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Yangming disease is characterized by "Wei Jia Shi" (Stomach Family Excess, referring to the excess syndrome of intense pathogenic heat in the stomach and intestines with accumulation of dry feces).

The Yangming channel belongs to the Fu organs responsible for transmission and transformation; it should alternate between fullness and emptiness. When food enters the stomach, the stomach is full and the intestines are empty; when food moves down into the intestines, the intestines are full and the stomach is empty. If there is only fullness without emptiness, this constitutes the root cause of Yangming disease. Simple "stomach excess" does not equate to Yangming disease, but all manifestations of Yangming disease originate from "stomach excess." Therefore, "Wei Jia Shi" serves as the general outline for the Yangming channel. However, the causes leading to "excess" require careful examination: there is excess present before the onset of illness, excess formed after the onset; excess caused by external constraint of wind-cold preventing heat dissipation, excess resulting from severe fluid depletion due to erroneous use of sweating, vomiting, or purging methods, excess due to hyperactivity of heat within the primary channel, and excess transmitted from other channels. This text merely lists that the root cause lies in "excess," and one must not assume that "stomach excess" automatically indicates a condition suitable for purgation. Comparing the Yangming outline here with that in *Neijing·Re Lun* (Treatise on Cold Damage), they differ. *Re Lun* emphasizes meridians, placing the pathology at the exterior; whereas this text focuses on interior syndromes, where interior disharmony constitutes Yangming disease. Although other clauses may mention exterior symptoms, Zhang Zhongjing's intent is not primarily on treating the exterior; nor is his intent on other channels when complications arise. Yangming governs "closing" (He); thus, for any interior disharmony, the focus is on "closing disease." Constipation is indeed "closing"; oliguria is also "closing." Inability to eat, difficulty in consuming large meals, initial desire to eat followed by inability to eat, are all manifestations of "closing." Spontaneous sweating and night sweats indicate the exterior is open while the interior is closed. Conversely, absence of sweating indicates both interior and exterior are closed. Various "closing diseases" may or may not appear; hence, the outline uniquely identifies "stomach excess" as the standard. "Stomach excess" does not exclusively refer to hard, dry feces, but is defined in contrast to diarrhea. Diarrhea indicates the stomach family is not in excess. Therefore, after resolving via sweating, if diarrhea occurs due to stomach disharmony, it is not termed Yangming disease. If there is stomach deficiency without diarrhea, it belongs to Yangming. Even cases starting with hard stool followed by loose stool generally fall under "Wei Jia Shi." The reason is that Yangming and Taiyin share the middle jiao but have distinct functions. The stomach governs reception, so Yangming governs excess; the spleen governs transportation and distribution, so Taiyin governs diarrhea. Although both involve the stomach organ, their division of labor distinguishes the two channels.

Q: "What are the external manifestations of Yangming disease?" A: "Body fever, spontaneous sweating, aversion to cold is absent, but aversion to heat is present."

Yangming governs the interior, yet has external manifestations because internal pathology manifests externally; these are not separate external symptoms. The external manifestation of stomach excess involves body heat feeling like steaming, where intense interior heat reaches the surface, differing from the fever of exterior pathogens in Taiyang disease. Sweating is profuse and continuous, overflowing from the interior without cessation, differing from sweating caused by wind pathogens in Taiyang disease. Since exterior cold has dispersed, there is no aversion to cold; since interior heat is constrained, there is aversion to heat. Due to the root cause of "Wei Jia Shi," external signs of body fever and spontaneous sweating appear, along with the clinical picture of no aversion to cold but aversion to heat. However, this only indicates the emergence of pathological mechanisms, not an immediate indication for purgation; mild agents should be used to harmonize. Purgation is only appropriate when delirium, tidal fever, irritability, and abdominal distension occur simultaneously.

These four points constitute the outline of Yangming external symptoms. Thus, even cold deficiency in the stomach can be called Yangming disease because its external presentation matches this description.

In Yangming disease, if the pulse is floating and tight, tidal fever will definitely occur at regular intervals; if the pulse is only floating, night sweating will definitely occur.

