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The Yangming channel governs the interior, internally reflecting on the Stomach Fu organ, and externally reflecting on the muscles. Therefore, there is a distinction between disease in the channel (Jing) and disease in the Fu organ. As stated in the Treatise: if there is body heat, vexation, thirst, eye pain, nasal dryness, inability to sleep, aversion to cold is absent but aversion to heat is present, this is Yangming channel disease; if there is gradually increasing fever, delirium, continuous sweating in the hands, feet, and axillae, abdominal fullness and pain, and unrelieved defecation, this is Yangming Fu disease. Their manifestations each have three types: For channel disease, there is the case where pathogenic factors have transmitted to Yangming but the Taiyang exterior syndrome has not yet resolved, accompanied by Taiyang symptoms such as headache, aversion to cold, and anhidrosis; there is the case where Taiyang pathogenic factors have resolved and completely transmitted to Yangming, presenting only with Yangming symptoms such as high fever, sweating, mental restlessness, insomnia, and thirst with desire to drink; there is the case where Yangming pathogenic factors are unresolved and re-transmit to Shaoyang, accompanied by Shaoyang symptoms such as chest pain, alternating chills and fever, bitter taste in the mouth, vomiting, dizziness, and deafness. For Fu disease, there is Taiyang-Yangming, referring to when a Taiyang disease, after diaphoresis, emesis, purgation, or promoting urination, results in loss of body fluids, dryness in the Stomach, and Taiyang pathogenic factors taking advantage of the gastric dryness to transmit to Yangming, causing frequent urination and difficult defecation; this is called "Splee Constriction" (Pi Yue). There is Zheng-Yang-Yangming (True Yangming), referring to when a patient's Yang qi is inherently abundant, or there is retained food, and Taiyang pathogenic factors, upon transmitting to Yangming, immediately enter the Stomach Fu, causing constipation; this is called "Stomach House Excess" (Wei Jia Shi). There is Shaoyang-Yangming, referring to when the disease has reached Shaoyang, where harmonization should be used, but diaphoresis and promoting urination were mistakenly applied, damaging body fluids, leading to dry-heat in the Stomach, and re-transmitting to Yangming, causing hard and dry stools; this is called "Difficulty in Defecation" (Da Bian Nan). To treat Yangming channel disease, one may use Ge Gen Tang (Kudzu Decoction) or Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root) to induce sweating, or Bai Hu Tang (White Tiger Decoction) to clear heat, or Chai Hu Bai Hu Tang (Bupleurum White Tiger Decoction) to harmonize, according to the specific syndrome. To treat Yangming Fu disease, although all are suitable for purgation, there are degrees of severity. Thus, one may use the Three Cheng Qi Decoctions (San Cheng Qi Tang) to purge, Ma Ren Wan (Hemp Seed Pill) to moisten and unblock, or honey suppositories/pig bile enemas to guide out stagnation, treating according to the condition. This is the general overview of Yangming disease. Now, the cases in the channel and in the Fu are detailed in this chapter to facilitate differentiation for readers, ensuring that clinical treatment proceeds without confusion.

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Yangming disease is essentially Wei Jia Shi (Excess in the Stomach House).
[Annotation]
The Yangming channel internally reflects on the Stomach Fu and externally reflects on the skin and muscles. When Taiyang pathogenic factors transmit to the channel, it manifests as external signs of Yangming disease; when they transmit to the Stomach Fu, it manifests as Wei Jia Shi.
[Collected Notes]
Fang Youzhi states: Yangming includes both the channel and the Fu. "Shi" (Excess) refers to dry stool forming obstruction and fullness, unable to pass. Although onset times vary, one cannot rigidly adhere to the number of days.

