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(This is the original text of Zhang Zhongjing.)

Question: There are Taiyang Yangming, Zhengyang Yangming, and Shaoyang Yangming. What does this mean? Answer: Taiyang Yangming refers to Pi Yue (Spleen Constraint). (This section, along with the following two sections, is a Q&A set up by Zhang Zhongjing to illustrate that all three Yang meridians have syndromes where pathogenic factors enter the Fu organs. Yangming refers to the Stomach Fu organ. Cheng Wuji's commentary states: When pathogenic factors transmit from the Taiyang meridian into the Fu organ, it is called Taiyang Yangming; when they transmit from the Yangming meridian into the Fu organ, it is called Zhengyang Yangming; when they transmit from the Shaoyang meridian into the Fu organ, it is called Shaoyang Yangming. The classic states: "For diseases of these three meridians that have entered the Fu organ, purgation may be used." This is what is meant. Regarding Taiyang Yangming, Pang Anshi says: Originally a Taiyang disease, if sweating, purgation, or diuresis is applied, this depletes body fluids (Jin Ye), causing dryness in the stomach, thereby transforming into Yangming and forming the Pi Yue syndrome. I believe that dryness in the stomach leads to hyperactive heat in the Spleen Qi. Before illness, although water and grain received by the stomach transform into dregs and descend into the Large Intestine, since Spleen Qi is hyperactive and hot, the essence of water cannot distribute properly. Without qi of water to moisten the intestines, it is as if surrounded and bound, so although stool desires to pass, it is very difficult. This is the constraint of the intestines, actually caused by hyperactive heat in the Spleen Qi. My note: For this discussion, Zhang Zhongjing naturally uses Hemp Seed Pill (Maziren Wan) for treatment. Cheng Wuji also cites Minor Order the Five Viscera Decoction (Xiao Chengqi Tang), which is incomprehensible. Probably, the case Cheng Wuji cited—"After Taiyang disease, if vomiting, purgation, or sweating was applied, resulting in slight vexation, frequent urination, and consequently hard stool"—is a case where Pi Yue has not yet formed, hence Xiao Chengqi Tang is used. To say this is Pi Yue would be an error.)

Zhengyang Yangming refers to Wei Jia Shi (Stomach House Excess). Fang Youzhi's *Shanghan Lun Tiaobian* states: "Zheng" means the primary meridian. Because the disease reaches the primary meridian, it enters the Stomach Fu to form Stomach Excess. Pang Anshi says: If a patient originally has abundant wind and strong qi, leading to depletion of body fluids, or initially experiences aversion to cold, and after sweating, the aversion to cold ceases but fever returns; or upon onset, immediately experiences fever and delirious speech, this is named Zhengyang Yangming. From this, we know there are two pathways for pathogenic factors to enter the Fu organ: aversion to cold indicates transmission from the Taiyang meridian; immediate fever indicates entry into the Fu from the primary meridian. Chen Liangsi from Wulin also said: There are cases where one contracts disease directly from the Yangming meridian and enters the Stomach Fu, such as stated in *Suwen*: "Struck on the face, then descends to Yangming." There are also cases where pathogenic factors transmit from other meridians to Yangming before entering the Fu, such as the subsequent transformation into Yangming mentioned later. Generally, once Taiyang transforms into Yangming, it becomes Zhengyang Yangming, not Taiyang Yangming. This distinction must be clarified. I believe the pathway for Shaoyang Yangming entering the Fu follows similar logic. A question arises: In the previous section, Pang cited a later section regarding why there is text about Yangming disease saying "Taiyang disease if sweating..." leading to transformation into Yangming as Taiyang Yangming. Now, Chen cites this same text here saying "Once Taiyang transforms into Yangming, this is also Zhengyang Yangming." Which is correct? I answer: Both statements are correct; scholars must differentiate based on clinical presentation. If transformed into Yangming but still carrying Taiyang exterior symptoms, such as headache and stiff neck, or aversion to cold, this is Taiyang Yangming. If there is no headache, no stiff neck, and absolutely no Taiyang exterior symptoms, this is Zhengyang Yangming. Shaoyang Yangming is differentiated similarly by the presence or absence of alternating chills and fever.)

