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(Rest of text continues from previous context) Renshen (Ginseng Radix), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Tiantong (Asparagi Radix) are herbs that ascend and rise to clear heat; they are used to avoid lower cold and to nourish the upper. Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Ganjiang (Zingiberis Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma) are acrid-sweet herbs that move outward and disperse warmth; they are used to distance from upper heat and to harmonize the interior. Divided into three warm doses to be taken completely, if sweating occurs the disease is cured. The intention lies in being gentle so as not to damage righteous qi, thoroughly eliminating pathogenic factors and removing them completely. Although the pulse is deep and slow at the cun position and absent at the chi position, and symptoms include cold limbs and unceasing diarrhea, upon investigation it is fundamentally not a pure yin-cold pathogen. Therefore, there are concurrent symptoms of sore throat and expectoration of pus and blood. This is a disease of confused cold and heat, and mixed yin and yang, all resulting from drastic purgation damaging the middle jiao. Thus, Zhang Zhongjing uses this decoction with the primary goal of eliminating pathogens; once pathogens are removed, righteous qi naturally settles.

After eight or nine days of Taiyang Shanghan (Exogenous Cold Damage), purgation was performed. The patient presents with chest fullness, irritability, fright, difficulty urinating, delirium, heaviness of the entire body, and inability to turn over. Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) should be administered.

[Annotation] After eight or nine days of Taiyang Shanghan, if the pathogen is unresolved and the exterior syndrome is incomplete, purgation must not be used. If purgation is mistakenly applied, the pathogen sinks inward due to deficiency. In the upper jiao, lightly it causes chest fullness; heavily, it forms Jie Xiong (Chest Binding). Chest fullness results from heat entering the chest and qi stagnation. In the middle jiao, lightly it causes irritability and fright; heavily, it causes coma and mania. Irritability, fright, and delirium result from heat invading the heart and spirit unrest. In the lower jiao, lightly it causes difficulty urinating; heavily, it causes hypogastric fullness and pain. Difficulty urinating results from heat lodging in the lower jiao and obstruction of water passages. Pathogenic factors obstructing the Sanjiao (Triple Burner) prevent Ying and Wei (Nutritive and Defensive Qi) from circulating. With no outlet for water, it seeps into the muscles and skin, causing heaviness of the entire body and inability to turn over. Chaihu Jua Longgu Muli Tang is used, with the main principle being harmonization and stabilization, combining attack and tonification.

[Commentary] This clause describes heaviness due to damp-heat in Yang meridians. Mistaking it for heaviness due to yin-cold-dampness caused by fluid exhaustion, blood stasis, and failure of yang qi to circulate would be an error. For heaviness due to cold-dampness, Zhenwu Tang (True Warrior Decoction) or Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) are used because there is no thirst and no internal heat. For heaviness due to hot-dampness, Baihu Tang (White Tiger Decoction) or Chaihu Jia Longgu Muli Tang are used because there is delirium, irritability, and stomach heat. Heaviness due to wind-dampness or wind-warmth also involves concomitant cold or heat; thus, this formula uses Fuling (Poria) and Banxia (Pinelliae Rhizoma) along with Dahuang (Rhei Radix et Rhizoma) as assistants.

[Ji Zhu Commentary] Fang Youzhi stated: Chest fullness occurs after purgation when interior deficiency allows external heat to enter the interior, carrying phlegm-fluids to clash upward at the diaphragm, causing irritability. Fright injures the heart; the heart stores the spirit and resides below the diaphragm. When righteous qi is deficient and pathogenic factors prevail, the spirit is unsettled. Heaviness of the body and inability to turn over occur because Shanghan originally causes whole-body pain. Exhaustion of fluids leads to blood stasis and poor circulation, transforming into sluggishness and severe heaviness.

