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Yangming disease, with a pulse that is floating and tight, dry throat, bitter taste in the mouth, abdominal fullness and wheezing, fever with sweating, aversion to cold absent but aversion to heat present, and heaviness of the body. If sweat-inducing methods are erroneously applied, restlessness ensues, accompanied by mental confusion and delirious speech. If burning needle therapy is erroneously used, palpitations, fearfulness, irritability, and insomnia occur. If purgative methods are erroneously applied, the stomach becomes empty and hollow, pathogenic factors move to disturb the diaphragm, causing deep-seated vexation and regret (Ao Nao) in the heart. In cases where there is a coating on the tongue, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the primary treatment.

These pulse and symptom patterns are similar to Yangming Wind-Strike. The former is named Wind-Strike due to aversion to cold; this one is named Yangming disease due to the paradoxical aversion to heat. Yangming governs the muscles. When heat is extreme and fluids are depleted, failing to moisten the tissues, the muscles lose harmony, resulting in body heaviness. This represents a half-exterior, half-interior syndrome of Yangming. The pathogen has entered the abdomen and is no longer between the Ying (Nutrient) and Wei (Defensive) levels. Although the pulse is floating, it should not be treated as an exterior syndrome requiring sweating; although the pulse is tight, warming needles should not be added simply because of body heaviness; the Stomach home has just begun to solidify but has not yet reached dryness and hardness, so purgatives should not be used merely for wheezing, fullness, and aversion to heat. Erroneous sweating depletes Kidney Yin fluids, causing restlessness; exhaustion of Heart Yin fluids leads to mental dullness and confusion; lack of Stomach fluids results in dry, hard stool and delirium. Erroneous use of warming needles adds fire to fire, causing fear and palpitations; Earth (Spleen) and Water (Kidney) are oppressed by fire, leading to irritability and inability to sleep. Yangming Wind-Strike involves the Qi level and should not be blindly purged. Here, since signs of Stomach excess are present, purging is not necessarily wrong. However, purging empties the Stomach; while symptoms like wheezing, fullness, sweating, aversion to heat, and body heaviness may cease, pathogens lingering in the Upper Jiao will not be eliminated by purging, thus disturbing the diaphragm and causing deep-seated vexation and regret. In Yangming disease, erroneous sweating is considered severe, while erroneous purging is lighter. The phrase "coating on the tongue" connects to the preceding four sections. Aversion to cold and preference for heat are governed by the Heart Master; symptoms of confusion, fearfulness, and regret are caused by Heart pathology, hence the tongue should be examined. The tongue is the external manifestation of the Heart; the severity of Heart heat can be evidenced by the thickness and depth of color of the tongue coating. Zhizi Chi Tang summarizes the symptoms of the previous four sections. It must be understood that this formula is designed to simultaneously resolve both exterior and interior aspects when the Stomach home first receives pathogens, not solely for post-purging conditions. Initially, Yangming disease is neither entirely exterior nor entirely interior; all symptoms lie in the semi-exterior region within. Sweating, purging, and warming needles are all contraindicated. What method should be used? Only emesis serves as an outlet for expelling Yangming exterior pathogens. However, if the disease is in the chest, Gouti San (Melon Spike Powder) is appropriate. Since the disease here is in the abdomen, Gouti San is unsuitable, and Zhizi Chi Tang is indicated. Exterior symptoms such as spontaneous sweating, aversion to heat, and body heaviness will be resolved; interior symptoms such as wheezing, fullness, dry throat, and bitter taste will naturally subside.

The presence of Zhizi Chi Tang in Yangming disease is analogous to Guizhi Tang (Cinnamon Twig Decoction) in Taiyang disease; both can expel pathogens and rectify errors, allowing the Upper Jiao to unblock, fluids to descend, and Stomach Qi to harmonize.

If there is thirst with desire to drink water, dry mouth, and dry tongue, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated.

The preceding text describes Yang pathogens entering from the exterior into the interior; this section describes a syndrome progressing from shallow to deep. Dry throat, bitter taste, and aversion to heat indicate heat in the interior but not yet affecting the Heart; confusion, fearfulness, and regret indicate entry into the Heart but not yet the Stomach; dryness, thirst, and desire to drink indicate heat has entered the Stomach but has not yet caused dryness and hardness. Baihu Jia Renshen Tang clears Stomach Fire and supports Original Qi, completely independent of sweating, emesis, or purging methods.

If the pulse is floating, there is fever, thirst with desire to drink water, and dysuria, Zhu Ling Tang (Polyporus Decoction) is indicated.

