Library

If purgation should have been used but was delayed, the true qi becomes deficient and weak. Upon administering Chengqi Tang (Cassia Seed Decoction), shortly after swallowing, sweat appears on the forehead, hair roots become dry and itchy, pathogenic fire flares upward, hands and feet become cold, and in severe cases, tremors, vexation, restlessness, and a manic state occur. This is because the middle jiao qi has always been deficient and cannot withstand the medication; this condition is named "medication annoyance" (Yao Fan). Whenever such a syndrome is encountered, one should urgently administer ginger soup to resolve it; adding more fresh ginger when decocting the medicine will prevent these symptoms. It is also advisable to divide the dose into two or three administrations to prevent vomiting and inability to retain the medicine.

After taking Chengqi Tang, if there is no bowel movement in the abdomen, or if it occurs only the next day, or if the original medicine is vomited up within half a day, this is due to prolonged illness without timely purgation, causing severe deficiency of middle qi which fails to transport the medicine. This condition is named "medicine suspension" (Ting Yao), indicating that heavenly yuan (innate vitality) is nearly extinct, a sign of great misfortune. One should use ginger to harmonize the medicinal properties, or add Ren Shen (Ginseng Root) to assist stomach qi. There are also cases where pathogenic factors are substantial and the disease is severe, but the dosage is too light, resulting in ineffective action.

During epidemic febrile diseases, patients may be restless in sitting and lying, with restless hands and feet. They rise from bed before settling down, pace around as soon as they sit, and attempt to lie down again immediately upon rising, having no moment of peace. Some may grasp at clothing, beds, or walls, or pick at empty air and fingers. When the physician arrives to take the pulse, the patient withdraws their hand. The six pulses are not distinct, and the chi pulse is absent. This is due to habitual depletion and loss of root essence; unable to overcome the pathogen, the primordial qi fails to govern, leading to irritability and restlessness. Although this is not mania, its danger exceeds that of mania. The method should be major tonification. However, there are cases requiring urgent purgation; if after purgation the cold limbs return to normal, the chi pulse reappears, and irritability subsides slightly, this indicates that pathogenic factors have receded somewhat and righteous qi has temporarily recovered, allowing slight yang to extend. If within two hours the pathogen gathers again and previous symptoms recur, do not purge again just because the previous purge was effective; doing so will lead to rapid death. Urgent vigorous tonification is required; if tonification is insufficient, death ensues. In this syndrome, if there is no significant heat in the interior and exterior, and the indications for purgation are incomplete, there is a chance of survival. It is like an empty city wall; even residual invaders can enter directly. Neither fighting nor defending is possible, and the danger is evident.

If purgation should have been performed but was delayed, blood is exhausted and qi is consumed, leading to internal heat, vexation, thirst, and delirious speech, with all indications for purgation present. However, if multiple purgations are administered, thirst and heat both decrease, and purgation indications disappear completely, but delirious speech persists after five or six days, this should not be considered excess. This is because the pathogen has left, but the primordial spirit has not yet recovered. Qing Zao Yang Rong Tang (Clear Dryness and Nourish Ying Decoction) should be used, with Chen Sha (Cinnabar) added, one qian. Zheng Sheng (feeble muttering) and Chan Yu (delirious speech) present similar attitudes and behaviors; they differ only in being deficiency or excess syndromes, and should not be classified as two separate diagnostic categories.