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In cases where the fever is extremely severe, and there is concern that Chengqi Tang (Cinnamon Twig and Rhubarb Decoction) may not be able to reduce the heat; or in cases where the heat persists even after purgation has been administered; or in cases where excessive heat is accumulated internally, leading to a profound Yang Jue (cold extremities due to internal heat blocking yang qi circulation), such that the yang qi is constrained and unable to circulate to the body surface and limbs, resulting in coldness of the entire body, unbearable severe pain, stiffness and tension in the neck and back, cyanosis of the eyes with ocular pain, dizziness, mental confusion, dry or painful throat, irritability and thirst, spontaneous sweating, vomiting, diarrhea, abdominal distension with solid pain, vexation and restlessness, rapid breathing, and delirious speech. Although the pulse may be rapid and fine, because the accumulated heat is extremely deep and obstructs the pulse vessels, the pulse may paradoxically appear deep, fine, and nearly imperceptible. Laypeople, failing to understand the transformative nature of this pathology, often mistakenly diagnose it as an extreme Yin-toxic condition in Cold Damage.

In cases where, upon initial onset, yang-heat suddenly becomes extremely intense presenting with these symptoms; or in cases of Lianggan (simultaneous involvement of exterior and interior meridians) with severe heat intensity, it is generally appropriate to use Jiedu Tang (Detoxification Decoction) combined with Da Chengqi Tang (Major Order to Preserve the Yield Decoction) to purge. If the heat does not subside, purgation should be repeated. Although ancient texts state: "If heat remains after three purgations, death ensues," there are instances where, following proper protocol, three to five purgations were performed, resulting in ten to twenty bowel movements, after which the heat subsided and the patient survived, thereby avoiding certain death from failure to purge the heat.

After purgation, if the heat slightly subsides but recovery is incomplete, Huanglian Jiedu Tang (Coptis Detoxification Decoction) should be used for regulation. In cases where purgation was missed, leading to extreme heat, causing coldness of the body, minute pulse, and coma approaching death, immediate purgation would cause the residual yin fluids to abruptly cease, leading to death due to subsequent exhaustion of yang qi. Without purgation, death also occurs. In such scenarios, it is appropriate to use Liangge San (Cooling the Chest Powder) or Huanglian Jiedu Tang, or a combination of both, or Baihu Tang (White Tiger Decoction) combined with Liangge San, to nourish yin and retreat yang, allowing the accumulated heat to gradually dissipate. As a result, the chest and heart will feel warm, and the pulse will gradually reappear. Only when the pulse regains strength can Sanyi Chengqi Tang (Three-One Order to Preserve the Yield Decoction) be used for purgation, or the condition can be regulated with Jiedu Tang plus Liuyi San (Six-to-One Powder). After recovery, antipyretic herbs should be taken, and foods that induce heat should be avoided.

For Nei Re Mai Jue (interior heat manifesting as pulse jue), Baihu Tang (White Tiger Decoction) is appropriate. In cases of extreme heat and profound jue where all purgative medicines have been exhausted and bowel movement still cannot be achieved, the condition is incurable and leads to death; in this desperate situation, Huanglian Jiedu Tang (Coptis Detoxification Decoction) with one qianbi of Gansui powder added can be used for purgation.