The previous section was based on the various symptoms of the first section; this section builds upon the mention of drinking water in the preceding text. The repeated use of "if" highlights Zhang Zhongjing's detailed approach to managing diseases. Where Zhizi Chi Tang is insufficient, Baihu Tang follows; where Baihu Tang is insufficient, Zhu Ling Tang follows. These are the initial three methods for treating Yangming disease. This is done to preserve Stomach fluids, preventing both Stomach dryness and water accumulation invading the Stomach. Further implications are found in the Zhu Ling Tang section.

After sweating, emesis, or purging, deficiency vexation and insomnia occur. If severe, the patient tosses and turns, experiencing deep-seated vexation and regret in the heart; Zhizi Chi Tang is indicated. If there is shortness of breath, Zhizi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is indicated. If vomiting occurs, Zhizi Shengjiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is indicated.

Deficiency vexation is a transformed syndrome of Yangming, treated according to symptoms using Gardenia formulas, similar to how Taiyang transformed syndromes are often treated with modified Guizhi Tang. Replacing burning needles with emesis, and using "regret" to encompass confusion and fearfulness, allows for mutual textual interpretation. Zhizi Chi Tang was originally designed for irritability and vexation, and can also treat deficiency vexation; thus, Yangming deficiency differs from Taiyang deficiency, and Yangming vexation differs from Taiyang vexation. Although the first sentence mentions sweating, emesis, and purging, the main point refers specifically to post-purging states, as Yangming diseases are often mishandled by premature purging. "Tossing and turning" vividly depicts the state of insomnia, bringing life to the term "deficiency vexation." This is because fire nature is agitated, leaving the Heart without support. The Heart resides above the Stomach, which is the exterior of Yangming. All Heart diseases stem from Yangming exterior pathogens; thus, Zhizi Chi Tang is formulated to induce emesis顺势 (following the trend). Generally, Taiyang exterior syndromes require sweating but not emesis; Yangming exterior syndromes require emesis but not sweating; Taiyang interior syndromes require promoting urination but not purging; Yangming interior syndromes require purging but not promoting urination. People today only know sweating as resolving the exterior, unaware that emesis also resolves the exterior; thus, within Zhang Zhongjing's great principles, they recognize sweating and purging but omit emesis. Shortness of breath and vomiting are differentiated from deficiency vexation. Vexation inevitably damages Qi; add Licorice to tonify Qi. Deficiency heat binding together inevitably causes vomiting; add Ginger to disperse pathogens.

After sweating or purging, if vexation-heat and chest oppression occur, Zhizi Chi Tang is indicated.

"Oppression" refers to stagnation. If vexation is deficiency vexation, then heat is deficiency heat, and oppression is deficiency oppression. This results from heat damaging the Monarch (Heart), leading to insufficient Heart Qi. Treating with Zhizi Chi Tang exemplifies "benefiting Heart Yang, allowing even cold to circulate freely." After erroneous purging, stagnation is not in the epigastrium but in the chest; thus, Zhizi Chi Tang is still used, following the same logic as using Guizhi Tang for unresolved exterior symptoms after purging in Taiyang disease. Generally, if the disease does not change, the formula should not change.

After purging, if vexation increases and the epigastrium is soft to pressure, it is deficiency vexation, suitable for Zhizi Chi Tang.

Increased vexation means vexation recurring after resolution. Softness of the epigastrium contrasts with chest oppression and differs significantly from hardness of the epigastrium. It must be known that Yangming deficiency vexation contrasts with Stomach excess heat; it is "empty" deficiency, not "weak" deficiency.

In Yangming disease, after purging, if there is residual heat on the exterior, warm hands and feet, no formation of Chest Binding, deep-seated vexation and regret in the heart, hunger but inability to eat, and sweating only on the head, Zhizi Chi Tang is indicated.

Residual heat on the exterior means body heat has not subsided. Warm hands and feet indicate no profuse sweating yet, resembling pre-purging symptoms, showing that premature purging was inappropriate. Absence of Chest Binding indicates no fluid retention in the epigastrium, confirming Yangming dry transformation. Deep-seated vexation and regret indicate persistent heat in the Upper Jiao. Hunger but inability to eat indicates pathogenic heat failing to digest food. Sweating only on the head without jaundice indicates Heart Fire flaring upward and absence of fluid retention in the skin. This refers to post-purging transformations. Yangming disease inherently has indications for purging. However, if exterior signs persist and purging is too early, although the Stomach may not be damaged, Upper Jiao Fire depression fails to communicate. Zhizi Chi Tang should still be used to induce emesis; once the Heart is clear, interior and exterior naturally harmonize.

