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Zhang Zhongjing stated: If purgation is inappropriately applied when it is contraindicated, the interior becomes deficient and heat enters, leading to *xie re li* (diarrhea with accompanying exterior heat), restlessness, and numerous other complications; mild cases become critical, while severe cases result in death. In Taiyang disease, if for two or three days the patient cannot lie down and purgation is wrongly applied, if the diarrhea stops, *Jie Xiong* (chest binding syndrome) will inevitably develop; if the diarrhea does not stop, and purgation is applied again on the fourth day, this constitutes *xie re li*. In Taiyang disease, if the exterior symptoms remain unresolved but multiple purgations are used, heat from the exterior combines with the interior to cause diarrhea that does not cease, accompanied by epigastric fullness and hardness, where both exterior and interior conditions remain unresolved; Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) should be administered. In combined Yangming and Shaoyang diseases, if the pulse remains rapid and diarrhea persists, heat will combine to cause pus and blood in the stool.

Commentary: These four passages all discuss situations where the exterior syndrome remains unresolved but purgation is mistakenly used, causing external heat to persist while internal diarrhea develops; hence it is called "xie re xia li" (diarrhea with accompanying heat). The character "re" (heat) here refers to exterior heat, not interior heat. The character "xie" (accompanying/combining) means coordination, not夾 (clinging/mixing); it signifies that both exterior and interior are diseased. Therefore, for treating such conditions, there is only one formula, Guizhi Renshen Tang, making its rationale obvious. As Cheng Wuji stated in *Ming Li Lun*: "When exterior pathogens transmit to the interior, interior deficiency accompanies heat to cause diarrhea," he also spoke of exterior pathogens. Alas, later scholars fail to understand this meaning; merely because of the term "xie re," they often mistake exterior for interior, and cold for heat. Whenever diarrhea is seen, regardless of exterior-interior or deficiency-excess patterns, it is considered interior heat and labeled as "xie re xia li." Moreover, recently some practitioners, even without prior mistaken purgation, recklessly use Huangqin (Scutellariae Radix) and Lianzi (Lotus Plumule) to treat exterior heat; when exterior syndromes encounter cold, the heat fails to dissipate, leading to diarrhea. Or, those with inherently weak spleen and stomach who experience loose stools upon exposure to cold are also suffering from this syndrome. Upon seeing diarrhea, one further claims it is "xie re"; how egregious is this error! Have they not observed Zhang Zhongjing's Guizhi Renshen Tang? Is that a formula for treating interior heat? Reversing cold and heat treatments has killed many people. I specifically highlight this point.

In general, if urine is clear in patients with Shanghan (Cold Damage), the disease is not in the interior but remains in the exterior; exterior resolution through sweating should be employed. If urination is smooth, the disease is not in the Qi level but in the Blood level, as urination depends on Qi transformation.

Exuberant Yang leads to epistaxis; Yin deficiency leads to difficult urination.

In general, for Shanghan patients with smooth urination, the prognosis is mostly auspicious because the interior pathogenic factor is not severe.

Zhang Zhongjing said: In Yangming disease, if there is profuse sweating and thirst, Zhu Ling Tang (Polyporus Decoction) must not be given, because excessive sweating causes stomach dryness, so one must not further promote diuresis.

The Treatise states: For patients with dampness diseases, there is generalized body pain, fever, a sallow complexion resembling smoke staining, head sweat only, stiffness in the back, a desire to cover oneself and face fire, and a tongue coating resembling moss. This is due to heat in the Dantian (lower jiao) and cold in the chest, thirst with an inability to drink water; this is a presentation of Shi Bi (dampness bi-syndrome). If the patient has difficult urination but frequent, loose stools, treatment should focus solely on promoting diuresis.

In general, if the exterior syndrome of Shanghan is not yet resolved and the disease is in the Yang level, diuretics should not be immediately used. Depleting body fluids makes obtaining sweat more difficult and may lead to dry stools.