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[General Principle] Zhang Zhongjing stated: In Yangming disease, profuse sweating is the norm. If there is a lack of sweating and the body feels as if insects are crawling under the skin, this is due to long-standing deficiency.

[Commentary] Zhao Sizhen said: The sensation of insects crawling under the skin corresponds to the symptom of body itching described in Taiyang disease. "Long-standing deficiency" refers to insufficiency of Wei Qi (Defensive Qi) at the exterior, leading to a lack of Jin-Ye (Body Fluids) nourishing the skin. This causes the Cou-Li (pores and skin texture) to become dry and astringent, making it difficult for sweat to be excreted. If one argues that deficiency requires tonification, one must consider that Yangming has been invaded by pathogenic factors; can pathogens be treated with tonification? Formulas such as Shu Fu Tang (Atractylodes and Aconite Decoction) or Huang Jian Zhong Tang (Astragalus Middle-Warming Decoction), as used in *The Living Manual*, are astringent and stop-sweating agents. Using them would further stagnate Ying (Nutritive) and Wei (Defensive) Qi, preventing the pathogen from exiting and causing internal heat to arise. Moreover, since there are no symptoms of vomiting, diarrhea, or stomach deficiency indicating an interior condition, but rather only a deficiency of exterior Qi in the skin, the appropriate method is harmonization. It is advisable to borrow Xiao Chai Hu Tang (Minor Bupleurum Decoction); if there is heat, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) may be used. Thus, sweet and acrid formulas can harmonize Ying and Wei, promote the circulation of fluids, and resolve the condition.

Cheng Jiaoqian said: This is a syndrome where Stomach Heat combines with Cold Pathogens and becomes stagnant in the muscle layer. The mention of "long-standing deficiency" clarifies the reason why the pathogen cannot penetrate out to the muscular surface.

Fang Xingzhong said: The Yangming channel governs the muscles. Since the Cou-Li are open, profuse sweating is expected; therefore, the absence of sweating is considered abnormal. The lack of sweating allows Cold to prevail and the Cou-Li to close, resulting in the sensation of insects crawling on the body.

Wei Litong said: The sensation of insects crawling under the skin indicates that Pathogenic Heat desires to exit the exterior as heat and sweat, but the Healthy Qi is too weak to facilitate this. Consequently, the Stomach cannot form a solid excess pattern. It is explicitly stated that this is due to long-standing deficiency. To allow the heat to penetrate the exterior, sweat must be allowed to penetrate the exterior. However, since Yangming has already formed an interior syndrome and the Middle Qi is deficient, and there is no indication for diaphoresis (sweating-inducing therapy), the treatment should solely focus on clearing heat and tonifying deficiency. This sweat is not induced by diaphoretics nor by muscle-releasing agents, but rather by tonifying deficiency and clearing heat, thereby resolving both exterior and interior aspects simultaneously. Yu Jia Yan suggested that Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) is an example. It is accurate to describe this syndrome as Stomach Deficiency with Heat, but inaccurate to describe it as Stomach Cold. In the Taiyang chapter, when discussing diseases about to enter the interior to form Stomach Excess, it is often emphasized that if the Stomach has not yet formed excess, purgation should not be rushed. From this, we can understand that when a disease initially transmits to Yangming, it often remains in the channels rather than entering the fu organs. One should not hastily conclude that purgation is the only treatment option.