Cheng Zhi stated: Irritability and abdominal fullness after purgation are treated with Zhizi (Gardeniae Fructus) and Houpo (Magnoliae Officinalis Cortex) because the pathogen has entered the abdomen. Chest fullness, irritability, and fright after purgation are treated with Longgu (Fossilized Mammoth Bones) and Muli (Ostreae Concha) because the pathogen has entered the heart. Irritability and fright caused by fire therapy are treated with Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) to retrieve externally floating heart-yang. Irritability and fright caused by purgation are treated with Chaihu Jia Longgu Muli Tang to resolve internal blockage of heart-yang. Da Xianxiong Tang (Major Chest-Binding Decoction) and Xiao Xianxiong Tang (Minor Chest-Binding Decoction) are distinguished by high/low location and urgency/severity. Various Xiexin Tang (Drain the Epigastrium Decoctions) are distinguished by cold/heat and deficiency/excess. Banxia and Fuling treat phlegm; Huangqin and Lianmu (Coptidis Rhizoma) descend rebellious qi; Zhizi and Chishao (Sojae Preparata) induce vomiting for empty irritability; Renshen and Fuzi (Aconiti Lateralis Radix Praeparata) restore deficient yang. The major principles of post-purgation treatment are contained herein.

Yu Chang stated: It is considered cautious to use purgation only after passing through the stages for eight or nine days! Who knew that residual external pathogens would sink inward due to deficiency? While the pathogen is still between the exterior and interior, the disorder has already affected the Spirit. To repair heaven and bathe the sun at this point, is it not difficult?

Zhang Lu stated: This belongs to the interior syndrome of Shaoyang (Lesser Yang). Many commentators incorrectly classify it as a Heart meridian disease. Shaoyang has three prohibitions and must not be violated recklessly. Even though eight or nine days have passed and stages have been traversed, mistaken purgation still allows pathogens to invade internally, damaging Stomach Earth and depriving Gallbladder Wood of nourishment. Phlegm accumulates above the diaphragm, causing such changes. Therefore, Xiaochaihu Tang (Minor Bupleurum Decoction) is used to harmonize the interior and exterior, expel fluids, and promote fluid circulation. Longgu and Muli are added to calm Liver-Gallbladder fright.

Chaihu Jia Longgu Muli Tang Formula
Chaihu (4 liang), Banxia (washed, 2 he), Longgu (1.5 liang), Renshen (1.5 liang), Dahuang (2 liang), Muli (1.5 liang), Fuling (1.5 liang), Qiandan (Lead Carbonate, 1.5 liang), Guizhi (1.5 liang), Shengjiang (Fresh Ginger, 1.5 liang), Dazao (Jujube, split, 2 pieces).
These eleven ingredients are boiled in 8 sheng of water to yield 4 sheng. Add cut Dahuang, boil for one or two more boils, strain, and take 1 sheng warm.

[Formula Analysis] This syndrome involves mixed yin and yang pathogens; this formula contains mixed attacking and tonifying herbs. Chaihu and Guizhi resolve residual exterior pathogens; Dahuang attacks internal heat that has sunk inward; Renshen, Shengjiang, and Dazao tonify deficiency and harmonize the Stomach; Fuling and Banxia promote urination and descend rebellious qi; the astringent and heavy properties of Longgu, Muli, and Qiandan calm fright, secure the Heart, and pacify the Spirit. This is using mixed herbs to treat a mixed disease.

Individuals who sweat profusely (Han Jia) should not undergo strong diaphoresis again. Doing so will cause mental confusion and vagueness, and pain in the genitalia after urination. Yu Yuliang Wan (Yuku Lithospermum Pill) should be given.

[Commentary] Yu Yuliang Wan is an astringent herb for dysentery and does not fit this syndrome. The five characters "give Yu Yuliang Wan" are likely interpolations (erroneous additions).

[Annotation] Han Jia refers to individuals prone to sweating. Strong diaphoresis means inducing heavy sweating. The Heart governs Blood, and sweat is the fluid of the Heart. Heavy sweating severely damages Blood, leaving the Heart without support, resulting in mental vagueness and restlessness. Fluid depletion in the lower part causes the Zongjin (major tendons/genitals) to lose nourishment, leading to penile pain after urination.

[Ji Zhu Commentary] Fang Youzhi stated: The Heart governs Blood and stores the Spirit. Profuse sweating leads to Blood deficiency and an empty Heart residence. Mental vagueness and confusion occur because the empty residence causes the Spirit to scatter. Yin refers to the Zongjin. Pain occurs because fluid depletion leads to loss of nourishment.