Yangming pulse patterns differ from Taiyang. In Taiyang, a floating and tight pulse is accompanied by body pain, absence of sweating, aversion to cold, and persistent fever. Here, tidal fever occurring intermittently indicates that aversion to cold is about to cease; this is the pulse pattern just before tidal fever develops. This is what is meant by "tightness entering the interior"; one cannot rigidly adhere to the notion that "tight pulse equals cold." In Taiyang, a purely floating pulse implies absence of sweating. Here, night sweating occurs due to interior heat. Furthermore, it differs from the initial stage of this channel where floating pulse accompanies absence of sweating and wheezing; thus, one cannot rigidly apply the rule that "floating pulse indicates exterior." A floating and tight pulse does not fit the Mahuang Tang syndrome; body fever with sweating does not fit the Guizhi Tang syndrome. Administering Mahuang or Guizhi decoctions when yang is abundant leads to death. These pulse changes stem from meridian variations, not a contradiction between pulse and disease. One must understand that Zhang Zhongjing differentiates channels and pulses, and one should not rely solely on pulse to diagnose.

After three days of cold damage, the Yangming pulse becomes large.

A large pulse represents the convergence of two yangs, indicating yang abundance inside and out. At the beginning of Yangming disease, when the pathology is still at the exterior, the pulse is merely floating and not yet large, similar to Taiyang, allowing for Mahuang or Guizhi treatments. By the second day, aversion to cold ceases spontaneously, replaced by aversion to heat. By the third day, heat intensity peaks, causing the pulse to become surging and large accordingly. This is the correct pulse for "Wei Jia Shi." If the pulse is small rather than large, it belongs to Shaoyang.

*Neijing* states: "When Yangming prevails, the pulse is short and choppy." This refers to the normal pulse during autumn when metal qi dominates. It also states: "The Yangming pulse image is large and floating." This refers to the pathological pulse of converging yangs.

If the pulse is floating and large, the epigastrium feels hard despite heat, and the pathology belongs to the Zang organs, purgation should be used, avoiding sweating; if the pathology belongs to the Fu organs, frequent urination should be avoided, as frequent urination leads to hard stools. Profuse sweating exacerbates heat; scant sweating makes defecation difficult. If the pulse is slow, purgation is not yet indicated.

This outlines the major principles for treating Yangming disease. Yangming governs diseases arising from fluids; when fluids dry up, "Wei Jia Shi" forms. There are two ways fluids dry up: excessive sweating damages upper jiao fluids, and excessive urination damages lower jiao fluids. Once damaged, stools become hard and difficult to pass, hence sweating and diuresis are prohibited. Pulses that are floating-tight, floating-slow, floating-rapid, or floating-slow are not suitable for purgation but for sweating. Here, a floating-large pulse is unsuitable for sweating but suitable for purgation because it represents the third-day Yangming pulse; a large pulse indicates disease progression, so one must not rigidly hold that "floating means exterior." "Epigastrium" refers to the stomach opening. Epigastric hardness reveals aspects of stomach excess. Because exterior pulses should not show interior signs, it is said to be "reversely hard." "Heat belonging to Zang" refers to heat in the heart and lungs, not specifically stomach excess. "Purgation" here means clearing heat, not attacking excess, akin to using Huangqin Tang to remove heat. "Do not allow" is prohibitive language, implying the intention to clear heat from the heart. Once the upper jiao is unblocked, fluids descend naturally, and stomach qi harmonizes. "Belonging to Fu" refers to the bladder, not the stomach. Bladder heat causes frequent urination. The prohibition implies the need to nourish yin. "Belonging to Fu" is supplementary; the main point is Zang heat. The sentence on profuse sweating directly follows the sweating clause. Sweat is the fluid of the heart; sweating indicates heat in the Zang. Why prohibit sweating? Because profuse sweating depletes fluids, and fire seeks dryness, worsening heat and making stools harder. Even slight sweating may lead to hard stools, favoring urgent purgation. Zhang Zhongjing treats Yangming not fearing stomach excess but fearing Zang heat, prioritizing clearing heat over purging. Prohibiting sweating and diuresis preserves fluids, thereby harmonizing excess. However, syndromes have deficiency/excess, and pulses have true/false qualities. If the pulse is slow, it is not Zang excess; thus, floating-large pulses are deficient. Zhang Zhongjing highlights this to clarify that epigastric hardness with heat in the Zang prohibits reckless purgation, demonstrating extreme caution.

