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Cheng Wuji's Commentary: There are two types of "rumbling in the abdomen" (borborygmus), both belonging to "bad disease" (complications due to mismanagement). One is caused by applying purgation incorrectly to Taiyang cold damage (use Gancao Xiexin Tang, Licorice Decoction for Releasing the Epigastrium) because improper purgation damages Yin Qi. The other arises after sweating and resolution of the exterior syndrome but results from this condition (use Shengjiang Xiexin Tang, Fresh Ginger Decoction for Releasing the Epigastrium) because improper sweating damages Yang Qi. Generally, using these two formulas aims to restore the Qi of Yin and Yang.

In Cold Damage or Wind Strike, if the physician erroneously applies purgation, the patient suffers diarrhea dozens of times a day with undigested food, borborygmus, epigastric fullness and hardness, dry heaving, irritability, and restlessness. Seeing the epigastric fullness, the physician purges again, worsening the fullness. This is not due to accumulated heat; rather, it is because of Spleen/Stomach deficiency and rebellious pathogenic Qi ascending, leading to hard stools. Gancao Xiexin Tang is indicated. (See detailed discussion on Diarrhea).

After Cold Damage sweating resolves the exterior syndrome, if there is disharmony in the Stomach, epigastric fullness and hardness, frequent belching with a smell of fermented food, fluid retention under the hypochondrium, borborygmus, and diarrhea, Shengjiang Xiexin Tang is indicated. (See detailed discussion on Fullness).

Cheng Wuji's Commentary: "Quansuo" (curling up) refers to the body curling inward without ability to extend. This indicates extreme Yin-Cold. Even if seen in Yang meridians, if exterior symptoms persist, warming meridian agents like Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) should be used. How much more so in Shaoyin disease with interior cold, diarrhea, and cold extremities? Formulas like Sini Tang (Frigid Extremities Decoction) cannot be omitted. Cases with Yin but no Yang are incurable.

In Shaoyin disease with diarrhea, if the diarrhea stops spontaneously, the patient feels aversion to cold and curls up, but hands and feet remain warm, it is treatable (some suggest Sini Tang or Zhenwu Tang). In Shaoyin disease with aversion to cold, curling up, frequent spontaneous irritability, and desire to remove clothing/bedding, it is treatable (The Manual of Experience suggests Xiaochaihu Tang, Minor Bupleurum Decoction). In Shaoyin disease with aversion to cold, curling up, diarrhea, and cold extremities, it is incurable. In Shaoyin Sini syndrome with aversion to cold, curling up, absent pulse, no irritability but only restlessness, death ensues.

Cheng Wuji's Commentary: "Jiuji" (cramping/tightness) refers to stiffness and difficulty in flexion and extension. Regardless of the meridian involved, such symptoms are caused by Yin-Cold, as Cold has the nature of contraction. Zhang Zhongjing’s methods indicate that even in Taiyang disease or Wind-Dampness intermingling causing spasms, formulas like Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) or Gancao Fuzi Tang (Licorice and Aconite Decoction) are prescribed. How much more so in Yin meridian interior diseases or Huoluan (cholera-like syndromes), where Sini Tang-type formulas are essential?

In Taiyang disease, excessive sweating leads to continuous leakage of sweat, aversion to wind, difficulty urinating, slight cramping of the four limbs making flexion and extension difficult. Guizhi Jia Fuzi Tang is indicated. (Formula see Self-Sweating). In Wind-Dampness intermingling causing severe joint pain, inability to flex/extend, sweating, shortness of breath, dysuria, aversion to wind, or mild edema, Gancao Fuzi Tang is indicated. (Formula see Body Pain). In Cold Damage with floating pulse, spontaneous sweating, frequent urination, irritability, slight aversion to cold, and cramping of the foot, Guizhi Jia Fuzi Tang should originally be used. Using Guizhi Tang to attack the exterior was an error. Instead, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be made to restore Yang. If effective and feet warm, Shaoyao Gancao Tang (Peony and Licorice Decoction) should be made to relax the foot. If heavy sweating occurs, fever persists, internal tightness, limb pain, diarrhea, cold extremities, and aversion to cold appear, Sini Tang is indicated. In Yi Jing (Exchange of Yin and Yang) disease, with heavy body, shortness of breath, lower abdominal urgency, and cramping of knees and shins, Shao Kun San (Burnt Underwear Powder) is indicated.

Wu’s Note: When Cold Damage follows massive sweating and exposure to wind, sweat flow is obstructed. Wind pathogen invades the collaterals due to deficiency, causing twitching and cramping of hands and feet, inability to flex/extend, and tendon tightness. Niubang Gen San (Arctium Root Powder) should be taken raw.
Niubang Gen San Formula:
Niubang Gen (Arctii Radix, 10 segments), Mahuang (Ephedrae Herba, roots and joints removed), Chuan Niuxi (Achyranthis Bidentatae Radix), Tian Nanxing (Arisaematis Rhizoma Preparatum) (each 6 qian). Finely chop the herbs, place in a stone mortar, add 1 sheng of good wine, grind finely. Prepare a pit in yellow earth, heat with half a sheng of charcoal until red-hot, remove fire, clean the pit, put the medicine mixture into the pit, burn with charcoal until black, take out, and grind into fine powder. Take 1 qian per dose, mixed with warm good wine, three times daily. Effective. Applying Baicao Gao (Hundred Herbs Ointment) externally is also beneficial.