In Shanghan (Cold Damage) at five to six days, after vigorous purging, if body heat persists and there is knotted pain in the heart, the disease is not resolving; Zhizi Chi Tang is indicated.

Disease originating in Yang but treated with purging leaves exterior heat unresolved and causes knotted pain in the heart. Although milder than Chest Binding, it is more severe than regret. Chest Binding involves water accumulation in the chest and hypochondrium, treated with Xianxiong Tang (Major Pinellia Decoction); water depression is broken. Here, heat accumulates in the heart, treated with Zhizi Chi Tang; fire depression is vented.

Zhizi Chi Tang:
Zhizi (Gardeniae Fructus) (14 pieces) Xiangchi (Prepared Fermented Soybeans) (4 he, wrapped in silk)
Take these two ingredients, boil in 4 sheng of water. First decoct Zhizi until 2.5 sheng remains, then add Xiangchi. Boil until 1.5 sheng remains, remove dregs, divide into two doses. Take warm. If vomiting occurs, stop subsequent doses.

Zhizi Gancao Chi Tang:
Add Gancao (Licoriae Radix) (2 liang) to the base formula. Remainder of preparation is the same as above.

Zhizi Shengjiang Chi Tang:
Add Shengjiang (Zingiberis Rhizoma Recens) (5 liang) to the base formula. Remainder of preparation is the same as above.

This is an emetic and draining agent for Yangming half-exterior, half-interior syndromes. Shaoyang half-exterior is cold, half-interior is hot. Yangming heat moves from interior to exterior, presenting heat without cold. Exterior signs include body heat, sweating, absence of aversion to cold but presence of aversion to heat, body heaviness, or eye pain, nasal dryness, and inability to sleep. Interior signs include dry throat, bitter taste, tongue coating, irritability, thirst, deep-seated vexation and regret, abdominal fullness, and wheezing. This heat is half-exterior, half-interior. Although the pulse is floating and tight, it cannot be diagnosed as Taiyang disease and is not suitable for sweating agents. Moreover, the disease is in the chest and abdomen but has not entered the Stomach Fu organ, so purging is inappropriate. The method should be emesis to disperse pathogens. Zhizi is bitter and can drain heat, cold and can overcome heat; its shape resembles the Heart; its red color corresponds to the Heart, thus removing Heart vexation, confusion, regret, and knotted pain. Beans resemble the Kidney; processed into Chi, they become light and float upward, enabling pathogens in the Heart and abdomen to exit via the mouth. One emesis relieves the Heart and abdomen, clearing all interior and exterior vexation-heat. This is because "diseases of the Two Yangs originate in the Heart and Spleen"; the aforementioned symptoms represent Heart-Spleen heat, not Stomach heat, aligning with the principle "where heat belongs to the Zang organs, attack it, do not induce sweating." If heat damages Qi causing shortness of breath, add Licorice to tonify Qi. If deficiency heat binds causing vomiting, add Ginger to disperse pathogens. Zhizi paired with Chi in Zhizi Chi Tang, and Red Bean paired with Chi in Gouti San, both embody the interaction of Heart and Kidney.

In Shanghan, if a physician uses pill-based purgatives vigorously, and body heat persists with slight vexation, Zhizi Ganjiang Tang (Gardenia and Dried Ginger Decoction) is indicated.

Attacking the interior does not avoid cold; using pill purgatives vigorously implies cold pathogens remaining in the middle. Slight Heart vexation without regret indicates emesis is unsuitable. Use Zhizi to relieve vexation and double the amount of Ganjiang (Zingiberis Rhizoma) to drive out internal cold and disperse exterior heat. Cold utilized through heat, heat utilized through cold; two ingredients form the prescription, completing the three methods.

After Shanghan purging, if there is Heart vexation, abdominal fullness, and restlessness, Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction) is indicated.

Heart vexation makes lying down difficult; abdominal fullness makes standing up difficult. Restlessness indicates Heart heat transferring to the Stomach, differing from the tossing-and-turning deficiency vexation. Zhizi treats vexation; Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) drain fullness. This is a subtle agent resolving both Heart and abdomen. Heat has entered the Stomach, so emesis is contraindicated; stool is not yet dry and hard, so purging is contraindicated. This is a preliminary step toward Xiao Chengqi Tang (Minor Order the Qi Decoction).

Zhizi Ganjiang Tang:
Zhizi (14 pieces) Ganjiang (Dried Ginger) (2 liang)
Take these two ingredients, boil in 3 sheng of water until 1.5 sheng remains, remove dregs, divide into two doses. Take warm.

Zhizi Houpo Tang:
Zhizi (14 pieces), Houpo (4 liang), Zhishi (Immature Bitter Orange). Remainder of preparation is the same as above.

