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Yangming Disease. The general principle lies in distinguishing between the Meridian syndrome (Jing Zheng) and the Fu-organ syndrome (Fu Zheng). Those belonging to the Meridian syndrome should be classified as exterior syndromes. Although there is a distinction between Wind-stroke (Zhong Feng, characterized by the ability to eat) and Cold-injury (Zhong Han, characterized by inability to eat), once the pathogen has invaded the Middle Jiao, it is unnecessary to differentiate strictly between Wind and Cold, or to focus on Ying and Wei (Defensive and Nutritive Qi). One only needs to judge based on the following: if Taiyang symptoms have not yet fully resolved, presenting with spontaneous sweating and a slow pulse, Guizhi Tang (Cinnamon Twig Decoction) can be used; if there is no sweating and the pulse is floating, Mahuang Tang (Ephedra Decoction) can be used; if Shaoyang symptoms are gradually appearing, presenting with tidal fever, a string-taut, floating, large, and short pulse, abdominal fullness, Da Chaihu Tang (Major Bupleurum Decoction) or Xiao Chaihu Tang (Minor Bupleurum Decoction) can be used to separately extract pathogens from the exterior and the half-exterior/half-interior. Only when the stiffness of the head and neck disappears and the pulse becomes long and large can Gegen Tang (Kudzu Root Decoction) be used to greatly induce sweating to release pathogens from the muscle layer. Therefore, Meridian syndromes are treated in a separate chapter. As for Fu-organ syndromes, although there are three types of Yangming distinctions, the emphasis is particularly placed on whether the patient can eat: ability to eat indicates strong Stomach Qi, while inability to eat indicates weak Stomach Qi. Most patients who can eat are suitable for purgative therapy, differing only in urgency. However, those with weak Stomach Qi and inability to eat may have accompanying deficiency-cold or heat-binding. If it is deficiency-cold, symptoms such as spontaneous diarrhea, jaundice, vomiting, and hiccups with a slow pulse will occur, requiring Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Frigid Extremities Decoction). If it is heat-binding, symptoms such as abdominal fullness, delirium, constipation, and a choppy pulse will occur, requiring Honey Suppository or Gallbladder Suppository methods. One must not rigidly assume that all Fu-organ diseases being Yang syndromes require cold purgatives exclusively, nor forbid warm agents.

In Yangming disease, the ability to eat is named Wind-stroke; the inability to eat is named Cold-injury.
Wind is Yang; Yang can digest grain, hence the ability to eat. Cold is Yin; Yin cannot digest grain, hence the inability to eat. When pathogens merge into Yangming, reaching the junction of Ying and Wei in the Middle Jiao, they become indistinguishable as a unified whole. The only reliable differentiator is the ability or inability to eat.

After three days of Cold-injury, the Yangming pulse is large.
Because Qi and Blood in Yangming are abundant, its pulse is long and large.

A floating and large pulse should indicate the need for sweating; if the physician mistakenly uses purgation, this is a major error (Da Ni).

In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Sweating is appropriate, and Guizhi Tang (Cinnamon Twig Decoction) is indicated.
In Yangming disease, if the pulse is floating, there is no sweating, and wheezing occurs, sweating will lead to recovery, and Mahuang Tang (Ephedra Decoction) is indicated.
These two clauses state that Taiyang pathogens have just entered Yangming but have not left the Taiyang meridian. Thus, Guizhi Tang (Cinnamon Twig Decoction) is still used to resolve the muscle layer, allowing Wind pathogens to exit via the Wei level; Mahuang Tang (Ephedra Decoction) is used to induce sweating, allowing Cold pathogens to exit via the Ying level. Differentiating Ying and Wei in Yangming is difficult and relies entirely on pulse and symptoms. For Wind pathogens transmitting to Yangming, if spontaneous sweating is profuse, the pulse changes from slow to delayed. For Cold pathogens transmitting to Yangming, if fever is severe, the pulse changes from tight to floating. These are signs of pathogens remaining in the Meridian. If pathogens transmit to the Fu organs, a delayed pulse will become rapid, and a floating pulse will become excess. If neither rapid nor excess, it is definitely Stomach deficiency, unsuitable for purgation.

