
Huo Xun (fire fumigation) is an ancient method for forcibly inducing sweat, similar to modern methods using heated beds or warm coverings to induce sweating. In Taiyang disease, applying fire fumigation without inducing sweating causes severe internal heat and restlessness. The Yin fluids are further damaged, and without Yin, Yang cannot transform into sweat, thus failing to resolve the condition. The fire penetrates the Yin aspect, damaging the Yin collaterals and forcing blood downward, leading to hematochezia. Naming it "Fire Evil" indicates that one should treat the Fire Evil rather than specifically treating the hematochezia.

[Collected Notes]
Fang Youzhi stated: "Zao" (restlessness/agitation) refers to rapid twitching of hands and feet. "Dao" implies "fan" (contrary/reversal), meaning merely agitated but failing to resolve. Sweat is the fluid of blood. Blood moves when heated. Since fire is intensely hot and sweating did not occur, blood must overflow recklessly, hence hematochezia occurs.
Cheng Yingmao stated: In Taiyang disease, fire fumigation fails to induce sweat, indicating that the body's fluids were originally deficient. Without Yin, Yang cannot transform into sweat. With Yin deficiency exacerbated by fire, heat has no outlet, causing the patient to be restless and uneasy.

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If the pulse is floating and the heat is intense, applying moxibustion is contraindicated. This is a Excess pattern treated as Deficiency. Due to the fire, pathological factors move upward, causing dryness of the throat and hematemesis (vomiting blood).

[Annotation]
A floating pulse with intense heat indicates Excess-Heat at the exterior; there is no rationale for moxibustion. Applying it constitutes treating an Excess pattern as Deficiency. Consequently, heat is stirred by the fire, becoming blazing, inevitably leading to dry throat and hematemesis. In the previous case, fire injured the Yin aspect, forcing blood downward, causing hematochezia. In this case, fire injures the Yang aspect, forcing blood upward, causing hematemesis.

[Collected Notes]
Cheng Yingmao stated: Exterior Excess with heat, mistaken for Deficiency-Cold, leads to the use of moxibustion. Heat has no way to vent out, so due to the fire, it attacks inward. Pathogens are constrained externally, while fire attacks internally, injuring Lung Metal, resulting in dry throat and hematemesis.
Wang Hu stated: Treating exterior wind-heat with moxibustion is treating Excess as Deficiency.

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A pulse that is fine and rapid strongly contraindicates moxibustion. Fire becomes a pathogenic factor, causing irritability and rebellion. It pursues Deficiency and chases Excess, scattering blood within the vessels. Although the fire energy is slight, its internal attack is powerful, leading to scorched bones and damaged sinews, with blood difficult to restore.

[Annotation]
A fine and rapid pulse indicates Yin deficiency and blood scarcity; moxibustion is absolutely contraindicated. If mistakenly applied, mugwort fire attacks internally, causing irritability and rebellion. "Irritability" means Yin is disturbed by Yang. "Rebellion" refers to pursuing Deficiency and chasing Excess. Yin is originally deficient; adding fire makes it more deficient (pursuing Deficiency). Yang is originally excess; adding fire makes it more excessive (chasing Excess). However, since blood is already consumed and scattered, even slight mugwort fire in the vessels has powerful internal attacking force. Thus, bones become scorched, sinews damaged, and blood is hard to recover.

[Collected Notes]
Yu Chang stated: A fine and rapid pulse is a sign of Yin deficiency with much heat. Applying moxibustion here makes the deficient more deficient and the hot more hot, leading to injury and disability.
Cheng Yingmao stated: For those with blood scarcity and Yin deficiency showing a fine and rapid pulse, moxibustion is especially contraindicated. Blood moistens and lubricates sinews and bones. If deprived of moisture, where fire reaches, bones will scorch and sinews will damage. Internal injury to Yin inevitably leads to dispersion in the meridians.

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When Ying Qi (Nutritive Qi) is weak, adding burning needles causes blood to stagnate and fail to circulate, resulting in increased fever and irritability.

[Annotation]
Weak Ying Qi refers to deficient and scant Ying Blood. Once Ying Blood is deficient, mistakenly adding burning needles causes Ying Blood to dry up, stagnate, and fail to flow. This goes beyond just scorched bones and damaged sinews; it results in increased fever and irritability.

[Collected Notes]
Cheng Zhi stated: This warns against burning needles when Ying Qi is weak. Yin deficiency generates internal heat; adding burning needles to assist Yang combines two heats, preventing Ying Blood from circulating, leading to external fever and internal irritability.
Tang Buyan stated: Initially, although flow was slight, burning needles forced it; subsequently, it stagnated and failed to move, as burning needles exhausted it.
Zhang Lu stated: Fire is a Yang pathogen that inevitably injures Yin Blood. Treatment should focus primarily on rescuing Yin.

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The pulse is floating, indicating the need for diaphoresis (sweating to release the exterior). If moxibustion is used, the pathogen has no exit. Due to the fire, the pathogen intensifies. From the waist down, the body will feel heavy and numb, termed Huo Ni (Fire Reversal).

