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All symptoms manifest as difficulty in urination, therefore all can be primarily treated with Wuling San (Five-Ling Powder). If urination is normal, it must not be used, for fear of further damaging the body fluids, as this condition belongs to the interior syndrome of the Yangming channel; hence, it cannot be used. From this, we can understand that Wuling San (Five-Ling Powder) is not a specific agent solely for treating water-heat interaction, but rather the principal formula for treating difficulty in urination caused by water-heat retention. The sovereign herb is Xie (Alisma Rhizome), which is salty and cold; saltiness enters the Water Mansion (Kidney/Bladder), and coldness overcomes heat pathogens. The assistant herbs are Ling (Poria) and Fu Ling (Poria with Wood), which have a light and permeating nature, unblocking and regulating the water passages, directing water downward to the Bladder, thereby draining both water and heat together. Bai Zhu (Atractylodis Macrocephalae Rhizoma) is used for its drying-dampness property to strengthen the Spleen and assist Earth, acting as a dike to control water overflow. Gui Zhi (Cinnamon Twig) is used for its acrid and warm nature to disseminate and unblock Yang Qi, steaming and transforming the San Jiao (Triple Burner) to facilitate water movement. With the descending action of Ling (Poria) and Fu Ling (Poria with Wood), Ze Xie (Alisma Rhizome) doubles its water-draining efficacy, resulting in free urination and preventing water accumulation. Bai Zhu (Atractylodis Macrocephalae Rhizoma) relies on Gui Zhi (Cinnamon Twig) to ascend, rapidly enhancing the effect of unblocking Yang, causing Qi to rise and fluids to transform, thus stopping thirst. If fever persists, replace Gui Zhi (Cinnamon Twig) with Rou Gui (Cinnamon Bark); after taking the medicine, drink plenty of warm water to induce sweating for cure. This indicates that this formula not only treats the interior syndrome of water retention causing difficulty in urination but also resolves the exterior syndrome of fever caused by water retention. Adding Ren Shen (Ginseng Radix et Rhizoma) creates Chunze Tang (Spring Marsh Decoction), whose intent is specifically to assist Qi transformation to generate fluids. Adding Yin Chen (Artemisiae Scopariae Herba) creates Yinchin Wuling San (Yinchen Five-Ling Powder), which is effective for treating damp-heat jaundice in patients with neither exterior nor interior excess and difficulty in urination.

[Collected Commentaries] Cheng Yingmao stated: The Taiyang (Greater Yang) channel has the exterior as its marked aspect (Biao) and the Bladder as its root (Ben). Wind-stroke with fever indicates pathogenic invasion of the marked aspect. After six or seven days without resolution, the pathogen from the marked aspect transfers into the Bladder. This is called invading the root. Although Wuling San (Five-Ling Powder) and the two formulas Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) are all medicines for the Taiyang channel, one releases the muscle layer to treat the exterior, while the other promotes urination to treat the interior; their respective domains of treatment for the exterior and root are distinct.

[Annotation] This clause refers to cases with both exterior and interior syndromes, not to the Taiyang-Yangming exterior-interior syndromes characterized by fever with sweating, dry mouth with vexatious thirst, immediate consumption of ingested water, and spontaneous urination. Rather, it refers to the Taiyang-Bladder exterior-interior syndromes characterized by fever without sweating, moist mouth with vexatious thirst, vomiting immediately after drinking, and difficulty in urination. Although this disease does not explicitly mention the symptoms of no sweating and difficulty in urination, if there were sweating and free urination, the ingested water would escape via the exterior or exit downward, and certainly no "Water Rebellion" (Shuini) syndrome would occur. Zhang Zhongjing's use of Wuling San (Five-Ling Powder), requiring patients to drink warm water to induce sweating for cure, intends to promote urination and sweating; thus, it is known that symptoms of no sweating and difficulty in urination must exist.

In Taiyang disease, if urination is free, due to excessive water intake, palpitations in the epigastrium will inevitably occur; if urination is scanty, severe urgency in the lower abdomen will inevitably occur.

[Note] In the initial stage of Taiyang disease, there is no desire for water; when it is about to transmit to Yangming, there is a desire for water; this is the norm. Now, in the initial stage of Taiyang disease, there is excessive water intake, indicating that the person’s Stomach was dry in their usual state. Assuming Stomach Yang is not deficient, the ingested water could be distributed to the exterior and transformed into sweat for resolution. Now, with excessive water intake and insufficient Stomach Yang, even if urination is free, water will inevitably stagnate in the Middle Jiao, causing palpitations in the epigastrium. If urination is additionally scanty, water will stagnate in the Lower Jiao, causing severe lower abdominal urgency.

