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(Confusion: In older texts, the symptom of "crossing hands over the heart" was incorrectly included here; it has now been removed.)

Cheng Wuji's Commentary: "Yu" (郁) refers to qi stagnation and inability to flow freely; "Mao" (冒) refers to mental cloudiness and lack of clarity, commonly known as coma. These conditions are caused by deficiency allowing cold pathogenic factors to invade. The *Neijing* states: "Various deficiencies encountering cold result in Jue (cold extremities/reversal)." Qi stagnation, mental cloudiness, and numbness are all due to cold qi invading the upper body while the interior is deficient. Luo Longji advocated using Fuzi Tang (Aconite Decoction), doubling the dosage of Renshen (Ginseng), and adding Chuanxiong (Sichuan Lovage Rhizome), Tianma (Gastrodia Rhizome), and Ganjiang (Dried Ginger). Furthermore, it is stated: In Taiyang disease, if purgation is used first without resolution, followed by sweating, this results in both exterior and interior deficiency. Consequently, the patient experiences Mao (dizziness/cloudiness). Patients with Mao will recover spontaneously upon sweating, because the exterior harmonizes. If sweating does not occur, the condition persists; Ren Shen San Bai Tang (Ginseng Three Whites Decoction) added with Chuanxiong and Tianma may be used. For those with lower jiao deficiency and a faint pulse, Fuzi (Aconite Root) should be added to warm the Kidney channel, which consolidates the root. The *Neijing* says: "To nourish the shoots, one must solidify the root; to chop the roots, the branches will wither." This is what is meant. The *Jin Gui Yao Lue* states: New postpartum women suffer from three diseases: one is Jing (spasm), two is Yu Mao (depression and cloudiness), and three is difficult defecation. After blood loss and sweating, with excessive cold exposure, Yu Mao occurs. It also states: Postpartum women with Yu Mao have a faint pulse, cannot eat, and have hard stools; this is due to blood deficiency leading to Jue, and Jue inevitably leads to Mao. Recovery from Mao requires profuse sweating. From this, we know that Yu Mao belongs to deficiency-cold patterns. Additionally, in Shaoyin disease, if diarrhea stops but dizziness occurs, accompanied by frequent episodes of cloudiness, it is a death sign, indicating extreme deficiency and collapse.

Taiyang Disease: Purgation was used first without resolution, followed by sweating, resulting in exterior and interior deficiency, causing the patient to experience Mao. Patients with Mao recover when they sweat, because sweating harmonizes the exterior. If the interior is not harmonized, purgation may be applied subsequently.
(Note: Cheng Wuji interpreted 'Yu' as 'Mao', which is considered insufficiently precise. According to *Shuowen Jiezi*, 'Mao' consists of 'Yue' (head covering) and 'Mu' (eye). Here, 'Zhi Mao' implies something obscuring the eyes, meaning coma. Interpreting 'Mao' merely as 'Yu' loses the etymological origin, the clinical reality, and Zhang Zhongjing's intent. The phrase 'Li Wei He' (interior not harmonized) might be textual corruption for 'De Li He' or similar; corrected here according to Song editions.) Various conditions involving cold invasion result in Jue, Qi Stagnation, Mao, numbness, oral rigidity, inability to speak, and shivering.

Taiyang and Shaoyang Bingbing (Combined Disease): Stiffness and pain in the head and neck, or dizziness and cloudiness, sometimes feeling like Jie Xiong (chest binding) with hardness below the heart. Acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated. (See section on Neck Stiffness for details.)

Yangming Disease: Difficulty in urination, alternating difficulty and ease in defecation, occasional slight fever, panting, Mao (cloudiness/dizziness), and inability to lie down indicate dry stool accumulation. Da Chengqi Tang (Major Order the Qi Decoction) is appropriate.

Shaoyin Disease: Desire to sleep, cessation of diarrhea followed by dizziness and frequent episodes of cloudiness indicates a fatal prognosis.

Jueyin Disease: Diarrhea with undigested food, deep and slow pulse, red face, slight body heat, followed by Qi stagnation, cloudiness, and sweating indicates recovery. (See section on Diarrhea for details.)

After vomiting or purgation in Shanghan, restlessness with a faint pulse occurs. After eight or nine days, epigastric hardness, hypochondriac pain, qi rushing to the throat, dizziness, cloudiness, and twitching of meridians may lead to Wei syndrome (flaccidity) if prolonged.

