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Yangming Wind-Strike (Yangming Zhongfeng) presents with bitter taste in the mouth, dryness of the throat, abdominal fullness, slight panting, fever accompanied by aversion to cold, and a floating and tight pulse. If purgation is mistakenly applied, it will result in aggravated abdominal fullness and difficulty in urination.

This clause lacks the meridian symptoms of eye pain and nasal dryness, as well as the superficial pulse that is long at both the Cun and Chi positions. The slight panting, aversion to cold, and floating-tight pulse are identical to the Mahuang Tang Syndrome (Ephedra Decoction Syndrome) of the Taiyang (Greater Yang) disease. The bitter taste and dry throat resemble a combined disease of Taiyang and Shaoyang (Lesser Yang). Furthermore, with the addition of abdominal fullness, it seems similar to a simultaneous contraction of Taiyang and Taiyin (Greater Yin). Since manifestations from other meridians are intermixed while the symptoms of this meridian (Yangming) are not yet prominent, why is it named Yangming Wind-Strike? Because there is no stiffness of the head and neck, it does not belong to Taiyang; because there is no deafness or red eyes, it does not belong to Shaoyang; because there is no abdominal pain and spontaneous diarrhea, it does not involve Taiyin. From this we know that the mouth is the orifice of the Stomach, the throat is the gate of the Stomach, the abdomen is the chamber of the Stomach, and panting is a manifestation of Stomach disease. Although there is currently aversion to cold, it will cease within two days; the floating-tight pulse is also a sign of impending tidal fever. This represents the exterior aspect of the interior disease at the initial stage of Yangming, caused by a constitutional deficiency of body fluids (Jin-Ye), hence these symptoms. If abdominal fullness is mistaken for excess heat in the Stomach and purged, the exhaustion of body fluids will lead to further abdominal fullness and difficulty in urination, while the stool may become easier to pass. This marks the transition from wind-strike to cold-strike, from stomach excess to stomach deficiency, and the mechanism behind the shift from initial ability to eat to later inability to eat. In cases of Cold Damage (Shanghan) or wind-strike, if even one symptom of the Chaihu Tang (Bupleurum Decoction) pattern appears, it should be treated according to the Shaoyang syndrome. Thus, bitter taste and dry throat should be treated as a Shaoyang syndrome. A floating and tight pulse should be described as wiry (Xian).

In Yangming wind-strike, the pulse is wiry, floating, and large, accompanied by shortness of breath, abdominal fullness, pain in the hypochondrium and heart region, obstruction of qi upon prolonged palpation, nasal dryness, absence of sweating, lethargy, jaundice affecting the whole body and face, difficulty in urination, tidal fever, frequent hiccups, and swelling around the ears. Acupuncture provides slight relief, but the exterior syndrome remains unresolved. If the disease persists beyond ten days and the pulse remains wiry and floating, administer Xiao Chaihu Tang (Minor Bupleurum Decoction); if the pulse is only floating without other residual symptoms, administer Mahuang Tang (Ephedra Decoction). If there is anuria, aggravated abdominal fullness, and worsening hiccups, the condition is incurable.

This clause does not mention fever. The term "wind-strike" implies latent exterior heat. "Exterior unresolved" refers to this exterior heat, implicitly suggesting that the interior has resolved. "Disease persisting beyond ten days" is a rhetorical variation indicating the interior has resolved, which should be linked to the phrase "exterior unresolved." The phrase "no residual symptoms" follows "exterior unresolved." "Acupuncture" here refers to needling the Foot-Yangming Meridian to drain excess. "Slight relief" means the interior symptoms have all subsided, but the exterior symptoms remain; it does not mean the swelling around the ears has merely decreased slightly. A wiry-floating pulse indicates that the previous large-floating pulse has diminished, leaving only the wiry quality. This shows that the Yangming pulse and symptoms have ceased, leaving only Shaoyang exterior pathogenic factors, so Xiao Chaihu Tang can be used to resolve the exterior. If the pulse is only floating without wiry or large qualities, it is neither a Yangming nor a Shaoyang pulse. "No residual symptoms" means all previous symptoms have vanished, indicating no Yangming or Shaoyang syndromes. Only Taiyang exterior pathogenic factors remain unscattered, so Mahuang Tang can be given to resolve the exterior. The reason is that Yangming resides in the center; its wind pathogen either transfers from Taiyang or Shaoyang. The mutual scorching of two Yangs causes the exterior heat to persist beyond ten days. With no other symptoms to rely on, treatment must depend on the pulse. Therefore, a wiry-floating pulse indicates residual wind transferring from Shaoyang; a purely floating pulse indicates residual wind transferring from Taiyang. Anuria, aggravated abdominal fullness, and worsening hiccups follow the symptom of swelling around the ears. This indicates unresolved interior conditions: difficulty in urination progresses to anuria, abdominal fullness does not subside, and hiccups worsen. This is not caused by acupuncture, nor is it a transformation after using Chaihu or Mahuang Tang. Taiyang governs the exterior, so wind-strike often presents with exterior symptoms; Yangming governs the interior, so wind-strike often presents with interior symptoms. The wiry pulse is the Shaoyang pulse; the area around the ears, hypochondrium, and lower ribs belongs to Shaoyang. Yangming wind-strike presenting with Shaoyang pulse and symptoms occurs because the Gallbladder is the residence of wind. If it does not combine with Taiyang and Shaoyang pulse/symptoms, but is solely a Yangming disease, it is not named wind-strike. Referencing bitter taste and dry throat, most Yangming wind-strikes transfer from Shaoyang.

