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Miao Xiyong said: In Taiyang disease (Disease of the Taiyang channel), the symptoms include fever, aversion to cold, aversion to wind, headache with stiffness in the nape and neck, stiffness in the waist and spine, and generalized bone pain. The pulse is floating and surging but not rapid. It mostly does not transmit to other channels. If irritability and a rapid pulse appear, this indicates that the disease is about to transmit; it is appropriate to induce sweating first to resolve the exterior pathogenic factor. The primary prescription is Qianghuo Tang (Notopterygium Decoction). Notopterygii Rhizoma et Radix (Qianghuo) 3 qian, Peucedani Radix (Qianhu) and Puerariae Radix (Gegen) each 2 qian, Glycyrrhizae Radix et Rhizoma (Gancao) 8 fen, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Jujubae Fructus (Zao) 1 piece, Armeniacae Semen Amarum (Xingren) 9 grains. This formula should be used in late autumn and winter. Zi Su Ye (Perilla Leaf) and Cong Bai (Scallion White) may be added according to circumstances. If in severe winter, upon contracting the pathogen immediately, taking this medicine fails to produce sweat, add Ephedrae Herba (Mahuang) 1 qian and Zingiberis Rhizoma Recens (Shengjiang) 4 slices to the original formula (totaling 7 slices of ginger). Once sweat is produced, do not take more. If the patient feels irritable, prefers cool environments, dislikes heat, and has thirst, this indicates the disease is about to transmit to the Yangming channel. If external symptoms such as headache and generalized bone pain persist, or if accompanied by thirst, dry nose, eye pain, and inability to sleep, this is a combined Taiyang-Yangming syndrome. Add Gypsum Fibrosum (Shigao), Anemarrhenae Rhizoma (Zhimu), and Ophiopogonis Radix (Maidong) to Qianghuo Tang, and administer in large doses. The disease resolves once sweat is produced.

If there is spontaneous sweating, irritability, headache, and persistent generalized bone pain, use Notopterygii Rhizoma et Radix (Qianghuo) 1 qian, Cinnamomi Ramulus (Guizhi) 7 fen, Gypsum Fibrosum (Shigao) 1 liang 2 qian, Ophiopogonis Radix (Maidong) 6 qian, Anemarrhenae Rhizoma (Zhimu) 3 qian, Phyllostachydis Folium (Zhuye) 120 leaves, Paeoniae Radix Alba (Baishao) 2 qian, and Glycyrrhizae Radix et Rhizoma (Gancao) 8 fen. If one contracts Taiyang disease in winter, presenting with aversion to cold and wind, headache, generalized bone pain, spontaneous sweating, and no thirst, use Cinnamomi Ramulus (Guizhi) 8 fen, Paeoniae Radix Alba (Baishao) 2 qian, Glycyrrhizae Radix et Rhizoma (Gancao) 1 qian, Jujubae Fructus (Zao) 3 pieces, and Zingiberis Rhizoma Recens (Shengjiang) 1 slice.

If Taiyang disease does not resolve, heat accumulates in the Bladder, and the patient exhibits manic-like behavior. If blood discharges spontaneously, the disease heals. If external symptoms remain unresolved, purgation is contraindicated; one must first resolve the exterior. After the exterior syndrome subsides, if there is urgency and binding in the lower abdomen, purgation may be performed using Tao Ren Cheng Qi Tang (Peach Kernel Downward-Flowing Decoction). If there is no blood retention syndrome, Da Cheng Qi Tang (Major Downward-Flowing Decoction) is used. Zhengyang Yangming disease refers to excess heat in the Stomach and Intestines. Symptoms include constipation, spontaneous sweating, tidal fever, thirst, dry throat, dry nose, vomiting or dry heaving, ocular discomfort preventing sleep, fear of human voices and wooden sounds, fear of fire, aversion to heat rather than cold, or initial aversion to cold followed quickly by fever. Severe cases may involve delirium, mania, picking at clothes and bedrails. The pulse is surging, large, and long. The exterior should be urgently resolved using Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), administered in large doses. If there is no vomiting and no sweat, Gegen Tang (Kudzu Decoction) is given, also in large doses. If the exterior syndrome has resolved, the pulse is slow and small, and urination is free, the disease is healed. If after resolving the exterior, pathogens bind internally causing constipation and scanty dark urine, Tiao Wei Cheng Qi Tang (Regulate the Stomach Downward-Flowing Decoction) or Xiao Cheng Qi Tang (Minor Downward-Flowing Decoction) should be used for purgation. After purgation, palpating the abdomen: if there is no pain and the area feels peaceful, the disease is resolved. If there is pain, dry feces remain; repeat the previous purgative method until the abdomen is peaceful and bowel/bladder movements are unobstructed.