Cheng Yingmao stated: The Heart governs Blood, and sweat is the Heart's fluid. Individuals who sweat frequently clearly have Heart deficiency and Blood scarcity. Heavy sweating causes the Heart to lose nourishment, leading to vague Spirit and palpitations, which is called confusion. The Small Intestine and Heart are exterior-interior partners. Heart fluid deficiency leads to Small Intestine water depletion, causing genital pain after urination.

Individuals with a history of epistaxis (Nu Jia) must not undergo diaphoresis. If diaphoresis is induced, sweating will cause the arteries in the depression of the forehead to become tight and urgent, eyes staring straight ahead without movement, inability to close the eyelids, and insomnia.

[Annotation] Nu Jia includes those with hematemesis. For anyone with frequent nosebleeds or vomiting blood, Yin Qi is suddenly exhausted. If diaphoresis is induced again, fluid exhaustion causes all vessels to lose nourishment. The vessels in the depression of the forehead corners are scorched by heat, becoming tight and urgent. Staring straight ahead means the eyes are wide open and immobile. Inability to close eyelids means the lids cannot shut. All these result from heat scorching vessels, causing contraction. Insomnia occurs because Yang Qi cannot enter Yin. These diseases represent critical conditions of excess Yang and deficient Yin. Who says Nu Jia can be lightly diaphoresed!

[Ji Zhu Commentary] Yu Chang stated: Eyes see because of Blood; sweat is the liquid of Blood. Individuals with nosebleeds have damaged Clear Yang Qi. Further diaphoresis causes the forehead to depress, reflecting upper Jiao exhaustion. All vessels connect to eye tendons. Tight pulses cause eyes to stare upward and not close. Unclosed eyes lead to insomnia. In Shanghan, irritability and dizziness indicate impending epistaxis, suitable for Mahuang Tang to induce sweating. Here, it warns against diaphoresis for chronic blood-loss individuals to avoid further deficiency.

Individuals with blood loss (Wang Xue Jia) must not undergo diaphoresis. If diaphoresis is induced, they will experience chills and tremors.

[Annotation] After blood loss, when Qi and Blood have not recovered, termed Wang Xue Xu Jia (Blood-Loss Deficient Individuals), diaphoresis must not be used. Initially, blood loss may involve Yang-Heat, but after blood loss, Heat leaves with the Blood, and Qi perishes with Blood, endangering Yang. Further diaphoresis causes Yang Qi to become weak and unable to sustain itself, inevitably resulting in cold chills and trembling. Inducing sweat in Yin-deficiency leads to Yin collapse (e.g., sudden hematemesis/epistaxis), causing inability to close eyes, insomnia, and Yin collapse signs. Inducing sweat in Yang-deficiency leads to Yang collapse (e.g., Wang Xue Xu Jia), causing chills, tremors, and Yang collapse signs.

[Ji Zhu Commentary] Fang Youzhi stated: Blood loss implies Yin deficiency; diaphoresis further destroys Yang, causing chills and tremors.

Cheng Yingmao stated: Blood loss and Yin deficiency mean Yang has lost its foundation. Diaphoresis causes Yang to escape externally, leading to chills and tremors, representing dual exhaustion of Yin and Yang. Whenever diaphoresis is indicated, one must consider the Ying Blood of the Yin meridians, as seen here.

Wei Litong stated: Rather than saving Yang after sweat-induced Yang collapse, is it not better to save Yin beforehand to sustain Yang, preventing Yang collapse via sweating?

Individuals with dry throat (Yan Hou Gan Zao Zhe) must not undergo diaphoresis.

[Annotation] Dry throat indicates insufficient fluids. Further diaphoresis will further deplete fluids, hence the warning. Even if indications for diaphoresis exist, it must not be performed.

[Ji Zhu Commentary] Fang Youzhi stated: Dry throat indicates chronic fluid deficiency rooted in Kidney Water insufficiency, as the Shaoyin Meridian circles the throat. Diaphoresis causes further fluid loss.

