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Question: Why is "insomnia" (bu de mian) considered a Yangming Fu-organ syndrome? Answer: Insomnia can occur in both Yin and Yang channels. Cases involving delirium and inability to sleep are caused by heat in the Yangming Stomach. The Classics state: "When the Stomach is disharmonious, sleep is restless." When the Stomach is invaded by pathogenic heat, it becomes disharmonious; due to this disharmony, insomnia occurs. If initially there is eye pain, nasal dryness, and insomnia, this is a Yangming Channel disease, treated primarily with Gegen Tang (Kudzu Decoction). If there is steaming fever, spontaneous sweating, dry thirst, a flooding pulse, and insomnia, this is a simultaneous disease of the Yangming Channel and Fu-organ, characterized by diffuse heat, treated primarily with Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). If there is tidal fever, spontaneous sweating, constipation, delirious speech, and insomnia, this is a Yangming Fu-organ disease, characterized by concentrated heat, treated by purging with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). If the pathogenic factors of Cold Damage have been resolved, but recurrence occurs due to dietary indiscretion, leading to mental restlessness, dry retching, oral dryness, groaning, and insomnia, treat primarily with Baohe Tang (Harmonize the Middle Decoction) added with Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma). Another question arises: Insomnia generally belongs to heat syndromes, yet sometimes administering cold medicines worsens the condition. Why? Answer: This is because excessive sweating or purging has severely depleted body fluids, leaving empty heat harassing the Heart, causing insomnia. Suanzaoren Tang (Ziziphus Seed Decoction) or Zhenwu Tang (True Warrior Decoction) should be used. Although insomnia seems common, if the Shaoyin pulse is deep and fine, accompanied by diarrhea, cold extremities, irritability, and insomnia, it is difficult to treat.

Question: Why does "dry thirst" (zao ke) belong to Yangming Fu-organ syndrome? Answer: When cold pathogens are on the exterior, there is no thirst; when pathogens transmit inward and transform into heat, thirst occurs. In Taiyang syndrome cases with thirst, it is a Bladder Fu-organ disease, and the thirst is mild. In Yangming Channel disease, one may only want to rinse the mouth with water without swallowing, which is not true thirst; upon entering the Fu-organ, severe thirst occurs. In Shaoyang syndrome, there is only bitter taste in the mouth and no thirst; if thirst appears, it indicates the pathogen is about to transmit to Yangming. Zhang Zhongjing stated that if thirst occurs after taking Chaihu Tang (Bupleurum Decoction), it belongs to Yangming. All three Yin channels may present with thirst because they connect to the Stomach Fu-organ. Thus, dry thirst definitively belongs to Yangming syndrome. For further details, refer to the section on Jueyin syndrome and Xiao Ke (Wasting-Thirst).

Question: Why is "spontaneous sweating" (zi han) considered a Yangming Fu-organ disease? Answer: When Cold Damage pathogens are on the exterior, the pores are closed and dense, so there is no sweat; when they enter the Fu-organ, heat radiates outward, causing spontaneous sweating. The sudden change from no sweat to sweating indicates that heat pathogens have entered the Fu-organ, steaming the body like boiling water in a cauldron, thus causing sweat. Another question arises: Spontaneous sweating is treated with Guizhi Tang, such as Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite Root), why? Answer: Using Guizhi Tang for spontaneous sweating refers to Taiyang Wind Strike syndrome; using Guizhi Jia Fuzi Tang refers to cases where excessive sweating led to unceasing leakage of sweat, aversion to wind and cold, indicating exterior deficiency. If it is a Yangming Fu-organ disease with dry thirst and delirious speech, who would dare use Guizhi? Zhang Zhongjing noted under the Guizhi Jia Fuzi Tang section "no vomiting, no thirst." It is evident that with Yangming dry thirst, there is no rationale for using Guizhi. Generally speaking, headache and fever present together indicate Wind Strike spontaneous sweating; sweating leaking continuously after sweating therapy indicates Yang deficiency spontaneous sweating; irritability, thirst, ability to drink water, aversion to heat rather than wind and cold, indicate Yangming Fu-organ spontaneous sweating. Another question arises: Zhi Zhong Zheng (Direct Transmission Syndrome) also presents with spontaneous sweating, why? Answer: In Zhi Zhong Zheng, cold sweat occurs spontaneously, the pulse is deep and slow, and the hands and feet are cold, which is a sign of衰竭 of True Yang. This is worlds apart from the steaming and boiling appearance of spontaneous sweating caused by Yangming Stomach heat. Another question arises: Heatstroke-induced spontaneous sweating also involves thirst, how to distinguish it? Answer: In spontaneous sweating due to heatstroke, although there is thirst, the pulse must be wiry, thin, hollow, and slow. The Classics state: "Pulse surging and body hot comes from Cold Damage; pulse deficient and body hot comes from Heatstroke." Excess patterns are treated with Ren Shen Baihu Tang (Ginseng White Tiger Decoction); deficiency patterns are treated primarily with Shiwei Xiangru Yin (Ten-Ingredient Mosla Drink).