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[Chapter on Yangming Disease]

Fu-Bing Lian-Jing (Disease of the Fu Organ involving the Meridian): The patient experiences irritability, fever, and sweating, after which symptoms resolve. Or it manifests like malaria with fever occurring at Rib-Shu hours (3-5 PM). This belongs to Yangming disease. If the pulse is excess, purgation is indicated; if the pulse is floating and deficient, diaphoresis is indicated. For purgation, use Da Cheng Qi Tang (Major Order the Qi Decoction); for diaphoresis, use Gui Zhi Tang (Cinnamon Twig Decoction).

Yangming disease with a slow pulse, profuse sweating, and slight aversion to cold indicates that the exterior syndrome has not yet resolved; diaphoresis may be used (Gui Zhi Tang pattern). Yangming disease with a floating pulse, no sweating, and wheezing will resolve with diaphoresis (Ma Huang Tang pattern). In combined Taiyang and Yangming disease presenting with wheezing and chest fullness, purgation is contraindicated (Ma Huang Tang pattern). In Taiyang disease, stiffness and discomfort in the nape and back with sweating and aversion to wind are treated with Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root). In Taiyang disease, stiffness and discomfort in the nape and back without sweating and with aversion to wind are treated with Ge Gen Tang (Kudzu Root Decoction). In combined Taiyang and Yangming disease with spontaneous diarrhea, Ge Gen Tang is used. In combined Taiyang and Yangming disease without diarrhea but with vomiting, Ge Gen Jia Ban Xia Tang (Kudzu Root Decoction plus Pinellia) is used.

Fu-Bing (Disease of the Fu Organ): The general principle of Yangming disease is "Wei Jia Shi" (Excess in the Stomach and Intestines). After three days of Shang Han (Cold Damage), the pulse becomes large, the body is hot, there is spontaneous sweating, no aversion to cold, but rather aversion to heat; this is the external manifestation of Yangming disease. Some patients on the first day do not have fever but have aversion to cold. Why? It is said that although there is aversion to cold on the first day, it will cease spontaneously, followed by spontaneous sweating and aversion to heat. Why does the aversion to cold cease? Because Yangming resides in the center and belongs to Earth, the pathogen does not transmit further. Although there is initial aversion to cold, it stops by the second day; this is also an external manifestation of Yangming disease. Shang Han with fever, no sweating, vomiting, inability to eat, yet with sweating and continuous sweating on the forehead is an external manifestation of Yangming disease. Shang Han with a floating and slack pulse, warm hands and feet naturally, indicates the disease is related to Taiyin; jaundice should develop. If urination is normal, jaundice will not develop. By the seventh or eighth day, if the stool becomes hard, it has transferred to Yangming; the patient will have slight sweating on the forehead, which is also an external manifestation of Yangming disease.

Taiyang-Yangming disease refers to Pi Yue (Spleen Constraint); Zheng Yang Yangming disease refers to Wei Jia Shi (Stomach Excess); Shao Yang-Yangming disease refers to dryness in the stomach, irritability, and difficulty defecating after sweating or promoting urination; these are origins of Yangming disease. In Taiyang disease, if sweating, purgation, or promoting urination depletes fluids, causing dryness in the stomach and transfer to Yangming, manifesting as infrequent bowel movements, internal excess, and difficulty defecating, this is an origin of Yangming disease. If initial treatment of Taiyang disease involves insufficient sweating, leading to transfer to Yangming, this is an origin of Yangming disease. In Bing Yang (Combined Taiyang and Yangming) disease, if initial sweating is insufficient, leading to transfer to Yangming with continued slight sweating and no aversion to cold: if the Taiyang syndrome persists, purgation is contraindicated as it is adverse; mild diaphoresis may be used. Persistent redness of the face indicates Yang Qi stagnation in the exterior; resolution via fumigation is appropriate. If sweating is insufficient and Yang Qi cannot disperse, the patient becomes irritable, unable to locate pain, sometimes in the abdomen, sometimes in the limbs, with shortness of breath requiring sitting; this is due to insufficient sweating. Re-sweating will cure it. How to know sweating was insufficient? A choppy pulse indicates this. If Taiyang disease persists after three days of sweating with steaming fever, it belongs to the Stomach; Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) is indicated. In Bing Yang disease, if Taiyang syndrome resolves but tidal fever, continuous sweating on hands and feet, difficulty defecating, and delirium occur, purgation cures it; Da Cheng Qi Tang is indicated.

