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[General Principle] Zhang Zhongjing said: In Yangming disease, if the face appears reddish, purgation must not be used. If purgation is mistakenly applied, it will inevitably lead to fever, yellowing of the skin, and difficult urination. When a patient presents with difficult urination, stool that is occasionally difficult and occasionally easy, slight fever at times, wheezing, and dizziness preventing them from lying down, this indicates the presence of dry fecal impaction (dry shit). Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
Two or three days after contracting the disease, if the pulse is weak, there are no symptoms of Taiyang disease or Shaoyang disease (Chaihu syndrome), but rather irritability and hardness in the epigastrium. By the fourth or fifth day, even if the patient can eat, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be given in small amounts to gently harmonize the stomach and intestines. If there is still no bowel movement, by the sixth or seventh day, if urine output is scanty, and even if the patient cannot eat, but the stool is hard at the beginning and loose at the end, one must wait until urination becomes smooth and the stool is confirmed to be hard before using Da Cheng Qi Tang for purgation. In Yangming disease, if there is difficult urination due to cold invasion, inability to eat, sweating on the hands and feet, and stool that is hard initially but loose later, this suggests the impending formation of a stubborn mass (Gu Jia).

[Commentary] Cheng Wuji stated: Yellowing of the skin, Pi syndrome (fullness and obstruction), and difficult urination caused by heat diseases are all due to the stagnation of heat. Difficult urination caused by the binding of wind-dampness or Yangming wind-strike is due to the assault of cold pathogens. Difficulty in urination often results from prior sweating or purgation therapies.

[General Principle] Zhang Zhongjing said: If the pulse is floating, there is fever, thirst with a desire to drink water, and difficult urination, Zhu Ling Tang (Polyporus Decoction) is the primary treatment.

[Commentary] Wang Kentang stated: The character "floating" here is erroneous. *Huo Ren Shu* (The Book That Saves Lives) states: For a floating pulse, use Wu Ling San (Five-Ingredient Powder with Poria); for a sinking pulse, use Zhu Ling Tang. From this, we know that the original text likely omitted the character "not" after the word "pulse." Wu Ling San consists of Fu Ling (Poria), Zhu Ling (Polyporus), Ze Xie (Alisma), plus Gui Zhi (Cinnamon Twig) and Bai Zhu (Atractylodes Macrocephala Rhizome). Zhu Ling Tang consists of Zhu Ling (Polyporus), Fu Ling (Poria), Ze Xie (Alisma), plus E Jiao (Donkey-Hide Gelatin) and Hua Shi (Talcum). Gui Zhi and Bai Zhu have acrid-sweet flavors and belong to Yang, primarily acting on the exterior; E Jiao and Hua Shi have sweet-cold flavors and belong to Yin, primarily acting on the interior. Zhu's words can be said to faithfully reflect Zhongjing's intent. However, because Zhu wished to clearly distinguish between the two formulas, he deliberately contrasted "sinking" with "floating," causing later generations to doubt. It is inappropriate to mention a sinking pulse in the context of the Three Yang diseases, which would otherwise prevent suspicion of textual omission in the classic. Furthermore, while Taiyang diseases indeed present with a floating pulse, Yangming disease is interior to the exterior; thus, its pulse is described as "long" rather than "floating." A long pulse is neither floating nor sinking. Cheng Wuji interpreted it directly as a floating pulse, whereas Zhu Gong discussed it as a sinking pulse; both were mistaken. If one says, "For a floating pulse, use Wu Ling San; for a sinking pulse, use Zhu Ling Tang," then the true meaning is captured.