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Question: There are Taiyang Yangming, Zhengyang Yangming, and Shaoyang Yangming diseases. What does this mean? Answer: Taiyang Yangming refers to Pi Yue (Spleen Constraint). Zhengyang Yangming refers to Wei Jia Shi (Stomach House Excess). Shaoyang Yangming refers to the condition where, after sweating or promoting urination, the stomach becomes dry, causing irritability, excess heat, and difficulty in defecation. The general principle of Yangming disease is Wei Jia Shi (Stomach House Excess).

Question: How does one contract Yangming disease? Answer: When suffering from Taiyang disease, if improper methods such as inducing sweat, purging, or promoting urination are used, body fluids are depleted, the stomach becomes dry, and the condition transforms into Yangming disease. If one fails to defecate, internal excess heat accumulates, and defecation is difficult, this is called Yangming disease. In cold damage with a floating and slow pulse, and naturally warm hands and feet, the pathogen is associated with the Taiyin meridian. Taiyin disease typically presents with jaundice; however, if urination is unobstructed, jaundice will not occur. After seven or eight days, if the stool becomes hard, it has transformed into Yangming disease. A solid yang pulse indicates that excessive sweating leads to the exhaustion of yang within and the loss of body fluids, causing the stool to become hard.

In Yangming disease, the ability to eat indicates Wind Strike, while the inability to eat indicates Cold Strike. In Yangming disease, if there is only dizziness without aversion to cold, the patient can eat and may cough; such a person will definitely have a sore throat. If there is no cough, there is no sore throat. In Yangming disease, if the patient cannot eat and heat-clearing drugs are used, hiccups will inevitably occur. This is because the stomach is deficient and cold; since the patient's original qi is deficient, clearing heat will cause hiccups.

In Yangming disease, a slow pulse, difficulty in eating to fullness, slight irritability and dizziness after eating, and necessarily difficult urination indicate impending Gu Dan (Grain Jaundice). Purging will not relieve abdominal fullness due to the slow pulse. Yangming disease tends to resolve between Shen and Xu hours (3 PM to 7 PM). In cold damage, if vomiting is frequent, even if Yangming symptoms exist, purging is contraindicated. In Yangming disease, if the face is red, purging is contraindicated; purging will cause fever, yellow complexion, and difficult urination. In Yangming disease, if there is hardness and fullness below the heart, purging is contraindicated. If purged and diarrhea continues uncontrollably, death ensues; if diarrhea stops, recovery occurs.

If cold damage presents with constipation for six or seven days, headache, and fever, Chengqi Tang should be administered. If urine is clear, the pathogen is still in the exterior, and sweating is indicated. If headache is severe, epistaxis may occur, and Guizhi Tang is suitable. In Yangming disease, with a floating pulse, anhidrosis, and wheezing, sweating will lead to recovery; Mahuang Tang is suitable. In Yangming disease, with hardness and fullness in the hypochondrium, difficult defecation, vomiting, and a white tongue coating, Xiaochaihu Tang may be given. If the Upper Jiao becomes unobstructed, body fluids descend, stomach qi harmonizes, and mild sweating occurs, the disease resolves.

Yangming Wind Strike presents with wiry, floating, and large pulses, shortness of breath, abdominal fullness, pain in the hypochondrium and chest, obstruction of qi upon pressure, dry nose, anhidrosis, lethargy, generalized and facial jaundice, difficult urination, tidal fever, intermittent hiccups, and swelling around the ears. Acupuncture provides slight relief, but the exterior syndrome remains unresolved. If the disease persists beyond ten days and the pulse remains floating, Xiaochaihu Tang is given; if the pulse is merely floating without other symptoms, Mahuang Tang is given. If urination is obstructed, abdominal fullness worsens, and hiccups appear, the condition is untreatable.

Yangming Wind Strike presents with bitter taste, dry throat, abdominal fullness, slight wheezing, fever, aversion to cold, and a floating, tight pulse. Purging will cause abdominal fullness and difficult urination. (Xu Xueshi states: Xiaochaihu Tang is suitable.) In Yangming abdominal fullness with a floating, tight pulse, bitter taste, dry throat, and wheezing, if there is fever, sweating, aversion to cold turning into aversion to heat, and heavy body, sweating, moxibustion with burning needles, and purging are all contraindicated. (See section on spontaneous sweating.) In Yangming disease, a floating and tight pulse indicates regular tidal fever; a merely floating pulse indicates night sweats.

Regarding Wei Jia Shi and constipation, even a child knows purging is indicated. However, Zhang Zhongjing's method dictates that even with Stomach Excess, if the exterior is unresolved or there is a half-exterior/half-interior syndrome, Guizhi Tang or Chaihu Tang should first be used to resolve the exterior, followed by assessment of deficiency and excess.

In Yangming disease, with spontaneous sweating, further sweating and diuresis deplete internal fluids. Even if the stool is hard, purging is contraindicated. One should wait for the urge to defecate and use Honey Suppository (Mi Jian Dao) to guide the stool. Tugua Gen (Root of Trichosanthes Kirilowii) or Pig Bile can also be used.

Honey Suppository Method: Use seven he of honey, boil gently in a copper vessel until it thickens like maltose, stirring to prevent burning. When cool enough to mold, shape into a cone, sharp at the head, finger-thick, about two cun long. Insert into the anus while warm, hold in place, and remove when the urge to defecate arises. Pig Bile Formula: Mix juice from one large pig gallbladder with a little vinegar, and enema into the anus. After a meal's time, the stool will pass naturally.

