(Confusion: Old medical texts erroneously included the symptom of "hands covering the heart" in this category, which has now been removed.)

Cheng Wuji's commentary: "Yu" (郁) refers to qi stagnation and inability to flow freely; "Mao" (冒) refers to mental confusion and lack of clarity, commonly known as coma. These conditions are caused by deficiency allowing cold pathogenic factors to invade. The *Neijing* states: "Various deficiency syndromes encountering cold will result in Jue (cold extremities), Mao (dizziness/confusion), and numbness." This is because cold pathogens invade upward when the body is weak. Luo Longji advocated treating this with Fuzi Tang (Aconite Decoction), doubling the dosage of Renshen (Ginseng), Chuanxiong (Sichuan Lovage Rhizome), Tianma (Gastrodia Rhizome), and Jiangtang (Dried Ginger). Furthermore, it is stated: In Taiyang disease (disease of the Taiyang channel), if purgation is used first without success, followed by sweating therapy, this leads to both exterior and interior deficiency. Consequently, the patient experiences Mao (dizziness/confusion). Patients with Mao who sweat will recover spontaneously, as this indicates the harmonization of the exterior. If sweating does not occur and the condition persists, Ren San Bai Tang (Three Whites Decoction with Ginseng) added with Chuanxiong and Tianma should be used; for those with lower jiao deficiency and a faint pulse, Fuzi (Aconite Root) is added to warm the Kidney channel, thereby consolidating the root. The *Neijing* says: "To nourish the shoots, one must solidify the roots; to chop the roots, the branches will wither." This principle applies here. The *Jingui Yaolue* states: Postpartum women suffer from three diseases: one is Jing (spasm), two is Mao (confusion), and three is difficult defecation. This is due to blood loss combined with sweating and excessive exposure to cold, leading to Mao. It also states: For postpartum Mao, the pulse is faint, there is an inability to eat, and hard stools, all resulting from blood deficiency causing Jue, which inevitably leads to Mao. Recovery from Mao requires profuse sweating. From this, we can understand that Mao belongs to deficiency-cold syndromes. Additionally, in Shaoyin disease (disease of the Shaoyin channel), if diarrhea stops but dizziness occurs and the patient frequently feels dizzy/faint, it is a death sign, indicating extreme deficiency and Yang collapse.

In Taiyang disease, if purgation is used first without success, followed by sweating, this leads to both exterior and interior deficiency. Consequently, the patient experiences Mao (dizziness/confusion). Patients with Mao who sweat will recover spontaneously. This is because sweating harmonizes the exterior. If the interior is not yet harmonized, then purgation may be used again.
(Cheng Wuji interpreted "Yu" as "Mao," which I believe is not sufficiently precise. According to *Shuowen Jiezi*, the character "Mao" consists of "Yue" (head covering) and "Mu" (eye). "Yue" refers to head coverings worn by children and barbarians. The "Mao" described here means something obscuring the eyes, implying coma. Interpreting "Mao" as "Yu" today not only loses the original etymological meaning but also contradicts the pathology and Zhang Zhongjing's intent. The phrase "Li Wei He" (Interior not harmonized) is sometimes corrupted; adding "Wei" without removing "De" violates textual logic. This is corrected according to the Song edition. Various conditions invaded by cold present with Jue (cold extremities), Mao (dizziness/confusion), numbness, oral rigidity/inability to speak, and shivering.)

When Taiyang and Shaoyang diseases occur simultaneously (Bing Bing), presenting with stiffness and pain in the head and neck, occasional dizziness and confusion, or sensations resembling Jie Xiong (chest binding) with hardness in the epigastrium, acupuncture at Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated. (See relevant sections for details on neck stiffness.)

In Yangming disease (disease of the Yangming channel), patients exhibit difficulty urinating, alternating difficulty and ease in defecation, occasional slight fever, wheezing, dizziness/confusion, and inability to lie flat. This indicates dry stool accumulation. Da Chengqi Tang (Major Order the Qi Decoction) is appropriate.

Shaoyin disease presents with somnolence. If diarrhea stops but dizziness occurs and the patient frequently feels dizzy/faint, it is a death sign.

Jueyin disease (disease of the Jueyin channel) presents with diarrhea containing undigested food, a deep and slow pulse, facial redness, slight body heat, and inevitable Mao (confusion) with sweating before resolution. (See relevant sections for details on diarrhea.)

After vomiting or purgation in Shanghan (Cold Damage), restlessness and a faint pulse occur. After eight or nine days, epigastric fullness and hardness, hypochondriac pain, Qi rushing to the throat, dizziness/confusion, and twitching of meridians occur. Prolonged persistence leads to Wei syndrome (flaccidity).