In Yangming disease, inability to eat suggests underlying deficiency; do not lightly recommend purgation. For Yangming disease with dizziness, cough, and sore throat, decoct Ge Gen (Puerariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Jie Geng (Platycodonis Radix), and Mai Dong (Ophiopogonis Radix) thickly, and administer frequently. For Yangming disease with no sweat, difficult urination, and internal restlessness (Ao Nan), jaundice will likely develop; urgently use Zhi Zi (Gardeniae Fructus), Mai Dong (Ophiopogonis Radix), and Dan Dou Chi (Prepared Soybean) in a large, thick decoction. If yellow skin is already visible, urgently add Yin Chen (Artemisiae Scopariae Herba) as the sovereign herb. For Yangming disease with epistaxis due to missed sweating therapy, use Jing Jie (Schizonepetae Spica), Pu Huang (Typhae Pollen), and Ce Bai Ye (Biota Top Leaf) each 2 qian, Ge Gen (Puerariae Radix) and Di Huang (Rehmanniae Radix) each 3 qian, Mai Dong (Ophiopogonis Radix) 5 qian, Mu Dan Pi (Moutan Cortex) half qian, and Mao Gen (Imperatae Rhizoma) 2 liang, decocted thickly. Drink with child's urine. For Yangming disease with hardness and fullness in the epigastrium, the pathogen has not entered the abdomen; do not purge. Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with Gua Lou (Trichosanthis Fructus) crushed, Jie Geng (Platycodonis Radix) 2 qian, and Huang Lian (Coptidis Rhizoma) 1 qian.

For Yangming disease with internal pathogen binding, sweating followed by heaviness, shortness of breath, abdominal fullness and wheezing, tidal fever, and continuous sweating on hands and feet, the stool is hard. From the sixth or seventh day, purgation is indicated. If Xiao Cheng Qi Tang (Minor Downward-Flowing Decoction) fails, switch to Da Cheng Qi Tang (Major Downward-Flowing Decoction) without increasing the dose. If the stool is not hard, do not purge lightly. If Yangming disease persists after sweating with abdominal urgency, urgent purgation is needed. In Cold Damage lasting six to seven days, with unclear vision and unsteady eyes, no exterior syndrome, and difficulty defecating, use Cheng Qi Tang (Downward-Flowing Decoction). If Yangming purgation was premature, resulting in external heat, warm hands/feet, no chest binding, internal restlessness, anorexia, and only head sweating, use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). For Yangming disease with only tidal fever, loose stools, and persistent chest fullness, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Renshen (Ginseng) removed and Huang Lian (Coptidis Rhizoma) and Gua Lou (Trichosanthis Fructus) added. For Yangming disease with spontaneous sweating or post-sweating free urination leading to internal fluid depletion, thirst, and hard difficult stool, do not attack with purgatives. Wait for the natural urge to defecate, or use honey suppositories or pig bile enemas. After severe purgation, if six to seven days pass without defecation, unresolved irritability, and abdominal fullness/pain due to retained food, use Cheng Qi Tang again. Vomiting after eating indicates Yangming, not Shaoyang. For internal chest烦热 (heat and vexation), Zhu Ru Tang (Bamboo Shavings Decoction) is used: Zhu Ru (Bamboo Shavings) 3 qian, Mai Dong (Ophiopogonis Radix) 5 qian, Pi Pa Ye (Loquat Leaf) 3 large slices, Lu Gen (Imperatae Rhizoma) 3 liang. For internal deficiency without heat signs (free urination, no thirst), Wu Zhu Yu Tang (Evodia Decoction) is used: Wu Zhu Yu (Evodiae Fructus) 2 qian, Renshen (Ginseng) 3 qian, Sheng Jiang (Fresh Ginger) half qian, Zao (Jujube) 3 pieces, decocted in water, taken three times daily.

