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[Cheng Wuji's Commentary] Inability to speak and difficulty in articulation present two syndromes: one is Taiyang Wind-Warmth (Taiyang Fengwen), the other is Shaoyin sores in the throat. Both are caused by pathogenic heat from transmitted diseases obstructing and closing off the orifices, not by Yin-Cold syndromes. When Qi and Blood circulate freely, joints open up, and speech can be produced.

[Taiyang Disease Chapter] After sweating therapy, if the body remains burning hot, it is called Wind-Warmth. The pulse at both Cun and Chi positions is floating; there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring, and difficulty speaking (see detailed description under Wind-Warmth).

[Shaoyin Disease Chapter] If the disease progresses to injury and sores forming in the throat, resulting in inability to speak and voice loss, treat with Kujiu Tang (Bitter Wine Decoction).

[Wu Qian's Commentary] There are six types of aphonia (loss of voice):
1. Shaoyin disease with throat injury and sores causing inability to speak: treat with Jizi Kujiu Tang (Egg Yolk Bitter Wine Decoction) added with wine.
2. Huhu (Fox-Herpes) cold damage with sores on the upper lip, dry throat, and hoarseness: treatment seen in this section.
3. Jing syndrome (spasm) with locked jaw causing inability to speak: also seen in this section.
4. Heat disease with hoarseness and silence, no sweat for three to four days: fatal prognosis.
5. Excessive heat and fire injuring Lung Metal causing inability to speak: clear Lung heat and descend fire to cure.
6. Wind-heat congestion and severe cough causing hoarseness: eliminate wind and descend phlegm-fire.
Additionally, cases where dispersal was neglected, allowing wind-pathogen to lodge in the Lungs, should be treated by dispersing the pathogen.

[Cheng Wuji's Commentary] Wind-Warmth causes snoring; Taiyang Wind-Strike causes nasal whistling (bi ming). These result from wind qi obstruction and impaired defense Qi. Although Yangming, Shaoyin, and the Three Yang channels may experience Wind-Strike, since the pathogen is not in the exterior, there is no nasal whistling or snoring.

[Taiyang Disease Chapter] Wind-Strike presents with a floating Yang pulse and weak Yin pulse. Floating Yang indicates spontaneous heat generation; weak Yin indicates spontaneous sweating. Symptoms include aversion to cold (se se), aversion to wind (xi xi), mild fever (xi xi), nasal whistling, and dry retching. Treat with Guizhi Tang (Cinnamon Twig Decoction). If after sweating therapy the body remains burning hot, with a floating pulse, spontaneous sweating, heaviness, sleepiness, snoring, and difficulty speaking, do not use purgation or fire therapy.

(Urinary Difficulty)
[Cheng Wuji's Commentary] Urinary difficulty (xiao bian bu li) has several types: urinary difficulty following mistaken purgation results from internal depletion of body fluids; urinary difficulty following sweating results from external loss of body fluids; jaundice, Pi syndrome (glomus), and heat diseases with urinary difficulty are caused by heat stagnation; rheumatism-wind interaction and Yangming wind-strike leading to urinary difficulty or cold pathogen invasion leading to difficult urination often result from sweating or purgation errors and require careful differentiation.