[Collected Notes] Fang Youzhi said: Excessive water intake leading to palpitations in the epigastrium occurs because the Heart is a Fire organ; excessive water suppresses it. Scanty urination leads to water stagnation, hence the lower abdominal urgency.
Wang Hu said: In Taiyang disease, free urination indicates no pathogenic heat in the Bladder fu-organ. If the person drinks excessively, this heat is in the Upper Jiao, with hyperactive Heart Fire. Although urination is free, excessive drinking due to thirst causes water stagnation attacking Fire, inevitably leading to palpitations in the epigastrium. If the person drinks excessively but urinates scantily, this heat is in the Lower Jiao, where Taiyang pathogenic heat follows the channel into the fu-organ. Water accumulates and fails to move, causing severe urgency in the interior of the Bladder.

After sweating, excessive water intake will inevitably cause wheezing; bathing with water will also cause wheezing.

[Note] The previous clause discussed excessive water intake before sweating, caused by Stomach heat and fluid deficiency. This clause discusses excessive water intake after sweating, caused by fluid loss and Stomach dryness. The absence of palpitations in the epigastrium and lower abdominal urgency is because the water did not stagnate in the Middle or Lower Jiao, but in the Upper Jiao; thus, water attacking the Lung inevitably causes wheezing. "Water irrigation" refers to washing the body with water. Wheezing from excessive water intake is due to drinking cold water, injuring the interior with cold. Wheezing from water irrigation is due to external cold injury to the form. Both injure the Lung, hence both cause wheezing.

[Collected Notes] Wei Litong said: This clarifies that the wheezing in this clause can be caused by water. Although the wheezing from drinking excessively due to thirst and the wheezing from irrigation without thirst have different origins, the resulting pathology is the same.

After sweating, Guizhi Tang (Cinnamon Twig Decoction) must not be administered again. If there is sweating and wheezing without significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.

[Note] In Taiyang disease, if mild wheezing occurs after mistaken purgation, the exterior is unresolved; Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) should be used to release the Taiyang muscle-layer and treat wheezing. In Taiyang disease with Guizhi Tang (Cinnamon Twig Decoction) syndrome, if the physician mistakenly uses purgation, resulting in diarrhea, rapid pulse, sweating, and wheezing with unresolved exterior, Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) should be used to release Yangming muscle-layer heat and treat wheezing. Now, after sweating in Taiyang disease, if there is sweating and wheezing without significant heat and aversion to cold, it is known that the pathogen is no longer in the Taiyang exterior; and since there is sweating without aversion to heat, the pathogen is not in the Yangming interior. The reason for sweating and wheezing, without significant heat or aversion to cold, is that the pathogen resides exclusively in the Taiyin Lung channel. Therefore, Guizhi Tang (Cinnamon Twig Decoction) must not be used again; instead, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) should be given to disperse Lung pathogens, after which sweating and wheezing will cease spontaneously.

Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) Formula
Mahuang (Ephedrae Herba, removed nodes, 4 liang)
Xingren (Prunus Armeniaca Semen, skin and tips removed, 50 pieces)
Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang)
Shigao (Gypsum Fibrosum, wrapped in silk, crushed, 0.5 jin)
Take these four ingredients, add 7 sheng of water, first boil Mahuang (Ephedrae Herba) until reduced by 2 sheng, remove white foam, add the remaining herbs, boil to obtain 3 sheng, remove dregs, and take 1 sheng warm.

[Collected Notes] Ke Qin said: Shigao (Gypsum Fibrosum) is a heavy agent for clearing fire; Qinglong Tang (Green Dragon Decoction) and Baihu Tang (White Tiger Decoction) both rely on it for success. However, improper use can invite disaster. Qinglong Tang is used for no-sweat irritability, utilizing Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus) to disseminate defensive Yang; Baihu Tang (White Tiger Decoction) is used for sweating with vexatious thirst, requiring Jingmi (Oryza Sativa Germen) to preserve Stomach fluids. Here, there is internal heat but no external cold, so Jiang and Gui are not used. The wheezing is in the Lung, not the Stomach, so Jingmi (Oryza Sativa Germen) is not needed. The intent focuses on preserving Yin, not worrying about Yang collapse. Thus, Gui Zhi (Cinnamon Twig) is removed from Mahuang Tang (Ephedra Decoction) to avoid its restraining effect, taking Mahuang (Ephedrae Herba) for exclusive opening, Xingren (Prunus Armeniaca Semen) for descending, Gancao (Glycyrrhizae Radix et Rhizoma) for harmonizing, and doubling Shigao (Gypsum Fibrosum) for coldness to clear internal excess heat. This results in profuse sweating, eliminating internal and external vexatious heat and wheezing.

