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(Stomach excess with constipation, spontaneous sweating, inability to sleep, tidal fever, delirium, mania/restlessness, picking at bedclothes and air, thirst, vomiting)

The characteristic of Yangming disease is "excess in the stomach-intestines" (Wei Jia Shi), which is called Zheng Yang Yangming. For mild cases, Da Chai Hu Tang (Major Bupleurum Decoction) may be used; for severe cases, Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. This occurs when pathogenic factors transmit from the Yangming channel into the fu organs. The classic states: In Yangming disease, if the pulse is slow, there is sweating but no aversion to cold, the body will feel heavy, there is shortness of breath, abdominal fullness, and tidal fever. This indicates that the exterior syndrome has resolved and interior purgation can be performed. If there is continuous sweating on the hands and feet, it indicates that the feces have hardened, and Da Cheng Qi Tang should be administered. If there is profuse sweating accompanied by slight fever and aversion to cold, the exterior has not yet resolved; if the fever is not tidal, Cheng Qi Tang formulas should not be given. If there is abdominal fullness and obstruction, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be given to gently harmonize the stomach qi, avoiding drastic purgation. This illustrates that Yangming disease can also remain in the channel stage before fully entering the fu organs, and exterior resolution is still appropriate. Even with significant fullness and obstruction, only gentle purgation with Xiao Cheng Qi Tang is warranted. Whether the pathogen is in the stomach or the channel, careful examination is required. Yangming syndromes rarely arise spontaneously but are often transmitted from Taiyang. When combined with Taiyang disease, Ge Gen Tang (Kudzu Decoction) is used; when combined with Shaoyang disease, Huang Qin Shao Yao Tang (Scutellaria and White Peony Decoction) is used. Transmission from Shaoyang to Yangming without combination follows similar principles. Treatment methods for Yangming channel diseases include diaphoresis, emesis, purgation, warming, harmonizing, resolving, and acupuncture.

Diaphoresis: Gui Zhi Tang (Cinnamon Twig Decoction), Ma Huang Tang (Ephedra Decoction), Wu Ling San (Five-Ingredient Powder with Poria), Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction).
Emesis: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction).
Purgation: Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction), Da Cheng Qi Tang, Di Dang Tang (Resist the Awaiting Decoction), Ma Ren Wan (Hemp Seed Pill), Yin Chen Hao Tang (Artemisia Capillaris Decoction), Xiao Cheng Qi Tang.
Warming: Wu Zhu Yu Tang (Evodia Decoction), Si Ni Tang (Four Reversal Decoction).
Harmonizing/Resolving: Bai Hu Tang (White Tiger Decoction), Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction), Zhu Ling Tang (Polyporus Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), Mi Dao Jian (Honey Suppository), Pig Gallbladder Juice, Tu Gua Gen (Trichosanthes Kirilowii Root), Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Decoction).
Acupuncture: For heat entering the blood chamber, puncture Qi Men (Liv 14).

Question: There are Taiyang Yangming, Zheng Yang Yangming, and Shaoyang Yangming. What do these mean?
Answer: Taiyang Yangming refers to Pi Yue (Spleen Confinement). The classic states: At the foot pulse, floating and choppy; floating indicates strong stomach qi, choppy indicates frequent urination. The interaction of floating and choppy leads to difficult defecation, known as Spleen Confinement, treated with Ma Ren Wan. After three days of Taiyang disease, if sweating fails to resolve the condition and steaming fever appears, it belongs to the stomach and is treated with Tiao Wei Cheng Qi Tang.
Zheng Yang Yangming is Wei Jia Shi (Excess in the Stomach-Intestines).
Shaoyang Yangming occurs after sweating or diuresis, leading to dryness, irritability, heat in the stomach, and difficulty passing stool. It is treated with Xiao Cheng Qi Tang to induce mild diarrhea, as Shaoyang disease contraindicates direct purgation. According to materia medica, Rhubarb soaked in wine enters the Taiyang channel, while washed in wine enters the Yangming channel; the depth of treatment depends on the amount of wine used. Furthermore, Taiyang and Zheng Yang Yangming use wine-soaked Rhubarb in Cheng Qi Tangs, whereas Shaoyang Yangming does not, as it is a lower channel. Thus, Taiyang Yangming should use Tiao Wei Cheng Qi Tang (Rhubarb wine-soaked); Zheng Yang Yangming should use Da Cheng Qi Tang (Rhubarb wine-washed); Shaoyang Yangming should use Xiao Cheng Qi Tang, omitting wine processing and Mirabilite due to Shaoyang contraindications against sweating and purging, administering it in small doses. These notes refute errors by Cheng Wuji. Additionally, Pi Yue Wan is for Taiyang Yangming, and Da Chai Hu Tang may be used for Shaoyang Yangming. Further details are found under the section on constipation.

