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When the Taiyang syndrome is treated with sweating methods, and excessive sweating occurs, leading to dryness in the stomach, irritability, and inability to sleep, if the patient desires water, it should be given in small amounts frequently. Once the stomach qi harmonizes, the condition will resolve. If the pulse is floating, urination is difficult, and thirst is present, Wuling San (Five-Ingredient Powder with Poria) [Zheng 66] is indicated. After purgation followed by re-sweating, if there is restlessness and insomnia during the day but quietness at night, without vomiting or thirst, without exterior syndrome, with a deep and faint pulse, and no significant heat on the body, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) [Zheng 73] is indicated.

If, after sweating, emesis, or purgation, there is empty irritability and insomnia, which becomes severe with tossing and turning and mental depression (Ao Nao), Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) [Zheng 45] is suitable for inducing emesis. (One dose of Zhizi Chi Tang consists of one and a half cups; divide into two doses. If emesis occurs after the first dose, stop subsequent doses.) In severe cold damage with high fever, dry retching, groaning, delirium, and insomnia, Huanglian Jiedu Tang (Coptis Decoction for Detoxification) [Za 87] is indicated. After emesis or purgation in cold damage, if there is heart vexation, fatigue, and insomnia day and night, Suanzao Tang (Sour Jujube Decoction) [Za 88] is indicated. In Shaoyin disease, if after two or three days there is heart vexation and insomnia, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) [Za 104] is indicated. If Shaoyin disease presents with diarrhea, thirst, and insomnia, Zhuling Tang (Poria Decoction) [Zheng 67] is indicated.

Another question asks: Why does insomnia occur after recovery from cold damage? This is because residual heat combines with the Yang qi, while Yin qi has not yet recovered, thus causing insomnia post-illness. Zhi Zi Wu Mei Tang (Gardenia and Mume Fruit Decoction) [Za 89] is indicated.

(85) Question: Hypersomnia

Hypersomnia has four syndromes: Fengwen (Wind-Warmth) syndrome, Xiao Chaihu Tang syndrome, Shaoyin syndrome, and Huhe (Fox Confusion) syndrome. If the pulses at Cun, Guan, and Chi positions are all floating, accompanied by headache, fever, spontaneous sweating, heaviness of the body, panting, flaccidity of the four limbs, and a desire to sleep silently, this is Fengwen syndrome. Fengwen syndrome should not be treated with sweating methods; Weirui Tang (Jade Bamboo Decoction) [Za 45] is indicated. (See Question 45 in Volume 6). If the pulse is floating, accompanied by stiffness and pain in the head and neck, and aversion to cold, this is Taiyang syndrome. If ten days have passed, the pulse is floating and fine, and the patient desires sleep, the exterior pathogen has resolved. If chest fullness and hypochondriac pain occur, Xiao Chaihu Tang (Minor Bupleurum Decoction) [Zheng 29] is given. If the pulse is merely floating, Mahuang Tang (Ephedra Decoction) [Zheng 20] is indicated. If the pulses at Cun, Guan, and Chi positions are all deep and fine, and the patient only desires sleep, this is Shaoyin syndrome. Si Ni Tang (Frigid Extremities Decoction) [Zheng 75] must be prepared urgently to restore Yang qi; delay is not permissible. If the presentation resembles cold damage, with heavy limbs, drowsiness, and a desire to sleep, examine the lips. Sores on the upper lip indicate worms eroding the five zang organs; sores on the lower lip indicate worms eroding the lower parts. This should be treated as Huhe syndrome. (See Question 99 in Volume 11).

(86) Question: Cool body with sweating, pain in both hypochondria, or dry retching

This is a Shizao Tang (Ten Jujubes Decoction) syndrome. Zhang Zhongjing stated: In Taiyang Wind-Strike with diarrhea and vomiting/retching, interior attack is permissible only after the exterior is resolved. If attacks occur at specific times, with headache, epigastric hardness and fullness, pain radiating to the hypochondrium, dry retching, shortness of breath, sweating, and no aversion to cold, this indicates the exterior is resolved but the interior is unharmonized. Shizao Tang [Zheng 89] is indicated. Generally, hypochondriac pain indicates fluid retention (Yin), requiring differentiation between exterior and interior. Dry retching, mild diarrhea, fever, and cough indicate exterior fluid retention, treated with Xiao Qinglong Tang (Minor Green Dragon Decoction) plus Wanghua (Stellerae Radix Cortex). A cool body, resolved exterior syndrome, dry retching, and hypochondriac pain indicate interior fluid retention, treated with Shizao Tang. Shizao Tang differs significantly from Xiao Qinglong Tang; one must assess the patient's deficiency and excess before administration, and never prescribe recklessly.