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Yang Excess Repelling Yin presents with coldness of the body and limbs, aversion to heat, vexation, thirst, and difficult defecation. The pulse is deep and slippery, the fingernails are red, and the urine is red. Treatment with sweating, purging, or clearing methods is appropriate to restore yin integrity.

[Annotation] The Classic states: "When yang qi is excessively abundant, yin qi cannot circulate mutually." "Not circulating mutually" means they do not enter each other. Since they do not enter each other, yin is repelled to the exterior, hence it is called "Yang Excess Repelling Yin." Although the external signs include coldness of the body and limbs, resembling a yin-cold pattern, internally there is vexation, thirst, difficulty in defecation, red urine, aversion to heat, unwillingness to wear clothes, red fingernails, and a deep, slippery pulse—a full set of excess-heat signs of yang. If sweating, purging, and clearing methods are applied appropriately, excess yang will diminish, and yin will be preserved. For exterior excess with no sweating, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction). For interior excess with constipation, use the Three Chengqi Decoctions. For intense heat without exterior or interior excess signs, use Jiedu Baihu Tang (Detoxifying White Tiger Decoction).

[Collected Annotations] Liu Wansu said: "When heat accumulates severely within, the pulse should be rapid and frequent. However, due to extreme heat accumulation obstructing the pulse vessels, the pulse may instead appear deep, thin, and nearly imperceptible. Laypeople, unaware of the principles of transformation, mistakenly consider this as transmission to extreme cold and yin toxicity. In cases where yang-heat becomes suddenly severe at onset, presenting such symptoms, or in simultaneous cold-heat syndromes with severe heat, one should generally use Jiedu Plus Dachengqi Tang (Detoxifying Plus Great Order the Qi Decoction) to purge. After the heat subsides slightly but recovery is incomplete, use Huanglian Jiedu Tang (Coptis Detoxification Decoction) to regulate. If slight heat remains, use Liangge San (Cooling Chest Powder) to regulate. If failure to purge leads to extreme heat, resulting in cold body, faint pulse, and coma approaching death, urgent purging would cause the residual yin to abruptly cease, leading to certain death, as yang has already exhausted. Not purging also leads to death; one should use Liangge San or Huanglian Jiedu Tang to nourish yin and retreat yang, allowing accumulated heat to gradually dissipate, so that the chest and heart become warm again and the pulse gradually returns."

Yin Excess Repelling Yang presents with pale-red complexion, fever without thirst, cold limbs with vexation, clear watery diarrhea, clear urine, and cyan-white fingernails. The pulse is floating and faint. Treatment involves Tongmai Sini Tang (Pulse-Returning Cinnamon and Aconite Decoction) to restore yang.

[Annotation] The Classic states: "When yin qi is excessively abundant, yang qi cannot circulate mutually." "Not circulating mutually" means they do not enter each other. Since they do not enter each other, yang is repelled to the exterior, hence it is called "Yin Excess Repelling Yang." "Pale-red complexion" refers to a floating, superficial reddish hue on the face. Externally, there is facial redness, fever, and vexation, resembling a yang-heat pattern. Internally, however, there is no thirst, clear watery diarrhea, clear urine, cyan-white fingernails, cold limbs, and a floating, faint, nearly imperceptible pulse—a full set of yin-cold deficiency signs. One should use Tongmai Sini Tang taken cold to follow the yin-cold nature and restore yang. If diarrhea stops but the pulse does not return, double the dosage of Renshen (Ginseng Radix et Rhizoma). If there is diarrhea and no pulse, use Baitong Plus Pig Gallbladder Bile and Human Urine Decoction. For cold limbs and severe vexation approaching death, use Wuzhuyu Tang (Evodia Decoction).