This clause discusses wind-strike extensively but omits aversion to wind and aversion to heat. One must understand that although there is initial aversion to cold, it ceases naturally after two days. Since the wind pathogen is not yet resolved, there is no aversion to heat. This distinguishes Yangming wind-strike from Taiyang and Shaoyang, and shows that lingering wind after passing through meridians differs significantly from primary Yangming diseases.

The above discusses Yangming wind-strike syndromes.

In Yangming disease, the ability to eat is termed wind-strike, while the inability to eat is termed cold-strike.

Taiyang governs the exterior, so syndromes are distinguished by exterior signs. Yangming governs the interior, so even if symptoms appear on the exterior, the condition is distinguished by interior signs. Here, the distinction between wind and cold is not only based on the ability to eat, but also to assess the deficiency or excess of the Stomach. Wind and cold are essentially one entity, differentiated by the patient's Stomach Qi. This clause addresses the initial reception of exterior pathogens in Yangming, prioritizing the differentiation of Stomach deficiency/excess as a diagnostic guideline. Its focus is not merely on dividing Yangming into wind-strike and cold-strike.

In Yangming disease, if cold-strike prevents eating, accompanied by difficulty in urination and continuous sweating from the hands and feet, this indicates the impending formation of a stubborn mass (Gu-Jia). The stool will likely be hard initially and loose later. This occurs because of cold in the Stomach and the failure to separate water and grain.

Stomach excess leads to middle-jiao heat, enabling digestion; Stomach deficiency leads to middle-jiao cold, preventing eating. Yangming disease takes Stomach excess as its root, but Stomach cold must be deeply guarded against. Generally, fever, sweating, absence of aversion to cold, and preference for heat define Yangming disease. Here, only hand-and-foot sweating occurs, meaning less fluid loss externally; difficulty in urination means fluid is not lost downward. Yangming disease worries about fluid depletion; here, there is greater concern about the inability to generate fluids.

"Gu-Jia" refers to stools that are hard initially and loose later. Although the anus is constipated, the intestines are not completely dry. Loose stool is a sign of undigested food and water; interpreting Gu-Jia as a fixed accumulation is erroneous. Note: The Large and Small Intestines belong to the Stomach. To know the deficiency or excess of the Stomach, one must examine the bowels and urine. If urination is free, stool is definitely hard; if urination is difficult, stool is hard initially and loose later. People today only recognize hard stool, difficult defecation, and constipation as Yangming disease. Do they also recognize difficult urination, oliguria, infrequent urination, or anuria as Yangming disease?

In Yangming disease, if the patient cannot eat, attacking the heat will inevitably cause hiccups. This is due to deficiency-cold in the Stomach. Because the person is constitutionally deficient, attacking the heat will cause hiccups.

If deficiency-cold in the Stomach prevents eating, drinking water will trigger hiccups.

One must understand that in Yangming disease where eating is impossible, despite fever and aversion to heat, one must not attack the heat. Inability to eat indicates deficiency-cold in the Stomach. Using cold herbs to clear exterior heat constitutes an attack, not necessarily referring to Chengqi Decoctions. The treatment principle for Yangming in Cold Damage favors purgation, but Zhang Zhongjing’s core philosophy emphasizes caution against purgation when inappropriate. Thus, he repeatedly advises distinguishing Stomach deficiency and excess.

In Yangming disease, a slow pulse, abdominal fullness, difficulty in eating until full, mild irritability after eating, dizziness, and inevitable difficulty in urination indicate the impending development of Grain Jaundice (Gu-Dan). Even if purgation is used, abdominal fullness remains unchanged because of the slow pulse.