In Yangming disease, a slow pulse with sweating but no aversion to cold indicates heavy body, shortness of breath, abdominal fullness, and wheezing. With tidal fever, the exterior is resolving, and interior attack is possible. Continuous sweating on hands and feet indicates hardened stool; Da Cheng Qi Tang is the main formula. If there is profuse sweating, slight fever, and aversion to cold, the exterior is unresolved; if fever is not tidal, Cheng Qi Tang formulas are contraindicated. If abdominal fullness and obstruction are severe, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be used to mildly harmonize Stomach Qi. If Yangming disease follows emesis, purgation, or sweating with slight irritability and frequent urination leading to hard stool, Xiao Cheng Qi Tang is indicated. If Yangming disease presents with irritability without prior emesis or purgation, Tiao Wei Cheng Qi Tang is indicated. If Yangming disease originally had sweating but heavy sweating was applied, leaving slight irritability and unclear mental state, the stool must be hard due to fluid depletion and stomach dryness. Check urination frequency; if it decreases from 3-4 times to 2 times daily, stool will pass soon as fluids return to the stomach; this is a pattern of fluid depletion causing hardness.

If Yangming disease has spontaneous sweating or sweating followed by free urination, fluids are internally exhausted. Even if stool is hard, purgation is contraindicated; wait for the urge to defecate and use Mi Jian Dao (Honey Suppository). Tu Gua Gen (Trichosanthes Kirilowii Root) and Da Zhu Dan Zhi (Large Pig Bile) can also be used as suppositories. At the Yuyang pulse, floating and choppy: floating indicates strong Stomach Qi, choppy indicates frequent urination; their interaction causes difficulty defecating, known as Pi Yue (Spleen Constraint); Ma Ren Wan (Hemp Seed Pill) is indicated.

On the second or third day, with a weak pulse, no Taiyang or Shao Yang symptoms, irritability, and epigastric hardness: by the fourth or fifth day, if the patient can eat, give a small amount of Xiao Cheng Qi Tang to harmonize slightly. By the sixth day, give one sheng of Cheng Qi Tang. If no bowel movement for six or seven days and urine is scanty, even if unable to eat, the initial stool may be hard but later loose; do not purge until urine flows freely and stool is definitely hard; Da Cheng Qi Tang is suitable. In Yangming disease with tidal fever and slightly hard stool, Da Cheng Qi Tang may be given; if not hard, do not give. If no bowel movement for six or seven days and suspicion of dried feces exists, give a small amount of Cheng Qi Tang. If flatus occurs, purgation is indicated; if not, initial hardness followed by looseness will result in bloating and anorexia upon purging. Giving water to a thirsty patient may cause hiccups. Subsequent fever indicates hard, scanty stool; harmonize with Xiao Cheng Qi Tang.

In Yangming disease with delirium and tidal fever, a slippery and rapid pulse indicates Xiao Cheng Qi Tang. Give one sheng; if flatus occurs, give another sheng. If no flatus, do not give again. If no bowel movement the next day and the pulse becomes faint and choppy, indicating interior deficiency, it is difficult to treat; do not give Cheng Qi Tang again.

After emesis and purgation in Shang Han, if unresolved with no bowel movement for five to ten days, tidal fever at Rib-Shu hours, no aversion to cold, talking alone as if seeing ghosts, confusion, picking at clothes, fearfulness, slight wheezing, and fixed gaze: a wiry pulse indicates survival; slight delirium only indicates Da Cheng Qi Tang. If one dose relieves, stop subsequent doses.

In Shang Han on the fourth or fifth day, a deep pulse with wheezing and fullness indicates interior pathology. Incorrect sweating causes fluid loss and hard stool, leading to exterior deficiency and interior excess, eventually causing delirium. Sweating with delirium indicates dried feces in the Stomach due to Wind. Purge only after the meridian cycle passes; premature purgation causes speech disorder due to exterior deficiency and interior excess.

After thirteen days of unresolved Shang Han with delirium, heat requires purgation. If urination is free, stool should be hard; if diarrhea occurs but the Stomach pulse is harmonious, it indicates incorrect pill-based purgation by the physician. If spontaneous diarrhea occurs with a normally harmonious pulse (instead of faint/cold), it indicates interior excess; Tiao Wei Cheng Qi Tang is indicated.

In Yangming disease, post-purgation irritability with dried feces in the Stomach allows purgation; if abdominal fullness is slight and stool is initially hard then loose, purgation is contraindicated. In Yangming disease with delirium, tidal fever, and inability to eat, dried feces are present; Da Cheng Qi Tang is indicated. If able to eat, only stool is hard. Urinary difficulty with alternating hard/loose stool, slight fever, wheezing, dizziness, and inability to lie down indicates dried feces. No bowel movement for five to six days with periumbilical pain, irritability, and periodic onset indicates dried feces. After severe purgation, if no bowel movement for six to seven days with persistent irritability and abdominal fullness/pain, this indicates dried feces and retained food.