In Yangming disease, if the epigastrium is hard and full, do not purge. If purged and diarrhea persists uncontrollably, death ensues; if diarrhea stops, recovery occurs.

Although Yangming symptoms are present and epigastric hardness might suggest purgation, if it is hard but not fully distended, heat pathogens are scattered in the stomach and not yet consolidated. Recklessly purging heat causes cold to rise after heat leaves, transferring cold to the spleen, turning excess into deficiency, leading to uncontrollable diarrhea. If diarrhea stops spontaneously, it indicates the stomach is not deficient and the spleen is solid; rotting filth is expelled, and pathogens remain, leading to recovery. The previous clause involved heat in the Zang, favoring urgent purgation to preserve fluids. This clause involves early intense heat, prohibiting reckless purgation to protect middle qi. Note that abdominal distension belongs to Taiyin; Yangming and Taiyin are paired. Stomach excess causes Taiyin to transfer to Yangming; stomach deficiency causes Yangming to transfer to Taiyin. This precision in Zhang Zhongjing’s treatment requires careful attention by diagnosticians.

In cold damage, if vomiting is frequent, even if Yangming symptoms exist, do not purge.

Frequent vomiting indicates water qi in the upper jiao. Even with stomach excess, Xiaochaihu Tang should be used to regulate fluids; purging risks uncontrollable diarrhea. Note that in Yangming disease, if fluids are not depleted, purgation must be strictly avoided. Abdominal distension and vomiting are related Taiyin-Yangming syndromes; stomach excess and deficiency distinguish Yangming and Taiyin. Although "Wei Jia Shi" produces myriad changes, it remains a vital yang state; uncontrollable diarrhea, unresponsive to Renshen and Fuzi, is a dead yin state.

In Yangming disease, with spontaneous sweating, if sweating is induced again and urination is free, this indicates internal exhaustion of fluids. Although stools are hard, do not purge. Wait until the patient desires defecation, then use Honey Suppository to facilitate passage. Radix Trichosanthis (Tianguagen) or large pig bile enemas can also serve as guides.

Spontaneous sweating followed by induced sweating exhausts upper jiao fluids externally; free urination exhausts lower jiao fluids internally. With both upper and lower fluids exhausted, stomach fluids are depleted, explaining hard stools. Hard stools with free urination indicate interior excess without interior heat. Yangming excess worries about dryness less than heat. Since there is no interior heat here, external moistening of dryness suffices. The repetition of "spontaneous" emphasizes that for stomach excess without transformation, natural processes should be allowed, avoiding reckless treatment. One must probe the patient's preferences; guide them when they wish to defecate, and wait quietly otherwise. Why? "Wei Jia Shi" is the disease root but also the life root. Prohibiting purgation considers potential deficiency first.

In Yangming disease, originally with spontaneous sweating, if the doctor induces heavy sweating, and although the illness improves, mild vexation persists, this is due to hard stools. Fluid depletion and stomach dryness cause hard stools. Ask how many times the patient urinates daily. If previously 3-4 times and now only twice, stools will likely pass soon. Now, with reduced urination frequency, fluids return to the stomach, ensuring stools will pass soon.

Treating disease requires addressing the root. The stomach is the root of fluids. Sweat and urine derive from fluids. Original spontaneous sweating and normal urination indicate abundant stomach fluids. Zhang Zhongjing mentions "fluid depletion" to warn those who neglect fluids. "Illness resolved" refers to cessation of fever and sweating. Vexation implies aversion to heat. Mild vexation suggests aversion to heat will cease; persistence indicates hard stools. Reduced frequency refers to twice daily. Hard stools and reduced urine result from stomach fluid depletion, not interior yang excess. Due to stomach dryness, ingested water cannot ascend to the lung to regulate water passages and descend to the bladder, causing reduced urine. However, ascending qi can still transport essence to the spleen; fluids generate each other and return to the stomach. Stomach qi harmonizes, and stools pass naturally, requiring no suppositories. This shows that those with abundant baseline fluids will recover fluids even after depletion. It demonstrates that for "Wei Jia Shi," hesitation is advised, warning against reckless purgation or sweating. Listing treatments: slow pulse forbids purgation, epigastric fullness forbids purgation, frequent vomiting forbids purgation, free urination and reduced frequency forbid purgation. All illustrate that "Wei Jia Shi" is not an indication for purgation.

