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In Yangming disease, if there is hardness and fullness in the epigastrium (heart below), purgation must not be used. If purgation is mistakenly applied and diarrhea persists without stopping, the prognosis is fatal; if the diarrhea stops, recovery occurs.

Epigastric stuffiness and fullness are signs of Taiyin disease. In Taiyin disease, abdominal fullness with vomiting and spontaneous diarrhea that worsens over time occur; if purgation is mistakenly applied, it inevitably leads to hardness and binding below the chest, which is this situation. When Yangming disease presents with the Taiyin symptom of epigastric hardness and fullness, it indicates excess Yin and deficient Yang, thus purgation is contraindicated.

If purgation is mistakenly applied, Spleen Yang sinks and fails, leading to persistent diarrhea, which is fatal; if Yang returns and diarrhea stops, recovery occurs.

Yangming Wind-Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, and a floating and tight pulse. If purgation is mistakenly applied, abdominal fullness will worsen, and urination will become difficult.

Yangming Wind-Strike with bitter taste and dry throat indicates concurrent Shaoyang syndrome; abdominal fullness indicates concurrent Taiyin syndrome; fever, aversion to cold, and a floating and tight pulse resemble the Da Qing Long Tang syndrome of Taiyang Wind-Strike in Cold Damage. However, this involves Yangming Fu-heat steaming outward, where sweating should occur and the pulse should be slow. The current tight pulse and aversion to cold indicate that Wei Qi (Defensive Qi) is constrained externally, and Stomach Yang is deficient, unable to induce sweating. Externally, there is constraint from Jia Wood (Gallbladder/Liver); internally, there is invasion by Taiyin (Spleen). This results in dual stagnation of the channels and Fu organs, preventing the release of pathogens. Yangming disease has reached a state of extreme exhaustion at this point. If purgation is further mistakenly applied, it will fully transform into a Taiyin syndrome, characterized by abdominal fullness and difficult urination. The specific treatment method is detailed in the section on Zhu Ling Tang in the next chapter.

In Yangming disease, with a floating and tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, absence of aversion to cold but presence of aversion to heat, and heaviness of the body: if diaphoresis (sweating-inducing therapy) is mistakenly applied, restlessness, mental confusion, and delirium may occur; if burning needle therapy is mistakenly applied, fright, irritability, and insomnia will definitely ensue.

If purgation is mistakenly applied, resulting in an empty stomach, disturbance of pathogenic Qi moving to the diaphragm, and mental vexation and oppression (Xin Zhong Ao Nao) with coating on the tongue, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary formula.

If there is thirst desire to drink water, dry mouth, and dry tongue, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is the primary formula.

If the pulse is floating, there is fever, thirst desire to drink water, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is the primary formula.

Yangming disease with a floating and tight pulse presents Taiyang symptoms; dry throat and tongue present Shaoyang symptoms; abdominal fullness presents Taiyin symptoms; fever, sweating, absence of aversion to cold but presence of aversion to heat indicate Stomach heat radiating outward. However, the presence of Taiyin abdominal fullness suggests abundant Earth dampness, inevitably causing body heaviness. With excessive dampness and deficient Yang, diaphoresis, purgation, and burning needle therapies are all contraindicated.

If diaphoresis is mistakenly applied, Yang collapses, restlessness arises, spirit deteriorates, mental confusion occurs, and delirium follows. If burning needles are mistakenly applied, excessive sweating leads to Yang collapse, causing fright, irritability, and inability to lie down and sleep.

If purgation is mistakenly applied, Yang collapses, Earth (Spleen) fails, the stomach becomes empty, failing to defend against Yin pathogens. Pathogenic Qi from the Lower Jiao reverses upward to disturb the diaphragm, repelling Yang in the Chest, causing mental vexation and oppression, generating turbid stasis. Heart orifices are affected, manifesting as tongue coating. Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is suitable to purge turbid stasis and clear vexatious heat.

If after purgation, Yin fluids are depleted, causing thirst, dry mouth, and dry tongue, Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction) is suitable to clear Metal (Lung) heat, dissipate heat, tonify Qi, and generate fluids.

If after purgation, Yang is exuberant while Earth dampness remains, with a floating pulse, fever, thirst, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is suitable. Fu Ling (Poria) and Zhu Ling (Polyporus), Hua Shi (Talcum), and Ze Xie (Alisma) promote urination to drain dampness; E Jiao (Donkey-hide Gelatin) nourishes Wood (Liver) to clear wind. Earth dampness constrains Wood, stagnation generates heat, causing fever; Wood Qi is blocked, failure of dispersion and descent causes difficult urination; Wood stagnation generates Wind, consuming Lung fluids, causing thirst; Wind Qi rises, causing a floating pulse. In cases of abdominal fullness and body heaviness, mistaken purgation damages Yang and increases dampness, leading to these manifestations. This clarifies the meaning of "abdominal fullness and difficult urination" from the previous chapter.