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[Outline] Zhang Zhongjing stated: The defining characteristic of Yangming disease is "Wei Jia Shi" (Stomach-Fullness Excess, referring to an excess syndrome characterized by intense heat in the stomach and intestines and accumulation of dry stool).

[Commentary] Zhu Gong stated: Absence of aversion to cold, but presence of aversion to heat; sweating from the palms and hypochondrium; dryness and aggregation in the stomach; tidal fever (fever occurring at specific times); constipation; normal urination; abdominal fullness with panting; or delirium. If the pulse is floating and slippery, it is a Interior Syndrome. An Interior Syndrome refers to internal heat. Internal heat belongs to the Yangming channel. Treatment requires purgation.

Li stated: In an Interior Syndrome, initially the pulse is floating and large, but now it has become deep and rapid; initially the spirit is clear and quiet, but now it is irritable and restless; initially there is headache, fever, and aversion to cold, but now there is no aversion to cold, only aversion to heat; irritability is doubled; chest pain extending to the umbilicus and abdomen; spontaneous sweating from the hypochondrium and palms, leading to stomach dryness; dry and constipated stool; dark and scanty urine; dry mouth; mania and delirium; throwing off clothes and blankets; waving hands and kicking feet; all six pulses are forceful. This is a Heat Syndrome transmitted through the meridians. It is also said that if a patient with Yang Excess is mistakenly treated with diaphoresis (sweating method), death will ensue. There are cases where these symptoms appear immediately upon onset of illness, regardless of the number of days passed; timely purgation should be employed. Failure to purge will lead to obstruction of Qi and Blood, resulting in Jue (cold extremities/collapse). Furthermore, another view holds: If the condition is purely Exterior with no trace of Interior pathology, when resolving the Exterior, do not attack the Interior; if the condition is purely Interior with no trace of Exterior pathology, when attacking the Interior, do not resolve the Exterior. If both Exterior and Interior signs are present, or if Exterior signs predominate over Interior signs, or if the Exterior is urgent while the Interior is slow, treat the Exterior first, then attack the Interior. Conversely, if Interior signs predominate over Exterior signs, or if the Interior is urgent while the Exterior is slow, attack the Interior first, then rescue the Exterior. Additionally, for Exterior Deficiency and Interior Excess, medications should be pungent and cool; for Interior Deficiency and Exterior Excess, medications should be pungent and hot. In all cases, regulating the Interior is primary; only after the internal Qi is rectified can the Exterior be treated. Although internal conditions are most urgent, the Exterior cannot be neglected. The distinction between Exterior/Interior and Deficiency/Excess clarifies the physician's principles significantly.

Shen Jin'ao's Note: Although Yangming disease may also involve Exterior pathology, its root always lies in Wei Jia Shi (Stomach-Fullness Excess). The outline highlights this root, implying that consideration of the Exterior is not absent.

[Outline] Zhang Zhongjing stated: In Cold Damage (Shanghan) lasting four or five days, if the pulse is deep and accompanied by panting and chest fullness, the deep pulse indicates an Interior condition. However, if one mistakenly induces sweating, body fluids will leak out, making defecation difficult. Over time, this leads to delirium.

If there is thirst desire to drink water and no Exterior signs, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is the primary treatment. After treating Cold Damage with sweating, if the body and eyes turn yellow, this occurs because cold-dampness remains in the Interior unresolved. Purgation is contraindicated; instead, seek treatment within the framework of cold-dampness syndromes. For Yangming disease presenting with delirium and tidal fever, and a pulse that is slippery and rapid, Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated. Administer one sheng of Xiao Chengqi Tang. If bowel sounds indicating gas passage (zhuan shiqi) occur, administer another sheng. If no gas passage occurs, do not administer more.

If the patient does not have a bowel movement the next day and the pulse becomes faint and choppy, this indicates Interior Deficiency. It is difficult to treat, and Chengqi decoctions should not be administered again. If sweating accompanies delirium, it is due to dry feces retained in the stomach, attributed to Wind pathogen. Purging is required. However, purging should only be performed after the pathogen has passed through the current meridian stage. Premature purging will cause confused speech due to Exterior Deficiency and Interior Excess. Proper purging will lead to recovery; Da Chengqi Tang (Major Order the Qi Decoction) is appropriate.

[Commentary] Zhu Gong stated: In early Cold Damage, fever and aversion to cold are present. After sweating, if aversion to cold ceases but fever intensifies with restlessness, and the pulse changes from floating-large to surging-forceful, or deep-thin-rapid; if the mental state changes from clear-quiet to manic-delirious, this indicates Stomach Excess and Yang Hyperactivity. Another dose of sweating will cause death; purging is necessary for recovery.

After sweating, if further exterior-resolving treatment is avoided, it is because the pulse is deep and forceful. If the pulse is floating, further sweating is required. If after sweating, there is no aversion to cold, only fever, with a deep-forceful pulse or delirium, this indicates Stomach Excess and Yang Hyperactivity; sweating is contraindicated, and purging is required. If the condition persists after purging, it implies that both Exterior and Interior pathogens have weakened. In Yangming disease, headache without aversion to cold but with aversion to heat is caused by Stomach Excess. Yangming Qi Excess attacks the head. Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) is used. If a patient presents with fever for eight or nine days without Exterior or Interior signs, and the pulse is floating and rapid, Da Chaihu Tang (Major Bupleurum Decoction) should be used to purge. Add Dahuang (Rhubarb Root) if constipation is present.