After purgation, Guizhi Tang (Cinnamon Twig Decoction) must not be administered again. If there is sweating and wheezing without significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.

[Note] This elaborates on the previous clause, explaining that although the disease acquisition routes differ (post-sweating vs. post-purgation), the treatment method is the same. In cases of post-purgation with no significant heat, sweating, and wheezing, it is known that the pathogen is not in the exterior but in the Lung; thus, Guizhi Tang (Cinnamon Twig Decoction) must not be used again, and Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) should be used to treat the Lung. The wheezing after sweating in the former case and wheezing after purgation in the latter case have different etiologies but identical manifestations; therefore, treatment follows the manifestation rather than the etiology, using this decoction for both, which is also the principle of "treating the acute symptom first" in wheezing disorders.

[Collected Notes] Fang Youzhi said: Although sweating and purgation differ, the resulting wheezing from mismanagement is the same. Because the wheezing is identical, they share the same treatment.

In Taiyang wind-stroke, if there is no diarrhea but vomiting and reverse qi flow, once the exterior is resolved, the interior can be attacked. If the patient has sweating occurring at intervals, headache, epigastric fullness and hardness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is disharmonious; Shizao Tang (Ten-Date Decoction) is the primary treatment.

[Annotation] The character "xia" (down/diarrhea) in "xiali" should be "bu" (not). If it were "xia," how could one use the harsh Shizao Tang (Ten-Date Decoction) for simultaneous vomiting and diarrhea? Only constipation with epigastric fullness, hardness, and pain constitutes an interior disease; difficulty in urination, vomiting, reverse qi, and shortness of breath constitute a fluid-retention disease, which can then be attacked. The character "zuo" (act/happen) in "fazuo" should be "re" (heat). If there is sweating without heat, it is Shaoyin yin-cold fluid retention, the Zhengwu Tang (True Warrior Decoction) syndrome. Moreover, "zuo" does not fit the context of the surrounding sentences.

[Note] Taiyang wind-stroke involves exterior pathogens. No diarrhea but vomiting and reverse qi involve interior fluid retention. Once the exterior pathogen is resolved, interior fluid retention can be attacked. Examining the patient: continuous slight sweating, intermittent fever, headache. If aversion to cold persists, the exterior is unresolved and cannot be attacked. If there is no aversion to cold, the exterior is resolved. Seeing additionally the interior disharmony of epigastric fullness and hardness radiating to the hypochondrium, dry retching, shortness of breath, and urgent fluid retention with no outlet, Shizao Tang (Ten-Date Decoction) is directly used as a harsh agent to attack the nest of water pathogens without hesitation.

[Annotation] In Shanghan (Cold Damage) with unresolved exterior and water stagnation in the epigastrium causing vomiting and reverse qi, cold binds the exterior, preventing water qi from dispersing; Xiao Qinglong Tang (Minor Green Dragon Decoction) should be used to sweat and dissipate it. In Fengzhong (Wind Strike) with unresolved exterior and water stagnation in the epigastrium causing vomiting, fluid blocks the middle, preventing water qi from transmitting and excreting; Wuling San (Five-Ling Powder) should be used to dissipate and promote urination. These are all cases of unresolved exterior where interior fluid cannot be attacked. Regarding Shizao Tang (Ten-Date Decoction) and Guizhi Qushaoyao Ji Baizhu Fuling Tang (Cinnamon Twig Decoction minus Peony plus Atractylodes and Poria) from the lower section, both treat patients with chronic fluid retention having exterior-interior syndromes. Shizao Tang (Ten-Date Decoction) treats headache, fever, sweating, no aversion to cold (exterior resolved) with epigastric fullness, hardness, and pain (interior disharmony), focusing solely on attacking the interior. Guizhi Qushaoyao Ji Baizhu Fuling Tang (Cinnamon Twig Decoction minus Peony plus Atractylodes and Poria) treats headache, fever, no sweating (exterior unresolved) with mild epigastric fullness and pain (interior disharmony), focusing on resolving the exterior first. However, the severity of epigastric hardness, fullness, and pain differs.