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In Sanitation Disease (Shang Han), on the third day, the pulse becomes large.
[Annotation]
"The first day Taiyang, second day Yangming, third day Shaoyang" describes the sequence of transmission in the *Nei Jing*, not a rigid rule based on days. Saying "third day Yangming pulse large" means the pulse is neither the floating-large pulse of Taiyang-Yangming nor the string-large pulse of Shaoyang-Yangming, but specifically the large pulse of Zheng-Yang-Yangming. This occurs because pathogenic heat enters the interior and the Stomach, forming an internal excess diagnosis, hence the pulse appears thus.
[Collected Notes]
Fang Youzhi states: "Third day" broadly covers wind-strike as well. A large pulse indicates abundant Qi and Blood in Yangming.
Shen Mingzong states: This is the true pulse of Yangming. Zhang Zhongjing said "third day Yangming pulse large" because Yangming is a Fu organ of abundant Qi and Blood. When wind-cold transmits, pathogenic factors become excessive in the middle, making the pulse appear large; this is the true pulse of Yangming pathogenic excess. However, one must confirm this pulse before considering purgation. If accompanied by Taiyang floating-tight or Shaoyang string-thin pulses, or slow-rapid-slippery-rough-deficient-weak pulses, it indicates deficiency of Qi, Blood, Yin, or Yang. Even with signs of great excess and fullness, one must examine carefully, perhaps testing with Xiao Cheng Qi Tang (Minor Order the Qi Decoction) or using honey suppositories, and must not directly apply aggressive purgation.

Originally a Taiyang disease at onset, diaphoresis was attempted, but sweat did not come out thoroughly, leading to transmission to Yangming.
[Annotation]
Yangming disease often originates from Taiyang onset. If diaphoresis is performed but sweat does not emerge thoroughly, the method is incorrect, leaving residual pathogenic factors that transmit to Yangming. Pathogens in the channel manifest as external signs; pathogens entering the Fu manifest as Wei Jia Shi.
[Collected Notes]
Fang Youzhi states: This explains the main idea that improper diaphoresis in Taiyang leads to pathogen entering the Stomach.

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In Yangming disease, if the patient can eat, it is named Wind-Strike (Zhong Feng); if unable to eat, it is named Cold-Strike (Zhong Han).
[Annotation]
When Taiyang pathogens transmit to Yangming, they may come from Wind-Strike or Cold-Strike. One distinguishes them by appetite. If the patient can eat, it is named Wind-Strike, indicating transmission from Wind-Strike. Wind is a Yang pathogen, and Yang can transform grain, so the patient can eat. If unable to eat, it is named Cold-Strike, indicating transmission from Cold-Strike. Cold is a Yin pathogen and cannot transform grain, so the patient cannot eat.
[Collected Notes]
Fang Youzhi states: This uses appetite to distinguish Wind from Cold. Yangming governs water and grain; Wind allows eating, Yang transforms grain; Cold prevents eating, Yin fails to kill grain. "Ming" here means "is". "Zhong Han" is synonymous with Shang Han. The gist is to trace Wind-Cold transmitted from Taiyang, distinguishing them as such, not implying Yangming itself is directly struck by Cold.
Wang Hu states: Zhang Zhongjing says "Zhong Han" has the same meaning as "Shang Han", not a true Cold syndrome. If it were true Cold, it would be Stomach House deficiency-cold, treated with Li Zhong Tang (Regulate the Middle Decoction). Now, inability to eat indicates Stomach Qi excess, with pathogen not yet in the Fu and no stagnant heat formed. Thus named Zhong Han, it is actually no different from Shang Han.

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Question: What are the external signs of Yangming disease? Answer: Body heat, spontaneous sweating, absence of aversion to cold, and presence of aversion to heat.
[Annotation]
Yangming disease has external and internal signs. Tidal fever, spontaneous sweating, and constipation are internal signs; body heat, spontaneous sweating, absence of aversion to cold, and aversion to heat are external signs. Spontaneous sweating here indicates transmission from Wind-Strike, sharing external signs with Wind-Strike. However, body heat, no aversion to cold but aversion to heat identifies it as Yangming external signs, distinct from Wind-Strike. Yangming heat arises in the muscles, manifesting as steaming heat, unlike the intermittent fever of Taiyang.
[Collected Notes]
Fang Youzhi states: This explains external signs of Yangming disease transmitted from Taiyang Wind-Strike.
Wei Litong states: How to distinguish Taiyang Wind-Strike unresolved transmitting to Yangming? Question: How do we know when the interior syndrome arrives? We must verify the external manifestations. Answer: Taiyang Wind-Strike presents with body heat, spontaneous sweating, and aversion to wind. If body heat and spontaneous sweating occur without aversion to wind-cold but with aversion to heat, the disease has left Taiyang and entered Yangming. This is Yangming disease transmitted from Taiyang Wind-Strike.