Honey Suppository Formula:
Seven he of honey.
Cook one ingredient in a copper vessel until it thickens like malt syrup. Stir constantly to prevent burning. When moldable, shape by hand into suppositories, pointed at one end, finger-thick, about two inches long. Form while hot; they harden when cold. Insert into the anus; remove when defecation is desired.

Pig Bile Formula:
One large pig gallbladder, extract juice, add a little vinegar, instill into the anus. After approximately one meal time, stools containing old food and waste will pass, with excellent effect.

Q: "Some patients develop aversion to cold without fever on the first day. Why?" A: "Even if developed on the first day, aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat."

Yangming disease typically manifests on the second or third day. The previous clause referred to existing fever; this traces back to the pre-fever stage. On the first day of wind-cold invasion, the pathology is still at the Yangming exterior, similar to Taiyang onset, allowing Mahuang or Guizhi treatments. By the second day, exterior pathogens dissipate, so aversion to cold ceases. Cold stops, heat intensifies, causing spontaneous sweating and aversion to heat. The image of converging yangs appears. Yangming disease often transfers from other channels. Here, the primary channel absorbs cold pathogens; stomach yang activates, expelling cold and transforming into heat. Transfer due to fluid depletion usually takes six to seven days, not one or two. Initially, Yangming aversion to cold resembles Taiyang but lacks head and neck stiffness. Fever and sweating resemble Taiyang Guizhi syndrome. However, "no aversion to cold but aversion to heat" is the pivot of Yangming. Primary channel invasion varies: affecting the face causes eye pain and nasal dryness (pathogen high, heat wins over cold); affecting the chest (Yin region) near the stomach allows rapid resolution of cold.

Q: "Why does aversion to cold cease spontaneously?" A: "Yangming resides in the center earth, the destination of all things, with no further transmission. Starting with aversion to cold, it stops by the second day; this is Yangming disease."

Taiyang disease may have aversion to cold for eight to nine days. Shaoyang features alternating chills and fever; Yin channels have worsening chills. Without sweating or warming the center, how can they cease? Only Yangming aversion to cold ceases spontaneously without exterior release, unlike other channels. The phrase "starting with aversion to cold" emphasizes "Yangming resides in the center." Knowing Yangming aversion to cold stops easily reveals the nature of Yangming disease. The stomach is Wu Earth, located in the middle jiao. Exterior, interior, cold, and heat pathogens all converge and transform here, drying into excess. Excess has nowhere else to transmit, making "Wei Jia Shi" the root of Yangming disease.

Above discusses stomach excess syndrome.

Q: "How does Taiyang become Yangming disease?" A: "In Taiyang disease, if sweating, purging, or promoting urination depletes fluids, causing stomach dryness, it transfers to Yangming. Stomach excess and difficult defecation constitute Yangming."

This clarifies Taiyang transferring to Yangming. This fluid depletion mechanism creates the "Wei Jia Shi" root. Zhang Zhongjing’s Yangming pathology originates from the *Ling Shu* statement that Yangming governs diseases of fluids. Thus, despite symptoms like body fever and nasal dryness in *Re Lun*, the focus remains on fluids. Symptoms like bitter taste, dry throat/nose, inability to sweat, jaundice, and difficult urination in wind-stroke are due to fluid insufficiency. Abdominal distension, urinary difficulty, and indistinguishable food/water are due to fluid metabolism failure. Hence, Zhang Zhongjing earnestly warns practitioners about fluid depletion in treating Yangming.

If the yang pulse is faint and sweating is scant, it indicates self-harmonization; profuse sweating indicates excess. If the yang pulse is solid and sweating is induced, profuse sweating is also excess. Excess leads to yang excess in the interior, fluid depletion, and hard stools.

Yangming governs diseases of fluids. Erroneous sweating damages fluids, causing "Wei Jia Shi." Guizhi syndrome involves original sweating; excessive sweating depletes fluids. Mahuang syndrome involves original absence of sweating; excessive sweating depletes fluids. Although this refers to Taiyang transfer, Yangming exterior syndromes can also exhibit this.