In Taiyang disease, with a slow inch pulse, floating guan pulse, and weak chi pulse, fever, sweating, aversion to cold, no vomiting, but epigastric stuffiness, this is due to physician-induced purging. If not purged, and the patient is not averse to cold but thirsty, it has transformed into Yangming. Frequent urination leads to hard stool; ten days without defecation causes no distress. For thirst, give small amounts of water and treat appropriately. Thirst is treated with Wuling San. In Yangming disease, originally with spontaneous sweating, if the physician induces heavy sweating again, and although the illness improves, slight irritability remains, this is due to hard stool caused by fluid depletion and stomach dryness. Ask about daily urination frequency; if it decreases, fluids return to the stomach, and defecation will occur soon.

In Yangming disease with tidal fever and constipation for six or seven days, suspecting dry feces, administer a small amount of Xiao Chengqi Tang. If flatus occurs, dry feces are present, and purging is allowed. If no flatus, no dry feces, and purging is forbidden. (See section on tidal fever.) In Yangming disease with sweating, hard stool, and delirium, Xiao Chengqi Tang is suitable. (See section on delirium.) Constipation with abdominal fullness requires purging; if pain surrounds the navel, it is dry feces, and Chengqi Tang is suitable. If fullness and pain extend from the epigastrium to the lower abdomen, it is Jie Xiong (Chest Binding), and Xianxiong Tang is suitable. (See section on abdominal pain.) In Yangming disease without vomiting or purging, if there is mental restlessness, Tiaowei Chengqi Tang is suitable. In Yangming disease, fever and sweating indicate heat dispersing outward, preventing jaundice. If only the head sweats, the body is dry, sweat stops at the neck, urination is difficult, and thirst for liquids exists, this is stagnant heat in the interior, leading to jaundice; Yinchen Tang is the main treatment. With difficult urination, alternating hard and soft stool, slight fever, wheezing, vertigo, and inability to lie down, Da Chengqi Tang is suitable. (See section on inability to lie down.) In Yangming syndrome, if the patient suffers from forgetfulness, there must be blood stasis. Due to old blood stasis, forgetfulness occurs; although stool is hard, defecation is easy, and the color is black; Didang Tang is suitable for purging. (See section on blood stasis.) If there are no interior symptoms, but after purging the rapid pulse persists, digestion is rapid, yet constipation lasts six or seven days, blood stasis is present, and Didang Tang is suitable. In cold damage after six or seven days, if vision is blurred, eyes are unresponsive, with no exterior/interior signs, difficult defecation, and slight fever, this is an excess syndrome requiring urgent purging with Da Chengqi Tang. At the foot pulse, floating and choppy indicates strong stomach qi and frequent urination; their interaction causes difficult defecation and Spleen Constraint, treated with Maren Wan.

Maren Wan (Zhu Danxi says: It moves qi excess and releases the exterior.)
Hemp Seed (one sheng), Peony, Prepared Magnolia Bark (peeled, ginger-processed), Immature Bitter Orange (each four liang), Apricot Kernel, Rhubarb (roasted, each eight liang).
Grind into powder, mix with honey to make pills the size of tung seeds. Take 20-30 pills with rice broth. Increase dose if ineffective. Three times daily.

In Yangming, mouth dryness with desire to rinse mouth but not swallow indicates impending epistaxis. (The Huoren Shu says: Mild cases use Xijiao Tang, severe cases use Didang Tang.)

Xu Xueshi treated two patients in one household who had been ill for ten days. One had fever, anhidrosis, constipation, scanty urination, and lethargy; the pulse was large, long, and solid. He used Chengqi Tang to purge, resulting in recovery. The other had Yangming spontaneous sweating, constipation, free urination, fluid deficiency, dry mouth, and a large, empty pulse. He used Honey Suppositories three times, expelling dry feces and resolving the condition with loose stools. The family asked why treatments differed despite similar Yangming obstruction. Xu replied: Although symptoms are similar, spontaneous sweating and free urination indicate no fluid reserve, so harsh purging of the five zang organs is contraindicated. One must carefully distinguish subtle differences. Just as in fortune-telling, identical birth data can yield different fates based on subtle depths, caution is essential.

In Yangming disease, profuse sweating with anhidrosis and a sensation of insects crawling under the skin indicates chronic deficiency. In Yangming disease, anhidrosis with free urination, followed by vomiting, cough, and cold limbs after three days, leads to headache. If there is no vomiting/cough and limbs are warm, there is no headache. (Note: Free urination indicates internal cold attack; cold limbs and headache indicate external cold attack.)

Yangming Stomach Excess with floating pulse, anhidrosis, and wheezing is treated with Mahuang Tang. (See section on Stomach Excess with Exterior Syndrome.) Yangming disease with anhidrosis, free urination, and mental agitation leads to jaundice; Yinchen Hao Tang is suitable.

A floating and rapid pulse with ability to eat and constipation indicates Excess, named Yang Jie (Yang Knot), worsening on the seventeenth day. A sinking and slow pulse with inability to eat, heavy body, and hard stool indicates Yin Jie (Yin Knot), worsening on the fourteenth day.

Shaoyin disease with lethargy, abdominal fullness, and constipation is treated with Chengqi Tang. (See section on lethargy.)