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Ephedrae Herba (Mahuang, 麻黄) [devoid of nodes] three liang; Cinnamomi Ramulus (Guizhi, 桂枝) [devoid of bark] two liang; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [roasted] two liang; Armeniacae Semen Amarum (Xingren, 杏仁) [devoid of skin and tip] seventy seeds; Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) four liang.

The above five herbs are boiled in nine sheng of water. First, boil Ephedrae Herba until the volume reduces by two sheng, then skim off the foam on the surface. Add the remaining herbs and continue boiling to obtain two and a half sheng of decoction. Strain the dregs, and take eight he of the liquid warm. After ingestion, cover with blankets to induce a slight perspiration.

[Commentary]
Cinnamomi Ramulus has acrid and sweet properties, which reside primarily in its bark. If the bark is removed, it becomes dead wood; how could it still possess the efficacy of releasing the muscle layer and inducing sweating? The characters "devoid of bark" should be deleted, and subsequent prescriptions should follow this principle.

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Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), characterized by joint pain accompanied by irritability, and a deep and fine pulse, is named Shi Bi (Bi syndrome due to dampness obstruction). The manifestations of Shi Bi include difficulty in urination and loose stools. The treatment principle is to promote diuresis.

[Annotation]
This passage elaborates on the previous one, stating that for patients with dampness suffering from body pain, sweating is contraindicated; instead, promoting diuresis is indicated. In Taiyang disease, if there is irritative pain in all joints and the pulse is floating and fine, the dampness is exterior, and sweating is appropriate. However, if there is difficulty in urination, loose stools, and a deep and fine pulse, the dampness is interior, and promoting diuresis is appropriate. Currently, when dampness pervades both interior and exterior, causing irritative joint pain, qi stagnation, difficulty in urination, and loose stools, it is termed Shi Bi. Although there is body pain, the pulse is neither floating nor fine, so sweating is contraindicated. If the pulse is deep and fine, only promoting diuresis is indicated. If diuresis resolves and loose stools cease, but the Bi syndrome persists and body pain remains, then sweating may be employed.

[Collected Notes]
Zhao Liang stated: Bi pain, due to irritative joint pain and a deep and fine pulse, is named Shi Bi. The Classics state: "Excess dampness leads to loose stools." Difficulty in urination and loose stools indicate internal excess of dampness. One must first promote diuresis to drain dampness from the abdomen. Thus, it is said: "Treating dampness without promoting diuresis is not the correct method." If, after urination improves, the joint Bi syndrome remains unresolved, treatment from the exterior is necessary.

Li [Name Redacted] stated: The Taiyang channel runs along the exterior of the body, so external pathogens can invade it, including dampness. Joint pain indicates dampness retained in the joints. Dampness stagnation and steaming generate heat, causing irritability. The Classics state: "Submerged and accumulated water presents with a deep and fine pulse," which is the pulse of internal dampness. "Bi" means blockage and obstruction, consistent with the meaning in the *Nei Jing* that "excess dampness causes Bi." Current difficulty in urination indicates dampness excess internally, corresponding to the *Nei Jing*'s statement: "Excess dampness leads to loose stools." Promoting diuresis removes dampness, stopping diarrhea and irritability.

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Patients with chronic dampness may present with sweating only on the head, stiffness of the back, and a desire to cover themselves with blankets and seek warmth from fire. If purgatives are administered prematurely, hiccups, chest fullness, difficulty in urination, and a tongue coating resembling a fur (white and slippery) may occur. This pattern is due to heat in the Dantian (lower abdomen) and cold in the chest. The patient feels thirsty and desires water but cannot drink, resulting in dry mouth and irritability.