Shaoyang Yangming refers to sweating and diuresis having been performed, resulting in dryness, vexation, excess in the stomach, and difficulty passing stool. (Shaoyang Yangming originates from Shaoyang meridian disease. Shaoyang disease should not be treated with sweating or diuresis. If sweating is mistakenly induced, body fluids are lost at the surface; if diuresis is mistakenly induced, body fluids are further depleted. Once body fluids are gone, pathogenic factors transmit to the Yangming Fu organ, causing dryness, vexation, and excess in the stomach, leading to difficult defecation. This is because the stomach lacks fluids, causing dryness, which generates vexing heat. Although Zhang Zhongjing mentions "excess in the stomach," I believe his use of "excess" inherently includes the Large Intestine Fu. Only when the Large Intestine Fu is excess does stool become difficult to pass. Moreover, the Large Intestine belongs to the Yangming meridian. Pang Anshi said: When disease transmits to Shaoyang, and due to mistaken sweating and diuresis, causing stomach dryness and difficult defecation, it is called Shaoyang Yangming. Cheng Wuji, in his commentary on the previous section regarding "Wei Jia Shi," cited "Yangming disease with slow pulse..." and prescribed Major Order the Five Viscera Decoction (Da Chengqi Tang). However, for this section on "difficult defecation," he provided no treatment method. Later practitioners used the three Chengqi Decoctions to treat the upper three conditions respectively, but I find this explanation inadequate. Generally, Taiyang Yangming syndromes suit Cinnamon Twig Decoction with Added Rhubarb (Guizhi Jiada Huang Tang); Zhengyang Yangming syndromes suit the selective use of the three Chengqi Decoctions; Shaoyang Yangming syndromes suit Major Bupleurum Decoction (Da Chaihu Tang). This is an unchangeable principle.)

The definition of Yangming disease is Wei Jia Shi (Stomach House Excess). Chen's commentary from Wulin states: This section follows the previous three sections. Although the pathways for the three types of Yangming disease to enter the stomach differ, the nature of pathogenic factors in the Stomach House is essentially the same. Thus, Zhengyang Yangming is indeed Wei Jia Shi, but Pi Yue of Taiyang and difficult defecation of Shaoyang are also forms of Wei Jia Shi. Since they all enter Yangming and constitute Stomach Excess, it is summarized as: The manifestation of Yangming disease is Wei Jia Shi. *Tiaobian* states: "Excess" refers to hardened stool, fullness, and inability to pass. My note: This implies that "Wei Jia Shi" should be viewed together with Large Intestine Fu excess, as the intestine and stomach are connected above and below. Therefore, Haizang argued: "Having five or six pieces of dry feces in the stomach" does not mean they are literally in the stomach, but refers generally to Yangming. Saying "stomach" implies including the Large Intestine. Currently, when stool is hardened and causes fullness, the fire-dryness qi of the Large Intestine reverses and ascends, hence named "excess in the stomach." Essentially, there is no physical object in the stomach. Based on Haizang's words, the meaning of "excess" elucidates the concept of "Wei Jia Shi" mentioned earlier. Scholars should study this carefully to understand the principle.)

Question: How does one contract Yangming disease? Answer: If Taiyang disease is treated with sweating, purgation, or diuresis, this depletes body fluids, causing dryness in the stomach, thereby transforming into Yangming. Failure to defecate, internal excess, and difficulty passing stool constitute Yangming disease. (This section sets up a Q&A to clarify Yangming Fu disease. Question: How is Yangming Fu disease contracted? Answer: It arises from Taiyang disease where improper treatment via sweating, purgation, or diuresis白白ly depletes body fluids. Body fluids gather in the stomach. Once depleted, the stomach becomes dry. The unresolved Taiyang pathogen transforms into the Yangming Fu organ. "Not changing clothes" means failure to defecate. Cheng Wuji's commentary notes: Failure to defecate means stomach contents cannot be excreted, leading to internal excess. Internal excess refers to hardness and binding within the Large Intestine. Due to this internal binding, defecation is difficult. Such cases are Yangming Fu excess syndromes. My note: Although this condition arises from unresolved Taiyang disease transforming into Yangming Fu, the absence of any Taiyang meridian symptoms alongside failure to defecate, internal excess, and difficult defecation classifies it as Zhengyang Yangming, a purgative indication according to *Shanglun Pian*. A question arises: If Taiyang disease is purged, stomach contents should be removed. Even if fluids are depleted and the stomach is dry, why would internal excess form again? I answer: During the initial stage of Taiyang disease, improper purgation only depletes sweat. The stomach contents remain unexcreted, eventually transforming into Yangming and forming dry feces, thus creating internal excess. Here, Zhang Zhongjing only demonstrates how to identify the syndrome, omitting treatment methods.)