Generally, Yangming disease involves much sweat and outward loss of fluids, leading to dry stomach and hard stool, which causes delirium; treat with Xiao Cheng Qi Tang. If delirium stops after one dose, do not continue. For Yangming disease with delirium, tidal fever, and slippery-rapid pulse, use Xiao Cheng Qi Tang. If abdominal gas turns after medication, give another dose; if not, do not give more. If the next day there is still no defecation and the pulse becomes faint and choppy, it indicates interior deficiency and is difficult to treat; do not purge further. Yangming disease with bloody discharge and delirium indicates heat entering the Blood Chamber; sweat stops at the head. Use Jing Jie (Schizonepetae Spica) and Ge Gen (Puerariae Radix) each 3 qian, Huang Qin (Scutellariae Radix) and Mu Dan Pi (Moutan Cortex) each half qian, Mai Dong (Ophiopogonis Radix) 5 qian, Sheng Pu Huang (Raw Typhae Pollen) 2 qian, decocted thickly and drunk with child's urine.

For Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness with wheezing, fever with sweating, aversion to heat, and body heaviness: if purged, the Stomach becomes empty, rebellious qi disturbs the diaphragm, causing internal restlessness. With tongue coating, use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). With thirst and dry tongue, use Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng). With floating pulse, fever, thirst, and difficult urination, use Zhu Ling Tang (Polyporus Decoction). For Yangming disease with diarrhea accompanying heat, use Liu Yi San (Six-to-One Powder). For epigastric stuffiness, use Huang Lian Gua Lou Tang (Coptis and Trichosanthis Decoction) mixed in. For floating-slow pulse, exterior heat with interior cold, and diarrhea with undigested food, use Si Ni Tang (Frigid Extremities Decoction). For Fuyang pulse floating and choppy with frequent urination and hard stool, this is Spleen Constriction (Pi Yue); use Ma Zi Ren Wan (Hemp Seed Pill), 10 pills three times daily.

Yangming excess causes delirium; deficiency causes Zheng Sheng (repetitive speech). Zheng Sheng means repeating words. Fixed gaze with delirium, wheezing/fullness, or diarrhea indicates death. Excessive sweating or re-sweating leading to delirium with a short pulse indicates death; a harmonious pulse indicates survival. If vomiting or purgation fails to resolve the condition, with no defecation for five to ten days, evening tidal fever, no aversion to cold, and solitary speech resembling seeing ghosts: if severe, the patient does not recognize others, picks at clothes/bedrails, is terrified and restless, with slight wheezing and fixed gaze. A wiry pulse indicates life; a choppy pulse indicates death (choppy pulse in Yang syndrome shows Yin signs). Mild cases with only fever and delirium are treated with Da Cheng Qi Tang; if diarrhea occurs, stop administration. Yangming disease with mania, discarding clothes, running, and climbing high singing is Yangming excess; urgently purge with Cheng Qi Tang. If stool is not bound, administer large-dose Bai Hu Tang (White Tiger Decoction): Shi Gao (Gypsum) 4 liang, Mai Dong (Ophiopogonis Radix) 2 liang, Zhi Mu (Anemarrhenae Rhizoma) 1.5 liang, Da Qing Ye (Isatidis Folium) 1 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 7 qian.