[Annotation]
Sweating only on the head in dampness patients results from upper dampness and lower heat steaming upward, not from the heat of Yangming interior excess steaming upward. Back stiffness is due to the heaviness of dampness, not the spasm caused by wind-damp. The desire to cover oneself and seek warmth reflects temporary cold generated by excessive dampness, not the aversion to cold seen in Cold Damage. If one mistakenly treats the head sweat (misinterpreted as Yangming interior heat) with purgatives, dampness transforms into cold and invades the deficiency. Invading the upper jiao causes lung qi rebellion and chest fullness; invading the middle jiao causes stomach disharmony and hiccups; invading the lower jiao impairs bladder qi transformation, leading to difficulty in urination. A white, slippery tongue coating resembling fur indicates that erroneous purgation caused heat to sink, creating heat in the Dantian. Cold accumulates in the upper jiao (chest), causing thirst for water that cannot be swallowed. Heat below generates dry mouth and irritability, while cold above prevents the generation of body fluids. Thus, despite dry mouth and tongue, the patient cannot drink much.

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If dampness patients are erroneously purged and present with sweating on the forehead, mild wheezing, and free urination, the prognosis is fatal. Similarly, persistent diarrhea is also fatal.

[Annotation]
This continues the discussion on the previous paragraph regarding the consequences of erroneous purgation, clarifying the fatal signs of head sweating in dampness patients. Erroneous purgation leading to forehead sweating and mild wheezing, if accompanied by difficulty in urination, does not necessarily indicate death. However, if urination is free, it indicates that this is not dampness overflowing upward, but rather yang collapsing upward, hence the term "fatal." If diarrhea persists, it indicates not the expulsion of dampness, but the collapse of middle qi with downward flow, hence also "fatal."

[Collected Notes]
Zhao Liang stated: Erroneous purgation leads to reversal. Reversal causes yang to escape from above and yin to collapse from below. Forehead sweating and mild wheezing represent the escape of yang; free urination and persistent diarrhea represent the collapse of yin. The separation of yin and yang is a sign of certain death. By inference, if purgation causes forehead sweating and wheezing but bowel and bladder movements are obstructed, yin has not collapsed, and the root of yang remains; if purgation causes free bowel and bladder movements but there is no forehead sweating or wheezing, yang has not escaped, and the root of yin remains. In these cases, yin and yang are not separated, and treatment can be tailored to the specific syndrome.

Li Weixi stated: Previously, it was stated that dampness patients should have their urination promoted because internal dampness stagnation naturally impedes urination. Here, post-purgation interior deficiency leads to spontaneous free urination and fluid exhaustion causing death. These situations cannot be generalized.

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When a patient suffers from whole-body pain and fever that worsens in the late afternoon (Shi hour, approx. 3-5 PM), it is named Feng Shi (Wind-Damp). This condition arises from sweating exposed to wind or prolonged exposure to cold. Mahuang Xingyi Yicao Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) may be administered.

[Annotation]
"Patient" refers to those with whole-body pain. Both dampness patients and wind-damp patients suffer from whole-body pain. However, dampness pain is heavy and limits turning over, whereas wind-damp pain is light and spasmodic, limiting flexion and extension. This distinguishes the pain types. Dampness fever does not vary significantly between morning and evening, whereas wind-damp fever inevitably worsens in the late afternoon. This is because dampness is constant, while wind fluctuates. Tracing the etiology, it results from sweating exposed to wind or prolonged cold exposure. Therefore, Mahuang Xingyi Yicao Gancao Tang, which disperses wind-damp, is indicated.

[Collected Notes]
Cheng Lin stated: Whole-body pain and fever indicate wind-damp at the exterior. "Ribu" refers to the Shen hour (3-5 PM). The Yangming channel is prosperous during Shen, You, and Xu hours. Earth dislikes dampness. When wind-damp interferes during the peak time of Yangming, the struggle between pathogen and healthy qi causes worsening symptoms. Sweat belongs to the category of dampness. Whether caused by sweating exposed to wind or entering cold water after exertion, both result in wind-damp disease.

Wei Litong stated: Spasm syndromes require wind to manifest; even if cold is present, it attaches to wind. Bi syndrome due to dampness requires cold to manifest; even if wind is present, it attaches to cold. This is a fixed principle.