[Taiyang Disease Chapter] Cold damage with unresolved exterior and fluid retention in the epigastrium, presenting with dry retching, fever, cough, thirst, diarrhea, dysphagia, urinary difficulty, hypogastric fullness, or wheezing: treat with Xiao Qinglong Tang (Minor Blue Dragon Decoction), removing Mahuang and adding Fuling (Poria). After excessive sweating in Taiyang disease, stomach dryness causes irritability, insomnia, desire for water, and urinary difficulty: if the pulse is floating, use Wuling San (Five-Ingredient Powder with Poria); if not floating, use Zhuling Tang (Polyporus Decoction). If epigastric fullness persists after treating Pi syndrome with Xixin Tangs despite thirst, oral dryness, irritability, and urinary difficulty: use Wuling San. After taking Guizhi Tang or undergoing sweating/purgation, if headache, neck stiffness, mild fever, anhidrosis, epigastric fullness, slight pain, and urinary difficulty persist: use Guizhi Qu Gui Jia Fuling Baizhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala). Drinking too much water in Taiyang disease causes epigastric palpitations and scanty urine: use Fuling Jiangzhi Tang (Poria and Ginger Decoction). If accompanied by jaundice, hard hypogastrium, and deep-knotted pulse: use Yinyin Tang (Artemisia Capillaris Decoction). If the exterior is unresolved but purged mistakenly, resulting in no chest binding but only head sweating and urinary difficulty: jaundice will likely develop, treat with Yinyin Tang (or Zhizi Bopi Tang/Gardenia and Phellodendron Bark Decoction).

[Yangming Disease Chapter] A red face indicates contraindication for purgation; it leads to fever, yellow complexion, and urinary difficulty. In Yangming disease with urinary difficulty: if cold damages the Stomach causing inability to eat, continuous sweating on hands/feet, and stool initially hard then loose: this suggests impending Gujia (chronic constipation mass). If appetite is normal and bowel movements regulate, joint pain, mild fever sensation, sudden madness, continuous sweating leading to resolution: this indicates Water failing to overcome Grain Qi, merging with sweat; tight pulse indicates recovery. Anhidrosis, mental restlessness (ao nao), or mild head sweating after fire therapy, or head sweating without body sweating stopping at the neck, thirst for drinks, all suggest impending jaundice. If floating pulse, fever, thirst, and urinary difficulty occur: Zhuling Tang is indicated. (Note: The character "floating" here is erroneous. *Huoren Shu* states floating pulse uses Wuling San, deep pulse uses Zhuling Tang. Thus, "not floating" was likely omitted. Taiyang Wuling San adds Guizhi and Baizhu to Zhuling, Zexie, Fuling; Yangming Zhuling Tang adds Ejiao and Huashi. Guizhi/Baizhu are sweet/acrid-yang acting externally; Ejiao/Huashi are sweet-cold-yin acting internally. Zhang Zhongjing’s intent is preserved. However, confusion arose regarding deep vs. floating pulses in Yangming. Correct interpretation: Floating pulse -> Wuling San; Not floating -> Zhuling Tang.) Patients with urinary difficulty, alternating hard/loose stools, slight fever, asthma, dizziness, inability to lie down: have dry feces, treat with Dachengqi Tang (Major Order the Qi Decoction). Early stage (2-3 days), weak pulse, no Taiyang/ShaoYang signs, irritability, epigastric hardness: give Xiaochengqi Tang (Minor Order the Qi Decoction) sparingly to harmonize slightly. If no bowel movement for 6-7 days and scanty urine: even if unable to eat, initial hardness followed by looseness indicates stool is not yet hard; wait for free urination to confirm hard stool before using Dachengqi Tang.

[Shaoyang Disease Chapter] Cold damage or wind-strike after 5-6 days, with alternating chills/fever, hypochondriac pain, anorexia, irritability, frequent vomiting, epigastric palpitations, or urinary difficulty: treat with Xiaochaihu Tang (Minor Bupleurum Decoction). After sweating and purging, with hypochondriac fullness, slight knotting, urinary difficulty, thirst, no vomiting, only head sweating, irritability, alternating chills/fever: treat with Chaihu Guijiang Tang (Bupleurum and Cinnamon Branch Decoction). After purging on day 8-9, with chest fullness, fright, urinary difficulty, delirium, body heaviness, inability to turn: treat with Chaihu Jia Longgu Muli Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction).

[Shaoyin Disease Chapter] Urinary difficulty with spontaneous diarrhea and abdominal pain defines Shaoyin disease. With heavy limbs and water retention: use Zhenwu Tang (True Warrior Decoction). With pus/blood in stool: use Taohua Tang (Peach Blossom Decoction). With Four-Chi syndrome (cold extremities): use Sini San (Frigid Extremities Powder) plus Fuling.