Taiyang-Yangming disease with diarrhea accompanying heat uses Liu Yi San (Six-to-One Powder) mixed with Huang Lian Tang (Coptis Decoction). Taiyang-Yangming concurrent disease with exterior symptoms persisting for six-seven days and mania indicates heat in the Lower Jiao; the lower abdomen should be hard and full with free urination; purge the blood with Tao Ren Cheng Qi Tang (Peach Kernel Downward-Flowing Decoction). In concurrent diseases of two Yang channels, after Taiyang symptoms cease, with tidal fever, sweating, difficult defecation, and delirium, use Da Cheng Qi Tang (Major Downward-Flowing Decoction).

Shaoyang disease symptoms include bitter taste, dry throat, vertigo/dizziness, alternating chills and fever, hypochondriac pain, chest fullness or pain, deafness, wiry-thin pulse, headache, and fever; this belongs to Shaoyang. Shaoyang disease must not be treated with sweating; sweating leads to delirium. If the Stomach harmonizes, it self-heals; if not, irritability and palpitations occur. On the third day of Cold Damage, a small Shaoyang pulse indicates the disease is about to end.

When Taiyang disease transmits to Shaoyang without resolving, presenting with hypochondriac hardness/fullness, dry retching, anorexia, alternating chills and fever, and a deep-tight pulse without prior vomiting or purgation, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) three times daily: Chai Hu (Bupleuri Radix) 2.4 qian, Renshen (Ginseng), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Fresh Ginger) each 9 fen, Ban Xia (Pinelliae Rhizoma) half qian, Da Zao (Jujube) 2 pieces. Modifications: If chest vexation without vomiting, remove Ban Xia and Renshen, add Gua Lou Shi (Trichosanthis Fructus) one piece. If epigastric fullness, remove Da Zao, add Mu Li (Ostrea Shell) 2.5 qian. If thirsty, remove Ban Xia, add Renshen and Hua Fen (Trichosanthis Radix). If abdominal pain, remove Huang Qin, add Baishao (Paeoniae Radix Alba) 3 qian. If palpitations with difficult urination, remove Huang Qin, add Fu Ling (Poria) 2 qian. If not thirsty with slight external heat, remove Renshen, add Guizhi (Cinnamomi Ramulus) 1 qian (avoid in summer). Cover warmly to induce slight sweat for cure. If coughing, remove Renshen and Zao, add Wu Wei Zi (Schisandrae Fructus) 1 qian with a little Gan Jiang (Dried Ginger).

Concurrent Yangming-Shaoyang disease必然 (inevitably) presents with diarrhea; slippery-rapid pulse indicates retained food; purge with Cheng Qi Tang. If vomiting, purgation, sweating, or warm needle therapy cause delirium and Chai Hu syndrome ceases, this is a "ruined disease" (Huai Bing); determine the error and treat accordingly.

Combined disease of the Three Yangs presents with a large pulse, prominent Guan position, somnolence, and sweating upon closing eyes. Formula: Bai He (Lilii Bulbus) 1 liang, Mai Dong (Ophiopogonis Radix) 5 qian, Zhi Gan Cao (Honey-fried Licorice) 1 qian, Zhi Mu (Anemarrhenae Rhizoma), Baishao (Paeoniae Radix Alba), Hua Fen (Trichosanthis Radix) each 2 qian, Zhi Gui Jia (Prepared Tortoise Shell) 3 qian, Zhuye (Bamboo Leaf) 50 leaves. For Combined Three Yangs with abdominal fullness, body heaviness, delirium, and urinary incontinence, use Bai Hu Tang (White Tiger Decoction) plus Bai He (Lilii Bulbus).

In Cold Damage lasting six-seven days, without significant fever but with irritability, this indicates Yang leaving and entering Yin. On the third day of Cold Damage, the Three Yang periods end, and the Three Yin should receive pathogens; however, if the patient can eat and does not vomit, it indicates the Three Yin are not receiving pathogens.