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Chest and hypochondriac pain, deafness, with both the Cun (inch) and Chi (cubit) pulses presenting as Xian (Wiry), indicates a disease of the Shaoyang (Lesser Yang) channel (The discussion can be found in *Huo Ren Shu*, which advocates treating it with Chai Hu Tang).

When pathogenic factors accumulate as excess in the chest, causing郁郁 (depressive) pain in the chest, inability to eat, and relief upon palpation accompanied by salivation and diarrhea occurring more than ten times, while the pulse is paradoxically Chi (Slow) and the Cun pulse is Wei (Fine) and Hua (Slippery), this condition can be treated with emesis; the diarrhea will then cease.

After vomiting or purging, if the patient desires to vomit, experiences chest pain, loose stools, abdominal fullness, and irritability, Tiao Wei Cheng Qi Tang should be used (for details, see the section on Vomiting).

Deafness has two causes: one results from excessive sweating leading to deficiency; the other is due to Shaoyang Wind Strike. Chest and hypochondriac pain, deafness, with both the Cun and Chi pulses presenting as Xian (Wiry), indicates a disease of the Shaoyang channel.

Before taking the pulse, if the patient covers their heart with their hands, and when asked to cough does not do so, this must be because they are deaf and cannot hear the command. This occurs because excessive sweating has caused deficiency (Huang Qi Jian Zhong Tang may be used). In Shaoyang Wind Strike, with bilateral hearing loss, red eyes, chest fullness, and irritability, emesis and purging are contraindicated; if mistakenly used, palpitations and fright will ensue (Xiao Chai Hu Tang may be considered).

Simultaneous disease of the Shaoyang and Jueyin channels presents with deafness, retraction of the testicles, and cold limbs; this is a Liang Gan (Two-Channel) syndrome. When Ying and Wei (Nutritive and Defensive Qi) of the Jueyin channel are blocked, presenting with deafness, testicular retraction, and unconsciousness, the condition is critical. For Shi Wen (Damp-Warmth), treatment focuses on the Taiyin channel; sweating is contraindicated. If sweat is induced, the patient may become unable to speak, suffer from deafness, lose awareness of their condition, develop cyanosis of the body, and change facial color; this is termed "Zhong" (Severe/Heavy) (Bai Hu Jia Cang Zhu Tang may be used).

Yang Du (Yang Toxin) syndrome, at its onset, involves deep and heavy pathogenic toxins. If sweating or purging is missed when indicated, or if heat pathogens enter due to deficiency after vomiting/purging, or if hot medicines are mistakenly taken causing toxic heat to spread like adding firewood to a fire, the symptoms include six pulses being Chen (Deep) and Shi (Excess), tongue rolling and scorching black, nostrils resembling smoke coal, brocade-like erythema on the body and face, delirious speech, running and jumping, climbing walls and roofs, singing while standing high, discarding clothes and running. These are all manifestations. Treatable within five days; untreatable after six or seven days.

Sheng Ma Bie Jia Tang: Treats Yang Du disease characterized by red face with brocade-like macules, sore throat, and expectoration of pus and blood.
Ingredients: Sheng Ma (2 liang), Dang Gui, Shu Jiao (stir-fried to remove moisture), Gan Cao (each 1 liang), Bie Jia (one piece the size of a finger), Xiong Huang (half a liang, ground). The above six ingredients are boiled in four sheng of water to yield one sheng, taken in one dose. Sweating indicates cure. *Zhou Hou Bei Ji Fang* and *Qian Jin Fang* contain Gui Zhi but no Bie Jia in their Yang Du Sheng Ma Tang; Yin Du Gan Cao Tang contains no Xiong Huang.

Appendix:
*Huo Ren Shu* Yang Du Sheng Ma Tang: Treats Shang Han (Cold Damage) becoming Yang Du within one or two days, or transforming into Yang Du after vomiting/purging following medication. Symptoms include backache, irritability, restlessness, red face, delirium, running, hallucinations, diarrhea, floating-large-rapid pulse, red face with brocade-like macules, sore throat, and expectoration of pus and blood. Treatable within five days; untreatable after six or seven days.
Ingredients: Sheng Ma, Xi Jiao (sliced), She Gan, Huang Qin, Ren Shen, Gan Cao (equal parts). The above are coarsely crushed, decocted in water, and taken again after a meal interval. Cover warmly to induce sweating in hands and feet; if unresolved, prepare another dose.

Yang Du Zhi Zi Tang: Treats Yang Du Shang Han with fever and pain in all joints.
Ingredients: Sheng Ma, Huang Qin, Xing Ren, Shi Gao (each 2 qian), Zhi Zi, Chi Shao Yao, Zhi Mu, Da Qing (each 1 qian), Gan Cao (0.5 qian), Chai Hu (1.5 qian). The above are coarsely crushed; take half a liang per dose with five slices of Sheng Jiang and one hundred grains of Chi Xiao Dou, decocted together.

Da Huang San: Treats unresolved Yang Du Shang Han with internal heat, mental confusion, and mania-like state.
Ingredients: Da Huang (1.5 liang), Gui Xin (0.75 liang), Gan Cao (roasted), Mang Xiao, Da Fu Pi, Mu Tong (each 1 liang), Tao Ren (21 pieces). The above are coarsely crushed, decocted in water, and administered until bowel movement is achieved.

