A mild condition leads to coughing, and coughing results in the expulsion of phlegm. Purgation stops the coughing, but diarrhea persists. If diarrhea does not cease, it feels as if insects are gnawing in the chest. When porridge is consumed, it is immediately expelled. There is difficulty in urination, stiffness in both flanks, labored breathing, and the neck and back pull on each other. The arms become numb, and extreme cold paradoxically causes sweating. The body becomes as cold as ice, the eyes lose their clarity, and speech becomes incessant. Despite consuming a lot of food, this is a sign of "elimination of the middle." Although the mouth wishes to speak, the tongue cannot move forward.

bubble_chart Note

• Yang exuberance leads to phlegm, while yang deficiency leads to fluid retention. Coughing with a faint pulse indicates a cough due to yang deficiency, hence coughing results in the expulsion of phlegm and fluid.
• If the pulse is strong, purgation is appropriate. However, with a faint pulse, purgation exacerbates the cold and deficiency, so although the cough stops, diarrhea continues unabated.
• The sensation of insects gnawing in the chest is due to stomach cold causing the movement of parasites, hence porridge is expelled upon consumption.
• Diarrhea with vomiting indicates cold in the middle; difficulty in urination suggests retained fluids; stiffness in both flanks, labored breathing, the neck and back pulling on each other, and numbness in the arms are all signs of external cold and fluid retention.
• Compared to Shaoyin fluid retention, this condition lacks body pain, while the other lacks the pulling of the neck and back and numbness in the arms.
• If the cold is extreme, it paradoxically causes sweating, the body becomes as cold as ice, the eyes lose their clarity, speech becomes incessant, and death ensues.
• With such symptoms, consuming a lot of food indicates "elimination of the middle."
• Although the mouth wishes to speak, the tongue is short and difficult to extend, which is also a sign of death.

bubble_chart Collected Annotations

• Zhang Lu said: "Incorrect purgation leading to incessant diarrhea empties the stomach, and consuming a large amount of food in response is 'elimination of the middle.' Shaoyin deficiency with cold paradoxically causes cold sweat, leading to external collapse. Symptoms such as the mouth wishing to speak but the tongue being unable to move forward, and other fatal signs, all arise from incorrect purgation. The harm of incorrect purgation is thus."