In Yangming disease, if there is only dizziness, no aversion to cold, hence the ability to eat, and coughing, the person will certainly have a sore throat. If there is no coughing, the throat will not hurt.
This is a syndrome of Stomach Heat combining with Wind pathogens attacking upward, due to the moving nature of Wind. Wind pathogens attack the Stomach, causing Stomach Qi to rebel upward, resulting in coughing. The pharynx is connected to the Stomach; severe coughing damages the pharynx, hence the sore throat. Fuling Guzhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) is indicated to disperse Wind pathogens and remove Dampness from the Stomach. If Stomach Qi does not rebel, there will be no coughing or sore throat.

Yangming disease typically involves profuse sweating. If there is instead no sweating, and the body feels like insects crawling under the skin, this is due to prolonged deficiency.
This is a syndrome of Stomach Heat combined with Cold pathogens stagnating in the skin. "Prolonged deficiency" explains why pathogens cannot be expelled from the exterior. Guizhi Er Yuespi Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra and Magnolia Bark Decoction) is indicated, not implying the use of tonics.

In Yangming disease, if there is no sweating, urination is clear, and after two to three days, vomiting, coughing, and cold extremities occur, the person will certainly suffer from headache. If there is no vomiting, no coughing, and no cold extremities, the head will not hurt.
Yangming with no sweating, vomiting, coughing, and cold extremities results from injury to both Ying and Wei with deep penetration of pathogenic heat. However, clear urination indicates that pathogenic heat is not internal but external, not lower but upper. Hence, headache is certain. Xiao Qinglong Tang (Minor Green Dragon Decoction) is indicated. If there is no vomiting, coughing, or cold extremities, and urination is clear, pathogenic heat will likely exit via the water passages; there would be no reason for it to attack the vertex inversely.

In Yangming disease, if the mouth is dry and the patient desires to rinse water in the mouth but not swallow, epistaxis (nosebleed) will certainly occur.
Desiring to rinse but not swallow indicates pathogens have entered the Blood level. Blood is Yin and cannot dissolve water. The Yangming meridian originates at the nose; blood heated recklessly will flow from the nasal passage.

If the pulse is floating, there is fever, dry mouth, dry nose, and the patient can eat, epistaxis will occur.
The ability to eat indicates pathogens are not in the interior but in the meridian, hence epistaxis will occur.

In Yangming disease, if the pulse is floating and tight, there will certainly be tidal fever occurring at specific times. If the pulse is only floating, there will certainly be night sweats.
A floating, tight pulse with tidal fever indicates Taiyang Cold pathogens desire to enter the Yangming Fu organs but have not yet done so. Although not entered, tidal fever symptoms appear prematurely. A floating pulse with night sweats indicates Taiyang Wind pathogens are about to transmit to the Shaoyang meridian but have not yet done so. Although not transmitted, night sweat symptoms appear first. Generally, Shaoyang has little Qi and Blood and does not primarily govern sweating. However, because pathogenic heat steams internally affecting Yangming, and Yangming's muscle pores are naturally firm, sweat cannot exit. During sleep, when Spleen Qi is inactive and muscle pores open, pathogenic heat escapes, causing night sweats. Although this is a Shaoyang syndrome, it essentially relates to Yangming.