Question: What are the exterior manifestations of Yangming disease? Answer: Feverish body, spontaneous sweating, no aversion to cold, but aversion to heat. (Previously, it was stated that Yangming disease involves internal excess in the stomach, but its exterior manifestations were not mentioned. Hence, this section asks: What are the exterior signs of Yangming disease entering the Fu? Answer: The exterior signs of Yangming are feverish body and spontaneous sweating. "Feverish body" refers to heat in the anterior body. Feverish body differs from "fa re" (fever); the heat lies in the muscle layer, unlike "fa re" which is merely superficial on the skin. Spontaneous sweating occurs because internal excess heat steams and forces body fluids out. Furthermore, this spontaneous sweating differs from that in Taiyang Wind Strike syndrome. In Taiyang disease, sweat is scanty and does not penetrate fully. In this condition, sweat is driven out by internal heat, flowing profusely and uncontrollably. No aversion to cold indicates the pathogen is not at the exterior. Aversion to heat confirms heat is at the interior. Since cold damage typically involves aversion to cold, aversion to heat is considered contrary. Although aversion to heat is an internal sign, its manifestations appear externally, such as throwing hands and feet or pushing away covers. Thus, observing external signs confirms Yangming Fu excess. *Shanglun Pian* uses this section to discuss Yangming Wind Strike combined with Taiyang; believing the pathogen remains in the meridian is a grave error. Generally, this section describes a syndrome suitable for Chengqi Decoction.)

Question: Some patients experience one day of illness without fever but with aversion to cold. Why? Answer: Although it has been one day, the aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat. (This section, linked with the next, elaborates that Yangming disease can also present with aversion to cold, using Q&A to clarify. Question: Yangming disease usually presents with fever and no aversion to cold. Why is there a case of initial aversion to cold without fever? This aversion to cold differs from Taiyang aversion to cold. Taiyang is the Water Meridian, so its exterior cold is severe. Yangming is the Dryness-Metal Meridian, so its exterior cold is mild. Because it is mild, the answer states: Although present for one day, aversion to cold will cease spontaneously. "Cease spontaneously" means the cold resolves without exterior-releasing treatment. It is followed by spontaneous sweating and aversion to heat, which are the exterior signs of Yangming disease entering the Fu. Cheng Wuji commented: Lack of fever and presence of aversion to cold indicate the pathogen has not fully entered the Fu and still carries exterior pathogen. This exterior pathogen belongs to the Yangming meridian. The patient likely has headache and frontal pain with aversion to cold externally, and stomach Fu excess internally, soon followed by spontaneous sweating and aversion to heat. *Tiaobian* critiques this: Initially contracting Yangming, the exterior qi is blocked, causing non-febrile aversion to cold, which quickly transforms into heat because the pathogen does not primarily concern the exterior. This insight aligns well with Zhang Zhongjing's intent.)

Question: Why does the aversion to cold cease spontaneously? Answer: Yangming resides in the center, Earth element. It is the destination of all things, with nowhere else to transmit. Although initially experiencing aversion to cold, it stops by the second day. This constitutes Yangming disease. (This explains the reason for the spontaneous cessation of aversion to cold. It ceases because the Yangming Stomach Fu resides in the center of the body, nourishing the four peripheries. Cheng Wuji noted: Diseases in the four peripheries can all transmit to the Stomach. Stomach belongs to Earth, and Earth is the destination of all things. When all things return to Earth, their transformation decays and ceases, becoming static. Hence, "nowhere else to transmit." Although initially aversive to cold, it stops by the second day, analogous to extreme winter cold subsiding when Earth energy prevails. This refers to Zhengyang Yangming, a purgative indication. *Tiaobian* comments on "destination of all things, nowhere else to transmit": Yangming's correct treatment is purgation. Only when pathogenic factors from the five Zang and six Fu organs all converge here, with no other exit, does it become a purgative Yangming syndrome. Do not mistake this lightly.)