Cheng Yingmao stated: Whenever diaphoresis is indicated, one must consider Upper Jiao fluids, as seen here.

Zhang Lu stated: This clause differs from "closure in the throat." This warns that diaphoresis deprives Yangming fluids; the other warns that diaphoresis deprives Shaoyin blood.

Individuals with Lin syndrome (Lin Jia) must not undergo diaphoresis. If diaphoresis is induced, hematuria will occur.

[Annotation] Lin Jia refers to diseases where damp-heat accumulates in the Bladder, causing painful, difficult urination. Diaphoresis removes dampness via sweat, leaving Heat behind. The Water Organ becomes depleted, forcing blood from its own channels to exit via urine.

[Ji Zhu Commentary] Cheng Zhi stated: Internal heat in the Bladder causes Lin syndrome. Further diaphoresis dries the Bladder further, causing hematuria.

Individuals with chronic sores/ulcers (Chuang Jia) must not undergo diaphoresis even if they have body pain. If diaphoresis is induced, Jing (Spasm) disease will result.

[Annotation] At the onset of Chuang Jia, before toxicity matures, diaphoresis is indicated to dissipate. After ulceration, Qi and Blood are damaged. Even with body pain indicating exterior syndrome requiring diaphoresis, it must not be used. Fear that sweating further weakens Ying and Wei, allowing external Wind to invade. Even without external Wind, tendons losing fluid nourishment will inevitably lead to neck stiffness and opisthotonos, forming Jing disease.

[Ji Zhu Commentary] Yu Chang stated: Body pain is a sign of Cold injuring Ying Blood, warranting diaphoresis. However, Chuang Jia individuals have weak exterior and hidden Ying Blood consumption. Further diaphoresis allows external Wind to attack weakness and internal Blood to fail to nourish, leading to neck stiffness and opisthotonos. Jing disease is also a Bladder disease.

In Taiyang Shanghan, adding warm needle therapy will definitely cause fright.

If burning needles are used to induce sweating, and the needle sites are exposed to cold, resulting in red nodules, Ben Tun (Running Piglet) disease will definitely develop, characterized by Qi rushing from the lower abdomen to the Heart. First, moxa one cone on each nodule, then administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon), increasing the amount of Cinnamon.

[Annotation] In Taiyang Shanghan, adding warm needles causes fright because the patient fears the sudden application, not necessarily developing a fright disease afterward. Burning needles is warm needle therapy. Inducing sweat via burning needles is a diaphoretic method, but needle sites must avoid cold. If careless, external Cold invades, Fire stagnates in vessels, blood fails to circulate, and red nodules form. The fire from warm needles creates red nodules; invaded by Cold, it not only fails to resolve but attracts Yin pathogens. When needles were added, the Heart was frightened, allowing Kidney Yin to exploit Heart deficiency, harassing Heart Yang and causing Ben Tun. Ben Tun is Kidney Yin pathogen, characterized by Qi rushing from lower abdomen to Heart. Moxa one cone on each nodule externally dispels Cold; subsequently, Guizhi Jia Gui Tang is given. Increasing Cinnamon internally attacks Kidney pathogens.

Guizhi Jia Gui Tang Formula
In the Guizhi Tang formula, add two liang of Gui (Cinnamon), totaling five liang. Rest follows Guizhi Tang method.

[Ji Jie Commentary] Xu Bin stated: This is Taiyang Wind Pathogen. Due to burning needles inducing sweat and subsequent Cold exposure, pathogens enter from Taiyang Fu (Bladder) into the paired Kidney, causing Ben Tun. Thus, following Taiyang example, the full Guizhi Tang is used. Doubling Cinnamon internally drains Yin Qi and drives out external pathogens.

In Taiyang Bing, fire fumigation was used. No sweat was produced. The person became irritable. When the appropriate time for resolution passed without relief, defecation of blood occurred. This is named Huo Xie (Fire Pathogen).