The nature of Zhizi allows it to descend curvingly; it is not an emetic agent. Only the fermented aroma of Chi rises to熏 (fumigate) the Heart and Lungs, inducing vomiting. Observing that Gouti San must be taken with Chi juice confirms that the emetic effect lies in Chi, not Zhizi. Zhizi Ganjiang Tang removes Chi and adds Ginger to achieve horizontal dispersion; Zhizi Houpo Tang replaces Chi with Zhishi and Houpo to achieve downward drainage, avoiding upward projection. Old editions stating "stop subsequent doses if vomiting occurs" for both formulas are erroneous. Observing Zhizi Baipi Tang and Yinchen Hao Tang, which contain Zhizi but do not mention vomiting, and the contraindication for patients with chronic loose stools, clarifies Zhizi's nature.

For Shanghan with body heat and jaundice, Zhizi Baipi Tang (Gardenia and Phellodendron Bark Decoction) is indicated.

Body heat and sweating characterize Yangming disease. If cold pathogens are too heavy, Yang Qi is constrained in the exterior, preventing sweating and heat release, leading to jaundice. Yellow is the color of Earth; intense Stomach Fire and depleted fluids cause yellowing in the muscles. This differs distinctly from Taiyang erroneous purging where cold water remains in the skin; it is not suitable for sweating, emesis, or purging. Bitter-sweet agents are required for regulation. Zhizi, Baipi (Phellodendri Cortex), and Gancao are all yellow in color and moist in texture. Zhizi treats internal vexation; Baipi treats exterior heat; Gancao harmonizes Qi. Diseases of form and color are treated using corresponding forms and colors.

Zhizi Baipi Tang:
Zhizi (15 pieces) Gancao (2 liang) Huangbai (Phellodendri Cortex)
Take these three ingredients, boil in 4 sheng of water until 1.5 sheng remains, remove dregs, divide into two warm doses.

In Yangming disease, absence of sweating, dysuria, and deep-seated vexation and regret in the heart indicate impending jaundice.

Yangming disease typically presents with sweating; absence of sweating prevents heat release. Dysuria prevents heat descent. Heart fluids fail to sustain, causing deep-seated vexation and regret even without prior sweating or purging. Absence of sweating and dysuria are the origins of jaundice; deep-seated vexation and regret are the precursors. However, absence of thirst and abdominal fullness makes Yinchen Hao Tang unsuitable; Zhizi Baipi Tang will resolve the jaundice.

If Yangming disease is subjected to fire therapy, with slight sweating on the forehead and dysuria, jaundice will definitely develop.

Yangming disease lacks exterior signs and should not be sweated, let alone subjected to fire coercion. The forehead is the area of the Heart; slight sweating here indicates exhaustion of Heart fluids. Heart deficiency leads to Kidney deficiency, causing dysuria and jaundice. How else can Zhizi Baipi Tang restore fluids amidst depletion?

In Yangming disease, if the face is fully red, purging is contraindicated; otherwise, fever and yellowing will occur, along with dysuria.

Full redness of the face indicates Yang Qi constrained in the exterior, requiring sweating for resolution. Erroneous purging prevents heat release, causing recurrent fever and transformation of redness into yellow. The previous section resulted from fire reversal; this section from erroneous purging. The former had dysuria before jaundice; this section has jaundice before dysuria. Both result from fluid depletion failing to regulate water passages. Zhizi and Baipi are needed to nourish the source and generate fluids; diuretic agents are unsuitable. For jaundice not yet developed, Zhizi Chi Tang is appropriate; for developed jaundice, Zhizi Baipi Tang is appropriate.

Zhang Zhongjing has two methods for treating Taiyang jaundice: Head sweating only with dysuria requires Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Small Soybean Decoction) to sweat; lower abdominal hardness with normal urination requires Di Dang Tang (Di Dang Decoction) to purge. He has two methods for treating Yangming jaundice: Head sweating, dysuria, and abdominal fullness require Yinchen Hao Tang plus Da Huang (Rhei Radix et Rhizoma) to purge; body heat, jaundice, and iatrogenic cases require Zhizi Baipi Tang to clear. Diuretic agents are never used. It must be known that Zhang Zhongjing's treatment of Yangming focuses on preserving fluids, avoiding promoting urination, fearing Stomach dryness above all, adhering to the principle "treat diseases by seeking their root."

When using any Zhizi Tang, if the patient has a history of chronic loose stools, it must not be administered.

Since ancient times, if Stomach Qi is not firm, even Zhizi is contraindicated. One must be cautious when using Chengqi Tang formulas.