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Question: In some cases, on the first day of illness, there is no fever but aversion to cold. Why? Answer: Although on the first day, aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat.
[Annotation]
Taiyang disease involves aversion to cold; Yangming disease involves aversion to heat. In Yangming disease, if on the first day there is no fever but aversion to cold, it is because residual pathogenic factors from the Taiyang exterior have not fully resolved. However, these residual factors cannot persist long as they seek to transmit to Yangming; thus, aversion to cold will cease, and spontaneous sweating with aversion to heat will appear.
[Collected Notes]
Fang Youzhi states: This explains external signs of Yangming disease transmitted from Taiyang Cold-Strike.
Cheng Yingmao states: Yangming aversion to cold still carries exterior characteristics; Fu disease involves aversion to heat. Whether the exterior resolves must be verified here.
Zheng Zhongguang states: This distinguishes external signs of Yangming Cold-Strike. No fever but aversion to cold originates from Cold-Strike. Cessation of aversion to cold indicates pathogen passing the exterior. Spontaneous sweating indicates pathogenic heat stagnating in muscles, opening pores, and leaking sweat.
Wei Litong states: Taiyang Cold-Strike can also transmit to Yangming. Question: On the first day, initially seeing no fever but only aversion to cold, what disease is this? Answer: First-day aversion to cold, though resembling Taiyang Cold-Strike, will cease spontaneously, followed by spontaneous sweating and aversion to heat. This is Yangming disease transmitted from Taiyang Cold-Strike. Taiyang Wind-Strike's true disease is fever, aversion to wind, and spontaneous sweating; Taiyang Cold-Strike's true disease is aversion to cold and anhidrosis. Upon transmitting to Yangming, the true disease becomes sweating and aversion to heat.

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Question: Why does aversion to cold cease spontaneously? Answer: Yangming resides in the center and governs Earth. It is the destination of all things, with nowhere further to transmit. Initially there may be aversion to cold, but it stops by the second day; this is Yangming disease.
[Annotation]
This explains the cessation of aversion to cold in the previous clause. Yangming belongs to the Stomach, resides in the center, and corresponds to Earth. Earth is the destination of all things; thus, pathogenic heat returning to the Stomach has nowhere further to transmit, mirroring the concept of all things returning to Earth. On the first day of Yangming onset, aversion to cold persists because the Taiyang exterior is unresolved. By the second day, aversion to cold ceases, indicating Taiyang pathogens have fully merged into Yangming, constituting Yangming disease.
[Collected Notes]
Fang Youzhi states: Cessation of aversion to cold by the second day indicates heat entering the interior and impending aversion to heat, referring to Zheng-Yang-Yangming.
Cheng Yingmao states: Although the Six Channels are divided into Yin and Yang, the Stomach governs them. All Zang-Fu organs submit to its command. Once dry-heat exists, regardless of whether pathogens come from the Three Yang or Three Yin channels, they transform into heat. Yin and Yang pathogens all return to Stomach Earth, hence "destination of all things, nowhere further to transmit."