In original Taiyang disease, if sweating is induced initially but is incomplete, it transfers to Yangming.

"Complete" means stopping; it is synonymous with profuse sweating.

In cold damage transferring to Yangming, the patient has continuous slight sweating.

This is another synonym for continuous sweating. It broadly refers to cold damage, not specifically Taiyang.

In cold damage with fever, absence of sweating, vomiting, inability to eat, but suddenly profuse sweating, this indicates transfer to Yangming.

The mechanism of stomach excess lies in profuse sweating; the clinical sign is inability to eat. Initially, cold constraint prevents sweating; subsequently, sudden stomach yang activation causes profuse sweating. Vomiting and inability to eat indicate inherent stomach excess, differing from dry heaving. Sudden sweating distinguishes it from Taiyang wind-stroke, confirming Yangming excess.

In Taiyang disease, cun pulse slow, guan pulse floating, chi pulse weak, with fever, sweating, recurrent aversion to cold, no vomiting, but epigastric stuffiness, this results from physician-induced purgation. If not purged, and the patient has no aversion to cold but thirst, this indicates transfer to Yangming. Frequent urination leads to hard stools; ten days without defecation causes no distress. For thirst wanting water, give small amounts. Treat according to method, using Wuling San.

The pathology lies in thirst. Combined with Guizhi pulse/symptoms, it indicates baseline fluid deficiency. Frequent urination rules out Xiao Ke (wasting-thirst). Thus, hard stools result from fluid insufficiency, not stomach excess. Ten days without defecation without distension/pain/hardness does not constitute Chengqi syndrome. Drinking water and promoting urination is the correct treatment for stomach excess with weak pulse. Wuling San is chosen over Zhuling Tang because exterior heat remains. This is concurrent Taiyang-Yangming disease. See Wuling syndrome discussion for details.

In cold damage, floating-slow pulse and warm hands/feet indicate connection to Taiyin. Taiyin disease typically causes jaundice. If urination is free, jaundice does not occur. By the seventh/eighth day, if stools become hard, it becomes Yangming disease.

Taiyin transferring to Yangming occurs because Yangming is dry earth. It is not due to meridian/exterior-interior relationships but always due to fluid depletion. The pathology hinges on urination. Urinary difficulty means fluids do not circulate, causing damp-earth disease in muscles. Free urination means fluids escape, causing dry-earth disease in the stomach.

Guest asks: "In Taiyin disease, with free urination, sudden irritability and diarrhea on day 7-8 remains Taiyin, but hard stools become Yangming. Why start same but end different?" Answer: "Yin and yang occupy different positions; yang pathways are excess, yin pathways are deficient. Thus, spleen excess eliminates rotting filth, following Taiyin 'opening'; stomach excess blocks earth pathways, forming Yangming 'closing'. This is the distinction."

Above discusses transfer syndromes from other channels.

Q: "How to differentiate Yang Jie (Yang Knotting) and Yin Jie (Yin Knotting) pulses?" A: "Floating-rapid pulse, ability to eat, constipation indicates excess, named Yang Jie. Expected severity on day 17. Deep-slow pulse, inability to eat, heavy body, reverse hard stools indicates Yin Jie. Expected severity on day 14."

Floating is yang/exterior; rapid is heat/Fu. Deep is yin/interior; slow is cold/Zang. Ability to eat is yang/interior heat; inability to eat is yin/middle cold. Light body is yang; heavy body is yin. Constipation is yang; spontaneous diarrhea is yin. This is the fixed pattern of yang excess and yin deficiency. However, yang syndromes can have spontaneous diarrhea, and yin syndromes can have hard stools. Excess contains deficiency, deficiency contains excess, reflecting yin/yang fluctuation. Thus, stomach excess due to yang pathogens is Yang Jie; due to yin pathogens is Yin Jie. Yang Jie eats but does not defecate; Yin Jie cannot eat but can defecate. Why? Upper body is yang, lower body is yin. Yang Jie affects yin, causing constipation; Yin Jie affects yang, causing anorexia. This reflects yang overcoming yin and yin overcoming yang. Three pentads equal half a month...