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27. After three days of Taiyang disease (Taiyang Syndrome), if sweating therapy has already been applied, but emesis, purgation, or warm needle therapy is subsequently used without resolving the condition, it may lead to adverse changes and become a "ruined syndrome" (Bad Zheng). At this stage, one must observe the pulse and symptoms to determine which meridian has been affected. It becomes difficult to distinguish between Yin and Yang or the specific manifestations of the Six Meridians. The patient's condition is critical and life-threatening, making conventional diagnostic reliance precarious. In such cases, only Du Shen Tang (Single Ginseng Decoction) should be administered cold. If sweat appears gently on the nose, it indicates a sign of recovery.

[Annotation] When Taiyang disease persists for three days and sweating therapy fails to resolve it, the use of emesis, purgation, or warm needles—if appropriately indicated—would lead to resolution. However, if these methods are inappropriate, not only will the disease remain unresolved, but it may also cause adverse reactions, transforming into a "ruined syndrome." One must observe the pulse and symptoms to identify which meridian's pathology has caused the deviation. For instance: after sweating, symptoms of Yang collapse (Yang Wang), thirst, restlessness, and delirium may occur; after purgation, middle-jiao cold, chest binding (Jie Xiong), or epigastric fullness and hardness (Pi Ying) may arise; after emesis, internal irritability and abdominal distension may appear; after warm needle therapy, jaundice, epistaxis, palpitations, or mania may ensue. Treatment should follow the specific symptoms. In severe cases where the pulse is faint and nearly imperceptible, consciousness is lost with inability to speak, patients grasp at clothing or bedrails, or cross their hands over the heart, indicating a critical state where Yin/Yang differentiation and Six Meridian patterns are indistinguishable. At this juncture, only Ren Shen (Ginseng Root) decoction, taken slowly while cool, should be used to await a turning point. If gentle sweat appears on the nose, it signifies a prognosis of survival.

28. Exterior syndromes are suitable for sweating therapy. Taiyang meridian involvement presents with anhidrosis (lack of sweat), fever, aversion to wind and cold, stiffness and pain in the head and nape, and body aches. If spontaneous sweating occurs, it clearly indicates an Exterior Deficiency syndrome.

[Annotation] An exterior syndrome refers to pathogenic cold residing in the exterior, characterized by anhidrosis, fever, aversion to wind and cold, stiffness and pain in the head and nape, and body aches. Since the Taiyang meridian governs the exterior, it is termed an exterior syndrome. Cases presenting these symptoms without sweat belong to Exterior Excess. However, even with these symptoms, if spontaneous sweating is present, it belongs to Exterior Deficiency, and gentle sweating therapies should not be used lightly. Even if wind pathogens are present, only Guizhi Tang (Cinnamon Twig Decoction) should be used to release the muscle layer. For Exterior Excess with anhidrosis, severe cases are primarily treated with Mahuang Tang (Ephedra Decoction); mild cases with Mahuang Guizhi Banxia Banxia Tang (Mahuang and Guizhi Half-Half Decoction). Cases with intermittent sweating are primarily treated with Guizhi Er Mahuang Yi Tang (Guizhi Two, Mahuang One Decoction). For Exterior Excess with severe irritability and heat, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) is primary; for milder cases, Da Qinglong Tang (Major Blue-Green Dragon Decoction) is primary. For those without irritability but with heat, Guizhi Er Yuebi Yi Tang (Guizhi Two, Yuebi One Decoction) is primary. Regarding the above exterior syndromes, it is not necessary for all symptoms to be present, nor does the number of days matter. As long as one or two symptoms such as headache and aversion to cold are observed, it indicates that the exterior syndrome has not resolved. Even if interior syndromes exist, the exterior must be resolved first. Only after the exterior is resolved can interior treatments be applied. Clinicians must not fail to differentiate carefully. See the Taiyang Chapter for details.