[Collected Notes] Du Ren said: Shizao Tang (Ten-Date Decoction) is suitable only for robust individuals and should not be used lightly.
Fang Youzhi: "Then the interior can be attacked" implies advising against premature purgation. From "sweating" to "shortness of breath," it indicates that although there are interior signs, purgation is not yet indicated. Only when "sweating without aversion to cold" appears does it connect the preceding and following text, indicating that purgation is now indicated.
Yu Chang said: This syndrome is similar to Jie Xiong (Chest Binding). However, Jie Xiong involves pathogen binding in the chest, which is high; this involves the epigastrium and hypochondrium, which is low. Yet, exterior must be resolved before attacking, similar to the warning for attacking Jie Xiong. Using Shizao (Jujube Dates) is similar to Xian Xiong Tang (Trap Chest Decoction) because Shanghan purgative methods are mostly set for Wei Shi (Stomach Excess). Wei Shi involves intense internal pathogenic heat, requiring Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) to purge. Here, the pathology is in the chest and hypochondrium, not the Stomach, so purging agents are useless; thus, herbs that eliminate heat and drive out fluid from the chest and hypochondrium are chosen as the purgative method.
Zhang Zhicong said: Headache is an exterior sign. But it can also be interior, e.g., Shanghan with constipation for five to six days, headache with fever, treated with Chengqi Tang (Descending Qi Decoction). This contrasts with the current clause: sweating, no aversion to cold, headache, indicating exterior resolved with interior fluid retention, treated with Shizao Tang (Ten-Date Decoction). Thus, whenever encountering wind-cold headache with unresolved exterior, differentiation is required.
Cheng Yingmao said: The confusing point is that besides headache, only sweating exists, making exterior-interior differentiation difficult. Sweating with fever and aversion to cold indicates slight exterior involvement; sweating with fever and no aversion to cold indicates only interior involvement. Knowing the exterior is resolved, the interior Qi is bound by fluid pathogens and disharmonious; even headache belongs to interior pathogen attacking upward, unrelated to the exterior.
Wei Litong said: Since Taiyang pathogen has entered the interior, purgation is indicated. However, it does not go down to the chest-diaphragm or intestines-stomach, but to the heart and hypochondrium. This position is slightly lower than purging Jie Xiong (Chest Binding) and slightly higher than purging Wei Shi (Stomach Excess); this is another method of purgation. One must recognize that although the method is purgation, different syndromes require different approaches. At the junction of Taiyang and Yangming, exterior and interior must be differentiated to apply sweating or purgation. The interior purgation there is for pathogenic heat combining with food to form Stomach Excess; the interior purgation here is for pathogenic heat combining with fluid retention to form Fluid Excess. Both require exterior resolution before purgation; this is the commonality.

Shizao Tang (Ten-Date Decoction) Formula
Yuan Hua (Genkwa Flos, processed)
Gan Sui (Kansui Radix)
Da Ji (Euphorbiae Pekinensis Radix)
Da Zao (Jujubae Fructus, torn open, 10 pieces)
Grind the three herbs equally into separate powders. Add 1.5 sheng of water, first boil ten fat Da Zao (Jujubae Fructus), obtain 0.8 sheng, remove dregs, add the herbal powders. Robust adults take one qianbi (coin-sized measure), frail adults take half a qianbi, take warm on an empty stomach at dawn. If stool is scanty and disease remains, take more the next day, increasing by half a qianbi. After obtaining rapid loose stools, nourish oneself with millet porridge.

[Formula Explanation] Zhang Zhongjing’s formulas for treating water vary greatly; this is the most harsh. Generally, water-pathogen diseases manifest as wheezing, cough, palpitations, choking, vomiting, or diarrhea, affecting only one area. Here, water pathogens remain bound in the middle, causing epigastric, abdominal, and hypochondriac fullness, hardness, and pain, blocking the ascending and descending Qi of the San Jiao (Triple Burner). With exterior pathogens resolved, sweating is inappropriate; with interior fluid retention excess, light diuretics are insufficient. Without selecting the harshest water-draining agents to directly subdue it, the Middle Qi will fail, leaving us helpless. Gan Sui (Kansui Radix), Yuan Hua (Genkwa Flos), and Da Ji (Euphorbiae Pekinensis Radix) are all acrid, bitter, cold, and extremely toxic. Used together, their flavors complement each other, allowing direct attack on the water-nest, breaking the dikes, and causing massive purgation to resolve the illness in one stroke. However, where pathogens gather, Qi is deficient; using toxic drugs to attack pathogens will damage the Spleen and Stomach. Without mild, sweet, and緩 (soothing) agents as masters, the pathogens may be eliminated, but life will perish too. Since these drugs are extremely toxic and harsh, Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) cannot serve as sovereigns, and Gancao (Glycyrrhizae Radix et Rhizoma) is incompatible; thus, ten large, fat Da Zao (Jujubae Fructus) are chosen as sovereigns. To protect the Spleen and Stomach and to moderate the harsh toxicity. After rapid purgation, nourish with millet porridge: to replenish grain Qi internally and prevent pathogen recurrence. This is Zhang Zhongjing’s method of using toxic drugs to attack disease, perfect in both beauty and goodness. Ignorant people, confused by the theory that "sweet causes fullness," dare not use it, failing to understand the principle of mutual restraint.