In Yangming Wind-stroke, the pulse is string-taut, floating, large, and short, with shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of Qi upon long pressure, dry nose, inability to sweat, lethargy, generalized and facial jaundice, difficulty in urination, tidal fever, frequent hiccups, and swelling around the ears. Acupuncture provides slight relief. If the exterior remains unresolved and the condition persists beyond ten days, and the pulse continues to float, give Xiao Chaihu Tang (Minor Bupleurum Decoction). If the pulse is only floating without other symptoms, give Mahuang Tang (Ephedra Decoction). If there is no urination, abdominal fullness, and added hiccups, it is untreatable.
This clause describes Yangming Wind-stroke syndromes, comprising seven or eight parts, while Cold-injury syndromes comprise two or three parts. The text mentions "inability to sweat" and the use of "Mahuang Tang," revealing the intent. This is a critical Yangming syndrome where Taiyang symptoms have not resolved and Shaoyang symptoms are concurrent. Pathogens cannot transmit or dissipate from the Yangming position. The key to Cold-injury is initially fearing transmission, as transmission generates changes and consumes fluids/Qi. Later, one fears non-transmission, as stagnation leads to severity and lack of venting. Zhang Zhongjing highlights the subtlety of "non-transmission." A string-taut, floating, large pulse with shortness of breath and abdominal fullness indicates non-transmission. Hypochondriac pain and obstruction indicate non-transmission. Dry nose, no sweat, lethargy, and jaundice indicate non-transmission. Difficulty urinating, tidal fever, and hiccups indicate Stomach Heat blazing and blocked pathways, hence non-transmission. Swelling around ears resolving slightly with acupuncture indicates internal pathogens do not transmit, but external blood stasis remains. After ten days, if the exterior is unresolved and the pulse floats, giving Xiao Chaihu Tang (Minor Bupleurum Decoction) pushes pathogens toward Shaoyang. If only floating, Mahuang Tang (Ephedra Decoction) pushes them back to Taiyang. No urination, abdominal fullness, and hiccups indicate Stomach pathogens obstructed internally and Qi failing upward. There is no method to drive them out then. Otherwise, why use Mahuang Tang after ten days?

Desire to vomit after eating belongs to Yangming, treated with Wuzhuyu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, it belongs to the Upper Jiao.
This clause distinguishes vomiting: Taiyang and Yangming origins differ. Desire to vomit after eating indicates Stomach Cold, opposite to Taiyang aversion to cold and hot vomiting. One must fear mistaking cold for heat. If worsening after Wuzhuyu Tang (Evodia Decoction), it is clearly Taiyang Heat, not Stomach Cold.

In Cold-injury, if vomiting is frequent, even with Yangming symptoms, purgation is contraindicated.
Frequent vomiting indicates pathogens in the Upper Jiao. Even with Yangming symptoms, purgation is forbidden as it allows pathogens to invade inward. If Shaoyang symptoms are present, harmonization is required; purgation is absolutely contraindicated.

Diseases with excess Yang-Heat, if purged, result in hardness.
Excess Yang-Heat presents Yangming symptoms but belongs to the Meridian syndrome, which is not suitable for purgation. Mistaken purgation allows Yang pathogens to sink inward, forming Pi Hardness (Stagnant Hardness) rather than Jie Xiong (Chest Binding).

Absence of Yang, Excess Yin, with hard stool: purgation will cause undigested food in stool and abdominal fullness.
"Absence of Yang, Excess Yin" means internal fluid depletion and empty Stomach Yang, with Yin pathogens rebelling upward, causing Pi Fullness and anorexia. Similar to mistaken purgation leading to Pi. Re-purgating will cause undigested food and abdominal fullness. In Shaoyang Wind-stroke with abdominal fullness and anorexia, mistaken purgation causes similar symptoms. However, in Yangming "Absence of Yang, Excess Yin," mistaken purgation causing undigested food/fullness can be treated with Xiexin Tang (Gallbladder Decoction variants). In Shaoyang Wind-stroke, even Sini Tang (Frigid Extremities Decoction) may fail to rescue.

The above are all Yangming Meridian syndromes.

Yangming disease tends to resolve from Shen hour to Xu hour (3 PM to 7 PM).
The previous clause refers to the time of self-resolution for Yangming Meridian syndromes.