前阳明少阳。邪由阳明之表而来。此阳明太阴。邪从阳明之里而及。胃与脾联。此表里俱病也。
如见舌苔白带灰黑色。或白中带黑点。或边黄中黑。或前半黄后半黑。或纯黄燥苔。或
黄分八字。种种形色。皆阳明太阴之验。外症身体灼热。口渴唇燥。左关数。右
关滑。此阳明热邪内蕴。以致 不得透。毒不得解。因与太阴为表里而传入也。急宜透之提之。不使毒
邪陷入三阴。用二角、芩连、连翘、牛蒡、桔梗、薄荷等。使 外达而解。如 点隐隐不得外透。加
角刺数分以透之。如大便秘而潮热谵语者。阳明为重。太阴为轻。下之可也。
邵评∶阳明热邪内郁成 。不外达而内传太阴。实热症也。仍宜提邪外达。
前阳明太阴。因阳明之邪失表失清。以致将陷太阴。作实证治。故犹用提透。此阳明少阴。由其人本属
阴虚。即病在阳明。而少阴已不能支。此土来克水。水不济火也。当作虚症治。
凡见舌苔中黄边紫。前半黄。后半紫。或前半白。后半红。脉左数右洪。外症潮热。舌
燥唇焦。口糜气秽。齿衄烦渴。此景岳所谓阳明有余。少阴不足之症也。宜大小甘
露、玉女煎之类。随症加减。无不应手。
邵评∶此肾阴亏而胃有热。气血两燔。灼耗肾水之正法。
The previously discussed Shaoyang and Yangming diseases involve pathogenic factors originating from the exterior of the Yangming channel. The current discussion on Taiyin and Yangming diseases involves pathogenic factors spreading from the interior of the Yangming to the Taiyin. The Stomach and Spleen are exteriorly-interiorly related; this constitutes a condition where both the exterior and interior channels are diseased.
If the tongue coating presents with grayish-black color, or white with black spots, or yellow edges with a black center, or yellow anterior half with a black posterior half, or purely yellow and dry coating, or yellow in an "eight" shape distribution, these various appearances are all signs of Taiyin and Yangming disease. External symptoms include burning heat of the body, thirst, and dry lips. The pulse is rapid at the left Guan position and slippery at the right Guan position. This indicates that Yangming heat pathogens are internally accumulated, causing the rash/toxin to fail to erupt and the toxin to remain unresolved. Because the Taiyin and Yangming are exteriorly-interiorly related, the pathogen transmits into the Taiyin. Urgent treatment should focus on venting and lifting to prevent the toxin/pathogen from sinking into the Three Yin channels. Medications such as Fructus Armeniacae Amarum (Niu Bang Zi), Radix Scutellariae (Huang Qin), Rhizoma Coptidis (Huang Lian), Flos Forsythiae (Lian Qiao), Semen Plantaginis (Niu Bang Zi - *Note: Context implies Niu Bang Zi for venting, though text says Niu Bang twice, likely one is Fructus and one is Seed, or typo in source. Standard term for venting is Fructus*), Radix Platycodi (Jie Geng), and Folium Menthae (Bo He) can be used to allow the pathogen to reach the exterior and resolve. If the rash points are faint and fail to erupt externally, add several fen of Spina Gleditsiae (Jiao Ci) to assist eruption. If there is constipation accompanied by tidal fever and delirious speech, the Yangming aspect is heavy and the Taiyin aspect is light; purgation may be applied.
Shao's Commentary: Yangming heat pathogens accumulate internally forming rashes, failing to reach the exterior and transmitting internally to the Taiyin. This is a excess-heat syndrome. It remains appropriate to lift and vent the pathogen to the exterior.
The previously mentioned Taiyin and Yangming disease occurred because the Yangming pathogen was not properly released via sweating or cleared, leading it to sink into the Taiyin. Treated as an excess syndrome, the method of lifting and venting is still used. The current mention of Yangming and Shaoymin disease occurs because the patient inherently possesses Yin deficiency. Even if the disease is in the Yangming, the Shaoyin cannot sustain it. This represents Earth (Spleen/Stomach) overcoming Water (Kidney), resulting in Water failing to control Fire. It should be treated as a deficiency syndrome.
Whenever the tongue coating shows a yellow center with purple edges, yellow anterior half with purple posterior half, or white anterior half with red posterior half, and the pulse is rapid on the left and flooding on the right, accompanied by external symptoms of tidal fever, dry tongue, scorched lips, oral ulcers, foul breath, gingival bleeding, irritability, and extreme thirst, this corresponds to Zhang Jingyue's description of "Yangming Excess and Shaoyin Deficiency." Formulas such as Da Xiao Gan Lu Yin (Major and Minor Sweet Dew Decoction) or Yu Nu Jian (Jade Woman Decoction) should be used, modified according to symptoms, yielding immediate results.
Shao's Commentary: This is the correct method for treating Kidney Yin deficiency with Stomach heat, where Qi and Blood are simultaneously blazing, scorching and consuming the healthy essence of Kidney Water.
Xiao Chai Hu Tang (Minor Bupleurum Decoction), Huang Qin Tang (Scutellaria Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), Chai Hu Qu Shen Xia Jia Gui Zhi Lou Gen Tang (Bupleurum Decoction minus Ginseng and Pinellia plus Cinnamon Twig and Trichosanthes Root Decoction), Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), Huang Lian Tang (Coptis Decoction).