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Question: How does one acquire Yangming disease? Answer: In Taiyang disease, if diaphoresis, purgation, or promoting urination causes loss of body fluids and dryness in the Stomach, pathogenic factors transmit to Yangming. Constipation, internal excess, and difficulty in defecation constitute Yangming disease.
[Annotation]
Question: Why does Yangming Stomach Excess occur? Answer: When pathogens are in Taiyang, diaphoresis, purgation, or promoting urination are intended to expel pathogens. If treatment is appropriate, pathogens resolve and health returns. If inappropriate, body fluids are lost, causing Stomach dryness. Residual exterior pathogens take advantage of the dry-heat to transmit to Yangming, forming Stomach Excess in three ways: Constipation ("Bu Geng Yi") is Taiyang-Yangming Pi Yue; Internal Excess ("Nei Shi") is Zheng-Yang-Yangming Wei Jia Shi; Difficulty in Defecation ("Da Bian Nan") is Shaoyang-Yangming Da Bian Nan. Though all are purgable, severity varies: Pi Yue is milder than Da Bian Nan, which is milder than Wei Jia Shi. Pi Yue and Da Bian Nan often result from inherent fluid deficiency or improper treatment (sweating/purgation/diuresis). Wei Jia Shi results from inherent Yang abundance and retained food, becoming excess even without prior treatment. Previously treated cases involve blood/fluid loss causing dryness, requiring moistening. Untreated cases involve heat excess causing dryness, requiring clearing heat. This explains the differentiation among the Three Cheng Qi Decoctions, Pi Yue Wan, and honey/solanum/pepig bile guides.
[Collected Notes]
Fang Youzhi states: Ancients changed clothes for bowel movements; "Bu Geng Yi" means no bowel movement.
Cheng Yingmao states: Transmission levels include not just resolved/unresolved exterior, but also dry-excess vs. dry-non-excess upon entering the interior. Hence, there are Yangming diseases of Bu Geng Yi, Nei Shi, and Da Bian Nan. Exterior/Interior status dictates purgation contraindications/appropriateness. Interior excess/dryness dictates major/minor purgation.
Wang Hu states: If Taiyang disease is purged, stomach contents are gone; why would dryness cause internal excess? Answer: Improper purgation in early Taiyang loses fluids but leaves incomplete removal of stomach contents. Pathogens transmit to Yangming, forming dry feces, resulting in internal excess.

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Question: What are Taiyang-Yangming, Zheng-Yang-Yangming, and Shaoyang-Yangming? Answer: Taiyang-Yangming is Pi Yue; Zheng-Yang-Yangming is Wei Jia Shi; Shaoyang-Yangming is dryness, vexation, and excess in the Stomach after diaphoresis and diuresis, leading to difficulty in defecation.
[Annotation]
Purgable conditions in Yangming extend beyond Wei Jia Shi. There are three main categories, clarified here. Taiyang pathogens exploiting Stomach dry-heat transmit to Yangming as Taiyang-Yangming (Bu Geng Yi, no discomfort, named Pi Yue). Taiyang pathogens combining with retained food and dry-heat form Zheng-Yang-Yangming (Constipation, internal excess, fullness-pain, named Wei Jia Shi). Shaoyang pathogens, after mistaken diaphoresis/diuresis damages fluids, exploit Stomach dryness to transmit to Yangming as Shaoyang-Yangming (Hard, difficult defecation, named Da Bian Nan).
[Collected Notes]
Cheng Zhi states: All Three Yang channels can enter the Stomach Fu. Yangming is the Sea of Water and Grain, Earth receives all things. Pathogens from Taiyang entering Stomach Fu are Taiyang-Yangming (Taiyang disease after emesis/purgation/sweating, slight vexation, frequent urination, dry stool); Spleen constriction requires Minor Cheng Qi Tang to gently harmonize. Pathogens from Yangming Channel entering Stomach Fu are Zheng-Yang-Yangming (Fever, sweating, Stomach dryness, delirium); Stomach excess requires Major Cheng Qi Tang to purge. Pathogens from Shaoyang transferring to Stomach Fu are Shaoyang-Yangming (Shaoyang contraindicates sweating; sweating causes delirium, belonging to Stomach); Fluid exhaustion requires Hemp Seed Pill to moisten and harmonize. If exterior signs of Three Yang persist, standard Yangming treatments are contraindicated.

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In Yangming disease, if the pulse is floating and tight, tidal fever occurring at fixed times is certain; if the pulse is only floating, night sweating is certain.
[Commentary]
Spontaneous sweating is a Yangming sign; night sweating is a Shaoyang sign. "Night sweating" should likely be "spontaneous sweating" for textual coherence.
[Annotation]
Yangming channel disease pulse should be floating-long; Fu disease pulse should be solid-large. Floating-tight pulse with timed tidal fever indicates Yangming disease with Taiyang Cold-Strike pulse, suggesting transmission from Cold-Strike. Unresolved Taiyang Cold-Strike implies anhidrosis; thus, despite Yangming tidal fever, treat as Taiyang-Yangming Cold-Strike with Ma Huang Jia Ge Gen Tang (Ephedra Decoction plus Kudzu Root) to sweat. If tidal fever occurs with only floating (not tight) pulse, it indicates Yangming disease with Taiyang Wind-Strike pulse, suggesting transmission from Wind-Strike. Unresolved Taiyang Wind-Strike implies spontaneous sweating; treat as Taiyang-Yangming Wind-Strike with Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Kudzu Root) to resolve.
[Collected Notes]
Shen Mingzong states: This is Yangming syndrome with Taiyang pulse. Floating-tight indicates unresolved Taiyang exterior cold; timed tidal fever indicates established Yangming interior syndrome. Only floating indicates Taiyang wind injuring Wei, hence sweating.