Haizang (School of Zhang Yuansu/Li Dongyuan): When Shanghan transmits to the 5th or 6th day, it gradually changes into unconsciousness and aphasia, or muttering in sleep, red eyes, cracked lips, dry tongue without desire to drink. Porridge is swallowed if offered, but refused otherwise. The six pulses are fine and rapid, not surging. There is no epigastric fullness or abdominal distension, and urination/defecation are normal. By the 10th day, the appearance resembles drunkenness. Physicians often use Da Chengqi Tang for persistent unconsciousness, which is an error. This is because the heat has transmitted to the Hand-Shaoyin Heart Channel. However, its origin is unknown. Answer: Originally, Taiyang channel suffered wind attack. Wind is a yang pathogen damaging Wei qi, causing yin blood to dry. Heat accumulates in the Bladder. Ren water pathology reverses to transmit to Bing fire (Small Intestine). Bing and Ding are siblings, transmitting to the Heart. Heart fire presses down and steams the Lung, causing unconsciousness. Since the Lung is a clear and descending organ, internal fire causes cloudiness. Zhi Zi Huang Lian Huang Qin Tang (Gardenia, Coptis, and Scutellaria Decoction) is suitable. If the pulse indicates Bing (Small Intestine), Dao Chi San (Guide Out Red Powder) is used; if Ding (Heart), Xie Xin Tang (Drain the Epigastrium Decoction) is used. Misusing Liang Ge San (Cool the Terrace Powder), which acts on qi-level blood, is incorrect unless the right cun pulse is deep, slippery, and forceful. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is also close to correct. If Xi Jiao is unavailable, Sheng Ma (Cimicifuga Rhizome) can substitute, which is a Yangming channel herb clearing blood-heat. If floating and deep pulses are both forceful, indicating heat in both Bing and Ding, half doses of Dao Chi San and Xie Xin Tang together are appropriate. This transmission from Bladder to Bing involves Foot channels transmitting to Hand channels (lower to upper); Bing to Ding is exterior to interior; Ren to Ding is Gen trigram to Li trigram. Yue Jing Chuan (skipping channels) involves Fu organs transmitting to Zang organs. *Huo Ren Shu* claims Shanghan only transmits through Foot channels, not Hand channels, which is incomplete. Transmission from Foot to Hand channels does occur. As stated in the classics, Shanghan may transmit to one channel or skip to three; treatment must not be rigid but based on pulse and symptoms. Swallowing food indicates the pathogen is not in the Stomach; refusal indicates unconsciousness. If heat is not in the interior, using Chengqi decoctions for purgation leads to death. (Note: Pulse in Bing means floating; Pulse in Ding means deep; Pulse in both Bing and Ding with heat means both floating and deep pulses are forceful.)

Yu Yunqu, Grand Secretary: Possessed robust constitution and hearty appetite. In the summer of June in the Xinmao year, he contracted febrile disease. His limbs were not very hot, but he intermittently threw his limbs about as if restless. He was confused, unaware of his surroundings, occasionally uttering unintelligible words, but not delirious. His pulse was faint and thin, nearly imperceptible. Some suggested Yin pattern requiring warming; others suggested purgation. Lu Kui, his examiner, said: "You decided cases for Zeng Zhizhai and Feng Zhuo'an." I replied: "This is a Yang disease presenting with Yin pulse, which is untreatable by standard rules. However, given his constitution and the extreme summer heat externalizing, plus internal inflammation from wine and moxa, the pulse should be surging and rapid. Why is it so? Perhaps heat is constrained and unable to extend? Also, he has not had a bowel movement for seven days." I tentatively prescribed Da Chaihu Tang (Minor Bupleurum Decoction) for purgation, using only 2 qian of Dahuang (Rhubarb), well-decocted. Imperial Physician Wang Leian strongly argued against this, suggesting Da Chengqi Tang instead. I said: "With such pulse and signs, harsh purgation is inappropriate. Wait until Da Chaihu Tang fails, then try Tiao Wei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction); if that fails, Xiao Chengqi Tang (Minor Order the Qi Decoction); finally Da Chengqi Tang would not be too late." After medication, bowel movement occurred, pulse returned, and limbs warmed. I told Leian: "Had we used Da Chengqi Tang, would you not regret it?" Subsequently, several doses of Huang Lian Jie Du Tang (Coptis Decoction for Resolving Toxicity) cured him. In early July, I took the examination in Nanjing with Mr. Lu, and the illness did not recur. The following year, upon returning home, I read Liu Hejian's *Shanghan Zhi Ge*. It states: "Internal accumulation of severe heat requires rapid pulses; due to extreme heat obstructing the vessels, the pulse may become deep, fine, and nearly absent." Laypeople misunderstand this, thinking it is cold-toxic transmission. Some present with sudden severe heat initially; some with double-infection severe heat should use detoxification plus Da Chengqi Tang. If heat subsides slightly after purgation but remains, use Huang Lian Jie Du Tang. If slight heat remains, use Liang Ge San. If purgation was missed, leading to extreme heat, cold body, faint pulse, and impending coma/death, immediate purgation would cause sudden collapse of residual yin due to exhaustion of yang. Not purging also leads to death. Use Liang Ge San or Huang Lian Jie Du Tang to nourish yin, retreat yang, and gradually dissipate accumulated heat, warming the chest and restoring the pulse. I sighed: "The ancients anticipated my thoughts!" Yu Taishi suffered exactly from missed purgation leading to extreme heat, cold body, faint pulse, and coma. Life and death hung in the balance between purging and not purging, severely or mildly. Alas, how careful one must be! I record this as a warning for the world.