Hai Zang's Ge Gen San: Treats Yang Du with body heat like fire, headache, irritability, thirst, dry and painful throat.
Ingredients: Ge Gen (0.75 liang), Huang Qin, Da Huang (vinegar-fried), Gan Cao, Zhi Zi, Po Xiao (each 0.5 liang). The above are coarsely crushed, decocted in water, and taken.

*Huo Ren Shu* Hei Nu Wan: Treats epidemic diseases where no sweat has occurred after six or seven days, with Hong Da (Surging-Large) or Shu (Rapid) pulse, red face, eye pain, severe body heat, irritability, delirium, desire to run, extreme thirst. Also treats cases where heat remains in the chest for over five to six days, jaw is locked preventing speech, classified as Huai Shang Han (Ruined Cold Damage) deemed incurable by physicians, or where vital essence is exhausted but warmth remains in the epigastrium; administering medicine after opening the mouth can revive the patient. Also treats Yang Du and eruptive rashes.
Ingredients: Ma Huang (deprived of nodes, soaked, 3 liang), Da Huang (2 liang), Fu Di Mei (ground), Huang Qin, Mang Xiao, Zao Tu Mo (ground), Liang Shang Chen, Xiao Mai Nu (each 1 liang). The above are powdered, mixed with refined honey to form pills the size of marbles. Grind one pill in fresh well water and administer; if thirsty, allow drinking fresh water freely. Within moments, chills should occur; after chills subside, sweating indicates recovery. If no sweat, administer another pill; mild diarrhea is also effective. "Xiao Mai Nu" refers to immature wheat grains that fail to form ears; when rubbed, they appear black and sprout-like. This medicine is only suitable for patients with extreme thirst and heightened agitation; if not thirsty, administration may cause harm.
For Hong Da pulses, internal and external heat accumulation, rolled and scorched-black tongue, and nostrils resembling smoke coal, apply wet cloths layered and repeatedly soaked in cold water to the chest. Change water dozens of times. For severe heat, immerse the patient in water until heat subsides; this is also a good method.

Dan Sha Wan: Treats critical conditions of Yin and Yang Du in Shang Han.
Ingredients: Bo Shang Liu Huang, Shui Yin, Tai Yin Yuan Jing Shi, Tai Yang Shi (each 1 liang), Xiao Shi (0.5 liang). Powder the above, stir-fry evenly in a non-oiled pot over moderate heat until gray, grind finely. Mix with fresh ginger juice and steamed bread dough to form pills the size of mung beans. Take five pills per dose with Long Nao (Borneol), ginger juice, and honey water to suppress agitation. For Yang Du, use Jujube Decoction; for Yin Du, use plain water. Do not roast under eaves.
Bai Hu Jia Ren Shen Tang is also known as Hua Ban Tang. For severe macules, use Qing Dai Yi Wu Tang. For sore throat, use Xuan Shen Sheng Ma Tang.

Qing Dai Yi Wu Tang:
Ingredient: Qing Dai (size of a jujube). Grind in fresh well water and take.

Xuan Shen Sheng Ma Tang:
Ingredients: Sheng Ma, Xuan Shen, Gan Cao (each 0.5 liang). Decoct three zhan of water to one and a half zhan, strain, and take.

Tao Hua: In Yang Du Shang Han where medication fails, with skin erosion, shedding of hand and foot skin, body red as cinnabar, eyes fiery, extreme irritability and thirst, strong and forceless Hong pulse, and unconsciousness, San Huang Shi Gao Tang is indicated. Alternatively, use Sheng Ma Zhi Zi Tang to induce vomiting. If heat is severe with alternating mania and coma, locked jaw, and inability to swallow medicine, use the water-soaking method; once the jaw relaxes and mania subsides, administering medicine is effective, such as Hei Nu Wan, which should not be used lightly.

Li Gao: When Yang Qi alone prevails and Yin Qi suddenly ceases, irritability, running wildly, delirium, red face, sore throat, and macules occur, or diarrhea of yellow-red stool with Hong Shi or Hua Cu pulses; sour and bitter medicines should be used to rescue. For mild Yin and Yang Du, Jie Geng Da Huang Tang, Yang Du Sheng Ma Tang, Zhi Zi Ren Tang, or Long Dan Cao Yi Wu Tang may be used.

Zhao Sizhen: Yang is rooted in Yin, and Yin is rooted in Yang; without Yang, Yin cannot transform; without Yin, Yang cannot generate. Thus, neither can exist independently. Zhang Zhongjing stated: If Yang Qi ceases first and Yin Qi later, death ensues with blue complexion; if Yin Qi ceases first and Yang Qi depletes later, death ensues with red complexion. This shows that Yin and Yang Qi in the body must not be excessively deficient; once depleted, there is no chance of recovery. However, *Huo Ren Shu* states that Yin Du involves "Yang Qi cessation" and Yang Du involves "Yin Qi cessation." If already ceased, it is an incurable condition, rendering medicine useless. This likely refers to the severity of Yin and Yang syndromes complicated by toxic vapors, hence named Yin Du and Yang Du. Therefore, medicines use Sheng Ma, Xi Jiao, Xiong Huang, Da Qing, etc., to resolve toxicity. Once Yang Du is resolved, Yin Qi recovers; once Yin Du is resolved, Yang Qi recovers, leading to resolution through profuse sweating. Why does *Huo Ren Shu* not describe Yang Du as "extreme Yang abundance and minimal Yin" and Yin Du as "extreme Yin abundance and minimal Yang," thereby avoiding the implication of absolute depletion?