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Q: What is the cause of Yangming disease?
A: If Taiyang disease (disease of the Taiyang channel) is treated with sweating, purging, or promoting urination, it may lead to the depletion of body fluids and dryness in the stomach. Consequently, it transforms into Yangming disease. If the patient fails to defecate, internal excess heat accumulates, and defecation becomes difficult, this is termed Yangming disease.

Yangming disease originating from Taiyang disease occurs because individuals with vigorous Shaoyang qi (vital energy of the Shaoyang channel), when suffering from Taiyang disease and undergoing sweating, purging, or water-draining treatments, lose their body fluids, causing stomach dryness. This leads to a transformation into Yangming disease, characterized by internal dryness-heat and excess, resulting in hard stools; this is called Yangming disease.

In original Taiyang disease, if sweating is induced at the very beginning but the sweat is not thorough, it may transform into Yangming disease.
If sweating in Taiyang disease is thorough, the exterior pathogen is resolved, and the interior qi flows freely. However, if sweating is incomplete, the exterior pathogen remains unresolved, and heat stagnates in the fu organs, leading to a transformation into Yangming disease.

When both Yang channels are involved (Er Yang Bing - simultaneous Taiyang and Yangming disease), and sweating was attempted at the onset of Taiyang disease but was incomplete, transforming into Yangming disease, followed by continuous slight sweating and absence of aversion to cold: if the Taiyang exterior syndrome has not yet ceased, purging must not be used; using purging in this case is a contraindicated error (ni). In such situations, mild sweating should be induced. If the patient's face is persistently red, it indicates that yang qi is constrained and stagnant in the exterior. Treatment should involve resolving the exterior through fumigation. If sweating was incomplete, failing to allow the constrained yang qi to vent, and the necessary sweating was not achieved, the patient will experience irritability, pain with no fixed location (sometimes in the abdomen, sometimes in the limbs), which cannot be pinpointed by pressure, along with shortness of breath and an inability to lie down comfortably. All these symptoms result from incomplete sweating. Re-inducing sweating will lead to recovery. How do we know the sweating was incomplete? We know this from the choppy pulse (se mai).

When the disease transmits to the Yangming fu organs while the Taiyang exterior syndrome persists, it is called "Er Yang Bing." Due to incomplete sweating at the onset of Taiyang disease, meridian heat steams inward, transforming into Yangming disease. Continuous slight sweating without aversion to cold indicates the manifestation of fu-organ heat. Fu-organ heat is suitable for purging; however, if the Taiyang exterior syndrome is not resolved, purging is forbidden, as it causes the exterior yang to sink inward, which is termed a contraindicated error. Mild sweating can be used to release the exterior. If the exterior pathogen is strong and the face is persistently red, it signifies yang qi constrained in the exterior with no outlet, steaming upward to the head and face. Internal medication combined with external fumigation should be used to ensure thorough resolution, avoiding mere slight sweating that might leave pathogens behind. If sweating is incomplete, preventing the constrained yang qi from venting outward, the stomach qi is internally obstructed, leading to irritability and wandering pain (in the abdomen or limbs) that cannot be located by pressure, accompanied by blocked meridians and shortness of breath. All these conditions stem from incomplete sweating. Re-inducing sweating will cure the condition. How do we know it is due to incomplete sweating? Because the pulse is choppy. A choppy pulse indicates yang qi constraint and lack of smooth flow. "Fuyu" means depression or stagnation. The *Book of Han* mentions "The Empress Dowager was depressed and wept blood," and the *Chu Ci* states "Heart depressed and internally injured." The fumigation method involves placing boiling water in a basin and allowing the patient to sit under a blanket to be heated by the steam to induce sweat; this is most effective and suitable for lower-body conditions.