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Moli San (Oyster Shell Powder, Miscellaneous Formula 2), followed by Jianzhong Tang (Establish the Middle Decoction) (Zheng 37).

(71) Inquiry into Panting (Chuan)
Panting caused by Shanghan (Cold Damage) involves only two syndromes: Taiyang (Greater Yang) syndrome and Yangming (Bright Yang) syndrome. In Taiyang syndrome, characterized by headache, fever, body pain, aversion to wind, absence of sweating, and panting, diaphoresis (sweating therapy) is indicated; this belongs to Mahuang Tang (Ephedra Decoction) syndrome (Zheng 20). If it is a Guizhi Tang (Cinnamon Twig Decoction) syndrome, but the physician erroneously applies purgation, resulting in persistent diarrhea and a rapid pulse, the exterior syndrome remains unresolved; if accompanied by panting and sweating, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) should be used (Zheng 28). If mild panting occurs after erroneous purgation in Taiyang syndrome, it is because the exterior syndrome has not resolved; Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction with Added Magnolia Bark and Apricot Seed) should be used (Zheng 19). After diaphoresis, Guizhi Tang must not be administered again; if sweating and panting occur without significant internal heat, Mahuang Xingzicao Ganshi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be given. In Yangming syndrome, characterized by sweating, aversion to cold absent, abdominal fullness, panting, and tidal fever, purgation is indicated; this belongs to Chengqi Tang (Assist the Qi Decoction) syndrome (Zheng 42). However, in Yangming syndrome, if the pulse is floating, there is no sweating, and panting occurs, diaphoresis will lead to recovery; Mahuang Tang (Zheng 20) is appropriate.
When Taiyang and Yangming syndromes combine, presenting with panting and chest fullness, purgation is contraindicated; Mahuang Tang is appropriate. Additionally, after diaphoresis, excessive water intake leading to coughing and mild panting indicates water retention in the epigastrium, where Kidney Qi attacks the Heart; Xiaolongqing Tang (Minor Green Dragon Decoction) with Mahuang removed and Xingren (Apricot Seed) added should be used (Zheng 36). If there is lower abdominal fullness, remove Mahuang and add Fuling (Poria) (Zheng 26). Another question arises: Since Mahuang primarily treats panting, why is it removed here? This is because the treatment targets panting caused by water retention in the epigastrium, aiming to prevent excessive sweating; combined with difficulty in urination and lower abdominal fullness, Mahuang is removed and Fuling is added.

(72) Inquiry into Thirst
A floating pulse with thirst belongs to Taiyang syndrome. In Shanghan, if the exterior is unresolved and there is water qi in the epigastrium causing thirst, Xiaolongqing Tang with Banxia (Pinellia) removed and Gualougen (Trichosanthes Root) added should be used (Zheng 36). In Taiyang syndrome, if after taking Guizhi Tang, profuse sweating leads to severe irritability and thirst, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be used (Zheng 65). A floating pulse, difficulty in urination, slight fever, and extreme thirst (Xiaoke) indicate Wuling San (Five-Ingredient Powder with Poria) (Zheng 66). In Shanghan lasting four or five days, if there is body heat, aversion to wind, fullness under the hypochondrium, warm hands and feet, and thirst, Xiao Chaihu Tang (Minor Bupleurum Decoction) with Banxia removed and Renshen (Ginseng) plus Gualougen added is the primary formula (Zheng 29). If Taiyang syndrome presents with burning body heat and thirst, it is Fengwen (Wind-Warmth); Gualougen Tang (Trichosanthes Root Decoction) can be used, and Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction) may be given in spring and autumn (Zheng 93). In Yangming syndrome, if there is sweating only on the head, difficulty in urination, thirst with desire for fluids, and impending jaundice, Yinchen Tang (Artemisia Capillaris Decoction) and Xiao Chaihu Tang with Banxia removed and Renshen plus Gualougen added are appropriate (Zheng 29). Injury from wind-cold and heat, or fever with aversion to wind and thirst, belongs to Shaoyang (Lesser Yang) syndrome. In Shaoyang syndrome, with hardness under the hypochondrium, constipation, vomiting, white tongue coating, and thirst, Xiao Chaihu Tang with Banxia removed and Renshen plus Gualougen added is indicated (Zheng 29). Spontaneous diarrhea with thirst belongs to Shaoyin (Lesser Yin) syndrome. When Shanghan heat enters the zang organs and flows into the Shaoyin meridian, which governs the Kidneys, and since the Kidneys detest dryness, thirst with desire to drink occurs; for Shaoyin diarrhea, cough, vomiting, and thirst, Zhuling Tang (Polyporus Decoction) is the primary treatment (Zheng 67). For diarrhea with desire to drink water due to heat, Baitouweng Tang (Pulsatilla Decoction) is indicated (Zheng 108).
Strictly avoid: In Taiyang syndrome with no sweating and thirst, Baihu Tang (White Tiger Decoction) must not be given. Zhang Zhongjing stated: For thirst with desire to drink water, if there is no exterior syndrome, Baihu Jia Renshen Tang is used. A floating pulse, fever, and no sweating indicate an unresolved exterior; Baihu Tang is contraindicated. Instead, Yiyi (Coix Seed) or Xiaolongqing Tang with Banxia removed and Gualougen added (Zheng 36) may be used. In Shanghan lasting four or five days, with body heat, aversion to wind, fullness under the hypochondrium, warm hands and feet, and thirst, Xiao Chaihu Tang with Banxia removed and Renshen plus Gualougen added is appropriate (Zheng 29). In Yangming syndrome with profuse sweating and thirst, Wuling San is contraindicated. Because profuse sweating causes dryness in the middle jiao, and Zhuling Tang further promotes urination, it is unsuitable; Yiyi Zhuye Tang (Coix Seed and Bamboo Leaf Decoction) may be given. Zhang Zhongjing said: In Yangming syndrome with periodic onset and profuse sweating, urgent purgation is required. Is Baihu Tang never suitable for thirst in Taiyang syndrome? Only after sweating in Taiyang syndrome, if the pulse becomes large and forceful with thirst, can Baihu Tang be given. Is Wuling San never suitable for thirst in Yangming syndrome? Only in Yangming syndrome with difficulty in urination, scant sweating, floating pulse, and thirst, can Wuling San be given. These are all subtle methods of Zhang Zhongjing (Zhang Zhongjing’s Zhuling Tang indication also states: For floating pulse, fever, thirst with desire to drink, and difficulty in urination, Zhuling Tang is the primary treatment) (Zheng 67). In any disease, water should not be given unless there is extreme thirst. For mild thirst with dry throat, only small sips of moistening liquids should be taken to harmonize the Stomach Qi.
If there is extreme thirst with severe irritability, capable of drinking one dou, give five sheng of water; if no water is given at all, the body will become dry, unable to sweat, leading to death from panting. Laypeople often see that drinking water leads to sweating in cases of thirst, so they encourage excessive drinking even for mild thirst, causing water retention in the epigastrium, leading to fullness, stagnation, and death from panting. In such cases, Wuling San (Zheng 66) or Xiongan Wan (Thorax-Breaking Pill) (Zheng 39) should be given. The *Jingui Yaolue* states: In seasonal diseases, if at day five or six there is thirst with desire to drink but inability to drink much, water should not be given. Why? Because the heat in the abdomen is still insufficient to transform the water, which would instead cause new pathology.
By day seven or eight, if there is extreme thirst with desire to drink, water should still be given according to the syndrome, ensuring it is not excessive, and avoiding forcing the patient to drink to capacity. Many people only note Zhang Zhongjing’s statement: “The ability to drink water after illness indicates impending recovery,” and thus force water upon patients with mild thirst, causing countless disasters. Generally, water qi disorders in Shanghan are caused by excessive water intake. Water retained in the epigastrium, with Qi attacking the Heart, causes palpitations or panting; accumulation in the chest and hypochondrium causes Water Accumulation in the Chest; cold deficiency in the Stomach causes vomiting or hiccups; collision of cold Qi causes dysphagia; pressure on the Lungs causes cough; infiltration into the intestines causes diarrhea; pathogenic heat forcing accumulation in the Lower Jiao causes difficulty in urination, lower abdominal fullness, or tenesmus; overflow into the skin causes edema. If Yang Toxin causes extreme restlessness and thirst, Heinu Wan (Black Slave Pill) is indicated (Miscellaneous Formula 20). For deep-seated latent heat from Summerheat that does not resolve after repeated treatments, causing incessant thirst, Jiuzheng Huanglian Wan (Wine-Steamed Coptis Pill) is indicated (Miscellaneous 79).