When Taiyang disease is first contracted, if sweating is induced but the sweat is incomplete, it transforms into Yangming. (This section describes Taiyang disease transforming into Yangming meridian syndrome. As stated in Section 5: If Taiyang disease is sweated excessively, depleting fluids and causing stomach dryness, it transforms into Yangming. This is excessive sweating, where the pathogen leaves the exterior, becoming Yangming Fu disease. Here, during early Taiyang, insufficient sweating leads to transformation into Yangming. This is insufficient sweating, where the pathogen remains at the exterior. Therefore, I state this is Yangming meridian disease. Following Zhang Zhongjing's method, Pueraria Decoction (Gegen Tang) should be used. The meaning of "incomplete sweating" is noted in the Taiyang Middle section.)

Cold damage presenting with fever, no sweat, vomiting, inability to eat, but conversely with persistent dripping sweat, indicates transformation into Yangming. (Fever, no sweat, vomiting, and inability to eat originate from Cold Damage starting in the Taiyang meridian. Taiyang Cold Damage patients normally cannot eat, which is why Zhang Zhongjing states after Mahuang Decoction that drinking warm porridge is unnecessary. However, vomiting indicates Yangming Fu excess. Cold damage should have no sweat. Now, persistent dripping sweat appears. "Zhi zhi ran" describes condensed sweat. External sweating indicates internal steaming of Yangming Stomach Fu excess heat. Thus, Taiyang meridian disease transforms into Yangming Fu disease.)

On the third day of cold damage, the Yangming pulse is large. ("Large" pulse refers to a surging and long quality under the fingers. Cheng Wuji cites classics: Yangming disease manifests on the second or third day. By the third day of cold damage, pathogenic factors transmit to Yangming. Yangming has abundant qi and blood. When qi and blood are constrained by heat, the pulse becomes large. I believe "large pulse" in Yangming has two meanings: when pathogen merges with the meridian, the pulse is large; when pathogen enters the Fu, the pulse is also large. Cheng Wuji only mentioned the meridian, missing the Fu aspect. Generally, a large and floating pulse indicates pathogen merging with the meridian; a large and excess pulse indicates pathogen entering the Fu. Pulses do not occur alone; one must analyze combined pulses to distinguish meridian vs. Fu syndromes.)

If cold damage presents with a floating and moderate pulse, and spontaneous warmth of the hands and feet, it is associated with Taiyin. Taiyin disease typically causes jaundice. However, if urination is free, jaundice will not occur. By the seventh or eighth day, if stool becomes hard, it is Yangming disease. (This section discusses Taiyin disease transforming into Yangming. Although termed cold damage, the pulse should be floating and tight. Here it is floating and moderate. Why? Cold pathogen penetrates the Three Yang meridians to enter Taiyin, arriving slowly, unlike the urgent Taiyang pathogen with a tight pulse. Moderate is the native pulse of the Spleen. Cold enters Taiyin, yet the pulse remains floating because the pathogen is still in the meridian. Spleen governs the four extremities. Taiyin cold qi transforms into heat, causing spontaneous warmth of hands and feet. This is "associated with Taiyin." Taiyin is the Damp-Earth meridian. Cold-damp binding stagnates and generates heat, causing jaundice. Yellow is the color of stagnant Earth. If urination is free, spleen dampness is removed, heat does not stagnate internally, and jaundice does not occur. By the seventh/eighth day, frequent urination depletes fluids, making stomach dry-heat extreme. Dry stomach leads to dry intestines, causing hard stool. This is transformation into Yangming disease, a Fu excess syndrome. My note: This syndrome is similar to Pi Yue, except it begins as Taiyin cold damage. Treatment should also follow Zhang Zhongjing's Hemp Seed Pill.)

When cold damage transforms and associates with Yangming, the patient exhibits persistent, slight sweating. (This elaborates on the previous point. Previously, it was stated that cold damage associated with Taiyin. Now, having transformed to associate with Yangming, the exterior signs include not only free urination but also persistent, slight sweating. Heat steams internally, moistening the exterior. Although sweat is slight, the Fu excess syndrome is confirmed. My note: If Taiyin transforms to Yangming without sweating, the Taiyang meridian syndrome might not have resolved. Even with free urination and hard stool, one dare not lightly use purgatives.)