In Taiyang disease, if exterior signs are unresolved, purgation must not be performed; purgation is contrary to treatment. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) is appropriate.

[Note] "Exterior signs unresolved in Taiyang disease" refers to unresolved exterior signs suitable for Guizhi Tang (Cinnamon Twig Decoction). Whenever exterior signs are unresolved, regardless of whether sweating has been induced, even if there are indications for purgation, unless it is an emergency purgation case, purgation must not be performed. Purgation is contrary to treatment. To resolve the exterior, Guizhi Tang (Cinnamon Twig Decoction) should still be used.

[Collected Notes] Wang Kentang said: Even a trace of headache and aversion to cold indicates unresolved exterior; purgation must not be performed.
Cheng Yingmao said: If exterior signs remain unresolved after purgation, the exterior must still be resolved. Use the appropriate medicine for the existing signs; do not assume Guizhi Tang (Cinnamon Twig Decoction) is unsuitable just because purgation was performed.
Wang Hu said: Purgation is contrary because it attacks the interior when the disease is in the exterior, which is inconsistent with proper treatment principles.

In Taiyang disease, if initial sweating fails to resolve the condition, followed by mistaken purgation, and the pulse is floating, the disease is not cured. Floating indicates the pathogen is in the exterior; mistaken purgation causes failure to cure. Now, with a floating pulse, it is known the pathogen is still in the exterior; the exterior must be resolved for cure, preferably with Guizhi Tang (Cinnamon Twig Decoction).

[Note] In Taiyang disease, if initial sweating fails to resolve the exterior, sweating should be repeated; mistaken purgation is inappropriate. Failure to cure with a floating pulse is because the pathogen is in the exterior, and purgation was mistakenly used. Now, after mistaken purgation without becoming contrary, the pulse remains floating, indicating the pathogen is still in the exterior; Guizhi Tang (Cinnamon Twig Decoction) should still be used to resolve the exterior for cure.

[Collected Notes] Cheng Yingmao said: Cure or non-cure is distinguished by the pulse. If cured, the pulse will no longer be floating and will leave the exterior. If the pulse is floating, it indicates the pathogen is still in the exterior; the previous purgation was erroneous, causing non-cure. Do not dwell on past errors; focus on the present. Focus not on past symptoms, but on the current pulse. If the pulse is floating, the pathogen is still in the exterior; even if time has passed, the exterior must be resolved for cure. Use the medicine corresponding to the pulse; do not assume Guizhi Tang (Cinnamon Twig Decoction) is unsuitable just because purgation was performed.

If sweating was originally indicated but purgation was used instead, this is contrary treatment; if sweating was performed first, the treatment is not contrary. If purgation was originally indicated but sweating was used instead, this is contrary treatment; if purgation was performed first, the treatment is not contrary.

[Note] Establishing rules for contrary treatment revolves around exterior and interior; treatment of exterior and interior revolves around sweating and purgation. For diseases with exterior and interior signs, one must determine whether to sweat or purge first. Proper sequence is compliant; improper sequence is contrary. If the exterior is urgent and purgation is used instead of sweating, this is contrary; if sweating is performed first followed by purgation, the treatment is not contrary. If the interior is urgent and sweating is used instead of purgation, this is contrary; if purgation is performed first followed by sweating, the treatment is not contrary.

[Collected Notes] Cheng Zhi said: This means sweating and purgation have priorities and urgency; one must not act backwards.
Wang Hu said: In treating Shanghan, if exterior signs are urgent, sweat immediately; if interior signs are urgent, purge immediately. Do not rigidly adhere to sweating first then purging. Proper sweating and purgation result in non-contrary treatment.