In combined Yangming and Shaoyang disease with diarrhea, a non-deficient pulse is favorable; a deficient pulse indicates failure and mutual overcoming. A slippery and rapid pulse indicates retained food requiring purgation; Da Cheng Qi Tang is indicated. In combined San Yang disease, a floating-large pulse at Guan position, somnolence, and sweating upon closing eyes are noted.

A superficial pulse with slight sweating indicates harmony; excessive sweating indicates excess. A solid superficial pulse with excessive sweating leads to interior Yang exhaustion and fluid depletion, causing hard stool. A floating and knotted pulse indicates Yang-Yin interaction generating Stomach heat and interior Yang exhaustion. Unresolved sweating with abdominal fullness/pain requires urgent purgation. Yangming disease with fever and profuse sweating requires urgent purgation. Shang Han on the sixth or seventh day with unclear vision, incoherent eyes, no exterior-interior syndrome, difficulty defecating, and slight fever indicates excess requiring urgent purgation.

Yangming disease with forgetfulness indicates blood stasis; stool may be hard but passage is easy with black color; purgation with Di Dang Tang (Resist the Pill) is indicated. Patients with no exterior-interior syndrome, fever for seven to eight days, floating-rapid pulse, may be purged. If pulse remains rapid after purgation with heat combining to cause hunger, and no bowel movement for seven to eight days with blood stasis, Di Dang Tang is indicated. If pulse remains rapid with unceasing diarrhea, heat combines with pus in stool.

In Yangming disease, bleeding and delirium indicate Heat entering the Blood Chamber; sweating only on the head requires puncturing Qi Men (LR14) to drain heat. Yangming disease resolves between Shen and Xu hours (3-7 PM).

[Deficiency Patterns]

In Yangming disease, ability to eat indicates Wind Strike; inability to eat indicates Cold Strike. If Cold Strike prevents eating, with urinary difficulty and sweating on hands/feet, Gu Jia (Solid Mass) may form with hard-then-loose stool due to cold water in the Stomach. A floating-slow pulse with exterior heat and interior cold, with clear undigested food in diarrhea, requires Si Ni Tang (Frigid Extremities Decoction). If Stomach deficiency-cold prevents eating, drinking water causes hiccups. In Yangming disease, attacking heat when unable to eat causes hiccups due to Stomach deficiency-cold. After severe emesis/purgation in Shang Han, extreme deficiency with excessive sweating and subsequent water-induced sweating causes hiccups due to Stomach cold. Hiccups with abdominal fullness require checking anterior/posterior obstructions and relieving them. Yangming disease with lack of sweating and sensation of insects crawling on skin indicates long-term deficiency. Lack of sweating with free urination, cough, vomiting, and cold extremities within two to three days causes headache; absence of these symptoms means no headache. Yangming disease with vertigo, no aversion to cold, ability to eat, and cough causes sore throat; absence of cough means no sore throat. Desire to vomit after eating belongs to Yangming; Wu Zhu Yu Tang (Evodia Decoction) is indicated. Worsening after taking the decoction indicates Upper Jiao pathology. In Shang Han, frequent vomiting contraindicates purgation even with Yangming symptoms.

In Taiyang disease with Cun-Huan, Guan-Fu, Chi-Ruo pulses, fever, sweating, aversion to cold, no vomiting but epigastric痞 (fullness/stagnation) caused by physician's purgation: if not purged, no aversion to cold but thirst indicates transfer to Yangming. Frequent urination causes hard stool. Ten days without bowel movement causes no distress. Thirst for water requires small amounts and methodical rescue; Wu Ling San (Five-Ling Powder) is indicated for thirst. Epigastric fullness/hardness in Yangming disease contraindicates purgation; if purged and diarrhea stops, it cures. Yangming Wind Strike with bitter taste, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and tight pulse: purgation causes abdominal fullness and urinary difficulty.

Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, no aversion to cold but aversion to heat, and heavy body: sweating causes irritability and delirium; fire needle causes fearfulness and insomnia; purgation empties the Stomach, allowing hostile Qi to move the Diaphragm causing irritability and tongue coating. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. Thirst with dry mouth/tongue requires Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction). Floating pulse, fever, thirst, and urinary difficulty require Zhu Ling Tang (Polyporus Decoction). Heavy sweating leading to Yang collapse with delirium and a harmonious pulse is not fatal. Excess causes delirium; deficiency causes Zheng Sheng (repetitive speech). Post-purgation Yangming disease with exterior heat, warm hands/feet, no chest binding, irritability, hunger, inability to eat, and head-only sweating indicates Zhizi Chi Tang.