Yangming Wind Strike presents with bitter taste in the mouth, dry throat, abdominal fullness, slight panting, fever, aversion to cold, floating and tight pulse. If purged, abdominal fullness worsens and urination becomes difficult. (This Yangming disease involves wind-cold pathogen remaining in the meridian, combined with Taiyang exterior symptoms. Although termed Yangming Wind Strike, it should feature fever but not aversion to cold or floating-tight pulse. The presence of fever, aversion to cold, and floating-tight pulse indicates residual Taiyang cold pathogen. Yangming meridian encircles the mouth; bitter taste indicates bile reflux, showing Yangming heat invading the Shaoyang meridian. Yangming meridian follows the throat; only Taiyin meridian encircles the pharynx. Dry throat indicates excessive Spleen heat, showing Yangming heat invading the Taiyin meridian. Yangming meridian follows the abdomen. Wind-cold striking Yangming causes stagnation heat in the meridian, leading to abdominal fullness. Heat excess and qi congestion cause lung qi rebellion, resulting in slight panting. Yangming wind-heat combined with Taiyang cold is purely exterior syndrome with exterior pulse. Although abdominal fullness is present, it is not severe excess requiring purgation. Mistaken purgation depletes internal fluids, allowing exterior pathogen to enter deeply, worsening abdominal fullness and causing difficult urination. This affects both Stomach and Bladder. *Tiaobian* warns: Physicians must be cautious when treating Yangming/Taiyang meridian diseases affecting the Fu organs. My note: Zhang Zhongjing provides no treatment here. Chang Qizhi in *Bu Wang Lun* suggests Guizhi Mahuang Ge Ban Tang and Xiao Chaihu Tang. Chang's reasoning: Yangming Wind Strike with Taiyang Cold Damage pulse resembles Zhang Zhongjing's Da Qing Long Tang minus irritability, hence Ge Ban Tang. I believe Zhang Zhongjing's method prefers Gegen Tang. Following Chang's logic for bitter taste, Xiao Chaihu Tang is added. I suggest that for accompanying symptoms like bitter taste and dry throat, Gegen Tang should be the main formula, supplemented with cooling herbs like Scutellaria Root (Huang Qin). After mistaken purgation, treatment should follow specific symptoms, either purging abdominal fullness or promoting urination.)

In Yangming disease, ability to eat is named Wind Strike; inability to eat is named Cold Strike. (This refers to Yangming disease where wind-cold pathogen is in the meridian, presenting with fever, eye pain, nasal dryness, and insomnia. Yangming governs water and grain. Cheng Wuji noted: Wind is yang pathogen, yang pathogens digest food, so Wind Strike patients can eat. Cold is yin pathogen, yin pathogens do not digest food, so Cold Strike patients cannot eat. My note: Zhang Zhongjing's "Cold Strike" is synonymous with Cold Damage, not true cold syndrome. True cold syndrome involves deficient-cold stomach, treated with Wu Ji San or Lizhong Tang. Inability to eat here indicates excess stomach qi, with pathogen not yet entering Fu and no stagnating heat generated. Hence named Cold Strike, effectively identical to Cold Damage. Cheng Wuji also noted: Yang pathogens digest food, yin pathogens do not. Since wind-cold pathogen has not fully entered the stomach and remains in the meridian, eating ability distinguishes Wind Strike from Cold Damage. If pathogen fully enters stomach causing stagnating heat and severe excess/fullness, even those who could eat will lose appetite. Thus, "ability to eat" colloquially called "fire hunger" is not stomach deficiency; do not feed them. Generally, for Yangming disease, fasting is best. This section refers to wind-cold directly striking Yangming meridian, not transmitting from Taiyang. If transmitted from Taiyang, the distinction between wind and cold becomes indistinguishable by the time it reaches Yangming. Note that Taiyang Wind Strike treated with Guizhi Tang requires warm porridge to induce sweat, indicating Taiyang Wind Strike is associated with ability to eat. Taiyang Cold Damage treated with Mahuang Tang does not require porridge, indicating Taiyang Cold Strike is associated with inability to eat. Thus, upon initial entry into Yangming, eating ability distinguishes Wind Strike from Cold Strike.)

If Yangming disease involves Cold Strike, with inability to eat, difficult urination, and persistent dripping sweat from hands and feet, this is developing into Gu Jia (fixed mass). Stool will be initially hard and finally loose. This is because the stomach is cold, failing to separate water and grain.