(73) Inquiry into Epistaxis (Nasal Bleeding)
In Shanghan Taiyang syndrome, epistaxis often signifies resolution because Yang Qi is heavy. Zhang Zhongjing stated, “Excess Yang leads to epistaxis.” If the pulse is floating and tight with no sweating, and Mahuang Tang (Zheng 20) is ineffective, causing irritability and blurred vision, severe cases will result in epistaxis. If minor epistaxis occurs and the pulse remains floating and tight, Mahuang Tang should be administered again; if the pulse becomes faint after epistaxis, Mahuang Tang is contraindicated. If the pulse is floating with spontaneous sweating, and Guizhi Tang is ineffective, with the Guizhi syndrome persisting, severe headache may lead to epistaxis. If minor epistaxis occurs and the pulse remains floating, Guizhi Tang should be administered again; if the pulse becomes faint after epistaxis, Guizhi Tang is contraindicated. Generally, in Shanghan, epistaxis with a faint pulse contraindicates diaphoresis. Treatment method: Patients prone to epistaxis must not undergo diaphoresis, otherwise, sunken forehead, tight pulse, fixed gaze unable to blink, and insomnia may occur. However, if there is no sweating with epistaxis and the pulse remains floating and tight, Mahuang Tang must be given again; if there is sweating with epistaxis and the pulse remains floating and relaxed, Guizhi Tang must be given again. If the pulse is faint, Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used. For unceasing epistaxis, Maohua Tang (Maple Flower Decoction) is indicated. If epistaxis is accompanied by thirst, irritability, and vomiting water upon drinking, first administer Wuling San (Zheng 66), then Zhuye Tang (Zheng 95). Another question: Are there cases of epistaxis in Yin syndromes?
Yin syndromes lack heat, so how can epistaxis occur? In Shaoyin syndrome, if there is only cold limbs and no sweating, forced diaphoresis will certainly disturb the blood. It is unknown which channel the blood will exit from; it may come from the mouth and nose, or from the ears and eyes. This is called “Lower Cold and Upper Exhaustion” and is difficult to treat.

(74) Inquiry into Abdominal Fullness, Body Heaviness, Difficulty Turning, Numbness in the Mouth, Greasy Face, Delirium, and Urinary Incontinence.
This is a combined syndrome of the Three Yang meridians, treated primarily with Baihu Tang (Zheng 64). Diaphoresis is contraindicated; inducing sweating leads to delirium, while purgation leads to sweating on the forehead and cold extremities. If there is spontaneous sweating, Baihu Jia Renshen Tang (Zheng 65) should be used. The second inquiry discusses combined syndromes.