Taiyang disease, on the second or third day, the patient cannot lie down but desires to sit up, there must be a knot in the epigastrium, and the pulse is faint and weak. This indicates that there is originally a cold component. If purgation is mistakenly applied and the diarrhea stops, it will inevitably lead to thoracic accumulation. If the diarrhea does not stop, purgation is repeated on the fourth day, resulting in diarrhea with fever.

Note: The character "之" in "四日復 purgation" should be "利". In the previous text, if the diarrhea has not stopped, how could there be a reason to repeat purgation? Careful consideration will reveal that this must be a transcription error.

bubble_chart Annotation

• Taiyang disease refers to stiffness and pain in the neck and head with aversion to cold.
• On the second or third day, if the patient cannot lie down but desires to sit up, it indicates that the disease has transmitted to the Yangming.
• The epigastrium is the region of the stomach; the knot indicates that there must be a knot in the stomach region.
• If the pulse is full and large, it indicates heat and a knot in the stomach region, and purgation should be applied. Now, the pulse is faint and weak, indicating cold and a knot in the stomach region, and purgation should not be applied. Applying purgation when it should not be applied is called mistaken purgation.
• On the second or third day, it is the right time to resolve the exterior of the Taiyang and Yangming. Mistaken purgation causes exterior heat to enter the interior due to deficiency, leading to spontaneous diarrhea. If the diarrhea stops by itself, it indicates that the patient has stomach excess and transforms into dryness, inevitably leading to thoracic accumulation. Now, if the diarrhea does not stop and continues on the fourth day, it indicates that the patient has stomach deficiency and transforms into dampness, thus inevitably leading to diarrhea with fever.

bubble_chart Collected Annotations

• Cheng Zhi said: "This is a case of exterior pattern mistakenly treated with purgation, leading to the transformation of thoracic accumulation and heat diarrhea. One must be cautious. Since the pulse is faint and weak, it indicates a cold knot in the epigastrium, and the method should be to warm and disperse. The physician saw the knot in the epigastrium and mistakenly applied purgation to cause diarrhea, which is a wrong treatment."
• Wang Hu said: "In Taiyang disease, on the second or third day, if the patient cannot lie down but desires to sit up, and there is heat accumulation in the epigastrium, it seems that purgation could be applied. However, the pulse is faint and weak, and the patient originally has a cold component. How could purgation be applied?"