In combined San Yang disease, abdominal fullness, heavy body, difficulty turning, incoherent speech, facial dirtiness, delirium, and urinary incontinence: sweating worsens delirium; purgation causes sweating on the forehead and cold extremities (entering Taiyin). Spontaneous sweating requires Bai Hu Tang (White Tiger Decoction). Profuse sweating with thirst in Yangming disease contraindicates Zhu Ling Tang as it further depletes fluids in a dry Stomach. Dry mouth desiring to rinse but not swallow indicates impending epistaxis. Floating pulse, fever, dry mouth/nose, and ability to eat indicate impending epistaxis. Floating-tight pulse in Yangming disease indicates tidal fever; floating only indicates night sweats. Initial desire to eat with urinary difficulty, normal stool, joint pain, and sudden madness with sweating indicates Grain Qi overcoming Water; tight pulse indicates recovery. Red face in Yangming disease contraindicates purgation, leading to fever, yellow complexion, and urinary difficulty. Lack of sweating, urinary difficulty, and irritability indicate jaundice. Fire therapy with slight forehead sweating and urinary difficulty indicates jaundice. Fever and sweating allow Heat to vent, preventing jaundice. Head-only sweating up to the neck, urinary difficulty, and thirst indicate Stagnant Heat in the Interior causing jaundice; Yin Chen Hao Tang (Artemisia Capillaris Decoction) is indicated. Slow pulse with fullness after eating, vertigo, and urinary difficulty indicates Grain Jaundice; purgation fails due to slow pulse.

Yangming Wind Strike with wiry-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac pain, nasal dryness, inability to sweat, somnolence, whole-body/jaundice, urinary difficulty, tidal fever, occasional hiccups, and swelling around ears: acupuncture provides slight relief. If exterior remains unresolved after ten days with continuing floating pulse, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is given. If only floating pulse without other symptoms, Ma Huang Tang is given. Tidal fever with loose stool and normal urination with persistent hypochondriac fullness indicates Xiao Chai Hu Tang. Hypochondriac fullness/hardness, constipation, vomiting, and white tongue coating indicate Xiao Chai Hu Tang; opening the Upper Jiao harmonizes the Stomach, leading to sweating and resolution.

[Untreatable Conditions]

Shang Han after emesis/purgation with no bowel movement for five to ten days, tidal fever, no aversion to cold, talking alone, confusion, picking at clothes, fearfulness, slight wheezing, fixed gaze, and choppy pulse indicates death. Epigastric fullness/hardness in Yangming disease with unceasing reverse diarrhea after purgation indicates death. Heavy sweating leading to Yang collapse, delirium, and short pulse indicates death. Fixed gaze, delirium, wheezing/fullness, or diarrhea indicates death. Yangming Wind Strike with complex symptoms including inability to urinate, abdominal fullness, and added hiccups is untreatable.

[Formulas]

Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root): Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root), Da Zao (Jujube), Sheng Jiang (Fresh Ginger), Ge Gen (Kudzu Root).
Ge Gen Tang (Kudzu Root Decoction): Ge Gen (Kudzu Root), Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), Da Zao (Jujube).
Ge Gen Jia Ban Xia Tang (Kudzu Root Decoction plus Pinellia): Ge Gen (Kudzu Root), Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), Da Zao (Jujube), Ban Xia (Pinellia Tuber).
Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction): Da Huang (Rhubarb Root), Gan Cao (Licorice Root), Mang Xiao (Mirabilite).
Da Cheng Qi Tang (Major Order the Qi Decoction): Da Huang (Rhubarb Root), Mang Xiao (Mirabilite), Zhi Shi (Bitter Orange).
Xiao Cheng Qi Tang (Minor Order the Qi Decoction): Da Huang (Rhubarb Root), Hou Po (Magnolia Bark), Zhi Shi (Bitter Orange).
Mi Jian Dao Fang (Honey Suppository Formula): Boiled into suppositories inserted into the rectum.
Zhu Dan Zhi Fang (Pig Bile Formula): Mixed with vinegar and灌 (instilled) into the rectum.
Ma Ren Wan (Hemp Seed Pill): Ma Zi (Hemp Seed), Shao Yao (Peony Root), Xing Ren (Apricot Seed), Da Huang (Rhubarb Root), Hou Po (Magnolia Bark), Zhi Shi (Bitter Orange), refined honey pills.
Wu Zhu Yu Tang (Evodia Decoction): Wu Zhu Yu (Evodia Fruit), Sheng Jiang (Fresh Ginger), Ren Shen (Ginseng Root), Da Zao (Jujube).
Zhu Ling Tang (Polyporus Decoction): Zhu Ling (Polyporus), Fu Ling (Poria), Ze Xie (Alisma), Hua Shi (Talcum), E Jiao (Donkey-hide Gelatin).