In Taiyang disease, after mistaken purgation, if the pulse is Cu (rapid and intermittent) without Jie Xiong (Chest Binding), this indicates impending resolution. If the pulse is Fu (floating), Jie Xiong (Chest Binding) will definitely occur; if the pulse is Jin (tight), throat pain will definitely occur; if the pulse is Xian (wiry), bilateral hypochondriac stiffness will definitely occur; if the pulse is Xi Shu (fine and rapid), headache will persist; if the pulse is Chen Jin (deep and tight), vomiting will definitely occur; if the pulse is Chen Hua (deep and slippery),xie Re Li (Heat-Collateral Diarrhea) will occur; if the pulse is Fu Hua (floating and slippery), bleeding from below will definitely occur.

[Annotation] "Cu" (rapid and intermittent) should be "Fu" (floating) to align with the text stating non-Jie Xiong (Chest Binding) indicates impending resolution. "Fu" (floating) should be "Cu" (rapid and intermittent) to align with Jie Xiong (Chest Binding) and chest fullness in the Treatise. "Jin" (tight) should be "Xi Shu" (fine and rapid), and "Xi Shu" (fine and rapid) should be "Jin" (tight) to match the original pulses of the two channels in the Treatise. "Fu Hua" (floating and slippery) should be "Shu Hua" (rapid and slippery); Fu Hua (floating and slippery) is the pulse for Baihu Tang (White Tiger Decoction) syndrome in the Treatise, while Shu Hua (rapid and slippery) is the pulse for pus and blood discharge. Careful study of various chapters will reveal this.

[Note] In Taiyang disease, mistaken purgation leads to different variations because each person’s Zang-Qi differs, transforming according to the invaded channel. Mistaken purgation sinking pathogens usually causes Jie Xiong (Chest Binding); if Jie Xiong (Chest Binding) does not occur and the pulse is Fu (floating), the interior is harmonious and rejects the pathogen, which remains in the exterior, indicating impending resolution. If the pulse is Cu (rapid and intermittent), it is the pulse of Yang-excess solid pathogens, so Jie Xiong (Chest Binding) will definitely occur. Xi Shu (fine and rapid) is the pulse of Shaoyin pathogenic heat; throat pain is the sign of Shaoyin pathogenic heat. Mistaken purgation sinking pathogens into Shaoyin requires treatment according to Shaoyin. Xian (wiry) is the Shaoyang pulse; bilateral hypochondriac stiffness is the Shaoyang sign. Mistaken purgation sinking pathogens into Shaoyang requires treatment according to Shaoyang. Jin (tight) is the Taiyang pulse; headache is the Taiyang sign. Mistaken purgation with pathogens remaining in the exterior requires treatment according to Taiyang. Chen Jin (deep and tight) is the pulse of cold pathogens entering the interior; vomiting is the sign of Stomach Yang rejection. Mistaken purgation of exterior pathogens sinking into the Stomach requires treatment according to Yangming. Chen Hua (deep and slippery) is the pulse of retained food. Mistaken purgation of exterior pathogens combining with heat entering the interior causing diarrhea requires treatment according to Xie Re Li (Heat-Collateral Diarrhea). Shu Hua (rapid and slippery) is the pulse of accumulated heat. Mistaken purgation of exterior pathogens sinking into Yin, damaging Ying and causing bleeding, requires treatment according to pus and blood discharge.

[Annotation] Cu (rapid and intermittent) is indeed a Yang pulse. If Cu (rapid and intermittent) is forceful, it is excess, diagnosing Jie Xiong (Chest Binding) solid pathogens; if Cu (rapid and intermittent) is weak, it is deficiency, diagnosing chest fullness deficiency pathogens. Thus, in the Treatise, Cu (rapid and intermittent) pulse with Jie Xiong (Chest Binding), head sweating, and slight tidal heat is treated with Xian Xiong Tang (Trap Chest Decoction) to purge; Cu (rapid and intermittent) pulse with chest fullness, sweating, and slight aversion to cold is treated with Guizhi Qushaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Aconite) to warm. Observing these treatments for deficiency and excess of the Cu (rapid and intermittent) pulse allows for analogy.

[Annotation] Throat pain is a sign present in both cold and heat Shaoyin syndromes. Dry, swollen, and painful throat indicates heat; non-dry, non-swollen, but painful throat indicates cold. Thus, in the Shaoyin chapter, there are two treatment methods: Ganjie Tang (Licorice and Platycodon Decoction) and Tongmai Sini Tang (Unbind the Pulse and Reverse Cold Decoction).