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Attack with purgation. In Section 36, it is mentioned that one wishes to use Da Cheng Qi Tang (Major Order the Qi Decoction), so here Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is used as a test. The principles are interconnected; detailed explanations can be found in the *Qian Zhu* (Light Annotations). If the stool is hard, but suddenly the frequency of urination decreases, this indicates that body fluids should return to the stomach, and the stool will naturally pass soon; no purgation is necessary. Detailed explanations can be found in Section 25; one should savor this carefully. Section 39 states that sweating and delirious speech occur because dry feces are in the stomach, which is due to Wind pathogen. One may only purge after the disease has passed through its stages. If purged too early, speech will surely become chaotic. This is nothing but earnest admonition against light-minded or premature purgation. Tao Jie'an said: "Only when all five conditions—fullness (Pi), distension (Man), dryness (Zao), excess (Shi), and hardness (Jian)—are present can [Da Cheng Qi Tang] be used." Although this statement is not entirely refined, it serves as a warning needle for the rash. However, the three urgent purgation cases in the *Lun* do not fall under these five syndromes. Section 70 says: "In Cold Damage after six or seven days, if the eyes cannot see clearly and the pupils are unresponsive, without exterior or interior syndromes, with difficult defecation but no interior excess syndrome (meaning the stool is not hard, only felt to be difficult), and with slight fever (without exterior syndrome, so there is no high fever, only slight fever), this is an Excess syndrome. Urgent purgation is required; Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate." This refers to the vigorous heat qi moving upward into the orifices. Section 71 says: "Yangming Disease, with fever and profuse sweating, requires urgent purgation." There is only fever and sweating, without dryness, thirst, hardness, or excess syndromes, yet urgent purgation is still indicated; this undoubtedly involves the vigorous qi. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate. This refers to vigorous heat qi moving inward and outward, forcing body fluids to escape externally. Section 72 says: "After sweating, the disease does not resolve, and abdominal fullness and pain occur; urgent purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate." This refers to vigorous heat qi not moving upward to the orifices, but descending along the navel and abdomen. Outside of these three cases, although there is no explicit text on urgent purgation, there are situations where delay is inadvisable. Section 73 says: "Abdominal fullness that does not decrease, even if slightly reduced, is negligible; purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate." This refers to formless vigorous qi of Yangming gathering from the epigastrium into the tangible chest and abdomen, which differs from the original qi of Yangming. Generally, at the onset of this syndrome, the disease is often not severe, and patients and physicians often pay little attention. If treated by those who have read Xue Lizhai, Zhang Jingyue, and old village scholars who have extensively studied the Eight Masters, death is certain. This syndrome in the Yangming Chapter is very difficult to treat; other symptoms can be treated according to the methods in this chapter, making it easy. Those who read well should understand this themselves; it cannot be fully exhausted by pen and paper.

A disciple asked: "Contemporary scholar Ke Yunbo states that Yangming exterior syndrome presents with body heat, spontaneous sweating, aversion to cold being absent and aversion to heat appearing, because internal heat emits outward. One should use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce vomiting according to the trend. Later generations fail to recognize Yangming exterior syndrome; they dare not use Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang (Cinnamon Twig Decoction), nor do they know to use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). They wait until the heat is deep and extreme before administering Bai Hu Tang (White Tiger Decoction) or Cheng Qi Tangs. This shows ignorance of Zhongjing's initial method for treating Yangming, thereby abandoning Zhongjing's vomiting method. His theory is quite advanced; what does your lord think?" I replied: "Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) treats syndromes such as vexation, mental restlessness (Ao Nao), and insomnia. It is an essential medicine for early-stage Yangming syndromes that have not yet become solid. Used skillfully, it yields versatile benefits. However, saying 'induce vomiting according to the trend' follows previous errors and loses the original intent of the formula. Moreover, transferring Gua Di San (Melon Tip Powder) for inducing vomiting into the Yangming Chapter is even more erroneous. He proposed 'upper dispersing, middle clearing, lower purging' as the three major methods for treating Yangming. Let me ask: Does the Yangming Chapter ever contain clauses on inducing vomiting?" The disciple asked again: "Is it true that sweating and promoting urination are great taboos in Yangming?" I replied: "This is correct theory, but one must not be dogmatic. Sections 52 and 53 explicitly mention Ma Huang Tang (Ephedra Decoction) and Gui Zhi Tang (Cinnamon Twig Decoction). Furthermore, in Section 58, Gui Zhi Tang (Cinnamon Twig Decoction) and Da Cheng Qi Tang (Major Order the Qi Decoction) stand as exterior and interior counterparts: if the pulse is solid, purgation is suitable; if floating and deficient, sweating is suitable. Section 62 states: 'If the patient does not fear cold but feels thirsty, this has transferred to Yangming.' If urination is frequent, the stool will surely be hard. Even if ten days pass without defecation, there is no distress. If thirsty and desiring water, give small amounts, and rescue according to the method. For thirst, Wu Ling San (Five-Ingredient Powder with Poria) is appropriate. The meaning is that since there is no distress after ten days, Da Cheng Qi Tang (Major Order the Qi Decoction) is contraindicated, and drinking several liters of water is unlikely. Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is also unsuitable. Only Wu Ling San (Five-Ingredient Powder with Poria) helps the spleen qi transform and transport; drinking warm water induces sweating, thus relaxing both interior and exterior. Reading this reveals that prohibiting sweating is the standard treatment, while sweating is originally intended to remove heat and preserve body fluids, serving as an expedient method. Section 43 states: 'If the pulse is floating, there is fever, thirst, and difficulty in urination, Zhu Ling Tang (Polyporus Decoction) governs.' The meaning is that promoting uritation contains the principle of nourishing yin, adhering to Yangming treatment methods. However, the latter half adds: 'In Yangming Disease, if sweating is profuse and there is thirst, Zhu Ling Tang (Polyporus Decoction) must not be given, because profuse sweating causes dryness in the stomach, and Zhu Ling Tang (Polyporus Decoction) would further promote urination.' Reading this, we know that promoting urination is originally intended to clear fire and preserve body fluids, representing a skillful expedient use. It may be used if sweating is not profuse, but not if sweating is profuse. Since sweat and urine share the same source but have different destinations, among expedients, the standard treatment remains paramount."