[Annotation]
A floating pulse indicates exterior pathogens suitable for diaphoresis. Mistakenly using moxibustion damages blood fluids, preventing sweat formation. Instead, the exterior pathogen has no exit and intensifies due to fire. Rather than causing scorched bones/damaged sinews externally or hematemesis/hematochezia internally, it manifests as heaviness and numbness below the waist. This likely occurs because the person originally had Dampness in the lower body, which transforms according to Dampness. "Heavy" implies "sticking," meaning immovable heaviness. It is not named Bi Syndrome (Obstruction) because it is not caused by Wind-Cold-Damp, but by Huo Ni (Fire Reversal) disrupting Qi communication.

[Collected Notes]
Fang Youzhi stated: Bi refers to Dampness disease. Due to Fire Reversal, Fire Evil combined with Yang Evil rebels upward. Yang cannot descend, Yin cannot function, Qi transformation fails, and water dampness cannot excrete. Thus, Dampness sticks to the lower body, causing heaviness and numbness.
Cheng Yingmao stated: Floating pulse at the exterior suggests diaphoresis is appropriate. Moxibustion fails to induce sweat, leaving the pathogen with no exit. It intensifies due to fire. Even without scorched bones/damaged sinews, fire blocks the pathogen, gradually exhausting Yin Qi. The Lower Jiao is governed by Ying Blood; if Ying Qi exhausts and fails to transport, heaviness and Bi syndrome occur, named Huo Ni. This shows that to treat such Bi, one must first treat the Fire.

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The clinical presentation resembles Shaoyin Cold Damage (Shang Han), but the pulse is neither wiry-tight nor weak. If weak, thirst is inevitable; if subjected to fire therapy, delirium (Chan Yu) is inevitable. [Correction: The text notes three instances of "weak" should be "rapid".] If the pulse is weak/rapid, with fever and floating, resolution requires sweating for recovery.

[Note on Textual Criticism]
The three characters "weak" (ruo) should all be "rapid" (shu). If they were "weak," where would the heat come from? This contradicts the logic and is unsupported elsewhere in the treatise.

[Annotation]
"Resembling Shang Han" means the symptoms mimic Cold Damage. However, the pulse is not wiry-tight but rapid. Rapid indicates heat. Floating and rapid pulse with heat at the exterior indicates Taiyang syndrome; deep and rapid heat at the interior indicates Yangming syndrome. Rapid pulse signifies heat; heat entering Yangming causes thirst. If subjected to fire coercion, heat intensifies, causing delirium. Although rapid pulse diseases involve fever, treatments differ. If pulse is floating-rapid with fever, resolve via diaphoresis (sweating); Da Qing Long Tang (Major Blue Green Dragon Decoction) is indicated. If pulse is deep-rapid with fever, resolve via purgation; Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction) is indicated. If pulse is rapid without exterior/interior signs, only fever, thirst, and delirium exist, do not use diaphoresis or purgation; Bai Hu Tang (White Tiger Decoction) or Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) should be used to clear heat.

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In Cold Damage with a floating pulse, if the physician uses fire to coerce sweating, causing Yang collapse (Wang Yang), symptoms of fright, mania, restlessness, and inability to lie still will occur. Gui Zhi Qu Shao Yao Jia Shu Ku Long Gu Mu Li Jiu Ni Tang (Guizhi Decoction Removing Paeonia plus Farflower Leaf, Dragon Bone, and Oyster Shell Decoction for Rescue from Reversal) should be administered.

[Annotation]
In Cold Damage with a floating pulse, instead of using Mahuang Tang or Guizhi Tang, the physician used fire to coerce sweat. Excessive sweating led to Yang collapse, manifesting as fright, mania, and restlessness. This error arises because fire heat originates from the Heart, and massive loss of Jin-Ye (body fluids) causes the Shen (Spirit/Mind) to lose its anchor. Fuzi Si Ni Tang (Aconite Decoction to Restore the Prostrate Yang) is not used because this is Yang collapse due to fire coercion. Instead, Gui Zhi Tang removing Shao Yao (Paeonia Root), plus Shu Ku (Farflower Leaf), Long Gu (Dragon Bone), and Mu Li (Oyster Shell) is used. Shao Yao is removed because its Yin nature is sluggish and it inhibits Guizhi from rapidly reaching the exterior, defeating the purpose of emergency rescue. Moreover, with Long Gu and Mu Li securing the sinking Shen, the astringent property of Shao Yao is unnecessary. Shu Ku is cold and bitter; cold overcomes heat, and bitterness directs rebellious Qi downward. It is essential for correcting the chaotic reversal of Fire Evil.

[Collected Notes]
Yu Chang stated: In the chapter, misusing Da Qing Long Tang caused cold limbs, muscle twitching, and Yang collapse due to excessive sweating, treated with Zhen Wu Tang (True Warrior Decoction). Here, Yang collapse due to fire coercion involves the Yuan Yang (Primal Yang) of the Heart being scattered by fire, causing fright, mania, and restlessness. Delaying even slightly renders divine medicines useless; thus, this decoction rescues. When Yang Shen scatters, seek restoration through Yang. Guizhi Tang is a Yang formula, but Shao Yao's Yin-astringency must be removed to allow rapid ascent to the Yang position. Adding Shu Ku, whose nature is urgent, along with Long Gu and Mu Li (solid bone/mineral substances acting as vessels), carries the Shen back to its residence.