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In Yangming disease, if the pulse is slow, sweating is profuse, and there is slight aversion to cold, the exterior is unresolved. Diaphoresis is indicated; Gui Zhi Tang (Cinnamon Twig Decoction) is appropriate.
[Commentary]
"Fever" should follow "profuse sweating". Without it, slow pulse, profuse sweating, and slight aversion to cold indicate exterior Yang deficiency, a Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) pattern. Using Gui Zhi Tang to sweat would be illogical; likely a transcription error.
[Annotation]
Yangming pulse should be rapid-large. Slow pulse with profuse sweating, assuming no fever/aversion to cold, would mean resolved Taiyang exterior. Here, fever and slight aversion to cold indicate unresolved exterior. Thus, Gui Zhi Tang should be used to release the muscle layer and induce sweating, driving the pathogen newly entering Yangming back to the exterior.
[Collected Notes]
Cheng Zhi states: Wind-strike transmitting to Yangming with unresolved exterior still requires Gui Zhi Tang to release the muscle layer.
Wang Hu states: Early transmission of Taiyang to Yangming Channel with wind pathogen. Slow pulse is a variation of Taiyang Wind-Strike slow pulse; as pathogen approaches interior, pulse slows. Profuse sweating indicates Yangming heat and loose pores. Slight aversion to cold indicates residual exterior wind. Treat per Taiyang Wind-Strike example. However, since it is Yangming disease, Zhang Zhongjing's method suggests Gui Zhi Jia Ge Gen Tang is more appropriate.

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In Yangming disease, if the pulse is floating, there is no sweating, and wheezing, diaphoresis leads to recovery; Ma Huang Tang (Ephedra Decoction) is appropriate.
[Annotation]
Yangming disease pulse should be floating-large, symptoms should include sweating. Floating pulse alone indicates exterior disease; anhidrosis and wheezing indicate exterior excess. Taiyang pathogens have not fully entered Yangming but remain in the exterior. Treat as Taiyang Cold-Strike; diaphoresis cures; Ma Huang Tang is appropriate.
[Collected Notes]
Zhang Lu states: Distinguishing Ying and Wei in Yangming relies entirely on pulse and symptoms. Wind pathogen pulse in Yangming: after profuse sweating, slowness replaces speed. Cold pathogen pulse in Yangming: after high fever, floating replaces tightness. These indicate pathogen in the channel. If entering Fu, slow becomes rapid, floating becomes solid. If not rapid/solid, it is not Stomach excess, and cannot withstand purgation.
Wang Hu states: Anhidrosis and wheezing with floating (not tight) pulse: how to define as Yangming? Because the patient has eye pain, nasal dryness, body heat, and insomnia, hence Yangming disease.
Wei Litong states: This is a Taiyang-Yangming syndrome, not deeply entered Yangming, allowing pathogen to exit via exterior, preventing return to Stomach.

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If the Yang pulse is faint and sweating is scant, it indicates self-harmonization; if sweating is profuse, it indicates excess. If the Yang pulse is solid, and diaphoresis causes profuse sweating, it also indicates excess. Excess leads to Yang isolation in the interior, loss of body fluids, and dry stool.
[Annotation]
This elaborates on the pulse and symptoms from the previous clause. Faint Yang pulse means floating and weak; Solid Yang pulse means floating and strong. In Wind/Cold strike, faint Yang pulse means mild heat, steaming exterior to produce sweat. Scant sweating indicates self-harmonization/resolution. Profuse sweating indicates failure to resolve due to excess. Solid Yang pulse means intense heat; inducing sweat due to heat causing profuse sweating is also excess. Excessive sweating leads to Yang extreme in the interior, fluid loss, and dry stool forming internal excess. Purgation becomes necessary. Thus, when inducing sweat, one must anticipate this risk.