A floating, wiry, and large pulse in Yangming indicates wind-strike. A slow pulse indicates cold-strike and lack of Yang. Difficulty in eating until full is due to abdominal fullness; abdominal fullness is due to difficulty in urination; irritability and dizziness are triggered by overeating. Food entering the Stomach sends turbid Qi to the Heart, causing irritability. Yang deficiency fails to transform fluids, so clear-yang does not ascend, causing dizziness upon eating; turbid-clear fluids do not descend, causing abdominal fullness and urinary difficulty. Stomach-Warmth fails to reach the Cun position, resulting in a slow pulse. The *Jin Gui Yao Lue* states: "When grain Qi fails to digest, the Stomach suffers from fullness, turbid Qi flows downward, urination is blocked, and the body becomes yellow, this is called Grain Jaundice." One should use Wuling San (Five-Ingredient Poria Pill) to regulate the Stomach and promote diuresis, rather than using Yinchen Hao Tang (Artemisia Capillaris Decoction) to purge. Purging would leave abdominal fullness unchanged and lead to Chu-Zhong (Elimination of the Middle) and hiccups. The reason is that a slow pulse indicates cold in the Zang organs. Spleen Excess allows rotting filth to depart spontaneously. Difficulty in eating until full indicates the Spleen fails to grind and transport. Purging further weakens the Spleen, leading to failure to transform and expel, hence persistent abdominal fullness.

In Cold Damage with a slow pulse, if Huangqin Tang (Scutellaria Decoction) is incorrectly administered to clear heat after six or seven days, death is certain. A slow pulse indicates cold; administering Huangqin Tang removes heat, causing cold in the abdomen and inability to eat. If the patient suddenly eats, this is called Chu-Zhong (Elimination of the Middle), a fatal sign.

Cases introducing Yangming disease typically present with fever, sweating, no aversion to cold, and aversion to heat. Mentioning Cold Damage implies aversion to cold; mentioning clearing heat implies fever. A slow pulse indicates lack of Yang and inability to sweat; one must take Guizhi Tang (Cinnamon Twig Decoction) with warm rice gruel to generate sweat from grain Qi. Huangqin Tang is designed for dysentery with concurrent heat, not for slow-pulse exterior heat. Failing to recognize the slow pulse as interior cold and instead clearing residual exterior heat causes heat to vanish and cold to arise. The previously unable-to-eat patient now suffers from cold-strike, while the sudden ability to eat indicates Chu-Zhong. Chu-Zhong means Stomach-Yang cannot sustain itself and falsely borrows Grain Qi for self-rescue, akin to a dying person forcibly eating.

In Yangming disease, if the patient initially desires to eat, but urination is obstructed while stool remains normal, and they experience joint pain, a slight feeling of heat, sudden manic outbursts, and profuse sweating leading to resolution, this is because Water Qi fails to overcome Grain Qi. Qi and sweat emerge together; if the pulse is tight, recovery occurs.

Initial desire to eat indicates the Stomach is not deficient-cold. Obstructed urination indicates stagnant Water Qi. Normal stool indicates the Stomach is not excess. Joint pain indicates dampness flowing into joints. Slight heat sensation indicates failed drying transformation and dampness in the skin. The Stomach is originally not deficient; due to stagnation of Water Qi, extreme depression leads to sudden mania. Sweat is generated from Grain Qi; profuse sweating indicates Water Qi and Grain Qi exiting together as sweat. A tight pulse contrasts with a slow pulse; here, it does not refer to cold.

If the pulse is slow, and by the sixth or seventh day the patient loses appetite, this is called late onset (Wan-Fa), caused by water retention, indicating the disease is unresolved. If appetite is normal, the disease is resolving.

From initial ability to eat to the sixth/seventh day (when Yang Qi recovers), loss of appetite indicates Stomach cold due to water retention, termed late onset, as stubborn masses or Grain Jaundice remain unresolved. Normal appetite indicates restored Stomach-Yang, signaling resolution.

In Cold Damage, excessive vomiting and purging cause extreme deficiency. Subsequent excessive sweating, combined with exterior Qi stagnation, followed by administering water to induce sweating, results in hiccups. This is due to deficiency-cold in the Stomach.

Yangming resides in the center; fluid depletion can lead to excess or deficiency, both transforming into Yangming disease. Transformations to excess can be purged; transformations to deficiency require warming.

The above discusses Yangming cold-strike syndromes.

Yangming disease tends to resolve from Shen hour (3-5 PM) to Xu hour (7-9 PM).

Shen and You hours are governed by Yangming, known as dusk. "Tendency to resolve" always refers to the exterior. For Taiyang, headache stops and aversion to cold ceases; for Yangming, fever and aversion to heat cease.

The above discusses the time of resolution for Yangming disease.