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Guo Yong stated: Yin-toxin (Yin Du) and Yang-toxin (Yang Du) in Shanghan disease are among the most severe conditions. Zhang Zhongjing had formulated two decoctions involving Shengma and Gancao, yet they are now absent from Zhang's extant works. Only the *Mai Jing* (Pulse Classic) records two chapters on their differentiation, and the *Qianjin Fang* mentions them briefly. Examining the modifications of these two decoctions reveals similarities and differences with Zhang Zhongjing's original intent. The *Jingui Yaolue* combines Yin-toxin and Yang-toxin into one section, stating: "For both Yin-toxin and Yang-toxin, Shengma Biejia Tang (Cinnamon Twig and Turtle Shell Decoction) is the primary treatment." Previous medical texts do not support this assertion. However, these two diseases are as opposite as ice and charcoal, and their treatments are diametrically opposed. Although various texts mention the two Shengma-Gancao decoctions with identical ingredients, they differ from the *Yaolue*. Thus, doubts arise. Only the two formulas in the *Huo Ren Shu* (Book that Saves Lives), which use different medications, seem most reasonable. However, the source of the Shengma Tang in the *Huo Ren Shu* is not cited; it is presumed that Zhu Shi (Zhu Gong) must have had a basis for this. I now adopt the two herbs from the *Huo Ren Shu*. (Shi Ruo noted: These two formulas are recorded in the *Waitai Miyao*, claiming origin from the *Gujin Luyan Fang*.)

Wang Shuhe's *Mai Jing* states: Yang-toxin manifests as heaviness of the body, pain in the lower back and back, restlessness and discomfort, delirious speech, running about, hallucinations of seeing ghosts, hematemesis, or diarrhea. The pulse is floating, large, and rapid. The face is red with mottled patterns like brocade. There is sore throat and expectoration of pus and blood. It is treatable within five days but incurable after seven days. Some cases of Shanghan transform into Yang-toxin within one or two days, or following emetic or purgative treatments. Shengma Tang is indicated. Pang Shi added that Gegen Longdan Tang (Pueraria Root and Gentiana Decoction) is also suitable. Guo Yong remarked: This disease occurs frequently; without proper treatment, patients often die from massive hematemesis and hematochezia. Even when using yin-nourishing and heat-clearing herbs, detoxifying agents must be included for the prescription to be effective.

The *Huo Ren Shu* states: In Yang-toxin disease, yang qi alone is hyperactive while yin qi suddenly fails. This inevitably leads to agitation, delirium, and aimless running. The face is red with brocade-like mottling, there is sore throat, or passage of yellow-red stool. The pulse is surging, full, slippery, and hurried. Sour and bitter herbs should be used to restore yin qi and resolve the condition through profuse sweating. Options include Tingli Kujiu Tang (Descurainia Seed and Vinegar Decoction), Shengma Tang, Dahuang San (Rhubarb Powder), Zhizi Ren Tang (Gardenia Seed Decoction), and Heinu Wan (Black Slave Pill). One may select an appropriate formula. Guo Yong commented: For simultaneous exterior and interior excess-heat syndromes, Heinu Wan is suitable. If it is confirmed that the heat resides in the interior rather than the exterior, purge using Poxiao (Mirabilite), Dahuang (Rhubarb), and Taoren (Peach Kernel). Among these, Shengma should be administered in larger doses. Yang-toxin arises violently, unlike Yin-toxin. (Original text missing here) Lei Shi Qiangren. (Original text missing here) And for children, it is advisable to use Shengma Tang prophylactically to prevent toxicity.

Furthermore, it is said: In recent times, treating Shanghan with a surging pulse, internal and external knotted heat, curled and scorched-black tongue, and nostrils resembling soot involves wetting a cloth with water, layering several cloths, soaking them in fresh water, wringing out slightly, and applying to the chest. When the cloth warms up from evaporation, re-soak it in cold water and apply again. Change to fresh water dozens of times a day. For severe heat, immerse the patient in water until the heat subsides. This is also a good method.

Guo Yong stated: Immersing a person in water is a measure of last resort. Although usable, it is difficult to implement. It is only feasible if internal heat has slightly abated but the condition persists. Otherwise, the water may force external heat inward, leading to collapse. Generally, mania due to yang deficiency differs from the "xia zheng" (syndromes requiring purgation) in Shanghan. The latter presents merely with restlessness in sitting or lying down; Yang-toxin involves an urge to rise and run, accompanied by strength that others cannot restrain, even jumping into rivers. Occasionally, such patients may survive, but this is not a standard approach. Guo Yong added: In Lingnan, heat zhang (malaria-like fever) is treated by crushing earthworms and drinking the clear juice obtained by soaking them in fresh cold water. I have not tried this. It is said that Otter Liver (Tagan) treats heat but not cold. I once suffered from post-illness tidal fever and found that taking a small amount of Otter Liver powder mixed with cold water stopped it. However, I have never used it for high fever. I record this casually for future reference.