[Jueyin Disease Chapter] Cold damage with hiccups and abdominal fullness: check anterior (urine) and posterior (stool) obstructions and relieve them. For urinary difficulty with floating pulse: Wuling San; non-floating: Zhuling Tang. Urinary difficulty with joint pain, inability to flex/extend, sweating, aversion to wind, edema: Rheumatism, use Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction). Deep-slow pulse with rapid stool: Damp-Bi, use Wuling San per *Huoren Shu*.

[Appendix]
[Zhao Xianke's Note] Yin syndrome with urinary difficulty, cold extremities, and fine/weak pulse: avoid diuretics that are cold/slippery; use Fanyin Dan (Return to Yin Pill) and moxa Stone Gate (Shimen CV5).
[Collected Notes] For cold damage with complete urinary retention, point YinGu (KI10) and YinLingQuan (SP9).
[Wu Qian's Commentary] For cold damage with urinary retention, puncture Ren Mai points 1 cun below umbilicus (deep insertion) and ZhiGou (SJ6) 3 cun above wrist. Differentiate by Six Channels:
Taiyin: Fullness, diarrhea, urinary difficulty, deep pulse without heat: Lizhong Tang + Wuling San plus Houpo and Muxiang to separate turbidity.
Jueyin: Cold closure, cold extremities, hidden pulse, retracted testicles, urinary difficulty: Sini Tang, Tongcao, Fuling, or moxa Qihai (CV6)/Shimen (CV5), or scallion moxibustion.
Yin deficiency with fire agitation: red/astringent urine: add Mutong, Shengdi, Zhimu, Huangbai Wan.
Internal heat with constipation and red/astringent urine: Bazheng San (Eight-Ingredient Powder for Rectification).
Non-thirsty urinary difficulty: Heat in Blood level; use Zhimu, Huangbai, Shengdi. Bladder stores fluids; Qi transformation allows excretion. Profuse sweating depletes fluids, reducing urine; do not diurese further to avoid fluid exhaustion. Spontaneous urination should not be forcibly stopped to avoid heat entering Bladder and causing Blood Stasis.

[Urinary Difficulty]
Post-sweating urinary difficulty: If Taiyang sweating leads to unceasing leakage, aversion to wind, urinary difficulty, stiff limbs: Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). Fire-induced sweating in Taiyang Wind-Strike causes blood/qi overflow, jaundice, excess Yang/deficient Yin, epistaxis tendency, urinary difficulty. Fire-induced sweating in Shaoyin causes cough, diarrhea, delirium, urinary difficulty.

Post-purgation urinary difficulty: Two types. Pulse slow/floating/weak, aversion to wind/cold, post-purge: hypochondriac fullness, jaundice, neck stiffness, urinary difficulty. Yangming excess heat, fever/aversion to cold, tight floating pulse, post-purge: abdominal fullness, urinary difficulty.

Hypochondriac pain, jaundice, urinary difficulty: If Yangming excess untreated, use Xiaochaihu Tang. Post-purge anorexia with neck stiffness: avoid Chaihu.

[Zhao Xianke's Note] Regarding urinary difficulty in cold damage: Zhang Zhongjing describes profuse sweating leakage treated with Guizhi Jia Fuzi Tang; Yangming wind-strike with string-taut/large pulse, tidal fever, hiccups; or tight floating pulse mistaken purgation causing abdominal fullness; Yangming floating-slow pulse with post-prandial vexation/dizziness. *Huoren Wen* distinguishes transmitted heat from wind-leakage Yang collapse. Guizhi Jia Fuzi Tang addresses Yang collapse/channel deficiency, not merely Yin deficiency with Yang aggregation. Differentiate Xiaochaihu, mistaken purgation, and Grain Jaundice syndromes separately from Yang aggregation/transmitted pathogen. Add a clause: "Profuse sweating causing Yang collapse and fluid insufficiency also causes urinary difficulty," attributing this to Guizhi Jia Fuzi Tang.