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Yangming disease originally presented with spontaneous sweating. The physician incorrectly applied a heavy diaphoretic method. Although the illness had largely resolved, the patient still experienced slight vexation and a lingering sense of discomfort. This indicates that the feces must be hard due to the depletion of body fluids (Jin-Ye) and dryness in the stomach. At this time, one should inquire about the frequency of urination per day.

If the patient previously urinated three or four times a day but now only twice, it can be deduced that the feces will pass soon. Since the frequency of urination has decreased, it is known that body fluids are returning to the stomach; therefore, bowel movement will likely occur spontaneously shortly.

Originally presenting with spontaneous sweating, followed by another heavy diaphoresis, the heat was expelled with the sweat, and the condition had improved. However, slight vexation and general malaise persisted because excessive sweating depleted body fluids, causing dryness in the stomach and resulting in hard feces. One should ask how many times the patient urinates daily. If urination was frequent before but is now reduced, the feces will likely pass soon because body fluids are returning to the stomach, moistening the intestines and stomach.

In Yangming disease, if there is spontaneous sweating or if urination is naturally profuse after diaphoresis, this indicates an internal depletion of body fluids. Even if the feces are hard, purgatives should not be used. Instead, when the patient feels the urge to defecate but cannot, honey suppositories should be inserted into the anus to guide the passage of stool. Alternatively, juice from Trichosanthes kirilowii root (Tugua Gen) or large pig bile may be used as a guiding agent.

Originally presenting with spontaneous sweating, if diaphoresis is applied again, or if urination is naturally profuse, this constitutes internal depletion of body fluids and cannot be compared to cases of stomach heat and dry earth. Although the feces are hard, purgatives are contraindicated. When the patient feels the urge to defecate but the stool is stuck and does not pass, honey suppositories should be inserted into the anus to guide the stool. Trichosanthes kirilowii root (injecting its juice mixed with a little water into the anus via a bamboo tube causes immediate defecation) and large pig bile can both serve as guiding agents.

[Honey] Seven he.
Take the above single ingredient and place it in a copper vessel. Simmer over low heat until it slightly thickens to a syrup-like consistency, stirring constantly to prevent burning or sticking. When it becomes pliable enough to form pills, shape it while hot into a cone-shaped suppository, sharp at the head, as thick as a finger and approximately two cun long. It must be shaped while hot, as it hardens upon cooling. Insert it into the anal canal and hold the buttocks tightly together until the urge to defecate arises, then remove it.

[Large Pig Gallbladder] One piece.
Extract the juice from the above ingredient, mix with a small amount of vinegar, and instill into the anal canal. After approximately the duration of one meal, the stool will be expelled.

The pulse at Duyang (Chongyang point on the foot dorsum) is floating and choppy. A floating pulse indicates strong Stomach Qi; a choppy pulse indicates frequent urination. The combination of floating and choppy pulses leads to difficulty in defecation. This is due to "Spleen Constraint" (Pi Yue), for which Mahuang Wan (Cannabis Seed Pill) is indicated.
The Yangming Stomach Meridian runs from the head to the foot, passing through the arterial pulse on the dorsum of the foot, known as Chongyang, hence the term Duyang pulse. Excess Yang results in a floating pulse, indicating robust Stomach Qi. Blood deficiency results in a choppy pulse, indicating dysfunction of Wind-Wood dispersion leading to frequent urination. The combination of floating and choppy pulses creates dry earth and depleted water, making defecation difficult. The Spleen Qi is constrained and knotted, resulting in hard, small fecal pellets. This is a Taiyang-Yangming syndrome (Chapter 8 states that Taiyang-Yangming refers to Spleen Constraint). Mahuang Wan (Cannabis Seed Pill) is appropriate. In this formula, Hemp Seed (Huo Ma Ren) and Apricot Seed (Xing Ren) moisten dryness and lubricate the intestines; White Peony Root (Bai Shao) and Rhubarb (Da Huang) clear wind and drain heat; Magnolia Bark (Hou Po) and Immature Bitter Orange (Zhi Shi) move stagnation and resolve knotting.