[Annotation] Fire fumigation is an ancient coercive sweating method, similar to modern heated kang covering for sweating. In Taiyang Bing, fire fumigation failed to produce sweat. The person suffered severe internal heat and irritability, further injuring Yin fluids. Without Yin, Yang cannot transform sweat, so the condition remains unresolved. Fire enters Yin, damaging Yin collaterals, forcing blood downward, causing bloody stool. Named Huo Xie to indicate treating the Fire Pathogen rather than just the bloody stool.

[Ji Zhu Commentary] Fang Youzhi stated: Zao (restlessness) is rapid movement of hands and feet. Dao (arrive) means reverse; meaning futile agitation without resolution. Sweat is fluid of Blood; Blood moves with Heat. Fire is intensely hot. Since no sweat occurred, Blood must overflow, causing bloody stool.

Cheng Yingmao stated: Taiyang Bing treated with fire fumigation failed to produce sweat, indicating chronic fluid deficiency. Without Yin, Yang cannot transform sweat. Yin deficiency injured by Fire, Heat has no exit, causing restlessness.

If the pulse is floating and heat is severe, moxibustion is contraindicated. Applying it to an Excess pattern while treating it as Deficiency causes Heat to move due to Fire, resulting in dry throat and hematemesis.

[Annotation] Floating pulse with severe heat indicates Excess Heat in the Exterior. Moxibustion is inappropriate. Applying it mistakes Excess for Deficiency (Shi Shi error). Heat stirred by Fire flares up, inevitably causing dry throat and hematemesis. The previous clause: Fire injured Yin, forcing blood downward (bloody stool). This clause: Fire injured Yang, forcing blood upward (hematemesis).

[Ji Zhu Commentary] Cheng Yingmao stated: Exterior Excess with Heat misdiagnosed as Deficiency-Cold, treated with moxibustion. Heat has no outlet, moves due to Fire, attacks internally. Pathogens bound externally, Fire attacks internally, damaging Lung Metal, causing dry throat and hematemesis.

Wang Hu stated: Exterior Wind-Heat treated with moxibustion treats Excess as Deficiency.

If the pulse is fine and rapid, moxibustion is extremely contraindicated. Fire becomes a pathogen, causing irritability and rebellion, chasing deficiency and pursuing excess. Blood scatters in vessels. Though Fire Qi is slight, its internal attack is powerful, scorching bones and damaging tendons, making blood recovery difficult.

[Annotation] Fine and rapid pulse indicates Yin deficiency and Blood scarcity; moxibustion is absolutely contraindicated. Mistaken moxibustion causes internal attack by Mugwort Fire, leading to irritability and rebellion. Irritability is Yin disturbed by Yang. Rebellion is chasing deficiency and pursuing excess. Yin is originally deficient; adding Fire makes it more deficient (chasing deficiency). Yang is originally excess; adding Fire makes it more excess (pursuing excess). Blood is already consumed; though Mugwort Fire Qi in vessels is slight, its internal attack is powerful. This causes scorched bones, damaged tendons, and difficult blood recovery.

[Ji Zhu Commentary] Yu Chang stated: Fine and rapid pulse indicates Yin deficiency with Heat. Moxibustion here makes deficiency worse and Heat worse, leading to injury unless stopped.

Cheng Yingmao stated: In Blood-deficient Yin-deficient individuals with fine-rapid pulse, moxibustion is especially contraindicated. Blood moistens and lubricates bones and tendons. Loss of moisture means Fire scorches bones and damages tendons, internally injuring Yin, scattering into meridians.

If Ying Qi is weak, adding burning needles causes blood to stagnate and not flow, leading to further fever and irritability.

[Annotation] Weak Ying Qi means deficient Ying Blood. If Ying Blood is already deficient, mistaken burning needles cause Ying Blood to dry up and stagnate, failing to circulate. This goes beyond scorched bones and damaged tendons! Hence, further fever and irritability occur.

[Ji Zhu Commentary] Cheng Zhi stated: This warns against burning needles in weak Ying. Yin deficiency causes internal heat. Adding burning needles to assist Yang combines two heats, stopping Ying Blood circulation, causing external fever and internal irritability.

Tang Buyan stated: Initially, it flows slightly, forced by burning needles; later, it stagnates and stops, exhausted by burning needles.