Question: How does one contract Yangming disease?
Answer: If Taiyang disease is treated with sweating, purgation, or diuresis improperly, fluids are depleted, the stomach becomes dry, and the condition transforms into Yangming. Failure to defecate, internal excess, and difficulty passing stool constitute Yangming disease. Cheng Wuji notes: Untreated Taiyang disease, exacerbated by sweating/diuresis, depletes fluids and dries the stomach. Pathogens enter the fu organs and transform into Yangming. Ancient people changed clothes when using the toilet; failure to do so implies constipation. Without excretion, stomach contents accumulate, causing internal excess. Lack of stomach fluids combined with accumulated heat makes defecation difficult, resulting in Yangming interior excess.

In cold damage, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin patients typically develop jaundice; however, if urination is free, jaundice will not occur. By the seventh or eighth day, if the stool hardens, it becomes Yangming disease. Cheng Wuji notes: Floating indicates pathogenic yang, slow indicates spleen pulse. Cold damage with floating/slow pulse suggests Taiyin guest heat. Pathogens in the three yang channels cause hot extremities; in Taiyin, warm extremities; in Shaoyin/Jueyin, cold extremities. Warm extremities indicate association with Taiyin. Taiyin is earth; when steamed by pathogens, color manifests externally as jaundice. Free urination prevents heat accumulation and jaundice. Hard stool by day seven-eight indicates Taiyin pathogens entering the fu organs and transforming into Yangming.

In Yangming disease, the ability to eat distinguishes Wind Strike (Zhong Feng) from Cold Strike (Zhong Han). Those who can eat have contracted Wind (Yang pathogen, which aids digestion); those who cannot eat have contracted Cold (Yin pathogen, which hinders digestion).

Yangming disease presenting with only vertigo, no aversion to cold, allowing eating, and accompanied by coughing, will necessarily involve throat pain. If there is no cough, there is no throat pain. Vertigo here refers to mental confusion rather than visual darkness. Cheng Wuji explains: Yangming wind strike causes wind-cold to attack the stomach, causing rebellious stomach qi and coughing. The throat is connected to the stomach; severe coughing injures the throat. If stomach qi does not rebel, there is no cough or throat pain. While stomach qi governs vomiting and lung qi governs coughing, Cheng Wuji’s attribution of cough solely to stomach rebellion is questionable; it is likely wind invading the lungs, as the lung governs qi and wind is a qi-related pathogen.

If a Yangming patient cannot eat and heat-clearing measures are applied, hiccups will result because the stomach is deficient and cold. Attacking heat in a deficient stomach exacerbates the condition. Cheng Wuji notes: Deficiency cold in the stomach combined with heat-clearing drugs creates a conflict of deficiency and cold, causing hiccups. The classic warns against aggressive treatment in cases of weak pulse and stomach deficiency with heat, as removing heat leaves cold behind.

Yangming disease with a slow pulse, inability to eat large meals, postprandial mild vexation and vertigo, and difficult urination suggests impending Grain Jaundice (Gu Dan). Purging will not relieve abdominal fullness because the slow pulse indicates cold. Cheng Wuji notes: Slow pulse means pathogens have entered the interior but not yet transformed into heat. Cold in the stomach causes postprandial vexation and vertigo due to grain qi clashing with cold. If urination is unobstructed, heat escapes and jaundice does not form. If urination is obstructed, grain heat accumulates, leading to jaundice. Since this is cold-type jaundice, purging increases cold and fails to reduce fullness. The classic states: Slow pulse indicates purgation is not yet appropriate.

Yangming disease tends to resolve between Shen (3-5 PM) and You (5-7 PM), times when Yangming Dry Metal is prosperous.

In cold damage, if vomiting is frequent, even if Yangming symptoms exist, purgation is contraindicated.

If a Yangming patient has a red face, purgation is contraindicated. Purging will cause fever, yellow complexion, and difficult urination. Cheng Wuji explains: Generalized redness indicates heat in the channel, not the fu organs. Purging damages stomach qi and fluids, allowing channel heat to invade the stomach, causing fever, jaundice, and urinary difficulty. Zhang Yuansu adds: Although Yangming often requires purgation, facial redness indicates heat remains in the channel. Aggressive purging drives channel heat into the stomach, causing郁accumulation and jaundice, similar to early purging leading to Chest Bind.

If a Yangming patient has hardness and fullness below the heart (epigastrium), purgation is contraindicated. If purged and diarrhea persists until death, it is fatal; if diarrhea stops, recovery occurs. Abdominal fullness indicates pathogens in the fu organs (purgable), but epigastric hardness/fullness indicates shallow pathogens not yet fully in the fu organs. Stopping diarrhea indicates pathogen elimination and qi restoration. Persistent diarrhea indicates qi collapse. Shang Zhide notes: "Shallow" is better understood as "high" or superficial.