There are cases where Yang Excess symptoms appear immediately upon onset of illness; purging is required without adhering strictly to the number of days.

In cases of severe stagnation and oppression from the heart/chest down to the umbilicus and abdomen, abdominal pain, inability to sit or lie comfortably, dizziness, oppression, and extreme panting, purging should be administered immediately without waiting for other symptoms. For constipation with oppressive discomfort but still retaining some Exterior signs, small doses of Xiao Chengqi Tang should be given to relieve it, avoiding excessive dosage that causes severe diarrhea. Failure to purge leads to obstruction of Qi and Blood, resulting in cold extremities. Physicians who fail to recognize this may misdiagnose Yin Jue (Yin Collapse) and administer warming herbs, causing disaster swiftly. Careful examination is essential.

Liu Wansu stated: For Interior Syndromes, if the pulse is forceful but not floating, with no aversion to wind/cold, no body ache, spontaneous sweating, delirium, constipation, or dry throat/abdominal fullness, purging is indicated while sweating is contraindicated. Choose among the three Chengqi Decoctions. Regardless of whether the pathogen is Wind-Cold, Summerheat, or Dampness, or if neither Exterior nor Interior signs are obvious, provided there is no Exterior sign but indications for purging exist, Sanyi Chengqi Tang (Three-One Order the Qi Decoction) is suitable. Although this medicine is strongly purgative, as long as Exterior Heat does not enter the Interior, complications like Jie Xiong (Chest Binding) or Pi (Glomus) will not occur. In cases of extreme heat binding where multiple purgations fail to relieve the condition and the patient is near death, add Gansui (Kansui Root) to Da Chengqi Tang. For Interior diseases with deep-thin pulses, regardless of pathogen type or presence of Exterior/Interior signs, or injury from various internal/external pathogens, with or without sweating, with heart/abdominal pain/fullness, delirium, irritability, and accumulated internal heat, any case with a deep pulse should be treated with Sanyi Chengqi Tang combined with Jiedu Tang (Detoxification Decoction). Both Jiedu Tiaowei Tang and Chengqi Decoctions can purge intense heat.

Wei Litong stated: A slippery and rapid pulse indicates that while slipperiness suggests heat excess in the Interior, rapidity indicates that the heat has not yet formed solid excrement. Generally, when heat first enters the Fu organs, transforming from floating to deep-large with sluggishness, purging is appropriate. However, a slippery-rapid pulse suggests the heat is still moving rapidly and has not yet hardened into a mass. Xiao Chengqi Tang, which clears heat and regulates fluids, is sufficient. The subsequent discussion demonstrates careful deliberation.

Shen Jin'ao's Note: Interior Syndromes include Deficiency, Excess, Cold, Dampness, and Heat. Any pathogen entering the Interior constitutes an Interior Syndrome, not solely referring to Pathogenic Excess and Yang Hyperactivity.

[Outline] Zhang Zhongjing stated: In Cold Damage, if the pulse is floating and slippery, this indicates Heat on the Exterior and Pathogen in the Interior. Baihu Tang (White Tiger Decoction) is the primary treatment.

[Commentary] Zhang Jiabin stated: When Yang pathogens are on the Exterior, there is Exterior Heat; when Yin pathogens are on the Exterior, there is Exterior Cold. When Yang pathogens are in the Interior, there is Interior Heat; when Yin pathogens are in the Interior, there is Interior Cold. When pathogens are in the Half-Exterior/Half-Interior region without fixed location, alternating chills and fever occur. When pathogens are on the Exterior, the heart and abdomen are not full; when in the Interior, the heart and abdomen are painful and full. When on the Exterior, patients moan uncomfortably; when in the Interior, they are restless, irritable, and chaotic. When on the Exterior, appetite is preserved; when in the Interior, appetite is lost. In the Half-Exterior/Half-Interior, appetite is diminished but not completely absent. On the Exterior, there is no irritability or vomiting; in the Interior, there is irritability, fullness, and vomiting. Initial signs of heart irritability, preference for vomiting, and gradual epigastric glomus indicate transmission from Exterior to Interior. Purging is contraindicated. If the disease originates in the Exterior with complete external symptoms but the pulse is faint and micro, it is due to insufficiency of Primordial Yang failing to reach the exterior. Rescue the Interior by assisting Yang and dispersing Yin is the superior strategy.

Ke Qin stated: This section discusses the pulse without detailing symptoms, inferring the pulse from the Baihu Tang syndrome. Relying solely on the pulse without examining symptoms, although mentioning both Exterior and Interior, emphasizes Interior Heat, described as "Heat binding in the Interior, with Heat manifesting in both Exterior and Interior."

Shen Jin'ao's Note: Symptoms such as fever without sweat, dry mouth/thirst, heart irritability, dry tongue coating, desire to drink several liters of water, and constipation constitute Baihu Tang syndrome. These symptoms correspond to the aforementioned pulse.

[Outline] Zhang Zhongjing stated: In Cold Damage, if the pulse is slippery and accompanied by cold extremities (Jue), this indicates Heat in the Interior. Baihu Tang is the primary treatment.

[Commentary] Shen Jin'ao's Note: A slippery pulse with cold extremities indicates Yang Jue (Yang Collapse/Jue). This is known as "Extreme Yang resembling Yin." However, this diagnosis requires accompanying signs of irritability, thirst with desire to drink, ability to eat, and difficulty in defecation to confirm Interior Heat.