Zhang Lu stated: Fire is Yang pathogen, injuring Yin Blood. Treatment should prioritize saving Yin.

If the pulse is floating, diaphoresis is appropriate. Using moxibustion prevents pathogen exit. Due to Fire, pathogen intensifies. Disease manifests as heaviness and numbness from waist down, named Huo Ni (Fire Reversal).

[Annotation] Floating pulse indicates exterior pathogen, suitable for diaphoresis. Mistaken moxibustion injures Blood, preventing sweat formation. Pathogens have no exit, intensifying due to Fire. Instead of scorched bones/damaged tendons or hematemesis/bloody stool, heaviness and numbness from waist down occur. This implies chronic Dampness in the lower part, transforming according to Dampness. "Heavy" means adherent and immovable. Not named Bi (Obstruction) because it is not Wind-Cold-Damp Bi, but Huo Ni (Fire Reversal) causing lack of communication.

[Ji Zhu Commentary] Fang Youzhi stated: Bi is Damp disease. Fire reversal treats Fire Pathogen combined with Yang Pathogen reversing upward. Yang fails to descend, Yin fails to function, Qi transformation fails, Water fails to drain. Dampness adheres to lower body causing heavy Bi.

Cheng Yingmao stated: Floating pulse in exterior favors diaphoresis. Moxibustion prevents sweat, leaving pathogen with no exit, intensifying due to Fire. Even without scorched bones/tendons, Fire blocks pathogen, gradually exhausting Yin Qi. Lower Jiao is governed by Ying Blood. Ying exhaustion fails to transport, causing heaviness and Bi, named Huo Ni. This shows that to treat Bi, one must first treat the Fire.

The presentation resembles Shanghan, but the pulse is not wiry-tight but weak. Weak pulse indicates thirst. Fire coercion causes delirium. Weak pulse indicates fever. Floating pulse resolves with sweating and cure.

[Commentary] The three instances of "weak" should be "rapid". If "weak", where does the heat come from? The text logic fails, and this theory is absent elsewhere in the Treatise.

[Annotation] "Resembling Shanghan" means symptoms mimic Shanghan. But the pulse is not wiry-tight but rapid; rapid indicates Heat. Floating-rapid pulse, Heat in Exterior, Taiyang syndrome. Deep-rapid pulse, Heat in Interior, Yangming syndrome. Rapid pulse indicates Heat; Heat entering Yangming causes thirst. Fire coercion increases Heat, causing delirium. Although rapid pulse diseases all involve fever, treatment differs. Floating-rapid fever resolves with diaphoresis (Da Qinglong Tang). Deep-rapid fever resolves with purgation (Tiaowei Chengqi Tang). Rapid pulse without exterior/interior signs, only fever/thirst/delirium, requires neither diaphoresis nor purgation; Baihu Tang or Huanglian Jiedu Tang clears Heat.

In Shanghan with floating pulse, the doctor used fire coercion, causing Yang collapse. Symptoms include fright, mania, restlessness. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Freesia Rhizome, Dragon Bone, and Oyster Shell to Rescue the Counterflow) should be administered.

[Annotation] Shanghan with floating pulse should be treated with Mahuang or Guizhi. Using fire coercion induces excessive sweating, collapsing Yang, causing fright, mania, and restlessness. Fire error sends Heat to the Heart and depletes fluids, leaving Spirit unsupported. Fuzi and Sini Tang are not used because this is Yang collapse from Fire. Guizhi Tang minus Shaoyao, plus Shuqi, Longgu, and Muli is used. Shaoyao is removed fearing its Yin nature is sluggish and restricts Guizhi from rapidly reaching the exterior, defeating the emergency rescue purpose. With Longgu and Muli securing collapse, Shaoyao's sour astringency is unnecessary. Shuqi is cold and bitter; cold conquers Heat, bitter descends rebellious Qi. Essential for chaotic Fire Pathogen.

[Ji Zhu Commentary] Yu Chang stated: In the chapter, mistaken Da Qinglong Tang caused cold extremities, muscle twitching, and Yang collapse from excessive sweat, treated with Zhenwu Tang. This case...