Haizang (Zhang Yuansu/Li Dongyuan school physician) states: When Shanghan transmits to the fifth or sixth day, it gradually changes into unconsciousness and muteness, or speaking alone in sleep, red eyes, cracked lips, dry tongue without desire to drink, ability to swallow thin gruel if offered but refusal otherwise, fine and rapid pulses without fullness, no epigastric blockage, no abdominal distension, and normal urination/defecation. Or after ten days, the appearance resembles drunkenness. Physicians seeing persistent unconsciousness often use Da Chengqi Tang for purgation, which is an error. This is because they do not realize the heat has transmitted to the Hand-Shaoyin Heart channel. However, they fail to identify its origin. The answer is: Originally, Taiyang channel Wind-Strike. Wind is a Yang pathogen damaging Wei (Defensive) Qi, causing Yin Blood to dry. Heat accumulates in the Bladder, and the pathogen reversely transmits to Bing Fire (Small Intestine/Pericardium level). Bing and Ding are like siblings, thus transmitting to the Heart channel. Heart Fire presses down and steams the Lung, causing unconsciousness. Since the Lung is a pure and descending organ, internal fire causes unconsciousness. Zhi Zi Huang Lian Huang Qin Tang (Gardenia, Coptis, and Scutellaria Decoction) is suitable. If the pulse indicates Bing (floating), Dao Chi San (Guide Out Red Powder) is used; if Ding (deep), 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. If the right Cun pulse is deep, slippery, and forceful, it may be used. Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) is also close to correct. The original text suggests substitening Shengma (Cimicifuga) for Xi Jiao (Rhinoceros Horn), which is a Yangming channel herb for clearing blood-level 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 taken together are appropriate. This syndrome involves Bladder transmitting to Bing, Foot channels transmitting to Hand channels (lower to upper); Bing to Ding (exterior to interior); Ren to Ding (Gen trigram to Li trigram). Transgressing channels involves Fu organs transmitting to Zang organs. *Huoren Shu* states Shanghan only transmits through Foot channels, not Hand channels; this statement is incomplete. Transmission from Foot to Hand channels does occur. How do we know? The classics state Shanghan may transmit to one channel or skip to three channels; it cannot be treated via a single route. Treatment depends on observing pulses and external signs—this is flexible practice. Swallowing food indicates the pathogen is not in the Stomach; refusal to eat is due to unconsciousness. Since the pathogenic heat is not in the interior, misusing Chengqi formulas for purgation will certainly lead to death. (Pulse in Bing refers to floating; Pulse in Ding refers to deep; Pulse in both Bing and Ding with heat refers to forceful floating and deep pulses.)

Yu Yunqu, a Grand Secretary, had a robust constitution and hearty appetite. In the summer of June in the Xinmao year, he suffered from a febrile disease. His limbs were not very hot, but he intermittently threw his limbs about in a restless manner, was confused and unaware of his surroundings, occasionally spoke incomprehensible words but not delirious speech. His pulse was faint and thin, nearly absent. Some argued it was a Yin syndrome requiring warming; others argued for purgation. My colleague Lu Kui said, "You previously advised Zeng Zhizhai and Feng Zhuo'an, both Grand Secretaries, and they deferred to you." I said, "This is a Yang syndrome presenting with Yin pulses, which is technically incurable." However, given his natural constitution and the intense summer heat externally scorching him, plus internal inflammation from alcohol and moxibustion, he should have had high fever and a full, rapid, forceful pulse. Why was it so? Was it due to constrained heat unable to extend? Moreover, he had not defecated for seven days. I tentatively used Da Chaihu Tang (Major Bupleurum Decoction) for purgation, using only two qian of Dahuang (Rhubarb), decocted thoroughly. Imperial Physician Wang Leian strongly argued this was insufficient and suggested Da Chengqi Tang instead. I replied, "With such pulses and symptoms, harsh purgation is inappropriate. Wait until Da Chaihu Tang fails, then use Tiao Wei Chengqi Tang (Regulate the Stomach Order the Qi Decoction); if that fails, then Xiao Chengqi Tang (Minor Order the Qi Decoction), and finally Da Chengqi Tang." After taking the medicine, defecation occurred, the pulse became palpable, and hands and feet warmed. I told Leian, "Had we used Da Chengqi Tang, would we not regret it later?" Subsequently, several doses of Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) cured him. In early July, Lu and I went to Nanjing to supervise examinations, and the illness did not recur. The following year, upon retiring, I read Liu Hejian's *Shanghan Zhige*. It states: "Severe internal heat accumulation requires rapid pulses; extreme heat obstructs pulse vessels, paradoxically causing deep, faint, nearly absent pulses." Laypeople misunderstand this mechanism, mistaking it for extreme cold/Yin toxicity. Some present with sudden severe Yang heat initially; some with simultaneous severe heat transmission should generally receive detoxification plus Da Chengqi Tang. If heat subsides slightly but persists after purgation, Huanglian Jiedu Tang regulates it; if slight heat remains, Liang Ge San regulates it. If failure to purge leads to extreme heat, cold body, faint pulse, and impending coma/death, urgent purgation causes sudden destruction of residual Yin due to exhausted Yang. Not purging also leads to death. One should use Liang Ge San or Huanglian Jiedu Tang to nourish Yin, retreat Yang, and gradually dissipate accumulated heat, restoring warmth to the chest and pulse generation. Sighing at the book, I thought, "The ancients anticipated my thoughts!" Yu Taishi's condition was exactly that of extreme heat from delayed purgation, leading to 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.