Library

If a patient experiences vexation and heat, which resolve after sweating; or presents with symptoms resembling malaria, specifically fever occurring in the late afternoon (Shen, You, Xu hours), this belongs to Yangming disease. If the pulse is solid (Shi), purgation is indicated; if the pulse is floating and deficient (Fu Xu), diaphoresis is indicated. For purgation, Da Cheng Qi Tang (Major Order the Qi Decoction) is used (see Taiyang Chapter 5); for diaphoresis, Gui Zhi Tang (Cinnamon Twig Decoction) is used (see Taiyang Chapter 5).

If the exterior syndrome of Taiyang has not yet resolved, leading to vexation and heat that resolve upon sweating, but subsequently symptoms resembling malaria recur with daily fever at Ribu time (the period between Shen, You, and Xu hours, when Yangming energy is prosperous. According to *Book of Han: Treatise on Astronomy*, observing winds on the first day of the first month helps predict crop suitability: from dawn to mealtime for wheat, mealtime to dusk for millet, dusk to Ribu for sorghum, Ribu to Xiaibu for beans, Xiaibu to sunset for hemp. Ribu occurs after sunset, while Xiaibu is before sunset, corresponding to the time when Dry Metal governs, i.e., Shen, You, Xu hours), this indicates involvement of Yangming.

Yangming disease manifests as either Jing (Channel) syndrome or Fu (Organ) syndrome. Jing syndrome involves exterior heat radiating outward, characterized by a floating and deficient pulse. Fu syndrome involves interior heat knotting inward, characterized by a solid pulse. A solid pulse indicates the need for purgation to drain interior heat; a floating and deficient pulse indicates the need for diaphoresis to release exterior heat. Purgation employs Da Cheng Qi Tang (Major Order the Qi Decoction): Da Huang (Rhei Radix et Rhizoma) and Mang Xiao (Natrii Sulfas) break up stagnation and drain heat; Hou Po (Magnoliae Officinalis Cortex) and Zhi Shi (Aurantii Fructus Immaturus) direct turbidity downward and eliminate fullness. Diaphoresis employs Gui Zhi Tang (Cinnamon Twig Decoction): Sheng Jiang (Zingiberis Rhizoma Recens), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Da Zao (Jujubae Fructus) tonify spleen and stomach essence and harmonize middle qi; Gui Zhi (Cinnamomi Ramulus) and Bai Shao (Paeoniae Radix Alba) unblock collaterals and vent Ying (Nutritive) depression.

When Yangming disease transmits from Taiyang, water-dampness enters the fu organs, remaining entirely as a Jing (Channel) syndrome. Jing syndromes are treated with diaphoresis. If the pathogen has not left the Taiyang channel, Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang (Cinnamon Twig Decoction) are used. If the pathogen is about to enter the Yangming fu organ, Ge Gen (Puerariae Lobatae Radix) is added. Although vomiting and diarrhea in Yangming disease do not yet constitute a solid interior syndrome requiring purgation, the pressure on the channels and depression in the fu organs indicate that stomach heat is forming. Therefore, Ge Gen (Puerariae Lobatae Radix) is used to simultaneously resolve channel and fu depression. With proper treatment, there will be no risk of the disease leaving the channel and entering the fu organ.

In Yangming disease, if the pulse is slow (Chi), sweating is profuse, and there is slight aversion to cold, the exterior syndrome has not yet resolved. Diaphoresis may be applied using Gui Zhi Tang (Cinnamon Twig Decoction) (see Taiyang Chapter 5).

Slow pulse, sweating, and aversion to cold are signs of Taiyang Wind Strike syndrome, thus Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate. However, excessive sweating indicates flourishing Stomach Yang, hence it is termed Yangming disease.

In Yangming disease, if the pulse is floating, there is no sweating, and wheezing occurs, diaphoresis leads to recovery. Ma Huang Tang (Ephedra Decoction) is indicated (see Taiyang Chapter 20).

Floating pulse, no sweating, and wheezing are signs of Taiyang Cold Damage syndrome, thus Ma Huang Tang (Ephedra Decoction) is appropriate. When Taiyang channel pathogens transmit internally to the Yangming fu organs, if the Yangming fu pathogens are not yet solidified and the Taiyang channel pathogens have not yet subsided, Taiyang exterior-releasing herbs should be used. Even if there are interior indications for purgation, if the exterior syndrome is unresolved, purgation must not be performed. One must first use Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang (Cinnamon Twig Decoction) to release wind-cold from the exterior, and then consider purgation. Wind pulses are floating and slow (Huan); cold pulses are floating and tight. The term "slow" (Chi) here is a variant expression for "slow/relaxed" (Huan). Omitting "floating" for wind and "tight" for cold is a stylistic ellipsis. When Taiyang transmits to Yangming, the pulse must exhibit a large (Da) quality amidst the slow and tight characteristics, as previously stated in the chapter: "After three days of cold damage, the Yangming pulse is large." Thus, it is not reiterated here.